Harnessing Artificial Intelligence for Enhanced Renal Analysis: Automated Detection of Hydronephrosis and Precise Kidney Segmentation.

Background and objective: Hydronephrosis is essential in the diagnosis of renal colic. We automated the detection of hydronephrosis from ultrasound images to standardize the therapy and reduce the misdiagnosis of renal colic. Methods: Anonymously collected ultrasound images of human kidneys, both normal and hydronephrotic, were preprocessed for neural networks. Six "state of the art" models were trained and cross-validated for the detection of hydronephrosis, and two convolutional networks were used for kidney segmentation. In the testing phase, performance metrics included true positives, true negatives, false positives, false negatives, accuracy, and F1 score, while the evaluation of the segmentation task involved accuracy, precision, dice, jaccard, recall, and ASSD. Key findings and limitations: A total of 523 sonographic kidney images (423 nonhydronephrotic and 100 hydronephrotic) were collected from three different ultrasound devices. After training on this dataset, all models were used to evaluate 200 new ultrasound kidney images (142 nonhydronephrotic and 58 hydronephrotic kidneys). The highest validation accuracy (98.5%) was achieved by the AlexNet model (GoogLeNet 97%, AlexNet_v2 96%, ResNet50 96%, ResNet101 97.5%, and ResNet152 95%). The deeplabv3_resnet50 and deeplabv3_resnet101 reached a dice coefficient of 94.74% and 94.48%, respectively, on the task of automated kidney segmentation. The study is limited by analyzing only hydronephrosis, but this specific focus enabled high detection accuracy. Conclusions and clinical implications: We show that our automated ultrasound deep learning model can be trained and used to interpret and segmentate ultrasound images from different sources with high accuracy. This method will serve as an automated tool in the diagnostic algorithm of acute renal failure in the future. Patient summary: Hydronephrosis is crucial in the diagnosis of renal colic. Recent advances in artificial intelligence allow automated detection of hydronephrosis in ultrasound images with high accuracy. These methods will help standardize the diagnosis and treatment renal colic.

Relación del nivel socioeconómico con el rendimiento académico de estudiantes durante la pandemia por COVID-19 / Relationship of socioeconomic level with the academic performance of students during the COVID-19 pandemic

Introducción: el nivel socioeconómico (NSE) de las familias tiene un papel fundamentan en el desempeño académico de los estudiantes. Durante la pandemia, las familias con NSE bajo tuvieron menores oportunidades y se acrecentaron las desigualdades por limitaciones económicas y técnicas, lo cual pudo haber influido en las calificaciones y rendimiento académico de los alumnos. Objetivo: identificar la relación entre el NSE y el rendimiento académico de un grupo de estudiantes de licenciatura en enfermería durante la pandemia COVID-19. Metodología: estudio transversal, cuantitativo, analítico, con alumnos que tuvieron educación a distancia, se utilizó el instrumento denominado Nivel Socioeconómico (NSE) de la Asociación Mexicana de Agencias de Inteligencia de Mercado y Opinión Pública (AMAI), así como los promedios del semestre cursado en línea Resultados: participaron 167 alumnos, entre las variables de rendimiento académico y nivel socioeconómico se obtuvo un valor de p = 0.961, para las variables de sexo y estado civil se encontró asociación con un valor de p < 0.05. Conclusiones: no se identificó ninguna relación entre las variables del rendimiento académico y el nivel socioeconómico; sin embargo, otras variables como estado civil y sexo dieron significancia estadística, por lo que se sugiere ahondar en estas variables, así como su relación con el rendimiento académico.

Introduction: The socioeconomic level (SES) of families has a fundamental role in the academic performance of students, during the pandemic families with a low SES had fewer opportunities and increased inequalities due to economic and technical limitations, which could influence grades and academic performance. of the students Objective: To identify th e relationship between the SES and aca demic performance of nursing undergraduate students during COVID-19. Methodology: Cross-sectional, quantitative, analytical study with students who had distance education, the instrument called Socioeconomic Level (NSE) of the Mexican Association of Market Intelligence Agencies and Public Opinion (AMAI) was used. and the averages of the semester completed online. Results: 167 students participated, between the variables of academic performance and socioeconomic level a value of p = 0.961 was obtained, for the variables of sex, marital status an association was found with a p value less than 0.05. Conclusions: No relationship was identified between the variables of academic performance and socioeconomic level, however, other variables such as marital status and sex gave statistical significance, so it is suggested to delve into these variables as well as their relationship with academic performance.

