LC Group Research Articles

PurposeThis study aimed to explore factors affecting adherence to remote home-based pulmonary rehabilitation (PR) in patients with stable chronic obstructive pulmonary disease (COPD) and to develop a predictive model.Patients and MethodsThis multicenter, cross-sectional survey study included 86 patients who underwent 12 weeks of health education-integrated, home-based PR with remote monitoring. Patients were stratified into high-completion (HC, ≥ 70%) and low-completion (LC, < 70%) groups. Demographic data, clinical features, and psychological parameters were analyzed. Receiver operating characteristic curve and area under the curve (AUC) analyses evaluated the predictive performance of key indicators. Binary logistic regression identified four predictors: Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE), Outcome Expectations for Exercise Scale (OEE), Montreal Cognitive Assessment (MoCA), and Visual Analog Scale (VAS). These components formed an optimized predictive model with corresponding formula and cutoff values.ResultsA cross-sectional survey of 71 patients, 44 in the HC group and 27 in the LC group, revealed significantly higher scores in the HC group in the following domains of the 36-Item Short Form Health Survey (SF-36), including physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, mental health, and social functioning, as well as in the MoCA scores (all p-values < 0.05). Significant intergroup differences were also observed in PRAISE, OEE and VAS scores (all p < 0.001). PRAISE (AUC = 0.810), OEE (AUC = 0.784), MoCA (AUC = 0.719), and VAS (AUC = 0.801) demonstrated discriminatory power in assessing PR adherence. The combined predictive model achieved an AUC of 0.895 (95% confidence interval: 0.812–0.977, p < 0.05), with 77.8% sensitivity and 93.2% specificity.ConclusionSocial cognitive theory (SCT) originated from social learning theory. It explains human behavior through a triadic, dynamic, and reciprocal model. This model posits continuous interaction among an individual’s behavior, cognitive factors, and environmental context. The four-variable predictive model, based on SCT, effectively evaluates adherence to home-based PR under remote monitoring in patients with COPD. Among the indicators in the four-variable model, PRAISE shows potential as a target for intervention to enhance PR completion rates.

The aim of this study was to evaluate the crosslinguistic validity of the Crosslinguistic Nonword Repetition Test (CL-NWR) based on a large multicountry sample by investigating factors related to language ability, as well as potential confounds. The data consisted of CL-NWR scores from children aged 37-165 months, collected by 18 research teams across 15 countries. Item-level analysis was employed to examine any nondesirable effects of gender, socioeconomic status, bilingual status, and the amount of exposure to the test language, as well as desirable effects of age, item length, and clinical status (children categorized as typically developing [TD], with developmental language disorder [DLD], or with reported language concerns [LC], respectively). Subsamples were used to evaluate the consistency of findings across three time points and between different versions of the CL-NWR. Bayesian analysis provided strong evidence for the effects of age, item length, and clinical status on CL-NWR performance, as well as consistency across time points. In contrast, there was weak or no evidence for the effects of gender, socioeconomic status, bilingual status, amount of exposure, or test version. Additionally, there were two interactions between (a) item length and clinical status, suggesting that children with DLD found longer nonwords disproportionately more challenging than TD children, and (b) age and clinical status, with the gap between TD and LC groups narrowing with age. The CL-NWR was unaffected by environmental and demographic factors that often influence language assessments, including some nonword repetition tests. Performance was driven by factors reflecting language abilities. This makes the CL-NWR a unique and valuable tool for language assessment contributing to the identification of DLD in diverse linguistic, social, and geographical contexts.

Deciphering the enzymatic responses, composition, network complexity, and functional degraders of the marine sediment bacterial community in response to 2-methyl-4-isothiazoline-3-one exposure.

