Article Reviews Research Articles

Best Practices in Caring for Seriously Ill Patients.

Palliative care (PC) is the art and science of providing goal-concordant care, skillfully managing complex and refractory pain and nonpain symptoms, mitigating suffering, and augmenting quality of life for seriously ill patients throughout the course of the illness trajectory. The primary team should provide generalist PC for all seriously ill patients and know when to refer patients to specialist PC. Specialty-level PC services should be reserved for complex problems beyond the scope of primary PC. This article reviews principles and best practices to support patient-centered PC.

The neutrophil extracellular traps in neurological diseases: An update.

Neutrophil extracellular traps released by neutrophils are web-like DNA structures adhered to granulin proteins with bactericidal activity and can be an important mechanism for preventing pathogen dissemination or eliminating microorganisms. However, they also play important roles in diseases of other systems, such as the central nervous system. We tracked the latest advances and performed a review based on published original and review articles related to neutrophil extracellular traps and neurological diseases. Generally, neutrophils barely penetrate the blood-brain barrier into the brain parenchyma, but when pathological changes such as infection, trauma, or neurodegeneration occur, neutrophils rapidly infiltrate the central nervous system to exert their defensive effects. However, neutrophils may adversely affect the host when they uncontrollably release neutrophil extracellular traps upon persistent neuroinflammation. This review focused on recent advances in understanding the mechanisms and effects of neutrophil extracellular traps release in neurological diseases, and we also discuss the role of molecules that regulate neutrophil extracellular traps release in anticipation of clinical applications in neurological diseases.

The Causal Relationship Between Skin Microbiota and Facial Aging: A Mendelian Randomization Study.

Facial aging is a complex process influenced by environmental factors, genetics, and lifestyle. The contribution of the skin microbiota to this process remains poorly understood. This two-sample Mendelian randomization (MR) study was performed using genome-wide genotype data from the UK Biobank and previously published studies on skin microbiota. The primary approach for MR analyses included inverse-variance weighting (IVW), MR-Egger regression, simple mode, weighted median, and weighted mode methods. Sensitivity analyses were performed to assess heterogeneity and pleiotropy, and reverse-direction MR analyses were performed to evaluate potential reverse causation. The MR analysis identified ten skin microbiotas with potential causal relationships with facial aging. Protective skin microbiotas included Genus Finegoldia, ASV011 [Staphylococcus (unc.)], ASV008 [Staphylococcus (unc.)], phylum Firmicutes, Family Rhodobacteraceae, and ASV021 [Micrococcus (unc.)], which were negatively associated with facial aging. Conversely, Order Pseudomonadales, Family Moraxellaceae, ASV039 [Acinetobacter (unc.)], and phylum Bacteroidetes were positively associated with facial aging, indicating a risk factor for accelerated aging. Sensitivity analyses confirmed the robustness of these findings, and reverse-direction MR analyses did not suggest any reverse causation. This study identified specific skin microbial that may influence facial aging and offered new insights into the rejuvenation strategies. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inoculation theory

ABSTRACT Inoculation theory is a theory of resistance to influence that builds on analogous relationships with medical vaccination. In short: Exposure to weakened forms of challenges motivates resistance to stronger challenges encountered later. Throughout its 60 + year lifespan, scholars have applied inoculation theory as a messaging strategy across issues and contexts, including politics, health, and commerce. Additionally, inoculation theory scholarship has clarified how inoculation messaging confers resistance, moving beyond the traditional components (threat and refutational preemption) to consider other factors, including emotions. This article reviews key findings in inoculation theory research and then proposes particularly promising areas for future research.

An Overview of Radiation Countermeasure Development in Radiation Research from 1954 to 2024.

Preparation for medical responses to major radiation accidents, further driven by increases in the threat of nuclear warfare, has led to a pressing need to understand the underlying mechanisms of radiation injury (RI) alone or in combination with other trauma (combined injury, CI). The identification of these mechanisms suggests molecules and signaling pathways that can be targeted to develop radiation medical countermeasures. Thus far, the United States Food and Drug Administration (U.S. FDA) has approved six countermeasures to mitigate hematopoietic acute radiation syndrome (H-ARS), but no drugs are available for prophylaxis and no agents have been approved to combat the other sub-syndromes of ARS, let alone delayed effects of acute radiation exposure or the effects of combined injury. From its inception, Radiation Research has significantly contributed to the understanding of the underlying mechanisms of radiation injury and combined injury, and to the development of radiation medical countermeasures for these indications through the publication of peer-reviewed research and review articles.

Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies

BackgroundAs an emerging technology in robot-assisted (RA) surgery, the potential benefits of its application in transforaminal lumbar interbody fusion (TLIF) lack substantial support from current evidence.ObjectiveWe aimed to investigate whether the RA TLIF is superior to FG TLIF in the treatment of lumbar degenerative disease.MethodsWe systematically reviewed studies comparing RA versus FG TLIF for lumbar degenerative diseases through July 2022 by searching PubMed, Embase, Web of Science, CINAHL (EBSCO), Chinese National Knowledge Infrastructure (CNKI), WanFang, VIP, and the Cochrane Library, as well as the references of published review articles. Both cohort studies (CSs) and randomized controlled trials (RCTs) were included. Evaluation criteria included the accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL), and surgical revision. Methodological quality was assessed using the Cochrane risk of bias and ROBINS-I Tool. Random-effects models were used, and the standardized mean difference (SMD) was employed as the effect measure. We conducted subgroup analyses based on surgical type, the specific robot system used, and the study design. Two investigators independently screened abstracts and full-text articles, and the certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.ResultsOur search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher “clinically acceptable” accuracy than FG (RR: 1.0382, 95% CI: 1.0273–1.0493). And RA had 1.12-folds higher “perfect” accuracy than FG group (RR: 1.1167, 95% CI: 1.0726–1.1626). In the case of proximal FJV, our results indicate a 74% reduction in occurrences for patients undergoing RA pedicle screw placement compared to those in the FG group (RR: 0.2606, 95%CI: 0.2063- 0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391–0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756–4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265–0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238–3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357–0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953–1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592–1.0495). Our findings are limited by the residual heterogeneity of the included studies, which may limit the interpretation of the results.ConclusionIn TLIF, RA technology exhibits enhanced precision in pedicle screw placement when compared to FG methods. This accuracy contributes to advantages such as the protection of adjacent facet joints and reductions in intraoperative radiation dosage and blood loss. However, the longer preoperative preparation time associated with RA procedures results in comparable surgical duration and radiation time to FG techniques. Presently, FG screw placement remains the predominant approach, with clinical surgeons possessing greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be considered the optimal choice.Systematic review registrationPROSPERO CRD42023441600.

Nutritional management of muscle mass loss in patients with Post-COVID-19 Syndrome: a scoping review

Post-Covid-19 Syndrome (PCS) is a condition that causes persistent symptoms and impacts nutritional status such as loss of muscle mass. The objective of this study was to review and map scientific evidence on nutritional management in the loss of muscle mass in patients with PCS. The scoping review protocol was prepared following the PRISMA-ScR guidelines. Review articles not written in English or those that included only hospitalized patients and pertained to conditions other than PCS were excluded. Data extraction followed the methodology outlined by the Cochrane Review Group. Of the 81 articles initially identified, only five met the inclusion criteria. The selected studies emphasized the importance of recovering muscle mass, higher protein and caloric intake, and physical strength exercises. Consequently, nutritional interventions aimed at mitigating muscle mass loss should prioritize strategies that increase caloric and protein consumption.

Nutritional Support for ICU Patients Receiving Extracorporeal Membrane Oxygenation Therapy: A Meta-Analysis

Abstract Background ECMO constitutes a mechanical technique that provides extracorporeal gas exchange or/and circulatory support for patients with refractory life-threatening pulmonary or/ and cardiac failure. There is infrequent evidence regarding the optimal nutritional management and related clinical outcomes for adult critically-ill patients receiving ECMO. Objective This study was conducted to evaluate the effect of nutritional intervention on clinical outcomes in adult critically ill patients receiving Extracorporeal Membrane Oxygenation Therapy. Methodology Advanced search was conducted in Medline, PubMed, google scholar and the Egyptian Knowledge Bank for cohort studies that were published in English until September 2020. Inclusion Criteria cohort studies which assess nutrition support in adult critically-ill patients receiving ECMO therapy, and include at least one of these outcomes a) 28-day mortality, b) length of ICU stay, C) duration of mechanical ventilation and d) incidence of infection. Exclusion Criteria duplicate reports, Abstracts, case reports, case series, review articles, editorials and clinical guidelines. In addition, studies with unavailable full text or studies with different outcomes were excluded. Results 7 studies with a total number of 2358 patients were included in the meta-analysis. Estimates and their 95% confidence intervals (CI) were calculated, then pooled for analysis. Nutrition support in adult critically ill patients receiving ECMO was significantly related to 28-day mortality ( 95% CI 0.428 = 0.329–0.527; p < 0.001), increased ICU length of stay ( 95% CI 29.512 (22.930–36.095), and P value < 0.001), duration of mechanical ventilation (95% CI 17.985 = 4.682–31.288; p < 0.008) and incidence of infection ( 95% CI 0.105 ( 0.066 – 0.144), and P value < 0.001). Conclusion The study indicates positive association between effective nutrition support and clinical outcomes for adult critically-ill patients receiving ECMO therapy.

