Treatment Protocols Research Articles

Investigating the interaction of zno nanoparticles with flagellum and fimbriae in multi-drug resistant uropathogenic bacteria encoding fli and fim genes.

Due to the increasing occurrence of drug resistant urinary tract infections (UTI) among children, there is a need to investigate alternative effective treatment protocols such as nanoparticles. Flagella and fimbriae are primary factors contributing the virulence of urinary tract infecting bacteria. The aim of this study was to assess the antibacterial effects of zinc oxide nanoparticles which have been synthesized using both chemical and green methods on multi-drug resistant (MDR) uropathogenic bacteria encoding fli and fim genes and investigating their binding ability to bacterial appendage proteins. A total of 30 urine culture samples were collected from children under 2 years old diagnosed with urinary tract infection. The isolates underwent antibiotic suseptibility assessment and the isolates demonstrating MDR were subjected to molecular amplification of fimG (fimbrial) and fliD and fliT (flagellal) genes. The confirmation of cellular appendages was achieved through silver nitrate staining. The antibacterial efficacy of the synthetized nanoparticles was assessed using the micro and macrodilution methods. The successful binding of nanoparticles to bacterial appendage proteins was confirmed through mobility shift and membrane filter assays. The dimensions of chemically synthesized ZnO nanoparticles and green nanoparticles were measured at 30nm and 85nm, respectively, with the exhibition of hexagonal geometries. The nanoparticles synthesized through chemical and green methods exhibited minimum inhibitory concentrations (MIC) of 0.0062-0.025g/L and 0.3g/L, respectively. The ability of ZnO nanoparticles to bind bacterial appendage proteins and to combat MDR uropathogenic bacteria are promising for new treatment protocols against UTI in children in future.

Mapping the Nanotechnology Patent Landscape in the Field of Cancer.

Currently, cancer is still a significant disease that seriously endangers human health. Therefore, advanced diagnostic technology and treatment protocols are urgently needed. The rapid development of nanotechnology is expected to provide new ideas for cancer diagnosis and treatment. The research aims to comprehensively demonstrate the hotspots of nanotechnology applications in cancer. In this study, an International Patent Classification codes co-occurrence network is constructed to visualize the technology landscape by simultaneously locating and ranking technologies that play an integral role in nanotechnology diffusion and bridging in the field of cancer. In addition, community identification and topic modeling highlight the latent topics in patent documents. The visualization results of the patent network yield five main clusters: Cluster 0 is a nanoparticle composition delivery system with liposomes as the primary carrier. Cluster 1 is mainly represented by nano-immunotherapy with immune checkpoint inhibitors. Cluster 2 is nano phototherapy based on photodynamic therapy and photothermal therapy. Cluster 3 is diagnostic imaging involving nanotechnology. Cluster 4 is a drug delivery system with nanovesicles and albumin nanoparticles as carriers. It was found that carriers represented by liposomes, vesicles, and albumin nanoparticles are essential nanomaterials in the current anticancer drug delivery systems. Integrating next-generation immunosuppressants and nanotechnology will become an important development direction for future immunotherapy. Organic/inorganic nanomaterials are pivotal in cancer imaging diagnosis and phototherapy.

Effect of thoracic manipulation on neck pain in the mobility group: A randomized controlled trial.

