Low Volume Research Articles

Prevalence, Medicaid use and mortality risk of low FEV1 in adults aged 20–35 years old in the USA: evidence from a population-based retrospective cohort study

BackgroundThe prevalence, Medicaid use and mortality risk associated with low forced expiratory volume in 1 s (FEV1) among young adults aged 20–35 years are not well understood, despite its potential...

Association of Biological Age Acceleration with Cardiac Morphology, Function, and Incident Heart Failure: Insights from UK Biobank Participants.

Advanced age is associated with an increased risk of adverse cardiovascular events. The relationship between biological age acceleration (BAA), cardiac size, cardiac function, and heart failure (HF) is not well-defined. Utilizing the UK Biobank cohort, we assessed biological age using the Klemera-Doubal and PhenoAge method. BAA was quantified by residual analysis compared to chronological age. Cardiovascular magnetic resonance (CMR) imaging provided detailed insights into cardiac structure and function. We employed multivariate regression to examine links between BAA and CMR-derived cardiac phenotypes. Cox proportional hazard regression models analyses was applied to explore the causative relationship between BAA and HF. Additionally, Mendelian randomization was used to investigate the genetic underpinnings of these associations. A significant correlation was found between increased BAA and deleterious changes in cardiac structure, such as diminished left ventricular mass, lower overall ventricular volume, and reduced stroke volumes across ventricles and atria. Throughout a median follow-up of 13.8 years, participants with greater biological aging showed a heightened risk of HF (26% per standard deviation [SD] increase in KDM-BA acceleration, 95% confidence intervals [CI]: 23%-28%; 33% per SD increase in PhenoAge acceleration, 95% CI: 32%-35%). Mendelian randomization analysis suggests a likely causal link between BAA, vital cardiac metrics, and HF risk. In this cohort, accelerated biological aging may serve as a risk indicator for altered cardiac dimensions, functionality, and the onset of heart failure among middle-aged and elderly adults. It holds promise as a focal point for evaluating risk and developing targeted interventions.

Regional hippocampal atrophy reflects memory impairment in patients with early relapsing remitting multiple sclerosis.

Research work has shown that hippocampal subfields are atrophic to varying extents in multiple sclerosis (MS) patients. However, studies examining the functional implications of subfield-specific hippocampal damage in early MS are limited. We aim to gain insights into the relationship between hippocampal atrophy and memory function by investigating the correlation between global and regional hippocampal atrophy and memory performance in early MS patients. From the Italian Neuroimaging Network Initiative (INNI) dataset, we selected 3D-T1-weighted brain MRIs of 219 early relapsing remitting (RR)MS and 246 healthy controls (HC) to identify hippocampal atrophic areas. At the time of MRI, patients underwent Selective-Reminding-Test (SRT) and Spatial-Recall-Test (SPART) and were classified as mildly (MMI-MS: n.110) or severely (SMI-MS: n:109) memory impaired, according to recently proposed cognitive phenotypes. Early RRMS showed lower hippocampal volumes compared to HC (p < 0.001), while these did not differ between MMI-MS and SMI-MS. In MMI-MS, lower hippocampal volumes correlated with worse memory tests (r = 0.23-0.37, p ≤ 0.01). Atrophic voxels were diffuse in the hippocampus but more prevalent in cornu ammonis (CA, 79%) than in tail (21%). In MMI-MS, decreased subfield volumes correlated with decreases in memory, particularly in the right CA1 (SRT-recall: r = 0.38; SPART: r = 0.34, p < 0.01). No correlations were found in the SMI-MS group. Hippocampal atrophy spreads from CA to tail from early disease stages. Subfield hippocampal atrophy is associated with memory impairment in MMI-MS, while this correlation is lost in SMI-MS. This plays in favor of a limited capacity for an adaptive functional reorganization of the hippocampi in MS patients.

