Conflicting Results Research Articles

DISCREPANCIES IN THE OUTCOME OF PLASMA ALDOSTERONE LEVELS ASSESSED BY IMMUNOASSAY AND MASS SPECTROMETRY - CLINICAL RELEVANCE FOR THE DIAGNOSIS OF PRIMARY HYPERALDOSTERONISM

Objective: To assess potential discrepancies in the clinical interpretation of the salt loading test (SLT) resulting from the assessment of aldosterone concentrations by two different methods - immunoassay and mass spectrometry. Design and method: Eighty-one patients (47F, 34M, mean age 47.7 ± 14.1 years) with suspected primary hyperaldosteronism (PA) who underwent an SLT were included in the ongoing study. Patients had their treatment modified according to current guidelines prior to the test. The SLT was performed in the sitting position and blood samples were taken before and after 4 hours of administration of 2 litres of saline. An aldosterone concentration higher than 61 ng/dL (170 pmol/L) was considered indicative of a diagnosis of PA. Plasma aldosterone concentrations from the same samples were assessed by: (1) chemiluminescence-based immunoassay (CLIA), LIAISON® by DiaSorin, and (2) liquid chromatography-mass spectrometry (LC-MS), MassChrom Chromsystems kit, UHPLC technique using a QTRAP 6500+ instrument (Sciex). Renin concentration was assessed by CLIA. Results: Median plasma aldosterone concentrations after saline administration assessed by CLIA were significantly higher than those assessed by LC-MS (64.4 vs 44.0 ng/dL; p < 0.001). The correlation coefficients for plasma aldosterone concentration after saline administration was 0.69 (p < 0.001). PA was diagnosed by one of the methods in 22 of patients and by both methods in 16 patients. Conflicting results were obtained in 6 patients (7.4%): in 5 patients CLIA was suggestive of PA but LC-MS not and in one patient LC-MS was suggestive of PA but CLIA not. In four cases, plasma aldosterone concentrations were slightly above or below the cut-off values (CLIA vs LC-MS: 62.9 vs 53; 61.9 vs 50; 97.8 vs 61 and 112 vs 58 ng/dL) in at least one of the methods. In the other two cases, the discrepancies were more pronounced (50 vs 80 ng/dL and 126 vs 24 ng/dL). Conclusions: Discrepant results of aldosterone assessment by CLIA and LC-MS methods were obtained in 7.4% of patients. Discrepancies were generally related to borderline results. If a plasma aldosterone concentration value close to the cut-off values is obtained, a repeat determination using another method should be considered.

Vitamin D status and chronic obstructive pulmonary disease risk: a prospective UK Biobank study

BackgroundLow vitamin D status has been linked to an increased risk for various inflammatory diseases. Conflicting results have been reported regarding chronic obstructive pulmonary disease (COPD). This study aims to...

Utilizing the strategic concession behavior in a bargaining game for optimal allocation of water in a transboundary river basin during water bankruptcy

In basins that lie across multiple administrative boundaries, for instance in international river basins like the Nile, water tends to be contested especially during times of scarcity. Riparian countries sharing a transboundary river basin may emphasize the multi-dimensionality of their water demands to obtain access to a greater portion of the available shared water. As a result, the frequency and intensity of water conflicts may increase, hindering the sustainable development of riparian countries and threatening the security and stability of the whole region. Therefore, designing a fair, reasonable, and adaptive allocation scheme is of paramount importance to ensure the integrity of livelihoods and ecosystem health. This paper analyzed the general features of transboundary river basins and built an allocation mechanism combining Bankruptcy Theory with Bargaining and Concession games. A Bankruptcy-Concession-Bargaining Game Model (BCBGM) was constructed to ensure multi-agent participation, multi-stage negotiation, and optimal allocation. Considering the different water demand preferences and linked satisfaction functions, the framework yielded an optimal solution by making concessions on the water claims of riparian countries. As a case study, the proposed model was applied to allocate the limited water resources of the Euphrates-Tigris River. To further measure the stability of model allocation results, a model was built to evaluate the stability of water allocation. The results show that the stability of the allocation output from the proposed allocation framework was relatively high compared to those obtained from classical allocation rules, such as Proportion, Adjusted Proportion, Constrained Equal Loss, and Constrained Equal Award. The model's results satisfied the Pareto efficiency, individual rationality, and maximized group utility. Therefore, for the most part, the allocation outputs of the proposed scheme were generally self-enforceable and sustainable.

