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This study aims to evaluate the effects of BPC-157, synthetic thymosin beta-4 (TB-500), and their combination on Achilles tendon healing using biomechanical, histopathological, histochemical, and immunohistochemical analyses in a rat model. Thirty-two male Sprague-Dawley rats, each aged 12 weeks and weighing approximately 330 g, underwent standardized Achilles tendon transection and repair and were randomly assigned to four groups, with eight rats in each group: control, BPC-157 (10 &#xb5;g/kg/day), TB-500 (60 &#xb5;g/kg/day), and combined BPC-157 + TB-500 (BPC + TB). Treatments were administered intraperitoneally for four weeks postoperatively. At four weeks, tendons were harvested for biomechanical testing or histological evaluation. Maximum load to failure was assessed biomechanically. Histological and histochemical analyses included hematoxylin-eosin, Masson trichrome, Alcian blue, and Sirius red staining and were evaluated using Bonar and Movin scoring systems. Expression of collagen types I and III was assessed immunohistochemically and semiquantified using H-score analysis. Biomechanical testing revealed higher maximum load to failure values in the BPC-157 and TB-500 groups compared to controls, reaching statistical significance in the TB-500 group (p < 0.05). Histopathological evaluation demonstrated significantly lower total Bonar scores in the TB-500 group (p = 0.016) and significantly lower total Movin scores in the TB-500 and BPC + TB groups (p = 0.017 and p = 0.040, respectively) relative to controls, indicating improved tendon architecture, collagen alignment, and reduced degenerative changes. The BPC-157 group showed numerically lower scores without reaching statistical significance for total scores. Sirius red birefringence analysis showed increased type I collagen organization and altered type III collagen distribution in treatment groups, particularly in the TB-500 group, suggesting progression toward matrix maturation. Immunohistochemical analysis revealed no significant differences in collagen type I expression among groups, whereas collagen type III expression differed significantly, consistent with histochemical findings. Combined BPC-157 and TB-500 treatment did not confer additional benefits compared to either agent alone. In this exploratory rat model study, both BPC-157 and TB-500 were associated with improved histopathological parameters and extracellular matrix organization during early Achilles tendon repair, with TB-500 additionally demonstrating a significant biomechanical advantage at four weeks. The absence of additive effects with combination therapy may reflect convergence on shared downstream pathways; however, this hypothesis requires further experimental confirmation. These preliminary findings indicate that both peptides warrant further investigation as candidate adjuncts to tendon repair, pending dose-optimization and longer-term studies.

This study aims to evaluate the clinical and objective biomechanical outcomes at a minimum 10-year follow-up following open double-Tajima repair combined with a structured functional loading protocol. Between January 2011 and December 2014, a total of 47 consecutive non-competitive adults (Tegner Activity Scale &#x2264; 4) with acute unilateral Achilles tendon rupture treated with open double-Tajima repair and an eight-week functional loading protocol were included in this retrospective cohort study. The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes included isokinetic dynamometry (peak torque at 30&#xb0;/s and total work at 120&#xb0;/s for plantar flexion and dorsiflexion), joint position sense, and ankle/calf circumference. Between-limb comparisons were performed. Of the patients, 35 were male and 12 were female with a mean age at the time of surgery of 36.7 &#xb1; 6.6 (range, 22 to 55) years. The mean follow-up was 132.4 &#xb1; 13.5 (range, 120 to 168) months. The rupture involved the dominant limb in 29 patients (61.7%) and the non-dominant limb in 18 patients (38.3%). The primary outcome (AOFAS score) showed no statistically significant between-limb difference: the median score was 91.0 (IQR, 91.0 to 93.0) on the operated limb versus 93.0 (IQR, 91.0 to 93.0) on the contralateral limb (median difference: 0.00 points; 95% confidence interval [CI]: -1.00 to 1.00; p = 0.92). No statistically significant between-limb differences were detected across the secondary outcomes, including peak torque at 30&#xb0;/s, total work at 120&#xb0;/s, joint position sense, and ankle/calf circumference (p &#x2265; 0.09 for all). The complication rate was 4.3% (2/47): one partial rerupture managed conservatively and one superficial wound infection treated with oral antibiotics. No complete reruptures were observed. Open double-Tajima repair combined with a structured functional loading protocol seems to be associated with clinically acceptable long-term outcomes in this cohort of non-competitive adults. However, given the retrospective, single-cohort design without an independent comparison group or formal equivalence framework, these findings should be interpreted as descriptive long-term observations.

