[Rethinking scientific integrity in plastic surgery: Reflections on editorial and institutional responsibilities]

Plastic surgery, by nature an innovative discipline, has historically relied on clinical case reports to advance its techniques. Often unique, these cases are a valuable vehicle for disseminating breakthroughs - especially in a field marked by highly individualized practices and artisanal surgical approaches, where randomized trials are often impractical. However, this reliance on case reports raises significant ethical concerns. In multidisciplinary settings, attribution of contributions often remains ambiguous. Misconduct, such as unauthorized publications or omission of institutional recognition, threatens the integrity of scientific output. As artificial intelligence reshapes biomedical research - automating literature reviews and meta-analyses - original case reports, by their singularity, escape these predictive models. Their heuristic value fully justifies their inclusion within the spectrum of scientific evidence. For this reason, their publication must be tightly regulated. Redefining publication standards in our field is essential. This includes the systematic application of international guidelines (CARE, SCARE, STROBE, GRIPP2), mandatory institutional approval before submission, formal training in research ethics for junior staff, and full transparency regarding patient consent and authorship attribution. When rigorous, novel, and well-contextualized, the clinical case remains a cornerstone of surgical progress. By safeguarding it from opportunistic misuse, we preserve its scientific and educational value.

Alkaline Phosphatase-Targeted, Gadolinium-Labeled Nanoparticles for Enhanced Multimodal Imaging of Liver Cancer

Liver cancer remains one of the most lethal malignancies worldwide, primarily due to limited diagnostic and therapeutic strategies. Biological imaging agents capable of selective accumulation in cancerous liver tissue offer a promising route for earlier detection and improved patient outcomes. In this work, we synthesized and characterized alkaline phosphatase (ALP)-targeted, gadolinium-labeled gold nanoparticles (AuNPs) designed for simultaneous detection using magnetic resonance imaging (MRI), computed tomography (CT), and fluorescence (Fl) microscopy. The synthesized AuNPs feature 13 nm gold cores functionalized with ALP-binding ligands and Gd(III)-macrocycles. Characterization by ultraviolet-visible (UV-vis) spectroscopy, dynamic light scattering (DLS), transmission electron microscopy (TEM), and energy dispersive X-ray spectroscopy (EDX) confirmed successful functionalization. During the functionalization process, variations in Gd(III) loading, surface packing density, and r1 relaxivity were observed; however, high reproducibility was achieved when including methanol during the AuNP labeling protocol. In vitro studies with HepG2 liver cancer and HEK293 kidney cells demonstrated selective cellular uptake in relation to cellular ALP expression levels. Optimized uptake conditions demonstrated 10-fold increase in Gd(III) internalization into HepG2 versus HEK293 cells. Further imaging by scanning electron microscopy (SEM) and TEM on thinly sliced cell samples verified the intracellular localization of these nanoparticles. Collectively, these findings underscore the potential of ALP-targeted, gadolinium-labeled AuNPs as a versatile multimodal imaging platform for the early detection of liver cancer.

Case Report: Based on the diamond theory, successful treatment of stubborn tibial nonunion after six surgeries using PRP-augmented therapy: a case report and literature review

Background

The treatment of stubborn tibial nonunion remains a significant challenge. This case report describes a patient who underwent six surgeries and was treated using a stepwise surgical approach based on the diamond theory. The application of platelet-rich plasma (PRP) enhanced autologous iliac bone grafting combined with locked compression plate fixation ultimately achieved successful healing. This study also reviews relevant literature to explore the treatment experiences and outcomes of similar cases.

Patient and methods

A middle-aged Asian male with severe heart disease underwent five failed surgeries, including two autologous bone graft procedures. Clinically, he presented with right calf pain, poor soft tissue condition on the anterior medial tibia, and signs of nonunion. During the sixth surgery, we applied a stepwise surgical procedure based on the diamond theory, achieving excellent clinical and bone healing, as well as satisfactory limb function at a follow-up of 11.3 months post-operation.

Conclusion

We utilized a stepwise surgical procedure based on the diamond theory: locked compression plate internal fixation, PRP-enhanced structural autologous iliac bone grafting, and bioactive center creation techniques, providing a strong and stable mechanical and superior biological environment for the nonunion site.

"Divergent Needs and the Empathy Gap": Exploring the Experience of Workplace Violence Against Nurses Employed in the Emergency Department

BACKGROUND/OBJECTIVES

Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses' professional attitudes, their work life and related implications to patient safety issues may be valuable. We investigated ED nurses' living experience of exposure to workplace violence by healthcare service users, with focus on the impact on them.

METHODS

Following a qualitative study design, data were collected (January-June 2024) through semi-structured interviews with open-ended questions and were analyzed according to an inductive, content analysis approach. Participants provided informed consent, and data collection continued until theoretical saturation was reached.

RESULTS

The sample included six nurses. Various forms of workplace violence and its psychological, social, and professional consequences were identified. Violence was more frequently perpetrated by patients' relatives, with verbal aggression being the most common form. A fundamental divergence in needs and expectation between patients and their family members/caregivers, on one side, and participants, on the other, revealed a pronounced empathy gap. Each group remained focused on its own priorities while struggling to recognize or accommodate others' perspectives. This lack of mutual understanding contributed to tension that, in some cases, escalated even into physically violent incidents against the participants. A similar gap was identified between the participants' needs and administrators' attitudes and related policies. The failure of administrative measures to bridge this gap was described as a crucial factor in further escalating conflicts and tension in the ED.

CONCLUSIONS

Further research on quality improvement projects, including all stakeholders, aiming to enhance empathy in all parties involved is proposed.

IgM-functionalized biomimetic nanovaccine for immunological activation and bacterial toxin neutralization

Pore-forming toxins (PFTs) are exotoxins secreted by bacteria that aggregate and perforate cell membranes through mechanisms such as binding to specific membrane proteins, thereby killing cells and promoting bacterial invasion, migration, and proliferation. In this study, an anti-virulence factor strategy and vaccine were combined to develop folic acid-modified red blood cell membrane-hybrid liposomes (FA-RCM-Lips). By utilizing the aggregation and perforation mechanism of pore-forming toxins on red blood cell membranes, Vibrio vulnificus hemolysin A (VvhA) was efficiently loaded as the antigenic protein, thereby neutralizing the toxicity of the toxin while maximizing the retention of its antigenic activity and constructing a toxoid nanovaccine (FA-RCM-Lips(VvhA)). The nanocarrier served as an adjuvant to enhance antigen uptake by antigen-presenting cells, while folic acid molecules adsorbed natural IgM, enhancing antigen uptake and presentation by B cells through the IgM-complement pathway. FA-RCM-Lips reduced the hemolysis rate of VvhA by 98.78 % and simultaneously inhibited VvhA-induced skin and tissue toxicity. Subcutaneous and intravenous immunization with FA-RCM-Lips(VvhA) induced stronger IgG titers, improved antigen presentation, enhanced immune responses, and provided immunoprotection in mice.

Comparative Effectiveness and Safety of Moderate-Intensity Pravastatin Versus Atorvastatin in Patients with Dyslipidemia: A Retrospective Cohort Study Using a Common Data Model of Multicenter Electronic Health Records in South Korea

AIM

To compare the effectiveness and safety of moderate-intensity pravastatin 40 mg/day and atorvastatin 10 mg/day in patients with dyslipidemia.

METHODS

We conducted a retrospective cohort study using electronic health records of 19 million patients across 14 secondary/tertiary hospitals, standardized to a Common Data Model. New users of pravastatin (40 mg/day) and atorvastatin (10 mg/day) were identified. Six distinct cohorts were used to assess the comparative effectiveness in preventing major adverse cardiovascular events (MACE) and the risks of new-onset diabetes mellitus (NODM), myalgia or rhabdomyolysis, and hepatotoxicity (measured by aspartate aminotransferase [AST]/alanine aminotransferase [ALT]). Propensity score matching (PSM) was applied to each cohort for effectiveness and safety analyses, followed by a meta-analysis of hospital-specific results.

RESULTS

After PSM, patients were equally assigned to the pravastatin and atorvastatin groups for primary (n = 2,688/group) and secondary MACE prevention (n = 1,258/group) and to assess the risk of NODM (n = 2,391/group), new-onset myalgia or rhabdomyolysis (n = 11,799/group), and hepatotoxicity (AST, n = 4,034/group; ALT, n = 3,655/group). No significant differences were observed in the hazard ratios (HRs) for primary (HR = 0.84; 95% CI, 0.59-1.20) and secondary MACE prevention (HR = 0.89; 95% CI, 0.68-1.16). Similarly, no significant difference was observed in the risk of NODM (HR, 0.99; 95% CI, 0.79-1.23). The risk of new-onset myalgia/rhabdomyolysis (HR = 0.82, 95% CI, 0.69-0.96) and the incidence of abnormal elevations in AST levels (2.35% vs. 3.37%, p＜0.05) were significantly lower in the pravastatin group.

CONCLUSION

Moderate-intensity pravastatin (40 mg/day) showed comparable effectiveness to moderate-intensity atorvastatin (10 mg/day) in preventing MACE with a more favorable safety profile.

