Following lumbar spinal fusion surgery (LSFS), some patients experienced a disruptive recovery, characterized by persistent pain, functional limitations, and difficulty resuming life. However, little is known about their preoperative experiences. To explore the preoperative experiences of patients in disruptive recovery following LSFS. A secondary analysis was performed on qualitative data aligned with the Standards for Reporting Qualitative Research. Participants from four UK surgery centers underwent two semi-structured interviews following LSFS and completed weekly diaries. Three recovery trajectories emerged from the first month's diaries: meaningful, progressive, and disruptive. Transcripts from the interviews with participants in disruptive recovery, conducted two weeks following LSFS, were analyzed using interpretative phenomenological analysis, focusing on their preoperative experiences. Two independent researchers defined themes through an iterative process. Collaborative analytical process and reflexive dialogs were used to enhance trustworthiness, with ideography maintained through constant data comparison and discussion. Seven themes were interpreted from eight participants. Patients' experiences while living with back problems captured in "compounded struggles" and "multidimensional effects of back problems." Their experiences with the treatment process and the factors influencing their decision to undergo surgery were described in "experiences in the treatment process" and "journey to surgery." Their experiences before surgery were identified in "understanding surgery: awareness and expectations," "psychological burden," and "preparation for surgery." Findings revealed complex patient challenges, diverse treatment interactions, long waits, multifactorial surgery decisions, with identified preoperative gaps, informing future research of patient needs to improve LSFS outcomes.
Haglund syndrome is a multifactorial condition characterized by posterosuperior calcaneal prominence, retrocalcaneal bursitis, and varying degrees of Achilles tendon involvement. While both open and endoscopic surgical techniques have been described, the optimal approach for cases with associated tendon pathology remains debated. To evaluate pain and functional outcomes following open surgical management of Haglund syndrome using deformity excision, retrocalcaneal bursa excision, and suture anchor-based Achilles tendon repair. Analytical observational Prospective cohort study. This study included 30 patients treated between 2022 and 2024 with clinically and radiographically diagnosed Haglund syndrome refractory to conservative management. All patients underwent open surgical excision of the Haglund deformity and retrocalcaneal bursa, along with Achilles tendon debridement and repair (tenodesis) using a double-loaded 5 mm titanium suture anchor. Outcomes were assessed using the Visual Analogue Scale (VAS) for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score preoperatively and at 1-year follow-up. Pre- and postoperative outcomes were compared using paired statistical analysis. The mean VAS pain score improved significantly from 6.63 ± 1.33 preoperatively to 1.40 ± 1.04 at final follow-up (p < 0.001). The mean reduction in VAS pain scores was 5.23 (95% CI 4.66-5.80), demonstrating a large clinical effect (Cohen's d = 3.43). The mean AOFAS score improved from 60.93 ± 13.13 to 83.13 ± 6.98 (p < 0.001). The mean functional improvement was 25.27 points (95% CI 22.22-28.31), also revealing a large effect size (Cohen's d = 3.10).Two patients (6.7%) developed superficial wound complications, which resolved with conservative management. No cases of deep infection, tendon re-rupture, or implant failure were observed. Open surgical management with suture anchor-based Achilles tendon repair appears to provide significant improvement in pain and function in patients with refractory Haglund syndrome. However, given the absence of a control group and limited objective outcome measures, further comparative studies are required. Level II, prospective cohort study.
To evaluate the visual and anatomical outcomes of modified sutureless flanged intrascleral intraocular lens (IOL) fixation in pediatric patients with insufficient capsular or zonular support. This retrospective case series included pediatric patients (≤ 18 years) who underwent flanged intrascleral IOL fixation between January 2022 and August 2023 at Beijing Tongren Hospital, with a minimum follow-up of two years of follow-up. All patients underwent a comprehensive ophthalmic examination. IOL tilt and decentration were automatically measured using swept-source anterior segment optical coherence tomography, and haptic intrascleral visibility was graded as none or invisible (Grade 0), mild or slight (Grade I), and moderate or obvious (Grade II). Fifteen eyes from 11 patients (mean age, 11.5 ± 4.1 years) were included, with a mean follow-up of 29.0 ± 4.4 months. At the final visit, the mean best-corrected visual acuity (BCVA) improved from 0.75 ± 0.57 to 0.21 ± 0.18 logMAR (t = 3.867, P = 0.002). Mean IOL tilt and decentration were 3.99 ± 2.50° and 0.35 ± 0.35 mm, respectively. Haptic visibility was graded as Grade 0 in 13.6%, Grade I in 72.7%, and Grade II in 13.6%. No cases required IOL repositioning. Sutureless flanged intrascleral IOL fixation demonstrated favorable visual outcomes and stable IOL positioning in pediatric patients. Systematic grading of haptic intrascleral visibility provided additional information regarding postoperative haptic embedding. This technique provides a safe and effective alternative to sutured fixation for secondary IOL implantation in children.
