Descending necrotizing mediastinitis (DNM) is a relatively uncommon complication of deep neck infections. However, with inappropriate use of antibiotics, steroids, or underlying medical problems such as immunocompromised conditions, this type of infection can become life-threatening. We report a case of Ludwig Angina with DNM, diagnosed at the end of December 2019. The subject was a 17-year-old female admitted to the pediatric intensive care unit after two weeks of clinically significant distress and swelling in her neck, tongue, and lips. The predominant underlying oropharyngeal infection originated from the mandibular 3rd molar. The patient was successfully treated due to early diagnosis and adequate medical intervention. Supportive medications were highly effective, including bronchodilators to assist in breathing and improve lung air entry, intravenous glucocorticoids like dexamethasone for their anti-inflammatory effect, and a regimen of antibiotics. No surgical intervention was necessary; the only procedures performed were percutaneous drainage of an abscess in the submandibular area and chest tube insertion for pleural effusion. Early diagnosis and appropriate medical treatment are critical in managing DNM. Supportive medications and minimally invasive procedures can effectively manage the condition, avoiding the need for extensive surgical intervention. This case highlights the importance of vigilant diagnosis and comprehensive medical management in improving patient outcomes.
Eisenmenger syndrome (ES), a severe complication of uncorrected congenital heart defects, is characterized by pulmonary hypertension and right-to-left intracardiac shunting resulting in systemic hypoxemia. Double outlet right ventricle (DORV), a rare congenital anomaly where both great arteries arise predominantly from the right ventricle, further exacerbates hemodynamic instability. Pregnancy in women with ES and DORV is associated with extremely high maternal and fetal mortality rates, requiring meticulous, multidisciplinary management. A 20-year-old Gravida 1 Para 0 woman at 34 weeks gestation presented with progressive dyspnea, cyanosis, and generalized edema. She had a single antenatal visit with no cardiovascular evaluation. Examination revealed finger clubbing, elevated jugular venous pressure, pitting edema, bibasilar lung crackles, and a systolic murmur. Vital signs were notable for heart rate 130 bpm, BP 110/70 mmHg, RR 25/min, and SpO₂ 80% on supplemental oxygen. Laboratory tests showed anemia and elevated CRP without fever. Imaging and echocardiography revealed a large ventricular and atrial septal defect with bidirectional shunt, severe tricuspid regurgitation, and estimated pulmonary artery pressure of 85 mmHg. DORV was suggested with the aorta arising from the right ventricle. A multidisciplinary team opted for vaginal delivery. Labor was induced with misoprostol (Bishop score 5) under continuous maternal monitoring. The patient delivered vaginally after 4 h. The newborn weighed 2.7 kg, with Apgar scores of 5 and 7 at 1 and 5 min, respectively. Postpartum, the mother received diuretics, blood transfusions, and antibiotics for elevated CRP. She stabilized by day seven and was transferred to cardiology for ongoing management. This case highlights the challenges of managing pregnancy in women with ES and complex congenital heart defects like DORV. The successful vaginal delivery emphasizes the importance of a multidisciplinary approach, individualized treatment plans, and comprehensive monitoring to minimize risks. This case also demonstrates that vaginal delivery can be a viable option in selected patients when meticulously managed. Careful planning and multidisciplinary care can lead to favorable outcomes in pregnancies complicated by ES and DORV, despite their significant risks.
​Balloon rupture during transcatheter aortic valve implantation (TAVI) is a rare but life-threatening complication. We report a successful bailout strategy following TAVI balloon rupture during the deployment of a 24.5 mm Myval valve. Upon partial inflation failure, the valve and ruptured balloon were retracted into the descending aorta. To overcome friction, diluted propofol (1 mg in 10 mL saline) was injected through the balloon lumen as a chemical lubricant, facilitating safe balloon disengagement. Following en bloc removal of the damaged system and placement of a new sheath, the first valve was intentionally deployed in the descending aorta using a sequential balloon expansion strategy (20 mm followed by 27.5 mm). A second 24.5 mm Myval valve was subsequently implanted at the native annulus without complications. This case highlights the novel use of propofol lubrication as a rapid, effective endovascular bailout technique.
