Management Pathway Research Articles

10 tips on how to reduce iatrogenic AKI

Abstract Acute kidney injury (AKI) is a heterogeneous syndrome associated with worse clinical outcomes. Many treatments and procedures in the hospitalized patient can cause AKI. Hence, the incidence of iatrogenic AKI is expected to be high. In this review, we provide 10 practical tips on how to manage and avoid iatrogenic AKI. We cover identification of vulnerable patients by epidemiological data and recommend the usage of renal stress biomarkers for enhanced screening of high-risk patients. Further, we discuss the limitations of current diagnostic criteria of AKI. As a key takeaway, we suggest the implementation of novel damage biomarkers in clinical routine to identify subclinical AKI, which may guide novel clinical management pathways. To further reduce the incidence of procedure-associated AKI, we advocate for certain preventive measures. Foremost, this includes improvement of hemodynamics and avoidance of nephrotoxic drugs whenever possible. In cases of severe AKI, we provide tips for the implementation and management of renal replacement therapy and highlight the advantages of regional citrate anticoagulation. The furosemide stress test might be of help in recognizing patients who will require renal replacement therapy. Finally, we discuss the progression of AKI to acute and chronic kidney disease and management of this growing issue. Both can develop after episodes of AKI and have major implications for patient co-morbidity and long-term renal and non-renal outcomes. Hence, we recommend long-term monitoring of kidney parameters after AKI.

Targeting interleukin-6 pathways in giant cell arteritis management: A narrative review of evidence.

Giant cell arteritis (GCA) is a chronic inflammatory vasculitis with a significant impact on vascular and patient health. It may present with non-specific symptoms and can lead to severe complications if not managed effectively. This narrative review explores the treatment of GCA with interleukin-6 pathway inhibitors, focusing on key studies from selected databases published between 2018 and 2024. The findings reveal that the current treatment primarily involves glucocorticoids (GCs), but their long-term use is associated with adverse effects. Targeting the interleukin-6 (IL-6) pathway offers therapeutic benefits by reducing inflammation and sparing GC use. Tocilizumab, a humanized immunoglobulin G1κ monoclonal antibody that blocks the IL-6 receptor, has demonstrated efficacy in achieving sustained remission and improving quality of life in people with GCA. However, challenges remain in understanding the optimal duration of therapy, managing relapse upon discontinuation, and addressing long-term structural vascular outcomes. Additional research is needed to further elucidate the complex pathogenesis of GCA and to optimize treatment strategies to achieve sustained remission both clinically and histologically while minimizing adverse effects. This review provides a comprehensive overview of the evidence of IL-6 inhibition in GCA management, highlighting both its therapeutic benefits and the challenges associated with its use.

A new telemedicine-based sleep service using WatchPAT® ONE for patients with suspected OSA: what does the patient experience?

Obstructive Sleep Apnea is a widespread disease but is very underdiagnosed and undertreated. The aim of this study is to assess the effectiveness and patient satisfaction of using the WatchPAT® ONE, a disposable home sleep apnea test device, within a telemedicine-based management pathway. All patients who used the telemedicine services for OSA diagnosis using the WatchPAT® ONE were prospectively enrolled in the study. Patients receive the device at home and download its associated application to learn how to perform the test autonomously at night. Clinicians then review automated results transmitted by the cloud and conduct the follow-up visit via telemedicine, providing diagnostic and therapeutic guidance. The study included 167 patients (78% male; mean age 55 ± 14 years; BMI: 27.5 ± 4.5kg/cm²), with a mean distance of 147.29 ± 172.35km from our hospital. The median time from test request to result delivery was 5 working days. The study cohort showed a median pAHI of 16.7 events/h, a median pODI was 7.9 events/h, and an pRDI of 20.7 events/h. 99% of respondents were satisfied with the remote management. Half of the subjects found both the application installation and the device operation extremely easy, and 60% of them were willing to recommend the use of WatchPAT® ONE. The telemedicine pathway represents an efficient and patient-friendly method for diagnosing OSA. This approach improves diagnostic ease and accessibility while reducing time to diagnosis and societal and healthcare costs. Further large-scale studies are necessary to confirm these results.

