Poor Status Research Articles

Radiomics-Based Prediction of Collateral Status from CT Angiography of Patients Following a Large Vessel Occlusion Stroke.

A major driver of individual variation in long-term outcomes following a large vessel occlusion (LVO) stroke is the degree of collateral arterial circulation. We aimed to develop and evaluate machine-learning models that quantify LVO collateral status using admission computed tomography angiography (CTA) radiomics. We extracted 1116 radiomic features from the anterior circulation territories from admission CTAs of 600 patients experiencing an acute LVO stroke. We trained and validated multiple machine-learning models for the prediction of collateral status based on consensus from two neuroradiologists as ground truth. Models were first trained to predict (1) good vs. intermediate or poor, or (2) good vs. intermediate or poor collateral status. Then, model predictions were combined to determine a three-tier collateral score (good, intermediate, or poor). We used the receiver operating characteristics area under the curve (AUC) to evaluate prediction accuracy. We included 499 patients in training and 101 in an independent test cohort. The best-performing models achieved an averaged cross-validation AUC of 0.80 ± 0.05 for poor vs. intermediate/good collateral and 0.69 ± 0.05 for good vs. intermediate/poor, and AUC = 0.77 (0.67-0.87) and AUC = 0.78 (0.70-0.90) in the independent test cohort, respectively. The collateral scores predicted by the radiomics model were correlated with (rho = 0.45, p = 0.002) and were independent predictors of 3-month clinical outcome (p = 0.018) in the independent test cohort. Automated tools for the assessment of collateral status from admission CTA-such as the radiomics models described here-can generate clinically relevant and reproducible collateral scores to facilitate a timely treatment triage in patients experiencing an acute LVO stroke.

Effect of sulfate on the osmoregulatory and physio-biochemical responses of GIFT (Oreochromis niloticus) juveniles reared in potassium-deficient medium saline waters.

The inland saline waters were continuously observed to have low potassium concentrations compared to their seawater counterpart of the same salinity. We hypothesize that the toxic effect of sulfate may manifest in low potassium saline (LPSW) waters compared to brackish water of the same salinity. Thus, LC50 trials were performed in GIFT (genetically improved farmed tilapia) fry (0.5 ± 0.02 g) to determine the acute sulfate toxicity in freshwater (FW, 0.5 g L-1), artificial seawater (ASW, 10 g L-1), and LPSW (10 g L-1). The median lethal concentrations (96h LC50) of sulfate ion in FW, LPSW, and ASW for the GIFT were 5.30 g L-1, 2.56 g L-1, and 2.98 g L-1, respectively. A second experiment was conducted for 21 days, exposing fish to a sub-lethal level of sulfate ion (SO42-) concentration (1000 mg L-1, one-fifth of FW LC50) with different types of waters (FW, freshwater, 0.5 g L-1; ASW, artificial seawater, 10 g L-1; LPSW, low potassium saline water, 10 g L-1) with and without sulfate inclusion to constitute the treatments as follows, (FW, FW + SO4, ASW, ASW + SO4, LPSW, LPSW + SO4). The effect of sulfate on GIFT reared in sulfate-rich potassium-deficient medium saline water was evaluated by focusing on the hematological adjustments, stress-induced oxidative damage, and osmoregulatory imbalances. The survival was not altered due to the sulfate concentration and K+ deficiency; however, there were significant changes in branchial NKA (Na+/K+-ATPase) activity and osmolality. The increase in NKA was highest in LPSW treatment, suggesting that internal ionic imbalance was triggered due to an interactive effect of sulfate and K+ deficiency. The cortisol levels showed a pronounced increase due to sulfate inclusion irrespective of K+ deficiency. The antioxidant enzymes, i.e., SOD (superoxide dismutase), catalase, GST (glutathione-S-transferase), and GPX (glutathione peroxidase), reflected a similar pattern of increment in the gills and liver of the LPSW + SO4 groups, suggesting a poor antioxidant status of the exposed group. The hepatic peroxidation status, i.e. TBARS (thiobarbituric acid reactive substances), and the peroxide values were enhanced due to both K+ deficiency and sulfate inclusion, suggesting a possible lipid peroxidation in the liver due to handling the excess sulfate anion concentration. The hematological parameters, including haemoglobin, total erythrocyte count, and hematocrit level, reduced significantly in the LPSW + SO4 group, indicating a reduced blood oxygen capacity due to the sulfate exposure and water potassium deficiency. The hepatic acetylcholine esterase activity was suppressed in all the treatments with sulfate inclusion, while the highest suppression was observed in the LPSW + SO4 group. Thus, it is concluded that sulfate-induced physiological imbalances manifest more in potassium-deficient water, indicating that environmental sulfate is more detrimental to inland saline water than freshwater or brackish water of the same salinity.