A 21-year-old female patient with schizophrenia, whose primary symptom was refractory auditory hallucinations, developed intracranial hypertension syndrome following her first session of modified electroconvulsive therapy (MECT), presenting with severe headache, projectile vomiting, diplopia and meningeal signs. She subsequently received 1 Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left temporo-parietal cortex with each session delivering 1,500 pulses at 74% of the resting motor threshold. Her auditory hallucinations diminished markedly 3 days after completing rTMS and resolved completely 1 week later, accompanied by improved social functioning. No recurrence was observed during 3 weeks of follow-up. This case primarily demonstrates that rTMS may represent a safe and effective alternative for patients with refractory auditory hallucinations who are intolerant to MECT. It serves as a clinical reminder to maintain vigilance for elevated intracranial pressure following MECT, particularly in patients with a history of migraine.
Trauma is a major health problem, killing 4.5 million people each year. Most (84%) of these deaths are in low- and middle-income countries (LMICs), where resources for trauma care are constrained, often severely. These resource constraints lead to discrepancies in outcomes, with higher case-fatality rates for similar injuries in LMICs compared with high-income countries. Over one million trauma deaths could be averted each year if case-fatality rates in LMICs could be brought down to high-income country levels. There have been many local examples of affordable and sustainable improvements in trauma care and trauma outcomes in LMICs. The WHO and professional societies have worked to make more sustained progress globally. These efforts have resulted in moderate improvements in the availability of resources for trauma care, as assessed by consensus panels over the past 20 years. During this time, mortality for trauma has declined by 24% in the richer half of the world (high-income and upper middle-income countries) and by 15% in the poorer half (low-income and lower middle-income countries). To make further progress, there are several priorities (long-term efforts that probably require significant investment and new technology) and opportunities (which are immediately actionable). Priorities include increased availability of blood; improved care for traumatic brain injury; and improved prehospital care. Several opportunities are calling out for immediate action: increased use of trauma short courses and quality improvement programs; development of an international trauma registry for benchmarking; and use of the newly updated edition of the International Association for Trauma Surgery and Intensive Care's Guidelines for Essential Trauma Care for needs assessments of trauma care resources, with advocacy to fill identified gaps.
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder. Left ventricular outflow tract (LVOT) obstruction typically results from systolic anterior motion (SAM) of the anterior mitral leaflet. We describe a 26-year-old man with HCM in whom SAM was generated by isolated elongation of the posterior mitral leaflet, a rare mechanism with important clinical implications. He was diagnosed during childhood by a paediatric cardiologist and followed until transition to adult care. On presentation, he was in NYHA (New York Heart Association) class II with asymmetric septal hypertrophy (25 mm) and posterior leaflet elongation causing LVOT obstruction. Cardiac magnetic resonance confirmed hypertrophy and late gadolinium enhancement at the site of maximal wall thickness. Genetic testing revealed a pathogenic MYH7 variant (p.Ile263Thr) and a MYH6 classified as of uncertain significance. Treatment with mavacamten 5 mg led to a reduction of the LVOT gradient from 63 to 32 mmHg and symptomatic improvement. This case illustrates an unusual anatomical substrate for LVOT obstruction in HCM and emphasizes the role of multimodality imaging in diagnosis. It also highlights the therapeutic potential of myosin inhibition with mavacamten in avoiding invasive interventions in complex phenotypes.
Hemorrhagic cystitis (HC) in children is most associated with infection or treatment-related toxicity, whereas other cases remain uncommon. We report a 5-year-old boy presenting with recurrent painless gross hematuria in whom a structured, stepwise evaluation excluded glomerular, infectious, structural, and systemic causes. Cystoscopy revealed diffuse mucosal inflammation with focal hemorrhagic changes involving the bladder neck and posterior wall, consistent with noninfectious HC. In the absence of an identifiable etiology and with persistent symptoms, management was directed toward restoring urothelial barrier integrity using intravesical hyaluronic acid (HA). The clinical response was rapid, with resolution of gross hematuria after the first instillation, followed by sustained remission and progressive endoscopic improvement. The treatment was well tolerated, and the patient remained disease-free at 12 months of follow-up. This case highlights the diagnostic complexity of unexplained hematuria in children and supports a potential role of urothelial barrier dysfunction in the pathogenesis of noninfectious HC.
