Ideal Time Research Articles

The Feasibility of Thrombolysis Followed with Ultrasound-Guided Percutaneous Transluminal Balloon Angioplasty in Acutely and Sub-Acutely Thrombosed Arteriovenous Fistulas.

Prompt resolution of arteriovenous fistula (AVF) thrombosis is essential to minimize the need for temporary dialysis catheters. Identifying the ideal timing for the management of thrombosed arteriovenous fistula (AVF) is an area that has not been thoroughly explored. Herein, we examined a local infusion of urokinase for thrombolysis followed by ultrasound-guided percutaneous transluminal balloon angioplasty (PTA) in acute and subacute AVF thromboses. This retrospective cohort research assessed thrombosed AVF in patients referred to the Second Xiangya Hospital. We included patients who underwent local thrombolysis followed by ultrasound-guided PTA treatment between January 1, 2018, and January 1, 2020. Results. We enrolled the records of 86 patients into the present study, including 44 patients with acute AVF thrombosis (group 1: thrombus age, < 72 hours) and 42 patients with subacute AVF thrombosis (group2: thrombus age, 72 hours to seven days). The thrombolytic success rate was 79.5% in group 1 and 42.9% in group 2 (P < .001). All patients underwent ultrasound-guided PTA to dissolve any residual thrombi regardless of thrombolytic success. Technical success after PTA procedures was achieved in 93.2% of patients in group 1 and 88.1% in group 2 (P = .417). Primary patency at six months was comparable between the two groups (67.5% vs. 64.8%, P = .564). We observed that thrombolytic effect does not affect PTA success rate, and six-month patency rate. Direct local infusion of urokinase to the affected area followed by ultrasound-guided PTA constitutes a minimally invasive and effective method for salvaging thrombosed AVF in contrast to abandoning the occluded fistula.

AUDIT TO EVALUATE CURRENT RADIOTHERAPY (RT) PLANNING PATHWAY: COULD CURRENT PRACTICE BE IMPROVED BY THE TIMING OF MAGNETIC RESONANCE IMAGING (MRI)?

Abstract AIMS To evaluate the current guidance for glioblastoma (GBM) and primary brain radiotherapy (RT) planning. Current practice in this centre utilises pre and post-surgical MRI for RT target delineation. This study aims to explore the practicality and impact of scheduling an RT planning-specific MRI no more than 2 weeks before RT treatment start date (TSD). Time from surgery to RT TSD will also be explored. METHOD Fifty GBM patients, treated between August 2022 and October 2023, were audited retrospectively. Included patients were treated with radical intent and must have had surgery or biopsy. Age, gender or performance status (PS) were excluded from audit criteria. Age of MRI used for RT planning and surgery to TSD was noted. RESULTS Early results showed that the average age of MRI used for RT planning was 7 weeks old and Surgery to TSD was 7 weeks. A new pathway was introduced after 37 patients as these results were considered unacceptable. The new pathway included 1 reserved MRI appointment and one reserved RT Mask/CT appointment per week. 13 patients’ pathways were audited after introduction of the new pathway. The results showed that the average age of MRI used for RT planning was 2 weeks old and surgery to TSD was 6 weeks. CONCLUSION Limitations of the audit included disparity between number of patients before and after introduction of the new pathway. This was because of the time limitation for completion of the study. Improvement was seen in timing of MRI to TSD. However, the small improvement in timing of surgery to TSD was impacted by human factors rather than organisational influence, for example, surgical deconditioning, delays for wound healing and patient choice. This study has shown that the ideal timing of MRI can be achieved.

Imminent risk of LVEF decline in asymptomatic patients with primary mitral regurgitation.

