Laboratory Test Results Research Articles

Low-dose cement stabilized large particle size graded crushed stone: Laboratory and field investigations

Compared with traditional graded crushed stone (GCS), the maximum aggregate size of large particle size GCS (LPS-GCS) is larger and the content of large-size aggregates is more, which can form an interlocking skeletal structure with a stronger bearing capacity. Nevertheless, LPS-GCS occasionally exhibits unstable performance, and one effective way to enhance LPS-GCS's mechanical and physical properties is to stabilize it with low-dose cement. In this study, four cement contents (1.5 %, 2.0 %, 2.5 %, and 3.0 %, by mass) were selected to form low-dose cement stabilized LPS-GCS (LCS-LPS-GCS) mixtures with a maximum aggregate particle size of 53 mm. Unconfined compressive strength (UCS) and compressive resilient modulus (CRM) tests were performed on LCS-LPS-GCS samples for different cement contents and curing times. Moreover, prediction models and correlations for the UCS and CRM at different curing times were established. Furthermore, a test road was used to evaluate the LCS-LPS-GCS's field compaction level and deflection. Laboratory test results indicated that while the California bearing ratio was significantly higher than that of conventional GCS, the maximum dry density of LPS-GCS designed in this study was close to that of conventional GCS. With the same cement content, LCS-LPS-GCS outperformed conventional GCS in terms of UCS and CRM. Based on the variation law of the mechanical properties, the ideal cement content should be around 2.5 %. There was a strong positive correlation between UCS and CRM scores from LCS-LPS-GCS. The UCS and CRM were appropriate to be predicted by exponential and growth functions models, respectively. The field investigations indicated that asphalt pavements reconstructed with LCS-LPS-GCS had high compaction and low deflection, resulting in better bearing capacity and durability. The results of this investigation can serve as a reference for the design and application of LCS-LPS-GCS base for long-lasting and resilient pavements.

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

Gentamicin Pharmacokinetics in Neonates Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy.

The purpose of this study was to review the pharmacokinetic profile of gentamicin among neonates with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) treatment. This was a retrospective study of neonates with HIE undergoing TH in the neonatal intensive care unit who received gentamicin between 2009 and 2014. Demographic information, diagnoses, laboratory test results, and medication administration and monitoring information were collected, and data were analyzed using SciPy. A total of 57 neonates were analyzed. The median birth weight was 3.25 kg (interquartile range [IQR] 2.8-3.68), and median gestational age was 39 weeks (IQR 38-40). An elevated gentamicin trough level (defined as > 2 mg/L) was observed in 61% (35/57) of neonates. Half of the neonates (49%) had multiple gentamicin trough levels obtained, and 4% of the neonates were switched to an alternate agent. There was a significant difference in the number of dosing interval changes in neonates with elevated gentamicin trough levels compared with those with therapeutic gentamicin trough levels (P < 0.001). Of the neonates with elevated gentamicin trough levels, 14% (5/35) failed their hearing screen (P = 0.389). Neonates with HIE undergoing TH may have an altered pharmacokinetic profile, requiring multiple blood draws so medication levels can be monitored and doses adjusted.Traditional gentamicin dosing regimens may not be ideal for this patient population, and further guidance is required for alternative treatment regimens.

Evaluation of ultrasonic and mechanical methods for assessing dentin demineralization in children's permanent teeth in vitro

Relevance. With the advent of advanced methods for functional diagnostics, dentists have gained new opportunities for detecting carious lesions. However, the diagnostic sensitivity of these methods requires further investigationPurpose. To evaluate the condition of intact and demineralized dentin in children's permanent teeth using both ultrasonic and mechanical methods.Materials and methods. Divided cross-section" models were created from premolars extracted from children for orthodontic purposes. After a 20-day exposure to a demineralizing buffer solution with a pH of 4.5, both the intact and demineralized dentin cross-sections were tested using ultrasonic and mechanical methods.Results. Statistically significant differences were observed in the mean ultrasonic signal speed C between two independent sample groups: intact dentin (Group 1) and demineralized dentin (Group 2), based on Mann-Whitney U-test calculations (p = 0.01). In Group 2, the mean value of C was 27% lower compared to Group 1. Additionally, significant differences were found in the mean ultimate strength σ between two independent groups: intact dentin (Group 3) and demineralized dentin (Group 4), with Group 4 showing a 29.5% reduction in the mean σ value, according to Mann-Whitney U-test calculations (p = 0.01).Conclusion. Demineralization leads to significant changes in both the ultrasonic and mechanical properties of dentin. Statistical analysis of the laboratory test results using the "divided cross-section" model supports the effectiveness and diagnostic sensitivity of the methods applied for evaluating the extent of dentin demineralization.