Measurements of bulk and contact thermal resistances of PEMFC gas diffusion and microporous layers

The thermal conductivity and thermal contact resistance of gas diffusion layer (GDL) and microporous layer (MPL) are key parameters that affect the performance of proton exchange membrane fuel cells. Conflicting results were reported in previous studies, including the effect of PTFE (Polytetrafluoroethylene) on the GDL effective thermal conductivity, and the magnitude of the thermal contact resistance between the GDL substrate and the MPL coating. In view of this, the two-thickness method is used to measure the thermal conductivity and the thermal contact resistance of a Toray GDL with a MPL coating. The results show that when the loading pressure is increased from 0.25 MPa to 2 MPa, the effective thermal conductivity of the GDL increases from 1.22 W m−1 K−1 to 1.81 W m−1 K−1, while the effective thermal conductivity of the MPL coating remains unchanged at 0.5 W m−1 K−1. Treatment with 20 wt% PTFE reduces the effective thermal conductivity of the GDL by 25%. The thermal contact resistance between the GDL substrate and the MPL coating accounts for only 6.35% of the total thermal resistance of the GDL-MPL components, indicating that this thermal contact resistance is not a major factor in the PEMFC design.

Социальный конфликт в сфере государственного управления: информационно-коммуникационные технологии разрешения

The article is devoted to the problem of managing social conflicts in public administration. The issues of improving communication skills and information support for management decision-making are considered. A conflict is a constant phenomenon of modern life and quite naturally many conflict situations take place in the sphere of public administration. This is due to a variety of views, differences of opinions and conflicting interests. Disagreements between employees of government bodies, their opinions or views on management problems are inevitable. The failure to respond to or stop these conflicts before full deployment reduces system performance and the amount of public services provided. To effectively respond to conflicts, government officials need new knowledge and access to new resolution tools. It is necessary to build a conflict model that will allow to analyze its essence and trace the optimal directions of its resolution. It is important to reach an abstract model. Therefore, today many theoretical and methodological surveys lie in the plane of building a common conflict model in public administration. One of the ways of such a combination can be to compile an algorithm for handling conflict situations in the field of management based on the conflict database. The database should contain information about the causes of conflicts, methods of their settlement, positive and negative consequences of the conflict, the results of a constructive conflict, signals indicating the presence of a conflict, recommendations for resolving the conflict. Accurate identification and correct use of new information solutions gives employees the opportunity to properly approach conflicts, which will certainly contribute to improving the image of public administration.

The problem with confidence: too much and too little results in poorer achievement, inner conflict, and social inhibition.

Confidence is defined as the feelings and thoughts people have during a task that result in judgments about their performance. Evidence suggests that confidence is trait-like, but thus far research on the relative match between confidence and accuracy has been primarily restricted to over-confidence effects, and subject to the methodological flaws involved with using difference scores. We sought to answer an exploratory question in this research, whether discrepancies in ability and confidence in either direction reliably predicted individual differences on a broad-spectrum and commercially available personality test, the California Psychological Inventory (CPI260). Participants were 220 employed adults who had previously taken the CPI260 for career development purposes. They were invited to complete a measure of cognitive ability and confidence in return for feedback on the same. Data were modeled using polynomial regression and response surface analysis, to determine whether and how CPI260 personality traits were associated with matches or mismatches between accuracy and confidence in the same test. We identified negative curvilinear effects along the line of disagreement for four CPI260 scales, suggesting that both under- and over-confidence were associated with personality. In contrast to our expectations, individuals who were under-confident and those who were over-confident had lower achievement potential, less social confidence, and more inner conflict than other individuals in this sample. Although preliminary, these findings suggest that both over-confident and under-confident individuals are aware of potential weaknesses that impede their functioning.

