Elevated Group Research Articles

The safety of maxillary sinus floor elevation and the accuracy of implant placement using dynamic navigation.

To date, it remains a challenge to conduct maxillary sinus floor elevation (MSFE) owing to heterogeneity of anatomical structures and limited operative visibility of the maxillary sinus. The aim of this study is to investigate the safety of MSFE and the accuracy of implant placement using dynamic navigation. Forty-two implants were placed in thirty-five patients requiring implantation in posterior maxilla with dynamic navigation. They were assigned to either lateral window sinus floor elevation (LWSFE) group (n = 22) or transcrestal sinus floor elevation (TSFE) group (n = 20) according to the residual alveolar bone height (RBH). Platform deviation, apex deviation and angular deviation between actual and planned implant placement were measured in precision evaluation software. Three deviations of two groups were compared via SPSS 22.0 software. Neither accidental bleeding nor perforation of Schneiderian membrane occurred in any patients. The actual window position of LWSFE was consistent with the preoperative design. There were no significant differences in platform, apex and angular deviations between the two groups (P > 0.05). In this study the dynamic navigation harvested clinically acceptable safety of MSFE and accuracy for implant placement in posterior maxillary region. The dynamic navigation would provide the clinician with assistance in achieving precise preoperative planning and reducing complications in surgical procedures. The granular bone grafts used in the LWSFE did not significantly affection on the accuracy of the simultaneous implant placement under the guidance of dynamic navigation.

The BRAF V600E Mutation and Clinicopathological Changes Among Patients With Hashimoto thyroiditis, Papillary Thyroid Carcinoma With Hashimoto Thyroiditis, and Nodular Goiter.

The study aimed to investigate the BRAF V600E mutation and clinicopathological changes among patients with Hashimoto thyroiditis (HT), papillary thyroid carcinoma (PTC) with Hashimoto thyroiditis (HT), or nodular goiter (NG). A total of 87 patients with the BRAF V600E mutation who were diagnosed with HT (including with hyperplasia dysplasia), PTC with HT, and PTC with NG were enrolled. Clinical data, concentrations of antithyroglobulin antibodies (TGAb) and thyroid microsomal antibodies (TMAb) in the serum thyroid-function levels, and the result presence of the BRAF V600E mutation were retrospectively analyzed. There were significant differences in the BRAF V600E mutation rates between the HT and PTC with HT groups (P <0.05) and the HT and PTC with NG groups (P <0.05), whereas no significant difference was found between the PTC with HT and PTC with NG groups. There was no difference in incidences of PTC between HT with elevated TGAb and TMAb group and those with baseline levels. The incidence of multifocal PTC was higher in the PTC with HT group; however, the difference was not significant. Our findings documented that BRAF mutation distinguished between the benign HT and the malignant PTC groups. The serum levels of TGAb and TMAb autoantibodies did not directly correlate with PTC in the background of HT. HT and NG may similarly contribute to the pathogenesis of PTC.

Investigation of subclinical ocular inflammation in the aqueous humor of patients with myopia following bilateral sequential collamer lens implantation

BackgroundThe aqueous humor, a transparent fluid secreted by the ciliary body, supports the lens of the eyeball. In this study, we analyzed the cytokine and chemokine profiles within the aqueous humor of the contralateral eye post-implantation of an implantable collamer lens (ICL) to evaluate potential subclinical inflammation in the second eye subsequent to ICL implantation in the first eye. MethodsAqueous humor samples were procured from both eyes of 40 patients (totaling 80 eyes) prior to bilateral ICL insertion. Subsequently, a comprehensive statistical analysis was conducted using the Luminex assay to quantify 30 different cytokines in these samples. ResultsCompared to the first eye, the aqueous humor of the second eye demonstrated decreased concentrations of IFN-γ (P = 0.038), IL-13 (P = 0.027), IL-17/IL-17 A (P = 0.012), and IL-4 (P = 0.025). No significant differences were observed in other cytokine levels between the two groups. Patients were then categorized based on the postoperative rise in intraocular pressure (IOP) in the first eye. The group with elevated IOP displayed elevated levels of EGF in the aqueous humor of the first eye (P = 0.013) and higher levels of PDGF-AB/BB in the aqueous humor of the second eye (P = 0.032) compared to the group with normal IOP. Within the elevated IOP group, the levels of EGF (P = 0.013) and IL-17/IL-17 A (P = 0.016) in the aqueous humor were lower in the second eye than in the first eye. In the normal IOP group, cytokine levels did not differ notably between eyes. ConclusionFollowing sequential ICL implantation, it appears that a protective response may be activated to mitigate subclinical inflammation in the second eye induced by the initial implantation in the first eye. Additionally, the increase in IOP subsequent to surgery in the first eye may correlate with the presence of inflammatory mediators in the aqueous humor.

