Total Duration Research Articles

P833 Burden of steroid use in patients with moderate ulcerative colitis in Europe and the United States

Abstract Background Steroids are an effective short-term therapy option for induction of remission of ulcerative colitis (UC). However, long-term and frequent steroid use is common in clinical practice despite the risks of complications and adverse events.1 We aimed to describe disease burden in moderate UC patients (pts) based on their steroid use history. Methods Data were drawn from the Adelphi UC Disease Specific Programme™, a cross-sectional survey of gastroenterologists (GIs) and their pts in France, Germany, Italy, Spain, the UK and US from Jan 2020–Mar 2021. GIs reported patient demographics, clinical characteristics, treatments and healthcare resource utilization (HCRU). Pts reported quality of life (QoL) via the EQ-5D, short inflammatory bowel disease questionnaire (SIBDQ), and work productivity and activity impairment (WPAI) questionnaire. Pts had received 5-ASA or immunomodulator with no biologic or Janus kinase inhibitor in the 90 days following treatment initiation, had a history of physician-assessed moderate disease severity or a Mayo endoscopic subscore of 2, and no history of colectomy. Pts were categorized as: no steroids (NS; never received steroids), short term/intermittent (ST/I; currently receiving intermittent steroids or received steroids within the last two years for <90 days), or long term/escalated (LT/E; received steroids for ≥90 days within the last two years or had undergone steroid dose escalation within their current course). Analyses were descriptive. Results Overall, 217NS, 88 ST/I and 172 LT/E pts were analysed (Table 1). Median (interquartile range) total steroid use duration was 4.1 (1.6–22.3) months for ST/I and 14.9 (5.8–36.7) months for LT/E. NS (24.4%), ST/I (25.0%) and LT/E (26.2%) pts experienced abdominal pain; 0.5%, 4.6% and 5.2% had severe/extremely severe pain, respectively. Non-bloody diarrhoea was reported by 16.6%, 14.8%, 20.9% of pts, respectively. In the last 12 months, mean (standard deviation; SD) number of health care visits for NS, ST/I and LT/E was 6.1 (6.2), 7.3 (4.8), 8.0 (7.1); mean (SD) number of tests was 20.8 (17.2), 23.3 (15.7), 25.2 (18.2), respectively. NS, ST/I and LT/E patients reported mean EQ-5D scores (0.85, 0.81, 0.79), SIBDQ total scores (54.6, 49.7, 48.3) and overall work impairment (19.4, 23.1, 27.7). Key comorbidities experienced by ST/I and LT/E were hypertension, depression and diabetes (Figure 1). Conclusion Patients with long-term or escalated steroid use had high symptom burden, frequent comorbidities, high HCRU, and poor QoL. This highlights the need for alternative treatment approaches for moderate UC patients to avoid long-term steroid use. 1. Cross R.K. Inflamm Bowel Dis. 2017;23(10):1689–1701

P549 Liver stiffness assessed with TE-CAP tends to increase with longer duration of disease in Crohn’s disease: A prospective cohort study for the evaluation of hepatic abnormalities in inflammatory bowel disease

Abstract Background Intestinal mucosal injury is supposed to cause liver disease and abnormal liver profiles are frequently observed in inflammatory bowel disease (IBD) patients. Therefore, we investigated the hepatic manifestations of IBD in Korea. Methods A prospective cohort for the evaluation of hepatic abnormalities in IBD was established at Kosin University Gospel Hospital, Busan, Korea in 2018. From December 2018 to June 2023, patients who diagnosed with IBD were consecutively enrolled and conducted both abdominal sonography and transient elastography-controlled attenuation parameter (TE-CAP) with liver function tests, viral tests, lipid profiles, and fecal calprotectin. Results Three hundred twelve (138 Crohn's disease, CD, 174 ulcerative colitis, UC, and 200 men) patients were enrolled. Mean ages (years old) were 46.4 in UC and 37.5 in CD. Mean body mass indexes, BMIs were 23.1 in UC and 21.9 in CD. Mean CAP (dB/m) score was 222.439 (±55.375) [UC 232.408 (±53.476), CD 209.869 (±55.358)]. Mean E (kPa) value was 4.481 (±1.801) [UC 4.496 (±2.028), CD 4.461 (±1.474)]. Mean fecal calprotectins were 982 in UC and 1160 in CD. The mean durations of disease (months) were 36.8 in UC and 44.0 in CD. In abdominal sonography, abnormal findings in gallbladder were found 38/169 (22.4%) in UC and 38/137 (27.7%) in CD (P=0.834). (Table 1) HBs Ag positivity was 7/173 (4.0%) in UC, 5/138 (3.6%) in CD (P=0.847). Anti-HBs was positive in 115/173 (66.4%) in UC and 68/138 (49.2%) in CD (P=0.002). Anti-HBc IgG was positive in 46/112 (29.1%) in UC and 17/130 (13.0%) in CD (P=0.001). Anti-HCV was positive in 0/173 (0.0%) in UC and 3/138 (2.1%) in CD (P=0.051). In UC patients, CAP value was associated with BMI (r=0.498, P<0.0001), triglyceride (TG) (r=0.264, P<0.0001), and low-density lipoprotein (LDL) (r=0.162, P=0.033). E value was related to BMI (r=0.267, P<0.0001). In CD patients, CAP value was associated with BMI (r=0.661, P<0.0001), total cholesterol (r=0.290, P=0.001), TG (r=0.286, P=0.001), LDL (r=0.217, P=0.011) and fecal calprotectin (r=-0.343, P<0.0001). E value was associated with total bilirubin (r=0.369, P<0.0001), ALP (r=0.236, P=0.005), r-GTP (r=0.318, P<0.0001), AST (r=0.384, P<0.0001), ALT (r=0.277, P<0.001) and disease duration (r=0.239, P=0.005). In CD patients with a disease duration of more than 1 year, the E value was confirmed to increase gradually as the disease period lengthened (r=0.346, P=0.004). (Figure 1) Conclusion In CD patients, liver stiffness tends to increase with longer duration of disease or active liver inflammation. Both UC and CD patients, fatty liver may occur attributed to abnormal metabolic profiles. In addition, there is a need to encourage HBV vaccination in IBD patients in HBV endemic area, especially in UC patients.

