Therapeutic Plan Research Articles

Risk Factors And Angiographic Profile of Young Adult Less Than 40 Years of Age in Bangladeshi Population

Back ground: : Coronary artery disease (CAD) in young adults under the age of 40 is an increasing medical, social, psychological, and economic concern, owing to the rise of civilization-related diseases and an unhealthy lifestyle. The problem of CAD in young people has not been studied as thoroughly as it has in older people, as current data consists primarily of case reports and small series, which are frequently tied to genetic features and family occurrence of the illness. Aim: To evaluate the risk factors for ischemic heart disease and the angiographic pattern of young adults with CAD who presented with chest pain in the ER. Methods : We conducted this observational study at Ibrahim Cardiac Hospital & Research Institute in Dhaka, Bangladesh, from February 1 to June 30, 2024. Patients with chest discomfort aged 21-40 years who underwent coronary angiography were included in the study. Results: This retrospective analytical investigation was carried out from February 1st to June 30th, 2024, with 110 patients enrolled in the department of cardiology at Ibrahim Cardiac Hospital & Research Institute. Patients aged 21 to <40 years were separated into two groups: 21-30 years and more than 30 to <40 years, with a mean age of 34.28±4.25 years. All patients underwent a coronary angiogram, which revealed that 30% had non-flow limiting coronary arteries, 29.1% had single vessel disease, 22.7% had double vessel disease, 17.3% had triple vessel disease, and 0.9% had left main with or without coronary involvement. Patients aged 30 to under 40 had more coronary artery disease than those aged 21 to 30. Conclusion: Young patients have distinct coronary artery disease patterns, hence the therapeutic plan must be tailored to their demographic. In this vulnerable age group, there should be a stronger emphasis on risk factor identification and management.

MRI features of breast cancer immunophenotypes with a focus on luminal estrogen receptor low positive invasive carcinomas

To compare the magnetic resonance imaging (MRI) features of different immunophenotypes of breast carcinoma of no special type (NST), with special attention to estrogen receptor (ER)-low-positive breast cancer. This retrospective, single-centre, Institutional Review Board (IRB)-approved study included 398 patients with invasive breast carcinoma. Breast carcinomas were classified as ER-low-positive when there was ER staining in 1–10% of tumour cells. Pretreatment MRI was reviewed to assess the tumour imaging features according to the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Of the 398 cases, 50 (12.6%) were luminal A, 191 (48.0%) were luminal B, 26 (6.5%) were luminal ER-low positive, 64 (16.1%) were HER2-overexpressing, and 67 (16.8%) were triple negative. Correlation analysis between MRI features and tumour immunophenotype showed statistically significant differences in mass shape, margins, internal enhancement and the delayed phase of the kinetic curve. An oval or round shape and rim enhancement were most frequently observed in triple-negative and luminal ER-low-positive tumours. Spiculated margins were most common in luminal A and luminal B tumours. A persistent kinetic curve was more frequent in luminal A tumours, while a washout curve was more common in the triple-negative, HER2-overexpressing and luminal ER-low-positive immunophenotypes. Multinomial regression analysis showed that luminal ER-low-positive tumours had similar results to triple-negative tumours for almost all variables. Luminal ER-low-positive tumours present with similar MRI findings to triple-negative tumours, which suggests that MRI can play a fundamental role in adequate radiopathological correlation and therapeutic planning in these patients.

Chatbots in Cancer Applications, Advantages and Disadvantages: All that Glitters Is Not Gold.

The emergence of digitalization and artificial intelligence has had a profound impact on society, especially in the field of medicine. Digital health is now a reality, with an increasing number of people using chatbots for prognostic or diagnostic purposes, therapeutic planning, and monitoring, as well as for nutritional and mental health support. Initially designed for various purposes, chatbots have demonstrated significant advantages in the medical field, as indicated by multiple sources. However, there are conflicting views in the current literature, with some sources highlighting their drawbacks and limitations, particularly in their use in oncology. This state-of-the-art review article seeks to present both the benefits and the drawbacks of chatbots in the context of medicine and cancer, while also addressing the challenges in their implementation, offering expert insights on the subject.

Source Control and Antibiotics in Intra-Abdominal Infections.

