Status Classification Research Articles

Association of the Revised Cardiac Risk Index with 1-year postoperative mortality: A single-center retrospective study.

To explore risk factors for 1-year postoperative mortality and to identify its association with the Revised Cardiac Risk Index (RCRI). This was a retrospective cohort study involving 54,933 patients aged 18years and above who were surgically treated under general or regional anesthesia in a tertiary hospital in Singapore. Independent risk factors for 1-year postoperative mortality were identified by univariate Cox regression analysis. The association between the RCRI and 1-year postoperative mortality was assessed by the Kaplan-Meier estimator and multivariate Cox regression analysis and was further validated in subgroup analyses stratified by the sex, age, and type of anesthesia. A total of 54,933 eligible patients were enrolled in this study that included 23,922 patients classified as RCRI Class I, 25,979 as Class II, 3700 as Class III, and 1332 as Class IV. Cox regression analysis demonstrated that male sex, age, higher American Society of Anesthesiologists (ASA) physical status classification level, regional anesthesia, emergency surgery, degree of anemia, and increased RCRI were significantly associated with the increased risk of 1-year postoperative mortality (HR>1, all P<0.001). The significant association between RCRI and 1-year postoperative mortality still existed after adjusting for confounding factors. An RCRI Class IV was associated with a mortality risk greater than two-fold larger than that observed at an RCRI Class I (adjusted HR 2.14, 95% CI 1.78 to 2.56, p<0.001). Subgroup analyses revealed that the 1-year postoperative mortality was significantly higher in patients with RCRI Class IV than that of Classes I-III regardless of the sex, age, and type of anesthesia. RCRI is significantly correlated with 1-year postoperative mortality regardless of sex, age, and type of anesthesia. Further studies to validate these findings are warranted.

Evaluation of MRI characterisation of histopathologically matched lymph nodes and other mesorectal nodal structures in rectal cancer.

To evaluate current MRI-based criteria for malignancy in mesorectal nodal structures in rectal cancer. Mesorectal nodal structures identified on baseline MRI as lymph nodes were anatomically compared to their corresponding structures histopathologically, reported as lymph nodes, tumour deposits or extramural venous invasion. All anatomically matched nodal structures from patients with primary surgery and all malignant nodal structures from patients with neoadjuvant treatment were included. Mixed-effects logistic regression models were used to evaluate the morphological criteria irregular margin, round shape, heterogeneous signal and nodal size, as well as the combined 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus criteria, with histopathological nodal status as the gold standard. In total, 458 matched nodal structures were included from 46 patients (mean age, 67.7 years ± 1.5 [SD], 27 men), of which 19 received neoadjuvant treatment. The strongest associations in the univariable model were found for short-axis diameter ≥ 5 mm (OR 21.43; 95% CI: 4.13-111.29, p < 0.001) and heterogeneous signal (OR 9.02; 95% CI: 1.33-61.08, p = 0.024). Only size remained significant in multivariable analysis (OR 12.32; 95% CI: 2.03-74.57, p = 0.006). When applying the ESGAR consensus criteria to create a binary classification of nodal status, the OR of malignant outcome for nodes with positive ESGAR was 8.23 (95% CI: 2.15-31.50, p = 0.002), with corresponding sensitivity and specificity of 54% and 85%, respectively. The results confirm the role of morphological and size criteria in predicting lymph node metastases. However, the current criteria might not be accurate enough for nodal staging. Question Pretreatment lymph node staging in rectal cancer is challenging, and the ESGAR consensus criteria are not fully validated. Findings Although the ESGAR criteria correlated with malignant outcomes, diagnostic performance in terms of particular sensitivity, but also specificity, was not high. Clinical relevance Accurate nodal staging in rectal cancer is crucial for individual treatment planning. However, this validation of the current ESGAR consensus criteria suggests that these should be used with caution.

Predictive Factors for 24-h Survival After Perioperative Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort Study.

