Primary Indication Research Articles

373. FLIPPING THE SCRIPT: ENDOFLIPPING THROUGH ESOPHAGEAL CHALLENGES WITH A TWIST!

Abstract Background High-resolution esophageal manometry (HRM) is the gold standard for studying esophageal motility disorders but isn't universally available, and it's also reported as invasive and uncomfortable. The EndoFLIP system offers a dynamic evaluation of the esophagogastric junction (EGJ), crucial for patients with inconclusive HRM or undergoing endoscopic or surgical therapy such as myotomy or fundoplication. EndoFLIP is a practical tool in patients with dysphagia with normal upper endoscopy, allowing diagnostic assessment during the same procedure, and better selecting patients for subsequent HRM. Methods We conducted a retrospective study where we analyzed EndoFLIP procedures performed at a tertiary center from January 2022 to February 2024, for multiple indications, including characterization of findings on HRM, primary investigation of patients with dysphagia undergoing diagnostic upper endoscopy, motility study in patients intolerant to HRM, and post-therapeutic endoscopic/surgical assessment. Results Sixty-nine patients submitted to EndoFLIP procedures were included (39.1% male; 60.9% female) with a median age of 62 years. The primary indication was dysphagia, with 17.3% of patients being intolerant or referred with inconclusive HRM. EndoFLIP enabled diagnosis in all patients, even with an inconclusive HRM. Endoflip was performed on patients with treated achalasia with recurrence of dysphagia (16%), of which 55% exhibited reduced distensibility of EGJ. The evidence of reduced distensibility allowed patient selection for further treatment. Seven patients underwent EndoFLIP to characterize EGJOO. Comparing paired data from HRM and EndoFLIP, overall concordance was only 47,1%. Endoflip showed a large discordance for the EGJOO group, with 50% having normal findings and 20% confirming EGJOO. 43,8% of patients diagnosed with EGJOO confirmed by EndoFLIP underwent endoscopic therapy during the same procedure, allowing the diagnosis and treatment at the same time. Four patients with gastroesophageal reflux disease, intolerant to HRM and proposed for Nissen fundoplication, underwent EndoFLIP for EGJ and esophageal motility evaluation. Currently, they are proposed for surgery due to the normal findings on EndoFLIP. Conclusion The use of EndoFLIP in evaluating esophageal motility disorders presents a paradigm shift, overcoming the limitations of traditional methods like HRM. Our retrospective study demonstrates its pivotal role in diagnosing and managing patients with dysphagia submitted to diagnostic endoscopy, especially post-interventions like achalasia or Nissen fundoplication. With its ability to provide comprehensive assessments and guide tailored treatments, EndoFLIP emerges as a valuable tool in clinical practice. Its impact on patient management, evidenced by alterations in treatment strategies in over 80% of cases, underscores its significance.

An Evaluation Index System to Assess Nurse Competency in Enhanced Recovery After Surgery Programs: A Delphi Study

PurposeTo construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery programs and provide a scientific foundation for their training and assessment. MethodsUtilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than 0.25. The weights of the indicators were calculated using the Analytic Hierarchy Process. ResultsThe study developed a system to that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). ConclusionsThe developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Doxorubicin-induced Immunogenic Cell Death Impairs Tumor Progression and Distant Metastasis in a 4T1 Breast Cancer Tumor Model.

Cancer is an individual disease and its formation and development are specific to each host. Conventional treatments are ineffective in complex cases, such as metastasis, and have severe adverse side effects. New strategies are needed to address the problem, and the use of immunogenic cell death (ICD) as a trigger or booster of the immune system through the exposure of damage-associated molecular patterns, along with tumor antigens, by cancerous cells is presented as an immunization approach in this work. For this purpose, 4T1 cells were exposed to doxorubicin (DOX) for 24 hours and then, these cells undergoing ICD were subcutaneously administered to mice. The ICD induction by DOX on 4T1 was assessed by flow cytometry and image analysis. This immunization process was performed three times and after the last administration, the immunized mice were challenged with a subcutaneous xenograft of live cancer cells. The results demonstrate that the mice immunized with cells undergoing ICD after exposure to DOX presented no primary tumor or indications of distant metastatic lesion development. In summary, our findings indicate that the immunization process utilizing ICD is indeed efficacious in managing this aggressive form of pre-clinical breast cancer.

