RR Values Research Articles

The Effect of PPARγ rs1801282 Variant on Mortality Risk Among Asians With Chronic Kidney Disease: A Cohort Study and Meta-Analysis.

Background: Chronic kidney disease (CKD) is a public health issue, and an independent risk factor for cardiovascular disease. The peroxisome proliferator-activated receptor gamma (PPARG) plays an important role in the cardiovascular system. Previous studies have examined one important exon polymorphism, Pro12Ala, in PPARG with respect to mortality of CKD patients, but the results were inconsistent and current evidence is insufficient to support a strong conclusion. This study aimed to examine the correlation between Pro12Ala gene polymorphism and mortality among Asians with CKD by trial sequential analysis (TSA). Methods: The research was divided into observational research and meta-analysis. For the cohort study, 767 subjects from dialysis centers in Taipei were selected as samples, and tracked from December 2015 to February 2017. For the meta-analysis, relevant literature from “PubMed” and “Embase” databases (until December 2016), was searched and TSA was used to verify the results. In order to achieve the best evidence hierarchies, our retrospective cohort study was added to the meta-analysis and the TSA. Results: The combined sample size for Asian was 1,685 after adding our cohort study, and there was no significant correlation between PPARG Pro12Ala and mortality by the allele model (RR: 0.85, 95% CI: 0.39–1.83, I2 = 79.3%). Under the parameter setting with the RR value of 1.5, TSA estimation presented that the cumulative sample size entered into the futility area, and it confirmed the conclusion in this study. Conclusion: We found that PPARG Pro12Ala gene polymorphism was not related to mortality in CKD Asians patients, and validated our conclusion using TSA after adding our sample.

Ambient Particulate Air Pollution and Daily Hospital Admissions in 31 Cities in Poland

A strong and consistent association has been observed between morbidity or mortality rates and PM concentration, and is well documented in many countries. In Poland, despite poor air quality, studies concerning the evaluation of acute health effects of ambient air pollution on morbidity from respiratory or cardiovascular diseases are rare. We examined the short-term impact of PMx concentration on hospital admission in 31 Polish cities based on the daily PM10, PM2.5 concentration, meteorological variables, and hospital data. The generalized additive model (GAM) and a random-effects meta-analysis were used to assess the impact of air pollution on morbidity within the exposed population. Almost 1.6 million cardiovascular admissions and 600 thousand respiratory disorders were analyzed. The RR values for PM10-related cardiovascular and respiratory hospital admissions in Poland are equal to 1.0077 (95% confidence interval, 1.0062 to 1.0092) and 1.0218 (95% confidence interval, 1.0182 to 1.0253), respectively, while for PM2.5 1.0088 (95% confidence interval, 1.0072 to 1.0103) and 1.0289 (95% confidence interval, 1.0244 to 1.0335), respectively. Moreover, a moderate heterogeneity of RR estimates was observed between the analyzed cities (I2 values from 27% to 45%). The presented analysis confirms the significant association between hospital admission and PMx concentration, especially during heating seasons.

THE FUNCTION OF RECOMMENDATION OF A PHARMACISTS IN REDUCE PIMs (POTENTIALLY INAPPROPRIATE MEDICATIONS) OF GERIATRIC PATIENTS AT THE GENERAL HOSPITAL DR. MOEWARDI SURAKARTA


 The prevalence of potentially inappropriate medications (PIMs) is quite high in geriatric patients. PIMs can be detected using an explicit prescription indicator (a criterion). Explicit criteria that can be used in the identification of PIMs in geriatric patients include: BEERS Criteria, STOPP Criteria, and START Criteria. This study aims to analyze drugs included in the PIMs category based on BEERS Criteria, STOPP Criteria, and START Criteria. This research is a semi-experimental study (intervening in the form of giving recommendations) with prospective data collection in the geriatric ward of Regional General Hospital Dr. Moewardi Surakarta in the period from October 2019 to January 2020. The results showed that out of 70 patients, there were 47 PIMs, PIMs based on BEERS Criteria for 20 patients (28.6%), PIMs based on STOPP Criteria for 10 patients (14.3%) and PIMs based on START Criteria for 17 patients (24.3%). Bivariate analysis showed that there was a relationship between the incidence of adverse drug events (ADEs), with recommendations that were followed up on PIMs based on BEERS Criteria with an RR value of 25 (95% CI 1,2: 520,7), P = 0.04 and PIMs based on START Criteria with an RR value of 5 (95% CI 1: 35.9), P = 0.04, whereas the results of the bivariate analysis on PIMs based on STOPP Criteria showed that there was no relationship between the incidence of ADEs with the recommendations that were followed up with a RR value of 4 (95% CI 0.13: 119.2), P = 0.50. Based on the results of univariate and bivariate statistical analysis, it can be concluded that there are still many incidents of PIMs based on BEERs Criteria, STOPP Criteria, and START Criteria and pharmacists have an important function to reduce PIMs so that the incidence of ESO due to PIMs can be minimized in the regional general hospital Dr. Moewardi Surakarta.
 
