Sample Size Research Articles

Rehabilitation and Physical Activity in Ehlers-Danlos Syndrome: A Review of Interventions and Outcomes

Purpose of Research: This study aims to explore the impact of physical activity on the quality of life of individuals with Ehlers-Danlos Syndrome (EDS), a group of disorders affecting connective tissues. The focus is on understanding how tailored exercise programs can improve symptoms and overall well-being across different EDS subtypes. Research Materials and Methods: A PubMed review identified studies on Ehlers-Danlos syndrome, quality of life, and exercise. Relevant peer-reviewed research from the last 20 years was included, screened, and synthesized. Basic Results: The findings indicate that physical activity plays a crucial role in improving the quality of life for individuals with EDS. Tailored exercise programs, including proprioceptive and stabilization exercises, have been shown to reduce pain and enhance functional capacity. Additionally, interdisciplinary approaches combining physical therapy with cognitive-behavioral strategies can mitigate psychological factors such as anxiety and depression, which are prevalent among EDS patients. Studies highlight the importance of adapting exercises to individual needs to avoid exacerbating symptoms like joint instability and chronic pain. Conclusions: In conclusion, physical activity is a vital component of EDS management, offering benefits in pain reduction, improved joint function, and enhanced quality of life. However, further research is necessary to determine the optimal exercise strategies for different EDS subtypes and to address the limitations of current studies, which often suffer from small sample sizes and heterogeneity in interventions. Developing personalized treatment plans that integrate physical therapy with psychological support can significantly improve patient outcomes and should be a priority in future studies. Additionally, there is a need to explore the effectiveness of interventions in pediatric and adolescent populations with EDS.

High prevalence of HLA-B51 and ocular involvement in Behçet's disease: a multicenter cross-sectional study.

Behçet's disease (BD) is a rare multisystem vasculitis. Globally, BD exhibits a unique geographic distribution, with the highest prevalence along the historic Silk Road. To study the demographics, clinical characteristics, and outcomes of BD in the United Arab Emirates (UAE). A multicenter retrospective chart review study was conducted at hospitals in the UAE from 2008 to 2024. All adult and pediatric patients who were diagnosed with BD by a rheumatologist and treated within the timeframe were included in the study while those who received any alternative final diagnosis were excluded. The results were analyzed using descriptive and inferential statistics. One hundred and twenty-three patients were treated and monitored for BD. Most were female (n = 70, 57%). Their median age was 32years (24-41), and approximately two-thirds were Emirati (n = 82, 67%). Twelve patients (10%) had a family history of BD, including 7 (6%) with first-degree BD. The time from the initial symptoms to diagnosis was 11.9months (2.3-31.0). The most common clinical manifestations were oral ulcers (n = 99, 81%), arthralgia (n = 63, 51%), genital ulcers (n = 62, 50%), and ocular involvement (n = 37, 30%). Most of the patients were HLA-B51 positive (n = 92, 84%). At diagnosis, 36 (29%) met the ISG criteria, 73 (59%) met the ICBD criteria, and 50 (41%) met neither criteria. The male patients exhibited more major organ involvement (ocular, neurological, vascular, and cardiac), greater use of corticosteroids and anti-TNFa medications, and greater disease activity than the female patients. Among the patients with isolated ocular manifestations (n = 9) who met neither classification criteria, most were female (56%), with a median age of 37years (26.5-3.5). None had a family history of autoimmune conditions, and all were HLA-B51 positive. Most of these patients (n = 8, 89%) received corticosteroids, 5 (56%) received azathioprine, and 2 (22%) received anti-TNFa therapies. These findings provide insights into the clinical profile of BD in the UAE. Notably, we found a high proportion of patients with positive HLA-B51 and ocular manifestation. Further research with larger sample sizes is needed to better understand these associations.

