Evaluating the Strength and Quality of Evidence in American Heart Association/American Stroke Association's Guidelines for Aneurysmal Subarachnoid Hemorrhage and Spontaneous Intracerebral Hemorrhage.

BACKGROUND: Clinical practice recommendations guide healthcare decisions. This study aims to evaluate the strength and quality of evidence supporting the American Heart Association (AHA)/American Stroke Association (ASA) guidelines for aneurysmal subarachnoid hemorrhage (aSAH) and spontaneous intracerebral hemorrhage (ICH). METHODS: We reviewed the current AHA/ASA guidelines for aSAH and spontaneous ICH and compared with previous guidelines. Guidelines were classified based on the Class of recommendation (COR) and Level of evidence (LOE). COR signifies recommendation strength (COR 1: Strong; COR 2a: Moderate; COR 2b: Weak; COR 3: No Benefit/Harm), while LOE denotes evidence quality (LOE A: High-Quality; LOE B-NR: Moderate-Quality, Not Randomized; LOE B-R: Moderate-Quality, Randomized; LOE C-EO: Expert Opinion; LOE C-LD: Limited Data). RESULTS: For aSAH, we identified 84 recommendations across 15 guideline categories. Of these, 31% were classified as COR I, 30% as COR 2a, 17% as COR 2b, and 18% as COR 3. In terms of LOE, 7% were based on LOE A, 10% on LOE B-R, 65% on LOE B-NR, 14% on LOE C-LD, and 5% on LOE C-EO. Compared to previous guidelines, there was a 46% decrease in LOE A, a 45% increase in LOE B, and an 11% decrease in LOE C. For spontaneous ICH, 124 guidelines were identified across 31 guideline categories. Of these, 28% were COR I, 32% COR 2b, and 9% COR 3. For LOE, 4% were based on LOE A, 35% on LOE B-NR, and 42% on LOE C-LD. Compared to previous guidelines, there was a 78% decrease in LOE A, an 82% increase in LOE B, and a 14% increase in LOE C. This analysis highlights that less than a third of AHA/ASA guidelines are classified as the highest class of recommendation, with less than 10% based on the highest LOE. CONCLUSION: Less than a third of AHA/ASA guidelines on aSAH and spontaneous ICH are classified as the highest class of recommendation with less than 10% based on highest LOE. There appears to be a decrease in proportion of guidelines based on highest LOE in most recent guidelines.

Synthesis of N-Alkyl-3-[2-oxoquinolin-1(2H)-yl]propanoic Acid Derivatives and Related Compounds: Cytotoxicity and EGFR Inhibition of Some Propanamide Derivatives.

A series of 20 new structure-modified quinolin-2-one derivatives were prepared for biological evaluation. This was successfully achieved based on chemoselective reactions of heterocyclic amides with acrylic acid derivatives, which gave 3-[2-oxoquinolin-1-(2H)-yl] propanoic acid derivatives (N-substitution via a unique behavior). The ester was reacted with hydrazine to afford the corresponding hydrazide. Both the corresponding ester and hydrazide were used as building blocks to modify the quinolone structure and give N-hydroxyl propanamides, oxadiazoles, and thiosemicarbazides. The corresponding carboxylic acid and hydrazide were used to prepare several amides: N-alkyl-3-[2-oxoquinolin-1(2H)-yl]propanamides via azide and dicyclohexyl carbodiimide coupling methods. Among derivatives, compound 9e exhibited potent cytotoxicity against MCF-7 cells with an IC50 value of 1.32 µM compared to doxorubicin with an IC50 value of 1.21 µM. Additionally, it caused potent EGFR inhibition by 97% with an IC50 value of 16.89 nM compared to Erlotinib with an IC50 value of 29.8 nM. Finally, the binding mode of compound interactions toward EGFR was highlighted using a molecular docking study; compound 9e exhibited good binding affinity with a binding energy of -17.89 kcal/mol, and it formed H-bond interactions with Met 769 as the key amino acid of interaction. Accordingly, compound 9e may be developed as an EGFR-oriented chemotherapeutic antibreast cancer agent.

