Incidental pulmonary nodules may lead to a high proportion of early-stage lung cancer: but it requires more than a high CT volume to achieve this

Background

The management of pulmonary nodules plays a critical role in early detection of lung cancer. Computed tomography (CT) has led to a stage-shift towards early-stage lung cancer, but regional differences in survival rates have been reported in Denmark. This study aimed to evaluate whether variations in nodule management among Danish health regions contributed to these differences.

Material and Methods

The Danish Health Data Authority and Danish Lung Cancer Registry provided data on CT usage and lung cancer stage distribution, respectively. Auditing of lung cancer stage IA patient referrals and nodule management of stage IV lung cancer patients was conducted in seven Danish lung cancer investigation centers, covering four of the five Danish health regions. CT scans were performed up to 2 years before the patients' diagnosis from 2019 to 2021.

Results

CT usage has increased steadily in Denmark over the past decade, with a simultaneous increase in the proportion of early-stage lung cancers, particularly stage IA. However, one Danish health region, Region Zealand, exhibited lower rates of early-stage lung cancer and overall survival despite a CT usage roughly similar to that of the other health regions. The audit did not find significant differences in pulmonary nodule management or a higher number of missed nodules by radiologists in this region compared to others.

Conclusion

This study suggests that a high CT scan volume alone is not sufficient for the early detection of lung cancer. Factors beyond hospital management practices, such as patient-related delays in socioeconomically disadvantaged areas, may contribute to regional differences in survival rates. This has implications for future strategies for reducing these differences.

Shape-Stabilized PEGylated Silica Aerogel-Composite as an Energy Saving Building Material

Balancing thermal and visual comfort in buildings necessitates effective insulation to counteract heat loss and gain, especially with temperature variances. One promising approach is to combine phase change materials, such as poly(ethylene glycol) (PEG), with high-performance insulators like silica aerogel (Siag). To bolster opto-thermal performance in building envelopes, we introduce a smart insulation composite material through PEG integration, i.e., PEGalyation with Siag. Central to this thermal behavior is the PEG's phase change properties, which foster a shape-stabilized framework with Siag through their porous confinement. Preliminary observations indicate notable capabilities of obstructing near-infrared light while preserving satisfactory visible transparency. An optimized Siag@PEG composite with 5% loading of PEG has the visible range transmission of ∼92%, a decrease of ∼72% in thermal conductivity which is lower than pure glass and PEG, leading to a temperature dependent switchable hydrophobic to hydrophilic wettability characteristics. As a prototype window, the thermal performance evaluation of the synthesized composite, through experimental and computational studies, shows a decrease in indoor temperature of ∼20% with a higher temperature difference of ∼20 °C between outdoor and indoor weather conditions. This lightweight composite can act as sponge media to fill inside the double-paned window and for retrofitting existing glazing to boost the energy efficiency of buildings with facile manufacturing and scalability.

Assessment of Repeat Revascularization in Percutaneous Coronary Intervention Randomized Controlled Trials as a Surrogate for Mortality: A Meta-Regression Analysis

The association of repeat revascularization after percutaneous coronary intervention (PCI) with mortality is uncertain. To assess the association of repeat revascularization after PCI with mortality in patients with coronary artery disease (CAD). We identified randomized controlled trials comparing PCI with coronary artery bypass graft (CABG) or optimal medical therapy (OMT) using electronic databases through January 1, 2022. We performed a random-effects meta-regression between repeat revascularization rates after PCI (absolute risk difference [%] between PCI and CABG or OMT) with the relative risks (RR) of mortality. We assessed surrogacy of repeat revascularization for mortality using the coefficient of determination (R2), with threshold of 0.80. In 33 trials (21,735 patients), at median follow-up of 4 (2-7) years, repeat revascularization was higher after PCI than CABG [RR: 2.45 (95% confidence interval, 1.99-3.03)], but lower vs OMT [RR: 0.64 (0.46-0.88)]. Overall, meta-regression showed that repeat revascularization rates after PCI had no significant association with all-cause mortality [RR: 1.01 (0.99-1.02); R2=0.10) or cardiovascular mortality [RR: 1.01 (CI: 0.99-1.03); R2=0.09]. In PCI vs CABG (R2=0.0) or PCI vs OMT trials (R2=0.28), repeat revascularization did not meet the threshold for surrogacy for all-cause or cardiovascular mortality (R2=0.0). We observed concordant results for subgroup analyses (enrollment time, follow-up, sample size, risk of bias, stent types, and coronary artery disease), and multivariable analysis adjusted for demographics, comorbidities, risk of bias, MI, and follow-up duration. In summary, this meta-regression did not establish repeat revascularization after PCI as a surrogate for all-cause or cardiovascular mortality.