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Patients with tetralogy of Fallot, pulmonary atresia and major aortopulmonary collateral arteries (TOF/PA/MAPCAs) demonstrate enlarged aortic dimensions. Although aortic z-scores derived from normal populations are widely used, these have limited utility in a population where dilation is nearly universal. The objectives of the study were to determine the range of values of aortic dilation across pediatric patients with TOF/PA/MAPCAs, characterize the trajectory of aortic growth before and after surgical intervention, and report the incidence of important aortic complications at long-term follow-up. We performed a retrospective evaluation of pediatric TOF/PA/MAPCAs patients repaired only at our institution over 20 years (2003-2023). Aortic dimension measurements were performed on up to 3 echocardiograms for each patient: initial echocardiogram (before any intervention), intermediate echocardiogram (< 30 days before complete repair), and post-operative echocardiogram (≥ 1 year following complete repair). Last available echocardiogram was also reviewed. Degree of aortic regurgitation and rates of aortic growth were assessed and compared by surgical strategy. 224 patients were included in the study, 73 (33%) underwent staged repair with a surgical aortopulmonary window and/or bilateral unifocalization to central shunt before eventual complete repair. All aortic dimension z-scores on the initial and intermediate echocardiograms were classified as severely dilated. There was a statistically significant increase in aortic annulus (p = 0.006) and ST junction (p < 0.001) z-scores between the initial and intermediate echocardiograms, with a significant decrease in all aortic dimension z-scores by the post-operative echocardiogram, returning to initial z-score values. Growth rates (mm/year) between the initial and intermediate echocardiograms compared to the intermediate and post-operative echocardiograms were greater for aortic annulus (8.9 ± 12.1 vs. 1.7 ± 3.2, p < 0.001), root (10.6 ± 9.3 vs. 2.3 ± 3.1, p < 0.001), and ST junction (9.1 ± 8.7 vs. 2.0 ± 3.3, p < 0.001), and did not differ by surgical strategy (staged vs. single-stage complete repair). Aortic dimension z-scores continued to significantly decrease at long-term follow-up (median follow-up time 8.5 years [IQR 3.8-13 years]). Only 4 patients in the cohort had more than mild aortic regurgitation at the post-operative echocardiogram (2 moderate, 2 severe), and all 4 patients eventually required surgical intervention on the aortic valve and ascending aorta within the long-term follow-up time frame. Our study demonstrated severely dilated z-scores for all aortic measurements across time, with an increase in growth rates before complete repair and return to initial values over a year following septation with continued decrease at long-term follow-up. These results support that progressive aortic dilation after complete repair does not occur, and despite severe aortic dilation, the incidence of requiring major aortic intervention for patients with TOF/PA/MAPCAs at long-term follow-up remains low. These findings may serve as the foundation for establishing normative reference values specific to this population, and could facilitate the development of new z-score equations that more accurately reflect expected aortic dimensions. Improved characterization of the longitudinal findings in this population better equips us to counsel families, and provides helpful clinical guidance for interval surveillance evaluations.
To develop a model that predicts screw loosening at user-specified postoperative time points after lumbar fusion. We retrospectively enrolled patients who underwent single-level lumbar interbody fusion at five hospitals: three hospitals for training and two for external testing. Preoperative CT images, clinical characteristics, and postoperative follow-up CT images were collected. Many patients had multiple follow-up CT scans, with screw loosening evaluated for each. Multimodal models were developed using preoperative CT images and the day of the follow-up CT scans as inputs and the occurrence of screw loosening on that day as the label. Three types of preoperative CT images were prepared and used for training: original, whole vertebra, and vertebral body. The results were evaluated in testing, and the best model with the highest AUC among the three was selected. Additionally, clinical characteristics were incorporated as an additional input, and the result was also evaluated. A total of 212 patients (mean age, 66.5 ± 11.3, 123 male) with 552 follow-up CT scans were included: 412 follow-ups for training and validation, and 140 follow-ups for testing. The model using vertebral body showed the best performance, with an AUC of 0.823 (95% CI, 0.737-0.895) and a sensitivity of 0.914 (95% CI, 0.769-0.999). When clinical characteristics were added to the input, no improvement was observed, with an AUC of 0.721 (95% CI, 0.621-0.817). The model predicted screw loosening at any postoperative time point with high AUC and sensitivity and has the potential to enable more thorough patient management.
