Difference In Time Research Articles

Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome

Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome

Comparative efficacy and safety of intelligent pressure-controlled versus flexible vacuum-assisted ureteral access sheath for 2-4 cm renal calculi.

Retrograde intrarenal surgery (RIRS) is being increasingly used to treat 2-4 cm renal stones, which can be attributed to advances in flexible ureteroscopes and ureteral access sheaths (UASs). Despite the improvement and application of flexible vacuum-assisted (FV) and intelligent pressure-controlled (IPC) UASs, no studies have compared their therapeutic efficacy and safety. Therefore, this study aimed to compare the therapeutic efficacy and safety of IPC-UAS and FV-UAS in RIRS 2-4 cm renal stones. We included 96 and 103 patients who underwent IPC-UAS and FV-UAS RIRS, respectively, for 2-4 cm renal stones. Stone-free rate (SFR), operative time, and complications were compared between the two groups. The immediate SFR was 69.8% and 82.5% in the IPC-UAS and FV-UAS groups, respectively (P<0.05). There were no significant between-group differences in the 1-month SFR (84.4% vs. 84.5%, P>0.05). The IPC-UAS group had a shorter hospital stay (5.2±2.4 vs. 6.2±3.2 days, P=0.018) and lower cost (CNY13014.7±3240.7 vs. CNY14022.5±2301.6, P=0.012) than the FV-UAS group. There were no significant between-group differences in operative time or complications. Regarding RIRS for 2-4 cm renal stones, the IPC-UAS group can achieve a 1-month SFR similar to that of the FV-UAS group, with shorter hospitalization and lower cost. Additionally, the IPC-UAS is a promising device for efficient and safe RIRS, considering its intelligent pressure regulation. Our findings could inform optimal UAS selection for managing large renal calculi and demonstrate the utility of the novel IPC-UAS in improving outcomes of RIRS for 2-4 cm renal stones.

Disparities in Access to Timely Waitlisting Among Pediatric Kidney Transplant Candidates.

Kidney transplantation with minimal or no dialysis exposure provides optimal outcomes for children with end-stage kidney disease. We sought to understand disparities in timely access to transplant waitlisting. We conducted a retrospective, registry-based cohort study of candidates ages 3 to 17 added to the US kidney transplant waitlist 2015 to 2019. We defined "preemptive waitlisting" as waitlist addition before receiving dialysis and compared demographics of candidates based on preemptive status. We used competing risk regression to determine the association between preemptive waitlisting and transplantation. We then identified waitlist additions age >18 who initiated dialysis as children, thereby missing pediatric allocation prioritization, and evaluated the association between waitlisting with pediatric prioritization and transplantation. Among 4506 pediatric candidates, 48% were waitlisted preemptively. Female sex, Hispanic ethnicity, Black race, and public insurance were associated with lower adjusted relative risk of preemptive waitlisting. Preemptive listing was not associated with time from waitlist activation to transplantation (adjusted hazard ratio 0.94, 95% confidence interval 0.87-1.02). Among transplant recipients waitlisted preemptively, 68% had no pretransplant dialysis, whereas recipients listed nonpreemptively had median 1.6 years of dialysis at transplant. Among 415 candidates initiating dialysis as children but waitlisted as adults, transplant rate was lower versus nonpreemptive pediatric candidates after waitlist activation (adjusted hazard ratio 0.54, 95% confidence interval 0.44-0.66). Disparities in timely waitlisting are associated with differences in pretransplant dialysis exposure despite no difference in time to transplant after waitlist activation. Young adults who experience delays may miss pediatric prioritization, highlighting an area for policy intervention.

