Maintenance Rate Research Articles

A RE-AIM Analysis of a Mental Health App for Undergraduate and Medical Students during the COVID-19 Pandemic: A Retrospective Cross-Sectional Study.

The purpose of this study was to use the RE-AIM framework to evaluate the implementation of a mental health app designed for undergraduate and medical students during the COVID-19 pandemic. Medical (n = 270) and undergraduate students (n = 1386) from five universities in the Appalachian region in the United States participated in this study. Universities from the United States were recruited to deploy the Sharpen app for medical and undergraduate students. The Sharpen app provided psychoeducational modules in mental health literacy, social-emotional learning, mindfulness-based stress reduction, and suicide prevention to promote protective factors for students. The utilization of the Sharpen app was analyzed using the RE-AIM framework using a retrospective, cross-sectional design. Reach: A total of 12.72% of medical students and 6.00% of undergraduate students participated in the study. Medical students viewed significantly more pages, had a significantly higher unique page view average, and a statistically significant exit percentage when compared to undergraduate students. Adoption: A total of 100% of the universities that were recruited participated in the study. Five out of six implementation criteria were included, indicating high implementation. Maintenance: All of the universities continued using the Sharpen app following the end of data collection, resulting in a 100% maintenance rate. The RE-AIM framework indicated usability and maintenance by medical and undergraduate students. Future research needs to implement a more rigorous design to determine the impact of the Sharpen app on mental health outcomes in medical and undergraduate students.

Spatial correlation of left atrial low voltage substrate in sinus rhythm versus atrial fibrillation: The rhythm specificity of atrial low voltage substrate.

Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional ablation of low voltage substrate (LVS) during SR. However, voltage mapping during SR may be hindered in persistent and long-persistent AF patients by immediate AF recurrence after electrical cardioversion. We assess correlations between LVS extent and location during SR and AF, aiming to identify regional voltage thresholds for rhythm-independent delineation/detection of LVS areas. (1) Identification of voltage dissimilarities between mapping in SR and AF. (2) Identification of regional voltage thresholds that improve cross-rhythm substrate detection. (3) Comparison of LVS between SR and native versus induced AF. Forty-one ablation-naive persistent AF patients underwent high-definition (1 mm electrodes; >1200 left atrial (LA) mapping sites per rhythm) voltage mapping in SR and AF. Global and regional voltage thresholds in AF were identified which best match LVS < 0.5 mV and <1.0 mV in SR. Additionally, the correlation between SR-LVS with induced versus native AF-LVS was assessed. Substantial voltage differences (median: 0.52, interquartile range: 0.33-0.69, maximum: 1.19 mV) with a predominance of the posterior/inferior LA wall exist between the rhythms. An AF threshold of 0.34 mV for the entire left atrium provides an accuracy, sensitivity and specificity of 69%, 67%, and 69% to identify SR-LVS < 0.5 mV, respectively. Lower thresholds for the posterior wall (0.27 mV) and inferior wall (0.3 mV) result in higher spatial concordance to SR-LVS (4% and 7% increase). Concordance with SR-LVS was higher for induced AF compared to native AF (area under the curve[AUC]: 0.80 vs. 0.73). AF-LVS < 0.5 mV corresponds to SR-LVS < 0.97 mV (AUC: 0.73). Although the proposed region-specific voltage thresholds during AF improve the consistency of LVS identification as determined during SR, the concordance in LVS between SR and AF remains moderate, with larger LVS detection during AF. Voltage-based substrate ablation should preferentially be performed during SR to limit the amount of ablated atrial myocardium.