Peritectic orthopyroxene entrainment during partial melting of garnet peridotite produced the Bushveld Complex chromite deposits

AbstractOne of the largest chromium deposits on Earth occurs in the Rustenburg Layered Suite (RLS) of the Bushveld Complex as laterally continuous chromitite layers. None of the hypotheses proposed for the origin of the chromitites can explain both the abundance of Cr in the RLS and the unusual enrichment in Cr and V over Ni, relative to typical depleted mantle values. This study investigates the possibility that the layering and chromitite formation are consequences of the entrainment of source components into the magmas that formed the RLS. Thermodynamic modelling results reveal a wedge-shaped domain in pressure-temperature space in the subcratonic mantle within which Cr-bearing orthopyroxene forms as a peritectic product of incongruent melting. Entrainment of this orthopyroxene produces magmas that crystallise peritectic olivine and chromite on ascent, due to the consumption of orthopyroxene by melt. The chromite- and olivine-bearing magmas intrude as sills and can produce chromite and dunite layers by density separation. This model, which interprets the RLS Sr-isotopic composition to reflect prior mantle metasomatism by crustal fluids (ideally ancient and of low volume), readily explains the formation of chromitite layers from relatively thin sills, as well as the very high ratios of Cr and V to other compatible elements relative to typical mantle compositions. The special circumstances required to produce the RLS chromitites do not relate to some oddity of repetitive crustal assimilation or magma compositions that allow chromite-only saturation. Rather, they relate to speed of melting and magma extraction which enabled peritectic orthopyroxene entrainment to the magmas.

The economic impact of E-commerce on the U.S. airports: Cost savings and productivity growth

The rise of e-commerce, fueled by digitalization and shifting in consumer demand, has revolutionized air cargo. While all e-commerce stakeholders are engaged in fierce competition to increase their market share, airports as integral elements of the air cargo supply chain could not be apathetic to this competition. This study examines the economic implication of e-commerce on high cargo volume airports, focusing on cost savings and productivity growth. Utilizing the Farrell measure of input-oriented technical efficiency, we estimate scope economies for the U.S. airports between 2009 and 2019. The results reveal higher scope economies for high cargo volume airports, indicating greater cost savings resulting from e-commerce activities. In addition, the Malmquist index is employed to assess productivity growth. The index is decomposed into technical change, efficiency change, and scale change. The findings show a 3.3% overall productivity growth in the U.S. airport industry, primarily driven by technical change. Besides, high cargo volume airports exhibit higher productivity growth compared to low cargo volume airports, with 4.1% and 2.9% growth rates, respectively. The gap between high cargo volume and low cargo volume airports widened in 2017, aligning with the pre-pandemic peak in e-commerce activity. Furthermore, high cargo volume airports experience higher efficiency gains and technical advancements. While efficiency gains are attributed to improved performance and increased capacity utilization, the technical advancements can be explained by the digitalization and customized operations associated with e-commerce. Overall, the results highlight the significant contribution of e-commerce to cost savings and productivity growth in high-cargo volume airports.

Effect of COVID-19 lockdown on glycated haemoglobin testing and utilisation in KwaZulu-Natal, South Africa

Background: Diabetic monitoring and treatment guidelines are easily accessible, but compliance is poor in KwaZulu-Natal. The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on diabetic healthcare, both directly and through public health interventions.Objective: This study aimed to close the gaps in knowledge concerning glycated haemoglobin (HbA1c) test utilisation and how this was affected by the COVID-19 lockdown in KwaZulu-Natal.Methods: We reviewed HbA1c test volumes and results from public health facilities in the 11 health districts in KwaZulu-Natal, South Africa. We compared testing trends and glycaemic control between two 10-month study periods before (March 2019 – December 2019) and during (March 2020 – December 2020) the COVID-19 pandemic.Results: The number of HbA1c tests performed decreased 6.1% during the pandemic period, with 173 760 HbA1c tests performed in 2019 and 163 236 HbA1c tests performed in 2020. There was a statistically significant increase in the average HbA1c level during the pandemic (mean HbA1c level in the pre-pandemic period: 70.5 mmol/mol [8.6%] versus mean HbA1c level in the pandemic period: 72.7 mmol/mol [8.8%]; p-value 0.001). Of patients with suboptimal HbA1c results (83 421 in 2019, 83 259 in 2020), 11 656 (14.0%) in 2019 and 10 086 (12.1%) in 2020 had more than one HbA1c test performed during the study period.Conclusion: The COVID-19 pandemic impacted glycaemic monitoring in KwaZulu-Natal with lower HbA1c test volumes and worse glycaemic control seen during the pandemic. HbA1c testing practices are not in keeping with recommended guidelines.What this study adds: The study demonstrates that the COVID-19 pandemic impacted HbA1c utilisation in KwaZulu-Natal. Importantly, HbA1c testing practices in KwaZulu-Natal are not in keeping with Society for Endocrinology, Metabolism and Diabetes of South Africa guidelines regarding the monitoring of diabetic patients, and this requires more attention for future diabetic healthcare interventions.

