Optimal Time Research Articles

Comprehensive Analysis of Perioperative Factors Influencing the Risk of Biochemical Recurrence in Patients with Radical Prostatectomy.

To analyze the perioperative factors that influence the risk of biochemical recurrence (BCR) in patients with localized PCa undergoing radical prostatectomy Materials and Methods: A total of 457 patients, operated by 2 surgeons in our high-volume oncological center were included in the initial database. Patients who underwent RP for clinically localized PCa in our clinic from 2016 to 2021 were included in the study. Perioperative data were retrospectively reviewed for this study. Follow-up data including post-operative PSA and adjuvant treatment was prospectively gathered by contacting the patients or from the follow-up consultation. Final database was composed of 366 patients who underwent open or 3D laparoscopic RP. Statistical analysis was performed to emphasize the most powerful parameters that influence the BCR. Results: Accounting for multivariable analysis, 4 parameters were statistically significant: initial PSA (iPSA), Gleason score, vascular involvement and positive surgical margins. For the group of patients with no positive margins, 3 parameters were statistically significant: iPSA above 10,98 ng/mL (AUC=0,71); lymph node involvement and Gleason score. Multivariable Cox regression showed that positive margins and iPSA had a significant impact on the time to BCR. Patients that received adjuvant therapy were excluded from the study. Out of the whole cohort, 27,3% of patients presented BCR. Perioperative factors need to be carefully analyzed and a detailed follow-up needs to be conducted in order to assess the risk of biochemical recurrence, resulting in the optimal time for adjuvant treatment implementation.

Perinatal management of pregnancies with Fetal Congenital Anomalies: A guide to Obstetricians and Pediatricians.

Background Congenital anomalies are responsible for approximately 20% of all neonatal deaths worldwide. Improvements in antenatal screening and diagnosis have significantly improved the prenatal detection of birth defects; however, these improvements have not translated into the improved neonatal prognosis of babies born with congenital anomalies. Objectives An attempt has been made to summarise the prenatal interventions, if available, the optimal route, mode and time of delivery and discuss the minimum delivery room preparations that should be made if expecting to deliver a fetus with a congenital anomaly. Methods The recent literature related to the perinatal management of the fetus with prenatally detected common congenital anomalies were searched in English peer-reviewed journals from the PubMed database, to work out an evidence-based approach for their management. Results Fetuses with prenatally detected congenital anomalies should be delivered at a tertiary care centre with facilities for neonatal surgery and paediatric intensive care if needed. There is no indication for preterm delivery in the majority of cases. Only a few congenital malformations, like high-risk sacrococcygeal teratoma, congenital lung masses with significant fetal compromise, fetal cerebral lesions or neural tube defects with Head circumference >40 cm or the biparietal diameter is ≥12 cm, gastroschisis with extracorporeal liver, or giant omphaloceles in the fetus warrant caesarean section as the primary mode of delivery. Conclusion The prognosis of a fetus with congenital anomalies can be significantly improved if planning for delivery, including the Place and Time of delivery, is done optimally. A multi-disciplinary team should be available for the fetus to optimize conditions right from when it is born.

Postsurgical utility of copeptin for the prediction of postoperative arginine vasopressin deficiency.

