Management Challenges Research Articles

Investigation of polyvinylpyrrolidone-catechol-derived chitosan nanoconjugates allowed for kidney-targeted treatment of cisplatin-induced acute kidney injury and nursing care management.

Acute kidney injury (AKI) resulting from cisplatin (Cs) chemotherapy presents a significant challenge in clinical management. The study aimed to fabricate a novel compound Polyvinylpyrrolidone-catechol-derived chitosan nanoconjugates (PCChi-NC) for targeting Cs-induced AKI. Characterization studies utilizing UV-visible spectrophotometry, FT-IR, XRD, and TEM revealed a spherical morphology with diameters ranging from 20 to 60nm. In vitro assessments utilizing HEK 293 cell lines demonstrated the biocompatibility of PCChi-NC without eliciting toxic effects. Furthermore, PCChi-NC exhibited a notable reduction in Cs-induced cell death in kidney cells, as evidenced by biomarker analysis. Anti-inflammatory analysis of mouse kidney homogenates revealed a decrease in TNF-α and IL-1β levels, indicative of the therapeutic efficacy of PCChi-NC in mitigating Cs-induced kidney inflammation. Moreover, In vivo, experimental analysis was evidenced by stable body weight and histopathological changes in mice. Our findings highlight the potential of PCChi-NC as a promising candidate for targeted therapy in Cs-induced AKI, owing to its unique renal targeting capacity.

What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients.

Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population. We conducted a literature search in PubMed up to April 2024, focusing on CMV infection and disease in patients with overt immunosuppression (hematopoietic stem cell and solid organ transplantation, solid or hematologic malignancies, HIV infection, immunosuppressive drugs, including corticosteroids, and primary immunodeficiencies) admitted to the intensive care unit (ICU). As there is limited ICU-specific data on CMV in immunosuppressed patients, many of the findings were extrapolated from the general literature. CMV infection and disease in immunocompromised critically ill patients is associated with increased mortality and presents significant management challenges. Clinical manifestations are diverse, shaped by the underlying immune deficiency and primary disease. Pneumonia and encephalitis are among the most severe CMV end-organ diseases. CMV infection may also increase the risk of secondary infections and induce life-threatening conditions, such as thrombotic microangiopathy. Importantly, CMV reactivation is not synonymous with CMV disease, and qPCR testing of body fluids cannot reliably differentiate between viral shedding and tissue-invasive infection, which requires histopathological confirmation. Ganciclovir is commonly the first-line anti-viral, though maribavir shows potential for patients unresponsive to other antivirals. Identifying patients who require prophylactic or preemptive antiviral therapy is essential. CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV's pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.

ANGIOGRAPHIC PROFILE IN YOUNG PATIENTS PRESENTING WITH STEMI

Background: ST-elevation myocardial infarction (STEMI) is a severe form of acute coronary syndrome that is traditionally more prevalent among older populations. However, a growing number of cases are being observed in younger individuals, presenting unique challenges in diagnosis and management. Understanding the angiographic and demographic characteristics of this younger population is crucial for developing targeted interventions and improving outcomes. Objective: To evaluate the angiographic characteristics, associated variables, and demographic features of young patients (aged ≤45 years) diagnosed with STEMI. Methods: This prospective study included 78 patients, aged 45 years or younger, who presented with a confirmed diagnosis of STEMI on electrocardiography and coronary angiography. The study was conducted at the Department of Cardiology, Shifa International Hospital, Islamabad, from 19th September 2024 to 18th December 2024. Data were collected on patient demographics, cardiovascular risk factors, and angiographic findings. Angiographic evaluation included coronary artery involvement, lesion location, severity, and complexity. Subgroup analyses were performed based on age, gender, and cardiovascular risk factors. Statistical analysis was performed using SPSS version 23, with significance set at p < 0.05. Results: The mean age of participants was 40.2 years, with 41.02% aged ≤35 and 58.98% aged 36–45. Males comprised 71.79%, while females accounted for 28.21%. Cardiovascular risk factors were present in 57.69% of patients, with smoking being the most prevalent (67.94%), followed by hypertension (32.05%) and diabetes (20.51%). The most commonly affected coronary artery was the RCA (43.75% in ≤35 and 47.83% in 36–45), followed by the LAD (31.25% and 34.78%, respectively) and LCx (25% and 39.13%, respectively). No significant gender differences were observed in angiographic characteristics. Conclusion: This study highlights the angiographic and demographic profile of young STEMI patients, emphasizing the predominance of male patients with significant cardiovascular risk factors, particularly smoking. Further research with larger cohorts is needed to confirm these findings and explore potential gender differences.