Terrestrial pollution discharge induces spatiotemporal heterogeneity in riverine nitrogen dynamics. Accurately identifying sensitive temporal phases, spatial hotspots, and primary pollution sources is essential for effective riverine environmental management. This study developed an identification framework to delineate spatiotemporal pollution hotspots and source contributions in the Dai River basin by coupling intensive monitoring with the export coefficient method. The results indicated that the flood season was a critical period for increased total nitrogen (TN) pollution. Approximately 60% of the annual rainfall occurred in July and August, resulting in a 2.5-fold increase in TN concentrations in August compared to June. Moreover, rainfall events exceeding 100&#xa0;mm/day led to 2- to 3.5-fold increases in TN concentrations relative to pre-event levels, with maximum increases surpassing 14-fold. Automatic monitoring data revealed a decreasing trend in TN concentrations from upstream to downstream. Intensive monitoring identified the Yu, Xidai, and Sha rivers at the headwaters as pollution hotspot zones, characterized by higher nitrogen concentrations and larger basin areas. The export coefficient model results showed that urban domestic wastewater and livestock farming were the dominant sources, accounting for 35.87% and 35.55% of total discharges, respectively. Yuguan town exported 33.34 t of nitrogen, contributing 47% of the total discharges. Based on hotspot identification, we proposed differentiated and integrated management measures for each town.

Infant sleep is multidimensional, with sleep habits and sleep problems often co-occurring and changing rapidly during early life. Evidence links infant sleep with later neurodevelopmental and behavioral outcomes, yet few studies have examined overall sleep patterns, their changes over time, and outcomes across multiple preschool domains. We examined associations of sleep patterns at 6 and 12&#xa0;months and their transitions with preschool neurodevelopmental and behavioral outcomes. This prospective cohort study included 1707 children from the Shanghai Birth Cohort. Infant sleep at 6 and 12&#xa0;months was assessed using the Brief Infant Sleep Questionnaire. Sleep patterns were identified at each time point using latent class analysis based on multiple sleep indicators, and children with sleep data at both ages were classified into transition groups. At age 4, outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ), Social Responsiveness Scale-Short Form (SRS-SF), and Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Multivariable linear regression estimated associations. At 6 and 12&#xa0;months, 66.02% and 69.18% of infants were classified as having a good sleep pattern. Among children with sleep data at both time points, 51.57% had consistently good sleep, 16.68% improved, 14.44% deteriorated, and 17.31% had consistently poor sleep. Poor sleep at 6&#xa0;months was associated with higher SDQ Total Difficulties scores. Poor sleep at 12&#xa0;months was associated with higher SDQ Total Difficulties, SRS-SF Total, and BRIEF-P Global Executive Composite scores. Consistently poor sleep from 6 to 12&#xa0;months was associated with less favorable outcomes than consistently good sleep. Poorer infant sleep patterns, especially at 12&#xa0;months and when persistent from 6 to 12&#xa0;months, were associated with less favorable preschool neurodevelopmental and behavioral outcomes. These findings support infant sleep patterns as an early-life factor relevant to developmental research and monitoring.

