Physiological Status Of Patients Research Articles

Medical image intelligent diagnosis system based on facial emotion recognition and convolutional neural network

The facial emotional information of patients is one of the important indicators of their health status. By combining facial emotion recognition technology, medical imaging intelligent diagnostic systems can more comprehensively understand the psychological and physiological status of patients. This study first selected medical imaging datasets from the publicly available Medical Machine Learning Image Standard database and performed necessary preprocessing, including data cleaning, enhancement, and standardization. Next, a CNN model is constructed to extract key features from medical images and facial expression images through structures such as convolutional layers, activation functions, pooling layers, and fully connected layers. In addition, the system also integrates facial emotion recognition module and medical image analysis module, improving the comprehensiveness of diagnosis through feature fusion. Finally, the diagnostic results are displayed through a user interaction interface. Through comparative experiments, this study verified that the proposed CNN model outperforms traditional LSTM and SVM models in terms of accuracy, recall, and precision. The CNN model has shown significant advantages in medical imaging intelligent diagnosis systems, especially achieving a recall rate of 99%, demonstrating extremely high disease recognition ability. The results of this study not only provide new research directions for the field of intelligent diagnosis in medical imaging, but also lay a solid foundation for future clinical applications.

Medical image intelligent diagnosis system based on facial emotion recognition and convolutional neural network

The facial emotional information of patients is one of the important indicators of their health status. By combining facial emotion recognition technology, medical imaging intelligent diagnostic systems can more comprehensively understand the psychological and physiological status of patients. This study first selected medical imaging datasets from the publicly available Medical Machine Learning Image Standard database and performed necessary preprocessing, including data cleaning, enhancement, and standardization. Next, a CNN model is constructed to extract key features from medical images and facial expression images through structures such as convolutional layers, activation functions, pooling layers, and fully connected layers. In addition, the system also integrates facial emotion recognition module and medical image analysis module, improving the comprehensiveness of diagnosis through feature fusion. Finally, the diagnostic results are displayed through a user interaction interface. Through comparative experiments, this study verified that the proposed CNN model outperforms traditional LSTM and SVM models in terms of accuracy, recall, and precision. The CNN model has shown significant advantages in medical imaging intelligent diagnosis systems, especially achieving a recall rate of 99%, demonstrating extremely high disease recognition ability. The results of this study not only provide new research directions for the field of intelligent diagnosis in medical imaging, but also lay a solid foundation for future clinical applications.

Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?

To investigate the effect of a prehabilitation program on peri- and post-operative outcomes in adult cervical deformity (CD) surgery. Operative CD patients ≥ 18years with complete baseline (BL) and 2-year (2Y) data were stratified by enrollment in a prehabilitation program beginning in 2019. Patients were stratified as having undergone prehabilitation (Prehab+) or not (Prehab-). Differences in pre and post-op factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. 115 patients were included (age: 61years, 70% female, BMI: 28kg/m2). Of these patients, 57 (49%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI, and frailty. Surgically, Prehab+ were able to undergo longer procedures (p = 0.017) with equivalent EBL (p = 0.627), and shorter SICU stay (p < 0.001). Post-operatively, Prehab+ patients reported greater reduction in pain scores and greater improvement in quality of life metrics at both 1Y and 2Y than Prehab- patients (all p < 0.05). Prehab+ patients reported significantly less complications overall, as well as less need for reoperation (all p < 0.05). Introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling patients to undergo longer surgeries with lessened risk of peri- and post-operative complications.

