Ethanol ablation of the vein of Marshall (VOM) has become one of the treatments for persistent atrial fibrillation (AF) and mitral-dependent atrial flutter (AFL). The presence of persistent left superior vena cava (PLSVC) poses a challenge to the procedure. We demonstrated a patient with a large PLSVC where a single conventional balloon could not occlude the vein. By adapting interventional cardiology knowledge and tools, a successful ethanol ablation was achieved using a double-balloon occlusion technique. In conclusion, employing proper devices and adapting interventional cardiology knowledge can result in successful VOM ethanol ablation in this tough scenario.

There is a paucity of research studying the experiences of peri/menopause 2. In a female-dominated profession such as clinical psychology, peri/menopause is likely to impact on clinical psychologists’ (CPs’) professional practice. This study aims to explore female CPs’ experiences of peri/menopause and how this impacts their professional practice. Ten interviews with female UK-trained CPs were analysed using an interpretative phenomenological analysis. Three superordinate and six subordinate group experiential themes were identified: Perimenopause threatening professional identity (“What is happening to me?”, “Am I just being lazy?”, “Just keep going”), The multiplicity of peri/menopause (“It’s like having another job”, “The hormonal woman”, Gains and losses of ageing), and The value of sharing lived experience. This study adds to the understanding of how peri/menopause impacts on women’s professional lives. It highlights the need to consider peri/menopause as a potential barrier to career progression in female-dominated professions, such as clinical psychology.

A document by Shrikrishna Shinde. Click on the document to view its contents.

Objectives Malignancies involving the temporal bone account for less than 2% of all head and neck cancers. This paper aims to outline management, complications and outcomes in a single surgeon’s, tertiary referral centre practice in the United Kingdom. Methods A retrospective review of patients who underwent lateral temporal bone resection (LTBR) under a single surgeon from 2012 to 2021 was undertaken. 5 year disease free survival and 5 year overall survival was determined. Results 23 cases required LTBR. Cutaneous malignancy accounted for 18/23 cases,. Squamous cell carcinoma was the most common pathology (12/23). 5 year overall survival was 52% (12/23), 5 year disease free survival was 39% (9/23). Conclusion Optimal treatment is still evolving, surgical treatment in the form of a LTBR appears to confer good locoregional control rates. Distant disease free survival rates are poor and reflects the aggressive nature of the disease.

Purpose Tracheoesophageal speech (TES) with a voice prosthesis (VP) is considered standard care in many countries for voice rehabilitation after total laryngectomy. Until recently, VPs were not available in China, and therefore patients had to use other communication methods. The aim of this study was to evaluate the feasibility of secondary tracheoesophageal puncture (TEP) as well as the effectiveness of TES as a method of voice rehabilitation in Chinese-speaking individuals living in China. Materials and Methods This clinical study was designed as a multicenter prospective single arm study. Thirty-six laryngectomy patients were enrolled and underwent a secondary tracheoesophageal puncture with placement of a Provox Vega. Voice assessments (clinician rated, objective assessment, and patient reported) were performed prior to VP placement and after 24 weeks, and VPs were changed every 3 months. Voice rehabilitation success and complications were recorded. Clinical Trials.gov Identifier: NCT05482815. Results There was a statistically significant improvement in clinician rated perceptual speech assessment (fluency, speed, pitch, intelligibility) at 24 weeks after TEP compared to baseline scores prior to placement of a VP. Sound intensity was significantly higher after TEP compared to pre-TEP, however, no significant change in maximum phonation time was observed. Patient reported voice handicap index was significantly lower after TEP compared to baseline. At the end of the study, 81% of the participants (29/36) were considered to have achieved an effective voice. Conclusion TEP is a feasible and an effective communication option post-laryngectomy for patients in China.