 
 
 
 
 
 

Detecting the Causal Nexus between Particulate Matter (PM10) and Rainfall in the Caribbean Area

In this study, we investigate the interactions between particulate matter that have an aerodynamic diameter less than 10 μm diameter (PM10) and rainfall (RR) in entropy framework. Our results showed there is a bidirectional causality between PM10 concentrations and RR values. This means that PM10 concentrations influence RR values while RR induces the wet scavenging process. Rainfall seasonality has a significant impact on the wet scavenging process while African dust seasonality strongly influence RR behavior. Indeed, the wet scavenging process is 5 times higher during the wet season while PM10 impact on RR is 2.5 times higher during the first part of the high dust season. These results revealed two types of causality: a direct causality (RR to PM10) and an indirect causality (PM10 to RR). All these elements showed that entropy is an efficient way to quantify the behavior of atmospheric processes using ground-based measurements.

Association between atmospheric particulate matter and emergency room visits for cerebrovascular disease in Beijing, China.

The association between atmospheric particulate matter and emergency room visits for cerebrovascular disease were evaluated in Beijing. A generalized additive model was used to evaluate the associations between particulate matter and cerebrovascular disease, based on the daily data of meteorological elements, PM concentrations, and emergency room (ER) visits for cerebrovascular disease in Beijing from 2009 to 2012. Long-term trends and the effects of holidays, the day of the week, and confounding factors were controlled to determine the lag effect at 0-6days. Single- and double-pollutant models were employed for different age and sex groups. The effect of PM2.5 concentration on the number of daily ER visits for cerebrovascular disease was much stronger than that of PM10 concentration. PM2.5 and PM10 had maximum RR values of 1.096 and 1.054 at lag 6 for patients aged 61-75years. For each inter-quartile range (IQR) increase in PM10 concentration, the maximum RR values for the total, males, females, aged 15-60years, aged 61-75years, and aged > 75years were 1.024, 1.044, 1.043, 1.038, 1.054, and 1.032, respectively. For each IQR increase in PM2.5 concentration, the maximum RR values for the total, males, females, aged 15-60years, aged 61-75years, and aged > 75years were 1.038, 1.064, 1.076, 1.054, 1.096, and 1.049, respectively. The RR values of the double-pollutant models were lower than those of the single-pollutant models. This study showed that the effects of PM pollution on cerebrovascular disease were different among different gender and age groups, and aged 61-75years were mostly sensitive to particulate matters. The effects of PM2.5 on cerebrovascular disease were stronger than those of PM10. Our results can provide scientific evidence for the local government to take effective measures to improve air quality and the health of residents. The online version contains supplementary material available at 10.1007/s40201-021-00776-w.

Gastroscopy sedation: clinical trial comparing propofol and sufentanil with or without remimazolam.

Propofol-sufentanil is often used in clinical anesthesia for patients undergoing sedative gastroscopy, but there are still adverse events such as longer recovery time, respiratory depression and higher doses of propofol etc. This study was to evaluate the sedative effect of remimazolam-propofol-sufentanil in sedative gastroscopy. Patients who were going to have gastroscopy examination were randomly divided into two groups: group RM (remimazolam-propofol-sufentanil group) and group PR (propofol-sufentanil group). Patients of each group were anesthetized according to the corresponding anesthesia procedure, and all observation indices were recorded. In the RM group, there were only small and unsignificant changes in the values of SBP, HR, RR and SpO<inf>2</inf> after anesthesia (P>0.05), while the values of SBP, HR, RR and SpO<inf>2</inf> in the PR group at each time point after anesthesia were significantly lower than those at T0, and the values of SBP and RR at T2, T3 and T4 were also significantly lower than those at T1 (P<0.05). The dosage of propofol (38±9 mg) in the RM group was significantly less than that (115±15 mg) in the PR group, meanwhile the anesthesia time (8.4±1.6 min), awakening time (2.9±0.8 min), discharge time (6.7±3.1 min) of the RM group were also significantly shorter than those of the PR group (14.5±3.3, 8.7±1.9, 12.4±3.6 min) (P<0.05), but there was no statistical significance between the two groups in other indices (P>0.05). In clinical practice, remimazolam-propofol-sufentanil sedative scheme has more advantages than propofol-sufentanil sedative scheme.

