Standard Laboratory Tests Research Articles

Wildfire burn severity and post-wildfire time impact mechanical and hydraulic properties of forest soils

Vegetation contributes to the overall slope stability and is recognized as an environmentally friendly nature-based solution. Wildfires burn and denude vegetated slopes, thus increasing the risk of shallow landslides and debris flows. However, little attention has been given to assessing the effects of burn severity and the time elapsed since a wildfire on the hydro-geomechanical properties of burned slopes. This study performed a series of standard laboratory tests to evaluate the shear strength and saturated hydraulic conductivity (ksat) of forest soils collected from moderate-low (ML) burned, moderate-high (MH) burned, and unburned (UB) test plots. The plots were sampled one, four, and six months after the March 2022 wildfire in Uljin County, South Korea. The results show that the continuous deterioration of roots highly depended on the burn severity. The root biomass of ML- and MH-burned soils was consistently lower than those of the UB soils. The root deterioration reduced the shear strength of the soils temporally. The burned soil's cohesion intercept was 1.80–2.30 times lower than that of the UB soil six months post-wildfire, with the friction angle unaffected. One- and four-months post-wildfire, ksat of the burned soils was 1.22–3.15 times lower than the UB soil. Such lowered ksat was due to the fine ash-clogged pores and hydrophobic layers beneath the soil surface. However, six months post-wildfire, the burned soils' ksat increased by approximately twice that of the pre-wildfire condition because of macropore flow passages formed by impoverished roots. The appreciation of sand fraction, depreciation of fines content, and weakening of hydrophobicity over time have also emphasized their role in the temporal shifts in the properties of the ML- and MH-burned soils. The documented results herein can be incorporated into rainfall infiltration and stability analyses of wildfire-affected slopes, landslide susceptibility mapping, and mitigation measures design.

A Visco-Elasto-Plastic Constitutive Law for Deformation Prediction of High Concrete Face Rockfill Dams

Deformation predictions in high Concrete Face Rockfill Dams tend to underestimate observed settlements due to scale effect and breakage phenomena that cannot be adequately captured by laboratory tests. This paper presents a Visco-Elasto-Perfectly Plastic (VEPP) model for predicting deformations in high Concrete Face Rockfill Dams (CFRDs) that addresses these challenges incorporating explicitly key rockfill parameters like grain size and post-compaction porosity, which influence both the non-linear elastic and plastic behaviors of rockfill. The VEPP model enables deformation prediction while using standard laboratory test results. The model’s effectiveness was demonstrated through its application to the 233 m high Shuibuya Dam, the tallest CFRD in the world. The VEPP model predictions closely align with observed deformations throughout the dam’s construction, impoundment, and early operational stages. By using physically meaningful parameters, the model reduces the uncertainty associated with the empirical assessment of model parameters using back-analysis from similar projects. While the VEPP model offers improved predictive accuracy, particularly during early design phases, further advancements could be achieved by refining the creep formulation and accounting for grain size evolution during construction. This approach has the potential to optimize the design and construction of future high CFRD construction.

Monte Carlo simulations of the fracture resistance of an asphalt pavement layer

The purpose of the proposed numerical model is to analyze the cracking of the wearing course in a pavement overlay, assuming a pre-existing crack that passes through the binding layer and base. The computations employed the author's simulation-based Monte Carlo material model, which describes the failure process of a Semi-Circular Bend (SCB) specimen during standard laboratory testing of asphalt concrete. A key feature of this model is the incorporation of the random nature of material parameters, allowing for the simulation of result dispersion when analyzing a sufficiently large population of samples. The proposed FEM model and obtained material data were directly applied to the numerical analysis of the pavement structure. The comprehensive computational algorithm allows for a random description of the load that induces crack propagation in the pavement wearing course, leading to the creation of a histogram that defines the range of failure load dispersion. Such supporting calculations can assist in optimizing asphalt mix design and, in the future, may allow for the estimation of pavement structure reliability.

Guidelines for the prescription of standard hematology and biochemistry clinical laboratory tests in the intensive care unit: A scoping review protocol.

