Initial Score Research Articles

Reward learning capacity in a community sample of individuals who use cannabis.

Cannabis use has been linked to deficient reward processing; however, little is known about its relation to the specific construct of reward learning, in which behavior is modified through associating novel stimuli with a positive outcome. The probabilistic reward task was used to objectively evaluate reward learning in 38 individuals who use recreational cannabis and 34 control comparison participants from the community. Reward learning was evidenced by the development of a response bias, which indicates the propensity to modulate behavior as a function of prior reinforcement. Both cannabis and control groups demonstrated reward learning, with no group differences in response bias development. Among cannabis participants, trending significant relationships between greater chronicity, r(36) = -.30, p = .077, self-reported potency, r(19) = -.33, p = .052, and poorer reward learning were found. Nonsignificant relationships were found between reward learning and frequency, age of initiation, weekly quantity or Cannabis Use Disorder Identification Test-Revised (CUDIT-R) scores (all p > .05). The ability to form noncannabis reward associations is promising for the success of therapeutic interventions for problematic cannabis use; however, indications of severity of use in relation to poorer reward learning suggests a need for a better pharmacological and pharmacokinetic understanding of cannabis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of a single-day pre-academy physical test training session on physical fitness scores of police candidates.

Concerns are sometimes raised by police applicants undertaking physical fitness testing that they were unfamiliar with the test requirements which in turn negatively impacted their performance. The aim of this study was to investigate the effects of a single day physical test training session on physical fitness scores of police candidates. The sample consisted of female police candidates (n = 133) who attended a pre-academy training session. On the first day of pre-training, candidates' physical fitness was measured following official assessment day protocols. Measures included maximal handgrip strength, number of push-ups in 10 sec (PU), number of sit-ups in 30 sec (SU), standing long jump (SLJ), Abalakow jump test (AJ), 12 min Cooper running test (CT), and a motor educability test (ME). After the assessment, the overseeing UCIPS staff provided a detailed test skills briefing to candidates (e.g., common mistakes made during testing, how test performance could be improved, etc.). Immediately after the briefing, candidates performed the tests once again. Differences between results were measured using a paired samples t-test with significance set at 0.05. Paired sample t-tests determined significant (p < 0.001), large (Rank-Biserial Correlation = 1.00), improvements in physical fitness scores during the second assessment following familiarisation and feedback on test performance. Pre-academy training may be effective in improving candidates' physical fitness scores, in most tests, prior to the official assessment for the enrolment to police studies. Thus, to optimise initial candidate scores and opportunities for successful enlistment, police agencies may benefit from providing pre-assessment training.

Characterizing the Impact of Facial Rehabilitation on Acute Facial Paralysis.

Evidence on facial rehabilitation therapy (FRT) for acute facial paralysis (FP) remains limited. We present a retrospective review of patients with acute FP who have received FRT with physical therapists within 1 year of FP onset as determined by Sunnybrook Facial Grading Scale (SFGS) composite scores. A total of 702 patients with a clinical diagnosis of FP were referred to a university rehabilitation program between January 1, 2015 and January 1, 2022. Seventy-six patients met the criteria, defined as FP diagnosis <12 months before FRT initiation, ≥3 therapy sessions, and sufficient follow-up data. Average number of treatment sessions between SFGS scores was 7.7. History of cancer, sex, number of treatment sessions, and initial SFGS score were correlated with change in SFGS. Time to treatment was not correlated with change in SFGS score. SFGS improved with each additional treatment session (p < 0.01). Each additional point in the initial SFGS was correlated with less change in the final SFGS score (p < 0.01). FRT can provide meaningful improvement in functionality for patients with acute FP, regardless of time to treatment. Furthermore, patients who present with poorer functionality at baseline and those who undergo more treatment are most likely to see SFGS improvement. Research comparing the effect of facial rehabilitation with other treatment modalities and to a control cohort is warranted.

