Alternative Treatment Option Research Articles

Microwave ablation versus liver resection for patients with hepatocellular carcinomas.

Microwave ablation (MWA) is an emerging ablative therapy that surpasses previous methods by achieving higher temperatures and creating larger ablation zones within shorter periods. This study compared the therapeutic outcomes of MWA with those of liver resection in real-world clinical practice. A total of 178 patients with 259 nodules who underwent MWA or liver resection between January 2015 and July 2023 were enrolled. Local tumor progression-free survival (LTP), overall progression-free survival (OP), and overall survival (OS) were assessed based on the treatment modality for the index nodule. Of the 178 patients, 134 with 214 nodules underwent MWA, and 44 with 45 nodules underwent liver resection. The median follow-up period was 2.0 ± 1.5 years. The annual incidence of LTP was 3.7% for MWA and 1.4% for liver resection. Treatment modality did not significantly affect LTP-free survival (hazard ratio: 0.61, 95% confidence interval: 0.14-2.69, P = 0.511). For nodules larger than 3 cm, LTP-free survival was not affected by the treatment modality. Similarly, OP-free survival and OS were not influenced by treatment modality. MWA and liver resection demonstrated comparable treatment outcomes in terms of local tumor control, overall recurrence, and survival. MWA may be an alternative treatment option for select patients; however, further studies are necessary to generalize these findings.

Two Conventional Implants versus Four Mini-Dental Implants to Retain Mandibular Overdentures: A Systematic Review of Clinical and Radiological Outcomes.

It is essential to compare conventional dental implants (CDIs) and Mini-Dental Implants (MDIs). This systematic review evaluates the clinical and radiological outcomes of individuals receiving MDI-retained overdentures (ODs) compared to CDI-retained ODs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the current systematic review. The PubMed, Scopus, and Cochrane databases were examined for evidence-based research articles addressing the clinical and radiological outcomes of MDI and CDI published from January 2013 to September 2024. Two independent specialists conducted an autonomous search and established predefined screening criteria. The risk of bias (RoB) for randomized controlled trials (RCTs) was evaluated using the criteria established by the Cochrane Handbook for Systematic Reviews of Interventions for scientific merit. The informational database and manual searches produced 242 papers. Eight RCTs were examined after eliminating duplicates and organizing the publications according to the qualifying criteria. MDI-retained ODs have been shown to provide numerous benefits, including reduced bone resorption, enhanced aesthetics, occlusion, and tooth location, improved occlusal load direction, and maintenance of occlusal vertical dimension. The current systematic review suggests that using mini-dental implants to retain overdenture prostheses could be a viable alternative treatment option due to the high survival rates, acceptable marginal bone loss, and improvements in patient satisfaction and oral health-related quality of life metrics.

Noninvasive oxygenation and ventilation strategies for viral acute respiratory failure: a comprehensive systematic review and meta-analysis

BackgroundThe COVID-19 pandemic has resulted in a critical shortage of respiratory ventilators, highlighting the urgent need to explore alternative treatment options for patients with acute respiratory distress syndrome (ARDS) caused by respiratory viruses, as an alternative to invasive mechanical ventilation (IMV) in future pandemics.ObjectivesThe objective of this study was to assess the effectiveness of alternative noninvasive oxygenation and ventilation strategies in comparison to invasive mechanical ventilation (IMV) in patients with virus-induced acute respiratory failure (ARF). The primary outcome was the all-cause ICU mortality rate.MethodsA systematic review was conducted following the Cochrane guidelines and PRISMA reporting guidelines. The search encompassed databases such as Medline, Cochrane CENTRAL, and Embase to identify relevant indexed literature. Additionally, gray literature was included by consulting regulatory agencies. The included studies compared various oxygenation and ventilatory alternatives, such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or noninvasive mechanical ventilation (NIMV) with IMV. An exploratory meta-analysis was performed by calculating the risk ratio (RR) by random effects and meta-regression to explore possible sources of heterogeneity and to compare ventilatory alternatives against IMV to reduce mortality, length of stay (LOS) days in ICU, nosocomial infection, and barotrauma.ResultsA total of forty-seven studies were included in this systematic review. NIMV had an RR of 0.70 (0.58–0.85), HFNC had an RR of 0.54 (0.42–0.71), and CPAP had an RR of 0.80 (0.71–0.90), with meta-regression models that reduced heterogeneity to 0%. For LOS days in ICU, NIMV had 0.38 (− 0.69: − 0.08) lower days and HFNC 0.29 (− 0.64: 0.06) lower days with meta-regression models that reduction heterogeneity to 0% for HFNC and 50% for NIMV. Not enough studies reported nosocomial infection or barotrauma to evaluate them in a meta-analysis. The overall quality of evidence, as assessed by GRADE evaluation, was determined to be from very low to medium certainty depending on the ventilatory strategy and outcome.ConclusionsThe findings of this systematic review support the use of alternative noninvasive oxygenation and ventilation strategies as viable alternatives to conventional respiratory ventilation for managing viral-induced ARF. Although it is essential to interpret these findings with caution given the overall low to medium certainty of the evidence, the integration of these modalities as part of the management strategies of these patients could help reduce the utilization of ICU beds, invasive ventilators, and costs in both developed and developing countries.

