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Aims: While factors associated with adverse events are well elucidated in setting of isolated left ventricular dysfunction, clinical and imaging-based prognosticators of adverse outcomes are lacking in context of biventricular dysfunction. The purpose of this study was to establish role of clinical variables in prognosis of biventricular heart failure (HF), as assessed by cardiac magnetic resonance imaging., Methods: Study cohort consisted of 840 patients enrolled in DERIVATE registry with coexisting CMR-derived right ventricular (RV) and left ventricular (LV) dysfunction, as defined by RV and LV ejection fractions ≤45 % and ≤ 50 %, respectively. The primary objective was to identify factors associated with adverse long-term outcomes, defined as composite of all-cause death and HF hospitalizations (DHFH). Kaplan-Meir curves were plotted for survival analysis. Cox proportional hazard models were constructed to estimate adjusted hazard ratios (aHRs) and associated 95 % confidence intervals for clinical variables and their correlation with adverse events., Results: Mean age was 61.0 years; 83.1 % were male, 26.6 % had diabetes mellitus (DM), and 45.9 % had non-ischemic cardiomyopathy. At median follow-up of 2 years, DHFH occurred in 32.5 % of the cohort. Kaplan-Meir analysis showed higher rate of DHFH in patients with DM (35.2 % vs. 22.6 %, p < 0.001). Multivariate Cox regression analysis showed that DM was independently associated with DHFH (aHR 1.61 [95 % CI: 1.15-2.25]; p = 0.003). Importantly, ACE-inhibitor/ARB usage in patients with DM was associated with significant reduction in DHFH (aHR 0.53 [95 % CI: 0.31-0.90]; p = 0.02)., Conclusion: In patients with biventricular HF, DM was a strong predictor of DHFH, with ACE-inhibitor/ARB usage having cardioprotective effect., Competing Interests: Declaration of competing interest Subhi J. Al’Aref is supported by NIH: National Institutes of Health, USA 2R01 HL12766105 & 1R21 EB030654 and receives royalty fees from Elsevier. Carlo De Cecco received grant from Siemens. Gianluca Pontone received institutional fees by General Electric, Bracco, Heartflow, Medtronic, Bayer, Bhoeringher. Juerg Schwitter received research support by Bayer Healthcare Switzerland. U. Joseph Schoepf received grant by Astellas, Bayer, General Electric, and Siemens Healthcare, personal fees by Guerbet, speaking honorarium by Heartflow. Akos Varga-Szemes received grant from Siemens Healthcare and personal fees from Elucid Bioimaging. The other authors have no conficts of interestes relevant to this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: As the global prevalence of diabetes mellitus increases, the incidence of non-healing wounds in diabetic patients is expected to rise significantly, according to the International Diabetes Federation (IDF), around 537 million adults currently suffer from diabetes mellitus worldwide and 20% to 30% of individuals with diabetes are hospitalized due to diabetic foot ulcers. Conventional treatments such as traditional dressings often fall short in ensuring satisfactory wound healing, this Meta-analysis investigates the therapeutic potential of Adipose-derived Stem Cells (ADSCs) as a promising strategy for addressing this challenge., Aims: To Assess the Therapeutic Potential of Adipose-Derived Stem Cells for Managing Diabetic Foot Ulcers compared to conventional lines of treatments., Methods: The PubMed, SCOPUS, Web of Science Core Collection, Cochrane Library, and ClinicalTrials.gov. databases were searched from January 2000 and December 2023, articles were primarily evaluated regarding their titles and abstracts, then full-text screening was assessed against the inclusion and exclusion criteria by utilizing Rayyan software. The Cochrane risk of bias (RoB 2) assessment tool was used to identify the risk of bias in our included studies. A statistical analysis was performed using Review Manager (RevMan) Version 5 software. Dichotomous data was subjected to risk ratio analysis, while continuous data underwent Mean Difference (MD) evaluation, all was reported with 95% confidence intervals, P value is considered statistically significant if less than 0.05., Results: Regarding the total healing state, five studies reported that more participants healed completely at the end of the follow-up period in the ADSCs group (Risk ratio = 1.56, 95% CI [1.32, 1.86], P < 0.00001), for the healing rate the overall effect estimate favors the ADSCs group (pooled effect estimate = 1.84, 95% CI [1.51, 2.89], P < 0.00001), and regarding the healing time the pooled mean difference of the studies demonstrated that the ADSCs group required fewer days to heal than the standard care group. (pooled mean difference = -19.33, 95% CI [-37.36, -1.29], P = 0.04)., Conclusion: ADSCs provide favorable healing results and safety compared to standard care for diabetic foot ulcers., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The most frequent type of non-Hodgkin lymphoma (NHL) is diffuse large B-cell lymphoma (DLBCL). Although lymph nodes are the most commonly affected organs compromising 70% of DLBCLs, only 5% of extranodal lymphomas represent skeletal muscle involvement. Specifically, abdominal wall muscle involvement is rare and there are only a few reported cases of DLBCL with this type of muscle involvement. Painful abdominal mass was the main presenting symptom in these reported cases., Case: We are reporting a relapsed DLBCL with abdominal wall muscle involvement in a 65-year-old male, presenting with a discomfort and heaviness sensation in the right iliac region with no associated pain., Conclusion: A rare case of DLBCL with recurrence in the abdominal wall muscles as painless masses was reported in this case report. To our knowledge, it is considered the fourth reported in the medical literature. It shows the importance of the diagnostic process that combines imaging with histological examination and immune stains for accurate diagnosis., (© 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Objective: Clinicians have noted that the ongoing war on Gaza has had a psychological impact on people with multiple sclerosis (PwMS) whose mental health is particularly vulnerable during stressful times such as these. The present study sought to examine the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among PwMS in Jordan during the Gaza war outbreak., Methods: This was a cross-sectional study involving 171 patients (PwMS) out of 372 patients approached (46% response rate) who were being seen in the MS unit at Al Bashir Hospital, Ammann, Jordan. Inclusion criteria required that participants had been following daily news updates of the October 7 war in Gaza during a period of 4 months., Results: Of participants, 125 (73.1%) were female, 98 (57.3%) were on therapy for less than five years, and 30 (17.5%) reported having a relapse during the past 6 months. Significant PTSD symptoms were identified in 58.5% (100 of 171 participants). Those at higher risk were the unemployed (OR = 2.14, 95% CI = 1.13-4.07, P = 0.02), whereas patients receiving dimethyl fumarate (19.9%) were at lower risk (OR = 0.43, 95% CI = 0.19-0.94, P = 0.02)., Conclusion: The high rate of significant PTSD symptoms among people with MS in this study underscores the need for attention by primary care providers and the implementation of a comprehensive multidisciplinary approach to optimize the mental well-being of this fragile population., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The association of hospital and physician procedure volume with outcome has not been well evaluated for atrial fibrillation (AF) ablation in contemporary practice., Objective: This study aimed to determine the association between hospital and physician AF ablation volume and procedural success (isolation of all pulmonary veins) and major adverse events (MAEs)., Methods: Procedures reported to the National Cardiovascular Data Registry AFib Ablation Registry between July 2019 and June 2022 were included. Hospital and physician procedural volumes were annualized and stratified into quartiles to compare outcomes. Three-level hierarchical (patient, hospital, and physician) models were used to assess the procedural volume-outcome relationship., Results: A total of 70,296 first-time AF ablations at 186 US hospitals were included. Overall, procedural success and MAE rates were 98.5% and 1.0%, respectively. With hospital volume (Q4) as a reference, the likelihood of procedural success was lower for Q1 (odds ratio [OR], 0.44; 95% CI, 0.29-0.68), Q2 (OR, 0.50; 95% CI, 0.33-0.75), and Q3 (OR, 0.60; 95% CI, 0.40-0.89); the results were similarly significant for physician volume. With MAE for hospitals, there was an inverse procedural volume relationship for Q1 (OR, 1.78; 95% CI, 1.26-2.52) but not for Q2 (OR, 1.06; 95% CI, 0.77-1.46) or Q3 (OR, 1.19; 95% CI, 0.89-1.58) and similarly for physicians in Q1 and Q2 but not in Q3. An adjusted MAE ≤1% was predicted by an annual volume of approximately 190 for hospitals and 60 for physicians., Conclusion: In this national cohort, hospital and physician AF ablation procedural volumes were directly related to acute procedural success and inversely related to rates of MAE., Competing Interests: Disclosures Dr Freeman reports advisory board/consulting fees from Boston Scientific, Medtronic, Biosense Webster, and PaceMate; and equity in PaceMate. Dr Zeitler reports nonfinancial research support from Biosense Webster, Boston Scientific, and Sanofi; travel/speaking for Abbott, Biosense Webster, Medtronic, and Philips; and advisory board/consulting fees from Biosense Webster and Medtronic. Dr Zei reports consulting fees from Biosense Webster, Abbott, Volta Medical, and Medtronic. Dr Sanders served on the advisory board of Medtronic, Abbott, Boston Scientific, PaceMate, and CathRx; the University of Adelaide, Australia has received on his behalf lecture, research funding, and/or consulting fees from Medtronic, Abbott, Boston Scientific, and Becton-Dickenson., (Published by Elsevier Inc.)