Inhalation safety and tolerability of a novel fixed-dose combination of glycopyrronium-vilanterol powder in Wistar rats

Fixed-dose combinations (FDCs) offer therapeutic benefits like enhanced efficacy, reduced adverse effects, and better patient compliance, making them cost-effective. They are particularly effective in managing chronic obstructive pulmonary disease (COPD). Combining a long-acting muscarinic antagonist with a long-acting beta-agonist improves lung function, reduces the need for rescue bronchodilators, alleviates respiratory symptoms, and enhances the overall quality of life in COPD patients. This study evaluated the safety and tolerability of a novel FDC containing vilanterol, a selective β2-adrenoreceptor agonist, and glycopyrronium, an antimuscarinic agent, in Wistar rats. Vilanterol promotes bronchodilation, while glycopyrronium reduces bronchoconstriction. Repeated-dose toxicity testing at three dosage levels (6.25 + 12.5 mcg/kg/day, 12.5 + 25 mcg/kg/day, and 25 + 50 mcg/kg/day) through nose-only exposure showed that the FDC was well-tolerated, with no significant clinical signs of toxicity. Key parameters, including body weight, feed consumption, ophthalmic examination, clinical pathology, and bronchoalveolar lavage fluid analysis, showed no adverse effects. Minimal, non-dose-related microscopic lesions and normal alveolar macrophage responses were observed. The no-observed-adverse-effect level, based on actual concentration and duration of exposure, was established at 25 + 50 mcg/kg/day, indicating the FDC's safety and suitability for further development in COPD management.

Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis

OBJECTIVE

The objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.

METHODS

The reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case-control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle-Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.

RESULTS

Our study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I2 = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36-3.72, I2 = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15-4.24, I2 = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84-11.38, I2 = 96%), male gender (OR 3.56, 95% CI = 1.50-8.42, I2 = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83-3.66, I2 = 0%), COPD (OR 4.72, 95% CI = 3.80-5.86, I2 = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58-4.69, I2 = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29-7.49, I2 = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51-7.06, I2 = 90%), and hypertension (OR 2.21, 95% CI = 1.29-3.79, I2 = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25-1.83, I2 = 90%), advanced age (OR 1.91, 95% CI = 1.42-2.58, I2 = 94%), nutritional status (OR 2.62, 95% CI = 1.55-4.44, I2 = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17-2.21, I2 = 79%).

CONCLUSIONS

This study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.

Evaluating the MPM III and SAPS III prognostic models in a war-affected, resource-limited setting: a prospective study from the Gaza Strip

BACKGROUND

Validation studies of prognostic models used in critical care have yet to be conducted in Palestine. The intense conflict in the Gaza Strip presents an opportunity to evaluate the performance of local ICUs and validate the performance of the MPM and SAPS models within a resource-limited and highly stressed healthcare system.

METHODS

A prospective study conducted from October to December 2024 included all patients admitted to ICUs in three of the four critical care units operating in the Gaza Strip. Sociodemographic, clinical, physiological, and laboratory parameters were collected, along with information regarding the clinical course and ICU outcomes. The MPM-III and SAPS-III scores were calculated, and their discrimination and calibration were assessed using AUROC and the Hosmer-Lemeshow test, respectively. Furthermore, the difference between the predicted and actual mortality rates was visualized, and standardized mortality rates (SMR) were calculated. Except for the Hosmer-Lemeshow test, a p-value of less than 0.05 was deemed statistically significant. All statistical analyses were conducted using R Studio.

RESULTS

The cohort included 101 patients, of whom 72.27% were surgical cases and 58.41% were admitted from the ER. The ICU mortality rate was 30.69%. The median duration of ICU admission was four days [IQR 2-9] and was significantly longer for surgical cases than for medical cases. Physiological and laboratory parameters, along with interventions associated with higher mortality, included a lower GCS, burns, elevated leukocyte and platelet counts, lower PPO2, dysrhythmias, intracranial mass effect, and the need for mechanical ventilation or central venous catheterization. The predicted mortality rates were 16.63% for MPM0-III and 16.82% for SAPS-III. SMRs indicated that both models underestimated ICU mortality (SMR, MPM0-III 1.85; SAPS-III 1.83), with the discrepancy more likely to occur in high-risk patients. ROC curves demonstrated acceptable to good discriminatory power for both models (AUROC, MPM0-III 0.79 (95% CI 0.7-0.88); SAPS-III 0.87 (95% CI 0.80-0.94)). The Hosmer-Lemeshow test yielded statistically insignificant results for both models, indicating good calibration.

CONCLUSION

The outcomes of critical care units in the Gaza Strip during the studied period of the war were comparable to those of other hospitals in the West Bank and other LMICs without active conflicts. The MPM-III and SAPS-III demonstrated good discrimination and calibration, making them valid tools for enhancing ICU performance and improving resource utilization in the Gaza Strip.

Nonfatal Injuries Among Skilled Nursing and Residential Care Facility Workers Treated in U.S. Emergency Departments, 2015-2022

INTRODUCTION

Skilled nursing and residential care facilities (SNRCFs) report among the highest nonfatal occupational injury rates compared to the overall working population. This cross-sectional study reports nonfatal emergency department (ED)-treated injury national estimates among U.S. SNRCF workers.

METHODS

Nonfatal ED-treated occupational injury data were analyzed (2015-2022) from the National Electronic Injury Surveillance System, Occupational Supplement, a national probability sample of approximately 67 U.S. EDs. Occupational injuries in SNRCFs were selected using relevant U.S. Census Bureau industry codes. National estimates and rates per 10,000 worker full-time equivalents (FTEs) were calculated using the U.S. Current Population Survey. Piecewise linear regression models examined temporal trends in biannual injury rates.

RESULTS

An estimated 569,800 (95% confidence interval 420,400-719,200) injuries occurred from 2015 to 2022, a rate of 302 (223-382) per 10,000 FTEs. Most injuries occurred among females (81%). The most prevalent injury events were overexertion and bodily reaction [38%; 116 (85-147) per 10,000 FTEs], violence [24%; 73 (46-100) per 10,000 FTEs], and falls, slips, and trips [16%; 49 (35-63) per 10,000 FTEs]. SNRCF injury rates were higher than the rest of the healthcare industry and all industries. SNRCF injury rates declined from 2015-2021 [average biannual change -9.6% (-13.3%, -5.9%), p <.001]. Following a 2021 trend change, there was a non-significant increase in injury rates.

CONCLUSIONS

Among the working population, SNRCF workers experience a high rate of nonfatal ED-treated occupational injuries. Future research should confirm trends and study effectiveness and uptake of evidence-based injury prevention interventions across settings.

Artificial intelligence in predicting EGFR mutations from whole slide images in lung Cancer: A systematic review and Meta-Analysis

BACKGROUND

Epidermal growth factor receptor (EGFR) mutations play a pivotal role in guiding targeted therapy for lung cancer, making their accurate detection essential for personalized treatment. Recently, artificial intelligence (AI) has emerged as a promising tool for identifying EGFR mutation status from digital pathology images. This systematic review and meta-analysis evaluate the diagnostic accuracy of AI models in predicting EGFR mutations from whole slide images (WSIs) in lung cancer patients.

METHODS

A comprehensive search was conducted across four databases (EMBASE, PubMed, Web of Science, and Scopus) for studies published up to June 20th, 2024. Studies employing AI algorithms, including machine learning and deep learning techniques, to predict EGFR mutations from digital pathology images were included. The risk of bias and applicability concerns were assessed using the QUADAS-AI tool. Diagnostic accuracy metrics such as sensitivity, specificity, and the Area Under the Curve (AUC) were extracted. Random-effects models were applied to synthesize the AI model performance. This study is registered with PROSPERO (CRD42024570496).

RESULTS

Out of 1,828 identified studies, 16 met the inclusion criteria, with 4 eligible for meta-analysis. The pooled results demonstrated that AI algorithms achieved an AUC of 0.756 (95% CI: 0.669-0.824), a sensitivity of 66.3% (95% CI: X-Y), and a specificity of 68.1% (95% CI: X-Y). Subgroup analyses revealed that AI models using in-house datasets, surgical resection samples, the ResNet architecture, and tumor-focused regions exhibited improved predictive performance.

CONCLUSION

AI models exhibit potential for non-invasive prediction of EGFR mutations in lung cancer patients using WSIs, although current accuracy and precision warrant further refinement. Future research should aim to enhance AI algorithms, validate findings on larger datasets, and integrate these tools into clinical workflows to optimize lung cancer management.

Platelet indices at admission and their performance associated with predicting all-cause mortality in the ICU: a large cross-sectional cohort study

Platelet indices at admission offer the most opportune time for clinical decision-making, as they provide earliest insights, unlike later assessments during the intensive care unit (ICU) stay. There is emerging evidence suggesting the utility of platelet indices in predicting mortality. The objective of this study was, for the first time as far as the literature indicates, to elucidate the utility of seven platelet indices at admission in a large ICU cohort using Sysmex XN-series analysers. This cross-sectional study enrolled 592 ICU patients. The association of platelet indices at admission with the in-ICU and 90-day mortality was evaluated using logistic regression and receiver operating characteristic curve analysis. Of the platelet indices studied, absolute-immature platelet fraction (A-IPF), and mean platelet volume (MPV) and percentage-immature platelet fraction (%-IPF) were shown to be independently associated with predicting the in-ICU and 90-day mortality, respectively. The A-IPF cut-off value for predicting the in-ICU mortality was >6.4 × 109/L (adjusted area under the curve (aAUC) 0.736, and adjusted Odds Ratio (aOR) 1.04), and the MPV and %-IPF cut-off values for predicting the 90-day mortality were >9.5 fL (aAUC 0.759, and aOR 1.26) and >6.3% (aAUC 0.762, and aOD 1.06), respectively (all p < 0.05). Admission A-IPF was the best predictor of in-ICU mortality, while admission MPV and %-IPF were the best predictors of 90-day mortality. These indices, all measured at admission, provide the earliest possible data relevant to mortality prediction. These are routinely available indices which deserve to be considered for new future ICU scoring systems.