Growth performance, nutrients digestibility, intestinal microbiota and histology altered in broilers fed maize- or sorghum-based diets.

This study aimed to evaluate the effect of varying levels of sorghum-based diets as an alternative to maize in broiler nutrition. A total of 320 one-day-old male Ross 708 broiler chickens were randomly allocated to four treatment groups (5 pens per treatment and 16 birds per pen), comprising a control group with a basal diet and groups receiving sorghum-based diets with 20%, 40%, and 100% maize replacement. The overall weight gain was significantly (p < 0.0001) higher in the control group, followed by 20%, 40%, and 100% sorghum replacement. Additionally, overall feed intake was significantly (p < 0.01) higher in the 20% sorghum replacement group compared to the control and other groups. Broilers fed sorghum-based diets exhibited a significantly (p < 0.01) increased feed conversion ratio. Carcass characteristics showed no significant differences between broilers fed corn and sorghum; however, the digestibility of crude protein and apparent metabolizable energy significantly (p < 0.01) increased in the 20% sorghum-corn replacement compared to the 40% and 100% replacement levels. Ileal villus height and width did not differ among the corn-sorghum-based diets, regardless of the replacement percentage. Furthermore, among the cecal microbiota, Lactobacillus count was significantly (p < 0.041) higher in the 20% corn-sorghum diet compared to the 40% and 100% replacement levels. These findings suggest that replacing corn up to 20% of corn with sorghum in broiler diet positively impact growth performance, gut health, nutrient digestibility, and cecal microbiota in broilers. However, larger replacements (40% and 100%) may have negative implications for broiler production and health.

Femoro-popliteal endovascular interventions.

Peripheral artery disease (PAD) is a worldwide major health challenge, and it is a strong predictor of mortality and morbidity. The advances in PAD treatment have resulted in many therapeutic options or endovascular interventions (EVIs) for endovascular revascularization if drug therapy does not lead to substantial improvement. Randomized controlled trials (RCTs) have reported the efficacy of various EVIs such as atherectomy, stents, and medicated balloons over the traditional transluminal angioplasty; however, the standard treatment for PAD remains unclear due to the lack of head-to-head comparative studies between different EVIs. Additionally, the variable outcomes between clinical trials regarding the functional capacity and quality of life (QoL) make it difficult to ascertain the superiority of one particular EVI over another. Therefore, the latest PAD clinical trials should include head-to-head comparisons between different EVIs, and this review aimed to highlight the femoro-popliteal EVIs, evidence supporting each intervention and why those EVIs are used.

Serial Post-Operative Radiographs in Surgically Managed Pediatric Supracondylar Humeral Fractures: Are They Always Required?

Objective:  Supracondylar humeral fractures are among the most common pediatric fractures that require surgical intervention when displaced. Recent attention has been directed towards the utilization of serial radiographs in the post-operative period and their effect on decision-making. This study aimed to determine the usefulness of postoperative radiographs early post-operatively, with the goal of determining the optimal frequency for these radiographs. Methods: Pediatric patients who sustained a supracondylar humeral fracture and underwent operative intervention over a 15-year period were included in this study. Data were collected, including the baseline characteristics of the patients, fractures, and operative interventions. In addition, the time until healing, the total number of X-rays before K-wire removal, and postoperative function were evaluated. Results: A total of 122 pediatric patients were included, with a mean age of 5.33 ± 2.93 years. Most fractures were Gartland Type III (74.6%). Most fractures healed at 4 (36.1%) and 3 weeks (35.2%) after surgery. Of the cohort, 94.3% underwent four different x-rays before wire removal, with 4.9% requiring revision surgery. All revision cases were Gartland type 3, and for all cases, the decision to revise was made within three weeks of surgery. Conclusion: Routine post-fixation radiography should not be performed for surgically treated supracondylar humeral fractures before healing. An exception is the Gartland type 3 fracture, for which earlier imaging may be indicated.

