Embryonic exposure to flubendiamide induces hepatotoxicity in domestic chicks by altering drug-metabolizing enzymes, antioxidant status, and liver function

Pesticides have increased crop yield but severely impacted ecosystems and non-target organisms. Flubendiamide, a new generation pesticide, targets insect larvae but also affects non-target organisms. This study examines the effects of lowest observed effect concentration of technical grade flubendiamide (0.5 µg/µL) flubendiamide on chick liver, focusing on cytochrome P450 (CYP) enzyme expression, oxidative stress, and liver damage. Chick embryos treated with flubendiamide showed significant alterations in CYP mRNA and protein levels, indicating increased toxicant accumulation. Elevated CYP3A4, CYP1A1, CYP1A2, and CYP2C19 levels were noted, suggesting enhanced biotransformation and detoxification processes. However, increased oxidative byproducts led to oxidative stress, as evidenced by decreased glutathione (GSH) levels and elevated superoxide dismutase (SOD) and catalase activities. DCFDA staining confirmed increased hydrogen peroxide (H2O2) levels, indicating heightened reactive oxygen species (ROS). Liver function tests revealed significant increases in serum ALP, ALT, and AST levels, indicating acute liver damage. Histopathological analysis showed structural liver damage, including expanded sinusoidal spaces, impaired portal veins, and compromised hepatocyte architecture. These findings underscore flubendiamide's potential hepatotoxicity in non-target organisms, emphasizing the need for cautious pesticide use to minimize environmental impacts.

A new nano approach to prevent tumor growth in the local treatment of glioblastoma: Temozolomide and rutin-loaded hybrid layered composite nanofiber

Total resection of glioblastoma (GB) tumors is nearly impossible, and systemic administration of temozolomide (TMZ) is often inadequate. This study presents a hybrid layered composite nanofiber mesh (LHN) designed for localized treatment in GB tumor bed. The LHN, consisting of polyvinyl alcohol and core-shell polylactic acid layers, was loaded with TMZ and rutin. In vitro analysis revealed that LHNTMZ and LHNrutin decelerated epithelial-mesenchymal transition and growth of stem-like cells, while the combination, LHNTMZ +rutin, significantly reduced sphere size compared to untreated and LHNTMZ-treated cells (P < 0.0001). In an orthotopic C6-induced GB rat model, LHNTMZ +rutin therapy demonstrated a more pronounced tumor-reducing effect than LHNTMZ alone. Tumor volume, assessed by magnetic resonance imaging, was significantly reduced in LHNTMZ +rutin-treated rats compared to untreated controls. Structural changes in tumor mitochondria, reduced membrane potential, and decreased PARP expression indicated the activation of apoptotic pathways in tumor cells, which was further confirmed by a reduction in PHH3, indicating decreased mitotic activity of tumor cells. Additionally, the local application of LHNs in the GB model mitigated aggressive tumor features without causing local tissue inflammation or adverse systemic effects. This was evidenced by a decrease in the angiogenesis marker CD31, the absence of inflammation or necrosis in H&E staining of the cerebellum, increased production of IFN-γ, decreased levels of interleukin-4 in splenic T cells, and lower serum AST levels. Our findings collectively indicate that LHNTMZ +rutin is a promising biocompatible model for the local treatment of GB.

Fatal outcome of postpolypectomy syndrome: A case report

Postpolypectomy syndrome (PPS), also known as postpolypectomy coagulation syndrome or transmural burn syndrome, is a rare complication following colonic polypectomy characterized by abdominal pain, fever, and leukocytosis. Herein, we present a case of a patient in his 70s who developed abdominal pain and fever after a polypectomy. He was diagnosed with PPS, which rapidly progressed to septic shock necessitating left hemicolectomy. Pathological findings confirmed intestinal necrosis and severe electrocoagulation injury. Despite surgical intervention, the patient succum to multiple complications. While usually mild, approximately 0.07% of PPS cases require hospitalization due to localized peritonitis from electrocautery. Conservative management is effective, though severe complications are rare. Despite its generally favorable prognosis, our case highlights rapid progression to fatal septic shock postsurgery. Recognition of PPS is crucial, particularly in patients with abdominal pain postpolypectomy, as it can lead to life-threatening outcomes.

Single-Stage Endoscopic Repair of Pediatric Basal Encephalocele: A Comprehensive Multimedia Case Report

BACKGROUND AND IMPORTANCE

Basal encephaloceles are the result of a concomitant cranial and dural defect that allows for inferior displacement of cerebral tissue, meninges, and cerebrospinal fluid into the paranasal sinuses and outside the cranial vault. This work illustrates a step-by-step surgical approach of a successful single-stage, endoscopic repair of a congenital basal encephalocele in a 10-year-old child, using a free mucosal middle turbinate graft that provided effective results without utilization of traditional open reconstructive techniques or vascularized flaps.

CLINICAL PRESENTATION

A previously healthy 10-year-old male with a history of unilateral clear rhinorrhea was admitted as an inpatient because of an acute episode of nausea, vomiting, and confusion, accompanied by fever, diplopia, and bilateral abducens nerve palsies. Preoperative imaging revealed a 2-cm right-sided intranasal mass accompanied by a subcentimeter skull base defect spanning the lateral lamella. After completing a course of intravenous antibiotic therapy for 1 week after a negative lumbar puncture to ensure clearance of intracranial infection, the decision was made to proceed with definitive endoscopic skull base repair to obviate recurrent bacterial meningitis episodes and potential neurological complications.

CONCLUSION

This study demonstrates technical feasibility of a single-stage endoscopic endonasal approach for pediatric basal encephalocele resection and repair which minimizes craniofacial morbidity associated with traditional open approaches and sinonasal morbidity associated with local pedicle-based flaps for small cranial base defects in this unique patient population.

Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases

INTRODUCTION AND IMPORTANCE

Mesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult.

CASE PRESENTATION

We present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma.

CLINICAL DISCUSSION

BCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology.

CONCLUSION

Mesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

Lung cancer screening in India: Preparing for the future using smart tools & biomarkers to identify highest risk individuals

There is a growing burden of lung cancer cases in India, incidence projected to increase from 63,708 cases (2015) to 81,219 cases (2025). The increasing numbers are attributed to smoking (India currently has nearly 100 million adult smokers) and environmental pollution. Most patients present with advanced disease (80-85% are incurable), causing nearly 60,000 annual deaths from lung cancer. Early detection through lung cancer screening (LCS) can result in curative therapies for earlier stages of lung cancer and improved survival. Annual low-dose computerized tomography (LDCT) is the standard method for LCS. Usually, high-risk populations (age>50 yr and >20 pack-years of smoking) are considered for LCS, but even such focused screening may be challenging in resource-limited countries like India. However, developing a smart LCS programme with high yield may be possible by leveraging demographic and genomic data, use of smart tools, and judicious use of blood-based biomarkers. Developing this model over the next several years will facilitate a structured cancer screening programme for populations at the highest risk of lung cancer. In this paper, we discuss the demographics of lung cancer in India and its relation to smoking patterns. Further, we elaborate on the potential applications and challenges of bringing a smart approach to LCS in high-risk populations in India.

Enhancing orthopaedic surgery research: developing manuscripts using systematic checklists

BACKGROUND AND CHALLENGES

Writing and publishing research is important in the fields of orthopaedic surgery, and medicine in general. In recent years, the number of orthopaedic publications has significantly increased, highlighting the value of possessing the ability to write and publish a paper. However, publishing research is not an easy task, especially if English is not a native language. Non-native English speakers have been reported to experience barriers to writing and publishing research in English, the dominant language of scientific publication. This affects not only individual researchers, but also the scientific community in general. To improve reporting in scientific manuscripts, many peer-reviewed guidelines have been published for a variety of study designs and study types. These guidelines are made available through the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network and have associated checklists that guide authors in the synthesis of their research manuscript.

PURPOSE

Whether you are a non-native English speaker or a novice research writer, these checklists can ameliorate the process of building your manuscript. The purpose of this paper is to empower orthopaedic researchers, and researchers in general, through an easy-to-follow framework for writing a research manuscript using available checklists and general research knowledge.

Surgical management of anterior sacral meningoceles: an illustrated case series and review of the literature

BACKGROUND

Anterior sacral meningocele (ASM) is an uncommon variant of spinal dysraphism. Surgical correction for this condition is challenging and optimal corrective approaches are uncertain.