Thoracic spine manipulation (TSM) increases the thoracic spine's range of motion (ROM), effectively reducing pain intensity and disability in patients with mechanical neck pain. We aimed to determine the effect of TSM on neck pain intensity and functional impairment in patients classified under the "mobility" category in Childs' classification. In this randomized controlled trial, patients with mechanical neck pain who met the inclusion criteria were randomly assigned to either the TSM (n = 21) or sham manipulation (n = 20) group. The primary outcomes were pain during neck rotation and subjective improvement assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC), respectively. The secondary outcomes were NPRS at rest, disability (assessed using the Neck Disability Index [NDI]), and ROM of the cervical and thoracic spine rotation. Outcome measurements were performed at baseline, immediately after treatment, 1 week after treatment, and at the 4-week follow-up. Linear mixed models were used to analyze the NPRS, NDI, and ROM. The GROC was analyzed using a chi-square test for the percentage recording ≥+4; the means of each group were compared using an unpaired t-test. The NPRS with neck rotation, neck and thoracic ROM, and NDI showed significant interactions between the groups. The NPRS with neck rotation was significantly lower in the TSM group than in the sham group at all time points after the treatment (p < 0.001). There was no difference between the groups in the proportion showing moderate (≥+4) improvement according to the GROC; however, there was a significant difference in the mean values (p = 0.013). Incorporating TSM into treatment protocols may improve clinical outcomes in patients with neck pain, potentially leading to better pain management and functional recovery. Therefore, physiotherapists should consider TSM as a viable and effective intervention to improve patient outcomes in neck pain rehabilitation.

Standardization of quantitative PCR (qPCR) method to detect the level of parasitaemia in Babesia gibsoni infected dogs

The present investigation aimed to quantitatively assess the level of parasitemia in dogs using qPCR.The dogs selected for this study were infected with the haemoprotozoan parasite Babesia gibsoni. In the study, dogs diagnosed with babesiosis were divided into two groups (n = 12) and subjected to distinct treatment strategies. The first group received clindamycin-metronidazole-doxycycline (CMD) therapy, while the second group was treated with a combination of buparvaquone-azithromycin (BPV-AZM). The level of parasitemia in the infected dogs was determined using an absolute quantification-based qPCR method. This assessment was conducted both prior to initiating the treatment and on the 10th day following the commencement of the treatment protocols. On the tenth day after the initiation of treatment, the CMD group exhibited a lower level of parasitemia in comparison to the BPV-AZM group. In the CMD treated groups, the mean parasitemia decreased from 4.9E + 06 to 3.4E + 06, indicating a reduction in parasitic load. Conversely, in the BPV-AZM treatment groups, the mean parasitemia increased from 1.62E + 06 to 2.87E + 06, suggesting an increase in parasitic load. On the 10th day, the CMD-treated group demonstrated a statistically significant decline in the level of parasitemia, with a P-value of ≤0.001. This indicates a strong and significant reduction in parasitic load following the CMD treatment. Therefore, the absolute quantification-based qPCR method could effectively assess the initial treatment response by measuring the level of parasitemia.

Diagnosis and treatment of anterior cruciate ligament injuries: Consensus of Chinese experts part II: Graft selection and clinical outcome evaluation

BackgroundIn the recent decade, there has been substantial progress in the technologies and philosophies associated with diagnosing and treating anterior cruciate ligament (ACL) injuries in China. The therapeutic efficacy of ACL reconstruction in re-establishing the stability of the knee joint has garnered widespread acknowledgment. However, the path toward standardizing diagnostic and treatment protocols remains to be further developed and refined. ObjectiveIn this context, the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM) collaboratively developed an expert consensus on diagnosing and treating ACL injury, aiming to enhance medical quality through refining professional standards. MethodsThe consensus drafting team invited experts across the Greater China region, including the mainland, Hong Kong, Macau, and Taiwan, to formulate and review the consensus using a modified Delphi method as a standardization approach. As members of the CSSM Lower Limb Study Group and the CAOS Arthroscopy and Sports Medicine Study Group, invited experts concentrated on two pivotal issues: “Graft Selection” and “Clinical Outcome Evaluation” during the second part of the consensus development. ResultsThis focused discussion ultimately led to a strong consensus on nine specific consensus terms. ConclusionThe consensus clearly states that ACL reconstruction has no definitive “gold standard” graft choice. Autografts have advantages in healing capability but are limited in availability and have potential donor site morbidities; allografts reduce surgical trauma but incur additional costs, and there are concerns about slow healing, quality control issues, and a higher failure rate in young athletes; synthetic ligaments allow for early rehabilitation and fast return to sport, but the surgery is technically demanding and incurs additional costs. When choosing a graft, one should comprehensively consider the graft's characteristics, the doctor's technical ability, and the patient's needs. When evaluating clinical outcomes, it is essential to ensure an adequate sample size and follow-up rate, and the research should include patient subjective scoring, joint function and stability, complications, surgical failure, and the return to sport results. Medium and long-term follow-ups should not overlook the assessment of knee osteoarthritis.