PREVALENCE OF SMOKING IN INSTITUTIONALISED ADOLESCENT ORPHANS OF PATNA, BIHAR

Background: Smoking is a significant public health concern with detrimental effects on overall well-being. Vulnerable populations, such as institutionalized adolescent orphans, may face unique challenges that contribute to higher rates of smoking initiation and maintenance. This study aimed to investigate the prevalence of smoking among institutionalized adolescent orphans in Patna, Bihar, and identify associated factors. Methods: A cross-sectional study was conducted among institutionalized adolescent orphans aged 13-18 years in Patna, Bihar. A structured questionnaire was administered to collect data on smoking behavior, demographics, initiation age, frequency of smoking, duration, reasons for smoking, exposure to tobacco advertising, knowledge about the harmful effects of smoking, and previous attempts to quit. Data were analyzed using descriptive statistics and subgroup analyses. Results: A total of 250 institutionalized adolescent orphans participated in the study. The overall prevalence of smoking was found to be 17%. Male participants exhibited a higher prevalence of smoking (22%) compared to females (11%). The prevalence increased with age, with the highest rates observed among the 17-18 years age group. Exposure to tobacco advertising and peer pressure were identified as influential factors associated with smoking initiation. A considerable proportion of smokers reported a lack of awareness about the harmful effects of smoking. Previous attempts to quit smoking were reported by 25% of smokers. Conclusion: The study highlights a significant prevalence of smoking among institutionalized adolescent orphans in Patna, Bihar. Gender, age, exposure to tobacco advertising, peer pressure, and lack of awareness were identified as important factors associated with smoking behavior in this population. The findings emphasize the need for targeted interventions and policies addressing these factors to reduce smoking rates and improve the overall well-being of institutionalized adolescent orphans. Further research is needed to evaluate the effectiveness of specific interventions and to explore additional factors influencing smoking behavior in this context

HIC: A high‐reliable in‐band control network for perception layer of software‐defined IoT

AbstractWith the rapid development of the Internet of Things (IoT) and the popularity of the software‐defined idea, the software‐defined Internet of Things (SD‐IoT) came into being. However, the transmission conflict between control flow and data flow in the perception layer with poor channel resources has become an important constraint for SD‐IoT. Thus, this paper adopts the idea of isolated forwarding control flow based on an in‐band channel, that is, selecting some sensor nodes to be responsible for forwarding control flow, and proposes high‐reliable in‐band control network (HIC), a high‐reliability in‐band control network. In order to support real‐time tasks in the IoT environment, HIC adopts a divided control area to support parallel responses of multiple partially overlapping tasks. Further, in each control area, the graph theory is used to model the control node selection problem, and an algorithm for efficiently solving the model is designed based on the community detection method. Finally, we developed the HIC experimental platform composed of HIC‐topology and HIC‐simulation and carried out simulation experiments and analysis from topology generation, maintenance, and operation. The experimental results show that HIC could better adapt to the SD‐IoT under multi‐task deployment, and has great advantages in terms of the success rate and time of topology rapid maintenance compared with similar solutions.

Missed Opportunities for Urate Lowering Therapy after Gout Flares in Frail Patients Living Alone

Background/Aims: Irrespective of socioeconomic status, urate lowering therapy (ULT) is crucial for all chronic gout patients. We investigated the presence of missed opportunities for ULT among underprivileged patients treated at a major public hospital in Korea after a severe gout flare.Methods: We first collected information on patients admitted under the diagnosis of gout (International Classification of Diseases 10th Revision code M10) at a major public hospital from March 2011 to February 2022. De-identified patient data, including sociodemographic status, uric acid levels, list of medications, and outpatient follow-up data, were extracted. The patients were grouped into frail patients, who were living alone and were admitted to the specialized ward (SPE), and those who were admitted to the general ward (GEN). Primary endpoints were the outpatient visit rate immediately after discharge and the rate of ULT maintenance after a year.Results: Acute gouty arthritis was the chief event during admission in 136 cases. The mean (± standard deviation) age was 60.1 (± 16.1) years, and 95% of the patients were male. Only 18% of the patients were on ULT before admission. The patients were divided into the SPE (n = 25) and GEN (n = 111) groups. Body mass index in the SPE group was lower than in the GEN group (23.4 [± 4.4] and 25.1 [± 3.7], respectively, &lt;i&gt;p&lt;/i&gt; = 0.082). The uric acid levels at admissio in the SPE and GEN groups were 9.6 (± 2.7) and 7.6 (± 2.3), respectively (&lt;i&gt;p&lt;/i&gt; = 0.0023). After discharge, 80% and 95.5% of the SPE and GEN group participants presented to the outpatient department within 1 month, respectively (&lt;i&gt;p&lt;/i&gt; = 0.019). ULT was continued or initiated in 85% of the patients. However, fewer patients continued colchicine for at least 3 months in the SPE group compared to the GEN group (25.0% and 43.4%, respectively). After 1 year, the SPE group had a higher rate of loss to follow-up (32.0% vs. 23.4%), higher uric acid levels (7.4 [± 3.8] vs. 6.2 [± 2.1]), and fewer ULT users (41.2% vs. 50.6%) compared to the GEN group, but the differences were not statistically significant.Conclusions: Frail patients who lived alone, even in the metropolitan area, missed opportunities for ULT and long-term gout care. Joint efforts on the part of health authorities and social workers are necessary to devise a strategy for better access and management among underprivileged gout patients.

