Anthracycline-based chemotherapy with doxorubicin plus cyclophosphamide (AC) is commonly used for breast cancer during the second and third trimesters of pregnancy, yet pharmacokinetic data for these drugs in pregnant patients are limited. This case report evaluates changes in the plasma concentrations of doxorubicin and cyclophosphamide during pregnancy in a breast cancer patient undergoing AC to clarify the influence of gestation on drug pharmacokinetics. A 39-year-old woman with stage IIA breast cancer diagnosed at 16 weeks of gestation received four cycles of AC, with doses based on her pre-pregnancy body surface area. Plasma concentrations of doxorubicin and cyclophosphamide were measured by LC-MS/MS 24h after administration during the first and third cycles. Doxorubicin concentrations were 5.5 and 8.2 ng/mL in the first and third cycles, respectively, which were lower than reported in non-pregnant patients. Cyclophosphamide concentrations were respectively 1.3 and 1.1µg/mL, which were comparable to non-pregnant levels. No serious maternal or fetal adverse events were observed, and plasma concentrations remained stable over time. Doxorubicin concentrations during pregnancy were 30%-60% lower than those reported in non-pregnant patients. We did not observe a gestational decline in doxorubicin concentrations between the two sampling points in this patient, likely due to gestational changes in factors that can influence pharmacokinetic parameters (e.g., persistent P-glycoprotein upregulation). Cyclophosphamide pharmacokinetics remained unchanged. Although further studies are needed to confirm the optimal dosing and safety, these findings suggest that AC with pre-pregnancy body surface area-based dosing may be feasible in pregnant patients.

Background: Psoriasis vulgaris is a systemic inflammatory disease increasingly prevalent in Southeast Asia, often complicated by metabolic syndrome. While Secukinumab, an IL-17A inhibitor, is established in Western cohorts, real-world data on its efficacy in Indonesian populations with high adiposity burdens are scarce. This study evaluates the therapeutic response and safety of Secukinumab 300 mg in a Balinese cohort characterized by severe disease and metabolic risk factors. Methods: We conducted a retrospective cohort study at a tertiary referral center in Bali from January 2023 to December 2024. The study included 39 adult patients with moderate-to-severe psoriasis treated with Secukinumab 300 mg. The primary endpoint was the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75) at Week 17. Fisher’s Exact Test was employed to analyze response differences between obese and non-obese subgroups. Results: The cohort exhibited a high systemic burden: 44.2% were obese (Body Mass Index greater than or equal to 25 kg/m2), and 53.8% had concomitant psoriatic arthritis. Baseline disease severity was high with a median body surface area of 25.0%. At week 17, 32 patients (82.1%; 95% confidence interval: 67.3–91.0%) achieved PASI 75. Subgroup analysis revealed no statistically significant difference in response rates between obese and non-obese patients (p > 0.99), suggesting efficacy is maintained despite metabolic burden. No severe adverse events or discontinuations were documented in the medical records. Conclusion: Secukinumab 300 mg demonstrates substantial efficacy in an Indonesian population with a severe phenotypic profile, maintaining therapeutic clearance in metabolically compromised patients. The safety profile appears favorable, though limited by retrospective data capture.