2020 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines state that the ideal time for mitral valve surgery in primary mitral regurgitation (PMR) is when the LV approaches but has not yet reached echocardiographic LV ejection fraction (EF) < 60% or LV end-systolic dimension (ESD) > 40 mm. However, it is difficult to know the imminent risk of crossing this threshold when the surgical outcome is less optimal. Using machine learning and statistical models, we have shown that cardiac magnetic resonance (CMR) LV sphericity index (SI) and LV mid circumferential strain rate (SRcirc) added to LVEF and LVESD predict LVEF < 50% after mitral valve surgery. Here we test the hypothesis that these CMR features predict LVEF < 60% in asymptomatic PMR patients at 18 months. 33 asymptomatic PMR patients with moderate to severe mitral regurgitation had CMR with tissue tagging at baseline and every 6 months for 18 months. Two types of models were employed to predict LVEF < 60% at 18 months: a model using CMR features at a single time point (e.g., baseline) and a model utilizing repeated measurements over time. CMR LVEF decreased below 60% in 13 patients over 18 months. LVEF varied over time with an inverse relation to mean arterial pressure and mean end-systolic wall stress. Random Forest models utilizing LV SI, LV mid SRcirc, LVESD, and LVEF at a single time point (baseline) had a predictive accuracy of 64%. LV SI, LV mid SRcirc, LVESD and LVEF at baseline, 6, and 12 months achieved a higher predictive accuracy of 79%, improved sensitivity from 57% to 85% than baseline alone and identified a threshold of CMR LVEF 63%-64% signaling LVEF < 60%. The variability of LVEF due to blood pressure dependence may require a longitudinal study that incorporates LVEF, LVESD, SRcirc at multiple time points to identify the threshold at which LVEF is at risk for decline to less than 60%.

Thermodynamics and Kinetic Study for Removal of Orange-G Dye from Aqueous Solution by Nano Composite

In this study, where graphene oxide was prepared by Hummer method, while copper oxide was prepared in the green way using (capparies spinosa) plant extract as a reducing agent, these oxides were diagnosed as well as the binary nanocomposite by several techniques including Fourier Transform Infrared Spectroscopy (FTIR), X-rays diffraction , and field Emission scanning electron microscopy (FESEM), after that the superimposed (GO/CuO) was used to adsorbent the orange G dye ( Orange - G) from its aqueous solutions, A number of factors affecting adsorption were studied (equilibrium time, surface weight, pH, concentration effect, temperature). The results showed that the ideal time for adsorption of the orange dye (orange-G) on the surface of the nanocomposite (GO/CuO) was (30min), the best ideal weight for dye removal was (0.05gm), the best concentration was (20ppm), and the best acid function was (pH=2). After that, the adsorption kinetics were also studied by applying the pseudo first and second order of adsorption. The results showed that the adsorption process follows the false second-order kinetics. The thermodynamic functions of the removal process were also studied, and it was found that the value of (DH) is negative for the surface of the composite (GO/CuO) with dye. Meaning the adsorption process is exothermic, and that the DG0 has negative value, meaning that the adsorption processes occur spontaneously. positive DS0 values indicate that the molecules are becoming less bound

Pulsed Signal Duration Shaper with Adaptive Response Thresholds

His paper represents a shaper designed to restore the width of rectangular pulses transmitted over an open-optic (wireless) communication channel and having shape distortions in the form of amplitude modulation, pedestal and tightening of the front and decay. The principle of pulse width recovery is based on the formation of voltage comparator thresholds adaptive to changes in high and low pulse signal levels. Due to the use of sample-and-hold circuit (UVH - S/H circuit) in the circuit, the values of the input signal levels are stored in the previous half-periods. The threshold voltage of the comparator before its operation is formed as the output voltage of a resistive voltage divider into two inputs, one of which is supplied with the current voltage of the input signal, and the other with the voltage level of the signal recorded in the S/H circuit at the previous half-cycle of information pulses. The study presents the method for estimated error in pulse width formation from comparator bias voltages, S/H circuit and modulation changes in the shape of the information signal. The example provides quantitative estimates of the error. In the Micro Cap circuit modeling environment, a model experiment was performed, diagrams of the signal source and shaper models on ideal components and time diagrams of the device operation are presented. The operability of the device during the passage of a pulse signal with the above-mentioned shape distortions has been confirmed. A large depth of modulation of the input signal amplitude is allowed. The formative properties of the circuit are provided. The speed of the shaper is determined by the speed of the comparator and the S/H circuit. To reduce the error of the duration forming of information pulse signals, it is necessary to choose a voltage comparator and sample-and-hold circuit devices with minimal static errors.