RGB sensor integrated into unmanned aerial vehicle for monitoring cyanobacterial density in reservoirs

Abstract The proliferation of cyanobacteria has become a significant water management challenge due to the increasing eutrophication of water supply reservoirs. Cyanobacterial blooms thrive on elevated nutrient concentrations and form extensive green mats, disrupting the local ecosystem. Furthermore, many cyanobacterial species can produce toxins that are lethal to vertebrates called cyanotoxins. Traditional monitoring methods are inefficient for assessing water quality in reservoirs as a whole, given that sampling is only carried out in the catchment area for the public water supply, which exposes the population to the risk of contamination due to the multiple uses of these reservoirs. Therefore, novel monitoring methods supported by recent technological advances, such as the use of unmanned aerial vehicles (UAVs), are being tested for their effectiveness in monitoring cyanobacterial densities in aquatic ecosystems. This study analyzed UAV images of two water supply reservoirs to assess the effectiveness in monitoring cyanobacterial density. The UAVs were equipped with RGB sensors and flew over the study areas on the same day and at the same locations as water sampling performed for the determination of phytoplankton density, biovolume and chlorophyll-a. The phytoplankton community was dominated by cyanobacteria in both reservoirs. High coefficients of determination were obtained in the predictive models for chlorophyll-a concentration (r2 = 0.92), total phytoplankton and cyanobacterial densities (r2 = 0.89 and r2 = 0.97, respectively), and total phytoplankton and cyanobacterial biovolumes (r2 = 0.96 for both). Applying the predictive models to the orthomosaics generated from the UAV RGB images enabled the visualization of the spatial distribution of the phytoplankton and cyanobacterial biomass through distribution maps. This method has potential application in the management of water bodies that are crucial to the public water supply.

Implementasi Recycle dalam Meningkatkan Partisipasi Masyarakat Peduli Sampah di Komunitas Pasar MMTC

Indonesia faces big challenges in waste management, with waste volumes continuing to increase every year. As a densely populated island country, factors such as rapid population growth, urbanization, changes in consumption patterns, and a lack of waste management infrastructure have also exacerbated this condition. Based on observations at the MMTC market, the rubbish problem is very serious due to the large amount of rubbish strewn about that is not cleaned up by traders. This research aims to explore efforts to increase education and training about recycling for the community, increase community participation in maintaining cleanliness through recycling activities in market communities, develop an efficient and effective recycling management system, and identify barriers to implementing recycling programs. reset on the MMTC market. The expected output of this research is increasing public awareness and participation in maintaining market cleanliness through recycling activities, comprehensive research results reports, and publication in SINTA indexed journals. It is hoped that this research can be an important step in efforts to create a cleaner and more sustainable market environment in Indonesia.