OBJECTIVE

To share our experience of managing this rare condition using the posterior trans-sacral approach and provide a contemporary review of the literature.

METHODS

Retrospective review of case notes, operative records, and imaging of eligible patients treated via the posterior trans-sacral approach between 2006 and 2020 at our regional neurosciences centre.

RESULTS

Three patients, two females and one male with a mean age of 30 years (range 16-38), were treated. Presenting symptoms included lower abdominal pain and recurrent miscarriages. Patients underwent corrective surgery using the posterior approach involving a sacral laminectomy, durotomy and closure of the communicating fistula. A single patient required reoperation due to early recurrence. Another patient proved challenging because of a very large sacral fistula and required two procedures due to the development of high-pressure headaches secondary to a recurrence. All patients improved symptomatically postoperatively and remained symptom free at the last clinic follow-up and have been discharged. Following review of the literature, only two other non-syndromic cases have been described.

CONCLUSIONS

ASM is an uncommon congenital abnormality, typically presenting with mass effect symptoms secondary to a presacral cystic mass. Surgical management using a posterior approach to close the meningeal sac is feasible and less invasive than an anterior approach. Long term clinical outcomes in our series were satisfactory.

Bilateral spontaneous internal carotid artery dissection; a treatment dilemma: A case report and literature review

INTRODUCTION

Spontaneous carotid artery dissection in association with exercise is well known. A bilateral occurrence is a rarely reported finding. SVS guidelines discussed the role of antiplatelets and anticoagulants in management, however, management of dissections associated with pseudoaneurysm formation is still controversial. Herein, we report a case of walking-induced spontaneous bilateral carotid artery dissection complicated by a unilateral pseudoaneurysm formation treated conservatively with satisfactory outcome.

CASE PRESENTATION

A 41-year-old male presented with a sudden severe headache, blurred vision, and transient right upper limb weakness after a long walk. Initial CT angiography showed bilateral carotid artery dissection. The patient was managed conservatively with antiplatelet therapy and close follow up. Follow-up imaging showed gradual resolution of the dissection bilaterally and a stable right internal carotid artery pseudoaneurysm. Five years later, the patient remained asymptomatic with shrinking ICA pseudoaneurysm.

DISCUSSION

Bilateral spontaneous carotid artery dissection is a rare condition that can present with stroke-like symptoms, including visual changes and motor deficits, as observed in the presented case. Conservative management with antiplatelet therapy showed a favorable outcome, aligning with the recommendations of the SVS guideline. The role of antiplatelet therapy in managing pseudoaneurysms as a complication of dissection remains controversial, with endovascular interventions generally preferred despite reported complications. However, in our case, conservative management with antiplatelet therapy showed satisfactory outcomes, as supported by some recent studies.

CONCLUSION

The reported case presents a rare occurrence of spontaneous bilateral carotid artery dissection complicated by a unilateral pseudoaneurysm formation. Conservative treatment with antiplatelets is associated with good outcomes, and potentially in highly selected patients complicated with pseudoaneurysm formation.

Technological Advancements in Augmented, Mixed, and Virtual Reality Technologies for Surgery: A Systematic Review

Recent advancements in artificial intelligence (AI) have shown significant potential in the medical field, although many applications are still in the research phase. This paper provides a comprehensive review of advancements in augmented reality (AR), mixed reality (MR), and virtual reality (VR) for surgical applications from 2019 to 2024 to accelerate the transition of AI from the research to the clinical phase. This paper also provides an overview of proposed databases for further use in extended reality (XR), which includes AR, MR, and VR, as well as a summary of typical research applications involving XR in surgical practices. Additionally, this paper concludes by discussing challenges and proposed solutions for the application of XR in the medical field. Although the areas of focus and specific implementations vary among AR, MR, and VR, current trends in XR focus mainly on reducing workload and minimizing surgical errors through navigation, training, and machine learning-based visualization. Through analyzing these trends, AR and MR have greater advantages for intraoperative surgical functions, whereas VR is limited to preoperative training and surgical preparation. VR faces additional limitations, and its use has been reduced in research since the first applications of XR, which likely suggests the same will happen with further development. Nonetheless, with increased access to technology and the ability to overcome the black box problem, XR's applications in medical fields and surgery will increase to guarantee further accuracy and precision while reducing risk and workload.

Sympathetic Ophthalmia Following an Evisceration Surgery-A Case Report

Sympathetic ophthalmia (SO) is a rare, bilateral, granulomatous, panuveitis following perforating trauma or surgical intervention in one eye. Here, and to the best of knowledge, we report the first case of SO following an evisceration surgery in Pakistan. A 32-year-old, Pakistani, female presented with pain and decreased visual acuity in her right eye, at Civil Hospital, Karachi, 1 week after an evisceration surgery was performed on her left eye, following corneal perforation due to unresolved keratitis. Diagnosis of SO was made on the basis of clinical presentation and confirmed by slit lamp examination which revealed mutton fat keratic precipitates, posterior synechiae, and optic disc swelling. She was administered high-dose corticosteroids to which she did not respond. She was then prescribed methotrexate which resolved the inflammation and improved visual acuity. Initiating prompt treatment for the sympathizing eye led to effective management of the patient and prevented complete blindness.

Chitosan-encapsulated selenium nanoparticles alleviate CCl4 induced hepatotoxicity through synergistically modulating NF-κB and Nrf2 signaling pathways and regulating Bcl-2 and Caspase-3 expression: A comprehensive study with multiple regression analysis

BACKGROUND

The delivery of selenium in a nano-form (Se-NPs) is a promising modality of treatment for various oxidative stress-induced diseases.

OBJECTIVE

This study aims to investigate the conceivable effects of selenium nanoparticles either alone (Se-NPs) or encapsulated with chitosan (Se-CS-NPs) on toxicity induced by CCl4 in rats.

METHODS

Eighty albino rats were divided equally into eight groups. The first group was the placebo. The second group was a positive control, while the third and the fourth groups got orally (Se-NPs 5 mg/Kg) and (Se-CS-NPs 225 mg/Kg) respectively. The fifth and sixth groups were protective groups in which Se-NPs or Se-CS-NPs were given simultaneously. The seventh and eighth groups were therapeutic as they received either Se-NPs or Se-CS-NPs after stopping the CCl4 injection for 4 weeks more.

RESULTS

Our results showed that the protective and therapeutic groups showed an increase in caspase-3 gene expression with a decline in the expression of Bcl-2, Nrf2, and AFP genes. Histopathological and immunohistochemical investigations showed the role of selenium nanoparticles either alone or coated with chitosan in decreasing fibrotic marker collagen I positive reaction CONCLUSION: Selenium nanoparticles showed an excellent effect in counteracting the toxic effect of carbon tetrachloride on liver functions, inflammation reactions, and apoptosis process. Moreover, using selenium nanoparticles has a strong role in preserving the liver architecture with its normal constituents. No additional benefit was observed when the selenium nanoparticles were encapsulated with chitosan.

Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus - A case series

INTRODUCTION AND IMPORTANCE

Pilonidal disease may present with a draining secondary sinus or granuloma, but the development of these findings is not well-characterized.

CASE PRESENTATION

Two adolescent males presented with pilonidal disease. The first patient had a gluteal cleft abscess, and an incision and drainage procedure was performed. Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue. He underwent a pit-picking procedure along with excision of the granuloma. A large amount of hair was also removed from within the pilonidal sinus. The second patient underwent an incision and drainage procedure to treat the pilonidal abscess. The incision site evolved into a granuloma with recurring drainage. A pit-picking procedure was performed, and the granuloma was excised. During the excision, a moderate amount of hair was evacuated from the pilonidal sinus.

CLINICAL DISCUSSION

Many pilonidal patients present with a granuloma or secondary sinus at the gluteal cleft, but there has been no documentation of the natural history of this development. The role of hair is central to pilonidal disease pathophysiology and is a known factor in foreign body granuloma formation - a cutaneous inflammatory response to endogenous or exogenous material in the dermis that is not broken down readily by macrophages.

CONCLUSION

Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast: A case series

Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. In 2005, only 109 cases have been reported since its initial description in 1986 by Vuitch et al. when it presented in one patient as a palpable breast mass. We retrospectively reviewed data from 2020 to 2023 of patients diagnosed with PASH by surgical excision. Our 13 cases represent one of the most numerous reported from a single institution. All histologic specimens were examined by a single pathologist. All patients had breast masses on imaging or were clinically evident. Eleven of the patients (84.6%) were diagnosed by surgical excision, whilst only two (15.4%) were diagnosed by core needle biopsy. Imaging revealed no strongly distinctive features for PASH. The age of the patients ranged from 25 to 68 years. All but one of the women were premenopausal at the time of diagnosis. This study suggests that PASH is a lesion whose diagnosis is often incidental and the recommended treatment is more commonly surgical.

