Treatment Methods Research Articles

Degradation of antiviral drug molnupiravir using a dual function FeIIFeIIILDH@carbon felt cathode in the heterogeneous electro-Fenton process: Kinetics and mineralization study

Pharmaceuticals constitute one of the more widely reported anthropogenic micropollutants, and their removal usually requires a specific treatment method. The oxidative degradation and mineralization of molnupiravir (MNP), a novel antiviral drug used for COVID treatment, were investigated for the first time by EF processes using both raw carbon felt (CF) and modified dual-function CF cathodes. The classical electro-Fenton (CEF) process using CF cathode has significant challenges, including a narrow pH range and a lack of ability to reuse the catalyst. To overcome these limitations, a dual-function FeIIFeIII layered double hydroxide modified carbon felt (FeIIFeIIILDH@CF) cathode was developed using a hydrothermal method. The FeIIFeIIILDH@CF cathode was characterized using BET, FTIR, SEM, cyclic, and linear sweep voltammetry. The efficiency of FeIIFeIIILDH@CF cathode for the removal of MNP compared with that of raw carbon felt (CF) cathode, including the effects of operating parameters. The heterogeneous electro-Fenton (HEF) process with FeIIFeIIILDH@CF cathode allowed an almost complete mineralization (98.08 % TOC removal) of 0.1 mM MNP solution. The mineralization ability of the FeIIFeIIILDH@CF cathode was more than 95 % after 5 cycles, suggesting a good reusability of the synthesized cathode. The absolute rate constant for the oxidation of MNP with ●OH (2.22 ± 0.03 ×109 M−1 s−1) was also determined for the first time. In addition, the modified LDH cathode has the advantage of being effective over a wide pH range while avoiding the use of an iron salt as a catalyst.

CO2 Laser Crystallization in Ambient for Highly Efficient FAPbI3 Perovskite Solar Cells.

Metal halide perovskite solar cells have achieved tremendous progress and have attracted enormous research and development efforts since the first report of demonstration in 2009. Due to fabrication versatility, many heat treatment methods can be utilized to achieve perovskite film crystallization. Herein, 10.6µm carbon dioxide laser process is successfully developed for the first time for perovskite film crystallization. In addition, this is the first time formamidinium lead triiodide solar cells by laser annealing under ambient are demonstrated. The champion cell produces a power conversion efficiency of 21.8%, the highest for laser-annealed perovskite cells. And this is achieved without any additive, passivation, or post-treatment.

Randomized, Blinded, Controlled Clinical Trial of Polylactide-Collagen Scaffold in Treatment of Shoulder Osteochondritis Dissecans in Dogs.

The aim of our study was to investigate a degradable polylactide-collagen scaffold (COPLA) in the treatment of shoulder osteochondritis dissecans (OCD) in dogs. The study was a controlled, randomized, blinded clinical trial with a parallel group design with a 1.5-year follow-up. Twenty dogs with uni- or bilateral shoulder OCD (29 shoulders) were randomized to receive a COPLA or arthroscopic debridement only (Control). The outcome of treatment was assessed with gait and stance analysis, passive range of motion measurement, pain and lameness evaluation, Helsinki Chronic Pain Index, and computed tomography (CT). Eighteen dogs (25 shoulders) completed the study. The clinical outcome variables improved significantly from baseline in COPLA and Control groups after treatment but no significant differences emerged between groups. Significantly fewer COPLA than Control shoulders had osteoarthritis (OA) in CT at 6 months (p = 0.019) but the difference was not significant at 1.5 years. At 1.5 years, all dogs were sound and pain-free in joint palpation, but OA was diagnosed in 13/18 dogs (18/25 shoulders) with CT. The results suggest that COPLA scaffold slowed down the development of OA at 6 months but it did not improve the clinical recovery or prevent OA in dogs with shoulder OCD in long-term follow-up at 1.5 years compared with arthroscopic debridement only. Regardless of the treatment method, clinical recovery was good, but OA developed in the majority of dogs.

Classification of anatomy and treatment approaches for aneurysms originating from the proximal of the A1 segment of the anterior cerebral artery in clinical settings.