Surveillance after Focal Therapy - a Comprehensive Review.

to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa). a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications. Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month "for-protocol" prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month. FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.

Timing of intravenous immunoglobulin treatment and outcome in Guillain-Barré syndrome: Is time nerve?

Despite treatment, a considerable proportion of patients with Guillain-Barré syndrome (GBS) experience poor recovery, highlighting a therapeutic need. There is a lack of evidence that treatment timing affects recovery. This study aims to investigate the effects of intravenous immunoglobulin (IVIg) timing on disability and speed of recovery in GBS. We performed a retrospective study of 136 IVIg-treated GBS patients admitted to two Korean centers between 2010 and 2021. We analyzed the effect of time to IVIg on the GBS disability scale (GBS-DS) and the degree of improvement from nadir (∆GBS-DS) at 1, 3, 6, and 12 months, as well as the time to regain the ability to walk or run unaided. Time to IVIg was treated either as a continuous variable or categorized into 1-week intervals to explore critical time windows. Known prognostic factors, the modified Erasmus GBS Outcome Scores on admission and pre-treatment serum albumin levels were adjusted as covariates. Shorter time to IVIg was independently associated with better GBS-DS, greater ∆GBS-DS, and shorter time to walk or run unaided at all time points. The therapeutic effect of IVIg was notably diminished when administered beyond the first 2 weeks of onset. Our study highlights the timing of IVIg as a modifiable prognostic factor in GBS. The earlier IVIg is initiated, the better the outcomes, with the ideal time window being within the first 2 weeks. These findings underscore the importance of prompt diagnosis and early intervention to optimize recovery in GBS patients.

Revisiting the musical reminiscence bump: insights from neurocognitive and social brain development in adolescence.

Music listening is enjoyed across the lifespan and around the world. This has spurred many theories on the evolutionary purpose of music. The Music for Social Bonding hypothesis posits that the human capacity to make music evolved for the purpose of creating and preserving relationships between one another. Considering different time periods of music use across the lifespan, adolescence is especially a period of social reorientation away from family towards peers, characterized by new social bonds and increased prosocial behavior. This shift is accompanied by notable structural and functional changes in brain networks supporting reward processing and prosocial behavior. Reviewing the extant literature on developmental cognitive neuroscience and adolescent music use, we propose that neurocognitive changes in the reward system make adolescence an ideal developmental time window for investigating interactions between prosocial behavior and reward processing, as adolescence constitutes a time of relative increase in music reward valuation. Testing this hypothesis may clarify our understanding of developmental trajectories in music reward valuation, and offer insights into why music from adults' adolescence holds a great deal of personal significance.

Effect of Early Levodopa Treatment on Mortality in People with Parkinson's Disease.

