A Comprehensive Review on Comparative Analysis of Operative Efficiency and Postoperative Recovery in Robotic Versus Laparoscopic Hepatectomy.

Minimally invasive liver surgery, particularly hepatectomy, has evolved significantly with the advent of laparoscopic and robotic techniques. These approaches offer potential benefits over traditional open surgery, including reduced postoperative pain, shorter hospital stays, faster recovery, and improved cosmetic outcomes. This comprehensive review aims to compare the operative efficiency and postoperative recovery outcomes of robotic and laparoscopic hepatectomy. It seeks to provide an in-depth analysis of the advantages and limitations of each technique, assess their cost-effectiveness, and explore emerging trends and future directions in minimally invasive liver surgery. A comprehensive literature search was conducted to identify studies comparing robotic and laparoscopic hepatectomy. The review includes an analysis of operative time, intraoperative blood loss, conversion rates, postoperative pain, length of hospital stay, complication rates, oncological outcomes, and overall cost. Additionally, advancements in technology and future research directions were explored to provide a comprehensive overview of the current landscape and future potential of these surgical techniques. Both robotic and laparoscopic hepatectomy have demonstrated comparable outcomes in terms of oncological safety and effectiveness. However, robotic hepatectomy offers advantages in terms of precision and dexterity, particularly in complex cases, due to its advanced visualization and instrumentation. Laparoscopic hepatectomy, while associated with shorter operative times and lower costs, is limited by technical challenges, especially in major liver resections. The review also highlights the increasing adoption of robotic systems, despite their higher costs and the need for specialized training. Robotic and laparoscopic hepatectomy are both viable options for minimally invasive liver surgery, each with distinct advantages and limitations. The choice between the two should be based on patient-specific factors, the complexity of the procedure, and the surgeon's expertise. Ongoing advancements in technology, including the integration of artificial intelligence and augmented reality, are expected to further refine these techniques, enhancing their efficacy and accessibility. Future research should focus on large-scale, multicenter trials to provide more definitive comparisons and guide clinical decision-making.

Unleashing the role of e-word of mouth on purchase intention in select Facebook fan pages of smart phone users.

OBJECTIVE: This study aims to examine the impact of e-WOM on customer purchase intentions in Facebook fan pages using theories of trust, value co-creation and brand attitude. The present research has set out to explore this emerging domain of study and has thus developed & tested propositions which attempt to establish a relationship between e-WOM and customer's purchase intentions. A deeper understanding of this possible association is obtained by studying the mediating roles of Trust, Value Co-Creation, Brand Image and Brand Attitude. METHODOLOGY: The context for exploring this phenomenon is chosen to be the fan pages of smartphone brands on Facebook. The study involved conducting a sample survey of 490 respondents, comprising of both male and female, who belong to 5 smartphone brands Facebook fan pages-Samsung, Moto G, Lenovo, MI and ASUS are considered for the study. Out of which sample of 100 each has been targeted individually. FINDINGS: The findings suggested that e-WOM significantly predicts the purchase intentions of the customers of a specific product and considerable impacted on the purchase decision. The findings of the study also reveal that customer 's trust beliefs, perceived value co-creation, brand image and brand attitude partially mediate in between relationships of e-WOM and purchase intention. CONCLUSION: The actual presence of different types of consumer electronics brands on the social media, more prominently, the smartphones, which undoubtedly are the most ubiquitous product of this segment. In fact, this indicates that presence on social media is a well- thought organizational strategy developed by companies to gain partial control over the customer 's decision- making process by establishing a close connect with the customers for a long period. IMPLICATION: This consequence will significantly impact the decision-making process of marketers or practitioners in relation to their marketing tactics. This research also indicates that marketers could devise more effective methods for distributing marketing content through social networking sites, while corporations can cultivate favorable electronic word-of-mouth for their products or services. Through the implementation of social media marketing strategies, companies can increase their sales volume and generate higher revenue. The study examined the role of trust, virtual community participation, and desire to purchase as mediators on smartphone brand fan sites on Facebook. It was observed that these factors had a partial influence on customer purchase intention.

Microbial biosurfactants: Green alternatives and sustainable solution for augmenting pesticide remediation and management of organic waste.

