Total Interval Research Articles

Longitudinal changes in systemic right ventricular remodeling in adult patients with transposition of the great vessels as assessed by cardiovascular magnetic resonance imaging

BackgroundSystemic right ventricular (sRV) physiology occurs in patients with congenitally corrected transposition of the great arteries (ccTGA) and D-TGA post atrial switch repair, and the natural history is of progressive sRV dysfunction. No study has assessed longitudinal changes in sRV remodeling by serial CMR. MethodsPatients evaluated at two adult congenital heart disease centers and who underwent ≥2 CMR exams were studied. Indexed sRV end-diastolic volume (sRVEDVi), end-systolic volume (sRVESVi), and ejection fraction (sRVEF) were determined by a core laboratory. Concurrent echocardiograms were assessed for degree of systemic TR (sTR). Tricuspid valve events were defined as ≥moderate sTR, or interval tricuspid replacement (TVR). Generally, the earliest and most recent studies were compared. A subset of patients were followed with ≥moderate sTR, and then subsequently underwent interval TVR. For these patients, two study time-intervals were defined to analyze the impact of each event independently. Results67 patients were studied (33±11 years, 47% male, 33% ccTGA), with 72 total time intervals studied (median interval 9.0 years [IQR 4.6-13.3]). There was a small increase in sRVEDVi over time (ΔsRVEDVi 5.5±15.8ml/m2, p<0.001), but mean change in sRVEF was not significant (ΔsRVEF 0.1±6.9%, p=0.86); notably, confidence intervals were wide for both. ccTGA patients had a trend towards greater decrement in sRVEF (ΔsRVEF -1.7±6.8 vs 1.3±6.7%, p=0.06). For each 25ml/m2 increase in baseline sRVEDVi, there was a 1.8% decrease in sRVEF (95% CI -3.2% to -0.5%, p=0.01). Patients without significant sTR had lesser deterioration in sRVEF compared to those with ≥moderate sTR or with interval TR intervention (ΔsRVEF 1.8±6.9% vs -2.1±6.6% and -2.6±4.5, p<0.05). Interval sRV conduction delay was associated with a trend towards greater decrements in sRVEF (ΔsRVEF -3.9±6.3 vs. 0.9±6.8%, p=0.07). Overall, underlying congenital anatomy, baseline sRVEDVi, advanced sTR or interval TVR, and sRV conduction delay explained only 16% of the variability in ΔsRVEF over time. ConclusionsLongitudinal changes in sRV remodeling were small, with great heterogeneity. Apparent risk factors in our study, namely underlying congenital anatomy, baseline sRVEDVi, TR events, and sRV conduction disease accounted for only 16% of the variability seen in the longitudinal change of sRVEF.

Sol–gel synthesized lithium–cobalt co-doped titanium (IV) oxide nanocomposite as an efficient photocatalyst for environmental remediation

Abstract In this study, lithium cobalt co-doped titanium oxide (Li:Co-TiO2) was reported via the sol–gel method in a one-pot synthesis approach and their potential applications were evaluated for the photodegradation of organic dye as photocatalysts. The structural and optical properties of the photocatalysts were respectively elucidated using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and diffuse reflectance spectroscopy (DRS). The morphological and elemental composition of the Li:Co-TiO2 was established by high-resolution field-emission scanning electron microscopy (FESEM) coupled with EDX, which confirmed a successful preparation of the photocatalysts. The modification of TiO2 with Li:Co changes the optical properties of the pristine TiO2 with a reduction in the bandgap (3.26–2.8 eV) of the resultant photocatalysts. The photocatalytic activity of Li:Co-TiO2 composites was examined for their efficacy through the degradation of Methylene Blue (MB) dye. The photodegradation revealed an improved performance of Li:Co-TiO2 in the degradation of MB compared to pristine TiO2. The total amount of the degraded MB dye within the total time interval of the irradiation was recorded to be 72 % and 87 % for TiO2 and Li:Co co-doped TiO2 respectively. The enhanced results obtained from the photocatalytic activity of Li:Co-TiO2 to degrade MB, suggest that the composite is a potential candidate for environmental remediation and photocatalysis applications.