Background: Perioperative cardiac arrest (POCA) remains a major challenge in surgical settings, with low survival after cardiopulmonary resuscitation (CPR). This study aims to identify predictive factors for 24 h survival after CPR and cause of POCA. Method: A retrospective, single-center study was conducted on patients aged ≥18 years who experienced POCA and received CPR in the operating room or within 2 h postoperatively at Chiang Mai University Hospital from 2010 to 2019. The multivariable analysis of independent survival predictors was performed using risk regression models. Results: There were 288 cases of cardiopulmonary arrest requiring CPR, with 61 patients surviving. Significant predictors of survival after perioperative CPR included the American Society of Anesthesiologists physical status classification (ASA) 1-2 (RR 2.53; 95%CI 1.69-3.77; p < 0.001), preoperative hemoglobin ≥ 8 g/dL (RR 2.27; 95%CI 1.05-4.89; p = 0.036), preoperative oxygen saturation ≥ 90% (spontaneous breathing in room air) (RR 3.19; 95%CI 1.21-8.41; p = 0.019), initial end-tidal carbon dioxide between 35 and 45 mmHg (RR 1.55; 95%CI 0.98-2.44; p = 0.059), and duration of CPR ≤ 30 min (RR 3.68; 95%CI 1.51-8.98; p = 0.004). The major cause of POCA was hypovolemia (74.30%). Conclusions: This study identifies several critical predictors for 24 h survival following POCA, which can inform pre-operative optimization and perioperative management. Timely interventions, such as blood transfusions and volume resuscitation, are crucial in improving survival outcomes, particularly in trauma and high-risk patients. Further multi-center studies are needed to validate these findings and explore long-term outcomes to refine perioperative cardiac arrest management.

Health Care Providers' Attitudes and Knowledge Related to Tic Disorder Identification and Treatment.

Our study assessed child-serving health care providers' attitudes and knowledge related to identification and treatment of tic disorders including Tourette syndrome (TS), among children. We analyzed cross-sectional data from the 2022 Fall DocStyles, a web-based survey of health care providers. The analytic sample included 1058 child-serving providers (403 family practitioners, 232 internists, 251 pediatricians, and 172 nurse practitioners or physician assistants). We calculated point prevalence estimates and 95% confidence intervals and used χ2 tests to statistically test differences by provider type and metro status of practice setting. Less than two-thirds of providers (62.4%) considered evaluation of tics as their role, less than half (40.8%) considered diagnosis of tic disorders their role, and around one-fourth considered treatment of patients with tic disorders to be their role (27.3%). Lack of knowledge of tics/TS and lack of comfort evaluating patients for tics and tic disorders were the most often reported barriers to identification and diagnosis for most provider types, and across practice metro status categories. Online training was the most preferred source of information about tics and tic disorders overall and for each provider type. These findings support previous reports indicating challenges in health care provider comfort and knowledge in identifying and diagnosing tic disorders, and the need for more education opportunities around evaluation and diagnosis. Communication and training to support the needs of child-serving providers could improve the access to care for children with tics and tic disorders.

Multistage deep learning for classification of Helicobacter pylori infection status using endoscopic images.

The automated classification of Helicobacter pylori infection status is gaining attention, distinguishing among uninfected (no history of H. pylori infection), current infection, and post-eradication. However, this classification has relatively low performance, primarily due to the intricate nature of the task. This study aims to develop a new multistage deep learning method for automatically classifying H. pylori infection status. The proposed multistage deep learning method was developed using a training set of 538 subjects, then tested on a validation set of 146 subjects. The classification performance of this new method was compared with the findings of four physicians. The accuracy of our method was 87.7%, 83.6%, and 95.9% for uninfected, post-eradication, and currently infected cases, respectively, whereas that of the physicians was 81.7%, 76.5%, and 90.3%, respectively. When including the patient's H. pylori eradication history information, the classification accuracy of the method was 92.5%, 91.1%, and 98.6% for uninfected, post-eradication, and currently infected cases, respectively, whereas that of the physicians was 85.6%, 85.1%, and 97.4%, respectively. The new multistage deep learning method shows potential for an innovative approach to gastric cancer screening. It can evaluate individual subjects' cancer risk based on endoscopic images and reduce the burden of physicians.