Embolization of an Intracranial Vertebral Artery Aneurysm via the Deep Cervical Artery.

Treatment of vertebral artery aneurysms can be challenging due to the unusual vascular anatomy or unfeasibility of traditional endovascular techniques. We describe a novel approach for endovascular treatment of a ruptured intracranial vertebral artery aneurysm with bilateral vertebral artery occlusions and hypoplasia of the posterior communicating arteries. Successful coil embolization was performed using a collateral pathway for microcatheterization via anastomosis between the deep cervical artery and the vertebral artery. This case report highlights a novel alternative endovascular treatment approach for vertebrobasilar aneurysms in case of a poor vascular status with occlusion or lack of traditional endovascular access routes.

INTEGRATED USE OF PSB AND ORGANIC FERTILIZERS TO IMPROVE YIELD AND QUALITY OF BELL PEPPER (Capsicum Annum L.) CV. GREEN WONDER

Bell pepper is an important Solanaceous crop that is cultivated all around the globe for its economical and nutritional value. In Pakistan, it is cultivated mainly in Sindh and Punjab province of Pakistan. However, average yield ha-1 is quite low as compared to the rest of the world. One of the main reasons for this low yield is poor phosphorous status. The current study was conducted to estimate the effects of organic application combined with PSB biofertilizers (Phosphorus Solubilizing Bacteria) on growth and yield of bell pepper. Organic amendments included leaf compost (LC), farmyard manure (FYM) and poultry manure (PM). Bell pepper cultivar “Green Wonder” was used as test crop. FYM and PM showed better results as compared to LC in most of the measured parameters. Plant height in FYM and PM was 59.79 and 59.07 cm while PSB application produced 67.84 cm high plants. Maximum leaf area was 176.98 cm2 that for FYM and was further increased up to 204.43 cm2 when supplemented with PSB. Bell pepper yield was also maximum in FYM i.e. 1211.7 g while PM showed a value of 1077.6. g. However, when PSB was applied in combination with these treatments, yield plant-1 was further increased up to 1393.4 and 1227.6 g, respectively. Total soluble solids were statistically at par among all the organic amendments but higher than control. Ascorbic acid was maximum in PM (58 mg 100 g-1) and followed by FYM (55.53 mg 100 g-1). PSB application showed a value of 72.46 mg 100 g-1. It is recommended from these results that application of organic amendments and PSB should be practiced enhancing that yield and quality of bell pepper.

Factors associated with inadequate dietary diversity among adolescent girls in Hurumu Woreda High School, Oromia Region, Southwest Ethiopia.

Inadequate diet among adolescent girls leads to anatomical and physiological disturbances which will contribute to the vicious intergenerational cycle of malnutrition. However, only a few studies are available in Ethiopia on dietary diversity among adolescent girls who are attending school. The objective of this study is to assess factors associated with inadequate dietary diversity among high school adolescent girls in Hurumu Woreda, Southwest Ethiopia, 2022. An institution-based cross-sectional study was conducted among 374 high school adolescent girls from 3 May 2022 to 12 June 2022 and selected by using simple random sampling techniques. Data were collected through face-to-face interviews using structured questionnaires. Epi-data version 4.6.0 was used to enter the data, which were then exported to SPSS version 26 for analysis. Simple binary and multivariable logistic regressions were performed to identify factors associated with inadequate dietary diversity. In this study, the magnitude of inadequate dietary diversity among adolescent girls was 62.6% [95% CI: 57.5-66.5]. Living with more than five family members (AOR = 1.8, 95% CI: 1.16-3.44), consumption of sweet foods/beverages (AOR = 2.2, 95% CI: 1.07-3.41), poor nutritional knowledge (AOR = 2.5, 95% CI: 1.48-3.89), and poor household wealth tercile (AOR = 2.8, 95% CI: 1.44-5.12) were significantly associated with inadequate dietary diversity. Living with more than five family members, poor household wealth status, consumption of sweet foods/beverages, family size, and poor nutritional knowledge were factors significantly associated with inadequate dietary diversity. Hence, nutrition education, the use of family planning methods, and securing income-generating activities should be implemented.

