Laboratory Results Research Articles

Healthcare resource utilisation and cost of care of systemic inflammation in individuals with atherosclerotic cardiovascular disease and chronic kidney disease

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a chronic disease, progressed by localised or systemic inflammation (SI). Chronic kidney disease (CKD) facilitates the presence of SI and is associated with an increased risk of ASCVD. Previous studies have estimated that 1–2% of the population in Western countries suffer from both conditions. Purpose To investigates the healthcare costs and resource utilisation for individuals diagnosed with ASCVD and CKD, with or without SI. Method The study applied data from the Danish national health and administrative registries from 1994-2022. Patients with ASCVD were identified by ICD-10 codes. CKD was identified by eGFR [15-59mL/min/1.73m2], in the Register of Laboratory Results for Research (RLRR). The latter date of diagnosis of the two diseases were used as index date. CRP-test results were extracted from RLRR. Individuals with conditions associated with CRP-levels and tests observed in association with CVD events or antibiotic/antiviral drug use were excluded. Individuals with at least two valid CRP tests were included. If two CRP-test results ≥2mg/L to <20mg/L were observed less than six month apart, and within two years of index, the individuals were classified to have SI. Individuals diagnosed in the first year of available eGFR were excluded to ensure only incident individuals in the study. Outcomes included costs and use of inpatient (duration ≥12h) and outpatient (<12h) hospital care, cost of primary care and prescription drugs (adjusted to 2022 currency). Results were derived using linear regression models. Results A total of 19,162 individuals’ incident between 2012-2022 were identified – 68% had SI. SI individuals had higher healthcare costs from five years before to three years after index. Individuals generated a total healthcare cost of EUR 69,554 (SI) and EUR 39,540 (no SI) in the study period (difference EUR 30,014, p<0.001). In adjusted analysis, the attributable cost in the three years following index was 1.4 times higher for individuals with SI, compared to individuals with no SI (difference EUR 12,922, p<0.001). Inpatient care accounted for 85% of the cost. SI individuals had significantly more inpatient hospital contacts from four years before to five years after index (7 attributable contacts total, 4.7 attributable contacts after index, 1.2 times more, p<0.001), and more outpatient contacts from five years before to three years after index (6.2 attributable contacts total, 2.3 attributable contacts after index, 1.3 times more, p<0.001). The largest difference was found in the year following index, where the difference was EUR 7,666 (1.5 times higher, p<0.001) cost, 1.5 (1.3 times higher, p<0.001) inpatient hospital contacts, and 1.1 (1.3 times higher, p<0.001) outpatient hospital contacts (adjusted estimates). Conclusion Individuals with SI represent a significant burden to the healthcare system, both in terms of healthcare cost and healthcare resource utilisation.Total healthcare costsAttributable hospital contacts

Usage patterns and outcomes of drug coated ballons at a tertiary care center - a cohort analysis in 462 patients

