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Coiera and Fraile-Navarro question whether AI scribes are being evaluated on metrics that truly impact care. While current evaluations focus on the quality of the initial draft, signed clinical notes are dynamic, as their content can be copied, summarized, coded, and re-ingested by downstream AI tools. We argue that safety must be measured downstream, focusing on how small errors in initial documentation can compound across the patient's electronic health record.
Accidents and injuries are the leading causes of preventable death among adolescents and are often related to substance use. About 60% of US high school students have tried alcohol and 22% report current alcohol use. Preventing and reducing adolescent alcohol use would contribute to substantial health benefits and prevent major health morbidity and mortality. Advances in interactive narrative learning technologies hold promise for designing games for health that effectively deliver age-appropriate and personalized behavior change interventions. The Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE) is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded alcohol prevention intervention by leveraging the dual mechanisms of interactive narrative and 3D game technologies. This pre-post study aims to examine the impact of INSPIRE on adolescents' self-efficacy to avoid risky alcohol-related behavior and knowledge about alcohol risk. A total of 44 adolescents in high school (aged 14-16 years; mean 15.16, SD 0.95; n=22, 50% female) were recruited using convenience sampling from an after-school program in the San Francisco Bay Area. The largest proportion of participants identified as Hispanic or Latine (n=15, 34%), followed by White, Asian, and multiple racial or ethnic backgrounds. Participants completed two 20-minute web-based interactive narrative episodes. We compared pretest and posttest data to examine changes in adolescents' self-efficacy and knowledge using a combination of questionnaire and computer interaction trace log data. Self-efficacy was measured using a 24-item scale (α=.95; 0-10 rating). Knowledge was assessed using 10 multiple-choice items derived from in-game content. Pre-post changes were analyzed using Wilcoxon signed-rank tests (α=.05), with rank-biserial correlation effect sizes and 95% CIs. Approximately 25% (n=11, 95% CI 14.6%-39.4%) of study participants reported having consumed alcohol at least once, and 23% (n=10, 95% CI 12.8%-37.0%) reported alcohol use within the past year. Self-efficacy scores significantly increased from 7.97 (SD 2.24) at pretest to 8.72 (SD 1.58) at posttest, with a mean difference of 0.75 (95% CI 0.59-0.91; P<.001; r=0.89). Knowledge scores also significantly increased from 5.09 correct (median 5.0, IQR 4.0-6.0) at pre-test to 6.11 correct (median 7.0, IQR 5.0-8.0) at posttest, with a mean increase of 1.02 (95% CI 0.31-1.74; Wilcoxon signed-rank test, P<.001; r=0.57). Reflection tool clustering revealed 4 behavioral strategy endorsement profiles. As a first of its kind interactive narrative intervention, INSPIRE offers an innovative theoretically grounded model for supporting adolescent health behavior change. This study enhances our understanding of how to use innovative learning technologies to reduce risky alcohol use. Extending prior research in the field through using personalized narrative adaptations, this study indicates that through reinforcing goals and decisions to avoid risky behavior, adolescents can enhance their self-efficacy beliefs to avoid risky alcohol use and increase their knowledge about alcohol risk. Implications of these outcomes include the potential to facilitate the generalization of preventive behaviors to real-life situations.
Physical training reshapes cardiovascular and autonomic regulation, yet the resting divergence between general- and strength-endurance loading is poorly characterized in cadets. In this observational study, male cadets administratively assigned to predominantly general- (n = 27) or strength-endurance (n = 25) training were examined before and after a 4-month programme. Resting electrocardiography, heart-rate, blood-pressure and respiratory variability, breathing pattern and baroreflex sensitivity were recorded by spiroarteriocardiorhythmography during spontaneous and paced (0.1, 0.25 Hz) breathing. Within-group change was tested with Wilcoxon signed-rank tests and the group × time interaction with Mann-Whitney tests on change scores, under Benjamini-Hochberg false-discovery-rate control. Significant within-group change was confined to the strength-endurance group: lower heart rate (- 9.8%), longer RR (+ 10.8%) and QT (+ 4.8%), a higher systolic-pressure LF/HF ratio (+ 91%) and respiratory changes including minute ventilation and VO₂ (both - 23.8%; all q ≤ 0.043). The general-endurance group changed significantly only in QT and the Skibinski index. Groups did not differ in absolute values; however, the group × time interaction was significant only in the ventilatory domain and persisted after normalization to body mass (p = 0.008), whereas chronotropic, spectral-HRV and haemodynamic changes did not. Controlled-breathing reactivity declined in both groups; fitness improved across a military-applied battery, most in strength endurance. These exploratory findings suggest that the divergence between loadings is one of within-programme trajectory rather than absolute level, the only robust between-group signal being ventilatory economization. Spectral HRV did not change significantly, and the autonomic and cardiac findings should be regarded as hypothesis-generating.
