Why patients with symptomatic uncomplicated diverticular disease (SUDD) may develop acute diverticulitis (AD) is still unknown. We analyzed the gut microbiota (GM) in two SUDD patients, one who did experience SUDD recurrence but not AD occurrence (case 1) and one who did experience AD occurrence during follow-up (case 2). The GM of these patients showed differences in terms of phyla (Firmicutes and Bacteroidota in case 1; Actinobacteriota and Proteobacteria in case 2) and subgenera (Prevotella and Phascolarctobacterium in case 1 and Alloprevotella, Prevotella, Holdemanella, Turicibacter, Eubacterium eligens group, and Dialister in case 2). This novel insight may advance our ecological understanding of this complex disease.
Territorial Gastroenterology Service, Barletta-Andria-Trani Local Health Agency, 49 Via Torino, Andria 76123, Italy.Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome, Italy.
Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.
GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Italy.
Bioscience of microbiota, food and health
Biosci Microbiota Food Health. 2025;44(1):1-3.
Can gut microbiota explain acute diverticulitis occurrence in patients with symptomatic uncomplicated diverticular disease?

Beer contains a variety of bioactive ingredients and trace elements that can regulate bodily functions, and moderate consumption of beer can enhance immune responses. This study aimed to investigate the potential benefits of moderate consumption of alcoholic or non-alcoholic beer on the gut microbiome, immunity, and intestinal barrier function in immunosuppressed BALB/c mice induced by cyclophosphamide (CTX). Model mice with CTX-induced immunosuppression were administered alcoholic or non-alcoholic beer or galacto-oligosaccharides (GOS) for 28 consecutive days. The GOS and beer intervention groups all showed alleviation of spleen tissue damage, an increased immune organ index, decreased gut inflammation, and reduced serum concentrations of D-lactic acid, lipopolysaccharide, and tumor necrosis factor α. High-throughput 16S rRNA gene sequencing revealed higher relative abundances of Firmicutes and Actinobacteriota, and lower relative abundances of Bacteroidota, Lactobacillus, and Bifidobacterium, in CTX mice than in normal control mice. In addition, Firmicutes showed lower abundance, while Desulfobacterota showed higher abundance in CTX mice with non-alcoholic beer intake than without it. Spearman correlation analysis indicated that Bacteroidota was negatively correlated with propionic acid and butyric acid, while Desulfobacterota was positively correlated with butyric acid. Proteobacteria was negatively correlated with acetic acid, propionic acid, isobutyric acid, and valeric acid. Helicobacter was positively correlated with valeric acid. In conclusion, this is one of the first studies to examine the modulatory effects of moderate alcohol consumption in immunocompromised mice. Our findings indicate that beer consumption can alter the gut microbiome and metabolites, enhancing immunity in mice.
State Key Laboratory of Biological Fermentation Engineering of Beer, Tsingtao Brewery Co., Ltd., Qingdao, Shandong, PR China.
Department of Microecology, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, PR China.
Biosci Microbiota Food Health. 2025;44(1):32-42.
Effects of moderate beer consumption on immunity and the gut microbiome in immunosuppressed mice.

The beneficial effects of water-soluble dietary fiber on liver fat and fibrosis involve the gut microbiota; however, few epidemiological studies have investigated this association. This large-scale epidemiological study aimed to determine the effect of water-soluble dietary fiber intake on liver fat and fibrosis via gut microbiota for the general population. We divided low- and high-intake groups by median daily water-soluble dietary fiber intake and matched background factors by propensity score matching for sex and age. The high-intake group had lower controlled attenuation parameters, a lower fatty liver index, and a lower mac-2-binding protein glycosylated isomer level than the low-intake group. Furthermore, in the high-intake group, the prevalences of metabolic dysfunction-associated steatotic liver disease and cardiometabolic criteria were significantly lower than in the low-intake group. In the high-intake group, there were increases and decreases in 16 bacterial species. Of them, those belonging to Faecalibacterium and Gemmiger had higher relative abundances than the other species and had a negative correlation with the fatty liver index and its components triglyceride and glutamyl transpeptidase in a multivariate analysis adjusted for confounding factors. On the other hand, Dorea showed a significant negative correlation with liver stiffness measure, even though Dorea was decreased in the high-intake group. Faecalibacterium and Gemmiger are butyrate-producing bacteria, suggesting that water-soluble dietary fiber may inhibit fatty liver via gut butyric acid production.
Department of Gastroenterology, Hematology and Clinical immunology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562, Japan.
Division of Endoscopy, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562, Japan.
Department of Preemptive Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562, Japan.
Biosci Microbiota Food Health. 2025;44(1):49-57.
Gut microbiota involvement in the effect of water-soluble dietary fiber on fatty liver and fibrosis.

Airag, a fermented mare's milk in Mongolia, exhibits diverse flavors and microbiota due to distinct production processes and environments in nomadic households. Recently, there has been a shift from the traditional cow skin container, 'khokhuur', to a plastic container for airag production, potentially impacting the microbiota and quality. To address this notion, we aimed to elucidate the differences in the microbiota between airag samples from a plastic container and those from a khokhuur. We collected airag samples produced using either a plastic container or khokhuur from three houses in Mogod Sum (county) in Bulgan Aimag (province) and analyzed the chemical and microbiome properties of the obtained samples. Compared with the khokhuur, the plastic containers exhibited high heat retention at night and boosted lactate production, which sustained a lower pH level in airag. A series of alpha diversity indices of airag microbiota were significantly higher in airag produced in khokhuurs than in those produced in the plastic containers. In particular, Lactobacillus helveticus was the most dominant species, accounting for more than 90% of the total population in airags produced in the plastic containers and khokhuur, whereas some other lactic acid bacteria species and environmental bacteria more colonized airags produced in khokhuurs. The khokhuur itself is likely a source of these bacterial species and likely provides a niche, and the wider volatility of temperature may allow the growth of this wide range of bacteria while maintaining a lower level of lactic acid fermentation.
Division of Systems Bioengineering, Department of Bioresource and Biotechnology, Faculty of Agriculture, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
Organization for the Strategic Coordination of Research and Intellectual Properties, Meiji University, 1-9-1 Eifuku, Suginami-ku, Tokyo 168-8555, Japan.
Information and Research Institute of Meteorology, Hydrology and Environment, Ulaanbaatar 15160, Mongolia.
Mongolian University of Life Sciences, Zaisan, Ulaanbaatar 17024, Mongolia.
School of Commerce, Meiji University, 1-9-1 Eifuku, Suginami-ku, Tokyo 168-8555, Japan.
Biosci Microbiota Food Health. 2025;44(1):90-99.
Impact of container type on the microbiome of airag, a Mongolian fermented mare's milk.

Phagocytosis by immunocompetent cells is a key role in the biological defense mechanism and is the starting point of the reaction that leads from innate to acquired immunity. Several studies have demonstrated that some lactic acid bacteria strains activate the innate and acquired immune systems of the host. However, further investigation of the mechanism and improvement of usefulness is needed because the effect differs depending on the type and strain of lactic acid bacteria. In this study, we focused on the phagocytosis to lactic acid bacteria and investigated changes in phagocytic activity in vitro using several species of lactic acid bacteria and α-lipoic acid, which was expected to enhance phagocytosis. As a result, we found that α-lipoic acid treatment increased phagocytosis in several lactic acid bacteria. Strains of lactic acid bacteria with increased phagocytosis were found to have decreased CD36 expression when lactic acid bacteria alone were used, and CD36 expression was restored when α-lipoic acid was used in combination, indicating a correlation between increased phagocytosis and CD36 expression. Furthermore, the combination of Lactococcus lactis subsp. hordniae NBRC 100931 and α-lipoic acid increased phagocytosis over time and enhanced IgA production. These results suggest that the combination of α-lipoic acid and lactic acid bacteria increases the phagocytosis capacity of immunocompetent cells and may enhance the immunostimulatory effects of lactic acid bacteria.
Narita Development Center, SSP Co., Ltd., 1143 Nanpeidai, Narita-shi, Chiba 286-8511, Japan.
Local Brand R&D, SSP Co., Ltd., Opera City Tower, 3-20-2 Nishi Shinjuku, Shinjuku-ku, Tokyo 163-1488, Japan.
Biosci Microbiota Food Health. 2025;44(1):43-48.
α-Lipoic acid increases phagocytosis of some lactic acid bacteria via modulation of CD36 expression.

Probiotics exert their beneficial effects by improving the intestinal environment. Heat-inactivated probiotics may show similar effects. However, whether multi-strain mixtures (MSM) are better than single strains, irrespective of whether the bacteria are alive or dead, is unknown. In this study, we examined the gut-improving efficacy of an MSM consisting of four dead bacterial strains using an in vitro model that simulates the human gut environment. In the in vitro model, human feces were inoculated with a single-strain or MSM, and the microbial composition and fermentation products were assessed. The 16S rRNA gene sequences showed that the MSM tended to change the microbial community structure more than single strains. Furthermore, the results of a microbial diversity analysis showed that despite differences among single strains, the effect of the MSM increased with the abundance of any single strain. A similar trend was observed for fermentation products. These results suggested that the MSM made from dead bacteria exerted additive effects that may provide new health benefits to more people.
Central Research Institute, Itoen Ltd., 21 Mekami, Sagara-cho, Haibara-gun, Shizuoka, Japan.
Department of Agrobioscience, Graduate School of Agricultural Science, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe 657-8501, Japan.
Biosci Microbiota Food Health. 2025;44(1):58-69.
Additive effect of mixtures of multiple strains combining the effects of single strains on human gut microbiota in vitro.

The global probiotics market has been continuously growing, driven by consumer demand for immune-enhancing functional foods, dietary supplements, and natural therapeutics for gastrointestinal and gut function-mediated diseases. Probiotic microorganisms represent a diverse group of strains with complex but generalized mechanistic patterns. This review describes the various immunomodulatory mechanisms by which probiotics exert their effects, including the competitive exclusion of pathogenic microbes, production of antimicrobial substances, modulation of the immune system, and improvement of gut barrier function. In addition, the various formulations and methods of delivery of probiotics and the safety concerns associated with these products are also discussed.
Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam.
Department of Food Science, Széchenyi István University, Mosonmagyaróvár, 9200, Hungary.
Biosci Microbiota Food Health. 2025;44(1):4-15.
Action and immunomodulatory mechanisms, formulations, and safety concerns of probiotics.

In end-stage kidney disease requiring hemodialysis, patients at nutritional risk have a poor prognosis. The gut microbiota is important for maintaining the nutritional status of patients. However, it remains unclear whether an altered gut microbiota correlates with increased nutritional risk in patients undergoing hemodialysis. Therefore, we retrospectively analyzed patients who underwent hemodialysis at our hospital between April and December 2022. Nutritional risk was evaluated using the Geriatric Nutritional Risk Index (GNRI), and patients were divided into low- and high-GNRI groups. Patients' clinical conditions and alterations in the gut microbiota were compared between the two groups. The study included a total of 38 patients with moderate to severe frailty. The low-GNRI group had 18 patients, and the high-GNRI group had 20 patients. The low-GNRI group had more severely frail patients. Serum transthyretin, cholinesterase, total cholesterol, and β2-microglobulin were significantly lower in the low-GNRI group than in the high-GNRI group. Significant differences in the relative abundances of the Actinobacteria and Proteobacteria phyla were observed between the two groups. The genus Bifidobacterium was significantly less abundant in the high-GNRI group than in the low-GNRI group. At the species level, Bifidobacterium adolescentis and Bifidobacterium bifidum were significantly lower in the low-GNRI group. Our results indicated that GNRI can be a useful nutritional risk index that accurately reflects the comprehensive differences in clinical condition in patients undergoing hemodialysis. The deficiency of B. adolescentis and B. bifidum was strongly associated with an increased nutritional risk in patients undergoing hemodialysis.
Department of Surgery, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yamaguchi 742-1352, Japan.Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Department of Pediatrics, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yamaguchi 742-1352, Japan.
Department of Surgery, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yamaguchi 742-1352, Japan.
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Biosci Microbiota Food Health. 2025;44(1):26-31.
Verification of an alteration in the gut microbiota that increases nutritional risk in patients on hemodialysis.

α-Cyclodextrin (αCD), a cyclic hexasaccharide composed of six glucose units, is not digested in the small intestine but is completely fermented by gut microbes. Recently, we have reported that αCD supplementation for nonathlete men improved their 10 km biking times. However, the beneficial effects of αCD on exercise are not yet fully understood. Therefore, we conducted a randomized, double-blind, placebo-controlled, parallel-group study to confirm the reproducibility and obtain additional data, employing a larger sample size and a greater αCD dose than that used in our previous study. Age, body mass index, estimated V̇O2 max, and Bacteroides uniformis cell number in feces were used as stratifying factors. Eighty-one healthy nonathlete men aged 20 to 49 years who had exercise habits received a placebo (n=42) or αCD (1 g/day; n=39) for 9 weeks. Similar to our previous study, αCD supplementation significantly improved endurance exercise performance (10 km biking time trial) compared with the placebo (placebo=1,126.4 ± 133.6 s, αCD=1,073.2 ± 116.7 s, p=0.016). In addition, we observed a significantly reduced visual analog scale score for post-exercise fatigue (placebo=59.0 [46.3-54.3] mm, αCD=48.8 [37.0-50.3] mm, p=0.043). The heart rate increase was lower in the αCD group than in the placebo group during exercise (placebo=152.3 ± 11.1 bpm, αCD=144.2 ± 16.3 bpm, p=0.016). These results indicate that αCD supplementation improves endurance exercise performance and reduces post-exercise fatigue in nonathlete men.
Department of Group Project Strategy, Asahi Quality & Innovations, Ltd., 1-1-21 Midori, Moriya-shi, Ibaraki 302-0106, Japan.
Department of Corporate Strategy, Asahi Quality & Innovations, Ltd., 1-1-21 Midori, Moriya-shi, Ibaraki 302-0106, Japan.
Core Technology Laboratories, Asahi Quality & Innovations, Ltd., 1-1-21 Midori, Moriya-shi, Ibaraki 302-0106, Japan.
Institute for Advanced Biosciences, Keio University, 246-2 Mizukami, Kakuganji, Tsuruoka-shi, Yamagata 997-0052, Japan.Gut Environmental Design Group, Kanagawa Institute of Industrial Science and Technology, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan.Transborder Medical Research Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki 305-8575, Japan.Laboratory for Regenerative Microbiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Biosci Microbiota Food Health. 2025;44(1):80-89.
α-Cyclodextrin supplementation improves endurance exercise performance and reduces post-exercise fatigue in human males: a randomized, double-blind, placebo-controlled, parallel-group study.

Although the clustered regularly interspaced short palindromic repeat (CRISPR)-Cas system has been extensively developed since its discovery for eukaryotic and prokaryotic genome editing and other genetic manipulations, there are still areas warranting improvement, especially regarding bacteria. In this study, BRD0539, a small-molecule inhibitor of Streptococcus pyogenes Cas9 (SpCas9), was used to suppress the activity of the nuclease during genetic modification of Lacticaseibacillus paracasei, as well as to regulate CRISPR interference (CRISPRi). First, we developed and validated a CRISPR-SpCas9 system targeting the sirA gene of L. paracasei. Then BRD0539 was used for CRISPR-dependent DNA cleavage in vivo. Our results suggested that the inhibitor worked partially in both Escherichia coli and L. paracasei. Next, we designed a CRISPRi system in a L. paracasei strain by inserting an inactive SpCas9 gene into the chromosome and introducing a plasmid encoding for a single guide RNA (sgRNA) targeting the sirA gene. Expression of sirA was successfully inhibited in the recombinant strains, and CRISPRi was abolished in an inhibitor-dependent manner. Our findings may help expand the CRISPR toolbox for research on lactic acid bacteria and other microbes.
Department of Agricultural Chemistry, Graduate School of Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan.
Bioproduction Research Institute, National Institute of Advanced Industrial Science and Technology, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8566, Japan.
Biosci Microbiota Food Health. 2025;44(1):70-79.
Application of the SpCas9 inhibitor BRD0539 for CRISPR/Cas9-based genetic tools in Lacticaseibacillus paracasei.

The experimental team achieves impressive progress in detecting the signature of the local magnetic response of a system close to a phase transition.
© The Author(s) 2024. Published by Oxford University Press on behalf of China Science Publishing & Media Ltd.
Department of Physics, KTH Royal Institute of Technology, Sweden.
Viewpoint on 'Oscillating paramagnetic Meissner effect and Berezinskii-Kosterlitz-Thouless transition in underdoped Bi2Sr2CaCu2O8+δ'.

The physical process in the macroscopic world unfolds along a single time direction, while the evolution of a quantum system is reversible in principle. How to recover a quantum system to its past state is a complex issue of both fundamental and practical interests. In this article, we experimentally demonstrate a novel method for recovering the state in quantum walks (QWs), also known as full-state revival. Moreover, we observe two other important phenomena in QWs, recurrence and periodicity, via simplifying and repeatedly implementing the scheme, respectively. Our experiments show that obtaining these phenomena requires neither any information of the initial state nor full information of the coin operations. Our work sheds new light on quantum state engineering and recovery, and the initialization of quantum devices based on QWs.
Beijing Computational Science Research Center, Beijing 100193, China.
School of Physics, Southeast University, Nanjing 211189, China.
College of Electronic and Information Engineering, Shandong University of Science and Technology, Qingdao 266590, China.
Experimental revival of an unknown state from the past in quantum walks.

Research Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science (NIMS), Japan.
Research Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science (NIMS), Japan.Graduate School of Pure and Applied Sciences, University of Tsukuba, Japan.
Cooler, stronger, smaller: improving thermoelectric cooling.

The article presents a perspective on how the emerging generative AI technology can shape social media and the new challenges in studying social media in this generative.
School of Cyber Science and Technology, University of Science and Technology of China, China.
Institute of Fundamental and Frontier Studies and Yangtze Delta Region Institute (Huzhou), University of Electronic Science and Technology of China, China.
School of Cyber Science and Technology, University of Science and Technology of China, China.Institute of Fundamental and Frontier Studies and Yangtze Delta Region Institute (Huzhou), University of Electronic Science and Technology of China, China.
Complexity of social media in the era of generative AI.

Utricle is an important vestibular sensory organ for maintaining balance. 3,3'-iminodipropionitrile (IDPN), a prototype nitrile toxin, has been reported to be neurotoxic and vestibulotoxic, and can be used to establish an in vivo damage model of vestibular dysfunction. However, the mechanism of utricular HCs damage caused by IDPN is unclear. Here, we first studied mice balance behavior and HCs damage in IDPN utricle damage model, and found that IDPN injection in vivo can cause vestibular dysfunction and HCs damage, which is more pronounced than neomycin damage model. Then we used RNA-seq to characterize the transcriptome of IDPN damaged utricle in detail to identify genes and pathways that play roles in this process. We found 1,165 upregulated genes and 1,043 downregulated genes in IDPN damaged utricles, and identified that NF-κB pathway and TNF pathway may play important roles in IDPN damage model. Our study provides details of transcriptome of IDPN utricle damage model for further study of vestibular dysfunction.
Copyright © 2024 Tian, Huang, Xiao, Jiang, Ma, Lin, Tang, Wang, Dai, Tong, Ye, Sheng, Chai and Zhang.
State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Life Sciences and Technology, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, China.Southeast University, Shenzhen Research Institute, Shenzhen, China.
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Environmental Health, School of Environmental Science and Engineering, Hainan University, Haikou, China.
State Key Laboratory of Digital Medical Engineering, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital, School of Life Sciences and Technology, Advanced Institute for Life and Health, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing, China.Southeast University, Shenzhen Research Institute, Shenzhen, China.Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China.Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.Institute for Stem Cell and Regeneration, Chinese Academy of Science, Beijing, China.Beijing Key Laboratory of Neural Regeneration and Repair, Capital Medical University, Beijing, China.
Characterization of 3,3'-iminodipropionitrile (IDPN) damaged utricle transcriptome in the adult mouse utricle.

The lower limb is vascularized by the femoral artery, which continues as the popliteal artery. After the distal margin of the popliteus muscle, the popliteal artery divides into the anterior and posterior tibial arteries. Anatomical variations in the bifurcation of the popliteal artery are frequent. One such variation is the aberrant anterior tibial artery, in which the artery runs anterior to the popliteus muscle instead of following the normal dorsal course. We report a case in which this anatomical variation was diagnosed with vascular ultrasound in a patient complaining of intermittent claudication in the left lower limb. The examination ruled out any possibility of obstructive arterial injury and identified a high bifurcation of the popliteal artery and the anterior tibial artery running anterior to the popliteus muscle and the tibial cortex. This anomalous variation is of great clinical importance, especially in surgical procedures involving the knee. Surgical injury to these arteries can lead to formation of pseudoaneurysm, compartment syndrome, or necrosis and can even result in limb amputation.
Universidade Positivo - UP, Curitiba, PR, Brasil.
Universidade Federal do Paraná - UFPR, Complexo do Hospital de Clínicas - CHC, Curitiba, PR, Brasil.
Vascular ultrasound diagnosis and clinical implications of aberrant anterior tibial artery: case report.

Ulnar artery aneurysms are extremely rare and are mainly associated with hypothenar hammer syndrome, an ischemic disorder of the hand resulting from mechanical and repetitive trauma to the hypothenar region. The ulnar artery is hit against the hook of the hamate bone, causing damage to the vessel wall and leading to occlusion or formation of an aneurysm. We describe the case of a truck driver who underwent resection of an ulnar artery aneurysm in the right hand and reconstruction using end-to-end anastomosis with no complications or recurrence.
Universidade Federal do Ceará - UFC, Hospital Universitário Walter Cantídio - HUWC, Fortaleza, CE, Brasil.
Universidade Federal do Ceará - UFC, Fortaleza, CE, Brasil.
Surgical management of ulnar artery aneurysm in hypothenar hammer syndrome.

Post-transcriptional mechanisms, such as alternative splicing and polyadenylation, are recognized as critical regulatory processes that increase transcriptomic and proteomic diversity. The advent of next-generation sequencing and whole-genome analyses has revealed that numerous transcription and epigenetic regulators, including transcription factors and histone-modifying enzymes, undergo alternative splicing, most notably in the nervous system. Given the complexity of regulatory processes in the brain, it is conceivable that many of these splice variants control different aspects of neuronal development. Mutations or dysregulation of splicing and transcription regulatory proteins are frequently linked to various neurodevelopmental disorders, highlighting the importance of understanding the role of neuron-specific alternative splicing in maintaining proper transcriptional regulation in the brain. This review consolidates current insights into the role of alternative splicing in influencing transcriptional and chromatin regulatory programs in neuronal development.
Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United States.
Post-transcriptional regulation of the transcriptional apparatus in neuronal development.

Avascular necrosis (AVN) of the hip, a rare cause of pelvic pain in the third trimester of pregnancy, often presents with nonspecific symptoms that resemble common musculoskeletal conditions. This ambiguity, coupled with concerns about the safety of magnetic resonance imaging (MRI) during pregnancy, can hinder timely diagnosis. We report a unique case of a 32-year-old primigravida diagnosed with a hip fracture and bilateral AVN of the femoral head in the immediate postpartum period, a complication seemingly not previously documented in pregnant patients. The initial management involved closed reduction and internal fixation using cannulated screws. However, progressive femoral head collapse necessitated revision to a total hip arthroplasty. This case underscores the importance of early diagnosis and recognition of AVN in pregnancy to prevent severe complications. It highlights the diagnostic challenges and emphasizes the need for heightened awareness and earlier imaging investigations in similar clinical scenarios.
Department of Clinical Surgical Sciences, The University of the West Indies, Trinidad and Tobago.
Department of Surgery, Port-of-Spain General Hospital, Port of Spain, Trinidad and Tobago.
Case Rep Womens Health. 2025-03;45():e00675.
Bilateral avascular necrosis leading to hip fracture in pregnancy: A case report.

Sharing aggregate results with research participants is a widely agreed-upon ethical obligation; yet, there is little research on communicating study results to diverse populations enrolled in genomics research. This article describes the cocreation of a visual narrative to explain research findings to families enrolled in a clinical genomics research study.The design process involved researchers, clinicians, study participants, a physician illustrator, and a health communications expert. Drawing on themes identified in interviews with participating families, the team developed a story and comic about a fictional family participating in genomic research in the hopes of finding an explanation for their child's condition.Design adjustments to improve the clarity and relatability of the story and accompanying images were prompted by feedback from study participants, who showed a high degree of interest in and support for the project. Spanish and English versions of the final comic book were distributed to study participants, and the feedback received was positive.Our project highlights the feasibility of using visual storytelling to convey genomic research findings to socioeconomically diverse participants. A participatory design process enhances the relevance and relatability of results sharing materials and demonstrates respect for those who contribute to clinical genomics research.
Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA.UCSF Bioethics, University of California, San Francisco, CA.
Institute for Health and Aging, University of California, San Francisco, CA.Department of Social and Behavioral Sciences, University of California, San Francisco, CA.
UCSF Bioethics, University of California, San Francisco, CA.
UCSF Bioethics, University of California, San Francisco, CA.Institute for Health and Aging, University of California, San Francisco, CA.Department of Social and Behavioral Sciences, University of California, San Francisco, CA.
Using visual storytelling to share aggregate findings with families participating in clinical genomics research.

Bone marrow stimulation treatment by bone marrow stromal cells (BMSCs) released from the bone medullary cavity and differentiated into cartilage via microfracture surgery is a frequently employed technique for treating articular cartilage injuries, yet the treatment presents a main drawback of poor cartilage regeneration in the elderly. Prior research indicated that aging could decrease the stemness capacity of BMSCs, thus we made a hypothesis that increasing old BMSCs (OBMSCs) stemness might improve the results of microfracture in the elderly. First, we investigated the correlation between microfracture outcomes and BMSCs stemness using clinical data and animal experiments. The outcomes of microfracture surgery in the elderly were significantly decreased as compared with the young counterparts while the stemness capacity of OBMSCs was also significantly decreased, and they were positively correlated. To investigate the role of BMSCs stemness in microfracture, we developed microfracture-mimic cartilage regeneration organoid models. In vitro experiments identified SPI1 as a potential stemness target gene, which could enhance the stemness and chondrogenesis of OBMSCs. The implantation of cartilage regeneration organoids made by SPI1-overexpressed OBMSCs could notably enhance cartilage regeneration in the old rats as compared with the microfracture treatment alone. Furthermore, molecular docking suggested a possible interaction between SPI1 and 5-Aza-2'-deoxycytidine (5Aza). The application of 5Aza could significantly improve the result of microfracture by upregulating SPI1. In summary, we identified SPI1 as a novel stemness target of OBMSCs, which was beneficial for the improvement of microfracture-stimulated cartilage regeneration in the elderly.
Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
SPI1 facilitates microfracture-mediated cartilage regeneration in the elderly by enhancing bone marrow stromal cells ctemness.

USDA-ARS Range Sheep Production Efficiency Research Unit, Dubois, ID, USA.USDA-ARS SCINet Program and AI Center of Excellence, Beltsville, MD, USA.
USDA-ARS Range Sheep Production Efficiency Research Unit, Dubois, ID, USA.
Center for Epidemiology and Animal Health, USDA/APHIS/Veterinary Services, Fort Collins, CO, USA.
USDA-ARS Northwest Watershed Research Center, Boise, ID, USA.
Animal frontiers : the review magazine of animal agriculture
Precision animal husbandry: using artificial intelligence for camera traps to optimize animal production and management decision support systems.

Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706, United States.
Artificial intelligence applied to dairy science: insights from the Dairy Brain Initiative.

Department of Animal Science; College Station, Texas A&M AgriLife Extension, TX, USA.
Department of Agricultural Economics; Stillwater, Oklahoma State University, OK, USA.
Generative artificial intelligence in extension: a new era of support for livestock producers.

Department of Animal Science, Iowa State University, Ames, Iowa 50011, USA.
Preparing the AI-assisted animal scientist: faculty and student perspectives on enhancing animal science education with artificial intelligence.

Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65211, USA.
Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65211, USA.Division of Animal Sciences, University of Missouri, Columbia, MO 65211, USA.Genetics Area Program, University of Missouri, Columbia, MO 65211, USA.
From reactive to proactive: impact of artificial intelligence on management and selection of livestock.

Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, USA.
Institute of Data Science, Texas A&M University, College Station, TX, USA.
Institute of Data Science, Texas A&M University, College Station, TX, USA.School of Performance, Visualization and Fine Arts & Institute of Data Science, Texas A&M University, College Station, TX, USA.
Computer vision algorithms to help decision-making in cattle production.

Department of Animal Sciences, Purdue University, West Lafayette, IN, USA.
Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA.
A peep into the future: artificial intelligence for on-farm poultry welfare monitoring.

Facultad de Zootecnia y Ecología, Universidad Autónoma de Chihuahua, Chihuahua, México.Department of International Development, School of Agriculture, Policy and Development, University of Reading, Reading, UK.
Facultad de Zootecnia y Ecología, Universidad Autónoma de Chihuahua, Chihuahua, México.
Facultad de Medicina Veterinaria y Zootecnia, Departamento de Nutrición Animal, Universidad Autónoma del Estado de México, Toluca, México.
Departamento de Medicina y Zootenia de Rumiantes, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Mexico City, CP. 04510, Mexico.
División Académica de Ciencias Agropecuarias, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México.
Facultad de Agronomía y Veterinaria, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
Department of School of Agriculture, Policy and Development, University of Reading, Reading, UK.
Faculty of Agricultural Sciences, Animal Production Institute, Universidad Austral de Chile, Valdivia, Chile.
IciAgro Litoral, Universidad Nacional del Litoral-CONICET, Kreder 2805 Esperanza (3080), Argentina.
Laboratório de Zootecnia, Centro de Ciências e Tecnologias Agropecuárias (CCTA), Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF), Campos dos Goytacazes, RJ, Brazil.
Faculty of Agriculture, Department of Animal Science, University of Birjand, Birjand, Iran.
The role of artificial intelligence in Latin American ruminant production systems.

Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53703, USA.
Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53703, USA.Department of Biological Systems Engineering, University of Wisconsin-Madison, Madison, WI 53703, USA.
Artificial intelligence for livestock: a narrative review of the applications of computer vision systems and large language models for animal farming.

Historically, psychiatric diagnoses have been made based on patient's reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders. The utilization of neuroimaging or biomarkers to make the diagnosis and manage psychiatric disorders remains a distant goal. There have been several studies that examine brain imaging in psychiatric disorders, but more work is needed to elucidate the complexities of the human brain. In this editorial, we examine two articles by Xu et al and Stoyanov et al, that show developments in the direction of using neuroimaging to examine the brains of people with schizophrenia and depression. Xu et al used magnetic resonance imaging to examine the brain structure of patients with schizophrenia, in addition to examining neurotransmitter levels as biomarkers. Stoyanov et al used functional magnetic resonance imaging to look at modulation of different neural circuits by diagnostic-specific scales in patients with schizophrenia and depression. These two studies provide crucial evidence in advancing our understanding of the brain in prevalent psychiatric disorders.
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Department of Psychiatry, Campbell University School of Osteopathic Medicine, Buies Creek, NC 27506, United States.
Department of Psychiatry and Behavioral Health, Mercyhealth Hospital and Trauma Center, Janesville, WI 53548, United States. mandy.drmandeep@gmail.com.
Advancement in utilization of magnetic resonance imaging and biomarkers in the understanding of schizophrenia.

The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus (GDM) development using advanced proteomic techniques, such as Isobaric tags for relative and absolute quantitation isobaric tags for relative and absolute quantitation and liquid chromatography-mass spectrometry liquid chromatography-mass spectrometry. Their analysis revealed 47 differentially expressed proteins in the GDM group, with retinol-binding protein 4 and angiopoietin-like 8 showing significantly elevated serum levels compared to controls. Although these findings are promising, the study is limited by its small sample size (n = 4 per group) and lacks essential details on the reproducibility and reliability of the protein quantification methods used. Furthermore, the absence of experimental validation weakens the interpretation of the protein-protein interaction network identified through bioinformatics analysis. The study's focus on second-trimester biomarkers raises concerns about whether this is a sufficiently early period to implement preventive interventions for GDM. Predicting GDM risk during the first trimester or pre-conceptional period may offer more clinical relevance. Despite its limitations, the study presents valuable insights into potential GDM biomarkers, but larger, well-validated studies are needed to establish their predictive utility and generalizability.
Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, Punjab, India.
Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com.
Department of Ophthalmology, RP Eye Institute, Delhi 110001, India.
Intricacies during pregnancy with gestational diabetes mellitus.

Dementia is a group of diseases, including Alzheimer's disease (AD), vascular dementia, Lewy body dementia, frontotemporal dementia, Parkinson's disease dementia, metabolic dementia and toxic dementia. The treatment of dementia mainly includes symptomatic treatment by controlling the primary disease and accompanying symptoms, nutritional support therapy for repairing nerve cells, psychological auxiliary treatment, and treatment that improves cognitive function through drugs. Among them, drug therapy to improve cognitive function is important. This review focuses on introducing and commenting on some recent progress in exploring drugs to improve cognitive function, especially the new progress in drug treatment for AD. We mainly discuss the opportunities and challenges in finding and developing new therapeutic drugs from the aspects of acetylcholinesterase, N-methyl-D-aspartate glutamate receptor, amyloid protein, tau protein and chronic immune inflammation.
Department of Neurology, The Third Affiliated Hospital of Guizhou Medical University, Duyun 558099, Guizhou Province, China.Department of Neurology, Wulong Branch of the People's Hospital Affiliated to Chongqing University, Wulong 408500, Chongqing, China. baih2020@gmc.edu.cn.
Department of Neurology, Guizhou Medical University, Guiyang 550004, Guizhou Province, China.
Searching for new drugs to treat Alzheimer's disease dementia through multiple pathways.

Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure. Some oculoplastic conditions, like nasolacrimal duct obstruction, have been extensively studied, whereas others, like eyelid malposition and thyroid eye disease, have received minimal or no research.To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.A cross-sectional survey was disseminated among ophthalmologists all over India. The survey included questions related to pre-operative evaluation, anaesthetic and surgical techniques preferred, post-operative care, the use of adjunctive therapies, and patient follow-up patterns.A total of 180 ophthalmologists responded to the survey. Most practitioners (89%) felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised. The most common surgical techniques employed were lacrimal drainage procedures (Dacryocystorhinostomy) (63.3%), eyelid malposition repair (36.9%), and ptosis repair (58.7%). Post-operatively, 47.7 % of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries. Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.Approximately 50% of ophthalmologists handle prevalent oculoplastic issues themselves, seeking the expertise of an oculoplastic surgeon under particular conditions. Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery. Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.
Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India. bigyan_panda@yahoo.co.in.
Department of Vitreo-Retina, Trilochan Netralaya, Sambalpur 768004, India.
Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India.
Department of Glaucoma Services, LV Prasad Eye Institute, Bhubaneswar 751013, India.
Department of Statistics, Apollo Hospitals, Chennai 823104, India.
Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period: A questionnaire-based study.

Machine learning (ML) is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis, thus creating machines that can complete tasks otherwise requiring human intelligence. Among its various applications, it has proven groundbreaking in healthcare as well, both in clinical practice and research. In this editorial, we succinctly introduce ML applications and present a study, featured in the latest issue of the World Journal of Clinical Cases. The authors of this study conducted an analysis using both multiple linear regression (MLR) and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease (NAFLD). Their results implicated age as the most important determining factor in both groups, followed by lactic dehydrogenase, uric acid, forced expiratory volume in one second, and albumin. In addition, for the NAFLD- group, the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure, as compared to plasma calcium and body fat for the NAFLD+ group. However, the study's distinctive contribution lies in its adoption of ML methodologies, showcasing their superiority over traditional statistical approaches (herein MLR), thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.
Research Unit of Radiology and Medical Imaging, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece.2 Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Chaidari 12462, Greece. nick.arkoudis@gmail.com.
Department of Gastroenterology, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece.
Machine learning applications in healthcare clinical practice and research.

Monkeypox (Mpox), is a disease of global public health concern, as it does not affect only countries in western and central Africa.To assess Burundi healthcare workers (HCWs)s' level of knowledge and confidence in the diagnosis and management of Mpox.We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023. The questionnaire comprises 8 socioprofessional-related questions, 22 questions about Mpox disease knowledge, and 3 questions to assess confidence in Mpox diagnosis and management. The data were analyzed via SPSS software version 25.0. A P value < 0.05 was considered to indicate statistical significance.The study sample comprised 471 HCWs who were mainly medical doctors (63.9%) and nurses (30.1%). None of the 22 questions concerning Mpox knowledge had at least 50% correct responses. A very low number of HCWs (17.4%) knew that Mpox has a vaccine. The confidence level to diagnose (21.20%), treat (18.00%) or prevent (23.30%) Mpox was low among HCWs. The confidence level in the diagnosis of Mpox was associated with the HCWs' age (P value = 0.009), sex (P value < 0.001), work experience (P value = 0.002), and residence (P value < 0.001). The confidence level to treat Mpox was significantly associated with the HCWs' age (P value = 0.050), sex (P value < 0.001), education (P value = 0.033) and occupation (P value = 0.005). The confidence level to prevent Mpox was associated with the HCWs' education (P value < 0.001), work experience (P value = 0.002), residence (P value < 0.001) and type of work institution (P value = 0.003).This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose, treat or prevent it. There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs. We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.
Department of Dermatology, Cosmetology and Venereology, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, Guangdong Province, China.Department of Dermatology and Venereology, Kamenge Teaching Hospital, University of Burundi, Bujumbura 1020, Burundi.
Department of Infectious Diseases, Kamenge Teaching Hospital, University of Burundi, Bujumbura 1020, Burundi.
General Directorate of Healthcare Supply, Modern and Traditional Medicine, Nutrition and Registration, Ministry of Public Health and Fight Against HIV/AIDS, Bujumbura 1055, Burundi.
Department of Epidemiology, National Institute of Public Health, Bujumbura 350, Burundi.General Directorate of Planification, Ministry of Public Health and Fight Against HIV/AIDS, Bujumbura 1055, Burundi.
Department of Dermatology, Cosmetology and Venereology, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, Guangdong Province, China.
Department of Dermatology, Cosmetology and Venereology, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, Guangdong Province, China. liangdoctor@163.com.
Assessing healthcare workers' knowledge and confidence in the diagnosis, management and prevention of Monkeypox.

Gestational diabetes mellitus (GDM) refers to varying degrees of abnormal glucose metabolism that occur during pregnancy and excludes patients previously diagnosed with diabetes. GDM is a unique among the four subtypes of diabetes classified by the international World Health Organization standards. Although GDM patients constitute a small proportion of the total number of diabetes cases, the incidence of GDM has risen significantly over the past decade, posing substantial risk to pregnant women and infants. Therefore, it warrants considerable attention. The pathogenesis of GDM is generally considered to resemble that of type II diabetes, though it may have distinct characteristics. Analyzing blood biochemical proteins in the context of GDM can help elucidate its pathogenesis, thereby facilitating more effective prevention and management strategies. This article reviews this critical clinical issue to enhance the medical community's sufficient understanding of GDM.
Department of Neurology, The Third Affiliated Hospital of Guizhou Medical University, Duyun 558099, Guizhou Province, China. baih2020@gmc.edu.cn.
New exploration on pathogenesis and early diagnosis of gestational diabetes.