India’s Silent Struggle: A Scoping Review on Postpartum Depression in the Land of a Billion Mothers

Background: Postpartum emotional issues, including postpartum blues, postpartum psychosis, and postpartum depression (PPD), affect many mothers worldwide. The prevalence of postpartum blues ranges from 300 to 750 per 1,000 mothers, while postpartum psychosis has a prevalence of 0.89–2.6 cases per 1,000 births. PPD affects 100–150 new mothers per 1,000 births, and its prevalence can go above 25% globally. Depression in mothers can have long-lasting impacts on children and the next generation, affecting their growth, development, and relationships. However, the condition of PPD is frequently misdiagnosed, and women who suffer from it do not receive treatment. There is a lack of solid systematic evidence that looks at the overall burden of PPD and the risk factors that are associated with it in India. The awareness of PPD is critical in managing the symptoms and seeking professional support, and studies are needed to evaluate and assess the situation in India. Methodology: This study is a systematic literature review with a scoping review approach aimed at providing existing evidence on the awareness and prevalence of PPD in India. The search strategy for the electronic bibliographic search included a list of related terms and factors of awareness and prevalence of PPD. The search encompassed six prominent databases. The assessment tools used in studies from 2012 to 2023 study the factors using the Postpartum Depression Literacy Scale (PoDLiS) and the Edinburgh Postpartum Depression Scale, which measure the awareness and prevalence of PPD. Results: The study found a significantly low volume of studies conducted in India to determine the prevalence of PPD. The materials or studies accessible are hospital-based research with a minimal number of samples. The reported prevalence rate of postpartum depression (PPD) in India varies across different studies, ranging from 4% to 48.5%. Among mothers who gave birth either naturally or by cesarean section in a hospital setting, one study reported the lowest prevalence rate (4%). The prevalence of PPD among women in India is estimated to be 18% based on the average score across all research. A study that evaluated the moms in the community found that PPD was prevalent in new mothers at a rate of 21.5%. There are three studies, in particular, that focus on how aware people are of PPD. Two studies found that 54% of the family members of postpartum moms and women undergoing tertiary pediatric care are aware of PPD. Discussion: Many studies point to the lack of social support as a significant risk factor for mental health complications after delivery. History of depression, anxiety, adverse life events, partner abuse, low economic status, complications at childbirth, and a traumatic childbirth experience are some of the associated factors identified in the studies. Studies have also shown that women who undergo a cesarean section have a higher risk of developing PPD than those with a vaginal delivery.

Immunoadsorption as a method of antibody donation during the COVID-19 pandemic.

Initial therapeutic efforts to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) included the use of plasma from convalescent donors containing anti-SARS-CoV-2 antibodies. High-neutralizing antibody titres are required for therapeutic efficacy. This study aims to show that immunoadsorption followed by tangential flow filtration can be used to obtain antibody concentrates with high-neutralizing capacities. Eligible donors (n = 10, five males and three females) underwent immunoadsorption using adsorber columns specific for human antibodies. Glycine-washed out eluates of 1.5 L volume were further concentrated by tangential flow filtration using 30 kDa ultrafiltration membranes. The same membranes were applied for diafiltrations to exchange residual glycine for 0.9% normal saline. Antibody concentrates were obtained within 8 h from the start of donation and had, 4.58 ± 1.95, 3.28 ± 1.28 and 2.02 ± 0.92 times higher total IgG, IgA and IgM concentrations, 3.29 ± 1.62 and 3.74 ± 0.6 times higher SARS-CoV-2 N and S antibody concentrations and 3.85 ± 1.71 times higher SARS-CoV-2 S-specific IgG concentrations compared to the donors' peripheral blood. The specific SARS-CoV-2 virus neutralization capacities increased in all but one concentrate. All antibody concentrates (50-70 mL final volume) passed microbiological tests, were free of hazardous glycine levels and could be stored at -80°C and 4°C for 1 year with 20 ± 3% antibody loss. Immunoadsorption followed by tangential flow filtration is a feasible procedure to collect IgG, IgA and IgM as well as SARS-CoV-2 N- and S-specific antibody concentrates of low volume, free of albumin and coagulation factors. Whether these concentrates can be used as passive immunisation in infected patients remains to be elucidated.