Low-Dose Triple-Pill vs Standard-Care Protocols for Hypertension Treatment in Nigeria: A Randomized Clinical Trial.

With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies. To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering. Randomized, parallel-group, open-label, multicenter trial conducted in public hospital-based family medicine clinics in Nigeria. Black African adults with uncontrolled hypertension (≥140/90 mm Hg) who were untreated or receiving a single blood pressure-lowering drug. Participants were randomly allocated to low-dose triple-pill or standard-care protocols. The triple-pill protocol involved a novel combination of telmisartan, amlodipine, and indapamide in triple one-quarter, one-half, and standard doses (ie, 10/1.25/0.625 mg, 20/2.5/1.25 mg, and 40/5/2.5 mg), with accelerated up-titration. The standard-care protocol was the Nigeria hypertension treatment protocol starting with amlodipine (5 mg). The primary effectiveness outcome was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of trial treatment due to adverse events, both from randomization to month 6. The first participant was randomized on July 19, 2022, and the last follow-up visit was on July 18, 2024. Among 300 randomized participants (54% female; mean age, 52 years; baseline mean home blood pressure, 151/97 mm Hg; and clinic blood pressure, 156/97 mm Hg), 273 (91%) completed the trial. At month 6, mean home systolic blood pressure was on average 31 mm Hg (95% CI, 28 to 33 mm Hg) lower in the triple-pill protocol group and 26 mm Hg (95% CI, 22 to 28 mm Hg) lower in the standard-care protocol group (adjusted difference, -5.8 mm Hg [95% CI, -8.0 to -3.6]; P < .001]). At month 6, clinic blood pressure control (<140/90 mm Hg) was 82% vs 72% (risk difference, 10% [95% CI, -2% to 20%]) and home blood pressure control (<130/80 mm Hg) was 62% vs 28% (risk difference, 33% [95% CI, 22% to 44%]) in the triple-pill compared with the standard-care protocol group; these were 2 of 21 prespecified secondary effectiveness end points. No participants discontinued trial treatment due to adverse events. Among Black African adults with uncontrolled hypertension, a low-dose triple-pill protocol achieved better blood pressure lowering and control with good tolerability compared with the standard-care protocol. Pan African Clinical Trials Registry Identifier: PACTR202107579572114.

Keep Cool but Don't Freeze: The Influence of William J. Mills Jr. on the Treatment of Frostbite.

Dr William J. Mills Jr., an Alaskan orthopedic surgeon, helped establish the current protocols for frostbite treatment and changed a dogma used for more than 140 years that was established by Napoleon's surgeon general of the army, Baron Dominique-Jean Larrey. During Napoleon's 1812 siege of Moscow, Larrey noticed the destructive effects of using open fire heat for warming frozen body parts, so he suggested rubbing snow or immersion in cold water. Dr Mills treated many cold injuries during his medical career. After setting up his medical practice in Anchorage, Alaska, he realized the inefficiency of the established protocols and started researching new treatments for frostbite. Dr Mills followed Meryman's method of rapidly thawing frozen red blood cells in warm water. Mills and his colleagues established a treatment protocol for freezing cold injury that included rapid warming in warm water. These studies resulted in the publication of three key papers in 1960 and 1961. These papers were the first clinical studies that described rapid warming as a treatment. Subsequently, rapid warming, with some variation in water temperatures, has been accepted as the standard of treatment. Due to his outstanding contribution to the treatment of frostbite, he has been referred to as "the nation's leading authority on cold injury." Mills and his colleagues created a new classification system that divided frostbite into two levels, superficial and deep, which was more applicable in clinics than the traditional 4-tier classification. The 2-tier classification is still useful outside of the hospital setting.

