Oral Nicotine Pouch (ONP) use is more common among people who smoke cigarettes or vape nicotine, with smoking or vaping cessation identified as a main motive for use. However, evidence is limited as to how variables that may be considered precursors to successful smoking or vaping cessation (e.g., motivation to quit, self-efficacy) are associated with current ONP use. To address this gap, we collected cross-sectional data from 700 U.S. adults (M age = 33.3, SD = 5.5, 45% women; 65% White) who primarily smoked cigarettes (n = 350) or vaped (n = 350). Results showed that motivation to quit smoking and vaping was inversely associated with past-30-day ONP use frequency among individuals who primarily smoked [Incidence Rate Ratio (IRR) = 0.82 (0.70, 0.95), p < 0.01] and primarily vaped [IRR = 0.81 (0.68, 0.97), p < 0.05], respectively. Among individuals who primarily smoked, greater number of past-year quit attempts, but not self-efficacy or trying to quit smoking at present, was positively associated with higher frequency of past-30-day ONP use [IRR = 1.09 (1.03, 1.16), p < 0.01]. Among individuals who primarily vaped, self-efficacy, but not past-year quit attempts or trying to quit vaping at present, was positively associated with higher past-30-day ONP use frequency [IRR = 1.07 (1.01, 1.14), p < 0.05]. Based on the current data, lower motivation to quit smoking or vaping may be associated with higher past-month ONP use count. More population-based studies are needed to better understand the consequences of ONP use on smoking and vaping.
Suicidal ideation (SI) and suicidal attempt (SA) rates are rising among youth in the United States; however, research on SI/SA in youth with sickle cell disease (Y-SCD) remains limited. Using the Pediatric Health Information System, we examined the prevalence and demographic factors associated with SI/SA among Y-SCD (10-18 years) seeking acute care between 2015 and 2024. Overall, 358 (3.08%) Y-SCD had ≥ 1 SI/SA encounter and 0.76% of all acute encounters among Y-SCD included a code for SI/SA. Female sex (p < 0.0001) and public insurance (p = 0.0009) were significantly associated with SI/SA. Findings highlight the need for suicide screening in acute care settings for Y-SCD.
Do Not Attempt Resuscitation (DNAR) decisions are ethically and clinically complex, shaped by prognostic uncertainty, communication barriers, and sociocultural factors. In Saudi Arabia, Fatwa No. 12086 and Ministry of Health national policy permit withholding cardiopulmonary resuscitation (CPR) without family consent when three qualified physicians deem resuscitation futile. Despite this established framework, inconsistent DNAR implementation persists across Saudi clinical settings. To assess the knowledge, attitudes, and applied practices regarding DNAR among multidisciplinary healthcare workers (HCWs) in the Aljouf region of northern Saudi Arabia and to identify barriers to its consistent implementation. In this multicenter cross-sectional survey, 461 licensed HCWs, including physicians, nurses, and allied health professionals, from 10 hospitals and 7 primary healthcare centers across the Aljouf region completed a structured, bilingual, self-administered online questionnaire between September 20 and November 15, 2025. Data were analyzed using descriptive statistics, the Kruskal-Wallis test with Bonferroni-corrected post-hoc comparisons, and multivariable logistic regression to identify independent predictors of high knowledge scores. Exposures and outcomes were defined a priori. Overall, 96% of participants achieved satisfactory knowledge scores (≥60%), with a median score of 9 out of 10 (IQR: 8-9). However, two clinically critical gaps were identified: only 52.9% correctly recognized that family consent is not legally required for DNAR in Saudi Arabia, and only 51.2% identified the correct management of cardiac arrest following confirmed brain death. Physicians scored significantly higher than nurses, technicians, and pharmacists (Kruskal-Wallis, p = 0.0003). In multivariable logistic regression, prior direct involvement in a DNAR decision was the strongest independent predictor of high knowledge (OR 2.39; 95% CI 1.11-5.16; p = 0.03), while nurses were approximately 50% less likely than physicians to achieve a high knowledge score (OR 0.50; 95% CI 0.29-0.83; p = 0.008). Although 78.3% considered DNAR ethically necessary and 82.2% agreed it protects patients from unnecessary suffering, 78.5% found family discussions challenging and 83.1% acknowledged strong cultural influences on DNAR decisions. Only 55.1% knew where to locate their institutional DNAR protocol. This study suggests that, although most HCWs appear to possess adequate theoretical knowledge of DNAR policy, two clinically critical gaps were identified: widespread misconception that family consent is legally required and poor understanding of cardiac arrest management following confirmed brain death. Acknowledging the limitations of convenience sampling and potential self-selection bias, these findings point toward the value of targeted multidisciplinary education, structured communication training, and improved institutional protocol accessibility as potentially important strategies to bridge the gap between policy and practice.