Deformation behaviour of strain-softening rock mass in tunnels considering deterioration model of elastic modulus

By analyzing the composite effects of the plastic shear strain and confining stress according to the laboratory test results, a model adopting a deteriorating elastic modulus for the intact rock is proposed. Soft rock such as coal and the strong rock such as granite with different quality are investigated. Geological Strength Index (GSI) is adopted to represent the integrity of rock, to be specific, from intact rock to the rock mass. Specifically, for the strain-softening rock mass, the elastic modulus is gained by introducing GSI into the deterioration model. The strength parameters are obtained by fitting GSI into Hoek-Brown failure criterion. Then, the elastic modulus and strength parameters of the rock mass are employed in the numerical procedure for solving out the rock deformation, the radii of the plastic softening and residual zones of the tunnels. The rationality of the numerical procedure is verified with the existing semi-analytical and analytical procedures. In the discussion, the influences of the critical plastic parameters and GSI, on the elastic modulus, rock deformation, radii of the plastic softening and residual zones are investigated. Five models for the variation of the modulus including the proposed deterioration model are defined. The rock mass deformation behaviours of the five models are compared. The results indicate that, in the plastic softening zone that is far away from the tunnel periphery, the elastic modulus is more sensitive to the plastic shear strain, whereas near the tunnel periphery, the elastic modulus is primarily affected by the confining stress. Regarding a linear decrease of the elastic modulus versus the plastic shear strain overestimates the elastic modulus to some extent, especially for the soft rock mass.

Pica in sickle cell disease: nutritional management and implications

Background: Individuals with sickle cell disease (SCD) frequently experience nutritional disturbances, including deficiencies in essential micronutrients. Iron and zinc deficiency anemia has been specifically associated with pica, an atypical eating behavior. Aims: This systematic review aimed to characterize pica among individuals with SCD, focusing on potential nutritional causes. Methods: A comprehensive literature search was conducted across the MEDLINE (PubMed), Latin American and Caribbean Center on Health Sciences Information (Bireme), and Google Scholar databases from July 2017 to January 2024. Eligible articles included original observational studies, interventions, and case reports involving individuals with SCD across all age groups. Literature reviews, doctoral or master's theses, unrelated studies, and duplicate publications were excluded. Results: Ten studies were selected that described the occurrence of pica episodes in the SCD population and explored potential associated nutritional causes. The most prevalent genotype was Hb SS, with ages ranging from 2 to 23 years. Males were more predominant than females in the included studies. Approximately 51.05% of the studied population exhibited pica behavior. Some studies observed that children with pica behavior had low weight and/or height and abnormal laboratory test results. The most commonly consumed objects were paper, foam, fabric, dust, soil, clay, and rubber, although the quantity and frequency of object consumption were not reported in most studies. The most reported symptoms associated with pica behavior included abdominal pain, vomiting, constipation, vaso-occlusive events, dizziness, and fatigue. Clinical interventions in the studies were pain medication, intestinal cleansing, intestinal resection, intravenous hydration, antibiotic therapy, gastric "bezoar" removal, and cognitive-behavioral therapy. The majority of the studied population was monitored by health centers, with frequent return visits. In all studies, physicians were responsible for clinical care. Conclusion: A significant association between SCD and pica was evident in the reviewed studies. Iron and zinc deficiencies emerged as potential contributing factors to this atypical eating behavior. Keywords: Pica, sickle cell disease, iron, zinc, eating disorders.

Current status of research on the diagnosis and treatment of acute ethylene glycol poisoning

Acute ethylene glycol poisoning often leads to acute kidney injury, and delays in diagnosis and treatment can lead to severe multi-organ dysfunction and even death. At present, there is a lack of specific laboratory tests that can be used for rapid clinical diagnosis, and diagnosis and evaluation only rely on medical history, clinical symptoms, and non-specific laboratory test results. Key treatments include alcohol dehydrogenase inhibitors (fomcpizole or ethanol) and hemodialysis, which is not approved in China. A clear understanding of the mechanism of toxicity, pathophysiology, clinical manifestations, efficacy and limitations of laboratory tests, and treatment options after ethylene glycol poisoning can help accelerate the early diagnosis, treatment, and prognosis of patients after ethylene glycol poisoning. This article reviews this article in order to provide a reference for clinicians.

