Early Failure Research Articles

Intestinal ultrasound scan predicts corticosteroid failure and colectomy risk in patients with ulcerative colitis.

Intestinal ultrasound (IUS) is an emerging modality for assessing disease activity, extent, and treatment response in ulcerative colitis. This study aimed to evaluate the potential of IUS in predicting severe flares, the need for rescue therapy (corticosteroid failure), and colectomy in patients with ulcerative colitis. We conducted a retrospective review of medical records, collecting clinical and IUS data. The Milan Ultrasound Criteria (MUC) score was used to assess ulcerative colitis severity. Group comparisons were performed to identify differences in MUC scores between mild-to-moderate and severe ulcerative colitis, between steroid responders and nonresponders, and between patients who underwent colectomy and those who did not. Receiver operating characteristic (ROC) analysis was used to predict outcomes in patients with ulcerative colitis. This analysis included 102 patients with ulcerative colitis categorized as mild/moderate (60) or severe (42). MUC scores were significantly higher in the severe ulcerative colitis group compared with the mild/moderate group ( P < 0.001). Analysis (using ROC) identified a cutoff MUC score of >8.54 to indicate severe ulcerative colitis with good sensitivity (64.29%) and excellent specificity (93.33%). Similarly, a cutoff of MUC > 10.54 showed promise in predicting corticosteroid failure, with acceptable sensitivity (50%) and high specificity (90.91%). Finally, a cutoff MUC score >12.5 demonstrated potential for predicting colectomy, exhibiting moderate sensitivity (55.56%) but excellent specificity (96.97%). IUS may be useful for differentiating severe ulcerative colitis from mild-to-moderate disease, identifying early stage failure of corticosteroid therapy, and predicting the potential need for colectomy.

A method based on DWRNet and MGAU for RUL prediction of bearing with few samples

Accurately predicting the remaining useful life (RUL) of a bearing is crucial in the prognostics and reliability management of machinery. Owing to the cost of wind power operation and maintenance and commercial barriers, collecting early failure samples of gearbox bearings is costly. Accordingly, the prediction of the RUL of bearings with few samples remains a challenging problem. To address this challenge, a two-stage method based on DWRNet and MGAU is proposed to predict the RUL of bearings with few samples. First, a bearing’s health indicator (HI) is constructed using a dynamic weighted residual network (DWRNet), which utilizes a dynamic weighted residual block to fully extract the fault feature of the bearing. Then, a meta-gated adaptive unit (MGAU) neural network is implemented to predict RUL of bearings with few samples via a gated adaptive unit and multi-task learning. Finally, the prediction ability of the proposed method is verified using a dataset of bearings.

The influence of alien dislocations on the plasticity of [formula omitted]-axis Mg single crystals under tension and compression

Uniaxial tension and compression tests were conducted on as-grown [0001] Mg single crystals and on [0001] single crystals containing an alien distribution of basal dislocations to elucidate their effect on the deformation mechanisms and strain hardening. During tensile deformation, the basal dislocations induce elasto-plastic transition and micro-yielding that precede the gross deformation by twinning. They decrease the stress for twin nucleation, the tensile strength, and the failure strain compared to the virgin single crystals. The weakening of the microstructure and early failure are attributed to the higher density of micro cracks formed in the crystals with alien basal dislocations. The extraneous basal dislocations alter entirely the deformation mechanisms and strain hardening characteristic of [0001] single crystals under compression. They suppress the pyramidal slip as a dominant deformation mode and promote the gross deformation by cooperative basal slip and twinning during extended deformation plateau. The deformation twinning is of anomalous type, nucleating and propagating with the assistance of extraneous basal dislocations at the negative Schmid Factor and against the imposed compressive strain. τtw≈2.1±0.2MPa is found as the basal slip-assisted twinning stress in Mg.

Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis

BackgroundPlasmapheresis is widely used for severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) to remove excessive triglycerides from plasma. This study aimed to evaluate whether plasmapheresis could improve the duration of organ failure in HTG-AP patients.MethodsWe analyzed a cohort of patients from a multicenter, prospective, long-running registry (the PERFORM) collecting HTG-AP patients admitted to the study sites within 72 h from the onset of symptoms. This study was based on data collected from November 2020 to March 2023. Patients who had organ failure at enrollment were involved in the analyses. The primary outcome was time to organ failure resolution within 14 days. Multivariable Cox regression model was used to evaluate the association between plasmapheresis and time to organ failure resolution. Directed acyclic graph (DAG) was used to identify potential confounders.ResultsA total of 122 HTG-AP patients were included (median [IQR] sequential organ failure assessment (SOFA) score at enrollment, 3.00 [2.00–4.00]). Among the study patients, 46 underwent plasmapheresis, and 76 received medical treatment. The DAG revealed that baseline serum triglyceride, APACHE II score, respiratory failure, cardiovascular failure, and renal failure were potential confounders. After adjusting for the selected confounders, there was no significant difference in time to organ failure resolution between patients undergoing plasmapheresis and those receiving exclusive medical treatment (HR = 1.07; 95%CI 0.68–1.68; P = 0.777). Moreover, the use of plasmapheresis was associated with higher ICU requirements (97.8% [45/46] vs. 65.8% [50/76]; OR, 19.33; 95%CI 2.20 to 169.81; P = 0.008).ConclusionsIn HTG-AP patients with early organ failure, plasmapheresis was not associated with accelerated organ failure resolution compared to medical treatment but may be associated with more ICU admissions.Trial registration: The PERFORM study was registered in the Chinese Clinical Trial Registry (ChiCTR2000039541). Registered 30 October 2020.

Remaining useful life prediction of rolling bearings based on performance evaluation and multifractional generalized Cauchy model with adaptive drift

The proposed Remaining Useful Life (RUL) prediction framework utilizes several advanced techniques to accurately estimate the remaining service life of rolling bearings. The framework includes early failure assessment, adaptive failure threshold (FT) determination, and a multifractional generalized Cauchy model (MfGC). The early failure assessment is enabled by establishing early FTs and health indicator (HI) curves generated by the Mahalanobis distance cumulative sum (MD-CUSUM) technique. The proposed dynamic fault threshold update method uses the BOX-COX transformation and Chebyshev inequality to determine confidence intervals for evaluating the fault threshold time. The multifractional nature of the MfGC process is characterized by independent, time-varying Hurst indices and fractional dimensions, and the long-range dependence (LRD) characteristics and stochasticity of the process are explained by the diffusion terms generated from the MfGC differential time series. The MfGC model with adaptive drift is constructed for various degenerate trajectories, and a method for estimating the model’s parameters is proposed. The effectiveness of the proposed RUL prediction method is demonstrated using the XJTU-SY bearing dataset.

Impact of distension pressure on saphenous vein endothelial injury in coronary artery bypass grafting.

Long saphenous vein grafts (LSVGs) are pivotal conduits in coronary artery bypass grafting (CABG), yet concerns persist regarding early failure and long-term patency. Endothelial damage, a potent initiator of graft failure, necessitates exploration of factors contributing to endothelial injury during LSVG preparation. A prospective, single-center study was conducted, assessing the impact of unregulated distension pressure on LSVG endothelium during CABG. Histological and CD31 (cluster of differentiation 31) immunohistochemical analyses were performed on 21 paired vein samples, categorized into non-distended (group A) and distended (group B) groups. Pressure recordings were obtained using different syringe sizes during vein distension. Histological examination revealed a significantly higher percentage of endothelial cell loss in distended veins (31.95% ± 31.31) compared to non-distended veins (11.67% ± 28.65) (p = 0.034). CD31 immunohistochemistry corroborated greater endothelial cell loss in distended veins (p = 0.001). The pressure recordings with a 20-cc syringe, as opposed to using a 10-cc syringe, were considerably lower (44.5mmHg vs. 92.75mmHg) emphasizing the inverse relationship between syringe size and pressure generated. In our study, pre-existing endothelial injury was observed in one-third of diabetic patients (36%), with all instances of such injury exclusively identified in individuals with diabetes. Unregulated distension pressure during LSVG preparation is associated with greater endothelial damage, as evidenced by histological and immunohistochemical analyses. The inverse relationship between syringe size and pressure underscores the importance of controlled distension.

