Observation Time Points Research Articles

A Comparative Study of Intravenous Dexmedetomidine with Local Infiltration of Ropivacaine in Attenuation of Stress Response to Skull Pin Insertion in Craniotomies.

Objective Skull pin insertion in patients undergoing craniotomies elicits hemodynamic and neuroendocrine stress response that may be deleterious to the patient. Various drugs and techniques have been documented in literature to abate this stress response. Against this background, we aimed to compare the efficacy of intravenous dexmedetomidine and local infiltration of ropivacaine for attenuation of stress response to pin insertion in craniotomies. Methods Eighty-eight adult patients undergoing craniotomy under general anesthesia from March 2019 to April 2020 requiring application of head holder were randomized into two equal groups. After intubation, 0.75 µg kg -1 of dexmedetomidine over 10 minutes through infusion was given in group D, while local infiltration at pin sites was done with 0.5% ropivacaine, 2 mL at each site in group R. Hemodynamic parameters and levels of serum cortisol, prolactin, and blood glucose were measured before and after pin insertion. Unpaired t -test for continuous variables and Mann-Whitney U test was used for nonnormally distributed variables. Results Heart rate was statistically similar between the two groups at all the observed time points. The difference in mean arterial pressure values between the two groups was found to be statistically significant only from 10 to 20 minutes after pin insertion being statistically similar at rest of the time points. Levels of serum glucose, cortisol, and prolactin values 30 minutes after pin insertion were statistically similar between both groups. Conclusion We concluded that both interventions are equally efficacious in attenuation of hemodynamic and stress response to head holder application in patients undergoing craniotomies.

Effects of controlled ovarian stimulation on thyroid function during pregnancy†.

Controlled ovarian stimulation (COS) is a major component of assisted reproductive technologies. Clinically, it has been observed that some women experience changes in thyrotropin levels following COS, which then bring about subclinical hypothyroidism and may adversely affect conception. Studies have also shown that the specific degree as well as the tendency of changes in thyroid function vary with differences in thyroid function before pregnancy, thyroid autoimmunity, the COS regimen, and the observation time point. However, the associated pathophysiological mechanism of the effects of COS on pregnancy has not yet been fully elucidated. This may be because increased estradiol levels, caused by COS, induce increased levels of thyroxine-binding globulin, resulting in a decrease in free thyroxine (FT4) level and an increase in TSH level. Conversely, it has also been observed that human chorionic gonadotropin (hCG) can act directly on thyroid cells, exerting opposite effects on FT4 and TSH levels. Additionally, the effects of COS on thyroid function may be more pronounced, especially in women with autoimmune thyroid disease or thyroid dysfunction before pregnancy, ultimately leading to subclinical hypothyroidism. Here, we review recent research progress regarding the effects of COS on thyroid function during pregnancy.

Remdesivir Reduces Mortality in Hemato-Oncology Patients with COVID-19.

IntroductionRemdesivir is the first agent with proven clinical efficacy against coronavirus disease 2019 (COVID-19); however, its benefit is associated with early use, and its efficacy has been poorly studied in patients with hemato-oncological diseases, who have an increased risk of a severe course of infection. This study aimed to assess the effects of remdesivir on mortality, mechanical ventilation, and the duration of hospitalization in both the general population and in patients with hemato-oncological diseases.Materials and MethodsLongitudinal data for 4287 patients with confirmed COVID-19 were analyzed, including a subset of 200 individuals with hemato-oncological diseases. In total, 1285 (30.0%) patients received remdesivir, while the remaining patients were treated with other methods. Survival statistics for the 14- and 30-day observation time points were calculated using non-parametric and multivariate Cox models.ResultsMortality for the 14- and 30-day observation time points was notably lower among patients receiving remdesivir (7.2% vs 11.6%, p < 0.001 and 12.7% vs 16.0, p = 0.005, respectively); however, in multivariate models adjusted for age, sex, lung involvement, and lactate dehydrogenase and interleukin-6 levels, the administration of remdesivir did not reduce patient mortality at either the 14-day or 30-day time points. Among patients with haemato-oncological disease, significant survival benefit was observed at 14 and 30 days for patients treated with remdesivir (11.3% vs.16.7% and 24.2% vs 26.1%, respectively; p < 0.001). A favorable effect of remdesivir was also noted for the 14-day time point in multivariate survival analysis (HR:4.03 [95% confidence interval:1.37–11.88]; p = 0.01).ConclusionRemdesivir significantly reduced the early mortality rate in COVID-19 patients with comorbid hemato-oncological disease, which emphasizes the need to administer this agent to immunosuppressed patients.

