Central vein sign (CVS) is a common feature in multiple sclerosis (MS) lesions, but its frequency in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) varies significantly across studies. Paramagnetic rim lesions (PRLs) are described in MS, but not in MOGAD. Our goals were to evaluate the prevalence of PRLs and CVS in a large multicenter cohort of pediatric MOGAD. We compared CVS frequencies between acute vs remission phases, as well as with longitudinal dynamics of lesion evolution. In this longitudinal retrospective multicenter study, clinical MRIs were assessed from pediatric patients with MOGAD, who had (1) ≥1 brain lesion, (2) susceptibility-based imaging (SBI), and (3) follow-up MRI at least 3 months apart. T2-weighted and fluid-attenuated inversion recovery sequences were analyzed for lesion detection and resolution. SBI was used to assess CVS and PRLs following North American Imaging in MS Cooperative criteria. A total of 65 patients and 130 scans were included. A total of 520 lesions were evaluated. The most common reason for lesion exclusion was size (n = 143, large confluent lesions, n = 122, <3 mm, n = 21). CVS was detected in 97 of 327 (29.7%) lesions, with 32 of 65 (49.2%) patients having at least 1 CVS+ lesion. Patients with ≥1 CVS+ lesion (32/65, 49.2%) had a higher number of lesions (p = 0.002) and lesions suitable for CVS analysis (p < 0.001). Of the 31 patients with ≥3 brain lesions, 11 of 31 (35.5%) had >40% CVS+ lesions and 7 (22.5%) had >50% CVS+ lesions. Only 4 patients had ≥6 CVS+ lesions. The proportion of CVS+ lesions was lower in patients who had SBI acquired during an acute attack vs patients scanned during remission (16% vs 33%, p = 0.015). The rate of lesion resolution was higher in CVS- lesions (177/230, 76%) compared with CVS+ (42/97, 42%, p < 0.001). No PRLs were identified. Lesion pathobiology in MOGAD is heterogeneous. CVS identified persistent rather than transient lesions, with resolution more common among CVS- lesions. The high frequency of confluent or multivein lesions limited the proportion suitable for CVS analysis. MRI timing influenced CVS detection, which was higher in remission, suggesting that time of acquisition contributes to variability across MOGAD studies. No PRLs were found, supporting their potential as biomarkers distinguishing MOGAD from MS.

Trigger thumb is a common hand condition in children, and the necessity of observing a period before surgery is debated due to factors such as the metachronism of bilateral lesions, inconsistent severity, and rates of spontaneous resolution. The exact prevalence of bilateral lesions in these cases remains uncertain. Understanding these rates could help avoid unnecessary surgeries and reduce anesthetic exposure. This systematic review defines atypical bilateral trigger thumb as either metachronous or exhibiting inconsistent bilateral lesions. Its aim is to estimate the overall prevalence of atypical pediatric bilateral trigger thumb and determine the optimal observation duration to prevent unwarranted surgeries. This study followed the PRISMA guidelines and registered in the PROSPERO. The PubMed, Embase, and Cochrane Library databases were searched for all relevant studies up to August 2025. The Joanna Briggs Institute's quality assessment checklist was utilized to evaluate study quality. A random-effects meta-analysis was employed to synthesize prevalence rates from individual studies. Sensitivity and subgroup analyses were conducted to identify sources of heterogeneity and compare prevalence estimates. A total of five studies were included for the final analysis, with 1240 pediatric trigger thumbs. Our final meta-analysis showed that the pooled prevalence estimate of atypical pediatric bilateral trigger thumb was determined to be 5.9% (95% CI 2.7- 12.3). Significant heterogeneity was observed across the studies included in this analysis (I² = 85%; P < 0.001). Subgroup analyses showed that the pooled prevalence of metachronisim and inconsistent degree was 3.4% (95% CI 2.5- 4.8, p < 0.001) and 10.7% (95% CI 3.1- 30.7, p = 0.002), respectively. Three studies reported the age at the first visit ranged from 20.1 to 31 months, while the period of metachronism spanned from 12 to 18 months. Our study demonstrates that some cases of pediatric trigger thumb exhibit bilateral metachronism and varying degrees of severity, supporting a period of 12 to 18 months of observation before surgical intervention to minimize the risk of unnecessary or secondary procedures. Given the limited evidence in this systematic review and meta-analysis, it is imperative that future research includes rigorously designed, large-sample randomized controlled trials to strengthen the evidence base. PROSPERO (CRD42024562483).

