OBJECTIVE: The aim of this study was to examine the relationship between the frequency and duration of physical therapy (PT) and the development of hospitalization-associated disability (HAD) in hospitalized geriatric patients with heart failure (HF).
METHODS: This single-center, retrospective, observational study included hospitalized patients with HF aged 65 years or older who had received PT. Data regarding demographics, comorbidities, laboratory findings, medications, rehabilitation, and activities of daily living (ADLs) status were collected from electronic medical records. Based on the average frequency and duration of PT, patients were divided into three groups: Group 1, ≥3 days/week and ≥120 minutes/week; Group 2, ≥3 days/week and <120 minutes/week; and Group 3, <3 days/week and <120 minutes/week. Logistic regression analysis was performed to identify the association between the average frequency and duration of weekly PT and the incidence of HAD.
RESULTS: In all, 105 patients (mean age, 84.8 years; proportion of women, 59%) were enrolled in the study, and 43 (41.0%) patients exhibited HAD at discharge. In the multivariate logistic regression analysis, Group 2 (odds ratio [OR], 3.66) and Group 3 (OR, 6.71) had a significantly elevated risk of developing HAD using Group 1 as the reference, even after adjusting for age, ADLs before admission, cognitive function, and severity of HF.
CONCLUSIONS: This study showed that a lower frequency and shorter duration of PT are associated with developing HAD in hospitalized geriatric patients with HF. However, further prospective studies are required to confirm these findings.

Rivers worldwide are warming due to the impact of climate change and human interventions. This study investigated river heatwaves in the Vistula River Basin, one of the largest river systems in Europe using long-term observed daily river water temperatures from the past 30 years (1991-2020). The results showed that river heatwaves are increased in frequency and intensity in the Vistula River Basin. The total number of river heatwaves showed clear increasing trend with an average rate of 1.400 times/decade, the duration of river heatwaves increased at an average rate of 14.506 days/decade, and the cumulative intensity of river heatwaves increased at an average rate of 53.169 °C/decade. The Mann-Kendall (MK) test was also employed, showing statistically significant increasing trends in the total number, duration, and intensity of heatwaves for all rivers, including the main watercourse of the Vistula River and its tributaries, with few exceptions. Air temperature is the major controller of river heatwaves for each hydrological station, and with the increase of air temperatures, river heatwaves will increase in frequency and intensity. Another impacting factor is flow, and with the increase of flow, river heatwaves tend to decrease in number, duration and intensity. The results suggested that mitigation measures shall be taken to reduce the effect of climate change on river systems.

UNASSIGNED: The recommended duration of vasoactive drugs in esophageal variceal bleeding (EVB) spans 2-5 days. Prior meta-analyses of randomized trials include only a few studies that compared short vs. long vasoactive drug durations approximating this time range, including older management techniques, and only assessed variceal rebleeding at 5 days. We identified several additional randomized controlled trials (RCTs) assessing rebleeding at various durations, with updated management of EVB.
UNASSIGNED: We performed an updated systematic review and meta-analysis assessing the effect of shortening the vasoactive drug duration by 48-72 h. The primary outcome was rebleeding within 5 days. Secondary outcomes included rebleeding, mortality due to rebleeding, and all-cause mortality within 4-6 weeks (extended period) with subgroup analysis by vasoactive drug and type of endoscopic therapy. Length of stay, blood transfusion requirements and terlipressin-related adverse events were additional secondary outcomes.
UNASSIGNED: Our comprehensive search strategy and screening process yielded 14 RCTs with 1060 patients (75.1% male): 7 trials used terlipressin, 4 octreotide, and 3 somatostatin. Shortened durations combined with band ligation led to similar rebleeding, with a trend towards less rebleeding when populations with more severe liver disease were excluded. There was greater rebleeding and mortality over an extended period when shorter durations were combined with sclerotherapy. Longer durations were associated with a longer hospital stay and, for terlipressin, more adverse events.
UNASSIGNED: Shorter vasoactive drug durations combined with band ligation in selected populations appear safe. Higher powered RCTs are needed, involving patients with different degrees of severity of EVB and liver disease.