Genomic object detection: An improved approach for transposable elements detection and classification using convolutional neural networks.

Analysis of eukaryotic genomes requires the detection and classification of transposable elements (TEs), a crucial but complex and time-consuming task. To improve the performance of tools that accomplish these tasks, Machine Learning approaches (ML) that leverage computer resources, such as GPUs (Graphical Processing Unit) and multiple CPU (Central Processing Unit) cores, have been adopted. However, until now, the use of ML techniques has mostly been limited to classification of TEs. Herein, a detection-classification strategy (named YORO) based on convolutional neural networks is adapted from computer vision (YOLO) to genomics. This approach enables the detection of genomic objects through the prediction of the position, length, and classification in large DNA sequences such as fully sequenced genomes. As a proof of concept, the internal protein-coding domains of LTR-retrotransposons are used to train the proposed neural network. Precision, recall, accuracy, F1-score, execution times and time ratios, as well as several graphical representations were used as metrics to measure performance. These promising results open the door for a new generation of Deep Learning tools for genomics. YORO architecture is available at https://github.com/simonorozcoarias/YORO.

Follow up of a cohort of patients with acute coronary syndrome without obstructive coronary disease. At a tertiary care center during 2019 and 2020

Introduction: 10% of acute myocardial infarctions occur with nonobstructive coronary arteries (MINOCA). These myocardial infarctions represent a group of conditions with less than 50% stenosis. The characteristics of the population with MINOCA in the region are unknown. The objective is to characterize the population with MINOCA and identify the factors associated with adverse outcomes. Materials and methods: this was an analytical cohort study which identified various char acteristics of patients with MINOCA at a tertiary care center in Pereira. From January 1, 2019, to December 31, 2020, 1,500 coronary arteriographies were reviewed; 292 met the angiographic criteria for MINOCA and, of these, 163 patients met the inclusion criteria. The primary outcome was a composite of hospitalization for angina/heart failure, reperfusion therapy, and death from cardiovascular causes and from any cause at six months and one year. Results: the median age was 64 years; 54% (n=88) were men. Arterial hypertension was the most prevalent comorbidity (n=100; 61.3%), and the most common electrocardiographic presenta tion was T wave inversion (29.7%; n=47). Altogether, 19.3% (n=28) and 25.5% (n=37) had some outcome at six months and one year. One-year mortality was 5.5%. On multivariate analysis, the initial troponin, moderate to severe aortic regurgitation and right bundle branch block were associ ated with the event. Conclusion: we have presented the Colombian study with the largest cohort of patients with MINOCA, identifying factors associated with adverse outcomes. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2742).

Inpactor2: a software based on deep learning to identify and classify LTR-retrotransposons in plant genomes.

LTR-retrotransposons are the most abundant repeat sequences in plant genomes and play an important role in evolution and biodiversity. Their characterization is of great importance to understand their dynamics. However, the identification and classification of these elements remains a challenge today. Moreover, current software can be relatively slow (from hours to days), sometimes involve a lot of manual work and do not reach satisfactory levels in terms of precision and sensitivity. Here we present Inpactor2, an accurate and fast application that creates LTR-retrotransposon reference libraries in a very short time. Inpactor2 takes an assembled genome as input and follows a hybrid approach (deep learning and structure-based) to detect elements, filter partial sequences and finally classify intact sequences into superfamilies and, as very few tools do, into lineages. This tool takes advantage of multi-core and GPU architectures to decrease execution times. Using the rice genome, Inpactor2 showed a run time of 5 minutes (faster than other tools) and has the best accuracy and F1-Score of the tools tested here, also having the second best accuracy and specificity only surpassed by EDTA, but achieving 28% higher sensitivity. For large genomes, Inpactor2 is up to seven times faster than other available bioinformatics tools.

