Retropharyngeal carotid body tumor: A challenge in terms of surgical technicality

INTRODUCTION AND IMPORTANCE

Carotid body tumors are rare neoplasms originating from neural crest cells, commonly presenting as a painless, slow-growing mass in the lateral neck. The retropharyngeal variant of these tumors is particularly uncommon, with an incidence of approximately 2.6 %.

CASE PRESENTATION

A 50-year-old man presented to the Otolaryngology Department at Rasoul Akram Hospital with a painless 3 × 4 cm mass on the right side of his neck, which had gradually increased in size. Clinical examination revealed a pulsatile, nontender mass exerting pressure on the right lateral aspect of the pharynx. A CT scan showed a well-defined, enhancing retropharyngeal mass located between the internal and external carotid arteries on the right side, suggestive of a carotid body tumor. The patient underwent surgical resection, achieving complete tumor removal without complications. A four-year follow-up revealed no signs of tumor recurrence.

CLINICAL DISCUSSION

Carotid body tumors are indolent masses. Diagnosis typically involves clinical evaluation, supplemented by imaging techniques such as ultrasound, CT scan, and MRI, which aid in delineating the tumor's morphology and dimensions. Surgical resection remains the preferred treatment, aiming to achieve complete tumor excision while preserving blood flow, avoiding damage to critical organs and nerves, and safeguarding brain function.

CONCLUSION

The retropharyngeal location of carotid body tumors represents an exceptionally rare variant, and their surgical resection presents a significant challenge for surgeons. This case report offers crucial insights into the surgical management of a retropharyngeal carotid body tumor, serving as a valuable resource for future surgeons who may face similar cases.

Analysis of 73 Cases of Percutaneous Cholecystostomy for Acute Cholecystitis: Patient Selection is Key

Background: Percutaneous cholecystostomy (PC) rates have substantially increased in England over the past two decades. However, its utilization and clinical outcomes at a local level are not well documented or understood. This study aimed to characterize the cohort of patients who underwent PC and resulting clinical outcomes at a tertiary center for hepatobiliary and emergency general surgery. Methods: This is a retrospective cohort study of patients treated between 2012 and 2020 at a single center. A subgroup analysis was conducted to compare outcomes between Tokyo grade 2 and Tokyo grade 3 patients. Results: In the 73-patient cohort, a 57.1% increase in PC was observed between 2012 and 2020. Compared to the gold-standard Tokyo guidelines, 36 patients (49.3%) met the criteria for PC. Postprocedural complications occurred in 50 patients (68.5%), including PC tube dysfunction (27.4%), intra-abdominal abscess (20.5%), external bile leak (8.2%), and biloma (5.5%). Recurrent biliary infection developed in 30 patients (41.1%). Twenty-seven patients (37%) underwent emergency reinterventions due to acute cholecystitis recurrence. Twenty patients (27.4%) required radiological reintervention. Seven patients (9.6%) required emergency cholecystectomy, and ten patients (13.7%) underwent an elective cholecystectomy. Overall, 36 patients (49.3%) died during the follow-up period. Five patients (6.8%) died during index admission. Subgroup analysis demonstrated a higher rate of complications in the Tokyo grade 3 subgroup of 82.8% vs. 59.1% (P = .04). Patients from this subgroup were also more likely to require emergency additional abscess drainage (17.2% vs. 2.3%, P = .034). There was no significant difference in the number of emergency cholecystectomies performed between groups. Patients from the Tokyo grade 2 subgroup were more likely to have an elective cholecystectomy in the future (20.5% vs. 3.4%, P = .044). Conclusions: PC was overperformed in our patient cohort, and was associated with high postprocedure morbidity and mortality. Clinicians should be discerning in patient selection criteria for PC.

A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension

BACKGROUND/OBJECTIVES

Peri-intubation hypotension is a known complication of endotracheal intubation. In the hospital setting, peri-intubation hypotension has been shown to increase hospital mortality and length of stay. The use of prophylactic vasopressors at the time of sedation induction to prevent peri-intubation hypotension has been raised. This systematic review and meta-analysis aims to review the safety and efficacy of this practice.

METHODS

The study was fully registered with PROSPERO on 13 October 2022, and screening for eligibility was initiated on 20 September 2024. Randomized controlled trials, along with retrospective or prospective cohort studies, were included in the search. The terms "peri-intubation hypotension", "vasopressors", "intubation", and "anesthesia induced hypotension" were used to search the title/summary in PubMed, Cochrane Library, and Google Scholar databases. An assessment of bias for each study was conducted using the Newcastle-Ottawa Quality Assessment Scale. The primary outcome was the rate of hypotension peri-intubation. Any complications secondary to hypotension or vasopressors were the secondary outcome.

RESULTS

We identified 13 studies, which were all randomized controlled studies, to include in the final analysis. The risk ratio for preventing peri-intubation hypotension was 1.6 (95% CI, 1.2-2.14) with the use of prophylactic phenylephrine while giving propofol versus no prophylactic vasopressors and 1.28 (95% CI 1.03-1.60) with the use of ephedrine.

CONCLUSIONS

These findings suggest that in patients undergoing intubation in the operating room with propofol, prophylactic vasopressors given with induction for intubation decrease the odds of hypotension.

Clicks for credit: an analysis of healthcare professionals' social media use and potential for continuing professional development activities

BACKGROUND

Previous studies have examined social media habits and utilization patterns among various groups of healthcare professionals. However, very few studies have evaluated the use of social media to support continuing professional development activities. The goal of the 2023 Clinical Education Alliance social media survey was to explore how HCPs interact professionally with social media, describe utilization trends, and identify barriers to using social media to disseminate CPD content.

METHODS

We conducted an online anonymous, voluntary survey of healthcare professionals contained in the Clinical Education Alliance learner database from January to March 2023. The survey was distributed via email and all learners were invited to participate regardless of profession or specialty. This survey consisted of 16 questions and collected demographic information and social media utilization and habits of healthcare professionals.

RESULTS

Of the 2,615 healthcare professionals who completed the survey, 71.2% use social media. Most respondents were physicians (50.6%) practicing in an urban setting (59.6%) and have been practicing for more than 15 years (70.5%). The most widely used platform was Facebook (70.7%), but there were no significant differences among the different professions. Of the respondents who use social media, 44.5% used social media to access continuing professional development-certified activities. Surveyed learners preferred passive participation with social media content. Participant-reported concerns include issues with legitimacy of the information, privacy, time constraints, and institutional barriers.

DISCUSSION

As the continuing professional development community continues to evolve and seek new innovative strategies to reach healthcare professionals, the findings of this survey highlight the need to identify and enact social media-based strategies aimed to engage healthcare professionals and provide them with unbiased evidence-based education.

Acute fibrinous and organizing pneumonia after lung transplantation: A case report of treatment with infliximab and tocilizumab and literature review

Introduction

Acute fibrinous and organizing pneumonia (AFOP) is a severe form of acute lung injury which can occur after lung transplantation. Treatment is empiric, based on immunosuppressive regimens and the mortality rate is very high.

Case presentation

We report the case of a young lung transplant (LT) recipient who developed AFOP following a respiratory viral infection while on suboptimal maintenance immunosuppression due to adherence issues. Diagnosis was confirmed by cryobiopsies showing intra-alveolar fibrin balls. Despite high dose systemic corticosteroids, the patient developed severe respiratory failure requiring mechanical ventilation. IV infliximab and tocilizumab were administered. The patient was extubated 11 days later and discharged to home 42 days after intubation with 1L/min O2. She developed severe pleuritic pain needing opioid treatment and died 4 months later.

Conclusion

While high-dose systemic corticosteroids remain the first line of treatment, the use of anti TNF-α has shown promising results in case reports. Furthermore, we propose prompt realization of a cytokine panel analysis in both blood and bronchoalveolar lavage to better guide the adjuvant administration of a targeted anti-inflammatory therapy.

Factors affecting the return of spontaneous circulation in cardiac arrest patients

The aim of this study was to determine the factors affecting the return of spontaneous circulation (ROSC) in cardiac arrest patients who underwent quality chest compressions as recommended by international guidelines. In this retrospective observational study, the data of nontraumatic out-of-hospital cardiac arrest (OHCA) patients (n = 784) brought by an ambulance to emergency between January 2018 and December 2019 were extracted from the validated hospital automation system. About 452 patients met inclusion criteria. All eligible patients for analysis were treated with an automatic cardiopulmonary resuscitation (CPR) device for chest compression.. Significance threshold for P-value was < 0.05. Logistic regression analysis was used to determine the factors affecting mortality. 61.7% (n = 279) of the study population was male and 65.0% of patients (n = 294) had OHCA. 88 patients (19.5%) had a shockable rhythm and were defibrillated. There was a 0.5-fold increase in mortality rate in patients with thrombocyte count < 199 × 109/L (OR: 0.482, 95% CI: 0.280-0.828) and CPR duration longer than 42 minutes led to a 6.2-fold increase in the probability of ROSC (OR: 6.232, 95% CI: 3.551-10.936) (P < .05). There is no clear consensus on the ideal resuscitation duration; however, our study suggests that it should last at least 42 minutes.