Balancing therapeutic effect and safety in ventilator parameter recommendation: An offline reinforcement learning approach

Reinforcement learning (RL) is increasingly applied in recommending ventilator parameters, yet existing methods prioritize therapeutic effect over patient safety. This leads to excessive exploration by the RL agent, posing risks. To address this, we propose a novel offline RL approach that leverages existing clinical data for exploration, employing fitted Q evaluation (FQE) for policy evaluation to minimize patient risk compared to online evaluation. Our method introduces a variational auto-encoder-gumble softmax (VAE-GS) model, discerning the hidden relationship between patient physiological status and ventilator parameters to constrain the exploratory space of the agent. Additionally, a noise network aids the agent in fully exploring the reachable space to find optimal ventilator parameters. Our approach significantly enhances safety, as evidenced by experiments on the Medical Information Mart for Intensive Care III (MIMIC-III) dataset. It outperforms existing algorithms including the deterministic policy gradient algorithm (DDPG), soft actor-critic (SAC), batch-constrained deep Q-learning (BCQ), conservative Q-learning (CQL), and closed-form policy improvement operators (CFPI), showing improvements of 76.9%, 82.8%, 23.5%, 49.1% and 23.5%, respectively, while maintaining therapeutic effect.

Reducing rate of total colectomies for ulcerative colitis but higher morbidity in the biologic era: an 18-year linked data study from New South Wales Australia.

This study aims to investigate the trends in UC surgery in New South Wales (NSW) at a population level. A retrospective data linkage study of the NSW population was performed. Patients of any age with a diagnosis of UC who underwent a total abdominal colectomy (TAC) ± proctectomy between Jul-2001 and Jun-2019 were included. The age adjusted population rate was calculated using Australian Bureau of Statistics data. Multivariable linear regression modelled the trend of TAC rates, and assessed the effect of infliximab (listed on the Pharmaceutical Benefits Scheme for UC in Apr-2014). A total of 1365 patients underwent a TAC ± proctectomy (mean age 47.0 years (±18.6), 59% Male). Controlling for differences between age groups, the annual rate of UC TACs decreased by 2.4% each year (95% CI 1.4%-3.4%) over the 18-year period from 1.30/100000 (2002) to 0.84/100000 (2019). An additional incremental decrease in the rate of TACs was observed after 2014 (OR 0.83, 95% CI 0.69-1.00). There was no change in the proportion of TACs performed emergently over the study period (OR 1.02, 95% CI 0.998-1.04). The odds of experiencing any perioperative surgical complication (aOR 1.54, 95% CI 1.01-2.33, P = 0.043), and requiring ICU admission (aOR 1.85, 95% CI 1.24-2.76, P = 0.003) significantly increased in 2014-2019 compared to 2002-2007. The rate of TACs for UC has declined over the past two decades. This rate decrease may have been further influenced by the introduction of biologics. Higher rates of complications and ICU admissions in the biologic era may indicate poorer patient physiological status at the time of surgery.

Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review.

Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.

Implementation of Smart Health Monitoring System Using Egde Computing

The last ten years have seen a shift in the healthcare monitoring systems, making them one of the most important systems. Because of a lack of timely medical attention for individuals suffering from various illnesses, humans are struggling with the issue of untimely mortality. The main objective was to create a dependable IoT-based patient monitoring system that would enable healthcare providers to keep track of their patients, whether they are in a hospital or at home, in order to provide better treatment. Sensors, a data collecting unit, and a microprocessor make up the majority of a mobile device-based wireless healthcare monitoring system that was built in order to offer real-time online information about a patient's physiological status. The Internet of Things (IoT), edge computing, cloud computing, and other emerging information technologies have all contributed to the development of smart healthcare. The Internet of Things (IoT) concepts have been widely applied to connect the available medical resources and provide patients with intelligent, dependable, and efficient healthcare. One of the paradigms that can harness the benefits of the IoT to improve the patient's lifestyle is health monitoring for active and supported living. We have introduced an IoT architecture that has been specially designed for healthcare applications in this project. Hence the proposed architecture collects the sensor data through Node MCU microcontroller

