Vital Signs Research Articles

Novel Approach to Fat Reduction: A Phase I Study Evaluating Safety and Tolerability of STP705 in Abdominoplasty

Background: RNAi therapeutics are a rapidly developing technology with broad medical applications predicated on reducing the expression of genes with key links to disease pathogenesis. The TGF-β1/Smad3 and COX-2 signaling pathways are strongly implicated in obesity and type 2 diabetes. Reducing the expression of TGF-β1 and COX-2 may have benefits in fat reduction procedures. The aim of this study was to assess the safety and tolerability of STP705 (a TGF-β1/COX-2 siRNA complex in a polypeptide nanoparticle vehicle) injections in persons undergoing abdominoplasty. A secondary aim was to make initial histologic observations on the efficacy of STP705 injections in inducing adipocyte apoptosis for the purpose of focal fat reduction. Methods: The study treatment consisted of 3 rounds of treatment with 7 subcutaneous abdominal injections of STP705 or placebo. Eight female subjects aged 18-65 years received 120 μg, 240 μg, or 360 μg STP705 in 0.5 or 1.0 ml doses (per injection) or an equivalent amount of placebo injected randomly across seven 1 cm2 areas. Treatments were administered 28 days apart with follow-ups occurring at 2 and 7 days’ post-procedure. Tissue samples from each of the 7 injection sites were harvested from total abdominoplasty excisional specimens obtained 28 days after the final injection. Safety assessments were conducted, including physical examination, clinical laboratory tests, electrocardiograms, evaluation of local skin reactions (LSRs), and collection of adverse events (AEs). Lipolytic and inflammatory effects of STP705 were assessed by blinded histologic analysis of harvested tissue samples. Results: There were no clinically significant changes in clinical labs, vital signs, or ECGs. The incidence of LSRs was low throughout the study. There were 3 moderate AEs deemed likely to be related to STP705 injection; none required intervention, and all resolved without dose modification. Histology revealed marginally dose-dependent tissue response with adipocyte destruction and fat remodeling. Conclusion: In general, STP705 was well tolerated at all concentrations and volumes studied. STP705 demonstrated excellent safety, and initial histologic analysis is suggestive of its efficacy in adipocyte destruction. The lack of cutaneous side effects with STP705 injection is an advantage over current treatments for similar indications.

Dermal and Systemic Pharmacokinetics of Oral DFD-29 (minocycline hydrochloride modified release capsules, 40 mg) vs Oral Doxycycline 40 mg in Healthy Subjects

