Standard Protocol Research Articles

Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives.

The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy. ERAS for craniotomy has been shown to reduce the length of hospital stay and costs without increasing complications. ERAS protocols may also reduce postoperative nausea and vomiting and perioperative opioid requirements, highlighting their potential to enhance patient outcomes and health care efficiency. Despite these benefits, guidelines, and strategies for ERAS in craniotomy remain limited. This narrative review explores the current global landscape of ERAS for craniotomy, assessing existing literature and highlighting knowledge gaps. Experts from 26 countries with diverse cultural and socioeconomic backgrounds contributed to this review, offering insights about current ERAS protocol applications, implementation challenges, and future perspectives, and providing a comprehensive global overview of ERAS for craniotomy. Representatives from all 6 World Health Organization geographical world areas reported that barriers to the implementation of ERAS for craniotomy include the absence of standardized protocols, provider resistance to change, resource constraints, insufficient education, and research scarcity. This review emphasizes the necessity of tailored ERAS protocols for low and middle-income countries, addressing differences in available resources. Acknowledging limitations in subjectivity and article selection, this review provides a comprehensive overview of ERAS for craniotomy from a global perspective and underscores the need for adaptable ERAS protocols tailored to specific health care systems and countries.

Petunidin attenuates vinclozolin instigated testicular toxicity in albino rats via regulating TLR4/MyD88/TRAF6 and Nrf-2/Keap-1 pathway: A pharmacodynamic and molecular simulation approach

Vinclozolin (VZN) is a widely used fungicide which exerts deleterious impacts on various organs including testis. Petunidin (PDN) is a polyphenolic compound that demonstrates a broad range of pharmacological activities. Thirty-two rats were divided into 4 groups including the control, VZN (100 mg/kg), VZN (100 mg/kg) + PDN (4 mg/kg) and PDN (4 mg/kg) treated group. The activities of antioxidant enzymes were assessed by using previously documented protocols. The gene expressions were determined by using qRT-PCR. The levels of hepatic function and apoptotic markers were evaluated by using standard ELISA technique. The histological analysis was carried out as per the standard protocol of histology. It was revealed that VZN disrupted the Nrf-2/Keap-1 pathway. Moreover, the activities of catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD), heme-oxygenase-1 (HO-1) and glutathione reductase (GSR) were reduced whereas levels of reactive oxygen species (ROS) & malondialdehyde (MDA) were promoted following the VZN intoxication. Furthermore, VZN intoxication reduced total sperm count, viability, motility as well as luteinizing hormone (LH), follicle stimulating hormone (FSH), and plasma testosterone. Besides, administration of VZN decreased the expressions of 3β-Hydroxysteroid dehydrogenase (3β-HSD), steroidogenic acute regulatory protein (StAR) and 17β-Hydroxysteroid dehydrogenase (17β-HSD). Moreover, VZN exposure escalated the expressions of Bcl-2–associated X protein (Bax) and cysteine–aspartic acid protease-3 (Caspase-3) while reducing the expressions of B-cell lymphoma-2 (Bcl-2). Additionally, VZN administration increased the gene expression of toll-like receptor 4 (TLR4), tumor necrosis factor receptor-associated factor 6 (TRAF-6) and myeloid differentiation primary response 88 (MyD88). The levels of interleukin-6 (IL-6), nuclear factor kappa-B (NF-κB), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and the activity of cyclooxygenase-2 (COX-2) were promoted following the VZN administration. Furthermore, VZN intoxication disrupted the normal histology of testicular tissues. However, VZN + PDN treatment ameliorated testicular damage via regulating aforementioned dysregulations owing to its anti-inflammatory, antioxidative as well as anti-apoptotic potentials. Lastly, molecular docking (MD) was performed to assess the effectiveness of PDN as a curative compound by analyzing its binding affinity with the targeted proteins (Keap1, TLR4 and StAR). Our in-silico evaluations confirmed that PDN possesses the potential to interact with binding pockets of these proteins, emphasizing its capability as a curative compound to mitigate VZN-prompted reproductive damage.

Quantitative analysis of pressure levels in manual lymphatic drainage across stages of breast cancer-related lymphedema: implications for optimized treatment protocols.

