Background: Sepsis is one of the leading causes of death in critically ill patients. Currently, commonly used clinical prognostic scoring systems such as Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation II (APACHE II), although having certain predictive value, have limited sensitivity in reflecting real-time organ functional status. Diaphragmatic dysfunction is significantly associated with mortality in septic patients. However, traditional methods for assessing diaphragmatic function are complex. This study aims to investigate the predictive value of a novel assessment model that combines bedside diaphragmatic ultrasound with procalcitonin (PCT), B-type natriuretic peptide (BNP), and lactate (Lac) for short-term prognosis (28-day mortality) in septic patients, in order to provide a more convenient and dynamic prognostic assessment tool for clinical practice. Methods: This retrospective study enrolled 74 sepsis patients at Beijing Chaoyang Hospital from September 2021 to June 2023. All eligible patients with sepsis during the study period were included. Based on 28-day mortality, patients were categorized into survivors (n=45) and non-survivors (n=29). Demographic data, APACHE II scores, and laboratory measurements (PCT, BNP, Lac) within 24 hours of admission were collected. Diaphragmatic function was assessed via bedside ultrasonography: diaphragm excursion (DE) was measured during quiet breathing, and diaphragm thickness at end-inspiration (DTei) and end-expiration (DTee) were recorded to compute the diaphragmatic thickening fraction (DTF). Group comparisons were performed. Variables showing significant differences or clinical relevance in univariate analyses were entered into a multivariate logistic regression model to identify independent prognostic factors. Model performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: (I) Baseline characteristics were similar between groups. (II) Non-survivors exhibited significantly elevated serum PCT, BNP, and Lac levels, alongside reduced DTei, DTee, DTF, and DE values. The non-survivor group had lower DTei, DTee, DTF, and DE, with means of 0.21 +/- 0.02 cm, 0.17 +/- 0.02 cm, 22.11%+/- 5.81%, 1.08 +/- 0.21 cm, respectively. (III) Univariate analysis revealed PCT, BNP, Lac, DTF, and DE were significantly associated with 28-day mortality in sepsis patients, with odds ratios (ORs) of 1.028, 1.114, 1.626, 0.879, and 0.008, respectively. Multivariable logistic regression confirmed DTF and DE as independent predictors, with ORs of 0.892 and 0.051, respectively. ROC analysis demonstrated that the combined use of all five parameters yielded the highest predictive accuracy [area under the curve (AUC) =0.890; sensitivity 96.6%, specificity 57.80%], outperforming individual markers. Conclusions: Diaphragmatic ultrasonography (DTF and DE) combined with serum biomarkers (PCT, BNP, Lac) enhances the predictive capability for short-term (28-day) survival in sepsis patients, aids in the early identification of high-risk patients, and provides early warning for clinical intervention, although its specificity remains limited.
Background: Speckle-tracking echocardiography (STE) has emerged as a sensitive tool for detecting subclinical myocardial dysfunction in hypertension. However, a comprehensive bibliometric analysis summarizing the research landscape, trends, and hotspots in this field is lacking. This study aims to systematically analyze the current research status, trends, and hotspots of speckle tracking echocardiography in hypertension using bibliometric methods. Methods: We retrieved publications related to STE and hypertension from the Web of Science Core Collection (WoSCC) between November 1, 2005 to January 31, 2025. A total of 449 eligible articles were included and analyzed using CiteSpace (6.4.R1) and VOSviewer (1.6.21) for annual output, country/ institution collaboration, journal distribution, keyword co-occurrence, and co-citation clustering. We conducted a bibliometric analysis of publications retrieved from the WoSCC from November 1, 2005 to January 31, 2025. After rigorous screening, 449 articles were analyzed using CiteSpace (6.4.R1) and VOSviewer (1.6.21) for temporal trends, collaborative networks, journal distributions, and conceptual evolution. Results: The annual publication output followed a significant growth trajectory (y = 3.4725X1.6363, R2=0.9983), with accelerated growth of approximately 25% annually during 2012-2014. Italy (90 publications, 32.16 citations per paper), China (70 publications), and the USA (69 publications, 39.38 citations per paper) were the most productive countries. High-impact journals including Hypertension (20 publications, 39.35 citations/paper) and Journal of the American Society of Echocardiography (15 publications, 98.20 citations/paper) published fewer but highly cited articles. Research hotspots evolved from left ventricular hypertrophy assessment (pre-2016) to myocardial work evaluation (post-2018), with "myocardial work" showing the strongest recent citation burst (strength: 7.43). Conclusions: STE is a valuable tool for early detection of myocardial injury in hypertension, and international collaboration plays a pivotal role in advancing the field. Future research should focus on standardizing STE parameters, validating clinical utility in diverse populations, and exploring its prognostic value.