Current and future trends in vertical transportation

In the middle of the 19th century, the invention of a safety device that prevented elevators from falling enabled the construction of tall buildings and skyscrapers. In the middle of the 20th century, control systems started to serve the given calls automatically by relay technology, and later by electro-mechanical systems. In the 1970s-80 s, software-based control systems invaded elevator technology. Passenger service levels improved with the application of mathematical methods such as artificial intelligence. When the old relay boards of the skyscrapers in New York were modernized by software-based group controls, passenger waiting times dropped to less than half. In this millennium, the need to reduce elevator core space has further increased, since a significant number of buildings already exceed 300 m. The challenge in constructing tall buildings is that elevator groups can occupy the rentable area of a building. At the elevator planning stage, elevator core space can be decreased by zoning the building. The latest trends include systems with several elevator cars running in the same shaft. With modern control systems, passenger journey times can be decreased and handling capacity increased. This article deals with mathematical methods used in elevator dispatching problems. Building traffic simulation is utilized to search for an elevator arrangement that saves the most space in an example building. The design criteria of the ISO 8100–32 standard are used in selecting the elevator arrangements.

Can optic disc vessel density help in cases of residual disc elevation after shunt surgery in cases of idiopathic intracranial hypertension?

AimTo detect if we can use the reduction in the optic disc vessel density as an indicator to the reduction in intracranial tension in patients with residual optic disc elevation after shunt surgery as fundus examination in those cases is not conclusive.Patients and method21 patients with papilledema due to idiopathic intracranial hypertension underwent shunt surgery. Full neurological and ophthalmological assessments were done. The optic disc vessel density was measured before and 3 months after surgery. Patients were then divided according to the resolution of papilledema into 2 groups: 1) Residual disc elevation group. 2) Completely resolved disc edema group. CSF pressure was measured via lumber puncture preoperative for all patients and 3 months post-operative only for patients with residual disc edema. A comparison between both groups was done.ResultsThere was a highly statistically significant difference between the two groups as regard the papilledema grade (the residual disc elevation group had a higher grade of papilledema) with P-value=0.000. As regard the difference in the preoperative optic disc vessel density between the two groups, there were statistically significant differences (optic disc vessel density was more in the residual disc elevation group). As regard the postoperative optic disc vessel density, there were non-significant differences between the two groups in whole image, inside disc and peripapillary vessel density (either in macro or microvasculature).ConclusionThe optic disc vessel density decreased with normal postoperative CSF opening pressure in cases with residual disc elevation postoperatively. Thus, in cases of residual optic disc swelling after shunt surgery, we can detect the reduction of intracranial pressure by the reduction in the optic disc vessel density which is a safe non-invasive technique. That may help in cases of residual disc elevation.

Impact of change in the Naples prognostic score after neoadjuvant chemoradiotherapy on survival in esophageal squamous cell carcinoma patients.

To assess the clinical relevance and prognostic value of changes in the Naples prognostic score (NPS) after neoadjuvant chemoradiotherapy (NACR) among esophageal squamous cell carcinoma (ESCC) patients. We studied 232 locally advanced ESCC patients who received NACR before undergoing esophagectomy retrospectively. Categorizing individuals into the elevated NPS group and the non-elevated NPS group based on the change in NPS after NACR (ΔNPS > 0 or ∆NPS ≤ 0), we examined and compared the clinicopathological characteristics, survival rates, and postoperative complications between these 2 groups (∆NPS = post-NACR NPS - pre-NACR NPS). Results: Out of the 232 patients enrolled, 105 exhibited elevated NPS levels, while 127 showed non-elevated NPS levels. Survival analyses indicated inferior overall survival (OS) (p=0.024) and recurrence-free survival (RFS) (p=0.047) in the elevated NPS cohort compared to the non-elevated NPS cohort. Subsequent cox regression analyses identified the post-NACR change in NPS as an independent prognostic indicator for RFS (p=0.029) and OS (p=0.036). Elevated NPS post-NACR emerged as a significant indicator of worse prognosis for locally advanced ESCC patients who underwent NACR. This finding has great potential to be useful for recognizing high-risk ESCC patients who received NACR before undergoing esophagectomy and making individualized subsequent therapeutic decisions in clinical practice.

