Higher Scores Research Articles

Effects of A Brief Resonance Frequency Breathing Exercise on Heart Rate Variability and Inhibitory Control in the Context of Generalised Anxiety Disorder

Abstract Generalised anxiety disorder (GAD) is associated with cognitive and physiological symptoms including uncontrollable worry, inhibitory control deficits, and low heart rate variability (HRV). Literature linking HRV and inhibition in GAD is predominantly correlational. The present experiment investigated whether HRV has a causal role in maintaining inhibitory control. Participants (N = 135, 111 female) aged 18–37 reporting high levels of symptoms associated with GAD (GAD-7 scores ≥ 10; Penn State Worry Questionnaire scores ≥ 56) were assigned to an experimental or active control condition and completed baseline measures of HRV, respiration rate, and inhibitory control. The experimental condition completed resonance frequency breathing (RFB) training, and the control condition practiced breathing at their mean breathing rate before repeating the inhibitory control assessment. Participants also completed the breathing training before a behavioural worry task. The experimental condition was predicted to show increased HRV, alongside improved inhibitory control and better ability to stop worrying as compared to the control condition. HRV increased during the experimental condition, as compared to the control condition. However, there were no significant effects of RFB on inhibitory control or worry, or on HRV during the inhibitory control tasks. In conclusion, RFB can increase HRV in high GAD scorers, but further research is required to determine whether there is a relationship between increased HRV and symptoms of GAD in a single session experiment.

Molecular optimization using a conditional transformer for reaction-aware compound exploration with reinforcement learning

Designing molecules with desirable properties is a critical endeavor in drug discovery. Because of recent advances in deep learning, molecular generative models have been developed. However, the existing compound exploration models often disregard the important issue of ensuring the feasibility of organic synthesis. To address this issue, we propose TRACER, which is a framework that integrates the optimization of molecular property optimization with synthetic pathway generation. The model can predict the product derived from a given reactant via a conditional transformer under the constraints of a reaction type. The molecular optimization results of an activity prediction model targeting DRD2, AKT1, and CXCR4 revealed that TRACER effectively generated compounds with high scores. The transformer model, which recognizes the entire structures, captures the complexity of the organic synthesis and enables its navigation in a vast chemical space while considering real-world reactivity constraints.

Perceived coercion amongst healthcare workers during the COVID-19 pandemic

Direct and prolonged exposure to stress and uncertainty among healthcare workers (HCWs) during the COVID-19 pandemic likely had a significant negative impact on their mental health and general wellbeing. Although the contributors to such distress remain to be fully understood, the construct of perceived coercion appears to be relevant. Among HCWs, perceived coercion is conceptualised as appraisals about lack of control/‘freedom to choose’ and pressure to perform patient-care duties in the context of unprecedented threat of contagion from patients. To improve our understanding of perceived coercion amongst HCWs, we developed a 10-item scale—the Pandemic-specific Perceived Coercion Scale for Healthcare Workers (PPCS-HCW) scale—designed to be adaptable and applicable for use in future mass-contagion emergencies. A preliminary (exploratory) factor analysis (N = 546) showed that relevant items coalesced around three factors—‘internal pressure’, ‘external pressure’ and ‘perceived coercion’, that partly overlap with previous conceptualisations of perceived coercion. The exploratory conceptual and psychometric structure was confirmed in a separate sample of HCWs from the UK and Norway (N = 483). On average, across the three PPCS-HCW scale factors, HCWs showed low levels of perceived coercion (M = 0.22 (95% CI [0.11, 0.33] on a − 3 to + 3 scale). However, cluster analysis identified three groups: low (− 1.09 (95% CI [− 1.20, − 0.99]), moderate (0.17 (95% CI [0.08, 0.25]) and high scoring (1.57 (95% CI [1.47, 1.67]) PPCS-HCW clusters. High scoring participants showed higher levels of psychological distress, avoidance coping and compassion fatigue. In summary, our findings suggest that perceived coercion is a relevant construct in understanding the adverse psychological impact of large-scale contagion emergencies on HCWs.