A Unique Presentation of Early Onset Colon Cancer in the Setting of Helicobacter Pylori Positivity, IgA Deficiency and a Germline 18p DeletionKelsey Gay, DO1, Smita Dandekar, MBBS, MD11Division of Pediatric Hematology-Oncology, Penn State Health Children’s Hospital, Hershey, PA

Background: High-frequency oscillatory ventilation (HFOV) presents challenges for non-invasive CO 2 monitoring due to its rapid oscillations. This study examines the feasibility of instantaneous CO 2 partial pressure (INST CO 2) monitoring during HFOV with a capnometer equipped with a mainstream CO 2 sensor. Methods: This study included seven neonates receiving HFOV in the neonatal intensive care unit (NICU) at Shizuoka Children’s Hospital. INST CO 2 values were recorded over 3- and 5-min intervals surrounding each blood gas sampling to determine the maximum INST CO 2 value (INST CO 2 MX). The primary outcome was the correlation between INST CO 2 MX and arterial partial pressure of carbon dioxide (PCO 2). Results: A total of 216 paired INST CO 2 MX and PCO 2 values were analyzed. The coefficient of determination ( R 2) was 0.571 for INST CO 2 MX (3 min) and 0.579 for INST CO 2 MX (5 min). Univariable and multivariable analyses revealed that a lower fraction of inspired oxygen (FiO 2), reduced minute ventilation, and increased postnatal age were associated with improved concordance between INST CO 2 MX and PCO 2. Conclusion: INST CO 2 MX demonstrated a strong correlation with PCO 2 in neonates undergoing HFOV. This novel, non-invasive monitoring approach may serve as a valuable tool for neonatal respiratory management. Future research is needed to validate these findings in broader patient populations and across various ventilatory settings.

BK polyomavirus nephropathy (BKPyV-nephropathy) leads to functional failure of kidney grafts in the early post-transplant period. The intensity of immunosuppressive therapy plays a significant role in the activation of BK polyomavirus (BKPyV) replication. We prospectively evaluated 457 per-protocol biopsies of kidney grafts in a group of 161 newly transplanted patients within the 1 st year after surgery. The incidence of excessive immunosuppression was calculated using the Calcineurin Inhibitor Nephrotoxicity Score (CINS). In case of detection of toxicity and BKPyV replication, the dose of tacrolimus and/or mycophenolate was reduced and the effect on the inhibition of BKPyV activation and regression of toxic changes were compared. In parallel, we studied the effect of preemptive reduction of tacrolimus dose on the onset of BKPyV replication in case of isolated detections of toxicity. A concomitant dose reduction of tacrolimus and mycophenolate in patients with histological evidence of toxicity and significant BKPyV replication was associated with an early and significant decrease in the plasma BKPyV-DNAemia load compared to isolated mycophenolate reduction (P = 0.023), significant decrease in CINS (P = 0.001) and better functional parameters at the end of one-year follow-up (P = 0.024). Preemptive tacrolimus dose reduction in case of toxicity signs was associated with a lower incidence of BKPyV replication, without increasing the risk of acute rejection.

The transient receptor potential vanilloid 1 (TRPV1) channel, known as the heat and capsaicin (CAP) receptor, plays a crucial role in pain sensation. Although CAP and its analogs can induce topical analgesia, their use is limited by severe thermoregulatory side effects. Here, we provide robust evidence that the bone antiresorptive agent zoledronic acid (ZOL) exerts analgesic effects by inhibiting TRPV1. In vitro, ZOL suppresses CAP-evoked responses in dorsal root ganglion (DRG) neurons and reduces TRPV1 channel conductance in Xenopus laevis oocytes, inhibiting its activity over a broad concentration range by occluding the permeation pathway from both the extracellular and intracellular sides. In vivo, ZOL administration attenuates thermal nociceptive behaviors in mice and flies exposed to noxious heat. Moreover, ZOL prevents CAP- and TRPV1-mediated synaptic effects, mimicking the actions of the TRPV1 antagonist capsazepine. Collectively, these findings identify ZOL as a potent TRPV1 blocker and provide compelling mechanistic insight into its analgesic effects in vivo, positioning it as a promising scaffold for the development of novel pain-relief compounds.

