Common Condition Research Articles

Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs.

The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones. Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings. A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455). Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees.

Integrative Approaches to Managing Gut Health.

To summarize key integrative approaches to managing common gastrointestinal conditions. Lifestyle interventions like diet, exercise, and stress reduction impact the gut microbiome and gastrointestinal symptoms. Evidence supports mind-body therapies, herbs, certain supplements, and other modalities as complimentary approaches, when appropriate, for common conditions like irritable bowel syndrome or gastroesophageal reflux disease. An integrative approach optimizes both conventional treatments and incorporates lifestyle modifications, complimentary modalities, and the doctor-patient relationship.

Prognostic gene landscapes and therapeutic insights in sepsis-induced coagulopathy

BackgroundSepsis is a common and critical condition encountered in clinical practice that can lead to multi-organ dysfunction. Sepsis-induced coagulopathy (SIC) significantly affects patient outcomes. However, the precise mechanisms remain unclear, making the identification of effective prognostic and therapeutic targets imperative. MethodsThe analysis of transcriptome data from the whole blood of sepsis patients, facilitated the identification of key genes implicated in coagulation. Then we developed a prognostic model and a nomogram to predict patient survival. Consensus clustering classified sepsis patients into three subgroups for comparative analysis of immune function and immune cell infiltration. Single-cell sequencing elucidated alterations in intercellular communication between platelets and immune cells in sepsis, as well as the role of the coagulation-related gene FYN. Real-time quantitative PCR determined the mRNA levels of critical coagulation genes in septic rats' blood. Finally, administration of a FYN agonist to septic rats was observed for its effects on coagulation functions and survival. ResultsThis study identified four pivotal genes—CFD, FYN, ITGAM, and VSIG4—as significant predictors of survival in patients with sepsis. Among them, CFD, FYN, and ITGAM were underexpressed, while VSIG4 was upregulated in patients with sepsis. Moreover, a nomogram that incorporates the coagulation-related genes (CoRGs) risk score with clinical features of patients accurately predicted survival probabilities. Subgroup analysis of CoRGs expression delineated three molecular sepsis subtypes, each with distinct prognoses and immune profiles. Single-cell sequencing shed light on heightened communication between platelets and monocytes, T cells, and plasmacytoid dendritic cells, alongside reduced interactions with neutrophils in sepsis. The collagen signaling pathway was found to be essential in this dynamic. FYN may affect platelet function by modulating factors such as ELF1, PTCRA, and RASGRP2. The administration of the FYN agonist can effectively improve coagulation dysfunction and survival in septic rats. ConclusionsThe research identifies CoRGs as crucial prognostic markers for sepsis, highlighting the FYN gene's central role in coagulation disorders associated with the condition and suggesting novel therapeutic intervention strategies.

A review of ADHD detection studies with machine learning methods using rsfMRI data.

Attention deficit hyperactivity disorder (ADHD) is a common mental health condition that significantly affects school-age children, causing difficulties with learning and daily functioning. Early identification is crucial, and reliable and objective diagnostic tools are necessary. However, current clinical evaluations of behavioral symptoms can be inconsistent and subjective. Functional magnetic resonance imaging (fMRI) is a non-invasive technique that has proven effective in detecting brain abnormalities in individuals with ADHD. Recent studies have shown promising outcomes in using resting state fMRI (rsfMRI)-based brain functional networks to diagnose various brain disorders, including ADHD. Several review papers have examined the detection of other diseases using fMRI data and machine learning or deep learning methods. However, no review paper has specifically addressed ADHD. Therefore, this study aims to contribute to the literature by reviewing the use of rsfMRI data and machine learning methods for detection of ADHD. The study provides general information about fMRI databases and detailed knowledge of the ADHD-200 database, which is commonly used for ADHD detection. It also emphasizes the importance of examining all stages of the process, including network and atlas selection, feature extraction, and feature selection, before the classification stage. The study compares the performance, advantages, and disadvantages of previous studies in detail. This comprehensive approach may be a useful starting point for new researchers in this area.

