Main Treatment Research Articles

Addiction Therapeutic Communities in Saudi Arabia: An Evaluation of the Resident Retention Rates and Their Correlation With the Type of Drug Used.

Long-term retention is a reliable, well-studied factor associated with enhanced outcomes in addiction therapeutic communities (ATCs). The aim of this study was to estimate resident retention rates of ATCs in Saudi Arabia at three and six months, completion of therapy, and early dropout, and investigate their correlation with the type of drug used and other social variables. This was a cohort retrospective study and data of all residents admitted to all Saudi ATCs since their establishment in 2000 through September 2014 were collected from their files. There were five Saudi ATCs during the study period. The date of admission, discharge date, socio-demographics, and drug use were reported. Retention rates at three and six months and dropouts in the first week were calculated, and the correlation with the type of drug used was studied using multinomial binary logistic regression analysis. Out of a total of 2050 files, 2003 were suitable for analysis. All residents were male adults. The retention rate for three and six months was 45% and 28%, respectively, and 8.3% dropped out in the first week. The median duration of stay was 77 days. Unemployment and being a student were associated with the completion of treatment. The type of drug used showed no significant correlation with retention rates or dropouts. Three-month retention, treatment completion, and dropout within the first week were reasonable, comparable, and consistent with reported rates worldwide. These rates can be considered an indicator of successful Saudi ATC programs. The type of drug used does not make a difference in retention and dropout rates in the present study, which is in line with the ATC management system that does not view the type of drug as a main treatment outcome modifier.

Post-transplant lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation: a case report, meta-analysis, and systematic review

BackgroundPost-transplant lymphoproliferative disorders (PTLD) are rare but severe complications that occur after solid organ or allogeneic hematopoietic stem cell transplantations (allo-HSCT), with rapid progression and high mortality. Primary central nervous system (CNS)-PTLD are rarely recognized histo-pathologically. In addition, the diagnostic value of the Epstein–Barr virus (EBV) DNA copies in CNS-PTLD remains poorly understood.ObjectivesWe herein report a case of monomorphic EBV-associated CNS-PTLD (diffuse large B-cell lymphoma, DLBCL) after allo-HSCT and perform a meta-analysis to assess the efficacy of PTLD treatment strategies in recent years.MethodsWe present the case report covering clinical manifestations, diagnosis, treatment, and outcomes of a patient with primary CNS-PTLD. Additionally, we include a systematic review and meta-analysis of the clinical characteristics of 431 patients with PTLD after allo-HSCT. We evaluate the main treatment options and outcomes of PTLD management, including rituximab, chemotherapies, and autologous or human leukocyte antigen (HLA)-matched EBV-specific cytotoxic T lymphocyte infusion (EBV-CTLs)/donor lymphocyte infusion (DLI).ResultsThe meta-analysis revealed an overall response rate of 69.0% for rituximab alone (95% CI: 0.47–0.84), 45.0% for rituximab plus chemotherapies (95% CI: 0.15–0.80), and 91.0% for rituximab plus EBV-CTLs/DLI (95% CI: 0.83–0.96). The complete response (CR) rate after treatments for PTLD was 67.0% (95% CI: 0.56–0.77). Moreover, the 6-month and 1-year overall survival (OS) rate was 64.0% (95% CI: 0.31–0.87) and 49.0% (95% CI: 0.31–0.68), respectively.ConclusionsThis case highlighted the urgent need for effective, low-toxic treatment regimens for CNS-PTLD. Our meta-analysis suggested that rituximab combined with EBV-CTLs/DLI could be a favorable strategy for the management of PTLD after allo-HSCT.

Body Height of MPS I and II Patients after Hematopoietic Stem Cell Transplantation: The Impact of Dermatan Sulphate.

Hematopoietic stem cell transplantation (HSCT) comprises one of the two main treatment regimens for patients with mucopolysaccharidoses (MPS). There is a scarcity of literature concerning the process of growth in children with Mucopolysaccharidosis type I (MPS I) and Mucopolysaccharidosis type I (MPS II) after HSCT. The aim of this manuscript was to evaluate the therapeutic effect of HSCT on the heights of patients with MPS I and MPS II. It was an observational, single-center study on patients with MPS I and II treated with HSCT. 6 MPS patients, including 4 MPS I and 2 MPS II, underwent HSCT at a median age of 2 years. All patients are alive to date, with a median age of 7.7 years (range 5.5-12 years) at the last follow-up. In both (MPS I and MPS II) groups of patients treated with HSCT, the growth rate was higher than in untreated patients and was found to be in line with the population norm. In both MPS I and MPS II patients who were treated with HSCT, normalization of urinary GAG excretion was observed. Additionally, no bands of DS and HS in GAG electrophoresis were visible. Both MPS I and MPS II patients presented height gain after HSCT compared to the curves of untreated patients. The absence of dermatan sulphate after HSCT could lead to normal growth in bone length.

