Total Subjects Research Articles

Cervical spine positioning patterns amongst hand surgeons: A critical analysis of surgical posture

AimThis study aims to assess the cervical spine positioning of consultant and trainee hand surgeons during standardised hand surgeries, focusing on the prevalence of sustained end-range postures, particularly cervical spine flexion. BackgroundSurgeons often perform procedures that require maintenance of sustained postures for prolonged periods of time. Hand surgeons may be at increased risk of sustained end of range postures, particularly cervical spine flexion. This can lead to strain on the musculoskeletal structures of the neck. Recent evidence suggests a higher incidence of neck dysfunction in hand surgeons, leading to an associated morbidity. MethodsWe examined hand surgeons of all experience levels during 40 common hand surgery procedures. We used real-time dynamic goniometric measurements of neck flexion using the “UPRIGHT GO 2” device and accompanying smartphone app. Neck flexion exceeding 40° was used as the threshold for defining an acceptable neck position. ResultsAnalysis included 20 total subjects at various levels of medical training (SHO n ​= ​6, Registrar n ​= ​9, Consultant n ​= ​5) performing surgeries under different conditions. Maladaptive neck positions were prevalent, with junior surgeons exhibiting such postures for 71 ​% of procedure time compared to 60 ​% for consultants. This underscores the potential contribution of sustained end-range postures to cervical spine dysfunction in hand surgeons, highlighting an early intervention opportunity. Notably, participants reported varied experiences with neck pain and expressed unanimous interest in integrating biofeedback posture devices into surgical training, with a single consultant expressing reservations.

Body composition, cardiovascular fitness and attention of school-aged male children practicing sports club activities: A cross-sectional.

The positive effects of physical activity on physical fitness, bone health, academic achievement, cognitive functions, mental health, and reduced obesity have been proven. This study aims to investigate the relationship between sports club activities, physical activity selected health-related fitness, and the d2 attention test. A cross-sectional study was conducted in different sports clubs. A total of 78 male students aged 10-13 years participating in various branches of sports clubs were included in the study, 42 of whom were assigned to the sports group and 36 to the control group. Questionnaires were administered to assess sports club participation and attention levels, while physical health profiles were tested with body composition and Yo-Yo IR1C performance measures. Data were analyzed according to sports participation and the five most frequently reported sports. The means and standard deviation of each study value were calculated for the total subjects and by participating in sports activity using the IBM SPSS (version 23) analysis program. Data normality was checked and confirmed by the Skewness and Kurtosis Tests. The results showed that boys enrolled in a sports activity had lower body mass (-17.9%, P < 0.05 d = 0.72), body mass index (-13.4%, P < 0.05, d = 0.87), and body fat (%) (-54.1%, P < 0.05, d = 1.38) and higher VO2max 32.3% (P < 0.05, d = 3.67), than the non-active group. The boys active in sports clubs also had better results in the total number of items processed (11%, P < 0.05 d = 0.50) and in concentration performance (17.7%, P < 0.05 d = 0.56) than the non-active group. In correlation analyses, VO2max was negatively associated with body mass, body mass index, and body fat (P = 0.011; P = 0.001 and P = 0.00, respectively) and positively related to the total number of items processed and concentration performance (P = 0.003 and P = 0.015, respectively). In the Pearson Correlation analyses, body fat showed a lower negative correlation with TN (r = 0.33; P = 0.003) and CP (r = 0.28; P = 0.015). Boys participating in regular sports have lower body mass, BMI, and BF values. In addition, boys who participated in sports showed higher imaginary fitness and selective attention and concentration capacity results, as expected, for any sports part compared to their body peers. Another attempt from this study is that body mass and body fat percentage recovery are negatively associated with fitness. Considering the increasing prevalence of obesity in children and adolescents due to sedentary living, which has become a worldwide epidemic, it is recommended that pedagogical and public health strategies and policies be developed based on the physical fitness level of children.

Assessment of Anatomical Variations in the Anterior Loop of the Mental Nerve in the Northeast Population to Estimate a Safe Zone for Implant Prosthesis: An Institution-Based Study.