Artificial intelligence in the diagnosis and treatment of acute appendicitis: a narrative review.

Artificial intelligence is transforming healthcare. Artificial intelligence can improve patient care by analyzing large amounts of data to help make more informed decisions regarding treatments and enhance medical research through analyzing and interpreting data from clinical trials and research projects to identify subtle but meaningful trends beyond ordinary perception. Artificial intelligence refers to the simulation of human intelligence in computers, where systems of artificial intelligence can perform tasks that require human-like intelligence like speech recognition, visual perception, pattern-recognition, decision-making, and language processing. Artificial intelligence has several subdivisions, including machine learning, natural language processing, computer vision, and robotics. By automating specific routine tasks, artificial intelligence can improve healthcare efficiency. By leveraging machine learning algorithms, the systems of artificial intelligence can offer new opportunities for enhancing both the efficiency and effectiveness of surgical procedures, particularly regarding training of minimally invasive surgery. As artificial intelligence continues to advance, it is likely to play an increasingly significant role in the field of surgical learning. Physicians have assisted to a spreading role of artificial intelligence in the last decade. This involved different medical specialties such as ophthalmology, cardiology, urology, but also abdominal surgery. In addition to improvements in diagnosis, ascertainment of efficacy of treatment and autonomous actions, artificial intelligence has the potential to improve surgeons' ability to better decide if acute surgery is indicated or not. The role of artificial intelligence in the emergency departments has also been investigated. We considered one of the most common condition the emergency surgeons have to face, acute appendicitis, to assess the state of the art of artificial intelligence in this frequent acute disease. The role of artificial intelligence in diagnosis and treatment of acute appendicitis will be discussed in this narrative review.

A novel design strategy of track‐based asymmetric nonlinear energy sink for seismic response mitigation of structures

AbstractMass dampers, whether linear or nonlinear, rely on resonance with the structure to achieve optimal control performance. However, linear mass dampers require frequency tuning, while nonlinear mass dampers are sensitive to input energy levels, rendering both inadequate for control problems that involve frequency and energy uncertainties. To address this issue, the track asymmetric nonlinear energy sink (TANES) has been developed as a robust mass damper against frequency and energy changes. In this study, a novel design strategy consisting of physical and parameter design was proposed for TANESs. First, TANESs with inverted tracks as the auxiliary mass were proposed, resulting in a significant reduction in the dimensions and weight of the device. The new physical design was then realized, and the mathematical descriptions of the TANES system were validated through experiments on a two‐story frame structure. Subsequently, a parameter design method was proposed to match the frequency variation pattern of the TANES with the given structural and load conditions. Following the design procedure, three TANESs with markedly different track shapes were obtained and compared with existing mass dampers under different types of excitations. Results showed that the frequency responses of the TANES systems subjected to harmonic ground excitations shared great similarity with those of a well‐tuned TMD system at small‐to‐moderate energy levels. As the energy level increased, nonlinear responses such as strongly modulated responses were observed in the TANES systems with decrease structural frequencies, which significantly reduced the resonant peak in the frequency responses. The frequency responses of the TANES systems were consistent with the design objective and could be used to quantitatively predict the robustness performance of the devices under impulsive and seismic excitations. With the reduced dimensions and weight resulting from the inverted‐track configuration and the robustness performance in line with common structural and load conditions, the proposed design strategy of TANESs demonstrated great potential in the seismic response mitigation of engineering structures.

Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia.

Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. We analysed questionnaires that had complete demographic data. Eighty-seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires.