Intra-abdominal infections (IAIs) account for a major cause of morbidity and mortality, representing the second most common sepsis-related death with a hospital mortality of 23-38%. Prompt identification of sepsis source, appropriate resuscitation, and early treatment with the shortest delay possible are the cornerstones of management of IAIs and are associated with a more favorable clinical outcome. The aim of source control is to reduce microbial load by removing the infection source and it is achievable by using a wide range of procedures, such as definitive surgical removal of anatomic infectious foci, percutaneous drainage and toilette of infected collections, decompression, and debridement of infected and necrotic tissue or device removal, providing for the restoration of anatomy and function. Damage control surgery may be an option in selected septic patients. Intra-abdominal infections can be classified as uncomplicated or complicated causing localized or diffuse peritonitis. Early clinical evaluation is mandatory in order to optimize diagnostic testing and establish a therapeutic plan. Prognostic scores could serve as helpful tools in medical settings for evaluating both the seriousness and future outlook of a condition. The patient's conditions and the potential progression of the disease determine when to initiate source control. Patients can be classified into three groups based on disease severity, the origin of infection, and the patient's overall physical health, as well as any existing comorbidities. In recent decades, antibiotic resistance has become a global health threat caused by inappropriate antibiotic regimens, inadequate control measures, and infection prevention. The sepsis prevention and infection control protocols combined with optimizing antibiotic administration are crucial to improve outcome and should be encouraged in surgical departments. Antibiotic and antifungal regimens in patients with IAIs should be based on the resistance epidemiology, clinical conditions, and risk for multidrug resistance (MDR) and Candida spp. infections. Several challenges still exist regarding the effectiveness, timing, and patient stratification, as well as the procedures for source control. Antibiotic choice, optimal dosing, and duration of therapy are essential to achieve the best treatment. Promoting standard of care in the management of IAIs improves clinical outcomes worldwide. Further trials and stronger evidence are required to achieve optimal management with the least morbidity in the clinical care of critically ill patients with intra-abdominal sepsis.

Implementation of a monitoring system for adherence to the therapeutic plan by the multidisciplinary team in the ICU: rationale and study design

Implementation of a monitoring system for adherence to the therapeutic plan by the multidisciplinary team in the ICU: rationale and study design

In-Hospital Mortality in Patients With Acute Myocardial Infarction: A Literature Overview.

Acute myocardial infarction (AMI) continues to be a predominant cause of global morbidity and mortality, with in-hospital mortality (IHM) serving as a pivotal metric for patient outcomes. This review explores the influence of several clinical variables on IHM in individuals with AMI. Factors such as age, gender, body mass index (BMI), smoking habits, existing comorbidities, prior coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and biomarkers, including high-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase MB (CK-MB), significantly affect the prognosis of the patient. Advanced age and comorbid conditions such as diabetes and hypertension exacerbate myocardial damage and systemic impacts, thus increasing IHM. Gender and BMI are also critical, and women and patients with obesity face different risks. Smoking increases both the risk of AMI and IHM, underscoring the importance of cessation interventions. ST-elevation myocardial infarctionis associated with elevated IHM and requires immediate reperfusion therapy, while non-ST-elevation myocardial infarctionrequires customized management for risk assessment. Previous CABG and PCI add complexity to AMI treatment and elevate IHM due to pre-existing coronary pathology and the intricacies of the procedures involved. The application of biomarker-centered techniques facilitates the swift identification of individuals at elevated risk, improves therapeutic planning, and reduces IHM for patients with AMI. Understanding and incorporating these clinical determinants are essential to optimize the management of AMI, minimize IHM, and improve patient outcomes. This all-encompassing strategy requires ongoing research, quality improvement efforts, and personalized care approaches.

Comparative evaluation of efficacy of Trayodashang Guggul versus Rasona Pinda as an adjuvant with Katibasti in the management of Grudhrasi (Sciatica): A randomized controlled trial.