Characteristics of coal crack development and gas desorption in the stress affected zone of rock pillar

Coal (Rock) pillar retaining in the mining of protective layer would cause gas dynamic disaster in the protected layer. Based on the gas geological conditions of the two-layer coal seam in Jinhe Coal Mine of Yaojie Mining District, the stress evolution law of coal seam in the rock pillar affected area was studied by theoretical analysis and numerical simulation, and the crack development law of coal seam in different loading stages under conventional triaxial loading was studied by CT scanning technology. With the analysis of the stress evolution and crack development of coal in rock pillar affected area, the gas extraction effect under different stress states and the gas desorption law after pressure relief antireflection were studied on site. The results showed that the stress of coal in the rock pillar affected area is in the approximate elastic stage of the conventional triaxial stress-strain curve, and the cracks of coal are mainly closed at this stage. Meanwhile, the increase of stress leaded to the decrease of coal permeability and the poor gas extraction effect. CT scanning tests under conventional triaxial loading were carried out in the laboratory, and three-dimensional visual models of coal sample cracks were constructed at different loading stages. When loading to the linear elastic stage, the crack volume and surface area were reduced by 74% and 71% compared with the ones in initial state. At the same time, the expression between stress σ and crack density T was further established. After comprehensive control measures such as intensive drilling discharge, presplitting blasting and coal water injection were taken to the coal in rock pillar affected area, the crack density T could reach the crack development level of the conventional triaxial loading softening stage, realizing the crack development of the coal under low stress. The enclosed gas in front of the coal could desorption flow during the roadway driving. And the predict index value K1 also decreased from 0.57 mL/(g·min1/2) to 0.17 mL/(g·min1/2) continuously. The safety of coal roadway in rock pillar affected area was realized, and the accuracy of numerical simulation and laboratory test results was verified, which had certain reference significance for coal roadway excavation under this similar conditions.

Prescribing Hydroxyurea in Sickle Cell Disease Patients: The Pattern and Association with Co-Prescribed Medications Used to Manage the Disease Complications.

Background and Objectives: Hydroxyurea (HU) is an effective medication used to reduce the frequency of painful crises associated with sickle cell disease (SCD). However, data describing its prevalence among SCD patients in the Eastern Region of Saudi Arabia are scarce. This is a multi-center, retrospective, cross-sectional study that aims to investigate the pattern of prescribing HU in SCD patients and to determine the association between prescribing HU and other co-prescribed medications used to manage SCD complications. Methods: Data were collected from patients who visited the hematology clinics of Al-Qatif Central Hospital (QCH) and King Fahad Hospital in Hofuf (KFHH) between June 2021 to May 2023. The data included demographics, prescribed medications, and recent laboratory test results, all of which were collected from patients' medical records. Descriptive statistics were utilized to assess the difference between HU users vs. non-users. A binary logistic regression model was used to determine the association between prescribing HU and co-prescribed medications used to manage SCD complications. The results are presented as the odds ratio (OR) and 95% confidence interval (95% CI). Results: This study included 2816 SCD patients with a 56% prevalence of HU prescription. HU was prescribed for young age groups more often compared to old age group patients. Young males were more likely to be prescribed with HU compared to females, and it becomes dominant in females after the age of 36. HU users were more likely to have paracetamol (69% vs. 53%, OR = 1.9, 95% CI 1.6-2.2), NSAIDs (50% vs. 35%, OR = 1.7, 95% CI 1.5-2), and opioids (41% vs. 37%, OR = 1.3, 95% CI 1.1-1.6) co-prescribed, and less often to have laxatives (8% vs. 5%, OR = 0.66, 95% CI 0.48-0.9) and anticoagulants (22% vs. 15%, OR = 0.56, 95% CI 0.46-0.68) co-prescribed compared to non-users. Conclusions: The pattern of prescribing HU, supported by the association findings, raises concerns about patients' compliance and adherence to HU therapy. Early health education, specifically to young female SCD patients, is warranted to increase the success rate of HU therapy.

Predictive Value of PHRI for Recurrence within One Year after UC Treatment: A Retrospective Study.

