Good Condition Research Articles

Alternative therapy for lymphoma with febrile neutropenia using traditional Chinese medicine: A case report

IntroductionFebrile neutropenia is a common complication in patients undergoing chemotherapy for hematologic malignancies and is associated with significant morbidity and mortality. Primary granulocyte colony-stimulating factor (G-CSF) prophylaxis is consistently associated with a notable reduction in the risk of febrile neutropenia. However, the use of G-CSF in patients who are already neutropenic from chemotherapy remains controversial. Studies have shown that 12.9% of cancer patients incorporate traditional Chinese medicine (TCM) to alleviate chemotherapy side effects in Taiwan; thereby providing an alternative management strategy for neutropenic fever in cancer patients. Case presentationThis is an 18-year-old female with newly diagnosed precursor T-lymphoblastic lymphoma. After chemotherapy, the patient developed febrile neutropenia. Despite the use of antibiotics and G-CSF, the febrile neutropenia persisted for two months. Approximately ten days after the initiation of traditional Chinese medicine decoction with the strategy of tonifying the spleen and stomach, clearing yin fire, and uplifting yang, her absolute neutrophil count (ANC) had gradually increased. Additionally, after two weeks of treatment, her fever subsided. The patient continued with chemotherapy and was discharged in stable condition. DiscussionAntibiotic use aligns with the TCM perspective of an “attack” approach. Conversely, our TCM decoction was designed to raise the ANC by tonifying the spleen and stomach, clearing Yin Fire, and uplifting Yang. Li Dongyuan, one of the four great masters of the Jin Yuan Dynasty, created the formula: Bupiwei Shengyang Sanhuo Decoction that is notable in this regard. The herbs in our decoction have shown hematopoietic and myelosuppression-alleviating effect. For many patients who do not respond adequately to G-CSF alone, integrative treatments involving both TCM and Western medicine can offer additional therapeutic benefits by increasing blood cell counts.

A Model-Based Reinforcement Learning Algorithm for Multi-Agent Cooperation Nash Equilibrium With Unstable Communication

Solving Nash equilibrium is important to multi-agent systems, in which the communication is an important factor. However, many proposed reinforcement learning (RL) based algorithms take into account the communication factors by assuming stable communication conditions, which does not hold in the real environment. In this paper, we analyze the effect of a typical RL algorithm in the cases of unstable communication and communication failure, which causes information loss between agents, leading to isolation of agents and affecting algorithm convergence. Then, we propose a model-based RL algorithm to solve Nash equilibrium for multi-agent systems when agents are isolated, and prove its convergence and rationality through mathematical proofs. The simulations results show the effectiveness of the proposed algorithm.

Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey.

Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown. This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care. In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan. The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected. Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption.

Sustainability index and a bibliometric of photovoltaic thermal with rectangular channel

The main challenge associated with solar panels is the need to reduce excessive heat and optimize efficiency to achieve stable conditions. Therefore, a combination of collector and cooling technologies, such as Photovoltaic Thermal (PVT) Technology, is needed to address this problem. This research used water-based rectangular channel to cool the PVT through the Ansys simulation method. A total of nine variations of mass flow rates, which ranged from 0.001 to 0.009 kg/s and six solar intensities between 500 W/m2 and 1000 W/m2 were used to achieve the optimal performance. An energetic analytical method with average Sustainability Index (SI) of 0.001-0.009 kg/s and 1.186 at 1000 W/m2 intensity were incorporated. Furthermore, the maximum average Waste Exergy Rasio (WER) value of 0.854 at a 500 W/m2 intensity was used to determine the flow rate. The highest average Exergetic Ecological Index (EcEI) value recorded was -0.687 at a 1000 W/m2 radiation intensity, while the highest average Improvement Potential (IP) value was 421.145 W. The results showed that the simulation serve as a valuable point of reference in the design and advancement of water-based rectangular channel within future PVT technology.