The precise location of the anterior loop is of utmost importance during implant surgery to avoid any postoperative complications. The aim of the institution-based study was to determine the prevalence of the anterior loop with respect to age and gender in the northeast population. Sixty outpatients opting for implant prostheses in the interforaminal region of the mandible were enrolled in this study based on the inclusion and exclusion criteria. The anterior loop was identified in 18.3% of the total subjects, and the mean length of the anterior loop was found to be 3.37 ± 0.53 mm. Planning for prosthetic-driven the implant placement was possible in 54.5% of the subjects. Proper treatment planning using cone beam computed tomography (CBCT) with a radiographic stent is paramount important for the safe placement of implant in the presence of the anterior loop of the mental nerve.

Aerobic Training on the Physical Fitness and Technical Variables of Male Ice Hockey Players

Hockey attained greater level of popularity all over the World and played on sand, natural grass and artificial turf ground. The modem game of hockey demands that each member of the team be able to play in all positions. The purpose of the study was to find out the effect of aerobic training on physical fitness and skill variables of men hockey players. The selected physical fitness and skill variables were hitting and dribbling, To achieve this purpose total (N=30) subjects selected from Faculty of General Adapted Physical Education and Yoga, Ramakrishna Mission Vivekananda Educational and Research Institute, Coimbatore. The subjects are selected by purposive sampling method. The subjects are equally divided into two groups namely group - I (n - 15) Aerobic training with Skill Training group and group –II (n - 15) acted as control group. Their age ranged between 18 to 25 years. The physical fitness variable cardio respiratory endurance was measured with 12 minutes run/walk test and skill variables namely dribbling was tested with SAI Hockey Skill Test. The training periods consists a total of eight weeks, which includes training for 5 days a week from evening 5 to 6 pm. The collected data were treated with paired ‘t’ test. The results of the study shows that aerobic training play a significant role in improving physical fitness variables namely cardio respiratory endurance and skill performance variables namely hitting and dribbling of college men hockey players.

Elementary School Students' Compliance with the 24 Movement Guidelines in Pringsewu Regency in 2023

The Covid-19 pandemic has caused a crucial reduction in the need for physical education and interaction time in physical activity, so this has become a challenge for all teachers in schools. The aim of this research is to investigate 24-hour movement guidelines between pandemic vs. post-pandemic. The method used in this research is cross sectional with an observational approach. The total subjects in this study were 620 elementary school students with an average age of 10.87 ± 0.51 years, weight 37.12 ± 8.37 kg, and height 140.11 ± 4.73 cm. The results of the research show that after the pandemic, children's outdoor play habits and sleep duration increased sharply as time in front of the screen decreased, although they tended to be the same as conditions during the pandemic. It is hoped that these findings can be a reference for parents and teachers in schools to implement a healthy lifestyle by prioritizing physical activity compared to screen use. so that habits during the pandemic can be overcome and students can increase their level of fitness

Unveiling Cardiovascular Risk Factors in Diagnosed and Undiagnosed among Rural Population: a Prospective Observational Study

Background: Cardiovascular disease is a leading cause of morbidity and mortality worldwide. It is caused by a combination of genetic, environmental, and lifestyle factors.Several risk factors contribute to the higher prevalence of CVD in rural areas. Objective: The objective of this study was to determine prevalence of individual risk factors among undiagnosed and diagnosed patients with cardiovascular diseases. Materials and methods: A prospective observational study was carried out among the rural areas of pathanamthitta district. The sample size of the study was 500 individuals. The study period ranged from 6 months. The data was collected using a semi structured questionnaire and various instruments to evaluate risk factors including diabetes mellitus, blood pressure and BMI were used. Results: Of the total population of 500 individuals,22.4% of the total subjects were diagnosed with cardiovascular disease, and about 77.6% of the subjects were not diagnosed with cardiovascular disease. The prevalence of individual risk factors for the diagnosed population were higher than that of the undiagnosed population, although 27.5% of the undiagnosed population were found to have high risk for developing cardiovascular disease. Conclusion:The prevalence of social habits such as smoking, alcoholism and tobacco consumption is a contributing factor to cardiovascular disease. Lifestyle diseases such as hypertension, diabetes mellitus, and dyslipidemia are prevalent in causing cardiovascular disease. Among the individuals not diagnosed with cardiovascular disease, one third of the population were having high risk of developing CVD

Serum Vitamin D, Mania and Depression-Related Scores: A Comparison among Mixed Bipolar, Mania, and Healthy Subjects.