Efficacy and Safety of Nimotuzumab in Combination with Radiotherapy or Chemoradiotherapy for Local Advanced Head and Neck Cancer: A Systematic Review and Meta-analysis.

The present meta-analysis aimed to evaluate the efficacy and safety of adding nimotuzumab to radiotherapy (RT) or chemoradiotherapy (CRT). Prospective randomized controlled studies at EMBASE, PubMed, and the Cochrane Library from January 1, 2010, to October 1, 2022, were searched. Data on the overall survival (OS), progress-free survival (PFS), disease-free survival (DFS), complete response rate (CRR), objective response rate (ORR), and all grade adverse events were collected from the enrolled publications. OS was the primary measurement indicator. Pooled analysis was performed with relative risks (RRs), hazard risks (HRs), and their corresponding 95% confidence intervals (CIs) in the software Stata SE 16.0. Six randomized controlled studies were included in the analysis of the overall pooled effect. As compared to the control group, the nimotuzumab intervention group exhibited improved OS by 21% (pooled HR=0.79,95% CI: 0.64-0.98, P=0.028), along with PFS up to 31% (HR=0.69, 95% CI: 0.55-0.86, P=0.001) and DFS up to 29% (HR=0.71, 95% CI: 0.56-0.91, P=0.006), increased CRR as 50% (RR=1.50, 95% CI:1.09-2.04; P=0.012), and ORR as 35% (RR=1.35, 95% CI:1.04-1.73; P=0.022). Regarding safety, nimotuzumab in combination with RT or CRT did not increase the incidence of all grade adverse events (pooled-RD=-1.27, 95% CI:-2.78-0.23, P=0.099). The present meta-analysis has demonstrated that nimotuzumab, in combination with RT or CRT, could provide survival benefits and increase response rates. Its safety profile has been found to be controllable.

Analysis of the Influence of Online Public Opinion on Corporate Brand Value: An Efficient Way to Avoid Unexpected Shocks from the Internet

Nowadays, online public opinions (OPOs) significantly impact corporate brand value (CBV). To prevent corporate brand crises caused mainly by OPOs, it is essential to detect anomalies in OPOs related to corporate reputation in a timely manner. This study explores how dramatic changes in OPOs affect market capital value (MCV), the primary indicator of CBV, and aims to construct a CBV early warning evaluation model. First, a set of OPO indicators dedicated to CBV are selected based on correlation analysis between various popular OPO and CBV indicators collected through a literature review. The method of Criteria Importance Through Intercriteria Correlation (CRITIC) is then employed to determine the indicator weights using data collected from popular social media platforms. Finally, the vector auto-regression (VAR) model is applied to validate the effectiveness of the proposed evaluation model. A case study involving several Chinese enterprises shows that abnormal changes in their MCVs consistently follow abnormal fluctuations observed in their OPOs, with a significant delay. This finding enables managers to promptly detect potential crises from the internet and take actions to avoid unexpected shocks.

Efficiency-Centered Fault Diagnosis of In-Service Induction Motors for Digital Twin Applications: A Case Study on Broken Rotor Bars

The uninterrupted operation of induction motors is crucial for industries, ensuring reliability and continuous functionality. To achieve this, we propose an innovative approach that utilizes an efficiency model-based digital shadow system for in situ failure detection and diagnosis (FDD) in induction motors (IMs). The shadow model accurately estimates IM losses and efficiency across various operational conditions. Our proposed method utilizes efficiency as the primary indicator for fault detection, while losses serve as condition indicators for fault diagnosis based on real-time motor parameters and loss sources. We introduce a bond graph as a fault diagnosis network, linking loss sources, motor parameters, and faults. This interconnected approach is the key aspect of our proposed diagnostic method and aims to be used in fault diagnosis as a general method. A case study of a broken rotor bar is used to validate the proposed method using a dataset of five motors. Among these, one motor operates without failure, while the remaining four exhibit broken rotor faults categorized as 1, 2, 3, and 4. The proposed method achieves 99.99% precision in identifying one to four defective rotor bars in IMs. Comparative analysis demonstrates good performance compared to vibration-based FDD approaches. Moreover, our methodology is computationally efficient and aligned with Industry 4.0 requirements.