Rising Prevalence of Urinary Incontinence and Nocturia Amid the COVID-19 Pandemic

BACKGROUND

Urinary incontinence (UI) and nocturia are common lower urinary tract symptoms (LUTS) that significantly affect quality of life. The COVID-19 pandemic has introduced behavioral, psychological, and physiological disruptions that may have exacerbated the prevalence of these conditions. Additionally, these changes may also be influenced by long-term sequelae of COVID-19 infection or other concurrent factors. However, large-scale investigations into these trends are limited.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023 were used to analyze the prevalence of LUTS, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI), mixed urinary incontinence (MUI), and nocturia, before (2017-2020) and during the pandemic (2021-2023). Age-adjusted prevalence trends were analyzed overall and by sex and race/ethnicity. Sensitivity analysis included data from 2013 to 2016 to differentiate natural trends from pandemic-related impacts.

RESULTS

The prevalence of SUI, UUI, MUI, and nocturia significantly increased during the pandemic compared to pre-pandemic levels (p < 0.0001). SUI rose from 24.89% to 29.65%, UUI from 20.80% to 28.65%, MUI from 9.17% to 16.83%, and nocturia from 26.96% to 34.78%. These trends were consistent across sexes and racial groups. Sensitivity analysis confirmed that these increases exceeded natural trends, suggesting a potential pandemic-related effect.

CONCLUSION

This study reveals a significant rise in the prevalence of LUTS, including SUI, UUI, MUI, and nocturia, during the COVID-19 pandemic. Further research is needed to determine whether these changes stem from the direct physiological effects of COVID-19 infection or are influenced by broader pandemic-related factors such as lifestyle changes, healthcare disruptions, and psychological stress.

Prevalence of sleep disturbances among intensive care nurses: A systematic review and meta-analysis

BACKGROUND

Demanding intensive care unit (ICU) work environments may lead to sleep disturbances in nurses, impacting their health and potentially patient safety. Yet, the prevalence remains unclear around the world.

AIM

To quantify the prevalence of sleep disturbances in intensive care nurses.

STUDY DESIGN

Systematic review and meta-analysis. A database search was conducted in Embase, PubMed, Web of Science, Scopus and CINAHL from their inception to April 2024 for relevant studies. Data from observational studies (cross-sectional or cohort) that reported the prevalence of sleep disturbances, assessed using the Pittsburgh Sleep Quality Index (PSQI > 5), pooled in random-effects meta-analyses. Subgroup analyses were used to investigate variations in the prevalence estimates in terms of available variables. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant protocol was registered in PROSPERO (CRD42023476428).

RESULTS

In total, 24 articles were included in this study published from 1996 to 2023. Included studies were from 15 unique countries. Almost all of the studies were descriptive cross-sectional studies (n = 22; 91.7%). The included studies encompassed a range of intensive care nurses, from 42 to 605, involving a total of 3499 intensive care nurses. The reported proportion of intensive care nurses with sleep disturbances ranged from 20.0% to 100.0%, with a median of 76.7% (interquartile range: 62.9-85.7). The pooled prevalence of sleep disturbances in intensive care nurses was 75.1% (95% confidence interval: 37.2-53.1; 95% prediction interval: 30.5-95.4).

CONCLUSIONS

Sleep disturbance is a common issue in intensive care nurses. The study results highlight the importance of implementing effective interventions as early as possible to improve ICU sleep quality.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of sleep disturbances among intensive care nurses necessitates global interventions. Gender-neutral approaches that acknowledge comparable risks and stable prevalence over time require long-term strategies. Raising awareness through programmes is vital for implementing evidence-based interventions to promote sleep health in intensive care nurses.

Cemental tear - a series of 14 cases of surgical periodontal treatments with a follow-up of up to ten years

Cemental tear is a relatively uncommon condition with low awareness among dentists. It can mimic other periodontal diseases as well as endodontic disease, and it should be part of the differential diagnosis. The total number of cases reported worldwide is still low and knowledge on conservative treatment prognosis is poor. This case series aims to report retrospectively the long-term results of teeth with cemental tear treated consecutively with periodontal surgery. Patients were managed between the years 2012-2023 in a specialist clinic in the north of Sweden. The treatment consisted of periodontal surgery with or without regenerative techniques, and when necessary, orthograde or retrograde endodontics. Fourteen patients (14 teeth), ranging from 36-85 years old, of which ten were male, were observed up to 131 months. Four teeth were extracted, all within the first 12 months, with clear signs of remaining infection. Three patients showed uncertain healing. One tooth was rescheduled for operation but in another location of the same tooth. The other six patients successfully healed, one after a re-operation. Conservative treatment of cemental tears has an acceptable prognosis, even in severely damaged teeth.

Occupationally Relevant Zinc- and Copper-Containing Metal Fumes Inhibit Human THP-1 Macrophage TNF and IL-6 Responses to Bacterial Stimuli

Metal workers have an increased risk of severe lobar pneumonia due to exposure to metal fume particles, which lead to recent pneumococcal vaccination recommendations. To investigate the effects of metal fume-derived zinc oxide (ZnO) and copper oxide (CuO) particles on airway immune responses, human THP-1-derived macrophages are exposed in vitro to the bacterial pathogen-associated molecular patterns (PAMPs) lipopolysaccharide (LPS), lipoteichoic Acid (LTA), or peptidoglycan (PGN), together with particle suspensions. Particles are generated through metal inert gas (MIG) soldering. Spectrometric and microscopic analysis confirms CuO and ZnO as main components. Macrophage IL-6 and TNF mRNAs are quantified by qPCR and secreted protein levels by electrochemiluminescent multi-spot assay. A dose-dependent increase in macrophage TNF and IL-6 mRNA (4 h) and protein (24 h) levels following exposure to PAMPs is significantly inhibited by 2 µg mL-1 CuO/ZnO particles (n = 5). Additionally, CuO/ZnO particles significantly inhibit TNF protein expression in unstimulated macrophages, while IL-6 protein levels are unaffected (n = 5). The presented in vitro immunotoxicity approach may extend existing new approach methodology (NAM) elements for chemical risk assessment and possibly exposure limit evaluation refinements. These findings implicate that CuO/ZnO particles suppress macrophage proinflammatory responses to PAMPs, potentially compromising lung immunity, underlining current vaccine recommendations and efforts for preventive occupational health guidelines.

Reconstructive strategies using abdominal flaps for cutaneous malignancies: A case series

INTRODUCTION AND IMPORTANCE

Cutaneous lesions such as Marjolin's ulcer-a malignant transformation of chronic ulcerative wounds or scars into squamous cell carcinoma-and fungating soft tissue sarcomas, which are rapidly progressing tumours originating from mesenchymal tissues, exhibit a diverse range of clinical and pathological characteristics. These aggressive malignancies are characterized by high recurrence rates and poor prognoses. Traditionally, amputation was the primary treatment; however, limb salvage has become the preferred approach, necessitating extensive reconstruction with flap reconstruction.

CASE PRESENTATION

In this report, we present two cases of Marjolin's ulcer and one case of a fungating soft tissue sarcoma, detailing their clinical presentations, diagnostic workups, and management. Each patient underwent wide tumour excision followed by abdominal flap reconstruction.

CLINICAL DISCUSSION

The shift from amputation to limb-sparing surgery highlights the advancements in oncologic and reconstructive techniques, allowing for better functional and aesthetic outcomes.

CONCLUSION

This report underscores the critical role of early detection and a multidisciplinary approach in optimizing limb preservation and functional outcomes.

Owner-inflicted ocular injuries: A novel study of dog bite trauma caused by familiar pets: A case series

INTRODUCTION AND IMPORTANCE

This novel study aims to investigate ocular injuries caused by dog bites inflicted by the victims' own pets. The study examines the types of injuries, the breeds of dogs involved, the demographics of the victims, and the clinical management strategies used. It also seeks to highlight the need for preventive measures and the importance of responsible dog ownership in minimizing these injuries.

CASE PRESENTATION

A retrospective review of medical records from Shiraz Eye Center, Khalili Hospital, between 2022 and 2024 was conducted for patients who suffered ocular trauma from bites by their domestic dogs. Only patients with identifiable dog breeds were included. Data collected included patient age, gender, injury type, surgical intervention, medical management, outcomes, and complications. All patients underwent surgery within 2 days of injury and were followed up for at least 3 months. The majority of patients (71 %) were between 12 and 28 years old. Rottweilers and German Shepherds were the most commonly involved breeds. The most frequent injury was lower canaliculi lacerations (57 %), with some cases presenting both lower and upper lid margin lacerations. Surgical interventions primarily involved canalicular repair with Crawford stents and lateral tarsal strip procedures. Complications included ectropion and telecanthus in two cases, but no visual impairments were noted.

DISCUSSION

This study underscores the significant risk of ocular injuries inflicted by owners' own dogs, with young individuals being the most affected group. Rottweilers and German Shepherds were the most frequently involved breeds, but smaller breeds like Pomeranians also caused serious injuries. Lower canalicular lacerations were the most common injury, reflecting the anatomical vulnerability of the central facial region. Timely surgical intervention, primarily canalicular repair with Crawford stents and lid margin repairs, yielded positive outcomes with minimal complications. These findings emphasize the importance of responsible pet ownership, public education, and preventive strategies to reduce such injuries. Additionally, the psychological impact of these injuries, particularly in children, remains an area requiring further research.

CONCLUSION

This study highlights the risks of ocular injuries from dog bites inflicted by familiar pets. It emphasizes the importance of responsible dog ownership, public education, and preventive measures, particularly for vulnerable groups. Further research into the psychological impact of these injuries and larger studies are needed to develop effective prevention strategies.

Surgical outcomes of isolated coronary artery bypass grafting for acute and chronic coronary artery syndromes: based on Sulaimani cardiac registry

Background

The leading cause of death worldwide is coronary artery disease. Globally, coronary artery bypass grafting is among the most frequently carried out procedures. A number of factors, including but not limited to gender, age, comorbidities, duration of cardiopulmonary bypass time, and surgical urgency, influence the short-term mortality following Coronary Artery Bypass Grafting (CABG).

