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Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage
Get PDFBACKGROUND: Subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale, cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH. We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators. We extracted ORs from the individual studies and aggregated these using a random effects model. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations assessment and ROBINS-I or RoB-2.RESULTS: 24 articles were included. In SAH, we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality (OR: 0.68, 95% CI 0.46 to 1.00), higher probability of favourable functional outcome (OR: 1.80, 95% CI 1.30 to 2.51), and reduced risks of DCI (OR: 0.28, 95% CI 0.18 to 0.42) and cerebral vasospasm (OR: 0.28, 95% CI 0.18 to 0.42), compared with conventional therapy. Cisternal irrigation with vasodilatory agents was associated with lower mortality (OR: 0.32, 95% CI 0.13 to 0.79) and reduced risk of cerebral vasospasm (OR: 0.37, 95% CI 0.17 to 0.79). The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.CONCLUSION: In this study, we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy. There is no evidence to support cisternal irrigation treatment of IVH.</p
How can firms implement smart manufacturing through supply chain collaboration? A multiple-case study from China
Get PDFThe complex system characteristics of Smart manufacturing (SM) require firms collaborating with supply chain members to implement SM transformation. However, the motives, methods, and influencing factors of such collaboration remain unclear. Addressing this gap, we conduct a multi-case study of four manufacturing firms and obtain three findings based on complex adaptive system theory. First, the motives of supply chain collaboration include the adaptation to the environment of high customisation, technical complexity, policy, and horizontal competition. Second, firms collaborate with supply chain members in terms of equipment customisation and information interconnection, to establish the data and equipment foundation of SM. This process is affected by the scale and volume of invested resources. Based on these, firms further build collaborative platforms to realise the integrated management of all supply chain links and improve the SM capability through the iteration of solutions, which are affected by the degree of security in data sharing. Third, supply chain collaboration improves the quality and satisfaction, reduces the cost, and shortens the cycle of SM implementation. This study not only addresses whether and how supply chain collaboration influences SM implementation, but also provides guidance to help companies implement SM through a gradual multi-stage collaboration in supply chain.</p
Applicability of Yeast Extract in Postgate Culture Medium for Microbiologically Influenced Corrosion Tests
Get PDFThis study was initiated to investigate the influence of yeast extract (YE), a component not naturally present in produced water, on in vitro experiments of microbiologically influenced corrosion (MIC) in a modified Postgate’s Medium B with 32 g/L NaCl (MPB). The concern was that MPB’s inclusion YE could potentially skew the results of corrosion studies. In the laboratory, static MIC tests containing postgate with and without YE were incubated for 25 d at two temperatures, 20°C and 38°C, after which analyses were performed: H 2S concentration, corrosion rate, maximum pitting penetration rate, and microbial community analysis. A significant reduction in H 2S production was observed when YE was omitted. However, an increase in corrosion was observed, suggesting that H 2S production and sulfate reduction might not be the most critical metrics for MIC. The maximum pitting penetration rate, determined by extrapolating the depth of the deepest pit on a coupon over 1 y, showed an increase with the omission of YE, but the results were not statistically significant. 16S rRNA amplicon sequencing of liquid samples revealed less bacterial DNA in samples without YE. The omission of YE caused a dramatic shift in the microbial community, with a significant increase in the relative abundance of Spirochaetaceae and a decrease in Desulfovibrionaceae at 20°C. At 38°C, the omission of YE led to an increase in the relative abundance of several families not usually associated with increases in microbial corrosion. The study emphasized the importance of multiple lines of evidence approach for diagnosing MIC, as relying solely on corrosion morphology or the presence of microorganisms can lead to false conclusions. The addition of YE to Postgate media, while beneficial for bacterial growth, seemed to inhibit the corrosion that researchers and operators aim to simulate experimentally. Excluding YE appeared to foster a more realistic microbial community, suggesting its omission in future studies. These findings question the inclusion of YE in the Postgate medium for corrosion tests and call for further research into the role of specific bacterial families in MIC, the impact of microbial diversity on MIC, and the potential role of unknown organisms in MIC. The study also emphasizes the need for a more comprehensive approach to diagnosing MIC, incorporating multiple lines of evidence.</p