Structural, electrical, and metabolic alterations in the brain characterize neurodegenerative illnesses, which include Parkinson’s disease (PD), Huntington’s disease (HD), Tardive Dyskinesia (TD), epilepsy, Alzheimer’s disease (AD), and schizophrenia. Five distinct phosphoproteins make up the family of cytosolic proteins known as collapsin response mediator proteins (CRMPs), which are significantly produced throughout the nervous system’s development phase. This implies that CRMPs play a crucial part in directing the proliferation of neurons and the formation of axons. These proteins come in two varieties, one shorter (65 kDa) and the other longer (80 kDa) with N-terminal extensions. They are encoded by five different genes. Increased CRMP expression during central nervous system development is linked to several signaling networks, including the Rho Kinase pathway, glycogen synthase kinase-3 (GSK-3), and cyclin-dependent kinase 5 (CDK-5). These signaling pathways’ hyperphosphorylation of CRMP-2 under pathological circumstances leads to neurodegeneration in a number of neurological diseases. In neurodegenerative illnesses, phosphorylated versions of CRMP-2 impair neuronal polarity and limit axonal development, whereas unphosphorylated forms stimulate microtubule assembly and axonal growth. The focus of this review is on investigating the therapeutic effectiveness of CRMP-2 modulation in the treatment of different neurodegenerative diseases.

Background Schizophrenia is a complex mental disorder characterized by recurring episodes of psychosis, which disrupt an individual’s perception of reality. Symptoms often emerge gradually in early adulthood and can persist throughout life. Diagnosing schizophrenia involves thorough assessments of behavior, psychiatric history, and input from those close to the individual. The disorder’s heterogeneity complicates understanding its causes and mechanisms. Recent research has spotlighted ketamine, an NMDA receptor antagonist, as a crucial tool for studying psychosis. In this study, we induced schizophrenia-like conditions in rats using ketamine administered to the prefrontal cortex, confirmed through behavioral and neurochemical evaluations. We found that dysregulation of neurotransmitters such as dopamine (DA), serotonin, and glutamate plays a significant role in psychosis development. Experimental Approach Resveratrol (RSV) exhibited antioxidant properties and positively influenced DA levels, while tetrabenazine (TBZ) targeted dysregulated DA neurotransmission. Both compounds showed promise in alleviating behavioral deficits associated with ketamine-induced psychosis. Additionally, they may help mitigate neuroinflammatory changes linked to oxidative stress in the brain. Conclusion This research underscores the potential of RSV and TBZ as therapeutic agents for restoring neurotransmission disrupted by psychosis, offering new avenues for managing schizophrenia effectively.

Title:Rehabilitation Challenges and Strategies Following Arthroscopic-Assisted Lower Trapezius Tendon Transfer: A Case Report with Postoperative Wound Complication

Pediatric atopic dermatitis (AD), as one of the most prevalent chronic allergic diseases in children, poses significant challenges to affected children and their families. Current clinical treatments for this condition primarily involve topical corticosteroids, oral antihistamines, and biologic injections. In recent years, increasing attention has been paid to the potential association between vitamins and atopic dermatitis. Vitamins including A, B, C, D, E, and K have been explored as non-pharmacological interventions that modulate the immune system and may influence the onset and progression of atopic dermatitis. To gain deeper insights into their mechanisms, we have reviewed existing research on the relationship between vitamins and atopic dermatitis. Additionally, we discuss the immunomodulatory roles of vitamins and their potential effects on atopic dermatitis, along with a summary of studies examining vitamin supplementation as a therapeutic approach for this condition. Our objective is to provide theoretical foundations and practical guidance for the clinical management and lifestyle interventions of atopic dermatitis through the regulation of vitamin levels.