Objective: Manic and mixed episodes of bipolar disorder are important episodes of this disorder. The aim of the current study was to assess serum vitamin D (SVD) levels in patients with mania and mixed bipolar disorder, compared to healthy subjects. Method : The current cross-sectional study was conducted on 75 subjects, including healthy subjects (n = 25), patients with acute-phase mania (n = 25), and patients with mixed bipolar disorder (n = 25). The SVD levels were measured in all of the enrolled subjects. The Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), and Clinical Global Impression- Severity (CGI-S) were used to assess disease activity in patient groups. Data analysis was performed using SPSS version 18. For statistical analysis, analysis of variance (ANOVA), independent-sample t test, Pearson correlation, and Chi-square tests were utilized. P-values < 0.05 were considered statistically significant. Results: The results showed that the mean of SVD was significantly lower in mania and mixed bipolar patients compared to healthy subjects (P < 0.05). In addition, the number of subjects with SVD ≥ 20 ng/ml was higher in the healthy group compared to the patient groups (P < 0.05). Also, SVD was negatively correlated with the CGI-S (r = -0.311; P = 0.028), YMRS (r = -0.464; P = 0.001), and HDRS (r = -0.393; P = 0.005) in the total patient subjects. Conclusion: Prevalence of low SVD was considerably high in mania and mixed bipolar patients compared to healthy subjects. Additionally, meaningful negative correlations were found between SVD and disease activity-related variables including the HDRS, YMRS, and CGI-S.

Impairment of Renal Function and Dyselectrolytemia in Perinatal Asphyxia

Background: Perinatal asphyxia is one of the major causes of neonatal death and disabilityworldwide. Asphyxiated newborns are vulnerable to develop impaired renal functions andderangement in electrolytes level.Objective: To determine the effects of perinatal asphyxia on renal functions and serumelectrolytes.Methods: This cross sectional observational study was conducted at inpatient department ofPaediatrics of Rangpur Medical College Hospital from May 2017to October 2017. After parentalpermission and clearance, total 200 eligible hospitalized term neonates fulfilling the inclusionand exclusion criteria were enrolled into the study. Estimation of serum creatinine, blood urea,serum sodium and potassium were done for every neonate after hospitalization. Data collectionand processing were done for each patient. Data were analyzed through SPSS software (version16.0). Level of significance was predetermined as p&lt;0.05.Results: Analysis revealed that out of 200 neonates 130(65%) patients were in Hypoxic IshchemicEncephalopathy stage-ll followed by 50(25%) and 20(10%) patients in stage-lll and stage-lrespectively. Of total subjects, 68(34%) neonates had raised serum creatinine (p&lt;0.001) andmajority (36 cases out of 50,18% of total) of them were in stage-lll. Blood urea wasraised(p&lt;0.001) in more than half (112 cases out of 200, 56% of total neonates) of the asphyxiatedneonates, higher level was observed in stage-ll and stage-lll. Majority of asphyxiated neonates139(69.5%) were hyponatremic which was significant in all stages of birth asphyxia (p=0.026).Hyperkalemia observed in 38(19%) asphyxiated neonates which was significant with increasedseverity of perinatal asphyxia (p=0.007).Conclusion: Renal function impairment and electrolyte abnormalities are common in asphyxiatednewborns. The degree of hyponatremia, hyperkalemia, raised serum creatinine and blood urea levelwere directly proportionate to severity of asphyxia. The early identification and time basedintervention to assess renal function and electrolyte abnormality in the early post asphyxiatedperiod will significantly reduce the morbidity and mortality.

Genetic variations of low-density lipoprotein cholesterol on metabolic disorders in obstructive sleep apnea