Effect of Crop Establishment Methods on Rhizospheric Soil Microbiota in Mustard Due to Different Land-Use Systems

A field study was conducted to assess the effect of crop establishment methods on rhizospheric soil microbiota in mustard due to different land-use system at the Research Farm, Department of Forestry, College of Agriculture, JNKVV, Jabalpur (MP) for two consecutive years (2022–23 and 2023-24). The experiment was assessed in the double-split plot design with three replications. The experiment consisted of two land-use systems as main plot treatment (S1: Agroforestry system and S2: Open system), three crop establishment methods of mustard (M1: Broadcasting, M2: Line sowing, and M3: Transplanting) as sub-plot treatments and four levels of boron (B0: Control, B1: 1 kg ha-1 as basal B2: 2 kg ha-1 and B3: ½ kg ha-1 as basal + ½ kg ha-1 as foliar spray) as sub-sub plot treatments. The soil samples were collected after harvesting of crop during both the years of study to analyse soil microbiota (total bacteria, azotobacter, rhizobium, total fungi and actinomycetes). The results revealed that, significantly higher counts of azotobacter (31.37 CFU x 105), rhizobium (21.99 CFU x 106), total bacteria (42.78 CFU x 106), total fungi (8.30 CFU x 105) and actinomycetes (12.98 CFU x 105) were higher under agroforestry system than the open system. Meanwhile higher counts of azotobacter, rhizobium, total bacteria, total fungi and actinomycetes were found to be significantly superior in broadcasting (29.59 CFU x 105, 20.28 CFU x 106, 37.52 CFU x 106, 7.97 CFU x 105, 12.68 CFU x 105, respectively) over both line sowing and transplanting crop establishment methods. In case of boron levels, no significant changes occurred in the soil biology under both agroforestry and open systems. Hence, it could be concluded that vegetative cover over soil helps to proliferation of population of soil microbiota in the rhizospheric zone of crop.

Influence of Postoperative Insulin Resistance on Short-Term Outcomes of Radical Gastrectomy for Gastric Cancer: A Microbiome and Metabolome-Based Prospective Cohort Study.

Gastrectomy is one of the main treatment modalities for gastric cancer (GC) and induces pathophysiological changes that significantly affect patients' postoperative recovery. In this study, we investigated the relationships between altered insulin resistance (IR), inflammation, and gut microbiota associated with gastrectomy. This study was a single-center prospective cohort investigation involving 60 patients with GC who underwent gastrectomy between May 2023 and April 2024. Monitoring encompassed IR, inflammation, and nutrition-related markers via blood assays, while gut microbiota analysis employed high-throughput sequencing, and short-chain fatty acids (SCFAs) were examined through targeted metabolomics. The study is registered under the number ChiCTR2300075653. The patients exhibited a significant increase in post-gastrectomy IR markers (P < 0.001), accompanied by elevated inflammation markers (P < 0.001), and also showeddecreased nutrition-related indicators (P < 0.001). Notable alterations were observed in the gut microbiota, including reductions in Bifidobacterium and Faecalibacterium, an increase in Streptococcus, and a noteworthy decrease in fecal butyrate. Patients with postoperative IR exhibited poorer inflammation markers (P < 0.05), nutritional indicators (P < 0.05), and postoperative recovery parameters (P < 0.05). Furthermore, significant negative correlations were observed between IR and Bifidobacterium,Faecalibacterium,as well as butyrate. Patients with GC post-gastrectomy displayed heightened IR, exacerbated inflammation, and compromised nutritional status. Disturbed gut microbiota and reduced fecal butyrate were observed. Gut microbiota and metabolite butyrate production may be predictors of postoperative IR and short-term outcomes in patients with GC.