While much of the focus on long COVID (LC; defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) has been on health status and quality of life, the impact on individual work productivity and financial distress are less well established. To assess differences in work and financial outcomes among individuals with current, resolved, and no LC up to 3 years after initial infection. This prospective, multisite, longitudinal cohort study enrolled adult participants (age ≥18 years) with at least 1 reported SARS-CoV-2 infection from December 7, 2020, to August 29, 2022. Follow-up electronic surveys were collected through April 2, 2024. Data were analyzed from January 20 to February 4, 2025. Self-reported resolved or current LC and vaccination status. Financial toxicity was measured using Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (FACIT-COST), and work impact was measured using the Work Productivity & Activity Impairment questionnaire (version 2.0). Of 3663 participants (mean [SD] age, 40.2 [14.2] years; 2429 [66.3%] female), 994 (27.1%) reported current LC, 2604 (71.1%) never had LC, and 65 (1.8%) had resolved LC. Participants with current LC reported more overall work impairment due to health (mean [SD], 17.7% [25.3%] of total hours worked per week) compared with those who never had LC (mean [SD], 3.2% [11.8%] of total hours) and resolved LC (mean [SD], 5.6% [12.2%] of total hours), with significantly increased odds of any work impairment compared with those who never had LC (adjusted odds ratio [aOR], 7.24; 95% CI, 5.68-9.21). The current LC group had increased odds of missing work due to their health (aOR, 2.62; 95% CI, 1.93-3.57) and of experiencing work impairment (aOR, 11.82; 95% CI, 8.90-15.70) compared with the group who never had LC. Individuals with current LC had increased odds of having moderate to high FACIT-COST scores compared with those who never had LC (aOR, 5.20; 95% CI, 3.92-6.89) and compared with those with resolved LC (aOR, 3.16; 95% CI, 1.19-8.41). Participants who were vaccinated had lower overall work impairment (aOR, 0.71; 95% CI, 0.55-0.92), impairment while working (aOR, 0.66; 95% CI, 0.50-0.87), impairment of nonwork activities (aOR, 0.74; 95% CI, 0.57-0.96), and financial toxicity (least-squares mean difference, 1.07; 95% CI, 0.19-1.95) compared with those who were not vaccinated. In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported LC reported worse work impairment, missed work, and financial distress compared with those who never had LC, while vaccination was associated with improved work outcomes and less financial distress even among individuals with LC. These data underscore the need for postpandemic assistance programs, as well as vaccination to decrease societal harms.

The aim of this study was to examine the effects of supplementing Guizhou black goats with Houttuynia cordata extract (HCE) during summer on growth performance, anti-inflammatory activity, and rumen fermentation parameters. A completely randomized single-factor experimental design was employed. Twenty-four healthy Guizhou black goats, with similar body weights (16.03 ± 0.79 kg), were randomly divided into three groups, with eight replicates per group and one goat per replicate. The control group (CON) was fed a basal diet, the LC and HC groups received the basal diet supplemented with 500 mg/kg and 1,000 mg/kg of HCE, respectively. The ADG in the HC group was significantly higher (p < 0.05) than that in the CON group. The digestibility of DM in both the LC and HC groups was significantly higher (p < 0.05) than in the CON group. Additionally, the digestibility of CP, GE, and NDF in the HC group was significantly higher (p < 0.05) than in the CON group. GSH-Px levels in both the LC and HC groups were significantly higher (p < 0.05) than in the CON group. T-AOC in the HC group was also significantly higher (p < 0.05) than in the CON group. MDA levels in the HC group were significantly lower (p < 0.05) than in both the LC and CON groups (p < 0.05). The TP content in the HC group was significantly higher (p < 0.05) than in the CON group. IgA levels in both the LC and HC groups were significantly higher (p < 0.05) than in the CON group. The levels of IL-6 and IL-8 in the HC group were significantly lower (p < 0.05) than in the LC and CON groups. Interestingly, the IL-10 level in the HC group was significantly higher (p < 0.05) than in the LC and CON groups. The TNF-α level in the HC group was significantly lower (p < 0.05) than in the CON group. The HCE had no significant (p > 0.05) effect on rumen pH, NH3-N, and VFAs. In conclusion, a high dose of HCE improved growth performance, apparent nutrient digestibility, and enhanced antioxidant, immune, and anti-inflammatory responses in goats.