In ayurveda, sciatica can be correlated to ' Grudhrasi' under Vata Nanatmaja-Vyadhi (neurological disorders caused by Vata, one of the bodily humour). In this mainly bodily humours vata and kapha are vitiating producing symptoms like piercing pain, stiffness, twitching, numbness and pain radiating from lumbosacral region to lower limb up to the foot. Therapeutic plan includes stabilizing and bringing back the vitiated vata and kapha humours to equilibrium. The prevalence of sciatica varies considerably ranging from 3.8% in the working population to 7.9% in the nonworking population. Comparative evaluation of efficacy of Rasonapinda and Trayodashang guggul as an adjuvant to katibasti (oil pooling therapy) in the management of Grudhrasi (Sciatica). To assess the efficacy of Rasonapinda as an adjuvant to katibasti in subjective and objective parameters of Grudhrasi (Sciatica). To assess the efficacy of Trayodashang guggul as an adjuvant to katibasti in subjective and objective parameters of Grudhrasi (Sciatica). To compare the efficacy of Rasonapinda and Trayodashang guggul as an adjuvant to katibasti in subjective and objective parameters. Standardisation of Rasonapinda (modified formvati). In this study, a total of 60 patients will be enrolled and divided equally into two groups. In group A, Trayodashang Guggul 500 mg twice a day after meal with warm water for 30 days adjuvant with katibasti for the initial 7 days will be given. In group B, Rasonapinda 500 mg twice a day after meal with warm water adjuvant with katibasti for the initial 7 days will be given for 30 days. The result will be assessed on baseline of subjective and objective parameters and data will be compared after treatment. It will be based on observations and results obtained. CTRI No. - CTRI/2022/12/048534 Dated - 27/12/2022.

Compassionate use of esketamine intranasal in patients with severe major depressive disorder resistant to the treatment.

Treatment-resistant depression (TRD) is defined as the failure of at least two antidepressants in adequate doses and timing during a major depressive episode. Esketamine intranasal (ESK-IN) has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of TRD in combination with other antidepressants. To assess the effectiveness and tolerability of a sample of TRD patients who received treatment with ESK-IN as part of the compassionate use program. A retrospective, observational study was carried out on patients with a diagnosis of TRD enrolled in the early access program of ESK-IN in nine centers. Effectiveness was assessed with the Montgomery-Asberg depression rating scale (MADRS) at four time points: baseline, 28, 90, and 180 days of treatment. The sample included 71 patients (70% women) with a mean baseline MADRS score of 38.27 ± 5.9 and total or partial work disability rates of 85%. ESK-IN treatment was associated with a statistically and clinically significant reduction in the severity of depressive symptoms at all time points assessed. The presence of side effects was common but the majority were mild in severity and resolved after the observation period. Those patients who received psychotherapy in combination with ESK-IN showed a significantly lower MADRS score at 90 and 180 days than those patients who did not undergo psychotherapy. ESK-IN has proven to be effective and safe in a clinical sample of patients with severe TRD. To optimize clinical outcomes, the pharmacological treatment for TRD should always be integrated into a comprehensive therapeutic plan that encompasses strategies such as psychotherapy, social support, and family interventions.

Perceived Relational Empathy and Resilience in People with Spinal Cord Injury at the End of Acute Care: A Cross-Sectional Study.

In patients with spinal cord injury (SCI), patient-reported outcomes (PROMs) and experience of care measures (PREMs) are extremely relevant for the prognosis. However, there is a paucity of research on these topics. We conducted a cross-sectional study to investigate the relationships between these patient outcomes and other demographic and clinical variables in adult SCI patients discharged from the intensive care unit of an Italian tertiary rehabilitation hospital. We administered the Consultation and Relational Empathy (CARE) for perceived relational empathy, the Spinal Cord Independence Measure III self-report (SCIM-SR) for functional autonomy, the Numeric Rating Scale (NRS) for pain, and the Connor-Davidson Resilience Scale (CD-RISC-10) for resilience. Study participants consisted of 148 adults with SCI; 82.4% were male, with a mean age of 49.9 years (SD = 16.6). The lesion was traumatic in 82.4% and complete in 74.3% of cases. The median length of hospital stays was 35 days (interquartile range-IQR = 23-60). Perceived relational empathy was positively associated with resilience (r = 0.229, p = 0.005) and negatively associated with the length of the stay and lesion completeness. Resilience had a weak negative association with pain (r = -0.173, p = 0.035) and was unrelated to other variables. Clinicians should consider the routine assessment of PREMs and PROMs in order to personalize post-discharge therapeutic plans and identify appropriate measures to ensure continuity of care.