EXPLORING THE IMPACT OF TEACHER SOCIAL IDENTITY ON MOTIVATIONAL ENHANCEMENT

In the field of psychology, motivation is viewed as the process through which individuals prioritize incoming messages based on their needs and subsequently engage in behaviour accordingly. When exploring factors contributing to teachers' motivation, it becomes crucial to emphasize the role of teachers' social identity. Teachers with elevated social identity and group belonging levels often integrate didactic and innovative methods in their teaching practices, driven by their confidence in their abilities. These methods not only foster students' independence and autonomy but also enhance the learning environment. As part of the study, 405 teachers from both private and public schools in five diverse cities across Georgia took part in the quantitative survey. The convenience sampling method was employed throughout the research process; therefore, the results cannot be generalized to the population of teachers in Georgia. The study reveals that teachers perceive themselves and their colleagues similarly, indicating a strong collective identity within the teaching community, regardless of individual differences. Demographic factors such as teacher status, income, city, and education do not significantly affect this sense of belonging. Identified regulation emerges as the primary form of motivation among teachers, reflecting their perception of the importance of their profession. Moreover, there is a positive correlation between social identity and teacher motivation, suggesting that a stronger sense of belonging corresponds to higher motivation levels.

Adverse respiratory patterns in near-term spontaneously breathing newborn lambs with elevated airway liquid volumes at birth.

Recent evidence indicates that respiratory distress (RD) in near-term infants is caused by elevated airway liquid (EL) volume at the beginning of air-breathing after birth. While the adverse effects EL volumes on newborn lung function are known, the effects on respiratory control and breathing patterns shortly after birth (<4 h) are unknown. We investigated the effects of EL volumes on cardiorespiratory function and breathing patterns in spontaneously breathing near-term newborn lambs in the first hours after birth. At 137-8 days gestation (2-3 days prior to delivery; term ∼147 days), sterile surgery was performed on fetal sheep (n = 17) to implant catheters and blood flow probes. At 140 days, lambs were delivered via caesarean section under spinal anaesthesia. Airway liquid volumes were adjusted to mimic the level expected following vaginal delivery (∼10 ml/kg; Controls; n = 7), or elective caesarean section (∼30 ml/kg; elevated airway liquid group; EL; n = 10). Spontaneous breathing and cardiorespiratory parameters were recorded over four hours after birth. Non-invasive respiratory support with supplemental oxygen was provided if required. EL lambs required higher inspired oxygen levels (p = 0.0002), were less active (p = 0.026), fed less (p = 0.008) and had higher respiratory morbidity scores than Controls (p < 0.0001). EL lambs also displayed higher rates of breathing patterns associated with RD, such as expiratory braking and tachypnoea. These patterns were particularly evident in male EL lambs who displayed higher levels of severe respiratory morbidity (e.g., expiratory braking) than female EL lambs. The study demonstrates that EL volumes at birth trigger respiratory behaviour and breathing patterns that resemble clinically recognised features of RD in term infants.

