Antimicrobial resistance in community-acquired enteric pathogens among children aged ≤ 10-years in low-and middle-income countries: a systematic review and meta-analysis

Introduction

Antimicrobial resistance (AMR) is a global health priority. This systematic review summarizes the prevalence of AMR in enteric pathogens originating from the community, specifically among ≤10-year-old children in low-and middle-income countries (LMICs). In addition, it presents the proportions of pooled resistance in Campylobacter spp., Escherichia coli, Shigella spp., and Salmonella spp. (CESS) to clinically relevant antibiotics.

Methods

Six online repositories, namely PubMed, Medline, Web of Science, Cochrane Library, CABI, and EMBASE were searched for articles published between January 2005 and September 2024. Random-effects meta-analysis models were constructed to estimate the pooled AMR proportions for CESS pathogens, and a subgroup analysis by region was also carried out.

Results

A total of 64 publications from 23 LMICs met our inclusion criteria. The pooled estimates of E. coli AMR for clinically important antibiotics were as follows: sulfamethoxazole/trimethoprim (SXT) 71% [95%CI: 57-82%]; ampicillin (AMP) 56% [95%CI: 44-67%]; ciprofloxacin (CIP) 10% [95%CI: 5-20%]; and ceftriaxone (CRO) 8% [95%CI: 2-31%]. The proportions of AMR detected in Shigella spp. were AMP 76% [95%CI: 60-87%]; nalidixic acid (NA) 9% [95%CI: 2-31%]; CIP 3% [95%CI: 0-15%]; and CRO 2% [95%CI: 0-19%]. The proportions of Salmonella spp. AMR were AMP 55% [95%CI: 35-73%] and SXT 25% [95%CI: 15-38%]. The proportions of Campylobacter spp. AMR were erythromycin (ERY) 33% [95%CI: 12-64%] and CIP 27% [95%CI: 8-61%]. There was high variability in the regional subgroup analysis, with high interstudy and regional heterogeneity I2 ≥ 75%.

Conclusion

Our results shed light on drug-resistant enteric bacterial pathogens in young children, providing evidence that CESS pathogens are becoming increasingly resistant to clinically important antimicrobials. Regional differences in resistance patterns between these community isolates highlight the need for strong national and regional surveillance to detect regional variations and inform treatment and appropriate antibiotic stewardship programs. The limitations of our findings include high regional variability, significant interstudy heterogeneity, and underrepresentation of certain LMICs.

Systematic review registration

https://inplasy.com/inplasy-2024-2-0051/, registration number: INPLASY202420051.

SpO2/FiO2 Correlates with PaO2/FiO2 (P/F) and Radiological Biomarkers of Severity: A Retrospective Study on COVID-19 Pneumonia Patients

Background: In patients with COVID-19 pneumonia, the estimation of PaO2 represents the method of choice for monitoring a patient's oxygenation status and assessing disease severity. The aim of this study is, therefore, to investigate the correlation between SpO2/FiO2 and PaO2/FiO2, as well as radiological and laboratory biomarkers of severity. Methods: In this monocentric observational, analytical, retrospective large cohort study, consecutive patients with a confirmed diagnosis of pneumonia from SARS-CoV-2, hospitalized at the Cotugno Hospital-AORN dei Colli-of Naples, between 1 September 2020 and 28 February 2022 were considered for study inclusion. Patients with missing data were excluded. Results: We included 585 patients (median age 63 [22-95]). Mean PaO2/FiO2 was 203 [66-433], whilst mean SpO2/FiO2 was 240 [81-471]. We found that P/F ratio could be predicted from S/F ratio, as described by the linear regression equation (P/F = 13.273 + 0.790 × S/F). In addition, we found that SpO2/FiO2 ratio significantly correlated with HRCT score and laboratory markers of severity, including IL-6, D-Dimer, and NLR. Conclusions: SpO2/FiO2 ratio represents a highly useful resource as a valid surrogate of P/F ratio in patients with COVID pneumonia, also correlating with other biomarkers of severity, such as HRCT score and key laboratory markers.

Hepatocellular Carcinoma and the Role of Liver Transplantation: An Update and Review

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Multiple treatment modalities are available for the management of HCC, depending on its stage as determined by the Barcelona Clinic Liver Cancer staging system. Because liver transplantation (LT) theoretically removes the cancer and replaces the organ at risk for future malignancy, LT is often considered the most definitive and one of the most efficacious treatment options for HCC. Nevertheless, the success and efficacy of liver transplantation depend on various tumor characteristics. As a result, multiple criteria have been developed to assess the appropriateness of a case of HCC for LT, with the pioneering Milan Criteria established in 1996. Over the past 20 to 30 years, these criteria have been critically evaluated, expanded, and often liberalized to make LT for patients with HCC a more universally applicable option. Furthermore, the development of other treatment modalities has enabled downstaging and bridging strategies for HCC prior to LT. In this narrative and comprehensive review, we provided an update on recent trends in the epidemiology of HCC, selection criteria for LT, implementation of LT across different regions, treatment modalities available as bridges, downstaging strategies, alternatives to LT, and, finally, post-LT surveillance.

Global burden of blindness and vision loss among children and adolescents: A systematic analysis for the global burden of disease study 2021

AIM

This study investigates the global burden of vision impairment caused by refraction disorders, near vision loss, and other vision loss among children and adolescents from 1990 to 2021. The analysis is categorized globally by sex, age, and socio-demographic index (SDI), with a focus on predicting trends to 2035.

METHODS

Data weas obtained from the Global Burden of Disease Study 2021. We reported the prevalence and disability-adjusted life-years (DALYs) of vision impairment due to refraction disorders, near vision loss, and other vision loss globally. Then, we described the prevalence and DALYs numbers and rates by sex, SDI and age. Next, we analyzed the relationship between rate and SDI. Finally, bayesian age-period-cohort (BAPC) analysis model was used to predict the trends from 2022 to 2035 globally by sex and age.

RESULTS

The prevalence and DALYs rates for refraction disorders had a statistically significant trend of reduction in four age groups globally and were positively associated with SDI. The prevalence and DALYs rates for near vision loss were increasing in four age groups, and were negatively associated with SDI. The BAPC model indicates that the age-specific prevalence and DALYs rates of refraction disorders and other vision loss in both men and women will remain on a downward trend until 2035, while near vision loss continues to rise.

CONCLUSIONS

The findings underscore that there are extensive variations based on the type of vision impairment, age group, sex and SDI. Policies should be tailored to specific types in order to effectively alleviate the burden.

Interleukin-15 gene polymorphism in children with celiac disease: a single-center experience

The purpose of this study is to evaluate the demographics, clinical presentation, laboratory findings, and gastrointestinal endoscopic findings in children with CD and assess their relationship with interleukin-15 (IL-15) single-nucleotide polymorphism (SNP) (rs2857261) and serum IL-15 levels. This case-control and prospective cohort study included 54 newly diagnosed pediatric CD patients attending the Gastroenterology Clinic at Alexandria University Children's Hospital and 44 age- and sex-matched healthy controls. Demographics, clinical data, laboratory tests, Marsh classification, and IL-15 SNP (rs2857261) genotypes were analyzed. Follow-up after 9 months on a gluten-free diet (GFD) was conducted. The mean age of patients and controls was 8.62 ± 4.4 and 8.07 ± 4.7 years, respectively, with no significant difference (p = 0.55). Male representation was 48.1% in patients and 47.7% in controls (p = 0.97). The most common presenting symptoms in CD patients were abdominal distension (61.11%) and failure to thrive (59.26%). Laboratory findings showed that mean anti-tissue transglutaminase immunoglobulin A was 103 ± 168 U/ml, and anti-endomysium immunoglobulin A was positive in 51.85% of patients. Histopathological assessment revealed Marsh 3C as the most common finding (37%), while 37% of patients were diagnosed without biopsy. IL-15 SNP (rs2857261) analysis showed a significantly higher prevalence of the A/A genotype in CD patients compared to controls (p < 0.0001). The A/G and G/G genotypes were protective against CD, with odds ratios of 0.088 and 0.079, respectively. No significant associations were observed between IL-15 genotypes and clinical, laboratory, or histological variables. After 6 to 9 months on a GFD, genotype did not significantly influence symptom resolution (p > 0.05).

CONCLUSIONS

Serum IL-15 levels are elevated in newly diagnosed pediatric CD patients. The IL-15 SNP (rs2857261) A/A genotype is associated with increased susceptibility to CD, while the A/G and G/G genotypes appear protective. These findings highlight IL-15 as a potential biomarker and therapeutic target in CD. Further large-scale studies are warranted to validate these findings and explore therapeutic applications.

WHAT IS KNOWN

• Celiac disease is an immune-mediated enteropathy linked to HLA-DQ2/DQ8 alleles, with IL-15 playing a key role in its pathogenesis. • Variability in IL-15 genetic polymorphisms has been suggested but remains underexplored in pediatric populations.

WHAT IS NEW

• This study identifies the IL-15 SNP (rs2857261) A/A genotype as a risk factor for CD, while A/G and G/G genotypes are protective. • Elevated serum IL-15 levels in newly diagnosed patients highlight its potential as a biomarker and therapeutic target.

Long Non-Coding TP73-AS1: A Potential Biomarker and Therapeutic Target in Cancer

Tumor protein 73 antisense RNA 1 (TP73-AS1), a newly discovered long non-coding RNA (lncRNA), the dysregulated expression of which is closely related to the occurrence, drug resistance, and prognosis of various cancers. Exploring the regulatory mechanism of TP73-AS1 provides a new research direction for cancer diagnosis and treatment. On this basis, we briefly review the molecular structural and dual regulatory roles of TP73-AS1 in cancer. In addition, we outline its three molecular mechanisms in cancer: binding to proteins, regulating signaling pathways, and serving as molecular sponges. Subsequently, we introduce the role of TP73-AS1 in common malignant tumors such as gastric cancer (GC), lung cancer, colorectal cancer (CRC), etc. Last, emphasis is given to the potential clinical value of TP73-AS1, especially as single nucleotide polymorphisms of this lncRNA are associated with the risk of GC and CRC. Therefore, this review highlights the significance of TP73-AS1 as a novel biomarker and therapeutic target.

