Lower Values Research Articles

Impact of relative cisplatin dose to skeletal muscle mass on adverse events in patients with head and neck cancer undergoing chemoradiotherapy.

Chemoradiotherapy (CRT) with high-dose cisplatin (CDDP) is the standard treatment for locally advanced head and neck squamous cell carcinoma (HNSCC). Although dosing is based on body surface area (BSA), some patients experience CDDP-related adverse events (AEs). We aimed to evaluate the impact of relative CDDP dose to skeletal muscle mass (SMM) on chemotherapy-associated AEs in patients with HNSCC undergoing CRT with high-dose CDDP. We retrospectively analyzed data of patients who underwent CRT with high-dose CDDP (80-100mg/m2, triweekly) between 2010 and 2023. SMM was measured as the cross-sectional muscle area at the third cervical vertebra (C3-SMM) using computed tomography; the skeletal muscle index (SMI) was defined as SMM normalized by squared height. The CDDP index was defined as the prescribed CDDP dose divided by SMI. CDDP-related AEs were assessed during the first cycle using Common Terminology Criteria for Adverse Events v5.0. Overall, 306 patients were identified. The CDDP index cutoff value best associated with grade ≥ 3 AEs was 10.312. Grade ≥ 3 hematological toxicities exhibited stronger association with high CDDP index value than with low CDDP index value (26.9% vs 16.3%, P = .033). Multivariate analysis revealed that high CDDP index value and creatinine clearance < 70mL/minute were predictive factors for grade ≥ 3 AEs (odds ratio [OR] 2.55, P = .008; OR 3.68, P = .002, respectively). The CDDP index based on C3-SMM was an independent predictive factor for grade ≥ 3 CDDP-related AEs. C3-SMM is potentially more useful than BSA for determining the optimal CDDP dose in patients with HNSCC.

Interfacial Electron Beam Lithography Converts an Insulating Organic Monolayer to a Patterned Single-Layer Conductor with Puzzling Charge Transport Performance.

The direct generation of conducting paths within an insulating surface represents a conceptually unexplored approach to single-layer electrical conduction that opens vistas for exciting research and applications fundamentally different from those based on specific layered materials. Herein we report surface channels with single-layer -COOH functionality patterned on insulating n-octadecyltrichlorosilane monolayers on silicon that exhibit unusual ionic-electronic conduction when equipped with ion-releasing silver electrodes. The strong dependence of charge transport in such channels on their lateral dimensions (nanosize, macro-size), the type (p, n) and resistivity (doping level) of the underlying silicon substrate, the nature of the insulating spacer layer between the conducting channel and the silicon surface, and the postpatterning chemical manipulation of channel's -COOH functionality allows designing channels with variable resistivities, ranging from that of a practical insulator to some unexpectedly low values. The unusually low resistivities displayed by channels with nanometric widths and micrometer-millimeter lengths are attributed primarily to enhanced electronic transport within ultrathin nanowire-like silver metal films formed along their conductive paths. Function-structure correlations derived from a comprehensive analysis of electrical, atomic force microscopy, and Fourier transform infrared spectral data suggest an unconventional mode of conduction in these channels, which has yet to be elucidated, apparently involving coupled ionic-electronic transport mediated and enhanced by interfacial electrical interactions with charge carriers located outside the conducting channel and separated from those carrying the measured current. These intriguing findings hint at effects akin to Coulomb pairing in the proposed mechanisms of excitonic superconductivity in interfacial nanosystems structurally related to the present metalized surface channels.

The association between heparin sensitivity index and postoperative blood loss in Chinese patients undergoing elective off-pump coronary artery bypass grafting: a single center retrospective study.

