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Background This real‐world evidence study compared risks of cardiovascular events in hospital settings among patients with chronic kidney disease (CKD) with and without hyperkalemia. Methods and Results Adults with CKD stages 3b/4 with and without hyperkalemia were identified from Optum's deidentified Market Clarity Data (January 2016–August 2022). Patients with hyperkalemia were exact and propensity score matched to patients without hyperkalemia. The index date was the first CKD stage 3b/4 diagnosis with ≥1 hyperkalemia diagnosis and ≥1 serum potassium >5.0 mmol/L in the preceding 12 months (baseline) for patients with hyperkalemia and a randomly selected CKD stage 3b/4 diagnosis for controls. Cardiovascular composite end points included major adverse cardiovascular events plus (a composite end point of all‐cause mortality, myocardial infarction, stroke, or heart failure) and cardiac arrhythmias (a composite end point of new onset atrial fibrillation and other atrial and ventricular arrythmias), all in the hospital setting. We compared cardiovascular events between cohorts using cause‐specific Cox proportional hazards regression. The study included 5301 matched pairs in the analysis of major adverse cardiovascular events plus and 5564 in the analysis of arrhythmia. Cardiovascular events were more likely among patients with hyperkalemia relative to those without hyperkalemia, with the risk of major adverse cardiovascular events plus increased by 32% (23%–40%) and the risk of arrhythmia increased by 59% (44%–75%; both P

Prolonged retention of urinary catheters (UC) after vaginal surgery is a common practice aimed at preventing postoperative urinary retention and enhancing the success rate of surgery. However, this approach also increases the chance of urinary tract infection (UTI), prolongs hospital stay (LOS), and delays recovery. Balancing these considerations, we investigated the effect of the timing of UC removal. We conducted a comprehensive literature search using four databases to identify all randomized controlled trials (RCTs) involving patients who underwent transvaginal surgery and had UC removal within 7 days postsurgery. This systematic review was conducted by two reviewers independently following the PRISMA guideline. This study investigated the timing of catheter removal in relation to the incidence of urinary retention, UTI, and LOS. A total of 8 RCT studies, involving 952 patients were included in the meta-analysis. Six studies revealed no significant difference in the urinary retention rate between early catheter removal group (24 h) and delayed removal group (>48 h, P = 0.21), but exhibited a significantly reduced UTI rate (P

As the fleet of high-speed rail vehicles expands, ensuring train safety is of the utmost importance, emphasizing the critical need to enhance the precision of axel temperature warning systems. Yet, the limited availability of data on the unique features of high thermal axis temperature conditions in railway systems hinders the optimal performance of intelligent algorithms in alarm detection models. To address these challenges, this study introduces a novel dynamic principal component analysis preprocessing technique for tolerance temperature data to effectively manage missing data and outliers. Furthermore, a customized generative adversarial network is devised to generate distinct data related to high thermal axis temperature, focusing on optimizing the network’s objective functions and distinctions to bolster the efficiency and diversity of the generated data. Finally, an integrated model with an optimized transformer module is established to accurately classify alarm levels, provide a comprehensive solution to pressing train safety issues, and, in a timely manner, notify drivers and maintenance departments (DEPOs) of high-temperature warnings.

Mycoviruses have been found in various fungal species across different taxonomic groups, while no viruses have been reported yet in the fungus Exserohilum rostratum. In this study, a novel orfanplasmovirus, namely Exserohilum rostratum orfanplasmovirus 1 (ErOrfV1), was identified in the Exserohilum rostratum strain JZ1 from maize leaf. The complete genome of ErOrfV1 consists of two positive single-stranded RNA segments, encoding an RNA-dependent RNA polymerase and a hypothetical protein with unknown function, respectively. Phylogenetic analysis revealed that ErOrfV1 clusters with other orfanplasmoviruses, forming a distinct phyletic clade. A new family, Orfanplasmoviridae, is proposed to encompass this newly discovered ErOrfV1 and its associated orfanplasmoviruses. ErOrfV1 exhibits effective vertical transmission through conidia, as evidenced by its 100% presence in over 200 single conidium isolates. Moreover, it can be horizontally transmitted to Exserohilum turcicum. Additionally, the infection of ErOrfV1 is cryptic in E. turcicum because there were no significant differences in mycelial growth rate and colony morphology between ErOrfV1-infected and ErOrfV1-free strains. This study represents the inaugural report of a mycovirus in E. rostratum, as well as the first documentation of the biological and transmission characteristics of orfanplasmovirus. These discoveries significantly contribute to our understanding of orfanplasmovirus.