A Comparative Investigation on Solar PVT- and PVT-PCM-Based Collector Constancy Performance

Solar photovoltaic (PV) technology has a lower adoption rate than expected because of different weather conditions (sunny, cloudy, windy, rainy, and stormy) and high material manufacturing costs. To overcome the barriers to adoption, many researchers are developing methods to increase its performance. A photovoltaic–thermal absorber hybrid system may shift its performance, but to become more efficient, the technology could improve with some strong thermal absorber materials. A phase change material (PCM) could be a suitable possibility to enhance the (electrical and thermal) PV performance. In this study, a solar PVT hybrid system is developed with a PCM and analyzed for comparative performance based on Malaysian weather conditions. The result shows PV performance (both electrical and thermal) was increased by utilizing PCMs. Electrical and thermal efficiency measurements for different collector configurations are compared, and PV performance and temperature readings are presented and discussed. The maximum electrical and thermal efficiency found for PVT and PVT-PCM are 14.57% and 15.32%, and 75.29% and 86.19%, respectively. However, the present work may provide extensive experimental methods for developing a PVT-PCM hybrid system to enhance electrical and thermal performance and use in different applications.

Evaluating the Stress-Strain Relationship of the Additively Manufactured Lattice Structures

Extensive amount of research on additively manufactured (AM) lattice structures has been made to develop a generalized model that can interpret how strongly operational variables affect mechanical properties. However, the currently used techniques such as physics models and multi-physics simulations provide a specific interpretation of those qualities, and are not general enough to assess the mechanical properties of AM lattice structures of different topologies produced on different materials via several fabrication methods. To tackle this problem, this study develops an optimal deep learning (DL) model based on more than 4000 data points, which has been optimized by analyzing three different hyper-parameters optimization schemes including gradient boost regression trees (GBRT), gaussian process (GP), and random forest (RF) with different data distribution schemes such as normal distribution, nth root transformation, and robust scaler. With the robust scaler and nth root transformation, the accuracy of the model increases from R² = 0.85 (for simple distribution) to R² = 0.94 and R² = 0.88, respectively. After feature engineering and data correlation, the stress, unit cell size, total height, width, and relative density are chosen to be the input parameters to model the strain. The optimal DL model is able to predict the strain of different topologies of lattices (such as circular, octagonal, Gyroid, truncated cube, Truncated cuboctahedron, Rhombic do-decahedron, and many others) with decent accuracy (R² = 0.936, MAE = 0.05, and MSE = 0.025). The parametric sensitivity analysis and explainable artificial intelligence (by using DeepSHAP library) based insights confirm that stress is the most sensitive input to the strain followed by the relative density from the modeling perspective of the AM lattices. The findings of this study would be helpful for the industry and the researchers to design AM lattice structures of different topologies for various engineering applications.

Improving the melting performance in a triple-pipe latent heat storage system using hemispherical and quarter-spherical fins with a staggered arrangement

This study aims to evaluate the melting characteristics of a phase change material (PCM) in a latent heat storage system equipped with hemispherical and quarter-spherical fins. A vertical triple-pipe heat exchanger is used as the PCM-based heat storage unit to improve the melting performance compared with a double-pipe system. Furthermore, the fins are arranged in inline and staggered configurations to improve heat transfer performance. For the quarter-spherical fins, both upward and downward directions are examined. The results of the system equipped with novel fins are compared with those without fins. Moreover, a fin is added to the heat exchanger's base to compensate for the natural convection effect at the bottom of the heat exchanger. Considering similar fin volumes, the results show that the system equipped with four hemispherical fins on the side walls and an added fin on the bottom wall has the best performance compared with the other cases with hemispherical fins. The staggered arrangement of the fins results in a higher heat transfer rate. The downward quarter-spherical fins with a staggered configuration show the highest performance among all the studied cases. Compared with the case without fins, the heat storage rate improves by almost 78% (from 35.6 to 63.5 W), reducing the melting time by 45%.

Clinical and Economic Profile of Homeless Young Adults with Stroke in the United States, 2002 - 2017

INTRODUCTION

. Homelessness is a major social determinant of health. We studied the clinical and economic profile of homeless young adults hospitalized with stroke.

METHODS

. We studied the National Inpatient Sample database (2002-2017) to evaluate trends of stroke hospitalization, clinical outcomes, and health expenditure in homeless vs. non-homeless young adults (<45 years).

RESULTS

. We identified 3,134 homeless individuals out of 648,944 young adults. Homeless patients were more likely to be men, Black adults and had a higher prevalence of cardiometabolic risk factors and psychiatric disorders than non-homeless adults. Both homeless and non-homeless adults had a similar prevalence of ischemic and hemorrhagic stroke. Between 2002 and 2017, hospitalization rates per million increased for both non-homeless (295.8 to 416.8) and homeless adults (0.5 to 3.6) (P≤0.01). Between 2003 and 2017, the decline in in-hospital mortality was limited to non-homeless adults (11% to 9%), while it has increased in homeless adults (3% to 11%) (P<0.01). The prevalence of acute myocardial infarction (6.8% vs. 3.3%, P<0.01), and acute kidney injury (13.1% vs. 9.4%, P<0.01) was also higher in homeless vs. non-homeless adults. The length of stay and inflation-adjusted care cost were comparable between both study groups. Finally, a higher proportion of homeless patients left the hospital against medical advice than non-homeless adults.