Abstract Background The usage of drug coated ballons (DCB) in percutaneous coronary interventions (PCI) is rising. Initially applied in in-stent restenosis (ISR), wider clinical applications especially in de novo lesions (DNL) are discussed. Here we aim to assess the pattern of usage as well as the clinical and angiographic outcomes associated with DCB. Methods For this analysis we included all patients treated with DCB during PCI, at a tertiary care centre between 01/2015 and 12/2021. Cath lab results of all patients were screened to assess the DCB indication. Patients were followed up until 09/2022 to assess clinical as well as angiographic complications. Results A total of 7608 interventions were carried out between 2015 and 2021, in 462 (6.1%) a DCB was used. The median follow-up time were 3.1 years (IQR 1.6 to 4.4 years), the median age of our patient population was 66 (IQR 58-75) and 24.7% (n=114) were female. There were 92 of 462 (19.9%) cases including a DNL preparation, 335 (72.5%) cases treating an ISR, in 6 (1.3%) cases both, DNL and ISR were treated, and in 29 (6.3%) cases DCB were used for other reasons (e.g. pre-/ postdilatation in coronary stenting). The mean DCB inflation diameter was significantly higher in ISR with 3.50mm (IQR 3.0-3.5mm) compared to DNL with 2.50mm (2.00-2.50mm, p-value <0.001 ) While the number of DCBs used is rising over time (179 cases [38.7%] in 2015-2018, 283 cases [61.3%] in 2019-2021), the proportion of de novo lesions showed no significant difference (37/179 [20.7%] in 2015-2018, 61/282 [21.6%] in 2019-2021, p-value 0.806, Figure 1). Patients with DCB for ISR had significantly higher rates of arterial hypertension (ISR: 255 [76.1%], DNL: 57 [62.0%], both: 3 [50.0%], other: 20 [69.0%] p value 0.029), hyperlipidaemia (ISR: 228 [68.1%], DNL: 56 [60.9%], both: 2 [33.3%], other: 14 [48.3%], p value 0.041) and previous myocardial infarction (ISR: 231 [69.0%], DNL: 33 [35.9%], both: 2 [33.3%], other: 8 [27.6%], p-value <0.001). When analysing the outcomes, patients with DNL showed lower rates of acute myocardial infarction (8 [8.2%] vs 51 [15.0%]) as well as target lesion (6 [6.1%] vs 56 [16.5%]) and any revascularization (27 [27.6%] vs 122 [35.9%])%]), yet a higher rate of cardiovascular mortality (19 [5.6] vs 9 [9.2%]) during the follow up period compared to patients treated for ISR (Figure 2). Both groups showed a very low rate of target lesion thrombosis within 30 days after PCI (1 [1.0%] vs 1 [0.3%], p-value 0.745). Conclusions The use of DCB in PCIs is increasing, yet as we were able to emphasize with our data, they are primarily used in ISR as well as lesions with a small vessel diameter with favourable outcomes indicated by low event rates. Research should expand beyond small-vessel disease and ISR to assess safety and outcomes of DCB in DNL, larger vessels and bifurcation interventions with one stent to further assess its potential benefits in a wider field of indications.

A Decision Support System for Machine Learning-Based Determination of Zinc Deficiency: A Study in Adolescent Patients

Background: Over the past three years, zinc deficiency among adolescents has varied based on region and access to healthcare. Globally, zinc deficiency affects approximately 2 billion people, leading to serious issues such as immune problems and growth delays, particularly in developing countries. In the U.S., around 10% of adolescents experienced zinc deficiency in 2021, with a higher prevalence among teenage girls. In Europe, deficiency rates are generally low but can be significant in Eastern Europe and Central Asia. In Asia, particularly in rural and low-income areas, deficiency rates range from 20 - 30%. In Turkey, the prevalence is high due to poor nutrition. Objectives: This study aimed to develop a machine learning-based decision support system to determine zinc deficiency in children and adolescents aged 10 - 18 years. Methods: This machine learning-based study was conducted with 370 adolescents aged 10 - 18 years to assess their zinc deficiency. The dataset consists of 8 feature vectors and an output vector. The machine learning methods used in the analysis include Logistic Regression, Naive Bayes, Decision Tree (CART), K-NN (K-Nearest Neighbors), SVM (Support Vector Machine), Gradient Boosting Classifier, AdaBoost Classifier, Bagging Classifier, Random Forest Classifier, MLP Classifier (Multilayer Perceptron), and XGB Classifier (XGBoost Classifier). Evaluation metrics such as accuracy, precision, recall, and F1 score were used to assess the performance of these methods. Including specific values for these metrics, such as "SVM achieved 94.6% accuracy," would allow readers to quickly compare the effectiveness of the models. Different metrics serve various purposes: Accuracy provides an overall view of performance, precision and recall highlight specific aspects, and the F1 score balances precision and recall. Results: The mean age of the patients in the dataset was 13.79 ± 1.18 years. Of the children, 64.32% (n = 238) were female and 35.68% (n = 132) were male. It was found that 62.7% (n = 232) of the children had low zinc levels, while 37.3% (n = 138) did not require zinc supplementation. Thirteen different machine learning methods were applied to a 70% training and 30% testing set. As a result, the SVM method provided the most successful outcome with 94.6% accuracy. Implementing the SVM-based system in pediatric clinics could improve efficiency and patient care by automatically detecting high-risk zinc deficiency patients based on lab results, providing early intervention alerts for faster treatment, and improving health outcomes. Highlighting these practical applications could increase the study’s appeal to healthcare professionals by demonstrating its real-world benefits. Providing detailed information on these applications would enhance the study’s clarity and practical value, making it more valuable for researchers and healthcare providers interested in AI tools for adolescent health. Conclusions: This study concluded that machine learning methods can effectively determine zinc deficiency in children. The SVM method demonstrated superior classification performance compared to the other methods. An SVM-based decision support system could be integrated into pediatric outpatient clinics to enhance diagnostic accuracy and patient care.

