Pan-immune-inflammation value: a new prognostic index in epithelial ovarian cancer.

BACKGROUND: Epithelial ovarian cancer (EOC) is one of the deadliest gynaecological malignancies worldwide. The aim of this retrospective study was to create a predictive scoring model based on simple immunological and inflammatory parameters to predict overall survival (OS) and progression-free survival (PFS) in patients with EOC. METHODS: We obtained 576 EOC patients and randomly assigned them to the training set (n = 405) and the validation set (n = 171) in a ratio of 7:3. We retrospectively evaluated the association between PIV and OS and PFS using a novel immunoinflammatory marker, according to the optihmal treshold of PIV, we divided the patients into two different subgroups, high PIV (PIV > 254.9) and low PIV (PIV ≤ 254.9). Pan-immune Inflammatory Value (PIV) was computed as follows: neutrophil count (109/L) × platelet count (109/L) × monocyte count (109/L)/lymphocyte count (109/L). Then developed a simple score prediction model based on several independent prognostic parameters using Cox regression analysis. We used receiver operator characteristic (ROC) curves, calibration plots, and decision analysis (DCA) curves to evaluate the performance of the model. Finally, we used Kaplan-Meier curves to ensure that the model could distinguish well between low- and high-risk groups. RESULTS: There was a significant difference in survival outcomes between high PIV (PIV > 310.2) and low PIV (PIV ≤ PIV310.2) (3-year survival rates of 61.34% and 76.71%, respectively); 5-year OS, 25.21% and 51.14%, respectively; 3-year PFS, 40.90% and 65.30%; 5-year PFS, 19.33% and 39.73%, respectively). Column plots of OS and PFS were constructed using independent prognostic factors. In the training module, the 3-, 5-, and 10-year AUCs for OS and PFS column charts were 0.713, 0.796, 0.839, and 0.730, 0.799, 0.826, respectively.In the validation cohort, the 3-, 5-, and 10-year AUCs for OS and PFS column charts were 0.676, 0.803, 0.685, and 0.700, respectively, 0.754, 0.727. The calibration curves showed good agreement between predicted survival and actual observations. The decision analysis curves also showed that the current model has good accuracy and clinical applicability. 3-year OS was 61.34% and 76.71%, respectively; 5-year OS was 25.21% and 51.14%, respectively; 3-year PFS was 40.90% and 65.30%, respectively; 5-year PFS was 19.33% and 39.73%, respectively. CONCLUSIONS: We constructed and validated a PIV-based nomogram to predict OS and PFS in EOC patients, with a view to helping gynaecologists converge on oncologists in their treatment and follow-up expertise in epithelial ovarian cancer.

Spatio-temporal Relationship between Three-Dimensional Deformations of a Collapsible Tube and the Downstream Flowfield.

The interactions between fluid flow and structural components of collapsible tubes are representative of those in several physiological systems. Although extensively studied, there exists a lack of characterization of the three-dimensionality in the structural deformations of the tube and its influence on the flow field. This experimental study investigates the spatio-temporal relationship between 3D tube geometry and the downstream flow field under conditions of fully open, closed, and slamming-type oscillating regimes. A methodology is implemented to simultaneously measure three-dimensional surface deformations in a collapsible tube and the corresponding downstream flow field. Stereophotogrammetry was used to measure tube deformations, and simultaneous flow field measurements included pressure and planar Particle Image Velocimetry (PIV) data downstream of the collapsible tube. The results indicate that the location of the largest collapse in the tube occurs close to the downstream end of the tube. In the oscillating regime, sections of the tube downstream of the largest mean collapse experience the largest oscillations in the entire tube that are completely coherent and in phase. At a certain streamwise distance upstream of the largest collapse, a switch in the direction of oscillations occurs with respect to those downstream. Physically, when the tube experiences constriction downstream of the location of the largest mean collapse, this causes the accumulation of fluid and build-up of pressure in the upstream regions and an expansion of these sections. Fluctuations in the downstream flow field are significantly influenced by tube fluctuations along the minor axes. The fluctuations in the downstream flowfield are influenced by the propagation of disturbances due to oscillations in tube geometry, through the advection of fluid through the tube. Further, the manifestation of the LU-type pressure fluctuations is found to be due to the variation in the propagation speed of the disturbances during the different stages within a period of oscillation of the tube.