CONCLUSIONS

. Homeless young stroke patients had significant comorbidities, increased hospitalization rates, and adverse clinical outcomes. Therefore, public health interventions should focus on multidisciplinary care to reduce health care disparities among young homeless adults.

Intraoperative radiotherapy for pancreatic cancer: implementation and initial experience

This article reports on the first series of patients to receive intraoperative radiotherapy for pancreatic cancer in the UK. The data suggest that this treatment modality is feasible and safe, laying a platform for collaborative multicentre trials to better assess efficacy.

Demoralization, depression and anxiety in postpartum women of culturally and linguistic diverse backgrounds in Australia

INTRODUCTION

The present study aims to investigate whether mothers from Culturally and Linguistically Diverse (CALD) backgrounds present with higher levels of demoralization in comparison with their non-minority counterparts, and to explore potential correlations between demoralization and anxiety as well as depression in the same sample of mothers.

METHODS

Women admitted to a public tertiary care teaching hospital were invited to participate in the study within 24–48 hours following delivery. The study compared women who did not regard English as their main spoken language to native English-speaking women. Women were asked to complete the demographic Kissane Demoralization Scale (KDS) and Being a Mother Scale (BaM-13) questionnaires. Participants were contacted by phone, 6 to 8 weeks after they had completed the KDS and the BaM-13 questionnaires, to complete an Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Scale (STAI) questionnaires.

RESULTS

Mothers of CALD background presented with significantly higher scores on the KDS (p<0.001), STAI (p<0.001) and EPDS (p<0.001) scales in comparison with their non-CALD counterparts. Furthermore, when mothers were reassessed after 6 to 8 weeks, higher KDS scores in the postnatal period predicted significantly higher anxiety and depression scores, according to STAI (p<0.001) and the EPDS (p<0.001), respectively.

CONCLUSIONS

The results of this study reveal that, mothers of CALD background manifest higher levels of demoralization as well as anxiety and depression in the postpartum period when compared with their non-CALD counterparts.

Predictive Value of Clinical and Questionnaire Based Screening Tools of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus

Background

Obstructive sleep apnea (OSA) is a major health problem for people with type 2 diabetes mellitus (DM2) and is associated with poorer glycemic control. Early detection is critical to proper management. In this study, we planned to assess and compare the diagnostic accuracy of various OSA screening tools in patients with DM2.

Methods

In this cross-sectional study, we consecutively recruited 58 patients with DM2, presenting to the endocrinology department of Services Hospital Lahore between February 2020 to March 2021. Along with demographic and anthropometric measurements, including BMI and neck circumference, participants answered the snoring, tiredness, observed apnea, high blood pressure - BMI, age, neck circumference, and gender (STOP-BANG) questionnaire, Berlin questionnaire, and Epworth sleepiness scale. All participants then underwent an overnight, level 3 polysomnography.

Results

The overall prevalence of OSA, diagnosed by overnight polysomnography, was 65.5% in type 2 diabeticDM2 patients. The STOP-BANG questionnaire had the highest sensitivity for mild, moderate, and severe OSA i.e., 84.2%, 90.3%, and 100% respectively. Berlin questionnaire also had 100% sensitivity for severe OSA and was most specific for mild and moderate OSA (70% and 63% respectively) whereas the Epworth sleepiness scale had the highest specificity of 53.3% for severe OSA.

Conclusion

This study shows that OSA is highly prevalent in DM2 patients in Pakistan. The STOP-BANG and Berlin questionnaire proved to be effective screening tools, especially for severe OSA. Results of our study should encourage the routine use of these questionnaires in clinical practice, to help in the early identification of OSA in diabetics.

Trends in Characteristics and Outcomes of Hospitalized Young Patients Undergoing Coronary Artery Bypass Grafting in the United States, 2004 to 2018

Background

Data are limited about young adults' characteristics and outcomes undergoing coronary artery bypass grafting (CABG).

Methods and Results

We used the National Inpatient Sample database to identify adults aged 18 to 45 years who underwent CABG between 2004 and 2018. The data were weighted to generate national estimates of the entire US hospitalized population. We identified 110 463 CABG cases, equivalent to 62.2 per 1 000 000 person‐years; 27.1% were women, and 70.2% were White adults. Overall, annual CABG volume per 1 000 000 significantly decreased from 87.3 in 2004 to 45.7 in 2018. The prevalence of obesity, diabetes mellitus, hypertension, drug abuse, and chronic medical conditions increased over time. Overall, inpatient mortality was 1.76%; ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation myocardial infarction, heart failure, peripheral vascular disease, renal failure, and valvular surgery were associated with higher inpatient mortality. Women had higher inpatient mortality than men (2.29% versus 1.57%), and Black patients had higher deaths than White patients (2.86% versus 1.58%). Inpatient mortality remained stable overall, according to sex, race, or clinical indication of CABG. However, the mean length of stay (8.4 days in 2004 to 9.5 days in 2018) and inflation‐adjusted cost of care ($40 522.8 in 2004 to $52 434.2 in 2018) significantly increased during the study period.