Impact of preoperative intra-aortic balloon pump on outcomes in coronary artery bypass grafting for unprotected left-main coronary artery disease.

Background: Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes. Methods: This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE). Results: IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) vs. 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] vs. 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) vs. 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) vs. 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) vs. 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) vs. 4 (5%), P>0.99], heart failure [5 (6.25%) vs. 7 (8.75%), P=0.75], MI [7 (8.75%) vs. 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) vs. 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) vs. 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) vs. 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) vs. 4 (IQR 2-7.5) days, P=0.01]. Conclusions: Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient.

A Survey on the Knowledge, Attitude, and Practice of Students at Jazan University Regarding Calorie Menu Labeling in Restaurants and a Literature Review.

BACKGROUND: The global rise in obesity and related health complications has cast a spotlight on the urgent need for initiatives that promote informed dietary decisions. This cross-sectional study investigates the knowledge, attitudes, and practices of university students at Jazan University, Saudi Arabia, regarding menu calorie labeling. The study examines how these variables may affect dietary decisions, body mass index (BMI), and support for proposed legislative measures requiring calorie disclosure on restaurant menus. METHODS: The study included 581 Saudi university students who were 18 years of age or older as a convenience sample. A three-part questionnaire that asked about demographics, anthropometric measurements, and attitudes and behaviors related to calorie counting was completed by the participants. Using the Statistical Product and Service Solutions (SPSS, version 25.0; IBM SPSS Statistics for Windows, Armonk, NY) program, chi-square, t-tests, and ANOVA tests were used to evaluate the data. Both informed consent and ethical approval were obtained. RESULTS: The study finds that, even while more than half of the participants knew their recommended daily calorie intake and exhibited curiosity about calorie information on menus, this knowledge did not always result in healthy eating habits. Participants' opinions and behaviors regarding calorie labeling were significantly correlated with their BMI levels, indicating the importance of education in promoting nutritional awareness and healthy eating habits. New calorie labeling regulations received higher approval from people who regularly ate out. CONCLUSION: This study emphasizes the necessity of comprehensive nutritional education initiatives to raise calorie knowledge and encourage Saudi Arabian university students to make healthier eating choices. It also emphasizes the possible effects of legislative measures requiring calorie information on menus, particularly among regular diners. However, while evaluating the results, it is important to take into account the study's limitations, including self-reported data and convenience sample. To support menu calorie labeling legislation and inform targeted public health interventions for university students' eating behaviors, more research that takes cultural quirks and regional settings into account is necessary.

Developing novel multifunctional protective clothes for disabled individuals using bio-based electrospun nanofibrous membranes.

A novel kind of protective apparel for handicapped persons has been created with bio-based electrospun nanofibrous (NFs) membranes. Hydrophobic membranes with fine polylactic acid (PLA) NFs had a smooth, bead-less structure with an average diameter of 950 nm. The hydrophilic layer has a similar pattern but a smaller fiber diameter dispersion and an average diameter of 750 nm. The silica nanoparticle-modified super-hydrophobic top layer (contact angle, ~153°) repels water and keeps the user dry. Super-hydrophilic silver nanoparticles in the fabric's bottom layer react with perspiration to kill microorganisms. The fabric's porosity (avg. 1.2-1.5 µm) allows for breathability, while silica nanoparticles boost infrared radiation reflection, keeping users cool on hot days. The dual-layer textile has 4.9 MPa ultimate tensile strength and 68 % elongation compared to the membrane's super-hydrophobic and super-hydrophilic layers. Wearing protective clothes reduced hand temperature by 25 % in direct sunlight and 13 % in a sun simulator with 1 Sun. This fabric will work well for adult diapers, outdoor clothing, and disability accessories. Overall, the protective textiles may improve the quality of life for disabled and elderly people by providing usable textile items adapted to their needs.

Outcomes of dietary alpha-lipoic acid on testicular vascularization, steroid hormones, and seminal quality in aged Baladi bucks.

