Return to work (RTW) is a crucial outcome parameter for active patients undergoing shoulder arthroplasty. However, literature reporting on RTW rates is scarce. The purpose of this study was to assess the RTW rate following shoulder arthroplasty in patients of working age and to identify factors associated with successful RTW. This retrospective cohort study included patients under 63 years of age who underwent shoulder arthroplasty with a minimal follow-up of 2 years. Participants completed 2 types of questionnaires: a work-specific questionnaire and questionnaires to assess their shoulder function (the Patient-Derived Constant Murley Score, the Subjective Shoulder Value, Oxford Shoulder Score, the Simple Shoulder Test, and a Work-Related Questionnaire for Upper extremity disorders). Factors related to RTW were analyzed using the Mann-Whitney U test and chi-squared test. Out of the 103 included patients, 69 (67.0%) returned to work, with 40 of them (58.0%) resuming their previous job full-time. The mean time to RTW was 16 weeks. Factors associated with successful RTW included higher educational level, less physically demanding work, pre-operative sick leave of less than one year, and post-operative support received at work. Age, gender, body mass index, American Society of Anesthesiologists score, type of procedure, indication for surgery, and post-operative complications did not significantly influence RTW rates. Patients who returned to work showed significantly better patient-reported outcome measures. Sixty-seven percent of patients successfully returned to work after shoulder arthroplasty. Predictive factors for successful RTW included educational level, job physicality, pre-operative sick leave, and the extent of post-operative support received at work. Neither the type of arthroplasty, indication for surgery, presence of complications nor the need for revision surgery significantly impacted RTW outcomes. These findings may guide pre-operative counseling and help to manage post-operative work-related expectations in patients undergoing shoulder arthroplasty.
Chronic limb-threatening ischemia (CLTI) is a severe manifestation of peripheral arterial disease associated with high risks of amputation and mortality. Trials of cell-based therapies in patients unsuitable for revascularization ("no-option" or "poor-option" CLTI) have produced inconsistent results, underscoring the need for improved prognostic enrichment, baseline risk balancing, and protocol-defined stratification. This structured narrative review synthesizes evidence linking host-state markers-including laboratory biomarkers, clinical host-state factors, and physiologic/perfusion indices-to clinically meaningful CLTI outcomes. Inflammatory, nutritional, renal, metabolic, lipid, coagulation-related, infection, dialysis, frailty, smoking, etiology, and perfusion-related variables may shape the regenerative microenvironment and contribute to heterogeneity in cell therapy trial outcomes. However, current evidence primarily supports prognostic risk stratification rather than validated prediction of differential treatment response. We therefore interpret treated-cohort associations and post hoc subgroup observations as hypothesis-generating candidate variables for prospective host-state × treatment interaction testing, not as validated predictive biomarkers. We propose a conceptual trial-design framework: first, confirm no-option or poor-option CLTI through multidisciplinary review, guideline-aligned assessment, objective hemodynamic testing, vascular imaging, and multidomain assessment; second, provisionally categorize patients into favorable, intermediate, and unfavorable host-state profiles using approximate prognostic ranges for prospective validation rather than clinical eligibility cutoffs, treatment-selection rules, or gatekeeping thresholds; third, ensure clinically necessary stabilization before eligibility confirmation and treat any run-in or post-randomization optimization strategy only as an optional, secondary, protocol-justified design component; and fourth, apply stratified randomization, covariate adjustment, blinded outcome adjudication, and prespecified host-state × treatment interaction analyses. Integrating host-state biomarkers and clinical factors into CLTI cell therapy trial design may support prognostic enrichment, stratified enrollment, baseline risk adjustment, and hypothesis-driven evaluation of treatment-effect heterogeneity. The proposed profiles are hypothesis-generating trial-design strata, not validated clinical eligibility criteria, treatment-selection rules, or biomarker-based gatekeeping thresholds. Prospective validation will require standardized biomarker assays, harmonized endpoints, transparent reporting of cell products and concomitant care, and randomized testing of host-state × treatment interactions to advance precision regenerative medicine in this setting.
Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection characterized by necrosis of the fascia and subcutaneous tissues, with high rates of amputation and mortality. Early diagnosis and aggressive surgical intervention are critical determinants of outcome, yet data from eastern India remain scarce. This study aimed to describe the clinicopathological profile of NF and evaluate factors associated with poor outcomes in patients admitted to a tertiary care center in Jharkhand. This hospital-based observational study was conducted in the Department of General Surgery, Tata Main Hospital, Jamshedpur, from November 2020 to March 2022. One hundred consecutive patients diagnosed with NF were enrolled. Demographic data, clinical features, microbiological findings, and surgical management were recorded using a predesigned proforma. In-hospital mortality was used as the surrogate for poor outcomes. The chi-square test was used to assess associations between clinical variables and mortality, with p<0.05 considered statistically significant. The mean age of participants was in the 41-60-year group, with a male preponderance (76%). Diabetes mellitus was the most common comorbidity (66%). The lower extremity was the most frequently affected site (75%). Staphylococcus species (29%) and Escherichia coli (25%) were the predominant isolates. Debridement was performed in 97% of patients, and amputation was required in 18%. In-hospital mortality was 14%. On statistical analysis, diabetes mellitus (p=0.022), delayed or absent debridement (p=0.008), requirement of multiple surgeries (p=0.002), and amputation (p=0.009) were significantly associated with poor outcome. Diabetes mellitus, delayed or absent debridement, requirement of multiple operative sittings, and amputation were significantly associated with in-hospital mortality in NF. Early clinical recognition and prompt aggressive surgical intervention, with meticulous management of diabetes, are essential to improve outcomes in this life-threatening condition.
Dementia is a leading cause of disability and mortality in Europe, yet no recent harmonised assessment has described its impact across the European Union (EU-27) and the WHO European Region. We used data from the Global Burden of Disease Study 2023 (GBD 2023) to estimate prevalence, mortality, and disability-adjusted life years (DALYs) for dementia from 1990 to 2023. Estimates were produced for the EU-27 and the WHO European Region, by age and sex. Non-fatal outcomes were modelled using DisMod-MR 2.1, and dementia-attributable mortality was estimated using an excess-mortality framework. We also quantified DALYs attributable to six modifiable risk factors. In 2023, 7.76 million people (95% UI 6.69-8.72) were living with dementia in the EU-27 and 12.28 million (10.44-13.90) in the WHO European Region, representing ∼90% increases since 1990 despite modest declines in age-standardised prevalence. Prevalence was nearly twice as high in women as in men. Dementia rose from the eighth to the third leading cause of death in the EU-27. Dementia accounted for 5.49 million DALYs (2.44-11.41) in the EU-27. An estimated 41% (24.4-57.4) of dementia DALYs in the EU-27 were attributable to modifiable risk factors, particularly ambient particulate matter pollution, high fasting plasma glucose, and high body-mass index, which are disproportionately concentrated in socioeconomically disadvantaged populations. Despite modest declines in age-standardised rates, the absolute burden of dementia in Europe continues to rise, driven by population ageing. The substantial contribution of modifiable risk factors highlights major opportunities for prevention. Robust, country-specific estimates are essential to guide integrated strategies combining prevention and care planning. Regione Puglia and CNR for Tecnopolo per la Medicina di Precisione; Regione Puglia for the national "Fund for Alzheimer's and Dementia 2021-2023" (Piano Regionale Demenze 2021/2023).
The COVID-19 pandemic was associated with increased maternal morbidity and mortality, with racially minoritized women having worse outcomes than other women in the United States. However, there is little understanding of pandemic-specific stressors that may contribute to disparate outcomes. Thus, this analysis provides descriptive statistics of COVID-19 pandemic related factors among a sample of women who recently gave birth in the United States that can inform future public health disaster preparedness. Cross-sectional analysis of secondary data. Analysis of 2020-2021 Pregnancy Risk Assessment Monitoring System COVID-19 supplement data (weighted n = 453,231) identified five pandemic experience factors through factor analysis: family household stressors, housing instability, COVID prevention measures, COVID household exposure, and external exposure. Prevalence of each factor was estimated overall and by demographic factors. Family household stressors affected 42.1% of women, including increased anxiety (48.5%) and job loss (29.9%). Housing instability impacted 11.3%, while 35.2% struggled accessing prevention supplies. Significant disparities emerged: Black and Hispanic women experienced highest family stress rates (48.5%, 48.0%); American Indian/Alaska Native women faced greatest housing instability (21.6%). Younger, unmarried women and those with lower education, Medicaid enrollment, or pre-existing vulnerabilities experienced disproportionate burdens. Findings necessitate targeted emergency preparedness protocols prioritizing pregnant women's social support infrastructure, including housing assistance programs, expanded childcare services, and guaranteed access to prevention resources. The pandemic exacerbated maternal health disparities, with marginalized communities bearing the greatest burden. Medicaid expansion and culturally-responsive interventions should be implemented to support vulnerable populations during public health crises.