Development of idealized human aortic models for in vitro and in silico hemodynamic studies.

Background: The aorta, a central component of the cardiovascular system, plays a pivotal role in ensuring blood circulation. Despite its importance, there is a notable lack of idealized models for experimental and computational studies. Objective: This study aims to develop computer-aided design (CAD) models for the idealized human aorta, intended for studying hemodynamics or solid mechanics in both in vitro and in silico settings. Methods: Various parameters were extracted from comprehensive literature sources to evaluate major anatomical characteristics of the aorta in healthy adults, including variations in aortic arch branches and corresponding dimensions. The idealized models were generated based on averages weighted by the cohort size of each study for several morphological parameters collected and compiled from image-based or cadaveric studies, as well as data from four recruited subjects. The models were used for hemodynamics assessment using particle image velocimetry (PIV) measurements and computational fluid dynamics (CFD) simulations. Results: Two CAD models for the idealized human aorta were developed, focusing on the healthy population. The CFD simulations, which align closely with the PIV measurements, capture the main global flow features and wall shear stress patterns observed in patient-specific cases, demonstrating the capabilities of the designed models. Conclusions: The collected statistical data on the aorta and the two idealized aorta models, covering prevalent arch variants known as Normal and Bovine types, are shown to be useful for examining the hemodynamics of the aorta. They also hold promise for applications in designing medical devices where anatomical statistics are needed.

Predictive value of inflammation and nutritional index in immunotherapy for stage IV non-small cell lung cancer and model construction.

Identifying individuals poised to gain from immune checkpoint inhibitor (ICI) therapies is a pivotal element in the realm of tailored healthcare. The expression level of Programmed Death Ligand 1 (PD-L1) has been linked to the response to ICI therapy, but its assessment typically requires substantial tumor tissue, which can be challenging to obtain. In contrast, blood samples are more feasible for clinical application. A number of promising peripheral biomarkers have been proposed to overcome this hurdle. This research aims to evaluate the prognostic utility of the albumin-to-lactate dehydrogenase ratio (LAR), the Pan-immune-inflammation Value (PIV), and the Prognostic Nutritional Index (PNI) in predicting the response to ICI therapy in individuals with advanced non-small cell lung cancer (NSCLC). Furthermore, the study seeks to construct a predictive nomogram that includes these markers to facilitate the selection of patients with a higher likelihood of benefiting from ICI therapy. A research initiative scrutinized the treatment records of 157 advanced NSCLC patients who received ICI therapy across two Jiangxi medical centers. The cohort from Jiangxi Provincial People's Hospital (comprising 108 patients) was utilized for the training dataset, while the contingent from Jiangxi Cancer Hospital (49 patients) served for validation purposes. Stratification was based on established LAR, PIV, and PNI benchmarks to explore associations with DCR and ORR metrics. Factorial influences on ICI treatment success were discerned through univariate and multivariate Cox regression analysis. Subsequently, a Nomogram was devised to forecast outcomes, its precision gauged by ROC and calibration curves, DCA analysis, and cross-institutional validation. In the training group, the optimal threshold values for LAR, PIV, and PNI were identified as 5.205, 297.49, and 44.6, respectively. Based on these thresholds, LAR, PIV, and PNI were categorized into high (≥ Cut-off) and low (< Cut-off) groups. Patients with low LAR (L-LAR), low PIV (L-PIV), and high PNI (H-PNI) exhibited a higher disease control rate (DCR) (P < 0.05) and longer median progression-free survival (PFS) (P < 0.05). Cox multivariate analysis indicated that PS, malignant pleural effusion, liver metastasis, high PIV (H-PIV), and low PNI (L-PNI) were risk factors adversely affecting the efficacy of immunotherapy (P < 0.05). The Nomogram model predicted a concordance index (C-index) of 0.78 (95% CI: 0.73-0.84). The areas under the ROC curve (AUC) for the training group at 6, 9, and 12 months were 0.900, 0.869, and 0.866, respectively, while the AUCs for the external validation group at the same time points were 0.800, 0.886, and 0.801, respectively. Throughout immunotherapy, PIV and PNI could act as prospective indicators for forecasting treatment success in NSCLC patients, while the devised Nomogram model exhibits strong predictive performance for patient prognoses.