Assessment of using different ozone-friendly R22 alternative refrigerants in residential air conditioners in a high-ambient temperature country

The performance of a vapor compression refrigeration system (VCRS)-based residential air conditioner operating in a high-ambient temperature (HAT) country was investigated using six zero-ODP (ozone depletion potential) refrigerants as replacements to R22. The non-flammable alternative refrigerants considered in the present research were R134a, R404A, R407C, R410A, R448A, and R507A. Using the basic conservation laws, the VCRS was modeled during steady-state operation and solved using engineering equation solver (EES) software. Coefficient of performance (COP), pressures and temperatures at compressor suction and discharge, Global Warming Potential (GWP), critical pressure and temperature, compressor pressure ratio, volumetric cooling capacity (VCC) specific cooling capacity (SCC), and refrigeration effect were utilized as assessment criteria for the alternative refrigerants considered. From these refrigerants, the highest values of suction pressure, discharge temperature, and condenser pressure were attained by R410A. In addition, the discharge temperatures for all refrigerants, except R134a, were all higher than their corresponding critical values, causing a quicker drop in the VCRS’s performance. As an alternative refrigerant, R407C showed the highest SCC of 141.0 kJ/kg followed directly by 139.2 and 138.0 kJ/kg for R410A and R448A, respectively. A reverse trend was found for VCC with respective values of 4722 and 3775 kJ/m3 for R410A and R448A. Lower volume flow rates and smaller-sized compressors are expected for higher VCC refrigerants. The same trend was found for the compressor’s specific work input and condenser’s specific heat transfer with values of (51.14, 46.82, and 45.38 kJ/kg) and (190.3, 187.8, and 183.4 kJ/kg) for R410A, R407C, and R448A, respectively. For applications in HAT countries, larger condenser’s specific heat transfer makes the refrigerant more applicable. Conversely, with respect to COP, refrigerant R134a with a value of 3.075 was the superior alternative followed by R448A and R407C with respective COPs of 3.042 and 3.011. Based on the overall assessment in terms of environmental obligation, COP, compressor input power, refrigerant flow rate required, and all the evaluations made in this research, refrigerant R448A was recommended as the most appropriate substitute to R22 which can effectively be used in residential air conditioners in a HAT country.

AlN and Nb(C,N) Composite Precipitation Behaviors and Their Effects on Austenite Grain Growth in SCr420H High‐Temperature Carburized Gear Steel

The effects of nitrogen (N) and niobium (Nb) contents on the precipitation behaviors of AlN, Nb(C,N), and AlN‐Nb(C,N) precipitates and austenite grain growth during the pseudo‐carburizing process are investigated for the carburized steel SCr420H. The results indicate that an increase of N content from 0.011% to 0.019% leads to the emergence of fine and uniform austenite grain structure in the sample while being held at 930 °C for 6 h, which is attributed to a notable rise in the number density of AlN and a decrease in the coarsening rate of AlN. In the steel containing 0.023% Nb, the composite precipitates AlN‐Nb(C,N) play a primary role in the pinning effect on austenite grains growth. The isolated Nb(C,N) and AlN precipitates have minor pinning effects due to their very low volume fractions. Nb(C,N) cap forming on AlN substrate obeys the Shoji–Nishiyama orientation relationship. The favorable lattice matching between AlN and Nb(C,N) and accelerated coarsening rate of Nb(C,N) cap decrease hindrances to the nucleation, growth, and coarsening of Nb(C,N) on AlN substrate. Meanwhile, these simultaneous effects also suppress the same processes for the isolated Nb(C,N) in the matrix.

