Long-term Studies Research Articles

Long-term comparison and performance study of consumer grade electronic radon integrating monitors.

This study reports the performance of 7 types of consumer grade passive Electronic Radon Integrating Monitors, ERIM (AlphaE, AER Plus, Canary, Corentium Pro, Radon Scout Home, Ramon and Wave) and passive etched track radon detectors. All monitors and passive radon detectors were exposed side by side for 2 periods of 3 months under controlled conditions in the UKHSA radon chamber and in a stainless steel container to an average radon concentration of 4781 Bq m-3 and 166 Bq m-3, respectively. The performance of each individual monitor was compared with Atmos 12DPX and AlphaGUARD P30 reference instruments. The performance of the monitors was evaluated by estimating the biased, precision and measurement errors of each type. &#xD;It was found that UKHSA passive radon detectors showed excellent performance (measurement error < 10%) at both higher and lower exposures. The AlphaE, Canary and Ramon showed excellent performance, with measurement error < 10%, when they were exposed to radon concentrations between 4000 Bq m-3 and 6000 Bq m-3 in the UKHSA radon chamber. However, when the monitors were exposed to radon levels below the UK radon Action Level of 200 Bq m-3, the only ERIM which had a measurement error <10% was the Radon Scout Home. All other monitors showed a significant decrease in their performance with measurement errors ranging between 20% and 50%. &#xD;The calibration factor, which is the ratio between the measured value (background is subtracted) and the reference value, was also studied. It was found that the calibration factors of individual monitors changed significantly. Calibration measurements in 2019 and in 2023 found that the percentage change varied between -46% and +63%. This shows the importance of initial and regular calibration, and maintenance of the monitors.&#xD.

Effects of Immersive Technology-Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach.

The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs. This systematic review aimed to identify the contents of immersive technology-based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature. A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology-based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%). These findings support the effectiveness of immersive technology-based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology-based nursing education on NWKM level 4.

Annotated catalogue of Pakistani Acrididae (Orthoptera: Caelifera: Acridoidea)

An annotated catalogue of Acrididae (Orthoptera: Caelifera) of Pakistan and its two adjacent territories is presented. A total of 169 species (including subspecies) belonged to 66 genera and 29 tribes with 14 subfamilies are reported from this region. Oedipodinae (56) was the most species-rich subfamily, followed by Gomphocerinae (30), Acridinae (15), Calliptaminae with (12), Eyprepocnemidinae (12) Oxyinae (9), Hemiacridinae (10), Cyrtacanthacridinae (8), Catantopinae (7), Tropidopolinae and Teratodinae each with (3), Spathosterninae (2) and Coptacrinae, and Melanoplinae are represented by a single species. Pakistan harbors about 51.76% of the Acridomorpha species recorded for subtropical Asia, including 13.61% of the Caelifera, are endemic. Since the first checklist was published in 1990, which listed 39 species, hundreds of additional specimens from the region have been collected and databased, new species have been described, and the taxonomic status of some species has changed. Due to a lack of long-term studies for most localities, several species that were new at the time of collection are meanwhile described from other areas of Southeastern Asia. Specimen data from insect collections, databases, scientific literature, and unpublished records were compared to the original checklist. Our list includes three endemic species, 11 rare species, seven first-time reports, including five expected and 18 dubious records. Additionally, there are a few species from protected areas, although no consistent analysis has yet been done on species restricted to protected areas in Pakistan. A detailed account of subfamilies, endemic and rare species, and those anticipated to occur in Pakistan is also presented. This checklist provides baseline data for researchers and the public, strengthening the pest framework for management.