Systematic evaluation and meta-analysis of randomized controlled trial of TCM facial mask in the treatment of acne

Objective: To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine masks in the auxiliary treatment of acne, and provide evidence-based reference for clinical practice. Methods: Computer search of PubMed, China Knowledge Network (CNKI), WanFang, VIP (VIP) and other databases, collect randomized controlled trials of traditional Chinese medicine mask alone or in combination with conventional therapies to treat acne, and extract data from clinical studies that meet the inclusion criteria. Cochrane review Handbook 5.1 was used for quality evaluation, and stata 15.1 was used for meta-analysis. Results: A total of 13 articles were included, and a total of 945 patients with acne were included. Meta results showed that the clinical cure rate of acne treated with traditional Chinese medicine mask was significantly higher than that of the control group, which was statistically significant (P=0.000). The RR value and 95% CI were 1.71 ( 1.40, 2.10); Compared with non-TCM facial mask treatment, the total clinical effective RR value and 95% CI for acne treatment with TCM facial mask is 1.22 (1.15, 1.29); TCM facial mask is better than acne comprehensive grading system score (GAGS) The control group, with statistical significance (P=0.000), the estimated SMD point and 95% CI was -0.92 (-1.18, -0.65); there was no statistical difference between the treatment group and the control group in adverse reactions (P=0.344) , RR value and 95% CI were 0.73 (0.38, 1.40). Discussion: Traditional Chinese medicine masks have a definite clinical effect and good safety in the auxiliary treatment of acne. Commonly used Chinese medicines include heat-clearing medicines and blood-activating medicines for removing blood stasis. However, limited by the quality of the included studies, this conclusion still needs more large-sample, multi-center, high-quality RCTs for verification.

Influence of presence or absence of posts on the failure rates of post endodontic restorations: A systematic review and meta-analysis.

The study was designed to evaluate the existing evidence on the failure rates of post-endodontic restorations retained with and without post in endodontically treated teeth (ETT). Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Protocol (PRISMA-P) guidelines were used to formulate the review. Randomized controlled trials (RCT's) and prospective clinical studies comparing post endodontic restorations retained with and without post were included. PubMed/Medline, Embase, Cochrane Library and Scopus databases were searched to recognize relevant full-text articles in English language. The quality of the RCT's were evaluated using the Cochrane collaboration tool to assess the risk of bias and reported as having high, low or unclear risk. Random-effects model at a 95% confidence interval was used for the meta-analysis. Meta-analyses was performed using the Mantel -Haenszel method31 and risk ratio, with a 95% confidence interval (CI), was estimated for dichotomous data. Random effects model32 was used as the pooling method and 95% confident interval (α = .05 for RR values) in Review Manager (RevMan) [Computer program]. Version 5.4. The Cochrane Collaboration, 2020). Four studies comparing post retained and post free restorations in ETT with a total of 916 restorations were included in the analysis. The total risk ratio was 2.16, (95% CI:1.25 to 3.72). ETT with post retained restorations exhibited significantly lower failure rates compared to restorations without post. Well-designed RCT's are warranted to develop a clinical protocol with respect to post-retained restorations.

The association between ozone and ischemic stroke morbidity among patients with type 2 diabetes in Beijing, China

BackgroundThe association between ozone and ischemic stroke has been widely reported; however, the association among patients with type 2 diabetes (T2D) has remained largely unknown. MethodsThe time series data of daily morbidity and concentrations of ozone from 2014 to 2018 were collected in Beijing, China. A time-stratified case-crossover study combined with a distributed lag nonlinear model was used to estimate the ozone effect on stroke morbidity among T2D patients. Based on principal diagnosis, ischemic stroke cases were identified according to the International Classification of Diseases (I63), and a history of T2D was coded as E12. ResultsA total of 149,757 hospital admissions for ischemic stroke among T2D patients were recorded in Beijing. Approximately U-shaped exposure-response curves were observed for ozone and ischemic stroke morbidity among T2D patients. With a reference at 54.91 μg/m3, extreme-low (5th: 9.59 μg/m3) ozone was significantly associated with a decreased risk for ischemic stroke [RR = 0.88, 95% confidence interval (CI): 0.80–0.98]. Subgroup analysis showed that extremely low-ozone (5th) level only had a significant protective effect in males and elderly population, with a RR value of 0.86 (95% CI: 0.76–0.97) and 0.85 (95% CI: 0.75–0.96), respectively. Extreme-high ozone (99th: 157.06 μg/m3) was significantly associated with an increased risk for ischemic stroke (RR = 1.33, 95% CI: 1.12–1.57). The effect size was 1.34 (95% CI: 1.10–1.63) for males and 1.32 (95% CI: 1.07–1.63) for females, and the difference was not significant (Z = -0.29, P = 0.77). The effect size in younger adults was significantly higher than that in participants aged ≥65 years [1.52 (95% CI: 1.21–1.91) vs. 1.22 (95% CI: 1.01–1.47), Z = -1.62, P < 0.05]. ConclusionsU-shaped associations were observed between ozone and ischemic stroke morbidity in T2D patients. Men and elderly population are vulnerable to low-ozone level, and the younger adults are more susceptible to extremely high-ozone level than the elderly.