To quantify the pressure levels necessary for effective Manual Lymphatic Drainage (MLD) in managing Breast Cancer-Related Lymphedema (BCRL) across various stages, and to contribute to the development of standardized protocols for MLD therapy. The study included 42 patients with BCRL (Stages I-III) and 14 certified lymphedema therapists. Forearms and upper arm circumferences were measured pre and post a 21-day MLD intervention. A tactile sensor system recorded the applied pressure during treatment. The data were preprocessed and statistically analyzed to assess pressure patterns and their stage-specific impacts on lymphedema. The mean age of the patients was 52.4years, and that of the therapists was 39.1years. A statistically significant reduction in arm circumference was observed post-MLD treatment (P < 0.05). The pressure applied varied across stages: I forearm 16.5-20.1mmHg, I upper arm 16.1-20.7mmHg; II forearm 16.6-19.8mmHg, II upper arm 19.7-23.8mmHg; III forearm 29.3-34.3mmHg, III upper arm 29.7-34.3mmHg. No statistically significant difference was found between forearm and upper arm treatment pressures within Stages I (P = 0.283) and III (P = 0.08), while Stage II exhibited a significant difference (P < 0.001). Across the same treatment area, pressures for Stages I and II in the forearm were significantly lower than those in Stage III (P < 0.001). The treatment pressure differences between forearm stages I and II were not statistically significant (P > 0.05). Differences in upper arm treatment pressures across Stages I, II, and III were also statistically significant (P < 0.001). The study provides quantitative evidence on the pressure ranges needed for MLD across different stages of BCRL. It highlights the importance for stage-specific pressure adjustments to optimize treatment outcomes. These findings contribute to the existing body of knowledge on MLD and offer valuable data that could inform the development of rehabilitation technologies, including intelligent robots and visualization systems, as well as enhance therapist training programs.

Determining the Relationship Between Corneal Stiffening and Tissue Dehydration After Corneal Cross-Linking.

To quantify corneal cross-linking (CXL)-induced stiffening via mechanical testing to estimate the impact of changes in hydration levels (H) and evaluate depth-dependent tissue hydration after CXL. Eighty-three porcine corneal buttons were divided into three groups: Standard protocol CXL (S-CXL), accelerated CXL (A-CXL), and untreated (nonirradiated riboflavin-only) controls. Samples were hydrated or dehydrated to modulate H and dynamic mechanical analyzer compression tests were performed to measure Young's modulus (E). To extract the solid tissue network modulus, the cornea was modeled as a biphasic material after measuring E at different H. Corneal hydration was correlated with depth-dependent tissue thickness characterized by confocal reflection microscopy (CRM). Young's modulus increased fourfold after S-CXL (0.72 ± 0.1 MPa) and threefold after A-CXL E (0.53 ± 0.12 MPa) versus controls (0.17 ± 0.045 MPa). However, H decreased from 4.07 ± 0.35 in controls to 2.06 ± 0.2 after S-CXL and 2.79 ± 0.12 after A-CXL. After H modulation and biphasic mechanical modeling, Young's modulus for corneal solid tissue network showed only a 1.8-fold increase after S-CXL (2.25 MPa) and 1.5-fold increase after A-CXL (1.85 MPa) versus controls (1.22 MPa). With CRM, the overall thickness of the corneal tissue was found to linearly correlate to hydration H as expected. No appreciable depth dependence of hydration-induced thickness changes throughout the corneal buttons were observed. Corneal tissue hydration changes significantly impact measured corneal stiffness after CXL using mechanical testing. Not considering H leads to major overestimation of the stiffening effect of the CXL procedure. Depth-dependence of corneal thickness because of changing hydration is strongly dependent on the integrity of the tissue.

Investigating the Routes to Produce Cellulose Fibers from Agro-Waste: An Upcycling Process

The agriculture and agri-food sectors produce substantial amounts of plant-based waste. This waste presents an identifiable research opportunity to develop methods for effectively eliminating and managing it in order to promote zero-waste and circular economies. Plant-based waste and by-products are acknowledged as valuable sources of bioactive compounds, including cellulose fibers. Direct application of these fibers in non-food sectors such as textiles can reduce the environmental impact of secondary raw materials. This review aims to provide an overview of novel concepts and modern technologies for efficiently utilizing plant-based waste and by-products from the agricultural and agro-industrial sectors to extract fibers for a variety of final applications, including the fashion industry. Two major routes are identified to produce cellulose fibers: the extraction and purification of natural cellulose fibers and the extraction and purification of cellulose pulp that is further processed into manmade cellulosic fibers. Scalability of experimental results at the laboratory or pilot level is a major barrier, so it is critical to develop closed-loop processes, apply standardization protocols, and conduct life cycle assessments and techno-economic analyses to facilitate large-scale implementation.