Are higher ambient temperatures before oocyte retrieval associated with adverse oocyte-related outcomes in women undergoing their first IVF or ICSI cycle? Higher pre-retrieval temperatures are associated with reduced oocyte yield, an effect partially mediated through LH and partially counteracted by compensatory increases in FSH and estradiol (E2). Evidence on the impact of ambient temperature on IVF/ICSI outcomes is emerging but limited. A recent study reported weak negative associations between higher ambient temperatures during folliculogenesis and oocyte yield, though the effect was modest and findings across populations remain inconsistent. However, these findings are further limited by small sample sizes, specific clinical subpopulations or geographic regions, which prevents the establishment of a generalizable dose-response relationship and leaves the underlying biological mechanisms largely unexplored. A retrospective cohort study of 58&#xa0;468 women undergoing their first IVF/ICSI cycle with oocyte retrieval between 1 January 2018 and 31 May 2024. Women undergoing their first IVF/ICSI cycle were included. The primary outcomes were total oocytes retrieved, mature oocytes retrieved, and 2PN (two pronuclei) fertilized oocytes. Secondary outcomes included rates of oocyte maturation, normal fertilization, and blastocyst formation. Basal sex hormone levels were measured during the early follicular phase (cycle days 2-4). Environmental exposure data, including both ambient temperature and apparent temperature (integrating air temperature and humidity), were assessed over biologically relevant exposure windows. Generalized linear mixed-effects models were used to estimate associations between temperature exposures and oocyte-related outcomes. Restricted cubic spline models assessed nonlinearity. A counterfactual causal mediation analysis examined the roles of basal sex hormones. Stratified analyses by age, BMI, antral follicle count, anti-M&#xfc;llerian hormone, season, COVID-19 period, and the distance to ART center, along with sensitivity analyses, were performed to evaluate robustness. Each 1&#xb0;C increase in apparent temperature was associated with significant decreases in total oocytes retrieved (-0.20%; 95% CI: -0.28%, -0.12%), mature oocytes retrieved (-0.17%; 95% CI: -0.26%, -0.09%), and 2PN fertilized oocytes (-0.19%; 95% CI: -0.28%, -0.09%); consistent associations were observed for ambient temperature (-0.25%, -0.22%, and -0.22% per 1&#xb0;C, respectively). For rate-based outcomes, no significant associations were observed for the normal fertilization rate or blastocyst formation rate; the mature oocyte rate showed small positive associations in longer-term exposure windows (3-week and 90-day). Mediation analyses indicated that LH partially mediated these associations, accounting for up to 5.23% of the total effect, while both FSH and E2 exhibited suppression effects. The observational design cannot definitively establish causality. Unmeasured confounding (e.g. individual indoor climate control, occupational heat exposure) and residential address-based exposure assessment are potential sources of bias. Restricting the primary analysis to completed cycles may introduce selection bias, although sensitivity analyses incorporating canceled cycles yielded consistent estimates. Higher ambient temperatures represent a modifiable environmental risk factor for oocyte yield in ART treatment, with basal sex hormone pathways, including LH as a partial mediator and compensatory shifts in FSH and E2, providing a plausible biological basis for this effect. In the context of rising global temperatures, these findings suggest that ambient thermal exposure during the peri-folliculogenesis period warrants clinical attention, and that monitoring basal sex hormone levels may help identify patients at risk of a suboptimal ovarian response in high-temperature settings. This study was supported in part by the Technology Innovation and Research & Development Project of the Chengdu Science and Technology Bureau (No. 2024-YF05-02159-SN), the Open Fund of Chongqing Maternal and Child Disease Control and Public Health Research Center (No. CQFYSJ01001), the Program of Inheritance and Innovation of Traditional Chinese Medicine in Chongqing (Chongqing Traditional Chinese Medicine [2022] No. 33), and Chongqing Yuzhong District Natural Science Foundation Project (No. 20240118). All authors declare that they have no conflicts of interest related to this study. N/A.

The aim of this study was to determine the prevalence and distribution of ophthalmologic abnormalities, particularly binocular vision disorders and refractive errors, in children diagnosed with idiopathic scoliosis (IS). Between September 2025 and December 2025, a total of 48 pediatric patients diagnosed with IS (scoliosis group) and 41 age- and sex-matched healthy children (control group) were included in this prospective, cross-sectional, case-control study. The Cobb angle (&#x2265; 10&#xb0;) was considered in the scoliosis assessment. Based on Cobb angle measurements, scoliosis patients were classified into two subgroups: mild scoliosis (10&#xb0;-20&#xb0;, n = 26) and moderate scoliosis (21&#xb0;-40&#xb0;, n = 22). All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoscopic vision measurement. Of a total of 48 patients with IS included in the study, 14 were male and 34 were female with a median age of 14 (range, 6 to 18) years. The control group consisted of 41 participants. Of them, 16 were male and 25 were female with a median age of 11 (range, 5 to 16) years. Cervicothoracic scoliosis was identified in 30 patients (62.5%) in the scoliosis group. The number of patients with refractive error requiring glasses was significantly higher in the scoliosis group (p = 0.030). Stereoacuity levels were significantly lower in the scoliosis group (p < 0.001), and this difference was observed in both mild and moderate scoliosis subgroups. However, multivariable logistic regression analysis adjusting for age and sex revealed no independent association between scoliosis and decreased stereopsis or refractive error. Children with idiopathic scoliosis exhibit reduced stereopsis and a higher frequency of refractive errors requiring spectacles. These findings suggest a potential association between scoliosis and visual function. Therefore, ophthalmologic evaluation may be considered as part of the clinical assessment of children with scoliosis.

