Standard Protocol Research Articles

Variation in Cost Centers Following Gastrointestinal Cancer Surgery.

Despite cost-standardization efforts, significant variations in hospital costs persist in insurance claims. We sought to identify and quantify factors driving cost variability at hospital and cost center levelsfollowing acomplex gastrointestinal surgical procedure. Individuals who underwent pancreatectomy (PA), colectomy (CO), and proctectomy (PR) were identified from the Surveillance, Epidemiology, and End Results database. Index surgery costs across 1,262 hospitals were compared, adjusting for clinical, demographic, and geographic factors. Multilevel regression modeling identified factors associated with variability in charges. Among 35,908 individuals (PA: 8.2%; CO: 79.4%; PR: 12.4%), the median age was 78 years (interquartile range [IQR] 72-84), with 56.1% male. Median Medicare payments varied significantly by cancer type (CO: $21,704, PA: $26,709, PR: $21,228; p < 0.001). Operating room ($6,891, 23.82%), hospital stay ($5,931, 20.9%), and professional fees ($4,352, 15.35%) were the top cost centers, comprising 60% of total costs. Surgeons had the highest charges (PA: $2,037; CO: $2,131; PR: $2,243), followed by anesthesiologists (PA: $622; CO: $431; PR: $480). Charges for critical care specialists and pathologists were relatively low. Multilevel modeling demonstrated total charge variability was primarily influenced by patient factors (83%), followed by surgeon factors (9%) and hospital factors (8%). There was marked variation in spending at the cost center level in the surgical treatment of gastrointestinal cancers. Patient factors demonstrated the greatest variability, followed by hospital and surgeon-level factors. Implementing value-based healthcare and standardized surgical protocols may improve both care quality and cost-effectiveness.

A consolidated framework for implementation research (CFIR) guided exploration of key informant perspectives on establishing a pharmacist-led anticoagulation service in primary care: a qualitative study.

Globally, pharmacist-led anticoagulation services have improved patient outcomes in secondary and tertiary care settings. However, there is a paucity of literature about establishing such services within primary care settings. This study explored key informants' perceptions regarding the systemic and procedural factors influencing development and implementation of a pharmacist-led anticoagulation service in a primary care setting. A descriptive qualitative study was conducted at Qatar's largest primary healthcare institution, the Primary Health Care Corporation (PHCC). Selected key informants, including healthcare center managers, pharmacy leads, physician leads and primary care physicians with cardiology privileges, were purposively recruited. Semi-structured interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and analyzed using framework analysis. Elven key informants were interviewed. The participants expressed confidence in the feasibility and effectiveness of implementing anticoagulation service in primary care to address patients' needs. Key factors (mapped to CFIR domains) included ensuring pharmacist competency (Characteristics of Individuals), establishing effective internal and external communication (Inner and Outer Setting), and addressing staffing shortages (Inner Setting). Participants also emphasized on developing standardized operational protocols and training programs (Process), as well as integrating services with secondary care (Outer Setting). Despite challenges such as staffing, participants believed the service would effectively address patient needs if adequately supported. The implementation of pharmacist-led anticoagulation services in primary care settings was identified as both feasible and essential for improving patient outcomes. The insights from this study can inform future initiatives aimed at enhancing anticoagulation management in primary care settings.

