Low Rate Research Articles

The Time of Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding: An Observational Study

Objectives: In cases of nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic intervention within the first 24 hours is widely recommended. However, data on the efficacy of urgent endoscopy are limited. Here, we used the Glasgow–Blatchford score to assess bleeding outcomes based on time-to-endoscopy.Methods: Prospectively collected multicenter data, which included 1554 patients with NVUGIB, were retrospectively reviewed between February 2011 and December 2013. Based on time-to-endoscopy, patients were grouped into the early (<24 hours) versus the delayed (≥24 hours) group and the urgent (<6 hours) versus the nonurgent (≥6 hours) group. The rates of re-bleeding, mortality, secondary intervention, transfusion, and morbidity aggravation were analyzed.Results: The mean time-to-endoscopy and median Glasgow–Blatchford score were 33.0±75.5 hours and 12 (range: 1–23), respectively. Univariate analyses revealed that in the delayed endoscopy group, the transfusion and re-bleeding rates were higher (hazard ratio [HR]: 1.257, 95% confidence interval [CI]: 1.026–1.540) and lower (HR: 0.610, 95% CI: 0.413–0.901), respectively. Multivariate analysis revealed that delayed endoscopy was a significant factor for lower re-bleeding rate (HR: 0.576, 95% CI: 0.387– 0.859), which was prominent in the low-risk group (HR: 0.417, 95% CI: 0.225–0.774). Multivariate analysis showed that when compared with the low-risk group, in-hospital comorbidity aggravation was more common in high-risk patients who underwent non-urgent endoscopy (HR: 2.957, 95% CI: 1.045–6.454).Conclusions: In low-risk patients, delayed endoscopy is sufficient for NVUGIB management. In high-risk patients, urgent endoscopy reduced comorbidity aggravation during hospital care.

The role of intra-vascular imaging in patients undergoing intravascular lithotripsy: Insights from the COIL registry.

The role of intra-coronary imaging in patients with stent failure undergoing intravascular lithotripsy (IVL) is unclear. We aimed to assess clinical outcomes in patients undergoing IVL treatment for stent failure stratified according to the use of intra-coronary imaging and lesion complexity. This is a pre-specified subgroup analysis of patients who were included in the coronary intravascular lithotripsy in patients with stent failure (COIL) registry (international multi-centre study assessing IVL treatment for stent failure in 6 European centres). A complex lesion was defined if IVL treatment was used in the left main, true bifurcation, long lesion, or coupled with athero-ablative therapy. The primary endpoint was the composite of cardiac death, spontaneous myocardial infarction, or target vessel revascularization (TVR) at 12 months. There were 102 patients analyzed, of whom 27 (26%) patients had complex anatomy. The use of intra-coronary imaging following IVL in stent failure was more frequent in patients with complex versus Noncomplex anatomy (56% vs. 31%, p = 0.022). IVL treatment was effective in both groups, however, patients with complex anatomy had worse clinical outcomes (30% vs. 11%, p = 0.02), driven by a higher rate of TVR (26% vs. 8%, p = 0.017). In the complex group, patients who underwent intracoronary imaging post intervention had lower event rate compared to those without imaging (13% vs. 50%, p = 0.038). In patients undergoing IVL treatment for stent failure with complex coronary anatomy, the use of intra-coronary imaging was associated with fewer adverse events compared to angiography guided intervention.

Experimental and numerical investigation on the performance of binary solid-solid phase change materials with integrated heat pipe and aluminium foam based heat sink for thermal management of electronic systems

Phase change material (PCM) is widely utilised in thermal management systems (TMS), however its low thermal conductivity inhibits performance. Heat pipe and porous materials are incorporated into PCM due to their high thermal conductivities to form a hybrid system that substantially enhances PCM's heat transfer capability. This study investigates experimentally and numerically, the cooling performance of heat sink by integrating aluminium foam and heat pipe (HP) with binary Neopentyl glycol (NPG)/Trihydroxy methyl-aminomethane (TAM) solid-solid phase change material (SS_PCM) obtained at 90/10 wt% (N9T1), 70/30 wt% (N7T3) and 50/50 wt% (N5T5). Compared to pure NPG thermal conductivity, N9T1, N7T3, and N5T5 samples demonstrated relative enhancement ratios of 0.017, 2.46, and 2.84. Different heat sink configurations are examined at three constant power levels 15, 17 and 19 W for the same charging period of 10000 s to determine the optimal cooling arrangement. During the charging period, hybrid cooling (PCM-Foam-HP) system with fan in contrast to an empty sink achieved the highest temperature reduction of 58.31 %, 58.99 % and 59.89 % at power levels of 15, 17 and 19 W, respectively. N9T1, N7T3 and N5T5 combinations lowered temperature by 4.6 %, 5.9 % and 10.8 %, respectively, when compared to NPG. Furthermore, all configurations performed better at lower heat generation rates by extending the safe operational period (SOP).The investigation concluded that N5T5 SS_PCM-aided heat sinks with integrated aluminium foam and heat pipe with fan reduced temperatures the most and performed best in all aspects. Finally, the experimental results for TMS were numerically validated using COMSOL software.