Conclusions

Despite the increased burden of cardiometabolic risk factors, the inpatient mortality in young adults undergoing CABG remained stable during the last 15 years. However, CABG volumes have decreased, but length of stay and inflation‐adjusted costs have increased over time.

P–280 Changes in oolemma height during ICSI injection on day 0 is associated with day 5–6 blastocyst formation

Study question

Does the oolemma response to ICSI injection on day 0 affect blastocyst formation on day 5–6 (d5/6)?

Summary answer

A large change in oolemma height during ICSI injection on day 0 is associated with lower blastocyst formation rates on d5/6.

What is known already

The oolemma changes in all dimensions (i.e. height, width and depth) and can exhibit different reactions in ICSI during needle injection. This is seen as instant rupture or with little needle pressure, normal rupture with the needle pushed approximately halfway through, or difficult rupture with repeated attempts or the needle passing 3/4 of the oocyte width. Previous studies have shown that these responses can affect degeneration and fertilisation rates on day 1, however, there is little research on its effect on blastocyst formation rates. Furthermore, most previous studies have used qualitative methods to assess oolemma response.

Study design, size, duration

This is a retrospective study using ICSI procedure videos conducted by four embryologists in a private clinic from 2013–2015. All videos of procedures which did not result in 2PN or in which the oocyte was not fully visible were excluded. Six operators categorised 455 videos (by majority vote) into four groups based on the oolemma response: oolemma breakage within 1/4, between 1/4 and 1/2, between 1/2 and 3/4 and beyond 3/4 of the oocyte’s width.

Participants/materials, setting, methods

A U-Net neural network model was trained to extract the frame of maximum oolemma indent from each video which were validated by a human operator; any in which maximum indent occured after breaking of the oolemma were excluded. The ratio of starting to maximal indent width/height were calculated automatically and human-validated. Chi-squared tests were performed for each ratio vs d5/6 blastocyst formation. These results were compared with those obtained from purely human annotations.

Main results and the role of chance

From the purely human annotations, the percentages of oocytes in groups 1–4 respectively were: 3.3%, 85.3%, 11.4% and 0%. This variation in oolemma response may be due to the arrangement of thick and thin microfilaments or cortical granules in the cytoskeleton. When analysed with d5/6 blastocyst formation, these showed no significant result (p = 0.12) which is consistent with findings using the model.

The artificial intelligence (AI) model processed 26 frames per second. During human validation of the ratios calculated at maximal indentation, 36% of width ratios and 31% of height ratios were rejected.

The proportion of blastocysts formed in the upper and lower quartile for each ratio was analysed. Both the upper (0.49) and lower (0.41) quartiles of the width ratios were not significant for d5/6 blastocyst formation. The lower (1.12) quartile of height ratios showed no significance, however there were significantly fewer blastocysts formed on d5/6 for the upper (1.18) quartile of height ratios (p &lt; 0.025). This subtle change in the height ratio, which was significant for d5/6 blastocyst formation was not taken into account when grouping oocytes any previous literature (and our human labelling).

Limitations, reasons for caution

This study was conducted at a single clinic so variations between clinics were not captured in the study and would need further collaborations to confirm the proportion of oocytes responses. Due to the small sample size, this study also did not identify any group 4 oocytes cultured until d5/6.

Wider implications of the findings: The grouping criteria in this study were more quantitative than previous work yet indicated no correlation between the oolemma group and d5/6 blastocyst formation. However, changes in the height which are hard to assess in real-time (and which have been neglected in previous literature) were seen to be significant.

Trial registration number

NA

GC-MS metabolic profiling and anti-urease activity of nonpolar fractions of Calligonum Polygonoides L. (Polygonaceae) and Crateva Adansonii DC. Prodr. (Capparaceae)

Purpose: To determine the urease-inhibitory activity and chemical constituents of fractions of Calligonum polygonoides and Crateva adansonii separated by physical properties. Methods: The anti-urease activities of different fractions of the plants (methanol, n-hexane, CHCl3, nbutanol) were evaluated using a standard procedure. The chemical constituents of the extracts with the highest urease-inhibitory activity were determined by gas chromatography-mass spectrometry. Results: The n-hexane fractions of both plants had higher urease-inhibitory activity and a lower halfmaximal inhibitory concentration (IC50) than the other extracts. GC-MS evaluation revealed that nhexane fraction of C. polygonoides was rich in fatty acids (39.36 %), sterols (22.29 %), long chain alkanes (98.5 %), and a few volatiles (5.26 %), while the n-hexane fraction of C. adansonii had high levels of alkanes (35.03 %), sterols (10.46 %), fatty acid esters (46.82 %), and triterpenes (23.76 %). Conclusion: The n-hexane fractions of the plants demonstrate high urease-inhibitory activity. Thus, these plant-based anti-urease fractions can potentially serve as a starting point for the development of novel antibacterial agents with enhanced efficacy and reduced antibiotic resistance in the treatment of pathological conditions and infections associated with urease.