Contextualized Interactive Video as a Reading Tool for Daycare Pupils of Selected Barangay in Manila City amidst COVID19

Reading is essential for personal growth and development, and early failure to acquire it can lead to social problems. To ensure effective learning, teachers must collaborate with parents and adopt new technology. The Bahay Kubo Application, a contextualized interactive video, was used to improve emerging readers' reading abilities and comprehension, benefiting teachers, parents, and caregivers. The study aims to determine the effectiveness of “Bahay Kubo” Learning Application in developing / enhancing the reading skills of the daycare pupils of Selected Barangay in Manila City. Purposive sampling was used to select the population. The Bahay Kubo app significantly improved reading performance, meeting objectives and making the learning process significant for learners. Daycare centers should develop reading strategies that suit learners' learning styles, encourage parental participation, and provide ongoing professional development. Schools should also offer home teaching strategies and explore free applications to enhance children's reading capabilities.

Power Signal Analysis for Early Fault Detection in Brushless DC Motor Drivers Based on the Hilbert–Huang Transform

Brushless DC machines have demonstrated significant advantages in electrical engineering by eliminating commutators and brushes. Every year, these machines increase their presence in transportation applications. In this sense, early fault identification in these systems, specifically in the electronic speed controllers, is relevant for correct device operation. In this context, the techniques reported in the literature for fault identification based on the Hilbert–Huang transform have shown efficiency in electrical systems. This manuscript proposes a novel technique for early fault identification in electronic speed controllers based on the Hilbert–Huang transform algorithm. Initially, currents from the device are captured with non-invasive sensors in a time window during motor operation. Subsequently, the signals are processed to obtain pertinent information about amplitudes and frequencies using the Hilbert–Huang transform, focusing on fundamental components. Then, estimated parameters are evaluated by computing the error between signals. The existing electrical norms of a balanced system are used to identify a healthy or damaged driver. Through amplitude and frequency error analysis between three-phase signals, early faults caused by system imbalances such as current increasing, torque reduction, and speed reduction are detected. The proposed technique is implemented through data acquisition devices at different voltage conditions and then physical signals are evaluated offline through several simulations in the Matlab environment. The method’s robustness against signal variations is highlighted, as each intrinsic mode function serves as a component representation of the signal and instantaneous frequency computation provides resilience against these variations. Two study cases are conducted in different conditions to validate this technique. The experimental results demonstrate the effectiveness of the proposed method in identifying early faults in brushless DC motor drivers. This study provides data from each power line within the electronic speed controller to detect early faults and extend different approaches, contributing to addressing early failures in speed controllers while expanding beyond the conventional focus on motor failure analysis.

Efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in mainland Tanzania, 2019

BackgroundArtemisinin-based combination therapy (ACT) has been a major contributor to the substantial reductions in global malaria morbidity and mortality over the last decade. In Tanzania, artemether-lumefantrine (AL) was introduced as the first-line treatment for uncomplicated Plasmodium falciparum malaria in 2006. The World Health Organization (WHO) recommends regular assessment and monitoring of the efficacy of the first-line treatment, specifically considering that artemisinin resistance has been confirmed in the Greater Mekong sub-region. This study's main aim was to assess the efficacy and safety of AL for treating uncomplicated P. falciparum malaria in Tanzania.MethodsThis was a single-arm prospective antimalarial drug efficacy trial conducted in four of the eight National Malaria Control Programme (NMCP) sentinel sites in 2019. The trial was carried out in outpatient health facilities in Karume-Mwanza region, Ipinda-Mbeya region, Simbo-Tabora region, and Nagaga-Mtwara region. Children aged six months to 10 years with microscopy confirmed uncomplicated P. falciparum malaria who met the inclusion criteria were recruited based on the WHO protocol. The children received AL (a 6-dose regimen of AL twice daily for three days). Clinical and parasitological parameters were monitored during follow-up over 28 days to evaluate drug efficacy.ResultsA total of 628 children were screened for uncomplicated malaria, and 349 (55.6%) were enrolled between May and September 2019. Of the enrolled children, 343 (98.3%) completed the 28-day follow-up or attained the treatment outcomes. There were no early treatment failures; recurrent infections during follow-up were common at two sites (Karume 29.5%; Simbo 18.2%). PCR-corrected adequate clinical and parasitological response (ACPR) by survival analysis to AL on day 28 of follow-up varied from 97.7% at Karume to 100% at Ipinda and Nagaga sites. The commonly reported adverse events were cough, skin pallor, and abdominal pain. The drug was well tolerated, and no serious adverse event was reported.ConclusionThis study showed that AL had adequate efficacy and safety for the treatment of uncomplicated falciparum malaria in Tanzania in 2019. The high recurrent infections were mainly due to new infections, highlighting the potential role of introducing alternative artemisinin-based combinations that offer improved post-treatment prophylaxis, such as artesunate-amodiaquine (ASAQ).

