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Background: To analyze the clinical manifestations, endoscopic features, pathological features, endoscopic resection, and prognosis of esophageal granular cell tumors (GCTs). Methods: The present study retrospectively analyzed and followed up the clinical data of 62 patients diagnosed with esophageal GCTs who underwent endoscopic resection at Zhongshan Hospital of Fudan University between July 2007 and March 2022. The clinicopathological features, endoscopic diagnosis, and treatment experience of esophageal GCT patients were summarized. Results: Among the 62 patients with esophageal GCT, there were 34 males and 28 females, with an average age of 49.3 ± 11.7 years. Only 11 patients had symptoms, such as epigastric discomfort, regurgitation or dysphagia. One patient had multiple lesions, and the rest had single lesions, totaling 63 lesions. Most lesions (53/63) were located in the median and lower esophagus, the diameters ranged from 3 to 22 mm. The endoscopic morphology of the GCTs was molar, flat, hemispherical, or irregular submucosal protuberance. Endoscopic ultrasound (EUS) was performed in 38 cases, most cases (31/38) were hypoechoic, and 32 cases were appeared as homogeneous lesions. There were no complications during or after the endoscopic operations, and the en bloc resection rate was 100%. The negative rate of microscopic incisional margin was 63.5% (40/63). No patients developed recurrence during the follow-up period. The follow-up duration was 21–197 months (100.5 months for average). Conclusion: Esophageal GCT is a rare disease with no obvious symptoms and a good prognosis. Endoscopic resection is a safe and effective method of diagnosis and treatment for esophageal GCTs. A microscopic positive tumor margin may not increase the rate of recurrence. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods and Results Conclusions Hepatitis C virus genotype 5 (HCV‐GT‐5) is found mainly in South Africa. In our area in central France, the prevalence of HCV‐GT‐5 is 14%.Here we evaluated sustained virological response at week 12 post‐treatment (SVR12) in 147 HCV‐GT‐5 patients from 14 French university hospitals (2014–2021) treated with direct‐acting antivirals (DAA) in real‐life. Patients had mainly received sofosbuvir/ledipasvir ± ribavirin, sofosbuvir/velpatasvir, and glecaprevir/pibrentasvir. Overall SVR12 was 98% (144/147). Two patients experienced relapse: one was successfully retreated with the same DAAs (sofosbuvir/ledipasvir) plus ribavirin, and the other refused further DAA treatment. One patient with virological failure (sofosbuvir/velpatasvir) had received a second treatment (sofosbuvir/velpatasvir/voxilaprevir) and progressed to cure.HCV‐GT‐5 patients treated with a DAA regimen had a 99% SVR12 in intention‐to‐treat (including initial therapy and retreatment) and 100% SVR12 per protocol. Sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, and glecaprevir/pibrentasvir show very good efficacy in real‐world HCV‐GT‐5 patients. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Discussion The study was performed to examine the effects of death anxiety on diet‐fluid restriction non‐adherence in hemodialysis patients.This descriptive, cross‐sectional, and correlational study was performed with 118 hemodialysis patients who received treatment in the dialysis unit of a university hospital and a state hospital in Elazığ, eastern Turkey. The study data were obtained with the “Descriptive Data Form”, “Death Anxiety Scale”, and “Dietary and Fluid Restriction Non‐Adherence Scale”.The average Death Anxiety Scale total score of the patients was 10.00 ± 4.75. The “Duration of non‐adherence with diet” mean score was 1.66 ± 1.70, “Degree of non‐adherence with diet” mean score was 1.24 ± 1.19, “Duration of non‐adherence with fluid restriction” mean score was 1.61 ± 1.71, and “Degree of non‐adherence with fluid restriction” mean score was 1.16 ± 1.13. The independent variable Death Anxiety Scale significantly and negatively affected the dependent variable “Duration of non‐adherence with diet”, “Degree of non‐adherence with diet”, “Duration of non‐adherence with fluid restriction”, and “Degree of non‐adherence with fluid restriction”.Hemodialysis patients face serious death anxiety, their degree of non‐adherence with diet‐fluid restriction was low as death anxiety scores increased, and the degree of non‐adherence with diet‐fluid restriction decreased. [ABSTRACT FROM AUTHOR]

Parkinson’s disease represents a significant public health issue, with alterations in the intestinal microbiota playing an important role in its aetiology. This study aimed to investigate the intestinal microbiota in Parkinson’s disease patients. Conducted with 30 Parkinson’s patients and 22 healthy controls, the participants were recruited from the neurology department of the Mohamed VI University Hospital in Marrakech. Data collection used an exploitation form and microbiological analysis of stool samples. The average age of Parkinson’s patients was 62.2 years (standard deviation 8.40). Results indicated that the total germ count in Parkinson’s patients was significantly higher than in controls (p = 0.036). Specifically, the counts of Clostridium (463.10^3 CFU/g) in Parkinson’s patients were higher compared to controls (101.10^3 CFU/g) (p < 0.001), Lactobacillus (1965.10^3 CFU/g) versus controls (933.10^3 CFU/g) (p = 0.031), and Streptococcus (510.10^4 CFU/g) versus controls (320.10^4 CFU/g) (p = 0.022). These findings suggest that the intestinal microbiota may serve as a potential biomarker for Parkinson’s disease. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of this study was to determine whether circulating tumor human papillomavirus (HPV) DNA is a potential specific biomarker for cervical cancer (CC).This retrospective matched study included 87 patients with cervical intraepithelial neoplasia (CIN), 29 CC patients (FIGO IA1‐IVA) and 29 HPV‐negative controls at Yuhuangding Hospital of Qingdao University (from July 2022 to September 2023). The digital droplet PCR (ddPCR) was used to detect and quantify ctHPV DNA in the plasma of patients with HPV16, 18, 33, 52, or 58‐associated CC.The ctHPV DNA was exclusively detectable in HPV‐positive samples, with no detection in patients across various CIN stages (n = 87) or HPV‐negative controls (n = 29). Additionally, ctHPV DNA was identified in nine out of 10 late‐stage patients (90%) and six out of 19 early‐stage patients (31.6%).The ctHPV DNA serves as a specific biomarker for the diagnosis CC. Additionally, this discovery addresses the knowledge gap in ctHPV DNA research in the early stages of CC and promotes clinical diagnosis and treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to develop a novel therapeutic approach for the treatment of ovarian cancer while investigating the role of tumor-infiltrating lymphocytes (TILs) in the context of ovarian cancer therapy. The primary aim is to establish a technical procedure for the isolation of tumor cells, lymphocytes, and dendritic cells (DCs) derived from ovarian cancer tissues or ascites. Subsequently, the focus lies on the generation of dendritic cell-tumor infiltrating lymphocytes (DC-TILs) exhibiting specific cytotoxic capabilities aimed at targeted therapeutic interventions. The cytotoxic impact of DC-TIL interactions on tumor cells was investigated through in vitro experimentation. This research aims to provide fundamental experimental insights for the future clinical advancement of TIL therapy in ovarian cancer. Methods: The experimental samples included fresh surgical specimens and ascites specimens procured from three patients (ranging in age from 32 to 75), sourced from the Department of Gynecology at the Third Bethune Hospital of Jilin University. TILs were extracted through in vitro isolation from solid tumor tissues, while primary tumor cells and DCs were obtained from ascites specimens. Tumor-specific antigens derived from patient tumor cells were utilized to stimulate the maturation of DCs. TILs were subsequently co-cultured with antigen-stimulated DC cells. Subsequently, TILs with specific killing effects were obtained, and the cytotoxic impact of DC-TILs on tumor cells was detected in vitro. Results: (1) TILs were successfully obtained through expansion from the tumor tissue of a patient diagnosed with ovarian cancer. (2) DCs were successfully induced from ascites cells harvested from patients diagnosed with ovarian cancer. (3) TILs significantly enhanced the cytotoxicity of tumor cells following DC stimulation. Conclusion: TILs have the capacity to augment the cytotoxicity directed towards tumor cells following DC stimulation. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Gitelman syndrome (GS) is an autosomal recessive salt-losing tubulopathy characterized by renal potassium loss, hypokalemia, metabolic alkalosis, hypocalciuria, hypomagnesemia, and hyper-reninemic hyperaldosteronism. Finerenone is a non-steroidal mineralocorticoid receptor antagonist that inhibits receptor-mediated sodium reabsorption and decreases receptor overactivation. This report describes a 35-year-old man with hypokalemia, a mass in the right adrenal gland, and a diagnosis of Gitelman syndrome with a c.1456>A heterozygous variant of the SLC12A3 gene, treated with finerenone. Case Report: A 35-year-old man was admitted to the affiliated Hospital of Qingdao University because of a mass in the right adrenal gland. He was in generally good condition upon admission. He was a non-smoker and non-drinker. The examination at admission led to diagnosis of severe hypokalemia. Genetic tests showed that he carried a homozygous pathogenic variant c.1456>A in SLC12A3, which can confirm the diagnosis of Gitelman syndrome. Spironolactone was used to increase the blood potassium level, but after adverse effects were noted, finerenone was used, which greatly improved his blood potassium levels. Conclusions: For patients with Gitelman syndrome who cannot tolerate adverse effects such as sex hormone-related adverse reactions from using non-selective mineralocorticoid receptor antagonists, especially male patients, finerenone may be considered as an adjunct therapy for potassium retention and magnesium supplementation. To the best of our knowledge, this is the first report in the world of using finerenone to treat Gitelman syndrome. This provides more options for treatment of patients in the future. [ABSTRACT FROM AUTHOR]