3-Indoleacetic Acid-Modified Chondroitin Sulfate-Mediated Paclitaxel Nanocrystal Assembly for the Treatment of Pancreatic Cancer.

High drug-loading nanocrystals show significant advantages in delivering hydrophobic small-molecule drugs. However, these nanocrystals face challenges, including inherent instability and limited targetability. In this study, we developed a paclitaxel nanocrystal delivery platform based on chondroitin sulfate modified with 3-indoleacetic acid (CS-IAA). Paclitaxel and CS-IAA assembled into stable nanocrystals (PTX@CS-IAA, PC) with a high drug loading (up to 46.6%), facilitated by π-π stacking and hydrophobic interactions. CS-IAA targets tumors through CD44 receptors, which helps to minimize off-target effects. Additionally, CS-IAA, serving as a functional delivery vehicle, can significantly increase reactive oxygen species (ROS) levels at the tumor site. In an orthotopic pancreatic cancer mouse model, PTX@CS-IAA nanocrystals showed significantly enhanced antitumor effects. When PTX@CS-IAA was combined with the αPD-L1 antibody, the survival of mice with pancreatic tumors was further prolonged. This study provides valuable insights into alternative treatment options for pancreatic cancer, with the potential to improve patient prognosis and survival.

Sarcoma of the descending aorta: a case report

Introduction: Primary malignant aortic tumors are rare and diagnosis can be difficult due to the variety of clinical manifestations. This malignant disease, which originates in the intima or medial layers of the aorta, presents a complex diagnostic and therapeutic dilemma. Due to their insidious growth and nonspecific symptoms, they are often diagnosed postmortem. Case presentation: We present the case of a sarcoma of the descending part of thoracic aorta in a 69-year-old man. The initial symptoms were hypertension crisis, chest pain, shortness of breath and swollen legs. A computed tomography scan of the chest and abdomen revealed an obstructive mass in the thoracic aorta. Treatment consisted of performing a prosthesis of the thoracic aorta and removal of thrombi/tumor masses from the thoracoabdominal aorta and iliac artery on both sides, as well as chemotherapy. Conclusion: Aortic sarcoma should be recognized as a potential cause of a large thrombus in the aorta. Palliative procedures, including open aortic replacement may also serve as alternative treatment options for aortic sarcoma. Introduction Primary malignant aortic tumors are rare and the diagnosis can be challenging due to the variety of clinical manifestations. We report here a rare case of intimal sarcoma that presented as a coarctation-like syndrome. Moreover, we review the literature and discuss the diagnostic approach, treatment options, and prognosis.

Efficacy and safety of NeoAdjuvant chemotherapy with or without tIslelizumab followed by debulking surgery for oVarian cancEr (NAIVE study) in China: study protocol of an open-label, phase II, randomised controlled trial

IntroductionThe prognosis for epithelial ovarian cancer (EOC) is exceedingly poor, with patients diagnosed with stage III/IV tumours typically offered cytoreductive surgery in conjunction with chemotherapy as a standard treatment option....

Refractory eosinophilic pustular folliculitis treated with tofacitinib: a case series and literature review.