Malignant transformation (MT) of mature cystic teratoma (MCT) has a poor prognosis, especially in advanced cases. Concurrent chemoradiotherapy (CCRT) has an inhibitory effect on MT.Herein, we present a case in which CCRT had a reduction effect preoperatively. A 73-year-old woman with pyelonephritis was referred to our hospital. Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) revealed squamous cell carcinoma. The patient was diagnosed with MT of MCT. Due to her poor general condition and renal malfunction, we selected CCRT, expecting fewer adverse effects. After CCRT, her performance status improved, and the tumor size was reduced; surgery was performed. Five months postoperatively, the patient developed dissemination and lymph node metastases. Palliative chemotherapy was ineffective. She died 18 months after treatment initiation.EUS-FNB was useful in the diagnosis of MT of MCT; CCRT suppressed the disease and improved quality of life.
Department of Obstetrics and Gynecology, Saku Central Hospital Advanced Care Center, Saku City 385-0051, Nagano, Japan. kondorabass@hotmail.co.jp.
Department of Obstetrics and Gynecology, Saku Central Hospital Advanced Care Center, Saku City 385-0051, Nagano, Japan.
Stage IV malignant transformation of mature cystic teratoma palliatively treated with concurrent chemoradiotherapy: A case report.

Ependymoma with lipomatous differentiation is a rare type of ependymoma. The ZFTA fusion-positive supratentorial ependymoma is a novel tumor type in the 2021 World Health Organization classification of central nervous system tumors. ZFTA fusion-positive lipomatous ependymoma has not been reported to date.We reported a case of a 15-year-old Chinese male who had a sudden convulsion lasting approximately six minutes. Magnetic resonance imaging showed a round cystic shadow of approximately 1.9 cm × 1.5 cm × 1.9 cm under the right parieto-occipital cortex. Microscopic examination showed characteristic perivascular pseudorosettes and adipose differentiation in the cytoplasm. Immunohistochemical staining showed that the tumor cells were negative for cytokeratin, NeuN, Syn and p53, but positive for GFAP, vimentin and S-100 protein. Significant punctate intracytoplasmic EMA immunoreactivity was observed. The level of Ki-67 was about 5%. Genetic analysis revealed ZFTA: RELA fusion. A craniotomy with total excision of the tumor was performed. The follow-up time was 36 months, no evidence of disease recurrence was found in magnetic resonance imaging.Based on these findings, the patient was diagnosed as a ependymoma with ZFTA fusion and lipomatous differentiation. This case report provides information on the microscopic morphological features of ependymoma with ZFTA fusion and lipomatous differentiation, which can help pathologists to make a definitive diagnosis of this tumor.
China Medical University, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China. yujuanhan@foxmail.com.
Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
Anshan Cancer Hospital, Anshan 114000, Liaoning Province, China.
Lipomatous ependymoma with ZFTA: RELA fusion-positive: A case report.

The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required. The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella. Despite this, both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°. The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion. The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial. This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers' understanding of this technique, especially because reported clinical outcomes have remained sparse.
Division of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina.
Division of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina. ignaciogmansilla@gmail.com.
Navigating medial patellotibial ligament reconstruction: Clinical perspectives and surgical strategies.

Therapeutic advancements for the polyglutamine diseases, particularly spinocerebellar degeneration, are eagerly awaited. We evaluated the safety, tolerability, and therapeutic effects of L-arginine, which inhibits the conformational change and aggregation of polyglutamine proteins, in patients with spinocerebellar ataxia type 6 (SCA6).A multicenter, randomized, double-blind, placebo-controlled phase 2 trial (clinical trial ID: AJA030-002, registration number: jRCT2031200135) was performed on 40 genetically confirmed SCA6 patients enrolled between September 1, 2020, and September 30, 2021. The main inclusion criteria were as follows: SCA6 diagnosed by genetic testing, 20 years of age or older, Scale for the Assessment and Rating of Ataxia (SARA) walking score of at least one point, and SARA total score of at least 10 points, and ability to walk 10 m or more with or without an assistive device. The investigational drug was administered orally at 0.50 g/kg/day (L-arginine group: L-arginine 0.38 g/kg/day; placebo group: L-arginine 0.0 g/kg/day) for 48 weeks. Subjects who consented to participate were assigned a subject identification code, and were allocated 1:1 to the L-arginine or the placebo group, according to a predetermined allocation chart. The primary efficacy endpoint was change in total Scale for the Assessment and Rating of Ataxia (SARA) score from baseline to 48 weeks. The secondary endpoints were 1) SARA walking + standing score, 2) each of the eight SARA scales at 0, 4, 8, 16, 24, 32, 40, and 48 weeks, and 3) TUGT, BDI-II, CGI, PGI-I, and SF-8.Forty patients received the investigational drug, and 37 completed the study (L-arginine group: 18; placebo group: 19). The mean medication adherence rate was 97.2% in the l-arginine group. Regarding the primary endpoint, the difference between the L-arginine group and the placebo group was -1.52 (95% CI: -3.10 to 0.06, P = 0.0582). As the secondary endpoints, the change of SARA total score from baseline was greater in the L-arginine group than in the placebo group at all assessment time points, but the differences were not significant. Two serious (required hospitalization) adverse reactions occurred in the L-arginine group, including one case of pneumonia (severe, death) and one case of abnormal liver function (moderate, recovery).L-arginine treatment resulted in an improvement tendency in SARA total score of SCA6 patients. Our results suggest that a phase 3 study of L-arginine for SCA6, with a 48-week observation period and change in total SARA score as the primary endpoint, may be feasible for further analyzing the therapeutic effect of L-arginine. However, careful consideration of statistical power and sample size is necessary.Japan Agency for Medical Research and Development and Health Labour Sciences Research Grant, Japan.
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.Advanced Treatment of Neurological Diseases Branch, Endowed Research Branch, Brain Research Institute, Niigata University, Niigata, Japan.
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.Department of Neurology, Niigata City General Hospital, Niigata, Japan.
Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan.
Department of Neurophysiology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Medical Innovation, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan.Life Science Research Institute, Kindai University Faculty of Medicine, Osaka, Japan.Neurotherapeutics, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
L-arginine in patients with spinocerebellar ataxia type 6: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial.

Pancreatic cancer is highly aggressive and has a low survival rate primarily due to late-stage diagnosis and the lack of effective early detection methods. We introduce here a novel, noninvasive urinary extracellular vesicle miRNA-based assay for the detection of pancreatic cancer from early to late stages.From September 2019 to July 2023, Urine samples were collected from patients with pancreatic cancer (n = 153) from five distinct sites (Hokuto Hospital, Kawasaki Medical School Hospital, National Cancer Center Hospital, Kagoshima University Hospital, and Kumagaya General Hospital) and non-cancer participants (n = 309) from two separate sites (Hokuto Hospital and Omiya City Clinic). The main inclusion criteria included a diagnosis of pancreatic cancer based on pathological or imaging examination, while multiple primary cancers were excluded. Extracellular vesicles were enriched using a polymer-based precipitation method, and miRNAs were comprehensively analyzed by small RNA sequencing. A machine learning model for pancreatic cancer detection was developed using a training dataset (n = 315) consisting of 99 pancreatic cancer participants (of which 33 were early-stage [I/IIA]) and 216 non-cancer participants, and validated with a test dataset (n = 147) consisting of 54 pancreatic cancer participants (of which 9 were early-stage [I/IIA]) and 93 non-cancer participants.This method showed consistent performance, with areas under the receiver operating characteristic curves of 0.972 (95% confidence interval [CI], 0.928-0.996) and 0.963 (95% CI, 0.932-0.988) in the training and test sets, respectively. The sensitivities for pancreatic cancer detection were 93.9% (95% CI, 87.5%-97.3%) and 77.8% (95% CI, 64.9%-87.3%) overall and 97.0% (95% CI, 83.9%-99.8%) and 77.8% (95% CI, 44.2%-95.9%) for stage I/IIA pancreatic cancer, respectively. The specificities were 91.7% (95% CI, 87.1%-94.7%) and 95.7% (95% CI, 89.4%-98.5%), respectively. We also evaluated the sensitivity of CA19-9 for pancreatic cancer detection in 140 patients with pancreatic cancer, and it was 37.5% (95% CI, 23.5%-53.8%) for stages I/IIA pancreatic cancer. Performance in early-stage cancer detection was significantly higher for miRNA-based pancreatic cancer detection. Functional enrichment analysis of pancreatic cancer-associated urinary miRNAs revealed that the urinary miRNA signature reflects miRNA patterns of the pancreatic cancer tissue itself as well as those of the tumor microenvironment.Urinary extracellular vesicle miRNAs may reflect signals from both tumor cells and their microenvironment, offering a unique opportunity for detection of pancreatic cancer from early to late stages. While this study has a limitation due to the relatively small sample size, our approach has the potential to contribute to treatment outcomes through population screening. Our primary goal is to make this assay more accessible to a broader population, particularly in areas with limited hospital access where cancer is often detected at a late stage, leveraging the advantage of using urine samples that can be collected at home.This research was supported by the Japan Agency for Medical Research and Development (AMED) under Grant Number JP24he2302007 and Craif Inc.
Department of Pathology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Hokkaido, Japan.
Department of Health Screenings, Hokuto Hospital, Obihiro, Hokkaido, Japan.
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Department of Gastroenterology and Hepatology, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Department of Gastroenterology and Hepatology, Kawasaki Medical School, Kurashiki, Okayama, Japan.Department of Gastroenterology, Hokuto Hospital, Obihiro, Hokkaido, Japan.
Department of Digestive Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Surgery, Kumagaya General Hospital, Kumagaya, Saitama, Japan.Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA.
Department of Surgery, Kumagaya General Hospital, Kumagaya, Saitama, Japan.
Department of Diagnostic Pathology, Kumagaya General Hospital, Kumagaya, Saitama, Japan.
Department of Experimental Therapeutics, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.Outpatient Treatment Center, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Department of Experimental Therapeutics, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Department of Experimental Therapeutics, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Craif. Inc, Nagoya, Aichi, Japan.Institute of Innovation for Future Society, Nagoya University, Nagoya, Aichi, Japan.
Vascular Biology and Molecular Pathology, Faculty and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Center for Cancer Genomics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Department of Pathology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Hokkaido, Japan.Center for Cancer Genomics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
A noninvasive urinary microRNA-based assay for the detection of pancreatic cancer from early to late stages: a case control study.

GLP-1 receptor agonists beyond diabetes management.

Despite the availability of various pharmacological and behavioural interventions, alcohol-related mortality is rising. This systematic review aimed to critically evaluate the existing literature on the association between glucagon-like peptide-1 receptor agonists use (GLP-1 RAs) and alcohol consumption.Electronic searches were conducted on Ovid Medline, EMBASE, PsycINFO, clintrials.gov, and ProQuest until the end of March 2024. An updated search was done on 7th of August 2024. The primary outcome was to explore the association between GLP-1 RAs use and change in alcohol consumption. Secondary outcomes included evaluating the impact of GLP-1 RAs on occurrences of alcohol-related events, healthcare utilisation, and the effect on functional magnetic resonance imaging (fMRI) cue reactivity. This study is registered with PROSPERO #CRD42024531982.Six studies totalling 88,190 participants were included with 38,740 (43.9%) receiving GLP-1 RA, but only 286 participated in randomised controlled trials. Pooled mean age was 49.6 years (SD = 10.5). RCT data did not show a reduction in alcohol consumption over 30 days after 24 weeks of treatment with exenatide versus placebo (heavy drinking days 6.0 [higher in control group], 95% CI -7.4 to 19.4, p = 0.37), a subgroup analysis found a positive effect in people with obesity (BMI >30 kg/m2), with significant reductions in brain reward centre cue reactivity on fMRI. In a secondary analysis of an RCT participants taking dulaglutide compared to placebo were 29% more likely to reduce alcohol intake (relative effect size 0.71, 95% CI 0.52-0.97, p = 0.04). Observational studies showed fewer alcohol-related healthcare events and a significant reduction in alcohol use with GLP-1 RAs treatment compared to DPP4-Dipeptidyl peptidase 4 use, no treatment and/or alcohol intake at baseline.There is little high-quality evidence demonstrating the effect of GLP-1 RAs on alcohol use. Subgroup analysis from two RCTs and supporting data from four observational studies suggest that GLP-1 RAs may reduce alcohol consumption and improve outcomes in some individuals. Heterogeneous study findings warrant further research to establish the effectiveness and safety of GLP-1 RAs in this population.National Institute for Health and Care Research (NIHR): Award-ID: NIHR155469; NIHR154191; NIHR155530. NIHR Nottingham Biomedical Research Centre, Award-ID: BRC-1215-20003.
Nottingham Digestive Diseases Centre (NDDC), Translational Medical Sciences, School of Medicine, University of Nottingham, NG7 2UH, UK.NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK.
Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK.
National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, UK.
Faculty of Health and Life Sciences, University of Exeter, Exeter EX4 4QJ, UK.
NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, UK.Diabetes Research Centre, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK.
Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2UH, UK.Division of Food, Nutrition & Dietetics, School of Biosciences, University of Nottingham, Loughborough LE12 5RD, UK.
Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2UH, UK.
Liver Unit, Hospital Clinic, Barcelona, Spain.Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK.
Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, M139WL, UK.
Association between glucagon-like peptide-1 receptor agonists use and change in alcohol consumption: a systematic review.

The WHO has highlighted that: promotion of e-cigarettes has led to marked increases in e-cigarette use by children and adolescents. The long-term neuropsychiatric and psychological consequences of substance abuse in adolescence is well recognised. Limited data exists on the adolescent burden of vaping-related nicotine addiction and behavioural and/or psychological dependence to guide pharmacological or behavioural interventions to stop electronic cigarette usage.A self-administered brief electronic survey was provided to a large, sample of high school students from January to October 2023 in South Africa. Questions on vaping usage, initiation, reasons for continuation and indicators of physical and psychological dependence were asked. A mixed methods approach was used to obtain and analyse quantitative and qualitative responses.25,149 students from 52 South Africa schools completed the survey. 45.8% identify as female, 51.7% male, 0.3% transgender, 2.1% do not identify with a gender. Current vaping was reported by 16.83% (95% CI: 16.47-17.30), with 36.71% reporting ever using a vaping product (95% CI: 26.06-37.36). The odds of vaping increased by grade but not with increasing school affluence. 47% vaped within the first hour of waking suggesting high nicotine addiction. Vaping initiation reasons of: 'social influences' and 'curiosity', changed significantly to ongoing motivations of: 'enjoyment', 'managing mental distress' and 'addiction' to nicotine. Paired quantitative/qualitative responses regarding stress and dependence showed inconsistencies at the individual student level.Vaping in the schools surveyed was high and increased by grade but was not associated with school level affluence. Drivers for vaping initiation change significantly to persistence drivers with significant nicotine addiction. Adolescent perceptions (qualitative/quantitative) are frequently incongruent suggesting that mixed methods evaluations are required to understand individual level drivers of vaping. Urgent interventions tailored to this population are required. Nicotine addiction may require off-label pharmacotherapies alongside tailored behavioural interventions utilising the expressed concerns, psychological and dependence measures elicited from adolescents.This study was funded in part by research grant from the Cambridge-Africa ALBORADA Research Fund G12753.
Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa.
Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, South Africa.
Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town and Groote Schuur Hospital, South Africa.
Utrecht University, Department of Interdisciplinary Social Science, Netherlands.
Utrecht University, Department of Interdisciplinary Social Science, Netherlands.University of Cambridge, School of Clinical Medicine, England.
Electronic cigarette usage amongst high school students in South Africa: a mixed methods approach.

Adolescents (10-19 years old) have poor outcomes across the prevention-to-treatment HIV care continuum, leading to significant mortality and morbidity. We conducted a systematic review and meta-analysis of interventions that documented HIV outcomes among adolescents in HIV high-burden countries.We searched PubMed, EMBASE, Scopus, and the Cochrane Library for studies published between January 2015 and September 2024, assessing at least one HIV outcome along the prevention-to-care cascade, including PrEP uptake, HIV testing, awareness of HIV infections, ARV adherence, retention, and virological suppression. We included studies from 37 HIV high-burden countries evaluating interventions with a comparator group. Random-effects meta-analysis was used to pool the effects of the interventions on study outcomes. While the primary focus was on outcomes related to the HIV care cascade, we also evaluated social outcomes and mental health outcomes when sufficient data were available. Adolescent engagement in studies was assessed using Hart's ladder. The study was registered in PROSPERO, CRD42024569203.We identified 12,411 unique records, of which 99 were included in the final analysis, comprising 57 randomized controlled trials and 42 non-randomized studies, with a total sample size of 441,252 participants. Our analysis found that asset-building interventions significantly improved HIV testing uptake (three studies, RR: 1.38, 95% CI 1.15-1.65) compared to control conditions. Differentiated service delivery interventions were associated with improved ART retention (five studies, RR: 1.18, 95% CI 1.04-1.36) and virological suppression (seven studies, RR: 1.19, 95% CI 1.06-1.33) compared to control conditions. Financial incentives significantly enhanced ART adherence (two studies, RR: 1.52, 95% CI 1.23-1.89) compared to control conditions. Digital interventions, such as mobile phone applications and telehealth services, significantly increased HIV testing uptake (two studies, RR: 1.79, 95% CI 1.23-2.61) compared to control conditions. Positive impacts were also observed for these interventions on social outcomes. Most studies adopted minimal to moderate adolescent engagement. For HIV testing, a stronger effect was seen in studies with moderate to substantial adolescent engagement, yielding an RR of 2.37 (95% CI: 1.43-3.93; nine studies), compared to a lower RR of 1.23 (95% CI: 1.15-1.31; 13 studies) in studies with minimal engagement. Notably, the strength of evidence is moderate to low due to the considerable heterogeneity across studies and limited included studies.Our data demonstrate several evidence-based interventions that can enhance adolescent HIV outcomes across the care continuum. Our findings are relevant in many HIV high-burden countries and can help to inform national and regional adolescent HIV policy.This study was supported by UNICEF, the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA), and the US NIH (NIAID K24AI143471, NICHD 1UG1HD113156, UM2HD116395).
University of North Carolina Project-China, Guangzhou, China.Dermatology Hospital of South Medical University, Guangzhou, China.
Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Social Policy and Intervention, University of Oxford, UK.
Social Innovation in Health Initiative (SIHI), Nnamdi Azikiwe University, Awka, Nigeria.Department of Zoology, Nnamdi Azikiwe University, Awka, Nigeria.
Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
Department of International Clinic, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Brown School of Social Work, Washington University in St. Louis, St Louis, MO, United States.
Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda.
Nuffield Department of Medicine, University of Oxford, UK.
Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia.
Barts and The London School of Medicine and Dentistry Queen Mary University of London, UK.
School of Medicine/Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
University of North Carolina Project-China, Guangzhou, China.Dermatology Hospital of South Medical University, Guangzhou, China.Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.
HIV/AIDS Section, Health Programmes, United Nations Children's Fund, New York, USA.
University of North Carolina Project-China, Guangzhou, China.Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
HIV interventions across the care continuum for adolescents in high-burden countries: a systematic review and meta-analysis.

The study aimed to explore the utility of contrast-enhanced ultrasound (CEUS) as a tool for detecting minimal inflammation in rheumatoid arthritis (RA) patients in sustained remission (SR) and to correlate the findings with Disease Activity Score 28 (DAS28) status scores and various ultrasound (US) scores.Thirty RA patients in SR (minimum 6 months), 12 with active disease, and 10 healthy controls were included. Clinical evaluations and US assessments were performed, including grayscale US (GSUS), power Doppler US (PDUS), and Global OMERACT-EULAR Synovitis Score (GLOESS). The CEUS was performed in the two most active joints and was scored semi-quantitatively (SQ) and quantitatively.Healthy controls and remission RA patients had similar total US scores. Active RA patients had higher US scores than the healthy and remission groups, with statistically significant differences in all the groups compared to the healthy group. However, significant differences were only observed in the GSUS and GLOESS when comparing active RA patients with the remission group. Ninety-five joints were selected for the CEUS, and we detected more microvascularization with the SQ CEUS score than with the PDUS in all groups (18 vs. 58% in the remission group; p-value 0.006). The weighted Cohen's kappa for the intra-rater and inter-rater IACUS CEUS score was 0.714 (confidence interval 0.610-0.819, p-value < 0.001) and 0.540 (confidence interval: 0.419-0.662, p-value < 0.001), respectively. Spearman's correlation between the SQ CEUS and quantitative scores was 0.655.For the majority of RA patients in SR, conventional US may fail to detect microvascularization potentially related to the subclinical disease. The CEUS may be helpful for this purpose.
Copyright © 2024 Polido-Pereira, António, Khmelinskii, Arese, Teixeira, Vieira-Sousa, D'Agostino and Fonseca.
Rheumatology Department, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.GIMM - Gulbenkian Institute for Molecular Medicine, Lisbon, Portugal.
Universitá Cattolica del Sacro Cuore-Foundation Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Rheumatology Department Catholic University of Sacred Hearth, Foundation Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Contrast-enhanced ultrasound as a valuable tool to detect minimal inflammation in RA patients in sustained remission.

CellSight Technologies, Inc., San Francisco, CA, United States.
Molecular Imaging Program at Stanford, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States.
Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan.
Editorial: Tumor microenvironment and beyond: imaging systemic immunity with PET.

Immune checkpoint inhibitors (ICIs) have been widely applicated for the treatment of patients with advanced esophageal cancer. Skin-related adverse reactions are frequent with ICIs, with toxic epidermal necrolysis (TEN) being a severe and potentially life-threatening cutaneous reaction.We present a case of a 70-year-old male with locally advanced esophageal cancer who developed severe toxic epidermal necrolysis (TEN) after 18 days of tislelizumab combined with chemotherapy. The condition rapidly progressed to cover approximately 90% of his body. After treatment with intravenous methylprednisolone, immunoglobulin, and antibiotics, along with active nutritional support and wound care, the patient recovered from TEN induced by tislelizumab.Treatment for TEN is complex, and no standardized guidelines currently exist. We propose an economical, safe, effective, and simple strategy for similar TEN patients.
Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China.
Department of Oncology, Ganzhou People's Hospital, Ganzhou, China.
Case report: Toxic epidermal necrolysis induced by tislelizumab in a patient with esophageal squamous cell carcinoma.

Acute fatty liver of pregnancy (AFLP) is a severe complication that can occur in the third trimester or immediately postpartum, characterized by rapid hepatic failure. This study aims to explore the changes in portal vein blood flow velocity and liver function during pregnancy, which may assist in the early diagnosis and management of AFLP.This longitudinal study was conducted at a tertiary healthcare center with participants recruited from routine antenatal check-ups. The study included healthy women aged 20-40 years with singleton pregnancies. Doppler ultrasonography was used to assess portal vein flow and velocity, complemented by standard laboratory tests to monitor liver function. A nomogram model integrating the clinical features and Doppler ultrasonography parameters was constructed using logistic regression analysis for differentiating AFLP from normal controls.A total of 135 women were enrolled, divided into control and AFLP groups. The AFLP group demonstrated a significant reduction in portal vein flow velocity and alterations in liver dimensions. Laboratory tests indicated elevated liver enzymes and altered lipid profiles in the AFLP group. Statistical analysis showed that portal vein flow velocity could be a sensitive marker for predicting liver dysfunction in AFLP. The area under the receiver operating characteristic (ROC) curves (AUC) of the nomogram model were 0.88 (95% confidence interval [CI]: 0.82-0.95) with specificity, sensitivity, negative predictive value, and positive predictive value of 67.8, 95.0, 95.0, and 67.8, respectively, in the training cohort and 0.86 (95% CI: 0.72-0.98) and 86.9, 75.0, 83.3, and 80.0 in the test cohort, respectively. The calibration curves demonstrated good agreement between the predicted and observed probability for predicting AFLP.The study underscores the potential of using portal vein flow velocity as an early diagnostic marker for AFLP in pregnant women. Further research is required to establish standardized diagnostic thresholds for portal vein flow measurements.
Copyright © 2024 Zhao, Zhang, Li, Zhou, Jiang, Jia and Qin.
Department of Medical Ultrasound, Jinshan Hospital of Fudan University, Shanghai, China.
Department of Medical Ultrasound, The Central Hospital of Karamay, Karamay, China.
Department of Medical Ultrasound, Jinshan Hospital of Fudan University, Shanghai, China.Department of Medical Ultrasound, The Central Hospital of Karamay, Karamay, China.
Reduced portal vein blood flow velocity in acute fatty liver of pregnancy.

Health is one of the Sustainable Development Goals. The importance of health promotion is growing in the context of an aging population and increasing life expectancy. Prevention is often underestimated and neglected by citizens. This article aims to identify the socioeconomic predictors of preventive health check-ups by general practitioners in the Czech Republic, focusing on selected age groups. An original dataset is prepared based on data for 2010-2019 provided by the largest health insurance company in the Czech Republic, the General Health Insurance Company. Correlation and regression analysis methods are used to achieve the objectives. Two models are built and tested: (1) preventive examinations model and (2) preventive examinations in age group 65+ model. Based on the results, preventive medical examinations in the pensioner group depended on economic indicators, such as the average wage, employment, and gross domestic product, in the analyzed period. For the total population, overall population size, the average age, urbanized area, and level of education play a key role. The results reveal a difference between the general population group and the 65+ population group. Government interventions and health policies promoting prevention should consider using appropriate incentive policy instruments targeting the 65+ population to prolong active life in senior age.
Copyright © 2024 Zimmermannova, Vevoda, Schovankova and Holy.
Science and Research Centre, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia.
Department of Humanities and Social Sciences, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia.
Socioeconomic predictors of preventive health check-ups by a general practitioner in the Czech Republic.

This pilot study aimed to identify early predictors of drug retention in patients with clinically active peripheral psoriatic arthritis who initiated or switched to therapy with biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs).Clinical and ultrasound assessments were conducted at baseline (t0) and subsequently at 1 (t1), 3 (t3), and 6 (t6) months. Ultrasound evaluations targeted joints/entheses according to PsASon-Score13 and the most clinically involved joint/enthesis/tendon or the two most clinically involved joints/entheses/tendons (MIJET and 2MIJET). After 6 months of follow-up, patients were divided into two groups based on drug retention, determined by the clinician's assessment of treatment efficacy (cResponder vs. non-cResponder). Main endpoints were ultrasound changes in MIJET, 2MIJET, and GUIS (Global US Inflammation Subscore) derived from PsASon-13.Twenty-nine patients were enrolled, 22 cResponders and 7 non-cResponders at t6. In the comparison between cResponders and non-cResponders, GUIS variation significantly differed in Δt6-t0, while MIJET and 2MIJET variations were significant as early as Δt3-t0 and confirmed in Δt6-t0. The ultrasound response of MIJET and 2MIJET was faster in cResponders treated with JAKi vs. those treated with TNFi and IL-17/12-23i, significant in Δt1-t0.Ultrasound imaging of clinically involved joint sites may be a valuable early predictor of therapy response for predicting drug retention at 6 months in patients with psoriatic arthritis.
Copyright © 2024 Cozzi, Scagnellato, Lorenzin, Collesei, Oliviero, Damasco, Cosma, Basso, Doria and Ramonda.
Rheumatology Unit, Department of Medicine-DIMED, University - Padova University Hospital, Padua, Italy.
Cancer Genomics Core-Lab, Istituto Oncologico Veneto IRCCS, Padua, Italy.
Laboratory Medicine, Department of Medicine-DIMED, University - Padova University Hospital, Padua, Italy.
Predictors of response to bDMARDs and tsDMARDs in psoriatic arthritis: a pilot study on the role of musculoskeletal ultrasound.

We report a rare case of fungal keratitis caused by Neurospora, a filamentous fungus that is widely distributed in soil and graminaceous plants.A 40-year-old Mongoloid male patient came to our outpatient clinic with painful swelling of the left eye and redness, after being cut by a tree branch 1 week prior. After examination, the patient was diagnosed with a corneal ulcer of the left eye, and was given levofloxacin eye drops and levofloxacin ophthalmic gel. However, the patient did not respond to the treatment. After admission to the hospital, fungal mycelium was found in the corneal smear. To further identify the pathogen, a corneal scraping culture was used to extract fungal DNA and PCR amplification was performed using ITS universal primers, which was later sequenced and identified as Neurospora. We used fluconazole injections (0.2 g/100 mL) as eye drops to treat the patient once every hour, and itraconazole (200 mg) was administered orally once a day. After a few days, the patient's condition improved.To the best of our knowledge, this is the first reported case of fungal keratitis caused by Neurospora in China. In this case, conventional topical and systemic treatment resulted in a favorable outcome. In patients with suspected fungal keratitis, medical treatment should be started urgently, and the treatment plan should be adjusted according to the subsequent experimental results and the patient's condition.
Department of Laboratory Medicine, The First Affiliated Hospital of Ningbo University, Ningbo First Hospital, Ningbo, China.
Department of Clinical Laboratory, The Affiliated Peoples' Hospital of Ningbo University, Ningbo, Zhejiang, China.
Department of Ophthalmology, Ningbo Yinzhou No.2 Hospital, Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China.
Fungal keratitis caused by Neurospora: a case report.

Epigenetics in Human Health and Disease Program Baker Heart and Diabetes Institute Melbourne Victoria Australia.Baker Department of Cardiometabolic Health The University of Melbourne Parkville Australia.
Epigenetics in Human Health and Disease Program Baker Heart and Diabetes Institute Melbourne Victoria Australia.Department of Medicine and Therapeutics The Chinese University of Hong Kong (CUHK) Hong Kong SAR China.
Targeting EZH1/2: tackling epigenetic resistance advances cancer therapy.

Therapies against hematological malignancies using chimeric antigen receptors (CAR)-T cells have shown great potential; however, therapeutic success in solid tumors has been constrained due to limited tumor trafficking and infiltration, as well as the scarcity of cancer-specific solid tumor antigens. Therefore, the enrichment of tumor-antigen specific CAR-T cells in the desired region is critical for improving therapy efficacy and reducing systemic on-target/off-tumor side effects. Here, we functionalized human CAR-T cells with superparamagnetic iron oxide nanoparticles (SPIONs), making them magnetically controllable for site-directed targeting. SPION-loaded CAR-T cells maintained their specific cytolytic capacity against melanoma cells expressing the CAR-specific antigen chondroitin sulfate proteoglycan (CSPG4). Importantly, SPIONs suppressed cytokine release in the loaded CAR-T cells, shifting the cell death phenotype in the tumor cells from pyroptosis to apoptosis. Furthermore, SPION-loaded CAR-T cells could be enriched in a dynamic flow model through an external magnetic field and be detected in MRI. These results demonstrate that lytic cytotoxicity is retained after SPION-functionalization and provides a basis for future site-specific immunotherapies against solid tumors with reduced systemic adverse side effects.
© 2025 The Author(s). MedComm published by Sichuan International Medical Exchange & Promotion Association (SCIMEA) and John Wiley & Sons Australia, Ltd.
Department of Otorhinolaryngology Head and Neck Surgery Section of Experimental Oncology and Nanomedicine (SEON) Else Kröner-Fresenius-Stiftung Professorship Universitätsklinikum Erlangen Erlangen Germany.
Department of Otorhinolaryngology Head and Neck Surgery Section of Experimental Oncology and Nanomedicine (SEON) Else Kröner-Fresenius-Stiftung Professorship Universitätsklinikum Erlangen Erlangen Germany.Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) Erlangen Germany.
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) Erlangen Germany.Department of Dermatology Universitätsklinikum Erlangen Erlangen Germany.Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg (CCC ER-EMN) Erlangen Germany.Deutsches Zentrum Immuntherapie (DZI) Erlangen Germany.
Institute of Micro- and Nanostructure Research & Center for Nanoanalysis and Electron Microscopy Interdisciplinary Center for Nanostructured Films Friedrich-Alexander-University Erlangen Erlangen Germany.
Department of Otorhinolaryngology Head and Neck Surgery Section of Experimental Oncology and Nanomedicine (SEON) Else Kröner-Fresenius-Stiftung Professorship Universitätsklinikum Erlangen Erlangen Germany.Institute of Microwave and Photonics Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) Erlangen Germany.
Chair of Robotics Science and Systems Intelligence Munich Institute of Robotics and Machine Intelligence (MIRMI), TUM School of Computation, Information and Technology Technical University of Munich Munich Germany.
Loading of CAR-T cells with magnetic nanoparticles for controlled targeting suppresses inflammatory cytokine release and switches tumor cell death mechanism.

Metastasis continues to pose a significant challenge in tumor treatment. Evidence indicates that choline dehydrogenase (CHDH) is crucial in tumorigenesis. However, the functional role of CHDH in colorectal cancer (CRC) metastasis remains unreported. The study explored the functional role and mechanism of CHDH in CRC metastasis using human CRC tissues and a xenograft mouse model. CHDH expression was significantly higher in CRC compared to normal tissues and showed a positively correlation with CRC tumor-nodes-metastasis stage. CRC cell lines showed increased CHDH expression compared to normal controls. CHDH knockdown suppressed cell migration in vitro and tumor metastasis in vivo. Similarly, ectopic CHDH expression enhanced cell migration in vitro and tumor metastasis in vivo. Results suggested that CHDH affected the histone H3 trimethylation levels, which upregulated prolyl 4-hydroxylase α-subunit (P4HA) family gene (P4HA1/2/3) expression, further stabilizing collagen I expression and increasing IL17RB expression, which promoted downstream c-Jun activation. Together, P4HA and IL17RB promote CRC cell metastasis. P4HA and c-Jun inhibitors abolished CHDH-mediated CRC cell metastasis in vitro and in vivo. Collectively, the above findings provide novel evidence that that CHDH mediates CRC cell metastasis and may be a promising target for metastatic CRC therapy.
Cheeloo College of Medicine Shandong University Jinan China.Shandong Provincial Precision Medicine Laboratory for Chronic Non-communicable Diseases, Institute of Precision Medicine Jining Medical University Jining China.
Shandong Provincial Precision Medicine Laboratory for Chronic Non-communicable Diseases, Institute of Precision Medicine Jining Medical University Jining China.
Department of Oncology and Southwest Cancer Center Southwest Hospital, Third Military Medical University (Army Medical University) Chongqing China.
Department of Oncology The Seventh Medical Center of Chinese PLA General Hospital Beijing China.
Department of General Surgery Affiliated Hospital of Jining Medical University, Jining Medical University Jining China.
Prolyl 4-hydroxylase α-subunit family regulation of type I collagen deposition and IL17RB/c-Jun activation synergistically mediate choline dehydrogenase promotion of colorectal cancer metastasis.

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that is primarily known for causing severe joint and muscle symptoms, but its pathological effects have extended beyond these tissues. In this study, we conducted a comprehensive proteomic analysis across various organs in rodent and nonhuman primate models to investigate CHIKV's impact on organs beyond joints and muscles and to identify key host factors involved in its pathogenesis. Our findings reveal significant species-specific similarities and differences in immune responses and metabolic regulation, with proteins like Interferon-Stimulated Gene 15 (ISG15) and Retinoic Acid-Inducible Gene I (RIG-I) playing crucial roles in the anti-CHIKV defense. We observed upregulated and downregulated metabolic status in CHIKV-infected rhesus monkeys and mice, respectively. Additionally, we identified host factors such as S100 Calcium-Binding Protein A8/A9 (S100A8/A9), Voltage-Dependent Anion Channel 1/2 (VDAC1/2), Complement Component 3 (C3), Apoptosis-Inducing Factor Mitochondria-Associated 1 (AIFM1), Endothelial Cell-Specific Chemotaxis Regulator (ECSCR), and Kininogen 1 (KNG1) that may contribute to CHIKV-induced inflammation and hemorrhage. These insights put emphases on the importance of understanding CHIKV's impact on organs beyond joints and muscles, providing potential therapeutic targets and enhancing our understanding of CHIKV pathogenesis. This research underscores the need for appropriate animal models in CHIKV studies and informs the development of targeted therapies to address its systemic effects.
Yunnan Key Laboratory of Cross-Border Infectious Disease Prevention and New Drug Development Institute of Medical Biology Chinese Academy of Medical Sciences and Peking Union Medical College Kunming China.
Yunnan Key Laboratory of Cross-Border Infectious Disease Prevention and New Drug Development Institute of Medical Biology Chinese Academy of Medical Sciences and Peking Union Medical College Kunming China.Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College) Ministry of Education Beijing China.State Key Laboratory of Respiratory Health and Multimorbidity Beijing China.
Multiorgan proteomic analysis of infected animal models predict potential host factors for chikungunya virus.

Cancer-associated fibroblasts (CAFs) are intrinsic components of the tumor microenvironment that promote cancer progression and metastasis. Through an unbiased integrated analysis of gastric tumor grade and stage, we identified a subset of proangiogenic CAFs characterized by high podoplanin (PDPN) expression, which are significantly enriched in metastatic lesions and secrete chemokine (CC-motif) ligand 2 (CCL2). Mechanistically, PDPN(+) CAFs enhance angiogenesis by activating the AKT/NF-κB signaling pathway. The canonical NF-κB signaling protein P65 binds to the promoter region of CCL2, inducing its expression. Additionally, we found that CCL2 interacts with its nonclassical receptor ACKR1 (expressed on endothelial cells) to exert its proangiogenic effects. Furthermore, the disruption of CCL2-ACKR1 communication via a CCL2 neutralizing antibody or the inhibition of AKT signaling transduction using AKT inhibitors effectively suppressed tumor growth. Together, this study elucidates the mechanism by which PDPN(+) CAFs promote angiogenesis, providing a deeper understanding of the molecular processes underlying CAF-mediated angiogenesis and suggesting potential therapeutic targets for gastric cancer treatment.
Department of Gastric Surgery Fudan University Shanghai Cancer Center Shanghai China.Department of Oncology Shanghai Medical College, Fudan University Shanghai China.
Department of Oncology Shanghai Medical College, Fudan University Shanghai China.Department of Pathology Fudan University Shanghai Cancer Center Shanghai China.Institute of Pathology Fudan University Shanghai China.
Department of Oncology Shanghai Medical College, Fudan University Shanghai China.Department of Endoscopy Fudan University Shanghai Cancer Center Shanghai China.
Department of Artificial Intelligence Medicine, Graduate School of Medicine Chiba University Chiba Japan.
Department of Oncology Shanghai Medical College, Fudan University Shanghai China.Department of Medical Oncology Fudan University Shanghai Cancer Center Shanghai China.
PDPN+ cancer-associated fibroblasts enhance gastric cancer angiogenesis via AKT/NF-κB activation and the CCL2-ACKR1 axis.

Gout, a common chronic disease, is characterized by the formation and deposition of monosodium urate (MSU) crystal deposition in articular and nonarticular structures. Osteoarthritis (OA), the most prevalent type of arthritis, is a progressive degenerative joint disease. Previous clinical studies have reported that gout frequently affects OA joints; however, the underlying mechanism remains unidentified. Recently, OA synovium has been proposed as a favorable vehicle for MSU crystal deposition. Therefore, this study aimed to investigate whether OA synovium acts as a nidus for MSU crystal deposition inducing severe gout flares, using label-free, highly-specific stimulated Raman scattering (SRS) microscopy combined with innovative preclinical models-synovial organoids. Crystal deposition, cellular phagocytosis, and subsequent inflammation intensity was imaged in ex vivo synovial organoids using SRS microscopy and other biochemical techniques. Results revealed that MSU crystals were more likely to deposit in OA synovium than in normal synovium. Furthermore, OA synoviocytes were more capable of phagocytosing crystals, leading to severe inflammation, and thus, expediting gout. These findings offer a potential explanation for why gout is preferred in OA joints and offer significant insights into the pathophysiology of gout, thereby informing prevention and management strategies for OA to prevent or alleviate the subsequent progression of gout.
Department of Sports Medicine Huashan Hospital Fudan University Shanghai China.
State Key Laboratory of Surface Physics and Department of Physics Human Phenome Institute Multiscale Research Institute of Complex Systems Academy for Engineering and Technology Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education) Fudan University Shanghai China.
Osteoarthritis synovium as a nidus for monosodium urate crystal deposition inducing severe gout studied by label-free stimulated Raman scattering combined with synovial organoids.