This scoping review protocol describes the strategy for a scoping review that aims to provide a comprehensive overview of published guidelines for the prescription of standard laboratory tests performed in intensive care unit (ICU) patients. The use of clinical laboratories is constantly increasing. However, there is evidence of inappropriate use. Inappropriate laboratory testing has the potential to harm patients, increase costs, burden staff, and has an environmental impact. Effective management can be achieved through demand managing strategies, such as providing guidelines on performing the appropriate test, for the right patient, at the right time. Although national and international guidelines exist for individual tests, a comprehensive summary of available recommendations for laboratory testing in the ICU is currently unavailable. This scoping review will incorporate documents that provide explicit advice on which test to perform in ICU patients. We selected 34 tests routinely ordered in the ICU. This review will consider any document type that matches our concept and context. We will consider gray literature with appropriate adherence to guidelines methodology. We will not limit the review by geographical location, but will only include articles published in English. Our scoping review will follow the Joanna Brigg Institute (JBI) methodology. We will search Medline (PubMed), Embase, Scopus, Google Scholar, and Google. Our search strategy adheres to the JBI 3-step construction approach for systematic reviews. We will search for keywords related to guidelines, laboratory testing, and the 34 selected tests. We will report our study using the S1 Checklist. Review registration number: osf.io/yfs9z.

Comparison of Blood-Gas Hemoglobin and Electrolyte Measurements and Automated Laboratory Values in Pediatric Kidney Transplant Patients.

The reliability of blood-gas measurements compared with automated laboratory tests in providing rapid results for pediatric patients is currently under investigation. The compatibility between fast-response blood-gas tests and standard automatic laboratory tests remains a subject of debate. In this retrospective single-center study, our objective was to compare the measurements of hemoglobin and electrolytes obtained through blood-gas analysis with the corresponding values obtained from standard laboratory tests in pediatric renal transplantation, specifically focusing on the immediate pretransplant period. We retrospectively investigated 26 pediatric kidney transplant patients in the pretransplant period. We reviewed their medical records and compared and simultaneous measurements of hemoglobin, sodium, and potassium from a blood-gas analyzer versus a laboratory automatic analyzer. We assessed the agreement between the 2 analyses with BlandAltman analysis and Cohen kappa statistic. Among the 26 pediatric kidney transplant recipients, mean age was 10.1 ± 4.9 years and 60.0% were male patients. The mean differences between blood-gas and the venous laboratory analyzer (95% CI) were as follows: 0.11 g/dL for hemoglobin (-0.27 to 0.05 g/dL; P > .05), 0.39 mEq/L for sodium (-0.58 to 1.35 mEq/L; P > .05), and 0.00 mEq/L for potassium (-0.25 to 0.25 mEq/L; P > .05). Cohen kappa test showed the highest agreement for sodium, with no significant difference in mean values. Our study demonstrated strong agreement between hemoglobin, sodium, and potassium values obtained through blood-gas measurements and venous blood samples in pediatric kidney transplant recipients. Demonstrating the concordance between rapid blood-gas analysis and automated laboratory tests can offer valuable guidance to clinicians.

Biofluid Detection of Pathological α-Synuclein in the Prodromal Phase of Synucleinopathies.

Synucleinopathies are disorders characterized by the aggregation and deposition of pathological α-synuclein conformers. The underlying neurodegenerative processes begin years or decades before the onset of cardinal motor symptoms. This prodromal phase may manifest with various signs or symptoms. However, there are no current standardized laboratory tests to ascertain the progression and conversion of prodromal conditions such as mild cognitive impairment, isolated REM sleep behavior disorder or pure autonomic failure. The aim of this systematic review was to evaluate the diagnostic possibilities using human biofluids as source material to detect pathological α-synuclein in the prodromal phase of synucleinopathies. Our review identified eight eligible studies, that investigated pathological α-synuclein conformers using cerebrospinal fluid from patients with prodromal signs of synulceinopathies to differentiate this patient group from non-synucleinopathies, while only one study investigated this aspect using blood as medium. While previous studies clearly demonstrated a high diagnostic performance of α-synuclein seed amplification assays for differentiating synucleinopathies with Lewy bodies from healthy controls, only few analyses were performed focussing on individuals with prodromal disease. Nevertheless, results for the early detection of α-synuclein seeds using α-synuclein seed amplification assays were promising and may be of particular relevance for future clinical trials and clinical practice.