ROBOTIC-ASSISTED POSTERIOR TRACHEOPEXY (RAPT), A MINIMAL INVASIVE APPROACH TO TREAT SEVERE TRACHOBRONCOMALACIA: A RETROSPECTIVE SINGLE CENTER EXPERIENCE.

We report the first characterization results of an optical time-stamping camera based on the Timepix4 chip coupled to a fully depleted optical silicon sensor and fast image intensifier, enabling sub-nanosecond scale, time-resolved imaging for single photons. The system achieves an RMS time resolution of 0.3 ns in direct detection mode without the intensifier and from 0.6 to 1.5 ns in the single-photon regime with an intensifier for different amplitude-based signal selections. This shows that Timepix4 provides a significant improvement over previous Timepix3-based cameras in terms of timing precision, and also in pixel count and data throughput. We analyze key factors that affect performance, including sensor bias and timewalk effect, and demonstrate effective correction methods to recover high temporal accuracy. The camera's temporal resolution, event-driven readout and high rate capability make it a scalable platform for a wide range of applications, including quantum optics, ultrafast imaging, and time-correlated photon counting experiments.

Effective complaint management systems are increasingly recognised as critical enablers of operational excellence in higher education institutions. However, empirical evaluations of such systems within university settings remain limited. This study evaluates the performance and governance effectiveness of UiTM’s e-Aduan system as the university’s centralised digital platform for recording, monitoring, and resolving complaints. The study aims to assess how the system contributes to service responsiveness, resolution efficiency, and institutional accountability. Using a three-year dataset (2023–2025), the analysis examines complaint volumes, closure rates, and response timeliness, supplemented by workflow documentation, dashboard analytics, governance records of 242 moderators across 87 departments, and both internal and external audit reports. The findings indicate a steady improvement in service performance, with complaint resolution rates rising from 81% in 2023 to over 90% in 2025, alongside consistent outcomes across departments. These results suggest that a well-structured and systematically governed complaint management system strengthens transparency, enhances organisational performance, and supports the pursuit of operational excellence in university administration. This study contributes to the limited literature on digital complaint management in higher education and offers practical insights for institutions seeking to improve service quality and stakeholder trust through data-driven governance mechanisms.

Bridging hospital and community pharmacy at transition of care: Improving the management of drug-related problems at discharge through hospital pharmacy hotlines.

Uterine artery embolization versus dienogest for symptomatic adenomyosis: A randomized controlled trial of short-term efficacy.

Very Low Earth Orbit (VLEO) satellites, operating at altitudes below 450 km, provide tremendous potential in the domain of remote sensing. Their proximity to Earth offers high resolution, low latency, and rapid revisit rates, allowing continuous monitoring of dynamic systems and real-time delivery of vertically integrated earth observation products. Nonetheless, the application of VLEO is not yet fully realized due to numerous complexities associated with VLEO satellite development, considering atmospheric drag, short satellite lifetimes, and social, political, and legal regulatory fragmentation. This paper reviews the recent technological developments supporting sustainable VLEO operations with regards to aerodynamic satellite design, atomic oxygen barriers, and atmospheric-breathing electric propulsion (ABEP). Furthermore, the paper provides an overview of the identification of regulatory and economic barriers that extort additional costs for VLEO ranging from frequency band allocation and space traffic management to life-cycle cost and uncertain commercial demand opportunities. Nevertheless, the commercial potential of VLEO operations is widely acknowledged, and estimated to lead to an economic turnover in the order of 1.5 B USD in the next decade. Learning from the literature and prominent past experiences such as the DISCOVERER and CORONA programs, the study identifies key gaps and proposes a roadmap to sustainable VLEO development. The proposed framework emphasizes modular and serviceable satellite platforms, hybrid propulsion systems, and globally harmonized governance in space. Ultimately, public–private partnerships and synergies across sectors will determine whether VLEO systems become part of the broader space infrastructure unlocking new capabilities for near-Earth services, environmental monitoring, and commercial innovation at the edge of space.