21 Acute complications following aesthetic filler treatments: A proposed management pathway for OMFS junior trainees

21 Acute complications following aesthetic filler treatments: A proposed management pathway for OMFS junior trainees

Expert consensus on multidisciplinary clinical management for chronic kidney disease

Chronic kidney disease (CKD) has been a major public health challenge threatening human health worldwide. When patients with CKD eventually progress to end-stage kidney disease, it imposes a substantial burden on individuals and society. Currently, the diagnosis rate of CKD in China remains low, with an unfavorable status regarding diagnosis and treatment. Therefore, it is urgent to establish a comprehensive prevention and treatment system of CKD, that enhances the multidisciplinary clinical management pathway for CKD patients while improving physicians' co-screening and co-management capabilities across various disciplines for high-risk individuals. Based on current evidence and clinical experience, we formulate the expert consensus on multidisciplinary clinical management approach for CKD, which aims to achieve early detection, early treatment, delay the progression of kidney failure, reduce the risk of cardiovascular, cerebrovascular diseases as well as death in CKD patients, while improving the prognosis of CKD patients and alleviating the burden of CKD disease with a multidisciplinary co-screening co-management model for CKD.

Anticonvulsant effects of pentoxifylline on seizures induced by pentylenetetrazole and maximal electroshock in male mice: The role of the nitrergic pathway

IntroductionEpilepsy remains a challenge, with one-third of patients experiencing refractory seizures despite current anti-seizure medications. The nitrergic system, which involves nitric oxide (NO) and NO synthase (NOS) enzymes, plays a complex role in seizure pathophysiology. Pentoxifylline (PTPh), an FDA-approved phosphodiesterase inhibitor, has anticonvulsant effects; however, its relationship with the pathway is unclear. This study focused at how the nitrergic system could be involved in PTPh’s anticonvulsant effects. MethodsSeizures were induced in male mice by intravenous pentylenetetrazole (PTZ) infusion (absence-like seizures), intraperitoneal PTZ injection, and maximal electroshock (generalized tonic-clonic seizures). PTPh was administered at various doses, alone or in combination with the NO precursor L-arginine, as well as non-selective (L-NAME) and selective NOS inhibitors (nNOS inhibitor 7-NI and iNOS inhibitor aminoguanidine). Seizure thresholds, latencies, incidence, and mortality were assessed. Moreover, in the next paradigm, using maximal electroshock model, we evaluate possible protective effects of PTPh against generalized tonic-clonic seizures and subsequent mortality. ResultsIn the intravenous PTZ model, PTPh (≥150 mg/kg) increased the seizure threshold, potentiated by L-arginine but reduced by L-NAME and 7-nitroindazole. In the intraperitoneal PTZ model, 150 mg/kg PTPh decreased tonic seizure frequency, which was mitigated by aminoguanidine. However, PTPh failed to prolong clonic seizure latency. In the maximal electroshock test, 100 mg/kg PTPh protected against tonic seizure incidence (reduced by aminoguanidine). Although PTPh could not reduce mortality, its combination with L-NAME or 7-nitroindazole increased mortality compared with the vehicle-treated group. ConclusionPTPh exerted anticonvulsant effects against absence-like and generalized tonic-clonic seizures, likely through modulation of the nitrergic system involving neuronal, endothelial, and inducible NOS isoform. These findings provide novel insights into the complex interplay between NO signaling and the anticonvulsant actions of PTPh, highlighting the potential therapeutic implications of targeting the NO pathway in epilepsy management.

Nonvariceal Upper Gastrointestinal Bleeding: What an Interventional Radiologist Should Know

AbstractAcute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with significant morbidity and mortality. The most common cause of NVUGIB is peptic ulcer disease, but the differential diagnosis is diverse. The management of NVUGIB begins with resuscitation of the patient followed by early upper gastrointestinal (GI) endoscopy for diagnosis and initial treatment. Endovascular interventions have largely replaced surgery for the cases where endoscopic therapy fails, reflecting a paradigm shift toward minimally invasive and effective management strategies. It is essential to have a comprehensive understanding of arterial anatomy, common vascular variations, and different collateral pathways for successful endovascular management of NVUGIB. This review provides a thorough overview of NVUGIB, encompassing the management algorithm, imaging protocol, anatomical considerations, embolization techniques, types of embolic agents, and potential complications that interventional radiologists should consider when managing cases of NVUGIB.