Airway Management in Patients With Severe Traumatic Brain Injuries in the Emergency Unit: Integratva Review

Objective: The present study aims to analyze the best practices, risk factors, and challenges involved in airway management in patients with severe TBI, both in the prehospital and hospital settings, in order to identify interventions that optimize clinical outcomes. Method: An integrative literature review was conducted based on studies published between 2019 and 2024. The research was structured by the PICo (Population, Interest and Context) strategy, focusing on patients with severe TBI, airway management and ventilation. After screening 325 articles, 10 studies were selected for critical analysis, following the PRISMA guidelines. Results and Discussion: It was observed that early intubation, although crucial, presents significant variations in effectiveness depending on the training and experience of the team. Complications such as excessive hyperventilation, aspiration, and difficulties in airway management in patients with cervical spine injuries were recurrent in the studies. The implementation of standardized protocols and the use of advanced devices, such as videolaryngoscopy, have been identified as essential measures to reduce complications and improve outcomes. The need for a trained multidisciplinary team and the use of evidence-based guidelines was also highlighted as critical to treatment success. Conclusion: Airway management in patients with severe TBI is complex and requires a careful and well-trained approach. The review emphasizes the importance of well-defined protocols and continuous training of emergency responders to optimize survival and neurological outcomes for these patients.

Ventricular-arterial coupling: Advances and current perspectives in cardiovascular research

The concept of ventricular-arterial coupling (VAC) was first introduced in the early 1980s to quantify the relationship between left ventricular contractility and arterial load. The mathematical formulation of VAC, expressed as the ratio of arterial elastance to ventricular elastance, has since then been refined with adjustments to allow for non-invasive assessment. By the early 2000s, advancements in echocardiography, cardiac magnetic resonance and arterial tonometry provided non-invasive alternatives to the traditional invasive method of cardiac catheterization, broadening the clinical application of VAC. Emerging technologies, such as machine learning and computational models, have further enhanced the precision and personalization of VAC, with potential applications in heart failure, hypertension and other clinical scenarios.&lt;br /&gt; This review describes the physiological basis and the historical development of VAC, highlights the non-invasive assessment techniques, and discusses the potential for personalized treatment based on VAC insights. Machine learning models trained on large datasets from non-invasive imaging modalities may open new avenues in predicting individual patient responses to therapies. However, lack of standardized protocols across imaging modalities represents a challenge, making the call for standardization critical for consistent clinical application. This review underscores the need for harmonized methodologies to better utilize VAC in personalized medicine, aiming to improve cardiovascular outcomes through tailored therapies.

Use of Postoperative Radiotherapy and Multiple Adjuvant Treatments After Surgical Removal of a Giant Retroauricular Keloid ina Pediatric Patient.

The use of postoperative radiotherapy (PORT) for the treatment of keloids in the pediatric population is rare, despite being a common pathology at this age. Recurrences after surgery are very common. The absence of a standardized protocol for the management of recurrent keloids further complicates therapeutic decision-making. Here, we present a clinical case involving a recurrent giant retroauricular keloid in a pediatric patient, demonstrating a satisfactory response to a comprehensive approach involving surgery, PORT, and periodic injections of 5-fluorouracil with corticosteroid. We believe that reporting this case adds value as a potential therapeutic option in the absence of established protocols for recurrent keloids in pediatric patients.