Outcomes of left ventricular assist device implantations at Karolinska University Hospital: A retrospective study

ObjectiveTo descriptively present data and outcomes of Left ventricular assist device (LVAD) implantations at Karolinska University hospital. MethodsData were collected from consecutive patients (n=44) who were implanted with HeartMate 3 (HM3) at Karolinska University Hospital between 2017 and 2022. The study presents baseline characteristics, clinical course during the inpatient hospital care after implantation, adverse events, and clinical outcomes. ResultsMedian intensive care unit stay and hospital stay after HM3 implantation was 8 (interquartile range [IQR] 6; 15) and 28 days (IQR 22; 36), respectively. In total, 73% underwent ramp test at some point after the implantation. Death from all causes within 30 days post-implantation was 5%. A total of 21 patients (48%) underwent right heart catheterization, at a median of 0.5 years (IQR 0.3;0.7) after implantation, and all exhibited optimally unloaded left ventricles. During the study period, 34% of the patients were transplanted, 5% were explanted, and 16% died with LVAD. In total, 11% and 5% suffered from early and late right ventricle failure, respectively. Acute renal failure affected 46% and 18% had drive-line infection. Spontaneous cerebral haemorrhage and cerebral infarction affected 5% and 7% of the study population, respectively. Gastrointestinal bleeding affected 16%. The median LVAD-duration was 10 months (IQR 5;22). The one-year survival rate with LVAD was 85%, and the two-year survival rate was 80%. ConclusionsThe results of this low volume single-center retrospective study on LVAD implantations align with the results of other studies and international registries.

Efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in mainland Tanzania, 2018

BackgroundThe use of artemisinin-based combination therapy (ACT) is recommended by the World Health Organization for the treatment of uncomplicated falciparum malaria. Artemether-lumefantrine (AL) is the most widely adopted first-line ACT for uncomplicated malaria in sub-Saharan Africa (SSA), including mainland Tanzania, where it was introduced in December 2006. The WHO recommends regular assessment to monitor the efficacy of the first-line treatment specifically considering that artemisinin partial resistance was reported in Greater Mekong sub-region and has been confirmed in East Africa (Rwanda and Uganda). The main aim of this study was to assess the efficacy and safety of AL for the treatment of uncomplicated falciparum malaria in mainland Tanzania.MethodsA single-arm prospective anti-malarial drug efficacy trial was conducted in Kibaha, Mlimba, Mkuzi, and Ujiji (in Pwani, Morogoro, Tanga, and Kigoma regions, respectively) in 2018. The sample size of 88 patients per site was determined based on WHO 2009 standard protocol. Participants were febrile patients (documented axillary temperature ≥ 37.5 °C and/or history of fever during the past 24 h) aged 6 months to 10 years. Patients received a 6-dose AL regimen by weight twice a day for 3 days. Clinical and parasitological parameters were monitored during 28 days of follow-up to evaluate the drug efficacy and safety.ResultsA total of 653 children were screened for uncomplicated malaria and 349 (53.7%) were enrolled between April and August 2018. Of the enrolled children, 345 (98.9%) completed the 28 days of follow-up or attained the treatment outcomes. There were no early treatment failures, but recurrent infections were higher in Mkuzi (35.2%) and Ujiji (23%). By Kaplan–Meier analysis of polymerase chain reaction (PCR) uncorrected adequate clinical and parasitological response (ACPR) ranged from 63.4% in Mkuzi to 85.9% in Mlimba, while PCR-corrected ACPR on day 28 varied from 97.6% in Ujiji to 100% in Mlimba. The drug was well tolerated; the commonly reported adverse events were cough, runny nose, and abdominal pain. No serious adverse event was reported.ConclusionThis study showed that AL had adequate efficacy and safety for the treatment of uncomplicated falciparum malaria. The high number of recurrent infections were mainly due to new infections, indicating the necessity of utilizing alternative artemisinin-based combinations, such as artesunate amodiaquine, which provide a significantly longer post-treatment prophylactic effect.