A randomized clinical trial evaluating Hydralazine’s efficacy in early-stage Alzheimer’s disease: The EHSAN Study

Alzheimer’s Disease (AD), a neurodegenerative disorder escalating worldwide, remains incurable with existing interventions merely mitigating symptoms. Hydralazine, an antihypertensive agent, has displayed neuroprotective potential in AD animal models via amplification of mitochondrial functionality and stimulation of stress management and repair pathways. Nevertheless, its effectiveness and tolerability in human AD cohorts are yet to be confirmed. This study protocol describes the design of an ongoing, single-center, randomized, triple-blind, placebo-controlled trial to assess hydralazine’s effects on cognitive function in mild to moderate -stage AD patients. We will enroll 424 patients aged 50 and older, meeting NINCDS-ADRDA criteria for probable AD with Mini-Mental State Examination scores from 12–26. They’ll be randomly assigned to receive either hydralazine HCL (25 mg, thrice daily) or a placebo for 12 months. The primary outcome is the Alzheimer’s Disease Assessment Scale change from baseline to 12 months. Secondary outcomes include various measures using Lawton instrumental activities of daily living scale, neuropsychiatry inventory, and caregiver activity survey. This trial will explore the potential benefits and risks of hydralazine in mild to moderate AD treatment. It’s the first trial examining hydralazine’s impact on mild to moderate -stage AD in human and is registered at the Iranian Registry of Clinical Trials (IRCT20200711048075N1, registered 29/07/2020) and ClinicalTrials.gov (NCT 04,842,552AQ, registered 13/04/2021). Ethics approval was granted by the Research Ethics Committee of the National Institute for Medical Research Development (IR.NIMAD.REC.1398.424), following the SPIRIT Statement guidelines. Findings will be disseminated via peer-reviewed publications and conferences. This inaugural human clinical trial evaluates hydralazine’s impact on patients in the mild to moderate AD. Executed with a randomized, triple-blind, placebo-controlled methodology, this study incorporates a significant sample size and an extended monitoring duration. Multiple parameters, including cognitive capabilities, will be assessed. Potential limitations include the inherent homogeneity of the AD cohort, the lack of biomarker assays, and the unpredictable progression of the disease. Notably, the study might not elucidate the protracted effects of hydralazine beyond a 12-month period. Another limitation of our clinical trial is that patients were diagnosed with Alzheimer’s disease based solely on clinical evaluation and MRI findings, without the inclusion of specific biomarkers, which may impact the accuracy and specificity of the diagnosis. Trial registration: Iranian Registry of Clinical Trials (IRCT20200711048075N1, registered 29/07/2020) and ClinicalTrials.gov (NCT 04,842,552, registered 13/04/2021).

Modulation of Serum Metabolic Profiles by Bifidobacterium breve BBr60 in Obesity: A Randomized Controlled Trial.

Obesity, a prevalent metabolic disorder in youth, leads to complications and economic strain. Gut dysbiosis significantly contributes to obesity and metabolic issues. Bifidobacterium breve, a probiotic strain, may help regulate gut dysbiosis and benefit obese individuals. However, more research is needed on its effect on serum metabolism. A total of 75 overweight or obese young adults (aged 19-45) participated in the current study, and were randomly divided into probiotic and placebo groups using a random number table. Both groups received dietary guidance and underwent twelve weeks of intervention with either oral Bifidobacterium breve BBr60 (BBr60) or a placebo. After the intervention, collection and analysis of fasting serum samples were conducted using mass spectrometry coupled with liquid chromatography. Analyses of associations were conducted in order to determine the correlations between key serum metabolites and clinical obesity indicators, aiming to understand the influence of BBr60. Due to 10 participants dropping out for personal reasons, the study included 32 and 33 participants in the placebo and the BBr60 groups, respectively. The BBr60 intervention significantly regulated 134 serum metabolites and influenced crucial metabolic pathways in obesity management (p < 0.05), including ascorbate and aldarate metabolism for oxidative stress reduction, cholesterol metabolism for lipid regulation, parathyroid hormone synthesis, secretion and action for the endocrine system, oxidative phosphorylation for enhanced energy efficiency, and glycolysis/gluconeogenesis for glucose metabolism. Analysis showed a positive relationship between fasting blood glucose (FBG), aspartate aminotransferase (AST), total protein (TP), and the content of 5-Methyl DL-glutamate (p < 0.05). Similarly, body mass index (BMI), weight, and body fat percentage (BFP) were positively linked to serum metabolites (1-Hydroxycyclohexyl) acetic acid, and 5-Oxooctanoic acid (p < 0.05). Significant associations of AST levels with key serum metabolites in cholesterol metabolism pathways further suggest BBr60's potential to improve liver function and overall metabolic health in overweight or obese individuals. These findings support BBr60's effectiveness in modulating serum metabolic profiles and suggest it may improve liver function and BMI in overweight or obese individuals by regulating key serum metabolites.