Age-related changes in brain signal variability in autism spectrum disorder

BackgroundBrain signal variability (BSV) is an important understudied aspect of brain function linked to cognitive flexibility and adaptive behavior. Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by social communication difficulties and restricted and repetitive behaviors (RRBs). While atypical brain function has been identified in individuals with ASD using fMRI task-activation and functional connectivity approaches, little is known about age-related relationships with resting-state BSV and repetitive behaviors in ASD.MethodsWe conducted a cross-sectional examination of resting-state BSV and its relationship with age and RRBs in a cohort of individuals with Autism Brain Imaging Data Exchange (n = 351) and typically developing (TD) individuals (n = 402) aged 5–50 years obtained from the Autism Brain Imaging Data Exchange. RRBs were assessed using the Autism Diagnostic Interview-Revised (ADI-RRB) scale. BSV was quantified using the root-mean-square successive difference (rMSSD) of the resting-state fMRI time series. We examined categorical group differences in rMSSD between ASD and TD groups, controlling for both linear and quadratic age. To identify dimensional relationships between age, group, and rMSSD, we utilized interaction regressors for group x age and group x quadratic age. Within a subset of individuals with ASD (269 subjects), we explored the relationship between rMSSD and ADI-RRB scores, both with and without age considerations. The relationship between rMSSD and ADI-RRB scores was further analyzed while accounting for linear and quadratic age. Additionally, we investigated the relationship between BSV, age, and ADI-RRB scores using interaction regressors for age x RRB and quadratic age x RRB.ResultsWhen controlling for linear age effects, we observed significant group differences between individuals with ASD and TD individuals in the default-mode network (DMN) and visual network, with decreased BSV in ASD. Similarly, controlling for quadratic age effects revealed significant group differences in the DMN and visual network. In both cases, individuals with ASD showed decreased BSV compared with TD individuals in these brain regions. The group × age interaction demonstrated significant group differences in the DMN, and visual network brain areas, indicating that rMSSD was greater in older individuals compared with younger individuals in the ASD group, while rMSSD was greater in younger individuals compared with older individuals in the TD group. The group × quadratic age interaction showed significant differences in the brain regions included in DMN, with an inverted U-shaped rMSSD-age relationship in ASD (higher rMSSD in younger individuals that slightly increased into middle age before decreasing) and a U-shaped rMSSD-age relationship in TD (higher rMSSD in younger and older individuals compared with middle-aged individuals). When controlling for linear and quadratic age effects, we found a significant positive association between rMSSD and ADI-RRB scores in brain regions within the DMN, salience, and visual network. While no significant results were observed for the linear age × RRB interaction, a significant association between quadratic age and ADI-RRB scores emerged in the DMN, dorsal attention network, and sensorimotor network. Individuals with high ADI-RRB scores exhibited an inverted U-shaped relationship between rMSSD and age, with lower rMSSD levels observed in both younger and older individuals, and higher rMSSD in middle-aged individuals. Those with mid-range ADI-RRB scores displayed a weak inverted U-shaped rMSSD-age association. In contrast, individuals with low ADI-RRB scores showed a U-shaped rMSSD-age association, with higher rMSSD levels in younger and older individuals, but a lower rMSSD in middle-aged individuals.ConclusionThese findings highlight age-related atypical BSV patterns in ASD and their association with repetitive behaviors, contributing to the growing literature on understanding alterations in functional brain maturation in ASD.

Screening for depression, anxiety, and psychological distress associated with low back pain by musculoskeletal and spinal clinicians. A scoping review.