1249 Single-Center Outcomes of Onyx Frontier and Resolute Onyx Drug-Eluting Balloon Mounted Stents for Rescue Stenting for Acute Large Vessel Occlusion

INTRODUCTION: Mechanical thrombectomy (MT) is a common treatment for large vessel occlusions with recent literature expanding its indications. In cases where MT fails, rescue stenting may be necessary to achieve reperfusion; however, the absence of standardized techniques or devices poses a challenge. METHODS: A retrospective chart review was performed of all patients who underwent rescue stenting, in the setting of MT, using Onyx Frontier or Resolute Onyx stents at a single institution. Technical details, procedural complications, and patient outcomes were recorded for each case. RESULTS: In total, 21 Onyx Frontier and Resolute Onyx stents were deployed in 18 patients undergoing rescue stenting. Among these, 13 involved the use of Resolute Onyx stents, while 5 cases utilized Onyx Frontier stents. Stent locations included the middle cerebral artery (40%), internal carotid artery (15%), vertebral artery (20%), and basilar artery (25%). The average NIHSS score before MT was 13.83 (range 0-31). The median initial mRS score was 0, while the median mRS score at follow-up was 3. Successful reperfusion, as assessed by TICI scores, was achieved in 43.8% of patients for TICI 3, 43.8% for TICI 2C, and 12.5% for TICI 2B. The average proximal vessel diameter was 2.31 mm, and the most used stent length was 12 mm. Post-revascularization, 33% of patients experienced hemorrhage, of which only one patient (16.7%) had symptomatic hemorrhage due to vessel rupture necessitating hemicraniectomy. CONCLUSIONS: Onyx Frontier and Resolute Onyx stents are well-suited for rescue stenting in cases where aspiration and stentriever techniques fail during MT. These balloon-mounted drug-eluting stents exhibit excellent navigability, rendering them appropriate for rescue revascularization procedures. Our findings demonstrate that these stents confer a high degree of technical success and a low rate of intra- and post-procedural complications.

Improvement in simultaneous processing through metacognitive instruction

This study presents the improvement generated in simultaneous processing by the application of metacognitive instruction to 3rd grade primary education students. A pre-post-follow-up test design was used. The sample consisted of 30 students from one classroom. Two groups were formed; an intervention group comprising students in the classroom who presented difficulties in simultaneous processing, showing a cognitive weakness that compromises reading comprehension, and a comparison group comprising the rest of the students in the class. The instruments used were the Das-Naglieri Cognitive Assessment System (DN CAS), Assessment of Reading Comprehension (ACL) test and the Reading Awareness Scale (ESCOLA). The groups were equivalent in socioeconomic and cultural status and in successive processing. Reading and study variables were used as differentiators: simultaneous processing and reading awareness. A metacognitive training program based on the Planning Facilitation method was applied to the intervention group. The comparison group followed the usual curricular activities of the classroom and for the education level, according to the traditional teaching model. The program was implemented in 48 sessions over 12 weeks. After the intervention, the group with weakness improved significantly in simultaneous processing and reading awareness; the comparison group did not show any change in their initial scores. The metacognitive instruction that facilitates discussion between students and reflective verbalization about reading tasks promotes improvement in reading awareness and in the simultaneous processing necessary for reading comprehension.

Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease.

Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18years) and adults (≥ 18years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.