Summary: Purpose: Nowadays most children with congenital heart disease (CHD) are expected to survive to adulthood. The healthcare focus needs to pay close attention to the important developmental tasks during their growth process. The women with CHD face some challenges in their critically developmental stages during pregnancy, delivery, and even motherhood. The lived experience of being a mother needs to be further concerned. This study aimed to explore the lived experience of first-time mothers with CHD. Methods: Descriptive phenomenological design was adopted. Semi-structured interviews were conducted from April to August 2018 with 11 primiparous women with CHD, who were recruited from the pediatric and adult cardiology outpatient departments at a medical center and who had a child aged between 6 months and 3 years. Giorgi's phenomenological analysis method was employed. Results: Six main themes arose from the analysis: (1) recognizing pregnancy risks, (2) performing self-care for health, (3) building self-worth from my baby, (4) adapting to postpartum life and adjusting priorities, (5) enjoying being a first-time mother, and (6) the factors contributing to success in high-risk childbirth. Conclusions: The experiences that occurred prior to and after labor that were identified in this study can assist women with CHD to more capably prepare for and understand the process of becoming a mother, including recognition of the importance of a prepregnancy evaluation. The findings of this study can help women with CHD to better understand the path to becoming a mother and prepare themselves for the challenges that lie ahead.

Primary liver cancer, mainly comprising hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), remains a major global health problem. Although ICC is clinically different from HCC, their molecular differences are still largely unclear. In this study, precision N‐glycoproteomic analysis was performed on both ICC and HCC tumors as well as paracancer tissues to investigate their aberrant site‐specific N‐glycosylation. By using our newly developed glycoproteomic methods and novel algorithm, termed ‘StrucGP’, a total of 486 N‐glycan structures attached on 1235 glycosites were identified from 894 glycoproteins in ICC and HCC tumors. Notably, glycans with uncommon LacdiNAc (GalNAcβ1‐4GlcNAc) structures were distinguished from their isomeric glycans. In addition to several bi‐antennary and/or bisecting glycans that were commonly elevated in ICC and HCC, a number of LacdiNAc‐containing, tri‐antennary, and core‐fucosylated glycans were uniquely increased in ICC. More interestingly, almost all LacdiNAc‐containing N‐glycopeptides were enhanced in ICC tumor but not in HCC tumor, and this phenomenon was further confirmed by lectin histochemistry and the high expression of β1‐4 GalNAc transferases in ICC at both mRNA and protein expression levels. The novel N‐glycan alterations uniquely detected in ICC provide a valuable resource for future studies regarding to the discovery of ICC diagnostic biomarkers, therapeutic targets, and mechanism investigations.

Abstract Background Fremanezumab, a fully humanized monoclonal antibody (mAb; IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP), is approved for the preventive treatment of migraine in adults. The efficacy and safety of fremanezumab for migraine prevention have been demonstrated in randomized, double-blind, placebo-controlled trials. Real-world effectiveness data are needed to complement clinical trial data. This study assessed the effectiveness of fremanezumab across different subgroups of adult patients with episodic migraine (EM), chronic migraine (CM), or difficult-to-treat (DTT) migraine in real-world clinical settings. Methods This retrospective, panel-based online chart review used electronic case report forms. Patient inclusion criteria were a physician diagnosis of EM or CM; age ≥ 18 years at the time of first fremanezumab initiation; ≥ 1 dose of fremanezumab treatment; ≥ 1 follow-up visit since first initiation; and ≥ 2 measurements of monthly migraine days (MMD; with 1 within a month before or at first initiation and ≥ 1 after first initiation). Changes in MMD and monthly headache days were assessed during the follow-up period. These endpoints were evaluated in subgroups of patients by migraine type (EM/CM) and in subgroups with DTT migraine (diagnosis of medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or prior exposure to a different CGRP pathway–targeted mAb [CGRP mAb]). Results Data were collected from 421 clinicians and 1003 patients. Mean (percent) reductions from baseline in MMD at Month 6 were − 7.7 (77.0%) in EM patients, − 10.1 (68.7%) in CM patients, − 10.8 (80.6%) in the MO subgroup, − 9.9 (68.3%) in the MDD subgroup, − 9.5 (66.4%) in the GAD subgroup, and − 9.0 (68.7%) in the prior CGRP mAb exposure subgroup. Improvements in MDD or GAD severity were reported by 45.5% and 45.8% of patients with comorbid MDD or GAD, respectively. Conclusions In this real-world study, fremanezumab demonstrated effectiveness for migraine regardless of migraine type or the presence of factors contributing to DTT migraine (MO, GAD, MDD, or prior exposure to a different CGRP mAb).