Brazil has implemented multiple policies targeting congenital syphilis (CS); however, evaluations of their effectiveness remain limited. This study aimed to analyze temporal trends in annual rates of gestational syphilis (GS) and CS from 2011 to 2022 across Brazil and its regions. It was hypothesized that effective prenatal care would enable early GS detection and that appropriate treatment of pregnant patients and their partners would reduce CS detection rate. This temporal study used GS and CS notification data from all Brazilian municipalities. National and regional annual rates were analyzed using the joinpoint regression model. Annual percent change (APC), average APC (AAPC), 95% confidence intervals, and p values were calculated. A total of 586,855 new GS cases and 272,491 CS cases were reported during the study period. GS rates increased throughout Brazil and all regions, accompanied by a decline in APC values. For CS, rates achieved overall stabilization in Brazil as well as the North, Midwest, and South regions, whereas the Southeast and Northeast regions experienced continuous growth with a reduced APC from 2015 and 2017, respectively. Although CS trends stabilized or increased at reduced APC values over time, rates remain high. Additional efforts are required to eliminate the disease, including earlier initiation of prenatal care and improved prevention, diagnosis, and treatment of syphilis in pregnant patients and their partners.
This study examined procedural success and long-term outcomes of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO) compared with de novo CTO. While contemporary techniques have improved acute success rates for IS-CTO PCI, data on long-term outcomes remain limited. We aimed to examine procedural success rates for IS-CTO PCI using contemporary techniques, evaluate long-term clinical outcomes with extended follow-up, identify independent predictors of major adverse cardiac events, and compare our findings with recent multicenter registries. We analyzed 501 consecutive CTO PCI procedures in 456 patients at our institution between January 2018 and December 2023. Patients were stratified into IS (n = 82, 16.4%) and de novo CTO (n = 419, 83.6%) groups. The primary endpoint was a composite of in-stent restenosis requiring revascularization, heart failure hospitalization, myocardial infarction, and stroke at median follow-up of 713.5 days. Cox proportional hazards regression identified predictors of adverse events. Patients with IS-CTO had a higher prevalence of diabetes (58.5% vs. 47.5%, p = 0.067) and prior myocardial infarction (46.3% vs. 27.5%, p = 0.001). Procedural success was similar (86.6% vs. 79.5%, p = 0.136) with comparable in-hospital complications. However, at median follow-up of 713.5 days, patients with IS-CTO experienced higher rates of the composite endpoint (26.4% vs. 12.8%, p = 0.003), driven by in-stent restenosis (20.8% vs. 5.2%, p < 0.001). After adjustment, IS-CTO showed a trend toward increased risk for composite outcome (HR 2.03, 95% CI 1.00-4.11). Independent predictors of composite outcome included heart failure (HR 2.15, 95% CI 1.17-3.94) and male sex (protective: HR 0.49, 95% CI 0.26-0.90). Despite achieving procedural success comparable to de novo CTO, IS-CTO PCI is associated with significantly worse long-term outcomes over extended follow-up, particularly recurrent restenosis. These findings underscore the need for improved therapeutic strategies in this challenging population.
