Notable Factors Research Articles

The Influence of Lesion Length on the Efficacy of Angioplasty with Atherectomy in Treating Infrapopliteal Artery Disease: Systematic Review and Meta-Analysis.

For the treatment of infrapopliteal artery disease (IPAD), endovascular intervention is a main choice, including atherectomy (ATH) and balloon angioplasty. However, the comparative efficacy between both approaches was heterogeneous in prior studies. Lesion length is a critical factor in IPAD anatomy classification. There is no meta-analysis to study the influence of lesion length on the effects of atherectomy for IPAD treatment. This meta-analysis aimed to determine the efficacy of angioplasty with ATH in different ranges of lesion length compared to angioplasty without ATH. Studies comparing ATH and angioplasty without ATH, which published up to April 2024 were retrieved from Pubmed, Embase, and Web of Science. Endpoints included limb prognosis and vessel complications. Referring to Trans-Atlantic Inter-Society Consensus, 10 cm lesion length was defined as a cutoff value for subgroup analysis. Pooled data were calculated using the Revman 5.4 and Stata 15, presented as odds ratio (OR) with 95% confidence interval (CI). Heterogeneity was calculated using I2 value. Methodological quality was assessed by Cochrane tool and Newcastle-Ottawa Scale. The robustness of findings would be evaluated by sensitivity analysis. Egger's test was performed to detect publication bias. Eleven studies (8412 patients) were included in this meta-analysis. Significant higher technical success was detected in ATH group (OR=1.99, 95% CI 1.44-2.76, I2=0%). In a subgroup of mean lesion length <10cm, ATH was associated with lower incidence of dissection (OR=0.19, 95% CI 0.05-0.67, I2=15%, p=0.01) and bailout stenting (OR=0.18, 95% CI 0.05-0.71, I2=16%, p=0.01). No significant differences were found between ATH and no ATH cohorts in primary patency (OR=1.65, 95% CI 0.85-3.19), all-cause death (OR=0.75, 95% CI 0.5-1.13), limb salvage (OR=1.03, 95% CI 0.75-1.41), target-lesion revascularization (OR=0.77, 95% CI 0.47-1.27), and embolization (OR=1.19, 95% CI 0.5-2.83). For IPAD, lesion length is a notable factor affecting the efficacy of ATH. In comparisons with angioplasty without ATH, the use of ATH is contributable in achieving higher technical success. The superiority of ATH may appear in reducing dissection and bailout stenting in treating IPAD with length <10cm. Nevertheless, regardless of lesion length, there seems that ATH cannot effectively improve limb salvage compared to angioplasty alone.Clinical ImpactPrior results of several meta-analyses comparing angioplasty with atherectomy to angioplasty alone were inconsistent in prognosis of infrapopliteal artery disease (IPAD), due to high heterogeneity. Considering the lesion length plays a critical role in IPAD anatomy classification, we performed an updated meta-analysis and subgroup analysis based on average lesion length to furtherly evaluate the efficacy of angioplasty following atherectomy. Our study revealed atherectomy showed advantages in obtaining technical success for IPAD ≥ 10cm and reducing the risks of bailout stenting and dissection for IPAD < 10cm. Atherectomy may prevent target-vessel complications rather than improving late patency and limb salvage effectively.

Enhancing Motorcycle Safety and Security Using Biometric Verification and Helmet Detection Through AI and ML Integration

The automotive industry, like many others, has had to adapt to newer technologies, including biometrics, AI, and Machine Learning (ML) over the years. In this chapter, a sophisticated technique directed on improving vehicle security through biometric verification and helmet detection is described using TensorFlow and a custom-built Arduino-based system. A notable factor contributing to fatalities in these motorcycle accidents is lack of helmet use among riders. Ensuring that riders put on helmets before they get on their motorcycles is done through monitoring with CCTV cameras or by manually supervising traffic intersections by police. These methods however entail high levels of manual labor. Through these approaches, some motorcycle riders without helmets have been tracked, and their license plates captured via CCTV cameras. In this methodology, the algorithm first identifies moving objects as motorcycles or non-motorcycles. Moreover, the system assesses whether classed helmeted riders are wearing helmets. If not, the device applies an OCR technique to capture the license plate

Evaluation of the Combined Effects of Tobacco and Diabetes on Periodontal Health Outcomes in India: A Longitudinal Cohort Study