Prognostic Significance of Pan-Immune-Inflammation Value in Patients with HER2-Positive Metastatic Breast Cancer Treated with Trastuzumab Emtansine.

Trastuzumab emtansine (T-DM1) is a mainstay therapy for HER2-positive metastatic breast cancer (mBC). However, identifying patients who will benefit most remains a challenge due to the lack of reliable biomarkers. The recently developed pan-immune-inflammation value (PIV), a novel immune-inflammation marker, could aid in this regard, considering the immunomodulatory effects of T-DM1. Therefore, we aimed to evaluate the association between the PIV and the efficacy of T-DM1 in patients with HER2-positive mBC. A total of 122 HER2-positive mBC patients treated with T-DM1 were included. Receiver operating characteristic (ROC) curve analyses were conducted to determine the optimal PIV threshold value for survival prediction. Kaplan-Meier survival curves and Cox regression analyses were used for univariable and multivariable survival analyses, respectively. The median age was 51 years, and 95.1% of the patients had ECOG PS 0-1. The optimal PIV cutoff value was identified as 338 in ROC analyses (AUC: 0.667, 95% CI: 0.569-0.765, p = 0.002). The multivariate analysis revealed that patients in the high-PIV group had significantly shorter OS (HR: 2.332; 95% CI: 1.408-3.861; p = 0.001) and PFS (HR: 2.423; 95% CI: 1.585-3.702; p < 0.001) than patients in the low-PIV group. Additionally, both ORR and DCR were significantly lower in the high-PIV group (36.6% vs. 61.3%, p = 0.011; 56.1% vs. 76.0%, p = 0.027). Our findings suggest that pre-treatment PIV may be a novel prognostic biomarker for HER2-positive mBC patients receiving T-DM1. A low PIV level is associated with more favorable outcomes. Future prospective studies are warranted to validate these findings and explore the potential utility of PIV in aiding treatment decisions.

Rupture point is associated with divergent hemodynamics in intracranial aneurysms.

Background: Understanding the risk factors leading to intracranial aneurysm (IA) rupture have still not been fully clarified. They are vital for proper medical guidance of patients harboring unruptured IAs. Clarifying the hemodynamics associated with the point of rupture could help could provide useful information about some of the risk factors. Thus far, few studies have studied this issue with often diverging conclusions. Methods: We identified a point of rupture in patients operated for an IAs during surgery, using a combination of preoperative computed tomography (CT) and computed tomography angiography (CTA). Hemodynamic parameters were calculated both for the aneurysm sac as a whole and the point of rupture. In two cases, the results of CFD were compared with those of the experiment using particle image velocimetry (PIV). Results: We were able to identify 6 aneurysms with a well-demarcated point of rupture. In four aneurysms, the rupture point was near the vortex with low wall shear stress (WSS) and high oscillatory shear index (OSI). In one case, the rupture point was in the flow jet with high WSS. In the last case, the rupture point was in the significant bleb and no specific hemodynamic parameters were found. The CFD results were verified in the PIV part of the study. Conclusion: Our study shows that different hemodynamic scenarios are associated with the site of IA rupture. The numerical simulations were confirmed by laboratory models. This study further supports the hypothesis that various pathological pathways may lead to aneurysm wall damage resulting in its rupture.

Awareness of peripheral IV catheters among nurses, physicians, and trainees: A prospective cohort study.