Patients and methods

220 consecutive CABG patients who underwent surgery between January 2022 and December 2022 were included in a prospective comparative analysis carried out at a single location. Convenience sampling was the approach used to obtain the data.

Results

60.4 ± 9.4 CI (95% 36-81) years was the average age of all patients. Just 32.3% of participants were smokers. In 15.5% of cases, patients had emergent surgery. There was no discernible correlation between the pre-operative and intraoperative composite score and early morbidities. However, emergency surgery had a significant value of (P = 0.018) in relation to hospital mortality. Additionally, there was a strong correlation between in-hospital mortality and the cross-clamp time and CPB (P = 0.000 and 0.05). Our subjects underwent survival analysis using Kaplan-Meier, with a mean follow-up duration of 50.43 ± 12.36 weeks. Eleven deaths were reported in the first year's results.

Conclusion

Survival is significantly impacted by CABG. If at all possible, it is preferable to improve a patient's condition before surgery in order to reduce mortality. The patient's chance of survival is impacted by complications including stroke and extended intubation. In some patients, re-examination should be allowed with a low barrier because the alternative might be fatal.

The Relationship Between Jugular Foramen Schwannoma and Surrounding Membrane Structures and Its Surgical Application

BACKGROUND AND OBJECTIVES

Surgical resection of jugular foramen (JF) schwannomas with minimal neurological complications is challenging because of their difficult-to-access location and complex relationships with surrounding neurovascular structures, even for experienced neurosurgeons. In this article, we elucidate the membranous anatomy of JF schwannomas, with the aim of reducing iatrogenic injury to the lower cranial nerves (LCNs) during surgery.

METHODS

The clinical data of 31 consecutive patients with JF schwannomas were reviewed. The relationship between the tumor and the surrounding membranous structures was observed during dissection. Samples were analyzed using Masson's trichrome and immunofluorescence staining to study the membranous characteristics. Histological-radiographic correlations were also summarized.

RESULTS

In this series, we found that all 3 type B, 2 type C, and 8 type D tumors (according to the Kaye-Pellet grading system) were entirely extradural in location, whereas the 18 type A tumors could be subdural (9 cases) or extradural (9 cases), which frequently could not be predicted preoperatively based on whether the tumor had intraforaminal extension. The dural capsule, when present, could be used as an insulating layer to protect LCNs. With this subcapsular dissection technique, postoperative LCN dysfunction occurred in 10 patients (32.3%), which was usually temporary and mild.

CONCLUSION

The different relationships between the tumor and membranous structures of the JF is related to the distinct point of tumor origin and the complex anatomy of the meningeal dura within the JF. Subcapsular dissection technique is recommended for better preservation of LCNs when the dural capsule is identified.

Assessing the feasibility of near infrared autofluorescence imaging in minimally-invasive video assisted parathyroidectomy and the autofluorescence signature of parathyroid adenomas. A single center surgical case series

BACKGROUND

The role of near-infrared autofluorescence (NIRAF)-imaging in thyroid surgery is well-established. However, its role in hyperparathyroidism surgery is yet to be defined due to the lack of consensus regarding the autofluorescence (AF) pattern of parathyroid adenomas (PAs). Furthermore, its utility in minimally invasive video-assisted parathyroidectomy (MIVAP) has yet to be assessed.

OBJECTIVE

To assess the feasibility of utilizing NIRAF-imaging via the limited-access of MIVAP and whether PAs demonstrate a unique AF signature allowing NIRAF-imaging to serve as an intraoperative diagnostic tool.

METHODS

The clinical records of patients who underwent MIVAP for hyperparathyroidism between February and October 2024 were retrospectively reviewed. The primary endpoint was to assess the feasibility of NIRAF-imaging in MIVAP and whether PAs demonstrate a defining AF pattern. Secondary endpoints included whether certain AF patterns of PAs correlated with specific PA features including cell type, size, and/or location. Furthermore, operative-time and cost implications were assessed.

RESULTS

24 consecutive patients underwent MIVAP for hyperparathyroidism. NIRAF-imaging was feasible via the limited-access with no technical difficulties reported. AF patterns included high-intensity AF in 10 (38.5%), low-intensity AF in 10 (38.5%), and cap AF in 6 (23%). A new AF pattern was also described and referred to as "double cap AF". No significant differences in the patterns of AF were observed (p = 0.2). The pattern of AF did not considerably correlate with the predominant cell type, size or location of the PA. However, mediastinal PAs demonstrated a significantly higher tendency for cap AF. The additional time added to the procedure applying the technology was only a few minutes. However, it conferred a considerable additional cost.

CONCLUSION

In experienced hands, a direct minimal-access did not preclude utilizing NIRAF-imaging. PAs seem to lack a uniform characteristic AF signature implying a limited diagnostic role of NIRAF-imaging in parathyroid surgery apart from confirming normal parathyroid tissue. The study has been registered in ClinicalTrials.gov; registration number: NCT06779760.

Quadruple bilateral fracture-dislocation of the elbow and the wrist: A rare and complex case report

We report an exceptionally rare and complex case of quadruple bilateral fracture dislocation of the elbow and the wrist in a 39-year-old construction worker, who sustained the injury after falling from a scaffold of 9 m secondary to a 6.9 magnitude earthquake. The patient was treated with a combination of closed and open reduction, internal fixation, and radial head arthroplasty, and had a good functional outcome at 12 months follow-up, with no complications or instability. This case illustrates the challenges and the possibilities of managing such complex injuries, and adds to the scarce literature on this topic.

The role of surgical navigation in the endoscopic resection of a rare skull base tumor, case report

INTRODUCTION AND IMPORTANCE

Chondrosarcoma is a primary malignancy affecting mainly long bones. The location in the sinonasal tract and in a young female patient is exceptional. We aim through this case report to relate our own experience with a combined endoscopy-navigation approach in the resection of an ethmoidal chondrosarcoma.

CASE PRESENTATION

We report the case of an 18-year-old girl, who was presenting hyposmia, headache and unilateral retroorbital pain with a normal physical exam. Imageries were performed showing an invasive tissular and calcified ethmoidal tumor recalling a chondrosarcoma. She underwent a macroscopic complete resection of the tumor via a binostril endoscopic endonasal approach using navigation. Postoperative head CT and MRI showed a complete resection of the tumor.

CLINICAL DISCUSSION

The gold standard treatment is a complete surgical excision with tumor-free margins which is challenging in the ethmoidal location. In literature, the role of navigation in endoscopic surgeries is debated. In our case, the navigation-guided binostril endoscopic approach enabled a precise tumor localization, with a wide field of vision of vital structures nearby and of tumor limits, ensuring an excellent result with an optimal resection.

CONCLUSION

Chondrosarcomas of the sinonasal tract are rare and represent a compelling diagnostic and treatment challenge. Surgery is the mainstay treatment of sinonasal chondrosarcomas. Endoscopic endonasal surgery associated with surgical navigation offers a great control of the lesion and its margins with good results motivating its adoption as a therapeutic strategy in selected cases.

Over-the-counter products for insomnia in adults: A scoping review of randomised controlled trials

BACKGROUND

Insomnia is highly prevalent and poses significant personal and socio-economic challenges. While the National Institute for Health and Care Excellence (NICE) recommendations define possible medical approaches, over-the-counter products are commonly used to self-manage insomnia symptoms. This scoping review aims to determine the size and scope of the evidence-base regarding the effectiveness and safety of over-the-counter products for insomnia symptoms in adults.

METHODS

The electronic databases of CENTRAL, MEDLINE, EMBASE, PsycINFO, and AMED were searched from inception to December 19th, 2022, for all randomised controlled trials evaluating over-the-counter products compared to placebo, in adults aged 18-65 with insomnia symptoms. Results were synthesised descriptively.

RESULTS

51 randomised controlled trials were included, evaluating herbal products (n = 34), dietary supplements (n = 15), herbal-dietary combinations (n = 4), and over-the-counter medicines (n = 2). Sample sizes ranged between 10 and 405 participants. Eleven studies were conducted in participants with co-morbidities. Interventions were most frequently given as monotherapy and compared against placebo. Most studies (n = 41) demonstrated interventions' positive effects on insomnia symptoms. Among the most studied products, valerian and melatonin have substantial evidence to demonstrate their effectiveness and safety. Promising products demonstrating benefits compared with prescription medication alone included: valerian; lemon balm and fennel; and valerian, hops, and passionflower. Intervention-related side effects were mostly mild and transient. No serious adverse events were reported across all studies.

CONCLUSIONS

Over-the-counter products show promising, but inconclusive findings in alleviating insomnia symptoms in adults. Future research should focus on investigating products currently used in real life, consider economic evaluations, and be evaluated in populations with co-morbidities and ethnic minorities, to better guide clinical advice.

Association between possible bruxism, sleep quality, depression, anxiety and stress by gender. A cross-sectional study in a Spanish sample

OBJECTIVE

To explore the associations between possible bruxism, sleep quality, depression, anxiety and stress, with a specific focus on gender differences.

MATERIAL AND METHODS

An online questionnaire was administered to 400 Spanish-speaking participants, without cognitive impairments. The survey included the possible bruxism self-perception test of Lobbezoo et al., the Pittsburgh Sleep Quality Index, and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Participants were recruited using a "snowball" sampling technique over a five-month period in 2024. The Chi-square test and the Fisher-Freeman-Halton exact test were used for statistical analysis. The significance level was set at 0.05.