ABSTRACT Background: Recognized as a major dental issue, periodontal disease is a dental health challenge that requires due attention due to its dire health consequences. Periodontitis has two notable risk factors: smoking and diabetes; however, there is an evident gap in existing studies in understanding their combined effect on the periodontal health of the Indian population. This longitudinal study investigates the independent and interactive effects of tobacco and diabetes on periodontal health in an Indian cohort. Methods: A representative sample of 800 adults, aged 30–60 years participated in this study. Baseline data were collected through clinical examinations (including periodontal probing depths, clinical attachment loss, bleeding on probing), structured interviews (assessing tobacco use habits and medical history), and blood tests (for HbA1c levels to determine diabetic status). Follow-up assessments were conducted at one-year intervals for a period of five years. Data were analyzed using SPSS to perform regression analyses to assess the associations between tobacco use, diabetes, and periodontal health outcomes, adjusting for potential confounders, such as age, gender, socioeconomic status, and oral hygiene practices. Results: The prevalence of tobacco use in the study population was 35%, while 15% of participants had diabetes. Both tobacco use and diabetes were independently associated with increased risk of periodontitis (OR = 2.5 for tobacco users, 95% CI: 1.8–3.4; OR = 3.1 for diabetics, 95% CI: 2.1–4.5). Individuals with both tobacco use and diabetes exhibited significantly worse periodontal health outcomes compared to those with neither risk factor (OR = 4.8, 95% CI: 3.2–7.2). Conclusions: This study highlights the detrimental impact of tobacco use and diabetes on periodontal health in India.

Abstract 4134: An inhibitor of the atypical protein kinase C-ζ impede the growth of gastric cancer cells by inducing apoptosis

The global statistics on gastric cancer suggest that it is the fifth most common type of cancer in terms of prevalence and third-most common type in terms of death rate. The considerably high mortality of gastric cancer is mainly because of the fact that it is mostly diagnosed when the disease has progressed to the advanced stage. While the bacterium Helicobacter pylori is known to be the most common cause of gastric cancer, other notable risk factors also include high salt intake, age and diets lacking in fruits and vegetables. Demographic data have revealed that the regions of East Asia, Eastern Europe and South America are notable hotspots of this type of cancer. Endoscopic resection is considered as the major treatment procedure for early detected gastric cancer while those diagnosed in later stages are treated with surgeries such as D2 lymphadenectomy. Previously, the Atypical Protein Kinases C (aPKCs) - ζ and ι - have been documented to play significant roles in elevated cell proliferation in various cancer types. Here, an inhibitor of the aPKC-ζ, known as ζ-stat (8-hydroxy-1,3,6- naphthalenetrisulfonic acid), that specifically inhibits the aPKC-ζ on a gastric cancer cell line (i.e., AGS) was used to observe its effects on cell proliferation. In separate trials, AGS cells were treated with ζ-stat for 72 hours (about 3 days). An assortment of drug concentrations for the inhibitor was tried and the analysis of the cell count demonstrated that the cell proliferation decreases were statistically significant for the drug in all concentrations. The highest decrease was observed at 10 µM (P &amp;lt; 0.0001) as the number of cells diminished to approximately 44%. Our previous research has revealed that ζ-stat downregulates the aPKC-ζ by interfering with established cancer pathways to cause cell deaths. Henceforth, Western Blot analysis of AGS cells treated with ζ-stat have shown evidence of apoptosis. There have been considerable decreases in the levels of total PARP, Caspase 3 and Survivin. Likewise, levels of cleaved-Caspase 3 and cleaved-PARP have also increased along with the mitochondrial apoptotic marker Cytochrome C. Current investigations include how ζ-stat play into some of the well-established gastric cancer pathways to lead to cell deaths with techniques such as Western Blot analysis, Immunoprecipitation Assays and Flow cytometry. Citation Format: Abiral Hasib Shourav, Abigail Olatunji, Mahfuza Marzan, Radwan Ebna Noor, Mildred Acevedo-Duncan. An inhibitor of the atypical protein kinase C-ζ impede the growth of gastric cancer cells by inducing apoptosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4134.

Global Burden of Cardiovascular Disease Attributable to Sugar-Sweetened Beverages in Middle-Aged Adults: An Age-Period-Cohort Modelling Study.