The heparin sensitivity index (HSI) is closely associated with perioperative ischemic events and increased blood loss in cardiac surgery. Previous studies have produced conflicting results. Therefore, this study aimed to investigate the relationship between HSI and postoperative blood loss specifically in Chinese patients undergoing elective off-pump coronary artery bypass grafting (OPCAB). Patients underwent OPCAB between March 2021 and July 2022 were retrospectively included. Enrolled patients were classified into Low-HSI (HSILOW; HSI < 1.3) and Normal-HSI (HSINORM; HSI ≥ 1.3) groups. HSI = [(activated clotting time (ACT) after heparin) - (baseline ACT)] / [loading dose of heparin (IU/kg)]. Primary outcome included postoperative blood loss at 24h. Secondary outcomes were total postoperative blood loss, transfusion requirement of red blood cell (RBC), fresh frozen plasma (FFP), platelet concentrates (PC), and other complications. We retrospectively analyzed 303 Chinese OPCAB patients. HSILOW group had higher preoperative platelet (PLT) count (221 × 109/L vs. 202 × 109/L; P = 0.041) and platelet crit (PCT) value (0.23% vs. 0.22%; P = 0.040) compared to HSINORM group. Two groups showed no significant differences in postoperative blood loss at 24h (460mL vs. 470mL; P = 0.252), total blood loss (920mL vs. 980mL; P = 0.063), RBC transfusion requirement (3.4% vs. 3.1%; P = 1.000), FFP transfusion requirement (3.4% vs. 6.2%; P = 0.380), and other complications. Preoperative high PLT count was associated with low intraoperative HSI value (odds ratio: 1.006; 95% confidence interval: 1.002, 1.011; P = 0.008). Intraoperative HSI value was not associated with postoperative blood loss in Chinese patients undergoing OPCAB. Preoperative high PLT count was an independent predictor of low intraoperative HSI value.

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD)-related advanced fibrosis and cirrhosis in the United States population utilizing AGILE 3 + and AGILE 4 scores: analysis of the NHANES 2017-2018 cycle.

Studies attempted to estimate MASLD-related advanced fibrosis (AF) and cirrhosis (MC) prevalence utilized tests with low positive predictive value (PPV) which overestimates prevalence. AGILE3 + and 4 scores were developed to increase the PPV of both; respectively. In this study, we used these scores to assess the prevalence of AF and MC. Participants aged ≥ 18 years with VCTE exam in the NHANES 2017-2018 cycle were included. We excluded pregnant women, patients with excessive alcohol intake, hepatitis B/C, and ALT or AST > 500 IU/L. MASLD was defined with CAP score > 248 dB/m. MASLD subjects with AGILE 3 + score of ≥ 0.68 and AGILE 4 score of ≥ 0.57 were considered to have advanced fibrosis and cirrhosis; respectively. AGILE 3 + of 0.45-0.67 and AGILE 4 of 0.25-0.57 were grey zone, whereas AGILE 3 + < 0.45 and AGILE 4 < 0.25 were considered a rule-out. 1244 subjects were included in the final analysis. The Median age was 53 (51.4-54.6) years, 55.6% were male, median BMI was 33.8kg/m2 and 41.1% had T2DM. Based on AGILE 3+, 80.3% of the MASLD population were at low risk for AF and 11.5% were in grey zone. The prevalence of AF due to MASLD was 8.1% corresponding to 4.5million Americans. Based on AGILE 4 score, 96.5% of the MASLD population were at low risk for cirrhosis and 2.4% were in the grey zone. The prevalence of MASLD-cirrhosis was 1.1% corresponding to 610,000 Americans. Our results suggest that approximately 4.5million people in the U.S. have AF and 0.6million have cirrhosis due to MASLD.

Optimal vaccination strategies for imperfect vaccines and variable host susceptibility

I present a method to allocate a given number of vaccines to members of a population who differ in their susceptibility to the disease so that the final size of the epidemic is minimised. I consider an arbitrary distribution of protection that the vaccine confers, including the extreme cases of leaky and all-or-none vaccines. The optimal vaccination policy depends on the distribution of protection. While for low values of the basic reproduction number R0 the optimal policy prioritises the most susceptible hosts, I show that for almost any distribution there is a threshold value of R0 above which the order of priority reverses and the least susceptible hosts should be vaccinated. The exception where this does not happen is the all-or-none vaccine. However, even a small deviation from the ideal all-or-none distribution can imply that the limited number of vaccines should be given to less susceptible hosts already at realistic values of R0.