Arginine vasopressin deficiency (AVD) following neurosurgical procedures for pituitary disorders is common and can delay discharge. Copeptin, a stable surrogate marker of arginine vasopressin, may predict postoperative AVD. The authors' aim was to assess the optimal postoperative sampling time and cut-point concentration of copeptin to predict the development of postsurgical AVD. Adults without preexisting AVD who were undergoing surgery for a pituitary lesion between February 2020 and April 2022 were eligible for study inclusion. Two samples were drawn from each patient postoperatively to assess the copeptin concentration using an immunofluorescent assay. Samples were denoted as "early" (within 6 hours of extubation) or "postoperative day 1" (POD1; within 10-30 hours of extubation). Patients were evaluated for the development of AVD. One hundred ninety-two patients (54.2% female) with a median age of 54.5 years (IQR 39.8-67.0 years) were included in the study. The median copeptin concentration at both time points was significantly lower in those with AVD (transient or permanent; n = 22, 11.5%) than in those without (early: 4.9 vs 18.7 pmol/L, p < 0.001; POD1: 3.4 vs 4.9 pmol/L, p < 0.001) but did not differ in those who developed transient versus permanent AVD. The optimal copeptin cut point for the prediction of AVD was < 8.5 pmol/L for early samples (sensitivity 0.70, specificity 0.80, positive predictive value [PPV] 0.29, negative predictive value [NPV] 0.96) and < 4.3 pmol/L for POD1 samples (sensitivity 0.82, specificity 0.63, PPV 0.22, NPV 0.96). In early samples, a copeptin cutoff of 22.9 pmol/L increased the sensitivity for the detection of AVD to 95% with an NPV of 99%. The proportion of patients who had AVD was higher (60.0% vs 8.8%, p < 0.001) and the copeptin concentration lower (early: 4.3 vs 17.0 pmol/L, p < 0.001; POD1: 2.7 vs 4.9 pmol/L, p < 0.001) among those who had undergone surgery for a craniopharyngeal duct pathology versus a pituitary adenoma. Although copeptin was lower in patients with persistent Cushing's disease than in those in remission, the difference did not reach statistical significance (early p = 0.11, POD1 p = 0.52). Furthermore, the copeptin concentration could not predict the development of syndrome of inappropriate secretion of antidiuretic hormone. Patients without AVD who had received stress dose steroids intraoperatively had lower median early copeptin (11.7 vs 19.1 pmol/L, p = 0.027). In early postoperative copeptin samples, the optimal copeptin cut point for AVD diagnosis was < 8.5 pmol/L, and a level > 22.9 pmol/L had predicative utility in excluding AVD. Caution should be used when interpreting copeptin results, as patients administered glucocorticoids intraoperatively without AVD had lower median copeptin concentrations.

Coupling model predictive control and rules-based control for real-time control of urban river systems

Model Predictive Control (MPC) has the potential to enhance flood control in urban river systems. However, the computational burden of online optimization hinders the application of MPC to large-scale areas. To address this, we propose a method incorporating both Rules-Based Control (RBC) and MPC based on surrogate models. MPC optimizes the operation of gates and pumping stations in the area of interest, while RBC is implemented in a specific region that does not participate in online optimization, thereby reducing calculation time. We have successfully validated this approach in coastal urban river systems in China, reducing the decision variables from 109 to 24 and narrowing the simulation area from 165 km2 to 15 km2. During the Typhoon Lupit rainfall test, the total computation time and the highest online optimization time were only 33.9 % and 38.1 % of the full MPC system, respectively. Additionally, the method demonstrated impressive results, including a significant 94.62 % reduction in flood volume and a remarkable 96.5 % decrease in flood duration. These findings demonstrate that our method effectively addresses the challenge of long computation times for online optimization in urban river systems and presents a novel approach for implementing urban flood mitigation strategies.

DeepHealthNet: Adolescent Obesity Prediction System Based on a Deep Learning Framework.

The global prevalence of childhood and adolescent obesity is a major concern due to its association with chronic diseases and long-term health risks. Artificial intelligence technology has been identified as a potential solution to accurately predict obesity rates and provide personalized feedback to adolescents. This study highlights the importance of early identification and prevention of obesity-related health issues. To develop effective algorithms for the prediction of obesity rates and provide personalized feedback, factors such as height, weight, waist circumference, calorie intake, physical activity levels, and other relevant health information must be taken into account. Therefore, by collecting health datasets from 321 adolescents who participated in Would You Do It! application, we proposed an adolescent obesity prediction system that provides personalized predictions and assists individuals in making informed health decisions. Our proposed deep learning framework, DeepHealthNet, effectively trains the model using data augmentation techniques, even when daily health data are limited, resulting in improved prediction accuracy (acc: 0.8842). Additionally, the study revealed variations in the prediction of the obesity rate between boys (acc: 0.9320) and girls (acc: 0.9163), allowing the identification of disparities and the determination of the optimal time to provide feedback. Statistical analysis revealed that the performance of the proposed deep learning framework was more statistically significant (p 0.001) compared to the other general models. The proposed system has the potential to effectively address childhood and adolescent obesity.