Optimizing prediction of metastasis among colorectal cancer patients using machine learning technology

BACKGROUND AND AIM

Colorectal cancer is among the most prevalent and deadliest cancers. Early prediction of metastasis in patients with colorectal cancer is crucial in preventing it from the advanced stages and enhancing the prognosis among these patients. So far, previous studies have been conducted to predict metastasis in colorectal cancer patients using clinical data. The current research attempts to leverage a combination of demographic, lifestyle, nutritional, and clinical factors, such as diagnostic and therapeutical factors, to construct an ML model with more predictive insights and generalizability than previous ones.

MATERIALS AND METHODS

In this retrospective study, we used 1156 CRC patients referred to the Masoud internal clinic in Tehran City from January 2017 to December 2023. The chosen machine learning algorithms, including LightGBM, XG-Boost, random forest, artificial neural network, support vector machine, decision tree, K-Nearest Neighbor and logistic regression, were utilized to establish prediction models for predicting metastasis among colorectal cancer patients. We also assessed features based on the best-performing model to improve clinical usability. To show the generalizability of the established prediction model for predicting CRC metastasis, we leveraged the data of 115 CRC patients from Imam Khomeini Hospital in Sari City. We assessed the predictive ability of LightGBM as the best-performing model based on external data.

RESULTS

The LightGBM model with a PPV of 97.32%, NPV of 84.67%, sensitivity of 83.14%, specificity of 93.14%, accuracy of 88.14%, F1-score of 87.51%, and an AU-ROC of 0.9 [Formula: see text]0.01 obtained satisfactory performance for prediction purposes on this topic. Factors including the history of IBD, family history of CRC, number of lymph nodes involved, fruit intake, and tumor size were considered as more strengthful predictors for metastasis in colorectal cancer and clinical usability. The external validation cohort showed a PPV of 0.8, NPV of 0.85, sensitivity of 0.78, specificity of 0.86, accuracy of 0.834, F1-score of 0.795, and AU-ROC of 0.77[Formula: see text]0.03, demonstrating satisfactory generalizability when leveraging external data from other clinical settings.

CONCLUSION

The current empirical results indicated that LighGBM has predictive competency that can be leveraged by physicians in clinical environments for early prediction of metastasis and enhanced prognosis in patients with colorectal cancer.

CLINICAL TRIAL NUMBER

Not applicable.

The Pooled Prevalence of Metabolic Syndrome in Morocco Population: A Systematic Review and Meta-Analysis of 32 Studies

The prevalence of metabolic syndrome (MetS) is increasing worldwide. This is becoming a significant public health problem. In Morocco, it is estimated that 94.3% of people aged between 18 and 69 years have at least one risk factor for non-communicable diseases. This systematic review and meta-analysis aimed to measure the overall prevalence of MetS in the Moroccan population. This systematic review included studies published up to March 20, 2024. Data were retrieved from international databases, including EMBASE, Scopus, and MEDLINE/PubMed. Searches were conducted using the keywords "metabolic syndrome," "prevalence," and "Moroccan." The overall prevalence of MetS was calculated using a random-effects model to account for heterogeneity across studies. A total of 32 studies were conducted in Morocco, with a sample of 13 889 participants. The overall prevalence of MetS in the Moroccan population was 34.68%, with 39.66% in women and 30.51% in men. The pooled prevalence in apparently healthy individuals was 29.41%, which increased to 61.84% in patients with type 2 diabetes, 58.81% in patients with general obesity, 47.09% in patients with hypertension, and 28.29% in patients with rheumatoid arthritis. For an average age under 40 years, the pooled prevalence was 25.44%; for an average age between 40 and 50 years, the pooled prevalence was 25.52%; and for an average age of 50 years or more, the prevalence was 43.23%. The results of this study highlight the huge prevalence of MetS in the Moroccan population, with significant variations depending on the subgroups studied, diagnostic criteria used, and age group, highlighting the urgent need to develop and implement effective strategies to tackle this major public health challenge in Morocco.

Assessing COVID-19 Mortality in Serbia's Capital: Model-Based Analysis of Excess Deaths

Background

Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics.

Objective

This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital's population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets.

Methods

Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates.

Results

The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0-19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20-39 years had an estimated increase in mortality of 32.95%. For people aged 60-79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade.

Conclusions

The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible.

Performance of artificial intelligence chatbots in responding to the frequently asked questions of patients regarding dental prostheses

BACKGROUND

Artificial intelligence (AI) chatbots are increasingly used in healthcare to address patient questions by providing personalized responses. Evaluating their performance is essential to ensure their reliability. This study aimed to assess the performance of three AI chatbots in responding to the frequently asked questions (FAQs) of patients regarding dental prostheses.

METHODS

Thirty-one frequently asked questions (FAQs) were collected from accredited organizations' websites and the "People Also Ask" feature of Google, focusing on removable and fixed prosthodontics. Two board-certified prosthodontists evaluated response quality using the modified Global Quality Score (GQS) on a 5-point Likert scale. Inter-examiner agreement was assessed using weighted kappa. Readability was measured using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) indices. Statistical analyses were performed using repeated measures ANOVA and Friedman test, with Bonferroni correction for pairwise comparisons (α = 0.05).

RESULTS

The inter-examiner agreement was good. Among the chatbots, Google Gemini had the highest quality score (4.58 ± 0.50), significantly outperforming Microsoft Copilot (3.87 ± 0.89) (P =.004). Readability analysis showed ChatGPT (10.45 ± 1.26) produced significantly more complex responses compared to Gemini (7.82 ± 1.19) and Copilot (8.38 ± 1.59) (P <.001). FRE scores indicated that ChatGPT's responses were categorized as fairly difficult (53.05 ± 7.16), while Gemini's responses were in plain English (64.94 ± 7.29), with a significant difference between them (P <.001).

CONCLUSIONS

AI chatbots show great potential in answering patient inquiries about dental prostheses. However, improvements are needed to enhance their effectiveness as patient education tools.

N-Acetylcysteine to Reduce Kidney and Liver Injury Associated with Drug-Resistant Tuberculosis Treatment

Background: New drug classes and regimens have shortened the treatment duration for drug-resistant tuberculosis, but adverse events (AEs) and organ toxicity remain unacceptably common. N-acetylcysteine (NAC) has demonstrated potential in reducing kidney and liver toxicity in other clinical settings, but efficacy in drug-resistant tuberculosis treatment has not been rigorously evaluated. Method: A randomized controlled trial was conducted at Kibong'oto Infectious Diseases Hospital in Tanzania to assess the efficacy of NAC in reducing AEs in patients undergoing rifampin-resistant pulmonary tuberculosis treatment. Participants received an all-oral standardized rifampin-resistant regimen alone, with NAC 900 mg daily, or NAC 900 mg twice daily for 6 months. AEs, severe AEs, and renal and liver toxicity were monitored monthly and classified according to the Risk, Injury, Failure, Loss, and End-stage kidney disease criteria and National Cancer Institute Common Terminology Criteria for Adverse Events. Incident ratios and Kaplan-Meier curves were employed to compare group event occurrences. Results: A total of 66 patients (mean age 47 ± 12 years; 80% male) were randomized into three groups of 22. One hundred and fifty-eight AEs were recorded: 52 (33%) in the standard treatment group, 55 (35%) in the NAC 900 mg daily group, and 51 (32%) in the NAC 900 mg twice-daily group (p > 0.99). Severe AEs were observed in four patients in the standard group, two in the NAC 900 mg daily group, and three in the NAC 900 mg twice-daily group. Renal toxicity was more prevalent in the standard treatment group compared to those that received NAC (45% vs. 23%; p = 0.058), with a shorter onset of time to toxicity (χ2 = 3.199; p = 0.074). Liver injury events were rare across all groups. Conclusion: Among Tanzanian adults receiving rifampin-resistant tuberculosis treatment, NAC did not significantly reduce overall AEs but demonstrated important trends in reducing renal toxicity.

Evaluating the validity and consistency of artificial intelligence chatbots in responding to patients' frequently asked questions in prosthodontics

STATEMENT OF PROBLEM

Healthcare-related information provided by artificial intelligence (AI) chatbots may pose challenges such as inaccuracies, lack of empathy, biases, over-reliance, limited scope, and ethical concerns.

PURPOSE

The purpose of this study was to evaluate and compare the validity and consistency of responses to prosthodontics-related frequently asked questions (FAQ) generated by 4 different chatbot systems.

MATERIAL AND METHODS

Four prosthodontics domains were evaluated: implant, fixed prosthodontics, complete denture (CD), and removable partial denture (RPD). Within each domain, 10 questions were prepared by full-time prosthodontic faculty members, and 10 questions were generated by GPT-3.5, representing its top frequently asked questions in each domain. The validity and consistency of responses provided by 4 chatbots: GPT-3.5, GPT-4, Gemini, and Bing were evaluated. The chi-squared test with the Yates correction was used to compare the validity of responses between different chatbots (α=.05). The Cronbach alpha was calculated for 3 sets of responses collected in the morning, afternoon, and evening to evaluate the consistency of the responses.

RESULTS

According to the low threshold validity test, the chatbots' answers to ChatGPT's implant-related, ChatGPT's RPD-related, and prosthodontists' CD-related FAQs were statistically different (P<.001, P<.001, and P=.004, respectively), with Bing being the lowest. At the high threshold validity test, the chatbots' answers to ChatGPT's implant-related and RPD-related FAQs and ChatGPT's and prosthodontists' fixed prosthetics-related and CD-related FAQs were statistically different (P<.001, P<.001, P=.004, P=.002, and P=.003, respectively), with Bing being the lowest. Overall, all 4 chatbots demonstrated lower validity at the high threshold than the low threshold. Bing, Gemini, and ChatGPT-4 chatbots displayed an acceptable level of consistency, while ChatGPT-3.5 did not.