Exploring Sperm Cell Rheotaxis in Microfluidic Channel: The Role of Flow and Viscosity.

Rheotaxis is a fundamental mechanism of sperm cells that guides them in navigating towards the oocyte. The present study investigates the phenomenon of sperm rheotaxis in Newtonian and non-Newtonian fluid media, which for the first time explores a viscosity range equivalent to that of the oviductal fluid of the female reproductive tract in rectilinear microfluidic channels. Three parameters, the progressive velocity while performing rheotaxis, the radius of rotation during rheotaxis, and the percentage of rheotactic sperm cells in the bulk and near-wall regions of the microfluidic channel, were measured. Numerical simulations of the flow were conducted to estimate the shear rate, flow velocity, and the drag force acting on the sperm head at specific locations where the sperms undergo rheotaxis. Increasing the flow velocity resulted in a change in the position of rheotactic sperm from the bulk center to the near wall region, an increase and subsequent decrease in the sperm's upstream progressive velocity, and a decrease in the radius of rotation. We observed that with an increase in viscosity, rheotactic sperms migrate to the near wall regions at lower flow rates, the upstream progressive velocity of the sperm decreases for Newtonian and increases for non-Newtonian media, and the radius of rotation increases for Newtonian and decreases for non-Newtonian media. These results quantify the effects of fluid properties such as viscosity and flow rate on sperm rheotaxis and navigation, thereby paving the way for manipulating sperm behavior in microfluidic devices, potentially leading to advancements in assisted reproduction techniques.&#xD.

Clinical efficacy of enhanced recovery surgery in Da Vinci robot-assisted pancreatoduodenectomy

Da Vinci robot-assisted pancreaticoduodenectomy offers advantages, including minimal invasiveness, precise, and safe procedures. This study aimed to investigate the clinical effectiveness of implementing enhanced recovery after surgery (ERAS) concepts in Da Vinci robot-assisted pancreaticoduodenectomy. A retrospective analysis was conducted on clinical data from 62 patients who underwent Da Vinci robot-assisted pancreaticoduodenectomy between January 2018 and December 2022. Among these patients, 30 were managed with ERAS principles, while 32 were managed using traditional perioperative management protocols. Surgical time, intraoperative blood loss, postoperative oral intake time, time to return of bowel function, time to ambulation, visual analog scale (VAS) pain scores, fluid replacement volume, length of hospital stay, total hospital expenses, complications, and patient satisfaction were recorded and compared between the two groups. Postoperative follow-up included assessment of postoperative functional scores, reoperation rates, SF-36 quality of life scores, and survival rates. The average follow-up time was 35.6 months (range: 12–56 months). There were no statistically significant differences in general characteristics, including age, surgical time, intraoperative blood loss, and preoperative medical history between the two groups (P > 0.05). Compared to the control group, the intervention group had an earlier postoperative oral intake time, faster return of bowel function, rapid ambulation, and shorter hospital stays (P < 0.05). The intervention group also had lower postoperative VAS scores, lower fluid replacement volume, lower total hospital expenses, and a lower rate of complications (P < 0.05). Patient satisfaction was higher in the intervention group (P < 0.05). There were no statistically significant differences between the two groups in two-year functional scores, reoperation rates, quality of life scores, and survival rates (P > 0.05). Implementing ERAS principles in Da Vinci robot-assisted pancreaticoduodenectomy substantially expedited postoperative recovery, lowered pain scores, and diminished complications. However, there were no notable differences in long-term outcomes between the two groups.

Measurable Outcomes of an Ophthalmology and Rheumatology Coordinated Care Clinic.

