Assessing disease activity using the pediatric Crohn’s disease activity index:Can we use subjective or objective parameters alone?

BACKGROUND The pediatric Crohn’s disease activity index(PCDAI)is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.AIM To examine which items on the PCDAI drive assessment of disease activity,and how subgroups of subjective and objective items reflect change in disease state over time.METHODS Selective raw data from three prospectively collected datasets were combined,including 703 children with full PCDAI data at baseline,at 3-mo(Q1,n=670),and 1-year(Q4,n=474).Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.RESULTS Abdominal pain,well-being,weight,and stooling had the highest change scores over time.Objective indicators including albumin,abdominal exam,and height velocity followed.Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4(P<0.001 and P<0.05).Subjective and objective subgroups of items predicted less variance(18%and 22%)on total PCDAI scores at Q1 and Q4 compared to the full PCDAI,or a composite scale(both 32%)containing significant predictors.CONCLUSION Although subjective items on the PCDAI change the most over time,the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone.Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.

Potential of an activity index combining acceleration and location for automated estrus detection in dairy cows

The objective of this study was to assess the effectiveness and practicability of an activityindex combining acceleration and location data for automated estrus detection in dairycows. By using a wearable neck tag, measurements of acceleration and location were gathered from 22 multiparous cows monitored incessantly for 6 days to derive activity recordsof each cow. The maximum-minimum distance clustering (MMDC) method was used todivide hourly activity data into low, medium, high, and intensity level groups. The weightedsum of the proportions of the low, medium, high, and intensity activities in an hour constituted the activity level. The activity index was defined as the ratio of the variation inhourly activity level compared to the same time period during the previous three days. Furthermore, whether the cow was in estrus was judged above a set threshold. The studyshowed that the power consumption and communication effects of the neck tags wereacceptable for indoor-housing conditions. For the two consecutive time periods, theactivity-index-based detection algorithm achieved 90.91% for accuracy, 100% for precision,100% for specificity, 83.33% for recall, 90.91% for F1 score, and 0.82 for Kappa coefficient. Onthe basis of these results, it can be concluded that the combination of acceleration andlocation in the activity index can promote estrus detection in dairy cows.

Trading-flow assisted estimation of the jump activity index

Existing estimators for the jump activity index only made use of the price dynamics of assets.In this study,we incorporate trading information and propose a trading-flow-adjusted(TA)estimator for the jump activity index for pure-jump Ito semimartingales observed at high frequencies.We derive the central limit theorem of the estimator and perform simulation studies that justify the theory.The new estimator is shown to be more efficient in terms of the convergence rate as compared with the existing estimators,which use only the price information under some realistic conditions.Empirical analysis shows estimates with lower standard errors than those that do not incorporate the trading information.

Strength Activity Index of Air Quenched Basic Oxygen Furnace Steel Slag

Air quenched basic oxygen furnace steel slag （BOF-SS） is processed at very high cooling rate, which is expected to have different cementitious properties from conventional slowly cooled BOF-SS. For this purpose, the strength activity indexes of air quenched and slowly cooled BOF-SS are investigated. The results reveal that, under the specific surface area （S） of 490 m^2/kg, the compressive strength activity index reaches 1.24 after 28 days with replacement of 15% air quenched BOF-SS and reaches 1.05 after 28 days with replacement of 20% air quenched BOF-SS and 30%granulated blast furnace slag （GBFS）. The cementitious activity of air quenched BOF-SS is obviously higher than that of slowly cooled BOF-SS, mainly because it contains more C3 S and glassy phases.

Mechanical Property and Microstructure of Cement Mortar with Carbonated Recycled Powder

Carbonated recycled powder as cementitious auxiliary material can reduce carbon emissions and realize high-quality recycling of recycled concrete.In this paper,microscopic property of recycled powder with three carbonation methods was tested through XRD and SEM,the mechanical property and microstructure of recycled powder mortar with three replacement rates were studied by ISO method and SEM,and the strengthening mechanism was analyzed.The results showed that the mechanical property of recycled powder mortar decreased with the increasing of replacement rate.It is suggested that the replacement rate of recycled powder should not exceed 20%.The strength index and activity index of carbonated recycled powder mortar were improved,in which the flexural strength was increased by 27.85%and compressive strength was increased by 20%at the maximum.Recycled powder can be quickly and completely carbonated,and the improvement effect of CH pre-soaking carbonation was the best.The activity index of carbonated recycled powder can meet the requirements of Grade II technical standard for recycled powder.Microscopic results revealed the activation mechanism of carbonated recycled powder such as surplus calcium source effect,alkaline polycondensation effect and carbonation enhancement effect.

