Median Increase Research Articles

Evaluation of the Efficacy of Focal Vibration Therapy-Novafon as an Assistive Therapeutic Tool for Children With Feeding and Swallowing Disorders.

Paediatric dysphagia refers to any feeding and/or swallowing problem that affects nutritional or liquid intake safety or adequacy. There is a prominent lack of available evidence-based effective therapeutic tools to facilitate the rehabilitation of feeding and/or swallowing disorders in children. The purpose of this study was to assess the effectiveness of focal vibration therapy-Novafon as an assistive therapeutic intervention for children with feeding and swallowing difficulties. The study involved 122 children with dysphagia who were divided into two groups: (1) 61 children who received conventional dysphagia therapy (cCDTh) and (2) 61 children who received conventional dysphagia therapy in combination with Novafon therapy (cCDTh+NTh). All children were evaluated for pre-, mid- and post-dysphagia therapy with the Gugging Swallowing Screen (GUSS) and Pediatric Eating Assessment Tool-10 (PEDI-EAT-10) in different Cypriot school and health settings. PEDI-EAT-10 total scores for both groups observed that the cCDTh+NTh group had a significant decrease in the overall median between pre- and post-dysphagia therapy total score (Median = 3.00) compared to the cTDTh score (Median = 7.00). GUSS total scores between the two groups showed an increase in overall medians but the cCDTh+NTh group (Median of pre-therapy = 16.50, mid-therapy = 19.00 and post-therapy = 20.00) noted a higher increase in medians compared to the cCDTh group (Median of pre-therapy = 15.00, mid-therapy = 16.00 and post-therapy = 17.00). The present study highlights that focal vibration therapy using Novafon may serve as an effective and supportive approach within conventional dysphagia therapy for children. Further research is necessary to enhance the evidence-based literature on the use of Novafon in paediatric dysphagia.

Feasibility of Using 18F-FDG PET/CT Radiomics and Machine Learning to Detect Drug-Induced Interstitial Lung Disease

Background: Bleomycin is an oncolytic and antibiotic agent used to treat various human cancers because of its antitumor activity. Unfortunately, up to 46% of the patients treated with bleomycin develop drug-induced interstitial lung disease (DIILD) and potentially life-threatening interstitial pulmonary fibrosis. Tools and biomarkers for predicting and detecting DIILD are limited. Therefore, we aimed to evaluate the feasibility of 18F-FDG PET/CT, PET radiomics, and machine learning in distinguishing DIILD in an explorative pilot study. Methods: Eighteen Hodgkin’s lymphoma (HL) patients, of whom 10 developed DIILD after treatment with bleomycin, were retrospectively included. Five diffuse large B-cell lymphoma (DLBCL) patients were included as a control group since they were not treated with bleomycin. All patients underwent 18F-FDG PET/CT scans before (baseline) and during treatment (interim). Structural changes were assessed by changes in Hounsfield Units (HUs). The 18F-FDG PET scans were used to assess metabolic changes by examining the feasibility of 504 radiomics features, including the mean activity of the lungs (SUVmean). A Random Forest (RF) classifier evaluated the identification and prediction of DIILD based on PET radiomics features. Results: HL patients who developed DIILD showed a significant increase in standard SUV metrics (SUVmean; p = 0.012, median increase 37.4%), and in some regional PET radiomics features (texture strength; p = 0.009, median increase 101.6% and zone distance entropy; p = 0.019, median increase 18.5%), while this was not found in HL patients who did not develop DIILD and DLBCL patients. The RF classifier correctly identified DIILD in 72.2% of the patients and predicted the development of DIILD correctly in 50% of the patients. There were no significant differences in HUs over time within all three patient groups. Conclusions: Our explorative longitudinal pilot study suggests that certain regional 18F-FDG PET radiomics features can effectively identify DIILD in HL patients treated with bleomycin, as significant longitudinal increases were observed in SUVmean, texture strength, and zone distance entropy after the development of DIILD. The metabolic activity of these features did not significantly increase over time in DLBCL patients and HL patients who did not develop DIILD. This indicates that 18F-FDG PET radiomics, with and without machine learning, might serve as potential biomarkers for detecting DIILD.