BackgroundThe study aimed to explore the relationship between low-density lipoprotein cholesterol (LDL-C) genetic variants and obstructive sleep apnea (OSA) and its complications, including cardiovascular diseases (CVD), insulin resistance (IR), and metabolic syndrome (MS).Method4329 individuals with suspected OSA who underwent a comprehensive assessment of anthropometric, biochemical, and polysomnography (PSG) data, along with 30 LDL-C single nucleotide polymorphisms (SNPs) were enrolled. The 10-year Framingham CVD risk score (FRS), IR and MS were evaluated for each subject. Linear regression and logistic regression were utilized to examine the correlations among these variables.ResultsAfter the Benjamini-Hochberg correction, linear regression results indicated positive correlations between variants rs3741297 and rs629301 with FRS (β = 0.031, PBH=0.002; β = 0.026, PBH=0.015). Logistic regression revealed that rs3741297 increased MS risk among total subjects [OR = 1.67 (95% CI:1.369–2.038), PBH=1.32 × 10− 5] and increased IR risk in females [OR = 3.475 (95% CI:1.653–7.307), PBH=0.03]. In males, rs2642438 decreased MS risk [OR = 0.81 (95% CI:0.703–0.933), PBH=0.045].ConclusionsThe rs3741297 variant correlated with susceptibility to CVD, IR, and MS in the OSA population. OSA, CVD, IR and MS share a potentially common genetic background, which may promote precision medicine.Cinical trial registrationThe study protocol was registered with the Chinese Clinical Trial Registry (ChiCTR1900025714).

Analysis of Albumin to Globulin Ratio as A Prognostic Predictor in Lupus Nephritis Patients

Lupus Nephritis (LN) is a manifestation of Systemic Lupus Erythematosus (SLE), which targets the kidney. Based on histopathology, the World Health Organization divides the disease into five classes: normal pattern, mesangial, focal, diffuse proliferative, and membranous. Albumin to Globulin Ratio (AGR) compares serum albumin with serum globulin levels. Low AGR value is associated with poor prognosis of diseases such as cancer, liver cirrhosis, and other chronic inflammatory diseases such as LN. This study aimed to analyze the AGR value as a prognostic predictor in LN patients based on disease classes with a retrospective descriptive cross-sectional approach. Total subjects were 109, which consisted of class 1 (n=15), class 2 (n=37), class 3 (n=9), class 4 (n=21), and class 5 LN (n=27). Data of disease classes, serum albumin, and serum globulin/total protein levels were collected. SPSS version 25, Mann-Whitney, Kruskal-Wallis, Chi-Square, and Spearman's correlation test were used for statistical analysis. The ROC curve determined the cut-off. Test results were significant if p &lt;0.05. The lowest mean AGR value (0.79) was found in class 4 LN (p&lt;0.05). The optimal cut-off AGR was 1.10 to categorize mild-moderate and severe degrees. AGR prognostic value: sensitivity=95.8%; specificity=78.8%; Positive Prediction Value (PPV)=78.0%; Negative Prediction Value (NPV)=96.0%, accuracy = 86.2%. There was a negative strong correlation between the AGR value and LN class with a correlation coefficient R of -0.777 (p&lt;0.001). AGR marker has a good sensitivity and specificity as a predictor of LN progression.

Understanding the Role of Self-Attention in a Transformer Model for the Discrimination of SCD From MCI Using Resting-State EEG.

The identification of EEG biomarkers to discriminate Subjective Cognitive Decline (SCD) from Mild Cognitive Impairment (MCI) conditions is a complex task which requires great clinical effort and expertise. We exploit the self-attention component of the Transformer architecture to obtain physiological explanations of the model's decisions in the discrimination of 56 SCD and 45 MCI patients using resting-state EEG. Specifically, an interpretability workflow leveraging attention scores and time-frequency analysis of EEG epochs through Continuous Wavelet Transform is proposed. In the classification framework, models are trained and validated with 5-fold cross-validation and evaluated on a test set obtained by selecting 20% of the total subjects. Ablation studies and hyperparameter tuning tests are conducted to identify the optimal model configuration. Results show that the best performing model, which achieves acceptable results both on epochs' and patients' classification, is capable of finding specific EEG patterns that highlight changes in the brain activity between the two conditions. We demonstrate the potential of attention weights as tools to guide experts in understanding which disease-relevant EEG features could be discriminative of SCD and MCI.

Perbedaan Tingkat Academic Burnout pada Siswa Ditinjau dari Jenis Sekolah SMA/SMK/MA

The condition of exhaustion experienced by students as a result of excessive pressure to meet academic demands at school is also known as academic burnout. Burnout in students can lead to an increased risk of depression and decreased academic performance. The different operational curriculum used by each type of school results in students experiencing different academic demands. This study aims to see differences in the level of academic burnout among students in terms of the type of school, SMA / SMK / MA. The research method used is quantitative with a comparative causal approach. The subjects of this study were high school students in West Sumatra. The total subjects in this study were 165 people. The level of students' academic burnout was measured using the academic burnout scale adapted from Maharani (2019). The scale was adapted from a measurement tool developed by Schaufeli et al. (2002), MBI-SS (Maslach Burnout Inventory-Student Survey). The results showed that there was no significant difference in the level of academic burnout among students in terms of school type. However, the average score of MA students is higher than that of SMA and SMK students.