The phase 3 EAGLE-1 trial demonstrated noninferiority of oral gepotidacin to ceftriaxone plus azithromycin for treating uncomplicated urogenital gonorrhea. To reflect real-world practice, we conducted an exploratory analysis of efficacy assessed by nucleic acid amplification tests (NAAT). EAGLE-1 (NCT04010539) compared the efficacy and safety of oral gepotidacin (2 × 3000 mg) with intramuscular ceftriaxone (1 × 500 mg) plus oral azithromycin (1 × 1000 mg) in participants (≥12 years) with uncomplicated urogenital gonorrhea. Urogenital specimens for NAAT were collected at baseline and test-of-cure (days 4-8). The microbiological intent-to-treat (micro-ITT) population comprised all participants who received ≥1 dose of study treatment, with culture-confirmed ceftriaxone-susceptible urogenital Neisseria gonorrhoeae at baseline. The microbiologically evaluable NAAT test-of-cure population comprised micro-ITT participants with valid baseline NAAT-positive results, who followed important trial protocol components and valid test-of-cure NAAT results. NAAT-confirmed treatment success was defined as nucleic acid clearance at the test-of-cure. High concordance between NAAT and culture results was observed (98.4%). In the micro-ITT population, NAAT-confirmed success rates at the test-of-cure were 82.5% (151/183) for gepotidacin and 75.0% (132/176) for ceftriaxone plus azithromycin (adjusted difference 8.2%, 95% confidence interval [CI], -0.1%, 16.5%); numerically lower than the corresponding culture-confirmed success rates of 92.6% (187/202) and 91.2% (186/204). In the microbiologically evaluable NAAT test-of-cure population, NAAT-confirmed success rates at the test-of-cure were 88.3% (151/171) for gepotidacin and 86.3% (132/153) for ceftriaxone plus azithromycin (adjusted difference 3.8%, 95% CI, -3.6%, 11.2%). The NAAT-confirmed success rates were high and similar between treatments, supporting the primary analysis results based on culture.
Balloon aortic valvuloplasty (BAV) remains a vital tool as a bridge to definitive treatment, a palliative therapy, or a stabilizing procedure for hemodynamically unstable patients. Our aim was to characterize patients undergoing BAV and identify predictors of procedural success, major adverse cardiovascular and cerebrovascular events, and in-hospital mortality. This retrospective, single-center registry embraced consecutive patients undergoing BAV between 2010 and 2022. Procedural success was defined as mean pressure gradient reduction > 10 mm Hg. Major adverse cardiovascular and cerebrovascular events was the primary composite endpoint. Among 136 patients (57 men [41.9%]; mean [standard deviation] age 78.5 [8.9] years), BAV was performed as: a bridge to transcatheter aortic valve implantation (n = 42, 30.9%), palliative procedure (n = 49, 36.0%), prognostic procedure during transcatheter aortic valve implantation qualification (n = 33, 24.3%). Sixteen patients underwent percutaneous coronary intervention (14 before [10.3%] and 2 during BAV [1.5%]). Procedural success was reported in 60 patients (44.1%) and independently associated with a higher mean pressure gradient (odds ratio [OR], 1.09; 95% confidence interval: 1.002-1.19; P = 0.04). Major adverse cardiovascular and cerebrovascular events occurred in 23 patients (16.9%), was independently predicted by a higher maximal aortic valve gradient (OR, 1.02; P = 0.014) and need for intubation (OR, 15.5; P = 0.003). In-hospital mortality was 6.6%, with precedent percutaneous coronary intervention being its independent predictor (OR, 32.0; P = 0.015). Patients after successful BAV more frequently underwent subsequent aortic valve replacement. Balloon aortic valvuloplasty remains a valuable procedure, particularly as a bridge to definitive treatment. Major adverse cardiovascular and cerebrovascular events and mortality risk remains significant, highlighting the fragile nature of the patients' population.