Abstract 4144548: High Morbidity and Mortality in Adults With Turner Syndrome and Aortic Dilation: A Retrospective Cohort Study from the Healthy Heart Project

Introduction: Turner syndrome (TS) is caused by the partial or complete absence of one sex chromosome and affects 1 in 2500 liveborn infants. Hypertension, bicuspid aortic valve (BAV), and thoracic aortic aneurysms (TAAs) are more prevalent in TS compared to the general population and predispose to aortic dissections, which may occur in young adults with TS. We hypothesize that adults with TS who have TAAs experience a high rate of adverse cardiovascular outcomes. Methods: Adults with TS who had Healthy Heart Project (HHP) echocardiograms at national conferences between 2003 and 2023 were contacted for enrollment in descending order of the aortic size index (ASI, cm/m 2 ), defined as the ratio of the maximum ascending aortic diameter to body surface area. After informed consent, clinical characteristics and outcomes (as numbers of participants or median and interquartile range) were abstracted from questionnaires and medical records. Results: Sixty-four of 704 total HHP participants were contacted and 19 (with 10 of the 20 highest ASI values) were enrolled with complete data. The baseline ASI was 2.19 (0.48), compared to 1.51 (0.36) for all other HHP participants. The median age was 59 (13) years. The most prevalent characteristics were 45,X (10) or 45,X/46,XX (6) karyotypes; BAV (9), coarctation (4), or no congenital lesions (6); and hypertension (12). A mean of 10 serial aortic images were available for each participant over a follow up period of 14 (9.8) years. The median increase in aortic diameter was 0.09 (0.29) mm/yr at the sinuses of Valsalva and 0.26 (0.44) mm/yr at the ascending aorta. Seven participants underwent aortic operations due to enlarging TAAs when the median ascending diameter was 3.83 (0.67) cm (ASI 2.58 (0.11) cm/m 2 ). In 3 cases, operations were urgent due to cardiovascular symptoms or rapid aortic dilation, but there were no acute aortic dissections. The median time between the index image and subsequent repair was 3.5 (7.0) years. Three HHP participants with the 8th, 15th, and 42nd largest ASI values died prior to follow up. One death was caused by complications after surgical aortic valve replacement at age 20. Conclusions: In a cohort of adults with TS and TAAs, 40% (7/19) developed progressive aortic enlargement requiring aortic repairs and there were 3 deaths. These observations underscore the importance of lifelong surveillance and timely intervention to prevent deaths due to cardiovascular disease in TS.

Multicriteria optimization achieves superior normal tissue sparing in volumetric modulated arc therapy for gastric cancer.

To evaluate the benefits of volumetric modulated arc therapy (VMAT) based on multicriteria optimization (MCO) for gastric cancer patients, particularly the protection of serial organs at risk (OARs) that overlap with the target volume. MCO and single-criterion optimization (SCO) VMAT plans were conducted among 30 gastric cancer patients, with a prescription dose of 50.4Gy delivered in 28 fractions. All treatment plans underwent review, and a comparison was made between the active planning time and different dose-volume parameters. Both the MCO and SCO VMAT plans achieved the target dose coverage, with no significant difference in the conformity index (CI) for the planning target volume (PTV), at median CI values of 0.887 and 0.891, respectively (P = 0.417). The MCO plans showed a slight but significant increase in the homogeneity index of the PTV, with a median increase of 0.029 (P < 0.001). Additionally, the MCO plans resulted in a lower D2% to the small intestine and duodenum, with reductions of 3.43Gy and 0.3Gy, respectively (P < 0.05). Furthermore, the Dmax to the small intestine correlated moderately with the overlapping volume between the small intestine and the target volume (ρ = 0.42, P = 0.023). Except for the mean dose to the liver, the MCO plans performed better in terms of dose indicators for other OARs. Moreover, compared to the SCO plans, the median active planning time in the MCO plans was significantly reduced by 53.2min (P < 0.0001). MCO can effectively help the physicians to quickly select an optimal treatment plan for patients with gastric cancer. It has been shown that MCO VMAT plans can significantly reduce the dose to OARs and shorten the active planning time, with acceptable target coverage. In addition, these plans take less dosimetric time, thereby streamlining the treatment planning process.

Effects of Kinesio tape on individuals with carpal tunnel syndrome: a randomized controlled study