Cardiovascular disease (CVD) presents a significant burden among middle-aged adults (aged 35-64). Diet high in sugar-sweetened beverages is a notable CVD risk factor. Using Global Burden of Disease data from 1990 to 2019, age-standardized rates (ASRs) and average annual percentage change of ASRs were used to describe this burden and its changing trend. In 2019, global CVD-related ASR (per 100 000) of deaths attributable to sugar-sweetened beverages in middle-aged adults reached 1.91 (95% uncertainty interval [UI], 1.07-2.63) compared with 2.75 (95% UI, 1.76-3.59) in 1990. The global ASR of disability-adjusted life years (DALYs) reached 69.71 in 2019 (95% UI, 38.38-96.36) compared with 97.98 (95% UI, 62.29-128.39) in 1990. Men had more than twice the deaths and DALYs as women. Low and low-middle sociodemographic index regions exhibited a higher burden of DALYs and deaths. In 2019, India and China had the highest numbers of deaths and DALYs and the Solomon Islands and Afghanistan recorded the highest ASRs of deaths and DALYs. A negative linear correlation was observed between sociodemographic index and ASRs of deaths (R=-0.10, P=0.010) and DALYs (R=-0.09, P=0.031) across 21 Global Burden of Disease regions. An inequalities analysis indicated that DALYs due to CVD were disproportionately higher in countries with lower sociodemographic index in 2019 (concentration index of inequality=-0.05 [95% CI, -0.1 to -0.01]). Globally, sugar-sweetened beverages have contributed to a substantial increase in DALYs and deaths related to CVD in middle-aged adults over the past 30 years, especially among men and in low sociodemographic index countries.

Fostering resilience: exploring financial inclusion as a catalyst in mitigating economic policy uncertainty and safeguarding food security in developing countries

Purpose This study aims to investigate the nexus among economic policy uncertainty (EPU) and food security, while also analyzing the mediating effect of financial inclusion in mitigating the adverse impacts of EPU and strengthening food security in developing countries. Design/methodology/approach Using a quantitative approach, panel data from 2004 to 2021 for 24 countries was evaluated to develop a comprehensive food security index covering four dimensions: food supply, food access, food utilization and food stability, which are further composed of 12 elements. The “Baron and Kenny Three Step Methodology” together with Sobel test was used to investigate the direct and mediating impact of financial inclusion on the association among EPU and food security. To mitigate the issue of endogeneity, instrumental variable technique and two-step generalized methods of moments (GMM) were used. For robustness, the authors use the average mean of EPU as a substitute and use Sustainable Development Goal (SDG) No. 2 (No Hunger) as an alternative measure of food security. Findings The findings indicate that EPU adversely affects overall food security, including its dimensions such as food supply, food access, food utilization and food stability. This study further demonstrates that financial inclusion plays a significant mediating role in the association among EPU and food security. The results highlight that financial inclusion emerged as a notable factor in mitigating the negative effects of EPU on food security. Practical implications Governments and policymakers should prioritize and implement programs aimed at improving financial inclusion, which will help individuals and nations to adopt required tools they need to build resilience against EPU, and ultimately safeguarding their food security. This eventually leads toward attainment of not only SDG 2 (No Hunger) but also assists in achieving SDG 1 (No Poverty) and SDG 10 (Inequality Reduction). These comprehensive efforts will also lead to the establishment of sustainable future for all. Originality/value There is limited body of research that explores the interplay of these three variables within a single study. Likewise, the role of financial inclusion as a mediator in the association among EPU and food security represents a novel contribution. The study uses a multi-indicator approach to comprehensively measure key variables such as food security and financial inclusion.

USE OF G10 SCORING SYSTEM TO PREDICT DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY AND CONVERSION TO OPEN CHOLECYSTECTOMY