Eosinophilic pustular folliculitis (EPF) is an uncommon skin condition that presents as follicular papules or pustules. The treatment of EPF is challenging due to the high relapse rates. This study aimed to evaluate the efficacy and safety of tofacitinib as a treatment for EPF. We presented 3 patients with refractory EPF who had been successfully treated with tofacitinib at our clinic and conducted a literature review using the PubMed database to gain further insight into this promising therapy. Our patients were effectively treated with tofacitinib. To date, only three patients with EPF treated with Janus kinase (JAK) inhibitors have been reported and reviewed: one treated with tofacitinib and two with abrocitinib. Complete remission was observed in all the above patients, with no adverse events or relapses reported during an average follow-up period of 4.3 months. Tofacitinib may be an emerging alternative treatment option for EFP patients. Larger randomized controlled studies are needed to confirm these findings.

How We Diagnose and Manage Refractory and Resistant Herpes Simplex Virus Mucocutaneous Infection After Hematopoietic Cell Transplantation.

Herpes simplex virus (HSV) infection is a clinically significant complication in hematopoietic cell transplant (HCT) recipients. Refractory and resistant (R/R) HSV infections may occur in this patient population, particularly after prolonged exposure to anti-HSV agents. To provide a comprehensive review of the diagnostic approach and the treatment options for R/R HSV mucocutaneous infections in HCT recipients and to highlight future treatment strategies. We searched the PubMed Central Database and Embase to identify published studies on R/R HSV infections in HCT recipients. We used the search terms "herpes simplex virus," "resistant*," OR "refractory," "immunocompromised," "immunosuppress*," and "immunodeficien*," and screened the results for articles reporting R/R HSV infections among HCT recipients. We chose an HCT recipient with a complicated refractory HSV infection as a representative clinical case. A clear clinical definition of refractory HSV infection is currently not available, which can lead to delays in diagnosis and treatment, negatively impacting patient care. Apart from two small randomized controlled trials in the 1990s that looked at treatment with systemic foscarnet and topical cidofovir in patients living with human immunodeficiency virus, all treatment recommendations for R/R HSV infections are based on observational studies and case reports. The use of alternative treatment options often comes with serious side effects, such as kidney toxicity. This underscores the urgent need for safer and effective treatment options. Pritelivir, a new oral antiviral medication, is currently being studied in a phase 3 trial for R/R HSV infections in immunocompromised patients. Limited data from the Early Access Program, which allows compassionate use, suggests that pritelivir holds promise as a treatment option for HCT recipients with R/R HSV infections. The proposed R/R HSV mucocutaneous infection diagnostic and treatment algorithm guides the appropriate management of these difficult-to-treat infections, potentially improving patient outcomes.

Impact of Oral Frailty in Prosthodontic Care of an Aging Population

Sri Lanka, being one of the fastest aging nations in the world, need to embrace the unprecedented pres-sure this has on its health and social services in a holistic manner. The risk of frailty increases with aging and the prevalence of oral hypofunction raises along with physical dependency, cognitive decline, malnutrition and multimorbidity. With the advancement in healthcare services and increased public awareness, more people are retaining their natural or rehabilitated teeth into old age. Prosthodontic management should not only em-phasize proper oral function examination and treatment planning but also on home care of the prosthesis. This review will discuss the challenges and alternative prosthodontic treatment options for persons with oral frailty.

Very Early Health Technology Assessment for Potential Predictive Biomarkers in the Treatment of Advanced Non-Small Cell Lung Cancer.