Reassessing Normal Voiding Standards: A Cross-Sectional Study Based on Medical Professionals’ Evaluations with Portable Uroflowmetry and IPSS

Background/Objectives: LUTS and voiding dysfunctions are prevalent in urology clinics, with uroflowmetry and IPSS as the prevailing diagnostic methods. Nevertheless, objective assessment can be constrained by age, gender, and variability in the test conditions. Portable (home) uroflowmetry addresses these limitations, allowing for more natural urinary flow recordings beyond clinic confines. This study aims to characterize spontaneous voiding patterns in healthcare professionals, exploring gender differences, variability in repeated measurements, and correlations among voiding parameters, IPSS, age, and BMI. Methods: This cross-sectional study was conducted during the SIU 43rd Congress in Istanbul using smart uroflow devices such as the Oruba Oruflow Uroflow Recorder, which were installed in public toilets. A total of 431 healthcare professionals participated by providing demographic information and completing the IPSS questionnaire. The data analysis included uroflowmetric parameters such as maximum flow rate (Qmax), average flow rate (Qave), and voided volume (VV), in addition to IPSS and demographic data to assess the possible associations with IPSS, age, BMI, and gender differences. Results: Of the participants, 76% were male and 24% female, with a higher prevalence of LUTS in women. Despite no significant gender difference in voided volume, men with lower volumes demonstrated more severe LUTS. Notably, women exhibited higher Qmax and Qave rates irrespective of their IPSS scores, contrasting with men whose flow rates declined with age and LUTS severity. In men, the total IPSS score was inversely associated with uroflowmetric performance, particularly impacting voiding symptoms over storage symptoms. Repeated measurements revealed noteworthy variability in Qmax and VV, without any influence from gender, BMI, age, or symptom severity. Conclusions: Our findings highlight the importance of gender-specific considerations in evaluating voiding complaints through uroflowmetry and IPSS. The significant variability observed in repeated uroflowmetry studies underlines the need for multiple measurements. Overall, this research emphasizes the significance of portable (home) uroflowmetry and calls for a reassessment of normal voiding standards in (non) clinical settings.

Effect of Low-Frequency Pulsed Electrotherapy Combined with Acupoint Nursing on Postpartum Urinary Retention in Patients with Vaginal Delivery.

This study was carried out to investigate the effect of low-frequency pulsed electrotherapy combined with acupoint massage on postpartum urinary retention (PUR). The patients were divided into control group, intervention group 1, and intervention group 2 according to the nursing method. The control group received conventional postpartum care, intervention group 1 received conventional postpartum care and low frequency pulsed electrotherapy, and intervention group 2 received conventional postpartum care, low-frequency pulsed electrotherapy, and Shuidao point massage. The bladder function, comfort score, and quality of life score before and after intervention were compared among the three groups. The bladder function, comfort level, and quality of life of intervention group 1 and intervention group 2 after nursing were significantly better than those of the control group. In addition, intervention group 2 had better bladder function than intervention group 1, with lower residual urine volume and higher bladder compliance. In the Kolcaba score, the mental dimension of intervention group 2 was significantly higher than that of intervention group 1. In terms of QOL scores, the social function, physical function, and state of material life scores of intervention group 2 were significantly higher than those of intervention group 1. Low-frequency pulsed electrotherapy combined with acupoint massage can significantly improve the bladder function, comfort, and quality of life of patients with PUR.

Safety-in-Numbers for route choice of bicycle trips: A choice experiment approach for commuters

Safety-in-Numbers (SiN) implies that the risk of collision per road user is less when there are more road users. Although the available literature has confirmed the existence of SiN as an objective measure of safety, the effect on perceived safety, especially in the context of bicycle riders, has received much less attention. This study investigates the SiN effect on the perceived safety of bicycle riders that influences route choice behavior. A stated preference survey was performed in the South Delhi district of Delhi. The effect of attributes like posted speed limit, the volume of motorized traffic, bicycle infrastructure, and bicycle traffic/ crowding on route choice behavior was investigated. A binary logit model was developed to quantify the effect of these attributes on route choice. The results indicate that, in general, riders prefer routes with more bicycle traffic, hence validating SiN. But the effect does not always hold. For some riders, in the presence of dedicated bicycle infrastructure, when the perceived safety is higher, the presence of more bicycle traffic acts as crowding and demotivates riders to choose that route. The study also reveals that riders prefer routes with a low volume of motorized traffic and dedicated bicycle infrastructure. The outcomes suggest that a policy that encourages infrastructural development to provide lateral separation will encourage more people, hence increasing bicycle mode share as well as the perceived safety of riders.