This retrospective study compared postoperative prediction errors of recent formulas using standard- or total keratometry (K or TK) for intraocular lens (IOL) power calculation in post-myopic LASIK patients. It included 56 eyes of 56 patients who underwent uncomplicated cataract surgery, with at least 1-month follow-up at Keio University Hospital in Tokyo or Hayashi Eye Hospital in Yokohama, Japan. Prediction errors, absolute errors, and percentage of eyes with prediction errors within ± 0.25 D, ± 0.50 D, and ± 1.00 D were calculated using nine formulas: Barrett True-K, Barrett True-K TK, Haigis-L, Haigis TK, Pearl-DGS, Hoffer QST, Hoffer QST PK, EVO K, and EVO PK. Statistical comparisons utilized Friedman test, Conover's all-pairs post-hoc, Cochran's Q, and McNemar post-hoc testing. Root-Mean-Square Error (RMSE) was compared with heteroscedastic testing. Barrett True-K TK had the lowest median predicted refractive error (-0.01). EVO PK had the smallest median absolute error (0.20). EVO PK had the highest percentage of eyes within ± 0.25 D of the predicted value (58.9%), significantly better than Haigis-L (p = 0.047). EVO PK had the lowest mean RMSE value (0.499). The EVO PK formula yielded the most accurate IOL power calculation in post-myopic LASIK eyes, with TK/PK values enhancing accuracy. [ABSTRACT FROM AUTHOR]

Objective: Microcirculatory disturbances can contribute to organ dysfunction in patients undergoing major surgeries and critical illness. Incident dark field imaging (CytoCam, Braedius Medical BV, Huizen, Netherlands) provides direct visualization of the microcirculation. To utilize this method in daily clinical practice, automated image analysis is essential. This study aims to compare the automated analysis of recorded microcirculation video sequences using CytoCamTools V2 Analysis Manager (Braedius Medical BV) with established manual analysis using Capillary Mapper (Version 1.4.5, University Hospital Münster, Germany) as reference method. Methods: Sublingual microcirculation video sequences were recorded in patients undergoing laparotomy at four time points (before surgery, 2 and 6 h after surgery, and on the first postoperative day) using incident dark field imaging. Agreement between automated and manual analysis of total vessel density (TVD), perfused vessel density (PVD), and proportion of perfused vessels (PPV) was compared using intraclass correlation (ICC) and Bland–Altman method. Results: A total of 336 videos from 30 patients were analyzed. The ICC between the two measurement methods was 0.13 for TVD, 0.14 for PVD, and 0.16 for PPV. Bland–Altman analysis showed mean differences (95% limits of agreement) of 10.46 mm/mm2 (−1.73–22.65 mm/mm2) for TVD, 8.25 mm/mm2 (−9.88–26.39 mm/mm2) for PVD, and − 3.96% (−59.58%–51.65%) for PPV. Discussion: Automated microcirculatory analysis using the Analysis Manager did not show clinically acceptable agreement with manual analysis using Capillary Mapper. Consequently, automated video analysis using the Analysis Manager does not appear to be a suitable approach. Trial Registration: ClinicalTrials.gov identifier: DRKS00020264 [ABSTRACT FROM AUTHOR]

Background/Objectives: The 28-day mortality rate for septic shock is high, necessitating rapid and effective empiric antimicrobial therapy. In this study, we investigate whether the rate of catecholamine dose reduction in septic shock can indicate bacterial susceptibility to initial antimicrobial therapy or not. Methods: This retrospective observational study involved 108 adult patients with bacteraemia and septic shock admitted to the intensive care unit of Nihon University Itabashi Hospital between January 2017 and December 2023. They were classified into the Susceptible or Resistant groups based on the bacteria's susceptibility to the initial empiric antimicrobial therapy. Catecholamine dosages were converted to norepinephrine equivalent (NEE) scores, with the time course from the peak to the end of administration measured at NEE reductions. Results: Of the 108 patients, 94 were in the Susceptible group and 14 in the Resistant group. The Susceptible group showed faster reductions in catecholamine doses: the time to reduce the dose from the maximum NEE to 25% was 19 vs. 49.5 h (p = 0.0057), and to 0%, it was 29 vs. 54 h (p = 0.0475). The time to reduce the dose from the maximum NEE to 75% was 8 vs. 12.5 h (p = 0.0733), and to 50% it was 13 vs. 21.5 h (p = 0.1081). Conclusions: In septic shock with bacteraemia, a faster catecholamine dose reduction indicates bacterial susceptibility to the initial empiric antibiotics. This reduction rate can serve as an early clinical indicator of the appropriate initial empiric therapy. [ABSTRACT FROM AUTHOR]

Background/Objective: Multidrug-resistant (MDR) bacteria pose a significant threat to global health, especially in intensive care units (ICUs), where high antibiotic consumption drives antimicrobial resistance. Selective digestive decontamination (SDD) is a strategy designed to prevent nosocomial infections and colonization by MDR pathogens. This study aimed to evaluate the impact of implementing an SDD protocol on antibiotic consumption and colonization by carbapenemase-producing Enterobacterale (CPE) in a specific ICU setting. Methods: This quasi-experimental study was conducted in the ICU of a university hospital from June 2021 to June 2023. Patients were divided into two groups: pre-intervention (before SDD) and post-intervention (after SDD implementation). Data on antibiotic consumption (expressed as defined daily doses (DDDs) per 100 stays), nosocomial infections, colonization rates, and the incidence of MDR bacteria were collected. A statistical analysis was conducted to compare the pre- and post-intervention groups. Results: A total of 3266 patients were included, with 1532 in the pre-intervention group and 1734 in the post-intervention group. The implementation of the SDD protocol resulted in a significant reduction in total antibiotic consumption (p = 0.028), with notable decreases in carbapenem use (p < 0.01) and colonization by CPE (p = 0.0099). The incidence of nosocomial infections also decreased in the post-SDD group, although this reduction was not statistically significant. Conclusions: The implementation of the SDD protocol in this ICU setting significantly reduced antibiotic consumption and colonization by CPE. These findings suggest that SDD may be a valuable tool in managing antimicrobial resistance in critical care settings, without contributing to the development of MDR bacteria. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed factors influencing the complete removal and recurrence of bile duct stones in patients with surgically altered anatomy (SAA) undergoing double‐balloon endoscopy‐assisted endoscopic retrograde cholangiography (DBERC). Methods: A retrospective analysis of 289 patients with SAA treated for biliary stones with DBERC at Jichi Medical University Hospital (January 2007 to December 2022) was conducted. Evaluation of factors impacting complete stone removal was performed in 257 patients with successful bile duct cannulation. Logistic and Cox proportional hazards regression models were used to compute the odds ratios (ORs) and hazard ratios (HRs) at 95% confidence intervals (CIs). Results: Of 257 patients, 139 (54.0%) and 209 (81.3%) achieved initial and complete removal, respectively. Recurrence occurred in 55 (21.4%) patients. Factors associated with initial complete stone removal included cholangitis (P < 0.01, OR 0.48, 95% CI 0.27–0.83), number of stones (P < 0.01, OR 0.31, 95% CI 0.18–0.54), and largest stone diameter (P < 0.01, OR 0.37, 95% CI 0.20–0.67). The size of the largest stone was associated with complete removal (P = 0.01, OR 0.24, 95% CI 0.13–0.76). Recurrence was associated with cholangitis (P = 0.046, HR 0.54, 95% CI 0.29–0.99), congenital biliary dilatation (P = 0.01, HR 2.65, 95% CI 1.21–5.80), and number of stones (P = 0.02, HR 1.96, 95% CI 1.12–3.41). Conclusions: Successful complete bile stone removal in patients with SAA depends on the stone diameter and number. Stone recurrence is influenced by the number of stones and history of congenital biliary dilatation. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to examine the role of two-dimensional shear wave elastography (SWE) in the assessment of the vascular wall of the carotid arteries and atherosclerotic plaques in patients with rheumatoid arthritis with moderate and low disease activity versus healthy controls. Methods: An observational case–control study was carried out at the University Medical Hospital "Kaspela" in Plovdiv, Bulgaria, from June 2023 to August 2024. This study included 24 patients with rheumatoid arthritis (RA) and 25 healthy controls. We employed two-dimensional SWE (2D-SWE) to examine the vessels around the plaques. The potential links with the degree of stenosis, plaque type, and cardiovascular risk were analyzed. Results: In the RA group, the 2D-SWE values showed significant positive correlations with the severity of the atherosclerotic plaques (rs = 0.461; 95% CI: 0.049 to 0.739; p = 0.023) and the degree of stenosis (rs = 0.920; 95% CI: 0.793 to 0.970; p < 0.001). Based on 2D-SWE, a ROC curve analysis distinguished higher severity plaques from lower severity plaques with an AUC = 0.818, 95% CI: 0.683 to 0.913. The optimal cut-off value of 2D-SWE > 32.40 kPa was associated with a sensitivity of 96%, a specificity of 56%, a positive predictive value (PPV) of 66.70%, and a negative predictive value (NPV) of 92.90%. Conclusion: Elastography can be an effective technique for assessing and stratifying atherosclerotic plaques in patients with RA, as well as for aiding in the early detection and subsequent prevention of future complications. [ABSTRACT FROM AUTHOR]

