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Patients with chronic diseases often experience learned helplessness (LH), which affects their psychological state and triggers physical symptoms, seriously affecting their quality of life. The Chronic Disease Helplessness Survey (CDHS) was developed to measure LH in patients with chronic diseases, but it has not been validated in the Chinese population. The aim of this study was to translate the CDHS into Chinese and validate its reliability and validity in Chinese patients with chronic diseases, thus providing an appropriate assessment tool for the Chinese population. A forward-backward English-Chinese-English translation of the CDHS was performed according to standard practice. This study recruited 106 chronic disease patients from March to May 2024, and 100 cases in September 2025. The Chinese CDHS has 12 items in three dimensions: cognitive, motor, and emotional. The criterion-related tools used included the Learned Helplessness Scale-18 (LHS-18), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD). Criterion-related validity was assessed by examining the correlations between CDHS scores and the scores of these tools. The internal consistency was tested via Cronbach's α, the test-retest reliability was tested via the intraclass correlation coefficient (ICC), and the construct validity was tested via Exploratory Factor Analysis and Confirmatory Factor Analysis. The Chinese CDHS had a Cronbach's α of 0.896, indicating good internal consistency, and an ICC of 0.929, indicating high stability. EFA and CFA showed a good fit for the three-factor model (χ2/df = 1.623, CFI = 0.961, TLI = 0.949, NFI = 0.905, RMSEA = 0.078). CDHS scores were positively correlated with LHS-18 (r = 0.659, P < 0.001), GAD-7 (r = 0.659, P < 0.001), and PHQ-9 (r = 0.714, P < 0.001) scores and negatively correlated with SEMCD scores (r = -0.614, P < 0.001), demonstrating good criterion-related validity. The Chinese CDHS has good reliability and validity for assessing learned helplessness in Chinese chronic disease patients and is a valuable tool for early psychological intervention, it could be used in screening, clinical decision-making, or monitoring psychological states over time.
Coronary artery lesions (CALs) represent the most serious complications of Kawasaki disease (KD), and the early identification of children at high risk for CALs is critical for guiding treatment strategies. This study aimed to develop a nomogram-based model to predict the risk of CALs in children with KD. This retrospective analysis enrolled 255 children diagnosed with KD between January 2024 and May 2025. Feature selection was performed using the least absolute shrinkage and selection operator regression. Variables with non-zero coefficients were subsequently incorporated into multivariable logistic regression to identify risk factors associated with CALs. A nomogram was constructed based on these predictors, and internal validation was performed using the bootstrap resampling method. The performance of the model was assessed using receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA). The incidence of CALs in children with KD was 29.4% (75/255). Our results identified age, clinical type, platelet count (PLT), and thrombin time (TT) as independent risk factors for CALs in children with KD. The area under the ROC curve of the model was 0.807 (95% confidence interval [CI] = 0.750-0.860). The calibration curves and the Hosmer-Lemeshow goodness-of-fit test revealed good consistency between the predicted probabilities and observed outcomes, and DCA confirmed that the model had good clinical utility. We developed and internally validated a nomogram-based predictive model based on age, clinical type, PLT, and TT that may facilitate the early identification of children with KD at high risk of developing CALs.
Despite regular physical activity (PA) is beneficial to maternal health and her fetus, engagement in PA among pregnant women is inactive. It is essential to assess barriers to PA in this population to increase pregnant women's PA level. However, there is a lack of reliable and valid tools to evaluate barriers to PA during pregnancy in China. Therefore, the study aimed to translate and validate the Barriers to Physical Activity during Pregnancy Scale (BPAPS) in Chinese pregnant women. A study of 448 pregnant women was conducted in China from November to December 2023. After obtaining the author's permission, the translation of the BPAPS was carried out with a standardized procedure. The validity of the BPAPS was measured by the content validity, construct validity, and criterion validity in this study. The reliability of the BPAPS was evaluated using internal consistency and test-retest. The final Chinese version of the BPAPS had four domains with 28 items. The content validity index of all items ranged from 0.875 to 1.000. Exploratory factor analysis extracted four factors, explaining 62.332% of the total variance. The four-factor model was confirmed. The initial model did not fit well. After modification, the final model had a reasonable fit to the data: the chi-square to degrees of freedom ratio was 2.439, the root mean-square-error of approximation was 0.068, the comparative fit index was 0.913, the incremental fit index was 0.913, and the tusker-lewis index was 0.903. This scale also had good criterion validity (r = 0.605, P<0.001). The Cronbach's alpha and intraclass correlation coefficient of the total scale were 0.942 and 0.860, indicating good reliability. The Chinese version of the BPAPS has good reliability and validity. It can be used as an effective tool to assess barriers to PA in Chinese pregnant women.