RP-UHPLC-MS Chemical Profiling, Biological and In Silico Docking Studies to Unravel the Therapeutic Potential of Heliotropium crispum Desf. as a Novel Source of Neuroprotective Bioactive Compounds

Heliotropium is one of the most important plant genera to have conventional folklore importance, and hence is a potential source of bioactive compounds. Thus, the present study was designed to explore the therapeutic potential of Heliotropium crispum Desf., a relatively under-explored medicinal plant species. Methanolic extracts prepared from a whole plant of H. crispum were studied for phytochemical composition and possible in vitro and in silico biological properties. Antioxidant potential was assessed via six different assays, and enzyme inhibition potential against key clinical enzymes involved in neurodegenerative diseases (acetylcholinesterase (AChE) and butyrylcholinesterase (BChE)), diabetes (α-amylase and α-glucosidase), and skin problems (tyrosinase) was assayed. Phytochemical composition was established via determination of the total bioactive contents and reverse phase ultra-high performance liquid chromatography mass spectrometry (RP-UHPLC-MS) analysis. Chemical profiling revealed the tentative presence of 50 secondary metabolites. The plant extract exhibited significant inhibition against AChE and BChE enzymes, with values of 3.80 and 3.44 mg GALAE/g extract, respectively. Further, the extract displayed considerable free radical scavenging activity against DPPH and ABTS radicals, with potential values of 43.19 and 41.80 mg TE/g extract, respectively. In addition, the selected compounds were then docked against the tested enzymes, which have shown high inhibition affinity. To conclude, H. crispum was found to harbor bioactive compounds and showed potent biological activities which could be further explored for potential uses in nutraceutical and pharmaceutical industries, particularly as a neuroprotective agent.

The effect of maize-alfalfa intercropping on the physiological characteristics, nitrogen uptake and yield of maize

In Northeastern China, the intensive cropping system and increased use of chemical fertilizer has caused severe problems in terms of sustainable agricultural development. Therefore, to improve agricultural sustainability and crop productivity the farming system needs to be modified in the region. A pot experiment was conducted to evaluate the effect of maize-alfalfa intercropping on the physiological characteristics, nitrogen (N) uptake and yield of the maize crops in northeast China in 2017-2018. The study findings showed that intercropping under N fertilization progressively improved the physio-agronomic indices of the maize crop as compared to mono-cropping. The grain yield, 100 seed weight and biomass dry matter of maize crop improved in intercropping when it was practiced with N fertilizer. Furthermore, intercropping with N fertilization increased the chlorophyll content of the maize crop at bell-mouthed, silking, filing and mature stages by 19%, 44%, 12%, and 9% in 2017 and by 23%, 43%, 15%, and 11% in 2018, respectively, as compared with the monocropping system. Unlike monocropping, intercropping with N fertilization increased the photosynthesis rate (14% and 15%), stomatal conductance (74% and 98%) and transpiration rate (74% and 75%) in 2017 and 2018, respectively. However, intercropping reduced intercellular CO₂ (C_i ). Moreover, intercropping with N fertilization increased the maize N content of grain and leaves as well as total N uptake by 49%, 31% and 93% in 2017 and 53%, 34% and 132%, respectively, in 2018 as compared to monocropping. In conclusion, our results suggest that maize-alfalfa intercropping with optimal N fertilization provides a practical method for improving growth, yield and N accumulation in the maize crop.

Examining the Relationship of Online Social Networking Sites' Activities, Customers' Brand Choice, and Brand Perception in Health-Related Businesses

The purpose of this study was to examine the effect of online social networking site activities on brand choice for health-related businesses; the study also explored the mediating impact of brand perception on the connection of online social networking site activities and brand choice in health-related businesses. A self-administered questionnaire was used for data collection from 300 customers, randomly selected from health sector businesses in Pakistan. The findings indicate that online social networking site activities had a substantial influence on customers’ brand choice in health-related businesses and that brand perception mediates the connection between online social networking site activities and customers’ brand choice in health-related businesses. The research also recognized the increasing significance of online social networking sites in health-related businesses. The study offers insights for health-related companies and their managers on visualizing brand perception as well.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Comparison of Renal Outcomes in Patients With Left Ventricular Assist Device and Heart Transplantation

BACKGROUND

Renal function is a major consideration for orthotopic heart transplantation (OHT) and left ventricular assist device (LVAD) therapy. We compared serial changes in renal function and outcomes between patients who underwent OHT and LVAD therapy over 12 months.

METHODS

Forty-five and 58 consecutive patients who underwent LVAD implantation (all bridge to transplant or candidacy) and OHT from April 2014 to November 2016 were included. Six of these patients were in both LVAD and OHT cohorts. Survival analysis was calculated using Kaplan Meier and log rank methods. Univariate analysis of data was performed using χ², Mann-Whitney, Kruskal-Wallis, and Wilcoxon signed rank tests where appropriate. Comparisons of the renal function to baseline were conducted using generalized estimating equations.