Background: Patients with circulatory failure have high mortality rates and require prompt assessment of microcirculation. Despite the improvement in hemodynamic parameters, microcirculatory dysfunction persists. We measured subcutaneous regional tissue oxygen saturation (rSO2) with near-infrared spectroscopy (NIRS), which can assess microcirculation in patients with circulatory failure. Methods: A finger-worn oximeter with NIRS measured rSO2 in the forehead, thenar eminence, thumb, and knees. First, the rSO2 was measured in healthy adult volunteers (n = 10). Circulatory failure was defined as a systolic blood pressure ≤ 90 mmHg and lactate ≥ 2 mmol/L. The study included 35 patients without circulatory failure and SOFA score of 0 at ICU admission and 38 patients with circulatory failure at ICU admission. Both groups included a single-center prospective study of patients who were transported to the ICU of the Nihon University Hospital. The rSO2 was measured only on ICU admission in the non-circulatory failure group and later in the circulatory failure group. Results: In the volunteer group, rSO2 at each site was approximately 58%. The rSO2 was significantly lower in the circulatory failure group than in the non-circulatory failure group (knee, p < 0.01). In the circulatory failure group, knee rSO2 showed a significant negative correlation with SOFA score (Day 0, ρ = −0.37, p = 0.02; Day 1, ρ = −0.53, p < 0.01; Day 2, ρ = −0.60, p < 0.01). Conclusions: Subcutaneous knee rSO2 was associated with SOFA score and was considered an indicator of microcirculatory dysfunction and organ damage. [ABSTRACT FROM AUTHOR]

Purpose: Malaria keeps on being a serious global health threat, especially in many tropical countries, where it is endemic. Also in non-endemic countries, like Spain, malaria is an issue that requires attention due to the presence of imported cases. Methods: This is a retrospective study, including all patients diagnosed with malaria at Severo Ochoa University Hospital from 2006 to 2022, being classified according to: (I) their type of stay in an endemic area as visiting friends and relatives (VFR), migrants of recent arrival (MRA), or tourism and business (T&B), and (II) the mode of presentation as microscopic (MM) or submicroscopic (SMM) malaria. Results: In this study, 132 patients (23.7% of all suspected) were diagnosed with malaria. The PCR was the most sensitive technique (99.2%), followed by antigen detection (78.8%) and microscopy (75%), with Plasmodium falciparum being the predominant species (94.7%). VFR was the largest group infected with malaria (69.7%), mostly symptomatic (98.2%) and presenting MM (90.2%). Instead, MRA patients (25%) presented milder (47.4%) or no symptoms (31.6%) and higher cases of SMM (42.4%). Coinfection with another imported pathogen was present in 19 patients (14.4%), being MRA more frequently coinfected (30.3%) Conclusion: This study shows the need for establishing systems for VFRs to attend pre-travel consultations to reduce malaria imported risk. In the case of MRA, screening for imported diseases should be conducted upon their arrival. Finally, we highlight two cases of co-infection with imported viruses, showing that presence of symptoms resembling malaria from another imported pathogen does not exclude malaria. [ABSTRACT FROM AUTHOR]

With more than 30 million medical applications annually, 99mTc is the most widely used radioisotope. Nevertheless, the discharge of 99mTc and its radioactive nuclear isomer 99Tc through medical facilities into the aqueous environments is mostly unknown. This is related to the low absolute Tc mass used in medical examinations and consequent trace levels of Tc emitted from respective facilities. In this work, a new approach employing automated on-line extraction chromatography and anion-exchange chromatography was developed and coupled to inductively coupled plasma-mass spectrometry. The extraction column was filled with TK201 resin to preconcentrate, purify and elute pertechnetate ([99Tc]TcO4−) as the most relevant Tc species. The eluting 99Tc fraction was focused and separated on an anion-exchange chromatography column and directly calibrated into a mass flow using an on-line isotope dilution-like approach named isobaric dilution analysis. To accommodate ultra-trace levels in strong matrices with high grades of particulate contamination, the automated method was complemented by a newly developed manual filtration and preconcentration workflow with TK201 impregnated filter disks, reaching a combined preconcentration factor as high as 4615. An aerosol desolvation nebulization system was used additionally to boost sensitivity, achieving an ultimate limit of detection (LOD) as low as 0.70 ± 0.02 fg kg−1. As proof of concept, a wastewater sample from a retention basin of a local university hospital was collected. This wastewater contained 99Tc emitted in diagnostic procedures and levels were determined to be as low as 89 ± 4 fg kg−1. [ABSTRACT FROM AUTHOR]

Background Fosfomycin is an antibiotic extensively used to treat uncomplicated urinary tract infections in women, and it is available in different salts and formulations. The European Medicines Agency (EMA) recommends further studies to characterize the pharmacokinetics of fosfomycin calcium for oral administration and to justify its dosage recommendation. Objectives A population pharmacokinetic model of fosfomycin calcium was developed after oral administration to healthy women. Methods A clinical trial (a randomized, open-label, bioavailability study of single and multiple doses of 1000 mg capsules, single dose of 500 mg capsule and single dose of 250 mg/5 mL suspension of oral fosfomycin calcium under fasted conditions in healthy women volunteers, Code: PD7522.22, EudraCT: 2020-001664-28) was carried out at the Clinical Trial Unit, Araba University Hospital (Vitoria-Gasteiz, Spain). Twenty-four healthy women were included in the study, and plasma samples were collected at different times over a period of 24 h. The concentration–time data of fosfomycin in plasma were modelled by a population approach using a nonlinear mixed-effects modelling implemented by NONMEM 7.4 (ICON Clinical Research LLC, North Wales, PA, USA). Results The pharmacokinetics of fosfomycin was best described by a two-compartment model. Creatinine clearance and body weight were identified as covariates for fosfomycin clearance and volume of distribution, respectively. Conclusions This study provides relevant information on the pharmacokinetic profile of fosfomycin in women after oral administration as calcium salt. This population model may be very useful for establishing dosage recommendations of fosfomycin calcium to treat urinary tract infections in women. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop a population pharmacokinetic (PPK) model for oral apatinib in Chinese oncology patients and investigate the factors influencing the pharmacokinetics of apatinib. Methods: We gathered 199 blood concentration monitoring data points from 91 inpatient oncology participants receiving oral apatinib at the Third Affiliated Hospital of Soochow University. Covariates, such as age, gender, body weight, and indices of liver and renal function, were examined to assess their influence on the pharmacokinetic parameters of apatinib. The PPK model was developed using the nonlinear mixed-effects modeling procedure (NONMEM), and model validation was conducted using the bootstrap method and normalized prediction distribution error (NPDE) method. Results: The structural model adopted a one-compartment structure with first-order elimination. Notably, aspartate aminotransferase (AST) and the co-administered drug type emerged as primary covariates affecting apatinib clearance (CL/F). The finalized model was expressed as CL/F (L/h) = 56.7 × (AST/26.6)−0.298 × θ, when apatinib was combined with monoclonal antibodies, θ was 1; when combined with paclitaxel, θ was 0.58; when combined with other drugs (e.g., platinum, capecitabine, or the combination of tegafur, gimeracil, and oteracil potassium), θ was 1.60; When used as monotherapy, θ was 1.38. V/F = 674 L, and the absorption rate constant (Ka) was fixed at 0.08 h−1. Bootstrap results affirmed the model's reliability and stability, while NPDE outcomes attested to the model's fit. Conclusion: Our study successfully established a PPK model for apatinib in oncology patients, revealing that liver function status and co-administered drug types significantly impacted apatinib CL/F. This finding underscored the potential necessity for dose adjustments to optimize efficacy, particularly in patients undergoing different chemotherapy regimens involving apatinib. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of clinical ethics counselling in medicine in terms of satisfaction of the participants, support of ethical decision-making, perceived impact on clinical care, moral competence and quality of communication is now empirically well validated. In psychiatry, more and more institutions have structures for clinical ethics consultation as well; however, there is still a lack of evaluative accompanying research on the benefits and differential indications of the various forms and models of clinical ethics counselling in psychiatry. Aim of the work: The article presents the principles and the step by step application of the principle-oriented clinical ethics consultation according to the Basel model 2.0. Material and methods: The article is based on material and procedures developed at the Clinical Ethics Unit of the University Hospital Basel and the University Psychiatric Clinics Basel for the principle-oriented clinical ethics consultation according to the Basel model 2.0. Results and discussion: Principle-oriented clinical ethics consultation according to the Basel model 2.0 is suitable for dealing with moral issues and conflicts in psychiatric practice and for their ethical reflection; however, further evaluative accompanying research is needed on the benefits and differential indications of this and other models of clinical ethics support in psychiatry. [ABSTRACT FROM AUTHOR]

