Preventive Medical Treatment Research Articles

The socioeconomic dimension of forest therapy: A contribution to human well-being and sustainable forest management

Forests provide a variety of ecosystem services that contribute in various ways to human well-being. In times of land-use pressures, urbanisation, and nature degradation, the societal demand for forest-based therapeutic uses is increasing. Although nature-related therapies and the beneficial effects of nature on health and well-being are an old concept in cultures such as Asia and, more recently, Europe, forest therapy offers are increasingly taking hold in the forest recreation landscape. This Commentary paper identifies recent forest therapy offers and research in Asia and Europe that focus on the therapeutic effects of forests and examine their underlying rationales, practices, and status. In particular, we elaborate the socioeconomic potential of forest therapy to contribute to human health and sustainable forest management. Based on a scoping review on forest therapy offers and research, we found that countries such as Japan and South Korea are ahead of European countries in the professionalization of forest therapy offers and respective studies. While the number of studies that demonstrate the positive health benefits of forests are increasing, there is a lack of understanding the link with forest management approaches and forest and health policies. A lack of socioeconomic evaluation hinders its successful integration into policy frameworks, and prevents its use as an alternative forestry product or preventive medical treatment. For forest therapy to become part of the forestry portfolio and a medical alternative, we recommend:•Interdisciplinary research approaches and new actor alliances that link societal demands for forest therapy with insights from forest management and medical health research,•Transdisciplinary research and multi-actor approaches to link insights from forest and medical research with practitioners’ skills for forest management, service design, and communication,•To identify trade-offs and conflict potentials with forest therapy, for example in relation to timber production or questions of insurance in case of injuries by falling branches etc., that allow to develop integrated and sustainable solutions,•Policy backup and economic support for forest managers and owners to compensate for their efforts to manage their forests for therapeutic purposes•Recognition of forest therapy as an explicit part of the forestry portfolio and an alternative medical offer for clinical treatments.

Exploring the Frontiers of Health Tourism: A Bibliometric Analysis of Research Themes and Trends.

Health tourism, encompassing both wellness and medical tourism, serves individuals seeking preventive care, relaxation, and medical treatments in diverse global destinations. This bibliometric study leverages Scopus for bibliographic data to analyze the scientific production in health tourism. The analysis, conducted using Biblioshiny and CiteSpace, focuses on annual scientific production, identifies the most productive authors, and highlights the most relevant sources. Additionally, the study examines countries' scientific outputs and provides a historiographic overview of the field. Trend topics and thematic maps visualize the evolution of research themes, while keywords with the strongest citation bursts are identified. Co-citation analysis reveals influential works and collaborations, and a timeline view of country collaborations illustrates the global research network. The study concludes that while health tourism research has significantly expanded, there is a need for longitudinal studies on long-term outcomes and patient satisfaction. Furthermore, the integration of wellness and medical services, as well as the exploration of ethical and legal frameworks, remain underdeveloped. Practical implications suggest that policymakers should focus on developing uniform regulations and resilient practices to enhance the sustainability and attractiveness of health tourism. These findings provide a comprehensive overview of the current state and future directions of health tourism research, highlighting critical areas for further investigation.

Acute and preventive medical treatment of cluster headache in Taiwan: A narrative review.

Cluster headache (CH) is a debilitating neurological disorder characterized by severe, unilateral pain and ipsilateral autonomic symptoms. Chronic CH is exceedingly rare in Taiwan, constituting approximately 1% of all CH cases. This narrative review provides an up-to-date overview of the acute and preventive treatment strategies for CH in Taiwan, focusing on currently available pharmacological options in the country. The treatment approach for CH in Taiwan involves a stepwise strategy. High-flow oxygen and triptan nasal sprays are the mainstays of acute treatment, providing rapid relief and good tolerability. Transitional treatments, such as oral steroids and suboccipital steroid injections, serve as a crucial bridge between acute and long-term preventive therapies, offering temporary relief while minimizing side effects through a carefully limited duration. For preventive treatment, verapamil is the first-line option, with lithium and topiramate being the second-line alternatives. Among the CGRP monoclonal antibodies, galcanezumab has demonstrated efficacy in the prevention of episodic CH. Preventive treatments are personalized to individual patients, starting with low doses and close monitoring for adverse effects. Neuromodulatory therapies, such as non-invasive vagus nerve stimulation, show promise for chronic and refractory CH but have limited availability in Taiwan. In conclusion, despite the availability of various acute and preventive treatment options, unmet needs in the management of CH in Taiwan remain. In particular, increased awareness and education among healthcare professionals to improve the diagnosis and management of CH in Taiwan should be implemented.

