Effective Rate Research Articles

Correlation Analysis of Serum 25-Hydroxyvitamin D Levels With Immune Function and Calcium-Phosphate Metabolism in Patients With Bronchial Asthma Treated With Combination Therapy

It was to investigate the clinical efficacy of the combination therapy of fluticasone propionate inhalation aerosol and vitamin D (VD) in pediatric bronchial asthma (BA) and analyze the correlation between serum 25-(OH)-D3 levels and immune function, as well as calcium-phosphorus metabolism. A total of 110 patients with BA were recruited. Regarding treatment plan, patients were randomly rolled into a single-drug treatment group (SDT, treated with fluticasone propionate inhalation aerosol alone) and a dual-drug treatment group (TDT, treated with the combination of fluticasone propionate inhalation aerosol and VD). The changes in serum 25-(OH)-D3 levels, immunoglobulins, T lymphocyte subsets, and inflammatory cytokine levels in children with BA under different treatment modalities were compared. Clinical symptom disappearance, asthma control, and quality of life (QoL) were assessed, and the total effective rate and adverse reactions (ARs) were compared. A control group consisting of 60 healthy children who underwent concurrent physical examinations was included. The differences in serum 25-(OH)-D3 levels, immunoglobulins, and T lymphocyte subset levels between children with BA and healthy controls were compared, and their correlations were analyzed. The TDT group showed a drastic reduction in the disappearance time of lung wheezing and dyspnea relative to the SDT group. Furthermore, the TDT group exhibited notable improvements in lung function parameters, including forced vital capacity (FVC), forced expiratory volume at one second (FEV1), FEV1/FVC, and peak expiratory flow (PEF). Blood gas analysis revealed a great decrease in PaCO2 and an increase in PaO2. The Childhood Asthma Control Test (C-ACT) scores for asthma control and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores for QoL showed marked increases in the TDT group. Moreover, the TDT group demonstrated notable increases in serum 25-(OH)-D3 levels, immunoglobulins (IgA, IgG, and IgM), T lymphocyte subsets (CD4+ and CD8+), as well as blood calcium and phosphorus levels. Additionally, the TDT group exhibited a prominent increase in the anti-inflammatory cytokine interleukin (IL)-10 level and a drastic decrease in the pro-inflammatory cytokines IL-6 and tumor necrosis factor alpha (TNF-α) levels (all P<0.05). The total effective rates of treatment in the SDT group and TDT group were 83.64 % and 96.36 %, respectively, with AR rates of 16.36 % and 7.27 %. The TDT group exhibited a superior total effective rate and an inferior incidence of ARs to the SDT group (both P<0.05). Additionally, in contrast to the control group, the BA group showed notable decreases in serum 25-(OH)-D3 levels, immunoglobulins (IgA, IgG, and IgM), T lymphocyte subsets (CD4+, CD8+, and CD4+/CD8+), as well as blood calcium and phosphorus levels (all P<0.05). Prior to treatment, there was a positive correlation between serum 25-(OH)-D3 levels and immunoglobulins (IgA, IgG, and IgM), T lymphocyte subsets (CD4+ and CD8+), as well as blood calcium and phosphorus levels in children with BA (P<0.05). In patients with BA, combined treatment with inhaled fluticasone propionate aerosol and VD may have a regulatory effect on serum 25-hydroxyVD levels, immune function, and calcium-phosphate metabolism. The correlation between serum 25-(OH)-D3 levels and immune function, as well as calcium-phosphate metabolism, suggested that VD may play a crucial role in the immune regulation and calcium-phosphate metabolism of BA.

Analysis of the nursing effect of five-tone therapy combined with acupoint massage on chemotherapy of lung cancer.