Papillary thyroid cancer (PTC) is the most common form of differentiated thyroid cancer (DTC). While most cases respond to standard treatments, a subset becomes refractory to radioiodine therapy (RAIR). This study aims to develop a clinically applicable scoring system based on baseline characteristics to predict RAIR in PTC patients. A retrospective analysis of 150 PTC patients (50 RAIR and 100 responders) was conducted at a tertiary center between 2011 and 2023. Patients were classified as RAIR if they received ≥ 600 mCi of cumulative radioiodine but exhibited disease progression. Baseline clinical, histopathological, and laboratory data were extracted. Univariate and multivariate logistic regression analyses identified significant predictors of RAIR status. A predictive scoring system was developed based on weighted odds ratios (OR), and its diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Age ≥ 50 years (OR = 12.85), early serum thyroglobulin (Tg) ≥ 15 ng/mL (OR = 20.95), lateral lymph node metastasis (OR = 4.13), and early distant metastasis (OR = 29.95) were independent predictors of RAIR. The proposed 10-scale scoring system demonstrated high diagnostic accuracy (AUC = 0.94), with a score ≥ 3 predicting RAIR with 94% sensitivity and 85% specificity. A score ≥ 6 achieved 100% specificity and positive predictive value. Our practical scoring system, based on readily available clinical and laboratory parameters, offers a clinically oriented tool for the early identification of RAIR PTC patients. Prospective multi-center validation is needed to confirm its utility in guiding treatment decisions and improving patient outcomes.
While personality pathology and childhood trauma are established correlates of adolescent suicidality, it remains unclear which factors differentiate between suicidal ideation and suicide attempts. In a clinical inpatient sample of 570 adolescents (age: M = 15.2 years, SD = 1.37; 22% male, 78% female), we assessed personality functioning (ICD-11 framework), identity diffusion, childhood trauma, non-suicidal self-injury disorder, and categorical personality disorders (ICD-10 framework) using structured interviews and validated questionnaires. Group differences were examined across adolescents with suicide attempts, suicidal ideation only, and no suicidal symptoms. Logistic regression analyses tested the independent contribution of these factors to suicidal status. Adolescents with suicidal symptoms showed significantly higher impairments in personality functioning, higher identity diffusion, more childhood trauma, and a higher prevalence of personality disorders than non-suicidal adolescents. However, adolescents with suicidal ideation only and those with suicide attempts did not differ on these variables. In contrast, non-suicidal self-injury was most prevalent among adolescents with suicide attempts and emerged as the strongest independent correlate of suicidal status (OR = 2.84, 95% CI [1.74, 4.61]). Impairments in personality functioning and childhood trauma appear to reflect general vulnerability factors for adolescent suicidality, whereas non-suicidal self-injury may represent a factor that is more closely associated with suicidal attempts. Targeting self-injurious behavior may be critical for identifying and intervening in adolescents at risk of acting on suicidal thoughts.
External iliac artery (EIA) injury associated with pelvic ring injury (PRI) is rare but represents a particularly devastating pattern of pelvic trauma, combining life-threatening hemorrhage and critical limb ischemia. Although vascular reconstruction is generally recommended, limb salvage may be unrealistic when severe soft-tissue destruction and contamination coexist. Guidance on abandoning salvage attempts and proceeding to early amputation or hemipelvectomy remains limited. We reviewed our institutional experience with patients sustaining combined PRI and EIA injury between 2013 and 2026. The injury characteristics, treatment strategies, and outcomes were analyzed. The severity of vascular injury, limb ischemia status, and pelvic fracture patterns were classified using established systems. Management decisions were examined within a staged surgical strategy focusing on damage control, stabilization, and reconstruction. Five patients with high-energy trauma were identified. All patients had severe EIA injuries associated with major soft-tissue damage. Revascularization was attempted in two patients, but limb salvage was unsuccessful in all 5 cases. Despite repeated debridement, four patients ultimately required hemipelvectomy following progressive necrosis and infection. All patients survived after prolonged multidisciplinary treatment. Combined EIA injury and PRI represents an extreme form of pelvic trauma in which vascular patency alone does not ensure limb survival. When severe soft-tissue destruction is present, prolonged salvage attempts may only delay definitive management. Early recognition of a non-salvageable limb and consideration of timely hemipelvectomy may be important in selected patients.