73 Deworming to improve growth in early-weaned spring born hair sheep lambs

Abstract In lambs, the stress of weaning and the lack of a fully developed immune system can increase susceptibility to gastrointestinal nematodes (GIN). Lack of an effective GIN control strategy around this time can have a significant impact on lamb growth, productivity and mortality. The objective of this study was to determine the influence of deworming at weaning on growth performance in hair sheep lambs. St. Croix (STX) and Barbados Blackbelly (BB) lambs used in the study were born on pasture, weaned at 60.2 ± 0.4 d of age, and transitioned in pens for 87 d post-weaning before turning out to pasture. After accounting for initial FAMACHA eyelid color score, breed, and birth type (single or multiple) at weaning, 54 STX (n = 32) and BB (n = 22) lambs weighing 11.7 ± 0.4 kg were dewormed (DEW) or not (CON) with a combination of levamisol (Prohibit; 8 mg/kg BW) moxidectin (Cydectin; 0.2 mg/kg BW) and albendazole (Valbazen; 7.5 mg/kg BW). To evaluate the effect of deworming treatment, BW and body condition scores (BCS; scale 1-5) were recorded at weaning and at end of transition to pasture. Blood and fecal samples were also collected for determination of packed cell volume (PCV) and fecal egg counts (FEC). Pooled treatment group feces (d 0 – 98) were collected and cultured to determine GIN genera at weaning. Data were analyzed using repeated measures in a mixed model, and FEC were log transformed prior to analysis. There was a mixed population of GIN at weaning averaging 65% and 35% for H. contortus and Tricostrongylus spp. At weaning, BCS, PCV, and FEC were similar between treatment groups and averaged 1.6 ± 0.07, 36.5 ± 0.6%, and 399 ± 54.4 epg, respectively. Combination deworming reduced FEC by 99%. At turnout, DEW lambs (2.3 ± 0.1) tended (P = 0.08) to have greater BCS than CON lambs (2.0 ± 0.1) and PCV was greater (P &amp;lt; 0.001) in DEW versus CON lambs (37.2 ± 0.9 and 33.3 ± 0.8%, respectively). There was also a tendency (P = 0.09) for breed to influence BCS (2.3 ± 0.1 and 2.0 ± 0.1 for BB and STX, respectively). The FEC at turnout was not influenced by treatment or breed (496.7 ± 75.1 epg). Additionally, DEW lambs (131.8 ± 5.2) tended (P = 0.09) to grow faster than CON (119.9 ± 4.7 g/d) lambs, a difference more pronounced in STX DEW (g/d) than STX CON lambs (136 ± 6.1 vs 110 ± 6.5 g/d; P &amp;lt; 0.05). Even though deworming tended to promote faster growth rates in lambs used in this study, alternative, more sustainable, parasite control strategies should be considered in the wake of increasing dewormer resistance.

104 Maternal pre- and post-partum supplementation of Bacillus-based DFM enhanced cow and calf performance

Abstract This study evaluated the effects of maternal supplementation of Bacillus-based direct-fed microbials (DFM) on physiology and growth performance of Bos indicus-influenced cow-calf pairs. On d 0 (~139 d before expected calving date), 72 fall-calving, Brangus crossbred beef heifers (25 to 37.5% Bos indicus; 20 to 22 mo of age) pregnant with their first offspring were stratified by their initial body weight (BW; 431 ± 31 kg) and body condition score (BCS; 6.0 ± 0.36; scale 1 to 9), and randomly allocated into 1 of 12 bahiagrass pastures (1 ha and 6 heifers per pasture). Treatments were randomly assigned to pastures (6 pastures per treatment) and consisted of heifers supplemented with 1 kg/d of soybean hulls dry matter (DM) added (BAC) or not (CON) with a Bacillus-based DFM mixture (BovacillusTM; Chr. Hansen A/S, Hørsholm, Denmark) from d 0 to 242 (139 ± 4 d prepartum to 104 ± 4 d postpartum). Calves were weaned on d 242 (96 ± 30 d of age) and then allocated into 1 of 16 drylot pens and limit-fed the same concentrate at 3.25% of BW until d 319. Maternal treatment effects were not detected (P ≥ 0.29) for herbage allowance, forage nutritive value, and heifer activity on pasture. Heifer BCS on d 39 and 63 tended (P ≤ 0.09) to be greater, whereas heifer BCS on d 91 was greater (P = 0.01) for BAC vs. CON heifers and did not differ (P ≥ 0.20) between treatments on d 179 and 242. Plasma concentrations of glucose did not differ from d 0 to 63 (P ≥ 0.14) but were greater (P = 0.005) on d 179 and tended (P = 0.09) to be greater on d 242 for BAC vs. CON heifers. First offspring BW at birth, ADG from birth to early weaning, and BW weaning did not differ (P ≥ 0.19), but BW at drylot exit (d 319) was greater (P = 0.05) for BAC vs. CON calves. Maternal treatment effects were not detected (P ≥ 0.42) for calf serum concentrations of IgG at birth, and post-vaccination plasma concentrations of glucose, cortisol and haptoglobin. However, serum titers against bovine respiratory syncytial virus (BRSV) were greater (P = 0.04) for BAC vs. CON calves on d 287, whereas seroconversion against parainfluenza 3 virus (PI-3) was greater (P &amp;lt; 0.01) for BAC vs. CON calves on d 271. Thus, maternal supplementation of Bacillus-based DFM increased prepartum BCS gain and postpartum plasma concentrations of glucose of heifers and led to positive carryover effects on post-weaning BW gain and some indicators of humoral immune response to vaccination in their first offspring.