Uncertainty and rapid changes in treatment guidelines are influencing factors for medication use during the COVID-19 pandemic. Therefore, this study aimed to evaluate antibiotic utilization in Community Health Centers (CHCs) between 2020 and 2021. Prescription data from adult outpatient visits (≥ 18 years) receiving prescription services at 35 CHCs in South Jakarta, Malang regency, and Bengkulu city, comprising 796,598 prescriptions, were examined using the ATC/DDD methodology and DU90% analysis. These regions were purposively selected to represent three distinct healthcare archetypes, namely metropolitan (South Jakarta), rural-urban continuum (Malang Regency), and regional cities outside Java (Bengkulu City). Wilcoxon signed-rank and Chi-square tests were used to determine statistical differences between years. The proportion of adult patient visits receiving a minimum of one antibiotic prescription decreased by 1.56% in 2021 (p < 0.001). Malang Regency recorded the highest rates, decreasing by 2.24% in 2021. Furthermore, the highest DDD values for all antibiotics each year were recorded in South Jakarta, except for Cefadroxil, which peaked in Malang regency. Six antibiotics were constituted in the DU90% segment, with Amoxicillin accounting for over 50% of prescriptions and reaching 425 DDD/1000 patient visits/year in South Jakarta in 2020. In 2021, Azithromycin prescriptions increased significantly by 7.51%, as shown by a p of 0.0161. The average prescribing rate (14.57%) remained below the WHO optimal indicator (< 30%). Antibiotic use in CHCs declined during the pandemic, but there was a significant increase in Azithromycin prescriptions.
Bipolar disorder (BD) is associated with facial emotion recognition (FER) deficits. Among these, impairments in recognizing moral emotions may be especially relevant to social dysfunction, but their relationship with brain structure remains poorly defined. In this cross-sectional case-control study, 48 euthymic adults with BD (BD-I, n = 20; BD-II, n = 28) and 45 sex- and age-matched healthy controls completed a computerized FER task and 3T T1-weighted MRI scan. FER efficiency (accuracy/response time) for facial moral (anger and disgust) emotion expressions and gray-matter volume (GMV) from 9 bilateral a priori fronto-limbic/salience regions were compared between groups. Group-specific psychometric networks (regularized partial-correlation, i.e. Gaussian graphical models; LASSO/EBIC) integrating FER and GMV nodes were estimated and compared using the Network Comparison Test. Relative to BD-II and controls, BD-I showed lower FER efficiency, with poorer decoding of moral but not neutral facial expressions. Network structure differed between BD-II and controls, whereas global network strength was comparable across all pairwise group comparisons. Exploratory centrality analyses suggested a more frontally weighted configuration in BD-I, with the superior frontal gyrus among the more central nodes. In BD-I, persistently reduced ability to decode morally salient facial cues co-occurred with subtype-related differences in fronto-limbic structural covariance.