BackgroundChronic hepatitis B (CHB) is a major health problem worldwide and is a major contributor to the progression of cirrhosis and hepatocellular carcinoma (HCC). Accurate monitoring of the immune response and liver inflammation in CHB patients is critical for effective disease management. N6-methyladenosine (m6A) plays a pivotal role in viral replication and immune modulation. However, the clinical significance of m6A regulators in the host immune system during CHB is still unclear. This study investigated the expression of key m6A regulators (METTL3, METTL14, IGF2BP3, and ALKBH5) in peripheral blood mononuclear cells (PBMCs) from CHB patients to explore their potential as noninvasive biomarkers for CHB diagnosis.MethodsA total of 119 participants were recruited, among which 101 were CHB patients and 18 were healthy controls. PBMCs were isolated, and the mRNA expression levels of four key m6A regulators were analysed via quantitative real-time PCR (qRT‒PCR). Spearman correlation analysis was used to investigate the relationships between m6A regulator expression and inflammatory markers. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CHB.ResultsThe mRNA expression levels of METTL3 decreased in the LC, CHB (no-LC) (CHB without LC) and HC (healthy control) groups, and the differences were statistically significant (P < 0.05). METTL14 demonstrated a comparable expression pattern, although significant differences were evident only between the LC and HC groups (P < 0.05). ALKBH5 and IGF2BP3 levels were lower in LC patients than in CHB patients (non-LC patients) (P < 0.05). Moreover, METTL3 and METTL14 were negatively correlated with inflammation and cirrhosis markers, such as the neutrophil‒lymphocyte ratio (NLR) and the platelet‒lymphocyte ratio (PLR), but positively correlated with the lymphocyte‒monocyte ratio (LMR) (P < 0.05). Univariate analysis identified METTL3, PLR and AST as significant predictors of CHB. Multivariate logistic regression confirmed that reduced METTL3 expression, PLR and AST were independent risk factors for CHB progression (P < 0.05).ConclusionThese findings suggest that m6A regulators, particularly METTL3, are associated with CHB progression and immune response modulation. METTL3, in combination with other inflammatory markers, is a promising non-invasive biomarker for monitoring CHB disease activity, providing new insights into HBV-related disease progression and potential therapeutic targets.

The aim of this study was to evaluate the effect of vitamin C on reducing cardiovascular oxidative stress in sepsis rat models. An experimental animal study with a post-test control group design was conducted at the Laboratory of Animal Research, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia, from September to December 2023, using 18 male Wistar strain rats (Rattus norvegicus). Rats were divided into three groups: control (Group K), lipopolysaccharide 5 mg/kg body weight (BW) (Group L), and lipopolysaccharide 5 mg/kg BW with oral vitamin C (18 mg/day) (Group LC). Rats were euthanized after two weeks with ketamine (15–20 mg/kg intraperitoneally) and cervical dislocation. Blood samples (3 mL) and heart organs were collected. Nitric oxide (NO) levels were measured through enzyme-linked immunosorbent assay (ELISA), and cardiac muscle cells were observed using an Olympus CX21 microscope. The LC group exhibited a significantly lower mean endothelial dysfunction score than the L group (p&lt;0.001), although no significant difference in NO levels was observed between L and LC groups (p=0.262), indicating that vitamin C did not significantly affect NO levels. This suggests that the improvement in endothelial function observed in the LC group may be mediated through mechanisms other than NO modulation. The MANOVA test revealed that vitamin C administration accounted for 84.8% of changes in endothelial function in the sepsis rat model (p&lt;0.001). In conclusion, vitamin C confers a protective effect against severe cardiac and endothelial damage, as evidenced by the amelioration of necrosis, inflammatory cell infiltration, congestion, and vacuolization caused by lipopolysaccharide.