Pesticide pollution remains a significant environmental challenge, necessitating the exploration of sustainable alternatives. Biosurfactants are a class of unconventional surface-active chemicals that are produced by microorganisms. Biosurfactants have many applications in treating oil spills, emulsifiers, pharmaceuticals, and agriculture. Compared to chemical surfactants, they have benefits such as biodegradability, less toxicity, and a greener option because they are derived from microbes. Biosurfactants have recently been shown to have the potential to speed up pesticide cleanup. Biosurfactants are used in pesticide remediation because of their exceptional foaming ability, high selectivity, and wide range of pH, salinity, and temperature operating windows. Microbial biosurfactants emerged as potential agents for the treatment of organic waste and agricultural residue. This review unfolds the promising realm of microbial biosurfactants as green solutions for environmental sustainability, particularly in agricultural practices, with special reference to pesticide remediation. This article highlights the escalating need for eco-friendly alternatives, paving the way for discussing biosurfactants. Moreover, the articles discuss in detail various advancements in the field of rapid screening of biosurfactants, either using a conventional approach or via advanced instruments such as GC-MS, HPLC, NMR, FTIR, etc. Furthermore, the article unveils the molecular mechanisms and the microbial genes driving biosurfactant synthesis, offering insights into enhancing production efficiency. Moreover, the article explores diverse applications of microbial biosurfactants in sustainable agriculture, ranging from soil remediation to crop protection. The article also highlights the various functions of microbial biosurfactants for enhancing the decomposition and recycling of organic waste and agricultural residues, emphasizing their potential for sustainable waste management strategies. Overall, the review underscores the pivotal role of microbial biosurfactants as green alternatives for addressing pesticide pollution and advancing environmental sustainability.

Pain Assessment and Analgesic Requirements after Sleeve Gastrectomy: A Comparison Study of Robotic versus Laparoscopic Approaches.

Background: Sleeve gastrectomy is the most common bariatric procedure worldwide, yet postoperative pain management remains a concern. This study aimed to compare pain medication usage and pain scores between laparoscopic sleeve gastrectomy (LSG) and robotic sleeve gastrectomy (RSG) patients, addressing the potential benefits of RSG in postoperative pain control. Methods: A retrospective review of our institutional bariatric surgery registry included 484 patients (435 LSG, 49 RSG) who underwent surgery between September 2015 and November 2020. Pain management medications, including opioid use converted to morphine milligram equivalents (MMEs), and Numerical Rating Scale (NRS) scores were analyzed postoperatively using mixed-effects models. Results: RSG patients reported lower pain scores in the initial 24 h post-surgery and received significantly lower doses of morphine equivalents compared to LSG patients (median 7.5 mg vs. 12.5 mg, p < 0.001). RSG procedures had longer operative times (122.5 ± 27.1 vs. 89.9 ± 30.5 min, p < 0.001) but a shorter average length of stay (2.24 ± 0.60 vs. 2.65 ± 1.49 days) compared to LSG. Conclusions: These findings suggest that RSG may lead to reduced immediate postoperative pain and lower opioid requirements compared to the laparoscopic approach, despite longer operative times. Further randomized controlled trials are needed to confirm these observations and evaluate long-term outcomes.

Functional Outcomes of Bone-Patellar Tendon-Bone Versus Quadrupled Semitendinosus and Gracilis Autografts for Anterior Cruciate Ligament Reconstruction.

Introduction Anterior cruciate ligament reconstruction (ACLR) with autografts has been available for decades; however, the choice of graft is still debated. Here, we compared the functional outcomes of the two most widely used autografts, bone-patella tendon-bone (BPTB) and quadruple-stranded semitendinosus/gracilis (ST/G) autografts, at six months following ACLR. Materials and methods This prospective study was performed in the Department of Orthopedics of Yenepoya Medical College and Hospital located in Mangalore, Karnataka, India, a tertiary care institute over a period of 18 months (November 2018 to April 2020). The study included 38 adult patients who underwent ACLR and were randomly divided into two groups: BPTB autograft (n=19) or ST/G autograft (N=19). The patients were followed up at one-, three-, and six months. Postoperatively, surgical morbidity, knee stability functional outcome on Lysholm score, and knee range of motion (ROM) were assessed. Results The groups were homogenous and comparable regarding age, sex, side of ACL affected, duration of tear to treatment, and muscle wasting (all p-values > 0.05). At six months, the majority of the patients had a tibial translation of 0-2 mm on the Lachman test and anterior drawer test, and the groups did not differ significantly (both p-values > 0.05). Additionally, at six months, both groups demonstrated a significant increase in mean Lysholm score and mean ROM (both p-values < 0.001). However, the groups did not differ in mean Lysholm score and mean ROM at baseline and any of the follow-up visits (all p-values > 0.05). Conclusion At six months, ACLR with BPTB and ST/G autografts produced significant and comparable knee stability, functional outcome, and ROM.