To explore the spatial relationship between A1 segment proximal anterior cerebral artery aneurysms and their main trunks, classify them anatomically and develop targeted treatment strategies. This single-center retrospective analysis involved 39 patients diagnosed with aneurysms originating from the proximal of A1 segment of the anterior cerebral artery (2014-2023). Classify the patient's aneurysm into 5 types based on the location of the neck involving the carrier artery and the spatial relationship and projection direction of the aneurysm body with the carrier artery, and outcomes from treatment methods were compared. Among 39 aneurysms, 18 cases underwent endovascular intervention treatment, including 6 cases of stent assisted embolization, 1 case of flow-diverter embolization, 5 cases of balloon assisted embolization, and 6 cases of simple coiling. At discharged, the mRS score of all endovascularly treated patients was 0, and the GOS score was 5 at 6 months after discharge. At discharge, the mRS score of microsurgical clipping treated patients was 0 for 15 cases, 3 for 1 case, 4 for 1 case and 5 for 2 cases. Six months after discharge, the GOS score was 5 for 16 cases, 4 for 2 cases, 3 for 2 cases, and 1 for 1 case. GOS outcomes at 6 months were better for endovascularly treated patients (p = 0.047). Results showed better outcomes for the endovascular treatment group compared to microsurgical clipping at 6 months after surgery. The anatomical classification of aneurysms in this region may be of help to develop effective treatment strategies.

The mutagenic effect of cold plasma on Medicago sativa L.

To explore the feasibility of using cold plasma as a mutagenesis breeding technology for forage crops, in this study we used the Medicago sativa L. cultivar, Zhongcao No. 3, as the experimental material. The effects of plasma treatments on Medicago sativa L. were analyzed through the use of plasma and activated water. Treatments with plasma and activated water inhibited plant height but promoted root growth. By creating a closed environment, adding a dielectric barrier plate, and combining these two treatment methods, the greatest impact can be had on the growth of Medicago sativa L. seeds. After treatment, the plant heights were approximately half those of the control group, and the root lengths were approximately 1.6 times those of the control group. Through emission spectroscopy, it was found that active particles such as O, NO2, and N2* were present and could be considered to have produced plasma-activated water through contact with the water surface, thus affecting the survival and growth of the seeds. Whole-genome resequencing (WGRS) was performed on the wild-type and selected mutants after treatment, with an average sequencing depth of 115.93×, an average genome alignment rate of 91.72 %, and an average genome coverage rate of 91.85 %. Various types of mutations were detected and annotated. After filtering, 7,822,324 SNP (single nucleotide polymorphisms) sites, 2,161,917 indel sites, 200,544 SV sites, 238 CNV (copy number variation) sites. The SNPs, indels (insertions/deletions), and SVs (structural variations) were mainly heterozygous, with heterozygosity rates of 87.13 %, 92.16 %, and 83.49 %, respectively. The CNVs were dominated by low copy numbers, accounting for 53.77 %. These results indicate that plasma treatment has significant effects on plant growth and genome of Medicago sativa L.

Short-Term Effects of Cold Therapy and Kinesio Taping on Pain Relief and Upper Extremity Functionality in Individuals with Rotator Cuff Tendonitis: A Randomized Study

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. To the best of our knowledge, no studies have compared the effects of Kinesio taping (KT) and cold therapy (CT) on individuals with RCT. To this end, this study aimed to investigate and compare the short-term effects of KT and CT on pain relief and upper extremity functionality in individuals with RCT. Materials and Methods: One hundred and fourteen individuals were assessed for eligibility. Fifty-two individuals with RCT who met the inclusion criteria and agreed to participate were randomly allocated into either the KT or the CT group. A standardized home exercise program was given to all the participants. Their pain intensity, upper extremity function, shoulder range of motion (ROM), and grip strength were evaluated initially and after the three days of KT or CT applications. Results: All the assessment values significantly improved in the KT group. In the CT group, only the pain scores (except for the numerical rating scale (NRS) pain score during activity) were significantly improved in the CT group at the end of the third day of application compared to the initial values (p < 0.05). For all the measurement outcomes, the effects of time × group interactions were statistically significant (p < 0.05) in favor of the KT group, except for the resting pain (p = 0.688). Conclusions: The findings suggest that KT and CT could be used as adjunctive modalities to exercise for resting and night pain relief in patients with RCT. KT also had positive effects on the activity pain, function, ROM, and grip strength. The use of KT along with an exercise program could be a more effective therapeutic choice than the use of CT for improving night pain, activity pain, and upper extremity function during the short-term rehabilitation of RCT patients.

