Mortality and Morbidity After Open Surgical Lower Extremity Revascularization in Patients With Peripheral Artery Disease and Concurrent Abdominal Stoma.

OBJECTIVES: Patients with peripheral artery disease (PAD) often require treatment with open lower extremity revascularization (LER). Patients with PAD often have other comorbidities and associated conditions that affect procedural outcomes, including abdominal stomas. The aim of this work is to investigate the impact that stomas may have on postoperative outcomes and complications. METHODS: We performed a 5-year (2016-2020) analysis of the Nationwide Readmission Database. We identified all adult patients undergoing open LER. These patients were categorized into 2 groups: stoma and no-stoma. Propensity score matching (1:1) was used to control for demographics and comorbidities. Index admission outcomes and readmission rate were examined. RESULTS: 212,275 open LER patients were identified. A matched cohort of 3088 patients (1:1 stoma vs no-stoma) was obtained. Patients with stomas had higher rates of several postoperative complications: acute posthemorrhagic anemia (29.1%, P < 0.01), acute kidney injury (21.4%, P < 0.001), index sepsis (10.3%, P < 0.001), and index SSI (2.8%, P < 0.001). There were no significant statistical differences between the 2 groups for acute myocardial infarction. Those with stomas had worse outcomes: greater in-hospital mortality (4.7%, P < 0.05), length of stays (median 7 days, P < 0.001), total charges (median 108,037 dollars, P < 0.001), discharges to long-term care facilities (30.8%, P < 0.001), discharges to their own homes needing home health care (30.1%, P < 0.001), 30-day readmission rates (23.2%, P < 0.01), and 30-day readmission mortality (6.1%, P < 0.01). CONCLUSIONS: Concurrent abdominal stoma is associated with increased postoperative morbidity and mortality after open LER. Further prospective studies are needed to validate these results.

Wearable sensors based on artificial intelligence models for human activity recognition.

Human motion detection technology holds significant potential in medicine, health care, and physical exercise. This study introduces a novel approach to human activity recognition (HAR) using convolutional neural networks (CNNs) designed for individual sensor types to enhance the accuracy and address the challenge of diverse data shapes from accelerometers, gyroscopes, and barometers. Specific CNN models are constructed for each sensor type, enabling them to capture the characteristics of their respective sensors. These adapted CNNs are designed to effectively process varying data shapes and sensor-specific characteristics to accurately classify a wide range of human activities. The late-fusion technique is employed to combine predictions from various models to obtain comprehensive estimates of human activity. The proposed CNN-based approach is compared to a standard support vector machine (SVM) classifier using the one-vs-rest methodology. The late-fusion CNN model showed significantly improved performance, with validation and final test accuracies of 99.35 and 94.83% compared to the conventional SVM classifier at 87.07 and 83.10%, respectively. These findings provide strong evidence that combining multiple sensors and a barometer and utilizing an additional filter algorithm greatly improves the accuracy of identifying different human movement patterns.

Mapping the Grounds for Mortalities in Acute Myeloid Leukemia Through Registry Analyses: A Retrospective Cohort Study of Children, Adolescents, and Young Adults Patients.

Background: Our objective was to identify non-malignant factors that contribute to mortality in children, adolescents and young adults, aiming to improve patient follow-up and reduce mortality rates to achieve better survival outcomes. Methods: We analyzed 8,239 acute myeloid leukemia (AML) cases diagnosed between 2000 and 2019 in the USA. Using version 8.4.0.1 of the Surveillance, Epidemiology, and End Results (SEER)*Stat software, we calculated the standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) for each cause of death. Results: Out of the 3,165 deaths observed in the study population, the majority (2,245;70.9%) were attributed to AML itself, followed by non-AML cancers (573; 18.1%) and non-cancerous causes (347; 10.9%). Conclusions: Patients with AML are at a higher risk of developing other types of cancer and granulocyte deficiencies, which increases the risk of death from non-cancerous causes such as infections. Moreover, treatment for AML carries the risk of cardiac problems. AML is commoner in males than females.

Chemical composition and studying the possible neuroprotective effect of iridoids-rich fraction from Pentas lanceolata leaves using rotenone model of Parkinson's disease in mice.

