A multidisciplinary analysis of over 53,000 fascioliasis patients along the 1995-2019 countrywide spread in Vietnam defines a new epidemiological baseline for One Health approaches.

Fascioliasis, only foodborne trematodiasis of worldwide distribution, is caused by Fasciola hepatica and F. gigantica, liver flukes transmitted by freshwater snails. Southern and southeastern Asia is an emerging hot spot of F. gigantica, despite its hitherto less involvement in human infection. In Vietnam, increasing cases have been reported since 1995, whereas only sixteen throughout 1800-1994. A database was created to include epidemiological data of fascioliasis patients from the 63 Vietnam provinces throughout 1995-2019. Case profiles were based on serology, symptoms, eosinophilia, imaging techniques, stool egg finding, and post-specific-treatment recovery. Radio broadcasting about symptoms and costless diagnosis/treatment led patients to hospitals after symptom onset. Yearly case numbers were modelled and spatio-temporally analyzed. Missing data and confounders were assessed. The countrywide spread has no precedent. It started in the central coast, including 53,109 patients, mostly adults and females. Seasonality, linked to vegetable consumption, peaks in June, although the intensity of this peak differs according to relief/climatic zones. Incidence data and logistic regression curves are obtained for the first time in human fascioliasis. Fasciolid hybrids accompanying the spreading F. gigantica flukes, and climate change assessed by risk index correlations, are both ruled out as outbreak causes. Human-guided movements of livestock from an original area prove to be the way used by fasciolids and lymnaeid vectors to expand geographically. Radix viridis, a highly efficient transmitting and colonizing vector, played a decisive role in the spread. The use of irrigated crop fields, widely inhabited by R. viridis, for livestock grazing facilitated the transmission and spread of the disease. General physician awareness and diagnostic capacity improvement proved the successful impact of such knowledge transfer in facilitating and increasing patient infection detection. Information, education and communication to the public by radio broadcasting demonstrated to be very helpful. Fasciola gigantica is able to cause epidemic and endemic situations similar to F. hepatica. The magnitude of the human outbreak in Vietnam is a health wake-up call for southern and southeastern countries of Asia which present the highest human population densities with increasing food demands, uncontrolled livestock inter-country exchange, foreign import practices, and monsoon's increasing climate change impact.

Blood Pressure/Heart Rate-Derived Ratios as Indices of Health and Cardiovascular Pathology.

This communication, based on a review of the relevant literature on ratios deriving from blood pressure and heart rate measurements, and their conformance/nonconformance to the mathematical golden rule (ie, 1.681), proposes that such ratios, particularly emanating from large numbers of home blood pressure and heart rate measurements obtained by the patients themselves or their caretakers, may constitute new risk markers, useful in the assessment of health and cardiovascular pathologies, prognosis of morbidity and mortality, and implementation to clinical practice and research.

Risk assessment of heavy metals and total petroleum hydrocarbons (TPHs) in coastal sediments of commercial and industrial areas of Hormozgan province, Iran.

The significant increase in the pollution of heavy metals and organic pollutants, their stable nature, and their high toxicity are gradually becoming a global crisis. In a recent study, a comprehensive assessment of the spatial distribution of heavy metals and total petroleum hydrocarbons (TPHs), as well as an assessment of their ecological risks in the sediments of 32 stations located in commercial and industrial areas (Mainly focusing on petrochemical and power industries, desalination plants and transit Ports) of Hormozgan province (East and West of Jask, Bandar Abbas, Qeshm, and Bandar Lengeh) was performed during 2021-2022. The sediment samples were digested with HNO3, HCl and HF solvents. The concentration of heavy metals was determined with furnace and flame systems of atomic absorption spectrometer. The concentration of heavy metals showed significant spatial changes between stations. The ecological assessment indices between the regions indicated that the stations located in Shahid Bahonar Port, Suru Beach, and Khor gorsouzuan had a higher intensity of pollution than other places and significant risks of pollution, especially in terms of Cr and Ni. The average contamination degree (CD) (14.89), modified contamination degree (MCD) (2.48), pollution load index (PLI) (2.32), and potential ecological risk index (PERI) (100.30) showed the sediments in the area of Shahid Bahonar Port, Suru beach and Khor gorsouzuan, experience significant to high levels of pollution, especially Cr and Ni. Using contamination factor (CF) and Geoaccumulation index (Igeo), Cr was considered the most dangerous metal in the studied areas. Based on the global classification of marine sediment quality for the concentrations of TPHs, the sediments of the studied stations were classified as non-polluted to low pollution. In all regions, indices of the PELq (General toxicity) and CF (Contamination factor) were much lower than 0.1 and 1 respectively, showing the absence of adverse biological effects caused by TPHs in sediments. It is necessary to consider comprehensive and impressive strategies to control and reduce pollution of heavy metals, especially in the areas of Shahid Bahonar Port, Suru Beach, and Khor gorsouzuan, so that the sources of this pollution are required to be identified and managed.