Tattooing in Young Adults: Patterns, Complications and Reasons for Dermatological Consultation at a Tertiary Care Center

Background: A tattoo is a dermatological procedure in which pigmented dyes are injected into the dermis using needles or a tattooing device, leading to permanent or semi-permanent skin pigmentation. This process may trigger an immune response and can potentially cause dermatological issues such as allergic reactions, granuloma formation, or Koebnerization in susceptible individuals. It is an ancient practice observed across various cultures for religious devotion, cosmetic enhancement, identification of prisoners, criminals and slaves and even for therapeutic pain relief. Objective: This study aimed to examine the diverse tattoo patterns among individuals and analyse the underlying reasons for their visits to the dermatology department in tertiary care center. Methods and Results: A total of 63 patients with tattoos, who sought tattoo removal at the dermatology department, were enrolled between February 2023 and January 2024. The majority sought removal due to rejection in medical examinations for Army or SSB recruitment. Informed consent was obtained from each participant and clinical photographs were captured using a high-resolution 16-megapixel camera. These images were analysed to study tattoo patterns, associated conditions and complications due to pigment innoculation. The majority of patients were aged 21-30 years (n=41), predominantly Hindu males, mostly students and urban residents. The most common tattoo designs included names of loved ones (n=20), followed by religious symbols like “Om” or “Trishul” (n=16) and “Ma” (n=14). Most patients sought removal due to job requirements (n=24) or changes in relationship status (n=9) while remaining others (n=16) due to poor quality or desire for a new tattoo. The remaining cases (n=14) experienced complications related to tattoos and sought treatment. Conclusion: Given the limited sample size, further research with a larger population covering a wider age range is recommended.

Association between serum spexin levels and diabetic nephropathy in patients with type 2 diabetes: a cross-sectional study.

Diabetic nephropathy (DN) is a serious complication of diabetes, with a high prevalence ranging from 21.8% in China, 35.3% in African countries, and an overall prevalence of 20-40% worldwide. This study investigated serum spexin levels in patients with type 2 diabetes, comparing those with and without DN, and explored its association with metabolic parameters. This cross-sectional study was conducted among patients with type-2 diabetes according to ADA guidelines. After obtaining informed consent, urine albumin-to-creatinine-ratio (ACR) was determined and patients were categorized into two groups: with-nephropathy (ACR ≥ 30) and without-nephropathy (ACR < 30). The correlation between spexin and demographic, anthropometric, and biochemical variables was further determined. Logistic regression analysis was used to assess the relationship between spexin and the likelihood of DN. Receiver Operating Characteristic (ROC) curve analysis determined the optimal serum spexin cutoff for distinguishing between groups. A total of 97 diabetic individuals (33 with DN, 64 without) participated in the study. Serum spexin was significantly lower in patients with DN compared to those without DN (p < 0.001). Spexin concentrations showed an inverse correlation with LDL and ACR levels. Lower spexin levels were associated with a reduced likelihood of DN (OR 0.46, 95% CI 0.31-0.69; p < 0.001). ROC curve analysis identified a cutoff value of 81.10ng/ml, with an area under the curve of 0.986, demonstrating 95.3% sensitivity and 94.1% specificity for diagnosing DN. Lower serum spexin levels are associated with impaired kidney function, indicating its potential as a predictive biomarker for diabetic nephropathy. However, further validation in larger and more diverse cohorts is needed to address limitations such as sample size and unmeasured confounders.

A Global Cross-Sectional Database Study of Low Dose FVIII SHL Prophylaxis in Haemophilia A.