Analysis of rescue strategies for acute thrombosis during STA-MCA bypass surgery and the literature review

Background and objectivesSTA-MCA bypass surgery is mainly used for Moyamoya disease, giant intracranial aneurysms, and resection of intracranial tumors requiring sacrifice of blood vessels. The intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis.MethodsThis study involved 209 patients (272 hemispheres) who underwent STA-MCA surgery between November 2020 and December 2023. Intraoperative acute thrombosis occurred in eight patients (3.83%,8 hemispheres). We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed.ResultsEight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred.ConclusionOur treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.

Bioelectret Materials and Their Bioelectric Effects for Tissue Repair: A Review.

Biophysical and clinical medical studies have confirmed that biological tissue lesions and trauma are related to the damage of an intrinsic electret (i.e., endogenous electric field), such as wound healing, embryonic development, the occurrence of various diseases, immune regulation, tissue regeneration, and cancer metastasis. As exogenous electrical signals, such as conductivity, piezoelectricity, ferroelectricity, and pyroelectricity, bioelectroactives can regulate the endogenous electric field, thus controlling the function of cells and promoting the repair and regeneration of tissues. Materials, once polarized, can harness their inherent polarized static electric fields to generate an electric field through direct stimulation or indirect interactions facilitated by physical signals, such as friction, ultrasound, or mechanical stimulation. The interaction with the biological microenvironment allows for the regulation and compensation of polarized electric signals in damaged tissue microenvironments, leading to tissue regeneration and repair. The technique shows great promise for applications in the field of tissue regeneration. In this paper, the generation and change of the endogenous electric field and the regulation of exogenous electroactive substances are expounded, and the latest research progress of the electret and its biological effects in the field of tissue repair include bone repair, nerve repair, drug penetration promotion, wound healing, etc. Finally, the opportunities and challenges of electret materials in tissue repair were summarized. Exploring the research and development of new polarized materials and the mechanism of regulating endogenous electric field changes may provide new insights and innovative methods for tissue repair and disease treatment in biological applications.

Choosing the optimal method for surgical treatment of rhegmatogenous retinal detachment

The problem of the structural and functional effectiveness of episcleral and endovitreal treatment methods of rhegmatogenous retinal detachment remains open to this day.The aim of the study. To assess the clinical effectiveness of surgical treatment of rhegmatogenous retinal detachment using episcleral and endovitreal methods.Material and methods. An analysis of the electronic database and a detailed assessment of the treatment of 285 patients with rhegmatogenous retinal detachment for 2005–2022 were carried out. A comparative analysis was made in two groups: group 1 – patients after episcleral surgery (n = 155); group 2 – patients after endovitreal surgery (n = 130). The initial condition and the extent of surgery were comparable. Results. From 2005 to 2009 in 65.9 % of cases, episcleral buckling predominated; from 2009 to 2021 – posterior closed vitrectomy (in 64.8–88.7 % of cases). The incidence of primary retinal reattachment was 74.2 % and 71.5 %. The number of relapses after vitreoretinal surgery slightly exceeded the values in the group 1 – 28.4 % versus 25.7 %, and in 20% of cases the first relapse occurred before silicone aspiration as a result of subsilicone proliferation. The total number of surgical interventions per person, taking into account mandatory silicone aspiration, in the group 1 was 1.3, in the group 2 – 2.25 for the entire observation period. The visual acuity of patients in group 1 was 2 times higher than that of the comparison group – 0.21 ± 0.02 and 0.1 ± 0.03, respectively (p < 0.05).Conclusion. Episcleral treatment methods of rhegmatogenous retinal detachment are characterized by better anatomical, reconstructive and functional effects with fewer re-operations

Holistic Approaches in Endometriosis - as an Effective Method of Supporting Traditional Treatment: A Systematic Search and Narrative Review.

