Background: and Purpose In the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial, treatment with nerinetide was associated with improved outcomes in patients who did not receive intravenous alteplase. We compared the effect of nerinetide on clinical outcomes in patients without concurrent intravenous alteplase treatment within different patient subgroups. Methods: ESCAPE-NA1 was a multicenter randomized trial in which acute stroke patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) >4 undergoing endovascular treatment (EVT) were randomized to intravenous nerinetide or placebo. The primary outcome was independence (modified Rankin Scale [mRS] score 0–2) at 90 days. We assessed baseline, clinical, and imaging variables as predictors of outcome and for evidence of treatment effect modification. We constructed two multivariable models using variables known prior to randomization and variables known immediately post-EVT procedure to provide adjusted estimates of effect. We assessed for evidence of treatment effect modification using multiplicative interaction terms within each model. Results: Four hundred forty-six patients were included in the analysis. Clinical outcomes were better in patients randomized to the nerinetide arm (mRS 0–2: 59.4% vs. 49.8%). There was possible treatment effect modification by ASPECTS score; patients with ASPECTS 8–10 showed a larger treatment effect compared to those with lower ASPECTS score. Younger age, lower NIHSS score, lower baseline serum glucose, absence of atrial fibrillation at baseline, higher ASPECTS score, middle cerebral artery (vs. internal carotid artery) occlusion, use of conscious or no sedation (vs. general anesthesia), and faster treatment were all predictors of favorable outcome. Conclusion Patients in the nerinetide arm who were not treated with concurrent alteplase showed improved clinical outcomes and the treatment effect was larger among patients with favorable ASPECTS profiles.

Heart failure with preserved ejection fraction (HFpEF) is a major healthcare problem with increasing prevalence. There has been a shift in HFpEF management towards early diagnosis and phenotype-specific targeted treatment. However, diagnosing HFpEF remains challenging due to a lack of universal criteria and patient heterogeneity. This review aims to provide a comprehensive assessment of the diagnostic workup of HFpEF, highlighting the role of echocardiography in HFpEF phenotyping.

The application of extended reality (XR) technology is rapidly expanding in the medical field, including anesthesia. This review aims to introduce the current literature on XR utilization to help anesthesiologists adopt this technology in education and clinical practice. XR is useful for both knowledge acquisition and skill training in a wide range of settings, from students to medical professionals. One of its major benefits is harm reduction through simulation scenarios that allow for immersion in clinical situations and opportunities to practice procedures and tasks. These scenarios often involve both technical and non-technical skills, enabling clinicians to enhance their capabilities without risking patient safety. In clinical settings, XR can also be used with patients to increase familiarity with medical procedures, provide education, and reduce anxiety. XR can also serve as a distraction technique, diverting the patient’s attention from medical procedures and enhancing comfort, which may contribute to reduced opioid use. Although the potential benefits of XR in anesthesia have been reported in various educational and clinical contexts, challenges, such as limited financial reimbursement and restricted technical accessibility, remain. With further research and technological advancements, XR technology has the potential for widespread adoption in anesthesia practice.

Purpose: The aim of this study was to identify, compile, and report the technical specifications of current and historical intraoral digital radiographic systems and recommend standardised reporting practices for production companies. Materials and Methods: A comprehensive report was prepared on 150 intraoral digital radiographic systems, comprising 105 sensor-based (70%) and 45 phosphor storage plate (PSP)-based systems (30%). Technical specifi cations were obtained from official company sources and scientific articles to ensure a complete collection of available data. Results: These systems were produced by 55 companies across 11 countries, with the United States leading (35.3%), followed by France (12%). Among the sensor systems, 76.2% used complementary metal-oxide-semiconductor (CMOS) technology, with notable variations in sizes and resolutions. PSP systems were available in 7 plate sizes and displayed diverse resolutions and scanning times. Twenty-one companies produced both sensor- and PSP-based systems, 33 produced only sensor-based systems, and 1 produced exclusively PSP-based systems. Conclusion This report identified 150 digital radiographic systems, revealing wide variability in technicalspecifications and a lack of standardised reporting protocols. The comprehensive summary and recommendations forconsistent documentation provided here can help clinicians make informed decisions and encourage manufacturers and production companies to adopt uniform reporting standards aligned with local regulatory frameworks.

