Search Results (39,090)

Background/Objectives: Obstetric patients undergoing elective cesarean section (CS) with combined spinal–epidural (CSE) anesthesia often experience intraoperative nausea and vomiting (N&V). While prophylactic treatment with antiemetic drugs can be effective, it may also carry potential adverse effects for both the mother and the baby. To address this, we designed a randomized clinical trial to assess the effectiveness of transdermal scopolamine patches and electrical P6 stimulation as preventive measures for N&V in patients scheduled for elective CS under CSE anesthesia. Methods: Following the Institutional Review Board approval and informed consent, a total of 240 patients were randomly allocated into three groups: (1) transdermal scopolamine, (2) P6 stimulation (via a peripheral nerve stimulator), and (3) combined transdermal scopolamine and P6 stimulation, with 80 parturients in each group. The primary outcome was defined as the presence or absence of intraoperative nausea and vomiting during the procedure. Results: The incidences of intraoperative nausea and vomiting were similar across all three treatment groups, with no significant differences observed at any point during the surgery. Additionally, there were no notable differences in overall satisfaction with anesthetic care among the three study groups. Conclusions: These findings indicate that while both transcutaneous P6 acupoint stimulation and transdermal scopolamine are straightforward, safe, and effective methods, combining these two antiemetic strategies does not offer additional benefits in reducing nausea and vomiting. Nevertheless, both approaches may be particularly appealing to patients and obstetric anesthesiologists who prioritize treatments with fewer potential side effects. Full article

Background/Objectives: Clinical trials are essential in the development of new medical treatments, offering crucial data on their safety and effectiveness. Methods: This study provides a comprehensive analysis of clinical trials registered on ClinicalTrials.gov, examining the current landscape, challenges, and innovations that have shaped the field over the past century. Data were extracted on 7 March 2025 and analyzed to identify patterns in trial design, sponsorship, participant demographics, and geographical distribution. Results: The analysis reveals a continuous increase in clinical trial registrations, peaking in 2021, driven by the COVID-19 pandemic. Most trials focus on cancer, reflecting its global burden, with randomized controlled trials (RCTs) being the most common study design. However, challenges persist, including underrepresentation of certain demographics, limited global distribution, and insufficient reporting of trial results. Additionally, the underrepresentation of pediatric, elderly, and minority populations in trials limits the generalizability of findings. Conclusions: The analysis underscores the need for more inclusive and globally distributed research to address disparities in health outcomes. Full article

Background: This prospective study aimed to evaluate renal function using retinol binding protein 4 (RBP4), cystatin C, and glomerular filtration rate (GFR) in relation to physical activity and lesion level in children with neurogenic bladder (NB) post-myelomeningocele. Methods: Two groups were studied: 33 children with NB and 20 healthy controls. Data collected included demographic details, physical activity levels, uroflowmetry, urodynamic diagnosis, and renal function parameters. Urinary RBP4 and serum cystatin C were measured using ELISA, and GFR was calculated using the Schwartz formula. Results: The NB group had higher median serum cystatin C and urinary RBP4/creatinine ratios compared to the control group (0.28 vs. 0.22; 18.6 vs. 3.2, respectively). The participants were categorized based on activity levels, lesion levels, catheterization status, and urodynamic diagnosis. No differences in RBP4, cystatin C, or urodynamic diagnosis were observed according to activity and lesion levels. Significant differences in GFR were found based on activity and lesion levels, with higher median GFR in NB children (182.7 vs. 147.3). No differences were found between catheterized and non-catheterized children in the studied parameters. Conclusions: Elevated urinary RBP4 in NB patients suggests possible proximal renal tubule dysfunction. Higher serum cystatin C despite lower creatinine levels indicates altered renal function in NB children. Urinary RBP4 correlates positively with bladder pressure at maximum cystometric capacity, suggesting potential utility in therapy monitoring and modification. Full article