BACKGROUND: Peripheral intravenous catheters (PIVs) are the most frequently used invasive device in hospitalized patients. These devices are not benign and are associated with complications. However, clinician awareness of them is variable and poorly understood. METHODS: We conducted a prospective, multicenter, observational point prevalence study to assess awareness of PIV presence among clinicians caring for hospitalized patients in 4 hospitals between May 2018 and February 2019 located in Michigan, USA. We first assessed patients for the presence of a PIV then interviewed their providers. Differences in awareness by provider type were assessed via χ² tests; P < .05 was considered statistically significant. Analyses were performed on Stata MP v16. RESULTS: A total of 1,385 patients and 4,003 providers were interviewed. Nurses had the greatest awareness of overall PIV presence, 98.6%, while attendings were correct 88.1% of the time. Nurses were more likely to correctly assess PIV presence and exact location than physicians (67.7% vs <30% for all others). Awareness of PIV presence did not significantly vary in patients on contact precautions or those receiving infusions. CONCLUSIONS: Given the ubiquity of PIVs and known complications, methods to increase awareness to ensure appropriate care and removal are necessary.

A digital image analysis approach to understand the microscopic and macroscopic phenomena in dissolved air flotation.

Dissolved air flotation (DAF) is an effective method for separating suspended oil and solid particles from wastewater by utilizing small air bubbles. This study aims to investigate the impact of key factors, such as saturating pressure and water flow rate, on the separation of fine oil droplets from a water stream. The macroscopic flow patterns within the cell were analyzed using particle image velocimetry (PIV), while Digital Image Analysis (DIA) was employed to study microscopic phenomena, including oil droplet rising velocity and oil-bubble contact mechanisms. Our findings propose a safe operating window (specifically, water flow rate and saturation pressure) for the effective separation of oil droplets without any oil escaping into the clean water stream. It was found that the oil droplet rising velocity increases with the saturation pressure up to 200 kPa. However, a further increase in the pressure of the air saturating chamber leads to a decrease in oil droplet rising velocity. Additionally, we identified a peak in rising velocity at an oil droplet size of approximately 200 µm. Below this threshold, the rising velocity increases with droplet size, while for droplet sizes exceeding 200 µm, the rising velocity decreases with size. This behavior can be explained by the conflicting effects of droplet size increment according to the Stokes law for the rising velocity of oil droplets. As the droplet size increases, the average density of the bubbles/droplet aggregate rises, reducing the ∆ρ in the Stokes law and subsequently lowering the aggregate rising rate. However, as per the Stokes law, the oil droplet rising velocity increases proportionally to the square of its size.

Epidemiological and Genetic Characteristics of Respiratory Viral Coinfections with Different Variants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

This study aimed to determine the incidence and etiological, seasonal, and genetic characteristics of respiratory viral coinfections involving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Between October 2020 and January 2024, nasopharyngeal samples were collected from 2277 SARS-CoV-2-positive patients. Two multiplex approaches were used to detect and sequence SARS-CoV-2, influenza A/B viruses, and other seasonal respiratory viruses: multiplex real-time polymerase chain reaction (PCR) and multiplex next-generation sequencing. Coinfections of SARS-CoV-2 with other respiratory viruses were detected in 164 (7.2%) patients. The most common co-infecting virus was respiratory syncytial virus (RSV) (38 cases, 1.7%), followed by bocavirus (BoV) (1.2%) and rhinovirus (RV) (1.1%). Patients ≤ 16 years of age had the highest rate (15%) of mixed infections. Whole-genome sequencing produced 19 complete genomes of seasonal respiratory viral co-pathogens, which were subjected to phylogenetic and amino acid analyses. The detected influenza viruses were classified into the genetic groups 6B.1A.5a.2a and 6B.1A.5a.2a.1 for A(H1N1)pdm09, 3C.2a1b.2a.2a.1 and 3C.2a.2b for A(H3N2), and V1A.3a.2 for the B/Victoria lineage. The RSV-B sequences belonged to the genetic group GB5.0.5a, with HAdV-C belonging to type 1, BoV to genotype VP1, and PIV3 to lineage 1a(i). Multiple amino acid substitutions were identified, including at the antibody-binding sites. This study provides insights into respiratory viral coinfections involving SARS-CoV-2 and reinforces the importance of genetic characterization of co-pathogens in the development of therapeutic and preventive strategies.