8061 Background: Patients with established interstitial lung disease (ILD) have both increased risk of developing non-small cell lung cancer (NSCLC) and higher mortality than patients without a history of ILD. We hypothesized the mutational landscape of NSCLC arising in the setting of ILD would be different than sporadic or smoking-associated cancers, potentially leading to different treatment options given the question of safety of immune checkpoint inhibitors (ICIs) in this population. Methods: We retrospectively identified 330 patients with NSCLC, of which 77 patients had pre-existing diagnoses of ILD with probable or definite usual-interstitial pattern made by radiographic or biopsy findings for comparison to randomly selected patients with NSCLC without clinically apparent ILD. Clinical characteristics, histologic information, mutational data, and treatment regimens were collected using the Stanford Research Repository and compared between patients with NSCLC and established ILD (LC-ILD) and NSCLC without ILD (LC). Statistical comparisons between groups were done with Mann-Whitney testing with significance set at p&lt;0.05. Results: Baseline characteristics including age, sex, race, ethnicity, smoking status, NSCLC type, and NSCLC stage at diagnosis did not differ between the LC-IPF and LC groups. There was significantly lower prevalence of EGFR mutations in the LC-IPF group (33.0% vs 3.0%, p&lt;0.0001) and significantly higher prevalence of KRAS G12D mutations (19.0% vs 41.7%, p=0.05). Baseline tumor proportion score (TPS) between LC and LC-ILD groups was not significantly different (28.2% vs 16.3%, p=0.063) however there were significantly fewer patients with high PD-L1 expression (TPS ≥ 50%) in the LC-ILD group (32.0% vs 16.7%, p=0.036). Occurrence of clinically significant treatment-related pneumonitis occurred in 15 patients in the LC-ILD group with etiologies identified as radiation (n=8, N=20, 40.0%), surgery (n=1, N=40, 2.5%), osimertinib (n=1, N=1, 100%), pembrolizumab (n=2, N=5, 40.0%), docetaxel (n=2, N=4, 50.0%, and pemetrexed (n=1, N=19, 5.7%). Conclusions: These retrospective data highlight the differences in driver mutations in NSCLC in patients with preceding fibrotic lung disease, suggesting potentially divergent biologic underpinnings for tumorigenesis. These results, particularly the under-representation of EGFR -mutations, over-representation of KRAS G12D mutations, and scarcity of therapeutically actionable mutations in the LC-ILD population, lead to limited therapeutic options. Surgically-associated pneumonitis was rare, but radiation, docetaxel, and pembrolizumab appeared high risk for pneumonitis in treated patients, suggesting need careful consideration of risks when treating this unique population.

Effects of yeast β-glucan on fermentation parameters, microbial community structure, and rumen epithelial cell function in high-concentrate-induced yak rumen acidosis in vitro.

A significant factor contributing to reproductive failure in dairy cattle that raised the possibility of culling was ovarian cysts. Its etiology and pathogenesis remained a puzzle, but investigation of the associated tissue modulation, particularly those of the ovaries, oviduct, and uterus, might shed some light on its development. Therefore, the current study aimed to assess changes induced by follicular and luteal cyst formation in the ovary, oviduct, and uterus. In addition, the aims also involved the effect of these cyst formations on the interstitial glands and mast cell distribution in the ovaries of dairy cows. Genital organs of healthy, non-pregnant buffalo-cows (n = 45) were collected from the abattoir. According to the ovarian status, buffalo-cows were divided into three equal groups (15 for each): one normal healthy group was the control group (Ctrl group) and two diseased groups. The first diseased group was the group of buffalo-cows with follicular cysts (FC group), while the second one was the group with luteal cysts (LC group). Blood and tissue samples were collected to determine progesterone levels and do histological investigations of the reproductive organs. Hematoxylin and eosin, Alcian blue-PAS, and Alcian blue-safranin-O stains were used for investigating ovarian tissues, interstitial glands (IGs), and mast cells (MCs), respectively. Results showed that significantly reduced thickness of the ovarian cortex and medulla, loss of ovarian folliculi, hemorrhage, and dilated blood vessels were observed in the FC and LC groups compared to the Ctrl group. In addition, the cystic ovaries significantly reduced interstitial gland count that was characterized by histopathological alterations that included atrophied and apoptotic cells and fragmentation, fading, and pyknotic nuclei. Likewise, in cystic ovaries, mast cell counts were found significantly reduced compared to the Ctrl group. The ovarian cysts significantly reduced the length and diameter of oviductal mucosal villi that were characterized by severe histopathological fluctuation in the ciliated cells and protruding and non-protruding secretory cells. For the uterus, the average thickness of the myometrium and endometrium in the ovarian cyst groups was significantly reduced compared to the Ctrl group. Furthermore, histopathological changes in the uterine glands, including severe apoptotic alterations, fading, pyknotic, and fragmented nuclei, were observed. In conclusion, the current study indicated that follicular and luteal cyst formations in the ovary induced various changes in the reproductive organs, interstitial glands, and mast cell distribution in the ovarian stroma, providing insights into the potential pathogenesis of cyst formation.