Trends in the prevalence of Chronic Kidney Disease in the United States, 1999–2018

BackgroundChronic Kidney Disease (CKD) is an escalating public health concern in the United States, linked with significant morbidity, mortality, and healthcare costs. Despite known risk factors like age, hypertension, and diabetes, comprehensive studies examining temporal trends in CKD prevalence are scarce. This study aims to analyze these trends using data from the National Health and Nutrition Examination Survey (NHANES).MethodsThis cross-sectional study analyzed NHANES data spanning 20 years (1999–2018), including 55,081 adults aged 20 years and above. Key renal function indicators like estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) were assessed, and CKD stages were categorized accordingly.ResultsA fluctuating trend in CKD prevalence was observed, with early CKD stages (G1–G3) increasing from 9.28% in 1999–2000 to 12.93% in 2017–2018. Advanced CKD stages (G4–G5) showed a slight increase in prevalence from 0.3% in 1999–2000 to 0.51% in 2017–2018. Notable disparities were observed across age groups, diabetes status, and racial categories. Relatively, the elderly, women, and non-Hispanic whites have a higher prevalence of CKD, while individuals with diabetes have a consistently higher prevalence of early CKD from 1999 to 2018. The increasing prevalence of diabetes during the study period highlights its significant role as a CKD risk factor.ConclusionThe prevalence of CKD in the U.S. has been rising over the period 1999–2018, and varying across demographic groups, underscoring significant disparities and risk factors. These insights are crucial for healthcare planning, policy formulation, and targeted interventions for CKD management.

Procedural Sedation in the Emergency Department – An Observational Study: Does Nil Per Os Status Matter?

Introduction: Procedural sedation (PS) is commonly performed in the emergency department (ED). Nil per os (nothing by mouth) (NPO) guidelines extrapolated from standards for patients undergoing elective procedures in the operating room have been applied to ED PS patients. There has been no large study of ED PS patients comparing differences in adverse events and PS success rates based on NPO status. Methods: From a cohort of consecutive ED PS patients of all ages in the 20 EDs of one hospital system—one quaternary ED, four tertiary EDs, six community hospital EDs, one rural ED, two pediatric EDs, and six freestanding EDs in two states in the Midwest and South—we conducted a retrospective analysis on a prospective database over 183 months from April 2000–June 2015. Primary outcome was the incidence of side effects and complications, which comprised the adverse effects. The side effects were nausea, vomiting, itching/rash, emergence reaction, myoclonus, paradoxical reaction, cough, and hiccups. Complications were oxygen desaturation &amp;lt;90%, respiratory depression (respiratory rate &amp;lt;8), apnea, tachypnea, hypotension, hypertension, bradycardia, and tachycardia. Normal vital signs were age dependent. Secondary outcome was successful sedation defined as completion of the procedure. We examined the association between adverse events and successful sedation with NPO status. Results: Of 3,274 visits, exact NPO status was known in 2,643 visits. Comparison of NPO &amp;lt;8 hours in 1,388 patients vs ≥ 8 hours in 1,255 patients revealed side effects 5.5% vs 4.5% (P = 0.28); complications 11.9% vs 17.7% (P &amp;lt; 0.001); adverse events 16.3% vs 21.5% (P &amp;lt; 0.001), interventions 4.1% vs 4.4% (P = 0.73), and procedural completions 94.3% vs 89.7% (P &amp;lt; 0.001). After adjustment for age, sex, transfer status, American Society of Anesthesiology physical status classification, race, primary sedative, multiple sedatives, sedative plus analgesic, and primary analgesic, we found no association betweenNPOstatus and side effects (P = 0.68), complications (P = 0.48), or adverse effects (P = 0.26); however, procedural completion rate remained significantly higher for NPO &amp;lt; 8 hours (P = 0.007). Conclusion: A nil per os status ≥8 hours may have similar or worse outcomes than NPO &amp;lt;8 hours, which is contrary to many suggested guidelines. Strict adherence to NPO guidelines in ED procedural sedation patients may not be necessary.