Influence of Polyaluminum Chloride Residue on the Strength andMicrostructure of Cement-Based Materials

In this paper,cement and dechlorinated Polyaluminum Chloride Residue(PACR)have been used to prepare a net slurry and mortar specimens.Two hydration activity indicators have been used to quantitatively analyze the dechlorinated PACR hydration activity.In particular,the effect of dechlorinated PACR content on the compressive strength of mortar has been assessed by means of compressive strength tests.Moreover,X-ray diffraction(XRD)and scanning electron microscopy(SEM)have been employed to observe the microstructure of the considered hydration products.The following results have been obtained.The 28th day activity index of the dechlorinated PACR is 75%,and therefore it meets the criterion for the use of active admixture.The increase in the content of the dechlorinated PACR tends to reduce the compressive strength of mortar specimens,however,it is beneficial to its later strength growth.When the content is not greater than 10%,the strength remains unchanged,otherwise,it decreases.The PACR does not form a new crystalline phase in the cement slurry,and the dechlorinated PACR remains active until the age of the 28th day.The inclusion of the PACR mainly deteriorates the early strength of the cement slurry,but it promotes the production of hydration products in the cement slurry after the 7th day.

In vitro and comparative study on the extracellular enzyme activity of molds isolated from keratomycosis and soil

AIMTo isolate and identify the molds involved in mycotic keratitis; to isolate corresponding species from soil samples; to compare the extracellular enzyme activity indices of the molds isolated from keratitis cases and the corresponding soil isolates.

Activity of Reducing Steel Slag of EAF

Reducing steel slag （RSS） was mainly acquired from five electric-arc furnace （EAF） steelmaking plants （among them, the products of two plants were carbon steel and those of other plants were stainless steel） for research tests. The chemical properties, compound compositions, activities and contents of main expansive compounds were tested. The results showed that the field sampled RSS had a very high crystallinity and hydraulicity with main chemical compositions close to those of Portland cement. It can be known from the study that in case of C/S ratio higher than 2.0, the main compound compositions are C2S, C3S, C2F and f-CaO. However, after the RSS was stored for six months, an obvious variation occurred with potential pre-hydration in RSS, where the SO3 content was slightly reduced and the compressive activity index was obviously higher than that at the 28th day.

Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis

Objective:The ulcerative colitis endoscopic index of severity(UCEIS)and the Mayo endoscopic score(MES)are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis(UC).The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.Methods:Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The median follow-up was 81 months,and all the data were analyzed in January 2021.The primary outcome was the need for step-up treatment,which included the use of corticosteroids,immunomodulatory,or surgery during admission and follow-up.Data were analyzed using the c2 or Fisher exact test,Spearman test,t-test,and ManneWhitney U test.Results:Totally,65 patients were enrolled,of whom 12(18.5%)needed step-up treatment due to nonresponse to mesalazine.The UCEIS score,MES,and the ulcerative colitis disease activity index(UCDAI)score were significantly higher in patients who had nonresponse to mesalazine(UCEIS score:6.92±0.69 vs.4.45±1.17,p<0.001;MES:2.67±0.49 vs.2.15±0.69,p=0.024;UCDAI score:9.33±1.87 vs.6.70±2.38,p=0.002).In the multivariate analysis,the UCEIS score(OR=25.65,95%CI:3.048 e45.985,p=0.003),UCDAI score(OR=1.605,95%CI:1.144e2.254,p=0.006),and C-reactive protein level(OR=1.056,95%CI:1.006e1.108,p=0.026)were independent risk factors of nonresponse.The area under the ROC curve of UCEIS was 0.95,with a sensitivity of 100%and specificity of 84.6%,a cut-off value of 6,which outperformed the MES with an area under the ROC curve of 0.70.When the UCEIS score≥6,60%of patients eventually needed step-up treatment.Conclusions:The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine.The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score≥6.