Oral Health and Lifestyle Factors in Rural Adults of Jharkhand, India.

There is a lack of health care facilities and poor oral health awareness among the rural adult population of Jharkhand which may significantly influence oral health status and lifestyle scores. To assess the oral hygiene status, lifestyle factors, and various risk factors associated with poor lifestyle scores in the rural adult population of Jharkhand. This cross-sectional study included 400 rural adults (35-44 years) populations. Face-to-face interviews were used to collect sociodemographic data and data on oral hygiene practices. Lifestyle factors were assessed using Health Practice Index (HPI). Oral health status was assessed using the oral health assessment proforma provided by the World Health Organization (WHO). A significantly higher (p value < 0.0001) prevalence of tobacco consumption was reported by males (94.0%) compared to females (4.0%). The males (54.0%) reported significantly higher (p value < 0.0001) poor lifestyle scores compared to females (38.0%). A significantly higher (p value < 0.0001) number of oromucosal lesions (13.0%) was found in males compared to females (1.0%). There was a significant difference (p value < 0.0001) in the oral hygiene status between males and females with majority of males (60.0%) having poor oral hygiene. A bivariate analysis was performed, and unadjusted odds ratio was computed. The factors that became significant were then entered into logistic regression model (enter method). The results of logistic regression analysis showed that education (OR = 0.3, p value = 0.003), systemic diseases/long-term medication (OR = 2.9, p value = 0.004), tobacco consumption (OR = 2.9, p value = 0.006), oral hygiene status (OR = 2.4, p value = 0.007), and dental caries (OR = 2.9, p value = 0.004) were significant predictors of poor lifestyle scores. The rural adult population in Jharkhand has poor oral hygiene status and poor lifestyle scores. It is important to raise awareness regarding good oral hygiene and the negative effects of tobacco consumption. The dental visit should be encouraged, and the concept of preventive care needs to be instilled.

Perceived Barriers to the Adoption of Climate Smart Adaptive Livelihood Technology by the Farmers in Flood Prone Areas of Assam

Flood is an annual major natural disaster of Assam. It causes a huge loss to human, animal, crop, infrastructures and natural resources. Since agriculture is the prime source of livelihood and majority of inhabitants resides in rural areas, the impact of flood has a vital role in the living conditions of Assam’s population. In the present study different kinds of barriers were identified which found to create resistance in the resilience building by the farmers in the studied area. Here the Garrett’s ranking technique was used to rank the barriers associated with the resilience building by the farmers in the study area. The problem of limited skills upon climate smart adaptive livelihood technology (CSALT) got the highest mean score of 65.55 and ranked 1st among all the identified problems. However, the last rank was given to the problem of limited resources with farmers to invest in CSALT having mean score 44.44. It was seen that after the extension problem the other key problems in descending order of value were economic problem such as unavailability of quality seeds and planting materials at right time, unavailability of labour in vital period of farming, in addition to which higher wage and lack of post harvest technologies and marketing facilities were also observed along with communication and information problems and socio-personal problem. Moreover reluctance to take up new project due to deprived risk taking ability, lack of awareness and skill on advanced farming technologies, lack of interest in cultivation due to poor return in short term with poor educational status of the farmers were some of the observed barriers.