355 Risk Factors for Intrathecal Baclofen Pump Implantation Infections: A Retrospective Database Analysis

INTRODUCTION: Baclofen, a GABAB receptor agonist, can be delivered via intrathecal baclofen (ITB) pumps for patients with intractable spasticity. Prior literature has shown infection rates ranging between 10-30%. METHODS: A multi-institutional de-identified database TriNetX was queried to identify patients with: 1) implantation of ITB pump + infection within 6 months or 2) implantation of ITB pump without infection within 6 months. Two populations were analyzed: only pediatric patients, then patients of all ages. Characteristics were compared using log-rank tests and independent-sample t-tests. RESULTS: 1,880 patients were identified in the pediatric cohort, of which 236 (12.6%) developed infection. 13,936 patients of all ages were identified, of which 1955 (14.0%) developed infection. In pediatric patients who developed infection, there were higher rates of diagnoses of overweight and obesity, malnutrition, and hypokalemia; the prevalence of diabetes was also higher, but this analysis was limited by small sample size. In patients of all ages, all medical diagnoses assessed were significantly more prevalent in patients with infection. Erythrocyte sedimentation rates and platelets were significantly higher in all patients with an infection. Additionally, the number of emergency department visits within 6 months was significantly higher in the infection group for pediatric (t = 3.571, p = 0.0004) and all-age (t = 7.882, p &lt; 0.0001) patients. CONCLUSIONS: This study suggests that patients with certain comorbidities are at increased risk for infection post-ITB implantation. Since prevalence of diabetes, abnormal coagulation profile, tracheostomy, and B-vitamin deficiency remained significantly different between infection vs. no-infection cohorts as sample size increased with the addition of adults, these diagnoses should be considered when calculating the infection risk of ITB pump. Studies are underway to investigate the time of highest infection risk post-ITB implantation and the optimal time for ITB reimplantation after removal for infection.

A real options approach to renewable energy module end-of-life decisions under multiple uncertainties: Application to PV and wind in China

The issue of large-scale retirements of renewable energy modules has attracted considerable attention from governments and the public worldwide. Using the Chinese wind and photovoltaic industries as examples, this paper, for the first time, employs a real options approach to explore the optimal time for energy firms to retire their power plants and to predict the future trend of renewable energy wastage from a bottom-up perspective. The results show that the optimal retirement time for the four subdivided categories ranges from 16 to 23 years. The later the investments are made, the earlier the decommissioning time comes and the lower the project returns. Furthermore, wind projects have been found to generate more revenue than PV projects for the same size, and the gap continues to widen. Offshore wind technology always has the longest optimal service life (18.62 years in 2022) and the greatest project returns (10.84 million CNY in 2022). Annual utilization hours, the renewable electricity price and the waste price can accelerate the retirement of plants and generate more revenue for energy companies, while the initial investment cost has a completely opposite effect. The first wave of PV retirements will occur in 2035 at 305.82 GW, while onshore wind will be in 2036 at 530.77 GW and offshore wind will not explode until 2040 at 65.84 GW. An assessment of potential policies suggests that for every 100 CNY increase in incentive strength, the retirement wave arrives 1 year earlier. In contrast, for every 100 CNY increase in the strength of penalties, the retirement wave is delayed by 1 year. In addition, we verify that the size of the plants does not affect the forecast of the retirement trend, indicating that the assumptions about installed capacity do not cause bias.

Enhancing rainwater harvesting and groundwater recharge efficiency with multi-dimensional LSTM and clonal selection algorithm

Rainwater harvesting stands out as a promising solution to alleviate water scarcity and alleviate pressure on conventional water reservoirs. This work introduces a pioneering strategy to elevate the efficiency of rainwater harvesting systems through the fusion of Multi-Dimensional Long Short-Term Memory (LSTM) networks and the Clonal Selection Algorithm (CSA). The Multi-Dimensional LSTM networks serve to model intricate temporal and spatial rainfall patterns, enabling precise predictions regarding the optimal times and locations for rainwater abundance. This insight is pivotal in refining the design and operation of rainwater harvesting setups. Drawing inspiration from the immune system, the Clonal Selection Algorithm is employed to optimize site selection and resource allocation, ensuring the maximal utilization of harvested rainwater. The adaptability and robustness of CSA prove invaluable in tackling the dynamic nature of rainfall patterns. This research endeavor is dedicated to enhancing groundwater levels and optimizing its sources through the implementation of efficient harvesting techniques. By delving into innovative methodologies, it aims to contribute significantly to sustainable water management practices and ensure a reliable supply of groundwater for various societal needs. The experiments are conducted to study the effectiveness of rainwater harvesting systems, where the proposed method achieves increased efficiency, thereby reducing dependence on conventional water sources and contributing to sustainable water management practices. The proposed CSA-LSTM model demonstrates superior performance compared to ACO-ANN and PSO-BPNN, achieving higher training, testing, and validation accuracies while exhibiting lower training, testing, and validation losses. Additionally, CSA-LSTM showcases excellent site suitability, high resource utilization, and robustness to changes, with a fast response time, emphasizing its potential for efficient and effective applications.