A biopsychosocial assessment of a person with low back pain (LBP) should include the detection of psychological risk factors. Pragmatically, clinicians often use their clinical impression rather than questionnaires to screen for psychological risk factors. This scoping review explores how accurately depression, anxiety, and psychological distress can be identified by musculoskeletal (MSK) or spinal clinicians using clinical impression alone. The study protocol was pre-registered on Open Science Framework (OSF) https://osf.io/pt3a6/ . A comprehensive search strategy using five databases (MEDLINE, CINAHL, Academic Search Complete, APA PsycInfo, APA PsycArticles) was conducted by two independent reviewers, with additional searching of references. Studies must have included adults with LBP, who were assessed by MSK or spinal clinician for depression, anxiety or psychological distress using their clinical impression as well as a reference standard questionnaire. Data were synthesised descriptively and thematically for each psychological factor separately. Eight studies involving MSK clinicians (n = 4) and spinal clinicians (n = 4) were eligible. Four different reference standard questionnaires were used. Overall MSK and spinal clinicians were not accurate at identifying depression, anxiety or psychological distress in adults with LBP using only clinical impression. Mean sensitivity for accurate identification of high reference standard questionnaire scores for depression, anxiety, and psychological distress ranged between 12.0% and 40.0%. Mean sensitivity was marginally higher when the threshold was reduced to analyse clinician ability to accurately capture any abnormal psychological state (34.0% to 54.1%). Mean specificity values acrosshigher thresholds ranged from 88.7% to 93.6%. Overall, clinician impression alone is insufficient for MSK and spinal clinicians to accurately identify depression, anxiety and psychological distress in adults with LBP. The general tendency of the clinicians was to underestimate their presence. Without formal assessment of the psychological status of patients with LBP, clinicians will have an incomplete understanding of concordant psychological factors, and may fail to notice the requirement to refer on for appropriate psychological management.

Prognostic value of serum inflammatory markers in patients with esophageal squamous cell carcinoma undergoing surgery: a two-center retrospective cohort study

Background and purposeThe combined assessment of the neutrophil-platelet score and prognostic nutritional index is yet to be applied in evaluating the prognosis of patients following an operation for esophageal cancer. This study aimed to identify independent prognostic factors for patients undergoing operation for esophageal cancer and to construct a nomogram model for predicting median overall survival (mOS).MethodsA cohort of 660 patients with esophageal cancer from two clinical centers in China was recruited, comprising a training cohort (n = 511) and a validation cohort (n = 149). Survival rates were compared using Kaplan–Meier curves and the log-rank test. The Cox regression model was used to identify independent prognostic factors.ResultsThe Multi-variable Cox regression analysis revealed that tumor, node, metastasis stage, smoking status, neutrophil-platelet score, and prognostic nutritional index were independent postoperative prognostic factors for patients with esophageal cancer (P < 0.05). The mOS (129.0 months, 95% confidence interval (CI) not reached) was significantly higher in patients with a low neutrophil-platelet score than those with a high score (43.0 months, 28.1–57.9; P < 0.05). Conversely, the mOS (42.0 months, 95% CI 6.7–55.2) was lower in the low prognostic nutritional index score group than the high score group (125.0 months, 95% CI 96.4–153.6; P < 0.05). Evaluation metrics, including the concordance index (0.69 in the training group and 0.70 in the validation group), receiver operator characteristic curve analysis (In the training cohort, the AUCs for predicting 1-, 3-, 5- and 10-year overall survival rates using the nomogram were 76.19%, 69.07%, 70.12% and 68.17%, respectively; in the validation cohort, the corresponding predicted values were 76.66%, 77.18%, 75.04% and 79.57%, respectively), calibration curve, and decision curve analysis, demonstrated the clinical utility of the constructed prediction model.ConclusionsServing as systemic inflammatory biomarkers, the neutrophil-platelet score and prognostic nutritional index offer valuable prognostic insights for patients with esophageal cancer, augmenting predictive capabilities.

Cardiac magnetic resonance quantified epicardial fat volume is associated with complex coronary artery disease among diabetics

BackgroundEpicardial and pericardial adipose tissues are two distinct types of visceral fat in close adherence to the heart and were found to be increased among diabetics.AimTo investigate the correlation between cardiac magnetic resonance (CMR)-quantified epicardial (EFV) and pericardial fat (PFV) volumes and the complexity of coronary artery disease (CAD) among diabetic and non-diabetic patients.MethodsThis was a cross-sectional study that included 111 patients having CAD as indicated by coronary angiography and who underwent CMR. Epicardial and pericardial fat volumes were measured along short-axis CMR-derived images. CAD severity and complexity were evaluated using the syntax score (SS). Patients were classified into diabetic and non-diabetic groups based on their HbA1c and were compared regarding clinical, angiographic, and CMR data. Those with high SS were compared against low/intermediate SS. The correlation of measured EFV and PFV with the SS was evaluated, and possible predictors for high-SS were assessed.ResultsDiabetic patients (n = 64, 57.7%) had significantly high syntax scores, and significantly larger absolute and indexed EFV and PFV compared to non-diabetics. Both EFV and PFV showed a significant positive correlation with HbA1c and SS. EFV ≥ 119.55 ml significantly predicted high-SS (AUC = 0.84, 95%CI = 0.76–0.91, sensitivity = 77% and specificity = 82.5%) among the study population. Different cutoff points of EFV significantly predicted high SS among diabetics and non-diabetics with respective reasonable sensitivity and specificity. Age and EFV were consistently predictive of high SS on different multivariable regression models.ConclusionIncreased epicardial adipose tissue was a significant independent predictor of severe and complex CAD, representing a possible risk marker and potential therapeutic target, particularly among diabetics.

