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Background and Objectives: Wrestling is a high-intensity competitive sport with a high prevalence of knee injuries, among which anterior cruciate ligament (ACL) tears and other knee pathologies are common and clinically impactful. The wrestlers involved in this study ranged in age from 18 to 35 years old, including both professional and amateur athletes. All participants had achieved remarkable accomplishments in various national and international competitions, such as champions of the National Wrestling Championship and medalists of the Asian Wrestling Championship. These athletes sustained knee injuries during high-intensity training or competition, and were clinically diagnosed with ACL tears or other knee pathologies accordingly. Accurate diagnosis of ACL tears based on magnetic resonance imaging (MRI) is of critical importance for clinical decision-making and rehabilitation planning. However, the conventional manual analysis of MRI images is not only time-consuming but also prone to subjective deviations and diagnostic errors.    Methods: We propose a joint model combining an Improved Political Optimizer (IPO)—a metaheuristic optimization algorithm inspired by political competition and coalition strategies—with a Convolutional Neural Networks (CNN) to detect ACL tears in wrestlers. MRI images undergo standardization, normalization, and data augmentation before CNN automatically extracts deep features of the ACL region. IPO globally optimizes key CNN hyperparameters (e.g., learning rate, convolutional kernel size), enhancing both accuracy and efficiency.    Results: The IPO-optimized CNN achieved 93.5% accuracy, 91.8% sensitivity, and 94.7% specificity, while reducing training time by over 60% compared to traditional methods. Grad-CAM heatmaps confirmed that model attention aligns with expert-identified diagnostic regions.    Conclusion: The proposed IPO–CNN framework offers an accurate, efficient, and interpretable MRI-based solution for ACL tear detection, providing practical support for sports injury diagnosis and rehabilitation.
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Background and Objectives: Breast cancer is among the most prevalent cancers in women, ranking as the second cause of women’s death from cancer after lung cancer. Known as the most important lipophilic antioxidant, vitamin E plays a key role in preventing cancer. This study aims to analyze the serum levels of vitamin E and its effects on breast cancer.   Methods: In this case–control study, 42 women with breast cancer were compared with 50 healthy women. The enzyme-linked immunosorbent assay (ELISA) test with a ZellBio kit (made in Germany) was employed to measure the serum levels of vitamin E. The T-test, Anova, and  Pearson correlation were used in SPSS 26 to determine the significant differences of data.   Results: The mean age (± standard deviation) of the case group was 46.9 (± 7.01), whereas that of the control group was 40.8 (± 4.7) with a significant difference (P=0.000). Moreover, the mean vitamin E serum level of the case group was significantly lower than that of the control group (P=0.002). The findings also indicated that the serum level of vitamin E had no significant association  with the cancer stage, cancer grade, tumor size, estrogen status, progesterone status, and HER2.   Conclusion: The serum levels of vitamin E are lower in patients with breast cancer than in a healthy population.
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   Background and Objectives: Breast cancer is one of the common problems of women, and anemia is another serious disorder that is associated with this condition. In this study, we aimed to examine anemia in breast cancer patients and its relationship with their various pathological factors and tumor grade, and stage at different ages.   Methods: In this retrospective case-control study, the information of patients who were diagnosed with breast cancer and underwent surgery at Razi Hospital in Rasht, and their tissue samples were examined in the pathology laboratory, was collected. In this way, the patients were divided into anemic and non-anemic groups, and their pathology reports and laboratory parameters were examined and statistically analyzed.   Results: In this investigation, a total of 90 patients' pathology reports and laboratory findings were examined. Of the participants, 72 were identified as anemic, while 18 were non-anemic. The mean age of the cohort was 11.81±54.83. The study demonstrated a substantial correlation between anemia and advanced tumor stage (P < 0.001) as well as higher tumor grade (P = 0.001). Among anemic patients, prominent proportions exhibited nipple involvement (80%), simultaneous skin involvement (40%), vascular invasion (71%), lymphatic invasion (84%), neuronal invasion (57%), and necrosis in their pathological samples (41%). On the other hand, within the non-anemic group, none of the patients displayed nipple involvement, while smaller percentages had skin involvement (22%), vascular invasion (17%), lymphatic invasion (28%), neuronal invasion (17%), and necrosis in the pathological membrane (11%).   Conclusion: Anemic patients had a significantly higher degree of tumor at the time of diagnosis, and their tumor was at a higher stage than that of non-anemic patients. Vascular invasion, lymphatic invasion, and neuronal invasion in pathological samples were significantly less in the non-anemic group, and generally, based on multiple analyses, and in the matched model, hematocrit variable and lymphatic invasion had the greatest predictive effect.
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   Background and Objectives: Dynamic neuromuscular stabilization (DNS) is an exercise protocol that has recently attracted attention of many researchers in field of chronic pain control.Objectives: To investigate the effectiveness of DNS exercises on the thickness of core muscles and level of pain and disability in people with non-specific low back pain (NSLBP).   Methods: In a randomized clinical trial, 44 people with NSLBP with an age range between 30 and 50 years were randomly divided into two groups: intervention and control, with 22 in each group. The control group received routine physical therapy exercises, while the intervention group performed DNS exercises. The thickness of transverse abdominis and multifidus muscles was assessed during the abdominal hallowing maneuver and in the standing position using ultrasound. Pain and functional disability were assessed using the visual analog scale and Roland-Morris disability questionnaire, respectively. The outcomes were measured in both groups before and after 8 weeks of interventions.   Results: The results showed that after the 8-week intervention, the multifidus muscle thickness during muscle contraction and in the standing position, as well as transverse abdominis thickness in the standing position, were significantly greater in the DNS group compared to the control group (P<0.001). However, there was no significant difference in the TrA percentage thickness change during abdominal hallowing between the DNS and control groups. Additionally, pain and disability scores were significantly decreased in the DNS group compared to the control group after the intervention (P<0.001).   Conclusion: The study suggests that use of DNS exercises in people with NSLBP can help improve the activity level of core muscles and stability of lumbar vertebrae, which are both important components of physiotherapy goals for patients with NSLBP.