The precise mechanisms behind early embryonic arrest due to sperm-related factors and the most effective strategies are not yet fully understood. Here, we present two cases of male infertility linked to novel TDRD6 variants, associated with oligoasthenoteratozoospermia (OAT) and early embryonic arrest. To investigate the underlying mechanisms and promising therapeutic approaches, Tdrd6 knock-in and knock-out mice were generated. The Tdrd6 variant male mice demonstrated OAT and embryonic arrest, mirroring the clinical observations of our patients. Sperm from both affected individuals and mice exhibited aberrant localization of phospholipase C zeta and oocyte activation deficiency (OAD). The application of artificial oocyte activation (AOA) effectively overcame the infertility caused by the variants, facilitating successful pregnancies and live births in both human and mice. Additionally, our research revealed that OAD influences the expression of multitude of genes at the 2-pronuclear (2PN) stage, with the Mos gene playing a pivotal role in early embryonic arrest. The injection of Mos mRNA can mitigate this arrest. To our knowledge, this is the first study to show that sperm-related OAD affects gene expression at the 2PN stage and elucidate how AOA overcomes male factor-derived embryonic arrest, enabling successful pregnancies and live births.
Department of Assisted Reproduction Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China.
Medicinal Chemistry and Bioinformatics Center Shanghai Jiao Tong University School of Medicine Shanghai China.
Altered zygotic gene expression caused by sperm with Tdrd6 variants disrupts early embryonic development.

Psilocybin therapy (PT) produces rapid and persistent antidepressant effects in major depressive disorder (MDD). However, the long-term effects of PT have never been compared with gold-standard treatments for MDD such as pharmacotherapy or psychotherapy alone or in combination.This is a 6-month follow-up study of a phase 2, double-blind, randomised, controlled trial involving patients with moderate-to-severe MDD. Participants were recruited from a hospital in the UK. Male or female patients with major depressive disorder (DSM-IV), moderate to severe depression (HAM-D ≥17), no MRI or SSRI contraindications, confirmed diagnosis by a GP or mental healthcare professional, aged 18-80, and competent in English were eligible. Patients were randomly assigned (1:1) to receive either two 25 mg doses of the psychedelic drug psilocybin administered orally combined with psychological support ('psilocybin therapy' or PT) and book-ended by further support or a 6-week course of the selective serotonin reuptake inhibitor (SSRI) escitalopram (administered daily at 10 mg for three weeks and 20 mg for the subsequent three weeks) plus matched psychological support ('escitalopram treatment' or ET). The primary outcome measure was change from baseline in the score on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16) at week 6, which has been reported previously. Herein, we present results at the 6-month follow-up time point. Measures of social functioning, connectedness, and meaning in life constituted the study's secondary outcomes during follow-up. Safety in the follow-up period was not assessed. This trial is registered at ClinicalTrials.gov, NCT03429075.Between January 15th, 2019 and March 20th, 2020, 59 patients were enrolled and 30 (11 females [37%] and 19 males [63%]) were assigned to the psilocybin group and 29 (9 females [31%] and 20 males [69%]) to the escitalopram group. 25 participants in the PT group and 21 in the ET group completed the 6-month follow-up. At the 6-month follow-up, both PT and ET conditions yielded sustained improvements in depressive symptom severity. The mean between-condition difference in QIDS-SR-16 scores at 6-months was 1.51 (95% CI: -1.35, 4.38; p = 0.311). Secondary outcomes demonstrated that PT had greater mean between-condition differences in functioning (WSAS: -7.46; 95% CI: -12.4, -2.47; p < 0.001), psychological connectedness (WCS: 11.02; 95% CI: 1.25, 20.83; p = 0.033), and meaning in life (MLQ: 4.86; 95% CI: 0.67, 9.05; p = 0.021) compared to ET.Six-week intensive treatments with either psilocybin or escitalopram (with psychological support) for MDD were associated with long-term improvements in depressive symptom severity. The greater degree of improvement in the PT arm at follow-up on psychosocial functioning, meaning in life, and psychological connectedness suggests warrant future research. However, these results are descriptive and should be interpreted with caution. Key limitations of the study include its suboptimal power to detect small but meaningful differences between treatments, missing data, the potential use of additional interventions during the follow-up period, and reliance on self-reported treatment assessments. These factors may affect the interpretation of the study findings and should be considered when evaluating the results.The Alexander Mosley Charitable Trust and by the founding partners of Imperial College London's Centre for Psychedelic Research.
Centre for Psychedelic Research, Division of Psychiatry, Department Brain Sciences, Imperial College London, United Kingdom.
Centre for Psychedelic Research, Division of Psychiatry, Department Brain Sciences, Imperial College London, United Kingdom.Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioural Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Centre for Psychedelic Research, Division of Psychiatry, Department Brain Sciences, Imperial College London, United Kingdom.Departments of Neurology and Psychiatry, University of California San Francisco.
Effect of psilocybin versus escitalopram on depression symptom severity in patients with moderate-to-severe major depressive disorder: observational 6-month follow-up of a phase 2, double-blind, randomised, controlled trial.

N4-acetylcytidine (ac4C) modification is a crucial RNA modification widely present in eukaryotic RNA. Previous studies have demonstrated that ac4C plays a pivotal role in viral infections. Despite numerous studies highlighting the strong correlation between ac4C modification and cancer progression, its detailed roles and molecular mechanisms in normal physiological processes and cancer progression remain incompletely understood. This review first outlines the key regulatory enzyme mediating ac4C modification, N-acetyltransferase 10 (NAT10), including its critical roles in regulating RNA stability, transcriptional efficiency, and translational fidelity. Additionally, it systematically summarizes the essential functions and mechanisms of ac4C modification in normal biological processes, including stem cell fate determination, spermatogenesis and oogenesis, embryonic development, cellular senescence, and bone remodeling. Furthermore, this review delves into the central roles and molecular mechanisms of ac4C modification in regulating malignant proliferation, cell cycle arrest, EMT, drug resistance, cell death, cancer metabolism, and tumor immunotherapy. It also emphasizes the potential of NAT10 as a prognostic biomarker and its therapeutic potential as a target for disease treatment. In summary, this review clarifies the multifaceted roles of ac4C modification in both health and disease and explores NAT10-targeted therapies with the aim of advancing cancer research and improving patient outcomes.
Gastrointestinal Surgical Unit Suining Central Hospital Suining Sichuan China.
Department of Hepatobiliary Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China.
Department of Oncology Suining Central Hospital Suining Sichuan China.
Department of Clinical Laboratory Medicine Suining Central Hospital Suining Sichuan China.
Department of Medicine UF Health Cancer Center University of Florida Gainesville Florida USA.
RNA N4-acetylcytidine modification and its role in health and diseases.

Amsterdam UMC Location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands.Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
In search of stories: narrative-aesthetic interventions to hear cancer patients' voices.

Breast cancer-the impact of conflict and displacement.

Patients with cancer expect prolonged life (overall survival, OS) or better life (quality of life, QOL) from cancer treatments. However, majority of new cancer drugs are now being approved not based on improved OS or QOL, but based on surrogate endpoints such as tumor shrinkage or delayed tumor progression. These surrogate endpoints, including their validity as a proxy for overall survival, differ based on disease settings and lines of treatment but in general, most surrogate measures have weak correlation with outcomes that matter to patients. Nevertheless, they are being increasingly used as the basis for regulatory decisions. The current tension in this space is between adoption of surrogate endpoints for early access to cancer drugs versus the need for confirmation that the drugs improve outcomes that matter and not merely improve scan results or surrogate endpoints. In this article, we provide a comprehensive review of surrogate endpoints currently used in oncology trials both in curative and advanced disease settings, including their definition, methodology for validation, existing evidence for their surrogacy, predictive versus prognostic reliability of surrogate endpoints, the promise of surrogate endpoints, their pitfalls, and the way forward. Using a Q&A format, we discuss answers to the most commonly asked questions regarding surrogate endpoints in oncology. Our review answers the following frequently asked questions about surrogate endpoints in oncology: how are surrogate endpoints defined? How are they validated? What is a patient-level versus trial-level surrogate? What are the benefits of using surrogate endpoints? What level of surrogacy is required for regular versus accelerated approval? Are we overusing surrogate endpoints? Should we use surrogate endpoints in adjuvant settings? Can surrogacy be extrapolated from one setting to another? What is the surrogacy of progression-free survival for OS and QOL? Why does PFS not correlated with OS or QOL? Why do regulators rely on surrogate endpoints? We end this article with a proposal on the way forward.
Department of Oncology, Northeast Cancer Center, Northern Ontario School of Medicine, Sudbury, ON, Canada.
Hematology/Medical Oncology, Compass Oncology, Portland, OR, USA.
Department of Medicine, Queen's University, Kingston, Canada.
Department of Oncology, Queen's University, Kingston, Canada.
Department of Oncology, Queen's University, Kingston, Canada.Department of Public Health Sciences, Queen's University, Kingston, Canada.Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada.
Frequently asked questions on surrogate endpoints in oncology-opportunities, pitfalls, and the way forward.

Use of health applications (apps) to support healthy lifestyles has intensified. Different app features may support effectiveness, including gamification defined as the use of game elements in a non-game situation. Whether health apps with gamification can impact behaviour change and cardiometabolic risk factors remains unknown. We conducted a systematic review and meta-analysis to determine the effect of health apps with gamification compared to non-gamified apps (control) on physical activity and cardiometabolic risk factors.MEDLINE, EMBASE, and Cochrane library databases were searched through May 21st, 2024. We included controlled trials in adults (≥1 years) of all health backgrounds, with intervention periods ≥8-weeks, assessing the effect of gamification strategies used in health behaviour apps on adherence, cardiometabolic risk factors, total energy, and dietary nutrients of concern. Independent reviewers extracted relevant data and assessed risk of bias. Outcomes included physical activity and cardiometabolic risk factors (adiposity, glycemia, lipids, blood pressure and dietary factors). Data were pooled using the inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CI). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Protocol registration was on ClinicalTrials.gov (NCT04633070).36 trials (49 trial comparisons, n = 10,079) met eligibility criteria; most targeted physical activity or weight loss. Use of gamification in apps compared to non-gamified interventions resulted in trivial increases in steps (489 steps/day [64 to 914]; high), and reductions in body mass index (-0.28 kg/m2 [-0.44 to -0.12]; moderate) and body weight (-0.70 kg [-1.18 to -0.22]; moderate), and small important reductions in body fat (-1.92% [-2.71 to -1.14]; high) and waist circumference (-1.16 cm [-1.93 to -0.39]; moderate). No differences were observed for other outcomes (very low-to-high).Current evidence provides a good indication that gamification features in apps targeting physical activity or measures of adiposity results in slight improvements in these outcomes compared to non-gamified versions. Recommendations to use an app for increasing physical activity or targeting weight loss should consider those with gamification features.None.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain.Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus 43201, Spain.Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid 28029, Spain.School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.
School of Environment, Enterprise and Development, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Division of Endocrinology and Metabolism, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.
Effect of digital health applications with or without gamification on physical activity and cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials.

Across a series of eight high-powered studies (N = 6,866), we develop a method for assessing impartial intergenerational beneficence, defined as intergenerational concern for all possible future generations. Across our studies, roughly 20% of participants displayed impartial intergenerational beneficence. Participants with impartial intergenerational beneficence expressed greater perceptions that future threats can be resolved, support for policies seeking to protect future generations of people, and a profound sense of responsibility for the long-term survival and prosperity of humanity. Similarly, associations with various future-oriented attitudes, patterns of prosociality, and longtermism-related behaviors and intentions were noted. This research thus introduces a method to capture impartiality in expressed intergenerational concern and finds that people who display impartial intergenerational concern endorse prosocial principles, such as altruism and utilitarianism, while also being more concerned about their own future, the future of others, and how they will be remembered by others.
Personality & social psychology bulletin
Impartial Intergenerational Beneficence: The Psychology of Feeling (Equal) Intergenerational Concern for All Future Generations.

Sarcopenia is defined as a muscle-wasting syndrome that occurs with accelerated aging, while cachexia is a severe wasting syndrome associated with conditions such as cancer and immunodeficiency disorders, which cannot be fully addressed through conventional nutritional supplementation. Sarcopenia can be considered a component of cachexia, with the bidirectional interplay between adipose tissue and skeletal muscle potentially serving as a molecular mechanism for both conditions. However, the underlying mechanisms differ. Recognizing the interplay and distinctions between these disorders is essential for advancing both basic and translational research in this area, enhancing diagnostic accuracy and ultimately achieving effective therapeutic solutions for affected patients. This review discusses the muscle microenvironment's changes contributing to these conditions, recent therapeutic approaches like lifestyle modifications, small molecules, and nutritional interventions, and emerging strategies such as gene editing, stem cell therapy, and gut microbiome modulation. We also address the challenges and opportunities of multimodal interventions, aiming to provide insights into the pathogenesis and molecular mechanisms of sarcopenia and cachexia, ultimately aiding in innovative strategy development and improved treatments.
Department of Neurology West China Hospital of Sichuan University Chengdu Sichuan China.Institute of Brain Science and Brain-Inspired Technology of West China Hospital Sichuan University Chengdu Sichuan China.Department of Neurology Chengdu Shangjin Nanfu Hospital Chengdu Sichuan China.
Sarcopenia and cachexia: molecular mechanisms and therapeutic interventions.

Background and Purpose: The Nurse Practitioner Holistic Caring Instrument (NPHCI) is a 19-item, investigator-developed instrument designed to measure holistic caring in nurse practitioner (NP) practice. This paper evaluates multi-sample psychometric testing of the instrument, describing data from three samples, with analysis supporting the NPHCI as a valid and reliable instrument. Methods: The NPHCI has been administered in patient, NP program faculty, and NP convenience samples. Development of the NPHCI was guided by Shuler's NP practice model and Swanson's theory of caring. Construct validity was estimated using Interitem correlation, exploratory factor analysis and confirmatory factor analysis. Reliability of the instrument was assessed in all three samples via Cronbach's alpha. Findings: Exploratory factor analysis consistently supported the identification of three subscales in the NPHCI, and confirmatory factor analysis demonstrated a good fit between the theoretical constructs and empirical indicators in the data. The instrument has demonstrated strong reliability in three samples. Conclusions: The NPHCI demonstrates acceptable reliability and validity but further psychometric testing is indicated.
University of Central Florida, College of Nursing, Orlando, FL, USA.
Journal of holistic nursing : official journal of the American Holistic Nurses' Association
The Importance and Psychometric Soundness of an Instrument to Measure Holistic Nursing in NP Care.

Ambiguity acts as a veil that can help conceal and justify dishonest behavior. While an individual's ability to disambiguate information in a task may help remove the veil of ambiguity and thus promote honesty, the relationship between ambiguity, ability, and dishonesty is currently unexplored. To investigate this, we employed an experimental design where participants attempted to resolve an ambiguous task and reported their performance. Results showed that ambiguity and dishonesty increase in unison. Importantly, the participants who resolved ambiguity acted less dishonestly (Study 1). In Studies 2a, 2b, and 3, we increased participants' ability by briefly training them to disambiguate the information presented in the task. The results showed that participants acted less dishonestly when their ability levels were increased. Overall, the findings indicate that dishonesty can be reduced not only by making tasks less ambiguous but also by enhancing an individual's ability to successfully resolve ambiguity.
Seeing Through the Fog: The Ability to Resolve Ambiguity Reduces Dishonesty.

This article explores the life and work of Dr Caroline F. Hamilton, one of the pioneering female physicians sent from the USA to the Ottoman Empire in the late 19th century. Over a career spanning three decades, Hamilton provided critical medical care, especially to women, at the Azariah Smith Memorial Hospital in Aintab, overcoming legal, cultural, and political obstacles to become one of the first women licensed to practise medicine in the region. Her contributions, particularly in treating Muslim women who had limited access to male doctors, were significant in advancing healthcare in a conservative society. Hamilton's role extended beyond direct patient care, she also trained local health workers, contributing to long-term improvements in healthcare. Her efforts during times of war, epidemics, and humanitarian crises exemplified her resilience and dedication. This article highlights Hamilton's broader legacy, examining how her work reflects the intersection of gender, medicine, and missionary activity in a complex geopolitical context while also contributing to the introduction of Western medical practices in the Ottoman Empire.
Faculty of Humanities and Social Sciences, Sakarya University, Sakarya, Turkey.
A medical trailblazer in the Ottoman Empire: The legacy of Dr Caroline Frances Hamilton (1861-1944).

Ureteral stenosis is a frequent complication after kidney transplantation, causing significant morbidity and potential graft function impairment. Treatment options include conservative management, endourological procedures, surgical interventions and percutaneous nephrostomy (PCN). While PCN effectively relieves obstruction, it comes with its own complications. This study evaluates the risk factors, incidence, complications and outcomes of PCN in this population. We conducted a retrospective case series analysis of 98 kidney transplant recipients who underwent PCN. Data on demographics, clinical characteristics and procedural outcomes were collected and analysed to assess the incidence of complications and identify associated risk factors. Among the 98 recipients, the median age at transplant was 56 years, with 52% being male. The most common comorbidities included hypertension (75.5%) and diabetes mellitus (35.7%). Complications occurred in 38.8% of patients, with infections being the most frequent (74.4%), including urinary tract infections (28.9%) and pyelonephritis (22.4%). The primary organisms identified were gram-negative bacteria (55.1%). Reconstructive surgery was required in 35.7% of cases and patient survival was 83.7% at follow-up. In conclusion, PCN in kidney transplant recipients is associated with a high rate of complications, particularly infections. Effective management necessitates the identification and addressing of associated risk factors such as diabetes, elevated BMI and specific induction therapies. While PCN is vital for preserving graft function, further research should focus on refining clinical protocols and developing targeted preventive strategies for high-risk patients.
© 2025 Asian Pacific Society of Nephrology.
Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA.
Percutaneous Nephrostomy in Kidney Transplant Recipients: Incidence, Risk Factors, Complications and Outcomes.

Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, 86 Wood Lane, London, W12 0BZ, United Kingdom.Polypharmacy Action Learning Sets, Imperial College Health Partners, 307 Euston Road, London, NW1 3AD, United Kingdom.
Rethinking polypharmacy: empowering junior doctors to tackle a chronic condition in modern practice.

Eugène Hertoghe (1860-1928), a Belgian internist and former vice-president of the Royal Academy of Medicine of Belgium, made significant contributions to the understanding and treatment of chronic hypothyroidism. He provided a detailed clinical description of the condition, emphasizing its multisystemic manifestations and hereditary aspects. Hertoghe also documented the therapeutic use of thyroid extract, reporting its effectiveness in alleviating symptoms of hypothyroidism. Among his contributions, he described the Hertoghe sign, a rare clinical feature characterized by the loss of the outer third of the eyebrows, commonly associated with myxoedema, as well as with cases of toxic poisoning, infections, and atopic dermatitis.
Department of the History of Medicine and Ethics, Erciyes University School of Medicine, Melikgazi, Kayseri, Türkiye.
Department of Medicine, Nova Southeastern University Medical School, Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA.
Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
Eugene Hertoghe (1860-1928): Pioneer in endocrinology and the treatment of hypothyroidism.

Bone tissue regeneration can be affected by various architectonical features of 3D porous scaffold, for example, pore size and shape, strut size, curvature, or porosity. However, the design of additively manufactured structures studied so far was based on uniform geometrical figures and unit cell structures, which often do not resemble the natural architecture of cancellous bone. Therefore, the aim of this study was to investigate the effect of architectonical features of additively manufactured (aka 3D printed) titanium scaffolds designed based on microtomographic scans of fragments of human femurs of individuals of different ages on in vitro response of human bone-derived mesenchymal stem cells (hMSC). Four different types of titanium scaffold (33Y, 48Y, 56Y, and 63Y, where the number indicates the age of the individual) were fabricated using laser beam powder bed fusion (PBF-LB) and characterized with respect to the dimensional features, permeability, and stiffness. hMSC were seeded onto the scaffolds and MTS, DNA, alkaline phosphatase, and alizarin red assays were used to study cell viability, proliferation, and osteogenic differentiation. Microcomputed tomography revealed that the largest average pore size was in scaffolds 63Y (543 ± 200 μm), which was nearly twice as large as the smallest pores in scaffolds 56Y. Moreover, scaffolds 63Y exhibited the highest porosity (~61%), while the other architectures had porosity of ~43%-44%. Scaffolds 63Y also had the lowest surface area-to-volume ratio (11.07 ± 0.05 mm-1), whereas scaffolds 56Y had the highest (14.80 ± 0.06 mm-1). Furthermore, scaffolds 33Y had the largest strut size (398 ± 124 μm), exceeding the size in scaffolds 56Y (the smallest strut size) by over 1.5 times. CFD simulations indicated that the hydraulic permeability was the highest for scaffolds 63Y (5.24 × 10-9 m2; order of magnitude higher than in the other architectures). Stiffness of the investigated scaffolds, determined by finite element modeling, ranged from ~29 GPa (63Y) to ~60 GPa (56Y). This study demonstrates that the highest manufacturing accuracy in 3D printed structures based on architectural designs inspired by cancellous bone could be achieved when the structures were characterized by moderate strut sizes, the largest pores, and the highest porosity and permeability. The scaffold with the highest porosity and permeability (i.e., 63Y) yielded the lowest cell retention. Regarding the osteogenic differentiation, a correlation was found between the mineralization of the deposited extracellular matrix and the hydraulic permeability, pore size, and surface area-to-volume ratio but not the porosity.
Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland.
Faculty of Mechanical and Industrial Engineering, Warsaw University of Technology, Warsaw, Poland.
Multidisciplinary Research Center, Cardinal Stefan Wyszynski University in Warsaw, Dziekanow Lesny, Poland.
Journal of biomedical materials research. Part A
Mimicking Nature: Effect of Architectural Design Inspired by Cancellous Bone on the Biological Response of hMSC Cultured on Titanium Scaffolds Fabricated by Laser Beam Powder Bed Fusion.

There is a complex interplay between the gut microbes, liver, and central nervous system, a gut-liver-brain axis, where the brain impacts intestinal and hepatic function while the gut and liver can impact cognition and mental status. Dysregulation of this axis can be seen in numerous diseases. Hepatic encephalopathy, a consequence of cirrhosis, is perhaps the best studied perturbation of this system. However, patients with cirrhosis have been shown to have increased incidence of other disorders of mental health which may be otherwise less clinically identifiable. Sexual dysfunction affects a large proportion of patients with cirrhosis and is associated with decreased quality of life. Screening for sexual dysfunction in patients with cirrhosis is often overlooked, and even when identified, treatment options are limited, particularly in patients with advanced liver disease. The mechanism by which patients with cirrhosis develop sexual dysfunction is multifactorial, but a key driver of this clinical manifestation is alterations in circulating sex hormones. In patients with cirrhosis, low serum sex hormones have been shown to be associated with higher mortality regardless of MELD score. The gut microbiome has been shown to have an immense metabolic capacity to metabolize steroid hormones. This sterolbiome has already been implicated in other disease processes and has been linked to low circulating sex hormones, suggesting a new mechanism by which sex hormones may be altered in disease states where the gut-liver-brain axis is disrupted. The aim of this review is to cover sex hormone changes and sexual dysfunction in cirrhosis, examine the gut microbiome and its metabolic capacity, particularly for steroid hormones, and consider how microbial changes using fecal microbiota transplant could modulate sexual dysfunction.
Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA, USA.
Interaction of the Gut-Liver-Brain Axis and the sterolbiome with sexual dysfunction in patients with cirrhosis.

Rapid response teams (RRTs) are prevalent in healthcare institutions worldwide. Repeated activations are associated with increased morbidity and higher resource utilisation, and represent a heterogeneous population that may benefit from early identification. To date, there are no published data on repeat RRT activations in Singapore. We aimed to compare the characteristics and outcomes between patients who required single versus multiple RRT activations.We conducted a prospective cohort study of daytime RRT activations from February 2018 to June 2020 in Singapore General Hospital. Repeat activations were defined as patients who had two or more activations during their admission. Patient demographics, clinical characteristics, RRT interventions, patient disposition after activation and hospital length of stay were recorded. The primary outcome of interest was in-hospital mortality.A total of 1055 patients were included, with 85 requiring repeat RRT activations. There was no significant difference in comorbidities and functional performance status at the time of first activation between patients with single versus repeated activations. Patients with repeat activations had more days in hospital before their index activation, a longer hospital length of stay and higher in-hospital mortality. Repeat activations had the strongest association with mortality on multivariate analysis.Our study found that repeat RRT activations were significantly associated with higher in-hospital mortality rates and increased hospital length of stay, independent of age, performance status and comorbidities. The results of our study highlight the need for early recognition and intervention in this patient group and discussion on goals of care when appropriate.
Copyright © 2025 Singapore Medical Journal.
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Specialty Nursing, Nursing Division, Singapore General Hospital, Singapore.
Respiratory Therapy Unit, Singapore General Hospital, Singapore.
Characteristics and outcomes of patients with repeat rapid response team activations in a tertiary centre in Singapore.

Increasing age is associated with an increased incidence of necrotising fasciitis. In this study, we aimed to compare the clinical presentation, investigations, microbiology and clinical outcome in elderly (age ≥60 years) and nonelderly (age <60 years) patients with extremity necrotising fasciitis.A retrospective review of patients with extremity necrotising fasciitis who were surgically treated between January 2005 and December 2021 was conducted. The following patient outcomes were studied: amputation and mortality rates, length of stay, performance of surgery within 24 h and accuracy of diagnosis at presentation.A total of 167 patients were treated. Of these patients, 66 (39.5%) were aged ≥60 years and 101 (60.5%) were aged <60 years. Elderly patients were more likely to have ischaemic heart disease ( P = 0.001), immunosuppression ( P = 0.019) and bullae ( P = 0.025) on presentation. Significantly more elderly patients had monomicrobial gram-negative infections ( P = 0.006). Elderly patients had significantly higher amputation (42.4% vs. 22.8%, P = 0.01) and mortality (34.8% vs. 18.8%, P = 0.02) rates.In patients aged ≥60 years, necrotising fasciitis of the extremities is associated with significantly increased risk of amputation and mortality. It is important for the treating surgeon to be aware of this association, so that early appropriate empirical antibiotics and radical surgical debridement can be initiated and the patient appropriately counselled.
Department of Orthopaedic Surgery, National University Health System, Singapore.
Nuffield Orthopaedic Centre, Oxford University Hospitals, UK.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore.
Necrotising fasciitis in the elderly: comparison between patients aged 60 years and older and those younger than 60 years.

This study systematically explores the oncogenic role of the long non-coding RNA (lncRNA) LINC00115 in endometrial cancer (EC) and reveals its unique mechanism in promoting proliferation, invasion, and metastasis via the JAK/STAT signaling pathway. LINC00115 is significantly upregulated in EC tissues and closely associated with advanced TNM staging and lymph node metastasis. Functional assays showed that knockdown of LINC00115 suppressed EC cell proliferation, invasion, and metastasis, while overexpression enhanced these malignant behaviors. In vivo models confirmed that LINC00115 overexpression accelerates tumor growth and metastasis. Our study is the first to identify LINC00115 as a key activator of the JAK/STAT pathway through direct interaction with KH-type Splicing Regulatory Protein (KHSRP), a previously unrecognized mechanism in EC. This finding provides new insights into lncRNA-mediated signaling regulation and highlights LINC00115 as a novel biomarker and promising therapeutic target for EC, offering a theoretical basis for developing targeted therapies.
© The Author(s) 2025. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Department of Reproductive Medicine, The First Affiliated Hospital of Henan University of CM, No. 19, Renmin Road, Jinshui District, Zhengzhou City, Henan Province, China.The First Clinical Medical College of Henan University of Traditional Chinese Medicine, No. 19, Renmin Road, Jinshui District, Zhengzhou City, Henan Province, China.
School of Medicine of Henan University, North Section of Jinming Avenue, Longting District, Kaifeng City, Henan Province, China.
Elevated LINC00115 expression correlates with aggressive endometrial cancer phenotypes via JAK/STAT pathway modulation.

To develop a new test to assess the motor coordination of the upper limbs, and to investigate the test-retest and inter-rater reliability, construct validity, standard error of measurement (SEM), minimum detectable change (MDC), and the reference values.The Upper Extremity Motor Coordination Test (UEMOCOT)was applied for 20 s, with the individual touching two targets (one right and one left) as quickly as possible, first with the hand (manual task) and then with the index finger (finger task). To test-retest reliability, the UEMOCOT was administered two times. To ensure inter-rater reliability, the test was scored simultaneously by two assessors. For convergent construct validity, the Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT) were applied. Reference values were established according to sex, age, and limb side (dominant/non-dominant).Inter-rater and test-retest reliability, for both tasks and limbs, were good with all the intraclass correlation coefficient above 0.90. Regarding convergent construct validity, the UEMOCOT manual task, for both sides, correlated moderately with BBT (0.59 ≤ r ≤ 0.64; p < 0.01), while the UEMOCOT finger task, for both sides, correlated moderately with NHPT (-0.57 ≤ r ≤ -0,58; p < 0.01). The SEM values were adequate, and the MDC for manual and finger tasks were 11/8 and 6/6 (dominant/non-dominant), respectively. Young people, men, and the dominant limb showed higher scores, indicating better coordination.The results showed that UEMOCOT is valid and reliable for assessing the motor coordination of the upper limbs, with adequate SEM values and MDC values ranging from 6 to 11. Finally, UEMOCOT reference values were established according to sex, age, and upper limb side.
Department of Physiotherapy, Centro Universitário FUNCESI, Itabira, Brazil.
Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Department of Physiotherapy, Centro Universitário FUNCESI, Itabira, Brazil.Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Physiotherapy research international : the journal for researchers and clinicians in physical therapy
Development, Measurement Properties and Reference Values of the Upper Extremity Motor Coordination Test: A New Motor Coordination Test of the Upper Limbs.

The emergence of telesurgery has received global interest, with secure network transmission identified as a crucial determinant of its success. This study aimed to evaluate the safety and viability of employing quantum cryptography communication in remote partial nephrectomy.The surgeon operated on the patient from a distance of over 260 km using remote control of a surgical robot. Key evaluation metrics for the telesurgery procedure included success rate, incidence of complications, network latency, and packet loss.The average BMI of these patients was 29.4 kg/m2, the average warm ischaemia time was 26 min, and the packet loss rate was 0%. Postoperative patient recovery, as indicated by follow-up results, was favourable.We introduced a novel telesurgical paradigm for partial nephrectomy based on quantum cryptography communication. The application of pioneering technology provides patients with a safer choice for telemedical treatment and promotes the application of telesurgery.
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.
Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China.
National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.
The international journal of medical robotics + computer assisted surgery : MRCAS
Innovative Integration of Robotic-Assisted Laparoscopic Telesurgery and Quantum Cryptography Communication in Urology: Clinical Application and Initial Experience.

Identifying whether perceived stigma or personal stigma more significantly affects nurses' attitudes towards seeking psychological help is essential for effectively addressing current challenges and facilitating early intervention for the well-being of nurses and their patients.The aim of this study was to explore the mediating roles of personal stigma and depression in the relationship between perceived stigma among nurses and their attitudes towards seeking psychological help.The sample of this descriptive cross-sectional study consisted of 302 nurses working in a university hospital in southern Turkey, selected using the purposive sampling method, between April 1 and May 1, 2021. Data collection tools were Personal Information Form, Attitudes Towards Seeking Psychological Help Scale-Short Form, Depression Stigma Scale, and Beck Depression Inventory. The data were analyzed using SPSS version 26.0. Correlation and regression analyzes were used to examine the relationships between attitudes towards seeking psychological help, personal stigma, perceived stigma, and Beck depression levels. Mann-Whitney U and Kruskal-Wallis tests were employed to compare scale scores across socio-demographic variables. The mediation models were tested with variables such as perceived stigma, personal stigma, and Beck depression levels as mediators. Results were presented with 95% confidence intervals, and significance was set at p < 0.05.Attitudes towards seeking psychological help were negatively influenced by nurses' stigma levels, especially, by personal stigma levels. Additionally, nurses' attitudes were positively influenced by their unit of work and the presence of a chronic illness, while being male and experiencing higher levels of personal stigma had a negative impact. No significant relationships were found between perceived stigma, personal stigma, and depression levels.High levels of personal stigma negatively affect attitudes towards seeking psychological help; however, when considered alongside working in oncology and having a chronic illness, the impact of personal stigma becomes positive. Future research should delve deeper into these dynamics to develop targeted strategies for reducing personal stigma and enhancing help-seeking behaviors among nurses. Interventions are necessary to foster positive help-seeking attitudes among nurses and reduce stigma. Aligned with the findings of this study, training and awareness initiatives aimed at improving mental health literacy among nurses can play a pivotal role in reducing stigma and encouraging proactive use of mental health resources.
Department of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, Mersin, Turkey.
Department of Nursing, Çankırı Karatekin University Faculty of Health Science, Çankırı, Turkey.
Department of Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey.
Department of Biostatistics and Medical Informatics, İnönü University Faculty of Medicine, Malatya, Turkey.
Journal of evaluation in clinical practice
Stigma, Depression, and Attitudes Towards Seeking Psychological Help Among Nurses: The Role of Personal Stigma as an Inconsistent Mediator.

Some mammals including the swine carry a fibrous vestigial clavicle, but a subclavius muscle (SBM) extends between the first rib and the supraspinatus muscle surface fascia. We aimed to examine development of the SBM and clavicle for finding a specific factor to provide the curious morphology.Histological sections of early- and midterm fetuses of the swine, human and mouse were observed and compared at the almost same morphological stage.In all three species, the initial SBM was seen extending between the cartilaginous first rib and a mesenchymal clavicle. At the early stage, the human and mouse fetuses carried the mesenchymal manubrium sterni above the heart bulbus as well as the acromion above the humeral head. However, in the swine fetus, the manubrium remained far caudal to the first rib, while the acromion was in the laterocaudal side of the glenohumeral joint. In place of the acromion, the swine supraspinatus muscle was large and covered the humeral head. At midterm, the human and mouse SBM attached to the membranous bone of the clavicle. Endochondral ossification occurred at the lateral and medial ends of the human clavicle, while it was seen in the medial half of the mouse clavicle anlage with a homogenous eosinophilic matrix.The swine clavicle seemed to lose the endochondral parts due to the caudally-shifted manubrium sterni and acromion. The medial or clavicular attachment of the swine SBM might migrate to a nearby fascia of the supraspinatus muscle in the later development.
Department of Anatomy and Embryology, School of Medicine, Complutense University, Madrid, Spain.
Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan. kitamurakei@tdc.ac.jp.
Division of Internal Medicine, Iwamizawa Asuka Hospital, Hokkaido, Japan.
Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan.
Comparative anatomy of the subclavius muscle and clavicle: a histological study using human, swine and mouse fetuses.

Distance education emerged as a potential solution to enhance access, standardize content, and facilitate updates. However, student perceptions varied widely. The COVID-19 pandemic prompted a rapid shift towards distance education in anatomy, presenting challenges and opportunities for medical students globally. A crucial area of study is how distant learning, utilized once more during the 2023 earthquakes, affects medical education and students. This study investigates medical students' perspectives on anatomy education in remote and in-person settings.This study involved surveying first and second-year medical students to gather their opinions and experiences regarding distance and face-to-face education. The advantages and disadvantages of anatomy distance education were then analyzed based on the students' responses.Individuals who preferred traditional in-person education were less inclined to utilize digital resources, whereas those who selected remote education shown a greater preference for the usage of digital resources (p < 0.001). Similarly, individuals who favored traditional in-person education exhibited low levels of confidence in online exams, whereas those who preferred remote education shown high levels of confidence (p < 0.001).Considering the results of our study and our location in a potentially hazardous area affected by the North Anatolian Fault line in the Marmara Region of Türkiye, we believe that our experiences with distance education will help in effectively maintaining the Anatomy in Medicine education process.
Tekirdağ Namık Kemal University School of MedicineTekirdağ, Türkiye.
Recep Tayyip Erdoğan University School of Medicine, Department of Anatomy, Rize, Türkiye.
Tekirdağ Namık Kemal University School of MedicineTekirdağ, Türkiye. alize05@yahoo.com.
Anatomy education in transition: examining medical student experiences during the distance education.

The rapid growth of aesthetic medicine has led to an increased demand for non-surgical cosmetic procedures in the frontal region of the face. However, alongside this rise in popularity, there is a growing awareness of the potential complications associated with these procedures especially connected with fillers. The intricate vascular anatomy of the forehead, specifically the supratrochlear (STA) and supraorbital (SOA) arteries, poses significant risks if not thoroughly understood. While the morphological course of these vessels is well-documented and analysed, detailed knowledge about their depth remains vital for enhancing procedural safety.Five research papers were analyzed in the meta-analysis. The analyses of STA and SOA were performed in two distinctive places bilaterally: at the level of the glabella and above the eyebrow.A total of 201 SOA arteries and 282 STA arteries were analysed at the following horizontal levels, respectively: at the level of the glabella and above the eyebrow. The final results were as follows: 5.68 mm, 95% CI (4.58-6.78) for SOA at the glabella, 5.53 mm, 95% CI (4.79-6.28) for SOA above the eyebrow, 4.45 mm, 95% CI (3.43-5.47) for STA at the glabella, and 3.53 mm, 95% CI (3.21-3.85) for STA above the eyebrow.The supratrochlear artery tends to become more superficial along its path, while the supraorbital artery remains at a consistent depth across various anatomical levels. For injections in the medial part of the forehead, it is advisable to place the needle up to 2.5 mm deep or laterally to the artery's path. In contrast, injections in the lateral part of the forehead can be administered at slightly deeper depths, up to 3.5 mm. To minimise the risk of complications, performing a high-resolution linear ultrasonography (USG) exam prior to injection is recommended, allowing for needle placement either laterally or medially to the vessels.
Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland. trzeciak.mateusz6@gmail.com.
Department of Oral Surgery, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland, Poland.
Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
The depth of arterial supply of forehead: a meta-analysis.

Variations in the development of carpal bones are uncommon, with the scaphoid bone typically forming from the fusion of the os centrale carpi and the radial chondrification center during embryogenesis. A bipartite scaphoid is a rare congenital disorder that occurs when these ossification centers fail to fuse, with a prevalence ranging from 0.1% to 0.6% in adult dissection. The differentiation between a bipartite scaphoid and pseudoarthrosis is challenging, complicating accurate diagnosis and evaluation. A 37-year-old male presented with right wrist pain following a minor fall. Physical examination revealed no visible deformity or swelling but restricted range of motion due to pain. Radiographic imaging identified a bipartite scaphoid with two distinct, similar-sized ossification centers, regular oval shape, smooth margins, and consistent cortical-to-medullary ratio, with no acute fractures or dislocations. The patient was treated conservatively with non-steroidal anti-inflammatory drugs and immobilization. Upon follow-up, the patient reported complete pain resolution and full range of motion in the wrist. This case emphasizes the unusual occurrence of a bipartite scaphoid bone in a patient experiencing wrist pain after a minor injury. It highlights the challenge of differentiating between a congenital bipartite scaphoid and post-traumatic pseudoarthrosis, underscoring the importance of considering this uncommon developmental variant when diagnosing and treating wrist pain.
Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, Bulgaria.
Medical University of Sofia, Sofia, Bulgaria.
Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Clinical Anatomy, Masovian Academy in Plock, Płock, Poland.
Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia, Bulgaria. georgievgp@yahoo.com.
The elusive bipartite scaphoid: a rare congenital variant or misdiagnosed pseudoarthrosis? A proposal for novel radiological criteria.

