Analysis of the clinical characteristics and outcomes of pregnant women with different degrees of pulmonary hypertension

OBJECTIVES

To investigate the clinical situation and pregnancy outcome of pregnant women with pulmonary arterial hypertension (PAH).

METHODS

A retrospective analysis was conducted on 125 pregnant women with varying degrees of PAH who were treated in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of the University of Science and Technology between January 2016 and January 2023. The patients were divided into the mild group (58 cases), the moderate group (42 cases), and the severe group (25 cases) based on the pulmonary artery systolic blood pressure (PASBP) measurements. Mild was considered as PASBP 30-49 mmHg, moderate as PASBP 50-79 mmHg, and severe as PASBP ≥80 mmHg. The clinical data, cardiac function grade, etiology, and pregnancy outcome of the pregnant women with different degrees of severity of PASBP were analyzed.

RESULTS

Out of the 125 cases, the primary cause of PAH was congenital heart disease in 46 cases, followed by idiopathic heart disease in 32 cases, preeclampsia in 30 cases, rheumatic heart disease in 10 cases, and perinatal cardiomyopathy in 7 cases. A significant correlation was observed between the severity of PAH and the cardiac function grade, indicating that higher PASBP levels were associated with worse cardiac function (New York Heart Association functional classification system) (p < .05). Most deliveries were conducted via cesarean section, predominantly under intraspinal anesthesia. It was found that as the severity of PAH increased, there was a corresponding escalation in the incidence of adverse outcomes, including preterm birth, neonatal asphyxia, the need for intensive-care-unit transfer for both mothers and newborns, maternal death, perinatal death, extended postoperative hospital stay, and increased hospital expenses (p < .05).

CONCLUSIONS

The higher the pulmonary artery pressure, the worse the prognosis and outcome in pregnant patients with severe PAH.

Occurrence and associated factors of self-reported medical errors among Chinese physicians and nurses: a cross-sectional survey

BACKGROUND

Medical errors (MEs) significantly threaten patient safety globally. This study aimed to explore multidimensional factors associated with self-reported MEs among Chinese physicians and nurses.

METHODS

A cross-sectional online survey using snowball sampling collected 7197 valid responses from Chinese physicians and nurses between October 2020 and April 2022. A self-reported question assessed MEs within the past three months. Sociodemographic characteristics, work-related factors, and mental distress were collected. Data were analyzed using stepwise logistic regression.

RESULTS

1285 (17.9%) physicians and nurses self-reported MEs during the previous 3 months. Factors associated with higher odds of self-reported MEs included male sex (OR: 1.44, 95% CI: 1.23-1.69), physician status (OR: 1.48, 95% CI: 1.26-1.73), history of mental illness (OR: 1.49, 95% CI: 1.16-1.91), longer weekly working hours (OR: 1.20-1.23, 95% CI: 1.03-1.47), workplace violence experience (OR: 1.54-1.75, 95% CI: 1.30-2.17), and dissatisfaction with the medical practice environment (OR: 1.20, 95% CI: 1.05-1.37). Conversely, being married (OR: 0.74, 95% CI: 0.62-0.89), holding a bachelor's degree or higher (OR: 0.82, 95% CI: 0.70-0.97), and having more years of professional practice (OR: 0.96, 95% CI: 0.95-0.97) were associated with lower odds of self-reported MEs. Self-reported MEs were significantly and positively correlated with burnout (OR: 1.40, 95% CI: 1.20-1.62), depressive symptoms (OR: 1.38-1.45, 95% CI: 1.04-1.84), perceived stress (OR: 1.28-1.62, 95% CI: 1.06-2.02), and excessive daytime sleepiness (OR: 1.27-1.46, 95% CI: 1.10-1.79).

CONCLUSIONS

Self-reported MEs are relatively common among Chinese physicians and nurses, and are associated with various factors. Poor workplace conditions and mental distress are linked to an increased risk of MEs. Implementing effective interventions to improve workplace conditions and mental health is crucial for reducing MEs.

Comorbidities and anthropometric parameters in obstructive sleep apnea syndrome: a phenotype-based study

PURPOSE

Obstructive Sleep Apnea Syndrome (OSAS) is a heterogeneous syndrome and shows different phenotypic, clinical and physiopathological features. The aim of this study was to examine the relationships between OSAS phenotypes and comorbidities and anthropometric measurements and to identify OSAS phenotypes that should be referred for early diagnosis and treatment.

MATERIALS AND METHODS

We retrospectively reviewed 600 patients who underwent polysomnography (PSG) in our sleep center. Seven phenotypes were defined as Simple Snoring (SS)-Control, Mild, Moderate and Severe OSAS, Rem Dependent OSAS (RDO), Position Dependent OSAS (PDO) and Rem+Position dependent OSAS (R+PDO). Demographic data, anthropometric measurements and comorbid diseases of the patients were obtained retrospectively from their files. OSAS phenotypes were compared with comorbidities and anthropometric measurements.

RESULTS

Severe OSAS was the most common phenotype. Oxygen desaturation index (ODI) and anthropometric measurements showed significant differences between phenotypes (p < .001). Hypertension (HT) (43.7%) and ischemic heart disease (CHD) (14.2%) were the most common comorbidities and were most commonly associated with severe OSAS. In logistic regression analysis, neck circumference (NC) and body mass index (BMI) were the anthropometric measures that predicted OSAS phenotypes. NC and BMI predicted severe OSAS, NC predicted PDO and R+PDO, and BMI predicted RDO.

CONCLUSION

This study revealed that OSAS phenotypes exhibit different clinical and anthropometric characteristics and differ in comorbidity risks. HT was found to be higher in severe OSAS, moderate OSAS and R+PDO, and CHD was higher in severe OSAS and RDO. Our study emphasized the importance of phenotypic characteristics as well as AHI in the management of comorbidities in OSAS.

Adult ileo cecal intussusception as a manifestation of colon carcinoma: A case report

BACKGROUND

Intussusception is the invagination of a segment of the bowel into an adjacent segment. It is the most common cause of intestinal obstruction in children, but in adults, it is rare, accounting for 1% of all intestinal obstructions and 5% of all intussusceptions, with malignancy being the most common cause. In the past, it was typically diagnosed intraoperatively. However, with the availability of computed tomography for abdominal imaging, recognizing the condition's signs has become crucial. Surgical intervention is essential for managing neoplastic cases and their complications.

CASE SUMMARY

A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen, abdominal distension, vomiting, and persistent constipation. Over the past two months, she has also experienced considerable weight loss. After an initial history review, examination, and imaging investigations, the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon. This condition was surgically managed through an extended right hemi colectomy.

CONCLUSION

Intussusception is uncommon in adults, but it should be considered in patients with intestinal obstruction. Surgical intervention is essential.

Chitosan nanovectors for siRNA delivery: New horizons for nonviral gene therapy

The growing interest in RNA-based therapeutics has positioned small interfering RNA (siRNA) as a promising tool for gene silencing with high specificity and efficacy. However, the successful clinical application of siRNA therapies requires efficient delivery systems to overcome extracellular and intracellular barriers. Chitosan, a naturally derived polysaccharide, has gained significant attention as a non-viral vector due to its biodegradability, biocompatibility, mucoadhesive properties, and capacity to enhance cellular uptake. These attributes make chitosan an attractive alternative to lipid-based nanoparticles, which currently dominate siRNA delivery platforms. Recent advancements in chitosan-based nanoformulations, including chemical modifications and functionalization strategies, have improved siRNA stability, targeting efficiency, and transfection potential, addressing key limitations such as low bioavailability and immunogenicity. Despite these advances, challenges remain in achieving optimal release kinetics, scalability, and consistent therapeutic efficacy. Future research efforts will focus on engineering chitosan derivatives with enhanced physicochemical properties, integrating multifunctional nanocarriers, and refining formulation strategies to bridge the gap between preclinical research and clinical translation. The continued development of chitosan-based siRNA therapeutics holds significant potential for advancing precision medicine and expanding treatment options for a variety of diseases, including cancer, metabolic disorders, and inflammatory conditions.

Unusual foreign body in the buccal mucosa: A case report

BACKGROUND

Intraoral honeybee stings are very rare. Stings by these insects occur 25% of the time in the head and neck region. In addition, a stinger intraorally can lead to persistent irritation, inflammation, and secondary infections if not promptly excised.

CASE SUMMARY

We report the case of a 52-year-old female patient who was stung in her mouth by a honeybee, causing a local irritation. The patient presented with a one-month history of pain, swelling, and redness in the left buccal mucosa. Inadvertently retained, the stinger was discovered during a clinical evaluation following initial treatment for facial swelling and erythema. After the stinger was removed, the patient’s symptoms resolved without complications.

CONCLUSION

This case emphasizes the importance of thorough examination and prompt management of insect stings to prevent prolonged discomfort and potential complications.

Respiratory function and sleep parameters in adults following recovery from acute COVID-19

The impact of COVID-19 on lung function and sleep in otherwise healthy individuals has been subject to a limited number of studies. The aim of this study was to investigate the effect of COVID-19 on pulmonary function and sleep in adults. Participants, 50-85 years old, who had recovered from COVID-19 (COVID-19 group: n = 48) and those without history of COVID-19 (control group: n = 28) underwent pulmonary function assessment (Forced Vital Capacity, FVC, and Slow Vital Capacity, SVC) using spirometry. Sleep and circadian variables were measured objectively with wrist-worn actigraphy for seven days. Subjective sleep of participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). There were no significant differences in age (60 ± 6 vs 62 ± 6 years), BMI (26.30 ± 4.25 vs 26.48 ± 3.60 kg/m2), or pulmonary function (FVC, 4.02 ± 1.04 vs 3.80 ± 0.98 L, p = 0.36; and SVC, 3.82 ± 1.09 vs 3.89 ± 0.92 L, p = 0.76) between COVID-19 and control groups. The COVID-19 group had significantly reduced sleep efficiency (0.87 ± 0.04 vs 0.91 ± 0.04, p < 0.01), increased sleep disturbance (awakenings, 1.70 ± 1.02 vs 1.15 ± 1.15, p < 0.01; and wakefulness after sleep onset, 35:05 ± 25:37 vs 20:02 ± 12:48 min, p = 0.01) and PSQI score (5.19 ± 2.88 vs 3.93 ± 2.89, p = 0.01), compared to the control group. Individuals with history of COVID-19 demonstrate reduced sleep quality compared to a non-COVID-19 control group.