The most lethal human protozoan parasite is plasmodium falciparum: severe malaria-associated acute renal failure - a case report

Introduction and importance

Malaria continues to be a significant global public health problem, particularly in endemic nations. The most common cause of acute renal failure is a Plasmodium falciparum infection.

Case presentation

A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and a lack of appetite. The patient had no prior history of malaria. He was not given any antimalarial medication as prophylaxis while traveling to his workplace. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient's blood. At the border of the colitis, the liver was palpable. Both the chest radiograph and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. He received 1000 ml of normal saline solution with 40% glucose solution as part of his supportive care. He received intravenous artesunate 60 mg (2.4 mg/kg) when he was admitted to an ICU, and then every 12 and 24 h for the next 3 days (a total of three doses, 540 mg).

Clinical discussion

A typical symptom of severe malaria is acute kidney injury, which also carries its own risk of death. In regions with active transmission, Plasmodium falciparum is recognized as a significant contributor to acute renal damage.

Conclusion

The mechanism proposed for kidney injury by severe malaria is hemodynamic dysfunction, followed by inflammation and immunological dysregulation in the patient in this study. He had reduced serum sodium levels within the red blood cells, which led to calcium influx into the cell, altering the red blood cell's deformability.

COVID-19 is associated with high blood glucose levels: diabetic neuropathy during the SARS-CoV-2 pandemic: a case report

Introduction and Importance

The nerves in the legs and feet are most frequently damaged by diabetic neuropathy. The COVID-19 infection is associated with a high risk of neuropathy symptoms.

Case Presentation

On 12 July 2022, a 58-year-old black female retiree with significant symptoms of numbness and muscle weakness in the hands and legs was brought into the emergency room. Seventeen years prior, she was diagnosed with type 2 diabetes mellitus. Metformin 1.5 g twice a day and glibenclamide 10 mg twice a day were part of her therapy regimen. When she was admitted to the emergency room, she described a one-day history of shortness of breath, frequent urination, excessive thirst, hyperglycemia, excessive appetite, fever, headache, and dehydration. A chest radiograph showed bilateral diffuse, patchy airspace opacities that could be caused by multifocal pneumonia or viral pneumonia. She started receiving 1000 ml of fluid resuscitation (0.9% normal saline) as soon as she was moved to an ICU, along with a drip-in insulin infusion.

Clinical Discussion

Diabetes, infections like COVID-19, poor vitamin levels, and other factors can all contribute to diabetic neuropathies. According to the Centers for Disease Control and Prevention, patients with type 2 diabetes mellitus are much more likely to experience severe morbidity and death from coronavirus disease.

Conclusion

Symptoms of diabetic neuropathy continued for months after a COVID-19 infection test resulted in a positive result.

Ruptured aortic aneurysm with previous endovascular aneurysm repair in a patient with high-grade angiosarcoma

Ruptured aortic aneurysms after endovascular repair is rare, particularly in the absence of type I or type III endoleaks. In such cases, a thorough investigation into the causes is imperative, including the consideration of an underlying malignancy. We report a case involving a 78-year-old woman who experienced abdominal aortic aneurysm rupture 4 years after aortic endograft treatment. We explanted the endograft and performed aortobi-iliac bypass. Initial aortic thrombus pathological analysis revealed atherosclerosis. However, the patient returned 4 months later with multiple lesions suggestive of metastases, and a reevaluation of the pathology slides uncovered a diagnosis of angiosarcoma.

Insights into the Medial Pectoral Nerve Transfer for Shoulder Abduction in Brachial Plexus Injuries: A Retrospective Case Series Analysis

BACKGROUND

Treatment priority in C5, C6, and C7 brachial plexus root avulsion is the recovery of shoulder function through reinnervation of shoulder muscles. The medial pectoral nerve is a potential donor for axillary nerve transfer, but outcomes are sparsely reported. This study reports the results of medial pectoral nerve transfer to the axillary nerve.

METHODS

We conducted a retrospective analysis of 12 patients with traumatic brachial plexus injury (C5, C6, and C7 root avulsion) who underwent medial pectoral nerve transfer to the axillary nerve. Sociodemographic and clinical characteristics, including electromyography findings, were documented. We assessed postoperative shoulder abduction strength and range of motion. Statistical analyses compared presurgery and postsurgery outcomes and contrasted our results with those from a study using spinal accessory nerve transfer to the suprascapular nerve.

RESULTS

Postsurgery, the mean shoulder abduction range of motion was 65.45°, with a median strength of M2. Significant improvement was noted compared to preoperative values. However, outcomes did not significantly surpass those from spinal accessory nerve transfer. Electromyography showed a low incidence of motor unit action potentials in the deltoid.

CONCLUSIONS

Medial pectoral nerve transfer to the axillary nerve did not yield superior results in shoulder abduction and deltoid reinnervation in our group of patients. At present, different nerve donors may also need to be considered for deltoid muscle reinnervation in patients with C5, C6, and C7 root avulsion to achieve better shoulder abduction recovery.

Clinician Prediction of Early Readmission Among Kidney and Liver Transplant Recipients

Introduction: Patients are at risk of hospital readmission after kidney and liver transplantation due to the complexity of posttransplant care. Currently, clinical practice relies on providers' prediction since there is a lack of specific strategies. However, the accuracy of clinicians' ability to predict readmissions using clinical judgment alone is unknown. Research Question: What is the accuracy of clinicians' ability to predict readmissions after transplantation using clinical judgment alone? Design: In 2019, clinical providers at a large, urban transplant center were electronically surveyed. Primary surgeons, nephrologists, transplant pharmacists, hepatologists, and nurses were asked, within 24 h of any kidney or liver transplant recipient discharge, to predict whether a patient would be readmitted within 30 days, and the suspected causes of readmission. Prediction accuracy was assessed by sensitivity, specificity, positive and negative predictive value, and F-score. Kappa scores were calculated to assess agreement between transplant surgeons and other providers. Results: Overall, N = 34 unique providers were surveyed about 148 kidney and 63 liver transplant recipients, and 27.0% of kidney recipients and 25.4% of liver recipients were readmitted within 30 days. The positive predictive values were low among clinical providers, ranging from 0.25 to 0.55. Agreements between providers were weak, but higher among kidney transplant providers (range: 0.42-0.44) than for liver transplant providers (range: -0.02-0.26). Conclusion: Clinical judgment alone to predict readmission among transplant recipients may not be sufficient and a combination of clinicians' predictions, multitiered discharge surveillance strategies and data-based predictive models may better identify high-risk patients and guide interventions to reduce readmission.

Clinical manifestations and treatment outcomes among hospitalised COVID-19 patients in tertiary hospitals in Tanzania, 2021-2022: a retrospective cohort study

Background

There have been differential mortality rates from COVID-19 in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this study in a sub-Saharan African setting. The aim of this study was to describe the clinical manifestations and outcomes of patients diagnosed with COVID-19 in selected tertiary hospitals in Tanzania.

Methods

This was a retrospective analysis of hospitalised adults confirmed SAR-COV-2 infection in five tertiary-level hospitals in Tanzania. Data collected and analysed included sociodemographic, radiological and clinical characteristics of the patients as well as the outcome of the admission (discharge vs death).

Results

Out of 1387 COVID-19 patients, 52% were males. The median age was 60 years ((IQR)=(19-102)). The most common symptoms were dyspnoea (943,68%), cough (889, 64%), fever (597,43%) and fatigue (570, 41%). In-hospital mortality was (476, 34%). Mortality significantly increased with increasing age, being the most in age >90 years (aHR (95% CI)=4.4 (2.52 to 28.82), p=0.02). Other predictors of mortality were not possessing a health insurance, (aHR (95% CI)=3.7 (1.09 to 14.25), p=0.04); chest pain, (aHR (95% CI)=2.27 (1.36 to 4.13), p=0.03); HIV positivity, (aHR (95% CI)=3.9 (1.46 to 8.15), p=0.03); neutrophilia, (aHR (95% CI)=1.12 (1.01 to 2.65), p=0.03); no use of ivermectin, (aHR (95% CI)=1.21 (1.04 to 1.57), p=0.04) and non-use of steroids, (aHR (95% CI)=1.36 (1.18 to 2.78), p=0.04). The retrospective nature of this study which based on documented patients' records, with a large number of patients left out of the analysis due to missed data, this might in a way affect the results of the present study.

