Point-of-care tests, diagnostic uncertainty and antimicrobial stewardship in the ICU: procalcitonin or PCR to aid antibiotic-stop decisions - an observational cohort study.

Objectives: Intensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/- de-escalation to aid stop decisions. We hypothesised that a direct infection indicator, PCR-POCT, would influence stop judgements more than indirect PCT.

Video atlas of pulmonary segmentectomy: robotic-assisted right S3 segmentectomy with 3-dimensional imaging.

Robotic-assisted thoracic surgery has become increasingly utilized in recent years. Complex lung cancer resection surgery can be performed using a robotic approach. It facilitates 3-dimentional visualization of structures, enhanced manipulation of tissues and precise movements.

Patient-reported and surgical outcomes of profunda artery perforator (PAP) flap breast reconstructions compared to deep inferior epigastric perforator (DIEP) using BREAST-Q.

Background: Autologous breast reconstruction patients require thorough assessment, with the profunda femoris artery perforator (PAP) flap having become an important autologous reconstruction option alongside the deep inferior epigastric perforator (DIEP) flap. Breast reconstruction impacts patients psychologically, physically and mentally. The BREAST-Q aids in the assessment of patient-reported outcome measures (PROMs).

Efficacy of Amitriptyline in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.

Background/aims: Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy.

Methods: A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS.

Evolving Trends and Future Demands in ENT Procedures: A Nationwide 10-Year Analysis.

: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and resource planning in ENT. : Hospital Episode Statistics data were extracted between April 2012 and April 2023.

Healthcare Financing in Saudi Arabia: A Comprehensive Review.

Saudi Vision 2030 is a game-changer for all aspects of the economy, including healthcare. This article provides a comprehensive overview of healthcare financing in the Kingdom of Saudi Arabia (KSA). It identifies key healthcare financing challenges that must be addressed to achieve the initiative's envisioned health system goals.

Microbial and chemically induced reductive dechlorination of polychlorinated biphenyls in the environment.

Polychlorinated biphenyls (PCBs) are persistent organic pollutants and are emitted during e-waste activities. Once they enter into the environment, PCBs could pose toxic effects to environmental compartments and public health. Reductive dechlorination offers a sustainable solution to manage the PCBs-contaminated environment.

Machine learning models predicting risk of revision or secondary knee injury after anterior cruciate ligament reconstruction demonstrate variable discriminatory and accuracy performance: a systematic review.

Background: To summarize the statistical performance of machine learning in predicting revision, secondary knee injury, or reoperations following anterior cruciate ligament reconstruction (ACLR), and to provide a general overview of the statistical performance of these models.

Methods: Three online databases (PubMed, MEDLINE, EMBASE) were searched from database inception to February 6, 2024, to identify literature on the use of machine learning to predict revision, secondary knee injury (e.g.

Base of Skull & Spinal Canal Narrowing in an Adolescent with Autosomal Recessive Hypophosphatemic Rickets Type 2.

Autosomal recessive hypophosphatemic rickets type 2 (ARHR2) is an uncommon hereditary form of rickets characterised by chronic renal phosphate loss and impaired bone mineralisation. This results from compound heterozygous or homozygous pathogenic variants in ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), a key producer of extracellular inorganic pyrophosphate (PPi) and an inhibitor of fibroblast growth factor23 (FGF23). ENPP1 deficiency impacts FGF23 and increases its activity.

Paracrine role of endothelial IGF-1 receptor in depot-specific adipose tissue adaptation in male mice.

During recent decades, changes in lifestyle have led to widespread nutritional obesity and its related complications. Remodelling adipose tissue as a therapeutic goal for obesity and its complications has attracted much attention and continues to be actively explored. The endothelium lines all blood vessels and is close to all cells, including adipocytes.

Insight into the Environmental Health Consciousness of Medical Students Regarding the Perceived Impacts of Climate Change on Human Health.

Climate change represents an unprecedented global public health crisis with extensive and profound implications. The Lancet Commission identified it as the foremost health challenge of the 21st century. In 2015, air pollution alone caused approximately 9 million premature deaths worldwide.

Developing standards for the implementation of stepped care in child and youth mental health service settings: protocol for a multi-method, delphi-based study.

Introduction: Canadian youth mental health (YMH) systems have the potential to urgently tackle the mental health treatment gap currently impacting young people, and stepped care (SC) is one model that can address this need. The adoption of SC models can guide the development of better-connected YMH systems by simplifying transitions and care pathways. To do so requires robust standards that are co-created across stakeholder groups, including with lived experience experts, to ensure the effective implementation of SC models.