Rebound Hyperthermia in Exertional Heat Stroke.

Exertional heat stroke (EHS) is a life-threatening condition requiring rapid reversal of hyperthermia to prevent poor health outcomes. Current treatment protocols aim for a cooling rate of 0.15 C/min using various modalities. This case report details a 22-year-old male who, despite initial successful cooling measures, experienced rebound hyperthermia, necessitating the use of endovascular cooling (EVC). The patient collapsed during a 19.3 km (12-mile) ruck march in Fort Moore, Georgia, with an initial core temperature of 41.6ºC. Conventional cooling methods, including ice sheets and chilled intravenous saline, adequately cooled the patient to target temperatures; however, discontinuation of cooling methods resulted in rebound hyperthermia. Endovascular cooling was eventually initiated, resulting in euthermia after 36 hours of continued use. During his hospital admission, the patient was evaluated thoroughly for underlying etiologies contributing to his rebound hyperthermia. This workup did not yield any concerning pathology, except for bilateral foot cellulitis noted on physical examination, which was subsequently managed with antibiotics. Despite initial complications, the patient recovered within 5 days and returned to duty after 2 months. Several case reports have been published regarding the use of EVC in the management of EHS. These reports, however, describe its use in initial management of EHS or in cases where hyperthermia was refractory to other conventional cooling methods. To our knowledge, this is the first report of its kind highlighting its successful implementation in rebound hyperthermia. Early recognition and initiation of cooling measures are critical in EHS cases. Future directions include developing EHS-specific EVC protocols for patients experiencing refractory or rebound hyperthermia.

Improving Pulmonary Tuberculosis Treatment Adherence: The role of patient knowledge in Cirebon, West Java, Indonesia

Background: With 10 million cases around the world, pulmonary tuberculosis (TB) has been classified as a highly contagious disease and mostly affecting low and middle countries. Having the second highest incident cases in West Java of Indonesia, Cirebon becomes a challenging city in order to reduce the number of TB cases in the country. Aims: This study aims to identify the patients’ knowledge and treatment phases, and how the two factors encourage patients to comply with their medication. Methods : This cross-sectional observational study was conducted among 91 new pulmonary tuberculosis patients at the Cirebon City Community Lung Health Centre, selected using random sampling. Not only respondent characteristics, but also data on the patients' knowledge levels, treatment phases, and medication adherence were collected using a questionnaire and medical records. To assess the relationship between these variables, the collected data was then analyzed using the Spearman Correlation test. Ethical clearance was obtained from the Health Research Ethics Commission, and informed consent was gathered from all participants. Results: This study reveals the most updated characteristics of the Tuberculosis patients at the Cirebon City Community Lung Health Center aged 15-64 years old with treatment duration ranged 1-6 months. The majority have insufficient knowledge about tuberculosis (45.1%), and 75.8% of patients adhered to their prescribed medication regimen, regardless of their knowledge level. The data indicates a significant positive correlation between knowledge level and medication adherence (p = 0.015), with 95% of patients with good knowledge adhering to treatment compared to only 34% with poor knowledge. Furthermore, there is a significant relationship between adherence and treatment duration (p = 0.002), as 85% of patients who adhered to treatment did so for more than two months. Conclusion: The study shows that patients with better knowledge of tuberculosis are more likely to stick to their medication, which also leads to longer treatment durations. Given the high incidence of TB in the region, these findings suggest the need for targeted educational programs to enhance patients' understanding of TB, thereby improving adherence to treatment protocols. Received: 20 May 2024, Reviewed: 09 June 2024, Revised: 26 August 2024, Accepted: 30 August 2024.