Uncovering efficient operational strategies for simultaneous anammox and heterotrophic denitrification (SAD) granular process at different nitrogen loadings: A model-based evaluation

The simultaneous anammox and denitrification granular process effectively removes nitrogen and organic matter, but its optimization for variable nitrogen loading rates (NLRs) is challenging due to regulatory complexities and delays. This study developed and evaluated a modified model to determine an effective operational strategy, using data from batch tests and long-term experiments. Simulations revealed a spatial cross-distribution of anammox bacteria and heterotrophic denitrification bacteria (HDB) within the granules, and HDB tended to grow on the surface. Higher NLRs (from 0.35 to 14.06 kg N (m3·d)−1) extended the time to reach steady state, limiting the treatment capacity to 7.73 kg N (m3·d)−1 at NH4+-N/NO2−-N/COD = 1:1.32: 0.5. At different influent NH4+-N concentrations (NH4+-NInf: 40, 150, and 300 g N m−3), single-factor simulations showed that optimal nitrogen removal and granular stability were achieved at specific NO2−-N/NH4+-N ratios (1.2–1.3), C/N ratios (1.2–0.8), and particle sizes (500–1000 μm). Adjusting the NO2−-N/NH4+-N (1.0–1.6) and C/N ratios (0.2–1.2) zones synergistically improved the operational efficiency (TN removal efficiency >90 %). Notably, elevated NH4+-NInf amplified single-factor effects, complicating efficient optimization. These insights significantly inform the process design and operation in varying NLR wastewater contexts.

Sheep rotational grazing strategy to improve soil organic carbon and reduce carbon dioxide emission from spring wheat in an arid region

Context Cultivating forage crops is crucial to improve feed production, and grazing is an important utilisation method to improve soil fertility. Aim Improving soil organic carbon (SOC) content and reducing carbon dioxide (CO2) emission through grazing management from a spring wheat field. Methods We compared sheep rotational grazing and control, and studied their effects on SOC and CO2 emission from a spring wheat field. Key results Sheep rotational grazing improved SOC content (by 23.5%) and soil easily oxidised organic carbon (EOC) content (by 7.7%) and reduces soil microbial biomass carbon (MBC) content (by 35.8%) compared with the control. Sheep rotational grazing reduced CO2 emission compared with the control. Sheep grazing reduced cumulative CO2 emission by 28.9% and 33.0% in May and June compared with the control. Conclusions Sheep grazing improved SOC content and reduce CO2 emission from a spring wheat field. Implications Based on our short-term study, sheep rotational grazing has a significant effect on SOC, EOC and MBC contents and CO2 emission from spring wheat fields in arid regions. For a large-scale assessment of sheep grazing on soil fertility and CO2 emission, more investigation for different soils and climates is necessary. Furthermore, a long-term study is also necessary to better understand the effect of sheep rotational grazing on soil fertility and CO2 emission from spring wheat fields in arid regions.

СЕЛЕКЦИОННЫЕ КРИТЕРИИ ЗАСУХОУСТОЙЧИВОСТИ ТВЕРДОЙ ЯРОВОЙ ПШЕНИЦЫ В УСЛОВИЯХ ЗАПАДНОЙ СИБИРИ

The aim of research is to conduct a comparative assessment of varieties of durum spring wheat for drought resistance in the conditions of Western Siberia. The experiments were laid out after fallow in the conditions of the southern forest-steppe at the stationary site of the laboratory of selection of durum wheat of the Federal State Budgetary Scientific Institution Omsk Scientific Center. In long-term studies (2001–2018) on a large set of varieties (26), when studying the yield, the number of grains in an ear, the weight of 1000 grains, the parameters of drought resistance were determined. In this case, the following indicators for these traits were calculated: average over the years of research, average in dry years, average in favorable years, the degree of reduction under stress compared to conditions without stress, the drought resistance index (DSI according to R.A. Fischer, R. Maurer). Tests on the studied characteristics revealed the following varieties: by yield – Omskiy Izumrud, Aleyskaya, Omskaya Stepnaya, Zhemchuzhina Sibiri, by weight of 1000 grains – Bezenchukskaya Stepnaya, Omskaya Stepnaya, Aleyskaya, Elizavetinskaya, Svetlana, by the number of grains in an ear – Omskiy Izumrud, Saratovskaya Zolotistaya, Zhemchuzhina Sibiri, Omskaya Stepnaya, Bezenchukskaya Stepnaya. According to the general integrated assessment, the best indicators were obtained for the varieties Omskaya Stepnaya, Omskiy Izumrud, Bezenchukskaya Stepnaya, Aleyskaya, Zhemchuzhina Sibiri, Saratovskaya Zolotistaya. The indicators of average values under drought, the degree of reduction under stress conditions, the drought resistance index for grain yield, 1000-grain weight, and the number of grains in an ear are reliable criteria for drought resistance of hard spring wheat. The best differentiating ability is possessed by tests calculated by yield and the number of grains in an ear.