Introduction Toxic Epidermal Necrolysis (TEN) is a life-threatening dermatologic emergency, with particularly high morbidity and mortality in children due to their vulnerable skin barrier and propensity for systemic complications. When TEN is further complicated by respiratory failure, the competing demands of airway management and skin preservation pose a significant therapeutic challenge. Case report We report a case of a 6-year-old boy with TEN involving 70% body surface area and concurrent respiratory failure. The patient required endotracheal intubation and mechanical ventilation, which exacerbated facial skin injury. A structured, multidisciplinary, and phased nursing protocol was implemented, integrating respiratory support with meticulous skin, ocular, oral, and urogenital care. Interventions & outcomes A coordinated team comprising pediatric intensive care, dermatology, infectious diseases, and nutrition specialists guided management. Skin care was staged according to wound healing phases, utilizing non-adhesive dressings, topical recombinant bovine basic fibroblast growth factor (bFGF) gel, and innovative tube-securement techniques. Systemic and mucosal care protocols were rigorously applied. The patient achieved complete re-epithelialization by day 35, was successfully extubated, and discharged in stable condition on day 46 with no major sequelae. Conclusion This case demonstrates that a structured, phase-based, and multidisciplinary nursing approach can effectively balance life-sustaining interventions with tissue preservation in severe pediatric TEN. The strategy highlights the importance of adaptive wound staging, trauma-minimizing techniques, and proactive mucosal protection, offering a replicable framework for similar critical care scenarios.

Abstract This study aimed to study the coupling between the left ventricle and left atrium in pediatric patients with mitral valve prolapse (MVP) by utilizing strain parameters and the left atrioventricular coupling index (LACI). A retrospective analysis was conducted over six years to identify patients with MVP and moderate mitral regurgitation who had undergone cardiac MRI. The study included 20 patients and 20 healthy controls. Functional and strain assessments of the left ventricle (LV), right ventricle (RV), and left atrium (LA) were performed and compared to those of healthy controls. LACI was determined by calculating the ratio of the LA end-diastolic volume indexed to the left ventricular end-diastolic volume indexed, and it was correlated with conventional CMR and strain parameters. Native T1 mapping was used as a non-contrast CMR technique to assess diffuse myocardial fibrosis in all patients. LACI revealed a negative correlation with left ventricular end-diastolic volume indexed to body surface area (LVEDVI) and total left atrial ejection fraction (LAEF) ( r = -0.39, -0.65, P < 0.05, respectively). In addition, LACI showed a correlation with strain parameters, specifically with LA longitudinal peak positive strain rate and left ventricular global circumferential strain (LV GCS) ( r = 0.35, -0.49, P < 0.05, respectively). The results from the multivariate regression analysis indicated that the left atrial longitudinal reservoir strain (ξs) was independently associated with left ventricular ejection fraction [β = 0.529; 95% confidence intervals (CI) = 0.192 to 0.866] and LV GRS [β = 0.229; 95% CI = 0.128 to 0.330]. There were statistically significant differences in LACI and LA ξs between patients who experienced clinical events such as arrhythmia and those who did not, with p-values of < 0.05. Strain parameters showed better results in evaluating LA and LV coupling in our patient group. Elevated native T1 values correlated with LACI, impaired LV, and LA strain parameters.

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research.

Plutella xylostella poses a severe threat to cruciferous crops globally and has evolved resistance to a broad spectrum of insecticides. This escalating resistance underscores an urgent need to develop novel insecticides with unique structures and distinct modes-of-action. In this study, a series of oxime ether sulfonamide derivatives containing cyclopropane fragments were designed and synthesized using the alkyl oxime ether ethanesulfonamide compound ZY-9 as the lead compound. Indoor insecticidal bioassay showed that compound 3a-28 displays the greatest insecticidal activity against P. xylostella with a median lethal concentration (LC50) value of 13.30 mg L-1, which was comparable to those of the commercial insecticides diflubenzuron (13.90 mg L-1) and diafenthiuron (14.74 mg L-1). Synergism studies indicated that compound 3a-28 presents a synergistic effect in combination with diafenthiuron, indoxacarb, chlorfenapyr and abamectin. Field trials demonstrated that compound 3a-28 achieved 62.58% control efficacy, which was comparable to that of diafenthiuron. Morphological observation of the larvae revealed severe damage to the body surface, particularly to the setal sockets and epidermal collapse. Biochemical analysis results showed that compound 3a-28 could increase the chitin content and inhibit the chitinase activity [Median inhibitory concentration (IC50) = 14.10 mg L-1]. Molecular docking confirmed that compound 3a-28 stably binds to the active pocket of chitinase (OfChtI). Additionally, preliminary toxicity evaluation results demonstrated that compound 3a-28 exhibits excellent biosafety. The novel cyclopropane-containing oxime ether sulfonamide derivative 3a-28 is a highly promising insecticide candidate against P. xylostella, featuring a unique chitinase-inhibiting mechanism. The findings of this study lay a solid foundation for the future development of insecticides. © 2026 Society of Chemical Industry.