RiskPath: Explainable deep learning for multistep biomedical prediction in longitudinal data

Many diseases are the end outcomes of multifactorial risks that interact and increment over months or years. Timeseries AI methods have attracted increasing interest given their ability to operate on native timeseries data to predict disease outcomes. Instantiating such models in risk stratification tools has proceeded more slowly, in part limited by factors such as structural complexity, model size and explainability. Here, we present RiskPath, an explainable AI toolbox that offers advanced timeseries methods and additional functionality relevant to risk stratification use cases in classic and emerging longitudinal cohorts. Theoretically-informed optimization is integrated in prediction to specify optimal model topology or explore performance-complexity tradeoffs. Accompanying modules allow the user to map the changing importance of predictors over the disease course, visualize the most important antecedent time epochs contributing to disease risk or remove predictors to construct compact models for clinical applications with minimal performance impact.

Role of diaphragmatic ultrasound in patients with acute exacerbation of chronic obstructive pulmonary disease

Assessing diaphragm function status is vital for diagnosing and treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Diaphrag-matic ultrasound has become increasingly important due to its non-invasive nature, absence of radiation exposure, widespread availability, prompt results, high accuracy, and repeatability at the bedside. The diaphragm is a crucial respiratory muscle. Decline or dysfunction of the diaphragm can lead to dyspnea and even respiratory failure in AECOPD patients. In this editorial, we comment on an article, retrospectively analyzed ninety-four acute exacerbations of chronic obstructive pulmonary disease patients who received mechanical ventilation from January 2022 to December 2023. The study found that the diaphragm thickening fraction, an index from diaphragm ultrasound, can better predict the outcome of non-invasive ventilation in patients with AECOPD. The value of non-invasive ventilation in treating respiratory failure caused by AECOPD has been widely acknowledged. Diaphragmatic dysfunction diagnosed with ultrasound is associated with prolonged mechanical ventilation and weaning times and higher mortality.

Two Clinically Implementable Digital PCR Assessments of DNA Methylation for Diagnosing Heavy Alcohol Consumption

BACKGROUND

Heavy alcohol consumption (HAC) has a profound adverse effect on human health. Unfortunately, there is a relative lack of tools that are easily implementable in clinical settings and that can be used to supplement self-reporting in the diagnosis and management of HAC. In part, this paucity is due to limitations of currently available biological measures and a mismatch between available biological measures and the needs of clinicians managing HAC.

OBJECTIVES

We first review the pros and cons of existing biological measures. Next, we review the underlying theory and the performance characteristics of two recently developed methylation-sensitive digital PCR (MSdPCR) assays, referred to as the Alcohol T Score (ATS) and ZSCAN25, for the assessment of chronic and recent HAC, respectively. Finally, we outline a paradigm for improving the clinical diagnosis and management of alcohol use disorders by utilizing these new markers of alcohol consumption.

CONCLUSIONS

We conclude that further studies to understand the test performance characteristics of each of these epigenetic tools in larger, diverse populations are in order.

Rosmarinic acid protects against cyclophosphamide-induced hepatotoxicity via inhibition of oxidative stress, inflammation, and apoptosis and upregulation of Nrf2 in mice

Cyclophosphamide (CP) is widely used in chemotherapy to treat various types of cancer. However, it is toxic to the liver and other organs. Rosmarinic acid (RA) possesses anti-inflammatory, antioxidant, and cytoprotective properties. This study investigated the protective effects of RA against CP-induced liver injury in mice. Mice were treated with RA (25, 50, and 100 mg/kg) for 15 days and followed by a single injection of CP on day 16th. CP injection resulted in an elevation in serum AST, ALT, and ALP, along with multiple histopathological alterations in the liver. CP also induced increased levels of MDA and NO, associated with declined GSH, SOD and CAT. RA pretreatment prevented liver injury, alleviated the enhanced levels of MDA and NO, and restored antioxidants defenses, hence avoiding the oxidative injury in the liver. Moreover, RA pretreatment attenuated NF-κB p65 and proinflammatory cytokines levels. Liver of CP-injected mice also showed a decrease in Bcl2, accompanied with elevated BAX and caspase-3 expression, an effect that RA pretreatment alleviated. In addition, pretreatment of CP-administrated mice with RA restored the Nrf2 expression in the liver. Taken together, this study suggests a potential application value of RA in preventing CP hepatotoxicity and sheds light on the possible mechanism.

Impact of innovative technologies on quality and safety in surgery

Technological advancements gradually lead to the revision and transformation of healthcare, training, and research. Surgery is a field of medicine where the collaboration of human resources and the application of innovative technologies could elevate faithfulness and efficiency. The article, exploring the technologies and analyzing them in terms of their reliability, the benefits of performing precision surgeries, the effectiveness in the outcome of surgery with less psychosomatic fatigue, and the improvements in the training process for surgeons, emphasizes the safety and quality that can be achieved. The study was conducted by searching the relevant papers mainly from 2016-2024 using different online databases such as Web of Science, Google Scholar, and PubMed to examine the impact of adopting new technologies in medicine. This paper highlights that the use of innovative technologies in a wide range of surgical procedures could, by adapting interdisciplinary procedures, provide significant results in issues related to safety, quality, reliability, and training.

Sleep disturbances and female infertility: a systematic review

BACKGROUND

Sleep disturbances are more prevalent among women with infertility. Current research increasingly highlights the significant relationship between sleep disturbances and female infertility, suggesting that sleep may be a key factor in reproductive health. In this review, we aim to delve into the complex interplay between sleep disturbances and female infertility, as well as to assess the underlying mechanisms involved, and seek to illuminate the causes of sleep-related fertility issues. The understanding of these contents may help clinicians enhance clinical strategies for managing sleep disturbances in women facing infertility challenges and provide timely support to those seeking fertility treatments.

METHODS

A comprehensive literature search was conducted in the PubMed and EMBASE databases. Studies that described sleep patterns or any type of sleep disturbance, sleep breathing disorders and their associations with female infertility or female fecundity, published between January 1, 2010, and November 1, 2023, were identified and extracted. The screening, data extraction, and quality assessment processes were independently performed by paired reviewers. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools for observational and cohort studies.

RESULTS

A total of 1,179 articles were initially identified from the search strategy (PubMed, n = 377; EMBASE, n = 802). After removing duplicates (n = 83) and screening for eligibility (n = 75), 19 studies were reviewed and determined to be eligible for inclusion. Infertile women generally report poorer sleep quality and exhibit more evening sleep chronotypes. Sleep disorders are significantly associated with infertility. Poor sleep quality, extreme sleep durations, and certain sleep chronotypes are associated with poorer fertility treatment outcomes, such as a reduced number of retrieved oocytes, decreased embryo quality, and lower fertilization rates. Obstructive sleep apnea (OSA) is also more prevalent in women with fertility issues, especially those with polycystic ovary syndrome (PCOS), and may negatively impact reproductive outcomes. The circadian rhythms of the Clock gene system, melatonin and hormone dysregulation, oxidative stress and immune response are considered to be potential mechanisms explaining how sleep disturbance impairs reproductive function, remain to be fully elucidated, and therefore, require further investigation.

CONCLUSIONS

Sleep disturbances are negatively associated with female infertility and poor fertility treatment outcomes. Longitudinal studies are expected to substantiate these findings and inform more nuanced approaches to prior sleep management and lifestyle advisement for infertile women, especially those undergoing fertility treatments.

TRIAL REGISTRATION

This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42024498443).

A simplified approach to managing a complex infected left ventricular pseudoaneurysm

BACKGROUND

Left ventricular pseudoaneurysm (LVP) is a rare but life-threatening condition resulting from acute myocardial infarction, trauma, bacterial infection, or previous cardiac operations. Diagnosis can be challenging as LVPs remain asymptomatic or present with nonspecific clinical symptoms. Early diagnosis is crucial to prevent rupture and recurrent septicemia. Various imaging techniques can aid in diagnosis, including transthoracic echocardiography (TTE), transesophageal echocardiography, computed tomography angiography, and cardiac magnetic resonance imaging.

CASE REPORT

A 72-year-old man with a history of coronary artery bypass grafting presented with episodes of recurrent fever. An infected LVP was diagnosed using TTE and thoracic Computed tomography (CT) angiography. The patient underwent removal of the infected hematoma with excision and repair of the pseudoaneurysm via left anterior thoracotomy with peripheral cannulation. The neck of the pseudoaneurysm was repaired with a Dacron patch. Post-operative TTE showed no residual pseudoaneurysm tissue, and the patient recovered well.

CONCLUSION

Our experience with the anterior thoracotomy approach with peripheral cannulation in specific cases of infected LVPs has yielded promising results. However, it is crucial to recognize that this approach may not be universally suitable.