3D printing has multiple applications in the practice of medicine, including but not limited to the construction of 3D models to facilitate training in ultrasound-guided regional anaesthesia. Such models are typically far less expensive than commercially developed "phantom" trainers, making them particularly attractive in scenarios where budget constraints may impact regional anaesthesia training opportunities.&#xa0;The PEricapsular Nerve Group (PENG) block is a relatively recently described regional anaesthesia technique that is particularly useful in providing post-operative analgesia to patients undergoing hip replacement. To date, there are very few commercially available phantom models that permit the practice of the PENG block ex vivo, and those that do exist are considerably costly to purchase. This report describes the process of using readily accessible home 3D printing technology to create an extremely low-cost, simple-to-assemble phantom of the hip region, suitable for practicing the needling techniques necessary to carry out the PENG block. It may be of particular interest to regional anaesthesia training centres where funding issues present an obstacle to purchasing commercial models. The report demonstrates construction feasibility and preliminary sonographic usability of such a phantom, without formal evaluation of trainee learning, expert-rated fidelity, and comparative educational value. Free, open-source software and 3D models were used to prepare an appropriate pelvic model for printing. Stereolithography (SLA) 3D printing technology was used to produce a resin-based model of the pelvis, with gelatine utilised to create a tissue layer encompassing the model. A sonographic representation of the psoas tendon (a notable landmark in the block) was created, utilising pasta strands encompassed in nitrile and embedded in the gelatine at the expected location along the pelvic brim.&#xa0;The ultrasound characteristics of this phantom were reasonable, and the phantom permitted multiple needling attempts.&#xa0;The total cost for the production of this phantom was slightly over 12 euros (excluding initial 3D printer purchase and post-processing materials), and the total preparation time was 20 hours, including print time, print pre- and post-processing time, and gelatine setting times.&#xa0;This 3D phantom was produced using home 3D printing technology and affordable, readily available materials, for an exceptionally low cost and relatively fast production time. The limitations of the phantom include a short shelf life if not frozen, simplified anatomy, and relatively low ultrasonographic soft-tissue fidelity. Additional strategies for improving these aspects are discussed and could be implemented if desired.

This study aims to evaluate the midterm clinical outcomes of patients with complex clubfoot treated using the Ponseti method and to assess the sustainability of deformity correction over time. Between January 2016 and January 2021, a total of 38 feet in 26 patients with complex clubfoot treated using the modified Ponseti method were retrospectively analyzed. The patients were divided into two groups: those treated entirely in our institution (study center group) and those referred from external centers after unsuccessful initial treatment (external center group). Clinical severity was assessed using the Pirani score, and ankle dorsiflexion (DF) was measured during follow-up. Functional outcomes were evaluated using the Pirani-Based Score (PBS) and the Oxford Ankle Foot Questionnaire (OxAFQ). Relapse rates, additional procedures, and treatment success were analyzed. Independent predictors of outcomes were identified. Of a total of 26 patients included in the study, 2 were male and 24 were female with a mean age of 6.78 &#xb1; 1.29 (range, 5 to 8) years. Of these patients, 14 (53.8%) had unilateral involvement, while 12 (46.2%) had bilateral deformity. The external clinic group presented at a significantly later age than the study center group (p < 0.001), while baseline deformity severity was comparable. Pirani scores and DF measurements improved significantly in both groups, with no intergroup differences during follow-up (p > 0.05). Functional outcomes showed a significant difference in PBS scores, which were higher in the external clinic group (p = 0.045), indicating worse functional performance, while the OxAFQ scores were similar between groups (p = 0.911). Relapse rates were higher in the own clinic group but did not reach statistical significance (p = 0.254). Multivariate analysis revealed that age was the only independent predictor of treatment success (odds ratio [OR] = 2.067, p = 0.019), while referral status was not an independent determinant. The modified Ponseti method provides effective midterm correction in complex clubfoot regardless of referral status. Although referred patients present later and may demonstrate worse functional outcomes, referral source does not independently influence treatment success. Early recognition and appropriate application of modified Ponseti principles remain critical for optimal outcomes.