Conclusion

In-hospital mortality was 34%. The independent predictors of mortality were advanced age, HIV infection, no possession of a health insurance, chest pain, neutrophilia and no use of steroids or ivermectin.

Recognizing the biological barriers and pathophysiological characteristics of the gastrointestinal tract for the design and application of nanotherapeutics

The gastrointestinal tract (GIT) is an important and complex system by which humans to digest food and absorb nutrients. The GIT is vulnerable to diseases, which may led to discomfort or even death in humans. Therapeutics for GIT disease treatment face multiple biological barriers, which significantly decrease the efficacy of therapeutics. Recognizing the biological barriers and pathophysiological characteristics of GIT may be helpful to design innovative therapeutics. Nanotherapeutics, which have special targeting and controlled therapeutic release profiles, have been widely used for the treatment of GIT diseases. Herein, we provide a comprehensive review of the biological barrier and pathophysiological characteristics of GIT, which may aid in the design of promising nanotherapeutics for GIT disease treatment. Furthermore, several typical diseases of the upper and lower digestive tracts, such as Helicobacter pylori infection and inflammatory bowel disease, were selected to investigate the application of nanotherapeutics for GIT disease treatment.

Acute Necrotizing Pancreatitis Leading to Hemosuccus Pancreaticus and Hemorrhagic Shock in the Setting of Decompensated Cirrhosis

Hemosuccus pancreaticus (HP) is a rare, life-threatening cause of upper gastrointestinal bleeding, often linked to chronic pancreatitis and pseudoaneurysm rupture into the pancreatic duct. However, its occurrence in acute necrotizing pancreatitis with decompensated cirrhosis is exceedingly rare and poses significant diagnostic and treatment challenges. We report a case of a 34-year-old male with decompensated alcoholic cirrhosis who developed hemorrhagic shock from HP following acute necrotizing pancreatitis. The initial imaging revealed a pancreatic tail hematoma and a splenic artery pseudoaneurysm, that was later found to have ruptured into the pancreatic duct, causing intermittent GI bleeding. Endoscopy showed clots extruding from the ampulla, and angiography confirmed active bleeding, leading to endovascular coil embolization. Despite intervention, the patient's coagulopathy and hemodynamic instability, related to his cirrhosis, worsened, ultimately resulting in death under comfort care. This case underscores the importance of considering HP in patients with pancreatic disease and unexplained GI bleeding, especially in the presence of pseudoaneurysms, as timely endovascular or surgical management, coupled with a multidisciplinary approach, is essential to improve outcomes.

Optimizing perioperative lung protection strategies for reducing postoperative respiratory complications in pediatric patients: a narrative review

Background and Objective

Despite significant advancements in the safe delivery of anesthesia and improvements in surgical techniques, postoperative respiratory complications (PRCs) remain a serious concern. PRCs can lead to increased length of hospital stay, worsened patient outcomes, and higher hospital and postoperative costs. Perioperative lung injury and PRCs are more common in children than in adults owing to children's unique physiology and anatomical characteristics. Studies have shown that lung-protective ventilation (LPV) strategies can improve lung function and minimize the risk of PRCs in adults. However, individualized LPV in children remains underexplored. This narrative review provides an overview of the various perioperative pulmonary protection strategies and their effect on pediatric PRCs.

Methods

We searched PubMed for articles published from 2000 to 2024, setting our inclusion criteria to include studies that involved pediatric patients, addressed LPV strategies, and reported data on PRCs. Non-English language studies, case reports, editorials, conference abstracts, and non-full text published literatures were excluded. We utilized the following keyword strategy: (((lung protective ventilation) OR (PEEP)) OR (recruitment maneuver)) OR (low tidal volume) AND (2000:2024[pdat])) AND (pediatric) filters. In total, 1,106 articles were retrieved, with only 23 being deemed relevant to the review. Data extraction and analysis were conducted by two independent researchers to ensure accuracy and consistency. We conducted descriptive statistical analysis for quantitative data and thematic analysis for qualitative data.

Key Content and Findings

The key content are an overview of risk factors for PRCs in children including the patients themselves, anesthesia, and surgery, as well as the effectiveness of LPV strategies in pediatric surgery, including low tidal volume (TV), positive end-expiratory pressure (PEEP), ultrasound-guided pulmonary recruitment maneuver (RM), low fraction of inspired oxygen (FiO2), pressure-controlled ventilation (PCV), as well as fluids, pain, and high-flow nasal cannula (HFNC). We found that age, mechanical ventilation with general anesthesia, and thoracic surgery increased the risk of PRCs in children. The application of LPV strategies in pediatric surgery had positive effect, including low TV combined with titrated PEEP, age- and physiologically appropriate FiO2, ultrasound-guided RM, target directed fluid infusion, adequate analgesia, and the use of HFNC in special circumstances. However, we also found that the application of LPV has certain potential risks and therefore needs to be implemented according to the patient's actual age and physical condition.

Conclusions

Perioperative LPV strategies show potential benefits in reducing lung injury and PRCs in pediatric patients. These strategies, including low TV, appropriate individualized PEEP, lung RM, and avoidance of high FiO2, appear to be effective methods for protecting lung function in pediatric patients. Additionally, perioperative fluid management and effective pain control are crucial for lung protection. The emerging use of HFNC therapy shows promise, but further research is needed to fully understand its benefits.

Case Report: A rare case of antenatally diagnosed mature adrenal teratoma in an infant: insights and literature review

Teratomas are germ cell tumors that arise from the derivatives of the three germ cell layers. They are categorized into subtypes by the extent of maturation, with mature teratomas being the most common subtype. While they can arise in various extragonadal regions, including the retroperitoneum, their occurrence in the retroperitoneal space is extremely rare. It is even more exceptional for these tumors to be located within the adrenal gland. In this report, we describe an 18-day-old female infant who presented with a left suprarenal mass. The mass was detected during prenatal screening via ultrasound at 30 weeks of pregnancy. Evaluation after birth, including a chest and abdomen computed tomography (CT) scan, revealed a large, well-defined left suprarenal mass. The mass was surgically resected and found to measure 9 cm × 7 cm × 5 cm. Histopathological examination confirmed a cystic mature teratoma containing a variety of well-differentiated tissues. The patient has shown excellent progress over the 1-year follow-up, with no evidence of recurrence. Only a few cases of mature adrenal teratoma have been reported, highlighting the importance of this case report.

Using a blend of oilseed meals in the diets of Nile tilapia (Oreochromis niloticus): effects on the growth performance, feed utilization, intestinal health, growth, and metabolic-related genes

In this study, Nile tilapia were fed a blend of oilseed meals (BOM) that includes cottonseed meal (CSM), linseed meal (LSM), sesame meal (SSM), and sunflower meal (SFM) at a ratio of 1 CSM: 1 LSM: 1 SSM: 1 SFM. Six diets were formulated where the first diet included FM and SBM as protein sources and considered the positive control diet (FM). Another five FM-free diets were formulated, where SBM was substituted with BOM and included at 0, 100, 200, 300, and 400 g/kg diet. After 90 days, the FBW, WG, and PER were markedly increased while FCR decreased by FM-based diet and BOM at 0, 100, or 200 g/kg compared to fish-fed BOM at 300, and 400 g/kg (P < 0.05). The groups treated with BOM at 100-200 g/kg demonstrated considerable impairments, followed by those treated with BOM at 300 g/kg. Furthermore, fish given BOM at 400 g/kg had significantly less intestinal histological characteristics than the other groups. The relative expression of the IGF-1, GHR1, FABP, and CCK genes were downregulated in tilapia-fed BOM at 200, 300, and 400 g/kg compared to fish-fed FM-based diet (P < 0.05). The relative cost of feed per kg fish gain showed 4.42, 7.11, 8.14, 10.32, and 8.10% reduction rates in fish-fed SBM, or BOM at 100, 200, 300, and 400 g/kg. In conclusion, dietary BOM can be incorporated in Nile tilapia diets at up to 200 g/kg without affecting growth performance or feed utilisation. High inclusion levels (300 and 400 g/kg) may impair growth performance and feed utilisation by disrupting intestinal histological characteristics and reducing expression of growth and metabolic genes (GHR1, IGF-1, FABP, and CCK) in the liver.