Predicting coronary artery severity in patients undergoing coronary computed tomographic angiography: Insights from pan-immune inflammation value and atherogenic index of plasma.

BACKGROUND AND AIMS: Coronary computed tomographic angiography (CCTA) is pivotal in diagnosing coronary artery disease (CAD). We explored the link between CAD severity and two biomarkers, Pan-Immune Inflammation Value (PIV) and Atherogenic Index of Plasma (AIP), in stable CAD patients. METHODS AND RESULTS: A retrospective observational study of 409 CCTA patients with stable angina pectoris. Logistic regression identified predictors of severe CAD, stratified by CAD-RADS score. Receiver Operating Characteristic (ROC) curves evaluated predictive performance. PIV and AIP were significant predictors of severe CAD (PIV: OR 1.002, 95% CI: 1.000-1.004, p < 0.021; AIP: OR 0.963, 95% CI: 0.934-0.993, p < 0.04). AUC values for predicting severe CAD were 0.563 (p < 0.001) for PIV and 0.625 (p < 0.05) for AIP. Combined with age, AUC improved to 0.662 (p < 0.02). CONCLUSIONS: PIV and AIP were associated with severe CAD, with AIP demonstrating superior predictive capability. Incorporating AIP into risk assessment could enhance CAD prediction, offering a cost-effective and accessible method for identifying individuals at high risk of coronary atherosclerosis.

The pan immune inflammatory value in relation to non-alcoholic fatty liver disease and hepatic fibrosis.

BACKGROUND: Inflammation played a critical role in non-alcoholic fatty liver disease (NAFLD). Here, we aimed to explore the relationship between inflammatory biomarkers and the prevalence of NAFLD and hepatic fibrosis in US participants. METHODS: Individuals with complete data from National Health and Nutrition Examination Survey (NHANES), 2017-2020 pre-pandemic cycle dataset were referred to this study. We identified NAFLD by vibration-controlled transient elastography (VCTE) on the basis of controlling attenuation parameter (CAP) ≥274dB/m. Liver fibrosis was confirmed by liver stiffness measurement (LSM) ≥8.2kPa. Multivariate logistic regression models were applied to estimate the correlations between inflammatory biomarkers and the prevalence of NAFLD and hepatic fibrosis based on sample weights. RESULTS: All together 5026 subjects were incorporated into the study cohort. Among these subjects, 2209 were classified as having NAFLD, and 8.35 % were diagnosed with hepatic fibrosis. Pan immune inflammatory value (PIV), instead of systemic immune inflammatory index (SII), was positively correlated with the rate of NAFLD or hepatic fibrosis. Subgroup analysis for NAFLD revealed that the positive relationships of the PIV existed in males (OR=1.52, 95 % CI: 1.01-2.28, p = 0.046) and participants below 60 years of age (OR=1.49, 95 % CI: 1.05-2.1, p = 0.028). Moreover, subgroup analysis for hepatic fibrosis revealed that the positive relationships of the PIV existed in females (OR=2.09, 95 % CI: 1.2-3.63, p = 0.014) and participants below 60 years of age (OR=1.74, 95 % CI: 1.09-2.77, p = 0.023). CONCLUSIONS: A higher PIV, but not SII, is associated with a higher likelihood of NAFLD and liver fibrosis, suggesting that the PIV is a more valuable inflammatory marker for assessing NAFLD and liver fibrosis in participants, especially for those who are below 60 years of age.

Role of allogeneic placental tissues in penile inversion vaginoplasty.