This study aims to evaluate the reliability of cervical vertebral maturation (CVM) staging in determining skeletal maturity in patients with adolescent idiopathic scoliosis (AIS), focusing on the effect of professional experience among orthopedic surgeons. Between January 2023 and January 2025, this reliability and agreement study included a total of 72 patients aged between nine and 16 years who were diagnosed with AIS. Intra- and inter-rater reliability were analyzed using weighted kappa (&#x3ba;) statistics with standard errors (SEs) and 95% confidence intervals (CIs). A total of 72 full-spine lateral radiographs were independently assessed by 10 raters with varying levels of orthopedic expertise, including medical students, residents, consultants, and spinal surgeons. None of the raters had prior experience with the CVM classification. Each rater performed CVM staging twice with a four-week interval between assessments. Of the patients, 33 were male and 39 were female with a mean age of 13.07 &#xb1; 1.97 (range, 9 to 16) years. Overall intra-rater reliability was substantial (&#x3ba; = 0.64, SE = 0.032, 95% CI: 0.569-0.714), and overall inter-rater reliability was moderate (&#x3ba; = 0.52). Although spinal surgeons showed slightly higher intra-rater reliability overall, inter-rater reliability declined between assessments (first assessment &#x3ba; = 0.61 vs. second assessment &#x3ba; = 0.34). Consultants exhibited the highest inter-rater agreement (&#x3ba; = 0.62), whereas residents showed improvement between assessments (&#x3ba; = 0.40 vs. 0.52); however, no significant difference observed between groups. The reliability of CVM staging for assessing skeletal maturity in AIS patients does not significantly differ across levels of orthopedic expertise. While CVM staging has potential as a radiation-sparing method, the overall moderate agreement, particularly among physicians without prior experience, indicates that reliability is not significantly influenced by professional experience.

Return to preinjury level of activity after anterior cruciate ligament reconstruction (ACLR) in the general population has been widely studied in the literature. However, the rate of return to military duty (RTMD) after ACLR is still not well determined. Furthermore, reasons for not returning to the preinjury level of military duty remain uncertain. To determine (1) the rate of RTMD after ACLR and (2) factors associated with returning to the preinjury level of military duty after ACLR. Case series; Level of evidence, 4. Patients who have served and/or are currently serving in the military and who underwent a primary ACLR and were within 1 to 5 years postoperatively were eligible to participate in the study. All participants completed a questionnaire that inquired about patients' characteristics, including age, sex, tobacco usage, military rank, and preinjury military and physical activities. Return to preinjury level of military duty was determined by using a multidomain definition of RTMD that includes the type and frequency of military activities, as well as standing hours (defined as a continuous measure of total duration per duty day spent standing, walking, or moving). Individuals who did not return to their prior level of military duty were asked to report the reasons for not returning. A total of 94 male military personnel with a mean age of 30.3 &#xb1; 5.7 years participated in the study. Only 11 (11.7%) individuals returned to their preinjury level of military duty using the authors' comprehensive definition at a mean follow-up of 1.83 &#xb1; 0.76 years. Of the 94 participants, 51 (54.3%) returned to their preinjury standing hours, 32 (34.0%) to their preinjury type of military activity, and 30 (31.9%) to their preinjury frequency of military activity. Of those who did not RTMD, 83% reported fear of reinjury or lack of confidence as a reason for not returning, while 76% reported persistent knee problems. The rate of return to preinjury level of military duty in Jordanian military personnel after ACLR using a comprehensive definition for return to duty is only 11.7%. Fear of reinjury or lack of confidence in the injured knee and ongoing knee problems are the most commonly reported reasons for not returning to the prior level of military duty.

Objectives: Psychological disorders are prevalent medical conditions that can negatively affect oral health. Due to the increase in the elderly population, and higher risk of psychological conditions in this age group, this study assessed the association of mental health evaluated by the 28-Item General Health Questionnaire (GHQ-28) and oral health in the elderly patients. Materials and Methods: Overall, 150 elderly patients aged 60 years and higher presenting to the dental clinic of School of Dentistry, Tehran University of Medical Sciences in 2019 participated in this cross-sectional study. Oral and dental examinations were conducted to assess the dental caries status using the decayed, missing, and filled teeth (DMFT) index, number of existing teeth, and self-reported dry mouth. Sociodemographic status, oral hygiene behaviors, and medical history of the participants were also recorded. The GHQ-28 was used to assess their mental health. Data were analyzed by SPSS version 25 using the correlation tests (alpha=0.05). Results: Of all the participants, 64 (42.7%) were females, and the age range was 60 to 90 years (mean age: 67.56&#xb1;6.42 years). The mean total GHQ score was 4&#xb1;3.8. The DMFT score and number of teeth had significant associations with severe depression and social dysfunction (P<0.05). Dry mouth was directly associated with the total GHQ score and anxiety (P<0.05). Conclusion: Elderly people with severe depression suffered from poor oral health. Comprehensive oral and dental examination and paying close attention to mental health aspects should be considered in regular dental check-ups and oral health promotion programs for the elderly.