The World Health Organization definition of palliative care describes dying as a 'normal' process and it, along with related ideas of 'ordinary' or 'natural' dying, is important in understanding what a 'good' death is. This scoping review aims to explore how dying has been described as 'normal', 'ordinary' or 'natural' in empirical palliative care literature to provide palliative care stakeholders with evidence-based insights into how this concept may enable quality dying experiences and a 'good' death. A scoping review was conducted by searching six online databases (Medline (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCO), Web of Science, and Scopus) for empirical English-language palliative care literature that explicitly described dying as 'normal', 'ordinary', 'natural', or their interchangeable terms 'standard, 'typical' or 'usual'. A narrative synthesis was used to present the clusters of features associated with their descriptions. Twenty-one studies used 'normal', 'ordinary', 'natural' and 'typical' dying. They were often employed as a single statement despite some authors' concerns regarding the lack of conceptual clarity. Interchangeability between 'normal' and 'natural' dying was observed. Understandings of 'normal', 'natural' and 'typical' were found to be diverse, subjective, and contextually bounded. Although there was some evidence that 'normal', 'natural' and 'typical' dying can influence the quality of dying experiences in palliative care, there was no evidence for 'ordinary' dying due to a lack of explicit use in the included studies. Understandings of dying as 'normal', 'natural' or 'typical' are held by clinicians and patients to play an important role in shaping the quality of dying experiences and providing a 'good' death in palliative care. However, the use of each idea remains heterogeneous, with conflicting definitions across terms. The diffuse evidence base suggests that the potential benefits, harms or limitations of their use in palliative care are therefore unclear. For this reason, we recommend caution regarding their use in practice or policy.
Hearing-related quality of life is a crucial outcome for adults with cochlear implants. The Cochlear Implant Quality of Life (CIQOL)-35 Profile is a patient-reported outcome measure originally developed in English. In a previous study, this instrument was cross-culturally adapted into German to address the need for standardized assessment tools in German-speaking regions. To ensure the adapted instrument meets psychometric criteria, validation is required. The German adaptation of the CIQOL-35 Profile was validated through an online survey including questions on demographics, the German CIQOL-35 Profile, and the German Nijmegen Cochlear Implant Questionnaire (NCIQ). The collected data were analyzed for reliability and validity. A total of 204 adults (aged 19-87 years) with bilateral hearing loss completed the online survey. Cronbach's α between 0.84 and 0.91 demonstrates good internal consistency for all subscales of the CIQOL-35 Profile and the global outcome. Moderate to strong correlations (rs = 0.55-0.85) between the CIQOL and NCIQ indicate good convergent validity. Confirmatory factor analysis established construct validity for the German CIQOL instruments. These findings confirm that the adapted German version of the CIQOL instruments is a reliable and valid measure for assessing hearing-related quality of life in adults with cochlear implants and demonstrates higher validity than the NCIQ. The availability of the CIQOL in multiple languages facilitates international comparability of research results and increases clinical application. Implementing quality of life instruments in clinical practice enables a more comprehensive evaluation of patient outcomes and may help identify patient needs that may be addressed in therapy and rehabilitation.