Modic Changes in the Lumbar Spine: Exploring Their Association with Abdominal Aortic Calcification as a Potential Indicator of Systemic Atherosclerosis

Study DesignCross-sectional study on the correlation between abdominal aortic calcification (AAC) and Modic changes (MC). ObjectiveTo investigate whether AAC, a marker for a poor vascular status, is associated with MC in patients suffering from degenerative disc disease. Summary of Background DataLittle is known regarding the etiology of MC in the lumbar spine. Currently, insufficient vascularization of the endplate has been proposed to contribute to the appearance of MC. MethodsRadiological images of patients (n=130) suffering from degenerative lumbar disc disease were reviewed. Type and severity of MC were assessed using MR images, and severity of AAC was evaluated using CT images or fluoroscopy. Both items were dichotomized into minimal and relevant grades. The correlation between them was studied using Spearman’s correlation test, with age as a covariate. ResultsOf the patients, 113 (87%) demonstrated MC (31% type I, 63% type II, and 6% type III) (55% relevant grade), and 68% had AAC (44% relevant grade). Spearman statistical analysis revealed that AAC was correlated with age (p<0.001), whereas MC were not (p=0.142). AAC severity was significantly correlated with MC, remaining so after age adjustment (p<0.05). While MC type I lacked correlation with AAC, MC type II were significantly correlated with AAC (0.288, P=0.015); however, this association lost significance after adjusting for age (P=0.057). ConclusionAAC and MC (mainly MC type II) are associated, indicating that reduced blood supply or even a poor systemic vascularization status due to atherosclerotic disease may play a role in the formation of MC. Future studies focusing on the etiology of MC should pay more attention to patients’ vascular status and determinants of abdominal aorta calcification.

Determinants of diabetic nephropathy among diabetic patients in Ethiopia: Systematic review and meta-analysis.

Diabetic nephropathy (DN) is a long-term kidney disease among diabetic patients. It is the leading cause of end-stage renal failure. In Ethiopia, DN affects the majority of diabetic populations, but there were inconsistent findings about the determinant factors across the studies. We have accessed studies using PubMed, Embase, EBSCO, Web of Science, OVID, and search engines including Google and Google Scholar published up to June 2023. The study populations were diabetic patients with nephropathy. The quality of each included article was assessed using the Newcastle-Ottawa quality assessment scale. The odds ratios of risk factors were pooled using a random-effect meta-analysis model. Heterogeneity was assessed using the Cochrane Q statistics and I-Square (I2). The publication bias was detected using the funnel plot and/or Egger's test (p< 0.05). Trim and fill analysis was carried out to treat the publication bias. The protocol has been registered with the reference number CRD42023434547. A total of sixteen articles were used for this reviewed study. Of which, eleven articles were used for advanced age, ten articles for duration of diabetic illness, ten articles for poor glycemic control, and eleven articles for having co-morbid hypertension. Diabetic patients with advanced age (AOR = 1.11, 95% CI: 1.03-120, I2 = 0.0%, p = 0.488), longer duration of diabetic illness (AOR = 1.23, 95% CI = 1.05-1.45, I2 = 0.0%, p = 0.567), poor glycemic control (AOR = 2.57, 95% CI: 1.07-6.14; I2 = 0.0%, p = 0.996), and having co-morbid hypertension (AOR = 4.03, 95% CI: 2.00-8.12, I2 = 0.0%, p = 0.964) were found to be factors associated with DN. The findings of the study revealed that diabetic patients with advanced age, longer duration of diabetic illness, poor glycemic control status, and co-morbid hypertension were the determinant factors of DN. Therefore, treatment of co-morbid hypertension and high blood glucose and regular screening of renal function should be implemented to detect, treat, and reduce the progression of DN. Furthermore, healthcare workers should give due attention to diabetes with advanced age and a longer duration of diabetes illness to prevent the occurrence of DN.

Abstract TP146: Collateral Status-Based Model for Hemorrhagic Transformation in Successfully Recanalized Medium Vessel Occlusions