Evaluate the impact of an Ophthalmology/Rheumatology multidisciplinary clinic for patients with anterior uveitis by comparing outcomes between those who received traditional care (TC) versus coordinated care (CC). We conducted a retrospective cohort study of children with anterior uveitis from a pediatric tertiary care center between 2013 and 2022. Standard descriptive statistics were used; survival analyses explored differences in cohort disease activity and biologic DMARDs use. Steroid use by cohort was compared using generalized estimating equation model with Poisson distribution and log link. Complications were compared using logistic regression. Number of visits in each cohort were assessed using Poisson generalized estimating equation model adjusted for complications. We studied 215 anterior uveitis patients: 66% were female, 53% had JIA, 23% were idiopathic, with a median age at diagnosis of eight (interquartile range (IQR) 5-12). CC was associated with a 60% higher hazard (HR = 1.6; p < 0.01) of reaching disease control, when controlling for time since diagnosis and anterior chamber cell counts at beginning of disease activity. CC was associated with starting biologic DMARDs faster than TC (p < 0.01). Compared to TC, CC had a 96% lower rate of corticosteroid use per appointment within the first year (p< 0.01). The visit rate was 64% lower for CC, when controlling for total complications per patient. Patients who received multidisciplinary care had better outcomes than patients who received traditional care. Limitations include different cohort-start times and absence of defined criteria for coordinated care referral.

A CNN-based approach for anomaly detection in smart grid systems

Power grids are always a major center of attraction for attackers due to their large coverage area, complex technological infrastructure, remote access facilities, connectivity, and many more. The power grids that have bidirectional power flow, information interchange, and advanced communication technologies to improve the quality of power transmission and distribution are called smart grids. DoS attacks and false data injection attacks are the two major attacks on smart grids. This paper considers a false data injection attack considering noise reduction, state estimation, system parameters, and control system generation. Firstly, we measure the noise and mitigate it using the data matrix of the devices (sensors, generators, substations, and breaker systems). Secondly, state estimation uses the CNN to track the injected attack types. Finally, a control system is designed to provide anomaly patterns to the devices as input to prevent attacks in the future. The experimental results show that the proposed method achieves a higher anomaly detection rate with a lower error rate (approximately . 1.43%). The network performance parameters are providing significant results; throughput (12 Mbps), PDR (0.005%), execution time (1.43 s), and energy consumption are reduced by 12%–15% as compared to the existing research findings.

Systematic review of Apgar scores & cyanosis in Black, Asian, and ethnic minority infants.

Apgar score and cyanosis assessment may disadvantage darker-skinned babies. This review explored cyanosis and Apgar score assessments in Black, Asian, or minority ethnic neonates compared to White neonates. Four databases were searched. Studies of any methodology were included. A narrative synthesis was undertaken. Ten studies were included. Three studies involving over 39 million neonates showed Apgar score ≤3 was predictive of neonatal mortality across all ethnicities. Black babies with Apgar score ≤3 had lower mortality rates before 28 days, however, variations in scoring practices were also observed. Three further studies (n = 39,290,014) associated low Apgar scores with poorer mental development up to 22 months, especially in mixed ethnicity and Black infants. One study reported inadequate training in assessing ethnic minority neonates. Cyanosis was the focus of three included studies (n = 455) revealing poor visual assessment of cyanosis across ethnicities. With pulse oximetry occult hypoxemia occurred slightly more frequently in Black neonates. Tongue color indicated oxygen requirement at birth, regardless of ethnicity. Apgar scores correlate well with neonatal mortality in all ethnicities, however scoring variations exist. Cyanosis assessment is challenging, with tongue and lips the best places to observe in the absence of pulse oximetry. Assessment of the color component of the Apgar score and of cyanosis visually are not accurate in babies with darker skin. Small racial differences may exist for pulse oximetry in neonates, but it is more reliable than visual assessment.