This research aims to analyze the implementation of the "Jalak Wadul Mas" (Jawa Timur Layanan Pengaduan Warga dan Dukungan Masyarakat/East Java Citizen Complaint Service and Community Support) innovation program in improving the welfare of people with social welfare problems (PMKS) in East Java Province. The Social Service of East Java Province developed this program as an integrated digital platform for complaint handling, social assistance distribution, and empowerment of vulnerable groups. Using the policy implementation theory from Edward III, this study examines four critical factors: communication, resources, disposition, and bureaucratic structure. This qualitative research employs a descriptive approach, with data collected through in-depth interviews, observation, and documentation at the Social Service of East Java Province during June-August 2025. Informants include program managers, field social workers, PMKS beneficiaries, and community stakeholders. The results indicate that the Jalak Wadul Mas program has successfully served 45,678 PMKS across 38 districts/cities in East Java, with a 78% complaint resolution rate and average response time of 3 working days. The program integrates multiple services, including emergency assistance, rehabilitation referrals, skills training, and economic empowerment. Key success factors include strong leadership commitment, adequate technology infrastructure, and collaborative networks with community organizations. Challenges remain in human resource capacity, internet connectivity in remote areas, and cross-sectoral coordination. This study recommends strengthening digital literacy training for beneficiaries, expanding mobile service units, developing real-time monitoring dashboards, and establishing sustainable funding mechanisms.

BACKGROUNDBlunt traumatic aortic injury (BTAI) is a life-threatening injury, commonly associated with high-speed motor vehicle collisions. Historically, open surgical repair was the standard treatment, however with the advancement of endovascular techniques such as thoracic endovascular aortic repair (TEVAR), management strategies shifted towards endovascular repairs. Non-operative management (NOM) strategies are also favored for patients with low-grade injuries and particularly high-grade injuries recently. The Society for Vascular Surgery (SVS) 2011 guidelines recommend that grade I injuries should be managed non-operatively; newer studies also support NOM for grade II injuries.AIMTo review higher-grade injuries. NOM can be favored for selected patients with grade III injuries.METHODSA retrospective review of literature to assess NOM in BTAI, using the PubMed, CINHAL, EBSCO, and Google Scholar databases, included articles published in the last 20 years between January 2003 and December 2023. Studies included Cohort studies, case-control studies, and observational studies. Two authors independently screened the titles, abstracts, and performed data extraction. Outcomes were compared by the type of treatment: NOM vs endovascular repair (TEVAR) vs open repair.RESULTSWe identified 27 studies in our review that met the selection criteria. Most of the studies were based on retrospective analysis of institutional data, and only 16 papers reported BTAI in accordance with SVS reporting standards. A trend of increasing mortality across the BTAI grade was observed. There were heterogeneous results regarding outcomes after non-operative compared with endovascular and surgical repair. For grade I and II BTAI, NOM was associated with lower mortality, reduced rates of unplanned intervention, and resolution of pathology on follow-up. There were reports of NOM of grade III BTAI with reasonable outcomes and a high rate of resolution on follow-up, but data were limited due to very few studies focusing on this subgroup.CONCLUSIONThis review article provides the most up-to-date literature. Currently literature supporting the NOM for low-grade BTAI (grades I and II) treatment. Current SVS guidelines recommend endovascular repair for grade III BTAI patients; however, a few studies showed that grade III BTAI can be managed non-operatively with active surveillance in a selected group of patients. Literature requires further studies to compare NOM vs TEVAR in higher-grade BTAI population.

Cystic biliary atresia (CBA) is a rare variant of type III biliary atresia (BA). This study aimed to investigate the clinical features and prognosis of CBA in comparison to non-CBA cases. A retrospective analysis was conducted on 196 children diagnosed with type III BA between December 2016 and December 2020. This cohort included 22 cases in the CBA group and 174 cases in the non-CBA group. All children underwent Kasai portoenterostomy (KPE) and were subjected to standardized follow-up with a maximum of 5years. We compared and analyzed the age at surgery, postoperative jaundice resolution rates, native liver survival rates, and complication rates between the two groups. Patients in the CBA group underwent surgery at a significantly younger age compared to those in the non-CBA group (P < 0.001). There were no statistically significant differences in preoperative liver function indices, such as ALT and AST, between the two groups (P > 0.05). Postoperative cholangitis occurred less frequently in the CBA group than in the non-CBA group (P = 0.009). The rates of jaundice resolution at 6 and 12months post-surgery were significantly higher in the CBA group than in the non-CBA group (P < 0.05). The five-year native liver survival rate was 67.87% for the CBA group, compared to 40.10% for the non-CBA group (P < 0.0233). The overall prognosis for CBA is superior to that of non-CBA. Children with CBA received surgical intervention earlier; the postoperative jaundice resolution rate and five-year native liver survival rate of the children were higher than that of non-CBA. These findings provide valuable clinical guidance for the individualized treatment and follow-up management strategies for CBA.