A new species of monopisthocotylan parasite has been identified on the body surface of the Antarctic rockcod Notothenia coriiceps Richardson, in the coastal waters surrounding Galindez Island, West Antarctica. The newly described species, Pseudobenedenia galindezensis sp. n., is morphologically distinct from all previously recognized species within the genus Pseudobenedenia as evidenced by a combination of unique morphometric traits. These include the shape and size of opisthaptoral sclerotized elements, the presence of a particularly robust accessory sclerite, and a characteristic ratio between the anterior hamulus and accessory sclerite. These features collectively support its recognition as a separate species. A well-developed orifice of the common genital opening was observed and measured in the newly described species, an anatomical feature not previously documented in Pseudobenedenia. Measurements of the vagina are provided for the first time for all of the described Pseudobenedenia species. The presence or absence of a distinct gap between the testes represents a novel diagnostic character introduced in this description. Additional distinguishing features include the length-to-width ratios of the testes and body, as well as the body length-to-opisthaptor length ratio, all of which further support the species' distinctiveness. Molecular analyses of 18S and 28S nuclear markers were conducted to study the phylogenetic position of this new species within the family Capsalidae. The results indicated consistent genetic divergences, which were accompanied by observed morphological differences, thereby substantiating the classification of the species as new to science. Molecular analysis was conducted to differentiate P. galindezensis sp. n. from the closely related Pseudobenedenia coriicepsi. This new species was found on a fish host that is morphologically distinct from most collected N. coriiceps, characterized by its larger size and reddish color; its identity was confirmed using mitochondrial cox1 sequences. A significant finding of our study is that one nototheniid species can host more than one species of Pseudobenedenia.

Safety of leadless versus transvenous pacemakers in patients with low body surface area: a matched-pair analysis.

Actinomycetes and fungi have been found to be important sources of bioactive natural products. Evaluation the diversity of culturable insect-asscociated microorganisms, and screening strains with bioactive activity holds a promising for the development of lead compounds. Here, the diversity, antimicrobial and herbicidal activities of culturable actinomycetes and fungi from Hermetia illucens was investigated for the first time. A total of 34 strains of actinomycetes and 27 strains of fungi were isolated from the gut and body surface of H. illucens. Among them, Streptomyces (97.1%) and Geotrichum (14.8%) were the most abundant genera in actinomycetes and fungi, respectively. The herbicidal bioassay showed that the fermentation broth of 3 actinomycetes and 13 fungi presented good inhibition activity (> 50%) against Echinochloa crusgalli and Abutilon theophrasti. The antibacterial bioassay showed that the crude extracts from 10 strains of actinomycetes (29.4%) displayed antibacterial activity against at least one pathogenic bacterium with the inhibition zone diameter (IZD) of 7.0-22.0mm at the concentration of 30µg/6mm filter paper disc. Especially, the strain of S. tritolerans MFT2 exhibited strong antibacterial activity against S. aureus with the IZD of 22.0mm, which were comparable to that of the positive gentamicin sulfate (IZD = 24.7mm). Total of four known compounds were isolated from MFT2 by column chromatography, and were further identified as gilvocarcin M (1), gilvocarcin V (2), γ-valerolactone (3), and chrysomycin C (4) based on NMR and MS. Among them, compounds 1-2 exhibited moderate antibacterial activities against P. syringae pv. actinidiae with the IZD of 10.3 and 13.2mm respectively at the concentration of 30µg per disc, which were weaker than that of gentamycin sulfate (IZD = 25.7mm). Furthermore, both compounds 1 and 2 exhibited moderate phytotoxicity against E. crusgalli with inhibition rate of 56.7% and 44.1% at a concentration of 100µg/mL, respectively. In conclusion, the rich sources of actinomyces and fungi associated with H. illucens offers promising avenues for discovering novel antimicrobial agents and bioherbicides.