Understanding the challenges faced by second language (L2) learners in lexical tone perception is crucial for effective language acquisition. This study investigates the impact of exaggerated acoustic properties on facilitating Mandarin tone learning for English speakers. Using synthesized tone stimuli, we systematically manipulated pitch contours through three key modifications: expanding the fundamental frequency (F0), increasing F0 (female voice), and extending the overall duration. Our objectives were to assess the influence of F0 expansion, higher F0, longer duration, and varied syllables on Mandarin tone learning and generalization. Participants engaged in a non-adaptive trial-by-trial tone identification task. Mixed-effects logistic regression modeling was used to analyze accuracy across learning phases, acoustic factors, and tones. Findings reveal improvements in accuracy from training to testing and generalization phases, indicating the effectiveness of perceptual training to tone perception for adult English speakers. Tone 1 emerged as the easiest to perceive, while Tone 3 posed the most challenge, consistent with established hierarchies of tonal acquisition difficulty. Analysis of acoustic factors highlighted tone-specific effects. Expanded F0 was beneficial for the identification of Tone 2 and Tone 3 but posed challenges for Tone 1 and Tone 4. Additionally, longer durations also exhibited varied effects across tones, aiding in the identification of Tone 3 and Tone 4 but hindering Tone 1 identification. The higher F0 was advantageous for Tone 2 but disadvantageous for Tone 3. Furthermore, the syllable ma facilitated the identification of Tone 1 and Tone 2 but not for Tone 3 and Tone 4. These findings enhance our understanding of the role of acoustic properties in L2 tone perception and have implications for the design of effective training programs for second language acquisition.

暂无摘要。

UNASSIGNED: Previous studies that suggest a shorter time from cervical ripening balloon placement to delivery with shorter total balloon placement time have excluded patients with prior cesarean deliveries.
UNASSIGNED: To evaluate, in patients with a prior history of cesarean delivery undergoing cervical ripening with a double-balloon catheter, whether planned removal of device after 6 vs 12 hours would result in shorter time to vaginal delivery.
UNASSIGNED: A before-and-after study was performed after a practice change occurred November 2020, shortening the planned time of double-balloon catheter placement for cervical ripening from 12 to 6 hours. Data were collected via retrospective electronic chart review. Primary outcome was time from balloon placement to vaginal delivery. Secondary outcomes included rates of cesarean delivery, maternal intraamniotic infection, and uterine rupture. Kaplan-Meier curves compared median times to delivery between the groups. A Cox proportional-hazards model was used to adjust for time of balloon placement, number of previous vaginal deliveries, and co-medications used.
UNASSIGNED: From November 2018 to November 2022, 189 analyzable patients with a prior history of cesarean delivery received a double-balloon catheter for cervical ripening during their trial of labor. Patients were separated into pre- and postpolicy change groups (n=91 and 98, respectively). The median time to vaginal delivery for the pregroup was 28 hours (95% CI: 26, 35) and 25 hours (95% CI: 23, 29) for those in the postgroup (P value .052). After adjusting for dilation at time of balloon placement, number of previous vaginal deliveries, and co-medication, the estimated hazard ratio for successful vaginal delivery postpolicy change was 1.89 (95% CI: 1.27, 2.81). There were no differences in rates of secondary outcomes.
UNASSIGNED: In patients with prior cesarean delivery undergoing mechanical cervical ripening with a double-balloon catheter, planned removal at 6 hours compared to 12 hours may result in higher chances of successful vaginal delivery and possibly a shorter time to delivery, without increasing rates of cesarean delivery and intraamniotic infection.

This letter discusses the publication by Feng et al. Iodine, selenium, and vitamin D are closely associated with thyroid hormone production in humans; however, the efficacy of selenium and vitamin D supplementation for type 2 diabetes mellitus (T2DM) patients with Hashimoto\'s thyroiditis (HT) remains controversial. In the retrospective study we discuss herein, the authors highlighted significant improvements in thyroid function, thyroid antibodies, blood glucose, and blood lipid in T2DM patients with HT following addition of vitamin D and selenium to their antidiabetic regimens, underscoring the value of these supplements. Our team is currently engaged in research exploring the relationship between micronutrients and HT, and we have obtained invaluable insights from the aforementioned study. Based on this research and current literature, we recommend a regimen of 4000 IU/day of vitamin D and 100-200 μg/day of selenium for over three months to six months for patients with HT, particularly for those with concurrent T2DM.

UNASSIGNED: Tracheostomy decannulation in children with craniofacial deformities poses challenges due to airway obstruction and the developing brain. This study aimed to compare decannulation outcomes based on age at tracheostomy and duration of cannulation so as to identify the best time for decannulation for children with long-term tracheostomy.
UNASSIGNED: This retrospective study included 12 children at a single centre who underwent decannulation after prolonged tracheostomy for craniofacial deformities. Data on demographics, clinical features, decannulation process and outcomes were collected. Children were divided into two groups: ≤6 years (n = 7) and >6 years (n = 5) at tracheostomy insertion.
UNASSIGNED: All children underwent successful decannulation without immediate complications. One case of mild tracheomalacia and one of subglottic stenosis were treated pre-decannulation. Children ≤6 years demonstrated better post-operative adaptation in swallowing and speaking compared to the >6 years group. Notably, early and prolonged tracheostomy in the ≤6 years group was associated with easier adaptation post-decannulation. Social interaction was another challenge, particularly for the >6 years group.
UNASSIGNED: The timing and duration of tracheostomy significantly impacts post-decannulation adaptation, likely due to factors such as neuroplasticity, muscle memory and psychological adjustment. This emphasises the need for comprehensive care, especially for older children. Early tracheostomy in children may allow them to adapt speech and swallowing skills, easing post-decannulation regain of skills. Conversely, older children with fully developed skills may struggle to relearn them after tracheostomy and decannulation. Age at tracheostomy and duration of cannulation influences decannulation outcomes in children with craniofacial deformities. Further research is crucial to develop targeted interventions for better post-operative care, particularly for older children.