Risk factors for avascular necrosis in patients with systemic lupus erythematosus: a multi-center cohort study of Chinese SLE Treatment and Research Group (CSTAR) Registry XXII

BackgroundAvascular necrosis is a common organ damage in SLE patients, which can influence patients’ life quality. Conflicting results exist in risk factors of AVN in SLE patients. The aim of this study was to illustrate risk factors predicting the occurrence of avascular necrosis (AVN), also known as osteonecrosis, in systemic lupus erythematosus (SLE) patients in Chinese SLE Treatment and Research Group (CSTAR), a multi-center cohort of Chinese SLE patients.MethodsSLE patients in CSTAR without existing AVN at registration were included. At least two follow-ups and an observation period of no less than 2 years for AVN event were required. Univariate and multivariate Cox regression analyses were used to evaluate risk factors for AVN in SLE patients. Coefficient B was transformed to risk score for the development of a risk stratification model.ResultsOne hundred six (2.59%) of 4091 SLE patients were diagnosed AVN during follow-ups of no less than 2 years. Multi-variate Cox regression analysis suggested that SLE onset age ≤ 30 (HR 1.616, p 0.023), arthritis (HR 1.642, p 0.018), existing organ damage (SDI ≥ 1) at registration (HR 2.610, p < 0.001), positive anti-RNP (HR 1.709, p 0.006), and high glucocorticoid maximum daily dose at registration (HR 1.747, p 0.02) were independent risk factors. A risk stratification system was developed according to the risk factors, and patients were divided into high risk (3–6) and low risk (0–2). The AUC of 0.692 indicated moderate discrimination. The calibration curve in internal validation was drawn.ConclusionPatients with SLE onset age ≤ 30, arthritis, existing organ damage (SDI ≥ 1) at registration, positive anti-RNP, and high glucocorticoid maximum daily dose at registration are at high risk for AVN and require attention.

Potential therapeutic benefit of ursodeoxycholic acid in the management of non hepato-biliary upper gastrointestinal disorders.

To examine the potential therapeutic effects of ursodeoxycholic acid (UDCA) on diseases of the esophagus, stomach, and duodenum. A search was conducted using EBSCO, Medline, PubMed, Google Scholar and Web of Science as well as international guidelines using MESH terms for treatment of UDCA for diseases of the upper gastrointestinal disorders in adult humans without regard to publication language or date restrictions. A total of 256 articles and 22 guidelines were initially identified, and 221 were excluded. Final revision of 13 articles and 22 guidelines confirmed that UDCA is found to have a cytoprotective role in Barret's esophagus within esophageal disorders, improves abdominal pain in functional dyspepsia, and does not alter Helicobacter pylori colonization or inflammation. Conflicting results are noted regarding the role of UDCA in the duodenum as chemopreventive treatment for familial adenomatous polyposis, with polyps regressing and their growth characteristics improving with low doses (10-25mg/kg/day). On the contrary, no positive effect was noted upon the combination with Celecoxib and with doses of 1000-2000mg or 20-30mg/kg/d. Gastrointestinal side effects were predominantly reported. No side effects necessitated hospitalization or ICU admission. Ursodeoxycholic acid has a limited therapeutic role in functional dyspepsia. There is promising evidence that it may serve as a chemopreventive for Familial adenomatous polyposis and Barret's esophagus, although further research is needed to confirm these findings.PROSPERO No.: CRD 42021267689.

42P Conflicting results of BCL2 based on HER2 status in patients with breast cancer

42P Conflicting results of BCL2 based on HER2 status in patients with breast cancer

Apparent Opportunities and Hidden Pitfalls: The Conflicting Results of Restoring NRF2-Regulated Redox Metabolism in Friedreich's Ataxia Pre-Clinical Models and Clinical Trials.

Friedreich's ataxia (FRDA) is an autosomal, recessive, inherited neurodegenerative disease caused by the loss of activity of the mitochondrial protein frataxin (FXN), which primarily affects dorsal root ganglia, cerebellum, and spinal cord neurons. The genetic defect consists of the trinucleotide GAA expansion in the first intron of FXN gene, which impedes its transcription. The resulting FXN deficiency perturbs iron homeostasis and metabolism, determining mitochondrial dysfunctions and leading to reduced ATP production, increased reactive oxygen species (ROS) formation, and lipid peroxidation. These alterations are exacerbated by the defective functionality of the nuclear factor erythroid 2-related factor 2 (NRF2), a transcription factor acting as a key mediator of the cellular redox signalling and antioxidant response. Because oxidative stress represents a major pathophysiological contributor to FRDA onset and progression, a great effort has been dedicated to the attempt to restore the NRF2 signalling axis. Despite this, the beneficial effects of antioxidant therapies in clinical trials only partly reflect the promising results obtained in preclinical studies conducted in cell cultures and animal models. For these reasons, in this critical review, we overview the outcomes obtained with the administration of various antioxidant compounds and critically analyse the aspects that may have contributed to the conflicting results of preclinical and clinical studies.