Patient-reported outcome measures (PROMs) are essential for evaluating functional recovery after orthopaedic trauma. However, obtaining accurate pre-injury baseline PROM scores is often infeasible due to the emergent nature of traumatic injuries. This study aimed to assess the reliability of retrospective patient- and proxy-reported pre-injury functional status over time. This prospective observational study was conducted at a level I trauma center and included 173 adult patients presenting with acute upper or lower extremity fractures. Participants completed Patient-Reported Outcomes Measurement Information System Computer Adaptive Test (PROMIS CAT) surveys at week-0 (within 7 days of injury), week-2 and week-6 post-injury, all retrospectively recalling their pre-injury functional status. A subset of 91 patients also had designated proxies complete the same PROMIS surveys at the week-0 time point. Paired t-tests and Wilcoxon signed-rank tests evaluated score differences over time and between patients and proxies. Reliability was assessed using intraclass correlation coefficients (ICC), Bland-Altman plots and linear mixed-effects models adjusted for age, sex, comorbidities and baseline ambulatory status. PROMIS scores remained consistent across the three time points, with minimal mean differences (e.g., lower extremity: week 0-6 difference = 0.2 ± 3.9, p = 0.66). ICCs demonstrated excellent within-patient reliability (lower extremity: 0.94; upper extremity: 0.96). Comparisons between patient and proxy reports also demonstrated high agreement, with small mean differences (lower extremity: 0.29 ± 3.7; upper extremity: -0.19 ± 2.5), and Bland-Altman plots revealed no systematic bias. Notably, a ceiling effect was observed in upper extremity PROMIS scores across all time points, limiting their variability. Patients can reliably recall their pre-injury functional status up to 6 weeks following orthopaedic trauma, as there was little variation between week-0, week-2 and week-6 self-assessments. Additionally, proxy-reported scores provide highly concordant estimates of pre-injury function, making them a valid alternative when patients are unable to self-report. These findings support the use of retrospective PROM assessments in both clinical care and research to establish pre-injury baselines and track recovery in the orthopaedic trauma population.
To identify determinants of visually significant cataract among type 2 diabetes mellitus patients attending a tertiary eye care center hospital in south Ethiopia. An unmatched case-control study was conducted at Hawassa University Comprehensive Specialized Hospital-Tertiary Eye Care and Training Center from February to April 2024. We enrolled 80 cases and 160 controls. The data were collected through interviews, physical measurements, and medical records revision using a pretested questionnaire. Variables with a P-value < 0.2 in a Pearson's chi-square test were included in a multivariate logistic regression model, where a P-value < 0.05 was used to declare statistical significance of the predictors. The response rate was 91.95%. Significant predictors of visually significant cataract were urban residence (AOR = 3.58, 95% CI 1.53-7.42), current substance use (AOR = 6.29, 95% CI 3.16-9.28), diabetes duration of 2-5 years (AOR = 2.88, 95% CI 1.30-6.74), diabetes duration > 5 years (AOR = 4.35, 95% CI 2.14-7.38), and comorbid hypertension (AOR = 4.01, 95% CI 2.15-8.19). Urban residency, current substance use, longer duration of diabetes mellitus, and hypertension were statistically significant predictors of visually significant cataract. Early and periodic eye screening for these high-risk groups is essential for timely intervention.
Pain remains a critical issue among hospitalized children and may negatively affect postoperative recovery. In addition to pharmacological pain management, nonpharmacological approaches have been used to support pediatric care. Among these emerging approaches, socially assistive robots (SARs) may offer an opportunity to support children during hospitalization. However, limited evidence exists regarding the use of SARs in pediatric postoperative recovery and their influence on children's emotional responses during child-robot interaction (CRI). This study aimed to examine changes in postoperative pain levels following a SAR intervention among hospitalized children. In addition, it aimed to explore emotional responses during CRI using automated facial expression analysis. A single-arm pre-post study was conducted in a pediatric surgical ward. Children recovering from surgery participated in a structured SAR intervention consisting of 3 phases: warm-up, educational video, and interactive engagement. Pain outcomes were assessed using the self-reported Wong-Baker FACES pain rating scale and the observer-rated FLACC (face, legs, activity, cry, and consolability) scale. Emotional responses were evaluated using automated facial expression analysis, which generated continuous emotional valence scores ranging from -1 (negative) to +1 (positive). Wilcoxon signed-rank tests were used to analyze pain outcomes, and Friedman tests were used to examine differences in emotional valence across intervention phases. A total of 37 children were included in the pain outcome analysis, and 35 (95%) children were included in the emotional valence analysis after excluding participants with insufficient facial expression data. Significant reductions were observed in both self-reported and observed behavioral pain following the intervention. Self-reported pain scores decreased from a median of 6 (IQR 4-6) to 4 (IQR 2-4; P<.001), and FLACC scores decreased from a median of 3 (IQR 2-4) to 1 (IQR 1-2; P<.001). Emotional valence remained negative across all intervention phases. The Friedman test did not reach statistical significance across the 3 phases and showed a small effect size (P=.05). The SAR interventions may be associated with lower postoperative pain scores among hospitalized children. Although emotional valence did not significantly change during CRI, automated facial expression analysis was implemented and demonstrated the feasibility of continuous affective assessment in a real-world pediatric clinical setting. These findings support the potential use of the SAR interventions as a complementary strategy in pediatric postoperative care and provide preliminary evidence supporting the integration of real-time affective assessment into pediatric health care.
