To describe the use and appointment status of a nationally integrated telehealth pathway in a single-provider public developmental pediatrics clinic in Türkiye and to examine factors associated with telehealth appointment completion and cancellation. This retrospective single-center study included all telehealth appointments scheduled through Türkiye's national Central Physician Appointment System (Merkezi Hekim Randevu Sistemi: MHRS) using the Ministry of Health remote patient assessment module between 1 December 2023 and 1 December 2025. Telehealth appointments were physician-scheduled for selected clinical situations as a complement to prior in-person developmental assessment. Appointment indications, child and family characteristics, and telehealth appointment status categories (completed, cancelled, no-show) were described. Child-level multivariable binomial generalized linear models with logit link and robust standard errors were used to examine factors associated with telehealth completion and cancellation. A total of 526 telehealth appointments were scheduled for 380 children. Telehealth was most commonly used among children with prematurity or neonatal risk and for selected remote assessment purposes, including home-based naturalistic observation and caregiver-shared video review. Overall, 77.4% of telehealth appointments were completed, 20.5% were cancelled, and 2.1% were classified as no-show; among non-cancelled telehealth bookings, the no-show rate was 2.6% (11/418). In adjusted analyses, higher maternal education, paternal age 25-34 years, and travel distance ≥ 100 km were associated with higher cancellation and lower completion, whereas household income and rural residence were not independently associated. In this public developmental pediatrics clinic, a physician-scheduled telehealth pathway integrated within the national appointment system was used as a supplementary service for selected follow-up, counselling, and remote observational assessment needs. Telehealth appointment completion was generally high, but families living ≥ 100 km from the clinic had less favorable appointment status patterns. These findings support telehealth as a complementary service model in developmental pediatrics and highlight the need to address barriers affecting attendance. • Telehealth is increasingly used in developmental pediatrics, but evidence from routine public services, particularlyin low- and middle-income countries, remains limited. • Missed appointments can reduce usable clinical capacity in single-provider public subspecialty clinics. • This study describes a two-year, physician-scheduled telehealth pathway integrated into Türkiye's CentralPhysician Appointment System within a public developmental pediatrics clinic. • Within the telehealth cohort, maternal education, paternal age 25-34 years, and travel distance ≥ 100 km were associated with less favorable appointment status patterns.
Intracerebral hemorrhage (ICH) is associated with high early mortality. Guidelines recommend a rapid and sustained reduction of systolic blood pressure to <140 mmHg. Achieving and maintaining this target in refractory hypertension often requires prolonged intravenous therapy and complex escalation of oral antihypertensive regimens. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), combines renin-angiotensin blockade with natriuretic peptide augmentation and has proven antihypertensive efficacy; however, data about its real-world use during the acute phase of ICH remain limited. We performed a single-center retrospective cohort study of consecutive patients with acute ICH and untreated refractory hypertension. Following the institutional introduction of ARNI in 2022, patients receiving ARNI as a scheduled second-line oral antihypertensive were compared with historical controls. The primary endpoint was time to antihypertensive regimen stabilization, defined as the time point at which escalation of scheduled oral antihypertensives was no longer required and intravenous or rescue short-acting antihypertensives were discontinued. Secondary outcomes included the number of scheduled oral antihypertensives at stabilization and the discharge modified Rankin Scale (mRS) scores. Thirty patients with ARNI (ARNI group: 2022-2024) and 30 consecutive historical controls (non-ARNI group: pre-2021) were included. Baseline characteristics were similar between groups. The mean time to antihypertensive regimen stabilization tended to be shorter in the ARNI group, i.e., 119.6 hours in the ARNI group and 143.3 hours in the non-ARNI group (unadjusted p = 0.275). In multivariable linear regression, ARNI use was independently associated with shorter stabilization time (partial regression coefficients (B) = -40.427 hours; 95% confidence interval (CI): -79.833 to -1.021; p = 0.045). At stabilization, the ARNI group required fewer scheduled oral antihypertensives compared to controls (median: 2.0 (interquartile range: 2.0-2.0) vs. 2.0 (2.0-3.0); p = 0.030; adjusted B = -0.483; 95% CI: -0.825 to -0.140; p = 0.006). The discharge mRS scores did not differ between the groups. In our routine clinical practice, early incorporation of ARNI as a second-line oral antihypertensive in acute ICH was associated with earlier completion of antihypertensive regimen adjustment processes and reduced treatment complexity. These results support the usefulness of ARNI as a practical second-line antihypertensive for goal-oriented blood pressure management and provide hypothesis-generating data for future prospective studies.