Robotic and Laparoscopic Adrenalectomy for Pheochromocytoma: An International Multicenter Study

Background and objectiveRobotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients. MethodsData for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI). Key findings and limitationsOf 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07–1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07–1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63–1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023). Conclusions and clinical implicationsRA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma. Patient summaryPheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used.

Operative management of Charcot neuropathy of the foot and ankle: A retrospective cohort study of long-term outcomes

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the main treatment, but surgical intervention has gained interest to improve poor long-term outcomes. Few long-term outcome studies exist on operative management of CN. A retrospective chart review was performed to analyze demographics, comorbidities, complications, and outcomes of operative management of CN. Patients were divided into two cohorts for analysis: limited surgical intervention (LSI) and reconstructive surgery (RS). Fifty-eight patients with CN treated surgically over 11 years were identified. Average follow-up was 46 months (range, 1 to 173 months). The mean age was 60.2 (range, 29 to 81) years, and the average body mass index was 34.3. Diabetes caused CN in 72.4 % (42/58) of patients. The LSI cohort (n = 32) had significantly higher rates of presenting infection (59.4 %; 19/32) and ulceration (87.5 %; 28/32) compared with the RS cohort (n = 26; 23.1 % [6/26] and 50 % [13/26], respectively). Rates of postoperative infection and ulceration were lower in the LSI group (25 % [8/32] and 34.4 % [11/32], respectively) than the RS group (42.3 % [11/26] and 42.3 % [11/26], respectively). The amputation rate for the LSI cohort was 21.9 % (7/32) compared with 23.1 % (6/26) for RS. This large, single-center study of operatively treated CN patients showed no significant difference between LSI and RS. This study provides data to help surgeons counsel patients on expected outcomes.

Fractures around the knee in elderly patients: Balancing fixation and arthroplasty approaches, a multicenter experience.

In recent years, a discernible shift has occurred in the approach to knee pathologies, specifically in the management of acute fractures. Traditionally, fractures were primarily treated through osteosynthesis, whereas prosthesis replacement was primarily reserved for degenerative issues. Outcomes of this investigation aim to elucidate the potential indications and contraindications for the use of prosthetic interventions in the management of such fractures and to propose a scoring system that can be adopted for the choice between the two different approaches. A retrospective observational study was conducted on patients treated for periarticular knee fractures, with a focus on elderly patients. Patients aged older than 65 years treated in three Italian centers were recruited. Inclusion criteria comprised fractures around the knee, including distal femur types 33-A, 33-B, and 33-C, and proximal tibia types 41-A, 41-B, and 41-C, in accordance with the AO/OTA classification. Surgical treatment with osteosynthesis or arthroplasty was required and investigated. Between August 2017 and October 2022, 91 patients with periarticular knee fractures underwent surgical treatment, 23.1 % males and 76.9 % females, with 78 % undergoing osteosynthesis and 22 % acute total knee replacement. Distal femoral fractures constituted 37.4 %, while 62.6 % were proximal tibial fractures. Average age at surgery was 76.4 years. Patient outcomes were assessed using PROMs, revealing generally positive results, including survivorship of 95 % at the final follow-up for both groups using the Kaplan Meier survival estimate. The study introduces a novel Total Knee Replacement Indication Scoring System (TKRISS) based on the AO Classification. Nowadays osteosynthesis remains the main treatment for fractures around the knee. In a geriatric patient's population and in carefully selected patients replacement can be a valid option for early weight bearing and quicker recovery comparing to fixation. The Total Knee Replacement Indication Scoring System provides a useful tool for healthcare to assess the potential indication for TKR in the context of knee fractures. It integrates a range of relevant factors, acknowledging the complex nature of patient care. Further clinical research and validation are essential to refine and optimize this scoring system.

Клинические особенности и коморбидные нейропсихиатрические состояния у педиатрических пациентов с тикозными расстройствами. Обзор.