Management of depth to achieve timely arteriovenous fistula utilization

ObjectiveFailure to achieve timely arteriovenous fistulae (AVFs) utilization due to excessive depth (>6 mm) remains an ongoing concern for dialysis access. This study evaluates the outcomes of radiocephalic (RCF) and brachiocephalic (BCF) fistula elevation required for access utilization. MethodsA retrospective review of all patients undergoing first-time autologous access over 10 years was undertaken. RCF and BCF were analyzed, and cases of initial access failure due to depth alone were selected for study. Primary and staged brachio-basilic AVF were excluded. Outcomes of early thrombosis, line placement, maturation (successful progression to hemodialysis [HD), reintervention, and functional dialysis (continuous HD for 3 consecutive months) were examined. ResultsFrom January 2012 to December 2022, 1733 patients (67% female; mean age, 61 ± 14 years) underwent autologous AVF placement. Of these, 298 patients (17%) had depth-related AVF access issues (BCF, 71% and RCF, 29%). Nineteen percent of these AVFs underwent a primary balloon-assisted maturation (BAM), and 2% had side branch coil embolization before consideration for elevation. The average time to intervention for depth was 11 ± 4 weeks after primary creation. During elevation, side branch ligation occurred in 38% of cases, and 15% underwent intraoperative BAM, The pre-elevation depth was 8.2 ± 3.1 mm, and the mean post-elevation depth was 4.7 ± 2.9 mm (P = .002). Early thrombosis (<18 days) occurred in 4% of cases. There was no mortality, and the 30-day major adverse cardiac event rate was 2%, with a 30-day morbidity of 5%, which was driven by wound issues. Six percent of the AVFs underwent follow-up BAM within 3 months. Mean maturation of the AVFs was 74% ± 3% vs 72% ± 3% (P = .58) for the elevation vs no-elevation groups at 24 weeks, respectively. However, there was an increase in tunneled central line placement in pre-emptive fistula patients due to the delay in maturation (elevation, 17% vs no-elevation, 8%; P = .008). There was a mean successful access time of 6 ± 3 weeks after elevation (16 ± 4 weeks after access creation). There was a median of 2.4 secondary interventions per year after elevation compared with a median of 2.7 secondary interventions per year without elevation. Mean access functionality was 68% ± 8% vs 75% ± 8% at 3 years for the elevation vs no-elevation groups, respectively (P = .25). ConclusionsElevation of deep BCF and RCF occurs late after placement but can be successfully achieved with low morbidity and satisfactory long-term functionality. It results in an increase in tunneled central line placement in pre-emptive fistula patients. Elevation is a valuable adjunct to AVF maturation and enhances an autologous access policy.

Beyond cholesterol: Exploring serum ferritin’s and high-sensitivity C-reactive protein role in cardiovascular risk

Background: Iron, a pivotal element in the oxidation of low-density lipoprotein (LDL) cholesterol, exerts influence on inflammatory responses and exhibits a positive association with coronary heart disease. Elevated levels of the inflammatory marker, C-reactive protein (CRP), serve as a predictive risk factor for subsequent cardiac events. Aims and Objectives: This study explores the interplay between cardiovascular disease risk factors and serum ferritin concerning CRP. Materials and Methods: A cohort of 750 subjects (375 males and 375 females) was subjected to analysis. Elevated levels were defined as CRP &gt;3.0 mg/L, serum ferritin &gt;200 ng/mL, total cholesterol &gt;200 mg/dL, and LDL-cholesterol &gt;160 mg/dL. HDL cholesterol levels below 40 mg/dL were categorized as low. Results: Within the low LDL-cholesterol group, no discernible correlation was observed between serum ferritin and high-sensitivity CRP (hsCRP) (odds ratio [OR] of 54.95, 95% confidence interval [CI] = 0.81–3.48, P&lt;0.148). Conversely, a correlation was identified in the elevated LDL-cholesterol group (OR of 10.98, 95% CI=1.12–111.22, P&lt;0.05). Furthermore, the introduction of an interaction term in the assessment of the correlation between elevated hsCRP and LDL-cholesterol reaffirmed a robust correlation between hsCRP and serum ferritin (P&lt;0.005). Conclusion: The oxidation of LDL-cholesterol by serum ferritin emerges as a potential contributor to inflammatory reactions and heightened hsCRP levels. Prospective studies are warranted to investigate whether interventions targeting the reduction of serum ferritin and CRP levels, through medical interventions and lifestyle modifications, could prove efficacious in preventing cardiovascular diseases.

Expression of CD30 in Patients with Diffuse Large B-Cell Lymphoma and Clinical Significance