Effectiveness of Cognitive Remediation Interventions for Schizophrenia in Asian Population: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Cognitive deficits are an integral part of schizophrenia, with negatively impacting functionality. Current treatments, primarily pharmacological, do not adequately address these cognitive impairments. Cognitive remediation (CR) interventions, designed to improve cognitive functions, have shown promising outcomes. However, most research has been conducted in western contexts, necessitating a review of CR effectiveness in the Asian populations. This systematic review aims to provide comprehensive update on the effectiveness of CR interventions in improving cognition among individuals with schizophrenia in Asian countries. The meta-analysis aims to synthesize and summarize the relevant CR studies to obtain a pooled estimate of effectiveness. Methods: A systematic search of three databases, PubMed, Ovid MEDLINE, and EMBASE, was conducted from the date of inception to March 19, 2024, for eligible records using prespecified search criteria. Primary studies with a randomized controlled trial (RCT) design, conducted on individuals aged 18–65 years, diagnosed with schizophrenia in Asian countries, comparing CR interventions with other non-pharmacological interventions or treatment as usual, reporting cognitive outcomes, using standardized tools, and published in English were included in the study. The review excluded unpublished RCTs, low-quality studies, open-label studies, cohort studies, studies focusing on noncognitive outcomes, and those lacking a clear comparison arm. The quality of the studies was assessed using the Cochrane risk of bias 2 (RoB2) tool by two independent reviewers. Meta-analyses were performed using R version 4.3.0 software using meta package to synthesize the overall impact of CR interventions on cognitive outcomes. Results and Discussion: This systematic review included 17 studies with 1272 participants, conducted in China, Japan, Hong Kong, Taiwan, Iran, Korea, and Singapore. The interventions varied in type and format. These were delivered through group and individual sessions, both in-person and computer-based, with varied duration. Quality assessment done with RoB2 tool indicated high-risk concerns in 14 of the studies. The meta-analysis of four studies on composite cognitive scores using the brief assessment of cognition in schizophrenia showed a significant positive effect of CR interventions (standardized mean difference [SMD] = 0.89, 95% confidence interval [CI]: 0.35 to 1.43). For executive functioning, the meta-analysis of three studies indicated no significant improvement (SMD = 0.75, 95% CI: −0.11 to 1.61). Conclusion: CR is an effective intervention for improving cognitive functions in individuals with schizophrenia in Asia based on the meta-analysis conducted, akin to evidence from western countries. However, quality concerns and high heterogeneity among the included studies underscore the need for standardized protocols and uniform outcome measures to enhance the reliability of future research.

Tranexamic Acid in Liposuction: A Systematic Review of Literature and Meta-Analysis.

Tranexamic acid (TXA) is increasingly employed in plastic surgery to reduce perioperative hemorrhage. This systematic review assesses TXA's impact on blood loss, bruising, and fat graft survival following liposuction. A PRISMA-compliant systematic review was conducted. PubMed, Google Scholar, and Cochrane Library were searched using relevant keywords. Adult liposuction patients, receiving "intravenous TXA", "topical TXA", or "placebo", were categorized into "treatment" or "control" groups. Randomized controlled trials, prospective or retrospective cohort studies, and case-control studies were included, while uncontrolled observational studies, systematic reviews, letters, animal studies, and conference abstracts were excluded. Data on blood loss and bruises severity were synthetized into Excel spreadsheets. Study quality was independently assessed by two reviewers. Statistical analysis was accomplished employing forest plots for Hedge's G effect sizes and standardized mean differences, I2 heterogeneity, and publication bias using Egger's regressions and trim-and-fill funnel plots. Seven studies encompassing 457 patients were analyzed. Findings suggest that intravenous and topical TXA may contribute to blood loss reduction and a potential decrease in bruises severity following liposuction. No thromboembolic or serious complications were reported, suggesting a favorable safety profile for its routine use. TXA's impact on fat graft survival remains unknown. This meta-analysis suggests that TXA might be beneficial in reducing blood loss and bruising after liposuction, but the results are not definitive due to study limitations. Larger randomized controlled trials with standardized protocols of TXA administration, and better-designed measurement instruments are needed to confirm these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evolution of dosimetric parameters through PRRT and potential impact on clinical practice: data from the prospective phase II LUMEN study

BackgroundPeptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-TATE has emerged as a promising treatment for gastroenteropancreatic neuroendocrine tumours (GEP-NETs). Its treatment protocol is currently standardised for all patients, resulting in different patient outcomes. This study investigates the variability of tumours and organs-at-risk (kidneys and red marrow) dosimetric parameters across treatment cycles in patients with pancreatic and intestinal NETs. Data from 37 patients enrolled in a prospective phase II study (LuMEn) were analysed. Treatment consisted of four cycles of [177Lu]Lu-DOTA-TATE administered 8–12 weeks apart. Three-time-point SPECT/CT imaging was performed after each treatment cycle, and dosimetry of tumours and organs-at-risk (kidneys and red marrow) was conducted following the medical internal radiation dose formalism. Coefficients of variation (CoV) assessed the variability of absorbed doses, activity concentrations on day 1, and effective half-lives. Linear mixed effect models (SAS software) were used to investigate the evolution of the dosimetric parameters over cycles, discerning between different primary NET types and grades of tumours.ResultsThere is an important variability in absorbed doses and activity concentrations among patients, particularly in tumours (CoV: ~50%). Tumour absorbed doses and activity concentrations decreased over treatment cycles in pancreatic NETs, although at a limited rate (~-13%/cycle). An opposite trend was observed for the kidneys ( ~ + 8%/cycle). Effective half-lives remained relatively constant across cycles for both organs-at-risk and tumours. The primary NET type significantly influenced effective half-lives in tumours, shorter in pancreatic NETs than intestinal NETs (77 h vs. 107 h, p < 0.0001). No significant effect of the grade was observed on either of the variables investigated.ConclusionsOur study revealed considerable variations in tumour absorbed doses among patients with NETs treated with a standardized protocol. These findings confirm the need for personalized dosimetry approaches in PRRT, considering patient and tumour characteristics.Trial registrationEudraCT Number: 2012-003666-41. Clinicaltrials.gov identifier: NCT01842165. Registered 25 April 2013, https://clinicaltrials.gov/ct2/show/NCT01842165.

Frequency of Positive Findings on MRI of The Patients Diagnosed with Vertebral Metastases on Bone Scintigraphy

Objective: The present study is conducted with the aim to compare the bone scan and MRI findings for detecting spinal metastasis in our local population. Study design and duration: This cross sectional study was conducted at Radiology Department of Pakistan Institute of medical Sciences, Islamabad from May 2019-May 2020. Material and Methods: Total 30patients with confirmed diagnosis of cancer who were suspected for spinal metastasis on Tc-99m bone scan and sent for radiologic workup for confirm diagnosis of s pine lesions were enrolled. MRI was performed on 1.5-tesla system using standard protocol. Spine was divided into four regions: cervical, thoracic, lumber and sacral regions. Region-wise bone metastasis were analyzed and compared for bone scan and MRI. Interpretations were considered concordant if both reports showed positive for metastatic lesions, while discordant if readings differ. Results: 63.3% of the study population were female. Mean age of the enrolled patients was 59.3±14.9 years. All the lesions of cervical region were concordant. Most of the discordance for MRI was noted for lumbar region, where 7 patients were reported as negative who were positive on bone scan. In case of bone scintigraphy, 2 patients were discordant for thoracic region who were positive on MRI. Conclusion: Very low discordance rate exists among MRI and bone scan. MRI is an effective imaging tool for detection of spinal metastasis with added benefits of no radiation dose to the patient and wider availability as compare to the bone scintigraphy.

Retardation of myopia by atropine regimes.

Myopia is a huge health problem due to its high frequency, vision losses and public health cost. According to the World Health Organization, at least 2.2 billion people have vision impairment. Although myopia can be controlled at its early and middle stages, unfortunately, no cure can be achieved so far. Among the methods to control myopia, atropine, a muscarinic receptor antagonist, is the oldest but still the most effective for retardation of myopia progression. Despite such a fact, standard protocols have not been established for clinicians to use atropine for treatment of myopia. In this article, a concise and up to date summary of myopia epidemiology and pathogenesis and summarized therapeutic effects and side effects, possible mechanisms and application methods of atropine were provided in hope for clinical doctors to effectively control this problematic disease. At present, the protocol is recommend: use higher dose (1%) of atropine intermittently to effectively slowdown myopia progression in schoolchildren for 2y, and to significantly reduce side effects of atropine by decrease of atropine frequency for 1y and inhibit myopic rebound by withdrawal of topical atropine gradually for 1y. Application of a lower dose (0.05%) atropine regime should also be considered due to its effectiveness and application at regular basis.

Age and Gender Related Variability in the Strength of Auricular Cartilage in Living Humans.