FAN score predicts prognosis after platinum-based first-line chemotherapy in patients with metastatic urothelial carcinoma

We have reported that the FAN score, which consists of the fibrosis-4 (Fib-4) index, albumin–bilirubin (ALBI) score, and neutrophil–lymphocyte ratio (NLR), is a prognostic marker for patients receiving pembrolizumab for mUC. However, it remains unclear whether the FAN score is a prognostic factor for platinum-based first-line chemotherapy. We included 126 patients with mUC who received platinum-based first-line chemotherapy. The median PFS and overall survival (OS) were 6.3 months (95% confidence interval [CI] 4.5–8.0) and 14.0 months (95% CI 11.1–16.9), respectively. Multivariable analysis showed that Fib-4 index (HR 3.85, 95% CI 1.09–13.58, p = 0.036), ALBI score (HR 1.53, 95% CI 1.01–2.31, p = 0.045), and NLR (HR 1.76, 95% CI 1.14–2.71, p = 0.010) were independently associated with PFS. The FAN score was also associated with PFS (HR 2.56, 95% CI 1.62–4.05, p < 0.001). The median PFS for patients with low FAN score (≤ 1) and those with high FAN score (≥ 2) were 7.8 (95% CI 5.0–9.0) months and 3.0 (95% CI 1.6–5.8) months, respectively. In conclusion, the FAN score is a prognostic factor for mUC patients who are treated with platinum-based first-line chemotherapy.

Allostatic load and cardiometabolic health in a young adult South African population: The African-PREDICT study.

Sustained stress, assessed as a high allostatic load score (ALS), is an independent cardiovascular disease (CVD) risk factor in older adults but its associations in young people are undefined. Since neurological maturation impacts stress adaptation and CVD risk, we assessed the relationship of ALS with CVD profile using a tiered approach stratified by age (emerging adults 20-24y, EA vs. young adults 25-30y, YA) and ALS (high vs. low). In 1054 healthy African-PREDICT participants, we determined: 1) ALS in EA vs. YA; 2) the relationship between ALS with cardiovascular health; and 3) the odds of high ALS>4 to identify masked hypertension and prediabetes as cardiometabolic outcomes. A 9-component four-domain ALS was compiled: neuro-endocrine (dehydroepiandrosterone, cortisol), inflammatory (interleukin-6, C-reactive protein), cardiovascular (systolic and diastolic-blood pressure), and metabolic (total cholesterol, HDL-cholesterol, body mass index). Retinal vessel caliber, pulse wave velocity (PWV), cardiac structure and function were assessed. Median ALS was 3 (range:1-9). A high-ALS>4 was more common in YA vs. EA (47%vs.35%, P=0.032). Higher ALS associated with narrower retinal arteries (P<0.01), greater PWV (P=<0.01), lower diastolic (P<0.01) and left ventricular function (P<0.01). High-ALS increased the odds of having masked hypertension, prediabetes, narrower retinal arteries, higher LV mass, poorer diastolic and ventricular function (all P≤0.01) in EA and YA independent of traditional CVD risk factors. The composite ALS identified early stress dysregulation in cardiometabolic health and higher odds for prediabetes and masked hypertension in young adults. Cumulative stress may be a modifiable independent cardiometabolic risk factor in younger populations that needs further investigation.

The Clinical and Molecular Characterization of Distinct Subtypes in Adult T Cell Acute Lymphoblastic Leukemia.