CONCLUSIONS

Currently, AI chatbots show limitations in delivering answers to patients' prosthodontic-related FAQs with high validity and consistency.

Intensive care and inpatient nurse's intention to leave the profession. Association with psychologicosocial variables

INTRODUCTION

The intention to leave the health profession has been studied as one of the consequences of the work and emotional overload experienced by nurses during the pandemic. However, few studies have focused on ICU nurses. The studies on intention to leave the profession focus on working conditions and symptomatology, without analyzing the personal characteristics involved.

OBJECTIVE

To explore the evolution of the intention to leave the profession in ICU nurses (with respect to hospitalization nurses). In addition, to analyse the possible differences in anxiety, burnout and psychosocial variables (self-efficacy, resilience, cognitive fusion) between nurses who intend to quit and those who do not.

METHOD

Observational, descriptive, longitudinal, prospective study with three data collection periods. Non-probabilistic convenience sampling was performed.

RESULTS

Six months after the end of the confinement period in Spain, higher dropout percentages were observed in ICU (49.2%) than in hospitalization (33.3%) (p = .07). One year later, the percentages of intention to leave tend to be equal (50.8% in ICU and 43.9% in hospitalization) (p = .438). With respect to the differential profile of ICU nurses who intend to leave the profession (compared to those who do not), higher scores were observed in anxiety (p = .037), emotional exhaustion (p < .001), decreased personal fulfilment (p = .031) and cognitive fusion (p = .023).

CONCLUSION

A high percentage of ICU nurses show intention to leave the profession, and associations were found with the anxiety experienced at the beginning of the pandemic, with high emotional exhaustion and low personal fulfilment. It is important to highlight in our study the relationship between intention to leave the profession and personal variables such as cognitive fusion.

Hemoperfusion Combined With Continuous Renal Replacement Therapy in the Management of ARDS COVID-19 Patients: A Quasi-Experimental Study

Background and Aims

Critically ill patients in COVID-19 to the intensive care unit (ICU) may develop multiple organ dysfunction syndrome, with some requiring extracorporeal organ support. This study aimed to assess the effects of combined CytoSorb hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the improvement of the multiorgan failure of patients with COVID-19.

Methods

Fifty-six patients hospitalized in the ICU with a confirmed diagnosis of COVID-19 were included in this quasi-experimental study. All the patients had acute respiratory distress syndrome (ARDS). They were treated with 1-4 sessions of HP therapy.

Results

Serum Interleukin-6 (IL6), C-reactive protein (CRP), d-dimer, procalcitonin (PCT), Neutrophil gelatinase-associated lipocalin (NGAL), ferritin, and bilirubin levels were decreased, while the concentration of albumin was significantly increased after HP/CRRT (p < 0.05). No significant differences were observed in O2 saturation (Sao2) and creatinine levels.

Conclusion

Combined HP and CRRT hold promise as a potential intervention for severe COVID-19 cases with multiple organ dysfunction, leading to improved clinical outcomes.

Pon1 and Sult1a1 Polymorphisms and Breast Cancer Among Young Women in Brazil

Purpose: To investigate the association of genetic polymorphisms Gln192Arg and Leu55Met of Paraoxonase 1 (PON1) gene, and Arg213His of Sulfotransferase 1A1 (SUT1A1) gene with occurrence of breast cancer among young women living in Rio de Janeiro city. Methods: This is a hospital-based case-control study including 265 women aged 18-35 years, diagnosed with breast cancer at National Cancer Institute; and 277 controls in the same age group selected among women patients and companions of three general hospitals from Rio de Janeiro public health network. Polymorphisms genotyping was performed using the PCR-RFLP technique. Results: For PON1 gene, breast cancer women had a greater chance of being homozygote for Leu55Met polymorphism (ORadjusted = 1.42, 95% CI= 0.67-3.00, recessive model) and a lower chance of having at least one allele of Gln192Arg polymorphism (ORadjusted = 0.75, 95% CI = 0.50-1.13, dominant model), but without statistical significance. Accordingly, frequency of the haplotype Met55/Arg192 was lower among breast cancer women, but no statistically significant association was observed (ORadjusted = 0.85; 95% CI = 0.48-1.51). SULT1A1 His/His genotype was significantly associated with a protective effect for breast cancer (OR adjusted = 0.51, 95% CI = 0.28-0.91, recessive model). Conclusion: Arg213His polymorphism of SUT1A1 gene showed a protective effect against breast cancer among Brazilian young women. More studies with different designs are needed to understand the role of PON1 and SULT1A1 polymorphisms in breast cancer development in young Brazilian women.

Suicidal Ideation in Patients With Multiple Sclerosis and Its Association With Clinical and Demographic Characteristics

BACKGROUND

Chronic neurological diseases, such as multiple sclerosis (MS) are important risk factors for some psychological disorders, such as depression and consequently suicidal behavior. As suicidal ideation (SI) is one of the important factors in predicting suicide attempts and suicide deaths, the recognition of factors related to the occurrence of SI in patients with MS has high value.

OBJECTIVE

This study aims to assess the association between sociodemographic, psychological, and disease characteristics with SI in patients with MS.

METHODS

A sample of 400 subjects with MS was selected from a referral outpatient MS clinic in Tehran, Iran (2024). Participants completed a personal information questionnaire, the patient health questionnaire-9 (PHQ-9), the hospital anxiety and depression scale (HADS), and the beck scale for suicidal ideation (BSSI). Logistic regression models (univariate and multivariate) were conducted to determine the association between each variable and SI using odds ratio (OR) and 95% confidence interval (CI). Finally, the correlation between depression, anxiety, and the SI scale was measured by bivariate Pearson correlation analyses.

RESULTS

The sample consisted of 77% women, and the mean age was 36.91 years. Among them, 149 (37.2%) of cases were identified with suicidal ideation at some period in life. Findings in the multivariate regression model represented that an increase in age had a significant protective effect on SI (adjusted OR [AOR] 0.95, 95% CI 0.92 to 0.98, p = 0.003). Moreover, the history of previous suicide attempts doubled the odds of SI (AOR 2.18, 95% CI 1.05 to 4.54, P = 0.038). Finally, both depression score (measured by PHQ-9) and anxiety score (measured by HADS) had significant associations with SI.

CONCLUSION

People with MS are highly prone to suicidal thoughts and even suicide attempts; this should not be ignored in routine clinical visits due to other physical complaints. They need to be discussed with patients, and effective psychiatric interventions should be applied to reduce the risks.

Investigating the effect of rAzurin loaded mesoporous silica nanoparticles enwrapped with chitosan-folic acid on breast tumor regression in BALB/C mice

This study aimed to examine how mesoporous silica nanoparticles-chitosan-folic acid impacted the release of recombinant Azurin within the tumor environment. The goal was to trigger apoptosis and stimulate immune responses against both transformed and normal cells in BALB/c mice. The study found that the use of rAzu-MSNs-CS-FA, a specific formulation containing mesoporous silica nanoparticles-chitosan-folic acid, resulted in pH-responsive behavior and slower release of rAzurin compared to other groups. This formulation inhibited MCF7 cells at higher concentrations, induced apoptosis in cells, and caused DNA degradation. It also increased the uptake efficiency of rAzurin and stimulated the secretion of TNF-α, INF-γ, and IL-4 while inhibiting the secretion of IL-6. Furthermore, it regulated the expression of specific genes (upregulating tlr3 and downregulating tlr2, 4, and 9). In animal studies with BALB/c mice, the rAzu-MSNs-CS-FA formulation led to tumor regression and decreased tumor volume over 21 days. Overall, this formulation showed promising results in inducing cytotoxic effects against cancer cells, promoting apoptosis, and eliciting appropriate immune responses, suggesting its potential as a valuable therapy for breast cancer.

Accuracy and Consistency of Gemini Responses Regarding the Management of Traumatized Permanent Teeth

BACKGROUND

The aim of this cross-sectional observational analytical study was to assess the accuracy and consistency of responses provided by Google Gemini (GG), a free-access high-performance multimodal large language model, to questions related to the European Society of Endodontology position statement on the management of traumatized permanent teeth (MTPT).

MATERIALS AND METHODS

Three academic endodontists developed a set of 99 yes/no questions covering all areas of the MTPT. Nine general dentists and 22 endodontic specialists evaluated these questions for clarity and comprehension through an iterative process. Two academic dental trauma experts categorized the knowledge required to answer each question into three levels. The three academic endodontists submitted the 99 questions to the GG, resulting in 297 responses, which were then assessed for accuracy and consistency. Accuracy was evaluated using the Wald binomial method, while the consistency of GG responses was assessed using the kappa-Fleiss coefficient with a confidence interval of 95%. A 5% significance level chi-squared test was used to evaluate the influence of question level of knowledge on accuracy and consistency.

RESULTS

The responses generated by Gemini showed an overall moderate accuracy of 80.81%, with no significant differences found between the responses of the academic endodontists. Overall, high consistency (95.96%) was demonstrated, with no significant differences between GG responses across the three accounts. The analysis also revealed no correlation between question level of knowledge and accuracy or consistency, with no significant differences.

CONCLUSIONS

The results of this study could significantly impact the potential use of Gemini as a free-access source of information for clinicians in the MTPT.

Evaluation of validity and reliability of AI Chatbots as public sources of information on dental trauma

AIM

This study aimed to assess the validity and reliability of AI chatbots, including Bing, ChatGPT 3.5, Google Gemini, and Claude AI, in addressing frequently asked questions (FAQs) related to dental trauma.