Prosthetic joint infection (PJI) following total knee arthroplasty remains a serious complication. Although two-stage revision is considered the gold standard, predictors of failure remain unclear. This study aimed to identify factors associated with failure after two-stage revision for knee PJI using conventional statistics with exploratory machine-learning validation. A retrospective review was conducted on 154 patients who underwent two-stage revision for knee PJI between 2018 and 2022 at a high-volume arthroplasty center. All patients completed a minimum 24-month follow-up (mean 36.3 ± 20.3 months). Treatment success and failure were defined using MSIS Tier-1 criteria. Independent predictors of failure were identified using multivariate logistic regression and Random Forest classification model. Most infections were late in onset (91.6%), and 68.2% were culture-positive. Difficult-to-treat (DTT) organisms were identified in 22.1% of cases and were associated with significantly worse postoperative WOMAC, KSS, and OKS outcomes (all P < .001). Multivariate analysis identified DTT organisms (odds ratio 0.035, P < .001) and shorter time from index surgery to infection (odds ratio 1.033, P = .016) as independent predictors of failure. The random Forest model demonstrated an overall accuracy of 84.2% and identified DTT organisms, pre-revision C-reactive protein levels, and time from index surgery as the most influential variables contributing to classification performance. Most failures occurred within 30 months of reimplantation. DTT organisms and shorter time from index surgery to infection were independent predictors of failure following two-stage revision for knee PJI. Exploratory machine-learning analysis identified similar predictor patterns and supports the importance of microbiological factors in determining outcomes.
Population ageing has emerged as a major public health challenge globally and in India. Elderly individuals residing in old age homes often face physical, social, and psychological challenges that may adversely affect their well-being. This study aimed to assess the level of well-being and identify its determinants among elderly residents of selected old age homes in Kolkata. A cross-sectional study was conducted among 273 elderly individuals aged ≥60 years residing in four selected old age homes in Kolkata, West Bengal, from November 2020 to October 2022. Data were collected through face-to-face interviews using a predesigned and pretested schedule. Well-being was assessed using the World Health Organization-Five Well-Being Index (WHO-5), functional status using the Katz Activities of Daily Living (ADL) scale, and psychological distress using the Patient Health Questionnaire-4 (PHQ-4). Factors associated with well-being were examined using multivariable logistic regression. The mean age of the participants was 74.1 ± 7.8 years, and 142 (52.1%) were male participants. The mean WHO-5 score was 13.32 ± 3.72, with 152 (55.7%) of participants demonstrating good well-being. Chronic morbidity was present in 255 (93.5%) of participants, while 253 (92.7%) experienced some degree of psychological distress. Well-being was negatively correlated with age (rho = -0.311, p < 0.001) and psychological distress (rho = -0.242, p < 0.001), and positively correlated with functional status (rho = 0.339, p < 0.001). In multivariable analysis, nuclear family background (adjusted odds ratio (AOR): 1.9; 95% confidence interval (CI): 1.04-3.75), married status (AOR: 2.8; 95% CI: 1.35-6.11), previous government employment (AOR: 3.1; 95% CI: 1.29-7.31), voluntary admission to the old age home (AOR: 3.6; 95% CI: 1.82-7.39), duration of stay ≤2 years (AOR: 4.8; 95% CI: 1.19-19.8), and absence of psychological distress (AOR: 3.0; 95% CI: 1.29-7.31) were independently associated with good well-being. More than half of the elderly residents demonstrated good well-being, although psychological distress was highly prevalent. Functional independence, psychosocial factors, and psychological health were important determinants of well-being. Strategies aimed at strengthening mental health support, maintaining functional ability, and fostering supportive institutional environments may help improve well-being among institutionalized elderly populations.