Background: This study aimed to identify the baseline characteristics predictive of Psoriasis Area and Sensitivity Index (PASI) 90 response to guselkumab and assess treatment effectiveness outcomes for PASI 90 responders and PASI 90 non-responders. Methods: This post hoc analysis used data from a prospective, multicenter, observational study of guselkumab in Korean patients with moderate-to-severe psoriasis conducted between February 2019 and March 2022. Stepwise logistic regression analysis was used to identify baseline characteristics predictive of PASI 90 response. Results: Of 339 patients, 245 (72.3%) week-28 PASI 90 responders and 94 (27.7%) non-responders were identified. Baseline characteristics significantly predictive of PASI 90 response in multivariate logistic regression were absence of family history of psoriasis (odds ratio [OR]: 0.35; p = 0.0266), higher PASI score (OR: 1.22; p = 0.0006), higher body surface area of psoriasis involvement (OR: 0.95; p = 0.0127), prior phototherapy use (OR: 2.44; p = 0.0108), and reduced concomitant topical agent use (OR: 0.41; p = 0.0044). More PASI 90 responders versus non-responders achieved absolute PASI score ≤ 2 by week 44 (95.8% vs. 67.5%) and Dermatology Life Quality Index scores of 0 or 1 by week 28 (72.2% vs. 34.0%). Conclusions: Guselkumab PASI 90 responders had unique baseline characteristics that may predict positive treatment outcomes.

This study investigated the physiological and hematological responses of polo horses to road transportation exposed to high ambient temperatures. Twenty Argentine polo horses were transported by truck for about 20 hours during the hot-dry season. Key physiological variables such as rectal temperature (RT), body surface temperature (BST), heart rate (HR), and respiratory rate (RR), along with hematological indices [packed cell volume (PCV), red blood cell count (RBC), hemoglobin concentration (Hb), platelet count (PLT), and white blood cell count (WBC)], were measured one week before travel, immediately after unloading, and during recovery. Meteorological parameters were recorded to assess environmental impact. Ambient temperature (AT) during unloading exceeded the thermoneutral zone for horses, indicating heat stress. Upon arrival, RR and RT increased beyond normal ranges, reflecting thermoregulatory strain caused by elevated AT and temperature-humidity index (THI). BST across measured body regions rose immediately after transport and decreased after rest. Hematological results showed temporary increases in PCV, Hb, RBC, WBC, and lymphocyte counts, suggesting stress-related physiological adjustments. These findings suggest that prolonged transport in hot, dry conditions results in significant thermal and hematological changes, potentially increasing disease susceptibility. The results highlight the importance of considering environmental factors and implementing effective management strategies to reduce transportation stress in horses.

Cardiovascular magnetic resonance-derived metrics as diagnostic markers for left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