Tolosa–Hunt syndrome in children and adolescents: A systematic review

AbstractObjectiveThis systematic review aims to consolidate and analyze the existing evidence on Tolosa–Hunt syndrome (THS) in the pediatric population, focusing on clinical features, diagnostic challenges, treatment outcomes, and prognosis.BackgroundTolosa–Hunt syndrome is a rare headache disorder caused by idiopathic inflammation of the cavernous sinus, orbital apex, or orbit, resulting in neuro‐ophthalmological manifestations. It is uniquely characterized by cranial nerve palsies and often responds well to steroids.MethodsA comprehensive literature search was conducted using three databases along with the gray literature. We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, and the review protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42024576802). The review included case reports and case series published in multiple languages that documented pediatric or adolescent cases of THS. We excluded any cases that were irrelevant, had insufficient details, were unsure of the diagnosis, or were later re‐diagnosed with another condition. Data on clinical presentations, imaging findings, treatment modalities, and outcomes were extracted and analyzed using Microsoft Excel 2021.ResultsThe initial literature search provided 325 articles of which 55 articles discussing 61 unique pediatric patients were included. The median (interquartile range [IQR]) age was 11 (8–15) years, with a female predominance (70% [43/61]). Common symptoms included unilateral headache (48% [29/61]), retro‐orbital pain (56% [34/61]), and cranial nerve palsies, predominantly involving the oculomotor nerve (66% [40/61]). The median (IQR) duration of symptoms was 14.5 (5–35) days. Imaging often revealed contrast enhancement on magnetic resonance imaging with cavernous sinus/orbital apex lesions. Steroid therapy was the mainstay of treatment, with 91% (52/57) of patients receiving corticosteroids. High‐dose steroids ranged from 500–1000 mg/day, with some cases requiring combined therapy (typically intravenous methylprednisolone followed by oral prednisolone) and subsequent tapering. A few patients (5% [3/61]) experienced spontaneous improvement without steroids. Recurrence was noted in 33% (20/61) of patients, often necessitating prolonged or repeated corticosteroid therapy, and some cases required additional immunosuppressive therapies (infliximab/adalimumab) for management. The median (IQR) time to symptom resolution was 14 (4.5–38.5) days, while the median (IQR) duration of follow‐up was 730 (195–1095) days.ConclusionTolosa–Hunt syndrome in children presents significant diagnostic and management challenges due to the complexity of symptoms and the rarity of the condition. Accurate diagnosis and prompt steroid therapy are crucial after ruling out other causes, although recurrence remains a considerable risk. The present systematic review relies heavily on case reports and case series and is therefore at high risk of publication bias. Further research is needed to establish standardized treatment protocols and improve long‐term outcomes in this population.

Challenges in Managing Closed Gastroschisis: Addressing a Rare and Complex Variant of Abdominal Wall Defect

ABSTRACT Background: In closed gastroschisis, the initial herniation of the intestines through the abdominal wall defect subsequently leads to spontaneous closure of the defect during fetal development, even before the migration of the intestines back to the abdominal domain. Materials and Methods: This study investigates the clinical presentation, diagnostic challenges, and management strategies of closed gastroschisis through a retrospective review of six cases presented at our clinic between 2009 and 2024. Data were prospectively collected and analyzed to gain insights into the varied presentations and outcomes of this rare condition. Results: In this cohort of six patients with closed gastroschisis, none had undergone antenatal ultrasonographic examination, and all presented to the emergency department immediately after birth with a mass protruding from the abdominal wall. Each patient underwent evaluation and laparotomy for definitive management. Five of the six children showed favorable outcomes at the 48-month follow-up, while one patient succumbed to postoperative sepsis. Conclusions: Abdominal wall defects, including closed gastroschisis, are congenital anomalies requiring prompt diagnosis and treatment. This rare variant presents unique challenges in management due to its atypical features. The findings from this study contribute to a better understanding of closed gastroschisis and its management, highlighting the importance of early diagnosis and intervention in improving patient outcomes in pediatric surgical practice. Antenatal diagnosis and prompt surgical intervention as early as possible after birth are the mainstays of treatment.

A comparative analysis of lumboperitoneal shunt outcomes in patients with post-hemorrhagic and post-traumatic hydrocephalus

Hydrocephalus, whether arising from post-hemorrhagic or post-traumatic origins, poses significant challenges in clinical management. Lumboperitoneal shunting (LPS) emerges as a viable therapeutic intervention, yet comparative analyses between these etiologies remain scarce. This retrospective study aims to compare the efficacy and safety of LPS placement in patients with post-hemorrhagic (PHH) and post-traumatic hydrocephalus (PTH). This retrospective study investigates shunting outcomes in patients aged 18 years or older diagnosed with PHH or PTH who underwent LPS between 2014 and 2018. Primary outcomes included shunt reoperation rates, with secondary outcomes encompassing modified Rankin Scale (mRS) and National Institute of Health Stroke Scale (NIHSS) scores, Evans index, complications, and length of hospital stay. Favorable outcomes were defined as an mRS score of 2 or less. A total of 34 PHH and 48 PTH patients were included, with baseline characteristics being similar between groups. Shunt reoperation rates were comparable between PHH (23.5%) and PTH (27.1%) groups (P = 0.716). At 2 years, favorable outcomes were observed in 82.4% of PHH patients and 72.9% of PTH patients (P = 0.318). NIHSS scores at discharge (P = 0.230) and at 2 years (P = 0.530) showed no significant differences. However, PHH patients exhibited shorter hospital stays post-LPS implantation (P = 0.025). LPS placement demonstrates comparable outcomes in patients with PHH and PTH, with similar rates of shunt reoperation and complications, as well as equivalent neurological outcomes. However, Notably, PTH patients exhibited a higher risk of shunt malfunction compared to PHH patients, along with prolonged hospital stays post-LPS implantation.