Immune checkpoint inhibitor (ICI)-containing treatment is currently prescribed as first-line treatment for all patients with advanced non-small cell lung cancer (NSCLC) without targetable driver mutations. However, only 30-45% of patients show no progression within 12 months after treatment start. Various biomarkers are being studied to save costly and potentially harmful treatment in non-responders. We evaluated the cost-effectiveness of implementing a hypothetical predictive biomarker for ICI-containing treatment response compared with standard of care (e.g., no implemented biomarker) for pembrolizumab-containing treatment in patients with advanced NSCLC in the Netherlands. Standard-of-care-based and predictive-biomarker-based strategies were compared using Markov models for three first-line pembrolizumab-containing treatments depending on a patient's tumor programmed cell death ligand-1 (PD-L1) expression and histology. A Dutch healthcare system perspective was adopted. Assuming a receiver operating characteristic-area under the curve of 1.0 in identifying responders, alternative treatments were offered for non-responders in the predictive-biomarker-based strategy. Parameters and assumptions were based on real-world data from surveys, literature using a targeted search, expert opinion, and registries. Outcomes included differences in costs, survival (life years (LYs)), and survival corrected for health-related quality of life (QoL) quality-adjusted life-years (QALYs) between the predictive-biomarker- and standard-of-care-based strategy. Implementing a predictive biomarker in pembrolizumab-carboplatin-paclitaxel treatment led to a mean survival reduction of 24 days (- 0.067 LYs) (18 days corrected for QoL (- 0.049 QALYs)), with cost savings of €22,606 compared with standard of care. Pembrolizumab monotherapy and pembrolizumab-pemetrexed-platinum treatments showed survival reductions of 4.5 and 3.9 months, respectively (3.6 and 2.8 months corrected for QoL), with cost savings of €24,345 and €28,456. Sensitivity analyses confirmed consistent cost savings and survival reductions. Survival losses were mainly observed due to the lower survival rates associated with the alternative first-line treatment options available for non-responders in the predictive-biomarker-based strategy within each pembrolizumab-containing treatment regimen. Pembrolizumab-carboplatin-paclitaxel treatment also showed survival gains under certain conditions related to QoL and survival estimates. Our study highlights the importance of careful de-implementation of ICI-treatments in advanced NSCLC, balancing costs reductions and side effects without comprising survival. In the pembrolizumab-carboplatin-paclitaxel treatment regimen, the survival loss could be considered negligible. Future research should define acceptable tradeoffs and thresholds for de-implementation, considering factors such as survival of alternative treatments and responder classification to guide predictive biomarker implementation and optimize health resource allocation.

Treatment effect of head extension by cervical collar on moderate obstructive sleep apnea-A randomized controlled trial.

As available treatments in obstructive sleep apnea are all associated with side-effects or adherence problems, there is a need for alternative treatment options. In this randomized, open, parallel-group intervention study, the effect of head extension by cervical collar was evaluated in patients with moderate obstructive sleep apnea. One-hundred patients with moderate obstructive sleep apnea (apneas and hypopneas per estimated hours asleep = respiratory events index: 15-30) were randomized to either lifestyle intervention, or cervical collar in combination with lifestyle intervention. Both groups received lifestyle advice. In addition, the treatment group was treated with a cervical collar, which allows adjustment of head extension, during sleep. Assessment with questionnaires and polygraphy were performed at baseline and after 6 ± 2 weeks. A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. In the intention-to-treat analysis, the cervical collar in combination with lifestyle intervention group decreased their respiratory events index (p = 0.008) and oxygen desaturation index (p = 0.008) more than the lifestyle intervention group, with a mean difference of -4.5 and -4.3, respectively. In the sub-analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups -9.1, p = 0.018) but not on non-supine apnea-hypopnea index (-2.3, p = 0.17). We conclude that head extension by cervical collar during sleep resulted in improved respiratory events index and oxygen desaturation index values in patients with moderate obstructive sleep apnea. Cervical collar can be a second-line treatment option in this group, especially in positional obstructive sleep apnea.

Satisfied with the worst health outcomes or unsatisfied with the best: explaining the divergence between good patient-reported outcomes and low satisfaction and vice versa among knee arthroplasty patients – a retrospective cohort study

ObjectivesTotal knee arthroplasty (TKA) is an effective treatment for patients with end-stage knee osteoarthritis but some patients exhibit a discrepancy between patient-reported outcomes (PROs) and patient satisfaction (PS). This study aims to identify predictors for patients reporting unfavorable PROs but high PS and vice versa.Materials and methodsThis retrospective cohort study categorized patients from nine German hospitals into four groups based on (i) whether they achieved a minimal clinically important difference (MCID) in knee functionality, measured with a joint-specific PRO from admission to 12-month post-surgery; and (ii) whether they were satisfied at 12 months post-surgery. The groups were (A) Satisfied Achievers (satisfied, MCID reached), (B) Dissatisfied Achievers (not satisfied, MCID reached), (C) Satisfied Non-Achievers (satisfied, MCID not reached) and (D) Dissatisfied Non-Achievers (not satisfied, MCID not reached). Exploratory analyses were performed to understand differences between the four groups using chi-squared tests and ANOVA. Multinomial logistic regression models were conducted to identify predictors for the allocation of patients in groups.ResultsA total of 1546 knee arthroplasty patients with a mean age of 65.9 years, 54.1% female, were included. 1146 (74.1%) patients were Satisfied Achievers, 131 (8.5%) were Dissatisfied Achievers, 141 (9.1%) were Satisfied Non-Achievers, and 128 (8.3%) Dissatisfied Non-Achievers. The results showed that higher improvements in health-related quality of life, pain and fatigue symptoms significantly decreased the likelihood of being a Dissatisfied Achiever and a Satisfied Non-Achiever. Comorbidities of blood circulation, chronic back pain or diabetes increased the likelihood of being a Dissatisfied Achiever, while depression decreased the likelihood of being a Satisfied Non-Achiever.ConclusionAddressing individual health concerns, e.g. through expectation management, and assessing alternative treatment options might improve satisfaction in line with functional improvements. A closer evaluation at which physical impairment level surgery is beneficial could help to improve the care of Satisfied Non-Achievers.