High-acuity Medicare beneficiaries with annual expenditures exceeding $12,000 disproportionately drive the total cost of care (TCOC) through preventable acute utilization and are natural candidates for value-based and shared savings arrangements. Whether remote patient monitoring (RPM) produces near-term TCOC reductions in this cost-stratified population has been insufficiently evaluated in real-world practice. A retrospective pre-post cohort analysis was conducted among 597 Medicare beneficiaries enrolled for at least 5 months in a technology-enabled RPM program, each with annualized preenrollment TCOC ≥$12,000. Patients received a cellular-enabled blood pressure monitor linked to a HIPAA-compliant platform staffed by licensed care navigators. The primary outcome was change in annualized TCOC over the 12 months before and after program initiation. Given right-skewed cost distribution (skewness = 4.47), the Wilcoxon signed-rank test was the primary inferential procedure. Secondary outcomes included per-1,000-patient rates of emergency department (ED) visits, inpatient hospitalizations, and 30-day readmissions. The mean age was 76.6 ± 8.2 years; 55.6% were female. The median annualized TCOC declined from $25,956 to $11,792, a reduction of $10,932 per patient (Wilcoxon p < 0.001; rank-biserial r = 0.47). The mean TCOC fell from $39,291 to $27,255 (p < 0.001). ED visits declined 19.9% (p < 0.001) and inpatient hospitalizations 40.9% (p < 0.001). Reductions were significant across all four baseline cost quartiles. Baseline TCOC was the dominant predictor of postenrollment costs (β = 0.50; p < 0.001; R2 = 0.23). At $100 per member per month, estimated net savings were $6.47 million (ROI: 9.0:1). Short-term RPM participation was associated with substantial reductions in TCOC and acute utilization among high-acuity Medicare beneficiaries, supporting RPM as a viable intervention to advance this population toward value-based care models. Prospective controlled evaluation is warranted to establish causal attribution.
Post-occlusive reactive hyperemia (PORH) is widely used to assess microvascular function. Increasing attention has been directed toward temporal characteristics of the PORH response and the need for individualized arterial occlusion pressure (AOP); however, comparative data across athletes with different training profiles and non-athletic controls remain limited. To compare PORH-derived microcirculatory parameters among individuals with different training backgrounds using an individualized AOP approach. This cross-sectional study included 60 participants (n = 60, 50 males and 10 females) divided into four groups (n = 15 each): marathon runners, bodybuilders, mixed martial arts (MMA) athletes, and non-athletic controls. PORH was assessed using laser Doppler flowmetry (LDF). The analyzed parameters included resting flow (RF), biological zero (BZ), maximum peak perfusion (MAX Peak), time to peak perfusion (TP), and time to recovery (TTR). Between-group comparisons were performed using the Kruskal-Wallis test with post-hoc analysis, and effect size was calculated (ε2). The Kruskal-Wallis test revealed a significant between-group difference only for TP (H = 18.914; p = 0.0003; ε2 = 0.28). MMA athletes exhibited a significantly shorter TP (20.6 ± 3.0 s) compared with marathon runners (47.5 ± 36.1 s), bodybuilders (42.9 ± 21.4 s), and the general population (37.9 ± 15.9 s). No significant differences were observed for RF, BZ, MAX Peak, or TTR (all p > 0.05). Time to peak perfusion is a sensitive parameter distinguishing microvascular responses across training profiles. A shorter time to peak perfusion (TP) is generally interpreted as a more efficient microvascular response and improved vascular reactivity. MMA athletes demonstrate a faster microvascular response following occlusion, likely reflecting training-specific vascular adaptations associated with mixed, high-intensity exercise. These findings highlight the importance of AOP individualization and the use of temporal PORH parameters in microcirculatory assessment of athletes.