Objective To evaluate the validity, safety, and feasibility of automated algorithm-based arterial occlusion pressure (AOP) measurement compared to pulsed wave Doppler ultrasound across supine, seated, and standing positions.Approach This two-phase sequential study enrolled healthy adults. In Phase One (n=46), AOP was measured using both automated and Doppler ultrasound methods at three body positions in randomized order. Validity was assessed using intraclass correlation coefficients (ICC), Bland-Altman analysis, and proportional bias testing. Safety was evaluated through measurement duration and pain perception. Feasibility was assessed by the first-attempt success rate. In Phase Two (n=15), a post hoc study examined whether averaging two automated measurements improved accuracy in supine position.Main results Automated algorithm-based AOP measurement demonstrated good agreement withDoppler ultrasound in supine (ICC=0.76), seated (ICC=0.87), and standing (ICC=0.83) positions. However, 95% limits of agreement ranged from -38 to +48 mmHg across positions. A significant negative proportional bias was observed in supine (p=0.031), indicating underestimation at higher AOP values. Automated measurements required significantly longer duration than Doppler across all positions (p<0.001). Pain perception was comparable between methods. First-attempt success rate was significantly lower for automated measurement in standing compared to Doppler method (87% vs. 100%, p=0.041). In Phase Two, 73% of participants demonstrated improved accuracy when averaging two automated measurements.Significance Automated algorithm-based arterial occlusion pressure (AOP) assessment demonstrates acceptable validity and safety when performed in seated and standing positions, supporting its use for individualized pressure prescription in these postures. However, clinicians and practitioners should exercise caution when determining AOP in the supine position, as proportional bias and reduced agreement with Doppler ultrasound may result in underestimation at higher AOP values. When measuring AOP in standing positions, providing external support (e.g., upper limb support on a stable surface) to reduce lower limb muscle activation may improve first-attempt success rates.
Endotracheal intubation (ETI) is a cornerstone of advanced prehospital airway management but remains associated with considerable procedural risk, particularly when multiple intubation attempts are required. First-pass success (FPS) is an established quality indicator because repeated attempts increase the risk of hypoxaemia, aspiration, oesophageal intubation, haemodynamic instability and cardiac arrest [1-4]. Although video laryngoscopy (VL) is recommended by international airway guidelines [5-8], evidence regarding the optimal blade geometry for prehospital airway management remains limited. We investigated the association between video laryngoscope blade geometry and FPS in a physician-staffed helicopter emergency medical service (HEMS). We conducted a prospective bicentric observational study at two German physician-staffed HEMS bases between January 2017 and December 2019. Consecutive prehospital ETIs performed using the C-MAC® PM video laryngoscope were prospectively documented. Blade selection was at the discretion of the treating physician. The primary outcome was FPS. Secondary outcomes included glottic visualisation, intubation duration, number of attempts, airway-related adverse events and video laryngoscopy-associated technical problems. A total of 283 video laryngoscopic intubations were analysed. Overall first-pass success (FPS) was 71.0% (201/283). Blade-specific FPS rates were 72.0% for Macintosh size 3, 72.6% for Macintosh size 4 and 61.9% for the hyper angulated D-Blade, without significant differences between blade geometries (p = 0.601). Adequate glottic visualisation (Cormack-Lehane grade I-II) was achieved in 96.8% of patients. Mean intubation duration was 42.5 ± 34.2 s. Airway-related adverse events occurred in 5.7% of patients and video laryngoscopy-associated technical problems in 12.6%. In an exploratory multivariable analysis, blade geometry was not independently associated with FPS, whereas difficult laryngoscopy conditions, poor glottic visualisation and technical problems were associated with failed first-pass intubation. Video laryngoscopy provided excellent glottic visualisation irrespective of blade geometry. Neither univariable nor exploratory multivariable analyses demonstrated an independent association between blade geometry and first-pass success. Instead, difficult airway conditions, poor glottic visualisation and video laryngoscopy-associated technical problems appeared to exert a greater influence on procedural success. Given the observational design and limited number of hyper angulated blade intubations, these findings should be regarded as hypothesis-generating and require confirmation in larger prospective multicentre studies incorporating standardised difficult-airway assessment.