Abstract Background The efficacy and tolerability of fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP) and is approved for the preventive treatment of migraine in adults, have been demonstrated in randomized, double-blind, placebo-controlled trials. Real-world data can further support those clinical trial data and demonstrate the full clinical benefits of fremanezumab. This chart review assessed the effectiveness of fremanezumab for improving clinical outcomes in adult patients with migraine treated according to real-world clinical practice. Methods This retrospective, panel-based, online physician chart review study used electronic case report forms with US physicians. Patient inclusion criteria were a physician diagnosis of migraine, fremanezumab treatment initiation at ≥ 18 years of age after US Food and Drug Administration approval, ≥ 1 dose of fremanezumab treatment, and ≥ 2 assessments of monthly migraine days (MMD; 1 within 30 days before treatment initiation and ≥ 1 after initiation). Changes from baseline in MMD, monthly headache days (MHD), and Migraine Disability Assessment (MIDAS) and 6-item Headache Impact Test (HIT-6) scores were assessed over 6 months. These endpoints were evaluated in the overall population and subgroups divided by dosing schedule and number of prior migraine preventive treatment failures. Results This study included data from 421 clinicians and 1003 patients. Mean age at fremanezumab initiation was 39.7 years, and most patients were female (75.8%). In the overall population, mean baseline MMD and MHD were 12.7 and 14.0, respectively. Mean (percent) reductions from baseline in MMD and MHD, respectively, were − 4.6 (36.2%) and − 4.7 (33.6%) at Month 1, − 6.7 (52.8%) and − 6.8 (48.6%) at Month 3, and − 9.2 (72.4%) and − 9.8 (70.0%) at Month 6. Mean (percent) reductions from baseline in MIDAS and HIT-6 scores also increased over the 6-month study period, from − 6.2 (21.6%) and − 8.4 (14.0%) at Month 1 to − 18.1 (63.1%) and − 16.2 (27.0%) at Month 6, respectively. Improvements in these outcomes over 6 months were observed across all evaluated subgroups. Conclusions This real-world study demonstrated effectiveness of fremanezumab treatment for up to 6 months, irrespective of dosing regimen or number of prior migraine preventive treatment failures, reflecting ongoing, clinically meaningful improvements in patient outcomes.

Early blight, caused by Alternaria solani, is an important disease affecting tomatoes. Biological control offers an environmentally friendly approach to controlling pathogens. Herein, we identified a B. amyloliquefaciens strain XJ5 and investigated its biocontrol mechanism against A. solani. A. solani growth was significantly inhibited by XJ5, with the inhibition rate of cell-free culture supernatants reaching 82.3%. Furthermore, XJ5 crude protein extracts inhibited conidia germination and altered the mycelial morphology of A. solani. To uncover the potential biocontrol mechanism of XJ5, we analyzed its genome sequence and transcriptome. The genome of XJ5 comprised a 4.16 Mb circular chromosome and two circular plasmids. A total of 13 biosynthetic gene clusters and 127 genes encoding hydrolases were identified, suggestive of the ability of XJ5 to secrete antagonistic secondary metabolites and hydrolases. Transcript analysis revealed 174 differentially expressed genes on exposing A. solani to XJ5 crude protein extracts. The expression of genes related to chitin and mannose synthesis was downregulated, indicating that XJ5 metabolites may impact chitin and mannose synthesis in A. solani. Overall, these findings enhance our understanding of the interactions between B. amyloliquefaciens and phytopathogens and pave the way for the agricultural application of this promising biocontrol agent.