Promoting inclusive recruiting and selection into military training schools: Admission waivers versus retesting.

There is high-level interest in diversifying workforces, which has led organizations-including the U.S. Armed Forces-to reevaluate recruiting and selection practices. The U.S. Coast Guard (USCG) has encountered particular difficulties in diversifying its workforce, and it relies mainly on the Armed Services Vocational Aptitude Battery (ASVAB) for assigning active-duty recruits to one of 19 specialized training schools. When recruits' scores fall below ASVAB entrance standards, the USCG sometimes offers admission waivers. Alternatively, recruits can retest until their ASVAB scores meet the entrance standard. Retesting has shown mixed results in the personnel selection literature, so our main interest is to determine whether retesting or waivers best support USCG recruits' training school outcomes, especially for recruits identifying as an underrepresented minority (URM). We use data from 16,624 USCG recruits entering between 2013 and 2021 and fit augmented inverse propensity weighted models to assess differences in training outcomes by pathway to admission while accounting for self-selection into pathways. Our analyses found (a) no difference in training outcomes between recruits who qualified from their initial scores and recruits who retested, (b) recruits who received waivers were less likely to complete training school on time and spent more time in remedial training when they failed training school compared to those who retested, and (c) improvement in training outcomes for retesting over waivers was larger for recruits identifying as an URM. Results suggest that retesting may be an effective strategy for workforce diversification and for improving outcomes among recruits identifying as an URM. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury.

Glasgow coma scale (GCS) score is the most widely used clinical score for the initial assessment of neurologically injured patients and is also frequently used for prognostication. Other scores such as the Full Outline of UnResponsivness (FOUR) score and the Glasgow Coma Scale-Pupils (GCS-P) score have been more recently developed and are gaining popularity. This prospective cohort study was conducted to compare various scores in terms of their ability to predict outcomes at 3 months in patients with traumatic brain injury (TBI). The study was carried out between October 2020 and March 2022. Patients who presented to the hospital with TBI were assessed for inclusion. Initial coma scores were assessed in the emergency department and again after 48 hours of admission. Outcome was assessed using the extended Glasgow outcome score (GOSE) at 3 months after injury. The receiver operating curve (ROC) was plotted to correlate coma scores with the outcome, and the area under the curve (AUC) was compared. A total of 355 patients with TBI were assessed for eligibility, of which 204 patients were included in the study. The AUC values to predict poor outcomes for initial GCS, FOUR, and GCS-P scores were 0.75 each. The AUC values for 48-hour coma scores were 0.88, 0.87, and 0.88, respectively. The GCS, FOUR, and GCS-P scores were found to be comparable in predicting the functional outcome at 3 months as assessed by GOSE. However, coma scores assessed at 48 hours were better predictors of poor outcomes at 3 months than coma scores recorded initially at the time of hospital admission. Chawnchhim AL, Mahajan C, Kapoor I, Sinha TP, Prabhakar H, Chaturvedi A. Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury. Indian J Crit Care Med 2024;28(3):256-264.