Assessment of IL-6 Pathway Inhibition in Gastrointestinal Behçet's Disease from Immunological and Clinical Perspectives.

Behçet's disease is an autoinflammatory disorder characterized by relapsing and remitting vasculitis that can manifest in various forms, including gastrointestinal Behçet's disease (GIBD). Its complications (e.g., intestinal perforation) are among the primary causes of morbidity and mortality. GIBD pathogenesis involves the enhanced production of certain cytokines, e.g., tumor necrosis factor α and interleukin-6 (IL-6), which could serve as a target for potential therapies. This review provides an overview of GIBD, including the diagnosis and immunopathogenesis as it is currently understood, and evaluates the emerging role of the inhibition of IL-6 (classic and trans-signaling) as an alternative treatment option for patients with GIBD. Given the current paucity of data, we reflected on the potential of IL-6 inhibitors such as tocilizumab and olamkicept based on immunopathogenic considerations and available clinical data in patients with inflammatory bowel disease (IBD), in whom clinical response or remission was induced. The selective inhibition of IL-6 trans-signaling may bring new impetus to the development of this drug class, particularly regarding safety. Still, the benefits of IL-6 inhibitors for patients with GIBD need to be evaluated in appropriate proof-of-concept studies. The clinical outcomes of IL-6 inhibitors in IBD are promising and may suggest their potential relevance in GIBD.

Exploring Physician and Patient Perspectives on Expectations and Role Models Towards Chronic Pain Treatment in General Practice: A Qualitative Cross-Sectional Study.

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the holistic management of chronic pain in general practice. To inform intervention development, this study explored expectations and perceived role models of general practitioners (GP) and patients regarding chronic non-cancer-related pain management in general practice with a focus on patient expectations of GPs and themselves, as well as GP expectations of patients and their anticipation of patient's expectations. Methods: Data were collected via semi-structured guide-based interviews with general practitioners and patients. Pseudonymized verbatim transcripts were analyzed using an inductive-deductive approach with a structuring qualitative content analysis. The Theoretical Domains Framework served as an analytical framework to explore behavioral aspects associated with expectations and role perceptions. Results:n = 25 interviews were analyzed (GP: n = 10, patient: n = 15). Findings indicate that patients considered themselves as the main actor in the therapy process yet expected guidance and care coordination from their GP. The essential role GPs play in pain management was emphasized. Role models indicated by GPs and some patients represent a care ideal, which was also reflected in discussed expectations. GPs anticipated that patients would place high relevance on pharmacological options. Patients highlighted their preference of non-pharmacological and alternative treatment options. Conclusions: Our findings demonstrate the importance of holistic, individually tailored chronic pain management in general practice. Systematic, multifaceted case management, as planned in the RELIEF project, may contribute to high-quality primary care for affected individuals.

Phytochemical analysis and biological activities of solvent extracts and silver nanoparticles obtained from Woodwardia unigemmata (Makino) Nakai.