A 3D-printed tumor-on-chip: user-friendly platform for the culture of breast cancer spheroids and the evaluation of anti-cancer drugs

Tumor-on-chips (ToCs) are useful platforms for studying the physiology of tumors and evaluating the efficacy and toxicity of anti-cancer drugs. However, the design and fabrication of a ToC system is not a trivial venture. We introduce a user-friendly, flexible, 3D-printed microfluidic device that can be used to culture cancer cells or cancer-derived spheroids embedded in hydrogels under well-controlled environments. The system consists of two lateral flow compartments (left and right sides), each with two inlets and two outlets to deliver cell culture media as continuous liquid streams. The central compartment was designed to host a hydrogel in which cells and microtissues can be confined and cultured. We performed tracer experiments with colored inks and 40 kDa fluorescein isothiocyanate dextran to characterize the transport/mixing performances of the system. We also cultured homotypic (MCF7) and heterotypic (MCF7-BJ) spheroids embedded in gelatin methacryloyl hydrogels to illustrate the use of this microfluidic device in sustaining long-term micro-tissue culture experiments. We further demonstrated the use of this platform in anticancer drug testing by continuous perfusion of doxorubicin, a commonly used anti-cancer drug for breast cancer. In these experiments, we evaluated drug transport, viability, glucose consumption, cell death (apoptosis), and cytotoxicity. In summary, we introduce a robust and friendly ToC system capable of recapitulating relevant aspects of the tumor microenvironment for the study of cancer physiology, anti-cancer drug transport, efficacy, and safety. We anticipate that this flexible 3D-printed microfluidic device may facilitate cancer research and the development and screening of strategies for personalized medicine.

ЗЕРНОПРОДУКТИВНОСТЬ И АДАПТАЦИОННЫЙ ПОТЕНЦИАЛ СОРТОВ ЛЮПИНА УЗКОЛИСТНОГО В УСЛОВИЯХ КРАСНОЯРСКОЙ ЛЕСОСТЕПИ

The aim of research is to evaluate the varieties of angustifolia lupine in terms of grain yield and adaptability parameters in the conditions of the Krasnoyarsk forest-steppe. Long-term field experiments were carried out on the experimental field of the Borsky Scientific and Production Complex of the Krasnoyarsk State Agrarian University in 2020–2022. The objects of the study are the varieties of narrow-leaved lupine: Vityaz, Belozerny 110, Belorozovy 144, Bryansky Kormovoy, Nadezhda, Siderat 46, Uzkolistny 53 and the SN 78-07 variety sample. Meteorological conditions during the years of the study varied. The 2020 growing season was warm and moisture-rich, the environmental conditions index (Ij) was 4.7. In 2021, during the main periods of growth and development, with the exception of the 3rd ten-day period of June, there was a significant moisture deficit against the background of air temperatures exceeding the climatic norm, the environmental conditions index was negative (–3.8). In 2022, uneven moisture was observed, sharp temperature changes at the beginning of plant development, the environmental conditions index was negative (–0.9). The average grain yield varied from 11.5 c/ha (variety Nadezhda) to 20.3 c/ha (variety Siderat 46). The contribution of the "vegetation conditions" factor to the formation of the lupine grain yield was 60.8 %, the contribution of the "variety" factor was 31.2 %. The varieties Belozerny 110 (bi = 1.16) and Siderat 46 (bi = 1.39) have high ecological plasticity. The highest ecological stability was noted in the varieties Siderat 46 and Uzkolistny 53, in both genotypes Sd2 = 0.02. The Vityaz variety surpasses other varieties in stress resistance. The highest genetic flexibility was demonstrated by the varieties Siderat 46, Vityaz, Belorozovy 144 and the variety sample SN 78-07. The yield range was 34.4 % (Vityaz) – 50.0 % (Nadezhda). In gene¬ral, according to the adaptive capabilities, the varieties of narrow-leaved lupine were distributed according to a decreasing trend as follows: Siderat 46 &gt; Vityaz &gt; SN 78-7 = Narrow-leaved 53 &gt; Belorozovy 144 &gt; Belozerny 110 &gt; Nadezhda &gt; Bryansky Kormovoy.