An agent-based workflow for evaluating interpersonal visibility in healthcare environment

ABSTRACT Healthcare environment design evaluation (HEDE) can help create a safe environment, and interpersonal visibility among users is a key metric for assessing the safety of HEDE due to its role in caregiving observation. Traditional tools for visibility evaluation mainly focus on physical obstructions, neglecting the impact of the user’s mobility behavior, which is common in the healthcare environment. To address this challenge, this study developed a five-step workflow to evaluating interpersonal visibility among mobile users in healthcare environment: 1) collection of empirical behavior data from users; 2) construction of user journeys; 3) validation of agent-based simulation (ABS) reliability; 4) utilization of ABS to simulate user behavior in a virtual environment; and 5) computation of total visibility duration and time intervals between users using the parametric computation tool. This workflow was tested in 25 long-term care facilities for the elderly with dementia and subsequently evaluated by experts. The evaluation results confirm the effectiveness of this workflow. The core contribution and novelty of this workflow lie in its integration of ABS and parametric computation, which enables the evaluation of interpersonal visibility among mobile users, thereby contributing to the safety of the healthcare environment.

Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: The VERY-STEMI study

BackgroundVentricular arrhythmias (VAs) mainly occur in the early post-myocardial infarction (MI) period. However, studies examining the association between total myocardial ischemia time interval and the risk of new-onset VAs during a long-term follow-up are scarce. MethodsThis study (symptom-to-balloon time and VEntricular aRrhYthmias in patients with STEMI, VERY-STEMI study) was a multicenter, observational cohort and real-world study, which included patients with ST-segment elevation MI (STEMI) undergoing percutaneous coronary intervention (PCI). The primary endpoint was cumulative new-onset VAs during follow-up. The secondary endpoints were the major adverse cardiovascular events (MACE) and changes in left ventricular ejection fraction (ΔLVEF, %). ResultsA total of 517 patients with STEMI were included and 236 primary endpoint events occurred. After multivariable adjustments, compared to patients with S2BT of 24 h-7d, those with S2BT ≤ 24 h and S2BT > 7d had a lower risk of primary endpoint. RCS showed an inverted U-shaped relationship between S2BT and the primary endpoint, with an S2BT of 68.4 h at the inflection point. Patients with S2BT ≤ 24 h were associated with a lower risk of MACE and a 4.44 increase in LVEF, while there was no significant difference in MACE and LVEF change between the S2BT > 7d group and S2BT of 24 h-7d group. ConclusionsS2BT of 24 h-7d in STEMI patients was associated with a higher risk of VAs during follow-up. There was an inverted U-shaped relationship between S2BT and VAs, with the highest risk at an S2BT of 68.4 h.

Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care.

Prehospital resuscitation with blood products is gaining popularity for patients with traumatic hemorrhage. The MEDEVAC trial demonstrated a survival benefit exclusively among patients who received blood or plasma within 15 minutes of air medical evacuation. In fast-paced urban EMS systems with a high incidence of penetrating trauma, mortality data based on the timing to first blood administration is scarce. We hypothesize a survival benefit in patients with severe hemorrhage when blood is administered within the first 15 minutes of EMS patient contact. This was a retrospective analysis of a prospective database of prehospital blood (PHB) administration between 2021 and 2023 in an urban EMS system facing increasing rates of gun violence. PHB patients were compared to trauma registry controls from an era before prehospital blood utilization (2016-2019). Included were patients with penetrating injury and SBP ≤ 90 mmHg at initial EMS evaluation that received at least one unit of blood product after injury. Excluded were isolated head trauma or prehospital cardiac arrest. Time to initiation of blood administration before and after PHB implementation and in-hospital mortality were the primary variables of interest. A total of 143 patients (PHB = 61, controls = 82) were included for analysis. Median age was 34 years with no difference in demographics. Median scene and transport intervals were longer in the PHB cohort, with a 5-minute increase in total prehospital time. Time to administration of first unit of blood was significantly lower in the PHB vs. control group (8 min vs 27 min; p < 0.01). In-hospital mortality was lower in the PHB vs. control group (7% vs 29%; p < 0.01). When controlling for patient age, NISS, tachycardia on EMS evaluation, and total prehospital time interval, multivariate regression revealed an independent increase in mortality by 11% with each minute delay to blood administration following injury (OR 1.11, 95%CI 1.04-1.19). Compared to patients with penetrating trauma and hypotension who first received blood after hospital arrival, resuscitation with blood products was started 19 minutes earlier after initiation of a PHB program despite a 5-minute increase in prehospital time. A survival for early PHB use was demonstrated, with an 11% mortality increase for each minute delay to blood administration. Interventions such as PHB may improve patient outcomes by helping capture opportunities to improve trauma resuscitation closer to the point of injury. Prospective, Level IV.