Preparing Future Medicine Physicians to Care for Cancer Survivors: Project ECHO® in a Novel Internal Medicine and Family Medicine Residency Curriculum.

Cancer survivorship education is limited in residency training. The goal of this pilot curriculum was to teach medicine residents a structured approach to cancer survivorship care. During the 2020-2021 academic year, we held eight 45-min sessions in an ambulatory noon conference series for a community family medicine (FM) and internal medicine (IM) residency program. The curriculum used Project ECHO®, an interactive model of tele-education through Zoom video conferencing, to connect trainees with specialists. Each session had a cancer-specific focus (e.g., breast cancer survivorship) and incorporated a range of core survivorship topics (e.g., surveillance, treatment effects). The session format included a resident case presentation and didactic lecture by an expert discussant. Residents completed pre- and post-curricular surveys to assess for changes in attitude, confidence, practice patterns, and/or knowledge in cancer survivorship care. Of 67 residents, 23/24 FM and 41/43 IM residents participated in the curriculum. Residents attended a mean of 3 sessions. By the end of the curriculum, resident confidence in survivorship topics (surveillance, treatment effects, genetic risk assessment) increased for breast, colorectal, and prostate cancers (p < 0.05), and there was a trend toward residents stating they ask patients more often about cancer treatment effects (p = 0.07). Over 90% of residents found various curricular components useful, and over 80% reported that the curriculum would improve their practice of cancer-related testing and treatment-related monitoring. On a 15-question post-curricular knowledge check, the mean correct score was 9.4 (63%). An eight-session curriculum improved resident confidence and perceived ability to provide cancer survivorship care.

Impacto da técnica de dissecção/ reentrada anterógrada nas intervenções coronárias percutâneas para oclusão crônica: registro LATAM Chronic Total Occlusion / Impact of antegrade dissection and re-entry technique on coronary percutaneous interventions for chronic total occlusion: the LATAM Chronic Total Occlusion registry

Introdução: As mais novas técnicas de intervenção coronária percutânea em oclusões crônicas podem melhorar o sucesso técnico. Os objetivos deste estudo foram descrever a segurança e a eficácia da técnica de dissecção/reentrada anterógrada como estratégia inicial de revascularização. Métodos: Registro multicêntrico de países latino-americanos (LATAM Chronic Total Occlusion). Analisamos as características iniciais e os desfechos dos casos em que foi empregada dissecção/ reentrada anterógrada como estratégia primária ou de resgate após escalonamento de fios por via anterógrada. Foram excluídos os casos de abordagem retrógrada. Os médicos usaram dissecção anterógrada convencional e técnica de reentrada. Resultados: Dos 1.875 pacientes analisados, em 50 foi planejada a dissecção/reentrada anterógrada, e, em 1.825, foi planejado o escalonamento de fios por via anterógrada primário. Deu-se preferência à dissecção/reentrada anterógrada em pacientes mais idosos e com história de revascularização (revascularização do miocárdio: dissecção/ reentrada anterógrada em 33,3% e escalonamento de fios por via anterógrada primário em 13,4%, com p<0,001; intervenções coronárias percutâneas em 66,6 e 48,8%, respectivamente, com p=0,012). Oclusões crônicas mais longas (30mm [22-41] e 21mm [15-30], p<0,001) e calcificações moderadas ou graves (62 e 42,6%, com p=0,008) foram associadas à seleção da dissecção/reentrada anterógrada primária, ao invés do escalonamento de fios por via anterógrada primário. Houve correlação significativa entre o aumento do escore J-CTO (X2=37, df=5; p<0,001) e o uso da dissecção/ reentrada anterógrada. O escalonamento de fios por via anterógrada primário teve taxa de sucesso de 88,4%, e a dissecção/reentrada anterógrada, de 76,7%. Para o escalonamento de fios por via anterógrada primário e dissecção/reentrada anterógrada de resgate, o uso do dispositivo CrossBoss® foi relacionado às maiores taxas de sucesso (92,3 e 82,7%, respectivamente). Os desfechos a curto prazo foram semelhantes nos grupos. Conclusão: Na América Latina, a técnica de dissecção/ reentrada anterógrada foi segura e efetiva, tanto como estratégia primária quanto de resgate, mesmo quando utilizada em lesões de maior complexidade. O uso de dispositivos específicos foi relacionado a uma maior taxa de sucesso.