In Situ Accumulation of CaOx Crystals in C. quitensis Leaves and Its Relationship with Anatomy and Gas Exchange

The accumulation of crystal calcium oxalate (CaOx) in plants is linked to a type of stress-induced photosynthesis termed ‘alarm photosynthesis’, serving as a carbon reservoir when carbon dioxide (CO2) exchange is constrained. Colobanthus quitensis is an extremophyte found from southern Mexico to Antarctica, which thrives in high-altitude Andean regions. Growing under common garden conditions, C. quitensis from different latitudinal provenances display significant variations in CaOx crystal accumulation. This raises the following questions: are these differences maintained under natural conditions? And is the CaOx accumulation related to mesophyll conductance (gm) and net photosynthesis (AN) performed in situ? It is hypothesized that in provenances with lower gm, C. quitensis will exhibit an increase in the use of CaOx crystals, resulting in reduced crystal leaf abundance. Plants from Central Chile (33°), Patagonia (51°), and Antarctica (62°) were measured in situ and sampled to determine gas exchange and CaOx crystal accumulation, respectively. Both AN and gm decrease towards higher latitudes, correlating with increases in leaf mass area and leaf density. The crystal accumulation decreases at higher latitudes, correlating positively with AN and gm. Thus, in provenances where environmental conditions induce more xeric traits, the CO2 availability for photosynthesis decreases, making the activation of alarm photosynthesis feasible as an internal source of CO2.

Clinical features and management of women with Mayer-Rokitansky-Küster-Hauser syndrome in a Thai population.

This study aimed to describe the clinical features, associated extragenital anomalies, and management of Mayer- Rokitansky-Küster-Hauser (MRKH) syndrome in a Thai population. This retrospective study analyzed the medical records of 96 patients with MRKH syndrome diagnosed and treated at a university hospital and tertiary referral center in southern Thailand between 2000 and 2022. The study included 96 patients with MRKH syndrome. The most common symptom was primary amenorrhea (88.5%), followed by difficulty or inability to engage in sexual intercourse (9.4%) and pelvic mass (2.1%). Notably, 80.3% of the patients did not have extragenital malformations and were diagnosed with MRKH type I (typical form), whereas 19.7% were categorized as MRKH type II (atypical form). Skeletal malformations were the most frequent extragenital anomalies and were present in 19.5% of patients, with scoliosis being the most common skeletal condition. Other extragenital malformations included renal (8.5%) and neurological (1.0%) abnormalities. Clinical vaginal examination revealed complete atresia in 21.8% and vaginal hypoplasia (median vaginal length, 3 cm) in 78.2% of the patients. Half of the patients did not receive treatment because they had not engaged in sexual intercourse. In this cohort, 41.7% of the patients had no difficulty performing sexual intercourse. Hence, self-dilation therapy or concomitant dilation was recommended. Only eight patients (8.3%) underwent surgical reconstruction of the vagina. This study confirmed the complexity and heterogeneity of the phenotypic manifestations of MRKH, including the degree of vaginal atresia and types and rates of associated malformations.

Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery.

Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management. Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated. Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended. There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education. Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.

Common mental health conditions and considerations in pediatric chronic kidney disease.

The mental health of youth with chronic kidney disease (CKD) has been increasingly recognized as an area of clinical need. The development of mental health concerns is influenced by a range of physiological, psychological, and environmental factors. Some of these factors are common across child development, but some are more unique to youth with CKD. Mental health concerns are associated with increased risk for a range of poor medical outcomes (e.g., adherence, risk of transplant rejection) and quality of life concerns. In this educational review, we discuss the current evidence base regarding the development of mental health concerns in youth with CKD. The review covers multiple domains including mood and anxiety disorders, traumatic stress, and neurodevelopmental disorders. Estimated prevalence and hypothesized risk factors are outlined, and the potential impact of mental health on medical care and functional outcomes are reviewed. Finally, we introduce options for intervention to support positive mental health and offer recommendations for building access to mental health care and improving the mental health education/training of medical professionals.

Research progress on acupuncture therapy for spastic hemiplegia after ischemic stroke

Spastic hemiplegia is a common clinical condition in patients with ischemic stroke, which has a significant impact on their motor function and quality of life. A large number of clinical studies have shown that acupuncture has significant advantages in treating spastic hemiplegia after stroke, and it is worth further promoting and applying in clinical practice due to its simple operation, high safety, and mild side effects. The commonly used clinical methods for acupuncture therapy of spastic hemiplegia after ischemic stroke include filiform needle therapy, electroacupuncture therapy, fire needle therapy, warm needle therapy, and other different acupuncture methods and acupoint selection methods, which can promote the recovery of limb motor function in patients. However, there is currently no clear international standardized treatment plan for acupuncture therapy. In the future, we should strengthen the rigor of clinical practice and research, and strive to contribute to the improvement of the quality of life of stroke patients.