Despite previous studies on auricle morphology, research on its biomechanical properties remains limited. This study aims to assess age- and gender-related variations in auricle strength in living humans. A prospective, clinical study was conducted to assess auricle stiffness at three antihelix points (superior, middle, and inferior) using a digital Newton meter. Measurements were conducted in two modes to assess the force needed to move the auricle medially by 1, 2, 3, and 4mm, and the peak force required to displace the auricle medially to a distance of 1mm from the mastoid skin. Morphological measurements were also recorded to assess the auricle dimensions and projections at various levels of the auricle. Data were analyzed to examine age-related and gender-related distributions, as well as to investigate correlations between morphological parameters and resistance measurements. The study included 226 ears from 52 women and 61 men, aged 2-85 years. Age significantly influenced most anthropometric measurements, with males generally exhibiting larger ears. Resistance values increased with age, particularly in age groups over 35 and 50. Gender did not significantly affect resistance values. Positive correlations were found between auricle dimensions and resistance values, indicating increased resistance with increased auricle projection. This study provides a comprehensive mechanical resistance map of the auricle, demonstrating age-related changes in stiffness and regional variations in mechanical properties. These findings are valuable for refining surgical techniques, tissue engineering, and potentially for forensic applications. Further research on diverse populations and standardization of measurement protocols are recommended. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical effectiveness of a standardized community-based supervised post-acute rehabilitation model after total knee arthropathy: A pilot study

Background: Hospital-based outpatient physiotherapy is the standard of care for subacute rehabilitation after total knee arthroplasty (TKA) in Singapore. This study explores the clinical effectiveness of a standardized rehabilitation model at community-based rehabilitation centers to align the appropriate utilization of tertiary and community rehabilitative resources. Methods: In this pilot study, patients who had undergone TKA were assigned to either control group (n=30) or to intervention group (n=29). The control group received usual hospital-based outpatient physiotherapy, while the intervention group received rehabilitation at a community-based rehabilitation center based on standardized institution protocol. Primary and secondary outcomes were assessed at baseline and at 3 months post TKA. Results: Baseline characteristics in both groups were not significantly different. All patients completed the study. At 3 months, there were no significant differences in the Time Up and Go test (P&lt;0.853), median 30 s chair rise (P=0.347), knee flexion passive range of motion (P=0.933), knee extension passive range of motion (P=0.409), and presence of knee extension lag (P=0.360). There was a lower pain intensity in the intervention group compared with the control group (P=0.003). Conclusions: A community-based post-acute TKA rehabilitative model demonstrated improvements in functional outcomes, and reduced pain intensity in study participants, with these findings being similar to that of standard of care hospital-based outpatient physiotherapy. This model of care warrants further evaluation in larger clinical trials.

Challenges in Snakebite Management in India: Insights from a Physician Survey with Special Focus on Kerala and treatment of bites by Hump-nosed Pit Vipers (Hypnale spp.)

Background India has a high incidence of snakebite-related mortality, making effective snakebite management crucial. This study aimed to explore current practices, challenges, and opportunities for improvement in snakebite management across India. Methods A cross-sectional survey was conducted among physicians in India covering aspects such as scope of practice, snake identification, first aid measures, institutional management, and specific management practices for hump-nosed pit viper ( Hypnale hypnale) bites. The survey included 37 questions across 5 sections, with data collected via emails, professional networks, and online platforms. Statistical analysis was performed using SPSS Statistics 23 (IBM Corp, Armonk, NY), and manual thematic analysis was applied to open-ended responses. Results The survey revealed a discrepancy between physicians’ confidence and accuracy in snake identification, with some still reporting outdated first aid and treatment practices. Despite recognizing the importance of snake species identification, a significant portion of respondents incorrectly identified the snakes. The study highlighted variability in institutional practices for snakebite management, such as administering prophylactic antibiotics and tetanus prophylaxis and monitoring periods for asymptomatic patients. In managing H hypnale viper bites, a demand for specific guidelines and a monovalent antivenom was evident because the current polyvalent antivenom is ineffective for this species. Conclusions The survey emphasizes the need for improved training in snake identification, standardized treatment protocols, and the development of region-specific antivenoms. It emphasizes the necessity of updating guidelines to address the unique challenges of snakebite management in India, particularly for species not covered by existing antivenoms.

Urban Building Energy Models: how can we improve the treatment of uncertainty for energy policy decision-making?