Physiological responses of Santa Inês x Dorper ewes and lambs to thermal environment of silvopasture and open pasture systems

The silvopasture is a sustainable livestock system, which has great potential for sheep, mainly focused on the thermal comfort and welfare of animals. However, there is a lack of information regarding the thermal environment and physiology of ewes and lambs raised in this system. This study was therefore aimed at assessing the influence of microclimate on the thermal comfort of postpartum ewes and lambs kept in silvopastoral (SP) or open pasture (OP) systems during the summer. Postpartum crossbred ewes (Santa Inês x Dorper; n = 24) and their lambs (n = 24) were randomly allocated to SP or OP group, being distributed into four paddocks per group (three ewes and three lambs per paddock). The microclimate characterization measured were dry-bulb ambient temperature (Ta, ºC), black globe temperature (Tbg, ºC), relative humidity (RH, %), grass temperature (Tg, ºC) and wind speed (WS, m s−1). These variables were then applied to calculate the temperature and humidity index (THI), black globe temperature and humidity index (BGHI), and radiant heat load (RHL). To assess the thermophysiology response, the respiratory rate (RR, breaths min−1), heart rate (HR, beat min−1), rectal temperature (RT, ºC), and hair coat surface temperature (ST, ºC) were analyzed. Regarding the microclimate variables, Ta and Tg were higher in OP than in SP (P = 0.008 and P < 0.001, respectively), while SP presented higher RH values (P = 0.037). There was no significant difference in WS between the systems (P = 0.288). As expected, all indices showed lower mean values in SP compared to OP, mainly the radiant heal load (P < 0.001). Regarding the thermophysiology response, the RR of ewes was significantly higher in OP (129 ± 4.5 breaths min−1) than in SP (85 ± 4.7 breaths min−1) (P < 0.001). The RT was higher in the OP, but only in the afternoon (P < 0.001). Meanwhile, lambs in OP also presented higher RR (105 ± 3.5 breaths min−1) and RT (39.9 ± 0.1 °C) values than in SP (74 ± 2.8 breaths min−1 and 39.9 ± 0.1 °C, respectively). Following the prior trends, during the afternoon lambs showed higher values of RR than in the morning. However, the difference between those periods was small for RT. The ST of ewes in SP was lower compared to ewes in OP (P < 0.001). In the afternoon, the difference of ewes in SP had ST 4.3 °C lower compared to OP, while for lambs, the ST in the afternoon increased by 5.3 °C more in OP than in SP. The study suggests that the presence of trees reduced hyperthermia for both ewes and lambs further supporting the SP as a sustainable farming system that promotes thermal comfort and welfare for small ruminants.

The correlation study on human respiratory syncytial virus daily incidence and meteorological parameters in the main urban area of Chongqing from 2009 to 2019