Foot-and-mouth disease (FMD) causes severe global economic loss, necessitating rapid viral characterization. Nanopore sequencing provides a simple, real-time workflow suitable for on-site outbreak response, addressing the limitations of conventional methods. In this study, we optimized a previously published amplicon-based protocol and used this method to characterize a diverse range of samples (vesicular fluid, epithelium, serum, nasal/oral swabs, and environmental samples) collected during FMD outbreaks in 2025 in the Republic of Korea. Of the 129 samples collected, we successfully recovered complete genomes from 37 samples and VP1 sequences from 85 samples. Amplifying the S-fragment in isolation and separately barcoding each pool of PCR amplicons markedly improved sequence recovery. Furthermore, sequencing success depended on viral load and sample type. Based on comparisons with real-time RT-PCR results, whole-genome sequence (WGS) recovery exceeded 77.3% at cycle threshold (Ct) values ≤25 across all clinical samples. In the Ct > 30 category, serum samples yielded the highest WGS recovery rates (44.4%). This rate was markedly higher than the success rates observed for epithelium (20.0%) and nasal swabs (9.1%), whereas oral swabs and environmental samples failed to yield any sequences (0%). However, VP1 recovery from environmental samples reached 80% at Ct ≤ 30 (8/10), providing an approach to enable non-invasive monitoring. These findings demonstrate that amplicon-based nanopore sequencing is a practical method for the rapid generation of genomic data during FMD outbreaks.IMPORTANCEAlthough rapid detection and genomic data analysis are crucial for effective foot-and-mouth disease (FMD) control, the collection of these data can be challenging for certain sample types and impacted by reduced viral loads that result from nationwide FMD vaccination. This study provides a practical solution through large-scale evaluation of an optimized amplicon-based nanopore sequencing protocol to enhance the sequencing success rates for both clinical and environmental samples. Using a modified protocol to enhance genome recovery, we demonstrated that sequence data could be retrieved from diverse sample types (even with high real-time RT-PCR cycle threshold values). We identified serum as the most suitable sample, with environmental sample sequencing allowing for non-invasive monitoring during outbreaks. These results support the use of nanopore sequencing for rapid genomic analysis, particularly in outbreak responses, such as rapid surveillance, emergency vaccine selection, and epidemiological monitoring.
The Colonoscopy Outreach for Rural Communities (CORC) study is a randomized controlled trial testing the effectiveness of a remotely-delivered patient navigation program to increase colonoscopy completion for colorectal cancer (CRC) screening among rural and underserved patients. This study assesses CORC's success in recruiting rural patients and outlines approaches for including rural residents in clinical research. We conducted descriptive analyses of rurality designations for enrolled patients based on their ZIP code using the Federal Office of Rural Health Policy (FORHP) definition and Rural-Urban Commuting Area (RUCA) codes. The primary care organization (PCO) partnership was based on Rural-Urban Continuum Codes (RUCCs). To recruit patients, CORC partnered with two PCOs in urban counties (RUCC = 3) and four PCOs in rural counties (RUCC >3). Of 527 participants, 75% (n = 394) lived in rural areas overall; 43.3% resided in large rural areas, 38.3% in small rural areas, and 18.4% in isolated rural areas. Nearly all (97.3%) participants recruited from the four PCOs located in rural counties lived in FORHP-designated rural areas, whereas urban PCOs contributed both rural (53.3%) and urban participants. Partnering with rural PCOs in a pragmatic clinical trial led to successful recruitment of rural patients. Working with PCOs in urban counties also contributed to successful rural patient recruitment. Several key approaches included partnering with primary care to reach patients in their communities, using multiple strategies to understand PCO's populations served, and tailoring recruitment to rural patients' unique needs. These strategies may help researchers increase the representation of rural populations in clinical research.