Haemophilia treatment is costly and only 25% of patients receive adequate care. Although not optimal, Factor VIII (FVIII) low-dose prophylaxis (LDP) may reduce annual joint bleeding rates. Understanding FVIII usage, collected through the Web-Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo) platform, and its association with Gross National Income per capita (GNI) and Universal Health Coverage index (UHCI) may provide insights in global disparities. To provide insights in FVIII use to advocate for LDP in low-income countries by providing: (i) statistical summary of FVIII usage, LDP prevalence, GNI and UHCI in WAPPS-Hemo in 2017-2023; (ii) estimation of the relationship between LDP probability (PLDP) and GNI/UHCI for children (≤12 years) and adults; (iii) exploratory comparison of pharmacokinetics (PKs) across LDP/non-LDP. Descriptive statistics/graphical summaries for (i) and (iii), mixed-effects logistic regression for (ii). Data from 6223 severe haemophilia patients (ages 0.1-92 years) showed that 18% and 32% of countries used ≤1% LDP infusions in children and adults. LDP prevalence rose annually, peaking at 7% for children and 14% for adults. GNI was found lower in LDP-prevalent countries in children. In both children and adults, PLDP demonstrated an inverse association with GNI and UHCI. PK outcomes were similar across LDP status, except potentially for plasma-derived products in children, however limited by sample size. Underrepresentation of low-resource countries in WAPPS-Hemo underscores the financial challenges in haemophilia treatment. The association between GNI/UHCI and PLDP suggests cost-driven adoption of LDP in low-resource settings, especially in children. PK outcomes average similarities may facilitate LDP-usage in WAPPS-Hemo. NCT02061072, NCT03533504 (ClinicalTrials.gov).

Remote Work and Hybrid Model: Impact of Challenges and Future Trends at TRDFIN Support Service Private Limited, Chennai

The rapid adoption of remote work and hybrid work models has transformed the way organizations operate. These models, accelerated by the COVID-19 pandemic, have introduced new challenges and opportunities for Human Resource (HR) management. Predictive analysis has emerged as a critical tool for organizations to optimize workforce management, improve employee engagement, and ensure productivity in remote and hybrid settings. The study is conducted at TRDFIN, a leading financial services and consulting firm based in Chennai. TRDFIN is a global financial services and consulting firm established in 2021. The company specializes in financial analytics, investment consulting, and digital transformation services. TRDFIN has embraced remote and hybrid work models to adapt to the changing work environment. By leveraging predictive analysis, organizations can identify patterns and trends in employee behavior, develop targeted retention strategies, and enhance training programs to meet the evolving needs of the workforce. The primary objective of this study is to gain a better understanding of the challenges and future trends of remote and hybrid work models at TRDFIN. Primary data was collected through structured questionnaire method. The popluation size is 205 and the sample size is 100. The research focuses on the challenges and future trends of remote and hybrid work models, with an emphasis on employee training, performance, and productivity.

The simulation studies: a generalized class of Hartley-Ross type under non-response conditions

ABSTRACT In the context of sample surveys, it is only sometimes feasible to obtain complete and accurate information. Non-response represents a significant challenge in this context. As this is a common occurrence in the context of estimation, various approaches are employed to eliminate it. This paper proposes a new class of estimators constructed by combining non-response and unbiased estimator approaches. The simulation study provides a comprehensive evaluation of the performance of various estimators by considering a wide range of scenarios, including different sample sizes, correlation coefficients, non-response rates, and z-values. This extensive simulation framework has explored multiple conditions and variations to ensure a thorough assessment of estimator performance under different settings. The findings show that each member of the proposed family of estimators consistently exhibits a higher PRE value than all other estimators under the scenarios tested.

Purine xanthine oxidase inhibitors are not conducive to the prognosis of chronic heart failure: a meta-analysis.

According to previous studies, the efficacy of xanthine oxidase inhibitors (XOIs) in patients with chronic heart failure (CHF) is still controversial. Therefore, the purpose of this study was to investigate the efficacy of XOIs in patients with CHF. Up to July 2024, we searched PubMed, EMBASE, Medline, Web of Science, and Cochrane Library for studies on the efficacy of XOI in patients with CHF. The main results included all-cause mortality, cardiovascular (CV) mortality, and heart failure (HF) hospitalization rates. The results were evaluated by hazard ratio (HR) and 95% confidence interval (95% CI). A total of eight studies were included in this meta-analysis, of which five were cohort studies and three were randomized controlled trials (RCTs). The total sample size was 301,345. The experimental group was exposed to allopurinol or hydroxypurinol. The all-cause mortality (HR = 1.26, 95% CI 1.05-1.51, p = 0.013) and CV mortality (HR = 1.58, 95% CI 1.17-2.14, p = 0.03) in the experimental group were higher than those in the control group. In terms of HF hospitalization, there was no difference between both groups (HR = 1.21, p = 0.292). Subgroup analysis showed that the CV hospitalization rate of the experimental group was higher than that of the control group, regardless of frequency and dose levels. The all-cause mortality in the low-dose group was higher than that in the control group (HR = 1.39, p = 0.033). The CV mortality of the low-dose group (HR = 1.55, p = 0.006) and the prevalent group (HR = 1.50, p = 0.042) was higher than that of the control group. Purine XOI exposure may be unfavorable for the prognosis of CHF patients and is affected by the frequency and dose of use.