Abstract Urban Building Energy Models (UBEMs) are emerging as a powerful tool for cities and regions seeking to make decisions on the best pathways for increasing the energy efficiency of their buildings. As model results are used to inform critical policy decisions, it is essential to understand and communicate the limits of inference of model results and how sensitive they are to changes in inputs. In the absence of standard datasets and protocols for model validation, Uncertainty Analysis and Sensitivity Analysis (UASA) procedures offer vital insights. However, there is no consensus on how UASA should be applied to bottom-up building physics-based UBEMs, nor on how different use cases might influence the choice of UASA approach. This study uses a systematic review of the literature (2009-2023) to explore the procedures which are applied and assess their appropriateness. We find a need for a more holistic view of uncertainty to be taken, and present a decion framework for selecting the most appropriate form of quantiative sensitivity analysis, based on model form, data provenance and use case. We also propose a number of approaches to improve the application of sensitivity analysis in UBEM studies, including the importance of undertaking a complementary assessment of information quality.

Effect of Early Postoperative Mobilization on Functional Recovery, Hospital Length of Stay, and Postoperative Complications After Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects: A Prospective, Randomized Controlled Trial.

Patients undergoing perineal defect reconstruction with the internal pudendal artery perforator (IPAP) flap traditionally face 5days of postoperative bed rest (BR) to minimize surgical risks. However, prolonged BR can exacerbate postoperative physiologic changes such as increased fatigue, reduced body mass, and declining lung function, while also leading to complications such as pneumonia, delirium, deep vein thrombosis, and pressure injuries. This study assessed the effectiveness, feasibility, and safety of an adapted early mobilization (EM) program for these patients. This prospective, randomized, controlled clinical study involved 51 patients assigned to adapted EM (n = 25) or BR (n = 26). Whereas EM included core exercises, orthostasis training, gait training, muscle strengthening, and aerobic exercises after surgery, BR followed standard bed rest protocols. The primary outcome was independent ambulation for 3 m on postoperative day 5. The secondary outcomes included 6-min walk test (6MWT) distances on days 5 and 30, hospital length of stay, healing time, postoperative complications, fatigue prevalence, and quality of life. On day 5, EM improved ambulation significantly compared with BR (68.0% vs 38.5%; P = 0.035) and achieved greater 6MWT distances on days 5 (108.78 vs 47.73m; P = 0.041) and 30 (243.8 vs 166.29m; P = 0.018). The EM patients were discharged earlier (66.7% by day 10 vs 33.3% of the BR patients; P = 0.043), with comparable healing times (P = 0.06) and postoperative complication rates (68% vs 80.8%; P = 0.296). Fatigue prevalence and quality of life did not differ significantly between the two groups. Early mobilization after IPAP flap reconstruction is safe and feasible, promoting early ambulation and recovery and facilitating earlier discharge without increasing complications.

Порівняльний аналіз змін лактату і сечовини у сечі спортсменів-лучників за різного фізичного та психологічного навантаження

The qualified athletes training includes, in addition to physical training, also the improvement of the psychological state aimed at the formation of the athlete’s state of the readiness for competitive activity. Considering this, the search for non-invasive assessment methods for monitoring the physical and psychological activity of athletes is very urgent. Understanding this condition can help create methods and tools to adaption to the extreme conditions of such activities. According to the “clogging” theory, fatigue is an overtime accumulation of various metabolites (in particular, lactic acid, urea, etc.) in the body’s bio­logical fluids. Therefore, the study was aimed at evaluating the impact of a specialized self-training technique under different psychological (training and official competitions) and physical (before and after physical exertion) states on the changes in urinary metabolite excretion of the archers. In the study, 16 young athletes (5 masters of archery and 11 candidates for master of sports) participated. Athletes were randomly divided by age and qualification into two groups: control (worked out according to the standard protocol) and experimental (auto-training methods were additionally used). The research was conducted under different physical (before and after training) and psychological (training (rest stage) and official competitions (start stage)) conditions. The subject of biochemical monitoring was the metabolites lactate and urea, which were determined in urine samples of archers taken according to the protocol before and after physical exertion during regular training and official competitions. The lactic acid concentration, as well as urea, in the urine of archers did not change during training sessions of sportsmen after performing physical activity of the usual type. That is, the use of the auto-training technique during regular training sessions does not affect the accumulation of the studied metabolites in the urine, which is probably due to the short-term use (one week) of the technique itself. With help of two-way ANOVA analysis, it was established that changes of the lactic acid concentration in urine are mainly due to physical (80 %) and psychological (3.6 %) loadings of athletes, and urea changes – the unaccounted factors (88.8 % on average). At the official competitions stage, after the auto-training method systematic application, a concentration of the lactate significant decreased by 9.7±0.4 % (р&gt;0.95) in the urine of archers compared to controls after the usual physical exercises implementation. Under these conditions, the lactic acid level in the urine of athletes is mainly determined by the using of auto-training technique (68.2 %) and the psychological (6.4 %) load. It should be noted that the share of influence of the unaccounted factors for both athlete’s groups was moderate and amounted to 20.4 % on average. The urea level in the urine insignificant increased after training in both athlete groups, both during training sessions and during official competitions, and was also independent of the athletes’ use of auto-training technique. At the official competitions stage, after the systematic application of the auto-training technique, the concentration of lactate in the urine of archers significant decreased by 9.7±0.4 % (р&gt;0.95) compared to the control group after performing the usual physical exercises implementation. Under these conditions of the Start stage, changes of the lactic acid concentration in the urine of athletes depend mainly by the using of auto-training technique (68.2 %) and psychological load of archers (6.4 %). It should be noted that the share of influence of unaccounted factors for both groups of athletes was moderate and amounted to 20.4 % on average. The urea level in the urine insignificant increased after training in both athlete groups, both during training sessions and during official competitions, and was also independent of the athletes’ use of auto-training technique.