The use of complementary therapies to relieve the side effects of chemotherapy in lung cancer patients is becoming increasingly popular. Practices from traditional Chinese medicine, such as acupoint massage and five-tone therapy, have demonstrated potential in alleviating symptoms such as nausea and vomiting experienced during chemotherapy. This study aims to determine the effectiveness of combining five-tone therapy with acupoint massage in reducing chemotherapy-related symptoms in lung cancer patients. The main objective is to determine how these complementary therapies affect the quality of life and well-being of people undergoing chemotherapy for lung cancer. In this paper, 80 patients diagnosed with lung cancer who needed chemotherapy drugs were randomly divided into 2 groups, 40 patients. The first was treatment; the second was control. Chemotherapy drugs were combined with a 5-hydroxytryptamine blocker (granisetron), and acupoint massage was combined with pentatone therapy to prevent nausea, vomiting, and other gastrointestinal reactions. A 5-hydroxytryptamine blocker (granisetron) was combined with chemotherapy drugs to prevent nausea, vomiting, and other gastrointestinal reactions. Moreover, the difference in treatment effect was observed. Among 40 cases in treatment, 13 cases were clinically controlled, 15 cases were markedly effective, 9 cases were effective, and 3 cases were ineffective. The total effective rate was 92.50%; among 40 cases in control, 6 cases were clinically controlled, 16 cases were markedly effective, 12 cases were practical, and 6 cases were invalid. The total effective rate was 85.00%. By integrating traditional Chinese medicine techniques, healthcare professionals can augment the supportive care offered to those undergoing chemotherapy for lung cancer.

Clinical effects of anweiyang capsule and Pinellia decoction for eradication of Helicobacter pylori and healing of peptic ulcers

Peptic ulcers are a prevalent and often chronic condition within the digestive system, frequently prone to recurrence. This study aims to evaluate the clinical effects of Anweiyang capsule combined with Pinellia Heart-Draining Decoction on Helicobacter pylori eradication, ulcer healing rates, and improvement of Traditional Chinese Medicine (TCM) syndromes in patients with peptic ulcers. A total of 100 patients were randomly assigned to an observation group (n = 50), receiving the herbal combination, and a control group (n = 50), receiving standard Western medical treatment. The total effective rate was significantly (P < 0.05) higher in the observation group (96%) compared to the control group (80%). After 4 weeks of treatment, serum procalcitonin (PCT) and C-reactive protein (CRP) levels decreased, while prostaglandin E2 (PGE2) levels increased in both groups; however, the observation group exhibited better results (P < 0.05). The observation group achieved a H. pylori eradication rate of 94% and an ulcer healing rate of 82%, compared to 64% and 56% in the control group, respectively. Improvement in TCM syndrome scores was more significant in the observation group (P < 0.05). Moreover, the incidence of adverse reactions was significantly (P < 0.05) lower in the observation group (4%) compared to the control group (18%). In conclusion, Anweiyang capsule combined with Pinellia Heart-Draining Decoction significantly enhances the eradication rate of H. pylori and the ulcer healing rate without substantially increasing the risk of adverse reactions, demonstrating its safety and reliability for patients.

Therapeutic effect of proprioceptive neuromuscular facilitation combined with muscle energy technique on post-stroke dysphagia.

According to the Global Burden of Disease Study the prevalence of stroke worldwide has significantly increased from 1990 to 2019, making it the second leading cause of death worldwide. Approximately 70%-80% of stroke patients are unable to live independently due to disability. To explore the therapeutic effect of proprioceptive neuromuscular facilitation (PNF) combined with muscle energy technique (MET) on post-stroke dysphagia. A total of 122 stroke patients with dysphagia admitted to our hospital from January 2017 to December 2020 were divided into the control group (n= 61) and the study group (n= 61). Patients in the control group received conventional rehabilitation plans, while those in the study group were given a combined therapy of MET and PNF. Standard Swallowing Function Assessment Scale (SSA), Videofluoroscopic Swallow Study (VFSS), Swallowing Quality of Life (SWAL-QOL) scores, Water Swallow Test (WST) grading, and efficacy indicators were compared between two group with t-tests, Wilcoxon signed-rank test, χ2 test or Fisher's exact probability test. After treatment, the study group showed lower SSA score (P= 0.036), and VFSS, P= 0.013 than the control group. The changes in SSA score (P= 0.013) and VFSS score (P< 0.001) in the study group were greater than the control group. Furthermore, after treatment, both the study group and the control group showed a decrease in WST grading (P< 0.001); and the degree of post-treatment WST grading decline in the study group was higher (P= 0.009). Besides, after treatment, the SWAL-QOL score of the study group was higher than the control group (P< 0.001); and the effective rate of patients in the study group was higher than that in the control group (P= 0.021). Compared with traditional rehabilitative training strategies, PNF combined with MET can effectively improve swallowing function, and enhance the quality of life in patients with post-stroke dysphagia.