The ideal timing for initiating levodopa in newly diagnosed people with Parkinson's disease (PD) is uncertain due to limited data on the long-term effects of levodopa. The aim was to investigate whether early levodopa initiation postpones mortality (primary outcome), the requirement of device-aided therapies, and the incidence of PD-related complications, such as fall-induced injuries. Using nationwide claims data from Dutch hospitals (2012-2020), we grouped newly diagnosed PD individuals as "early initiators" (initiating levodopa within 2 years of diagnosis) or "nonearly initiators." We used the national death registry to assess mortality and health-care claims to assess PD-related complications and device-aided therapies. We used marginal structural models to compare mortality and device-aided therapy rates between groups, and a Poisson regression model to compare PD-related complication rates. Among 29,943 newly diagnosed PD individuals (mean age at diagnosis: 71.6, 38.5% female), there were 24,847 early and 5096 nonearly levodopa initiators. Over a median 4.25 years, 8109 (27.1%) died. The causal risk ratio for mortality was 1.04 (95% confidence interval [CI] 0.92-1.19) for early versus nonearly initiators. The risk ratio of receiving any device-aided therapy was 3.19 (95% CI 2.56-5.80). No association was observed with incidence of PD-related complications (incidence rate ratio: 1.00, 95% CI 0.96-1.05). Early levodopa initiation in PD does neither postpone nor accelerate mortality or PD-related complications, nor does it precipitate earlier occurrence of PD-related complications or mortality. However, we cannot exclude that the results were influenced by residual confounding due to unmeasured risk factors of mortality.

Complications of pediatric macrocystic lymphatic malformations of the head and neck: a survival analysis of treated and untreated patients.

To compare events of recurrent swelling between treated and untreated patients with macrocystic lymphatic malformations of the head and neck not involving the airway. The frequency and timing of emergency department (ED) visits related to the event were analysed to provide data on efficacy and ideal timing of treatment. A 5-year retrospective review of a hospital database was conducted reviewing 35 patients (15 female, 20 male; mean age 3.9 years) with macrocystic lymphatic malformations of the head and neck not involving the airway. Patients treated with oral medications were excluded. A survival analysis was performed comparing the incidence of recurrent swelling of the malformation. A Cox regression analysis was conducted using age, gender, diameter of lymphatic malformation at presentation, and echogenicity on US as covariates. Fisher's test and mean comparisons were performed to correlate the populations baselines and the number and frequency of ED visits between the 2 groups. Thirteen patients underwent sclerotherapy soon after initial presentation and 22 elected for observation. The two baseline populations differed at presentation with the treatment group being younger (1.4 ± 2.4 vs. 5.4 ± 6.3 years, p = 0.03) and with larger lesions (5.7 ± 2.7 vs. 4.0 ± 1.7cm p = 0.03). Mean follow-up time was 2.7 years. Survival analysis showed 1 or multiple recurrences affected 16 patients in the untreated group and 3 patients in the treated group. (p = 0.04). Age, gender, diameter of the lesion at presentation and increased echogenicity on US were not predictive factors of recurrence. Although the probability of visiting the ED at least once did not differ between the two groups (p = 0.42), patients from the non-treatment group were more likely to visit the ED more than once (p = 0.03). Sclerotherapy treatment may reduce the chance of recurrent swelling or an event after initial presentation to the ED.

Early Versus Late Initiation of Dialysis in CKD Stage 5: Time for a Consensus

Chronic kidney disease (CKD), a major global public health problem, emerged as one of the leading causes of death, affecting over 800 million individuals worldwide, with significant burden to patients and their caregivers, and may lead to end-stage kidney disease (ESKD). The decision on optimal initiation of chronic dialysis is a common problem faced by nephrologists, patients and caregivers due to lack of adequate data. Determining the ideal time to initiate maintenance dialysis for individuals struggling with ESKD has remained a puzzle.Currently, there is no consensus among guidelines as to the best time to initiate dialysis. Discrepancies in guidelines stem from lack of adequate data, necessitating larger randomized controlled trials to fill this major gap and come to a universal acceptance by the nephrology community about the optimal time to initiate dialysis for patients with advanced CKD. The fact that there has been only one randomized controlled trial that addressed early vs. late dialysis initiation is inadequate to convincingly answer such as critical clinical decision making.In this review, we will analyze the available literature and try to come with recommendations for further studies to guide nephrologist to the best time to initiate dialysis for patient approaching ESKD.

The role of video-assisted thoracoscopy in chest trauma: a retrospective monocentric experience.