High demand for endoscopic procedures contributes to prolonged wait times and limited access to care, particularly in safety-net health systems. Missed appointments, including no-shows and late reschedules, further strain resources and delay diagnosis and treatment. Epic Systems provides a proprietary Risk of Patient No-Show Model, previously validated in primary care settings, but its performance in predicting attendance for endoscopy appointments has not been evaluated. A retrospective cohort study was conducted among adults scheduled for outpatient endoscopy at a single safety-net hospital between January 1, 2023, and August 1, 2024. Patients aged ≥ 18 years with at least one prior encounter in the electronic medical record (EMR) were included; inpatient procedures and early cancellations (> 2 days before the appointment) were excluded. The primary outcome was appointment completion versus no-show. Epic's predicted no-show risk, demographic characteristics, procedure type, and patient portal activation status were extracted. The relationship between predicted and observed no-show rates was assessed using the coefficient of determination (R²) and linear regression. Secondary analyses stratified results by patient portal activation. Among 4,658 unique patients, the median age was 59 years, 52.2% were male, and the cohort was racially and linguistically diverse. Overall, 1,493 patients (32.1%) did not attend their scheduled endoscopy. Epic's predicted no-show risk demonstrated a strong linear correlation with actual no-show rates (R² = 0.87). Observed missed appointment rates followed the equation: Missed Appointment Rate = 1.30 × (Epic Risk) + 0.16, indicating a baseline no-show rate of 16%. Each percentage-point increase in Epic's predicted risk corresponded to a 1.3-point increase in observed no-show rate. Patients without an activated patient portal (MyChart) had approximately 5-percentage-point higher no-show rates across the risk spectrum. Epic's Risk of Patient No-Show model shows strong correlation with real-world endoscopy attendance and may support predictive overbooking and targeted outreach to improve endoscopy unit efficiency. Given its integration within the EMR, this tool offers a practical framework for operational interventions, though further validation across diverse health systems is warranted.
Patients with Medicaid compared with private insurance have increased difficulty gaining access to orthopedic care. How insurance status affects access to care for young athletes (football; from here, all "young athletes" are football players) with hip labrum tears has yet to be assessed. The purpose of this study was to determine whether there is a difference in insurance acceptance rates for Medicaid versus Blue Cross Blue Shield (BCBS) for young athletes with a hip labral tear. Fifty orthopedic clinics across 10 states were contacted using a standardized script. Each clinic was called twice: once as a young athlete with BCBS and once with a young athlete with Medicaid, requesting an appointment for a hip labral tear. The primary outcome was appointment success. Secondary outcomes included barriers to scheduling and wait times. Statistical analysis was performed using chi-squared and Mann-Whitney U tests. All clinics accepted BCBS insurance, whereas only 16 (32%) accepted Medicaid (P<0.0001). Young athletes with BCBS successfully scheduled an appointment 100% of the time compared with only 24% for young athletes with Medicaid (P<0.0001). Of the 34 clinics that did not accept Medicaid, 22 (65%) cited not accepting the insurance, and 11 (32%) required a referral. Among clinics that accepted both insurance types, there was no significant difference in median wait time (13 vs 14 days, P=0.44). For young athletes with hip labrum tears, it is more difficult to schedule appointments with Medicaid insurance compared with BCBS insurance. The main barrier to care with Medicaid for young athletes is requiring a primary care physician referral.