Implementation of Smart Health Monitoring System Using Edge Computing

The last ten years have seen a shift in the healthcare monitoring systems, making them one of the most important systems. Because of a lack of timely medical attention for individuals suffering from various illnesses, humans are struggling with the issue of untimely mortality. The main objective was to create a dependable IoT-based patient monitoring system that would enable healthcare providers to keep track of their patients, whether they are in a hospital or at home, in order to provide better treatment. Sensors, a data collecting unit, and a microprocessor make up the majority of a mobile device-based wireless healthcare monitoring system that was built in order to offer real-time online information about a patient's physiological status. The Internet of Things (IoT), edge computing, cloud computing, and other emerging information technologies have all contributed to the development of smart healthcare. The Internet of Things (IoT) concepts have been widely applied to connect the available medical resources and provide patients with intelligent, dependable, and efficient healthcare. One of the paradigms that can harness the benefits of the IoT to improve the patient's lifestyle is health monitoring for active and supported living. We have introduced an IoT architecture that has been specially designed for healthcare applications in this project. Hence the proposed architecture collects the sensor data through Node MCU microcontroller&#x0D;

Combined pelvic and acetabular injuries: clinical features and treatment strategies of a unique injury pattern

BackgroundTo explore the clinical characteristics of patients with unstable pelvic fractures combined with acetabular fractures and to discuss the treatment strategies for such patients to help guide treatment.MethodsWe retrospectively assessed 24 patients admitted to our hospital from June 2018 to June 2022 with unstable pelvic fractures combined with acetabular fractures, including 15 male patients and 9 female patients with a mean age of 44.8 years. According to the Tile pelvic fracture classification, 15 cases were type B, and 9 cases were type C. The acetabular fractures were classified using the Letournel–Judet classification. There were 8 transverse fractures, 4 transverse and posterior wall fractures, 3 anterior and posterior hemitransverse fractures, 6 both-column fractures, 2 T-shaped fractures and 1 anterior column fracture. We recorded the cause of the patient's injury and vital signs on admission and assessed the patient's treatment strategy and prognosis.ResultsAll patients completed the surgery successfully, and the follow-up ranged from 6 to 42 months, with a mean of 23 months. The healing time for pelvic fractures ranged from 11 to 21 weeks, with a mean of 14.8 weeks, and the postoperative displacement of the posterior pelvic ring ranged from 1.2 to 9.0 mm, with a mean of 3.5 mm. The final clinical outcome at follow-up was evaluated using the Majeed scale: excellent in 11 cases, good in 10 cases and fair in 3 cases; the excellent rate was 87.5%. The time to healing of the acetabular fracture ranged from 13 to 25 weeks, with a mean of 15.9 weeks, and the postoperative displacement of the acetabular fracture ranged from 0.6 to 5.2 mm, with a mean of 1.9 mm. Hip function was assessed at the final follow-up using a modified Merle D’ Aubigné and Postel scale: there were 9 excellent, 11 good and 4 acceptable scores; an excellent rate of 83.3% was achieved.ConclusionPatients with unstable pelvic fractures combined with acetabular fractures suffer severe trauma and complex mechanisms of injury. Treatment needs to be individualized, taking into account the patient's physiological status, fracture classification and degree of displacement.

Implication of American Society of Anesthesiologists Physical Status (ASA-PS) on tonsillectomy with or without adenoidectomy outcomes

BackgroundThe American Society of Anesthesiologists Physical status classification (ASA-PS) is a simple categorization of a patient's physiological status during the perioperative period. The role of ASA-PS in predicting operative risk and complications following tonsillectomy with or without adenoidectomy (T ± A) has not been studied. The objective of the study was to identify the association of the pre-operative ASA-PS with 30-day complication rates and adverse events following T ± A. Study designA retrospective analysis was performed using data from the American College of Surgeons' National Surgical Quality Improvement Program database (ACS NSQIP) of patients aged 16 years or older who underwent T ± A between 2005 and 2016. Patients were stratified into ASA-PS Classes I/II and III/IV. Patient demographics, preoperative comorbidities, pre-operative laboratory values, operation-specific variables, and postoperative outcomes in the 30-day period following surgery were compared between the two subsets of ASA-PS groups. ResultsOn multivariate analysis, patients with ASA class III and IV were more likely to experience an unplanned readmission (OR 1.39, 95 % CI 1.09–1.76; p = 0.007), overall complications (OR 1.49, 95 % CI 1.28–1.72; p < 0.001), major complications (OR 1.52, 95 % CI 1.31–1.77, p ≤ 0.001), reoperation (OR 1.33, 95 % CI 1.04–1.69; p = 0.022), and extended length of stay >1 day (OR 1.78, 95 % CI 1.41–2.25; p < 0.001) following a T ± A. ConclusionHigher ASA-PS classification is an independent predictor of complications following T ± A. Surgeons should aim to optimize the systemic medical conditions of ASA-PS classes III and IV patients prior to T ± A and implement post-operative management protocols specific to these patients to decrease morbidity, complications, and overall health care cost.