A Brief Historic Review of Research on Early Life Stress and Inflammation across the Lifespan

BACKGROUND

Extensive evidence from animal and human studies indicates that exposure to stress during sensitive developmental periods significantly increases the risk for psychiatric and physical disorders, resulting in reduced longevity. Chronic immune activation has been suggested as one pathway through which early adverse experiences may become biologically embedded. This paper highlights selected key findings and questions that first emerged in the literature and founded the field and then examines how research methods and questions have evolved over time.

SUMMARY

During the past decades, evidence from preclinical, clinical, and epidemiological studies has accumulated suggesting consequences of early life stress (ELS) exposure for immune function, particularly increased chronic inflammation or inflammatory responses. Scientific approaches to study the effects of ELS on the immune system have changed since the first studies on this topic were published.

KEY MESSAGES

Across different study designs, species, and methods, a consistent association between childhood adversity and a pro-inflammatory phenotype has been reported. We critically discuss which topics warrant further consideration and how current findings could be used to develop targeted interventions to prevent or reverse the biological embedding of ELS and resultant disease manifestations.

Absorbable Haemostatic Artefacts as a Diagnostic Challenge in Postoperative Follow-Up After Oncological Resection in Head and Neck Tumours: Systematic Review of Current Literature and Two Case Reports

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena.

Liver-related aspects of valoctocogene roxaparvovec gene therapy for hemophilia A: expert guidance for clinical practice

Adeno-associated virus-based gene therapy (valoctocogene roxaparvovec) is an attractive treatment for hemophilia A. Careful clinical management is required to minimize the risk of hepatotoxicity, including assessment of baseline liver condition to determine treatment eligibility and monitoring liver function after gene therapy. This article describes recommendations (developed by a group of hemophilia experts) on hepatic function monitoring before and after gene therapy. To prevent harmful liver-related effects, gene therapy is contraindicated in patients with uncontrolled liver infections, autoimmune hepatitis, liver stiffness ≥8 kPa, or cirrhosis. Before using gene therapy in patients with liver steatosis or other liver disorders, the risk of liver damage should be considered using a highly individualized approach. Treatment is not recommended in patients with abnormal liver enzymes, including alanine aminotransferase (ALT) at any level above the upper limit of normal (ULN). Therefore, pretreatment assessment of liver health should include laboratory tests, abdominal ultrasound, and liver stiffness measurements by transient elastography (TE). In the first year after therapy, ALT levels should be monitored 1 to 2 times per week to detect elevations ≥1.5× ULN, which may require immunosuppressant therapy. Patients with ALT elevation should receive prednisone 60 mg/d for 2 weeks, followed by stepwise tapering when ALT returns to baseline. ALT monitoring should continue long term (every 3-6 months), along with abdominal ultrasound (every 6 months) and TE (yearly) evaluations. When patients with good liver health are selected for treatment and closely monitored thereafter, ALT elevations can be promptly treated and are expected to resolve without long-term hepatic sequelae.

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today. Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life. However, despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing, the same has never been conclusively verified in clinical trials. Some observational evidence however, does exists which supports the improved cardiac hemodynamics, lower the rate of atrial fibrillation, heart failure and stroke in dual-chamber pacing compared to single-chamber pacing. In the index study by Haque et al, right ventricular pacing, particularly in ventricular paced, ventricular sensed, inhibited response and rate responsive pacemaker adversely impacted the left ventricular functions over 9-months compared to dual pacing, dual sensing, dual responsive and rate responsive pacemaker. Although there are key limitations of this study, these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.

Sebaceous carcinoma of the back: a case report and literature review

BACKGROUND

Extra ocular sebaceous carcinoma is a very rare, aggressive, malignant tumor arising in the adnexal epithelium of sebaceous gland that account for only about 25% of all sebaceous carcinomas (Wick et al. in Cancer 56(5):1163-72, 1985). The diagnosis of this tumor is difficult because its clinical appearance is atypical. The common treatment consists in wide local excision of the lesion with removal of local lymph node. We report the second case of sebaceous carcinoma involving the back. It was treated with surgical excision and sentinel lymph node biopsy.

CASE PRESENTATION

A 69 year-old Caucasian woman presented with an erythematous, violaceus and exophytic lesion with central ulceration and leakage of purulent material in dorsal region at the level of T10-T11, measuring 7 × 6 cm in size. A biopsy of the lesion reported a moderately differentiated sebaceous carcinoma with lymph, vascular and perineural invasion. Extension studies revealed axillary lymphadenopathy and a renal lesion suggestive of angiomyolipoma based on tomographic findings. A biopsy of the axillary lymphadenopathy was performed, which was negative for malignancy. A wide excision of the lesion with a 2 cm margin and sentinel lymph node biopsy were performed. On histopathological examination was confirm the diagnosis of sebaceous carcinoma of the back. The patient had a good clinical course, and it was decided to follow up clinically every 6 months.

CONCLUSION

Sebaceous carcinoma can occur in locations other than the ocular region. It is frequently difficult to diagnose and has an unpredictable prognosis. The back is a particularly unusual site for this lesion. Surgery remains the mainstay of treatment, and a sentinel lymph node biopsy can be performed instead of removing all regional lymph nodes.

Patients With Diabetes on Sodium-Glucose Cotransporter-2 Inhibitors Undergoing Total Knee Arthroplasty Are at Increased Odds for a Number of Postoperative Adverse Events But Reduced Risk of Transfusion

INTRODUCTION

Diabetes mellitus (DM) is a common comorbidity in total knee arthroplasty (TKA) patients, which has been associated with multiple complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are one class of medications recently approved to better manage DM. This study investigates the correlation of SGLT2i use on postoperative complications and revision rates for diabetic patients undergoing TKA.

METHODS

The M157 PearlDiver database was used to identify DM patients undergoing primary TKA. Those prescribed SGLT2i were identified and matched in 1:4 ratio with control DM patients based on age, sex, obesity diagnosis, and Elixhauser comorbidity index. Ninety-day adverse events and 5-year rates of revision were abstracted and compared by multivariable regression, controlling for age, sex, Elixhauser comorbidity index, long-term insulin use, obesity, metformin use, and active tobacco use.

RESULTS

A total of 164,474 TKA patients with DM were identified, of which SGLT2i were prescribed for 9,246 (5.6%). On multivariable analysis, SGLT2i use in DM patients was independently associated with higher odds of aggregated adverse events driven by myocardial infarction (odds ratio [OR] 2.40), sepsis (OR 1.81), urinary tract infection (OR 2.10), pneumonia (OR 1.87), and acute kidney injury (OR 1.33) but had lower odds of transfusion (OR 0.31) ( P < 0.0001 for each). On multivariable analysis, 5-year survival to revision TKA were not markedly different between the matched cohorts.

DISCUSSION

SGLT2i are being increasingly prescribed for DM patients undergoing TKA. Although they are associated with increased risk of multiple 90-day perioperative adverse outcomes, they are also associated with reduced incidence of blood transfusion. These results may guide surgical decision making and counseling for patients taking this group of medications and align with some prior studies related to glucagon-like protein-1 agonists.

Use of a large-bore 088 intracranial access support catheter for delivery of large intracranial devices: case series with the TracStar LDP in 125 cases

BACKGROUND

The delivery of neuroendovascular devices requires a robust proximal access platform. This demand has previously been met with a 6Fr long sheath (8Fr guide) that is placed in the proximal internal carotid artery (ICA) or vertebral artery segments. We share our experience with the first 0.088 inch 8Fr guide catheter designed for direct intracranial access.

METHODS

We retrospectively reviewed a prospectively maintained IRB-approved institutional database of the senior authors to identify all cases where the TracStar Large Distal Platform (LDP) was positioned within the intracranial vasculature, defined as within or distal to the petrous ICA, vertebral artery (V3) segments, or transverse sinus. Technical success was defined as safe placement of the TracStar LDP within or distal to the described distal vessel segments with subsequent complication-free device implantation.

RESULTS

Over the 41-month study period from January 2020 to June 2023, 125 consecutive cases were identified in whom the TracStar LDP was navigated into the intracranial vasculature for triaxial delivery of large devices, 0.027 inch microcatheter and greater, for aneurysm treatment (n=108, 86%), intracranial angioplasty/stenting (n=15, 12%), and venous sinus stenting (n=2, 1.6%). All cases used a direct select catheter technique for initial guide placement (no exchange). Posterior circulation treatments occurred in 14.4% (n=18) of cases. Technical success was achieved in 100% of cases. No vessel dissections occurred in any cases.