Aims/Background Accurate prediction of recurrence after treatment is crucial for controlling the progression and improving the prognosis of active ulcerative colitis (UC) patients. Previous studies have evaluated the therapeutic response in UC patients by assessing mucosal healing, using measures such as the Paddington International Virtual ChromoendoScopy Score (PICaSSO) and the PICaSSO Histological Remission Index (PHRI). The PHRI is effective for evaluating treatment response and disease control in UC patients, but its predictive value for short-term recurrence has not been reported in the literature. Therefore, this retrospective analysis of clinical data aims to explore the predictive value of the PHRI and provide a reference for improving the prognosis of UC patients. Methods Clinical data of UC patients in clinical remission admitted to our hospital from June 2017 to June 2023 were retrospectively collected. Patients were divided into the recurrence group and the non-recurrence group, based on whether they experienced recurrence during the one-year follow-up. Clinical data, laboratory test results, and PHRI scores were collected. Variables that showed statistically significant differences between groups in univariate analysis were included in multivariate logistic regression analysis. The predictive value of PHRI was analyzed with receiver operating characteristic (ROC) curve analysis. Results One hundred and two UC patients in the clinical remission stage were included in this study, and there were no cases of loss to follow-up. Among them, 36 patients (35.29%) experienced recurrence within the one-year follow-up, whereas 66 patients (64.71%) did not. Compared with the non-recurrence group, the recurrence group had a more number of cases with lesions in the left-sided colon and extensive colon, higher percentages of cases that were moderate or severe, and a significantly higher colonoscopy score (p < 0.05). Compared with the non-recurrence group, the PHRI score of the recurrence group was significantly higher (p < 0.001). Multivariate logistic regression analysis showed that that the lesion range (OR = 4.127, p = 0.005), disease severity (OR = 3.889, p = 0.019), colonoscopy score (OR = 6.128, p < 0.001), and PHRI score (OR = 5.466, p < 0.001) were independent risk factors for recurrence in UC patients. The results of ROC curve analysis showed that the area under the curve of the PHRI score in predicting the recurrence of UC patients was 0.838 (95% CI: 0.760-0.916). When the optimal cut-off value was 1 point, the sensitivity and specificity were the highest, which were 89.58% and 65.58%, respectively, indicating that PHRI score had good predictive value. Conclusion The lesion extent, disease severity, endoscopic score, and PHRI score are associated with recurrence within one year in UC patients in the clinical remission stage, and the PHRI score has good predictive value.

Plasma and serum volume remain unchanged following a 12-h fast from food and drink despite changes in blood and urinary hydration markers.

The effect of mild dehydration on plasma and serum volume has not been well established. Furthermore, the ability of urinary and blood biomarkers to monitor small hydration changes have not been solidified. There were two objectives of this research: 1. Determine if mild dehydration affects plasma and serum volume; 2. Determine if mild dehydration can be detected better by urinary or blood biomarkers. 47 subjects were recruited; 10 subjects were removed from the study and 37 subjects (27% male) completed the study. This was a crossover study design such that each subject underwent all protocols in a counterbalanced order. Protocols consisted of 12-h dehydration, 12-h hydration, and control. Neither plasma volume (p = 0.914), plasma volume status (p = 0.649), nor serum volume (p = 0.273) were different among protocols. Body mass (p < 0.001) was lower following the dehydration protocol. Urine color (p < 0.001), urine osmolality (p < 0.001), urine specific gravity (p < 0.001), serum osmolality (p < 0.001), and plasma osmolality (p < 0.001) were all lower following the hydration protocol. Hematocrit (p = 0.842) and hemoglobin concentration (p = 0.558) were not different among protocols. Dehydration did not affect plasma or serum volume. Therefore, a 12-h fast from food and water as done in this study will not likely affect laboratory test results of biomarker concentration. All 3 urinary measures were able to detect changes in hydration status, whereas only 2 blood measures were able to detect changes in hydration status. This may indicate that urinary measures are best at detecting small changes in hydration status.