Objective: To explore the relationship between the daily incidence of human respiratory syncytial virus (HRSV) and meteorological parameters in the main urban area of Chongqing. Methods: This study took 3 107 children hospitalized with acute lower respiratory tract infections from June 2009 to June 2019 in department of Respiratory medicine, Children's Hospital of Chongqing Medical University (CHCMU). Nasopharyngeal aspirate (NPA) was collected on the day of admission to detect HRSV and common respiratory virus; combined with the meteorological data of the main urban area of ​​Chongqing during the same period, the correlation and distribution lag nonlinear model analysis of the daily incidence of HRSV and meteorological parameters were carried out. Results: Among 3 107 children, HRSV positive accounted for 34.53% (1 073 cases), the age was 6 (3, 13) months, and males accounted for 64.31% (690 cases). The daily incidence of HRSV was negatively correlated with minimum temperature (r=-0.220, P<0.001), maximum temperature (r=-0.221, P<0.001), average temperature (r=-0.221, P<0.001) and precipitation (r=-0.052, P<0.001), and positively correlated with sunshine time (r=0.011, P<0.001) and average relative humidity (r=0.095, P<0.001). Compared with the reference temperature (20 ℃), when the lowest temperature of 6-10 ℃ lags for 4-8 d, the RR value of HRSV was 1.11-1.14, and when the lowest temperature of 5-19 ℃ lags for 5 d and 2-19 ℃ lags for 10 d, the RR values were 1.02-1.14 and 1.00-1.03. When the cumulative lag is 5, 10, 15 and 21 d, compared with the reference temperature (20 ℃), the RR (95%CI) values at the lowest temperature of 10.4 ℃ were 1.93 (1.08-3.46), 3.49 (1.64-7.45), 5.00 (2.01-12.46) and 6.69 (2.18-20.48); the RR (95%CI) values of the lowest temperature of 22.1 ℃ were 0.87 (0.77-0.98), 0.77 (0.66-0.90), 0.74 (0.62-0.89) and 0.68 (0.55-0.85). In the cumulative effect, compared with the reference temperature (20 ℃), the gender stratification showed that the maximum RR (95%CI) values of the lowest temperature for boys and girls under different lag days were 7.24 (1.84-28.51) and 2.19 (1.07-4.46), the age stratification showed that the maximum RR (95%CI) values of the lowest temperature for children<6 months old and children ≥6 months old under different lag days were 4.72 (1.05-21.23) and 11.98 (1.70-84.35). Conclusions: In the main urban area of Chongqing, the daily incidence of HRSV in children is correlated with climatic parameters. Among them, the lowest temperature has a delayed and cumulative effect on HRSV infection. 6-10 ℃ has a greater impact on the incidence of HRSV when the lag is 4-8 days. The effect has a more obvious impact on the incidence of HRSV in boys and children ≥ 6 months.

The relationship between QT interval and pain severity in trauma patients in the emergency department

Aim: Cardiac depolarization occurs in patients experiencing pain from acute traumas, and changes in QT interval could indicate the state of ventricular depolarization. Thus, we aimed to determine the relationship between pain severity and QT interval in patients experiencing acute trauma. Material and Method: Seventy patients, who were conscutively- admitted to the Emergency Department due to moderate or severe trauma (study group), and sixty healthy individuals (control group) were included in this study. The QT interval was calculated for each group before and after analgesia and visual analog scale pain levels were recorded. Statistical analyses were performed using SPSS for Windows software (ver. 21.0; SPSS Inc., Chicago, IL, USA). Data are presented as medians±interquartile range (IQR). Statistical significance was determined using Mann-Whitney U, Wilcoxon, and chi-square tests, with a p-value &lt;0.05 considered significant. Results: The mean age of patients with trauma and control patients was 31.50±25 years and 35.00±20 years, respectively. Among trauma patients, QT, RR and corrected QT (QTc) intervals were significantly different before and after analgesia (P&lt;0.001). Similarly, the average pre-analgesia QT, RR and QTc values also differed between pre- and post-analgesia trauma patients (p=0.007, p&lt;0.001, and p&lt;0.001, respectively). However, no differences in QT values were observed before and after analgesia between patients experiencing moderate versus severe pain (p&gt;0.05). Conclusion: In trauma patients, acute pain prolonged the QT interval, which reverted to normal following the administration of nonsteroidal anti-inflammatory drugs. However, additional comparative studies on this topic are required.

Emission inventory and control policy for non-road construction machinery in Tianjin.

The establishment of a non-road construction machinery emission inventory forms the basis for the analysis of pollutant emission characteristics and for the formulation of control policy. We analyzed and investigated data on populations, emission factors, and activity levels for the construction machinery in Tianjin to estimate an emission inventory. Finally, a variety of emission reduction scenarios were used to simulate emission reductions and propose the most effective control policy. The results show that total emissions of CO, HC, NOx, PM10, and PM2.5 from non-road construction machinery in Tianjin of 2018 reached 4180.78, 951.44, 5833.85, 383.92, and 365.70 t, respectively. Forklifts, excavators, and loaders were the three most important emission sources in Tianjin. There are clear differences in the emissions of different districts. Large machinery emissions were mainly distributed across the Binhai New Area, which includes high volumes of port machinery and tractors in Tianjin Port. Based on various emission reduction scenarios, the effect of emission reductions is estimated. The IAD affected the reduction of CO and HC emissions with RR values of 17.6% and 17.3%, respectively, while EMO affected the mitigation of PM10 and PM2.5 emissions and RR values by 18.0% and 18.4%, respectively. The emission reduction control policy for non-road construction machinery is proposed, including the accelerated updating of non-road machinery emission standards; integrating diesel engine research and development institutions to accelerate the development of vehicle after-treatment technology; and establishing a cooperation mechanism for scientific research institutes, government departments, and enterprises in the control of non-road mobile machinery emissions.