Biochemical and molecular characterization of Campylobacter fetus isolates from bulls subjected to bovine genital campylobacteriosis diagnosis in Spain

BackgroundBovine genital campylobacteriosis (BGC) is caused by Campylobacter fetus subsp. venerealis (Cfv) including its biovar intermedius (Cfvi). This sexually transmitted disease induces early reproductive failure causing considerable economic losses in the cattle industry. Using a collection of well-characterized isolates (n = 13), C. fetus field isolates (n = 64) and saprophytic isolates resembling Campylobacter (n = 75) obtained from smegma samples of breeding bulls, this study evaluated the concordance of the most used phenotypic (H2S production in cysteine medium and 1% glycine tolerance) and molecular (PCR) methods for the diagnosis of BGC and assessed possible cross-reactions in the molecular diagnostic methods.ResultsCharacterization at the subspecies level (fetus vs. venerealis) of C. fetus isolated from bull preputial samples using phenotypic and molecular (PCR targeting nahE and ISCfe1) methods showed moderate concordance (κ = 0.462; CI: 0.256–0.669). No cross-reactions were observed with other saprophytic microaerophilic species or with other Campylobacter species that can be present in preputial samples. Whole genome sequencing (WGS) of discrepant isolates showed 100% agreement with PCR identification. For the differentiation of Cfv biovars, comparison of the H2S test (at 72 h and 5 days of incubation) and a PCR targeting the L-cysteine transporter genes showed higher concordance when H2S production was assessed after 5 days (72 h; κ = 0.553, 0.329–0.778 CI vs. 5 days; κ = 0.881, 0.631–1 CI), evidencing the efficacy of a longer incubation time.ConclusionsThis study confirmed the limitations of biochemical tests to correctly identify C. fetus subspecies and biovars. However, in the case of biovars, when extended incubation times for the H2S test (5 days) were used, phenotypic identification results were significantly improved, although PCR-based methods produced more accurate results. Perfect agreement of WGS with the PCR results and absence of cross-reactions with non-C. fetus saprophytic bacteria from the smegma demonstrated the usefulness of these methods. Nevertheless, the identification of new C. fetus subspecies-specific genes would help to improve BGC diagnosis.

Inhospital outcomes of implantation of a centrifugal left ventricular assist device in patients with endstage heart failure: experience of the Chazov National Medical Research Center of Cardiology

Aim. To study the inhospital outcomes of implantation of a centrifugal left ventricular assist device (LVAD) in patients with end-stage heart failure (HF).Material and methods. There were following inclusion criteria: estimated body surface area &gt;1,2 m2, end-stage HF, LV ejection fraction &lt;30%, cardiac index &lt;2,2 l/min, long-term optimal therapy for HF. Patients were considered for implantation of a centrifugal (LVAD) as part of the final therapy, but subsequent heart transplantation was not ruled out if appropriate.Results. LVAD was implanted in 23 patients. All patients were men (mean age, 59,1±10 years; mean body mass index, 26±4,6 kg/m2). Ten patients had dilated cardiomyopathy, while 13 — ischemic one. Diabetes was revealed on in 3 (13%) patients, while chronic kidney disease and cancer — in 3 (13%) and 4 (17%) patients, respectively. The mean value of the six-minute walk test (6MWT) upon admission to the hospital was 257±71 meters. In one patient with gastric cancer, the device was implanted as a part of bridging therapy strategy. Thirty-day mortality was 9% (n=2). One of the deceased patients had a long history of end-stage heart failure, body weight deficiency, and frailty with severe muscle weakness. The second death was the result of early postoperative right ventricular failure. At discharge, patients had optimal LVAD performance based on anthropometric characteristics and physical activity. According to echocardiography, the criteria for unloading the left heart chambers have been achieved. The distance of 6MWT at discharge was 298±78 meters.Conclusion. Inhospital outcomes of implantation of a centrifugal LVAD in patients with end-stage HF demonstrate high efficiency in supporting systemic hemodynamics with an acceptable safety profile in patients with extremely high perioperative risk.