Combining nutritional status with TNM stage: a physiological update on gastric cancer staging for improving prognostic accuracy in elderly patients.

The tumor-node-metastasis (TNM) staging system does not take the patient's physiological status into consideration, reportedly making it insufficient for predicting survival outcomes in frail cancer patients. We assessed the prognostic values of several nutrition- and inflammation-based markers in combination with pTNM stage in gastric carcinoma (GC) patients. In total, 1166 patients undergoing GC surgery were studied. The prognostic capabilities of 3 nutritional and 3 systemic inflammatory parameters were examined. We developed new staging systems by adding these markers, individually, to the pTNM stage. We then compared the prognostic capabilities of our new systems with that of pTNM stage alone. We also assessed the prognostic values of these systems by dividing our patient cohort into elderly (≥ 65years) and non-elderly groups. Our novel staging systems had greater predictive capabilities for overall survival (OS) than pTNM alone. Most notably, survival discrimination was significantly increased for pTNM when it was combined with albumin-based nutritional indices (geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI)). Our new staging systems incorporating GNRI or PNI into pTNM had significantly better predictive capability for OS, especially non-GC mortality, than pTNM alone in elderly GC patients. In the non-elderly patients, the predictive capabilities of the new staging systems for OS differed minimally from that of pTNM. The predictive capability of pTNM stage was particularly enhanced when this parameter was combined with nutritional markers. Our new approach aids in predicting survival outcomes, especially non-GC-related death, in elderly GC patients.

P63. Assessing the effects of prehabilitation protocols on postoperative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?