Background: Reducing radiation dose without compromising diagnostic image quality remains a central challenge in non-contrast abdominal computed tomography (CT). This study aimed to evaluate the clinical value of a deep learning reconstruction algorithm, Philips-developed precise image (PI), in achieving this balance. Methods: This retrospective study included 120 patients who underwent non-contrast abdominal CT scans and were randomly divided into three dose groups based on the DoseRight Index (DRI): Group A (DRI =18), Group B (DRI =20), and Group C (DRI =22). For each patient, raw data were reconstructed using filtered back projection (FBP), iDose4, PI standard, and PI smooth. Objective parameters-including CT value, standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR)-were measured for the liver, pancreas, and abdominal aorta. Subjective image quality and radiation dose metrics were also analyzed. Results: The PI smooth algorithm consistently yielded the best performance, with significantly lower noise and higher SNR and CNR than other reconstructions across all organs and dose groups (all P<0.05). In inter-group comparisons using PI smooth, Group B (DRI =20) demonstrated noise levels and SNR comparable to those of the higher-or lower-dose groups in key organs, and subjective image quality scores of PI smooth images were comparable between Group B and the other groups, with only a small but statistically significant difference between Group A and Group C (P=0.03). Conclusions: The combination of a low-dose protocol (DRI =20) and the PI smooth reconstruction algorithm significantly reduces radiation exposure while maintaining both objective and subjective image quality comparable to conventional higher-dose scans. This approach offers a practical and effective strategy for implementing radiation dose optimization in routine abdominal CT imaging.
Background: Pulmonary rehabilitation (PR) is a comprehensive, multidisciplinary intervention that has been shown to significantly improve symptoms, functional capacity, and quality of life in individuals with chronic respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). Despite strong evidence supporting its effectiveness, PR remains underutilized in many healthcare settings. This study aimed to evaluate the level of knowledge, attitudes, practices, and perceived barriers related to PR among healthcare professionals in the Kingdom of Saudi Arabia (KSA). Methods: A cross-sectional online survey was conducted among licensed healthcare professionals across KSA between May and December 2023. A total of 328 participants who met the inclusion criteria were enrolled. Data were collected using a validated questionnaire adapted from previously published studies, covering domains of PR knowledge, attitudes, clinical practices, and perceived barriers. Descriptive statistical analysis was used to summarize the findings. Results: Overall, approximately 30% of participants demonstrated good knowledge of PR, while 25.6% exhibited poor knowledge. Awareness gaps were evident across several PR components. The most reported barriers to PR implementation and patient referral included limited awareness of PR benefits, lack of accessible PR centers, and insufficient professional training. Conclusions: Healthcare professionals in KSA demonstrated moderate knowledge of PR, with several systemic and educational barriers limiting its implementation. These findings highlight the need for targeted educational initiatives, improved access to PR services, and stronger institutional support to enhance referral practices and participation rates nationwide.
Background: Delayed hypersensitivity reaction or late phase reaction (LPR) is a rare adverse event following skin prick testing (SPT). Allergen immunotherapy (AIT) provides several advantages for patients with allergic disorders. It can significantly decrease or eliminate allergy symptoms, prevent the development of new allergies, and provide long-lasting relief. Tolerance for the allergen typically continues after immunotherapy ends. To our knowledge, the question of whether AIT could be administered to patients with LPR after a skin prick test has not extensively been documented in the previous literature. Case Description: Here were 2 cases that exhibited LPR following SPT and subsequently received subcutaneous AIT safely. A 48-year-old man presented with one year history of severe chronic spontaneous urticaria accompanied by angioedema. He started the first dose of subcutaneous AIT (concentration of 1/million) about 4 hours after SPT but developed itching, erythema, and large wheals (about 8 mm in diameter; grade I) at the SPT site about 6 hours after SPT. He then began subcutaneous immunotherapy again after one week but complicated by systemic reaction (skin rash and hives that are spreading with mild swelling in lips). This reaction was improved by antihistamines and steroids only with subsequent doses. Subsequently, the patient was tried on low concentrations (concentration of 1/10 million) of subcutaneous AIT which was well tolerated. In addition, a 30-year-old female with a history of chronic spontaneous urticaria not associated with angioedema for 8 months. Three hours after SPT, the patients developed localized itching, erythema, and large wheals (about 6 mm in diameter; grade I) at the SPT site without subcutaneous AIT yet, which was consistent with a LPR. The patient received systemic corticosteroids to control this symptom. She then began subcutaneous AIT (1/million) and tolerated it without experiencing any local or systemic adverse reactions. Both cases demonstrated a favorable clinical response after one year treatment. Conclusions: It is important for allergists to recognize the LPR as a potential outcome of SPT. However, it is not a contraindication for AIT, but the initiation needs to be delayed by 2 days to minimize side effects in these patients.