Dermal and Systemic Pharmacokinetics of Oral DFD-29 (minocycline hydrochloride modified release capsules, 40 mg) vs Oral Doxycycline 40 mg in Healthy Subjects Adelaide A. Hebert, MD,1 Srinivas Sidgiddi, MD2 1UTHealth Houston McGovern Medical School, Houston, TX; 2Journey Medical Corporation, Scottsdale, AZ Introduction: A modified-release, low-dose formulation (DFD-29) of minocycline hydrochloride (HCl) is under investigation for the treatment of rosacea. This Phase 1 study compared the dermal and systemic pharmacokinetics of DFD-29 (minocycline HCl, 40 mg) and doxycycline 40 mg in healthy, adult subjects. Methods: This randomized, open-label, single-center, parallel-group study evaluated the systemic and dermal pharmacokinetics of once-daily administration of oral DFD-29 40 mg capsules or oral doxycycline 40 mg for 21 days in healthy adult volunteers. On Day 1, subjects received the assigned study drug under fasting conditions. Blood was sampled before drug administration, every 30 minutes for 4 hours, hourly for 4 hours, and 12 and 24 hours post dose. Dermal interstitial fluid (ISF) was sampled using three open-flow microperfusion probes before dosing, hourly for 8 hours, and at 11-12, 15-16, and 23-24 hours post dose. After discharge, subjects continued to take assigned study drug once daily through Day 21, when they returned to the center and underwent the same procedures as on Day 1. Safety was evaluated by monitoring adverse events (AEs), vital signs, and laboratory tests. Results: A total of 24 subjects were randomized and completed the study. On Day 1, mean plasma Cmax levels with DFD-29 (382.8 ng/mL) and doxycycline (405.9 ng/mL) were comparable (Pr > 0.716). By Day 21, mean plasma Cmax had nearly doubled with doxycycline but remained constant with DFD-29 (701.9 vs 337.7 ng/mL; Pr > 0.037). Mean plasma AUC was also significantly greater with doxycycline than with DFD-29 at Day 21 (6074.8 ng.hr/mL vs 3957.6 ng.hr/mL, Pr > 0.013). In contrast, mean dermal Cmax concentrations were numerically higher with DFD-29 (40 mg) than doxycycline at Day 1 (109.7 vs 81.5 ng/mL; Pr > 0.117) and Day 21 (125.7 vs 114.7 ng/mL; Pr > 0.681). The mean dermal AUC at Day 1 also was greater with DFD-29 than with doxycycline (1412.29 ng.hr/mL Vs 1088.55 ng.hr/mL, Pr > 0.213), and at Day 21 it was similar in the two groups (1604.77 ng.hr/mL for DFD-29 and 1573.63 ng.hr/mL for doxycycline, Pr > 0.954). Both DFD-29 and doxycycline 40 mg were well tolerated by the healthy volunteers. Conclusion: Minocycline from DFD-29 with its modified-release formulation provides higher dermal concentration than doxycycline from Day 1 onwards at a similar dose. The higher concentration from Day 1 at the site of action is expected to translate into a clinically meaningful impact in the treatment of patients with rosacea. This study and abstract are funded by Journey Medical Corporation.

Systemic air embolism associated with endoscopic retrograde cholangiopancreatography: A case report

BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a key procedure for diagnosing and treating biliary and pancreatic disorders. Although effective, it carries risks, including rare but severe complications such as air embolism. CASE SUMMARY We report a case of a 58-year-old man who developed extensive air embolism during ERCP. He previously underwent a Whipple procedure and experienced a sudden drop in vital signs and loss of consciousness. Immediate intervention with hyperbaric oxygen therapy and supportive care led to gradual recovery. Imaging confirmed widespread air embolism, which resolved with continued treatment. CONCLUSION Air embolism is a rare, critical complication of ERCP, especially in patients with prior surgery such as pancreaticoduodenectomy. Early detection and prompt treatment, including hyperbaric oxygen therapy, are crucial for favorable outcomes.

Avatar-based versus conventional patient monitoring with distant vision: a computer-based simulation study.

Patient monitoring in the perioperative setting can be challenging, especially when monitoring multiple patients simultaneously or managing dynamic situations that require movement around the operating room. We aimed to evaluate whether avatar-based patient monitoring, which presents vital signs in the form of changing colors, shapes and motion, improves remote vital sign recognition compared to conventional monitoring. We conducted a prospective, single-center, computer-based simulation study to evaluate how anesthesia providers recognize vital signs when using the Philips Visual Patient Avatar at different viewing distances (8 and 16m) compared to conventional monitoring. The primary outcome was the total number of correctly identified vital signs which were compared for the two distances and the two devices using mixed Poisson regression. We analyzed data from 28 anesthesia providers who participated in 112 simulations. The correct recognition rate using the Visual Patient Avatar compared to conventional monitoring at 8m was increased by 74% (rate ratio 1.74, 95% CI, 1.42 to 2.14, p < 0.001) and by 51% at 16-meter viewing distance (rate ratio 1.51, 95% CI, 1.23 to 1.87, p < 0.001). We observed scenario-specific superior performance for six vital signs at 8m. The results provide empirical evidence that avatar-based monitoring can significantly improve the perception of vital signs when using distant vision.