Herbal medicine exhibiting cell cycle arrest: A short review

Cancer treatment often involves the use of chemotherapy, which can have significant side effects. Herbal medicines have been used for centuries and have shown potential as sources of new therapeutic agents. This review explores the role of specific herbal medicines, such as ginseng, curcumin, berberine, epigallocatechin gallate (EGCG), and quercetin, in inducing cell cycle arrest, a mechanism that controls cell proliferation. The review discusses the molecular mechanisms underlying these effects, their potential in combination with chemotherapy, and their implications for clinical application in cancer therapy. The combination of herbal medicines with conventional chemotherapeutic agents can result in synergistic effects that enhance therapeutic efficacy. However, there are challenges in terms of standardization, safety evaluation, and the need for more research to understand the molecular mechanisms and optimize treatment protocols. With further investigation and clinical validation, herbal-drug combination therapies could have a significant impact on cancer treatment.

The combined application of pulsed electromagnetic fields and platelet-rich plasma in the treatment of early-stage knee osteoarthritis: A randomized clinical trial.

This study aims to evaluate the therapeutic efficacy of combined treatment with pulsed electromagnetic fields (PEMFs) and platelet-rich plasma (PRP) injection in improving pain and functional mobility among patients with early-stage knee osteoarthritis (KOA). We hypothesize that this combined therapy can yield superior treatment outcomes. Based on the different treatment regimens, we divided 48 patients diagnosed with Kellgren-Lawrence grades I-III KOA into 3 groups: the PRP group, the PEMFs group, and the PRP + PEMFs group. Each subtype of KOA patients was randomly assigned to different treatment groups. In the PRP group, patients received intra-articular injections of leukocyte-rich platelet-rich plasma once a month for 3 consecutive months. In the PEMFs group, patients receive low-frequency PEMFs irradiation therapy with a frequency of 30 Hz and intensity of 1.5 mT, once daily, 5 times a week, for a consecutive treatment period of 12 weeks. In the PRP + PEMFs group, patients receive both of the aforementioned treatment protocol. The treatment effects on patients are evaluated at baseline and at weeks 4, 8, and 12 post-treatment. Assessment parameters include visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne Index score, and knee joint range of motion. From the 4th to the 12th week of treatment, the visual analog scale scores, Western Ontario and McMaster Universities Osteoarthritis Index scores, and Lequesne index scores of patients in all 3 groups gradually decreased, while knee joint mobility gradually increased (P < .05). At weeks 4, 8, and 12 after treatment, the PRP combined with PEMFs group showed significantly better scores compared to the PRP group and the PEMFs group, with statistically significant differences (P < .05). A total of 7 patients experienced adverse reactions such as knee joint swelling, low-grade fever, and worsening knee joint pain after treatment, all of which disappeared within 1 week after treatment. The incidence of complications did not differ significantly among the 3 groups (P = .67). PRP, PEMFs, and the combination of PRP and PEMFs therapy all effectively alleviate knee joint pain and improve joint function. However, compared to single treatment modalities, the combined therapy of PRP and PEMFs demonstrates more pronounced efficacy.

Role of homoeopathy of AYUSH in tuberculosis

The article deals with an age-old problem called Tuberculosis. In India, the condition is known as ‘Kshaya’ as the body gets wasted. Similarly, the programmatic portal to deal with the disease is called ‘Nikshaya portal’. The disease is also associated with the partition of India. It is believed that if the TB condition of Jinnah was known to the congress leaders, they would have delayed the formation of partition and thus avoiding the horrors of partition. Raj Kapoor’s movie ‘Aah’ showed him dying from TB as the world did not have any curative method by the time of release of the movie. One of the exponent of homoeopathy, Dr. E. A. Farrington who introduced the concept of comparative materia medica lost his life to TB at the age of 38 years. In 1994, the lead author had a young girl suffering from cough and the cough did not subside with the Homoeopathic medicines. Eventually, the case was referred and it turned out to be a case of pulmonary TB. Thus, the article sees the role of homoeopathy through the eyes of medical pluralism where homoeopathy has a specific and critical role in the entire gamut of TB. It suggests a treatment protocol as a complement to the existing therapeutics. It builds on the property of homoeopathy as essential medicine (EM) where it is cost effective, therapeutically effective while having no side effects. Using these three properties, mass coverage can be done through inclusion of Homoeopathy. The approach will surely lessen the TB burden of the nation.