INTRODUCTION. Tic disorders are a common neurological pathology among children and adolescents. Tic disorders and comorbid conditions affect patients' socialization, education, and emotional state. Social stigmatization and discrimination caused by tic disorders have an irreparable impact on personality development, making it necessary to raise awareness and understanding of these conditions. AIM. The objective of this study is to analyze the literature on the features of the etiology, diagnosis, and clinical manifestations of tic disorders and comorbid disorders. MATERIAL AND METHODS. An analysis of DSM-5-TR and ICD-11 criteria, as well as 28 international literature sources from the PubMed database, was performed. This analysis provided descriptions of the diagnostic criteria, etiology, and pathogenesis of tic disorders and comorbid disorders. Data on the clinical manifestations of comorbid disorders, differential diagnosis, and main treatment approaches were also presented. RESULTS AND DISCUSSION. The prevalence of tic disorders is about 1% of the population, with 1 in 5 schoolchildren experiencing tics during their development. Currently, the exact causes of tics are unknown; it is assumed that tic disorders is a multifactorial disease involving heredity, environmental factors, and immune-mediated mechanisms. Additionally, dysfunctions in the cortico-striato-thalamo-cortical circuits and neurotransmitter imbalances play significant roles. About 80% of patients with tics have comorbid neuropsychiatric disorders such as attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, autism spectrum disorders, mixed anxiety-depressive disorders, and sleep disturbances, which in some cases present challenges in the differential diagnosis and treatment of these conditions. CONCLUSION. The high degree of comorbidity in tic disorders necessitates a multidisciplinary approach, involving neurologists, psychiatrists, clinical psychologists, and behavioral therapy specialists. This collaboration aims to achieve the maximum therapeutic effect and improve the quality of life for patients. KEYWORDS: tics, chronic tics, Tourette syndrome, Gilles de la Tourette Disorder

Ginsenoside Rb1-loaded bionic nanoparticles alleviate sepsis-induced acute lung injury by reducing mitochondrial oxidative stress to inhibit macrophage PANoptosis

Cytokin storms play a key role in the pathogenesis of acute lung injury (ALI) caused by sepsis, in which pulmonary macrophage PANoptosis is involved. At present, the main treatment methods for sepsis-induced ALI are antibiotics and fluid resuscitation, but the efficacy of these methods is unsatisfactory enough; therefore, the development of new therapeutic methods is urgently needed. In this study, we developed a novel bionic nanoparticle (R@ZQC NPs) using ZIF-8 nanoparticles as a carrier, internally supported with ginsenoside Rb1, and externally coated with quaternated chitosan and a macrophage membrane layer by layer. The biomimetic nanoparticles controlled the release of Rb1, had good biocompatibility, strong antibacterial activity, and targeted the inhibition of pulmonary macrophage PANoptosis. In vitro and in vivo, R@ZQC NPs effectively inhibited the activity of Escherichia coli and reduced mitochondrial damage by activating the AMPK pathway, thus alleviating the inflammatory response and ameliorating sepsis-induced ALI. In summary, this study revealed the great potential of R@ZQC NPs for antimicrobial activity, targeted inhibition of macrophage PANoptosis and reduction of the inflammatory response and represents the first attempt of R@ZQC NPs in the treatment of sepsis-induced ALI. This study provides new therapeutic ideas and strategies for the clinical treatment of sepsis-induced ALI.

Safety and Efficacy of Fixed-Dose Combination of Adapalene and Benzoyl Peroxide in Acne Vulgaris Treatment: A Systematic Review of Clinical Trials.

The Global Burden of Disease Study 2020 ranked acne vulgaris as the eighth most common skin condition, with a global estimated prevalence of 9.4%. The clinical presentation of acne vulgaris ranges from comedones to nodules and cysts. The main treatment options for acne are retinoids, antibiotics, and benzoyl peroxide (BPO). This study aimed to evaluate the reported efficacy and safety of the combination treatment with retinoid and benzoyl peroxide. Three databases (ScienceDirect, Google Scholar, and PubMed) were searched using keywords such as acne, adapalene/benzoyl peroxide, and randomized controlled trial, and specific search moods such as "Title and abstract" for PubMed and "Title, abstract, and keywords" for ScienceDirect. On Google Scholar, the "allintitle" option was utilized. The articles were searched for the years between 2003 and 2023. The eight trials selected for systematic review reported randomized controlled trials in 4,596 individuals with the first trials being conducted in February 2007 and the last one in May 2022. There were 52.8% females in the trials, and the trials reported a primary reduction of acne lesions (efficacy) from 27.5% to 70.2%.The occurrence of adverse effects was also variable (ranging from 2.7% to 57.9%), but these effects were mild and vanished with time. The results showed that the combination of adapalene and benzoyl peroxide is a safe and effective treatment.

Targeting the cancer cells and cancer-associated fibroblasts with next-generation FGFR inhibitors in prostate cancer co-culture models.