Exploring the Role of Serum Osteonectin and Hsp27 in Pediatric MAFLD Diagnosis and Cardiometabolic Health.

BACKGROUND: Childhood obesity is one of the major challenges of public health policies. The problem of fatty liver in childhood, known as MAFLD (metabolic dysfunction-associated fatty liver disease), is of particular interest as the gold standard diagnosis technique is invasive (liver biopsy). Hence, efforts are made to discover more specific biomarkers for the MAFLD signature. Therefore, the aim of the study was to evaluate Osteonectin and Hsp27 as biomarkers for MAFLD diagnosis and to assess their links with auxological and biochemical profiles of overweight and obese pediatric subjects. METHODS: A cross-sectional study in which we (re)analyzed data from the MR PONy cohort comprising 71 pediatric subjects. Auxological data, liver ultrasonography and biochemical serum profile were recorded. Lipid-derived indices and body composition indices were calculated. Nevertheless, serum Osteonectin and Hsp27 levels were assessed using an ELISA approach. RESULTS: MAFLD prevalence was 40.8%. Higher Osteonectin levels were noted in MAFLD subjects versus non-MAFLD subjects and in dyslipidemic children regardless of their liver function status. Lipid-derived indices had good diagnostic capacity for MAFLD. CONCLUSIONS: We confirm Osteonectin as a MAFLD diagnosis biomarker in children. Also, lipid-derived indices are useful as metabolic-associated organ impairment markers in children even before the onset of obesity.

A mathematical model for thrombotic risk assessment in type 2 diabetes.

Hyperglycaemia is known to alter the circulating lipids in diabetics. Combinatorial effect of in vivo synthesis of lipids and dietary lipids leads to atherosclerosis. Uncontrolled diabetes is linked with the cardiovascular outcome. This data has correlated the Castelli's Risk Index (CRI-I and CRI-II), Atherogenic Index of Plasma and Atherogenic Coefficient with microvascular complications of T2DM. Etio-pathogenesis of cardiovascular risk factors and lipid biomarkers speaks of the thrombotic events of cerebrovascular accidents and also the reno-vascular mechanisms of renal arterial thrombotic events. Documentary evidence have proved that the micro albuminuria is a "cutting edge" to assess the microvascular complications of renal and retina. Uncontrolled diabetes is known to alter the triglycerides, lower HDL-cholesterol and elevate LDL-cholesterol. Alteration of lipid profile mimics a major link between diabetes and the increased cardiovascular risk in diabetic patients.

Environmental investigation on the use of a phosphogypsum-based road material: Radiological and leaching assessment.

The transformation of phosphate ore into phosphoric acid results in the generation of high volumes of phosphogypsum (PG), an industrial by-product largely stockpiled worldwide. This solution, considered as the least damaging to the environment, constitutes a risk for the receiving environment due to the presence of harmful impurities such as heavy metals and radionuclides which hinder its large-scale valorization. This paper presents an environmental characterization of Moroccan phosphogypsum and an investigation on the environmental performance of a new lime (L) - fly ash (FA) treated phosphogypsum based road material. The concentration of metallic trace elements (Cr, Pb, Ni, Zn, Cu) in raw phosphogypsum ranged between 0.2 and 243 ppm, while its radioactivity reached 970 Bq/kg for Ra-226. The environmental performance of the proposed new road material (40% PG, 42% FA, 18% L) was evaluated using radiological risk indices besides static and dynamic leaching tests. The results showed a radioactivity reduction up to 82%, and an immobilization of metallic trace elements ranging from 25 to 100%. The stabilization/solidification mechanisms involved in the lime - fly ash treatment would be responsible for the fixation of these contaminants within the newly formed matrix.