Abstract Background The role of platelets on the prognosis of patients with liver transplantation remains unclear. Thus, we aimed to evaluate the influence of preoperative platelet count on postoperative morbidity after liver transplantation. Methods Clinical data of the patients who received liver transplantation from January 2015 to September 2018 were evaluated. Results Of the 329 patients included, the average age was 46.71 ± 0.55 years, and 243 were men (75.2%). The incidence of posttransplant portal vein complication was significantly higher in the high platelet count group (> 49.5 × 109/L; n = 167) than in the low platelet count group (≤ 49.5 × 109/L, n = 162, 12.6% vs. 1.9%). After multivariable regression analysis, high platelet count was independently associated with postoperative portal vein complication (odds ratio [OR]: 8.821, 95% confidence interval [CI]: 2.260 to 34.437). After the inverse probability of treatment weighting analysis, patients in the high platelet count group had significantly higher risk of portal vein complication (OR: 9.210, 95%CI: 1.907 to 44.498, p = 0.006) and early allograft dysfunction (OR: 2.087, 95%CI: 1.131 to 3.853, p = 0.019). Conclusions Preoperative platelet count > 49.5 × 109/L was an independent risk factor for posttransplant portal vein complication and early allograft dysfunction. High preoperative platelet count could be an adverse prognostic predictor for liver transplantation recipients.

Abstract Background The relative benefits and risks of long-term maintenance treatment with antipsychotics have not been well studied in patients with bipolar disorder and major depressive disorder. For example, while antipsychotic dose reduction has been recommended in the management of serious side effects associated with antipsychotics, there is limited evidence on the impact of lowering doses on the course of underlying mood disorders. Methods This retrospective cohort study analyzed the impact of antipsychotic dose reduction in patients with bipolar disorder or major depressive disorder. Medical claims from six US states over a 6-year period were analyzed for patients with ≥10% or ≥ 30% reductions in antipsychotic dose (cases) and compared using survival analyses with matched controls receiving a stable dosage. Outcomes included hospitalizations for disease-specific mood disorders, other psychiatric disorders and all-cause emergency room visits, and claims for tardive dyskinesia. Results A total of 23,992 patients with bipolar disorder and 17,766 with major depressive disorder had a ≥ 10% dose reduction, while 19,308 and 14,728, respectively, had a ≥ 30% dose reduction. In multivariate analyses, cases with a ≥ 10% dose reduction had a significantly increased risk of disease-specific admission (bipolar disorder: hazard ratio [95% confidence interval], 1.22 [1.15–1.31]; major depressive disorder: 1.22 [1.11–1.34]), other psychiatric admission (bipolar disorder: 1.19 [1.13–1.24]; major depressive disorder: 1.17 [1.11–1.23]), all-cause admission (bipolar disorder: 1.17 [1.12–1.23]; major depressive disorder: 1.11 [1.05–1.16]), and all-cause emergency room visits (bipolar disorder: 1.09 [1.05–1.13]; major depressive disorder: 1.07 [1.02–1.11]) (all P

Objective. Reasons for the increased incidence of chronic kidney disease (CKD) in patients with chronic hypoparathyroidism are poorly understood. This study evaluated associations between levels of albumin-corrected serum calcium, serum phosphate, and calcium-phosphate product and the odds of CKD development in patients with chronic hypoparathyroidism. Design. A retrospective nested case-control study of adult patients with chronic hypoparathyroidism who had ≥1 prescription for calcitriol who developed CKD and matched controls who did not develop CKD were selected from the IBM® Explorys electronic medical record database. Patients. The study included a cohort of 300 patients for the albumin-corrected serum calcium analysis and 80 patients for the serum phosphate and calcium-phosphate product analyses. Measurements. We examined associations between albumin-corrected serum calcium, serum phosphate and calcium-phosphate product levels, and the risk of devloping CKD (defined as ≥2 outpatient estimated glomerular filtration values