Inhibition of androgen receptor (AR) signaling is the main treatment strategy in advanced prostate cancer (PCa). A subset of castration resistant prostate cancer (CRPC) bypasses the AR blockade by increased fibroblast growth factor receptor (FGFR) signaling. The first- and second-generation, non-covalent FGFR inhibitors (FGFRis) have largely failed in the clinical trials against PCa. In this study, we tested the drug sensitivity of LNCaP, VCaP, and CWR-R1PCa cell lines to second-generation, covalent FGFRis (FIIN1, FIIN2) and a novel FGFR downstream molecule inhibitor (FRS2αi). 2D and 3D mono- and co-cultures of cancer cells, and cancer-associated fibroblasts (CAFs) were used to mimic tumor-stroma interactions in the extracellular matrix (ECM). The treatment responses of the FGFR signaling molecules, the viability and proliferation of cancer cells, and CAFs were determined through immunoblotting, migration assay, cell viability assay, and real-time imaging. Immunofluorescent and confocal microscopy images of control and treated cultures of cancer cells and CAFs, and their morphometric data were deduced. The FGFRis were more effective in mono-cultures of the cancer cells compared with co-cultures with CAFs. The FRS2αi was specifically effective in co-cultures with CAFs but was not cytotoxic to CAF mono-cultures as in the case of FIIN1 and FIIN2. At the molecular level, FRS2αi decreased p-FRS2α, p-ERK1/2, and activated apoptosis as monitored by cleaved caspase-3 activity in a concentration-dependent manner in the co-cultures. We observed no synergistic drug efficacy in the combination treatment of the FGFRi with ARi, enzalutamide, and darolutamide. The FRS2αi treatment led to a decrease in proliferation of cancer cell clusters in co-cultures as indicated by their reduced size and Ki67 expression. CAFs exert a protective effect on cancer cells and should be included in the invitro models to make them physiologically more relevant in screening and testing of FGFRis. The FRS2αi was the most potent agent in reducing the viability and proliferation of the 3D organotypic co-cultures, mainly by disrupting the contact between CAFs and cancer cell clusters. The next-generation FGFRi, FRS2αi, may be a better alternative treatment option for overcoming ARi treatment resistance in advanced PCa.

Successful Localization by Hyperselective Arterial Calcium Injection Test for Surgical Resection of Insulinoma: A Case Report.

Surgery is the main treatment for insulinoma, and precise preoperative localization is important to determine the extent of resection and to rule out multiple lesions. The selective arterial calcium injection (SACI) test is instrumental in the localization of insulinoma. Here we report a patient in whom the exact location of pancreatic insulinoma could not be determined by the conventional SACI test, and thus surgery was replaced with oral diazoxide. The hyperselective SACI test subsequently localized the lesion accurately, allowing surgical resection of the pancreatic body and tail while preserving the pancreatic head. We recommend the use of the hyperselective SACI test when the conventional SACI test fails to accurately determine the location of insulinoma lesions within the pancreas.

Ethion food poisoning outbreak in Pereira, Colombia, 2022

Introduction Ethion is an organophosphate used as an acaricide and insecticide, that is restricted worldwide. In Colombia, pesticide poisoning is the third most common cause of chemical intoxication. On 9 October 2022, an outbreak of ethion poisoning occurred in Pereira. The aim of this study was to describe the clinical and epidemiological characteristics of the outbreak. Methods This is a descriptive study of an outbreak of organophosphate poisoning. The onset of symptoms occurred on 9 October 2022, following the consumption of empanadas. Information was collected on sociodemographic characteristics and clinical manifestations, as well as from paraclinical examinations. Data were obtained from clinical histories, field epidemiological investigations, and inspection visits. Food samples were collected for analysis by gas chromatography-mass spectrometry. Attack rates, proportions, and measures of central tendency, dispersion, and position were calculated. Results The case definition was met by 37 individuals with a median age of 30 years; all presented with muscarinic symptoms, 29 patients presented with nicotinic symptoms, and 20 patients presented with neurological symptoms. Males were the most affected (57%), and the most common time of symptom onset was 10:00 am. Twenty-three patients (62%) required intensive care unit admission, of whom 14 (38%) required mechanical ventilation. No deaths were reported. Erythrocyte acetylcholinesterase activity was reduced in all patients. Ethion was detected in mass-prepared maize and empanadas at concentrations greater than 0.1 mg/kg. The consumption of empanadas was identified as the common source. Discussion In Colombia, pesticide poisonings are the third most common type of poisoning caused by chemical substances reported to the National Health Institute through the National Public Health Surveillance System. In the present outbreak, ethion was in empanadas, likely due to contamination of cooking oil. Conclusions We describe a large ethion-contaminated food poisoning outbreak reported in Colombia. The main symptoms were muscarinic, and the main treatment measures employed were atropine and respiratory support. Increased awareness of pesticide poisoning and training for food handlers are needed.