Drug survival analysis of dupilumab and associated predictors in patients with atopic dermatitis in South Korea: single-center, retrospective study

Dupilumab is a biologic medication that is used for the treatment of moderate-to-severe atopic dermatitis (AD). Long-term data on dupilumab drug survival in Asia patients with AD are limited. A single-center, retrospective study was performed to assess drug survival between March 2019 and March 2023. Drug survival and associated characteristics were analyzed using Kaplan–Meier survival curves and multivariate Cox regression analysis, respectively. A total of 124 patients with AD (Mean age [standard deviation], 26.0 [8.6] years) with a 4 years-overall dupilumab drug survival rate of 87.9%, were included in this study. Characteristics associated with shorter drug survival were the low eczema area and severity index (EASI) scores at baseline (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75–0.94, p-value = 0.003) and non-insurance coverage of dupilumab (HR 11.87; 95% CI 3.28–42.99, p-value = 0.001). This retrospective study demonstrated good overall 4-year dupilumab survival (87.6%) in South Korea. Patients with low baseline EASI scores and those who did not have insurance for dupilumab treatment discontinued the therapy frequently. To the best of our knowledge, this is the first long-term dupilumab drug survival study conducted in Asia with predictors.

Remote Sensing for Restoration Change Monitoring in Tropical Peat Swamp Forests in Malaysia

Effective planning and management strategies for restoring and conserving tropical peat swamp ecosystems require accurate and timely estimates of aboveground biomass (AGB), especially when monitoring the impacts of restoration interventions. The aim of this research is to assess changes in AGB and evaluate the effectiveness of restoration efforts in the North Selangor Peat Swamp Forest (NSPSF), one of the largest remaining peat swamp forests in Peninsular Malaysia, using advanced remote sensing techniques. A Random Forest machine learning method was employed to upscale AGB estimates, derived from a ‘LiDAR AGB model’, to larger landscape-scale areas with Sentinel-2 spectral and textural variables. The time period under investigation (2015–2018) marked a concentrated phase of restoration and regeneration efforts in NSPSF. The results demonstrate an overall increase in tropical peat swamp AGB during these years, where the total amount of estimated AGB stored in NSPSF increased from 19.3 Tg in 2015 to an estimated 19.8 Tg in 2018. The research found that a tailored variable selection approach improved predictions of AGB, with optimised input variables (n = 62) and parameter adjustments producing a good plausible result (R2 = 0.80; RMSE = 55.2 Mg/ha). This paper concludes by emphasizing the importance of long-term studies (&gt;5 years) for analyzing the success of tropical peat swamp restoration methods, with a potential for integrating remote sensing technology.

Interannual variability and seasonality of litterfall in three temperate and boreal forest ecosystems of eastern Canada: A synthesis of long-term monitoring

Litterfall is a major pathway for transferring aboveground biomass to the forest floor and thus plays an important role in building forest soil carbon stocks. However, inter- and intra-annual variability of litterfall remains poorly documented, especially in North American temperate and boreal forests, due to the lack of recent long-term studies at high sampling frequencies. This potentially creates uncertainties in estimates of forest carbon budget models. The objectives of the present study were to 1) quantify the mean annual flux, interannual variability, and seasonality of litterfall in three sites (dominated respectively by sugar maple (Acer saccharum Marsh.), balsam fir (Abies balsamea (L.) Mill. 1768), and black spruce (Picea mariana (Mill.) B.S.P.)) in eastern Canada over a period of 22–32 years, 2) relate the litterfall amounts and temporal variations to the changes in the size of major organic matter pools in these ecosystems, and 3) compare our litterfall estimates with reference values used in national greenhouse gas inventories. Litterfall production decreased from the sugar maple to the balsam fir and black spruce sites, preponderantly due to species composition. Litterfall evolution was related to the aboveground biomass of live trees in both conifer sites; in contrast, in the broadleaf site, changes in forest composition and structure were apparently the main drivers. The litterfall seasonality varied between broadleaf and conifer sites and could be explained by a sigmoidal model. Substantial departures from the seasonality for some given years were likely due to important climatic anomalies. Forest floor biomass remained stable over time at all three sites despite the increase in litterfall at the balsam fir and sugar maple sites and rapid forest floor turnover at the latter site. Our analyses of litterfall suggest that reference values from the literature used for national greenhouse gas inventories underestimate annual litterfall and forest floor carbon stocks for temperate and boreal forests.