Cesarean Section under General Anesthesia over 10 Years at Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: The global surge in cesarean deliveries necessitates safe anesthetic practices to optimize outcomes. While the neuraxial block is the preferred method, specific conditions warrant general anesthesia. This study is aimed to determine the prevalence of cesarean sections under general anesthesia at a tertiary care center. Methods: A descriptive cross-sectional study was conducted on cesarean sections performed between April 14, 2013, and April 13, 2023, at a tertiary care center. Ethical approval was obtained from the Institutional Review Committee (Reference number: 20092023/01). Total sampling was done. Data for the past ten years were manually collected from hospital records using a self-structured proforma and analyzed using Microsoft Excel 2018 and IBM SPSS version 26. The point estimate and 95% confidence interval were calculated for the study. Results: In this study, there were 216 (2.98%) (95% CI: 2.59-3.38%) cesarean sections under general anesthesia in 10 years. Notably, among them, there were 103 (47.69%) primigravida, nullipara 130 (60.19%), 135 (62.50%) with no living children, and 161 (74.54%) without any past abortions. In most cases, 182 (84.26%) were emergency procedures and 34 (15.74%) were elective. Fetal bradycardia with distress was the primary indication observed in 121 (56.02%) cases, followed by 32 (14.81%) maternal requests. Additionally, twenty-one cases were found initially planned as cesarean sections under subarachnoid block but were converted to general anesthesia. The prevalence in this study was found within the recommended limits.Conclusions: The findings highlight that the majority of these procedures were emergency cases, predominantly due to fetal distress, with a notable proportion involving primigravida and nulliparous women.

Contested Ecological Transition in Small and Medium-Sized Cities: The Case of Rochefort, France

In Europe, small and medium-sized cities (SMSCs) face significant challenges related to climate change and environmental degradation. In France, recent governmental measures have sought to accelerate the ecological transition (ET) across its national territory, aiming to meet carbon reduction targets and preserve biodiversity. Since the pandemic, SMSCs have been at the forefront of this ET policy, benefiting from support programmes designed to revitalise neglected city centres. However, several studies have already highlighted that, despite being “tailored” to the specificities of each beneficiary city, these programmes are largely inspired by metropolitan models focused on economic growth and territorial competitiveness. This article aims to highlight that the ET directives applied to SMSCs also derive from practices in larger cities, embodying an “institutionalised” conception of ecology as part of broader attractiveness strategies. An investigation conducted in 2021 in Rochefort (France) demonstrates that ET policies are often utilised as tools for enhancing territorial attractiveness, akin to promoting city tourism and industrial development. Using a mixed-method approach that includes semi-structured interviews and mapping workshops, we will analyse the representations and aspirations of inhabitants regarding the future of their living environment. This will help them envision an ecologically sustainable and socially viable trajectory for their city and ascertain whether it differs from ET policies. The objective of this research is to identify alternative action levers beyond national directives for SMSCs concerning ET, distinguishing them by their unique trajectories, thus revealing other comparative advantages, notably their size and scale as primary ecological indicators.

Postoperative Radiotherapy Using VMAT for RNI Including IMN in Breast Cancer: Report of Short-term Follow-up.

The application of volumetric-modulated arc therapy (VMAT) in postoperative radiotherapy for breast cancer has recently garnered considerable interest, especially when regional lymph node irradiation (RNI), is extended to include the internal mammary node (IMN) region, along with whole-breast or chest wall irradiation. This study aimed to assess both acute and late toxicities, as well as breast cancer outcomes, during the observation period. This retrospective study aimed to assess the safety and feasibility of VMAT in postoperative radiotherapy, including the IMN region, for patients with breast cancer at our hospital. We included 33 eligible patients who received postoperative VMAT radiotherapy, including the IMN region, between November 2018 and July 2021. The primary indications for implementing VMAT were the presence of IMN metastases before primary systemic therapy or more than four axillary lymph node metastases. The median prescribed dose for the chest wall or conserved breast and regional lymph nodes was 50 Gy in 25 fractions. In 16 cases, a simultaneous boost (median, 10 Gy) was administered to residual lymph node metastases. VMAT facilitated a reduction in the mid- or high-dose range to organs at risk, exemplified by V20Gy and V40Gy of the ipsilateral lung, which were 24.10% and 6.84%, respectively, while ensuring adequate target dose irradiation, V45Gy=95.23%. No serious adverse events, including symptomatic radiation pneumonitis, occurred during the 15-month median observation period. Our findings demonstrate the safety and effectiveness of postoperative radiotherapy for breast cancer, including the IMN region, when using VMAT.