BACKGROUND: Senescence is accompanied by a progressive decrease in male reproductive performance, mainly due to oxidative stress and endothelial dysfunction. Alpha lipoic acid (ALA) is a potent antioxidant, that diffuses freely in aqueous and lipid phases, possessing anti-inflammatory and anti-apoptotic properties. This study aimed to examine the effects of supplemental dietary ALA on testicular hemodynamics (TH), circulating hormones, and semen quality in aged goats. Twelve Baladi bucks were divided into two groups (n = 6 each); the first fed a basic ration and served as a control group (CON), while the second received the basic ration supplemented with 600 mg ALA/ kg daily for consecutive eight weeks (ALA). RESULTS: There were improvements in testicular blood flow in the ALA group evidenced by a lower resistance index (RI) and pulsatility index (PI) concurrent with higher pampiniform-colored areas/pixel (W3-W6). There were increases in testicular volume and decreases in echogenicity (W3-W5; ALA vs. CON). Compared to the CON, ALA-bucks had higher serum concentrations of testosterone, estradiol, and nitric oxide (W3-W5). There were enhancements in semen traits (progressive motility, viability, morphology, and concentration, alanine aminotransferase enzyme) and oxidative biomarkers (catalase, total antioxidant capacity, and malondialdehyde). CONCLUSIONS: ALA dietary supplementation (600 mg/kg diet) improved aged bucks' reproductive performance by enhancing the testicular volume, testicular hemodynamics, sex steroids, and semen quality.

Natural dyes developed by microbial-nanosilver to produce antimicrobial and anticancer textiles.

Developing special textiles (for patients in hospitals for example) properties, special antimicrobial and anticancer, was the main objective of the current work. The developed textiles were produced after dyeing by the novel formula of natural (non-environmental toxic) pigments (melanin amended by microbial-AgNPs). Streptomyces torulosus isolate OSh10 with accession number KX753680.1 was selected as a superior producer for brown natural pigment. By optimization processes, some different pigment colors were observed after growing the tested strain on the 3 media. Dextrose and malt extract enhanced the bacteria to produce a reddish-black color. However, glycerol as the main carbon source and NaNO3 and asparagine as a nitrogen source were noted as the best for the production of brown pigment. In another case, starch as a polysaccharide was the best carbon for the production of deep green pigment. Peptone and NaNO3 are the best nitrogen sources for the production of deep green pigment. Microbial-AgNPs were produced by Fusarium oxysporum with a size of 7-21 nm, and the shape was spherical. These nanoparticles were used to produce pigments-nanocomposite to improve their promising properties. The antimicrobial of nanoparticles and textiles dyeing by nanocomposites was recorded against multidrug-resistant pathogens. The new nanocomposite improved pigments' dyeing action and textile properties. The produced textiles had anticancer activity against skin cancer cells with non-cytotoxicity detectable action against normal skin cells. The obtained results indicate to application of these textiles in hospital patients' clothes.

Circular economy reinforcement through molecular fabrication of textile wastes with microbial synthesized ZnO nanoparticles to have multifunctional properties.

The fibrous wastes generated from the mills of textile production can be recycled and converted into high add-values products to be implemented in several applications. The current study aimed to employ commercial free cellulase enzyme to partially hydrolyze (activate) the polyester cotton blended (PET/C) fibrous wastes by creation functional groups such as OH and COOH on their surfaces. The activated fibrous wastes were then modified by coating with ZnO nanoparticles (ZnO-NPs) biosynthesized by actinobacterial cultures free supernatant. The isolate was identified as Streptomyces pseudogriseolus with accession number of OR574241. The conditions that influence the actino-synthesis of ZnO-NPs were optimized and the product was characterized using spectroscopic vision, FTIR, XRD, TEM and SEM. The characteristic ZnO peaks were obviously observed by EDX analysis with 0.38 and 0.75% (wt%), respectively. TEM analyses proved the nanoscale of ZnO-NPs (5-15 nm) which was followed by cytotoxic evaluation for the produced NPs. Fortunately, the tested actino-ZnO-NPs didn't have any cytotoxicity against human normal fibroblast cell line (BJ1), which means that the product can be safely used in a direct-contact with human skin. The treated PET/C blended waste fabrics coated with ZnO-NPs showed high antimicrobial activity and ultraviolet protection values after functionalization by cellulase. EDX analysis demonstrates the presence of Zn peaks on the coated fabrics compared with their absence in blank and control samples, while SEM images showed the formation of a thin layer of ZnO-NPs on the fabric surface. The obtained smart textile can be applied several needed sectors.