Monitoring the lactation-related behaviors of sows and their piglets in farrowing crates using deep learning

Pig farming is a major sector of livestock production. The preweaning stage is a critical period in the pig farming process, where lactation-related behaviors between sows and their piglets directly influence the preweaning survivability of the piglets. Lactation-related behaviors are mutual interactions that require the combined monitoring of both the sow and her piglets. Conventional naked-eye observation is discontinuous and labor-intensive and may result in undetected abnormal behavior and economic losses. Thus, this study proposed to monitor the lactation-related behaviors of sows and their piglets simultaneously and continuously using computer vision. Videos were recorded from farrowing crates using embedded systems equipped with regular RGB cameras. The sow posture recognition model (SPRM), comprising a convolutional neural network (CNN) of the architecture EfficientNet and a long short-term memory network, was trained to identify seven postures of sows. The piglet localization and tracking model (PLTM), comprising a CNN of the architecture YOLOv7 and a simple online and realtime tracking algorithm, was trained to localize and track piglets in the farrowing crate. The sow posture information was then combined with the piglet activity to detect unfed piglets. The trained SPRM and PLTM reached an accuracy of 91.36% and a multiple object tracking accuracy of 94.6%. The performance of the proposed unfed piglet detection achieved a precision of 98.4% and a recall of 90.7%. A long-term experiment was conducted to monitor lactation-related behaviors of sows and their piglets from the birth of the piglets to day 15. The overall mean daily percentages ± standard deviations (SDs) of sow postures were 6.8% ± 2.9% for feeding, 8.8% ± 6.6% for standing, 11.8% ± 4.5% for sitting, 20.6% ± 16.3% for recumbency, 14.1% ± 6.5% for lying, and 38.1% ± 7.5% for lactating. The overall mean daily percentages ± SDs of piglet activities were 38.1% ± 7.5% for suckling, 22.2% ± 5.4% for active, and 39.7% ± 10.5% for rest. The proposed approach provides a total solution for the automatic monitoring of sows and their piglets in the farrowing house. This automatic detection of abnormal lactation-related behaviors can help in preventing piglet preweaning mortality and therefore aid pig farming efficiency.

Effectiveness and Duration of Action of Dolomite Screening Particles Used for Reclamation of Acidic Soils. Empirical Models of the Acidification Process of SodPodzolic Light Loamy Soil (according to Field Experience)

In a long-term 10-variant microfield experiment based on a mediumacidic sod-podzolic light loamy soil, a comparative study of the reclamation properties of the screening of dolomite crumbs stored in dumps, without separation into fractions (SIF), particles of 5–7 and 7–10 mm in size and dolomite flour (DF) prepared from the screening of dolomite when sifting dolomite crumbs with the diameter of the holes is 0/25 mm. The experiment lasts for 14 experimental years. It has been revealed that dolomite particles of 5–7 and 7–10 mm in size are valuable calcareous material. Their use leads to the neutralization of soil acidity already in the year of liming. The higher the dose of application, the greater the reclamation effect. There were no significant differences in the effect of granules of 5–7 and 7–10 mm in size, applied in equivalent doses, on the pH value. The positive effect of liming with meliorant in the amount of 3 and 5 doses of hydrolytic acidity (Ah) did not end after 14 experimental years after reclamation and allowed to postpone the period of repeated (maintenance) liming. The positive effect of using a natural mixture of chalk fractions (SIF) in a scientifically justified dose was inferior to dolomite flour. Clustering of individual variants of the experiment was carried out according to their effect on the рHKCl value for the entire period of the experiment. Linear trends of the averaged dependencies of the acidification process for meliorant particles of various sizes over the entire period of the experiment have been developed. The mechanisms of interaction of dolomite particles with soil in the process of land reclamation are considered.