Muscle-origin creatinine-cystatin C ratio is an osteoporosis marker in individuals with normal renal function: evidence from observational and Mendelian randomization analysis.

Creatinine-cystatin C ratio (CCR) has been demonstrated as an objective marker of sarcopenia in clinical conditions but has not been evaluated as an osteoporosis marker in individuals with normal renal function. We selected 271,831 participants with normal renal function from UK Biobank cohort. Multivariable linear/logistic regression and Cox proportional hazards model were used to investigate the phenotypic relationship between CCR and osteoporosis in total subjects and gender-stratified subjects. Based on the genome-wide association study (GWAS) data, linkage disequilibrium regression (LDSC) and Mendelian randomization (MR) analysis were performed to reveal the shared genetic correlations and infer the causal effects, respectively. Amongst total subjects and gender-stratified subjects, serum CCR was positively associated with eBMD after adjusting for potential risk factors (all P<0.05). The multivariable logistic regression model showed that the decrease in CCR was associated with a higher risk of osteoporosis/fracture in all models (all P<0.05). In the multivariable Cox regression analysis with adjustment for potential confounders, reduced CCR is associated with the incidence of osteoporosis and fracture in both total subjects and gender-stratified subjects (all P<0.05). A significant non-linear dose-response was observed between CCR and osteoporosis/fracture risk (P non-linearity < 0.05). LDSC found no significant shared genetic effects by them, but PLACO identified 42 pleiotropic SNPs shared by CCR and fracture (P<5×10-8). MR analyses indicated the causal effect from CCR to osteoporosis/fracture. Reduced CCR predicted increased risks of osteoporosis/fracture, and significant causal effects support their associations. These findings indicated that the muscle-origin serum CCR was a potential biomarker to assess the risks of osteoporosis and fracture.

Assessing the joint effects of mitochondrial genes and physical activity on the psychiatric phenotype of subjective well-being based on the UK Biobank data.

Subjective well-being (SWB) is an important measure for mental health status. Previous research has shown that physical activity can affect an individual's well-being, yet the underlying molecular mechanism remains to be clarified. In this study, we aim to evaluate the potential interactions between mitochondrial genes and physical activity (PA) as well as their combined effects on individual well-being. SWB phenotype data in UK Biobank were enrolled for this study including nine aspects such as work/job satisfaction, health satisfaction, family relationship satisfaction, friendships satisfaction, financial situation satisfaction, ever depressed for a whole week, general happiness, general happiness with own health and belief that own life is meaningful. We made analysis for each aspects separately. Firstly, mitochondria-wide association studies (MiWAS) was conducted to assess the association of mitochondrial Single Nucleotide Polymorphisms SNP with each aspect of SWB. Then an interaction analysis of mitochondrial DNA (mtDNA) mutation and PA was performed to evaluate their joint effect on SWB status. Meanwhile, these two analysis were made for female and male group separately as well as the total samples, all under the control of possible confounding factors including gender, age, Townsend Deprivation Index (TDI), education, alcohol consumption, smoking habits, and 10 principal components. MiWAS analysis identified 45 mtSNPs associated with 9 phenotypes of SWB. For example, m.15218A > G on MT-CYB in the health satisfaction phenotype of the total subjects. Gender-specific analyses found 30 mtSNPs in females and 58 in males, involving 13 mtGenes. In mtDNA-PA interaction analysis, we also identified 10 significant mtDNA-PA interaction sets for SWB. For instance, m.13020T > C (MT-ND5) was associated with the SWB financial situation satisfaction phenotype in all subjects (P = 0.00577). In addition, MiWAS analysis identified 12 mtGene variants associated with SWB, as MT-ND1 and MT-ND2. However, in mtDNA-PA interactions we detected 7 mtDNA affecting psychiatric disorders occurring, as in the friendships satisfaction phenotype (m.3394T > C on MT-ND1). Our study results suggest an implication of the interaction between mitochondrial function and physical activity in the risk of psychiatric disorder development.