On the stabilization mechanisms of a diffusion edge flame in a cross-flow configuration

This work focuses on the stabilization and combustion efficiency of a gaseous diffusion flame at the lip of a hole where pure methane is injected into a crossflow of air. This configuration mimics the flame base of many flares, used to burn excess gas in the oil and gas industry. In a flare, the flame base, near the lips of the fuel jet duct, is a critical zone where the flame attaches or not. When the cross flow air speed is too high or the torch lips too cold, the flame cannot attach to the lips so that methane can leak below the lifted flame front near the injector lip and avoid combustion totally. This cannot be accepted for climate change since unburnt fuel like methane has a radiation forcing larger than 20 times the value reached for CO2. Combustion efficiencies close to unity are expected for the flares of the future. Two main parameters control the anchoring of the diffusion flame on a thin lip: the air cross-flow velocity uair and the temperature of the lip or equivalently its cooling, measured here by a thermal resistance Rth. Dimensional analysis is used to construct two reduced parameters controlling stabilization and simulations are performed to populate this diagram. The resulting diagram shows how uair and Rth control flame anchoring. Large values of Rth (adiabatic lips) lead to high lips temperatures and to flames which can resist high air cross-flow velocities. For low values of Rth (cold lips), the flame lifts off for smaller values of uair. The simulations also reveal that triple flames are the flame elements controlling the flame anchoring and how these triple flames interact with the lips forming a flame topology called RS (Rim Stabilized) edge flame.

Photoactivated Anticancer Activity of Cobalt(III) Complexes with Naturally Occurring Flavonoids Chrysin and Silibinin.

Photoactive metal complexes of bioessential transition metal ions with natural chelators are gaining interest as photocytotoxic agents for cancer photodynamic therapy (PDT). We report six new cobalt(III) complexes with a mixed-ligand formulation [Co(B)2(L)](ClO4)2 (Co1-Co6), where B represents a N,N-donor α-diimine ligand, namely, phenanthroline (phen; Co1, Co2), dipyrido[3,2-d:2',3'-f]quinoxaline (dpq; Co3, Co4), and dipyrido[3,2-a:2',3'-c]phenazine (dppz; Co5, Co6), and L is the monoanionic form of the naturally occurring flavonoids chrysin (chry; Co1, Co3, Co5) and silibinin (sili; Co2, Co4, Co6). Complexes displayed a d-d absorption band within 500-700 nm and exhibited excellent dark and photostability in solution. Cytotoxicity studies indicated significant activity of Co5 and Co6 against cervical (HeLa) and lung (A549) cancer cells under visible light (400-700 nm) irradiation giving low micromolar IC50 values (2.3-3.4 µM, phototoxicity index ~ 15-30). The complexes demonstrated notably low toxicity against normal HPL1D lung epithelial cells. Flow cytometry assay revealed an apoptotic mode of cell damage triggered by the complexes when irradiated. ROS generation assay indicated the involvement of singlet oxygen species in the cell death mechanism when irradiated with light. Overall, complexes Co5 and Co6 with coordinated dipyridophenazine and flavonoid ligands are potential candidates for cancer PDT applications.

PH-Responsive, Wide Color Gamut Dynamic Color Display Enabled by PDMAEMA Brush-Based Fabry-Perot Resonant Cavity.

Dynamic color-changing materials have attracted broad interest due to their widespread applications in visual sensing, dynamic color display, anticounterfeiting, and image encryption/decryption. In this work, we demonstrate a novel pH-responsive dynamic color-changing material based on a metal-insulator-metal (MIM) Fabry-Perot (FP) cavity with a pH-responsive poly(N,N-dimethylaminoethyl methacrylate) (PDMAEMA) brush layer as the responsive insulating layer. The pH-responsive PDMAEMA brush undergoes protonation at a low pH value (pH < 6), which induces different swelling degrees in response to pH and thus refractive index and thickness change of the insulator layer of the MIM FP cavity. This leads to significant optical property changes in transmission and a distinguishable color change spanning the whole visible region by adjusting the pH value of the external environment. Due to the reversible conformational change of the PDMAEMA and the formation of covalent bonds between the PDMAEMA molecular chain and the Ag substrate, the MIM FP cavity exhibits stable performance and good reproducibility. This pH-responsive MIM FP cavity establishes a new way to modulate transmission color in the full visible region and exhibits a broad prospect of applications in dynamic color display, real-time environment monitoring, and information encryption and decryption.

Isolated single-photon emitters with low Huang–Rhys factor in hexagonal boron nitride at room temperature

The development of stable room-temperature bright single-photon emitters using atomic defects in hexagonal boron nitride flakes (h-BN) provides significant promise for quantum technologies. However, an outstanding challenge in h-BN is the creation and detection of isolated, stable single-photon emitters with high emission rates and with very low Huang–Rhys (HR) factor. Here, we discuss the quantum photonic properties of a single, isolated, stable quantum emitter that emits single photons with a high emission rate and a low HR value of 0.6 ± 0.2 at room temperature. A scanning confocal image confirms the presence of a deserted, single-quantum emitter with a prominent zero-phonon line at ∼578 nm with a well-separated phonon sideband at 626 nm. The second-order intensity-intensity correlation measurement shows an anti-bunching dip of ∼0.25 with an emission lifetime of 2.46 ± 0.1 ns, reinforcing distinct features of the single-photon emitter. The importance of low-energy electron beam irradiation and subsequent annealing is emphasized to achieve stable, reproducible single-photon emitters.