Next-generation chemotherapy treatments based on black hole algorithms: From cancer remission to chronic disease management

ProblemTherapeutic planning strategies have been developed to enhance the effectiveness of cancer drugs. Nevertheless, their performance is highly limited by the inefficient biological representativeness of predictive tumor growth models, which hinders their translation to clinical practice. ObjectiveThis study proposes a disruptive approach to oncology based on nature-inspired control using realistic Black Hole physical laws, in which tumor masses are trapped to experience attraction dynamics on their path to complete remission or to become a chronic disease. This control method is designed to operate independently of individual patient idiosyncrasies, including high tumor heterogeneities and highly uncertain tumor dynamics, making it a promising avenue for advancing beyond the limitations of the traditional survival probabilistic paradigm. DesignHere, we provide a multifaceted study of chemotherapy therapeutic planning that includes: (1) the design of a pioneering controller algorithm based on physical laws found in the Black Holes; (2) investigation of the ability of this controller algorithm to ensure stable equilibrium treatments; and (3) simulation tests concerning tumor volume dynamics using drugs with significantly different pharmacokinetics (Cyclophosphamide and Atezolizumab), tumor volumes (200 mm3 and 12 732 mm3) and modeling characterizations (Gompertzian and Logistic tumor growth models). ResultsOur results highlight the ability of this new astrophysical-inspired control algorithm to perform effective chemotherapy treatments for multiple tumor-treatment scenarios, including tumor resistance to chemotherapy, clinical scenarios modelled by time-dependent parameters, and highly uncertain tumor dynamics. ConclusionsOur findings provide strong evidence that cancer therapy inspired by phenomena found in black holes can emerge as a disruptive paradigm. This opens new high-impacting research directions, exploring synergies between astrophysical-inspired control algorithms and Artificial Intelligence applied to advanced personalized cancer therapeutics.

Extracellular vesicles as the next-generation modulators of pharmacokinetics and pharmacodynamics of medications and their potential as adjuvant therapeutics.

Pharmacokinetics (PK) and pharmacodynamics (PD) are central concepts to guide the dosage and administration of drug therapies and are essential to consider for both healthcare professionals and researchers in therapeutic planning and drug discovery. PK/PD properties of a drug significantly influence variability in response to treatment, including therapeutic failure or excessive medication-related harm. Furthermore, suboptimal PK properties constitute a significant barrier to further development for some candidate treatments in drug discovery. This article describes how extracellular vesicles (EVs) affect different aspects of PK and PD of medications and their potential to modulate PK and PD properties to address problematic PK/PD profiles of drugs. We reviewed EVs' intrinsic effects on cell behaviours and medication responses. We also described how surface and cargo modifications can enhance EV functionalities and enable them as adjuvants to optimise the PK/PD profile of conventional medications. Furthermore, we demonstrated that various bioengineering strategies can be used to modify the properties of EVs, hence enhancing their potential to modulate PK and PD profile of medications. This review uncovers the critical role of EVs in PK and PD modulation and motivates further research and the development of assays to unfold EVs' full potential in solving PK and PD-related problems. However, while we have shown that EVs play a vital role in modulating PK and PD properties of medications, we postulated that it is essential to define the context of use when designing and utilising EVs in pharmaceutical and medical applications. Existing solutions for pharmacokinetics and pharmacodynamics modulation are limited. Extracellular vesicles can optimise pharmacokinetics as a drug delivery vehicle. Biogenesis and administration of extracellular vesicles can signal cell response. The pharmaceutical potential of extracellular vesicles can be enhanced by surface and cargo bioengineering. When using extracellular vesicles as modulators of pharmacokinetics and pharmacodynamics, the 'context of use' must be considered.

Deep learning-based automated bone age estimation for Saudi patients on hand radiograph images: a retrospective study