To investigate the expression and clinical significance of CD30 in patients with diffuse large B-cell lymphoma (DLBCL). A retrospective analysis was conducted on 124 cases of primary DLBCL diagnosed at Changzhou Second People's Hospital Affiliated with Nanjing Medical University from January 2018 to July 2020. The expression of CD30 in patients with DLBCL was detected by immunohistochemical method, and the clinicopathological characteristics were analyzed and compared between CD30+ and CD30- groups. Kaplan-Meier analysis was used for survival analysis. The relationship between CD30 expression and clinical features and prognosis were analyzed. Among the 124 patients with DLBCL, 19 patients expressed CD30, and the positive rate is 15.32%. The clinico-pathological characteristics of CD30+ in patients with DLBCL were characterized by low age, more common in males, fewer extranodal lesions, lower international prognostic index (IPI), GCB type being more common in Hans subtype, and achieving better therapeutic effects (P < 0.05). However, there were no significant statistical differences in B-symptoms (P =0.323), Ann Arbor staging (P =0.197), Eastern Cooperative Oncology Group (ECOG) score (P =0.479), lactate dehydrogenase (LDH) (P =0.477), and the involvement of bone marrow (P =0.222). There were significant differences in OS and PFS between the CD30+ and CD30- groups (χ2=5.653, P =0.017; χ2＝4.109，P =0.043), the CD30+ group had a better prognosis than that of the CD30- group. The results of subgroup analysis showed that the CD30+ group in the IPI score=1-2, LDH elevated group had a better prognosis (P < 0.05). In the subgroups of Ann Arbor staging III-IV (P =0.055) and non GCB type (P =0.053), the CD30+ group had a good prognosis trend, but the difference was not statistically significant. The results of univariate analysis showed that the good prognosis of DLBCL patients was closely related to CD30+ expression, no B-symptoms, early Ann Arbor staging, low ECOG score, normal LDH, low IPI score, fewer extranodal involvement, and obtaining the best therapeutic effect as CR (all P <0.05). COX multivariate regression analysis showed that the presence of B-symptoms and achieving the best therapeutic effect as Non-CR were independent risk factors affecting the prognosis of DLBCL patients (P < 0.05). The CD30+ expression in DLBCL patients indicates a good prognosis and has certain diagnostic value in evaluating the prognosis of DLBCL patients.

Directional optimization of elevator scheduling algorithms in complex traffic patterns

Elevator systems in buildings face challenges due to unpredictable passenger flow, which can make scheduling elevators complicated to optimize their operation. Most of the existing algorithms are developed based on pattern recognition and may not be effective in scenarios where patterns are difficult to classify, especially when elevator operations involve uncertain human behaviors. To address this issue, this paper proposes a time-dependent optimization model that considers long-term and multi-floor peaks, with a focus on peak floors. The proposed model accounts for dynamic scheduling patterns of elevators and represents passenger flow direction as a relation matrix. The proposed direction optimization method contains several functions to guide iteration direction and improve the efficiency of an iteration process based on classical algorithms. This method also ensures the stability of Markov chains by adjusting an iteration process. The feasibility of the proposed method is supported by the relevant theory, and experimental results show that the direction-optimized algorithms outperform classical algorithms, resulting in the superb operating efficiency of elevators at a lower cost. This paper contributes to the development of efficient algorithms for scheduling elevators in complex traffic patterns, which can improve performance of elevator group systems in buildings. The proposed method is not only limited to elevators but can also be extended to other transportation systems with flow requirements.

The Association Between Components of Metabolic Syndrome and Abnormal Electrocardiograms in the Saudi Population: A Retrospective Study.