Sex differences in patient journeys to diagnosis, referral, and surgical treatment of trigeminal neuralgia: implications for equitable care.

Trigeminal neuralgia (TN) is an orofacial pain disorder that is more prevalent in females than males. Although an increasing number of studies point to sex differences in chronic pain, how sex impacts TN patients' journeys to care has not been previously addressed. This study sought to investigate sex differences in patients' journeys to diagnosis, referral, and treatment of TN within a large national context. Patients with classic TN (n = 100; 50 females and 50 males) were randomly selected through chart reviews at the largest surgical treatment center for TN in Canada for a cross-sectional study. Statistical tests, including Welch's t-test, the chi-square test, Pearson's correlations, and analyses of covariance, were conducted with Python. Key discrepancies between sexes in access to care were identified. Females had a significantly longer referral time interval (average 53.2 months vs 20.4 months, median 27.5 months vs 11.0 months, p = 0.018) and total time interval (average 121.1 months vs 67.8 months, median 78.0 months vs 45.2 months, p = 0.018) than males, despite reporting higher pain intensity at referral. Although medically intolerant patients had a significantly shorter referral time interval than medically tolerant patients (average 13.0 months vs 41.0 months, median 6.0 months vs 17.0 months, p < 0.001), medically tolerant females had a significantly longer referral time interval than medically tolerant males (average 59.9 months vs 21.7 months, median 30.0 months vs 12.0 months, p = 0.017). No statistically significant differences were detected between the sexes for diagnostic time interval (average 63.3 months vs 43.0 months, median 24.0 months vs 24.0 months, p = 0.263) or treatment time interval (average 4.6 months vs 4.7 months, median 4.0 months vs 3.0 months, p = 0.986). Critical sex differences in patients' journeys to TN surgical treatment were identified, with females enduring considerably longer referral timelines and expressing significantly greater pain intensity than males at referral. Taken together, our findings suggest the presence of unconscious bias and discrimination against females and highlight the need for expediting TN treatment referral for female TN patients.

Mesoporous Silicas Obtained by Time-Controlled Co-Condensation: A Strategy for Tuning Structure and Sorption Properties.

Mesoporous silicas synthesized by the co-condensation of two and three different silica monomers were synthesized by varying the time intervals between the addition of individual monomers, while the total time interval was kept constant. This resulted in different structural properties of the final silicas, particularly in their porosity and local ordering. One of the obtained samples exhibited an unusual isotherm with two hysteresis loops and its total pore volume was as high as 2.2 cm3/g. In addition, to be thoroughly characterized by a wide range of instrumental techniques, the obtained materials were also employed as the adsorbents and release platforms of a diclofenac sodium (DICL; used here as a model drug). In the case of DICL adsorption and release, differences between the samples were also revealed, which confirms the fact that time control of a monomer addition can be successfully used to fine-tune the properties of organo-silica materials.

Are delays in diagnosis and treatment of acute leukemia in a middle-income country associated with poor outcomes? A retrospective cohort study