BackgroundThe efficacy of primary angioplasty is limited due to the fact that a considerable number of patients do not achieve adequate levels of myocardial tissue perfusion. The degree of reperfusion depends on multiple clinical, angiographic and therapeutic factors. Objectives To identify the independent factors associated with the absence of myocardial tissue reperfusion after primary angioplasty. Material and MethodsA total of 140 patients included in the Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial (PREMIAR) were analyzed. This study evaluated the use of filter distal protection device during angioplasty in patients with acute ST- segment elevation myocardial infarction at high risk of thrombosis (only including baseline TIMI grade 0-2 flow). The primary end point of the study was the rate of complete ST-segment resolution at 60 minutes, defined as ≥ 70% recovery compared with baseline during continuous ST-segment monitoring. A model of logistic regression was developed to identify independent predictors. ResultsComplete resolution of ST-segment deviation 60 minutes after angioplasty was observed in 82 patients (63%), while 53 patients (37%) presented partial ST-segment resolution which was associated with rates of mortality, reinfarction and/or heart failure at 30 days of 8.5% and 18.9%, respectively (p=0.07). The variables associated with absence of adequate myocardial tissue reperfusion were anterior infarction (79% versus 33%; p=0.001), higher heart rat (81±20 versus 70±15; p=0.001) and history of current smoking (25% versus 51%; p=0.002), compared to optimal tissue reperfusion. In addition, there was a trend towards greater prevalence of diabetes (26% versus 16%; p=0.13), longer time interval from the onset of symptoms to angioplasty (minutes) (217±167 versus 182±134; p=0.19) and Killip class &gt;1 (30% versus 17%; p=0.07), respectively. Multivariate analysis demonstrated that anterior myocar-dial infarction was associated with absence of complete reperfusion (OR 8.22, 95% CI 3.67-18.4; p&lt;0.001), while the use of glycoprotein IIb/IIIa inhibitors (OR 4.21, 95% CI 1.34-13.22; p=0.014) and current smoking (OR 3.84, 95% CI 1.58-9.50; p=0.003) correlated with complete reperfusion. ConclusionsA considerable proportion of patients undergoing primary angioplasty do not achieve adequate myocardial tissue reperfusion. This phenomenon is associated with adverse outcomes. Anterior myocardial infarction correlates with less degree of tissue reperfusion. Conversely, current smoking and the use of glycoprotein IIb/IIIa inhibitors are associated with better tissue reperfusion after primary angioplasty.

A BSTRACT Background: Medication-related osteonecrosis of the jaw (MRONJ) is a serious and debilitating condition characterized by exposed bone in the maxillofacial region in patients with a history of antiresorptive or antiangiogenic therapy. While various management strategies exist, there is no universally accepted standard of care. Methods: A retrospective chart review was conducted for 30 patients diagnosed with MRONJ, who were treated at our institution between 2024 and 2025. All patients received a standardized protocol consisting of a medical regimen (pre- and post-operative antibiotics, chlorhexidine mouthwash, and a drug holiday) followed by surgical intervention (sequestrectomy or debridement with primary wound closure). Results: The primary outcome, complete resolution, was achieved in 83.3% of patients, with a recurrence rate of 16.7%. The mean healing time was approximately 10.4 weeks. Post-operative complications were infrequent but did occur, including wound dehiscence (13.3%), postoperative infection (10%), and pain (26.7%). These results suggest that the combined medical and surgical protocol is a highly effective treatment for MRONJ, yielding a favorable resolution rate with manageable complications. Conclusion: The combined medical and surgical protocol is a highly effective and reliable treatment strategy for MRONJ. The high rate of complete resolution and low rate of complications support this approach as a viable management option.