Astragali radix vesicle-like nanoparticles improve energy metabolism disorders by repairing the intestinal mucosal barrier and regulating amino acid metabolism in sleep-deprived mice

BACKGROUND

Sleep disorder is widespread and involves a variety of intricate factors in its development. Sleep deprivation is a manifestation of sleep disorder, can lead to energy metabolism disturbances, weakened immune system, and compromised body functions. In extreme situations, sleep deprivation can cause organ failure, presenting significant risks to human health.

PURPOSE

This study aimed to investigate the efficacy and mechanisms of Astragalus Radix vesicles-like nanoparticles (AR-VLNs) in counteracting the deleterious effects of sleep deprivation.

METHODS

The ICR mice were divided into control, model, AR-VLNs high dose (equivalent to 20 g/kg crude drug), AR-VLNs low dose (equivalent to 10 g/kg crude drug), AR high dose (equivalent to 20 g/kg crude drug), and AR low dose (equivalent to 10 g/kg crude drug). The REM (rapid eye movement) sleep-deprivation model was established, and evaluations were conducted for motor function, antioxidant capacity, and energy metabolism indices. Moreover, CACO-2 cells damage was induced with lipopolysaccharide to evaluate the repairing ability of AR-VLNs on the intestinal cell mucosa by measuring permeability. Furthermore, metabolomics was employed to elucidate the mechanisms of AR-VLNs action.

RESULTS

AR-VLNs were demonstrated to enhance the motor efficiency and antioxidant capacity in REM sleep-deprived mice, while also minimized pathological damage and restored the integrity of the intestinal mucosal barrier. In vitro experiments indicated the anti-inflammatory effect of AR-VLNs against LPS-induced cell damage. Additionally, metabolomic analysis linked these effects with regulation of the amino acid metabolic pathways. Further confirmation from molecular biology experiments revealed that the protective effects of AR-VLNs against the deleterious effects of REM sleep deprivation were associated with the restoration of the intestinal mucosal barrier and the enhancement of amino acid metabolism.

CONCLUSION

AR-VLNs administration effectively improved energy metabolism disorders in REM sleep deprived mice, by facilitating the repair of the intestinal mucosal barrier and regulating the amino acid metabolism.

An intracranial odyssey: pediatric ganglioneuroma arising from the trigeminal ganglion: a case report and review of the literature

BACKGROUND

Ganglioneuroma represents an uncommon benign tumor arising from the sympathetic nerves, and its development from the fifth nerve is an infrequent entity. Few ganglioneuromas arising from the fifth nerve have been discussed in literature. The authors describe the second pediatric ganglioneuroma arising from the fifth nerve.

CASE PRESENTATION

A 7 year-old Asian male suffering from left-sided facial paresthesia, accompanied by several episodes of complex seizures over the past 2 years, presented to our clinic. The patient also complained of sudden unconsciousness and concurrent upward gaze lasting less than a minute. A brain computed tomography scan and magnetic resonance imaging revealed an isodense lesion containing focal calcifications measuring 31 × 28 mm and a solid mass extending from the pontine surface to Meckel's cave, probably originating from the fifth nerve or its root entry zone. The lesion was mildly hypointense on T1-weighted sequences and hyperintense on T2-weighted and fluid attenuated inversion recovery sequences. Gadolinium injection revealed only minimal heterogeneous enhancement. Histopathologic and immunohistochemical findings were consistent with ganglioneuroma. A lateral approach via retrosigmoid incision and suboccipital lateral craniectomy toward the cerebellopontine angle was performed under neuromonitoring supervision, and the postoperative period was uneventful.

CONCLUSION

Although ganglioneuroma arising from the fifth nerve is an extremely rare entity, it should be considered when diagnosing lesions in Meckel's cave or the cerebellopontine angle cistern.

Socioeconomic status and sleep duration among a representative, cross-sectional sample of US adults

BACKGROUND

Sleep is a crucial determinant of physical and mental health outcomes, and insufficient sleep is highly prevalent among United States adults. Although some risk factors of poor sleep have been extensively studied, including substance use, age, health behaviors, and others, the associations between socioeconomic status (SES) and sleep remain inconclusive. There is limited evidence on SES and sleep duration among the US adult population. This study analyzed the relationships between three SES indicators (poverty, education, and food security), and sleep duration.

METHODS

We used responses from the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES). Respondents younger than 25 years old were excluded. Sleep duration was classified using self-reported sleep time and stratified by work vs. non-workdays. SES was operationalized using three indicators: poverty-income ratio, educational attainment, and food security status. We imputed missing data for socioeconomic status and outcome variables using multiple imputation. Weighted Poisson regression models with robust standard errors were used to calculate the crude and adjusted prevalence ratios for insufficient sleep duration (< 7 h of self-reported sleep) on workdays and non-workdays separately by each of the three SES indicators.

RESULTS

We included a total of 8,457 individuals. In the adjusted model, participants with lower income, educational status, and food security had significantly higher prevalence of insufficient sleep duration on both workdays and non-workdays. For example, low-income individuals (poverty-income ratio < 1) had 1.22 (95% CI 1.04-1.44) and 2.08 (95% CI 1.61-2.67) higher prevalence of insufficient sleep as compared to high income individuals on workday and non-workdays, respectively. In general, we found larger differences by level of SES indicator for the non-workday than for the workday outcome. There were no major differences in gender-stratified analysis. We also found that lower SES was associated with higher prevalence of excessive sleep (≥ 9 h).

CONCLUSION

Socioeconomic status indicators are significantly associated with sleep duration in the US adult population. Lower SES correlates with increased prevalence of insufficient sleep duration, which has implications for the overall wellbeing of US adults with lower SES. Targeted interventions and further research are needed to reduce this disparity.

Comparing Management Strategies for Thoracolumbar Injury Classification and Severity Score of 4 (TLICS = 4) in the Pediatric Population: A Single-Institutional Experience

BACKGROUND

Thoracolumbar (TL) fractures are uncommon injuries in the pediatric population. Surgery is recommended for TL fractures with significant deformity, posterior ligamentous complex disruption, or neurological compromise. The Thoracolumbar Injury Classification and Severity Scale (TLICS) has been validated in pediatric populations and serves as a valuable tool for guiding treatment decisions. However, there remains a lack of clarity regarding the appropriate treatment for patients with a TLICS of 4. While conservative and surgical techniques have been described, most studies focused on adult populations, and there is no consensus on the appropriate management in the pediatric population. We reviewed our institutional experience of TL fractures in young children with TLICS of 4, managed both non-operatively and operatively.

METHODS

A retrospective review of a single institution's experience managing pediatric patients (<18 years old) with TL fractures receiving a TLICS of 4 from 2015 to 2023 was conducted to determine the clinical outcomes following non-operative and operative treatment.

RESULTS

Among 11 pediatric patients, 4 were managed with bracing alone, primarily for posterior column fractures, using a thoracolumbar sacral orthosis (TLSO). Four patients underwent minimally invasive screw fixation (MISF), for Chance or posterior column fractures, with an average operative time of 143 min, blood loss of 29 cc, length of stay (LOS) of 9.8 days, and a follow-up interval of 6 months. Three patients received open posterior screw fixation (OPSF), most commonly for Chance fractures, with averages of 129 min operative time, 225 cc blood loss, 9.7 days LOS, and 4 months follow-up. Both MISF and OPSF utilized intra-operative imaging, with lower radiation exposure in the MISF group. One MISF patients had hardware failure evident by screw lucency on follow-up imaging.

CONCLUSIONS

Bracing and surgery are safe management options for pediatric TL fractures receiving a TLICS of 4. MISF is an effective alternative treatment strategy, comparable to OPSF, with the advantage of reduced blood loss and radiation exposure. Further studies with age-matched cohorts and long-term outcomes may help determine the optimal management course.

Potential applications of engineered bacteria in disease diagnosis and treatment

Probiotics are live microorganisms that confer health benefits to the host when administered in appropriate quantities. This beneficial effect has spurred extensive research in the medical and health fields. With rapid advancements in synthetic biology, the genetic and biological characteristics of a broad array of probiotics have been elucidated. Utilizing these insights, genetic editing technologies now enable the precise modification of probiotics, leading to the development of engineered bacteria. Emerging evidence underscores the significant potential of these engineered bacteria in disease management. This review explores the methodologies for creating engineered bacteria, their preliminary applications in healthcare, and the mechanisms underlying their functions. Engineered bacteria are being developed for roles such as in vivo drug delivery systems, biosensors, and mucosal vaccines, thereby contributing to the treatment, diagnosis, and prevention of conditions including inflammatory bowel disease (IBD), metabolic disorders, cancer, and neurodegenerative diseases. The review concludes by assessing the advantages and limitations of engineered bacteria in the context of disease management.

Association between metabolic acidosis and post-intubation hypotension in airway management performed in the emergency department

Introduction

Post-intubation hypotension (PIH) is a common complication of intubations performed in the emergency department (ED). Identification of patients at high-risk for PIH is a major challenge. We aimed to determine whether pre-intubation metabolic acidosis affects the incidence of PIH in the ED.