Objective: To identify and address factors impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement for implementing doable solutions. Design: Mixed methods approach Setting: District Matiari, Sindh, Pakistan. Population : Cases of maternal deaths, neonatal deaths and stillbirth Methods: Facility-based death audit review system integrated with community engagement based on WHO guidelines, established in three secondary level care health facilities. The ”Four Delays Model” was applied to identify and address factors contributing to maternal and perinatal deaths. Main outcome measures: Factors contributing to delays in maternal and newborn care; implemented doable solutions addressing these delays. Results: Using the “Four Delays Model” key factors identified were i) Lack of education and awareness (Delay 1-2), ii) Inadequate transport mechanism (Delay 3), iii) Multiple referrals (overlapping Delay 3-4), and iv) Limited facility operational hours and delayed medical care (Delay 4). Local audit committee recommended and implemented doable solutions including community awareness sessions engaging both men and women, ambulance services, improved referral systems, and facility-level administrative measures such as providing antenatal cards, maintaining DHIS records, and enhancing inter-facilities communications. Conclusion: Local community engagement influenced the willingness of policymakers to implement actionable solutions. Health systems need to improve women’s access and availability of healthcare facilities during and after pregnancy. Scaling up audit review systems with feedback loops is recommended for future reduction in mortality rates in resource constrained settings particularly where comprehensive national-level mortality data is lacking.

River systems worldwide are undergoing severe ecological and morphological degradation due to prolonged anthropogenic interventions, such as channelization and dam construction, which disrupt sediment continuity and natural flow regimes. In response, river re-naturalization projects have emerged as essential strategies to restore the dynamic balance of fluvial systems. However, these actions frequently encounter unintended morphodynamic consequences, including sediment erosion and deposition, altered flow patterns, and disrupted channel stability, which pose significant challenges to achieving ecological, navigational, and flood management objectives. This study addresses the critical challenges associated with secondary channel re-opening, a common practice in re-naturalization projects, focusing specifically on low-lying river systems. By employing a combination of numerical modeling and theoretical analysis, we investigate how key design parameters, such as localized levee lowering, influence the river reach equilibrium. The research highlights how an inappropriate project design can amplify sedimentation in the primary channel branch, reducing navigability, increasing maintenance costs, and offsetting ecological gains. To support management authorities and project designers, this work emphasizes the need for a multidisciplinary framework that incorporates long-term morphodynamic projections alongside ecological restoration goals. The findings provide insights into balancing environmental sustainability with operational functionality, offering guidance for improving the resilience and success of future re-naturalization efforts worldwide.

Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in Africa, accounting for over 1 million deaths annually. This burden is worsened by urbanization, modern lifestyle changes, limited healthcare access, and underreporting due to inadequate diagnostic tools. As CVD prevalence rises, Africa faces challenges in prevention, diagnosis, and management, particularly in rural areas. Addressing this crisis requires innovative approaches, and artificial intelligence (AI) has emerged as a transformative solution. Main Body: AI offers opportunities to revolutionize cardiovascular care by improving diagnostic accuracy and enabling personalized treatments. Predictive analytics, machine learning, and telemedicine can process structured and unstructured data from m-Health applications, wearable devices, and hospital records to facilitate early detection. Advanced applications, such as genome-wide association studies (GWAS) and precision medicine, further enhance genetic analysis and optimize treatment. Despite its advantages, AI integration faces challenges, including inadequate infrastructure, high implementation costs, and limited digital literacy among healthcare providers. Data privacy concerns remain critical, with only 36 of 55 African countries enacting data protection laws. Policy and funding constraints further hinder AI adoption, especially in rural areas. Conclusion: To overcome these barriers, Africa must develop ethical standards for data use, invest in workforce training, and strengthen healthcare infrastructure. Public-private partnerships and global collaborations are essential for capacity building and securing funding. Also, successful AI applications in some African countries and around the world can be modeled across Africa to improve cardiovascular health outcomes.