Post-traumatic osteoarthritis (PTOA) is a common and clinically important complication after ankle fracture surgery, but reliable individualized risk stratification remains limited. This study aimed to develop and externally validate a Cox-based risk prediction model for postoperative PTOA after ankle fracture surgery and to assess its incremental value over traditional early postoperative clinical evaluation indicators. This prospective two-center cohort study consecutively enrolled patients with surgically treated ankle fractures from Center I (March 2020 to March 2024) and Center II (March 2021 to March 2024). After screening 964 patients, 812 were included, with 605 assigned to the training cohort and 207 to the external validation cohort. Structural PTOA, the primary endpoint, was defined as the first occurrence of Kellgren-Lawrence grade ≥ 2 on postoperative weight-bearing ankle radiographs. Five incremental Cox models were developed using clinical, biochemical, nursing/perioperative, radiographic, and surgical variables. LASSO was used for feature selection, followed by multivariable Cox regression. Internal validation was performed using 1,000 bootstrap resamples, and external validation was conducted in an independent geographic cohort. The 2-year incidence of structural PTOA was 24.0% (145/605) in the training cohort and 29.0% (60/207) in the validation cohort. Fourteen variables entered the full multivariable Cox model, and 11 independent predictors were retained for the final parsimonious model. The final comprehensive model showed the best performance, with an apparent C-index of 0.892, a bootstrap-corrected C-index of 0.887, and an external validation C-index of 0.865. Relative to the postoperative 3-month AOFAS score as a clinically relevant reference comparator, the comprehensive model showed higher predictive performance, with a continuous net reclassification improvement of 0.785 and an integrated discrimination improvement of 0.285. Time-dependent ROC analysis demonstrated favorable discrimination at 6, 12, and 24 months in both cohorts. Calibration and decision curve analyses also supported good agreement and clinical utility. A prospective, multi-source Cox prediction model for structural PTOA after ankle fracture surgery was successfully developed and externally validated. The final 11-variable model demonstrated good discrimination, robust validity, and clear incremental value over traditional early postoperative clinical evaluation indicators, supporting its potential use for individualized risk stratification after ankle fracture surgery.
To systematically identify patient-reported outcome measures (PROMs) used to assess health-related quality of life (HRQoL), symptoms, and disease burden in patients with multiple myeloma (MM), and to appraise their measurement properties using the COSMIN methodology. A systematic review was conducted in accordance with the COSMIN guideline for reviews of PROMs. Eligible studies reported PROM development, content validation, cross-cultural adaptation, or one or more measurement properties of PROMs used in adult patients with MM. Methodological quality was assessed using the COSMIN Risk of Bias checklist. The results for each measurement property were rated against the COSMIN criteria for good measurement properties, and the certainty of evidence was graded using the modified GRADE approach recommended by COSMIN. Twenty-six studies involving 14 PROMs were included. The EORTC QLQ-MY20 was the most frequently evaluated MM-specific module, followed by MyPOS, HM-PRO, MDASI-MM, FACT-MM, MySIm-Q, and QLICP-MM. Evidence was most often available for internal consistency, structural validity, and hypothesis testing for construct validity. By contrast, formal evidence on measurement error, criterion validity, and cross-cultural validity was seldom reported. No PROM demonstrated uniformly high-quality evidence across all key measurement properties. The EORTC QLQ-MY20 and MyPOS showed the broadest body of supportive evidence and appear to be the most defensible options for MM-specific HRQoL assessment, although additional high-quality content validity and longitudinal measurement studies remain necessary. Current evidence supports the use of several MM-specific PROMs, particularly the EORTC QLQ-MY20 and MyPOS, but the overall evidence base remains uneven. Future research should prioritize patient-centered content validation, measurement-error evidence, cross-cultural validity, responsiveness, and interpretability to strengthen PROM selection for MM clinical trials and practice. Multiple myeloma patients often experience pain, fatigue, and other issues affecting their quality of life during treatment. To accurately understand patients’ experiences, doctors use various questionnaires (instruments). This study systematically reviewed all currently used instruments for multiple myeloma, analyzing their scientific rigor and accuracy. QLQ-MY20 and MyPOS have shown good psychometric properties in current evidence, but they have missing or low-quality evidence for some measurement attributes. No single PROM has high-quality evidence for all attributes. However, most instruments require further validation for cross-cultural use (e.g., in different countries). This research helps doctors choose the most appropriate instruments for monitoring patient health.