Verification of Qianlong Shutong Formula in the Treatment of Benign Prostatic Hyperplasia.

To investigate the mechanisms through which Qianlong Shutong Formula (QLSTF) exerts its effects on the management of benign prostatic hyperplasia (BPH). BPH is a prevalent condition among older men and poses significant management challenges due to the limited effectiveness and potential side effects associated with current treatment options. QLSTF, a traditional Chinese medicine, has been utilized in the treatment of BPH; however, its mechanism of action remains inadequately understood. This study aimed to identify potential therapeutic targets of QLSTF for the management of BPH through the application of network pharmacology and subsequent experimental validation. QLSTF compounds were identified utilizing liquid chromatography-mass spectrometry (LC-MS). Potential targets of QLSTF, as well as BPH-related targets, were retrieved from public databases. Crucial bioactive ingredients, potential targets, and signaling pathways were acquired through bioinformatics analysis, including protein-protein interaction (PPI), as well as the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Subsequently, molecular docking was carried out to predict the combination of active compounds with core targets. Lastly, in vitro and in vivo experiments were conducted to further verify the findings. A total of 52 bioactive ingredients of QLSTF and 760 QLSTF-BPH-related targets were screened. Bioinformatics analysis revealed that Afzelin, Ononin, Glycitin, Emodin and Erythritol may be potential candidate agents. AKT1, SRC, STAT3, GRB2, HRAS, MAPK3, PIK3CA, PIK3R1, HSP90AA1, and EP300 could become potential therapeutic targets. PI3KAKT signaling pathway might play an important role in QLSTF against BPH. Moreover, molecular docking suggested that Afzelin, Ononin, Glycitin, Emodin, and Erythritol combined well with AKT1, SRC, STAT3, HRAS, MAPK3, PIK3CA, and PIK3R1, respectively. In vitro and in vivo experiments showed that QLSTF could inhibit the proliferation of cells, as well as the PI3K-Akt signaling pathway, which further confirmed the prediction by network pharmacology strategy and molecular docking. QLSTF may exert its therapeutic effects on BPH by modulating the PI3K/AKT signaling pathway and inhibiting glandular hyperplasia. This study offers valuable insights into the therapeutic targets of QLSTF in the management of BPH.

Bottling it? Consumer responses to less environmentally friendly products: A choice experiment for water in plastic packaging in the UK.

Consumers have several options when confronted with less environmentally friendly packaging like water in single use plastic bottles - they can ignore environmental concerns and proceed with a purchase, refuse to buy any such product, seek out a less damaging version like water in biodegradable bottles, and/or engage in offsetting/compensatory behavior such as donating to a charity. Understanding how consumers value these options is an important academic and management challenge. To address this, a stated choice experiment is employed. It considers the preferences of a representative sample of UK consumers for bottled water with the attributes: packaging (PET versus biodegradable), charity donation (environment/social/none), origin (domestic/foreign), and price. Data were analyzed using random parameter logit modeling, incorporating a latent variable into the model, which captured environmentally conscious behavior. Based on the model estimations, domestic origin, biodegradable packaging, and charity donations (both for environmental and social causes) positively affect decision-makers' perceived utility. In keeping with moral consistency theory, as consumers' level of nature relatedness and green consumption values increase, biodegradable packaging becomes more preferable than non-biodegradable packaging, and the likelihood of refusing to purchase any bottled water option, rises, respectively. In contrast, high levels of materialist values are associated with lower environmental consciousness. The paper provides evidence to managers regarding consumers' valuation of more environmentally friendly packaging, and strategies to increase uptake.

Serum KL-6 levels reflect the severity of interstitial lung disease caused by immune checkpoint inhibitors.