Experimental investigations on ultrasonic elliptical vibration turning of SiCp/Al composites

ABSTRACT This study identifies key factors affecting SiCp/Al surface formation in ultrasonic elliptical vibration assisted turning (UEVT) and conventional turning (CT) by scratch tests, end face cutting experiments and theoretical analysis. It also evaluates cutting parameters’ effects on deformation of SiCp/Al. Experimental findings underscore theimportance of vibration effect and removal rate. At lower cutting speeds, the ironing effect results in a dense morphology during UEVT that is advantageous for enhancing both surface quality and microhardness. The high removal speed increases the particle-tool interaction, promotes the generation and propagation of cracks indeformation zone. Specifically, at a reasonable cutting speed (200 mm/min), the utilization of vibration results in a 59% reduction in surface roughness and a commendable enhancement in microhardness, coupled with a significant suppression of tool wear. The results of this study are expected to provide positive theoretical recommendations for improving the machinability of SiCp/Al in UEVT.

Capabilities and limitations of smoothed particle hydrodynamics for the simulation of two‐phase flow instabilities

AbstractSmoothed particle hydrodynamics (SPH) is a mesh‐free, Lagrangian particle‐based method that is able to simulate multiphase flows in an economical manner. However, its ability to capture the flow regimes and regime transitions in two phase (liquid‐gas) internal flows, such as pipe or channel flows is not yet generally established. To address this lack in understanding, we first examine a laminar rising bubble case in order to evaluate the fluid‐fluid interface representation and transient interface evolution by the solver. With a focus towards the transition mechanism from a stratified flow regime to a slug flow regime, we investigate the Kelvin–Helmholtz instability (KHI) both qualitatively and quantitatively, initially focusing on a low density ratio () and then extending it to a high density ratio (). For the low density ratio, we conduct an analysis of the temporal evolution and demonstrate that the SPH solver captures the initial exponential growth in qualitative agreement with inviscid linear stability theory (LST) and reference numerical data for shear‐dominated flow with Richardson number . By conducting eight additional simulations for various for the high density ratio, we demonstrate that the numerically obtained parameter value for instability is around , which is in reasonable agreement with the theoretically expected value of . Based on the SPH results obtained for the range , we suggest a simple parameterization of the reduction of the effective growth rate proportional to .

Effect of Intravitreal Bevacizumab (Anti VEGF) Injection on Renal Function

Background: Vascular endothelial growth factor (VEGF) plays an important role in the development of both Proliferative Diabetic Retinopathy (PDR) &amp; Diabetic Macular Odema (DMO). An intravitreal anti-VEGF agent is an effective new modality of treatment. Some studies have dealt with systemic effects of intravitreal injection of anti-VEGF. However, decreasing renal function has been reported recently. Aims: To investigate the effect of intravitreal bevacizumab (anti VEGF) injection on renal function. Methods: This quasi-experimental study was carried out in the Department of ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, during March 2019 to August 2021. A total of 40 patients with retinopathy treated with intravitreal injection bevacizumab were included in this study, out of which 20 patients having diabetic kidney disease (DKD) and rest 20 patients without diabetic kidney disease (No DKD). The patients having Diabetic Kidney Disease (DKD) whose Urinary Albumin Creatinine Ratio (UACR) &gt; 30 mg/g or Effective Glomerular Filtration Rate (eGFR) &lt; 60mL/min/1.73m2, No Diabetic Kidney Disease (No DKD) whose UACR &lt; 30 mg/g or eGFR &gt; 60mL/min/1.73m2. Patients of both sexes and age above 18 years were enrolled in this study. Pre- injection and 1 month after 3rd dose of intravitreal injection of bevacizumab, UACR, Serum Creatinine and eGFR were measured and compared. Results: It was observed that half (50.0%) of the patients in DKD and more than half (65.0%) in No DKD belonged to age group 50-59 years. Male was predominant in both the groups. The mean pre-injection of serum creatinine was 1.23±0.53 mg/dl in DKD and 0.87±0.22 mg/dl in No DKD. The mean post-injection of serum creatinine was 1.19±0.45 mg/dl in DKD and 0.87±0.16 mg/dl in No DKD. The mean pre-injection of UACR was 1294.9±968.26 mg/g in DKD and 13.8±5.99 mg/g in No DKD. The mean post-injection of UACR was 1142.11±1024.06 mg/g in DKD and 13.01±6.87 mg/g in No DKD. The mean difference of serum creatinine, eGFR and UACR were not significant (p&gt;0.05) between pre-injection and post-injection in both groups. Conclusion: Serum creatinine, eGFR and UACR were almost similar between pre-injection and post-injection in patients with diabetic kidney disease (DKD) and patients without diabetic kidney disease (No DKD).