T-cell acute lymphoblastic leukemia (T-ALL) is a clonal proliferative malignant disease characterized by abnormal T-cell development. The classification of T-ALL primarily hinges on immunophenotype, encompassing early T-cell precursor (ETP)-ALL, near-ETP-ALL, and non-ETP-ALL. We summarized clinical information from 117 patients, with genetic data available for 77 patients and transcriptomic data available for 24 patients. An ETP-like score model was established based on transcriptome, aiming to address the subjectivity in the current T-ALL immunophenotype classification. The retrospective analysis indicated that ETP immunophenotype was not a prognostic factor for T-ALL patients. Compared to non-ETP-ALL patients, ETP-like patients including ETP-ALL and near-ETP-ALL were more likely to carry MED12 gene mutations, which may predict a dismal outcome. Transcriptomic analysis suggested that T-ALL patients with different immunophenotypes were in accordance with the T-cell development trajectory, while ETP-like patients exhibited characteristics of early T-cell development. Finally, we established an ETP-like score model and confirmed its efficiency across four independentcohorts, with sensitivity exceeding 80%. And T-ALL patients with high ETP-like score were associated with poor prognosis. In conclusion, our study elucidated the clinical and molecular features of distinct subtypes of T-ALL patients, providing new valuable insights for T-ALL classification.

Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South

ABSTRACT We present a retrospective study of people with HIV (PWH) admitted to the medical intensive care unit (MICU) of an 862-bed academic, safety-net hospital. We aimed to determine the characteristics of ICU admissions among PWH, measure the mortality in this population and identify predictors of mortality. All patients ≥ 18 years old with a diagnosis of HIV infection admitted to the MICU between January 1, 2017 and December 31, 2019 were included. A total of 195 ICU admissions occurred during the study period. The mean age was 46.2 years, 77.4% were male and the majority were people of color. Overall, 125 (64.8%) patients had CD4<200 cells/mL and 12 (6.7%) were newly diagnosed with HIV. ICU mortality was 21.5% and hospital mortality was 24.6%. High APACHE score and CD4<200 were independent predictors of ICU mortality. Our three-year retrospective analysis of PWH admitted to the ICU in a large urban safety-net hospital in the US South during the recent modern ART era identified high ICU- and hospital mortality. We also identified a higher mortality risk at each step of the HIV care cascade, reinforcing the importance of proactive interventions including expanded HIV testing and implementation of strategies which improve engagement in care, ART adherence and virologic suppression.

The interaction between circadian syndrome and genetic susceptibility in the risk of incident dementia: A longitudinal cohort study.

Despite growing interest in circadian disturbances as potential triggers for dementia, the specific impact of circadian syndrome (CircS) on dementia incidence remains poorly understood. Moreover, the role of genetic susceptibility modulating these effects remains to be explored. Dementia-free participants from the UK Biobank cohort were included in the analysis. To evaluate the association between CircS and the incidence of dementia, as well as the modifying influence of genetic susceptibility on this relationship, Cox proportional hazards models were utilized. During a median follow-up period of 14.55 years, 3,965 incident dementia cases were documented. CircS was found to significantly increased the risk of incident dementia, with a hazard ratio (HR) of 1.401 (95 % confidence interval [CI]: 1.296, 1.516). Compared to a CircS score of ≤3, mild CircS (HR: 1.259, 95 % CI: 1.146-1.383), moderate CircS (HR: 1.667, 95 % CI: 1.461-1.903), and severe CircS (HR: 2.028, 95 % CI: 1.397-2.944) were all significantly associated with an elevated risk of dementia. There were significant multiplicative interactions between CircS and genetic susceptibility (Pinteraction<0.001). Participants with both a high polygenic risk score (PRS) and CircS had the highest risk of incident dementia (HR: 2.551, 95 % CI: 2.169, 3.001), compared to those with a low PRS and no CircS. CircS was associated with an increased risk of dementia, which might be aggravated by genetic susceptibility.

Longitudinal MRI-Driven Multi-Modality Approach for Predicting Pathological Complete Response and B Cell Infiltration in Breast Cancer.