Tumor immunotherapy, particularly immune checkpoint inhibitors (ICIs), has emerged as a powerful strategy in treating malignant tumors, exhibiting efficacy in both first-line and second-line treatments for advanced non-small cell lung cancer (NSCLC). Despite their success, ICIs can lead to adverse reactions, including interstitial lung disease (ILD), with an incidence ranging from 2.7% to 20.0%. The lack of clear correlations with dosage, duration, or drug efficacy, coupled with nonspecific clinical manifestations, poses challenges in timely diagnosis and effective management. This study examined the association between ICIs-related ILD and serum levels of KL-6 and inflammatory markers in NSCLC patients. A total of 382 NSCLC patients with squamous cell carcinoma (SQC, n=81), adenocarcinoma (ACA, n=132), and large cell carcinoma (LCC, n=169) were included, of whom 191 developed ILD following ICIs treatment. Serum KL-6, TNF-α, IL-8, and IL-6 were quantified using ELISA. Results showed significantly elevated serum KL-6 levels in ILD patients (759.35±214.14U/mL) compared to those without ILD (270.81±124.98U/mL). Cancer subtype analysis revealed increased KL-6 levels across SQC, ACA, and LCC ILD patients (SQC: 645.89±255.07, ACA: 797.39±192.30, LCC: 783.57±191.21; p<0.001). ROC analysis identified diagnostic thresholds for KL-6: 277.4U/mL for SQC (sensitivity 0.9756, specificity 0.8250), 346.9U/mL for ACA (sensitivity 0.9583, specificity 0.8333), and 281.3U/mL for LCC (sensitivity 0.9873, specificity 0.6111). Correlation analysis showed a significant relationship between KL-6 and TNF-α (r=0.4626, p=0.0023), IL-8 (r=0.5584, p=0.0001), and IL-6 (r=0.5336, p=0.0003) in SQC ILD patients. These findings suggest that elevated KL-6 levels and inflammatory markers are indicative of ILD in ICIs-treated NSCLC patients, with potential diagnostic implications across cancer subtypes.

Navigating the Complexities of Molar Incisor Hypomineralization: Challenges and Strategies in Pediatric Dentistry.

Background: Molar incisor hypomineralization (MIH) presents a multifaceted challenge in pediatric dentistry, impacting diagnostics, clinical management, resource accessibility, and psychosocial care. The condition's complexity is exacerbated by diagnostic variability, overlapping clinical symptoms, and the need for tailored treatment approaches. Objectives: This study aims to explore the key challenges associated with the management of MIH in pediatric dentistry, including diagnostic precision, clinical management, resource limitations, interdisciplinary care, long-term follow-up, and psychosocial impact, and to propose strategies for overcoming these obstacles. Methods: A comprehensive literature review was conducted to identify and synthesize existing evidence on MIH's etiology, diagnosis, treatment, and prognosis. The review highlighted the barriers encountered in providing optimal care, particularly in resource-constrained settings, and explored potential solutions through clinical and interdisciplinary approaches. Results: The key findings included the need for standardized diagnostic criteria, the role of individualized treatment plans, and the importance of resource allocation. Limited access to specialized equipment and education hampers care, especially in under-resourced areas. Long-term management complexities were further compounded by the necessity for interdisciplinary collaboration and attention to psychosocial factors affecting pediatric patients. Conclusion: Effective MIH management requires standardized diagnostic protocols, resource advocacy, interdisciplinary collaboration, and holistic patient care. Advancements in research, education, and policy are essential to improve outcomes in pediatric patients. By addressing both clinical and psychosocial challenges, the overall well-being of MIH-affected children can be enhanced.

Neurogastroenterology and motility disorders in patients with cirrhosis.

Neurogastroenterology and motility disorders are complex gastrointestinal conditions that are prevalent worldwide, particularly affecting women and younger individuals. These conditions significantly impact the quality of life of people suffering from them. There is increasing evidence linking these disorders to cirrhosis, with a higher prevalence compared to the general population. However, the link between neurogastroenterology and motility disorders and cirrhosis remains unclear due to undefined mechanisms. In addition, managing these conditions in cirrhosis is often limited by the adverse effects of drugs commonly used for these disorders, presenting a significant clinical challenge in the routine management of patients with cirrhosis. This review delves into this connection, exploring potential pathophysiological links and clinical interventions between neurogastroenterology disorders and cirrhosis.