CONCLUSION

The TracStar LDP is an 0.088 inch 8Fr guide catheter that can establish direct intracranial access with an acceptable safety profile. This can be achieved in a wide range of neurointerventional cases with a high rate of technical success.

Case Report: Combined Laparoscopic Perineal Hernia and Abdominal Parastomal Hernia Repair With a Mesh After Abdominoperineal Resection: A Video Vignette and Review of the Literature

BACKGROUND

Postoperative perineal hernia (PH) is an uncommon complication after abdominoperineal resection (APR). Different techniques have been described in literature and there is no consensus regarding the optimal repair approach. In the present study, we reported a case of a laparoscopic combined repair of a perineal hernia and abdominal parastomal hernia (PSH) with mesh. Studies have shown that the prosthetic PSH and PH repair can be performed at the same time by laparoscopy with the same trocars positioning, adding the advantages of minimally invasive surgery and avoiding large laparotomy.

METHODS

A literature search in Pubmed was performed. All articles in English describe laparoscopic repair of combined perineal and parastomal hernias. A case presentation of an 83-year-old woman with combined parastomal and perineal hernias after abdominoperineal resection (APR) shown in a video vignette is provided.

RESULTS

Three single patient case reports published between 2016 and 2023 were found in literature. Two patients with rectal cancer underwent APR procedure, while the third patient underwent an anterior pelvic exenteration (APE) for carcinoma of the urinary bladder (CUB). The laparoscopic procedures did not require conversion and all procedures successfully closed the defect using a mesh. In our case, the operative time was 3 h with the major time spent for PH repair. The intraoperative blood loss was non-significant and the postoperative course was regular. The patient has been discharged on the fourth postoperative day. At 1 year follow-up, the patient noticed a great improvement in her daily-life due to the absence of the previous discomforts and there was no evidence of early recurrence or other postoperative complications.

CONCLUSION

Combined laparoscopic transabdominal PH and PSH repair with the use of synthetic mesh was shown to be a safe and effective repair for this rare disorder. To accurately compare techniques, we require prospective studies with longer follow up durations.

Long-term outcomes after acute primary angle closure: case series from Moorfields Eye Hospital, UK

BACKGROUND

There is limited data regarding the morbidity and progression to primary angle closure glaucoma in those presenting with acute primary angle closure (APAC) in the UK. We aim to report on the vision and intraocular pressure (IOP) outcomes and treatment required after an APAC episode and to identify any risk factors that could predict worse outcomes.

METHODS

A retrospective observational case series review including 117 consecutive patients (121 eyes) attending Moorfields Eye Hospital, at a tertiary referral unit in the UK, with APAC was performed.

RESULTS

Most patients (73%) had visual acuities of ≥6/12, meeting the UK driving standard, at the final follow-up. Only 15% (17 eyes) had severe visual impairment, as defined by the WHO, in the affected eye, of which 6.6% (eight eyes) were due to glaucoma. The delayed presentation was linked to a higher need for further medical treatment (OR=2.83, 95% CI 1.09 to 7.40, p=0.03). Patients who underwent phacoemulsification were at lower risk of having blindness in the affected eye (OR 0.18, 95% CI 0.05 to 0.69, p=0.01), having elevated IOP (OR 0.10, 95% CI 0.01 to 0.75, p=0.02) or requiring further medical treatment (OR 0.34, 95% CI 0.12 to 0.99, p=0.04). Older age (OR 1.26, 95% CI 1.08 to 1.48, p<0.01) was associated with worse visual outcomes.

CONCLUSIONS

APAC causes low long-term visual and treatment morbidity in this largely Caucasian patient group in the UK. Phacoemulsification as a treatment may enhance visual outcomes and reduce the need for further IOP-lowering treatment.

CARE-radiology statement explanation and elaboration: reporting guideline for radiological case reports

Despite the increasing number of radiological case reports, the majority lack a standardised methodology of writing and reporting. We therefore develop a reporting guideline for radiological case reports based on the CAse REport (CARE) statement. We established a multidisciplinary group of experts, comprising 40 radiologists, methodologists, journal editors and researchers, to develop a reporting guideline for radiological case reports according to the methodology recommended by the Enhancing the QUAlity and Transparency Of health Research network. The Delphi panel was requested to evaluate the significance of a list of elements for potential inclusion in a guideline for reporting mediation analyses. By reviewing the reporting guidelines and through discussion, we initially drafted 46 potential items. Following a Delphi survey and discussion, the final CARE-radiology checklist is comprised of 38 items in 16 domains. CARE-radiology is a comprehensive reporting guideline for radiological case reports developed using a rigorous methodology. We hope that compliance with CARE-radiology will help in the future to improve the completeness and quality of case reports in radiology.

Association of obstructive sleep apnea with bone metabolism in older adults: a hospital-based study

PURPOSE

Obstructive sleep apnea (OSA) significantly affects patients' quality of life; however, the mechanisms, such as its effects on bone mineral density (BMD) and bone turnover marker (BTM) expression, remain unclear. In this study, we investigated the relationships among OSA, BMD, and (BTMs) in older adults.

METHODS

This retrospective study enrolled 260 participants (114 women; 44.5%). Data of an established system (Alice NightOne) were used to diagnose OSA and analyze nocturnal hypoxia. Participants were divided into four groups according to respiratory event index (REI) (control, < 5 times/hour; mild OSA, 5-15 times/hour; moderate OSA 15-30 times/hour; severe OSA ≥ 30 times/hour). BMD were mesured by dual-energy x-ray absorptiometry. BTMs including bone specific alkaline phosphatase (BALP), tartrate-resistant acid phosphatase 5b (TRAP-5b) were collected.

RESULTS

Patients with OSA had higher BMD at first lumbar vertebra, left and right femur than those without (all p < 0.05). REI was positively correlated with BMD at the first lumbar vertebra (r = 0.181, p = 0.006), left femur (r = 0.160, p = 0.014), and right femur (r = 0.243, p < 0.001). In participants with body mass index (BMI) of 18-24 kg/m2 (N = 96), the correlation between REI and BMD at the left femur(r = 0.251, p = 0.019) and right femur (r = 0.258, p = 0.018) remained. Multiple regression analysis showed that OSA was significantly associated with osteoporosis (p = 0.034, 95% confidence interval, 0.092-0.100, odds ratio, 0.092). MSaO2 was positively correlated with TRAP5b (r = 0.560, p = 0.007). In participants with a BMI of ≥ 24 kg/m2(N = 164), MSaO2 was negatively correlated with BALP (r = -0.331, p = 0.034). No significant association between REI and BMD was observed.

CONCLUSIONS

OSA and hypoxia were associated with higher BMD in older adults in BMI of 18-24 kg/m2 but not in participants with a BMI of ≥ 24 kg/m2. This study suggests a negative association between OSA and osteoporosis in non-overweight and obese population. BMI played an important role. The study's findings could help exploration mechanisms of osteoporosis and promoting its treatment.

Association between osteoprotegerin and RANKL single nucleotide polymorphisms and destructive rhinosinusitis in patients with granulomatosis with polyangiitis

BACKGROUND

Chronic invasive rhinosinusitis with facial bone damage is a common cause of functional and social impairment in granulomatosis with polyangiitis (GPA) patients. To the best of our knowledge, there is no clinical or laboratory biomarker to predict bone damage.

METHODS

This case-control study included 90 patients with GPA and 270 health controls (HCs). Patients were categorized according to the presence of tomographic facial bone erosions. Frequency of RANKL and osteoprotegerin single nucleotide polymorphisms (SNPs), analyzed by real-time polymerase chain reaction, were compared between patients and HCs, and between patients with and without bone damage. Clinical, therapeutic, and laboratory data were analyzed.

RESULTS

Facial bone erosion was observed in 55.5% of patients. No difference was found in the frequency of SNPs between patients with GPA and HCs. GPA patients were compared according to the presence or absence of bone damage, and a difference was found in the frequencies of osteoprotegerin G1181C (rs2073618) and RANKL A290G (rs2277438). A multivariate analysis showed that the CC genotype of osteoprotegerin 1181 was independently associated with bone erosion (OR = 3.95, CI95%=1.20-13.00, P = 0.02), as were the presence of the G allele in RANKL A290G (OR = 6.13, CI95%=1.95-19.26, P = 0.002) and higher disease duration (OR = 1.08, CI95%=1,01-1.15, P = 0.04).