Patients Monitoring and Data Management System for Hospitals

This work concerns creating a monitoring system for a smart hospital using Raspberry Pi to measure vital signs. The readings are continually sent to central monitoring units outside the room instead of being beside the patients, to ensure less contacting between the medical staff and patients, also the cloud is used for those who leave the hospital, as the design can track on their medical cases. Data presentation and analysis were accomplished by the LabVIEW program. A Graphical User Interface (GUI) has been created by the Virtual-Instrument (VI) of this program that offer real-time access to monitor patients' measurements. If unhealthy states are detected, the design triggers alerts and sends SMS message to the doctor. furthermore, the clinicians can scan a QR code (which is assigned to each patient individually) to access its real-time measurements. The system also utilizes Electrocardiography (ECG) to detect abnormalities and identify specific heart diseases based on its extracted parameters to encourage patients to seek timely medical attention, while aiding doctors in making well-informed decisions. To evaluate the system's performance, it is tested in the hospital on many patients of different ages and diseases as well. According to the results, the accuracy measurement of SpO2 was about 98.39%, 97.7% for (heart rate) and 98.7% for body temperature. This shows that the system can offer many patients receiving health services from various facilities, and it ensures efficient data management, access control, real-time monitoring, and secure patient information aligning with healthcare standards.

Total Antioxidant Status in Critically Ill Patients with Traumatic Brain Injury and Secondary Organ Failure—A Systematic Review

Introduction: The available literature indicates that oxidant–antioxidant imbalance plays a significant role in the pathophysiology of traumatic brain injury and the subsequent secondary organ dysfunctions. However, there is a lack of studies summarizing the knowledge in this area, and no clear guidelines exist regarding the use of biomarkers of oxidative stress as diagnostics tools. Methods: The present work aims to provide a systematic review of the literature on the use of total antioxidant capacity (TAC) assays in predicting the outcomes of traumatic brain injury (TBI). A literature search was conducted up to 1 September 2024, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, using the PubMed and Scopus databases. Based on the inclusion criteria, 24 studies were used for the final review. Results: Promising data indicate that TAC assays are useful in predicting 30-day mortality and neurological outcomes. Moreover, they correlate with radiological findings on CT scans in brain injury and the clinical classifications of injuries, as well as the parameters of organ failure. Conclusions: Total antioxidant capacity assays can be used to assess the extent of brain damage and prognosticate general vital functions. Future experiments should include long-term randomized clinical trials on larger populations of TBI patients.

The outcomes of electronic personal health records in patients with heart failure or coronary artery disease.

There are limited data on the efficacy of smartphone-based personal health records (PHRs) in patients with cardiovascular disease. This study aimed to examine the processes, outcomes and challenges associated with the implementation of integrated PHRs in patients with heart failure (HF) or coronary artery disease (CAD). This prospective single-group study evaluated the effects of a PHR system with the capability to capture electronic health records and vital signs in patients with HF or CAD. The outcomes measured were the 6-month changes in blood pressure (BP), body weight (BW), brain natriuretic peptide (BNP) levels, lipid profiles and haemoglobin (Hb) A1c levels. Between June 2021 and March 2022, we enrolled 111 patients (median age: 61years and 47% women) with CAD and/or HF. Over 6months, the PHR review count distribution was skewed: median 749 times (lowest 2, highest 5724)/180days, suggesting both low and excessive PHR users. After 3days, 23% of the patients discontinued inputting their vital signs and medication status. At 6months, compared with patients who discontinued, those who continued to input their vital signs (N=86) showed a significant decrease in their systolic BP and LDL-C levels but not in the diastolic BP, BW, BNP, HDL-C, triglyceride or HbA1c levels. The implementation of smartphone-based PHRs in daily practice is challenging for patients with HF or CAD. However, we observed positive indications of the benefits of PHR in these patients. UMIN000044369.