Attention-deficit hyperactivity disorder (ADHD) is associated with a higher risk of premature mortality compared to the general population, although reported risks vary. The aim of this paper was to review studies that have examined associations between premature mortality and ADHD and consider factors that could explain variation in risk estimates. A literature search was carried out using online databases (PMC, OVID, and Scopus library) to identify relevant articles. We then considered: sample ascertainment, sample size, method of diagnosing ADHD and age at diagnosis, sex, age range for mortality data, hazard ratio/ mortality rate ratio (95% confidence interval), sample size, and cause of death, as factors that could explain variation in risk estimates. We focus on nine papers that report risk of all-cause mortality in population samples via hazard ratios, odds ratios, and mortality ratios, which varied from 1.07 to 4.44. Higher risk estimates were found in studies that followed up to older ages and among individuals who were female, diagnosed with ADHD later, and had psychiatric comorbidity. Most follow up found non-natural causes (e.g. suicide, accidents) to be the most prevalent cause of death but studies with longer follow up suggested that non-natural causes may be more important in older individuals. Evidence suggests that ADHD medication reduces the risk of premature mortality but findings are clearer for stimulant than for non-stimulant medication. Clinicians need to be aware that females with ADHD, those with a delayed ADHD diagnosis and who show psychiatric comorbidity are at highest risk of premature mortality. However prescribing ADHD medication may reduce this risk.
To identify screening intervals and BI-RADS-specific management pathways that balance cancer detection yield against recall burden in ultrasound-based breast cancer screening in China. We analysed 1,694,838 ultrasound examinations reported with BI-RADS (2018-2023). For BI-RADS 1/2, inter-screen intervals were evaluated by recall rate, cancer detection rate (CDR), positive predictive value (PPV), and early-stage proportion. For BI-RADS 0/3/4/5, we assessed associations between biopsy waiting time and PPV/early-stage proportion, and examined imaging follow-up outcomes for BI-RADS 4A. Among 337,497 screening intervals following BI-RADS 1/2, longer intervals were associated with higher CDR (0.13-0.54 per 1,000) but higher recall (17.4%-22.1%) and lower PPV (61.1%-31.0%), while early-stage proportion remained stable. The interval that best balanced yield and downstream burden was 13-24 months for women aged ≥ 40 years and 25-36 months for women aged < 40 years, achieving higher detection yield and PPV without a material increase in recall. Among 1,949 BI-RADS 4/5 biopsies, PPV was low for 4A (12.3%-25.0%), declined markedly with biopsy delay for 4B (60.5% to 25.0%), and remained consistently high for 4C/5 (> 60%/>93%). Among BI-RADS 4A lesions 64.7% (10,909/16,871) showed imaging downgrading during follow-up. In 487 BI-RADS 3 cases undergoing biopsy, delayed biopsy increased PPV without changing early-stage proportion. A 2-year screening interval is recommended for women aged 40-64 years, extendable to 3 years for those aged < 40. Prompt biopsy is warranted for BI-RADS 4B/4C/5. The high image downgrade rate of BI-RADS 4A suggests overestimation and supports imaging-based triage, requiring further validation. Imaging surveillance is preferable for BI-RADS 3 lesions.
This study investigated how acute fatigue of the rectus abdominis (RA) and erector spinae (ES) muscles affects the biomechanical and viscoelastic properties of the thoracolumbar fascia (TLF). 45 healthy young men (18-30 years) participated. Two separate fatigue protocols were applied for RA and ES muscles. Fascia's stiffness, creep, and relaxation time were assessed before and after each protocol using the MyotonPRO™ device. The changes in fascial properties following RA fatigue were compared with those following ES fatigue. No significant changes were observed in any fascial parameter after RA fatigue. In contrast, ES fatigue resulted in significant decreases in stiffness and significant increases in creep and relaxation time (p < 0.05). Following ES fatigue, TLF stiffness decreased by 24.40 ± 37.25, while creep and relaxation time increased by 0.08 ± 0.19 and 1.75 ± 3.62, respectively. Post-fatigue comparisons revealed greater increases in creep (p = 0.01) and relaxation time (p = 0.02) in the ES group compared to the RA group. These findings highlight the different acute effects of RA and ES fatigue on the TLF and suggest that muscle-specific loading influences fascial responses. Clarifying these dynamics may enhance the application of fascial-targeted strategies not only for symptom management but also for preserving tissue health and optimizing physical performance. This study has been registered in Clinical Trials under the number NCT06432062.