Background: The newest techniques of percutaneous coronary interventions for chronic total occlusion may improve technical success. The objectives were to describe safety and efficacy of antegrade dissection and reentry technique as initial revascularization strategy. Methods: A multicenter registry from Latin American countries (LATAM Chronic Total Occlusion). Baseline characteristics and outcomes of cases using antegrade dissection and reentry as primary strategy or bailout of antegrade wire escalation were analyzed. Retrograde approach cases were excluded. Physicians used conventional antegrade dissection and reentry technique. Results: Out of 1,875 patients analyzed, 50 were planned primary antegrade dissection and reentry and 1,825 planned primary antegrade wire escalation. Primary antegrade dissection and reentry was preferred in older patients, with a history of revascularization (coronary artery bypass graft: primary antegrade dissection and reentry in 33.3% and primary antegrade wire escalation in 13.4%; p<0.001; percutaneous coronary interventions in 66.6% and 48.8%, respectively; p=0.012). Longer chronic total occlusions (30mm [22-41] and 21mm [15-30]; p<0.001), moderate or severe calcification (62% and 42.6%; p=0.008) were associated with the selection of primary antegrade dissection and reentry, instead of primary antegrade wire escalation. There was a significant correlation between increasing J-CTO score (X2=37, df=5; p<0.001), and use of primary antegrade dissection and reentry. Primary antegrade wire escalation had a success rate of 88.4%, and primary antegrade dissection and reentry of 76.7%. For primary antegrade wire escalation and bailout antegrade dissection and reentry, the use of the CrossBoss® device was related to the highest rates of success (92.3 and 82.7%, respectively). Short-term outcomes were similar in both groups. Conclusion: In Latin America, antegrade dissection and reentry was safe and effective, both as primary or bailout strategy, even when used for higher complexity lesions. The use of dedicated devices was related to a higher success rate.

Cov-caldas: A new COVID-19 chest X-Ray dataset from state of Caldas-Colombia.

The emergence of COVID-19 as a global pandemic forced researchers worldwide in various disciplines to investigate and propose efficient strategies and/or technologies to prevent COVID-19 from further spreading. One of the main challenges to be overcome is the fast and efficient detection of COVID-19 using deep learning approaches and medical images such as Chest Computed Tomography (CT) and Chest X-ray images. In order to contribute to this challenge, a new dataset was collected in collaboration with "S.E.S Hospital Universitario de Caldas" ( https://hospitaldecaldas.com/ ) from Colombia and organized following the Medical Imaging Data Structure (MIDS) format. The dataset contains 7,307 chest X-ray images divided into 3,077 and 4,230 COVID-19 positive and negative images. Images were subjected to a selection and anonymization process to allow the scientific community to use them freely. Finally, different convolutional neural networks were used to perform technical validation. This dataset contributes to the scientific community by tackling significant limitations regarding data quality and availability for the detection of COVID-19.

Revisable and high-strength wheel-spun alginate/graphene oxide based fibrous rods towards a flexible and biodegradable rib internal fixation system.

The intramedullary splint insertion fixation system is the mainstream clinical solution to severe rib fractures. However, the titanium alloy scaffolds have limitations in biocompatibility, flexibility and complexity of surgeries. Here we present a revisable wheel-spun alginate (Alg)/graphene oxide (GO)-based fibrous rod as a potential alternative for a rib internal fixation system. The reversible fusion and fission capability was obtained by optimized Alg/GO blended spinning and GO coating post-treatment. The mechanical performance of the demonstrated rod samples matches the properties of the human rib. A self-designed cubic matrix was used to conduct in situ cell culture. In vitro evaluation not only confirms the cell viability and migration on the fibers' surface, but also investigated the degradation and fission performance of fibrous rods. With a simple, minimally invasive implantation and controlled swelling, Alg/GO fibrous rods are able to tightly fix the rib fracture wound while maintaining sufficient flexibility.