Efficacy and safety of remimazolam tosylate for patients undergoing off-pump coronary artery bypass grafting: a study protocol for a non-inferiority randomised controlled trial in China

IntroductionMaintaining haemodynamic stability is crucial but challenging during the induction and maintenance of general anaesthesia (GA) in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Remimazolam tosylate is a novel...

Human Operator Mental Fatigue Assessment Based on Video: ML-Driven Approach and Its Application to HFAVD Dataset

The detection of the human mental fatigue state holds immense significance due to its direct impact on work efficiency, specifically in system operation control. Numerous approaches have been proposed to address the challenge of fatigue detection, aiming to identify signs of fatigue and alert the individual. This paper introduces an approach to human mental fatigue assessment based on the application of machine learning techniques to the video of a working operator. For validation purposes, the approach was applied to a dataset, “Human Fatigue Assessment Based on Video Data” (HFAVD) integrating video data with features computed by using our computer vision deep learning models. The incorporated features encompass head movements represented by Euler angles (roll, pitch, and yaw), vital signs (blood pressure, heart rate, oxygen saturation, and respiratory rate), and eye and mouth states (blinking and yawning). The integration of these features eliminates the need for the manual calculation or detection of these parameters, and it obviates the requirement for sensors and external devices, which are commonly employed in existing datasets. The main objective of our work is to advance research in fatigue detection, particularly in work and academic settings. For this reason, we conducted a series of experiments by utilizing machine learning techniques to analyze the dataset and assess the fatigue state based on the features predicted by our models. The results reveal that the random forest technique consistently achieved the highest accuracy and F1-score across all experiments, predominantly exceeding 90%. These findings suggest that random forest is a highly promising technique for this task and prove the strong connection and association among the predicted features used to annotate the videos and the state of fatigue.

Correlation between EtCO2 and PCO2 in patients undergoing critical care transport

ABSTRACT OBJECTIVES End-tidal carbon dioxide (EtCO2) monitoring is widely used as a surrogate for the partial pressure of carbon dioxide (PCO2) in critically ill patients receiving manual or mechanical ventilation in prehospital, emergency, and critical care settings. Specific targets for ETCO2 are a key component of Emergency Medical Services (EMS) protocols, especially for specific patient groups such as those with traumatic brain injury. However, the correlation between EtCO2 and venous or arterial PCO2 is uncertain. We aimed to assess the correlation between EtCO2 and PCO2 in intubated patients undergoing critical care transport (CCT), and in specific subgroups of patients. METHODS We performed a retrospective review of patients undergoing emergency transport by a multi-state CCT agency. Patients were included if they had an advanced airway and both an EtCO2 and PCO2 reading within 5 minutes of each other. We obtained data on patient demographics, transport characteristics, medical categories, vital signs, lab values, and specific interventions. We performed univariable and multivariable binary logistic regression to assess the association between delta PCO2 and these characteristics. RESULTS We included 6,459 patients (mean age 58.4 years [SD 18.5], 57.1% male), of which a subset of 551 patients had multiple EtCO2-PCO2 measurements within 5 minutes. The median (IQR) initial delta PCO2 was 12.9 mmHg (7.1, 21.9). 3,967 (61.4%) patients had a delta PCO2 >10 mmHg and 1,843 (28.5%) had a delta PCO2 >20 mmHg. We identified an independent association between delta PCO2 >10 mmHg and age, male sex, interfacility transport, venous sampling site, respiratory rate, hypotension, hypoxia, and thoracostomy. In patients with multiple blood gas measurements, 76% had delta PCO2 >10 mmHg over the duration of the transport. CONCLUSIONS We identified substantial differences between EtCO2 and PCO2 across patients with medical and traumatic conditions undergoing critical care transport. The PCO2 assessment should be strongly considered as part of ventilatory management in patients encountered in emergency and critical care settings.