Background: Clinical remission has recently been proposed as a possible treatment goal even in severe asthma. In this real-world study, we aimed to assess the achievement rate and predictive factors of clinical remission using omalizumab in patients with severe asthma. Methods: This retrospective observational study included patients with severe asthma initiated with omalizumab therapy and recruited from the asthma clinic of the Akdeniz University Hospital, Turkey. Clinical remission was defined as patients who received no oral corticosteroid (OCS) therapy; showed no exacerbations; showed an asthma control questionnaire score of ≤ 1, asthma control test (ACT) of ≥ 20, or both and, FEV1 of ≥ 80% predicted. Results: A total of 58 patients were included in the study, with an average age of 56.4 ± 13.6 years. The mean duration of asthma was 23.5 ± 11.8 years and the mean duration of omalizumab treatment was 80.05 ± 35.04 months. Clinical remission rates were 25.9% in the first and second year, 34.0% in the third year, 34.1% in the fourth year and 47.4% in the fifth year. Pre-omalizumab ACT, FEV1 (%) and OCS use were significantly higher in patients with clinical remission at 1 year. Logistic regression analyses showed that none of the factors predicted clinical remission. Conclusion: Omalizumab has the potential to induce disease remission in a significant proportion of people with severe asthma, and this is maintained and improved over time. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine the effects of the Covid-19 pandemic and lockdown policies in Germany on frequency and treatment of peritonsillar abscess at a tertiary referral center in Germany. Methods: This retrospective case-control study analyzed all cases of peritonsillar abscess treated from 03/01/2018 until 08/30/2022 at Augsburg ENT University Hospital, Germany, through abscess tonsillectomy and/ or incisional drainage. Data was collected and correlated to Covid-19 Stringency Index using codes based on the Institute for Hospital Remuneration System in Germany. After excluding 303 cases, 975 abscess tonsillectomy and incisional drainage cases were studied, with the first German lockdown serving as cutoff date. Treatment algorithm was maintained regardless of co-infection with Covid-19. Results: A total of 174 patients received abscess tonsillectomy as therapy, while 801 patients underwent incisional drainage. Before the first German lockdown, 452 patients received incisional drainage. Since the pandemic, 349 cases of incisional drainage were registered (OR = 0.54, 95%-CI [0.27–0.86], p = 0.04), despite no significant change in the percentage of peritonsillar abscess of all ENT emergencies. The mean age at presentation with PTA was 39.8 years, and the rate of relapse was 4.0%. The study found no association between the scale of policy measures and treatment (OR = 1.00, 95%-CI [0.99–1.01], p = 0.52). Conclusion: The results indicate that, despite the reduction in capacities due to Covid-19, the proportion of patients with peritonsillar abscess treated through abscess tonsillectomy increased at Augsburg ENT University Hospital since the first German lockdown. Hospitalization times could still be reduced with comparable relapse rates. [ABSTRACT FROM AUTHOR]

Background: The vasopressor dose needed is a common measure to assess the severity of cardiovascular failure, but there is no consensus on the ranges of vasopressor doses determining different levels of cardiovascular support. We aimed to identify cutoffs for determining low, intermediate and high doses of noradrenaline (norepinephrine), the primary vasopressor used in intensive care, based on association with hospital mortality. Methods: We conducted a binational registry study to determine cutoffs between low, intermediate and high noradrenaline doses. We required the cutoffs to be statistically rational and practical (rounded to the first decimal and easy to remember), and to result in increasing mortality with increasing doses. The highest noradrenaline dose in the first 24 h after intensive care unit (ICU) admission was used. The cutoffs were developed using data from 8079 ICU patients treated in the ICU at Kuopio University Hospital, Finland, between 2013 and 2019. Subsequently, the cutoffs were validated in the eICU database, including 39,007 ICU admissions to 29 ICUs in the United States of America in 2014–2015. The log‐rank statistic, with the Contal and O'Quigley method, was used to determine the cutoffs resulting in the most significant split between the noradrenaline dose groups with regard to hospital mortality. Results: The two most prominent peaks in the log‐rank statistic corresponded to noradrenaline doses 0.20 and 0.44 μg/kg/min. Accordingly, we determined three dose ranges: low (<0.2 μg/kg/min), intermediate (0.2–0.4 μg/kg/min) and high (>0.4 μg/kg/min). Mortality increased, whereas the number of patients decreased consistently with increasing noradrenaline doses in both cohorts. In the development cohort, hospital mortality was 6.5% in the group without noradrenaline administered and 14.0%, 26.4% and 40.2%, respectively, in the low‐dose, intermediate‐dose and high‐dose groups. Compared to patients who received no noradrenaline, the hazard ratio for in‐hospital death was 1.4 for the low‐dose group, 4.0 for the intermediate‐dose group and 7.5 for the high‐dose group in the validation cohort (p <.001). Conclusions: The highest noradrenaline dose is a useful measure for quantifying circulatory failure. Cutoffs 0.2 and 0.4 μg/kg/min seem to be suitable for defining low, intermediate and high doses. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of intraoperative neuromonitoring (IONM) on vocal cord palsy (VCP) rates and assess the temporal trends in VCP rates. Methods: The subjects of this retrospective study were patients who underwent thyroidectomy for thyroid cancer between March, 2014 and June, 2022, at a university hospital in Korea. We compared VCP rates between the non-IONM and IONM groups and analyzed the risk factors for VCP and VCP rates over time. Results: A total of 712 patients were included in the analysis. The rates of transient and permanent VCP did not differ significantly between the non-IONM and IONM groups. Transient VCP occurred in 4.6% and 4.3% patients (p = 0.878) and VCP was permanent in 0.7% and 0.4% patients (p = 0.607) in the non-IONM and IONM groups, respectively. Among the nerves at risk, transient damage occurred in 2.8% and 3.0% patients (p = 0.901), and permanent damage occurred in 0.4% and 0.3% (p = 0.688), respectively. Multivariate analysis revealed no significant risk factors for VCP. There was a significant decreasing trend in VCP rates over time as the cumulative number of cases increased (p = 0.017). Conclusions: IONM did not reduce the risk of VCP significantly. However, the declining trend of VCP rates suggests that the surgeon's experience may mitigate VCP risk. [ABSTRACT FROM AUTHOR]

Objectives: Specific human leukocyte antigen (HLA) haplotypes are associated with Behçet's disease. Because the effects of HLA-A26 and its combination with HLA-B51 on organ involvement in Behçet's disease have not been well demonstrated, we aimed to examine them. Methods: This multicentre, cross-sectional, observational study enrolled patients with Behçet's disease who visited Kyoto University Hospital between 2018 and 2021 or Kurashiki Central Hospital between 2006 and 2016 (n = 200). Disease severity was evaluated using the Krause score. Results: Uveitis and gastrointestinal involvement were observed in 95/196 and 57/167 patients, respectively. The HLA alleles identified were HLA-B51 (n = 52/106), HLA-A26 (n = 25/88), and HLA-B51 and HLA-A26 (n = 6/88). In patients harbouring HLA-B51, the presence of HLA-A26 was associated with higher frequencies of uveitis (P = .03) and coexistence of uveitis and gastrointestinal involvement (P = .002) and higher Krause scores (P = .02). Furthermore, the presence of HLA-A26 was associated with a higher frequency of uveitis in patients with gastrointestinal involvement (P = .001) and gastrointestinal involvement in patients with uveitis (P = .001). Conclusions: Since specific HLA haplotypes and their combinations are associated with organ involvement, both HLA-A and HLA-B haplotypes should be confirmed when screening for affected organs. [ABSTRACT FROM AUTHOR]

Pancreatic pathologies causing portomesenteric occlusion complicate extirpative pancreatic resection due to portomesenteric hypertension and collateral venous drainage. Patients with portomesenteric occlusion undergoing pancreatectomy were identified between 2007 and 2020 at Stanford University Hospital. Demographic and clinical data, technique and perioperative factors, and post-operative outcomes were analyzed. Of twenty-seven (27) patients undergoing venous revascularization during pancreatectomy, most (15) were for pancreatic neuroendocrine tumor. Occlusions occurred mostly at the portosplenic confluence (15). Median occlusion length was 4.0 cm [3.1–5.8]. Regarding revascularization strategy, mesocaval shunting was used in 11 patients, in-line venous revascularization with internal jugular conduit in three patients, traditional venous resection and reconstruction in 9 patients, and thrombectomy in two patients. Median cohort operative time and estimated blood loss were 522 min [433–638] and 1000 mL [700–2500], respectively. Median length of stay was 10 days [8–14.5] with overall readmission rate of 37%. Significant complications occurred in 44% of patients despite only one (4%) perioperative mortality. Despite the technical complexity for managing portomesenteric occlusions, early revascularization strategies including mesocaval shunting or in-line venous revascularization are feasible and facilitate a safe pancreatic resection for surgically fit patients. [ABSTRACT FROM AUTHOR]