Background: This study investigated how intensive clinical nursing training influences the confidence of newly registered nurses in speaking up about their opinions and concerns within their current work settings., Method: A qualitative approach with thematic analysis was used. In-depth interviews were conducted with 64 newly graduated RNs to explore their experience in attending an undergraduate intensive clinical training course., Results: Four main themes emerged from the texts: (a) facing the workplace reality with confidence, (b) being equipped with knowledge and skills, (c) merging with the health care team, and (d) being empowered with high self-esteem., Conclusion: The newly graduated nurses believed that the intensive clinical nursing training course enhanced their confidence, improved their communication skills, and empowered them to speak up for their rights and those of their patients. [ J Contin Educ Nurs. 2025;56(1):14-19.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

This study aimed to investigate the protective effect of a novel capsaicinoid glucoside (CG) against H 2 O 2 -induced oxidative stress in HepG2 cells and elucidate its underlying molecular mechanism. CG treatment significantly reduced H 2 O 2 -induced cell mortality and attenuated the production of lactate dehydrogenase and malondialdehyde in a dose-dependent manner. Moreover, CG drastically reduced the ROS levels 18.7, 37.4, and 43.8% at concentrations of 25, 50, and 100 µg/mL, respectively. while increased glutathione content and catalase activity. Most importantly, in silico analysis revealed that CG effectively interacted with each of TRPV1 and Nrf2 by H-bonds, π-π interactions, and hydrophobic forces without simulation fluctuations over 50 ns. TRP, LYS, THR, LEU, GLN, VAL, ILE, and TYR residues of the tested proteins were all involved in the interaction with CG. These findings suggested that CG could reduce H 2 O 2 -induced oxidative stress in HepG2 cells via TRPV1/Nrf2 pathway which could be validated in functional foods/supplements formulations., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Evans syndrome is a rare disorder characterized by the simultaneous or sequential combination of autoimmune hemolytic anemia and immunological thrombocytopenia, together with a positive direct antiglobulin test. This syndrome, which can be primary or secondary, is a rare initial manifestation of autoimmune diseases, notably systemic lupus erythematosus, with 1.7-2.7% of patients with systemic lupus erythematosus developing secondary Evans syndrome, sometimes preceding the onset of systemic lupus erythematosus symptoms., Case Presentation: A 47-year-old Middle Eastern female presented with symptoms including shortness of breath, chest pain, and weakness. Physical examination revealed pallor, pale conjunctiva, icteric sclera, tachycardia, and tachypnea. She was diagnosed with Evans syndrome owing to hemolytic anemia, thrombocytopenia, and a positive Coombs test, where initial resistance to treatment prompted intensive therapy with methylprednisolone, intravenous immunoglobulin, and rituximab. Subsequent identification of systemic lupus erythematosus on the basis of positive anti-nuclear antibodies and anti-double-stranded deoxyribonucleic acid antibodies led to treatment with mycophenolate mofetil and hydroxychloroquine. Further evaluations uncovered Hashimoto's thyroiditis and pernicious anemia, necessitating thyroxine supplementation and vitamin B12 injections., Conclusion: Hematologic abnormalities play a crucial role in the diagnostic framework of systemic lupus erythematosus. This case highlights a patient initially diagnosed with Evans syndrome, revealing an underlying systemic lupus erythematosus. The presentation underscores the significance of hematologic manifestations as integral components of the diagnostic framework for autoimmune diseases, emphasizing the intricate relationship between Evans syndrome and systemic lupus erythematosus., Competing Interests: Declarations. Ethics approval and consent to participate: This article does not contain any studies with human participants or animals performed by any of the authors. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: Authors declare no competing interests., (© 2024. The Author(s).)

Background: Acute pancreatitis is one of the leading causes of mortality and morbidity. Most acute pancreatitis scoring systems have no pathophysiologic basis when evaluating severity. Such a limitation led to an interest in measuring intra-abdominal pressure (IAP) as a method to predict outcomes in patients with acute pancreatitis., Aims: Investigate the predictive impact of intra-abdominal hypertension (IAH) on mortality and clinical outcomes in a patient hospitalized with severe acute pancreatitis., Methods: We conducted a systematic search of the PubMed, Embase, and Cochrane databases from inception through November 2021 for studies evaluating the effect of IAH on acute pancreatitis. Relevant data were extracted and analyzed using STATA 17 software. A random-effects model was used for all variables. Publication bias was assessed using Egger's test., Results: Fourteen studies investigating 1197 patients were included. Mortality, multiorgan dysfunction syndrome, pancreatic necrosis, renal, respiratory, and cardiovascular failure were more likely in the IAH group. However, infected necrosis and surgical intervention were not statistically significant between the two groups. After excluding abdominal compartment syndrome patients, mortality and respiratory failure were the only outcomes, which remained statistically significant., Conclusions: Patients admitted to the hospital with severe acute pancreatitis have higher odds for mortality, multiorgan dysfunction syndrome, renal, respiratory, and cardiovascular failure if they developed IAH. IAH remained a strong predictor of mortality and respiratory failure even in the absence of abdominal compartment syndrome. Therefore, the development of IAH is a strong predictor of mortality and poor clinical outcome in such a population., Competing Interests: Declarations. Conflict of interest: All authors have no conflicts of interest. No financial arrangements are related to the research or assistance with manuscript preparation., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: The safety and efficacy of paroxysmal atrial fibrillation (PAF) ablation with the HELIOSTAR multielectrode radiofrequency (RF) balloon catheter have been demonstrated in European studies; data from elsewhere are lacking. This prospective, multicenter study conducted in the United States, Italy, and China investigated the safety and efficacy of pulmonary vein isolation (PVI) using HELIOSTAR in drug-refractory symptomatic PAF., Methods: The primary effectiveness endpoint (PEE) was 12-month freedom from documented atrial fibrillation/atrial flutter/atrial tachycardia plus freedom from acute procedural failure, nonstudy catheter failure, repeat ablation failure, direct current cardioversion (DCCV), and Class I/III antiarrhythmic drug (AAD) failure. The primary safety endpoint was the occurrence of early-onset primary adverse events (PAEs). Cerebral magnetic resonance imaging (MRI) and cardiac computed tomography were performed in a patient subset to assess silent cerebral lesions (SCLs) and severe pulmonary vein (PV) stenosis, respectively., Results: Across 36 centers, 257 eligible subjects in the main phase had the study catheter inserted. Acute PVI was achieved in all subjects, with the majority (94.1%) using the balloon catheter only. In 67.7% and 92.2% of subjects, respectively, PEE and freedom from repeat ablation were met; clinical success rate was 77.7%. The PAE rate was 5.1%. One of 15 (6.7%) subjects with MRI showed a new SCL at 1 month postablation, which resolved at 3 months. Clinically meaningful improvements in Atrial Fibrillation Effect on QualiTy-of-life scores were seen at 3 months and were sustained to 12 months postablation, and accompanied with reduction of Class I/III AAD use and DCCV., Conclusion: STELLAR confirmed the safety and efficacy of the HELIOSTAR catheter for PVI, with clinically meaningful improvements in quality of life in patients with drug-refractory symptomatic PAF. Most PVIs were achieved without focal touch-up, and > 90% of patients were free from repeat ablation at 12 months., Trial Registration: ClinicalTrials.gov Identifier: NCT03683030., (© 2024 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Importance: Current epilepsy management protocols often depend on anti-seizure medication (ASM) trials and assessment of clinical response. This may delay the initiation of the ASM regimen that might optimally balance efficacy and tolerability for individual patients. Machine learning (ML) can offer a promising tool for efficiently predicting ASM response., Objective: The objective of this review is to synthesize the available information about the effectiveness and limitations of ML models in predicting and classifying the response of patients with epilepsy to ASMs, and to assess the impact of various data inputs on prediction performance., Evidence Review: We conducted a comprehensive search of studies utilizing ML models for ASM response prediction using PubMed and Scopus up until November 2024., Findings: The review included 37 studies. Various data types, including clinical information, brain MRI, EEG, and genetic data, are useful in predicting responses to ASMs. Tree-based ML algorithms and Support Vector Machines are the most used models. Reported results vary widely, with certain models achieving near-perfect accuracy and others performing similar to random classifiers. The review also highlights the limitations of this research field, especially concerning the quality and quantity of data., Conclusions and Relevance: The findings indicate that while ML models show great promise in predicting ASM responses in epilepsy, further research is required to refine these models for practical clinical application. The review underscores both the potential of ML in advancing precision medicine in epilepsy management and the need for continued research to improve prediction accuracy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