CHARACTERISTICS AND OUTCOME OF LEFT MAIN STEM PCI AMONG WOMEN

Left main stem disease is a severe condition affecting a major coronary artery, traditionally treated with coronary artery bypass grafting. Recent advancements in percutaneous coronary intervention have made it a viable option, particularly for women who face unique risks and outcomes compared to men. Objective: This study aims to evaluate the characteristics and outcomes of percutaneous coronary intervention for left main stem disease in female patients, focusing on procedural outcomes and changes in laboratory parameters before and after the intervention. Methods: A prospective observational study was conducted from January to July 2024 with 68 female patients, aged 18 and above, from Fauji Foundation Hospital Rawalpindi. Various percutaneous coronary intervention techniques were used, and data on ejection fractions, access methods, and procedural specifics were collected. Pre- and post-procedural laboratory outcomes including haemoglobin, creatinine, platelet counts, and alanine aminotransferase levels were analyzed. Results: The mean age of participants was 63.6 years. Diabetes, hypertension, and dyslipidemia were common comorbidities. Laboratory results showed stable haemoglobin levels, slight increases in creatinine, and consistent platelet counts and ALT levels post-procedure. Statistical analysis revealed no significant changes in these parameters, indicating minimal impact on anaemia, renal function, and platelet or liver function. Conclusion: percutaneous coronary intervention for the left main stem in females generally results in stable laboratory outcomes with minimal impact on anaemia, renal function, and platelet or liver function. The procedure is safe with a low mortality rate. Continuous monitoring is recommended to manage any potential complications effectively.

Development of a compact forage harvester equipped with a stem length orienter and rectangular deflector for small farms

The object of the study is the technological processes of high-quality crushing of stem feeds, due to the oriented feeding of stems into the grinding chamber and transportation of the crushed mass through a rectangular deflector. A review of the literature sources has shown that at present, the design and technological scheme of a small-sized forage harvester has not yet been developed, which in turn ensures high-quality crushing of stem feeds and reduces operating costs in small farms. As a result of theoretical studies, analytical expressions were obtained to determine the mass velocity at the deflector outlet and the range of mass ejection in the horizontal section. The combine productivity when mowing alfalfa was equal to 6.22 t/h, the range of mass ejection in the horizontal direction was within 7.5...8.0 m (theoretical value – 7.8 m), the average size of crushed particles was 32.89 mm (estimated length – 33.5 mm), the difference between theoretical and actual values is 1.5 %. The results of laboratory and field tests showed the efficiency of the forage harvester, the reliability of the analytical expressions obtained and the efficiency of the stem length orienter was determined. A distinctive feature of the research results is that a design and technological scheme of a small-sized forage harvester equipped with an orienter and a theoretical description of the feed transportation process through a rectangular deflector were developed. According to the presented design and technological scheme, the deflector and orienter have a simplified design and good quality of crushing stem feeds. All this proves the practical significance and applicability of the developed forage harvester

Relationship Between Diet and Nutritional Status with Blood Sugar Levels in Type 2 Diabetes Mellitus Outpatients at RSUD Ibnu Sina Gresik

Type 2 Diabetes Mellitus is a chronic disease with an increasing incidence in Indonesia and is closely related to blood sugar control. This study was conducted aimed to analyze the relationship between diet and nutritional status with blood sugar levels in outpatients with Type 2 Diabetes Mellitus at Ibnu Sina Gresik Hospital. A cross-sectional study design was employed along with observational analysis. The sample included 34 patients selected using the Accidental Sampling technique. Data were collected through interviews, questionnaires, measurements of height and weight, and laboratory results. The study was conducted from December 2023 to April 2024, and the data were analyzed using univariate and bivariate analysis using the chi-square test. The results showed that patients with poor diet and overweight tend to have abnormal blood sugar levels, with p=0.014 for diet and p=0.023 for weight gain, both significant (p<0.05). In conclusion, there is a relationship between diet and nutritional status and blood glucose levels in patients with Type 2 Diabetes Mellitus. It is recommended, patients should implement a diet according to the 3J principle, do sufficient physical activity, regularly monitor blood sugar levels, and make dietary changes such as reducing simple carbohydrates and sugar to manage blood sugar levels.