Characterization of the Epileptogenic Phenotype and Response to Antiseizure Medications in Lissencephaly Patients.

Patients with lissencephaly typically present with severe psychomotor retardation and drug-resistant seizures. The aim of this study was to characterize the epileptic phenotype in a genotypically and radiologically well-defined patient cohort and to evaluate the response to antiseizure medication (ASM). Therefore, we retrospectively evaluated 47 patients of five genetic forms (LIS1/PAFAH1B1, DCX, DYNC1H1, TUBA1A, TUBG1) using family questionnaires, standardized neuropediatric assessments, and patients' medical reports. All but two patients were diagnosed with epilepsy. Median age at seizure onset was 6 months (range: 2.1-42.0), starting with epileptic spasms in 70%. Standard treatment protocols with hormonal therapy (ACTH or corticosteroids) and/or vigabatrin were the most effective approach for epileptic spasms, leading to seizure control in 47%. Seizures later in the disease course were most effectively treated with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, resulting in seizure freedom in 20%. Regarding psychomotor development, lissencephaly patients presenting without epileptic spasms were significantly more likely to reach various developmental milestones compared to patients with spasms. Classic lissencephaly is highly associated with drug-resistant epilepsy starting with epileptic spasms in most patients. The standard treatment protocols for infantile epileptic spasms syndrome lead to freedom from seizures in around half of the patients. Due to the association of epileptic spasms with an unfavorable course of psychomotor development, early and reliable diagnosis and treatment of spasms should be pursued. For epilepsies occurring later in childhood, ASM with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, appears to be most effective.

Combined Open Surgery and CO2 Laser for Giant Supraglottic Hemangioma in an Adult: A Case Report.

Laryngeal hemangiomas are rare vascular tumors, mainly in children, and less common in adults. Giant lesions typically require multiple endoscopic procedures and temporary tracheostomy. Open surgery allows single-procedure removal with fewer complications. CO2 laser excision controls bleeding and minimizes tissue damage. This study evaluates this hybrid approach to manage adult giant supraglottic hemangiomas. A 54-year-old woman with a giant supraglottic hemangioma was successfully treated using a combination of open surgery and CO2 laser. Limited data on adult laryngeal hemangiomas result in a lack of established treatment protocols. For giant supraglottic hemangiomas, combining open surgery with CO2 laser resection offers distinct advantages: enhanced lesion visibility, optimal airway control, effective hemostasis, reduced tissue damage, and lower recurrence rates. This hybrid approach also supports rapid recovery and favorable clinical outcomes. Combining open surgical excision with CO2 laser is effective for managing giant supraglottic hemangiomas in adults.

"Neurobehavioral toxicity of Cold plasma activated water following oral gavage in mice".

Cold plasma-activated water (PAW) is a novel technology that was recently used in biomedical research; Despite its potential, PAW's safety remains inadequately assessed. The study explores the impact of PAW on behavioral responses and brain tissue histopathology in mice. Ten-week-old female albino mice were divided into three groups each containing 10 mice (5 replicates, 2 mice/cage) and received either distilled water (DW), or distilled water exposed to cold atmospheric plasma (CAP) for 3min (PAW-3), or 15min (PAW-15) by oral gavage in a dose of 200μL/mice (3 times/week) for four weeks. PAW exhibited altered physicochemical properties compared to DW. Mice exposed to PAW demonstrated reduced burrowing activity, marble burying ability, and novel object recognition compared to controls, indicating potential neurobehavioral alterations. PAW-treated groups displayed notable histological lesions in brain tissues, including nerve cell necrosis, vascular congestion, and Purkinje cell degeneration, confirming neurotoxic effects. Positive reactions for NF-κB and iNOS in brain tissues of PAW-treated mice corroborated the histopathological findings, suggesting neuroinflammation and oxidative stress. The study highlights the need for further investigation into PAW's safety profile and optimal treatment protocols to mitigate potential neurobehavioral toxicity in biomedical research.