Reactivation of adult-onset Still's disease after use of the COVID-19 ChAdOx1-S vaccine.

A woman in her 60s with a history of adult-onset Still's disease (AOSD) in remission for 14 years received the ChAdOx1-S vaccine as a booster to her initial vaccination schedule (two doses of CoronaVac vaccine 6 months apart). Two weeks later, she consulted for symptoms suggestive of AOSD reactivation. This was confirmed during hospitalisation, where renal and cardiac involvement were also observed. Despite using high-dose corticosteroids, troponin T and N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) were persistently elevated. Tocilizumab was used, with which the patient achieved complete remission of her symptoms and normalised her laboratory tests.

Carcinoma adenoide quístico de tráquea / Adenoid Cystic Carcinoma of the Trachea

Se describe el caso de una mujer de 51 años, nunca fumadora y sin antecedentes médico-quirúrgicos de interés, profesora de informática. Fue remitida a consultas de neumología por un estridor espiratorio de dos meses de evolución, que interfería parcialmente en su trabajo, bajo la sospecha de posible asma bronquial. La exploración física únicamente reveló dicho estridor espiratorio

Effect of Momordica charantia Administration on Anthropometric Measures and Metabolic Profile in Patients with Obesity: A Pilot Clinical Trial.

The aim of this study was to evaluate the effect of Momordica charantia (MC) administration on anthropometric measures in patients with obesity. A randomized, double-blind, placebo-controlled pilot clinical trial was carried out in 24 patients with obesity. Twelve patients randomly received MC (2000 mg/day) for 12 weeks, and 12 patients received placebo. Body weight (BW), body mass index (BMI), waist circumference (WC), body fat percentage, as well as clinical and laboratory determinations, were evaluated before and after the intervention. Results showed that while reductions in BW, BMI, WC, and body fat percentage were observed in the MC group, these differences did not reach statistical significance. Significant decreases in triglycerides (TG) (1.9 ± 0.6 mM vs. 1.7 ± 0.7 mM, P ≤ .05) and very low-density lipoprotein (VLDL) (0.4 ± 0.1 mM vs. 0.3 ± 0.1 mM, P ≤ .05) levels were found after the intervention with MC. In contrast, significant increases in BW (83.0 ± 10.7 kg vs. 84.6 ± 9.1 kg, P ≤ .05) and BMI (31.9 ± 1.5 kg/m2 vs. 33.0 ± 1.3 kg/m2, P ≤ .05) were observed in the placebo group. In conclusion, no significant reductions in BW, BMI, WC, and body fat percentage were observed after MC administration; however, MC significantly decreased TG and VLDL levels. The protocol was registered at ClinicalTrials.gov with the identifier NCT04916379.

Current Progress in Vascular Engineering and Its Clinical Applications.

Coronary heart disease (CHD) is caused by narrowing or blockage of coronary arteries due to atherosclerosis. Coronary artery bypass grafting (CABG) is widely used for the treatment of severe CHD cases. Although autologous vessels are a preferred choice, healthy autologous vessels are not always available; hence there is a demand for tissue engineered vascular grafts (TEVGs) to be used as alternatives. However, producing clinical grade implantable TEVGs that could healthily survive in the host with long-term patency is still a great challenge. There are additional difficulties in producing small diameter (<6 mm) vascular conduits. As a result, there have not been TEVGs that are commercially available. Properties of vascular scaffolds such as tensile strength, thrombogenicity and immunogenicity are key factors that determine the biocompatibility of TEVGs. The source of vascular cells employed to produce TEVGs is a limiting factor for large-scale productions. Advanced technologies including the combined use of natural and biodegradable synthetic materials for scaffolds in conjunction with the use of mesenchyme stem cells or induced pluripotent stem cells (iPSCs) provide promising solutions for vascular tissue engineering. The aim of this review is to provide an update on various aspects in this field and the current status of TEVG clinical applications.

Effect of Banaba (Lagerstroemia speciosa) on Metabolic Syndrome, Insulin Sensitivity, and Insulin Secretion.