Substances use among a sample health care workers in Iran: prevalence, pattern of use and gender differences

ABSTRACT Background Substance use (SU) among HCWs leads to reduced productivity and overall health and, moreover, is a negative role to promote SU reduction. Aim This study aimed to estimate the prevalence of SU and assess its determinants among HCWs. Methods The study analyzed data related to the first phase of the SHAHWAR Cohort study which included 1177 university employees. Results The prevalence of current tobacco use is 11.6% (2.7% in women, and 24.5% in men), and the prevalence of lifetime tobacco use was 19.8 (6.3% in women, and 39.3% in men). The ratio of hookah: cigarette use in women is about seven times that of men. The self-reported current tobacco, alcohol and opium use were 11.6% (M: F ratio > 9), 2.6% (M: F ratio > 6) and 1.4% (M: F ratio > 7) of total subjects. There was a significant difference in substance or alcohol users based on gender, job position, working schedule, employment status, marital status and education levels. There was a negative correlation between job security and stability in terms of work status among workers with substance or alcohol use. Conclusion Since implementation of preventive interventions knowing the high-risk groups and occupational risk factors, the results of the present study may meet this need.

TRENDS OF ASPHYXIAL DEATHS AND ITS ASSOCIATION WITH VARIOUS DEMOGRAPHIC FACTORS REPORTED TO FORENSIC MEDICINE DEPARTMENT PESHAWAR; AN AUTOPSY-BASED RETROSPECTIVE STUDY

Objectives: To find the frequency of reported asphyxial deaths to gender and pattern of injury reported. This study also intended to identify the causes and the association between age, area, and gender of the deceased with sexual assault-related asphyxial deaths. Methods: A retrospective chart review was conducted at the Department of Forensic Medicine and Toxicology Khyber Medical College Peshawar from 1st July 2018 to 30th June 2023 (5 years data). All the subjects who died due to asphyxia and were presented for autopsy at the department were included in the study. Cases with incomplete documentation and those referred from other districts were excluded from the study. Results: Of the total 187 subjects, 66.8% (n=125) were males and 33.2% (n=62) were females with male to female ratio of 2:1. In the data, 57.2% (n=107) belonged to urban areas and 42.8% (n=80) were of rural areas. In total subjects, 88.8% (n=166) had immediate deaths, 6.4% (n=12) had delayed ones, and 4.8% (n=9) were undetermined. The most prevalent type of asphyxia was mechanical 113 (60.4%). The most common cause of asphyxia death was found to be hanging at 34.22%. However, of the 187 subjects, 5.3% (n=10) had intoxications, of which 1.6% (n=3) had tetrahydrocannabinol (THC), carbon monoxide (CO) and morphine poisoning each and 0.5% (n=1) had methamphetamine poisoning. Conclusion: Our study concluded that asphyxial deaths were more prevalent in males in the middle-aged group. Asphyxial deaths were found more in urban areas than in rural areas. Mechanical asphyxia was the most common type of asphyxia while hanging was the most common pattern. Key words: asphyxia, tetrahydrocannabinol, mechanical, traumatic, sexual, iatrogenic, and chemical asphyxia.

NOCTURNAL HYPERTENSION: THE VEILED DARK SIDE OF HYPERTENSION MANAGEMENT IN A REAL WORLD

Objective: Nocturnal hypertension (NH) is highly prevalent among Chinese and Asian populations, while it is usually undetected and uncontrolled in real world clinical practice. This study is aimed to explore the status of nocturnal blood pressure (BP) control in subjects undergone 24h ambulatory blood pressure monitoring (ABPM) in China. Design and method: A nationwide 24h ABPM database was analyzed. NH was defined as average nighttime BP &gt;=120/70 mmHg according to the recent Chinese and European hypertension guidelines. Results: A total of 210782 Chinese adult subjects undergone 24h ABPM between 2020-2022 with suspected and established hypertension were include in this preliminary analysis. Half of the participants was male, the mean age was 59.5(+/-15.3) years. The average nocturnal BP was 127.8/76.0 (+/- 20.0/ 12.9) mmHg. Overall, nocturnal BP was under controlled (&lt;120/70 mmHg) among 23% of the participants, 20% in male, 26% in female, much less than the 45% of daytime BP control and 35% of 24h average BP control in the total subjects. Nighttime systolic BP &lt;120 mmHg was found in 37% of the participants, while nighttime diastolic BP&lt;70 mmHg was seen in 32% of the participants. Conclusions: NH was uncontrolled in about 3/4 of Chinese adults undergone 24h ABPM, indicating an urgent need for NH detecting and managing in practice.