RESULTS

Renal function had a biphasic course among the LVAD cohort, increasing at 30 days but reducing at 6 and 12 months. Meanwhile, estimated glomerular filtration rate (eGFR) was seen to progressively decline among OHT recipients. Altogether, eGFR was significantly higher at 6 and 12 months among the LVAD cohort compared to OHT (68.3 vs 59.4, P = .046; 68.3 vs 50.4, P = .015). Compared to the baseline average, eGFR had risen among the LVAD patients (P = .031) but had decreased among the OHT group (P < .001) at 12 months. No significant difference in survival was seen at 1 year (84.4% vs 81.0%; P = .540) and 2 years (78.3% vs 78.8%, P = .687) between the cohorts.

CONCLUSION

Despite poorer baseline renal function, LVAD therapy was associated with comparable survival and better renal outcomes compared to OHT at 12 months. Renal impairment may favor the use of LVAD therapy over OHT in the short term.

Meta-Analysis of Efficacy and Safety of Proton Pump Inhibitors with Dual Antiplatelet Therapy for Coronary Artery Disease

BACKGROUND

There is inconsistency in the literature regarding the clinical effects of proton pump inhibitors (PPI) when added to dual antiplatelet therapy (DAPT) in subjects with coronary artery disease (CAD). We performed meta-analysis stratified by study design to explore these differences.

METHODS AND RESULTS

39 studies [4 randomized controlled trials (RCTs) and 35 observational studies) were selected using MEDLINE, EMBASE and CENTRAL (Inception-January 2018). In 221,204 patients (PPI = 77,731 patients, no PPI =143,473 patients), RCTs restricted analysis showed that PPI did not increase the risk of all-cause mortality (Risk Ratio (RR): 1.35, 95% Confidence Interval (CI), 0.56-3.23, P = 0.50, I² = 0), cardiovascular mortality (RR: 0.94, 95% CI, 0.25-3.54, P = 0.92, I² = 56), myocardial infarction (MI) (RR: 0.97, 95% CI, 0.62-1.51, P = 0.88, I² = 0) or stroke (RR: 1.11, 95% CI, 0.25-5.04, P = 0.89, I² = 26). However, PPI significantly reduced the risk of gastrointestinal (GI) bleeding (RR: 0.32, 95% CI, 0.20-0.52, P < 0.001, I² = 0). Conversely, analysis of observational studies showed that PPI significantly increased the risk of all-cause mortality (RR: 1.25, 95% CI, 1.11-1.41, P < 0.001, I² = 82), cardiovascular mortality (RR: 1.25, 95% CI, 1.03-1.52, P = 0.02, I² = 71), MI (RR: 1.30, 95% CI, 1.16-1.47, P < 0.001, I² = 82) and stroke (RR: 1.60, 95% CI, 1.43-1.78, P < 0.001, I² = 0), without reducing GI bleeding (RR: 0.74, 95% CI, 0.45-1.22, P = 0.24, I² = 79).

CONCLUSION

Meta-analysis of RCTs endorsed the use of PPI with DAPT for reducing GI bleeding without worsening cardiovascular outcomes. These findings oppose the negative observational data regarding effects of PPI with DAPT.

Acute blood transfusion reactions in a tertiary care hospital in Pakistan - an initiative towards haemovigilance

OBJECTIVE

In this study, we report acute blood transfusion reactions at our hospital, compare our analysis with the reported data and identify areas for improvement.

BACKGROUND

Haemovigilance programmes have been implemented in many countries, and adverse events associated with blood transfusion are published in their annual reports. Pakistan has no current established programme.

MATERIAL AND METHODS

A cross-sectional study was conducted, and all adverse reactions reported to the blood bank from January 2014 to March 2016 were included. An adverse response in the patient, related to administration of blood (within 24 h), was considered an immediate transfusion reaction.

RESULTS

During the study period, 20 956 blood components were issued. A total of 32 (0·15%) adverse reactions were documented. Allergic reactions were the most common adverse event observed in 15 (46·8%) of the cases. Febrile non-haemolytic transfusion reaction (FNHTR) was the second most common reaction seen in nine (28%) followed by bacterial contamination in four (12·5%) and acute haemolytic reaction in two (6·2%) of the cases.

CONCLUSION

The low incidence indicates underreporting and the need for a formal haemovigilance system. International benchmarking between different medical systems is helpful to identify areas in the transfusion process that have to be changed to improve transfusion safety.

Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: A randomised double blind controlled trial

BACKGROUND AND AIMS

Omega-3 fatty acids (FA) can ameliorate the hyper-inflammatory response that occurs in conditions such as severe acute pancreatitis (SAP) and this may improve clinical outcome. We tested the hypothesis that parenteral omega-3 FA from a lipid emulsion that includes fish oil could be beneficial in patients with predicted SAP by reducing C-reactive protein (CRP) concentration (primary outcome), and modulating the inflammatory response and improving clinical outcome (secondary outcomes).