Background: Cerebral perfusion pressure (CPP) is an important target in aneurysmal subarachnoid hemorrhage (aSAH), but it does not take into account autoregulatory disturbances. The pressure reactivity index (PRx) and the CPP with the optimal PRx (CPPopt) are new variables that may capture these pathomechanisms. In this study, we investigated the effect on the outcome of certain combinations of CPP or ΔCPPopt (actual CPP-CPPopt) with the concurrent autoregulatory status (PRx) after aSAH. Methods: This observational study included 432 aSAH patients, treated in the neurointensive care unit, at Uppsala University Hospital, Sweden. Functional outcome (GOS-E) was assessed 1-year postictus. Heatmaps of the percentage of good monitoring time (%GMT) of PRx/CPP and PRx/ΔCPPopt combinations in relation to GOS-E were created to visualize the association between these variables and outcome. Results: In the heatmap of the %GMT of PRx/CPP, the combination of lower CPP with higher PRx values was more strongly associated with lower GOS-E. The tolerance for lower CPP values increased with lower PRx values until a threshold of −0.50. However, for decreasing PRx below −0.50, there was a gradual reduction in the tolerance for lower CPP. In the heatmap of the %GMT of PRx/ΔCPPopt, the combination of negative ΔCPPopt with higher PRx values was strongly associated with lower GOS-E. In particular, negative ΔCPPopt together with PRx above +0.50 correlated with worse outcomes. In addition, there was a transition toward an unfavorable outcome when PRx went below −0.50, particularly if ΔCPPopt was negative. Conclusions: The PRx levels influenced the association between CPP/ΔCPPopt and outcome. Thus, this variable could be used to individualize a safe CPP-/ΔCPPopt-range. [ABSTRACT FROM AUTHOR]

Background: Propolis was added to the European baseline series (EBS) in 2019. Objectives: To investigate the frequency and relevance of positive patch tests to propolis in the EBS and to study co‐reactivities. Patients and Methods: Retrospective study in patients patch tested between June 2019 and November 2023 in a university hospital in Amsterdam, The Netherlands. Results: Of 3134 consecutive patients, 299 (9.5%) had a positive reaction to propolis 10% pet. Only nine reactions (3%) were judged to be clinically relevant. There were significant co‐reactivities to Myroxylon pereirae resin (balsam of Peru), colophonium, fragrance mixes 1 and 2, and to limonene and linalool hydroperoxides. A steep increase in rates of positive reactions to propolis was observed from 2020 to 2023. This was highly likely the result of the replacement of Chinese propolis with Brazilian propolis by the manufacturer. Conclusions: Positive patch tests for propolis are very frequent in Amsterdam, but only a few of these reactions are relevant. Most are probably (pseudo‐)cross‐reactions in patients with fragrance allergies. Propolis in the EBS has very limited value for dermatologists and patients in The Netherlands. Changes in patch test materials should be provided to all users to avoid misinterpretation of patch test results. [ABSTRACT FROM AUTHOR]

Aim: To elucidate the effects of ultra‐processed foods (UPFs) on body weight and ad libitum energy intake compared with non‐UPFs. Materials and Methods: In this randomized, open‐label crossover study conducted at the University of Tokyo Hospital, overweight/obese Japanese male participants were randomly assigned (1:1) to start the study with consumption of either UPFs or non‐UPFs for 1 week, followed by a 2‐week washout period, before crossing over to the alternate food diet for 1 week. Individuals with diabetes, hypertension or any other medical conditions who visited a hospital regularly were excluded. The meals were designed to be matched for the total energy and macronutrient levels. The primary outcome was the difference in the body weight change between the UPF and non‐UPF periods. The differences in the average daily energy intake and chewing frequency were assessed as one of the prespecified secondary outcomes. Results: Nine eligible participants were randomly assigned to start the study with either UPFs or non‐UPFs. All participants completed the study. During the UPF period, participants gained 1.1 kg more weight (95% confidence interval 0.2 to 2.0; P =.021) and consumed 813.5 kcal more per day (342.4 to 1284.7; P =.0041) compared with during the non‐UPF period. Regarding the chewing frequency, the number of chews per calorie was significantly lower during the UPF period (P =.016). Conclusions: Consumption of UPFs causes significant weight gain. Medical nutritional therapy focused on reducing the consumption of UPFs could be an effective strategy for preventing obesity. [ABSTRACT FROM AUTHOR]

An increasing number of drug-resistant bacteria have been identified recently. In particular, drug-resistant bacteria have been linked to unfavorable prognoses in patients with bacteremia, highlighting the need for rapid testing. Our previous studies have focused on the utility of a drug susceptibility testing microfluidic (DSTM) method using microfluidic channels. A system with this DSTM method for screening for β-lactamases can rapidly detect extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs). In this study, we have evaluated the clinical utility of pre-treatment for screening positive blood cultures using the DSTM method. A total of 178 positive blood cultures and five simulated samples of MBL-producing bacteria were prepared at Kochi University Hospital, Japan. The pretreatment consisted of a two-step centrifugation. The obtained sediments were screened with the DSTM method for the production of β-lactamase based on morphological changes in the bacteria after 3 h of incubation. The pretreatment functioned properly for all samples. Of the 25 ESBL samples, 21 were positive for ESBLs. Four false-negative samples, all obtained from the same patient, contained CTX-M-2 enzyme-producing Proteus mirabilis and showed insusceptibility to an ESBL inhibitor. The simulated samples prepared for MBL screening were positive for MBLs. When combined with a method for rapidly identifying bacterial species, DSTM may enable patients with bloodstream infections to start receiving appropriate treatment within 4 h after positive blood cultures are screened. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the clinical feasibility of reducing the risk of unfavourable fractures during Le Fort III osteotomy by using a navigation-guided technique. A study was carried out involving 20 patients with Crouzon syndrome treated with Le Fort III osteotomy and distraction osteogenesis from 2018 to 2023 at the International Hospital of Peking University. The Le Fort III osteotomy procedure in experimental group (9 patients) was carried out under the guidance of navigation technique, while in historical control group (11 patients) was carried out by free hand. Immediate postoperative CT scans were acquired within 24h after surgery to observe the osteotomy lines and detect unfavourable fracture lines. There were 4 patients with unfavourable fractures in the navigation group (4/9 = 44%) while 10 patients in the freehand group (10/11 = 91%), with a statistically significant difference in the probability of unfavourable fracture and the number of fracture lines between the two groups (P < 0.05). The difference in unfavourable fracture incidence in the two groups was significant in zygomatic area (P < 0.05) while not significant in mid-palatal area (P > 0.05). And the surgical duration of the navigation group was significantly shorter than that of the freehand group (216 min vs 280 min) (P < 0.05). The above findings suggest that the navigation-guided technique is effective in reducing the risk of unfavourable fractures in Le Fort III osteotomy procedure and decreasing the surgical duration. [ABSTRACT FROM AUTHOR]

Background: The purpose of clinical microbiology testing is to provide important information for clinical diagnosis and treatment. The correct collection, processing, and transportation of specimens are the key to the success of clinical microbiological examination. Methods: Retrospective analysis was done on the composition and causes of unqualified microbial samples submitted by clinical departments from 2019 to 2020 at the Affiliated Hospital of Nantong University. The solutions were proposed from the perspective of nursing management. Results: In 2019, the hospital received 64,244 clinical microbial specimens. The unqualified rate of samples was 8.96%, of which the unqualified sputum accounted for 84.74%. After strengthening the communication with the medical laboratory, increasing publicity and training, and improving the information system and other auxiliary monitoring functions, the unqualified rate of clinical microbial specimens was reduced to 6.05% in 2020. Conclusions: Continuously improving the theoretical and practical abilities of nurses can reduce the unqualified rate of samples. [ABSTRACT FROM AUTHOR]