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Background and Objectives: Trauma is a major global health concern, with severity ranging from minor injuries to life-threatening conditions. While some patients can be managed on an outpatient basis, others require urgent intervention. Timely and accurate triage is essential to reduce mortality and morbidity in severe cases. To support rapid clinical decision-making, especially in prehospital and emergency settings, several trauma scoring systems have been developed to stratify risk and prioritize care. This study aimed to compare the predictive performance of five commonly used trauma scoring systems in estimating 28-day mortality in adult trauma patients.   Methods: This retrospective study included adult trauma patients (≥18 years) transported by 112 ambulance services to Kütahya Health Sciences University Emergency Department between December 1, 2019, and December 31, 2021. Prehospital Index (PHI), triage-Revised Trauma Score (T-RTS), Glasgow Coma Scale (GCS), Mechanism-GCS-Age-Arterial Pressure (MGAP), and Modified Rapid Emergency Medicine Score (mREMS) were calculated. The association of scores with 28-day mortality was investigated. Receiver operating characteristic (ROC) analysis was used to determine the predictive value.All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software.   Results: Exactly 4,142 trauma patients were included in this study. Approximately 62% of the patients were male (n=2,567), and 3.4% (n=141) of them died in the first 28 days. The mean age of the surviving patients was 41.2±22.8 years, and the mean age of the non-survivor patients was 72.3±20.6 years (P<0.001). The mechanism of trauma was blunt trauma in 92.4% of the patients in the survivor group (n=3,699) and 97.9% in the non-survivor group (n=138) (P=0.013). It was observed that the mREMS, MGAP, GCS, RTS, and T-RTS scores were predictive of mortality in the first 28 days (P<0.001), whereas the PHI score was not (P=0.1501). The score with the highest predictive value was the mREMS (Area Under the Curve (AUC): 0.902; P<0.001; 95% Confidence Interval (CI): 0.892–0.910).   Conclusion: The mREMS and MGAP scores were superior to other systems in predicting short-term mortality in trauma patients.
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Background and Objectives: Previous studies on Red Blood Cell Distribution Width (RDW)  and Systemic Immune Inflammatory Index (SII)  have focused on the prognosis of breast cancer, but few studies have explored its diagnosis. The study aimed to determine the clinical value of the RDW and SII in preoperative peripheral blood in differentiating benign from and malignant breast diseases.   Methods: Patients with breast disorders who visited our hospital for the first time between June 2021 and June 2022 were enrolled.The expression levels of RDW, SII, NLR, PLR and LMR were compared between the two groups. These indicators were analyzed useing the ROC. Analysis indicators included the optimal value, AUC, sensitivity, specificity,and their combination. Subsequently, binary logistic regression was performed to establish the RDW+SII diagnostic model. Finally, the correlation between the RDW and SII and related pathological parameters was analyzed.   Results: Except for LMR, the RDW, SII, NLR, and PLR in the breast cancer group than those in the benign breast disease group, and the differences were statistically significant. According to the ROC curve analysis, the AUC of tne RDW was 0.668, which was the highest among the five indicators.The best critical value of the RDW in identifying benign and malignant breast masses was 13.00, with a sensitivity of 57.42% and a specificity of 71.28%.The optimal critical value of the RDW+SII diagnostic model established by binary logistic regression was 0.38, with a sensitivity of 79.78%, a specificity of 50.54%, and an AUC of 0.705. The RDW and RDW+SII diagnostic models were associated with the TNM stage of breast cancer.   Conclusion: The RDW and RDW+SII diagnostic models based on preoperative peripheral blood have guiding significance for the diagnosis and evaluation of breast cancer.
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Background: Gastric cancer (GC) is a leading cause of cancer-related mortality, and postoperative malnutrition and immune dysfunction significantly impact recovery. While nutritional support is a vital aspect of postoperative care, previous studies have primarily focused on comparing the effectiveness of parenteral nutrition (PN) and enteral nutrition (EN). However, the potential benefits of combining these methods (PN+EN) to enhance quality of life (QoL) and immune recovery in gastric cancer (GC) patients remain largely unexplored. In this study we address this gap by evaluating different postoperative nutritional approaches. Methods: Sixty postoperative GC patients were randomly assigned to PN, EN, or PN+EN groups. The primary outcome was the overall health status and quality of life (QoL) score, using the EORTC QLQ-C30, while secondary outcomes included immune function markers, assessed by lymphocyte counts (CD3+, CD4+, and CD8+) and immunoglobulin levels (IgA, IgG). Results: By day 7, the PN+EN group showed significantly greater improvements in Global Health Status/QoL and Physical Function (both P < 0.05) compared to the PN and EN groups. Additionally, the PN+EN group exhibited higher IgA and IgG levels (P < 0.05) and improved lymphocyte recovery (P < 0.01). Conclusion: A combined PN+EN approach enhances postoperative recovery in GC patients, significantly improving QoL and immune function. These results support the use of PN+EN in clinical practice to optimize outcomes for GC patients following surgery.