Preterm birth influences early functional brain maturation at term-equivalent age. Using resting-state functional magnetic resonance imaging from a large Chinese neonatal cohort (62 term-born and 107 preterm neonates), we examined static and dynamic network organization using multi-level graph-theoretical analyses. Preterm neonates exhibited reduced global integration and segregation, reflected by lower global efficiency, clustering coefficient, and local efficiency, together with increased characteristic path length. Widespread nodal and modular alterations were observed across multiple networks. Dynamic analyses revealed selective edge-level disturbances involving the right parahippocampal gyrus and its connections with default mode, visual, and limbic networks, despite limited group differences in global or nodal dynamic metrics. Developmental analyses further showed associations between specific global metrics and postmenstrual age at scan. Network measures were also associated with prenatal factors, including multiple pregnancy and cesarean delivery. These findings characterize early alterations in static and dynamic functional network organization after preterm birth and highlight prenatal factors potentially related to neonatal brain development.
Cardiac myxoma is the most common primary cardiac tumor and typically arises in the left atrium. Large, mobile myxomas may prolapse through the mitral valve and produce functional mitral stenosis with secondary pulmonary hypertension. We report a 57-year-old woman with cardiovascular risk factors (hypercholesterolemia and obesity) who presented with New York Heart Association class III dyspnea and palpitations. First-line transthoracic echocardiography revealed a giant, mobile left atrial mass (4.7 x 4.8 cm) attached to the basal third of the interatrial septum, prolapsing into the left ventricle and producing a mean transmitral gradient of 16 mmHg with severe pulmonary hypertension (estimated pulmonary artery systolic pressure approximately 80 mmHg). Preoperative coronary computed tomography (CT) angiography, performed to exclude significant coronary artery disease given her cardiovascular risk factors and to characterize the intracardiac mass non-invasively, confirmed the mass and showed coronary atheromatosis without significant stenosis. The mass was surgically resected within two weeks of diagnosis via a minimally invasive thoracoscopic approach, decided in a multidisciplinary heart team meeting, with femoro-femoral cannulation, without preoperative anticoagulation; activity restriction and close clinical monitoring were maintained while awaiting surgery. The postoperative course was uncomplicated, with early extubation and rapid mobilization. At one-month follow-up, the transmitral gradient and pulmonary artery pressures had normalized, with a stable, mild residual mitral regurgitation and complete symptom resolution. Histopathological examination showed a well-circumscribed, non-encapsulated, smooth-surfaced proliferation of spindle-to-stellate cells within an abundant myxoid stroma, without atypia, mitoses, or necrosis; immunohistochemistry was positive for calretinin, confirming the diagnosis of myxoma. This case illustrates the diagnostic and hemodynamic impact of a giant left atrial myxoma and the feasibility of a minimally invasive thoracoscopic resection in a carefully selected patient.
Posterior spinal fusion (PSF) is the standard surgical treatment for progressive adolescent idiopathic scoliosis (AIS). While return to sport after PSF has been described, return to school (RTS) remains poorly defined despite its educational and psychosocial importance. This study aimed to quantify RTS timelines, compare anticipated versus observed absences, and evaluate demographic, surgical, psychosocial, and socioeconomic predictors. Consecutively enrolled English-speaking AIS and juvenile idiopathic scoliosis (JIS) patients undergoing PSF at a single institution between 2022 and 2025 were prospectively studied. Preoperative surveys captured demographics, school type, anticipated RTS, and awareness of accommodations available through a patient's school setting. Postoperative surveys documented actual RTS, attendance, and barriers. RTS was defined as the first day the patient resumed full-day, in-person school attendance. Partial day attendance, hybrid instruction, and virtual learning were not separately analyzed. The Pain Catastrophizing Scale assessed psychological status, and the Area Deprivation Index (ADI) measured socioeconomic context. Group comparisons used chi-square/Fisher's exact tests and t-tests/Mann-Whitney U; regression identified predictors. A total of 118 patients (84% female; mean age 14.5 ± 1.9 years) were included. Families anticipated 31.4 days of absence, while 71 postoperative respondents reported a mean absence of 46.8 ± 18.6 days (P = .022). Homeschool and private school students demonstrated numerically shorter RTS intervals than public school students (26.3, 32.8, and 43.1 days, respectively); however, these differences did not reach statistical significance (P = .160). Fusion length, sex, ADI, and race were not independent predictors of RTS. AIS/JIS patients undergoing PSF returned to school at a mean of 6.7 weeks, approximately 2 weeks later than anticipated. Exploratory analyses suggested possible differences by school type and psychosocial factors, which should be investigated further in future, larger studies. (1)There may be an educational gap, as families tend to underestimate the time required for their child to return to school (RTS).(2)Surgical and demographic factors, including length of fusion, sex, Area Deprivation Index, and race, were not associated with time to RTS. II, Prospective cohort study.