Impact of the Fetal Echocardiogram on Maternal Depression and Well-Being.

Fetal echocardiography allows for prenatal diagnosis of congenital heart disease (CHD). The objective of this study is to assess for the impact of fetal echocardiogram on levels of well-being and depression in pregnant women. Adult pregnant women carrying a fetus < 31-week gestational age were enrolled in the prospective observational study from February 2022 to June 2022. These subjects were split into two cohorts: those with CHD and those without CHD. Surveys were distributed prior to the fetal echocardiogram, six weeks later and six weeks after delivery. These surveys consisted of the Edinburgh Postpartum Depression Scale (EPDS) and questions about topics, such as anxiety and social support. Of the 152 subjects enrolled, 14 women had a fetus with CHD and 138 women had a fetus without CHD. Initial EPDS scores were elevated for the study population compared to the general population. Six weeks later, EPDS scores remained elevated. For the post-partum surveys, the EPDS scores were decreased below the rate of the general population for the group without CHD and similar to the general population rate for the CHD group. Anxiety, worry, and guilt remained low for both groups after the initial survey. Counseling from the pediatric cardiologist may help decrease anxiety and worry. Social support, like support groups, may be helpful for women carrying a fetus with CHD.

Strengths intervention imparted through a blended learning approach to advance personal growth initiative among Pakistan’s university students during COVID-19

To enhance the teaching-learning process and protect all concerned during COVID-19, a blended learning approach—comprising online learning as well as offline personal and collaborative learning—was used to impart a strengths intervention to foster personal growth initiative (PGI) among Pakistan’s university students. The sample comprised 176 students randomly allocated to a treatment (n = 88) and a wait-list control (n = 88) group. Growth curve modeling analyzed the developmental changes in participants’ PGI scores over time. PGI increased to a greater extent in the treatment group than in the control group immediately after the intervention as well as four and eight months later. There were also significant changes in students’ initial status (intercepts) and rates of changes over time (slopes). Moreover, students with high initial PGI scores had a slower linear increase, whereas those with low initial PGI scores had a faster increase in linear growth over time.

Effect of low fibrinogen level on in-hospital mortality and 6-month functional outcome of TBI patients, a single center experience.

In patients affected by traumatic brain injury (TBI), hypofibrinogenemia within the initial hours of trauma can be expected due to vascular and inflammatory changes. In this study, we aimed to evaluate the effect of hypofibrinogenemia on the in-hospital mortality and 6-month functional outcomes of TBI patients, admitted to Rajaee Hospital, a referral trauma center in Shiraz, Iran. This study included all TBI patients admitted to our center who had no prior history of coagulopathy or any systemic disease, were alive on arrival, and had not received any blood product before admission. On admission, hospitalization, imaging, and 6-month follow-up information of included patients were extracted from the TBI registry database. The baseline characteristics of patients with fibrinogen levels of less than 150mg/dL were compared with the cases with higher levels. To assess the effect of low fibrinogen levels on in-hospital mortality, a uni- and multivariate was conducted between those who died in hospital and survivors. Based on the 6-month GOSE score of patients, those with GOSE < 4 (unfavorable outcome) were compared with those with a favorable outcome. A total of 3049 patients (84.3% male, 15.7% female), with a mean age of 39.25 ± 18.87, met the eligibility criteria of this study. 494 patients had fibrinogen levels < 150mg/dl, who were mostly younger and had lower average GCS scores in comparison to cases with higher fibrinogen levels. By comparison of the patients who died during hospitalization and survivors, it was shown that fibrinogen < 150mg/dl is among the prognostic factors for in-hospital mortality (OR:1.75, CI: 1.32:2.34, P-value < 0.001), while the comparison between patients with the favorable and unfavorable functional outcome at 6-month follow-up, was not in favor of prognostic effect of low fibrinogen level (OR: 0.80, CI: 0.58: 1.11, P-value: 0.19). Hypofibrinogenemia is associated with in-hospital mortality of TBI patients, along with known factors such as higher age and lower initial GCS score. However, it is not among the prognostic factors of midterm functional outcome.