A Maintenance Cost and Work Performance Analysis on Irrigation Network at Kaubun Irrigation Area of East Kutai Regency, Indonesia

An irrigation network maintenance is an effort to maintain and secure the irrigation network to be always ready and well functioned. In facilitating its operational implementation and maintain its sustainability cycle, it can be attained through maintenance, repair, prevention, and security activities that must be conducted in continuity. The Kaubun irrigation area is one of the irrigation areas under the authority of central government with area length of 1,150 Ha (standard area) and 736 Ha (functional area), located in the East Kutai Regency. The Kaubun irrigation area has 1 (one) weir or dam and 2 (two) main canals. The irrigation network maintenance has not been carried out in routine and periodical ways either by the East Kalimantan Provincial Government or by the East Kutai Regency Government. Sediment accumulation is one of the main problems found in the secondary irrigation canal and able to cause canal blockage, reduced water flow capacity and increased infrastructure damage. This research was carried out by evaluating the Irrigation Network System and observing several factors causing channel damage with a guidance from regulation of Minister of Public Works and Public Housing Number:12/PRT/M/2015 on date 6 April 2015, regarding Exploitation and Maintenance of Irrigation Network. Result of the research showed that recapitulation of the work performance index for Kaubun Irrigation Network System was obtain the largest optimum value in Physical Infrastructure aspect with an index value of 29.01. Meanwhile, the result from main treatment priority by employing Analytic Hierarchy Process (AHP) method found the Physical Infrastructure aspect has a limiting value of 0.462. Finally, the routine and periodical maintenance costs for the Kaubun irrigation area is IDR.3.753.835.675.00

Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review.

Hepatic compartment syndrome (HCS) is a rare but life-threatening entity that consists of a decreased portal flow due to intraparenchymal hypertension secondary to subcapsular liver hematoma. Lethal liver failure can be observed. We report three cases, and review the literature. A 54-year-old male was admitted for extensive hepatic subcapsular hematoma after blunt abdominal trauma. Initially, he underwent embolization of the hepatic artery's right branch, after which he presented clinical deterioration, major cytolysis (310 times the upper limit of normal [ULN]), and liver failure with a prothrombin time (PT) at 31.0%. A 56-year-old male underwent liver transplantation for acute alcoholic hepatitis. On postoperative day 2, he presented a hemorrhagic shock associated with deterioration of liver function (cytolysis 21 ULN, PT 39.0%) due to extensive hepatic subcapsular hematoma. A 59-year-old male presented a hepatic subcapsular hematoma five days after a cholecystectomy, revealed by abdominal pain with liver dysfunction (cytolysis 10 ULN, PT 63.0%). All patients ultimately underwent urgent surgery for liver capsule excision, hematoma evacuation, and liver packing, if needed. The international literature was screened for this entity. These three patients' outcomes were favorable, and all were alive at postoperative day 90. The literature review found 15 reported cases. HCS can occur after any direct or indirect liver trauma. Surgical decompression is the main treatment, and there is probably no place for arterial embolization, which may increase the risk of liver necrosis. A 13.3% mortality rate is reported. HCS is a rare complication of subcapsular liver hematoma that compresses the liver parenchyma, and leads to liver failure. Urgent surgical decompression is needed.

Application Development of Baihui (GV20) Moxibustion in Ancient China: a Data Analysis Study Based on Ancient Books.