The potential mechanism of action of gut flora and bile acids through the TGR5/TRPV1 signaling pathway in diabetic peripheral neuropathic pain.

Diabetic peripheral neuropathic pain (DPNP) is a major complication of diabetes that markedly affects the quality of life and health status of patients. Recent studies have investigated the potential regulatory influence of gut flora and bile acids on DPNP via the TGR5/TRPV1 signaling pathway. Dysbiosis of the gut flora not only directly affects bile acid metabolism but also significantly correlates with diabetes-associated neuropathy through interactions with the bile acid receptor TGR5 and the ion channel TRPV1. This review describes how alterations in the gut flora and bile acid metabolism contribute to the pathogenesis of DPNP through the TGR5/TRPV1 signaling pathway, revealing potential applications for this pathway in DPNP management. Furthermore, experimental and clinical studies have demonstrated the modulation of gut flora and bile acid metabolism as well as targeting the TGR5/TRPV1 signaling pathway as an innovative therapeutic approach. Further studies are warranted to elucidate the underlying mechanism and develop treatment modalities based on gut flora regulation and signaling pathway interventions, thus providing novel insights and approaches for DPNP therapy.

Research on Integrated Management Path of Comorbidity Based on Grounded Theory.

This study seeks to thoroughly investigate the generation mechanism of the integrated management pathway for comorbidities, as well as its implementation and execution in practical settings. The findings aim to offer insights for the development of an integrated mechanism for comorbidity services. The collected raw data was coded and analyzed in depth by utilizing grounded theory as the research methodology, in conjunction with NVivo 14.0 software for qualitative analysis, and by adhering to domestic and international guidelines and consensus on comorbidity management. Following the three-level coding process, a total of 49 initial categories, 14 main categories, and 4 core categories (supply-type, demand-type, collaboration-type, and environment-type) were identified. Subsequently, a four-dimensional comprehensive comorbidities management pathway model, referred to as the "Derivative driving force-management pathway-main body network-operation mechanism," was developed. The model integrates the four paths of supply-type, demand-type, collaboration-type, and environment-type with the derived dynamics, subject network, and operation mechanism of comorbidities management. This not only enhances the comprehensiveness and continuity of comorbidities management but also establishes clear direction and evaluation indices for future empirical research.

HPB SO32 - Outcomes Following Surgical Resection for Duodenal Adenocarcinoma – A Single Centre Experience

Abstract Background Duodenal adenocarcinomas are rare cancers and their clinico-oncological management pathways tend to follow that of small bowel tumours. The aim of this study was to determine the outcomes of patients undergoing surgical resection for duodenal adenocarcinoma. Method Retrospective data of all patients who underwent surgical resection for duodenal adenocarcinoma between January 2008 to December 2023 were included. Collated data included demographics, clinico-pathological features and survival outcomes. Results Thirty-one patients were included, with a mean age of 65.7 (± 9.6) years and a greater proportion were male patients (58.1%). The predominant site of the primary tumour was at D2 section of the duodenum (58.1%). The majority of patients required a pancreatico-duodenectomy (80.6%) and 58.1% experienced minor morbidity (Clavien-Dindo I-II) while 22.6% experienced major morbidity (Clavien-Dindo III-V). There were 4 (12.9%) peri-operative mortalities. Results The median post-operative follow-up was 29.7 (IQR 61.5) months. Only 37.0% of patients received adjuvant chemotherapy while 13 patients (48.1%) experienced disease recurrence. The 3- and 5-year overall survival was 44.3% and 33.3%, respectively, while the disease-free survival at 3 and 5 years were 37.0% and 29.6%, respectively. Patients who received adjuvant chemotherapy had a trend towards improved mean overall survival in comparison to patients who did not receive chemotherapy following surgery [80.3 vs 51.2 months; log rank 1.857, p=0.173]. Nevertheless, the median disease-free survival was similar between both groups [24.0 vs 26.0 months, log rank 0.016, p=0.901]. Patients who experienced major morbidity (Clavien-Dindo III-V) were significantly more likely to have a poorer median overall survival compared to patients with minor morbidity (Clavien-Dindo I-II) [72.1 vs 3.4 months; log rank 16.860, p&amp;lt;0.001]. Conclusion Major morbidity (Clavien-Dindo III-V) following surgery is associated with poorer overall survival. Patients who received adjuvant chemotherapy following surgical resection for duodenal adenocarcinoma may have a trend towards improved overall survival.