Advancements in Virtual Bioequivalence: A Systematic Review of Computational Methods and Regulatory Perspectives in the Pharmaceutical Industry

Background/Objectives: The rise of virtual bioequivalence studies has transformed the pharmaceutical landscape, enabling more efficient drug development processes. This systematic review aims to explore advancements in physiologically based pharmacokinetic (PBPK) modeling, its regulatory implications, and its role in achieving virtual bioequivalence, particularly for complex drug formulations. Methods: We conducted a systematic review of clinical trials using computational methods, particularly PBPK modeling, to carry out bioequivalence assessments. Eligibility criteria are emphasized during in silico modeling and pharmacokinetic simulations. Comprehensive literature searches were performed across databases such as PubMed, Scopus, and the Cochrane Library. A search strategy using key terms and Boolean operators ensured that extensive coverage was achieved. We adhered to the PRISMA guidelines in regard to the study selection, data extraction, and quality assessment, focusing on key characteristics, methodologies, outcomes, and regulatory perspectives from the FDA and EMA. Results: Our findings indicate that PBPK modeling significantly enhances the prediction of pharmacokinetic profiles, optimizing dosing regimens, while minimizing the need for extensive clinical trials. Regulatory agencies have recognized this utility, with the FDA and EMA developing frameworks to integrate in silico methods into drug evaluations. However, challenges such as study heterogeneity and publication bias may limit the generalizability of the results. Conclusions: This review highlights the critical need for standardized protocols and robust regulatory guidelines to facilitate the integration of virtual bioequivalence methodologies into pharmaceutical practices. By embracing these advancements, the pharmaceutical industry can improve drug development efficiency and patient outcomes, paving the way for innovative therapeutic solutions. Continued research and adaptive regulatory frameworks will be essential in navigating this evolving field.

Fecal Microbiota Transplantation: A Systematic Review of Therapeutic Potential, Preparation Techniques, and Delivery Methods Across Medical Conditions

Fecal microbiota transplantation (FMT) is revolutionizing the treatment of gastrointestinal disorders by leveraging the gut microbiome in innovative ways. This systematic review evaluates the clinical effectiveness and safety of FMT across various medical conditions, offering insights into its therapeutic potential and limitations. A comprehensive search of PubMed, Web of Science, Scopus, Embase, and ClinicalTrials.gov from January 2000 to December 2023 identified 97 relevant studies on FMT's efficacy, safety, and microbiome changes after eliminating duplicates. FMT has demonstrated high success rates, particularly in treating recurrent and refractory Clostridium difficile infections (CDI), with up to 90% effectiveness, establishing it as a primary treatment for antibiotic-resistant cases. FMT’s applications are expanding to inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease, as well as metabolic disorders and neuropsychiatric conditions. Remission rates for IBD range from 37-45%, with outcomes influenced by donor characteristics, stool preparation, and disease subtype. with mild, self-limiting side effects such as transient diarrhea and abdominal cramping. However, rare serious adverse events underscore the need for rigorous donor screening and standardized preparation protocols to mitigate risks. FMT’s ability to restore healthy gut flora highlights its promise in both gastrointestinal and systemic disease management. However, further research is essential to establish optimized procedures, standardized guidelines, and long-term safety data to facilitate its integration into mainstream medical practice.

Riverbank plastic distributions and how to sample them

As plastic pollution exists in aquatic ecosystems globally, monitoring its abundance and distribution has become crucial for understanding transport pathways, sources, sinks, and impacts. Riverbanks are accumulation zones for plastic, but the selection of monitoring methods is constrained by research goals, available resources, and site-specific conditions. This diversity in approaches has led to disparate datasets, highlighting the need for standardized monitoring protocols. Here, we study the spatial distribution of plastic at the riverbank scale, quantify the uncertainty of existing riverbank methods, and provide recommendations for improved monitoring based on the balance between uncertainty loss and increase in effort. We measured riverbank plastic abundance at eight Dutch riverbanks, categorizing the items using 108 item categories (River-OSPAR). For every riverbank, an area of 100 by 25 meters was subdivided into five-by-five-meter squares, resulting in 100 individual monitored sub-areas. We found riverbank plastic exhibited high spatial variability, with deposition patterns ranging from parallel to the waterline to clustered, random, or uniform (Moran’s I between -0.050 and 0.301). Individual measurements from diverse sampling protocols are 5-49 times less accurate than estimates derived from extensive sampling, highlighting the diminishing impact of specific methods with increased data collection. Lastly, our findings suggest that increasing the sampling area quickly reaches diminishing returns in terms of accuracy. Reducing the sampled area by 80% only increases the uncertainty in estimating the true plastic density by 20%. While standardized protocols are essential for data comparability, a rigid, uniform sampling approach may be less efficient and resource-intensive than a flexible (step-wise) strategy that adapts to local conditions. By demonstrating that extensive sampling can mitigate the differences between unique sampling protocols, this study promotes a shift towards flexible and efficient riverbank plastic monitoring, ultimately accelerating global efforts to combat plastic pollution.