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Background and Objectives: The use of cone-beam computed tomography (CBCT) for accurate diagnosis is increasing; however, there is a significant gap in the literature regarding the reasons for CBCT requests in maxillofacial surgery. This study aimed to analyze the CBCT referral process of patients who applied for maxillofacial surgery clinic by assessing the request reasons for CBCT imaging.   Methods: Patients with insufficient conventional images who were admitted to the oral surgery department between January 2018 and June 2019 were retrospectively analyzed. Patients were classified based on their CBCT referral reasons. The mean ages of female and male patients were statistically compared using the independent samples t-test. The distribution of mean ages by gender was assessed using the Kruskal-Wallis test, while the mean ages of patients for the top three reasons for requesting CBCT were compared using the Chi-Squared test.   Results: A total of 2376 patients were grouped based on their CBCT referral reasons. The most frequent reason was the evaluation of impacted mandibular third molar with 823 (34.6%) patients. 365 (15.36%) patients were referred to CBCT for the various odontogenic cysts and benign tumors, and 357 (15.02%) patients were referred to CBCT for an implant evaluation. The least frequent reasons were for the calcified areas with 9 (0.4%) patients, and for the sleep apnea with 3 (0.13%) patients.   Conclusion: As a result, the most common need for CBCT in maxillofacial surgery practice was to evaluate the position of the impacted mandibular third molar.
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Background and Objectives: Breast cancer is the most common cancer in women worldwide and poses a major public health challenge. Early detection and effective treatment are essential for better survival and outcomes. Traditional diagnostic and treatment approaches have evolved over time, and recent advancements in artificial intelligence (AI), including screening, diagnosis, treatment, and prognosis, have shown great promise in revolutionizing breast cancer care.   Methods: The PubMed, Web of Science, and Scopus databases were searched using terms such as “artificial intelligence”, “machine learning”, “breast cancer”, and “breast neoplasm”, prioritizing recent publications.   Results: AI’s ability to assist in medical imaging, predict cancer risk, and integrate with other screening methods is transforming traditional practices. Studies have demonstrated AI’s potential to match or even surpass that of human experts in cancer detection, increasing diagnostic accuracy and aiding in classifying tumor subtypes and grades. AI-driven predictive models are instrumental in predicting disease progression and treatment outcomes, allowing for more personalized therapeutic interventions. The adoption of AI in mammography has been shown to reduce radiologists’ workload while maintaining or improving diagnostic performance. AI models in ultrasound imaging enhance the differentiation of benign and malignant lesions, thus reducing unnecessary biopsies. In MRI, AI aids in precisely detecting and characterizing breast lesions, outperforming traditional methods.   Conclusion: AI has significantly enhanced breast cancer care by improving diagnostic accuracy, aiding in early detection, and enabling personalized treatment. Its integration into screening and imaging processes is revolutionizing traditional practices, offering promising advancements in both clinical outcomes and healthcare efficiency.
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Background and Objectives: Hospital reimbursement is a critical component of the hospital financial system that directly impacts hospital cash flow and profitability. Given the increasing medical costs and financial pressures, reducing deductions due to errors and mistakes in reimbursement processes is of great importance. The purpose of this study is to accurately and transparently analyze the factors affecting deductions and identify weaknesses in hospital financial and administrative processes.    Methods: This study was conducted to examine the extent and causes of deductions in inpatient files and to improve the hospital reimbursement process for patients who encountered deductions during the years 2022-2023. The research community includes experts involved in hospital deductions and handling hospital bills, including hospital supervisors and revenue unit experts or financial affairs experts in a selected teaching general hospital in Tehran in 2023. It used the Six Sigma approach as a process optimization method. The intervention was carried out by implementing the phases of the Six Sigma method in the hospital.   Results: In this study, the reimbursement process was examined from the time of patient admission, recording medical information, calculating costs, sending information to insurance, and finally receiving payments. By implementing the phases of the Six Sigma method, the number of cases examined and the total amount of deductions in the year 2023 have decreased significantly. These changes have also caused the average monthly deduction percentage to decrease from 1.33% in 2022 to 0.82% in 2023.    Conclusion: The results of this study showed that the use of Six Sigma in improving the hospital reimbursement process significantly reduced financial deductions. Also, by improving the speed of processes, the time for reimbursements was reduced, which led to increased patient satisfaction and reduced financial pressure on the hospital. Overall, the results of the study indicate that the careful implementation of Six Sigma methods can significantly increase hospital productivity and reduce unnecessary costs, while maintaining the quality of services to patients.
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Background: Traditional general anaesthesia for ureteroscopy typically employs neuromuscular blocking agents (NMBAs) with endotracheal intubation, which may lead to postoperative complications including residual paralysis and delayed recovery. Objective: To investigate the effectiveness and safety of general anaesthesia without NMBAs combined with SaCo Video Laryngeal Mask (SaCoVLM™) ventilation. Methods: This single-centre, randomised, double-blind trial enrolled 180 patients undergoing ureteroscopy. Patients were randomly divided into the NMBA group (N group, n=90) and NMBA-free group (NF group, n=90). Both groups received midazolam, sufentanil and propofol for induction, with vecuronium added only in the N group. Primary outcomes included haemodynamic parameters, first insertion success rate, extubation time, and postoperative recovery scores. Statistical analysis was performed using independent t-tests and chi-squared tests with significance set at p<0.05. Results: No significant differences were observed in first insertion success rate (87.7% vs 90.0%, p=0.640), haemodynamics, or intraoperative body movements between groups. Both groups showed satisfactory muscle relaxation without adverse events. The NF group demonstrated significantly shorter extubation times (9.6±1.8 vs 13.3±1.7 min, p<0.001), higher modified Aldrete scores at 10 minutes post-extubation (9.7±0.4 vs 9.0±0.2, p<0.001), and better TOFr recovery (94.6±2.52 vs 93.4±1.9, p<0.001). No significant differences were found in laryngeal complications within 24 hours postoperatively. Conclusion: General anaesthesia without NMBAs combined with SaCoVLM ventilation ensures smooth ureteroscopy implementation with shorter extubation times and improved recovery compared to traditional NMBA-based approaches.