Despite significant advancements in achieving high recanalization rates (80%-90%) for large vessel occlusions through mechanical thrombectomy, the issue of futile recanalization remains a major clinical challenge. Futile recanalization occurs when over half of patients fail to experience expected symptom improvement after vessel recanalization, often resulting in severe functional impairment or death. Traditionally, this phenomenon has been attributed to inadequate blood flow and reperfusion injury. More recently, ongoing neuronal death after reperfusion, which leads to the progression of the ischemic penumbra into the core infarct, has been termed futile reperfusion. This review explores the complex role of autophagy mechanisms in futile reperfusion following ischemic stroke, with a focus on its relationship to neuronal survival. We also examine the regulation of autophagic activity by epigenetic mechanisms. By investigating autophagy's role in ischemic stroke, we aim to identify novel pathways for precision treatment.
Luhe Institute of Neuroscience, Capital Medical University, Beijing, China.Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
Luhe Institute of Neuroscience, Capital Medical University, Beijing, China.Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China.Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
Mechanisms of Autophagy in Ineffective Reperfusion After Ischemic Stroke.

Metabolism is the name given to all of the chemical reactions in the cell involving thousands of proteins, including enzymes, receptors, and transporters. Inborn errors of metabolism (IEM) are caused by defects in the production and breakdown of proteins, fats, and carbohydrates. Micro ribonucleic acids (miRNAs) are short non-coding RNA molecules, ⁓19-25 nucleotides long, hairpin-shaped, produced from DNA. They play key roles in regulating gene expression of target mRNAs at both transcriptional and post-transcriptional levels. Altered expression of miRNAs has emerged as an additional molecular mechanism implicated in the pathogenesis of many diseases, this altered miRNA expression is also present in inherited metabolic diseases. A single miRNA can regulate targets associated with similar cellular processes and pathways, making miRNAs powerful therapeutics to restore the impaired cellular functions seen in disease phenotypes by enhancing the cellular response. Although the miRNA research field has advanced significantly in recent years, studies in IEM are still limited. Further research on miRNA expression specifically related to IEM may allow the identification of new biomarkers for the diagnosis, progression, and prognosis of diseases. In this review, the literature studies between miRNAs and IEMs, diagnosis, prognosis, follow-up, and treatment possibilities of miRNAs were analyzed. We present recent advances on miRNAs in IEM and an overview of current miRNA therapeutics for the clinic.
© The Author(s) 2025. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine.
Department of Molecular Medicine, Graduate School of Health Sciences, TOBB University of Economics and Technology, Ankara 06510, Turkey.
Department of Medical Biology and Genetics, Faculty of Medicine, TOBB University of Economics and Technology, Ankara 06510, Turkey.
DESAM Research Institute, Near East University, Nicosia 99138, Cyprus.
Department of Pediatric Metabolic Diseases, University of Health Sciences, Ankara Etlik City Hospital, Ankara 06170, Turkey.
Effects of miRNAs in inborn error of metabolism and treatment strategies.

Cellular metabolism is inextricably linked to transmembrane levels of proton (H+), sodium (Na+), and potassium (K+) ions. Although reduced sodium-potassium pump (Na+-K+ ATPase) activity in tumors directly disturbs transmembrane Na+ and K+ levels, this dysfunction is a result of upregulated aerobic glycolysis generating excessive cytosolic H+ (and lactate) which are extruded to acidify the interstitial space. These oncogene-directed metabolic changes, affecting intracellular Na+ and H+, can be further exacerbated by upregulation of ion exchangers/transporters. As Na+/H+ imbalances impact tumor invasion, chromosomal rearrangements, proliferation rate, angiogenesis, and immune function, measuring interstitial H+ (H+ o) or pH (pHo) and interstitial Na+ (Na+ o) could provide unique insights into cancer hallmarks. We obtained proton (1H) and sodium (23Na) magnetic resonance spectroscopic imaging (MRSI) data to map pHo and Na+ o in a human-derived glioblastoma model (U87) in vivo with sorafenib (protein kinase inhibitor) treatment and a placebo. In U87 tumors, sorafenib slowed tumor growth compared to placebo and restored transmembrane H+ and Na+ levels. Placebo tumors maintained an interstitial space that was less salty and more acidic, similar to naive U87 tumors, implying a proliferative state. However, sorafenib-treated tumors had interstitial space that became more salty and less acidic, comparable to normal tissue. Importantly, these interstitial ionic changes occurred prior to tumor growth changes. These results imply that glioblastoma therapies, which may perturb transmembrane ions by different mechanisms (e.g., ion pumping, exchange, and/or transport), can be tracked by merging 1H with 23Na MRSI to measure treatment effectiveness.
Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA.
Department of Radiology & Biomedical Imaging, 300 Cedar St, Yale University, New Haven, Connecticut, USA.
Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA.Department of Radiology & Biomedical Imaging, 300 Cedar St, Yale University, New Haven, Connecticut, USA.
Sorafenib Alters Interstitial Proton and Sodium Levels in the Tumor Microenvironment: A 1H/23Na Spectroscopic Imaging Study.

Throwing a baseball involves intense exposure of the arm to high speeds and powerful forces, which contributes to an increasing prevalence of arm injuries among athletes. Traditional rigid exoskeletons and rehabilitation equipment frequently lack portability, safety, ergonomic design, and affordability. Traditional rehabilitation approaches frequently require therapist monitoring, resulting in therapy delays. This paper describes a Pneumatic Artificial Muscle (PAM) based soft robotic sleeve designed for upper limb rehabilitation, with an emphasis on elbow flexion and extension in baseball pitchers.The experiment included five healthy male baseball pitchers aged 20-24 with no history of upper limb injuries, ensuring their suitability for testing the effectiveness of the PAM-based sleeve in supporting elbow flexion and extension specific to baseball pitching. The effectiveness of the PAM-based soft sleeve was evaluated utilizing a pre-post design that included surface electromyography (sEMG). Participants were tested for muscle activation and range of motion both with and without the device. The sleeve has two operational modes: Active Surge Flex Mode, which detects movement intention using sEMG and delivers targeted help, and Steady Passive Mode, which allows repetitive flexion and extension without intentional muscle activation.The PAM-based sleeve reduced muscle activation in both triceps and biceps, with reductions of approximately 40% (p < 0.05) and 60% (p < 0.05), respectively. When activated based on assistance thresholds, triceps and biceps EMG amplitudes were further reduced by 30% (p < 0.05) and 50% (p < 0.05), respectively. The flexion angle remained consistent between 70 and 90°, indicating smooth and controlled movements. The Co-Contraction Index (CCI) decreased from 0.31 to 0.12, highlighting a reduction in unnecessary muscle co-activation, thereby improving movement efficiency.The PAM-based soft robotic sleeve provides a convenient and effective upper limb rehabilitation solution that is specifically designed for baseball pitchers. The sleeve reduces the physical strain of pitchers by reducing muscle activation in both the biceps and triceps, as well as decreasing the Co-Contraction Index (CCI). Its portability, convenience of use, and potential to improve muscle efficiency make it an effective tool for improving rehabilitation outcomes.
Department of Biomedical Engineering, University of Engineering and Technology (UET) Lahore, Narowal Campus, Narowal, Pakistan.
Department of Biomedical Engineering, University of Engineering and Technology (UET) Lahore, Narowal Campus, Narowal, Pakistan.Department of Electrical Engineering, University of Engineering and Technology (UET) Lahore, Narowal Campus, Narowal, Pakistan.
A Soft Robotic Sleeve for Physiotherapy: Improving Elbow Rehabilitation in Baseball Pitchers.

This methodological paper explores the intricacies of implementing evidence-based medicine in the health care sector specifically focusing on the clinical practice guideline (CPG) published by the American Physical Therapy Association's Academy of Oncologic Physical Therapy for diagnosing upper quadrant lymphedema secondary to cancer (diagnosis CPG). Although CPGs are widely available, their implementation into clinical practice remains inconsistent, slow, and complex. To address this challenge, this paper employs the Knowledge-to-Action framework, offering a detailed description of the seven stages through the lens of an in-progress case study on the implementation of the diagnosis CPG. This paper underscores the important role of knowledge translation in identifying both barriers and facilitators to effective CPG implementation. Through targeted strategies, such as stakeholder engagement and adaptation of interventions, this paper offers a framework for aligning clinical practice with evidence-based recommendations to improve overall workflow and improved patient outcomes.
© 2025 American Academy of Physical Medicine and Rehabilitation.
Board Certified Clinical Specialist in Oncological Physical Therapy, LANA Certified Lymphedema Therapist, Midwestern University, Physical Therapy Program, Downers Grove, Illinois, USA.
Board Certified Clinical Specialist in Oncological Physical Therapy, Oregon State University-Cascades, Program in Physical Therapy, Bend, Oregon, USA.
Board Certified Clinical Specialist in Oncological Physical Therapy, Board Certified Clinical Specialist in Women's Health Physical Therapy, LANA Certified Lymphedema Therapist, Select Medical, ReVital Cancer Rehabilitation, Mechanicsburg, Pennsylvania, USA.
PM & R : the journal of injury, function, and rehabilitation
Methodological description of knowledge translation: Implementation of clinical practice guidelines into clinical practice.

Evidence suggests nasal airflow resistance reduces after rapid maxillary expansion (RME). However, the medium-term effects of RME on upper airway (UA) airflow characteristics when normal craniofacial development is considered are still unclear. This retrospective cohort study used computer fluid dynamics (CFD) to evaluate the medium-term changes in the UA airflow (pressure and velocity) after RME in two distinct age-based cohorts.The study included 48 subjects who underwent RME divided into two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). The nasal cavity and pharyngeal anatomy were segmented from Cone-beam computed tomography reconstructions taken before RME (T0) and 12 after RME (T1). The two UA airflow variables (pressure and velocity) were simulated using CFD. The maxillary expansion (PW) amount, two cross-sectional area measurements (CS1 = anterior cross-section and CS2 = posterior cross-section), and four UAs' subregions (NC = nasal cavity, PAtotal = pharyngeal airway, NP = nasopharynx, VP = velopharynx, and OP = Oropharynx) were also considered. All data were statistically analyzed.At the baseline, the airflow pressure, velocity, and noted obstructions were significantly higher in the EEG compared to LEG. At T1, there was a significant improvement in the median airway parameters in both groups, which was remarkably greater in the EEG. A significant negative correlation was found between pressure/velocity and both CS2 and NP. According to the CFD plots, the airflow pressure and velocity changes could be attributed to the reduction of the adenotonsillar tissues' sizes, which were remarkably more marked in the EEG.The results of this study cannot be generalized since they referred to a retrospective orthodontic sample without obstructive adenotonsillar hypertrophy.Twelve months after RME, normal craniofacial developmental changes and spontaneous adenotonsillar tissues volume regression could represent the most significant factors influencing UA airflow changes.
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario 'Gaspare Rodolico-San Marco', Via Santa Sofia 78, 95123, Catania, Italy.
Orthodontic Graduate Program, University of Alberta, Edmonton Clinic Health Academy, 11405 - 87 Avenue NW, AB, Canada.
Changes in upper airway airflow after rapid maxillary expansion considering normal craniofacial development as a factor: a retrospective study using computer fluid dynamics.

The FEBS Journal publishes primary papers as well as reviews in the molecular life sciences relating to the molecules and mechanisms underpinning biological processes. Editor-in-Chief Seamus Martin shares some thoughts on the nature of conducting research, some highlights of the past year at the journal, and what is in store for 2025.
© 2025 Federation of European Biochemical Societies.
The FEBS Journal Editorial Office, Cambridge, UK.Department of Genetics, Trinity College, Dublin 2, Ireland.
The FEBS Journal in 2025: in all science, error precedes the truth.

Department of Ultrasound, Nanchong Central Hospital, Nanchong, Sichuan Province, People's Republic of China.
Department of Radiology, Nanchong Central Hospital, Nanchong, Sichuan Province, People's Republic of China.
Department of Ultrasound, Nanchong Central Hospital, Nanchong, Sichuan Province, People's Republic of China.Echocardiography medical center, Beijing Anzhen Hospital,Capital Medical University. Beijing 100029, China.Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308). Beijing 100029, China.
European heart journal. Cardiovascular Imaging
Eur Heart J Cardiovasc Imaging. 2025-01-07;():.
A bulb in the heart: a rupture of the non-coronary Valsalva sinus aneurysm into the atrial septum.

Viral Immunity and Pathogenesis Unit, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA.
Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Twin Cities, Minnesota, USA.
Oropuche Virus-An Emerging Pathogen With Escalating Risk for Outbreaks of Human Infection.

With an increasing concentration of microplastics (MPs) in every biome, laboratories with a focus on creating histology slides from resin-embedded specimens could be partially responsible for expanding the emission of microscopic resinous particles into the environment. With current research elucidating harmful health impacts from MPs, releasing them incautiously is arguably unethical and, in the near future, plausibly illegal. The Orthopedic Bioengineering Research Laboratory (OBRL) is in Colorado, a state known not only for its natural beauty but also for its increasing number of legislative amendments aimed at reducing plastic pollution. The histology department of the OBRL has chosen to self-regulate due to the importance of protecting health and the environment. Because virtually every molecule of plastic ever created is still in existence, a greater need for MP research and mitigation has become apparent. Remediation is specifically important due to findings indicating negative impacts on neurodevelopment, neuronal organelle function, mental health, and the increased risk of dementia.
Mechanical Engineering, Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA.
Preserving brain health by minimizing microplastic output from resin histology.

Titanium disulfide quantum dots (TiS2QDs) has garnered significant research interest due to its distinctive electronic and optical properties. However, the effectiveness of TiS2QDs in electromagnetic interference (EMI) shielding is influenced by various factors, including their size, morphology, monodispersity, tunable bandgap, Stokes shift and interfacial effects. In this study, we propose a systematic approach for the synthesis of TiS2QDs with small size (3.1 nm), uniform dispersion (∼1.5 nm), a transition from indirect to direct bandgap (bulk 0.09 eV-monolayer 0.69 eV), large Stokes shift (∼93 nm) and larger surface area containing multiple active interfaces, achieved through ultrasound-assisted liquid phase processing. Subsequently, these QDs are combined with carbon nanotubes (CNTs) to fabricate an aerogel with outstanding EMI shielding capabilities. The resulting TiS2QDs composite CNTs (C-TiS2) aerogel demonstrates robust EMI shielding of 51.9 dB within the microwave X-band (8-12.4 GHz) due to its porous and lightweight structure, effectively mitigating incoming electromagnetic (EM) radiation. Overall, this study highlights the promising properties of C-TiS2aerogel for applications in both civilian and military fields.
© 2025 IOP Publishing Ltd. All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Institute of Nonlinear Optics, College of Science, JiuJiang University, Jiangxi 334000, People's Republic of China.College of Economics and Management, Jiangxi Polytechnic University, Jiangxi 330041, People's Republic of China.
Institute of Nonlinear Optics, College of Science, JiuJiang University, Jiangxi 334000, People's Republic of China.
TiS2quantum dots composite carbon nanotubes aerogel with electromagnetic interference shielding effect.

Because of the lengthening of their life-expectancy, more people with cystic fibrosis (CF) now pursue parenthood. To explore the experience of parenting while having CF, 18 French parents with CF were interviewed (including 12 mothers and 9 participants with a lung transplant). A thematic analysis of the interview transcripts was conducted. Within the domain of parenthood, seven themes were found: Journey to Parenthood; Experience of Parenthood; Daily Life; Administrative and Financial Aspects; Interaction of CF with Children's Lives; The Spouse; The Children. This paper documents the positive aspects of parenthood, and the logistical and emotional challenges faced by participants and how they adjust to them. Notably, this paper highlights the struggle of most participants to become parents, the sensitive period of lung transplant surgery for the family, what children are told about CF, and how children's lives are coloured by a sense of normality and worries for their sick parent.
Hopital Cochin, Assistance Publique des Hôpitaux de Paris, France.
Université Paris Cité, France.Hopital Européen George Pompidou, Assistance Publique des Hopitaux de Paris, France.Institut Gustave Roussy, France.
Exploring the lived experiences of parents living with cystic fibrosis: A qualitative study.

Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China.
Urgent Call for Attention to HIV-Associated Lymphoma: After AIDS 2024, the 25th International AIDS Conference.

Typical atrial flutter (AFL), defined as cavotricuspid isthmus (CTI)-dependent macro-re-entrant atrial tachycardia, often causes debilitating symptoms, and is associated with increased incidence of atrial fibrillation, stroke, heart failure, and death. Typical AFL occurs in patients with atrial remodeling and shares risk factors with atrial fibrillation. It is also common in patients with a history of prior heart surgery or catheter ablation. It is characterized by a recognizable ECG pattern that is highly predictive of CTI-dependent re-entry in patients without iatrogenic atrial scars. Typical AFL is difficult to manage medically due to poor efficacy of rate-controlling and antiarrhythmic drugs. Catheter ablation has been established in randomized trials to be superior to medical management in terms of safety, efficacy, and clinical outcomes including hospitalization and quality of life. Catheter ablation aims at achieving bidirectional conduction block across the CTI, which can be efficiently assessed by well-established techniques such as differential pacing. Long-term ablation success requires creating a stable transmural and continuous lesion, which can be optimized by systematic assessment of ablation parameters and lesion contiguity. The present review discusses the epidemiology, mechanisms, ECG characteristics, medical management, and catheter ablation of typical AFL.
Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
Journal of cardiovascular electrophysiology
J Cardiovasc Electrophysiol. 2025-01-07;():.
Typical Atrial Flutter: A Practical Review.

The accurate non-invasive detection and estimation of central aortic pressure waveforms (CAPW) are crucial for reliable treatments of cardiovascular system diseases. But the accuracy and practicality of current estimation methods need to be improved. Our study combines a meta-learning neural network and a physics-driven method to accurately estimate CAPW based on personalized physiological indicators. We collected data from 260 patients who underwent catheterization surgery, using measured CAPW and personalized physiological indicators (e.g., weight, body mass index (BMI), radial mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), radial systolic blood pressure (SBP), and radial diastolic blood pressure (DBP)) as input for neural network training. The output of the neural network are the Gaussian characteristic parameters of the single-period decomposed CAPW. The neural network model was constructed using the model-agnostic meta-learning (MAML) algorithm framework. Applying the physical characteristics of CAPW to the loss function, served to increase the constraints on the output and improve the accuracy of CAPW estimation. To verify the accuracy of the model, we compared measured and estimated CAPW in 52 patients. The results are consistent with a normalized root mean square error (NRMSE) of 0.0206. The predictions had low biases, namely SBP: 4.97 ± 4.42 mmHg, DBP: 4.78 ± 5.98 mmHg, and MAP: 0.35 ± 3.36 mmHg. The results demonstrate the accuracy and practicability of the approach to estimate CAPW. It can provide personalized parameters to calculate myocardial ischemia indicators (e.g., instantaneous wave-free ratio [iFR] and fractional flow reserve [FFR]) and may contribute to the early monitoring and prevention of cardiovascular diseases.
College of Chemistry and Life Science, Beijing University of Technology, Beijing, China.
Cell and Developmental Biology, University College London, London, UK.
Department of Cardiology, Peking University People's Hospital, Beijing, China.
International journal for numerical methods in biomedical engineering
Int J Numer Method Biomed Eng. 2025-01;41(1):e3905.
Estimation of Central Aortic Pressure Waveforms by Combination of a Meta-Learning Neural Network and a Physics-Driven Method.

Discrimination (unfair treatment due to group membership) is relatively common among adolescents and has been linked to poor sleep and physical health. Individual differences in physiological functioning may moderate these associations. A sample of 323 youth (48% boys, 52% girls; 58.5% White, 40.9% Black, Mage = 17.38 years, SD = 10.18 months) participated. Adolescents reported on discrimination and health, wore actigraphs to measure sleep, and came to the laboratory to assess respiratory sinus arrythmia reactivity (RSA-R) to two stressful tasks. Results indicate that discrimination was directly associated with health. Furthermore, discrimination interacted with RSA-R to predict sleep and health. Discrimination was related to more sleep activity and poorer health when RSA increased relative to baseline (augmentation), and better sleep quality (higher efficiency, fewer long wake episodes), when RSA decreased relative to baseline (suppression). Findings support the importance of examining physiological regulation as a protective/vulnerability factor when attempting to explicate relations between discrimination and health.
Discrimination, sleep, and physical health: Moderation by respiratory sinus arrythmia reactivity.

Population Health Sciences Institute, Newcastle University, United Kingdom.
PHC Department, Ministry of Public Health, Lebanon.
UK-MED Risk Communication and Community Engagement, Ellen Wilkinson Building, University of Manchester, United Kingdom.
Department of Public Health, Qatar University.UK-MED Risk Communication and Community Engagement, Ellen Wilkinson Building, University of Manchester, United Kingdom.
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit
The increasing threat of vaccine-preventable diseases in Lebanon.

Breast cancer is often thought to occur at a younger age among Arab women based on the mean or median age at diagnosis, or the proportion of women diagnosed with breast cancer at a young age.To compare age-specific breast cancer incidence rates among women from selected Arab countries with selected high- and middle-income countries.We examined population-based, age-specific, national or regional breast cancer incidence data for 2008-2012 and 2013-2017 from Australia, Brazil, Canada, Germany, Japan, United Kingdom, and United States of America, and compared them with data from Algeria, Bahrain, Jordan, Kuwait, Morocco, Qatar, and Saudi Arabia.Breast cancer incidence among young women in the selected Arab countries was comparable to, or even lower than, the selected high- and middle-income countries. In contrast to the continued increase in rates observed in the high- and middle-income countries, the rates tended to plateau or decrease among older Arab women. Age-standardized incidence rates were lower than crude rates in the Arab countries.We found no evidence that Arab women are at higher risk of developing breast cancer at a younger age. The high number of cases among them was probably due to the younger population structure. These findings are important for refining breast cancer screening policies in the region.
Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Radiology, King Abdulaziz University, Jeddah, Saudi Arabia.
لا دليل على إصابة النساء العربيات بسرطان الثدي في سن أصغر. إيمان الخلاوي، هدى الطوخي. لقد شاع الاعتقاد بأن النساء العربيات يتعرضن للإصابة بسرطان الثدي في سن أصغر من غيرهن، وذلك استنادًا إلى متوسط عمر المصابات في الدول العربية سجلات سريرية، بدون الأخذ في الحسبان التركيبة السكانية الشاملة. مقارنة معدلات الإصابة بسرطان الثدي بحسب السن بين نساء من بلدان عربية مختارة وبعض البلدان المرتفعة والمتوسطة الدخل. حلَّلنا بيانات سكانية محدَّدة الأعمار عن معدلات الإصابة بسرطان الثدي على المستوى الوطني أو الإقليمي في الفترة 2008-2012 والفترة 2013-2017 من أستراليا والبرازيل وكندا وألمانيا واليابان والمملكة المتحدة والولايات المتحدة الأمريكية، وقارنَّاها ببيانات من الجزائر والبحرين والأردن والكويت والمغرب وقطر والمملكة العربية السعودية. كان معدل الإصابة بسرطان الثدي بين الشابات في البلدان العربية المختارة مماثلًًا أو حتى أقل منه في البلدان المختارة ذات الدخل المرتفع والمتوسط. وعلى النقيض من الزيادة المستمرة الملحوظة في معدلات الإصابة في البلدان ذات الدخل المرتفع والمتوسط، تميل المعدلات إلى الثبات أو الانخفاض بين النساء العربيات الأكبر سًّنا. كما قد تؤثر ممارسات الكشف المبكر على هذه المعدلات. لا دليل على أن النساء العربيات أكثر عرضة لخطر الإصابة بسرطان الثدي في سن أصغر. وربما كان ارتفاع عدد الحالات بينهن راجعًًا إلى التركيبة السكانية الأصغر س اّنًّ، ولهذا تبعات مهمة في سن توصيات الكشف المبكر. Absence de preuve indiquant que le cancer du sein est plus fréquent chez les jeunes femmes arabes. Il est souvent considéré que le cancer du sein survient à un âge plus jeune chez les femmes arabes, en se basant sur l'âge moyen ou médian au moment du diagnostic, ou sur la proportion de femmes chez qui le cancer du sein a été diagnostiqué alors qu'elles étaient jeunes. Comparer les taux d'incidence du cancer du sein en fonction de l'âge chez les femmes de certains pays arabes avec ceux observés dans des pays à revenu élevé ou intermédiaire. Nous avons analysé les données nationales ou régionales sur l'incidence du cancer du sein, basées sur la population et en fonction de l'âge, pour les périodes 2008−2012 et 2013−2017 dans les pays suivants : Allemagne, Australie, Brésil, Canada, États-Unis d'Amérique, Japon et Royaume-Uni. Ces données ont été comparées avec celles provenant de l'Algérie, de l'Arabie saoudite, de Bahreïn, de la Jordanie, du Koweït, du Maroc et du Qatar. L'incidence du cancer du sein chez les jeunes femmes dans les pays arabes sélectionnés était comparable, voire inférieure, à celle des pays à revenu élevé ou intermédiaire sélectionnés. Contrairement à l'augmentation continue des taux observée dans les pays à revenu élevé et intermédiaire, les taux ont eu tendance à se stabiliser ou à diminuer chez les femmes plus âgées dans les pays arabes. Les taux d’incidence standardisés selon l’âge étaient inférieurs aux taux bruts dans ce groupe de pays. Nous n'avons pu établir aucune preuve que les femmes arabes présentent un risque accru de développer un cancer du sein à un plus jeune âge. Le nombre élevé de cas observés dans ces pays était probablement dû à la structure de la population plus jeune. Ces constatations sont primordiales pour affiner les politiques de dépistage du cancer du sein dans la Région.
No evidence that breast cancer occurs at higher rates among young Arab women.

Hospital wastewater poses a significant threat to human health due to the presence of difficult-to-degrade organic compounds, active pharmaceutical ingredients and multiple inorganic substances that can pollute water resources and ecosystems.To compare the effectiveness of different techniques for removing organic load from hospital laboratory wastewater in Aleppo, Syria.We treated wastewater samples from hospital laboratories at Aleppo University Hospital, Syria, using several techniques, including biological treatment with the rotating biological contactor, adsorption with Syrian natural clay, coagulation with aluminium sulphate, advanced oxidation with ultrasound, and a combined treatment using natural clay and ultrasound. We assessed the organic load removal efficiency for each technique under different conditions.The most effective technique was the combination of natural clay and ultrasound. Applying natural clay at a concentration of 1 g/L of wastewater along with ultrasound at 40 kHz for 30 minutes achieved chemical oxygen demand and biochemical oxygen demand values suitable for irrigation, in accordance with the Syrian standard. The chemical oxygen demand value decreased to 212 mg/L with 94% removal rate, and the biochemical oxygen demand value decreased to 82 mg/L with 87% removal rate.Based on our findings, techniques that combine different methods of hospital wastewater treatment, such as combining adsorption with advanced methods like ultrasound, are more effective than those that use single methods. Such techniques should be promoted.
Department of Environmental Engineering, Faculty of Civil Engineering, University of Aleppo, Aleppo, Syria.
Department of Basic Sciences, Faculty of Civil Engineering, University of Aleppo, Aleppo, Syria.
تحليل مقارن لتقنيات معالجة مياه الصرف الصحي لمختبرات أحد المستشفيات في الجمهورية العربية السورية. عبد الرحمن تتان، فاطمة جعارة، نوزت النبغلي. تشكل مياه الصرف الصحي الناتجة عن المستشفيات تهديدًا كبيرًا لصحة الإنسان، لاحتوائها على مركبات عضوية يصعب تحلُّلها، ومكونات صيدلانية فعَّالة، والعديد من الملوثات غير العضوية التي يمكن أن تلوث الموارد المائية والنُّظم الإيكولوجية. هدفت هذه الدراسة الى مقارنة فعالية التقنيات المختلفة لإزالة الحمل العضوي من مياه الصرف الصحي لمختبرات المستشفى في حلب، الجمهورية العربية السورية. عالجنا عينات من مياه الصرف الصحي الناتجة عن مختبرات مشفى حلب الجامعي في الجمهورية العربية السورية بعدة تقنيات، من بينها المعالجة البيولوجية بالجهاز التلامسي البيولوجي الدوار، والامتزاز بالطمي السوري الطبيعي، والتخثُّر بكبريتات الألومنيوم، والأكسدة المتقدمة بالموجات فوق الصوتية، والمعالجة المشتركة بالطمي الطبيعي والموجات فوق الصوتية، ثم قيَّمنا كفاءة كل تقنية منها في إزالة الأحمال العضوية في ظل ظروف مختلفة. كان المزج بين الطمي الطبيعي والموجات فوق الصوتية التقنية الأكثر فعالية. فقد أدَّى استخدام الطمي الطبيعي بتركيز 1 جرام/ لتر من مياه الصرف الصحي، إلى جانب الموجات فوق الصوتية بتردد 40 كيلوهرتز لمدة 30 دقيقة، إلى ظهور قِيَم مناسبة للري من مطلوبية الأكسجين الكيميائية ومطلوبية الأكسجين البيوكيميائية، وذلك وفقًا للمعيار السوري. وانخفضت قيمة مطلوبية الأكسجين الكيميائية إلى 212 مليجرام/ لتر بمعدل إزالة بلغ 94٪، وانخفضت قيمة مطلوبية الأكسجين البيوكيميائية إلى 82 مليجرام/ لتر بمعدل إزالة بلغ 87٪. استنادًا إلى نتائج البحث، توصَّلنا إلى أن التقنيات التي تجمع بين طرق مختلفة لمعالجة مياه الصرف الصحي للمستشفيات، مثل الجمع بين الامتزاز والطرق المتقدمة، كالموجات فوق الصوتية مثلًًا، أكثر فعالية من تلك التي تستخدم طريقة واحدة. وينبغي التشجيع على استخدام مثل هذه التقنيات. Analyse comparative des techniques de traitement des eaux usées dans les laboratoires hospitaliers en République arabe syrienne. Les eaux usées des hôpitaux constituent une menace importante pour la santé humaine en raison de la présence de composés organiques difficiles à dégrader, de principes actifs pharmaceutiques et de nombreux polluants inorganiques susceptibles de contaminer les ressources en eau et les écosystèmes. Comparer l'efficacité de différentes techniques d'élimination de la charge organique des eaux usées des laboratoires hospitaliers à Alep (République arabe syrienne). Nous avons traité des échantillons d'eaux usées provenant des laboratoires hospitaliers de l'Hôpital universitaire d'Alep, en utilisant plusieurs techniques, notamment le traitement biologique à l'aide d'un contacteur biologique rotatif, l'adsorption avec de l'argile naturelle syrienne, la coagulation par sulfate d'aluminium, l'oxydation avancée par ultrasons et un traitement combiné à base d'argile naturelle et des ultrasons. Nous avons évalué l'efficacité de l'élimination de la charge organique pour chaque technique dans des conditions différentes. La technique la plus efficace était la combinaison d'argile naturelle et d'ultrasons. L'application d'argile naturelle à une concentration de 1 g/L d'eaux usées, combinée à l'utilisation d'ultrasons à 40 kHz pendant 30 minutes a permis d'obtenir des valeurs de demande chimique d'oxygène et de demande biochimique d'oxygène adaptées à l'irrigation, conformément à la norme syrienne. La valeur de la demande chimique d'oxygène a diminué pour atteindre 212 mg/L avec un taux d'élimination de 94 %, et la valeur de la demande biochimique d'oxygène a baissé à 82 mg/L avec un taux d'élimination de 87 %. Selon nos constatations, les techniques combinant différentes méthodes de traitement des eaux usées des hôpitaux, comme l'adsorption associée à des méthodes avancées telles que les ultrasons, sont plus efficaces que celles qui n'utilisent qu'une seule méthode. Ces techniques devraient être encouragées.
Comparative analysis of hospital laboratory wastewater treatment techniques in Syrian Arab Republic.

Child maltreatment is a global issue that significantly impacts children's lives. In 2018, 32% of 15-year-olds in Albania reported experiencing physical abuse.To assess the prevalence and sociodemographic correlates of child abuse and neglect in Albania.This was the 2022 Health Behaviour in School-aged Children nationwide survey in Albania conducted among 1877 schoolchildren (55% girls) aged 15 years. We collected data on sociodemographic characteristics, physical abuse, emotional abuse, sexual abuse, emotional neglect, and exposure to domestic violence. We analysed the data using SPSS version 19.0 and used binary logistic regression to assess associations between child abuse, neglect and sociodemographic characteristics.Lifetime prevalence rates were 33.1% for physical abuse, 16.2% for emotional abuse, 3.7% for sexual abuse, 15.7% for emotional neglect, and 7.0% for witness to domestic violence. Children living in urban areas had higher odds of experiencing physical or emotional abuse (OR = 1.4 and 1.6, 95% CI = 1.1-1.7 and 1.2-2.2). Girls had higher odds of experiencing emotional abuse (OR = 1.8, 95% CI = 1.4-2.4) or emotional neglect (OR = 3.4, 95% CI = 2.5-4.6). Girls and children from less affluent families had lower odds of experiencing sexual abuse (OR = 0.6, 95% CI = 0.3-0.9; OR = 0.5, 95% CI = 0.3-0.8, respectively). Children whose fathers were unemployed had higher odds of witnessing domestic violence (OR = 1.9, 95% CI = 1.1-3.2).Abuse and neglect are highly prevalent among Albanian children aged 15 years, raising concerns over their future wellbeing. Action is needed by professionals and caregivers and at policy level to mitigate the negative impact and promote children's protection and well-being in the country.
Faculty of Medicine, University of Medicine, Tirana, Albania.
Faculty of Medicine, University of Medicine, Tirana, Albania.Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Institute of Public Health, Tirana, Albania.
United Nations Population Fund Office in Albania.
Faculty of Medicine, University of Medicine, Tirana, Albania.Institute of Public Health, Tirana, Albania.
انتشار إساءة معاملة الأطفال في ألبانيا. كاميل ديكا، مارسيدا دولي، جينك بورازيري، رودينا تشوماشي، رومينا هالا، إلسونا أجولي، جنتيانا كيراكو. إساءة معاملة الأطفال مشكلة عالمية لها أثر بالغ على حياتهم، وفي عام 2018، أبلغ 32٪ من الأطفال البالغين 15 عامًا في ألبانيا عن تعرضهم للاعتداء البدني. هدفت هذه الدراسة الى تقييم مدى انتشار إساءة معاملة الأطفال وإهمالهم في ألبانيا والارتباطات الاجتماعية السكانية بهما. أُجريَ في عام 2022 استقصاء السلوك الصحي للأطفال في سن الدراسة على الصعيد الوطني في ألبانيا، وشمل 1877 مشاركًا من تلاميذ المدارس الذين تبلغ أعمارهم 15 سنة (55٪ منهم فتيات). وخلال هذا الاستقصاء جمعنا بيانات عن الخصائص الاجتماعية السكانية، والاعتداء البدني، والإيذاء العاطفي، والاعتداء الجنسي، والإهمال العاطفي، والتعرض للعنف الأسري. وقد حلَّلنا البيانات بالإصدار 19.0 من برمجية SPSS، واستخدمنا الانحدار اللوجستي الثنائي لتقييم الارتباط بين إساءة معاملة الأطفال وإهمالهم والخصائص الاجتماعية السكانية. بلغت معدلات الانتشار مدى الحياة 33.1٪ للاعتداء البدني، و16.2٪ للإيذاء العاطفي، و3.7٪ للاعتداء الجنسي، و15.7٪ للإهمال العاطفي، وكان 7٪ شهداء على حالات عنف أسري. وكان احتمال التعرض للاعتداء البدني أو الإيذاء العاطفي أكبر لدى الأطفال الذين يعيشون في مناطق حضرية (نسبة الأرجحية = 1.4 و1.6، بينما كان فاصل الثقة 95٪ = 1.1–1.7، و1.2–2.2). وكان احتمال تعرُّض الفتيات للإيذاء العاطفي (نسبة الأرجحية = 1.8، فاصل الثقة 95٪ = 1.4–2.4) أو الإهمال العاطفي (نسبة الأرجحية = 3.4، فاصل الثقة 95٪ = 2.5–4.6) أعلى. أمَّا الاعتداء الجنسي فقد كانت احتمالية التعرض له أعلى بين الفتيان والأطفال من الأُسر الثرية (نسبة الأرجحية = 0.6، فاصل الثقة 95٪ = 0.3–0.9؛ نسبة الأرجحية = 0.5، فاصل الثقة 95٪ = 0.3–0.8، على التوالي). وكان احتمال التعرض للعنف الأسري أكبر بين الأطفال الذين كان آباؤهم عاطلين عن العمل (نسبة الأرجحية = 1.9، فاصل الثقة 95٪ = 1.1–3.2). تنتشر الإساءة والإهمال انتشارًا كبيرًا بين الأطفال الألبانيين في عمر 15 عامًا، وهو ما يثير المخاوف والقلق بشأن عافيتهم في المستقبل. ويجب اتخاذ الإجراءات اللازمة من جانب المهنيين والقائمين على الرعاية، وعلى مستوى السياسات، للتخفيف من الأثر السلبي للمشكلة وتعزيز حماية الأطفال وعافيتهم في البلد. Prévalence de la maltraitance des enfants en Albanie. La maltraitance des enfants constitue un problème mondial , ayant un impact significatif sur leur vie. En 2018, 32 % des jeunes albanais âgés de 15 ans ont déclaré avoir été victimes de sévices physique s. Évaluer la prévalence et les corrélats sociodémographiques associés à la maltraitance et à la négligence envers les enfants en Albanie. Il s'agissait de l'enquête nationale 2022 sur le comportement des enfants d'âge scolaire en matière de santé menée en Albanie auprès de 1877 écoliers (55 % de filles) âgés de 15 ans. Nous avons recueilli des données sur les caractéristiques sociodémographiques, les sévices physique s, psychologique s, l'abus sexuel, la négligence émotionnelle et l'exposition à la violence domestique. Nous avons analysé les données à l'aide du logiciel SPSS version 19.0 et utilisé la régression logistique binaire pour évaluer les associations entre la maltraitance, la négligence des enfants et les caractéristiques sociodémographiques. Les taux de prévalence au cours de la vie étaient de 33,1 % pour les sévices physique s, de 16,2 % pour la violence psychologique, de 3,7 % pour l'abus sexuel, de 15,7 % pour la négligence émotionnelle et de 7,0 % pour l'exposition à la violence domestique. Les enfants vivant dans des zones urbaines avaient un risque accru de subir des sévices physiques ou psychologiques (odds ratio = 1,4 et 1,6 ; IC à 95 % = 1,1−1,7 et 1,2−2,2). Les filles étaient plus susceptibles de subir de la violence psychologique (odds ratio = 1,8 ; IC à 95 % = 1,4−2,4) ou de la négligence émotionnelle (odds ratio = 3,4 ; IC à 95 % = 2,5−4,6). Les filles et les enfants issus de familles moins aisées étaient moins susceptibles de subir des abus sexuels (odds ratio = 0,6 ; IC à 95 % = 0,3−0,9 ; odds ratio = 0,5 ; IC à 95 % = 0,3−0,8, respectivement). Les enfants dont les pères étaient sans emploi avaient une probabilité plus élevée d'être témoins de violences domestiques (odds ratio = 1,9, IC à 95 % = 1,1−3,2). La maltraitance et la négligence sont très répandues chez les enfants albanais âgés de 15 ans, ce qui soulève des préoccupations concernant leur bien-être futur. Des mesures doivent être prises par les professionnels et les aidants, ainsi qu'au niveau des politiques, pour atténuer les effets négatifs et promouvoir la protection et le bien-être des enfants dans le pays.
Prevalence of child maltreatment in Albania.