A study on the factors influencing mortality risk in sepsis-induced acute kidney injury based on analysis of the MIMIC database

Sepsis-induced acute kidney injury (SA-AKI) significantly increases mortality and healthcare burdens. Identifying key mortality risk factors is crucial for improving patient outcomes. This study aims to identify the primary factors affecting mortality in SA-AKI patients using the MIMIC-III database. A retrospective analysis was conducted on 4868 SA-AKI patients from the MIMIC-III database. Clinical data from the first 24 h of ICU admission were analyzed using logistic regression to identify mortality predictors. Key mortality predictors included advanced age (OR = 1.015, 95% CI: 1.006-1.024), severe AKI stages (OR = 1.470, 95% CI: 1.285-1.676), low serum albumin (OR = 0.606, 95% CI: 0.506-0.722), delayed antibiotics (OR = 1.001, 95% CI: 1.000-1.002), high AST (OR = 1.035, 95% CI: 1.027-1.083), and bilirubin (OR = 1.055, 95% CI: 1.037-1.083). The area under the curve (AUC) of the combined predictors for mortality risk was 0.796, indicating high predictive accuracy. Conclusions: Early intervention and monitoring of identified risk factors such as age, AKI stage, albumin levels, and antibiotic timeliness can enhance survival rates in SA-AKI patients.

Saving exposed titanium mesh cranioplasty using adipocutaneous anterolateral thigh flap: A case series

Introduction

Scalp thinning and soft tissue atrophy are significant risk factors for prosthetic material exposure after cranioplasty surgery. Reconstruction of the forehead and scalp to ensure functional coverage and aesthetics continues to be challenging.

Patients and Methods

This prospective study assessed 15 patients with titanium mesh material exposure, scalp thinning, and soft tissue atrophy following cranioplasty from 2020 to 2023 to identify contributory factors. All patients underwent reconstruction with free adipocutaneous anterolateral thigh flap to cover skin defects and fill soft tissue. The results were evaluated based on flap survival, coverage, and symmetry after surgery.

Results

The average age in the study was 40.46 (range 11-68) years, and the male/female ratio was 9/6. From 2020 to 2023, 15 free adipocutaneous anterolateral thigh flaps were used for reconstruction. Complete flap survival was achieved in 93.3 % (14/15) patients with all titanium mesh implants retained. Symmetry and soft tissue hypoplasia correction was achieved in all 15 cases.

Conclusion

Adipocutaneous anterior lateral thigh (ALT) flap is a versatile flap to treat complications following cranioplasty with titanium mesh. The ALT flap provides extensive coverage, reduce the risk of recurrent infections, and create an implant for soft tissue atrophy or skin thinning to restore the scalp's aesthetics.

Effect of methoxychlor on liver function, lipid peroxidation, and antioxidants in experimental rats

Background

Methoxychlor (MXC), a widely used pesticide, poses significant toxicological risks to various biological systems. It is an environmental contaminant and the only organochlorine pesticide still using instead of DDT. Endocrine disruption of MXC is also under investigation.This study aimed to investigate the effects of MXC on antioxidant status, lipid peroxidation, and liver metabolism in experimental rats.

Methods

Male Wistar rats were divided into control and treatment groups, with the latter receiving 150 mg/kg and 250 mg/kg body weight (BW) of MXC via oral administration for 30 days. Liver function was assessed by measuring circulating biomarkers, including Alanine Transaminase (ALT), Aspartate Transaminase (AST), and Alkaline Phosphatase (ALP). Oxidative damage was evaluated by determining Thiobarbituric Acid Reactive Substances (TBARS), hydroperoxide (HYP), and other lipid peroxidation markers. Key enzymes involved in antioxidant defense mechanisms were also analyzed in the liver of experimental animals.

Results

Our results demonstrated a significant increase in ALT, AST, and ALP levels in the serum of rats exposed to MXC, indicating impaired liver function. This was accompanied by elevated lipid peroxidation, further emphasizing oxidative stress. Moreover, the activities of antioxidant enzymes such as SOD, GPx, and CAT were markedly reduced in the MXC-exposed groups compared to the controls, suggesting a compromised antioxidant defense system.

Conclusion

These findings suggest that methoxychlor exposure disrupts liver function and induces oxidative stress by enhancing lipid peroxidation, thereby depleting natural antioxidant defenses. This study highlights the potential hepatotoxic effects of methoxychlor and underscores the role of oxidative stress in mediating its toxicity.

A comparative analysis of unsupervised machine-learning methods in PSG-related phenotyping

Obstructive sleep apnea is a heterogeneous sleep disorder with varying phenotypes. Several studies have already performed cluster analyses to discover various obstructive sleep apnea phenotypic clusters. However, the selection of the clustering method might affect the outputs. Consequently, it is unclear whether similar obstructive sleep apnea clusters can be reproduced using different clustering methods. In this study, we applied four well-known clustering methods: Agglomerative Hierarchical Clustering; K-means; Fuzzy C-means; and Gaussian Mixture Model to a population of 865 suspected obstructive sleep apnea patients. By creating five clusters with each method, we examined the effect of clustering methods on forming obstructive sleep apnea clusters and the differences in their physiological characteristics. We utilized a visualization technique to indicate the cluster formations, Cohen's kappa statistics to find the similarity and agreement between clustering methods, and performance evaluation to compare the clustering performance. As a result, two out of five clusters were distinctly different with all four methods, while three other clusters exhibited overlapping features across all methods. In terms of agreement, Fuzzy C-means and K-means had the strongest (κ = 0.87), and Agglomerative hierarchical clustering and Gaussian Mixture Model had the weakest agreement (κ = 0.51) between each other. The K-means showed the best clustering performance, followed by the Fuzzy C-means in most evaluation criteria. Moreover, Fuzzy C-means showed the greatest potential in handling overlapping clusters compared with other methods. In conclusion, we revealed a direct impact of clustering method selection on the formation and physiological characteristics of obstructive sleep apnea clusters. In addition, we highlighted the capability of soft clustering methods, particularly Fuzzy C-means, in the application of obstructive sleep apnea phenotyping.

Incidental appendiceal mucocele discovery: A case series and literature review

INTRODUCTION

Low-grade appendiceal mucinous neoplasms (LAMNs) are rare entities that can present significant challenges when discovered incidentally by general surgeons during surgery or through postoperative pathology. These lesions may mimic common abdominal conditions and are often not suspected preoperatively.

METHODS

We present a case series of five patients in whom appendiceal mucoceles were incidentally identified either intraoperatively or on postoperative pathological examination. The patients ranged from 36 to 79 years old and presented with symptoms such as right lower quadrant pain, initially attributed to appendicitis, ovarian torsion, or other gynecological conditions. Intraoperative findings varied from dilated appendices with mucinous content to large cystic masses involving adjacent structures.

RESULTS

In each case, the general surgeon had to make immediate decisions regarding management. Surgical interventions included laparoscopic appendectomy and open right hemicolectomy, with an emphasis on careful handling to prevent rupture and spillage of mucin. Postoperative pathology confirmed LAMNs, with tumor stages ranging from pTis to pT4a. Some patients required additional procedures, such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), due to the presence of acellular mucin or peritoneal involvement. The discussion focuses on practical guidance for general surgeons when faced with an incidental appendiceal mucocele. Key recommendations include avoiding intraoperative rupture by gentle handling, assessing the need for extended resection based on intraoperative findings, and ensuring thorough communication with pathology for accurate staging. Postoperative management should involve reviewing pathology reports carefully, considering referral to a multidisciplinary team for higher-stage tumors, and implementing long-term surveillance protocols due to the risk of recurrence.

CONCLUSION

General surgeons play a critical role in the initial management of incidentally discovered appendiceal mucoceles. Prompt recognition and appropriate intraoperative decision-making are essential to optimize patient outcomes. By adhering to careful surgical techniques and collaborating with multidisciplinary teams, surgeons can effectively manage these unexpected findings and mitigate potential complications associated with LAMNs.

Sex Specific Outcomes With Cardiac Resynchronization Therapy in Patients With Symptomatic Heart Failure Having Reduced Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis

Cardiac resynchronization therapy (CRT) has emerged instrumental in managing heart failure. Notably, there is a lack of evidence of CRT efficacy among both sexes. Thus, this meta-analysis focuses on the long-term benefits of CRT in both sexes. PubMed, The Cochrane Library and clinicaltrials.gov were searched for articles from 2010 to 2024. ROB2 was used to assess risk of bias of RCTs. Newcastle Ottawa Scale was used for quality appraisal of cohorts. Meta-analysis was conducted on Revman 5.4. Out of 2722 articles, only 9 RCTs and 18 cohorts were included. Our results demonstrated that females had a significantly lower risk of composite outcomes compared to males in both RCTs (RR 0.80; 95% CI [0.68, 0.94], P = .006) and cohorts (RR 0.76; 95% CI [0.63, 0.92], P = .004). Results were similar for all-cause mortality. For heart failure hospitalization, only cohorts showed a significant lesser risk in females (RR 0.78; 95% CI [0.65, 0.93], P = .006). Left ventricular ejection fraction improved significantly in females but no differences were observed for NYHA class improvement. Males showed a 31% lower survival rate. However future trials are needed to highlight this variation.