BACKGROUND CONTEXT Previous studies have demonstrated that preoperative rehabilitation (prehab) may be beneficial in adult cervical deformity surgery. Though protocols vary widely, general overlap exists in terms of inclusion of mental and physical modalities in order to optimize patient outcomes. However, there remains a paucity of literature in regards to assessing outcomes in a controlled setting. PURPOSE To assess the effects of prehabilitation on peri- and postoperative outcomes in adult cervical deformity surgery. STUDY DESIGN/SETTING Retrospective review of prospective CD database. PATIENT SAMPLE A total of 290 CD patients. OUTCOME MEASURES Peri- and postoperative complication rates; medication usage; HRQLs. METHODS Operative CD patients 18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in prehabilitation protocols beginning in 2019, consisting of physical therapy, nutritional counseling and/or psychological counseling. Patients were stratified as having underwent prehabilitation (Prehab+), versus those who did not (Prehab-). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors and complication rates were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated via NDI mapped to SF6D using validated methods. RESULTS A total of 115 patients were included (56.37±8.90 years, 38% female, 29.84±6.19 kg/m2). Of these patients, 57 (49.6%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI and frailty. In terms of BL HRQLs, Prehab+ significantly lower mJOA scores (p=.047), though were equivalent in NDI and EQ5D scores (both p>.05). Baseline opioid usage was comparable prior to prehab enrollment (p=.093). Surgically, Prehab+ were able to undergo longer procedures (p=.017) with equivalent EBL (p=.627), and shorter SICU stay (p.05) and QALYs gained by 2Y (.43 vs .40, p>.05). CONCLUSIONS This study demonstrates that introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling them to undergo longer surgeries with lessened risk of peri- and postoperative complications. Though cost-effectiveness of such programs should be further assessed, prehabilitation should be considered for eligible patients to assist in optimizing recovery and reducing complications or reoperations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Previous studies have demonstrated that preoperative rehabilitation (prehab) may be beneficial in adult cervical deformity surgery. Though protocols vary widely, general overlap exists in terms of inclusion of mental and physical modalities in order to optimize patient outcomes. However, there remains a paucity of literature in regards to assessing outcomes in a controlled setting. To assess the effects of prehabilitation on peri- and postoperative outcomes in adult cervical deformity surgery. Retrospective review of prospective CD database. A total of 290 CD patients. Peri- and postoperative complication rates; medication usage; HRQLs. Operative CD patients 18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in prehabilitation protocols beginning in 2019, consisting of physical therapy, nutritional counseling and/or psychological counseling. Patients were stratified as having underwent prehabilitation (Prehab+), versus those who did not (Prehab-). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors and complication rates were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated via NDI mapped to SF6D using validated methods. A total of 115 patients were included (56.37±8.90 years, 38% female, 29.84±6.19 kg/m2). Of these patients, 57 (49.6%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI and frailty. In terms of BL HRQLs, Prehab+ significantly lower mJOA scores (p=.047), though were equivalent in NDI and EQ5D scores (both p>.05). Baseline opioid usage was comparable prior to prehab enrollment (p=.093). Surgically, Prehab+ were able to undergo longer procedures (p=.017) with equivalent EBL (p=.627), and shorter SICU stay (p.05) and QALYs gained by 2Y (.43 vs .40, p>.05). This study demonstrates that introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling them to undergo longer surgeries with lessened risk of peri- and postoperative complications. Though cost-effectiveness of such programs should be further assessed, prehabilitation should be considered for eligible patients to assist in optimizing recovery and reducing complications or reoperations.

Pharmacokinetic profiles of antifungal drugs during extracorporeal membrane oxygenation life support

Extracorporeal membrane oxygenation (ECMO), a kind of life support technology that can replace lung and heart function, is widely used in critical respiratory and circulatory exhaustion. Because of the serious diseases and the use of interventional catheters, patients receiving ECMO life support are often administrated with broad-spectrum antimicrobial agents, which increase the risk of fungal infection. Fungal infection during ECMO can increase mortality. How to effectively control fungal infection is a thorny problem faced by clinicians. During the treatment of ECMO, the patient's physiological status, ECMO oxygenation membrane, circulation pipeline and other factors may change the pharmacokinetic profiles of antifungal drugs, thereby affect the clinical efficacy of drugs. This artical reviews the pharmacokinetic characteristics of antifungal drugs during ECMO support, in order to provide references for clinical antifungal treatment.

Preoperative geriatric assessment, a promising tool to improve outcomes in aortic pathology interventions.

Due to population aging and the spread of endovascular techniques for aortic diseases, there has been an increase in older population intervened. Objectively assessing patient's global status becomes mandatory in advanced ages, as impaired functional status and frailty are associated with higher postoperative mortality rates. The aim of this paper is to evaluate the impact of a systematic geriatric preoperative assessment on the outcomes of aortic interventions. All patients above 60 years old with surgical indication for aortic disease between September 2016 and May 2019 underwent a standardized geriatric assessment. It analyzed physiological reserve, frailty, and life expectancy. An algorithm was created for its application before intervention indication. Variables registered were patient's data, type of aortic disease, type of intervention, geriatric assessment result, mortality and follow-up time. A bivariate analysis was performed. One hundred forty-four patients were included. Geriatric report was unfavorable for intervention in 6.25% (N.=9). From these, 88% (N.=8) were finally rejected for intervention. In those undergoing aortic intervention (N.=127) there was a 7% mortality rate (N.=9) and in the no-intervention group (N.=17) mortality rate raised up to 35% (N.=6). No aortic-related mortality was reported. A relevant association between an unfavorable geriatric report and mortality was found "OR 0.036 (CI 0.0082-0.155)." A protective relationship between any aortic intervention and mortality was found, with OR 0.139 (CI 0.043-0.447). Geriatric assessment is a valid tool to estimate life expectancy and patient's physiological status. An unfavorable report correlates with short-term non-aortic mortality independently of undergoing intervention. This has a high clinical relevance, and it highlights its practical applicability to improve aortic surgery indication's quality and optimize resource investment.