The aim of this clinical study was to investigate the effects of functional treatment with twin block (TB) and Herbst appliances on sleep quality. A total of 46 patients having mandibular retrognathia and identified with OSA were divided randomly into two groups: Twin Block (TB) and Herbst appliances. Changes in sleep parameters (apnoea-hypopnea index (AHI), supine AHI, oxygen desaturation index (ODI), minimum oxygen saturation) at baseline (B/L) and an average of 8-month follow-up (F/U) detected by polygraphy and Pittsburgh Sleep Quality Index (PSQI) were the primary outcomes. Treatment of the mandibular retrognathia was the secondary outcome. Shapiro Wilk test and Q-Q graphs were used to evaluate the distribution of variables according to groups, Mann Whitney U test was used to evaluate the two independent group means of measurements. Paired sample t test was used to evaluate the differences between the B/L and F/U times at p < 0.05 significance level. Among 46 patients randomized, AHI changed from B/L to F/U in Herbst group statistically significant (1.08 (-0.47-2.63), p = 0.031). While the change from B/L to F/U in the supine AHI was significant in Herbst group (3.29 (-0.20-6.78), 95% (CI), p = 0.001), this value did not reach statistical significance in TB group (0.39 (-0.59-1.37), 95% (CI), p = 0.531). ODI altered from B/L to F/U in Herbst group statistically significant (2.09 (0.58-3.60), p = 0.013). There was no change in minimum oxygen saturation following treatment in all groups (3.81 (-1.38-9.00), p = 0.166; 0.87 (-3.17-4.91), p = 0.680, respectively). The F/U values of SNB, ANB and Wits were statistically significantly higher than the B/L values (95% (CI), p < 0.001) in both groups. The average PSQI values were decreased significantly in both groups following functional treatment (95% (CI), p < 0.05). Significant improvement was observed in sleep parameters with Herbst appliance. Functional orthodontic treatment was found to be effective for adjunctive treatment for OSA. Changes in skeletal sagittal measurements were significant in all groups.
Polarized training intensity distribution (POL) typically involves 80% of endurance training volume to be spent in the Moderate intensity domain (MOD) and 20% to be in the Severe intensity domain-commonly performed as high-intensity interval training (HIIT). POL is popular in all endurance sports, but the independent contributions of MOD vs. HIIT on performance outcomes have not been experimentally tested. We therefore sought to compare training adaptions following HIIT with (POL) and without (HIIT) the addition of MOD cycling in moderately-trained endurance athletes. Nineteen cyclists and triathletes (17 men) were recruited and randomly allocated to 3 days/week of HIIT with (POL) or without (HIIT) an additional 240 min/week of MOD cycling for 6 weeks. Time trial (TT) performance, peak work rate (WRpeak), and lactate thresholds (LT1, LT2) were assessed pre- and post-intervention. WRpeak and lactate thresholds were re-assessed at week 3 to re-prescribe exercise intensities. Both groups reduced their TT time by an average of 8.5 ± 1.2%. Despite the POL group performing ~ 23 more hours of training across 6 weeks, we did not observe any time*group interactions in TT performance, WRpeak, LT1, or LT2. Exploratory analyses revealed that the modest between-group effect size (η2 = 0.4) would require > 100 participants per group to detect a statistically significant difference. We conclude that the addition of MOD training to a HIIT program does not yield further improvements in performance over a 6-week period. Performance improvements in a moderately trained population following 6 weeks of training appear to be driven primarily by the Severe-intensity component of training.