Seleção de herbicidas pré-emergentes para o trigo

ABSTRACT Weed control is a challenge in crop management due to the limited number of registered herbicides, especially for preemergent application. This study aimed to investigate the selectivity of pre-emergent herbicides with different mechanisms of action for wheat. The experiment consisted of two stages: the first involved screening under greenhouse conditions, and the second assessing the selected treatments under field conditions, with a focus on crop yield. Plant phytointoxication, crop stand, and shoot dry weight were assessed in the greenhouse experiment, and tillering, crop stand, plant height, canopy closure, yield, 1000-grain weight, and hectoliter weight in the field. Under greenhouse conditions, [imazapic + imazapyr], pendimethalin, isoxaflutole, florpyrauxifen, and halosulfuron-methyl produced the best results and were selected for the field experiment. Florpyrauxifen was the only herbicide that was selective both in greenhouse and field experiments. Isoxaflutole and trifluralin did not damage wheat in any of the field evaluations. Despite reducing crop performance in some assessments, pendimethalin and flumioxazin provided yield, hectoliter weight, and 1000-grain weight results equivalent to the herbicide-free control. Florpyrauxifen (1.08 g ha-1) was the most promising herbicide. Trifluralin (900 g ha-1), pendimethalin (1750 g ha-1), isoxaflutole (60 g ha-1), and flumioxazin (40 and 60 g ha-1) also produced grain yields equivalent to the control without herbicide.

Coronary artery disease and percutaneous coronary intervention in patients with severe chronic kidney disease.

Coronary artery disease (CAD) is the leading cause of mortality among patients with chronic kidney disease (CKD), presenting unique challenges in diagnosis and management. Advanced CKD patients often present with atypical symptoms, and conventional diagnostic and interventional approaches carry risks, including contrast-induced nephropathy and the potential need for renal replacement therapy. These risks have led to the phenomenon of "renalism," where necessary procedures may be deferred due to concerns over renal injury. Emerging techniques, such as ultra-low contrast angiography (ULCA) and zero-contrast percutaneous coronary intervention (PCI), offer promising solutions by minimizing or eliminating contrast exposure. This review discusses the clinical presentation of CAD in CKD patients, limitations of traditional diagnostic approaches, and the challenges in managing these high-risk patients. It also provides an overview of ULCA and zero-contrast PCI techniques, which have shown both safety and feasibility even in complex cases. As these techniques continue to evolve, zero-contrast PCI holds the potential to become an essential component of revascularization strategies for high-risk CKD patients, enhancing procedural safety while maintaining therapeutic efficacy.

Challenges and needs in disaster preparedness: A qualitative study

Introduction: Natural disasters that occur suddenly and unpredictably can cause losses for communities. Communities have varied understanding of disasters which influence their perceptions of risks and appropriate anticipatory actions. This study explores stakeholders' perceptions and preferences related to disaster preparedness to design more inclusive and responsive risk mitigation programs.Methods: A qualitative study with a descriptive phenomenological design was conducted from March to June 2024. Forty-eight participants who met the inclusion criteria were involved through purposive sampling. The inclusion criteria were participants who were directly impacted by the Mamuju disaster on January 14 and 15, 2021. Data were collected through six focus group discussions of eight people each until saturation. The FGD guidelines were informed by disaster nursing, management, and crisis health experts. As Graneheim and Lundman proposed, content analysis was used to analyze the data. Ethical approval from the University of Indonesia's Research Ethics CommitteeResults: Five main themes were found from the emerging data: 1) Holistic response during disasters, 2) Needs for emergency disaster handling, 3) Disaster warning system based on tradition and technology, 4) Challenges in leadership and resource management in disaster situations, 5) Hopes and efforts in future disaster management.Conclusion: Determining the challenges and needs of communities during disasters is crucial for improving disaster response effectiveness. This requires disaster socialization, exercises for victim handling, evacuation drills, exercises for communicating early warning responses, leadership, and resource management training, as well as disaster preparedness simulations. Such efforts are needed to support the sustainability of community-based disaster preparedness

Bibliometric analysis of laryngeal cancer treatment literature (2003-2023).