Carbon dioxide emission evaluation of biochar based vegetation concrete for ecological restoration projects

Vegetation concrete is increasingly being used for slope stabilization in highways, green roofing in urban developments, and erosion control in coastal areas due to its sustainable solutions for enhancing landscape aesthetics, mitigating pollution, and protecting the environment. However, the environmental and economic impacts of different mix proportions, particularly concerning CO2 emissions, remain insufficiently explored. This study aimed to identify the optimal mix proportions of vegetation concrete through laboratory testing that minimize CO2 emissions while ensuring compatibility with plant growth and cost-effectiveness. The vegetation concrete mix were prepared using different quantities of biochar (5 %, 10 %, and 15 %) and cement content (4 %, 8 %, and 12 %) by weight to evaluate their impact on porosity, unconfined compressive strength (UCS), alkalinity, plant compatibility, cost-effectiveness, and CO2 emissions from raw materials. The results indicate that increasing the biochar content from 0 % to 15 % led to a 16 % reduction in porosity and a 92 % increase in UCS of vegetation concrete. Similarly, increasing the cement content from 0 % to 12 % resulted in an 11 % decrease in porosity and a substantial 200 % increase in the UCS of vegetation concrete. Moreover, the addition of 5 % biochar had a beneficial effect on plant growth, however, increasing the biochar content beyond this level adversely impacted plant development. Based on laboratory test results, the recommended optimal mix for vegetation concrete includes a mix of 5 % biochar, 8 % low-alkaline sulfoaluminate cement, 6 % sawdust, and 6 % ferrous sulfate. The analysis of CO2 emission of the materials studied showed that cement contributed the most to CO2 emissions, followed by biochar, sawdust, water, and soil. Notably, the utilization of sulfoaluminate cement led to a 31.8 % reduction in CO2 emissions compared to Portland cement, while also lowering the overall cost of vegetation concrete by 24.7–33.8 %. This research underscores the necessity of scientifically establishing relationships between the composition of plant-based concretes and their environmental and economic performance. In summary, this study identifies optimal mix proportions for vegetation concrete, leveraging low-alkaline sulfoaluminate cement and biochar to minimize CO2 emissions, enhance landscape aesthetics, and ensure compatibility with plant growth, thus emphasizing its potential as a sustainable and cost-effective construction material.

Strain-softening model for granite and sandstone based on experimental and discrete element methods

Combing macroscopic experimental method and mesoscopic numerical method, this study analyses the strain-softening behaviours of granite and sandstone. From the macroscopic perspective, the stress–strain curves of granite and sandstone under different confining pressures are studied by laboratory triaxial compression test. Variations of post-peak reduction modulus and critical plastic shear strain versus confining stress are obtained. Evolution of strength parameters at peak, residual and strain-softening stage are proposed. Then a method to develop the strain-softening model of hard and soft rocks is presented. From the mesoscopic perspective, based on the laboratory test results, the parameters of discrete element method PFC for the samples of the granite and sandstone are calibrated. Comparing the basically consistent results of laboratory experiment and numerical simulation, the feasibility of discrete element method is verified. Evolutions of mesoscopic crack propagation and mesoscopic particle displacement field in the complete failure process are analysed. Typical stresses of granite sample and sandstone sample in the failure stage are investigated. Above combined macroscopic experimental method and mesoscopic numerical method systematically analyse the characteristics of hard rock and soft rock in the strain-softening stage. Failure process and mechanical property of hard rock and soft rock are revealed at the macroscopic and mesoscopic levels. The initiation and propagation process of micro-cracks in rock are thoroughly investigated. The research results provide a scientific foundation for the analyse of strain-softening behaviour of hard rock and soft rock. The result shows that both the mesoscopic numerical method and macroscopic experimental method indicate that the failure pattern of sandstone is influenced by both confining pressure and axial stress, while granite is mainly affected by axial stress.

Comprehensive comparative evaluation of the eight pediatric estimated glomerular filtration rate equations in a large Korean pediatric patient cohort

IntroductionAlthough estimated glomerular filtration rate (eGFR) are continuously developed for pediatric population, impact of height measurement is often neglected due to variable dynamic growth changes in children. This study aimed to compare differential impacts of eGFR values calculated by six equations that do not use height information. Materials and methods3503 Korean pediatric patients with creatinine/cystatin C assay-based laboratory results from 2008 to 2021 were analyzed for clinical course using a total of 8113 laboratory test results. Baseline eGFR was calculated by eight different equations including two widely used equations incorporating height parameter. Along with the agreement of CKD (chronic kidney disease) stage categorization by different equations, clinical outcome of incident CKD diagnosis in 13 years of study period were compared. ResultsAmong a total of 28 pairwise comparisons among eight equations, only 4 combinations of comparisons revealed optimal P15 values (≥80 % concordance), with FAS-age equation being both concordant with two equations using height parameter. Clustering of eight equations by incident CKD diagnosis in subsequent tests also highlighted FAS-age as candidate equation within the same cluster with Schwartz-bedside and FAS-height equations. When the equation values were classified into Kidney Disease Improving Global Outcomes (KDIGO) CKD stages, the distribution patterns for stage 1 and 5 were significantly different among eGFR equations. FAS-age equation revealed the highest agreement with Schwartz-bedside and FAS-height equations that incorporate the height data. ConclusionsThe eGFR equation type should be considered to establish the eGFR intervals for CKD stage classification, particularly in the pediatric patient population. Cautious interpretation is required for eGFR value along with clinical context.