Integration of operational lockout/tagout in a joint production and maintenance policy of a smart production system

Accidents during maintenance operations are frequently occurring and sometimes even fatal. The lack of energy locking is one of the main factors of accidents during maintenance. The Lockout/Tagout (LOTO) process aims to ensure the safety of workers by providing a control of equipment energies before and after preventive or corrective maintenance activities. However, LOTO is often seen as an unnecessary delay that increases production costs. The objective of this work is to minimize production and inventory costs of finished products, while guaranteeing the safety of workers during maintenance activities by the implementation of operational LOTO actions, which allows for production continuity during the securing of energy sources. This work studies the problem of production and maintenance planning of a smart production system that deteriorates according to its age affecting its reliability and availability. The system under study consists of a production unit processing a single type of parts and exposed to random failures and repairs. The decision variables for this control problem are the machine age dependent production and preventive maintenance rates of the machine. The proposed model is based on the stochastic optimal control theory and the optimality conditions are obtained by the dynamic programming approach. Such conditions are of the Hamilton-Jacobi-Bellman (HJB) type and have been solved by numerical methods for concrete industrial case applications. The developed model is validated using a numerical example and a sensitivity analysis is conducted to study the behavior of the system related to the variations of some parameters. A comparative study shows that the proposed operational LOTO strategy performs better than a traditional LOTO strategy in optimizing maintenance operations and reducing incurred costs. This study proposes new managerial policies in terms of joint management of production, maintenance and safety.

Single versus double transeptal puncture: characterization and outcomes in a single tertiary center

Abstract Funding Acknowledgements Type of funding sources: None. Background An ablation catheter in conjunction with a circular mapping catheter (CMC) requiring a double transeptal puncture (TSP) for left atrial access is conventionally used for atrial fibrillation (AF) ablation in the majority of centers. In the recent years, different operators have combined a single transseptal puncture technique with 3D high-density mapping catheters for pulmonary veins isolation (PVI) in AF patients. Objective The aim of this analysis is to compare two different strategies, single versus double TSP, regarding duration of the procedure, radiation dose, complications and long-term outcomes. Methods Retrospective analysis of an AF large cohort of consecutive patients that underwent PVI with radiofrequency energy (RF) using a 3D mapping system, either with single or double TSP, from 2016 to 2020. Results We included 341 patients (female 35,8 %, paroxysmal AF 64,2 %) who underwent catheter ablation with RF. At the time of the ablation, age was 59,1 ± 11,8 years old, and the mean CHA2DS2-VASc score was 1,6 ± 1,3. All patients were taking oral anticoagulation. Single TSP was performed in 165 (48,4%%) patients and double TSP in 176 (51,6%) patients. In 56 (16,4%) cases (50 [30,3%] in the single TSP and 6 [3,4%] in the double TSP), the procedure was a repeat ablation after AF recurrence. Operator experience (defined as ≥5 years of AF ablation procedures) was equally distributed between the two groups. The average procedure time single (129 ± 33,2 minutes vs. 122 ± 34,9 minutes, for single and double TSP, respectively) did not reach statistical difference between the two groups (p = 0,55), but there was a significant difference regarding fluoroscopy time (13 ± 6,3 vs. 19 ± 9,1, for single and double TSP, respectively; p &amp;lt; 0,001). Acute complications were less frequent in the single TSP approach (5,6 % vs. 9,7 %, for single and double TSP, respectively), but did not reach statistical significance. At 2-year follow-up, sinus rhythm maintenance rate was similar in both groups (77% vs. 78%, p=0,85). At 2 and 4 year follow-up, the Kaplan-Meier survival curves revealed no difference in time to AF recurrence between the two groups (log- rank p = 0,974 and p = 0,965). However, further analysis of subgroups according to type of AF revealed a significant difference among the subgroup with persistent AF submitted to double TSP (log rank p = 0,007) during a total of follow-up of 4 years. Conclusion A simplified single-TSP technique using high-density multi-electrode 3D mapping is a safe and highly successful approach for AF ablation. This approach yields a substantial reduction in fluoroscopy time, with the potential to avoid acute complications when compared to a conventional double-TSP strategy.