RESULTS

Possible bruxists made up 25.4 % of women (n = 67) and 14.7 % of men (n = 20), with a statistically significant difference (P = 0.019). Depression was present in 30.0 % of participants (33.0 % of women and 24.3 % of men; P = 0.072), anxiety in 30.7 % (36.0 % of women and 20.6 % of men; P = 0.002), and stress in 29.0 % (33.3 % of women and 20.6 % of men; P = 0.008). No significant association was found between possible bruxism and emotional disorders in men, whereas a strong association was observed in women (P < 0.001). Similarly, no statistically significant relationship was found between possible bruxism and sleep quality in either gender. However, poor sleep quality was more common among women than men (54.6 % vs 43.7 %; P = 0.040).

CONCLUSIONS

Poor sleep quality, anxiety, stress and depression and possible bruxism are more frequent among women. While no association between possible bruxism and emotional disorders was found in men, a significant relationship was observed in women. Furthermore, although no direct association between possible bruxism and sleep quality was detected, sleep quality was significantly associated with emotional disorders in both genders.

CLINICAL RELEVANCE

These findings suggest that emotional disorders may contribute to the development of possible bruxism in women but not in men. Therefore, women with emotional disorders should be closely monitored, as they are particularly susceptible to possible bruxism and poor sleep quality. Dentists play a crucial role in diagnosing possible bruxism and identifying patients who may benefit from psychological support.

Paraquat poisoning: a case series of 15 survivors and narrative review

Background

Paraquat (PQ) poisoning is a grave concern in developing countries due to its wide availability. Acute paraquat poisoning can have both systemic and local manifestations, with mortality rates that can reach as high as 90%; pulmonary complications and multiple organ dysfunction syndromes being major causes. This case series is a unique retrospective observational study of 15 survivors from South India.

Case presentation

The case series consists of 15 cases, with a mean age of 24.6 years (excluding outliers), that were alleged to have taken varying amounts of paraquat dichloride. Patients exhibited a diverse range of symptoms affecting multiple organ systems, with particular emphasis on kidney, liver, and lung function. Treatments included a combination of hemodialysis, targeted drug therapy in the form of N-acetyl cysteine, anti-inflammatory therapy with corticosteriods and symptomatic therapy. The case descriptions also include the details of the amount of paraquat allegedly ingested, the ingestion to hospitalization time, demographics, etc, that further help in determination of prognosis.

Overview

PQ can cause a variety of clinical signs and symptoms, including gastrointestinal, renal, hepatic, and pulmonary problems. Less commonly, it can also affect the neurological and cardiac systems. Treatment is mainly focused on reducing the effective PQ concentration in blood, as no antidote has been named till date. The paper also discusses the various treatments available, drugs and procedures, and their mechanisms. Also prognostic factors like age, amount, ingestion to hospitalization time, etc.

Conclusion

The study underlines the need for defined treatment protocols, prognostic factors, and enforcing restrictions on availability of this deadly poison.

Prediction of MRI in intra-operative findings for spinal meningeal diseases

BACKGROUND

A large variety of spinal meningeal diseases have been described in the literature, and differential diagnosis is often complex, requiring a good knowledge of the different entities and accurate neuroimaging. The purpose of this article was to depict the most relevant diagnostic features on the commonly utilized MRI sequences for the main and most frequent pathologies of the spinal arachnoid and to correlate them with intraoperative findings.

MATERIAL AND METHODS

Five cases harboring each different spinal meningeal diseases were analyzed, illustrated, extensively described, and discussed: arachnoid web, arachnoiditis, idiopathic spinal cord herniation, intradural arachnoid cyst, extradural arachnoid cyst. All the cases were surgically treated in the same institution (Neurological Hospital, Lyon, France). We underlined imaging clues for differential diagnosis to help physicians to elaborate the right diagnosis and guide the surgical management.

RESULTS

MRI was efficient to determine the nature of the arachnoid or/and dural disease as well as to predict precisely the intra-operative findings. Six key-radiological features were selected, helping differential diagnosis: localization (intra/extradural/both), aspect of the spinal cord (compressive effect/displacement/scalpel sign), arachnoid bride, CSF turbulent flow, vertebral scalloping, absence of gadolinium-enhancement.

CONCLUSION

MRI demonstrated excellent correlation with intra-operative findings for all the five spinal meningeal diseases analyzed. Although rare, these pathologies must be recognized by clinicians considering that appropriate treatment most often permit to relieve the symptoms.

Predictive Factors for Converting Endoscopic to Open Carpal Tunnel Release

Introduction: Both open and endoscopic methods of carpal tunnel release are accepted treatments for carpal tunnel syndrome. The objective was to determine the endoscopic to open conversion rate of all carpal tunnel surgeries. We evaluated potential predictive factors for an increased rate of conversion. Methods: The IRB/IRBnet approved (#20210613/1639264) a retrospective chart review of all attempted endoscopic carpal tunnel surgeries performed from July 1, 2012 through June 30, 2021. Charts were reviewed for procedure, age, sex, body mass index (BMI), electromyograph (EMG) reading, wrist arthritis on x-ray, preoperative steroid injections, trainee as surgeon, diabetes, hand dominance, and operated side. Conversion rate was noted. A chi-square test using a P-value of <0.05 was used to determine the statistical significance of the patients' age, sex, BMI, EMG severity, the presence of wrist arthritis, preoperative steroid injections, resident as surgeon, diabetic status, and operated hand dominance as predictive factors for conversion. Results: The plastic surgery service attempted 1053 endoscopic carpal tunnel releases using the Chow dual port technique over a 9-year period. Forty-five cases converted to an open release. Median age (P = 0.54), sex (P = 0.43), median BMI (P = 0.76), EMG severity (P = 0.20), wrist arthritis (P = 1.0), preoperative steroid injections (P = 0.65), resident surgeon (P = 0.53), diabetes (P = 0.50), and operated hand dominance (P = 0.36) were not statistically significant predictive risk factors. Nineteen of 45 converted cases had a future successful contralateral endoscopic release. Conclusion: Our study found a 4.27% endoscopic to open conversion rate. No identifiable risk factors could predict conversion. Prior conversion does not determine a future contralateral conversion.

ETAD: a case series of endoscopic transanastomotic drainage of anastomotic leak by colonoscopy

BACKGROUND

Transanal drain placement is the preferred treatment for coloanal and low colorectal anastomotic leaks (AL). Endoscopic placement of double-pigtail stents (DPS) has been described sparingly in the colorectal literature for more proximal AL. Our objective was to investigate the efficacy of endoscopic transanastomotic drain (ETAD) placement in leaks after colorectal surgery.

METHODS

This is a case series of 12 patients who underwent ETAD placement for AL (12 patients) between May 2020 and July 2023. Patients with contained leaks were treated with ETAD if they were hemodynamically stable without peritonitis. Outcomes we evaluated included length of stay, need for readmission, need for reoperation, duration of drain placement, and reversal of diverting stomas.

RESULTS

Of the 12 patients, 5 were female and had a median age of 63. Indications for index surgery included diverticulitis (n = 9), inflammatory bowel disease (n = 1), rectal cancer (n = 1), and uncertain diagnosis (n = 1). 5 patients had stomas created (loop ileostomies,) at the index operation. Leaks were identified a median of 80 days (range 9-211) for diverted patients and a median of 15 days (range 5-18) for non-diverted patients. At the time of ETAD, three patients required readmission, four patients remained admitted from index operation, and five patients were treated as outpatients. All diverting loop ileostomies were reversed. The median duration of ETAD was 55 days (range 38-115 days). All were successfully managed with ETAD; no patients required revision of their anastomoses or new diverting stoma.

CONCLUSIONS

Endoscopic DPS placement into contained colorectal leaks was successful in promoting healing and avoiding reoperation in 100% of our patients. All ostomies but one have been reversed. Larger studies are necessary to evaluate safety and efficacy, long-term outcomes, and the appropriate patient population for consideration.

Generative artificial intelligence in oncology

PURPOSE OF REVIEW

By leveraging models such as large language models (LLMs) and generative computer vision tools, generative artificial intelligence (GAI) is reshaping cancer research and oncologic practice from diagnosis to treatment to follow-up. This timely review provides a comprehensive overview of the current applications and future potential of GAI in oncology, including in urologic malignancies.

RECENT FINDINGS

GAI has demonstrated significant potential in improving cancer diagnosis by integrating multimodal data, improving diagnostic workflows, and assisting in imaging interpretation. In treatment, GAI shows promise in aligning clinical decisions with guidelines, optimizing systemic therapy choices, and aiding patient education. Posttreatment, GAI applications include streamlining administrative tasks, improving follow-up care, and monitoring adverse events. In urologic oncology, GAI shows promise in image analysis, clinical data extraction, and outcomes research. Future developments in GAI could stimulate oncologic discovery, improve clinical efficiency, and enhance the patient-physician relationship.

SUMMARY

Integration of GAI into oncology has shown some ability to enhance diagnostic accuracy, optimize treatment decisions, and improve clinical efficiency, ultimately strengthening the patient-physician relationship. Despite these advancements, the inherent stochasticity of GAI's performance necessitates human oversight, more specialized models, proper physician training, and robust guidelines to ensure its well tolerated and effective integration into oncologic practice.

"Floating Island" Technique: Case Series of a Novel Technique for Surgical Management of Interdigitating Calcified Thoracic Disc Herniations

OBJECTIVE

The objective of this study was to describe the use of a novel approach, the "floating island" technique, to surgically address calcified thoracic disc herniation (cTDH) that interdigitates with adjacent dura and to report clinical and radiographic outcomes of patients.

METHODS

A retrospective case series was conducted by examining the electronic medical records of consecutive patients who underwent thoracic discectomy from August 2017 to December 2022. Of 65 patients treated for thoracic disc herniation, 37 had cTDHs. Five of these 37 patients underwent treatment with the floating island technique, which involves osseous separation, debulking, and ligamentous separation.