Parkinsonism is an age-related neurodegenerative illness that affects motor coordination leading to loss of dopaminergic neurons. Many medications are used for the treatment of Parkinson's disease but are only symptomatic and have a limited effect on the progression of this ailment. Therefore, bioactive compounds which derived from plants have been examined for their ability to improve the neuronal damage and cell death happened in parkinsonian patients. In this study the iridoids-rich fraction isolated from Pentas lanceolata (PIRF) leaves was investigated for its phytoconstituents. Seven iridoids (1-7) and one flavonol diglycoside (8) were isolated, and their chemical structures were achieved by 1H and 13C nuclear magnetic resonance and ESI-MS spectral data. Compound 1 (6ß,7ß-epoxy-8-epi-splendoside) and 5 (gaertneroside) were isolated for the first time from Pentas genus as well as compound 8 (kaempferol-3-O-robinobioside). The current study aims to investigate the possible anti-parkinsonian effect of PIRF using a rotenone model of Parkinsonism in mice. Behavioural tests (wirehanging, stair and wooden-walking tests) were done to examine the motor coordination in mice after treatment. Biochemical and histopathological examinations for brain striatum in different groups were also evaluated. Results revealed that rotenone-treated mice had poor motor functions described by depletion of dopamine and Ach levels, a significant increase in proinflammatory cytokines, IL-1B, TNF-α and Mcp-1 and oxidative biomarkers with subsequent reduction in antioxidant mediators. Disorganization of striatum, degenerated neurocytes, slight vacuolation, shrunken neurons with pyknotic nuclei and apoptotic cells are displayed by histopathological examinations. Treatment with PIRF ameliorates the neurodegeneration-induced by rotenone in the brain of mice. The anti-parkinsonian effect of PIRF could be attributed to their bioactive constituents of iridoids.

Comparative metabolomics analysis of Citrus medica var. sarcodactylis Swingle and Limonia acidissima Linn. Fruits and leaves cultivated in Egypt in context to their antiviral effects.

A comprehensive study of fruits and leaves extracts of Citrus medica var. sarcodactylis Swingle and Limonia acidissima L. family Rutaceae was accomplished to investigate their antiviral activity along with their zinc oxide nanoparticles formulation (ZnONPs) against the avian influenza H5N1 virus. A thorough comparative phytochemical investigation of C. medica and L.acidissima leaves and fruits was performed using UPLC-QTOF-MS-MS. Antiviral effects further aided by molecular docking proved the highly significant potential of using C. medica and L.acidissima extracts as medicinal agents. Antiviral potency is ascendingly arranged as L. acidissima leaves (LAL) > L. acidissima fruits (LAF) > C. medica leaves (CML) at 160 µg. Nano formulation of LAF has the most splendid antiviral upshot. The metabolomic profiling of CMF and LAL revealed the detection of 48 & 74 chromatographic peaks respectively. Docking simulation against five essential proteins in survival and replication of the influenza virus revealed that flavonoid di-glycosides (hesperidin, kaempferol-3-O-rutinoside, and kaempferol-7-neohesperidoside) have shown great affinity toward the five investigated proteins and achieved docking scores which approached or even exceeded that achieved by the native ligands. Hesperidin has demonstrated the best binding affinity toward neuraminidase (NA), haemagglutinin (HA), and polymerase protein PB2 (-10.675, -8.131, and -10.046 kcal/mol respectively. We propose using prepared crude methanol extracts of both plants as an antiviral agent.

Photodynamic therapy mediated by methylene blue-loaded PEG accelerates skin mouse wound healing: an immune response.

PURPOSE: Conventional approaches for enhancing wound healing may not always yield satisfactory results. Instead, we test the effectiveness of a newly developed photodynamic therapy (PDT) that uses methylene blue (MB) loaded with polyethylene glycol (PEG) (MB-PEG) hydrogel to accelerate wound healing process in mice. METHODS: A dorsal skin incision with 6 mm punch which topically subjected to MB-PEG hydrogel and a low-level laser light of red light to assess the regeneration process of wounded skin. A total of 63 adult male CD1 mice divided into normal group (no treatment) and other wound groups received different treatments of laser (650 ± 5 nm and power intensity of 180 mW/cm2), MB-PEG, or PDT (MB-PEG followed by laser). The wound healing parameters were investigated by histological examination of the skin and measuring of proinflammatory cytokines at the early stage (48 h) and a late one on day 21. RESULTS: at 48 h, the score of tissue granulation, inflammation, and angiogenesis process were markedly improved in wounded groups that received MB + PEG combined with laser compared to the group treated with laser alone. On day 21, a significant improvement of the inflammation was detected in the group treated with MB + PEG plus laser compared to the other groups. At 48 h, the upregulated serum levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß in the wound group were significantly (P < 0.001) reduced in the group treated with MB + PEG combined with laser. CONCLUSION: MB-PEG based hydrogel improves and accelerates wound closure in the context of laser compared to either single treatment.