The TEG 6s Global Hemostasis System is Useful for Coagulation Management in Simultaneous Pancreas and Kidney Transplantation: The First Two Cases

Introduction: Hypercoagulability-related graft thrombosis is the leading cause of graft failure after simultaneous pancreas-kidney transplantation (SPK). Addressing this issue is crucial to improve the outcomes of SPK recipients. Thromboelastography (TEG) has been used to assess the coagulation profiles of SPK recipients. Recently, a new-generation TEG device, the TEG 6s Global Hemostasis System, was introduced. This device offers advantages over TEG 5000, including less frequent calibration requirements, ease of use, and reduced sensitivity to movement. We hypothesized that TEG 6s would enhance coagulation management in SPK. Methods: We report two cases of Asian female SPK recipients in whom TEG 6s was used to assess coagulation status at six preset times during and after surgery. Results: Preoperatively, both patients exhibited hypercoagulability on TEG 6s. Postoperative intravenous heparin was administered, and the dose was titrated based on the TEG 6s results. Vascular thrombosis was not observed in either patient. Detailed TEG 6s and standard laboratory test results are reported. This pilot study demonstrates that TEG 6s monitoring can effectively assess coagulation status in SPK recipients, aiding in optimal coagulation management and reducing the risk of thrombotic complications leading to graft loss. The TEG 6s facilitated real-time and accurate coagulation assessment, allowing for tailored anticoagulant therapy. Conclusions: This is the first observational study to use TEG 6s in SPK recipients, indicating its potential benefits in improving patient outcomes. Further studies with larger sample sizes are warranted to validate these findings and establish comprehensive guidelines for using TEG 6s in SPK procedures.

Testing for nephrological diseases in pediatrics – the role of point-of-care devices and the medical analysis laboratory in the current context

Background and objectives. Nephrological diseases in children are common, representing an important burden on patients and healthcare. The purpose of this study is to evaluate the transition of the most recent advances in the in vitro diagnostics (IVD) field, including point-of-care (POC) testing methods, to the clinical practice in pediatrics. Materials and methods. Testing indications for pediatric nephrological diseases were identified in the available clinical guidelines and, for comparison, the developments in the IVD field were reviewed based on scientific literature about testing methods, performance evaluation, and POC testing implementation. Results. Testing in the context of nephrological diseases is widely addressed in the available clinical guidelines. While performant POC tests have been developed, the recommendations for testing do not address this progress, nor their integration with traditional laboratory tests. For example, urine dipstick testing has a central role in the management of urinary tract infections of children and it is a basis for clinical decisions, the same method being available for both POC and laboratory tests. Conclusions. Specific testing recommendations for nephrological conditions must be elaborated, based on the availability of the methods and their performances. Implementing POC testing is a challenge, but it can provide benefits for both the patient and the healthcare systems, in addition to the standard laboratory testing.

Purification of a reactive dyes mixture solution by means of pre-hydrolysed coagulants in the standard tests and coagulating flow system

Reactive dyes, widely used in textiles, often leach into sewage due to incomplete bonding with fibers. Coagulation offers an effective solution, yet standard lab tests for coagulation efficiency lack realism and are significantly labour and time-consuming. To address this, a novel approach is proposed: optimizing coagulation through a prototype lab flow. This system automates solution flow, reagent dosing, coagulation, and sludge separation via sedimentation and filtration. Tests reveal effective coagulation of various reactive dyes with pre-polymerized Al coagulants, but limited efficacy with Fe(III) coagulant. The flow system demonstrates mostly better purification results than jar tests, achieving around 95% colour removal with Al coagulants. This study highlights the efficacy of coagulation and filtration in jar tests, offering a simplified yet efficient method for assessing coagulation performance.