Exploring optimization strategies for support vector machine-based half-cell potential prediction

Purpose This study aims to assess support vector machine (SVM) models' predictive ability to estimate half-cell potential (HCP) values from input parameters by using Bayesian optimization, grid search and random search. Design/methodology/approach A data set with 1,134 rows and 6 columns is used for principal component analysis (PCA) to minimize dimensionality and preserve 95% of explained variance. HCP is output from temperature, age, relative humidity, X and Y lengths. Root mean square error (RMSE), R-squared, mean squared error (MSE), mean absolute error, prediction speed and training time are used to measure model effectiveness. SHAPLEY analysis is also executed. Findings The study reveals variations in predictive performance across different optimization methods, with RMSE values ranging from 18.365 to 30.205 and R-squared values spanning from 0.88 to 0.96. Additionally, differences in training times, prediction speeds and model complexities are observed, highlighting the trade-offs between model accuracy and computational efficiency. Originality/value This study contributes to the understanding of SVM model efficacy in HCP prediction, emphasizing the importance of optimization techniques, model complexity and dimensionality reduction methods such as PCA.

Emergency Medical Service Transport Time in Rural Farm and Non-Farm Pediatric Trauma

ABSTRACT Objectives Pediatric farm injuries tend to be more severe and have poorer outcomes compared to injuries sustained in non-farm settings. Timely emergency medical service (EMS) response and transport to definitive care is crucial for optimizing outcomes for trauma patients. We aimed to determine if pediatric farm injuries were associated with longer EMS response and transport times compared to pediatric non-farm injuries in rural communities. Methods The 2021 National EMS Information System (NEMSIS) database was used to identify rural EMS activations where injured pediatric patients who were transported to a hospital. Median transport times for farm and non-farm injuries, as well as other components of prehospital time and use of air EMS transport, were compared between injuries on farms and injuries in non-farm rural settings. Results The analytic sample included 22,248 rural EMS activations for pediatric injuries, of which 156 (1%) were for pediatric farm injuries. For non-farm and farm injuries, the median transport times were 20 minutes and 28 minutes, respectively. Median total prehospital time was 50 minutes compared to 62 minutes, and 9.8% of patients with non-farm injuries versus 20.5% of those with farm injuries were transported to a hospital by air EMS units. After multivariable adjustment, farm vs. non-farm injury location was associated with a 4 minute increase in EMS transport time, but no difference in initial EMS response time, EMS time on scene, or use of air EMS units. Conclusion Among children sustaining an injury that resulted in rural EMS activation, farm injuries were associated with prolonged transport time compared to non-farm injuries, which may contribute to worse in-hospital outcomes described to pediatric farm injuries in prior research.

Comprehensive fertility preservation can be offered in a timely manner around gonadotoxic therapy in children and adolescents.

Treatment for certain childhood cancers and nonmalignant conditions can lead to future infertility and gonadal failure. The risk of treatment delay must be considered when offering fertility preservation (FP) options. We examined the timeline from FP referral to return to treatment (RTT) in pediatric patients who underwent FP due to iatrogenic risk for infertility. A retrospective review was performed of patients with FP consultation due to an increased risk of iatrogenic infertility at Ann & Robert H. Lurie Children's Hospital of Chicago from 2018 to 2022. Data on diagnosis, age, treatment characteristics, and procedure were collected. A total of 337 patients (n=149 with ovaries, n=188 with testes) had an FP consultation. Of patients with ovaries, 106 (71.1%) underwent ovarian tissue cryopreservation (OTC), 10 (6.7%) completed ovarian stimulation/egg retrieval (OSER), and 33 (22.1%) declined FP. Of the patients with testes, 98 (52.1%) underwent testicular tissue cryopreservation (TTC), 48 (25.5%) completed sperm banking (SB), and 42 (22.3%) declined FP. Median time from referral to FP consultation was short (ovaries: 2days, range: 0-6; testes: 1day, range: 0-5). OSER had a significantly longer RTT versus OTC and no FP (52.5 vs.19.5 vs. 12days, p=.01). SB had a significantly quicker RTT compared to TTC or no FP (9.0 vs. 21.0 vs. 13.5days; p=.008). For patients who underwent OTC/TTC and those who declined FP, there was no significant difference in time from consultation to treatment. It is feasible to promptly offer and complete FP with minimal delay to disease-directed treatment.