Background: Laparoscopic cholecystectomy (LC) is the gold standard for treating gallbladder disease; however, some cases present technical challenges that necessitate conversion to open cholecystectomy (OC). Identifying factors associated with difficult LC and conversion to OC can help optimize surgical planning and patient counseling. Objective: To evaluate the frequency of difficult laparoscopic cholecystectomies and the rate of conversion to open cholecystectomies in patients undergoing laparoscopic cholecystectomy (LC). Study Design: Observational cross-sectional study. Setting: The study was conducted at Saidu Teaching Hospital in Swat. Duration of Study: The study was conducted over six months, from August 16, 2024, to February 16, 2025. Methods: A total of 126 patients undergoing laparoscopic cholecystectomy (gallbladder surgery) were included. Surgical difficulty was assessed using the G10 scoring system, which evaluates factors such as inflammation, adhesions, and anatomical variations. Conversion rates from LC to OC were recorded. Demographic characteristics, surgical difficulty, and outcome variables were analyzed using SPSS version 20. The statistical significance of the predictive factors was assessed, with p-values of less than 0.05 considered significant. Results: Difficult labor was observed in 14 patients (11.1%), while conversion to cesarean section was required in 8 cases (6.3%). Age and gender were significant predictors of difficult LC and conversion to OC. Patients with a higher BMI (&gt;24.9 kg/m²) had an increased likelihood of complex surgery and conversion; however, the association was not statistically significant. Conclusion: The frequency of difficult laparoscopic cholecystectomy was 11.1%, and the conversion rate to open surgery was 6.3%. Age and gender were notable predictive factors for surgical difficulty and conversion. Preoperative risk assessment using scoring systems, such as G10, can aid in surgical decision-making and improve patient outcomes.

Incidence, Risk Factors and Epidemiological Errors of Vancomycin Associated Acute Kidney Injury: A Systematic Review

Changes in the incidence of Vancomycin Associated-Acute Kidney Injury (VA-AKI), risk factors and applicability of studies are questionable in recent times. This review aims to evaluate the incidence, risk factors and the epidemiological errors of findings on VA-AKI. All studies related to vancomycin associated acute kidney injury in the past 20 years were identified from PubMed, MEDLINE, Google scholar and UWIlinC. During the past decade, the incidence of VA-AKI varied between 7.3% to 15.8%. The lowest incidence was found among the patients who received pharmacist intervention prior to the initiation of therapy, and the highest incidence was among elderly patients over 65-year-old. Notable risk factors were old age, high trough ≥15 μg/mL, AUC/MIC ratio &gt; 650 mg × hour/L, concomitant use of aminoglycosides, broad-spectrum antibiotics, diuretics and vasopressor, using vancomycin without pharmacist intervention, hyperuricemia, respiratory failure, cardiac failure, chronic kidney disease, mechanical ventilation, obesity and black race. Common epidemiological errors in these studies were generalization and selection bias. The disparity of facilities among healthcare services is a concern. Knowing modifiable risks, using vancomycin as monotherapy and advance consultation with pharmacists seem valuable preventive tools for VA-AKI regardless of resource settings.

Plasma cytokine levels and PCOS risk: Mendelian randomization analysis reveals IL6R as a preventive factor

BackgroundPolycystic ovary syndrome is a prevalent gynecological condition affecting primarily women of childbearing age. It is characterized by elevated androgen levels, ovulatory dysfunction, and morphological abnormalities. Despite extensive research from various perspectives, the etiology and pathogenesis of PCOS remain unclear. While controversial, many believe that individuals with PCOS exhibit a chronic low-grade inflammatory state. Cytokines play diverse roles in the initiation and progression of inflammation, contributing to this inflammatory milieu. Therefore, the aim of this study was to utilize publicly available genome-wide association study data to explore the potential causal relationship between cytokines and PCOS.MethodsTo accurately investigate the causal relationship between cytokines and PCOS, we initially defined cytokines using the GeneCrad and then identified cytokines in two independent large-scale plasma proteins. Subsequently, we employed a two-sample Mendelian randomization analysis framework. A series of quality control procedures were implemented to select eligible instrumental variables closely associated with the exposure. MR analysis was conducted using genome-wide association studies of PCOS in two independent European ancestry groups. Cochran, s Q test, MR-Egger and intercept test were employed to assess heterogeneity and pleiotropy in PCOS. Co-localization analysis, summary-data-based Mendelian randomization analysis, and HEIDI testing were utilized to further corroborate the relationship between positive findings and PCOS. Finally, systematical Mendelian randomization analysis between healthy lifestyle factors and PCOS-related proteins was conducted to identify which proteins could act as interventional targets by lifestyle changes.ResultsIn our investigation, we performed Mendelian randomization analysis on 33 cytokines in relation to PCOS using data from the deCODE and the Fenland. Our findings revealed that the plasma level of IL6R emerges as a notable protective factor against PCOS, exhibiting a substantial effect size. Moreover, we identified CCL22 as a significant risk factor for PCOS, a finding that was similarly validated and supported by independent cohorts.ConclusionOur Mendelian randomization analysis, leveraging genome-wide association study data from a sizable population cohort, unequivocally delineated a causal relationship between IL6R and PCOS. These results underscore the involvement of cytokines in the pathogenesis of PCOS and highlight their potential as promising therapeutic targets for addressing this intricate disease.