A predictor of outcome following head injury: A retrospective study

Background: Head injuries are a major cause of death and disability because of trauma, it happed in many countries of the world. The case of head injuries in the Emergency department, need immediate managing to victim to prevent further complications. The Nurses required to assess and recognize abnormality as soon as possible and further management of the victim to save their life. Through the physiological status. The patient's physiological status is the best way to recognize the prognosis, such as GCS, systolic blood pressure, respiratory rate, body temperature, and blood glucose levels while admitted to emergency ward.Purpose: To analyze and determine (simultaneously) a predicting factor the most dominant influencing significantly of outcome following head injuryMethods: A retrospective approach by analyze patient's medical records on January-December period in 2018 at H. Adam Malik General Hospital Medan. The study sample comprised 166 medical records which taken by purposive sampling technique with the following criteria: new admission (not referral), there were available data such GCS data, systolic blood pressure, respiratory rate, body temperature, blood glucose levels within 7 days under treatment.Results: Logistic regression test found that GSC (p 0.000; OR 2.583), systolic blood pressure (p 0.024; OR 0.947), and blood sugar levels (0.038; OR 0.982) had a significant effect on the mortality. The nurse must pay attention in handling patient head injuries who have a lower GCS scores and systolic blood pressure, following by high blood sugar levels.Conclusion: By evaluation of GCS, systolic blood pressure and blood sugar levels can predict the patient's current condition. The lower the GCS score, the higher the risk of death by 2.583 times and the lower the systolic blood pressure, the greater the risk of mortality by 0.947 times. The higher the blood sugar level, the risk of death increased by 0.982 times.

Portable Sensor System for Registration, Processing and Mathematical Analysis of PPG Signals

This article introduces an integrated photoplethysmographic (PPG) based cardiovascular monitoring system that consists of an individually portable PPG device for recording photoplethysmographic signals and a software system with a serverless architecture for processing, storing, and analyzing the obtained signals. The portable device uses the optical plethysmography technique for measuring blood volume in blood vessels. The device was tested and validated by a comparative analysis of three photoplethysmographic signals and one Electrocardiographic signal registered simultaneously in the target subject. The comparative analysis of these signals shows insignificant deviations in the obtained results, with the mean squared error between the studied signals being less than 21 ms. This deviation cannot affect the results that were obtained from the analysis of the interval series tested. Based on this result, we assume that the detected signals with the proposed device are realistic. The designed software system processes the registered data, performs preprocessing, determines the pulse rate variability, and performs mathematical analysis of PP intervals. Two groups of subjects were studied: 42 patients with arrhythmia and 40 healthy controls. Mathematical methods for data analysis in time and frequency domain and nonlinear methods (Poincaré plots, Rescaled Range Plot, Detrended Fluctuation Analysis, and MultiFractal Detrended Fluctuation Analysis) are applied. The obtained results are presented in tabular form and some of them in graphical form. The parameters studied in the time and frequency domain, as well as with the nonlinear methods, have statistical significance (p &lt; 0.05) and they can distinguish between the two studied groups. Visual analysis of PP intervals, based on Poincare’s nonlinear method, provides important information on the physiological status of patients, allowing for one to see at a glance the entire PP interval series and quickly detect cardiovascular disorders, if any. The photoplethysmographic data of healthy individuals and patients diagnosed with arrhythmia were recorded, processed, and examined through the system under the guidance of a cardiologist. The results were analyzed and it was concluded that this system could serve to monitor patients with cardiovascular diseases and, when the condition worsens, a signal could be generated and sent to the hospital for undertaking immediate measures to stabilize patient’s health.