Introduction: Collateral status imaging parameters are associated with predicting hemorrhagic transformation (HT) in acute ischemic stroke caused by large vessel occlusions. The purpose of this investigation is to examine the association between imaging biomarkers of poor collateral status and HT occurrence in distal medium vessel occlusion (DMVO) stroke patients. Methods: Data from two comprehensive stroke centers between 2019 and 2023 were retrospectively reviewed for acute ischemic stroke patients with M2-M4 segment middle cerebral artery occlusions. For inclusion, patients must have been successfully recanalized by mechanical thrombectomy with or without intravenous thrombolytic and ultimate modified thrombolysis in cerebral infarction (mTICI) score 2B/2C/3. Occurrence of HT was determined from post-interventional imaging, and HT subtype was defined by the ECASS 2 criteria. Significant univariate predictors were included in a forward stepwise logistic regression for outcome of HT, and adjusted odds ratios (aOR) were reported. Results: Of 60 patients, 17 (28.3%) patients had HT. Average age was 74 [IQR 64-81] years, 34 (56.7%) were female. The multivariate model (area under curve = 0.93) had three significant predictors: diabetes mellitus (aOR 36.5, 95% CI 4.9-272.2, p&lt;0.001); proximal versus distal occlusion (reference: distal, aOR 0.06, 95% CI 0-0.4, p=0.006); CBV index (aOR 0.0002, 95% CI 0-0.1, p=0.007). Conclusions: Lower CBV index (a marker of poor collateral status), presence of distal occlusions, and history of diabetes mellitus are significant predictors associated with increased odds of HT in successfully recanalized DMVO stroke patients. Larger studies are necessary to further validate our findings.

Real-world sequential treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in Japan.

Immune checkpoint inhibitors and enfortumab vedotin have opened new avenues for sequential treatment strategies for locally advanced/metastatic urothelial carcinoma (la/mUC). In the pre-enfortumab vedotin era, many patients could not receive third-line treatment owing to rapid disease progression and poor general status. This study aimed to analyze real-world sequential treatment practices for la/mUC in Japan, with a focus on patients who do not receive third-line treatment. We analyzed data for 1023 la/mUC patients diagnosed between January 2020 and December 2021 at 54 institutions from a Japanese nationwide cohort. At the median follow-up of 28.5 months, the median overall survival from first-line initiation for 905 patients who received systemic anticancer treatment was 19.1 months. Among them, 81% and 32% received second- and third-line treatment. Notably, 52% had their treatment terminated before the opportunity for third-line treatment. Multivariate logistic regression analysis revealed that low performance status (≥1), elevated neutrophil-to-lymphocyte ratio (≥3), and low body mass index (<21 kg/m2) at the start of first-line treatment were independent risk factors for not proceeding to third-line treatment (p = 0.0024, 0.0069, and 0.0058, respectively). In this cohort, 33% had one of these factors, 36% had two, and 15% had all three. This study highlights the high frequency of factors associated with poor tolerance to anticancer treatment in la/mUC patients. The findings suggest the need to establish optimal sequential treatment strategies, maximizing efficacy within time and tolerance constraints, while concurrently providing strong supportive care, considering immunological and nutritional aspects.

Abstract WP117: Improvement of Collateral Status in Thrombectomy-Eligible Stroke Patients During Inter-Hospital Transfer: Association With Clinical Factors and Outcome

Background: Ischemic stroke patients who are eligible for endovascular therapy (EVT), can be transferred from a primary stroke center (PSC) to an EVT-capable comprehensive stroke center (CSC). Little is known about the dynamics of the collateral circulation in this time-window. We aimed to explore changes in collateral status during inter-hospital transfer among patients with poor collaterals on presentation to the PSC. Methods: Data from patients with an anterior circulation large vessel occlusion (LVO), transferred to two CSCs were prospectively collected. A CT perfusion was obtained at the PSC followed by an MRI immediately on arrival at the CSC. The hypoperfusion intensity ratio (HIR), a measure of collateral blood flow, was calculated as the ratio of the Tmax volumes of &gt;10s and &gt;6s. Only patients with stable LVO at the CSC and poor collateral status at the PSC (HIR ≥ 0.40) were included. An HIR &lt; 0.40 in the CSC and a difference ≥ 0.10 was considered as HIR improvement. Results: Data from 104 patients with perfusion imaging at both PSC and CSC, were analyzed. Of them, we included 59 patients with an HIR ≥ 0.40 at the PSC. Sixteen (27%) patients experienced HIR improvement during transfer (Figure 1) . A smaller baseline core volume was independently associated with HIR improvement (OR for every 10 ml increase = 0.46 {95%CI 0.21-0.81}; p=0.03). Collateral improvement was associated with slower infarct growth during transfer (2.45 {95%CI 1.03-3.62} vs 7.77 {95%CI 4.56-17.86} ml/h; p&lt;0.01) and a better functional outcome at 90 days post stroke (median mRS 3 {IQR 1-5} vs 4 {IQR 4-6}; p=0.01). Conclusion: During inter-hospital transfer spontaneous improvement in collateral status, as measured by HIR, is commonly seen, and associated with a smaller infarct core at the PSC, slower infarct growth during transfer, and better functional outcomes. Future neuroprotective trials targeted at collateral improvement, might consider the use of the HIR change as a surrogate outcome marker.