To evaluate the clinical utility and positivity predictors of inpatient stress testing (iST) in a real-world cohort of troponin-negative patients. Retrospective cohort. Large community hospital in Midwest, USA. Adults with suspected coronary ischemia who had negative serial troponins and underwent iST during the index admission. iST, and downstream interventions. iST positivity and its clinical predictors, its diagnostic performance against invasive coronary angiography (ICA), revascularization rates, and 90-day outcomes. Among 769 patients, iST positivity was 9.4%. Presenting symptoms, and most traditional cardiovascular risk factors were not independently associated with iST positivity. However, established atherosclerotic cardiovascular disease was associated with a higher likelihood of a positive iST (p = 0.03). Among the selectively referred subgroup undergoing ICA, iST demonstrated moderate sensitivity (77.1%) but poor specificity (47.4%) for obstructive coronary artery disease (CAD), with limited discriminatory ability (AUC = 0.62). The negative likelihood ratio (0.48) indicated only modest reduction in post-test probability following a negative iST. Revascularization occurred in 42.1% of ST-positive patients referred for ICA and 20.0% of ST-negative patients. At 90 days, major adverse cardiovascular events were rare (0.7%) across the cohort. Among troponin-negative patients, presenting symptoms and traditional cardiovascular risk factors did not predict iST positivity, with iST demonstrating low diagnostic yield and poor discrimination for obstructive CAD. Overall, these findings suggest that routine reflexive iST in this population may provide limited incremental diagnostic value within this clinical pathway. However, as a retrospective study with clinician-driven referrals, these findings show associations, not causation.
Musculoskeletal (MSK) pain is a common condition during pregnancy, yet its broader functional, psychological, and social impacts remain underexplored, particularly in Middle Eastern populations. This study aimed to assess the prevalence and distribution of MSK pain during pregnancy, evaluate its impact on health-related quality of life (HRQoL), and identify associated sociodemographic, obstetric, and lifestyle factors. A cross-sectional study was conducted among 300 pregnant women attending a tertiary university hospital in Riyadh, Saudi Arabia. Data were collected using the validated Short Form-12 (SF-12) Health Survey. Statistical analyses included chi-square tests, independent t-tests, and multivariate logistic regression. The mean age of participants was 32.5 ± 5.5 years, and 54.3% were in their third trimester. MSK pain was highly prevalent, with lower back pain being the most commonly reported site (64.3%). The mean overall HRQoL score was 51.9 ± 18.5, with 47.3% of participants classified as having poor quality of life. MSK pain was significantly associated with lower scores in physical functioning, mental health, social functioning, and overall quality of life. Multivariate analysis identified multiparity (AOR = 3.12) and physical inactivity (AOR = 2.34) as independent predictors of MSK pain. Musculoskeletal pain-particularly lower back pain-is highly prevalent during pregnancy and is significantly associated with reduced quality of life. Multiparity and physical inactivity are important associated factors. Promoting antenatal physical activity and targeted patient education may help reduce the burden of MSK pain.