Advancing evidence-based theories of suicide is critical for improving prevention efforts. The purpose of this study was to evaluate the Three-Step Theory of Suicide (3ST) in a sample of Iranian students. Participants (N = 1017, mean age = 24.2, 58.2% female, 9.4% with a prior suicide attempt) completed measures of psychological pain, hopelessness, connectedness, suicide capability, suicide ideation, suicide attempt, and demographics. Results largely support the theory's central premises. First, an interactive model of pain and hopelessness accounted for substantial variance (≈51%) in suicide ideation in the overall sample and in women. Among men, the full model (pain, hopelessness, and their interaction) explained similar amount of variance (≈ 52%) in suicide ideation, while the interaction term was not significant and did not explain additional variance over the main effects. Also, as hypothesized, connectedness was protective against escalating suicide ideation severity among those with suicide desire. Finally, suicide capability and its dispositional and practical component predicted suicide attempt history over and above current suicide ideation. These findings support the validity of 3ST of suicide within the context of a middle-income country. Implications for suicide prevention, clinical intervention and future research directions are discussed.
Conducted Electrical Weapons (CEWs) are widely used worldwide by law enforcement as an intermediate less-lethal force option. While CEW direct electrical effects are generally transient, and direct significant injuries are rare but sometimes severe, secondary effects from associated falls related to neuromuscular effects while rare, may also be severe. To characterize the frequency, severity, and injury patterns of permanent paralysis associated with CEW deployments, with emphasis on fall-related and law-enforcement force related trauma. We analyzed a curated case series of 17 incidents (2004-2024) in which individuals sustained paraplegia or tetraplegia associated with CEW use by law enforcement. We judged 13 of these falls to have been caused by the CEW while 4 may have been only temporally related. Demographics, circumstances, injury mechanisms, and neurological outcomes were summarized descriptively. Of the 17 cases we found, 15 were in the USA and 2 were in the UK. Permanent tetraplegia occurred in 8 cases and paraplegia in 8 cases; there was a single recovery. The mean age was 37 years (range 17-65). All cases involved subjects actively resisting or attempting to flee law enforcement interaction. Elevated falls with head-first impacts, generating thoracic or cervical spine trauma, predominated as causes. Subject paralysis following CEW deployment is a rare but severe complication of attempted electrical weapon control by neuromuscular effects.
Data were collected prospectively from 60 Veterans at risk for suicide at multiple time points over a one year period to identify predictors of suicidal events in the next 90 days. This outcome included suicide attempts, interrupted/aborted attempts, preparatory behaviors, or suicide-related hospitalizations. Entry criteria included prior year suicidal behavior or prior week severe suicidal ideation. At each time point, participants completed neurocognitive testing and self-report measures of suicidality, and reported suicide-related events since the previous time point. Available data include suicide-related outcomes, question-level data for clinical interviews and self-report measures (including assessments of suicidal thoughts and behaviors, suicidal ideation severity, as well as the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Holmes-Rahe Stress Inventory, Automatic Thoughts Questionnaire (ATQ-30), and Acquired Capacity for Suicide Scale (ACSS)), and trial-level data for neurocognitive testing (including go-no/go task, a reward- and punishment-based learning task, death/suicide version of the Implicit Association Task, a memory recognition test), as well as latent cognitive variables extracted from computational modeling of the neurocognitive tests. This data may be used in secondary analyses for identification of predictors of multiple suicide-related outcomes over different time frames.
In the following, we attempt to map the narrative and psychological moments of suicide in the multifaceted document compiled by Michel Foucault. Pierre Rivière murdered his mother, sister, and brother in 1835, and later, after writing his memoirs, committed suicide in prison. In the analysis, we examine the documents from the perspective of suicide: after an introduction, where we explain our method, we attempt to analyze Pierre Rivière's memoirs from these perspectives and then summarize. Keywords: suicide; psychiatry; psychology; narrative; Pierre Rivière.