Saudi Arabia has a high metabolic syndrome (MetS) prevalence. Having MetS increases the risk of cardiovascular disease (CVD), CVD mortality, and myocardial infarction (MI). There is a lack of information regarding MetS and electrocardiogram (ECG) abnormalities in Saudi Arabian populations. Further, it is unclear to what extent MetS components are associated with abnormal ECGs in Saudi populations. We investigated whether ECG abnormalities and MetS are associated with Saudi adults. Furthermore, we assessed the relationship between ECG abnormalities and the components of MetS based on the age and gender of the individuals. Materials and methods: A retrospective study was conducted at Dr Soliman Fakeeh Hospital in Jeddah, Saudi Arabia, on 208 patients with MetS. Participants' clinical and laboratory data were examined. A detailed analysis of the ECG was performed. ECG abnormalities were divided into minor and major abnormalities based on Novacode criteria. In addition to ischemic ECG findings, the ECG showed prolonged PR intervals, prolonged P duration, prolonged QRS duration, and prolonged QTc intervals. Results: One hundred and thirty-seven participants (65.9%) had elevated fasting blood glucose (FBS), 129 had central obesity (62%), 93 had high blood pressure (BP) (44.7%), 74 had elevated triglycerides (35.6%), and 49 had low high-density lipoprotein (23.6%).An abnormal ECG was found in 86 (41.3%) participants. It consisted of ischemic ECGs, atrioventricular (AV) block (first and second degrees), bundle branch block (right bundle branch block [RBBB], left bundle branch block [LBBB], RBBB with left anterior hemiblock, RBBB with right anterior hemiblock), arrhythmias (premature ventricular contractions [PVCs], premature atrial complexes [PACs], atrial fibrillation [AF], sinus bradycardia, sinus arrhythmia), prolonged QTc, prolonged PR interval, and prolonged QRS duration. There were 29 (13.9%) cases with multiple ECG abnormalities, 57 (27.4%) had one abnormal ECG, 42 (20.2%) had minor abnormal ECGs, and 44 (21.2%) had major abnormal ECGs. Middle-aged and elderly males accounted for the majority of these ECG changes. In the central obesity group, 22 participants (10.6%) had ischemic ECGs, 18 (8.7%) had prolonged QTc, 10 (4.8%) had first-degreeAV block, 6 (2.9%) had sinus bradycardia, 7 (3.4%) had RBBB, 4 (1.9%) had LBBB, 3 (1.4%) had PVCs, 2 (1%) had ventricular preexcitation, and one (0.5%) had PACs. An elevated FBS group included 19 participants (9.1%) with an ischemic ECG, 18 (8.7%) with a prolonged QTc, 11 (5.3%) with a first-degreeAV block, 9 (4.3%) with sinus bradycardia, 6 (2.9%) with slight ST-T abnormality, 5 (2.4%) with RBBB, and 5 (2.4%) with LBBB. Finally, one (0.5%) of these patients had second-degreeAV block, RBBB with left anterior hemiblock, left anterior hemiblock, PVCs, AF, ventricular preexcitation, and sinus arrhythmia for each. Saudi Arabian populations with MetS were strongly associated with abnormal ECG findings, particularly ischemic ECG findings, AV block (firstand second degrees), and BBB (RBBB, LBBB). Middle-aged and elderly males accounted for the majority of these ECG changes. The most important factors contributing to ECG changes were elevated FBS and central obesity.

Inflammatory Cytokines Associated with Obesity, Type-2 Diabetes, and Hypertension Exacerbate Breast Cancer Risk in Underserved African American and Latin American Women.

Background: Comorbid chronic diseases, such as obesity, Type-2 Diabetes (T2D), and hypertension (HTN), are major public health issues and highly prevalent among underserved African Americans (AA) and Latin Americans (LA). Elevated inflammatory cytokines are underlying processes in comorbidities (obesity, T2D, and HTN) that could contribute to tumorigenesis and adverse cancer outcomes. Methods: A panel of 19 cytokines was measured by Luminex assay from 570 AA and LA women's serum samples. The comorbidities and breast cancer information were extracted from our existing clinical database. Comorbidity-associated cytokines were identified by linear regression analysis, and the odds ratios of increasing cytokines for breast cancer were evaluated by Logistic regression. Results: Women with obesity, T2D, and HTN elevated specific groups of cytokines. EGF, MCP1, MDC, MIP-1b, and Groα were independent of T2D and HTN significantly associated with obesity. TGFβ1 and TGFβ2 were T2D-associated cytokines, and MIB-1b, TNFα, and VEGFα were HTN-associated cytokines. Among those comorbidity-associated cytokines, CXCL1, CCL4, CXCL10, TNFα, TGFβ1, and TGFβ2 were also significantly associated with breast cancer diagnosed at age < 50. Two or more comorbidities further increased the levels of Groα, MIP-1b, TNFα, and TGFβs. Conclusions: Comorbidity-associate cytokines could augment the risk of breast cancer for AA and LA women.

Comparing semi-recumbent lateral position vs semi-recumbent position in preventing VAP and ARDS in traumatic brain injury patients requiring mechanical ventilation