Objective: This study aimed to provide pooled predictors of ANC (antenatal care) service use among women of reproductive age in Ethiopia. Methods: Studies were systematically searched using PubMed, Medline, CINAHL, EMBASE, and Google Scholar. The Newcastle–Ottawa scale (NOS) tool was utilized for quality assessment (risk of bias). All data analyses were conducted by utilizing Stata version 17. A random-effects model was used to obtain the pooled predictors of ANC use. The publication bias was checked using a funnel plot and Egger’s regression test. Results: Twenty-two studies with a sample size of 25,671 were included in this review. The identified predictors of ANC service use were highest wealth rank (AOR 1.92 [95% CI: 1.53–2.31]), formal women education (AOR 2.40 [95% CI: 1.75–3.06]), formal husband education (AOR 1.49 [95% CI: 1.36–1.66]), women age ≥ 20 (AOR 1.75 [95% CI: 1.47–2.17]), mass media exposure (AOR 1.44 [95% CI: 1.21–1.66]), good maternal knowledge about the pregnancy complication (AOR 1.49 [95% CI: 1.11–1.88]), planned pregnancy (AOR 1.59 [95% CI: 1.28–1.91]), women autonomy (AOR 1.42 [95% CI: 1.23–1.62]), and positive husband attitude about the ANC service use (AOR 2.63 [95% CI: 1.47–3.79]). Conclusions: Several predictors have increased the ANC service utilization, like wealth status, women’s and their husbands’ education, older/increasing women’s age, media exposure, maternal knowledge about pregnancy complications, planned pregnancy, women’s autonomy to decide on household health care, and positive husband attitude about the ANC service utilization. Full article

Background: According to the ISSVA 2018 classification, arteriovenous malformations (AVMs) are high-flow vascular malformations, distinct from low-flow lesions. About 60% of extracranial AVMs occur in the head and neck, making their management a focus of maxillofacial surgery. Due to their complexity, precise diagnosis and careful treatment planning are crucial for optimal aesthetics and structural preservation. The standard approach combines embolization with surgical resection, though Bleomycin electrosclerotherapy (BEST) has recently gained recognition. Methods: From July 2023 to December 2024, a total of 16 patients with vascular malformations were treated with bleomycin electrosclerotherapy at the Azienda Ospedaliera Universitaria Senese (AOUS). Among them, two patients were affected by arteriovenous malformations. These two patients underwent this treatment to avoid more invasive and demolitive procedures, considering the anatomical region involved. Both patients had previously been treated at other hospitals, experiencing subsequent lesion recurrence. Preoperative evaluation included angiographic and ultrasound studies. The patients underwent electrosclerotherapy sessions and were closely monitored during follow-up. The uniqueness of this innovative approach lies in the use of fractionated doses of bleomycin for each treatment session, compared to the standard protocols described in the literature. Results: BEST has demonstrated efficacy in the treatment of high-flow AVMs by delivering bleomycin into the interstitial tissue and subsequently applying electroporation so the drug’s effects can be precisely localized and amplified. The macroscopically evident results, patient satisfaction, and, most importantly, the objective ultrasound flow data demonstrate the effectiveness of this treatment. Conclusions: Arteriovenous malformations (AVMs) pose treatment challenges due to their variability and lack of standardized guidelines. This study explores electrosclerotherapy with bleomycin in two head and neck AVM cases, using fractionated doses to enhance safety and efficacy. The findings support its potential as a minimally invasive alternative, warranting further research on broader applications. Full article

Background/Objectives: Bipolar disorder (BD) is a complex and chronic mental health condition that poses significant challenges for both patients and healthcare providers. Traditional treatment methods, including medication and therapy, remain vital, but there is increasing interest in the application of artificial intelligence (AI) to enhance BD management. AI has the potential to improve mood episode prediction, personalize treatment plans, and provide real-time support, offering new opportunities for managing BD more effectively. Our primary objective was to explore the potential role of AI in transforming the management of BD, specifically in mood tracking, prediction, and personalized treatment regimens. Methods: To explore the potential role of AI in transforming BD management, we conducted a review of recent literature using key search terms. We included studies that discussed AI applications in mood tracking, prediction, and treatment personalization. The studies were selected based on their relevance to AI’s role in BD management, with attention to the PICO criteria: Population—individuals diagnosed with BD; Intervention—AI tools for mood prediction, treatment personalization, and real-time support; Comparison—traditional treatment methods (when available); Outcome—measures of mood episode prediction, treatment effectiveness, and improvements in patient care. Results: The findings from recent research reveal promising developments in the use of AI for BD management. Studies suggest that AI-powered tools can enable more proactive and personalized care, improving treatment outcomes and reducing the burden on healthcare professionals. AI’s ability to analyze data from wearable devices, smartphones, and even social media platforms provides valuable insights for early detection and more dynamic treatment adjustments. Conclusions: While AI’s application in BD management is still in its early stages, it presents transformative potential for improving patient care. However, further research and development are crucial to fully realize AI’s potential in supporting BD patients and optimizing treatment efficacy. Full article