ObjectiveCarpal tunnel syndrome (CTS) is a common neuromuscular disorder with an incidence rate of 4.9%. Research on the impact of Kinesio taping (KT) on electroneurography in individuals with CTS is limited, highlighting a significant gap in the literature. This study aimed to evaluate the effects of KT on palm numbness, pain intensity, hand grip strength, and median nerve electroneuromyography in individuals with mild to moderate CTS.MethodThis was a randomized, controlled, parallel design study. Twenty-seven participants diagnosed with CTS through hospital outpatient clinics were randomly assigned to either the control or KT group. The outcome measurements included hand grip strength, the Boston Carpal Tunnel Questionnaire (BCTQ), and electroneurography, assessed at baseline and after 6 weeks of intervention. The statistical method used was non-parametric analysis, comparing differences with the median and interquartile range (IQR).ResultsBoth the KT and control groups significantly improved the numbness grades, hand grip strength, and the BCTQ. The kinesio-taping group demonstrated an improvement in grip strength with a median increase of 2.21 kg (IQR: 0.65–3.79 kg), compared to the control group, which showed a median increase of only 0.70 kg (IQR: 0.22–1.45 kg). Statistical analysis revealed a significant difference between the two groups (p = 0.039), with an effect size of r = 0.33.ConclusionThis study suggested that KT can be a supplementary treatment to relieve pain intensity, enhance hand grip strength, and improve sensory conduction velocity, motor latency, and motor amplitude.Clinical Trial Registrationhttps://doi.org/10.1186/ISRCTN82192319, ISRCTNregistry (No. ISRCTN82192319).

The Efficacy of the Psychiatry Clerkship in Developing Students' Comprehensive Clinical Skills.

This study investigates the impact of the psychiatry rotation in developing students' clinical skills that are applicable across various medical specialties. Medical students at Saint Louis University completed the same survey before and after completing a 3½-week psychiatry rotation. Students rated 18 statements on a Likert scale. Statements were grouped into six categories to assess students' confidence in (1) managing medical issues of psychiatric patients, (2) addressing injurious behaviors, (3) gathering a clinical history, (4) de-escalating crises, (5) self-regulating emotions, and (6) empathizing with patients. Students' pre- and post-survey numerical responses were added within the six categories and compared using paired t-tests. Forty-three students completed both the pre-clerkship and post-clerkship surveys. For all six clinical skills categories, post-survey composite scores significantly increased. Managing medical complaints had a 7-point median score increase. Addressing injurious behavior had a 3-point median increase. Gathering a clinical history had a 4-point median increase. De-escalating crises had a 4-point median increase. Emotional self-regulation had a 2-point median increase. Empathizing with patients had a 2-point median increase. All six paired t-tests between pre- and post-surveys showed p-values < 0.001, indicating subjective improvement in students' performance for each clinical competency. The psychiatry rotation effectively increased medical students' perceived acquisition of essential clinical skills. These competencies, including gathering a history, emotionally self-regulating, and de-escalating crises, apply to nearly all medical specialties. Further research is needed to investigate which specific opportunities helped students develop these skills and the broader strengths of the psychiatry clerkship.

Prevention and management of hypertension in middle-aged and elderly through screening and education (Pre-post intervention)

Maintaining quality of life and physical health in the elderly is crucial for their overall well-being. Hypertension, a prevalent condition among the elderly in Indonesia, requires targeted interventions to mitigate its impact. A quasi-experimental pre-post intervention study was conducted in Bandar Lor, Kediri City, Indonesia, involving 106 elderly participants. The Paguyuban Raga Paruh Baya Lansia Sejahtera (PURABAYA), a senior wellness group program aimed to improve hypertension management through educational sessions on physical activity, nutrition, and hypertension management exercises. The program significantly increased participants' knowledge of physical activity (median increase from 59.62 to 82.69) and nutrition (median increase from 80.51 to 95.38). Systolic blood pressure decreased markedly (median from 173.86 mmHg to 142.53 mmHg), indicating improved hypertension control. However, there was no significant change in diastolic blood pressure. The findings underscore the effectiveness of targeted educational interventions in enhancing health literacy and managing systolic blood pressure among the elderly. The PURABAYA program's success suggests its potential for scalability and adaptation to broader public health initiatives.

Amide proton transfer-weighted CEST MRI for radiotherapy target delineation of glioblastoma: a prospective pilot study