Importance of clinical and radiological assessment of patient of osteoarthritis knee foroptimum outcome in total knee replacement

Background: Total knee replacement (TKR) provides symptomatic relief in patients with severe arthritis by removing pathologic joint tissue and restoration of the joint anatomy and function by the replacing with metal or plastic components leading to more stable biomechanics. Inspite of all advances in the surgical techniques 1 out of 5 people who undergo TKA remain unsatisfied. Clinical and radiological grading of osteoarthritis of knee may be an important prognostic marker to assess the outcome following TKR. Methods: Study conducted was retrospective study. Pre-op routine and clinical assessment data noted from departmental records. Correlation between ‘initial knee society score’ (KSSi) and ‘radiological severity’ in terms of (Kellgren-Lawrence) grade and varus angle with ‘change in knee society score’ (ΔKSS) assessed to reach at conclusion. Results: Lower KSS values, higher KL grading, higher femorotibial angle and were associated significantly with higher change in KSS values, i.e. better outcome. Conclusions: Severe OA knee with high FTA and higher KL grade has shown better outcome following TKA. In early stages it is better to manage the patient conservatively with medications and physiotherapy.

Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage.

Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment. Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed. A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), p < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), p < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), p = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), p = 0.001], and hemorrhage location (p = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH. Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.

Prognostic value of transthoracic echocardiography score for the prognosis of continuous ambulatory peritoneal dialysis patients

BackgroundWe devoted ourselves to proving that the initial transthoracic echocardiography score (TTES) had predictive significance for patients with continuous ambulatory peritoneal dialysis (CAPD).MethodsIn this retrospective analysis, 274 CAPD patients who had PD therapy were recruited sequentially. TTE exams were performed three months following the start of PD therapy. All patients were divided into two groups based on the strength of their TTES levels. TTES’s predictive value for CAPD patients was then determined using LASSO regression and Cox regression.ResultsDuring a median of 52 months, 46 patients (16.8%) died from all causes, and 32 patients (11.7%) died from cardiovascular disease (CV). The TTES was computed as follows: 0.109 × aortic root diameter (ARD, mm) − 0.976 × LVEF (> 55%, yes or no) + 0.010 × left ventricular max index, (LVMI, g/m2) + 0.035 × E/e’ ratio. The higher TTES value (≥ 3.7) had a higher risk of all-cause death (hazard ratio, HR, 3.70, 95% confidence index, 95%CI, 1.45–9.46, P = 0.006) as well as CV mortality (HR, 2.74, 95%CI 1.15–19.17, P = 0.042). Moreover, the TTES had an attractive predictive efficiency for all-cause mortality (AUC = 0.762, 95%CI 0.645–0.849) and CV mortality (AUC = 0.746, 95%CI 0.640–0.852). The introduced nomogram, which was based on TTES and clinical variables, exhibited a high predictive value for all-cause and CV mortality in CAPD patients.ConclusionTTES is a pretty good predictor of clinical outcomes, and the introduced TTES-based nomogram yields an accurate prediction value for CAPD patients.

Benefits of First Pass Recanalization in Basilar Strokes Based on Initial Clinical Severity.