Comparison of Femoral Nerve Block and Fascia Iliaca Block for Proximal Femoral Fracture in the Elderly Patient: A Meta-analysis.

IntroductionPain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively.MethodsSystematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study.ResultsFifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P > .05).ConclusionsFICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.

Associations between dental caries and ponderal growth in children: A Cambodian study

BackgroundThe evidence around the relationship between Early Childhood Caries (ECC) and undernutrition is sparse and mostly reported from cross-sectional data sets. This paper aimed to test the relationship between ECC and linear and ponderal growth trajectories.MethodsThis project involves secondary data analysis from the Cambodia Longitudinal Health and Nutrition Study. The analytical sample included a 2y-cohort of 894 children who were younger than 2 years of age at the time of first height and weight measurement. Statistical analysis used both logistic regression modelling and Latent Class Analysis to examine the effect of exposure to dental caries in the first 1000 days on weight for height Z-score (WHZ) and height for age Z-score (HAZ) trajectory class groups. The presence of any cavity and pulp involvement were examined using multinomial regression adjusting for gender, socioeconomic status, maternal age and education.FindingsWithin each class groupings (HAZ and WHZ groupings), there was a trend whereby those with one or more cavities had lower Z-scores across the three follow-up time points of observation. There was an association between exposure to caries and WHZ class membership whereby children with caries exposure were more likely belong to WHZ class groups with lower Z-scores over time.ConclusionsThe study offers evidence that ECC is correlated with less favourable ponderal growth categorized by WHZ trajectory class groups.

Peripheral Perfusion Index: A Predictor of Post-Spinal Hypotension in Caesarean Section.

BackgroundEarly prediction of hypotension helps to decide appropriate prophylactic measures and, hence, safe anaesthesia for mothers and improved neonatal outcomes. Perfusion index (PI) measured from a standard pulse oximeter has shown positive results in the prediction of hypotension. This study aims to determine if PI can equally predict hypotension in parturients after administration of spinal anaesthesia at different time points.MethodsParturients posted for elective caesarean section belonging to the American Society of Anesthesiology II (ASA II) were divided into two groups based on baseline PI as group A <3.5 and group B ≥3.5. Fifty-six parturients were enrolled in the study. PI and blood pressure were monitored at baseline, every two minutes for 12 minutes and every five minutes until the end of the surgery, after administration of spinal anaesthesia with hyperbaric bupivacaine 10 mg. Incidence of hypotension was compared between groups at all time points of observation. Spearman’s rank correlation coefficient was determined to check the correlation between baseline PI and the number of episodes of hypotension. Receiver operating characteristic (ROC) curve was plotted to determine the ideal cut-off at different time points.ResultsBaseline PI significantly correlated with the number of episodes of hypotension (r-0.525). The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) as compared to those with PI <3.5 (33.33%). The incidence of hypotension at sixth, 10th and 37th minutes post-spinal anaesthesia administration was significantly higher in the group with PI ≥3.5. The sensitivity and specificity for the 3.5 cut-off of PI were 85.7% and 60%, respectively, at the 6th and 10th minute after spinal administration. A higher cut-off of 3.9 increases the specificity to 69% without much change in the sensitivity.Conclusion Parturients with PI >3.9 at baseline have a higher risk of hypotension in the initial 10-12 minutes following spinal anaesthesia during caesarean delivery.

An Integrative Analysis of the Immune Features of Inactivated SARS-CoV-2 Vaccine (CoronaVac).