HPB SO68 - Evaluating the Outcome of Laparoscopic Cholecystectomy Against Key Performance Indicator (KPI) of the British Benign Upper GI Surgical Society (BBUGSS)

Abstract Background Laparoscopic cholecystectomy (LC) presents inherent challenges and potential for significant complications, influenced by both patient factors and surgical expertise. Recognizing this variability, the British Benign Upper GI Surgical Society (BBUGSS) has established Key Performance Indicators (KPIs) aimed at enhancing LC outcomes. This study conducts an audit of LC outcomes in a single centre district general hospital (DGH) in accordance with BBUGSS KPIs and thus aims to determine if quality LC by modern standards is achievable in a DGH. Method The present retrospective observational study examined all adult LC conducted between August 2022 and June 2024 by two specialized biliary surgeons at a single surgical unit within a DGH, which also serves as a referral center of biliary cases from affiliated hospitals. The analysis encompassed preoperative assessments, intraoperative observations, and postoperative outcomes, with a focus on aligning these findings against the benchmarks established by the BBUGSS KPIs. Results 141 patients were included; median age was 54 years (IQR 41-64) and 59.6% were female. 37.6% were emergency cases, 44.2% were for acute cholecystitis, 22.7% for gallstone pancreatitis and 63.1% underwent intra-operative cholangiogram. KPIsBBUGSS StandardOur resultDay case for elective cases50%42%Readmission (within 30 days)&amp;lt;10%4.3%Laparoscopic cholecystectomy for acute cholecystitis (within 7 days)&amp;gt;35%97%Laparoscopic cholecystectomy for gallstone pancreatitis (within 2 weeks)&amp;gt;95%100%Conversion to open&amp;lt;5%0.7%Morbidity&amp;lt;10%1.4%Bile leak after elective surgery&amp;lt;1.5%0%Retained bile duct stones&amp;lt;2.5%0%Bile duct injury&amp;lt;0.3%0%Mortality&amp;lt;0.1%0% Conclusion This study shows that with the exception of day-case rate in elective LC, all KPIs were satisfactorily achieved, indicating that high quality LC is achievable within a DGH. The majority of readmissions within 30 days were related to inadequate postoperative analgesia. We have since enhanced pain management pathways. It is hoped that this will also improve same day discharge for elective cases to achieve BBGUGS standard. We are committed to conducting annual audits to monitor and optimize surgical outcomes and would encourage other centers to consider adopting the same approach.

BN SO22 - Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: A systematic review and meta-analysis

Abstract Background Magnetic sphincter augmentation (MSA) through placement of the LINX device is an alternative to fundoplication in the management of gastro-esophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess efficacy, quality of life and safety in patients that underwent MSA, with a comparison to fundoplication. Method A literature search of MEDLINE, Embase, Emcare, Scopus, Web of Science and Cochrane library databases was performed for studies that reported data on outcomes of MSA, with or without a comparison group undergoing fundoplication, for GERD from January 2000 to January 2023. Meta-analysis was performed using random-effect models and between-study Results Thirty-nine studies with 8,075 patients were included: 6,983 patients underwent MSA and 1,092 a fundoplication procedure. More individuals discontinued proton-pump inhibitors (P&amp;lt;0.001; WMD 0.83) and had higher rates of satisfaction (P&amp;lt;0.001; WMD 0.85) following MSA compared to fundoplication. Functional outcomes including ability to belch (P&amp;lt;0.001; WMD 0.96) and emesis (P&amp;lt;0.001; WMD 0.92), and bloating (P=0.003; WMD 0.20) were better after MSA than after fundoplication, although MSA had higher rates of dysphagia (P=0.001; WMD 0.41). The overall erosion and removal rate following MSA was 0.24% and 3.9% respectively, indicating no difference in re-intervention rates between MSA and fundoplication (P=0.446; WMD 0.001). Conclusion MSA is a safe and effective procedure at reducing symptom burden of GERD and can potentially improve patient satisfaction and functional outcomes. However, randomized controlled trials directly comparing MSA with fundoplication are necessary to determine where MSA precisely fits in the management pathway of GERD.