Methods

This was a single-center, retrospective, observational study of consecutive patients requiring emergent endotracheal intubation (ETI) from November 1, 2016 to March 31, 2022 at Hyogo Emergency Medical Center, an urban ED. The primary outcome was PIH, defined as a decreased systolic blood pressure (sBP) of <90 mmHg, required initiation of any vasopressor, or a decrease in sBP by ≥ 20 % within 30 min following intubation. Patients were divided into two groups: those with pre-intubation metabolic acidosis (metabolic acidosis group), defined as pH < 7.3 and base excess (BE) < -4 mmol/L on arterial blood gas analysis, and those with no metabolic acidosis (without-metabolic acidosis group). The association between PIH and pre-intubation metabolic acidosis was examined using multivariable logistic regression models. A receiver operating characteristic (ROC) curve was produced to assess the predictive value of pre-intubation BE for PIH.

Results

The study included 311 patients. PIH occurred in 65.5 % (74/113) of patients in the metabolic acidosis group and 29.3 % (58/198) of patients in the without-metabolic acidosis group. Multivariable logistic regression demonstrated that metabolic acidosis was associated with PIH (odds ratio 4.06, 95 % confidence interval 2.31-7.11). In the ROC analysis, the optimal cut-off point for BE was -4.1 (sensitivity = 71 %, specificity = 70 %), with the area under the ROC curve 0.74.

Conclusion

Pre-intubation metabolic acidosis was significantly associated with PIH. Physicians.

Revealing antimicrobial resistance profile and associated factors of Vibrio vulnificus isolated from clinical, environmental, and seafood samples across asia: A systematic review and meta-analysis

The escalating antimicrobial resistance (AMR) in highly virulent Vibrio vulnificus poses a significant public health concern in Asia. Profiling the antibiogram of this pathogen is crucial for revealing its complex AMR patterns and guiding the selection of appropriate medications. Although previous studies have provided valuable insights regarding V. vulnificus AMR, they are constrained by limited sample diversity, inconsistent methodologies, and insufficient regional data. Moreover, no systematic attempt has been made to synthesize V. vulnificus AMR data across various sources and regions in Asia. A systematic review and meta-analysis are thus conducted in this study to assess the current AMR status of V. vulnificus isolated from clinical, environmental, and seafood samples. By synthesizing data from 32 articles across 13 Asian countries, a broader antibiogram has been provided, covering 13 major antimicrobial groups against V. vulnificus. Subgroup and regression analyses were also performed using study-level and country-specific covariates to explore the associated risk factors. The findings revealed low AMR rates for tetracyclines (4.89 %), quinolones (1.85 %), nitrofurans (0.86 %), and phenicols (0.61 %), highlighting their potential as primary treatment options. Conversely, high AMR rates were detected for lincosamides (80.32 %), polypeptides (64.42 %), and glycopeptides (56.14 %), necessitating careful consideration for their clinical use. For study-level covariates, subgroup and meta-regression analyses revealed that variations in the type of antimicrobial (R 2  = 26.5 %, p < 0.0001), country (R 2  = 18.33 %, p < 0.0001), and pathogen source (R 2  = 10.46 %, p = 0.0007) significantly contributed to between-study heterogeneity in the detected AMR rates across studies. Moreover, the analyses of country-specific covariates indicated that antimicrobial consumption (AMC) in healthcare systems (R 2  = 29.3, p = 0.06) and the country's gross domestic product (GDP) (R 2  = 28.59, p = 0.06) affected the variations in AMR rates across countries to some extent. Consideration of study-level and country-specific covariates is thus recommended for future research to effectively mitigate the threat of V. vulnificus AMR across Asia and reduce its pervasive impact on public health.

Exploring the therapeutic potential of triterpenoid saponins from Gymnema sylvestre: Mechanistic insights into hepatoprotection, immunomodulation, anticancer activities, molecular docking, and pharmacokinetics

The study comprehensively investigated the therapeutic potential of Gymnema sylvestre triterpenoid saponin extract (GST), encompassing its hepatoprotective, immunomodulatory, and anticancer activities. The study employed a Prednisolone (PRD)-induced immunosuppressed rat model to assess the hepatoprotective and immunomodulatory effects of GST. Using this model, GST was found to modulate haematopoiesis, improving RBC, platelet, and WBC counts, underscoring its potential in hematopoietic homeostasis. Organ atrophy, a hallmark of immunosuppression in spleen, thymus, liver, and kidneys, was reversed with GST treatment, reinforcing its hepatotrophic and organotropic capabilities. Elevated hepatic biomarkers, including alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and lipid peroxidase (LPO), indicative of hepatocellular injury and oxidative stress, were reduced with GST, underscoring its hepatoprotective and antioxidative effects. Additionally, GST restored depleted antioxidants glutathione (GSH) and superoxide dismutase (SOD), highlighting its strong antioxidative capabilities. Molecular insights revealed a downregulation of interleukin-2 (IL-2) and interleukin-4 (IL-4) mRNA in the spleen of immunosuppressed rats, while GST treatment significantly upregulated IL-2 and IL-4 mRNA expression, showcasing its immunomodulatory potential. Increased levels of tumor necrosis factor-α (TNF-α) associated with immune dysregulation were effectively decreased by GST, underscoring its role in modulating inflammatory responses and restoring immune balance. Molecular docking studies indicated strong inhibition of TNF-α by GST compounds. In terms of anticancer activity, GST demonstrated significant cytotoxicity against MCF-7, and MDA-MB-231 (breast cancer cell lines). Notably, GST demonstrated biocompatibility with normal CHO (Chinese hamster ovary cell line) and HUVEC (Human umbilical vein endothelial cells) cell lines. Molecular docking studies indicated strong inhibition of breast cancer proteins HER1 and HER2 (human epidermal growth factor receptors) by GST compounds. Additionally, pharmacokinetics, bioavailability, drug-likeness, and toxicity risk predictions suggest that GST compounds are pharmacologically favourable with no adverse effects.

Machine Learning for Enhanced COPD Diagnosis: A Comparative Analysis of Classification Algorithms

Background: In the United States, chronic obstructive pulmonary disease (COPD) is a significant cause of mortality. As far as we know, it is a chronic, inflammatory lung condition that cuts off airflow to the lungs. Many symptoms have been reported for such a disease: breathing problems, coughing, wheezing, and mucus production. Patients with COPD might be at risk, since they are more susceptible to heart disease and lung cancer. Methods: This study reviews COPD diagnosis utilizing various machine learning (ML) classifiers, such as Logistic Regression (LR), Gradient Boosting Classifier (GBC), Support Vector Machine (SVM), Gaussian Naïve Bayes (GNB), Random Forest Classifier (RFC), K-Nearest Neighbors Classifier (KNC), Decision Tree (DT), and Artificial Neural Network (ANN). These models were applied to a dataset comprising 1603 patients after being referred for a pulmonary function test. Results: The RFC has achieved superior accuracy, reaching up to 82.06% in training and 70.47% in testing. Furthermore, it achieved a maximum F score in training and testing with an ROC value of 0.0.82. Conclusions: The results obtained with the utilized ML models align with previous work in the field, with accuracies ranging from 67.81% to 82.06% in training and from 66.73% to 71.46% in testing.

Ethical Dilemmas Among Oncology Nurses in China: Cross-Sectional Study

Background

Effective communication about cancer prognosis is imperative for enhancing the quality of end-of-life care and improving patient well-being. This practice is sensitive and is heavily influenced by cultural values, beliefs, and norms, which can lead to ethical dilemmas. Despite their significance, ethical challenges in nursing related to prognosis communication are understudied in China.

Objective

This study aimed to examine the ethical dilemmas relating to cancer prognosis communication and their associated factors.

Methods

A cross-sectional design was employed to survey 373 oncology nurses in mainland China. Data were collected on ethical dilemmas, attitudes, barriers, experiences with prognosis communication, sociodemographics, and practice-related information. Ordinary least squares regressions were used to identify factors contributing to ethical dilemmas.

Results

Participants reported a moderate level of ethical dilemmas in prognostic communication (mean 13.5, SD 3.42; range 5-20). Significant predictors of these dilemmas included perceived barriers (P<.001), experiences with prognosis communication (P<.001), and years of work experience (P=.002). Nurses who perceived greater communication barriers, had more negative experiences with prognosis communication, and had less work experience were more likely to encounter ethical dilemmas in prognosis-related communication.

Conclusions

Chinese oncology nurses frequently encounter ethical dilemmas, as well as barriers, in communicating cancer prognoses. This study's findings emphasize the importance of culturally tailored communication training. Collaborative interprofessional training, particularly through physician-nurse partnerships, can perhaps enhance the proficiency of cancer prognosis-related communication.