P1029 Prevalance and risk factors of thromboembolism in Inflammatory Bowel Disease

Abstract Background Inflammatory bowel disease (IBD), as a chronic inflammatory condition, can affect atherosclerotic process, arterial events, and increase the formation of venous thromboembolism. The aim of this study was to determine the frequency of thromboembolism and the risk factors associated with acute thromboembolism in our IBD cohort. Methods A total of 3133 patients with 1414 Crohn's Disease (CD), 1667 Ulcerative Colitis (UC) and 52 Indeterminate Colitis who were admitted between 1999 and 2021 were retrospectively analyzed. Patients with acute arterial events and venous thromboembolism (n=39) during the follow-up period were compared with a control group (n=78) of the same gender and same diagnosis. Patients with Behçet's syndrome (n=126),systemic vasculitis (n=16) and hereditary thrombophilia (n=5) were excluded. Results Among 3133 IBD patients, number of patients with arterial events or venous thromboembolism at any time was 124, and the frequency was 3,95%. A total of 132 thromboembolic events, 86 arterial (65,2%) and 46 venous (34,8%) were recorded.Coronary artery disease was significantly higher in the UC group (2,3% vs. 1,2%; p=0.028). During follow-up, 40 acute thromboembolic events, 25 arterial and 15 venous, were seen in 39 patients (frequency 1,24%). There was no significant difference between the CD and UC groups in terms of acute thromboembolism (p=0.871). The presence of exacerbation, the presence of hospitalization, the number of priot hospitalizations and clinical activity at the last visit were associated with both arterial and venous thromboembolism; smoking history, age at diagnosis, body-mass index, non-mucosal CD (Montreal B2-B3) and higher basal CRP were associated with arterial thromboembolism only; higher CRP at the last visit, annual exacerbation frequency, presence of an additional inflammatory disease, presence of complications (surgery, abcess), longer total steroid traetment duration and also recent steroid therapy were associated only with venous thromboembolism. In regression analysis, recent steroid therapy and additional inflammatory disease were considered as independent risk factors for venous thromboembolism whereas age at diagnosis of IBD was considered as an independent risk factor for arterial events. Conclusion In addition to risk factors such as age, smoking and obesity, parameters indicating disease activity, inflammatory comorbidities and recent steroid therapy appear to be associated with acute thromboembolism in IBD patients.

Novel effect of topical Roquinimex and its combination with Clobetasol on an imiquimod-induced model of psoriasis in mice.

Psoriasis is a chronic inflammatory skin condition affecting multiple systems and the skin, with topical therapy representing the fundamental treatment modality for psoriasis. Investigate the effect of topical Roquinimex (ROQ) alone and combined with Clobetasol propionate (CLO) on imiquimod (IMQ)-induced mouse model as a novel approach to treating psoriasis. Sixty male Swiss Albino mice were divided into six groups of ten mice; all groups except the negative control received IMQ cream 5% (62.5 mg) as a once-daily topical application for six days. On the seventh day, five groups (except negative control) received one of the following treatments for eight days: no treatment (positive control), Petrolatum gel 15% as a twice-daily topical application (Petrolatum control), CLO 0.05% ointment once daily, ROQ ointment 1% w/w twice daily topically, topical preparation of 0.025% CLO ointment combined with ROQ ointment 0.5% w/w twice daily; the total duration of the study is 14 days. The clinical, pathological, and laboratory effects were then measured. The use of ROQ ointment alone or combined with CLO resulted in significant improvement in psoriasis lesions (measured by Baker's and PASI scores) compared to positive control groups (2.15±1.08, 1.60±0.61, 9.00±0.00, and 7.60±0.84, respectively for Baker's score) (1.50±1.08, 1.30±0.95, 11.70±0.48, 9.30±0.67, respectively for PASI score), a similar improvement seen for various inflammatory markers, including interleukin (IL)-10 (140.53±60.68, 285.63±92.16, 31.83±3.03, and 92.50±27.13 pg/ml, respectively), IL-17 (126.58±40.98, 124.26±61.40, 553.04±141.32, and 278.52±100.27 pg/ml, respectively), tumor necrosis factor-α (72.34±23.40, 30.11±7.01, 807.13±500.06, and 281.79±240.17 pg/ml, respectively), and vascular endothelial growth factor (109.71±29.35, 80.96±24.58, 552.20±136.63, 209.56±73.31 pg/ml and respectively). Roquinimex exerts its antipsoriatic effect through multiple mechanisms; its combination treatment with Clobetasol is a promising therapy for managing psoriasis.