Guidelines for peri-discharge management and follow-up of acute exacerbations of chronic obstructive pulmonary disease(2024 edition)

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important events in the course of chronic obstructive pulmonary disease(COPD), and its diagnosis, treatment and prevention are the focus of disease management. Optimizing the peri-discharge management of AECOPD will help to improve continuity of care, prevent recurrence of acute events in the short time, and improve long-term prognosis. In recent years, evidence on the peri-discharge period and the cluster management of AECOPD has accumulated, and confirming the benefit of early follow-up and management after discharge. By reviewing the available evidence, this guideline aims to standardize discharge management and follow-up pathways for AECOPD patients. This guideline is intended for physicians and nursing staff involved in the clinical practice of COPD.

Streamlining the Non-operative Management of Adhesive Small Bowel Obstruction: A Closed-Loop Audit Evaluating the Introduction of a Standardised Gastrografin Protocol in a District General Hospital.

Introduction Adhesive small bowel obstruction (ASBO) is a common cause of admissions to general surgery services. Water-soluble contrast (WSC), such as Gastrografin® (GGF), can be utilised in the conservative management of patients with ASBO, with predictive and possible therapeutic value. We audited the non-operative management of ASBO in the general surgery department of East and North Hertfordshire NHS Trust, a district general hospital. Following the introduction of a hospital-wide protocol standardising the use of GGF in patients with ASBO, a re-audit was conducted to assess its impact. Methods A retrospective audit of ASBO patients who received GGF was conducted in two cycles: before and after the implementation of the protocol. Data were collected between February and June 2022 for group 1 (pre-protocol) and between August and November 2023 for group 2 (post-protocol). Results Forty-eight patients were included in the analysis across both groups: 31 in group 1 (pre-protocol) and 17 in group 2 (post-protocol). The success rate of this non-operative trial with GGF increased from 77%(24/31) in group 1 to 88% (15/17) in group 2. The median duration of conservative management was two days in both groups. The median time from CT scan to GGF administration decreased from 24 hours in group 1 to 19 hours 22 minutes in group 2, and the interval between GGF administration and first abdominal radiograph decreased from 9 hours in group 1 to 6 hours 25 minutes in group 2. Conclusion Our closed-loop audit suggests that by streamlining the non-operative management pathway of adhesive small bowel obstruction, our standardised protocol is safe and possibly improves efficiency within a district general hospital setting.

Rising orthotospovirus incidence in India: Challenges and advances in management

Orthotospoviruses (OV) have emerged as a significant agricultural threat in India, posing a severe risk to critical crops, including tomato, chilli, watermelon and groundnut. This review explores the rising incidence of OV, including Groundnut Bud Necrosis Orthotospovirus (GBNV), Watermelon Bud Necrosis Orthotospovirus (WBNV), Capsicum Chlorosis Orthotospovirus (CaCV), Peanut Yellow Spot Orthotospovirus (PYSV), Iris yellow spot Orthotospovirus (IYSV) and Tomato Spotted Wilt Orthotospovirus (TSWV), along with the challenges in their management. These viruses have led to severe yield losses, sometimes causing complete crop failure due to their wide host range and the polyphagous nature of thrips. This further complicates control efforts by facilitating rapid spread across diverse crops and regions. The review highlights the multifaceted challenges in managing OV and thrips, including the lack of durable host resistance, limited diagnostic capabilities, and difficulties in controlling thrips populations. Current management strategies, including cultural practices, chemical control, biological control and resistant genotype development, have shown limited efficacy in providing long-term solutions. Recent advancements in biotechnological approaches, such as RNA interference, are discussed as promising pathways for improved virus management. The review underscores the need for genome editing techniques, such as CRISPR/Cas9, which offer the capacity to develop virus-resistant plants by targeting essential viral or vector genes to disrupt transmission cycles. Additionally, using nanoparticles for targeted delivery of antiviral compounds and novel detection tools presents another innovative solution to effectively mitigate the impact of OV on Indian agriculture.