One-lung ventilation (OLV) is used to isolate one lung during thoracic surgery, but manipulation and positioning can affect heart-lung interaction. Cardiomegaly may exacerbate these changes, especially in the left lateral decubitus (LLD) position. To investigate the effect of cardiomegaly on heart-lung interaction during OLV, particularly in the LLD position. A 20-year-old male with recurrent spontaneous pneumothorax was scheduled for right-sided bronchopleural fistula repair via thoracotomy. The patient presented with cardiomegaly (cardiothoracic ratio 75%) and echocardiographic evidence of right ventricular and atrial dilation. In the LLD position, OLV led to desaturation when both lungs were ventilated, but oxygenation improved when only the left lung was ventilated. Cardiomegaly alters heart-lung interaction during OLV, particularly in the LLD position. The enlarged heart exerts pressure on the left lung, impairing ventilation. When both lungs are ventilated in this position, ventilation is directed toward the right lung, reducing oxygenation and causing desaturation. However, restricting ventilation to the left lung improved oxygenation due to better lung compliance and less interference from the enlarged heart. Cardiomegaly affects heart-lung interaction during OLV in the LLD position. Oxygenation improves when only the left lung is ventilated, likely due to less compression of the left lung. The supine position may further enhance oxygenation even with bilateral ventilation. This case highlights the importance of considering cardiomegaly in OLV management. This section should be written as per the CARE checklist item 3.
ObjectiveUmbilical cord-derived mesenchymal stromal cells (UC-MSCs) are a promising treatment for knee osteoarthritis (KOA). This study aimed to (1) characterize early synovial fluid biomarker changes after intra-articular UC-MSCs therapy in advanced KOA and (2) explore their relationship with short-term clinical outcomes.MethodsIn this prospective, single-arm case series, 15 patients with advanced KOA (Kellgren-Lawrence III-IV) scheduled for total knee arthroplasty received a single intra-articular injection of 20 × 106 allogeneic UC-MSCs. Synovial fluid was aspirated at baseline and approximately 6 weeks post-injection. A panel of 29 soluble biomarkers related to inflammation, matrix remodeling, immune signaling, angiogenesis, and metabolism was quantified using multiplex immunoassays. Clinical status was evaluated with Patient-Reported Outcome Measures (PROMs) before and at a mean of 48 ± 18 days after the injection. Paired differences were analyzed using the Wilcoxon signed-rank tests.ResultsSignificant post-treatment differences were observed in biomarkers associated with extracellular matrix turnover (Matrix Metalloproteinase [MMP]-1, MMP-3, MMP-7, Cartilage Oligomeric Matrix Protein [COMP]), vascular remodeling (Vascular Endothelial Growth Factor [VEGF], Vascular Cell Adhesion Molecule [VCAM]-1), immune modulation (interleukin [IL]-8), and metabolic or structural regulation (Leptin, dickkopf [Dkk]-1). Most PROMs demonstrated significant improvements. These findings describe molecular changes in synovial fluid observed after intra-articular UC-MSC administration.ConclusionsIn this prospective single-arm cohort, intra-articular UC-MSC administration was feasible and well tolerated, and we observed pre-post changes in synovial fluid biomarkers and patient-reported outcomes. These findings do not establish causality and warrant confirmation in controlled studies. The study was registered at Clinicaltrials.gov: Mechanisms of Treatment Effects Using Cultured, Allogeneic Mesenchymal Stromal Stem Cells (MSCs) in Knee Osteoarthritis, NCT06078059, https://clinicaltrials.gov/study/NCT06078059?intr=NCT06078059.
Outpatient total shoulder arthroplasty (TSA) is increasingly performed as perioperative pathways and value-based care models expand. However, a subset of patients scheduled for outpatient TSA require unexpected inpatient admission, which may indicate higher perioperative risk and increased resource use. We hypothesized that older age, greater comorbidity burden, and longer operative time would be associated with conversion from planned outpatient TSA to inpatient admission, and that conversion would be associated with worse short-term outcomes. Planned outpatient TSA cases were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021. Revision arthroplasty, hemiarthroplasty, procedures for infection or malignancy, fracture-related cases, emergency or other nonelective cases, records with missing length of stay (LOS), and extreme LOS outliers were excluded. All included cases were planned outpatient procedures; patients with LOS 0-1 day comprised the Outpatient cohort, and those with LOS ≥2 days comprised the Conversion-to-Inpatient cohort. Demographics, comorbidities, operative time, and 30-day outcomes were compared between groups, and multivariable logistic regression identified independent predictors of conversion and associations with adverse events. A total of 6,755 planned outpatient TSA cases met inclusion criteria, including 6,302 (93.3%) Outpatient and 453 (7.2%) Conversion-to-Inpatient cases. Compared with Outpatient patients, the Conversion-to-Inpatient cohort was older (70.3 ± 9.6 vs 68.0 ± 9.5 years), more often female, and more frequently Hispanic, with higher BMI and a greater proportion of American Society of Anesthesiologists class ≥3 and comorbidities (all P < .05). Mean operative time was longer among converted patients (127.9 ± 59.3 vs 104.7 ± 40.8 minutes, P < .001). On multivariable analysis, older age, female sex, Hispanic ethnicity, ASA ≥3, diabetes, COPD, and longer operative time were independent predictors of conversion. Conversion-to-Inpatient status was associated with higher odds of 30-day reoperation, overall morbidity, bleeding transfusion, and non-home discharge, while adjusted 30-day readmission did not differ significantly between cohorts. Unplanned conversion from outpatient to inpatient status occurs in approximately 7% of planned outpatient TSAs and is associated with identifiable demographic, comorbidity, and operative risk factors, as well as higher morbidity, transfusion requirements, and non-home discharge. These findings may help inform patient counseling and perioperative planning for outpatient TSA pathways.