WWC1 mutation drives dopamine dysregulation and synaptic imbalance in Tourette's syndrome.

Tourette's syndrome (TS) is a major neurodevelopmental disorder characterized by childhood-onset motor and vocal tics. A W88C mutation in WWC1 gene is a notable risk factor for TS, but the underlying molecular mechanisms remain unclear due to the lack of suitable animal models. Here, we generate a mutant mouse line with human W88C mutation (W88CMut mice), which exhibits behavioral deficits similar to those observed in patients with TS, including repetitive motor behaviors and sensorimotor gating abnormalities. The W88C mutation leads to the degradation of kidney and brain (KIBRA) protein via a proteasomal pathway, evokes dopamine release in the dorsal striatum, and disrupts synaptic function through the dysregulation of Hippo pathway. Neuron-specific overexpression of wild-type WWC1 rescues synaptic and behavioral phenotypes in W88CMut mice. Together, this study not only provides a valuable mouse model for studying TS but also offers fresh insights into the molecular and synaptic mechanisms underlying neurodevelopmental abnormalities in TS.

The Term Structure of Credit Default Swap Spreads and the Cross Section of Options Returns

ABSTRACTThis paper, using the natural logarithmic form credit default swap (log CDS) slope, examines the variation in cross‐sectional 1‐month ATM delta‐hedged straddle returns. Our analysis reveals that the log CDS slope significantly and positively predicts these returns, even when accounting for several key volatility mispricing factors. Further investigation shows that this predictive relationship exhibits a strong time‐varying pattern, closely linked to market conditions. In contrast, the relationship between notable volatility mispricing factors and straddle returns remains relatively stable over time. Constructing a long‐short quintile portfolio on straddle options confirms that trading performance improves when the past 12‐month market return is at a historically lower level, market volatility is at a historically higher level, and the VIX is elevated. Log CDS slope, as a proxy for excess jump risk premium, significantly predicts delta‐hedged option returns during periods of high volatility.

A bibliometric and visualized analysis of interventional treatment for intracranial atherosclerotic stenosis (from 2004 to 2023).

Intracranial atherosclerotic stenosis is a notable factor leading to ischemic strokes, with a sustained elevated risk of recurrence despite intensive medical management. Recent years have witnessed a surge in research focusing on interventional strategies for addressing this condition. This study seeks to assess the current state and future development paths of interventional therapies for intracranial atherosclerotic stenosis, offering critical insights and recommendations for future research endeavors in this field. A comprehensive bibliometric evaluation was conducted using the bibliometric analysis tools VOSviewer_1.6.20 and CiteSpace 6.3.1, sourcing data from the Web of Science Core Collection database. This analysis encompassed literature related to interventional treatments for intracranial atherosclerotic stenosis from 2004 to 2023, supplemented by graphical illustrations. Following a thorough screening process, we identified 3,384 articles suitable for inclusion in this analysis. An observable increase in publication volume has been noted over the last two decades, with the United States leading in the number of publications. Interestingly, China has shown a significant rise in publication activity in recent years, with Capital Medical University being a prominent contributor. Noteworthy authors in this domain include Derdeyn, C.P. and Levy, E.I., and the Journal of Neurointerventional Surgery has emerged as the primary venue for these articles. The domain of interventional treatments for intracranial atherosclerotic stenosis presents considerable potential for future developments, highlighting the need for a concerted approach towards personalized and precise therapeutic strategies grounded in rigorous multicenter research.