BackgroundExtensive glioblastoma infiltration justifies a 15-mm margin around the gross tumor volume (GTV) to define the radiotherapy clinical target volume (CTV). Amide proton transfer (APT)-weighted imaging could enable visualization of tumor infiltration, allowing more accurate GTV delineation. We quantified the impact of integrating APT-weighted imaging into GTV delineation of glioblastoma and compared two APT-weighted quantification methods—magnetization transfer ratio asymmetry (MTRasym) and Lorentzian difference (LD) analysis—for target delineation.MethodsNine glioblastoma patients underwent an extended imaging protocol prior to radiotherapy, yielding APT-weighted MTRasym and LD maps. From both maps, biological tumor volumes were generated (BTVMTRasym and BTVLD) and added to the conventional GTV to generate biological GTVs (GTVbio,MTRasym and GTVbio,LD). Wilcoxon signed-rank tests were performed for comparisons.ResultsThe GTVbio,MTRasym and GTVbio,LD were significantly larger than the conventional GTV (p ≤ 0.022), with a median volume increase of 9.3% and 2.1%, respectively. The GTVbio,MTRasym and GTVbio,LD were significantly smaller than the CTV (p = 0.004), with a median volume reduction of 72.1% and 70.9%, respectively. There was no significant volume difference between the BTVMTRasym and BTVLD (p = 0.074). In three patients, BTVMTRasym delineation was affected by elevated signals at the brain periphery due to residual motion artifacts; this elevation was absent on the APT-weighted LD maps.ConclusionLarger biological GTVs compared to the conventional GTV highlight the potential of APT-weighted imaging for radiotherapy target delineation of glioblastoma. APT-weighted LD mapping may be advantageous for target delineation as it may be more robust against motion artifacts.Relevance statementThe introduction of APT-weighted imaging may, ultimately, enhance visualization of tumor infiltration and eliminate the need for the substantial 15-mm safety margin for target delineation of glioblastoma. This could reduce the risk of radiation toxicity while still effectively irradiating the tumor.Trial registrationNCT05970757 (ClinicalTrials.gov).Key PointsIntegration of APT-weighted imaging into target delineation for radiotherapy is feasible.The integration of APT-weighted imaging yields larger GTVs in glioblastoma.APT-weighted LD mapping may be more robust against motion artifacts than APT-weighted MTRasym.Graphical

Cardiac motion in patients with ventricular tachycardia: potential implications for the treatment of patients candidates to stereotactic arrhythmia radio-ablation (STAR)

Abstract Background Stereotactic arrhythmia radio-ablation (STAR) has proven to be a valid alternative treatment for refractory ventricular tachycardia (VT) in patients who are unsuitable to undergo standard catheter ablation (CA). It consists in the application of external beam radiotherapy in a single dose of 25 Gy to the target areas. There is increased research activity on better understanding the complex and fast motion of the heart and on reducing radiation toxicity. Purpose In the context of an in silico study to evaluate the feasibility of STAR with protons in patients with VT, the initial findings related to cardiac motion on the first 10 patients are here presented. Methods Prior to CA, each patient underwent ECG gated CT scans in expiratory breath-hold, with and without contrast and reconstructed at 30% (systole) and 80% (diastole) of the cardiac R-R cycle. Contouring of the ablation target as a clinical target volume (CTV) for proton treatment planning was performed based on a standard electrophysiological study with 3D eletroanatomical mapping. Two different treatment plans were created: the first with only the diastolic CTV as target (gated treatment), the second including both diastolic and systolic CTVs to create an Internal Target Volume (ITV) in the hypothesis of non-gated treatment. Robust optimization was used to create the Planning Target Volume (PTV). Results The target volumes used for treatment planning are given in Table 1. The median CTV was 10.90 (2.93-36.94) cm3 for diastole and 14.26 (1.73-36.31) cm3 for systole. These volumes are somewhat smaller than those reported in patients treated previously with STAR: this difference may be due to the fact that no respiratory motion was included in the target contour and that the study population includes many patients referred for ventricular ectopic beats without structural heart disease, where the ablation target is expected to be smaller as compared to patients with VT in structural heart disease. Despite a small median difference between the diastolic and systolic CTV of 0.53 (0.03-9.61) cm3, the ITV approach resulted in a median increase in volume compared to the largest of the two CTVs of 29 % (1%-44%). When considering the proton range uncertainty and potential errors in patient positioning (PTV), the target is this time enlarged by a factor 2.9 (1.9-3.9). This data indicates that both cardiac motion and uncertainties in patient positioning before treatment will have a large impact on the treatment volume thus affecting the amount of surrounding tissue exposed to radiation. Conclusion The ablation target contour at systole and diastole are of similar magnitude but their non-overlap results in a large increase in treated volume when radiation delivery is not gated for cardiac motion. Further analysis shall investigate on a case-by-case basis the potential reduction in risk of healthy tissue toxicity with cardiac-gated proton delivery.Table 1

Post-prandial acyl ghrelin infusion in heart failure patients increases gastric emptying rate