Ultrasound-Assisted Synthesis of High-Entropy Materials for Enhanced Oxygen Evolution Electrocatalysis

High-entropy materials (HEMs) play a significant role in the electrocatalytic oxygen evolution reaction (OER) due to their unique properties. However, there are still challenges in the preparation of HEMs for OER catalysts. In this study, the FeCoNiMnCr catalyst is synthesized for the first time using the ultrasonic hydrothermal-sintering technique and exhibits excellent performance for OER electrocatalysis. There is an optimal ultrasonic hydrothermal time and power for achieving the best OER performance. The results demonstrate that the performance of FeCoNiMnCr catalysts prepared through ultrasonic hydrothermal sintering (US-FeCoNiMnCr) is significantly improved compared with the traditional hydrothermal-sintering method. The US-FeCoNiMnCr catalyst exhibits an overpotential of 228 mV at the current density of 10 mA cm−2 and a Tafel slope as low as 45.39 mV dec−1 in an alkaline medium. Moreover, the US-FeCoNiMnCr catalyst demonstrates remarkable stability in electrocatalytic OER with a minimal potential increase observed even after 48 h. This work not only provides valuable insights into high-entropy material synthesis, but also presents a powerful electrocatalyst for water electrolysis.

Impact of Tracheostomy Timing Within the National Veterans Affairs Population.

There is a lack of a definitive study in the literature comparing early versus late tracheostomy and exploring the impact of tracheostomy timing on patient outcomes. This study may help guide treatment paradigms and contribute to a consensus for optimal tracheostomy timing. A retrospective review was performed comparing early versus late timing of tracheostomy placement and their respective outcomes. The authors used data provided by VA Informatics and Computing Infrastructure (VINCI) to find patients who received a tracheostomy at any VA Medical Center in the United States. There were a total of 25,334 tracheostomies in the database which satisfied our criteria. These occurred between the years 1999 and 2022. Propensity score matching assessed 17,074 tracheostomies, 8537 in either group. The median age of patients in the matched groups was 66 years, and approximately 97.4% of patients were male. Early tracheostomy timing was defined as the placement of the tracheostomy within 10 days of intubation. Outcomes included post-tracheostomy intensive care unit (ICU) days, post-tracheostomy hospital days, successful ventilator weaning, and all-cause mortality. Early tracheostomy was associated with significantly fewer ICU days and hospital days, and the early group experienced higher rates of successful ventilator weaning. Survival analysis of data within 5 years of tracheostomy showed that early tracheostomy was associated with significantly lower hazard for all-cause mortality. Our results add to the body of evidence that an earlier transition to mechanical ventilation by tracheostomy confers benefits in patient morbidity and mortality as well as resource utilization. 3 Laryngoscope, 2024.

Isoquercitrin alleviates pirarubicin-induced cardiotoxicity in vivo and in vitro by inhibiting apoptosis through Phlpp1/AKT/Bcl-2 signaling pathway.