Endometriosis is one of the gynecological diseases where women suffer from pain, quality of life decreased. The aim of this review was to describe the most common non-medical methods used in the treatment of symptoms associated with endometriosis and to determine their effectiveness. The review was performed in PubMed, Embase and Web of Science databases. Randomized controlled trials, case studies, observational studies, retrospective studies, prospective studies, pilot studies, trails, publications in English or Polish were searched based on the Participant-Intervention-Comparator-Outcomes-Study design (PICOS) format. The criteria used to select studies were: women with endometriosis, no cancer, included any physiotherapeutic or non-medical intervention. 3706 articles were found, however only 26 met the inclusion criteria and were included in the review. Quality of the studies was assessed by Risk of Bias 2 tool and ROBINS-1 tool. The most holistic approach used in the treatment of symptoms of endometriosis include physical therapy, manual therapy, electrophysical agents acupuncture, diet and psychological interventions. Most research has focused on relieving pain and increasing quality of life. Non-medical methods showed reduction of symptoms of endometriosis. Physical activity, manual therapy, electrophysical agents, acupuncture, diet and cognitive behavioral therapy showed no negative side effects and reduced pain, what improved the quality of life and reduced the perceived stress.

Phthalocyanine-enabled technologies for water treatment and disinfection strategies

Water treatment and disinfection are critical factors in ensuring a safe and sustainable water supply. Phthalocyanines (Pcs), a class of versatile and robust organic compounds, have garnered significant attention for their application in various water treatment processes. This review paper offers a groundbreaking investigation of Pc-enabled technologies within the domain of water treatment applications. The core aim of this review is to meticulously analyze the chemical and optical properties of Pcs, elucidate their photosensitization mechanism and establish the crucial connection between their chemical structure and photodynamic efficacy. The various modes of Pcs application in water treatment processes - whether in solution, immobilized, or integrated into water treatment membranes - emphasizing the strategies for their integration and effectiveness in disinfection and decontamination has also been extensively investigated. Moreover, it sheds light on the latest advancements and challenges in the field, providing valuable insights into future research for employing Pcs in environmentally sustainable water treatment methods.

Deep-sea microorganisms-driven V5+ and Cd2+ removal from vanadium smelting wastewater: Bacterial screening, performance and mechanism

The disorderly discharge of industrial wastewater containing heavy metals has caused serious water pollution and ecological environmental risks, ultimately threatening human life and health. Biological treatment methods have obvious advantages, but the existing microorganisms exhibit issues such as poor resistance, adaptability, colonization ability, and low activity. However, a wide variety of microorganisms in deep-sea hydrothermal vent areas are tolerant to heavy metals, possessing the potential for efficient treatment of heavy metal wastewater. Based on this, the study obtained a group of deep-sea microbial communities dominated by Burkholderia-Caballeronia-Paraburkholderia through shake flask experiments from the sediments of deep-sea hydrothermal vents, which can simultaneously achieve the synchronous removal of vanadium and cadmium heavy metals through bioreduction, biosorption, and biomineralization. Through SEM-EDS, XRD, XPS, and FT-IR analyses, it was found that V(V) was reduced to V(IV) through a reduction process and subsequently precipitated. Glucose oxidation accelerated this process. Cd(II) underwent biomineralization to form precipitates such as cadmium hydroxide and cadmium carbonate. Functional groups on the microbial cell surface, such as -CH2, C=O, N-H, -COOH, phosphate groups, amino groups, and M-O moieties, participated in the bioadsorption processes of V(V) and Cd(II) heavy metals. Under optimal conditions, namely a temperature of 40 °C, pH value of 7.5, inoculation amount of 10%, salinity of 4%, COD concentration of 600 mg/L, V5+ concentration of 300 mg/L, and Cd2+ concentration of 40 mg/L, the OD600 can reach its highest at 72 h, with the removal efficiency of V5+, Cd2+, and COD in simulated vanadium smelting wastewater reaching 86.32%, 59.13%, and 61.63%, respectively. This study provides theoretical insights and practical evidence for understanding the dynamic changes in microbial community structure under heavy metal stress, as well as the resistance mechanisms of microbial treatment of industrial heavy metal wastewater.