Background and study aims: Lynch syndrome (LS) is a hereditary autosomal dominant condition, with an increased lifetime risk of developing malignancies including colorectal cancer (CRC). Current guidelines differ in recommended colonoscopy-surveillance intervals from 1 to 2 years. Although colonoscopy is considered a safe procedure, there are risks of severe adverse events (SAEs), such as perforation and bleeding, as well as adverse events (AEs), such as abdominal discomfort and post-colonoscopy gastrointestinal infections. Colonoscopy-related bleeding and perforation rates have been reported 0.17% and 0.11%, respectively. However, there are insufficient data regarding complications of colonoscopy-surveillance for LS patients. This study aims to investigate the risk of AEs among LS patients during colonoscopy in the Stockholm region. Patients and methods: This retrospective cohort study includes 351 LS patients undergoing endoscopic surveillance at the Karolinska University Hospital, August 1989 – April 2021. Data from endoscopic surveillance colonoscopies were extracted from patients' medical records. Results: Of 1873 endoscopies in 351 LS patients, 12 complications (AEs) were documented within 30 days (0.64%) and with a total of 3 bleedings (SAEs, 0.16%). No perforations were identified. Conclusion: Colonoscopy surveillance for LS patients shows a comparatively low risk of AEs per-examination. Colonoscopy complications per-patient, including both SAEs and AEs, show a significantly higher risk. Colonoscopy complications only including SAEs, show a comparatively low risk. Understanding the lifetime risk of surveillance-related colonoscopy complications is important when designing targeted surveillance programmes. [ABSTRACT FROM AUTHOR]

Context Current guidelines for distinguishing Cushing's disease (CD) from ectopic ACTH secretion (EAS) are questionable, as they use pituitary magnetic resonance imaging (MRI) as first-line investigation for all patients. CRH testing is no longer available, and they suggest performing inferior petrosal sinus sampling (BIPPS), an invasive and rarely available investigation, in many patients. Objective To establish noninvasive personalized diagnostic strategies based on the probability of EAS estimated from simple baseline parameters. Design Retrospective study. Setting University hospitals. Patients Two hundred forty-seven CD and 36 EAS patients evaluated between 2001 and 2023 in 2 French hospitals. A single-center cohort of 105 Belgian patients served as external validation. Results Twenty-four-hour urinary free cortisol (UFC) had the highest area under the receiver operating characteristic curve for discrimination of CD from EAS (.96 [95% confidence interval (CI),.92-.99] in the primary study and.99 [95% CI,.98-1.00] in the validation cohort). The addition of clinical, imaging, and biochemical parameters did not improve EAS prediction over UFC alone, with only BIPPS showing a modest improvement (C-statistic index.99 [95% CI,.97-1.00]). Three groups were defined based on baseline UFC: < 3 (group 1), 3-10 (group 2), and > 10 × the upper limit of normal (group 3), and they were associated with 0%, 6.1%, and 66.7% prevalence of EAS, respectively. Diagnostic approaches performed in our cohort support the use of pituitary MRI alone in group 1, MRI first followed by neck-to-pelvis computed tomography scan (npCT) when negative in group 2, and npCT first followed by pituitary MRI when negative in group 3. When not combined with the CRH test, the desmopressin test has limited diagnostic value. Conclusion UFC accurately predicts EAS and can serve to define personalized and noninvasive diagnostic algorithms. [ABSTRACT FROM AUTHOR]

Background: Infliximab therapy is effective in controlling symptoms and attaining clinical remission of immune-mediated inflammatory diseases. However, treatment adherence is essential to achieve the therapeutic objective. This study aimed to determine the rate of adherence to infliximab treatment in patients treated at a referral center at a university hospital. Method: This ambispective cohort study included patients treated at the Professor Edgard Santos University Hospital (HUPES) referral center of our university hospital between March 2022 and February 2023. Sociodemographic, clinical, and pharmacotherapeutic data were collected from 101 patients through interviews and medical record reviews using a structured form. The adherence rate was defined as the proportion of days covered in a year. Patients who achieved an adherence rate > 80% were considered adherent. Results: The treatment adherence rate was 91.04%. Individuals with inflammatory bowel diseases had a 39.1% higher risk of non-adherence to treatment compared with other patients in our sample (p < 0,05). Most patients achieved remission or control of the underlying disease activity and had good functional capacities. The main reason for absence on the scheduled date was difficulty traveling to the referral center. Conclusions: Despite the reported difficulties, treatment adherence was observed to be high. As the study was conducted in a reference unit with multidisciplinary care and continuous monitoring for treatment effectiveness, safety, and adherence, welcoming and good communication between professionals and patients may have contributed to the high adherence rate. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusion The implementation of computer‐aided detection (CAD) devices in esophagogastroduodenoscopy (EGD) could autonomously identify gastric precancerous lesions and neoplasms and reduce the miss rate of gastric neoplasms in prospective trials. However, there is still insufficient evidence of their use in real‐life clinical practice.A real‐world, two‐center study was conducted at Wenzhou Central Hospital (WCH) and Renmin Hospital of Wuhan University (RHWU). High biopsy rate and low biopsy rate strategies were adopted, and CAD devices were applied in 2019 and 2021 at WCH and RHWU, respectively. We compared differences in gastric precancerous and neoplasm detection of EGD before and after the use of CAD devices in the first half of the year.A total of 33 885 patients were included and 32 886 patients were ultimately analyzed. In WCH of which biopsy rate >95%, with the implementation of CAD, more the number of early gastric cancer divided by all gastric neoplasm (EGC/GN) (0.35% vs 0.59%, P = 0.028, OR [95% CI] = 1.65 [1.0–2.60]) was found, while gastric neoplasm detection rate (1.39% vs 1.36%, P = 0.897, OR [95% CI] = 0.98 [0.76–1.26]) remained stable. In RHWU of which biopsy rate <20%, the gastric neoplasm detection rate (1.78% vs 3.23%, P < 0.001, OR [95% CI] = 1.84 [1.33–2.54]) nearly doubled after the implementation of CAD, while there was no significant change in the EGC/GN.The application of CAD devices devoted to distinct increases in gastric neoplasm detection according to different biopsy strategies, which implied that CAD devices demonstrated assistance on gastric neoplasm detection while varied effectiveness according to different implementation scenarios. [ABSTRACT FROM AUTHOR]

The purpose of this research was to summarize the clinical and prognostic features of pineal region meningiomas, evaluate treatment strategies and long-term prognoses, and improve the management of pineal region meningiomas. We retrospectively studied the data of 37 patients who received surgical resection for pineal region meningiomas at West China Hospital of Sichuan University from 2009 to 2021. Adjuvant gamma knife radiosurgery (GKRS) was conducted according to the extent of resection (EOR). Progression-free survival (PFS), Karnofsky performance status (KPS) scores and recovery of neurological function were adopted to assess a comprehensive management strategy for pineal region meningiomas. The most common symptom was headache associated with intracranial hypertension (75.7%). The occipital transtentorial approach (40.5%) and supracerebellar infratentorial approach (29.7%) were performed in most cases. Gross total resection (GTR) was achieved in 27 patients (73.0%) and the remaining patients were treated with subtotal resection (STR) combined with postoperative GKRS. With a mean follow-up period of 87.0 months, the progression rate was 10.0%, the 5-year PFS rate was 92.9%, and the ΔKPS was 16.3. Multivariate analysis revealed that the STR + GKRS and supracerebellar infratentorial approach were beneficial to the recovery of quality of life of patients. Pineal region meningiomas are sporadic but challenging. It is necessary to select the most appropriate surgical approach, EOR, and hydrocephalus treatment strategy for patients with pineal region meningiomas. Maximal safe resection to protect neurovascular function combined with postoperative GKRS can significantly improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions We have been able to use molecular targeted agents for unresectable hepatocellular carcinoma since 2009, and immune checkpoint inhibitors have been approved in recent years. We assessed the efficacy of systemic therapy in Hiroshima University Hospital by each era.A total of 357 patients who were treated with sorafenib, lenvatinib, atezolizumab plus bevacizumab combination therapy, or durvalumab plus tremeliumab combination therapy as first‐line systemic therapy in our hospital from November 2009 to December 2023 were enrolled in this retrospective cohort study. We divided the years from 2009 to 2023 into the following three periods: cohort I, 2009–2016, the single‐molecular targeted agent era; cohort II, 2017–2020, the multi‐molecular targeted agent era; and cohort III, 2020–2023, the immuno‐oncology era.The median survival time was 9.5 months in cohort I, 15.8 months in cohort II, and 20.2 months in cohort III. The median survival time in cohort III was significantly (p < 0.01) longer than in the other cohorts. The overall response rate by mRECIST was 4.1% in cohort I, 28.7% in cohort II, and 47.2% in cohort III. The disease control rate was 41.6% in cohort I, 61.2% in cohort II, and 73.6% in cohort III. Both overall response rate and disease control rate significantly increased by era.We consider that advancements in systemic therapy, along with changes in treatment strategies, such as sequential therapy after progression, contribute to the prolonged prognosis across different eras. [ABSTRACT FROM AUTHOR]