Comparing Single-Tooth Implant Placement With and Without Allogeneic Soft Tissue Augmentation: A Randomized Clinical Trial.

To explore the effect of adding an allogeneic soft tissue graft at the time of single implant placement using a fully digital workflow for implant placement and restoration without making either analog or digital impressions. A prospective randomized clinical study was performed enrolling 39 participants requiring single-tooth implants. The patients were randomized into one of two groups: (1) the graft group, which received an allogeneic dermal graft at the time of implant placement (n &#61; 19), or (2) the nongraft group (n &#61; 20). A fully digital surgical and restorative protocol was implemented for both groups. Intraoral scans were taken before implant placement (T0), at the time of final crown delivery (T1), and 1 year after placement (T2). Intraoral scans were aligned using Geomagic Control X 2020 software, and linear and volumetric changes in buccal tissues were measured at T0, T1, and T2. Implant survival, probing depths (PDs), and complications were recorded. Participants were asked to complete an Oral Health Impact Profile (OHIP)- 14 survey at T0 and T2. Marginal bone levels were measured at T0 and T2 on periapical radiographs. Overall, 39 participants completed surgery and restoration in the incisor, canine, premolar, and molar sites. Two early failures were recorded in central incisor positions (95% survival). Crown delivery without complication from the digital workflow (impressionless) was achieved for 36 out of 39 cases (92%), and implant depth control was the main challenge. At 1 year, 37 participants attended the follow-up appointment. Both groups showed gain in buccal tissue thickness without significant differences between the two groups for both linear and volumetric measurements (P > .05). Soft tissue grafting was associated with minimal added morbidity. The interproximal marginal bone changes were recorded as follows: -0.16 mm mesial and -0.12 mm distal for the graft group and -0.01 mm mesial and -0.11 mm distal for the nongraft group (P &#61; .07 for mesial and .83 for distal). The OHIP score was significantly reduced at T2 compared to T0 (P &#61; .003) for the entire cohort. Augmentation of the alveolar mucosa on the buccal aspect of single-tooth implants is associated with clinically favorable outcomes. A fully digital workflow has been validated to permit crown delivery on CAD/CAM abutments without implant impressions.

(814) - Pre-Implant Pulmonary Artery Pulsatility Index and Its Relationship with Early Right Ventricular Failure After Left Ventricular Assist Device Implantation: An INTERMACS Analysis

(814) - Pre-Implant Pulmonary Artery Pulsatility Index and Its Relationship with Early Right Ventricular Failure After Left Ventricular Assist Device Implantation: An INTERMACS Analysis

(379) - Monogenic and Polygenic Contributions to Early Onset Advanced Heart Failure Based on Whole Genome Sequencing

(379) - Monogenic and Polygenic Contributions to Early Onset Advanced Heart Failure Based on Whole Genome Sequencing

(812) - Novel Machine Learning Algorithms for Predicting Early Right Heart Failure Post Left Ventricular Assist Device Implantation: An Analysis from Theeuromacs Registry

(812) - Novel Machine Learning Algorithms for Predicting Early Right Heart Failure Post Left Ventricular Assist Device Implantation: An Analysis from Theeuromacs Registry

Immediate Weight-bearing Through Walker or Crutches After Surgical Fixation of Clavicle Fractures in Patients With Lower Extremity Fractures: A Retrospective Cohort Study.