Meta-Analysis of Surgical Treatment versus Sclerotherapy for Management Of Branchial Arch Lesions

Abstract Background Branchial arch lesions (BALS) are uncommon congenital malformations presenting mainly in first 2 decades with neck cysts, sinuses, fistulas, recurrent infections and have low potential to turn malignant. Surgical management of these lesions can be associated with significant risk of complications and recurrence. Sclerotherapy has been described as effective and less invasive alternative option. Aim of the Study is to summarize current available evidence regarding effectiveness and safety of surgery and sclerotherapy as two modalities of treatment for BALS. Methods A systematic review for all interventional studies on management of (BALS) was conducted in multiple medical databases from its inception till March 2021 with inclusion of all studies reporting on either surgical management or sclerotherapy for BALS in humans and reported effectiveness or safety outcomes. Diagnostic and review articles, single case reports and non-human studies were excluded. Proportional meta-analyses were utilized where there is only uncontrolled studies available reporting on outcomes. Assessment of quality was done with use of validated tool relevant to design of primary studies included and risk of bias of studies was assessed statistically. PRISMA Guidelines were followed in reporting of the study. Results A total of 525 studies were retrieved of which only 25 were eligible for inclusion. All included studies were uncontrolled case series; 18 reported on surgery and 7 reported on sclerotherapy The overall quality of included studies were fair to good according to NIH validated tool. Meta-analyses of surgical studies for BALS showed success rate of complete excision of 90%,96%,96% and 98% for first, second, third and fourth branchial arch lesions respectively with complications rates of 19.7%,5%,24% for first, second and third arch lesions. The rates of recurrence were 11.2%,2%,5%,1% for first to fourth arch lesions in order. The corresponding success rates of completed resolution for sclerotherapy were 86% with complications rates of 8% all of which were minor complications. There were no recurrences but recognized incomplete resolution. Conclusion Both surgery and sclerotherapy have satisfactory success in terms of complete excision/resolution of BALS. The risks of complications howeverseem to be more significant with surgical management however no controlled studies were available to allow for definitive conclusions. Further studies with standardized diagnostic criteria and treatment techniquesare needed to allow for prioritizing treatment lines based on conclusive evidence.

A Systematic Review of the Effect of Self-Hypnosis on Quality of Life in Breast Cancer Patients

Cancer is a chronic disease that affects the patient's quality of life. An important cause of cancer is emotional stress, anxiety and depression and emotional stress is known to persist after cancer treatment. This systematic review is aimed to determine the effect of hypnosis on the quality of life in breast cancer patients. Methods: A literature search was performed on databased from PubMed, SAGE, Scopus, ScienceDirect, EBSCOhost, in order to identified articles published from 2017 to 2022. The keywords to search those journals were “hypnosis” OR “self-hypnosis” AND “breast cancer” OR “Breast carcinoma” AND “quality of life” OR “wellbeing”. The detailed PICOT (Population, Intervention, Comparison, Outcome, Times) framework, established a priori, was used to include and exclude articles for this systematic review. Results.The results of the search and assessment resulted in 44 articles and then data extraction was carried out on 15 articles. It was found that hypnotherapy during surgery, chemotherapy and radiotherapy improved cognitive function and reduced adverse effects on social and physical function and improved overall quality of life in breast cancer patients. We suggest the need for randomized clinical trials to be conducted with sufficient follow-up and statistical power to confirm these results

Epilepsy, Antiepileptic Drugs, and Adverse Pregnancy Outcomes, 2: Major Congenital Malformations With Antiepileptic Drug Monotherapy.