Currently, an inactivated vaccine has been widely used with encouraging results as a prophylactic agent against COVID-19 infection, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants. However, in vitro SARS-CoV-2 vaccine-specific immune features remain elusive, hindering the promotion of a third dose of the vaccine. Here, we present a detailed in vitro immune cellular response and large-scale multi-omics analysis for peripheral blood mononuclear cells (PBMCs) from participants vaccinated with CoronaVac (Sinovac Life Sciences, Beijing, China) and recovered participants from COVID-19. The mean titers of SARS-CoV-2 serum-neutralizing antibodies were significantly increased after the boosting immunization (Day 45) compared to the unimmunized state. We observed that type-1 helper T cells (Th1) tended to dominate after the first dose of vaccine, while humoral immune responses became dominant after the second dose due to the activation of type-2 helper T cell (Th2), memory B cells, and plasmablasts. T follicular helper cells (Tfh) involved in antibody production were activated after the first dose and were maintained for the observed time points. Single-cell RNA sequencing of PBMCs revealed specific changes in cell compositions and gene expression in immunized participants. Multi-omics analysis also demonstrated that CoronaVac-specific serum proteins, plasma metabolites, and plasma lipid changes were skewed to those changes in convalescent patients. Collectively, we provide a comprehensive understanding of CoronaVac-specific in vitro immune features.

A combination of the K-L and S-P approaches for treating acetabular posterior wall factures accompanied by femoral head fractures with open reduction and internal fixation

BackgroundIn clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures).MethodsA retrospective study was conducted on 8 patients who underwent open reduction and internal fixation (ORIF) of Pipkin type IV fractures through the K-L combined with S-P approach in our hospital from January 2015 to January 2020. All 8 patients were successfully operated on without serious complications, such as important blood vessel and nerve damage, with an operation time of 143.8 ± 44.38 min and intraoperative blood loss of 225 ± 70.71 ml. Perioperative data were recorded. The Harris score was used to evaluate the clinical effect. Fracture reduction quality was evaluated according to the Matta radiological standard. The grade of ectopic ossification was evaluated by the Brooker grading method, and the stage of femoral head necrosis was evaluated by Ficat-Arlet staging.ResultsThe Harris score increased significantly from 57.38 ± 4.779 at 3 months, to 76.13 ± 3.682 at 6 months, 88.25 ± 3.495 at 12 months, and 92.13 ± 2.232 at 36 months postoperatively. After statistical analysis, compared with the previous observation time point, the data comparison differences between the groups were statistically significant. P < 0.001, P < 0.001, P < 0.05). By the time of the latest follow-up, 6 of the 8 patients had recovered to the level of pre-injury sports capacity. In contrast, the other 2 patients remained below the level of pre-injury sports capacity. In terms of imaging evaluation, the quality of fracture reduction on radiographs was graded as excellent in 6 patients and good in 2 patients according to Matta’s criteria. At the last follow-up, no heterotopic ossification or femoral head necrosis was found in of all the images. In addition, the hip joint space was normal in 6 cases, mildly narrowed in 1 case, and clearly narrowed in 1 case.ConclusionsThe K-L combined with S-P approach provides effective exposure for the reduction and fixation of Pipkin type IV fractures and achieves satisfactory clinical outcomes.

Bayesian Semiparametric Regression Analysis of Multivariate Panel Count Data

Panel count data often occur in a long-term recurrent event study, where the exact occurrence time of the recurrent events is unknown, but only the occurrence count between any two adjacent observation time points is recorded. Most traditional methods only handle panel count data for a single type of event. In this paper, we propose a Bayesian semiparameteric approach to analyze panel count data for multiple types of events. For each type of recurrent event, the proportional mean model is adopted to model the mean count of the event, where its baseline mean function is approximated by monotone I-splines. The correlation between multiple types of events is modeled by common frailty terms and scale parameters. Unlike many frequentist estimating equation methods, our approach is based on the observed likelihood and makes no assumption on the relationship between the recurrent process and the observation process. Under the Poisson counting process assumption, we develop an efficient Gibbs sampler based on novel data augmentation for the Markov chain Monte Carlo sampling. Simulation studies show good estimation performance of the baseline mean functions and the regression coefficients; meanwhile, the importance of including the scale parameter to flexibly accommodate the correlation between events is also demonstrated. Finally, a skin cancer data example is fully analyzed to illustrate the proposed methods.