BACKGROUND: Fluoroquinolones are the most commonly prescribed antibiotics. Because of their known tendency to drive antimicrobial resistance, their prescribing patterns need to be more restricted. This study aimed to describe the clinical practice of fluoroquinolone prescription, dose adjustments for renal impairment patients and bacterial resistance profiles, eventually providing evidence-based recommendations to optimize antibiotic prescribing practices in the local population.
METHODS: This retrospective, cross-sectional study was conducted at An-Najah National University Hospital in Palestine. The data were collected from admitted patients who were given ciprofloxacin or levofloxacin from July 2021 to June 2023. Data from 692 inpatients across various hospital departments were examined (409 for levofloxacin and 283 for ciprofloxacin). Statistical analysis was performed via IBM SPSS version 23.0 to summarize the demographic, clinical, and epidemiological data.
RESULTS: The sociodemographic profile revealed diverse age distributions, with 25.4% and 39% older than 50 years for ciprofloxacin and levofloxacin, respectively. Ciprofloxacin was predominantly used in the oncology department (28.2%), with surgical prophylaxis (22.6%) and febrile or afebrile neutropenia (21.1%) being the most common indications. Levofloxacin was predominantly used in the medical ward (45.7%), mainly for lower respiratory tract infection (58.8%) and prophylaxis for bone marrow transplantation (16.5%). Enterococcus and methicillin-resistant Staphylococcus aureus were the most commonly isolated pathogens, with 62.5% of the isolates demonstrating resistance to ciprofloxacin. Moreover, extended-spectrum beta-lactamase-producing Enterobacterales were the most common pathogen isolated, with 33.3% being resistant to levofloxacin. Statistical analysis revealed a significant association between the choice of antibiotic and the approach to therapy. Levofloxacin was significantly more likely than ciprofloxacin to be used as empiric therapy (p < 0.001), whereas ciprofloxacin was more likely to be used as targeted therapy (p < 0.001).
CONCLUSIONS: This study investigated prescribing practices and resistance to levofloxacin and ciprofloxacin in a large hospital in a developing country. According to the bacterial resistance profiles, we conclude that there is a need for hospital departments to exercise greater restraint on the use of these antibiotics. To this end, further studies addressing the clinical efficacy of fluoroquinolones against the current treatment guidelines to evaluate their appropriateness should be carried out.

UNASSIGNED: Although impaired auditory mismatch negativity (MMN) has consistently been found in individuals with schizophrenia, there are few and inconsistent reports on nonclinical individuals with schizotypy. To date, no studies have thoroughly assessed MMN with different degrees of deviant oddballs in nonclinical schizotypal samples. The aim of this study was to examine the extent of duration MMN (dMMN) amplitudes under two deviant duration conditions (large and small) in nonclinical participants with high schizotypal traits.
UNASSIGNED: An extreme-group design was utilized, in which 63 participants from the schizotypy and control groups were selected from a pool of 1519 young adults using the Schizotypal Personality Questionnaire (SPQ). MMN was measured using passive duration oddball paradigms. Basic demographic information and musical backgrounds were assessed and matched, while depression and anxiety were evaluated and controlled for. The repeated measures analysis of covariance was utilized to evaluate differences in dMMN between groups. The Bonferroni correction was applied for multiple comparisons. Partial correlation and multiple linear regression analyses were conducted to investigate the association between dMMN amplitudes and SPQ scores.
UNASSIGNED: The amplitudes of dMMN at Cz were significantly increased under the large deviance condition in nonclinical schizotypal individuals (F = 4.36, p = .04). Large-deviance dMMN amplitudes at Fz were positively correlated with mild cognitive-perceptual symptoms in the control group (rp = .42, p = .03). However, as schizophrenia-like symptoms worsened and approached the clinical threshold for schizophrenia, small-deviance dMMN amplitudes at Cz showed negative associations with the cognitive-perceptual factor in the schizotypy group (rp = -.40, p = .04).
UNASSIGNED: These results suggest the importance of considering the degree of deviation in duration when implementing the auditory oddball paradigm among nonclinical participants with schizotypal traits. In addition, our findings reveal a potential non-linear relationship between bottom-up auditory processing and the positive dimension of the schizophrenia spectrum.