(097) A Novel Therapeutic Strategy for Recovery from Cavernous Veno-Occlusive Dysfunction through Chronic Administration of Hepatocyte Growth Factor and a JNK Inhibitor in a Rat Model of Cavernous Nerve Injury

Abstract Introduction Structural alterations of penis including cavernosal apoptosis and fibrosis induce venous leakage in the corpus cavernosum or cavernosal veno-occlusive dysfunction, a key pathophysiology of erectile dysfunction (ED) after radical prostatectomy. Objective We aimed to determine if JNK inhibition in combination with intracavernosal administration of hepatocyte growth factor (HGF) would completely restore cavernosal veno-occlusive function (CVOF) in a rat model of ED induced by bilateral CN crush injury (CNCI). Methods A total of forty-two male Sprague-Dawley rats were randomly assigned to sham control (S), CNCI (I) and CNCI treated with combination of JNK inhibitors and HGF (J+H) for 5 weeks after surgery. All rats in each group were evaluated by dynamic infusion cavernosometry (DIC), caspase-3 activity assay, Masson’s trichrome staining, immunohistochemical staining of α-smooth muscle actin (α-SMA) and immunoblotting at 5 weeks after surgery. Results Regarding CVOF, Group I showed a decreased papaverine response, an increased maintenance and drop rates compared to Group S. Group J+H showed significant improvements in the three DIC parameters compared to Group I. There were no differences in papaverine response and drop rate between Group J+H and Group S. Regarding the structural integrity of corpus cavernosum, Group I had an increased caspase-3 activity, decreased SM/collagen ratio, decreased content of SM, decreased protein expression of PECAM-1, and decreased phosphorylation of c-Jun and c-Met. Group J+H had significant alleviation in the histological and molecular derangement compared to Group I. There were no differences in caspase-3 activity, SM content, PECAM-1 protein expression, c-Jun phosphorylation and c-Met phosphorylation between Group J+H and Group S. Conclusions Our data indicate that chronic administration of JNK inhibitors and HGF may restore CVOF to the level comparable to sham control level through preservation of structural integrity of the corpus cavernosum. Combination of JNK inhibition and HGF might be a potential therapeutic option for recovering from CVOD. Disclosure No

A novel stepwise approach incorporating ethanol infusion in the vein of Marshall for the ablation of persistent atrial fibrillation.

Apart from pulmonary vein isolation (PVI), several step-by-step procedures that aim to modify left atrial substrate have been proposed for the ablation of persistent atrial fibrillation (AF), yet the optimal strategy remains elusive. There are cumulative data suggesting an incremental benefit of adding vein of Marshall (VOM) ethanol infusion to PVI in patients with persistent AF. We sought to evaluate the feasibility and efficacy of a novel stepwise ablation approach, incorporating a VOM alcoholization step, for persistent AF. In this single-center study, we prospectively enrolled 66 consecutive patients with symptomatic persistent AF and failure of at least one antiarrhythmic drug (ADD). The ablation procedure consisted of (i) PVI, (ii) left atrial segmentation with VOM ethanol infusion and the deployment of linear radiofrequency lesions across the roof and the mitral isthmus and (iii) electrogram-based ablation of dispersion zones. The first two steps were performed in all patients, whereas the third step was carried out only in those still in AF at the end of the second step. Atrial tachycardias during the procedure were mapped and ablated. At the end of the procedure, cavotricuspid isthmus ablation was additionally performed in all patients. The primary endpoint was 12-month freedom from AF and atrial tachycardia after a single procedure and an initial three-month blanking period. Total procedure time was 153 ± 38.5 min. Fluoroscopy time was 16 ± 6.5 min and the radiofrequency ablation time was 26.14 ± 0.26 min. The primary endpoint occurred in 54 patients (82%). At 12 months, 65% of patients were off any AAD. In the univariate Cox regression analysis, left ventricular ejection fraction < 40% was the only predictor of arrhythmia recurrence (HR 3.56; 95% CI, 1.04-12.19; p = 0.04). One patient developed a pericardial tamponade and another a minor groin hematoma. A novel stepwise approach, including a step of ethanol infusion in the VOM, is feasible, safe and provides a high rate of sinus rhythm maintenance at 12 months in patients with persistent AF.