An ordered approach on geometric vitality function for risk measurement and its application in stock market analysis

In reliability analysis, the residual life of a component or system plays a key role in explaining a component's present condition as well as how long it will continue to function as intended under specific circumstances, thereby preventing premature failure and saving money. Based on this, Nair and Rajesh [Geometric vitality function and its applications to reliability. IAPQR Trans. 2000;25(1):1–8] proposed a new measure called the geometric vitality function that explains the system's failure pattern. In the present study, we have introduced the geometric vitality function in the context of order statistics by means of the relevation transform and also analysed the monotone and ordering properties of the proposed measure. The application of the proposed measure in the stock markets are explored in the present study. Finally, to estimate the proposed measure using a real life data set, a simple estimator has been introduced as well.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION.

To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. This is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety. Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. Virtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

HPB SO14 - Surprise Inside: Gallbladder Herniation in a Parastomal Hernia - A Rare Case Report and Management Insight

Abstract Background Parastomal hernias are a common complication of stoma formation, affecting approximately 40% of patients within two years. Gallbladder herniation within a parastomal hernia is a rare phenomenon, with only 18 cases previously reported. Patients are typically elderly females, with the condition attributed to ageing factors such as loss of visceral fat and elastic tissue, liver shrinkage, and the increased length and loss of elasticity of the gallbladder mesentery. These factors contribute to visceroptosis of the gallbladder, increasing its mobility and the risk of herniation. Method We present the case of a 68-year-old female with a four-day history of severe parastomal hernia pain and swelling. She had an emergency left hemicolectomy and transverse colostomy in the right upper quadrant 10 years prior for ischaemic colitis and perforation. Her stoma was functioning well. Vital signs and biochemistry results were normal. On examination her hernia was severely tender but partially reducible. CT revealed a right upper abdominal parastomal hernia containing loops of colon and surprisingly the gallbladder with a long stretched cystic duct. There was no evidence of cholecystitis, bowel obstruction, or compromise within the hernial sac. Results With analgesia, the patient's pain improved, though her hernia remained irreducible. She was discharged after two days of conservative management and referred back to the hospital where she had the initial operation. On enquiry with that hospital it was reported that an elective parastomal hernia repair with completion right colectomy and end ileostomy was performed. The gallbladder was mobilised and reduced back into the peritoneal cavity, and the hernial defect was closed. The patient made an excellent recovery and was discharged home three days after surgery. Conclusion Cholecystic parastomal herniation is a very rare phenomenon and should be considered as a differential in similar cases. Management should be based on clinical presentation, radiological diagnosis, and a multidisciplinary team approach. No standardised classification or approach exists. We propose classifying gallbladder herniations as either being simple (without inflammatory sequelae) or complicated (with cholecystitis, gallbladder torsion, incarceration or perforation). Simple herniations, such as the case presented, can be managed electively with intra-operative reduction of the gallbladder sufficing. Complicated herniations during acute admissions indicate the need for emergency surgical intervention with combined cholecystectomy and parastomal hernia repair.

Thyroid antibodies in Hashimoto's thyroiditis patients are positively associated with inflammation and multiple symptoms.

Hashimoto's thyroiditis (HT) is an autoimmune disease, characterized by abnormal elevation in thyroid peroxidase antibody (TPO-Ab) and/or thyroglobulin antibody (TG-Ab). Patients have multiple symptoms despite adequate hormone substitution. In the present study, we aimed to quantify the relationship between thyroid antibodies and multiple symptoms, inflammation and health-related life quality. A total of 108 HT patients with clinical euthyroid status and 57 heathy controls were recruited. Clinical parameters were determined by laboratory examination, and the symptoms burden and life quality were obtained by a Hashimoto's Thyroiditis Symptom Questionnaire and a SF-36 Questionnaire, respectively. Compared with healthy controls, multiple extrathyroidal symptoms were significantly more serious in HT patients despite euthyroid status, mainly including that related to digestive system (abdominal distension, constipation and diarrhea), endocrine system (chilliness, gain weight and facial edema), neuropsychiatric system (forgetfulness, anxiety, depressed, fatigue, insomnia, irritability, and indifferent) and mucocutaneous system (dry skin, pruritus, and hair loss). Furthermore, serum TPO-Ab and TG-Ab were both inversely correlated with health-related life quality of general health and vitality parameters, and positively correlated with pro-inflammatory factors of TNF-α and IFN-γ, as well as severity of abdominal distension, diarrhea, chilliness, forgetfulness and fatigue. Moreover, TG-Ab level was positively associated with depressed, insomnia and indifferent. HT patients suffered from a variety of symptoms, and the elevated thyroid antibodies were inversely associated with health-related life quality and positively associated with inflammation and multiple extrathyroidal symptoms.