Randomized trials demonstrating the benefits of thrombectomy for basilar artery occlusions have enrolled an insufficient number of patients with a National Institutes for Health Stroke Scale (NIHSS) score < 10 and shown discrepant results for patients with an NIHSS > 20. Achieving afirst pass recanalization (FPR) improves clinical outcomes in stroke. We aimed to evaluate the effect of the FPR on outcomes among basilar artery occlusion patients, characterized by prethrombectomy initial NIHSS score. We retrospectively analyzed the Endovascular Treatment in Ischemic Stroke (ETIS) registry of 279 basilar artery occlusion patients treated with thrombectomy from 6 participating centers. We compared the 90-day clinical outcomes of achieving aFPR versus no FPR, categorized by initial clinical severity: mild (NIHSS < 10), moderate (NIHSS 10-20) and severe (NIHSS > 20). We used Poisson regression with robust error variance to determine the effect of the NIHSS score on the association between FPR and outcomes. The FPR patients with NIHSS < 10 or NIHSS 10-20 were more likely to have afavorable clinical outcome (modified Rankin scale, mRS 0-3) than non-FPR patients (relative risk, RR = 1.32, 95% confidence interval, CI: 1.04, 1.66, p-value = 0.0213, and RR = 1.79, 95% CI: 1.26, 2.53, p-value = 0.0011, respectively). Asimilar benefit was not found in patients with severe symptoms. We found asignificantly lower risk of poor clinical outcome (mRS 4-6) in FPR patients with NIHSS 10-20, but not among patients with an NIHSS > 20. Achieving aFPR in basilar artery occlusion patients with mild (NIHSS < 10) or moderate (NIHSS 10-20) symptoms is associated with better clinical outcomes, but not in patients with severe symptoms. These results support the importance of further clinical trials on the benefits of thrombectomy in severe strokes.

The association of the Sequential Organ Failure Assessment score at intensive care unit discharge with intensive care unit readmission in the cardiac intensive care unit.

Unplanned intensive care unit (ICU) readmissions contribute to increased morbidity, mortality, and healthcare costs. The severity of patient illness at ICU discharge may predict early ICU readmission. Thus, in this study, we investigated the association of cardiac ICU (CICU) discharge Sequential Organ Failure Assessment (SOFA) score with unplanned CICU readmission in patients admitted to the CICU. We retrospectively reviewed the hospital medical records of 4659 patients who were admitted to the CICU from 2012 to 18. Sequential Organ Failure Assessment scores at CICU admission and discharge were obtained. The predictive performance of organ failure scoring was evaluated by using area under the receiver operating characteristic (AUROC) curves. The primary outcome was unplanned CICU readmission. Of the 3949 patients successfully discharged from the CICU, 184 (4.7%) had an unplanned CICU readmission or they experienced a deteriorated condition but died without being readmitted to the CICU (readmission group). The readmission group had significantly higher rates of organ failure in all organ systems at both CICU admission and discharge than the non-readmission group. The AUROC of the discharge SOFA score for CICU readmission was 0.731, showing good predictive performance. The AUROC of the discharge SOFA score was significantly greater than that of either the initial SOFA score (P = 0.020) or the Acute Physiology and Chronic Health Evaluation II score (P < 0.001). In the multivariable regression analysis, SOFA score, overweight or obese status, history of heart failure, and acute heart failure as reasons for ICU admission were independent predictors of unplanned ICU readmission during the same hospital stay. The discharge SOFA score may identify patients at a higher risk of unplanned CICU readmission, enabling targeted interventions to reduce readmission rates and improve patient outcomes.

Evaluation of characteristics and prognosis of COVID-19 patients requiring invasive mechanical ventilation during dominance of nonvariant, alpha, delta, and omicron variants in tertiary hospitals of Japan