Video-assisted thoracoscopy (VAT) plays an essential role in the exploration of pleural cavity after thoracic trauma, although some doubts about the precise and specific indications persist. This study examines the eligibility criteria for videothoracoscopy and establishes the ideal timing for VAT. Between January 2011 and November 2022, we observed 923 polytraumatized patients. All patients underwent computed tomography (CT) scan total body with and without contrast enhancement. Two hundred and nine patients carried out VAT within 10 ± 2h of injury while 8 patients after 20 ± 1h. The Injury Severity Score (ISS) was 31 ± 1 and the Glasgow Coma Scale was 14.1 ± 0.3 upon arrival at the hospital. One hundred and nineteen patients displayed hemothorax (55%), 62 hemopneumothorax (28.5%), 21 penetrating wound (9.6%), 10 pneumothorax (4.6%) and 5 chylothorax (2.3%). In 18 patients (8.3%) without vascular, diaphragmatic, or parenchymal lesion the treatment consisted in chest tube placement. VAT was converted to video-assisted thoracoscopic surgery (VATS) in 190 patients (87.5%), to open surgery in 8 (3.7%) and to laparoscopy in 1 (0.5%). Twelve patients (5.5%) with diaphragm ruptures < 5cm in diameter were treated by separate stitches suture in VATS. Only eight postoperative complications (4 pneumonia, three atelectasis and one pulmonary embolism) out of 217 VAT, positively resolved with medical treatment, were noted exclusively in patients undergoing minimally invasive approach 20 ± 1h after trauma. Early VAT in selected patients is a safe and easy procedure that ensure a quick diagnosis of lesions and an accurate management of the most thoracic injuries among trauma patients. The prompt identification of injuries, to avoid life-threatening conditions requiring rapid intervention, responds to medico-legal needs to which VAT fulfills.

Managing End of Life Needs of Frail, Older Adults in the Community: The Role of a Hospital-Based Community Outreach Team

Abstract Background Our current healthcare systems are designed around periods of acute illness and are ill equipped to meet the needs of multimorbid and frail adults with worsening mobility, cognition and function. According to The Irish Longitudinal Study on Aging (TILDA), Ireland has a high proportion of hospital deaths, indicating inadequate community and home care supports. Recognizing patients who are likely to benefit from supportive and palliative approaches with a goal to die at home can be done using a combination of tools and based on advanced care planning discussions. Methods In 2021, our Department for Older Persons Services allocated a team consisting of a Registrar and Advanced Nurse Practitioner in Frailty to form an outreach service. Inpatients who appear nearing end of life who have expressed wishes to avoid further hospitalization and to die at home are identified during their admission. Home visits allow for a holistic assessment and family members are given the opportunity to ask questions. We provide education on end of life, trying to anticipate needs and often see patients and families through periods of deterioration until they stabilize again in a ‘new normal’ or begin the process of active dying. We communicate with Public Health Nurses, General Practitioners and the Community Palliative Care Team. Results Families and carers supporting loved ones who wish to avoid further hospitalization and die at home benefit from combined medical and nursing support &amp; specialist expertise the team brings. Conclusion Addressing end of life for multimorbid patients living with severe frailty is a global challenge. Hospital admission is an ideal time to begin conversations regarding goals of care and initiate advanced care planning. The outreach team work together with hospital and community colleagues to the common goal of following patients’ wishes at end of life.