CSL040 is a soluble, recombinant fragment of the complement receptor 1 (CR1) extracellular domain that acts as an inhibitor of all three pathways of the complement system. Systemic toxicity, toxicokinetics (TK), and pharmacodynamics (PD) of CSL040 were assessed in two-week intravenous (IV) bolus studies in Han Wistar rats and cynomolgus monkeys. Recovery from any effects was evaluated during a four-week recovery period. Daily repeat-dose administration for 2 weeks at doses of up to 500 mg/kg CSL040 IV was well tolerated in rats and cynomolgus monkeys, leading to a no observed adverse effect level (NOAEL) of 500 mg/kg for both species. Safety pharmacology parameters such as electrophysiology of the heart, blood pressure, heart rate, and respiratory rate measurements, and general toxicological readouts were considered unaffected by CSL040 treatment. Anti-drug antibodies (ADAs) were observed in all cynomolgus monkeys and in some rats at the highest dose of CSL040, but with no effect on pharmacokinetics (PK), supportive of adequate exposure levels as required for a safety assessment. All three complement pathways were inhibited dose-dependently by CSL040. Additionally, no effect on cytokine levels by CSL040 was detected in vitro using a cytokine release assay. These non-clinical studies with CSL040 demonstrated PD activity consistent with its mode of action, adequate PK properties, and a safety profile supporting a phase 1 clinical strategy. A small follow-up study comparing the PK/PD effects of CSL040 following IV and subcutaneous (SC) administration also suggested that the latter route of administration might be a viable alternative to IV administration., Competing Interests: Declaration of competing interest S·W and M.P·H are listed as inventors on International Patent Publication number WO2019/218009. All authors are CSL employees, and all authors except TR are CSL shareholders., (Copyright © 2024 CSL Limited. Published by Elsevier Inc. All rights reserved.)

The present study examined the severity and the correlates of post-traumatic stress disorder (PTSD) and depression symptoms severity in newly diagnosed people with multiple sclerosis (PwMS) compared to healthy people during the outbreak of the Oct.7th war on Gaza. This is a cross-sectional case-control study recruiting 63 PwMS and 79 controls. The severity of PTSD and depression were measured using validated scales. There was no significant (p>0.05) difference in PTSD and depression scores between the PwMS and the controls. In addition, PwMS who experienced one or more relapses since diagnosis were at a significantly higher risk (B=9.29, t=2.06, p=0.04) for severe PTSD and severe depressive (OR=5.50, 95% CI=1.32-22.92, p=0.01). The study of the mental health of PwMS during times of crisis is emerging in developing countries, future larger-scale and follow-up studies are yet required., Competing Interests: Declaration of competing interest The authors declare no conflicts on interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Importance: One of 10 patients develop epilepsy in the late phase after cerebral venous thrombosis (CVT) diagnosis but predicting the individual risk is difficult., Objective: To develop and externally validate a prognostic score to estimate the individual risk of post-CVT epilepsy., Design, Setting, and Participants: This observational cohort study included both retrospective and prospective patients enrolled from 1994 through 2022. For development of the DIAS3 score, data from the International CVT Consortium (n = 1128), a large international hospital-based multicenter CVT cohort, were used. For validation, data from 2 independent multicenter cohorts, the ACTION-CVT (n = 543) and the Israel CVT study (n = 556), were used. Of 2937 eligible, consecutively enrolled adult patients with radiologically verified CVT, 710 patients with a history of epilepsy prior to CVT, follow-up less than 8 days, and missing late seizure status were excluded., Exposure: The prediction score (DIAS3) was developed based on available literature and clinical plausibility and consisted of 6 readily available clinical variables collected during the acute phase: decompressive hemicraniectomy, intracerebral hemorrhage at presentation, age, seizure(s) in the acute phase (excluding status epilepticus), status epilepticus in the acute phase, and subdural hematoma at presentation., Main Outcome and Measure: Time to a first late seizure, defined as occurring more than 7 days after diagnosis of CVT., Results: Of 1128 patients included in the derivation cohort (median age, 41 [IQR, 30-53] years; 805 women [71%]), 128 (11%) developed post-CVT epilepsy during a median follow-up of 12 (IQR, 3-26) months. According to the DIAS3 score, the predicted 1-year and 3-year risk of epilepsy in individual patients ranged from 7% to 68% and 10% to 83%, respectively. Internal and external validation showed adequate discrimination in the derivation cohort (1 year and 3 years: C statistic, 0.74; 95% CI, 0.70-0.79) and the 2 independent validation cohorts, (ACTION-CVT) 1 year: C statistic, 0.76; 95% CI, 0.67-0.84; 3 years: C statistic, 0.77; 95% CI, 0.66-0.84; and Israel CVT study 1 year: C statistic, 0.80; 95% CI, 0.75-0.86. Calibration plots indicated adequate agreement between predicted and observed risks., Conclusions and Relevance: The DIAS3 score (freely available online) is a simple tool that can help predict the risk of post-CVT epilepsy in individual patients. The model can improve opportunities for personalized medicine and may aid in decision-making regarding antiseizure medication, patient counseling, and facilitation of research on epileptogenesis in CVT.

Objective: To outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference., Methods: We identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate 2 years after surgery. Additionally, we present the 30-day postoperative complication rate., Results: Fifty underwent transoblique conduits and we matched them to 190 transrectus patients. Sixty-seven percent were men with a median age of 62. Exactly 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The 2-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least 1 postoperative complication., Conclusion: A transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Given the significance of investigating ovarian reserve in infertile women, the limitations of existing diagnostic tests, and the absence of similar studies in this area, the present study aimed to examine the relationship between systemic inflammatory markers in patients with diminished ovarian reserve referred to the fertility clinic of Alzahra Hospital in Rasht in the year 2023. This cross-sectional analytical study was conducted on 174 patients referred to the Alzahra Hospital fertility clinic in Rasht. Patients were divided into two categories based on their serum levels of anti-Müllerian hormone (AMH):AMH >1.1 (ng/ml) and AMH < 1.1(ng/ml). Demographic and laboratory variables, including age, BMI, parity, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red cell distribution width-to-platelet ratio (RPR), and follicle-stimulating hormone (FSH), were compared between the two groups. Significant difference between the two study groups regarding age and BMI, with the mean age and BMI of patients in the group with normal ovarian reserve being lower than those in the group with poor ovarian reserve. There was a significant difference in FSH levels, the group with poor ovarian response had higher FSH levels. Age and FSH were identified as independent predictive variables associated with diminished ovarian reserve in patients. According to the present study, a significant association between diminished ovarian reserve and inflammatory markers (NLR, PLR, and RPR) was not observed. However, FSH levels were significantly higher in the Diminished Ovarian Reserve (DOR) group. Furthermore, a meaningful correlation was only found between diminished ovarian reserve and age.

Introduction Magnetic resonance imaging (MRI) serves as a pivotal tool in the preoperative assessment of rectal cancer. This study aims to evaluate the accuracy of preoperative MRI pelvis in rectal cancer for locoregional staging, circumferential margin (CRM+), and vascular invasion (V1) with postoperative histopathological findings. Methods All patients who underwent preoperative staging MRI pelvis scanning for histology-proven primary rectal adenocarcinoma between January 2020 and July 2022 were included in this study. Preoperative MRI assessment data, including tumor (T), nodal (N) staging, and other prognostic factors, including circumferential margin and vascular invasion, were compared with histopathological reports. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were calculated. Agreement between MRI and pathology reports was evaluated using the weighted kappa statistic. Results The study included 143 patients. The accuracy of MRI is at its peak for T0 and T4 tumors (T0-97.9%, T4-93.37). The weighted kappa statistic for T staging is 0.401, and for N staging, it is 0.286. The standard kappa statistic for extramural vascular invasion (V) and circumferential resection margin (CRM) is 0.269 and 0.225, respectively. Conclusion MRI demonstrates fair agreement with pathology regarding T and N staging and exhibits high specificity for CRM and V1., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gowda et al.)

Spigelian hernia is a rare type of abdominal hernia; diagnosis is primarily through computed tomography, which is crucial for accurate diagnosis and planning early surgical intervention to preserve the herniated sac's contents., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Probing electrical and magnetic properties in aqueous environments remains a frontier challenge in nanoscale sensing. Our inability to do so with quantitative accuracy imposes severe limitations, for example, on our understanding of the ionic environments in a diverse array of systems, ranging from novel materials to the living cell. The Nitrogen-Vacancy (NV) center in fluorescent nanodiamonds (FNDs) has emerged as a good candidate to sense temperature, pH, and the concentration of paramagnetic species at the nanoscale, but comes with several hurdles such as particle-to-particle variation which render calibrated measurements difficult, and the challenge to tightly confine and precisely position sensors in aqueous environment. To address this, we demonstrate relaxometry with NV centers within optically-trapped FNDs. In a proof of principle experiment, we show that optically-trapped FNDs enable highly reproducible nanomolar sensitivity to the paramagnetic ion, (\mathrm{Gd}^{3+}). We capture the three distinct phases of our experimental data by devising a model analogous to nanoscale Langmuir adsorption combined with spin coherence dynamics. Our work provides a basis for routes to sense free paramagnetic ions and molecules in biologically relevant conditions.