Assessment of Anxiety Status and its Impact on Academic Performance of Undergraduate Medical Students of Bangladesh

Background: Mental health is essential for the well-being of both individuals and communities. Undergraduate medical students travel medical course with tremendous psychological stress because of new environment, language difficulties, curricular overload and frequent examinations. This may hamper their academic performance and mental strength. This study aimed to observe the anxiety status and academic performance of undergraduate medical students of Bangladesh. Methods: This cross-sectional study was performed among 1921 undergraduate medical students from five medical colleges in Bangladesh, who were selected using convenience sampling method. The study was conducted from July 2023 to June 2024. For assessment of anxiety level generalized anxiety disorder 7 (GAD 7) questionnaire was used. The academic performance of the students was self-reported by students as passed (regular/irregular) MBBS professional examinations. Results: The mean score to different questions related to determine their anxiety status were ranged from 31.83% to 39.5%. It was found that out of 1921 medical students, 40.6%, 29.6%, 17.9% and 11.9% had minimal, mild, moderate and moderately severe anxiety respectively. Different categories of anxiety level were found significantly higher among the female participants and in first academic phase. Majority of the participants passed regularly (&gt;90%) in their professional examinations. Conclusion: Based on the findings of the present study it can be concluded that undergraduate medical students suffer from varying degrees of Anxiety. Different socio-demographic variables have found significantly associated with different categories of anxiety status. Academic performances have been found affected by the different categories of anxiety as well. It can be concluded that anxiety should be reduced for the betterment of their academic performance and mental strength and ultimately to produce quality physicians to serve the community. BJME, Volume-16, Issue-01, January 2025: 49-60

The Documentation Status Continuum and the Impact of Categories on Healthcare Stratification

Public discourse on immigration and social services access has been contentious in immigrant-receiving countries. Scholars have examined immigrants’ marginalization as a form of civic stratification, where boundaries based on documentation status affect immigrants’ experiences and benefits granted by the state. This scholarship lacks a framework outlining existing documentation status categories and does not fully answer three research questions I pose in this article: (1) what is the alignment of documentation status categories relative to each other, (2) how does policy (re)configure those categories over time, and (3) how have documentation status categories shaped access to health care in the United States? This article answers those questions and argues that the documentation status continuum (DSC) framework fills these gaps. In the DSC, undocumented immigrants are at one end and citizens are at the other, with many documentation statuses in between. Public policy creates these statuses and generates stratification through allocating benefits based on one’s DSC position. Policy also shapes movement along the continuum, which shapes benefits eligibility. Using the 2006 Massachusetts Health Reform and national 2010 Affordable Care Act (ACA) Reform as policy examples and interviews conducted with 207 immigrants, healthcare professionals, and immigrant organization employees in Boston, this article demonstrates how healthcare access is stratified along the DSC between citizens and noncitizens. This has implications for various outcomes that social scientists examine amid increasing anti-immigrant sentiment in the US and beyond.

Simulation Research on Data Acquisition and Supervisory Control System of Distribution Network Based on Vector Regression Model