BackgroundCervical cancer remains a major global health challenge, disproportionately affecting low- and middle-income countries. Women living with HIV are at increased risk due to weakened immunity. This study assessed cervical cancer screening utilization and associated factors among HIV-positive women attending antiretroviral therapy (ART) clinics in Gondar town, Northwest Ethiopia.MethodsA multicenter institution-based cross-sectional study was conducted from November 1 to 30, 2025, using systematic random sampling. Data were collected through structured interviewer-administered questionnaires and analyzed using STATA 14. Bivariable and multivariable logistic regression analyses were performed, with P < .05 considered statistically significant.ResultsScreening utilization was 30.2%. Good knowledge (AOR = 3.44; 95% CI: 2.22-5.16), favorable attitude (AOR = 2.81; 95% CI: 2.28-6.61), and history of sexually transmitted infections (AOR = 2.22; 95% CI: 1.83-4.13) were significantly associated.ConclusionScreening utilization was low. Strengthening health education, improving ART counseling, and integrating screening into routine HIV care are recommended. Use of Cervical Cancer Screening and Related Factors Among Women Living with HIV in Public Health Facilities of Gondar Town, Northwest EthiopiaCervical cancer is one of the most common cancers affecting women worldwide. It is especially common in low- and middle-income countries. Women living with HIV have a higher risk of developing cervical cancer because their immune system is weakened. Regular cervical cancer screening can help detect early changes in the cervix and prevent the disease. However, many women living with HIV do not use these screening services. This study examined how many women living with HIV use cervical cancer screening services and what factors influence their use of screening. The study was conducted among women attending antiretroviral therapy (ART) clinics in public health facilities in Gondar town, Northwest Ethiopia. Data were collected using interviews with structured questionnaires. The results showed that only 30.2% of women living with HIV had been screened for cervical cancer. The study found that women who had good knowledge about cervical cancer, those who had a positive attitude toward screening, and those who had a history of sexually transmitted infections were more likely to use cervical cancer screening services. The findings indicate that cervical cancer screening among women living with HIV is still low. Improving awareness and knowledge about cervical cancer, providing better counseling services in ART clinics, and integrating cervical cancer screening into routine HIV care may help increase screening use. Strengthening these efforts could help detect cervical cancer earlier and reduce illness and death among women living with HIV.
Papillary thyroid microcarcinoma (PTMC) generally exhibits an excellent prognosis. However, a subset of patients develops high-volume (>5 nodes) central lymph node metastasis (CLNM), which is associated with increased recurrence risk and may influence surgical decision-making. Reliable preoperative risk stratification for high-volume CLNM in clinically node-negative (cN0) PTMC remains challenging. Therefore, this study aimed to develop and validate a nomogram for predicting high-volume CLNM in unilateral cN0 PTMC. In this retrospective study conducted at a single center, 1,500 patients with unilateral cN0 PTMC who received surgical treatment were included. Patients were randomly allocated to training cohort and validation cohort at a 7:3 ratio. Independent predictors of high-volume CLNM were identified using multivariate logistic regression analysis. A nomogram was constructed using the training cohort and subsequently validated. Multivariate logistic analysis identified male sex, age ≤50 years, maximal tumor diameter >8 mm, and tumor multifocality as independent predictors for high-volume CLNM. The nomogram showed good discrimination performance, with a concordance index (C-index) exceeding 0.70 in both the training and validation cohorts. Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis indicated favorable clinical applicability. A practical nomogram was developed to predict high-volume CLNM in patients with unilateral cN0 PTMC. This model may facilitate individualized preoperative risk stratification and assist clinicians in optimizing surgical strategies, particularly in the context of increasingly conservative management of PTMC.