Mitigating renal dysfunction in liver cirrhosis: Therapeutic role of ferrous sulphate, folic acid, and its co-administration

Purpose: This study evaluated the effects of an 8‑week liquid diets with different carbohydrate contents–64% energy in HINE E‑Gel (ST) and 50% energy in HINE E‑Gel LC (LC)–on glycemic control and nutritional status in a mouse model of type 2 diabetes mellitus (db/db mice). The objective was to determine whether reducing carbohydrate intake within the Dietary Reference Intakes for Japanese people improves glycemic control indices, addressing the evidence gap in regarding the long‑term safety and efficacy of low‑carbohydrate enteral nutrition in patients with diabetes.Methods: db/db mice (n=10 per group) and non‑diabetic db/m mice (n=4) as controls were fed ST, LC, or AIN‑93G diets ad libitum for 8 weeks. The diets primarily differed in carbohydrate content (64% in ST vs. 50% in LC). Blood glucose and glycated hemoglobin (HbA1c), plasma glucose and glycoalbumin, organ weights, and renal function markers were measured weekly or at 4 and 8 weeks. Histopathological examinations of the liver and kidneys were performed at 8 weeks.Results: At 8 weeks, the LC group showed significantly lower plasma glucose (P=0.0051) and glycoalbumin (P=0.0013) levels compared to the ST group, with a trend toward lower HbA1c (P=0.0514). Although body weight was significantly higher in the LC group (P=0.0038), there were no significant differences between the ST and LC groups in caloric intake, renal function, or histopathological findings.Conclusion: Reducing carbohydrate intake to 50% of total energy within dietary guidelines may improve glycemic control in diabetic mice, suggesting the need for further long‑term evaluation for clinical applications.

Background: Laparoscopic cholecystectomy has replaced open cholecystectomy as the standard treatment for cholelithiasis. However, it is associated with a higher incidence of common bile duct (CBD) injury. (LC) has become the preferred treatment for cholelithiasis; however, it carries a higher risk of common bile duct (CBD) injury compared to open cholecystectomy. It is a largely replaced open cholecystectomy (OC) but is associated with higher rates of common bile duct (CBD) injury. This study compares the frequency of CBD injury between the two techniques. To compare the frequency of CBD injury in open cholecystectomy versus laparoscopic cholecystectomy. Methodology: A randomized controlled trial was conducted at the Department of Surgery, People Medical College Hospital Nawabshah, from July 1 to December 31, 2020. A total of 320 patients aged 20–50 years with cholelithiasis were randomly divided into two groups: 160 underwent open cholecystectomy and 160 laparoscopic cholecystectomy CBD injuries were diagnosed clinically (jaundice) and confirmed via MRCP. Frequency of CBD injury was observed and analyzed statistically using SPSS 22.0, with significance at p ≤ 0.05. Results: Out of 320 patients (160 in each group) Mean age was 33.5±8.7 years; 54.7% were female, CBD injury was observed in 3.8% of patients in the open cholecystectomy group compared 9.4% of the laparoscopic group. The difference was statistically significant (p = 0.042). Indicating a significantly higher rate in laparoscopic procedures and those with diabetes had higher injury rates in the LC group. Conclusion: Laparoscopic cholecystectomy is associated with a higher frequency of CBD injury compared to open cholecystectomy. Enhanced surgical training and safety protocols are essential.

Current guidelines recommend vancomycin concentrations of 10-20μg/mL for most infections, with higher levels (15-20μg/mL) suggested for severe cases. However, evidence supporting these recommendations in periprosthetic joint infection (PJI) is limited. This study aims to evaluate the impact of different vancomycin concentration ranges (10-15 vs. 15-20μg/mL) on the safety and effectiveness in PJI population. This retrospective study included 37 patients with vancomycin Therapeutic Drug Monitoring due to periprosthetic joint infection. Patients were categorized into two groups according to vancomycin concentrations, low concentration group (10-15μg/mL) and high concentration group (15-20μg/mL). Patients were followed up for at least 2years. The long term clinical outcomes, inflammatory markers, as well as adverse events were compared. A physiologically based pharmacokinetic model was established to compare vancomycin distribution in kidney and bone marrow between the two groups. There were 23 (62.16%) patients classified as the HC group and 14 (37.84%) as the LC group. The average steady-state trough concentration (Css) in the HC group was 17.74μg/mL, and in the LC group was 12.11μg/mL. At the end of follow-up, two patients (5.40%) in the HC group had died, and one (2.7%) was readmitted for joint fusion due to recurrent infections, whereas no deaths or readmissions occurred in the LC group. However, no significant differences were identified. Similar improvements from baseline were observed across WOMAC, Harris, HSS, and SF-12 scores between the groups. The synovial white blood cell (WBC) count was significantly lower in the HC group compared to the LC group (5,481 vs. 7,106/μL, P = 0.009), with a more pronounced reduction from baseline noted. The PBPK model showed a greater increase in drug distribution to the bone marrow in the HC group (20.66μg/mL vs. 14.34μg/mL), with a smaller rise in the kidney (376.2μg/mL vs. 327.7μg/mL). Maintaining vancomycin concentrations of 15-20μg/mL is associated with better infection control for PJI patients who present with higher synovial WBC account, without compromising patient safety, joint function, or long-term quality of life.