With the gradual maturity of deep learning and the Internet of Things, a smart grid is urgently needed to be established. For the intellectualization of the power grid, non-intrusive load monitoring (NILM) technology is the key step of intellectualization. The traditional load monitoring method is an invasive scheme, in which monitoring sensors are usually installed at the output end of each grid load. This method requires a lot of manpower and material resources in terms of equipment installation and maintenance, which is difficult to sustain. Therefore, monitoring electrical appliances are installed at the entrance of the distribution network to decompose the classification and operation status of the individual electrical appliances in the grid. Aiming at the problem of long-term multi-state electrical apparatus monitoring, this paper mainly optimizes the two optimal deep learning models Seq2Seq and WindowGRU based on activation function optimization, regular function optimization and neural network structure optimization. PReLU, Leaky-ReLU and ELU are used and tested. For the optimization based on regular functions, the value of F1-score is 0.9700, which is 0.1534 more than the optimization algorithm Seq2SeqLR in this paper. Meanwhile, it can also reach 0.8100 for other devices, which is 0.2373 more than the nilmTCN designed in this paper. The Recall value of the identification is improved to 0.6673, which is significantly higher than that of other models. It is proved that the research contents of this paper can improve the effective analysis of load energy consumption data, and can minimize unnecessary energy consumption to achieve the purpose of saving electricity.

Extent and predictors of socio economic deprivation in urban geriatric subjects: evidence from Varanasi, India

Old age Socio Economic Deprivation (SED) is a significant issue because geriatric subjects (60 years and above) are more vulnerable to SED than the other age group. Socio-economic deprivation refers to deprivation in terms of economic parameters, food, water sanitation, shelter and information. The predictors of SED in geriatric subjects have been the least researched area. The objective of the present study was to find out predictors of SED. This study was carried out by adopting a cross-sectional study design on 616 (279 male and 337 female) geriatric subjects (60 years and above) selected by a multistage sampling procedure from urban Varanasi, India. Pre-designed, pre-tested proforma was used for assessing socio-economic deprivation in subjects by using interview techniques. Data was analyzed by using SPSS version 22.0. In order to find out predictors of all significant variables in bivariate analysis, viz., associates of socioeconomic deprivation were subjected to a logistic regression model. According to Rangrajan Committee criteria 38.0% subjects were below the poverty line. Food, water and sanitation deprivation were to the extent of 44.8%, 29.2% and 14.8%, respectively. As many as 32.6 % and 40.9% of subjects were deprived of shelter and education, respectively. There existed a significant association of gender, marital status, caste, religion, type of family and literacy status of study subjects with SED. However, the logistic model nullified the significant association of these variables with SED. In comparison to family size &lt; 3 risk of SED was 3.31 (CI: 1.13-9.68) and 10.17 (CI: 2.44-42.45) times more in subjects with family size 3-6 and &gt;6, respectively. When upper, upper middle and lower middle socio-economic status categories were considered as reference it was found that risk for SED was significantly (p&lt;0.01) more in lower and upper lower SES categories. Odds of SED for lower and upper lower SES were 84.13 (CI: 15.9-244.63) and 18.24 (CI: 8.69-38.24) times higher than their counterparts, respectively. People with socioeconomic deprivation need to have focused attention based on the predictors of SED. Limiting family size, ensuring income generation activities and economic security are key inputs for optimum dividends in tackling SED.

Risk factors for prolonged surgical duration of tracheobronchial foreign body removal in children: a single-center retrospective study.

This study aims to analyze the clinical characteristics of children with tracheobronchial foreign body and to investigate the factors influencing the surgical duration of rigid bronchoscopic foreign body removal under general anesthesia. We retrospectively identified 421 children diagnosed with tracheobronchial foreign body undergoing rigid bronchoscopy between January 2020 and December 2021. A comprehensive analysis was conducted on patient demographics, including age, weight, gender, American Society of Anesthesiologists (ASA) physical status classification, foreign body type and location, duration of foreign body retention, preoperative symptoms, signs, imaging findings, tracheobronchial manifestations observed during bronchoscopy, and surgical durations. Statistical analysis utilized both univariate and multivariate linear regression models to assess factors influencing the surgical duration of tracheobronchial foreign body removal in children. The mean age of children with tracheobronchial foreign body was 1.59 years (1.32, 2.04). The male-to-female ratio was 1.8:1, and the ASA physical status classification was predominantly ASA II (96.7%). Organic foreign body accounted for 94.8% of cases, with 91.7% located unilaterally. Univariate and multivariate linear regression analyses revealed that ASA III, pulmonary rales, and the presence of one, two, or three specific tracheobronchial manifestations observed during bronchoscopy-including mucosal hyperemia and edema, purulent exudate, and granulation tissue-were independent risk factors associated with prolonged surgical duration for foreign body removal (P < 0.05). ASA III, pulmonary rales, and various tracheobronchial manifestations observed during bronchoscopy are significant risk factors associated with prolonged surgical duration for foreign body removal in children.