Hubungan IMT, kekuatan, daya ledak, kelincahan, dan daya tahan kardiovaskuler dengan kemampuan dribbling bola basket

Sports are considered physical activities undertaken primarily to enhance basic body movement skills or specific sports abilities. Basketball has become one of the most popular and widely enjoyed sports among the general public. As sports disciplines evolve, optimal efforts are required to achieve maximum performance. However, achieving peak performance in sports is not as easy as it might seem. This research aims to further explore the correlational relationship between body mass index, arm muscle strength, arm muscle power, agility, and cardiovascular endurance to support the dribbling abilities of extracurricular participants at SMAN 1. Data was collected through observation and analyzed using correlational regression statistical approaches, detailing a population of 35 participants, with a sample size of 35 participants. The research findings indicate a significant relationship between body mass index, arm muscle strength, arm muscle power, agility, cardiovascular endurance, and the dribbling abilities of the participants

HPV-independent squamous sell carcinoma of cervix: a clinicopathological, immunohistochemical, and molecular analysis of six cases.

HPV-independent squamous cell carcinoma (SCC) of the cervix is a rare subtype associated with aggressive clinical behavior and poor prognosis, as reported in limited studies with small sample sizes. This study aims to investigate the clinicopathological, immunohistochemical, and molecular characteristics of six cases of HPV-independent SCC. Formalin-fixed, paraffin-embedded tissues from six patients were analyzed using immunohistochemistry and Next-Generation Sequencing (NGS). Human papillomavirus (HPV) testing was performed using the Aptima HPV assay, and immunohistochemical markers, including p16, p53, PD-L1, HER2 and CK5/6 were evaluated. The median age at diagnosis was 62years. Key histopathological features included an infiltrative-destructive growth pattern, pronounced keratinization, and extensive necrosis in the majority of cases. All tumors were p16-negative and high-risk HPV-negative by the Aptima HPV assay, confirming their HPV-independent status. One case exhibited p53 overexpression and HER2 positivity (score 3 +). Five out of six patients succumbed to the disease. FIGO stages ranged from IIB to IVB. Molecular analysis identified mutations in TP53 and PIK3CA, as well as novel CTNNB1 and TERT promoter mutations, and HER2 amplification. In five of six patients PD-L1 expression with at least CPS score of 2,5 was observed. HPV-independent cervical SCC typically affects older patients and is associated with poor clinical outcomes. This study highlights TP53 and PIK3CA mutations and novel findings, including CTNNB1, TERT promoter mutations, and HER2 amplification. The observed PD-L1 expression patterns may suggest potential benefits from immunotherapy. Further research is warranted to better understand the clinicopathologic characteristics and molecular drivers of HPV-independent SCC and to explore novel therapeutic strategies.

Examining the Effectiveness of Monitoring and Evaluation Strategies in Public Sector Projects: A Study of CDF Loans in Mtendere Areas of Lusaka

This study was aimed at establishing strategies used by the local community to participate in the monitoring and evaluation of Constituency development fund projects and loan disbursement. The specific objectives were to establish levels of local community participation in monitoring and evaluation, to evaluate the effectiveness of strategies used in monitoring and evaluation of CDF loans, and to ascertain limitations of Monitoring and Evaluation of the community after obtaining loans from the local council. The study used a descriptive design and incorporated Primary and Secondary sources of data. The target population for the research was 250, from which the sample size of 150 was arrived at. Purposive and systematic sampling was employed in data collection and analysis using qualitative methods. The study found that community members were actively involved in the monitoring and evaluation of loan disbursement. Furthermore, the local authority developed a tracking system for all loan beneficiaries in the study area. It was observed that 65.95% of the participants believed that the tracking system was very effective in tracking every beneficiary in the area. However, 35.05% answered in the negative and attributed it to political influence. The study concluded that monitoring and evaluation tools were effective in tracking, monitoring, and evaluating loan performance by the beneficiaries. There was a need for Lusaka City Council to sensitize the public on the importance of CDF System Management through radio, TV, and posters so that the attitudes improve from good to at least best.