Current Concepts in Orthobiologics for Achilles Tendon Injuries: A Critical Analysis Review.

» Platelet-rich plasma and hyaluronic acid are low-risk and potentially high-reward treatments for Achilles tendinopathy, although clinical studies have yielded mixed results with questionable methodological quality» Case series and reports have reported that bone marrow aspirate, stem cells, and amniotic membrane products can improve functional outcomes, alleviate pain, and facilitate return to sport and activities, but high-level evidence studies are lacking» Exosomes are a promising novel biologic with laboratory studies showing improved collagen organization and cell proliferation, greater tendon mechanical properties, and prevention of extracellular matrix breakdown.» Standardization of protocols with clear reporting is necessary for future studies evaluating orthobiologic therapies for Achilles tendon injuries.

Make it a standard? The creation and variability assessment of a consensus standard protocol for Tenebrio molitor larvae feeding trials

Abstract Interest in the nutrition of the yellow mealworm (Tenebrio molitor L.) larvae is on the rise, leading to an increase in publications on this topic. The absence of a standard protocol and resulting differences in experimental designs reduces comparability among studies and impedes research on mealworm nutrition. To address this, a consensus standardised protocol was developed specifically for the evaluation of mealworm larval growth and performance in feeding trials. The efficacy of this protocol was evaluated through an international ring test involving seven partners using two wheat brans as dry feed (a standard bran and a local bran) at 27 °C and 60% relative humidity. As experimental units, plastic crates filled with 2.1 kg of bran and 10,000 4-week-old larvae were used with six replicates. Agar gel was provided as wet feed ad libitum. The mean individual larval weight and the number of larvae per crate were determined weekly until either three or more replicates ran out of feed or pupation exceeded 10%. At harvest, the total larval fresh biomass and amount of frass was determined. Larval samples were taken for chemical analysis. To assess the protocol, the within (repeatability) and between (reproducibility) laboratory variability was calculated for each parameter. The repeatability was good (limit at 12% (standard) and 14% (local)). The reproducibility was poorer with a limit 2.7 times higher for the standard feed (36%) and 3.8 times higher for the local feed (55%). For both feeds, the total larval fresh harvest, amount of frass and the larval protein concentration were the most consistent both within and among laboratories. The highest variability was observed at the early life stages and for the larvae ash content. The detailed consensus standard protocol and repeatability/reproducibility estimates can be used as basis for future mealworm feeding trials, comparing results and future improvements.

Optimal Antihypertensive Systolic Blood Pressure: A Systematic Review and Meta-Analysis.

Systolic blood pressure (SBP) lowering reduces major cardiovascular disease (CVD) and all-cause mortality. However, the optimal target for SBP lowering remains controversial. We included trials with random allocation to an SBP <130 mm Hg treatment target and CVD as the primary outcome. Data were extracted from each study independently and in duplicate using a standardized protocol. Random-effects meta-analysis was used to obtain pooled hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality comparing SBP <130 and ≥130 mm Hg treatment targets. A secondary analysis compared the same outcomes for randomization to an SBP target of <120 or <140 mm Hg. Seven trials, including 72 138 participants, met the eligibility criteria. Compared with an SBP target of ≥130 mm Hg, an SBP target of <130 mm Hg significantly reduced major CVD (HR, 0.78 [95% CI, 0.70-0.87]) and all-cause mortality (HR, 0.89 [95% CI, 0.79-0.99]). Compared with an SBP target of <140 mm Hg, an intensive SBP target of <120 mm Hg significantly reduced major CVD (HR, 0.82 [95% CI, 0.74-0.91]), but all-cause mortality was marginally insignificant (HR, 0.85 [95% CI, 0.71-1.01]). Adverse events were significantly more likely in the intensive SBP target groups, but the absolute risks were low. This study suggests targeting an SBP <130 mm Hg significantly reduces the risks of major CVD and all-cause mortality. The findings also support an SBP target of <120 mm Hg, based on a smaller number of trials. URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023490693.