The Association between Regular Sports Participation and Immune Status in College Students Using Immune Status Questionnaire

College students may lack physical activity due to academic burden. This puts them at a higher risk of decreased immunity. This study aimed to investigate the association between sports participation and immune status. This was a cross-sectional retrospective study. Participants were 170 Atma Jaya Medicine and Health Science School students consisting of 59 boys (34.7%) and 111 girls (65.3%). Seventy-nine (46.5%) students participated in the Sports Students Club from December 2021 - December 2022, and 91 did not (53.5%). There were four sports, i.e., badminton, basketball, futsal, and volleyball. Data was taken from July-August 2023. Immune status was assessed using the Indonesian Immune Status Questionnaire (ISQ) version. The amounts of boys engaged in sports activity was significantly greater than girls [45(76.3%) vs 34(30.6%), p=0.001]. One hundred eleven students (65.3%) had good immune status, consisting of 65 girls (58.6%) and 46 boys (78%); 59 students (74.7%) participated in sports, and 52 students (57.1%) did not. Sex and sports participation were associated with immune status (p=0.000 and p=0.017, respectively). Students with good immune status had higher final ISQ scores than those with poor immune status (8.37±1.4 vs 3.84±1.4, p=0.000). Skin problems, headache, and muscle joint pain (MJP) were the three most common illnesses. Sports participation was a protective factor for skin problems, headache, and MJP (OR 0.27, 0.34, 0.41; 95%CI 0.14-0.53, 0.17-0.67, 0.20- 0.84; p=0.000, 0.002, 0.013, respectively). Regular sports participation is associated with favorable immune status. Sport participation could be a protective factor for some symptoms.

Current Psychotic-Like Experiences Among Chinese College Students: Prevalence, Correlates, and Its Relationship with Suicidal Ideation.

Current psychotic-like experiences (PLEs) are prevalent among adolescents. However, epidemiological data on the prevalence rate of current PLEs among college students and its clinical correlates are scarce and limited. To address this study gap, this study aimed to investigate the prevalence and correlates of current PLEs among Chinese college students. A cross-sectional study was designed with a sample of 18,578 college students in China. Each participant completed a survey on social-demographic characteristics variables, PLEs, sleep disturbance, depression, anxiety, and suicidal ideation. Logistic regression analyses were conducted to explore the influential factors for PLEs among all participants and suicidal ideation among those with PLEs. Among Chinese college students, 40.3% of the participants reported having at least one PLE in the past month, while 7.5% had frequent PLEs. Males, age, residence location in town, left-behind experiences, poor family economic status, chronic physical illness, family history of mental disorder, BMI ≥ 28 [obesity], sleep disturbance, depression, anxiety, and suicidal ideation were independent correlates for frequent PLEs. Furthermore, the prevalence of suicidal ideation among participants with frequent PLEs was 32.1%. Lower grades, sleep disturbance, depression, and anxiety were independent predictors of suicidal ideation among college students who experience PLEs frequently. Current PLEs are widespread among Chinese college students. Suicidal ideation is largely prevalent among individuals who suffer frequent PLEs, suggesting that special measures and attention should be provided to these students based on relevant factors to prevent their suicidal ideation and behavior.