METHODOLOGY

A set of 30 FAQs was initially formulated by collecting responses from four AI chatbots. A panel comprising expert endodontists and maxillofacial surgeons then refined these to a final selection of 20 questions. Each question was entered into each chatbot three times, generating a total of 240 responses. These responses were evaluated using the Global Quality Score (GQS) on a 5-point Likert scale (5: strongly agree; 4: agree; 3: neutral; 2: disagree; 1: strongly disagree). Any disagreements in scoring were resolved through evidence-based discussions. The validity of the responses was determined by categorizing them as valid or invalid based on two thresholds: a low threshold (scores of ≥ 4 for all three responses) and a high threshold (scores of 5 for all three responses). A chi-squared test was used to compare the validity of the responses between the chatbots. Cronbach's alpha was calculated to assess the reliability by evaluating the consistency of repeated responses from each chatbot.

CONCLUSION

The results indicate that the Claude AI chatbot demonstrated superior validity and reliability compared to ChatGPT and Google Gemini, whereas Bing was found to be less reliable. These findings underscore the need for authorities to establish strict guidelines to ensure the accuracy of medical information provided by AI chatbots.

The effect of the intensive care unit nurse manpower on care behaviours and stress level on the nurses

BACKGROUND

Nurses working in the intensive care units (ICU) regarding the work-index-nursing work environment, the effect level ICU environment has on the nurses' care behaviors and stress levels of the nurses should be determined.

OBJECTIVE

The study aimed to investigate the effect of the nurse manpower on care behaviours and stress level of the nurses working in the ICU.

METHODS

This was a cross-sectional and correlational study. The sample of the study consisted of 123 nurses working in the ICUs. The data were collected using the survey form, Distress Thermometer (DT), The Practice Work Environment Scale of the Nursing Work Index (PES-NWI), and Caring Behaviors Scale-24 (CBS-24).

RESULTS

The mean age of nurses in the ICU was 30.2±5.6 and the mean of working time in the intensive care unit of nurses in the ICU was 3.7 ± 3.1 years. The mean of the DT was 4.8 ± 3.4, and the mean score of PES-NWI was 2.6 ± 1.0 and the mean score of CBS-24 was 4.7 ± 1.1 in nurses in the ICU. The regression model which was studied to investigate the relationship between caring behaviors and stress and nurse manpower of nurses working in intensive care unit was significant.

CONCLUSION

Care behaviors and stress levels of nurses working in intensive care units are negatively affected by insufficient nurse manpower.

Molecular Characterization and Analysis of Human Trichostrongylus Species in an Endemic Region of Iran Based on COX 1 Gene; A Cross-Sectional Study

Background and Aims

Trichostrongylus species are the causative agents of zoonotic disease, which has been frequently reported from animals in Iran. The aim of this study was to identify, molecular characterization and analysis of Trichostrongylus species isolated from humans, in an endemic region, based on cytochrome c oxidase (COX) 1.

Methods

A total of 206 fresh stool samples were collected from residents of endemic villages of sampling area. All samples had been examined using conventional parasitological methods, along with the PCR technique. After amplification and sequencing of a discriminative region of COX1 gene, the phylogeny relationship, haplotype network, and molecular diversity between Trichostrongylus spp., were scrutinized using PopART networking, DnaSP v.6, and MEGA10 software.

Results

In total, from 206 fecal samples, 71 people (34.4%) were infected with Trichostrongylus spp. The ~700-bp fragment of the COX1 was amplified in all 71 morphological positive samples, however, 33 samples were successfully sequenced, belonging to Trichostrongylus spp. In this study, T. colubriformis was the predominant species and one sequence was characterized as T. vitrinus. Our sequences were grouped together with sequences, which were obtained from animals in the same region (97.17% similarity). In total, 26 haplotypes were identified and haplotype diversity ranged from 0.988 ± 0.012.

Conclusions

In view of the importance of Trichostrongylosis to public health as zoonotic infection, information about its prevalence in animal and human populations can provide valuable information on how different types of this parasite are transmitted between people and animal's host.

Developing the Short-Form of Lymphedema Needs Questionnaire for Iranian Breast Cancer Patients

PURPOSE

The informational needs of patients with Breast Cancer-Related Lymphedema (BCRL) have not been sufficiently addressed in the scientific literature. Moreover, the only existing questionnaire in this field contains many items. Therefore, the purpose of this study is to develop a short-form version of this questionnaire.

METHODS

The questionnaire items were extracted from the Lymphoedema Needs Questionnaire-Breast Cancer (LNQ-BC). Demographic variables and clinical characteristics were considered separately. Out of 62 items, 24 were selected, and 2 additional questions were included based on feedback from 10 experts. 100 participants with BCRL completed the short-form questionnaire. Exploratory Factor Analysis (EFA) was performed using principal components extraction and varimax rotation, and Cronbach's alpha was calculated for each dimension.

RESULTS

After evaluating the content validity, the instrument's construct validity with 26 items was conducted using EFA. The KMO (Kaiser-Meyer-Olkin) value was equal to 0.879 and Bartlett's sphericity test was significant (p-value < 0.001), indicating the data's adequacy and appropriateness to perform EFA. Five extracted dimensions were named: "Lymphedema information needs" (5 items), "Informational support, peers" (5 items), "Access to a lymphedema care specialist" (5 items), "Physical and daily activities" (7 items) and "Financial issues and compression garments" (4 items). The level of needs in this study in all dimensions was high (more than 77%).

CONCLUSIONS

The high factor loadings and the total explained variance of 78.152% support the construct validity of the short questionnaire. Although some items exhibited cross-loadings, the majority loaded strongly on a single factor, indicating good discriminant validity. Providing services according to the needs of patients can be prioritized. Healthcare providers, insurers, and individuals should be better informed about lymphedema, its associated costs, and the importance of implementing appropriate management programs.

Competing and Noncompeting Risk Models for Predicting Kidney Allograft Failure

Background

Prognostic models are becoming increasingly relevant in clinical trials as potential surrogate end points and for patient management as clinical decision support tools. However, the effect of competing risks on model performance remains poorly investigated. We aimed to carefully assess the performance of competing risk and noncompeting risk models in the context of kidney transplantation, where allograft failure and death with a functioning graft are two competing outcomes.

Methods

We included 11,046 kidney transplant recipients enrolled in ten countries. We developed prediction models for long-term kidney graft failure prediction, without accounting (i.e., censoring) and accounting for the competing risk of death with a functioning graft, using Cox, Fine–Gray, and cause-specific Cox regression models. To this aim, we followed a detailed and transparent analytical framework for competing and noncompeting risk modeling and carefully assessed the models' development, stability, discrimination, calibration, overall fit, clinical utility, and generalizability in external validation cohorts and subpopulations. More than 15 metrics were used to provide an exhaustive assessment of model performance.

Results

Among 11,046 recipients in the derivation and validation cohorts, 1497 (14%) lost their graft and 1003 (9%) died with a functioning graft after a median follow-up postrisk evaluation of 4.7 years (interquartile range, 2.7–7.0). The cumulative incidence of graft loss was similarly estimated by Kaplan–Meier and Aalen–Johansen methods (17% versus 16% in the derivation cohort). Cox and competing risk models showed similar and stable risk estimates for predicting long-term graft failure (average mean absolute prediction error of 0.0140, 0.0138, and 0.0135 for Cox, Fine–Gray, and cause-specific Cox models, respectively). Discrimination and overall fit were comparable in the validation cohorts, with concordance index ranging from 0.76 to 0.87. Across various subpopulations and clinical scenarios, the models performed well and similarly, although in some high-risk groups (such as donors older than 65 years), the findings suggest a trend toward moderately improved calibration when using a competing risk approach.

Conclusions

Competing and noncompeting risk models performed similarly in predicting long-term kidney graft failure.

MCT4 is an independent prognostic factor and affects immune cell infiltration in patients with colorectal liver oligometastases

BACKGROUND

Monocarboxylate transporter 4 (MCT4) is a novel biomarker related to the level of immune cell infiltration, but its impact on tumor immune microenvironment (TIME) of colorectal liver oligometastases (CLO) remains unclear. The aim of this study was to assess MCT4 expression in primary tumor and liver oligometastases, investigate its impact on immune cell infiltration and its prognostic value for CLO patients undergoing liver resection.

METHODS

We retrospectively selected 135 CLO patients who underwent curative liver resection between June 1999 and December 2016, and samples included 74 primary tumor tissues and 122 liver metastases. Immunohistochemistry (IHC) was performed to detect MCT4 expression in paraffin-embedded specimens and tyramine signal amplification (TSA) was used to detect the density of tumor-infiltrating lymphocytes, including CD3 + , CD8 + and Foxp3 + . Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and log-rank test, and independent prognostic factors were identified with Cox regression modeling.

RESULTS

Survival analysis indicated that CLO patients with low MCT4 expression had better 3-year RFS and 3-year OS rates than those with high MCT4 expression. Multivariate analysis indicated that high MCT4 expression was independently associated with poor RFS and OS. High MCT4 expression was associated with a lower number of intratumoral CD3 + /CD8 + T cells and was associated with higher Foxp3 + T cells infiltration. Patients with low MCT4 expression and high levels of differential immune infiltration had longer survival.

CONCLUSIONS

MCT4 overexpression was associated with an unfavorable prognosis in patients with CLO and MCT4 expression level had an impact on intratumoral immune infiltration degree. A novel parameter that combined MCT4 expression level and differential immune infiltration level was constructed to stratify patients with CLO into different risk groups.

Exploring the potential of large language models in identifying metabolic dysfunction-associated steatotic liver disease: A comparative study of non-invasive tests and artificial intelligence-generated responses

BACKGROUND AND AIMS

This study sought to assess the capabilities of large language models (LLMs) in identifying clinically significant metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

We included individuals from NHANES 2017-2018. The validity and reliability of MASLD diagnosis by GPT-3.5 and GPT-4 were quantitatively examined and compared with those of the Fatty Liver Index (FLI) and United States FLI (USFLI). A receiver operating characteristic curve was conducted to assess the accuracy of MASLD diagnosis via different scoring systems. Additionally, GPT-4V's potential in clinical diagnosis using ultrasound images from MASLD patients was evaluated to provide assessments of LLM capabilities in both textual and visual data interpretation.