RESULTS

The floating island technique was applied using the posterolateral approach in 3 patients and the anterolateral approach in 2 patients. One patient experienced a cerebrospinal fluid leak, which was managed without a lumbar drain. All patients showed radiographic improvement of spinal cord compression postoperatively and were admitted to an intensive care unit for 1 night. Hospital stays ranged from 2 to 6 nights, with 4 patients discharged home and 1 to a rehabilitation facility. Neurological improvement or baseline status was observed in all patients at discharge, with follow-up ranging from 9 to 24 months. Nurick grade improved in all patients by at least 1 point, with no progression of symptoms.

CONCLUSIONS

The floating island technique offers a promising option for the surgical management of interdigitating cTDH, demonstrating excellent immediate radiographic and long-term clinical outcomes. Further studies are needed to validate these findings and determine the technique's generalizability.

Characterization of non-alcoholic fatty liver disease-related hepatocellular carcinoma on contrast-enhanced ultrasound with Sonazoid

PURPOSE

This study aimed to evaluate the contrast-enhanced ultrasound with Sonazoid (Sonazoid-CEUS) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

In this retrospective study, patients who underwent surgical resection and were histopathologically diagnosed with NAFLD or cirrhosis-related HCC were included. All patients received Sonazoid-CEUS examinations within 1 week prior to hepatic surgery. The enhancement patterns of HCC lesions were evaluated and compared between the two groups according to the current World Federation for Ultrasound in Medicine and Biology guidelines. Multivariate logistic regression analysis was used to assess the correlations between Sonazoid-CEUS enhancement patterns and clinicopathologic characteristics.

RESULTS

From March 2022 to April 2023, a total of 151 patients with HCC were included, comprising 72 with NAFLD-related HCC and 79 with hepatitis B virus (HBV) cirrhosis-related HCC. On Sonazoid-CEUS, more than half of the NAFLD-related HCCs exhibited relatively early and mild washout within 60 seconds (54.2%, 39/72), whereas most HBV cirrhosis-related HCCs displayed washout between 60 and 120 seconds (46.8%, 37/79) or after 120 seconds (39.2%, 31/79) (P<0.001). In the patients with NAFLD-related HCC, multivariate analysis revealed that international normalized ratio (odds ratio [OR], 0.002; 95% confidence interval [CI], 0.000 to 0.899; P=0.046) and poor tumor differentiation (OR, 21.930; 95% CI, 1.960 to 245.319; P=0.012) were significantly associated with washout occurring within 60 seconds.

CONCLUSION

Characteristic Sonazoid-CEUS features are useful for diagnosing HCC in patients with NAFLD.

Spontaneous uterine rupture in the second trimester with fetal Cyclopia at a resource-limited setting: A case report

INTRODUCTION AND IMPORTANCE

Spontaneous uterine rupture in the second trimester is a rare and life-threatening obstetric emergency, typically associated with pre-existing risk factors. This case presents a unique instance of spontaneous uterine rupture in a multiparous woman without typical risk factors, highlighting the challenges of diagnosis and management in a resource-limited setting. The associated fetal cyclopia adds to the rarity of the case and contributes to the existing literature on uterine rupture. This report demonstrates the need for high clinical suspicion and prompt intervention, even in the absence of usual risk factors.

CASE PRESENTATION

A 30-year-old, gravida 7, para 6 female presented with a two-day history of abdominal pain, vomiting, and subjective fever. The patient progressed to hemodynamic instability, vaginal bleeding, and loss of consciousness within a few hours of admission.

CLINICAL DISCUSSION

The main diagnosis was spontaneous uterine rupture with hemoperitoneum and a non-viable fetus with cyclopia. The therapeutic interventions included emergency exploratory laparotomy, evacuation of the hemoperitoneum, and subtotal hysterectomy. The patient recovered well and was discharged on postoperative day five.

CONCLUSION

This case underscores the unpredictable nature of uterine rupture and the importance of maintaining a high index of suspicion for this diagnosis, even in the absence of typical risk factors, particularly in resource-limited settings. Prompt surgical intervention and appropriate postoperative care are essential for favorable maternal outcomes.

Development of a Core Critical Care Data Dictionary With Common Data Elements to Characterize Critical Illness and Injuries Using a Modified Delphi Method

OBJECTIVES

To develop the first core Critical Care Data Dictionary (C2D2) with common data elements (CDEs) to characterize critical illness and injuries.

DESIGN

Group consensus process using modified Delphi approach.

SETTING

Electronic surveys and in-person meetings.

SUBJECTS

A multidisciplinary workgroup of clinicians and researchers with expertise in the care of the critically ill and injured.

INTERVENTIONS

The Delphi process was divided into domain and CDE portions with each composed of two item generation rounds and one item reduction/refinement rounds. Two in-person meetings augmented this process to facilitate review and consideration of the domains and by panel members. The final set of domains and CDEs was then reviewed by the group to meet the competing criteria of utility and feasibility, resulting in the core dataset.

MEASUREMENTS AND MAIN RESULTS

The 23-member Delphi panel was provided 1833 candidate variables for potential dataset inclusion. The final dataset includes 226 patient-level CDCs in nine domains, which include anthropometrics and demographics (8), chronic comorbid illnesses (18), advanced directives (1), ICU diagnoses (61), diagnostic tests (42), interventions (27), medications (38), objective assessments (26), and hospital course and outcomes (5). Upon final review, 91% of the panel endorsed the CDCs as meeting criteria for a minimum viable data dictionary. Data elements cross the lifespan of neonate through adult patients.

CONCLUSIONS

The resulting C2D2 provides a foundation to facilitate rapid collection, analyses, and dissemination of information necessary for research, quality improvement, and clinical practice to optimize critical care outcomes. Further work is needed to validate the effectiveness of the dataset in a variety of critical care settings.

Systematic Review and Case Report of a Left Gonadal Vein Anastomosing Hemangioma

Background/Objectives: Anastomosing hemangioma (AH) is a rare, benign vascular tumor predominantly found in the genitourinary tract and often associated with impaired renal function. Due to its nonspecific radiological features, AH is frequently misinterpreted as a malignant vascular neoplasm, particularly angiosarcoma (AS), leading to potentially unnecessary surgical interventions. This study presents a systematic review of AH cases and describes a rare instance of retroperitoneal AH arising from the left gonadal vein, which was resected due to diagnostic uncertainty. Methods: A 68-year-old man underwent imaging for benign prostatic hyperplasia, incidentally revealing a 15-mm hypervascular retroperitoneal nodule adjacent to the left psoas muscle. Imaging findings, including moderate metabolic uptake on 18FDG-PET/CT, raised suspicion for AS. Given the diagnostic uncertainty and high-risk location, the multidisciplinary team (MDT) recommended surgical resection. Laparoscopic excision was performed, and histopathological analysis confirmed AH. The patient remained asymptomatic at a 22 month follow-up. In addition, a systematic review of 159 cases from 64 studies (2009-2024) was conducted to analyze radiological features, treatment approaches, and outcomes. Results: Among the reviewed cases, 68% were incidentally diagnosed, with AH occurring predominantly in the genitourinary system (70%), especially in the kidney, adrenal gland, and ovary. Chronic kidney disease (CKD) was present in 23.3% of cases, while 19.5% had a history of malignancy. Imaging was inconclusive in differentiating AH from malignancies: CT (71.9%) and MRI (6.1%) were the most used modalities, but none could reliably exclude AS. Management strategies included upfront surgical resection in 85%, while a growing proportion (9%) of cases underwent biopsy-based observation rather than immediate surgery. No cases were followed with imaging alone. Conclusions: AH remains a diagnostic challenge due to its overlap with malignant vascular tumors. While surgical excision is often performed, our review highlights an increasing trend toward conservative management with biopsy-based diagnosis. Improved awareness and the integration of histopathology, molecular markers, and MDT-based decision-making are crucial to prevent overtreatment in cases of suspected AH.

The underlying mechanism behind the different outcomes of COVID-19 in children and adults

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has affected hundreds of millions of people globally, resulting in millions of deaths. During this pandemic, children have demonstrated greater resistance than adults, exhibiting lower infection rates, reduced mortality, and milder symptoms. Summarizing the differences in resistance between children and adults during COVID-19 can provide insights into protective mechanisms and potential implications for future treatments. In this review, we focused on summarizing and discussing the mechanisms for better protection of children in COVID-19. These protective mechanisms encompass several factors: the baseline expression of cell surface receptor ACE2 and hydrolase TMPRSS2, the impact of complications on COVID-19, and age-related cytokine profiles. Additionally, differences in local and systemic immune responses between children and adults also contribute significantly, particularly interferon responses, heterologous protection from non-COVID-19 vaccinations, and immune status variations influenced by micronutrient levels. The advantageous protection mechanisms of these children may provide insights into the prevention and treatment of COVID-19. Importantly, while age-related metabolic profiles and differential COVID-19 vaccine responses may contribute to protection in children, current comparative research remains limited and requires further investigation.

AI-Driven Detection of Obstructive Sleep Apnea Using Dual-Branch CNN and Machine Learning Models

Background/Objectives: The purpose of this research is to compare and contrast the application of machine learning and deep learning methodologies such as a dual-branch convolutional neural network (CNN) model for detecting obstructive sleep apnea (OSA) from electrocardiogram (ECG) data. Methods: This approach solves the limitations of conventional polysomnography (PSG) and presents a non-invasive method for detecting OSA in its early stages with the help of AI. Results: The research shows that both CNN and dual-branch CNN models can identify OSA from ECG signals. The CNN model achieves validation and test accuracy of about 93% and 94%, respectively, whereas the dual-branch CNN model achieves 93% validation and 94% test accuracy. Furthermore, the dual-branch CNN obtains a ROC AUC score of 0.99, meaning that it is better at distinguishing between apnea and non-apnea cases. Conclusions: The results show that CNN models, especially the dual-branch CNN, are effective in apnea classification and better than traditional methods. In addition, our proposed model has the potential to be used as a reliable, non-invasive method for accurate OSA detection that is even better than the current state-of-the-art advanced methods.