Background: Team-based learning (TBL) is a relatively recent approach in contrast to problem-based learning (PBL), which has long been established. Both approaches support learner-centered, peer-assisted education in interactive small-group settings. The objective of this study was to evaluate and compare the effectiveness of TBL and PBL in promoting active learning, critical thinking and improving overall academic performance among undergraduate dental students. Methods: This was a mixed-methods quasi-experimental study which included first-year Bachelor of Dental Surgery (BDS) students from January to September 2022. This study was conducted at a private dental institute in Abbottabad, Pakistan. A purposive sampling technique was used, dividing the 42 included students into two independent cohorts (n=21 for PBL and n=21 for TBL). The data collection tool consisted of 3 sections, the first was a structured, pre-tested questionnaire comparing effectiveness of the two methodologies, the second section consisted of peer-review and team evaluation and the third section contained open-ended questions for students' feedback. The scores of the PBL and TBL were calculated and compared, along with a questionnaire comparing students' satisfaction with their teams and their perceptions regarding PBL and TBL. The statistical analysis for quantitative data, such as the means of test scores and facilitators' assessments, was performed using Student's independent samples t-test. Thematic analysis was used to quote and characterize qualitative data. Results: With a total of 45 students, 42 students fulfilled the criteria. The results of TBL scores, which included the team readiness assurance test (tRAT) and post-test, revealed significantly higher values than PBL (P<0.001). The results revealed that PBL was effective in group discussion, while TBL was more effective in time management (P=0.005), motivation (P=0.02), and level of challenge (P<0.001). The pre-reading materials in TBL were found to be very effective in class efficiency. Conclusions: Both TBL and PBL are methods that promote active learning and critical thinking skills. TBL proved to be more effective in improving academic achievement, and this could be attributed to its organized nature and focus on prior preparation. However, it lagged behind in developing teamwork, leadership, and application skills. In essence, TBL can be considered more effective in terms of learning outcomes.
Background: Accurate prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in esophageal squamous cell carcinoma (ESCC) patients is essential for optimizing individualized treatment strategies. This study investigates the potential of diffusion-weighted magnetic resonance imaging (DWIMRI) and the neutrophil-to-lymphocyte ratio (NLR) at baseline as predictive biomarkers for the pathologic response to nCRT in patients with ESCC. Methods: A retrospective analysis was conducted at Zhengzhou University Affiliated Cancer Hospital on a cohort of thirty ESCC patients who underwent nCRT followed by surgery between December 2013 and July 2017. Baseline DWI-MRI parameters and hematology data were collected within one week before initiating nCRT. The NLR and average apparent diffusion coefficient (ADC) value of the tumor were calculated. Receiver operating characteristic (ROC) curves were employed to evaluate the accuracy of ADC, NLR, and a combined index in predicting the pathologic response to nCRT. Results: Among the thirty patients, twenty exhibited a favorable pathologic response to nCRT. High ADC values (>1.86 & times;10 mm2/s) and low NLR (<= 2.31) at baseline were significantly associated with a positive pathologic response in ESCC patients. ROC analysis revealed area under the curves (AUCs) of 0.750 and 0.758 for ADC value and NLR, respectively, with optimal cut-off values of 1.86 & times;10-3 mm2/s [sensitivity: 63.6%] and 2.31 (sensitivity: 75.0%, specificity: 80.0%, PPV: 88.2%, NPV: 61.5%). The combined index demonstrated an improved sensitivity (95.0%) and NPV (87.5%) at an optimal threshold of 0.48, yielding an AUC of 0.840. Conclusions: In conclusion, the pre-treatment ADC-NLR index is a promising biomarker that may guide personalized nCRT strategies in ESCC by identifying patients for treatment modification, a potential that now requires validation in prospective trials to impact clinical care.