Incidence Rate of Post Coronary Artery Shunt Complications; Age Dependent!

Numerous complications, such as postoperative arrhythmia and stroke, have been observed following coronary artery bypass graft (CABG) surgery. This study sought to examine the impact of aging on the incidence of post-coronary artery shunt complications. Aging is a physiological process experienced by every living cell, beginning early in development. Age plays a crucial role in determining postoperative complications, including those related to CABG. A retrospective analysis was conducted on 290 patients who underwent CABG at the Mordovian Republic Hospital between 2017 and 2021. The sample was divided into two age-based groups: the first group comprised 126 patients (mean age range: 55.21-60.00), and the second group included 163 patients (mean age range: 66.11-80.00). Statistical analyses employed in this study encompassed descriptive statistics, Chi-square test, T-test, one-way ANOVA test, ROC analysis, and Pearson correlation using Statistica 12 software. Elderly patients in the second group demonstrated a higher incidence of post-CABG arrhythmia (p<0.012528). Moreover, the second group experienced markedly longer ICU and total hospitalization days following CABG, with p-values of less than 0.000000 and 0.000072, respectively. Notably, elderly individuals in the second group faced an increased risk of developing psychosis after CABG surgery (p<0.007379). Furthermore, psychosis was found to be significantly associated with longer ICU hospitalization (p<0.000140). Postoperative stroke occurred more frequently among the elderly (second group) with a p-value of less than 0.037736. Consequently, postoperative stroke was associated with extended ICU hospitalization (p<0.000747). The usage of internal thoracic arteries (ITAs) was lower among the elderly (second group), with a p-value of less than 0.016145. Regarding correlations, a direct association was observed between age and ICU days, total hospitalization days, and the number of complications, with correlation coefficients (r) of 0.189046, 0.141415, and 0.138565, respectively. Elderly individuals in the second group who undergo CABG face a greater risk of developing psychosis, arrhythmia, prolonged total and ICU hospitalization, and stroke. The presence of arrhythmia, which is commonly observed in patients aged 63 years and older, significantly affects total hospitalization days. The number of complications is influenced by age, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, ICU hospitalization, and total hospitalization duration.

Effectiveness of Interferential Therapy with Hip Muscle Strengthening Exercises and Ultrasound Therapy with Hip Muscle Strengthening Exercises for Piriformis Syndrome

Background: Sciatic nerve irritation caused by the piriformis muscle ,which results in Buttock pain, sciatica, or bothis known as piriformis syndrome. The prevalence of PS with sciatic nerve piercing is 17% and 81% respectively,while it was present in 17.2% suffering from low back discomfort.Purpose: The purpose of this study is to find the effectiveness of interferential therapy with hip muscle strengtheningexercises and ultrasound therapy with hip muscle strengthening exercises for piriformis syndrome.Materials and Methods: About 220 participants were selected by using FAIR test and visual analogue scale oninclusion and exclusion criteria. Written informed consent was collected before the commencement of the study. The220 participants were allocated into 2 groups. Interferential therapy group (n=110) and ultrasound therapy group(n=110). Interferential therapy group were given interferential therapy with hip muscle strengthening exercisesand the ultrasound therapy group were given ultrasound therapy with hip muscle strengthening exercises. Theintervention was given 5 times a week for a total duration of 2 weeks. Study Period: October 2022-June 2023.Results: The collected data was statistically analyzed using paired and unpaired t test, when comparing theInterferential therapy group to the ultrasound therapy, the Interferential therapy group indicates significanteffects P&lt;0.0001 in piriformis syndrome, as assessed by VAS.Conclusion: This study concluded that the Interferential therapy group was found to be more effective than theultrasound therapy group in patients with Piriformis Syndrome.