Information System Design and Application of the Critical Path Method (CPM) Determining the Optimal Time for Implementing Activities

Information is the result of processing data from one or various sources, which is then processed so that it provides value, meaning and benefits. In the modern era, the use of technology plays a very important role as a means of information and promotion, especially in the field of websites in conveying information. The activity implementation plan carried out by the institution to determine the time period for completing activities still uses estimates as a guide. These estimates result in uncertain completion times. This is of course a problem in the implementation of activities, because late completion times result in time differences with the initial planned targets. Based on these conditions, the delivery of information is felt to be less than optimal because it does not yet have a website page, so the author feels that the West Sumatra Center for Public Policy Studies (PSKP) requires an information system that is able to support activities and provide information about the institution to be more effective and efficient. Then a schedule of the activity implementation process is needed from start to finish. One method that can be used for scheduling is the critical path method (CPM). This method is part of the work network method which is oriented towards determining schedules and estimating them which are deterministic (certain). With this CPM method, all activity processes are in accordance with the initial target

Enhancing reading speed: the reading acceleration effect in Italian adult readers

IntroductionEnhancing reading efficiency is of paramount importance in various academic, professional and clinical domains. Previous research, mostly from a single laboratory, has shown that externally imposed time constraints by means of text fading can enhance reading fluency in children and adults with varying reading abilities and in different languages.MethodsIn the present study, we aimed at replicating and extending previous results in Italian readers. Three experiments (N = 90) were conducted: (i) to investigate the effects of continuous fading compared to character-wise fading, (ii) to investigate the influence of enlarged inter-letter spacing on reading acceleration outcomes, and (iii) to probe whether reading gains can be reliably observed off-line (after the acceleration) by comparing accelerated reading with an analog non-accelerated procedure.ResultsOverall, results corroborate previous findings revealing that participants read 40% faster during the reading acceleration procedure, while maintaining the same accuracy levels. Continuous fading proved to be more effective than character-wise fading in enhancing reading speed, while larger inter-letter spacing did not significantly affect the reading speed gain. Albeit the non-clinical nature of our sample and its numerosity circumscribe the potential generalization, taking into account individual differences in the initial reading time, data suggests that reading acceleration leads to larger off-line speed increments with respect to non-accelerated reading.DiscussionTaken together, these findings offer valuable insights for the future application of reading acceleration procedures as part of multisession training programs for improving reading proficiency in a diverse range of clinical and non-clinical populations.

Automatic imitation is modulated by stimulus clarity but not by animacy.

Observing actions evokes an automatic imitative response that activates mechanisms required to execute these actions. Automatic imitation is measured using the Stimulus Response Compatibility (SRC) task, which presents participants with compatible and incompatible prompt-distractor pairs. Automatic imitation, or the compatibility effect, is the difference in response times (RTs) between incompatible and compatible trials. Past results suggest that an action's animacy affects automatic imitation: human-produced actions evoke larger effects than computer-generated actions. However, it appears that animacy effects occur mostly when non-human stimuli are less complex or less clear. Theoretical accounts make conflicting predictions regarding both stimulus manipulations. We conducted two SRC experiments that presented participants with an animacy manipulation (human and computer-generated stimuli, Experiment 1) and a clarity manipulation (stimuli with varying visual clarity using Gaussian blurring, Experiments 1 and 2) to tease apart effect of these manipulations. Participants in Experiment 1 responded slower for incompatible than for compatible trials, showing a compatibility effect. Experiment 1 found a null effect of animacy, but stimuli with lower visual clarity evoked smaller compatibility effects. Experiment 2 modulated clarity in five steps and reports decreasing compatibility effects for stimuli with lower clarity. Clarity, but not animacy, therefore affected automatic imitation, and theoretical implications and future directions are considered.