Evaluation of blood flow in arteritic anterior ischemic optic neuropathy using laser speckle flowgraphy: A case series

Background

Arteritic anterior ischemic optic neuropathy (AAION), primarily caused by giant cell arteritis, is a leading cause of blindness. This disease results in significant ocular blood flow (BF) impairment, though data on ocular hemodynamics are limited.

Methods

This observational case series enrolled four patients treated for AAION (age: 81.8 ± 7.8 years; male to female ratio: 3:1) who underwent laser speckle flowgraphy (LSFG) scanning at the initial visit and after steroid treatment in both eyes. Mean blur rate (MBR), an LSFG parameter that represents BF velocity, was obtained in the optic nerve head vessel area (ONH-MV), ONH tissue area (ONH-MT), and peripapillary choroid, in addition to common ophthalmologic parameters.

Results

At the initial visit, all affected eyes had no light perception in best-corrected visual acuity (BCVA) testing, and three cases had a severe increase in circumpapillary retinal nerve fiber layer thickness (cpRNFLT; 191.00 ± 42.03 μm). Pre-treatment, all affected eyes showed decreases in ONH-MV, ONH-MT, and choroidal MBR; this improved after steroid treatment by 80.3 ± 107.6 %, 39.1 ± 79.7 %, and 289.4 ± 303.4 %, respectively. Pre-treatment, all fellow eyes showed no impairment in BCVA or changes in the cpRNFLT. Post-treatment, two fellow eyes showed an increase in ONH-MV and ONH-MT parameters (72.8 ± 32.6 % and 82.2 ± 22.3 %, respectively), while all fellow eyes showed an increase in choroidal MBR (152.7 ± 126.1 %).

Conclusion

LSFG could be useful for monitoring ocular BF changes in eyes with AAION and asymptomatic fellow eyes before and after steroid treatment.

Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions

BACKGROUND AND OBJECTIVES

The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.

METHODS

This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.

RESULTS

No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.

CONCLUSION

For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.

Perioperative management and outcomes of surgical pulmonary valve replacement following tetralogy of fallot repair: A retrospective study

BACKGROUND

While the long-term prognosis of Tetralogy of Fallot (TOF) repair is favourable, the frequency of interventions for pulmonary valve insufficiency during follow-up remains high, raising concerns regarding its invasiveness. This study aimed to evaluate the safety measures and strategies for the perioperative management of pulmonary valve interventions following TOF repair.

METHODS

From November 2022 to December 2023, interventions in the pulmonary artery for TOF were performed in 17 patients; a retrospective analysis was conducted on all patients. Preoperative haemodynamic evaluation was performed using 4D-flow magnetic resonance imaging in all cases.

RESULTS

The 17 patients included in the study had a mean age of 24.1 ± 14 years. The mean duration from repair to re-intervention was 18.2 ± 12 years, with a preoperative right ventricular ejection fraction of 42.3 ± 12 %. The mean surgical time, cardiopulmonary bypass time, and aortic cross-clamp time were 389 ± 96, 210 ± 67, and 106 ± 48 min, respectively. Pulmonary valve replacement was performed in eight patients, with seven using porcine aortic valves and one using a bovine pericardial valve. The Rastelli-type procedure was performed in nine cases, with seven using expanded polytetrafluoroethylene valved conduits and two using composite grafts of a porcine bioprosthetic valve and Valsalva graft. Additional procedures included right ventricular outflow tract myectomy in nine patients, pulmonary artery reconstruction in five, cryoablation in four, coronary artery bypass grafting in three, tricuspid valve repair in three, and ventricular septal defect closure in one. There were no cases of early mortality, stroke, or re-operation within 30 days.

CONCLUSION

Interventions on the pulmonary valves following TOF repair can be safely performed with appropriate perioperative management. The primary goal of surgical pulmonary valve replacement is to preserve the right ventricular function and reconstruct a smooth pathway from the right ventricle to the pulmonary artery, considering future transcatheter interventions. Further long-term follow-up is necessary to assess outcomes, such as remote mortality, right ventricular function, and arrhythmia occurrence.

Diagnostic accuracy of machine learning algorithms in electrocardiogram-based sleep apnea detection: A systematic review and meta-analysis

Sleep apnea is a prevalent disorder affecting 10 % of middle-aged individuals, yet it remains underdiagnosed due to the limitations of polysomnography (PSG), the current diagnostic gold standard. Single-lead electrocardiography (ECG) has been proposed as a potential alternative diagnostic tool, but interpretation challenges remain. Recent advances in machine learning and deep learning technologies offer promising approaches for enhancing the detection of sleep apnea through automated analysis of ECG signals. This meta-analysis aims to evaluate the diagnostic accuracy of machine learning (ML) and deep learning (DL) algorithms in detecting sleep apnea patterns from single-lead ECG data. A comprehensive literature search across multiple databases was conducted through November 2023, adhering to PRISMA-DTA guidelines. Studies that included sensitivity and specificity data for ECG-based sleep apnea detection using (machine learning/deep learning) ML/DL were selected. The analysis included 84 studies, demonstrating high diagnostic accuracy for ML/DL algorithms, with pooled sensitivity and specificity of over 90 % in per-segment analysis and close to 97 % in per-record analysis. Despite strong diagnostic performance, variations in algorithm effectiveness and methodological biases were noted. This meta-analysis highlights the potential of ML and DL in improving sleep apnea diagnosis and outlines areas for future research to address current limitations.

Unmasking vestibular schwannoma: A series of unusual cases

INTRODUCTION

Vestibular schwannoma (VS) is a benign, slow-growing tumor that accounts for 80-90 % of cerebellopontine angle (CPA) tumors. While classic symptoms like hearing loss, tinnitus, and vertigo are well-recognized, atypical presentations can delay diagnosis.

CASE PRESENTATION

We present four unusual cases of VS. The first patient, a 33-year-old woman, initially presented with transient tinnitus and later developed peripheral vertigo. The second case involved a 52-year-old man with sudden hearing loss, vertigo, and aural fullness. The third case was a 17-year-old female with unilateral auditory neuropathy. The fourth patient, a 39-year-old woman, presented with intermittent tinnitus, balance disturbances, and facial stiffness.

DISCUSSION

Detailed history, physical examination, and audiological evaluation are crucial for identifying patients at risk for vestibular schwannoma, especially with atypical audiological findings, to avoid misdiagnosis.

CONCLUSION

This case series emphasizes the significance of considering VS as a differential diagnosis for atypical symptoms. Early recognition and proper practice can lead to optimal outcomes for patients and contribute valuable insights to the scientific field by broadening the understanding of the diverse spectrum of VS symptoms.

Short-term outcomes of modified Lapidus procedure using the InCore® Lapidus System for hallux valgus: Case series of four cases

INTRODUCTION

Hallux valgus is a common foot deformity often associated with first tarsometatarsal (TMT) joint instability. The Lapidus procedure, involving first TMT joint arthrodesis, is a well-established surgical procedure for severe cases, but the issue lies in the method of fixation. The InCore® Lapidus System is a novel intramedullary fixation system for modified Lapidus procedure. We here report the clinical experience of this system.

CASE PRESENTATION

We retrospectively reviewed four cases who underwent a modified Lapidus procedure using the InCore® Lapidus System and followed up at least 6 months. Surgical outcomes were evaluated by the hallux valgus (HV) and intermetatarsal (M1M2) angles on radiographs, bone union status on computed tomography (CT), postoperative pain levels, and the occurrence of complications. The HV angle improved in all four cases, ranging from 51° to 59° preoperatively and decreasing to 4° to 25° at the final follow-up. Similarly, the M1M2 angle improved in all four cases, with values decreasing from a preoperative range of 23° to 26° to a final range of 4° to 13°. All patients achieved bone union within three months, and postoperative pain was minimal (Numerical Rating Scale: 0-1) at six weeks postoperatively. No complications were observed.

CLINICAL DISCUSSION

Theoretical advantages of the InCore® Lapidus System include the ability to achieve joint compression using the device and the intramedullary fixation design, which may provide robust stability and a high rate of bone union. The system's design potentially reduces the risk of skin irritation, a common issue with plate fixation. Our clinical experiences supported these theoretical advantages.

CONCLUSION

The modified Lapidus procedure using the InCore® Lapidus System provided favorable short-term outcomes for hallux valgus without complications.

EMI-LTI: An enhanced integrated model for lung tumor identification using Gabor filter and ROI

In this work, the CT scans images of lung cancer patients are analysed to diagnose the disease at its early stage. The images are pre-processed using a series of steps such as the Gabor filter, contours to label the region of interest (ROI), increasing the sharpening and cropping of the image. Data augmentation is employed on the pre-processed images using two proposed architectures, namely (1) Convolutional Neural Network (CNN) and (2) Enhanced Integrated model for Lung Tumor Identification (EIM-LTI).•In this study, comparisons are made on non-pre-processed data, Haar and Gabor filters in CNN and the EIM-LTI models. The performance of the CNN and EIM-LTI models is evaluated through metrics such as precision, sensitivity, F1-score, specificity, training and validation accuracy.•The EIM-LTI model's training accuracy is 2.67 % higher than CNN, while its validation accuracy is 2.7 % higher. Additionally, the EIM-LTI model's validation loss is 0.0333 higher than CNN's.•In this study, a comparative analysis of model accuracies for lung cancer detection is performed. Cross-validation with 5 folds achieves an accuracy of 98.27 %, and the model was evaluated on unseen data and resulted in 92 % accuracy.

Early Outcomes on Triple-Branch Arch Device With Retrograde Left Common Carotid Branch: A Case Series

INTRODUCTION

Endovascular aortic arch repair using multibranch devices has been applied in patients considered at high risk for open repair. The aim of this case series was to report the early outcomes in patients managed with a new design 3 branch arch custom-made device, including a retrograde left common carotid artery (LCCA) branch.