Supersaturated oxygen (SSO2) therapy is a new therapy that reduces infarct size and improves myocardial remodeling after successful revascularization by percutaneous coronary intervention (PCI). An action mode via the improvement of coronary microvascular dysfunction (CMD) is suggested; however, the device requires a femoral puncture and keeping the patient in the interventional room for 60 minutes. Thus, the development of stratified medicine via CMD severity could be of interest. This study sought to investigate the action of SSO2 therapy on CMD in patients with anterior ST-segment elevation myocardial infarction (STEMI). In a prospective pilot study, consecutive patients with acute anterior STEMI undergoing primary PCI were enrolled. After successful PCI of a proximal lesion or middle left anterior descending artery, SSO2 therapy was performed. Blood was drawn from a femoral artery sheath (5F catheter), hyper-oxygenated by SSO2 therapy, and delivered to the origin of the left anterior descending artery a via a dedicated catheter by radial artery (6F catheter). Improvement in CMD was assessed by comparing the angiography-derived index of microcirculation resistance (Angio-IMR) before and after 60 minutes of SSO2 therapy measured on conventional angiographic images. ΔAngio-IMR was calculated as Angio-IMR before SSO2 - angio-IMR after SSO2. Twelve patients (all men; mean age, 64 [59-69] years) successfully completed the procedure. No complications were noted during the SSO2 procedure. Median Angio-IMR before SSO2 was 44.5 (32.5-52.5) and median Angio-IMR after SSO2 was 23 (20-30.5); P = .003. ΔAngio-IMR was statistically different between patients with or without Angio-IMR >40 at baseline (25 [16.2-29.7.5] vs 4.5 [1-11]; P = .004). In patients with anterior STEMI, SSO2 improves CMD measured by angio-IMR. Only patients with high Angio-IMR at baseline (>40) presented a significant decrease. These results need to be confirmed with more data, and thus, Angio-IMR could help to develop stratified medicine to use SSO2 in anterior STEMI patients with severe CMD.
To evaluate the characteristics, prognostic factors, and treatment outcomes in patients with superior oblique (SO) palsy. A retrospective review was conducted on patients diagnosed with SO palsy at King Chulalongkorn Memorial Hospital from January 2012 to October 2022. Patient demographics, etiology, preoperative strabismus evaluations, treatment approaches, and surgical outcomes were analyzed. Motor and sensory success criteria were ocular deviation ≤5 PD vertically, ≤10 PD horizontally, and the resolution of diplopia. Among 57 patients, 43 (75.4%) had acquired SO palsy, most commonly due to ischemia (50.9%). Unilateral involvement was observed in 48 patients (84.2%), while 9 (15.8%) had bilateral SO palsy. Congenital cases had higher odds of requiring surgery (OR 30, 95% CI [3.55-253.86]; p < .001) compared to acquired cases that resolved spontaneously. Among 26 surgeries, inferior oblique (IO) myectomy was the most common (57.7%). Motor and sensory successes were achieved in 84.6% and 50% of cases respectively. Vertical deviation improved from 13 (6-20) to 0 (0-3) PD (p < .001) at distance and from 13 (6-20) PD to 0 (0-3) PD (p < .001) at near. Postoperative drift toward overcorrection was noted at both distance (-4 [-5 to -2] PD; p < .001) and near (-4 [-8 to -1] PD; p = .002) but stabilized by 12 months. The Harada-Ito procedure reduced extorsion in bilateral cases from 25 (22-30) to 5 (0-10) degrees (p < .001), correcting 10 (7.5-11) degrees for each operated eye (p = .02). SO palsy management requires individualized treatment. Congenital cases were more likely to require surgery. IO myectomy is effective for vertical deviations ≤15 PD, while larger misalignments need combined procedures. The Harada-Ito procedure corrected 10 (7.5-11) degrees of extorsion for each operated eye in bilateral SO palsy. Aiming for early small residual hypertropia is advisable due to postoperative drift to overcorrection, particularly in congenital cases with large fusional amplitudes.
COVID-19 may contribute to worse outcomes in acute coronary syndromes through exaggerated inflammation, platelet activation, and endothelial injury, creating a prothrombotic environment. Mortality in ST-segment elevation myocardial infarction (STEMI) with concurrent COVID-19 is markedly higher than in prepandemic cohorts. We characterize patients with non-ST-segment elevation myocardial infarction (NSTEMI) and COVID-19 using core laboratory adjudicated data. We conducted a retrospective analysis of patients with NSTEMI and laboratory-confirmed COVID-19 from the William Osler Health System. Coronary angiograms and electrocardiograms were evaluated by the independent core laboratories. Overall, 155 patients (29.7% women, median age 67 years) were included. In-hospital mortality was 8.4%. In total, 67 patients underwent percutaneous coronary intervention, with 22.3% being unsuccessful. High thrombus grade (3-5) at presentation was observed in 43.3% of patients, and among those with a prior stent, 25% had stent thrombosis. Global systolic dysfunction occurred in 32.3% of patients. Electrocardiograms demonstrated diffuse, nonlocalizing ST changes, with a high prevalence of ST elevation in aVR (33%), conduction abnormalities (19.4%), and Q waves (16.9%), suggesting diffuse thrombotic disease. This is the first core laboratory description of NSTEMI patients with COVID-19. Compared with prepandemic NSTEMI cohorts, these patients experience higher mortality and lower procedural success rates, likely driven by diffuse thrombotic disease.