To investigate the association of amygdalar activity with disease activity, inflammatory markers, cerebrovascular events, and structural vascular injury in patients with Takayasu arteritis (TAK). A total of 303 TAK patients underwent 18F-fluorodexoyglucose positron emission tomography/computed tomography (¹⁸F-PET/CT). Amygdalar, bone marrow, and vessel wall SUV were quantified. Clinical, laboratory, and imaging data were collected. The median follow-up duration was 27 months, during which adverse events were recorded. No significant association was found between amygdalar SUV and cerebrovascular events in the overall cohort. However, among treatment-naïve patients, those with cerebrovascular events had significantly lower amygdalar SUVmax (9.3±2.0 v.s. 10.3±2.0, p=0.011) and SUVmean (6.6±1.2 v.s. 7.4±1.5, p=0.003) than event-free patients. The low SUV group had a higher proportion of cerebrovascular events (24.3% vs. 15.9%, P=0.045), along with elevated IgG and IgA levels and decreased lymphocyte counts. Amygdalar SUVmax was an independent protective factor against combined carotid and vertebral artery stenosis (OR=0.876, P=0.032). During follow-up, the event group had significantly lower amygdalar SUVmax than the new-onset symptom group (8.2±2.6 v.s. 10.4±1.8, P=0.030). Low amygdalar metabolic activity in TAK is associated with adverse vascular outcomes and serves as an independent protective factor against combined carotid-vertebral artery stenosis, suggesting its potential as a novel imaging biomarker.
Electronic patient-reported outcome (PRO) monitoring has shown benefits in advanced cancer, but data specific to metastatic breast cancer (mBC) remain limited. Fatigue is a common, clinically important, and functionally impairing symptom in mBC, making it a patient-centered target for electronic PRO monitoring. To determine whether digital PRO monitoring with alert-based responses reduces fatigue in patients with mBC. This multicenter randomized clinical trial was conducted from May 2021 to February 2024, with 12 months of follow-up, at 52 breast cancer centers in Germany and included women aged 18 years or older with mBC who were receiving systemic therapy at any point in the metastatic disease course, had a life expectancy of longer than 3 months, were able to read German, and had smartphone access. Data analysis started in February 2024 and lasted 6 months. The intervention group completed weekly PRO questionnaires via a smartphone using validated short forms from the European Organization for Research and Treatment of Cancer computerized adaptive testing core item bank. Automated alerts based on predefined PRO deterioration were emailed to trained local nurses or physicians, who contacted patients by telephone within 48 hours. The control group received usual care with quarterly PRO questionnaires and no alerts. The primary outcome was fatigue at 6 months. Secondary outcomes included fatigue, physical functioning, and quality of life over 12 months. PROs were reported as standardized T scores. Of 2008 patients screened, 924 (46.0%) were randomized, and 909 (45.3%) were included in the primary analysis (median age, 50 years [range, 19-83 years]). Baseline mean (SD) fatigue T scores were 57.6 (9.5) in the intervention group and 60.2 (9.0) in the control group (P < .001), with baseline PROs assessed after randomization but before group-specific follow-up began. At 6 months, adjusted mean fatigue was 54.5 (95% CI, 53.7- 55.4) vs 59.9 (95% CI, 59.0-60.8), yielding a mean difference of -5.4 points (95% CI, -6.6 to -4.1; P < .001), exceeding the minimal clinically important difference (MCID) of 3.3 points. At 6 months, physical functioning was higher in the intervention group (mean difference, 4.0; 95% CI, 2.6-5.4), exceeding its MCID (3.2), whereas the between-group difference in quality of life was 0.8 points (95% CI, 0.02-1.5), which was less than the MCID of 2.9. This randomized clinical trial found that digital PRO monitoring was associated with clinically meaningful reductions in fatigue and improved physical functioning. These findings support further evaluation of alert-based PRO monitoring in routine oncology care. German Clinical Trials Register: DRKS00024015.
Cataract surgery in patients with zonular weakness presents significant challenges and is associated with a higher risk of intraoperative and postoperative complications. Stabilization of the capsular bag using iris hooks during phacoemulsification is one approach to mitigate these risks. While previous studies have reported four-point iris hook fixation, our objective was to evaluate the safety and efficacy of five-point capsular stabilization in patients with generalized zonular weakness.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 2 Given name: [Saadet Gültekin] Last name [Irgat]. Also, kindly confirm the details in the metadata are correct.Dear Editorial Office, Thank you for your message. The author names are presented correctly except for Author 2. Please update the metadata for Author 2 as follows: Given name: SaadetFamily name: Gültekin IrgatAll other author details and metadata are correct. Thank you for your assistance. Kind regards, PATIENTS AND METHODS: Sixteen eyes of 14 patients with zonular weakness due to pseudoexfoliation who underwent phacoemulsification with five-point capsule and iris hook stabilization at Kütahya City Hospital were analyzed retrospectively. All surgeries were completed successfully. Adequate capsular stabilization was achieved using the five-point capsule and iris retractor configuration, and no intraoperative complications were observed. No clinically significant postoperative complications were observed among patients available for follow-up. Five-point capsular stabilization using iris retractors appears to be a safe and feasible technique for managing cataract surgery in eyes with generalized zonular weakness associated with pseudoexfoliation syndrome. The additional retractor positioned adjacent to the main incision may help reduce anterior tenting and facilitate intraoperative maneuvers. However, comparative studies are required to determine whether this configuration offers advantages over previously described stabilization techniques.