IntroductionAcute leukemias (ALs) are aggressive diseases that lead to death without medical attention. We evaluated the association between delays in diagnosis and poor outcomes in AL by evaluating the symptom onset to treatment intervals in adults with newly diagnosed AL and their effect on an early death (ED). MethodsWe assessed adults diagnosed with AL between 2015 and 2020 and evaluated baseline characteristics, the patient interval (PI), diagnostic interval (DI), treatment interval (TI) and the total time interval (TTI) to determine ED-associated factors. Main resultsWe assessed 102 patients with acute lymphoblastic leukemia (ALL), 57 with acute myeloblastic leukemia (AML) and 29 with acute promyelocytic leukemia (APL). Median interval days were PI 14, DI 10, TI 4 and TTI 31.5. The TI and TTI intervals were lower in APL than in ALL and AML; TI 1 vs. 4 and 3 (p = 0.001) and TTI 21 vs. 31 and 35 (p = 0.016). The 30-day and 60-day EDs were 13.8% and 20.7%, mainly infections. ECOG > 2 (OR = 15.0) and PI < 7 days (OR = 4.06) were associated with 30-day ED; AML (OR = 2.69), high-risk (OR = 3.34), albumin < 3.5 g/dl (OR = 5) and platelets < 20 × 103/uL (OR = 2.71) with a 60-day ED. ConclusionNone of the interval-delays were associated with an ED. Intervals seemed to be longer in patients without an ED, except for the TI, probably because of “the waiting time paradox.” Aggressive manifestations of disease may lead to shorter diagnostic intervals, but increased mortality.

0498 Home automated OSA quantification of night-to-night short term variability: analysis of the associated conditions

Abstract Introduction Single night in-lab polysomnography (PSG) is still the conventional procedure for making obstructive sleep apnea (OSA) diagnosis, or alternatively a home sleep apnea test (HSAT) in patients free from comorbidity. Recent publications drew attention to considerable internight within-subject variability in OSA clinical status, notably but not only with HSAT. Taking benefit of multiple nights recording in home-based setting using measurements of mandibular jaw movement (MJM) combined with automated machine learning analysis, this study aimed to investigate the effect of change in sleep parameters on the internight variability of the apnea hypopnea index (VAHI). Methods 160 adults suspected of having OSA successfully completed 3 sleep tests at home with the Sunrise device (Sunrise, Namur, Belgium). Data analysis implied generalized estimating equation (GEE) regression. Results Even though the internight variability of AHI was not statistically significant at the population level with a mean VAHI of -1.1 ± 7.8 events/h, such variability could lead to misdiagnosis and wrong therapeutic decisions based on a single night. After adjusting for effects of gender, body mass index (BMI), age, total sleep time (TST) and time interval between sleep tests, regression models indicated that sleeping in supine position was positively and independently associated with VAHI, the AHI increased by 0.95 event/h for each 10% of increase in sleeping time in supine position. VAHI was negatively and significantly (p &amp;lt; 0.01) associated with sleep efficiency and deep sleep; VAHI decreased of 0.16 event/h (0.04 to 0.28) and 0.29 event/h (0.17 to 0.42) for each % of increase in sleep efficiency and proportion of deep sleep, respectively. Conclusion At the individual level, position, sleep efficiency and deep sleep are associated with short-term internight variability in AHI. Clinical decision based on a single-night testing may lead to errors in OSA diagnosis with delayed or wrong therapeutic decisions. Support (if any)

Characteristics and survival analysis of breast cancer survivors with metachronous double primary cancers: a retrospective cohort study.

Breast cancer (BC) is the most frequently diagnosed malignancies in females, and its incidence has increased dramatically recently. Clinical studies have shown that BC patients are developing double primary cancers more frequently than by chance, and the prognosis has changed greatly. Previous articles rarely mentioned metachronous double primary cancers in BC survivors. Thus, further analysis of the clinical characteristics and survival differences may provide valuable information in BC survivors. In this study, we retrospectively analyzed 639 cases of double primary cancers in BC patients. Cox univariate and multivariate regression analyses of clinical factors of overall survival (OS) were performed in patients with double primary cancers when breast cancer was the primary tumor to assess the correlation between clinical factors and OS in these patients with double primary cancers. Among the double primary cancer patients, BC was the most frequent first primary cancer. In terms of numbers, thyroid cancer was the most common type of double primary cancer among BC survivors. Patients had a younger median age when BC occurred as the first primary cancer rather than the second primary cancer. The total mean time interval between the onset of double primary tumors was 70.8 months. With the exception of the thyroid and cervical cancer, the incidence of second primary tumors was <60% within 5 years. However, the incidence was >60% within 10 years. The mean OS of double primary cancer patients was 109.8 months. Additionally, patients who had thyroid cancer as their second primary cancer had the highest 5-year survival rate, followed by cervical, colon, and endometrial cancer, while patients who had lung cancer as their second primary cancer had the lowest 5-year survival rate. OS risk of BC survivors with second primary cancers was significantly associated with age, menopause status, family history, tumor size, lymph node metastasis, and human epidermal growth factor receptor 2 (HER2) status. The identification of double primary cancers in earlier stages could play a critical role in guidance and lead to better outcomes. A prolonged follow-up examination period for BC survivors is needed to provide better guidance and treatments.