Assessing the effectiveness of high-definition transcranial direct current stimulation for treating obsessive-compulsive disorder: Results from a randomized, double-blind, controlled trial

ObjectiveCharacterized by its disabling nature, obsessive compulsive disorder (OCD) affects individuals profoundly, with nearly 40% of patients showing resistance to initial treatment methods. Despite being safe and easily accessible, transcranial direct current stimulation (tDCS) lacks extensive substantiation supporting its efficacy in treating OCD. The objective of this study was to evaluate how cathodal high-definition transcranial direct current stimulation (HD-tDCS) applied to the right orbitofrontal cortex affected patients with OCD in terms of efficacy. Method47 patients with OCD were enrolled. They were randomly allocated to active or sham stimulation groups, and underwent HD-tDCS stimulation treatment for 2 weeks. The central electrode located in the right orbitofrontal cortex region was cathodic. The severity of the patients' obsessive-compulsive symptoms, depression and anxiety were assessed before and after treatment. ResultOut of the total, 44 patients concluded the treatment, comprising 23 participants from the active stimulation group and 21 from the sham stimulation group. Notably, substantial reductions in symptoms related to OCD, depression, and anxiety were exhibited in both groups. With a response rate of 26.1% in the active stimulation group and 23.8% in the sham stimulation group, there was no significant difference in efficacy observed. Furthermore, the reduction in depression and anxiety symptoms at the conclusion of the treatment was not notably superior in the active stimulation group. ConclusionThis study provided evidence for the acceptability and safety of HD-tDCS. Nevertheless, the study did not reveal notable clinical effectiveness of tDCS in addressing moderate to severe OCD in comparison to the sham stimulation group.

Multimodal effects of an extracellular matrix on cellular morphology, dynamics and functionality.

Articular cartilage defects can lead to pain and even disability in patients and have significant socioeconomic loss. Repairing articular cartilage defects remains a long-term challenge in medicine owing to the limited ability of cartilage to regenerate. At present, the treatment methods adopted in clinical practice have many limitations, thereby necessitating the rapid development of biomaterials. Among them, decellularized biomaterials have been particularly prominent, with numerous breakthroughs in research progress and translational applications. Although many studies show that decellularized cartilage biomaterials promote tissue regeneration, any differences in cellular morphology, dynamics, and functionality among various biomaterials upon comparison have not been reported. In this study, we prepared cartilage-derived extracellular matrix (cdECM) biomaterials with different bioactive contents and various physical properties to compare their effects on the morphology, dynamics and functionality of chondrocytes. This cellular multimodal analysis of the characteristics of cdECM biomaterials provided a theoretical basis for understanding the interactions between biomaterials and cells, thus laying an experimental foundation for the translation and application of decellularized cartilage biomaterials in the treatment of cartilage defects.

Assessment of Police Trainees’ Satisfaction with the Public Safety Basic Recruit Course of The National Police Training Institute

This study aimed to determine police trainees' satisfaction with the Public Safety Basic Recruit Course of the NPTI, and the significant difference in satisfaction between Criminology and non-criminology graduate police trainees. The study applied descriptive correlational research design and interviews using a self-made survey questionnaire for 218 respondents and prepared guided interview questions for five key informants from the graduating police trainees at NCRTC. The data obtained were collated, sorted, summarized, and subjected to statistical treatment methods. The result of the study revealed that police trainees were very satisfied with the Public Safety Basic Recruit Course. They greatly appreciated the quality of training program. However, facilities, equipment, and supplies needed attention and improvement. Interviews disclosed that despite high satisfaction, police trainees faced various challenges that dissatisfied them. These includes frequent shortages of water supplies, overcrowding of dormitories and classrooms, and insufficient faculty members. However, despite these, they remained optimistic that the training management can address it. Additionally, the study found that there was no significant difference in satisfaction between Criminology and non-criminology graduate police trainees. This suggests that both groups had similar levels of satisfaction, and highly appreciative with the training program. To enhance further the satisfaction of police trainees, the NPTI should focus on improving facilities, equipment, and supplies, and address the specific concerns raised by the trainees. Furthermore, an action plan should be developed, outlining realistic, measurable, and time-bound plans, programs, and activities to address the concerns of police trainees.