Hypertrophic Cardiomyopathy and Ventricular Arrhythmia

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Its clinical presentation is heterogeneous, ranging from asymptomatic patients to sudden death in young individuals. This complication is unpredictable, and no preventive medical treatment has proven effective. We report the case of a 32-year-old individual who was admitted for poorly tolerated ventricular tachycardia (VT), which was resolved with external electrical shock. We diagnosed localized hypertrophic cardiomyopathy, confirmed by MRI. This paper outlines the patient's medical journey, highlighting the rhythm complications experienced and the various therapeutic options available.

Avoidable mortality contributes to the European Union’s life expectancy and lifespan dispersion gaps

Abstract Background Mortality differences between established (EMS) and post-2004 European Union member states (NMS) remain large. Contributing to this gap are deaths avoidable through prevention (preventable mortality) or adequate medical treatment (treatable mortality). This study examined the potential of reduced avoidable, preventable, and treatable mortality to close life expectancy and lifespan dispersion gaps between EMS and NMS. Methods Death and population counts were extracted from the WHO Mortality Database to calculate age and cause-specific mortality rates for each EU member state for 2005-2014. Causes of death were categorised as avoidable, amenable, and preventable based on the OECD/Eurostat lists of preventable and treatable causes of death. The gaps in life expectancy at birth and life span dispersion between EMS and NMS were estimated where: 1) all amenable, preventable, and avoidable deaths were averted across the EU, and 2) NMS achieved the same level of avoidable mortality as EMS. Results Averting all avoidable deaths throughout the EU would reduce the life expectancy gap between EMS and NMS from 4.4 to 2.4 years for women and 7.4 to 3.3 years for men. The difference in lifespan dispersion would be reduced from 0.9 (favouring EMS) to 0.1 years (favouring NMS) in women and from 1.5 years to 0.3 years (favouring EMS) in men. Were NMS to achieve the avoidable mortality observed in EMS, the life expectancy gap between EMS and NMS would fall from 4.4 to 2.5 years for women and from 7.4 to 3 years for men, while the difference in lifespan dispersion would be reduced from 0.9 to 0.3 years in women and from 1.5 years to 0.3 years in men. Conclusions NMS achieving the avoidable mortality observed in EMS would have halved the life expectancy gap and almost eliminated the life span dispersion gap between EMS and NMS during 2005-2014. Effective exchange of best practices in prevention and treatment could transform mortality differences across the EU. Key messages • This is the first study to examine the potential of reduced avoidable, preventable, and treatable mortality to close the life expectancy and lifespan dispersion gaps between EMS and NMS. • Achieving the avoidable mortality observed in established EU member states in post-2004 EU member states would greatly reduce mortality differences across the EU.

An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study.