The Use of a Resurfacing Capitate Pyrocarbon Implant in Conjunction with a Proximal Row Carpectomy: A Systematic Review

AbstractDegenerative wrist disease may have varying etiologies, but solutions to deal with this debilitating condition center around several common management pathways. Once nonoperative measures have been exhausted, generally there is a choice between motion sparing procedures or a total wrist arthrodesis. The appropriateness of motion sparing procedures will be dictated by the extent and pattern of degeneration, and midcarpal arthrosis is typically a contraindication to a proximal row carpectomy. One solution to this problem is to employ a Resurfacing Capitate Pyrocarbon Implant. This study aimed to investigate the prevalence and effectiveness of this operation by systematically reviewing the literature. The findings of this review support the use of this implant in the setting of degenerative wrist disease, with reported outcomes comparable to similar operations. However, this is based on overall low numbers of reported outcomes with a reasonable chance of bias. Level of Evidence III.

Assessment and classification of different ashes from waste incinerators in Thailand

Rapid urbanisation and a growing population have led to a huge production of solid waste worldwide. To mitigate solid wastes, Thailand adapts incineration. As a consequence, a variety of fly ashes being produced in large quantities. Fly ash management is therefore a risk for the future. A comparison of the chemical and physical properties of five sources of ashes from the waste incinerators in three regions in Thailand, namely MFA1, MFA2, IFA, and fly ash that used in a ready-mixed concrete plant, CFA1 and CFA2 was conducted. Additionally, bottom ashes, MBA1, MBA2 and IBA were also characterized similarly. The analysis showed that coal fly ash from ready mixed concrete plant of CFA1 and CFA2 were classified under class F and C, respectively. The heavy metal analysis showed that fly ash from MFA1 and IFA has high amount of Zn (7,523 mg/kg and 28,315 mg/kg), followed by MFA1 has high amount of cadmium (127 mg/kg) and MFA1 and IFA showed high concentration of lead (1,955 mg/kg and 1,425 mg/kg). The present study show that fly ash often contains heavy metals, dioxins, and other hazardous substances, highlighting the need for detailed analysis to determine proper handling and disposal methods. Advanced classification systems, which may include parameters such as leaching behavior, particle size distribution, and contaminant concentrations, are essential for categorizing fly ash into appropriate management pathways, such as landfilling, resource recovery, or reuse in construction materials.

2023 expert consensus on decision pathway of metastatic hormone-sensitive prostate cancer management in Taiwan

This short communication presents a consensus-based expert opinion from a multidisciplinary team of Taiwanese experts in urology, medical oncology, and radiation oncology regarding the management of metastatic hormone-sensitive prostate cancer (mHSPC). Through a comprehensive review of recent clinical trials examining the efficacy of novel hormonal agents (NHAs) and docetaxel, alongside updated guidelines for mHSPC management, the experts have deliberated on the practical implications from currently available literatures. The discussion focused on the combination of androgen deprivation therapy, NHAs, and docetaxel, as reported in the leading studies including ARASENS (ODM-201 in Addition to Standard ADT and Docetaxel in Metastatic Castration Sensitive Prostate Cancer), ENZAMET (Enzalutamide in First Line Androgen Deprivation Therapy for Metastatic Prostate Cancer), and PEACE-1 (A Phase III Study for Patients with Metastatic Hormone naive Prostate Cancer) trial. The risk-benefit ratio between prolonged overall survival and the incidence of major adverse events was thoroughly evaluated. This consensus underscores the recommendation that early initiation of intensified triplet therapy with docetaxel, NHA, and androgen deprivation therapy is beneficial for fit mHSPC patients with highly aggressive disease characteristics, effectively prolonging overall survival with manageable risk of adverse events.