Effect of pre-strain on hydrogen-induced delayed cracking and hydrogen trapping behavior in high-strength martensitic steels

Pre-strain is a key factor affecting the critical conditions for hydrogen-induced delayed cracking (HIDC). In this study, the threshold stress and critical hydrogen concentration for HIDC of MS1300 and MS1500 steels with different pre-strains were measured by constant load tensile (CLT) tests. The results demonstrated that although MS1500 has higher strength, its safe service strength is lower than that of MS1300 when the hydrogen content exceeds 0.5 wppm. Additionally, the hydrogen penetration, thermal desorption spectroscopy, and hydrogen microprinting methods were also used to analyze the hydrogen-induced failure mechanism. These studies provide an effective data reference for improving the industrial production process.

Environmental and Behavioral Determinants of Septicemia Mortality in Türkiye: A Ten-Year Analysis

This study examines the environmental and behavioral factors associated with variations in septicemia mortality rates across Turkish provinces. Province-level data spanning ten years were analyzed using ordinal logistic regression modeling to determine the predictors of septicemia mortality. Environmental factors such as humidity, temperature, and air pollutants, along with behavioral aspects including alcohol consumption, were evaluated. Analysis of the provided data revealed significant regional variations in septicemia mortality rates across areas with diverse environmental and social characteristics. Higher median humidity and stable environmental conditions (low variability in humidity and temperature) correlated with reduced mortality rates. Alcohol consumption was identified as a risk factor, moderately increasing the risk of septicemia mortality. The findings highlight the intricate relationship between environmental stability, personal behaviors, and septicemia outcomes. The study accentuates the need for targeted public health strategies and suggests that mitigating environmental risks and fostering healthy behaviors could effectively reduce septicemia mortality. Further studies should focus on individual-level data and explore the relationship between these factors in different climatic conditions.

Cost management analysis of Objective Structured Clinical Examination (OSCE): guide to the universities of medical sciences

BackgroundThe Objective Structured Clinical Examination (OSCE) is a crucial assessment tool for evaluating learners’ ability to apply theoretical knowledge in practical clinical situations. It is widely accepted by both students and educators, and the costs associated with conducting OSCE assessments vary depending on the field of study, how it is implemented, staffing needs, standardized patients, and duration of the examination. This study examines the expenses related to administering OSCEs in medical universities.MethodConducted from June to September 2023; this mixed-method study elucidated the cost intricacies of executing a two-day OSCE with 14 eight-minute stations for 100 nursing students. This process unfolds in two phases: a qualitative segment comprising text reviews and 45-minute in-depth interviews with faculty members and OSCE experts, leading to the development of a validated checklist, followed by a quantitative phase in which the tool was distributed to 25 faculty members and 5 specialists for completion.ResultThe examination costs were delineated into three primary components: time, human resources, equipment, consumables, and necessary supplies. In 2023, the total implementation cost of the OSCE for 100 students across 14 clinical stations was $1028.07, with an estimated per-learner cost of $37.50. Human resources incurred the highest expenditure ($1649.37); while supply costs were relatively lower ($1072.17). Educational infrastructure expenses were excluded because the study focused on the Nursing and Midwifery Faculty’s Clinical Skills Center.ConclusionVarious factors influence OSCE costs, including national production capabilities of medical supplies, institutional credibility, governance status, examination frequency, student demographics, assessor composition, station count, course content, and examinee volume. The insights derived from this comprehensive examination are significant as entry benchmarks for healthcare systems and higher-level academic evaluations. Understanding OSCE cost dynamics facilitates resource optimization and assessment strategy refinement, thereby improving medical education efficacy.