To investigate whether noninvasive prenatal screening (NIPS) failure in a general-risk population is associated with an increased likelihood of cytogenetic abnormalities. This was a retrospective observational cohort study at a tertiary center, based on a general-risk population. Singleton pregnancies that underwent NIPS between May 12, 2017, and July 30, 2021, at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China, were included. The outcomes were the incidence of common autosomal aneuploidies (trisomy 21, 18, or 13), sex chromosome aneuploidies (SCAs), and copy number variations (CNVs) on the first attempt. From the reports of NIPS, the pregnancies with a failure were compared with those with a success. Propensity score overlap weighting was applied to adjust for maternal age, paternal age, parity, body mass index, method of conception and gestational age at the first blood collection. Of the 42 121 pregnancies included, 41 776 (99.18%) received reports and 345 (0.82%) did not on the first attempt at NIPS. Pregnancies with NIPS failure showed no significantly statistical difference in the risk for trisomy 21, 18, or 13 (0.29% vs. 0.23%; overlap weighting risk ratio [OW RR] 1.17; 95% CI 0.16-8.46), SCAs (4.08% vs. 7.89%; OW RR 0.53; 95% CI, 0.13-2.26) and CNVs (6.12% vs. 8.13%; OW RR 0.76; 95% CI, 0.23-2.53), compared with those with successful NIPS. These findings remained consistent in the sensitivity analyses. The evidence was insufficient that NIPS failure after first-trimester ultrasound screening could be associated with an increased risk of common autosomal aneuploidies, SCAs, and CNVs. Our findings suggest that in a general-risk population those who experience NIPS failure need to be managed on the basis of their basic risk.
Post-registration specialist nursing programmes must balance academic standards with workforce responsiveness, but fragmentation often persists across learning outcomes, assessment structures, and workload distribution. Although theoretical models including constructive alignment, programmatic assessment, competency-based education, and cognitive load theory promote coordinated design, empirical evaluation of integrated programme-level reforms remains limited, particularly regarding structural change and its association with measurable educational outcomes. This retrospective observational cohort study examined the association between a theory-informed programme-level structural redesign and student academic achievement in a United Kingdom (UK) post-registration specialist ophthalmic nursing programme. The study also introduces the Integrated Programme Reform Model (IPRM) as a framework for programme-level educational reform. Nine sequential cohorts of registered nurses were included (N = 106). Six cohorts completed the traditional programme structure (2018-2021; n = 73), and three cohorts completed the redesigned programme (2022-2023; n = 33). The redesign integrated strategies derived from alignment, programmatic assessment, competency-based progression, and workload redistribution. First-attempt summative assessment outcomes were compared using Welch's t-tests, Mann-Whitney U tests, and Fisher's exact tests. Effect sizes were calculated using Cohen's d. Following programme redesign, mean student achievement increased from 57.4% (SD 10.6) to 71.1% (SD 8.1), with a mean difference of 13.7% points (95% CI 10.0-17.4; p < 0.001; Cohen's d = 1.39). The proportion of students achieving distinction (≥ 70%) rose from 15.1% to 60.6% (p < 0.001), while the proportion of scores below the standardised 50% pass threshold fell from 19.2% to 0% (p = 0.005). These findings indicate a distribution-wide upward shift in achievement across the full performance spectrum, alongside reduced variability following redesign. Coordinated programme-level structural redesign was associated with sustained higher first-attempt academic achievement across successive cohorts. Causality cannot be inferred: the redesign coincided with a transition to master's-level provision and a change in assessment modality, the evaluation was conducted within a single programme by an author professionally involved in the redesign, and the data are historical. The IPRM is offered as a conceptual design heuristic for organising programme-level reform and requires prospective, independent, multi-site evaluation before any claim of effectiveness or transferability can be made.
Herbicide exposure can alter plant secondary metabolism with consequences for insect host selection, yet its effects on volatile organic compound (VOC) signaling remain poorly understood. Red maple (Acer rubrum L.) is a widely planted ornamental tree frequently attacked by flatheaded borers (Chrysobothris spp.), and herbicide injury has been associated with increased borer activity. We investigated how trunk application of two commercial herbicides, one contact herbicide (pelargonic acid) and one systemic herbicide (glyphosate), influence VOC emissions and associated nutritional and defensive chemistry in two red maple cultivars differing in susceptibility to Chrysobothris. Across a four-week field experiment, foliar VOCs were quantified alongside sugars, polyphenols, and tannins, and related to borer oviposition attempts and larval success. Herbicide exposure induced compound-specific and cultivar-dependent VOC responses, with the susceptible cultivar ('Brandywine') exhibiting greater temporal variability and elevated emissions of select monoterpenes, including β-myrcene. These VOC shifts coincided with increased foliar polyphenols and trunk sugar concentrations. In contrast, the less susceptible cultivar ('Autumn Blaze') showed comparatively stable chemical profiles across treatments. Oviposition attempts and larval occurrence were concentrated on herbicide-treated 'Brandywine' trees, particularly following contact herbicide exposure. Together, these results suggest that herbicide-induced modulation of VOC signaling, coupled with changes in nutritional and defensive chemistry, may influence adult host selection, larval performance following oviposition, and ultimately enhance host suitability and apparency to Chrysobothris.