To determine whether data-source choice alters conclusions about diabetes mortality trends, high-burden jurisdictions, and income-related inequality in the United States. We compared crude mortality rates (CMRs) and age-standardised mortality rates (ASMRs) from the CDC WONDER and Global Burden of Disease 2023 (GBD 2023) across 51 US jurisdictions during 1999-2023. Agreement, trends, high-burden classification, source discrepancy, spatial autocorrelation, and inequality were assessed using concordance analysis, Joinpoint regression, mixed-effects models, Moran's I, the slope index of inequality, and the concentration index. Across 1275 jurisdiction-year observations, CMR estimates were correlated but incompletely concordant (Pearson r = 0.76; concordance correlation coefficient = 0.72); concordance declined from 0.82 in 1999-2019 to 0.50 in 2020-2023. National CMR increased in CDC WONDER (AAPC, 0.60) but decreased in GBD 2023 (AAPC, -0.42). Opposite CMR trends occurred in 10 jurisdictions, and six had discordant high-burden classifications in 2023. The adjusted post-2019 signed discrepancy was -3.09 per 100 000, with no consistent spatial autocorrelation. Both sources showed higher ASMR in lower-income jurisdictions, with a steeper absolute gradient in CDC WONDER. Source choice changed conclusions about mortality trends, jurisdictional priority, and inequality. Discordant findings highlight the need for task-specific source selection and multisource review.
Gait asymmetries and compensatory strategies are common among individuals with unilateral transfemoral (TF) and transtibial (TT) amputation. Although these characteristics have been widely described in the prosthetic gait literature, comparative evidence directly examining differences between the 2 amputation levels, particularly using large-scale clinical data derived from long-term databases, remains limited. This study aimed to clarify gait asymmetry characteristics in individuals with unilateral lower limb amputation by comparing spatiotemporal gait parameters between TF amputees and TT amputees. A retrospective analysis was conducted on clinical gait data collected between 2013 and 2024 from 66 individuals at a Japanese rehabilitation center using a pressure-sensitive walkway system. Spatiotemporal parameters and symmetry indices (symmetry indices; a quantitative measure expressing interlimb differences as a normalized percentage difference between limbs) were calculated for each limb. Intergroup comparisons were conducted using the Mann-Whitney U test, and within-group comparisons of amputated vs. nonamputated limbs were performed using the Wilcoxon signed-rank test. TT amputees exhibited significantly greater walking speed, cadence, and stride length than TF amputees. Temporal asymmetries were more pronounced in TF amputees, whereas spatial and support-related asymmetries were more evident in TT amputees. Stride length asymmetry was also identified in the TF group. Symmetry indices for stance and swing phase durations were significantly greater in the TF group, whereas those for step width and double support time were greater in the TT group. Gait asymmetry patterns in lower limb amputees differ according to amputation level. TF amputees showed predominantly temporal asymmetry, whereas TT amputees demonstrated more marked spatial and support-related asymmetries. These findings support the clinical utility of symmetry indices in prosthetic gait assessment.