Effects of Dihydromyricetin Extracted from Ampelopsis grossedentata on Visceral Organ Indexes and Intestinal Digestive Enzyme Activities of Chickens

To provide a reference basis for reasonable development and utilization of Ampelopsis grossedentata resource and its application in production,we added 0.025%,0.05% and 0.1% dihydromyricetin（DMY）extracted from A.grossedentata into the basal diets of Yaoshan chickens,and studied the effects of DMY on visceral organ indexes and digestive enzyme activities of 40-day-old healthy Yaoshan chickens.Supplementation of DMY in basal diets influenced visceral organ weight,organ index,length and digestive enzyme activity of small intestine of chickens.Among them,0.05% DMY was the most appropriate volume for supplementation.Compared with control group（without DMY）,0.05% DMY reduced lung weight and index（P〉0.05）,significantly reduced liver weight（P〈0.05）,extremely reduced stomach weight and stomach index（P〈0.01）,increased activity of amylase in small intestine（P〉0.05）,significantly increased length of small intestine and activity of protease（P〈0.05）.Supplementation of 0.05% DMY reduced the visceral organ weight and organ index,enhanced digestion and absorption ability of gastrointestinal tract,thereby improving feed utilization rate and promoting the growth of chickens.

Progress of ulcerative colitis patients during the COVID-19 pandemic

BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stress.However,successive waves of the COVID-19 pandemic continuously followed the first.The effects of this chronic stress on the disease condition in UC patients are of interest.AIM To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave.METHODS Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020,the period of the first wave of the COVID-19 pandemic.In this study,an identical group of 289 UC patients was evaluated using UC-disease activity index(UC-DAI),endoscopic mucosal appearance score,and Matts pathological grade scoring.RESULTS Of the 289 UC patients included in the study in 2020,10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022,making three groups for 2020,2021 and 2022.No significant differences in characteristics were found among the three groups.UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic,but significantly recovered in 2021 and remained stable in 2022.Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022.CONCLUSION Disease activity of UC patients recovered in 2021 and remained stable in 2022,aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.

Effect of Rituximab Versus Mycophenolate Mofetil or Cyclophosphamide as Control in Lupus Nephritis:A Meta-Analysis

Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation;198 of them were treated with rituximab,while 447 were treated with mycophenolate mofetil or cyclophosphamide.We determined the odds ratio(OR)and mean difference(MD)with 95%confidence index(CI)to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random-or fixed-effects model by dichotomous or continuous techniques.Results:The rituximab group showed significantly higher complete renal remission rate(OR=2.52;95%CI 1.30-4.91,P=0.006)and total renal remission rates(OR=2.22;95%CI 1.36-3.63,P=0.001)than the control group.However,there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score(MD-1.16;95%CI-2.88-0.57,P=0.19),proteinuria(MD-0.31;95%CI-0.70-0.09,P=0.013),and serum creatinine(MD 0.01;95%CI-0.04-0.07,P=0.64)between the rituximab group and the control.Conclusion:Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates,with no significant difference in terms of shorter-end SLEDAI,proteinuria,and serum creatinine,compared with the control in individuals with lupus nephritis.

The Effect of Early versus Traditional Hospital Discharge on Activities of Daily Living for Women Undergoing Elective Cesarean Section. An Observational Cohort Study

Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scoring assessment was made and there was no significant difference between the two arms of the study. Initiation of successful breastfeeding, and neonatal readmission were similar in both groups. Conclusion: The policy of early discharge can be adopted in low-risk cases scheduled for elective uncomplicated CS provided that the mother and the neonate are in good general condition and proper instructions regarding red flag manifestations are given.