Male infertile couples: an actor-partner interdependence model of attachment styles and fertility pressure

BackgroundCouples undergoing artificial insemination by donor semen(AID) represent a unique group of infertility patients, the relationship between fertility pressure and attachment styles remains unclear. To investigate the fertility pressure and attachment dimensions in artificial insemination by donor semen(AID) couples, and develop an Actor-Partner Interdependence Model (APIM) for patient care.MethodsThis study is a cross-sectional study. From June to September 2021, couples who were about to receive AID treatment in our hospital were assessed using the Fertility Problem Inventory, and the Experiences in Close Relationships(ECR). Dyadic analysis applying the APIM was used.ResultsA total of 448 valid questionnaires were recovered, the effective response rate was 94.9%. The average score of men’s fertility pressure was higher than that of women’s(P = 0.021). The score of male attachment anxiety was higher than that of females(P = 0.038). Attachment avoidance(β = 0.46) and attachment anxiety(β = 0.33) in wives significantly impacted their fertility pressure. Attachment avoidance(β = 0.17) and attachment anxiety(β = 0.52) in husbands significantly impacted their fertility pressure. The attachment avoidance of wives’ had a significant impact on the husbands’ fertility pressure(β = 0.11).ConclusionOverall, the study revealed that in the couples who use donor sperm to expect pregnancy, the male has higher fertility pressure. Insecure attachment can cause more severe fertility pressure, fertility pressure is also affected by one’s partner.

The relationship between fixed dental prostheses, blood lead levels, and liver function: Mediating effects and gender differences

Metal alloys, pure titanium, metal-ceramics, and ceramic materials are used for fixed dental prostheses, which contained lead and potentially involved hepatotoxicity. To investigate the connection between fixed dental prostheses, blood lead levels, and liver function. A cross-sectional study enrolled 3624 American adults were conducted. Multivariate linear regression models and smooth curve fittings were used to describe correlations between the number of fixed dental prostheses, blood lead levels, and four liver function markers. Mediation analysis suggested an intermediary association of blood lead levels between prosthesis count and liver function. Here, number of fixed dental prostheses was significantly positive correlated with blood lead levels (p < 0.0001), but specifically negative correlated with alanine aminotransferase, lactate dehydrogenase, and gamma glutamyl transferase levels in males. Moreover, mediation analysis confirmed a mediating role for blood lead levels in the association between the number of prostheses and alanine aminotransferase levels in males only, with a mediation effect rate of 74.27% (p = 0.0020). An increased count of fixed prostheses is associated with changes in liver function markers in a gender-dependent manner, with blood lead levels serving as a potential mediator in males.

PENGARUH UKURAN PERUSAHAAN, PROFITABILITAS, DAN LEVERAGE TERHADAP TARIF PAJAK EFEKTIF (Studi Kasus pada Sektor Energi yang Terdaftar di Bursa Efek Indonesia Periode 2019-2022)

Taxes are one of the biggest contributions for the country. Therefore, the government tries to maximize tax revenue to finance the country's development needs. However, this is contrary to the company's objectives, which want the company's effective tax rate to decrease further away from the statutory tax rate. This research aims to know the effect of firm size, profitability, and leverage on effective tax rate. The sample selection used a purposive sampling technique and obtained 52 samples. Data analysis using multiple linear regression analysis with the IBM SPSS version 26 program. The research results show that firm size has a positive effect on the effective tax rate, profitability and leverage have a negative effect on the effective tax rate. Simultaneously company size, profitability and leverage influence the effective tax rate.