Visual dysfunction of superior colliculus and lateral geniculate nucleus in idiopathic blepharospasm

BackgroundThe etiology and pathophysiology of idiopathic blepharospasm (BP) are still largely unknown. It has been hypothesized that BP is the consequence of a dysfunction of the basal ganglia loop, although cortical areas, cerebellum, and other brainstem structures may be involved. There is some evidence that the superior colliculus (SC), a sensorimotor brainstem structure, is involved in another adult-onset focal dystonia, the cervical dystonia. To date, there is no data concerning the implication of the SC in BP. ObjectivesOur study aims to investigate the role of the SC in people with idiopathic BP compared to controls using fMRI and a visual stimulation paradigm based on luminance contrast variations. MethodsPeople with idiopathic BP and controls underwent brain fMRI using a standardized protocol, allowing modulation of visual activity in the SC, the lateral geniculate nucleus (LGN), and the primary visual cortex (V1), at increasing luminance levels (1 %, 3 %, 5 %, 9 %). ResultsTen BP women and ten sex- and age-matched controls were enrolled. Compared to controls, the BP group showed no modulation of visual responses at all luminance levels (p < 0.05) in both SC and LGN. In BP, BOLD responses in V1 were significantly lower at 5 % (p = 0.001), and 9 % (p = 0.002) luminance level. ConclusionsOur findings support the concept of SC and LGN dysfunction in idiopathic BP. Brain fMRI, targeting these sub-cortical visual structures, could play a future important role both as a biomarker and in our understanding of the pathophysiology of adult-onset focal dystonias.

Isolation of Small Extracellular Vesicles (sEVs) from the Apoplastic Wash Fluid of Nicotiana benthamiana Leaves.

Extracellular vesicles (EVs) are small membranous vesicles secreted by cells into their surrounding extracellular environment. Similar to mammalian EVs, plant EVs have emerged as essential mediators of intercellular communication in plants that facilitate the transfer of biological material between cells. They also play essential roles in diverse physiological processes including stress responses, developmental regulation, and defense mechanisms against pathogens. In addition, plant EVs have demonstrated promising health benefits as well as potential therapeutic effects in mammalian health. Despite the plethora of potential applications using plant EVs, their isolation and characterization remains challenging. In contrast to mammalian EVs, which benefit from more standardized isolation protocols, methods for isolating plant EVs can vary depending on the starting material used, resulting in diverse levels of purity and composition. Additionally, the field suffers from the lack of plant EV markers. Nevertheless, three main EV subclasses have been described from leaf apoplasts: tetraspanin 8 positive (TET8), penetration-1-positive (PEN1), and EXPO vesicles derived from exocyst-positive organelles (EXPO). Here, we present an optimized protocol for the isolation and enrichment of small EVs (sEVs; <200 nm) from the apoplastic fluid from Nicotiana benthamiana leaves by ultracentrifugation. We analyze the preparation through transmitted electron microscopy (TEM), nanoparticle tracking analysis (NTA), and western blotting. We believe this method will establish a basic protocol for the isolation of EVs from N. benthamiana leaves, and we discuss technical considerations to be evaluated by each researcher working towards improving their plant sEV preparations. © 2024 The Author(s). Current Protocols published by Wiley Periodicals LLC. Basic Protocol: Isolation and enrichment of small extracellular vesicles (sEVs) from the apoplastic fluid of Nicotiana benthamiana leaves.

Concurrent meningioma and intracranial aneurysm: Insights from an updated systematic review and a case report