Properties of Steel Slag and Stainless Steel Slag as Cement Replacement Materials:A Comparative Study

To enhance the understanding about the utilization of steel slags as a cementitious material, we comparatively studied the chemical, mineralogical and morphological properties of two types of steel slag; basicoxygen-furnace carbon slag(BOF C) and electric-arc-furnace stainless steel slag(EAF S). Moreover, we studied the standard consistency, setting time and the effect of the slag replacement ratios on the fluidity and compressive strength of blended cement mortar. The experimental results showed that BOF C had higher alkalinity, higher pH value and more hydraulic phases than EAF S. Both types of slag showed water reduction effect due to its high fineness. Neat BOF C paste showed flash set and acceleration in the initial setting time of blended cement especially at high slag proportions. However, EAF S prolonged the setting time of blended cement even at low slag proportions. The pH values for blended cement contained 50% BOF C or EAF S were lower than those of pure cement paste. Despite of slag type, compressive strength gradually decreased with increasing slags content. The strength of BOF C mortar was higher than that of EAF S mortar with the same replacement ratio for the same age. Slag activity index demonstrated that BOF C and EAF S conformed to the Chinese National Standard(GB/T 20491-2006) requirements for steel slag as grade one and grade two, respectively.

Impact of pain on health-related quality of life in patients with inflammatory bowel disease

AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated and verified on a visual analog scale (VAS). RESULTS: 87.9% of patients reported pain. Females and males reported comparable pain intensities and HRQOL. Surgery reduced pain in both genders (P = 0.023), whereas HRQOL only improved in females. Interestingly, patients on analgesics reported more pain (P = 0.003) and lower HRQOL (P = 0.039) than patients not on analgesics. A significant correlation was found in UC patients between pain intensity and HRQOL (P = 0.023) and CAI (P = 0.027), and in CD patients between HRQOL and CDAI (P = 0.0001), but not between pain intensity and CDAI (P = 0.35). No correlation was found between patients with low CDAI scores and pain intensity. CONCLUSION: Most IBD patients suffer from pain and have decreased HRQOL. Our study reinforces the need for effective individualized pain therapy in IBD patients.

Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

AIM To evaluate the role of oral curcumin in inducing clinical remission in patients with mild to moderate ulcerative colitis(UC).METHODS A prospective randomized double-blind placebo-controlled trial comparing the remission inducing effect of oral curcumin and mesalamine 2.4 g with placebo and mesalamine 2.4 g in patients of ulcerative colitis with mild to moderate severity was conducted from January 2003 to March 2005. The included patients received 1 capsule thrice a day of placebo or curcumin(150 mg) for 8 wk. Patients were evaluated clinically and endoscopically at 0,4 and 8 wk. The primary outcome was clinical remission at 8 wk and secondary outcomes were clinical response, mucosal healing and treatment failure at 8 wk. The primary analysis was intention to treat worst case scenario(ITT-WCS).RESULTS Of 300 patients with UC, 62 patients(curcumin: 29, placebo: 33) fulfilled the inclusion criteria and were randomized at baseline. Of these, 21 patients did not complete the trial, 41 patients(curcumin: 16, placebo: 25) finally completed 8 wk. There was no significant difference in rates of clinical remission(31.3% vs 27.3%, P = 0.75), clinical response(20.7% vs 36.4%, P = 0.18), mucosal healing(34.5% vs 30.3%, P = 0.72), and treatment failure(25% vs 18.5%, P = 0.59) between curcumin and placebo at 8 wk.CONCLUSION Low dose oral curcumin at a dose of 450 mg/d was ineffective in inducing remission in mild to moderate cases of UC.

The F-measure for Research Priority

Purpose： In this contribution we continue our investigations related to the activity index （A/） and its formal analogs. We try to replace the AI by an indicator which is better suited for policy applications. Design/methodology/approach： We point out that fluctuations in the value of the AI for a given country and domain are never the result of that country＇s policy with respect to that domain alone because there are exogenous factors at play. For this reason we introduce the F-measure. This F-measure is nothing but the harmonic mean of the country＇s share in the world＇s publication output in the given domain and the given domain＇s share in the country＇s publication output.Findings： The F-measure does not suffer from the problems the AI does Research limitations： The indicator is not yet fully tested in real cases R＆D policy management： In policy considerations, the AI should better be replaced by the F-measure as this measure can better show the results of science policy measures （which the AI cannot as it depends on exogenous factors）. Originality/value： We provide an original solution for a problem that is not fully realized by policy makers.