Performance evaluation of bamboo species for structural applications using TOPSIS and VIKOR: A comparative study

This study focuses on and investigates bamboo as a workable building material for civil engineering projects. The various bamboo species suitable for the building are identified and their intrinsic mechanical and physical properties are investigated to get a thorough understanding. A detailed methodology is proposed that presents all the steps performed from sample size collection to investigating the characteristics of the bamboo species and demonstrating bamboo's structural capabilities. The study provides insightful and technical knowledge that will be extremely helpful in advancing the sustainable incorporation of bamboo into civil engineering construction methods. The findings have proven that varieties of bamboo with higher density and lower shrinkage rates, such as Thyrsostachys Oliveri (Oliveri), perform superior in structural applications. Multi-criteria decision-making techniques (TOPSIS and VIKOR) revealed Dendrocalamus strictus (Manvel) and Thyrsostachys Oliveri (Oliveri) as top-performing species, making them suitable for structural applications.

Osseointegration potential of boron-coated titanium alloy pedicle screw in rabbit spine model

BackgroundSpinal implants’ longevity is crucial, but titanium alloys, while advantageous, lack strong bone integration. This study aimed to achieve better osseointegration rates by utilizing the ability of boron compounds to transform stem cells in the vertebra into osteoblasts.MethodTwenty male albino rabbits were divided into control (n = 10) and experimental (n = 10) groups. Control group received titanium alloy pedicle screws, while experimental group received boron-coated titanium alloy screws. Under general anesthesia, screws were inserted into the L6 and L7 lumbar spines. After 16 weeks, all animals were euthanized for histological examination. Vertebra samples underwent decalcification and H&E staining. Microscopic examination assessed osseointegration, necrosis, fibrosis, and vascularization using a triple scoring system by two blinded observers.ResultIn the boron-coated titanium alloy group, all subjects exhibited osseointegration, with 50% showing focal, 40% moderate, and 10% complete osseointegration. In the titanium alloy group, 90% showed osseointegration (70% focal, 10% moderate, and 10% complete).The differences between the groups were not statistically significant (p = 0.302). Focal necrosis rates were similar between groups, with 50.0% in the titanium alloy and 60.0% in the boron-coated group (p = 0.653).Fibrosis was absent in the titanium alloy group but present in the boron-coated group, albeit with lower rates of focal fibrosis (20.0%). However, the difference was not statistically significant (p = 0.086).Vascularization patterns showed no significant difference between groups.ConclusionBoron-coated titanium alloy pedicle screws provided osseointegration rates comparable to standard titanium screws and exhibited acceptable levels of necrosis and fibrosis. With stronger biomechanical properties, they could be a better alternative to currently used titanium screws.

Exploring the spatial interference effects elicited by social and non-social targets: A conditional accuracy function approach.

Recent studies employing the spatial interference paradigm reveal qualitative differences in congruency effects between gaze and arrow targets. Typically, arrows produce a standard congruency effect (SCE), with faster responses when target direction aligns with its location. Conversely, gaze targets often lead to a reversed congruency effect (RCE), where responses are slower in similar conditions. We explored this dissociation using the Conditional Accuracy Function (CAF) to assess accuracy across reaction time bins. Using a hierarchical linear mixed modelling approach to compare cropped eyes, and full faces as social stimuli, and arrows as non-social stimuli, we synthesized findings from 11 studies, which led to three distinct models. The results showed that with non-social targets, incongruent trials exhibited lower accuracy rates in the first bin than in subsequent bins, while congruent trials maintained stable accuracy throughout the distribution. Conversely, social targets revealed a dissociation within the fastest responses; alongside a general reduction in accuracy for both congruency conditions, congruent trials resulted in even lower accuracy rates than incongruent ones. These results suggest with gaze targets that additional information, perhaps social, in addition to the automatic capture by the irrelevant target location, is being processed during the earlier stages of processing.

Robotic compared with laparoscopic cholecystectomy: A National Surgical Quality Improvement Program comparative analysis