Buried pipelines are widely used, so it is necessary to analyze and study their fracture characteristics. The locations of corrosion defects on the pipe are more susceptible to fracture under the influence of internal pressure generated during material transportation. In the open literature, a large number of studies have been conducted on the failure pressure or residual strength of corroded pipelines. On this basis, this study conducts a fracture analysis on buried pipelines with corrosion areas under seismic loads. The extended finite element method was used to model and analyze the buried pipeline under seismic load, and it was found that the stress value at the crack tip was maximum when the circumferential angle of the crack was near 5° in the corrosion area. The changes in the stress field at the crack tip in the corrosion zone of the pipeline under different loads were compared. Based on the BP algorithm, a neural network model that can predict the stress field at the pipe crack tip is established. The neural network is trained using numerical model data, and a prediction model with a prediction error of less than 10% is constructed. The crack tip characteristics were further studied using the BP neural network model, and it was determined that the tip stress fluctuation range is between 450 MPa and 500 MPa. The neural network model is optimized based on the GA algorithm, which solves the problem of convergence difficulties and improves the prediction accuracy. According to the prediction results, it is found that when the internal pressure increases, the corrosion depth will significantly affect the crack tip stress field. The maximum error of the optimized neural network is 5.32%. The calculation data of the optimized neural network model were compared with the calculation data of other models, and it was determined that GA-BPNN has better adaptability in this research problem. [ABSTRACT FROM AUTHOR]

Mycoviruses are an important component of the virosphere, but our current knowledge of their genome organization diversity and evolution remains rudimentary. In this study, the mycovirus composition in a hypovirulent strain of Sclerotinia sclerotiorum was molecularly characterized. Nine mycoviruses were identified and assigned into eight potential families. Of them, six were close relatives of known mycoviruses, while the other three had unique genome organizations and evolutionary positions. A deltaflexivirus with a tripartite genome has evolved via arrangement and horizontal gene transfer events, which could be an evolutionary connection from unsegmented to segmented RNA viruses. Two mycoviruses had acquired a second helicase gene by two different evolutionary mechanisms. A rhabdovirus representing an independent viral evolutionary branch was the first to be confirmed to occur naturally in fungi. The major hypovirulence-associated factor, an endornavirus, was finally corroborated. Our study expands the diversity of mycoviruses and potential virocontrol agents, and also provides new insights into virus evolutionary modes including virus genome segmentation.

Rationale & Objective: Since the change in erythropoiesis-stimulating agent (ESA) labeling and bundling of dialysis services in the United States, few studies have addressed the clinical importance of ESA hyporesponsiveness and none have considered health care resource use in this population. We aimed to further explore ESA hyporesponsiveness and its consequences. Study Design: Retrospective observational cohort study. Setting & Participants: US Renal Data System Medicare participants receiving dialysis with a minimum 6 months of continuous ESA use from 2012 to 2014. Predictors: Erythropoietin resistance index (≥2.0 U/kg/wk/g/L) and ESA dose were used to identify ESA hyporesponders and hyporesponsive subgroups: isolated, intermittent, and chronic. Outcomes: Associations between ESA responsiveness and mortality, cardiovascular hospitalization rates, and health care resource use were evaluated and compared across subgroups. Analytical Approach: Baseline characteristics were compared using Wilcoxon rank sum tests for continuous variables and χ2 tests for categorical variables. Incidence rates of health care resource use were modeled using an unadjusted and adjusted generalized linear model. Results: Of 834,115 dialysis patients in the CROWNWeb database, 38,891 ESA hyporesponders and 59,412 normoresponders met all inclusion criteria. Compared with normoresponders, hyporesponders were younger women, weighed less, and had longer durations of dialysis (all P < 0.001). Hyporesponders received 3.8-fold higher ESA doses (mean, 94,831 U/mo) and erythropoietin resistance index was almost 5 times higher than in normoresponders. Hyporesponders had lower hemoglobin levels and parathyroid hormone levels > 800 pg/mL, and iron deficiency was present in 26.5% versus 10.9% in normoresponders. One-year mortality was higher among hypo- compared with normoresponders (25.3% vs 22.6%). Hyporesponders also had significantly higher rates of hospitalization for cardiovascular events, emergency department visits, inpatient stays, home health agency visits, skilled nursing facility, and hospice days. Limitations: Only US Medicare patients were included and different hyporesponder definitions may have influenced the results. Conclusions: This study explored ESA hyporesponsiveness using new definitions and incorporated clinical and economic outcomes. It established that ESA-hyporesponsive dialysis patients had higher mortality, cardiovascular hospitalization rates, and health care costs as compared with ESA-normoresponsive patients.