Racial, biological sex, and geographic disparities of venous thromboembolism in the United States, 2016 to 2019.

BACKGROUND: Venous thromboembolism (VTE) stands as the leading cause of preventable death within hospitals in the United States. Although there have been some studies investigating the incidence rates of VTE, there has yet to be a large-scale study elucidating disparities in sex, race, income, region, and seasons in patients with VTE. The goal of this study was to report the disparities in race, sex, income, region, and seasons in patients with VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT), in hospitalized patients from 2016 to 2019. METHODS: We used the United States National Inpatients Sample database to identify inpatients diagnosed with PE, DVT, and PE and DVT from 2016 to 2019. The inpatient incidence per thousand was calculated for sex and race using the weighted sample model. The regional and monthly incidence of DVT and PE per thousand inpatients and risk of incidence were calculated. Patients' characteristics including hospital type, bed size, median length of stay, median total charges, and mortality were also collected. RESULTS: We examined 455,111 cases of VTE, 177,410 cases of DVT, 189,271 cases of PE, and 88,430 cases of both DVT and PE combined. Over the study period, we observed a statistically significant trend among PE hospitalization incidences. There was a strong and positive correlation between DVT and PE inpatients. Black inpatients had the highest cumulative incidence of hospitalizations in all cohorts with 10.36 per 1000 in PE and 9.1 per 1000 in DVT. Asian and Pacific Islander inpatients had the lowest cumulative incidence with 4.42 per 1000 in PE and 4.28 per 1000 in DVT. Females showed the lowest cumulative incidence with 7.47 per 1000 in PE and 6.53 per 1000 in DVT. The Mountain region was the highest among PE hospitalizations with 9.62 per 1000. For DVT, the Middle Atlantic region was the highest at 8.65 per 1000. The in-hospital mortality rate was the highest among the PE hospitalizations at 7.3%. Also, the trend analysis showed significant increases among all groups. CONCLUSIONS: Over the study period (2016-2019), we report the racial, biological sex, and geographical disparities from the National Inpatient Sample database, highlighting that Black inpatients had the highest incidence of PE and DVT, whereas Asian/Pacific Islander inpatients had the lowest incidences of PE and DVT. Moreover, women had a lower incidence compared with men. The observed regional variations indicated that the incidence of PE was highest in the Mountain region, whereas the incidence of DVT was lowest in the Middle Atlantic region. There was an increase in the mortality of inpatients diagnosed with VTE reflecting the growing burden of this condition in the US health care system.

Is it possible to achieve multiplanar correction of complex deformities around the knee in children and adolescents using a monolateral external fixator?

PURPOSE: To present the technique of correction of multiplanar deformities around the knee in children and adolescents using the monolateral external fixator. Also, to evaluate the results of the technique regarding radiological correction, time to union, and possible complications. METHODS: A total of 29 patients (47 limbs) were prospectively included in the study (14 males and 15 females). Their median age was 13 years (range, 7-17). All patients had at least a 2-plane deformity around the knee which was corrected using a monolateral external fixator. The primary outcome measure was deformity correction (correction of mechanical axis deviation (MAD) in both the coronal and sagittal planes with correction of rotational deformities). The secondary outcome measures included bony union, radiographic, and functional results (assessed by using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score). RESULTS: The median pre-operative MAD improved from 6.3 to 0.4 cm post-operatively. According to the ASAMI scoring system, the radiographic scoring was excellent in all cases (100%), and the functional scoring was excellent in 22 cases (89.7%) and good in three cases (10.3%). CONCLUSION: The simple monolateral fixator can be an effective tool for multiplanar correction of complex deformities around the knee without limb length discrepancy.

Phoenix dactylifera L.: An Overview of Phytochemical Constituents and Impact on Women's Health.

Phoenix dactylifera L. (date palm) is the most significant member of the palm family (Arecaceae), particularly in the Middle East and Arab World. It is a valuable source of both primary and secondary metabolites including sugars, amino acids, phenolic acids, flavonoids, proanthocyanidins, carotenoids, phytosterols, terpenes and sphingolipids, besides vitamins and minerals. Besides, it possesses a wide array of pharmacologic activities viz. immunomodulatory, antioxidant, anti-inflammatory, hepatoprotective, nephroprotective, anti-mutagenic and anti-cancer activities, in addition to its positive effects on male and female fertility. Further research is still required to deeply understand its clinical implications, especially concerning women's health. Moreover, there are other Phoenix species that still need to be investigated to learn more about their undiscovered phytochemical components and biological activities.