Objective: This study examines the epidemiology of Mycoplasma pneumoniae (M. pneumoniae) infections among children in Suzhou, China, during various pandemic phases. The goal is to discern evolving epidemic trends and to furnish robust evidence for clinical diagnosis and treatment. Methods: From January 1, 2016, to December 31, 2023, 113,625 consecutive patients with respiratory infections from three hospitals in Suzhou, China (Children's Hospital of Soochow University, Children's Hospital of Wujiang District, and Affiliated Suzhou Hospital of Nanjing University Medical School), were retrospectively enrolled in a surveillance study. Additionally, in 2023, children hospitalized with M. pneumoniae pneumonia at the Children's Hospital of Soochow University were tested for genotype (P1 gene typing, SNP genotyping) and macrolide resistance in their bronchoalveolar lavage fluid. Results: From 2016 to 2023, the M. pneumoniae positive detection rate among pediatric respiratory infections fell from a pre-pandemic 21.1% to pandemic lows, then surged to 45.3% post-pandemic. Before the pandemic, peak M. pneumoniae infection rates occurred in summer, followed by autumn. Postpandemic, the highest peak rates were in autumn. Peak M. pneumoniae detection rates occurred in 2019 and 2023, with a notable increase in children aged 6 and older in 2023. In this study, 200 M. pneumoniae-positive bronchoalveolar lavage fluid (BALF) cases in 2023 were randomly selected and analyzed for P1 genotype and SNP genotype. Among 156 cases, 81.4% were P1 genotype and 18.6% were P2 genotype. The proportion of severe M. pneumoniae pneumonia with the P1 type was significantly higher than that with the P2 type (p <0.05). Of the 192 samples analyzed, 11 SNP genotypes were identified, with SNP-27 predominating (36.5%), followed by SNP-0 (21.4%), SNP-11 (18.8%), and SNP-34 (17.7%). Of the 192 BALF specimens, 97.3% exhibited macrolide resistance mutations, with A2063G mutations at 96.17%. The mutation rates for the 23S rRNA 2064 and 2,617 were 1.6 and 1.0%, respectively. Conclusion: Post-COVID-19 in Suzhou, China, M. pneumoniae infection patterns shifted significantly, with initial NPIs-induced declines followed by a sharp rise in cases, especially impacting school-age children. This trend underscores the importance of ongoing epidemiological surveillance and the development of strategic public health responses. [ABSTRACT FROM AUTHOR]

The risk of developing subsequent breast cancer is higher in women diagnosed with benign breast disease (BBD) but these studies were primarily performed in non-Hispanic white populations. Still, these estimates have been used to inform breast cancer risk models that are being used clinically across all racial and ethnic groups. Given the high breast cancer mortality rates among African American (AA) women, it is critical to study BBD in this population, to ensure the risk models that include this information perform adequately. This study utilized data from AA women who underwent benign breast biopsies at a hospital served by the University Pathology Group in Detroit, Michigan, from 1998 to 2010. Patients were followed for subsequent breast cancers through the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). BBD lesion scores were assigned to represent the severity or extent of benign breast lesions, with higher scores indicating a greater number of distinct lesion types. Of 3,461 eligible AA women with BBD in the cohort, 6.88% (n=238) subsequently developed breast cancer. Examined individually, six of the eleven lesions (apocrine metaplasia, ductal hyperplasia, lobular hyperplasia, intraductal papilloma, sclerosing adenosis, columnar alterations and radial scars) were significantly associated with increased risk of breast cancer after adjustment for age and year of biopsy and were further considered in multiple lesion models. For every different type of benign breast lesion, subsequent risk of breast cancer increased by 25% (RR=1.25, 95% CI: 1.10, 1.42) after adjustment for age at biopsy and proliferative versus non-proliferative disease. In summary, this study affirms the increased breast cancer risk in AA women with BBD, particularly in those with multiple lesions. These findings have implications for the management of breast cancer risk in millions of women affected by BBD, a high risk group that could benefit from personalized surveillance and risk reduction strategies. [ABSTRACT FROM AUTHOR]

Background: Brace therapy's influence on adolescent idiopathic scoliosis's (AIS) natural course is inconclusive. Methods: Brace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables' influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society's [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed. Results: The research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup. Conclusions: Brace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS's multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS's criteria. [ABSTRACT FROM AUTHOR]

Introduction: Difficulties in recruitment of veterinary specialists to academia is an ongoing problem for university teaching hospitals. The aim of this study was to determine the proportion of veterinary neurology specialists that plan to work in academia after their residency training and identify the main factors that may influence that decision. Methods: An electronic survey was distributed to European College of Veterinary Neurology (ECVN) residents in training and those that completed their residencies within the previous 12 months. Results: Despite similar numbers of residents training in clinical practice and academic institutions, most respondents (79.7%) planned to work in private practice. The most influential factors for deciding future workplace were quality of life, salary, location, and the number of other specialists (with specialists in subjects other than neurology viewed as more important than neurologists) working in the same institution. The most common reasons for not choosing academia were low compensation, excessive bureaucracy, and high administrative workload compared to private clinical practice. Discussion: Academic institutions need to review support for academic staff and provide stronger mentorship to overcome these problems and ensure provision of high-quality undergraduate teaching in veterinary neurology as well as promoting advancement of the field through basic and applied research. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical prognostic factors and treatments for angioimmunoblastic T-cell lymphoma (AITL) and develop a novel prognostic model specifically for AITL. Method: We retrospectively analyzed 231 patients with AITL from the First Affiliated Hospital of Zhengzhou University. Patients were enrolled between January 2014 and July 2023. The primary end points were overall survival (OS) and progression-free survival (PFS). Result: The patients' median age was 63 years, with 88.3% at an advanced stage (III/IV). The majority of patients (47.6%) received anthracycline-containing regimens, and there was no significant difference in survival compared with those treated with epigenetic-targeting and gemcitabine- containing regimens. The median PFS and OS were 6 and 17 months, respectively. In multivariate analysis, age >60 years, Eastern Cooperative Oncology Group performance status ≥2, elevated LDH, and splenomegaly were associated with inferior OS. Based on these four factors, a novel prognostic model (AITL model) was constructed that stratified patients into low, intermediate, and highrisk groups, with 2-year OS estimates of 63.6%, 42.1%, and 18.6%, respectively. Conclusion: Currently, there is no consensus on the optimal initial therapy for AITL, and the efficacy of anthracycline-containing regimens remains suboptimal. The novel model developed herein demonstrates predictive significance for both OS and PFS, and exhibits better stratification and discrimination capabilities. [ABSTRACT FROM AUTHOR]

Illness perceptions (IPs) encompass opinions regarding the nature, severity and curability of a disease. The aim of this cross-sectional study was to investigate the association between alexithymia and IPs among persons with multiple sclerosis (PwMS) and their partners, as well as within the dyads composed of PwMS and partners. PwMS referred to the Multiple Sclerosis Center of the University Hospital "Policlinico-San Marco" from 11th August 2021 to 7th January 2022 and their partners completed a battery of questionnaires, including the Toronto Alexithymia Scale-20 and the Illness Perception Questionnaire Revised. A dyadic data analysis (Actor-Partner Interdependence Model) was performed to test the effect of alexithymic traits both on a person's own illness perceptions (actor effect) and on the partner's illness perceptions (partner effect). 100 PwMS (71 women; mean age 47.6 ± 10.4 years) and 100 partners (29 women; mean age 49.1 ± 10.8 years), with a mean partnership duration of 20.1 ± 11.7 years, were enrolled. At the dyadic analysis, statistically significant small-to-moderate actor and partner effects were found considering alexithymia (total score and alexithymic facets) and IPs, whereby higher alexithymic traits related to higher negative perceptions (i.e. consequences, emotional representations) and lower positive ones (i.e. coherence, treatment control). Our findings support the relationship between alexithymia and negative illness appraisals. This data may inform therapeutic interventions aimed at reducing alexithymic traits, which in turn may reduce negative, and potentially dysfunctional, illness perceptions. [ABSTRACT FROM AUTHOR]

Background: Congenital lung malformation (CLM) is usually characterized by single-lobe involvement and multilobe involvement is uncommon. There is a lack of experience in the clinical features and surgical treatment of unilateral multilobar CLM. Therefore, this study aims to summarize the clinical characteristics and evaluate the safety and feasibility of thoracoscopic lung sparing resection in the treatment of unilateral multilobar CLM. Methods: A retrospective study was conducted on 34 patients with unilateral multilobar CLM, and 34 unilobar patients were randomly selected as the control group in West China Hospital of Sichuan University from 2014.1 to 2021.1. Clinical, operation and follow-up outcomes were compared between the two groups. Results: Twelve (35.2%) patients developed preoperative symptoms in the multilobar group more than 4(11.7%) the unilobar group (p = 0.02), the main preoperative symptom was infection; The multilobar group and unilobar group showed significant differences in mean intraoperative blood loss (13.3 mL vs. 7.5 mL; p = 0.02) and mean surgical time (95.6 min vs. 47.5 min; p = 0.037). The median length of postoperative hospital stay and the median chest tube placement time in the multilobar group were significantly longer (5 d vs.3 d, p = 0.045; 2 d vs.1 d, p = 0.031). There were one (2.9%) patient in unilobar group and 4(11.7%) patients in multilobar group developed complications postoperatively, which is no significant differences between the two groups(p = 0.16). No complications such as thoracic deformity, mediastinal deviation, scoliosis or recurrence were observed in either group at follow-up. Conclusions: Unilateral multilobar CLM cases are more susceptible to develop symptoms than unilobar cases. Thoracoscopic lung sparing resection in the treatment of unilateral multilobar CLM has high safety and can effectively avoid serious complications of unilateral multiple lobectomy or pneumonectomy. [ABSTRACT FROM AUTHOR]