Effect of Oral Bisphosphonates on Vertebral Fractures in Males Living with HIV: A Seven Year Study

Background: Osteoporosis and vertebral fractures (VFs) are frequently observed in males living with HIV (MLWH). While bisphosphonates seem effective on bone mineral density (BMD) in MLWH, data on VFs are lacking. In this real-life longitudinal study performed on 118 MLWH (median age 53) who were followed-up for a median of 7 years, we aimed to evaluate the long-term efficacy of oral bisphosphonates on VFs in MLWH. Methods: The inclusion criteria were age >18, stable HIV infection, bisphosphonate-naïve, blood samples from the same laboratory, and three densitometries and morphometries performed with the same densitometer. Results: At baseline, VFs were detected in 29/118 patients (24.6%). Patients with VFs were older (p. 0.042), had longer HIV infection duration (p. 0.046) and antiretroviral exposure (p. 0.025), and demonstrated higher luteinizing hormone levels (LH, p. 0.044). Of the 29 patients with VFs at inclusion, 11 developed new VFs, of which 8 were under oral bisphosphonates (p. 0.018). Among the 89 without basal VFs, 11 developed VFs, of which 2 were under oral bisphosphonates. Patients with a worsened bone condition (regarding BMD and/or new VFs, n. 32) had more frequently high LH levels (>9.4 mIU/mL, p. 0.046) and higher HCV co-infection compared to patients with a stable bone condition (p. 0.045). It should be noted that 38.6% of patients discontinued oral bisphosphonates due to medical indication or personal choice, and 14.0% never started them. Conclusions: In conclusion, we found that oral bisphosphonates were not completely effective in preventing VFs, especially in patients with VFs at baseline; this is probably due to the multifactorial pathogenesis of fragility fractures in this population. A poor adherence to treatment and attention to gonadal function are also important issues in this population.

Urban Cemeteries as Biodiversity Refuges: A Comparative Study of Plant Ecobiomorphs in Central Kazakhstan

Cemeteries are often overlooked in ecological studies, yet they represent unique urban microhabitats that contribute to the preservation of diverse plant species, including those adapted to various ecological niches. This study aimed to assess the species composition, ecological classifications, and abundance of vascular plants in the cemetery and surrounding areas to explore cemeteries’ role in conserving plant ecobiomorph diversity in arid climates. This study identified 79 plant species from 23 families within the cemetery compared with 31 species from 11 families in the surrounding area. The plant community in the cemetery was dominated by mesophytes, suggesting favorable and stable conditions for plant growth, while xerophytes were more common in the surrounding areas, indicating harsher, drier conditions. The diversity of plant life forms, including perennial herbs, shrubs, and trees, was significantly higher within the cemetery, indicating a more complex and resilient ecosystem. Our study demonstrates that cemeteries act as vital refuges for plant biodiversity. They offer significantly higher species diversity and more complex ecosystem structures compared with the surrounding areas. These findings emphasize the critical role cemeteries play in urban biodiversity conservation, particularly in increasingly arid environments.

Astragaloside IV Inhibits the Pyroptosis in the Acute Kidney Injury through Targeting the SIRT1/FOXO3a Axis.

Acute kidney injury (AKI) is a commonly encountered critical condition in clinical settings, often resulting from sepsis, infections or ischemia. Astragaloside IV (AS-IV) is the primary active component of Astragalus. The functions of Astragalus are mainly related to AS-IV, showing remarkable therapeutic effects in anti-inflammatory, antioxidant, immune-enhancing, and anti-tumor aspects. This study aimed to explore the role of AS-IV in AKI development. Lipopolysaccharide (LPS) was used to stimulate the HK-2 cells and rats to establish the AKI model in vivo and in vitro. After AS-IV treatment, the cell viability, pyroptosis rate, lactate dehydrogenase (LDH) activity, interleukin (IL)-18 and IL-1β contents, and cleaved-caspase-1, GSDMD-N, SIRT, FOXO3a protein levels were detected. Caspase-1 levels were analyzed by immunofluorescence staining. Additionallly, the acetylation levels of FOXO3a were detected by immunoprecipitation and Western blot assays. AS-IV treatment promoted the cell viability, and inhibited the pyroptosis, LDH activity, caspase-1 levels in the LPS stimulated HK-2 cells. AS-IV treatment decreased the IL-18 and IL-1β contents, cleaved-caspase-1 and GSDMD-N protein levels in both LPS stimulated HK-2 cells and rats. Furthermore, after EX527 treatment, a Sirtuin 1 (SIRT1) inhibitor, the role of AS-IV in the LPS stimulated HK-2 cells were reversed. AS-IV treatment increased the protein levels and decreased the acetylation levels of FOXO3a, which was reversed after EX527 treatment. Co-immunoprecipitation (CO-IP) assay and immunofluorescence staining confirmed that SIRT1 interacted with FOXO3a. In conclusion, this research demonstrated that AS-IV treatment inhibited the pyroptosis occurrence in LPS stimulated HK-2 cells and rats. This may be related to the SIRT1 mediated deacetylation of FOXO3a.