Women with epilepsy (WWE) are usually advised antiepileptic drug (AED) treatment even during pregnancy. It is therefore important to know what the major congenital malformation (MCM) risks might be with untreated epilepsy, and with first-trimester exposure to different AEDs in monotherapy. This article reviews recent findings from a large multinational registry, a large multinational population based study, and a large meta-analysis. In summary, data from the meta-analysis suggest that the MCM rate is 2%-3% in women without epilepsy and about 3% in WWE who were unexposed to AEDs during pregnancy. Data from the meta analysis also suggest that the MCM rate is approximately population level at 2.6%-3.5% with levetiracetam and lamotrigine and that it is about 4%-5% with carbamazepine, 2.8%-4.8% with oxcarbazepine, about 4% with topiramate, about 5%-7% with phenytoin, about 6%-9% with phenobarbital, and nearly 10% with valproate. The MCM risk with valproate is significantly higher than that with other AEDs (including topiramate and phenobarbital) that significantly increase the risk. Data from the registry suggest that risks are dose-dependent with valproate, phenobarbital, and carbamazepine and that the risk with valproate may be as high as 25% at doses >1,450 mg/d. Valproate is also associated with a wide range of MCMs. Data from the population-based study were generally confirmatory. Strengths and limitations of the studies are considered. The findings of these studies encourage the consideration of levetiracetam or lamotrigine monotherapy for WWE who are pregnant and strongly discourage the consideration of the older AEDs, especially phenytoin and phenobarbitone, and most especially valproate. These considerations also apply to all WWE of childbearing age because it may not be easy to change AEDs when pregnancy is planned and because pregnancy is often unplanned.

Эффективность комбинированного воздействия ультразвука и микроволн при обработке пищевых продуктов. Обзор

Modern methods of food processing combine ultrasonic and microwave treatment. This article reviews scientific publications on combined microwave and ultrasound technologies in food processing. The review involved standard methods of data analysis and covered 85 Scopus and Web of Science research papers on combined microwave and ultrasonic food treatment published in English in 2010–2023. The article describes the principles and specific features of ultrasonic and microwave food processing methods, their combinations, equipment design, and applications as part of various food processing stages, e.g., defrosting, drying, extraction, sterilization, etc. Microwaves increase the heating rate while ultrasound increases the efficiency of heat and mass transfer. Their combined use reduces processing time, improves product quality, facilitates moisture drainage, and provides uniform heating. The combined effect of microwaves and ultrasound increases the processing efficiency, thus preserving the nutritional value and quality of the final product. Ultrasonic technology serves as an aid to efficient and environmentally-friendly microwave heating, which has a wide range of applications in the food industry. The review can be used in further research in extraction, drying, defrosting, and sterilization. It can help food industry specialists to select optimal food processing methods.

Биоактивные вещества геропротекторной направленности

People are constantly exposed to adverse environmental factors that affect their health. If combined with hereditary predisposition, they may lead to gerontological changes that reduce healthy and working life expectancy. Some measures can prevent premature aging, e.g., a balanced diet or biologically active anti-aging substances also called geroprotectors. This article reviews biologically active geroprotectors with a view to select promising components for novel biologically active additives and functional foods. The review covered five years of Russian research articles and patents on biologically active anti-aging agents indexed in the National Center for Biotechnology Information, ScienceDirect, eLIBRARY.RU, and the database of the Federal Institute of Industrial Property. The domestic market demonstrates a growing demand for biologically active supplements: in 2023, it increased by 10% in value terms as consumers’ interest in a healthy and long life continues to grow. The review also included quality criteria for biologically active anti-ageing agents, e.g., such plant metabolites as vitamins, polyphenols, antioxidants, adaptogens, peptides, etc. Thymalin, epithalamin, dasatinib, and epithalon are available on the domestic market. The list of potential anti-aging agents includes ethylamine, carnosine, glutathione, ubiquinone, curcumin, rutin, quercetin, resveratrol, senolytics, and sirutins. These biologically active substances prevent oxidative stress, accumulation of lipofuscin, and senescent cells. The most effective anti-aging agents come from Vitis amurensis, Rhodiola rosea, Schisandra chinensis, Galega officinalis, Eleutherococcus senticosus, Withania somnifera, and Panax ginseng.