Hemodynamic parameters after Delayed Cord Clamping (DCC) in term neonates: a prospective observational study.

BackgroundDelayed cord clamping (DCC) is practiced worldwide, as standard care in both term and preterm babies. Our aim was to determine the hemodynamic effects of DCC on transitional circulation.Material and methodsThis prospective observational study was carried out in a tertiary care hospital, at Pune, India, from May 2018 to October 2019.Term neonates born during the study period were included. The primary outcome variables of the study were right ventricular output (RVO), left ventricular output (LVO), superior vena cava (SVC) flow (ml/kg/min) and heart rate(HR) at 12 ± 6 and 48 ± 6 h of life measured by point of care functional echocardiography. Inter-observer and intra-observer variability was calculated for these parameters.ResultsOut of a total of 2744 deliveries during the study period, 620 babies were included. Mean gestational age of the enrolled babies was 38.96 ± 1.08 weeks and mean birth weight was 2.9 ± 0.39 kg. Mean heart rate of babies recorded at 12 ± 6 h of life was 127 beats per minute (bpm) whereas it was 128 bpm at 48 ± 6 h of life. RVO {mean (SD)} was 209.55(44.89) and 205.85(46.35) ml/kg/min, LVO {mean (SD)} was 133.68(31.15) and 134.78(29.84) ml/kg/min whereas SVC flow {mean (SD)} was 106.85(26.21) and 109.29(25.11) ml/kg/min at 12 ± 6 and 48 ± 6 h of life respectively. There was good intra-observer agreement in all the variables.SGA babies had a significantly higher heart rate at 12 ± 6 h of life as compared to AGA babies, although this difference in heart rate could not be appreciated at 48 ± 6 h of life. However SGA babies had a higher LVO, RVO and SVC flow than AGA babies at both the time points of observation.ConclusionAfter DCC there is less fluctuation in the hemodynamic parameters (heart rate, cardiac output) at the two time points of observation.. As compared to AGA babies, SGA babies had a significantly higher baseline heart rate, LVO, RVO and SVC flow. LVO of SGA babies after delayed cord clamping is found to be significantly lower than LVO seen in other studies, favoring the cardio-stabilizing effect of DCC.Brief rationaleThis is the first study with a large sample size evaluating the hemodynamic effects of DCC in term neonates by functional echocardiography. The normative data of heart rate and cardiac output of term, stable babies with small for gestational age(SGA) as a special subgroup undergoing DCC requires further evaluation.

Risk factors for surgical complications and short-term outcomes evaluation after novel method of buried penis correction: A single-center experience

Buried penis is a condition that causes the penis to appear entrapped in the subcutaneous fatty tissues. Its significant impact on quality of life affects children as well as adults. This study aims to determine the risk factors for short-term surgical complications and assess patient and surgeon satisfaction after buried penis reconstruction using complete degloving and excision of dartos tissue technique without penile anchoring suture. A retrospective review was performed on all buried penis patients who underwent complete degloving and excision of dartos tissue by 3 different pediatric urologists at a single institution from July 2010-July 2020. The observation time point was taken from the last evaluation in the first 1 year postoperatively. Data were collected from questionnaires distributed to patients and surgeons. Patient demographics and perioperative data were extracted. Bivariate analyses were performed to identify the risk factors for short-term surgical complications. Patients' and surgeons' postoperative satisfaction was likewise assessed based on penis size, morphology, and voiding function. One hundred and thirty-three patients of median age 12 (2-35) years with median follow-up of 6 (1-12) months were included. The median penis length were 2 (1-3.5) cm before surgery with 3 (0.5-7) cm postoperative penile length enhancement. The postoperative penis size were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 92% of patients. The morphology were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 88% of patients. Voiding function were reported as "satisfied" or "very satisfied" by 100% of involved surgeons and 99% of patients. Prolonged edema (19.5%) was reported as the most frequent complication. Poor skin gliding occurred in 10.5% of patients. Subjective penis pain was reported in 6% of patients. Five (3.8%) patients who reported being unsatisfied with their penis size had postoperative penile length enhancement of 2 (0.5-2.5) cm (p=0.04). Trapped penis, uncorrected penile curvature, and dissatisfaction with the morphology were reported by one patient each. The uncorrected penile curvature has a correlation with the preoperative penile curvature (p=0.02). Buried penis reconstruction using complete dartos excision without penile anchoring suture is regarded safe and effective by both patients and surgeons. Prolonged edema is a reversible complication that can occur during early postoperative follow up (≤3 months) and obesity can be considered as one of the independent predictors for prolonged edema occurrence.