Association of adverse childhood experiences with lipid profiles and atherogenic risk indices in a middle-to-older aged population.

Background: Adverse childhood experiences (ACE) have been associated with poor later life health outcomes, including cardiovascular disease (CVD). Limited research investigating potential underlying biological mechanisms linking ACE to CVD exists, particularly regarding lipid biomarkers. Objectives: The aim of this study was to examine the associations between childhood adversity and unfavourable lipid profiles and derived atherogenic risk indices in a middle-to-older aged population. Methods: This cross-sectional study includes 1820 participants from the Mitchelstown cohort (49% male) in Ireland. Participants' self-reported history of childhood adversity (overall and by subtypes household dysfunction, abuse and neglect) were assessed through a validated 10-item ACE questionnaire. Lipid profiles were determined and atherogenic risk indices including Castelli's Risk Index 1 and 2 (CRI-I and CRI-II), Atherogenic Coefficient (AC) and Atherogenic Index Plasma (AIP) were generated. Logistic regression analysed ACE associations with unfavourable lipid outcomes, controlling for potential confounders. Results: ACE history (reported by 23% of sample), in particular childhood exposure to household dysfunction, was associated with later-life non-optimal TG and HDL-C concentrations and atherogenic risk indices CRI-II and AC in age and sex-adjusted models (all p < 0.05). In fully adjusted models, adults reporting ACE or exposure to household dysfunction were approximately twice as likely to have pro-atherogenic CRI-II relative to adults with no ACE (OR = 1.86, 95% CI: 1.19-2.92, p = 0.006 and OR = 2.19, 95% CI: 1.33-3.61, p = 0.002, respectively). Sex-stratified analysis demonstrated sex-specific associations. Conclusions: This study provides evidence that ACEs are common among older adults in Ireland and are associated with unfavourable lipid profiles and derived atherogenic risk indices.

Interrogating the validity of cumulative indices of environmental and genetic risk for negative developmental outcomes.

Indices of cumulative risk (CR) have long been used in developmental research to encode the number of risk factors a child or adolescent experiences that may impede optimal developmental outcomes. Initial contributions concentrated on indices of cumulative environmental risk; more recently, indices of cumulative genetic risk have been employed. In this article, regression analytic methods are proposed for interrogating strongly the validity of risk indices by testing optimality of compositing weights, enabling more informative modeling of effects of CR indices. Reanalyses of data from two studies are reported. One study involved 10 environmental risk factors predicting Verbal IQ in 215 four-year-old children. The second study included an index of genetic CR in a G×E interaction investigation of 281 target participants assessed at age 15 years and then again at age 31 years for observed hostility during videotaped interactions with close family relations. Principles to guide evaluation of results of statistical modeling are presented, and implications of results for research and theory are discussed. The ultimate goals of this paper are to develop stronger tests of conjectures involving CR indices and to promote methods for improving replicability of results across studies.

Insights into the effects of tea pruning litter biochar on major micronutrients (Cu, Mn, and Zn) pathway from soil to tea plant: An environmental armour.

A field study was conducted from 0 to 360 days to investigate the effect of tea pruning litter biochar (TPLBC) on the accumulation of major micronutrients (copper: Cu, manganese: Mn, and zinc: Zn) in soil, their uptake by tea plant (clone: S.3 A/3) and level of contamination in soil due to TPLBC. To evaluate the level of contamination due to TPLBC, a soil pollution assessment was carried out using the geo-accumulation index (Igeo), enrichment factor (EF), contamination factor (CF), potential ecological risk factor (PERF), individual contamination factor (ICF), and risk assessment code (RAC). The total content of Cu, Mn, and Zn gradually increased with increasing doses of TPLBC at 0D, and then decreased with time. The fractionation of the three micronutrients in soil changed after the application of TPLBC. The contamination risk assessment of soil for Cu, Mn, and Zn based on the Igeo, EF, CF, PERF,ICF, and RAC suggested that the application of TPLBC does not have any adverse effect on soil. Except for Mn, the bioconcentration and translocation factors were less than one for Cu and Zn. Results from this study revealed that the application of 400 kg TPLBC ha-1 is significantly better than the other treatments for Cu, Mn, and Zn at a 5% level of significance.

Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study.

Background: : Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection. Methods and Material: We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model. Results: Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively). Conclusions: SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.

Amelioration of diabetes and its complications by Manilkara zapota (L) P. Royen fruit peel extract and its fractions in alloxan and STZ-NA induced diabetes in Wistar rats.

Purpose: This study aims to evaluate the effects of Manilkara zapota (L) P. Royen fruit peel extract (EMZFP) and its fractions in ameliorating diabetes and its complications in alloxan and STZ-NA induced diabetes in Wistar rats. Methods: Antidiabetic effects of EMZFP were assessed in alloxan (150 mg kg-1) induced diabetes in differently grouped rats (n=6). Diabetic rats were treated with EMZFP 150, 300, and 600 mg kg-1 while, glimepiride (0.09 mg kg-1) was used as a reference standard. Treated animals were assessed for various biological parameters i.e. blood glucose, serum lipids, nephroprotective markers, cardiovascular risk indices, liver glycogen, neuropathy, body weight, and histopathology of kidneys. However, for evaluating antidiabetic effects of fractions (chloroform, acetone, ethyl acetate, and remaining ethanol fraction) of EMZFP, diabetes was induced by streptozotocin (60 mg kg-1)-nicotinamide (120 mg kg-1/ml) in differently grouped male rats (n=6). Diabetic rats were treated with EMZFP fractions 200 mg kg-1 however; glibenclamide (10 mg kg-1) was a reference standard and evaluated for blood glucose, serum lipids, cardiovascular risk indices, and diabetic neuropathy. Results: EMZFP 300 and 600 mg kg-1/day demonstrated significant antihyperglycemic effects with augmentation in glycogen content, perfection in serum lipid profile, cardiovascular risk indices, body weight enhancement, nephroprotective effects, beneficial in peripheral neuropathy, and histopathological evidence of reversal of glomerulosclerosis. EMZFP-Et and EMZFP-EA fractions depicted a significant improvement in blood glucose, serum lipid profile, cardiovascular risk indices, and peripheral neuropathy. Conclusion: EMZFP and its Et and EA fractions ameliorated diabetes and its complications by improving glycemic control and associated biochemical alteration. Highlights: • Manilkara Zapota (L.) P. Royen fruit peel 70% ethanolic extract exert antidiabetic effects• EMZFP significantly ameliorated diabetic biochemical parameters and its complications.• EMZFP-Et and EMZFP-EA fractions exert potential antihyperglycemic, hypolipidemic effects and significantly improved cardiovascular risk indices, and peripheral neuropathy.• Studied MZFP can be used as promising natural herbal source of antidiabetic principles.

Health risk assessment of commercial fish and shrimp from the North Persian Gulf.

BACKGROUND: Bioaccumulation of trace metals in the food web demands continuous monitoring of seafood safety. Here, the food safety of commercial fish bluespot mullet Crenimugil seheli, deep flounder Pseudorhombus elevates, and Jinga shrimp Metapenaeus affinis was assessed from commercial and industrial region of the West Bandar Abbas, the North Persian Gulf, for the first time. METHODS: For this purpose, concentrations of trace metals Ni, Zn, Cu, Cr, Cd, and Pb, and their health risks were investigated. RESULTS: Results showed the average concentration of all trace metals in all species was below concentrations proposed by WHO/FAO/USEPA. The finding on risk assessment of three species indicated three species are safe for daily consumption. Long-term consumption of three species would not pose potential non-carcinogenic health risk. However, it would result in carcinogenic effects from the ingestion of trace metals Ni, Cr, and Cd. CONCLUSIONS: The data emphasizes the need for the continuous monitoring in this industrial region in the future to manage and control pollutant sources and to ensure the quality of seafood.