PurposeIn pediatric medicine, precise estimation of bone age is essential for skeletal maturity evaluation, growth disorder diagnosis, and therapeutic intervention planning. Conventional techniques for determining bone age depend on radiologists’ subjective judgments, which may lead to non-negligible differences in the estimated bone age. This study proposes a deep learning-based model utilizing a fully connected convolutional neural network(CNN) to predict bone age from left-hand radiographs.MethodsThe data set used in this study, consisting of 473 patients, was retrospectively retrieved from the PACS (Picture Achieving and Communication System) of a single institution. We developed a fully connected CNN consisting of four convolutional blocks, three fully connected layers, and a single neuron as output. The model was trained and validated on 80% of the data using the mean-squared error as a cost function to minimize the difference between the predicted and reference bone age values through the Adam optimization algorithm. Data augmentation was applied to the training and validation sets yielded in doubling the data samples. The performance of the trained model was evaluated on a test data set (20%) using various metrics including, the mean absolute error (MAE), median absolute error (MedAE), root-mean-squared error (RMSE), and mean absolute percentage error (MAPE). The code of the developed model for predicting the bone age in this study is available publicly on GitHub at https://github.com/afiosman/deep-learning-based-bone-age-estimation.ResultsExperimental results demonstrate the sound capabilities of our model in predicting the bone age on the left-hand radiographs as in the majority of the cases, the predicted bone ages and reference bone ages are nearly close to each other with a calculated MAE of 2.3 [1.9, 2.7; 0.95 confidence level] years, MedAE of 2.1 years, RMAE of 3.0 [1.5, 4.5; 0.95 confidence level] years, and MAPE of 0.29 (29%) on the test data set.ConclusionThese findings highlight the usability of estimating the bone age from left-hand radiographs, helping radiologists to verify their own results considering the margin of error on the model. The performance of our proposed model could be improved with additional refining and validation.

Periodontal microbiology from undergraduate perspective: a questionnaire study

Background: Periodontal diseases are inflammatory conditions affecting the supporting structure of the teeth, leading to potential consequences such as gingivitis and periodontitis. The intricate interaction between host’s immune system and oral microbiome promotes this disease. The human oral cavity harbors a vast and diverse microbial community, collectively known as the oral microbiome comprising of bacteria, viruses, fungi, this ecosystem is influenced by factors such as genetics, host immunity, oral hygiene practices, diet and environmental variables. Among these microorganisms, bacteria take center stage in the initiation and progression of periodontal diseases. The objective was to assess the knowledge and awareness about the periodontal microbiology (periopathogens) among dental students. Methods: A self-designed questionnaire in English language containing 26 items was circulated using Google forms and was distributed among third, final year students and interns of PMNM dental college and Hospital, Bagalkot, India. The framework covered 3 domains: The first domain containing microorganism’s interaction in host causing periodontal disease, second domain about colonizers in dental plaque and certain aspects covered inflammatory response in host and the third domain containing therapeutic planning and future perspectives. Results: When looked into 1st domain student had a good knowledge on microorganism interaction in host, student had fair knowledge about the 2nd domain, they lack knowledge about the 3rd domain that is about therapeutic planning. Conclusions: Student have a fair knowledge about the periodontal pathogen and they lack knowledge about the therapeutic planning. It is indicative of students’ commitment to understanding the complex dynamics of oral microbiology.

The Effect of Sampling Context on Preschoolers' Finite Verb Morphology Composite Scores.

The finite verb morphology composite (FVMC) is a valid measure for charting children's tense development and for differentiating children with and without language impairment during preschool and early elementary years. However, it is unclear whether FVMC scores vary as a function of language sample elicitation contexts. The current study evaluated the performance on FVMC in preschool-aged children across different language sampling contexts. Participants were 38 English-speaking children who were between the ages of 3 and 4 years and below the mastery level of tense usage in three language sampling contexts, including conversation (free-play), picture description, and narratives (story retell). FVMC from each sampling context was computed by calculating the overall accuracy of copula be, auxiliary be, third-person singular present -s, and past tense -ed combined. A linear mixed-effects model comparison was carried out to determine the effect of sampling context on FVMC scores. After controlling for child age, mean length of utterance, and the number of obligatory contexts for FVMC scoring, FVMC scores were significantly higher in conversation than in picture description and narratives. In addition, FVMC scores across the three sampling contexts were significantly correlated (rs ≥ .62, p < .001). Although children's performance on FVMC relative to each other was quite stable across sampling contexts, FVMC scores may vary with sampling contexts. As compared to picture description and narratives, conversation may not adequately capture the limitation in preschoolers' tense development that is important for therapeutic planning.