Accurately predicting pathological complete response (pCR) to neoadjuvant treatment (NAT) in breast cancer remains challenging due to tumor heterogeneity. This study enrolled 2279 patients across 12 centers and develops a novel multi-modality model integrating longitudinal magnetic resonance imaging (MRI) spatial habitat radiomics, transcriptomics, and single-cell RNA sequencing for predicting pCR. By analyzing tumor subregions on multi-timepoint MRI, the model captures dynamic intra-tumoral heterogeneity during NAT. It shows superior performance over traditional radiomics, with areas under the curve of 0.863, 0.813, and 0.888 in the external validation, immunotherapy, and multi-omics cohorts, respectively. Subgroup analysis shows its robustness across varying molecular subtypes and clinical stages. Transcriptomic and single-cell RNA sequencing analysis reveals that high model scores correlate with increased immune activity, notably elevated B cell infiltration, indicating the biological basis of the imaging model. The integration of imaging and molecular data demonstrates promise in spatial habitat radiomics to monitor dynamic changes in tumor heterogeneity during NAT. In clinical practice, this study provides a noninvasive tool to accurately predict pCR, with the potential to guide treatment planning and improve breast-conserving surgery rates. Despite promising results, the model requires prospective validation to confirm its utility across diverse patient populations and clinical settings.

Forecasting Energy Consumption Trends with Machine Learning Models for Improved Accuracy and Resource Management in the USA

Accurate prediction of energy consumption patterns is vital for attaining sustainability and efficient economic planning. In the USA energy consumption trends have evolved substantially because of factors such as population growth, technological advancements, and shifts in consumption behaviors. The prime objective of this research project was to develop and evaluate machine learning algorithms with accuracy in predicting trends in America's consumption of energy. By employing complex methodologies such as neural networks, regression analysis, and ensemble approaches, this work aims to enhance the accuracy of forecasts in terms of demand for energy in residential, commercial, and industrial sectors. The U.S. consumption datasets covered a wide variety of information representing the consumption of electricity, use of fuel, and integration of renewable sources in residential, commercial, and transportation sectors. Most datasets used for analysis are taken from the U.S. Energy Information Administration (EIA) and the Department of Energy (DOE), offering in-depth statistics about production, consumption trends, and price trends. With our dataset consisting of continuous values for consumption of energy and many predictor factors, we compared a variety of machine algorithms, encompassing XG-Boost, Logistic Regression, and Random Forest. The implemented code compared three algorithms – Logistic Regression, Random Forest, and XG-Boost – in terms of performance via calculation and visualization of key evaluation metrics. It devised a function calculate-metrics to calculate accuracy, precision, recall, and F1-score for a prediction of each model over a test set. Retrospectively, comparing accuracy values, one can observe that Logistic Regression got a high score, with Random Forest following closely, and XG-Boost following a little behind them. Overall, through strategic plots, the comparative strengths and weaknesses of all three algorithms were seen, proving that Logistic Regression was the most reliable algorithm for predicting values in a dataset. Utility companies can benefit a lot through machine learning (ML)-based prediction in terms of distribution efficiency and overall operational efficiency. With ML algorithms, utility companies can utilize humungous volumes of consumption in the past to make future demand predictions with high accuracy.

Derivation and Validation of Risk Score Including Nutritional Status Among Patients With Chronic Limb-threatening Ischemia: Insight From I-PAD NAGANO Registry.

Geriatric nutritional related index (GNRI) is a simple and well-established screening method of nutritional status. We aimed to develop and validate a scoring system including GNRI to predict long-term outcomes in patients with chronic limb-threatening ischemia (CLTI) undergoing endovascular treatment (EVT). Patients undergoing EVT for symptomatic LEAD from August 2015 to August 2016 were enrolled into the I-PAD NAGANO registry, a prospective, multicenter, observational registry. We identified predictors of amputation-free survival (AFS) at 5 years using Cox proportional hazards regression and developed a risk scoring system. The predictive performance of the risk score was assessed. A total of 126 patients with CLTI were analyzed. Cox multivariate analysis revealed GNRI score <92 points, ≥72 years of age, hemodialysis, heart failure, and anemia to be significant predictors. We developed a 5-item risk score (I-PAD CLTI score) assigning points to each factor based on the magnitude of association with AFS at 5 years. The I-PAD CLTI score showed a c-index of 0.80 for 5-year AFS. Patients with high score (≥7 points, n=50) had an increased risk of AFS at 5 years compared with those with low score (<7 points, n=68) (26.5% vs 72.1%, p<0.001). A simple 5-item risk score including nutritional status showed reasonable discriminative and prognostic ability for long-term AFS among patients with CLTI. The I-PAD CLTI score, a simple five-item risk score including nutritional status determined by geriatric nutritional related index, showed reasonable discriminative and prognostic ability for long-term amputation free survival among patients with chronic limb-threatening ischemia. This risk score may be useful for clinicians to accurately predict patient's prognosis and thus identify high-risk patients who may derive the greater clinical benefit from more intensive risk modification. Further research is required to test the clinical utility of risk-score-based treatment approach to improve the prognosis of patients with chronic limb-threatening ischemia.