Risk-based implementation of COLREGs for autonomous surface vehicles using deep reinforcement learning.

Autonomous systems are becoming ubiquitous and gaining momentum within the marine sector. Since the electrification of transport is happening simultaneously, autonomous marine vessels can reduce environmental impact, lower costs, and increase efficiency. Although close monitoring is still required to ensure safety, the ultimate goal is full autonomy. One major milestone is to develop a control system that is versatile enough to handle any weather and encounter that is also robust and reliable. Additionally, the control system must adhere to the International Regulations for Preventing Collisions at Sea (COLREGs) for successful interaction with human sailors. Since the COLREGs were written for the human mind to interpret, they are written in ambiguous prose and therefore not machine-readable or verifiable. Due to these challenges and the wide variety of situations to be tackled, classical model-based approaches prove complicated to implement and computationally heavy. Within machine learning (ML), deep reinforcement learning (DRL) has shown great potential for a wide range of applications. The model-free and self-learning properties of DRL make it a promising candidate for autonomous vessels. In this work, a subset of the COLREGs is incorporated into a DRL-based path following and obstacle avoidance system using collision risk theory. The resulting autonomous agent dynamically interpolates between path following and COLREG-compliant collision avoidance in the training scenario, isolated encounter situations, and AIS-based simulations of real-world scenarios.

Ecotoxicological assessment of toxic elements contamination in mangrove ecosystem along the Red Sea coast, Egypt.

Identifying biochemical aspects of the potentially toxic elements (PTEs) is of particular concern in mangrove ecosystems, Avicennia marina (Forssk.) Vierh., due to their importance as natural buffers in coastal areas. Nonetheless, the microbial community dynamics and potential scavenging responses of mangrove ecosystems to the phytotoxicity of PTEs remain questionable. This study assesses the ecological risk benchmarks of some PTEs, including aluminum (Al), boron (B), barium (Ba), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn), and their microbial responses in the bottom sediments of mangrove ecosystems along Egypt's Red Sea coast. In particular, we assessed the role of microbial metabolites in biochemical cycling of nutrients and scavenging against phytotoxicity hazards. We quantified a spectrum of ecological risk assessment indices, which suggested elevated levels of PTEs in sediment, particularly Cr, Hg, and Pb. Canonical correspondence analysis and generalized linear mixed effects models indicate that the spatial biodiversity of microbial taxa is impacted significantly by the physicochemical characteristics of sediments and concentrations of PTEs. Results demonstrate that the microbial communities and their metabolites exert a significant influence on organic matter (OM) decomposition and the biochemical cycling of phytoavailable nutrients including nitrogen (N), phosphorus (P), and potassium (K). Spatially, nitrogenase activities were higher (411.5 µmoL h-1 mL-1) in the southern sites of the Red Sea coast relative to the northern locations (93.8 µmoL h-1 mL-1). In contrast, higher concentrations of phytohormones, including indole-3-acetic acid (IAA) (61.5 mg mL-1) and gibberellins (534.2 mg mL-1), were more evident in northern sites. Siderophores correlated positively with Fe concentration in sediments and averaged 307.4 mg mL-1. Overall, these findings provide insights into the biochemical signals of PTEs contamination in hostile environments, contributing to a better understanding of the future prospects of PTEs bioremediation in contaminated coastal environments.

Minerals, phenolics, and biological activity of wild edible mushroom, Morchella steppicola Zerova.

Tasteful morels (Morchella sp.) are one of the most popular mushrooms, both economically and scientifically. Due to their beneficial constituents, they are classified as functional foods. This study focuses on the chemical composition and biological activities of a wild edible mushroom, Morchella steppicola Zerova. The metal composition of this species reveals high levels of biogenic elements. However, according to the levels of iron and cobalt, and calculated health risk indices, this mushroom can be recommended for occasional consumption. Also, M. steppicola is found to be rich in gallic acid, protocatechuic acid, 4-hydroxybenzoic acid, and vanillic acid. Statistical analysis showed that mainly 4-hydroxybenzoic and vanillic acids are responsible for both antioxidant and inhibition of enzymes α-amylase and tyrosinase. Presented work acknowledges the fact that this mushroom has significant potential to be used for the treatment of several human disorders, similarly to other members of this genus.