Use of integrative and complementary practices in Brazil during the COVID-19 pandemic

The SARS-CoV-2 coronavirus pandemic posed an unprecedented challenge to global health. In the context of an overwhelmed healthcare system and the rising demand for alternative strategies to manage stress and anxiety, this study aims to investigate and analyze the use of Integrative and Complementary Practices (ICP) in Brazil during the COVID-19 pandemic, emphasizing their importance in promoting health and well-being. We conducted a cross-sectional study among n = 12,136 Brazilian adults predominantly female, white, under 40 years of age and with a predominantly higher education level between August 24 and December 16, 2020, to assess the use of ICP. An online questionnaire was applied, with questions validated in previous health surveys. The sampling method employed was 'virtual snowball,' post-stratification procedures were used to consider the Brazilian regions, gender, age group, and educational level. The reported prevalence of ICP use was 61.8%, with meditation (28.2%), Reiki (21.7%), herbal medicine (28.2%), and aromatherapy (16.5%) being the most utilized practices. ICPs were more frequently adopted by females, older age groups, individuals with health insurance, and those who practiced social distancing. Health promotion and well-being were the primary reasons for engaging in ICP. The high adherence to ICP during the COVID-19 pandemic in Brazil reflects the population's search for therapeutic alternatives focused on the well-being and mental health. The utilization of ICP indicates the need to integrate these practices into healthcare systems, considering their potential to complement conventional treatment, especially in times of crisis. Public health policies should recognize and facilitate access to such practices to reduce inequities and promote integrative health. This study contributes to the understanding of the role of ICP in a public health crisis, encouraging further investigation into the potential inclusion of these practices in the healthcare system.

Surgical Management of Pediatric Obstructive Sleep Apnea: Efficacy, Outcomes, and Alternatives-A Systematic Review

AIM

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder. OSA affects approximately 2 million Italians, although only 3% receive a diagnosis and correct treatment. This review aims to provide an overview to guide clinical decision making, ensuring that patients receive the most appropriate treatment for their specific condition.

MATERIAL AND METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered at PROSPERO under the ID CRD42024593760. A search on PubMed, Scopus, and Web of Science was performed to find papers that matched the topic, using the following Boolean keywords: ("obstructive sleep apnea" OR "OSA" OR "sleep apnea, obstructive") AND ("surgery" OR "surgical" OR "surgical techniques" OR "surgical treatment" OR "operative" OR "surgical procedures") AND ("treatment" OR "therapy" OR "management").

RESULT

The electronic database search found 20337 publications. After the screening and eligibility phase, 15 papers were chosen for the qualitative analysis.

CONCLUSIONS

Adenotonsillectomy (AT) significantly improves secondary outcomes like behavioral issues and quality of life, compared to watchful waiting with supportive care (WWSC). Alternative approaches such as tonsillotomy and adenopharyngoplasty (APP) offer promising results, with less postoperative discomfort and lower complication rates. However, further large-scale studies are needed to refine surgical techniques, assess long-term outcomes, and optimize individualized treatment strategies for OSA.

Echinocystic acid inhibits sepsis-associated renal inflammation and apoptosis by targeting protein tyrosine phosphatase 1B

Thefruits of Gleditsia sinensis Lam. have been utilized to treat inflammatory diseases in China. Echinocystic acid (EA), one pentacyclic triterpenoid isolated from thefruits of G. sinensis, exhibits an anti-inflammatory effect. However, its anti-sepsis activity and mechanism of action, especially the protective effect against sepsis-associated acute kidney injury (SA-AKI), are not investigated yet. This study is to explore the efficacy and potential mechanism of EA on SA-AKI. EA elevated the function of multiple organs and effectively reduced the increased inflammation and apoptosis of kidney tissue and HK-2 cells. DARTS, CETSA, and molecular docking experiments revealed that EA could directly bind to protein tyrosine phosphatase 1B (PTP1B), a widespread prototype non-receptor tyrosine phosphatase. Collectively, EA can alleviate murine SA-AKI though restraining inflammation and apoptosis and may be a potential natural drug for remedying SA-AKI.

Research Trends of Artificial Intelligence in Lung Cancer: A Combined Approach of Analysis With Latent Dirichlet Allocation and HJ-Biplot Statistical Methods

Lung cancer (LC) remains one of the leading causes of cancer-related mortality worldwide. With recent technological advances, artificial intelligence (AI) has begun to play a crucial role in improving diagnostic and treatment methods. It is crucial to understand how AI has integrated into LC research and to identify the main areas of focus. The aim of the study was to provide an updated insight into the role of AI in LC research, analyzing evolving topics, geographical distribution, and contributions to journals. The study explores research trends in AI applied to LC through a novel approach combining latent Dirichlet allocation (LDA) topic modeling with the HJ-Biplot statistical technique. A growing interest in AI applications in LC oncology was observed, reflected in a significant increase in publications, especially after 2017, coinciding with the availability of computing resources. Frontiers in Oncology leads in publishing AI-related LC research, reflecting rigorous investigation in the field. Geographically, China and the United States lead in contributions, attributed to significant investment in R&D and corporate sector involvement. LDA analysis highlights key research areas such as pulmonary nodule detection, patient prognosis prediction, and clinical decision support systems, demonstrating the impact of AI in improving LC outcomes. DL and AI emerge as prominent trends, focusing on radiomics and feature selection, promising better decision-making in LC care. The increase in AI-driven research covers various topics, including data analysis methodologies, tumor characterization, and predictive methods, indicating a concerted effort to advance LC research. HJ-Biplot visualization reveals thematic clustering, illustrating temporal and geographical associations and highlighting the influence of high-impact journals and countries with advanced research capabilities. This multivariate approach offers insights into global collaboration dynamics and specialization, emphasizing the evolving role of AI in LC research and diagnosis.

Large Language Models in Biomedical and Health Informatics: A Review with Bibliometric Analysis

Large language models (LLMs) have rapidly become important tools in Biomedical and Health Informatics (BHI), potentially enabling new ways to analyze data, treat patients, and conduct research. This study aims to provide a comprehensive overview of LLM applications in BHI, highlighting their transformative potential and addressing the associated ethical and practical challenges. We reviewed 1698 research articles from January 2022 to December 2023, categorizing them by research themes and diagnostic categories. Additionally, we conducted network analysis to map scholarly collaborations and research dynamics. Our findings reveal a substantial increase in the potential applications of LLMs to a variety of BHI tasks, including clinical decision support, patient interaction, and medical document analysis. Notably, LLMs are expected to be instrumental in enhancing the accuracy of diagnostic tools and patient care protocols. The network analysis highlights dense and dynamically evolving collaborations across institutions, underscoring the interdisciplinary nature of LLM research in BHI. A significant trend was the application of LLMs in managing specific disease categories, such as mental health and neurological disorders, demonstrating their potential to influence personalized medicine and public health strategies. LLMs hold promising potential to further transform biomedical research and healthcare delivery. While promising, the ethical implications and challenges of model validation call for rigorous scrutiny to optimize their benefits in clinical settings. This survey serves as a resource for stakeholders in healthcare, including researchers, clinicians, and policymakers, to understand the current state and future potential of LLMs in BHI.

Climate change and Vibrio vulnificus dynamics: A blueprint for infectious diseases

Climate change is having increasingly profound effects on human health, notably those associated with the occurrence, distribution, and transmission of infectious diseases. The number of disparate ecological parameters and pathogens affected by climate change are vast and expansive. Disentangling the complex relationship between these variables is critical for the development of effective countermeasures against its effects. The pathogen Vibrio vulnificus, a naturally occurring aquatic bacterium that causes fulminant septicemia, represents a quintessential climate-sensitive organism. In this review, we use V. vulnificus as a model organism to elucidate the intricate network of interactions between climatic factors and pathogens, with the objective of identifying common patterns by which climate change is affecting their disease burden. Recent findings indicate that in regions native to V. vulnificus or related pathogens, climate-driven natural disasters are the chief contributors to their disease outbreaks. Concurrently, climate change is increasing the environmental suitability of areas non-endemic to their diseases, promoting a surge in their natural populations and transmission dynamics, thus elevating the risk of new outbreaks. We highlight potential risk factors and climatic drivers aggravating the threat of V. vulnificus transmission under both scenarios and propose potential measures for mitigating its impact. By defining the mechanisms by which climate change influences V. vulnificus disease burden, we aim to shed light on the transmission dynamics of related disease-causing agents, thereby laying the groundwork for early warning systems and broadly applicable control measures.

Plasma Inclusive Resuscitation Is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines

INTRODUCTION

Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.

METHODS

Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.

RESULTS

Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (n = 39) compared to late PIR (n = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, P = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, P = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, P = 0.62).

CONCLUSIONS

In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.