Maternal periconception hyperglycemia, preconception diabetes, and risk of major congenital malformations in offspring.

What are the roles of maternal preconception diabetes and related periconceptional hyperglycemia on the risk of major congenital malformations (MCMs) in offspring? Maternal periconceptional glycated hemoglobin (HbA1c) levels over 5.6% were associated with an increased risk of congenital heart defects (CHD) in the offspring, and maternal preconception diabetes was associated with an increased risk of CHD, including when HbA1c levels were within euglycemic ranges. Maternal preconception diabetes has been linked with MCMs in the offspring. However, evidence concerning associations with specific periconception serum measures of hyperglycemia, and susceptibility of different organ systems, is inconsistent. Moreover, limited evidence exists concerning the effectiveness of antidiabetic medications in mitigating diabetes-related teratogenic risks. A large Israeli birth cohort of 46534 children born in 2001-2020. Maternal HbA1c test results were obtained from 90 days before conception to mid-pregnancy. Maternal diabetes, other cardiometabolic conditions, and MCMs in newborns were ascertained based on clinical diagnoses, medication dispensing records, and laboratory test results using previously validated algorithms. Associations were modeled using generalized additive logistic regression models with thin plate penalized splines. Maternal periconceptional HbA1c value was associated with CHD in newborns, with the risk starting to increase at HbA1c values exceeding 5.6%. The association between HbA1c and CHD was stronger among mothers with type 2 diabetes mellitus (T2DM) compared to the other diabetes groups. Maternal pre-existing T2DM was associated with CHD even after accounting for HbA1C levels and other cardiometabolic comorbidities (odds ratio (OR)=1.89, 95% CI 1.18, 3.03); and the OR was materially unchanged when only mothers with pre-existing T2DM who had high adherence to antidiabetic medications and normal HbA1c levels were considered. The rarity of some specific malformation groups limited the ability to conduct more granular analyses. The use of HbA1c as a time-aggregated measure of glycemic control may miss transient glycemic dysregulation that could be clinically meaningful for teratogenic risks. The observed association between pre-existing diabetes and the risk of malformations within HbA1c levels suggests underlying causal pathways that are partly independent of maternal glucose control. Therefore, treatments for hyperglycemia might not completely mitigate the teratogenic risk associated with maternal preconception diabetes. The work was supported by NIH grants K99ES035433, R01HD097778, and P30ES000002. None of the authors reports competing interests. N/A.

Association between ATG16L1 rs2241880(T300A) and rs4663421 and ANCA‑associated vasculitis in the Guangxi population of China: Propensity score matching analysis.

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a rare autoimmune disease with an unclear pathogenesis. The present study investigated the associations between autophagy-related protein 16-like 1 (ATG16L1) rs2241880(T300A) and rs4663421 and AAV. A total of 177 patients with AAV and 216 healthy controls were included. Propensity score matching was used to match the two groups of subjects in terms of sex, age and ethnicity. Analyses of the relationships between these genetic polymorphisms and AAV susceptibility, including comparisons of allele and genotype frequency distribution, linkage disequilibrium analysis and analysis of single nucleotide polymorphism (SNP) interactions between two loci were performed. The association between the loci and laboratory test results and renal pathology were also analysed. A total of 154 pairs of patients with AAV and healthy controls was successfully matched. Neither polymorphism was associated with AAV susceptibility. However, SNP interaction in the model constructed with the two loci was statistically significant (P=0.018), and the combination of the AA genotype of rs2241880(T300A) and GG genotype of rs4663421 was associated the highest disease risk. The differences in the Birmingham Vasculitis Activity Score (BVAS), C-reactive protein (CRP) levels and 24-h urine protein level between patients with the rs2241880(T300A) AA + AG genotypes and the GG genotype were statistically significant (P<0.05). Furthermore, significant differences in the severity of glomerulosclerosis and global sclerosis were detected between individuals with the AA + AG genotype and those with the GG genotype at the rs2241880(T300A) locus (P<0.05). Similarly, there were statistically significant differences in degree of segmental sclerosis between individuals with CC + CG genotypes and those with GG genotypes at the rs2243421 locus (P<0.05). In summary, the single gene polymorphisms of these loci were not associated with genetic susceptibility to AAV. However, SNP interactions may serve a role in the risk of AAV. The rs2241880(T300A) polymorphism may be associated with BVAS, CRP levels and 24-h urine protein level in AAV. These SNPs may be associated with glomerulosclerosis and segmental sclerosis.