Introduction Lynch syndrome is one of the most common hereditary cancers associated with germline alterations of DNA mismatch repair genes. Recent advances have shed light on its molecular pathogenesis, leading to the development of various testing strategies. The aim of this study is to evaluate whether all colorectal adenocarcinomas undergo immunohistochemistry (IHC) and microsatellite instability (MSI) testing to identify potential Lynch syndrome patients. Methods This study evaluated the compliance of MSI and IHC testing for Lynch syndrome in a tertiary cancer research centre. All patients undergoing colorectal cancer resection between April 2022 and December 2022 were identified from a prospectively maintained register. The histology, MSI, and IHC testing reports for these patients were recorded to check if they were done and reported. Only patients with colorectal adenocarcinoma were included in this study. Results A total of 314 patients had colorectal cancer resections. A total of 301 were included in the study, with a median age of 65 years (IQR = 35-95). Thirteen (4.14%) patients did not have MSI and IHC testing reported on the system. Of these, eight (61.53%) did not have an MSI/IHC testing request, four (30.76%) did not have sufficient specimens to be sent for further testing, one (7.69%) had MSI and IHC testing but the final report was yet to be authorized. Out of the eight who did not have the testing done, three had early polyp cancer and one had a goblet cell adenocarcinoma. Conclusion According to the data, our hospital has a 97.45% compliance with current guidelines, not considering the insufficient sample for testing and the authorization of the final report. A more comprehensive proforma may be needed to provide a feedback loop for further MSI and IHC testing when entering data into the system. Further auditing is required to check the effectiveness of the proforma in achieving complete compliance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Peter et al.)

Background Computed tomography (CT) scans play a crucial role in emergency surgical care, serving both diagnostic and prognostic functions. They significantly contribute to timely and effective patient care. This study aims to compare abdominal CT scan reports prepared by locally employed radiologists with those from outsourced radiology reporting services for patients presenting with acute surgical conditions. Additionally, the study evaluates how different reporting styles, such as free-text versus structured formats, influence the overall quality of the reports. Methods The study was conducted in the general surgery unit of North Manchester General Hospital, Manchester, a district general hospital in North West England. Patients admitted through the accident and emergency (A&E) under the general surgery team who underwent abdominal CT scans between August 2023 and October 2023 were included. Trauma patients and those who received non-abdominal CT scans were excluded. Local radiology reports were compared to outsourced reports using statistical analysis. The clarity and comprehensiveness of the reports were carefully evaluated, and the impact of free-text versus structured reporting formats was also considered. Results A total of 192 patients were included in the study, with a median age of 59 years. Compared to locally reported scans, outsourced radiology reports frequently omitted commentary on key anatomical structures, including the biliary system, spleen, kidneys, lymph nodes, mesentery and peritoneum, vasculature, bones and soft tissues, and lung bases. Reports using a structured format provided more thorough commentary on the spleen, adrenal glands, mesentery and peritoneum, and bones and soft tissues compared to free-text reports. Conclusion Outsourced radiology reports significantly underreported important abdominal anatomical structures. Free-text reporting was associated with significant omissions in abdominal anatomical structures, which could negatively affect clinical decision-making and management plans. Further studies are recommended to evaluate the comprehensiveness of outsourced radiology reporting and to ensure standardization in reporting, ultimately providing patients with high-quality emergency care., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Obayi et al.)

Advancements in allogeneic haematopoietic stem cell transplant (alloHSCT) procedures have improved patient outcomes over the last two decades, though invasive fungal infections (IFIs) remain a significant risk. The incidence of IFIs in alloHSCT recipients is estimated at 6%, with a mortality rate of 13%, and Aspergillus species are the most common pathogens involved. Posaconazole is effective in preventing IFIs post-transplant and is standard care during neutropenia or when managing graft-versus-host disease (GvHD) with high-dose steroids. However, azole prophylaxis may cause resistant Aspergillus species like A. calidoustus, which are difficult to treat. We report a case from our institution where a patient developed a dual infection with Aspergillus calidoustus and Talaromyces columbinus after alloHSCT and posaconazole prophylaxis. While A. calidoustus is known to cause IFIs in HSCT recipients, T. columbinus represents a previously unreported occurrence in medical literature. This case underscores the importance of a multifaceted diagnostic strategy, integrating BAL diagnosis, mycological cultures, direct microscopy, fungal speciation, susceptibility testing, and biomarkers. These comprehensive approaches are indispensable for accurate pathogen identification and effective management of IFIs with appropriate antifungal agents., (© 2024. The Author(s).)

Background: Atrial fibrillation (AF) ablation carries the risk of silent cerebral event (SCE) and silent cerebral lesion (SCL). Although "silent," these may have long-term clinical implications and are challenging to study as postprocedural magnetic resonance imaging (MRI) is not standard of care., Objective: The neurological assessment subgroup (NAS) of ADVENT compared cerebral effects of pulsed field ablation (PFA) with standard-of-care thermal ablation., Methods: The NAS included consecutive randomized PFA and thermal ablation patients who received postprocedural brain MRI 12-48 hours after ablation. Patients with apparent SCE or SCL findings underwent a modified Rankin scale assessment. MRI images were subsequently reviewed by a blinded brain imaging core laboratory., Results: In total, 77 patients with paroxysmal AF were enrolled at 6 centers; 71 had analyzable scans (34 PFA; 37 thermal ablation). Through individual center review, 6 PFA and 4 thermal scans were identified as SCE/SCL positive, of which 3 PFA and 0 thermal SCE/SCL findings were confirmed by a blinded core laboratory. MRI findings revealed 1 patient with 2- to 4-mm SCEs, 1 patient with a 3-mm SCE, and 1 patient with 2 SCLs (5.5 mm and 11 mm). All modified Rankin scale and National Institutes of Health Stroke Scale scores were 0 before discharge and at 90-day follow-up. There were only 2 neurological safety events (1 transient ischemic attack [PFA] and 1 stroke [thermal ablation]) in the ADVENT study, neither of which was part of the NAS., Conclusion: The ADVENT trial provides the first prospective, randomized data on the cerebral impact of PFA and thermal ablation of AF. Incidence of SCE/SCL after ablation in the NAS was low., Competing Interests: Disclosures C.P., consultant for Boston Scientific. E.P.G., consultant to Farapulse Inc and serves as an unpaid consultant to Boston Scientific Inc; lecture honoraria from Boston Scientific Inc. S.K.G., consultant for Medtronic and Boston Scientific. J.W., consultant for Biosense Webster, Abbott, Boston Scientific, and Thermedical. C.W., equity in inHEART and SoloPace, intellectual property with ensoETM and SoloPace; travel funds from Abbott and AtriCure. A.N., consultant for Abbott, Biosense Webster, and Boston Scientific. J.W.L., consultant to and received equity from Farapulse Inc (now divested) and serves as a consultant to Boston Scientific Inc. M.M., consultant for Boston Scientific. V.Y.R., consultant to and received equity from Farapulse Inc (now divested), and receives grant support from and serves as a consultant to Boston Scientific Inc; and unrelated to this manuscript, V.Y.R. has served as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical–Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics–Medtronic, EpiEP, Eximo, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, Valcare; and unrelated to this work, V.Y.R. has served as a consultant for Abbott, Adagio Medical, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Cairdac, Cardiofocus, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Philips, Pulse Biosciences; and unrelated to this work, V.Y.R. has equity in Atraverse, Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Key Clinical Message: Mature mediastinal teratoma (MMT) is a benign tumor that is composed of well-differentiated tissues from all three germ cell layers. Malignant tumors have a distinct feature of adhering to the surrounding organs. Therefore, adhesion of MMT to the adjacent tissues, as a benign tumor, is rare and considered a surgical challenge. It leads to incomplete tumor resection to avoid damage to the surrounding tissues., Abstract: MMT is a germ cell tumor that contains well-differentiated tissues from ectodermal, mesodermal, and endodermal germ cell layers. MMT comprises approximately 3%-12% of mediastinal tumors in adults and 60%-70% of mediastinal germ cell tumors. Complete surgical resection is the standard treatment. When adhesion to the surrounding tissues is present, residual tissues could be retained to reduce the injury of the peripheral blood vessels and nerves. We are reporting a rare case of MMT with adhesions to the pericardium and discussing the diagnostic and surgical challenges., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Competing Interests: Disclosures Dr Turagam has served as a consultant for Biosense Webster and Boston Scientific. Dr Nair has served as a consultant for Boston Scientific and Johnson & Johnson. Dr Doshi has served as a consultant for Boston Scientific and Abbott Vascular. Dr Valderrabano has served as a consultant for Biosense Webster and Abbott. Dr Natale has served as a consultant for Abbott, Biosense Webster, and Boston Scientific. Dr Halperin has served as a consultant for Abbott and Bayer HealthCare. Dr Mansour has received consulting fees from Biosense Webster and Boston Scientific. Dr Reddy has served as an unpaid consultant for Boston Scientific, Biosense Webster, and Abbott. Dr Reddy has served as a consultant to Boston Scientific and Abbott; and unrelated to this manuscript, he has served as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Append Medical, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, Cardiofocus, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EP Frontiers, Farapulse-Boston Scientific, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Laminar Medical, LuxMed, Medlumics, Neutrace, Nuvera-Biosense Webster, Oracle Health, Pulse Biosciences, Restore Medical, Sirona Medical, SoundCath; and unrelated to this work, has served as a consultant for Adagio Medical, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Cairdac, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Novo Nordisk, Philips; and has equity in Atraverse, DRS Vascular, Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: The aim of this work was to optimize a three-dimensional (3D) turbo-spin-echo (TSE) sequence using a small field-of-view (FOV) technique for the study of the cerebellopontine angle and to compare it with a constructive interference steady-state (CISS) sequence., Methods: A total of 30 consecutive patients underwent magnetic resonance imaging with a 3Tesla (T) scanner, including 3D CISS and the optimized 3D small FOV technique turbo spin echo (3D SFT-TSE) T2-weighted sequences for the study of the cerebellopontine angle. The 3D SFT-TSE sequence was optimized after three different steps, and a quantitative evaluation of the signal-to-noise ratio (SNR) was obtained according to the National Electrical Manufacturers Association (NEMA) method. Three neuroradiologists made a blind comparative qualitative evaluation of the images between the 3D CISS and the 3D SFT-TSE obtained after the third optimization step, based on spatial resolution, contrast resolution, and presence of artifacts and noise., Results: The calculation of SNR using the NEMA method confirmed the superiority of the third optimization step over the others. For both spatial and contrast resolution, the optimized SFT-TSE was considered better (p < 0.001) than the CISS, while image artifacts and noise were considered worse in the CISS sequence (p < 0.001). Intraobserver analysis showed that all neuroradiologists preferred the 3D SFT-TSE sequence in terms of both spatial resolution and contrast resolution and found more noise and artifact disruption in the CISS sequence., Conclusions: The use of the 2D radiofrequency pulse technique with a 3D SFT-TSE T2 sequence was significantly more efficient than the 3D CISS sequence for the study of the cerebellopontine angle and inner ear structures., Competing Interests: Declarations. Conflict of interest: V. Vitale, A. Varotto, I. Cracco, M. Mansour, L. Di Clemente, F.A. Raneri, A. Tecchio and G. Iannucci declare that they have no competing interests. All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The supplement containing this article is not sponsored by industry, (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Pediatric solid organ transplantation is challenging due to the limited availability of suitable organs resulting in an increasing waitlist. Many pediatric transplant recipients receive organs from deceased donors, often after neurologic determination of death. Organ donation from patients on extracorporeal membrane oxygenation (ECMO) at the time of death has been described in adults, offering the potential for donation after circulatory determination of death (DCDD) with minimal ischemia time., Case Description: DCDD on ECMO requires a coordinated and seamless approach from a multidisciplinary team for clinical care. In this article, we aim to describe our institutional DCDD practice guidelines, which involve withdrawing ECMO support in the pediatric intensive care unit (PICU) or the operating room (OR), followed by organ procurement after the declaration of death, and our experience with DCDD in 2 pediatric patients on ECMO. In case 1, withdrawal of life-sustaining therapies (WOLST) occurred in the PICU with transport to the OR for DCDD. In case 2, both WOLST and DCDD occurred in the OR. In the described context, ECMO provided hemodynamic stability with minimal warm ischemia time for the donated organs., Conclusions: This approach offers a novel resource for pediatric organ transplantation, potentially expanding the pediatric donor pool., (© 2024 Wiley Periodicals LLC.)