Suicide is a leading cause of death amongst youth, and suicide rates amongst young people have increased in South Korea in recent years. This study examined long-term trends in youth suicide and their associations with changes in a broad range of potential risk factors. Suicide data (1983-2024) for individuals aged 10-24 years were obtained from Statistics Korea. We used joinpoint regression analysis to investigate recent changes in trends in youth suicide and compared them with those for a range of potential risk factors, including socioeconomic factors, internet-related factors, academic-related factors, mental health, and suicide behaviours. Poisson regression analysis was conducted to examine the associations between year-on-year changes in youth suicide rates and potential risk factors. In South Korea, suicide rates in youth aged 10-24 years fluctuated over the study period but showed an upward trend in 2014 and reached the highest rates of 12.44 per 100,000 in 2021, with a 5.61% (95% confidence intervals: 3.91, 8.75) annual increase in 2014-2024. The recent rise in youth suicide rates was accompanied by an upward trend in the family violence rates, the prevalence of school bullying, participation rates and average hours spent in private supplementary tutoring, the prevalence of diagnosed mood disorders and self-reported suicidal ideation, and the rates of self-harm/suicide attempt presenting to hospitals, as well as a downward trend in the prevalence of good subjective health in youth. Regression analyses showed that time spent on internet use, participation and time spent in private supplementary tutoring, the prevalence of diagnosed mood disorders, and emergency department presentation rates for self-harm/suicide attempt were positively associated with youth suicide rates, whilst good subjective health was negatively associated. Meanwhile, poverty rates were negatively associated with youth suicide rates. Youth suicide rates increased in South Korea from the mid-2010s, and this increase could be influenced by a concurrent rise in internet use time, academic pressure, mental health problems, and self-harm/suicidal behaviour. Further research is needed to better understand the mechanisms underlying these associations. National Science and Technology Council and Ministry of Education in Taiwan.
Spinal dural arteriovenous fistulas (sDAVFs) are the most common spinal vascular malformation and a treatable cause of progressive myelopathy, yet diagnosis and optimal management remain challenging. This study presents a nine-year institutional experience using a multidisciplinary treatment algorithm that prioritizes endovascular embolization, with surgery reserved for unsuccessful or contraindicated cases. We retrospectively analyzed 15 patients treated between 2015 and 2023, all diagnosed by MRI and confirmed by digital subtraction angiography. Endovascular embolization was attempted as the initial treatment modality in all patients using contemporary liquid embolic agents. Three patients (20%) subsequently required surgical disconnection following unsuccessful or incomplete embolization. Lesions ranged from Th5 to L5, and most patients presented with varying degrees of motor deficits, gait disturbance, paresthesias, or sphincter dysfunction. Neurological improvement occurred in all but one patient, and no treatment-related complications were observed. Prior embolization attempts aided intraoperative localization in surgically treated cases, facilitating precise fistula identification. These findings demonstrate the feasibility and favorable outcomes of a multidisciplinary, stepwise treatment strategy in this single-center experience. Endovascular embolization served as the initial treatment modality, while surgical disconnection provided an effective complementary option in selected cases where embolization was unsuccessful or incomplete.