Background and aimsVentilator-associated pneumonia is a common nosocomial infection in the intensive care unit among traumatic brain injury patients, resulting in increased morbidity and mortality. We have assessed the effectiveness of semi-recumbent lateral positioning in comparison with semi‐recumbent positioning to prevent ventilator-associated pneumonia and acute respiratory distress syndrome in traumatic brain injury patients requiring mechanical ventilation. MethodsIn a single-blind prospective randomised clinical trial, 100 patients were recruited in the intensive care unit and randomly assigned to the control group (n = 50) and intervention group (n = 50). Patients in control group maintained semi-recumbent position with 30–45° head of bed elevation and intervention group maintained semi-recumbent lateral position with lateral turning ≥45° and head of bed elevation 30–45° every 4 h. Bronchoalveolar lavage for diagnosis of ventilator-associated pneumonia, Glasgow Coma Score, clinical pulmonary infection score, duration of mechanical ventilation, PaO2/FiO2 ratio and incidence of acute respiratory distress syndrome were investigated for 10 days. ResultsComparing semi-recumbent position with semi-recumbent lateral position, the latter showed significant decrease in ventilator-associated pneumonia with lower clinical pulmonary infection score at day 3 (6.5 ± 2.9; 1.8 ± 2.1; p < 0.001), day 7 (6.6 ± 2.6; 2.6 ± 2.3; p < 0.001) and day 10 (7.7 ± 2.9; 2.3 ± 2.3; p = 0.001) and decreased incidence of positive bronchoalveolar lavage cultures at day 3 (p = 0.02), day 7 (p < 0.001) and day 10 (p = 0.001). Duration of mechanical ventilation was significantly reduced at day 7 (p = 0.04) and day 10 (p < 0.001). The incidence of acute respiratory distress syndrome was not different. ConclusionSemi-recumbent lateral position results in significant less incidence of ventilator-associated pneumonia and reduced duration of mechanical ventilation. Trial registration numberICMR-NIMS CTRI/2019/01/016829.

Dynamic planning of office building elevator scheduling

Every morning rush hour is the most crowded time for elevators in office buildings, and many office workers will be late because they can't wait for the elevator. How to reasonably call the existing elevator resources has become a problem we need to pay attention to. In this paper, we will discuss the modeling of elevator scheduling optimization problem for office buildings. In this paper, the background and significance of the research is firstly explained, and then the elevator group linkage control system is briefly understood and analyzed, and the evaluation indexes are determined according to its multi-objective and diversified characteristics, and then the group control method focusing on making the elevator run time the shortest is adopted, and the principle of the ratio of elevator running period/total running time equal to the number of passengers transported/total passengers transported by the elevator in one cycle is followed to compare several common elevator running methods, and the results are summarized in the following table. Common elevator operation methods are compared, the most effective way to arrive at, and finally use dynamic programming to solve the partition point, to establish the optimal scheme of elevator scheduling for the office building division. Since it is not possible to expand the elevator in the office building, reducing the number of stops of each elevator to shorten the time required for the elevator to carry passengers becomes the most feasible method. After comparing the common elevator operation methods, it can be found that zoning can shorten the final average arrival time of passengers more than no zoning. That is, the elevators in an office building are divided into different zones, and each zone has a designated elevator serving a designated floor segment. In order to solve the floor segment allocation problem, the shortest path algorithm is used in this paper. The paper concludes with a summary and future outlook of the resulting optimization model.

Association between brachial-ankle pulse wave velocity and the risk of new-onset atrial fibrillation: A report from Kailuan prospective cohort study

One marker of arterial stiffness (AS) is the brachial-ankle pulse wave velocity (baPWV). We aim to investigate the predictive value of baPWV with regard to new-onset atrial fibrillation (AF). All participants without AF from 2010 to 2020 in the Kailuan cohort were included. The primary endpoint was new-onset AF. Participants were categorized into three study groups based on baPWV, with a normal baPWV group as a reference. The predictive value of baPWV was analyzed as a continuous variable. Multivariable Cox proportional hazard regression models were used to investigate the association. A total of 49,872 subjects (mean age: 47.57 years old, 74.2% male) were included with a mean follow-up of 6.17 (3.95–8.46) years. The risk of AF increased as the baseline baPWV increased, whereby the adjusted hazard ratio (aHR) of the borderline AS group and the elevated AS group were 1.82 (95% confidence interval [CI]: 1.18–2.80) and 2.08 (95% CI: 1.31–3.30), respectively. When considered as a continuous variable, each 361 cm/s increase in baseline baPWV, increased the risk of AF by 21.7% (aHR: 1.22; 95% CI: 1.08–1.37). In the subgroup analysis of non-hypertensive patients, the risks of AF were significantly higher in the borderline AS group (aHR: 3.16, 95% CI: 1.74–5.74) and elevated AS group (aHR: 2.26, 95% CI: 1.02–5.05). For patients with elevated BMI, the risk of AF in the elevated AS group was significantly higher (aHR: 1.69, 95% CI: 1.00–2.83). Baseline baPWV was associated with new-onset AF after adjustments. (Trial registration site and registration number are, respectively, http://www.chictr.org.cn/index.aspx and ChiCTR-TNRC-11001489).