Metabolic performance of black soldier fly larvae during entomoremediation of brewery waste

AbstractThis study aims to evaluate the metabolic performance, in terms of specific rates of growth and feed assimilation, as well as the cost of growth and maintenance of black soldier fly larvae, BSF, Hermetia illucens on brewery waste, a potential worldwide available resource for industrial scale insect production. Brewery waste lacks starch and thus has a nutritional profile substantially different from chicken feed, which is a well‐established and excellent starchy food source for BSF larvae. It is therefore interesting to gain insight into how BSF larvae perform on brewery waste. Larvae of the BSF were reared on chicken feed, on brewery waste and on mixtures of the two. Measurements of the weight of the larvae and their respiratory CO2 production were used to estimate metabolic performance on daily basis. The BSF larvae grew on all the substrates. They reached the highest weight on chicken feed, but their specific growth and feed assimilation rates were highest on the mixed substrates, in which the larvae also reached their maximal weight in the shortest time. Substrate‐dependent costs of growth were not observed while maintenance rates tended to be only slightly lower on the mixed substrates. Overall, the BSF larvae converted the low‐starch brewery waste and the starchy chicken feed into larval biomass about equally efficiently, although brewery waste led to smaller larvae and mixing of the two substrates enhanced feed assimilation and growth. Brewery waste seems thus a suitable resource for BSF larvae, comparable with chicken feed, with respect to their metabolic performance.

Six-month stability following extensive alveolar bone augmentation by sausage technique

BackgroundResorption of alveolar bone is a common sequela of tooth loss and presents a clinical problem, especially in the esthetic zone. When ridge resorption occurs, adequate bone augmentation is essential to obtain satisfactory esthetic results. The purpose of this study was to determine the increase and retention rate of bone height or width in patients who received extensive bone augmentation and to analyze factors affecting its prognosis and stability.MethodsThis study was performed on patients who received extensive bone augmentation by sausage technique at the Department of Oral and Maxillofacial Surgery at Ewha Womans University Mok-dong Hospital from January 1, 2018, to February 28, 2022. CBCT images were taken before and 6 months after surgery to compare the amount of increase in bone height or width at the graft site. They were measured using reliable points such as adjacent implants or cephalometric landmarks, inferior alveolar nerve canals as reference points.ResultsA total of 8 patients underwent extensive bone grafting during the given period (mean age was 53.75 years, 2 males and 6 females). Four patients received horizontal augmentation, and 4 received vertical augmentation. When divided by surgical site, 4 patients are in maxilla and 4 in mandible. The average amount of increase in bone width or bone height was 5.38 mm, and the retention rate was about 79.9% after 6 months. The retention rate of horizontal augmentation was 88.8%, which was higher than that of vertical augmentation, which was 74.5%. The maxillary area accounted for 92.2%, and the amount of bone resorption was lower than that of the mandibular area, which was 72.6%. The average stitch out period was about 2.4 weeks, and postoperative dehiscence was observed about 37.5% of the total, more frequently in the mandible (50.0%) than in the maxilla (25.0%).ConclusionIn conclusion, extensive bone augmentation achieved significant horizontal or vertical bone height or width increase, and the retention rate after 6 months was also high. In addition, surgery in the maxillary region showed a more successful bone augmentation than in the mandible, with a higher maintenance rate and fewer cases of dehiscence.

Novel potential therapeutic targets of alopecia areata.

Alopecia areata (AA) is a non-scarring hair loss disorder caused by autoimmunity. The immune collapse of the hair follicle, where interferon-gamma (IFN-γ) and CD8+ T cells accumulate, is a key factor in AA. However, the exact functional mechanism remains unclear. Therefore, AA treatment has poor efficacy maintenance and high relapse rate after drug withdrawal. Recent studies show that immune-related cells and molecules affect AA. These cells communicate through autocrine and paracrine signals. Various cytokines, chemokines and growth factors mediate this crosstalk. In addition, adipose-derived stem cells (ADSCs), gut microbiota, hair follicle melanocytes, non-coding RNAs and specific regulatory factors have crucial roles in intercellular communication without a clear cause, suggesting potential new targets for AA therapy. This review discusses the latest research on the possible pathogenesis and therapeutic targets of AA.