Neurocognitive performance of patients undergoing intravenous versus oral opioid agonist treatment: a prospective multicenter study on three-month treatment effects.

The first-line treatment for opioid dependence is opioid agonist treatment (OAT) with oral opioids. However, in some cases, treatment with intravenous diacetylmorphine (IV-DAM) is indicated. Research on neurocognitive impairments and treatment effects of OAT - particularly with IV-DAM - on neurocognitive functioning, is scarce. The current study is the first to investigate the neurocognitive performance of individuals on OAT with IV-DAM. Using a prospective study design with two timepoints of measurement, the first aim was to assess the nature and extent of neurocognitive functioning in individuals with opioid dependence by comparing participants' neurocognitive performance with normative data of the general population on admission to treatment (baseline) and after an initial three-month period of OAT (study end). The second aim was to examine whether and to what extent neurocognitive performance would improve after three months on OAT. The third aim was to investigate whether, and if so, to what extent the treatment method (IV-DAM vs. oral opioids) would lead to higher neurocognitive improvements at study end. Forty-seven opioid-dependent individuals (baseline; 33 individuals at study end) participated in this study (mean age: 34.3 years; 27.7% female). Participants underwent neuropsychological testing with a battery of 12 tests covering different neurocognitive domains, including attention, memory, and executive functions. Compared to normative data, opioid-dependent individuals showed impairments in almost every test both at baseline and at study end. At baseline, neurocognitive performance did not differ between individuals receiving IV-DAM or oral opioids for OAT. Compared to baseline, the neurocognitive performance did neither improve nor deteriorate after three months of treatment with neither IV-DAM nor oral opioids. However, a trend towards improvement was found for the memory domain. Given that neurocognitive impairments should be considered in treatment planning and therapeutic interventions. Since a reduced cognitive performance may affect both the treatment outcome and the therapeutic relationship unfavorably, specific neurocognitive training at the beginning of treatment should be considered.

Stakeholder exposure to and knowledge of tree pests and diseases and their management in urban areas

Urban trees and forests provide many benefits to the urban environment and are important for climate change adaptation. Yet, they are increasingly threatened by insect pests and diseases, hereafter tree pests/diseases. There is little evidence of the risk awareness and knowledge of different urban stakeholders of this growing threat, how they are affected by tree pests/diseases, and how they might respond to it. To fill this gap, we undertook an online survey of different key stakeholder groups associated with urban trees and forests in Germany. A majority of 75.8 % of the 186 respondents consider urban tree pests/diseases a severe problem and 51.1 % reported high knowledge of tree pests/diseases. There was a lack of knowledge of certain reportable quarantine pests/diseases (e.g., canker stain of plane, emerald ash borer, Xylella) and pest/disease management options (e.g., manual treatment methods and tree diversification). Respondents were most affected by the horse chestnut leafminer (61.3 %), ash dieback (58.1 %) and oak processionary moth (50.0 %). The most widely used pest remedial measures were improvements of tree living conditions (60.8 %) and purchases of plants from certified or trusted local sources (59.7 %). Multiple correspondence analysis showed a significant association between levels of knowledge of tree pests/diseases and pest management responses (11.7 %). Our results suggest that future efforts to improve urban tree health should be enhanced and tailored to the different requirements of various stakeholder groups. The findings of this first comprehensive study with a purely urban focus will inform the development of future activities that prevent or reduce the spread of tree pests/diseases in urban areas. Data AvailabilityThe survey respondents did not give permission for the full data to be accessed or used by third parties.