Many synthetic textiles are used in coastal restoration because natural fiber materials have lower durability and may degrade too quickly; however, these synthetic materials pose environmental risks, such as microplastic pollution. Motivated by the need for materials that balance durability with environmental sustainability, we assessed the feasibility of polyhydroxyalkanoate (PHA) coatings as a strategy to prolong the service life of burlap fabric. Three PHA-based polymers were applied by dip-coating, single-sided melt pressing, and double-sided melt pressing and then immersed in seawater at ∼5 m depth for 288 days. Visual observations, evaluation of the end-point mass loss data, and complementary molecular weight and X-ray scattering analyses show that durability depends on the processing method and polymer crystallinity: double-sided melt-pressed samples retained the most mass (compared to single-sided, dip-coated, and uncoated), and mass loss decreased with increasing initial PHA polymer crystallinity. Additionally, these data support a degradation pathway in which amorphous domains are preferentially eroded and crystalline lamellae thicken due to relaxation of entanglement constraints. These processing-crystallinity-durability relationships suggest that the residence time may be tuned to match restoration schedules, positioning melt-pressed PHA coatings as an ecologically sustainable alternative to persistent plastic materials.
The COVID-19 pandemic and associated school closures presented unprecedented challenges to university students' well-being, highlighting an urgent need to understand the factors influencing their health-related quality of life. This study aimed to explore the association between psychological distress, lifestyle, and career planning on the health-related quality of life of university students during the school closure period in China. A cross-sectional study was conducted, collecting data from 1965 Chinese college students locked down in campus during COVID-19 using a snowball sampling method via an online questionnaire platform (Wenjuan.com). Psychological distress and the health-related quality of life were measured by scales. Descriptive analysis, Chi-squared test and logistic regression analysis were employed to analyze the data. The mean physical component summary score was 47.5, while the mean mental component summary score was 36.8. Students who were women (OR=1.444, P = 0.003), having a boy or girl friend (OR=1.379, P = 0.008), with rural hukou (OR=1.446, P = 0.004), with low psychological distress (OR=4.589, P < 0.001), high physical activity intensity (OR=3.909, P < 0.001), a regular studying schedule arrangement (OR=2.553, P = 0.008), clear career planning (OR=1.570, P = 0.001) during COVID-19 were more likely to report a good physical component summary. For mental component summary, lower psychological distress (OR=8.330, P < 0.001), a regular studying schedule arrangement (OR=2.892, P = 0.001) and keeping same job-hunting pressure (OR=1.852, P = 0.003) were positive influencing factors, whereas having a boy or girl friend (OR=0.774, P = 0.032) and having no clear career planning (OR=0.752, P = 0.020) during COVID-19 were negative influencing factors. In conclusion, while health-related quality of life was generally good, lower psychological distress, healthier lifestyle habits, and clearer career planning were significantly associated with better health-related quality of life among university students during the pandemic-related school closure. These findings underscore the importance of integrating mental health support, lifestyle guidance, and career planning services into student support systems during public health crises. Future studies should develop and evaluate interventions targeting these modifiable factors.