Background: The role of allogeneic placental tissue (APT) in genital gender-affirming surgery (GAS) is not well understood. Penile inversion vaginoplasty (PIV), the most common genital GAS, often results in tissue healing- or wound-related complications, including scarring and neovaginal stenosis. Surgical reoperation and revision vaginoplasty are common. The aim of this study was to evaluate the contribution of APT to postoperative outcomes in PIV. Methods: The authors performed a retrospective analysis of consecutive adult patients undergoing primary PIV during a 6-year period (September 1, 2014 to September 1, 2020). Subjects receiving intraoperative application of an APT biomaterial were compared to those undergoing primary PIV without APT. Postoperative outcomes-including wound healing morbidity and reoperation-were compared between groups. Short- and long-term complications were classified using Clavien-Dindo. Results: A total of 182 primary PIV cases were reviewed (115 conventional PIV; 67 PIV-APT). The postoperative follow-up time for the population averaged 12.7 months. All-cause and wound related complications were significantly lower amongst PIV-APT patients when compared to conventional PIV (P=0.002 and P=0.004, respectively). The rate of long-term complications was significantly lower in PIV-APT subjects: prolonged pain (P=0.001), prolonged swelling (P=0.047), and neovaginal stenosis (P<0.001). The PIV-APT group required significantly less reoperation for vaginal depth enhancement (P=0.007). Conclusions: Though its use in urogenital reconstruction has been limited, this study indicates that the placement of APT during PIV significantly lowered the risk of complications associated with poor wound healing. This supports a novel use for placental tissues in reducing complications in genital GAS.

Effect of basket mesh size on the hydrodynamics of a partially filled (500 mL) USP rotating basket dissolution testing Apparatus 1.

The USP Rotating Basket Dissolution Testing Apparatus 1 is listed in the USP as one of the tools to assess dissolution of oral solid dosage forms. Baskets of different mesh sizes can be used to differentiate between dissolution profiles of different formulations. Here, we used Particle Image Velocimetry (PIV) to study the hydrodynamics of the USP Apparatus 1 using baskets with different mesh openings (10-, 20- and 40-mesh) revolving at 100 rpm, when the vessel was filled with 500 mL. The velocity profiles throughout the liquid were found to vary significantly using baskets of different mesh sizes, typically increasing with increased size of the opening of the basket mesh, especially for axial and radial velocities. This, in turn, resulted in a significantly different flow rate through the basket, which can be expected to significantly impact the dissolution rate of the drug product. A comparison between the results of this work with those of a previous study with a 900-mL fill volume (Sirasitthichoke et al., Intern. J. Pharmaceutics, 2021, 607: 120976), shows that although the hydrodynamics in the USP Apparatus 1 changed with fill level in the vessel, the flow rate through the basket was not significantly affected. This implies that tablets dissolving in the two systems would experience similar tablet-liquid medium mass transfer coefficients, and therefore similar initial dissolution rates, but different dissolution profiles because of the difference in volume.

Drafting behaviors in fish induced by a local pressure drop around a hydrofoil model.

Fish schooling has the improvement in hydrodynamic propulsive efficiency through the interaction of flow field induced by fish bodies and tail beat. Such energy-saving behaviors due to flow interactions also occur with changes in the flow field caused by structures. We examined the differences between a live fish swimming around a streamlined hydrofoil model prepared to represent fish body and swimming alone in a flow tank. We observed that the fish can remain in the same place without tail beating. It called "drafting" behavior. The analysis of fish drafting showed that fish obtained thrust using a local pressure drop caused by the high velocity flow even in the vicinity of the hydrofoil model at an angle of attack α of 10° to 20°without flow separation, and fish balanced forces by using an α of fish body. This tendency was confirmed in the model experiment using a two-axis load cell, and the forces acting on the fish body was the smallest value when the fish model was placed in the same conditions as a live fish experiment. We also confirmed by simulation and found that the α of fish body generated lift force and counteract the suction force. Above results indicate that a fish can balance the anterior-posterior and lateral direction forces by using a local pressure drop around a hydrofoil model as suction force, and using angle of attack on its body, thereby realizing drafting.

Does the Outcome of Graft Materials at Dental Implant Sites Differ Between Patients With Normal and Compromised Bone Health?