The aim of this study was to examine the association between self-rated health (SRH) and risk of atrial fibrillation (AFIB). We performed a cohort study including 104,198 middle-aged participants from the Västerbotten Intervention Programme, northern Sweden 1988-2014. All participants were free of AFIB at inclusion and completed a questionnaire including SRH. Participants were followed from the health examination to diagnosis of AFIB, death, migration or September 5, 2014. Cox regression analysis was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Among participants, 26.6% rated their health as very good, 46.6 as good, 20.4% as average, 5.1% as somewhat poor, and 1.4% as poor. In total, 4775 participants were diagnosed with AFIB. In a multivariable model adjusted for cardiovascular risk factors, good (HR 1.13 [95% CI 1.04, 1.22]), average (HR 1.28 [95% CI 1.16, 1.40]), and somewhat poor (HR 1.26 [95% CI 1.09, 1.45]) SRH were associated with increased AFIB risk compared to very good SRH. P-value for trend for increased AFIB risk with worsening SRH was <0.01. A significant interaction between SRH and sex was observed. In conclusion, poorer SRH is associated with increased risk of first-time AFIB.
Individual growth is an important demographic component in population dynamics that indicates the contribution of biomass to the population, such as an increase in length and weight over time. In addition, the length-at-age provides information concerning mortality, reproduction rates, survival, and biological factors, which are essential for stock assessment and fishery management. Age and growth studies have focused on estimating average growth trajectories based on length-at-age data from only one developmental stage, assuming a constant growth throughout the life cycle. However, the individuals within a cohort grow at different rates and speeds. This causes uncertainty in the mathematical models fitted to the data, both in the growth parameters and in the mean length-at-age within a cohort. The datasets included in this article were collected from two sources: 1) Fishery-independent data of shell length frequency and age of individuals in early growth stages (0-68 days) obtained under rearing experimental conditions. 2) Fishery-dependent data of shell length-at-age of adult individuals aged 3-47 years collected from commercial landings. The straight-line distance of live specimens was measured between the anterior and posterior margin of the shell. Specimens were then dissected to extract the shells. Age was determined as the number of internal growth lines. The length and age (days) datasets comprised 797 records for larvae and juveniles, and 357 records for adult individuals. These data provide valuable information for researchers, decision makers, the government, and private and academic institutions. The dataset enables comparative analyses and further investigations. Its reuse potential extends to broader topics, such as stock assessment, population dynamics, and fishery management.
Cystic Fibrosis (CF) is a genetic disease characterized by chronic pulmonary inflammation and infection, principally with Pseudomonas aeruginosa. P. aeruginosa can exhibit resistance to innate immune effectors and antibiotics by expressing virulence factors and forming antibiotic-resistant biofilms, which facilitate chronic infection in immunocompromised hosts. Therefore, new antimicrobials are required. MicroRNAs are mammalian short non-coding RNAs that negatively regulate protein expression. MiR-17-5p, an inhibitor of CXCL8/IL-8, can decrease neutrophil abundance in the CF lung. Here we investigate whether miR-17-5p has anti-P. aeruginosa properties. The sequences of the full-length miRNA and the miR-17-5p isoform miR.17.P4d_5p were tested for their ability to bind to RNA transcripts encoded by P. aeruginosa PAO1 (NC_002516) using the bioinformatics tools RocketmiR and IntaRNA. A miR-17-5p DNA tetrahedron (Td-miR.17.P4d_5p, Size = 118-180 nm) was tested for its delivery into CF bronchial epithelial cells and ability to inhibit IL-8 gene and protein expression, and its effects on P. aeruginosa growth, antimicrobial resistance, and biofilm formation. Successful delivery into CFBE41o- and 16HBE14o- cells inhibited IL-8 expression induced by Pseudomonas-conditioned medium (PAO1, Mucoid strains 1 and 2 p < 0.00001; PA14 p < 0.0001). Delivery into PAO1 and PA14 inhibited growth and biofilm formation while significantly enhancing their sensitivity to the antibiotic cefotaxime. Td-miR.17.P4d_5p also significantly inhibited biofilm formation in two clinical mucoid P. aeruginosa strains. qPCR and EMSA were used to investigate the mechanism of action of miR.17.P4d_5p. The data showed that miR.17.P4d_5p could inhibit expression of kynU (p < 0.00001), a tryptophan metabolism pathway molecule related to PAO1 growth, and the biofilm formation-related molecules pilL, fimX, ppkA and pslA (all p < 0.00001) in P. aeruginosa PAO1. The combined anti-IL-8 and anti-P. aeruginosa properties of miR.17.P4d_5p suggest its potential usefulness as a dual anti-infective and anti-inflammatory therapeutic strategy for CF.