EXPLORING THE LEVEL OF AWARENESS REGARDING BETA THALASEMIA AMONG THE PARENTS OF PATIENTS IN DISTRICT SWAT

Background: Thalassemia is a hereditary condition that affects globin chain synthesis in varying ways, and affect the hemoglobin production. The study objective was to determine the level of awareness among the parents of patients diagnosed with beta-thalesemia (βT). Methodology: A cross sectional descriptive study design was used to collect data from the parents of patient that regularly visit the blood transfusion centers in district swat from February to March 2024. The sample size of the study was 235 using purposive sampling technique, while data was collected through reliable and valid questionnaire. The study was approved by the ethical review committee while informed consent were taken from each participant. Data were analyzed through SPSS 22 as descriptive and inferential statistics. Results: In the current study majority of the parents were female 146 (62.1%), age group 31-40 years 164 (69.8%), house wife's 67 (28.5%), having monthly income 21000 to 50000 107 (45.5%), and parents with no education and matric 60 (25.5%). The majority of the patient level of awareness was good (42%), followed by poor awareness (31%), while 27% of the participant answer were neutral. Most parents are aware of prohibited foods, thalassemia signs, prevention tests, complications, drug avoidance, regular lab investigations, thalassemia genetic disorder, blood-related marriages, and HIV as blood-borne diseases. Conclusion: The study concluded that majority of the participant level of awareness was good, but a national basis campaign is required that address the preventive strategies to prevent thalassemia.

Headteachers Effectiveness in the Context of School Leadership: Perspective of Basic School Headteachers in Tamale Metropolis, Ghana

The effectiveness of headteachers is a critical determinant of school success, particularly in Ghana's basic educational system. This study examined the dynamics of school leadership within basic schools in the Tamale Metropolis, stressing how headteachers’ leadership practices impact school performance, teacher motivation, and student outcomes. Employing a quantitative approach, data were collected through questionnaire administration from a sample size of 136 headteacher respondents who were surveyed. Descriptive and inferential statistics were employed in analyzing the data. The findings showed that all twelve (12) considered predictors collectively accounted for a modest 96.8% of the variance observed in the leadership effectiveness of headteachers (f (7.522) = 336.035, p &lt; 0.05). The study further found that the headteachers functioned with a participatory democratic leadership model because they involved the teaching and non-teaching staff, learners, parents, and community stakeholders in their administration and leadership.

The Use of EQ-5D in the Middle East and North Africa Region: A Systematic Literature Review.