Impact of the COVID-19 Lockdown on Primary Bariatric Surgery: A Comparative Study of Weight Loss Trajectories and Perioperative Outcomes.

Background: The COVID-19 pandemic and subsequent lockdowns led to substantial changes in health-related behaviors and deferred elective surgeries. This study aimed to evaluate the impact of the COVID-19 lockdown on weight loss trajectories (WLT) and perioperative outcomes in primary bariatric surgery at a single tertiary referral center. Methods: Patients who underwent primary bariatric surgery immediately prior to the enforced lockdown (During-Lockdown Group, DLG) were compared with historical controls who underwent surgery before the lockdown (Before-Lockdown Group, BLG). WLT were estimated using a random intercept mixed-effects model with repeated measures. Cross-sectional group differences at 3- and 6-months post-surgery were examined. Perioperative outcomes were also analyzed. Results: A total of 273 patients were included (133 BLG, 140 DLG). The adjusted average weight decreased in both groups over time at different levels. The expected difference in weight between BLG and DLG at 3-months was 1.06 kg (P = .013) and at 6-months was .04 kg (P = .920), respectively. There were no statistically significant differences in postoperative complications, emergency department visits, re-admission rates, re-operation rates, or mortality. Conclusions: This study suggests that bariatric procedures performed before the COVID-19 lockdown were effective and safe. Despite a statistically significant difference in weight between groups at 3- and 6-months post-surgery, the difference was small and unlikely to be clinically significant. Short-term outcomes were comparable between the two groups. Further investigation is warranted to assess the impact of lifestyle changes during the lockdown on long-term bariatric surgery outcomes.

Comparison of Postoperative Muscle Strength Recovery Between Cisatracurium and Rocuronium.

Background Neuromuscular blocking agents are crucial for anesthesia but can cause reversible paralysis, leading to risks like postoperative residual dysfunction. Undetected paralysis in the post-anesthesia care unit (PACU) jeopardizes patient safety by impairing airway function and increasing complications. Effective reversal, assessed clinically or via nerve stimulation, is critical to prevent residual postoperative curarization (RPOC), which is linked to significant morbidity and mortality. Evaluating agents like rocuronium and cisatracurium helps optimize anesthesia outcomes and patient recovery. Methodology The study included 100 American Society of Anaesthesiologists (ASA) I and II patients approved by the Institutional Review Board of Kasturba Medical College, Mangalore, India. Patients were briefed about the study, provided written informed consent, and underwent pre-anesthetic evaluations, including discussions on anesthetic procedures and associated risks. They were instructed to fast overnight after consenting. Results The study compared 100 ASA I and II patients receiving rocuronium or cisatracurium during anesthesia, analyzing age distribution (p=0.429), gender (p=0.839), ASA status (p=0.228), and physical characteristics (height, weight, BMI, p>0.05). Recovery parameters such as hand grip, sustained head lift, and double burst stimulation (DBS) twitch response showed no significant differences between groups (p=0.538 for hand grip and sustained head lift; p=0.220 for DBS. Late recovery rates at 15 minutes were observed with 16% for hand grip, 14% for sustained head lift, and 26% for DBS in the rocuronium group; compared to 14%, 10%, and 16%, respectively, in the cisatracurium group. Conclusion The study found significant postoperative residual curarization in both groups, emphasizing the need for intraoperative and PACU peripheral nerve stimulation for effective assessment. Further research on intraoperative variables could improve understanding of residual paralysis in PACU, guiding better anesthesia management.

Association of Non-High-Density Lipoprotein Cholesterol With Cardiometabolic Risk Factors in Patients With Hypothyroidism.