The frozen elephant trunk (FET) technique was introduced as a possible single-stage procedure for treating aortic arch pathologies. However, up to a third of patients are reported to need subsequent completion (extension). This retrospective analysis aimed to evaluate the impact of early (within 30 days; EC group) versus late (>30 days; LC group) endovascular completion with thoracic endovascular aortic repair (TEVAR) in patients treated with FET. A single-center, retrospective analysis of all consecutive patients for the period between June 2017 and December 2023 who underwent FET and received endovascular extension was conducted. Indications for endovascular extension were aneurysms of the descending aorta, aneurysmal progress, endoleak, malperfusion, distal stent-induced new entry (dSINE), and aortic rupture. A total of 37 of 232 FET patients received endovascular extension (15.9%). Average age at the time of TEVAR was 63.3 ± 10.3 years. There was an increase in the maximum total aortic diameter post-FET from 40.8 ± 9 mm to 45.1 ± 14 mm prior to TEVAR. Only 14 patients (37.8%) had the desired complete occlusion of the false lumen or aneurysm prior to extension; 23 (62.2%) still had relevant perfusion of the false lumen or aneurysm. The EC and LC groups were defined by time between FET and TEVAR: a mean of 4.8 ± 5.2 days in the EC group and 18.4 ± 18 months in the LC group. The EC group had markedly more complex procedures, reflected in intensive care (10.7 ± 6.9 vs. 0.1 ± 0.3 days, p < 0.001) and hospitalization (22.4 ± 14.0 vs. 8.1 ± 5.6 days, p = 0.003) durations. There was one early death due to multiorgan failure in the EC group and there were none in the LC group. There were no major cardiac events in either group. In the EC group, seven patients (50%) suffered from postoperative respiratory failure and four (28.6%) developed acute kidney failure requiring dialysis. Only one patient in the LC group (4.3%) experienced complications. During follow-up, another three patients (21.4%) of the EC group died, but none of the LC group did. Post-extension aortic remodeling was similar in both groups, with complete occlusion achieved in 27 cases (72%) during early follow-up and increased to 90.6% after a mean of 22.0 ± 23.4 months. Following aortic arch repair using FET, there is still a need for second-stage repair in 16% of patients. Endovascular completion post-FET is safe and feasible with a technical success rate of 100%, but early completion is associated with greater morbidity and mortality. TEVAR extension surgery may be better delayed, if possible, until after recovery from the hybrid arch repair.

PurposeStudies in adult populations have reported preoperative predictors of difficult laparoscopic cholecystectomy, but paediatric data are not available. Predicting challenging cases permits improved operative planning.Methods Retrospective analysis of all laparoscopic cholecystectomies [LC] by three sub-specialist surgeons June 2017–April 2024. Difficult LC was defined by the presence of either: [i] operative time > 150 min; [ii] open conversion; [iii] additional surgeon consulted; [iv] anatomical variant; [v] significant bleeding/synthetic haemostatics. Logistic regression compared clinical, laboratory, and imaging findings between difficult LC and uncomplicated LC groups. Data are presented as median [IQR] with odds ratio [OR] [95th C.I].Results133 children [age 13 (1–15)], 81/133 [60.9% female]. Indications for surgery included biliary colic [64.7%], pancreatitis [17.3%], and others [18%]. 35/133 [26.3%] were defined as difficult LC. Significant predictors of difficult LC included: emergency admission [OR 6.18 (2.55–14.9), p = 0.000], history of pancreatitis [OR 2.96 (1.3–6.9), p = 0.01], history of cholecystitis [OR 3.57 (1.52–8.4), p = 0.003], LC during acute cholecystitis [OR 12.7 (3.2–49.5), p = 0.000], LC during acute pancreatitis [OR 3.33 (1.1–9.7), p = 0.03], raised WCC [OR 1.1 (1.03–1.18), p = 0.004], raised CRP [1.005 (1.001–1.01), p = 0.03], raised ALT [OR 1.007 (1.002–1.01), p = 0.01], hypoalbuminaemia [OR 0.86 (0.80–0.94), p = 0.00] and raised lipase OR 1.009 (1.001–1.02), p = 0.02], C-reactive to Albumin Ratio [OR 1.22 (1.04–1.44), p = 0.02, ultrasound diagnosis of acute cholecystitis [OR 7.44 (2.33–23.8), p = 0.001], thickened gallbladder [OR 3.52 (1.31–9.4), p = 0.001], impacted stone [OR 3.7 (1.5–9.4), p = 0.005], and bile duct dilation [OR 4.32 (1.84–10.1), p = 0.001].ConclusionMultiple predictors of difficult LC were identified. These predictors can be used to alert teams to consider whether extra resources may be required e.g., on-table cholangiogram, more operative time, or availability of additional surgeons.