NiMnO3 nanosheets with high specific capacitance were fabricated on carbon cloth (CC) substrates using a facile hydrothermal method. The composition, morphology, and structure of the products were characterized using x-ray diffraction, scanning electron microscopy, and transmission electron microscopy. In addition, cyclic voltammetry and constant current charge–discharge tests revealed that NiMnO3@CC electrodes presented excellent capacitive properties, and the specific capacitance reached 2330 F/g at the current density of 1 A/g. Moreover, after 1000 charge–discharge cycles at the current density of 10 A/g, the composites still maintained 67.8% of their initial capacity. Our results indicated that the NiMnO3@CC electrodes presented good electrochemical properties with potential application in the energy storage field.

Recently, an increasing number of ourmia-like viruses have been found in fungi; however, the features of these viruses remain unknown. Here, we report a novel ourmia-like virus isolated from Sclerotinia sclerotiorum. This virus, named S. sclerotiorum ourmia-like virus 4 (SsOLV4), has a genome 2,982 nt in length with a G-pentamer (GGGGG) at the 5′-terminus and a C-pentamer (CCCCC) at the 3′-terminus. The SsOLV4 genome has only one large putative open reading frame (ORF) predicted with both standard codes and mitochondrial codes and encodes an RNA-dependent RNA polymerase (RdRp). SsOLV4 is closely phylogenetically related to Pyricularia oryzae ourmia-like virus 1, with 42% identity between the RdRp amino acid sequences. We constructed full-length cDNA of SsOLV4 and synthesized RNA in vitro using the T7 RNA polymerase. The synthesized RNA could transfect S. sclerotiorum protoplasts efficiently. We further found that viral RNA could infect mycelia when mixed with PEG buffer. Our study suggests that a novel genus in family Botourmiaviridae should be established for SsOLV4 and other related viruses and demonstrates that one single-stranded RNA segment encoding RdRp is sufficient for ourmia-like viruses in fungi.

Brainstem tumors are heterogenous and cancerous glioma tumors arising from the midbrain, pons, and the medulla that are relatively common in children, accounting for 10% to 20% of all pediatric brain tumors. However, the prognosis of aggressive brainstem gliomas remains extremely poor despite aggressive treatment with chemotherapy and radiotherapy. That means there are many life-threatening patients who have exhausted all available treatment options and are beginning to face end-of-life stage. Therefore, the unique properties of highly selective heavy particle irradiation with boron neutron capture therapy (BNCT) may be well suited to prolong the lives of patients with end-stage brainstem gliomas. Herein, we report a case series of life-threatening patients with end-stage brainstem glioma who eligible for Emergency and Compassionate Use, in whom we performed a scheduled two fractions of salvage BNCT strategy with low treatment dosage each time. No patients experienced acute or late adverse events related to BNCT. There were 3 patients who relapsed after two fractionated BNCT treatment, characterized by younger age, lower T/N ratio, and receiving lower treatment dose. Therefore, two fractionated low-dose BNCT may be a promising treatment for end-stage brainstem tumors. For younger patients with low T/N ratios, more fractionated low-dose BNCT should be considered.

Abstract Background Data are limited on the benefits and risks of dose reduction in managing side effects associated with antipsychotic treatment. As an example, antipsychotic dose reduction has been recommended in the management of tardive dyskinesia (TD), yet the benefits of lowering doses are not well studied. However, stable maintenance treatment is essential to prevent deterioration and relapse in schizophrenia. Methods A retrospective cohort study was conducted to analyze the healthcare burden of antipsychotic dose reduction in patients with schizophrenia. Medical claims from six US states spanning a six-year period were analyzed for ≥10% or ≥ 30% antipsychotic dose reductions compared with those from patients receiving a stable dose. Outcomes measured were inpatient admissions and emergency room (ER) visits for schizophrenia, all psychiatric disorders, and all causes, and TD claims. Results A total of 19,556 patients were identified with ≥10% dose reduction and 15,239 patients with ≥30% dose reduction. Following a ≥ 10% dose reduction, the risk of an all-cause inpatient admission increased (hazard ratio [HR] 1.17; 95% confidence interval [CI] 1.11, 1.23; P