Evaluating proteome allocation of Saccharomyces cerevisiae phenotypes with resource balance analysis

Saccharomyces cerevisiae is an important model organism and a workhorse in bioproduction. Here, we reconstructed a compact and tractable genome-scale resource balance analysis (RBA) model (i.e., named scRBA) to analyze metabolic fluxes and proteome allocation in a computationally efficient manner. Resource capacity models such as scRBA provide the quantitative means to identify bottlenecks in biosynthetic pathways due to enzyme, compartment size, and/or ribosome availability limitations. ATP maintenance rate and in vivo apparent turnover numbers (kapp) were regressed from metabolic flux and protein concentration data to capture observed physiological growth yield and proteome efficiency and allocation, respectively. Estimated parameter values were found to vary with oxygen and nutrient availability. Overall, this work (i) provides condition-specific model parameters to recapitulate phenotypes corresponding to different extracellular environments, (ii) alludes to the enhancing effect of substrate channeling and post-translational activation on in vivo enzyme efficiency in glycolysis and electron transport chain, and (iii) reveals that the Crabtree effect is underpinned by specific limitations in mitochondrial proteome capacity and secondarily ribosome availability rather than overall proteome capacity.

Chronic treatment with a combination of hepatocyte growth factor and JNK inhibitor ameliorates cavernosal veno-occlusive dysfunction: a rat model of cavernous nerve injury.

Structural alterations of the penis, including cavernosal apoptosis and fibrosis, induce venous leakage into the corpus cavernosum or cavernosal veno-occlusive dysfunction, a key pathophysiology associated with erectile dysfunction after radical prostatectomy. We hypothesized that the effect of JNK inhibitors on reducing apoptosis and hepatocyte growth factor (HGF) on inducing tissue regeneration could be another treatment mechanism of erectile dysfunction after radical prostatectomy. To investigate whether JNK inhibition combined with intracavernosal administration of HGF can completely preserve cavernosal veno-occlusive function (CVOF) in a rat model of erectile dysfunction induced via bilateral cavernosal nerve crush injury (CNCI). A total of 42 male Sprague-Dawley rats were randomly assigned to sham control (group S), CNCI (group I), and CNCI treated with a combination of JNK inhibitor and HGF (group J + H) for 5weeks after surgery. Rats in each group were evaluated via dynamic infusion cavernosometry (DIC), caspase-3 activity assay, Masson trichrome staining, immunohistochemical staining of α-smooth muscle actin, and immunoblotting at 5weeks after surgery. Regarding CVOF, group I showed decreased papaverine response, increased maintenance, and drop rates of DIC when compared with group S. Group J + H showed significant improvement in the 3 DIC parameters vs group I. No differences in the 3 DIC parameters were found between group J + H and group S. Regarding the structural integrity of the corpus cavernosum, group I showed increased caspase-3 activity, decreased smooth muscle (SM):collagen ratio, decreased SM content, decreased protein expression of PECAM-1, and decreased phosphorylation of c-Jun and c-Met. Group J + H showed significant attenuation in histologic and molecular derangement as compared with group I. There were no differences in caspase-3 activity, SM content, SM:collagen ratio, PECAM-1 protein expression, c-Jun phosphorylation, and c-Met phosphorylation between groups J + H and S. Our results suggest that antiapoptotic and regenerative therapy for the corpus cavernosum is a potential mechanism of penile rehabilitation after radical prostatectomy. This study provides evidence that combination treatment of JNK inhibitor and HGF preserves erectile function by restoring corporal SM and endothelium. However, additional human studies are needed to confirm the clinical effect. Chronic treatment with JNK inhibitor and HGF may preserve CVOF to levels comparable to sham control by preserving the structural integrity of the corpus cavernosum and so represents a potential therapeutic option for preventing the development of cavernosal veno-occlusive dysfunction.

Machine learning-based analysis of risk factors for atrial fibrillation recurrence after Cox-Maze IV procedure in patients with atrial fibrillation and chronic valvular disease: A retrospective cohort study with a control group.