Mineralogy, petrography, and Rock-Eval pyrolysis of late Oligocene coal seams in the Malkara coal field from the Thrace Basin (NW Turkey)

The Thrace Basin hosts the second-largest natural gas and oil resource of Turkey. Several mineable late Oligocene coal seams are located close to natural gas fields in the basin. This study focuses on the assessment of late Oligocene seams in the Malkara coal field using mineralogical, petrographic, and Rock-Eval pyrolysis data. The variations in coal properties seem to be mainly controlled by common peat-forming vegetation and detrital input ratio into palaeomires. The studied samples are characterized by variable TOC, Tmax and HI values and high H contents. Even though the relatively high H contents seem to be related to high total liptinite contents, the presence of hydrogen-rich telohuminite macerals, particularly ulminite A, may be the main reason for elevated H contents in the studied samples. Furthermore, the Rock-Eval analyses results, which imply the presence of mixed type III-IV kerogens, conflict with coal petrography data. The differences could be a by-product of carbonate minerals breakdown during pyrolysis; however; the presence of hydrogen-rich telohuminite macerals, which could have originated from resinous woody peat-forming plants, could cause suppression S2 peak and elevation of S3 peak due to release additional COx from the breakdown of hydrogen- and oxygen-rich compounds in telohuminite macerals during pyrolysis. Therefore, HI, Tmax, and OI values are not matched with maceral compositions. Moreover, the relatively higher Tmax and %Rr values of studied late Oligocene coal seams in the Malkara coal field than early Oligocene shales and late Oligocene coals in the NE parts of the basin could be related to higher thermal gradient and/or post-Oligocene tectonic movements. Overall, the results imply that the coals are mostly gas-prone; thus, the studied coal seams along with unexploited coal seams near to the study area have a hydrocarbon generation potential for especially natural gas in the Danişmen Formation. The results of this study also show that the Rock-Eval pyrolysis data of low-rank humic coals similar to Malkara coals should be used with caution and cross-checked with results of traditional coal parameters such as ash yields, H contents, maceral, and mineralogical compositions to avoid misinterpretations.

Technical Advances in Respiratory Rate using Fusion Methods: A Review

Respiratory rate (BR) is a basic biological variable that is employed in a range of therapeutic applications. Yet, clinicians manually measure breaths while diagnostically ignoring RR's value. An irregular breathing rate is typically the first indication of a debilitating condition. In healthcare settings, a reliable estimate of respiratory rate is crucial. Traditional methods estimate RR using either ECG or PPG. However, there is a lack of consensus among existing algorithms in order to improve RR detection performance. One easy method is to fuse the best performing algorithms, which may easily improve the RR estimation. In this review, we will look at how modulation may be used to identify breathing rates using ECG or PPG.

Metal elements associate with in vitro fertilization (IVF) outcomes in 195 couples