RISK FACTORS FOR MENISCAL REPAIR FAILURE FOLLOWING CONCURRENT PRIMARY ACL RECONSTRUCTION: RESULTS FROM THE NEW ZEALAND ACL REGISTRY

BackgroundAnterior cruciate ligament (ACL) reconstruction with concomitant meniscal injury occurs frequently. Meniscal repair is associated with improved long-term outcomes compared to resection but is also associated with a higher reoperation rate. Knowledge of the risk factors for repair failure may be important in optimizing patient outcomes.PurposeThis study aimed to identify the patient and surgical risk factors for meniscal repair failure, defined as a subsequent meniscectomy, following concurrent primary ACL reconstruction.MethodsData recorded by the New Zealand ACL Registry and the Accident Compensation Corporation, the New Zealand Government's sole funder of ACL reconstructions and any subsequent surgery, was reviewed. Meniscal repairs performed with concurrent primary ACL reconstruction was included. Root repairs were excluded. Univariate and multivariate survival analysis was performed to identify the patient and surgical risk factors for meniscal repair failure.ResultsBetween 2014 and 2020, a total of 3,024 meniscal repairs were performed during concurrent primary ACL reconstruction (medial repair = 1,814 and lateral repair = 1,210). The overall failure rate was 6.6% (n = 201) at a mean follow-up of 2.9 years, with a failure occurring in 7.8% of medial meniscal repairs (142 out of 1,814) and 4.9% of lateral meniscal repairs (59 out of 1,210). The risk of medial failure was higher in patients with a hamstring tendon autograft (adjusted HR = 2.20, p = 0.001), patients aged 21–30 years (adjusted HR = 1.60, p = 0.037) and in those with cartilage injury in the medial compartment (adjusted HR = 1.75, p = 0.002). The risk of lateral failure was higher in patients aged ≤ 20 years (adjusted HR = 2.79, p = 0.021) and when the procedure was performed by a surgeon with an annual ACL reconstruction case volume of less than 30 (adjusted HR = 1.84, p = 0.026).ConclusionWhen performing meniscal repair during a primary ACL reconstruction, the use of a hamstring tendon autograft, younger age and the presence of concomitant cartilage injury in the medial compartment increases the risk of medial meniscal repair failure, whereas younger age and low surgeon volume increases the risk of lateral meniscal repair failure.

Linking Seed Traits and Germination Responses in Caribbean Seasonally Dry Tropical Forest Species

Understanding the relationships between seed traits and germination responses is crucial for assessing natural regeneration, particularly in threatened ecosystems like the seasonally dry tropical forest (SDTF). This study explored links between seed traits (mass, volume, moisture content, and dispersal type), germination responses (germinability, germination speed (v¯), time to 50% of germination (T50), synchrony, and photoblastism), and physical dormancy (PY) in 65 SDTF species under experimental laboratory conditions. We found that species with smaller seeds (low mass and volume) had higher v¯ and reached T50 faster than species with larger seeds. For moisture content, species with lower moisture content had higher germinability and reached the T50 faster than seeds with high moisture content. Abiotic dispersed species germinated faster and reached the T50 in fewer days. Most of the SDTF species (60%) did not present PY, and the presence of PY was associated with seeds with lower moisture content. As for photoblastism (germination sensitivity to light), we classified the species into three ecological categories: generalists (42 species, non-photoblastic), heliophytes (18 species, positive photoblastic, germination inhibited by darkness), and sciadophytes (5 species, negative photoblastic, light inhibited germination). This study intends to be a baseline for the study of seed ecophysiology in the SDTF.

Phase I Trial of SPECT-Guided Liver-Directed Radiotherapy for Patients with Low Functional Liver Volume.

Traditional constraints specify that 700 cc of liver should be spared a hepatotoxic dose when delivering liver-directed radiotherapy to reduce the risk of inducing liver failure. We investigated the role of single photon emission computed tomography (SPECT) to identify and preferentially avoid functional liver during liver-directed radiation treatment planning in patients with preserved liver function but limited functional liver volume after receiving prior hepatotoxic chemotherapy or surgical resection. This phase I trial with a 3 + 3 design evaluated the safety of liver-directed radiotherapy using escalating functional liver radiation dose constraints in patients with liver metastases. Dose limiting toxicities (DLTs) were assessed 6-8 weeks and 6 months after completing radiotherapy. All twelve patients had colorectal liver metastases and received prior hepatotoxic chemotherapy. Eight patients underwent prior liver resection. Median computed tomography (CT) anatomical non-tumor liver volume was 1,584 cc (range 764-2,699 cc). Median SPECT functional liver volume was 1,117 cc (range 570-1,928cc). Median non-target CT and SPECT liver volumes below the volumetric dose constraint were 997 cc (range 544-1,576 cc) and 684 cc (range 429-1,244 cc), respectively. The prescription dose was 67.5-75 Gy in 15 fractions or 75-100 Gy in 25 fractions. No DLTs were observed during follow-up. One-year in-field control was 57%. One-year overall survival was 73%. Liver-directed radiotherapy can be safely delivered to high doses when incorporating functional SPECT into the radiation treatment planning process which may enable sparing of lower volumes of liver than traditionally accepted in patients with preserved liver function. NCT02626312.