This study aimed to identify factors associated with favorable 1-year surgical outcomes after PreserFlo MicroShunt (PMS) implantation, with a particular focus on baseline ocular anatomy and postoperative filtration patterns assessed by anterior segment optical coherence tomography (AS-OCT). This cohort study included individuals with primary open-angle or exfoliation glaucoma who underwent PMS implantation. AS-OCT was performed 1 month postoperatively. Surgical success was defined by hypertensive thresholds of 12 mmHg (A), 15 mmHg (B), and 18 mmHg (C), with an intraocular pressure (IOP) reduction of ≥ 20% from baseline. Each criterion had a hypotensive limit of 6 mmHg. Multivariable Cox proportional hazards models were used to evaluate factors associated with favorable outcomes, considering both hypertensive and hypotensive failure limits. Eighty-eight eyes were analyzed. Median IOP decreased from 19 mmHg (interquartile range: 16-23.8) to 10 mmHg (8-13) at 12 months (p < 0.001). Qualified success rates at 12 months were 56.8% for criterion A, 70.5% for criterion B, and 73.9% for criterion C. Filtration toward the corneal limbus on AS-OCT was associated with a lower risk of hypertensive failure across all criteria (HR, 0.28-0.57; p = 0.008-0.031). Longer axial length was significant for criteria B and C (HR, 0.70 and 0.77; p = 0.002 and 0.008). Older age and exfoliation glaucoma were risk factors for hypotensive failure (HR, 1.05 and 3.75; p = 0.01 and 0.006). Both baseline ocular anatomy, represented by axial length, and filtration toward the corneal limbus on AS-OCT were independently associated with favorable 1-year outcomes following PMS implantation. Integrating preoperative anatomical assessment with early postoperative imaging findings may help clinicians better understand individual surgical responses.
Adolescents' focus on self-appearance may cause emotional eating. Resilience and coping skills may prevent this. This study investigates the relationship between emotional eating and resilience among high school students. This descriptive, relational study was conducted with 477 students from five high schools in Antalya, Türkiye. The data were collected face-to-face using Personal Information Form, the Emotional Eating Scale for Children and Adolescents, and the Child and Youth Resilience Measure. Parametric tests were used in analysis. Male students had higher scores in Emotional Eating Scale for Children and Adolescents, in anxiety-anger-frustration and feeling unsettled subscales. Anxiety-anger-frustration scores were related significantly to Body Mass Index and study-time snacking. Depressive symptoms scores were linked to snacking while watching. Feeling unsettled scores were related to sweets/snacks consumption and study-time snacking. Resilience was significantly associated with grade, income, academic success, fast food/snack intake, and regular meals. No significant correlation found between emotional eating and resilience. Regression showed emotional eating was affected by height and study-time snacking; resilience was affected by height, grade, income, academic success, regular dinners. Emotional eating and resilience are associated with sociodemographic and eating behavior factors, but no significant link was found between them.