Multidrug resistant bacteria are causing health problems and economic burden worldwide; alternative treatment options such as natural products and nanoparticles have attained great attention recently. Therefore, we aimed to determine the phytochemicals, antibacterial potential, and anticancer activity of W. unigemmata. Extracts in different organic and inorganic solvents were prepared, silver nanoparticles were prepared using the green synthesis method. Phytochemicals and antioxidant activity was determined spectrophotometry, anticancer potential was determined against gastric cancer and normal gastric epithelial cells using CCK8 and colony formation assays W. unigemmata was found to have a significant enrichment of various phytochemicals including flavonoids, terpenoids, alkaloids, carotenoids, tannins, saponins, quinines, carbohydrates, phenols, coumarins and phlobatanins. Among them phenolics (5289.89 ± 112.67) had high enrichment followed by reducing sugar (851.53 ± 120.15), flavonoids (408.28 ± 20.26) and ascorbic acid (347.64 ± 16.32), respectively. The extracts prepared in organic solvents showed strong antibacterial activity against P. aeruginosa (chloroform, 13.66±0.88, ethyl acetate, 8.66±4.33, methyl alcohol, 13.33±1.66, N-hexane, 12.33±0.88) and S. aureus (chloroform, 15±0.57, ethyl acetate, 16.33±0.33, methyl alcohol, 17.66±0.33 and N-hexane, 16.33±0.33). Aqueously prepared AgNPs showed remarkable activity against P. aeruginosa follwed by E. coli, 17.66 ± 1.85, S. aureus, 16.00 ± 1.73, K. pneumoniae, 14.33 ± 1.20, respectively. The ethanolic extracts (500 μg, 1000 μg, 2000 μg) of the W. unigemmata were found to have cytotoxicity against both gastric cancer (AGS and SGC7901) and normal cell lines (GES-1); a significant cellular proliferation arrest was observed. These results suggest that W. Unigemmata contains numerous bioactive phytochemicals and can be useful as a drug against MDR bacterial strains. These biomolecules covering AgNPs may enhance their biological activities, which can be employed in the treatment of various microbial infections.

Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study.

The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists' and patients' perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824.

Ovariohysterectomy in Cat as An Alternative Handling of Fetus Mummification Cases

Fetal mummification is a rare and challenging condition in cats that requires immediate intervention to mitigate potential risks to the mother and future pregnancies. This case study presents the diagnosis, treatment, and outcomes of Pawpaw, a cat diagnosed with fetal mummification. Ovariohysterectomy was performed as an alternative treatment method to address the critical condition of the cat. The diagnosis was established based on various factors, including indications, anamnesis, clinical symptoms, clinical examination, clinical findings, and investigative results. Diagnostic confirmation was achieved through blood haematology tests and ultrasound examinations. The therapeutic approach consisted of administering a combination of normal saline fluid therapy, glycerin, ondansetron, ceftriaxone, intramox, doxycycline, acetylcysteine, sakatonic liver, vitamins, ventolin, Tripura, meloxicam, impacting, and furosemide. Anesthesia during the ovariohysterectomy procedure involved the use of atropine sulfate, xylazine, and ketamine. Despite the extensive medical intervention, the cat, Bimbim, succumbed to its critical condition during the surgery. This case study highlights the importance of early diagnosis and prompt intervention in cases of feline fetal mummification. Ovariohysterectomy proved to be a viable alternative treatment option, although the critical condition of the cat posed significant challenges to its successful outcome. Further research and enhanced understanding of fetal mummification in cats are essential to improve the management and prognosis of this condition.

Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE) following hip fracture surgery: validation of the model that demonstrated good predictive power.

Proximal femoral fractures are common within the elderly population and are associated with a high risk of mortality and reduced quality of life. Hemiarthroplasty or osteosynthesis (extramedullary or intramedullary) is the primary treatment option for these fractures. However, within this fragile patient population many comorbidities, among others dementia, are seen. Therefore, predicting patients with a high mortality risk after surgery may lead to adopting alternative treatment options with less risks. This paper proposes a new model to distinguish patients with high postoperative mortality risk with adequate follow-up time in combination with a wide set of useful and available variables. Patients treated with hemiarthroplasty or osteosynthesis for proximal femoral fractures were studied, with a follow-up period of 6 months. Patients who died within this follow-up period were compared to survivors, and predicting variables were assessed in logistic regression: The Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE). The model was validated internally against a held-out dataset. Furthermore, the model performance was compared against the Almelo Hip Fracture Score (AHFS) on the same sample. Out of 2463 patients undergoing surgical treatment for proximal femoral fractures, 415 (16.8%) died within 183 days. Predictors for early mortality included old age, male sex, high heartbeat, KATZ-ADL and GFI scores, C-reactive protein and urea concentrations and low albumin concentration. Our model showed satisfactory predictive and discriminatory power (ROC curve = 0.81). Internal validation was good (ROC in validation dataset = 0.81), and better than the AHFS (ROC = 0.57). The ZHISLE model demonstrates good predictive power concerning mortality risk for old patients with a proximal femoral fracture. The model could benefit patients by indicating if a conservative, non-invasive policy might be a better option for those patients.