Clinical utility of EBV DNA testing of blood in immunocompetent and immunocompromised patients: A single-center experience.

Epstein-Barr virus (EBV) causes different clinical presentations in immunocompetent and immunocompromised persons, and thus indications for testing vary between these populations. We reviewed our institution's EBV DNA testing across these populations to understand its clinical utility and appropriateness. We conducted a retrospective chart review of adult patients with positive EBV nucleic acid amplification (NAAT) testing from November 2022 to 2023. We recorded demographics, indications for testing, EBV-related diagnosis, laboratory results, and whether testing influenced patient treatment. Of 3560 EBV NAAT tests, 187 (5.3%) were positive, representing 124 unique adult patients (51 immunocompetent and 73 immunocompromised). Reactivation of EBV was the most common diagnosis in both populations, followed by acute EBV infection in the immunocompetent and non-posttransplant lymphoproliferative disorder malignancies in the immunocompromised. In immunocompromised patients, positive tests led to treatment changes more frequently than in immunocompetent patients (27.4% vs 11.7%, P=.06). Testing affected clinical management in 0% to 2% of cases when sent for sepsis/shock and nonspecific viral syndromes compared to 37% to 49% of cases when sent for posttransplant and malignancy screening/monitoring. EBV NAAT testinginfrequently influenced clinical management in immunocompetent individuals but had a notable impact in immunocompromised patients, particularly those undergoing posttransplant or malignancy screening. This underscores the need for targeted testing to optimize resource utilization and cost-effectiveness.

Laboratory Data as a Potential Source of Bias in Healthcare Artificial Intelligence and Machine Learning Models.

Artificial intelligence (AI) and machine learning (ML) are anticipated to transform the practice of medicine. As one of the largest sources of digital data in healthcare, laboratory results can strongly influence AI and ML algorithms that require large sets of healthcare data for training. Embedded bias introduced into AI and ML models not only has disastrous consequences for quality of care but also may perpetuate and exacerbate health disparities. The lack of test harmonization, which is defined as the ability to produce comparable results and the same interpretation irrespective of the method or instrument platform used to produce the result, may introduce aggregation bias into algorithms with potential adverse outcomes for patients. Limited interoperability of laboratory results at the technical, syntactic, semantic, and organizational levels is a source of embedded bias that limits the accuracy and generalizability of algorithmic models. Population-specific issues, such as inadequate representation in clinical trials and inaccurate race attribution, not only affect the interpretation of laboratory results but also may perpetuate erroneous conclusions based on AI and ML models in the healthcare literature.

High prevalence of comorbidities in older adult patients with type 2 diabetes: a cross-sectional survey

BackgroundDiabetes is a global health problem, and its incidence and complications increase with the duration of the disease and over time. This increase in complications in older patients can lead to disability and a lower quality of life. This study aimed to investigate the rate of diabetes control and complications in older adults.MethodThis was a cross-section of an ongoing cohort of patients with type 2 diabetes mellitus (T2DM) aged 65 years and older. The clinical and laboratory characteristics of older adult patients with T2DM in good and intermediate health conditions were collected between 2010 and 2022.ResultsA total of 2,770 older adult patients with T2DM were enrolled, including 1,530(55.3%) female and 1,240 (44.7%) male participants. Metabolic syndrome, hypertension, and coronary artery disease were the most common comorbidities, affecting 1,889 (71.4%), 1,495 (54.4%), and 786 (29.2%) patients, respectively. Albuminuria was present in 626 (22.6%) patients, while retinopathy was detected in 408 (14.7%) patients, including 6% with proliferative retinopathy. Most patients were treated with oral antidiabetic agents (88.9%), with metformin being the most prescribed medication (85.6%). Statins were prescribed to 71.8% of the patients. The most prescribed antihypertensive medications were angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, prescribed to 54% and 15% of patients, respectively. The hemoglobin A1c (HbA1c) goal (HbA1c < 7.5%) was achieved in 1,350 (56.4%) patients, and the low-density lipoprotein cholesterol (LDL-C) goal (LDL < 100) was achieved in 1,165 (45.6%) patients. Blood pressure control (BP < 140/90) was achieved in 1,755 (65.4%) patients. All three goals were achieved in 278 (10.3%) patients. There were no significant differences in clinical laboratory results and the patients’ characteristics based on gender.ConclusionThe rate of progression of complications in older adult patients is higher than the effectiveness of the treatment, indicating the need for increased social support for this age group.