Dynamics of the Humus State of Southern Chernozem with Prolonged Use of Mineral Fertilizers in the Conditions of the Steppe Volga Region

The results of monitoring the dynamics of humus and total nitrogen of the southern chernozem in a long-term stationary experiment with the use of mineral fertilizers are presented. In the first 3 rotations of the grain-to-crop rotation, intensive mineralization of humus was noted in all variants of the experiment. In the conditions of grainsteam crop rotation, this process slowed down, and in the variant with the use of minimum doses of nitrogenphosphorus fertilizers in the 6th rotation, the accumulation of humic substances was revealed. The maximum decrease in humus content at the end of 8 rotations of crop rotation (more than 48 years) was observed in variants with the introduction of medium and high doses of nitrogenphosphorus fertilizers. The use of a minimum dose of fertilizers best compensated for the loss of humus of the southern chernozem during prolonged agricultural use. In comparison with the initial data, negative changes in the qualitative composition of humus were noted in the experiment, expressed in a decrease in the proportion of humic acids. At the end of the 8th rotation, the total nitrogen content in the soil decreased in all variants of the experiment.

Novel approach for tracheal resection in Morquio a syndrome with end-stage critical airway obstruction: a UK case series

BackgroundMucopolysaccharidosis (MPS) type IVA is a rare lysosomal storage disorder caused by aberrations of the N-acetyl-galactosamine-6-sulfatase (GALNS) enzyme. MPS IVA is associated with a wide gamut of respiratory and airway disorders that manifest in a continuum of severity. In individuals exhibiting severe phenotypic expression, terminal stages of the disease frequently culminate in life-threatening, critical airway obstruction. These manifestations of end-stage disease are engendered by an insidious progression of multi-level airway pathologies, comprising of tracheomalacia, stenosis, tortuosity and 'buckling'. Historically, the management of end-stage airway disease has predominantly leaned towards palliative modalities. However, contemporary literature has posited that the potential benefits of tracheal resection with aortopexy, performed under cardiopulmonary bypass (CPB), may offer a promising therapeutic option. In this context, we report on outcomes from patients undergoing a novel approach to tracheal resection that is combined with manubrial resection, leading to improved airway calibre, obviating the requisition for CPB.ResultsIn this study, seven patients with severe MPS IVA exhibited clinical symptoms and radiological evidence indicative of advanced airway obstruction. All patients had a tracheal resection with a partial upper manubriectomy via transcervical approach, which did not require CPB. The surgical cohort consisted of 5 females and 2 males, the median age was 16 years (range 11-19) and the median height was 105.6cm (range 96.4-113.4). Postoperatively, significant improvements were seen in forced expiratory volume in 1 second (FEV1), with a mean increase of 0.68 litres (95% CI: 0.45-0.91; SD: 0.20). Notably, other spirometry variables also showed meaningful improvements, providing evidence of positive treatment effects. Furthermore, there were no major long-term complications, and the procedure resulted in a significant enhancement in patient-reported domains using PedsQL (version 4.0).ConclusionsThis study represents the largest case series to date, on tracheal resection in patients with severe MPS IVA. Our findings demonstrate the effectiveness of the transcervical approach with partial manubriectomy for improving respiratory function and quality of life for individuals with advanced airway obstruction. Tracheal resection presents a promising treatment modality for severe cases of MPS IVA. Successful outcomes rely on meticulous multidisciplinary assessment, judicious decision-making, and appropriate timing of tracheal surgery. Further research and long-term follow-up studies are warranted to validate the long-term efficacy and safety of this approach.

A Decision Tree Model to Help Treatment Decision-Making for Unruptured Intracranial Aneurysms: A Multi-center, Long-Term Follow-up Study in a Large Chinese Cohort.