There are limited data on the cost of hyperkalemia. Methods: This retrospective analysis of the Truven MarketScan claims database assessed the economic burden of hyperkalemia among selected adult patients with hyperkalemia and matched controls. Results: A total of 39,626 cases (patients with hyperkalemia) were matched to 39,626 controls (patients without hyperkalemia) based on age, dialysis, chronic kidney disease (CKD) stage, heart failure, and renin-angiotensin aldosterone system inhibitor use. Compared with controls, cases incurred $4128 (95% confidence interval [CI] $3893–$4363) higher 30-day total health care costs ($5994 vs. $1865) and $15,983 (95% CI $15,026–$16,940) higher 1-year costs ($31,844 vs. $15,861). Among 11,221 matched pairs of patients with CKD and/or heart failure, cases incurred $5553 (95% CI $5059–$6047) higher 30-day total health care costs ($8165 vs. $2612) and $24,133 (95% CI $21,748–$26,518) higher 1-year costs ($48,994 vs. $24,861) than controls. The multivariable adjusted 1-year total health care cost difference was $15,606 (95% CI $14,648–$16,576) among all patients and $25,156 (95% CI $23,529–$26,757) among patients with CKD and/or heart failure. Cases had higher resource utilization rates including inpatient admissions (30-day: 0.14 vs. 0.03; 1-year: 0.44 vs. 0.19), outpatient visits (30-day: 3.33 vs. 2.28; 1-year: 26.58 vs. 18.53), and emergency department visits (30-day: 0.16 vs. 0.06; 1-year: 0.86 vs. 0.50) (all P < 0.001). When hospitalized, cases stayed 1.51 days (95% CI 1.22–1.80) longer and were 40% more likely to be readmitted. Conclusion: These data indicate that hyperkalemia is associated with a significant economic burden on afflicted patients and the health care system.

Cracks in transport pipelines significantly impact their structural safety, making pipeline fracture damage a major concern. While experimental tests can study crack growth, their setup and costs are substantial. To address this, our work involves parametric analyses to investigate the effects of initial crack length, load types and sizes, and pipe wall thickness on the crack tip stress field. The finite element model is established according to the actual operation, and the crack defects of the pipe are established by the extended finite element method (XFEM). The crack tip variation is studied by extracting the von Mises stress and strain at the crack tip. When the crack propagates, the stress field at the crack tip will fluctuate in a certain range. The relationship between stress field fluctuation and crack propagation was studied by changing the XFEM crack growth for comparative analysis. Utilizing 429 numerical results obtained from a parametric numerical model implemented with Python and Abaqus, we establish a back propagation (BP) neural network prediction model to forecast the stress field at the crack tip. The relative errors between the numerical results and the predictions by our model remain below 5%. In conclusion, our proposed approach for analyzing pipeline fracture under multiple loads proves valuable for pipeline safety assessment, and it offers useful insights for evaluating the suitability of transportation pipelines. [ABSTRACT FROM AUTHOR]

The flexoelectric effect, garnering extensive attention in recent years, is an electro-mechanical coupled gradient effect that widely exists in dielectric materials and holds great potential for applications in structural sensing and actuation. The parabolic shell structure, characterized by line focusing, finds widespread use in key structural components such as solar trough collectors and communication antennas. Distributed sensing of the structural states of these parabolic shells is critical for vibration control, health monitoring, and shape control of precision structural systems. Therefore, flexoelectric sensing research based on parabolic shell structure has become an important topic. This study establishes a mathematical model for flexoelectric sensing in a parabolic shell with four-sided simply supported boundary conditions. The model is based on the direct flexoelectric effect, and thin shell assumption, and incorporates specific Lamé parameters and curvature radius. The electro-mechanical strain gradient/signal generation characteristics and distributed modal flexoelectric signals on the parabolic shell are investigated. The sensing signal under the open-circuit conditions is deduced, and the flexoelectric sensing signal and sensing characteristics of different modes are analyzed. The formulation of the flexoelectric neural sensing signal for the parabolic shell structure is provided and divided into two components: a circumferential bending component and a longitudinal bending component. In the case studies, the effects of design parameters such as flexoelectric sensor thickness, size, and aspect ratios are evaluated and compared. The analysis and results of this study offer a theoretical foundation and reference for refining the design parameters of the flexoelectric sensor and determining its optimal sensing position, and potentially paving the way for new applications of flexoelectric sensing technology. [ABSTRACT FROM AUTHOR]