Needle phobia, which affects 19% of children aged 4 to 6 years, prevents many children from receiving necessary or preventive medical treatments. Digital interventions have been made to target needle phobia but currently rely on distraction rather than evidence-based exposure. We designed and evaluated a serious exposure-based mobile game called Dr. Zoo to reduce the fear of needles in children aged 3 to 6 years, where players administered shots to cartoon animals. We conducted a mixed methods study with 30 parents (mean age 35.87, SD 4.39 years) and their 36 children (mean age 4.44, SD 1.11 years) who played the game for 5 days leading to a scheduled appointment that included an injection (eg, influenza vaccination). After the study, parents completed exit surveys and participated in semistructured interviews to evaluate ease of use, acceptability, and preliminary effectiveness of the game and to provide insights on their experience with the game to inform future developments. Interview transcripts were analyzed by 3 independent coders following an open coding process and subsequently coded and discussed to reach consensus. Parents rated their child's difficulty in completing the game as very low on average (scale 1-5; mean 1.76, SD 0.82) and were highly likely to recommend Dr. Zoo to other parents (scale 1-5; mean 4.41, SD 0.87), suggesting Dr. Zoo's strong ease of use and high acceptability. In the exit survey, parents rated their child's fear as significantly lower after participating in the study (scale 1-5; mean 3.09, SD 1.17) compared with that before participating (scale 1-5; mean 4.37, SD 0.81; z score=-4.638; P<.001). Furthermore, 74% (26/35) of the parents reported that the game had a positive impact on their child's fear or perception of needles (only 2 parents reported a negative impact). Qualitative analysis of the interview transcripts revealed potentially important features of the game in this positive impact, such as the game's interactive design, as observed in 69% (24/35) of our participants. The results suggest that an evidence-based serious mobile game can be an easy-to-use, acceptable, and potentially effective intervention for changing young children's fear and perceptions of needles. Leveraging digital interventions may be a potential solution to needle anxiety as a public health concern.

Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey

BackgroundAging is associated with an increased prevalence of non-communicable chronic diseases (NCDs), functional impairments, and diverse demands for health services. This study analyzed the trends in older adults’ needs and utilization of health services from 1993 to 2018 in China, as well as chronic disease-related economic burdens.MethodsThe research data were collected from the six cross-sectional National Health Service Survey (NHSS), implemented every 5 years from 1993 to 2018. A multi-stage stratified random cluster sampling method has been adopted in the NHSS. The data on the older population's socio-economic characteristics, health service needs, and utilization were collected from the 6 waves National Health Service Survey (NHSS) 1993–2018. In the 2013 and 2018 NHSSs, EQ-5D-3L and visual analogue scale were used to evaluate the health condition. And the prevalence of NCDs and related Out-of-pocket (OOP) expenditures were collected. Functional dependency and impairment were collected in 2018. The Katz Activities of Daily Living scale was used to evaluate six functions, including self-feeding, dressing, bathing, transferring, toilet hygiene, and controlling bowel movements.ResultsThe two-week morbidity rate and prevalence of NCDs showed a rapid upward trend in older adults. With the development of health system reform and universal health insurance coverage, older adults' two-week medical consultation rate increased from 25.6% in 1993 to 40.1% in 2018, and the hospitalization rate rose from 6.1% to 24.9%. The difference in health service needs and utilization between urban and rural areas decreased, and the hospitalization rate in rural areas (26.3%) exceeded that in urban areas (23.6%) for the first time in 2018. Functional independence become more severe as aged. The proportion of severe functional impairment was 6.9% and 2% in the group aged 80 or over and group 70–79 years, respectively. Regarding disability status, 32.5% had hearing problems and 31.4% had visual impairment. The highest prevalence rates of NCDs in older adults were found in hypertension (36.9%), followed by diabetes (10.6%), cerebrovascular disease (5.4%), ischemic heart disease (4.5%), and intervertebral disc disease (4.2%). The average annual OOP expenditures attributed to NCDs increased from ¥2481.8 RMB in 2013 to ¥8255.9 RMB in 2018 for older adults. About 90.7% of older adults prefer to live in the residential community, leading to the demands for preventive healthcare (30.4%), medical treatment (14.1%), and elderly education (8.6%).ConclusionThe elevated risks of age-related impairments and chronic morbidities, and increased demands for preventive healthcare are critical public health issues. Policymakers should strengthen primary healthcare and move towards integrated delivery to improve access and quality of care for older adults. The integration of healthcare and social security constitutes an adaptive trend in meeting the multi-level demands of an aging society.

Immunomodulation Therapies for Atherosclerosis: The Past, the Present, and the Future.