Study protocol for Early Tracking of Childhood Health determinants (ETCHED): A longitudinal observational life course study

BackgroundThe prevalence of childhood obesity and diabetes continues to rise in the United States (US), especially among minority populations. The objective of the Early Tracking of Childhood Health Determinants (ETCHED) study is to investigate the role of adverse fetal and early-life risk exposures that contribute to the development of childhood obesity and metabolic risk.MethodsETCHED is a longitudinal observational study of American Indian/Alaska Native (AI/AN) and Hispanic pregnant woman and their offspring. Pregnant mothers ≥ 18 years old are enrolled at a large public hospital system in the southwestern US. Enrolled mothers are followed through pregnancy, delivery, and the maternal/offspring dyad will be followed until the child’s 18th birthday. At each maternal visit, questionnaires assessing medical history, diet, physical activity, sleep, perceived stress, and socioeconomic and sociocultural information are obtained. Standard laboratory tests during maternal visits include glycemic measures, lipids, and renal function. Additional bio samples obtained include venous blood samples and cord blood for obesity/metabolic biomarkers and genetic/epigenetic testing, urinalysis, placental tissue for examining functional pathways, breast milk for metabolomics, and stool for metabolites and microbiome analysis. The offspring will have 6 infant/toddler visits at 6–12 weeks, 4 months, 6 months, 18 months, 2 and 3 years respectively. Thereafter, they will undergo comprehensive research visits (major visits) at 4–5 years, 6–9 years, 10–13 years, and 14–17 years. The major visits in children include detailed medical history, anthropometry, developmental assessment, socioeconomic and environmental assessments (food insecurity, family structure, and childcare), feeding and activity, biochemical tests, genetics/epigenetic testing, and ultrasound elastography. Electronic health records will be reviewed for additional clinical information. The primary analysis will constitute estimation of correlation coefficients between continuous variables. The planned study duration in this ongoing study is 23-years.DiscussionThis is a life course study that that will examine biological and environmental risk factors for obesity and cardiometabolic risk from the intrauterine period to early childhood and adolescence in a population with high-risk of obesity and type 2 diabetes in the United States. The ETCHED study would also provide a unique opportunity to combine multi-omics and clinical data to create novel integrative models to predict the cardiometabolic risk associated with childhood obesity and possibly identify etiopathogenetic mechanisms and future targets of intervention.Trial registration numberClinicalTrials.gov identifier: NCT03481829. Updated July 19, 2024, https://clinicaltrials.gov/study/NCT03481829?cond=ETCHED&rank=1.

Mitochondrial dysfunction in platelets from severe trauma patients - A prospective case-control study

IntroductionTrauma-induced coagulopathy (TIC) refers to an abnormal coagulation process, an imbalance between coagulation and fibrinolysis due to several pathological factors, such as haemorrhage and tissue injury. Platelet activation and subsequent clot formation are associated with mitochondrial activity, suggesting a possible role for mitochondria in TIC. Comprehensive studies of mitochondrial dysfunction in platelets from severe trauma patients have not yet been performed. MethodsIn this prospective case-control study, patients with severe trauma (ISS≥16) had venous blood samples taken at arrival to the Emergency Unit of a Level 1 Trauma Centre. Mitochondrial functional measurements (Oxygraph-2k, Oroboros) were performed to determine oxygen consumption in different respiratory states, the H2O2 production and extramitochondrial Ca2+ movements. In addition, standard laboratory and coagulation tests, viscoelastometry (ClotPro) and aggregometry (Multiplate) were performed. Measurements data were compared with age and sex matched healthy control patients. ResultsSevere trauma patients (n = 113) with a median age of 38 years (IQR, 20–51), a median ISS of 28 (IQR, 20–48) met our inclusion criteria. Oxidative phosphorylation in platelet mitochondria from severe trauma patients significantly decreased compared to controls (34.7 ± 8.8 pmol/s/mL vs. 48.0 ± 19.7 pmol/s/mL). The mitochondrial H2O2 production significantly increased and greater endogenous Ca2+ release was found in the polytrauma group. Consistent with these results, clotting time (CT) increased while maximum clot firmness (MCF) decreased with the EX-test and FIB-test in severe trauma samples. Multiplate aggregometry showed significantly decreased ADP-test (38 ± 12 AUC vs. 112 ± 14 AUC) and ASPI test (78 ± 22 AUC vs. 84 ± 28 AUC) also tended to decrease in mitochondria of polytrauma patients as compared with controls. Significant strong correlation has been demonstrated between mitochondrial OxPhos and MCF while it was negatively correlated with ISS (R2=0.448, P˂0.05), INR, CT and lactate level of patients. ConclusionsThe present study revealed that severe trauma is associated with platelet mitochondrial dysfunction resulting in reduced ATP synthesis and impaired extramitochondrial Ca2+ movement. These factors are required for platelet activation, recruitment and clot stability likely thus, platelet mitochondrial dysfunction contributes to the development of TIC.