The prognostic significance of non-lymphoid immune cells of the tumor microenvironment, including neutrophils, eosinophils, and mast cells in breast carcinomas

Background and objectiveThe prognostic importance of lymphoid cells in the tumor microenvironment and their effect on treatment response have been demonstrated in many cancer types. However, there are limited studies on non-lymphoid immune cells. Conflicting results have been obtained regarding the effects of these cells on prognosis. Materials and methodsA total of 331 patients who underwent surgery for breast cancer were included. Patients that received neoadjuvant chemotherapy and those with distant metastasis were excluded. CD 15 immunohistochemistry was performed to detect tumor-infiltrating neutrophils (TINs) and eosinophils (TIEs), while Toluidine Blue histochemistry was performed to detect tumor-infiltrating mast cells (TIMs). ResultsHigh TINs were statistically associated with low ER expression (p < 0.001), low PR expression (p = 0.001), high Ki-67 proliferation index (p = 0.008), and HER2/TN molecular subtypes (p = 0.001). High TIEs were associated with low ER expression (p = 0.001), high Ki67 proliferation index (p = 0.005), and HER2/TN molecular subtype (p = 0.002). High TIMs were associated with high PR expression (p = 0.024), low Ki-67 proliferation index (p = 0.003), and high survival rate (p = 0.006). TIMs and TIEs were good prognostic factors for overall survival in Luminal A and Luminal B subtypes, while TINs and TIEs were found to be independent risk factors for disease-free survival. ConclusionThe evaluation of components of the tumor microenvironment including TINs, TIEs, and TIMs is easy and practical. High TIMs and TIEs are independent prognostic factors, especially in luminal molecular subtype of invasive breast carcinoma. However, to use this parameter in routine pathology practice, more studies from different centers and standard evaluation are needed.

Proton pump inhibitors increase the risk of nonsteroidal anti-inflammatory drug-related small bowel injury: A Systematic Review with Meta-analysis.

Conflicting results exist on the association between proton-pump inhibitor (PPI) and nonsteroidal anti-inflammatory drug (NSAID)-related small bowel damage. Aims: To determine whether PPIs increased the risk of NSAID-related small bowel damage by meta-analysis. Methods: A systematic electronic search in PubMed, Embase, and Web of Science was conducted from the time the database was created until 31 March 2022 for studies reporting associations between PPI use and outcomes, including the endoscopy-verified prevalence of small bowel injury, mean number of small bowel injuries per patient, change in hemoglobin level, and risk of small bowel bleeding in subjects taking NSAIDs. Meta-analytical calculations for odds ratio (OR) and mean difference (MD) were performed with the random-effects model and interpreted with 95% confidence intervals (CIs). Results: Fourteen studies comprising 1996 subjects were included. Pooled analysis demonstrated that concomitant use of PPIs significantly increased the prevalence and number of endoscopy-verified small bowel injuries (prevalence: OR=3.00; 95% CI: 1.74-5.16; number: MD=2.30; 95% CI: 0.61-3.99) and decreased hemoglobin levels (MD=-0.50 g/dL; 95% CI: -0.88 to -0.12) in NSAID users but did not change the risk of small bowel bleeding (OR=1.24; 95% CI: 0.80-1.92). Subgroup analysis demonstrated that PPIs significantly increased the prevalence of small bowel injury in subjects taking nonselective NSAIDs (OR=7.05; 95% CI: 4.70-10.59, 4 studies, I2=0) and COX-2 inhibitors (OR=4.00; 95% CI: 1.18-13.60, 1 study, no calculated I2) when compared to COX-2 inhibitors alone.Conclusion: PPIs increased the risk of NSAID-related small bowel damage, and the clinical significance of higher prevalence of small bowel injuries should be studied in future.

Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain

Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety.