Virtual discharge counseling: An assessment of scalability of a novel patient educational process across a multi-site urban emergency department.

Inadequate counseling at patient discharge from the emergency department can lead to adverse patient outcomes. Virtual discharge counseling can address gaps in discharge counseling and improve patients' understanding of instructions. A previously established virtual discharge counseling program was scaled across three emergency departments and expanded to 13 diagnoses. Utilizing a standardized protocol and script, counselors performed virtual discharge counseling via a remote, secure teleconference platform in the patients' preferred language. Virtual discharge counseling was performed with 166 patients. COVID-19, back pain, and headache were the most frequent diagnoses. The median counseling time was 14 min. Median counseling time for English was 11 min, versus 20 min for other languages (p < 0.001). Counseling times were the longest for COVID-19 and diabetes (18 min for each). We demonstrate the scalability of a virtual discharge counseling program. Our findings can assist in targeting virtual discharge counseling resources for limited English-proficiency patients and specific diagnoses that require longer counseling times.

An Exploratory Study: Can Native T1 Mapping Differentiate Sarcoma from Benign Soft Tissue Tumors at 1.5 T and 3 T?

Background/Objectives: T1 relaxation time has been shown to be valuable in detecting and characterizing tumors in various organs. This study aims to determine whether native T1 relaxation time can serve as a useful tool in distinguishing sarcomas from benign tumors. Methods: In this retrospective study, patients with histologically confirmed soft tissue sarcomas and benign tumors were included. Only patients who had not undergone prior treatment or surgery and whose magnetic resonance imaging (MRI) included native T1 mapping were considered. Images were acquired using both 1.5 T and 3 T MRI scanners. T1 histogram parameters were measured in regions of interest encompassing the entire tumor volume, as well as in healthy muscle tissue. Results: Out of 316 cases, 16 sarcoma cases and 9 benign tumor cases were eligible. The T1 values observed in sarcoma did not significantly differ from those in benign lesions in both 1.5 T and 3 T MRIs (p1.5T = 0.260 and p3T = 0.119). However, T1 values were found to be lower in healthy tissues compared to sarcoma at 3 T (p = 0.020), although this difference did not reach statistical significance at 1.5 T (p = 0.063). At both 1.5 T and 3 T, no significant difference between healthy muscle measured in sarcoma cases or benign tumor cases was observed (p1.5T = 0.472 and p3T = 0.226). Conclusions: T1 mapping has the potential to serve as a promising tool for differentiating sarcomas from benign tumors in baseline assessments. However, the standardization of imaging protocols and further improvements in T1 mapping techniques are necessary to fully realize its potential.