INTRODUCTION: Non-high-density lipoprotein cholesterol (non-HDL-C) levels can increase the cardiometabolic risk factors in patients with hypothyroidism, but the findings across studies have not been consistently conclusive. The aim of this study was to find the association between non-HDL-C and cardiometabolic risk factors in patients with hypothyroidism. MATERIAL AND METHODS: In this case-control study, a total of 120 subjects among which 60 diagnosed hypothyroidism patients and 60 age-matched healthy controls were enrolled, aged 30-65 years. Body mass index (BMI), waist circumference (WC), and systolic and diastolic blood pressures (SBP and DBP) were measured. Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), fasting blood sugar (FBS), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) were estimated. Low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and non-HDL-C were calculated. A p-value of <0.05 was considered statistically significant. RESULTS: Mean of BMI, WC, FBS, TSH, TC, TG, non-HDL-C, LDL-C, VLDL-C, SBP, and DBP were significantly elevated in cases compared to controls (p<0.001). However, the mean of T3, T4, and HDL-C were significantly reduced in cases compared to controls (p<0.001). Non-HDL-C has shown a significant positive correlation with age (r=0.345, p<0.01), TC (r=0.451, p<0.01), TG (r=0.269, p<0.05), LDL-C (r=0.402, p<0.01), and VLDL-C (r=0.269, p<0.05) among cases. However, non-HDL-C has shown a significant negative correlation with HDL-C (r=-0.330, p<0.05) among cases. Non-HDL-C significantly predicted cardiometabolic risk in patients with hypothyroidism (F(13,46)=3.500, p<0.001). CONCLUSION: Non-HDL-C has shown a significant association with age and lipid abnormalities in patients with hypothyroidism. Non-HDL-C significantly predicts cardiometabolic risk factors in patients with hypothyroidism.

The known and unknown about attention deficit hyperactivity disorder (ADHD) genetics: a special emphasis on Arab population.

Attention deficit hyperactivity disorder (ADHD) is a clinically and genetically heterogeneous neurodevelopmental syndrome characterized by behavioral appearances such as impulsivity, inattention, and hyperactivity. The prevalence of ADHD is high in childhood when compared to adults. ADHD has been significantly advanced by genetic research over the past 25 years. However, it is logically conceivable that both genetic and/or non-genetic factors, such as postnatal environmental and social influences, are associated with ADHD phenotype in Arab populations. While genetic influences are strongly linked with the etiology of ADHD, it remains obscure how consanguinity which is an underlying factor for many genetic diseases, contributes to ADHD subtypes. Arabian Gulf Nations have one the highest rates of consanguineous marriages, and consanguinity plays an important contributing factor in many genetic diseases that exist in higher percentages in Arabian Gulf Nations. Therefore, the current review aims to shed light on the genetic variants associated with ADHD subtypes in Arabian Gulf nations and Saudi Arabia in particular. It also focuses on the symptoms and the diagnosis of ADHD before turning to the neuropsychological pathways and subgroups of ADHD. The impact of a consanguinity-based understanding of the ADHD subtype will help to understand the genetic variability of the Arabian Gulf population in comparison with the other parts of the world and will provide novel information to develop new avenues for future research in ADHD.

Establishing a Mouse Model of Surgical Vocal Fold Injury.

OBJECTIVE: Animal models of vocal fold (VF) surgical injury and scar formation provide insight into the wound healing process. The purpose of this study was to establish an alternative model of surgical injury to the mouse VF using materials commonly available in most research laboratories or for purchase and to investigate wound healing of the epithelium (EP) and lamina propria (LP). METHODS: Mice were anesthetized by isoflurane gas delivery and positioned on a platform so that the larynx could be observed using a laryngoscope and dissection microscope. Unilateral VF injury was created using a wire brush. Mice were euthanized and the larynx evaluated 1-, 3-, 5-, 7-, 14-, and 28-days following injury. Histological and immunofluorescent analysis was used to evaluate thickness of the EP, LP area, proliferative (Ki67+) and basal cells (p63+) in the EP, and collagen III content in the LP. RESULTS: The depth of injury reached the superficial thyroarytenoid muscle on Day 1. The thickness of the EP of the injured VF was increased on Days 3 and 5, and the LP area was increased on Days 3, 5, and 7 as compared with the uninjured VF. Ki67+ and p63+ cells were increased on Day 3 and collagen III content was increased on Days 5 and 28 as compared with the uninjured VF. CONCLUSION: We successfully established an alternative method of creating unilateral VF injury in the mouse. This method will be useful for future research regarding VF surgical injury and wound healing. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Randomized Trials of Renal Denervation for Uncontrolled Hypertension: An Updated Meta-Analysis.