The EQ-5D is the most commonly used preference-based measure of health-related quality of life. There is limited evidence about the use of the EQ-5D in the Middle East and North Africa (MENA) region. This study aimed to systematically identify, review, summarize, and synthesize the published literature on using the EQ-5D in this region. A systematic literature review was conducted, according to the PRISMA 2020 guidelines, using PubMed, Cochrane, PsycINFO, and CINAHL and covering the period up to 30 August 2024. Studies using any version of the EQ-5D in adults or youth in the MENA region were included. Pilot studies, guidelines, study protocols, and reviews were excluded. Key study characteristics and outcomes assessed included study design, clinical area, population, type of EQ-5D data reported, reference value set used, and mode of administration. Title/abstract screening was conducted independently by two reviewers to assess eligibility for inclusion. Two researchers completed full-text screening and extracted data using a standardized form. Disagreements were referred to a third reviewer if not resolved by discussion. Results were summarized in systematic evidence tables. After removing duplicates, 18,034 references were considered for title/abstract screening. In total, 184 studies were included with a total sample size of 128,164 subjects. Of the included single-country studies, 42% were reported in Iran, 20% in Saudi Arabia, and 11% in Jordan. Patient populations were investigated in 86% of the studies, 23% of which targeted endocrine diseases. Study design was observational in 57% and experimental in 14% of the studies. Only 10% of the included studies applied the EQ-5D in an economic evaluation. The EQ-5D-3L version was used in 40% of the studies. However, the trend is towards a greater use of the 5L version in more recent years. Twenty percent of the studies reported EQ-5D results using the index score, frequencies of severity levels per dimension, and visual analog scale scores. EQ-5D modes of administration and funding sources were not reported in 16% and 20% of the studies, respectively. There is an increased use of the EQ-5D in the MENA region, especially since 2020. In the region, the use of the EQ-5D is more prevalent in clinical studies than in economic evaluation studies. The reporting heterogeneity indicates the need for guidance in reporting EQ-5D study results in this region.

Closing the supply chain loop: enablers, strategies, and outcomes of blockchain implementation in reverse logistics

The inefficiencies of conventional reverse logistics have prompted the implementation of systems that facilitate circularity in supply chain logistics. This study examines how the application of blockchain in reverse logistics enhances circular supply chain management (CSCM). It specifically delineates the motivations for blockchain adoption by logistics firms, their operational strategies for its application in reverse logistics, and the consequent impacts on CSCM. Employing an inductive approach and integrating Transaction Cost Economics (TCE) and Porter’s Value Chain (PVC) theories, we thematically analysed business news and expert opinions on 24 logistics firms obtained from LexisNexis. The study identifies four internal and four external drivers for blockchain adoption, three key use strategies, and five CSCM outcomes. Three propositions emerged from the interplay of drivers, strategies, and outcomes of blockchain use in reverse logistics. The findings provide new justifications for blockchain adoption by logistics companies, offering managers strategies to enhance supply chain circularity. A limitation is the relatively small sample size, which could be expanded in future studies as blockchain technology gains more prominence in logistics.

Human Resource Management in the Digital Era and Competitive Advantage Factor Affecting on Business Performance in Vientiane Capital, Lao PDR

Human resource management is a key area in the digital age, firstly in business. It is central to a business strategy, facilitates the attainment of competitive advantage and improves business performance. This research sought to examine the role of certain factors that affect competitive advantage, test these factors through Confirmatory Factor Analysis, and construct a model depicting the interrelationships between business performance in Vientiane Capital, Lao PDR. This research used quantitative research methods only. Data were obtained from a sample size of 256 SMEs in Vientiane Capital and were analyzed using Structural Equation Modelling for hypothesis testing. The research findings from testing the hypotheses shows that the Human Resource Management factors in this era of digitalization greatly impacts on competitive, with the t-value = 9.86, influence coefficient β=0.87, and P-value &lt; 0.001, likewise, the factors of competitive advantage have a positive impact on firm performance in the case of Vientiane Capital, the hypothesis is accepted at the t-value of 2.1, influence β=0.36 and P-value &lt;0.05, In addition, human resources management factors in this digital era also significantly impact the business performance in Vientiane Capital, the evidence for this is that t-Value is 2.88 with an influence coefficient β=0.54 and P-value &lt;0.05. Further, with respect to business performance the SEM model has the following values: (χ2/df)= 1.78; GFI=0.97; AGFI=0.93; CFI=0.99; RMSEA=0.05. Both factors account for business performance variance at R2=0.76. The findings of the research underline the importance of Human Resource Management in the development of firm’s competitive advantage and efficiency of business activity in rudimentary states regulating them within age. The evidence indicates that firms in Vientiane Capital should place more emphasis on their HRM practices in order to achieve greater competitive advantage and improved performance.