Optical properties of meso-tetra(sulphonatophenyl) porphyrins (TPPS 4) and their Fe 3+, Mn 3+, Zn 2+ complexes with different pH values studied using by picosecond pulse trains

Applying picosecond pulse trains propagating in meso-tetra(sulphonatophenyl) porphyrins and their Fe 3+, Mn 3+, Zn 2+ complexes, we studied the nonlinear dynamics at different pH values. The pulse train at wavelength 532nm is comprised of 20 subpulses with 70ps width and 13ns spacing. We simplified the energy structures of porphyrins and metalloporphyrins to five-level models. In solving coupled rate equations and two-dimensional paraxial field, we used Crank-Nicholson numerical method to do the calculations. The results revealed that in irregular metalloporphyrins with central paramagnetic ion Mn 3+ or Fe 3+, the central ion would act as electron acceptor, which leads to charge transfer of unpaired metal electron to the porphyrin ring π conjugated system, and strengthen the spin–orbit coupling of electronic systems and weaken the transition prohibition between electronic states in porphyrins. However regular metalloporphyrins with central diamagnetic ion Zn 2+ has similar optical properties to free base porphyrins, and Zn 2+ TPPS 4 has much longer excited state lifetimes and slower intersystem crossing. In solutions, hydrogen bond would be formed to porphyrin, which can change the transitions of π electrons and thus the charge transfer can be strengthened in the porphyrin ring. In weak intensity region with linear absorption, nonprotonated porphyrins with high pH value show better optical limiting (OL) effect. Conversely in high intensity region, protonated porphyrins with low pH value show better OL effect. Besides, increasing interaction distances of porphyrins and metalloporphyrins with laser pulses is another important factor to raise the OL effects.

P-036 Female age affects the combined impact of DNA fragmentation and high DNA stainability on embryo development in intracytoplasmic sperm injection cycles

Abstract Study question To investigate the role of female age in regulating the co-effect of DNA fragmentation index (DFI) and high DNA stainability (HDS) on ICSI embryological outcomes. Summary answer When female age exceeded 35, co-exposure high DFI and middle HDS might delay embryonic development after ICSI treatment. What is known already Sperm DNA damage had a negative influence on embryonic development. Oocytes and embryos have adopted specific response and repair mechanisms to repair sperm DNA damage. However, the DNA repair capacity in the oocyte is limited and likely decline with increasing age. Study design, size, duration This historical cohort study was included 1334 couples underwent ICSI from January 2017 to December 2022. An unsupervised K-means clustering method was used to divide participants into three clusters base on DFI value and HDS value, as follow: cluster 1 with low DFI values and low HDS values (lDFI-lHDS group), cluster 2 with middle DFI values and high HDS values (mDFI-hHDS group), and cluster 3 with high DFI values and middle HDS values (hDFI-mHDS group). Participants/materials, setting, methods All participants were further stratified into female age&amp;lt;35 subgroup and female age≥35 subgroup. The univariate and multivariate linear regression model was used for statistical analysis. Multivariate model was adjusted for female factor (including age, AMH, basal FSH and the numbers of retrieved oocyte) and male age which were significantly correlated with embryo development in univariate models. The main outcome measure was D5 blastocyst development rate and D6 blastocyst development rate. Main results and the role of chance In the female age&amp;lt;35 subgroup, D5 blastocyst development rate in the mDFI-hHDS group (48.53% [25.00%, 66.67%] and the hDFI-mHDS group (50.00% [28.57%, 71.07%]) was significantly higher than that in the lDFI-lHDS group (40.00% [0.00%, 63.96%]). No significant differences were observed between the three groups regarding D6 blastocyst development rate. And univariate model and multivariate model showed that the mDFI-hHDS group (adjusted B value=0.36, 95% CI: 0.08∼0.64, P=0.010) and hDFI-mHDS group (adjusted B value=0.41, 95% CI: 0.12∼0.70, P=0.006) had higher D5 blastocyst development rate compared with lDFI-lHDS group. In the female age≥35 subgroup, D5 blastocyst development rate in the hDFI-mHDS (20.00% [0.00%, 50.00%]) group was significantly lower than that in the lDFI-lHDS group (36.93% [0.00%, 66.67%]) and the mDFI-hHDS group (41.43% [0.00%, 63.54%]). Accordingly, D6 blastocyst development rate in the hDFI-mHDS group (66.67% [33.33%, 100.00%]) was significantly higher than that in the lDFI-lHDS group (50.00% [16.67%, 80.00%]) and the mDFI-hHDS group (50.00% [33.33%, 66.67%]). And both model showed that hDFI-mHDS group (adjusted B value=0.73, 95% CI: 0.36∼1.11, P&amp;lt;0.001) had higher D6 blastocyst development rate compared with the lDFI-lHDS group. Although not statistically significant, hDFI-mHDS had negative correlation with D5 blastocyst development rate. Limitations, reasons for caution The main weakness of this study was the participants were not randomized. Wider implications of the findings hDFI-mHDS group were negatively associated with D5 blastocyst development rate and positively related with D6 blastocyst development rate in female age≥35 subgroup. These results suggested that co-exposure high DFI and middle HDS might be recommended as a predictor for the detection of delayed embryo development when female age exceeded 35. Trial registration number not applicable