Exploring the Interplay between Emotional Attitudes toward Diabetes, Eating Behavior, and Glycemic Control in Patients with Type 2 Diabetes Mellitus.

This study aimed to assess the association between emotional attitudes toward diabetes, eating behavior styles, and glycemic control in outpatients with type 2 diabetes. Observational study. Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil. 91 outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behavior styles, and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages, and glycated hemoglobin values. Patients were categorized based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests. At baseline, no differences were observed in the proportion of patients with good glycemic control, eating behavior styles, and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycemic control compared to the reference group (OR=3.47; 95%CI=1.12-10.75), after adjusting for diabetes duration, sex, and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution. Patients with a positive attitude towards diabetes showed a greater reduction in glycated hemoglobin levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.

Identification of risk factors and establishment of prediction models for mortality risk in patients with acute kidney injury: A retrospective cohort study.

This study investigated factors influencing death in patients with Acute Kidney Injury (AKI) and developed models to predict their mortality risk. We analyzed data from 1079 AKI patients admitted to Changsha First Hospital using a retrospective design. Patient information including demographics, medical history, lab results, and treatments were collected. Logistic regression models were built to identify risk factors and predict 90-day and 1-year mortality. The 90-day mortality rate among 1079 AKI patients was 13.8% (149/1079) and the one-year mortality rate was 14.8% (160/1079). For both 90-day and 1-year mortality in patients with AKI, age over 60, anemia, hypotension, organ failure, and an admission Scr level above 682.3 μmol/L were identified as independent risk factors through multivariate logistic regression analysis. Additionally, mechanical ventilation was associated with an increased risk of death at one year. To ensure the generalizability of the models, we employed a robust 5-fold cross-validation technique. Both the 90-day and 1-year mortality models achieved good performance, with area under the curve (AUC) values exceeding 0.8 in the training set. Importantly, the AUC values in the validation set (0.828 for 90-day and 0.796 for 1-year) confirmed that the models' accuracy holds true for unseen data. Additionally, calibration plots and decision curves supported the models' usefulness in predicting patient outcomes. The logistic regression models built using these factors effectively predicted 90-day and 1-year mortality risk. These findings can provide valuable insights for clinical risk management in AKI patients.

Transplantation of human umbilical cord-derived mesenchymal stem cells improves age-related ovarian functional decline via regulating the local renin–angiotensin system on inflammation and oxidative stress

BackgroundAge-related reproductive aging is a natural and irreversible physiological process, and delaying childbearing is increasingly common all over the world. Transplantation of mesenchymal stem cells (MSCs) is considered a new and effective therapy to restore ovarian function, but the relevant mechanisms remain unclear. Recently, it has been found that there is a local Renin–angiotensin system (RAS) in human ovary and it plays a key role.MethodsAfter collecting follicular fluid from women who received oocyte retrieval for pure male factor infertility, the level of RAS components in it were detected, and the correlation analysis by linear regression. Then, the in vivo experiments on female C57BL/6 mice were designed to measure ovarian function, and the transcription and translation levels of RAS pathway were detected by molecular biology methods. Moreover, the role of RAS in regulating inflammation and oxidative stress in the co-culture system were explored in in vitro experiments on KGN cells.ResultsFirst, a total of 139 samples of analyzable follicular fluid were obtained. The local RAS of ovary, which is independent of systemic RAS (P > 0.05), is affected by age (Pearson r < 0, P < 0.05) and related to ovarian function, inflammation, oxidative stress indexes and assisted reproduction laboratory outcomes (P < 0.05). Next, the ovary/body weight of aging mice decreased significantly and serum sex hormones levels changed significantly (P < 0.01). The number of functional follicles decreased, while the atresia follicles increased (P < 0.05). After MSCs transplantation, all the above measures have been partially recovered (P < 0.05). Although several RAS components in aging ovary changed, MSCs only improved the expression level of AT1R (P < 0.05). Furthermore, the secretion ability and mitochondrial membrane potential of aging KGN cells decreased, while the intracellular ROS level and the aging cells ratio increased (P < 0.01). All the above measures have been partially recovered when co-cultured with MSCs (P < 0.05). After Ang(1–7) were added into the co-culture system, the above have been more significantly restored compared with Ang II (P < 0.05). Nevertheless, there was no statistical difference in estradiol level no matter which one was added (P > 0.05).ConclusionsTogether, our findings indicate that a novel possible mechanism to explain how stem cells restore age-related ovarian functional decline.