Validity across four common street-crossing distraction indicators to predict pedestrian safety

BackgroundMultiple distraction indicators have been applied to measure street-crossing distraction but their validities in predicting pedestrian safety are poorly understood.MethodsBased on a video-based observational study, we compared the validity of four commonly used distraction indicators (total duration of distraction while crossing a street, proportion of distracted time over total street-crossing time, duration of the longest distraction time, and total number of distractions) in predicting three pedestrian safety outcomes (near-crash incidence, frequency of looking left and right, and speed crossing the street) across three types of distraction (mobile phone use, talking to other pedestrians, eating/drinking/smoking). Change in Harrell’s C statistic was calculated to assess the validity of each distraction indicator based on multivariable regression models including only covariates and including both covariates and the distraction indicator.ResultsHeterogeneous capacities in predicting the three safety outcomes across the four distraction indicators were observed: 1) duration of the longest distraction time was most predictive for the occurrence of near-crashes and looks left and right among pedestrians with all three types of distraction combined and talking with other pedestrians (Harrell’s C statistic changes ranged from 0.0310 to 0.0335, P < 0.05), and for the occurrence of near-crashes for pedestrians involving mobile phone use (Harrell’s C statistic change: 0.0053); 2) total duration of distraction was most predictive for speed crossing the street among pedestrians with the combination and each of the three types of distraction (Harrell’s C statistic changes ranged from 0.0037 to 0.0111, P < 0.05), frequency of looking left and right among pedestrians distracted by mobile phone use (Harrell’s C statistic change: 0.0115), and the occurrence of near-crash among pedestrians eating, drinking, or smoking (Harrell’s C statistic change: 0.0119); and 3) the total number of distractions was the most predictive indicator of frequency of looking left and right among pedestrians eating, drinking, or smoking (Harrell’s C statistic change: 0.0013). Sensitivity analyses showed the results were robust to change in grouping criteria of the four distraction indicators.ConclusionsFuture research should consider the pedestrian safety outcomes and type of distractions to select the best distraction indicator.

Characteristics and predictors of outcomes with neoadjuvant imatinib in gastrointestinal stromal tumors: Real-world data from a large patient registry.

737 Background: The standard of care for patients with moderate or high-risk resectable gastrointestinal stromal tumors (GIST) is surgical resection followed by adjuvant therapy with imatinib. The impact of neoadjuvant imatinib on long-term outcomes is largely unknown. Methods: We interrogated the LifeRaft registry, a large international open cohort of patients with GIST. We included patients who did not have metastatic disease at diagnosis, underwent surgical resection and received neoadjuvant imatinib and had no recorded mutations of Kit exon 13 or PDGFRA exon 18 D842V. Baseline patient characteristics were described and survival probabilities were estimated and plotted using the Kaplan-Meier method. Cox regression was used to estimate the effect of demographic and clinical characteristics on recurrence-free survival (RFS) and overall survival (OS). For RFS, time was calculated from the date of surgery to disease recurrence/death, whichever came first. For OS, time was calculated from the date of surgery to death. Estimated effects of predictors were reported as hazard ratios (HR) along with 95% confidence intervals (CI). All statistical testing was two-sided and assessed for significance at the 5% level using SAS v9.4 (SAS Institute, Cary, NC). Results: Out 2,472 patients with GIST, 137 patients met the inclusion criteria and received neoadjuvant imatinib for a median of 6.8 months. Majority of the patients were aged 40 years or above (129/137, 94.2%) and were males (73/137, 53.3%). The majority of the patients had gastric GIST (72/137, 54.1%), followed by small intestine GIST (34/137, 25.6%) and other (27/137, 20.3%). Most patients had a tumor size of &gt;10 cm (66/137, 52.4%) at the time of diagnosis followed by &gt;5 cm - &lt;=10 cm (42/137, 33.3%) and &gt;2 cm - &lt;=5 cm (18/137, 14.3%). The median RFS for the cohort was 6.1 years. On multivariable analysis, tumor size (HR 1.08, 95% CI 1.05-1.12, p&lt;0.01) and the overall duration of treatment (neoadjuvant and adjuvant) with imatinib therapy (HR 0.98, 95% CI 0.97-0.99, p&lt;0.01) were significantly associated with RFS. A 1-cm increase in tumor size and 1-month increase in total time on imatinib was associated with an 8% increase and 2% decrease in risk of recurrence. The median OS was 14.2 years. Female gender (HR 0.23 95% CI 0.08-0.65, p&lt;0.01) and total length of time on imatinib (HR 0.97 95% CI 0.96-0.99, p&lt;0.01) were found to be significantly associated with OS. Female patients were associated with a 77% decreased risk of death and a 1-month increase in the total time on imatinib was associated with a 3% decrease in the risk of death. Conclusions: We show that most patients receiving neoadjuvant imatinib have gastric GIST with tumor size &gt;10 cm. Smaller tumor size and female gender predicted longer RFS and OS respectively. Longer total duration of imatinib therapy was associated with increased RFS and OS.