To evaluate the effect of Banaba (Lagerstroemia speciosa) on metabolic syndrome (MetS), insulin sensitivity, and insulin secretion. A randomized, double-blind, placebo-controlled clinical trial was carried out in 24 patients with diagnosis of MetS according to the International Diabetes Federation criteria. Body weight, waist circumference, and blood pressure were evaluated. Fasting plasma glucose (FPG) and insulin concentrations were measured every 30 min during 2 h after a 75-g dextrose load. Lipid profile was determined before and after the pharmacological intervention. Twelve patients received Banaba (500 mg) twice a day, before breakfast and dinner for 12 weeks. The remaining 12 patients received placebo at the same dosage. Body mass index, area under the curve (AUC) of glucose and insulin, insulin sensitivity, total insulin secretion, and the first phase of insulin secretion were calculated. After Banaba administration, there were significant decreases in systolic blood pressure (SBP) (121.5 ± 12.9 vs. 116.3 ± 9.8 mmHg, P = .050), FPG (5.9 ± 0.4 vs. 5.7 ± 0.4 mmol/L, P = .034), triglycerides (TG) (2.3 ± 0.4 vs. 1.7 ± 0.5 mmol/L, P = .021), very low-density lipoprotein (VLDL) (0.5 ± 0.1 vs. 0.3 ± 0.1 mmol/L, P = .021), AUC of insulin (50,675 ± 14,309 vs. 37,983 ± 19,298 mmol/L, P = .017), and insulinogenic index (0.4 ± 0.2 vs. 0.3 ± 0.2, P = .047). Eight patients (67%) of the Banaba group showed remission of MetS. In the placebo group, there was a downward trend toward statistical significance in the Stumvoll index (910.3 ± 514.1 vs. 651.0 ± 405.2, P = .062). Banaba administration leads to remission of MetS and a significant decrease in SBP, FPG, TG, VLDL, AUC of insulin, and total insulin secretion. Clinical Trial Registration number: NCT02767869.

Impacto de la primera ola pandémica COVID-19 sobre los indicadores asistenciales y de calidad de un servicio de urgencias de hospital / Impact of the first COVID-19 pandemic wave on the care and quality indicators of a hospital emergency department

Objetivo. Estudiar el impacto del Estado de Alarma Sanitaria (EAS) por la primera ola pandémica COVID-19 sobre el patrón de demanda asistencial cuantitativo y cualitativo de un servicio de urgencias de hospital (SUH). Método. Análisis retrospectivo transversal del total de visitas atendidas en un SUH de adultos durante el periodo de EAS en España comparado con un periodo similar antes de la pandemia. Se recogieron variables asistenciales, prioridad en triaje, el tiempo de espera para la clasificación, tiempo de clasificación y tiempo de espera de primera visita facultativa, diagnósticos de alta codificados y revisitas en 72 horas, entre otras. Además, se analizó la demanda por procesos tiempodependientes. Resultados. Durante el periodo EAS se apreció una disminución global de la demanda asistencial del 48,3% (IC 95%: 0,48-0,49), que llegó al 60,7% (IC 95%: 0,60-0,61) en la Fase 0 o fase de confinamiento. Por nivel de prioridad en triaje, hubo un descenso de asistencias más intenso cuanto menor era el grado de prioridad, especialmente durante la Fase 0 (35,1% para la prioridad I, hasta el 60,5% para la prioridad V). Los trastornos respiratorios fue la categoría diagnóstica más frecuente, seguida del dolor abdominal. El análisis de los procesos tiempo-dependientes constató una disminución de todos los procesos considerados emergentes. Conclusiones. El presente estudio muestra una disminución global de la demanda asistencial a un SUH de adultos durante el EAS por la primera ola pandémica COVID-19 en España, con descensos de las asistencias más intensos para las prioridades de menor gravedad. Igualmente se observa una disminución de los procesos tiempo-dependientes analizados. (AU)