Abstract Background Acyl ghrelin (ghrelin) increases cardiac output (CO) and contractility in patients with heart failure with reduced ejection fraction (HFrEF). In healthy humans, ghrelin increases gastric emptying rate (GER) and hunger, a potential add-on benefit for HFrEF patients suffering from cachexia with symptoms of delayed gastric emptying and loss of appetite. Aim Determine if post-prandial ghrelin infusion increases GER and hunger in HFrEF patients; compare to CO. Methods This study was a component of a double-blind placebo-controlled trial of acyl ghrelin vs. placebo in HFrEF. Patients (n=29) arrived fasted and received a 500 kcal breakfast and 1.5 g paracetamol. They next received placebo (vehicle, n=15) or ghrelin infusion (0.1 µg/kg/min, n=14) for 120 min. Blood was tapped for plasma at 0, 30, 60, 120 and 150 min into the meal. Plasma concentration of paracetamol was measured to assess GER of a liquid bolus. Hunger scores and CO were recorded. Mann-Whitney rank sum test was used for statistics. Results Paracetamol peaked at 30 min in 8 of 14 (57%) in the ghrelin treatment group versus 1 of 15 (7%) in the placebo group (P=0.004, Fig 1). Remaining patients peaked at later time points. There were no anomalous peaks at 0 min baseline or 2880 min (2 days). The ghrelin treatment group data was segregated into rapid (peak at 30 min, n=8) and slow (peak &amp;gt;30 min, n=6) GER subgroups. The rapid subgroup had a ghrelin treatment effect on CO (one-way repeat measures) (P&amp;lt;0.001, Fig 2). Baseline (t=0) CO for the rapid GER subgroup was 4.06 ±1.41 L/min (median ±SD) and 3.95 ±0.62 L/min for the slow GER subgroup (P=0.31). Data points shown are median ± SEM, each patient normalized to own baseline (100%); * P&amp;lt;0.05, ** P&amp;lt;0.01, *** P&amp;lt;0.001, pairwise comparison to baseline. Hunger gradually increased. The greatest increase in hunger was at 150 min, at which time median fold increase in hunger relative baseline was 1.6 (placebo), 1.7 (ghrelin, slow GER) and 2.3 (ghrelin, rapid GER). These hunger differences between groups did not reach significance. However, this trend was consistent with ghrelin induction of hunger, especially in those with potent GER and CO responses. Conclusions Ghrelin increases GER, and potentially hunger, in HFrEF patients in addition to increasing CO. Some HFrEF patients may benefit from this add-on effect.Fig 1.Time of paracetamol peak.Fig 2.Cardiac output.

Shifting cold regions streamflow regimes in North America affect flood frequency analysis

ABSTRACT Over threshold flood events in seventy years of data from 202 reference hydrometric stations in Canada and the United States were separated into nival, mixed, and pluvial flood types. While Mann-Kendall trend tests showed few significant trends in flood magnitude, significant changes in flood type fraction were found over time, with annual mean temperature, and with annual precipitation. Nival events decreased in frequency over the seventy-year period in 16% of sites, while mixed and pluvial events increased (5%, 12%). These changes indicate a shift from nival events towards more pluvial dominated systems. Fewer significant changes in flood type fraction were found with analysis against four climate indices. Flood frequency analysis using a combined distribution approach with the three flood types resulted in larger magnitude design flow estimates (median increase of 20 – 30 %) in comparison with the results from considering the data to be a single population.

Secondary erythrocytosis / polycythemia due to sodium glucose co-transporter 2 inhibitors: a real world heart failure cohort

Abstract Background Sodium glucose co-transporter 2 inhibitors (SGLT2-i) are one of the four pillars of guideline-directed medical therapy in heart failure with reduced ejection fraction and preserved ejection fraction according to the current ESC and AHA/ACC heart failure guidelines 1,2. As a result, there has been a significant increase in their use worldwide. Although SGLT2 inhibitors are known to increase hemoglobin and hematocrit levels, there is a lack of data on the burden of erythrocytosis or polycythemia in pivotal trials 3,4. Purpose In this retrospective cohort study, we investigated the prevalence and clinical outcomes of SGLT2-i related erythrocytosis in a tertiary heart failure outpatient clinic. Methods We reviewed clinical data from heart failure patients treated with an SGLT2 inhibitor at our tertiary centre between September 2019 and October 2023. Patients were included if they were taking SGLT2-i continuously for more than one month. Data were collected on Hb/Hct levels at baseline before initiation of SGLT2-i, at peak levels during therapy and at the last follow-up. Erythrocytosis was defined according to the 2017 WHO classification as Hb&amp;gt; 10.3 mmol/L and/or Hct&amp;gt; 49% in men and Hb&amp;gt; 10.0 mmol/L and/or Hct&amp;gt; 48% in females. Results A total of 173 patients with heart failure were included (median age 58 [49-66] years, 65% male). One hundred and fifty-six patients (90%) were using dapagliflozin, while 16 patients (9%) were using empagliflozin. The overall prevalence of SGLT2i related erythrocytosis was 39/173 (22.5%; median age 60 and 82% males). Eleven (6.3%) patients had pre-existing erythrocytosis at baseline. During a mean follow-up of 14±10 months, 28/173 (16.2%) patients developed new onset erythrocytosis. The median time to the peak of the Hb/Hct level was 6.5 months. Although the group with erythrocytosis had significantly higher Hb and Hct at baseline compared to the group without erythrocytosis (Hb 9.7 mmol/L ± 1.0 vs. 8.5 mmol/L ± 1.0; p&amp;lt;0.001 in men and 9.1 mmol/L ± 0.8 mmol/L vs. 8.1 ± 0.8; p=0.006 in females), they also experienced a significantly greater median increase in Hb from baseline to peak (1.05 mmol/L vs. 0.60mmol/L; p=0.01) (see Figure 1) There were significantly more males (82% vs 60%; p=0.01) in the erythrocytosis group compared to the non-erythrocytosis group. In addition, the prevalence of OSAS was significantly higher in the group with erythrocytosis compared to the group without erythrocytosis (31% vs. 8%; p&amp;lt;0.001). Conclusion Secondary erythrocytosis or polycythemia is common in patients with chronic heart failure. It is particularly common in men and in patients with obstructive sleep apnoea syndrome (OSAS). There were no excess thrombotic or thromboembolic events, probably because of the routine use of anticoagulants/antiplatelets and limited follow-up. To avoid unnecessary haematological referrals and potential clinical adverse events, increased awareness among clinicians is needed.Table 1.Baseline and clinical outcomesFig1.Hemoglobin levels over time

