METHODS: We undertook a retrospective review of all LB performed at our institution for suspected acute FB aspiration from August 2013 to January 2023. We analysed patient characteristics, clinical examination, radiological findings, and outcomes.
RESULTS: We found a total of 100 children under the age of 16 years who underwent LB for suspected FB aspiration. The mean age of our study population was 2.6 years. The population demographics were similar to the results from the previous study from our institution, with Māori and Pasifika children having the highest probability of finding a FB on LB. Male children presenting for suspected FB aspiration are 1.39 times more likely than female children to have a foreign body at LB (p = 0.04). Overall, having two or more positive findings had a sensitivity of 100 %. History or examination alone are more sensitive (both 95.6 %) but less specific (12.5 % and 31.3 %, respectively). Abnormal radiology alone was more specific (75.0) but less sensitive (77.9 %). The most common site of FB was the right bronchial tree (45.6 %), followed by the left (39.7 %). 95 % of FB were organic, and 54 % were nuts. The negative bronchoscopy rate was 32 %.
CONCLUSION: Two or more positive indicators in history, examination and radiological findings continue to be highly sensitive predictors for the presence of an aspirated foreign body in our paediatric population. We recommend a future large-scale multicentre study to confirm how applicable these findings would be to a broader cohort of patients.
METHODS: Participants (N = 750, Mage = 20.1 years) completed questionnaires assessing ACEs divided into adverse environment (AE) and childhood maltreatment (CM), exercise, and psychological distress. Salivary genomic DNA was used for genotyping. The significance of the moderated mediation model was assessed using bootstrapping.
RESULTS: There was a significant association between ACEs and psychological distress mediated by exercise. After addition of BDNF polymorphism, we found that the effect of ACEs on psychological distress through exercise was moderated by the BDNF polymorphism (index of moderated mediation = -0.19, [-0.48, -0.04], p-value ≤0.05). Further dividing ACE into AE and CM, the moderated mediation relationship remains significant only with AE (index of moderated mediation = -0.41, [-0.99, -0.10], p-value ≤0.05).
CONCLUSIONS: The interaction between BDNF polymorphism and exercise may be a suitable target for interventions in ACEs-experienced individuals for the prevention or reduction of psychological distress.
OBJECTIVES: This study aimed to examine two key drug repurposing methodologies in general diseases and specifically in AD, which are artificial intelligent (AI) approach and molecular docking approach. In addition, the hybrid approach that integrates AI with molecular docking techniques will be explored too.
METHODOLOGY: This study systematically compiled a comprehensive collection of relevant academic articles, scientific papers, and research studies which were published up until November 2024 (as of the writing of this review paper). The final selection of papers was filtered to include studies related to Alzheimer's disease and general diseases, and then categorized into three groups: AI articles, molecular docking articles, and hybrid articles.
RESULTS: As a result, 331 papers were identified that employed AI for drug repurposing in general diseases, and 58 papers focused specifically in AD. For molecular docking in drug repurposing, 588 papers addressed general diseases, while 46 papers were dedicated to AD. The hybrid approach combining AI and molecular docking in drug repurposing has 52 papers for general diseases and 9 for AD. A comparative review was done across the methods, results, strengths, and limitations in those studies. Challenges of drug repurposing in AD are explored and future prospects are proposed.
DISCUSSION AND CONCLUSION: Drug repurposing emerges as a compelling and effective strategy within AD research. Both AI and molecular docking methods exhibit significant potential in this domain. AI algorithms yield more precise predictions, thus facilitating the exploration of new therapeutic avenues for existing drugs. Similarly, molecular docking techniques revolutionize drug-target interaction modelling, employing refined algorithms to screen extensive drug databases against specific target proteins. This review offers valuable insights for guiding the utilization of AI, molecular docking, or their hybrid in AD drug repurposing endeavors. The hope is to speed up the timeline of drug discovery which could improve the therapeutic approach to AD.
METHODS: This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. Thirty-day postoperative stone-free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications.
RESULTS: Three hundred-ten patients were analyzed. Median age was 51; median stone volume was 1584 mm3. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14 minutes, median ureteroscopy time was 30 minutes, and median total operation time was 45 minutes. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. Thirty-day reintervention rate was 4.2% (13 cases). Three-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded.
CONCLUSION: The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.