METHODS

The Preferred Reporting Of CaSe Series in Surgery (PROCESS) guidelines were followed. All consecutive patients undergoing endovascular repair of an aortic arch lesion with a custom-made triple-branch device, including a retrograde LCCA branch (Cook Medical, Bloomington, IN, USA), between October 27, 2022, and February 28, 2023, were included. The presence of an arch aneurysm (degenerative or post-dissection) with diameter ≥55 mm and high risk for a conventional open repair set the indication for treatment. The primary outcomes were technical success and mortality at 30 days. Early morbidity and reinterventions were considered as secondary outcomes.

RESULTS

Eight elective patients (87.5% men, mean age 72.3±27.0 years) were included. Five of them (62.5%) had undergone a previous ascending aorta repair of an acute type A aortic dissection. All patients were asymptomatic, except one, with left recurrent laryngeal nerve compression. The mean maximum aortic diameter was 70.4±21.0 mm. Percutaneous femoral and axillary access was used in all cases except three in which a cut down for right carotid access was performed. Technical success was 100%. Femoral access to the LCCA and implantation of the bridging stent was performed without technical challenges. No death nor cerebrovascular event was recorded during the 30 day follow-up. Five patients (62.5%) presented major complications, 3 related to access needing reintervention and the remaining related to congestive heart failure (CHF), which were managed successfully with medical treatment. Follow-up (range 1-4 month) was uneventful, except for one patient who presented a secondary type Ia endoleak.

CONCLUSIONS

According to our early experience, the presence of a retrograde branch facilitated the revascularization of the LCCA through femoral access, decreasing the risk of cerebrovascular morbidity. Further analyses with longer follow-up are needed to evaluate the safety and efficacy of the device.Clinical ImpactData arising mainly from the retrograde branch for the revascularization of the LSA are encouraging from a variety of devices. The premiminary experience with a triple-branched arch device, with a retrograde branche for the LSA but also for the LCCA, was associated with no 30 day mortality and 100% technical success.The device's design allowed swift catheterization and completion of the LCCA revascularization using femoral access exclusively.

Childhood adversity in parents of patients with pediatric multiple sclerosis

BACKGROUND

Childhood environmental factors back to the prenatal environment can contribute to MS risk. Childhood adversity, which causes biological, behavioral, and epigenetic changes that can be passed down through families, has been understudied in MS. Here, we emphasize the need to understand the role that intergenerational adversity may play among families affected by MS.

OBJECTIVE

To evaluate the frequency and types of adverse childhood experiences among parents of children with MS.

METHODS

Individuals with pediatric MS (n = 68) were enrolled in a longitudinal study of cognition. At enrollment, the patient and one caregiver or parent completed questionnaires. As the pediatric participants were under age 18 at time of enrollment, one parent completed the Adverse Childhood Experiences (ACEs, a 10-item self-report measure) about the parents' own childhood. Results from the ACE questionnaire among parents of pediatric healthy controls (n = 96) and adults in a national cohort are also reported for comparison.

RESULTS

Over half of pediatric MS parents reported at least one ACE exposure. Of parents that did have ACE exposures, the exposures were broad in terms of abuse, neglect, and household dysfunction. Over 10 % of parents reported total ACE scores of 7 or above.

CONCLUSION

Over half of pediatric MS parents experienced some degree of childhood adversity. The impact of intergenerational adversity on the development of pediatric onset MS warrants further study.

The biomedical applications of artificial intelligence: an overview of decades of research

A significant area of computer science called artificial intelligence (AI) is successfully applied to the analysis of intricate biological data and the extraction of substantial associations from datasets for a variety of biomedical uses. AI has attracted significant interest in biomedical research due to its features: (i) better patient care through early diagnosis and detection; (ii) enhanced workflow; (iii) lowering medical errors; (v) lowering medical costs; (vi) reducing morbidity and mortality; (vii) enhancing performance; (viii) enhancing precision; and (ix) time efficiency. Quantitative metrics are crucial for evaluating AI implementations, providing insights, enabling informed decisions, and measuring the impact of AI-driven initiatives, thereby enhancing transparency, accountability, and overall impact. The implementation of AI in biomedical fields faces challenges such as ethical and privacy concerns, lack of awareness, technology unreliability, and professional liability. A brief discussion is given of the AI techniques, which include Virtual screening (VS), DL, ML, Hidden Markov models (HMMs), Neural networks (NNs), Generative models (GMs), Molecular dynamics (MD), and Structure-activity relationship (SAR) models. The study explores the application of AI in biomedical fields, highlighting its enhanced predictive accuracy, treatment efficacy, diagnostic efficiency, faster decision-making, personalised treatment strategies, and precise medical interventions.

Endovascular stent grafting for superior mesenteric vein erosion in necrotizing pancreatitis: A lifesaving intervention in a rare complication

Vascular complications, though rare, significantly increase the morbidity and mortality associated with necrotizing pancreatitis (NP). While arterial pseudoaneurysms are well-documented, major venous injuries, particularly superior mesenteric vein (SMV) erosion, are exceedingly uncommon, with only 2 cases previously reported in the literature. We describe a 41-year-old male with severe necrotizing pancreatitis complicated by abdominal compartment syndrome, who developed acute, life-threatening hemorrhage due to pancreatic enzyme erosion of the SMV. Surgical attempts to control the bleeding were unsuccessful, and the hemorrhage was ultimately managed with endovascular stent grafting of the SMV. This case underscores the complexity of vascular injuries in pancreatitis and highlights the potential role of endovascular interventions, such as venous stent grafting, as life-saving procedures when conventional surgical techniques fail. Our case adds to the limited but growing body of evidence supporting the use of venous stenting for mesenteric venous injuries in NP.

An Australian regional hospital's oesophagectomy experience: A 10-year case series from Tasmania

Introduction

Oesophagectomy is recommended as part of curative treatment for oesophageal cancer but is associated with substantial morbidity. Centralization has been recommended to improve outcomes, but this has not been widely applied in Australia. This study aimed to audit a regional hospital's experience over ten years and compare it to outcomes from national and international centres to support the view that oesophagectomy can be performed safely in select regional centres in Australia.

Methods

Patients undergoing oesophagectomy at a single regional hospital in North-East Tasmania, Australia between January 2014 and December 2023 were retrospectively identified. Preoperative patient and tumour characteristics, and outcomes (mortality, anastomotic leak, length of stay, respiratory complications, long-term complications and survival) were compared to other centres.

Results

65 patients were identified. 53 % were male, mean age was 65.2 years, 29.2 % had respiratory disease and 18.5 % were current smokers. The anastomotic leak rate was 7.7 %. 25 % developed pneumonia postoperatively. Average ICU length of stay was 4.6 days, median acute inpatient length of stay was 15 days. There was one in-hospital mortality and one 30-day mortality. 2 patients (3 %) required diaphragmatic hernia repair; 12 patients (18.5 %) required endoscopic dilatation of anastomotic strictures. The 5-year survival rate was 66 %. Our results compare favourably to published rates of anastomotic leak (10-15 %), inpatient stay (15 days), pneumonia (20-30 %), 30-day mortality (1-4 %) and anastomotic stricture (20 %).

Conclusions

Oesophagectomies can be safely performed in regional centres in Australia that routinely undertake a higher volume of cases per year, provided services required to manage complications are readily available.

Advancing the frontier of artificial intelligence on emerging technologies to redefine cancer diagnosis and care

BACKGROUND

Artificial Intelligence (AI) is capable of revolutionizing cancer therapy and advancing precision oncology via integrating genomics data and digitized health information. AI applications show promise in cancer prediction, prognosis, and treatment planning, particularly in radiomics, deep learning, and machine learning for early cancer diagnosis. However, widespread adoption requires comprehensive data and clinical validation. While AI has demonstrated advantages in treating common malignancies like lung and breast cancers, challenges remain in managing rare tumors due to limited datasets. AI's role in processing multi-omics data and supporting precision oncology decision-making is critical as genetic and health data become increasingly digitized.

METHOD

This review article presents current knowledge on AI and associated technologies, which are being utilized in the diagnosis and therapy of cancer. The applications of AI in radiomics, deep learning, and machine learning for cancer screening and treatment planning are examined. The study also explores the capabilities and limitations of predictive AI in diagnosis and prognosis, as well as generative AI, such as advanced chatbots, in patient and provider interactions.

RESULTS

AI can improve the early diagnosis and treatment of high-incidence cancers like breast and lung cancer. However, its application in rare cancers is limited by insufficient data for training and validation. AI can effectively process large-scale multi-omics data from DNA and RNA sequencing, enhancing precision oncology. Predictive AI aids in risk assessment and prognosis, while generative AI tools improve patient-provider communication. Despite these advancements, further research and technological progress are needed to overcome existing challenges.

CONCLUSIONS

AI holds transformative potential for cancer therapy, particularly in precision oncology, early detection, and personalized treatment planning. However, challenges such as data limitations in rare cancers, the need for clinical validation, and regulatory considerations must be addressed. Future advancements in AI could significantly improve decision-support systems in oncology, ultimately enhancing patient care and quality of life. The review highlights both the opportunities and obstacles in integrating AI into cancer diagnostics and therapeutics, calling for continued research and regulatory oversight.

Short-term and long-term outcomes of pancreas preserving total duodenectomy: A case series from a single center with 13 years' experience and complimentary meta-analysis

Backgrounds/Aims

To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD).

Methods

A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series. All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis.

Results

A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%-5.2%), CD II complications in 21.1% (14.6%-27.6%), CD III complications in 18.1% (9.3%-26.9%), CD IV complications in 2.7% (0.5%-4.9%), and CD V complications in 2.2% (0.2%-4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy.