To assess the efficacy and safety profile of Aurantii Fructus Immaturus flavonoid (AFIF) tablets in the treatment of patients with functional dyspepsia (FD). In this phase III, randomized, controlled clinical trial, participants diagnosed with FD from 7 medical centers across China were assigned by stratified block randomization to either AFIF treatment group (3 AFIF tablets, 0.29 g per tablet) or placebo group on the same schedule in a 3:1 ratio. The primary endpoint was the complete disappearance of 4 core FD symptoms, including postprandial fullness, early satiety, upper abdominal pain, and upper abdominal burning, following a 4-week treatment regimen (3 times daily). Secondary endpoints included the individual symptom disappearance rates and gastric emptying function after 4 weeks, as well as the disappearance rates for all 4 individual symptoms of FD at 4 weeks after treatment. Subgroup analyses included 3 clinical symptoms and 4 Chinese medicine patterns. Safety assessments included monitoring treatment-emergent adverse events (AEs), serious adverse events (SAEs), intervention-related AEs, and any AEs leading to discontinuation. Of the enrolled patients, 299 in the AFIF group and 99 in the control group were induded in the full analysis set (FAS) and safety set (SS). After 4 weeks of treatment, the complete disappearance of all 4 core FD symptoms was achieved in 31.44% (94 cases) of patients in the AFIF group compared to 6.06% (6 cases) in the placebo group (P<0.01). At 4 weeks after end of treatment, the rates of symptom disappearance were 23.43% (67 cases) in the AFIF group and 2.22% (2 cases) in the placebo group (P<0.01). Individual symptom disappearance rates were significantly higher in the AFIF group at both week 4 and 4 weeks after treatment (all P<0.01). Additionally, the patients in the AFIF group exhibited a significantly greater improvement in gastric emptying at 2 h post-meal [66.55% (50.03, 84.55)] compared to the placebo group [51.10% (44.75, 68.93), P=0.027]. At weeks 4 and 4 weeks after treatment, in the FAS, the disappearance rates of all 4 core FD symptoms remained higher in the AFIF group compared to the placebo group (all P<0.05). The per protocol set results similarly aligned with those observed in the FAS. Intervention-related AEs were reported in 6.02% (18 cases) of the AFIF group and 8.08% (8 cases) in the placebo group, with no SAEs recorded in either group. The patients in the AFIF group showed significantly higher complete symptom resolution rates of all 4 core FD symptoms at 4 weeks and 4 weeks after treatment across most subgroups, compared to the placebo group (all P<0.05). All AEs related to AFIF Tablets were mild. AFIF tablets demonstrated robust efficacy in alleviating the symptoms of FD, with a favorable safety profile. (Registration No. CTR20132482).

Percutaneous cholecystostomy (PC) is a minimally invasive intervention for managing acute cholecystitis in patients unfit for immediate cholecystectomy. Although it is widely used, its outcomes and factors influencing clinical success are not well understood.ObjectivesThe goal of this study was to assess the outcomes of PC by examining various factors such as gender, type of cholecystitis, and procedure timing to correlate with symptom improvement, mortality, and the need for additional medical interventions.Materials and methodsA cross-sectional study was conducted at The Royal Oldham Hospital UK, from December 2019 to June 2024. A total of 70 patients who underwent PC for acute cholecystitis were included. Data on patient demographics, type of cholecystitis, timing of the procedure, duration of catheter placement, and clinical outcomes were collected and analysed using appropriate statistical tests.ResultsSeventy patients (mean age 53.70±16.48 years; catheter duration 17.70±6.73 days) were analysed. Symptom resolution occurred in 61 (87.1%) patients and failed in nine (12.9%). Among middle-aged adults, 19 (90.4%) improved versus 42 (85.7%) older adults (p=0.766). In men, 36 (90.0%) cases were resolved, whereas 25 resolved in women (83.3%) (p=0.410). Bile leakage occurred in five (7.1%) patients, of which two (9.1%) were acalculous and three (6.3%) calculous (p=0.668). Mortality occurred in two patients (10.2%) in delayed PC and none (0.0%) in early PC (p=0.05). Additional interventions occurred in 32 (45.7%) patients: four (33.3%) short-term, nine (36%) moderate term and 19 (57.5%) long-term (p=0.945). PC led to high success (87.1%), low complications (7.1%), and low mortality (10.2%).ConclusionPC is an effective and safe way of managing acute cholecystitis in high-risk patients, with high symptom resolution and low complication rates. Our study findings did not reveal any significant effect of procedural and patient factors on outcomes. Appropriate patients and individually tailored management strategy is the key to advise best possible outcomes and long-term management.