METHODS

In a phase II randomized double-blind single-centre controlled trial, patients with predicted SAP were randomised to receive a daily infusion of fish oil containing lipid emulsion (Lipidem® 20%, BBraun) for 7 days (n = 23) or a daily infusion of a lipid emulsion without fish oil (Lipofundin® MCT 20%, BBraun) (n = 22).

RESULTS

On admission, both groups had comparable pancreatitis predicted severity and APACHE II scores. Administration of fish oil resulted in lower total blood leukocyte number (P = 0.04), CRP (P = 0.013), interleukin-8 (P = 0.05) and intercellular adhesion molecule 1 (P = 0.01) concentrations, multiple organ dysfunction score, sequential organ failure assessment score (P = 0.004), early warning score (P = 0.01), and systemic inflammatory response syndrome (P = 0.03) compared to the control group. The fish oil group had fewer new organ failures (P = 0.07), lower critical care admission rate (P = 0.06), shorter critical care stay (P = 0.03) and shorter total hospital stay (P = 0.04).

CONCLUSIONS

It is concluded that intravenous administration of a fish oil containing lipid emulsion, a source of omega-3 FA, improves clinical outcomes in patients with predicted SAP, benefits that may be linked to reduced inflammation. CLINICALTRIALS.

GOV NUMBER

NCT01745861.

EU CLINICAL TRIALS REGISTER

EudraCT (2010-018660-16).

Meta-Analysis of the Safety and Efficacy of the Oral Anticoagulant Agents (Apixaban, Rivaroxaban, Dabigatran) in Patients With Acute Coronary Syndrome

The significance of adding new oral anticoagulants (NOACs) to antiplatelet therapy in patients with acute coronary syndrome (ACS) is unclear. We conducted a meta-analysis to assess the safety and efficacy of adding NOACs (apixaban, rivaroxaban, and dabigatran) to single antiplatelet agent (SAP) or dual antiplatelet therapy (DAPT) in patients with ACS. Seven randomized controlled trials were selected using PubMed or MEDLINE, Scopus, and Cochrane library (inception to August 2017). The summary measure was random effects hazard ratio (HR) with 95% confidence interval (CI). The primary safety outcome was clinically significant bleeding. The secondary efficacy outcome was major adverse cardiovascular events (MACE; composite of myocardial infarction, stroke, and all-cause mortality). In 31,574 patients, addition of NOAC to SAP did not increase the risk of clinically significant bleeding (HR 0.82, 95% CI 0.56 to 1.20, p = 0.31); however, the risk of clinically significant bleeding was significantly increased with NOAC plus DAPT (HR 2.24, 95% CI 1.75 to 2.87, p < 0.001). NOACs had no statistically beneficial effect on MACE when used with SAP (HR 0.82, 95% CI 0.66 to 1.04, p = 0.10); however, a modest reduction in MACE was observed when NOACs were combined with DAPT (HR 0.86, 95% CI 0.78 to 0.93, p < 0.001). In conclusion, in patients with ACS, the addition of NOAC to DAPT resulted in increased risk of clinically significant bleeding, whereas only a modest reduction in MACE was achieved. The addition of NOACs to SAP did not result in significant reduction of MACE or increase in clinically significant bleeding.

Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population

Background

With the exception of areas with high prevalence of tuberculosis, medical thoracoscopy is becoming the diagnostic modality of choice for exudative pleural effusions. The aims of this study were to determine the diagnostic yield and safety of medical thoracoscopy for exudative pleural effusions and ascertain the etiology of such effusions in Qatar.

Methods

This is a retrospective-descriptive study of 407 patients who underwent diagnostic medical thoracoscopy for exudative pleural effusions from January, 2008 till December, 2015 at the only tertiary referral center performing this procedure in Qatar.

Results

Tuberculosis was the most common etiology of exudative pleural effusions in Qatar accounting for 84.5% of all causes. Around 85% of patients were young males (mean age of 33 ± 12.1 years). The diagnostic yield of medical thoracoscopy for tuberculous pleural effusion was 91.4%. Malignant pleural effusions accounted for 5.2% of cases. Minor bleeding occurred in 1.2% of cases with no procedure-related mortality observed.

Conclusion

Medical thoracoscopy is a very safe procedure. Tuberculous pleuritis is by far the most common etiology of exudative pleural effusions in Qatar. Closed needle biopsy is a worth consideration as an initial safe, easy and low-cost diagnostic modality for exudative pleural effusions in this country.

NiO-nanoflakes grafted graphene: an excellent photocatalyst and a novel nanomaterial for achieving complete pathogen control

The increased levels of industrial pollutants in water and of drug-resistant pathogens more generally are a serious threat to human and aquatic life. Herein, we present the solar-light-induced dye removal and bactericidal properties of nickel oxide (NiO) and graphene nanoplatelet (GNP) nanocomposites. The conducting nature of GNPs is the key factor that accounts for the enhanced photocatalytic and antibacterial activity. Remarkably, the graphene/NiO nanocomposite shows outstanding photocatalytic activity (99% degradation) as compared to NiO (34%) alone, which makes it a potential candidate for the depollution of dye-contaminated water. In addition, the optimized amount of GNPs in the graphene/NiO nanocomposite renders it an exceptional antibacterial material, producing 100% growth inhibition of pathogenic microorganisms (both Gram-positive and Gram-negative bacteria). Therefore, the graphene/NiO nanocomposite can be an innovative material to achieve complete pathogen control, alongside being an economic solution for water treatment.