Evaluation of 3-year tuberculosis external quality assessment results of public health laboratories.

Background We aimed to evaluate the 3-year participation status of tuberculosis (TB) laboratories in public health laboratories (PHL) tuberculosis external quality assessment (EQA) and EQA results. Method During 2018-2020, PHLs participated in the EQA programme organized annually by the National Tuberculosis Reference Laboratory (NTRL). Five kinds of EQA samples were sent to the participating laboratories on three parameters, including microscopy, culture and phenotypic first-line drug susceptibility testing and they were asked to perform according to the standard protocol. The results were taken over by the Tuberculosis Laboratories Surveillance Network (TULSA) web system and analysed. Results A total of 24 PHLs participated in the EQA in 2018; 30 in 2019 and 23 in 2020. In terms of sensitivity, specificity, accuracy and reproducibility in microscopy, respectively, in 2018, 20 of the laboratories were 100%, 4 of them 80%, and in culture 16 of them were 100% and 2 of them 80%; in 2019, 28 of them were 100%, 2 of them 80%, and in culture 11 of them were 100%, 6 of them 80%, 1 of them 60%; in 2020, 20 of them were 100%, 3 of them 80%, and in culture 13 of them were 100% and 3 of them 80%. Conclusion It is beneficial for laboratories working on TB to participate in EQA in terms of evaluating the accuracy and reliability of the method used.

Olokizumab plus methotrexate: safety and efficacy over 106 weeks of treatment

ObjectiveTo report long-term safety and tolerability of olokizumab (OKZ) in combination with methotrexate (MTX) in subjects with active rheumatoid arthritis (RA), using pooled data from three randomised clinical trials (RCT)...

Assessing the harmonization of structured electronic health record data to reference terminologies and data completeness through data provenance

AbstractIntroduction(1) Assess the harmonization of structured electronic health record data (laboratory results and medications) to reference terminologies and characterize the severity of issues. (2) Identify issues of data completeness by comparing complementary data domains, stratifying by time, care setting, and provenance.MethodsQueries were distributed to 3 Data Partners (DP). Using harmonization queries, we examined the top 200 laboratory results and medications by volume, identifying outliers and computing summary statistics. The completeness queries looked at 4 conditions of interest and related clinical concepts. Counts were generated for each condition, stratified by year, encounter type, and provenance. We analyzed trends over time within and across DPs.ResultsWe found that the median number of codes associated with a given laboratory/medication name (and vice versa) generally met expectations, though there were DP‐specific issues that resulted in outliers. In addition, there were drastic differences in the percentage of patients with a given concept depending on provenance.ConclusionsThe harmonization queries surfaced several mapping errors, as well as issues with overly specific codes and records with “null” codes. The completeness queries demonstrated having access to multiple types of data provenance provides more robust results compared with any single provenance type. Harmonization errors between source data and reference terminologies may not be widespread but do exist within CDMs, affecting tens of thousands or even millions of records. Provenance information can help identify potential completeness issues with EHR data, but only if it is represented in the CDM and then populated by DPs.