Lasting Effects of COVID-19 Pandemic on Prehospital Emergency Medical Service Missions.

The COVID-19 pandemic confronted prehospital emergency medical services (PHEMS) with immense challenges. This study aimed to investigate the development of PHEMS mission numbers and times in the COVID-affected region of Southwest Saxony (SWS). This was a retrospective analysis of PHEMS in SWS during lockdown periods and equal time spans in the previous and following years. Differences were tested for statistical significance using the chi-squared test and one-way analysis of variance (ANOVA). The total number of missions showed a substantial drop during the first (-16.6%) and the second (-4.5%) lockdown period compared with the previous year. Next-year periods showed a recovery that was nearly equivalent to the starting point. The first lockdown period was not associated with longer overall mission times. The minutes spent at the scene differed significantly between the first lockdown period (31.1 ± 3.52 min), previous year (28.4 ± 4.84 min), and follow-up period (31.8 ± 0.98 min). During the second lockdown, the overall mission times (71.6 ± 2.91 min), response times in minutes (8.9 ± 0.49 min), and minutes spent at the scene (31.4 ± 2.99 min) were significantly longer. The minutes spent at the scene (32.3 ± 18.68 min) and the overall mission time (69.6 ± 1.92 min) remained significantly longer during the control period. Our data confirm the impact of the SARS-CoV-2 pandemic on German PHEMS. It can be concluded that nationwide lockdown measures led to lasting effects regarding a reduction in the total mission number, transport-on-site released-ratio, and emergency time intervals in the following year, without lockdown restrictions. The lasting effects on the transport-on-site released-ratio and emergency time intervals call for a re-evaluation of the delivery of emergency services during pandemics. These findings can inform future policy decisions and resource allocations to ensure optimal emergency medical services.

Implementation of coyote optimization algorithm for solving unit commitment problem in power systems

The aim of the Unit Commitment(UC) problem is to find the optimum scheduling of the total generating units at lower operating costs while achieving the constraints of system and units. The decision variables contain the binary UC variables that characterize the 1/0 cases through the total time intervals in the study era. The scale of this problem grows speedily with great size of the electric power system and longer planning time. Fixing this large scale problem is a challenging process and computationally expensive. It is the most complicated optimization process in the operation and planning of the power system. Meta heuristics methods are capable to outlast the demerits of traditional deterministic methods in solving UC problem. One of the most recent meta heuristics methods is known as Coyote Optimization Algorithm (COA). It is depended on the adaptation attitude of the coyote by the surroundings and the coyote's experiences exchanging. It has a motivating mechanisms to gain a balance between exploitation and exploration. Also, it is very easy in implementation as it has only two control variables. Moreover, its capability to keep larger diversity helps it to get the optimal cost so it is proposed to handle the UC problem in this paper. The election of the schedule and production size are performed by COA. Achievement of COA is examined for two IEEE systems. Outcomes establish that the elected algorithm is supreme to the recorded literature methods in terms of total cost, CPU, percentage reduction, and statistical analysis.

Capacitive Couple-Based Transient Current Commutation in Solid-State Circuit Breakers

This letter presents a new auxiliary circuit to achieve transient current commutation (TCC) in dc solid-state circuit breakers (SSCBs). The auxiliary circuit consists of two parts: active injection circuits (AIC) and capacitive couplers. There are two contributions. First, coupling capacitors between AIC and the main branch are introduced to prevent short circuit failures in the auxiliary branch. Second, a boost converter-based resonant circuit is presented for AIC to achieve TCC in the main branch through couplers. The presented AIC tunes the duration time and amplitude of injected countercurrent pulses during dc current interruption. The working principle and design procedure of the auxiliary circuit are presented. The proposed topology is verified by experiments of a 2&#x00A0;kV&#x002F;100 A dc SSCB prototype under load current interruption. The experimental results show that the injected pulse current through couplers reaches 110 A, and it decays to zero within 12.5&#x00A0;&#x03BC;s. The total reaction time interval including the communication delay and the AIC current rising delay is 108&#x00A0;&#x03BC;s. Meanwhile, the peak voltages across the main branch and the coupler reach 2099 V and 2193&#x00A0;V, respectively.