The Moderating Effects of Gender and Study Discipline in the Relationship between University Students' Acceptance and Use of ChatGPT.

The intensive adoption of ChatGPT by university students for learning has encouraged many scholars to test the variables that impact on their use of such AI in their learning. This study adds to the growing body of studies, especially in relation to the moderating role of students' gender and their study discipline in their acceptance and usage of ChatGPT in their learning process. This study expanded the Unified Theory of Acceptance and Use of Technology (UTAUT) by integrating gender as well as study disciplines as moderators. The study collected responses from students in Saudi universities with different study disciplines and of different genders. The results of a structural model using Smart PLS showed a significant moderating effect of gender on the relationship between performance expectancy and ChatGPT usage. The results confirmed that the impact of performance expectancy in fostering ChatGPT usage was stronger in male than in female students. Moreover, social influence was shown to significantly affect males more than females in relation to ChatGPT usage. In addition, the findings showed that study discipline significantly moderates the link between social influence and ChatGPT usage. In the same vein, social influence significantly influences ChatGPT use in social sciences more than in applied sciences. Hence, the various implications of the study were discussed.

Marine fungal diversity unlocks potent antivirals against monkeypox through methyltransferase inhibition revealed by molecular dynamics and free energy landscape.

The escalating threat posed by the Monkeypox virus (MPXV) to global health necessitates the urgent discovery of effective antiviral agents, as there are currently no specific drugs available for its treatment, and existing inhibitors are hindered by toxicity and poor pharmacokinetic profiles. This study aimed to identify potent MPXV inhibitors by screening a diverse library of small molecule compounds derived from marine fungi, focusing on the viral protein VP39, a key methyltransferase involved in viral replication. An extensive virtual screening process identified four promising compounds-CMNPD15724, CMNPD28811, CMNPD30883, and CMNPD18569-alongside a control molecule. Rigorous evaluations, including re-docking, molecular dynamics (MD) simulations, and hydrogen bond analysis, were conducted to assess their inhibitory potential against MPXV VP39. CMNPD15724 and CMNPD30883, in particular, demonstrated a superior binding affinity and stable interactions within the target protein's active site throughout the MD simulations, suggesting a capacity to overcome the limitations associated with sinefungin. The stability of these VP39-compound complexes, corroborated by MD simulations, provided crucial insights into the dynamic behavior of these interactions. Furthermore, Principal Component Analysis (PCA) based free energy landscape assessments offered a detailed understanding of the dynamic conformational changes and energetic profiles underlying these compounds' functional disruption of VP39. These findings establish CMNPD15724, CMNPD28811, CMNPD30883, and CMNPD18569 as promising MPXV inhibitors and highlight marine fungi as a valuable source of novel antiviral agents. These compounds represent potential candidates for further experimental validation, advancing the development of safer and more effective therapeutic options to combat this emerging viral infection.

Syzgium cumini seed/poly vinyl alcohol based water resistant biodegradable nano-cellulose composite reinforced with zinc oxide and silver oxide nanoparticles for improved mechanical properties.