Surface spherical encoding and contrastive learning for virtual bone shape aging.

Bone shape changes are considered a relevant biomarker in understanding the onset and progression of knee osteoarthritis (OA). This study used a novel deep learning pipeline to predict longitudinal bone shape changes in the femur four years in advance, using bone surfaces that were extracted in knee MRIs from the OA initiative study, via a segmentation procedure and encoded as shape maps using spherical coordinates. Given a sequence of three consecutive shape maps (collected in a time window of 24 months), a fully convolutional network was trained to predict the whole bone surface 48 months after the last observed time point, and a classifier to diagnose OA in the predicted maps. For this, a novel multi-term loss function, based on contrastive learning was designed. Experimental results show that the model predicted shape changes with an L1 error comparable to the MRI slice thickness (0.7mm). Next, an ablation study demonstrated that the introduction of a contrastive term in the loss improved sensitivity of the OA classifier, increasing sensitivity from 0.537 to 0.709, just shy of the upper bound of 0.740 computed on the ground truth bone shape maps. Our approach provides a promising tool, suitable for patient specific OA trajectory analysis.

Survival analysis of patients with acute coronary syndrome receiving comprehensive coordinated care after myocardial infarction (KOS-Zawał).

This study aimed to analyze survival rates among patients with acute coronary syndrome (ACS) covered and not covered by the National Comprehensive Care after Myocardial Infarction (KOS-Zawał) program. A total of 179972 patients after myocardial infarction (MI) were enrolled in KOS-Zawał program between October 2017 and March 2020 and were included in the comparative analysis with survival analysis. A group of 24496 (13.61%) patients received KOS-Zawał services, while a group of 155476 (86.39%) were not covered by the KOS-Zawał program. The time points for observation of the incidence of death were set at 30, 180, and 365 days from the end of the first hospitalization. There was a lower incidence of death in favor of the KOS-Zawał group relative to the non-KOS-Zawał group both in hospital and at 30, 180, and 365 days after the end of hospitalization, respectively: 0.19% vs. 6.55%; 0.80% vs. 8.39%; 2.92% vs. 10.74%; and 6.35% vs. 13.40%. Survival analysis revealed a statistically significantly lower (P <0.0001) probability of death in the KOS-Zawał group compared with the non-KOS-Zawał group. Also, logistic regression analysis confirmed that patients in the KOS-Zawał group had a significantly lower risk of death than those in the non-KOS-Zawał group (odds ratio, 0.710; 95% confidence interval, 0.554-0.908; P = 0.007). The KOS-Zawał comprehensive care program reduces the risk of death in the first year after MI by 29%. There are indications of a biased interpretation of the data due to the initial better clinical status of post-MI patients covered by the KOS-Zawał program.

Analyzing travel destinations distribution using large-scaled GPS trajectories: A spatio-temporal Log-Gaussian Cox process

Under the increasingly serious city diseases, it is very important to deeply understand the spatio-temporal correlation between travel destination and urban built environment. The spatio-temporal point process has been widely used in many specific fields to explore the evolution of events. We employ a spatio-temporal Log-Gaussian Cox process model (LGCP) to analyze travel destination, which consists of three different components: a spatial component λ(s), a temporal component μ(t), and a separable log-Gaussian stochastic intensity field exp{Υ(s,t)}, to model and predict the destination. The spatial component and temporal component are modeled by the Poisson log linear regression model combined with covariates of interest separately. Spatial covariates including land use, demographics, travel origins and road network, and temporal covariates including the periodic function, weekdays and weekend variation, are selected as influencing factors to analyze the impact of building environment on travel destinations under different combinations of spatial and temporal covariates. Then, an extensible Markov chain Monte Carlo (MCMC) algorithm is applied to simulate Gaussian random field, and the fitted LGCP model can be used to obtain the prediction distribution of Gaussian random field beyond the last time point of data observation. In the experiment, taxi destination data collected in Shenzhen city May 6 to May 23, 2019 are used to validate modeling performance. The results in experiment shows the space–time positions of destination simulated by LGCP model are very similar to those observed. This study can provide strategy for urban planners and transportation administration to conduct reasonable policy to balance travel demand and public resources.

