LEARNING POINTS: Prolonged fluoroscopy in cardiac procedures can potentially lead to post-cardiac injury syndrome.Active pacemaker lead fixation is one of the risk factors for post-cardiac injury syndrome due to immune reaction.Left bundle branch area pacing in adults with congenital heart disease is challenging because of anatomical differences.
METHODS: This in-vitro study was conducted from April 2024 to September 2024 at Universiti Sains Malaysia and King Faisal University. Graphene oxide (GO) was reduced by dispersing GO in deionized water with sonication, followed by adding sodium hydroxide (NaOH) under vigorous stirring. The suspension obtained was centrifuged, washed, and dried to yield reduced graphene oxide (rGO). For functionalization, rGO was dispersed in ethanol and mixed with methylene blue (MB) solution, followed by stirring and drying to obtain MB-functionalized rGO. The antibacterial and antifungal activities of MB alone and in combination with rGO, with or without laser exposure, were tested using the agar well diffusion method. The paired sample t-test was used to compare the inhibition zones for different treatment groups of E. faecalis and C. albicans.
RESULTS: FTIR analysis confirmed successful functionalization by identifying specific functional groups of rGO and MB. Similarly, Raman spectroscopy indicated that GO-MB had an intermediate level of defects, and SEM analysis confirmed slight morphological changes with MB molecules attached to the rGO surface. Moreover, the antimicrobial test revealed that MB/rGO with laser performed significantly better (p=0.042) than MB/rGO without laser and MB with laser group (p=0.034) against E. faecalis.
CONCLUSIONS: The functionalization of MB with rGO and its application with laser treatment significantly enhanced antimicrobial and antifungal activity, suggesting potential benefits for endodontic treatments and other dental applications.
MATERIALS AND METHODS: Acellular meshes were engineered using liquid collagen. They underwent in vitro, mechanical and bench testing by surgeons. Sixty-nine male New Zealand rabbits were used to refine the design. The final prototype based on the TissueSpan patented technology was then implanted again in a 2 cm long urethral defect in 9 rabbits and in a 4 cm long defect in 6 dogs.
RESULTS: The TissueSpan technology platform allows for the manufacturing of tubular and rectangular meshes in different diameters and thicknesses. The tubular mesh acted as physical conduit to gap the urethral defect with a patent urethra demonstrated after 1month in both animal models. The mesh was absorbed within 1-3months. Spontaneous urothelial coverage of the mesh and smooth muscle cell migration into the surgical area was demonstrated even in a 4 cm long urethral defect. A first in man clinical trial was subsequently initiated.
CONCLUSION: The acellular mesh may have the potential to be an off-the-shelf product for substitution urethroplasty. Its mechanical properties allow surgeons to easily create a physical conduit while its material properties favor tissue remodeling. A large-scale clinical trial is still required to further confirm the safety, performance, and patient benefit of this new medical device.
METHODS: Participants first underwent oral health examinations to evaluate their plaque scores, bleeding scores, Community Periodontal Index of Treatment Needs (CPITN), and Decayed, Missing, and Filled Teeth (DMFT) index. Additionally, the oral health behaviours and oral health impact profiles of the participants were assessed through a structured questionnaire.
RESULTS: A total of 176 naval personnel participated in the study. Overall, the findings indicate high levels of plaque (30.7%) and bleeding scores (39.6%) while the CPITN results showed a significant proportion of participants (52.1%) requiring advanced periodontal treatment (CPITN 3 or 4). The DMFT index highlighted a substantial burden of dental caries with a mean score of 4.59 ± 4.24, including untreated decay (1.15 ± 1.63). The assessment of oral health-related quality of life using the OHIP-14 revealed low scores among some participants, with a mean of 13.47 and a maximum score of 42. Additionally, oral health behaviours were generally inadequate, with 12% of participants reporting infrequent brushing and 68.2% indicating limited use of interdental aids.
CONCLUSIONS: Oral diseases were highly prevalent among the selected population, with notable deficiencies in oral health behaviours such as toothbrushing frequency, the use of interdental cleaning aids, and tongue cleaning. Oral health issues also significantly impacted daily life, as evidenced by the OHIP-14 scores. These findings highlight the need for tailored oral health interventions within the naval setting to enhance deployment readiness, improve oral health outcomes, and elevate the quality of life for naval personnel.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: Using data from a multicenter, cluster-randomized controlled trial, this secondary analysis involved patients with baseline circulatory shock as defined by a cardiovascular Sequential Organ Failure Assessment score of two or more. Patients were dichotomized into transient or persistent circulatory shock depending on the duration, while transient circulatory shock was defined by the resolution of shock within the first day of enrollment. Early enteral nutrition was defined as the initiation of enteral nutrition within 48 h after intensive care unit admission. The association between early enteral nutrition and a composite outcome (presence of any organ failure on study day 10 or 28-day mortality) was investigated by multivariable and propensity-score-weighted multivariable logistic regression analyses.
RESULTS: Seven hundred and eighty-five patients were included in the analysis, and early enteral nutrition was administered to 385 patients (49.0 %) in the whole study cohort. In patients with transient circulatory shock (n = 527), 221 patients (41.9 %) received early enteral nutrition, and in those with persistent circulatory shock (n = 258), 164 patients (63.6 %) did so. For the overall cohort, there was no difference in the incidence of primary composite outcome between early enteral nutrition and 'no early enteral nutrition ' groups (adjusted odd ratio 0.84, 95 % confidence interval 0.60-1.18) after adjustment for potential confounders. In patients with transient circulatory shock, receipt of early enteral nutrition, compared to no early enteral nutrition, was significantly associated with reduced incidence of the composite outcome (adjusted odd ratio 0.63, 95 % confidence interval 0.41-0.95, p = 0.027). On the contrary, there is no association between early enteral nutrition and the incidence of the composite outcome in patients with persistent circulatory shock (adjusted odd ratio 1.28, 95 % confidence interval 0.64-2.58, p = 0.485). The results of propensity-weighted multivariable analysis conform to the primary analysis.
CONCLUSION: Early enteral nutrition was associated with improved clinical outcomes among patients with circulatory shock that resolved within the first day. RESEARCH REGISTRATION UNIQUE IDENTIFYING NUMBER (UIN) OF THE ORIGINAL NEED TRIAL: ISRCTN Registry, Registry number: ISRCTN12233792.
METHODS: A comprehensive literature review followed by in-depth interviews with key informants was conducted. Content analysis was performed to summarize the role of health equity in HTA in thirteen health systems in Asia, including Brunei Darussalam, Cambodia, China, Indonesia, Japan, Malaysia, Myanmar, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam.
RESULTS: Health equity was reported to be considered in most health systems' HTA process, except for Cambodia and Myanmar, which do not have an established HTA process. Interviews revealed that health equity has been more frequently considered to address the unmet medical needs of specific diseases (e.g., high disease burden or severity, rare diseases, cancer, and diseases affecting children and elderly) in Brunei Darussalam, China, Japan, Malaysia, Singapore, South Korea, Taiwan, Thailand, and Vietnam or inequities in the socially disadvantaged groups (e.g., socioeconomic status and geographical location) in Indonesia and the Philippines. Equity-informative economic evaluation was still in the early stages, with only three health systems reporting their use.
CONCLUSIONS: Health equity is considered in the HTA process in most Asian health systems. However, quantitative evaluation of health equity impact is still in its infancy as few health systems have just begun to perform equity-informative economic evaluations.