Psychiatric nurses in China face high psychological and occupational strain. Understanding the factors influencing their mental health is essential. This study aimed to determine the positive rate of psychological distress among Chinese psychiatric nurses and to examine the associations of psychological resilience and other psychosocial factors with psychological distress. A cross-sectional study was conducted from October 2024 to January 2025. Using an online survey, 436 psychiatric nurses from six hospitals in Jiangsu Province, China, were recruited. Data were collected using a general information questionnaire, the 12-item General Health Questionnaire (GHQ-12), and the Connor-Davidson Resilience Scale (CD-RISC). Chi-square tests, Spearman correlation, and multivariate logistic regression were employed for analysis. Of 436 nurses invited, 412 provided valid responses (response rate: 94.5%). The positive screening rate for psychological distress (GHQ-12 score ≥ 3) was 38.38%. Multivariate logistic regression analysis showed that among Chinese psychiatric nurses, higher psychological resilience (OR = 0.948, 95% CI: 0.931-0.965, p < 0.001) was associated with lower odds of psychological distress. In contrast, more frequent weekly night shifts (≥ 3 vs. ≤ 2; OR = 2.452, 95% CI: 1.212-4.959, p = 0.013) and poorer self-rated health status (per level increase; OR = 1.711, 95% CI: 1.274-2.299, p < 0.001) were associated with a greater odds of psychological distress. Psychological resilience, night shift frequency, and self-rated health status are significantly associated with psychological distress among Chinese psychiatric nurses. Interventions aimed at building resilience, optimizing work schedules, and promoting health may help protect their mental well-being. Not applicable.
This study aims to compare the efficacy of erector spinae plane (ESP) block with plain bupivacaine versus erector spinae plane block with bupivacaine supplemented with dexmedetomidine in patients scheduled for cesarean section. A randomized controlled trial involving 50 patients posted for elective lower segment cesarean section METHODS: Study participants were randomly assigned to receive bilateral ultrasound ‑ guided ESP block with 20 ml 0.25% bupivacaine alone (Group A, n = 25) or 20 ml of 0.25% bupivacaine with 0.5mcg/kg dexmedetomidine (Group B, n = 25) postoperatively. The primary outcome was total analgesic consumption in the first 24 h after surgery and the secondary outcomes were time for the first request to analgesia, duration of block, visual analog scale (VAS) in 48 h and incidence of adverse effects. Statistical analysis was done using IBM SPSS Statistics-23. Data were compared using the Kolmogorov-Smirnov Test and the Shapiro-Wilk Test, Chi‑square test, independent t‑test and Mann Whitney U test. The total number of analgesic doses (3.3 vs 2.1, mean difference CI 0.71 to 1.16; p=0.001), the total paracetamol required (2.0 vs 1.1 g, mean difference CI 0.53 to 1.22; p=0.001), and the total tramadol required (64 vs 50 mg, mean difference CI 4.79 to 23.20; p=0.004) were all lower in Group B, with statistically significant differences observed between groups. The time to first request for analgesia (8.3 h vs 12.6 h, with a mean difference in confidence interval -6.18 to 2.39, p=0.001) and the duration of block (10.95 h vs 16.47 h, with a mean difference in confidence interval -7.22 to 3.81, p=0.001) were both longer in Group B compared to Group A. The VAS score in Group B was lower and reached statistical significance at 2 h (p=0.001) and 12 h (p=0.048). The incidence of bradycardia was higher in Group B (p=0.01). Dexmedetomidine is an effective adjuvant to bupivacaine in ESP block for reducing total postoperative analgesia requirement and improving efficacy and duration of block in cesarean section.
In both the U.S. and Wisconsin, Black women and infants experience significantly higher rates of morbidity and mortality than their white counterparts. Our research team set out to explore how a community-based and culturally informed perinatal support model could address the needs of Black mothers and their families. We developed and implemented the Today Not Tomorrow Pregnancy and Infant Support Program (TNT-PISP), a community-based, culturally informed perinatal support model integrated with traditional obstetrical care. From October 2019 to August 2022, we held monthly support group sessions facilitated by Black community-based doulas, Black physicians, and community partners. Twenty-five participants engaged in topic-focused and freeform sessions to discuss mental health, breastfeeding, peripartum care, and medical racism. Data were collected through semi-structured interviews and focus groups and analyzed using the Daughtering Method and reflexive thematic analysis. Participants emphasized the importance of shared Black identity and culture in fostering connection and trust. The group's open, judgment-free environment allowed for meaningful conversations and emotional support. Participants valued the exchange of parenting knowledge and community resources. The program's flexible structure and child-friendly setting were key strengths, enabling consistent participation despite busy schedules. This study highlights the potential of community-based, culturally informed perinatal support programs to promote health equity for Black women and infants. Future research should explore such programs' long-term impacts and scalability in diverse settings. Continued efforts to integrate culturally relevant care models into traditional healthcare systems may help promote health inequities in Black communities.