This study aims to investigate the clinical effect of acupuncture combined with rehabilitation training in the treatment of knee osteoarthritis (KOA) under unified acupoint intervention. In this prospective, comparative study informed by systematic acupoint analysis, the literature related to acupuncture for KOA treatment was retrieved from public databases and the core acupoints were analyzed using the Traditional Chinese Medicine Inheritance Calculation System (TCMICS) software. Eighty-four patients were selected as the participants, and the clinical effect (total efficacy rate), Numeric Rating Scale (NRS) for pain score, American Knee Society Score (AKSS) for knee joint function and the self-care ability score for daily living activities were used to evaluate the treatment effect. The curative effect index was calculated using the AKSS scores. After analyzing the core acupoints, we selected the Dubi, Zusanli, Yanglingquan, Xuehai, Neixiyan and Liang Qiu acupoints for the acupuncture treatment. The patients were divided into a control group (n = 42 patients undergoing rehabilitation training) and an intervention group (n = 42 patients undergoing acupuncture combined with rehabilitation training). The control group consisted of 15 male and 27 female, with a mean age of 62.90 &#xb1; 11.531 (range, 40 to 78) years. The mean course of the disease was 4.07 &#xb1; 1.841 years. The intervention group consisted of 16 male and 26 female, with a mean age of 63.95 &#xb1; 10.613 (range, 41 to 79) years and a mean disease course of 4.76 &#xb1; 2.328 years. There was no significant difference between the groups before treatment (p > 0.05). After acupuncture treatment, the 92.85% total efficacy rate (n = 39) was significantly higher than the 73.80% (n = 31) in the control group. The mean AKSS of the control and intervention groups were 64.17 &#xb1; 11.148 and 66.67 &#xb1; 17.795, respectively, and the mean knee joint articulation scores were 57.40 &#xb1; 8.925 and 54.10 &#xb1; 10.150 in the two groups, respectively. Following treatment, the scores of knee joint function and knee joint articulation in the intervention group were higher than those in the control group (p < 0.05). For AKSS, the mean difference of the control group was 6.030, and the proportion of patients who reached the improvement of minimum clinically significant difference (MCID) standard was 80.95%. The mean difference of the intervention group was 10.98, and the proportion of patients who reached MCID was 100%. Following treatment, the self-care ability score in the intervention group were higher than those in the control group (p < 0.05). For modified Barthel Index (MBI), the mean difference of the control group and intervention group were 6.446 and 6.225, all accounting for 100%. The mean NRS scores were significantly decreased from 5.19 &#xb1; 1.042 to 1.93 &#xb1; 0.640 after one month of acupuncture treatment. Our study results suggest that acupuncture combined with rehabilitation training based on data mining can relieve patients' pain, accelerate the recovery of their knee joint function and improve their daily living ability, demonstrating high clinical value in practice.

peripherally inserted central catheters (PICCs) and totally implantable ports (Ports) are used for chemotherapy administration. This study aimed to compare their morbidity, mortality, and complication rates. a prospective, randomised, comparative single-centre study with 6 months of follow-up included adult patients with non-hematological malignancies eligible for chemotherapy (palliative, curative, or adjuvant intent). Primary endpoints were the frequency of adverse events (minor/major), impact on quality of life (EORTC QLQ-C30), and medico-economic cost. out of 206 randomised patients, 192 were analysed (Port: 102; PICC: 90). The overall complication rate was 12.5% (n=24). Major complications were significantly more frequent with PICCs (17.8%; 16/90) than with Ports (4.9%; 5/102), with a relative risk of 3.6 (95% CI 1.3-9.9; p=0.041). For chemotherapy lasting less than 6 months, the mean total cost was significantly higher for Ports (160,123.41 DA) than for PICCs (43,259.69 DA) (p<0.001). No significant difference was observed in overall quality of life, with a modest trend favoring Ports for global health and pain at three months. Ports, although costlier, are associated with a significantly lower risk of major complications. They may be preferred as a safe and effective access for long-term chemotherapy. The optimal choice should integrate treatment duration, patient risk profile, and economic constraints.