Packed red blood cell (pRBC) units are tested before transfusion to confirm compatibility, safety, and quality. Segments are lengths of heat-sealed tubing from the pRBC unit that enable compatibility testing without compromising sterility. If the degree of hemolysis differs between the segment and the parent unit, hematologic or metabolic testing of segments may lead to inaccurate assessment of the corresponding unit. We directly compared hemolysis indices between paired pRBC units and their corresponding segments to assess the degree of hemolysis and possible association with pRBC unit characteristics. Discarded pRBC units bearing at least 1 attached segment were obtained from a university hospital blood bank. Recorded characteristics included product expiration date, ABO/Rh type, and anticoagulant/additive solutions. Supernatant plasma was analyzed for hemolysis using the Roche cobas 8000 automated chemistry system H index. Associations between the H index and pRBC unit characteristics were also evaluated. A total of 42 paired pRBC units and corresponding segments were analyzed. The segment H index was statistically significantly higher than that of parent units (median [IQR], 309 [189-512] vs 98 [72-177]; Wilcoxon signed rank P < .001), with 39 of 42 (93%) paired samples demonstrating a higher H index in segments. The H index increased with the number of days past expiration both for segments (Spearman ρ = 0.69) and parent units (ρ = 0.61; both P < .001). No statistically significant association between H index and ABO blood group, Rh type, or additive solution type was identified. Our investigation revealed that pRBC segments had statistically significantly increased hemolysis compared with corresponding parent units. As a result, caution should be taken when using segments to assess hemolysis and other hematologic or metabolic testing.
Bilateral sagittal split osteotomy (BSSO) is widely used for mandibular advancement in patients with skeletal Class 2 malocclusion; however, long-term postoperative stability remains an important clinical concern. To evaluate long-term skeletal, dentoalveolar, and soft tissue stability following mandibular advancement with BSSO and rigid fixation. A retrospective cohort study was conducted in 32 patients undergoing mandibular advancement with BSSO and rigid fixation. Cephalometric measurements were obtained at four time points: preoperative, immediate postoperative, 12 months, and long-term follow-up (>3 years). Changes were analyzed using the Wilcoxon signed-rank test. The mean mandibular advancement was 5.42 ± 1.71 mm. Immediately after surgery, significant skeletal correction was achieved, with increased SNB and decreased ANB (both p < 0.001), accompanied by significant improvements in occlusal and soft tissue profile measurements. Most skeletal and occlusal parameters remained stable during the first postoperative year and throughout long-term follow-up, with no statistically significant changes observed between one year and the final evaluation. Soft tissue remodeling continued during follow-up, whereas overall skeletal and dental stability was maintained. Bilateral sagittal split osteotomy with rigid fixation effectively corrected skeletal Class 2 malocclusion and demonstrated favorable long-term skeletal, dental, and soft tissue stability.
To 1) improve pharmacy students' perceived confidence in communication skills and 2) identify perceptions of counseling a text-based AI-simulated patient using ChatGPT 4o. This study involved first-year pharmacy students in a required communications course at the University of Georgia. Four AI-simulated patients with unique characteristics and medication-related problems were developed in ChatGPT 4o. After didactic instruction, students completed a pre-survey, practiced counseling with the text-based AI patients to prepare for two separate graded standardized patient cases (GSPCs) and completed identical post-surveys after each GSPC to assess changes in confidence and overall perceptions. Quantitative data was analyzed using the Wilcoxon Signed Rank Test and thematic analysis was used for open-ended responses. Of 146 students, 117 (80.1%) completed all three surveys with significant improvements in perceived confidence observed across all 7 communication domains. The greatest gains were noted in initiating counseling sessions, applying prime questions, and using probing techniques in the first post-survey. While significant in the first post-survey, no significant changes were noted in nonverbal communication skills (body language, active listening) in the second post-survey. Thematic analysis of 386 comments identified five benefit themes (e.g., realistic practice, accessibility, structured counseling), four limitation themes (e.g., lack of human-like interaction, response limits), and four improvement areas (e.g., expanded scenarios, enhanced feedback). ChatGPT 4o text-based chatbot patients improved student perceived confidence in verbal counseling skills and was valued as a convenient, low-pressure, and accessible training tool. While limitations in realism and nonverbal skill development were noted, text-based AI-simulated patients represent a scalable supplement to traditional communication training in pharmacy education.