PurposeEnvironmental factors may affecting reproductive function reduction and embryonic development. Couples who are exposed to heavy metals for a long time may affect the outcome of in vitro fertilization (IVF). To evaluate the effect of elements on IVF outcomes, a total of 195 couples undergoing IVF were included in this study. MethodsElements including V, Cr, Mn, Ni, Cu, Zn, As, Mo, Cd, Ba, Hg, Tl, Pb were measured in serum and follicular fluid (FF) samples of female and semen samples of male by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Multiple linear regression were applied to evaluate the association between metal elements and semen quality parameters and the number of oocytes in MII stage. Poisson regression and the robust variance estimation of the generalized estimation equation were used to evaluate the association between elements and IVF outcomes. ResultsThe statistical results showed that Cr had a significant negative correlation with total sperm concentration (TSC) and total motile sperm count (TMC), the correlation coefficients were -0.52 (-0.27∼1.43) and -0.4(-1.24, 0.45), respectively. At the same time, Ba was significantly correlated with TSC and TMC, the correlation coefficients were 0.1(-0.15∼0.34) and 0.12(-0.13, 0.36), respectively. Cr, Ba and Pb in follicular fluid (FF) had a significant positive correlation with the number of oocytes in MII stage. The correlation coefficients were 3.15 (0.79, 5.52), 1.54 (-0.27, 3.36), 12.27 (7.49, 17.04). The Tl level of FF was significantly associated with the high probability of blastocyst formation and high-quality blastocysts (RR: 2.83, 95 % CI: 0.92∼7.95; RR: 3.12, 95 % CI: 0.64, 12.84). The Hg level (RR: 3.98, 95 % CI: 0.78∼14.77) and the Ba level in serum (RR: 12.75 95 % CI: 1.31∼89.71) were significantly correlated with high-quality blastocysts. The levels of Ni, Cu, Mo in seminal plasma of men were significantly correlated with blastocyst formation and high-quality blastocysts (RR values were all greater than 1.5). In addition, the level of Ba was significantly correlated with the high probability of blastocyst formation (RR: 1.7, 95 % CI: 1.14∼2.52). ConclusionOur results reveal that Cr, Ba and Pb may affect TSC, TMC and MII oocytes. Moreover, Ba, Cr, As, Hg and Tl in serum and Mo in seminal plasma were related to fertilization results, good embryos, blastocyst formation, high-quality embryos, and pregnancy and live birth rates. Tl in FF may related to the quality of embryonic development, Ba was an important risk factor which closely related to the outcomes of IVF in both male and female. Through our detection and statistical analysis of clinical samples, it is shown that although not all elements will affect the outcome of IVF the key elements we have selected need to arouse our attention, which benifit to the diagnosis and prevention of clinical infertility.

Effect of dietary water-soluble vitamins on the poor prognosis of low-grade cervical intraepithelial neoplasia-a prospective cohort study

Objective: To explore the effect of dietary water-soluble vitamins on the poor prognosis of low-grade cervical intraepithelial neoplasia (CINⅠ). Methods: A total of 564 participants with CINⅠ were selected from a community-based married women cohort established in 2014. The general baseline information was collected, and HPV genotyping was detected. A food frequency questionnaire was used to investigate dietary water-soluble vitamins' consumption and determine their exposure levels. The follow-up program was carried out for 12 months, and the regression, persistence, and progression of CINⅠ was determined according to histopathological results at 12-month. Results: The low-levels of dietary water-soluble vitamins could promote CINⅠ's persistence and progression, showing the increasing tendency of CINⅠ poor prognosis with the decrease of water-soluble vitamin levels. Especially folate, VB1, VB2, VB6, niacin, biotin, and VC (RR values were 15.22, 1.86, 1.92, 2.11, 2.98, 2.14, 2.19, respectively) played an important role. Considering the status of high-risk human papillomavirus (HR-HPV) infection, our results showed that the low levels of folate, niacin, biotin could promote the poor prognosis of CINⅠ. Conclusions: The low-level of dietary water-soluble vitamins could facilitate the poor prognosis of CINⅠ. In addition, folate, niacin, biotin were more effective on HR-HPV positive women.

426 Clinical Validation of A.I. Analysis of Photoplethysmogram (PPG) Based Sleep-Wake Staging, Total Sleep Time, and Respiratory Rate

Abstract Introduction The Photoplesthymogram (PPG) raw waveform is the basis for both the pulse rate and oximetry during polysomnography (PSG) and Home Sleep Apnea Tests (HSAT). The PPG has also recently become ubiquitous as a basis of continuous measurement for the most widely adopted consumer sleep technologies, particularly smart watches. In this study, we clinically validate AI performance for interoperable, PPG-based epoch-by-epoch Sleep-Wake staging (PPG-SW), Total Sleep Time (PPG-TST), and Respiratory Rate (PPG-RR), when compared to 1) PSG-based panel scoring by technologists (RPSGTs) and 2) PSG-based AI scoring (EEG-SW, EEG-TST, Effort Belt-RR). Methods We applied stratified random sampling with proportionate allocation to a database of N&amp;gt;10,000 retrospective PSGs. We controlled for: 1) Obstructive sleep apnea severity, 2) Sleepiness, 3) Medical diagnoses including sleep, psychiatric, neurologic, neurodevelopmental, cardiac, pulmonary, metabolic disorders, 4) Medications including benzodiazepines, antidepressants, stimulants, opiates, sedative-hypnotics, 5) Demographics including sex, age, BMI, weight, and height, to establish representative adult (N=100) PSG studies from which PPG samples were obtained. Double blinded scoring was prospectively collected for each PSG by 3 experienced RPSGTs randomized from a pool of 6 scorers. RR was established by mode when two scorers agreed on RR value and median otherwise. Results AI EEG-SW demonstrated 96%/94%/95% Sensitivity/Specificity/Accuracy compared to 2/3 majority PSG staging, and AI PPG-SW demonstrated 90%/89%/90% Sensitivity/Specificity/Accuracy compared to the same PSG panel. AI EEG-TST achieved a Pearson Correlation Coefficient (R-value) of 0.968 and AI PPG-TST achieved 0.873 R-value compared to 2/3 majority PSG-TST. When compared to the RR panel consensus in N=282 one-minute RR scoring epochs of PSG, AI Effort Belt-RR performance was &amp;lt;= 2 breaths-per-minute (brpm) in 93.6% of epochs with an average difference of 0.992 brpm, and AI PPG-RR performance was &amp;lt;= 2 brpm in 92.2% of epochs with an average difference of 0.996 brpm. Conclusion The study shows interoperable AI analysis performs robustly in evaluating PPG-based epoch-by-epoch sleep-wake stages, total sleep time, and respiratory rate, demonstrating state-of-art accuracy when compared to a prospective, double-blinded PSG scoring panel. This work has implications for consumer sleep technology, HSAT accuracy, inpatient sleep monitoring, and may support the growth of HSATs by increasing total sleep time accuracy and reliability. Support (if any):