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Background: Myoclonus, which can be caused by etomidate during the induction of general anesthesia, can lead to serious complications. Objectives: To explore the effects of pretreatment with remimazolam on reducing the incidence and severity of etomidate-related myoclonus. Methods: This study was a randomized controlled trial. In total, 216 patients were divided into 4 groups. Three groups received 0 mg/kg (E group), 0.025 mg/kg (LRE group), or 0.05 mg/kg (HRE group) remimazolam pretreatment before etomidate. Another group received only 0.2 mg/kg remimazolam (R group) as anesthesia. The primary outcome was the incidence and severity of myoclonus. Complications were also recorded. The two-way analysis of variance and chi-square test/Fisher’s exact test were used for the corresponding data. Results: The frequency of myoclonus was lower in the LRE group (14/50, 28%), HRE group (8/51, 16%), and R group (0/51, 0%) than in the E group (28/52, 54%), as well as the incidence (P < 0.001). Additionally, the HRE group performed better than the LRE group did (P < 0.001). Compared with those in the E group, the incidence of intraoperative and postoperative complications in the HRE, LRE, and R groups was significantly lower (P = 0.001), which were not significant different between HRE and LRE groups, and the complications in R group were lower than those in the HRE and LRE groups (P < 0.001). Conclusion: Pretreatment with remimazolam was feasible for preventing etomidate-related myoclonus during gastroscopy. Furthermore, 0.05 mg/kg remimazolam is more effective than 0.025 mg/kg remimazolam.
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Crisis events, such as armed conflicts and pandemics, trigger significant neural and cognitive changes that prioritize survival but impair higher-order functions, including analytical reasoning, working memory, and social cognition. This narrative review evaluates key brain mechanisms involved in crisis response, focusing on the amygdala, hippocampus, prefrontal cortex, and insula, which modulate attention, decision-making, memory, and empathy under stress. Building on these insights, we propose translational strategies for crisis management, including sensory processing optimization, concise brain-compatible communication, cognitive load reduction through structured decision frameworks, collective emotion regulation, and simulated empathy activation. These disruptions stem from heightened activity in the brain's limbic system, particularly the amygdala, resulting in hypervigilance and emotional reactivity that override reflective and socially attuned processes governed by the prefrontal cortex. These interventions align with the brain’s adaptive constraints, enhancing clarity, reducing panic, supporting intuitive decisions, and fostering social cohesion. This framework may integrate cognitive neuroscience into crisis planning and leadership, advancing neuromanagement and neuroleadership paradigms. Ultimately, embedding neuroscientific principles into crisis response can improve immediate outcomes and long-term psychological resilience in diverse and high-stress environments.
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Background and Objectives: Lower limb deep vein thrombosis (DVT) poses a significant risk to patients undergoing orthopedic surgeries. The aim of the present study was to develop a customized intervention plan and construct a risk prediction model for lower limb DVT in these patients.   Methods: We used a convenience sampling method due to its practicality and efficiency in clinical settings to enrol orthopaedic inpatients. The samples were divided into two groups: a training set (n=183) collected between January 2020-December 2021 for model development and a validation set (n=83) collected from February-July 2022 for validation of risk prediction model. Model performance was assessed using accuracy, sensitivity, specificity, and the area under the ROC curve (AUC).   Results: The model correctly identified 61 out of 83 patients, achieving 73.49% accuracy in identifying both DVT-positive and DVT-negative cases, with a sensitivity of 81.82% (9/11) for detecting DVT-positive patients and a specificity of 72.22% (52/72) for identifying non-DVT patients. The AUC (0.807, 95% CI: 0.671–0.894) reflects that the model had strong discriminatory ability, though some uncertainty remains, as reflected in the confidence interval with a Jorden index of 0.491 which balances sensitivity and specificity to optimize the model’s predictive power. The Sensitivity (83.4%) and Specificity (75.2%) of the model shows that it can effectively detect DVT cases while minimizing false positives. Multivariate regression analysis revealed that independent risk factors (occurrence rate<5%) included age (>60 years), post-surgery bedridden status (>5days), and spinal surgeries.   Conclusion: This study developed a risk prediction model for lower limb DVT in critically ill orthopaedic patients. Key risk factors, including advanced age, prolonged post-surgery bedridden status, and spinal surgeries. Larger multi-center studies are needed for validation.
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Background and Objectives: The popularity of hyperbaric oxygen therapy (HBOT) among athletes for speeding up recovery from sports injuries has been increasing recently. We aimed to systematically investigate the effect of HBOT on outcomes related to ankle function in acute ankle sprain.   Methods: A literature search was conducted using population, intervention, comparison and outcomes (PICO) method in PubMed, Scopus, Web of Science, ProQuest, Google scholar, and Science Direct databases to obtain literature published until January 2025. The studies quality was examined through modifies Downs and Black checklist. A narrative analysis was performed since meta-analysis could not be conducted.   Results: Five studies involving 122 individuals in the range of 18 and 34 years with a history of lateral ankle sprains were selected for final evaluation, all of whom received HBOT during the acute phase of their injuries. The HBOT was administered within the first 24 to 36 hours after the injury occurred. The quality of the studies varied, with three receiving a poor score and two receiving a good score. The outcome measures related to ankle function included ankle edema, pain levels, active and passive range of motion, overall ankle functionality, and the time taken to achieve recovery. There was a general consensus that follow-up visits after HBOT—especially when conducted at absolute atmospheric (ATA) pressure above 2—indicated significant improvement in these outcome measures compared to the initial visit for patients with lateral ankle sprains during the acute phase. However, there were discrepancies among the limited studies regarding the priority of HBOT compared to standardized physiotherapy.   Conclusion: While the studies had some limitations in number and scientific quality, this review indicated that HBOT can be an effective intervention for improving ankle function in the acute phase of a lateral ankle sprain if administered within the first 24 to 36 hours following the injury.