Central nervous system solitary fibrous tumors (CNS SFTs) are rare mesenchymal neoplasms. The 2021 World Health Organization (WHO) classification recognizes a single SFT entity characterized by NAB2::STAT6-associated biology. This study evaluated clinicopathologic and immunohistochemical features, with particular emphasis on STAT6, CD34, and p16 expression. We retrospectively reviewed 25 CNS SFTs identified between 2004 and 2024. Clinical, radiologic, histologic, immunohistochemical, treatment, and outcome data were collected. Histologic slides were reviewed by two neuropathologists. Immunohistochemistry for STAT6, CD34, and p16 was performed; molecular testing was unavailable. The cohort included 13 men and 12 women, with a mean age of 51 years. Among tumors with available site data, most were intracranial. WHO grades were grade 1 in 40%, grade 2 in 24%, and grade 3 in 36%. Nuclear STAT6 expression was present in all cases. CD34 expression was greatest in grade 1 tumors, whereas p16 expression was numerically highest in grade 3 tumors; neither marker showed a statistically significant association with recurrence. Tumor size increased across WHO grades. Outcome analyses were limited by few events and heterogeneous follow-up. CNS SFTs are clinicopathologically heterogeneous. STAT6 was a consistent diagnostic marker in this cohort. CD34 and p16 showed grade-related numerical patterns, but their prognostic value was not established. Larger, molecularly confirmed cohorts with standardized long-term follow-up are required.
Surgical lung resection, followed by chemotherapy and radiation therapy, is recommended for patients with early stage small cell lung cancer (SCLC). Combined SCLC, defined by the presence of non-SCLC, is associated with poorer survival than pure SCLC; however, reliable prognostic markers in surgically treated SCLC remain unclear. We aimed to investigate the prognostic factors for all SCLC subtypes undergoing surgery. We retrospectively evaluated patients with SCLC who underwent lung resection at our institute between 2000 and 2022. The clinical characteristics and surgical outcomes were analyzed. Among the 2,309 cases, 23 pure SCLC (1.00%) and 26 combined SCLC (1.12%) were identified. The patient characteristics were comparable between the groups. The 5-year overall survival rates were 46.0% for pure SCLC and 36.5% for combined SCLC, respectively (P = 0.89), while the recurrence-free survival rates were 27.7% and 30.0%, respectively (P = 0.76). A Multivariate Cox regression analysis revealed that the prognostic nutritional index (PNI) was an independent prognostic factor. Although a literature-based PNI cutoff of 45.0 was not significantly associated with survival differences (P = 0.162), our exploratory cohort-specific cutoff of 47.0 demonstrated a significant survival difference (P = 0.008), with a higher PNI associated with a better survival. The preoperative nutritional status may be a useful predictive marker of postoperative survival in patients with SCLC undergoing curative surgery.