A PSO-ANN-aided DC-bias Current Suppression Strategy for Three-phase DAB converter with Variable Duty Cycles
No full textDynamic performance is a critical index for three-phase dual active bridge (3ph-DAB) converter. However, the presence of dc bias in inductor current poses significant effects, such as overcurrent stress and increased power loss for 3ph-DAB converter. Additionally, the intricate structure and three control variables in variable duty cycles (VDCs) modulation pose significant challenges in analysis and deduction procedures, which suffer from high-manpower burden and low accuracy. This article proposes an artificial neural network (ANN) method to suppress the dc bias current without the need for human intervention. First, the traditional method based on space vector and piecewise modeling method is reviewed. Furthermore, the optimal objective function is established by analyzing the behavior of the converter, considering the deviation of the peak value of the inductor current between the transient and subsequent steady state. The PLECS software is utilized to acquire optimal datasets of transient variables that minimize the objective function via the particle swarm optimization (PSO) algorithm. Subsequently, two ANNs are then developed by utilizing these optimal datasets to yield data-driven models for transient variables. Finally, experimental results are given to validate the effectiveness of the proposed method, showing a reduction in the transient period to within one-third of the switching period and current stress to 88.5% compared to conventional schemes.</p
The association between antithrombotic drug regimen changes and clinical outcomes after stroke in atrial fibrillation
No full textBACKGROUND: The impact of post-stroke antithrombotic regimen in atrial fibrillation is uncertain.OBJECTIVE: This study aimed to describe antithrombotic therapy prescribing patterns after ischemic stroke and the impact on outcomes.METHODS: A total of 23,165 patients with atrial fibrillation experiencing ischemic stroke were identified. Subsequent post-stroke events included recurrent ischemic stroke, intracranial hemorrhage, major bleeding, mortality, and composite outcomes.RESULTS: Of those who were nonanticoagulated before a stroke, 33.5% remained nonanticoagulated and 39.2% were prescribed only antiplatelet agents (APs) after a stroke. Compared with non-vitamin K antagonist oral anticoagulants (NOACs) after stroke, there was a significant increase in ischemic stroke and mortality in nonanticoagulated patients (adjusted hazard ratio [aHR], 2.09 and 3.92) and AP users (aHR, 1.32 and 1.28). Post-stroke warfarin was associated with a significantly increased risk of major bleeding compared with NOACs (aHR, 1.23). Of 769 patients receiving NOACs before stroke and continuing NOACs after stroke, those switching to a different NOAC were associated with significantly higher risk of ischemic stroke (aHR, 2.07) and composite outcomes (aHR, 1.36-1.85) with no difference in intracranial hemorrhage, major bleeding, or mortality compared with those receiving the same NOAC after stroke. Of patients receiving NOACs before stroke, the risks of clinical events were similar between patients taking NOACs alone and those taking NOAC plus AP after stroke.CONCLUSION: NOAC alone after stroke was associated with a better clinical outcome compared with nonanticoagulation, AP, or warfarin. Of patients already taking NOACs before stroke, the addition of AP did not confer additional benefits compared with NOACs alone. A change of NOAC types after stroke was associated with a 2-fold higher risk of ischemic stroke and composite outcomes.</p
Risk of adverse events in anticoagulated patients with atrial fibrillation and non-alcoholic fatty liver disease
Get PDFBACKGROUND: The clinical impact of nonalcoholic fatty liver disease (NAFLD) in patients with atrial fibrillation (AF) is still controversial.AIM: To evaluate the 1-year risk of all-cause death, thromboembolic events, and bleeding in patients with AF-NAFLD.METHODS: Retrospective study with a health research network (TriNetX). Patients with AF on oral anticoagulation (OAC) were categorized according to the presence of NAFLD into 2 groups. The primary outcomes were the 1-year risks of (1) a composite cardiovascular outcome (all-cause death, myocardial infarction, stroke, cardiac arrest, and pulmonary embolism) and (2) a composite hemorrhagic outcome (intracranial hemorrhage and gastrointestinal bleeding). Cox regression analysis before and after propensity score matching was used to estimate hazard ratio (HR) and 95% 95% CI,. Sensitivity analyses investigated the risk associated with cirrhosis, thrombocytopenia, and type of OAC (warfarin vs non-vitamin K antagonist oral anticoagulants (NOACs).RESULTS: We identified 22 636 patients with AF-NAFLD (69 ± 12 years, 46.7% females) and 391 014 patients with AF and without liver disease (72 ± 12 years, 42.7% females). NAFLD was associated with a higher risk of composite cardiovascular (HR, 1.54; 95% CI, 1.47-1.61) and hemorrhagic (HR, 1.56; 95% CI, 1.42-1.72) outcomes. This was consistent also for all the single outcomes. Cirrhotic and thrombocytopenic patients with AF-NAFLD showed the highest risks. Compared to patients with AF-NAFLD on NOACs, those on warfarin were associated with a higher risk of cardiovascular and hemorrhagic outcomes.CONCLUSION: In patients with AF, NAFLD is associated with a higher 1-year risk of adverse events, with the risk of adverse events progressively increasing from noncirrhotic to cirrhotic and from nonthrombocytopenic to thrombocytopenic patients. NOACs were associated with a better effectiveness and safety profile compared to warfarin.</p
Work-Related Fear-Avoidance Beliefs and Risk of Low-Back Pain:Prospective Cohort Study Among Healthcare Workers
Get PDFPURPOSE: Low-back pain (LBP) is a prevalent condition among healthcare workers, negatively affecting well-being and work ability. Research has identified fear-avoidance beliefs, i.e., the belief that physical activities worsen or prolong pain, as a key psychological factor in LBP. Given the physical demands of healthcare work, understanding the link between fear-avoidance and LBP is crucial for effective prevention and management strategies. This study investigated the prospective association between fear-avoidance beliefs and risk of increased LBP intensity and duration in hospital workers.METHODS: Fear-avoidance beliefs and LBP were assessed in 1933 healthcare workers from 389 departments at 19 hospitals at baseline and 1-year follow-up. Associations between baseline work-related fear-avoidance beliefs (FABW) and LBP intensity and duration at follow-up were analyzed using cumulative logistic regression, adjusting for various factors including age, sex, baseline LBP, education, seniority, patient transfers, psychosocial work environment, and lifestyle.RESULTS: Moderate and high FABW was associated with higher odds of increased pain intensity (OR: 1.37 [95% CI 1.09-1.73] and 1.85 [95% CI 1.18-2.88], respectively) and prolonged pain duration (OR: 1.37 [95% CI 1.05-1.78] and 2.27 [95% CI 1.50-3.44], respectively). A sensitivity analysis including only female nurses showed similar results, with the high FABW group having significantly higher odds of increased pain intensity (OR 2.95, 95% CI 1.84-4.72) and duration (OR 2.64, 95% CI 1.55-4.49).CONCLUSIONS: Fear-avoidance beliefs increase the risk of LBP intensity and duration among healthcare workers, emphasizing the need for interventions dealing with psychological aspects of LBP.</p
Prevalence and prognostic relevance of electrocardiographic abnormalities among patients with ANCA-associated vasculitis
No full textObjectives: Current guidelines provide limited evidence for cardiovascular screening in ANCA-associated vasculitis (AAV). This study aimed to investigate the prevalence of ECG abnormalities and associations between no, minor or major ECG abnormalities with cardiovascular mortality in AAV patients compared with matched controls. Methods: Using a risk-set matched cohort design, patients diagnosed with granulomatosis with polyangiitis or microscopic polyangiitis with digital ECGs were identified from Danish registers from 2000 to 2021. Patients were matched 1:3 to controls without AAV on age, sex and year of ECG measurement. Associated hazards of cardiovascular mortality according to ECG abnormalities were assessed in Cox regression models adjusted for age, sex and comorbidities, with subsequent computation of 5-year risk of cardiovascular mortality standardized to the age- and sex-distribution of the sample. Results: A total of 1431 AAV patients were included (median age: 69 years, 52.3% male). Median follow-up was 4.8 years. AAV was associated with a higher prevalence of left ventricular hypertrophy (17.5% vs 12.5%), ST-T deviations (10.1% vs 7.1%), atrial fibrillation (9.6% vs 7.5%) and QTc prolongation (5.9% vs 3.6%). Only AAV patients with major ECG abnormalities demonstrated a significantly elevated risk of cardiovascular mortality [HR 1.99 (1.49-2.65)] compared with controls. This corresponded to a 5-year risk of cardiovascular mortality of 19.14% (16-22%) vs 9.41% (8-11%). Conclusion: Patients with AAV demonstrated a higher prevalence of major ECG abnormalities than controls. Notably, major ECG abnormalities were associated with a significantly increased risk of cardiovascular mortality. These results advocate for the inclusion of ECG assessment into routine clinical care for AAV patients.</p
Multidisciplinary team approach for CKD-associated osteoporosis
Get PDFChronic kidney disease-mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected four representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKD G5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.</p