Idiopathic intracranial hypertension (IIH) with progressive or vision-threatening disease may require surgical intervention such as optic nerve sheath fenestration (ONSF) or CSF diversion. Venous sinus stent (VSS) placement has emerged as an alternative treatment option in patients with venous sinus stenosis. The authors report their single-center experience with these three modalities, focusing on long-term visual outcomes, treatment durability, and reoperation patterns. The authors retrospectively reviewed the medical records of all newly diagnosed IIH patients undergoing ONSF, CSF diversion (ventriculoperitoneal shunt insertion), or VSS placement between 2010 and 2024. Demographic, clinical, and neuro-ophthalmological data were collected through last follow-up, including visual acuity, Humphrey visual field (HVF) mean deviation, retinal nerve fiber layer (RNFL) thickness, and Frisén grade. Treatment failure was defined as persistent papilledema, the need for a different surgical modality, or repeat surgery of the same type. Cure was defined as complete papilledema resolution or marked improvement in IIH-related symptoms. Statistical analysis included Kruskal-Wallis, pairwise Wilcoxon, and Fisher's exact tests, with Kaplan-Meier survival analysis for time-to-event outcomes. Thirty-six patients (mean age 32.3 ± 11.3 years, mean BMI 36.7 ± 8.9 kg/m2) were included; 94.4% presented with optic disc edema and 91.7% with visual deficits. Initial procedures were ONSF (n = 10), shunt insertion (n = 13), and VSS placement (n = 13). Failure occurred most frequently after ONSF (6/10, 60%), followed by VSS insertion (4/13, 30.8%) and shunt placement (4/13, 30.8%) (p = 0.273). Among failures, reoperation with the same modality experienced the highest rate of failure after shunt placement (40%) versus VSS insertion (23.1%) and ONSF (0%) (p = 0.056). Kaplan-Meier analysis showed earlier reoperations after VSS placement, typically acute/subacute, and later mechanical failures after shunt placement. Visual outcomes improved across all modalities. Visual acuity improved by a median of -0.13 logMAR (logarithm of the minimum angle of resolution) overall, with the greatest improvement after ONSF (-0.70 logMAR). HVF sensitivity improved by +4.8 dB, with the largest gains after shunt insertion (+6.2 dB) and ONSF (+5.7 dB). RNFL thickness decreased across groups, consistent with disc swelling resolution. The median time to papilledema resolution was shortest for ONSF (61 days) and shunt placement (88 days) compared with VSS insertion (176.5 days), although this was not statistically significant. Successful ONSF cases often resolved rapidly and completely. Surgical intervention for IIH achieved high rates of papilledema resolution and visual improvement, with low long-term failure rates. Each modality showed distinct strengths, limitations, and temporal failure patterns. Papilledema resolution and time to resolution may serve as meaningful clinical endpoints in future multicenter IIH studies.

Microaneurysm Reflectivity as a prognostic biomarker for intravitreal Treatment Response in Diabetic Retinopathy.

To study the antenatal follow-up of fetal urinary tract dilation (UTD) and its post-natal outcomes using the standard "UTD Classification System." In this prospective observational study, fetuses diagnosed with urinary tract dilatation were classified based on the multidisciplinary "UTD Classification System" and were followed up throughout the pregnancy and postnatally for 1 year. We excluded fetuses with additional structural abnormalities, genetic disorders, or intrauterine fetal death. During the study period, 46 108 antenatal scans were conducted; according to the eligibility criteria, 593 fetuses were included for analysis, with 81% belonging to the A1 group and 19% to the A2-3 group. The rate of antenatal resolution was significantly higher in the A1 group (64%) compared to the A2-3 group (3%) (p < 0.05). The female gender was protective and had higher spontaneous prenatal resolution among UTD A1 fetuses. However, post-natal persistence at 1 year (49% vs. 0.2%) and the need for surgery (32% vs. 1%) were higher in the A2-3 group. Higher maximum anteroposterior renal pelvic diameter (APRPD) and ureteric abnormalities in the last scan were independent predictors for surgery. Ours is one of the largest prospective studies on UTD classification. Key points noted in this study are that most of the resolving UTDs were from UTD A1, and obstructive uropathies were from the UTD A2-3 group. Higher maximum APRPD and ureteric abnormalities were independent predictors for surgery in the UTD A2-3 group.