Acute Vascular Complications of VA-ECMO in COVID-19 Patients. Does COVID-19 Affect the Outcome?

Extracorporeal membrane oxygenation (ECMO) through the femoral artery and vein can lead to significant vascular complications. We retrospectively studied the acute vascular complications of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in COVID-19 patients compared to non-COVID patients during the period from January 2020 to July 2023. Seventy-eight patients underwent VA-ECMO for various indications from January 2020 to July 2023. The studied patients had a mean age of 59.6 ± 6.9 years for non-COVID patients (38 patients), and 62.2 ± 7.6years for COVID patients (40 patients), with a P = 0.268. In non-COVID patients, The baseline characteristics were similar in both groups. The primary indications for ECMO were cardiac diseases, followed by respiratory failure (78.9% vs 10.5%). Conversely, in COVID patients, respiratory failure due to COVID-19 infection was the main indication (45% vs 40%). The overall incidence of general complications, including cerebrovascular stroke, acute kidney injury, intracardiac thrombi, and wound infection, was comparable in both groups (31.6% vs 45%). The overall incidence of vascular complications in both groups was 33.3%. Ipsilateral acute lower limb ischemia occurred in 5.3% vs 10% of non-COVID and COVID patients, respectively. Thrombosis of the distal perfusion catheter (DPC) occurred in 10.5% vs 15%, respectively. During the COVID-19 pandemic, an increasing number of patients required VA-ECMO due to associated respiratory failure. Patients undergoing VA-ECMO are at high risk of developing various vascular complications. COVID-19 significantly increases the risk of acute limb ischemia and distal perfusion catheter thrombosis in both upper and lower limbs. However, other VA-ECMO-related vascular complications are comparable between COVID-19 and non-COVID patients.

Enterprise Credit Risk Assessment Based on Hybrid Fuzzy Synthetic Evaluation Model

This article uses a hybrid fuzzy synthetic evaluation model to evaluate the credit risk of Shouguang vegetable enterprises, and designs four risk levels: impact degree, occurrence probability, risk manageability and government support level. The model uses average score technology to calculate the scores of secondary indicators, primary indicators and evaluation targets at each level, uses sorting technology to sort secondary indicators and primary indicators at each level, and uses fuzzy synthetic evaluation technology to construct Shouguang enterprise credit risk evaluation. The model uses the geometric mean method to calculate the comprehensive score, and summarizes the comprehensive score results to make decisions. Among them, the data in this article comes from a questionnaire, which was completed by a total of 41 professionals who have a better understanding of the credit risks of Shouguang vegetable companies Through calculation, the comprehensive credit risk score of Shouguang Vegetable Enterprise is 2.8585. The risk is medium risk. Banks can lend based on the operation of specific enterprises. The calculation results also show that the risk assessment results at different levels are not completely consistent. The main first-level risk indicators at the first three levels are "enterprise technological innovation" and "enterprise financial status", and the main first-level risk indicators at the last level are "Enterprise management level" and "enterprise development plan". Indicators related to corporate technological innovation and financial status are the main influencing indicators of the credit risk of Shouguang vegetable companies.

Construction and Analysis of New Quality Productivity Evaluation Index System in Shanghai

The development of new quality productivity is a significant strategic decision focused on high-quality economic development. Shanghai, as an influential international metropolis, leads the nation in scientific innovation, technological innovation, and industrial innovation, playing a pioneering and demonstrative role in promoting new quality productivity. This paper constructs an evaluation index system by collecting relevant data on new quality productivity from authoritative websites and integrating these data to present and analyze the evaluation index system for new quality productivity in Shanghai. The constructed evaluation index system comprises four primary indicators: scientific and technological innovation, industrial development, talent, and green development, along with corresponding secondary indicators. The study reveals that although there is room for improvement in innovation efficiency in Shanghai, the city shows a positive development trend in new quality productivity, particularly in the number of high-tech enterprises and investment in scientific research. This paper aims to provide a comprehensive understanding of the development status of new quality productivity in Shanghai and offer reference value for analyzing new quality productivity nationwide.