Evaluation of Heart Rate Fragmentation in Spontaneously Hypertensive Rats

Rapid heart rate (HR) variations at respiratory frequency range are well accepted as a marker of cardiac vagal modulation. Nevertheless, a new pattern of ultra-rapid HR variation has been recently studied and named as heart rate fragmentation (HRF). HRF is a type of sinoatrial instability characterized by the presence of numerous inflections points (from one bit to another) in RR interval time series. HRF has been shown to be increased in aging and coronary diseases and seems to be linked to the risk life-threatening cardiovascular events and death. This study aimed to evaluate the HRF in a rat model of spontaneous hypertension. Unanesthetized freely moving spontaneously hypertensive (SHR) and normotensive Wistar Kyoto (WKY) rats at 2 distinct ages, 4 to 6 weeks (young) or 12 to 15 weeks (adult), had their electrocardiogram recorded for 40 minutes. Series of RR intervals were generated and transformed into a sequence of symbols “-1”, “0” or “1” when the difference between successive RR values (transitions) was positive, zero, or negative, respectively. Transitions between symbols “-1” and “1” were labeled as “hard” (H) inflection points while those between “-1” (or “1”) and “0” were labeled as “soft” (S) inflection points. Next, sequences of 4 consecutive symbols (words - W) were distributed according to the number and type of transition they enclose. The total percentage of inflection points (PIP), the percentage of words with zero (W0), one (W1), two (W2) or three (W3) inflection points, as well as percentage of words enclosing only hard (WH), soft (WS) or mixed (WM), i.e., containing both types of inflection points, were quantified. PIP and W3 were lower in the young and adult SHR when compared to the counterparts WKY. In contrast, young and adult SHR showed a higher percentage of W0, W1 and W2 compared to WKY.Regarding the type of transition, the percentage of WH was lower, while the WS was higher, in young and adult SHR when compared to WKY counterparts. The percentage of WM was higher only in young SHR. In conclusion, although evidences indicate that cardiovascular diseases lead to an increase in HRF, we have shown lower HRF in hypertensive rats, with or without the presence of the hypertensive phenotype. However, the mechanisms giving rise to HRF are still unknown. Future studies must be conducted to evaluate whether the HRF pattern observed in young and adult SHR is maintained in elderly animals and to elucidate the mechanisms behind HRF in SHR and normotensive rats.

An investigation on shape memory behaviors of UHMWPE-based nanocomposites reinforced by graphene nanoplatelets

Graphene nanoplatelets (GNPs) was utilized to improve shape recovery rate (Rr) of ultra-high-molecular-weight polyethylene (UHMWPE) by compression molding technology. The results show that the melting temperature (Tm) and crystallinity of specimens are decreased, while the mechanical property is improved significantly. Additionally, shape memory behavior of UHMWPE nanocomposites is improved effectively, and the optimal shape memory effect with the shape fixity ratio (Rf) of about 95% and the Rr of about 97% was obtained. Meanwhile, the relationship among shape memory characteristics and microstructure, thermal and mechanical properties was analyzed. Besides, two kinds of shape memory testing methods, the bending test with a custom technique and the cyclic tensile test under DMA controlled strain mode, obtained the same trend and different values of Rf and Rr.