To evaluate the efficacy of the Cox-Maze IV procedure (CMP-IV) in combination with valve surgery in patients with both atrial fibrillation (AF) and valvular disease and use machine learning algorithms to identify potential risk factors of AF recurrence. A total of 1,026 patients with AF and valvular disease from two hospitals were included in the study. 555 patients received the CMP-IV procedure in addition to valve surgery and left atrial appendage ligation (CMP-IV group), while 471 patients only received valve surgery and left atrial appendage ligation (Non-CMP-IV group). Kaplan-Meier analysis was used to calculate the sinus rhythm maintenance rate. 58 variables were selected as variables for each group and 10 machine learning models were developed respectively. The performance of the models was evaluated using five-fold cross-validation and metrics including F1 score, accuracy, precision, and recall. The four best-performing models for each group were selected for further analysis, including feature importance evaluation and SHAP analysis. The 5-year sinus rhythm maintenance rate in the CMP-IV group was 82.13% (95% CI: 78.51%, 85.93%), while in the Non-CMP-IV group, it was 13.40% (95% CI: 10.44%, 17.20%). The eXtreme Gradient Boosting (XGBoost), LightGBM, Category Boosting (CatBoost) and Random Fores (RF) models performed the best in the CMP-IV group, with area under the curve (AUC) values of 0.768 (95% CI: 0.742, 0.786), 0.766 (95% CI: 0.744, 0.792), 0.762 (95% CI: 0.723, 0.801), and 0.732 (95% CI: 0.701, 0.763), respectively. In the Non-CMP-IV group, the LightGBM, XGBoost, CatBoost and RF models performed the best, with AUC values of 0.738 (95% CI: 0.699, 0.777), 0.732 (95% CI: 0.694, 0.770), 0.724 (95% CI: 0.668, 0.789), and 0.716 (95% CI: 0.656, 0.774), respectively. Analysis of feature importance and SHAP revealed that duration of AF, preoperative left ventricular ejection fraction, postoperative heart rhythm, preoperative neutrophil-lymphocyte ratio, preoperative left atrial diameter and heart rate were significant factors in AF recurrence. CMP-IV is effective in treating AF and multiple machine learning models were successfully developed, and several risk factors were identified for AF recurrence, which may aid clinical decision-making and optimize the individual surgical management of AF.

Twenty years of US nanopatenting: Maintenance renewal scoring as an indicator of patent value

This paper introduces a new measure of patent value – Maintenance Renewal Score (MRSc) – reflecting assignee valuing the patent by paying successive renewal fees. We generate MRSc's for nanotechnology patents issued by the US Patent Office from 1999 through 2009, with US assignees and US inventors. Patenting increases over this period, coincident with increased US funding of nanotechnology R&D. We compare maintenance rates over the period, and against a comparison set of all 1999 USPTO grants to US inventors/assignees. We find differences in propensity to maintain the nanopatents by institution type, technological sector, and patent complexity.

A Petri net model for optimization of inspection and preventive maintenance rates

A Petri net model for optimization of inspection and preventive maintenance rates

Effects of Atrial Fibrillation Radiofrequency Ablation in Patients Aged &gt; 75 Years Undergoing Mitral Valve Surgery

Few data exist about the efficacy of radiofrequency (RF) maze procedures in elderly patients with atrial fibrillation (AF) undergoing surgery for mitral valve disease. The aim of the present investigation was to evaluate the effects of AF ablation associated with mitral valve surgery on the recovery and long-term maintenance of sinus rhythm in elderly patients aged > 75 years. Moreover, we evaluated the effects on survival. This study included 96 consecutive patients with AF (42 men and 56 women) aged > 75 years (mean age 78 ± 3) who underwent RF ablation associated with mitral valve surgery (group I). This group was compared to 209 younger patients (mean age 65 ± 8 years) treated in the same period (group II). Baseline clinical and echocardiographic characteristics were similar in the two groups. Four patients died during hospitalization, one aged > 75 years. In surviving patients at the end of the follow-up period, sinus rhythm was present respectively in 64% of the elderly and 74% of younger patients (p = 0.778). The rate of persistence of sinus rhythm without AF recurrences (38% vs. 41%, p = 0.705) was similar in the two groups. After surgery, sinus rhythm was frequently never regained in aged patients (27% vs. 20%, p = 0.231). Elderly patients more frequently needed permanent pacing and had more hospitalizations and a higher number of non-AF atrial tachyarrhythmias. At eight-year follow-up, survival was lower in older patients (48% aged > 75 vs. 79% aged < 75 years). Elderly patients had a similar long-term rate of stable sinus rhythm maintenance in comparison to younger patients after AF radiofrequency ablation associated with mitral valve surgery. However, they needed more frequent permanent pacing and had higher rates of hospitalizations and post-procedural atrial tachyarrhythmias. The effects of survival are difficult to evaluate due to the different life expectancies of the two groups.

