Objective Assess the suitability of clinical vignettes in benchmarking performance online symptom checkers (OSCs). Design Observational study using a publicly available free OSC. Participants Healthily OSC, which provided consultations English, was used to record consultation outcomes from two lay and four expert inputters 139 standardised patient vignettes. Each vignette included three diagnostic solutions triage recommendation one categories urgency. A panel independent general...

The systemic-to-pulmonary shunt (SPS) remains an important palliative therapy in many congenital heart defects. Unlike other surgical treatments, the mortality after operations has risen. We used audit dataset to investigate potential reasons for this change and report national results. A total of 1993 patients classified 13 diagnoses underwent SPS procedure between 2000 2013. Indication trends by era also results before repair or next stage are reported. dynamic hazard model with competing...

The purpose of this paper is to identify immunologic hallmarks excessive bodyweight. analysis based on 176 adults (106 women, 70 men) who participated in a nested case-control study Italy. All participants were healthy at the time blood collection and aged between 36 75 years. We employed multivariate variance nonparametric Bayesian additive regression tree approach along with receiver operating characteristic (ROC) curve determine signature body weight (i.e., obesity overweight)....

Dietary fiber may modulate the environment of intestinal lumen, alter microflora populations, and influence immune response disease risk. Epidemiological investigations have suggested that higher intake is associated with lower overall mortality, in particular from cardiovascular digestive tract diseases. Here a panel 17 cytokines chemokines were measured plasma 88 cancer-free subjects sampled within Italian EPIC-Italy cohort. A statistically significant inverse association (p-trend = 0.01)...

Objective Surgical aortic valve replacement (AVR) remains the gold standard therapy for severe stenosis. Long-term survival data following AVR is required. Our objective was to provide a detailed contemporary benchmark of long-term among elderly patients (≥65 years) in UK. Methods We conducted retrospective cohort study 1815 adult undergoing surgical AVR± coronary artery bypass graft (CABG) surgery at single UK centre between 1996 and 2011. main outcome patient survival, which assessed by...

Treatment of infants with tetralogy Fallot (ToF) has evolved in the last two decades increasing use primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options a comparative study.This retrospective study data from UK National Congenital Heart Disease Audit. All (n=1662, median age 181 days) ToF no other complex defects undergoing or between...

Abstract Background Balancing oxygen supply and demand during cardiopulmonary bypass (CPB) is crucial to minimise adverse outcomes. This managed by adjusting delivery components – cardiac index (CI), haemoglobin concentration (Hb), arterial saturation (SaO 2 ) metabolic through temperature (Temp) changes. The extraction ratio (OER) responds these adjustments, affecting consumption, but this response not well understood. We aimed develop a mathematical model capture OER dynamics CPB quantify...

Abstract The emergence of large language models (LLMs) offers new opportunities to leverage, often unused, information in clinical text. This study examines the utility text embeddings generated by LLMs predicting postoperative acute kidney injury (AKI) paediatric cardiopulmonary bypass (CPB) patients using electronic health record (EHR) text, and explore methods for explaining their output. AKI is a significant complication CPB its prediction can significantly improve patient outcomes...

To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 T2D aged > 42 years between 1999 and 2018. Annual mean levels eight routinely measured were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise non-piecewise growth curve models assessed by status up to 19 (dementia) or last contact healthcare (no dementia). 23,546 patients developed...

Background Anomalous coronary artery from the pulmonary (ACAPA) is a very rare congenital anomaly that often occurs during infancy. Patients can present in critical condition. Methods We analysed procedure-related data national audit database for period 2000–2013. Results A total of 120 patients <1 year had repair isolated ACAPA using transfer or tunnel (Takeuchi) operation. Seven (6.8%) required mitral valve procedure at index and eight (7.8%) repair/replacement follow-up, including...

Many adults with repaired tetralogy of Fallot will require a pulmonary valve replacement (PVR), but there is no consensus on the best timing. In this study, we aim to evaluate impact age at PVR outcomes.This national multicentre retrospective study including all patients >15 years who underwent their first between 2000 and 2013. The optimal cut-off was identified using Cox regression classification tree analysis.A total 707 were included, median 26 (15-72) years. mortality rate 10 after...

Abstract Background Conventional Cardiopulmonary Bypass (cCPB) is a trigger of systemic inflammatory reactions, hemodilution, coagulopathy, and organ failure. Miniaturised (mCPB) has the potential to reduce these deleterious effects. Here, we describe our standardised ‘Hammersmith’ mCPB technique, used in all types adult cardiac operations including major aortic surgery. Methods The use remains limited by diversity technologies which range from extremely complex, micro systems ones very...

Objectives In young and middle-aged adults, there are three current options for aortic valve replacement (AVR), namely mechanical AVR (mechAVR), tissue (biological AVR) the Ross operation, with no clear guidance on best option. We aim to compare clinical effectiveness cost-effectiveness of procedure conventional in adults. Methods This is a systematic literature review meta-analysis options. Markov multistate model was adopted cost-effectiveness. Lifetime costs, quality-adjusted life years...

Cells react to changing intra- and extracellular signals by dynamically modulating complex biochemical networks. Cellular responses lead changes in gene protein expression. Since the majority of genes encode proteins, we investigated possible correlations between parameters expression patterns identify proteome-wide characteristics indicative trends common expressed proteins. Numerous bioinformatics methods were used filter merge information regarding annotations. A new statistical time...

Introduction Primary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children’s levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results several studies single intervention challenging because previous examined different outcomes used measures that are not feasible relevant for researchers in school settings. development and implementation core outcome set (COS)...

Familial hypercholesterolemia (FH), while highly prevalent, is a significantly underdiagnosed monogenic disorder. Improved detection could reduce the large number of cardiovascular events attributable to poor case finding. We aimed assess whether machine learning algorithms outperform clinical diagnostic criteria (signs, history, and biomarkers) recommended screening in United Kingdom identifying individuals with FH-causing variants, presenting scalable for general populations.

Abstract Background Familial hypercholesterolemia (FH) is a prevalent autosomal dominant disorder characterised by elevated low-density lipoprotein cholesterol (LDL-C) levels from birth. These LDL-C significantly amplify the lifetime risk of cardiovascular disease (CVD). While impact early and effective initiation lipid-lowering medication (LLM) on CVD well documented in genetically confirmed FH, additional addressing modifiable lifestyle factors (MLRF) that patient population remains...

COVID-19 cases were first detected in the UK January 2020 and vulnerable patients asked to shield from March reduce their risk of infection.To determine determinants diagnosis shielded versus non-shielded groups, adjusted for key comorbidities not explained by shielding.Retrospective cohort study adults with infection between 1 February 15 May west London.Individuals diagnosed identified SystmOne records using clinical codes. Infection risks sociodemographic factors, nursing home status,...

Background Accurate prediction of oxygen demand is essential for optimizing delivery during paediatric cardiopulmonary bypass (CPB), but traditional models may not fully account the influences temperature, age, and weight. We aimed to quantify these relationships assess age-related variability in extraction ratio (OER) response. Methods analysed data from 334 patients undergoing CPB, developing an extended GARIX model (eGARIX) that incorporates weight, nonparametric temperature modelling via...