The impacts of sex and the 5xFAD model of Alzheimer’s disease on the sleep and spatial learning responses to feeding time

IntroductionThe relationships between the feeding rhythm, sleep and cognition in Alzheimer’s disease (AD) are incompletely understood, but meal time could provide an easy-to-implement method of curtailing disease-associated disruptions in sleep and cognition. Furthermore, known sex differences in AD incidence could relate to sex differences in circadian rhythm/sleep/cognition interactions.MethodsThe 5xFAD transgenic mouse model of AD and non-transgenic wild-type controls were studied. Both female and male mice were used. Food access was restricted each day to either the 12-h light phase (light-fed groups) or the 12-h dark phase (dark-fed groups). Sleep (electroencephalographic/electromyographic) recording and cognitive behavior measures were collected.ResultsThe 5xFAD genotype reduces NREM and REM as well as the number of sleep spindles. In wild-type mice, light-fed groups had disrupted vigilance state amounts, characteristics, and rhythms relative to dark-fed groups. These feeding time differences were reduced in 5xFAD mice. Sex modulates these effects. 5xFAD mice display poorer spatial memory that, in female mice, is curtailed by dark phase feeding. Similarly, female 5xFAD mice have decreased anxiety-associated behavior. These emotional and cognitive measures are correlated with REM amount.DiscussionOur study demonstrates that the timing of feeding can alter many aspects of wake, NREM and REM. Unexpectedly, 5xFAD mice are less sensitive to these feeding time effects. 5xFAD mice demonstrate deficits in cognition which are correlated with REM, suggesting that this circadian-timed aspect of sleep may link feeding time and cognition. Sex plays an important role in regulating the impact of feeding time on sleep and cognition in both wild-type and 5xFAD mice, with females showing a greater cognitive response to feeding time than males.

In-Car Speech Enhancement Based on Source Separation Technique

Purpose: The purpose of this study was to investigate and analyze to increase the quality and intelligibility of speech in cars. The passenger dialogue inside the car, the sound of other equipment, and a wide range of interference effects are major challenges in the task of speech separation in-car environment.Methods: Speech enhancement based on the source separation algorithm has been proposed to enhance the preferred speech signals using a microphone array inside a car. The proposed approach determines the signal direction in the time domain by utilizing the time difference of arrival (TDOA). TDOA signals are processed, and an adaptive least mean square method is used to determine the enhanced preferred signal.Results: Experimental results show that the proposed approach yields an signal-to-noise ratio (SNR) of 7.4, perceptual evaluation of speech quality (PESQ) of 2.33 respectively. The proposed strategy outperforms existing methods in terms of PESQ, and SNR. The PESQ of the proposed method is 2.45%, and 5.22% better than the existing Independent Component Analyses, and Run length Source techniques.Conclusion: Finally, compared to the existing methods, the suggested speech enhancement algorithm is more reliable and flexible, and it can properly identify the exact location of the sound.

A global urban heat island intensity dataset: Generation, comparison, and analysis

The urban heat island (UHI) effect, a phenomenon of local warming over urban areas, is the most well-known impact of urbanization on climate. Globally consistent estimates of the UHI intensity (UHII) are crucial for examining this phenomenon across time and space. However, publicly available UHII datasets are limited and have several constraints: (1) they are for clear-sky surface UHII, not all-sky surface UHII and canopy (air temperature) UHII; (2) the estimation methods often neglect anthropogenic disturbance, introducing uncertainties in the estimated UHII. To address these issues, this study proposes a new dynamic equal-area (DEA) method that can minimize the influence of various confounding factors on UHII estimates through a dynamic cyclic process. Utilizing the DEA method and leveraging various gridded temperature data, we develop a global-scale (>10,000 cities), long-term (over 20 years by month), and multi-faceted (clear-sky surface, all-sky surface, and canopy) UHII dataset. Based on these estimates, we provide a comprehensive analysis of the UHII and its trends in global cities. The UHII is found to be greater than zero in >80% of cities, with global annual average magnitudes around 1.0 °C (day) and 0.8 °C (night) for surface UHII, and close to 0.5 °C for canopy UHII. Furthermore, an interannual upward trend in UHII is observed in >60% of cities, with global annual average trends exceeding 0.1 °C/decade (day) and over 0.06 °C/decade (night) for surface UHII, and slightly surpassing 0.03 °C/decade for canopy UHII. Notably, there exists a positive correlation between the magnitude and trend of UHII, suggesting that cities with stronger UHII tend to experience faster growth in UHII. Additionally, discrepancies in UHII are found between different temperature data, stemming not only from distinctions in data types (surface or air temperature) but also from differences in data acquisition times (Terra or Aqua), weather conditions (clear-sky or all-sky), and processing methodologies (with or without gap filling). Overall, our proposed method, dataset, and analysis results have the potential to provide valuable insights for future urban climate studies. The UHII dataset is publicly available at https://doi.org/10.6084/m9.figshare.24821538.