Combining Transurethral Resection of Fibrous Tissue and Temporary Urethral Stent Insertion Is an Optimal Strategy for Minimally Invasive Treatment of Recurrent and Long Urethral Strictures

This study investigated the optimal strategy for the treatment of chronic recurrent urethral strictures longer than 3 cm, using a temporary urethral stent. Between September 2011 and June 2021, 36 patients with chronic bulbomembranous urethral strictures underwent temporary urethral stent placement. Retrievable self-expandable polymer-coated bulbar urethral stents (BUSs) were placed in 21 patients (group A), and thermo-expandable nickel-titanium alloy urethral stents were placed in 15 patients (group M). Each group was subdivided into those with and without transurethral resection (TUR) of fibrotic scar tissue. The urethral patency rates at 1 year after stent removal were compared between the groups. The patients in group A showed a higher urethral patency maintenance rate at 1 year after stent removal than those in group M (81.0% vs. 40.0%, log rank test p = 0.012). Analysis of subgroups in which TUR was performed due to severe fibrotic scar, showed that the patients in group A showed a significantly higher patency rate than patients in group M (90.9% vs. 44.4%, log rank test p = 0.028). In the treatment of chronic urethral strictures with a long fibrotic scar, temporary BUS combined with TUR of fibrotic tissue seems to be the optimal minimally invasive treatment strategy.

Updated analysis: Effect of biweekly dosing schedule of trifluridine-tipiracil (TAS-102) on rates of myelosuppression and maintenance of therapeutic efficacy in patients (pts) with previously treated metastatic colorectal cancer (mCRC).

95 Background: For surgically unresectable metastatic colorectal cancer pts, a continuum of treatment is required to improve the OS of our pts. Oral trifluridine-tipiracil (TAS-102) is FDA approved in refractory mCRC per the RECOURSE trial. As per the FDA insert, the recommended dose is 35 mg/m2 twice daily (maximum = 80 mg/day) on Days 1-5 and Days 8-12 of 28-day cycles commonly resulting in Grade 3-4 neutropenia (38%), dose delays (53%), dose reductions (14%) and requiring G-CSF support (9%). To maintain efficacy and to potentially reduce toxicity, we analyzed an alternative biweekly dosing (Days 1-5 and Days 15-19 q28 days). Methods: A retrospective analysis was completed (2019-2022) at Vanderbilt-Ingram Cancer Center in pts with refractory mCRC and appendiceal cancer (CA) who completed ≥ 12 days of TAS-102 therapy and underwent surveillance imaging every 8-12 weeks. Patient data was assessed for ECOG performance status (PS), prior lines of therapy, the use of bevacizumab and CTCAE grade of treatment-related myelotoxicity. Evaluation of progression-free survival (PFS) was completed in mCRC pts. Results: Forty-three patients met the inclusion criteria, with a mCRC:appendiceal CA ratio of 39:4. The median age = 50 y/o (range 30-80); male:female 23:20; median ECOG PS = 1; median number of prior therapies = 3; and median duration of therapy = 97 days (range: 12-396). Associated grade 3/4 hematologic toxicities included: Neutropenia 39% [Grade 3 (12.2%), Grade 4 (2.4%)]; anemia 36.5% [Grade 3 (12.2%)]. No pts required G-CSF. No incidences of neutropenic fever were reported. Five pts (11.6%) required a dose delay and 3 pts (7%) required a dose reduction due to myelosuppression. In mCRC pts, the median PFS was 2.53 months. To date, 6 pts remain on treatment (range: 97-331). Conclusions: In our updated analysis, biweekly dosing of TAS-102 (35 mg/m2 twice daily; Days 1-5 and Days 15-19 of 28-day cycles) for pts with refractory mCRC and appendiceal CA demonstrated tolerable myelosuppression, while preserving PFS in pts with mCRC. With an improved toxicity profile, this alternative TAS -102 dosing schedule may potentially broaden utilization of TAS-102 in patients with borderline PS and may be a more favorable option for future combination studies. Additional prospective data are needed to validate these findings. To our knowledge, this remains the first analysis of biweekly TAS-102 in a US patient population.