BACKGROUND: Despite optimal medical therapy, a significant proportion of patients' blood pressure remains uncontrolled. Catheter-based renal denervation (RDN) has been proposed as a potential intervention for uncontrolled hypertension. We conducted an updated meta-analysis to assess the efficacy and safety of RDN in patients with uncontrolled hypertension, with emphasis on the differential effect of RDN in patients on and off antihypertensive medications. METHODS AND RESULTS: Online databases were searched to identify randomized clinical trials comparing efficacy and safety of RDN versus control in patients with uncontrolled hypertension. Subgroup analyses were conducted for sham-controlled trials and studies that used RDN devices that have gained or are currently seeking US Food and Drug Administration approval. Fifteen trials with 2581 patients (RDN, 1723; sham, 858) were included. In patients off antihypertensive medications undergoing RDN, a significant reduction in 24-hour ambulatory (-3.70 [95% CI, -5.41 to -2.00] mm Hg), office (-4.76 [95% CI, -7.57 to -1.94] mm Hg), and home (-3.28 [95% CI, -5.96 to -0.61] mm Hg) systolic blood pressures was noted. In patients on antihypertensive medications, a significant reduction was observed in 24-hour ambulatory (-2.23 [95% CI, -3.56 to -0.90] mm Hg), office (-6.39 [95% CI, -11.49 to -1.30]), home (-6.08 [95% CI, -11.54 to -0.61] mm Hg), daytime (-2.62 [95% CI, -4.14 to -1.11]), and nighttime (-2.70 [95% CI, -5.13 to -0.27]) systolic blood pressures, as well as 24-hour ambulatory (-1.16 [95% CI, -1.96 to -0.35]), office (-3.17 [95% CI, -5.54 to -0.80]), and daytime (-1.47 [95% CI, -2.50 to -0.27]) diastolic blood pressures. CONCLUSIONS: RDN significantly lowers blood pressure in patients with uncontrolled hypertension, in patients off and on antihypertensive medications, with a favorable safety profile. The efficacy of RDN was consistent in sham-controlled trials and contemporary trials using US Food and Drug Administration-approved devices.

Are the Clinical Outcomes and Cost-Effectiveness of Robot-Assisted Pedicle Screw Placement in Lumbar Fusion Surgery Superior to Computed Tomography Navigation and Freehand Fluoroscopy-Guided Techniques? A Systematic Review and Network Meta-Analysis.

OBJECTIVE: Spinal fusion surgery is known to be an expensive intervention. Although innovative technologies in the field aim at improving operative efficiency and outcomes, total costs must be considered. The authors hope to elucidate any differences between robot-assisted (RA) and computed tomography navigation (CT-nav) or freehand fluoroscopy-guided (FFG) pedicle screw placement in relation to patient outcomes and cost-effectiveness in lumbar fusion surgery (LFS). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors performed a systematic review to identify studies comparing clinical outcomes between CT-nav or RA versus FFG in LFS patients. All included studies utilized bilateral pedicle screws. Statistical analysis was performed using R. RESULTS: Of the 1162 identified studies, 5 were included in the analysis. Direct evidence showed that RA decreased hospital length of stay when compared to FFG (mean difference [MD]: -2.67 days; 95% confidence interval [CI]: -4.25 to -1.08; P < 0.01). Indirect evidence showed that RA decreased operative time when compared to CT-nav (MD: -65.57 minutes; 95% CI: -127.7 to -3.44; P < 0.05). For estimated blood loss, direct evidence showed that RA was superior to FFG (MD: -120.62 mL; 95% CI: -206.39 to -34.86; P < 0.01). However, no significant difference was found between RA and CT-nav for estimated blood loss (MD: 14.88 mL; 95% CI: -105.54 to 135.3; P > 0.05). There were no other significant differences in Oswestry Disability Index, visual analog scale, or complication or reoperation rates between RA and FFG or CT-nav. CONCLUSIONS: This study shows that RA pedicle screw placement in LFS provides similar patient outcomes to CT-nav and FFG. Robot-assisted operations were found to give rise to cost savings via decreased length of stay when compared to both CT-nav and FFG techniques. Cost-savings of $4086-$4865/patient and $7317-$9654/patient could be achieved when utilizing RA over CT-nav and FFG, respectively. However, extra upfront and maintenance costs may impact full adoption of RA in LFS.

The Aryl Hydrocarbon Receptor Controls IFNγ-Induced Immune Checkpoints PD-L1 and IDO via the JAK/STAT Pathway in Lung Adenocarcinoma.