The current work explored a comparative study of biodegradable jamun seed/polyvinyl alcohol (JS) nanocomposites reinforced with varying concentrations of ZnO and Ag2O nano-fillers. The effect of spherical shaped ZnO and Ag2O nanoparticles (NPs) on the on structure, morphology, swelling and solubility, crystallinity and mechanical properties together with biodegradation performance of the composite films was fully studied. SEM results showed uniform distribution of ZnO and Ag2O nanofillers into the JS matrix and dense or compact nanocomposite films were formed. JS-ZnO and JS-Ag2O nanocomposites with 0.5 wt% ZnO and Ag2O content showed maximum crystallinity i.e. 11.3 and 9.58 %, respectively, as determined by XRD. When compared to the virgin JS film (8.41 MPa), the resultant JS-ZnO-0.5 and JS-Ag2O-0.5 nanocomposites showed significantly enhanced tensile strength (35.7 MPa, 29.2 MPa), elongation at break (15.42 %, 14.62 %) and Young's modulus (141 MPa, 126 MPa), respectively. Also, reduced swelling (120.4 % and 116.1 %) and solubility ratio (17.45 % and 18.42 %) was observed for JS-ZnO-0.5 and JS-Ag2O-0.5 nanocomposites, respectively. Biodegradation results showed that maximum degradation (88 %) was achieved for the JS film within 180 days of soil burial whereas JS-ZnO-0.1 and JS-Ag2O-0.1 nanocomposites showed 78 % and 72 % degradation within 180 days, respectively.

Digital twin and fuzzy framework for supply chain sustainability risk assessment and management in supplier selection.

Risks in the supply chain can damage many companies and organizations due to sustainability risk factors. This study evaluates the supply chain risk assessment and management and then selects the best supplier in a gas company in Egypt. A comprehensive methodology can use the experts' opinions who use the linguistic variables in the spherical fuzzy numbers (SFNs) to evaluate the criteria and suppliers in this study based on their views. Selecting the best supplier is a complex task due to various criteria related to supply chain risk assessment, such as supply risks, environmental risks, financial risks, regularity risks, political risk, ethical risks, and technology risks and their sub-criteria. This study suggested a new combined model with multi-criteria decision-making (MCDM) under a spherical fuzzy set (SFS) environment to overcome uncertainty and incomplete data in the assessment process. The MCDM methodology has two methods: the Entropy and COmbinative Distance-based Assessment (CODAS) methods. The SFS-Entropy is used to compute supply chain risk assessment and management criteria weights. The SFS-CODAS method is used to rank the supplier. The main results show that supply risks have the highest importance, followed by financial and environmental risks, and ethical risks have the lowest risk importance. The criteria weights were changed under sensitivity analysis to show the stability and validation of the results obtained from the suggested methodology. The comparative analysis is implemented with other MCDM methods named TOPSIS, VIKOR, MARCOS, COPRAS, WASPAS, and MULTIMOORA methods under the SFS environment. This study can help managers and organizations select the best supplier with the lowest sustainability risks.

An unusual case of ureteric stricture post robotic partial nephrectomy of a renal mass managed by Memokath insertion.

Robotic assisted partial nephrectomy is the gold standard treatment for small renal masses. Ureteric stricture is a rare but serious complication that significantly increase the morbidity and worsens the quality of life for cancer patients. Definitive treatment such as surgical reconstruction or ureteroureterostomy is not always feasible as in patients with significant morbidity or high-risk patients. Other options include ureteric double J stent or nephrostomy tube placement with regular exchange. We present a case of iatrogenic upper ureteric stricture post robotic assisted partial nephrectomy for right renal mass that was discovered on postoperative follow up imaging treated with metallic ureteral stent (Memokath) as reconstructive surgery was difficult due to proximity to the tumor bed. We found that if reconstructive surgery is not feasible, metallic ureteral stents has good durability, better quality of life than ureteric double stents for the management of ureteric stricture.

Side-specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study.

BACKGROUND: Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA). METHODS: We retrospectively analyzed two hundred and seventy-one patients aged > 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included. RESULTS: Intraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p < 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147-27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996-30.38, p < 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323-47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07-1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other. CONCLUSION: LRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI.