Conclusions

PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

Health inequity: Possibilities of initiating pulmonary telerehabilitation programs for adults with chronic obstructive pulmonary disorders in conflict and low-resourced areas; A mixed-method phenomenological study

OBJECTIVE

The "triple problems of COPD"-underdiagnosis, underrecognition, and underdevelopment of pulmonary rehabilitation programs-are global. Pulmonary telerehabilitation (PTR) may solve these problems. This study aims to explore the possibility of launching PTR programs for adults in an area of conflict and low resources.

METHODS

A mixed methods convergent design was used to understand outpatient Pulmonary Rehabilitation (PR) unavailability. The medical records of 70 patients with COPD in the Ministry of Health (MoH) chest unit were analysed quantitatively. thirteen patients who received in-hospital physiotherapy were questioned via a structured and validated questionnaire, and 12 healthcare professionals (HCPs) were interviewed. Quantitative data was analyzed descriptively, and inferentially by the SPSS, outlining the means, standard deviations and percentages, and the chi-square, respectively. Qualitative data was analyzed thematically using the NVivo software, and five themes and 25 subthemes were identified. A thematic framework and triangulation model were depicted accordingly.

RESULTS

Seventy patients with a mean age of 65.3 ± 1.65 years and a mean hospital stay of 4.89 ± 0.392 days were managed with no admission, Physiotherapy (PT) referral, or discharge criteria. Patients reported needing outpatient PR (4.38 ± 1.193) and a willingness to adopt (3.77 ± .832). Interviews with HCP highlighted the environmental and professional challenges, opportunities, and PTR traits. Quantitative and qualitative data triangulation led to the COPD Sequential Triad (CST) theory.

CONCLUSION

This study identified the national, institutional, and professional challenges and opportunities of launching PTR programs in conflict and low-resourced areas, including the conflict's consequences, insufficient resources, and absence of a structured healthcare system and clinical practice guidelines. Promoting health equity in such areas necessitates that the international community and institutions isolate the healthcare sector from conflicts and apply more effective strategies. The study also illustrated the characteristics of the intended PTR programs, including mHealth, therapeutic devices, and hybrid programs along with supporting professional organizations' guidelines.

Endoscopic management of pancreatic and biliary duct stenoses due to a giant pseudoaneurysm in a patient clinically suggestive of Loeys-Dietz syndrome

Loeys-Dietz syndrome is a rare connective tissue disorder characterized by the formation of aggressive arterial aneurysms. There are a few reports of Loeys-Dietz syndrome with pseudoaneurysms causing simultaneous pancreatic and biliary stenoses. Herein, we report the case of a 42-year-old man with Loeys-Dietz syndrome who presented with acute pancreatitis and liver dysfunction caused by a giant pancreaticoduodenal artery pseudoaneurysm compressing the main pancreatic and bile ducts. To minimize the risk of pseudoaneurysm rupture during endoscopic intervention, transcatheter arterial embolization was performed, followed by endoscopic intervention. Although initial clinical improvement was observed after endoscopic stent placement, a fistula between the pancreatic duct and the thrombosed pseudoaneurysm was detected at 4 months but spontaneously closed with continued stenting. Despite persistent ductal stenosis requiring long-term stent management, the fistula had closed 1 year after the initial stent placement. To the best of our knowledge, this is the first report describing a structured treatment strategy for pancreaticobiliary obstruction caused by a Loeys-Dietz syndrome-related pseudoaneurysm. This case highlights the importance of a stepwise interventional radiology-first approach and careful follow-up for the management of complex vascular compressive syndromes.

Short-term impact of delayed surgical treatment on the prognosis of patients with T1bN1-stage PTC: a retrospective cohort study

BACKGROUND

As the incidence of papillary thyroid carcinoma (PTC) increases, optimal timing for surgical interventions remains undefined. While surgical delays are known to affect prognosis adversely in various cancers, their impact on PTC is controversial.

METHODS

A retrospective study was conducted on 478 T1bN1-stage PTC patients treated at West China Hospital from January 2020 to May 2022. Patients underwent thyroidectomy with lymph node dissection and were categorized into three groups based on surgical delay: ≤90 days (group A, n = 264), > 90-180 days (group B, n = 92), and > 180 days (group C, n = 122). Additionally, patients were reclassified into two groups based on a one-year threshold: ≤365 days (group D, n = 420) and > 365 days (group E, n = 58). Tumor metastasis rates and postoperative complications were analyzed across these groups.

RESULTS

The median surgical delay was 79 days, and the median follow-up was 1362 days. Tumor metastasis occurred in 1.67% (8 patients), while postoperative complications occurred in 5.65% (27 patients). Metastasis rates were 1.89%, 1.09%, and 1.64%, and complication rates were 5.68%, 4.35%, and 6.56% for groups A, B, and C, respectively. No statistically significant differences were observed in metastasis or complication rates among the three groups. Similarly, no significant differences were found between groups D and E in tumor metastasis (p = 1.000) or complication rates (p = 0.555).

CONCLUSION

Delayed surgery was not associated with significantly increased short-term tumor metastasis or postoperative complication rates in patients with T1bN1-stage PTC.

The comparison of two types of physiotherapy techniques on selected weaning indices of patients requiring mechanical ventilation: a single blind randomized controlled trial

Chest physiotherapy, a key component of bronchial hygiene therapy, plays an important role in the overall management and care of patients who require Mechanical Ventilation (MV). We compared the effects of two types of physiotherapy techniques on selected weaning indices of patients requiring MV. We conducted a single-blind randomized controlled clinical trial with pre- and post-measurements in 60 patients requiring MV. Randomization was performed via block randomization with Sequential Numbered Opaque Sealed Envelopes. Participants were randomized into (1) lung squeezing technique (LST) or (2) chest vibration and percussion technique (CVPT). Data collection was carried out using a researcher-created checklist that comprised two sections. The first section gathered patient demographic information, while the second section functioned as a vital sign record sheet. This vital sign record was further divided: the initial part documented systolic and diastolic blood pressure, pulse rate, oxygen saturation, and RSBI prior to the intervention, and the follow-up part captured the same vital signs at intervals of 5- and 25-minutes post-intervention. There was no statistically significant difference between systolic and diastolic blood pressure, respiratory rate, and oxygen saturation scores of the two study groups at baseline and at 5- and 25-minute intervals post-intervention (P > 0.05). However, in terms of rapid, shallow breathing index (RSBI), a significant difference was observed between the two groups scores at baseline (LST: 38.5 (36.2-44.1) vs. CVPT: 35.2 (33.7-38); P < 0.0), 5-minutes post-intervention (LST: 36.6 (34.3-44) vs. CVPT: 34.8 (32.2-36.9); P < 0.05) and 25-minutes post-intervention (LST: 37.1 (32.5-44.4) vs. CVPT: 34 (32.5-35.8); P < 0.05). The results demonstrated that LST outperformed CVPT in enhancing the RSBI, which serves as a weaning index for patients requiring MV. This suggests that LST may facilitate earlier weaning and extubation for these patients. IRCT20091215002861N18, 09/12/2022.Trial Registration Number: IRCT20091215002861N18, 09/12/2022.

Infection risk and management in patients with cirrhosis: A critical overview

In this paper, we analyze the article published by El Labban et al, which explores the impact of cirrhosis on patients with necrotizing fasciitis. The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population. Building upon their final observation regarding the importance of understanding this association, we will delve into the topic of infections in patients with liver cirrhosis. These patients exhibit intrinsic characteristics that make them particularly susceptible to infections, both bacterial and fungal. This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations, including the development of acute-on-chronic liver failure, which markedly worsens prognosis and mortality. Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections, multidrug-resistant organisms, and atypical clinical presentations. Delayed or inadequate management can lead to unfavorable outcomes, further complicating the course of their underlying liver disease. The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections. Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality. By raising awareness among clinicians about the complexity of these cases, we hope to contribute to optimizing the care of this high-risk population.

Roflumilast reduces the number of lung adenocarcinomas, inflammation, and emphysema in a smoking-induced mouse model

BACKGROUND

The prognosis of lung cancer complicated by chronic obstructive pulmonary disease is poor, and effective prophylactic agents have not been established. Given that inflammation is a shared pathogenic mechanism of both diseases, we aimed to evaluate the efficacy of roflumilast, a novel anti-inflammatory drug, in preventing emphysema and lung cancer using a smoking-induced lung cancer mouse model.

METHODS

Male A/J mice were exposed to 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, a potent carcinogen, and intermittent mainstream cigarette smoke for 20 weeks. Roflumilast or vehicle was administered via intragastric gavage once daily. Lung tissues were assessed for tumor nodules and emphysema, and bronchoalveolar lavage fluid was collected for cell counting. Emphysema severity and concentrations of inflammatory cytokines (IL-6, IL-1β, and TNF-α) were assessed. RAW 264.7 macrophage cells were used to assess cellular responses to cigarette smoke extract.

RESULTS

Roflumilast attenuated the increase in total cells and macrophages in bronchoalveolar lavage fluid induced by intermittent smoking exposure and significantly suppressed smoking-induced expressions of IL-6, IL-1β, and TNF-α. Roflumilast also reduced emphysematous changes and the number of lung tumors. In vitro, roflumilast attenuated cigarette smoke extract-induced expression of IL-6, IL-1β, and TNF-α in RAW 264.7 cells.

CONCLUSIONS

This study highlights the potential use of roflumilast as a chemopreventive agent for patients with chronic obstructive pulmonary disease who are at risk of lung cancer and underscores its relevance for future clinical application and research on phosphodiesterase-4 inhibitors.

Workplace violence against nurse: a systematic review and meta-analysis in Ethiopia

BACKGROUND

Workplace violence is a global public health concern, especially in developing nations. Nurses, due to the nature of their professional duties, often face an elevated risk of workplace violence. This risk is further exacerbated by the lack of adequate safety precautions and the presence of multiple potential perpetrators, making the work environment particularly hazardous for them.