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Background: Iliac vein compression syndrome is a peripheral venous disease that has attracted much attention in recent years. Severe iliac vein compression syndrome can lead to secondary deep vein thrombosis, aggravate chronic venous insufficiency of lower limbs, and lead to pain, swelling and other symptoms of affected limbs, which can be life-threatening if not treated in time. Objectives: it aimed to assess the outcome of endovascular intervention (EVI) on the levels of inflammatory factors in patients with May-Thurner syndrome (MTS) complicated with acute left lower extremity deep vein thrombosis (LEDVT). Methods: the medical records of 180 MTS subjects with acute left LEDVT undergoing EVI in Chongqing Dongnan Hospital from October 2020 to March 2024 were collected for research. All subjects were tested for blood routine, coagulation function, and inflammatory factors before and following remedy. Results: following remedy, the levels of inflammatory factors C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-6, and IL-10 were markedly decreased as against those before remedy (P <0.05). Moreover, the decrease of CRP level was positively correlated with the improvement of D-Dimer (D-D) and fibrinogen (FIB) levels. Only 8.33% of patients recurred within one year after operation, and the venous patency and Villalta score were markedly stable at 3 and 12 months after operation. Conclusion: this article shows that EVI can not only directly relieve vascular compression, but also positively affect the disease process by regulating the inflammatory response. It provides a scientific basis for the application of EVI in such diseases.
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Background and Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that can lead to joint damage and disability. Early and accurate prediction of its prognosis is crucial for timely intervention and improvement of patient outcomes. This work evaluated the accuracy of the musculoskeletal ultrasound combined with serum inflammatory factor (SIF) detection method in predicting the prognosis of RA.Methods: This was a research report. 80 patients with RA treated at Affiliated Northwest University, Third Hospital of Xi’an from February 2022 to May 2023 were recruited. Based on the prognosis, they were allocated into a good prognosis (GP) group (n=42) and a poor prognosis (PP) group (n=38). Musculoskeletal ultrasound, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and tumor necrosis factor-alpha (TNF-α) were measured in all patients. The Rheumatoid Arthritis Disease Activity Index (RADAI) was recorded before and after the patients were treated, and the accuracy of different indicators in predicting RA prognosis was compared. Data analysis was performed using SPSS 26.0. For categorical data, chi-square tests were conducted; for continuous data, t-tests were used. A P-value of <0.05 was considered statistically significant.Results:Musculoskeletal ultrasound showed that the blood flow parameter grading in the GP group was significantly different compared to the PP group (P=0.009), and the synovial proliferation parameter grading in the GP group also showed a significant difference when compared to the PP group (P=0.024). The levels of ESR, CRP, and TNF-α in patients increased with the increasing grades of synovial proliferation/blood flow parameters. Significant differences were observed in ESR (P=0.011), CRP (P=0.026), and TNF-α (P=0.009) levels among patients with different synovial proliferation parameter grades (P<0.05). After treatment, the RADAI score (P=0.038), CRP (P=0.002), ESR (P=0.011), and TNF-α (P=0.031) levels in the GP group were significantly lower than those in the PP group (P<0.05). The AUC for musculoskeletal ultrasound combined with CRP, ESR, and TNF-α in predicting PP in RA was significantly higher than that of musculoskeletal ultrasound (P=0.026), ESR (P=0.006), CRP (P=0.045), or TNF-α (P=0.033) alone (P<0.05).Conclusion:Musculoskeletal ultrasound jointed with SIFs demonstrated good accuracy and clinical significance in predicting the prognosis of RA.
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Gastric arteriovenous malformations (Gastric AVMs) are a rare etiology of upper gastrointestinal (GI) bleeding, and often present with ambiguous endoscopic findings. We hereby present the case of a 63-year-old man with recurrent upper GI bleeding, that was initially misdiagnosed as a submucosal tumor (SMT) following the initial gastroscopy, but was later diagnosed as a gastric AVM. Following the gastroscopy, the patient was treated with endoscopic hemostasis using metal clips. A re-bleeding episode prompted a second endoscopy 3 months following the procedure. This endoscopy revealed a donut-like ulcerated SMT lesion. Endoscopic ultrasonography (EUS) demonstrated a thickened mucosal layer with internal hypoechoic and anechoic regions, which indicated a vascular lesion. The presence of abundant blood flow within the lesion was confirmed on Doppler ultrasound. Digital subtraction angiography (DSA) corroborated these findings, demonstrating a characteristic donut-like image at the lesion site. The patient subsequently underwent laparoscopic-assisted partial gastrectomy, and had no postoperative bleeding episodes. Histopathological examination confirmed the diagnosis of gastric AVM.
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Background: Rapid rehabilitation surgical nursing focuses on multidisciplinary theories, adopts multiple models and optimization measures to reduce physiological and psychological stress as well as expedite postoperative recovery of patients. Nonetheless, there are few of studies analyzing the influence of rapid rehabilitation surgical nursing in patients undergo laparoscopic cholecystectomy.Objective: This study aims to assess the clinical use of rapid rehabilitation surgical nursing in laparoscopic cholecystectomy.Methods: Patients who underwent laparoscopic cholecystectomy in Suzhou hospital of Anhui medical university between June 2021 and July 2022 were separated into research group (RG) as well as control group (CG) based on different nursing plan, with 51 cases in each group. Routine nursing plan was implemented for CG patients. Rapid rehabilitation surgical nursing was implemented for RG patients.Results: The bowel sound recovery time, the first time of anal exhaust and getting out of bed, as well as the length of hospital stay in the RG were declined in contrast to the CG. Prior to nursing, no significance was found in VAS scores, IL-6 and CRP levels, as well as WHOQOL-BREF scores in both groups. After nursing, VAS scores were declined in both groups, and those in the RG were declined in contrast to the CG. IL-6 together with CRP levels were increased in both groups, but those in the RG were declined in contrast to the CG. WHOQOL-BREF scores of all dimensions were higher in both groups than before nursing, and those in the RG were elevated relative to the CG. Additionally, the total occurrence of complication in the RG was declined compared to the CG. The total nursing satisfaction in the RG was elevated relative to the CG (P<0.05).Conclusion: Application of rapid rehabilitation surgical nursing can expedite postoperative rehabilitation, reduce pain and stress response, promote quality of life and lessen complications in patients undergo laparoscopic cholecystectomy, thereby promoting nursing satisfaction, which is worthy for promotion.