METHODS: In this pragmatic, multicentre, parallel-group, unmasked, randomised, non-inferiority trial, children aged 5-16 years with suspected non-perforated appendicitis (based on clinical diagnosis with or without radiological diagnosis) were recruited from 11 children's hospitals in Canada, the USA, Finland, Sweden, and Singapore. Patients were randomly assigned (1:1) to the antibiotic or the appendicectomy group with an online stratified randomisation tool, with stratification by sex, institution, and duration of symptoms (≥48 h vs <48 h). The primary outcome was treatment failure within 1 year of random assignment. In the antibiotic group, failure was defined as removal of the appendix, and in the appendicectomy group, failure was defined as a normal appendix based on pathology. In both groups, failure was also defined as additional procedures related to appendicitis requiring general anaesthesia. Interim analysis was done to determine whether inferiority was to be declared at the halfway point. We used a non-inferiority design with a margin of 20%. All outcomes were assessed in participants with 12-month follow-up data. The trial was registered at ClinicalTrials.gov (NCT02687464).
FINDINGS: Between Jan 20, 2016, and Dec 3, 2021, 936 patients were enrolled and randomly assigned to appendicectomy (n=459) or antibiotics (n=477). At 12-month follow-up, primary outcome data were available for 846 (90%) patients. Treatment failure occurred in 153 (34%) of 452 patients in the antibiotic group, compared with 28 (7%) of 394 in the appendicectomy group (difference 26·7%, 90% CI 22·4-30·9). All but one patient meeting the definition for treatment failure with appendicectomy were those with negative appendicectomies. Of those who underwent appendicectomy in the antibiotic group, 13 (8%) had normal pathology. There were no deaths or serious adverse events in either group. The relative risk of having a mild-to-moderate adverse event in the antibiotic group compared with the appendicectomy group was 4·3 (95% CI 2·1-8·7; p<0·0001).
INTERPRETATION: Based on cumulative failure rates and a 20% non-inferiority margin, antibiotic management of non-perforated appendicitis was inferior to appendicectomy.
FUNDING: None.
METHODS: We searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (M.J.) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en route.
RESULTS: Several criteria must be met for a transfer to be considered. The safe transfer of patients with craniospinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel, and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions that can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended and is included herein. The timing of transfer concerning the postoperative patient deserves special consideration.
CONCLUSIONS: Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients.
METHODS: A qualitative study using interview approach was conducted in Hong Kong SAR and Malaysia. Thirty dental undergraduate students, each with one patient from the Faculty of Dentistry at The University of Hong Kong (n = 15) and Universiti Teknologi MARA (n = 15), were introduced to a digitally designed decision aid in missing tooth replacement prior to their treatment appointments. Semi-structured interviews were conducted with each student and patient, adhering to the interview protocol. Each interview was audio-recorded, transcribed, and subsequently coded to investigate the perceptions and potential advantages of this decision aid.
RESULTS: Thematic analysis identified three key themes from the dental students' perspective: communication, utilization, and satisfaction. From patients' perceptions, four central themes emerged: communication, treatment information, uncertainty, and utilization. Detailed examination of the data highlighted an enhancement in patients' confidence and trust in their dental care providers, as well as a marked increase in both student and patient satisfaction levels upon implementing this novel approach. The average satisfaction rates for students were 83 % for Hong Kong SAR and 82 % for Malaysia.
CONCLUSION: This patient-centered clinical decision aid helped to enhance communication between dental students and patients in both regions, ultimately leading to heightened patient satisfaction levels. Nonetheless, to address the present study's limitations, future studies should consider diversifying participant backgrounds, including patients without prior treatment discussions with students.
CLINICAL SIGNIFICANCE: Clinical decision aids are valuable tools in clinical teaching due to their enhancement of communication between clinicians and patients. They promote shared decision-making, leading to more personalized and evidence-driven treatment plans, ultimately improving patient care.
AIM: To analyze the burden of MD in the WPR from 1990 to 2021, along with associated risk factors, to reveal changing trends and emerging challenges.
METHODS: We used data from the Global Burden of Disease 2021, analyzing prevalence, incidence, and disability-adjusted life years (DALYs) of MD from 1990 to 2021. Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.
RESULTS: Between 1990 and 2021, the prevalence of MD rose from 174.40 million cases [95% uncertainty interval (UI): 160.17-189.84] to 234.90 million cases (95%UI: 219.04-252.50), with corresponding DALYs increasing from 22.8 million (95%UI: 17.22-28.79) to 32.07 million (95%UI: 24.50-40.68). During this period, the burden of MD shifted towards older age groups. Depressive and anxiety disorders were predominant, with females showing higher DALYs for depressive and anxiety disorders, and males more affected by conduct disorders, attention-deficit hyperactivity disorder, and autism spectrum disorders. Australia, New Zealand, and Malaysia reported the highest burdens, whereas Vietnam, China, and Brunei Darussalam reported the lowest. Additionally, childhood sexual abuse and bullying, and intimate partner violence emerged as significant risk factors.
CONCLUSION: This study highlights the significant burden of MD in the WPR, with variations by age, gender, and nation. The coronavirus disease 2019 pandemic has exacerbated the situation, emphasizing the need for a coordinated response.