Autumn Leucojum autumnale and spring L. trichophyllum: the same flower type for different seasons with a different pollination scenario

Plant reproduction may experience distinct evolutionary and ecological dynamics depending on their flowering phenology. Consequently, floral traits might undergo divergence selection to adapt to the difference in the abiotic and the biotic environment, especially if these traits affect intensity of competition plants experience due to pollinators. The present study analyzed the plant floral display, floral rewards, and the pollination and breeding systems of two related species of Leucojum, the autumn-blooming L. autumnale and the spring-blooming L. trichophyllum. The aim of the current study is to compare reproductive aspects of L. autumnale and L. trichophyllum due to differing environmental conditions. Both species needed pollinators to reproduce sexually, with zero (L. trichophyllum) or low values (c. 7.7%; L. autumnale) for fructification after self-pollination vs. over 90% after natural pollination (both species). Their flowers opened in the morning and closed at night, and neither produced nectar, only pollen as reward to pollinators. Plants of the L. autumnale studied population produced 1–4 inflorescences per plant vs. only 1 in L. trichophyllum, and the former presented a greater density of flowers per surface unit. Leucojum autumnale flowers were visited by Hymenoptera and those of L. trichophyllum only by two Coleoptera, which were most abundant at sunrise and sunset, whereas in the middle of the day, they visited Cistaceae flowers. This latter occurrence may represent a temporal niche partitioning rather than competition in relation to visiting hours, as the L. trichophyllum flowers offer a place for insects to spend the night, a period in which the flowers of the Cistaceae species have lost their petals.

3D Gravity and magnetic inversion modelling for geothermal assessment and temperature modelling in the central eastern desert and Red Sea, Egypt

The Central Eastern Desert and Red Sea region have emerged as a significant area of interest for geothermal energy exploration, owing to their unique geological characteristics and active tectonic activity. This research aims to enhance our understanding of the region's geothermal potential through a comprehensive analysis of gravity and magnetic data. By utilizing a 3D gravity inversion model, a detailed examination of subsurface structures and density variations was conducted. Similarly, a 3D magnetic inversion model was employed to investigate subsurface magnetic properties. Integration result from the Pygimli library ensured robustness and accuracy in the inversion results. Furthermore, a temperature model was developed using the WINTERC-G model and inversion techniques, shedding light on the thermal structure and potential anomalies in the study area. The analysis of the Bouguer gravity map, 3D gravity inversion model, and magnetic data inversion yielded significant findings. The Red Sea exhibited higher gravity values compared to the onshore Eastern Desert, attributed to the presence of a thinner and denser oceanic crust as opposed to the less dense continental crust in the Eastern Desert. The 3D gravity inversion model revealed distinct variations in density, particularly high-density zones near the surface of the Red Sea, indicating underlying geological structures and processes. Conversely, density gradually decreased with depth along the onshore line, potentially influenced by a higher concentration of crustal fractures. The magnetic data inversion technique provided additional insights, highlighting areas with demagnetized materials, indicative of elevated temperatures. These findings were consistent with the correlation between high-density areas and low magnetic susceptibility values, reinforcing the proposition of increased heat transfer from the Red Sea. Comparative analysis of temperature profiles further confirmed the presence of elevated temperatures in promising zones, emphasizing the geothermal potential associated with heat transfer from the Red Sea.This research contributes to the understanding of the geothermal resources in the Central Eastern Desert and Red Sea region. The results from gravity and magnetic data inversions, combined with temperature profiles, provide valuable information for future geothermal exploration and utilization efforts. The findings underscore the importance of geothermal energy in achieving sustainability and contribute to the global discourse on renewable energy sources.