Poverty is both a cause and a consequence of poor health, and the scarcity of resources limits access to essential health care services.To highlight the implications on health of the often-neglected social determinants.We examined the experiences of Shahida Parveen, a middle-aged, unmarried woman, living in a resource-poor setting in Rawalpindi, Pakistan, and the interplay of the social determinants and inadequate safety nets on her health and wellbeing.Shahida's narrative unveiled a poignant journey marked by health challenges early in her lifetime, her profound losses and the systemic barriers to accessing healthcare. Poverty, limited social support, and healthcare disparities emerged as central factors in shaping her health outcomes.This case report highlights the need for a more just and more inclusive healthcare system that guarantees comprehensive social safety nets and accessible health care services for vulnerable populations.
Central Institute of Family Medicine, Islamabad.
Islamabad Medical and Dental College, Islamabad.
National University of Medical Sciences, Rawalpindi.
ما بعد الاعتلال: فهم أثر المُحدِّدات الاجتماعية في حياة امرأة باكستانية في منتصف العمر. محمد أحمد عبد الله، بابر تسنيم شيخ، نرگس یوسف ستار، سید مجاهد كيلاني، أمير إسكندر أحمد، ولید قيصر شيخ. الفقر سبب من أسباب اعتلال الصحة ونتيجة له، وتساهم ندرة الموارد في الحد من إمكانية الحصول على خدمات الرعاية الصحية الأساسية. هدفت هذه الدراسة الى تسليط الضوء على آثار المحدِّدات الاجتماعية التي غالبًا ما يجري إغفالها على الصحة. درسنا التجارب التي مرت بها شهيدة بارفين، وهي امرأة في منتصف العمر وغير متزوجة، تعيش في بيئة فقيرة الموارد في راولبندي بباكستان، وبحثنا في أثر المُحدِّدات الاجتماعية وعدم كفاية شبكات الأمان على صحتها وعافيتها. كشفت حكاية شهيدة عن رحلتها المُثيرة للأسى بعد أن تعرضت في بداية حياتها لتحديات صحية، فضلًًا عن خسائرها الكبيرة، وعقبات النظام التي تحول دون حصولها على الرعاية الصحية. وتبين أن الفقر وقلة الدعم المجتمعي وتفاوتات الرعاية الصحية عوامل رئيسية في تشكيل حصائلها الصحية. يسلط تقرير الحالة هذا الضوء على الحاجة إلى نظام رعاية صحية أكثر عدلًًا وشمولًًا يضمن توفير شبكات أمان اجتماعي شاملة، وإتاحة خدمات الرعاية الصحية للفئات السكانية المُستضعفة. Au-delà de la maladie : comprendre les déterminants sociaux dans la vie d'une femme d'âge moyen au Pakistan. La pauvreté est à la fois une cause et une conséquence de la mauvaise santé, et la pénurie de ressources limite l'accès aux services de soins de santé essentiels. Mettre en évidence les implications des déterminants sociaux pour la santé, qui sont souvent négligés. Nous avons examiné les expériences de Shahida Parveen, une femme célibataire d'âge moyen vivant dans un milieu défavorisé à Rawalpindi (Pakistan), ainsi que l'interaction des déterminants sociaux et de l'insuffisance des filets de sécurité sur sa santé et son bien-être. Le récit de Shahida a dévoilé un parcours poignant marqué par des problèmes de santé survenus au début de sa vie, des pertes tragiques et des obstacles systémiques à l'accès aux soins de santé. La pauvreté, le soutien social limité et les disparités en matière de soins de santé sont apparus comme des facteurs essentiels qui influent sur les résultats qu'elle a obtenus dans le domaine de la santé. La présente étude de cas met en évidence la nécessité de créer un système de santé plus juste et inclusif qui garantit la mise en place de filets de sécurité sociale complets et de services de soins de santé accessibles aux populations vulnérables.
Beyond illness: Understanding the social determinants in the life of a middle-aged Pakistani woman.

Lebanon's economic and financial crises have affected the quality-of-life, including food safety and food security.To assess food safety knowledge and practices among a sample Lebanese population and the association with the sociodemographic and economic characteristics of participants.This cross-sectional study collected data online from 412 Lebanese adults aged ≥ 18 years [mostly female (77.7%)] between October and December 2021. The data included their sociodemographic characteristics, food safety knowledge and practices, experience of food insecurity, and financial wellbeing. We conducted logistic regression analyses to explore the associations between food safety knowledge and practices, sociodemographic variables, and food security status of participants.A significantly higher proportion of married (vs single) participants said they reheated refrigerated meat or chicken before consumption (74.3% vs 63.1%, P = 0.017). A significantly higher proportion of participants in the higher income category and those with university education (versus lower level of education) knew the characteristics of a contaminated food (34.2% vs 15.0%, P = 0.008). Older participants were significantly more knowledgeable about the management of leftover food (mean 34.54 years vs 31.25 years; P = 0.014). Household food security status did not show any statistically significant association with any of the 5 food safety measures examined.This study confirms the existence of suboptimal food safety knowledge and practices by almost half of the sample. There is therefore a need for evidence-based public health interventions to increase knowledge, and promote better practices, of safe food handling, thereby reducing the risk of foodborne diseases in Lebanon.
Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.Department of Nutritional Sciences, Faculty of Health Sciences, University of Balamand, Koura, Lebanon.
Department of Nutritional Sciences, Faculty of Health Sciences, University of Balamand, Koura, Lebanon.
Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon.Research Department, Psychiatric Hospital of the Cross, Beirut, Lebanon.Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon.
Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, United States of America.Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon.Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.Faculty of Pharmacy, Lebanese University, Hadath, Lebanon.
إستكشاف مدى الدراية بسلامة الأغذية وممارساتها في لبنان. جوان كرم، ميراي سرحان، شادية حداد، هالة صقر، لميس جمعة، باسكال سلامة. تركت الأزمات الاقتصادية والمالية في لبنان أثرها على جودة الحياة فيه، ويشمل ذلك سلامة الأغذية والأمن الغذائي. هدفت هذه الدراسة الى تقييم مدى الدراية بسلامة الأغذية والممارسات المتعلقة بها بين عينة من السكان اللبنانيين، وارتباط ذلك بالسمات الأخرى لهم :(العمرية، الجندرية، التعلمية، الحالة الإجتماعية ، الوضع الإقتصادي). جمعت هذه الدراسة المقطعية بيانات عبر الإنترنت عن العينة البالغ عددها (412)من اللبنانيين البالغين ، أعمارهم من (18) عام وما فوق، [معظمهم من الإناث (77.7٪)] في الفترة بين أكتوبر/ تشرين الأول وديسمبر/ كانون الأول عام (2021). وتضمّنت البيانات الخصائص الاجتماعية السكانية للمشاركين، ومعلوماتهم عن سلامة الأغذية وممارساتها، وتجاربهم مع التعرض لانعدام الأمن الغذائي، والازدهار المالي .تم إجراء تحليلات الانحدار اللوجستي لاستكشاف العلاقات بين المعرفة بممارسات سلامة الأغذية والمتغيرات الاجتماعية الديموغرافية وحالة الأمن الغذائي للمشاركين. ذكرت نسبة كبيرة إحصائيًّا من المشاركين المتزوجين (74.3٪)، مقابل (63.1٪) من غير المتزوجين ، الإحتمالية = 0.017)،أنهم أعادوا تسخين الدجاج أو اللحوم المبردة قبل تناولها.وكانت نسبة من المشاركين (34.2٪) هم من أصحاب الدخل المرتفع والحاصلين على تعليم جامعي مقابل (15.0٪) الحاصلين على مستوى تعليمي دون الجامعي (الإحتمالية= 0.008) يعرفون سمات الطعام الملوّث . أمَّا المشاركون الأكبر سنًّا فقد كانت نسبتهم أعلى من الناحية الإحصائية، فيما يتعلق بمعرفة طُرُق التعامل مع بقايا الطعام (متوسط السن 34.54 سنة مقابل 31.25 سنة؛الاحتمالية = 0.014). ولم يُظهر وضع الأمن الغذائي للأسر أي ارتباط ذي دلالة إحصائية بأي من التدابير الخمسة لسلامة الأغذية التي خضعت للدراسة. أكَّدت هذه الدراسة أن الدراية بسلامة الأغذية وممارساتها كانت دون المستوى الأمثل لدى ما يقرب من نصف العينة. ولذلك توجد حاجة إلى تدخلات صحية عامة لزيادة الوعي والتشجيع على أفضل الممارسات، فيما يتعلق بالتعامل الآمن مع الأغذية، ومن ثم الحد من خطر الأمراض المنقولة بالأغذية في لبنان. Étude des connaissances et des pratiques en matière de sécurité sanitaire des aliments au Liban. Les crises économiques et financières du Liban ont affecté la qualité de vie, y compris eu égard à la sécurité sanitaire des aliments et la sécurité alimentaire. Évaluer les connaissances et les pratiques en matière de sécurité sanitaire des aliments au sein d'un échantillon de la population libanaise et analyser leur association avec les caractéristiques sociodémographiques et économiques des participants. La présente étude transversale a permis de recueillir des données en ligne auprès de 412 adultes libanais âgés de 18 ans et plus [principalement de sexe féminin (77,7 %)] entre octobre et décembre 2021. Ces données portaient sur leurs caractéristiques sociodémographiques, leurs connaissances et leurs pratiques en matière de sécurité sanitaire des aliments, leur expérience de l'insécurité alimentaire et leur bien-être financier. Nous avons mené des analyses de régression logistique pour étudier l’association entre les connaissances et les pratiques en matière de sécurité sanitaire des aliments, les variables sociodémographiques ainsi que l’état de sécurité alimentaire des participants. Une proportion beaucoup plus élevée de participants mariés (par rapport aux célibataires) a déclaré avoir réchauffé à nouveau de la viande ou du poulet réfrigérés avant leur consommation (74,3 % contre 63,1 %, p = 0,017). Une proportion significativement plus importante de participants issus des catégories à revenu élevé et ceux ayant un diplôme universitaire (par rapport à ceux ayant un niveau d'études inférieur) connaissaient les caractéristiques d'un aliment contaminé (34,2 % contre 15,0 %, p = 0,008). Les participants plus âgés étaient significativement mieux informés sur la gestion des restes alimentaires (moyenne de 34,54 ans contre 31,25 ans ; p = 0,014). L'état de la sécurité alimentaire des ménages n'a montré aucune association statistiquement significative avec les cinq mesures de sécurité sanitaire des aliments examinées. La présente étude confirme que près de la moitié de l'échantillon présentait des connaissances et des pratiques sous-optimales en matière de sécurité sanitaire des aliments. Il est donc nécessaire de mettre en place des interventions de santé publique fondées sur des données probantes, visant à renforcer les connaissances et promouvoir de meilleures pratiques en matière de manipulation sûre des aliments, afin de réduire le risque de maladies d'origine alimentaire au Liban.
Exploring food safety knowledge and practices in Lebanon.

Neurology Department, Neurology and Neurophysiology Center, Vienna, Austria.
Flaccid paraplegia of the lower limbs in paediatric patients has many causes.

Despite numerous studies observing a positive correlation between family resilience and psychological well-being during the COVID-19 pandemic, the strength of this association varied considerably in previous research. This study aims to obtain reliable estimates for effect sizes and investigate the potential moderators of the association between family resilience and psychological well-being during the COVID-19 pandemic. Seventeen studies (65 effect sizes, 14,511 participants) were reviewed using a systematic literature search and the PRISMA approach. A three-level meta-analysis revealed a significant positive correlation (r = 0.504, p < 0.001) between family resilience and psychological well-being during the COVID-19 pandemic. Notably, education level significantly moderated this relationship, along with the type of psychological well-being and the measures used for assessment. These findings highlight the critical role of family resilience in enhancing psychological well-being and emphasize the importance of considering educational factors in designing interventions to improve psychological outcomes during pandemics.
Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.Key Laboratory of Adolescent CyberPsychology and Behavior (CCNU), Ministry of Education, Wuhan, China.
The association between family resilience and psychological well-being during the COVID-19 pandemic: A three-level meta-analysis.

While the early mental health of girls and boys is similar, as children age, girls tend to report worse mental health than boys. Explanations for these gendered disparities remain elusive. This study seeks to understand the social context in which mental health experiences are shaped. Utilizing a qualitative, constructivist approach to grounded theory, we conducted virtual semi-structured interviews with young people between ages 11 and 17 years (n = 20). Our major finding was that girls in particular experience incongruence between expectations about gender equality and everyday experiences of stereotypes, barriers, and discrimination. Girls reported pressures to satisfy multiple gender norms, such as traditional ideals about being feminine (kind and physically attractive) and modern ideas about being high achieving and smarter than boys. Findings suggest that young people are unequipped to navigate the incongruence between the expectation that they live in a gender-equal world and their experiences of gender-based constraints, nor do they appear to have the skills to critically identify the structural patterns that undergird their experiences. Explanations for gendered disparities in mental health may be related to the underlying context of discrimination, and both traditional and emerging gendered norms, barriers, and constraints. Finally, we highlight the responsibility of adults to facilitate child development in ways that are responsive to the changing faces of gender discrimination, which readily adapts to social discourse in new and subtle ways.
Department of Health Sciences, Brock University, St. Catharines, ON, Canada.
Department of Criminology, University of Ottawa, Ottawa, ON, Canada.
School of Mathematical and Computational Sciences, University of Prince Edward Island, Charlottetown, PE, Canada.
Incongruent Expectations: A Qualitative Study of the Gendered Experiences of Canadian Young People.

Data are scarce regarding Wolf-Parkinson White Syndrome (WPW) syndrome and asymptomatic pre-excitation in Africa. This study tried to understand the current approaches utilized in Africa for the diagnosis and management of both symptomatic and asymptomatic ventricular pre-excitation.The current prospective study was conducted in 20 centers located in 17 countries spanning all areas of Africa. Participants included had ventricular pre-excitation patterns. The data collected included symptoms, locations of accessory pathways (AP) and tachyarrhythmia, risk stratification, as well as acute and long-term management. In addition, we assessed the clinical effectiveness of the centers and the impact of socioeconomic and health metrics on these treatment approaches.Among 541 participants, 93% were diagnosed with WPW syndrome, with orthodromic atrioventricular reciprocating tachycardia (AVRT) being the most prevalent arrhythmia, affecting 55% of the cases. Approximately 30% of patients in Africa, except for the southern region, received intravenous amiodarone as the first-choice drug for orthodromic AVRT while adenosine was the drug of choice in the Southern region. Electrical cardioversion was the first-line treatment for pre-excited atrial fibrillation and antidromic AVRT across all of Africa. Radiofrequency ablation (RF) was the first long-term therapy option for 88% of patients in all African regions, unlike western and central Africa where it was implemented for less than 30% of patients (p < 0.001). The rates of RF success, long-term recurrence, and complications were 93%, 4.1%, and 3.8%, respectively.There are significant variations between African regions in terms of diagnostic workup, accessory pathway localizations, and volume of invasive treatment. Countries in Northern and Southern Africa are more advanced than other African countries in terms of modern management strategy. Additional government investments are necessary to enhance diagnostic likelihood and curative treatments as well as to reduce the gap between different regions in Africa.
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Interventional Cardiology Center of Douala, Douala, Cameroon.
Faculty of Medicine, South Valley University, Qena, Egypt.
Cardiology Unit, Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria.
Community Medicine Department, National Research Centre, Cairo, Egypt.
CHU Mustapha Cardiologi, Algiers, Algeria.
EThekwini Hospital, Durban, South Africa.
Hedi Chaker University Hospital of Sfax, Sfax, Tunisia.
National Teaching Hospital Hubert Koutoukou Maga, Cotonou, Benin Republic.
Lady Pohamba Private Hospital, Windhoek, Namibia.
Clinique Maison du Coeur, N'Djaména, Chad.
CHU la Référence Nationale, N'Djaména, Chad.
Clinica sagrada esperanca, Luanda, Angola.
Institut de cardiologie, CHU Treichville, Abidjan, Côte D'Ivoire.
Dr. A.G. Jeetoo Hospital, Port Louis, Mauritius.
Jakaya Cardiac Institute, Dar-Es-Salam, Tanzania.
Douala Gyneco-obstetric and Pediatric Hospital/University of Douala, Douala, Cameroon.Centre Hospitalier Le Raincy-Montfermeil, Montfermeil, France.
Clinical Profile and Management of Wolf-Parkinson White Syndrome and Asymptomatic Pre-Excitation Carriers in Africa: A Multicenter Pan African Registry From 17 Countries.

Understanding nitrous oxide induced subacute combined degeneration of the cord: Two case reports with a review of the pathophysiology and MRI features.

Low Yield of Urgent Haemoptysis Referrals for Lung Cancer Clinics.

Improving the visibility of Rare Diseases in General Medical Practice.

Crying out over spilt milk - Quantifying formula milk waste in a large maternity hospital.

Waste not, want not: measuring waste and potential clinical risk from limited gatekeeping.

Assessing the quality of transurethral resection of bladder tumour (TURBT) operation notes in line with EAU guidelines.

The Prevalence of Burnout in Healthcare Workers Presenting to Occupational Health.

A one year analysis of e-scooter injuries: more than half require specialist follow-up.

The use and benefit of venous blood lactate in ambulatory patients attending the Emergency Department.

Assessment of a pilot pathway redirecting low acuity emergency department patients.

Ectopic pregnancy with levonorgestrel-releasing intrauterine device (Jaydess) in situ.

The conservative management of a perforated duodenal ulcer in a morbidly obese patient.

Maternal Diaphragmatic Hernia in Pregnancy and Gastric Herniation and Ischaemia.

Acute Methaemoglobinaemia following ingestion of amyl nitrite.

Fungal splenic abscess secondary to bariatric tourism in an immunocompetent patient.

An audit and quality improvement project of STEMI care in a model 3 hospital.

The Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) have developed together Clinical Practice Guidelines (GPC) on the management of people affected by tuberculosis (TB) resistant to drugs with activity against Mycobacterium tuberculosis. These clinical practice guidelines include the latest updates of the SEPAR regulations for the diagnosis and treatment of drug-resistant TB from 2017 and 2020 as the starting point. The methodology included asking relevant clinical questions based on PICO methodology, a literature search focusing on each question, and a systematic and comprehensive evaluation of the evidence, with a summary of this evidence for each question. Finally, recommendations were developed and the level of evidence and the strength of each recommendation for each question were established in concordance with the GRADE approach. Of the recommendations made, it is worth highlighting the high quality of the existing evidence for the use of nucleic acid amplification techniques (rapid genotypic tests) as initial tests for the detection of the M. tuberculosis genome and rifampicin resistance in people with presumptive signs or symptoms of pulmonary TB; and for the use of an oral combination of anti-TB drugs based on bedaquiline, delamanid (pretomanid), and linezolid, with conditional fluoroquinolone supplementation (conditioned by fluoroquinolone resistance) for six months for the treatment of people affected by pulmonary multidrug-resistant tuberculosis (MDR-TB). We also recommend directly observed therapy (DOT) or video-observed treatment for the treatment of people affected by DR-TB.
Copyright © 2024 Sociedad Española de Neumología y Cirugía Torácica, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.
International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Autonomous University of Barcelona, Spain; Mycobacterial Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain; For Biomedical Research Centre in Infectious Diseases Network (CIBERINFEC), Carlos III Health Institute, Madrid, Spain. Electronic address: adrian.sanchez.montalva@gmail.com.
Prof. Head of the Pulmonology Service at the Dr. Negrín General University Hospital, Las Palmas de GC, Spain; Director of Scientific Activities ALOSA TB ACADEMY, Spain.
Microbiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; Department of Microbiology and Parasitology, Faculty of Medicine, University of Valencia, Mycobacterial Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain; SEIMC Quality Control, Madrid, Spain.
Integrated Research Program in Tuberculosis and Non-Tuberculous Mycobacteria (PII-TB&MNT), Centre for Biomedical Research in Public Health Network (CIBERESP), Barcelona Tuberculosis Research Unit, Spain.
Infectious Diseases Unit, Internal Medicine Department, Lucus Augusti University Hospital, Lugo, Spain; Mycobacterial Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.
Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; Serveis Clínics, Barcelona, Spain; Integrated Research Program in Tuberculosis (PII-TB) of the Spanish Society of Pneumology and Pathology of the Respiratory System (SEPAR), Barcelona, Spain; Centre for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Carlos III Health Institute, Madrid, Spain.
Pulmonology Section, San Agustín University Hospital, Avilés, Spain.
Tuberculosis Unit, Infectious Diseases, Internal Medicine Service, University Hospital Complex, Pontevedra, Spain; Immunology Research Group, Galicia Sur Health Research Institute, Spain.
Pulmonology Department, Dr. Negrín University Hospital of Gran Canaria, Las Palmas de GC, Spain; PII-TB&MNT & SEPAR Study Group, Spain.
Medical-Surgical Unit of Respiratory Diseases (UMQER) Virgen del Rocío University Hospital, Seville, Spain; Integrated Research Program in Tuberculosis and Non-Tuberculous Mycobacteria (PII-TB&MNT), Spain.
Clinical Unit of Infectious Diseases, Microbiology, and Clinical Parasitology (UCEIMP), Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Clinical and Molecular Microbiology Group, Mycobacteria Line, GEIM-SEIMC Study Group, PII-TB& MNT, SEPARATE, Spain.
Pulmonology Service, Cruces University Hospital (OSI EEC), Barakaldo, Spain; BioBizkaia Health Research Institute, Spain.
Writing committee of the Spanish MDR TB consortium
Executive Summary: Clinical Practice Guidelines on the Management of Resistant Tuberculosis of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).

An Audit on VTE Thromboprophylaxis and Incidence of Hospital Acquired Thrombosis.

All that Glitters is the Golden Patient: Improving staff morale through educational goal setting.

Maxillary Lift Technique: Bridging Gaps in Airway Management for Challenging Scenarios.

The Use of Biomarkers in Diagnosing Alzheimer's Disease: Recommendations of the Irish Working Group on Biological Approaches to the Diagnosis of Dementia.

Nursing interventions play a critical role in enhancing the quality of life (QoL) and therapeutic outcomes for cervical cancer patients undergoing chemotherapy. However, variations in nursing interventions and patient results require a meta-analysis to consolidate evidence on the most effective nursing approaches. This meta-analysis assessed how nursing care interventions influence QoL, adherence to chemotherapy, and the management of symptoms in cervical cancer patients. An extensive search through PubMed, Web of Science, and Cochrane Library databases yielded 17 randomized controlled trials (RCTs) that met the eligibility requirements. The findings revealed that nursing interventions significantly boosted QoL (OR = 1.28, 95% CI: 1.10 to 1.49), increased adherence to chemotherapy protocols (OR = 1.35, 95% CI: 1.15 to 1.60), and alleviated chemotherapy-induced symptoms like fatigue and nausea (OR = 1.42, 95% CI: 1.20 to 1.67). Funnel plots showed minimal publication bias in the studies analyzed. We conclude that nursing interventions significantly enhance QoL, treatment adherence, and symptom control for cervical cancer patients undergoing chemotherapy.
African Journal of Reproductive Health © 2024.
Department of Thoracic Oncology(Ⅱ), HangZhou Cancer Hospital, HangZhou, China.
Department of Thoracic Oncology(I), HangZhou Cancer Hospital, HangZhou, China.
Department of Integrated Oncology(I), HangZhou Cancer Hospital, HangZhou, China.
Les interventions infirmières jouent un rôle essentiel dans l'amélioration de la qualité de vie (QdV) et des résultats thérapeutiques des patientes atteintes d'un cancer du col de l'utérus et subissant une chimiothérapie. Cependant, les variations dans les interventions infirmières et les résultats des patients nécessitent une méta-analyse pour consolider les preuves sur les approches infirmières les plus efficaces. Cette méta-analyse a évalué comment les interventions en soins infirmiers influencent la qualité de vie, l'observance de la chimiothérapie et la gestion des symptômes chez les patientes atteintes d'un cancer du col de l'utérus. Une recherche approfondie dans les bases de données PubMed, Web of Science et Cochrane Library a donné lieu à 17 essais contrôlés randomisés (ECR) répondant aux critères d'éligibilité. Les résultats ont révélé que les interventions infirmières amélioraient de manière significative la qualité de vie (OR = 1,28, IC à 95 % : 1,10 à 1,49), augmentaient l'observance des protocoles de chimiothérapie (OR = 1,35, IC à 95 % : 1,15 à 1,60) et atténuaient les symptômes induits par la chimiothérapie comme la fatigue. et nausées (OR = 1,42, IC 95 % : 1,20 à 1.67). Les tracés en entonnoir ont montré un biais de publication minime dans les études analysées. Nous concluons que les interventions infirmières améliorent considérablement la qualité de vie, l'observance du traitement et le contrôle des symptômes chez les patientes atteintes d'un cancer du col de l'utérus et subissant une chimiothérapie.
Effectiveness of nursing care for cervical cancer patients undergoing chemotherapy: Systematic review and meta-analysis.

This was an original research. The objective of the study was to investigate the efficacy of laparoscopic type C radical hysterectomy by deep uterine vein approach in treating cervical cancer. Two hundred cases of cervical cancer were allocated into control group and intervention group. The control group underwent pelvic lymph node dissection + para-aortic lymph node resection followed by extensive hysterectomy. The intervention group underwent laparoscopic type C radical hysterectomy by deep uterine vein approach + pelvic lymph node dissection ± para-aortic lymph node resection. In comparison with the control group, the intervention group had significantly lower amount of blood loss, longer time of indwelling catheter, shorter time of abdominal drainage tube removal and anal exhaust, lower incidence of postoperative complications, higher rate of pathological stage upgrading, and higher quality of life score, and had lower recurrence rate. We conclude that laparoscopic C-type radical hysterectomy by deep uterine vein approach is effective, safe and reliable, and can promote patients quality of life, which is valuable for clinical use.
Department of Gynecology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, China.
Il s’agissait d’une recherche originale. L'objectif de l'étude était d'étudier l'efficacité de l'hystérectomie radicale laparoscopique de type C par approche veineuse utérine profonde dans le traitement du cancer du col de l'utérus. Deux cents cas de cancer du col de l'utérus ont été répartis dans le groupe témoin et le groupe d'intervention. Le groupe témoin a subi un curage ganglionnaire pelvien + une résection ganglionnaire para-aortique suivie d'une hystérectomie étendue. Le groupe d'intervention a subi une hystérectomie radicale laparoscopique de type C par approche veineuse utérine profonde + curage ganglionnaire pelvien ± résection ganglionnaire para-aortique. Par rapport au groupe témoin, le groupe d'intervention présentait une perte de sang significativement plus faible, une durée de cathéter à demeure plus longue, une durée plus courte du retrait du tube de drainage abdominal et de l'échappement anal, une incidence plus faible de complications postopératoires, un taux plus élevé d'évolution du stade pathologique et un taux plus élevé. score de qualité de vie et présentait un taux de récidive plus faible. Nous concluons que l'hystérectomie radicale laparoscopique de type C par approche veineuse utérine profonde est efficace, sûre et fiable, et peut améliorer la qualité de vie des patientes, ce qui est précieux pour une utilisation clinique.
Short-term efficacy of laparoscopic type C radical hysterectomy by deep uterine vein approach for treatment of cervical cancer.

Elevated serum uric acid (SUA) levels in pregnancy are linked to adverse outcomes, including preterm birth, preeclampsia, and low birth weight. To assess the predictive value of SUA levels in early pregnancy for adverse pregnancy outcomes (APOs). A cohort of 4,240 pregnant women admitted for delivery from January 2021 to December 2022 was analyzed. APOs were compared between women with hyperuricemia (HUA) (UA > 360 μmol/L) and those without HUA. Logistic regression (LR) analysis was used to identify risk factors for APOs. Among the cohort, 295 women (6.9%) had HUA. Compared to the non-HUA group, the HUA group had a higher BMI (22.45 vs. 21.34), higher rates of hypertension (6.1% vs. 3.4%), preterm birth (10.2% vs. 6.3%), and low birth weight (10.2% vs. 5.9%). Multivariate LR analysis identified elevated UA levels, BMI, diabetes, and preeclampsia as significant risk factors for APOs. The optimal UA threshold for predicting preterm birth was 253.855 μmol/L (sensitivity: 71.4%, specificity: 55.2%). Early pregnancy SUA levels are predictive of adverse pregnancy outcomes, providing a foundation for potential clinical interventions. Given the moderate sensitivity and specificity of the identified SUA threshold for predicting preterm birth, further research is warranted to refine these values and establish their clinical implications in obstetric practice.
Department of Obstetrics, Xiaolan People's Hospital of Zhongshan (The Fifth People's Hospital of Zhongshan), Zhongshan,528415, China.
Des taux élevés d’acide urique sérique (SUA) pendant la grossesse sont liés à des conséquences indésirables, notamment une naissance prématurée, une prééclampsie et un faible poids à la naissance. Évaluer la valeur prédictive des niveaux de SUA en début de grossesse pour les issues indésirables de la grossesse (APO). Une cohorte de 4 240 femmes enceintes admises pour un accouchement de janvier 2021 à décembre 2022 a été analysée. Les APO ont été comparées entre les femmes atteintes d'hyperuricémie (HUA) (UA > 360 μmol/L) et celles sans HUA. Une analy se de régression logistique (LR) a été utilisée pour identifier les facteurs de risque d'APO. Parmi la cohorte, 295 femmes (6,9 %) souffraient d’HUA. Comparé au groupe non-HUA, le groupe HUA présentait un IMC plus élevé (22,45 contre 21,34), des taux d'hypertension plus élevés (6,1 % contre 3,4 %), une naissance prématurée (10,2 % contre 6,3 %) et un faible poids à la naissance. (10,2% contre 5,9%). L'analyse LR multivariée a identifié des taux élevés d'UA, d'IMC, de diabète et de prééclampsie comme facteurs de risque importants d'APO. Le seuil optimal d’UA pour prédire l’accouchement prématuré était de 253,855 μmol/L (sensibilité : 71,4 %, spécificité : 55,2 %). Les niveaux de SUA en début de grossesse sont prédictifs d’issues indésirables de la grossesse, fournissant ainsi une base pour des interventions cliniques potentielles. Compte tenu de la sensibilité et de la spécificité modérées du seuil SUA identifié pour prédire l'accouchement prématuré, des recherches supplémentaires sont justifiées pour affiner ces valeurs et établir leurs implications cliniques dans la pratique obstétricale.
Predictive value of early pregnancy uric acid levels for adverse pregnancy outcomes.

Division of Obstetric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mfarber@bwh.harvard.edu.
Department of Cardiovascular Sciences, KU Leuven, UZ Leuven, Leuven, Belgium.
Best practice & research. Clinical anaesthesiology
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):155-156.
New frontiers in obstetric anesthesiology: Advocacy through innovation.

Since 2015, reductions in maternal mortality have stalled globally. In some parts of the world, severe maternal morbidity and mortality have increased, and most cases are thought to be from preventable causes. This is further exacerbated by significant racial, ethnic, and geographic disparities in maternal health outcomes, particularly among countries with diverse populations. Etiologies and presentations of maternal death and disease are broad and diverse, often requiring a multidisciplinary approach to address risk and manage medical complexity. Strategies that may reduce morbidity and mortality include the application of risk stratification models and systems for prompt recognition of clinical deterioration, implementation of maternal safety bundles, and point-of care tools such as coagulation testing and ultrasound. This review aims to provide a comprehensive overview of the epidemiology, etiology, and disparities in maternal morbidity and mortality outcomes, and provide a framework for anesthesiologists in helping mitigate risk and improve maternal health outcomes.
Copyright © 2024. Published by Elsevier Ltd.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, CWN L1, Boston, MA, 02115, USA. Electronic address: jjkim@bwh.harvard.edu.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, CWN L1, Boston, MA, 02115, USA. Electronic address: mfarber@bwh.harvard.edu.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, CWN L1, Boston, MA, 02115, USA. Electronic address: btaha@mgb.org.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):157-167.
Epidemiology, trends, and disparities in maternal mortality: A framework for obstetric anesthesiologists.

Labour analgesia is a crucial aspect of obstetric anaesthesia, aiming to alleviate pain during childbirth while ensuring maternal and foetal safety. Over the past decade, advancements in labour analgesia techniques have evolved, impacting initiation, maintenance, and outcomes. We emphasize the longstanding importance of epidural analgesia while recognizing the growing significance of combined spinal-epidural and dural puncture epidural techniques for labour initiation. Analgesia maintenance is optimally achieved with an epidural bolus regimen, either manual boluses, programmed intermittent boluses or patient-controlled epidural analgesia. Utilizing high-volume, low-dose combinations of local anaesthetics with lipophilic opioids demonstrates synergistic effects, facilitating dose reduction and minimising adverse effects. Adjuvants can play a role in specific clinical contexts. The increasing significance of ultrasound guidance for procedural precision is highlighted. The intricate nature of labour pain management underscores the importance of both patient and clinician involvement in decision-making processes. Future advancements in this field have the potential to enhance the well-being of women as well as their newborns.
Copyright © 2024 Elsevier Ltd. All rights reserved.
Department of Anaesthesiology, UZ Leuven, Leuven, Belgium. Electronic address: marie-camille.vanderheeren@uzleuven.be.
Department of Anaesthesiology, UZ Leuven, Leuven, Belgium.
Department of Anaesthesiology, GZA Hospitals, Antwerp, Belgium.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):168-175.
Initiation and maintenance of neuraxial labour analgesia: A narrative review.

Epidural analgesia is considered the gold standard for labour pain but may not be an option for all parturients due to patient choice or medical contraindication. Non-neuraxial alternatives for labour analgesia have been extensively studied and include both pharmacological and non-pharmacological options. Pharmacological options include the use of opioids and inhalational agents while non-pharmacological options range from non-invasive methods such as continuous labour support to techniques such as sterile water injection. Apart from effective analgesia, such techniques may improve maternal satisfaction. This review summarizes the evidence for available non-neuraxial labour analgesia modalities.
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore. Electronic address: lynn.chen.ning@singhealth.com.sg.
Department of Anaesthesia, Ulster Hospital, Belfast, Northern Ireland.
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):176-186.

This article offers a comprehensive clinical update on best practices for neuraxial and general anesthesia in cesarean delivery, the most frequently performed major surgical procedure globally. Current evidence-based strategies to address common anesthetic challenges, such as maternal hypotension and intraoperative breakthrough pain, are discussed in detail. Practical approaches for optimizing maternal hemodynamic stability, including the use of vasopressors, fluid management and maternal positioning, are reviewed. Additionally, the article explores best practices for general anesthesia, with an emphasis on new approaches to prolonging safe apnea time, rapid sequence induction and difficult airway management.
Perelman School of Medicine, University of Pennsylvania, Department of Anesthesiology and Critical Care, 3400 Spruce St, Suite 680 Dulles, Philadelphia, PA, 19104, USA. Electronic address: allison.lee@pennmedicine.upenn.edu.
Medicine Department, Lille University, Pôle d'Anesthésie Réanimation Médecine Péri-opératoire et Douleur, Centre Hospitalier Universitaire de Lille, 2 Rue Oscar Lambret, 59 037, Lille Cedex, France. Electronic address: max.gonzalezestevez@chu-lille.fr.
K. Bicetre School of Medicine, Paris-Saclay University, Département d'Anesthésie, Hôpital Antoine Béclère - APHP.Université Paris-Saclay, 157 rue de la porte de Trivaux, 92140, CLAMART, France. Electronic address: agnes.le-gouez@aphp.fr.
K. Bicetre School of Medicine, Paris-Saclay University, Département d'Anesthésie, Hôpital Antoine Béclère - APHP.Université Paris-Saclay, 157 rue de la porte de Trivaux, 92140, CLAMART, France. Electronic address: frederic.mercier@aphp.fr.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):187-198.

Caesarean delivery is the most performed inpatient surgery worldwide, with rates expected to rise. Optimising maternal recovery benefits not only the mother, but also the newborn and society. Enhanced Recovery After Caesarean delivery (ERAC) protocols standardize the approach to perioperative management of patients in order to accelerate early postoperative maternal rehabilitation. Implementation of ERAC protocols has been associated with improved maternal and neonatal outcomes including shorter hospital stay, lower pain scores and opioid consumption, fewer complications, higher maternal satisfaction, and greater breastfeeding success. Higher-quality evidence is needed to support and evaluate ERAC protocols as they continue to be refined with the application of regional analgesia and an individualized approach to pain management. Recent work has described the postpartum period as a complex multidimensional process. A holistic approach to measuring postpartum recovery could provide valuable insights for tailoring interventions and supporting services to promote maternal recovery after caesarean delivery.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA; Department of Anaesthesia and Perioperative Medicine, University College London Hospital NHS Foundation Trust, London, UK. Electronic address: s.ciechanowicz@nhs.net.
Department of Anesthesiology, University Hospital Leuven, Belgium.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):199-208.
Optimising recovery after caesarean delivery.

Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations. Therefore, second-line uterotonics, such as ergometrine, carboprost, sulprostone or misoprostol, need to be considered earlier than they have been in past clinical practice. Choice of second-line uterotonic will vary depending on the comorbidities of the patient. This article will outline each of the available first- and second-line uterotonics, their mechanisms of action, pharmacokinetics, side effects and contraindications. Comparisons between them will also be discussed, as well as differences in superiority and guidance on dosing, based on recent evidence.
Department of Anaesthesia, Guy's & St. Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK. Electronic address: desire.onwochei@gstt.nhs.uk.
Department of Anaesthesia, Guy's & St. Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK. Electronic address: neel.desai@gstt.nhs.uk.
Center for Reproductive Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, USA. Electronic address: ltsen@bwh.harvard.edu.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):209-220.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, and mitigating it is a global health priority. In this review, we discuss the measurement, assessment, and treatment of PPH. We review different methods of quantifying blood loss, including gravimetry, calibrated drapes and canisters, and colorimetric techniques. Additionally, we highlight the importance of obstetric-specific massive transfusion protocols, point-of-care coagulation testing, and the role of fibrinogen and tranexamic acid. Lastly, we review placenta accreta spectrum management. Anesthesiologists are critical participants in the management of PPH, ultimately influencing patient outcomes.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center & Parkland Memorial Hospital, 5323 Harry Hines Blvd, Dallas, Texas, 75390, USA. Electronic address: allison.mootz@utsouthwestern.edu.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. Electronic address: jkowalczyk@bwh.harvard.edu.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. Electronic address: sseifert@bwh.harvard.edu.
Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA. Electronic address: daniel.katz@mountsinai.org.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. Electronic address: screale@bwh.harvard.edu.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):221-232.
Postpartum hemorrhage assessment and targeted treatment.

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality and morbidity worldwide. Recent advances in understanding the hemostatic changes of pregnancy and PPH have led to the development of obstetric-specific approaches to resuscitation. This article aims to examine. 1) changes in the coagulation system during pregnancy. 2) types of coagulopathy associated with PPH, and. 3) the role of point of care tests of coagulation in PPH.
Department of Anaesthesia and Perioperative Medicine, Cardiff and Vale University Hospital, Cardiff, UK. Electronic address: nicholas.gill@wales.nhs.uk.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Department of Anaesthesia and Perioperative Medicine, Cardiff and Vale University Hospital, Cardiff, UK.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):233-245.
Navigating coagulopathy in obstetric hemorrhage: The role of point-of-care testing.