The objective of this paper was to assess the outcome of bone graft material at alveolar bone augmentation sites combined with dental implants in postmenopausal women with compromised bone health by evaluating cone beam computerized tomography (CBCT) scans at multiple time points.CBCT scans were analyzed on 55 postmenopausal women with compromised bone health status to determine the fate of alveolar bone augmentation. CBCT scans were taken immediately after surgery and 9 and 24 months postoperatively. The patient's medication regimens and durations were recorded, and the pixel intensity value (PIV) was measured and standardized using scoring criteria and visual assessment. Statistical analyses included 2-sample t tests for continuous variables and Fisher's exact tests for categorical variables.Among the normal patients, 73% received a grade 2 visual score, and 27% received a grade 1 visual score. After 24 months, 45% of patients received a grade 2 score, and 27% received a grade 3 score. In the osteoporotic group receiving medication, 77% of participants received a grade 1 visual score at the 9-month postoperative evaluation, while 23% received a grade 2 score. At the 24-month assessment, 55% of patients received a grade 1 score, 41% received a grade 2 score, and only 5% received a grade 3 score. Notably, although the graft material did not remodel into native bone, it was a scaffold for implants in controlled osteoporotic patients. The study's results show that the pixel intensity values of particulate graft materials are similar across the three different time points, suggesting that the graft material's pixel intensity value remains constant in postmenopausal women with osteoporosis. The study's limitations include a small sample size and a restricted 24-month follow-up period. This limited time frame may need to capture long-term changes or variations in graft materials adequately. Future research should include a larger sample size and have a longer follow-up duration to provide a more comprehensive understanding of the change in graft materials between patients with normal and compromised bone health.

Establishing a plan to improve pediatric patient comfort during PIV insertions and blood specimen collection: a quality improvement effort.

HIGHLIGHTS: Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. BACKGROUND: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. DESIGN AND METHODS: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. AIMS AND OBJECTIVES: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. RESULTS: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. CONCLUSIONS: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

Cavitation suppression and transformation of turbulence structure in the cross flow around a circular cylinder: Surface morphology and wettability effects.

Passive methods of flow and cavitation control appear to offer some of the best prospects in the field of hydraulic engineering and marine applications. In this article, we aimed at an experimental examination of the effect of wall roughness/wettability on the occurrence of cavitation and turbulence structure in the cross flow around and in the wake of a circular cylinder in two characteristic regimes. For this, we used three test bodies with different surface morphologies: smooth (reference), micro-scale irregularities (rough) and regular large-scale (of the order of a millimeter) texture (finned). Using high-speed imaging to observe vapor cavities, we revealed that cavitation is noticeably suppressed by both types of roughness. Applying the method of vapor phase detection (Pervunin et al., 2021), this finding was then quantitatively confirmed through an in-depth analysis of an ensemble of instantaneous velocity fields measured by PIV, indicating that modification of wall morphology is an effective method of cavitation control. The procedure of statistical vector filtration (Heinz et al., 2004) allowed us to remove outliers from the velocity fields and, thus, calculate various turbulence characteristics, including higher-order moments (i.e., the coefficients of skewness and excess). Wall irregularities were found to significantly affect the turbulence structure of the wake flow, but the higher-order moments downstream of the modified-surface cylinders turned out to be unexpectedly insensitive to a change in the flow regime, as opposed to the smooth one. Regardless of the type of surface morphology, the influence of roughness on the mechanism of formation of large-scale vortices and their characteristics was weakened. However, it caused overall disorganization of liquid motion in the cylinder wake, thus making local flow conditions highly unsteady. In addition, this process became more chaotic with an increase in the scale of irregularities.

The Effect of Mechanical Circulatory Support on Blood Flow in the Ascending Aorta: A Combined Experimental and Computational Study.