Perioperative red blood cell (RBC) transfusion remains common in cardiac surgery and is associated with increased morbidity and mortality. Accurate preoperative risk prediction is essential for patient blood management. The Fuwai-transfusion risk of on-pump cardiac surgery (FW-TRIC) score was previously developed and internally validated as a tool to estimate transfusion risk. This study aimed to externally validate the FW-TRIC score in a multicenter cohort. A retrospective multicenter study was conducted across nine cardiovascular centers in China from January to December 2024. Adult patients undergoing on-pump cardiac surgery were included, while those undergoing transplantation, mechanical circulatory support, or preoperative transfusion were excluded. The discriminative performance of the FW-TRIC score was evaluated using receiver operating characteristic (ROC) curve analysis, and calibration was assessed through linear regression of observed versus predicted transfusion rates. A total of 3,287 patients met inclusion criteria, with an overall perioperative RBC transfusion rate of 40.1%. The FW-TRIC score demonstrated good discrimination for predicting transfusion, with an AUC of 0.713 (95% CI, 0.696-0.731) and excellent calibration. All individual predictors of FW-TRIC score, including age, sex, NYHA classification, body surface area, previous cardiac surgery, emergency surgery, and surgery type, underperformed the prediction ability of FW-TRIC score (all P < 0.05 for AUC comparison). Performance remained good across all nine centers (AUCs > 0.65). Across all transfusion risk categories in the external validation cohort, the observed transfusion rates compared well with those predicted by the FW-TRIC model. The FW-TRIC score was externally validated as a robust and generalizable preoperative tool for predicting perioperative RBC transfusion in on-pump cardiac surgery. Its use enables effective transfusion risk stratification and supports personalized patient blood management strategies across diverse clinical settings.
Therapeutic inertia (TI) defined as failure to escalate or initiate adequate therapy when treatment goals are not met, contributes to poor outcome in patients with chronic obstructive pulmonary disease (COPD). This real-world study aimed to investigate TI and the discrepancy between disease control assessed by physicians' perception and objective methods. This was a post hoc analysis of data of 4801 patients with severe COPD (FEV1 < 50% predicted) included in an observational cross-sectional multicenter nationwide study conducted in Spain. Controlled vs. uncontrolled disease was considered according to COPD assessment test (CAT) score ≤ or > 16 and absence or presence of at least one exacerbation in the past 3 months. A 5-point Likert scale (very poor/poor; satisfactory/good/very good) was used to assess COPD control perceived by physicians and patients' satisfaction with treatment. Uncontrolled COPD was present in 3479 of 4801 patients (72.5%) and controlled COPD in 1322 (27.5%). Among patients with uncontrolled COPD, no treatment adjustments were made in 1519, with a rate of TI of 43.7%. In the multivariate analysis, former smokers, lower exacerbations history, white sputum, lower degree of dyspnea, higher adherence to inhaled therapy, use of dual/triple inhaled medications, absence of SABA use, secondary healthcare level, and patient's satisfaction with treatment were significantly associated with TI. Physicians perceived controlled disease in 2373 patients with uncontrolled COPD, with a discordance rate of 68.2%. Among patients with controlled COPD, the discordant rate was 6.3%. The most influential variables associated with controlled COPD rated by physicians were patients' satisfaction with treatment, no exacerbations in the past year, triple therapy, and ex-smoking status. The high rate of TI and the gap between actual COPD control and physicians' perceptions, highlights the urgent need to systematize and standardize the follow-up of patients with severe COPD in daily practice.
The anterior component of force (ACF) is key to proximal contact loss (PCL) after implant restoration, yet its quantitative impact remains unclear. This study employed digital model analysis to indirectly assess the effects of ACF and examine its association with PCL. Following final restoration, 3D surface and buccal occlusal data were obtained from ninety first molar implant sites and mesial adjacent teeth. Occlusal force-induced changes in proximal contact gap (ΔdP) and centroid position (ΔdC) were measured using Geomagic Wrap 2021 for indirect ACF estimation. Proximal contact gaps were measured under non‑occluding conditions at baseline and 6 months to calculate the change over time (ΔD). Univariate and multivariate analyses identified PCL-related biomechanical influencing factors, and a restricted cubic spline (RCS) model was developed and validated using Cohen's Kappa. The 6-month PCL incidence was 17.78%, and ΔdP emerged as a significant biomechanical influencing factor of ΔD (P < 0.001). RCS analysis revealed that the adjacent state remains stable when ΔdP is within the range of - 13 μm to 9 μm; beyond this range, imbalance occurs. The model demonstrated good fitting capability (κ = 0.59, P = 0.003). This study achieved an indirect assessment and quantification of the effect of ACF through digital model analysis technology, and clarified its correlation with the PCL of the implant, providing new evidence and methodological references for related biomechanical research.