IMPACT OF THE COVID-19 PANDEMIC ON BRUXISM AND THE DAILY LIFE OF CHILDREN AGED 7-10

Introduction: In 2020, the global pandemic of COVID-19 significantly affected our daily lives. The youngest students were most affected due to the establishment of distance education, which is associated with social isolation and increased screen time. Aim:To investigate the prevalence and specific risk factors for sleep bruxism associated with the COVID-19 pandemic in children aged 7-10 years, their eating habits and physical activity. Materials and methods: The object of the study are 267 children aged 7-10 years. The examined children underwent a clinical examination, during which the following were registered: dental status and attrition, oral hygiene and orthodontic status. Anamnestic data on nocturnal bruxism, physical activity, dietary habits, and screen exposure were obtained from 241 parents via a questionnaire. The results were statistically processed with SPSS-19. Results: The frequency of bruxism in children aged 7-10 is 21.4% (p<0.05). No increase in its frequency or intensity was found during the pandemic in the studied groups. The average increase in screen exposure during the pandemic was more than 60 minutes per day (p<0.05). In 1/4 of the children, physical activity during the pandemic decreased (p<0.05). In 21.6% of the examined children, the intake of simple carbohydrates increased (p<0.05). Conclusions: Bruxism is a common condition in school-aged children. The restrictive measures during the COVID-19 pandemic have led to a rise in some risk factors for bruxism oral and general health of children aged 7-10 years by increasing their screen exposure, consumption of simple carbohydrates and decreasing their physical activity.

Radiopaque marker colonic transit study in the pediatric population BSPGHAN Motility Working Group consensus statement.

Functional constipation (FC) is a common condition in childhood in the United Kingdom and worldwide. Various radiological approaches have been established for diagnostic purposes. The radiopaque marker study (ROMS) is universally accepted and used to assess colonic transit time (CTT) in children with FC. Despite being widely used, there is a lack of standardization with various technical protocols, reproducibility of different populations, the purpose for using investigation, variance in the number of markers used, the amount of study days and calculations, the need to empty the colon before performing the test, and whether to perform on medication or off, or the use of specific diets. As part of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) motility working group (MWG), we decided to explore further into the evidence, in order to provide guidance regarding the use of ROMS in dealing with FC in the pediatric population.

A pilot study on the efficacy of a seaweed mud application in the treatment of cellulite.

Cellulite represents a common multi-factorial condition that affects nearly all women and is now recognized as a clinical condition associated with systemic factors and negative psychological effects. Several noninvasive and minimally invasive treatments were developed during the last few years, but limited evidence supports many of them due to lack of evidence, insufficient participants, and potential adverse effects. This study aimed to evaluate the efficacy of a seaweed mud application in improving both the structure and function of tissues affected by cellulite. Sixty women with cellulite underwent 4-week applications of seaweed mud on the buttocks and thighs. The following assessments were performed at baseline and after the last treatment: photographic, clinical, and anthropometric evaluation; tests for elasticity and hydration; ultrasonography of cellulite nodules; and cellulite biopsies in the trochanteric region. Patient satisfaction was assessed using a 5-point Likert-scale questionnaire. The treatment resulted in a significant improvement in the severity of cellulite severity between the initial assessment and the 4-week follow-up, with enhanced structure, elasticity, and hydration of the affected tissues. Microscopic analysis of the cellulite biopsies revealed a significant restoration of dermal organization with induced collagen synthesis and reduced inflammation, edema, and lipid deposition following the 4-week seaweed mud applications. Additionally, the treatment led to a remarkable improvement in comfort and satisfaction as well as a reduction in body circumferences. The cosmetic application of seaweed mud has proven to be a safe, non-invasive treatment for improving the tissue alterations characteristic of cellulite.

Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa

IntroductionBetween 10 and 20% of children and adolescents globally experience common mental health conditions such as depression or anxiety. Given the dearth of mental health services in low- and middle-income countries, most mental health conditions among adolescents remain undiagnosed and untreated. In South Africa, few studies have explored the prevalence of depression and anxiety among young adolescents aged 10–14 years. This study examined the prevalence of, and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa. MethodsA cross-sectional study was conducted in 10 schools in the Western Cape Province from February to July 2022. Data were collected using a tablet-based survey and included sociodemographic items, the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire for Adolescents (PHQ-A) and other psychosocial measures. The prevalence of depression and anxiety was estimated based on cut-off scores for the GAD-7 and PHQ-A. Multivariable logistic regression models were used to investigate the associations between sociodemographic and psychosocial factors, and depression and anxiety. ResultsOf the 621 adolescents, 33.5% (n = 208) reported experiencing symptoms of depression and 20.9% (n = 130) symptoms of anxiety potentially indicative of a diagnosis. The results of the multivariable logistic regression model indicate that being in a higher grade in school (AOR = 1.65, CI:1.43–1.92), any lifetime alcohol use (AOR = 1.62, CI:1.04–2.64), other drug use (AOR = 2.07, CI:1.06–4.04), and witnessing violence among adults at home (AOR = 2.12, CI:1.07–1.41) were significantly associated with experiencing depressive symptoms. Being in a higher grade in school (AOR = 1.69, CI: 1.42–2.01), poor emotional regulation skills (AOR = 1.03, CI: 1.00–1.07), and the use of cannabis (AOR = 1.03, CI: 1.00–1.07) were significantly associated with experiencing anxiety symptoms. ConclusionThese findings add to our understanding of school-going adolescents' pressing mental health needs and suggest that mental health adolescent and caregiver interventions may be required to address mental health symptoms and associated risk factors.

Research Progress of Risk Factors Associated with Gestational Diabetes Mellitus.

Gestational Diabetes Mellitus (GDM) is a common endocrine condition associated with adverse pregnancy outcomes. In recent years, a growing number of risk factors associated with gestational diabetes mellitus have been defined. GDM poses a serious threat to maternal health. The etiology is complex and multifactorial and can be divided into inherent and modifiable factors. The inherent factors have been described in other literature, while the modifiable factors are mainly the risk of lifestyle habits. In this study, we performed a narrative review of the progress of risk factors associated with gestational diabetes mellitus.

Management of Acne in Pregnancy.

Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy.

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant. To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD. A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis. Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients. The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42. A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03). These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores. Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.

Adipocytokines as Predictors of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Development in Type 2 Diabetes Mellitus Patients.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver condition. Due to pathophysiological processes, MASLD's relation to type 2 diabetes mellitus (T2DM) is still unclear, especially when the role of adipocytokines is taken into consideration. This study aims to examine the potential predictive value of adiponectin and resistin for MASLD in T2DM. In a two-year study, 71 T2DM patients were categorized into MASLD-T2DM and non-MASLD-T2DM groups according to MASLD development. Serum samples were tested for resistin, adiponectin, high-density lipoprotein cholesterol, fasting glucose, and triglycerides. An appropriate equation is used to calculate the adiponectin/resistin (A/R) index. The optimal cut-off values for differentiating MASLD patients from non-MASLD patients were determined using receiver operating characteristic (ROC) curves and the corresponding areas under the curve (AUC). To predict the onset of MASLD in patients with T2DM, a logistic regression analysis was performed. There were significant differences in adiponectin (p<0.001), resistin (p<0.001), and A/R index (p<0.001) between T2DM individuals with and without MASLD. The ROC curve for resistin produced an AUC of 0.997 (p<0.001) with a sensitivity of 96.1% and a specificity of 100% for the cut-off point of 253.15. Adiponectin (OR, 0.054; 95% CI, 0.011-0.268; p<0.001) and resistin (OR, 1.745; 95% CI, 1.195-2,548; p=0.004) were found to be independent predictors for MASLD by logistic regression analysis. This study confirms the potential of adiponectin and resistin as predictors of MASLD development in T2DM.