To evaluate the safety, feasibility, and technical performance of a handheld robotic guidance system for ultrasound-guided percutaneous procedures across multiple procedural domains. A prospective, single-center, open-label feasibility study evaluated the Focalist™ handheld robotic guidance system (Mendaera Inc., USA) across multiple ultrasound-guided percutaneous procedures was performed between December 3 and December 11, 2025. Patients undergoing clinically indicated organ access, vascular access, or pain management injection procedures for urologic conditions were prospectively enrolled. Primary endpoints were safety and technical success. Secondary endpoints included procedural performance metrics and operator-reported user experience. A total of 61 ultrasound-guided percutaneous procedures were performed in 46 patients by 11 operators. Procedure categories included 20 organ access procedures, 31 pain management injections, and 10 vascular access procedures, including 15 specific procedures that had never previously been performed using the system. Technical success was achieved in 60 of 61 procedures (98.4%), with no device-related adverse events. First-attempt success occurred in 45 procedures (74%), with a mean of 1.4 needle attempts per procedure. Mean robotic procedure time (sterile scan start to needle at target) was 5.6 min. Operator survey responses indicated agreement that the system was easy to use (mean 3.7/5) and enhanced confidence during procedures (mean 3.7/5). In this prospective feasibility study, a novel handheld robotic ultrasound guidance system was used successfully across a diverse range of ultrasound-guided percutaneous procedures. High technical success and absence of device-related adverse events support consideration of its inclusion in standard of care workflows. CTRI/2025/11/098124. NCT07358351.
Venipuncture is a common and painful procedure in neonates. Sweet solutions (sucrose and glucose) are recommended and widely used as standard care for reducing neonatal procedural pain. Topical local anesthetics may also reduce procedural pain but generally require longer application times to achieve adequate analgesia. This study investigated the efficacy and safety of a novel topical lidocaine-nitroglycerin preparation as an adjunct to standard oral sweet solutions in neonates undergoing peripheral venous catheterization. In this double-blind randomized clinical trial, 84 neonates (≥ 34 weeks gestation) undergoing peripheral venous catheterization were randomized to receive either topical lidocaine/nitroglycerin 2% or placebo ointment, applied 15 min before the procedure. All neonates in both groups received 0.5 mL of 24% oral sucrose two minutes before venipuncture as standard care. Pain was assessed using the Premature Infant Pain Profile (PIPP) and Neonatal Facial Coding System (NFCS) scales using standardized procedures and video verification. The duration of crying, time to cry onset, number of venipuncture attempts, and adverse events were recorded. Neonates treated with lidocaine-nitroglycerin topical formulation plus standard oral sucrose had significantly lower PIPP scores [7.0 vs. 8.5, P = 0.038] and NFCS scores [5.0 vs. 7.0, P < 0.001] compared with placebo ointment plus standard oral sucrose. Crying duration was significantly shorter [10 s vs. 25 s, P = 0.045], and fewer neonates required repeated venipuncture (6 vs. 14, P = 0.041). No adverse reactions or clinical signs of methemoglobinemia were observed. Topical lidocaine/nitroglycerin 2% provided rapid analgesia and reduced repeated venipuncture attempts in neonates, offering a practical strategy for pain management in the neonatal intensive care unit (NICU). Further large multicenter trials are warranted to confirm efficacy and long-term safety. The trial was registered as IRCT20190810044500N19 (22/08/2021) https://irct.behdasht.gov.ir/trial/47524 .
Objective: To report the conservative management of a complex failed apexification in a permanent premolar complicated by severe internal root resorption, irregular apical calcification, and exceptionally thin root canal walls and to evaluate its long-term (56-month) clinical and radiographic outcomes. Methods: A 27-year-old male presented with chronic apical periodontitis in the right mandibular first premolar. A previous apexification attempt had failed, resulting in arrested root development, an apical calcified bridge, and extensive internal root resorption. CBCT imaging revealed a critical root canal wall thickness of less than 1 mm in the middle and coronal thirds. To avoid extraction or invasive surgery, a non-surgical apical barrier technique was performed. Due to the severe structural compromise and high risk of root fracture, mechanical instrumentation was minimized; instead, chemomechanical debridement was optimized using Er:YAG laser-activated irrigation. The apical region was sealed with a bioceramic material (iRoot BP), and the weakened root structure was reinforced intraradicularly with dual-cure flowable resin, followed by progressive occlusal adjustments. Results: At the 3-month follow-up, the patient was completely asymptomatic, and radiographs indicated initial periapical bone healing. The 56-month follow-up demonstrated progressive formation of mineralized tissue, apparent thickening of the root canal walls at root apex, complete resolution of periapical radiolucency, and a stable, functional occlusion. Conclusions: This case demonstrates that teeth with severe structural compromise and internal resorption following failed apexification are not necessarily hopeless. A tailored conservative approach, integrating advanced laser-assisted disinfection, bioceramic apical barriers, internal resin reinforcement, and meticulous occlusal management, can yield highly successful long-term outcomes, ensuring the preservation of the natural dentition.