MANEJO DE FERIDAS EM COELHO ATRAVÉS DO USO DA PELE DE TILÁPIA LIOFILIZADA

The study addresses the importance of treating skin lesions in veterinary medicine, with an emphasis on wound healing in rabbits with pododermatitis, including the use of Nile tilapia skin as a therapeutic alternative for grafting after debridement of necrotic ulcers. Skin lesions can be caused by trauma, bites or other causes, compromising vital skin functions, such as protection and defense against infections. Tilapia skin is rich in type I collagen and has been highlighted as an accessible and effective biomaterial in the treatment of wounds, stimulating cell regeneration and healing. The work reports the case of a rabbit, named Paçoca, diagnosed with ulcerative pododermatitis in the left pelvic limb, a chronic condition that can lead to serious complications. The clinical signs of the pathology are pain, abdominal and limb alopecia, edema, ulcerative lesions, loss of joint mobility with the presence of osteolytic reactions. Pododermatitis in rabbits is often related to factors such as cage floor quality, excess weight, and sedentary lifestyle. The rabbit’s treatment included debridement of necrotic tissue and the application of tilapia skin as a graft. The tilapia skin was prepared through a rigorous sterilization and preservation process, involving immersion in specific solutions and the application of antibiotics. The use of this skin as an occlusive dressing helped stimulate growth factors essential for skin regeneration, such as fibroblasts and keratinocytes. The use of this biomaterial proved effective in the treatment of wounds with significant tissue loss, avoiding the need for sutures and promoting healing through the formation of new tissue. Postoperative follow-up included the use of antibiotics and anti-inflammatories, and treatment with tilapia skin contributed to the successful recovery. The study highlights the effectiveness of the biomaterial in the management of skin wounds in rabbits, especially in the recovery of lesions caused by ulcerative pododermatitis. Therefore, after treatment, the rabbit presented good healing, the wound evolved positively, with formation of granulation tissue and epithelialization.

Kinematic signature of high risk labored breathing revealed by novel signal analysis.

Breathing patterns (respiratory kinematics) contain vital prognostic information. This dimension of physiology is not captured by conventional vital signs. We sought to determine the feasibility and utility of quantifying respiratory kinematics. Using inertial sensors, we analyzed upper rib, lower rib, and abdominal motion of 108 patients with respiratory symptoms during a hospital encounter (582 two-minute recordings). We extracted 34 features based on an explainable correspondence with well-established breathing patterns. K-means clustering revealed that respiratory kinematics had three dimensions apart from the respiratory rate. We represented these dimensions using respiratory rate variability, respiratory alternans (rib-predominant breaths alternating with abdomen-predominant ones), and recruitment of accessory muscles (increased upper rib excursion). Latent profile analysis of the kinematic measures revealed two profiles consistent with the established clinical constructs of labored and unlabored breathing. In logistic regression, the labored breathing profile improved model discrimination for critical illness beyond the Sequential Organ Failure Assessment (SOFA) score (AUROC 0.77 v/s 0.72; p = 0.02). These findings quantitatively confirm the prior understanding that the respiratory rate alone does not adequately represent the complexity of respiratory kinematics; they demonstrate that high-dimensional signatures of labored breathing can be quantified in routine practice settings, and they can improve predictions of clinical deterioration.