Clinical Practices and Opinions toward Gastrostomy Use in Patients with Atypical Parkinsonian Syndromes: A National Survey in the UK.

Severe dysphagia poses a significant challenge for clinicians regarding feeding tube choices, practices, and timing due to a lack of evidence-based guidance. To assess national clinical practices and opinions on gastrostomy use in patients with atypical parkinsonian syndromes (APS) across the UK. Online survey was administered to clinicians and allied health professionals regarding availability of services, current use, perceived advantages, and problems associated with gastrostomy insertion. We received responses from 47 respondents across 12 UK centers, including 44 clinicians specialized in APS. Consensus was observed regarding primary indications for gastrostomy insertion and circumstances justifying avoidance of the procedure. Limitations in recommending gastrostomy due to insufficient evidence on safety and outcomes, survival and quality of life were identified. Widespread agreement on delays in gastrostomy discussions was highlighted as a challenge in optimizing patient care, together with variability in current practices and concerns over the lack of a standardized gastrostomy pathway, emphasizing the need for further research to address existing evidence gaps. This multi-center survey highlights agreement among clinicians on key aspects of indication, challenges, and limitations such as delayed decision-making and the absence of standardized pathways regarding the timing, method, and overall approach to gastrostomy insertion in APS. This study identified next steps to facilitate a more structured approach to future research toward a consensus on best practices for gastrostomy in APS. Addressing these challenges is crucial for enhancing patient outcomes and overall care quality in APS.

The effect of type 2 diabetes mellitus on lid wiper epitheliopathy and ocular surface parameters

IntroductionThis cross-sectional study was conducted to investigate the impact of type 2 diabetes mellitus(DM) and its duration on indicators such as lid wiper epitheliopathy(LWE), and to assess the significance of LWE for early diagnosis of dry eye disease(DED) in DM patients. MethodsA total of 137 subjects with ocular surface disease index(OSDI) score ≥13 were divided into the non-DM group, the short-term DM group (duration <5 years), and the mid-to-long-term DM group(duration ≥5 years). Evaluations were conducted for LWE, OSDI, lipid layer thickness (LLT), partial blinking rate (PBR), fluorescein tear breakup time (FTBUT), corneal fluorescein staining score (CFS), eyelid margin score, and meibomian gland dropout (MGd). ResultsThe upper-LWE score and total LWE score in the mid-to-long-term group were higher than those in the non-DM group (p = 0.008 and p = 0.031, respectively). The lower-LWE scores were more severe than upper-LWE scores in the non-DM and short-term groups (p = 0.001 and p = 0.045, respectively).The confirmed diagnosis rate of DEWSII dry eye with LWE as the primary diagnostic indicator was significantly higher than that which utilize FTBUT<5s as the primary diagnostic indicator(p < 0.05). Compared to the non-DM group, the LLT was thinner and the MGd was more severe in the mid-to long-term group. The upper-LWE score was moderately positively correlated with the MGd, and the lower LWE score was moderately negatively correlated with LLT. ConclusionLWE, LLT, and MGd worsen with the progression of diabetes. Additionally, changes in LWE may precede the FTBUT, indicating that LWE could be considered as an important indicator for early diagnosis of DED in diabetic patients.

The effects of climate change and regional water supply capacity on integrated drought risk

Due to climate change, the frequency and duration of meteorological drought have increased. In addition, local water supply capacity has not met water demand in many regions, which will eventually lead to serious water shortages. To mitigate the effects of drought on sustainable water use, it is necessary to understand how climate change affects regional water supply capacity and drought risk. To this end, this study evaluated the drought response capacity of regional water supply systems and assessed the comprehensive drought risk in terms of drought hazard, vulnerability, and response capacity. To avoid subjectivity in risk analysis, structural equation modeling was used to select primary indicators and probability and statistical methods were used to assign weights to the indicators. The changes in drought risk in different climate change scenarios were assessed using sensitivity analyses. The overall results indicate that the future drought risks in Gyeonggi, Gyeongsang, Chungcheong, Jeolla, and Gangwon are 18, 12, 13, 9, and 10% higher, respectively, than the current risk level. The sensitivity analyses showed that Jinju in Gyeongsang province, which has a high drought response capacity, had the largest decreasing rate in drought risk. The quantified changes in drought risk under future climate change scenarios will be useful for identifying areas with a high drought risk and making decisions about drought mitigation under climate change.