This study aims to evaluate the mid-term clinical and functional outcomes of juxta-epiphyseal fractures of the proximal phalanx in pediatric patients. Between July 2013 and December 2023, a total of 23 pediatric patients treated for juxta-epiphyseal fractures of the proximal phalanx were retrospectively analyzed. Functional outcomes were assessed using four subtests of the Jebsen-Taylor Hand Function Test. To compare the Jebsen-Taylor Hand Function Test, a control group of healthy children (n = 23) from the outpatient clinic was formed. Patients were treated either with closed reduction and splinting or with closed reduction followed by Kirschner wire (K-wire) fixation according to fracture displacement and stability. Radiographs were evaluated for residual deformity and malunion using Campbell's lines. Of a total of 23 patients, 13 were male and 10 were female with a mean age of 7.24 &#xb1; 2.21 (range, 6 to 13) years. The fifth digit was the most commonly affected (n = 14), followed by the fourth (n = 5), middle (n = 2), and thumb (n = 2). In 15 patients, the injury occurred on the non-dominant hand. No malunions were detected. One patient demonstrated a pseudo-claw deformity. Hand function tests revealed statistically significant delays in patients with dominant-hand injuries compared to healthy controls (p < 0.05). Seven patients reported a change in hand dominance after injury. Our study results suggest that appropriate reduction techniques, including closed or K-wire-assisted fixation, offer favorable outcomes with minimal complications. However, functional impairment can be more notable, when the dominant hand is involved. Taken together, these findings emphasize the need for early intervention, close follow-up, and consideration of hand dominance during recovery planning.

Ticks are hematophagous ectoparasites of veterinary and public health relevance. This study examines the seasonal distribution, host-specific burden, and species composition of ticks infesting domestic animals in the Wayanad district of Kerala, India. A longitudinal field survey was conducted from 2022 to 2024 across 40 locations in 3 ecological zones of Wayanad. Ticks were manually collected from domestic animals; cattle, goats, dogs, and cats during 3 seasons: monsoon, winter, and summer. Collected ticks were morphologically identified to the species level. Descriptive statistics, Chi-square tests, and Kruskal-Wallis H tests (&#x3b1;&#x2009;=&#x2009;.05) were performed using Jamovi (v2.6.44). Additionally, a negative binomial regression model was fitted using R (v4.2.2) to identify predictors of tick burden. A total of 2562 ticks were collected. Tick abundance was highest during the monsoon (1231; 48.06%), followed by winter (965; 37.66%) and summer (366; 14.28%). Cattle accounted for the highest tick load (n&#x2009;=&#x2009;1529; 59.7%), followed by goats (592; 23.1%), dogs (313; 12.2%), and cats (128; 5.0%). Mean tick burden per animal was highest in Zone 1 (12.79&#x2009;&#xb1;&#x2009;6.01), and lowest in Zone 3 (10.20&#x2009;&#xb1;&#x2009;5.37). Seasonally, winter showed the highest mean burden (4.91&#x2009;&#xb1;&#x2009;3.63). Seven tick species from 3 genera were identified, with Haemaphysalis bispinosa being the most dominant. Regression analysis identified season and host as significant predictors. Compared to monsoon, summer burden was lower (IRR&#x2009;=&#x2009;0.36; 95% CI: 0.32-0.41; P&#x2009;<&#x2009;.001), while winter was moderately higher (IRR&#x2009;=&#x2009;1.15; CI: 1.05-1.25; P&#x2009;=&#x2009;.0017). Cattle exhibited a 4.05-fold higher burden than cats (IRR&#x2009;=&#x2009;4.05; CI: 3.39-4.87; P&#x2009;<&#x2009;.001). The presence of zoonotic tick vectors across hosts, seasons, and zones indicates high epidemiological risk the need for integrated ecological surveillance and region-specific tick control strategies. Tick Spread in Kerala&#x2019;s Domestic Animals Ticks are small, blood-sucking parasites that can spread dangerous diseases to animals and humans. In forest-rich areas like Wayanad district in Kerala, domestic animals often roam close to wildlife and may be at higher risk of tick infestations. However, little is known about which tick species are most common, which animals are most affected, and how tick numbers change with the seasons in this region. Between 2022 and 2024, we visited 40 locations across Wayanad and collected ticks from four types of domestic animals: cattle, goats, dogs, and cats. Tick collection was done during three seasons&#x2014;monsoon, winter, and summer. We carefully identified the tick species and recorded how many ticks each animal had. We then analyzed the data using statistical methods to understand which factors (like season or animal type) influenced tick numbers. We collected a total of 2,562 ticks. Most ticks were found during the monsoon season, but individual animals had the highest tick burden during winter. Cattle had the most ticks, followed by goats, dogs, and cats. The most common tick was Haemaphysalis bispinosa, especially in cattle and goats. Statistical models confirmed that both season and host type significantly influenced tick burden. Cattle were over four times more likely to be heavily infested compared to cats, and summer had the lowest tick counts. Some of the ticks we found are known carriers of serious diseases like Kyasanur Forest Disease (KFD), babesiosis, and rickettsial infections. Since these animals live near forests and sometimes interact with wildlife, there&#x2019;s a real risk of diseases spreading between animals and humans. Our findings highlight the need for regular tick monitoring and targeted control efforts in areas like Wayanad to protect both animal and human health.