Prescribed time bipartite output consensus tracking for heterogeneous multi-agent systems with external disturbances

This paper investigates the bipartite output consensus tracking problem for disturbed agent networks where the agents have different state dimensions. A prescribed time robust coordination control scheme is proposed, which consists of a leader-state observer and an output-regulation-based robust controller that both converge within a preset time. Time-scaling functions with preset parameters T1 and T2 respectively take effect in the observer and the controller, and by computing the output regulation matrix which turns the output errors of followers tracking the heterogeneous leader into their state errors, the model-mismatched agents could reach bipartite output tracking consensus within a total duration of T1+T2. Moreover, neural networks are deployed to estimate and eliminate the unknown disturbances. Thorough Lyapunov-based derivations approve the preset-time convergence and robustness for the controller. Numerical simulations are performed to verify the efficacy of the proposed control scheme.

Alpha-2a adrenergic receptor activation in genetic absence epilepsy: An absence status model?

The objective of the study was to propose a candidate animal model of absence status epilepticus induced by specific alpha-2a adrenergic receptor (α2AR) activation. We also aim to investigate the responsiveness of this model to classical anti-status or anti-absence medications. An α2AR agonist, dexmedetomidine (DEX), was injected intracerebroventricularly into adult rats with genetic absence epilepsy, and their electroencephalography (EEG) was recorded. The total duration, number, and mean duration of each spike-and-wave discharges (SWDs) were evaluated. The blocks of absence status events were classified as the initial and second sets of absence statuses. Ethosuximide (ETX) was administered as a pretreatment to another group of rats and later injected with 2.5 μg DEX. In addition, ETX, valproic acid (VPA), diazepam (DIAZ), and atipamezole (ATI) were administered after induced status-like events following DEX administration. Power spectral characteristics and coherence analysis were performed on the EEG to assess the absence status events and sleep. The 2.5 μg dose of DEX increased the total SWD duration and induced continuous SWDs up to 26 min. Following the initial absence status event, sleep was induced; then, the second period of absence status-like activities were initiated. ETX pretreatment blocked the occurrence of absence status-like activities. Power spectral density analyses revealed that DEX-induced post-sleep activities had higher power in delta frequency band (1-4 Hz) and attenuated power of 7 Hz harmonics (14 and 21 Hz) than the pre-injection seizure. The mean duration of SWDs were decreased in all the groups, but occasional prolonged activities were seen in ETX or VPA-injected rats but not with DIAZ or ATI. This study presents an absence status epilepticus animal model that is activated by α2AR activation to investigate the pathophysiological role of absence status. Unlike other agents ATI switched off the second set of absence statuses to normal SWDs, without sedation or lethargy, can show it may preferentially block absence status-like activity. This study proposes a rat model for prolonged seizures, resembling absence status epilepticus. Activating the brain's alpha-2a adrenergic receptor with dexmedetomidine induced seizures lasting up to 26 minutes. Ethosuximide pretreatment and post-treatment with valproic acid, diazepam, and atipamezole decreased induced seizures. The findings suggest this model is valuable for studying absence status epilepticus. In addition, atipamezole normalized abnormal seizures without sedation, hinting at its potential for targeted treatment and further research.

TERT single nucleotide polymorphism rs2736098 but not rs2736100 is associated with telomere length in HIV-infected patients on cART.

Continuous application of "combination antiretroviral therapy" (cART) has transformed Human immunodeficiency virus (HIV) infection into a manageable chronic disease; however, due to lasting inflammation and cumulative toxicity, progressive pathophysiological changes do occur and potentially lead to accelerated aging, among others, contributing to telomere shortening. The single nucleotide polymorphisms (SNP) rs2736100 and rs2736098 are particularly important for human telomerase (TERT) gene expression. The objective of this study was to evaluate the effects of clinical parameters and single nucleotide polymorphisms in TERT (rs2736100 and rs2736098) on telomere length in HIV-infected patients. This cross-sectional study included 176 patients diagnosed with HIV infection. Relative telomere length (RTL) was determined by real-time polymerase chain reaction (qPCR), whereas genotyping was performed by polymerase chain reaction, followed by restriction fragment length polymorphism analysis (PCR-RFLP). The mean age of the patients (p = .904), time since HIV diagnosis (p = .220), therapy-related variables such as the cART regimen (0.761), and total cART duration (p = .096) did not significantly affect RTL. TERT rs2736100 genotype showed no association with RTL. However, TERT rs2736098 heterozygotes (GA) had significantly longer telomeres (P = .049) than both homozygotes (GG and AA). Our findings support the fact that cellular aging in HIV-infected patients is influenced by the TERT rs2736098 polymorphism.

Development and validation of a multi-dimensional diagnosis-based comorbidity index that improves prediction of death in men with prostate cancer: Nationwide, population-based register study.