Percutaneous mechanical circulatory support (MCS) devices are designed for short-term treatment in cases of acute decompensated heart failure as a bridge to transplant or recovery. Some of the known complications of MCS treatments are related to their hemodynamics in the aorta. The current study investigates the effect of MCS on the aortic flow. The study uses combined experimental and numerical methods to delineate complex flow structures. Particle image velocimetry (PIV) is used to capture the vortical and turbulent flow characteristics in a glass model of the human aorta. Computational fluid dynamics (CFD) analyses are used to complete the 3D flow in the aorta. Three specific MCS configurations are examined: a suction pump with a counterclockwise (CCW) rotating impeller, a suction pump with a clockwise (CW) rotating impeller, and a discharge pump with a straight jet. These models were examined under varying flow rates (1-2.5 L/min). The results show that the pump configuration strongly influences the flow in the thoracic aorta. The rotating impeller of the suction pump induces a dominant swirling flow in the aorta. The swirling flow distributes the incoming jet and reduces the turbulent intensity near the aortic valve and in the aorta. In addition, at high flow rates, the local vortices formed near the pump are washed downstream toward the aortic arch. Specifically, an MCS device with a CCW rotating impeller induces a non-physiological CCW helical flow in the descending aorta (which is opposite to the natural helical flow), while CW swirl combines better with the natural helical flow.

Impact of variations in swimming velocity on wake flow dynamics in human underwater undulatory swimming.

Increasing the velocity of the lower-limb movement is crucial for improving underwater undulatory swimming (UUS) velocity. However, the underlying mechanism of how these movements influence swimming velocity have remained unclear. This study aimed to clarify the relationship between changes in swimming movement and the resulting changes in flow field as a result of changes in test flow velocity (U) in a water flume. A male student swimmer was tested with the following three U settings 0.8, 1.0 and 1.2 m/s. The lower-limb movements and wake flow behind the swimmer were compared. A motion capture system was employed for motion analysis, and a stereo PIV for visualizing the flow field. The findings revealed that, as U increased, the velocity vectors of the flow field in all directions (u, v, w) increased, as did the toe velocity. It was also suggested that with increasing U, the outward change in the toe velocity vector down-kick and the inward change in the toe velocity vector up-kick may have a positive effect on the vortices, contributing to an increase in the velocity vectors in the flow field. Furthermore, the high U, vortex re-capturing occurred during the transition from down-kick to up-kick, indicating that this might contribute to increased momentum. This suggests that the transition from the down-kick to the up-kick is necessary for gaining greater momentum. Notably, this study is the first to identify the factors that increase the swimming velocity of the UUS in the context of movement and flow field.

Association of immune inflammatory biomarkers with pathological complete response and clinical prognosis in young breast cancer patients undergoing neoadjuvant chemotherapy.

Background: The persistence of inflammatory stimulus has a tight relationship with the development of age-related diseases, ultimately resulting in a gradual escalation in the prevalence of tumors, but this phenomenon is rare in young cancer patients. Breast cancer arising in young women is characterized by larger tumor diameters and more aggressive subtypes, so neoadjuvant chemotherapy (NACT) can be especially appropriate for this population. Immune inflammatory biomarkers have been reportedly linked to the prognosis of some malignant tumor types, with varying results. In this study, we investigated the possible predictive value of blood-based markers in young breast cancer patients undergoing NACT, in addition to the association between the clinicopathological features and prognosis. Methods: From December 2011 to October 2018, a total of 215 young breast cancer patients referred to Harbin Medical University Cancer Hospital received NACT and surgery were registered in this retrospective study. The pretreatment complete blood counts were used to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and pan-immune-inflammation value (PIV). Results: NLR, PLR, MLR, and PIV optimal cut-off values were 1.55, 130.66, 0.24, and 243.19, as determined by receiver operating characteristic analysis. Multivariate analysis revealed that PIV, HR status, HER-2 status, and Ki-67 index were all independent predictive factors for pathological complete response. Subgroup analysis revealed that young breast cancer patients in the population characterized by low PIV and HR negative group were more likely to get pCR (P=0.001). The five-year overall survival (OS) rate was 87.9%, and Cox regression models identified PIV as independently related to OS. Conclusion: In the present study, the pretreatment PIV was found to be a useful prognostic indicator for pCR and long-term survival in young breast cancer patients undergoing NACT. High immune and inflammation levels, MLR and PIV were connected to poor clinical prognosis in young breast cancer patients. PIV is a promising biomarker to guide strategic decisions in treating young breast cancer.