Atherosclerotic cardiovascular disease is the most common cause of morbidity and death worldwide. Recent studies have demonstrated that this chronic inflammatory disease of the arterial wall can be controlled through the modulation of immune system activity. Many patients with cardiovascular disease remain at elevated risk of recurrent events despite receiving current, state-of-the-art preventive medical treatment. Much of this residual risk is attributed to inflammation. Therefore, finding new treatment strategies for this category of patients became of common interest. This review will discuss the experimental and clinical data supporting the possibility of developing immune-based therapies for lowering cardiovascular risk, explicitly focusing on vaccination strategies.

Knowledge of Nurses towards Post-exposure Prophylaxis for HIV infection at a Tertiary Health Care Center

IntroductionAcquired immunodeficiency syndrome is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus in which progressive failure of immune system allows life threatening opportunistic infection and cancer to thrive. Post exposure prophylaxis is preventive medical treatment recommended immediately after exposure to a pathogen. The objective of this research is to assess the level of knowledge regarding PEP of HIV among nurses.MethodsAn analytical cross sectional study was conducted among 164 nurses to assess the knowledge regarding PEP of HIV among nurses at the College of Medical Sciences and Teaching Hospital, Bharatpur. Data was collected using probability random sampling using self-structured questionnaire. Data was entered and analyzed using in statistical package for social science (SPSS) version 23 using descriptive and inferential statistical tools.ResultsAmong the 164 nurses, more than half (56.1%) were in the age 20-25years and had completed their PCL Nursing. Likewise, 35.4% had 2-4 years of experience. Also, 55.5% had a moderate level of knowledge, 18.9% had an inadequate level and 25.6% had adequate knowledge of PEP of HIV. The result of mean ± SD of knowledge was 11.18±3.125. There is statistically significant association between levels of knowledge with working area and total working experience.ConclusionsThe study shows that only 25.6% had adequate knowledge regarding PEP of HIV. Therefore, nurses should be up to date with their knowledge; engage in workshop and training programs periodically.

An In-Depth Prospective Comprehensive View on Myocardial Infarction (MI) in Young Adults.

Due to major advancements in myocardial infarction (MI) prevention and effective medical treatment, the death rate and incidence of MI have dropped considerably. We know that their risk factors and prognosis may differ; therefore, increasing primary and secondary prevention activities among young people is crucial. Multiple studies have found that MI is the deadliest form of coronary heart disease (CHD). As a result, we made an effort to illuminate MI in young people in our review of the literature. We found that young people, particularly women, are developing MI. Smoking is a key risk factor that should be targeted in an effort to minimize youth MI rates. It is thus important to create superior methods for measuring risk in young people, which may combine both standard and nonconventional risk factors, such as genetic rate scores and coronary artery calcium testing. Henceforth, addressing modifiable risk factors at a younger age has the greatest impact.

Male rheumatoid arthritis patients at substantially higher risk for cardiovascular mortality in comparison to women

BackgroundPatients with rheumatoid arthritis (RA) are at an increased risk for developing cardiovascular diseases. While advice regarding cardiovascular risk screening and management in RA patients has been incorporated in several guidelines in recent years, its implementation and adherence is still poor. ObjectivesTo assess the cardiovascular disease risk in new diagnosed RA patients and evaluate whether advice to initiate preventive medical treatment of high risk patients was followed. MethodsAll patients with a recent diagnosis of RA, aged 40–70 years, were screened between May 2019 and December 2022 for cardiovascular diseases and risk factors within the first year after diagnosis at the outpatient rheumatology clinic, as part of standard care. Screening included a physical examination with blood pressure measurement, and laboratory tests with lipid profile tests. All patients and their general practitioner (GP) received an overview with their cardiovascular risk profile and a calculated 10-year cardiovascular mortality risk. Cardiovascular risk was defined as low (<1%), intermediate (1–5%), high (5–10%) and very high (>10%). The national pharmacy network was consulted to check whether or not patients started preventive medication after screening. ResultsA total of 125 RA patients was included in this study. The mean age was 56 years and 78% was female. Median RA disease duration at screening was 6 months. Six patients (5%) indicated to have been screened before, and used antihypertensive medication. During screening, hypertension was found in 57% of male patients and 43% of female patients and dyslipidemia was found in 36% in male and 32% in female patients. 46% of male patients and 21% of female patients currently smoked. A high or very high 10-year cardiovascular mortality risk was found in 50% of male patients, but in only 4% of female patients. Only 26% of (very) high risk patients started antihypertensive or statin medication after screening. ConclusionsAn increased cardiovascular disease risk is often present in newly diagnosed RA patients, especially male patients, with a large proportion having undiagnosed and untreated hypertension and hypercholesterolemia. Even with structural screening and informing of the patients and GPs, treatment of cardiovascular risk factors in high risk patients remains insufficient. CV risk screening needs to be part of standard care for RA patients, with clear agreement on the responsibilities between primary and secondary care. Awareness of the importance of CVD risk screening needs to improve among both RA patients themselves and the GPs to ultimately reduce the cardiovascular burden of our patients. Obviously, a better collaboration between GPs and rheumatologists is urgently needed to lower the cardiovascular burden of our patients.