Correlation between antenatal magnesium sulfate (MgSO4) total dose and delivery time interval with umbilical cord blood brain-derived neurotrophic factor (BDNF) levels as a neuroprotection strategy in preterm birth

Background: Administration of antenatal magnesium sulfate (MgSO4) to pregnant women is thought to increase the synthesis of Brain-Derived Neurotrophic Factor (BDNF), which functions as a nerve-growth factor for the process of neurogenesis and also strengthen neuronal resilience in the hypoxic condition that occurs during preterm delivery. Protocols for administering antenatal MgSO4 differ between countries and institutions. One of the concerns is whether the dose is given and the time interval to delivery has a big contribution towards a better fetal outcome. These relationships have not been studied before. This study aimed to analyze the correlation of the total dose of MgSO4 and time interval to delivery with BDNF levels in cord blood. Methods: This study enrolled 72 pregnant women who will deliver the baby prematurely, with gestational age 28-34 weeks. Subjects were divided into three protocols groups: (1) 4 g iv. only, (2) 4 g iv. initial continued with 1 g/hours until maximum 24 hours, and (3) 6 g iv. initial continued with 2 g/hours until a maximum of 24 hours. At the time of delivery, cord blood of preterm babies was collected. The antenatal MgSO4 total dose and time interval to delivery were collected, and BDNF serum levels were then measured with enzyme-linked immunosorbent assay (ELISA). The correlation between antenatal MgSO4 total dose and time interval to delivery with BDNF levels was analyzed using Spearman’s correlation test. Result: There was a weak significant correlation of antenatal MgSO4 total dose and BDNF cord blood levels (p&lt;0.001; r=0.381). There was no significant correlation between delivery time interval and BDNF cord blood levels (p=0.44; r=0.092). Conclusion: Regarding the weak correlation of total dose and time interval to delivery with BDNF, we suggest that all protocols provide comparable outcomes if seen only from the BDNF increase perspective.

Time Intervals from the First Symptom to Surgery of Ovarian Malignancies in a Tertiary Government Hospital

Objective. This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.&#x0D; Methods. Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.&#x0D; Results. The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments’ clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.&#x0D; Conclusion. The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage

Effect of Bubbles and Liquid Drops Fluid Dynamics on the Lithium Recombination inside a Lithium Electrolytic Cell with Diaphragm

Metallic lithium, which is a critical and strategic metal for the world’s production of energy storage devices, is mainly produced from molten salt electrolysis. To increase the efficiency of the process, it is of utmost importance to prevent lithium recombination during the process to avoid energy waste. This research studies the behavior of the main variables involved in the reaction inside a -production experimental cell from the mass transfer, electrochemical and fluid dynamics standpoints. Simulations were done for a total electrolysis time interval of 600 s using a turbulent (k-ε) approach to solve the two-phase flow coupled to the lithium electrolysis process. To analyze the influence of cathode fluid dynamics in relation to the amount of recombined lithium, two configurations of the diaphragm were evaluated including the incorporation of a baffle at the bottom of the cell and the inclination of the diaphragm. The baffle reduced the amount of recombined lithium by and the diaphragm with an inclination < 90° reduced the total recombined mass by although it increased the energy consumption by with respect to the base case of a vertical diaphragm.