Two-echelon supply chain with production disruption and controllable deterioration considering carbon emission under Stackelberg game approach

This paper considers a two-echelon supply chain consisting of a manufacturer and a retailer in which the manufacturer faces a random production disruption risk. The manufacturer replenishes the unproduced items to fulfil the retailer’s order from the secondary market at a higher price. To attract more customers, this paper considers a customer’s demand dependent on product selling price, stock level, and freshness level of the fresh items. Furthermore, this paper considers preservation technology investment (PTI) to mitigate the deterioration rate of the items and carbon tax regulation to curb down carbon emissions revealed from the supply chain activities. The Stackelberg game approach with a leader–follower relationship is used considering the manufacturer as a leader and the retailer as a follower. Several theorems are developed to illustrate the concavity of the profit function and to find out the optimal solutions in which the objective is to maximize the manufacturer’s total profit subject to the minimum total cost that the retailer is willing to incur. Several numerical examples are presented to illustrate the proposed models and the obtained results are compared for with and without carbon tax policy. Finally, sensitivity analysis with some key managerial insights is given to demonstrate the model. The results show that a product’s freshness level influences consumers’ decision to buy more, and that’s why the freshness level is an important competitive tool to increase sales as well as the supply chain’s total profit.

Association between Neutrophil to Lymphocyte Ratio and Post Operative Atrial Fibrillation after Coronary Artery Bypass Graft operation.

ABSTRACT Background: Post operative atrial fibrillation (POAF) is associated with cardiovascular outcomes such as stroke, heart failure, and mortality. Neutrophil to lymphocyte ratio (NLR) is one of biomarker of inflammation. The use of cor pulmonary bypass(CPB), surgical trauma and reperfusion injury during cardiac surgery causes inflammation. NLR is suspected to be a biomarker that represents the inflammatory response as a modulator of POAF, but data are still lacking.This study analyzed the association between NLR and POAF after coronary artery bypass graft (CABG) operation.Methods: This was an Observational analytic study, involving patients after the CABG procedure in Kariadi Hospital between June 2022 to September 2023. NLR was assessed in the first three hours after operation. ECG Holter was attained for 96 hours post-CABG procedure.Results: The total subject was 62 patients, consisting of 57 men and 5 women with a mean age of 58,7 ± 6.39 years. Mean postoperative NLR 4.95 ± 2.17 with a median of 4.56 (1.52-11.00). There was a significant association between post-operative NLR with POAF after CABG (p=0.006, OR 4.64, 95%CI 1.50-14.35). High inotropic dose and β blocker initiation time less than 45 hours correlate significantly with POAF after CABG (p&lt;0.001, OR 6.94 dan p=0.001, OR 0.17).Conclusions: Postoperative NLR is associated significantly with POAF after CABG. Keywords: Neutrophil to Lymphocyte Ratio, Post Operative Atrial Fibrillation, coronary artery bypass graft, ECG Holter

Sleep Quality and Attentional Function in Adolescent Gamers Aged 13-14 Years in Makassar

The prevalence of adolescents who spend &gt;5 hours per day playing games has a higher risk of developing sleep disorders. Gaming addiction can cause sleep deprivation and the inability to concentrate, which can lead to attention disorders and impulsive behavior. This study is an analytical observational study with a cross-sectional design that aims to determine the relationship of sleep quality in adolescent gamers to impaired attentional function at SMP Negeri 30 Makassar which was conducted in January 2023. The total subject in the study was 64 people. Most of the subject had a duration of playing games of 3-6 hours per day, which totaled 35 (54,6%) people. Gamers who have abnormal sleep quality are 43 (67,2%). We found that the longer duration of gaming caused the sleep quality to decrease (p-value=0,032). There was a significant relationship between the Pittsburgh Sleep Quality Index (PSQI) score with the visual attention test score (p-value=0,001) and the digit span word test score (p-value=0,006). This study concludes that poor sleep quality is associated with impaired attentional function in the accuracy and reaction domain and impaired attentional function in the working memory domain.