Systematic review of Buzhong Yiqi method in alleviating cancer-related fatigue: a meta-analysis and exploratory network pharmacology approach

ObjectivesCancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by many cancer patients, necessitating effective treatments. This study utilizes meta-analysis and network pharmacology to comprehensively assess the efficacy of the Buzhong Yiqi prescription in alleviating cancer-related fatigue and to preliminarily explore the mechanism of its core drugs.MethodsWe included randomized controlled trials (RCTs) in cancer patients. The inclusion criteria encompassed a diagnosis of cancer-related fatigue, without limitation on cancer type, the experimental group receiving Buzhong Yiqi prescription, the control group receiving conventional treatment, patients awaiting treatment, and articles published in either English or Chinese. We conducted a search through 29 February 2024, across PubMed, Cochrane Database of Systematic Reviews, Cochrane Controlled Clinical Trials (CENTRAL), China Biomedical Literature Service (CBM), China National Knowledge Infrastructure (CNKI), WANFANG Database, and Weipu Database (VIP). Journal articles that met the inclusion criteria were selected for inclusion. Two independent investigators evaluated the quality of the included studies. A meta-analysis was performed utilizing the Stata 12.0 software package, where estimates of cancer-related fatigue were aggregated through the application of a random-effects model. We employed the Cochrane Risk of Bias Tool to evaluate potential biases in RCTs. The primary outcome measures utilized to assess the efficacy and safety of CRF treatment comprised the Revised Piper Fatigue Scale (PFS-R) and the Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The secondary outcomes encompassed the KPS score, the effective rate, the TCM syndrome score, and an evaluation of adverse reactions. The Traditional Chinese Medicine Systems Pharmacology (TCMSP) was utilized to identify the active ingredients and targets of BZD. Additionally, the Drug bank, Therapeutic Target Database (TTD), DiaGeNET, and GeneCards databases were utilized to retrieve relevant targets for CRC. The Venn diagram was employed to identify overlapping targets. Cytoscape software was utilized to construct a network of “herb-ingredient-target” and identify core targets. GO and KEGG pathway enrichment analyses were performed using R language software.ResultsIn comparison to the control group, patients with CRF who received BZYQ prescription exhibited marked improvements in KPS score, QLQ-C30 quality of life score, and effective rate. Conversely, PFS, TCM syndrome score, and adverse reaction assessments significantly decreased. The primary active ingredients in its core drugs may exert a positive therapeutic effect on CRF by targeting molecules such as AKT1, IL6, IL1B, PTGS2, CASP3, ESR1, and BCL2, as well as through signaling pathways including TNF, IL17, TLR, NF-κB, and C-type lectin receptor.ConclusionBZYQ demonstrates significant efficacy in treating CRF with minimal adverse reactions. It can serve as a fundamental treatment for CRF in clinical practice, and the medication can be tailored to individual patients for personalized therapy. The potential pharmacological mechanism of BZYQ in treating CRF, as predicted by network pharmacology, offers a molecular foundation for clinical CRF treatment.Systematic Review Registration:https://inplasy.com, identifier INPLASY202430025

Reduction of arrival time jitter or energy spread with arclike variable bunch compressors

Synchronizing free-electron laser pulses for time-resolved experiments is necessary as an unsynchronized system reduces the effective repetition rate of the experiment. Additionally, free-electron laser longitudinal coherence and spectral brightness are limited by electron beam energy spread. In this paper, a variable bunch compressor design and compression schemes were developed to: reduce klystron-induced arrival time jitter by 85% while preserving peak current and transverse emittance and to minimize electron beam correlated energy spread for potential self-seeding or HB-SASE modes. Published by the American Physical Society 2024

Past and Recent Progress on Metallic Digestive Tract Stents.

The implantation of digestive tract stents at various lesion sites can effectively improve digestive tract patency, opening up an excellent treatment method for diseases that are currently incurable or resistant to conventional surgery. Digestive tract stents have been extensively studied and widely used worldwide due to their unique advantages of simple implantation, low trauma, satisfactory effect, and low complication rate. Among the various types of stents, metallic stents have been developed to improve surgical efficacy due to their excellent mechanical properties and are constantly being improved. This review provides an overview of the design and development of conventional nonbiodegradable metallic digestive tract stents such as nitinol (NiTi alloy), stainless steel, and cobalt-based alloy stents. Furthermore, biodegradable metallic stents for the digestive tract, such as magnesium-based, iron-based, and zinc-based stents, are described. This paper also evaluates the advantages and disadvantages of existing metallic digestive stents as well as future research directions and challenges in the development of metallic digestive tract stents.