This study analysed perceptions of barriers to primary healthcare (PHC) access in a socially vulnerable and violence-affected community in Rio de Janeiro. A cross-sectional survey was conducted in the Manguinhos community, with approximately 1000 residents interviewed face to face in 2024. Data were collected using a structured questionnaire via REDCap, including sociodemographic variables, self-reported health conditions and Patient Health Questionnaire-2 and Generalised Anxiety Disorder-2 scales. Adapted narrative vignettes were used to describe profiles of individuals with or without mental health problems and socially stigmatised behaviours, allowing the assessment of perceived difficulty in accessing health services. Results showed no significant differences in perceived difficulty of access between Black and non-Black participants. However, men reported greater perceived difficulty in scenarios involving common mental disorders, suggesting the influence of internalised stigma. Younger participants perceived greater barriers in situations involving socially marginalised behaviours, reflecting a lack of trust in the responsiveness of health services. Conversely, formal diagnoses and medication use for diabetes and hypertension were associated with lower perceived barriers, indicating that prior engagement with the health system fosters greater familiarity and lower perceived difficulty. Item response theory analysis demonstrated good psychometric performance of the vignettes, confirming their methodological utility. The findings highlight the need to strengthen PHC to address mental health and social vulnerability demands and to reduce subjective barriers, particularly for men and younger individuals. They also underscore the importance of targeted strategies to promote equity in access to care in vulnerable settings.
Narcissistic Personality Disorder (NPD) involves disturbances in self-regulation, interpersonal functioning, and personality organization. Although traditionally characterized by grandiosity, contemporary models suggest that grandiose self-states coexist with vulnerable features such as shame, emotional dysregulation, and hypersensitivity to rejection. Recent evidence indicates that metacognitive impairments may underlie both grandiose and vulnerable narcissistic presentations; however, no study has examined how metacognition interacts with personality traits and interpersonal difficulties within an integrated system. A cross-sectional network analysis was conducted on 287 patients with NPD. Measures included the Metacognition Assessment Interview, the Pathological Narcissism Inventory, the Personality Inventory for DSM-5 (PID-5), the Inventory of Interpersonal Problems, and SCL-90-R Depression. A Gaussian graphical model with LASSO regularization was estimated, and expected influence was used as the primary index of node centrality. Network accuracy and stability were assessed through bootstrapping procedures. Narcissistic vulnerability was the most central node, followed by interpersonal sensitivity and metacognitive integration. Narcissistic vulnerability showed strong associations with PID-5 Negative Affectivity and Detachment, whereas narcissistic grandiosity was related to PID-5 Antagonism. Metacognitive integration occupied a central position, linking maladaptive traits and interpersonal distress. Network stability indices indicated good reliability. Findings suggest that narcissistic vulnerability and interpersonal hypersensitivity are central aspects of dysfunction in NPD, whereas metacognitive integration appears closely associated with the organization of psychological processes within the network. Although causal inferences cannot be drawn, the results are consistent with theoretical models underlying Metacognitive Interpersonal Therapy (MIT), supporting the potential relevance of targeting integrative metacognitive capacities in NPD treatment.
Yoghurt is a food product with strong sensory acceptance and health appeal, making its matrix a target for various innovative presentations and modifications. This study aimed to develop a yoghurt bar with the addition of probiotic microcapsules and to evaluate the effect of gelatine concentration on its chemical composition, microbiological stability, rheological properties and texture profile. Three formulations were developed: YB6 (6.66% gelatine dispersion), YB9 (9.33% gelatine dispersion) and YB12 (12% gelatine dispersion) Probiotics were microencapsulated by ionic gelation, achieving 93.46% encapsulation efficiency. Gelatine concentration influenced protein (YB6/YB9: 6.95 g.100 g-1; YB12: 7.65 g.100 g-1) and sodium content (YB6/YB9: 56.00 mg.100 g-1; YB12: 57.50 mg.100 g-1) but did not significantly alter other compositional parameters. Probiotic counts (log CFU.g-1) for Lactobacillus delbrueckii subsp. bulgaricus (YB6 = 7.08; YB9 = 7.34; YB12 = 7.4), Streptococcus thermophilus (YB6 = 9.20; YB9 = 9.08; YB12 = 9.18) and Lactobacillus acidophilus NCFM® (YB6 = 7.32; YB9 = 7.3; YB12 = 7.0) remained stable over 30 days at 5 °C, meeting regulatory standards for yoghurt classification. Gelatine concentration and temperature influenced rheological properties. At 10 °C, formulations exhibited no structural failure up to 1000 Pa of shear stress, whereas at 25 °C, YB9 and YB12 demonstrated higher structural integrity than YB6. YB12 presented the highest values of firmness, adhesiveness, cohesiveness, gumminess and elasticity. The yoghurt bar represents an innovative product that expands the range of fermented dairy options. The use of 9% or 12% gelatine dispersion in yoghurt bar production ensures good storage stability, protein enrichment and a suitable texture for handheld consumption, thereby expanding the scope of yoghurt-based offerings.