Cholestasis is a frequent phenomenon in patients with burn injury and linked with impaired outcomes. To explore longitudinal trajectories of cholestasis and validate the proposed definition of burn-associated cholestasis (BAC). 532 patients admitted to an intensive care unit (ICU) for burn injury over a 10-year timeframe were included in this single-center, retrospective cohort study. Burn severity, ICU treatment, and laboratory parameters were longitudinally collected from admission to discharge or death. Median total body surface area burned was 15% and 234 patients (44%) had severe burn (≥ 20%). 118 patients (22%) met the proposed criteria of BAC while 41%, 30%, and 68% developed elevated alkaline phosphatase, bilirubin, and gamma-glutamyl transferase, respectively. BAC was associated with burn severity, ketamine use, mechanical ventilation, and parenteral nutrition, and 85% of cases occurred in patients exposed to ketamine, mechanical ventilation, and parenteral nutrition. Hyperbilirubinemia (≥ 2× upper-limit-of-normal, i.e., BAC subtype B/C) was independently associated with mortality adjusting for burn severity, critical illness severity, and ICU-specific treatment. However, bilirubin alone provided better discrimination, especially regarding excess deaths after ≥ 7 days (Harrel's C: 0.80-0.83). Concordant increases in bilirubin and alkaline phosphatase/gamma-glutamyl transferase allow for early identification of an at-risk population. Developing hyperbilirubinemia until Day 14 identified a subgroup with severely impaired prognosis (survival at 90 days: 46% vs. 95%). Cholestasis is frequent following burn injury. Prognosis is determined by bilirubin dynamics independently of disease and burn severity. Hyperbilirubinemia is associated with excess mortality ≥ 7 days after surviving burn injury.

Towards Better Response Assessment of Cutaneous Chronic Graft-Versus-Host Disease: A Report from the National Institutes of Health Consensus Project Task Force.

ABSTRACTTo evaluate the efficacy and safety of narrow-band ultraviolet B (NB-UVB) in treating refractory Hailey-Hailey Disease (HHD), four HHD patients (36–68 years old, disease duration 5–20 years) were included. NB-UVB was administered twice weekly, with initial doses 0.300–0.500 J/cm² and 0.050 J/cm² increments per session, and some patients received concurrent topical medications; follow-up lasted 1.5–53 months, with outcomes assessed via lesion body surface area (BSA) and Visual Analog Scale scores (disease severity, Refractory Visual Analog Scale, pruritus). Onset time was 0.25–4 months: 2 patients achieved complete lesion clearance, the other 2 had 60% and 87.5% BSA reduction, and the longest remission was 18 months; only 1 patient reported moderate irradiation-site pain, with no severe adverse events. NB-UVB shows satisfactory efficacy and good safety in refractory HHD and may serve as a viable treatment option.

The development of Opistognathus rosenblatti from larvae to juveniles is described using 60 specimens (3.6-47.0 mm LP). Adults were captured in the Loreto Bay Marine Park, Gulf of California, Mexico. They were conditioned and bred in captivity. Changes from larva to juvenile in morphological, meristic, and pigmentation pattern characters were described from specimens preserved in formalin solution (4%). Meristic data of larvae and juveniles were 27-29 total myomeres, XI, 13 dorsal fin, II, 13 anal fin, 8+7-9 caudal fin, and 5 hypural bones. The pigmentation pattern of the larvae from preflexion to postflexion stage consisted of: A cephalic region with small melanophores on the dorsal surface of the brain, on the lower margin of the nasal capsule, on the lateral surface of the lower and upper jaws, on the nape, and the gular region; abdominal region with a series of melanophores on the intestinal sac margins, including the swim bladder; the trunk region with few melanophores in the last myomeres; caudal region with three series of stellate melanophores on the dorsal, ventral margins and medial-lateral section between myomeres 1-14. Other stellate melanophores were present throughout this section, which interlaced towards all margins, providing a very light brown coloration on this section of the body. The juvenile is yellow-orange, with small punctate melanophores that extend across its entire body surface. It also exhibits four discontinuous series of brown spots (circular to oval) extending from the ventral-posterior margin of the eye to the height of the tips of the bases of the dorsal and anal fins. The conjunction of pigmentation patterns, myomeres count, and fin meristics is a distinctive identifier for O. rosenblatti larvae and juveniles, as it is not observed in the larvae of other fish species.