Formulation and evaluation of herbal shampoo

The main objective of these study is to evaluate and formulate herbal shampoo. Shampoo are one of the cosmetic products used in daily life. Synthetic preservatives and detergents have sometimes been the cause of adverse effects among consumers. A more radical approach in reducing the synthetic ingredients is by incorporating natural ingredients whose functionality is comparable with their synthetic ingredients. The ingredients used in formulation of Herbal Shampoo are Ficus Religiosa leaves (Powder), Hibiscus Leaves (Powder), Reetha (Powder), Shikakai (Powder), Aloevera, then prepared by mixing with each other and evaluated for its organoleptic and physio-chemical characteristics and performance tests in terms of wetting time test, pH, solid contents, surface tension, dirt dispersion, foam Stability, and Viscosity was performed. The combination of several such ingredient of herbal origin has made it possible to secure highly effective dry powder shampoo. The formulation at laboratory scale was done and evaluated for number of parameters to ensure its safety and efficacy The Formulated Herbal Shampoo was clear and good appealing. It demonstrated good froth stability, detergency, good cleansing, small bubble size, low surface strain, and execution of good conditioning property. The physicochemical evaluation of the formulated shampoo showed ideal results. However, to improve its quality, product performance, and safety, further development was required.

Challenges of high-fidelity air quality modeling in urban environments – PALM sensitivity study during stable conditions

Abstract. Urban air quality is an important part of human well-being, and its detailed and precise modeling is important for efficient urban planning. In this study the potential sources of errors in large eddy simulation (LES) runs of the PALM model in stable conditions for a high-traffic residential area in Prague, Czech Republic, with a focus on street canyon ventilation, are investigated. The evaluation of the PALM model simulations against observations obtained during a dedicated campaign revealed unrealistically high concentrations of modeled air pollutants for a short period during a winter inversion episode. To identify potential reasons, the sensitivities of the model to changes in meteorological boundary conditions and adjustments of model parameters were tested. The model adaptations included adding the anthropogenic heat from cars, setting a bottom limit of the subgrid-scale turbulent kinetic energy (TKE), adjusting the profiles of parameters of the synthetic turbulence generator in PALM, and limiting the model time step. The study confirmed the crucial role of the correct meteorological boundary conditions for realistic air quality modeling during stable conditions. Besides this, the studied adjustments of the model parameters proved to have a significant impact in these stable conditions, resulting in a decrease in concentration overestimation in the range 30 %–66 % while exhibiting a negligible influence on model results during the rest of the episode. This suggested that the inclusion or improvement of these processes in PALM is desirable despite their negligible impact in most other conditions. Moreover, the time step limitation test revealed numerical inaccuracies caused by discretization errors which occurred during such extremely stable conditions.

Examining the Stability of Public Opinion in an Era of Polarization: A Review of Stable Condition

Examining the Stability of Public Opinion in an Era of Polarization: A Review of <i>Stable Condition</i>

Hemodynamic monitoring- (NOT) anursing task?!

Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.