Sensitivity assessment of optimal control strategies and cost-effectiveness analysis of a novel Candida Auris environmental transmission model in intensive care facilities

Candida Auris is an emerging fungal pathogen flagged by CDC as a serious global health threat among nosocomial infections in the recent times. As an evolving pathogen that often goes misidentified or unidentified under standard laboratory tests, it has the ability to cause fatal infections among the target population involving patients with serious medical conditions admitted to intensive care facilities, due to its capacity to resist anti-fungal treatment and the ability to persist in the hospital environment for long periods. The subject of this paper is to develop a deterministic model to study the transmission nature of Candida Auris wherein measures like apt admission screening methods with weekly screening follow-ups, transmission prevention, proper treatment protocols and environmental disinfection procedures are introduced as constant mitigating controls into the model initially which are later redefined as variable control functions during the optimal control analysis. The theory of optimal control implemented into the model helps us to understand the sensitivity of each control strategy upon the behaviour of each state variable. Further, cost-effectiveness analysis is rigorously conducted using incremental cost-effectiveness ratio (ICER) to identify and rank the control strategies involved based on their economic efficiency. Numerical simulation for the optimal control analysis is performed in MATLAB using the Forward–Backward Sweep Method and the findings are illustrated graphically.

Disturbances in Electrodermal Activity Recordings Due to Different Noises in the Environment.

Electrodermal activity (EDA) is a widely used psychophysiological measurement in laboratory-based studies. In recent times, these measurements have seen a transfer from the laboratory to wearable devices due to the simplicity of EDA measurement as well as modern electronics. However, proper conditions for EDA measurement are recommended once wearable devices are used, and the ambient conditions may influence such measurements. It is not completely known how different types of ambient noise impact EDA measurement and how this translates to wearable EDA measurement. Therefore, this study explored the effects of various noise disturbances on the generation of EDA responses using a system for the simultaneous recording of all measures of EDA, i.e., skin conductance responses (SCRs), skin susceptance responses (SSRs), and skin potential responses (SPRs), at the same skin site. The SCRs, SSRs, and SPRs due to five types of noise stimuli at different sound pressure levels (70, 75, 80, 85, and 90 dB) were measured from 40 participants. The obtained results showed that EDA responses were generated at all levels and that the EDA response magnitudes were significantly (p < 0.001) influenced by the increasing noise levels. Different types of environmental noise may elicit EDA responses and influence wearable recordings outside the laboratory, where such noises are more likely than in standardized laboratory tests. Depending on the application, it is recommended to prevent these types of unwanted variation, presenting a challenge for the quality of wearable EDA measurement in real-world conditions. Future developments to shorten the quality gap between standardized laboratory-based and wearable EDA measurements may include adding microphone sensors and algorithms to detect, classify, and process the noise-related EDA.

Differentiation of Prior SARS-CoV-2 Infection and Postacute Sequelae by Standard Clinical Laboratory Measurements in the RECOVER Cohort.