Objectives: To study the impact of the first COVID-19 pandemic wave state of emergency on qualitative and quantitative indicators of demand for the services of a hospital emergency department. Material and methods: Retrospective cross-sectional analysis of all visits by adults to the department during the Spanish state of emergency. The findings were compared to those for a similar period before the pandemic. We collected data for care variables, triage levels, wait times before triage, triage times, and times to first contact with a physician, discharge diagnostic codes, revisits within 72 hours, among other information. We also analyzed demand for timesensitive emergencies. Results: Demand for emergency department care decreased overall by 48.3% (95% CI, 0.48%-0.49%) while the state of emergency was in effect. The decrease was 60.7% (95% CI, 0.60%-0.61%) during phase 0 (lockdown). The decrease was more marked for the lower priority emergencies during lockdown (phase 0), at 60.5% for the lowest (level V) versus 35.1% for the highest priority (level I). The most frequent diagnoses were for respiratory conditions, followed by abdominal pain. There was a decrease in demand for treatment for all time-sensitive conditions. Conclusion: Overall demand for emergency care for adults fell during the first COVID-19 pandemic wave state of emergency in Spain. Lower priority emergencies for less serious problems saw the greatest decreases. We also saw a decrease in the use of time-dependent procedures. (AU)

Impact of the first COVID-19 pandemic wave on the care and quality indicators of a hospital emergency department. / Impacto de la primera ola pandémica COVID-19 sobre los indicadores asistenciales y de calidad de un servicio de urgencias de hospital.

OBJECTIVES: To study the impact of the first COVID-19 pandemic wave state of emergency on qualitative and quantitative indicators of demand for the services of a hospital emergency department. MATERIAL AND METHODS: Retrospective cross-sectional analysis of all visits by adults to the department during the Spanish state of emergency. The findings were compared to those for a similar period before the pandemic. We collected data for care variables, triage levels, wait times before triage, triage times, and times to first contact with a physician, discharge diagnostic codes, revisits within 72 hours, among other information. We also analyzed demand for timesensitive emergencies. RESULTS: Demand for emergency department care decreased overall by 48.3% (95% CI, 0.48%-0.49%) while the state of emergency was in effect. The decrease was 60.7% (95% CI, 0.60%-0.61%) during phase 0 (lockdown). The decrease was more marked for the lower priority emergencies during lockdown (phase 0), at 60.5% for the lowest (level V) versus 35.1% for the highest priority (level I). The most frequent diagnoses were for respiratory conditions, followed by abdominal pain. There was a decrease in demand for treatment for all time-sensitive conditions. CONCLUSION: Overall demand for emergency care for adults fell during the first COVID-19 pandemic wave state of emergency in Spain. Lower priority emergencies for less serious problems saw the greatest decreases. We also saw a decrease in the use of time-dependent procedures.

OBJETIVO: Estudiar el impacto del Estado de Alarma Sanitaria (EAS) por la primera ola pandémica COVID-19 sobre el patrón de demanda asistencial cuantitativo y cualitativo de un servicio de urgencias de hospital (SUH). METODO: Análisis retrospectivo transversal del total de visitas atendidas en un SUH de adultos durante el periodo de EAS en España comparado con un periodo similar antes de la pandemia. Se recogieron variables asistenciales, prioridad en triaje, el tiempo de espera para la clasificación, tiempo de clasificación y tiempo de espera de primera visita facultativa, diagnósticos de alta codificados y revisitas en 72 horas, entre otras. Además, se analizó la demanda por procesos tiempodependientes. RESULTADOS: Durante el periodo EAS se apreció una disminución global de la demanda asistencial del 48,3% (IC 95%: 0,48-0,49), que llegó al 60,7% (IC 95%: 0,60-0,61) en la Fase 0 o fase de confinamiento. Por nivel de prioridad en triaje, hubo un descenso de asistencias más intenso cuanto menor era el grado de prioridad, especialmente durante la Fase 0 (35,1% para la prioridad I, hasta el 60,5% para la prioridad V). Los trastornos respiratorios fue la categoría diagnóstica más frecuente, seguida del dolor abdominal. El análisis de los procesos tiempo-dependientes constató una disminución de todos los procesos considerados emergentes. CONCLUSIONES: El presente estudio muestra una disminución global de la demanda asistencial a un SUH de adultos durante el EAS por la primera ola pandémica COVID-19 en España, con descensos de las asistencias más intensos para las prioridades de menor gravedad. Igualmente se observa una disminución de los procesos tiempo-dependientes analizados.