Universal and nonuniversal statistics of transmission in thin random layered media

The statistics of transmission through random 1D media are generally presumed to be universal and to depend only upon a single dimensionless parameter-the ratio of the sample length and the mean free path, s = L / ℓ . Here we show in numerical simulations and optical measurements of random binary systems, and most prominently in systems for which s<1, that the statistics of the logarithm of transmission, ln ⁡ T , are universal for transmission near the upper cutoff of unity and depend distinctively upon the reflectivity of the layer interfaces and their number near a lower cutoff. The universal segment of the probability distribution function of the logarithm of transmission, P ( ln ⁡ T ) is manifested with as few as three binary layers. For a given value of s, P ( ln ⁡ T ) evolves towards a universal distribution as the number of layers increases. Optical measurements in stacks of 5 and 20 glass coverslips exhibit statistics at low and moderate values of transmission that are close to those found in simulations for 1D layered media, while differences appear at higher transmission where the transmission time in the medium is longer and the wave explores the transverse nonuniformity of the sample.

Study of the Relationship between Insulin Resistance, Iron Status Markers and Body Weight in a Sample of Egyptian Population

Abstract Background Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Aim of the Work The aim of this study is to investigate the relationship between insulin Resistance, iron Status Markers and body Weight in a sample of Egyptian population. Patients and Methods Our study was case control study conducted on 90 subjects their age was ranging form18 to 70 from diabetes outpatient clinic, and they were divided into 3 groups: Group (1): Non-obese non-diabetic as a control group, Group (2): Obese non diabetic and group (3): Obese diabetic. Results In our study, there was no statistical significant difference found between the three studied groups regarding iron study, Also our study showed that there was statistically non significant correlation between (ferritin level and TIBC), and (ferritin level, HOMA IR), but there was statistical significant positive correlation found between TIBC and FBS (p- value 0.045),Similarly, we did not observe either abnormally high or low ferritin values in our study on subjects with obesity. We found no association between this marker and body weight, in contrast with others. In our study, the higher insulin and HOMA-IR values observed in the subjects with TSAT&amp;lt;20% = 4.2(1.4-11.6) than those with TSAT &amp;gt;20% =2.4 (1.15-6.95), but statistically non significant p- value. The present study also showed that There was statistical significant positive correlation between (T.SAT, serum ferritin), (T.SAT, S.iron) and (T.SAT,SBP) (with p-value 0.03). Our study also showed that there was no statistical significant difference found between patients with T.sat ≤ 20% and those with T.sat &amp;gt; 20% regarding all the studied parameters except ferritin level and iron level was found higher in patients with T.sat &amp;gt;20% than those with T. sat ≤20% with p-value &amp;lt;0.001 and &amp;lt;0.001 respectively. Conclusion Characteristics of iron deficiency or iron overload were not observed in subjects with overweight/obesity and diabetic patients. Our results suggest a complex metabolic dysregulation.

Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population.

The process of identifying drug-related hospitalisations is subjective and time-consuming. Assessment tool for identifying hospital admissions related to medications (AT-HARM10) was developed to simplify and objectify this process. AT-HARM10 has not previously been externally validated, thus the predictive precision of the tool is uncertain. To externally validate AT-HARM10 in adult patients admitted to the emergency department (ED). This retrospective cross-sectional study investigated 402 patients admitted to the ED, Diakonhjemmet Hospital, Oslo, Norway. A trained 5th-year pharmacy student used AT-HARM10 to assess all patients and to classify their ED visits as possibly or unlikely drug-related. Assessment of the same patients by an interdisciplinary expert panel acted as the gold standard. The external validation was conducted by comparing AT-HARM10 classifications with the gold standard. According to AT-HARM10 assessments, 169 (42%) patients had a possible drug-related ED visit. Calculated sensitivity and specificity values were 95% and 71%, respectively. Further, positive and negative predictive values were 46% and 98%, respectively. Adverse effects/over-treatment and suboptimal treatment were the issues most frequently overestimated by AT-HARM10 compared with the gold standard. AT-HARM10 identifies drug-related ED visits with high sensitivity. However, the low positive predictive value indicates that further review of ED visits classified as possible drug-related by AT-HARM10 is necessary. AT-HARM10 can serve as a useful first-step screening that efficiently identifies unlikely drug-related ED visits, thus only a smaller proportion of the patients need to be reviewed by an interdisciplinary expert panel.