The effects of prognostic nutritional index, systemic immune inflammation index and HALP score on fistula formation, recurrence and mortality in laryngeal cancer patients.

The aim of this study was to investigate the effects of prognostic nutritional index (PNI), systemic immune inflammation index (SII) and hemoglobin, albumin, lymphocyte, platelet (HALP) score on fistula formation, recurrence and mortality in patients with laryngeal cancer. The study included 77 patients who underwent total laryngectomy operation between 2018 and 2021. 66 (85.7%) patients underwent primary and 11 (14.3%) patients underwent salvage total laryngectomy. PNI, SII and HALP scores and cutt-off values of all patients were determined and the relationships between pharyngocutaneous fistula (PCF) formation, recurrence and mortality were statistically analysed. The patients with a score less than the cut-off value were divided into two groups as Group 1, and the patients with a score equal to or greater than the cut-off value were divided into two groups as Group 2. The effect of PNI, SII and HALP on the development of FKF was not significant (P = 0.110, P = 0.135, P = 0.358). The effect of high SII and low HALP score on the development of recurrence was statistically significant (P = 0.001, P = 0.012). Low PNI increased the development of recurrence, but this increase was not statistically significant (P = 0.075). Overall survival rate was 68.8%. The effect of low PNI and HALP on survival was statistically significant (P = 0.011, P = 0.021). The effect of high SII on survival was not significant (P = 0.533). Low PNI index and HALP score and high SII index are cost-effective simple prognostic biomarkers that are significant in the development of FCF, as well as in the evaluation of recurrence and overall survival in the long-term follow-up of these patients.

Risk stratification for postoperative hypoxemia among bariatric surgery patients.

Patients with obesity, especially those suffering from obstructive sleep apnea (OSA), are prone to postoperative respiratory hypoxemia. The PRODIGY (prediction of opioid-induced respiratory depression in patients monitored by capnography) Score is used to predict respiratory complications that factor in sleep-disordered breathing. Data on the impact of OSA on the frequency and timing of postoperative desaturation trends after bariatric surgery are lacking. This cohort study included 195 patients who underwent robotic-assisted bariatric surgery between June 2022 and December 2023. Patients underwent were classified by OSA status (yes/no) and PRODIGY Risk Score (high/intermediate/low). All patients received low or opioid sparing anesthesia and were continuously monitored postoperatively using the Masimo Rad-97 device (Masimo, Irvine, CA, USA). Postoperative monitoring averaged 14.5 hours, including tracking several variables and SpO<inf>2</inf> values. We documented desaturations and opioid usage in 2-hour intervals. Patients also underwent 30-day postoperative follow up. Descriptive statistics were analyzed based on OSA status and PRODIGY scores using Student's t-test, ANOVA, and Fisher's Exact Test. Most study patients (57.4%) had OSA, were significantly older, and were predominantly female. Patients with OSA had substantially more prolonged exposure to SpO<inf>2</inf> ranges between 80-95% and experienced more frequent desaturation events between 10 and 14 hours after Post-Anesthesia Care Unit (PACU) discharge. Patients with high PRODIGY scores (>15) had significantly more desaturation events compared to intermediate and low-score groups. Postoperative desaturation rates are significantly higher among patients with OSA with high PRODIGY scores, especially in the delayed postoperative period. Continuous extended postoperative monitoring is warranted for these high-risk patients after bariatric surgery.