Assessment of comorbidity is crucial for confounding adjustment and prediction of mortality in register-based studies, but the commonly used Charlson comorbidity index is not sufficiently predictive. We aimed to develop a multidimensional diagnosis-based comorbidity index (MDCI) that captures comorbidity better than the Charlson Comorbidity index. The index was developed based on 286,688 men free of prostate cancer randomly selected from the Swedish general population, and validated in 54,539 men without and 68,357 men with prostate cancer. All ICD-10 codes from inpatient and outpatient discharges during 10 years prior to the index date were used to define variables indicating frequency of code occurrence, recency, and total duration of related hospital admissions. Penalized Cox regression was used to predict 10-year all-cause mortality. The MDCI predicted risk of death better than the Charlson comorbidity index, with a c-index of 0.756 (95% confidence interval [CI] = 0.751, 0.762) vs 0.688 (95% CI = 0.683, 0.693) in the validation cohort of men without prostate cancer. Men in the lowest vs highest MDCI quartile had distinctively different survival in the validation cohort of men with prostate cancer, with an overall hazard ratio [HR] of 5.08 (95% CI = 4.90, 5.26). This was also consistent within strata of age and Charlson comorbidity index, e.g. HR = 5.90 (95% CI = 4.65, 7.50) in men younger than 60 years with CCI 0. These results indicate that comorbidity assessment in register-based studies can be improved by use of all ICD-10 codes and taking related frequency, recency, and duration of hospital admissions into account.

Clinical Evaluation of Mahanarayana Taila Matra Basti in Anidra (Primary Insomnia)

Sleep is a naturally recurring state of mind and body. Insomnia disorder is defined as a subjective perception or complaint of inadequate or poor-quality sleep. Anidra has been described in detail by Acharyas in various contexts like Vata Nanatmaja Vikara, Vataja Jwara etc. Panchkarma therapies like Shirodhara, Shirobasti, Shiroabhyang, Shiropichu, Padaabhyang is very useful in treatment of Anidra. Insomnia is the most commonly encountered sleep disorder and occurs 10-50% of the population. Worldwide epidemiological studies assessed the prevalence of insomnia without restrictive criteria as 33% in general population. In Ayurveda, insomnia is described as Anidra and Nidranash under the heading of different disorders and conditions. Allopathic hypnotic drugs are useful for short term treatment in insomnia which is due to acute stage. Long term uses of certain classes of sedatives cause physical dependence, Ayurvedic approach in the disease is by pacifying the Doshas, paying special attention to Vata- Shamana, Santarpana and Srotoshodhak. Hence, with the aim of identifying and establishing an alternative, safer, effective and long-lasting treatment modality, the study entitled “Clinical Evaluation of Mahanarayana Taila Matra Basti in Anidra (Primary Insomnia)” was conducted in 56 patients. They were selected on the basis of standard inclusion and exclusion criteria and randomly allocated to two different treatment groups; Group- A (Mahanarayana Taila Matra Basti) and Group- B (Zolpidem). Total duration of the treatment was of 14 days along with a follow up period of 1 month. Both the interventions were almost equally effective, but in overall improvement of the patients “Group A” had better results than Group B. For better scientific validation, further research studies and clinical trials should be carried out with large sample size and longer duration of treatment.

Validation of behavioural sampling techniques for 20-25 kg pigs during transport

Monitoring behaviour during transport is challenging due to the design of vehicles and often limited deck height. The aim of the present study was to validate behavioural sampling techniques during transport. This study used data from four journeys, constituting a subset of 32 experimental journeys in a commercial vehicle transporting weaners of 20–25 kg for 23 h. In each journey, behaviour was observed in two compartments holding pigs, each with a deck height of either 60 cm or 90 cm.Body posture (upright, lying, sitting) was recorded using instantaneous scan sampling at 1 min intervals (considered ‘true’ occurrence). Based on these, less frequent sampling intervals were created (5, 10, 15, 30, and 60 min) and the resulting percentages of behaviour per hour were compared. Occurrences of inter-pig aggressive events were recorded using continuous sampling. It was investigated whether the occurrence of aggression when observed during selected recording sessions per hour (20, 30 and 40 min/h) differed from observing the whole hour throughout the journey (the ‘true’ occurrence).Two methods were used to compare sampling techniques. First, estimates of body posture and aggression were pairwise compared with the ‘true’ occurrence using regression metrics (RMSE, MAE, R2). The results showed that instantaneous scan sampling of body posture at 15 min intervals or less did reflect the ‘true’ values, whereas for aggression use of shorter recording sessions of 20 min/h generally did not reflect the ‘true’ values.Secondly, similar results were achieved by using mixed effects logistic regression. These models showed that sampling every 30 min differed from the ‘true’ values, whereas scanning in 5-, 15- or 60 min intervals did not. Compared with sampling the whole hour, the total duration of aggression was significantly underestimated in all three recording sessions (20, 30 and 40 min/h), while the total frequency of aggression was only significantly underestimated in 20 min/h recording session.Based on results of this study, the use of instantaneous scan sampling intervals of 15 min or less is considered valid for analyses of body postures during long distance transport of 20–25 kg pigs. Due to the sporadic occurrence of aggressive interactions, continuous sampling using recording sessions of 20 min cannot be recommended. Using longer recording sessions of 30 or 40 min/h should be approached with caution dependent on the specific scientific context.