Clinical Evaluation and Therapeutic Effects of Combination Treatment with Mecobalamin + Vitamin E in Recurrent Oral Ulcer

PurposeRecurrent oral ulcer is one of the most prevalent inflammatory ulcerative disorders of the oral mucosa. Due to the indeterminant cause and unpredictable course of the disease, clinical treatment of patients with recurrent oral ulcer is focused on relieving the pain, shortening the course of the disease, and prolonging the intermission period. Numerous chemical and biologic agents have been characterized as beneficial in the treatment of patients with recurrent oral ulcer, but there is currently no definitive therapy available. This study aimed to investigate the clinical effects and tolerability of combined mecobalamin tablets and vitamin E capsules in the treatment of recurrent oral ulcer. MethodsA total of 58 patients with recurrent oral ulcer admitted to our hospital were allocated to receive mecobalamin tablets + vitamin E soft capsules (test group) or Fe complex enzyme gargle only (control group) (n = 29 per group). Changes in parameters such as pain level, as measured on a 10-point visual analog scale (VAS); ulcer status and number of ulcers; proinflammatory cytokine levels; and quality of life, as measured using SF-36, from before to after treatment were measured. Mean intermission time and mean ulcer healing time were calculated. Total effectiveness rate was also calculated. The occurrences of adverse reactions in the two groups were quantified. FindingsThe total intermission time interval was significantly longer, the mean ulcer healing time was considerably shorter, the total number of ulcers was appreciably less, and the total effectiveness rate was significantly greater in the test group compared to the control group (all, P < 0.05). The VAS scores were significantly greater after treatment than before treatment in both the test and control groups (mecobalamin + vitamin E, 2.16 [1.09] vs 7.87 [0.51]; control, 3.72 [1.15] vs 7.94 [0.56]; both, P < 0.05). Interleukin (IL)-8, tumor necrosis factor α, and C-reactive protein levels were appreciably down-regulated in both groups when compared to before treatment. In addition, IL-2 concentration and SF-36 scores were much greater after treatment in the test group with respect to the control group. Levels of IL-8, TNF-α, and CRP were significantly lesser in the test group than in the control group (all, P < 0.05). ImplicationsThe combination of mecobalamin tablets and vitamin E soft capsules was effective in the treatment of recurrent oral ulcer. This combination can be used as an adjunctive therapy, offering effective pain control and improving quality of life in patients with oral ulcers.

An Analytical Model for Molecular Communication Over a Non-Linear Reaction-Diffusion Medium

One of the main challenges in diffusion-based molecular communication is dealing with the non-linearity of reaction-diffusion chemical equations. While numerical methods can be used to solve these equations, a change in the input signals or the parameters of the medium requires one to redo the simulations. This makes it difficult to design modulation schemes and practically impossible to prove the optimality of a given transmission strategy. In this paper, we provide an analytical technique for modeling the non-linearity of chemical reaction equations based on the perturbation method. The perturbation method expresses the solution in terms of an infinite power series. An approximate solution can be found by keeping the leading terms of the power series. The approximate solution is shown to track the true solution if either the simulation time interval or the reaction rate is sufficiently small. Approximate solutions for long time intervals are also discussed. An illustrative example is given. For this example, it is shown that when the reaction rate (or the total time interval) is low, instead of using a continuous release waveform, it is optimal for the transmitters to release molecules at two time instances.

Are Delays in the Diagnosis and Treatment of Acute Leukemia in a Middle-Income Country Associated with Poor Outcomes?