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are common drugs in patients with osteoarthritis (OA). NSAIDs are generally used at home by patients, without supervision, requiring proper knowledge and attitudes for correct practice. This study investigated the knowledge, attitude, and practice (KAP) of patients with OA toward NSAIDs. Methods This cross-sectional study enrolled patients with OA at the Qingpu Branch of Zhongshan Hospital of Fudan University between January and March 2024. The KAP scores and demographic information of respondents were collected through a self-designed questionnaire. Results There were 645 participants, with 579 (89.8%) over 45 years old and 394 (61.1%) females. The average scores for knowledge, attitude, and practice were 16.26 ± 3.79 (possible range: 0–24), 18.12 ± 1.99 (possible range: 5–35), and 29.20 ± 5.52 (possible range: 10–50), respectively. The structural equation model (SEM) found that for individuals currently using NSAIDs, the attitude had a direct effect on practice (β = 0.978, P < 0.001). For individuals not using NSAIDs, the attitude had a direct effect on practice (β = 0.936, P < 0.001). Conclusion This study suggested that adequate NSAID knowledge is the prerequisite for correct NSAID-related medical decisions, while attitude has a crucial intermediary effect. Healthcare professionals and society should strengthen education regarding the relevant knowledge of NSAIDs and guide the cultivation of positive attitudes toward NSAIDs. [ABSTRACT FROM AUTHOR]

In the treatment process of atopic dermatitis, pompholyx may occurs on palms and soles. However, there is limited knowledge about which patients are more likely to develop pompholyx and when it is expected to occur. Therefore, this study investigated the occurrence of pompholyx after the start of induction remission treatment. We collected medical information from48 AD patientswho visited Hiroshima University Hospital for the first time between January 2019 and December 2020, from the time of their first visit to 12 months later. In the initial group of 48 patients, 10 individuals developed pompholyx within 1 year after their first visit. There was no clear connection between the occurrence of pompholyx and treatment received. Most of the patients who developed pompholyx were above the age of 30. Serum thymus and activation-regulated chemokine (TARC) levels tended to be higher at the first visit in the group that later developed pompholyx compared to the group that did not. In conclusion, patients over the age of 30 with higher serum TARC levels may develop pompholyx while their AD is improving. It is crucial to provide these patients with information about the possibility of developing pompholyx during the course of their AD treatment and that it would be cured in the course of treatment. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Although Omega‐3 is thought to have anticoagulative properties, the potential untoward effects of Omega‐3 during pregnancy have not been investigated. No previous studies have been made to specifically assess its effect on postpartum hemorrhage (PPH). Our aim was to determine if an association exists between Omega‐3 intake during pregnancy and profuse PPH or massive PPH.Data on all deliveries that occurred at Karolinska University Hospital during the years 2007–2011 (n = 41 139) was collected from the medical record of Obstetrix, maternal health and delivery chart system. Women with reported Omega‐3 use in early pregnancy were considered exposed and all other as unexposed. Bivariate and adjusted multivariate analysis was performed on main outcomes.Omega‐3 use was associated with 25% increased odds of PPH (adjusted odds ratio (aOR) 1.25, 95% confidence interval [CI] (1.06–1.47)) and a more than doubled odds of massive PPH (aOR 2.36, 95% CI 1.26–4.44). In addition, there was a minor increase in the amount of blood loss. Although few, women on low‐dose discontinued terminated at 36th week showed no significant association to blood loss measurements.Our observational findings showed 25% higher odds of PPH and two times higher odds of massive PPH in women who reported using Omega‐3 in early pregnancy. Our findings give some support to advocate discontinued use of Omega‐3 in late pregnancy. [ABSTRACT FROM AUTHOR]

Mullerian adenosarcoma is rare, usually found in the uterine corpus and rarely in the cervix. Adenosarcoma that grows diffusely in the uterine cavity and the cervical canal is even rarer without symptoms. Herein, we report a rare case of multiple primary malignant neoplasms of Mullerian adenosarcoma accidentally detected and coexisting with cervical carcinoma in situ. Fortunately, the tumor was in the early stage and the Mullerian adenosarcoma was treated together with the cervical carcinoma in situ by hysterectomy + bilateral adnexectomy. Histopathology and immunohistochemistry results confirmed this diagnosis, further confirmed by a pathology consultation at the University Hospital. The patient recovered well from the surgical treatment and was discharged with regular follow-up. The patient did not undergo pelvis--abdomen CT and diagnostic curettage preoperatively, and no malignancy was detected by cryopathology intraoperatively, which may be related to the rarity of the disease and the relative lack of awareness and experience of our clinicians and pathologists for this tumor. We hope that this rare case can provide some lessons for gynecologists and pathologists. [ABSTRACT FROM AUTHOR]

Objective: Falls take a high priority among the prevalent medical conditions in old age. Despite this, a history of falls or the risk of future falls is not routinely assessed or properly managed in medical clinics in Sri Lanka. This study was done to evaluate the prevalence and factors associated with falls and recurrent falls among older adults attending medical clinics in four selected tertiary care centres in the country. Methods: A cross-sectional study was carried out at four centres (Teaching Hospital Karapitiya, Colombo South Teaching Hospital, Colombo North Teaching Hospital and University Hospital-Kotelawala Defence University) with 704 older adults, aged 65 years and above, attending medical clinics for more than six consecutive months. Information related to falls and possible associated factors (socio-demographic, behavioural, environmental and biological) were collected using an interviewer-administered questionnaire. Results: The Mean (SD) age of the participants was 72.5(5.5) years and 58.7% were females. Of the 704 total sample, 220 (31.3%, 95% CI 28–35%) participants experienced at least one fall after the age of 65, and 12.8% (95% CI 10–15%) (n = 90) experienced recurrent falls (two or more falls within the last 12 months). Falls were associated with gender, level of education, marital status, and physical dependence (p < 0.01). For those who had at least one fall, multiple logistic regression (MLR) revealed being single (p = 0.03, OR = 2.12, 95% CI; 1.052–4.304), being widowed/divorced/separated (p = 0.03, OR = 1.47, 95% CI; 1.039–2.093) compared to living with a spouse, presence of moderate (p = 0.007, OR = 1.72, 95% CI; 1.160–2.577) and severe (p = 0.001, OR = 2.98, 95% CI; 1.563–5.688) physical dependency compared to mild physical dependency as risk factors for falls. Having secondary education (p = 0.01, OR = 0.55, 0.350–0.876) was a protective factor for falls. For those with recurrent falls, MLR showed moderate physical dependency (p = 0.001, OR = 2.34, 95% CI; 1.442–3.821) compared to slight physical dependency as a risk factor. Conclusions: Approximately one-third of the older adults attending medical clinics had experienced at least a single fall, and one-eighth have had recurrent falls, which were mostly unrecorded and not clinically assessed. Physical dependency was the major contributing factor to falls and recurrent falls. Falls assessment should be included in the routine clinical assessment of older adults attending outdoor medical clinics. Health professionals should be educated to detect and assess those at risk of falling and take appropriate measures to prevent or minimize falls. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome(PCOS) is one of the main factors leading to infertility in women of reproductive age, which is often accompanied by metabolic changes such as obesity and chronic low-grade inflammation. Chronic inflammation may play an important role in the occurrence and development of metabolic diseases. Therefore, it is of great significance to explore the relationship between abnormal lipid metabolism and inflammation in PCOS patients. This study aims to analyze the correlation between systemic immune-inflammatory(SII) markers and dyslipidemia in patients with PCOS and their value in early diagnosis. Methods: A total of 617 PCOS patients aged 20–35 years (according to the Rotterdam diagnostic criteria) who visited the Reproductive Center of the First Hospital of Lanzhou University from January 2020 to December 2022 were included. According to the presence or absence of dyslipidemia, the patients were divided into normal lipid metabolism group and abnormal lipid metabolism group. The clinical data of the patients were collected and analyzed by SPSS software. Results: There were 454 patients with normal lipid metabolism and 163 patients with abnormal lipid metabolism. The SII level of the abnormal lipid metabolism group was higher than that of the normal group. As the SII quartile increased, TC, TG and LDL increased, while HDL decreased accordingly. The SII level was positively correlated with TC, TG and LDL, and negatively correlated with HDL (all P < 0.05). Among them, SII had the best predictive efficiency for dyslipidemia of polycyctic ovary syndrome at 489.375 (AUC: 0.718, 95%CI: 0.672–0.764), and SII was still associated with the increased occurrence of PCOS dyslipidemia after excluding confounding factors (P < 0.05). Conclusion: The high level of SII has a correlation with the occurrence of dyslipidemia in PCOS patients, and it has a value in the early diagnosis of PCOS. [ABSTRACT FROM AUTHOR]