Validating the US pancreas donor risk index in a Norwegian population, a retrospective observational study.

OBJECTIVES: Despite advances in immunosuppression and surgical technique, pancreas transplantation is still associated with a significant graft loss rate. The Pancreas Donor Risk Index (PDRI) is a pre-transplant scoring tool derived from a US population. We sought to validate the PDRI in a Norwegian population. METHODS: We retrospectively retrieved donor data for 344 pancreas transplants undertaken in Norway between 2000 and 2019, utilising the Scandiatransplant database, and matched these to the respective recipients. The PDRI score was calculated for each transplanted pancreas, these were then stratified into quintiles. The association between the PDRI quintiles and 1-year graft survival was calculated, and this was repeated for the different types of pancreas transplantation. The association between PDRI as a continuous variable, and graft survival was determined. Donor and recipient data were compared to the original US population. RESULTS: The overall 1-year graft survival was 82.7%. There were no significant differences in survival between the different PDRI quintiles. When viewed as a continuous variable, increased PDRI score was not associated with decreased graft survival. Significant differences between the Norwegian and US populations were found. CONCLUSIONS: When applied to a Norwegian population, the PDRI score was unable to predict 1-year graft survival.

Plasma atherogenic indices are independent predictors of slow coronary flow.

BACKGROUND: Although the pathophysiology of coronary slow flow (CSF) has not been fully elucidated, emerging data increasingly support potential role for subclinical diffuse atherosclerosis in the etiology of CSF. We aimed to investigate relationship between atherogenic indices and CSF. METHODS: 130 patients with CSF diagnosed according to Thrombolysis in Myocardial Infarction (TIMI)-frame count (TFC) method and 130 controls who had normal coronary flow (NCF) were included in this retrospective study. Atherogenic indices (atherogenic index of plasma [AIP], Castelli risk indices I and II [CRI-I and II]) were calculated using conventional lipid parameters. RESULTS: The logistic regression analyses demonstrated that AIP (OR, 5.463; 95% confidence interval [CI], 1.357-21.991; p = 0.017) and CRI-II (OR, 1.624; 95% CI, 1.138-2.319; p = 0.008) were independent predictors of CSF. Receiver operating characteristic analysis showed that the optimal cutoff value to predict the occurrence of CSF was 0.66 for AIP (sensitivity, 59%; specificity, 73%; area under curve [AUC], 0.695; p < 0.001) and 3.27 for CRI-II (sensitivity, 60%; specificity, 79%; AUC, 0.726; p < 0.001). CONCLUSIONS: AIP and CRI-II levels were independent predictors of CSF. Prospective studies in larger cohorts of patients may elucidate the role of atherogenic dyslipidemia in the pathophysiology of CSF.

Weight-bearing MRI with a knee flexion angle of 20°: a study on additional MRI investigation modalities to support a more accurate understanding of patellofemoral instability.