Introduction:Mexico, like other Middle-Income Countries (MIC), faces many challenges in the care of patients with cancer. The number of practicing physicians is lower than the recommended for the OECD, there is <1 hematologist/100,000 people, and the attention is centralized in big cities .It has been reported that children with acute lymphoblastic leukemia (ALL) suffer from significant diagnosis delays in Latin America but this has not been assessed in adults.There is a well-described association between delays in diagnosis and poor outcomes in some solid tumors. Acute leukemia (AL) is associated with a shorter time-to-diagnosis when compared with other malignancies. However, its impact on early death (ED) or long-term outcomes is not clear.Methods:We designed a retrospective single center study with the main objective of analyzing the diagnosis and treatment delays in adults with newly diagnosed AL in a referral center in Mexico City.We defined the following intervals. Patient interval (PI): from the first symptom to the first medical consultation. Diagnostic interval (DI): from the first medical consultation to the diagnosis. Treatment interval (TI): from the diagnosis to the treatment initiation. Total interval (TTI): from the first symptom to the treatment initiation.We evaluated patients ≥18 years diagnosed with ALL, acute myeloid leukemia (AML) or acute promyelocytic leukemia (APL) between January 2015-March 2020.Results:We included 187 patients with a median age of 36 years (18-90), the majority adolescent and young adults (AYA) (54.4%): 102 ALL, 56 AML and 29 APL.Almost half of them (43.4%) lived in Mexico City, only 20.3% had a professional degree and 80.2% had a low socioeconomic status (LSE).The majority (85.5%) received intensive chemotherapy, 6.7% a non-intensive regimen and 7.8% supportive care.The patients consulted a median of 3 different physicians (range 1-9) before the hematologist. The median interval times were: PI 14 days (0-182), DI 10 days (0-221), TI 4 days (0-22) and TTI 32 days (3-252).The TI and TTI were significantly shorter in patients with APL when compared with ALL and AML: TI of 1 vs. 4 and 3 days (p=0.001) and TTI of 21 vs. 35 and 31 days (p=0.002). The PI and DI were not different between AL subtypes (figure 1).Patients with comorbidities had a significant shorter DI: 9 (0-65) vs. 11 days (0-221), p=0.045. Patients living in Mexico City had a significant shorter DI: 7 (0-221) vs. 11.5 days (0-148), p=0.015; and TTI: 28 (3-252) vs. 34 days (3-183), p= 0.030.A DI > 3 weeks was associated with a higher risk of neutropenic colitis (15.9% vs. 6.0%): OR 2.94 (CI 1.03-8.43), p= 0.057.The 30-day and 60-day mortality were 12.8% and 19.3%, mainly derived from infectious complications in 58.3% and 69.4%. Risks factors for ED are summarized in table 1.Twenty patients had a TTI ≥ 85 days: 60% were AYA, the majority ALL (ALL 11, AML 7 and APL 2), with LSE (89.5%) and living outside Mexico City (70%). The 30-day and 60-day mortality were 15% and 25% for this group.None of the intervals was associated with a higher-risk of ED with the exception of longer TI for patients with APL who died within 60 days (2.5 vs. 1 day, p=0.024). None of the intervals was associated with complete remission probability or long-term overall survival.Conclusions:To our knowledge, this is the first insight into the delays in adults with AL in a MIC. Surprisingly, the median intervals are not different when compared with high-income countries (HIC). However, the upper limit of the ranges is significantly higher in Mexico than in the UK registry (TTI in Mexico for ALL and AML are 221 and 252 days vs. 64 and 85 days in the UK). In our study, delays do not impact in short or long-term outcomes. But we believe that there may be a significant number of patients with more aggressive disease, who died before diagnosis. ED is still high in Mexico and the leading cause is infections.Patients from Mexico City had shorter diagnostic intervals when compared to patients living outside the city. This could be related with structural barriers of the health system that make timely cancer care inaccessible. Patient navigation is a promising intervention to address cancer disparities that allows reducing times. Most of the patient navigation models are focus on solid tumors, in screening and palliative care and in HIC. In our population, with a high frequency of ALL and APL in AYAs with a good chance of cure, a patient navigation model needs to be adapted. [Display omitted] DisclosuresApodaca: Abbvie: Speakers Bureau; Asofarma: Consultancy, Speakers Bureau; Sanofi: Consultancy. Rangel-Patiño: Bristol: Consultancy; Abbvie: Speakers Bureau. Demichelis: ASH: Research Funding; Gilead: Consultancy; Bristol/Celgene: Consultancy, Speakers Bureau; Jazz: Consultancy; Novartis: Consultancy, Research Funding, Speakers Bureau; AMGEN: Consultancy, Speakers Bureau; Astellas: Consultancy; Abbvie: Consultancy, Speakers Bureau.

Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer.

Simple SummaryInformation about the relative length of patient stays, primary care, and prereferral intervals (from symptom onset to specialist referral) is very scarce, and how the presenting symptoms influence these intervals and referral routes remains unknown. This study assesses the impact of presenting symptoms on time intervals, number of visits at the primary care level, and referral pattern of patients with symptomatic oral cancer. This approach will allow targets to be identified for future interventions and the optimization of the treatment pathway for symptomatic oral cancer patients.This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3–76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61–0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.