Background/Objectives: Adult spinal deformity (ASD) affects sit-to-stand (STS) transitions due to abnormal spinal alignment, influencing muscle function. This study investigated lower-extremity electromyographic activity and kinematic parameters during STS transitions in ASD patients. Methods: A cross-sectional study was conducted with ASD patients scheduled for corrective surgery. The STS task was divided into three phases, and electromyographic activity, temporal parameters, and joint kinematics were compared between ASD patients and controls. Surface electromyography measured muscle activity, and a high-speed camera recorded phase durations and joint movements. Results: Compared to 17 controls, 17 ASD patients exhibited significantly increased %MVIC (ASD, controls, p-value) in the biceps femoris during the flexion momentum phase (23.7 ± 26.5, 12.3 ± 8.6, p = 0.048) and extension phase (48.6 ± 25.8, 32.8 ± 40.5, p = 0.011), and in the soleus during the flexion momentum phase (16.2 ± 7.5, 8.5 ± 2.9, p = 0.001). The ASD group also showed greater joint motion and longer phase durations during STS transitions. Conclusions: ASD patients display increased lower limb muscle activation, prolonged phase durations, and more joint motion during STS transitions. These findings highlight neuromuscular and biomechanical differences, though whether these are pathological, adaptive, or compensatory remains unclear. Full article

Objective: This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. Methods: We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000–2024) at two European centers. The primary endpoint was early outcome. We used a Kaplan–Meier curve to assess survival, and logistic regression to identify predictors. Results: Operative death rates were similar (hereditary: 13/106 [12.3%] vs. non-hereditary: 22/167 [13.2%], p = 0.83). Hereditary aortopathy patients were younger (median 42 vs. 54 years, p < 0.001) with lower BMI (24.1 vs. 28.4 kg/m², p < 0.001). Non-genetic patients had higher rates of chronic kidney insufficiency (58/167 (34.7%) vs. 14/106 (13.2%), p < 0.001), coronary artery disease (43/167 (25.7%) vs. 9/106 (8.5%), p < 0.001), and prior myocardial infarction (31/167 (18.6%) vs. 4/106 (3.8%), p < 0.001). Hereditary aortopathy patients suffered more often from post-dissection TAAA (68/106 [64.2%] vs. 44/167 [26.3%], p < 0.001) and prior aortic surgery (81/106 (76.4%) vs. 79/167 (47.3%), p < 0.001). Pulmonary complications (67.0% vs. 61.1%, p = 0.32), acute kidney injury (25.5% vs. 22.8%, p = 0.61), and spinal cord ischemia (6.6% vs. 10.2%, p = 0.31) were comparable between groups. Overall 5-year survival was 65.7%; the rate of any reintervention during follow up was 21.2%. Logistic regression identified no predictors for perioperative mortality. Conclusions: Open TAAA repair in patients < 60 years carries relevant perioperative mortality, which is comparable between hereditary and non-hereditary groups; non-hereditary patients had impaired preoperative cardiopulmonary status. Full article

Background: Inflammatory indices have been proposed as simple and routinely obtainable markers of systemic inflammation in cardiac disease. This study investigated whether the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the pan-immune inflammation value (PIV) serve as biomarkers for risk stratification and outcomes measures in patients with severe aortic stenosis (AS) following valve replacement (AVR). Methods: In this retrospective analysis (January 2017–June 2022), patients with AS underwent pre-procedural cardiovascular magnetic resonance (CMR) imaging and were assigned a treatment strategy by a multidisciplinary Heart Team: (1) transcatheter AVR, (2) surgical AVR, or (3) no valvular intervention. Kaplan–Meier estimates and regression analyses were used to demonstrate associations between the NLR, MLR, and PIV with myocardial fibrosis—assessed by late gadolinium enhancement (LGE) and extracellular volume (ECV) on CMR—and a combined endpoint of heart failure hospitalizations and all-cause mortality. Results: A total of 356 patients (median age: 80 years, 50% male) were followed for a median of 40 months, during which 162 (46%) reached the combined endpoint. Linear regression identified C-reactive protein, but not the presence of LGE or elevated ECV, as the only independent predictor of all three inflammatory indices (p for all <0.001). After multivariable adjustment for clinical (EuroSCORE II), laboratory (baseline N-terminal prohormone of brain natriuretic peptide [NT-proBNP] and C-reactive protein), and imaging parameters (AV mean pressure gradient, right ventricular ejection fraction, and ECV), the above-the-upper-quartile NLR (adjusted hazard ratio [aHR]: 1.45, 95%-confidence interval [CI]: 1.01–1.92, p = 0.042), MLR (aHR: 1.48, 95%-CI: 1.05–2.09, p = 0.025), and PIV (aHR: 1.56, 95%-CI: 1.11–2.21, p = 0.011) remained significantly associated with adverse outcomes. Following AVR, the median NLR (3.5 to 3.4) and PIV (460 to 376) showed a significant post-procedural decline compared to baseline (p ≤ 0.019 for both). Conclusions: Inflammatory indices are readily available biomarkers independently associated with adverse outcomes in severe AS following AVR. However, no significant relationship was observed between the NLR, MLR, PIV, and myocardial fibrosis on CMR. Full article

Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. In this study, we investigated the prevalence and severity of insufflation and discussed the potential impact on the outcome of resuscitation. Methods: This study was based on computed tomography (CT) images from two university hospitals in Munich, Germany, which were taken as part of the trauma room care of out-of-hospital cardiac arrest (OHCA) patients. According to local resuscitation protocol, CT performed during ongoing cardiopulmonary resuscitation or after the return of spontaneous circulation (ROSC) was archived to determine the potentially reversible cause of cardiac arrest. CT images from 2014 to 2018 were analyzed in this study. Using an advanced visualization and analysis platform for medical image data, the gas volume within the gastrointestinal tract was determined and compared between resuscitations with lethal and secondary survival outcomes. Results: A total of 92.44% of included OHCA patients (n = 172) showed signs of increased gastrointestinal gas volume in comparison to the physiologically prevalent gas volume. In OHCA patients with a lethal outcome, significantly more gas was detected in the gastrointestinal tract with a median of 757.40 mL compared to 380.65 mL in resuscitations with secondary survival (p ≤ 0.05; W = 4278). Furthermore, Cohen’s r was used to calculate the effect size, indicating a weak association with the outcome of resuscitation (r = 0.24). In addition, a logistic regression analysis was performed to examine the influence of age, gender (female), and the gas volume of the intestines and stomach on the dependent variable “death”. The analysis shows that the model, as a whole, is significant (Chi² = 17.67; p 0.02; n = 172) and supports the hypothesis that intestinal insufflation correlates with a lethal outcome from resuscitation (b = 0.001; OR 1.001 (95% CI [1.000–1.002]; p = 0.021). Conclusions: Insufflation in resuscitation patients is a common phenomenon with potential consequences for the outcome. Even if the effect we have shown appears small, the outcome of resuscitation patients can possibly be improved by preventing or correcting insufflation. To understand its potential impact on resuscitation outcomes fully, further work must be performed to investigate causality. Full article

Objectives: We aimed to compare the accuracy of ultrasound and computed tomography (CT) for the diagnosis of patients with suspected acute diverticulitis and to determine if ultrasound might serve as the primary tool for this purpose in the emergency department. Methods: A double-blind prospective study design was used. The study group included 142 consecutive patients with clinically suspected diverticulitis admitted to the emergency department of a tertiary medical center in 2016–2019. All underwent first ultrasound examination followed by abdominal CT. The final diagnosis was interpreted independently by an expert radiologist in a blinded fashion. Imaging data were compared with final diagnosis and we analyzed the findings against the medical, clinical, and laboratory data. Results: The final diagnosis was colonic diverticulitis in 98 patients. Sensitivity was 93.8% for ultrasound and 100% for CT; corresponding specificity rates were 86.7% and 100%. Agreement between the modalities was excellent (kappa = 0.81). CT demonstrated complicated diverticulosis in 18 patients: 8 pericolic abscesses, 9 micro-perforations, and 1 fistula. Ultrasound missed one abscess and five micro-perforations; however, all were small and were treated conservatively. Twenty-three patients were found to have an acute abdominal condition other than diverticulitis; sensitivity in these cases was 60.8% for ultrasound and 91.3% for CT. In 21 patients, the diagnosis was unknown. Conclusions: Ultrasound has similar sensitivity and specificity to CT for the diagnosis of acute colonic diverticulitis. We believe ultrasound may serve as the initial imaging modality in the emergency department, with CT reserved for large abscesses or inconclusive ultrasound findings. Full article