New Approaches to Etiotropic Therapy of ARVI Patients with Riamilovir

Aim. To study the efficacy and safety of Riamilovir in patients diagnosed with acute respiratory viral infection using several dosage regimens of the drug.Material and Methods. The clinical efficacy and safety of Riamilovir were evaluated based on the results of a study, that included 150 patients in three comparative groups, 50 patients each. The research groups received etiotropic antiviral therapy with 1 capsule (250 mg) of Riamilovir 3 times per day for 5 days in the first group; in the second group, patients received Riamilovir off-label — 1 capsule (250 mg) 5 times per day for 5 days; and the third group included 50 patients who received only pathogenetic treatment.Results. As a result of the study, Riamilovir demonstrated a high safety profile regardless of the dosage regimen; no adverse events were registered. It was shown that Riamilovir use, regardless of the dosage regimen, led to a statistically significant reduction in the duration of inpatient treatment. It should be noted that the shortest periods of hospitalization were observed in patients who received the studied drug at increased daily dosages. Riamilovir was found to reduce the duration and severity of general infectious signs of the disease, while complete elimination of ARVI pathogens occurred by the 6th day of hospitalization; the shortest total duration of fever and a number of respiratory tract syndromes was registered among patients receiving Riamilovir at a daily dose of 1250 mg for 5 days.Conclusion. The etiotropic antiviral drug Riamilovir has shown clinical efficacy when used in both treatment regimens in patients with acute respiratory viral infections, as well as a good safety profile.

An attention-based deep learning method for the detection of electrical status epilepticus during sleep from electroencephalogram waveform analysis in children

Electrical status epilepticus during sleep (ESES) is a special interictal electroencephalographic phenomenon observed in children with epilepsy. ESES refers to continuous or nearly continuous epileptiform discharges of bilateral (or unilateral) spikes and waves induced during non-rapid eye movement (NREM) sleep. It mainly manifests in a series of childhood epileptic syndromes characterized by seizures, ESES, and cognitive impairment, which seriously affect the health of children. Typically, the spike-wave index (SWI), which is the percentage of spikes and waves duration in the total NREM time, is an important criterion for diagnosing ESES. The SWI measures the proportion of the total duration of spikes and waves to the NREM sleep time within several hours. Currently, SWI is obtained primarily by manual measurement and calculation, which has a certain subjective bias, low accuracy, time and labor consumption, and is a waste of medical resources. Therefore, we designed a novel data segmentation model based on a multiresolution convolutional neural network and a self-attention mechanism to calculate the SWI quickly and accurately. This can assist clinicians in making more accurate judgments and providing a better guide for the treatment of children with epilepsy. A large amount of clinical patient data was used to test the proposed model. The results confirmed that this model has an acceptable generalization ability for data from different patients and the same patient at different times. Each performance index of the model was superior to that of current common models, thus fulfilling the requirements for clinical testing.

Ergonomics in Craniofacial Surgery: Can We Do Better? A Quality Improvement Study.

Many plastic surgeons experience musculoskeletal strain and injury from poor ergonomics during surgery. This is associated with reduced performance, shortened careers, and decreased quality of life. This study compared the ergonomics of the conventional operating table headrest and the Mayfield headrest in craniofacial surgery. A prospective cohort study of patients undergoing craniofacial operations between November 20, 2022 and April 26, 2023, within a single craniofacial surgeon's practice. The authors obtained data on the total duration of the operation and Rapid Entire Body Assessment (REBA) scores for the primary surgeon and assistant. Four operations (mean: 147 ± 60.9 min) were included in the regular headrest group, and 8 in the Mayfield headrest group (mean: 61±53.4 min). Four hundred fifty-five regular headrest time points and 851 Mayfield time points were recorded. Eight hundred thirty-five regular headrest time points and 538 Mayfield time points were recorded. The mean REBA score for the regular headrest was 5.79 ± 1.9, which was higher than the Mayfield (5.01 ± 2.0; P < 0.0001). Subgroup analysis showed the mean REBA score for the primary surgeon (5.89 ± 2.0) was higher than the assist (5.48 ± 1.6) in the regular headrest group (P < 0.0001), whereas the converse was true for the Mayfield headrest (primary surgeon: 4.67 ± 1.8, assist: 5.65 ± 2.15, P < 0.0001). Ergonomic scores were better using the Mayfield headrest than the regular headrest. The primary surgeon scored better with the Mayfield headrest, whereas the assists had better scores with the regular headrest.