The dermatological manifestations of the coronavirus cause severe acute respiratory syndrome. The current study investigates the morphological and histopathological relationship between the emergence of skin lesions and the severity of COVID-19 across the course of the disease via a cross-sectional study. There were skin lesions (maculopapular rash, vesiculobullous lesions, urticarial lesions, cutaneous thromboembolic "CT," and erythema multiforme-like lesions "EM-like") in confirmed COVID-19 instances. A total of 150 patients of both sexes were evaluated morphologically and were classified as early (44% of the total) or late based on the emergence of respiratory symptoms (one week before or two weeks after, respectively). The early and late diagnostic groups represented 44% and 56% of the total patients, respectively. Patients with no skin lesion and one skin lesion showed a significant correlation with disease timeline early and late stages ( X 2 = 22.38, P < 0.001; X2  = 4.432, P < 0.001, respectively). CT and EM-like were correlated with the disease severity, X 2 = 50.51, P < 0.001; X 2 = 19.186, P ≤ 0.001, respectively. In conclusion, our data suggested that the onset of dermatological lesions that developed during the COVID-19 pandemic may be a useful diagnostic and prognostic tool for COVID-19 severity. Therefore, a thorough examination of the skin may save time and bring physicians to an accurate diagnosis and, as a result, prompt treatment., Competing Interests: All authors declare that they have no conflicts of interest., (Copyright © 2024 Mahmoud A. Rageh et al.)

Background: Skin of color clinics (SOCCs) are dermatology clinics that provide specialized care for patients with melanated skin. Little is known about patient perceptions and attitudes toward these clinics., Objective: We sought to perform a survey study to assess the opinions of patients of color previously seen in our dermatology department toward SOCC., Methods: A 14-question survey was sent by email to patients of color seen at our institution between January 1, 2015 and December 31, 2021., Results: Out of 264 participants who completed the survey, 176 (66.7%) indicated they would prefer to be seen in a SOCC and 88 (33.3%) preferred to be seen in a general dermatology clinic (GDC). Clinic choice varied significantly by ethnicity, with Black/African American participants being the most likely to prefer SOCC over GDC than other races/ethnicities. Those interested in SOCC were primarily motivated by a search for expertise in the skin of color (SOC) and did not have a preference for the skin color of the SOCC dermatologist. Those interested in GDC were happy with their current care., Limitations: This study was limited by the single-center design and sample bias., Conclusion: Our results overall provide positive patient feedback for the creation of SOCCs as centers for expertise in SOC. The preference for SOCC varied by race/ethnicity, highlighting that clinic choice is best left to the patient., Competing Interests: None., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.)

Introduction: The aim of this study was to assess the yield of the endoscopic investigations performed following the resolution of acute diverticulitis., Methods: A retrospective multicentre study included patients with multislice computed tomography (MSCT)-proven diverticulitis, in four NHS hospitals, between January 2016 and April 2023. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the nondiseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group., Results: A total of 1,120 patients were included in the study, out of which 604 were females, with a median age of 61 years; 731 patients (65%) had uncomplicated diverticulitis (Hinchey 1A) while 389 (35%) had complicated diverticulitis (Hinchey 1B-4). Following the acute episode, 757 (74%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated diverticulitis was 0.14%. In the complicated diverticulitis group, the incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4% and 5.4%, respectively. Out of the 102 patients who underwent emergency colonic resection for suspected perforated diverticulitis, 18 (17.6%) had histological evidence of colonic malignancy., Conclusions: Endoscopic investigations following uncomplicated diverticulitis have a low yield for sinister colonic pathology. Colonoscopy should be planned following complicated diverticulitis and in patients with uncomplicated diverticulitis with suspicious radiological finding on index imaging or in patients with ongoing clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.