Efficacy of hyaluronic acid in temporomandibular disorders evaluated with diagnostic criteria for temporomandibular disorders (DC/TMD).

The study aimed to retrospectively assess the efficacy of hyaluronic acid (HA) in managing temporomandibular disorders (TMD) using the diagnostic criteria for temporomandibular disorders (DC/TMD). There has been an ongoing debate regarding the effectiveness of HA as a treatment option for TMD, which necessitated a thorough evaluation. The review adhered to PRISMA guidelines conducted across eight different databases, including PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, PsycINFO and CINAHL. The selection criteria included studies that evaluated the efficacy of HA in TMD patients, utilised DC/TMD, and were published in English. Data extraction and quality assessment were performed independently by two reviewers. ROB-2 tool was employed to assess methodological quality of the assessed studies. A total of 10 studies met the inclusion criteria. They demonstrated that HA was effective in improving various symptoms of TMD, such as pain, mouth opening and joint sounds over control group. But on the other end, platelet-rich plasma (PRP) was found to be better than HA intervention in alleviation of TMD symptoms. However, the degree of improvement varied across the studies. Some studies reported adverse effects, but these were typically minor and transient. Risk of bias assessment was low in all the included studies. The findings suggest that HA can be an effective treatment for TMD when evaluated with DC/TMD. However, the variation in effectiveness across studies indicates the need for individualised treatment planning and careful monitoring of adverse effects. Further research is needed to refine the treatment protocols and understand the long-term effectiveness and safety of HA in TMD management.

Prediction of hearing recovery with deep learning algorithm in sudden sensorineural hearing loss.

This study aimed to establish a deep learning-based predictive model for the prognosis of idiopathic sudden sensorineural hearing loss (SSNHL). Data from 1108 patients with SSNHL between January 2015 and May 2023 were retrospectively analyzed. Patients underwent standardized treatment protocols including high-dose steroid therapy and hearing outcomes were assessed after three months using Siegel's criteria and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. For predicting patient recovery, a two-layered classification process was implemented. Initially, a set of 22 Multilayer Perceptrons (MLP) networks was employed to categorize the patients. The outcomes from this initial categorization were subsequently relayed to a second-layer meta-classifier for final prognosis determination. The validity of this methodology was ascertained through a K-fold cross-validation procedure executed with 10 distinct splits. The prediction model for complete recovery, based on Siegel's criteria, demonstrated an accuracy of 0.892 and area under the curve (AUC) of 0.922. For the class A prediction, according to AAO-HNS classification, the model showed an accuracy of 0.847 and AUC of 0.918. These results suggest that the model may have the potential to contribute to the establishment of tailored patient management strategies by predicting hearing recovery in patients with SSNHL.

Effectiveness of a Wilms tumour treatment guideline adapted to local circumstances in sub-Saharan Africa: A report from Wilms Africa Phase II-CANCaRe Africa.