The effect of probiotics on severe oral mucositis in cancer patients undergoing chemotherapy and/or radiotherapy: A meta-analysis

PurposeOral mucositis is a frequent adverse reaction in cancer treatment. Probiotics exhibit anti-inflammatory and immunomodulatory properties that could prevent the occurrence of severe oral mucositis (SOM) induced by chemotherapy or radiation therapy in patients. This meta-analysis aimed to investigate the influence of probiotics on the incidence of SOM in cancer patients undergoing chemotherapy and/or radiotherapy. MethodsWe conducted a comprehensive search in PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) from their inception to September 2023. Dichotomous variables are analyzed with odds ratios (ORs) with 95% CIs, and statistical significance was set at a two-tailed P <0 .05. The primary outcome indicator was the effect of probiotics on SOM. Secondary outcome indicators included the effect of probiotics on oral mucositis and the ratio of diarrhoea. Statistical analysis was conducted using RevMan (5.4) and Stata 17.0 software. ResultsThe study included a total of 12 articles and involved 1055 patients. All patients had undergone either radiotherapy or chemotherapy. Our findings revealed that the experimental group, which received probiotics for treatment, exhibited a lower ratio of SOM compared to the control group that received traditional placebo treatment (OR=0.37, 95%CI [0.28, 0.50], P<0.01). Subgroup analysis revealed variations in the ratio of SOM based on therapeutic regimen, tumor type, and region. The overall ratio of oral mucositis was significantly lower in the experimental group compared to the control group (OR=0.19, 95%CI [0.09-0.39], P<0.01). The ratio of diarrhea in the two patient groups showed no significant difference (OR=0.85, 95%CI [0.24, 3.01], P>0.05). ConclusionThe results of this meta-analysis suggest that probiotics could decrease the occurrence of SOM.

Research on Supplier Selection of Pharmaceutical Enterprises under the Dual Carbon Target

With the proposal of national carbon peak and carbon neutrality targets, green supply chain management has become one of the important means of reducing carbon emissions. Based on elaborating on the connotation of new quality productivity, this article analyzes the supplier selection problem of pharmaceutical enterprises under the dual carbon target. A pharmaceutical supplier evaluation index system has been established from five aspects related to low-carbon and environmental protection, including technological innovation, research and development capabilities, digitization, intelligent production, environmental protection technology, and so on, with five primary indicators and 18 secondary indicators. Secondly, a game theory combination weighting method combining the G1 method and entropy weight method is used to determine the weights of indicators. A pharmaceutical supplier evaluation model is established by combining the matter element extension model. A company is used as an example to evaluate its 8 candidate suppliers and select the best supplier. Finally, corresponding measures are proposed to promote the healthy and sustainable development of pharmaceutical enterprises.

Same-day discharge coronary interventions: How to succeed?

Percutaneous coronary interventions(PCI) are the cornerstone of treatment in patients with coronary artery disease, generating substantial costs for the healthcare system. Considerable improvement in PCI technique, stent technology and antiplatelet therapy led to a complication rate of <5%, a success rate of >95% and lack of routine cardiothoracic surgical support. Thereby, the concept of same-day discharge following PCI has been proposed due to comparable efficacy, safety, and socioeconomic benefits to inpatient PCI. Although single-vessel disease was the primary indication for outpatient (OP) PCI, more complex scenarios such as multivessel disease, left main disease and chronic total occlusions were shown to be feasible and safe in OP setting as well. Currently available data shows that OP PCI leads to cost optimization, increased PCI center capacity, decrease in nosocomial infections rate and increased patient satisfaction, along with good clinical outcomes. Although OP PCI seems promising in a subset of well-prepared and compliant patients without severe comorbidities, there are some challenges to overcome before its routine implementation. To prevent unnecessary hospitalizations and unsafe same-day discharges, interventional cardiology teams should be trained to perform reliable risk-benefit assessments. Standardized forms should be created to obtain informed consent and instruct OP PCI patients and their relatives about postprocedural management. Here, we summarize the available data on OP and inpatient PCI outcomes, discuss the opportunities and challenges of OP PCI and propose a periprocedural patient management checklist, with the goal of facilitating OP PCI implementation in interventional cardiology centers.