АНАЛИЗ ДЕЯТЕЛЬНОСТИ ВРАЧЕЙ-ДЕРМАТОВЕНЕРОЛОГОВ, ОКАЗЫВАЮЩИХ МЕДИЦИНСКУЮ ПОМОЩЬ СЕЛЬСКОМУ НАСЕЛЕНИЮ В РЕСПУБЛИКЕ БАШКОРТОСТАН

Relevance. Currently, there is a low staffing of medical organizations with local doctors and medical specialists, including dermatovenerologists. This determines the low availability of primary medical care for the rural population for diseases of the skin and subcutaneous tissue. Purpose of the study. To analyze the activities of dermatovenerologists in providing primary specialized medical care to the rural population for diseases of the skin and subcutaneous tissue in the Republic of Bashkortostan. Materials and methods. The calculation of indicators characterizing the activities of dermatovenerologists in the Republic of Bashkortostan for 2017-2021 was carried out: the provision of the population with dermatovenereologists, staffing of regular positions of dermatovenereologists, staffing with individuals, part-time ratio, share of visits per one rural resident and one patient with skin diseases, number of visits in connection with the disease, in connection with the preventive purpose. Results. Level of supply of dermatovenerologists in the Republic of Bashkortostan in 2021. amounted to 0.54 per 10 thousand population. In recent years, the provision of dermatovenerologists in the rural population remains low: in 11.1% of rural areas there are no dermatovenerologists, and in 31.5% the level of provision is insufficient. For the period 2017-2021 a decrease in the number of visits to a dermatovenerologist for skin diseases was established by 16.3% (per rural resident from 0.29 to 0.24 visits per resident), as well as a decrease in the number of visits to a dermatovenerologist by 22.0% . (from 4.63 to 3.61 visits per patient). An extremely low volume of telemedicine consultations was revealed, which is a significant factor in reducing the availability of medical care for the rural population. Conclusions. In the Republic of Bashkortostan in recent years, the provision of dermatovenerologists for the rural population remains insufficient. Thus, there is a need to develop measures aimed at improving primary specialized medical care provided by dermatovenerologists to the rural population of the Republic of Bashkortostan.

Effect of the alveolar recruitment maneuver during laparoscopic colorectal surgery on postoperative pulmonary complications: A randomized controlled trial

Intraoperative lung-protective ventilation, including low tidal volume and positive end-expiratory pressure, reduces postoperative pulmonary complications. However, the effect and specific alveolar recruitment maneuver method are controversial. We investigated whether the intraoperative intermittent recruitment maneuver further reduced postoperative pulmonary complications while using a lung-protective ventilation strategy. Adult patients undergoing elective laparoscopic colorectal surgery were randomly allocated to the recruitment or control groups. Intraoperative ventilation was adjusted to maintain a tidal volume of 6–8 mL kg−1 and positive end-expiratory pressure of 5 cmH2O in both groups. The alveolar recruitment maneuver was applied at three time points (at the start and end of the pneumoperitoneum, and immediately before extubation) by maintaining a continuous pressure of 30 cmH2O for 30 s in the recruitment group. Clinical and radiological evidence of postoperative pulmonary complications was investigated within 7 days postoperatively. A total of 125 patients were included in the analysis. The overall incidence of postoperative pulmonary complications was not significantly different between the recruitment and control groups (28.1% vs. 31.1%, P = 0.711), while the mean ± standard deviation intraoperative peak inspiratory pressure was significantly lower in the recruitment group (10.7 ± 3.2 vs. 13.5 ± 3.0 cmH2O at the time of CO2 gas-out, P &lt; 0.001; 9.8 ± 2.3 vs. 12.5 ± 3.0 cmH2O at the time of recovery, P &lt; 0.001). The alveolar recruitment maneuver with a pressure of 30 cmH2O for 30 s did not further reduce postoperative pulmonary complications when a low tidal volume and 5 cmH2O positive end-expiratory pressure were applied to patients undergoing laparoscopic colorectal surgery and was not associated with any significant adverse events. However, the alveolar recruitment maneuver significantly reduced intraoperative peak inspiratory pressure. Further study is needed to validate the beneficial effect of the alveolar recruitment maneuver in patients at increased risk of postoperative pulmonary complications. Trial registration: Clinicaltrials.gov (NCT03681236).