ACUTE HEMORRHAGIC ABDOMEN IN YOUNG PATIENTS: CLINICAL MANIFESTATIONS AND SURGICAL TREATMENT

Acute hemorrhagic abdomen represents a surgical emergency that requires rapid diagnosis and immediate treatment. In young patients, the most common causes include perforated peptic ulcer, ruptured ectopic pregnancy, ovarian cyst torsion, and abdominal trauma. The clinical presentation is variable, but intense and sudden abdominal pain, associated with signs of hypovolemic shock (hypotension, tachycardia, pallor), is characteristic. Delay in diagnosis and treatment can lead to serious complications, such as hemodynamic instability, infection and death. Objective: The objective of this systematic review was to synthesize the available scientific evidence on the clinical manifestations and surgical treatment of acute hemorrhagic abdomen in young patients, with the aim of assisting health professionals in decision-making and therapeutic planning. Methodology: A systematic review of the literature was carried out, following the PRISMA checklist criteria. The PubMed, Scielo and Web of Science databases were searched using the following descriptors: “acute abdomen”, “hemorrhagic abdomen”, “young people”, “surgery”, “emergency”. Original articles published in the last 10 years were included, which addressed young patients diagnosed with acute hemorrhagic abdomen and described the clinical manifestations of the disease and the results of surgical treatments. Case studies, narrative reviews and articles that were not available in full were excluded. Results: The review identified a total of 17 studies that addressed acute hemorrhagic abdomen in young patients. The results demonstrated that intense and sudden abdominal pain is the most common symptom, often associated with nausea, vomiting and bloating. The presence of signs of peritoneal irritation, such as muscle guarding and pain upon sudden decompression, is suggestive of peritonitis. Complementary tests, such as blood count, coagulogram and computed tomography, are essential for diagnosing and staging the disease. The treatment of acute hemorrhagic abdomen is surgical and aims to control bleeding, remove the cause of hemorrhage and repair tissue damage. Exploratory laparotomy remains the gold standard for treatment, although laparoscopy has become increasingly popular in specialist centers. Conclusion: Acute hemorrhagic abdomen in young patients is a surgical emergency that requires a quick and effective approach. Early diagnosis and surgical treatment are essential for the patient's survival. High clinical suspicion, associated with the performance of appropriate complementary tests, allows diagnosis and initiation of treatment in a timely manner. Exploratory laparotomy remains the procedure of choice, but laparoscopy has proven to be a safe and effective alternative in many cases.

Managing Post-Transplant Diabetes Mellitus after Kidney Transplantation: Challenges and Advances in Treatment.

Kidney transplantation is the most effective treatment for end-stage renal failure but is associated with complications, including post-transplant diabetes mellitus (PTDM). It affects the quality of life and survival of patients and the transplanted organ. It can cause complications, including infections and episodes of acute rejection, further threatening graft survival. The prevalence of PTDM, depending on the source, can range from 4 to 30% in transplant patients. This article aims to discuss issues related to diabetes in kidney transplant patients and the latest treatments. Knowledge of the mechanisms of action of immunosuppressive drugs used after transplantation and their effect on carbohydrate metabolism is key to the rapid and effective detection of PTDM. Patient therapy should not only include standard management such as lifestyle modification, insulin therapy or pharmacotherapy based on well-known oral and injection drugs. New opportunities are offered by hypoglycemic drugs still in clinical trials, including glucokinase activators, such as dorzagliatin, ADV-1002401, LY2608204, TMG-123, imeglimine, amycretin and pramlintide. Although many therapeutic options are currently available, PTDM often creates uncertainty about the most appropriate treatment strategy. Therefore, more research is needed to individualize therapeutic plans and monitor these patients.

An internally and externally validated nomogram for predicting cancer-specific survival in octogenarians after radical resection for colorectal cancer

AimsWe aimed to develop an elaborative nomogram that predicts cancer-specific survival (CSS) in American and Chinese octogenarians treated with radical resection for CRC.MethodsThe patient data of newly diagnosed patients aged 80 years or older who underwent radical resection for CRC from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and then randomly divided into a training cohort and a validation cohort. The patients collected from our hospital were defined as the external validation cohort. Univariate and multivariate Cox regression was used to select independent predictive factors for the construction of a nomogram to predict 1-, 2- and 3-year CSS.ResultsThe multivariate Cox regression model identified age, T stage, N stage, perineural invasion, chemotherapy, tumour deposits, carcinoembryonic antigen level, number of lymph node metastases, and number of solid organ metastases as independent predictors of survival. The C-index of the nomogram for 1-, 2- and 3-year CSS was 0.758, 0.762, and 0.727, respectively, demonstrating significant clinical value and substantial reliability compared to the TNM stage. The calibration curve and area under the curve also indicated considerable predictive accuracy. In addition, decision curve analysis demonstrated desirable net benefits in clinical application.ConclusionWe constructed a nomogram for predicting the CSS of individual octogenarian patients with CRC who underwent radical resection. The nomogram performed better than the TNM staging system in this particular population and could guide clinicians in clinical follow-up and individual therapeutic plan formulation.