Competency-based medical education emphasizes early clinical exposure and integration of basic and clinical sciences. We evaluated the effectiveness of an integrated anatomy and transfusion medicine workshop in improving knowledge among first-year MBBS students. A quasi-experimental pre-post educational intervention study was conducted among first-year MBBS students attending a workshop on cubital fossa anatomy, venipuncture, bone marrow anatomy and related transfusion medicine procedures. Knowledge was assessed using an identical 11-item multiple-choice questionnaire administered immediately before and after the workshop. The primary analysis included MBBS students. Laboratory technicians attending the same workshop were analyzed separately as a descriptive subgroup. Paired t-test, Wilcoxon signed-rank test, 95% confidence intervals and Cohen's dz were used for analysis. Thirty-three first-year MBBS students were included in the primary analysis. Mean pre-workshop score increased from 8.09 +/- 1.40 to 10.06 +/- 1.09 after the workshop, with a mean paired improvement of 1.97 marks (95% CI: 1.50 to 2.44; paired t-test p<0.001; Wilcoxon p<0.001). The effect size was large (Cohen's dz=1.48). Thirty students (90.9%) improved and three (9.1%) remained unchanged; no student showed a decline. The proportion scoring at least 70% increased from 60.6% to 97.0%. Among six technicians, mean score improved from 5.17 +/- 1.17 to 8.50 +/- 0.84. An integrated anatomy-transfusion medicine workshop produced significant significantly improved students' immediate knowledge. Such multidisciplinary, clinically focused teaching sessions can effectively supplement routine anatomy education in competency-based medical curricula.
Living kidney donation among carefully selected individuals is generally considered safe but post-donation health risks vary by factors including family history. Data on long-term outcomes of related living kidney donors of recipients with familial Mediterranean fever (FMFLRD) are limited. This retrospective multicenter study reviewed the medical records of living donors who donated between 2010 and 2021 across six transplantation centers. Cardiovascular and kidney outcomes were compared between 37 FMFLRD and a propensity-matched control group of 74 donors to recipients without FMF (non-FMFLRD). Propensity score matching was based on donor age, sex, and follow-up time. Outcome measures included major cardiac events (MACE), new-onset hypertension, new-onset diabetes mellitus, proteinuria and estimated glomerular filtration rate (eGFR). The median follow-up duration of all donors was 4.0 years (interquartile range, IQR 2.0-11.0 years). The mean age of the FMFLRD group was 48.9 ± 9.3 years, The FMFLRD group showed a significantly lower proportion of MACE (2.7% vs. 17.6%, p = 0.026) and new-onset hypertension (13.5% vs. 39.2%, p = 0.004) and a trend towards a lower proportion of new-onset diabetes mellitus (2.7% vs. 14.9%, p = 0.052) compared to the non-FMFLRD group. There were no significant differences in long-term kidney function, as evidenced by similar eGFR and proteinuria levels between the groups. The FMFLRD group showed similar kidney outcomes and lower rates of cardiovascular and metabolic complications during follow-up compared with matched non-FMFLRD; however, given the retrospective design and relatively short follow-up duration, long-term donor safety remains uncertain and the results should be interpreted cautiously.
In Asia, laparoscopic splenectomy and azygoportal disconnection (LSD) is a primary and effective treatment for patients with cirrhotic portal hypertension. While LSD is widely recognized to improve liver function in cirrhosis, its specific effect on liver reserve function remains underexplored. This prospective study aimed to evaluate whether LSD enhances liver reserve function in these patients. Clinical data were collected over a 1-year follow-up after LSD, including the Child-Pugh score and class, albumin-bilirubin (ALBI) score and grade, indocyanine green retention rate at 15 min (ICG-R15), its plasma clearance rate (ICG-K), and its half-life (ICG-T1/2). After screening, 68 patients were included. At one year postoperatively, both Child-Pugh class and ALBI grade improved significantly after LSD (F = 4.52 and 7.48, respectively; both P < 0.001). Similarly, ICG-R15, ICG-K, and ICG-T1/2 all showed significant improvement compared to preoperative baseline values (F = 9.40, 69.43, 32.47, respectively; all P < 0.001). Moreover, compared to baseline, ICG-R15, ICG-K, and ICG-T1/2 demonstrated progressive and significant improvement from postoperative month (POM) 3 through POM 6 and POM 12 (all P < 0.001). Their maximum improvement was observed at POM 12, with changes of 42.3%, 25.8%, and 29.0%, respectively. These positive trends were consistently observed across their three ICG-R15-based subgroups (10% ≤ ICG-R15 < 20%, 20% ≤ ICG-R15 < 40%, and ICG-R15 ≥ 40%). LSD enhances liver reserve function in patients with cirrhotic portal hypertension. This improvement may contribute to a better quality of life and greater tolerance for potential future therapies, such as those required in the event of hepatocellular carcinoma. The trial registration identifier at clinicaltrials.gov is NCT05325437.