Initial Study on the Impact of Probiotics on Postoperative Gastrointestinal Symptoms and Gut Microbiota after Sleeve Gastrectomy: A Placebo-Controlled Study.

Sleeve gastrectomy (SG) has become the predominant bariatric surgery, leading to significant weight loss and reductions in obesity-related complications. However, postoperative gastrointestinal symptoms such as constipation and bloating are common. This study aims to evaluate the impact of probiotic supplementation on postoperative gastrointestinal symptoms in patients undergoing SG. The secondary aim is to analyze laboratory and stool test results. This prospective, placebo-controlled study included patients undergoing SG at a single center. Participants were adults without specific gastrointestinal diseases. They were randomly assigned to either the Probiotics or Controls group. Gastrointestinal symptoms and laboratory and stool tests were assessed before surgery and one month after. Thirty-one patients participated, with 15 in the Probiotics group and 16 in the Controls group. Probiotic supplementation significantly increased the number of stools per week (p = 0.027) and reduced constipation incidence (p = 0.002). Patients in the Probiotics group reported easier defecation and greater bowel movement completeness (p = 0.015, p = 0.004). No significant differences in weight loss or laboratory tests were observed between the groups. Stool microbiota analysis showed a return to normal levels of Enterococcus faecalis, Enterococcus faecium, and Clostridium perfringens in the Probiotics group and an increase in the Controls group. Probiotic supplementation after SG significantly reduces constipation without adverse effects. These findings suggest that incorporating probiotics into postoperative care protocols can enhance patient comfort and recovery.

Methylene blue therapy in addition to standard treatment for acute-phase septic shock: a pilot randomized controlled trial.

Methylene blue (MB) has been used to increase blood pressure in patients with septic shock by acting on guanylate cyclase and nitric oxide synthase. To determine whether the administration of MB to patients in the initial phase of septic shock leads to a reduction in the use of vasopressors compared to the Control group. This was a 1:1 randomized clinical trial of two groups (MB and Control). Forty-two patients were included in the present study; 23 patients were allocated to the Control group, and 19 were randomized to the MB group. Both groups had access to standard treatment, consisting of fluid replacement, vasopressors, and antibiotic therapy. Patients received a loading dose of MB (3 mg/kg) and maintenance (0.5 mg/kg/h) for 48 h. Vasopressor doses, laboratory test results, inflammatory and anti-inflammatory cytokine levels, and hemodynamic monitoring were recorded before the infusion of MB (T1) and after 20 min (T2), 2 h (T3), 24 h (T4), 48 h after the infusion started (T5) and 24 h after weaning (T6). MB therapy was started together with the indication of vasopressin (VAS) as a second vasopressor. The MB group showed an immediate reduction in NOR dosage, an earlier reduction in VAS dosage, and higher IL-10 levels compared to the Control group. Early administration of MB in combination with standard treatment for septic shock might be reduce vasopressors dose. Continuous infusion of MB for 48 h was considered safe and there was no adverse events. These results highlight the potential of MB as a safe adjuvant therapeutic option in the treatment of septic shock. https://clinicaltrials.gov/, identifier RBR-96584w4.