Travel-related sepsis with colitis and necrotizing skin and soft tissue infection after oysters consumption

We describe in this article a case of a 55-year-old woman admitted to our hospital in France, for oedema and paraesthesia of the lower limbs after returning from a trip to Florida. In only four hours, the patient's condition evolved into a multiple organs failure, leading the physicians to carry out a TAP scan and a CT angiogram of the lower limb, which showed acute pan-colitis and diffuse infiltration of the skin and soft legs tissues. Leg fasciotomy was performed and revealed necrotizing fasciitis and myonecrosis. The evolution was unfavorable, leading to shock and death 12 h after hospital admission. Culture revealed Vibrio vulnificus and rapid genome sequencing led to identification of MO6-24/O genotype. V. vulnificus is a bacterium commonly found in warm coastal water and responsible for necrosis SSTI after exposure to seawater through skin lesions and gastroenteritis after ingestion of contaminated seafood. Strain MO6-24/O found in our patient is associated with very poor prognosis. This case is uncommon in Europe but the modification of geographic distribution due to warming coastal waters in Pacific and Atlantic coastal regions of the northern hemisphere lead to consider V. vulnificus in travellers from coastal and estuarine regions, with history of exposure to water or seafood consumption, especially during the summer.

A Comparative Study of N-Acetyl Cysteine, Rosuvastatin, and Vitamin E in the Management of Patients with Non-Alcoholic Steatohepatitis: A Randomized Controlled Trial

Background: Non-alcoholic steatohepatitis (NASH) is characterized by increased production of proinflammatory cytokines, fibrosis, and hepatocyte apoptosis. This study aimed to assess the efficacy of N-acetyl cysteine (NAC), rosuvastatin (RSV), and vitamin E (VE) in patients with NASH. Methods: A double-blinded, parallel, randomized, controlled study was conducted and registered on clinicaltrials.gov (Identifier: NCT06105060), involving 135 NASH participants, who were divided into three groups: the control group (group 1), consisting of patients receiving standard therapy VE at a dosage of 400 IU twice daily. In the treated group (group 2), patients were administered NAC at a dosage of 1200 mg twice daily, while treatment (group 3) received RSV at a dosage of 20 mg once daily. FibroScan® examination of liver tissue and fibrosis scores, along with tests for liver aminotransferases, lipid profile, glycemic parameters, and renal and hepatic functions, were assessed before and after six months of treatment. Results: The analyzed groups demonstrated a significant reduction in steatosis and lipid peroxidation (p < 0.05). The NAC group demonstrated greater anti-inflammatory and anti-apoptotic effects compared to the RSV group, although this difference was not significant in the control group. NAC is conceded as the only significant antifibrotic agent in liver stiffness measurement (LSM), biological marker findings, and non-invasive liver fibrosis scores (p < 0.05), in addition to its improvement of several metabolic parameters and health-related quality of life. Conclusions: Patients receiving NAC demonstrated safety and efficacy in enhancing steatosis, fibrosis, and metabolic parameters, representing a novel strategy in the management of NASH.

Utilising intraoperative hand-held cryoneurolysis for enhanced post-thoracotomy pain control

Post-thoracotomy pain (PTP) is a challenging complication following thoracic surgery, often leading to chronic, debilitating symptoms. However, little is known about the potential of intraoperative cryoneurolysis (IC) as a solution for managing PTP. This retrospective case series reports the application of IC in three patients undergoing thoracic surgery for chest wall tumors. Under direct visualisation of the intercostal nerves, temporary inhibition of nerve signalling was achieved without disrupting the surrounding tissue using a handheld device. All three patients experienced decreased pain and reduced reliance on opioids during the 6 week postoperative period. These outcomes highlight the potential of IC to improve post-thoracotomy pain management.

Gut-directed therapeutics in inflammatory bowel disease

PURPOSE OF REVIEW

Tissue-directed therapies (TDTs) provide potential advantages, including improved tolerance, safety, and efficacy. This review provides a conceptual framework for understanding intestinal TDT and summarizes the current landscape of TDT in inflammatory bowel disease (IBD).

RECENT FINDINGS

Vedolizumab, a mAb targeting the gut homing α4β7 integrin, served as revolutionary proof-of-principle for the power of advanced TDT in IBD. The development of other monoclonal antibodies targeting cell adhesion molecules followed including abrilumab (α4β7), etrolizumab (β7), and ontamalimab (MAdCAM-1). MORF-057, an oral small molecule inhibitor of α4β7, is now in development for ulcerative colitis. Efforts have also been made toward gut specific JAK inhibitors. Microbiome-based therapies, including engineered probiotics, bacteriophages, and postbiotics, are gaining interest. There are also a number of innovative drug delivery methods, including engineered yeast, hydrogels, and nanoparticles, and viral-based gene therapy.

SUMMARY

Gut-targeted therapies range from novel variations on traditional drugs (i.e., mAbs and small molecules) to microbiome-based therapeutics and engineered delivery systems. They can be used alone or in combination with currently available therapies. Future directions should focus on the development of tried-and-true modalities (mAbs, small molecules) as well as the microbiome and more innovative delivery systems.

Predictors of sepsis, intensive care unit admission, and death in patients hospitalized for complicated skin and soft tissue infections: Retrospective study at a large tertiary-care center

Background

Complicated skin and soft tissue infections often lead to poor health outcomes, with necrotizing skin and soft tissue infections occurring in 70%-80% of hospitalized patients and a mortality rate typically exceeding 20%. The current study's main objective was to identify early predictors of sepsis, intensive care unit admission, and mortality in hospitalized complicated skin and soft tissue infection patients.

Methods

A retrospective review of records from 235 adult complicated skin and soft tissue infection patients admitted from 2012 to 2022 was conducted. Collected data included demographics, medical history, clinical presentation, treatment, and outcomes. Laboratory results were used to calculate the Laboratory Risk Indicator for Necrotizing Fasciitis score for diagnosing necrotizing fasciitis. Predictors of sepsis, intensive care unit admission, and death were identified using logistic regression analysis.

Results

Of the 235 patients, 42.1% were wheelchair-bound or bedridden; 93.2% had diabetes, 76.2% had cardiovascular disease, and 33.6% had kidney disease. Necrotizing fasciitis criteria were met by 75% of patients. Sepsis was diagnosed in 27.7% of patients, while 30.6% required intensive care unit admission, and 20.4% did not survive hospital discharge. Low mean arterial pressure and vasopressor use were significant predictors of all three severe outcomes, with pre-existing kidney disease also a predictor of in-hospital death. The Glasgow Coma Scale predicted both intensive care unit admission and sepsis, but not death.

Conclusions

Low mean arterial pressure, vasopressor use, and pre-existing kidney disease are key predictors of in-hospital death in patients hospitalized for complicated skin and soft tissue infection. The former two, and the patient's Glasgow Coma Scale, also appear to predict both intensive care unit admission and sepsis.

Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS)

BACKGROUND

Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes.

OBJECTIVE

The aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing CRT.

METHODS

This multicenter observational study included patients with LVEF ≤50% receiving CRT with either LBBAP or BVP at 18 centers from January 2018 to June 2023. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization (HFH). Secondary outcomes included separate analyses of HFH and all-cause mortality. Propensity score matching was used to balance baseline characteristics. Kaplan-Meier curves, Cox proportional hazards models, and competing risk analyses were performed.

RESULTS

A total of 2579 patients were included (BVP, 1118; LBBAP, 1461). In the propensity score-matched cohort (BVP, 780; LBBAP, 780), LBBAP demonstrated shorter paced QRS duration (129 ± 19 ms vs 143 ± 22 ms; P < .001). LBBAP was associated with a significantly lower risk of the composite primary outcome (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.98; P = .048) and reduced HFH (HR, 0.63; 95% CI, 0.49-0.82; P < .001). No significant difference in all-cause mortality was observed (HR, 0.82; 95% CI, 0.63-1.07; P = .156). Procedural complications were lower with LBBAP (3.5% vs 6.5%, P = .004).

CONCLUSION

LBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF <50% requiring CRT. Randomized trials are needed to confirm long-term benefits.

A Quantitative Analysis of Work System Factors and Well-Being Among Nurses and Physicians in Rural and Urban Settings During Covid-19 Pandemic

BACKGROUND

The aim of this study was to assess work system factors and nurse and physician well-being across professionals (nurse vs. physician) and geographic locations (rural vs. urban) during COVID-19 pandemic.

METHODS

This study invited nurses and physicians within four hospitals from one large healthcare system to participate: one urban academic medical center and three rural hospitals. We measured work systems factors using the National Academy of Medicine (NAM) framework and the National Institute for Occupational Safety and Health (NIOSH) survey. Wellbeing was measured using the 2-question summative burnout score, Patient Health Questionnaire (PHQ-9) to measure depression, and post-traumatic stress disorder (PTSD) checklist (PCL) to measure PTSD symptoms. Statistical analyses were conducted using Chi-square (for Likert-scale items) and t-tests (for continuous scales) as appropriate. Statistical significance was set at the .05 level, two-tailed.