Measuring Household Thermal Discomfort Time: A Japanese Case Study

This study proposes a metric to measure households’ discomfort related to thermal consumption time (hereafter referred to as t-discomfort). This metric relies on an ideal thermal consumption and calculates the gap between the usage times of thermal devices in vulnerable households compared to the ideal household. The t-discomfort is quantified using thermal data collected from 1298 households in the Tokyo and Oita prefectures in Japan. To create the ideal usage times of thermal devices, households are categorized into three clusters—Vulnerable (Vu), Semi-vulnerable (SVu), and Invulnerable (IVu)—based on their energy poverty ratio, and t-discomfort is subsequently calculated for each group. The IVu households are used as the ideal reference point for measuring thermal device usage in the other two categories. The findings of the study indicate that energy poverty does not necessarily lead to t-discomfort. Interestingly, the consumption time of heating devices among Vu households in both prefectures is longer than that of IVu households, despite the high energy prices. Conversely, SVu households, which do not experience severe energy poverty, tend to sacrifice their comfort by reducing their thermal consumption time. Additionally, the consumption time of cooling devices among Vu households in Oita is longer than that of IVu households, whereas in Tokyo, it is shorter. Two treatment strategies are evaluated to mitigate thermal discomfort in households without compromising resource availability. The first strategy integrates the thermal device consumption time with Japan’s current regulated time-of-use rates plan (daytime and nighttime). The results propose a three-tiered tariff plan (off-peak, mid-peak, and peak) to reduce the energy cost burden for Vu households. The second strategy recommends the installation of 12 rooftop solar panels for households in Tokyo and 11 panels for households in Oita. This strategy aims to maintain thermal comfort via a sustainable natural energy resource while minimizing energy costs.

Ideal Time to Conduct a Pharmacokinetic Investigation After Delivery to Fully Capture the Effect of Pregnancy on Drug Exposure.

The World Health Organization is pushing to accelerate the study of new human immunodeficiency virus drugs in pregnant women. However, regulatory guidelines do not specify when to conduct pharmacokinetic studies in postpartum women. This knowledge gap carries the potential to jeopardize the outcomes and conclusions of clinical trials aiming to study the effect of pregnancy on drug exposure. We used physiologically based pharmacokinetic (PBPK) modeling along with clinical data to determine the time needed after delivery for drug exposure to return to prepregnancy levels. A literature review was conducted to collect physiological parameters of pregnant and postpartum women. Regression analyses were performed to derive equations describing the parameters trajectory throughout pregnancy and post partum to inform our PBPK model. Published pharmacokinetic data in pregnant and postpartum women were used for the model verification. The PBPK model was subsequently applied to investigate pharmacokinetic changes throughout pregnancy and post partum. In agreement with the clinical data the PBPK model was able to describe the different effects of pregnancy on drug exposure, with bictegravir showing the largest reduction in exposure (approximately 50%) during the third trimester while ritonavir and raltegravir showing the lowest (approximately 30%). The successfully verified PBPK model predicted that all evaluated antiretrovirals mostly return to prepregnancy exposure 4 weeks after delivery. Pharmacokinetic investigations on hepatically cleared drugs should not be conducted before the fifth week after delivery to fully characterize the effect of pregnancy on drug exposure. Because physiological changes remain after delivery, early measurements can underestimate the pregnancy effect on pharmacokinetics, leading to suboptimal dosing recommendations during pregnancy.

Use of the senolytics dasatinib and quercetin for prevention of pelvic organ prolapse in a mouse animal model.