Despite advancements in medical science, the 5-year survival rate for laryngeal squamous cell carcinoma remains low, posing significant challenges in clinical management. This study explores the evolution of key topics and trends in laryngeal cancer research. Bibliometric and knowledge graph analysis are utilized to assess contributions in treating this carcinoma and to forecast emerging research hotspots that may enhance future clinical outcomes. The findings aim to guide researchers by identifying new areas, providing valuable insights and innovative perspectives. Data were extracted from the Web of Science Core Collection database on December 1, 2023. Bibliometric and knowledge mapping analyses were conducted using software tools such as R-Studio 4.1.3, CiteSpace 6.1.R6, VOSviewer 1.6.18, and http://bibliometre.com.(Both CiteSpace 6.1.R6 and VOSviewer 1.6.18 are widely used bibliometric analysis software tools, each with distinct features and applications. CiteSpace primarily focuses on analyzing literature citation relationships and generating knowledge graphs to visualize research hotspots, trends, and knowledge structures. Its data sources include platforms such as Web of Science. While CiteSpace excels in presenting knowledge structures through its advanced visualization capabilities, it is relatively complex to operate and less efficient in processing large-scale datasets. As a result, it is frequently employed in exploring research trends across multiple disciplines. On the other hand, VOSviewer is designed to construct various types of bibliometric networks and is characterized by its intuitive and user-friendly interface. It supports a wide range of data sources and produces visually appealing and clear visualizations, making it particularly suitable for multi-disciplinary bibliometric research. Additionally, VOSviewer provides valuable insights that can inform scientific research decision-making. Overall, the two tools differ in terms of functionality, data sources, visualization effects, and operational complexity, offering researchers complementary options for bibliometric analysis based on their specific needs.) From this database, 800 papers were extracted using specific criteria. After narrowing the scope to English-language publications, this number was reduced to 775. To ensure data quality, conference papers, letters, and editorial materials were excluded, focusing only on original research papers and review articles. The analysis showed that 760 theoretical works and review papers were published in 96 academic journals by 4210 authors from 1148 institutions across 60 countries/regions. The United States emerged as the most significant contributor to laryngeal cancer research. The Croatian Rudjer Boskovic Institute was notable for having the highest publication and citation counts. Among individual researchers, Osmak, M was identified as the most prolific and cited. Predominant international collaborations occurred between European and American countries. The Head and Neck Science Journal was the most frequently co-cited publication. Major research themes encompassed morphological aspects, chemotherapy, and molecular pathway mechanisms in laryngeal cancer treatment. Current research hotspots include disease prognosis, models, clinical trials, tumor recurrence, and surveillance. Notably, targeted therapy and immunotherapy are rapidly advancing fields. There is an urgent need to enhance global scholarly communication as the pursuit of effective laryngeal cancer treatment progresses. Focused research on targeting indicators for this type of cancer remains vital. An impending surge in research is driven by investigations into biomarkers, microenvironmental genetic mechanisms, alternatives to systemic chemotherapy, minimally invasive surgery, and herbal medicine explorations.

Novel insights into PAHs accumulation and multi-method characterization of interaction between groundwater and surface water in middle Yangtze River: Hydrochemistry, isotope hydrology and fractionation effect.

To meet the challenge of water quality protection and management in the middle Yangtze River and understand the accumulation mechanism of PAHs in aquatic complexity systems, caused by hydro-chemical changes, anthropogenic and geological activities, and intensive surface water-groundwater interaction, a comprehensive study is urgently needed. The study investigated the pollution levels, potential sources, accumulation mechanism, and groundwater- surface water interaction of polycyclic aromatic hydrocarbons (PAHs) in wet and dry seasons of the middle Yangtze River. There was no significant difference of PAHs accumulation between wet and dry seasons of the middle Yangtze River. PAHs occurrence in the middle Yangtze River was dominated by the input of tributary. Phenanthrene and Naphthalene were still the dominant species of PAHs. Coal combustion (CC) and biomass burning (BB) were the major contributor for the PAHs occurrence. However, the CC apportionment concentration increased by 6.18ng·L-1 from wet to dry season, suggesting higher density of coal consumption in dry season. The potential mechanism of PAHs occurrence was demonstrated by the mantel test and structural equation model (SEM). Results revealed that the pollution of the middle Yangtze River could be mainly affected by primary emission in wet and dry seasons due to the significant positive effect between eutrophication levels and PAHs pollution sources. Meanwhile, the difference in redox conditions could directly affect the fate of pollutants (including the valence state transformation of nitrogen and phosphorus). The stronger interaction of groundwater and surface water in dry season was presented by hydrochemistry and isotope hydrology (δ18O and δ2H). The similar result was also evidenced by fractionation effect of PAHs, because more similar behaviors of characteristic pollutants were observed in dry season. Consequently, PAHs can be considered as an effective geochemical tracer and further expanded their toxic effects through the surface water-groundwater interaction.