Analysis of groundwater and surface water quality using modelled water index and multivariate statistics in Kampala and Mbarara Districts, Uganda

The demand for domestic, public and industrial use of water increases with population growth. However, activities from humans and natural environment have resulted into decline in water quality. The aim of this study was to evaluate the quality of groundwater and surface water collected from Kampala and Mbarara districts of Uganda using water quality index and multivariate statistics. A total of 10 physicochemical parameters (pH, water temperature, chloride, sulphate, nitrate, electrical conductivity, total dissolved solids, total suspended solids, total solids, and phosphate) were measured monthly to evaluate the quality of water in the study districts. Results showed that sulphate, electrical conductivity and total dissolved solids were observed with significantly high values in surface water than the groundwater for both seasons. Among all the parameters measured, electrical conductivity was observed with the highest value (2129.67 ± 1.41 µS/cm) while nitrate concentration (0.57 ± 0.02 mg/L) was observed with the lowest during the wet season in surface water. In addition, the mean values of nitrate, electrical conductivity, total dissolved solids and sulphate detected in the groundwater and surface water were within the recommended limits, while phosphate and chloride were observed with mean concentrations above the regulatory limits in 50% of the samples. The correlation analysis revealed strong and positive association between electrical conductivity and total dissolved solids in groundwater and surface water for both seasons. Also, the chemical make-up of groundwater and surface water within the study districts revealed that the determination of water quality rests on two major indices (conductivity and anthropogenic-pollutants) based on the factor analysis. The two indices accounted for 0.619% in groundwater and over 0.70% in surface water, indicating more pollution in surface water. Moreover, the water quality index (WQI) values obtained ranged from 14.81 to 115.73 in dry season and 7.77 to 108.24 during the wet season. According to WQI classification, 42% of the samples collected fell within the “excellent” and “good” categories while others fell within “poor” and “unfit” categories (58%) during the dry season. Based on these findings, appropriate treatment methods, proper sanitation and waste management should be implemented in locations with critical water conditions. Also, frequent monitoring of groundwater and surface water quality by environmental protection agency is highly recommended.

Transforming Subdural Hematoma Treatment in the Elderly: Insights from an Endoscopic Case Series.

Subdural hematoma (SDH), a critical brain condition, significantly affects the elderly, making traditional surgeries risky due to their length and potential for blood loss. Endoscope-assisted evacuation offers a safer, less invasive alternative by reducing operation time and minimizing damage, providing an effective solution for older patients. This study evaluated six patients treated with endoscopic evacuation for different stages of SDH from August 2019 to July 2023. Selection criteria were based on altered consciousness, lack of severe brain contusion, SDH thickness over 1 cm, or midline shift over 0.5 cm. The technique used a burr hole and rigid lens endoscope for hematoma removal, focusing on shorter surgery times and better outcomes. Patients aged between 63 to 84 years showed no surgical fatalities, with all recovering well by discharge. Hematoma clearance rates were 76.9% at three days, improving to 96.8% after one month. Endoscope-assisted evacuation is a safe, efficient treatment for elderly patients with various stages of SDH, offering a less invasive option with potential for better outcomes. It supports the trend towards minimally invasive neurosurgery, with further research needed to optimize patient selection and understand long-term benefits.

Numerical Verification of a Polarization-Insensitive Electrically Tunable Far Infrared Band-Stop Meta-Surface Filter

Tunable filters have many potential applications in diverse fields, including high-capacity communications, dynamic beam shaping and spectral imaging. Although providing a high-performance solution for actively tunable devices, metasurface combined with tunable materials faces the great challenges of limited tuning range and modulation depth. Here, we propose a far-infrared tunable band-stop filter based on Fabry-Perot (FP) resonators and graphene surface plasmons. By switching the wavelength of the critical coupling condition of the filter via the gate voltage applied on graphene, achieving the dynamically tunable band-stop filtering at the central wavelengths from 12.4 μm to 14.1 μm with a modulation depth of more than 99%. Due to the symmetry of the proposed meta-atoms, the filter is insensitive to the polarization direction of the incident light. And it can realize more than 85% filtering efficiency within 60° angle of incidence around the vertical direction. By adjusting the geometry of the meta-atoms structure, it is feasible to move the operational range from the near-infrared to terahertz bands.