Background The healthcare sector contributes ~5% of global greenhouse gas emissions, with medicines responsible for ~10% throughout their lifecycle. Understanding how the environmental impact of medicines influences patients’ preferences relative to ease of use and cost supports interventions promoting appropriate medicine consumption, reduced waste, and environmental sustainability. Objective To investigate patient preferences and attitudes regarding the environmental impact of medicines in relation to ease of use and cost. Methods A cross-sectional survey (Dec 2022–Jan 2023) was conducted using the Dutch AMP pharmacy panel (>25,000 chronic medicine users). It included a discrete choice experiment (DCE) on medicines’ environmental impact, ease of use, and cost, and questions on environmental sustainability in medicine use and daily life. Latent class analysis identified groups with shared preferences. An environmental sustainability attitude score was calculated from daily life behavior. Results Of 25,787 invited panel members, 6,390 responded (24.8%), with 4,122 respondents included in the analysis (16.0%; mean age 68 years; 42.6% female). Four preference groups were identified: Eco-focused (55.7%), Cost-focused (20.1%), Indifferent (16.4%), and Eco-skeptical (7.8%). Environmental sustainability attitude scores were highest in the Eco-focused and Eco-skeptical (median 75.0%), followed by Indifferent and Cost-focused (median 66.7%). Important factors influencing this were environmental concerns (Eco-focused), environmental and personal health concerns (Eco-skeptical), costs (Cost-focused), and environmental, cost, and personal health concerns (Indifferent). Only 8.8–15.5% had good or very good knowledge about the environmental impact of medicines. Conclusion Environmental sustainability significantly affects medicine preferences, though heterogeneity exists. Tailored initiatives are required to promote environmentally sustainable pharmaceutical care.

This paper presents a rhythm-based expansion framework of dimensional space, introducing how structural rhythm governs the compression and dilation of energy fields across dimensions. This rhythmic mechanism explains the modulation of light speed, mass density, and dimensional coherence, and stands as a core concept within the Knot of Light framework.

OBJECTIVE To conduct a pilot study evaluating acceptability of pregnancy loss nomenclature amongst people with recent lived experience, and make recommendations for UK mass communication. DESIGN Electronic internet-based questionnaire. SETTING UK. POPULATION OR SAMPLE Service users who accessed UK healthcare for >1 experience(s) of pregnancy loss between 2021 and 2024 (n=391). METHODS Descriptive and inferential statistics. MAIN OUTCOME MEASURES Acceptability ratings for pregnancy loss nomenclature used diagnostically in UK healthcare settings. RESULTS Much nomenclature currently in use in UK pregnancy loss care was rated ‘unacceptable’ by a majority of study participants. Spontaneous abortion, incompetent cervix and cervical incompetence were among terminology rated as ‘unacceptable’ by >80% of the respondents rating terms for the process of loss. In contrast, pregnancy loss and ectopic pregnancy were rated ‘acceptable’ by >80% of respondents. As nomenclature for pregnancy loss outcomes, products, contents of the womb/uterus and tissue, were rated ‘unacceptable’ by >80% of respondents. Baby and ‘their given name’ were rated ‘acceptable’ by >80% of respondents across all gestational age brackets. Some terminology elicited mixed acceptability ratings. CONCLUSIONS Some pregnancy loss nomenclature attracted consensus acceptability or unacceptability ratings for respondents. The data inform evidence-based recommended alternatives which should be adopted for mass communications relating to pregnancy loss.

Aim: In this study, a population pharmacokinetic (PPK) model for imipenem was developed specifically for patients with febrile neutropenia 189 out of 250 words(FN) and hematological malignancies, with the aim of identifying optimal pharmacokinetic/pharmacodynamic (PK/PD) targets to predict antimicrobial efficacy and guide dosing regimens. Methods: A prospective, single-center, open-label study was conducted, analyzing 207 plasma samples from 121 Chinese patients with FN and hematological malignancies using chromatography. Pharmacokinetic parameters were evaluated using NONMEM to analyze the relationship between drug clearance and various patient-specific covariates. Results and conclusion: The analysis revealed that drug clearance was significantly impacted by creatinine clearance (CLCR), gamma-glutamyltransferase (GGT), and vancomycin (VAN) co-administration. The final PPK model was defined as follows: CL (L·h-1) = 21.36 × (CLCR/110.39)0.444 × (GGT/55.4)-0.119 + VAN × 3.78; central compartment volume (L) = 42.9; intercompartmental clearance (L·h-1) = 3.7; and peripheral compartment volume (L) = 59. The optimal PK/PD target for predicting imipenem’s antibacterial efficacy was determined to be an f%T > MIC of 90.48%. Therefore, dosing adjustments should account for CLCR, GGT levels, and VAN co-administration. For patients with infections caused by Pseudomonas aeruginosa or Acinetobacter baumannii, additional antimicrobial agents are recommended when necessary.