Pleomorphic adenoma (PA) of the salivary gland, particularly of the parotid gland, is generally considered benign but exhibits heterogeneous biological behavior, including recurrence and malignant transformation. While benign pleomorphic adenoma (BPA) and carcinoma ex pleomorphic adenoma (CXPA) are well defined, lesions with borderline or atypical features represent a clinically challenging gray zone with unclear surgical implications. This study aimed to characterize the clinicopathological features of borderline/atypical PA (BaPA) within the PA spectrum and to evaluate its recurrence parttern and malignant transformation risk. We conducted a single-center retrospective cohort study of surgically treated PAs diagnosed between 2008 and 2023. Cases were categorized as BPA, BaPA, and CXPA based on standardized histopathological re-review. BaPA and CXPA were considered higher-risk lesions within the PA spectrum. Preoperative fine-needle aspiration (FNA) concordance, Ki-67 proliferation index, surgical approach, and recurrence were analyzed, with follow-up focused on pathology-confirmed recurrence. A total of 1,306 cases were included, of which 87.9% arose in the parotid gland. FNA concordance with final diagnosis was high in BPA (84.0%) but substantially lower in BaPA (54.4%) and CXPA (32.1%). Ki-67 increased stepwise across tumor categories and showed good discriminative ability for malignant transformation (area under the curve =0.841), with an optimal cutoff value of 10%. During follow-up, recurrence occurred in 15.5% of BaPA and 27.0% of CXPA cases. In BaPA, recurrence was associated with surgical approach; in sensitivity analysis excluding enucleation cases, recurrence remained significantly lower after total parotidectomy than after superficial parotidectomy (7.0% vs. 19.2%, P=0.01). Among recurrent BaPA cases, malignant transformation occurred in 41.7% and was associated with longer tumor duration. In CXPA, recurrence was primarily associated with advanced T category and stage. These findings support PA as a clinicopathological continuum and suggest that BaPA may represent an intermediate-risk subgroup within this spectrum. Adequate local surgical control, awareness of the limitations of FNA, and incorporation of Ki-67 (≥10%) may aid individualized risk stratification and postoperative surveillance, while further validation of this category is warranted.
IntroductionAortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), involving less than 1% of all AAA and about 3% of ruptured aortic aneurysms.The conventional management of aortocaval fistula involved an open surgical approach, burdened by high mortality rates, while the endovascular repair has progressively become the mainstay of the vascular treatment.Case ReportA 73-year-old male patient presented to the emergency room with acute respiratory failure and signs of heart failure. A computed tomography angiography (CTA) demonstrated the presence of a 10 cm AAA, with a spontaneous rupture into the adjacent inferior vena cava (IVC). A bifurcated aortic endograft was therefore successfully deployed to exclude the ruptured AAA, with an immediate resolution of symptoms and an improvement in hemodynamic parameters. Nevertheless, a type IA endoleak was detected at a post-operative control CTA: its perfusion was sustained by communication with the IVC. A secondary intervention was deemed necessary, including both the proximal sealing fixation and the fistula closure. The aneurysmal sac was embolized with coils passing through the ACF, then, after performing the Intravascular Lithotripsy (IVL) of the right iliac axis, the Heli-FX EndoAnchor ® system was advanced and used to fix the proximal sealing zone, with a good angiographic and long-term, post-operative result.ConclusionThe endovascular treatment of ruptured AAA with ACF has proven to have lower morbidity and mortality than the surgical treatment. Numerous endovascular treatments have been used to treat aortocaval fistula: in the present case, the choice was dictated by the need to occlude the aneurysmal sac and to seal the type Ia endoleak in the same intervention. The combination of the aneurysmal sac embolization passing through the IVC and the Heli-FX EndoAnchor ® system seems to be a safe alternative in ruptured AAA with ACF.