BACKGROUND: Diagnosing patellofemoral instability disorders correctly, weight-bearing MRI (WB-MRI) has become an option. Aiming for a best possible accuracy in displaying potentially underlying causes, the named MRI modalities were sporadically even investigated in different knee flexion angles. However, despite confirmed MRI-outcome-differences between WB-MRI and non-WB-MRI, none of the described MRI modalities have so far established themselves. Mainly this is due to an unfeasibility in daily clinical routine in regard to time and economic aspects. Thus, we intended to evaluate an additional but reduced patellofemoral MR-imaging solely in a relevant 20° of knee flexion under WB- and non-WB-MRI conditions. METHODS: Seventy-three subjects with and without patellofemoral instability were investigated under supine as well as under WB-MRI conditions in a 20° of knee flexion angle. Patellofemoral risk indices in the sagittal plane (Insall-Salvati-Index, Caton-Deschamps-Index, Patellotrochlear Index) and the axial plane (Patella tilt of Fulkerson and Sasaki) were detected and compared between the different MRI conditions. Significance, reliability and Cohen's effect size was calculated. RESULTS: Nearly all assessed indices showed significant differences between patients and controls in the different MRI positions. Comparing pairwise, all measured indices failed to show significant differences between the two MRI positions. However, patella tilt angles of the patient group showed an elevation from supine to WB-MRI (14.00 ± 7.54° to 15.97 ± 9.10° and 16.34 ± 7.84° to 18.54 ± 9.43°). Here, Cohen's d showed small to medium effects between supine and WB-MRI. CONCLUSION: In comparison to standard MRI in supine position, axial risk indices seem to be accentuated under WB-MRI and a knee flexion angle of 20°. In particular, symptomatic cases with inconspicuous conventional MRI imaging, additional MRI imaging only in the axial plane in a 20° of knee flexion could be beneficious and useful in clinical daily routine.

Comparison of comorbidity indices for prediction of morbidity and mortality after major surgical procedures.

BACKGROUND: Assessing perioperative risk is essential for surgical decision-making. Our study compares the accuracy of comorbidity indices to predict morbidity and mortality. METHODS: Analyzing the National Surgical Quality Improvement Program, 16 major procedures were identified and American Society of Anesthesiologists (ASA), Charlson Comorbidity Index and modified Frailty Index were calculated. We fit models with each comorbidity index for prediction of morbidity, mortality, and prolonged length of stay (pLOS). Decision Curve Analysis determined the effectiveness of each model. RESULTS: Of 650,437 patients, 11.7%, 6.0%, 17.0% and 0.75% experienced any, major complication, pLOS, and mortality, respectively. Each index was an independent predictor of morbidity, mortality, and pLOS (p < 0.05). While the indices performed similarly for morbidity and pLOS, ASA demonstrated greater net benefit for threshold probabilities of 1-5% for mortality. CONCLUSIONS: Models including readily available factors (age, sex) already provide a robust estimation of perioperative morbidity and mortality, even without considering comorbidity indices. All comorbidity indices show similar accuracy for prediction of morbidity and pLOS, while ASA, the score easiest to calculate, performs best in prediction of mortality.

Impact of social lockdown due to COVID-19 on environmental and health risk indices in India.

Coronavirus disease (COVID-19) spread across the globe through the human transmission. The World Health Organization suggested social distancing to curb the community spread. After national social lockdown started in India, air quality improved drastically. This further hypothesized to influence the environment and human health, and this study is positively the first to weigh it using multiple indices. The calculated environmental indices are photochemical ozone creation potential (POCP), acidification potential (AP), and eutrophication potential (EP). The cancer risk, chronic health index (CHI), and acute health index (AHI) were considered to calculate the health risk. The spatial trend change in the air pollution reflecting on these indices are calculated for four Indian megacities Delhi, Bangalore, Hyderabad, and Kolkata. Temporal variation was accounted for monthly (2019 vs 2020), one-week and two-weeks period during the social lockdown. The results showed a significant decrease in environmental and health risk during the lockdown due to a corresponding decrement in air pollution. The decrease in the particulate matter was found to play a vital role in altering the air pollution mediated risks of interest. Delhi showed a maximum difference in POCP and Acute HI by recording a dip of 70.79% and 43.53% respectively in 2020 during lockdown. The maximum reduction in health risk indices was 41%, 31%, 17%, 19% for Delhi, Bangalore, Hyderabad, and Kolkata. Bangalore recorded the maximum decline in EP, Cancer risk, Chronic HI by 66.66%, 58.62%, and 58.76% in 2020 compared to 2019. A maximum fall in AP was seen in Kolkata by 57.23% in 2020 among all cities. The connection between these drop-in indices and the cause of air pollutants were well discussed. This present paper gives more in-depth insights into air pollution's effect on environmental and health parameters by connecting and converging various air pollution aspects into a single scale. This study also enlightens the importance of controlling air pollution to have a better environment and healthy life to attain sustainable development.