Background/Objectives: Identifying reliable biomarkers for healthy aging and longevity is a fundamental challenge in aging research and medical sciences. The neutrophil-to-lymphocyte ratio (NLR) is a readily measurable indicator of immune balance that reflects the interplay between innate immune activation and adaptive immune suppression. Methods: This study examined NLR values in 204 physically healthy residents (98 men and 106 women) stratified into four lifespan categories based on death certificates. Page’s test and ordinal regression (Cumulative Link Model) were used to assess trends with longevity. Results: In men, a downward trend in NLR values was observed. In women, a significant age-related decline in NLR was identified, with longer-lived individuals showing notably lower NLR values compared to their shorter-lived counterparts. The findings suggest that lower NLR is associated with longer survival, particularly in older women, reflecting superior immune regulation and reduced systemic inflammation. Conversely, elevated NLR may indicate immune dysfunction and heightened inflammatory burden. Conclusions: The results of this study complement existing findings, reinforcing the critical importance of immune balance in supporting healthy aging and longevity. These findings also underscore the potential of NLR as a robust biomarker for evaluating immune function and anticipating resilience to age-related decline, offering a practical tool for assessing immune health in the aging population. Full article

Background/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical variations in the IPA and surgical outcomes based on data from a multicenter prospective trial. Methods: A post hoc analysis was conducted based on the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial, in which patients randomly underwent LPPG or laparoscopic distal gastrectomy (LDG). The IPA variations were categorized into three groups: distal, caudal, and proximal. Clinicopathological characteristics and surgical outcomes were analyzed according to the IPA type. Results: Among the 192 patients, the distribution of IPA types was as follows: 45 (23.44%) distal, 74 (38.54%) caudal, and 73 (38.02%) proximal. There were no significant differences in the clinicopathological characteristics between the IPA types. Of the 119 patients who underwent LPPG, a significant difference in operative time was observed based on the IPA type, with a longer duration observed with the distal type compared to that of the proximal type (distal type vs. proximal type: 202.5 (150–275) vs. 170 (105–265) min, p = 0.0300). No significant differences were observed in other surgical outcomes. Conclusions: The distribution of IPA types was more diverse than that reported in previous studies. There was a statistically significant difference in the operating time based on the IPA type. Identifying IPA variations during LPPG may be beneficial for gastric cancer surgeons. Full article

Background/Objectives: The prevalence of myopia is increasing globally, including in Spain. The early detection of ocular biometric parameters associated with myopia development is crucial for implementing control strategies. This study aims to describe the normative biometric values in a Spanish school-aged population and compare them with previously established reference data. Methods: A cross-sectional, observational, and analytical study was conducted on 558 students aged 6 to 12 years from the Educare Valdefuentes School in Madrid. Ocular biometric parameters, including axial length (AL), corneal curvature (CR), anterior chamber depth (ACD), crystalline lens thickness (LT), corneal thickness (CCT), and posterior vitreous depth (PVD), were measured using IOLMaster 700. The axial length/corneal radius (AL/CR) ratio was calculated. Percentile growth curves were generated, and the results were statistically analyzed using IBM SPSS 29. Results: AL significantly increased with age (p < 0.001), and boys had longer AL than girls. The AL/CR ratio showed a moderate correlation with myopia risk (ρ = 0.647, p < 0.001). Compared to previous European studies, no significant differences were found, except for minor variations in AL and CR. Conclusions: These percentile-based biometric values provide a useful reference for monitoring ocular growth and assessing myopia risk in Spanish children. The AL/CR ratio remains a strong predictor of myopia development, supporting its role in early detection strategies. Full article

Hepatitis B virus (HBV) infection is a leading cause of chronic liver disease and liver cancer worldwide. Hepatocellular carcinoma (HCC) remains one of the major causes of cancer-related mortality globally. Effective prevention and management strategies for HBV infection are crucial in reducing liver-related complications, including HCC. HBV plays a distinct role in liver carcinogenesis, and there is growing knowledge about the factors contributing to its oncogenic potential. With advancements in HCC management, special attention must be given to the treatment of HBV infection in patients with HBV-induced HCC. In this review, we summarize current insights into the carcinogenic mechanisms of HBV and discuss the latest approaches to managing HBV-induced HCC. Full article