Nutritional Status of Patients with Neoplasms Undergoing Ambulatory Chemotherapy and Associated Factors.

Cancer, a leading cause of mortality globally and in Brazil, is influenced by environmental and behavioral factors, often linked to nutritional deficiencies such as low body mass index and muscle wasting, exacerbating prognostic outcomes and mortality rates. Timely nutritional interventions during chemotherapy are pivotal, necessitating continuous nutritional assessment for effective patient care management. This study aimed to assess the nutritional status of non-metastatic cancer patients undergoing chemotherapy and identify factors influencing their nutritional status. Patient evaluation involved sociodemographic data, clinical profiles, anthropometric measurements, blood biochemical analyses, and nutritional status classification employing the Patient-Generated Subjective Global Assessment (PG-SGA) criteria. Statistical analysis was performed using R software. Suspected malnutrition was identified in 5.81% of patients, with a significant association observed with gender, indicating a higher prevalence among men. Cancer stages II and III, along with a positive family history, correlated with heightened risk of malnutrition. Patients with suspected malnutrition exhibited older age, lower weight, body mass index (BMI), and reduced circumferences, underscoring the necessity of comprehensive nutritional assessment for optimized patient management during treatment. This study underscores a notable prevalence of malnutrition, particularly among patients with lower weight and BMI, affirming the reliability of PG-SGA criteria.

Comparative evaluation of TNM staging systems (eighth vs. ninth edition) for the non-surgical treatment of localized and locally advanced anal squamous cell carcinoma: Prognostic significance of T classification and lymph node status.

This study aims to compare the survival discrimination of the Tumor-Node-Metastasis (TNM) eighth and ninth editions for patients with localized and locally advanced (LLA) anal squamous cell carcinoma (ASCC) treated non-surgically and to evaluate the prognostic impact of T classification and lymph node (LN) status with data from the Surveillance, Epidemiology, and End Results database. We retrospectively included 6,876 patients in the comparison. We observed the inversion of survival outcomes for stages IIB and IIIA diseases in the TNM eighth edition [median overall survival (OS): 112 months for stage IIB vs. not reached for stage IIIA]. By contrast, it demonstrated improvement in the TNM ninth edition (median OS: not reached for IIB disease vs. 120 months for IIIA disease, P<0.001). In the correlation analysis, we observed an increased correlation between T classification and TNM staging systems (r value increased from 0.78 to 0.93) and a decreased correlation for the LN status (r value decreased from 0.83 to 0.59). For OS, variable importance analysis demonstrated more weight of importance for the T classification than the LN status (0.0871 vs. 0.0048). Additionally, decision curve analysis and time-dependent receiver operating characteristic analysis confirmed the prognostic accuracy of T classification rather than the LN status. In conclusion, TNM ninth edition is a better prognostic indicator than the eighth edition for patients with LLA ASCC treated non-surgically. T classification plays a more important prognostic role than the LN status and warrants further validation.

Analysis and classification of pig health status using hourly activity data: Combining statistical analysis and machine learning

Analysis and classification of pig health status using hourly activity data: Combining statistical analysis and machine learning

Prediction of In-Hospital Mortality after Emergency Laparotomy Using Glasgow Coma Scale, ASA Physical Status Classification, and P-POSSUM Score.

