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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Unusual foreign body in the buccal mucosa: A case report

BACKGROUND

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

CASE SUMMARY

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

CONCLUSION

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

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

Introduction

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

Patients and Methods

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

Results

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

Conclusion

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

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

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

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

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

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

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

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

Introduction

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

Methods

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

Results

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

Conclusions

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

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

AIM

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

RELEVANCE TO CLINICAL PRACTICE

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

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

INTRODUCTION AND IMPORTANCE

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

CASE PRESENTATION

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

CLINICAL DISCUSSION

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

CONCLUSION

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

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

INTRODUCTION AND IMPORTANCE

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

CASE PRESENTATION

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

DISCUSSION

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

CONCLUSION

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

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Background

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

Patients and methods

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

Results

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

Conclusion

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

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

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

INTRODUCTION AND IMPORTANCE

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

CASE PRESENTATION

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

CLINICAL DISCUSSION

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

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

Background

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

Case presentation

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

Overview

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Generative artificial intelligence in oncology

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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

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

INTRODUCTION AND IMPORTANCE

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

CASE PRESENTATION

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

CLINICAL DISCUSSION

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

CONCLUSION

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

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

OBJECTIVES

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

DESIGN

Group consensus process using modified Delphi approach.

SETTING

Electronic surveys and in-person meetings.

SUBJECTS

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

INTERVENTIONS

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

MEASUREMENTS AND MAIN RESULTS

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

CONCLUSIONS

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

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

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

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

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

Gut-directed therapeutics in inflammatory bowel disease

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

Mediating factors associated with alcohol intake and periodontal condition

Background

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

Methods

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

Results

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

Conclusion

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

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

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

Optimization of Postoperative Opioids Use Following Spine Surgery

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

CONCLUSION

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Primary Neuroendocrine Tumor of the Breast: A Rare Case

Primary neuroendocrine tumors (NETs) predominantly affect postmenopausal women. This case study focused on a 54-year-old woman who presented with a painless right breast lump. While the lump exhibited estrogen and progesterone receptor (PR) positivity, it lacked human epidermal growth factor receptor 2 expression. Further evaluation revealed positivity for the neuroendocrine markers chromogranin A (CGA) and synaptophysin (SYN). It also revealed a 3% positive Ki-67 proliferation index. Treatment for neuroendocrine breast cancer (NEBC) mirrors that of standard invasive breast cancer: breast conservation or mastectomy combined with sentinel lymph node biopsy or axillary dissection. The patient underwent a right mastectomy with sentinel lymph node biopsy, followed by hormonal therapy based on her tumor's immunohistochemical profile. Due to the low incidence and limited research on primary NETs, their exact origin remains shrouded in mystery. Accurate diagnosis, specific treatment options, and long-term prognosis remain significant challenges in managing this rare form of breast cancer.

An Update on IL-22 Therapies in Alcohol-Associated Liver Disease and Beyond

Excessive alcohol consumption drives the development of alcohol-associated liver disease (ALD), including steatohepatitis, cirrhosis, and hepatocellular carcinoma, and its associated complications, such as hepatorenal syndrome. Hepatocyte death, inflammation, and impaired liver regeneration are key processes implicated in the pathogenesis and progression of ALD. Despite extensive research, therapeutic options for ALD remain limited. IL-22 has emerged as a promising therapeutic target because of its hepatoprotective properties mediated through the activation of the STAT3 signaling pathway. IL-22 enhances hepatocyte survival by mitigating apoptosis, oxidative stress, and inflammation while simultaneously promoting liver regeneration through the proliferation of hepatocytes and hepatic progenitor cells and the up-regulation of growth factors. Additionally, IL-22 exerts protective effects on epithelial cells in various organs affected by ALD and its associated complications. Studies from preclinical models and early-phase clinical trials of IL-22 agonists, such as F-652 and UTTR1147A, have shown favorable safety profiles, good tolerability, and encouraging efficacy in reducing liver injury and promoting regeneration. However, the heterogeneity and multifactorial nature of ALD present ongoing challenges. Further research is needed to optimize IL-22-based therapies and clarify their roles within a comprehensive approach to ALD management. This review summarizes the current understanding of IL-22 biology and its role in ALD pathophysiology and ALD-associated complications along with therapeutic application of IL-22, potential benefits, and limitations.