Stereopsis is the perception of depth arising from binocular vision and is essential for fine motor skills and overall visual function in children. It has been observed that refractive errors diminish binocular function by causing visual blur and impairing fusion, which results in poor stereopsis. Poor stereoacuity can lead to inferior quality of vision and substandard work performance, especially where good eye-hand coordination and visual motor skills are required. The purpose of this study is to assess the level of stereoacuity among children with refractive errors and to determine the prevalence and pattern of subnormal stereopsis in the pediatric population. This cross-sectional study was conducted at a tertiary care center in Central India from October 2023 to September 2024 after Institutional Ethics Committee approval. A total of 120 children aged 5-17 years with previously diagnosed refractive errors and a history of spectacle use for at least one month were included. Children with strabismus, amblyopia, ocular pathology, or poor cooperation were excluded. All participants underwent detailed ophthalmic evaluation, including visual acuity assessment, slit-lamp examination, fundus evaluation, and refraction (dry and cycloplegic), followed by subjective correction. Stereoacuity was assessed using the Randot stereotest and categorized as normal (10-60 arc seconds), subnormal (61-120 arc seconds), moderate (121-240 arc seconds), and poor (≥241 arc seconds). Anisometropia was defined as an interocular difference of ≥ 1 D spherical or ≥ 1.5 D cylindrical power. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 17.0; SPSS Inc., Chicago, IL), and associations were tested using the chi-square test, with p < 0.05 considered significant.  The study included 120 children with a mean age of 11 ± 2.64 years, comprising 65 (54.17%) males and 55 (45.83%) females. The mean stereoacuity was 54.01 ± 32.19 arc seconds. Anisometropia was present in 19 (15.83%) patients. Normal stereopsis was observed in 96.82% of myopic patients, 93.48% of astigmatic patients, and 72.73% of hyperopic patients. Moderate-to-poor stereopsis was predominantly seen in hyperopic individuals (27.27%), whereas only 3.18% of myopes demonstrated subnormal stereopsis, with none showing moderate or severe impairment. Hypermetropic children had significantly poorer stereopsis compared to myopes. Anisometropia was associated with reduced stereopsis. Isometropic individuals demonstrated better stereoacuity (48 ± 28.18 arc seconds) compared to anisometropic individuals (60 ± 36.89 arc seconds) (t = 2.31, p = 0.02), indicating a significant impact of on binocular function. Hypermetropia is associated with poorer stereoacuity compared to myopia, and anisometropia negatively affects stereopsis when compared to isometropia. These findings highlight the importance of early detection and appropriate correction of refractive errors in children to prevent impairment of binocular vision. Routine screening of stereopsis should be incorporated into pediatric ophthalmic evaluation to ensure optimal visual development.
Spontaneous coronary artery dissection (SCAD) is an uncommon cause of cardiac ischemia that especially affects young women. Its true prevalence is not well established due to limitations in diagnosis. Although the symptoms of SCAD largely mimic those of acute coronary syndrome (ACS), the management is remarkably different. The etiology of SCAD is considered to be multifactorial, and underlying arteriopathic disease, such as fibromuscular dysplasia, is a well-known risk factor. We treated a case of a young woman who had recurrent SCAD involving three different coronary arteries, including the left anterior descending, right coronary artery, and obtuse marginal branch, on two different occasions without any identifiable underlying vascular disease or acute precipitant. She had STEMI (ST-segment elevation myocardial infarction) on her first presentation and NSTEMI (non-ST segment elevation myocardial infarction) on her second presentation nearly two years later. She underwent angiography on both occasions; however, she was treated medically without percutaneous coronary intervention (PCI) and had good outcomes with the resolution of symptoms.