Striking a balance: Exploring attention, attack accuracy and speed in fencing performance.

In fencing, it remains unclear whether practice enhances visual-spatial attention allocation. We explored whether this ability is improved in fencers and if it is related to attack speed and accuracy. Twelve novices (<1year of experience) and 12 trained epee fencers (18±10years of experience) visited the laboratory twice (familiarization and testing session). They performed a covert orienting of visuospatial attention test (COVAT) on a computer and an epee test, involving 30 trials of 3 shuttles followed by fast attack phases where the fencers quickly hit a target (randomly proposed out of 8). We measured COVAT reaction time, number of successful target hits, and execution time to hit in the fencing test. We found shorter COVAT reaction time for trained fencers (332±24ms) versus novices (367±32ms; p<0.001). The number of hits was greater for trained fencers (22±3) versus novices (16±3; p<0.001). ANCOVA showed a difference in execution time at the test (823±73ms vs. 913±141ms, p=0.035). A relationship was found between hits and execution time and between execution time and COVAT reaction time for the trained group (r=0.62, p=0.03 and r=0.70, p=0.01, respectively) but not in the novice group (r=0.11, p=0.72 and r=0.45, p=0.14, respectively). Mediation analysis showed that the relationship between execution time and number of hits (ADE: p=0.008) was not mediated by COVAT reaction time (ACME: p=0.17). These results evidence the importance of visual-spatial attention allocation in fencing and evidence differences between novices and trained fencers with important implications for talent development in the early career stage.

Antibiotics improve reproductive outcomes after frozen-thaw embryo transfer for chronic endometritis treatment, especially in those with repeated implantation failure

PurposeTo investigate the impact of antibiotic treatment for chronic endometritis (CE) on the pregnancy outcome of frozen-thawed embryo transfer (FET) cycles and the relevant clinical risk factors associated with CE.MethodsA retrospective cohort analysis was conducted on 1352 patients who underwent hysteroscopy and diagnostic curettage at Nanjing Maternal and Child Health Hospital from July 2020 to December 2021. All patients underwent CD138 immunohistochemical (IHC) testing to diagnose CE, and a subset of them underwent FET after hysteroscopy. Patient histories were collected, and reproductive prognosis was followed up.ResultsOut of 1088 patients, 443 (40.7%) were diagnosed with CE. Univariate and multivariate binary logistic regression analyses revealed that parity ≥ 2, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, hydrosalpinx, endometrial polyps, a history of ≥ 2 uterine operations, and RIF were significantly associated with an elevated risk of CE (P < 0.05). Analysis of the effect of CE on pregnancy outcomes in FET cycles after antibiotic treatment indicated that treated CE patients exhibited a significantly lower miscarriage rate (8.7%) and early miscarriage rate (2.9%) than untreated non-CE patients (20.2%, 16.8%). Moreover, the singleton live birth rate (45.5%) was significantly higher in treated CE patients than in untreated non-CE patients (32.7%). Survival analysis revealed a statistically significant difference in the first clinical pregnancy time between treated CE and untreated non-CE patients after hysteroscopy (P = 0.0019). Stratified analysis based on the presence of recurrent implantation failure (RIF) demonstrated that in the RIF group, treated CE patients were more likely to achieve clinical pregnancy than untreated non-CE patients (P = 0.0021). Among hysteroscopy-positive patients, no significant difference was noted in pregnancy outcomes between the treatment and control groups (P > 0.05).ConclusionInfertile patients with a history of parity ≥ 2, hydrosalpinx, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, endometrial polyps, a history of ≥ 2 uterine operations, and RIF are at an increased risk of CE; these patients should be recommended to undergo hysteroscopy combined with CD138 examination before embryo transfer. Antibiotic treatment can improve the reproductive outcomes of FET in patients with CE, especially those with RIF.