Chinese population have a high prevalence of unruptured intracranial aneurysm (UIA). Clinical and imaging risk factors predicting UIA growth or rupture are poorly understood in the Chinese population due to the lack of large-scale longitudinal studies, and the treatment decision for UIA patients was challenging. Develop a decision tree (DT) model for UIA instability, and validate its performance in multi-center studies. Single-UIA patients from two prospective, longitudinal multicenter cohort studies were analyzed, and set as the development cohort and validation cohort. The primary endpoint was UIA instability (rupture, growth, or morphological change). A DT was established within the development cohort and validated within the validation cohort. The performance of clinicians in identifying unstable UIAs before and after the help of the DT was compared using the area under curve (AUC). The development cohort included 1270 patients with 1270 UIAs and a follow-up duration of 47.2 ± 15.5months. Aneurysm instability occurred in 187 (14.7%) patients. Multivariate Cox analysis revealed hypertension (hazard ratio [HR], 1.54; 95%CI, 1.14-2.09), aspect ratio (HR, 1.22; 95%CI, 1.17-1.28), size ratio (HR, 1.31; 95%CI, 1.23-1.41), bifurcation configuration (HR, 2.05; 95%CI, 1.52-2.78) and irregular shape (HR, 4.30; 95%CI, 3.19-5.80) as factors of instability. In the validation cohort (n = 106, 12 was unstable), the DT model incorporating these factors was highly predictive of UIA instability (AUC, 0.88 [95%CI, 0.79-0.97]), and superior to existing UIA risk scales such as PHASES and ELAPSS (AUC, 0.77 [95%CI, 0.67-0.86] and 0.76 [95%CI, 0.66-0.86], P < 0.001). Within all 1376 single-UIA patients, the use of the DT significantly improved the accuracy of junior neurosurgical clinicians to identify unstable UIAs (AUC from 0.63 to 0.82, P < 0.001). The DT incorporating hypertension, aspect ratio, size ratio, bifurcation configuration and irregular shape was able to predict UIA instability better than existing clinical scales in Chinese cohorts. CLINICAL TRIAL REGISTRATION: IARP-CP cohort were included (unique identifier: ChiCTR1900024547. Published July 15, 2019. Completed December 30, 2020), with 100-Project phase-I cohort (unique identifier: NCT04872842, Published May 5, 2021. Completed November 8, 2022) as the development cohort. The 100-Project phase-II cohort (unique identifier: NCT05608122. Published November 8, 2022) as the validation cohort.

Ketamine Infusion for Reducing Post-Operative Pain and Opioid Use in Gynecological Surgery

This analysis aimed to evaluate the efficacy of ketamine infusion for reducing post-operative pain and opioid use in gynecological surgeries. A comprehensive review of recent studies revealed that ketamine consistently demonstrates significant pain-reducing and opioid-sparing effects across various surgical contexts, including gynecological procedures. Sub-anesthetic doses of ketamine were found to be effective and well-tolerated. However, optimal dosing regimens and timing of administration specific to gynecological surgeries require further investigation. The analysis recommends conducting large-scale, procedure-specific trials to establish tailored protocols for different gynecological surgeries. Additionally, long-term follow-up studies are needed to assess the impact on chronic pain development and persistent opioid use. This analysis is significant for refining pain management strategies in gynecological surgeries, potentially improving patient outcomes and addressing opioid-related concerns. It underscores the need for more flexible regulations to facilitate ketamine's clinical use in this context.

Long-Term Monitoring of Macroinvertebrate Community Assemblages and Species Composition on the Coast of Dokdo, East Sea of Korea