Systematisation of the causes that required revision hip replacement, methods of their solution, treatment results in Ukraine

BackgroundThe objective of this study is to organise data on complications following total hip replacement (THA) over a span of 10 years, specifically focussing on cases that necessitated revision endoprosthetic surgeries. The objective is to create a recommendation for an All-Ukrainian registry of initial and repeated hip arthroplasty (HA) and standardise the terminology used to define “revision of total hip replacement surgery”.MethodsThe retrospective analysis examined 236 instances of revision hip arthroplasty (rTHA) performed at the Institute of Traumatology and Orthopaedics Centre between January 2005 and December 2021. The primary factors for revision were identified through an analysis of the patient’s medical records, laboratory results, visual inspection, and the state of the previously implanted prosthesis. Demographic information, primary and revision HA dates, diagnoses, and causes of complications were recorded. The statistical analysis was conducted using the Statistica package (StatSoft), version 12.6 (2015), with a significance level of p < 0.05.ResultsOut of the 364 patients who were diagnosed with complications, 236 of them (55.17%) needed a procedure called 1rTHA. Among these cases, 152 (41.76%) were specifically diagnosed with aseptic component instability. Significant factors for mechanical loosening were a high body mass index (BMI ≥ 30) and older age, with respective t-values of 2.08 (p = 0.004) and 2.59 (p = 0.045). Osteoporosis significantly contributed to aseptic loosening and fractures around the implant. The occurrence of infectious complications was frequently linked to chronic infectious diseases (t = 3.37, p = 0.001). The overall percentage of need for 2rTHA was 27.22% (43 cases), with one case of infectious lesion following the revision.ConclusionsThe study emphasises the urgent requirement for standardised terminology and a comprehensive registry for hip arthroplasty procedures. Primary results indicate that cement-free fixation is more effective than cement-based fixation for revision in patients with aseptic instability and that two-stage arthroplasty is effective for treating infectious inflammation. Furthermore, the most effective treatment for femoral fractures with periprosthetic involvement was determined to be open repositioning and osteosynthesis with metal retainers. The aforementioned observations emphasise the need to create a comprehensive registry across Ukraine to support patient care, enable evidence-based practices, and enhance the overall effectiveness of hip arthroplasty operations.Clinical trial numberNot applicable.

Real-time detection of coke particles in blast furnace operations using machine learning: Case of a steel plant in India

The efficiency of blast furnace operations in a steel plant relies on the quality of raw materials, including coke. The particle size distribution (PSD) of coke plays a vital role in ensuring the efficiency of the blast furnace. Conventional methods of measuring average particle size are time-consuming and labour-intensive leading to delayed operations. To address the issue, various studies have used different techniques for real-time measurement of coke particle size, including laser diffraction, acoustic sounding, X-ray computed tomography, and computer vision. While these methods have shown successful applications, there have been limitations in their lower prediction accuracy and detection speed. Therefore, our study proposes a practical approach that leverages the integration of computer vision algorithms to enhance accuracy and detection speed. The proposed methodology is compared with the conventional method of measuring particle size in the lab at a blast furnace. Our results reveal that the YOLOv8 algorithm outperforms the conventional method, providing efficient detection of 5.419 frames per second and with a mean absolute error of [Formula: see text]1.77 mm within the lab results. YOLOv8 can perform object segmentation providing much more precise polygon masks of the coke particles instead of simply providing rectangular dimensions using traditional object detection, as explored in previous studies. This approach enables real-time monitoring of PSD and timely alerts to the onsite team, significantly improving the efficiency of blast furnace operations.

Clinical, laboratory, and echocardiographic characteristics of critical multisystem inflammatory syndrome in children: a retrospective, observational study