Minimized‐rate topramezone programs for goosegrass [Eleusine indica (L.) Gaertn.] control in Florida

AbstractGoosegrass [Eleusine indica (L.) Gaertn.] is one of the most troublesome warm‐season grassy weeds in subtropical climates of the southern United States. Currently, postemergence options are highly limited, and goosegrass control (GC) becomes more difficult as plants mature. Among current options, topramezone can control mature goosegrass. Research conducted in Florida suggests that despite seemingly effective control, recovery may be occurring from surviving roots. Therefore, this study assessed strategies aimed to ensure the persistent removal of mature goosegrass populations of Florida ecotypes. Two greenhouse studies were conducted to evaluate the response of goosegrass at one to three tillers and 4–10 tillers to topramezone applied once at rates from 0.8 to 12.2 g a.i. ha−1 (study 1) and at total rate reduced to 6.1 g a.i. ha−1 applied once or equally divided into two, four, or eight biweekly applications (study 2). Single topramezone applications at 6.1 g a.i. ha−1 provided comparable GC and biomass reduction to single applications at 12.2 g a.i. ha−1. Reduced rate‐based split‐programs of two and four biweekly applications improved GC and its persistence over a single application as evidenced by a &gt;250 increase in GC area under the progress curve and a &gt;20 days increase in days over 80% GC. Among the proposed extended application programs based on the reduced effective rate of topramezone, the most promising consists of four biweekly applications at a 0.125× rate, equivalent to 1.53 g a.i. ha−1.

Hydrodissection technique for pain relief during peri-microwave ablation in patients with subpleural non-small cell lung cancers.

This study aimed to assess the application value of the hydrodissection technique (HT) for pain relief during peri-microwave ablation (MWA) in patients with subpleural non-small cell lung cancers (NSCLCs). This retrospective study comprised 218 patients with subpleural NSCLCs who underwent computed tomography (CT)-guided percutaneous MWA. The patients were divided into two groups: HT-assisted MWA (HT group) and local pleural anesthesia (LPA)-assisted MWA (LPA group). Differences in the effective rates of pain relief during MWA, visual analog scale (VAS) scores post-MWA, complications, and complete ablative rates were assessed. The HT group comprised 101 patients (62 males and 39 females; mean age, 61.93 ± 10.57 years), while the LPA group comprised 117 patients (66 males and 51 females; mean age, 62.95 ± 11.16 years). The effective rate of pain relief in the HT group (82/101 patients, 81.19%) was significantly higher than that in the LPA group (66/117 patients, 56.41%), (p < 0.0001). The VAS scores at 6, 12, 24, and 48 h post-MWA were not statistically different between the two groups. The incidence of pneumothorax (grade ≥3) was significantly lower in the HT group (11/101 patients, 10.89%) than in the LPA group (27/117, 23.07%), (p = 0.0161). The complete ablative rates at 1, 3, 6, 12, and 24 months post-MWA were comparable of two groups. These results indicate that HT-assisted MWA of patients with subpleural NSCLCs could effectively provide pain relief and decrease the occurrence of pneumothorax, yielding a satisfactory local therapeutic response.

Perceived Social Support and Depression, Anxiety and Stress in Pregnant Women Diagnosed With Foetal Anomaly.

To examine the relationship between perceived social support level and depression, anxiety and stress in pregnant women diagnosed with foetal anomaly. This descriptive and correlational study was conducted in an advanced prenatal evaluation unit of a university hospital between December 2021 and May 2022. The study data collected from 131 pregnant women through a personal information form, depression, anxiety and stress scale (DASS-42) and multidimensional scale of perceived social support (MSPSS). Most of the pregnant women were in the second trimester of pregnancy, and more than half had been advised by a healthcare professional to terminate their pregnancy. Overall, the pregnant women reported moderate levels of social support, while their depression, anxiety and stress levels varied. There was a weak negative correlation between perceived social support from family, friends and multidimensional sources with stress, but the effect rate was low. Most pregnant women diagnosed with foetal anomaly have normal levels of depression, stress and anxiety. There is a weak negative correlation between perceived social support and stress, with family and friend support affecting stress levels at a low rate. Professional support should be provided, and both the woman's mental health and social support mechanisms must be evaluated. This study highlights the importance of social support in managing stress among pregnant women with foetal anomalies. While most women had normal levels of depression, anxiety and stress, increased social support from family and friends was shown to reduce stress. The findings underscore the need for healthcare professionals to assess and strengthen mental health and social support systems in this vulnerable population, informing interventions to improve psychosocial outcomes. This descriptive and correlational study adhered to the CONSORT guidelines for reporting non-randomised trials. No patient or public contribution.