Adverse Events During Intrahospital Transport of Critically Ill Children: A Systematic Review.

Intrahospital transport of a critically ill patient is often required to achieve a diagnostic and/or therapeutic objective. However, clinicians who recommend a procedure that requires transport are often not fully aware of the risks of transport. Clinicians involved in the care of critically ill children may therefore benefit from a clear enumeration of adverse events that have occurred during transport, risk factors for those events, and guidance for event prevention. The objective of this review was to collect all published harm and adverse events that occurred in critically ill children in the context of transport within a medical center, as well as the incidence of each type of event. A secondary objective was to identify what interventions have been previously studied that reduce events and to collect recommendations for harm prevention from study authors. Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and CINAHL were searched in January 2018 and again in December 2018. Terms indicating pediatric patients, intrahospital transport, critical illness, and adverse events were used. Titles and abstracts were screened and full text was reviewed for any article meeting inclusion criteria. If articles included both children and adults, incidence data were collected only if the number of pediatric patients could be ascertained. Of 471 full-text articles reviewed, 40 met inclusion criteria, of which 24 included only children, totaling 4104 patient transports. Heterogeneity was high, owing to a wide range of populations, settings, data collection methods, and outcomes. The incidence of adverse events varied widely between studies. Examples of harm included emergent tracheostomy, pneumothorax, and cardiac arrest requiring chest compressions. Respiratory and airway events were the most common type of adverse event. Hypothermia was common in infants. One transport-associated death was reported. When causation was assessed, most events were judged to have been preventable or potentially mitigated by improved double-checks and usage of checklists. Prospective studies demonstrated the superiority of mechanical ventilation over manual ventilation for intubated patients. Risk of adverse events during critical care transport appears to relate to the patient's underlying illness and degree of respiratory support. Recommendations for reducing these adverse events have frequently included the use of checklists. Other recommendations include optimization of the patient's physiological status before transport, training with transport equipment, double-checking of equipment before transport, and having experienced clinicians accompany the patient. All available recommendations for reducing transport-associated adverse events in included articles were collated and included.

Molecular Genetic Markers of Senescence: Current State of the Problem and Prospects for Development

According to the postulates in biology and medicine, an irreversible violation of any of the elements of a functional system inevitably leads to senescence and destruction of its entire integrity. At the same time, the phenotypic manifestation of the final stages of degradation is similar and due to the peculiarities of the structural and functional organization of living species. Based on this, the established list of symptoms describing age-related changes in the human body is currently applied in medical practice, which allows determining both the physiological status of patients and the development of necessary therapeutic measures. At the same time, the use of any universal approach to diagnose the occurrence and genesis of the processes of senescence is ineffective, which is associated with a wide range of factors and mechanisms causing this type of pathogenetic disorders. For this reason, for many decades, one of the main tasks of gerontology has been a comprehensive analysis of the process of senescence. The result of such large-scale studies was the emergence of a significant number of theories explaining the causes and mechanisms of aging. This review considers a number of theories of aging that have received extensive experimental confirmation and recognition in world practice: free-radical, telomeric, apoptotic, and genetic.

PB1665 TREATMENT OF FAVORABLE RISK YOUNG PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) USING A LOW‐DENSE/ LOW‐INTENSE CHEMOTHERAPY PROTOCOL