The role of serum markers PAPP-A β-hCG, AFP, and uE3 in predicting the risk of preeclampsia in early, middle, and late pregnancy.

Preeclampsia (PE) has adverse effects on pregnant women, fetuses, and newborns [1], and accounts for 3%-10% of pregnancy-related diseases globally. This study aimed to screen a series of prenatal markers (pregnancy-associated plasma protein [PAPP-A], β-human chorionic gonadotropin [β-hCG], alpha fetoprotein [AFP], and estriol [uE3]) to establish a risk model and evaluate the diagnostic values of the markers for predicting PE. Sixty-five pregnant women were enrolled in this study. They were divided into two groups containing healthy pregnant women (n= 51, the non-PE group) and pregnant women with PE (n= 14, the PE group). According to the stage of pregnancy, the pregnant women in each group were divided into early, middle, and late pregnancy groups for statistical analysis. The levels of PAPPA-A β-hCG, AFP, and uE3 were compared among these groups. Then, a risk model was established, and PE was diagnosed using receiver operating characteristic (ROC) curve results. In the early pregnancy group, the differences in the levels of PAPP-A, AFP, and uE3 between the PE and non-PE groups were statistically significant (P< 0.001, P= 0.029, and P= 0.033, respectively), while the difference in the single remaining marker was not statistically significant. A ROC curve analysis revealed that in early pregnancy, the sensitivity and specificity of PAPP-A were 76.5% and 71.4%, respectively, and the sensitivity and specificity of β-hCG were 82.4% and 57.1%, respectively. The sensitivity and specificity of the combination of the two markers for diagnosing PE were 86.3% and 57.1%, respectively. This study demonstrated that the combination of PAPP-A and β-hCG has diagnostic value for PE in pregnant women. Accordingly, we should formulate innovative PE screening strategies to target the prevention of PE and create important conditions for predictive and preventive personalized medical treatments.

For COVID-19, what are the priorities of normalized prevention and control strategies?

The COVID-19 pandemic has ravaged the world for three years. Most countries have adjusted policies and strategies in response to the burden of COVID-19. The severity of COVID-19 seems to be diminishing as the case fatality rate has declined and the number of vaccinated people has increased markedly. Given the large population worldwide, we need to pay attention to the continuing COVID-19 burden. Globally, the number of cases remains at a certain level, and the number of cases is still increasing in China. We also need to deal with shortages of medical resources, antipyretics, and home nursing facilities. SARS-CoV-2 will coexist with humans for a long time, and predicting viral mutations and pandemic trends will be difficult. The reform of the whole public health system is imperative. A comprehensive surveillance system should be created to determine the proportion of various pathogens and to guard against mixed infections of respiratory infectious diseases. A comprehensive response mechanism, including preventive measures and medical treatments, should be created as soon as possible to monitor the status of the epidemic and to deal with the long-term health burden of SARS-CoV-2.