Air temperature that is considered as cold varies according to individuals. Urban people who live in temperate climates are accustomed to mild cold with varying wind speeds, but relatively few studies have examined the effects of wind speed in mild cold on individuals wearing winter clothing, especially compared to studies conducted in severe cold environments. We examined thermoregulatory responses to varying wind speeds in mild cold, considering anthropometric characteristics of individuals. Ten healthy males (23.9 ± 3.3 years in age, 175.8 ± 4.9cm in height, 74.4 ± 7.0kg in body weight) participated in the following four wind conditions (0, 2, 4.5, and 7m·s-1) at an air temperature of -5°C (wind chill temperature: -5 to approximately -12 °C). Subjects wore winter clothing (IT, 2.1 clo), and every trial consisted of 80min (10-min rest, 60-min walking, and 10-min recovery). Rectal and gastrointestinal temperatures remained stable across all wind conditions, suggesting sufficient insulation from the winter clothing. However, peripheral skin temperatures decreased significantly with higher wind speeds (all Ps < 0.05), with finger temperature averaging 12.7°C at 7m·s-1. Overweight subjects showed less frequent shivering than normal-weight subjects. Both body surface area (BSA) and body mass index (BMI) were negatively correlated with overall thermal comfort and positively correlated with shivering frequency (all Ps < 0.05). BSA was also negatively correlated with toe temperature (P = 0.001). While typical winter clothing (2.1 clo) effectively maintains core temperature in wind chill conditions down to -12°C, extremities, particularly the hands, require better insulation. Peripheral skin temperatures and thermal comfort provide reliable indicators for assessing cold stress. Morphological properties of the body also influenced cold responses, with overweight individuals exhibiting less frequent shivering and larger body surface areas correlating with greater cold sensitivity. These findings offer insights into optimizing winter clothing design to improve comfort and safety in windy conditions in mild cold.

ObjectiveStrain imaging serves as a sensitive marker for detecting early subclinical myocardial systolic dysfunction. The purpose of this study was to evaluate the diagnostic and prognostic value of myocardial work indices in assessing subclinical myocardial systolic dysfunction in active acromegaly patients.Methods27 active acromegaly patients and 27 healthy controls matched for age, sex, height, weight, body mass index and body surface area were included in the study. Active acromegaly was diagnosed based on elevated serum insulin-like growth factor 1 (IGF-1) (>1× upper limit of normal) or insufficient GH suppression (nadir ≥0.4 ng/mL) during an OGTT. All participants underwent two-dimensional speckle-tracking echocardiography (2D-STE) for the assessment of cardiac function. STE extracted the corresponding strain parameters (such as global longitudinal strain (GLS), global circumferential strain and global radial strain) and work parameters (such as global work index, global constructive work, global wasted work (GWW) and global work efficiency (GWE)) by analyzing the motion (strain)–velocity (strain rate) of two or more local myocardial segments, combined with the left ventricular non-invasive pressure estimation technique. At the same time, correlation analysis was used to explore the factors affecting GWW and GWE in the acromegaly group.ResultsIn comparison with the control group, conventional echocardiography revealed that acromegaly patients did not exhibit a significant difference in left ventricular ejection fraction (60.3 ± 3.7 vs 59.1 ± 4.8, P = 0.312), a commonly used index to evaluate ventricular systolic function, STE showed that there was no significant difference in GLS (−18.3 ± 2.4 vs −17.4 ± 2.9, P = 0.514) between the control group and the acromegaly group. However, significant differences can be found in GWW (44.8 ± 31.1 vs 80.6 ± 75.6, P = 0.027) and GWE (97.0 ± 1.8 vs 95.0 ± 3.8, P = 0.020), and a significant correlation was observed between myocardial work parameters and 1.5 × ULN IGF-1.ConclusionGWW and GWE are sensitive markers for identifying subclinical myocardial systolic dysfunction, suggesting their potential as early markers for detecting subclinical myocardial systolic dysfunction in active acromegaly patients.