Safety of open airway reconstruction in high-risk post-COVID patients: A case-matched control study

ObjectivesCOVID-19 pneumonia patients may have high rates of intubation and reduced pulmonary function once recovered. Poor pulmonary function is a relative contraindication to open airway reconstruction, post-COVID patients may extrapolate as high-risk for open airway reconstruction. This presents challenges in airway stenosis management of post-COVID pneumonia patients. This study reports the safety and outcomes of open airway reconstruction in carefully selected post-COVID patients. MethodsA retrospective case-matched control study of six post-COVID tracheal stenosis cases treated with tracheal resection and six matched controls. Controls were matched based on age, length of stenosis, and comorbidities. Primary outcomes are peri-operative safety events and need for future airway interventions. ResultsPost-COVID cases and non-COVID controls were closely matched on age, length of stenosis, and comorbidities (p > 0.05). Duration of follow-up was not significantly different (p = 0.1894). No patients required reintubation, tracheostomy, ICU admission, or ventilator placement in the peri-operative period. There was one allergic reaction to antibiotics in a case and one aspiration pneumonia in a control. One case required in-office steroid injection and injection augmentation post-operatively, but no patients from either group required future operative airway intervention during the follow-up period. ConclusionPost-COVID tracheal stenosis cases had comparably excellent outcomes with matched controls after open tracheal construction, with few peri-operative safety events and minimal need for future interventions. These data indicate open airway reconstruction is a safe and effective option for the treatment of tracheal stenosis in carefully selected post-COVID patients. Level of evidence4

Unraveling the complexity of acute subdural hematoma in elderly patients: The impact of anticoagulant therapy and the pursuit of better outcomes.

Acute subdural hematoma (ASDH) is a critical and often fatal condition, particularly in elderly patients receiving anticoagulant therapy. With a growing global aging population, the incidence of traumatic brain injuries, including ASDH, is projected to rise, presenting significant challenges in clinical management. This study evaluates the outcomes of surgically treated ASDH in patients aged 65 years and older, comparing those who received anticoagulant therapy with those who did not. It also aims to identify the main risk factors for poor outcomes and explore preventive strategies in this vulnerable population. A retrospective analysis was conducted on 90 patients aged 65 years and older who underwent surgery for ASDH at our institution between 2018 and 2023. Patients were categorized into two groups based on anticoagulant therapy use. Demographic data, mechanisms of injury, clinical presentations, and outcomes, including mortality and reoperation rates, were analyzed. Radiological assessments included hematoma thickness, midline shift, and the presence of residual hematoma. No significant differences were observed in hematoma thickness, midline shift, or mortality between patients receiving anticoagulant therapy and those not on anticoagulants. However, a significant association was found between anticoagulant use and the mechanism of injury; patients on anticoagulants were more likely to sustain ASDH from low-energy trauma, such as a fall from the same level (p=0.005). Despite the high mortality rates associated with ASDH in elderly patients, the multidisciplinary approach employed, including the prompt reversal of coagulopathy, likely contributed to the observed outcomes. Acute subdural hematoma in elderly patients, particularly those receiving anticoagulant therapy, remains a challenging problem with a high rate of poor outcomes. This study highlights the urgent need for preventive measures to mitigate the risks associated with even minor trauma, especially in patients on anticoagulants. Our findings underscore the importance of appropriate management protocols, including the timely reversal of coagulopathy, in improving survival rates within this high-risk population. Further research is needed to develop and validate comprehensive preventive strategies and to investigate long-term outcomes in these patients.