Development of a Porcine Model of Arteriovenous Fistula Venous Stenosis Treated with Percutaneous Transluminal Angioplasty

To develop a porcine model for arteriovenous fistula (AVF) venous stenosis treated with percutaneous transluminal angioplasty (PTA) and compare outcomes of plain balloon angioplasty (POBA) to IN.PACT paclitaxel drug-coated balloons (DCB). Twelve castrated male Yorkshire pigs (4-5 months, 35-45kg) underwent renal artery embolization to induce chronic kidney disease (CKD). Twenty-eight days later, AVF was created by anastomosing the left external jugular vein to left common carotid artery. The pigs were divided into a pilot group (n=6) for optimizing the AVF technique (euthanized at day 4) and a definitive group (n=6) for validating PTA outcomes (euthanized at day 42). Stenosis developed at juxta-anastomosis 28 days later and was treated with POBA [pilot group (n=6), definitive group (n=3)] or DCB [definitive group only (n=3)]. Definitive group underwent biweekly 4D Flow MRI scans. All animals developed CKD, with significant increases in BUN (median increase: 2.6 to 3.2 mmol/L, P<0.001) and creatinine (median increase: 100 to 187 μmol/L, P<0.001). In the pilot group, one animal had an infected fistula, and AVF patency was 1/5. In the definitive group, the patency was 5/6 because the AVF technique was modified by resecting the sternomastoid muscle and increasing the spatulation. At day 42 post PTA, DCB treated AVF outflow vein showed increasing blood flow compared to POBA (DCB 209.8 ± 64.42 mm2 vs POBA 170.9 ± 95.52 mm2 p = 0.934). A porcine model of AVF venous stenosis treated with PTA was developed, with blood flow trends favoring DCB over POBA.

Serial manual bolus irrigation leads to critical intrarenal pressures during flexible ureterorenoscopy - time to abandon this manoeuvre.

To characterise the effect of solitary and serial manual bolus irrigations on intrarenal pressures (IRPs) and observe the clinical consequences. A pressure guidewire was used for IRP measurement during routine flexible ureterorenoscopy for management of renal stone disease, including manual bolus irrigation when required to maintain vision. The fluid bolus was either as a solitary manual bolus or a series of manual boluses in quick succession. The pre-bolus, maximal and difference between IRPs were calculated. A total of 50 procedures in 46 patients were analysed. In all, 68 solitary manual boluses and 38 serial manual boluses were observed to have been undertaken during these procedures. After a solitary manual bolus, the median (standard deviation [SD], range) increase in IRP was 22.4 (34.0, 0.1-160.8) mmHg, and the mean (SD, range) maximum IRP was 46.1 (41.7, 15.8-190.0) mmHg, with elevated IRPs persisting for a median (range) duration of 19 (4-66) s. After serial manual boluses, the median (SD, range) rise in IRP was 58.4 (64.7, 10.2-242.84) mmHg and the mean (SD, range) maximum IRP reached was 100.8 (69.7, 34.3-303.5) mmHg. The elevated IRPs endured for a median (range) of 42 (9-121 s; P < 0.01 in all comparisons), suggesting a much greater elevation of IRP with instances where serial bolus irrigation was undertaken. Manual bolus irrigation, both solitary but particularly serial boluses, produces significant rises in IRP and could logically result in pyelovenous backflow and sepsis. We suggest that this manoeuvre should be avoided to reduce complications during ureterorenoscopy.