Permanent Effect of SARS-CoV-2 on the Heart, Post Recovery

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Since December 2019, when the initial outbreak of COVID-19 occurred in China, a series of effective preventive control and medical treatment measures have been implemented, and have brought the pandemic under control to a certain extent. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention. A growing number of studies suggest many COVID-19 survivors experience some type of heart damage, even if they didn't have underlying heart disease and weren't sick enough to be hospitalized. Recent statistics estimate there being around 523.2 million cases of cardiovascular disease in the world, which represents the large population that this side effect or aftereffect potentially encompasses. According to research, there are structural changes in that take place when COVID enters a person’s body. In this case, the effect on the heart is relatively unknown or unproven. However, scientists and doctors have reported a couple of observations. First, the weight of the heart increased slightly after patients recovered from COVID. Second, Signs of cardiac enlargement and right ventricular dilatation were also noted. Under microscopic attention, scattered individual cardiomyocyte necrosis was visible as well. This paper will outline specific effects of COVID on the heart.

Dose-Response Effects of Low-Dose Ionizing Radiation on Blood Parameters in Industrial Irradiation Workers.

While previous studies have focused on the health effects of occupational exposure of radiations on medical radiation workers, few have analyzed the dose-response relationship between low radiation doses and changes in blood parameters. Even fewer studies have been conducted on industrial worker populations. Using a prospective cohort study design, this study collected health examination reports and personal dose monitoring data from 705 industrial irradiation workers who underwent regular physical examinations at Dongguan Sixth People’s Hospital. The dose-response effects of low-dose ionizing radiation on blood parameters were assessed using a generalized linear model and restricted cubic spline model. Red blood cell counts decreased then increased, before decreasing again with increasing ionizing radiation. This was in contrast to the curve of the total platelet count after irradiation. Additionally, a radiation dose of 2.904 mSv was the turning point for the nonlinear curve of hemoglobin count changes. In conclusion, long-term, low-dose ionizing radiation affects blood cell levels in industrial irradiation workers. There is a nonlinear dose-response relationship between red blood cell, platelet, and hemoglobin counts and the cumulative radiation dose. These findings should alert radiation workers to seek preventive medical treatment before the occurrence of any serious hematopoietic disease.

The Implementation of Laws and Policies on Children in Vietnam: Facts and Solutions

According to the international and Vietnamese laws and regulations, children are protected their lives. They have the rights for the best living and development conditions such as receiving the best health care, having priority in accessing and using preventive services and medical examination and treatment; being cared for and nurtured for comprehensive development; being educated and studied to develop comprehensively; having equal learning and educational opportunities; developing talents, aptitudes, creativity and inventions; having the right to have fun and entertainment; having equal opportunities to participate in cultural, artistic, physical training, sports and tourism activities appropriate to their age. To contribute to ensuring the full realization of children's rights, in this article, the author would like to clarify Vietnamese issues: (i) The results of the implementation of the laws and policies on children; (ii) Some shortcomings and limitations in the implementation of the laws and policies on children and their causes; (iii) Tasks and solutions for the achievement of the laws and policies on children; (iv) Some recommendations for the implementation of the laws and policies on children

Novel curve fitting method based on constrained optimization for the modelling of human brain aneurysms using Mooney–Rivlin hyperelastic materials in the entire range of deformations til rupture

Purpose: Brain aneurysms often prove fatal if ruptured, therefore, understanding their mechanical behaviour in the coupled system of vessels and blood flow can significantly help preventive surgical treatment. The purpose of this work was to analyse measurement data and to determine material parameters for the hyperelastic Mooney–Rivlin model for model building and numerical simulations of aneurysms. Methods: A total of 88 human brain aneurysm specimens of 41 patients obtained from surgery were processed in this work based on the tests performed by the authors in a previous project. A novel algorithm was proposed and applied in this work to fit stress–stretch ratio curves for multiple measurement data using constrained optimization with hard conditions to comply with known mechanical behaviour. Results: The method produced parameters of stretch ratio–stress curves for a number of groups of the specimens representing the average as well as the extreme stresses, separately for male and female subsamples. Stretch range both in compression and in tension up to rupture was covered and material stability for the entire range was also verified. Conclusions: The fitted curves with recommended range of validity are directly applicable to numerical finite element or coupled simulations of aneurysms supporting preventive medical treatment or decision making