The issue of obesity continues to reach new levels globally, affecting individuals across the age continuum. Obesity in pregnancy is associated with myriad comorbidities which may negatively impact the fetus, particularly dysfunctional labor and failure to progress ending in unplanned cesarean delivery. Neuraxial anesthesia represents the gold standard for cesarean delivery anesthesia and is increasingly beneficial for obese patients due to the risk of difficult airway. Obese parturients demonstrate higher rates of venous thromboembolism and wound infections and appropriate prophylaxis strategies to prevent these complications is imperative. While neuraxial anesthesia is the preferred technique for peripartum analgesia and cesarean delivery anesthesia, procedures can be technically challenging in patients with obesity, and may require more time, longer needles, increased experience, or ultrasound guidance. There is some concern for respiratory depression with the administration of neuraxial opioids in patients with obesity which has culminated in the development of post-operative monitoring guidelines.
Department of Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Durham, NC, 27710, USA. Electronic address: ctaylor@ecaa.com.
East Carolina Anesthesia Associates, WakeMed Hospital System, Greenville, NC, 27834, USA.
Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):257-266.
Morbid obesity: Optimizing neuraxial analgesia and cesarean delivery outcomes.

Despite advances in procedural techniques and equipment, postdural puncture headache (PDPH) remains a serious complication of labour epidural analgesia after accidental dural puncture (ADP). Often considered a temporary inconvenience, PDPH can be debilitating in the short term. It can also be associated with chronic manifestations and serious complications. The precise underlying mechanisms of PDPH are still incompletely understood, and longstanding beliefs of dysregulation of cerebrospinal fluid (CSF) homeostasis due to CSF fluid loss are currently being challenged. The existence of orthostatic headaches unrelated to CSF loss demands consideration of other mechanisms involved, for instance, related to the autonomic nervous system or the release of calcitonin gene-related peptide (CGRP) associated with activation of the meningeal and cerebral arteries. A multi-society international working group recently provided evidence-based recommendations on the prevention, diagnosis, and management of PDPH resulting from neuraxial procedures. According to the recommendations, there was insufficient evidence to support the routine use of intrathecal catheters or sphenopalatine ganglion blocks to prevent or treat PDPH. Both evidence-based and experimental strategies include stabilizing CSF dynamics through preventing CSF loss, supplementing CSF, or increasing production, and reducing cerebral vasodilation. Future research in PDPH preventive and therapeutic strategies can be facilitated with standardised definitions, interventions, and outcome measures. Analyses should consider various confounding factors and recognise the complex multifactorial nature of pain experience across diverse populations. Clinical care and research on PDPH will demand a multidisciplinary collaborative effort to elucidate the complexities of its pathophysiology and further improve patient outcome and quality of care.
Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318, Dordrecht, the Netherlands; Leiden University Medical Centre, Albert Schweitzerplaats 25, 3318, AT Dordrecht, Leiden, the Netherlands. Electronic address: xschyns@me.com.
Northwick Park Hospital Middlesex, UK. Electronic address: nuala.lucas@nhs.net.
Yale Medicine/Yale New Haven Health System, USA. Electronic address: Lisa.Leffert@Yale.edu.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):267-277.
Postdural puncture headache: Beyond the evidence.

Cardiovascular disease is a leading cause of morbidity and mortality for pregnant patients. A significant portion of cardiac morbidity and mortality is preventable and related to poor or delayed recognition of clinical warning signs and oversights in management. The establishment of pregnancy heart teams facilitates multidisciplinary planning to improve management of people with cardiovascular disease. Core members of the pregnancy heart team include obstetricians, midwives, cardiologists, anesthesiologists, nurses, and patient care coordinators. Additional specialists and subspecialists are included on pregnancy heart teams based on individual patient needs. This review discusses the practical aspects of the pregnancy heart team's approach to caring for pregnant people with cardiovascular disease.
Department of Anesthesiology, Duke University Medical Center, DUMC, 3094, Durham, NC, 27710, USA. Electronic address: Liliane.r.ernst@gmail.com.
Department of Anesthesiology, Duke University Medical Center, DUMC, 3094, Durham, NC, 27710, USA. Electronic address: marielouise.meng@duke.edu.
Department of Obstetrics and Gynecology, University of North Carolina, 3009 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599, USA. Electronic address: Johanna_quist-nelson@med.unc.edu.
Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3052, Australia. Electronic address: dominica.zentner@mh.org.au.
Joan Kirner Women's and Children's Sunshine Hospital, Western Health, St Albans, Australia. Electronic address: adennis@unimelb.edu.au.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):278-292.
Managing cardiovascular disease in pregnant people: Defining the pregnancy heart team.

OLV Clinic Aalst, Belgium. Electronic address: Stefaan.bouchez@olvz-aalst.be.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):1-3.
Thoracic anesthesia, ventilation, and oxygen delivery: 'A review of the recent advancements'.

Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods. The physiological changes of pregnancy demand close attention and adjustment of ECMO parameters, along with multidisciplinary collaboration. While potential complications such as bleeding and thromboembolism require vigilant management and optimal management of ECMO support in pregnancy still needs to be elucidated, ECMO nevertheless yields favorable maternal and fetal outcomes.
Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.
Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Saint John Regional Hospital, 400 University Ave, Saint John, NB, E2L 4L2, Canada. Electronic address: mike.wong@dal.ca.
Department of Anesthesiology, University of Maryland Medical Center, University of Medicine School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
Department of Anaesthesiology, University Hospitals Leuven (BE), Department of Cardiovascular Sciences, KU Leuven (BE), Herestraat 49, B-3000, Leuven, Belgium.
Best Pract Res Clin Anaesthesiol. 2024-09;38(3):293-301.
Extracorporeal membrane oxygenation and pregnancy.

The use of ultrasound (US) in the perioperative clinical management should be goal-directed, rapid, and reproducible. Thoracic US enables detailed examinations of vital structures, such as the airway, lung, pleural space, diaphragm, and heart. This chapter focuses on the value of US as a bedside tool to assess anatomy, guide procedures, and monitor vital organ function in patients undergoing thoracic surgery.
Department of Anaesthesiology, Intensive care and Emergency Medicine, OLV Clinic, Aalst, Belgium. Electronic address: Stefaan.bouchez@olvz-aalst.be.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):18-31.
Utility of ultrasound in thoracic anesthesia.

Anaemia is a common phenomenon in patients with malignant gynecological tumors. The occurrence of anaemia in the perioperative period leads to an increased probability of blood transfusion, increased surgical complications,poor wound healing, prolonged hospitalization, increased medical costs, and increased mortality. Intravenous iron, which is known for its rapid onset and lack of gastrointestinal side effects, has become increasingly prevalent in clinical practice. A total of 300 patients with gynaecological malignancies were admitted to The First Affiliated Hospital,Hengyang Medical School,University of South China between January, 2019 and December , 2021. Anaemia was assessed during routine blood tests by measuring red blood cell (RBC) counts, hemoglobin (Hb) levels, haematocrit (HCT) values, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH). The postoperative blood transfusion rate, transfusion volume, infection rate, and hospitalization duration were also recorded and comparisons were made between the control and treatment groups.Our study showed that preoperative intravenous iron injection can effectively increase haemoglobin levels in patients with anemia caused by gynecological cancer, reduces the probability of perioperative blood transfusion., decreases postoperative complications and infection rates, shortens hospital stays, and improves short-term prognosis in patients. We concluded that intravenous iron presents is a valuable clinical option for addressing perioperative anaemia in patients with gynecologic malignancies.
Gynecology &Obstetrics and Reproductive Medical Center,The First Affiliated Hospital, Hengyang Medical School,University of South China.
Department of Medical Oncology, The First Affiliated Hospital,Hengyang Medical School,University of South China.
Department of Cardiology, The First Affiliated Hospital,Hengyang Medical School,University of South China.
L'anémie est un phénomène courant chez les patientes atteintes de tumeurs gynécologiques malignes. La survenue d'une anémie pendant la période périopératoire entraîne une probabilité accrue de transfusion sanguine, une augmentation des complications chirurgicales, une mauvaise cicatrisation des plaies, une hospitalisation prolongée, une augmentation des coûts médicaux et une mortalité accrue. Le fer intraveineux, connu pour son action rapide et son absence d’effets secondaires gastro-intestinaux, est devenu de plus en plus répandu dans la pratique clinique. Au total, 300 patientes atteintes de tumeurs malignes gynécologiques ont été admises au premier hôpital affilié de la faculté de médecine de Hengyang de l'université de Chine du Sud entre janvier 2019 et décembre 2021. L'anémie a été évaluée lors d'analyses sanguines de routine en mesurant le nombre de globules rouges (GR). taux d'hémoglobine (Hb), valeurs d'hématocrite (HCT), volume corpusculaire moyen (VGM) et volume corpusculaire moyen hémoglobine (MCH). Le taux de transfusion sanguine postopératoire, le volume de transfusion, le taux d'infection et la durée d'hospitalisation ont également été enregistrés et des comparaisons ont été faites entre les groupes témoin et de traitement. Notre étude a montré que l'injection intraveineuse préopératoire de fer peut augmenter efficacement les taux d'hémoglobine chez les patients souffrant d'anémie causée par un cancer gynécologique. , réduit la probabilité de transfusion sanguine périopératoire., diminue les complications postopératoires et les taux d'infection, raccourcit les séjours à l'hôpital et améliore le pronostic à court terme des patients. Nous avons conclu que le fer intraveineux constitue une option clinique précieuse pour traiter l'anémie périopératoire chez les patientes atteintes de tumeurs gynécologiques malignes.
Intravenous iron therapy for treating patients with iron deficiency anaemia during the perioperative period of gynecological malignancy.

Lung cancer is among one of the most commonly diagnosed malignancies and is the leading cause of cancer-related mortality in both men and women globally, with an estimated 1.8 million deaths annually. Moreover, it is also the leading cause of cancer related deaths in the United States (U.S.), with an estimated 127,000 deaths annually. Approximately 50% of patients who undergo chest Computed Tomography (CT) are found to have a pulmonary nodule (PN), albeit 95% of these PNs are subsequently found to be benign. Further complicating the challenge of timely detection of lung cancer, is made more difficult by the fact that most patients are totally asymptomatic in early stage of disease. However, given that sponsored studies by National Cancer Institute (NCI) and other organizations showed a 20% reduction in lung cancer specific mortality with low dose CT scanning in patients at risk, it is reasonable to assume that clinicians will confront this clinical scenario more frequently. Consequently, due to these significant findings, the United States Preventive Services Task Force (USPSTF) recommended annual screening of high-risk patients. Therefore, as result of these recommendations, 240,000 new lung cancers were diagnosed in the U.S. in 2020, with an estimated 238,000 new cases in 2023. Given the multitude of challenges, the practice guidelines and recommendations for the management of these PNs are often tailored to available resources and trained personnel familiar with the various techniques and technologies. This review will discuss the evolution of various advancements when tissue biopsy is required: from sputum cytology, nonguided bronchoscopy, percutaneous CT guided biopsy, guided advanced bronchoscopic techniques such as endobronchial ultrasound (EBUS), radial Endobronchial Ultrasound (rEBUS) to the latest advancement of robotic-assisted bronchoscopy (RAB). Furthermore, as many of the aforementioned techniques require anesthesia, as integral members of the multidisciplinary team, anesthesiologists are often in the unique position of facilitating diagnosis and subsequent treatment by other subspecialists when providing anesthetic care for these patients with PNs. Additionally, the common anesthetic considerations and implications for the preoperative, intraoperative, and postoperative periods will be elucidated further, with special emphasis on the unique considerations for RABs. Combined hybrid procedures with RAB, EBUS and surgery will also be reviewed, as they offer potential reduction in time of diagnosis to definitive treatment. Lastly, the strategies employed to mitigate some of the commonly encountered challenges faced by anesthesiologists when caring for these patients will also be reviewed.
1400 Holcombe Blvd, FC 13.2000, Houston, TX, 77030, USA. Electronic address: icifeanyi@mdanderson.org.
1400 Holcombe Blvd, FC 13.2000, Houston, TX, 77030, USA. Electronic address: jsheir@mdanderson.org.
1400 Holcombe Blvd, FC 13.2000, Houston, TX, 77030, USA. Electronic address: Oidowu@mdanderson.org.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):38-46.
Robotic bronchoscopy: Evolution of advanced diagnostic technologies for pulmonary lesions.

Health care workers are at risk of infection from aerosolization of respiratory secretions, droplet and contact spread. This has gained great importance after the COVID19 pandemic. Intra-operative aerosol-generating procedures are arguably unavoidable in the routine provision of thoracic anesthesia. Airway management for such patients during the COVID-19 pandemic including tracheal intubation, lung isolation, one-lung ventilation and flexible bronchoscopy may pose a significant risk to healthcare professionals and patients. The thoracic anesthetic community has been confronted with the need to modify existing techniques to maximize safety for patients and healthcare professionals.
Department of Anesthesiology, Postoperative Care and Pain Management, Hospital General Universitario deValència, 46014 Valencia, Spain; Department of Surgery, Universitat de València, 46010 València, Spain. Electronic address: mgranellg@hotmail.com.
Department of Anesthesiology, Postoperative Care and Pain Management, Hospital General Universitario deValència, 46014 Valencia, Spain.
Department of Surgery, Universitat de València, 46010 València, Spain; Ivano-Frankivsk National Medical University, 76018 Ivano-Frankivsk, Ukraine.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):32-37.
Thoracic anesthesia in patients with airborne disease .

Innovations and challenges for lung separation or isolation have evolved during the last few years. In this chapter, we present the up-to-date, robust evidence available during the previous five years supporting the positions of the different devices, techniques, and tricks for their use in adult and pediatric patients undergoing various thoracic surgical interventions. Additionally, we presented an update on lung isolation in patients with airway difficulty and the suggested training level to master these techniques.
Department of Anaesthesiology and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. Electronic address: gelysamara@uoi.gr.
Department of Anaesthesia, Intensive Care and Emergency Medicine, OLV Clinic Aalst, Aalst, Belgium. Electronic address: gabija_valauskaite@yahoo.com.
Cardiothoracic Anesthesia, Anesthesiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Cardiothoracic Anaesthesia Unit, Department of Anaesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansour, Egypt. Electronic address: mohamedrefaatletahan@yahoo.com.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):4-17.

The utilization of extracorporeal membrane oxygenation (ECMO) in complex thoracic surgery has become more frequent in recent years due to advances in technology, increased availability, and improved outcomes. ECMO has emerged as a vital tool to facilitate thoracic surgery for patients who would have otherwise been deemed unsuitable candidates. It has redefined the boundaries of surgical possibility where conventional methods fall short. ECMO is typically employed in specific thoracic surgery where conventional ventilation is either inadequate or it interferes with the surgical field, and in procedures demanding both ventilatory and hemodynamic support.
From the Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA. Electronic address: lena.glowka@yale.edu.
From the Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA. Electronic address: wanda.popescu@yale.edu.
From the Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT, 06520-8051, USA. Electronic address: bhoumesh.patel@yale.edu.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):47-57.
Extracorporeal membrane oxygenation in thoracic surgery: A game changer!

The care for lung transplantation patients is a complex, multidisciplinary coordination of physician and non-physician teams throughout the perioperative period. The diversity of etiologies of recipient end-stage lung disease further complicate care, as recipients often present with concomitant end-stage cardiac disease. Recently, the use of extracorporeal membrane oxygenation has become the mechanical circulatory support of choice to provide cardiopulmonary stability throughout the perioperative period. This review will focus specifically on the anesthetic considerations for perioperative extracorporeal membrane oxygenation in lung transplantation throughout preoperative bridge to transplantation, intraoperative management, and postoperative utilization.
Department of Anesthesiology and Pain Management, Hospital Foch, Suresnes, France.
Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA. Electronic address: Martin.Archer@mayo.edu.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):58-63.
Anesthetic considerations for perioperative ECMO in lung transplantation.

The objectives of this minireview are two-fold. The first is to discuss the evolution of opioid analgesia in perioperative medicine in the context of thoracic non-cardiac surgery. Current standard-of-care, aiming to optimize analgesia and limit undesirable side effects, is discussed in the context of multimodal analgesia, specifically enhanced recovery after thoracic surgery pathways. The second is to review a developing research program that may ultimately add another element to the personalization of analgesic plans for individual cancer patients based on optimizing oncological outcomes. Termed precision oncoanalgesia, this emerging field aims to elucidate how individual patient-specific tumor omics (genomics, transcriptomics, etc.) may mediate the effects of analgesic drugs on oncological recurrence and survival.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Department of Anesthesia and Critical Care Medicine, 1275 York Avenue, New York, NY, 10028, USA. Electronic address: pedotoa@mskcc.org.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Department of Anesthesia and Critical Care Medicine, 1275 York Avenue, New York, NY, 10028, USA. Electronic address: fischerg@mskcc.org.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Department of Anesthesia and Critical Care Medicine, 1275 York Avenue, New York, NY, 10028, USA. Electronic address: mincer@mskcc.org.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):74-80.
The current (and possible future) role of opioid analgesia in lung cancer surgery.

Effective pain control is crucial in the management of thoracic surgical patients since it reduces postoperative morbidity and promotes recovery. These patients have co-existing respiratory diseases and impaired pulmonary function, which may be further impaired by surgery. With the adoption of minimally invasive surgical techniques and an emphasis on enhancing recovery after surgery, multimodal analgesia has gained popularity as a way to reduce perioperative opioid use and its associated adverse events such as respiratory depression. The literature related to opioid-sparing analgesia in thoracic surgery is still evolving. This review summarizes the latest research related to the use of various intravenous, oral, and perineural pharmacological agents as a part of multimodal analgesic regimen for pain relief in patients undergoing thoracic surgery and provides a summary for their application in clinical practice.
Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, 45267, OH, United States. Electronic address: Benu.Makkad@gmail.com.
Department of Anesthesiology, Columbia University, 622 W 168th St, New York, 10032, NY, United States. Electronic address: Bk127@cumc.columbia.edu.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):64-73.
Challenges in acute postoperative pain management in thoracic surgery.

This review documents the importance of postoperative interventions that accelerate the functional recovery of the thoracic surgical patient. Enhanced recovery after surgery (ERAS) pathways aim to mitigate the harmful surgical stress response. Improvements to the entire patient pathway, by removing unnecessary care elements while introducing evidence-based interventions, have synergistic effects. At the same time, some key care elements appear to be more important than others, including early removal of chest tubes, early mobilization, and the limited use of opioids. These care elements are all intertwined. The goals of early mobilization and opioid-sparing analgesia are more readily achieved once a chest tube has been removed. A focus on achieving these goals earlier, including on the day of surgery, may benefit a patient's recovery further. The result is superior patient outcomes including a quicker restoration of normal function, fewer complications, reduced opioid requirements, reduced costs, and a shorter length of stay.
Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. Electronic address: tim.batchelor@nhs.net.
Best Pract Res Clin Anaesthesiol. 2024-03;38(1):81-89.
Postoperative care after thoracic surgery in the times of ERAS.

Patient Blood Management evolved in recent years, focusing on the haematopoietic system as relevant to all disciplines of medicine. The allogeneic blood supply chain travels from donation, to fractionation, preservation, and storage, to therapeutic, established treatments, or prophylactics for a wide range of medical conditions. This supply chain 'connects' altruistic blood donors to patients in need, symbolising a 'gift relationship', emphasising the empathetic bond between donor and recipient. In 1988, the author proposed a paradigm shift in blood transfusion and, in 2005, introduced the term Patient Blood Management (PBM). PBM's origins are traceable to the late 19th century, when blood transfusion wasn't feasible for managing exsanguinating haemorrhage or critical anaemia. Landsteiner's discovery of the ABO blood groups firmly established blood component therapy into medical therapeutics. This article recounts the journey from a pre-blood transfusion era patient-centred approach, through the 20th century's blood product focus, and thenceforth back to the patient with the advent of PBM.
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Sydney Medical School, University of Sydney, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia. Electronic address: jpisbister@gmail.com.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):439-450.
Roads travelled: The journey to Patient Blood Management at 35 years.

Department of Anaesthesia, Austin Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. Electronic address: lachlan.miles@unimelb.edu.au.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):437-438.

Peri-operative bleeding is a major cause of morbidity and mortality in patients undergoing surgery. Tranexamic acid, an antifibrinolytic agent, is effective for prevention and treatment of bleeding in a variety of different surgical populations. This review summarizes the evidence supporting the use of tranexamic acid in major surgical settings including cardiac surgery, obstetrics, orthopedic surgery, and non-cardiac surgery. We discuss potential adverse effects with use of tranexamic acid including the theoretical risk of thrombosis. Lastly, we discuss other potential benefits of tranexamic acid including prevention of infection and maintenance of blood-brain barrier integrity.
Copyright © 2023. Published by Elsevier Ltd.
Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Hematology, Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
Division of Hematology, Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada. Electronic address: michelle.sholzberg@unityhealth.to.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):468-476.
Intra-operative tranexamic acid: A standard of care?

Iron deficiency, a pervasive global health issue, necessitates precise and reliable diagnostic methods, especially in clinical and surgical settings. This review examines an array of established markers of iron status, encapsulating parameters such as serum iron, ferritin, transferrin, and transferrin saturation alongside novel biomarkers like soluble transferrin receptor, zinc protoporphyrin, and hepcidin. We further scrutinise the potential and limitations of routine and novel diagnostic tools and strategies in distinguishing different anaemic conditions, such as iron deficiency anaemia, iron-restricted erythropoiesis, and anaemia of inflammation. Through a critical lens, we elucidate the current paradigms and pressing questions surrounding the diagnostic criteria and clinical ramifications of iron metabolism. By weaving together the nuances and diverging perspectives within the domain of iron deficiency diagnosis and management, this review aspires to foster a clearer understanding that can steer improved patient care and shape the trajectory of future research in this vital field.
Copyright © 2023 The Author. Published by Elsevier Ltd.. All rights reserved.
Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa. Electronic address: jody.rusch@uct.ac.za.
Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
Department of Medicine, J-floor, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):451-467.
Diagnosing iron deficiency: Controversies and novel metrics.

Postoperative anaemia is common among surgical patients. While often viewed as a benign condition, postoperative anaemia is neither inevitable nor harmless, being intricately linked with adverse outcomes. In this review, we summarize the prevalence, aetiology, and outcomes of postoperative anaemia and highlight prevention and management strategies. Further, we propose a novel framework to characterize postoperative anaemia as an acute organ injury (i.e., acute blood injury, anaemic subtype), thereby drawing attention to a condition that is frequently overlooked. Additionally, we discuss areas warranting further research, including risk stratification for patients at heightened risk for the development of postoperative anaemia and associated complications and determination of appropriate treatment strategies.
Copyright © 2023 Elsevier Ltd. All rights reserved.
Mayo Clinic Alix School of Medicine, Mayo Clinic, Minnesota, 200 1st St SW, Rochester, MN, 55906, USA. Electronic address: crispell.ethan@mayo.edu.
Mayo Clinic Alix School of Medicine, Mayo Clinic, Minnesota, 200 1st St SW, Rochester, MN, 55906, USA. Electronic address: trinh.jessica@mayo.edu.
Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Minnesota, 200 1st St SW, Rochester, MN, 55906, USA. Electronic address: warner.matthew@mayo.edu.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):486-494.
Postoperative anaemia: Hiding in plain sight.

Patients with cancer who receive allogeneic red blood cell transfusions are at risk of adverse reactions of varying severity. One of these reactions is immunomodulation, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor. Leucocytes are believed to be implicated in storage lesions and immunomodulation. However, the efficacy of leucodepletion in reducing immunomodulation is controversial. The theoretical link between these three interconnected events - storage lesions, immunomodulation and cancer progression remain controversial and poorly understood. This article summarizes the available evidence on efficacy of leucodepletion, storage lesions and transfusion related immunomodulation, while rationalizing the possible association between an immunomodulation triggering transfusion 'dose' in cancer patients and subsequent cancer recurrence.
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, USA; Anesthesiology and Surgical Oncology Research Group, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, USA; Anesthesiology and Surgical Oncology Research Group, USA. Electronic address: jcata@mdanderson.org.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):495-502.
Does one unit really matter? Immunological effects of transfusion after universal leucodepletion.

Anemia and red blood cell transfusion are associated with adverse outcomes. Large randomized trials have demonstrated that restrictive transfusion strategies can safely reduce patient exposure to transfusion, forming a foundational pillar of patient blood management. The restrictive transfusion thresholds in these trials ranged from 7 to 8 g/dL for different populations and this variability is reflected in recent guideline recommendations for transfusion triggers. Such variability implies heterogeneity among populations with respect to the transfusion threshold for optimal outcomes. Individual variability (tolerance to anemia, risk of tissue hypoxia, risk of red blood cell transfusion) has not been addressed by population-based trials, supporting the argument for 'physiological transfusion triggers' indicative of inadequate organ perfusion. However, physiological triggers have only been assessed in small feasibility trials without convincing outcome data. This review summarizes data from recent transfusion trials and transfusion guidelines, and reviews potential physiological triggers which could further refine transfusion practices and minimize risks of tissue hypoxia and adverse outcomes.
Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: David.Mazer@unityhealth.to.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):477-485.
How low can you go: Restrictive transfusion strategies in major surgery and physiological triggers.

Patient blood management is the umbrella term for a suite of initiatives designed to optimise blood product usage, minimise transfusion needs, and ensure appropriate and evidence-based transfusion practices. In this review we summarise published economic evaluations of patient blood management to determine whether they represent good value for money. We identified 54 economic evaluations of patient blood management, the majority of which had positive cost-effectiveness conclusions. In particular, anaemia management with ferric carboxymaltose, adopting a restrictive transfusion strategy, and the administration of tranexamic acid appear likely to be highly cost effective. Intraoperative cell salvage may be cost effective if used in patients at high risk of bleeding. Overall, patient blood management programmes are likely to reduce costs and improve patient outcomes in a wide range of patient populations. No identified evaluations included an assessment of the impact of patient blood management on preserving the blood supply.
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.
Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Australia; Centre for Health Economics, Monash Business School, Monash University, Australia. Electronic address: adam.irving@monash.edu.
Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Australia; Department of Clinical Haematology, Monash Health, Melbourne, Australia. Electronic address: zoe.mcquilten@monash.edu.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):511-518.
Does patient blood management represent good value for money?

Preoperative anemia affects one-third of patients undergoing major surgery and is associated with worse perioperative and postoperative outcomes; including length of hospital stay, allogeneic blood transfusion, morbidity, and mortality. Iron deficiency is the most common cause of anemia, and associative data suggests that preoperative correction of iron deficiency anemia could improve postoperative patient outcomes. However, data from randomized controlled trials (RCTs) do not appear to support the routine use of iron therapy to treat preoperative anemia. We present a literature review of large RCTs examining the efficacy of preoperative intravenous iron. We discuss the observation that although preoperative intravenous iron treatment can increase hemoglobin concentration prior to surgery in certain patient groups, the data do not clarify whether there is a direct benefit to patients. We address that preoperative intravenous iron may not be a feasible option and highlight the need to explore the mechanism and management of iron deficiency anemia in surgical patients.
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia. Electronic address: Beth.MacLean@research.uwa.edu.au.
Division of Hematology-Oncology, Department of Pediatrics, University of Michigan Medical School, Michigan, USA.
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):503-510.
Preoperative iron therapy: Where are we?

Preoperative anemia is frequent and is associated with poor patient outcomes and higher transfusion rates. Perioperative blood transfusion is also associated with poor outcomes. These observations justify efforts to increase hemoglobin levels in anemic patients before surgeries with a moderate to high bleeding risk. Erythropoiesis-stimulating agents (ESAs) were developed in the 80s and are now widely used for the treatment of renal and cancer-related anemia. In the perioperative settings, ESAs were successfully proposed for preoperative blood donation programs in the 90s. Since then, substantial evidence has been available demonstrating that high-dose ESAs associated with iron (ideally intravenously), administered 3-4 weeks before surgery, increase perioperative hemoglobin levels and reduce the need for blood transfusion in some surgeries. Different strategies might be proposed ranging from a systematic treatment for all patients with hemoglobin below 13 g/dL (especially in orthopedic and cardiac surgeries) to a more personalized approach to anemia treatment (targeting anemia related to inflammation or renal insufficiency). ESAs might increase the risk of adverse events, including thromboembolism, and the benefit-risk ratio must be carefully weighted for high-risk patients (particularly for those undergoing cancer surgery). The cost-effectiveness of ESA use remains to be evaluated.
Université d'Angers, Département Anesthésie Réanimation, CHU Angers, Angers, France; Université d'Angers, UMR CNRS 6015, Inserm U1083, Unité MitoVasc, Team Carme, Angers, France. Electronic address: Sigismond@lasocki.com.
Université d'Angers, Département Anesthésie Réanimation, CHU Angers, Angers, France; Université d'Angers, UMR CNRS 6015, Inserm U1083, Unité MitoVasc, Team Carme, Angers, France.
Université d'Angers, Département Anesthésie Réanimation, CHU Angers, Angers, France.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):519-526.
ESAs in perioperative anemia management: Who, what, how and why?

Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin concentrates, fibrinogen concentrates and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate. This review discusses these compounds, compares them to conventional blood products, discusses the trial data supporting their use, and reviews indications for intraoperative transfusion based on point-of-care testing and conventional laboratory results. While factor concentrates have become an increasingly popular option for treating acquired factor deficiency in surgical patients, evidence is evolving and clinical trial data in one surgical patient population may not be transferable to another. High quality clinical studies will help optimize management of coagulopathy and improve patient outcomes while decreasing any associated risks.
Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: Amir.Zabida@uhn.ca.
Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: research.anesthesia@utoronto.ca.
Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Best Pract Res Clin Anaesthesiol. 2023-12;37(4):527-536.
Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy - Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII.

This study assesses gender inequality in education and employment in BRICS (Brazil, Russia, India, China, and South Africa) countries between the 2000 and 2021, using data from the World Bank database. A descriptive data analysis was carried out as well as graphical representations to compare among countries. The results showed that that female education achieved significant success, especially at secondary and tertiary levels, through specific policies including financial support and affirmative actions. Brazil and Russia maintained an increasingly higher enrollment at the secondary level of education. In contrast, China recorded very rapid growth in tertiary enrollments, reaching over 92% enrolment of females. History, poverty, and social pressures were identified as systemic barriers in the enrollment of girls to school in India and South Africa. This study indicate that even when gains are achieved on the educational front, translating them into gains in terms of equality in employment proves difficult. Secondly, the unemployment rates among females in countries such as Brazil and South Africa are higher, reflecting more significant socio-economic problems. This calls for more vigorous policy responses toward gender inequality within the labour market through labour reforms, job creation policies, and specific support to women's employment in the informal sector in the BRICS countries.
Changchun Sci-Tech University, JiLin ChangChun 130600, China.
Cette étude évalue les inégalités entre les sexes dans l'éducation et l'emploi dans les pays BRICS (Brésil, Russie, Inde, Chine et Afrique du Sud) entre 2000 et 2021, à l'aide des données de la base de données de la Banque mondiale. Une analyse descriptive des données a été réalisée ainsi que des représentations graphiques pour comparer les pays. Les résultats ont montré que l'éducation des femmes a obtenu des succès significatifs, en particulier aux niveaux secondaire et supérieur, grâce à des politiques spécifiques comprenant un soutien financier et des actions positives. Le Brésil et la Russie ont maintenu un taux de scolarisation de plus en plus élevé dans l’enseignement secondaire. En revanche, la Chine a enregistré une croissance très rapide des inscriptions dans l’enseignement supérieur, atteignant plus de 92 % d’inscriptions de femmes. L’histoire, la pauvreté et les pressions sociales ont été identifiées comme des obstacles systémiques à la scolarisation des filles en Inde et en Afrique du Sud. Cette étude indique que même lorsque des progrès sont réalisés sur le plan éducatif, il s'avère difficile de les traduire en gains en termes d'égalité dans l'emploi. Deuxièmement, les taux de chômage des femmes dans des pays comme le Brésil et l’Afrique du Sud sont plus élevés, ce qui reflète des problèmes socio-économiques plus importants. Cela nécessite des réponses politiques plus vigoureuses à l'inégalité entre les sexes sur le marché du travail à travers des réformes du travail, des politiques de création d'emplois et un soutien spécifique à l'emploi des femmes dans le secteur informel dans les pays BRICS.
Gender inequality: policy responses to employment and education in BRICS countries.

West Nile virus (WNV), although underdiagnosed, is the most common mosquito-borne disease and the second most common cause of viral encephalitis in the United States. Fewer than 1% of those infected develop neuroinvasive disease.We present a cluster of 3 cases of neuroinvasive WNV that occurred between August and September 2023 and a review of the literature for neurologic involvement with this virus.Sunrise Electronic Health Record; PubMed; Google; Division of Infectious Disease Diagnostics, Northwell Health Laboratories, Little Neck, NY.The patients in all 3 cases were admitted with acute encephalopathy and other neurologic impairment. All 3 patients had a serum serologic diagnosis consistent with WNV. However, only one of 3 of the patients underwent a lumbar puncture with cerebrospinal fluid confirmation of WNV.Clinical and laboratory guidelines have been described for the diagnosis of neuroinvasive WNV infection. This is especially important in patients who do not have cerebrospinal fluid confirmation.WNV is underdiagnosed. Furthermore, although neuroinvasive WNV infection is uncommon, this diagnosis should be considered in patients presenting with abnormal neurologic signs and symptoms during the summer months in geographic areas where potential transmission is of concern.
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Department of Medicine, Long Island Jewish Forest Hills (Northwell Health), Forest Hills, NY.
Division of Infectious Disease Diagnostics, Northwell Health Laboratories, Little Neck, NY; and.
Department of Medicine, Long Island Jewish Forest Hills (Northwell Health), Forest Hills, NY.Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY.
West Nile Neuroinvasive Disease: Case Series and Review of the Literature.

Sickle cell patients may develop a multitude of antibodies and experience life-threatening events with transfusion such as hyperhemolysis syndrome or delayed hemolytic transfusion reaction. Further transfusion may not be possible in such cases.When conventional blood products are not available for transfusion yet the patient requires additional oxygen-carrying support, artificial oxygen carriers may be required. However, there are no such FDA-approved products available.Emergency investigational new drug applications for a polymerized hemoglobin-based oxygen carrier (HBOC-201, Hemopure) were completed, and Expanded Access use was granted for these patients. HBOC-201 is an investigational bovine hemoglobin-based oxygen carrier. Herein, we report how acute resuscitation with HBOC-201 was potentially life saving while waiting for supportive therapy, erythropoietin, and/or immune modulatory drugs to take effect in all 3 patients.
Transfusion Medicine, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Transfusion Medicine and Therapeutic Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM.
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Orthopaedic Hemophilia Treatment Center, Los Angeles, CA; and.
Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Artificial Oxygen Carriers Save Lives in Expanded Access Use: Three Cases when Blood Was Not an Option.

Department of Lymphatic Oncology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China.
Department of Lymphatic Oncology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.
An Investigation Into the Clinical Characteristics and Management Strategies for Patients With Lymphoma and Concomitant COVID-19.

Department of Anesthesiology, Ningbo Hangzhou Bay Hospital, Shanghai Jiao Tong University School of Medicine, Ningbo, China.
Department of Anesthesiology, Shanghai Renji Hospital,Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Anesthesiology, Ningbo Hangzhou Bay Hospital, Shanghai Jiao Tong University School of Medicine, Ningbo, China.Department of Anesthesiology, Shanghai Renji Hospital,Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Noninferiority Study of the Effects of Remimazolam Tosylate Versus Propofol on Cognitive Function in Elderly Patients Undergoing Elective Outpatient Colonoscopy.

University of Nevada, Reno School of Medicine, Reno, NV.Department of Neurology, Carson Tahoe Health, Carson City, NV.
Stanford University School of Medicine, Palo Alto, CA.Multidisciplinary Association for Psychedelic Studies, San Jose, CA.
Fermata Health, Brooklyn, NY; and.Acacia Clinics, Sunnyvale, CA.
Informed Consent to Psychedelic Medicine.

Enhancing the Evidence Base for the Efficacy of Nirmatrelvir-Ritonavir in Preventing COVID-19 Hospitalization and Mortality: A Call for Comprehensive Research Strategies.

Inferring the direction of image motion is an important component of visual processing. A study with in vivo dual electrophysiological recording now reveals that the sensitivity of visual cortical neurons to the direction of motion is established by specific neural connections from the visual thalamus.
Copyright © 2024 Elsevier Inc. All rights reserved.
Department of Gene Function and Phenomics, National Institute of Genetics, Mishima, Japan; Graduate Institute for Advanced Studies, Sokendai, Hayama, Japan.
Department of Gene Function and Phenomics, National Institute of Genetics, Mishima, Japan; Graduate Institute for Advanced Studies, Sokendai, Hayama, Japan. Electronic address: keisuke.yonehara@nig.ac.jp.
Motion detection: Specific thalamocortical connections revealed.

Body temperature regulation in endotherms requires warming the body when ambient temperatures are low and cooling the body when they are high. Now, neural circuitry that can achieve the opposite has been identified - a phenomenon called thermoregulatory inversion.
Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA. Electronic address: ramon.pinol@nih.gov.
Thermoregulation: When cooling cools and heating heats.

Non-N2-fixing cyanobacteria enter a state of dormancy when fixed nitrogen becomes limiting. Resuscitation from this state involves a complex program of events. A new study reveals how the dormancy-resuscitation switch is governed by metabolite-level control of glucose-6-phosphate dehydrogenase activity.
Institute for Microbiology, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany. Electronic address: gary.sawers@mikrobiologie.uni-halle.de.
Dormancy: Metabolite pools prime the cyanobacterial dormancy-resuscitation switch.

Are humans unique in using visual simulation to see beyond the 'here and now' in the mind's eye? A new study has now shown that monkeys can employ simulation to anticipate how physical events will unfold.
Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal. Electronic address: jason.fischer@fpce.uc.pt.
Visual simulation: Catching a glimpse of what's to come.

As soon as they can move, animals must learn to avoid potential predators. New research demonstrates that larval zebrafish can quickly learn to avoid specific predator-like robots in their first week of life, through coordinated noradrenergic and forebrain activity.
Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA. Electronic address: kam023@ucsd.edu.
Department of Neurobiology, School of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA. Electronic address: mlb@ucsd.edu.
Predator avoidance: Threat learning in week-old zebrafish.

A new study describes a fossilized ecdysozoan from Ediacaran rocks, extending the body fossil record for this hyper-diverse group and emphasizing the pivotal insights provided by Ediacaran fossils in documenting the early evolutionary history of major animal clades.
Department of Earth Sciences, University of Cambridge, Cambridge, UK. Electronic address: agscl2@cam.ac.uk.

A recently excavated Neanderthal skeleton from southern France has yielded DNA from a distinct lineage, different from other late Neanderthals. This suggests Neanderthals expanded and diversified about 120,000 years ago, and some of that diversity persisted in Europe until near the time of their extinction.
Centre for Human Evolution Research, The Natural History Museum, London, UK. Electronic address: c.stringer@nhm.ac.uk.
Human evolution: The lonely Neanderthal?

Department of Anthropology, University of Minnesota, Minneapolis, MN, USA. Electronic address: mnievesc@umn.edu.