ObjectiveMultisystem inflammatory syndrome in children (MIS-C) is a critical childhood disease that is associated with coronavirus disease (COVID-19). We aimed to describe the clinical, laboratory, and echocardiographic characteristics and outcome of critical MIS-C cases in Egyptian children during the first wave of the COVID-19 pandemic.DesignA retrospective, observational study.SettingA single-center tertiary pediatric intensive care unit (PICU).In Ain Shams university hospitals Cairo EgyptMethodsChildren admitted to the PICU diagnosed with severe MIS-C as per the Centers for Disease Control’s definition from June 23, 2020, to August 22, 2020, were included.ResultsThe patient’s mean age was 7.45 (interquartile range [IQR], 4.23) years, and the cause of PICU admission was hypotension and shock. All patients had a fever for 4.8 (IQR, 2.5) days before shock developed. Overall, 68% had a gastrointestinal manifestation, and 55.6% had a rash. Thirty-five of 45 patients had ≥ 4 elevated inflammatory markers. The cardiac troponin I level was elevated in 35 of 45 patients. The most common cardiac condition was valvulitis (tricuspid regurgitation, 29/45; mitral valve regurgitation, 28/45; pulmonary valve regurgitation, 5/45; atrial valve regurgitation, 4/45). Twenty-one patients had an impaired ejection fraction < 50%, and 17 patients had coronary dilatation. Six patients had pericardial effusion, 1 patient had dilated pulmonary arteries, and 6 patients (13.3%) died of their associated comorbidities. The mean PICU length of stay among patients with no associated comorbidities was 7 days.ConclusionsCritical cases of MIS-C had a spectrum of different cardiac conditions, with valvulitis being the most common one. The worst outcome occurred in patients with comorbidities and infants.

Machine Learning Algorithm-Aided Determination of Predictors of Mortality from Diabetic Foot Sepsis at a Regional Hospital in South Africa During the COVID-19 Pandemic.

Background and Objectives: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated factors associated with major amputation and mortality in patients admitted with DFS during the COVID-19 pandemic. Materials and Methods: Demographic information, COVID-19 and HIV status, clinical findings, laboratory results, treatment and outcome from records of patients with diabetic foot sepsis, were collected and analysed. Supervised machine learning algorithms were used to compare their ability to predict mortality due to diabetic foot sepsis. Results: Overall, 114 records were found and 57.9% (66/114) were of male patients. The mean age of the patients was 55.7 (14) years and 47.4% (54/114) and 36% (41/114) tested positive for COVID-19 and HIV, respectively. The median c-reactive protein was 168 mg/dl, urea 7.8 mmol/L and creatinine 92 µmol/L. The mean potassium level was 4.8 ± 0.9 mmol, and glycosylated haemoglobin 11.2 ± 3%. The main outcomes included major amputation in 69.3% (79/114) and mortality of 37.7% (43/114) died. AI. The levels of potassium, urea, creatinine and HbA1c were significantly higher in the deceased. Conclusions: The COVID-19 pandemic led to an increase in the rate of major amputation and mortality in patients with DFS. The in-hospital mortality was higher in patients above 60 years of age who tested positive for COVID-19. The Random Forest algorithm of ML can be highly effective in predicting major amputation and death in patients with DFS.

ABCG2 Gene Expression in Non-Small Cell Lung Cancer.

Background/Objectives: ATP-binding cassette subfamily G member 2 [ABCG2/breast cancer resistance protein (BCRP)] contributes to mechanisms of multidrug resistance (MDR) and is a marker of side population (SP) cells in human cancers. The primary objective of this study was to investigate the impact of ABCG2 gene expression on the non-small cell lung cancer (NSCLC) development, course of cancer disease, and patient prognosis using publicly available data. Obtained results were supplemented with assessment of ABCG2 expression in blood of NSCLC patients. Methods: The dataset of lung cancer was analyzed utilizing the TIMER 2.0, UALCAN, TNMplot, MEXPRESS, cBioPortal, MethSurv, KM Plotter, STRING, and ShinyGO 0.80 databases. Blood samples from 50 patients were assessed using the real-time PCR method. Results: The ABCG2 gene was expressed at a low level in NSCLC, and did not correlate with clinical aggressiveness of lung cancer. Higher ABCG2 expression improved overall survival, but only in LUAD. In addition, CpG sites located on the CpG island affecting the NSCLC patient's prognosis were indicated. In the case of our own laboratory results, the study did not reveal any changes in the ABCG2 expression levels in blood collected from patients at different time points during the diagnostic-therapeutic procedure. In the in silico analysis, most ABCG2 protein interactors were associated with the development of drug resistance. Conclusions: ABCG2 appears to have a particularly significant impact on the survival of patients with lung cancer and on the effect of immunotherapy related to immune cell infiltration. Presented findings may support personalized medicine strategies based on bioinformatics findings.