RESULTS

GPT-4 demonstrated comparable performance in MASLD diagnosis to FLI and USFLI with the AUROC values of .831 (95% CI .796-.867), .817 (95% CI .797-.837) and .827 (95% CI .807-.848), respectively. GPT-4 exhibited a trend of enhanced accuracy, clinical relevance and efficiency compared to GPT-3.5 based on clinician evaluation. Additionally, Pearson's r values between GPT-4 and FLI, as well as USFLI, were .718 and .695, respectively, indicating robust and moderate correlations. Moreover, GPT-4V showed potential in understanding characteristics from hepatic ultrasound imaging but exhibited limited interpretive accuracy in diagnosing MASLD compared to skilled radiologists.

CONCLUSIONS

GPT-4 achieved performance comparable to traditional risk scores in diagnosing MASLD and exhibited improved convenience, versatility and the capacity to offer user-friendly outputs. The integration of GPT-4V highlights the capacities of LLMs in handling both textual and visual medical data, reinforcing their expansive utility in healthcare practice.

Prognostication and integration of bedside lung ultrasound and computed tomography imaging findings with clinical features to Predict COVID-19 In-hospital mortality and ICU admission

INTRODUCTION

Bedside lung ultrasound (LUS) and computed tomography (CT) imaging are valuable modalities in screening and diagnosis of pulmonary diseases. This study aims to investigate the prognostic value of integrating LUS and CT imaging findings with clinical features to predict poor outcomes upon ER admission in COVID-19.

METHODS

Patients visiting the study center with clinical presentation and laboratory findings compatible with COVID-19 between April 2020 to January 2022 were considered for this study. Several imaging findings (ground glass opacity, consolidation, atelectatic bands, mosaic attenuation, ARDS pattern, crazy paving, pleural thickening in CT and A-line, comet-tail artifact, confluent B-Line in BLUS, pleural thickening and Consolidation in both modalities) were evaluated, alongside clinical assessments upon admission, to assess their prognostic value. The top radiological, LUS findings, and clinical signs were integrated in a nomogram for predicting mortality.

RESULTS

A total of 1230 patients were included in the analyses. Among the findings, consolidation in BLUS and CT imaging, and absence of A-lines were associated with mortality. In addition to these findings, ground-glass opacities, atelectatic band, mosaic attenuation, crazy paving, and confluent B-line were also associated with ICU hospitalization. Although, the prognostic value of individual markers was poor and comparable (AUC < 0.65), the combined use of top clinical and imaging findings in the associated nomogram led to a high accuracy in predicting mortality (Area under curve: 87.3%).

CONCLUSIONS

BLUS and CT imaging findings alone provide limited utility in stratifying patients for higher mortality and ICU admission risk and should not be used for risk stratification alone outside the context of each patient and their clinical presentations in suspected COVID-19 patients.

Artificial intelligence chatbots in endodontic education-Concepts and potential applications

The integration of artificial intelligence (AI) into education is transforming learning across various domains, including dentistry. Endodontic education can significantly benefit from AI chatbots; however, knowledge gaps regarding their potential and limitations hinder their effective utilization. This narrative review aims to: (A) explain the core functionalities of AI chatbots, including their reliance on natural language processing (NLP), machine learning (ML), and deep learning (DL); (B) explore their applications in endodontic education for personalized learning, interactive training, and clinical decision support; (C) discuss the challenges posed by technical limitations, ethical considerations, and the potential for misinformation. The review highlights that AI chatbots provide learners with immediate access to knowledge, personalized educational experiences, and tools for developing clinical reasoning through case-based learning. Educators benefit from streamlined curriculum development, automated assessment creation, and evidence-based resource integration. Despite these advantages, concerns such as chatbot hallucinations, algorithmic biases, potential for plagiarism, and the spread of misinformation require careful consideration. Analysis of current research reveals limited endodontic-specific studies, emphasizing the need for tailored chatbot solutions validated for accuracy and relevance. Successful integration will require collaborative efforts among educators, developers, and professional organizations to address challenges, ensure ethical use, and establish evaluation frameworks.

Investigation of Some Long Noncoding RNAs (LncRNAs) in Pediatric Inflammatory Bowel Disease (IBD): An Iranian Study

Introduction: According to the importance of long noncoding RNAs (LncRNA) in the pathogenesis of inflammatory bowel disease (IBD) and also the lack of study for pediatric IBD in this regard, we investigated the expression of a selected panel of LncRNAs in Iranian pediatric cases of IBD compared to adult cases and healthy samples. Methods: In this gene expression study, blood samples were taken from the three groups of pediatric IBD cases, adult IBD cases, and pediatric healthy samples (for gene expression calibration). The investigated LncRNAs were UCA1, CCAT, IFNG-AS1, and CDKN2B. Real-time PCR was used and fold changes (FCs) were reported. Results: A total of 50 individuals were studied including 28 cases of pediatric IBD, 12 cases of controls, and 10 cases of adult IBD. UCA1 showed upregulation in adult IBD (FC = 10.56, p = 0.007). CCAT showed downregulations for pediatric IBD (FC = 0.01, p < 0.001) and adult IBD (FC = 0.10, p = 0.039). IFNG-AS1 showed downregulation in pediatric IBD (FC < 0.01, p < 0.001). CDKN2B showed upregulation in pediatric IBD (FC = 17.39, p < 0.001). The results were in contrast with the literature. Conclusion: It seems that these LncRNAs may have different roles in pediatric IBD. Further studies are needed on pediatric cases of IBD.

The influence of face masks use, immunity boosters and visiting risky places on mental health during the COVID-19 pandemic in Serbia and Republic of Srpska (Bosnia and Herzegovina)

BACKGROUND

Because of the COVID-19 pandemic, people were recommended to implement new health behaviors into their daily routines to prevent the viral spread. The aim of this study was to investigate whether specific health behaviors, such as wearing face masks, taking immunity boosters and visiting risky places were associated with a higher level of stress due to COVID-19 in the general adult population.

METHOD

This cross-sectional study was conducted from September 1, 2020 to October 1, 2021 in eight randomly chosen cities of two Serbian speaking countries (Republic of Serbia and Republic of Srpska - Bosnia and Herzegovina). Participants filled a socio-epidemiologic questionnaire, COVID Stress Scales (CSS) and the Perceived Stress Scale (PSS).

RESULTS

The study included 2,301 participants with an average age of 36.72 ± 13.82 years of whom 54.9% were female (p = 0.001). Most participants were healthy, highly educated, employed, married, non-smokers and consumed alcohol. The mean total CSS score was 32.7 ± 23.8 out of 144, suggesting a relatively low stress due to COVID-19. The mean PSS was 19.43 ± 5.05 out of 40 indicating slightly increased level of general stress. Participants who reported higher CSS scores were more likely to wear face masks, use immunity boosters, go to cafes and clubs, have chronic illnesses, have suspicious, but not proven contact with COVID-19 positive people, and use multiple sources of information about COVID-19.

CONCLUSION

Few participants experienced high levels of stress due to COVID-19. People who used face masks, immunity boosters and visited risky places reported a higher level of stress during the pandemic.

The Effect of Naturally Acquired Immunity on Mortality Predictors: A Focus on Individuals with New Coronavirus

Background/Objectives: The spread of the COVID-19 pandemic has spurred the development of advanced healthcare tools to effectively manage patient outcomes. This study aims to identify key predictors of mortality in hospitalized patients with some level of natural immunity, but not yet vaccinated, using machine learning techniques. Methods: A total of 363 patients with COVID-19 admitted to Río Hortega University Hospital in Spain between the second and fourth waves of the pandemic were included in this study. Key characteristics related to both the patient's previous status and hospital stay were screened using the Random Forest (RF) machine learning technique. Results: Of the 19 variables identified as having the greatest influence on predicting mortality, the most powerful ones could be identified at the time of hospital admission. These included the assessment of severity in community-acquired pneumonia (CURB-65) scale, age, the Glasgow Coma Scale (GCS), and comorbidities, as well as laboratory results. Some variables associated with hospitalization and intensive care unit (ICU) admission (acute renal failure, shock, PRONO sessions and the Acute Physiology and Chronic Health Evaluation [APACHE-II] scale) showed a certain degree of significance. The Random Forest (RF) method showed high accuracy, with a precision of >95%. Conclusions: This study shows that natural immunity generates significant changes in the evolution of the disease. As has been shown, machine learning models are an effective tool to improve personalized patient care in different periods.

Zatariamultiflora hydroalcoholic extract: A triple-blind randomized controlled trial on immune genes, inflammation, and ulcerative colitis symptoms

ETHNOPHARMACOLOGICAL RELEVANCE

Zataria multiflora Boiss. (Shirazi thyme) is traditionally used for digestive disorders and inflammatory conditions. Despite its known anti-inflammatory, immunomodulatory, and antioxidant properties, there is limited clinical evidence on its efficacy for ulcerative colitis (UC).

AIM OF THE STUDY

To evaluate the effectiveness of Zataria multiflora Boiss. (Z. multiflora) extract in alleviating UC symptoms, reducing inflammatory markers, and modulating immune-related gene expression.

MATERIALS AND METHODS

In a multicenter, randomized, placebo-controlled, triple-blind trial in Iran, 92 participants received Z. multiflora extract (6 mg/kg/day) or a placebo for two months. Inflammatory markers and gene expression were analyzed from blood samples. Disease activity was assessed using the Partial Mayo Score (p-Mayo) and the Gastrointestinal Symptom Rating Scale (GSRS). Data were analyzed with SPSS software.