The IFN-γ ELISpot assay identifies culprit drugs in non-immediate drug hypersensitivity reactions (DHRs), but sensitivity is reduced in certain clinical contexts, particularly with systemic corticosteroid use. To evaluate whether anti-PD-L1 supplementation increases detectable drug-specific T-cell responses in patients at higher risk of false-negative conventional ELISpot results. In this retrospective cohort study, 223 patients (450 drug-level tests) with SCARs and other non-immediate DHRs underwent paired ELISpot testing under conventional and anti-PD-L1-supplemented conditions. Anti-PD-L1 was applied selectively to patients with corticosteroid use, remote reaction history, or DRESS phenotype. Positivity was defined as ≥20 SFU per 106 PBMCs. Paired positivity was compared by McNemar's test and SFU magnitude by Wilcoxon signed-rank test, with pre-specified subgroup analyses by corticosteroid exposure, phenotype, and drug class. Anti-PD-L1 supplementation increased ELISpot positivity from 14.4% (65/450) to 35.3% (159/450), an absolute increase of 20.9% (94 additional positive tests; p<0.001). Conventional positivity was numerically lower in corticosteroid-treated patients (11.6% vs 18.5%, p=0.059), whereas anti-PD-L1-modified positivity was similar between groups (35.4% vs 34.7%, p=0.950). Augmented responses were consistent across all phenotypes and correlated with established causality scores. Among 114 patients tested against more than one distinct drug, positivity remained predominantly limited to a single drug per patient under both testing conditions. Anti-PD-L1 supplementation substantially increased detectable ELISpot reactivity. Although conventional positivity was numerically lower in corticosteroid-treated patients, positivity was similar between groups after anti-PD-L1 supplementation. While single-drug positivity predominated, some patients showed reactivity to two or more drugs under anti-PD-L1-supplemented conditions. Prospective multicenter validation is warranted.
The magnitude and axis of surgically induced astigmatism depend on the sclera-corneal tunnel dimensions. Often, the incision depth is subjective, and standardization is rarely emphasized. This study attempts to evaluate a fixed scleral incision depth of 350 µm at 1-week post-op. The aim is to determine the SIA vector and centroid using the Pythagorean theorem and keratometric measurements. This study was conducted from January to July 2025 and recruited 42 patients at a tertiary health institution. All patients received scleral incisions to a depth of 350 µm after preoperative auto-keratometry measurements. Preoperative astigmatism was classified into WTR, ATR, and oblique types. The overall mean age was 67.14 (± 9.23) years, with 27 (64.29%) males and 15 (35.71%) females. A positive correlation (r = 0.93, 0.69) was found for pre- and post-operative keratometry. T-test for pre- and post-operative vertical keratometry revealed statistical significance (p < 0.0009). The mean SIA magnitude and axis were 2.05 (± 1.75) D and 77.94º (± 59.68º), respectively. The Wilcoxon signed-rank test showed statistical significance for SIA magnitude (p=0.0003). The centroid was at 22.3º. A 28.57% conversion rate from ATR to WTR was observed, with 71.43% remaining unchanged postoperatively. High prediction accuracy was observed for preoperative horizontal and vertical keratometry (R2 values of 0.93 and 0.74, respectively). This work adds a unique dimension to the literature by explicitly linking a fixed tunnel depth to the SIA vector and keratometric prediction. These results provide a platform for future research exploring scleral incision depth as a determinant of astigmatic outcomes. This study finds a statistically significant difference in vertical keratometry with moderate SIA magnitude. Astigmatic axis transition was unchanged in most patients, likely due to a standardized scleral incision depth. Centroid demonstrated a minimal SIA magnitude on horizontal keratometry. An excellent postoperative keratometry prediction was determined.