OBJECTIVES

This systematic review explores workplace violence against nurses in Ethiopia, its prevalence, causes, Perpetrators of violence in the Nurses' profession, consequences, influence on the profession, and strategies to prevent incidents based on relevant literature review.

REVIEW METHOD AND DATA SOURCES

The study sourced evidence from electronic databases like PubMed, Science Direct Scopus, Web of Science, and Google Scholar till January 30, 2024. The data was extracted from February 01-10 and later analyzed from February 15-March 15, and the report generation from March 15 to April 05, 2024, and reported findings per Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The study used pooled odds ratio and pooled proportion to assess exposure and outcomes. A meta-analysis was conducted using compressive met-analysis V4 packages, with forest plots for visual representation. Heterogeneity was evaluated using Cochran's Q-test and I² statistic. Sensitivity analysis was performed by systematically excluding one study.

RESULT

In Ethiopia, workplace violence against nurses was a significant issue, with an incidence ranging from 26.7 to 64%. The most common form of violence was verbal abuse, followed by physical, psychological, and sexual harassment. Factors like age, gender, marital status, job type, work environment, and staffing levels contribute to the issue. Over half of nurses change shifts due to concerns about violence, community dissatisfaction, unsatisfactory treatment, and challenging nurse-patient relationships.

CONCLUSION

The prevalence of WPV among nurses in Ethiopia is increasing. Nurses face a high risk of workplace violence due to direct patient contact and the nature of the profession. Thus, healthcare organizations can work towards creating a safer and more supportive environment for nurses, enforce a zero-tolerance policy, improve patient-nurse relationships, and provide psychological support to ultimately reduce the prevalence of workplace violence and ensure the well-being of healthcare professionals.

PROSPERO REGISTRATION NUMBER

CRD42024601317.

A novel and effective strategy for the treatment of large hepatic hemangioma: combining preoperative embolization with laparoscopic-assisted and ultrasound-guided ablation

BACKGROUND

Hepatic hemangioma is the most common benign liver tumor. This study aims to evaluate the feasibility, safety and efficacy of Trans-arterial embolization (TAE) combined with thermal ablation in the treatment of large hepatic hemangioma (> 5 cm).

METHODS

From January 2018 to December 2021, 82 patients and 112 large HH with a maximum mean diameter of 8.24 ± 0.26 cm (range: 4.3-16.0 cm) and a cumulative diameter of 9.45 ± 0.45 cm (range:5.0-29.6 cm) were treated with laparoscopic-assisted and ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) or microwave ablation (MWA) during a single general anesthesia episode following TAE. After surgery, therapeutic efficacy was assessed by contrast-enhanced imagings during follow-up. Median follow-up time was 14 months (range: 2-48 months).

RESULTS

All patients have a mean operating time of 79.10 ± 2.59 min. The plain CT revealed that 112 treated lesions were totally covered (100%). Hemoglobinuria was detected in 28 patients (34.1%), and there were no cases of acute renal failure. Abdominal pain occurred in 40 patients (48.8%), while peritoneal effusion in six (7.3%). Acute cholecystitis developed in 11 patients (13.4%), constipation in five (6.1%), and nausea and vomiting in 14 (17.1%). According to the Clavien-Dindo classification, 54 patients (65.9%) had minor complications, while none had severe complications. The follow-up, no Hepatic hemangioma growth was observed.

CONCLUSION

Preoperative TAE combined with thermal ablation is a novel therapeutic strategy for large HH. This strategy is simple, less risky, and feasible.

Influence of Montelukast Combined With Methylprednisolone on Liver Function, Platelet Count, Eosinophil Count, and Myocardial Enzymes in Bronchopneumonia Children With Wheezing

Aims/Background Bronchopneumonia is a common infectious disease in pediatrics, which can lead to myocardial and hepatic impairments. Children with bronchopneumonia accompanied by wheezing are vulnerable to hypoxia, which may damage other systems. Therefore, this study explored the influence of montelukast combined with methylprednisolone on liver function, platelet count, eosinophil count, and myocardial enzymes in children with bronchopneumonia accompanied by wheezing. Methods The clinical data of this retrospective study included 82 pediatric cases diagnosed with bronchopneumonia and wheezing between April 2022 and April 2024. Based on treatment methods, patients were divided into the methylprednisolone group (40 cases) as well as the montelukast and methylprednisolone group (42 cases). Therapeutic efficacy, resolution time of clinical symptoms, and adverse effects were recorded. Furthermore, liver function indicators, platelet count, eosinophil count, and myocardial enzyme levels were comparatively assessed using biochemical analyzer, hematology analyzer and biological kits in both groups. Results The total efficacy rate of the montelukast and methylprednisolone group was 95.2% (40/42), higher than the 77.5% of the methylprednisolone group (p = 0.018). Patients in the montelukast and methylprednisolone group had shorter hospitalization and clinical symptom disappearance times than the methylprednisolone group (both p < 0.05). In addition, there was no significant difference in total incidence of adverse reactions (p = 0.700). Methylprednisolone monotherapy or in combination with montelukast, substantially reduced liver function indicators, platelet count, eosinophil count, and myocardial enzyme levels (p < 0.05). Moreover, the platelet count, eosinophil count, and myocardial enzymes [aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB)] were reduced in the montelukast and methylprednisolone group compared to the methylprednisolone group after treatment (p < 0.05). Compared to the methylprednisolone group, alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL) levels were significantly diminished in the montelukast and methylprednisolone group following treatment (p < 0.05). Conclusion Montelukast and methylprednisolone combination therapy reduces platelet and eosinophil counts, alleviates myocardial and liver function damage, and demonstrates good therapeutic efficacy in children with bronchopneumonia accompanied by wheezing.

Distance travelled in the six-minute walk test in patients with chronic obstructive pulmonary disease as a predictor of mortality

BACKGROUND

Exercise intolerance in patients with COPD has significant implications for quality of life, hospitalization rates, and survival.

OBJECTIVE

To assess functional capacity using the six-minute walk test (6MWT) by categorizing the distance walked in six minutes (6MWD) into tertiles and to assess the impact of this functional capacity on predictors of survival over a 24-month follow-up in patients with Chronic Obstructive Pulmonary Disease (COPD).

METHODS

This prospective cohort study followed 118 patients with COPD for 24 months. Participants were stratified based on the 6MWD: Group 1 (mean distance 590-424 m); Group 2 (mean distance 423-337 m); and Group 3 (mean distance < 336 m). Symptoms and disease severity were assessed using CAT scores. Kaplan-Meier was used to determine the association between 6MWD and all-cause mortality.

RESULTS

The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. Furthermore, in regression analysis for mortality, it was identified for 6MWD (CI 0.994; p = 0.043) and peripheral oxygen saturation (SpO₂) (CI 0.735; p < 0.001). Kaplan-Meier survival analysis revealed that patients who walked less than 336 m in the 6MWD had the lowest probability of survival at 24 months (log-rank p < 0.05).

CONCLUSION

The 6MWD is a robust predictor of mortality over a 2-year period in patients with COPD, reflecting a broad spectrum of disease severity. Poorer 6MWD performance is associated with increased desaturation, impaired heart rate recovery, and greater symptom burden during exercise, as indicated by CAT scores.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of Tumor Characteristics on Endoscopic Endonasal Approach to Tuberculum Sellae and Planum Sphenoidale Meningiomas: Single Center Experience

BACKGROUND AND OBJECTIVES

The expanded endoscopic endonasal approach (EEA) has emerged as a viable alternative technique for the removal of tuberculum sellae meningioma (TSM) and planum sphenoidale meningioma (PSM), offering early tumor devascularization, wide optic canal decompression, while avoiding brain manipulation. The authors present 13-year experience with retrospective analysis evaluating the impact of tumor characteristics on the outcomes of TSM and PSM resections using the expanded EEA.

METHODS

Patients who underwent expanded EEA for TSMs or PSMs from 2010 to 2022 were analyzed. Patient's demographics, preoperative evaluations, tumor features, previous treatments, surgical outcomes, complications, follow-up, and recurrence rates were reviewed. Meningiomas were classified using the Sekhar-Mortazavi classification.

RESULTS

The study included 52 patients (32 with TSMs and 20 with PSMs). Visual impairment was the most common presenting symptom, occurring in 41 patients (78.8%). Gross-total resection (GTR) was achieved in 42 patients (80.7%), reaching 92% for Sekhar-Mortazavi class I tumors. GTR rates decreased with larger tumor size, optic pathway involvement, and vascular encasement. Fibrous and fibroelastic tumors had lower resection rates. The postoperative cerebrospinal fluid leak rate decreased from 23.3% (2010-2017) to 9% (2018-2022), and 34 patients (79%) experienced visual improvement after surgery.

CONCLUSION

The expanded EEA is a safe and effective technique for the resection of TSM and PSM, facilitating GTR and improving visual outcomes.

Antimicrobial Resistant Pathogens in the Oral Cavity of White (Carcharodon carcharias), Bull (Carcharhinus leucas) and Tiger (Galeocerdo cuvier) Sharks from the East Coast of Australia

Australia has one of the highest incidences of shark bites worldwide. Previous research on sharks has detected antibiotic-resistant pathogenic bacteria in the oral cavity, however, no such research has been conducted on species found in Australasian waters. In this study, 197 bacterial isolates were obtained from oral swabs taken from 153 sharks, including white (Carcharodon carcharias), tiger (Galeocerdo cuvier) and bull sharks (Carcharhinus leucas) caught on the east coast of Australia between May 2018 and April 2022. Isolates were identified using MALDI-TOF, and a disc diffusion assay was used to determine the antibiotic sensitivity of 72 isolates considered potential pathogens, including members of the genera Pseudomonas, Vibrio, Aeromonas, Enterobacter, Klebsiella and Psychrobacter. Resistance to one or more antibiotics was common, with 60%, 73%, and 74% of isolates from white, tiger and bull sharks resistant to one or more antibiotics, respectively. This research provides insights into which antibiotics are most suitable for treating shark bite wounds in eastern Australia, and possibly more broadly, to prevent infection. This study identified that over 51% of pathogens in the oral cavity of Australian sharks are resistant to one or more antibiotics, with most pathogens being resistant to commonly prescribed antibiotics. This research provides important information for medical professionals when it comes to treaty wounds inflicted by shark bites.