Comparison of Tumor Cell Responses to Different Radiotherapy Techniques: Three-Dimensional Conformal Radiotherapy (3D-CRT), Volumetric Modulated Arc Therapy (VMAT), and Helical Tomotherapy (HT)

Currently, advanced RT techniques such as VMAT and HT are being developed to optimize tumor coverage while minimizing radiation exposure to the surrounding organs that are at risk. Despite their growing clinical use, comparative studies evaluating the dosimetric and radiobiological effects of these modalities remain limited. In this study, A549, HeLa, and HepG2 cells were exposed to a single 2 Gy dose, using three RT techniques (3D-CRT, dual arc VMAT, and HT). Treatment plans were generated using a water phantom to ensure consistent target coverage and comparable dosimetric parameters across the techniques. Multiple radiobiological endpoints were assessed to evaluate the cellular responses. Although all three techniques yielded similar dosimetric parameters without statistically significant differences, the biological responses varied among the cell lines. Notably, VMAT and HT demonstrated superior tumor cell suppression compared to 3D-CRT. This was likely due to their enhanced dose conformity and modulation precision, which potentially led to improved tumor cell killing. These findings highlight the importance of integrating radiobiological assessments with physical dose metrics to inform the clinical application of advanced RT technologies. However, this study had several limitations. The use of a single radiation dose limited its clinical relevance, and the immediate post-irradiation assessments may not have captured delayed biological responses. Additionally, the small number of replicates may have reduced the study’s statistical power. Future studies incorporating dose fractionation schemes, time course analyses, and larger sample sizes are warranted to better simulate clinical conditions and further elucidate the radiobiological effects of advanced RT techniques.

Long-chain fatty acyl CoA synthetase 4 expression in pancreatic cancer: a marker for malignant lesions and prognostic indicator for recurrence

BackgroundLong-chain fatty acyl CoA synthetase 4 (ACSL4) is crucial for lipid metabolism, primarily catalyzing the formation of 12–20 carbon chain fatty acids. ACSL4 is upregulated in various cancers and linked to aggressive behavior and poor survival. A bioinformatics study showing ACSL4 upregulation in pancreatic cancer. However, utility for actual pathological diagnosis and clinical significance in pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasm (IPMN) are unexplored. This study aimed to investigate ACSL4 expression in PDAC and IPMN, and evaluate its clinical implications.MethodsWe examined ACSL4 expression using immunohistochemistry in 165 patients with PDAC and IPMN. Differences in ACSL4 expression between malignant and benign lesions were evaluated using the Pearson χ2 test. The association between ACSL4 expression, pathological parameters, and survival was assessed through Kaplan-Meier and Cox regression analyses in 96 patients with invasive cancer.ResultsCompared to normal pancreatic ducts, low-grade pancreatic intraepithelial neoplasm, and intraductal papillary mucinous adenoma (IPMA) (3.3%, 3.4%, and 2.7%, respectively), ACSL4 expression was significantly higher in invasive PDAC, noninvasive intraductal papillary mucinous carcinoma (IPMC), and invasive IPMC (77%, 86.7%, and 93.9%, respectively). In invasive cancers, low ACSL4 expression was associated with a higher frequency of lymphovascular invasion and recurrence and shorter disease-free survival (P = 0.006). Additionally, low ACSL4 expression was an independent prognostic factor for shorter disease-free survival in multivariable Cox regression analysis (HR = 2.409, 95% CI: 1.121–5.180, P = 0.024).ConclusionACSL4 expression helps differentiate cancerous from precancerous lesions in pancreatic cancer, but low expression is linked to a higher frequency of lymphovascular invasion and shorter disease-free survival in invasive cases. Due to the limited sample size and broad confidence intervals, the findings of this study should be interpreted with caution and require validation in larger, independent cohorts.