Senolytic agents have the potential to target age-related pathology associated with cellular senescence and reduce senescent cell activity in several disease processes. We utilized a mouse model of pelvic organ prolapse, Fibulin-5 knockout (Fbln-5-/-) mice, to assess the ability of dasatinib and quercetin (D+Q) to prevent development of prolapse. Four-week-old female Fbln-5-/- (n=63) and wild-type (WT) mice (n=54) were assigned to control (vehicle injection) or treatment (D = 5 mg/kg, Q = 50 mg/kg) groups. Weekly oral gavage injections were administered from weeks 4-8 of life. Pelvic organ prolapse quantification system measurements were obtained weekly. Vaginal tissue was harvested at 10, 12 and 20 weeks. Tissue analysis included immunostaining for cell cycle inhibitors, multiplex cytokine analysis, senescence-associated-β-galactosidase (SA-β-Gal) and histologic analysis of extracellular matrix proteins. Perineal body length was significantly longer in Fbln-5-/- treatment mice at 20 weeks. Expression of p16 and p53 was decreased in Fbln-5-/- treatment mice compared to controls (4.0% vs. 26.7%, p=0.0124 and 2.9% vs. 16.8%, p=0.272) at 20 weeks. Expression of SA-β-Gal and senescence-associated cytokines did not vary significantly between groups. At 20 weeks, vaginal tissue elastin content in Fbln-5-/- treatment mice increased compared to controls (1.04% vs. 0.84%, p=0.999). D+Q injections did not result in clinically significant differences in prolapse development but did demonstrate decreased expression of cellular senescence markers in Fbln-5-/- mice. This suggests senolytic agents may mitigate contributions of cellular senescence to tissue dysfunction associated with prolapse. Further studies are needed to confirm ideal timing, dosage, and route of senolytics in prevention of prolapse.

From Awareness to Action: Addressing Folic Acid Supplementation in Western India Among Women of Reproductive Age.

Background Folate, a vitamin B9, can be sourced naturally in the diet or the form of supplements. Studies highlight the prevention of neural tube abnormalities in women of reproductive age. To prevent these, low daily doses of FA (400-800 μg) are recommended for all women planning pregnancy, with higher doses for those with previous NTD-affected pregnancies. Folic acid supplementation lowers the risk of NTDs, other birth defects, and obstetrical complications. Methods The study explored awareness of and knowledge of folic acid supplements among women of childbearing age in Pune City, western Maharashtra, India. The cross-sectional survey was carried out at Symbiosis University Hospital and Research Centre (SUHRC), involving 300 female participants aged 16-44 years. The study utilized a structured questionnaire to evaluate participants' knowledge of folic acid supplements, their benefits, and usage patterns. Results Use as well as awareness of folic acid supplements was strongly associated with educational attainment. The awareness was low or none in participants who never attended school, and highest among the university graduates. The study included 300 women aged 16-45. About 43% of the study participants were between the ages of 23 and 29 years old; 57.7% were single, and 59.3% among them were university graduates. 59.7% of the study participants knew about folic acid supplements, but only 20% took them regularly. Knowledge about ideal timing and benefits was limited among them. 38% correctly identified prepregnancy as the ideal time to start. Only 18% knew it prevents neural tube defects, and 27% knew it could be obtained naturally. Conclusion The study highlights a lack of detailed knowledge about folic acid supplements among the study participants. Recommendations to enhance the supplement's intake include public health campaigns, enhanced healthcare provider education, easy-to-read informational materials, and strengthening government supplement programs to improve awareness and food fortification. Further research on consumption barriers for the supplement needs to be carried out.

Timing of Tracheostomy in ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: The ideal timing for tracheostomy in critically ill patients is still debated. This systematic review and meta-analysis examined whether early tracheostomy improves clinical outcomes compared to late tracheostomy or prolonged intubation in critically ill patients on mechanical ventilation. Methods: We conducted a comprehensive search of randomized controlled trials (RCTs) assessing the risk of clinical outcomes in intensive care unit (ICU) patients who underwent early (within 7-10 days of intubation) versus late tracheostomy or prolonged intubation. Databases searched included PubMed, Embase, and the Cochrane Library up to June 2023. The primary outcome evaluated was mortality, while secondary outcomes included the incidence of ventilator-associated pneumonia (VAP), ICU length of stay, and duration of mechanical ventilation. No language restriction was applied. Eligible studies were RCTs comparing early to late tracheostomy or prolonged intubation in critically ill patients that reported on mortality. The risk of bias was evaluated using the Cochrane Risk of Bias Tool for RCTs, and evidence certainty was assessed via the GRADE approach. Results: This systematic review and meta-analysis included 19 RCTs, covering 3586 critically ill patients. Early tracheostomy modestly decreased mortality compared to the control (RR -0.1511 [95% CI: -0.2951 to -0.0070], p = 0.0398). It also reduced ICU length of stay (SMD -0.6237 [95% CI: -0.9526 to -0.2948], p = 0.0002) and the duration of mechanical ventilation compared to late tracheostomy (SMD -0.3887 [95% CI: -0.7726 to -0.0048], p = 0.0472). However, early tracheostomy did not significantly reduce the duration of mechanical ventilation compared to prolonged intubation (SMD -0.1192 [95% CI: -0.2986 to 0.0601], p = 0.1927) or affect VAP incidence (RR -0.0986 [95% CI: -0.2272 to 0.0299], p = 0.1327). Trial sequential analysis (TSA) for each outcome indicated that additional trials are needed for conclusive evidence. Conclusions: Early tracheostomy appears to offer some benefits across all considered clinical outcomes when compared to late tracheostomy and prolonged intubation.