In this study, extracts of Thymbra spicata were obtained using supercritical carbon dioxide (scCO₂) extraction under two different pressure conditions, namely 120 atm (T1) and 300 atm (T2), while maintaining a constant temperature of 40 °C. GC-MS analysis demonstrated that increasing the extraction pressure from 120 to 300 atm enhanced the recovery of the major bioactive constituents, with thymol and carvacrol increasing from 22.65% to 14.05% in T1 to 28.04% and 18.48% in T2, respectively. The antibacterial activities of the obtained extracts were evaluated against 16 methicillin-resistant Staphylococcus aureus (MRSA) isolates using agar well diffusion and minimum inhibitory concentration (MIC) assays. In addition, the antibiofilm activity of the extracts against MRSA was investigated. Morphological alterations in bacterial cells following treatment were examined using scanning electron microscopy (SEM). Furthermore, the effects of the extracts on the expression levels of the icaA, dltB, and vraR genes were assessed. The T2 extract exhibited stronger antibacterial activity than the T1 extract, as evidenced by its lower MIC values. Notably, the MIC value of T2 was determined to be 64 µg/mL for 15 of the tested MRSA isolates. The agar well diffusion results further supported these findings, with T2 producing significantly larger inhibition zones than T1 (p < 0.05). At a concentration of 2×MIC, the T2 extract inhibited more than 66% of biofilm formation. Morphological evaluation revealed pronounced damage to the integrity of bacterial cells. Gene expression analysis demonstrated that T2 significantly downregulated the expression of the icaA, dltB, and vraR genes, suggesting its potential to attenuate biofilm formation, cell wall-associated functions, and stress response mechanisms in MRSA. Biocompatibility assessment demonstrated that both extracts exhibited low cytotoxicity toward L929 fibroblast cells, with cell viabilities of 89% for T1 and 87% for T2 at 1000 µg/mL. Overall, the superior antibacterial and antibiofilm activities of the T2 extract may be attributed to its higher thymol and carvacrol contents, highlighting the influence of extraction pressure on the recovery of bioactive compounds and its potential as a safe natural antimicrobial agent against MRSA.
This study presents the development and large-scale field application of a real-time PCR assay designed for the detection of Mycoplasma agalactiae in bulk tank milk from dairy sheep farms. The assay demonstrated high analytical specificity and sensitivity, enabling reliable identification of low levels of target DNA typically present in bulk milk samples. Following analytical validation, the test was used to estimate within-herd prevalence and was applied in a regional surveillance program encompassing more than 900 sheep farms across Sardinia, Italy. The findings reveal widespread but often low-prevalence circulation of M. agalactiae within Sardinian flocks. The real-time PCR assay proved effective for identifying infected herds through a non-invasive, cost-efficient sampling matrix, underscoring its value as a practical tool for early detection and herd-level surveillance. This approach provides a scalable framework for monitoring contagious agalactia in areas with high densities of small-ruminant farms and supports the establishment of sustainable milk-based surveillance systems.
Care partners of people with aphasia (PWA) are faced with unique challenges, as their loved one's loss of communication may create specific barriers to expression, mutual understanding, and interaction. Previous research has investigated the challenges faced by care partners of PWA. However, there is limited research that investigates the perceived aphasia education needs of these care partners. The purpose of the present study is to investigate the perspectives of care partners on education, challenges, benefits, and supports they experience when caring for a loved one with aphasia. This work may provide insight into the complexities of the experience of living as a care partner of someone with aphasia. We conducted three virtual focus groups, each including four participants. We asked each group a series of semistructured interview questions. The first and second authors coded the data and derived themes. Following analysis of the focus group data, our team identified themes that highlighted the importance of education, the challenging and rewarding aspects of being a care partner to a PWA, and the power of a support system for care partners. Care partners experience a range of different education needs, challenges, and benefits. Thus, there is no single plan of care that best fits all care partners; education should be person centered based on the needs of each family unit. These results serve as a guide for clinicians as well as underscore the importance of exploring first-hand accounts of care partner experiences in future studies.
Oral frailty may increase surgical risk; however, its association with postoperative infections in patients with colorectal cancer remains unclear. We evaluated whether preoperative oral frailty, assessed using the Oral Frailty Index-8 (OFI-8), could predict 30-day postoperative infectious complications. We retrospectively reviewed patients who underwent colorectal cancer surgery between April 2022 and December 2024 at our institution. Before surgery, patients completed the OFI-8 and Mini Nutritional Assessment Short-Form, which were verified by the nursing staff. A high oral frailty risk was defined as an OFI-8 score ≥ 4. Clinicopathological variables and infectious complications were compared between the groups. Logistic regression was used to identify the factors associated with complications. Among the 140 patients, those with OFI-8 ≥ 4 were older and had more polypharmacy, larger tumors, and a poorer renal function. Eighteen patients developed infectious complications. Age ≥ 75 years, rectal cancer, OFI-8 ≥ 4, and pathological T4 stage were identified as predictors of infectious complications. Multivariate analyses confirmed that OFI-8 ≥ 4 and rectal cancer were independent risk factors. Infectious complications were associated with prolonged hospitalization. OFI-8 is a simple outpatient screening tool for identifying patients at high risk of infectious complications following colorectal cancer surgery. Targeted OFI-8-guided perioperative risk interventions may improve the outcomes and reduce the healthcare burden.