Angiotensin-Converting Enzyme Inhibitor Washout Period Prior to Angiotensin Receptor/Neprilysin Inhibitor Initiation in the Inpatient Setting.

The 2022 AHA-ACC HFSA Guideline for Management of Heart Failure recommend initiating an angiotensin receptor/neprilysin inhibitor (ARNI) in patients with heart failure with reduced ejection fraction (HFrEF) who can tolerate an angiotensin-converting enzyme inhibitor (ACEi). The manufacturer recommends initiating a 36-hour washout period when switching from ACEi to ARNI due to an increased risk of adverse effects, including angioedema. This study investigated the adherence to the washout period when transitioning from ACEi to ARNI at a community hospital. The primary objective was to assess the rate of adherence to the 36-hour washout when transitioning patients from ACEi to ARNI. Secondary outcomes included heart failure exacerbation readmission rates within 90 days and the rate of adverse effects (angioedema, hypotension, acute kidney injury, and hyperkalemia). This was a retrospective cohort study including patients with HFrEF who were transitioned from ACEi to ARNI during their hospital stay between March 1, 2016 and December 31, 2022. Patients were excluded if they did not receive an ACEi or ARNI during their admission or if they had an ejection fraction >40%. Pearson chi-square was used to analyze categorical data. Of 33 patients included in this study, 67% received the full 36-hour washout period when transitioning from ACEi to ARNI. There were no significant differences between the rates of hospital readmissions or adverse effects between the groups. No patients experienced hyperkalemia or angioedema. This is the first study to our knowledge to describe real-world prescribing practices when transitioning patients from ACEi to ARNI for the treatment of HFrEF. Larger, multicenter studies are needed to provide more data on prescribing practices outside this single center. Future research should also include pharmacist's role in adhering to the recommended washout.

Hospital COVID-19 Burden and Adverse Event Rates

The COVID-19 pandemic introduced stresses on hospitals due to the surge in demand for care and to staffing shortages. The implications of these stresses for patient safety are not well understood. To assess whether hospital COVID-19 burden was associated with the rate of in-hospital adverse effects (AEs). This cohort study used data from the Agency for Healthcare Research and Quality's Quality and Safety Review System, a surveillance system that tracks the frequency of AEs among selected hospital admissions across the US. The study sample included randomly selected Medicare patient admissions to acute care hospitals in the US between September 1, 2020, and June 30, 2022. The main outcome was the association between frequency of AEs and hospital-specific weekly COVID-19 burden. Observed and risk-adjusted rates of AEs per 1000 admissions were stratified by the weekly hospital-specific COVID-19 burden (daily mean number of COVID-19 inpatients per 100 hospital beds each week), presented as less than the 25th percentile (lowest burden), 25th to 75th percentile (intermediate burden), and greater than the 75th percentile (highest burden). Risk adjustment variables included patient and hospital characteristics. The study included 40 737 Medicare hospital admissions (4114 patients [10.1%] with COVID-19 and 36 623 [89.9%] without); mean (SD) patient age was 73.8 (12.1) years, 53.8% were female, and the median number of Elixhauser comorbidities was 4 (IQR, 2-5). There were 59.1 (95% CI, 54.5-64.0) AEs per 1000 admissions during weeks with the lowest, 77.0 (95% CI, 73.3-80.9) AEs per 1000 admissions during weeks with intermediate, and 97.4 (95% CI, 91.6-103.7) AEs per 1000 admissions during weeks with the highest COVID-19 burden. Among patients without COVID-19, there were 55.7 (95% CI, 51.1-60.8) AEs per 1000 admissions during weeks with the lowest, 74.0 (95% CI, 70.2-78.1) AEs per 1000 admissions during weeks with intermediate, and 79.3 (95% CI, 73.7-85.3) AEs per 1000 admissions during weeks with the highest COVID-19 burden. A similar pattern was seen among patients with COVID-19. After risk adjustment, the relative risk (RR) for AEs among patients admitted during weeks with high compared with low COVID-19 burden for all patients was 1.23 (95% CI, 1.09-1.39; P < .001), with similar results seen in the cohorts with (RR, 1.33; 95% CI, 1.03-1.71; P = .03) and without (RR, 1.23; 95% CI, 1.08-1.39; P = .002) COVID-19 individually. In this cohort study of hospital admissions among Medicare patients during the COVID-19 pandemic, greater hospital COVID-19 burden was associated with an increased risk of in-hospital AEs among both patients with and without COVID-19. These results illustrate the need for greater hospital resilience and surge capacity to prevent declines in patient safety during surges in demand.