Enhancing lung cancer growth inhibition with calcium ions: Role of mid- and high-frequency electric field pulses

Calcium electroporation (CaEP) involves the combination of calcium ions with electroporation, which is induced by pulsed electric fields (PEFs). This study explores the application of high-frequency unipolar nanosecond pulsed electric fields (nsPEFs: 8–14 kV/cm, 200 ns, 10 kHz, 100 kHz, 1 MHz repetition frequency pulse bursts, n = 100) and their potential in inhibiting lung cancer cell growth. As a reference, standard microsecond range parametric protocols were used (100 µs x 8 pulses). Methods included cell permeability quantification through Yo-Pro-1 uptake, cell viability assays, immunofluorescence studies for apoptosis and EMT markers, analysis of cell death types depending on repetition frequency pulse bursts. We determined the susceptibility of human lung cancer to electric pulses, characterized the efficacy of CaEP, and investigated cell death types depending on repetition frequency pulse bursts. We have shown that adding calcium ions to the applied nsPEF protocol increases cytotoxicity. Additionally, the use of these electroporation parameters can modulate key cellular processes, such as the epithelial-mesenchymal transition and apoptosis, as indicated by changes in the expression of markers such as E-cadherin, N-cadherin, BCL-2, and p53. Changes in cell morphology over time were observed using holotomographic microscopy. The study provides insights into the modulation of key cellular processes, indicating that nsPEF technology could improve the outcomes of conventional cancer treatments through enhanced efficacy and potentially mitigating drug resistance mechanisms. The promising results advocate for further research to optimize nsPEF protocols for clinical application, highlighting the potential of electrical fields in advancing cancer therapy.

Unveiling Progress: A Systematic Review and Meta-Analysis of Endoscopic Posterior Cricoid Split With Posterior Cartilage Graft.

Subglottic and posterior glottic stenosis (PGS) narrows distinct areas of the larynx, while bilateral vocal fold immobility (BVFI) is characterized by static cords. Treatments include open surgeries and newer endoscopic methods, offering comparable safety, quicker recovery, and fewer complications. This study assesses the decannulation rate of endoscopic posterior cricoid split with posterior cartilage grafting (EPCCG) in pediatric patients with posterior glottic stenosis, subglottic stenosis (SGS), and BVFI. Other outcomes include complications, symptom relief, need for additional airway procedures, and hospital stay. We retrieved relevant records published between 2003 and 2024 from PubMed, Scopus, Web of Science, and Cochrane Library. Using OpenMeta v5.26.14 software, we pooled the decannulation rates from individual studies. Other outcomes reported in fewer studies than what justifies a meta-analysis were synthesized manually. The selection process yielded 15 articles, 11 of which were eligible for analysis. The decannulation rate had an estimated proportion of approximately 83.2% (95% CI: 74.0-92.4%). Complications were present in 6/70 patients, and no mortality was reported. Additional airway procedures were needed in 14/82 patients for whom the outcome was reported. Hospital stays averaged 6.1 days in four studies reporting the outcome. Symptomatic relief was achieved in most of the patients; however, some cases reported odynophagia and concerns about voicing. EPCCG shows promise in treating less severe cases of PGS, SGS, and BVFI, offering safety, short hospital stays, and symptomatic relief. However, its efficacy for advanced cases and comorbidities needs more research. The limitations, including multiple pathologies and comorbidities in patients, hinder broader applicability. More extensive studies with standardized protocols are required in order to overcome these limitations.

Effect of Hormones, Season and Lactation on Follicular Size, Oocyte Competency and Embryo Production in Sahiwal Cattle

Background: Transvaginal ultrasound-guided ovum pick-up (OPU) and in vitro embryo production (IVEP) techniques are widely used for enhancing reproductive efficiency. The number and quality of embryos have been reported to be influenced by various factors like source of hormones, season, lactation in cattle. Methods: Twenty-one multiparous, normal cyclic Sahiwal cows (aged: 6-8 years; lactating: n-11 and non-lactating: n-10) were selected randomly and the experiment was conducted during hot (April to September) and cold (October to March) seasons. All the donor cows were administered 10 µg GnRH at random stage of oestrous cycle followed by FSH (Folltropin-V™ or Stimufol) at the rate of 100, 60 and 40 mg after 48, 60 and 72 h of GnRH administration. After 24 hours of coasting period, follicular aspiration was performed by stabilizing the targeted follicles with the help of ultrasonography. The procedures of COCs grading, in vitro maturation, fertilization, followed by culture were performed as per the standard protocols. Results: The hormonal treatment was effective in improving the oocytes’ developmental competency and in vitro embryo production; with no statistical differences between the two sources. The follicle size distribution revealed a lower (P less than 0.05) medium-sized and small-sized follicular proportion during the hot season with a higher average count of dominant (large-sized) follicles. While, good quality (A+B+C) oocytes, matured and fertilized oocytes were significantly higher (P less than 0.05) in non-lactating donors, especially among cool-season collections.

Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta-analysis.

To assess the available evidence on whether nonsurgical periodontal treatment (NSPT) improves arterial stiffness outcomes in patients with periodontitis (PD). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and population, intervention, comparison, outcomes, and study design (PICOS) question, electronic databases were screened for clinical interventional studies addressing the impact of NSPT on pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) outcomes in PD patients. Furthermore, the research strategy was implemented using a hand search. Studies were selected, and data were extracted by two independent reviewers. Random effects models were applied to perform a meta-analysis, and methodological index for nonrandomized studies (MINORS) and Cochrane Rob2 tools were used to assess the risk of bias. Fifteen articles were finally included for qualitative synthesis. Among them, eight single-arm cohort studies met the final inclusion criteria for meta-analysis. The Rob2 analysis evidenced that one randomized clinical trial (RCT) had a low risk, three RCTs raised some concerns, and three RCTs had a high risk of bias, while the MINORS scores ranged from 9 to 14. The meta-analysis showed that NSPT significantly impacted FMD (p<0.001) and CIMT (p=0.004), while changes in PWV were not statistically significant. However, there was high heterogeneity among studies (I2=78% for FMD and I2=62% for CIMT). Despite some beneficial effects on FMD and CIMT, due to study limitations, high heterogeneity, and risk of bias, it cannot be concluded that NSPT is effective in improving arterial stiffness. Therefore, further studies are necessary to achieve high-quality evidence on the effect of NSPT on arterial stiffness outcomes in PD patients. PROSPERO ID CRD42024501399. Periodontitis (PD) has been associated with alterations in arterial stiffness outcomes related to early endothelial dysfunction. Based on noninterventional studies, this meta-analysis indicates that nonsurgical periodontal treatment (NSPT) may reduce cardiovascular disease risk in patients with PD. The moderate evidence derived from the studies that were finally included showed that NSPT had beneficial effects on flow-mediated dilatation and carotid intima-media thickness, while this trend was not observed for pulse wave velocity. Moreover, the findings of the present meta-analysis were characterized by high heterogeneity and risk of bias and were derived from uncontrolled clinical trials or randomized clinical trials with limitations. Therefore, more studies with standardized protocols and homogeneous arterial stiffness outcomes are needed to elevate the quality of the present evidence.

Effectiveness of virtual reality in cancer patients undergoing chemotherapy. Systematic review.

Virtual reality is on the rise and is currently postulated as one of the most innovative and promising techniques in the management of pain and anxiety in cancer patients, in the face of painful processes or the stress involved in chemotherapy treatment. The objective has been to find out the effectiveness of virtual reality in patients undergoing chemotherapy. Several literature reviews were conducted between November 2023 and January 2024 in the Pubmed, Web of Science and PEDro databases. The keywords "virtual reality," "cancer," "oncology," "exercise" and "chemotherapy" were combined using the Boolean operator AND. 641 manuscripts were selected as potential manuscripts and after elimination of duplicates and application of the inclusion and exclusion criteria, six articles comprised the final review sample. Virtual reality has proven to be an effective technique in reducing the anxiety, pain, asthenia and stress suffered by patients diagnosed with cancer and chemotherapy treatment. The distraction generated by this therapeutic modality, with a wide range of scenarios, helps to reduce the painful perception and worry of these procedures. However, there are no standard application guidelines or application protocols that demonstrate the superiority of one technique over another. Virtual reality could be a valid complementary tool in the treatment of patients undergoing chemotherapy, showing positive results in pain reduction, anxiety, stress or asthenia. More studies are needed, with larger sample sizes and long-term follow-ups to establish treatment protocols in relation to the frequency, intensity, duration and periodicity of interventions with virtual reality.