There are currently no validated clinical biomarkers of postacute sequelae of SARS-CoV-2 infection (PASC). To investigate clinical laboratory markers of SARS-CoV-2 and PASC. Propensity score-weighted linear regression models were fitted to evaluate differences in mean laboratory measures by prior infection and PASC index (≥12 vs. 0). (ClinicalTrials.gov: NCT05172024). 83 enrolling sites. RECOVER-Adult cohort participants with or without SARS-CoV-2 infection with a study visit and laboratory measures 6 months after the index date (or at enrollment if >6 months after the index date). Participants were excluded if the 6-month visit occurred within 30 days of reinfection. Participants completed questionnaires and standard clinical laboratory tests. Among 10 094 participants, 8746 had prior SARS-CoV-2 infection, 1348 were uninfected, 1880 had a PASC index of 12 or higher, and 3351 had a PASC index of zero. After propensity score adjustment, participants with prior infection had a lower mean platelet count (265.9 × 109 cells/L [95% CI, 264.5 to 267.4 × 109 cells/L]) than participants without known prior infection (275.2 × 109 cells/L [CI, 268.5 to 282.0 × 109 cells/L]), as well as higher mean hemoglobin A1c (HbA1c) level (5.58% [CI, 5.56% to 5.60%] vs. 5.46% [CI, 5.40% to 5.51%]) and urinary albumin-creatinine ratio (81.9 mg/g [CI, 67.5 to 96.2 mg/g] vs. 43.0 mg/g [CI, 25.4 to 60.6 mg/g]), although differences were of modest clinical significance. The difference in HbA1c levels was attenuated after participants with preexisting diabetes were excluded. Among participants with prior infection, no meaningful differences in mean laboratory values were found between those with a PASC index of 12 or higher and those with a PASC index of zero. Whether differences in laboratory markers represent consequences of or risk factors for SARS-CoV-2 infection could not be determined. Overall, no evidence was found that any of the 25 routine clinical laboratory values assessed in this study could serve as a clinically useful biomarker of PASC. National Institutes of Health.

Interrelations between iron content and immune dysfunctions in frequently ill children of the Aral Sea Region

The widespread occurrence of immune-dependent diseases and disturbances in iron metabolism, as well as their co-occurrence and the impact of iron deficiency on the immune system, underscore the relevance of this study. Modern data also indicate the involvement of iron in regulating cytokine production and protein synthesis by lymphocytes. In addition to the age-related characteristics of the child’s immune system, a significant factor in the development of inadequate course of the infectious process is the disruption of immune system adaptation, which can be caused by frequent infections, other somatic diseases such as anemia, and environmental factors. The aim of this study is to assess the relationship between iron levels and immune dysfunction in children with frequent acute respiratory diseases living in the Aral Sea region. A total of 127 children, who are native residents living at the epicenter of the ecological crisis, were examined. The children’s ages ranged from 1 to 5 years old. Among them, there were 105 frequently ill children (with 6 or more episodes of acute respiratory infections per year) with iron-deficiency anemia (IDA), and 22 healthy children of the same age. All children underwent clinical examination and standard laboratory tests, including complete blood count, relative content and ratio of T and B lymphocytes, as well as the levels of pro- and anti-inflammatory cytokines (IL-2 and 4) and ferritin in the serum. According to the results of the conducted research, it was found that among frequently ill children with iron-deficiency anemia (IDA), there is a moderate positive correlation between the relative quantity of T lymphocytes and the hemoglobin level (r = +0.62), as well as a strong positive correlation with the serum iron level (r = +0.78). This indicates a significant influence of iron deficiency on the level of cellular immunity. Clinical data also indicate a higher risk of respiratory infections development in children with IDA compared to the control group. Ferritin, hemoglobin, lymphocytes, and cytokines act as positive regulators of hematopoiesis in IDA conditions and contribute to the compensation of anemia during iron deficiency replenishment.

Efficacy of a new generation topical retinoid in the treatment of patients with moderate to severe acne on the face and trunk

BACKGROUND: The extreme prevalence of acne, long-term course and multifactorial pathogenesis necessitate the development of new drugs and treatment methods aimed at increasing efficiency and achieving clinical effects in the shortest possible time. This article presents data from two international clinical studies to determine the effectiveness and safety of trifarotene 50 µg/g (0.005%) cream in the treatment of patients with moderate acne on the face and trunk. AIM: To evaluate the safety and effectiveness of trifarotene cream, 0.005%, a new topical retinoid, for moderate acne of the face and trunk. MATERIALS AND METHODS: Two international, double-blind, randomized, placebo (vehicle) controlled, 12-week phase III studies screened 2817 and randomized 2420 patients 9 years of age and over. The effectiveness of the drug was assessed based on the registration of the number of patients who achieved the effect of "clear" or "almost clear" skin condition and an improvement of ≥2 points in terms of IGA on the facial skin and PGA on the truncal skin during 12 weeks of treatment, as well as by calculating the change in absolute number of inflammatory and non-inflammatory acne elements relatively to the initial level. The safety of therapy was assessed based on the registration of adverse events, local tolerability (the formation and severity of retinoic dermatitis), abnormalities in vital signs and the results of standard laboratory tests. RESULTS: The onset of effect of trifarotene versus that of its vehicle was rapid, with significant reductions in both inflammatory and noninflammatory lesion counts seen as early as 1 week after treatment on the face and as early as 2 weeks after treatment on the trunk. In both studies, at week 12 the facial success rates according to IGA and PGA and change in inflammatory and noninflammatory lesion counts (both absolute and percentage) were all highly significant (p 0.001) in favor of trifarotene when compared with the vehicle and the formation of the “almost clear” and “clean” effect was registered in the vast majority of patients, who used cream with 0.005% trifarotene. CONCLUSION: The results of the study demonstrated the pronounced clinical effectiveness of trifarotene cream 0.005% in the treatment of patients with moderate acne on the skin of the face and trunk.