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Background and Objectives: Previous studies have discussed the advantages of different anesthesia techniques in carotid artery surgery. However, there is not enough data comparing local anesthesia and block techniques. In this retrospective study, pain management during and after carotid endarterectomy cases is performed with regional and infiltration (tumescent) anesthesia.   Methods: Endarterectomy cases performed in our clinic between 2022 and 2023 were examined. The patient's age, gender, comorbidities, type of anesthesia (infiltration anesthesia, deep cervical plexus block), and postoperative pain levels of the patients were evaluated.   Results: Body Mass Index (BMI) means of patients were statistically significant and higher in cervical block patients compared to infiltration patients (P<0.05). Operation pain was significantly correlated with BMI (r=0.346; r<0.01) and medicine usage (r=-0.252; P<0.05). Pain after 24h was significantly correlated with operation duration (r=-0.296; P<0.05) and medicine usage (r=-0.286; P<0.05). The effect of medicine on operation pain was insignificant at a multivariate level (P>0.05), whereas the effect of BMI was significant (B=0.055; P<0.05) with controlling anesthesia type. Pain level according to BMI was significant with 0.717 Area Under Curve (AUC) value meaning 71.7% pain predictive value of BMI. Patients having a BMI over 22.85 had high pain with 93.2% positive predictive and 42.9% negative predictive level. Effects of medicine and operation duration on VAS after 24 hours were insignificant at the univariate level (P>0.05).   Conclusion: Although there is no medical justification, retrospectively, cervical block was preferred more in patients with high BMI. High BMI predicts intraoperative pain, suggesting tailored analgesia for obese patients." Further researches are needed to understand cervical block preference for higher BMI and its effects on operation pain.
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Background and Objectives: Anemia is one of the most important health-related challenges worldwide. Unenhanced brain CT scans can be used to correlate dural sinus density with hemoglobin level. This study investigates the predictive capability of dural sinus density, measured through unenhanced CT scans, to evaluate anemia in patients.   Methods: Patients who underwent unenhanced brain CT within 24 hours of hemoglobin test were selected for the study. The density of 5 regions of interest (ROI) in the dural sinuses was obtained and correlation with Hb level was analyzed.   Results: In our study with a sensitivity of 94% and a specificity of 95%, Dural sinus density proves to be an effective screening tool, using 36.5 HU as a cut-off. This cut-off makes for good sensitivity for further evaluation with blood tests. The analysis reveals a strong positive linear correlation between mean Hounsfield units (HU) and hemoglobin (Hb) levels, enabling the formulation of a predictive regression equation (Hb=1.604+(0.309×mean HU)).   Conclusion: Dural sinus density shows a strong relationship to the Hb level .By excluding confounding variables and utilizing a robust methodology, the findings advocate for the integration of automated Hb estimation via AI tools in CT imaging, which could significantly enhance clinical decision-making and patient outcomes. Overall, the study underscores the potential of Dural sinus density as a rapid and non-invasive indicator of anemia, aiming to reduce morbidity and mortality associated with this condition.
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Background and Objectives: Total knee arthroplasty (TKA) is often utilized in clinical therapy for knee joint diseases in middle and advanced stages. Nevertheless, because patients have severe pain after surgery and are prone to multiple complications, the recovery efficacy is not ideal. We attempted to clarify perioperative application value of the concept of Enhanced Recovery After Surgery (ERAS) for TKA.    Methods: A total of 92 patients under treatment with TKA in hospital from July 2021 to June 2022 were chosen and underwent division into control or experimental group in a random manner, with 46 cases each. The control group underwent conventional rehabilitation intervention. The ERAS concept was infiltrated for experimental group. The surgical rehabilitation, postoperative complications, negative emotions, knee-joint function, as well as nursing satisfaction in both groups underwent observation and analysis.   Results: Before operation, knee-joint function scores presented no difference between both groups (P>0.05). At 2 and 4 weeks after operation, knee-joint function scores in both groups presented improvement (P<0.05), and improvement in experimental group was better than that in controls (P<0.05). The postoperative recovery in experimental group was better than that in controls. After nursing intervention (P<0.05), total complication rate in experimental group was 6.52%, presented a marked depletion relative to 32.61% in controls (P<0.05). After nursing intervention, the total nursing satisfaction rate in experimental group was 97.83%, presented a marked elevation relative to 80.43% in controls (P<0.05). After nursing, the HAMD and HAMA scores in both groups were declined, and those in experimental group presented lower than that in controls (P<0.05).    Conclusion: Scientific infiltration of ERAS concept in perioperative period of TKA can alleviate physical and mental pain of patients, facilitate their physical recovery, deplete probability of complications, and improve knee function of patients, which has good application value.