Antenatal Breast Milk Expression Survey of Individuals Whose Pregnancy Was Complicated by Diabetes: Exploring Knowledge, Perceptions, Experiences, and Milk Volume Expressed.

Antenatal breast milk expression (ABE) offers a host of benefits, including reduced formula consumption, support for breastfeeding success, and increased maternal satisfaction. Despite these advantages, experience with ABE differs significantly, often leading to anxiety over perceived inadequate milk supply and eventual breastfeeding cessation. This study comprehensively evaluates the knowledge, attitudes, and real-world experiences of individuals with gestational or pregestational diabetes concerning ABE, with a focus on total milk volume expressed prior to birth. Utilizing a convenience sampling method, we surveyed individuals with gestational or pregestational diabetes from three health care facilities who were trained in ABE. Knowledge and perceptions were gauged through presurvey statements, while postsurvey statements were employed to measure experiences, both using a 5-point Likert scale. In parallel, a retrospective study assessed both maternal and infant outcomes among the same participant pool. Statistical comparisons between individuals with and without reservations were made using the Wilcoxon signed rank sum, Mann-Whitney, chi-square, and Fisher's exact tests. Of the 138 participants, 75% completed both survey segments, and 61% expressed reservations about ABE. Both groups were demographically similar and showed comparable newborn outcomes. However, individuals with reservations experienced heightened pain during ABE, reported lesser lactation support, and were less willing to repeat the process compared to those individuals without reservations. The median total ABE volume was significantly lower by 14 mL among those with reservations (7 vs. 21 mL, p = 0.009). Although both groups demonstrated improved attitudes toward the utility of ABE for individuals with gestational or pregestational diabetes, no significant shift occurred in the perception of ABE difficulty. Our results indicate that individuals with gestational or pregestational diabetes who have reservations about ABE face unique challenges and tend to express lower milk volumes. This underlines the need for specialized interventions and ongoing research to address antenatal lactation support and alleviate ABE-related concerns among individuals with gestational or pregestational diabetes. · Reservations of ABE were associated with reduced milk volumes.. · Regardless of reservations, ABE was felt to be beneficial.. · Our results underscore the need for more ABE education for those with reservations..

Regional nigral neuromelanin degeneration in asymptomatic leucine-rich repeat kinase 2 gene carrier using MRI

Asymptomatic Leucine-Rich Repeat Kinase 2 Gene (LRRK2) carriers are at risk for developing Parkinson's disease (PD). We studied presymptomatic substantia nigra pars compacta (SNc) regional neurodegeneration in asymptomatic LRRK2 carriers compared to idiopathic PD patients using neuromelanin-sensitive MRI technique (NM-MRI). Fifteen asymptomatic LRRK2 carriers, 22 idiopathic PD patients, and 30 healthy controls (HCs) were scanned using NM-MRI. We computed volume and contrast-to-noise ratio (CNR) derived from the whole SNc and the sensorimotor, associative, and limbic SNc regions. An analysis of covariance was performed to explore the differences of whole and regional NM-MRI values among the groups while controlling the effect of age and sex. In whole SNc, LRRK2 had significantly lower CNR than HCs but non-significantly higher volume and CNR than PD patients, and PD patients significantly lower volume and CNR compared to HCs. Inside SNc regions, there were significant group effects for CNR in all regions and for volumes in the associative region, with a trend in the sensorimotor region but no significant changes in the limbic region. PD had reduced volume and CNR in all regions compared to HCs. Asymptomatic LRRK2 carriers showed globally decreased SNc volume and CNR suggesting early nigral neurodegeneration in these subjects at risk of developing PD.