BackgroundLong-term COVID-19 (LC), which may affect the autonomic nervous system (ANS), is the term for the symptoms that some patients had for an additional month after contracting the virus. Therefore, during the LC phase, ANS status was evaluated in patients with mild-to-moderate COVID-19 using heart rate variability (HRV), a measurement of ANS function.MethodsA cross-sectional research with 173 participants - both positive and negative for COVID-19 – was conducted. Based on self-reports, patients with COVID-19 were classified as to whether they had LC or not. A 5-minute ECG recorder and data detection and response report were used to measure the ANS.ResultsThere were notable age differences across the groups (p = 0.034). Patients with LC under 25 years of age had a lower HRV categorized as a very-low-frequency (VLF) domain (p = 0.012). Compared to the group without LC, a higher number of people in the LC group had aberrant autonomic neuroactivity (p = 0.048).ConclusionMild-to-moderate patients with COVID-19 in young to middle age may develop autonomic dysfunction one month after infection.

IntroductionPelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury.MethodsBetween January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21–25 points), mild ED (16–21 points), moderate ED (9–15 points), and severe ED (5–7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking.ResultsA total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05).ConclusionVertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED.

This study aims to compare the efficacy of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic common bile duct exploration (LCBDE), and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of gallbladder stones with common bile duct stones. We conducted a retrospective comparative analysis based on surgical time, intraoperative blood loss, postoperative recovery metrics, total hospitalization costs, gastrointestinal quality of life index (GIQLI) before and after surgery, and the incidence of postoperative complications. No significant differences were found among the three groups in terms of the surgical success rate, first stone clearance rate, intraoperative blood loss, incidence of postoperative complications, and stone recurrence rate (p > 0.05). The LTCBDE group had shorter surgical time, earlier time to get out of bed, earlier first flatus time, shorter postoperative hospital stays, and earlier removal of abdominal drainage tube compared to the LCBDE and the ERCP + LC groups (all p < 0.05). The average hospitalization cost was also lower in the LTCBDE group (p < 0.05). LTCBDE for the treatment of gallbladder stones with common bile duct stones leads to faster recovery and improved quality of life. It is safe and effective, making it a method worthy of promotion.

Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard management for patients who present with common bile duct stone (CBDS). Although laparoscopic cholecystectomy is generally recommended for patients who have CBDS clearance, there is still a significant proportion of patients who are managed expectantly. Our study aimed to evaluate the outcomes of expectant management (EM) versus prophylactic cholecystectomy after initial endoscopic removal of CBDS. We performed a retrospective review of all patients who underwent ERCP for choledocholithiasis from 1st January 2017 to 31st December 2019. Patients were further classified into young or elderly group using age 60years as the cut-off. Primary outcomes measured biliary-related complications in each interventional group whereas secondary outcomes measured all-cause mortality. 136 patients (51.3%) had EM whereas 129 patients (48.7%) were initially planned for LC. There was 20.6% of recurrence of biliary events in EM group as compared to 3.9% in LC group. The median time from first ERCP to recurrence of biliary events in the EM group was 14months. Overall complications of LC group was low (5.4%) with nil operative-related mortality. However, there was a significant higher proportion of elderly patients in EM group in comparison to LC group (88.2% vs 31%) and 51.4% of EM group died during follow-up period with only one biliary-related death. Prophylactic cholecystectomy should be recommended for patients who have undergone ERCP clearance of CBDS. A watch-and-wait approach may be justified for elderly populations who are not ideal surgical candidates and a follow-up duration of up to 2years is recommended.