Diet strongly influences nutritional status, contributing to the coexistence of undernutrition and excess weight in many low- and middle-income countries. In Côte d'Ivoire, however, dietary patterns and their relationship to nutritional status are not well characterized, limiting evidence-based interventions addressing the dual burden of malnutrition. This study aims to 1) identify dietary patterns among urban Ivorian schoolchildren and adult females of reproductive age, 2) assess diet quality by pattern, and 3) characterize the sociodemographic factors and nutritional status of individuals within each pattern. We conducted a cross-sectional dietary survey in 4 cities (Bouaké, Daloa, Abengourou, and Yopougon). Dietary data were collected through one 24-h recall from 443 children (6-12 y) and 441 adult females (15-49 y); a second recall was administered to 12% of participants. Dietary patterns were derived using latent class analysis. Associations with nutritional status, sociodemographic indicators, diet quality, diet diversity, and nutrient adequacy (Probability of Adequacy) were examined using the 3-step bias-adjusted approach. Four dietary patterns were identified for each group. Two were found in both children and adult females ("Fish, oil, and vegetables" and "Dairy and sweet"), whereas children had "Poultry and fruit" and "Refined, red meat, and vegetable" patterns, and adult females had "Poultry, red meat, and fruit" and "Low energy intake" patterns. The fish and dairy patterns, more common in Bouaké and Daloa, were associated with lower education levels (and with occupation, housing, and dependent children among adult females only), yet showed higher diet quality, characterized by greater dietary diversity and nutrient adequacy. In contrast, the poultry (children) and low-intake (adult females) patterns showed poorer dietary diversity and nutrient adequacy. Dietary patterns among urban Ivorian children and adult females were largely comparable. Promoting familiar, fish- and vegetable-based diets may enhance nutrient adequacy. The early stage of nutrition transition suggests a window of opportunity for preventive policy action.This trial was registered at clinicaltrials.gov as NCT06175130.
Accurate identification of root canal anatomy is essential for endodontic success, particularly in mandibular incisors, where additional canals such as the lingual canal are frequently missed using conventional diagnostic methods. In this context, cone-beam computed tomography (CBCT) has emerged as a valuable tool for detecting complex anatomical variations. Therefore, this study evaluated the prevalence, distribution, and spatial characteristics of the lingual canal using CBCT, as well as its association with demographic factors. This observational, cross-sectional, retrospective study included CBCT scans from 342 patients (1,368 mandibular incisors). Images were acquired using standardized parameters (field of view: 10 × 5 cm; voxel size/slice thickness: 0.5 mm; interval: 1/1) and analyzed by a single previously trained examiner. Intra-rater reliability was assessed using test-retest analysis in 30% of the sample, demonstrating excellent agreement (ICC = 0.95). Associations between the presence of the lingual canal and demographic variables were evaluated using chi-square tests and odds ratios, while spatial characteristics were assessed using multivariate analysis of variance (MANOVA), adopting a significance level of p < 0.05. The overall prevalence of the lingual canal was 8.84%. It was significantly more frequent in males than females (p < 0.05) and was associated with age, with higher occurrence in individuals aged 40-59 years (p < 0.01). A higher prevalence was observed on the right side, and the predominant canal configuration was straight. Multivariate analysis showed no significant effect of sex, canal position, or their interaction on the combined spatial variables (distance and angle) (p > 0.05). Therefore, the lingual canal is a relatively frequent anatomical variation, more prevalent in males, middle-aged individuals, and on the right side. These findings highlight the importance of careful anatomical assessment to improve endodontic outcomes.