RESULTS

Overall, our results suggested that nurses and physicians working in the urban settings experience more impeding work system factors and are more burned out, depressed, exhibit more PTSD symptoms, and face greater overall well-being issues, when compared to nurses and physicians working in the rural settings.Conclusions/Applications to Practice:This study examined a comprehensive set of work system factors and well-being measures to better understand differences between rural and urban settings, and nurses compared to physicians. By examining this entire set of measures, we were able to provide a greater insight into the key differences, highlighting opportunities for policy-level contributions to prevent work related impairments from reaching the healthcare workforce.

Mediating factors associated with alcohol intake and periodontal condition

Background

Alcohol consumption has been reported to increase the risk of periodontal disease and various health abnormalities such as obesity, hyperglycemia, and liver abnormalities. While the link between these health abnormalities and periodontal disease has been established, their potential mediating role in the association between alcohol consumption and periodontal disease remains unclear. Therefore, this study aims to investigate the multiple mediating roles of obesity, hyperglycemia, and liver abnormalities in this association.

Methods

A cross-sectional study was conducted on 6,529 individuals aged 35-64 years who underwent workplace health check-ups in 2003 (mean age: 45.7 ± 8.7 years). The periodontal condition was evaluated using the mean pocket depth (PD), and participants were classified into no, light/moderate (alcohol consumption 0.1-29.9 g/day), and heavy (≥30 g/day) drinking groups. Causal mediation analysis was performed.

Results

Heavy drinking had a direct effect on the mean PD. Light/moderate drinking had a indirect effect on the mean PD through the body mass index (BMI), glucose level, alanine aminotransferase level (ALT), with proportion mediated of 25.1%, 8.9%, and 18.9%, respectively. The mediating role of glucose level was found in the association between heavy drinking and the mean PD with proportion mediated of 32.7%.

Conclusion

This study confirmed that alcohol consumption was associated with worse periodontal condition among Japanese adults who received workplace health check-ups. This association was partially contributed by several factors such as BMI, glucose level, and ALT.

Knowledge, attitudes, and practices of physicians regarding multidisciplinary treatment of obstructive sleep apnea: a cross-sectional study

To investigate physicians' knowledge, attitudes, and practices (KAP) regarding the multidisciplinary treatment of Obstructive Sleep Apnea (OSA). A multicenter cross-sectional study was conducted in May 2024, enrolling physicians from southwestern China. The study collected demographic data and assessed KAP through self-administered questionnaires, with the respiratory and otolaryngology departments defined as relevant departments. A total of 329 valid questionnaires were collected. Of these respondents, 173 (52.6%) were female, and 114 (34.7%) had participated in multidisciplinary OSA-related training. The mean scores for knowledge and attitudes were 24.61 ± 8.27 (possible range: 0-34) and 39.99 ± 4.34 (possible range: 10-50), respectively. Practice scores of the physicians in departments directly and indirectly involved in OSA treatment averaged 24.28 ± 4.70 and 21.28 ± 4.24 (possible range: 6-30), respectively. Structural equation modeling results indicated that in departments directly related to OSA, knowledge had a significant positive effect on both attitudes (β = 5.53, P < 0.001) and practices (β = 5.8, P < 0.001). For departments indirectly related to OSA, knowledge had a significant positive effect on attitudes (β = 5.41, P < 0.001). Physicians showed adequate knowledge and attitudes toward OSA treatment; targeted education is recommended to enhance consistency in practices across departments.

Oral Lipid Nanoparticles for Improving the Efficiency of Drug Delivery Systems in Ulcerative Colitis: Recent Advances and Future Prospects

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by persistent, recurrent, and relapsing inflammation of the mucosal layer. Its pathogenesis is complex and not yet fully understood, with current treatments mainly focused on alleviating symptoms through pharmacological methods. Direct drug administration for UC often leads to poor intestinal bioavailability, suboptimal targeting, and an increased risk of resistance. Therefore, there is an urgent need for effective drug delivery systems. Lipid nanoparticles (LNPs) are promising candidates for UC drug delivery due to their high biocompatibility, stability, and customizable properties. Oral administration, as a preferred treatment approach for UC, offers benefits such as convenience, cost-effectiveness, and better patient compliance. However, oral drug delivery systems must navigate the complex gastrointestinal tract to effectively target colonic lesions, posing significant challenges for LNP-based systems. Researchers are exploring ways to enhance oral delivery efficiency by adjusting LNP composition, surface functionalization, and coating. This article reviews recent advancements in oral LNP research aimed at improving drug delivery efficiency for UC treatment and discusses future prospects.

Optimization of Postoperative Opioids Use Following Spine Surgery

PURPOSE OF REVIEW

The present investigation evaluated the use of opioids for postoperative pain relief in spinal surgery patients.

RECENT FINDINGS

Pain management is a crucial component of postoperative care that greatly impacts patient outcomes. Postoperative pain management has been shown to allow for earlier mobility, discharge, and return to normal life. Opioids are the standard treatment for postoperative pharmacologic pain relief, but they are associated with the same adverse effects that pain management strives to mitigate. Opioids are associated with a large side effect profile, including a higher risk of various postoperative complications. Opioids are potentially highly addictive and postoperative use is associated with dependence, tolerance, and the current opioid epidemic. Some studies indicate that there are similar surgical outcomes amongst patients independent of whether opioids were prescribed opioids for pain relief.

CONCLUSION

Opioids should only be recommended for postoperative pain management under strict guidance and supervision from physicians. All 50 states have acute pain guidelines in place limiting opioid prescribing. One of the strategies of reducing postoperative opioid consumption is the emphasis on opioid alternatives that should be actively considered and explored prior to resorting to opioids. There are pharmacological and non-pharmacological options available for pain relief that can provide similar levels of analgesia as prescription opioid without unwanted effects such as tolerance and dependency. Proper assessment of patient history and risk factors can aid physicians in tailoring a pain management regimen that is appropriate for each individual patient. More research into efficacy and safety of alternative treatments to opioids is warranted.

The Mediating Role of Negative Mood Affect in the Relationship Between Perceived Stress and Vulnerability to Insomnia Among Student Pharmacist Shift Workers

Background

Perceived stress and vulnerability to develop insomnia are closely linked, with negative mood affect playing a key role. Shift workers, particularly student pharmacists juggling academic demands and irregular work schedules, are at heightened risk for stress-related sleep disturbances. While previous studies have explored their direct relationships, limited evidence exists on the dual role of negative mood affect as both a mediator and a non-mediator in these pathways. This study investigates the mediating role of negative mood affect in the relationship between perceived stress and vulnerability to develop insomnia and assesses whether negative mood affect mediates the reverse relationship.

Methods

A cross-sectional study was conducted on 86 student pharmacist shift workers at Notre Dame of Maryland University. Participants completed validated self-report measures, including the Perceived Stress Scale (PSS), the Ford Insomnia Response to Stress Test (FIRST), and the Positive and Negative Affect Schedule (PANAS). Mediation analysis using Hayes' PROCESS macro (Model 4) examined the mediating role of negative mood affect in both pathways. Bias-corrected bootstrapping with 5000 iterations calculated confidence intervals for indirect effects, with significance set at p < 0.05.

Results

Negative mood affect partially mediated the relationship between perceived stress and vulnerability to develop insomnia. Higher stress levels were associated with increased negative mood affect (b = 0.49, SE = 0.05, p < 0.01), which, in turn, was linked to greater insomnia vulnerability (b = 0.39, SE = 0.04, p < 0.01). The indirect effect was significant (b = 0.19, 95% CI [0.06, 0.33]). In contrast, negative mood affect did not mediate the reverse pathway (p = 0.15).

Conclusion

Negative mood affect significantly mediates the relationship between perceived stress and insomnia vulnerability but not the reverse pathway. Interventions targeting emotional regulation may help reduce stress-related sleep disturbances. Longitudinal studies are needed to confirm these findings and refine interventions.

Development of explainable artificial intelligence based machine learning model for predicting 30-day hospital readmission after renal transplantation

BACKGROUND

Hospital readmission following renal transplantation significantly impacts patient outcomes and healthcare resources. While machine learning approaches offer promising solutions for risk prediction, their clinical application often lacks interpretability. We developed an explainable artificial intelligence (XAI) based supervised learning model to predict 30-day hospital readmission risk following renal transplantation.

METHODS

We conducted a retrospective analysis of 588 renal transplant recipients at King Abdullah International Medical Research Center, with a predominance of living donor transplants (85.2%, n = 500). Our methodology included a four-stage machine learning pipeline: data processing, feature preparation, model development using stratified 5-fold cross-validation, and clinical validation. Multiple algorithms were evaluated, with gradient boosting demonstrating superior performance. Model interpretability was achieved through dual-approach analysis using SHAP (SHapley Additive exPlanations) and LIME (Local Interpretable Model-agnostic Explanations).

RESULTS

The gradient boosting model demonstrated strong performance (AUC 0.837, 95% CI: 0.802-0.872) with accuracy of 0.796 ± 0.050 and sensitivity of 0.388 ± 0.129. Length of hospital stay (38.0% contribution) and post-transplant systolic blood pressure (30.0% contribution) emerged as primary predictors, with differences between living and deceased donor subgroups. Pre-transplant BMI showed a higher importance in deceased donor recipients (12.6% vs. 2.6%), while HbA1c and eGFR were more impacting in living donor outcomes. The readmission rate in our cohort (88.9%, n = 523) was higher than previously reported ranges (18-47%), likely reflecting center-specific practices.

CONCLUSIONS

Our XAI-based machine learning model combines strong predictive performance with clinical interpretability, offering transplant physicians donor-specific risk stratification capabilities. The web-based implementation facilitates practical integration into clinical workflows. Given our single-center experience and high proportion of living donors, external validation across diverse transplant centers is essential before widespread implementation. Our approach establishes a framework for developing center-specific risk prediction tools in transplant medicine.