To determine the importance of the Glasgow Coma scale (GCS), ASA physical status classification system, and P-POSSUM score in predicting mortality among patients undergoing emergency laparotomies. An analytical study. Place and Duration of the Study: Department of General Surgery, Sheikh Khalifa Bin Zayed Al-Nahyan Hospital Muzaffarabad, Pakistan, from October 2020 to January 2022. All emergency laparotomies performed during the above-mentioned period were included consecutively, excluding trauma laparotomies, re-do laparotomies after elective surgery, appendectomies, cholecystectomies, pancreatectomies, organ transplantation surgeries, and laparotomies due to gynaecological or vascular causes such as ruptured abdominal aortic aneurysm. The GCS scores were broken down into mild (14-15), moderate (9-13), and severe (3-8) categories. The ASA scoring was classified into five classes, i.e., Classes I to V. The P-POSSUM scores were assessed for each of the following five groups: (≤10, 11-20, 21-30, 31-40, and ≥41). Out of 50 patients (mean age: 47 ± 19 years), there were 39 (78%) males and 11 (22%) females. The median values for GCS and P-POSSUM scores were 15 and 11.1, respectively. According to the ASA, most patients (21, 42%) fit into Class II. Twelve (24%) patients died, while 38 (76%) survived. The mortality rate increased with an increasing P-POSSUM score, a lowering GCS score, and a higher class of ASA (all p <0.001). The ROC curve analysis showed that P-POSSUM had the best performance at 0.987, followed by ASA (0.951) and GCS (0.411). The ASA Physical Status Classification System and P-POSSUM scoring were significantly predictive of mortality after an emergency laparotomy. ASA Physical Status Classification System, Emergency laparotomy, Glasgow coma scale, Mortality, Outcome, P-POSSUM.

Exploring Case Acceptance and Referral Needs in Pre-Anesthetic Checkup Clinic: A Tertiary Care Center Based Study

Introduction: The pre-anesthetic checkup clinic is a crucial component of perioperative care, assessing patients scheduled for elective surgery to determine their readiness. The acceptance of cases for surgery hinges on adequate preoperative investigations and the optimization of comorbidities. This study aimed to evaluate the case acceptance rate and identify the reasons for non-acceptance among patients visiting a PAC clinic in a tertiary care center in Nepal. Methods: A prospective observational study was conducted on 357 patients visiting the pre-anesthetic clinic for the first time. Patient demographics, American Society of Anesthesiologists physical status classification, acceptance rates, and reasons for non-acceptance were recorded and analyzed. Results: Of the 357 patients evaluated, 217 (60.8%) were accepted for surgery during their initial visit. The remaining 39.2% were not cleared due to insufficient investigations (20.1%) or the need for referral to subspecialty departments for the optimization of comorbidities (19%). The majority of referrals were related to cardiovascular and endocrine issues. Conclusion: The study reported a 60.8% acceptance rate for first-time preanesthetic clinic visits, with 39.2% of cases requiring further investigations or specialty referrals for comorbidity optimization.

聖武 천황 시기 관인 질서의 재구축

The purpose of this paper is clarifying how and why the governmental order was reconstructed under the Emperor Shomu’s reign in the first half of the 8th century. Additionally, I would like to discuss the relationship between transformation of the class system and status of officials originated from the continent. The Emperor Shomu succeeded to the throne from the former Emperor Genshō in 724 attempted primarily at strengthening the Ritsuryo system by ensuring the financial system and reorganizing officials. The class system became ambiguous and necessity of making clear ranks among clans emerged in the first half of the 8th century. For ensuring unity and ranks among officials simultaneously, he introduced new class system and determined seat position of each class at the New Year's Day banquets in 728. He evaluated capabilities of those who originated from the continent on one hand, delimited possibilities they became officials on the other hand. I assume we have to interpret this posture understanding entire his image on the state.