High strength and strain alginate fibers by a novel wheel spinning technique for knitting stretchable and biocompatible wound-care materials.

Alginate fibrous materials have been applied as wound dressing to enhance wound healing due to its nontoxic, biodegradable, and hemostatic nature. Conventional nonwoven fabrication tactics, however, showed weakness in inflammation, degradation stability and mechanical properties. Herein, the wet-spun alginate fibers were prepared by a novel wheel spinning technique, then knitted into wound dressing. Benefiting from optimized wet spinning parameters and the agglomeration of alginate multimers, the fibers were endowed with elevated mechanical performances and biodegradability, which allowed for the feasibility of knitting wound-care materials. Using the new wheel spinning technique, high strength alginate fibers with 173 MPa were produced with breaking strain up to 18% and toughness of 16.16 MJ*m-3. Meanwhile, alginate fibers with high breaking strain reaching 35% were produced with tensile strength of 135 MPa and toughness of 37.47 MJ*m-3. The overall mechanical performances of these alginate fibers with high breaking strain are significantly higher (up to 2 times) than those published in the literature in term of toughness. In vitro degradation evaluation revealed that this wet spun fibrous dressing had good aqueous absorbency (50%) and sustained biodegradation properties. Furthermore, the consequent cell viability study also proved that this alginate knitted fabric is biocompatible for being applied as wound dressing.

Hierarchical porous silk fibroin/poly(L-lactic acid) fibrous membranes towards vascular scaffolds.

Fibrous membranes played an important role to prepare tubular scaffolds for muscular artery regeneration. In this study, a strategy has been developed to combine silk fibroin (SF) with highly porous electrospun poly(L-lactic acid) (PLLA) fibrous membrane towards vascular scaffolds. After PLLA fibres were electrospun and collected, they were immersed into acetone to generate a porous structure with ultra-high surface area. While the pores on PLLA fibres were fulfilled with SF solution and dried, SF was coated uniformly and tightly on PLLA fibres. A multi-layer tubular structure of the tunica media was simulated by winding and stacking a strip of electrospun fibrous membrane. In vitro viability and morphology studies of A7r5 smooth muscle cells were undertaken for up to 14 days. Because the hydrophilicity of SF/PLLA composite fibres were improved dramatically, it had a positive effect on cell adhesion rate (97%) and proliferation (64.4%). Moreover, good cell morphology was observed via a multiphoton laser confocal microscope on SF/PLLA bioactive materials. These results demonstrated that the hierarchical porous SF/PLLA fibrous membranes are promising off-the-shelf scaffolds for muscular artery regeneration.

Evaluating the Effectiveness of Online Educational Modules and Interactive Workshops in Alleviating Symptoms of Mild to Moderate Depression: A Pilot Trial.

INTRODUCTION: Depression is a common health concern in primary care with barriers to treatment well documented in the literature. Innovative online psychoeducational approaches to address barriers to care have been well received and can be cost effective. This pilot trial evaluated the effectiveness of an online psychoeducation curriculum intended to alleviate symptoms of depression while utilizing minimal staff resources. METHODS: A small (n = 29) randomized control pilot study was conducted. Online psychoeducational content was delivered in 5 to 10-minute videos over 8 weeks. Participants engaged in moderated discussions on workshop topics. The Patient Health Care Questionnaire (PHQ-9) was used to measure pre/post scores. Two Likert scale questions were used to determine subjective changes in understanding of depression and coping skills. RESULTS: Paired T-test analysis showed an average PHQ-9 improvement of 4.37 (P = .01) in the intervention arm and 1.81 (P = .172) in the control group. No significant difference in delta PHQ-9 score was found between groups via difference in difference analysis (P = .185). Effect size was 0.59. No improvement in Likert scores for question 1 or 2 were detected by paired T test in either group. CONCLUSION: This pilot trial of interactive online psychoeducational content shows initial promise as there was a significant improvement in PHQ-9 scores within the intervention arm. The comparison of delta scores between intervention and control arms was not statistically significant although this is likely due to the underpowered nature of the pilot trial. This data trend justifies the need for a larger validation trial of this intervention.