Abstract WP170: Patients With Cerebral Microbleeds Are More Likely to Have Poor Collaterals at the Time of Mechanical Thrombectomy

Introduction: Collateral cerebrovasculature is important for the survival of penumbral tissue in patients with large vessel occlusive (LVO) stroke, and adequate collateralization is associated with favorable outcomes. The presence of cerebral microbleeds (CMB) have been implicated in vessel wall remodeling and impaired vasoreactivity. We investigated whether the presence of deep and/or lobar CMB predicts poor collateral recruitment in patients with LVO stroke who underwent thrombectomy (MT). Methods: We performed a retrospective, single-center study of adults who presented with LVO stroke and had MT between January 2012-June 2020. CT angiography of head prior to MT was used to assess collateral status with poor status defined as ≤50% filling and good status as &gt;50% filling. CMBs were assessed using T2*-weighted gradient echo or susceptibility weighted magnetic resonance images. Location of CMB was further characterized as deep vs. lobar using consensus definitions. Poor stroke outcome was defined as modified Rankin Scale (mRS) ≥3 at 90 days. Multivariable logistic regressions were performed to evaluate the associations between CMB, CMB types (lobar, deep, lobar+deep) and poor collaterals after adjusting for vascular risk factors. Results: Consecutive 151 subjects were included (mean age 68±15 years, 47% women), with a median NIHSS of 18. CMB were identified in 57 subjects (37.4%). Of these, 20.5% had lobar CMB, 5.3% had deep CMB and 11.9% had combined lobar &amp; deep CMB. Patients with CMB had higher odds of having poor collaterals compared to those without CMB (OR 1.56, 95% CI 1.09-2.23, P=0.015). The association of CMB with poor collaterals was strongest in patients with combined lobar &amp; deep CMB (OR 4.78, 95% CI 1.43-15.93, P=0.011), compared with those with exclusively deep CMB (OR 2.78, 95% CI 0.44-17.62, P=0.278) or lobar CMB (OR 0.52, 95% CI 0.19-1.38, P=0.188). Patients with poor collaterals were more likely to have poor outcome compared with those with good collaterals (48.4% vs. 31.0%, P=0.03). Conclusion: Cerebral microbleeds are independently associated with poor collateral recruitment when adjusted for traditional vascular risk factors. Further study is warranted to elucidate the differential effects of CMB types on collateral recruitment.

Vitamin D status in post-medieval Northern England: Insights from dental histology and enamel peptide analysis at Coach Lane, North Shields (AD 1711-1857).

The post-medieval period in Europe saw a dramatic increase in metabolic bone disease related to vitamin D deficiency (VDD). Recent paleopathological work has utilized interglobular dentin (IGD) as a proxy for poor vitamin D status during development, while enamel peptide analysis allows the identification of chromosomal sex in non-adult remains. Here we explore the relationship between sex, the presence of IGD, and macroscopic markers of VDD in an industrial era assemblage from Northeast England. 25 individuals (9 females, 9 males, 9 unknown sex) from the cemetery site at Coach Lane, North Shields (1711-1857) were selected for paleopathological analysis, histological assessment of IGD, and enamel peptide determination of chromosomal sex. Ground tooth sections from 21 individuals were of suitable quality for detection of IGD, and enamel peptide analysis confirmed the chromosomal sex of ten individuals. Sixteen individuals (76.1%) exhibited ≥1 episode of IGD. Nine of these (42.8%) exhibited >1 episode and four (19%) exhibited ≥4 episodes in regular intervals. Male sex was significantly associated with the presence of IGD (p = 0.0351; 100% males vs. 54.5% females). Females were more likely to exhibit macroscopic evidence of VDD (45.5% females vs 30% males) but this was not statistically significant. Periods of poor mineral metabolism during childhood appear much more prevalent at Coach Lane than macroscopic evidence suggests. Evidence of seasonal IGD episodes indicates that northern latitude played a major role in poor VD status in the Northeast of England. The significant association of IGD with male sex may be due to sex-related differences in dentinal mineralization or a higher risk of poor VD status in males aged <5 years. More work is needed to establish an evidence-based threshold for pathological levels of IGD before the presence of this feature can confidently be used as a biomarker for poor VD status.

Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan

After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N – 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46–28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Efficacy of immune checkpoint inhibitors in advanced large cell neuroendocrine carcinoma of the lung: A single‑institution experience.