Beep Test Does Not Induce Phosphorylation of Ras/MAPK- or JAK/STAT-Related Proteins in Peripheral Blood T Lymphocytes.

The Th1 cell subset is involved in the immunological response induced by physical exercise. The aim of this work is to evaluate the post-effort activation of Ras/MAPK and JAK/STAT signaling pathways in T cells of young, physically active men. Seventy-six physically active, healthy men between 15 and 21 years old performed a standard physical exercise protocol (Beep test). Phosphorylation levels of Ras/MAPK-(p38 MAPK, ERK1/2) and JAK/STAT-related (STAT1, STAT3, STAT5, and STAT6) proteins were evaluated by flow cytometry in Th and Tc cells post-effort and during the lactate recovery period. The performed physical effort was not a strong enough physiological stimulant to provoke the phosphorylation of ERK1/2, p38 MAPK, STAT1, STAT3, STAT5, and STAT6 in T cells, at least for the duration of our study (the end of the lactate recovery period). We conclude that more observation time-points, including shorter and longer times after the exercise, are required to determine if the Ras/MAPK signaling pathway is involved in modulating the post-effort immunological response.

Analysis of predictors of response to anti-IgE therapy in patients with severe atopic bronchial asthma in real clinical practice

Guidelines on Biological Therapy for Bronchial Asthma of the European Academy of Allergy and Clinical Immunology (EAACI) identified a number of controversial issues for additional outcome analysis using randomized clinical trials and data from routine clinical practice. In particular, there is unmet need to clarify algorithms for prescribing biologicals using predictors of response and its timing, taking into account risk factors and multimorbidity. Omalizumab is a recombinant humanized monoclonal anti-IgE antibody of IgG1 class used for the treatment of severe refractory atopic bronchial asthma (BA) and a variety of IgE-mediated diseases. Among biological agents, this "pioneer molecule" has the greatest experience in the "allergology and immunology" profile. Detailed description of the "nonresponders" portraits will allow to perform the therapy response assessment on time and facilitate rational planning of individual therapy, which is a prerequisite for biologicals era. Using only routine methods, it is possible to perform initial and dynamic screening to phenotype a heterogeneous cohort of patients with severe asthma and chose the optimal strategy. To identify predictors of nonresponse to omalizumab anti-IgE therapy in patients with severe atopic BA and to establish optimal timing of efficacy assessment using retrospective analysis of data from the Biologic Therapy Registry of Allergology and Immunology in routine clinical practice. A retrospective single-center registry study was conducted at the Allergy and Immunology Reference Center from June 2017 to August 2021. 135 patients with severe BA, with confirmed perennial sensitization, who received omalizumab according to the recommendations of the current version of GINA, were selected from the clinical and dynamic observational system (registry). Dosing regimen and administration frequency of omalizumab were determined in accordance with the instructions for the drug. Assessment of therapy efficacy was performed at the time point 4, 6 and 12 months. Patients were subgrouped into "responders" and "non-responders" according to the following criteria: ACT score less than 19 and/or difference between initial ACT score in dynamics less than 3 points; forced expiratory volume in the first second less than 80%; combination of these two criteria. Nonparametric methods of descriptive statistics were used in data processing: median, interquartile range. Differences were considered significant at p0.05. MannWhitney U-test, KruskalWallis one-way analysis of variance, and Fisher's 2 test were used to compare quantitative characteristics. Heterogeneous subgroups of patients differing in reaching the criteria of "non-responders" to treatment were identified; the informativity of modifiable and unmodifiable factors differed at time-points of dynamic observation. In the differential analysis, two profiles of "nonresponders" were defined in combination with the most significant predictors of "nonrsponse" to omalizumab. According to the data obtained, one of the clinical phenotypes, namely the combination of severe asthma with the Samters triad, corresponded to the characteristics of the patient "nonresponders": age of onset is about 30 years, females, severe exacerbations of BA while taking non-steroidal anti-inflammatory drugs, accompanied with high levels of eosinophilia. The data obtained illustrates the hypothesis of pathogenetic heterogeneity of severe BA with the phenomenon of overlapping phenotypes and can serve as an additional orienteer for creating the individual plan of anti-IgE therapy in real clinical practice.