RESULTS

The Z. multiflora group showed significant reductions in C-reactive protein (CRP) (p < 0.001), Interleukin-17 (IL-17) (p = 0.001), Interferon-gamma (IFN-γ) (p = 0.002), Nuclear Factor kappa B (NF-κB) (p = 0.002), T-box Transcription Factor T-bet (T-bet) (p = 0.006), and Retinoic Acid-Related Orphan Receptor gamma t (ROR-γt) (p < 0.001). No significant changes were observed in Erythrocyte Sedimentation Rate (ESR) (p = 0.25), GATA Binding Protein 3 (GATA3) (p = 0.09), and Forkhead Box P3 (FOXP3) (p = 0.17). Symptoms such as heartburn, acid reflux, bloating, diarrhea, and fecal urgency improved (p < 0.05). The GSRS score improved (p < 0.001), while the p-Mayo score did not show a significant change (p = 0.24).

CONCLUSION

Z. multiflora extract significantly alleviated UC symptoms and reduced inflammatory markers, indicating its potential as a complementary treatment for UC. However, the study was limited by its short intervention period and the absence of biopsy analysis to assess local tissue effects. Further longitudinal studies are required to validate these findings and determine long-term efficacy.

Effectiveness of various general large language models in clinical consensus and case analysis in dental implantology: a comparative study

BACKGROUND

This study evaluates and compares ChatGPT-4.0, Gemini Pro 1.5(0801), Claude 3 Opus, and Qwen 2.0 72B in answering dental implant questions. The aim is to help doctors in underserved areas choose the best LLMs(Large Language Model) for their procedures, improving dental care accessibility and clinical decision-making.

METHODS

Two dental implant specialists with over twenty years of clinical experience evaluated the models. Questions were categorized into simple true/false, complex short-answer, and real-life case analyses. Performance was measured using precision, recall, and Bayesian inference-based evaluation metrics.

RESULTS

ChatGPT-4 exhibited the most stable and consistent performance on both simple and complex questions. Gemini Pro 1.5(0801)performed well on simple questions but was less stable on complex tasks. Qwen 2.0 72B provided high-quality answers for specific cases but showed variability. Claude 3 opus had the lowest performance across various metrics. Statistical analysis indicated significant differences between models in diagnostic performance but not in treatment planning.

CONCLUSIONS

ChatGPT-4 is the most reliable model for handling medical questions, followed by Gemini Pro 1.5(0801). Qwen 2.0 72B shows potential but lacks consistency, and Claude 3 Opus performs poorly overall. Combining multiple models is recommended for comprehensive medical decision-making.

Influence of Sociodemographic Factors on Level Stress and Coping Strategies of Nurses and Midwives Caring for Newborns with Lethal Defects

Introduction: Nurses and midwives caring for newborns with lethal defects experience significant emotional stress. Understanding coping strategies and the factors influencing stress is crucial for improving their well-being and ensuring high-quality care. Objectives: The aim of this study was to identify the coping strategies used by nurses and midwives in stressful situations and to analyse the relationship between stress levels and selected sociodemographic and professional factors. Methods: A cross-sectional study was conducted in the second quarter of 2023 among 307 nurses and midwives working in neonatal and obstetric wards in the Silesian metropolitan area, Poland. A diagnostic survey method was applied using a standardised questionnaire. The Perceived Stress Scale (PSS-10) and the MINI-COPE Inventory were used to assess stress levels and coping mechanisms. A stratified random sampling method was employed to ensure representation from various professional backgrounds. Data analysis was conducted using descriptive statistics, chi-square tests, Spearman's correlation, and Cohen's d coefficient, with statistical significance set at p < 0.05. Results: High stress levels were associated with shorter professional experience, frequent exposure to lethal defects, and emotional discomfort in interactions with grieving families. The most commonly used coping strategies were active coping (M = 2.06, SD = 0.635) and planning (M = 1.95, SD = 0.590), whereas self-blame (M = 1.20, SD = 0.714, p < 0.001) and denial (M = 0.88, SD = 0.751, p < 0.001) were linked to higher stress levels. Positive reinterpretation (r = -0.211, p < 0.001) and seeking emotional support (r = -0.129, p = 0.024) correlated with lower stress levels. Nurses and midwives with secondary education reported higher stress levels compared to those with higher education (χ2(10) = 30.651, p = 0.001). Work experience played a role, with moderate stress levels most frequently observed among those with 2-5 years of professional experience (χ2(14) = 24.023, p = 0.046). Emotional involvement, particularly supporting parents during their farewell to the child (69.1%), was identified as the most stressful aspect of their work. Conclusions: Promoting adaptive coping strategies, such as positive reinterpretation and emotional support, can help reduce stress and improve the well-being of nurses and midwives. Implementing psychological support programmes and stress management training is essential for maintaining high-quality neonatal care.

Prognostic value of C-reactive protein levels in pulmonary infections: A systematic review and meta-analysis

BACKGROUND

C-reactive rotein (CRP) has been extensively studied as a biomarker that can predict mortality in patients with acute lung disease and our study aimed to elucidate the prognostic value of CRP levels for mortality in patients with various airway diseases, accounting for these differences and potential confounding factors accounts.

METHODS

An extensive literature search was conducted in several databases including PubMed, Embase, Web of Science, Scopus, and ProQuest to ensure the inclusion of up-to-date evidence from studies published between January 2019 and December 2024. Both fixed-effects and random-effects models were used to calculate pooled mean hazard ratios (HR) and odds ratios (OR) for mortality.

RESULTS

For mortality, the fixed effects model revealed a HR of 1.0065 (95% CI: 1.0054-1.0075, P < .0001), indicating a slightly increased risk of death associated with higher CRP levels. However, the random effects model, considering study heterogeneity, suggested an HR of 1.0488 (95% CI: 0.9978-1.1024, P = .0608), with significant heterogeneity (Q = 135.31, P < .0001). The OR analysis under the random effects model showed a more substantial increase in mortality risk with an OR of 1.2033 (95% CI: 1.0635-1.3614, P = .0033). Regarding ICU admissions and ventilation needs, substantial heterogeneity was also observed. The analysis did not find a statistically significant association between elevated CRP levels and ICU admission (OR = 1.1108, 95% CI: 0.9604-1.2847, P = .1568) or the necessity for ventilation (OR = 1.8981, 95% CI: 0.9651-3.7331, P = .0633), although both indicated trends towards increased risk.

CONCLUSION

CRP levels show a potential yet inconsistent association with mortality risk in patients with pulmonary infections. While elevated CRP levels suggest an increased risk of mortality, the results should be interpreted cautiously due to potential overestimation of the effect and the presence of publication bias.

Evaluation of a Retrieval-Augmented Generation-Powered Chatbot for Pre-CT Informed Consent: a Prospective Comparative Study

This study aims to investigate the feasibility, usability, and effectiveness of a Retrieval-Augmented Generation (RAG)-powered Patient Information Assistant (PIA) chatbot for pre-CT information counseling compared to the standard physician consultation and informed consent process. This prospective comparative study included 86 patients scheduled for CT imaging between November and December 2024. Patients were randomly assigned to either the PIA group (n = 43), who received pre-CT information via the PIA chat app, or the control group (n = 43), with standard doctor-led consultation. Patient satisfaction, information clarity and comprehension, and concerns were assessed using six ten-point Likert-scale questions after information counseling with PIA or the doctor's consultation. Additionally, consultation duration was measured, and PIA group patients were asked about their preference for pre-CT consultation, while two radiologists rated each PIA chat in five categories. Both groups reported similarly high ratings for information clarity (PIA: 8.64 ± 1.69; control: 8.86 ± 1.28; p = 0.82) and overall comprehension (PIA: 8.81 ± 1.40; control: 8.93 ± 1.61; p = 0.35). However, the doctor consultation group showed greater effectiveness in alleviating patient concerns (8.30 ± 2.63 versus 6.46 ± 3.29; p = 0.003). The PIA group demonstrated significantly shorter subsequent consultation times (median: 120 s [interquartile range (IQR): 100-140] versus 195 s [IQR: 170-220]; p = 0.04). Both radiologists rated overall quality, scientific and clinical evidence, clinical usefulness and relevance, consistency, and up-to-dateness of PIA high. The RAG-powered PIA effectively provided pre-CT information while significantly reducing physician consultation time. While both methods achieved comparable patient satisfaction and comprehension, physicians were more effective at addressing worries or concerns regarding the examination.

The role of social determinants of health in woman's intention to pregnancy: a model with the mediation of social support

BACKGROUND

Childbearing intention is a complex issue that is influenced by a number of factor. However, childbearing intention does not necessarily lead to actual behavior, and mediating factors are effective in the realization and emergence of reproductive behavior. Since childbearing intention is influenced by several factors, including the social determinants of health, a thorough understanding of the effect of health determinants on this intention will help the reproductive process. Therefore, the present study was conducted using a social support-mediated model to examine the role of social determinants of health in women's intention to pregnant.

METHODS

This cross-sectional study was conducted on 500 married women of reproductive age (age range 15-49 years old) who were referred to health centers affiliated with Shahid Beheshti University of Medical Sciences during 2022-2023. Sampling was performed in a multi-stage (class-cluster) manner. Data collection tools in this study included the Demographic Information Form, the Childbearing Intention Questionnaire, social determinants of health questionnaires such as the Ghodratnama Socio-Economic Status Questionnaire, the Perceived Social Support Questionnaire, and the Depression Anxiety Stress Scales (DASS-21), and the Dyadic Adjustment Scale (Spinner questionnaire). Data analysis was performed using SPSS21 software with descriptive statistical tests and analytical statistics. Laserl 8.8 software was also used to test the model using the path analysis statistical test.