Exploring the hemodynamic behavior of residual aneurysms after coiling and clipping: A computational flow dynamic analysis.

Residual intracranial aneurysms post-clipping or coiling pose a poorly established risk of rupture. Computational fluid dynamic (CFD) offers insights into hemodynamic changes following such interventions. This study aims to assess hemodynamic parameters in residual aneurysms pre- and post-treatment with surgical clips or coils using CFD. A retrospective analysis of consecutive patients between January 2015 and January 2024 was conducted. Digital subtraction angiography images were reconstructed using 3D modeling techniques, and hemodynamic parameters were analyzed with ANSYS® software. Six aneurysms were analyzed: Five unruptured and one ruptured. The aneurysms were located at the basilar apex (2), middle cerebral artery bifurcation (2), and origin of the posterior communicating artery (2). Post-treatment, there was a significant reduction in both aneurysm area (median reduction of 33.73%) and volume (median reduction of 25.3%). Five of the six cases demonstrated fewer low wall shear stress (WSS) areas, which could indicate a reduction in regions prone to thrombus formation and diminished risk of rupture. In the unruptured aneurysms, there was a median increase of 137.6% in average WSS. Notably, the only case with increased low WSS area also had the highest increase in average WSS. One basilar artery aneurysm showed increased WSS across all parameters, suggesting a higher rupture risk. The increase in average and high WSS area, along with a decrease in low WSS area, reflects a complex balance between factors of stability and rupture risk. However, a simultaneous increase in all WSS parameters may represent the highest rupture risk due to increased mechanical stress on the aneurysm wall, necessitating closer monitoring.

The Outcomes of Adult Acquired Buried Penis Surgical Reconstruction.

Adult Acquired Buried Penis (AABP) is a morbid condition that often requires surgical intervention. This retrospective study of 46 patients who underwent AABP surgery from November 2017 to July 2023 evaluates surgical outcomes, functional outcomes, and patient-reported outcomes. The median follow-up (FU) was 46 months. Patients were categorized by surgical complexity using the Pariser classification, with 76.1% undergoing high-complexity procedures (Pariser ≥ III). Common comorbidities included obesity (58.7%), prior circumcision (52.2%), and hypertension (52.2%). The low-complexity group had a shorter hospital stay (p = 0.02). No other significant differences were noted between groups in terms of Body Mass Index, operative time, or FU. Sexual dysfunction (45.7%) and urinary issues (38.1%) were the main reasons for surgical consultation. Skin grafting was required in 63.0% of patients; partial graft loss was more common in full thicknes skin graft group (p = 0.04). Postoperative complications occurred in 32.6% of patients, 13.3% of which were classified severe (Clavien ≥ III). The median increase in stretched penile length was 2 cm. The recurrence rate was 21.7%. The 12-month recurrence-free survival rate was 89.1%. All groups saw significant improvements in urinary and sexual function post-surgery (p < 0.05), and high patient satisfaction was reported (90.3%). Despite the complication rate, AABP surgery significantly improves quality of life, with ongoing advancements in technique anticipated to enhance outcomes further.

[formula omitted] Affects the crystalline calcium silicate hydrate minerals synthesized by fly ash-based silicon extraction solution and lime milk

When extracting amorphous silicon from fly ash using a strong alkaline solution, other elements such as Al also enter the silicon extraction solution in the form of AlOH4−. To systematically investigate the impact of AlOH4− on the synthesis of typical calcium silicate hydrate crystals in a silicon extraction solution, a specific amount of AlOH4− was added to the silicon extraction solution, and calcium silicate was hydrothermally synthesized at 90℃ and 230℃. Scanning electron microscopy (SEM) and Brunner−Emmet−Teller (BET) analysis revealed that with the increasing in AlOH4− content, microporous calcium silicate gradually loses its microporous morphology. While the specific surface area shows no significant change, the median pore diameter first increases from 1.47 nm to 1.58 nm and then decreases to 1.55 nm. The xonotlite fibers underwent a gradual refinement, diminishing from 0.28 to 0.15 µm. Simultaneously, the specific surface area increases from 28.87 to 56.8 m2/g. At an AlOH4− concentration of 3 mol/L, the microscopic morphology transforms into a sheet-like structure. X-ray diffraction (XRD) analysis reveals that AlOH4− promotes the formation of tobermorite while inhibiting the further development of calcium silicate. Additionally, Fourier transform infrared spectroscopy (FTIR) and nuclear magnetic resonance indicate that Al can replace Si in the calcium silicate hydrate system, primarily substituting positions the Q2 and Q3 sites. Qualitatively, it is suggested that with the increasing incorporation of Al, the polymerization degree of the silicon-oxygen tetrahedra decreases. According to experimental results, the concentration of AlOH4− should be below 0.05 mol/L when synthesizing microporous calcium silicate hydrate and less than 0.2 mol/L when synthesizing fibrous xonotlite-type calcium silicate hydrate.