Emerging Resistance and Virulence Patterns in Salmonella enterica: Insights into Silver Nanoparticles as an Antimicrobial Strategy.

This study aims to characterize antibiotic resistance (AR) and virulence markers in Salmonella spp. isolated from Romanian outpatients' stool samples. In 2019, community-acquired Salmonella strains were collected and identified using MALDI-TOF mass spectrometry, antibiotic susceptibility profiles have been determined with the MicroScan system, and soluble virulence factors were evaluated using specific culture media, while biofilm formation was quantified in 96-well plates. Molecular analysis targeted resistance genes for β-lactams (e.g., blaTEM and blaSHV); tetracyclines (e.g., tet(A)); sulphonamides; and quinolones, as well as virulence genes (e.g., invA, spvC, pldA, and held). Whole-genome sequencing (WGS) was performed on 19 selected isolates. A silver nanoparticles (AgNPsol) alternative to conventional antibiotics was tested for effectiveness against multidrug-resistant (MDR) isolates. From the total of 309 Salmonella isolates (65.05% from children under 4 years of age) belonging to four subtypes and four serovars, 27.86% showed resistance to at least one antibiotic, most frequently to tetracycline, ampicillin, and piperacillin. The strains frequently expressed haemolysin (67%), aesculinase (65%), and gelatinase (62%). Resistance to trimethoprim-sulfamethoxazole was encoded by the sul1 gene in 44.83% of the strains and to tetracyclines by the tet(A) gene (59.52%). The ESBL genes blaTEM, blaSHV, and blaCTX-M were detected by PCR in 16.18%, 2.91%, and 0.65% of the strains, respectively. Additionally, 98.63% of the strains carried the invA marker, with notable positive associations between blaSHV, qnrB, and sul1 with spvC. The present findings revealed significant patterns in Salmonella isolates, subtypes, serovars, AR, and virulence, emphasising the need for continuous surveillance of Salmonella infections. Additionally, the potential of AgNPs as an alternative treatment option was demonstrated, particularly for paediatric S. enterica infections.

Effectiveness of Abdominal Breathing Exercise to Control Gastroesophageal Reflux Disease, a Randomized Controlled Trial.

To determine the effect of actively training the crura of diaphragm which is a part of lower esophageal sphincter using abdominal breathing exercises to treat gastroesophageal reflux disease. With a randomized controlled study design, a total of 22 (11 in each group) clinically diagnosed patients of GERD presenting to the gastroenterology outpatient department at Holy Family Hospital in Pakistan were assessed using GERD related "quality of life index (QoLI)" questionnaire and their on-demand proton pump inhibitors (PPI) usage. Single blinding technique will be used. Patients ages 18-60 years with GERD were included. However, those with hiatal hernia > 2 cm, previous surgeries on LES and those with who could not undergo the breathing exercise training were excluded. The data was collected via interviews. The intervention group was trained to do a 5-min breathing exercise and advised to perform it 5 times a day for 4 continuous weeks. On demand PPI usage was self-recorded. The control group was also trained to perform a breathing exercise that had no effect on LES and was asked to self-record on demand PPI usage. After 4 weeks the data was collected from both groups and compared quality-of-life index and PPI usage. Data was retrieved and analyzed using SPSS version 22. Descriptive analysis was used for describing the study variables. Paired t-test was used for in group comparison before and after intervention and independent t test was used for between group comparison, p value of <0.05 was taken as significant. Mean PPI usage of the two groups was also compared. An improved QoLI and reduced PPI usage was seen in the intervention group as compared to control group. Paired t test confirmed a statistically significant difference, but the independent t test did not. Linear regression test showed that F (1,20) = 32.822, p = 0.000. Adjusted R value is 0.603. y = 13.182x +2.812. The beta value is 0.789 and p value is 0.000. The study concludes that abdominal breathing exercises can improve the GERD symptoms as assessed by QoLI score and on demand PPI usage. It advocates for an alternative treatment option for GERD patients that is more efficacious as compared to no breathing exercises and has less potential side effect as compared to continuous PPI use, enabling us to lead our way towards revolution in medicine providing more effective and less invasive treatment options to facilitate our patients.