Drug-resistant epilepsy: Current concepts, pathogenesis, risk factors, outcomes of surgical treatment

Despite the wide choice of antiepileptic drugs (AEDs), a third of patients remain resistant to the effects of modern AEDs. Drug-resistant epilepsy (DRE) is characterized by the inability to control seizures in a patient when using at least two adequate AED regimens at an effective daily dose as monotherapy or in combination. In this case, the mechanisms responsible for drug resistance are mainly either increased excretion of AEDs by transporters from epileptogenic tissue (the multidrug transporter hypothesis) or a decrease in the sensitivity of drug receptors in epileptogenic brain tissue. It is assumed that there are other mechanisms, but they remain understudied. A number of factors are associated with the risk of DRE developing in patients with diagnosed epilepsy, including genetic, iatrogenic, brain malformations, and others. Patients with DRE have a higher probability of developing psychopathological disorders (depression, anxiety, psychosis), the proportion of which is significantly higher than in the general population. They have a 10-fold increased risk of death due to injury, cognitive decline, and sudden unexpected death in epilepsy (SUDEP). The priority treatment method for DRE is surgery. Early identification of DRE is critical for identifying potential treatment alternatives and determining whether a patient is a surgical candidate. Analysis of data from clinical and instrumental research of operated patients with DRE in the early and late postoperative period will allow us to identify factors of unfavorable outcome and to increase the effectiveness of treatment for this category of patients.The aim was to study and to summarize literature data on the pathogenesis and risk factors of drug resistance to antiepileptic drugs in patients with epilepsy, justifying the need for timely identification of drug resistance and referral of patients with drugresistant epilepsy to specialized centers for possible surgical treatment.

Examining the educational experiences of Behvarzes from the insufficient participation of some people in preventive measures against the COVID-19 pandemic: a lesson for the future

BackgroundThis study aims to explore the experiences of Behvarzes regarding the reasons behind the insufficient participation of some individuals with the preventive protocols established during the COVID-19 pandemic.MethodsA qualitative study was conducted from July 2021 to December 2022 using the conventional content analysis method. Purposive sampling was employed to select 14 Behvarzes working in villages covered by Kashan University of Medical Sciences. Data were collected through semi-structured in-depth individual interviews and analyzed using conventional content analysis.ResultsThe study identified seven subcategories which were grouped into two main categories of reasons for inadequate compliance with health protocols by some individuals. These include: (1) Intentional non-compliance with preventive protocols, with the following subcategories: perceived obligation and adherence to social customs, denial of risk, belief in external health locus of control, and fear and distrust of prevention and treatment methods. (2) Unintentional non-compliance with preventive protocols, with the following subcategories: insufficient or contradictory information, negligence, and inevitability.ConclusionThe findings suggest that ensuring compliance with health guidelines is not a one-size-fits-all approach. providing empowerment and obstacle removal solutions to those forced to violate preventive protocols for various reasons are all critical components of successful interventions. Also, cultural familiarity can aid in the design of appropriate interventions to address these challenges.

Presentation and Management of Postpartum Granulation Tissue: A Single-Institution Retrospective Study.

Although the development of postpartum granulation tissue (PPGT) is an expected phase of healing of perineal and vaginal lacerations, the persistence of this tissue can result in delayed wound healing, pain, bleeding, and discharge. There is a paucity of information on the efficacy of the treatments used for pathologic PPGT. The objective of this study was to describe characteristics associated with the development of PPGT and the treatment methods currently used for management. This was a retrospective cohort study of 140 patients diagnosed with PPGT within one year of birth from 2012 through 2022 within a single health care system. Patients were identified by International Classification of Diseases and Current Procedural Terminology codes. Demographics, birth characteristics, symptoms, and treatment information were obtained and assessed in frequencies and means. Treatments were compared with 95% CIs and P values. Time to resolution was assessed by the number of weeks and the number of visits. It was the first vaginal birth for 129 (92%) patients in the study cohort. The majority (84.3%) of patients presented with pain. Almost half of all patients (45%) were diagnosed after 6 weeks postpartum. 30.0% of patients were initially treated conservatively. 76.4% of patients were treated with silver nitrate, and 33.6% had an excisional procedure. Successful conservative management had the lowest average number of visits to resolution with 1.39 visits (95% CI, 1.15-1.69), followed by silver nitrate alone with 1.95 visits (95% CI, 1.73-2.19), and excision with or without silver nitrate with 2.40 visits (95% CI, 2.07-2.78). Conservative management was unsuccessful 45% of the time, requiring additional treatment with silver nitrate or excision. 30% of patients treated with silver nitrate or excision continued to report pain even after the resolution of granulation tissue upon examination. PPGT is commonly associated with first vaginal births, often presents beyond 6 weeks postpartum, and frequently requires treatment.