Introduction: Due to the cardiotoxicity of pirarubicin (THP), it is necessary to investigate new compounds for the treatment of THP-induced cardiotoxicity. Isoquercitrin (IQC) is a natural flavonoid with anti-oxidant and anti-apoptosis properties. Thus, the present study aimed to investigate the influence of IQC on preventing the THP-induced cardiotoxicity in vivo and in vitro. Methods: The optimal concentration and time required for IQC to prevent THP-induced cardiomyocyte damage were determined by an MTT assay. The protective effect was further verified in H9c2 and HCM cells using dichlorodihydrofluorescein diacetate fluorescent probes, MitoTracker Red probe, enzyme-linked immunosorbent assay, JC-1 probe, and real time-quantitative polymerase chain reaction (RT-qPCR). Rats were administered THP to establish cardiotoxicity. An electrocardiogram (ECG) was performed, and cardiac hemodynamics, myocardial enzymes, oxidative stress indicators, and hematoxylin-eosin staining were studied. Voltage-dependent anion channel 1 (VDAC1), adenine nucleotide translocase 1 (ANT1), and cyclophilin D (CYPD) were detected by qRT-PCR, and the Phlpp1/AKT/Bcl-2 axis proteins were detected by western blot, confirming that IQC markedly increased cell viability and superoxide dismutase (SOD) levels, diminished the levels of ROS and MDA, and elevated mitochondrial function and apoptosis in vivo and in vitro. Results: Results showed that IQC reduced THP-induced myocardial histopathological injury, electrocardiogram (ECG) abnormalities, and cardiac dysfunction in vivo. IQC also decreased serum levels of MDA, BNP, CK-MB, c-TnT, and LDH, while increasing levels of SOD and GSH. We also found that IQC significantly reduced VDAC1, ANT1, and CYPD mRNA expression. In addition, IQC controlled apoptosis by modulating Phlpp1/AKT/Bcl-2 signaling pathways. IQC markedly increased H9c2 and HCM cell viability and SOD levels, diminished the levels of ROS and MDA, and elevated mitochondrial function in H9c2 and HCM cells to defend against THP-induced cardiomyocyte apoptosis in vitro. The AKT inhibitor IMQ demonstrated that IQC lacked antioxidant and anti-apoptotic properties. Moreover, our data showed that IQC regulates Phlpp1 expression, thereby influencing the expression levels of p-AKT, cytochrome c, caspase-3, caspase-9, Bcl-2, and Bax. Discussion: In conclusion, our results indicate that IQC protects the changes in mitochondrial membrane permeability in cardiomyocytes by regulating the Phlpp1/AKT/Bcl-2 signaling pathway, inhibits the release of cytc from the mitochondrial inner membrane to the cytoplasm, forms apoptotic bodies, induces cell apoptosis, and reduces THP induced cardiotoxicity.

A simple graphene oxide-based DNA purification strategy for plant pathogen detection.

The on-site molecular detection of plant pathogens is particularly important for the development of sustainable agriculture. Extracting DNA from plant tissues, microbes or coexisting environments is complex, labor-intensive and time-consuming. To facilitate this process, we propose a DNA purification strategy based on graphene oxide (GO). The excellent adsorption ability of GO was verified by visualizing changes in its microscopic surface and macroscopic mixture. To further optimize the DNA purification, we determined the optimal GO concentration and treatment time at 95 °C (2 mg mL-1 and 2 min, respectively). We confirmed that our strategy is effective on plant tissues and various microorganisms, and that the obtained DNA can be directly used for polymerase chain reaction amplification. Combining the proposed GO-based DNA purification method with the loop-mediated isothermal amplification method is superior, in terms of the required steps, time, cost and detection effect, to the cetyltrimethylammonium bromide method and a commercial kit for detecting plant pathogens. We present a feasible, rapid, simple and low-cost DNA purification method with high practical value for scientific applications in plant pathogen detection. This strategy can also provide important technical support for future research on plant-microbial microenvironments. © 2024 Society of Chemical Industry.

Reducing Hospital Readmission Risk Using Predictive Analytics

This study highlights the development and application of a predictive analytics system in a Midwestern hospital to assess and manage the risk of patient readmissions within 30 days of discharge. By integrating advanced analytical modeling with electronic health records, the system enables the creation of personalized care plans by accurately predicting patients' readmission risks and the optimal timing for interventions. The results suggest that such models can significantly improve resource allocation and the personalization of care plans, thereby reducing unnecessary readmissions and aligning with value-based, patient-centered healthcare goals.

Time of year and weather influence departure decisions of sandhill cranes at a primary stopover

The Rocky Mountain Population (RMP) of greater sandhill cranes uses a key stopover area, the San Luis Valley (SLV) in Colorado. Parameters of migration phenology can differ between autumn and spring and are affected by weather and environmental factors. We hypothesized that sandhill cranes in the SLV would have a longer stopover duration in autumn than in spring, and that wind assistance, crosswinds, temperature change, barometric air pressure, and surface water area would influence persistence probability. We used data from sandhill cranes fitted with transmitters that spanned autumn and spring, 2015-2022. We used an open robust design mark-recapture model to estimate stopover duration, arrival probability, and persistence probability. We examined the effects of weather and surface water on the persistence probability for 106 sandhill cranes in the SLV. Stopover duration was longer in autumn than in spring and had higher variability across years. Arrival probability to the SLV peaked on 13 October in autumn and 21 February in spring. Persistence probability declined around mid-December in autumn and mid-March in spring. We found that several weather covariates influenced persistence in both seasons. In autumn, sandhill cranes departed the SLV with higher tailwinds, lower crosswinds, and higher surface water availability. In spring, sandhill cranes departed the SLV with lower crosswinds and higher barometric air pressure at the surface and higher wind speeds at altitudes of about 3,000 m. The effect of wind speed was stronger later in the spring. Given the lower variability of arrival and persistence probability and shorter stopover duration in spring compared to autumn, we suspect that RMP sandhill cranes are using a time-minimization strategy during spring. However, given the use of supportive winds and weather conditions ideal for soaring, RMP sandhill cranes appear to be using strategies that save energy in both seasons. Our study identifies the optimal timing of water management and surveys for RMP sandhill cranes and confirms that weather influences their persistence. Understanding differences in migration patterns between seasons and the factors that influence persistence at stopover sites will also be important for anticipating phenological impacts from climate change and land use alterations.