RESULTS

The mean scores of depression, anxiety and stress were 5.03 ± 4.39, 4.49 ± 3.68 and 7.7 ± 4.67, respectively. The mean score of marital adjustment was 103.26 ± 23.49, indicating that the majority of women (60.4%) had marital adjustment. Based on the results of the path analysis, marital adjustment was the only variable that had a direct positive and significant causal relationship with the childbearing intention from only one path (B = 0.74). Moreover, based on the results of the path analysis, perceived social support had the most direct and indirect positive causal relationship with the childbearing intention to have children (B = 0.74). Among the components of DASS21, depression was the only variable that had both a direct and indirect negative causal relationship with childbearing (B=-0.12). Both stress and anxiety had a direct positive causal relationship with the childbearing intention (B = 0.11 and B = 0.15 respectively).

CONCLUSION

Factors such as marital adjustment, perceived social support, depression, stress, and anxiety, as structural social determinants of health, are associated with childbearing intention. Accordingly, changes in social structures depend on population planning and policies.

Lactiplantibacillus plantarum Moderating Effect on Autoimmune Celiac Disease Triggers

The only approved preventive treatment option GFD remains insufficient to manage Celiac Disease (CeD). A cohort of probiotic bacteria recently indicated that probiotic bacteria such as L. plantarum (LP) have a protective effect on CeD. LP has been a prominent probiotic, studied for numerous modulating properties. This review highlights and summarizes LP's ameliorating effect on various triggers/drivers of CeD. Probiotic LP potential for CeD is noticeable, mainly involving gut microbiota modulation, gluten digestion, intestinal homeostasis, CeD-associated pathogens reduction, and CD4 + T cell regulation. LP supplementation maintains intestinal physiology by improving the ratio of intestinal villus height to crypt depth. Gut microbiota modulation also improves tight junction proteins and the intestinal barrier. LP increases the digestibility of immunoreactive 33-mer gliadin peptides and regulates immune triggers such as CD4 + T cells. LP supplementation may minimize the gastrointestinal symptoms of CeD. Nevertheless, the therapeutic applicability of LP is subjected to significant clinical and nonclinical studies.

Role of hepatotropic viruses in promoting hepatocellular carcinoma-current knowledge and recent advances

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with chronic infections by hepatotropic viruses such as hepatitis B virus (HBV), and hepatitis C virus (HCV), being major risk factors. Chronic infections with these viruses are the leading cause of HCC worldwide, with HBV alone responsible for over 50% of cases. Despite advances in direct-acting antivirals (DAAs) for HCV and nucleos(t)ide analogues (NAs) for HBV, challenges remain in HCC prevention, early detection, and treatment. Recent research highlights the role of viral-induced metabolic alterations, such as the Warburg effect, mitochondrial dysfunction, and lipid dysregulation, in promoting HCC. Moreover, immune checkpoint inhibitors have emerged as effective treatments for advanced HCC, though responses vary between HBV- and HCV-related cancers. Additionally, novel therapeutic approaches and metabolic-targeted therapies offer promising avenues for virus-associated HCC treatment. Advancements in liquid biopsy biomarkers and artificial intelligence-driven diagnostics are improving HCC surveillance and risk stratification, potentially enabling earlier interventions. While HBV vaccination has significantly reduced HCC incidence, disparities in global vaccination coverage persist. Furthermore, antiviral therapies combined with structured surveillance programs have proven effective in reducing HCC incidence and mortality. This review highlights the complex connection between viral, genetic, and environmental factors in HCC development and underscores the importance of integrated prevention strategies to reduce its burden globally.

New insights on anti-tumor immunity of CD8+ T cells: cancer stem cells, tumor immune microenvironment and immunotherapy

Recent breakthroughs in tumor immunotherapy have confirmed the capacity of the immune system to fight several cancers. The effective means of treating cancer involves accelerating the death of tumor cells and improving patient immunity. Dynamic changes in the tumor immune microenvironment alter the actual effects of anti-tumor drug production and may trigger favorable or unfavorable immune responses by modulating tumor-infiltrating lymphocytes. Notably, CD8+ T cells are one of the primary tumor-infiltrating immune cells that provide anti-tumor response. Tumor cells and tumor stem cells will resist or evade destruction through various mechanisms as CD8+ T cells exert their anti-tumor function. This paper reviews the research on the regulation of tumor development and prognosis by cancer stem cells that directly or indirectly alter the role of tumor-infiltrating CD8+ T cells. We also discuss related immunotherapy strategies.

Impact of neonatal palliative care on neonates, their parents, and nurses: a systematic review

Background

Neonatal palliative care (NPC) is a comprehensive approach that addresses the physical, mental, social, and spiritual well-being of neonates in need of palliative care.

Objective and design

The objective of this systematic review was to examine the impact of NPC on the management of symptoms and conditions in neonates admitted to the neonatal intensive care unit, as well as its effects on their parents and nurses.

Methods

This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases, including Scopus, PubMed, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library, were searched up to July 30, 2024. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool.

Results

A total of 10 studies that met the inclusion criteria were included in the review. The results indicated that the implementation of an NPC program led to an increased use of analgesic drugs, a reduction in invasive therapeutic and diagnostic procedures for newborns, an increase in withdrawal of life support, more do-not-resuscitate orders, and greater parental involvement in the care of newborns. These findings suggest that providing NPC can improve parents' quality of life, as well as enhance symptom management and pain relief in newborns.

Conclusion

The implementation of an NPC program can benefit both neonates and parents. It can improve the quality of life and reduce stress for parents, enhance the quality of newborn care, foster better inter-team collaboration, and prevent unnecessary invasive procedures, leading to greater comfort for newborns and improved pain and symptom management.

The Effect of Helicobacter pylori Gene Combinations of cagA, cagE, virB11, vacA, and babA on the Outcome of Gastric Disease in a Southern Moroccan Population

Helicobacter pylori (H. pylori) possess an arsenal of virulence genes that makes them the main etiological factor in gastric diseases. In this study, 120 southern Moroccan patients who were dyspeptic were profiled to investigate the potential association between disease severity and the combination of multiple virulence genes. Gastric biopsies were taken from patients, followed by histopathological evaluation and genotyping of H. pylori using PCR. H. pylori was detected in 58.3% of cases, and genotypes were distributed as follows: oipA (94.3%), cagA (62.9%), virB11 (60%), babA (55.7%), dupA (54.3%), cagE (51.4%), iceA1 (31.4%), iceA2 (45.7%), vacA s2m2 (47.1%), vacA s1m1 (30%), and vacA s1m2 (7.1%). Statistically significant associations with males were observed for the cagA, cagE, and virB11 genes and multiple strain infections. Multivariate analysis revealed an association between cagE and heightened neutrophil activity, with an odds ratio (OR) of 4.99 (p = 0.03). The gene combination [cagA (+), cagE (+), virB11 (+), vacA s1m1, and babA (+)] emerged as a predictive factor for gastric cancer (OR = 11.10, p = 0.046), while the combination [cagA (-), cagE (-), virB11 (-), vacA s2m2, babA (+)] was associated with gastric atrophy (OR = 10.25, p = 0.016). Age (≤40 years) (OR = 5.87, p = 0.013) and moderate to severe bacterial density (OR = 15.38, p = 0.017) were identified as predictive factors for follicular gastritis. These findings underscore the significance of multigene profiling as a prognostic marker and emphasize the importance of age and sex in preventing adverse outcomes in severe gastric diseases.

Celiac Disease-Narrative Review on Progress in Celiac Disease

Celiac disease is defined as a systemic immunological disorder caused by gluten (gliadin and other prolamin) in genetically predisposed individuals, who present with a variety of gluten-dependent symptoms, specific antibodies, the presence of the HLA DQ2 and DQ8 histocompatibility antigen, and enteropathy. Its prevalence, depending on the studied population and methodology, is estimated at 0.75-1.6% of the general population. During the complex immune reaction it induces, most cells involved in inflammatory processes are activated, which leads to the gradual atrophy of intestinal villi and the proliferation of enterocytes within intestinal crypts. The pathogenesis of celiac disease is extremely complicated and is still the subject of research. According to the current diagnostic guidelines, the following criteria should be taken into account: clinical symptoms (intestinal and extraintestinal), the presence of antibodies against tissue transglutaminase in the IgA class, the level of total IgA, and the presence of typical histological changes in duodenal biopsies. Diet-resistant celiac disease is one of the most important clinical challenges, causing serious complications. Currently, the basic method for treating celiac disease is an elimination diet (i.e., the exclusion of products that may contain gluten from the diet), however, new therapeutic strategies are still being sought, mainly based on supplementation with exogenous endopeptidases, modification of the immune response, and the use of zonulin inhibitors and transglutaminase 2 inhibitors. Clinical trials of new drugs are ongoing. The gradually expanding knowledge about the pathogenesis of celiac disease may allow for the development of new therapeutic strategies for both patients with a mild disease course, as well as those that are diet-resistant.

Management of Fatigue in Inflammatory Bowel Disease: A Narrative Review

Inflammatory bowel disease (IBD) encompasses chronic inflammatory conditions of the digestive tract, including Crohn's disease and ulcerative colitis. Fatigue is one of the common and important extraintestinal symptoms in IBD patients, which significantly affects the patient's ability to work, daily life, social activities, emotional state, and cognitive function. Although the impact of fatigue on patients' quality of life cannot be ignored, medical professionals still have limited knowledge of its concepts, assessment tools, influencing factors, and non-pharmacological interventions, which may lead to neglect and inadequate management of the symptoms. The purpose of this article is to review the definition and epidemiological characteristics of IBD-related fatigue and to discuss the application of four commonly used fatigue assessment tools in patients with IBD. In addition, we will analyze the multiple factors that affect fatigue in IBD patients from three levels: physiological, psychological, and sociodemographic. Finally, we will assess the effectiveness of different non-pharmacological interventions in alleviating fatigue in people with IBD and make corresponding clinical recommendations.