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   Background and Objectives: Ultrasound imaging is crucial for breast cancer diagnostics but is prone to subjectivity, causing delays and errors. This study aims to improve diagnostic efficiency and reduce reliance on human interpretation by introducing a novel breast tumor diagnosis technique using a squid game optimization-inspired neural network (SGO-NN).   Methods: The proposed method combines a Siamese neural network (SNN) with SGO techniques to detect tumor variations in ultrasound images. Publicly available breast ultrasound images were preprocessed with a Gaussian filter to enhance quality and remove extraneous information. The Adaptive Watershed Transformation (AWT) approach was used for segmentation, and significant texture characteristics were extracted using the gray-level statistical matrix (GLSM) method. The SGO-NN technique was then trained to identify breast tumors.   Results: The SGO-NN method achieved high performance with sensitivity (94.80%), recall (93.50%), accuracy (91.30%), specificity (93.20%), and precision (92.70%). This performance surpassed existing methods, including Convolutional Neural Networks (CNN), Cubic-Support Vector Machine (C-SVM), and Extreme Gradient Boosting (XG-BOOST).   Conclusion: The SGO-NN method accurately recognizes breast cancers from ultrasound images and outperforms existing methods. This advancement shows significant potential for improving diagnostic processes, reducing human error in medical imaging, and broadening the application of automated diagnostics. Future work should focus on improving computational efficiency, enhancing interpretability through explainable AI approaches, and integrating modern imaging technologies for more accurate and accessible diagnosis.
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The Iranian Red Crescent Society (IRCS) is a prominent humanitarian organization focused on delivering disaster relief and emergency response services, alongside a wide range of health and social support programs. Its initiatives prioritize disease prevention, health promotion, emergency medical services, and water, sanitation, and hygiene (WASH), showcasing a comprehensive commitment to enhancing public health and community welfare throughout Iran. This study analyzes the IRCS's application of the IFRC 2030 Health and Care Framework through a review of documents, policies, and strategic plans. It highlights key programs aimed at improving community health and nutrition, vaccination efforts that have notably increased immunization rates, and collaborations with the Ministry of Health to enhance voluntary health services. The IRCS's significant contributions during the COVID-19 pandemic are emphasized, particularly its vaccination campaigns that ensured equitable access for citizens and vulnerable populations. Furthermore, the research explores the IRCS's humanitarian diplomacy efforts in partnership with international organizations to tackle public health challenges. The findings underscore the critical role of integrated health services and community empowerment in advancing health outcomes across Iran.
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Background and Objectives: In low and middle-income countries, there are high rates of transtibial amputations due to trauma. However, the low satisfaction with patellar tendon-bearing (PTB) socket fitting contributes to a low percentage of prosthesis users in these regions. The experience of a prosthetist is crucial for successful socket fitting. This study aimed to describe a mold modification characteristics performed by a skilled prosthetist to reduce the reliance on individual prosthetist skill.   Methods: To describe mold modification characteristics, scans were taken of the stump and socket of 5 individuals with transtibial amputations who received prostheses from a skilled prosthetist and reported satisfaction. Geometric differences between stump and socket scans were investigated. The study examined mold modifications in weight-bearing areas, including the mid patellar tendon (MPT), popliteal fossa (PF), lateral tibial flare (LTF), medial tibial flare (MTF), and non-weight-bearing areas, such as the fibular head (FH), distal anterior of tibia (DAT), distal posterior of tibia (DPT), and tibial crest (TC).   Results: The study found that in the FH, DAT, DPT, and TC regions, the socket height exceeded the stump by 1.2 mm, 8.8 mm, 6.8 mm, and 4.2 mm, respectively. In the PF, MPT, MTF, and LTF regions, the socket depth exceeded the stump by 9.3 mm, 10.3 mm, 4.1 mm, and 4.8 mm, respectively.   Conclusion: This descriptive study and the identified patterns represent an initial step toward defining characteristics for an appropriate socket design. This knowledge can help mitigate the impact of individual prosthetist skill on socket fit satisfaction.
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Background and Objectives: Hypertension and bladder cancer are frequently co-diagnosed in individuals who require blood pressure management and anti-cancer therapies. Immunotherapy has revolutionized cancer treatment. However, the role and clinical significance of the first-line anti-hypertensive drug amlodipine in immunotherapy outcomes remains largely elusive. To evaluate the role of amlodipine in enhancing the efficacy of anti-PD1 immunotherapy and its underlying mechanisms in bladder cancer.    Methods: Basic research methods were used in the present work. A murine syngeneic bladder cancer and melanoma model was employed to evaluate the therapeutic effect of the combination of amlodipine with anti-PD1. Additionally, immunohistochemistry was utilized to quantify CD8+ T cells and Ki67+ cells. Finally, several in-vitro and in-vivo assays were performed to explore the effects of amlodipine on human bladder cancer cells, and bioinformatics analysis and qPCR were conducted to explore the underlying mechanism.   Results: Amlodipine enhanced the tumor-inhibitory effects of anti-PD1 therapy, in line with the results in the melanoma model. Furthermore, the results of in-vitro and in-vivo experiments utilizing UMUC3 human bladder cancer cells revealed that amlodipine significantly suppressed tumor progression. Meanwhile, the results of in-vitro and in-vivo experiments demonstrated that amlodipine regulated NFAT2 expression, with the loss of inhibition following NFAT2 knockdown.    Conclusion: These results indicated that amlodipine suppresses tumor growth by regulating NFAT2 expression and enhancing anti-PD1 therapy effects. Indeed, these findings position amlodipine as an effective adjunctive therapy in bladder cancer treatment. Nevertheless, further mechanistic studies and clinical trials are warranted.