Background: The diagnosis of patients with acute abdominal pain is challenging. Diseases that can cause a "medical" acute abdomen include thyrotoxic crisis (TC), a life-threatening manifestation of thyrotoxicosis. Multifactorial abdominal pain may predominate over the classical signs of TC [sinus tachycardia or atrial fibrillation (AFib), heart failure, mental alterations, and hyperthermia]. Here, we report a patient with suspected acalculous cholecystitis, in whom TC and heart failure including cardiogenic shock were diagnosed postoperatively. Case Description: A previously healthy, anxious and febrile woman of African descent was admitted with upper abdominal pain spanning a two-week duration, and recurrent vomiting. She was hypertensive and had tachycardic atrial fibrillation without clinical signs of heart failure. The upper abdomen was tender to the touch with scant bowel sounds. Elevated inflammatory markers and a thickened gallbladder wall suggested acalculous cholecystitis. During the induction of anesthesia for planned cholecystectomy the patient became hypotensive, necessitating treatment with norepinephrine. Thyroid function tests, not available preoperatively, revealed overt thyrotoxicosis. TC with initially unrecognized Graves' disease was diagnosed. Right heart failure, confirmed by echocardiography, has contributed to the abdominal pain, since intraoperatively the gallbladder was not inflamed, and the surgeon noted mild serous ascites. Beta-blockers were given to slow the heart rate, and diuretics to achieve a negative fluid balance. In the intensive care unit (ICU), cardiogenic shock was diagnosed, requiring optimized heart failure therapy including the inotrope levosimendan. Initial multimodal thyrostatic treatment consisted of betablockers, inhibitors of thyroid peroxidase (carbimazole), an iodine uptake inhibitor, and corticosteroids. Despite a theoretical recurrence risk of 40% the patient remained euthyreotic, and carbimazole treatment ended after 2 years. The medical therapy was effective and well tolerated. Conclusions: TC is a rare cause of the "medical" acute abdomen with a complex pathophysiology, including heart failure, and must be ruled out before a surgical intervention is indicated. The diagnosis of TC remains clinical. The routine measurement of thyroid-stimulating hormone (TSH) levels prior to surgery is recommended as a screening test. Once diagnosed, multimodal thyrostatic treatment of TC must be started immediately. Surgery can exacerbate a TC and may induce a cardiogenic shock, which needs targeted treatment in the ICU.
The responsibilities of family caregivers-the partners, parents, children, siblings, and friends who play an instrumental role in the care of patients with chronic and life-limiting illnesses-are dramatically increasing. As healthcare moves from the hospital to the home, family caregivers are tasked with carrying out healthcare tasks that were once assumed by healthcare professionals, too often without training, education, and support. As a result, family caregivers often feel unprepared for their responsibilities and are at risk for profound psychosocial, functional, and financial distress, all of which place them at risk for becoming the next generation of patients with chronic and life-limiting illnesses. While recent United States (U.S.) policy has sought to address the training needs of family caregivers through the Caregiver Advise Record Enable (CARE) Act, its implementation has been inconsistent. Here, we argue that the CARE Act presents an invaluable opportunity to identify family caregivers early in the caregiving trajectory, intervene on their multifaceted challenges, and prevent poor long-term outcomes. Capitalizing on points of contact between hospital staff and family caregivers via the CARE Act to facilitate screening, documentation, and triage processes has the potential to mitigate much of the distress and poor outcomes currently experienced by the U.S.'s 53 million family caregivers.