Prokaryotes (Bacteria and Archaea) encode a highly diversified arsenal of defence systems that protect them against mobile genetic elements, such as phages and plasmids. In turn, mobile genetic elements encode anti-defence systems that allow them to escape the activity of these defence systems. This has resulted in an evolutionary arms race in which defence systems and anti-defence systems evolve and adapt continuously, driving intriguing innovation and enormous diversification on both sides. Over 150 prokaryotic defence systems have been identified to date. Anti-defence systems are known for only a subset of these, but more are being discovered at a steady rate. Despite an increasing understanding of the highly diverse molecular mechanisms of anti-defence systems, their diverse evolutionary origins, the selective pressures they are subjected to, and their ecological importance and implications often remain obscure. In this review, we describe the diverse strategies that phage and plasmid anti-defence systems employ to escape host defence systems. We explore the evolutionary origins of anti-defence systems and describe different factors that exert selective pressure, affecting their maintenance and diversification. We describe how, in turn, defence systems themselves evolved to act upon anti-defence mechanisms, thereby adding a new layer to the co-evolutionary battle between prokaryotes and their mobile genetic elements. We discuss how the continuous selective pressures found in dynamic microbial communities promote the retention and diversification of these anti-defence systems. Finally, we consider the ecological implications for both hosts and their mobile genetic elements, noting how the balance of defence and anti-defence strategies can shape microbial community composition, influence horizontal gene transfer, and impact ecosystem stability.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
Laboratory of Biochemistry, Wageningen University, 6708 WE Wageningen, The Netherlands.
Environment and Sustainability Institute, Biosciences, University of Exeter, Penryn TR10 9FE, UK.
Environment and Sustainability Institute, Biosciences, University of Exeter, Penryn TR10 9FE, UK. Electronic address: e.r.westra@exeter.ac.uk.
Laboratory of Biochemistry, Wageningen University, 6708 WE Wageningen, The Netherlands. Electronic address: daan.swarts@wur.nl.
Evolution and ecology of anti-defence systems in phages and plasmids.

Daniel Kronauer introduces the clonal raider ant, a unique species of ant that has no queens and where workers lay asexually produced eggs that develop into new workers.
Laboratory of Social Evolution and Behavior and Howard Hughes Medical Institute, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA. Electronic address: dkronauer@rockefeller.edu.

Endurance running is thought as critical for the evolutionary success of hominins. A new study analysing the running skills of the famous 'Lucy' - Australopithecus afarensis - finds that they performed poorer than modern humans, suggesting that key features of the human body plan evolved specifically to improve running performance.
Department of Anthropology, University College London, London, UK; McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK. Electronic address: a.wiseman@ucl.ac.uk.

Artificial urinary sphincter (AUS) is commonly used in France in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, it has never been assessed using patient-reported outcomes. This study aimed to evaluate the functional outcomes of robotic AUS implantation using validated questionnaires.The data from female patients who underwent robotic AUS implantation at a single academic center between 2014 and 2023 were collected prospectively. Preoperatively, all patients filled out a Urinary Symptoms Profile (USP) questionnaire, and the International Consultation Incontinence Questionnaire Short Form (ICIQ-SF). These were repeated at 3 mo postoperatively and annually along with a Patient Global Impression of Improvement (PGII) score. Quality of life was assessed using question 5 of the ICIQ-SF.Over the study period, 101 robotic female AUS implantation cases were performed by three surgeons. The median patient age was 66 yr (interquartile range: 53-73), and 86.9% had a history of previous SUI surgery. In our cohort, 12 patients had neurogenic SUI (11.8%). In terms of complications, there were 16 intraoperative (15.8%) and 26 postoperative (25.7%) complications, all of Clavien grade 1 or 2 except seven of Clavien grade 3B (major complication rate: 6.8%). All patient-reported outcomes improved significantly at 3 mo. The USP SUI subscore decreased from 7.3 preoperatively to 0.8 at 3 mo (/9; p < 0.0001), the USP overactive bladder subscore decreased from 12.6 to 5.1 (/21; p < 0.0001), and the ICIQ-SF decreased from 16.5 to 3.1 (/21; p < 0.0001). Quality of life improved, with the ICIQ-QoL decreasing from 8.8 preoperatively to 0.9 at 3 mo (/10; p < 0.0001). The 3-mo PGII score was 1/7 (very much improved) in 79 patients (78.8%).Robot-assisted AUS implantation in female patients has low morbidity and improves the patient-reported outcomes and quality of life of female patients with SUI due to ISD.This study represents the largest cohort of robotic female artificial urinary sphincter (AUS) implantation in the literature and is the first to report the patient-reported outcomes (PROMs) after female AUS implantation using validated questionnaires. We found significant improvement in all PROMs at 3 mo, except for voiding dysfunction symptoms. This study brings new robust data to help the widespread use of female AUS across the world, even if further studies with longer follow-up are needed to confirm that these results are maintained over time. We then compared the continence status reported by the patients with PROMs, finding a significant association. This highlights that the existing literature on female AUS, which lacks such PROMs, remains of interest.
Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.
Department of Urology, University of Rennes, Rennes, France. Electronic address: alexandreduboisint@gmail.com.
Department of Urology, University of Rennes, Rennes, France.
Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France.
Department of Urology, University of Rennes, Rennes, France; Department of Urology, Clinique Mutualiste La Sagesse, Rennes, France.
Impact of Robotic Artificial Urinary Sphincter Implantation in Female Patients on Quality of Life and Patient-reported Outcomes.

Pseudarthrosis is a major complication after posterior lumbar interbody fusion (PLIF) and transforaminal interbody fusion (TLIF), and its risk factors need to be identified. This study aimed to investigate the relationship between the number of remaining teeth (NRT) and pseudarthrosis.NRT, preoperative bone density of the proximal femur (percentages of young adult mean; % YAM), and preoperative procollagen type 1 N-terminal propeptide (P1NP) (μg/L) were retrospectively investigated in 63 patients (24 male and 39 female, mean age: 71.2 years, mean follow-up: 49.1 months) who underwent single-level PLIF/TLIF (L3/4, L4/5, L5/S1). Fusion status was analyzed on computed tomography (CT) scan at 24 months after surgery.Pseudarthrosis was significantly more frequent in the NRT ≤10 group than in the NRT ≥11 group (p < 0.05). Compared with the fusion group, the pseudarthrosis group had significantly higher population of males and lower % YAM. Logistic regression analysis was performed with the following variable combination models; Model 1: age, % YAM, NRT; Model 2: P1NP, % YAM, NRT; Model 3: sex, % YAM, NRT. NRT ≤10 was associated with pseudoarthrosis in all models (model 1: 95 % confidence interval (CI): 1.81-25.14, odds ratios (ORs): 6.74, p < 0.01, model 2; 95 % CI: 1.57-30.54, ORs: 5.88, p = 0.01, model 3; 95 % CI: 1.95-39.02, ORs: 7.07, p < 0.01). Sex was associated with pseudarthrosis in model 3 (95 % CI: 1.23-16.92, ORs: 4.30, p = 0.02).Small NRT was found to be a risk factor of pseudarthrosis after lumbar interbody fusion.
Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
Department of Orthopedic Surgery, Otaru General Hospital, 1-1-1, Wakamatsu, Otaru, Hokkaido, 047-8550, Japan.
Department of Orthopedic Surgery, Otaru General Hospital, 1-1-1, Wakamatsu, Otaru, Hokkaido, 047-8550, Japan; Department of Orthopedic Surgery, Sapporo Hospital, 16-1, N5E11, Sapporo, Hokkaido, 065-0005, Japan.
Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 065-0024, Japan. Electronic address: yka2q@pop.med.hokudai.ac.jp.
Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 065-0024, Japan.
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
Association between the number of remaining teeth and pseudarthrosis after lumbar interbody fusion: A retrospective cohort study.

This study aimed to assess the effect of implantation of fresh human amniotic membranes (HAM) on bone consolidation during distraction bone lengthening.Ten New Zealand white rabbits were used in this study. For each rabbit, we performed a diaphyseal tibial osteotomy after installing a single-plane distraction external fixator. Rabbits were divided into 2 groups (n = 5): an osteotomy and rapid lengthening of 2.8 mm/days (negative control (NC) group) or an osteotomy with implantation of fresh HAM and rapid lengthening of 2.8 mm/days (HAM group). We carried out a rapid lengthening at a rate of 2 turns/day for 7 days and a single turn on the 8th day knowing that one turn corresponds to an elongation of 1.4 mm. The total elongation obtained was 21 mm corresponding to 20-25 % of the length of the rabbit's tibia. A radiological study was carried out on 4 and 8 weeks after the end of lengthening. Micro-computed tomography (μ-CT) analysis was carried out 8 weeks after the end of the lengthening and after the sacrifice of the rabbits associated with histological analyses.For the HAM group, radiographic analysis showed that all cases consolidated with a homogeneous callus visible at 1 month after lengthening, and complete corticalization was demonstrated at μ-CT analysis. Histological staining exhibited thick continuous cortices with intramedullary fibro adipose tissue with a medulla rich in hematopoietic cells.The results show that HAM affects the stimulation of bone consolidation during bone lengthening by distraction.
Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP11 Lab, Faculty of Medicine, Sfax, Tunisia. Electronic address: najah.mounedi12@gmail.com.
Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP11 Lab, Faculty of Medicine, Sfax, Tunisia; Department of Orthopedics and Traumatology, CHU Habib Bourguiba, Sfax, Tunisia.
Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP11 Lab, Faculty of Medicine, Sfax, Tunisia.
Effect of human amniotic membrane on the consolidation during bone lengthening by distraction: Experimental study in rabbits.

Primary aldosteronism (PA) is a common, salt-sensitive form of endocrine hypertension. Compared with essential hypertension (EH), PA is more susceptible to cardiorenal complications and metabolic risks. However, PA has a low screening rate and a poor response to mineralocorticoid receptor antagonists (MRAs). In addition to somatic ion channel mutations and epigenetic alterations, which contribute to excessive production of aldosterone, cholesterol, as a crucial precursor for aldosterone biosynthesis, may be involved in PA pathogenesis. Abnormal adrenal cholesterol uptake and steroidogenesis have been found in patients with PA. Therefore, we propose that a statin-based therapeutic strategy may be pivotal for antagonizing PA-related comorbidities by targeting cholesterol-dependent adrenal steroidogenesis.
Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing, China.
School of Biomedical Sciences, Heart, and Vascular Institute, The Chinese University of Hong Kong, Hong Kong.
Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing, China; Chongqing Institute for Brain and Intelligence, Chongqing, China. Electronic address: zhuzm@tmmu.edu.cn.
Trends in endocrinology and metabolism: TEM
Trends Endocrinol Metab. 2025-01-06;():.
Targeting cholesterol-dependent adrenal steroidogenesis for management of primary aldosteronism.

Harmony between prostheses and periodontal tissues is essential. The presence of a fixed prosthesis has been reported to increase the risk of periodontal lesion onset in abutment teeth and to affect longevity. However, studies comparing the supragingival plaque biofilm on fixed prostheses and natural teeth are lacking.The purpose of this clinical study was to investigate the composition of supragingival plaque biofilm microorganisms on the surface of fixed prostheses and to identify differences with those of natural supragingival plaque microorganisms using 16S ribosomal deoxyribonucleic acid (rDNA) sequencing technology.A total of 40 participants were enrolled, including 20 with fixed prostheses and 20 healthy participants with no prostheses in the mouth; 60 samples of supragingival plaque were obtained. The groups included in this analysis were the cobalt chromium metal-ceramic crown group (P), zirconia ceramic crown group (A), natural tooth group with zirconia ceramic crown control (T_A), natural tooth group with cobalt chromium metal-ceramic crown control (T_P), and healthy group with no prostheses in the mouth (SUPP_A). The DNA of all samples was sequenced by using the 16S rDNA high-throughput sequencing technology, and the sequencing data were then examined bioinformatically using the Qiime, R, and PICRUSt2 software programs.The microbial composition and structural diversity of supragingival plaque on the surface of fixed prostheses were found to differ from those on natural teeth, with relatively high levels of periodontally related pathogens, including Treponema gingivalis, Selenomonas gingivalis, Porphyromonas gingivalis, and Prevotella_7 gingivalis. Functional analysis revealed that the fixed prosthesis group had relatively active microbial communities. The metabolism was relatively active, characterized by a high percentage of lipopolysaccharide biosynthesis, glycine, serine, and threonine metabolism associated with the development of periodontal disease. The microflora on the surface of ceramic crowns was more similar to that on natural teeth than to that on cobalt chromium metal-ceramic crowns.The present study found significant differences in the microbiological community composition of supragingival plaque between fixed prostheses and natural teeth. Notably, ceramic crowns exhibited less influence on the microbiological structure of supragingival plaque than metal-ceramic crowns. Therefore, the selection of ceramic materials for fixed restorations should be considered a crucial factor in preserving the health of periodontal tissues around abutment teeth from a microbiological perspective.
Copyright © 2025 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
Graduate student, Department of Stomatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Xiangzhou, Zhuhai City, Guangdong, PR China.
Resident, Department of Stomatology, Tai'an Central Hospital, 29 Longtan Road, Tai'an, Shandong Province, PR China.
Doctoral student, Key Laboratory for Zoonoses Research of the Ministry of Education, Institute of Zoonosis, College of Veterinary Medicine, Jilin University, Changchun, PR China.
Attending, Hospital of Stomatology, Jilin University, Changchun, PR China.
Professor, Department of Stomatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Xiangzhou, Zhuhai City, Guangdong, PR China.
Associate Professor, Department of Stomatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Xiangzhou, Zhuhai City, Guangdong, PR China. Electronic address: liqsh26@mail.sysu.edu.cn.
Microbial community analysis of supragingival plaque in patients with fixed prostheses.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: kaojh@ntu.edu.tw.
Journal of the Formosan Medical Association = Taiwan yi zhi
Response to Comments on Fibrosis-4 index stratifies risks of hepatocellular carcinoma in patients with chronic hepatitis C″.

Ethanol ablation (EA) has been proposed as a first-line treatment modality for recurrent symptomatic cystic thyroid nodules following initial aspiration. The efficacy of EA can be compromised when the initial nodule volume exceeds 10 mL. This study assessed the efficacy of single-session EA in managing thyroid cysts with an initial volume of ≥10 mL.This retrospective study included 70 patients, stratified into three groups on the basis of initial nodule volume: Group 1 (≥10, <20 mL), Group 2 (≥20, <40 mL), and Group 3 (≥40 mL). Primary outcomes were the volume reduction ratio (VRR) and therapeutic success rate (VRR >50%) at the 6-month follow-up post-EA. Secondary outcomes included improvements in symptom scores, cosmetic grades, and identification of factors influencing VRR.The median VRR at the 6-month was 94.8% (interquartile ranges: 88.3-98.1%), with a therapeutic success rate of 90%. Significant improvements were observed in nodule volume, symptom scores, and cosmetic grades (all p < 0.001). Nodules ≥40 mL had poorer symptom scores and cosmetic grades compared to nodules with volumes of ≥10 mL and <20 mL (p < 0.05), though VRR differences were not significant (p = 0.944). Solid portions and nodule vascularity negatively impacted VRR (p = 0.001 and p = 0.002).Single-session EA effectively reduces volume and improves symptoms and cosmetic outcomes for cystic thyroid nodules ≥10 mL, though larger, solid, and vascular nodules may require tailored treatment strategies.
Copyright © 2025 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.
Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Chung Jen Junior College of Nursing, Health Science Management, Yunlin, Taiwan; Department of Rehabilitation, Tung Wah Hospital, Nantou, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan. Electronic address: s31079@gmail.com.
Single-session ethanol ablation in the treatment of thyroid cysts ≥10 mL: Effectiveness and influencing factors.

Shanxi Bethune Hospital, Shanxi, China. Electronic address: 13100151533@163.com.
First Hospital of Shanxi Medical University, Shanxi, China.
Comment on Fibrosis-4 index stratifies risks of hepatocellular carcinoma in patients with chronic hepatitis C″: Fibrosis-4 index and hepatocellular carcinoma.

The effect of conservative treatments on sleep quality in carpal tunnel syndrome is unclear.Comparing the effect of splinting and kinesiotaping in carpal tunnel syndrome on functional status, pain, grip strength, nerve cross-sectional area and sleep quality.Randomized controlled study.The participants were divided into three groups. One group was given night splint and nerve tendon gliding exercises, one group was given kinesiotaping and nerve tendon gliding exercises and one group was given only nerve tendon gliding exercises. The participants was evaluated with Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Jamar hand dynamometer, ultrasonography by a blind investigator in the treatment group at baseline and at 3 months.A total of 90 participants, 53 women and 37 men, with a mean age of 47.6±10.5, participated in the study. The decrease in Boston symptom severity and functional status scores was higher in the kinesiotaping group than in the splint group (Cohen's d=-0.78). A statistically significant decrease was found in PSQI scores in all groups (p<0.05). A statistically significant decrease was found in the PSQI total and sleep duration component score in the kinesiotaping group compared to the splint group and the exercise group (Cohen's d=0.69).Both splinting and kinesiotaping are effective on pain, functional status, hand grip strength and median nerve cross-sectional area. This effect is greater in kinesiotaping. Splinting, kinesiotaping and nerve tendon gliding exercises treatments are effective in improving sleep quality, but this effect is greater in kinesiotaping.gov ID: NCT06514625.
Konya Beyhekim Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, Konya, Turkey. Electronic address: svskrpz@hotmail.com.
Konya Beyhekim Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, Konya, Turkey.
Konya City Hospital, Clinical Neurophysiology, Konya, Turkey.
Selcuk University Faculty of Medicine, Rheumatology, Konya, Turkey.
Journal of hand therapy : official journal of the American Society of Hand Therapists
Effect of splinting and kinesiotaping treatments on functional status, sleep quality and median nerve cross-sectional area in carpal tunnel syndrome: A single blind prospective randomized controlled study.

Quantifying the biomechanical properties of the thenar muscle can provide valuable insight into hand assessment methods.This study aimed to examine the reliability of myotonometer measurements in determining the biomechanical properties (tone, stiffness and elasticity) of thenar muscles in healthy individuals and explore sex-based variations. Additionally, it assessed the relationship between pinch strength and these properties.Cross-sectional reliability study.Fifty-five healthy young adult participants were recruited. Biomechanical properties of the abductor pollicis brevis and flexor pollicis brevis muscles - tone (Hz), stiffness (N/m), and elasticity (logarithmic decrement)-were measured using MyotonPRO, while pinch strength was assessed using a Baseline pinch gauge bilaterally. For intrarater reliability, the first rater (R1), conducted two sets of measurements at 30-minute intervals. Inter-rater reliability was evaluated by the second rater (R2) performing a set of measurements between R1's two sets.Fifty participants [mean age=22.84 (1.01) years, mean body mass index=20.86 (2.82) kg/m²] completed the study. Test-retest reliability for the biomechanical properties of the abductor pollicis brevis and flexor pollicis brevis muscles showed good to excellent consistency (ICCs: 0.78-0.97). Inter-rater reliability demonstrated sufficient consistency across (ICCs: 0.78-0.93). Sex-based differences were observed on the nondominant side, with males exhibiting lower logarithmic decrement scores for both muscles (p<0.05). Negative correlations were found between pinch strength and abductor pollicis brevis logarithmic decrement scores on both sides (p<0.05).The study confirms the reliability of MyotonPRO in evaluating the mechanical properties of the thenar muscle in healthy subjects, with good to excellent consistency. Sex-based differences in elasticity, along with the positive correlation between pinch strength, underscore the importance of sex-specific considerations, suggesting elasticity may be considered a key factor in grip strength improvement.ClinicalTrial.gov/NCT06004635.
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey. Electronic address: tlyfztcvk@gmail.com.
Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Experimental Anaesthesiology, Ulm University, Ulm, Germany.
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey.
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey.
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey; Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
Quantifying thenar muscle biomechanical properties: Sex-based variations and implications for grip strength.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. Conservative treatments are effective for treating mild and moderate CTS. There is still a need for studies to investigate the superiority of conservative treatments over each other.The aim of our study was to compare the efficacy of orthosis treatment and Kinesio taping (KT) treatment on pain, functional status, and grip strength in patients with idiopathic CTS.Randomized clinical trial.Sixty patients (90% women) who were diagnosed with mild or moderate CTS by electroneuromyography were included in this study. Patients were randomized into two groups: the orthosis and KT groups. Hand grip, and three-point pinch strength measuring with a dynamometer and a pinch meter, Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), and Short Form-36 Health Survey Questionnaire (SF-36) were used in clinical assessment. Clinical evaluations were made baseline and at the end of 4 weeks of treatment.Both KT and static wrist orthosis were found to be effective on SF-36 pain, VAS rest, VAS activity, LANSS, grip strength, three-point pinch strength, BCTQ symptom, and functional scores. The changes in VAS activity (between-group mean difference [MD] = -0.93; CI = -1.83:-0.03; p < 0.05; d = 1.74), BCTQ function scores (MD = -2.60; CI = -5.39:0.19; p < 0.05, d = 5.40), and SF-36 mental health scores (MD = 5.87; CI = 1.15:10.59; p < 0.05; d = 9.13) were significantly higher in the KT group compared to the orthosis group.KT, which is a straightforward and safe treatment that does not restrict daily activities, may offer a beneficial alternative to restrictive and uncomfortable orthosis therapy for treating mild to moderate CTS in those leading active daily lives.
Copyright © 2025 Elsevier Inc. All rights reserved.
Istanbul Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey.
Istanbul Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey. Electronic address: droguzmuhammed@gmail.com.
Cemil Tascioglu City Hospital, Physical Medicine and Rehabilitation Clinic, İstanbul, Turkey.
Is Kinesio taping an alternative to static wrist orthosis in patients with carpal tunnel syndrome? A randomized clinical trial.

Shoulder pain is a major musculoskeletal problem after wrist-hand immobilization. There is limited evidence regarding the relationship of kinesiophobia or pain catastrophizing with shoulder pain and disability after wrist-hand injury.To explore associations between kinesiophobia and pain catastrophizing with ipsilateral persistent shoulder disability in patients with wrist-hand injury after 6 months.Prospective study.Participants aged ≥18 years referred to hand therapy after wrist-hand injury requiring wrist-hand immobilization were recruited and completed the Numeric Pain Scale, Shoulder Pain and Disability Index, Pain Catastrophizing Scale (PCS), and Tampa scale for kinesiophobia (TSK) at baseline, after an immobilization period, and after 6 months.A total of 107 patients were included in the study. Scaphoid fractures were found in 49 (45.8%) of patients, and 58 (54.2%) had distal radius fractures. For each week of increased time spent in immobilization, the Shoulder Pain and Disability Index score increased by 10.2 points, 95% confidence interval (CI) [6.76, 13.57], with higher levels of immobilization being associated with increased shoulder pain and disability. The baseline TSK score was 17.4 and 11.2 at follow-up. The PCS score was initially 14.8 and decreased to 9.3 at follow-up. The addition of TSK and PCS to the predictive model led to a statistically significant increase in R2 of 0.163, F(2,100) = 47.471, p < 0.001.The duration of wrist immobilization following an injury may play a crucial role in the level of shoulder disability experienced at the 6-month mark post-injury. This shoulder disability may be influenced by factors such as fear of movement.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Physiotherapy Department, Faculty of Health Sciences, University of Malaga, Málaga, Spain; IBIMA Hand Research Group FE-17, Málaga, Spain.
School of Occupational Therapy, Touro University, Henderson, NV 33204, USA.
Physiotherapy Department, Faculty of Health Sciences, University of Malaga, Málaga, Spain; IBIMA Hand Research Group FE-17, Málaga, Spain. Electronic address: leiregam@uma.es.
Universidad Europea de Madrid, Villaviciosa de Odón, Spain.
Kinesiophobia, catastrophizing, and the duration of immobilization: A prospective study on factors associated with shoulder disability following wrist-hand injuries.

Angina with no obstructive coronary artery disease (ANOCA) occurs in approximately 40 % of patients who undergo diagnostic coronary angiography for symptoms of angina. Coronary physiology assessment (CPA) is a guideline proven method to assess and diagnose these patients for an effective treatment strategy. There is currently no data regarding optimal wire or sensor position for CPA using bolus coronary thermodilution.We reviewed CPA data and baseline demographics in a cohort of patients who underwent CPA for ANOCA. We evaluated coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients whereby maximal hyperemia was obtained in the middle portion (4-6 cm) of the left anterior descending artery (LAD) and the distal 2/3 of the LAD using linear regression, Paired t-test, and Bland-Altman analysis.We assessed 42 patients with a median age of 60.5 [50,67] and 72 % female. Median CFR in the mid-LAD was 3.55 [2.54, 4.58] and 2.71 [2.0,3.88; p = 0.01*] in the distal segment. Median IMR in the mid-LAD was 16.41 mmHg*s [10.60, 22.07] and 22.27 mmHg*s [14.79,37.0] in the distal segment (p = 0.01*). Average distal pressures (Pd) were 77.14 mmHg in the mid and 75.31 mmHg in the distal LAD (p = 0.57) with differing resting (0.75 s vs 0.97 s, p = 0.01*) and hyperemic (0.25 vs 0.40, p = 0.003*) transit times in the mid vs distal vessel, respectively.Here we demonstrate that CPA outcomes including CFR and IMR values are dependent upon wire positioning with deeper wire position resulting in lower CFR and higher IMR values.
Department of Internal Medicine, Baylor Scott and White, Temple, TX, United States of America.
Department of Internal Medicine and Division of Cardiology, Baylor Scott and White, Temple, TX, United States of America.
Baylor Baylor Scott and White, The Heart Hospital, Department of Cardiology, Plano, TX, United States of America.
Baylor Heart and Vascular Hospital, Department of Cardiology, Baylor Scott and White, Fort Worth, TX, United States of America.
Department of Internal Medicine and Division of Cardiology, Baylor Scott and White, Temple, TX, United States of America. Electronic address: Robert.Widmer@bswhealth.org.
Cardiovascular revascularization medicine : including molecular interventions
Evaluation of mid vs distal left anterior descending artery measures in coronary physiology assessment.

There is a growing body of data to support the presence of sex disparities in outcomes of cardiovascular related hospitalizations. Despite this, there remains a paucity of data on relationships between sex and in-hospital outcomes in patients receiving a left atrial appendage occlusion device (LAAOD).We examined the 2016-2020 Nationwide Readmission Database to identify patients with Atrial Fibrillation receiving a LAAOD. Men compromised the control group, while women comprised the cohort. The primary outcome was mortality. Secondary outcomes included odds of mechanical ventilation use, all cause 30 and 90 day readmission, pericardial complications, vascular complications requiring surgery and length of stay (LOS). Multivariate regression models were used to adjust for confounders.Among the patients with Atrial fibrillation receiving LAAOD (N = 59,655), 43 % were Female. A Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.92, 95 % CI 1.04-3.5), mechanical ventilation use (aOR 2.02, 95 % CI 1.4-2.9), all cause 30-day readmission (aOR 1.33, 95 % CI 1.22-1.45), all cause 90-day readmissions (aOR 1.31, 95 % CI 1.2-1.43), pericardial complications (aOR 2.5, 95 % CI 1.83-3.3), and longer LOS (1.34 vs 1.19 days, p < 0.001) compared to male patients. No differences were observed regarding vascular complications requiring surgery between both groups.The LAAOD procedure is a highly safe and effective intervention for patients with atrial fibrillation. However, a small subset of patients experiences fatal and non-fatal adverse outcomes, with women disproportionately affected. Further studies are needed to confirm these findings.
Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA. Electronic address: nadhem.abdallah@hcmed.org.
Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Cardiology Division, Hennepin Healthcare, Minneapolis, MN, USA.
Sex-based differences in cardiovascular outcomes among patients with atrial fibrillation undergoing left atrial appendage occlusion device placement.

Pulmonary hypertension (pHTN) has been associated with increased morbidity and mortality after mitral Transcatheter Edge-to-Edge Repair (TEER), but the association remains uncertain. This study aims to evaluate the impact of pHTN on cardiovascular outcomes following TEER.We searched PubMed, Scopus, and Medline to identify studies reporting outcomes after TEER in individuals with pHTN. Utilizing a random-effects model, we ascertained a pooled odds ratio (OR) of clinical outcomes in patients with pulmonary artery systolic pressure (PASP >50 mmHg) vs. without (PASP <50 mmHg) severe pHTN.We included seven studies with 27,965 patients. The mean age was 79.9 (±5.2) years; 53 % were male, and 75 % were New York Heart Association (NYHA) class-III/IV with a median follow-up of 360 days. Patients with severe pHTN had higher odds of in-hospital all-cause mortality (OR: 1.99, 95 % CI: 1.69-2.34, p < 0.00001) and Major adverse cardiovascular events (MACE) (OR: 1.38, 95 % CI: 1.22-1.56, p < 0.00001) compared to patients without severe pHTN.Severe pHTN is associated with increased risks of all-cause mortality, MACE, and higher heart failure rehospitalizations in patients undergoing mitral TEER. Prospective trials are necessary to validate the findings and determine if early intervention improves clinical outcomes.
Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX, USA.
Department of Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA.
Division of Cardiology, Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX, USA.
Dow University of Health Sciences, Karachi, Pakistan.
Department of Internal medicine and Cardiovascular disease, West Virginia University, Morgantown, WV, USA.
Independent Outcomes Researcher, Atlanta, GA, USA.
Department of Cardiovascular Sciences, Ascension St. Thomas Hospital/University of Tennessee Health Sciences Center, Nashville, TN, USA.
Impact of pulmonary hypertension on short and long-term outcome after mitral transcatheter edge-to-edge repair: A meta-analysis.

There has been a significant increase in the utilization of non-mechanical valves in the aortic position over time. However, details in reinterventions after aortic root replacement (ARR) with non-mechanical prosthesis were limited in the literature, despite the potential importance of reinterventions in the lifetime management of aortic valve disease.This is a single-center retrospective study, identifying all patients who underwent ARR with allograft, xenografts, and stented bioprosthetic valved conduit from 2010 to 2020. Cumulative incidence was plotted for aortic valve reintervention.A total of 523 patients underwent ARR with non-mechanical valves: allograft (n = 80, 15.3 %), xenograft (n = 267, 51.1 %), and stented bioprosthetic valved conduit (n = 176, 33.7 %). The mean age was 65.9 years old. A history of infective endocarditis was seen in 124 (23.7 %). Overall, valve reintervention was observed in 21 (4.0 %). The median time to reintervention was 4.77 years. The reason for valve reintervention included structural valve deterioration (n = 12), followed by infective endocarditis (n = 6), complication during mitral valve replacement (n = 1), cardiac mass (n = 1), and pseudoaneurysm (n = 1). None of the reinterventions were transcatheter-based. Expected reintervention rates were 8.1 ± 2.0 % at 10 years. Cox hazard regression analysis revealed ejection fraction <30 and heart failure were independently associated with long-term mortality while type of valve was not.Aortic valve reintervention was infrequent. Although subsequent valve in valve transcatheter intervention is often discussed when implanting non-mechanical valves, it was not a common strategy after ARR in our experience. The type of valve was not related to long-term mortality.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America. Electronic address: sultani@upmc.edu.
Reintervention after aortic root replacement with allograft, xenograft, and stented bioprosthetic valves.

Current literature involving gender-affirming voice therapy (GAVT) for transgender and nonbinary (TGNB) individuals is limited. This study describes treatment duration and satisfaction at a single institution.Retrospective cohort.Tertiary laryngology center.TGNB patients receiving gender-affirming treatment were identified.age, sex assigned at birth, gender identity, race, ethnicity, number/frequency of GAVT, Voice Handicap Index-10 (VHI-10), Trans Women Voice Questionnaire (TWVQ) (as appropriate), Gender Congruence Scale (GCS), patient and speech language pathologist (SLP) assessment of treatment satisfaction, and surgical data. Descriptive statistics were reported.82 TGNB patients [trans female (n=65), trans male (n=5), nonbinary (n=12)] sought gender-affirming voice care. Mean age was 33.6±10.7years. Majority were assigned male at birth (n=71). Mean presentation VHI-10 was 15.7±8. In the first year of treatment, patients had mean 5.7±3.1 (range 1-16, median 5) GAVT sessions, biweekly (n=36, 44%) or monthly (n=12, 15%). 62% (n=51) of patients were satisfied/very satisfied, 23% (n=19) fairly satisfied, and 10% (n=8) unsatisfied with GAVT outcomes. SLP impression of GAVT outcome was more variable: 15% (n=12) completely met voice goals and 11% (n=9) had excellent GAVT response. Most patients (39%, n=32) were making good progress, with further treatment recommended. SLP referred 11% (n=9) to the laryngologist for surgery consideration; 9% (n=6) underwent Wendler glottoplasty.Voice therapy is integral to gender-affirming voice care and often requires more sessions (mean 5.7) than the literature-reported average (∼4) for other voice diagnoses. Appropriate expectations should be set for patients, treating clinicians, and third-party payors about the increased anticipated duration of GAVT.
Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, California; Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, California.
UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, California. Electronic address: vyvy.young@ucsf.edu.
Journal of voice : official journal of the Voice Foundation
Gender-Affirming Voice Therapy Duration and Satisfaction: Experiences from a Single Institution.

Self-esteem and vocal perception are central aspects of identity and self-presentation, particularly within marginalized communities where voice and self-concept can be deeply intertwined with social acceptance and cultural dynamics. Among Brazilian gay men, generational differences in these areas may reflect broader social changes, shifts in stigma, and evolving notions of masculinity. This study aims to explore these differences, examining how self-esteem and self-assessed vocal descriptions vary across generations, thereby shedding light on specific needs and areas for potential support within these communities.To compare self-esteem and self-assessed vocal descriptions among different generations of Brazilian gay men.Observational, cross-sectional, mixed-methods study.A convenience sample of 266 Brazilian gay men completed an online survey, which included a sociodemographic questionnaire, the Rosenberg Self-Esteem Scale, and self-assessed vocal descriptive terms, between June 2 and July 14, 2023. Participants were categorized into generational groups based on age, following the definitions provided by the Pew Research Center: Baby Boomers (born 1946-1964), Generation X (born 1965-1980), Millennials (born 1981-1996), and Generation Z (born 1997-2012). Data analysis was performed using random forest techniques to identify variables relevant to generational differences and self-esteem, the frequency of descriptive terms, and multinomial logistic regression models to associate terms with self-esteem classification.Participants ranged from 18 to 71 years old, with an average age of 33.6 years. Regarding generations, 1.9% were Baby Boomers, 13.2% were Generation X, 63.2% were Millennials, and 21.8% were Generation Z. The Baby Boomer and Generation X cohorts exhibited satisfactory self-esteem, while Millennials and Generation Z showed average self-esteem. Terms such as low, good, out of tune, and effeminate were significant for Generation X; affected, pleasant, cheerful, and masculine for Millennials; and high-pitched, cheerful, excited, common, effeminate, insecure, and shy for Generation Z.There were significant differences in self-esteem and vocal perception among the different generations of Brazilian gay men. Younger generations, particularly Millennials and Generation Z, demonstrated average levels of self-esteem, highlighting the need for targeted interventions to improve self-esteem and vocal perception within these groups.
Copyright © 2025 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Speech-Language Pathology Department, São Paulo State University, UNESP, Av. Hygino Muzzi Filho, 737, Mirante, Marília, 17525-900, São Paulo, Brazil. Electronic address: gabrieltrevizanidepolli@gmail.com.
Chemistry Department of the Federal University of Espírito Santo - UFES, Av. Mal. Campos, 1468, Maruípe, 29047-105, Vitória, Espírito Santo, Brazil. Electronic address: marcia.cassago@gmail.com.
Paulista School of Politics, Economics, and Business, Universidade Federal de São Paulo - UNIFESP, Praça da República, 123/141, 01045-001, São Paulo, São Paulo, Brazil. Electronic address: renan.quinalha@unifesp.br.
Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 802 Vila Clementino, 04023-062, São Paulo, São Paulo, Brazil. Electronic address: renata.azevedo@unifesp.br.
Generational Differences in Self-Esteem and Vocal Perception Among Brazilian Gay Men.

Depression is a prevalent mental health disorder that presents substantial public health challenges. Emerging evidence underscores the role of dietary patterns in mitigating depressive symptoms. This study investigated the association between diet quality, assessed using the Recommended Food Score (RFS), and depressive symptoms, evaluated with the Patient Health Questionnaire-9 (PHQ-9), in a sample of Korean adults.This cross-sectional study analyzed data from 19,786 participants recruited from a general hospital in Korea, all of whom completed the RFS and PHQ-9 assessments. General characteristics and anthropometric indices were recorded. Statistical analyses included chi-square tests and binary logistic regression to calculate odds ratios (ORs) and 95% confidence intervals for depressive symptoms according to RFS scores, adjusting for potential confounders.Higher RFS scores were associated with reduced odds of depression in univariate (OR, 0.59; P<0.001) and multivariate (OR, 0.72; P<0.001) analyses. Sociodemographic factors, including older age, higher education, marital status, higher income, professional occupation, and regular exercise, were linked to decreased odds of depression. Conversely, female sex, current smoking, and alcohol consumption were associated with increased odds.The findings reveal an inverse relationship between diet quality and depressive symptoms among Korean adults, emphasizing the potential of dietary improvements in mental health promotion. Sociodemographic factors significantly influence depression risk. Future studies should adopt longitudinal designs incorporating a wider range of variables to elucidate these complex interactions.
Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Family Medicine, Seoul National University SMG-SNU Boramae Medical Center, Seoul, Korea.
Department of Family Medicine, Seoul National University SMG-SNU Boramae Medical Center, Seoul, Korea.Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.
The Relationship between Diet Quality, Measured by the Recommended Food Score, and Depression, Assessed Using the Patient Health Questionnaire-9: An Observational Study in Korea.

Living systems cannot rely on random intermolecular approaches toward cell crowding, and hidden mechanisms must be present to favor only those molecular interactions required explicitly by the biological function. Electromagnetic messaging among proteins is proposed from the observation that charged amino acids located on the protein surface are mostly in adjacent sequence positions and/or in spatial proximity. Molecular dynamics (MD) simulations have been used to predict electric charge proximities arising from concerted motions of charged amino acid side chains in two protein model systems, human ubiquitin and the chitinolytic enzyme from Ostrinia furnacalis. This choice has been made for their large difference in size and sociality. Protein electrodynamics seems to emerge as the framework for a deeper understanding of the long-distance interactions of proteins with their molecular environment. Our findings will be valuable in orienting the design of proteins with specific recognition patterns.
Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy.
International journal of molecular sciences
Molecular Dynamics Simulations Suggest That Side-Chain Motions of Charged Amino Acids Determine Long-Range Effects in Proteins: An Egg of Coulomb.

Tecnológico Nacional de México/Instituto Tecnólogico Superior de Atlixco-Departamento de Ingeniería Bioquímica, Atlixco, Puebla, Mexico.
Instituto Politécnico Nacional de México, Mexico. Electronic address: daniel.garcia-valle@outlook.com.
Expression of concern to Ice cream cone fortified with spent coffee ground: Chemical composition, quality and sensory characteristics, and in vitro starch digestibility [Food Chem. 459 (2024) 140288].

This cross-sectional study aimed to estimate the seroprevalence and the potential risk factors of Brucella infection among goats in family farms in the southern east of Algeria. A total of 196 sera samples were randomly collected from 59 family farms and tested in parallel by Rose Bengal test (RBT) and indirect ELISA (iELISA). A structured questionnaire was used to collect information on potential risk factors. Apparent seroprevalence values were 8.7% (95% CI: 5.49-13.45) and 2.04% (95% CI: 0.8-5.13) for RBT and iELISA respectively. The estimated true prevalence values were 11.1% (95% CI: 6.87-17.42) for the RBT test and 1.58% (95% CI: 0.3-4.74) for iELISA. Dog presence in family farm was significantly associated with Brucella spp. seropositivity (p=0.03) using iELISA, with at least 38 times the odds of brucellosis seropositivity (OR: 38.55, 95% CI: 1.42-1049.17). Goats with previous history of stillbirth were significantly associated with Brucella spp. seropositivity (p=0.04) using RBT, with almost six (6) times higher odds (OR: 6.62, 95% CI: 1.06-41.55). Origin of animals reared on family farms was also significantly associated with Brucella spp. seropositivity (p=0.05) using iELISA with higher odds in foreign goats (OR: 12.99, 95% CI: 1.03-163.22) and lower odds in goats born in farms (OR: 0.08, 95% CI: 0.01-0.97). Based on these findings, further epidemiological studies related to the perception of the disease by animal owners and brucellosis in herding dogs needed to be conducted.
Management of Animal Health and Productions Laboratory, Institute of Veterinary Sciences, University of Frères Mentouri Constantine 1; Regional Veterinary Laboratory of El Oued, National Institute of Veterinary Medicine.
Management of Animal Health and Productions Laboratory, Institute of Veterinary Sciences, University of Frères Mentouri Constantine 1. s_boussena@umc.edu.dz.
Research Laboratory Management of Local Animal Resources, Higher National Veterinary School Rabie Bouchama, Algiers.
Scientific and Technical Research Center for Arid Regions (CRSTRA), Touggourt, Algeria.
Department of Veterinary Management of Animal Resources, Faculty of Veterinary Medicine, Liège, Belgium.
Epidemiology of caprine brucellosis in family farms in the south east of Algeria.