A 3D Co-Culture System Inspired by Fracture Healing Cell Interactions for Bone Tissue Engineering

Peri-bone fibroblasts play a crucial role in regulating bone regeneration during early fracture healing. Inspired by the synergy between osteoblasts and fibroblasts at fracture sites, a biomimetic three-dimensional (3D) indirect co-culture system is developed, comprising a 3D scaffold and co-cultured cells. To mimic cellular interactions in the fracture healing zone, the scaffold features an inner-outer ring structure with communication channels that support indirect cell co-culture. This setup provides fibroblasts and osteoblasts with a 3D culture environment resembling the in vivo extracellular matrix, enhancing intercellular signaling while minimizing risks of direct contact. Mechanically tunable bioinks are formulated by incorporating hyaluronic acid methacrylate (HAMA) hydrogel into gelatin methacryloyl (GelMA) hydrogel to construct the scaffold. The optimal co-culture ratio is established in vitro, where fibroblasts are found to regulate the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) via zinc ion transport mechanisms. In vivo validations are conducted, including ectopic bone formation in nude mice and bone regeneration in rat cranial defect and tooth extraction socket models. This 3D indirect co-culture system enhances osteogenesis by promoting functional fibroblast-osteoblast interactions, offering a novel platform for co-culture studies and a promising strategy for clinical bone regeneration applications.

Natural orifice specimen extraction for diverticular disease: technique, outcomes and role of inflammatory markers

BACKGROUND

Minimally invasive colectomy is common for diverticular disease. Natural orifice specimen extraction (NOSE) is an innovative adjunct that avoids the morbidity of abdominal incisions. The aim of this study is to evaluate the outcome of NOSE in laparoscopic surgery for complications of diverticular disease, and assess the role of post-operative inflammatory markers.

METHODS

A multi-centre prospective study was conducted from 2012 to 2024. Consecutive patients who underwent emergency and elective NOSE colectomy for diverticular disease were included. Demographics, surgical techniques, post-operative complications and biochemical results were analysed.

RESULTS

NOSE colectomy was successful in 99.4% of patients (171/172), with a mean age of 59.9 years. Indications for surgery were phlegmon (35%), recurrent diverticulitis (27%), stricture (21%), fistulae (14%) and haemorrhage (2%). Mean length of stay was 5.7 days (SD 3.8), and anastomotic leak rate was 1.8%. Specimen longitudinal splitting increased operative time (254 vs. 220 min, p < 0.01) and length of stay (6.6 vs. 5.3 days, p = 0.02). Significantly higher inflammatory markers were observed in the longitudinal split group on post-operative days 2-4 without increased complication or anastomotic leak rates.

CONCLUSION

NOSE colectomy demonstrates excellent perioperative outcomes in this large series and is an effective approach for diverticular disease. Specimen debulking facilitates successful NOSE procedures, with expected increases in inflammatory markers which are not associated with higher complication rates.

House: Practical Abilities Represented on Television and Impact on mEdical Students ('House PARTIES')

[26 May 2025]: This article was published in Early View in error. The article is under embargo and will republish in December 2025.

Study on the correlation between insomnia degree and quality of life in psychiatric outpatients in Chifeng city

BACKGROUND

Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety. Chronic insomnia affects approximately 15% of the global population, with higher prevalence among females and the elderly. While existing research suggests a bidirectional relationship between insomnia and emotional disorders, the specific impact of insomnia severity on depression, anxiety, and quality of life remains unclear. This study investigates the correlation between insomnia severity and these factors in psychiatric outpatients, hypothesizing that greater insomnia severity is associated with higher levels of depression and anxiety, as well as poorer quality of life.

AIM

To explore the correlation between insomnia severity and depression, anxiety, and quality of life in primary chronic insomnia patients.

METHODS

From June to December 2023, 345 patients with primary insomnia in Chifeng city were recruited and divided into three groups based on Pittsburgh sleep quality index (PSQI) scores: Mild (n = 137), moderate (n = 162), and severe (n = 46). Demographic data were collected via questionnaires. Self-rating depression scale (SDS), self-rating anxiety scale (SAS), PSQI, and short form 36 (SF-36) scores were compared, and Pearson and partial correlation analyses were performed.

RESULTS

The greater the degree of insomnia, the greater the symptoms of depression and anxiety (P < 0.001). The more severe the insomnia, the lower the SF-36 score (excluding body pain), and the difference between the three groups was statistically significant (P < 0.001). Pearson correlation analysis and partial correlation analysis depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia (P < 0.001). Pearson correlation analysis and partial correlation analysis depicted the SF-36 scores were apparently positively correlated with the severity of insomnia (P < 0.05).

CONCLUSION

Depression and anxiety are independent factors influencing insomnia severity in primary chronic insomnia patients. Higher depression/anxiety levels correlate with worse insomnia, impacting quality of life.

Are the healers healthy? Exploring non-communicable diseases among healthcare workers in Ajman, United Arab Emirates

BACKGROUND

Non-communicable diseases (NCDs), particularly cardiovascular diseases, are a major cause of global mortality. In the Gulf Cooperation Council (GCC) nations, healthcare workers face increased risks of obesity, hypertension, and diabetes due to lifestyle-related behaviour. This study evaluates the frequency and determinants of NCDs among healthcare workers in Ajman, UAE.

METHODS

A self-administered questionnaire was used in this cross-sectional study covering socio-demographics, lifestyle factors, perceived stress, and self-reported personal and family history of NCDs. A convenience sampling technique was used to recruit 786 healthcare workers at tertiary hospitals in Ajman. NCDs included diabetes, hypertension, cardiovascular diseases, obesity, hyperlipidemia, cancer, respiratory diseases, GERD, arthritis, piles, gout, sciatica, musculoskeletal disorders, and thyroid disorders. Ethical approval (IRB-COM-STD-25-JAN-2024) was obtained, and informed consent was ensured. Data were analyzed using IBM® SPSS version 29.0, with descriptive statistics summarizing variables and Chi-square tests assessing associations between NCD frequency and related factors with statistical significance set at p < 0.05.

RESULTS

The mean age of the participants was 35.04 ± 9.93 years. The frequency of non-communicable diseases among the study population was 273 (35%), with hypertension taking the lead. Significant associations were found between age, education level, nationality, Body Mass Index (BMI) levels, family history of NCDs, sleep habits, and NCD prevalence. Higher rates of NCDs were observed among older individuals 120 (56.9%), those with higher education levels 78(49.4%), abnormal BMI levels 189(43,1%), individuals from the Southeast Asia Region 184(32.5%), and those with a family history of NCDs 215 (37.9%). Adequate sleep 243(33.3%), feeling well-rested 237(33.5%), and no daytime sleepiness 78(29.2%) were linked to lower NCD prevalence, while snoring 156(48%) and muscular pain 167(45.3%) were associated with higher rates. A significant association was found between NCD prevalence and the consumption of salty 56 (43.4%) and spicy foods 43(52.4%), with higher prevalence in those consuming them less frequently or not at all.

CONCLUSION

Non-communicable diseases were prevalent (35%) among healthcare workers in Ajman, UAE, with hypertension being the most common. NCD clustering was observed, with multiple conditions coexisting in several participants. Both modifiable (BMI, sleep habits, diet) and non-modifiable (age, nationality, family history) risk factors showed significant associations with NCDs. Targeted lifestyle interventions and early screening are essential to reduce NCD risk in this population.

The effect between etomidate and ketamine on peri-intubation hypotension in elderly patients in the emergency department

BACKGROUND

Peri-intubation hypotension (PIH) is associated with increased mortality. Etomidate and ketamine are commonly used as induction agents for tracheal intubation in the emergency department (ED) due to their favorable hemodynamic profiles. However, the effects of these agents on PIH remain controversial, and data on elderly patients are limited. This study aimed to compare the effects of etomidate and ketamine on PIH and 28-day mortality.

METHODS

A prospective, observational, propensity-matched cohort study was performed across two ED centers between March 23, 2022, and September 30, 2023. Patients aged 65 years and older requiring tracheal intubation and receiving either etomidate or ketamine as a single induction agent were included. The primary outcome was the incidence of PIH within 30 min post-induction, comparing etomidate and ketamine. PIH was defined as a systolic blood pressure (SBP) decrease of more than 20 % from baseline, SBP <100 mmHg (with or without fluid resuscitation), or the initiation or increased dose of vasopressor therapy. Secondary outcomes included 28-day mortality and subgroup analysis evaluating the effect of induction dose on PIH in patients with a shock index (SI) ≥0.9. Statistical analyses included a chi-square test to compare PIH incidence and Cox regression analysis to assess the association between induction agents and 28-day mortality. Multivariable Cox regression was adjusted for mortality by vasopressor initiation or escalation. Fractional polynomial regression was used to evaluate the relationship between induction agent dose and PIH.

RESULTS

A total of 418 patients were included in the analysis, with 222 patients matched in a 1:1 propensity score analysis. The incidence of PIH was 44.1 % in the etomidate group and 53.2 % in the ketamine group (risk difference 9.1 %, 95 % confidence interval [CI] -4.1 to 22.1, p = 0.179). 28-day mortality was 36.0 % in the etomidate group and 25.2 % in the ketamine group (hazard ratio [HR] 0.66, 95 % CI 0.41-1.07, p = 0.095). However, in patients who developed PIH and required vasopressors, ketamine was associated with a lower risk of 28-day mortality (adjusted HR 0.59, 95 % CI 0.36-0.97, p = 0.034). Among patients with SI ≥0.9, a higher induction agent dose was associated with an increased probability of PIH for both etomidate and ketamine.