BackgroundIn November 2021, the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in South Africa and subsequently rapidly spread around the world. Despite the reduced severity of the omicron variants, many patients become severely ill after infection and undergo invasive mechanical ventilation, but there are few reports on their background and prognosis throughout all variant periods. This study aimed to evaluate risk factors affecting patients requiring invasive mechanical ventilation with each variant of COVID-19 pandemic in Japan from nonvariants to omicron variants.MethodThis retrospective observational study was conducted at the Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital and Kansai Medical University Medical Center, Osaka, Japan, from March 2020 to March 2023. Eligible patients were those who underwent invasive ventilation for COVID-19 pneumonia. We set the primary endpoint as in-hospital mortality. Multivariable logistic regression analysis adjusted for clinically important variables was performed to evaluate the clinical outcomes.ResultsWe included 377 patients: 118 in the Nonvariant group, 154 in the Alpha group, 42 in the Delta group, and 63 patients in the Omicron group. Mortality rates for each group were 23.7% for the Nonvariant group, 12.3% for the Alpha group, 7.1% for the Delta group, and 30.5% for the Omicron group. Patient age was significantly associated with increased mortality (adjusted odds ratio [AOR]: 1.097; 95% confidence interval [CI]: 1.057–0.138, P < 0.001). Immunodeficiency (AOR: 3.388, 95% CI: 1.377–8.333, P = 0.008), initial SOFA score (AOR: 1.190, 95% CI: 1.056–1.341, P = 0.004), dialysis prior to COVID-19 (AOR: 3.695, 95% CI: 1.117–11.663, P = 0.026), and smoking history (AOR: 2.548, 95% CI: 1.153–5.628, P = 0.021) were significantly associated with increased mortality. Differences in variants were not significant factors associated with high mortality.ConclusionWe compared the background and prognosis of patients with COVID-19 pneumonia requiring invasive mechanical ventilation between SARS-CoV-2 variants. In these patients, differences in variants did not affect prognosis. Hospital mortality in critically ill COVID-19 patients was significantly higher in the older patients with bacterial coinfection, or patients with immunodeficiency, COPD, and chronic renal failure on dialysis.

Low unspliced cell-associated HIV RNA in early treated adolescents living with HIV on long suppressive ART.

Initiation of antiretroviral treatment (ART) in patients early after HIV-infection and long-term suppression leads to low or undetectable levels of HIV RNA and cell-associated (CA) HIV DNA and RNA. Both CA-DNA and CA-RNA, overestimate the size of the HIV reservoir but CA-RNA as well as p24/cell-free viral RNA can be indicators of residual viral replication. This study describes HIV RNA amounts and levels of cytokines/soluble markers in 40 well-suppressed adolescents who initiated ART early in life and investigated which viral markers may be informative as endpoints in cure clinical trials within this population. Forty adolescents perinatally infected with HIV on suppressive ART for >5 years were enrolled in the CARMA study. HIV DNA and total or unspliced CA-RNA in PBMCs were analyzed by qPCR/RT-qPCR and dPCR/RT-dPCR. Cell-free HIV was determined using an ultrasensitive viral load (US-VL) assay. Plasma markers and p24 were analyzed by digital ELISA and correlations between total and unspliced HIV RNA and clinical markers, including age at ART, Western Blot score, levels of cytokines/inflammation markers or HIV CA-DNA, were tested. CA-RNA was detected in two thirds of the participants and was comparable in RT-qPCR and RT-dPCR. Adolescents with undetectable CA-RNA showed significantly lower HIV DNA compared to individuals with detectable CA-RNA. Undetectable unspliced CA-RNA was positively associated with age at ART initiation and Western Blot score. We found that a higher concentration of TNF-α was predictive of higher CA-DNA and CA-RNA. Other clinical characteristics like US-VL, time to suppression, or percent CD4+ T-lymphocytes were not predictive of the CA-RNA in this cross-sectional study. Low CA-DNA after long-term suppressive ART is associated with lower CA-RNA, in concordance with other reports. Patients with low CA-RNA levels in combination with low CA-DNA and low Western Blot scores should be further investigated to characterize candidates for treatment interruption trials. Unspliced CA-RNA warrants further investigation as a marker that can be prioritized in paediatric clinical trials where the sample volume can be a significant limitation.