Large cell neuroendocrine carcinoma (LCNEC) is a rare and highly invasive lung cancer subtype with an overall poor prognosis. Due to its low incidence rate and unusual pathological features, the clinical management of LCNEC remains controversial. The present study aimed to assess the effect of immune checkpoint inhibitors (ICIs) on treatment response and survival outcomes in patients with advanced LCNEC. The clinical data from 148 patients with LCNEC treated with ICIs at The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) between January 2019 and September 2021 were retrospectively analyzed. Kaplan-Meier and multivariable Cox regression analyses were used to evaluate associations between clinicopathological variables and patient outcomes. Patients treated with ICIs demonstrated extended median overall survival (mOS) times [23.5 months; 95% confidence interval (CI), 18.524-28.476] compared with patients who did not receive ICIs (11.2 months; 95% CI, 4.530-18.930) (P<0.001). Univariate analysis revealed that histological subtype (P=0.043), lymph node metastases (P=0.032) and number of metastatic organs (P=0.009) were associated with a poor prognosis. The heterogeneity of pathological components was associated with prognosis, and the mOS time was shorter for mixed LCNEC than that for pure LCNEC (P=0.043). The median progression-free survival (mPFS) (9.78 vs. 9.37 months; P=0.82) and mOS (20.70 vs. 25.79 months; P=0.181) times showed no significant association with regard to different regimens of immuno-based combination therapy (chemotherapy combined with ICIs vs. anti-angiogenic agents combined with ICIs). Poor Eastern Cooperative Oncology Group performance status score (P=0.04), multiple organ metastases (P=0.02) and high cancer antigen 125 levels (P=0.01) were independent risk factors of a poor prognosis. The present findings offer valuable insights into potential prognostic markers and highlight the favorable impact of ICIs on OS in advanced LCNEC. Prospective clinical studies are required to validate the therapeutic value of ICIs in LCNEC.

A hybrid approach of deep learning to forecast financial performance: from unsupervised to supervised

The financial performance of a listed company is a common concern for shareholders, creditors, employees, securities analysts, and the government. Measuring and forecasting financial performance informs stakeholders about a company's overall well-being. In this study, we propose a hybrid approach that combines grey relation analysis, Self-Organized Mapping (SOM) neural network, and convolutional neural network to assess the financial performance of listed companies. Grey relation analysis measures financial performance, SOM neural network clusters, and convolutional neural network forecasts. Compared to other models, the hybrid convolutional neural network model has a better predictive effect, accurately forecasting the financial status of listed companies. Findings also reveal that 70.93 percent of listed companies in agriculture, forestry, husbandry, and fisheries have a poor financial status.

Characteristics of Two Lagoons in the Coastal Area of the Baltic Sea

The proposed study is focused on an ecological analysis of Latvian coastal lagoons, emphasizing their unique but vulnerable nature. Coastal lagoons are recognized as fragile ecosystems of significant ecological, social, and economic value, as recognized by the European Directive 92/43/EEC (Habitats Directive). Despite their protected status, the existence of these ecosystems can be threatened by morphological, hydrological, and anthropogenic changes. The uniqueness of these ecosystems can be determined by the large number of influencing factors and their dynamics. They are affected by seawater, their level of fluctuation, wind exposure, overgrowing with macrophytes, freshwater sources, and water flow generated streams affecting sediment transport and accumulation. All the influencing factors determine a highly trophic ecosystem, which in the studied lagoons is rated as medium to poor ecological status, which confirms the above-mentioned vulnerability and fragility. The aim of this study was to analyze two lagoons in the coastal area of the Baltic Sea in the Riga Gulf, by characterizing, for the first time, their current conditions and ecological parameters because understanding such ecosystems is only partial. The physicochemical composition of lagoon sediments and water shows the impact of seawater by increased electrical conductivity and the concentration of SO42− and Cl− in water, while the presence of detritus in sediments is almost non-existent; thus, the content of organic matter is low with relatively variable pH. The results show that the diversity of studied benthic macroinvertebrates, macrophytes, zooplankton, and even phytoplankton species is low, but there is higher diversity in lagoons and their parts with regular water exchange with the sea. The study provides valuable insight into the ecological dynamics of coastal lagoons in Latvia, shedding light on their current conditions, anthropogenic impact, and the need for sustainable management measures.