Investigating the Effects of the Height-to-Diameter Ratio and Loading Rate on the Mechanical Properties and Crack Extension Mechanism of Sandstone-Like Materials

The causes of the size effect (SE) and loading rate effect (LR) for rocks remain unclear. Based on this, a gypsum-mixed material was used to simulate sandstone, where the dosing ratio was 7.5% river sand, 17.5% quartz, 58.3% α-high-strength gypsum, and 16.7% water. The specimens were designed to have a height-to-diameter ratio (HDR) of 0.6~2, and three strain rates (SRs)—static, quasi-dynamic, and dynamic—were used to perform single-factor rotational uniaxial compression experiments. PFC2D was used to numerically simulate the damage pattern of a sandstone-like specimen. The results showed that the physical parameters did not change monotonically, as was previously found. The main reason for this is that the end-face friction effect (EFE) is generated when the dynamic SR or the HDR is 0.6~1, with a damage pattern of “X”. Under mechanical analysis, the power consumed by the EFE was inversely proportional to the HDR and directly proportional to the LR, and it can reduce the actual amount of energy transferred inside the specimen. This paper may provide a foundation for the study of non-linear hazards in coal and rock.

Meta-analysis of nifedipine and enalapril combination therapy for hypertensive patients with coronary heart disease

Background: Numerous clinical studies have demonstrated that the therapeutic efficacy of combining nifedipine and enalapril in treating hypertension with coronary heart disease surpasses that of nifedipine as a stand-alone treatment. However, the current evidence is not yet sufficient due to limitations in the sample size, and further validation is needed. To analyze and assess the clinical impact of nifedipine combined with enalapril on hypertension complicated with coronary heart disease, and provide evidence for rational drug use in clinic. Methods: We employed a revised version of the Jadad scale to assess the quality of the research literature following a rigorous screening process. The statistical analysis was performed utilizing the software RevMan 5.4.1 for data analysis. Heterogeneity in the studies was evaluated based on the results of the Q test (P value), and the OR value of the combined effect was calculated using either the model with fixed effects or the one with random effects, with the results presented in a forest plot. Furthermore, a sensitivity analysis was conducted by excluding articles with the highest impact, and potential bias in publication was assessed through the utilization of a funnel plot. Results: A total of 183 articles were initially identified, and after a comprehensive review, 14 clinical randomized controlled trials were chosen for analysis. The meta-analysis findings revealed that the trial group displayed a significantly higher overall effectiveness rate compared to the control group (OR=3.47, 95%CI 2.40-5.03). Additionally, the trial group exhibited a more pronounced reduction in blood pressure and greater enhancement in cardiac function (OR=5.55, 95%CI). Conversely, the control group had a lower occurrence of ischemic events compared to the trial group (OR=0.35, 95%CI 0.24-0.50). Sensitivity analysis confirmed the stability and reliability of the combined effect size results (OR=3.91, 95%CI 2.51-6.09, P&lt;0.00001). However, based on an assessment using funnel plot results suggested potential bias in publication. Conclusion: The combined administration of nifedipine and enalapril exhibits enhanced effectiveness compared to the sole use of nifedipine in individuals diagnosed with hypertension and coronary heart disease, rendering it a valuable alternative for clinical application.