Apert syndrome and obstructive sleep apnea: Timing for midface surgery

ABSTRACT Objective This study aims to determine the optimal timing for midface surgery in patients with Apert syndrome and Obstructive Sleep Apnea (OSA). Methods We reviewed relevant articles from Web of Science and PubMed and conducted a bibliometric analysis. Results A review of 74 documents published between 1981 and 2023 revealed that determining the optimal timing for surgery in cases of airway obstruction necessitates consideration of various factors, including the location and severity of airway abnormalities, craniofacial development, potential impact of treatment on future growth, psychological considerations, and overall physiological conditions. Although midface advancement surgery performed around ages 6 to 7 typically yields symptom relief and favorable long-term outcomes, the ideal surgical timing young children with severe OSA remains a contentious issue. Conclusion While midface surgery is frequently advocated at ages 6 to 7, there is an urgent need for enhanced cooperation and high-quality research to deepen our understanding.

Development of a Prioritized Anesthesiology Residency Critical Care Content Outline.

Critical care education is an important, mandatory component of residency training in anesthesiology. Currently, there is no accepted national standardized curriculum, and a prioritized critical care content outline would be beneficial to the creation of a pragmatic standardized residency curriculum. The modified Delphi method is a recognized method for establishing consensus in medical education. We developed a prioritized critical care content outline using the modified Delphi method. Topics were selected from critical care topics included in the Program Requirements for Graduate Medical Education in Anesthesiology and the American Board of Anesthesiology Content Outline. Panel members rated critical care topics on a 9-point Likert scale (1 = not important, 9 = mandatory). Consensus was defined as ≥75% rating the topic as very important to mandatory for inclusion (Likert scale 7-9). Topics with >80% consensus were removed from subsequent surveys and included in the final list, and topics with <50% were removed. Members were asked to select the ideal timing of topic delivery during residency (Foundational-Early Residency, Intermediate-Mid Residency, Advanced-Late Residency). A total of 158 panel members who were contacted using national anesthesiology organization email lists completed the initial round, 119 (75%) completed the second iteration, and 116 (73%) completed the third. Response rate on the first survey was (22/55) 40% for anesthesiology critical care program directors, (18/132) 14% for core anesthesiology residency program directors, and (77/1150) 7% for the remaining respondents. Trainees (n = 41) were not included in response rate calculations. Most participants (103/158, 65%) had completed both core anesthesiology and subspecialty critical care medicine training and most (87/158, 55%) had formal roles in medical education. Forty-one (26%) responders were currently in training. All panelists worked in institutions with graduate medical education (GME) learners. Fifty-eight of 136 (43%) topics met consensus for inclusion. Most consensus topics (50/58, 86%) were recommended to be delivered early during residency with the other 8 topics to be delivered in the middle of residency. We developed a prioritized critical care content outline for anesthesiology residents that includes highly recommended critical care topics with ideal timing for inclusion in residency. This outline provides the first step in developing a pragmatic standardized curriculum to guide faculty and programs in critical care education.