Clinical study of sodium bicarbonated Ringer's solution on fluid resuscitation of patients with hemorrhagic shock.

Fluid resuscitation is a crucial step in shock treatment, but the choice of crystal solution remains controversial. Sodium bicarbonated Ringer's solution can not only effectively expand blood volume, but also reduce tissue damage and acidosis. The study aims to evaluate the resuscitation effect of sodium bicarbonated Ringer's solution on patients with hemorrhagic shock. A total of 96 patients with hemorrhagic shock were randomly assigned to receive either normal saline solution (control group) or sodium bicarbonated Ringer's solution (experimental group). The changes in blood lactate, heart rate, arterial pH and mean arterial pressure (MAP) were measured at different time points. The 28-day survival rate, the incidence of complications, and the average length of hospital stay were recorded. Simult RESULTS: The heart rate, blood lactate, sodium, and chloride in the experimental group were significantly lower than those in the control group, while the MAP, potential of hydrogen (pH), bicarbonate, and base excess in the experimental group were significantly higher than those in the control group at every observed time point after resuscitation (p<0.05). Compared with the control group, the experimental group had a lower incidence of acute respiratory distress syndrome (ARDS) (8.3% vs. 22.9%, p<0.05), shorter mechanical ventilation time (2.2 vs. 3.5, p<0.05), and shorter intensive care unit length of stay (3.8 vs. 4.1, p<0.05). The 28-day survival rate between the two groups showed no significant differences (p>0.05). Early resuscitation with sodium bicarbonated Ringer's solution could better maintain acid-base balance and hemodynamic stability and reduce the risk of related complications.

Effects of advance exposure to an animated surgery-related picture book on preoperative anxiety and anesthesia induction in preschool children: a randomized controlled trial

BackgroundOur aim was to investigate whether early surgical preparation by reading an animated picture book about procedure-related events could reduce the preoperative anxiety in preschoolers.Methods131 patients, aged 3–6 years and underwent elective minor surgery were randomized either to a control or a picture book group. Both groups received general information about surgery and anesthesia in pre-anesthesia clinic. Patients in study group also received a surgery-depicting picture book for them to read at home a week earlier before surgery. Child anxiety was evaluated with the modified Yale Preoperative Anxiety Scale Short Form in six observing time points before anesthesia induction, and the compliance of anesthesia induction was assessed with the Induction Compliance Checklist (ICC).ResultsThere were significantly lower anxiety scores in picture book group than in control group at the time of ready for intravenous cannulation in operating room [51.9 (23.6) vs. 67.2 (22.0); mean difference 15.3; 95% confidence interval (CI) 6.4–24.1; P = 0.001] and at the time of pre-anesthesia visit [27.8 (7.6) vs. 33.2 (13.6); mean difference 5.3; 95%CI 0.93–9.8; P = 0.018]. No significant differences of anxiety levels were found between two groups at other observed time points: in the anesthesia outpatient clinic, in the holding area, at separation from parent to operating room (OR), and on entrance to OR (P = 0.584, 0.335, 0.228, 0.137, respectively). The percentage of children with poor induction compliance (i.e., ICC ≥ 6) was higher in control group compared with that in picture book group [38% vs.21%; odds ratio(95%CI): 0.78(0.61–0.99); P = 0.041].ConclusionsHome-reading an animated picture book to get familiar with the perioperative events earlier prior to surgery could effectively reduce the preoperative anxiety level and increase the compliance during the induction of anesthesia in preschool children.Trial registrationChiCTR2000033583, 06/06/2020 www.chictr.org.cn.