Acute Kidney Injury in Children: Classification, Recognition and Treatment Principles

Acute kidney injury (AKI) in children is a critical medical condition characterized by a sudden decline in kidney function. This article provides a comprehensive overview of AKI in pediatric populations, exploring its pathophysiology, the role of various drugs and the long-term implications for kidney health. Key topics include oliguria, anuria, urine output, hypervolemia and the interactions among them, as well as role of diuretic nephrotoxicity and the glomerular filtration rate. Concepts of electrolytes, acid–base balance and renal perfusion assessment are presented. Basic principles of intensive care unit (ICU) management, renal replacement therapy and the association with multiorgan failure are described. Additionally, the article discusses the potential long-term outcomes of AKI, including the risk of chronic kidney disease, hypertension and proteinuria.

Development of a core outcome set for neonatal septic shock management: a study protocol

BackgroundNeonatal septic shock represents a critical and life-threatening condition that necessitates immediate and personalized interventions. Prior research endeavors have been undertaken to inform the optimization of neonatal septic shock management, yet substantial heterogeneity prevails in the selection, measurement, and reporting of outcomes across relevant studies. The heterogeneity in outcome selections and measures impedes the comparability of results and the synthesis of evidence, thus contributing to suboptimal utilization of research findings. This protocol presents the methodology for identifying and developing a Core Outcome Set for Neonatal Septic Shock Management (COS-NSS), intended for use in both research and routine clinical practice.A rigorous four-stage approach will be employed to develop the COS-NSS. In Stage 1, a scoping review will be conducted to compile a list of currently reported outcomes for neonatal septic shock management. Stage 2 will involve an expert stakeholder meeting using a semi-structured discussion approach to elucidate all identified outcomes and outcome domains, as well as to gather any additional outcomes. Moving to Stage 3, a two-round e-Delphi survey involving a wide variety of stakeholders will be undertaken to elicit diverse perspectives on the level of importance assigned to each proposed outcome. Finally, in Stage 4, the results of the Delphi study will be discussed in a consensus meeting to determine and agree on the final list of outcomes that will constitute the COS-NSS.DiscussionThe stagewise approach integrates research evidence with multi-stakeholder perspectives to establish standardized outcomes that would improve consistency across neonatal septic shock trials. The development and uptake of the COS-NSS will facilitate effective comparison of studies, allowing for study synthesis and generation of high-quality evidence, thus ultimately fostering enhanced medical care for neonates suffering from septic shock.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: 2766. Registered on July 19th, 2023.

Post Mortem Molecular Biomarkers of Asphyxia: A Literature Review

Asphyxia is a critical condition characterized by inadequate oxygen supply to the body. Post mortem diagnostics of asphyxia present significant challenges in forensic pathology, particularly when there are equivocal signs during autopsy or uncertain circumstantial data. The identification of biochemical biomarkers that indicate asphyxia has emerged as a promising area of research, as these markers can provide vital insights into the physiological changes occurring at the cellular level during asphyxiation. We performed a review of the scientific literature on the search engines Pubmed and Scopus in order to assess the state of the art on this topic. The aim of this study is to analyze which are the most promising markers and methods in the post mortem diagnosis of asphyxia. The literature review highlighted the great potential that molecular investigations can have in the analysis of this type of death, especially considering that hypoxia determines strong biochemical alterations in response to cellular stress. These changes are marked by specific biochemical alterations, which can be detected through various advanced technologies and methodologies, including mass spectrometry, immunohistochemistry, and metabolomic profiling. The review evidenced a combination of markers that can be used for diagnostic purposes in various cases, including mechanical asphyxia, carbon monoxide (CO) poisoning, perinatal asphyxia, and drowning analysis. However, we highlight that, to date, there are still no standard protocols for forensic biochemistry in asphyxia. By scrutinizing the reliability of identified biomarkers and their potential to reshape forensic investigative practices, this research aims to elucidate the critical role that post mortem biochemical analysis can play in diagnosing asphyxia, ultimately contributing to a more nuanced understanding of death-related scenarios and the development of standardized protocols in forensic examinations.