ЛАПЧАТКА МУЛДАШЕВА POTENTILLA MULDASCHEVII KNIAZ. ET SEMERIKOV (ROSACEAE) – НОВЫЙ ЭНДЕМИЧНЫЙ ВИД ФЛОРЫ РЕСПУБЛИКИ БАШКОРТОСТАН

of the Southern Urals, candidate of biological sciences, senior researcher at the laboratory of Geobotany and Plant Resources of the Ufa Institute of biology of the Ufa Federal Research Center of the Russian Academy of Sciences, honored ecologist of the Russian Federation Albert Akramovich Muldashev in connection with his 70th anniversary, which was celebrated on August 25, 2024. The species Potentilla muldaschevii Kniaz. et Semerikov (family Rosaceae) is a narrow-local endemic of the Southern Urals (Uchalinsky Uplands). This species was described in 2006 from the territory of the Republic of Bashkortostan (RB) by famous scientists from Yekaterinburg M.S. Knyazev and V.L. Semerikov [2006]. The species is included in the Red Data Book of the RB 3rd edition [2021] with the regional protection status: 1) rarity status category: 1 – endangered species; 2) endangered status category: endangered species (EN – Endangered); 3) conservation status: II priority (it is necessary to implement one or more special measures to preserve the species in the Southern Urals). This species is very rare. In the RB, the species is known from 3 points in the Uchalinsky district: the Maly Irendyk ridge west of the village Tungatarovo (locus classicus), ridges to the north and south of the village of Polyakovka [Knyazev, Semerikov, 2006; materials of the LE Herbarium and the SVER Herbarium; Red Data Book…, 2021]. In the Chelyabinsk region, the species is found on the limestone Ustinovskie cliffs along the right bank of the Miass River (Miass district) [materials of the CSUH Herbarium; Knyazev, Semerikov, 2006; Red Data Book…, 2017].

The effect of supplementary parenteral nutrition with different energy intakes on clinical outcomes of patients after gastric cancer surgery

BackgroundTo investigate the effect of postoperative supplementary parenteral nutrition (SPN) containing varying energy intake levels during the early postoperative period on the clinical outcomes of patients diagnosed with gastric cancer.MethodsData from 237 patients, who were diagnosed with gastric cancer between January 2016 and June 2022, were retrospectively analyzed. Patients were divided into 2 groups based on mean daily SPN energy intake: low (L-SPN; < 20 kcal/kg/day); and high (H-SPN; ≥ 20 kcal/kg/day). Data regarding gender, age, body mass index, preoperative Nutrition Risk Screening 2002 (NRS 2002) score, American Society of Anesthesiologists Physical Status classification system, age-adjusted Charlson Comorbidity Index, diabetes, hypertension, chronic lung disease, and the Tumor-Node-Metastasis (TNM [Eighth edition]) classification were collected for propensity score matching (PSM). Postoperative indicators were monitored. A power analysis was performed during the design phase of this study to ensure that statistical power exceeded 80% to reliably detect differences between the 2 groups.ResultsAfter PSM, data from 128 patients were analyzed (H-SPN, n = 64; L-SPN, n = 64). The H-SPN group experienced shorter postoperative hospital stay (8.11 ± 6.00 days vs. 10.38 ± 7.73 days; P = 0.045) and a lower number of infectious complications (36 [56.3%] vs. 60 [93.8%]; P < 0.001), particularly pulmonary infections, compared with the L-SPN group. Additionally, no increase in hospitalization costs or non-infectious complications occurred in the H-SPN group. Subgroup analysis revealed that H-SPN significantly reduced the incidence of infectious complications among those < 65 years of age (hazard ratio [HR] [95% confidence interval (CI) 0.240 0.069–0.829]; P = 0.024), NRS 2002 score ≥ 3 (HR 0.417 [95% CI 0.156–0.823]; P = 0.028), age-adjusted Charlson Complexity Index < 2 (HR 0.106 [95% CI 0.013–0.835]; P = 0.033), and TNM stage III (HR 0.504 [95% CI 0.224–0.921]; P = 0.046).ConclusionsH-SPN effectively reduced postoperative infectious complications and the length of hospital stay, suggesting that early postoperative H-SPN may be an advantageous nutritional support strategy for patients diagnosed with gastric cancer.