Pacing strategies in marathons: A systematic review

BackgroundThe pacing strategy embodies the tactical behavior of athletes in distributing their energy across different segments of a race; therefore, a quantitative analysis of pacing strategies in marathon races could deepen the understanding of both pacing behavior and physical capacity in marathon athletics. ObjectiveThe objective of this systematic review was to synthesize and characterize pacing strategies in marathon road races by exploring the categories of pacing strategies and the factors that influence these strategies during marathon events. MethodsPreferred Reporting Items for Systematic Reviews guidelines were followed for systematic searches, appraisals, and syntheses of literature on this topic. Electronic databases such as Science Direct, SPORTDiscuss, PubMed, and Web of Science were searched up to July 2024. Records were eligible if they included pace performance measurements during competition, without experimental intervention that may influence their pace, in healthy, adult athletes at any level. ResultsA total of 39 studies were included in the review. Twenty-nine were observational studies, and 10 were experimental (randomized controlled trials). The assessment of article quality revealed an overall median NOS score of 8 (range 5–9). The included studies examined the pacing profiles of master athletes and finishers in half-marathon (n = 7, plus numbers compared to full marathon), full-marathon (n = 21), and ultramarathon (n = 11) road races. Considering that some studies refer to multiple pacing strategies, in general, 5 studies (∼13 %) reported even pacing, 3 (∼8 %) reported parabolic pacing, 7 (∼18 %) reported negative pacing, and 30 (∼77 %) reported positive pacing during marathon competitions. Gender, age, performance, pack, and physiological and psychological factors influence pacing strategies. ConclusionThis study synthesized pacing performance in marathons and highlighted the significance of examining pacing strategies in these events, offering valuable insights for coaches and athletes. Several key findings were highlighted: (1) pacing profiles and pacing ranges were identified as the primary indicators of pacing strategies; (2) the pacing strategy was found to be dynamic, with the most substantial effects attributed to gender and distance; and (3) three distinct types of pacing strategies for marathons were classified: positive, negative, and even pacing. These findings advance the understanding of marathon pacing strategies by shedding light on the factors that influence athletes’ pacing decisions and behaviors. Additionally, these findings offer practical benefits, aiding athletes in making well-informed tactical choices and developing effective pace plans to enhance marathon performance. However, due to the complex nature of marathon racing, further research is required to explore additional factors that might impact pacing strategies. A better grasp of optimal pacing strategies will foster progress in this area and serve as a basis for future research and advancements.

A novel hybrid features grey incidence model and its application in identifying key factors influencing air pollution in Jiangsu Province

Accurately assessing the key factors influencing air pollution is crucial for effective air pollution control. To address this need, we propose a novel Hybrid Features Grey Incidence Model (HFGIM), which integrates geometric feature differences from both proximity and similarity perspectives. Firstly, we extract geometric feature difference vectors of proximity and similarity from time series data and measure the overall feature difference degree by calculating vector norms. Secondly, we calculate the relative feature differences and information contribution rates of proximity and similarity to derive the hybrid feature differences coefficient between sequences, thereby obtaining the hybrid features incidence degree. After detailing the model’s properties and modelling steps, we introduce the Cross-sectional Data Hybrid Features Grey Incidence Model (C-HFGIM) and the Panel Data Hybrid Features Grey Incidence Model (P-HFGIM) for handling cross-sectional and panel data, respectively. Applying HFGIM, we identified the key pollutants and primary pollution source indicators of air pollution in Jiangsu Province. We also compared HFGIM with other classical grey incidence models to verify the proposed model’s effectiveness. Based on the analysis results, we propose policy recommendations for air pollution control in Jiangsu Province.