Dokdo Island’s diverse marine ecosystem requires long-term monitoring to understand the effects of rapid environmental changes, such as global warming, on macrobenthos species and communities. Current studies are often short-term and limited, highlighting the need for extended research to predict future changes to ecosystems. This study analyzed the environmental variables influencing macrobenthos through long-term monitoring. In total, 511 species (spp./23.4 m2) were identified with an abundance of 1709.9 individuals/m2 and a diversity of 2.9. Since 2020, there has been a decline in both the number of species and diversity, attributed to changes in sediment composition, particularly an increase in gravel and sand. The dominant species include the crustacean Abludomelita denticulata (17.6%), the polychaete Haplosyllis spongiphila (6.8%), the bivalve Glycymeris munda (5.6%), the polychaete Opisthodonta uraga (5.3%), and the bivalve Limatula japonica (3.8%). The macrobenthos community differs each year, as the dominant species G. munda has decreased in abundance since 2022 and L. japonica since 2021. Depth and gravel sediment strongly correlated with community variation. Site-specific analysis also showed significant differences, with depth, bottom temperature, and sediment composition as the influencing factors. These species thrive in cold water but their abundance declines with an increase in temperature. Continuous long-term monitoring is essential to understand and protect the Dokdo ecosystem amid rapid environmental changes. Long-term monitoring studies have revealed more species than have short-term studies, showing annual and site-specific environmental changes, including sediment erosion and bottom temperature increases. These changes have affected macrobenthos diversity, abundance, and community composition, necessitating ongoing research to determine the persistence of these trends and to protect the ecosystem.

Nationwide analysis of EVAR explantation outcomes in Korea: A comprehensive dataset study.

Endovascular aortic aneurysm repair (EVAR) is the primary treatment for abdominal aortic aneurysms, constituting 70%-80% of interventions. Despite initial benefits, long-term studies show increased mortality. Using nationwide data, this study assesses outcomes of EVAR, open aortic repair (OAR), and EVAR explantation (EE) in Korea, while exploring characteristics of late open conversion, including the rising EE incidence. Employing the National Health Insurance Service database, covering health-related data for nearly 50 million Koreans, the study spanned from 2002 to 2020. Patients with AAA diagnoses (I71.3 or I71.4) were categorized into OAR, EVAR, and EE groups based on procedural codes. Statistical analyses, including t-tests, Fisher's exact tests, Cox proportional hazard models, and multivariate Cox regression, assessed baseline characteristics, mortality risks, and factors within the EE group. The analysis encompassed 26,195 patients, with 66.19% in the EVAR group, 31.87% in the OAR group, and 1.94% in the EE group. EVAR cases steadily increased from 2002 to 2018. Survival rates favored EVAR, followed by OAR and EE. 30-day survival was lower in EE than EVAR. Multivariate analysis for EE revealed no risk factors for 30-days survival but identified age, chronic kidney disease, high Charlson Comorbidity Index scores, and less than 6months since EVAR as risk factors for overall mortality. Rising EE trends with increased EVAR adoption, particularly evident in the Korean dataset, underscore inferior outcomes. This highlights the critical need for strategic initial treatment decisions and timely interventions to enhance overall results and mitigate the unfavorable EE incidence.

Clinical and Economic Consequences of a First Major Bleeding Event in Patients Treated with Direct Factor Xa Inhibitors in Spain: A Long-Term Observational Study.

Aims: Our aims were to describe the clinical characteristics, adverse clinical events, healthcare resource utilization (HCRU) and costs of patients with major bleeding during direct Factor Xa inhibitor (FXai) use. Methods: This is a retrospective cohort study that included secondary data from computerized health records of seven Spanish Autonomous Communities. Patients with a first major bleeding during treatment with a direct FXai were analyzed during a 3-year period. Results: Of 8972 patients taking a direct FXai, 470 (5.24%) had major bleeding (mean age (SD) 77.93 (9.71) years, 61.06% women). The most frequent indications for using FXais were atrial fibrillation (78.09%) and venous thromboembolism (17.66%). Among those with major bleeding, 88.94% presented with gastrointestinal bleeding, 6.81% intracranial bleeding, 2.13% trauma-related bleeding and 4.26% other major bleeding. Prothrombin complex concentrates were used in 63.19%, followed by transfusion of blood products (20.21%) and Factor VIIa (7.66%). In total, 4.26% of patients died in the hospital due to the first major bleeding. At the study end (after 3-year follow-up), 28.94% of the patients had died, 12.34% had a myocardial infarction and 9.15% an ischemic stroke. At year 3, overall bleeding cost was EUR 5,816,930.5, of which 79.74% accounted for in-hospital costs to treat the bleeding episode. Conclusions: Despite the use of replacement agents being high, major events were common, with a 29% mortality at the end of the follow up, and HCRU and costs were high, evidencing the need for new reversal treatment strategies.