Optimal exercise of American options under time-dependent Ornstein–Uhlenbeck processes

We study the barrier that gives the optimal time to exercise an American option written on a time-dependent Ornstein–Uhlenbeck process, a diffusion often adopted by practitioners to model commodity prices and interest rates. By framing the optimal exercise of the American option as a problem of optimal stopping and relying on probabilistic arguments, we provide a non-linear Volterra-type integral equation characterizing the exercise boundary, develop a novel comparison argument to derive upper and lower bounds for such a boundary, and prove its Lipschitz continuity in any closed interval that excludes the expiration date and, thus, its differentiability almost everywhere. We implement a Picard iteration algorithm to solve the Volterra integral equation and show illustrative examples that shed light on the boundary's dependence on the process's drift and volatility.

Redefining Wound Healing Using Near-Infrared Spectroscopy.

No standard definition for a completely healed wound currently exists; it is recommended that providers use a reliable wound assessment tool to determine healing. The objective of this feasibility study was to determine if a point-of-care, noncontact, near-infrared (NIR) imaging device could provide an objective measure of wound resolution and guide clinical decision-making for the optimal time to transition from protective wound dressings and gradual return to full activity. In this single-center feasibility study, adult patients 18 years and older with a lower extremity wound of any size and etiology were seen weekly for wound assessment and standard-of-care treatment. The researchers performed serial imaging with a point-of-care, noncontact, NIR imaging device (Snapshot NIR ; Kent Imaging Inc) to assess the wound and surrounding skin and evaluated the difference in time to 100% reepithelialization on visual inspection and homogeneous tissue oxygen saturation levels at the wound site and surrounding closed skin envelope. An average time difference of 13.5 ± 10 days (median, 12 days; range, 0-35 days) was observed between 100% reepithelialization on visual wound inspection and imaging assessment. Further, NIR imaging could determine when a patient was at risk for recurrent wound breakdown. The addition of point-of-care, noncontact, NIR imaging may help guide clinical decision-making for the optimal time to transition from protective wound dressings with gradual return to full activity and minimize wound recurrence.

Machine Learning Model for Readmission Prediction of Patients With Heart Failure Based on Electronic Health Records: Protocol for a Quasi-Experimental Study for Impact Assessment.

Care for patients with heart failure (HF) causes a substantial load on health care systems where a prominent challenge is the elevated rate of readmissions within 30 days following initial discharge. Clinical professionals face high levels of uncertainty and subjectivity in the decision-making process on the optimal timing of discharge. Unwanted hospital stays generate costs and cause stress to patients and potentially have an impact on care outcomes. Recent studies have aimed to mitigate the uncertainty by developing and testing risk assessment tools and predictive models to identify patients at risk of readmission, often using novel methods such as machine learning (ML). This study aims to investigate how a developed clinical decision support (CDS) tool alters the decision-making processes of health care professionals in the specific context of discharging patients with HF, and if so, in which ways. Additionally, the aim is to capture the experiences of health care practitioners as they engage with the system's outputs to analyze usability aspects and obtain insights related to future implementation. A quasi-experimental design with randomized crossover assessment will be conducted with health care professionals on HF patients' scenarios in a region located in the South of Sweden. In total, 12 physicians and nurses will be randomized into control and test groups. The groups shall be provided with 20 scenarios of purposefully sampled patients. The clinicians will be asked to take decisions on the next action regarding a patient. The test group will be provided with the 10 scenarios containing patient data from electronic health records and an outcome from an ML-based CDS model on the risk level for readmission of the same patients. The control group will have 10 other scenarios without the CDS model output and containing only the patients' data from electronic medical records. The groups will switch roles for the next 10 scenarios. This study will collect data through interviews and observations. The key outcome measures are decision consistency, decision quality, work efficiency, perceived benefits of using the CDS model, reliability, validity, and confidence in the CDS model outcome, integrability in the routine workflow, ease of use, and intention to use. This study will be carried out in collaboration with Cambio Healthcare Systems. The project is part of the Center for Applied Intelligent Systems Research Health research profile, funded by the Knowledge Foundation (2021-2028). Ethical approval for this study was granted by the Swedish ethical review authority (2022-07287-02). The recruitment process of the clinicians and the patient scenario selection will start in September 2023 and last till March 2024. This study protocol will contribute to the development of future formative evaluation studies to test ML models with clinical professionals. PRR1-10.2196/52744.