Association of combined pulmonary fibrosis and emphysema in rheumatoid arthritis with high titer of rheumatoid factor and autoimmunity to the lung

BackgroundCombined pulmonary fibrosis and emphysema (CPFE) commonly coexists with connective tissue diseases (CTD), such as rheumatoid arthritis (RA). However, the risk factors contributing to the development of CTD-CPFE remain largely unidentified. This study aimed to characterize CPFE using a large cohort of consecutive RA patients and to elucidate potential risk factors associated with RA- CPFE development.MethodsA total of 976 RA patients were enrolled in this cross-sectional study to characterize RA-CPFE. Multiple logistic analyses were conducted to identify potential risk factors for RA-CPFE development. Patient IgG and IgM autoantibodies to primary human bronchial epithelial cells (HBEC) from healthy donors were assessed using flow cytometry.FindingsAmong the 976 RA patients, 414 (42.4%) developed interstitial lung disease (ILD), with 74 (7.6%) experiencing CPFE. In comparison to RA-CPFE patients with centrilobular or paraseptal emphysema, those with panacinar emphysema had higher emphysema scores and decreased pulmonary function parameters. Multiple logistic regression analysis revealed that male gender, cigarette smoking, occupational exposure to dust, high ILD score, high rheumatoid factor (RF) titers, and the presence of anti-SSA were associated with an increased risk for RA-CPFE. Additionally, levels of IgG and IgM autoantibodies to HBEC were elevated in RA-CPFE patients compared to healthy controls and positively correlated with RF levels.InterpretationThis study is the first to demonstrate the association of RA-CPFE with high titer of RF and the presence of autoantibodies against HBEC, suggesting a link between autoimmunity to the lung and RA-CPFE.

Design and development of a customized 3D-printed assistive device using modular 3D blocks

Purpose 3D printing enables the production of customizable, cost-effective, and reproducible items, making it a promising approach for manufacturing assistive devices. This study aims to develop customized 3D-printed assistive devices using 3D blocks. Methods A 3D scanner was used to scan the limbs and trunks where the devices would be worn. The study utilized 3D blocks capable of undergoing subdivision surfaces to match the scanned external appearance of limbs and trunks. The mass-spring model and Gauss-Newton method were applied to optimize the subdivision surfaces, ensuring a better fit for users’ hand shapes. Additionally, 3D blocks were used as design units for blending-based morphing, generating diverse 3D patterns. Results The proposed approach successfully enabled real-time manufacturing of customized external appearances for assistive devices. The resulting designs met usability, functionality, and aesthetic requirements. Usability testing, conducted using the Quebec User Evaluation of Satisfaction with Assistive Technology, demonstrated high satisfaction scores, confirming the effectiveness of 3D blocks in customizing assistive devices. Conclusions By integrating 3D scanning and printing technologies, this study highlights the feasibility of using reverse engineering to develop personalized assistive devices. The findings suggest that the proposed method enhances user satisfaction and provides a practical approach to assistive device customization.

Predictors of prognosis in stroke patients with tandem lesions who undergo emergent stenting.

The optimal endovascular approach for tandem lesions (extracranial internal carotid artery and intracranial large vessel occlusion) is not clear. Aims: The aim was to evaluate the follow-up results of stroke patients with tandem lesions who underwent emergent stenting of extracranial lesions with antithrombotic therapy combined with intracranial MT. Outcomes and predictors of poor prognosis and mortality compared with those of good prognosis at 90days, 1year, and 2years were assessed. A modified Rankin scale (mRS) score was used. Symptomatic intracranial hemorrhage (sICH), National Institutes of Health Stroke Scale (NIHSS) scores at admission and at 24h, successful recanalization, asymptomatic ICH, embolization, malignant infarction, decompression, in-stent restenosis and extracranial complications were also evaluated. The best age cutoff for predicting mortality was analyzed. A total of 71 subjects were included. Using patients with a good prognosis as a reference, the independent variables predicting a poor prognosis were a high 24-h NIHSS score and extracranial complications at all timepoints (3-month, 1-year, and 2-year follow-up). The most appropriate age cutoff for predicting 1-year mortality was 67years [AUC = 0.802 (95% CI = 0.684-0.920); p < .001]. The age cutoff determined for the first year was correlated with the prediction of mortality in the third month and the second year. No significant association was observed between sICH and the groups. In this study, the 24-h NIHSS score after reperfusion and age were predictors of poor prognosis and mortality in stroke patients with tandem lesions who underwent emergent stenting during thrombectomy.