Studying Hemodynamics during Weaning from Mechanical Ventilation among Critically ill Pediatric Patients

Abstract Background Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. Knowledge of the changes in the cardiopulmonary pathophysiology occurring during mechanical ventilation and its withdrawal is a prerequisite for early recognition of weaning failure of cardiovascular origin and optimal patient management. Aim of the Work Identification of hemodynamic and biomarkers changes during weaning process from mechanical ventilation and how these changes predict weaning success Methodology This cross sectional study was conducted on 50 children who were admitted to Pediatric Intensive Care Units and were mechanically ventilated and ready to be weaned according to weaning criteria. assessment of hemodynamic changes during weaning was done by tracing and comparing vital data, echocardiography parameters and levels of serum BNP and troponin in all patients during pressure support ventilation and at the end of spontaneous breathing trial (SBT) for identification of changes during weaning and risk factors for weaning failure. Results There was statistically significant increase in heart rate, cardiac index and E/A ratio at the end of SBTin all studied patients with lower cardiac index in patients who failed weaning, significant increase in TAPSE at the end of SBT with lower TAPSE in patients who failed weaning. Levels of BNP1 during pressure support were significantly higher in patients who failed weaning however levels of troponin didn’t show significant changes. Conclusion Transthoracic echocardiography can accurately detect changes in central hemodynamics induced by the SBT. It helps the attending physician to identify patients at high risk of weaning failure, when documenting a lower cardiac index, low TAPSE values.

Analyzing the link between built environment and physical activity: a spatial study in suburban area

Promoting physical activity is a significant concern that contributes to urban development, thereby fostering good health among city residents. This imperative highlights the interconnectedness between public health initiatives and the advancement of urban landscapes, reflecting the interdisciplinary nature of environmental science. Hence, this study aims to investigate the correlation between the built environment and access to physical activities within distinct local contexts. Utilizing the ordinary least squares estimation technique alongside spatial statistical analysis tools can facilitate the exploration of spatial disparities and interdependencies. Results pertaining to the built environment indicate significant differences within the built group context at a p-value level of 0.000. This suggests that within the local context, various activities, including those related to the transportation system, differ throughout the city. Findings regarding the link between the built environment and physical activity indicate that the relatively low R-squared values (0.10–0.20) may be attributed to the presence of grid areas with minimal walking distances. This finding underlines the key role of the built environment in promoting physical activity, highlighting the importance for urban planning and design to prioritize enhancements in active transportation infrastructure and increase access to urban activity nodes. This can be achieved by strategically distributing physical activity opportunities and ensuring accessibility via active transportation and public transit.

Retrospective Study for Evaluation of TIRAD Scoring System Irrespective of FNAC in Decision Making Outcomes in Thyroidectomy

Abstract Background Thyroid nodules present a common clinical problem. Palpable nodules are present in about 5% of the population, and are noted incidentally on ultrasound in up to 70% of people, with increased prevalence in older patients. The incidence of thyroid nodules has increased due to exposure to medical radiation, iodine intake, obesity, insulin resistance, genetics and inorganic phosphates. With a 300% increase in the annual thyroid cancer rate. Aim of the Work The aim of this study is to evaluate the value of Ultrasound and TIRAD scoring system for decision making outcomes in thyroidectomy done for thyroid nodules. Patients and Methods This Retrospective cohort study was conducted at (General surgery department), Ain Shams University Hospitals and Ain shams University specialized Hospitals and was conducted over a period of six months starting from date of approval of the protocol. Results In our study, Conventional sonography has 66.66% sensitivity and 92.5% specificity as it suspected malignancy (positive suspecting findings) in 14 patients; eight of them were proved to be malignant and six of them were benign by histopathology accounting for low positive predictive value (57.14%) and it suspected benignity (negative suspecting findings) in 78 patients; 74 of them were perfectly correlated with the histopathology accounting for high negative predictive value (94.87%). In our study, the rate of detecting patients with thyroid cancer (sensitivity) was calculated as 80%, the rate of distinguishing healthy individuals (specificity) was 88.88%, the Positive Predictive Value (PPV) was 57.14% and the negative predictive value (NPV) was 96% for FNAC. In our study, the sensitivity and the specificity of FNAC in detecting cancer was near to the literature but the (PPV) was lower than the literature and was non diagnostic in fourty patients (40%), we think that this discrepancy depends on many factors including radiology, pathology, and the materials used in FNAC method, and patients with multiple nodules. Conclusion Neck US and FNAC have proven low sensitivity in differentiating malignant from benign thyroid nodules