We compile and analyze ancient literature related to Baihui (GV20) moxibustion and summarize the development of its ancient clinical application. The Chinese Medical Classic (5th edition) was used as the search source to screen and organize articles related to Baihui moxibustion to establish a database. We created indexing norms according to study characteristics and indexed books, dynasties, literary styles, disease key words, matching acupoints, combinations, moxibustion amounts, and moxa cone sizes. SPSS version 24.0 software was used to calculate the index results. A total of 320 articles that met the requirements were finally included and were attributed to 99 ancient books, spanning from the Western Han Dynasty to the Qing Dynasty. A total of 45 keywords were used for disease evidence: the most frequent occurrences were internal medicine (primary category), limb meridians (secondary category), and head diseases (specific patterns). Baihui moxibustion has been updated and developed in the literature over the ages, and the method of Baihui moxibustion is diverse. The main treatment rule of Baihui moxibustion considers the whole body and close treatment of partial diseases. Baihui moxibustion also has the rule of following meridian indications, with treatment based on syndrome differentiation and compatible application. Baihui moxibustion alone has a relatively strong effect of raising yang and lifting the sunken, which can treat the sinking of qi and deficiency.

Levodopa-induced dyskinesia: brain iron deposition as a new hypothesis.

Parkinson's disease (PD) is a common neurodegenerative disease in the older adults. The main pathological change in PD is the degenerative death of dopamine (DA) neurons in the midbrain substantia nigra, which causes a significant decrease in the DA content of the striatum. However, the exact etiology of this pathological change remains unclear. Genetic factors, environmental factors, aging, and oxidative stress may be involved in the degenerative death of dopaminergic neurons in PD. Pharmacological treatment using levodopa (L-DOPA) remains the main treatment for PD. Most patients with PD consuming L-DOPA for a long time usually develop levodopa-induced dyskinesia (LID) after 6.5years of use, and LID seriously affects the quality of life and increases the risk of disability. Recently, studies have revealed that cerebral iron deposition may be involved in LID development and that iron deposition has neurotoxic effects and accelerates disease onset. However, the relationship between cerebral iron deposition and LID remains unclear. Herein, we reviewed the mechanisms by which iron deposition may be associated with LID development, which are mainly related to oxidative stress, neuroinflammation, and mitochondrial and lysosomal dysfunction. Using iron as an important target, the search and development of safe and effective brain iron scavengers, and thus the alleviation and treatment of LID, has a very important scientific and clinical value, as well as a good application prospect.

Efficacy of Respiration-controlled Radiotherapy Among Patients With Locally Advanced-stage Lung Cancer: A Population-based Study.

Definitive radiotherapy is the main treatment modality for patients with locally advanced stage lung cancer and a good performance status who are ineligible for surgery. Respiration-controlled radiotherapy (RCRT) has been recommended, but its effectiveness has been debated in the literature. Therefore, we aimed to study the efficacy of RCRT in definitive radiotherapy for locally advanced-stage lung cancer. We identified lung cancer patients diagnosed between 2011 and 2021 using data from the Taiwan Cancer Registry and related databases. In our primary analysis, we applied propensity score weighting (PSW) to balance observable potential confounders. We then compared the hazard ratio (HR) of death between the RCRT group and the non-RCRT group. Additionally, we conducted a comprehensive assessment of other outcomes and performed various supplementary analyses. The primary analysis included 3,020 patients. Overall survival did not significantly differ between the RCRT group and the non-RCRT group, with a PSW-adjusted HR of 0.79 (95% confidence interval=0.49-1.28, p=0.342). These findings were consistent with other outcomes and supplementary analyses. In locally advanced-stage lung cancer patients who received definitive radiotherapy, survival did not significantly differ between those treated with RCRT and those treated without RCRT. To our knowledge, this is the first population-based study on this topic.

Electrical brain networks before and after transcranial pulsed shockwave stimulation in Alzheimer's patients.

Alzheimer's disease (AD) is a neurodegenerative disorder that dramatically affects cognitive abilities and represents the most common cause of dementia. Currently, pharmacological interventions represent the main treatment to deal with the symptoms of AD; however, alternative approaches are readily sought. Transcranial pulse stimulation (TPS) is an emerging non-invasive neuromodulation technique that uses short, repetitive shockwaves with the potential to provide a wide range of vascular, metabolic, and neurotrophic changes and that has recently been shown to improve cognitive abilities in AD. This exploratory study aims to gain insight into the neurophysiological effect of one session of TPS in AD as reflected in electroencephalographic measures, e.g., spectral power, coherence, Tsallis entropy (TE), and cross-frequency coupling (cfc). We document changes in power (frontal and occipital), coherence (frontal, occipital and temporal), and TE (temporal and frontal) as well as changes in cfc (parietal-frontal, parietal-temporal, frontal-temporal). Our results emphasize the role of electroencephalographic measures as prospective markers for the neurophysiological effect of TPS.