Objectives: This study assessed the impact of rinsing water temperature on microleakage of dental composite restorations. Materials and Methods: This in vitro study was conducted on 72 extracted premolars. Buccal and lingual Class V cavities were prepared with gingival margins 1mm beneath the cementoenamel junction (CEJ) and occlusal margins 2mm above the CEJ. The specimens were classified into three groups (n=24) for rinsing with water at 23&#xb0;C, 4&#xb0;C, and 45&#xb0;C before the bonding procedure. Lingual cavities were bonded with a self-etch adhesive, and buccal cavities were bonded with a total-etch adhesive. After composite restoration, the specimens underwent 1000 thermal cycles between 5-55&#xb0;C. They were then divided into two groups for storage for either 24 hours or 2 months. Optical and electron microscopic assessments were performed to score microleakage at the occlusal and gingival margins of the specimens. The Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests were run to analyze the data (alpha=0.05). Results: Regardless of the bonding system and storage time, microleakage was significantly higher in the 4&#xb0;C rinsing water group (P<0.05). Gingival margins bonded with the total-etch adhesive had a significantly higher microleakage than the occlusal margins in both 23&#xb0;C and 45&#xb0;C groups (P<0.05), but the self-etch adhesive showed no significant difference (P>0.05). Conclusion: According to the results of this in vitro study, rinsing the cavity with warm water (23&#xb0;C and 45&#xb0;C) appears to be an effective method to reduce the rate of microleakage.

This study aims to investigate whether arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) provided more favorable early functional recovery and reduced surgical trauma compared to traditional open reduction and internal fixation (ORIF). A total of 84 patients with Schatzker type I-IV tibial plateau fractures treated between January 2021 and January 2024 were retrospectively analyzed. The MIPPO group (n = 41) underwent arthroscopy-assisted reduction plus MIPPO, while the ORIF group (n = 43) received conventional ORIF. Allocation was chronological, with ORIF predominant in the first two years and MIPPO in the latter two years. Operative parameters, postoperative drainage, radiographic outcomes (Rasmussen radiological score), functional recovery (Hospital for Special Surgery [HSS] score), range of motion (ROM), fracture healing time, hospital stay, and complications were compared. Of a total of 84 patients, 28 were male and 56 were female of 49.4 &#xb1; 9.0 (range, 27 to 69) years. The arthroscopy-assisted MIPPO group had significantly longer operative time (96.0 &#xb1; 18.2 vs. 84.0 &#xb1; 13.9 min, p = 0.001) but shorter incision length (3.9 &#xb1; 0.7 vs. 6.2 &#xb1; 0.9 cm, p < 0.001), less intraoperative blood loss (56.5 &#xb1; 9.6 vs. 72.6 &#xb1; 10.1 mL, p < 0.001), and lower postoperative drainage volume (47.1 &#xb1; 7.5 vs. 59.0 &#xb1; 7.0 mL, p < 0.001) than the ORIF group. The arthroscopy-assisted MIPPO group also achieved higher Rasmussen radiological scores (15.4 &#xb1; 1.4 vs. 14.0 &#xb1; 1.6, p < 0.001) and better HSS scores at one, three, and six months postoperatively (all p < 0.001). At six months postoperatively, the MIPPO group also demonstrated significantly improved knee ROM (118.5&#xb0; &#xb1; 8.2&#xb0; vs. 107.3&#xb0; &#xb1; 9.1&#xb0;, p < 0.001), a difference exceeding the clinically meaningful threshold for activities of daily living. However, no significant differences were found in hospital stay (p = 0.051), fracture healing time (11.4 &#xb1; 1.3 vs. 11.1 &#xb1; 1.3 weeks, p = 0.340), or the excellent-and-good rate of HSS score at final follow-up (95.1% vs. 97.7%, p = 0.746). Complication rates were similar between the groups (p = 1.000). For Schatzker type I-IV tibial plateau fractures, arthroscopy-assisted MIPPO provides more favorable early functional recovery and radiological reduction quality compared to conventional ORIF, with less surgical trauma and comparable early functional recovery and similar complication rates during follow-up. Although operative time is longer, this minimally invasive approach is a safe and effective option for managing these complex fractures. Its principal advantage is accelerated early recovery, particularly in knee ROM, enabling patients to reach clinically meaningful thresholds for activities of daily living sooner.