Purpose: This study was conducted to compare the objective image quality of radiographs acquired with a handheld X-ray device to those obtained with a wall-mounted X-ray device. Materials and Methods: Brightness, noise, uniformity, and contrast were evaluated. To assess the first 3 parameters,radiographs of an acrylic block were acquired with an unused photostimulable phosphor (PSP) plate from the VistaScan system (Mini Easy, Dürr Dental, Bietigheim-Bissingen, Germany). Initially, 6 radiographs were taken with a Focus X-ray wall-mounted device (Instrumentarium, Tuusula, Finland) operating at 60 kVp, 7 mA, and 0.125 s.Another 6 radiographs were captured using an Eagle handheld X-ray device (Alliage, São Paulo, Brazil) at 60 kVp, 2.5 mA, and 0.35 s. The means and standard deviations of the gray values for all radiographs were calculated using ImageJ (National Institutes of Health, Bethesda, MD, USA). For contrast assessment, radiographs of an aluminum step wedge were obtained using the same PSP plate, X-ray devices, and acquisition parameters. The percentage of contrast variation was determined. The impacts of the devices on image quality were compared using the Student t-test, with a significance level of 5% (P<0.05). Results: Compared with the wall-mounted device, the handheld device produced radiographs with higher brightness and noise, as indicated by mean values of 6.57 (0.49) and 3.49 (0.02), respectively. Furthermore, it demonstrated lower uniformity and contrast, with respective means of 3.75 (0.02) and 35.48 (0.09) (P<0.05). Conclusion Radiographs obtained using a handheld X-ray device exhibit lower theoretical image quality than those acquired with a wall-mounted device.

Objective: To understand the growth and development levels of four physical measurements in children aged 3-6 years in China, so as to provide a reference for child nutrition improvement and health promotion. Methods: A stratified random sampling method was used to collect physical measurement data from 120 kindergartens 25 842 children aged 3-6 years across 24 provinces and cities in seven natural geographical regions of North China, Northeast China, East China, Central China, South China, Southwest China and Northwest China from 2020 to 2023. The development levels of head circumference, chest circumference, waist circumference, and hip circumference were evaluated using a grading method. The analysis of gender and age differences was conducted using Mann-Whitney U- test and Kruskal-Wallis test, and the comparison of abnormal detection rates for different genders was conducted using Chi square test. Results: The distribution range of children aged 3-6 was 51.74(50.08, 53.33) cm in terms of head circumference, 55.73(52.09, 59.04) cm in terms of chest circumference, 53.04(48.92, 56.40) cm in terms of waist circumference, and 59.36(56.30, 62.32) cm in terms of hip circumference. The detection rate of abnormal head circumference in boys and girls aged 3-6 years old was relatively high (19.71%-42.02%), and the detection rate of abnormal physical circumference development levels in boys was higher than that in girls of all ages ( χ 2=5.63-83.35, P <0.05). The detection rate of abnormal hip circumference (4.89%-6.53%) and chest circumference (4.51%-6.38%) in boys and girls aged 3-6 was relatively low, and there was no statistically significant difference in the abnormal rate between different ages and genders ( χ 2=0.00-1.61, 0.00-3.71, P >0.05). The detection rate of abnormal waist circumference in boys and girls aged 3-6 was relatively high (13.70%-42.45%), and the detection rate of abnormal waist circumference in girls was higher than that in boys aged 4-6 groups ( χ 2=10.49-58.18, P < 0.05). Conclusions The overall physical development of children aged 3-6 years in China is improving, but the abnormal detection rates for head circumference and waist circumference are relatively high. Child healthcare should focus on preventing and treating abdominal obesity, with differentiated health intervention strategies based on different age groups and genders.

Objective: Mortality surveillance was established in the state of Victoria just before the COVID-19 pandemic. Here, we describe the establishment of this surveillance system, justify the modelling approach selected, and provide examples of how the interpretation of changes in mortality rates during the pandemic was influenced by the model chosen. Methods: Registered deaths occurring in Victoria from 1 January 2015 to 31 December 2020 were sourced from the Victoria Death Index. Observed mortality rates were compared to a raw historical 5-year mean and to predicted means estimated from a seasonal robust regression. Differences between the observed mortality rate and the historical mean (delta-MR) and excess mortality rate from the observed and predicted rates were assessed. Results: There were 20 375 COVID-19 cases notified in Victoria as of 31 December 2020, of whom 748 (3.7%) died. Victorians aged >=85 years experienced the highest case fatality ratio (34%). Mean observed mortality rates in 2020 (MR: 11.6; 95% confidence interval [CI]: 11.4, 11.9) were slightly reduced when compared with the annual rate expected using the historical mean method (mean MR: 12.2; 95% CI: 12.1, 12.3; delta-MR: -0.57; 95% CI: -0.77, -0.38), but not from the rate expected using the robust regression (estimated MR: 11.7; 95% prediction interval [PI]: 11.5, 11.9; EMR: -0.05; 95% CI: -0.26, 0.16). The two methods yielded opposing interpretations for some causes, including cardiovascular and cancer mortality. Discussion: Interpretation of how pandemic restrictions impacted mortality in Victoria in 2020 is influenced by the method of estimation. Time-series approaches are preferential because they account for population trends in mortality over time.

Heart failure with preserved ejection fraction (HFpEF) is a major healthcare problem with increasing prevalence. There has been a shift in HFpEF management towards early diagnosis and phenotype-specific targeted treatment. However, diagnosing HFpEF remains challenging due to a lack of universal criteria and patient heterogeneity. This review aims to provide a comprehensive assessment of the diagnostic workup of HFpEF, highlighting the role of echocardiography in HFpEF phenotyping.