Quantitative Chest CT Analysis: Three Different Approaches to Quantify the Burden of Viral Interstitial Pneumonia Using COVID-19 as a Paradigm

Objectives: To investigate the relationship between COVID-19 pneumonia outcomes and three chest CT analysis approaches. Methods: Patients with COVID-19 pneumonia who underwent chest CT were included and divided into survivors/non-survivors and intubated/not-intubated. Chest CTs were analyzed through a (1) Total Severity Score visually quantified by an emergency (TSS1) and a thoracic radiologist (TSS2); (2) density mask technique quantifying normal parenchyma (DM_Norm 1) and ground glass opacities (DM_GGO1) repeated after the manual delineation of consolidations (DM_Norm2, DM_GGO2, DM_Consolidation); (3) texture analysis quantifying normal parenchyma (TA_Norm) and interstitial lung disease (TA_ILD). Association with outcomes was assessed through Chi-square and the Mann-Whitney test. The TSS inter-reader variability was assessed through intraclass correlation coefficient (ICC) and Bland-Altman analysis. The relationship between quantitative variables and outcomes was investigated through multivariate logistic regression analysis. Variables correlation was investigated using Spearman analysis. Results: Overall, 192 patients (mean age, 66.8 ± 15.4 years) were included. TSS was significantly higher in intubated patients but only TSS1 in survivors. TSS presented an ICC of 0.83 (0.76; 0.88) and a bias (LOA) of 1.55 (-4.69, 7.78). DM_Consolidation showed the greatest median difference between survivors/not survivors (p = 0.002). The strongest independent predictor for mortality was DM_Consolidation (AUC 0.688), while the strongest independent predictor for the intensity of care was TSS2 (0.7498). DM_Norm 2 was the singular feature independently associated with both the outcomes. DM_GGO1 strongly correlated with TA_ILD (ρ = 0.977). Conclusions: The DM technique and TA achieved consistent measurements and a better correlation with patient outcomes.

When pulmonary arterial hypertension and pregnancy meet: a multidisciplinary clinical experts review

Pulmonary hypertension (PH) is a rare condition characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance, potentially leading to right ventricular failure. Pulmonary arterial hypertension (PAH) is the most common type of PH in women of childbearing age and, as per the modified World Health Organization (mWHO) classification of maternal cardiovascular risk, it falls into mWHO class IV and pregnancy is contraindicated. These patients face an exceptionally high risk of maternal mortality and morbidity, with estimated maternal cardiac event rates ranging from 40 to 100% during pregnancy, because physiological changes happening in pregnancy exacerbate the disorder. Despite these recommendations, there is a growing incidence of pregnancy among women with PAH. Early referral to specialized centers, personalized therapies and expert multidisciplinary care involving pulmonary hypertension specialists, obstetricians, critical care specialists, anesthesiologists, and neonatologists are crucial steps to ensure positive outcomes for both mother and fetus. This review aims to examine the current understanding of pregnancy in patients with PAH, drawing on the experience of our center in the multidisciplinary management of pregnant women with this condition. In particular, we want to focus the attention of clinicians on the following aspects: early referral of pregnant patients to specialized centers, detailed counseling on the implications of pregnancy, initiation of therapy in treatment-naive patients and potential adjustment of therapy in non-naive patients, periodic risk assessment, evaluation of the appropriate timing of delivery, multidisciplinary management of the most critical periods, which are delivery and the post-partum phase.

Unilateral nerve preservation during parametrectomy is not sufficient to prevent persistent urinary retention after cytoreductive endometriosis surgery

OBJECTIVES

This study sought to quantify the risks of urinary retention following different levels or degrees of nerve preservation during parametrectomies for deep endometriosis (DE).

METHODS

Women undergoing laparoscopic and robotic nerve-sparing DE surgeries were studied. The cases were divided into 6 groups according to the degree of preservation of parasympathetic parametrium fibers on each side: P1 (P1 left /P1 right-Excellent preservation: presacral and pararectal fascia bilateral preservation), P2 (P1/P2 or P2/P1, P2/P2-Regular preservation: fascia violation with local fat visualization-either of both sides; and P3 (P1/P3 or P3/P1, P2/P3 or P3/P2, P3/P3)-Poor preservation: musculature and pelvic floor exposure-even if only unilateral.

RESULTS

Of a total of 151 women eligible for the study, 110 (72.8%) had excellent nerve preservation; 24 (15.8%) had regular nerve preservation, and 17 (11.2%) had poor-nerve preservation. The incidence of elevated PVR was higher in the P3 group. Thirty-five patients were catheterized post-operatively, more common in the P3 group. In four cases from the P3 group, prolonged intermittent self-catheterization after discharge was necessary. The calculated risk of needing intermittent catheterization in the P3 group was 23.1% up to 8 weeks and 7.7% up to 8 months post-surgery.

CONCLUSION

Parametrectomy with poor-nerve preservation can lead to urinary retention, even with excellent contralateral preservation.

Utility of near-infrared fluorescent clip for the robot-assisted gastrectomy: Report of 2 cases (case series)

INTRODUCTION AND IMPORTANCE

The importance of preoperative tumor site marking has increased over the years, as the method of intraoperative primary lesion identification and determination of resection margins is one factor determining whether oncological safety and function-preserving gastrectomy are possible during surgery. We hypothesize that preoperative placement of the near-infrared fluorescent (NIRF) clip, ZEOCLIP FS, near the oral incision line of the gastric tumor will allow for Firefly recognition of the NIRF clip on da Vinci during surgery and easy determination of the tumor location and incision line. Hence, we report on two cases in which the procedure was performed.

CASE PRESENTATION

Case 1: A 62-year-old woman was diagnosed with early gastric cancer of 35 mm in size located in the greater curvature of the gastric angle and underwent robot-assisted distal gastrectomy. NIRF clips were placed around the negative biopsy-confirmed area on the tumor's oral side by endoscopy on the day before surgery. The clips were identified intraoperatively in Firefly mode, and we performed gastrectomy without using an intraoperative endoscope. Case 2: A 60-year-old man was diagnosed with early gastric cancer 40 mm in size on the anterior wall of the gastric angle and underwent robot-assisted distal gastrectomy. Similarly, NIRF clips were placed around the site of negative biopsy confirmation the day before surgery. NIRF clips were identified, and we performed gastrectomy.

CLINICAL DISCUSSION

The time taken to mark the gastric resection line after activating the Firefly imaging system was 120 and 154 s, respectively, and intraoperative endoscopy was not required. The advantage of our two-step method is that a surgeon can mark the clips the day before the surgery, even if they are not endoscopists. Increasing the recognition rate of fluorescent clips and preventing their remains are future issues.

CONCLUSION

Based on the results of the above two cases, ZEOCLIP FS is influential in determining the tumor's location and the resection line.

Macrophage activation syndrome in Sepsis: from pathogenesis to clinical management

BACKGROUND

Sepsis represents a significant global health and hygiene challenge. Excessive activation of macrophages in sepsis can result in certain patients displaying characteristics akin to those observed in Macrophage Activation Syndrome (MAS). MAS represents a grave immune system disorder characterized by persistent and severe inflammation within the body. In the context of sepsis, MAS presents atypically, leading some researchers to refer to it as Macrophage Activation-Like Syndrome (MALS). However, there are currently no effective treatment measures for this situation. The purpose of this article is to explore potential treatment methods for sepsis-associated MALS.

OBJECTIVE

The objective of this review is to synthesize the specific pathophysiological mechanisms and treatment strategies of MAS to investigate potential therapeutic approaches for sepsis-associated MALS.

METHOD

We searched major databases (including PubMed, Web of Science, and Google Scholar etc.) for literature encompassing macrophage activation syndrome and sepsis up to Mar 2024 and combined with studies found in the reference lists of the included studies.

CONCLUSION

We have synthesized the underlying pathophysiological mechanism of MALS in sepsis, and then summarized the diagnostic criteria and the effects of various treatment modalities utilized in patients with MAS or MALS. In both scenarios, heterogeneous treatment responses resulting from identical treatment approaches were observed. The determination of whether the patient is genuinely experiencing MALS significantly impacts the ultimate outcomes of therapeutic efficacy. In order to tackle this concern, additional clinical trials and research endeavors are imperative.

Nurses' level of sleepiness during night shift

AIMS

This study aimed to determine the peak hours of sleepiness and the factors affecting the sleepiness levels of nurses.

BACKGROUND

Sleepiness is commonly seen in individuals working night shifts. However, in case of nurses, this sleepiness can be a major threat to patient and staff safety.

METHOD

This was a prospective cross-sectional study. Data were collected between July and September 2023, and a stratified sampling method was used according to the departments in which the nurses worked. Data were collected using the Personal Information Form and Visual Analog Scale. Nurses reported their sleepiness levels at the beginning of each hour between midnight and 8:00 am.

EQUATOR CHECKLIST

The study adhered to the STROBE checklist for reporting.

RESULTS

The mean sleepiness levels of emergency department nurses, intensive care nurses, internal or surgical clinic nurses, and all nurses were 59.75 ± 15.50, 43.53 ± 20.49, 44.67 ± 18.88, and 49.15 ± 19.67, respectively. The highest sleepiness level of the nurses was at 05:00 am. A significant correlation was found between the variables of age, gender, marital status, sleep quality, number of patients cared, working style and satisfaction with working in the department, and sleepiness level (P < 0.05).

CONCLUSION

Nurses working night shifts experience sleepiness (highest at 5:00 am). In addition, the sleepiness levels of nurses are affected by some personal and clinical factors.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Based on the results, there is a need for necessary policies regarding nurses' working hours and working conditions. To protect patient and employee safety, necessary strategies should be devised regarding the hours when nurses experience the highest sleepiness and the factors affecting sleepiness levels.