DeMambaNet: Deformable Convolution and Mamba Integration Network for High-Precision Segmentation of Ambiguously Defined Dental Radicular Boundaries.

The incorporation of automatic segmentation methodologies into dental X-ray images refined the paradigms of clinical diagnostics and therapeutic planning by facilitating meticulous, pixel-level articulation of both dental structures and proximate tissues. This underpins the pillars of early pathological detection and meticulous disease progression monitoring. Nonetheless, conventional segmentation frameworks often encounter significant setbacks attributable to the intrinsic limitations of X-ray imaging, including compromised image fidelity, obscured delineation of structural boundaries, and the intricate anatomical structures of dental constituents such as pulp, enamel, and dentin. To surmount these impediments, we propose the Deformable Convolution and Mamba Integration Network, an innovative 2D dental X-ray image segmentation architecture, which amalgamates a Coalescent Structural Deformable Encoder, a Cognitively-Optimized Semantic Enhance Module, and a Hierarchical Convergence Decoder. Collectively, these components bolster the management of multi-scale global features, fortify the stability of feature representation, and refine the amalgamation of feature vectors. A comparative assessment against 14 baselines underscores its efficacy, registering a 0.95% enhancement in the Dice Coefficient and a diminution of the 95th percentile Hausdorff Distance to 7.494.

Collaborative goal setting in palliative rehabilitation: a case report

BackgroundPalliative rehabilitation amalgamates the principles of palliative care and rehabilitation to enhance patients’ quality of life by optimizing physical function and maximizing autonomy despite advancing illness. Alongside providing non-pharmacological symptom management, it emphasizes personalized goal-setting tailored to individual needs. This case illustrates the transformative impact targeted physiotherapy interventions can have on patients’ physical function, morale and motivation in spite of their expected deterioration.Case presentationAn 85-year-old male with angioimmunoblastic T cell lymphoma was admitted to home hospice care. He was referred for physiotherapy to optimize his function and mobility despite his short prognosis. A conversation guide was used throughout the duration of therapy to identify personal goals, prescribe and review the use of appropriate interventions, and discuss future therapeutic plans. Within a month he achieved his functional goals, experienced reduced physical dependency, and had increased satisfaction in his ability to participate more actively in self-care. This also resulted in significant improvements in his confidence, mood, and overall well-being. Engaging the patient actively in his care and management journey provided him with significant motivation and hope.ConclusionThe case study highlights the vital role of physiotherapists in facilitating transparent communication among patients, healthcare providers, and caregivers throughout palliative rehabilitation. Through open dialogue and utilizing conversation guides, physiotherapists help understand patient preferences, goals, and motivation. This patient-centred approach ensures that therapeutic interventions align with individual needs, enhancing overall patient care and the provision of holistic palliative care.

Prehabilitation Consultation on Self-Care and Physical Exercise in Patients Diagnosed with Abdominopelvic Cancer: Protocol of the Study.

Introduction: Prehabilitation in the field of oncology has been defined as "the process in the continuum of care that occurs between diagnosis and the start of treatment involving physical and psychological measures that determine the patient's baseline functional status." To determine the effectiveness of a Prehabilitation consultation on self-care and targeted physical exercise for patients diagnosed with abdominopelvic cancer. An observational study that will evaluate the pre-post efficacy of an ad-hoc designed Prehabilitation intervention. The study population consists of patients diagnosed with colon or gynecological cancer with a surgical indication as part of their therapeutic plan from the General Surgery Services. It is configured around four key interventions: (a) health education and self-care, (b) specific nutritional counseling, (c) initial psychological assessment, and (d) directed physical exercise intervention. Health education, self-care interventions, and physical exercise will be carried out weekly from diagnosis to the scheduled surgery day. Aspects such as self-care capacity or agency, perioperative anxiety, aerobic capacity, strength and flexibility, postoperative complications, and recovery time to adjuvant treatment will be measured using tools such as Appraisal of self-care agency scale (ASA), State Trait Anxiety Inventory (STAI), walking test, sit and Reach, Hand Grip or Squad Jump. Utilizing validated tools for analyzing selected variables will contribute to refining and expanding care guidelines, ultimately enhancing support for both patients and their caregivers.