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF JEERAKADI LEPA AND MUKHAKANTIKARA LEPA IN THE MANAGEMENT OF VYANGA(MELASMA)

Vyanga is one of the important diseases pertaining to hyper Pigmentation disorders. It is considered Kshudraro-gas, which occurs mainly due to vitiation of Vata, Pitta and Rakta. Vyanga presence of Neeruja, Tanu, Shyavav-arnayukta mandala on Mukhapradesha. Melasma is a hyperpigmented macular lesion that develops slowly and symmetrically over the malar area, bridge of the nose, forehead and upper lips, more commonly seen in females than males. Hyperpigmentation is due to increased melanocytes activity in epidermal and dermal layers. Brhajaka pitta is mainly related to Varna of twacha. So, Pitta is the main culprit to cause Vyanga. Here, all Jeerakadi Lepa's and Mukhakantikara Lepa's ingredients are Pittashamaka, Varnyakara, Raktaprasadaka, Twakprasadaka, Kandughna, Kusthaghna. Methods: A Randomized comparative clinical trial is adopted. In Group A were given Jeerakadi lepa with milk for 30 days application (once in a day).In Group B were given Mukhakantikara lepa with water for 30 days application (once in a day) .Total duration of study was carried out for 45 days. Results: By applying the Friedman test and Wilcoxon sign rank test for within the group it was sta-tistically significant. The Mann Whitney U test is applied between the groups the results showed statistically not significant. Hence, we conclude that we reject null hypothesis H0 and accept the alternate hypothesis H2. i.e H2 : Jeerakadi lepa is more effective than Mukhakantikara lepa in the management of Vyanga.

An empirical investigation of driver’s eye-catching effect in the entrance zone of freeway tunnels: A naturalistic driving experiment

This study aims to evaluate the impact of different visual attraction environments at the entrance zone of freeway tunnels on drivers' visual performance and subjective mental workload. Through a naturalistic driving experiment conducted on actual roads, participants experienced various visual attraction environments at the entrance zones of freeway tunnels. The selected visual environments included baseline, landscape-style architecture, tip slogan, and billboard scenarios. Objective visual performance was assessed using eye-tracking devices to collect participants' eye movement data, while subjective mental workload was evaluated through the NASA-TLX measurement reports administered after the driving experiment. The results indicate that the visual attraction environments at the entrance zone of freeway tunnels have significant impacts on drivers’ visual attention level, cognitive workload, and subjective mental workload. Under the billboard condition, participants exhibited the longest first fixation duration (FFD) and paid the earliest attention to visual attraction (reflected by participants positioned their initial fixation at the visual attraction farthest from the tunnel entrance zone (DFT)). Additionally, the tip slogan condition resulted in the highest mean fixation duration (MFD), the largest percentage of total fixation duration on the visual attraction (PTFD), and the highest cognitive workload (reflected in maximum pupil diameter (PD)). Billboard at the entrance zone of freeway tunnel had the greatest effect on attracting drivers’ visual attention, while tip slogan resulted in the highest cognitive workload on drivers. The results of the subjective mental workload evaluation (NASA-TLX) also indicated that tip slogan had the greatest impact on drivers’ subjective mental workload. This study provides valuable insights into the potential impact of different visual attraction environments at the entrance zone of freeway tunnels on drivers' eye-catching effect. The results contribute to both theoretical knowledge and practical applications in the field of transportation safety.

Successful Pregnancy and Vaginal Delivery after Oxytocin Massage for Nulliparous Women with Anemia and Undetected Foetal Congenital Anomaly: An Indonesian Case Report

Background: A factor that contributes to the poor health of both the mother and the fetus is Anemia. Pregnant women must therefore receive prenatal care that includes the identification and management of Anemia properly. Case Presentation: This case report provides an analysis of the pregnancy circumstances of Mrs. R, a 22-year-old housewife from a middle-class socioeconomic background, who is anticipating her first child. From the pregnancy data obtained, Mrs. R experienced anemia, supported by supporting examinations of hemoglobin levels. The management provided included iron supplementation and the consumption of beetroot, which has been proven to be an effective food to increase hemoglobin levels. At 40 weeks of pregnancy with no signs of labor, it was recommended to engage in sexual intercourse to stimulate contractions and undergo oxytocin massage at 40 weeks and 4 days of pregnancy. The parturition process ultimately took place at 40 weeks 5 days of gestation, spontaneously. The total duration of the first stage of labor was 22 hours, the second stage was 2 hours, the third stage was 11 minutes, and the fourth stage was 2 hours. The baby was born spontaneously, cried loudly, weighed 3,600 grams, and showed a cranial deformity, specifically asymmetric head shape. There were no complications during labor and the postpartum period. Although Mrs. R is deeply committed to maintaining a healthy pregnancy, managing the Anemia that was detected in the early stages of the pregnancy presents a formidable challenge. Through her scrupulous observance of monthly prenatal examinations and regular administration of blood supplement tablets and additional multivitamins, Mrs. R effectively controlled her Anemia, thereby facilitating the successful culmination of the delivery procedure. Conclusion: Accurate evaluation of anemia during pregnancy is crucial for the proper treatment of anemia. In Indonesia, the effective treatment of severe anemia necessitates ......