중위투표자 관점에서의 공공사회복지 지출 분석

This paper analyzes the growth of public social expenditures in Korea from a public choice perspective. Specifically, based on the median voter theory, we conduct an empirical analysis of social insurance expenditures such as national pension, national health insurance, and public social expenditures using time series data from 1993 to 2022. The empirical results support that changes in the budget constraint for lifetime utility maximization of the median voter, including financial assets, remaining life expectancy, and remaining working year, are associated with an increase in public social expenditure. In addition, macroeconomic variables such as the real interest rate, real economic growth, and the tax base per recipient are also found to affect public social expenditure. This paper suggests that as the age of the median voter increases, public social expenditures, including national pensions and national health insurance, are bound to increase both naturally and politically.

Humoral and T-cell-mediated responses to an insect-specific flavivirus-based Zika virus vaccine candidate.

Flaviviruses represent a significant global health threat and relatively few licensed vaccines exist to protect against them. Insect-specific flaviviruses (ISFVs) are incapable of replication in humans and have emerged as a novel and promising tool for flavivirus vaccine development. ISFV-based flavivirus vaccines have shown exceptional safety, immunogenicity, and efficacy, however, a detailed assessment of the correlates of protection and immune responses induced by these vaccines are still needed for vaccine optimization. Here, we explore the mechanisms of protective immunity induced by a previously created pre-clinical Zika virus (ZIKV) vaccine candidate, called Aripo/Zika (ARPV/ZIKV). In brief, immunocompromised IFN-αβR-/- mice passively immunized with ARPV/ZIKV immune sera experienced protection after lethal ZIKV challenge, although this protection was incomplete. ARPV/ZIKV-vaccinated IFN-αβR-/- mice depleted of CD4+ or CD8+ T-cells at the time of ZIKV challenge showed no morbidity or mortality. However, the adoptive transfer of ARPV/ZIKV-primed T-cells into recipient IFN-αβR-/- mice resulted in a two-day median increase in survival time compared to controls. Altogether, these results suggest that ARPV/ZIKV-induced protection is primarily mediated by neutralizing antibodies at the time of challenge and that T-cells may play a comparatively minor but cumulative role in the protection observed. Lastly, ARPV/ZIKV-vaccinated Tcra KO mice, which are deficient in T-cell responses, experienced significant mortality post-challenge. These results suggest that ARPV/ZIKV-induced cell-mediated responses are critical for development of protective immune responses at vaccination. Despite the strong focus on neutralizing antibody responses to novel flavivirus vaccine candidates, these results suggest that cell-mediated responses induced by ISFV-based vaccines remain important to overall protective responses.

Dollars and Disparities: Unraveling Executive Compensation Patterns in American Non-Profit Healthcare.

This study examines trends in executive compensation at non-profit hospitals across the United States from 2018 to 2022. The research aims to address gaps in the current literature by providing an up-to-date analysis of compensation practices and their relationship to hospital financial metrics. A descriptive longitudinal study was conducted using data from Form 990 filings of 20 randomly selected non-profit hospitals across four U.S. regions. Executive compensation data, along with hospital financial metrics, were extracted and analyzed. Statistical analyses included descriptive statistics, non-parametric tests for trend analysis, and correlation studies using Kendall's Tau B. The median increase in executive compensation over the five-year period was 23.4%, with a median annual increase of 6.2%. Significant positive correlations were found between executive compensation and hospital revenue (τ = 0.676, p < 0.001), net assets (τ = 0.600, p < 0.001), and net income (τ = 0.273, p < 0.001). However, percentage changes in these variables over time were not significantly correlated. The study reveals significant growth in executive compensation at non-profit hospitals, with notable regional variations. While compensation correlates strongly with hospital financial metrics, the lack of correlation in their respective changes over time suggests a complex relationship. These findings raise important questions about resource allocation and compensation practices in non-profit healthcare institutions, highlighting the need for further research and policy discussions.