Wilms tumour (WT) is one of the cancer types targeted by the Global Initiative for Childhood Cancer (GICC). The objective of this study was to describe the outcomes of Wilms Africa Phase II in sub-Saharan Africa. Wilms Africa Phase II used a comprehensive WT treatment protocol in a multi-centre, prospective study conducted in eight hospitals in Ethiopia (2), Ghana (2), Malawi, Cameroon, Zimbabwe and Uganda. Eligibility criteria were: age younger than 16years, unilateral WT, diagnosed between 1 January 2021 and 31 December 2022. We included 230 WT patients, median age 3years, 53% male. Median maximum tumour diameter at diagnosis was 13.6cm and 33% of patients had metastatic disease. Nephrectomy was performed in 71% of patients, of whom 21% had a tumour rupture. Two-year event-free survival (EFS) was 41.3%±3.9% after a median follow-up of 17months (range: 1-33months), with treatment abandonment considered an event. Treatment abandonment occurred in 26% and death during treatment in 14%. Disease relapse occurred in 10%. Two-year EFS of the 26 patients who received radiotherapy was 64.5%±9.7% with no reported disease relapse. Patients continue to present late with advanced WT in sub-Saharan Africa, and their survival is below the 60% GICC target. Prevention of treatment abandonment and treatment-related mortality remain important. Earlier diagnosis and access to radiotherapy are expected to decrease disease-related mortality.

Speckle-tracking echocardiography: a tool for early detection of cardiotoxicity in cancer patients after chemotherapy

In modern oncology, despite the efficacy of chemotherapy, there is a risk of cardiotoxicity resulting in heart failure. This necessitates early diagnosis to prevent complications and improve prognosis. The study is aimed at analysing the abilities of speckle-tracking echocardiography as a modern tool in detecting cardiotoxicity in the early stages. This non-invasive method allows evaluating myocardial strain and its contractility. During a thorough analysis and extensive review of the scientific literature, it was found that the speckle-tracking echocardiography technique demonstrates an exceptionally high sensitivity to detecting early signs of cardiotoxicity, significantly outpacing conventional echocardiography methods in this aspect. This advantage makes it an invaluable tool in the early detection of potentially dangerous changes in the myocardium, which is especially important for patients at risk of developing cardiotoxic reactions as a result of chemotherapy. Speckle-tracking echocardiography has a unique ability to identify even the slightest local abnormalities in the structure and function of the myocardium, significantly before any clinical symptoms become apparent, thereby allowing doctors to take preventive measures at the earliest stages. This outstanding diagnostic ability is supported by an extensive body of scientific research and publications that unequivocally confirm the effectiveness of speckle-tracking echocardiography as an advanced tool for the early diagnosis of cardiotoxic changes. Thus, the timely application of this technique can significantly reduce the risks to the cardiac health of patients and contribute to more effective treatment of oncological diseases. Speckle-tracking echocardiography serves as an important tool in the early detection of cardiotoxicity in patients undergoing chemotherapy, allowing clinicians to timely adapt treatment protocols and prevent the development of serious cardiovascular complications, thereby improving the prognosis and quality of life of cancer patients.

Opioid-environment interaction: contrasting effects of morphine administered in a novel versus familiar environment on acute and repeated morphine induced behavioral effects and on acute morphine ERK activation in reward associated brain areas.

We report that environmental context can have a major impact on morphine locomotor behavior and ERK effects. We manipulated environmental context in terms of an environmental novelty/ familiarity dimension and measured morphine behavioral effects in both acute and chronic morphine treatment protocols. Wistar rats (n=7 per group) were injected with morphine 10mg/kg or vehicle (s.c.), and immediately placed into an arena for 5min, and locomotor activity was measured after one or 5 days. The morphine treatments were initiated either when the environment was novel or began after the rats had been familiarized with the arena by being given 5 daily nondrug tests in the arena. The results showed that acute and chronic morphine effects were strongly modified by whether the environment was novel or familiar. Acute morphine administered in a novel environment increased ERK activity more substantially in several brain areas, particularly in reward-associated areas such as the VTA in comparison to when morphine was given in a familiar environment. Repeated morphine treatments initiated in a novel environment induced a strong locomotor sensitization, whereas repeated morphine treatments initiated in a familiar environment did not induce a locomotor stimulant effect but rather a drug discriminative stimulus dis-habituation effect. The marked differential effects of environmental novelty/familiarity and ongoing dopamine activity on acute and chronic morphine treatments may be of potential clinical relevance for opioid drug addiction.