Cardioversion (CV) is commonly used in the emergency department (ED) to treat recent-onset atrial fibrillation (AF) or flutter (AFL). The AFFELECT trial (NCT04267159) is an investigator-initiated, prospective, unblinded randomized controlled non-inferiority trial comparing experimental delayed rhythm control (elective CV performed within 5-9 days after the index visit) to standard acute rhythm control (CV performed in ED) in patients with recent-onset (duration <48 h) symptomatic AF/AFL suitable for rhythm control. A total of 500 patients are randomized in a 2:3 ratio to the acute and delayed groups, respectively, accounting for a possible one-third unplanned early CV rate in the delayed group due to higher symptom burden. Unplanned early CV means that patients with unbearable symptoms are offered the option for an earlier CV (before the 5-9 days target timeline) if needed. Patients randomized to delayed group are discharged immediately after adequate heart rate control (heart rate <110 bpm) and anticoagulation and are scheduled an appointment for delayed CV at a cardiology outpatient clinic (in transoesophageal echocardiography guidance if required). Patients randomized to acute CV undergo cardioversion in the ED within 48 h of arrhythmia onset and are assigned to a cardiologic outpatient clinic visit also within 5-9 days. The primary end-point is the presence of sinus rhythm on electrocardiogram at 4 weeks after the outpatient clinic visit. The AFFELECT trial tests whether delayed management of recent-onset AF/AFL is a non-inferior alternative to acute CV, aiming to reduce ED burden, number of needed CVs, and redirect care to specialized arrhythmia units.
Agenesis of the corpus callosum (ACC) presents with highly heterogeneous clinical features. Common methods rarely achieve accurate prenatal or early postnatal diagnosis and prognosis. We aimed to develop and test an interpretable deep neural network (DNN) that combines multimodal clinical data to improve diagnostic accuracy and neurodevelopmental outcome prediction. We collected data from 205 pediatric patients with ACC at Wuhan Children's Hospital between 2016 and 2024. A total of 27 clinical features were extracted, including neuroimaging findings, perinatal risk factors, and follow-up developmental quotients (Gesell Developmental Schedules and Gross Motor Function scores). Five-fold cross-validation was adopted. We built an eight-layer fully connected DNN with ReLU activation in the hidden layers. For categorical endpoints, a sigmoid output layer with binary cross-entropy loss was used. For continuous endpoints, a linear output layer with mean squared error loss was used. SHAP (Shapley Additive Explanations) values were used to quantify the contribution of individual features to model predictions. Performance was compared with a support vector machine (SVM) baseline and across hyperparameter settings. Area under the receiver-operating-characteristic curve (AUC), F1 score, precision, recall, mean absolute error (MAE), mean squared error (MSE), and coefficient of determination (R2) served as primary metrics. Across 12 neurodevelopmental disorders, the model reached an average AUC of 0.97. AUCs for intellectual disability, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), specific learning disorder and developmental coordination disorder ranged from 0.98 to 1.00. Prediction remained moderate for cerebral palsy (AUC = 0.74) and epilepsy (AUC = 0.67). MAE for both Gesell and Gross Motor Function scores was 0.10, with corresponding R2 values of 0.62 and 0.63. SHAP analysis identified extracranial malformation (clinical type III), facial dysmorphism and birth weight as the most influential features for developmental outcome. The DNN model outperformed the SVM baseline, with an AUC improvement of 0.16 for communication disorder and an R2 increase of 0.19 for Gesell score (p < 0.001). Ablation experiments confirmed eight layers, sixteen neurons per layer, a learning rate of 0.01 and ten training epochs as the optimal configuration. Additional layers or higher learning rates caused overfitting. The proposed interpretable DNN framework outperforms traditional classifiers in early ACC diagnosis and developmental outcome prediction. It provides a potential tool for clinical decision support. Larger samples and integration of raw imaging data are needed to enhance prediction of complex phenotypes such as cerebral palsy and epilepsy.