Nurse perspectives on supporting children and youth who use augmentative and alternative communication (AAC) in the pediatric intensive care unit

Many children who require hospitalization in the pediatric intensive care unit (ICU) are unable to or have difficulty communicating through speech, whether because of preexisting or acute conditions. Children who are unable to be heard and understood using only speech benefit from aided augmentative and alternative communication (AAC), including in hospital settings. This qualitative interview study sought to understand the perspectives of nurses on care and support for children who use or would benefit from aided AAC in the pediatric ICU. Participants were six nurses who worked in pediatric intensive care at a tertiary care unit of a children's hospital in the United States. Three main themes were identified related to nurses' views about supporting children's communication: (a) Caring for the Whole Child, (b) Needing Support from Others and Moving between Roles, and (c) Working with Available Resources and Demands. Nurses emphasized the importance of a holistic approach to care, the impact of others' support and knowledge, and a desire for building greater capacity for promoting children's access to effective communication. Findings offer insight that could improve patient-centered care for children with complex communication needs and support for nurses themselves, particularly within the broader context of ICU liberation.

Effects and implementation of an intervention to improve sleep, fatigue and recovery among healthcare workers with night shifts: A pre- and post-test study

BACKGROUND

Previous intervention studies among night workers mainly focused on single interventions and found inconclusive evidence for effectiveness. A comprehensive intervention approach that includes individual and environmental components has been argued as important. Gaining insight into contributing factors for the implementation of interventions for night workers and effectiveness is important to distinguish between theory and programme failure.

OBJECTIVES

To evaluate the effects and implementation of the PerfectFit@Night intervention to improve sleep, fatigue and recovery of night workers in healthcare, using the RE-AIM framework, which assesses reach, effectiveness, adoption, implementation and maintenance of interventions.

DESIGN

A prospective pre-post study design, with two measurements before and three and six months after the intervention.

SETTING

Twelve different departments of a university hospital in the Netherlands.

PARTICIPANTS

Healthcare workers working night shifts (n = 210).

METHODS

PerfectFit@Night consisted of environmental (provision of a powernap bed and healthy food, and workshop healthy rostering) and individual elements (e-learning and sleep coaching) and was implemented for three months in a phased manner. Questionnaires, logbooks and interview data were used. Effects of the intervention on sleep, fatigue and recovery were evaluated with mixed-effects models, and implementation factors of reach, adoption, implementation and maintenance were evaluated.

RESULTS

Night shift-related insomnia (-11 %-points, 95 % CI: -19 %, -4 % at three months), need for recovery (β: -2.45, 95 % CI: -4.86, -0.03 at six months) and fatigue (OR: 0.46, 95 % CI: 0.25, 0.86 at six months) decreased significantly after the intervention. No changes were found for subjective sleep quality and sleep duration. Barriers and facilitators for implementation were identified for each intervention element at individual (e.g., dietary preferences), organisational (e.g., responsibilities at work) and workplace levels (e.g., location of power nap bed), and for the intervention itself (e.g., useful information in e-learning). Although satisfaction was high and continuation was preferred, embedding of the intervention in the daily routine was limited. Facilitators for future implementation include a positive attitude towards the intervention, clear guidelines regarding intervention elements, appointment of night workers as ambassadors, and suitable conditions in terms of work demands and for the intervention elements.

CONCLUSIONS

The multi-faceted PerfectFit@Night intervention reduced insomnia, fatigue and need for recovery in night workers in healthcare. The most important facilitators to improve the implementation of PerfectFit@Night exist at the organisational level (e.g., positive attitude within the culture and suitable work demands). Combining effect and implementation evaluation is crucial to identify barriers and facilitators that hamper or enhance intervention effects.

TRIAL REGISTRATION

The study was registered in the Netherlands Trial Register on 17 January 2021 (trial number NL9224).

Comparison of serum alkaline phosphatase levels between two measurement methods in chronic hemodialysis patients in Japan: involvement of ABO blood group system and relationship with mortality risk

BACKGROUND

Elevated serum alkaline phosphatase (ALP) levels are a risk factor for all-cause mortality in hemodialysis patients. Traditionally in Japan, ALP measurements were conducted using the JSCC method, which yields higher ALP measurement values than the IFCC method, mainly due to its increased sensitivity to intestinal ALP.

METHODS

Serum total ALP levels before and after switching the assay method from JSCC to IFCC were compared among different blood types in 521 hemodialysis patients (Study 1). The association between ALP levels measured by the JSCC method and 7-year mortality was analyzed, including blood types and liver function parameters as covariates, in 510 hemodialysis patients (Study 2).

RESULTS

ALP levels measured by the JSCC method were approximately three times higher than those measured by the IFCC method, with significant elevation in patients with blood types B and O compared to those with blood types A and AB. Similarly, ALP levels measured by the IFCC method were significantly higher in patients with blood types B and O compared to those with blood types A and AB (Study 1). The highest tertile of ALP levels showed a significantly increased risk of all-cause mortality, even after adjusting for patient background. However, this significance disappeared when serum liver function-related or inflammatory markers were included as covariates (Study 2).

CONCLUSION

ALP levels measured by the JSCC method are associated with life prognosis, but caution should be exercised due to their elevation in patients with blood types B and O and in those with hepatic dysfunction or inflammation.

A case series on parathyroid carcinoma: Diagnostic challenges and therapeutic approaches

INTRODUCTION

Parathyroid carcinoma is an exceptionally rare endocrine malignancy, constituting <1 % of primary hyperparathyroidism (PHPT) cases. It presents with more severe hypercalcemia and higher PTH levels than benign parathyroid diseases, requiring increased clinical awareness for accurate identification and specialized management. The results of this case series may provide insight into the clinical presentation, diagnostic workup, surgical management, and prognosis of parathyroid carcinoma, supplemented by a comprehensive review of current diagnostic and therapeutic approaches.

METHODS

We retrospectively reviewed three cases of parathyroid carcinoma treated at a tertiary referral hospital. We analyzed patient demographics, clinical presentation, imaging studies, surgical interventions, histopathological findings, and follow-up data. We emphasized intraoperative decisions, criteria for achieving sustained hormonal control, and long-term monitoring protocols.

RESULTS

Patient 1: An 84-year-old male patient presented with severe hypercalcemia and elevated PTH levels. Preoperative imaging, including 4D CT and sestamibi scan, identified a 3.7 cm, 9.32-gram parathyroid mass, which was surgically resected. Despite removing the mass and normalizing calcium levels, PTH levels remained elevated, suggesting residual disease. Patient 2: A 77-year-old male patient with osteoporosis and a history of kidney stones underwent presurgical parathyroid scintigraphy, which indicated a right superior parathyroid adenoma. A 3 cm, 3.55-gram parathyroid carcinoma was successfully removed, normalizing calcium and PTH levels. Follow-up imaging and labs confirmed no recurrence. Patient 3: A 61-year-old female patient with end-stage renal disease presented with a 5 cm hypervascular neck mass. Preoperative 4D CT and ultrasound suggested an adenoma. After surgery, PTH levels normalized, but the patient died five years later from an unrelated stroke.

CONCLUSION

Parathyroid carcinoma is a rare malignancy that demands thorough diagnostic procedures, imaging techniques, precise surgical intervention, and vigilant long-term follow-up to manage the risk of recurrence. Elevated PTH and calcium levels should raise suspicion of malignancy, especially in severe hypercalcemia. This case series illustrates how the disease can present variably, with unique challenges in each patient. Despite the limitations of current adjuvant therapies, advancements in genetic and molecular research hold promise for future therapeutic options.

Anterior communicating artery aneurysm with concomitant A2 segment triplication and anterior communicating artery fenestration, A rare case series on microsurgical treatment

Introduction and importance

There are few cases of multiple simultaneous anterior communicating artery (AComA) aneurysms with A2 triplication and AComA duplication.

Cases presentation

(1) A fenestrated AComA with a saccular aneurysm (neck diameter 9 mm; dome height 8 mm) projecting superiorly from the distal AComA branch, as well as an anomalous artery arising from the posterior surface of the same AComA. (2) A duplicate AComA with a saccular aneurysm (neck diameter of 5 mm; dome height of 9 mm) projecting superioposteriorly from the distal AComA branch, as well as an anomalous artery arising from the anterior surface of the same AComA was diagnosed. Both were treated by microsurgical titanium clip occlusion.

Clinical discussion

Anatomical variations are believed to enhance the risk of anterior communicating artery (AComA) aneurysms, accounting for ~30% of all intracranial aneurysms. In such circumstances, the goal is to occlude the aneurysmal lesions safely while preserving the patency of other branches.

Conclusion

AComA aneurysms accompanied by anomalous triplicated A2 and fenestrated AComA are rare and challenging. Such complex cases response best using microsurgery using titanium clip occlusion with durable favorable outcomes.