Sleep in hospitalized children with cancer: relationship with psychiatric disorders and hospital conditions

Background. Children with cancer often undergo prolonged and recurrent hospitalization, which leads to an increased incidence of sleep disruptions and psychiatric disorders. This study aimed to objectively quantify the prevalence of sleep disruptions in hospitalized pediatric oncology patients and to determine the effects of psychiatric disorders, treatment regimens, and hospital conditions on sleep patterns. Method. This cross-sectional study included 39 children who were undergoing treatment and monitoring in the pediatric oncology inpatient service. Parents completed questionnaires providing information about their child’s sleep patterns, quality of life, and hospital conditions. The children were monitored for five days using actigraphy to record sleep parameters. They were evaluated with a semi-structured interview form (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-DSM 5-Turkish Adaptation) for psychiatric diagnoses. Results. Sleep disruptions were identified in 27 (69.2%) children with cancer. In addition to adjustment disorder and anxiety disorder psychiatric diagnoses, behavioral problems and emotional symptoms were more common in the group with sleep disruptions. Actigraphy measurements indicated that poor sleep was associated with younger age, recent cancer diagnosis, specific phobias, depression, daytime napping, and frequent vital sign assessments. Conclusion. Sleep problems in hospitalized children with cancer are linked to psychiatric comorbidities, treatment routines, and hospital conditions. By recognizing psychiatric symptoms and optimizing hospital conditions that affect sleep, healthcare providers can enhance the quality of sleep for these children.

Abstract 4138376: A Machine Learning Approach to Predict Percutaneous Coronary Intervention in Patients with Critical Illness and Signs of Myocardial Injury

Background: Critically ill patients frequently experience multi-organ dysfunction and unstable vital signs, increasing their risk of myocardial injury and elevated serum troponin levels. Myocardial injury from oxygen supply-demand mismatch, whether due to systemic disease or obstructive coronary artery disease (CAD), often leads to patients undergoing an invasive coronary angiogram (ICA) and potentially percutaneous coronary intervention (PCI) if obstructive CAD is identified. However, this procedure carries significant risks for critically ill patients. To address this challenge, we aimed to develop a machine learning (ML) model to predict the need for PCI in critically ill patients with myocardial injury. Methods: The study cohort included critically ill patients with elevated serum troponin levels who underwent ICA during their hospitalization at a single institution from 2012 to 2022. We defined critical illness as a life-threatening condition requiring intensive support for vital sign instability. Patients with atherothrombosis identified during ICA were excluded from the study, focusing only on patients with type 2 MI. We utilized Matplotlib to analyze patient data, including demographics, lab results, vital signs, and comorbidities. We then used XGBoost, a supervised ML algorithm, for binary classification tasks. An ensemble of decision trees was employed, with gradient boosting to correct errors from previous trees. XGBoost iteratively adjusted predictions, creating a model to predict which patients required PCI. Results: Out of 765 patients, 173 (22.6%) underwent PCI. The cohort had a mean age of 60.5 ± 13.5 years, with 41.7% being female. The ML model accurately identified non-PCI candidates at 75% and PCI candidates at 64%, achieving an overall accuracy of 73%. The three most important features identified by the model were a history of diabetes, diastolic heart failure, and whether the patient received a blood transfusion during hospitalization. Conclusion: A ML approach using XGBoost demonstrated moderate accuracy in predicting the need for PCI in critically ill patients with signs of myocardial injury. This prediction holds clinical significance due to the heightened risks associated with ICA in these patients. Given that PCI occurred in only 22.6% of the cohort, future models should include a higher proportion of patients who underwent PCI to improve the robustness and true positive accuracy of the model.