Intracranial venous thrombosis in a man taking clomiphene citrate

Clomiphene citrate is widely used by the female population for the management of a wide array of medical conditions especially those related to ovulation, but its use in male population remains controversial. Efficacy of clomiphene is not well established in male hypogonadism and infertility. Its side effects and complications are also poorly studied or reported. We present a case of a man with infertility issues for which he started receiving clomiphene citrate 3 weeks before presenting with progressive symptoms of headache, vomiting, transient blurred vision and diplopia, which eventually turned out to be the symptoms of intracranial venous thrombosis. After excluding the common causes of intracranial venous thrombosis and hypercoagulable state, clomiphene citrate seems the most likely culprit.

Inner shell as variation key of local hard clam Meretrix spp

The morphology and 12 shell morphometric features proportionate to shell length were analysed between local hard clam; Meretrix lyrata, M. meretrix and M. lusoria from Sarawak, Malaysia. Meretrix spp. was observed to comprise a unique feature of a pallial sinus scar for each species. Analysis of variance revealed significant differences among Meretrix spp. using proportion ratios of SL for SW; LL; AL; LCT; AW; PW and PS (p<0.05). Cluster analysis among morphometric features of M. lyrata, M. meretrix and M. lusoria were discriminated at 98.5% similarities and supported by the principal component analysis. The present study suggests that pallial sinus scar shape, together with interior and exterior morphometric features, were suitable as identification keys for Meretrix spp. Hence, the present study emphasizes on the application of interior, rather than exterior morphology and morphometric features in hard clam identification before further investigation can be performed through genetic identification means.

Comparison of condition index in the green-lipped mussel Perna viridis between Sebatu and Pasir Panjang, Peninsular Malaysia

The condition index (which relates to the tissue dry weight to shell volume) of the green-lipped mussel Perna viridis was investigated at Sebatu in Melaka and Pasir Panjang in Negri Sembilan from September 2003 to February 2004. Monthly samples of P. viridis were collected from culturing rafts at both sites. Variations in the average monthly condition index (CI) of P. viridis ranged from 21.06 to 26.72 g cm(-3) and 15.18 to 19.41 g cm(-3) in Sebatu and Pasir Panjang, respectively. Salinity values were lowest in November between 27.93 to 28.10 ppt in Sebatu and Pasir Panjang, respectively. Salinity then started increasing gradually until it reached 33.26 ppt in Sebatu and 31.23 ppt in Pasir Panjang in the month of February. Chlorophylla in Pasir Panjang showed higher fluctuation, ranging from 2.93 to 14.39 mg/L, while in Sebatu the fluctuations were lower and ranged between 7.70 and 9.37 mg l(-1). Rapid decline in CI values were recorded during January in Sebatu and February in Pasir Panjang. However, this rapid declining state of CI in P. viridis was an indication of its spawning period, when their gametes were released in the water column. These findings would help in the development of captive breeding techniques and mass seed production in aquaculture.

Impacts of gamete concentration, age and contact time on the fertilization success in the tropical species of white sea urchin, Salmaciella dussumieri

The globoid sea urchin (Salmaciella dussumieri) occurs abundantly in the Indo-West Pacific from the Island of the West Indian Ocean, East Africa, Magdagascar, Red Sea, South-East Arabia, Ceylon, Bay of Bengal, North Australia, Philippine, China and South Japan and Australia, and also has significant biological, ecological, aquaculture, conservational and medicinal importance. An experiment was carried out to assess the influence of sperm dilution, egg concentration, sperm-egg exposure time, and gamete aging on fertilization success of S. dussumieri in a captive laboratory condition. It has been found that dilution, age and contact time of sperm to egg were successively the most dominant factors effecting the success of fertilization, but concentration of eggs did not significantly so over the range investigated. The sperms retained their competency for more than two hours only in relatively dense sperm concentrations (≥ 10-(4) dilution of 'dry' sperm), although they exhibited lower capability and potency with increasing dilutions and age. In the trials of the egg-sperm exposure time, >80% eggs were fertilized within 10 sec of contact time at lower dilutions (10(-3)-10(-2)) of concentrated sperm, while some longer times were required to get the higher rates of fertilization. On the contrary, eggs remained in good quality for up to a period of 3 h and no abnormality or any adverse effects in fertilization were observed. The findings obtained from the present experiment reveal that limited longevity of diluted sperm have an important effect on fertilization rate of sea urchin eggs during natural spawning seasons in the field. Hence, the globoid sea urchin (S. dussumieri) is under extensive selective pressures to breed synchronously with the purpose of producing high sperm concentrations and higher sperm-egg interactions to maximize the success of fertilization in the water column.