Outcomes after radioscapholunate arthrodesis for intra-articular malunion of distal radius fractures.

PURPOSE: To study the clinical, radiological, and functional outcomes after of radioscapholunate (RSL) fusion for intra-articular malunion of the distal radius. METHODS: This retrospective study included 26 patients (17 males and 9 females) with intra-articular malunion of distal radius fractures who underwent RSL arthrodesis using locked miniplates (without distal scaphoid excision) between 2012 and 2020. Their mean age was 43 years (range, 32-56). Patients were assessed radiographically for union and clinically for range of motion, grip strength, and pain (assessed by Visual Analogue Scale (VAS) for pain). Functional evaluation was performed by using the Mayo modified wrist score (MMWS) and the Disabilities for the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: All patients showed complete healing at the fusion site after a mean of 8.7 weeks (range, 8-12). The mean follow-up period was 72 months (range, 60-84). The pinch strength improved from a mean of 6.2 kg (range, 3-12) to a mean of 9.8 kg (range, 5-18) which represents 80% of the contralateral side. The mean pinch strength was 7 kg (range, 5-18) which presents 80% of the other side. VAS for pain showed a mean improvement of 72.6%. The DASH score improved to a mean of 19.2 (range, 14-24). The MMWS improved to a mean of 68 (range, 45-86). At the final follow-up period, no degenerative changes were detected in the midcarpal joint. CONCLUSION: RSL arthrodesis (using locked miniplates without distal scaphoid excision) is a reliable surgical procedure to manage cases of radiocarpal OA after intra-articular malunion of distal radius fractures with good clinical and radiological outcomes. LEVEL OF EVIDENCE: Level IV- therapeutic.

Arsenic's shadowy influence: A systematic review of its carcinogenic role in gallbladder cancer.

INTRODUCTION: Gallbladder carcinoma (GBC) and cholangiocarcinoma are aggressive forms of cancer developed in the gallbladder and biliary tracts which are related to the liver. This systematic review aimed to highlight the significant association between gallbladder, biliary cancers, and arsenic exposure. METHODS: An extensive search was conducted in Embase, Cochrane, Scopus, PubMed, and Web of Science. We included studies that assessed arsenic levels in gallbladder cancer patients, without restrictions on age, sex, or language. Biological samples, such blood, bile, gallbladder tissue, gallstones, and hair were obtained, and arsenic levels were measured. Also, arsenic water and soil concentrations were collected. RESULTS: A total of 13 studies were included in our review. These studies included 2234 non-gallbladder carcinoma patients and 22 585 gallbladder carcinoma cases. The participant demographics showed a gender distribution of 862 males and 1845 females, with an age range of 20-75 years. The average body mass index (BMI) was 19.8 kg/m2 for nongallbladder carcinoma patients and 20.1 kg/m2 for gallbladder carcinoma cases. The selected studies examined arsenic concentrations across various biological samples, including blood, hair, gallstones, and bile. Blood arsenic levels ranged from 0.0002 to 0.3893 µg/g and were significantly associated with increased gallbladder carcinoma risk in several studies. Hair also demonstrated a significant correlation, with arsenic concentrations ranging from 0.0002 to 6.9801 µg/g. CONCLUSION: There is a strong link between arsenic exposure and gallbladder cancer or cholangiocarcinoma. Even chronic exposure to low-moderate amounts could lead to gallbladder carcinoma. These findings stress the need for more comprehensive and dedicated studies, to control arsenic water/soil levels and seek other preventive measures for this high mortality disease.

Structural aortic wall abnormalities following the Nikaidoh operation, which could be reversible and include a healing process.

The Nikaidoh operation continues to be used for patients with transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction. We recently reported structural and functional changes in the aortic root during the follow-up of a patient who underwent the Nikaidoh operation. These changes necessitated re-operation. The pathophysiology of these changes and their potential for reversibility have not yet been studied. In this communication, we describe the extensive structural changes in the aortic wall of the same patient.

Machine learning base models to predict the punching shear capacity of posttensioned UHPC flat slabs.