Comparison of clinical efficacy between modified Kamikawa anastomosis in laparoscopic proximal gastrectomy and Roux-en-Y anastomosis in laparoscopic total gastrectomy

To investigate the short-term clinical efficacy of laparoscopic proximal gastrectomy with modified Kamikawa anastomosis and laparoscopic total gastrectomy with Roux-en-Y anastomosis. Retrospective cohort study was conducted. The clinicopathological data of 268 patients who underwent laparoscopic proximal gastrectomy for adenocarcinoma of esophagogastric junction and upper gastric adenocarcinoma from January 2016 to October 2022 were collected. Among 268 patients, 26 underwent laparoscopic proximal gastrectomy with modified Kamikawa anastomosis were assigned to Kamikawa group and 242 underwent laparoscopic total gastrectomy with Roux-en-Y anastomosis were assigned to Roux-en-Y group. The sex, age, BMI, preoperative albumin, maximum tumor diameter, histological grade, and pathological stage of patients in the Kamikawa group and the Roux-en-Y group were subjected to 1:1 propensity score matching. After matching, 16 patients in Kamikawa group and Roux-en-Y group were respectively included in this study. Outcome measures: (1) Intraoperative condition. (2) Postoperative recovery. (3) Follow-up information. The patients' nutritional status, reflux esophagitis and anastomotic stoma were investigated by outpatient and telephone follow-up. Nutritional status assessment comprising body mass index and Nutritional Risk Screening 2002 score. (1) Intraoperative condition. All patients successfully underwent laparoscopic proximal gastrectomy and total gastrectomy. Compared with Roux-en-Y group, the digestive tract reconstruction time in Kamikawa group was longer 93.0(74.0–111.0)min vs. 39.7(35.1–46.2)min, t = -2.001, P = 0.055., and the difference was statistically significant (P < 0.05). There was no statistically significant difference in total operation time and intraoperative blood loss (P > 0.05). (2) Postoperative recovery. There was no statistically significant difference between Kamikawa group and Roux-en-Y group in first anal exhaust time, first postoperative liquid intake time, postoperative hospitalization time, and postoperative complications (P > 0.05). (3) Follow-up information. All patients were followed up. BMI and NRS 2002 scores in Kamikawa group were better than those in Roux-en-Y group at 6 and 12 months after surgery 22.9 ± 3.0 kg/m2 vs. 20.8 ± 2.2 kg/m2, t = 2.165, P = 0.038; 23.1 ± 3.0 kg/m2 vs. 20.3 ± 2.2 kg/m2, t = 3.022, P = 0.005 and 2 (1–2) vs. 2 (1–3), Z = -2.585, P = 0.010; 2 (1–2) vs. 2 (1–3), Z = -2.273, P = 0.023., the difference was statistically significant (P < 0.05). There was no significant difference in GERD scale score and occurrence of ≥ Grade B reflux esophagitis at 6 and 12 months after surgery between Kamikawa group and Roux-en-Y group (P > 0.05). Anastomotic stenosis was not found in all patients by postoperative upper gastrointestinal angiography. Laparoscopic proximal gastrectomy with modified Kamikawa anastomosis is safe and feasible for the treatment of esophagogastric junction and upper gastric adenocarcinoma, and can achieve good anti-reflux effect. Besides, compared with traditional laparoscopic total gastrectomy, its postoperative nutritional status is better.

Improved survival outcome of curative liver resection for Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma in the era of tyrosine kinase inhibitors.