Prognostic nutritional index during hospitalization correlates with adverse outcomes in elderly patients with acute myocardial infarction: a single-center retrospective cohort study

Background and aimsAcute myocardial infarction (AMI) is one of the most prevalent illnesses endangering the elderly’s health. The predictive nutritional index (PNI) has been shown in several studies to be a good predictor of nutritional prognosis. In this study, we explored the correlation between PNI during hospitalization and the outcome of elderly AMI patients.MethodsElderly AMI patients in the Cardiac Intensive Care Unit of Huadong Hospital from September 2017 to April 2020 were recruited for analysis. The clinical and laboratory examination data of subjects were retrieved. All enrolled patients were monitored following discharge. The primary clinical endpoints encompass major adverse cardiovascular events (MACEs) and Composite endpoint (MACEs and all-cause mortality). Survival analyses were conducted via the Kaplan–Meier and the log-rank analyses, and the Cox, proportional hazards model, was employed for hazard rate (HR) calculation.Results307 subjects were recruited for analysis. The optimal PNI threshold is 40.923. Based on the Kaplan–Meier analysis, the elevated PNI group experienced better prognosis (P < 0.001). Cox analysis demonstrated that the PNI group was a stand-alone predictor for elderly AMI patient prognosis (HR = 1.674, 95% CI 1.076–2.604, P = 0.022). Subgroup analysis showed that the HR of the PNI group was the highest in the ST-segment elevation myocardial infarction (STEMI) subgroup (HR = 3.345, 95% CI 1.889–5.923, P = 0.05), but no discernible difference was observed in the non-ST-segment elevation myocardial infarction (NSTEMI) subgroup.ConclusionBased on our analyses, the PNI during hospitalization can accurately predict the prognosis of elderly STEMI patients but not that of elderly NSTEMI patients.

Potentially compromised systemic and local lactate metabolic balance in glaucoma, which could increase retinal glucose and glutamate concentrations

To investigate the association between lactate metabolism and glaucoma, we conducted a multi-institutional cross-sectional clinical study and a retinal metabolomic analysis of mice with elevated intraocular pressure (IOP) induced by intracameral microbead injection. We compared lactate concentrations in serum and aqueous humor in age-matched 64 patients each with primary open-angle glaucoma (POAG) and cataract. Neither serum nor aqueous humor lactate concentrations differed between the two groups. Multiple regression analysis revealed that only body mass index showed a significant positive correlation with serum and aqueous humor lactate concentration in POAG patients (rs = 0.376, P = 0.002, and rs = 0.333, P = 0.007, respectively), but not in cataract patients. l-Lactic acid was one of the most abundantly detected metabolites in mouse retinas with gas chromatography and mass spectrometry, but there were no significant differences among control, 2-week, and 4-week IOP elevation groups. After 4 weeks of elevated IOP, d-glucose and l-glutamic acid ranked as the top two for a change in raised concentration, roughly sevenfold and threefold, respectively (ANOVA, P = 0.004; Tukey–Kramer, P < 0.05). Glaucoma may disrupt the systemic and intraocular lactate metabolic homeostasis, with a compensatory rise in glucose and glutamate in the retina.

Post-disclosure distress among racial and ethnic groups in a preclinical AD trial.

Trialists need a thorough understanding of whether reactions to Alzheimer's disease (AD) biomarker information differ among racial and ethnic groups in preclinical AD trials. We used data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease Study to analyze cognitively unimpaired participants' responses on the Impact of Event Scale (IES) 24 to 72hours after amyloid disclosure. We fit a linear regression model to test whether mean IES scores differed among participants from specific racial and ethnic groups. We considered potential effect modification by amyloid status. Reactions to disclosure did not significantly differ among participant groups based on self-reported race and ethnicity. Although the results were not significant when stratified by amyloid status, all racial and ethnic groups except for participants self-reporting Hispanic/Latino ethnicity were observed to have higher mean IES in the elevated amyloid group. These results support continued use of current disclosure methods in preclinical AD trials.