Anaphylaxis is a potentially life-threatening allergic reaction requiring prompt recognition and treatment. Although increasing trends in pediatric anaphylaxis have been reported worldwide, nationwide epidemiological data from Southeast Asia remain limited. This study aimed to investigate the epidemiology, clinical characteristics, and healthcare burden of pediatric anaphylaxis in Thailand using a national administrative database. We conducted a nationwide retrospective study using the Thai National Health Security Office database from 2019 to 2023. Children aged 1 month to <18 years hospitalized with anaphylaxis were identified using ICD-10-TM codes. Demographic characteristics, triggers, comorbidities, complications, and outcomes were analyzed. Temporal trends, regional variation, and factors associated with in-hospital mortality were evaluated. A total of 42,290 pediatric anaphylaxis hospitalizations were identified, increasing from 7877 cases in 2019 to 10,519 in 2023. School-aged children and adolescents accounted for the largest proportion, with male predominance (59.4%). Food-related reactions were more common in younger children, whereas insect-related reactions were more frequent in older age groups. Most patients had favorable outcomes, with a median hospital stay of 1 day and in-hospital mortality of 0.04%. Severe complications and certain comorbidities were associated with increased risk of adverse outcomes. Geographic variation was observed across regions. Pediatric anaphylaxis hospitalizations in Thailand increased during the study period, while mortality remained low. Age-related trigger patterns and regional differences highlight the need for improved surveillance, documentation, and targeted prevention strategies.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is emerging as the most common chronic liver disorder worldwide. However, most of the candidate drugs, except resmetirom, have failed in the metabolic dysfunction-associated steatohepatitis (MASH) trials. The diagnosis of MASH relies on the assessment of key histological features: steatosis, ballooning, lobular inflammation, and fibrosis. Additionally, the current regulatory guidelines consider histological scores as the essential surrogate for the entry and efficacy endpoint decisions in phase IIb and phase III clinical drug trials. The reproducibility of histological scoring systems is increasingly being questioned in clinical trials. Inconsistencies in histopathological reporting, reflected by low inter-observer agreement, are largely attributable to the lack of standardized definitions, ordinal scoring structure with inadequate number of categories, use of variable criteria, ill-defined terminologies, and subjectivity in interpretation, which are further influenced by pre-analytical lab factors. These limitations result in high screen failure rates, poor risk stratification, increased placebo response, and reduced study power in drug trials, making this a serious concern. Liver pathologists are well aware of the urgent need to harmonize definitions and terminology and to transition from semi-quantitative to quantitative measurements using digital pathology (DP) integrated with computer vision and artificial intelligence (AI). Furthermore, standardized, objective, reproducible, and reliable histology-based ground truth is essential for the development and validation of non-invasive diagnostic tests for MASH. Several deep learning (DL) models and architectures, trained on stained or unstained digitized tissue slides using supervised and unsupervised approaches, have been developed, tested, and validated in MASH clinical studies. Liver fibrosis, the strongest primary prognostic determinant of clinical outcomes, has been the most extensively studied histologic feature in MASH. The AI models have demonstrated superior performance with respect to reproducibility and granularity, quantification of fibrosis progression and regression, improved confidence and concordance in Pathologists' scoring, standardization of consensus-based scoring systems, validation of AI-based tools to assist pathologists, and prediction of clinical outcomes. However, several challenges remain in the implementation of DP-enabled AI models in MASLD clinical practice and drug trials. These include ethical and legal considerations, model explainability, patient data privacy and confidentiality, financial investment, and regulatory approvals required for clinical adoption. Nevertheless, digital pathology-coupled DL models have the potential to augment current histopathological assessment in MASH.
A 72-year-old woman with type A acute aortic dissection and a patent false lumen underwent emergency hemiarch replacement. On postoperative Day 13, routine contrast-enhanced computed tomography revealed an impending paradoxical embolism (IPE) and a right main pulmonary embolism. Surgical pulmonary thrombectomy and patent foramen ovale closure were performed. This case provides mechanistic insight into IPE development in the postoperative period. Early-phase hypercoagulability after acute aortic dissection, increased right atrial pressure due to pulmonary embolism, and anatomical factors such as pericardial effusion and altered aortic geometry after graft replacement may have facilitated right-to-left shunting through a previously undetected or functionally latent patent foramen ovale. The patient was discharged on postoperative Day 14 (hospitalization Day 27) and remained asymptomatic without recurrence during 5-year follow-up. This case highlights the importance of considering IPE after type A acute aortic dissection repair and supports routine postoperative imaging to detect clinically silent but life-threatening complications.