Faktor Risiko Diabetes Melitus dan Prevalensi Penyakit Jantung Koroner di RSU UKI Tahun 2021-2023

Coronary heart disease (CHD) remains a major cause of death globally, with its prevalence increasing over time. Diabetes mellitus is recognized as a significant risk factor for CHD. This study aims to explore the relationship between diabetes mellitus and CHD among patients at UKI General Hospital (RSU UKI). Utilizing a cross-sectional, retrospective, and descriptive-analytic design, this research analyzed medical records of CHD patients from January 2021 to December 2023, processed using SPSS software. Results indicated that CHD was most prevalent among individuals aged 60–69, with a higher incidence in men. Unemployment was common among CHD patients, and most had an education level above high school. During the study period, 79 CHD cases were recorded, with 21 patients having a history of diabetes mellitus. Data showed a consistent increase in CHD cases over the three-year period. The study revealed that individuals with diabetes mellitus were 3.5 times more likely to develop CHD. However, despite this finding, the data from RSU UKI indicated a relatively weak association between diabetes mellitus and CHD. These findings suggest that while diabetes mellitus is a notable risk factor for CHD, additional research is necessary to identify other contributing factors in this population.

The Relationship Between Obesity Status and Body Image Dissatisfaction on Gross Motor Skill Development and Cardiorespiratory Fitness in Children Aged 6-12 Years Old.

The harmonious development of gross motor skills (GMSs) is vital for children, fostering their physical, cognitive, and socio-emotional growth. This study aimed to achieve three primary objectives: (1) to establish standardized reference values for all GMS tests conducted; (2) to examine the impact of overweight and obesity on factors influencing the development of GMSs and cardiorespiratory fitness (CRF); and (3) to investigate the relationship between GMSs and CRF levels and body image dissatisfaction among Canadian children from the province of Québec. The study encompassed 3144 children aged 6 to 12 years (1535 boys and 1609 girls) recruited from 24 elementary schools situated in five urban areas. Anthropometric measurements included body mass, body height, and body mass index (BMI). Physical performance was assessed using a maximal aerobic power test and 12 GMS tests, which comprised two segmental speed tests, four agility tests, two static balance tests, one simple reaction time test, and three coordination tests. Body perception and body image dissatisfaction were evaluated using a silhouette scale featuring two sets of nine drawings depicting a spectrum of body shapes ranging from very thin to obese. Standardized normative values were established for each GMS test. GMSs demonstrated continuous improvement throughout childhood, albeit with a deceleration in progress during later developmental stages. At comparable age, boys generally outperformed girls on tests demanding greater strength, speed, or endurance, whereas girls exhibited superior performance in balance and hand-foot coordination tasks (p ≤ 0.05). However, segmental speed remained equivalent between sexes (p > 0.05). GMS and CRF were significantly influenced by obesity status. Children with a normal BMI demonstrated superior performance compared to their overweight or obese counterparts, particularly in tests requiring body mass displacement (p ≤ 0.05). Conversely, socioeconomic status exhibited no significant impact on body perception in boys (p = 0.106), but it was a notable factor among 6-8-year-old girls from lower socioeconomic backgrounds (p = 0.045). Obesity status is linked to diminished GMS performance, especially in tasks involving body mass movement. These findings underscore the importance of early intervention strategies to encourage an active lifestyle and promote a healthy body composition in children.

Comorbidity-related risk factors for acute respiratory distress syndrome in sepsis patients: A systematic review and meta-analysis.

Acute respiratory distress syndrome (ARDS) presents a significant challenge in the management of sepsis, with various comorbidities potentially influencing its development. Understanding the impact of these comorbidities is crucial for improving patient outcomes. This meta-analysis was conducted to investigate the relationship between various comorbidities and the development of ARDS in patients with sepsis, with the aim of improving understanding and management of this condition. The study included adult sepsis patients from 8 studies, totaling 16,964 participants. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS), and the data analysis was performed and reported as pooled odds ratios (ORs) computed using a random-effects model. Heterogeneity and publication bias were assessed using the I2 statistic and Doi plots with the Luis Furuya-Kanamori (LFK) index, respectively. Chronic obstructive pulmonary disease was significantly associated with an increased risk of ARDS (OR: 1.43, 95% confidence interval (95% CI): 1.02-2.01). Other comorbidities showed no significant associations: diabetes mellitus (DM) (OR: 0.88, 95% CI: 0.69-1.11), hypertension (HTN) (OR: 0.86, 95% CI: 0.56 to 1.34), coronary artery disease (CAD) (OR: 0.95, 95% CI: 0.86-1.06), congestive heart failure (CHF) (OR: 1.08, 95% CI: 0.61 to 1.90), chronic kidney disease (CKD) (OR: 0.89, 95% CI: 0.65-1.22), chronic liver disease (CLD) (OR: 1.13, 95% CI: 0.61-2.09), and cancer (OR: 0.90, 95% CI: 0.59-1.35). Additional analyses indicated moderate-to-high heterogeneity and some evidence of publication bias. Chronic obstructive pulmonary disease is a notable risk factor for ARDS in sepsis patients, suggesting the need for enhanced surveillance and management in this group. Further research is necessary to understand the mechanisms and explore other potential ARDS risk factors in sepsis.