To assess the safety of immediate upper extremity weight-bearing as tolerated (WBAT) rehabilitation protocol after clavicle fracture open reduction internal fixation (ORIF). Retrospective cohort study. Three Level 1 trauma centers. Patients older than 18 years who had ORIF of mid-shaft clavicle fractures and lower extremity fractures who were allowed immediate WBAT on their affected upper extremity through use of a walker or crutches were included. All clavicles were fixed with either precontoured clavicular plates or locking compression plates. Included patients were those who had clinical/radiographic follow-up until fracture union, nonunion, or construct failure. WBAT patients were matched in a one-to-one fashion to a cohort with isolated clavicle fractures who were treated non-weight-bearing (NWB) postoperatively on their affected upper extremity. Matching was done based on age, sex, and temporality of fixation. After matching, treatment and control groups were compared to determine differences in possible confounding variables that could influence the primary outcome, including patient demographics, fracture classification, cortices of fixation, and construct type. All patients were assessed to verify conformity with weight-bearing recommendation. Primary outcome was early hardware failure (HWF) with or without revision surgery. Secondary outcomes included postoperative infections and union of fracture. Thirty-nine patients were included in the WBAT cohort; there were no significant differences with the matched NWB cohort based on patient demographics. Both the WBAT and the NWB cohorts had 2.5% chance of acute HWF that required surgical intervention ( P = 1.0). Additionally, there was no difference in overall HWF ( P = 0.49). All patients despite weight-bearing status including those who required revision ORIF for acute HWF had union of their fracture ( P = 1.0). Our data would support that immediate weight-bearing after clavicle fracture fixation in patients with concomitant lower extremity trauma does not lead to an increase in HWF or impact ultimate union. This challenges the dogma of prolonged postoperative weight-bearing restrictions and allow for earlier rehabilitation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Non-Invasive Heart Failure Evaluation Using Machine Learning Algorithms.

Heart failure is a prevalent cardiovascular condition with significant health implications, necessitating effective diagnostic strategies for timely intervention. This study explores the potential of continuous monitoring of non-invasive signals, specifically integrating photoplethysmogram (PPG) and electrocardiogram (ECG), for enhancing early detection and diagnosis of heart failure. Leveraging a dataset from the MIMIC-III database, encompassing 682 heart failure patients and 954 controls, our approach focuses on continuous, non-invasive monitoring. Key features, including the QRS interval, RR interval, augmentation index, heart rate, systolic pressure, diastolic pressure, and peak-to-peak amplitude, were carefully selected for their clinical relevance and ability to capture cardiovascular dynamics. This feature selection not only highlighted important physiological indicators but also helped reduce computational complexity and the risk of overfitting in machine learning models. The use of these features in training machine learning algorithms led to a model with impressive accuracy (98%), sensitivity (97.60%), specificity (96.90%), and precision (97.20%). Our integrated approach, combining PPG and ECG signals, demonstrates superior performance compared to single-signal strategies, emphasizing its potential in early and precise heart failure diagnosis. The study also highlights the importance of continuous monitoring with wearable technology, suggesting a significant stride forward in non-invasive cardiovascular health assessment. The proposed approach holds promise for implementation in hardware systems to enable continuous monitoring, aiding in early detection and prevention of critical health conditions.

Gastric Insufflation with High Flow Nasal Oxygen Therapy in Adult Patients Admitted to Intensive Care Unit: An Observational Study.

With the provision of a small positive end-expiratory pressure (PEEP) effect, high-flow nasal oxygen (HFNO) therapy carries a risk of stomach distension. The present study was conducted to find out the air leak in the gastric antrum leading to gastric distension in adult patients with acute respiratory failure receiving HFNO therapy. Adult patients with early hypoxemic respiratory failure requiring HFNO therapy were enrolled in this trial. Before initiation of HFNO therapy, baseline gastric volume (GV) and the average number of peristaltic contractions over one minute were measured using ultrasound. Once the patient was stabilized on HFNO therapy, a 2nd, 3rd, and 4th ultrasound scans were acquired at 10, 20, and 30 minutes respectively. Vitals and blood gas values were recorded at the baseline and after 30 min of initiation of HFNO therapy. Patient comfort, duration of HFNO therapy, and outcome were also recorded. The GV at 10, 20, and 30 minutes were significantly larger (p < 0.001) compared to baseline. This increase in GV was associated with a significantly increased number of peristaltic contractions and had a significant positive correlation with the HFNO flow (r = 0.541; p < 0.001). The HFNO therapy was well tolerated by most of the patients and led to a significant improvement in the vitals and blood gas parameters at 30 minutes after initiation of HFNO therapy. In adult patients with hypoxemic respiratory failure, the use of HFNO therapy produces gas leaks into the stomach leading to increased gastric volume. The gastric distension increases the peristaltic contraction and higher flows result in more distension. Ramachandran A, Bhatia P, Mohammed S, Kamal M, Chhabra S, Paliwal B. Gastric Insufflation with High Flow Nasal Oxygen Therapy in Adult Patients Admitted to Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2024;28(4):393-398.