CONCLUSION

There was no statistically significant difference in PIH and 28-day mortality between etomidate and ketamine as a single induction agent in elderly patients in the ED.

Intubation Setting and Mortality in Trauma Patients Undergoing Hemorrhage Control Surgery: A Propensity Score-Matched Analysis

BACKGROUND

Endotracheal intubation is essential for airway management in trauma patients but may cause hemodynamic instability and delay critical resuscitation measures. Recent studies have suggested that emergency department (ED) intubation may be linked with higher mortality compared to operating room (OR) intubation in trauma patients. However, it remains unclear if these findings apply to broader trauma populations, including both civilian and military patients. This study uses a nationwide trauma registry to test the hypothesis that ED intubation is associated with higher in-hospital mortality among major trauma patients, compared to OR intubation.

METHODS

Registry-based analysis of the Israeli National Trauma Registry evaluating major trauma (Injury Severity Score [ISS] ≥16) patients requiring hemorrhage control surgery between 2016 and 2023. ED intubation was the main exposure variable with in-hospital mortality serving as the primary outcome. Multivariable logistic regression and propensity score matching were applied to adjust for confounders, including injury severity, ED vital signs, penetrating injury, and blood product administration.

RESULTS

The study included 975 patients, 470 (48.2%) of whom were intubated in the ED. ED-intubated patients had significantly higher ISS and higher proportion of profound shock compared to those intubated in the OR. In-hospital mortality was more common among patients intubated in the ED (22.6%) as compared with those intubated in the OR (8.5%). In the unadjusted logistic regression, ED intubation was associated with higher odds of in-hospital mortality (OR: 3.13, 95% confidence interval [CI], 2.15-4.62). However, after adjusting for several potential confounders, the association became nonsignificant and was persistent across sensitivity subgroup analyses. Propensity score matching resulted in 1:1 matching of 271 patients in each group, balancing characteristics such as ISS, profound shock, Glasgow Coma Scale, and penetrating injury. After matching, the mortality rate was similar between groups (12.5% for ED intubation vs 12.2% for OR intubation). In the matched cohort, logistic regression demonstrated no significant association between ED intubation and in-hospital mortality (OR: 0.97, 95% CI, 0.58-1.61). ED intubation was associated with a greater than 2-fold increase in odds of ICU admission in adjusted and propensity score-matched analyses.

CONCLUSIONS

ED intubation was not significantly associated with increased in-hospital mortality after controlling for injury severity and shock. These findings suggest that while ED intubation may be more frequent in severely injured patients, its independent impact on mortality in patients undergoing emergent surgery remains unclear, warranting further prospective investigation.

Nanoparticles and Nanomaterials: A Review from the Standpoint of Pharmacy and Medicine

Nanoparticles (NPs) represent a unique class of structures in the modern world. In comparison to macro- and microparticles, NPs exhibit advantages due to their physicochemical properties. This has resulted in their extensive application not only in technical and engineering sciences, but also in pharmacy and medicine. A recent analysis of the scientific literature revealed that the number of articles related to the search term "nanoparticle drugs" has exceeded 65,000 in the last decade alone, according to PubMed. The growth of scientific publications on NPs and nanomaterials (NMs) in pharmacy demonstrates the rapidly developing interest of scientists in exploring alternative ways to deliver drugs, thereby improving their pharmacokinetic and pharmacodynamic properties, and the increased biocompatibility of many nanopharmaceuticals is a unique key to two mandatory pharmaceutical requirements-drug efficacy and safety. A comprehensive review of the literature indicates that the modern pharmaceutical industry is increasingly employing nanostructures. The exploration of their physicochemical properties with a subsequent modern approach to quality control remains the main task of modern pharmaceutical chemistry. The primary objective of this review is to provide a comprehensive overview of data on NPs, their physicochemical properties, and modern approaches to their synthesis, modification of their surface, and application in pharmacy.

Object Detection in Laparoscopic Surgery: A Comparative Study of Deep Learning Models on a Custom Endometriosis Dataset

Background: Laparoscopic surgery for endometriosis presents unique challenges due to the complexity of and variability in lesion appearances within the abdominal cavity. This study investigates the application of deep learning models for object detection in laparoscopic videos, aiming to assist surgeons in accurately identifying and localizing endometriosis lesions and related anatomical structures. A custom dataset was curated, comprising of 199 video sequences and 205,725 frames. Of these, 17,560 frames were meticulously annotated by medical professionals. The dataset includes object detection annotations for 10 object classes relevant to endometriosis, alongside segmentation masks for some classes. Methods: To address the object detection task, we evaluated the performance of two deep learning models-FasterRCNN and YOLOv9-under both stratified and non-stratified training scenarios. Results: The experimental results demonstrated that stratified training significantly reduced the risk of data leakage and improved model generalization. The best-performing FasterRCNN object detection model achieved a high average test precision of 0.9811 ± 0.0084, recall of 0.7083 ± 0.0807, and mAP50 (mean average precision at 50% overlap) of 0.8185 ± 0.0562 across all presented classes. Despite these successes, the study also highlights the challenges posed by the weak annotations and class imbalances in the dataset, which impacted overall model performances. Conclusions: In conclusion, this study provides valuable insights into the application of deep learning for enhancing laparoscopic surgical precision in endometriosis treatment. The findings underscore the importance of robust dataset curation and advanced training strategies in developing reliable AI-assisted tools for surgical interventions. The latter could potentially improve the guidance of surgical interventions and prevent blind spots occurring in difficult to reach abdominal regions. Future work will focus on refining the dataset and exploring more sophisticated model architectures to further improve detection accuracy.

Beyond obesity: lean metabolic dysfunction-associated steatohepatitis from unveiling molecular pathogenesis to therapeutic advancement

Nonalcoholic fatty liver disease (NAFLD), now known by the name of metabolic dysfunction-associated fatty liver disease (MAFLD), with increased global incidence, has been recognized as a significant metabolic disorder. NAFLD includes a spectrum liver disease from hepatocellular fat accumulation (isolated steatosis) to an advanced form of liver injury known as nonalcoholic steatohepatitis (NASH), which refers to distinct histologic features, including hepatocellular steatosis and injury, necroinflammation, and eventually fibrosis. Nonobese or lean individuals associated with metabolic dysregulation usually demonstrated diverse risk factors compared to obese MAFLD. The presence of normal range body mass index (BMI) and excess visceral adiposity with increased cardiometabolic and renal comorbidities, along with sarcopenia, has been evidenced to be associated with lean MASH. Genetic predispositions accompanying lifestyle and environmental factors contribute to disease initiation and progression. The genetic influence in pathophysiology indicated the significant contributions of the following genes: PNPLA3, TM6SF2, APOB, LIPA, MBOAT7, and HSD17B13, and the impact of their disease-specific variants in the development of obesity-independent MASH. The epigenetic modifications exhibited differential DNA methylation patterns in the genes involved in lipid metabolism, particularly hypomethylation of PEMT. Diet-induced and genetic animal models of lean MASH, including Slc: Wistar/ST rats, PPAR-α, PTEN, and MAT1A knockout mice models, are indicated to be pivotal in the exploration of disease progression and observing the effect of therapeutic interventions. This comprehensive review comprises the molecular and genetic pathophysiology, molecular diagnostics, and therapeutic aspects of lean MASH to enunciate a diagnostic approach that combines detailed clinical phenotyping regarding genomic analysis.

Outcomes of Sedative Hypnotic Agents Used for Endotracheal Intubation in Critically Ill Adults: A Systematic Review with Exploratory Meta-Analysis

ObjectiveSpecific sedative hypnotic agents, administered to facilitate endotracheal intubation (ETI) in critically ill adults, may lead to adverse outcomes such as peri-intubation cardiovascular collapse. However, little is known from systematic investigations of the impact these individual agents have on cardiovascular function or other clinical outcomes.Data sourcesMEDLINE, Embase, CENTRAL, ClinicalTrials.gov, Scopus and Web of science databases.Study selectionWe conducted a systematic search for randomized and non-randomized studies that evaluated adult (≥18 years) critically ill patients who were sedated to facilitate ETI with ketamine, propofol, ketamine/propofol, etomidate, or a benzodiazepine and who had data on peri-intubation hemodynamics and at least one other outcome involving acute kidney injury, delirium, opioid use, intubation difficulty, sequential organ failure assessment, length of stay, or mortality. Eighty-five studies were identified for eligibility assessment with 23 included in the analysis.Data extractionTwo reviewers independently screened articles, extracted data from selected articles, and assessed risk of bias using ROBINS-I for observational studies and revised Cochrane Risk of Bias tool for randomized controlled trials.Data synthesisAcute cardiovascular dysfunction (peri-intubation hemodynamic instability and/or cardiac arrest) was similar between etomidate and ketamine with more events seen when propofol versus non-propofol sedation was administered. However, exploratory meta-analysis demonstrated no difference between etomidate and ketamine (OR 1.05 [95%CI 0.60-1.84]) or between etomidate and propofol (OR 0.91 [95%CI 0.33-2.46]). Compared to ketamine, etomidate demonstrated lower survival to hospital discharge in the included studies in exploratory meta-analysis OR 0.76 (95%CI 0.62-0.92). Limited data existed for other outcomes with no discernible differences between sedative agents.ConclusionsAcute cardiovascular dysfunction was more common when propofol, as compared to non-propofol sedation, was administered, although not statistically significant in exploratory meta-analysis. In addition, etomidate conferred lower survival to hospital discharge versus non-etomidate sedation, which was confirmed in exploratory meta-analysis of etomidate versus ketamine.