BackgroundData demonstrating the clinical benefit of robotic cholecystectomy over the laparoscopic approach are lacking. Herein, we aim to evaluate whether robotic cholecystectomy is associated with improved surgical outcomes compared with laparoscopic cholecystectomy. Study DesignThis is a retrospective cohort study that used the American College of Surgeons National Surgical Quality Improvement Program to compare the outcomes of patients who underwent robotic or laparoscopic cholecystectomy for benign indications in 2022. ResultsOf the 59,216 patients identified, 53,746 underwent laparoscopic cholecystectomy and 5,470 robotic. Compared with the robotic cohort, the patients in the laparoscopic cholecystectomy group were older (50.4 vs 49.7 years), were of the male sex (32.7% vs 29.7%), and comprised a greater percentage of other races than White, African American, and Asian (28.6% vs 14.8%). Multivariable logistic regression revealed that robotic cholecystectomy compared with the laparoscopic approach was independently associated with a lower risk of Clavien-Dindo complications grade 3 or 4 (odds ratio, 0.82; 95% confidence interval, 0.69–0.98), a lower rate of conversion to open (odds ratio, 0.44; 95% confidence interval, 0.32–0.61), and lower odds of requiring hospitalization ≥24 hours (odds ratio, 0.76; 95% confidence interval, 0.71–0.81). There were no significant differences between the 2 approaches in terms of reoperation (odds ratio, 0.69; 95% confidence interval, 0.47–1.00) and readmission (odds ratio, 0.94; 95% confidence interval, 0.82–1.10). ConclusionRobotic cholecystectomy was independently associated with a lower risk of serious complications, lower rate conversion to open, and hospitalization ≥24 hours compared with laparoscopic cholecystectomy. These findings suggest that new technologies might enhance the safety of minimally invasive surgery.

StarTracer is an accelerated approach for precise marker gene identification in single-cell RNA-Seq analysis

Revealing the heterogeneity among tissues is the greatest advantage of single-cell-sequencing. Marker genes not only act as the key to correctly identify cell types, but also the bio-markers for cell-status under certain experimental imputations. Current analysis methods such as Seurat and Monocle employ algorithms which compares one cluster to all the rest and select markers according to statistical tests. This pattern brings redundant calculations and thus, results in low calculation efficiency, specificity and accuracy. To address these issues, we introduce starTracer, a novel algorithm designed to enhance the efficiency, specificity and accuracy of marker gene identification in single-cell RNA-seq data analysis. starTracer operates as an independent pipeline, which exhibits great flexibility by accepting multiple input file types. The primary output is a marker matrix, where genes are sorted by the potential to function as markers, with those exhibiting the greatest potential positioned at the top. The speed improvement ranges by 2 ~ 3 orders of magnitude compared to Seurat, as observed across three independent datasets with lower false positive rate as observed in a simulated testing dataset with ground-truth. It’s worth noting that starTracer exhibits increasing speed improvement with larger data volumes. It also excels in identifying markers in smaller clusters. These advantages solidify starTracer as an important tool for single-cell RNA-seq data, merging robust accuracy with exceptional speed.

Robotic-assisted versus laparoscopic-assisted extended mesorectal excision: a comprehensive meta-analysis and systematic review of perioperative and long-term outcomes.

Concurrent neoadjuvant chemo-radiation (nCRT) with total mesorectal excision (TME) alone sometimes fails to cure lateral lymph node metastasis (LLNM). Therefore, additional lateral lymph node dissection (LLND) can help in the treatment of these patients. This is what we refer to as extended total mesorectal excision (eTME). Such operations (TME alone or eTME) can be performed using conventional laparoscopic techniques and robotic-assisted techniques as well. Our meta-analysis aims to compare the results of robot-assisted (R-eTME) versus laparoscopic-assisted extended mesorectal excision (L-eTME) in terms of short- and long-term outcomes. Databases searched using title and abstract included Medline (via PubMed), Web of Science, Scopus, and Embase, up to February 20, 2024. All studies that documented robotic versus laparoscopic procedures for extended total mesorectal excision (R-eTME versus L-eTME) and reported more than two relevant outcomes, were included in the study. Our meta-analysis demonstrates four significant outcomes (operative time, urinary complications, overall recurrence, and admission days) between the laparoscopic and robotic groups. The robotic approach shows advantages over the laparoscopic approach in these outcomes except for the operative time (minute), which was longer in the robotic group compared to the laparoscopic group. The laparoscopic group is associated with a higher overall recurrence than the robotic group with an Odds Ratio of 2(95% CI, 1-4, p = 0.05). This meta-analysis study showed that the R-eTME group had a lower recurrence rate compared to the L-eTME group. Additionally, hospital admission days increased significantly in the laparoscopic group. Other long-term outcomes did not differ significantly between the two groups. Short-term outcomes were similar, except for more urinary complications in the laparoscopic group. In conclusion, the study suggests that robotic surgery may offer advantages over laparoscopic surgery for eTME. Further research and analysis could provide further insight into the potential benefits of robotic surgery in this procedure, particularly when surgeon experience, center volume, and learning curve are taken into consideration.