The aim of this research is to present correction factors for the punching shear formulas of ACI-318 and EC2 design codes to adopt the punching capacity of post tensioned ultra-high-performance concrete (PT-UHPC) flat slabs. To achieve that goal, the results of previously tested PT-UHPC flat slabs were used to validate the developed finite element method (FEM) model in terms of punching shear capacity. Then, a parametric study was conducted using the validated FEM to generate two databases, each database included concrete compressive strength, strands layout, shear reinforcement capacity and the aspect ratio of the column besides the correction factor (the ratio between the FEM punching capacity and the design code punching capacity). The first considered design code in the first database was ACI-318 and in the second database was EC2. Finally, there different "Machine Learning" (ML) techniques manly "Genetic programming" (GP), "Artificial Neural Network" (ANN) and "Evolutionary Polynomial Regression" (EPR) were applied on the two generated databases to predict the correction factors as functions of the considered parameters. The results of the study indicated that all the developed (ML) models showed almost the same level of accuracy in terms of the punching ultimate load (about 96%) and the ACI-318 correction factor depends mainly on the concrete compressive strength and aspect ratio of the column, while the EC2 correction factor depends mainly on the concrete compressive strength and the shear reinforcement capacity.

Metabolomic study of the estrogenic and anti-osteoporotic potential of Erythrina bidwillii leaf.

Erythrina bidwillii Lindl., Leguminosae, constitutes a valuable crop for horticulture and medicine; however, it is rarely investigated. Menopause is a crucial transitional period in women's health. Women worldwide consider the use of phytoestrogens as a safe hormone replacement therapy to alleviate detrimental menopausal symptoms. Thus, the discovery of novel phytoestrogens is highly demanded. The present study aimed to investigate, for the first time, the metabolomic profile and the estrogenic potential of E. bidwillii Lindl. leaf. Ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry and gas chromatography-mass spectrometry metabolite profiling revealed the prevalence of alkaloids, flavonoids, isoflavonoids and fatty acids. Additionally, five erythrinan alkaloids, cristanine A (1), 8-oxoerythraline (2), (+)-erythrinine (3), (+)-erythraline (4) and 8-oxoerythrinine (5), along with the isoflavonoid genistin (6), were isolated. Erythrina bidwillii leaf extract exhibited significant in vivo estrogenic, anti-osteoporotic, anti-hyperlipidemic, hepatoprotective, and nephroprotective activities, utilizing ovariectomized rat model. Moreover, ethyl acetate and hexane fractions possessed significant in vitro estrogeic potential on MCF-7 cell lines. An in silico study of the isolated metabolites revealed that (+)-erythrinine (3) and 8-oxoerythrinine (5) exhibited the highest affinity for ERα and ERß, respectively, modeling them as potential estrogenic lead metabolites. Therefore, E. bidwillii leaf could be employed as promising hormone replacement therapy for postmenopausal women after thorough clinical trials.

TEMPORARY REMOVAL: The Effect of Preoperative Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During and After Elective Cesarean Delivery in Primigravida: A Double-Blinded, Randomized, Comparative-Placebo Trial.

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at: https://www.elsevier.com/about/policies/article-withdrawal.

Reflections on the surge in malaria cases after unprecedented flooding in Pakistan-A commentary.

Background: Malaria is a parasitic infection primarily caused by four main species of the genus Plasmodium, that is, Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, and Plasmodium malariae. It is transmitted through the bite of the female Anopheles mosquito. It holds the status of one of the leading causes of death in the developing world. Malaria is endemic to Pakistan, and the country experienced the worst floods in its history from April to October 2022. The stagnant flood water served as a breeding ground for mosquitoes, culminating in an alarming spike in malaria cases. According to the World Health Organization (WHO), the number of cases reported till August 2022 was more than in the whole year of 2021. There was more than a twofold rise in cumulative cases in 62 high-burden Pakistani Districts in August 2022 as compared to August 2021. Aims: This commentary aims to bring this emerging issue to notice and highlight the most effective probable measures to help eliminate and prevent the hazards the current outbreak poses. Results: Rapid planning and execution are needed to ensure the most efficient and rapid elimination of malaria. To educate the general public, the national government must start public awareness efforts in electronic, print, and social media and deploy solar-powered mobile healthcare units to far-flung areas. Prophylactic and postexposure treatments should be planned because larvicidal preventive measures are less practical in flood-affected vicinities. Conclusion: The most effective preventive strategy is drug prophylaxis, followed by insecticide-treated nets, indoor residual spraying, and untreated nets. Scientists should intensify their investigations for effective medications to alleviate the malaria burden in Pakistan.