This study was undertaken to evaluate the outcome of curative liver resection, (LR) of Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma (BCLC-C HCC) after tyrosine kinase inhibitors (TKIs) became approved as a treatment option for recurrent lesions. Sixty-seven patients with BCLC-C HCC who underwent curative LR were enrolled in this study. The patients were classified into two groups according to whether LR was performed before (n=24) or after (n=43) TKI approval ("beforeTKI" and "afterTKI" group, respectively). There was no difference in the median disease-free survival time after LR between the beforeTKI and afterTKI groups (5.6 and 7.1months, respectively; p=0.435). However, the median survival time after LR was longer in the afterTKI than beforeTKI group (42.7 and 14.9months, respectively; p=0.022). Univariate and multivariate analyses showed that the date of LR was the only independent factor affecting postresection survival. When the patients were limited to those with recurrence, there were no differences in the recurrence pattern or progression of HCC at the time of recurrence between the two groups. The only difference in the treatment distribution was the administration of TKIs (14 of 34 patients in afterTKI group and only 1 of 19 patients in beforeTKI group, p<0.001). These data suggest that TKI therapy for recurrent BCLC-C HCC is associated with improved overall survival. Thus, LR could be a promising option for BCLC-C HCC in the current era of TKI therapy.

Seasonal differences in participation and time spent in physical activity in Russia: The Know Your Heart survey.

This study aimed to assess the levels and investigate socioeconomic, demographic, and health-related predictors of winter and summer physical activity (PA) in Russia using the data from the Know Your Heart population survey conducted in Novosibirsk and Arkhangelsk (2015-2018; n=5068; aged 35-69years). Employing a series of probit, Tobit, and the Cragg models, we separated the predictors of the probability of participating in leisure-time PA from the predictors of time spent in PA. Our study showed that financial constraints limited males' participation in winter PA (probability of participation decreased by 12 percentage points) and females' engagement in winter and summer PA (decrease in the number of hours of practicing PA by approximately 1h a week). Education, self-reported health, smoking, and cues to action had different impacts on both probability and time spent in PA in winter and summer. We also found significant gender differences in participation and time spent in PA across seasons. Older age, poor health, and smoking were greater obstacles to PA for males compared to females both in winter and summer. However, males were more likely to follow physician's advice to lose weight and take up physical exercise. Information campaigns that promote physical activities, including those that are free of charge, are needed to help limit barriers to PA for people with low socioeconomic status and individuals with little or no exercise experience. Also, making sports more accessible to citizens by providing free and low-cost sports facilities can increase their participation and time spent in PA, improving individual health and productivity.

Treatment-free survival and partitioned survival analysis of patients with advanced renal cell carcinoma treated with nivolumab plus ipilimumab versus sunitinib: 5-year update of CheckMate 214

BackgroundImmunotherapy can be associated with prolonged disease control even after cessation of treatment without the need for further cancer-directed therapy. Treatment-related adverse events (TRAEs) can also persist after discontinuation of...

Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children.

Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method. Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared. The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients. PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

Efficacy of mini-endoscopic combined intrarenal surgery for pediatric kidney calculi: a single center retrospective study

Management of large pediatric kidney calculi (PKC) is challenging. This study aimed to evaluate the efficacy and safety of miniature endoscopic combined intrarenal surgery (mini-ECIRS) for PKC. We retrospectively analyzed mini-ECIRS in 16 pediatric patients undergoing kidney stone treatment between November 2014 and October 2023 to determine its safety, efficacy, and associated outcomes. The median age was 50.50 (interquartile range: 36.75, 84.75) months, and the mean stone size was 21.63 ± 11.65 mm. The stone-free rate was 81.25%. The median decrease in hemoglobin level on the day after surgery was 1.10 (0.80, 1.55), and no patient required a blood transfusion. The median number of general anesthesia procedures was 2.00 (2.00, 2.00). Postoperative complications included fever in two patients and difficulty in removing the ureteral stent in one patient. In this cohort, five patients underwent pre-stenting under general anesthesia before mini-ECIRS. Age was significantly lower in the pre-stenting group than in the non-pre-stenting (P < 0.01); however, there were no significant differences in operative time, stone-free rate, total number of general anesthesia procedures, hemoglobin loss, or postoperative hospital stay between the groups. Mini-ECIRS was found to be a safe and efficient treatment method with a high stone removal rate in pediatric patients.