Brucellosis is a neglected infectious disease caused by animals and is becoming a public health problem in developing countries. There are limited case reports of human brucellosis in Indonesia because the symptoms are not specific. This study investigated the association between serological tests for brucellosis among workers and their knowledge, attitude, and behavior. The study was conducted on farmworkers in a dairy cattle milking center in Boyolali and Cilawu. A total of 149 respondents, according to the inclusion criteria, were included. Around 3 ml of blood was collected from the respondents, followed by structured interviews to determine the level of knowledge, attitudes, and behavior towards brucellosis in humans. The sera were tested with the rose bengal test (RBT) and complement fixation test (CFT). Results showed that 3.3% of respondents were positive for RBT in Boyolali and 7.01% in Cilawu. However, CFT showed that 5.3% of respondents were positive in Cilawu, but 0% in Boyolali. The level of knowledge and attitudes of respondents regarding brucellosis in humans was still lacking, and the behavior of respondents on the farm was mostly good, in the sense of understanding the procedures for maintaining healthy dairy cattle correctly, but maintaining personal health was still lacking. This study underscores the need for immediate action to improve the situation. Public health professionals, researchers, and policymakers have a crucial role in implementing regular health education programs for farmworkers and improving the availability of personal protective equipment.
Primatology Study Program, IPB University, Bogor, Indonesia; Research Center for Pharmaceutical Ingredients and Traditional Medicine, National Research and Innovation Agency (BRIN), Cibinong, Indonesia. rn_smile01@yahoo.com.
Research Center of Veterinary, National Research, and Innovation Agency (BRIN), Cibinong, Indonesia.
Professor Nidom Foundation, Surabaya, Indonesia.
Human Brucellosis among the farmworkers in Cilawu and Boyolali, Indonesia.

This study sought to compare bacterial abundance and diversity in milk and feces of healthy lactating women with patients suffering from lactation mastitis, explore the pathogenesis of lactation mastitis, and develop new ideas for its treatment and prevention from a microbiological perspective. A total of 19 lactating mastitis patients and 19 healthy lactating women were recruited. Milk and fecal Specimens were obtained from both groups, and microbial community structure was analyzed using 16S rRNA gene sequencing. Our results reveal significant alternations in microbial composition and distribution of milk and feces between healthy lactating women and mastitis patients. The findings suggest that lactating mastitis patients have dysregulated gut and milk microbiota, and modulating the gut-mammary axis may be a potential strategy for preventing or treating mastitis.
Department of First Clinical School of Medicine,Zhejiang University of Traditional Chinese Medicine ,Zhejiang, 310053.
Department of Thyroid and Breast Surgery, Hangzhou linping District Maternal & Child Health Care Hospital, Zhejiang, 311113.
Department of Thyroid and Breast Surgery,Linping Hospital of Integrated Traditional Chinese and Western Medicine,Zhejiang, 311199.
Department of Mammary gland,The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, 310006.
Cette étude visait à comparer l'abondance et la diversité bactériennes dans le lait et les selles de femmes allaitantes en bonne santé avec des patients souffrant de mammite de lactation, à explorer la pathogenèse de la mammite de lactation et à développer de nouvelles idées pour son traitement et sa prévention d'un point de vue microbiologique. Au total, 19 patientes atteintes de mammite allaitante et 19 femmes allaitantes en bonne santé ont été recrutées. Des échantillons de lait et de matières fécales ont été obtenus des deux groupes et la structure de la communauté microbienne a été analysée à l'aide du séquençage du gène de l'ARNr 16S. Nos résultats révèlent des alternances significatives dans la composition microbienne et la distribution du lait et des selles entre les femmes allaitantes en bonne santé et les patientes atteintes de mammite. Les résultats suggèrent que les patientes allaitantes atteintes d'une mammite ont un microbiote intestinal et laitier dérégulé, et que la modulation de l'axe intestin-mammaire pourrait constituer une stratégie potentielle pour prévenir ou traiter la mammite.
Comparative study of breast and intestinal microecology in lactating women with and without mastitis.

This study investigated the professional values of midwifery students and the factors influencing these values. Conducted from January 6 to March 6, 2021, it involved 715 midwifery students who participated voluntarily. Data was collected using a Descriptive Data Sheet and the Professional Values of Midwives Scale. Statistical analysis included descriptive statistics, two-way ANOVA, Independent Samples T Test, and Bonferroni Correction. The mean age of participants was 20.63 years; 99.2% were single, and 29.7% were second-year students. Participants mostly graduated from the following schools to Anatolian high schools (57.5%) and predominantly lived in cities (55.1%), with 81.1% from nuclear families. A significant number of parents had a primary education (mothers: 50.8%, fathers: 35.4%). The mean score on the Professional Values of Midwives Scale was high. Significant differences in scores were noted based on age, high school type, long-term residence, family type, parental education, and interest in midwifery. However, the difference was not significant found. related to academic year, willingness to choose midwifery, preference ranking, self-suitability for the profession, or shifts in perspective before and after education. These findings emphasize the multifaceted nature of professional values in midwifery students and the various factors shaping their attitudes.
Midwifery Department, Faculty and Health Sciences, Ege University, Turkey.
Midwifery Department, Faculty and Health Sciences, Karabük University, Turkey.
Cette étude a porté sur les valeurs professionnelles des étudiantes sages-femmes et sur les facteurs influençant ces valeurs. Menée du 6 janvier au 6 mars 2021, elle a impliqué 715 étudiantes sages-femmes qui ont participé volontairement. Les données ont été recueillies à l'aide d'une feuille de données descriptives et de l'échelle des valeurs professionnelles des sages-femmes.L'analyse statistique comprenait des statistiques descriptives, une ANOVA à deux voies, un test T des échantillons indépendants et une correction de Bonferroni. L'âge moyen des participantes était de 20,63 ans ; 99,2 % étaient célibataires et 29,7 % étaient des étudiantes de deuxième année. La plupart des participants étaient diplômés d'écoles secondaires d'Anatolie (57,5 %) et vivaient principalement en ville (55,1 %), 81,1 % d'entre eux étant issus de familles nucléaires. Un nombre important de parents avaient suivi l'enseignement primaire (mères : 50,8 %, pères : 35,4 %). Le score moyen sur l'échelle des valeurs professionnelles des sages-femmes était élevé. Des différences significatives dans les scores ont été notées en fonction de l'âge, du type d'école secondaire, de la résidence à long terme, du type de famille, de l'éducation des parents et de l'intérêt pour la profession de sage-femme. Cependant, aucune différence significative n'a été constatée en ce qui concerne l'année scolaire, la volonté de choisir la profession de sage-femme, le classement des préférences, l'aptitude personnelle à la profession ou les changements de perspective avant et après les études. Ces résultats soulignent la nature multidimensionnelle des valeurs professionnelles chez les étudiantes en pratique sage-femme et les divers facteurs qui façonnent leurs attitudes.
Professional values and factors affecting these values in midwifery students.

Giant ovarian cysts (GOCs) have become less common in developed countries due to routine health screenings, but they remain prevalent in economically underdeveloped regions. Treatment options for GOCs depend on factors such as age, cyst characteristics, and pregnancy status. Minimally invasive single-port laparoscopic surgery has largely replaced traditional open surgery due to its aesthetic advantages and effectiveness. In this case series, six patients with giant ovarian cysts, including two pregnant women, underwent single-port laparoscopic surgery. The procedure was aimed to reduce scarring, ensure safety, and preserve fertility. Strict criteria were used to rule out malignancy and assess suitability for the minimally invasive approach. Five patients had successful surgeries with positive cosmetic outcomes, while one required conversion to a mini-laparotomy due to technical difficulties. Postoperative recovery was smooth, with patients expressing satisfaction with the aesthetic results. This study demonstrates that single-port laparoscopic surgery is a safe and effective method for treating large ovarian cysts, combining the advantages of traditional laparoscopy with enhanced cosmetic results. The approach is particularly beneficial for younger and pregnant patients, with careful timing of surgery recommended to minimize pregnancy-related risks.
Department of Obstetrics and Gynecology, Georgetown Public Hospital Corporation,Georgetown, Guyana.
Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing , China.
Les kystes ovariens géants (GOC) sont devenus moins courants dans les pays développés en raison des examens médicaux de routine, mais ils restent répandus dans les régions économiquement sous-développées. Les options de traitement pour les GOC dépendent de facteurs tels que l'âge, les caractéristiques du kyste et l'état de grossesse. La chirurgie laparoscopique mini-invasive à un seul port a largement remplacé la chirurgie ouverte traditionnelle en raison de ses avantages esthétiques et de son efficacité. Dans cette série de cas, six patientes présentant des kystes ovariens géants, dont deux femmes enceintes, ont subi une chirurgie laparoscopique à un seul port. La procédure visait à réduire les cicatrices, à assurer la sécurité et à préserver la fertilité. Des critères stricts ont été utilisés pour exclure la malignité et évaluer l’adéquation de l’approche mini-invasive. Cinq patients ont subi des interventions chirurgicales réussies avec des résultats esthétiques positifs, tandis qu'un a dû être converti en mini-laparotomie en raison de difficultés techniques. La récupération postopératoire s'est déroulée sans problème, les patients exprimant leur satisfaction quant aux résultats esthétiques. Cette étude démontre que la chirurgie laparoscopique à port unique est une méthode sûre et efficace pour traiter les gros kystes ovariens, combinant les avantages de la laparoscopie traditionnelle avec des résultats cosmétiques améliorés. L'approche est particulièrement bénéfique pour les patientes plus jeunes et enceintes, avec un timing minutieux de l'intervention chirurgicale recommandé pour minimiser les risques liés à la grossesse.
Surgery for giant ovarian cysts in Guyana using single-port laparoscopy: a retrospective case series analysis.

Through implementing a bidirectional Mendelian randomization (MR) study, the causal effects between gut microbiome and polycystic ovary syndrome (PCOS) were analyzed. Summary statistics for PCOS were acquired from the FinnGen consortium R8 release data, which included 27,943 cases and 162,936 controls. The inverse-variance weighting (IVW) method was adopted for analysis. Additionally, the causality involving exposure plus the outcome was evaluated by means of MR-Egger, weighted median, simple mode methods, as well as weighted mode. The IVW estimate showed that the genera Streptococcus plus Enterorhabdus served as protectors of PCOS. By contrast, the phylum Tenericutes, genera Anaerofilum, Coprococcus 2, Lachnospiraceae ND3007 group and Ruminiclostridium 5 were identified as risk elements of PCOS. Based on reverse MR analyses from PCOS on the intestinal microbiome based on the IVW method, the phyla Tenericutes, Actinobacteria, class Actinobacteria, genera Ruminococcaceae UCG004 and Christensenellaceae R 7group exhibited a down-regulation effect after PCOS onset. The genera Bacteroides, Barnesiella, Erysipelotrichaceae UCG003, Ruminococcus gnavus group, and Veillonella were up-regulated. No horizontal pleiotropy or significant IV heterogeneity was observed. We conclude that there is a causality relationship between gut microbiome and PCOS, where some bacterial taxa can be used as biomarkers to promote targeted diagnosis and therapy for PCOS.
Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, Jiangsu, China.Rugao Maternity Hospital, Rugao 226500, Jiangsu, China.
Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, Jiangsu, China.
Grâce à la mise en œuvre d’une étude de randomisation mendélienne (MR) bidirectionnelle, les effets causals entre le microbiome intestinal et le syndrome des ovaires polykystiques (SOPK) ont été analysés. Les statistiques récapitulatives sur le SOPK ont été acquises à partir des données de diffusion R8 du consortium FinnGen, qui comprenaient 27 943 cas et 162 936 contrôles. La méthode de pondération de variance inverse (IVW) a été adoptée pour l'analyse. De plus, la causalité impliquant l'exposition et le résultat a été évaluée au moyen des méthodes MR-Egger, de la médiane pondérée, du mode simple, ainsi que du mode pondéré. L'estimation IVW a montré que les genres Streptococcus et Enterorhabdus servaient de protecteurs du SOPK. En revanche, le phylum Tenericutes, les genres Anaerofilum, Coprococcus 2, le groupe Lachnospiraceae ND3007 et Ruminiclostridium 5 ont été identifiés comme éléments de risque du SOPK. Sur la base d'analyses IRM inverse du SOPK sur le microbiome intestinal basées sur la méthode IVW, les phyla Tenericutes, Actinobacteria, classe Actinobacteria, genres Ruminococcaceae UCG004 et Christensenellaceae R 7group ont présenté un effet de régulation négative après l'apparition du SOPK. Les genres Bacteroides, Barnesiella, Erysipelotrichaceae UCG003, le groupe Ruminococcus gnavus et Veillonella étaient régulés positivement. Aucune pléiotropie horizontale ni hétérogénéité IV significative n’a été observée. Nous concluons qu’il existe une relation de causalité entre le microbiome intestinal et le SOPK, certains taxons bactériens pouvant être utilisés comme biomarqueurs pour promouvoir un diagnostic et un traitement ciblés du SOPK.
Causal association between gut microbiome and polycystic ovary syndrome: A bidirectional Mendelian randomization study.

With 25% of teenagers pregnant by age of 19 and about half of these married before their 18th birth day, Uganda exhibits one of the highest rates of teenage pregnancy and child marriage globally. Comprehensive data on the drivers and barriers to addressing repeat teenage pregnancies and early child marriages remains limited. Using the narrative inquiry approach, the paper explores the key socio-cultural drivers and barriers to addressing repeat teenage pregnancies and early/forced marriages among stakeholders in the districts of Mbale, Kween, Namayingo and Kalangala. Guided by purposive sampling, a total of 125 qualitative interviews (80 key informant interviews (KIIs) and 45 focus group discussions (FGDs) were conducted. Data analysis was done using deductive thematic analysis in Atlas ti software. The drives of repeat teenage pregnancy (RPT) include the distorted community understanding of repeat teenage pregnancy; poverty at the household; norms, traditions and beliefs; cultural and traditional practices; lack of comprehensive sex education, school dropout, Peer pressure and influence, and vulnerable populations. The results point to a strong relationship between teenage pregnancy, early child/forced marriage and repeat teenage pregnancy across all the four districts and to poverty as the driving force.
Heroes for Gender Transformative Action - Amref Health Africa, Uganda.
Gender Equality and Social Inclusion Specialist DT Global, Indonesia.
Makerere University School of Public Health, Uganda.
Avec 25 % des adolescentes enceintes avant l’âge de 19 ans et environ la moitié d’entre elles mariées avant leur 18e jour de naissance, l’Ouganda présente l’un des taux de grossesses et de mariages d’enfants les plus élevés au monde. Les données complètes sur les facteurs déterminants et les obstacles à la lutte contre les grossesses répétées chez les adolescentes et les mariages précoces d’enfants restent limitées. En utilisant l'approche d'enquête narrative, l'article explore les principaux facteurs socioculturels et les obstacles à la lutte contre les grossesses répétées chez les adolescentes et les mariages précoces/forcés parmi les parties prenantes des districts de Mbale, Kween, Namayingo et Kalangala. Guidés par un échantillonnage raisonné, un total de 125 entretiens qualitatifs (80 entretiens avec des informateurs clés (KII) et 45 discussions de groupe (FGD) ont été menés. L'analyse des données a été effectuée à l'aide d'une analyse thématique déductive dans le logiciel Atlas ti. Les motivations des grossesses répétées chez les adolescentes ( RPT) comprennent la compréhension déformée par la communauté des grossesses répétées chez les adolescentes ; la pauvreté au sein des ménages ; le manque d'éducation sexuelle complète, l'abandon scolaire et la pression des pairs ; et d'influence, ainsi que les populations vulnérables. Les résultats mettent en évidence une relation étroite entre les grossesses précoces, les mariages précoces/forcés et les grossesses répétées chez les adolescentes dans les quatre districts, ainsi que la pauvreté comme force motrice..
Socio-cultural drivers and barriers to addressing repeat teenage pregnancies and early child /forced marriages in Central and Eastern Uganda.

The current study aims to determine how the interactions between practice (distributed/focused) and mental capacity (high/low) in the cloud-computing environment (CCE) affect the development of reproductive health skills and cognitive absorption. The study employed an experimental design, and it included a categorical variable for mental capacity (low/high) and an independent variable with two types of activities (distributed/focused). The research sample consisted of 240 students from the College of Science and College of Applied Medical Sciences at the University of Hail's. The sample was divided into four experimental groups. The study's most significant findings were the CCE's apparent favoritism of the group that studied using focused practice style and high mental capacity in the reproductive health skills test, as opposed to distributed practice style and low mental capacity in cognitive absorption. The findings will add to the ongoing debate over which of the two distributed/focused practice activity models is more effective in achieving desired educational results.
Ha'il University, Kingdom of Saudi Arabia.Suez Canal University, Egypt.
Ha'il University, Kingdom of Saudi Arabia.
L'étude visait à étudier les attentes de performance dans les tâches futures basées sur la gestion de l'apprentissage personnel pendant l'épidémie de Corona. Un échantillon aléatoire de 871 étudiants de l'Université de Hail a été sélectionné. Les échantillons de l’étude provenaient de facultés de sciences humaines, d’ingénierie et de médecine. L’étude était basée sur une conception d’étude transversale. L'étude a préparé une mesure des attentes futures en matière de performance pour les tâches. L'échelle est de 28 items. L'analyse factorielle a été utilisée pour vérifier la validité de l'échelle, et celle-ci a atteint des indicateurs acceptables de bon ajustement. L'échelle a atteint une stabilité acceptable en utilisant le coefficient alpha de Cronbach pour le facteur émotionnel de 0,57, le facteur cognitif de 0,94 et le facteur comportemental de 0,90. Les résultats ont révélé qu’il existe des différences dans les attentes futures en matière de performance en raison du sexe et du type d’université. Les résultats ont révélé qu’il existe des corrélations positives entre les attentes futures en matière de performances cognitives et émotionnelles, ainsi qu’une relation positive entre les performances émotionnelles et comportementales. Il existe également une relation négative entre les performances comportementales et cognitives.
Cloud computing practice activities and mental capacity on developing reproductive health and cognitive absorption.

This was an original article, and the objective of this study was to investigate the effects of bipolar transurethral plasma kinetic prostatectomy (TUPKP) on urodynamics and sexual function in benign prostatic hyperplasia (BPH) patients. One hundred and four BPH patients were divided into a control group and an intervention group. The control group received transurethral resection of prostate, while the intervention group received TUKEP. Relative to the control group, the intervention group presented less intraoperative blood loss and shorter bladder irrigation time, catheter retention time, and shorter hospital stay. Three months after surgery, the improvements of maximum urine flow rate (Qmax), pressure-flow rate (A-G) and residual urine volume (RV) in intervention group were more obvious than control group. One month after surgery, relative to control group, the intervention group had lower C-reactive protein (CRP), epinephrine (E) along with cortisol (Cor), cyclo-oxygenase 2 (COX-2) and vascular endothelial growth factor (VEGF) levels. On day 7 after surgery, PSA, EGF, and PGE2 levels in the intervention group were lower when compared to the control group. We conclude that TUKEP can diminish intraoperative blood loss, promote postoperative recovery, improve postoperative urodynamics and sexual function, and improve prognosis of BPH patients.
Department of Medical Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.Department of Clinical Laboratory, 363 Hospital, Chengdu, Sichuan 610016, China.
Department of Medical Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.Department of Clinical Laboratory, Maternity and Children's Health Care Hospital of Jinjiang District, Chengdu, Sichuan 610016, China.
Department of Clinical Laboratory, 363 Hospital, Chengdu, Sichuan 610016, China.
Department of Medical Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.Medical Research Center, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, 610031, China.
Il s'agissait d'un article original et l'objectif de cette étude était d'étudier les effets de la prostatectomie cinétique plasmatique transurétrale bipolaire (TUPKP) sur l'urodynamique et la fonction sexuelle chez les patients atteints d'hyperplasie bénigne de la prostate (HBP). Cent quatre patients atteints d'HBP ont été répartis en un groupe témoin et un groupe d'intervention. Le groupe témoin a reçu une résection transurétrale de la prostate, tandis que le groupe d'intervention a reçu TUKEP. Par rapport au groupe témoin, le groupe d'intervention présentait moins de pertes sanguines peropératoires, un temps d'irrigation de la vessie, un temps de rétention du cathéter et un séjour à l'hôpital plus courts. Trois mois après la chirurgie, les améliorations du débit urinaire maximal (Qmax), du débit pression-débit (A-G) et du volume urinaire résiduel (RV) dans le groupe d'intervention étaient plus évidentes que dans le groupe témoin. Un mois après la chirurgie, par rapport au groupe témoin, le groupe d'intervention présentait des taux de protéine C-réactive (CRP), d'épinéphrine (E) ainsi que de cortisol (Cor), de cyclo-oxygénase 2 (COX-2) et de facteur de croissance endothélial vasculaire (VEGF) plus faibles. ) niveaux. Au jour 7 après la chirurgie, les niveaux de PSA, d'EGF et de PGE2 dans le groupe d'intervention étaient inférieurs à ceux du groupe témoin. Nous concluons que TUKEP peut diminuer la perte de sang peropératoire, favoriser la récupération postopératoire, améliorer l'urodynamique et la fonction sexuelle postopératoires et améliorer le pronostic des patients atteints d'HBP.
Effects of transurethral 0bipolar plasma prostatectomy on urodynamics and sexual function in patients with prostatic hyperplasia.

Folic acid (FA) plays a crucial role in various biological processes. Insufficient intake of FA during pregnancy can lead to serious clinical complications, including neural tube defect. The current study sought to assess the awareness, knowledge, and usage of FA among young females in Jazan region of Saudi Arabia. This cross-sectional descriptive study involved 472 adult females from October 1 to 9, 2023, in Jazan region, Saudi Arabia. The questionnaire of the study was randomly distributed among females. The data showed that awareness and usage of FA supplementation were poor to fair among females. Furthermore, socio-demographic variables, including age, marital status, monthly income, education levels, number of pregnancies, and current pregnancy status, were found to be associated with awareness and utilization of FA supplementation. The study highlights the need to enhance awareness and knowledge of FA supplementation among females in the Jazan region. Introducing educational programs is essential in Saudi Arabia, particularly in the Jazan region, to enhance the knowledge and awareness of FA within the community.
Department of Medical Laboratory Technology, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia.
Jazan University Hospital, Jazan University, Jazan, Saudi Arabia.
Nursing Department, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia.
Department of Clinical Nutrition, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia.
Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirate.
Pediatric ward, Baish General Hospital, Jazan Health Affairs, Jazan, Saudi Arabia.
L'acide folique (AF) joue un rôle crucial dans divers processus biologiques. Un apport insuffisant en AF pendant la grossesse peut entraîner de graves complications cliniques, notamment une anomalie du tube neural. La présente étude visait à évaluer la sensibilisation, les connaissances et l'utilisation de l'AF chez les jeunes femmes de la région de Jazan en Arabie Saoudite. Cette étude descriptive transversale a porté sur 472 femmes adultes, menée du 1er au 9 octobre 2023, dans la région de Jazan, en Arabie Saoudite. Le questionnaire de l'étude a été distribué au hasard parmi les femmes. Les données ont montré que la sensibilisation et l'utilisation de la supplémentation en AG étaient faibles à passables chez les femmes. En outre, des variables sociodémographiques, notamment l'âge, l'état civil, le revenu mensuel, le niveau d'éducation, le nombre de grossesses et l'état actuel de la grossesse, se sont révélées associées à la connaissance et à l'utilisation de la supplémentation en AG. L'étude met en évidence la nécessité d'améliorer la sensibilisation et les connaissances sur la supplémentation en AG chez les femmes de la région de Jazan. L'introduction de programmes éducatifs est essentielle en Arabie Saoudite, en particulier dans la région de Jazan, pour améliorer les connaissances et la sensibilisation à l'AF au sein de la communauté.
Assessment of awareness, knowledge, and usage of folic acid among females in Jazan Region, Saudi Arabia.

Clinic of Cardiovascular Surgery, University of Health Sciences Türkiye, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye.
Clinic of Cardiology, University of Health Sciences Türkiye, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye.
Clinic of Cardiovascular Surgery, VM Medicalpark Bursa Hospital, Bursa, Türkiye.
A Novel Approach for the Treatment of Subclavian Steal Syndrome in a Patient Undergoing Coronary Artery Bypass Grafting.

Department of Microbiology, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun, India.
Department of Microbiology, PGIMER, Chandigarh, India.
Department of Dermatology, Venereology & Leprosy, Osmania General Hospital, Begum Bazar, Afzal Ganj, Hyderabad, India.
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Indian journal of dermatology, venereology and leprology
Indian J Dermatol Venereol Leprol. ;91(1):136-137.
Mycoplasma genitalium: An emerging superbug among men having sex with men.

Department of Public Health, Akdeniz University Faculty of Medicine, Antalya, Türkiye.
The Importance of Age Standardisation in Comparing Regional Inequalities.

Department of Clinical Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India.
Department of Municipal STD Clinic & ART Centre, Nagpada, Brihanmumbai Municipal Cooperation, Mumbai, Maharashtra, India.
Department of Child Health Research, ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, Maharashtra, India.
Department of Microbiology, Regional STI Training Research and Reference Laboratory, TNMC & BYL Nair Charitable Hospital Mumbai, Mumbai, Maharashtra, India.
Department of Abhyudayanagar Clinic, ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, Maharashtra, India.
Department of Biostatistics, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India.
Department of Microbiology, T.N. Medical College & B Y L Nair Ch. Hospital Mumbai, Mumbai, Maharashtra, India.
Department of Community Medicine, Seth GSMC & KEMH, MBBS, MD (Community Medicine), Mumbai, Maharashtra, India.
Indian J Dermatol Venereol Leprol. ;91(1):137-138.

Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital, Delhi, India.
Indian J Dermatol Venereol Leprol. ;91(1):1-2.
Gender equity in Indian dermatology: Are we moving in the right direction?

The Journal of thoracic and cardiovascular surgery
J Thorac Cardiovasc Surg. 2025-01-06;():.
Commentator Discussion: The impact of epiaortic ultrasound utilization in patients undergoing coronary artery bypass grafting.

Stimulating diuresis is crucial in heart failure (HF) treatment. Diuretic resistance develops in approximately 30% to 45% of patients with HF.We investigated the feasibility and safety of lateral epidural stimulation (LES) to enhance diuresis by stimulating renal afferent sensory nerves.In 16 pigs, volume overload with elevated and stable pressures was induced. Diuresis was measured during cycles of up to two hours, and glomerular filtration rate (GFR) was assessed in 12 of 16 experiments. The most effective vertebrae stimulation level was established first. T11-T12 stimulation effectiveness was tested, using a high current (1.2 mA) in one animal and relatively low currents (0.1-0.3 mA) in 15 animals. In three animals, LES effects were assessed during furosemide infusion.T11-T12 was the most effective vertebrae level for LES. Diuresis increased from 18 mL/20 min (SD = 4 mL/20 min) to 47 mL/20 min (SD = 32 mL/20 min) (n = 9, p < 0.0001), and GFR increased on average 44 [mL/min] (SD = 26, n = 6) (p < 0.001) during T11-T12 LES compared with baseline, excluding one experiment with high current and three lead misplacements. Negative effects in these excluded cases were, according to necroscopy, related to ventral root stimulation, causing shivering, muscle contractions, and elevated heart rate. LES enhanced diuresis during a continuous infusion of furosemide by 54% and 149% and GFR increased by 16 and 14 [mL/min] (two/three correct lead placement).LES at T11-T12 could rival the effectiveness of long-term HF diuretics. Unlike furosemide, LES positively affected kidney function.
Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
Silesian Park of Medical Technology, KardioMed Silesia, Zabrze, Poland; Department of Neurosurgery, Jan Paul II Hospital, Jastrzebie Zdroj, Poland.
Silesian Park of Medical Technology, KardioMed Silesia, Zabrze, Poland; Department of Cardiology and Angiology, Silesian Centre for Heart Diseases, Zabrze, Poland.
Silesian Park of Medical Technology, KardioMed Silesia, Zabrze, Poland.
Bakken Research Center, Maastricht, The Netherlands. Electronic address: lilian.kornet@medtronic.com.
Neuromodulation : journal of the International Neuromodulation Society
Electrical Diuretics: Lateral Epidural Stimulation of Dorsal Roots to Increase Diuresis.

Spinal cord stimulation (SCS) is a therapeutic option for those with chronic pain due to persistent spinal pain syndrome (PSPS). Current literature suggests a higher rate of SCS explant in female patients, but evidence regarding sex differences in the rates of receiving SCS therapy is limited. We do not know whether there is a disparity between female and male patients who receive SCS therapy. The objectives of this retrospective analysis were to determine whether there is a sex-based disparity in SCS therapy and SCS explants between female and male patients for the treatment of PSPS.This retrospective study included medical record data from TriNetX US collaborative research network (TriNetX, Inc, Cambridge, MA), which included 61 large US healthcare organizations. Patients with a diagnosis of PSPS were identified. From the PSPS cohort, those who received SCS therapy (leads and/or generator) were included for the primary outcome, which was to compare the rates of SCS therapy in women and men, and those who received SCS explants were included for the secondary outcome. Propensity matched scoring was used to ensure comparability of cohorts.The propensity-score matched sample included 87,681 female and 87,681 male patients for analysis, with SCS therapy being provided to 6782 women (risk of 7.735%) and 6783 men (risk of 7.736%), with a risk difference of -0.001%, 95% CI (-0.251%, 0.249%), z = -0.009, p = 0.9929. Within the same propensity-score matched sample, SCS explant occurred in 2999 women (risk of 3.420%) and 2608 men (risk of 2.974%). The risk difference was 0.446%, 95% CI (0.281%, 0.611%), z = 5.307, p < 0.0001.Our retrospective analysis shows that there is not a difference in the rates of SCS therapy between a matched sample of women and men with PSPS, and a small difference in rates of SCS explants between women and men.
MetroHealth Rehabilitation Institute, Metrohealth System, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: mgrabnar@metrohealth.org.
MetroHealth Rehabilitation Institute, Metrohealth System, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Sex Differences in Rates of Spinal Cord Stimulation Therapy and Spinal Cord Stimulator Explants: A Propensity-Score Matched Analysis.

Intrathecal baclofen (ITB) therapy is well documented as an effective treatment option for severe spasticity. Before ITB implantation, trials are conducted to evaluate efficacy, safety, and candidate suitability. While many centers conduct ITB trials, appropriate physical assessment has not been fully established. This study aimed to identify useful physical assessments for ITB trials in spastic paraparesis.Patients with spasticity who experienced paraplegia for at least 12 months and underwent ITB trials in Chiba University Hospital were included. Physical functions were assessed before ITB administration and 4 hours after ITB injection on each day of the ITB trial. Physical assessments included targeted neurological and musculoskeletal tests (modified Ashworth scale, deep tendon reflexes, clonus, active range of motion, and manual muscle test) and mobility tests (Berg Balance Scale, Timed Up and Go Test [TUG], 10-Meter Walk Test, and step length).A total of 22 patients underwent ITB trials. Among the physical assessments, the Modified Ashworth Scale, reflexes, clonus, active range of motion at hip abduction and ankle dorsiflexion, TUG, and step length showed significant differences between the assessments conducted before and during ITB trials. Conversely, active range of motion in most joints, the manual muscle test, and the 10-Meter Walk Test did not show significant differences. The total score of the Berg Balance Scale did not show significant differences, whereas only the item of placing alternate foot on stool was significantly different.Spasticity assessments, including the Modified Ashworth Scale and reflexes, and mobility assessments such as TUG and step length, were useful for detecting the effectiveness of ITB screening for spastic paraparesis. The TUG may be particularly suitable for detecting effects, as it is a quantitative and reliable measure that reflects actual movement in daily living activities.
Department of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan; Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: pseudoarthrosis7@chiba-u.jp.
Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan; Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan; Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan.
Optimizing Physical Assessment in Intrathecal Baclofen Screening Trials for High-Performing Patients With Spastic Paraparesis.

Macrophage-based cell therapies represent a cutting-edge frontier in immunotherapy, offering distinct advantages over conventional approaches like CAR-T. This review explores the potential of macrophages to orchestrate both innate and adaptive immune responses, enhancing the body's ability to combat diseases locally and systemically. Dubbed a Smart Cell Therapy, macrophages can initiate and coordinate complex immunological cascades, leveraging multiple immune system components while also performing effector functions. However, significant challenges persist in developing these therapies, including limited macrophage expansion capacity, inefficient genetic engineering, difficulties with large-scale production, and demonstrating late-stage clinical success. Despite these obstacles, ongoing research and clinical trials indicate that macrophage-based therapies hold immense potential to revolutionize treatment approaches across a spectrum of diseases, from cancer to regenerative medicine. With a focus on industry-led development, this review examines the current landscape of macrophage-based cellular therapies, discussing their promising potential and the substantial hurdles that must be overcome to realize their full therapeutic value.
Copyright © 2024 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.
Shoreline Biosciences, San Diego, California, USA.
Verseau Therapeutics, Newton, Massachusetts, USA; NextPoint Therapeutics, Cambridge, Massachusetts, USA.
Barcia Novel Therapies, Lexington, Massachusetts, USA. Electronic address: rnbarcia@yahoo.co.uk.
Smart Cell Therapy: an industry perspective on macrophages as living drugs.

This study conducted an analysis of medical malpractice litigation associated with anesthesia from 2013 to 2022, aiming to evaluate incidents of anesthesia-related safety concerns among surgical patients. The use of data derived from medical malpractice claims provided valuable insights into potential risks associated with anesthesia, contributing to the mitigation of medical malpractice and the enhancement of patient safety.A retrospective study.The characteristics of anesthesia-related medical malpractice litigation were analyzed using Lexis China database, including patient demographics, timing of the events, the surgical procedure, anesthesia methods, and anesthetic used, as well as case settlement information, verdict information, and monetary award data.Our analysis revealed a total of 183 instances where injury claims could be attributed to anesthesia. The median age of the participants was 26 years, with a predominant proportion of females (116/183, 63.39%). Most of the complaints were from secondary (74/183, 40.44%) and tertiary (85/183, 46.45%) hospitals. General anesthesia (107/183, 58.47%) accounted for the majority of claims, with the highest rates of cardiorespiratory failure or arrest (20/24, 83.33%) or hypoxic brain damage (38/58, 65.52%), which were the most prevalent causes of patient death or disability, respectively. The greatest potential for medical malpractice lawsuits in surgical procedures was found to be associated with cesarean sections, with a rate of 18.03% (33 out of 183 cases). Propofol (n = 6) and lidocaine (n = 4) were the anesthetics with the highest number of lawsuits.Despite the decreasing trend in medical malpractice litigation related to anesthesia over time, several notable hazards have been identified. These hazards included cardiorespiratory failure or arrest or hypoxic brain damage resulting from general anesthesia, a higher risk of cesarean section, the hazards associated with anesthesia-administered non-operating room, and the occurrence of severe adverse outcomes due to medication.
Copyright © 2025 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
Department of Anesthesiology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Deficits and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Renmin Nanlu, Chengdu, China.
Department of Anesthesiology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Deficits and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Renmin Nanlu, Chengdu, China. Electronic address: scucdx@foxmail.com.
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
Medical Malpractice Litigation Associated With Anesthesia: Result From the Lexis China Claims Database 2013 to 2022.

To analyze available evidence in the literature on the effect of aromatherapy for the management of postoperative pain in the postanesthesia care unit (PACU).Systematic review according to the Joanna Briggs Institute (JBI) model and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.The search was carried out in August 2023, using descriptors and keywords, in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, Cochrane Central Register of Controlled Trials, Excerpta Medica Database, PUBMED, Scopus, Virtual Health Library, Google Scholar, CAPES, BDTD, and ProQuest portals of theses and dissertations, with no language restrictions or time limit. The quality of evidence was assessed using the tool JBI's critical appraisal checklist for randomized controlled trials. PROSPERO Registration: CRD42023493421.A total of 2,251 studies were investigated, of which 7 studies were included in this review. All of the studies used the inhalation route to administer aromatherapy. They used essential oils such as lavender, lemon, sweet orange, geranium, clary sage, and damascene rose. Most applied the Visual Analog Scale to assess pain. Six studies showed that aromatherapy was effective in relieving pain in the PACU. Studies also observed a reduction in blood pressure, heart rate, incidence of nausea and vomiting, and a decrease in the necessity of antiemetics.The findings emphasize the promising positive effect of aromatherapy for pain management in postoperative care in the PACU. With proper training, aromatherapy can be considered an adjuvant intervention to be carried out by the nursing team.
Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
School of Nursing, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: fernanda@baratojo.com.br.
School of Nursing, University of Sao Paulo, Sao Paulo, Brazil.
School of Nursing, University of Sao Paulo, Sao Paulo, Brazil; Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil.
Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil; JBI Brazilian Affiliated Center, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil.
Effect of Aromatherapy for Postoperative Pain Management in the Postanesthesia Recovery Room: A Systematic Review.

Health technology assessment (HTA) guidelines are intended to support successful implementation of HTA by enhancing consistency and transparency in concepts, methods, process, and use, thereby enhancing the legitimacy of the decision-making process. This report lays out good practices and practical recommendations for developing or updating HTA guidelines to ensure successful implementation.The task force was established in 2022 and comprised experts and academics from various geographical regions, each with substantial experience in developing HTA guidelines for national health policymaking. Literature reviews and key-informant interviews were conducted to inform these good practices. Stakeholder consultations, open peer reviews, and expert opinions validated the recommendations. A series of teleconferences among task force members was held to iteratively refine the report.The recommendations cover 6 key aspects throughout the guideline development cycle: (1) setting objectives, scope, and principles of the guideline, (2) building a team for a quality guideline, (3) defining a stakeholder engagement plan, (iv) developing content and utilizing available resources, (v) putting in place appropriate institutional arrangements, and (vi) monitoring and evaluating guideline success.This report presents a set of resources and context-appropriate practices for developing or updating HTA guidelines. Across all contexts, the recommendations emphasize transparency, building trust among stakeholders, and fostering a culture of ongoing learning and improvement. The report recommends timing development and revision of guidelines according to the HTA landscape and pace of HTA institutionalization. Because HTA is increasingly used to inform different kinds of decision making in a variety of country contexts, it will be important to continue to monitor lessons learned to ensure the recommendations remain relevant and effective.
Copyright © 2024. Published by Elsevier Inc.
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand; University of Strathclyde, Glasgow, Scotland, UK.
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand. Electronic address: manit.s@hitap.net.
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Adelaide Health Technology Assessment (AHTA), The University of Adelaide, Adelaide, SA, Australia.
Radboud University Medical Center, Nijmegen, The Netherlands.
Pontificia Universidad Católica de Chile, Santiago, Chile.
Center for Health Economics, University of York, York, England, UK.
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
Good Practices for Health Technology Assessment Guideline Development: A Report of the Health Technology Assessment International, HTAsiaLink, and ISPOR Special Task Force.