Early vs delayed insertion of penile prosthesis in patients with refractory priapism: a systematic review and meta-analysis.

Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking. To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED). We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model. We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group. The results from this study favor an early approach to ED (within 30days) following ischemic priapism. However, it is important to consider patients' preferences, values, and psychological factors to make an informed decision.

Predictive role of the prognostic nutritional index in patients with pancreatic ductal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by curative pancreatic resection: A retrospective study using prospectively collected data.

Despite a strong association between nutritional indices and disease prognosis, evidence regarding the evaluation of nutritional indices after preoperative treatment for pancreatic ductal adenocarcinoma (PDAC) is insufficient. We evaluated the clinical significance of the prognostic nutritional index (PNI) in patients with resectable (R-) and borderline resectable (BR-) PDAC who received neoadjuvant chemoradiotherapy (NACRT) followed by pancreatic resection. We assessed 153 patients with R- and BR-PDAC who underwent NACRT followed by curative resection between 2009 and 2022. We evaluated the association between preoperative PNI after NACRT and short- and long-term outcomes. The median preoperative PNI value after NACRT was 42.1, and the optimal cutoff value from the time-dependent receiver operating characteristic curve was 38.6. The low PNI group (PNI < 38.6, n = 44) exhibited significantly worse inflammatory parameters, surgical outcomes, and prognoses than the high PNI group (PNI ≥ 38.6, n = 109). Multivariate analysis identified preoperative PNI ≤ 38.6 (hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.00-5.38, p = .049), blood loss ≥1642 mL (HR: 3.05, 95% CI: 1.65-5.64, p < .001), node positive pathology (HR: 2.10, 95% CI: 1.32-3.34, p = .002), and lack of postoperative adjuvant chemotherapy (HR: 3.55, 95% CI: 2.05-6.15, p < .001) as significant predictors of overall survival. For patients with R- and BR-PDAC receiving preoperative treatment, it is imperative to closely monitor their nutritional status when determining the optimal surgical procedure timing.

Visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors: A retrospective cohort study.

To investigate the visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors (PitNETs). A retrospective study was conducted on 28 patients who developed evident postoperative hematoma out of a total of 9,010 patients. The hematomas were classified into three types based on their CT appearance. Type 1a - mild high density with no tension, Type 1b - thin-layer high density; Type 2a - solid high density with large empty cavities, Type 2b - solid high density with small empty cavities; Type 3 -solid high density with no cavity showing high tension. Patient data were collected for analysis. The study cohort comprised 10 female and 18 male patients, with a mean age of 51.5±11.9 years. Most patients presented with large adenomas (median diameter 36mm). Postoperative visual sight improved in 12 patients, remained stable in 11 patients, and worsened in 5 patients. Notably, no patients experienced worsened visual sight beyond twenty-four hours after the operation. Among the five patients with visual deterioration, four had CT type 3 hematoma (4/6, 66.7%), and one had CT type 2b hematoma (1/9, 11.1%). Patients in the type 3 CT group were significantly more prone to experience visual deterioration compared to those in the type 2 group (odds ratio [OR] 2.154 [95% CI 1.858-611.014], P=.027). Four patients underwent repeat surgery after visual deterioration, resulting in visual improvement following a prolonged recovery period. Postoperative hematoma had limited impact on pituitary dysfunction and hyponatremia. Our study reveals a significant association between postoperative hematoma CT types and visual deterioration. For patients with stable visual sight and type 1 or 2a hematoma, conservative strategies may be considered. Conversely, type 2b and 3 patients are at higher risk of visual deterioration, especially within the first 24 hours after the operation. Consequently, early reoperation before vision worsens may be a prudent approach to reduce risks and improve visual outcomes, particularly in type 3 patients.