Abstract 4139115: Genomic, Phenomic, and Geographic Relationships with Leukocyte Telomere Length in the U.S. Yields New Insights for Neoplasms and Cardiometabolic Disease

Background: Leukocyte telomere length (LTL) is an age-related marker strongly associated with neoplasms and cardiometabolic disease. LTL is also intimately linked with clonal hematopoiesis of indeterminate potential (CHIP), a recently described risk factor for cardiovascular disease (CVD). However, population-scale investigations of LTL in diverse backgrounds are limited, and geolocational variance has not been studied. Method: LTL and CHIP were derived using blood-derived whole genome sequencing data from 244,819 diverse U.S. residents in the NIH All of Us Research Program (AoU). We performed association analyses of LTL with CHIP and other available health-related traits, Phecode, as well as geolocation data by ZIP code. Genome-wide association study (GWAS) of LTL in AoU and meta-analysis with UK Biobank were performed. All association tests were adjusted for age, sex, sequencing site, and the first 10 genetic principal components with multiple test corrections. Mediation analysis was adjusted for additional risk factors for CVD. Result: Among 244,819 AoU participants, 146,717 (59.9%) were female with mean (standard deviation) age 51.8 (±16) years. Estimated LTL correlated strongly with age, sex, and genetic ancestry in AoU. Socioeconomic status, lifestyle variables, anthropometry, blood biomarkers (e.g., lipids and glucose), and vital signs were associated with LTL in AoU. Phecode analysis showed LTL is associated with neoplasms and age-related conditions, including CVDs. LTL mediated some of the observed increased coronary artery disease risk among individuals with hematologic malignancies ( P &lt; 2 × 10 -16 ). Significantly longer LTL clustered in the West Coast and Central Midwest ( P = 0.001 and 0.033, respectively), while significantly shorter LTL clustered in the Southeast ( P = 0.001) (Figure). GWAS meta-analyses identified 197 loci, of which 36 (18%) were novel, including ancestry-specific loci. Rare variant aggregation test found 9 novel associated genes. Conclusions: LTL is a marker of biological age that is associated and interacts with neoplasms, CVDs, and its various risk factors, with notable geographic variability within the U.S. Germline genetic analyses of LTL yield new insights into drivers of LTL.

Abstract 4136550: In-hospital cardiac arrest can be detected by Innovative smart healthcare syste

Background: Predicting in-hospital cardiac arrest (IHCA) is crucial for preventing patient fatalities. However, it remains challenging due to the irregularities in time series data across various features. Previous studies relied on traditional medical scoring systems, but their accuracy was limited as the models were overly simplistic. Recent research using machine learning methods has shown improved results. In our work, we employ deep learning and time series approaches, which are considered the most powerful models for addressing complex problems in recent years. Method/Research Design: The cohort study took place in a hospital in Taiwan from January 2016 to August 2022, involving 252,000 patients in general wards. Input data encompassed basic information, vital signs, Glasgow Coma Scale scores, medication, etc., to predict IHCA occurrences within 24 hours. Given the immediacy of IHCA events, we utilized left alignment to handle time series. Evaluation metrics included the area under the receiver operating characteristic curve (AUROC). Results: We compared three types of settings. The first was based on scoring systems, where the national early warning system (NEWS) achieved an AUROC of 0.756, and the modified early warning score (MEWS) reached 0.653. In the next setting, based on the data summary within a given time interval, the machine learning models XGBoost and deep learning model TabNet achieved AUROCs of 0.863 and 0.839, respectively. This indicates that machine learning outperforms traditional medical methods. The final setting involved time series analysis, where XGBoost and the Gate Recurrent Unit (GRU) network achieved 0.848 and 0.904, respectively, surpassing all previous settings. Conclusion: Our study demonstrates that learning-based methods outperform rule-based methods in predicting IHCA events. Machine learning algorithms offer more possibilities and have the potential to address complex problems effectively. Moreover, considering time series data rather than summarizing within fixed intervals preserves information and leads to better scores. Leveraging the time series deep learning method, GRU shows promising potential in significantly reducing the risk of IHCA events.