Landmarks in the Traumatic Brain Injury A Retrospective Study

As one might expect, prehistoric brain surgery lacked knowledge of the anatomy, concept recognition of the disease, and comprehension of the disease’s origin. Unfortunately, failure to deeply understand these important principles delayed the progression of medical and surgical practice. Trepanation may be one of the oldest surgical interventions for which archaeological evidence is present. In the 1990s, standardized guidelines were developed and established for the management of traumatic brain injury. They included protocols regarding the pharmaceutical therapy and the management of increased ICP. Since then, research has improved TBI survival. Evidence of trepanation practice and other techniques in pre-Columbian Mesoamerica is demonstrated by the cranial remains in pre-Columbian burials, iconographic artworks, and post-colonial reports. The intellectual understanding of neurosurgery developed during the golden age of ancient Greece where no surgeon restricted oneself in strict to neurosurgery. Head injuries on the other hand appear to have been abundant; an expected result of wars and internecine conflict, as recorded by Herodotus, Thucydides, and Homer. Then and now, war remains the primary source of study material for the improvement of knowledge regarding head injuries. Surgical procedures for the management of even minimal lesions of the theca cranica, continued throughout the 16 th and 17 th Century. The surgical technique, with cross-shaped skin incision and the instruments used (trephine, lever, scalpel, gouge, protector of the meninx, etc.) would remain unchanged with respect to the past, but one should take notice at the improved quality of the materials and the ameliorated precision with which the instruments were made. Some instruments appeared to be real work of art, as shown by the findings now displayed in museums and in illustrations of the times. The most ancient technique of craniotomy involved using abrasive instruments to thin down the bony wall. Subsequently, circular incisions were progressively made deeper, or a series of small holes were made in a circular fashion. The remaining bony bridges between these small holes would be broken down. The two latter methods that continued to be used for a very long period depended on using metal instruments.

A note on the admissibility of complex BTZ metrics

We perform a nontrivial check of Witten’s recently proposed admissibility criterion for complex metrics. We consider the ‘quasi-Euclidean’ metrics obtained from continuing the BTZ class of metrics to imaginary time. Of special interest are the overspinning metrics, which are smooth in this three-dimensional context. Their inclusion as saddle points in the gravitational path integral would lead to puzzling results in conflict with those obtained using other methods. It is therefore encouraging that the admissibility criterion discards them. For completeness, we perform an analysis of smoothness and admissibility for the family of quasi-Euclidean BTZ metrics at all values of the mass and angular momentum.

The Western and Chinese exercise training for blood pressure reduction among hypertensive patients: An overview of systematic reviews.

Hypertension remains the world's leading cause of premature death. Interventions such as exercise, diet modification, and pharmacological therapy remain the mainstay of hypertension treatment. Numerous systematic reviews and meta-analyses demonstrated the effectiveness of western exercises, such as aerobic exercise and resistance exercise, in reducing blood pressure in hypertensive patients. There is recently emerging evidence of blood pressure reduction with Chinese exercises, such as Tai Chi, Baduanjin, and Qigong. The current overview of systematic reviews aims to evaluate the quality and descriptively summarize the evidence for the effectiveness of western and Chinese exercises for hypertension management. Thirty-nine systematic reviews were included in this overview, with 15 of those being on Chinese exercise. Evidence suggests that exercise training, regardless of Western or Chinese exercise, generally reduced both systolic and diastolic blood pressure. High-intensity intermittent training did not further reduce blood pressure when compared to moderate-intensity continuous training. Conflicting results on the effectiveness of blood pressure reduction when comparing Chinese and Western exercise training were observed. This suggests the comparable effectiveness of Chinese exercise training, in particularly Tai Chi, to general or aerobic exercise training in terms of blood pressure reduction. The Chinese exercise modality and intensity may be more suitable for the middle-aged and elderly population.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19.

Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors. This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters. In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters. Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Portland Cement Treated Soil: Evaluation and Conflict Results

In spite of soil treatment using Portland cement being well documented, it is hard to find all of the contents related to this topic in one document. This paper aims to provide information inventory about chemical and mechanical changes that take place in soil properties, and the alteration in engineering characteristics which occur in soil - cement mixtures. The mechanism of treatment over time is documented as well. Some conflicted results were detected in literature such as moisture – dry density relationship and dynamic properties of soil treated by cement. The suitability of cement as an additive for different soil types is discussed based on the results which were obtained by different authors. Based on the methodologies followed by laboratory and field studies, the mixture process involves deep and shallow mixing using cement as powder or slurry (grout). Finally, the paper discusses the sustainability of Portland cement as a manufacturing product. Generally, using cement as soil stabilizer induces a significant increase in soil strength, workability, and durability. Permeability and swelling potential are significantly decreased. In addition, a considerable improvement in soil compressibility is achieved for the soil – cement mixture. Negative environment impact is one of the major inherent disadvantages in cement production, where the cement production process is responsible for 5 – 8% of the total anthropogenic CO₂ emission. Furthermore, high energy consumption, depletion of resources and weakness against sulfate attack, carbonation and organic materials effects are significant inherent disadvantages in cement-treated soil. So, partial or full replacement of cement by more sustainable materials is recommended.

Abstract Number ‐ 164: Clot Density as a Predictor for Successful Mechanical Thrombectomy

Introduction Switching mechanical thrombectomy techniques (ADAPT, SR or combination) mid procedure has the potential to prolong time to recanalization as well as increase associated healthcare costs. The basis of selecting the frontline technique still relies heavily on the operators’ preference. Conflicting results indicating the varying performance of techniques relative to clot composition have been reported. Clot composition can be estimated based on clot density calculated in Hounsfield Units (HU) on pre‐intervention CT. Identifying how various clot composites behave can aid in the decision making for selecting a frontline technique.Our objective is to determine if clot density as measured by Hounsfield units can predict successful recanalization with ADAPT and the need for rescue stentriever when using ADAPT as the first line technique. Methods Retrospective review of all patients undergoing mechanical thrombectomy with first pass ADAPT at a single urban tertiary care academic stroke center. Clot HU values were calculated on pre‐intervention scans. We evaluated the number of passes, the use of rescue SR, the post intervention TICI grade and mRS on final follow up. Results There were 167 patients that underwent MT with ADAPT as the frontline approach. 122 were excluded for inability to calculate HU on pre‐ intervention scans, most often due to contamination with contrast media. 45 patients were included in the final analysis. 18/45 (40%) required SR rescue due to incomplete recanalization with first pass ADAPT. HU were dichotomized around the mean to “high” and “low”. Higher HU value was associated higher likelihood of SR use and higher final mRS scores, these however did not reach statistical significance. There was no difference in the total number of passes or the final TICI grade. AUC and ROC did not show a correlation between HU value and the use of SR or a higher number of passes need to achieve TICI ≥ 2b recanalization. Conclusions In our patient cohort, HU value was not able to predetermine the success rate of MT using ADAPT. There was no correlation between HU value and functional outcomes of patients. Reliability of clot HU value in determining MT success with ADAPT could not be established. Other factors should be considered when selecting frontline technique in mechanical thrombectomy.

The phenomenon of “processual transformation” as an indicator of the vulnerability of patients of late age in forensic psychiatry

IntroductionDemographic ageing in the world population is accompanied by increased negative social trends towards elderly persons, age discrimination, cruel treatment and violence.There is an increase in crimes against the elderly related to fraud with their property, physical violence by children because of claims on the property of their parents.We observe a growing number of property transactions committed under the influence of fraud, deceit, difficult life circumstances. There is an increasing number of elderly, deprived of legal capacity.ObjectivesIn order to identify the biological, socio-psychological, legal and victimological determinants we examined 235 patients of late age who underwent forensic psychiatric examination in a criminal and civil process.MethodsRevealed: «non-dementia» mental disorders - in 45.5%, psychosis - in 7.7%, dementia - in 46.8%.ResultsPatients can simultaneously and consistently participate in criminal and civil process in the status of accused, victims, plaintiffs, defendants, people in respect of whom the incapacity is determined.The reasons for initiating these cases were often interrelated, the result of a long-term family conflict, often related to the disposal of property.ConclusionsSuch a change in the processual status of patients was characteristic of the late age, reflected their victimization.This phenomenon was called “processual transformation”.The probability of " processual transformation " imposes special requirements on the quality of examination of patients of later age. They should be as objective and reliable.Since the previous expert opinions may affect the subsequent expert opinions in other processes.This phenomenon are legal determinants that can have a disadaptive effect on the late age.Disclosure of InterestNone Declared