Seismicity zoning at Coso geothermal field and stress changes from fluid production and migration

The Coso geothermal field is a major geothermal power production site in the western United States. It has been observed that low-magnitude seismic events (M < 3.71) are unevenly distributed in three distinct zones, namely, nearfield (<3 km), midfield (3–6 km), and farfield (> 6 km) from the Coso geothermal plant. These zones exhibit distinct changes in earthquake location before and during geothermal production episodes that began in 1986. After 1986, the midfield region of the main flank experiences a significantly lower seismicity rate than the surrounding areas before production episodes. During 2014–2019, the farfield earthquakes cluster in the eastern and western parts of the greater Coso area, which is discernably different from how those pre-production earthquake events were distributed along the conjugate NW-SE and SW-NW trending structures across the main flank. Here, we analyze the stage of stress with finite-element-based poroelastic simulations to illustrate how the spatiotemporal evolution of the seismicity is associated with the pattern of stress perturbations caused by fluid migration amid the operations of geothermal power plants. Generally, ∼70% of co-production seismicity is found in zones of increased Coulomb stress between 2014 and 2019 at >99% confidence. Meanwhile, the midfield zone of seismic paucity overlaps with the zone of decreasing pore-fluid pressure. Overall, the results provide a physical explanation of how decadal geothermal operations at Coso have perturbed stress-field changes and contributed to the evolving characteristic seismic pattern, shedding insights into assessing the seismic hazard in other geothermal settings.

Accelerated model-based T1, T2* and proton density mapping using a Bayesian approach with automatic hyperparameter estimation.

To achieve automatic hyperparameter estimation for the model-based recovery of quantitative MR maps from undersampled data, we propose a Bayesian formulation that incorporates the signal model and sparse priors among multiple image contrasts. We introduce a novel approximate message passing framework "AMP-PE" that enables the automatic and simultaneous recovery of hyperparameters and quantitative maps. We employed the variable-flip-angle method to acquire multi-echo measurements using gradient echo sequence. We explored undersampling schemes to incorporate complementary sampling patterns across different flip angles and echo times. We further compared AMP-PE with conventional compressed sensing approaches such as the -norm minimization, PICS and other model-based approaches such as GraSP, MOBA. Compared to conventional compressed sensing approaches such as the -norm minimization and PICS, AMP-PE achieved superior reconstruction performance with lower errors in mapping and comparable performance in and proton density mappings. When compared to other model-based approaches including GraSP and MOBA, AMP-PE exhibited greater robustness and outperformed GraSP in reconstruction error. AMP-PE offers faster speed than MOBA. AMP-PE performed better than MOBA at higher sampling rates and worse than MOBA at a lower sampling rate. Notably, AMP-PE eliminates the need for hyperparameter tuning, which is a requisite for all the other approaches. AMP-PE offers the benefits of model-based recovery with the additional key advantage of automatic hyperparameter estimation. It works adeptly in situations where ground-truth is difficult to obtain and in clinical environments where it is desirable to automatically adapt hyperparameters to individual protocol, scanner and patient.

Coffee consumption, cancer, and healthy aging: epidemiological evidence and underlying mechanisms.

This comprehensive review examines the role of coffee consumption in promoting healthy aging and its potential impact on cancer prevention. Previous research has shown that moderate coffee intake may contribute to extending healthspan and enhancing longevity through beneficial effects on cardiometabolic health and key biological processes involved in aging. However, the relationship between coffee consumption and cancer risk remains controversial. This review synthesizes longitudinal observational and interventional data on the effects of coffee consumption on overall and site-specific cancers, explores underlying biological mechanisms, and discusses clinical and public health implications. Additionally, the review highlights evidence from Mendelian randomization (MR) studies to assess potential causal relationships. Our findings suggest that coffee consumption is associated with a reduced risk of several cancers, including skin, liver, prostate, and endometrial cancers, and may also lower cancer recurrence rates, particularly in colorectal cancer. These protective associations appear consistent across different demographic groups, with the most significant benefits observed at consumption levels of three or more cups per day. However, evidence is inconclusive for many other cancers, and coffee consumption is consistently linked to an increased risk of lung cancer. MR studies generally do not support a strong causal relationship for most cancers, though some suggest potential protective effects for hepatocellular, colorectal, and possibly prostate cancers, with mixed results for ovarian cancer and an increased risk for esophageal cancer and multiple myeloma. The protective effect of coffee on liver and prostate cancer is supported by both observational and MR studies. The potential anti-cancer benefits of coffee are attributed to its bioactive compounds, such as caffeine, chlorogenic acids, and diterpenes, which possess antioxidant and anti-inflammatory properties. These compounds may reduce oxidative stress, inhibit cancer cell proliferation, induce apoptosis, and modulate hormone levels. The review emphasizes the need for further research to clarify dose-response relationships, causal associations, and the biological mechanisms underlying these associations. While coffee consumption appears to contribute to cancer prevention and healthy aging, caution is warranted due to the increased risk of certain cancers, highlighting the complexity of its health effects.