Background:ALL is a disease affecting the lifespan from neonates to elderly, however, overall survival reaches 90% using pediatric protocols. In older patients, survival is still very poor reaching only 45% which can be attributed to several reasons including heterogeneity of biology, physiologic status of patients as well as therapeutic approach. Another factor justifying the poor outcome is the low rate of enrollment in clinical trials of this population aged between 15‐39 years as defined by the National Cancer Institute (NCI).Aims:the study evaluates the response rate, progression free survival (PFS) and overall survival at % years (OS) as well as the safety profile.Methods:this is a multicenter study performed in part at Al Bairouni university cancer center, Al Mwasat charity and Ospedale Italiano in Damascus, Syria between 2008 and 2013 where we recruited 224 patients having a favorable risk ALL confirmed by Bone Marrow aspiration (morphologic study, Flocytometeric study and Karyotype) was performed in all patients. Induction with (Dxorubicin 45 mg/m2+ Cyclophosphamide 75 mg/m2+ Vincristin 1.4 mg/m2) every weeks X 4 weeks and prednisolone 1 mg/kg for 4 weeks. Complete responders consolidated with 1st block: Cyclophosphamide 75 mg/m2+ Cytarabine 30 mg/m2 BID/SC for 5 days+ 6‐Mercaptopurine 75 mg/m2 every day repeated every 14 days 4 times followed by a 2nd block: Methotrexate 3 gram/m2+ Kidrolase 10000IU repeated every 14 days for 4 times. Maintenance with cyclophosphamide 750 mg/m2+ Vincristin 1.4 mg/m2+ oral Methotrexate 15 mg + 6‐Mercaptopurine daily, repeated every month for 24 times. Intralthecal prophylaxis with Methotrexate as performed 2 times in the induction, with every consoloidation and every 3 month during maintenance.Results:complete remission in the first induction was seen in 185 patients (82.5%) with other 32 joined them after an extra induction round (96.8%). Only 8 patients progressed in the consolidation period versus 10 in the maintenance with a PFS of 88.9% at 5 years and 202 patients still surviving after 5 years with an overall survival rate of (90.17%). We have lost 4 patients in the induction and 2 in the consolidation due to unusual toxicity profile of Methotrexate, however, other toxicities were manageable. Response was more prominent in younger population (those younger than 22) (p value 0.003) and late in those with Philadelphia positive disease (p value 0.02).Summary/Conclusion:ALL is still a lethal disease especially in those who do not respond well to induction protocols. Progress was made during the last decade in both understanding the biology and employment of new treatment approach especially in pediatric population, however, results are still poor in elderly patients. Our study shows good results compared with published data which could be adopted in the light of other trials conducted to test our results.

Cardiac Rehabilitation in Wellington: Influence of a Comprehensive Exercise-Based 12-week Course on Key Indicators (2017–2019)

Background: Cardiac rehabilitation (CR) programs are delivered in various ways throughout New Zealand. HeartWorks aligns with current international World Health Organization guidelines for CR. The presented study evaluated the outcomes of a 12-week CR program on key indicators. Method: Patients participating in HeartWorks CR from the 1 January 2017 to 1 January 2019 were prospectively enrolled. Entry assessment criteria for rehabilitation included key indicators that were measured throughout the program. Generally, referrals were made by either a Cardiologist or General Practitioner. Results: Sixty-six patients started the HeartWorks CR program and 10.6% failed to complete; 18% of all patients were female; median age was 59 years (IQR, 51–68). Main indications were coronary disease (64%), heart failure (18%), and arrhythmias (11%). Participants completed an average of 42 exercise sessions (IQR, 24–57). After the 12-week CR program, left ventricular ejection fraction increased by 7.5% (p = 0.007), systolic blood pressure dropped by 8.4 mmHg (p < 0.0001), with further significant changes in weight, flexibility, Hospital Anxiety and Depression Scale, and VO2 submax (all p < 0.01). Women achieved a significantly higher increase in VO2 submax (change, 16 vs 9.5 mL/min/kg; p = 0.003). Conclusion: While the data are largely descriptive and lack a control group, they confirm the effectiveness of an advanced CR protocol through a range of indicators. Findings were consistent throughout indication groups. Reporting and comprehensive documentation of improvements and changes in patient physiological status are highly valuable for quality patient care. Overall, the health benefits of completing a comprehensive 12-week exercise-based cardiac rehabilitation program showed positive outcomes across the majority of measured points.