CONCLUSION

SNPs in osteoprotegerin G1181C and RANKL A290G may play a role in the development of destructive rhinosinusitis in patients with GPA. Genetic assessment may be useful for identifying high-risk individuals. This observational study might work as a basis for further research to better understand this association and clinical trials using RANKL/osteoprotegerin as therapeutic targets.

Effect of Hibiscus sabdariffa L. leaf flavonoid-rich extract on Nrf-2 and HO-1 pathways in liver damage of streptozotocin-induced diabetic rats

This study investigated the effects of flavonoid-rich extract from Hibiscus sabdariffa L. (Malvaceae) leaves on liver damage in streptozotocin-induced diabetic rats by evaluating various biochemical parameters, including the molecular gene expressions of Nrf-2 and HO-1 as well as histological parameters. The extract was found to significantly reduce liver damage, as evidenced by lower levels of fragmented DNA and protein carbonyl concentrations. Oxidative stress markers, including malondialdehyde (MDA) level, were also significantly (p < 0.05) decreased, while antioxidant biomarkers, like reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione-S-transferase (GST) were enhanced. Additionally, the extract improved the activities of key liver enzymes, including phosphatases and transaminases, and increased albumin levels. Importantly, the study demonstrated that H. sabdariffa extract effectively regulated the expression of Nrf-2 and HO-1, suggesting a significant role in mitigating liver damage. These findings highlight its potential as a therapeutic agent for liver protection in diabetic conditions.

A Comprehensive Review of Performance Metrics for Computer-Aided Detection Systems

This paper aims to provide a structured analysis of the performance metrics used in computer-aided detection (CAD) systems, specifically focusing on lung nodule detection in computed tomography (CT) images. By examining key metrics along with their respective strengths and limitations, this study offers guidelines to assist in selecting appropriate metrics. Evaluation methods for CAD systems for lung nodule detection are primarily categorized into per-scan and per-nodule approaches. For per-scan analysis, a key metric is the area under the receiver operating characteristic (ROC) curve (AUROC), which evaluates the ability of the system to distinguish between scans with and without nodules. For per-nodule analysis, the nodule-level sensitivity at fixed false positives per scan is often used, supplemented by the free-response receiver operating characteristic (FROC) curve and the competition performance metric (CPM). However, the CPM does not provide normalized scores because it theoretically ranges from zero to infinity and largely varies depending on the characteristics of the data. To address the advantages and limitations of ROC and FROC curves, an alternative FROC (AFROC) was introduced to combine the strengths of both per-scan and per-nodule analyses. This paper discusses the principles of each metric and their relative strengths, providing insights into their clinical implications and practical utility.

Best practice advice for asthma exacerbation prevention and management in primary care: an international expert consensus

Primary care clinicians play a key role in asthma and asthma exacerbation management worldwide because most patients with asthma are treated in primary care settings. The high burden of asthma exacerbations persists and important practice gaps remain, despite continual advances in asthma care. Lack of primary care-specific guidance, uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, and reliance on systemic corticosteroids or short-acting beta2-agonist-only therapy are challenges clinicians face today with asthma care. Evidence supports the use of inhaled corticosteroids (ICS) + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations, and the symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved adherence and outcomes. This expert consensus contains 10 Best Practice Advice Points from a panel of primary care clinicians and a patient representative, formed in collaboration with the International Primary Care Respiratory Group (IPCRG), a clinically led charitable organization that works locally and globally in primary care to improve respiratory health. The panel met virtually and developed a series of best practice statements, which were drafted and subsequently voted on to obtain consensus. Primary care clinicians globally are encouraged to review and adapt these best practice advice points on preventing and managing asthma exacerbations to their local practice patterns to enhance asthma care within their practice.

Post-COVID in healthcare workers and its consequences on quality of life, activities, participation, need for rehabilitation and care experiences: protocol of a cohort study

INTRODUCTION

Healthcare workers (HCWs) have been of particular relevance for overcoming the SARS-CoV-2 pandemic. At the same time they have been affected by SARS-CoV-2 infections with above average probability. Around 6.5% of the overall infected persons are likely to develop persistent symptoms resulting from the infection, known as long-COVID or post-COVID syndrome (PCS). The aim of this study is (1) to investigate the prevalence, course and characteristics of PCS in German HCWs, (2) to examine its effects on psychosocial variables, (3) to identify rehabilitation and healthcare needs and (4) to analyse treatment experiences.

METHODS AND ANALYSIS

In a cohort study with a randomised selection of participants (N=20 000) from the Employer's Liability Insurance Association for Health and Welfare Care, the health status of HCWs, who had COVID-19 in their professional context will be examined. There will be two measurement points: baseline (T1) and a 12-month follow-up (T2). The outcome measures are the health status with a particular focus on persistent or newly occurring symptoms after a SARS-CoV-2 infection, health-related quality of life, functional capacity, the subjective need for and utilisation of healthcare services. Pre-existing conditions, the course of the acute infection and sociodemographic factors are considered as predictors. An advisory board made up of affected HCWs supports the study by contributing to the surveys' contents.

ETHICS AND DISSEMINATION

The study has been approved by the Local Ethics Committee of the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf (LPEK-0518). For dissemination, the results will be published in peer-reviewed journals, presented at conferences and communicated to relevant stakeholders in general and rehabilitation medicine.

TRAIL REGISTRATION NUMBER

https://drks.de/search/de/trial/DRKS00029314.

The Effect of Insomnia on the Outcomes of Physical Therapy in Patients with Cervical and Lumbar Pain in Clinical Practice

Background and Objectives: The objective of the study is to determine whether there is a difference in physical therapy outcomes in patients with cervical and/or lumbar pain who have insomnia compared to patients without insomnia during a two-week period of active treatment under the conditions of routine clinical practice. Materials and Methods: The study population consisted of two groups of subjects with chronic back pain, a group with insomnia ("case") with a total of 38 subjects and a control group without insomnia ("control") with a total of 41 subjects, who filled out a set of measurement questionnaires: the McGill Pain Questionnaire and its short form (SF-MPQ), the Insomnia Severity Index (ISI) and the European Quality of Life Questionnaire of Life (Euro Qol; EQ-5D). Determination of the biomarkers of structural damage to the nervous tissue, neurofilament polypeptide (NEF-neurofilament polypeptide), neuron-specific enolase (NSE-neuron-specific enolase) and protein S100B was performed by measuring their concentrations in the blood using the ELISA method (enzyme immunosorbent assay). Statistical analysis of the collected data included a descriptive analysis, hypothesis testing methods and univariable and multivariable regression models. Results: At the end of the treatment visits, the level of pain remained higher in some subjects of the experimental group, but the statistical significance of the baseline difference disappeared because of the higher relative treatment response in the controls. Measured with a visual analogue scale, the treatment improved the patients' quality of life much more in experimental than control subjects, as is proven by the statistically significant difference for the percent change from baseline (~31% vs. ~14%). At baseline, all three neurotropic biomarkers had significantly higher serum values in the subjects of the experimental group than in the control patients, which suggested more damage to the neuronal structures. During the treatment course, their serum concentrations decreased, from 36% to 95%, but for S100B, unlike NES and NEF, there was no statistically significant difference between the study groups at the end of the treatment visits. Conclusions: The results of the study have immediate scientific and practical significance because they contribute to new knowledge about the place and role of insomnia in patients with cervical and/or lumbar pain who are treated with physical medicine methods in the conditions of routine clinical practice. The treatment of insomnia should be an indispensable part of therapeutic treatment for patients with back pain.

An infected intracranial dermoid cyst at the region of torcular herophili: A case report

Background

Dermoid cysts result from embryonic fusion anomalies, with intracranial dermoid cysts being rare (0.1-0.7% of intracranial tumors). Often asymptomatic, they can manifest as midline swelling, headaches, seizures, or cerebral ischemia. Recognition and management are crucial for mitigating complications and ensuring favorable patient outcomes.

Case Description

A 14-year-old girl presented with swelling at the occiput for 3 months. Initial imaging was suggestive of an extra-dural abscess in the occipital region with surrounding bone erosion. An infectious workup, including tests for tuberculosis, was non-contributory. A suboccipital craniectomy was done. On lifting, the bone flap, thick, purulent, and sebaceous contents with hair were spotted, which was adherent to the inner table of the skull and the dura overlying the torcular herophili, suggesting an infected dermoid cyst. A near-total excision was done, and culture-directed antibiotics were given. Postoperatively, the child made a complete recovery.