Optimizing water-fertilizer integration with drip irrigation management to improve crop yield, water, and nitrogen use efficiency: A meta-analysis study

So far, many studies have examined the effects of drip irrigation and water-fertilizer integration on crop yield indices, nutrient use efficiency (NUE), and water use efficiency (WUE). However, they are carried out under different conditions. Due to the scattered research results and the lack of general conclusions from published results, it is necessary to use meta-analysis as a structured method to draw a conclusion. Therefore, a meta-analysis was conducted to quantitatively evaluate the effects of water–fertilizer integration with drip irrigation (WFIDI) on nitrogen use efficiency (NUE), water use efficiency (WUE), and crop yield to explore the most suitable application strategy of WFIDI, further discussion of its impact mechanism. A total of 352 studies in the Chinese region were included, of which 84 studies met the entry criteria for the meta-analysis, and 779 pairs of data were finally obtained. The meta-analysis results showed that WFIDI improved NUE (31.3 %), WUE (34.5 %) and crop yield (12.5 %) by changing soil physical and chemical properties (SOC increased by 36.4 %, TN increased by 9.3 %, and ETC decreased by 11.5 %). In order to screen the key influencing factors and determine the applicable conditions, PCA and win-win analysis were carried out. The results showed that WFIDI was suitable for food crops and fruit trees in medium-textured soils. It is recommended to use subsurface drip irrigation with a lower flow rate (≤1Lh−1) and nitrogen fertilizer (10–25 % lower than the traditional nitrogen application rate of farmers). This study provides inspiration for efficient and economical agricultural water management.

Self-Screening for Cervical Cancer Offered through a Digital Platform in a Region of British Columbia with Lower Screening Rates

Self-Screening for Cervical Cancer Offered through a Digital Platform in a Region of British Columbia with Lower Screening Rates

The role of procedural factors on the outcomes of embolization followed by radiosurgery for the treatment of brain arteriovenous malformations: systematic review and proportional meta-analyses.

Multimodal therapy for brain arteriovenous malformations (bAVM) with embolization followed by stereotactic radiosurgery (E + SRS) has shown varying outcomes. Its benefits over other treatment modalities have been questioned. The goal of this systematic review was to determine the factors associated with cure and complication rates of this treatment strategy. A literature search in Medline and Global Index Medicus, from inception to October 2023, was performed. Studies reporting relevant outcome data from bAVM patients treated with E + SRS were included. Data on several patient, lesion and procedure-related factors were collected. Embolization intent was classified as Targeted (of high-risk features), Devascularizing (feeder embolization/flow reduction) and Occluding (intent-to-cure, nidus embolization). The primary outcome was obliteration rate. Secondary outcomes were post-SRS bleeding (PSB), post-embolization neurological complications (PENC) and post-SRS neurological complications (PSNC). Subgroup analyses included embolic agent, embolization intent and radiosurgery type. Proportional meta-analyses and meta-regressions were performed. Forty-one studies were included in the review. The pooled obliteration rate was 56.45% (95% CI 50.94 to 61.88). Meta-regression analyses showed higher obliteration rates with Copolymers and lower obliteration rates with Devascularizing embolization. The pooled PSB, PENC and PSNC rates were 5.50%, 13.75% and 5.02%, respectively. Meta-regression analyses showed higher rates of PSB, PENC and PSNC with Devascularizing embolization, Liquid & Solid embolic agents and Targeted & Devascularizing intent, respectively. Embolic agent and embolization intent were procedural factors associated with treatment outcomes of E + SRS in the management of bAVM patients. The efficacy and safety profiles favor copolymers as embolic agents and disfavor Devascularizing as embolization intent. The protocol of the systematic review was registered in PROSPERO as CRD42023474171.