O-088 Effect of low, medium and high risk chemotherapy on the ovarian reserve in children: results of the interim analysis of a prospective multicentric trial (CHANCE)

Abstract Study question How does the ovarian reserve of children diagnosed with cancer recover after chemotherapy that is considered as low or medium risk of future infertility? Summary answer The study showed no evidence that low and medium risk treatments impact the future ovarian function in children. What is known already Acute premature ovarian insufficiency (POI) post childhood cancer treatment is estimated around 6%, varying with treatment type and age at diagnosis. Long-term risk of treatment-related infertility is challenging to assess in this population as most of the data comes from retrospective trials involving adult cohorts of childhood cancer survivors. Benefit of fertility preservation at diagnosis is evident for high risk patients. However, for low or medium risk patients, the lack of knowledge on treatment effect on the ovarian reserve and on marker reliability in children complicates counselling. Study design, size, duration CHANCE is a prospective multicentric observational trial enrolling patients aged between 3 and 14 years at cancer diagnosis. We evaluated factors associated with the risk of future infertility such as hormonal levels, puberty and menstruation, and investigated the fertility preservation strategy. Parameters were assessed at screening, one year post-screening, end of the treatment, and during follow-up (FU) until 18 years of age. An interim analysis was planned considering the duration to reach the final endpoint. Participants/materials, setting, methods Between 2014 and 2023, 144 patients were enrolled. Patients were categorized in 3 groups by cumulative equivalent dose of cyclophosphamide (CED) received: &amp;lt;4000mg/m2 (low), 4000 to 8000mg/m2 (medium) and &amp;gt;8000 mg/m2 (high). Ninety-four patients with at least one year post-treatment follow-up were included in this analysis. Mean age at diagnosis was 8.4±4 years and 38% were prepubertal, with no difference between groups (p = 0.06 and 0.26, respectively). The median time of follow-up was 32.7 months. Main results and the role of chance Patients were categorized as low (n = 58), medium (n = 18) and high (n = 18) risk based on CED. Sarcoma were most frequent in high risk, while leukemia in low/medium risk groups (p &amp;lt; 0.0001). Fertility preservation was performed in 55.6%, 27.8% and 8.6% in high, medium and low risk group, respectively (p &amp;lt; 0.0001). The majority of them underwent ovarian tissue cryopreservation. POI was defined as induced puberty and/or FSH&amp;gt;25IU/l during FU. POI occurred in 10 out of 18 (55.6%) patients in high risk group, while in no patient in the low/medium risk groups except 1 with disease recurrence. POI was associated with high doses of chemotherapy (p &amp;lt; 0.0001) and increased age (p &amp;lt; 0.007). AMH levels significantly decreased in high and medium risk group during treatment. Recovery occurs in medium but not high risk groups (p = 0.84 and 0.02 between screening and values at 1-2 years and &amp;gt;3 years of FU using repeated measures analysis). Low AMH values (&amp;lt;0.5ng/ml) was observed at 2 years of FU in 14.3%, 28.6% and 69.2% of the patients in low, medium and high risk groups respectively. The impact of treatment, particularly in medium risk group, needs confirmation as around 35% of the patients were still prepubertal at the time of the analysis. Limitations, reasons for caution This is an interim analysis of a prospective trial designed to include 275 patients. Data should be cautiously interpreted due to not reaching the calculated optimal power population. Wider implications of the findings Our data confirmed that fertility preservation should be offered to all children and adolescent treated with high risk regimen. We did not provide evidence supporting its benefit for low/medium risk pre-pubertal children. For post-pubertal medium risk patients, fertility preservation may be considered during the FU based on patient decision. Trial registration number NCT02595255