Background: The concurrent presentation of meningioma and intracranial aneurysm (IA) poses diagnostic and therapeutic challenges, with no standardized management protocol available. This study aims to address this through an updated systematic review, delineating optimal strategies for managing this dual pathology. Methods: A systematic review was conducted across PubMed, Web of Science, and Embase databases. Articles were screened independently by two reviewers. Treatment strategies and patient outcomes were comprehensively analyzed to formulate a treatment framework based on several characteristics. In addition, one concurrent meningioma and IA case from our institution was presented. Results: A total of 69 articles comprising 115 patients were included in the study. The cohort exhibited a female predominance (80%) with a mean age of 56 (±13) years. Meningiomas were primarily localized to the frontotemporal and sellar regions, while aneurysms favored the anterior circulation – notably, 16.5% of cases presented with ruptured aneurysms. Management strategies varied based on the spatial relationship between lesions and aneurysm rupture status. In unruptured cases, 34% underwent a single craniotomy for simultaneous resection of both pathologies, while endovascular intervention was favored when the IA originated from an artery feeding the meningioma (73%). Remarkably, postoperative aneurysm rupture occurred in 33% of cases managed solely through tumor resection (range 0–30 days postop). Conclusion: This study proposes a comprehensive treatment algorithm to guide neurosurgeons in managing concurrent meningioma and IA cases. By considering individual patient intricacies, the feasibility of simultaneous management, aneurysm rupture risk, and symptomatology, this framework is a valuable tool for clinical decision-making in these complex scenarios.

Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real-world data.

This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan-Do-Study-Act cycles. From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure-specific perioperative Plan-Do-Study-Act cycles, three procedure-specific postoperative prescription Plan-Do-Study-Act cycles, and four general ambulatory surgical center enhanced recovery Plan-Do-Study-Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30-day reoperation rate. A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30-day reoperation rates were unchanged. The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay.

Improving central venous catheter care with chlorhexidine gluconate dressings: evidence from a systematic review and Meta-analysis

BackgroundThe prevention of catheter-related bloodstream infections (CRBSI) is a critical priority in the clinical management of central venous catheters (CVCs). This meta-analysis aims to evaluate the efficacy of chlorhexidine gluconate antibacterial dressings in the context of CVC care.MethodsA systematic literature search was performed in PubMed, Web of Science, Embase et al. databases up to May 28, 2024. The search targeted randomized controlled trials (RCTs) that investigated the impact of chlorhexidine gluconate antibacterial dressings on CVC-related outcomes. The meta-analysis was conducted using RevMan 5.3 software.ResultsThe final analysis included 14 RCTs involving a total of 8920 patients with CVCs, with participants divided into a chlorhexidine antibacterial dressing group (n = 4731) and a control group (n = 4189). The chlorhexidine dressing group demonstrated a statistically significant reduction in the incidence of CRBSI compared to the control group, with a relative risk (RR) of 0.48, 95% confidence interval (CI) 0.36–0.64, P < 0.001. The chlorhexidine dressing group also showed a significant decrease in bacterial colonization, with an RR of 0.46, 95% CI 0.38–0.55, P < 0.001. Assessment of publication bias through funnel plot asymmetry and Egger’s test revealed no significant bias in the included studies (all P > 0.05).ConclusionsThere is a notable reduction in the incidence of CRBSI and bacterial colonization in patients with CVCs through the application of chlorhexidine gluconate dressings. Given the compelling evidence, the integration of these dressings into standard nursing care protocols for the management of CVCs is advocated.

Bioactive Compounds Aimed at the AMPK Pathway: A Window into their Therapeutic Potential

Abstract: Current investigations have proposed that focusing on malignancy cell metabolism is an elective restorative methodology in cancer treatment. AMPK is the significant energy sensor regulating ordinary as well as malignancy cell metabolism. Drugs as AMPK activators can quell malignancy cell development through the various signalling cascade. AMPK enactment in light of natural AMPK activators, for example, BME, ICT, Thymoquinone, has been displayed to constrict mTOR, approving that BME can restrain cell development in ovarian malignant growth cells utilizing suppressing mTOR-mediated protein translation process. Nutraceuticals as well as traditional medicines operate as natural AMPK activators that regulate AMPK movement through a mechanism that is independent of AMP. These naturally occuring AMPK activators might straightforwardly actuate AMPK through single or more than one mechanism in AMPK initiation. Exploring the synergistic effects of compounds with existing cancer treatments could open new avenues for combinatorial therapy, potentially enhancing efficacy and reducing side effects. Moreover, understanding the precise molecular pathways through which these natural AMPK activators exert their effects will be crucial in designing targeted therapies that maximize their therapeutic potential. The integration of these nutraceuticals into standard cancer treatment protocols requires rigorous clinical trials to establish their safety, optimal dosing, and long-term benefits in cancer patients. With further investigation, the possibility of using natural AMPK activators in addition to traditional medicines could transform cancer treatment by providing more patient-friendly and comprehensive options.