Background: Evidence from clinical trials of early pulsed field ablation (PFA) systems in treating atrial fibrillation has demonstrated their promising potential to reduce complications associated with conventional thermal modalities while maintaining efficacy. However, the lack of a fully integrated mapping system, a staple technology of most modern electrophysiology procedures, poses limitations in lesion creation and workflow options. A novel variable-loop PFA catheter integrated with an electroanatomic mapping system has been developed that allows for real-time nonfluoroscopic procedural guidance and lesion indexing as well as feedback of tissue-to-catheter proximity. AdmIRE (Assessment of Safety and Effectiveness in Treatment Management of Atrial Fibrillation With the Bosense-Webster Irreversible Electroporation Ablation System), a multicenter, single-arm, Food and Drug Administration investigational device exemption study, evaluated the long-term safety and effectiveness of this integrated PFA system in a large United States-based drug-refractory symptomatic paroxysmal atrial fibrillation patient population., Methods: Using the PFA catheter with a compatible electroanatomic mapping system, patients with drug-refractory symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation. The primary safety end point was primary adverse event within 7 days of ablation. The primary effectiveness end point was a composite end point that included 12-month freedom from documented atrial tachyarrhythmia (ie, atrial fibrillation, atrial tachycardia, atrial flutter) episodes, failure to achieve pulmonary vein isolation, use of a nonstudy catheter for pulmonary vein isolation, repeat procedure (except for one redo during blanking), taking a new or previously failed class I or III antiarrhythmic drug at higher dose after blanking, or direct current cardioversion after blanking., Results: At 30 centers, 277 patients with paroxysmal atrial fibrillation (61.5±10.3 years of age; 64.3% male) in the pivotal cohort underwent PFA. More than 25% of the procedures were performed without fluoroscopy. Median (Q1, Q3) pulmonary vein isolation procedure, fluoroscopy, and transpired PFA application times were 81.0 (61.0, 112.0), 7.1 (0.00, 14.3), and 31.0 (24.8, 40.9) minutes, respectively. The primary adverse event rate was 2.9% (8 of 272), with the most common complication being pericardial tamponade. The 12-month primary effectiveness end point was 74.6%. The 1-year freedom from atrial fibrillation, atrial tachycardia, or atrial flutter recurrence rate after blanking was 75.4%. Substantial improvements in quality of life were observed as early as 3 months after the procedure, concurrent with a reduction in multiple health care use measures., Conclusions: AdmIRE confirmed the safety and effectiveness of the variable-loop PFA catheter, with short procedure and PFA application times and low fluoroscopy exposure., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05293639., Competing Interests: Dr Reddy reports receiving consulting fees and grant support from Biosense-Webster; unrelated to this article, serves as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, Cardiofocus, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Farapulse-Boston Scientific, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, Laminar Medical, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, and Valcare; unrelated to this work, has served as a consultant for Abbott, Adagio Medical, Append Medical, AtriAN, BioTel Heart, Biotronik, Boston Scientific, Cairdac, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Novo Nordisk, Philips, and Pulse Biosciences; and unrelated to this work, has equity in Atraverse, DRS Vascular, Manual Surgical Sciences, Newpace, Nyra Medical, Soundcath, Surecor, and Vizaramed. Dr Calkins receives consulting fees from Biosense Webster and Boston Scientific and payment for honoraria from Boston Scientific and Medtronic. Dr Mansour reports grants from Biosense Webster, Inc, and Boston Scientific; consulting fees from Biosense Webster, Inc, Boston Scientific, Philips, and Medtronic; support for attending meetings/travel from Biosense Webster, Inc, and Boston Scientific; and stock/stock options from NewPace Limited and EPD Solutions. Dr Wazni serves as a consultant for Biosense Webster. Dr Di Biase is a consultant for Biosense Webster, Stereoataxis, and Rhythm Management, and has received speaker honoraria/travel from Biosense Webster, St. Jude Medical (now Abbott), Boston Scientific, Medtronic, Biotronik, Atricure, Baylis, and Zoll. Drs Bahu and Liu have nothing to disclose. Dr Newton serves as a consultant for Biosense Webster. Dr Sauer receives grants from Biosense Webster and Medtronic and consulting fees from Boston Scientific, Biosense Webster, and Abbott. Dr Goyal receives consulting fees from Biosense Webster and Medtronic. Dr Iyer receives consulting fees from Biosense Webster. Dr Nair serves as a consultant for and receives research grants from Abbott, Boston Scientific, Medtronic, Biosense Webster, and Adagio, and receives research grants from Laminar. Dr Athill receives consulting fees from Boston Scientific, Abbott, and Biosense Webster, and payment/honoraria from Zoll and Janssen. Dr Hussein receives research grants from Boston Scientific and serves on steering committees for Biosense Webster. Dr Whalen serves on the advisory board for Biosense Webster. Dr Melby serves as a consultant for and receives research grants from Biosense Webster. Dr Natale serves as a consultant for Abbott, Biosense Webster, Biotronik, Boston Scientific, and iRhythm.

Objective: To evaluate predictive ability of a novel combined index, Charlson comorbidity index and C-reactive protein (CCI-CRP), for outcomes in renal cell carcinoma (RCC), and compare predictive outcomes with of CCI-CRP to its separate components and to the UCLA integrated staging system (UISS)., Patients and Methods: We retrospectively analyzed INMARC registry of RCC patients. Receiver Operator Characteristics (ROC) analysis was fitted to identify threshold defining low-CRP (LCRP) and high-CRP (HCRP). Patients were stratified according to CCI [low-CCI ≤ 3 (LCCI); intermediate-CCI 4-6 (ICCI); high-CCI > 6 (HCCI)] and CRP level. Kaplan-Meier analysis (KMA) was conducted for overall (OS) and cancer-specific survival (CSS). Based on survival analysis distribution we proposed a new stratification: CCI-CRP. Model performance was assessed with ROC/area under the curve (AUC) analysis and compared to CCI and CRP alone, and UISS., Results: We analyzed 2,890 patients (median follow-up 30 months). ROC identified maximum product sensitivity and specificity for CRP at 3.5 mg/L. KMA revealed 5-year OS of 95.6% for LCRP/LCCI, 83% LCRP/ICCI, 73.3% LCRP/HCCI, 62.6% HCRP/LCCI, 51.6% HCRP/ICCI and 40.5% HCRP/HCCI (P < .001). From this distribution, new CCI-CRP is proposed: low CCI-CRP (LCRP/LCCI and LCRP/ICCI), intermediate CCI-CRP (LCRP/HCCI and HCRP/LCCI), and high CCI-CRP (HCRP/ICCI and HCRP/HCCI). AUC for CCI-CRP showed improved performance for predicting OS/CSS vs. CCI alone (0.73 vs. 0.63/0.77 vs. 0.60), CRP alone (0.73 vs. 0.71/0.77 vs. 0.74) and UISS (0.73 vs 0.67/0.77 vs 0.73)., Conclusions: CCI-CRP, exhibits increased prognostic performance for survival outcomes in RCC compared to CCI and CRP alone, and UISS. Further investigation is requisite., Competing Interests: Disclosure The authors have stated that they have no conflict of interest., (Published by Elsevier Inc.)

Changes in the individual's attachment orientation toward greater security are considered an important clinical goal. One promising underlying process of change in attachment orientation is shifting the emotion regulation tendency, in which the individual progresses from overreliance on the self or on the other to regulate emotional arousal. The present study utilized a computational approach to study shifts in the emotion regulation tendency as these manifest in the patient's and therapist's vocally encoded emotional arousal. The study examined whether shifts in the regulation tendency are associated with decreases in the level of insecure attachment and in strengthening of the therapeutic alliance. Shifts in the regulation tendency were examined throughout the early stages of treatment (Sessions 1-4) using 11,710 talk turns within 52 patient-therapist dyads. Findings suggest that shifts in the emotion regulation tendency are associated with greater strengthening of the therapeutic alliance and a decrease in the level of attachment avoidance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Present bladder cancer therapies have relatively limited therapeutic impact and account for one of the highest lifetime treatment costs per patient. Therefore, there is an urgent need to explore novel and optimized treatment strategies. The present study investigated the effects of inhibiting endogenous hydrogen sulfide (H 2 S) production on bladder cell viability and in vivo tumor progression. We targeted the H 2 S-producing enzyme, cystathionine γ-lyase, in 5637 cells using propargylglycine (H 2 S inhibitor) and performed cytofluorimetric analysis to evaluate cell viability. We then tested the efficacy of propargylglycine alone or in combination with gemcitabine (conventional chemotherapy) in an intravesical murine model of bladder cancer. Magnetic resonance imaging and immunohistochemical staining for cell proliferation, apoptosis, immune-cell infiltration, and neovascularization were performed to evaluate tumor response. Compared to control conditions or cohorts, propargylglycine administration significantly attenuated bladder cancer cell viability in vitro ( p < 0.0001) and tumor growth ( p < 0.002) and invasion in vivo. Furthermore, propargylglycine enhanced the anti-cancer effects of gemcitabine, resulting in tumor regression ( p < 0.0001). Moreover, propargylglycine induced cleaved PARP-1-activated apoptosis ( p < 0.05), as well as intratumoral CD8 + T cell ( p < 0.05) and F4/80 + macrophage ( p < 0.002) infiltration. Propargylglycine also reduced intratumoral neovascularization ( p < 0.0001) and cell proliferation ( p < 0.0002). Importantly, the pro-apoptotic and anti-neovascularization effects of gemcitabine were enhanced by propargylglycine co-administration. Our findings suggest that inhibition of endogenous H 2 S production can be protective against bladder cancer by enhancing the chemotherapeutic action of gemcitabine and may be a novel pharmacological target and approach for improved bladder cancer diagnosis and treatments in the future.