To compare postoperative platelet counts in patients in whom intraoperative cell salvage (ICS) was performed using either a centrifugation-based device (ICS-centrifugation) or a filtration-based device (ICS-filtration; Same) for red blood cell recovery from shed blood, as well as to compare the transfusion requirements and outcomes of the patients in both groups. Observational, retrospective, single-center study. Academic hospital, June 2021 to May 2024. All patients admitted for scheduled cardiac surgery who had an anticipated duration of cardiopulmonary bypass ≥ 2 hours or underwent aortic arch surgery, redo or combined surgery, or multiple aorto-coronary bypasses, who had expressed their non-opposition to the use of their personal data for research purposes and for whom data collection was performed. Red blood cell recovery from shed blood with either the ICS-centrifugation device (n = 208) or the ICS-filtration device (n = 85) according to device availability. The primary outcome was the decrease in platelet count between the preoperative and postoperative assessments. Secondary outcomes included transfusion rate, postoperative morbidity, and length of hospital stay. A total of 293 patients were included, predominantly male (81.6%); the mean age was 66.2 years. Postoperatively, the platelet count decrease was greater in the ICS-centrifugation group than in the ICS-filtration group (74.9 × 109/L v 65.0 × 109/L; mean difference, 9.94 [95% confidence interval, 1.99-18.58]; p = 0.02). This difference was consistent in the multivariable analysis. The number of patients receiving intraoperative or postoperative transfusion by day 28 was higher in the ICS-centrifugation group than in the ICS-filtration group (49% v 34.1%, p = 0.03). Finally, the ICS-centrifugation group presented higher overall postoperative morbidity rates than the ICS-filtration group on day 28 (16.3% v 5.9%; odds ratio, 0.32 [95% confidence interval, 0.11-0.78]; p = 0.03). Compared with ICS-centrifugation, ICS-filtration may offer advantages in platelet salvage for shed blood, thereby reducing transfusion requirements and related morbidity in cardiac surgery patients. These results need to be confirmed by larger randomized studies with a special focus on clinical outcomes.
Adiposity trends in pediatrics are increasing, escalating the risk for chronic diseases, psychological disorders, and adulthood obesity; creating more complex patients at younger ages. Organizations struggle with excess body weight (EBW) screening and follow-up compliance due to a misunderstanding of the problem, provider bias, discomfort discussing weight-related topics, and improper data collection and recording. An evidence-based quality improvement (EBQI) initiative, following the Johns Hopkins Nursing Evidence-Based Practice model and Plan-Do-Study-Act, was undertaken in a private, for-profit, pediatric primary care organization, measuring screening and quarterly follow-up scheduling rates. Processes and structures for conducting EBW screening and follow-up appointments were reviewed and amended based on the literature. A university hospital endocrinology department educated participants on the impact of EBW in pediatric patients, proper screening, diagnosis, and follow-up. Implementation of this EBQI initiative resulted in average increases of 56% for body mass index (BMI) screenings and 1,100% in BMI follow-up visits scheduled compared to baseline data. EBQI initiatives that promote BMI screening and follow-up compliance positively impact organizational outcomes and ultimately patient outcomes.
Inguinal herniation containing a gravid uterus, also referred to as inguinal gravid hysterocele (IGH), is an uncommon clinical condition in dogs characterized by protrusion of the pregnant uterus through the inguinal canal. Only a few cases have been documented, and most were diagnosed in early gestation or following complications such as fetal death. To our knowledge, reports of IGH diagnosed close to term and successfully managed surgically, resulting in live offspring, are limited. A 7-year-old, 16 kg, intact mixed-breed female dog presented with a large, non-painful inguinal mass. Diagnostic imaging revealed a left-sided inguinal hernia containing the uterus with two viable fetuses, intestinal loops, and the spleen. Ultrasonographic biometry suggested day 55 of gestation, consistent with advanced pregnancy. Physical examination and hematological and biochemical parameters were within reference ranges. Based on stable clinical findings and fetal viability assessment, a cesarean section combined with herniorrhaphy and simultaneous ovariohysterectomy was scheduled two days later. Both fetuses were delivered alive and initially showed good vitality. Postoperative recovery of the dam was uneventful, with no recurrence of herniation. One neonate died at 14 days postpartum, whereas the second survived and was successfully weaned. This case highlights the importance of thorough diagnostic evaluation and strategic surgical planning in managing IGH. This represents one of the few reported cases of IGH diagnosed at a late stage of gestation and managed at term without prior surgical correction, demonstrating that favorable maternal and neonatal outcomes are achievable with timely intervention.
Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination in pregnancy is recommended to provide passive immunity to newborns. Few studies have assessed how pregnancy modifies vaccinated individuals' immune response to Tdap vaccination, with most focused on short-term responses (i.e., within 1 month). Here, we assessed anti-pertussis toxin (PT) immunoglobulin G (IgG) levels 9-15 months following Tdap vaccination in pregnant and non-pregnant active duty service members (ADSMs). This observational cohort study included 240 ADSMs pregnant at Tdap vaccination, 1:1 matched with 240 non-pregnant ADSMs on age, time between vaccine and serum collection, and receipt of other same-day vaccines (2011-2016). Serum samples (0-6 weeks before and 9-15 months after vaccination) were obtained from the Department of Defense Serum Repository. Anti-PT IgG levels were assessed using geometric mean concentrations (GMCs), and associations between pregnancy status at vaccination and anti-PT IgG levels were estimated through multivariable linear regression models. Pregnant vs. non-pregnant ADSMs had higher anti-PT IgG GMCs in both pre- (9.01 vs. 5.81, P < .01) and post-vaccine (27.71 vs. 22.33, P = .02) serums. Post-vaccine multivariable models adjusting for pre-vaccine levels were not significantly different between pregnant vs. non-pregnant ADSMs (b = -0.05, P = .42). Associations were modified by time since prior Tdap booster, and statistically different for pregnant individuals who received a booster <2 years prior (b = -0.22, P = .02). Tdap vaccination in pregnancy yielded a similar long-term anti-PT IgG response to vaccination outside of pregnancy; findings substantiate the current recommended vaccine schedule.
Esophageal squamous cell carcinoma (ESCC) has high risks of postoperative recurrence, complications, and prolonged nutritional and functional recovery, while conventional follow-up (scheduled visits with imaging, endoscopy, and laboratory testing) is often limited by delays and resource constraints. This review summarizes recent applications of artificial intelligence (AI) across perioperative ESCC care, with emphasis on postoperative surveillance and management. Following PubMed/MEDLINE, etc. were searched (inception-2025) for English-language studies using machine learning, deep learning, radiomics, natural language processing (NLP), and digital health algorithms in postoperative monitoring, recurrence prediction, complication warning, and remote follow-up. Evidence indicates that AI-enabled multimodal models integrating electronic health records, imaging radiomics, and biomarkers can predict major complications (e.g., anastomotic leak and pneumonia) with improved timeliness, enabling earlier intervention compared with symptom-triggered workflows. Imaging-driven radiomics combined with machine learning demonstrates robust performance for recurrence risk and recurrence-pattern prediction, supporting refined risk stratification beyond TNM staging and informing individualized surveillance intensity and adjuvant decision-making. Explainable approaches (e.g., SHAP) enhance clinical interpretability by identifying key predictors such as nutritional and inflammatory indices. Intelligent follow-up systems incorporating NLP, wearable sensors, and electronic patient-reported outcomes (ePROs) facilitate closed-loop monitoring, improve early issue detection, and strengthen patient-clinician communication.
Once-daily bedaquiline therapy is a WHO-listed alternative to thrice-weekly dosing for rifampicin-resistant tuberculosis, but, contrary to the thrice-weekly schedule, no guidance exists for treatment re-initiation after interruption. Using a population pharmacokinetic model, we simulated bedaquiline and M2 exposure under various interruption and reloading scenarios. Reloading strategies tailored to interruption duration restored bedaquiline exposure without clinically relevant increases in M2 peak concentrations, providing practical guidance for safe and effective treatment resumption of once-daily bedaquiline therapy.