Medical Behavior Choices of Older Adults in the Social Aging Model

Based on CHARLS survey data, we studied the choice of medical behaviors of the elderly under the social pension model, and analyzed the choice of medical behaviors of the elderly using the propensity matching method, starting from four levels: preventive medical behaviors, timely hospitalization behaviors, treatment selection behaviors, and medical expenditure behaviors. The results showed that the social pension had a significant effect on the behavioral choices of preventive medical treatment and timely hospitalization, while the social pension did not have a significant effect on the other medical behavioral choices of the elderly. It can be seen that the reasons for the choice of medical behavior come from the elderly's own needs and medical support policies and facilities on the one hand, and social pensions in old age on the other. At present, China should make medical insurance and old-age insurance form a synergy to meet the basic living and medical needs of the elderly in their old age and promote the health of the elderly based on ensuring the level of social old-age insurance for the elderly, the balance of the pension fund and the sustainable development of the system.

Abstract 11482: A Neural Network-Based Model Detects Low Ejection Fraction from Electrocardiograms Without Overt Rhythm or Conduction-System Abnormalities

Introduction: While detection of asymptomatic left ventricular dysfunction (LVD) is important given the effectiveness of preventive medical treatments, the gold standard method using echocardiograms requires trained experts and thus is less suitable for widespread screening. Previous studies have found that convolutional neural network (CNN) models could detect patients with LVD from 12-lead electrocardiogram (ECG). However, they were developed in an unselected population which included an unknown number of patients with overt rhythm and conduction system abnormalities, which frequently coexist with LVD. It is unclear to what extent these models relied on such obvious features to detect LVD from ECGs. Herein, we aimed to assess the ability of a CNN-based model to detect LVD using ECGs having no apparent rhythm or conduction abnormalities. Methods: 56,985 ECGs with an echocardiogram within a 2-week interval were identified from the BWH ECG database. The dataset was split into 28,465, 11,306 and 17,214 ECGs for derivation, validation and test, respectively, with no overlap of patients across groups. A CNN model was trained as a binary classifier to detect LVD, defined as LV ejection fraction &lt; 35 %. The final model was selected as that with the best area under the receiver operating characteristics curve (AUROC) on the validation set and performance assessed on the test set. The model was further tested after excluding ECGs with overt rhythm and conduction system abnormalities defined as the presence of atrial fibrillation, premature atrial complexes, premature ventricular complexes, electronically paced rhythms, left or right bundle branch block. Results: The mean patient age in the test set was 69.8 years, and 57.3% of patients were male. prevalence of low LVEF was 9.7%. The test dataset contained 7,633 ECGs with overt rhythm and conduction system abnormalities. The model yielded good accuracy with an AUROC of 0.91 (95% CI:0.90-0.91) to identify patients with LVD in the test data set. The model performed similarly in the presence or absence of rhythm or conduction-system abnormalities (AUROC 0.90 95% CI:0.89-0.92 and 0.89 95% CI:0.88-0.90 respectively). Conclusion: The model detected low LVEF from ECG without overt rhythm and conduction system abnormalities.

Cardiac Surgery Associated AKI Prevention Strategies and Medical Treatment for CSA-AKI.

Acute kidney injury (AKI) is common after cardiac surgery. To date, there are no specific pharmacological therapies. In this review, we summarise the existing evidence for prevention and management of cardiac surgery-associated AKI and outline areas for future research. Preoperatively, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be withheld and nephrotoxins should be avoided to reduce the risk. Intraoperative strategies include goal-directed therapy with individualised blood pressure management and administration of balanced fluids, the use of circuits with biocompatible coatings, application of minimally invasive extracorporeal circulation, and lung protective ventilation. Postoperative management should be in accordance with current KDIGO AKI recommendations.