Endoscopic ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

BACKGROUND Ulcerative colitis(UC)is usually diagnosed through histopathology,enteroscopy,clinical symptoms,and physical findings;however,it is difficult to accurately evaluate disease severity.AIM To investigate the value of endoscopic ultrasonography(EUS)in the evaluation of the severity and prognosis of UC.METHODS Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible,and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores.We performed EUS,calculated the UC endoscopic index of severity(UCEIS)and EUS-UC scores,and administered appropriate treatment.The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity,and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed.The UCEIS and EUS-UC scores before and after treatment were also compared.RESULTS A total of 79 patients were included in this study.According to the Mayo Index,23,32,and 24 patients had mild,moderate and severe UC,respectively.The UCEIS and EUS-UC scores were higher in moderate cases(4.98±1.04 and 5.01±0.99,respectively)than in mild cases(1.56±0.82 and 1.64±0.91,respectively,P<0.05).Furthermore,the UCEIS and EUS-UC scores(7.31±1.10 and 7.59±1.02,respectively)were higher in severe cases than in moderate cases(P<0.05).According to the modified Truelove and Witts scores,21,36,and 22 patients were classified as having mild,moderate and severe disease,respectively.The UCEIS and EUS-UC scores were significantly higher in moderate disease(4.79±1.11 and 4.96±1.23,respectively)than in mild disease(1.71±0.78 and 1.69±0.88,respectively,P<0.05).Additionally,the UCEIS and EUS-UC scores in severe disease(7.68±1.22 and 7.81±0.90,respectively)were significantly higher than in moderate disease(P<0.05).The UCEIS and EUSUC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score(P<0.05).The UCEIS and EUS-UC scores after 2 mo of treatment(3.88±0.95 and 4.01±1.14,respectively)and after 6 mo of treatment(1.59±0.63 and 1.64±0.59,respectively)were lower than the respective scores before treatment(5.93±1.79 and 6.04±2.01)(P<0.05).CONCLUSION EUS can clarify the status of UC and accurately evaluate the treatment response,providing an objective basis for formulation and adjustment of the treatment plan.

Research on the performance of steel slag and blast furnace slag composite admixture

This study investigates the properties of Baosteel steel slag and blast furnace （BF） slag in order to develop high-performance steel slag and BF slag composite admixture by optimizing the composite mixing technique. Based on the investigation of the stability of steel slag powder and the performance of cement mortar in different mixing ratios and different adding amounts of steel slag and BF slag composite admixture, rational mixing ratios and the adding amount range of steel slag and BF slag composite admixture were determined.

Perianal fistulodesis–A pilot study of a novel minimally invasive surgical and medical approach for closure of perianal fistulae

BACKGROUND Perianal fistulae strongly impact on quality of life of affected patients.AIM To challenge and novel minimally invasive treatment options are needed.METHODS Patients with Crohn’s disease(CD)in remission and patients without inflammatory bowel disease(non-IBD patients)were treated with fistulodesis,a method including curettage of fistula tract,flushing with acetylcysteine and doxycycline,Z-suture of the inner fistula opening,fibrin glue instillation,and Zsuture of the outer fistula opening followed by post-operative antibiotic prophylaxis with ciprofloxacin and metronidazole for two weeks.Patients with a maximum of 2 fistula openings and no clinical or endosonographic signs of a complicated fistula were included.The primary end point was fistula healing,defined as macroscopic and clinical fistula closure and lack of patient reported fistula symptoms at 24 wk.RESULTS Fistulodesis was performed in 17 non-IBD and 3 CD patients,with a total of 22 fistulae.After 24 wk,all fistulae were healed in 4 non-IBD and 2 CD patients(overall 30%)and fistula remained closed until the end of follow-up at 10-25 mo.In a secondary per-fistula analysis,7 out of 22 fistulae(32%)were closed.Perianal disease activity index(PDAI)improved in patients with fistula healing.Low PDAI was associated with favorable outcome(P=0.0013).No serious adverse events were observed.CONCLUSION Fistulodesis is feasible and safe for perianal fistula closure.Overall success rates is at 30%comparable to other similar techniques.A trend for better outcomes in patients with low PDAI needs to be confirmed.