Conclusion

The diagnosis of a dermoid cyst must be kept in mind, and it should be considered in the differential diagnosis of midline posterior fossa lesions. The risk of postoperative recurrence from incomplete excision should be weighed against the risk of injuring the venous sinuses during the extensive resection of dermoid cysts adherent to the torcular region.

Echocardiographic evaluation in patient candidate for liver transplant: from pathophysiology to hemodynamic optimization

Cardiovascular complications are common in patients with severe liver disease and are an important cause of peri-operative and post-transplant morbidity and mortality. Cirrhotic cardiomyopathy (CCM), often found in advanced liver disease, is characterized by diastolic dysfunction, systolic dysfunction, and electrophysiological abnormalities. While CCM may not cause symptoms at rest, it can become evident during stressful activities, such as surgery. Liver transplantation, while being the definitive treatment for end-stage liver disease (ESLD), carries significant cardiovascular risks. Preoperative cardiac evaluation is essential for assessing these risks and planning appropriate management. Cardiac imaging, particularly echocardiography, plays a crucial role in evaluating liver transplant candidates, helping to identify conditions such as CCM, pulmonary hypertension, hepatopulmonary syndrome, and others. Currently, liver transplant anesthetists must acquire echocardiographic knowledge and skills to evaluate the cardiocirculatory conditions of the transplanted patient, especially in the pre-operative phase, but also intra-operatively and post-operatively.

Evaluation of Malpractice Fear, Burnout, and Spiritual Well-Being among Physicians in Turkey: A Descriptive Study

This descriptive study was conducted with 406 physicians to evaluate fear of malpractice, burnout and spiritual well-being among physicians in Turkey. In our study, 81.5%, 11.6% and 6.9% of physicians experienced high, medium and low levels of fear of malpractice, emotional burnout, depersonalisation and personal accomplishment, respectively. However, physicians reported high levels of spiritual well-being and harmony with nature, moderate levels of transcendence and anomie. As spiritual well-being and transcendence increased, emotional burnout and depersonalisation decreased and personal accomplishment increased. In addition, as harmony with nature increased, depersonalisation decreased and personal accomplishment increased, and as anomie increased, emotional burnout and depersonalisation increased.

Reflections From the Annals of Surgical Oncology Social Media Committee: The Impact of Promoting Surgical Science Online

BACKGROUND

The Annals of Surgical Oncology (ASO) launched a Social Media Committee in 2022 to strategically promote surgical science, boost journal impact, and raise awareness of cutting-edge research. This study investigated the impact of the ASO Social Media Committee on journal visibility, publication engagement, and article-level metrics.

METHODS

Manuscripts accepted by ASO and promoted on Twitter/X between 21 September 2020 and 20 September 2023 were evaluated for differences in article and social media metrics. Pearson correlations evaluated the relationship between normalized article downloads and normalized likes, retweets/reposts, and quote tweets/quotes. Group comparisons of social media engagement by article type were performed.

RESULTS

In the 18 months before the formation of the ASO Social Media Committee, 1023 manuscripts were published, and 1023 were published in the 18 months afterward. The median Altmetric scores for articles published before (3.0; IQR, 0-7.0) and afterward (2.0; IQR, 0-7.0) were similar (p = 0.480). In contrast, the normalized median number of downloads per article was significantly greater after the Social Media Committee was formed (0.85 downloads per article [IQR, 0.55-1.48] vs 1.37 [IQR, 0.93-2.51]; p < 0.001). Positive correlations were noted for normalized downloads with likes (r = 0.14; p < 0.001), retweets/reposts (r = 0.08; p < 0.001), and quote tweets/quotes (r = 0.16; p < 0.001). No difference in social media engagement by article type was observed.

CONCLUSION

More downloads were noted for ASO articles posted by the Social Media Committee after normalization. An organized effort to promote surgical science likely improves article exposure. Future efforts should seek to expand article promotion to additional social media and networking platforms with a more international, multi-lingual approach.

Deep Infiltrating Endometriosis of the Left Ureter Managed with Laparoscopic Ureterolysis Combined with Allium Ureteral Self-Expandable Stent: A Case Report

Introduction: In endometriosis, urinary tract involvement occurs in 1-5.5% of cases, where the ureter is affected in 9-23%. Unfortunately, endometriosis may remain asymptomatic even with significant anatomical progression. A delay in the diagnosis and treatment of ureteral endometriosis may result in hydronephrotic kidney damage and functional impairment. Methods: We present a case of a 36-year-old woman with a left ureteral stricture caused by deep infiltrating endometriosis accompanied by severe kidney-induced arterial hypertension. In March 2022, the patient underwent both laparoscopic excision/evaporation of deep infiltrating endometriosis from the left ovarian fossa and left ureterolysis, followed by an ureterorenoscopic dilatation of the left ureter via the placement of an Allium self-expandable stent. Results: This stent was successfully removed 18 months later. A computed tomography check-up confirmed normal ureteral patency with no signs of endometriosis. Elevated blood pressure also resolved. Conclusions: Deep infiltrating endometriosis can lead to asymptomatic yet serious complications. A successful treatment of ureteral endometriosis may require multidisciplinary management, including a simultaneous laparoscopic and ureterorenoscopic approach. Ureteral stent placement is a minimally invasive state-of-the-art solution for ureteral stricture(s) and should be considered the first choice in women of reproductive age suffering from ureteral deep infiltrating endometriosis.

Boundary-blurred behaviors in academic teachers-students facebook interaction: are guidelines needed? A cross-sectional study

BACKGROUND

Communication via social networks has different norms than in the "offline" world and broadens the sphere of student-teacher interactions. Facebook is mainly used for social interaction and information sharing. However, it also serves as an education and learning platform. This risks boundary-blurred behaviors between students and their academic teachers in the virtual space. The current study examines the differences in perceived subjective norms, attitudes, and reported behaviors of academic teachers and nursing students' boundary-blurred behaviors with each other on Facebook.

METHODS

A cross-sectional study was utilized, guided by the Theory of Reasoned Action (TRA), examining attitudes, subjective norms, and reported virtual behaviors that signify blurred student-teacher boundaries. Data were collected among 223 nursing students and 78 academic teachers. The university's ethics committee approved the research (#21.9.19).

RESULTS

Consistent with the TRA, a significant correlation was found between virtual boundary-blurred behaviors and attitudes (r = .55, P < .001), university subjective norms (r = .48, p < .001), and peers' subjective norms (r = .47, p < .001). Nursing students' attitudes were significantly (t = 5.81; p < .001) more favorable towards boundary-blurred behaviors (M = 2.40, SD = 0.91) than those of academic-teachers (M = 1.71, SD = 0.83), and so were the perceived subjective norms of their student peers (M = 2.72, SD = 1.15) compared to those of their teachers (M = 2.09, SD = 1.14). Interestingly, the difference in reports of boundary-blurred Facebook behaviors between teachers (M = 1.36, SD = 0.52) and students (M = 1.49, SD = 0.70) was not significant. Boundary-blurred behaviors for teachers were best predicted by attitudes and perceived subjective norms of the university [R2 = 0.62; F(5,72) = 23.31], and for students by attitudes and perceived subjective norms of their peers [R2 = 0.45; F)5,216) = 28.88].

CONCLUSIONS

The differences demonstrated between students and teachers may emanate from the perception of the teacher's role and generational gaps. These may lead to miscommunication and the crossing of boundaries. The findings indicate the importance of setting more explicit guidelines for using social media in the context of student-teacher communication.

Navigating new horizons in inflammatory bowel disease: Integrative approaches and innovations

This editorial offers an updated synthesis of the major advancements in the management and treatment of inflammatory bowel disease (IBD), as documented in the World Journal of Gastroenterology between 2023 and early 2024. This editorial explores substantial developments across key research areas, such as intestinal microecology, computational drug discovery, dual biologic therapy, telemedicine, and the integration of lifestyle changes into patient care. Furthermore, the discussion of emerging topics, including bowel preparation in colonoscopy, the impact of the coronavirus disease 2019 pandemic, and the intersection between IBD and mental health, reflects a shift toward a more holistic approach to IBD research. By integrating these diverse areas of research, this editorial seeks to promote a holistic and multidisciplinary approach to IBD treatment, combining emerging technologies, personalized medicine, and conventional therapies to improve patient outcomes.