The impact of single-dose preoperative evolocumab combined with rosuvastatin therapy prior to emergency percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) remains insufficiently characterized within current guideline-directed medical therapy. In this prospective randomized trial conducted at Liaocheng People's Hospital (2023-2024), 80 STEMI patients undergoing emergency PCI were randomized to: Treatment group: Single subcutaneous evolocumab 140 mg plus oral rosuvastatin 10 mg administered pre-PCI, followed by rosuvastatin 10 mg/day; Control group: Rosuvastatin 10 mg/day alone initiated post-PCI. Primary endpoint was major adverse cardiovascular events (MACEs) at 6 months. Secondary endpoints included angina incidence, low-density lipoprotein cholesterol (LDL-C) levels, interleukins, and ST-segment resolution rate (STR). The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2500099498). Primary endpoint (MACEs): 5.0% (treatment group) vs. 12.5% (control group)(P = 0.228) at 6-month follow-up. Secondary endpoints: Angina incidence: 7.5% vs 27.5% (P = 0.037) at 6-month follow-up; LDL-C reduction: Significant in treatment group at day 1 (2.97 ± 0.63 vs 3.33 ± 0.78 mmol/L; P = 0.029), day 7 (1.66 ± 0.89 vs 2.25 ± 0.77 mmol/L, P = 0.003), and month 1 (P = 0.036); ST-segment resolution >70%: 60% vs 30% (P < 0.05); Inflammatory markers: Lower IL-6 (P = 0.02) and IL-17 (P = 0.01) in treatment group. While the evolocumab-rosuvastatin combination did not significantly reduce 6-month MACEs, it demonstrated clinically important benefits including reduced angina frequency, accelerated LDL-C lowering, improved myocardial reperfusion, and attenuated inflammatory response, with a favorable safety profile. These findings support further investigation of intensive lipid-lowering strategies in acute STEMI management.

ABSTRACTBACKGROUND:Telemedicine can promote access to specialized care and avoid travel to referral centers.OBJECTIVES:To present the environmental impacts and the positive results for the sustainability of the Brazilian public health system after the implementation of the TeleNordeste Project developed by hospital BP – A Beneficência Portuguesa de São Paulo.DESIGN AND SETTING:A retrospective cohort study was developed in three states in the Brazilian Northeast, Alagoas, Maranhão, and Piauí.METHODS:This study was conducted between August 2022 and December 2023. All patients participating in telemedicine care were selected for this type of care by Primary Health Care (PHC) doctors according to the need for clinical discussion. The variables analyzed were the total distance and time (round trip) saved by telemedicine care, the amount of carbon emissions not released into the environment, gasoline costs, resolution of care through teleconsultation, and evaluation of the Net Promoter Score.RESULTS:In total, 25,194 consultations were conducted via telemedicine, requiring in-person referral in 775 tele-interconsultations, representing a resolution rate of 96.92%. It saved approximately 10,737,287 miles (17,279,988.6 km) and 264,302 hours for patients and the municipal health department, and reduced carbon dioxide (CO2) emissions according to Environmental Protection Agency (EPA) parameters, estimated at 4,294,915 kg, saving US$ 1,660,068.89 (R$ 8,532,754.09) on gasoline.CONCLUSION:To our knowledge, in Brazil, this study is one of the first to present results on the impact of telemedicine on reducing carbon emissions in relation to the movement of patients to reference centers in healthcare networks and the resolution of care provided in health units in the context of the PROADI-SUS TeleNordeste Project developed by BP and promotes reflection on the potential benefits of telemedicine according to current evidence.