Colesteatoma do ápex petroso: um achado atípico

Introduction: Cholesteatoma, although relatively rare, presents significant challenges in clinical practice. Despite decades of research, its cause remains complex and elusive. Objective: This review aimed to summarize key findings on the epidemiology, pathophysiology, diagnosis and surgical management of cholesteatoma, highlighting current knowledge gaps and emerging trends in the field. Method: Narrative review carried out in the PubMed and Scielo databases. The search used the following keywords: “cholesteatoma, petros apex, minimally invasive surgical procedures”. The inclusion criteria comprised review articles, pre-clinical and clinical research published, written in Portuguese and English and available in complete text. The selected articles were analyzed based on the technologies covered, future perspectives, challenges, diseases mentioned and the central idea of the article. Result: 36 articles were included. Conclusion: Cholesteatoma is important in medical practice, despite being relatively uncommon in the general population. However, there are still doubts about its cause, but its diagnosis has been expanded through imaging tests in an attempt to reduce “second-look” operations and avoid them. Another field with constant growth is surgical treatment, since the complex anatomy requires that new techniques be managed to reduce injuries to important and vital structures in the region.

Article Review - Virus-Like Particles: A Comprehensive Review of Design, Applications, and Future Directions

Article Review - Virus-Like Particles: A Comprehensive Review of Design, Applications, and Future Directions

Necrotising fasciitis of the upper limb: a review of the literature.

Necrotising fasciitis is an uncommon life-threatening surgical emergency. While most commonly seen in the lower limb it can also affect the upper limb. This article reviews and summarises the current literature on necrotising fasciitis in the upper limb, covering common predisposing factors, clinical presentations, scoring systems, common organism types and the timing of surgical treatment. The key to managing this condition continues to be early clinical diagnosis and aggressive surgical debridement to attempt to reduce the morbidity and mortality of this condition.

The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review.

Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines. After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. In total, 140 met inclusion criteria and were included in the final review. Much of the literature explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 98/140) and Confusion Assessment Method (n = 81/140), respectively. Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.

Bone Loss in Diabetes Mellitus: Diaporosis

The objective of this review is to examine the connection between osteoporosis and diabetes, compare the underlying causes of osteoporosis in various forms of diabetes, and suggest optimal methods for diagnosing and assessing fracture risk in diabetic patients. This narrative review discusses the key factors contributing to the heightened risk of fractures in individuals with diabetes, as well as the shared elements impacting the treatment of both diabetes mellitus and osteoporosis. Understanding the close link between diabetes and a heightened risk of fractures is crucial in effectively managing both conditions. There are several review articles of meta-analysis regarding diaporosis. Nevertheless, no review articles showed collected and well-organized medications of antidiabetics and made for inconvenient reading for those who were interested in details of drug mechanisms. In this article, we presented collected and comprehensive charts of every antidiabetic medication which was linked to fracture risk and indicated plausible descriptions according to research articles.

The State of American Federalism 2023–2024: Judicialization of Gridlocked Politics

Abstract Contemporary American federalism, while characterized by nationalized policy battles in the states, is also increasingly defined by the centralization of power in the federal judiciary. In this introductory piece of the 2023–2024 Annual Review issue, we unpack the judicialization of federalism politics. This process, we argue, has been facilitated by national political gridlock, defined by increasing dysfunction in Congress, and the growth of the administrative presidency. In policy conflicts on subjects ranging from education and the environment to abortion and other individual rights, courts have played an increasingly significant role as the arbiter of the federal–state balance of power. As the articles in this Annual Review illustrate, with a few exceptions, judicialization of federalism has often resulted in the devolution of authority to the states, with significant implications for public policy and democratic institutions.

Current Treatments and Future Directions for Facial Paralysis.

Facial palsy is a condition that affects the facial nerve, the seventh of the twelve cranial nerves. Its main function is to control the muscles of facial expression. This involves the ability to express emotion through controlling the position of the mouth, the eyebrow, nostrils, and eye closure. The facial nerve also plays a key role in maintaining the posture of the mouth and as such, people with facial paralysis often have problems with drooling, speech, and dental hygiene. Due to the devastating effects on the quality of life of individuals with facial palsy, there are a multitude of various treatment options for the paralyzed face. This article reviews current management strategies, and points towards promising future directions for research in the field of facial reanimation.