Background: The Efficacy of Delayed Enhancement MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation randomized trial showed no difference in atrial fibrillation (AF) recurrence with additional delayed enhancement magnetic resonance imaging (DE-MRI) fibrosis-targeted ablation to pulmonary vein isolation (PVI) in persistent AF., Objective: We evaluated the effect of lesion delivery on ablation-induced scarring and AF recurrence., Methods: Lesions delivered, targeting fibrotic and nonfibrotic areas identified from preablation DE-MRI, were studied in relation to ablation-induced scarring on 3-month DE-MRI, including their association with arrhythmia recurrence., Results: A total of 593 patients treated with radiofrequency were analyzed: 293 (49.4%) underwent PVI and 300 (50.6%) underwent additional fibrosis-guided ablation. Lesion analysis showed that 80.9% in the MRI fibrosis-guided group vs 16.5% in the PVI group (P < .001) had ≥40% of baseline fibrosis targeted. MRI assessment of ablation-induced scar showed that 44.8% of fibrosis-guided ablation and 15.5% of PVI had ≥40% of their fibrosis covered by scar (P < .001), demonstrating significant attenuation from lesions delivered to scar formed. In the overall population, fibrosis coverage with scar was not associated with recurrence (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.80-1.01; P = .08 per 20% increase). In patients with baseline fibrosis < 20%, fibrosis coverage with scar was associated with lower recurrence than PVI (HR 0.85; 95% CI 0.73-0.97; P = .03), whereas the association was not significant when baseline fibrosis ≥ 20% (HR 0.97; 95% CI 0.80-1.17; P = .77). Significant center variation was observed in fibrosis targeting and coverage with scarring., Conclusion: Radiofrequency ablation lesions do not uniformly result in scar formation. A post hoc analysis suggests reduced arrhythmia recurrence when ablation-induced scarring covers fibrotic regions in patients with low baseline fibrosis., Competing Interests: Disclosures Dr Marrouche reported other from Marrek (founder) and from ECG Check (previous shareholder) outside the submitted work and a patent issued for MRI fibrosis imaging. Dr Wazni reported personal fees (for consulting services) from Biosense Webster and Boston Scientific during the conduct of the study. Dr Greene reported personal fees from DURECT Corporation, Janssen Pharmaceuticals, and Pfizer and grants from Boehringer Ingelheim, AstraZeneca, and CSL outside the submitted work. Dr Dean reported grants from Boston Scientific, Medtronic, Siemens, Biosense Webster, and Abbott during the conduct of the study and grants from the National Institutes of Health outside the submitted work. Dr Kholmovski reported personal fees and other (share ownership) from Marrek during the conduct of the study and outside the submitted work, grants from Medtronic outside the submitted work, and a patent issued for US 9713436 licensed to Marrek, US 10004425 licensed to Marrek, and US 10726545 licensed to Marrek. Dr Mansour reported personal fees (for consulting services) from Biosense Webster, Boston Scientific, and Medtronic and personal fees (holding equity) from EPD Solutions and New Pace Ltd outside the submitted work. Dr Marchlinski reported personal fees (scientific advisory board) from Abbott Medical, Biosense Webster, and Medtronic outside the submitted work. Dr Wilber reported other (executive committee for the clinical trial) from Abbott and Boston Scientific; other (coprimary investigator, clinical trial) from AtriCure; grants from Abbott, AtriCure, and Biosense Webster; and personal fees from the American College of Cardiology Foundation (Editor-in-Chief of the Journal of the American College of Cardiology editor’s page), Biosense Webster (consulting), and Medtronic (lectures for fellows) outside the submitted work. Dr Jaïs reported grants from Biosense Webster and Boston Scientific during the conduct of the study and grants from Acutus and Medtronic outside the submitted work. Dr Sanders reported other (advisory board and research grants to his institution) from Medtronic, Abbott Medical, and Boston Scientific; other (advisory board) from CathRx and PaceMate outside the submitted work; and support by a practitioner fellowship from the National Health and Medical Research Council of Australia. Dr Brachmann reported grants from Medtronic and Biotronik during the conduct of the study and personal fees from Medtronic outside the submitted work. Dr Bax reported departmental unrestricted research grants from Abbott, Edwards Lifesciences, Medtronic, Biotronik, Boston Scientific, GE Healthcare, Novartis, and Bayer outside the submitted work. Dr Deneke reported grants (education) from Biotronik and personal fees (speaker) from Abbott and Boston Scientific (scientific committee) outside the submitted work. Dr Calkins reported personal fees from Biosense Webster, Abbott, and Boston Scientific outside the submitted work. No other disclosures were reported., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Primary liver cancer is the third leading cause of cancer deaths worldwide and has one of the worst 5-year survival rates. This study examines US primary liver cancer incidence and incidence-based mortality trends over four decades., Research Design and Methods: The SEER-9 registry was used to study primary liver cancer cases from 1978 to 2018. The incidence and mortality rates were calculated based on gender, age, race, and stage of diagnosis. Joinpoint regression software was used to calculate the annual percent change., Results: The overall incidence rate of primary liver cancer from 1978 to 2018 increased by 2.71%/year (p<0.001). Rates in patients <50 years old began to fall in 2002 at a rate of -3.62%/year (p<0.001). Similarly, the incidence-based mortality rates for primary liver cancer increased by 2.15%/year (p<0.001). Whereas Whites incidence-based mortality rates began to plateau in 2012 (0.18%/year; p = 0.84), Blacks rates have declined since 2010 (-2.93%/year; p = 0.03), and Asian rates have declined since 1999 (-1.30%/year; p<0.001)., Conclusion: While the overall primary liver cancer incidence and incidence-based mortality have been increasing over the last four decades, there was an observed decline in incidence and incidence-based mortality in recent years, especially among at-risk subgroups., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Adra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: Conflicts of interest Dr Mufti has been speaker for AbbVie and Janssen. Dr Prajapati has served as an advisor, consultant, and/or speaker for: AbbVie, Actelion, Amgen, Apogee Therapeutics, Aralez, Arcutis, Aspen, Bausch Health, BioScript Solutions, Boehringer Ingelheim, Bristol-Myers Squibb, Canadian Psoriasis Network, Celgene, Cipher, Concert, CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, Johnson & Johnson, LEO Pharma, Medexus, Novartis, Organon, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant; investigator for: AbbVie, AnaptysBio, Arcutis, Arena, Asana, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Concert, CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, RAPT Therapeutics, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, and UCB; and received grants from: AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme. Dr Torres has been an advisor, consultant, investigator and/or speaker for: AbbVie, Almirall, Amgen, Arena Pharmaceuticals, Biocad, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Fresenius Kabi, Janssen, LEO Pharma, Eli Lilly, MSD, Mylan, Novartis, Pfizer, Samsung-Bioepis, Sanofi-Genzyme, Sandoz, and UCB. Dr Vender received honoraria as a speaker for Abb-vie, Amgen, Janssen, Galderma, GSK, Leo, Lilly, Merck, Novartis, Pfizer, Bausch-Health, Actelion, Celgene, Cipher, UCB and was a consultant for Abbvie, Amgen, BMS, Janssen, Galderma, GSK, Leo, Lilly, Merck, Novartis, Paladin Labs Inc., Pfizer, Bausch-Health, Actelion, Celgene, Cipher, and UCB. Dr Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Allergan, Amgen, Astellas, Bausche, Baxalta, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Fresenius Kabi, Galderma, Incyte, Janssen, LEO Pharma, Lilly, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Xenon. Author Bagit, Drs Maliyar, Mansour, Georgakopoulos, Rankin, Lytvyn, Zaaroura, Authors Park, Wang, and Dr Le have no conflicts of interest to declare.

A biomarker is a measured indicator of a variety of processes, and is often used as a clinical tool for the diagnosis of diseases. While the developmental process of biomarkers from lab to clinic is complex, initial exploratory stages often focus on characterizing the potential of biomarkers through utilizing various statistical methods that can be used to assess their discriminatory performance, establish an appropriate cut-off that transforms continuous data to apt binary responses of confirming or excluding a diagnosis, or establish a robust association when tested against confounders. This review aims to provide a gentle introduction to the most common tools found in diagnostic biomarker studies used to assess the performance of biomarkers with an emphasis on logistic regression., (© 2024. The Author(s).)

Coding according to the International Classification of Diseases (ICD)-10 and its clinical modifications (CM) is inherently complex and expensive. Natural Language Processing (NLP) assists by simplifying the analysis of unstructured data from electronic health records, thereby facilitating diagnosis coding. This study investigates the suitability of transformer models for ICD-10 classification, considering both encoder and encoder-decoder architectures. The analysis is performed on clinical discharge summaries from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset, which contains an extensive collection of electronic health records. Pre-trained models such as BioBERT, ClinicalBERT, ClinicalLongformer, and ClinicalBigBird are adapted for the coding task, incorporating specific preprocessing techniques to enhance performance. The findings indicate that increasing context length improves accuracy, and that the difference in accuracy between encoder and encoder-decoder models is negligible.