An Outline on the Advancements in Surgical Management of Osteoporosis-Associated Fractures.

Osteoporosis significantly impairs bone density and increases fracture risk, representing a substantial global health challenge. The effectiveness of traditional treatments such as calcium supplementation and exercise in completely preventing fractures is limited. This review explores recent advancements in surgical techniques and treatment modalities to manage osteoporotic fractures better and improve patient outcomes. Osteoporotic fractures demand specialized surgical techniques due to compromised bone quality. Vertebroplasty and kyphoplasty are minimally invasive procedures that provide rapid pain relief and structural support using bone cement. While vertebroplasty is effective, it carries risks of cement leakage and new fractures. Kyphoplasty, with added balloon inflation, reduces leakage risk and improves vertebral height restoration but is costlier. Cement-augmented screws enhance fixation but can increase adjacent fracture risk and pose long-term complications. Surgical advancements encompass robotic-assisted surgery, offering precision and accelerated recovery, alongside biologic agents like bone morphogenetic proteins (BMPs), which enhance bone healing while reducing secondary interventions and eliminating donor site morbidity. Bone graft substitutes such as calcium phosphate cements enhance biomechanical compatibility, decrease morbidity, and reduce fracture loss and pain. Balloon kyphoplasty aids in height restoration and pain relief and diminishes the risk of subsequent vertebral fractures. Bioglass scaffolds promote bone regeneration by improving bone mineral density and lowering the incidence of new fractures. Optimal perioperative care, including patient selection, nutritional management, and early mobilization strategies, is crucial for mitigating risks in vulnerable populations. While current surgical interventions provide significant pain relief and functional benefits, ongoing research and multidisciplinary collaboration are crucial to prospectively refine these techniques and reduce the burden of osteoporosis. New technologies, such as tissue engineering and gene editing, hold potential for future treatment paradigms.

Comparison Between Mono VS Dual VS Triple Antiplatelet Therapy In Patients With Ischemic Heart Disease Undergoing PCI, A Network Meta-Analysis.

AIMS: We aim to research the efficacy and safety of single(SAPT), dual(DAPT), and triple(TAPT) antiplatelets approaches across IHD patients undergoing PCI. METHODS AND RESULTS: A network meta-analysis was conducted until April 1st, 2024, using the netmeta package in R studio 4.3.3. Primary outcomes were cardiac death, myocardial infarction(MI), stent thrombosis, stroke, and major bleeding(BARC 3-5). From 25 studies, a total of 65115 patients were included. For cardiac death, TAPT had no different risk than DAPT compared to SAPT [RR = 0.74; 95%CI (0.40 to 1.35); p-value = 0.33], [RR = 1.01, 95%CI (0.84 to 1.19); p-value = 0.87] respectively. For MI, TAPT had no different risk than DAPT compared to SAPT [RR = 0.77; 95%CI (0.51 to 1.16); p-value = 0.2047], [RR = 0.81, 95%CI (0.64 to 1.03); p-value = 0.0850] respectively. For stent thrombosis, DAPT had no different risk than TAPT compared to SAPT [RR = 0.74; 95%CI (0.45 to 1.21); p-value = 0.2284], [RR = 0.84, 95%CI (0.27 to 2.59); p-value = 0.7630] respectively. For stroke, DAPT had no different risk than TAPT in comparison to SAPT [RR = 0.91; 95%CI (0.75 to 1.10); p-value = 0.3209], and [RR = 0.87, 95%CI (0.43 to 1.76); p-value=0.6937], respectively. For Major bleeding(BARC 3-5), DAPT and TAPT increased major bleeding compared to SAPT, with only DAPT showing statistical significance. [RR = 1.43; 95%CI (1.09 to 1.88); p-value = 0.0107], and [RR = 2.78, 95%CI (0.90 to 4.78); p-value = 0.0852], respectively. CONCLUSION: DAPT and TAPT increased the risk of bleeding events compared to SAPT. However, we found no significant differences between these regimens for the other primary outcomes.