HP22: Daily evolution of brain connectivity during the pre-ictal period in intracranial recordings of epileptic patients

Our understanding of epilepsy mechanisms has shifted its focus towards a dynamic, whole-brain network perspective. Several factors, such as circadian and multi-day cycles, are assumed to influence the likelihood of seizure occurrence. Moreover, this seizure susceptibility is critically dependent on anti-epileptic drug dosage. In this study, we aim to uncover changes in inter-regional communication that are associated with a systematic increase in seizure susceptibility. Uncovering this relationship is important to understand the mechanisms of seizure generation. Method: We investigated long-term, intracranial EEG recordings of 9 drug-refractory epileptic patients. In the context of their presurgical evaluation, anti-epileptic drugs were continuously decreased until seizures occurred (typically between fourth and sixth day). We quantified brain network changes using Directed Transfer Function in the interval between admission and first seizure. Furthermore, each measurement was characterized by various factors, such as time, drug dose, and interictal epileptic spike rate. Finally, to track connectivity changes in time, we projected them into low-dimensional space using Principal Component Analysis. Result: Connectivity changes were consistently linked to time (Pearson’s r range 0.22-0.82), drug dosage (0.24-0.79), interictal spikes and high-frequency oscillations (0.25-0.94), and circadian rhythm (0.21-0.74). These correlations were significant in 8/9 subjects (p<0.05, FDR corrected). When analyzing connectivity dynamics, we observed time points linked with seizure buildup. Their timing was patient-specific and varied between one and three days before seizure. Conclusion: Seizure susceptibility influences inter-regional communication. Interictal spikes and high-frequency oscillations are the most prominent factor. Connectivity investigations can unveil patient-specific critical time points during seizure buildup.

Dynamic Pain-Related Changes in Pulse-Graph Measurements in Patients with Primary Dysmenorrhea before and after Electroacupuncture Intervention and Its Correlation with TCM Pattern.

Objective To explore the dynamic changes recorded in pulse graph related to the changes in the severity of pain before and after electroacupuncture (EA) intervention among young women suffering from primary dysmenorrhea (PD). Methods A total of 147 female college students were recruited in this study. Based on participants' symptoms associated with menstruation, they were divided into the PD group and the healthy control group. In addition, participants in the PD group were further sorted into the Cold Coagulation and Blood Stasis Pattern (CCBSP) and Qi Stagnation and Blood Stasis Pattern (QSBSP) based on TCM diagnoses and their pulses differences. Participants in the PD group received EA at maximal pain during menstruation. The primary acupuncture points selected were SP 6 and RN 3, additional RN 4 for CCBSP, and LR 3 for QSBSP. Four observation time points were 7–10 days before menstruation (T0), maximal pain during menstruation (T1), immediately after EA (T2), and 30 mins after EA (T3). The severity of pain was assessed by a visual analog scale (VAS) along with a pulse analyzer to record the variations of the pulse graph throughout the changes of pain level. Results (1) The average VAS score in the PD group decreased from 5.44 ± 1.46 at T1 to 1.72 ± 1.27 at T2 and 1.59 ± 1.30 at T3. The average VAS score in participants of CCBSP at T1, T2, and T3 was higher than that of QSBSP. (2) At T1, h2, h3, h4, and w1/t were all significantly increased, compared with those at T0. At T2, t and t5 were both significantly increased, and w1/t, t1, and t1/t were all significantly decreased, compared with those at T1. At T3, w1/t, t1, and t1/t were all significantly increased, and t and t5 were both significantly decreased, compared with those at T2. (3) Comparing the pulse graphs between the healthy control and the PD groups, h1 was significantly lower at T0; w1/t was significantly higher at T1; t was significantly higher at T2; and t1 and t1/t were both significantly higher at T3 in PD group. (4) When comparing the pulse graphs between QSBSP and CCBSP, t4/t5 was significantly higher at T0 and t1 was significantly higher at T1 in the CCBSP group. Conclusion EA is effective in relieving primary dysmenorrhea. Our results showed the opposite changing of the pulse graph recorded before the onset of pain to the maximum pain and that from maximum pain to pain relief. Indeed, there were differences in the recorded pulse graphs between CCBSP and QSBSP (two patterns of PD) as described in traditional Chinese pulses diagnosis. The study has been registered in the Chinese Clinical Trial Registry (registered number: ChiCTR2000040065; registered date: 2020/11/19).