Percutaneous Screw Distraction for Anatomic Restoration: Case Series

BACKGROUND AND OBJECTIVES

Percutaneous pedicle screw fixation with distraction reduces morbidity after traumatic thoracolumbar burst fractures; however, there are substantial limitations, particularly for correction of kyphosis. The use of fixed-angle screws may offer improved anatomic restoration, facilitating greater postdistraction vertebral height restoration and spinal canal fragment reduction. We examined the radiographic results of distraction across fixed-angle screws immediately after surgery and in long-term follow-up.

METHODS

Demographic and clinical characteristics were captured for patients with traumatic thoracolumbar fractures undergoing percutaneous pedicle screw fixation by a single surgeon. Radiographic measurements were collected at predistraction, postdistraction, and long-term follow-up time points. Paired t -tests, Student's t -tests, Mann-Whitney U tests, and χ 2 tests were used to assess data where appropriate.

RESULTS

The case series included 22 patients (77.3% male; mean age 42.0 ± 18.4 years). Hounsfield density consistent with osteopenia was seen in 13.6% of patients at the time of injury. Sporting injuries and motor vehicle accidents were common (both 31.8%). Most injuries occurred at L1 (45.5%). Upon long-term follow-up, the mean injured-level predistraction cross-sectional area improved from 2.1 to 2.9 cm 2 ( P < .01). Compared with the superadjacent level, the injured-level cross-sectional canal area improved by 28.6% ( P < .01). Vertebral body index also improved significantly (18.8° mean change, P < .01). The mean bisegmental Cobb angle improved by 6.2° ( P = .01), and injured vertebral body compression decreased by 22.4% ( P < .01). Significant improvement in correction was achieved with experience, with final technique yielding superior cross-sectional area ( P = .04) and compression ratios ( P = .03).

CONCLUSION

Distraction across fixed-angle percutaneous screw instrumentation systems stabilizes traumatic thoracolumbar burst fractures, corrects deformity, and decompresses the spinal canal. Further comparative research is necessary to demonstrate whether outcomes are different between percutaneous instrumentation vs open fusion for thoracolumbar trauma.

Adverse childhood experiences and psychiatric comorbidity in multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis in the Canadian longitudinal study on aging

OBJECTIVES

Adverse childhood experiences (ACE) are associated with immune-mediated inflammatory diseases (IMID). We evaluated whether: (i) ACE associate with psychiatric comorbidity among individuals with IMID, including rheumatoid arthritis (RA), multiple sclerosis (MS), and inflammatory bowel disease (IBD); (ii) whether psychiatric disorders mediate the relationship between ACE and IMID; and (iii) whether these findings differ from those in individuals with other chronic physical disorders.

METHODS

Using data from the Canadian Longitudinal Study on Aging (CLSA) we performed a retrospective case-control study of participants aged 45-85 years recruited between 2010 and 2015. ACE were queried using questions derived from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire. We used multivariable logistic regression and causal mediation analysis to address our objectives.

RESULTS

We included 13,977 CLSA participants. Among the 31 % of IMID participants who reported a comorbid psychiatric disorder, 79 % reported a history of ACE. ACE associated with increased odds (OR [95 % CI]) of a psychiatric disorder (2.55 [1.02-6.35]) among participants with IMID; this did not differ across IMID. The total effect (OR [95 % CI]) of ACE on IMID was 1.11 (1.07-1.16), of which 10.60 % (8.04-17.47) was mediated by psychiatric disorders. We found similar associations among participants with other chronic physical disorders.

CONCLUSION

Our findings suggest that psychiatric disorders partially mediate the association between ACE and IMID. Most participants with IMID and comorbid psychiatric disorders report a history of ACE and may benefit from trauma-informed mental health care.

Unraveling the Complexities of Sleep Disturbances: A Scientific Perspective

How to cite this article: Uzunçıbuk H, Fiorillo L, Ronsivalle V, et al. Unraveling the Complexities of Sleep Disturbances: A Scientific Perspective. J Contemp Dent Pract 2024;25(12):1081-1083. Keywords: Circadian rhythm disorders, İnsomnia, Obstructive sleep apnea, Sleep disturbances.

Granulosa cell tumor - Different faces of one neoplasm. A case series

INTRODUCTION

Granulosa cell tumor (GCT) accounts for 3-5 % of all ovarian malignancies, being the most common among those originating from the sex cords and ovarian stroma. GCTs can be divided into juvenile and adult types, with the latter occurring mostly in perimenopausal women. These hormonally active tumors present diverse clinical manifestations, primarily related to elevated estrogen levels. The treatment is primarily surgical; other methods, mainly chemotherapy, are also used.

PRESENTATION OF CASES

Three cases highlight the heterogeneity of GCTs. Case 1 involved a 34-year-old woman diagnosed with ovarian tumor during routine gynecological follow-up. Stage IA GCT was diagnosed. Fertility-sparing surgery followed by chemotherapy led to a favorable outcome, including two pregnancies. Case 2 involved a postmenopausal woman with a large pelvic mass. Surgery revealed a Stage IA GCT. Chemotherapy was stopped early due to complications. Case 3 featured a 47-year-old with acute abdominal symptoms caused by a ruptured GCT, leading to emergency surgery and subsequent radical treatment.

DISCUSSION

GCTs are hormonally active, causing symptoms such as abnormal bleeding or abdominal discomfort. Prognosis is generally favorable, especially in early-stage cases. Long-term surveillance is essential due to the potential for late recurrences. Fertility-sparing surgery is feasible in young patients, while chemotherapy is mainly used for advanced disease or recurrence.

CONCLUSION

GCTs, in addition to being rare, present with a wide range of clinical manifestations. Individualized treatment based on patient age, tumor stage, and fertility plans is crucial for favorable outcomes. Long-term monitoring is recommended due to the risk of late recurrence.

Bart syndrome with musculoskeletal deformity: a rare case report

Introduction

Bart syndrome is a rare genetic disorder characterized by epidermolysis bullosa (EB), aplasia cutis congenita, that is congenital local absence of skin and nail abnormalities.

Case Presentation

The authors herein, present a case of a 14-year-old boy with Bart syndrome. The syndrome was diagnosed clinically. On examination, multiple generalized blisters were present and absence of nails in the toes of both feet and the middle finger of the left hand, which was associated with musculoskeletal deformity.

Discussion

Bart syndrome, an inherited autosomal dominant disorder, is an exceedingly rare disorder. Musculoskeletal deformity is an uncommon presentation of this syndrome. It is mostly associated with Dystrophic type of EB. It is mostly a clinical diagnosis; however, histopathological study, direct immunofluorescence, and genetic testing helps in diagnosing the type of EB.

Conclusion

The absence of skin in a localized area at birth is a crucial indicator for diagnosing Bart syndrome at birth, which later heals and can obscure the diagnosis. Early diagnosis and conservative management prevent the disease progression and complications.

Exploration of epileptic networks in temporal lobe encephaloceles with stereotactic EEG: Electroclinical characteristics and surgical outcomes

OBJECTIVE

Temporal lobe encephaloceles (TLEN) have been implicated as a cause of temporal lobe epilepsy (TLE), the treatment which is primarily surgical; however, there is no clear consensus on the optimal surgical approach, because it is unclear whether TLE related to TLEN can be addressed by a restricted encephalocele resection or if a more extensive resection is required. The aim of the current article is to report the clinical and electrophysiological profile of patients with TLE secondary to TLEN who underwent stereotactic electroencephalography (SEEG) implantation to identify the epileptogenic network.

METHODS

A retrospective review was performed of patients with TLE related to TLEN who underwent SEEG implantation. Medical charts were reviewed for demographic data, the results of noninvasive and invasive investigations, and operative details. Surgical outcomes were based on Engel classification with at least 6 months follow-up.

RESULTS

Nine patients were identified. The mean age at epilepsy onset was 28 years (range, 15-41 years), and 7/9 patients were female. Scalp EEG revealed interictal epileptiform activity most often maximum in the frontotemporal and/or temporal regions. A discrete TLEN was often not identified on initial imaging, but was identified during re-review or at the time of surgery. Seizure onset zones during SEEG were localized to the mesial temporal structures, the temporal pole, or both. One patient became seizure-free following SEEG and another refused further surgery. Of the 7 patients who underwent epilepsy surgery, 5/7 underwent an anterior temporal lobectomy-surgical outcomes were favorable, with 5/7 achieving Engel I outcomes.

SIGNIFICANCE

Invasive SEEG monitoring demonstrated ictal onsets may not be restricted to the TLEN, and often the temporal pole and mesial structures are involved at seizure onset. Ictal propagation patterns vary significantly, which may be related to the underlying pathology and explain the variability in semiology. These findings may inform surgical treatment options.

PLAIN LANGUAGE SUMMARY

Temporal lobe encephaloceles can cause intractable epilepsy, although their presence may be missed on routine imaging. The management of encephaloceles is primarily surgical; however, the optimal surgical approach can be unclear. Invasive monitoring with SEEG may help characterize the epileptogenic network and result in more optimal surgical outcomes.