Efficacy of hemoadsorption in the severe course of COVID-19

Introduction

Insufficiencies of the majority of targeted therapies for the most severe, life-threatening forms of COVID-19 warrant alternative, adjuvant treatment options for enhanced life maintenance that include extracorporeal blood purification and homeostasis support. The goal of the current study is to evaluate the clinical efficacy of hemoadsorption with mesoporous hypercrosslinked polystyrene beads (Efferon CT single-use cartridge) in an expanded cohort of patients with severe and critical COVID-19 resistant to antibody therapies and requiring post-therapy invasive mechanical lung ventilation (MLV) versus parameter-matched control group with no hemoadsorption.

Materials and methods

A single-center cohort study (NCT06402279) enrolled patients from October 2020 to February 2022: the Efferon CT group (non-responders to anti-cytokine antibody therapy requiring IMV, hemadsorption, and standard treatment, n = 65) and retrospectively acquired propensity-matched control group (no hemadsorption, standard treatment only, n = 65).

Results

This observational study revealed the capability of Efferon CT hemoadsorption to safely, rapidly, and significantly reduce the need for norepinephrine, increase the oxygenation index, prevent the sepsis-associated AKI, decrease the development of multiorgan failure, and restore the immune system balance by decreasing pro-inflammatory IL-6, ferritin levels, and neutrophil-to-lymphocyte ratio.

Conclusion

The clinical efficiency of hemoadsorption using Efferon CT was confirmed by the resolution of acute respiratory failure in 54% of patients, significantly increasing the number of days without mechanical ventilation and increasing early the index of oxygenation. Most importantly, the hemoadsorption with Efferon CT was safe and resulted in a significant decrease in the mortality of severe COVID-19 patients.

Clinical trial registration

www.clinicaltrials.gov, Identifier NCT06402279.

[Clinical Features and Functional Prognosis in Patients with Possible Autoimmune Encephalitis in a Neurological Emergency Department]

INTRODUCTION

Autoimmune encephalitis (AE) represents a severe neuropsychiatric disorder that requires early diagnosis. This study describes the frequency, clinical characteristics, and paraclinical findings in patients with possible autoimmune encephalitis treated in a neurological emergency department, as well as factors associated with poor functional prognosis at discharge.

MATERIAL AND METHODS

This was an observational ambispective cohort study including patients diagnosed with AE who were treated in a neurological emergency department in 2022. Demographic, clinical, and paraclinical characteristics were evaluated, along with functional outcomes using the modified Rankin scale (mRS); ≤2 points, was considered as good prognosis. In the statistical analysis we used the chi-squared test, Fisher's exact test, Student's T-test, and Mann-Whitney U test.

RESULTS

Out of 9046 patients, 31 (0.3%) met the criteria for probable autoimmune encephalitis (PAE). The average age was 28.4 ± 12.1 years and 51.6% were female. Cognitive alterations (90.3%), psychosis (74.2%), abnormal movements (71%), catatonia (67.7%), seizures/status epilepticus (64.5%, 19.4%), and dysautonomia (58.1%) were observed; 58.1% had a good functional prognosis. Factors associated with poor prognosis included older age (24.8 ± 5.0 vs. 33.4 ± 16.8, p = 0.049), status epilepticus (0% vs. 46.2%, p = 0.002), and lower frequency of headache (61.1% vs. 15.4%, p = 0.025).

CONCLUSIONS

AE represents a rare diagnosis even in a neurological emergency center; older age, status epilepticus and absence of headache were associated with poor functional prognosis at discharge.

The diagnostic criteria for psychosomatic research-revised (DCPR-R) in a National China multicenter cohort of patients with irritable bowel syndrome and overlapping gastroesophageal reflux disease

BACKGROUND AND AIMS

Past studies have shown a substantial overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). This study investigated the prevalence of DCPR-revised (DCPR-R) syndromes in patients with IBS alone and those with overlapping IBS-GERD. We also explored the relationship of these syndromes with various psychological scales.

METHODS

In total, 341 patients from the Chinese IBS cohort completed the GerdQ scale and a series of psychological questionnaires. Semi-structured interviews were conducted to evaluate DCPR-R, as well as scores on the Psychosocial Index (PSI), Psychosomatic Symptom Scale (PSSS), World Health Organization (WHO)-5 Well-being Index, Euthymia Scale, Patient Health Questionnaire-9, and 7-item Generalized Anxiety Disorder Scale.

RESULTS

Compared with patients with IBS alone, patients with overlapping IBS-GERD had a significantly higher prevalence of DCPR-R syndromes, particularly in areas such as demoralization, persistent somatization, despair-related demoralization, hypochondriasis, disease phobia, anniversary reaction, thanatophobia, and conversion symptoms. Patients with two or more types of DCPR-R syndromes were more likely to exhibit psychological disorders. In patients with IBS alone, the WHO-5 Well-being Index and PSI well-being scores were predictive of two or more DCPR-R syndromes. For patients with overlapping IBS-GERD, the PSSS score was an independent predictor.

CONCLUSION

This study highlights key differences in psychosomatic factors between patients with IBS alone and those with overlapping IBS-GERD. The DCPR-R syndromes and various psychological scales offer valuable tools for diagnosing and assessing these differences.

The potential applications of peptide-loading complex in cancer treatment

Immunotherapy for cancer has made significant strides in the last several years. The prognosis for cancer patients has significantly improved as a result, particularly in hematological diseases. However, it was discovered that translating these achievements to solid tumors proved challenging. The peptide-loading complex (PLC), a temporary multisubunit membrane assembly in the endoplasmic reticulum (ER), is crucial for initiating a hierarchical immune response. Chaperones calreticulin and tapasin make up the PLC, unique to class I glycoproteins, thiooxido-reductase ERp57, and a transporter associated with antigen processing. The loading and editing of major histocompatibility complex class I (MHC-I) molecules with peptide translocation into the ER are synchronized by the PLC. One of the immune escape strategies revealed for tumors so far is changes in the expression of MHC molecules. This is because MHC antigens are crucial in presenting antigens to T-lymphocytes and controlling NK cell activity. Furthermore, decreased MHC-I expression has been linked to malignancies resistant to T-cell-based cancer immunotherapies (adoptive transfer of antitumor CD8 T-cells or checkpoint inhibition). The PLC is essential for T-cell priming, differentiation, and tumor growth control because it can bind to a wide range of MHC-I allomorphs. In this review, we have looked into PLC's function and effects in all forms of cancer to improve cancer therapy techniques.

Confirmatory factor analyses of the Mandarin Chinese version of the perceived stressors in intensive care units among healthcare professionals

Background

The Perceived Stressors in Intensive Care Units (PS-ICU) scale was designed to assess both general and occupational stressors experienced by healthcare professionals (HCPs) under normal circumstances. It has demonstrated good psychometric properties in three languages: French, Spanish, and Italian. The aim of the present study was to translate the scale into Mandarin Chinese and to examine its construct validity and reliability.

Methods

This study was conducted from April 2022 to October 2023. In phase I, the scale was translated into Mandarin Chinese following the Cross-cultural adaptation guidelines and reviewed by expert panels. In phase II, the reliability and validation were tested by 530 HCPs working in tertiary grade A hospitals from two provinces (Shandong and Sichuan) in China. Fifty participants were contacted to evaluate the test-retest reliability and underwent a follow-up investigation 2 weeks after completing the initial online survey.

Results

The content validity ratio for the 50 questions varied between 0.8 and 1, with every item having S-CVI values exceeding 0.92. After removing 4 items, the Exploratory Factor Analysis (EFA) results revealed six factors. Confirmatory Factor Analysis (CFA) affirmed construct homogeneity, comprising of (1) lack of fit with families and the organizational functioning, (2) emotional load associated with patient and family, (3) difficulties associated with teamwork, (4) issues associated with workload and human resource management, (5) issues associated with complex/at-risk situations and skill, (6) and suboptimal care situations. The comprehensive scale displayed strong internal consistency (the total Cronbach's α = 0.96) and showed high 2-week test-retest reliability (Person's r = 0.95). The Job Content Questionnaire (JCQ) was employed to assess the criterion-related validity, alongside with the Maslach Burnout Inventory-Hunman Services Survey (MBI-HSS), which revealed either positive or negative associations between PS-ICU and these measures.

Conclusion

The final 46-item Mandarin Chinese version of the PS-ICU scale is reliable and valid for evaluating perceived stressors among HCPs under normal ICU conditions. It may significantly identify perceived stressors in the ICU providing a foundation for focused intervention research.

Evaluation of the performance of ChatGPT-4 and ChatGPT-4o as a learning tool in endodontics

AIMS

The aim of this study was to evaluate the accuracy and consistency of responses given by two different versions of Chat Generative Pre-trained Transformer (ChatGPT), ChatGPT-4, and ChatGPT-4o, to multiple-choice questions prepared from undergraduate endodontic education topics at different times of the day and on different days.

METHODOLOGY

In total, 60 multiple-choice, text-based questions from 6 topics of undergraduate endodontic education were prepared. Each question was asked to ChatGPT-4 and ChatGPT-4o 3 times a day (morning, noon, and evening) and for 3 consecutive days. The accuracy and consistency of AIs were compared using SPSS and R programs (p < .05, 95% confidence interval).

RESULTS

The accuracy rate of ChatGPT-4o (92.8%) was significantly higher than that of ChatGPT-4 (81.7%; p < .001). The question groups affected the accuracy rates of both AIs (p < .001). The times at which the questions were asked did not affect the accuracy of either AI (p > .05). There was no statistically significant difference in the consistency rate between ChatGPT-4 and ChatGPT-4o (p = .123). The question groups did not affect the consistency of either AI, too (p > .05).

CONCLUSIONS

According to the results of this study, the accuracy of ChatGPT-4o was better than that of ChatGPT-4. These findings demonstrate that AI chatbots can be used in dental education. However, it is also necessary to consider the limitations and potential risks associated with AI.