Long-term effects of concussion on attention, sensory gating and motor learning.

The current work aimed to understand the behavioral manifestations that result from disruptions to the selective facilitation of task-relevant sensory information at early cortical processing stages in those with a history of concussion. A total of 40 participants were recruited to participate in this study, with 25 in the concussion history group (Hx) and 15 in the control group (No-Hx). Somatosensory-evoked potentials (SEPs) were elicited via median nerve stimulation while subjects performed a task that manipulated their focus of attention toward or away from proprioceptive cues.

Enhancing the Recovery Process for Undergraduate Women Survivors of Sexual Violence: Identifying Facilitators to Healing.

The psychosocial impact of sexual violence (SV) on college-aged women necessitates understanding positive influences of survivors' healing processes. The purpose of this study, therefore, was to investigate facilitators in the healing journey for undergraduate SV survivors. Seventeen women were interviewed using Photo-experiencing and Reflective Listening (PEARL).

Stability and performance investigation using different electrode configurations and electrolyte compositions in an oxyhydrogen gas generator.

This study aimed to develop an efficient HHO generator with higher gas production, enhanced electrodes, and stable current density. For HHO generator stack fabrication, 15 plates of 304L stainless steel were utilized, accompanied with a 4 mm rubber separator to maintain the gap between electrodes. Each plate in the stack was connected a separate wire through lug spot welding, enabling the assembly of different configurations for testing.

Sociodemographic and clinical predictors of quality-of-life outcome in children and young people with primary brain tumour in Karachi, Pakistan: a prospective cohort study.

Background: Children and young people (CYP) with primary brain tumour (PBT) are at high risk for developing late effects, potentially affecting long-term quality of life (QoL). In low-income and middle-income countries, QoL has not been studied in depth in CYP. In the present study, CYP treated for PBTs in Pakistan were evaluated regarding (A) mean change in QoL scores pretreatment and 12 months post-treatment and (B) predictors of change in QoL scores 12 months post-treatment.

Electrocalcium coupling in brain capillaries: Rapidly traveling electrical signals ignite local calcium signals.

The routing of blood flow throughout the brain vasculature is precisely controlled by mechanisms that serve to maintain a fine balance between local neuronal demands and vascular supply of nutrients. We recently identified two capillary endothelial cell (cEC)-based mechanisms that control cerebral blood flow in vivo: 1) electrical signaling, mediated by extracellular K-dependent activation of strong inward rectifying K (Kir2.1) channels, which are steeply activated by hyperpolarization and thus are capable of cell-to-cell propagation, and 2) calcium (Ca) signaling, which reflects release of Ca via the inositol 1,4,5-trisphosphate receptor (IPR)-a target of G-protein-coupled receptor signaling.

Artificial intelligence-guided design of lipid nanoparticles for pulmonary gene therapy.

Ionizable lipids are a key component of lipid nanoparticles, the leading nonviral messenger RNA delivery technology. Here, to advance the identification of ionizable lipids beyond current methods, which rely on experimental screening and/or rational design, we introduce lipid optimization using neural networks, a deep-learning strategy for ionizable lipid design. We created a dataset of >9,000 lipid nanoparticle activity measurements and used it to train a directed message-passing neural network for prediction of nucleic acid delivery with diverse lipid structures.

Emerging paradigm: Molecularly targeted therapy with Dabrafenib and Trametinib in recurring pediatric gliomas with BRAF mutations: A narrative review.

Gliomas are tumors arising in the central nervous system, frequently associated with Class I mutations and BRAF fusions. These mutations are adverse prognostic factors in juvenile gliomas, leading to high rates of recurrence and poor response to current treatments. The blood-brain barrier and the heterogeneity of gliomas complicate the development of a single treatment strategy for all cases.

Understanding the effectiveness and quality of virtual cancer multidisciplinary team meetings (MDTMs): a systematic scoping review.

Introduction: Cancer multi-disciplinary team meetings (MDTM) assemble clinical experts to make diagnostic and treatment recommendations. MDTMs can take place in person, virtually, or in a hybrid format. Virtual and hybrid MDTMs have been in use for over two decades.

TFAP2C-DDR1 axis regulates resistance to CDK4/6 inhibitor in breast cancer.

Breast cancer is the predominant malignancy with the majority of cases are characterized as HR+/HER2-subtype. Although cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have shown remarkable efficacy in treating this subtype when combined with endocrine therapy, the development of resistance to these inhibitors remains a significant clinical obstacle. Hence, there is an urgent need to explore innovative therapies and decipher the underlying mechanisms of resistance to CDK4/6i.