Button Battery Ingestion: Exploring Socioeconomic Risk Factors.

Button Battery Ingestion: Exploring Socioeconomic Risk Factors.

Barriers and Facilitators to Cross-Institutional Referrals: System Configuration Analysis of VA Staff Experiences.

In 2014 and 2018, respectively, Congress passed the Veterans Access, Choice, and Accountability Act (Choice Act) and the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION Act), which expanded eligibility for and use of cross-institutional referrals among U.S. Veterans enrolled in the Veterans Health Administration. To identify facilitators and barriers to patient information sharing for cross-institutional, outpatient referrals resulting from policy changes. Applying the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework, we conducted work system and configural analyses of semi-structured interviews. Clinical and administrative staff in six Department of Veterans Affairs (VA) facility community care liaison program offices. Interviews focused on barriers and facilitators to sharing patients' information across healthcare institutions. Transcripts were summarized by domain and coded to consensus, followed by directed content analysis and visualization using configural diagrams. From 19 interviews, we characterized a nine-step, ad hoc referral process. Barriers were reported in four of nine referral steps: scheduling, coordination, sending of pre-visit clinical records, and receipt of post-visit records. Low adoption of new technology, strained relationships with CCN clinicians, and inconsistent policies were commonly reported barriers. Largely, perceived barriers were classified as technology, people, or organization factors. The COVID-19 pandemic and a transition between third-party administrators were reported as notable environment factors. VA staff perceived increases in patient care delays and staff workload associated with social and technical barriers to sharing patients' information across healthcare institutions. In the cross-institutional referral process, we identified the primary configuration or combination of work system factors-technology, people, and organization- related to prevalent barriers. System-level interventions are needed to enhance relationships with clinicians across healthcare institutions, implement policies that guide patient information exchange, and design supportive technologies for efficient clinician communication during cross-institutional referrals.

Analysis and Prediction of Ecological Vulnerability of the Central Plains Urban Agglomeration Based on the SRP Model

The analysis and prediction of ecological vulnerability of the Central Plains Urban Agglomeration, as a demonstration area for green ecological development planning, is important for understanding the current status and future development trends of the ecological environment in this region. This article is based on the "sensitivity-resilience-pressure" （SRP） model, selecting multi-source remote sensing spatial statistical data, using the entropy weight method to determine the weights of each index, and constructing an evaluation index system for the ecological vulnerability of the Central Plains Urban Agglomeration. This study analyzed the spatial distribution and temporal changes of ecological vulnerability in the study area from 2005 to 2020. With the help of the geographical detector model, the driving factors of ecological vulnerability in the study area were explored and combined with the CA-Markov model to predict the ecological vulnerability status in 2025. The results showed that： ① The Central Plains urban agglomeration was primarily characterized by mild vulnerability, exhibiting a spatial trend of higher vulnerability in the northwest and lower in the southeast. Over time, it displayed an evolutionary trend of first increasing and then decreasing. ② Regardless of whether the level of ecological vulnerability increased or decreased, each level tended to undergo large-scale transitions toward the nearest level, with the most important changes occurring in the severe vulnerability level. ③ Building area percentage, biological abundance, fractional vegetation cover, population density, and gross domestic product （GDP） were notable influencing factors that contributed to the ecological vulnerability of the Central Plains urban agglomeration, and the interaction between all these indicators had significantly increased. ④ The predictive results for 2025 showed a downward trend in ecological vulnerability, indicating an improvement in the ecological environment.

Exposome and prostate cancer: Experience in a remote hospital in French Guiana

Exposome and prostate cancer: Experience in a remote hospital in French Guiana

Body mass index and physical training-related injuries in military personnel: a systematic review and meta-regression analysis

IntroductionDiscrepancies exist in findings on how varying body mass index (BMI) levels impact physical training-related injuries across different studies. This systematic review and meta-analysis aimed to evaluate the relationship between...