Auricular Hematoma in Athletes: Treatment and Risks of Neglect

Introduction: Auricular hematoma is most often caused by direct blunt trauma to the outer ear and is frequently seen in individuals who engage in full-contact sports such as boxing, wrestling, and rugby. This condition occurs when blood accumulates between the cartilage and skin, resulting in pressure that compresses the perichondrium, leading to ischemia. If untreated, it can cause infections, perichondritis, necrosis, and permanent deformity, commonly referred to as "cauliflower ear". Standard treatment includes hematoma evacuation and the application of pressure dressings or sutures. However, alternative methods and modifications of standard approaches are currently under investigation. Aim of the Study: The aim of this study is to evaluate the current understanding of auricular hematoma and cauliflower ear in athletes, with an emphasis on new treatment approaches, prevention and the potential complications associated with untreated cases. Materials and Methods: A review of research literature was conducted through databases such as PubMed, Google Scholar, ResearchGate, and the Cochrane Library. Conclusion: Auricular hematoma is a prevalent injury in contact sports, requiring prompt and effective treatment to prevent complications. New evidence indicates that untreated auricular hematoma may lead to complications such as hearing loss and infections. Recent advancements in drainage techniques, surgical approaches, and non-invasive approaches offer promising management options. However, current research is limited by small sample sizes, underscoring the need for larger clinical trials and long-term studies.

Annotations on Indeterminate Cytology of Thyroid Nodules in Thyroidology: Novi Sub Sole?

Letter to the Editor Dear Editor, Indeterminate cytology (IC) remains the most challenging issue for health professionals working in thyroidology, thyroidologists [1-4]. We read a great deal of the article by Ali et al [5]. entitled "Clinicopathological Features of Indeterminate Thyroid Nodules: A Single-center Cross-sectional Study," published in 3rd volume, Barw Medical Journal. This study addresses a challenging and crucial issue by examining the characteristics and malignancy rates of thyroid nodules with IC, the most controversial category for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The authors evaluated the clinicopathological features of the thyroid nodules with Category III, TBSRTC, in a single-center cross-sectional study [5]. One of the strengths of the article is its focus on the challenges in managing IC. Ali and colleagues [5] thoroughly examine comprehensive data, including demographic details, medical history, laboratory tests, preoperative imaging, cytologic evaluation, and histopathological diagnosis. The results indicate a notable malignancy rate in Category III, TBSRTC. Furthermore, the study points out that malignancy tended to be younger, while benign nodules were significantly larger than malignant ones. The study also found a significant association between malignant nodules and Thyroid Imaging Reporting and Data System (TI-RADS) categories 4 and 5 and benign with TI-RADS 2 and 3, which findings align with some existing literature, providing valuable insights into the clinical assessment of IC. However, several limitations of the study warrant consideration. Firstly, its single-center and retrospective design may limit the generalizability of the findings to diverse populations and settings. As the authors acknowledge, the retrospective data collection might have resulted in missing crucial information. While TI-RADS scoring was provided, more specific ultrasound features of thyroid nodules could have been beneficial. Of note, does including or excluding noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), which has been considered a low-risk entity by the current understanding, affect and/or alter the overall results and the assessment of diagnostic performance and study outcome(s)? [2-4] Furthermore, which caliber of the needle had been utilized throughout the study with or without local and/or topical anesthetic agent(s), and would the utilization of thicker or finer needles in order to obtain cytologic samples with or without any local and/or topical anesthesia alter the outcome(s) of this study? [2] Moreover, which edition of TBSRTC has been used for the work and would stress the up-to-date 3rd edition of TBSRTC [3], considering both the novel and crucial subdivisions of category III might affect the study’s relevant outcome(s)? [3,4] Another point of attention is the relatively short data collection period compared to the publication. Finally, while the discussion section compares the findings with various studies in the literature, a more in-depth exploration of the methodological differences and potential discrepancies in results could have been provided. For instance, the conflicting views in the literature regarding the relationship between nodule size and malignancy risk could have been further contrasted with the study's findings. The authors also acknowledge the small sample size as a limitation. For future research, multi-center and prospective studies with detailed imaging, such as elastography and contrast-enhanced sonography, and investigations into the role of molecular markers in thyroid nodules with Category III could improve diagnostic accuracy and potentially reduce unnecessary surgical interventions. In conclusion, this study significantly contributes to the evaluation of IC in thyroidology despite its limitations. However, considering the noted limitations, further research with more comprehensive and methodologically robust studies in this area is warranted. This issue merits further investigation. Sincerely,