Current policies concerning artificial intelligence (AI) technology are falling behind the rapid growth of AI in healthcare due to the complexities of regulating such a dynamic domain. Similar to any pioneering technology, the application of AI in healthcare presents new ethical and legal dilemmas that extend beyond traditional bioethics, legislation, and governance. Currently, there are no definitive professional guidelines or standardised regulations governing AI in healthcare. This article examines the challenges that arise from the ethical considerations at the intersection of AI and healthcare research. The relevant ethical principles essential for ensuring the ethical use of AI in healthcare include justice, data stewardship, explainability of AI, accountability, and sustainability. We aim to discuss the ethical considerations that may arise at each stage of the AI development lifecycle based on the outlined principles, from early problem identification to post-deployment evaluation.

The ecosystem of the Yellow River Delta is at risk of salinization. Plant litter is an environmentally friendly and readily available improvement material. However, after the addition of litter, the changes in enzyme activity and carbon components of saline-alkali soil and their interrelationships have not been fully understood. This study used culture experiments to analyze changes in soil enzyme activities and carbon components following the addition of two plant litters ( Medicago sativa, Sorghum dochna). The results showed that within 30 days of cultivation, soil enzyme activities (β-glucosidase, urease, alkaline phosphatase, dehydrogenase) and labile carbon (DOC, MBC, POC) rose compared to the control. However, enzyme activities and labile carbon dipped by 80 days. Mineral-associated organic carbon (MAOC) remained non-significant change. There was strong positive links between DOC, MBC, POC and enzyme activities, highlighting labile carbon’s key role in driving microbial and enzymatic processes. Furtheremore, litter addition enhanced soil quality. This study showed short-term plant litter addition boosts soil enzyme activity and labile carbon in saline-alkali soils. But these gains aren’t long-lived, highlighting the need for ongoing organic inputs. Plant litters are eco-friendly, practical short-term soil amendments. For lasting soil fertility and resilience in saline-alkali ecosystems, long-term strategies blending organic inputs and microbial management are crucial.

The traditional LCF life prediction methods based on the macroscopic level cannot accurately describe the microscopic fatigue failure behavior of materials. Few studies investigate the effects of different strain ratios on LCF life prediction at constant maximum strain. Therefore, the crystal plasticity finite element method and representative volume elements are employed to examine the LCF behavior of nickel-based superalloy FGH4098 with different strain ratios at constant maximum strain. The parameter based on energy is also utilized to predict its LCF life. In addition, the applicability of the material's constitutive parameters under different strain ratios is analyzed. The results show that the use of specific constitutive parameters for different strain amplitudes significantly improves life prediction accuracy.

The sustainable development of China’s photovoltaic (PV) industry is increasingly acknowledged as a critical component in achieving the nation’s dual-carbon objectives. This study adopts a multidimensional framework to optimize PV systems, emphasizing four core dimensions: ecology, resources, environment, and low-carbon performance. It identifies key challenges within each domain, such as the ecological consequences of land use, the risks of resource depletion driven by rising metal demand, and the environmental threats posed by decommissioned PV modules. The analysis also addresses the carbon footprint and ecological impacts associated with PV power stations. To mitigate these issues, the paper introduces a multidimensional collaborative optimization model that integrates these four dimensions, aiming to foster the development of environmentally sustainable and low-carbon PV technologies. This model seeks to reduce the cumulative impacts across the identified areas, thereby supporting the PV industry’s sustainable expansion in China. Continued research is essential to refine region-specific deployment strategies, advance recycling technologies, and enhance integrated system optimization to meet China’s long-term sustainability and carbon mitigation goals.