BackgroundAortic diameter (AoD) changes with age and can decrease in shock states. Accurate AoD assessment is crucial for managing hypovolemic shock and guiding interventions such as resuscitative endovascular balloon occlusion of the aorta. This study hypothesized that clinical factors (eg, initial hemodynamic parameters, trauma severity, and laboratory results) would have a greater impact on the AoD than would age- or anthropometric-related factors in traumatic massive hemorrhage patients. We aimed to identify significant predictors of the descending AoD across two age groups (18–60 years and 61–91 years).MethodsA retrospective analysis was conducted on 243 massive hemorrhage patients at a level I trauma center. The aorta was automatically segmented in CT images via a deep learning architecture based on a Shallow Attention Network to obtain diaphragm-level AoD values. 152 patients were assigned to the younger group and 91 to the senior group. A random forest model was used to incorporate various clinical factors.ResultsIn the younger group, age and body surface area were the most important features (root mean square error (RMSE): train, 1.03; test, 2.70). In the senior group, hemoglobin, arterial pH, and heart rate were the most significant indicators (RMSE: train, 1.19; test, 3.95). The importance of age diminished in the senior group, whereas vital signs and laboratory values gained prominence.ConclusionOur findings reveal age-specific differences in factors influencing the AoD during traumatic hemorrhage. The results highlight the limitations of traditional methods for AoD estimation, especially in senior patients in whom dynamic physiological factors may play a major role. These insights can improve the accuracy of AoD assessment and management in hemorrhage patients across different age groups. The findings may contribute to developing an artificial intelligence-derived score that estimates the AoD, incorporating static and dynamic physiological factors.Level of evidenceIV, retrospective study having more than one negative criterion.

Psoriasis and depression frequently coexist, creating a complex, bidirectional relationship that complicates treatment. This study, integrating clinical assessments with transcriptomic and metabolomic analyses, hypothesizes that TYK2 (tyrosine kinase 2) inhibitors possess a dual therapeutic potential to simultaneously address both dermatological manifestations of psoriasis and the frequently accompanied depressive symptoms. In a cohort of 298 psoriasis patients evaluated using the Hospital Anxiety and Depression Scale (HADS), participants were categorized into a TYK2 inhibitor group, a Janus kinase (JAK) inhibitor group, and a non-JAK pool (comprising interleukin [IL]-23 biologics, IL-17 biologics, and other treatments) to avoid overlapping JAK pathway inhibition. Statistical analysis was conducted using generalized linear models (GENMOD), with adjustments for the following covariates: age, sex, Psoriasis Area and Severity Index (PASI), body surface area (BSA), prior systemic or biologic therapy within 12 months, disease duration, and phototherapy history. For HADS-D scores, the TYK2 inhibitor group showed significantly lower values compared with the non-JAK pool (β = 1.23, 95% confidence interval [CI]: 0.37-2.10). However, no significant differences were observed when compared with the IL-23 biologics group (β = 0.67, 95% CI: -0.76-2.10) or the JAK inhibitor group (β = 0.84, 95% CI: -1.54-3.21). Transcriptomic analysis of peripheral blood revealed significant downregulation of genes related to the IL-6 receptor, long-term depression pathways, and Th17 cell differentiation, while pathways associated with neuronal activity were upregulated. Metabolomic profiling highlighted a decrease in kynurenic acid, which is known for its pro-inflammatory and depressive effects, and an increase in 1H-indole-3-propanoic acid, an anti-inflammatory metabolite with neuroprotective properties. It is important to note that these findings are based on exploratory omics analyses, for which false discovery rate (FDR) control was applied. These findings provide a hypothesis that TYK2 inhibitors disrupt the persistent "peripheral inflammation-central depression" cycle by targeting the IL-23/Th17 axis and modulating the IL-6/tryptophan metabolic hub. This innovative, multi-targeted approach represents a possibility for treating psoriasis with comorbid depression, offering not only clinical improvements in both skin and mood symptoms but also enhanced patient adherence to treatment regimens.