The relationship between the Barthel Index and stroke-associated pneumonia in elderly patients and factors of SAP

BackgroundStroke-associated pneumonia (SAP) is a common complication in stroke patients, and the Barthel Index (BI) is a well-established metric for assessing activities of daily living (ADL). However, the association between BI and SAP in acute ischemic stroke (AIS) patients remains unclear. This study aims to investigate the relationship between BI at admission and SAP, and explore the factors in AIS elderly patients.MethodRetrospective data were collected from ischemic stroke patients hospitalized at the Second Affiliated Hospital of Nanchang University between January 2018 and July 2021, including their basic demographic and laboratory test results. Restricted cubic spline regression, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were employed to investigate the relationship between BI and SAP. Additionally, the Shapley Additive exPlanations (SHAP) method was used to identify the factors influencing SAP.ResultsThe study included 7,548 eligible stroke patients with a mean age of 75.1 ± 7.6 years, among which 41.14% were female. The SAP group demonstrated significantly lower BI compared to the non-SAP group (50.86 ± 35.60 vs. 75.27 ± 26.33, P < 0.001). Additionally, a conspicuous trend of decreasing SAP risk across the Q1-4 groups was observed (P < 0.001). The RCS analysis further confirmed a gradual reduction in SAP risk with increasing BI. Based on the clinical model, both the BI (NRI = 0.014, P = 0.005; IDI = 0.04, P < 0.001) and the NIHSS score (NRI = 0.09, P = 0.03; IDI = 0.025, P < 0.001) demonstrated additional predictive value for SAP. Multivariate logistic regression and SHAP analysis identified WBC, CONUT, TG, UA, and RBC levels, as well as the type of health insurance (urban employee basic medical insurance), as important independent predictors of SAP.ConclusionBI at admission constitutes a risk factor for the onset of SAP in elderly patients with AIS, Compared to the NIHSS and mRS score, BI may be a more reliable and practical predictor of SAP.

A Clinical-Electrographic Profile of Neonatal Seizures and Their Etiologies in a Single Level III Neonatal Intensive Care Unit

Background: Seizures are the most frequent neurological emergency in neonatal period and can be associated with significant mortality and subsequent neuro-developmental disability if not recognized and managed early. Repaid identification of neonatal seizures and evaluation is critically required to identify and treat the underlying etiology. Clinicians face a major challenge in diagnosing and treating neonatal seizure because of inconspicuous clinical presentation, variable electro-clinical correlation. Assessing the combination of clinical presentation, etiological factors, different diagnostic tools, and treatments, can broaden the knowledge and understanding towards neonatal seizure providing better management and outcome. Objective: To study the characteristics of clinical and electrographic profile of neonatal seizure and the relations to their etiologies in neonatal intensive care unit. Methods: This is a descriptive cross sectional retrospective study of electronic health records with ICD- 10 diagnosis of neonatal seizure from birth to 28 days, who were admitted to neonatal intensive care unit at Sheikh Shakhbout Medical City between January 2020 to December 2021. Clinical data obtained including basic demographics: gender, gestational age, mode of delivery, birth weight, and Apgar score. Onset and type seizure, type of antiepileptic drugs administered, EEG findings, brain imaging, results of relevant laboratory tests and etiology of seizure were collected. Results: Total 31 neonates included in the study. Majority were male (71%), term (87%), and birth weight &gt;2,5 kg (90%). Seizure within 24 hours was 58% and semiology was focal clonic in 32% of patient. No events in EEG in 81% and 6% had electrographic seizure (n=2). 94 % were treated with anti-convulsant, 86% of them before EEG. The majority (86%) received phenobarbitone as 1st line treatment and 83% received monotherapy. Leading causes of seizure were HIE (48%) followed by Vascular causes (16%). Seizure within 24 hours caused mainly by HIE (61%) and 60% of neonates with vascular and all infectious and genetic causes had seizure after 24 hours. In vascular causes, (60%) presented with focal clonic seizure. 60% of Multifocal epileptiform activity seen in HIE whereas focal presented more in vascular patient (36%). In HIE cases, 53% had normal brain MRI and 47% were abnormal. All cases with vascular causes had diagnostic abnormal MRI. The majority of HIE cases (87%) and all vascular cases received monotherapy. Conclusion: In this descriptive study of neonatal seizure, certain demographic data, clinical and electrographic characteristics had established links to their etiologies. Clinical events captured during EEG with no electrographic seizure are classified as non-epileptic clinical phenomenon. Diagnostic utility of EEG is required in diagnosis of involuntary movements and avoid unnecessary anti-seizure medications. Understanding the clinical-electrographic profile of neonatal seizure helps in the early recognition of specific etiologies, allowing an early diagnosis by organized diagnostic approach and management.