Background: Nontraumatic chylothorax is an uncommon cause of pleural effusion and a challenge to manage. Several radiological tests have been recommended for evaluation of chylothorax, but there is little evidence to guide clinicians on the utility, yield and optimal order of these diagnostic modalities. We aimed to evaluate the clinical utility of radiological tests including computed tomography (CT), positron emission tomography-CT (PET-CT) and lymphatic imaging such as magnetic resonance (MR) lymphangiogram in the management of nontraumatic chylothorax. Methods: A retrospective single-centre study of patients with nontraumatic chylothorax from January 2019 to December 2023. Radiological tests were classified based on their utility in supporting a specific diagnosis or guiding a diagnostic or therapeutic intervention. Results: Twenty patients with a median age of 66 [interquartile range (IQR), 56-75] years were included. The median pleural fluid triglyceride level was 5.04 (IQR, 2.82-18.32) mmol/L. Malignancy accounted for the majority (40.0%) of causes, of which lymphoma was the most common. High output or persistent chyle leak requiring >_2 therapeutic interventions were seen in 90% of patients, and 75% of patients had a large pleural effusion on ultrasonography (>_4 rib spaces). CT or PET-CT imaging was useful in 75% of patients, supporting a specific diagnosis in 8 (40.0%) patients and detecting abnormalities that guided tissue biopsy in 7 (35.0%) patients. Lymphatic imaging was performed in 12 (60.0%) patients, all of whom underwent MR lymphangiogram. An additional lymphoscintigraphy was performed in two patients and lymphangiography in one patient. Thoracic duct ligation was attempted in one patient after a small volume lymphatic leak was visualised on MR lymphangiogram. No significant abnormalities to direct lymphatic intervention were found on lymphatic imaging in the remaining 11 patients. Conclusions: In most patients with nontraumatic chylothorax, CT imaging provides specific diagnostic value and guides further evaluation such as tissue biopsy. Larger prospective studies are required to evaluate the utility of routine lymphatic imaging.
Background: Human immunodeficiency virus (HIV) exposure, whether through unsafe sexual behaviors or accidental contact with HIV-infected sources, poses significant health risks. Individuals exposed to HIV often experience stress, anxiety, and adverse effects from antiretroviral (ARV) drugs, all of which may affect their quality of life (QoL). Despite this, research on QoL outcomes among individuals undergoing postexposure prophylaxis (PEP) remains limited. This prospective cohort study aimed to evaluate changes in QoL and identify related factors among HIV-exposed adults. This study assessed mean QoL scores at two time points (T1: after HIV exposure and T2: after 28 days of prophylaxis), evaluated score changes, and identified associations with individual characteristics, social stigma, and psychological trauma. Methods: A total of 190 participants were enrolled using purposive convenience sampling at a tropical diseases hospital in Ho Chi Minh City from March to June 2023; 167 completed follow-up after 28 days of PEP. The Medical Outcomes Study HIV Health Survey (MOS-HIV) was used to assess QoL at baseline (T1) and after 28 days (T2). Linear regression was used to explore associations between QoL and HIV stigma, psychiatric disturbance, and sex. Results: Participants had a mean age of 31.3 +/- 9.5 years, and 78.4% were male. The mean QoL scores were 50.8 at T1 and 50.9 at T2, with no significant change (P=0.38). However, significant negative correlations were observed between QoL and HIV stigma (T1: beta=-0.192, P<0.001; T2: beta=-0.215, P=0.001), psychiatric disturbance (T1: beta=-2.640, P=0.005; T2: beta=-4.955, P<0.001), and female sex (T1: beta=2.030, P=0.02; T2: Conclusions: The QoL of HIV-exposed adults did not significantly improve after 28 days of PEP. Psychological distress, stigma, and female sex were associated with lower QoL. These findings suggest the need for mental health support, stigma reduction, and targeted interventions-particularly for women- during and after PEP.
Background: Programmed death-1 (PD-1) blocking agents are Food and Drug Administration (FDA) approved immune checkpoint inhibitors (ICIs), and a category 1 recommendation based on current National Comprehensive Cancer Network (NCCN) guidelines due to known clinical benefit in metastatic colorectal cancer (CRC) microsatellite instability-high (MSI-H) or defective mismatch repair (dMMR) CRC. These immunotherapy agents are currently not approved for use in metastatic microsatellite stable (MSS) CRC. Here we present a case of metastatic colon cancer that achieved a complete pathologic response after treatment with neoadjuvant pembrolizumab. Next generation sequencing of the patient's tumor revealed that his tumor had a molecular profile consistent with a MSS, polymerase epsilon (POLE)-mutated positive, KRAS wild type, BRAF wild type, tumor mutational burden-high (TMB-H) tumor. Case Description: A 31-year-old male presented with left lower quadrant abdominal pain and was ultimately determined to have metastatic colon cancer MSS, POLE-mutated positive tumor. He was started on chemotherapy but progressed on first-line chemotherapy. He was then switched to ICI therapy that resulted in a complete pathologic response at the time of surgery. Conclusions: ICI therapy led to complete pathologic response in this 31-year-old patient with MSS, TMB-H, POLE-mutated metastatic CRC now 37 months post-completion of neoadjuvant pembrolizumab as of last office visit 03/2025. These findings warrant consideration of further investigation of the role of neoadjuvant ICI in MSS, TMB-H, POLE-mutated CRC in a prospective setting.