Background: Pericardiocentesis offers a definitive diagnostic and a life-saving therapeutic modality through removal of pericardial fluid and relief of high intrapericardial pressure. Percutaneous pericardiocentesis has been performed via different approaches depending on different institutional experiences. In this paper, we present our institutional experience and review the current literature of the different approaches for performing percutaneous pericardiocentesis., Materials and Methods: We evaluated consecutive patients who underwent echocardiographic-guided pericardiocentesis via the apical approach for pericardial effusion between the period of April 1st, 2022, and April 1st, 2023, at University of Arkansas for Medical Sciences (UAMS). Health records were reviewed for clinical presentations, available imaging findings, procedural outcomes, and short-term follow up., Results: A total of eight consecutive cases of pericardiocentesis via the apical approach were found. Seven were successful. No complications were reported. Six patients had evidence of tamponade physiology on echocardiogram., Conclusion: Historically, pericardiocentesis has been most performed via the subxiphoid approach. However, an ultrasound-guided apical approach offers a safe and effective alternative and may be preferable in patients with challenging anatomies., (© 2024. The Author(s).)

Background: In recent years, obstructive sleep apnea (OSA) has been increasingly recognized as a significant health concern. No previous studies assessed the effect of recommended treatment modalities of patients with OSA on the temporomandibular joint (TMJ). The current study aimed to evaluate the effect of different treatment modalities of OSA, such as continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and oral myofunctional therapy (OMT) on subjective symptoms, clinical, and radiographic signs of temporomandibular disorders., Patients & Methods: This hospital-based prospective randomized controlled clinical trial study was approved by the institutional review board and formal patient consent, 39 OSA patients, ranging in age from 19 to 56 after confirmation with full night Polysomnography (PSG) with healthy TMJ confirmed clinically and radiographically with magnetic resonance imaging (MRI) were randomly allocated into three treatment groups. Group 1: 13 patients were managed with CPAP after titration, group 2: 13 patients were managed with digitally fabricated MAD, and group 3: 13 patients were managed with OMT. The following parameters were evaluated before and 3 months after the intervention. Pain using a visual analogue scale (VAS), maximum inter-incisal opening (MIO), lateral movements, and clicking sound of TMJ. MRI was done before and 3 months after the intervention., Results: Out of the 83 patients enrolled, 39 patients completed the treatment. There were no statistically significant differences in lateral jaw movements or clicking, and no significant difference in MRI findings between the three studied groups before and after the intervention. The OMT group showed a statistically significant difference in pain (p = 0.001), and MIO (p = 0.043) where patients experienced mild pain and slight limitation in mouth opening after 3 months of follow-up in comparison to MAD and CPAP groups., Conclusion: CPAP and MAD are better for preserving the health of TMJ in the treatment of OSA patients. While OMT showed mild pain and slight limitation of MIO (that is still within the normal range of mouth opening) compared to CPAP and MAD., Trial Registration: The study was listed on www., Clinicaltrials: gov with registration number (NCT05510882) on 22/08/2022., (© 2024. The Author(s).)

Introduction and Importance: Avascular necrosis (AVN) is a rare occurrence in the carpal region, especially in the triquetrum bone, which presents a diagnostic puzzle due to its infrequency and lack of trauma history. This case study explores the signs, diagnosis, and treatment of AVN in a healthy 22-year-old individual, emphasizing the need for early identification using suitable imaging methods., Case Presentation: A 22-year-old patient complained of persistent wrist pain, specifically on the ulnar side, without any history of injury. Clinical examination revealed tenderness without signs of inflammation, with normal sensation and movement. Initial X-ray results were inconclusive, prompting further investigation with MRI, which showed a decrease in signal intensity in the triquetrum bone, leading to the diagnosis of AVN., Clinical Discussion: The development of AVN involves compromised blood flow, often due to various factors. While AVN affecting carpal bones is uncommon, the triquetrum bone's robust blood supply typically protects against such conditions. However, this case highlights an exceptional occurrence. Gelberman's classification underscores the triquetrum's vascular nature, explaining why AVN is rare in this bone. MRI plays a crucial role in detecting AVN, especially when symptoms do not align with X-ray findings., Conclusion: Avascular necrosis should be considered in carpal bones, even without a history of trauma, with a focus on MRI for early detection. Although AVN of the triquetrum is rare, this case underscores the importance of timely recognition and conservative management. Further research is necessary to establish optimal treatment strategies for this unusual presentation., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Diabetes is a common chronic metabolic disease with a wide range of clinical symptoms and consequences and one of the main causes of death. For the management of diabetes, painless and continuous interstitial fluid (ISF) glucose monitoring is ideal. Here, we demonstrate continuous diabetes monitoring using an integrated microneedle (MN) biosensor with an emergency alert system. MNs are a novel technique in the field of biomedical engineering because of their ability to analyze bioinformation with minimal invasion. In this work we developed a poly(methyl methacrylate) (PMMA) based MN glucose sensor. The device was produced by the 3D printing technique, microfabrication, electrodeposition, and enzyme immobilization step. The in vitro test for the glucose MN sensor showed a linear range from 1.5 to 14 mM with a sensitivity of 1.51 μA mM -1 , limit of detection (LOD) of 0.35 mM and good selectivity. Highly repeatable sensing is observed with good reproducibility. The interference-free detection of glucose in the presence of physiologically relevant concentrations of ascorbic acid, uric acid, and mannose is demonstrated, along with the operational stability of the array. After resolving the biofouling consequences linked to on-body sensing, this MN platform would be appealing for minimally invasive electrochemical glucose monitoring. An alert is sent to confidants via email or SMS when the values are abnormal. The application is also able to display the recorded values in the form of a graph to help determine the state of health of the user over a period of time. It can be concluded that continuous monitoring and an emergency alert system are important for keeping an eye on diabetic patients and can send alert in case of an abnormal situation of the patient.

Clinical outcomes of catheter ablation for atrial fibrillation (AF) are suboptimal due, in part, to challenges in achieving durable lesions. Although focal point-by-point ablation allows for the creation of any required lesion set, this strategy necessitates the generation of contiguous lesions without gaps. A large-tip catheter, capable of creating wide-footprint ablation lesions, may increase ablation effectiveness and efficiency. In a randomized, single-blind, non-inferiority trial, 420 patients with persistent AF underwent ablation using a large-tip catheter with dual pulsed field and radiofrequency energies versus ablation using a conventional radiofrequency ablation system. The primary composite effectiveness endpoint was evaluated through 1 year and included freedom from acute procedural failure and repeat ablation at any time, plus arrhythmia recurrence, drug initiation or escalation or cardioversion after a 3-month blanking period. The primary safety endpoint was freedom from a composite of serious procedure-related or device-related adverse events. The primary effectiveness endpoint was observed for 73.8% and 65.8% of patients in the investigational and control arms, respectively (P < 0.0001 for non-inferiority). Major procedural or device-related complications occurred in three patients in the investigational arm and in two patients in the control arm (P < 0.0001 for non-inferiority). In a secondary analysis, procedural times were shorter in the investigational arm as compared to the control arm (P < 0.0001). These results demonstrate non-inferior safety and effectiveness of the dual-energy catheter for the treatment of persistent AF. Future large-scale studies are needed to gather real-world evidence on the impact of the focal dual-energy lattice catheter on the broader population of patients with AF. ClinicalTrials.gov identifier: NCT05120193 ., (© 2024. The Author(s).)

Ectopic hepatocellular carcinoma (HCC) is defined as HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue without any communication with the mother liver. It is very rare and difficult to diagnose by imaging alone. We report a case of a rare ectopic HCC mimicking a right para-aortic retroperitoneal mass and present a review of the literature. It is about a 79-year-old female patient, who presented with a progressive enlarged right paraaortic retroperitoneal mass, thought first to be leiomyosarcoma of vena cava on imaging. Subsequently, high alpha-fetoprotein (AFP) level and biopsy allowed the diagnosis of primary extrahepatic hepatocellular carcinoma., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Poor drug penetration, emerging drug resistance, and systemic toxicity are among the major obstacles challenging the current treatment of cutaneous leishmaniasis. Hence, developing advanced strategies for effective and targeted delivery of antileishmanial agents is crucial. Several drug delivery carriers have been developed till current date for dermal/transdermal delivery, especially those which are fabricated using eco-friendly synthesis approaches, since they protect the environment from the harmful effects of chemical waste disposal. This work describes the preparation of selenium nanoparticles loaded with silymarin via one-pot green reduction technique, for treatment of cutaneous leishmaniasis. The selected silymarin loaded selenium nanoparticles (SSNs4-0.1) displayed good loading efficiency of 58.22 ± 0.56 %, zeta potential of -30.63 ± 0.40 mV, hydrodynamic diameter of 245.77 ± 11.12 nm, and polydispersity index of 0.19 ± 0.01. It exhibited good physical stability, as well as high ex vivo deposition % in the epidermis (46.98 ± 1.51 %) and dermis (35.23 ± 1.72 %), which was further proven using confocal laser microscopy. It also exhibited significant cytocompatibility and noticeable cellular internalization of 90.02 ± 3.81 % in human fibroblasts, as well as high trypanothione reductase inhibitory effect (97.10 ± 0.30 %). Results of this study confirmed the successful green synthesis of silymarin-loaded selenium nanoparticles; delineating them as one of the promising antileishmanial topical delivery systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)