Single-arm, first-in-human feasibility study results for an ultra-low-cost insulin pump

BackgroundUse of Continuous Subcutaneous Insulin Infusion (CSII) has been shown to improve glycemic outcomes in Type 1 Diabetes (T1D), but high costs limit accessibility. To address this issue, an inter-operable, open-source Ultra-Low-Cost Insulin Pump (ULCIP) was developed and previously shown to demonstrate comparable delivery accuracy to commercial models in standardised laboratory tests. This study aims to evaluate the updated ULCIP in-vivo, assessing its viability as an affordable alternative for those who cannot afford commercially available devices.MethodsThis first-in-human feasibility study recruited six participants with T1D. During a nine-hour inpatient stay, participants used the ULCIP under clinical supervision. Venous glucose, insulin, and β-Hydroxybutyrate were monitored to assess device performance.ResultsParticipants displayed expected blood glucose and blood insulin levels in response to programmed basal and bolus insulin dosing. One participant developed mild ketosis, which was treated and did not recur when a new pump reservoir was placed. All other participants maintained β-Hydroxybutyrate < 0.6 mmol/L throughout.ConclusionThe ULCIP safely delivered insulin therapy to users in a supervised inpatient environment. Future work should focus on correcting a pump hardware issue identified in this trial and extending device capabilities for use in closed loop control. Longer-term outpatient studies are warranted.Trial RegistrationThe trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623001288617) on the 11 December 2023.

A light-weight and generalizable deep learning model for the prediction of COVID-19 from chest X-ray images

The detection of coronavirus disease (COVID-19) using standard laboratory tests, such as reverse transcription polymerase chain reaction (RT-PCR), is time-consuming. Complex medical imaging problems are currently being solved using machine learning and deep learning techniques. Our proposed solution utilizes chest radiography imaging techniques, which have shown to be a faster alternative for detecting COVID-19. We present an efficient and lightweight deep learning architecture for identifying COVID-19 using chest X-ray images which achieve 99.81% accuracy in intra-database testing and 100% accuracy in cross-validation testing on a separate data set. The results demonstrate the potential of our proposed model as a reliable tool for COVID-19 diagnosis using chest X-ray images, which can have a significant impact on improving the efficiency of COVID-19 diagnosis and treatment.

Association of cell-free DNA with the length of ulcerated plaque in the infarct-related artery and the myocardial infarct size among patients with ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention

Aim. To evaluate the changes of cell-free DNA (cfDNA) levels before and after percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute coronary syndrome (STE-ACS). To identify associations of cfDNA concentration before and after PCI with complications and length of ulcerated plaque in patients with STE-ACS.Material and methods. This prospective single-center observational pilot study included 44 patients with STE-ACS admitted to the cardiac intensive care unit during the period of May-August 2023. In all patients, along with standard laboratory tests, cfDNA level was measured upon admission and 24 hours after PCI. Assessment of cfDNA associations before and after PCI was carried out in relation to following significant complications and conditions in STE-ACS patients: death, acute left ventricular failure (ALVF), acute heart failure (AHF), arrhythmia, number of stents implanted, number of segments with impaired local contractility, total stent length.Results. The mean age of the patients was 60,6±9,6 years, of which 74,6% were men. TIMI 0-1 flow was recorded in 93,2% of the subjects. The most common complications were cardiogenic shock (18,4%), arrhythmia (16,9%), AHF (13,6%), ALV (11,9%). Death was recorded in 8,5%. Implantation of 1 stent in PCI was performed in 75% of cases, while in the rest, 2 or more stents were implanted. The proportion of patients with impaired local contractility was 90%, the median stent length was 24,0 (20,0-50,0) mm. CfDNA level on admission did not differ from level after PCI 94,5 (78,3-155,5) ng/ml vs 115,0 (71,0-152,0), p=0,46. However, it signi­ficantly exceeded the cfDNA concentration from a group of healthy volunteers (78,0 (59,7-106,0), p=0,017). Characteristic curve showed significant relationships both for the concentration of cfDNA before (with implantation of 2 or more stents (AUC 0,71 with 95% confidence interval (CI) 0,56-0,86, p=0,039), stent length &gt;24 mm (AUC 0,73 with 95% CI 0,58-0,89, p=0,009)) and after PCI (with the number of impaired local contractility segments (AUC 0,73 with 95% CI 0,57-0,89, p=0,014)). If the cfDNA level before PCI was &gt;90 ng/ml, the risk of implantation of 2 or more stents per procedure increased by 5,4 times (odds ratio (OR) 5,4, 95% CI 1,11-28,93, p=0,044). The risk of a stent length &gt;24 mm with pre-PCI cfDNA &gt;107 ng/ml increased 9-fold (OR 9,0 with 95% CI 2,2-36,9, p=0,001), and the cfDNA level after PCI &gt;105 ng/ml increased the risk of impaired local left ventricular (LV) contractility in 2 or more segments by 5 times (OR 5,0, 95% CI 1,23-20,3).Conclusion. In the studied group of patients with STE-ACS subject to intervention, the cfDNA concentration before PCI was associated with the implantation of ≥2 stents and the stent length (&gt;24 mm). CfDNA level before PCI was associated with the number of segments of impaired local LV contractility (≥2).

Angiotensin Receptor-Neprilysin Inhibitor Is Associated With Improved Cardiac Autonomic Function in Heart Failure.

Heart failure with reduced ejection fraction is associated with potentially deleterious imbalance of the cardiac autonomic nervous system. Sacubitril/valsartan (angiotensin receptor-neprilysin inhibitor [ARNI]) reduces cardiovascular mortality and hospitalization for heart failure with reduced ejection fraction. Whether ARNI affects the cardiac autonomic nervous system has not been studied. This investigator-initiated, prospective, single-center cohort study compared heart rate (HR) variability, HR, deceleration capacity, and periodic repolarization dynamics as noninvasive measures of the cardiac autonomic nervous system before and after initiation of ARNI therapy. Patients underwent standardized 12-lead Holter-ECG, echocardiography and laboratory testing before and 3 months after start of therapy. End points were changes in HR variability (SD of normal-to-normal intervals, mean square of differences between consecutive R-R intervals), HR, deceleration capacity, and periodic repolarization dynamics as well as ventricular function and NT-proBNP (N-terminal pro-B-type natriuretic peptide). Of 63 patients with heart failure with reduced ejection fraction enrolled, 48 (76.2%) patients were still on ARNI at follow-up. SD of normal-to-normal intervals increased from 25 to 36 milliseconds (P<0.001), mean square of differences between consecutive R-R intervals increased from 12 to 19 milliseconds (P<0.001), HR decreased from 73±9 bpm to 67±4 bpm, (P<0.001), and deceleration capacity increased from 2.1 to 4.4 milliseconds (P<0.001). A trend for periodic repolarization dynamics reduction was observed (5.6 deg2 versus 4.7 deg2, P=0.09). Autonomic changes were accompanied by increased left ventricular ejection fraction (29±6% versus 40±8%, P<0.001) and reduced NT-proBNP (3548 versus 685 ng/L, P<0.001). Correlation analysis showed a significant relationship between volume-unloading (as evidenced by NT-proBNP reduction) and autonomic improvement. Three months of ARNI therapy resulted in a significant increase in cardiac parasympathetic tone. The improvement in autonomic properties may be mediated by "volume unloading" and likely contributes to the beneficial effects of ARNI in heart failure with reduced ejection fraction. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04587947.