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Background and Objectives: Sepsis has high morbidity and mortality, and survivors often suffer from cognitive impairment, while the gut microbiota’s link to neurological diseases has prompted investigation into whether probiotics improve sepsis-related cognitive impairment. This study aimed to explore the effect of probiotics on sepsis - related cognitive impairment.    Methods: 135 sepsis patients in recovery (after antibiotic discontinuation) from Jan 2021 to Jun 2023 were enrolled in this retrospective study, and divided into control group (n = 67) and observation group (n = 68). The control group received conventional treatment plus placebo, while the observation group received probiotic + prebiotic preparations instead of placebo, in addition to conventional treatment. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at three time points: enrollment (T0), 6 months (T1), and 1 year (T2) post-treatment. Complications were monitored during the intervention, and complications were evaluated at T1 and T2. Independent/paired t-tests and chi-square test were performed.   Results: The follow - up loss rate was 16.42% in the control group and 19.12% in the observation group. At enrollment, cognitive function was similar (c2=0.072, P=0.788). Six months after treatment, the observation group had a lower prevalence of abnormal cognitive function than the control group and at the start (c2=4.763, P=0.029). One year later, the two groups had no significant difference in abnormal cognitive function prevalence (c2=3.319, P=0.069), but it was lower than at the start. For complications, there was no difference in cardio - respiratory and kidney diseases (all P>0.05), while the observation group had a lower prevalence of digestive diseases (c2=6.682, P=0.010).    Conclusion: Sepsis, cognitive impairment and the gut microbiota are closely related. Microbial therapies offer new treatment directions, but this study needs larger samples and multi - center verification.
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Background and Objectives: Posterior Reversible Encephalopathy Syndrome (PRES) is an acute neurological syndrome distinguished by a variety of clinical features and characteristic neuroimaging findings associated with focal cerebral edema. Heterogeneous etiologies are encountered, with acute hypertension due to renal disorders being the principal risk factor.Objectives: The primary aim of this study was to provide a comprehensive review of the available information regarding Posterior Reversible Encephalopathy Syndrome, including its clinical manifestations and risk factors in children.   Methods: An extensive search of the PubMed database was conducted for relevant articles published from January 2010 to December 2024. Correlated data from eligible articles were extracted and described.   Results: The principal neuroimaging finding of Posterior Reversible Encephalopathy Syndrome (PRES) is bilateral cerebral vasogenic edema, predominantly located in the occipital and posterior parietal white matter. Several mechanisms contribute to this condition, including dysfunction of cerebral autoregulation due to severe acute hypertension and breakdown of the blood-brain barrier resulting from endothelial injury. The combination of acute neurological manifestations, neuroimaging findings of vasogenic edema, and the presence of related provoking disorders raises suspicion for PRES. The mainstay of treatment is supportive care. In most patients, total resolution of abnormal clinical findings and imaging features occurs.   Conclusion: Although many clinical features of pediatric PRES are similar to those in adults, there are notable differences, particularly regarding neuroimaging findings. The spectrum of clinical and neuroimaging findings of PRES in children is not widely recognized. Early diagnosis of the syndrome, identification of related risk factors, and appropriate management are crucial and can be life-saving.
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Background and Objectives: Frailty is common in hemodialysis patients, affecting quality of life and clinical outcomes. Early identification can guide interventions, yet reliable predictive models for frailty risk remain limited. To determine the incidence of frailty in hemodialysis patients and develop a nomogram model for predicting frailty risk, aiding early identification and intervention.   Methods: A cross-sectional study with 400 hemodialysis patients collected clinical data, laboratory indicators, social support, depression, anxiety, and sleep quality. Frailty was assessed using the Fried Frailty Phenotype scale. Univariate and logistic regression analyses identified risk factors for frailty, which informed a predictive nomogram model. Model performance was evaluated via ROC curve, calibration curve, and decision curve analysis (DCA).   Results: Frailty incidence was 44.00%. Significant differences were observed between frailty and non-frailty groups in age, sex, education, diabetes, cardiovascular disease, serum albumin, social support, depression, anxiety, and sleep quality (P < 0.05). Logistic regression revealed that older age (OR=1.086, P=0.002), cardiovascular disease (OR=2.741, P=0.030), low serum albumin (OR=5.569, P<0.001), depression (OR=26.578, P<0.001), anxiety (OR=13.471, P<0.001), and poor sleep quality (OR=2.992, P=0.014) were significant risk factors. The nomogram demonstrated high predictive accuracy (AUC: 0.974 training, 0.980 validation). Calibration and DCA curves confirmed its reliability and clinical utility.   Conclusion: Age, cardiovascular disease, serum albumin, depression, anxiety, and sleep quality were key risk factors. The nomogram offers a practical and accurate tool for early frailty identification and intervention.
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   Background and Objectives: Both arthritis and low bone mineral density (LBMD) conditions are emerging as leading global causes of disability. Therefore, the study aims to report the associations between sex hormones, arthritis, and LBMD among different sexes and age groups, and provide a basis for the prediction of arthritis and LBMD.While in different sexes and ages, the associated sex hormone indicators vary to predict arthritis and LBMD. The results of this study may help clinicians monitor specific arthritis and LBMD by measuring sex hormone levels at an early stage.   Methods: In this cross-sectional analysis, data for this analysis were obtained from the 2013-2016 NHANES dataset including a total of 4950 participants, available on the official NHANES website. We compared categorical and continuous variables using chi-squared test or T-test. And binary logistic regression was conducted to analyze the association between sex hormone with arthritis and LBMD groups. Furthermore, to evaluate the performance of the indices, we examined the receiver operating characteristic curves (ROC).   Results: In this cross-sectional analysis, we observed that elder people (above 35) tend to be more associated with arthritis and LBMD problems in general, particularly the female group. Estradiol (E2) and (total testosterone) TT/E2 are the two most important indicators in the elder female. E2 is the protective factor to female arthritis (OR=0.99, 95%CI(0.99,1.00), P=0.030) and LBMD (OR=0.99, 95%CI(0.98, 0.99), P<0.001); while TT/E2 is the risk factor to female arthritis (OR=1.06, 95%CI(1.00,1.13), P=0.046) as well as LBMD (OR=1.13, 95%CI(1.03, 1.23), P=0.007).   Conclusion: Our findings indicated that estradiol and aromatase activity exert a protective effect against arthritis and LBMD, while the free androgen index (FAI) was found to have a protective effect against arthritis in males. This study explored a sex hormone regimen by extensively examining the associations between sex hormones and the dual health issues of arthritis and LBMD.