There is evidence showing that cognitive dysfunction is a typical characteristic in Alzheimer's Disease (AD) patients. CREB signaling-related neuronal dysfunction through ERK-RSK-CREB is a subtype of the pathological mechanism of AD. The present study aimed to investigate whether Scutellaria Barbata Flavonoids (SBFs) ameliorate the rats' cognitive impairment by targeting the ERK-RSK-CREB signaling pathway, utilizing the CREB indirect inhibition model by a specific ribosomal S6 kinase (RSK) inhibitor BI-D1870 application. Bioinformatics analysis was conducted to identify key pathways involved in AD. Based on this, an in vivo memory impairment model of related-AD was established in rats by indirect inhibition of CREB via intraperitoneal injection of the RSK inhibitor BI-D1870. Following successful memory impairment model of related-AD rats screening with the Morris water maze, the successful model rats were treated with SBFs (140 mg/kg) or the CREB activator Rolipram (0.5 mg/kg). Spatial and short-term memory were assessed using the Barnes maze and the Passive Avoidance Test, respectively. NeurN and Nissl body for neuronal integrity and the expression of ERK-RSK-CREB pathway-related molecules (p-CREB-Ser133/Ser142, RSK, CREB, EGR-1) were evaluated by histological staining, immunohistochemistry, and molecular biology techniques. Bioinformatics analysis identified the MAPK signaling pathway as a key pathway for further investigation. Experimentally, SBFs administration significantly improved both spatial and short-term memory deficits induced by BI-D1870. This cognitive recovery was associated with the restoration of neuronal Nissl bodies and NeuN expression. Mechanistically, SBFs upregulated the phosphorylation of CREB at Ser133 and the expression of RSK, CREB, and EGR-1 mRNA and/or protein, while concurrently downregulating the elevated phosphorylation of CREB at Ser142, which demonstrated the bidirectional regulatory mechanism of SBFs on CREB phosphorylation of the ERK-RSK-CREB pathway. This study demonstrates that BI-D1870 can cause the rats' memory deficits, and SBFs can mitigate BI-D1870-induced memory deficits by enhancing ERK-RSK-CREB signaling, similar to Rolipram. SBFs restored neuronal integrity (Nissl bodies, NeuN) and upregulated p- CREB-Ser133, RSK, CREB, and EGR-1, suggesting SBFs' neuroprotection. These findings highlight SBFs as a potential therapeutic agent for memory disorders via CREB pathway modulation. However, our research has some limitations. Bioinformatics identified the key signaling pathway involved in AD, but the BI-D1870 model merely estimates AD-related cognitive dysfunction; it does not recapitulate the full spectrum of AD pathology. Future studies should validate the efficacy, mechanisms, bioactive substances, and metabolized root of SBFs in more etiologically relevant transgenic AD models. Our findings indicate that SBFs exert neuroprotective effects against CREB indirect inhibitor-induced cognitive dysfunction, likely through the modulation of the ERK-RSK-CREB pathway. This suggests SBFs as a potential candidate for mitigating memory deficits associated with CREB dysregulation.
Following Coronary Artery Bypass Grafting (CABG) surgery, Healthcare Professionals (HCPs) implement postoperative patient care alongside Phase 1 Cardiac Rehabilitation (CR). Yet, HCPs' experiences, including enablers and barriers to the implementation of postoperative care alongside Phase 1 CR, are largely unknown. This study aimed to explore HCPs' perceptions of implementing postoperative care alongside Phase 1 CR, including assessing patient engagement, following CABG surgery. A qualitative study was undertaken using semi-structured interviews with 10 HCPs in a cardiothoracic unit at a large Australian tertiary hospital. Interview questions were underpinned by the Theoretical Domains Framework (TDF). Using purposive sampling, HCPs (registered nurses, allied health and surgical team), working in a surgical cardiac unit, were recruited from February to March 2023. NVivo 12.0 software was used to analyse the textual data using inductive content analysis to generate categories. Four categories related to HCPs' perceptions of implementation of postoperative care alongside Phase 1 CR were developed: (i) implementing individualised postoperative CABG care alongside Phase 1 CR, (ii) assessing baseline health status to inform postoperative CABG care and recovery, (iii) enhancing patient engagement through ongoing support post-CABG surgery, (iv) navigating barriers to implementing postoperative CABG care. HCPs described the complexity of implementing postoperative care alongside Phase 1 CR, where enablers and barriers influence the success of both interventions. Understanding HCPS' perceptions of implementation can assist in identifying strategies to overcome barriers and promote the implementation of individualised postoperative CABG care alongside Phase 1 CR. An individualised implementation enhances patients' engagement in their care.