While immunotherapy has shown efficacy in lung adenocarcinoma (LUAD) patients, many respond only partially or not at all. One limitation in improving outcomes is the lack of a complete understanding of immune checkpoint regulation. Here, we investigated a possible link between an environmental chemical receptor implicated in lung cancer and immune regulation, (the aryl hydrocarbon receptor/AhR), a known but counterintuitive mediator of immunosuppression (IFNγ), and regulation of two immune checkpoints (PD-L1 and IDO). AhR gene-edited LUAD cell lines, a syngeneic LUAD mouse model, bulk- and scRNA sequencing of LUADs and tumor-infiltrating leukocytes were used to map out a signaling pathway leading from IFNγ through the AhR to JAK/STAT, PD-L1, IDO, and tumor-mediated immunosuppression. The data demonstrate that: 1) IFNγ activation of the JAK/STAT pathway leading to PD-L1 and IDO1 upregulation is mediated by the AhR in murine and human LUAD cells, 2) AhR-driven IDO1 induction results in the production of Kynurenine (Kyn), an AhR ligand, which likely mediates an AhR→IDO1→Kyn→AhR amplification loop, 3) transplantation of AhR-knockout LUAD cells results in long-term tumor immunity in most recipients. 4) The 23% of AhR-knockout tumors that do grow do so at a much slower pace than controls and exhibit higher densities of CD8+ T cells expressing markers of immunocompetence, increased activity, and increased cell-cell communication. The data definitively link the AhR to IFNγ-induced JAK/STAT pathway and immune checkpoint-mediated immunosuppression and support the targeting of the AhR in the context of LUAD.

Nebivolol Polymeric Nanoparticles-Loaded In Situ Gel for Effective Treatment of Glaucoma: Optimization, Physicochemical Characterization, and Pharmacokinetic and Pharmacodynamic Evaluation.

Nebivolol hydrochloride (NEB), a 3rd-generation beta-blocker, was recently explored in managing open-angle glaucoma due to its mechanism of action involving nitric oxide release for the vasodilation. To overcome the issue of low ocular bioavailability and the systemic side effects associated with conventional ocular formulation (aqueous suspension), we designed and optimized polycaprolactone polymeric nanoparticles (NEB-PNPs) by applying design of experiments (DoE). The particle size and drug loading of the optimized NEB-PNPs were 270.9 ± 6.3 nm and 28.8 ± 2.4%, respectively. The optimized NEB-PNPs were suspended in a dual-sensitive in situ gel prepared using a mixture of P407 + P188 (as a thermo-sensitive polymer) and κCRG (as an ion-sensitive polymer), reported previously by our group. The NEB-PNPs-loaded in situ gel (NEB-PNPs-ISG) formulation was characterized for its rheological behavior, physical and chemical stability, in vitro drug release, and in vivo efficacy. The NEB-PNPs-loaded in situ gel, in ocular pharmacokinetic studies, achieved higher aqueous humor exposure (AUC0-t = 329.2 ng × h/mL) and for longer duration (mean residence time = 9.7 h) than compared to the aqueous suspension of plain NEB (AUC0-t = 189 ng × h/mL and mean residence time = 6.1 h) reported from our previous work. The pharmacokinetic performance of NEB-PNPs-loaded in situ gel translated into a pharmacodynamic response with 5-fold increase in the overall percent reduction in intraocular pressure by the formulation compared to the aqueous suspension of plain NEB reported from our previous work. Further, the mean response time of NEB-PNPs-loaded in situ gel (12.4 ± 0.6 h) was three times higher than aqueous suspension of plain NEB (4.06 ± 0.3 h).

Percutaneous Pulmonary Flow Restriction in Infants With Congenital Heart Disease.

Background: Restriction of PBF in infants born with CHD is often required to avoid pulmonary over-circulation prior to definitive intervention. The current standard is to surgically place pulmonary artery bands, but these have limitations and are associated with complications. Objectives: The purpose of this study was to a single-center experience with a relatively novel technique to percutaneously restrict pulmonary blood flow (PBF) in select infants with congenital heart disease (CHD). Methods: Patients were selected to undergo this procedure either due to low birth weight or prematurity. All of them had CHD that would result in over-circulation without control of PBF. By a percutaneous method, modified vascular plug devices were placed in the bilateral branch pulmonary arteries. Results: Seven neonates with CHD resulting in left-sided obstruction underwent this procedure. All patients demonstrated evidence of restricted PBF with a decrease in mean oxygen saturation from 95% to 84%. One patient required pulmonary artery band placement due to over-circulation 5 days after the procedure. All patients proceeded to full surgical intervention without device embolization or need for pulmonary arterioplasty. Hemodynamics demonstrated adequate limitation of PBF in 5 patients who underwent presurgical cardiac catheterization with a mean pulmonary vascular resistance of 1.52 WU × m2 and a mean transpulmonary gradient of 5.9 mm Hg. Conclusions: Percutaneous PBF restriction appears to be safe and a less invasive option to delay surgical intervention in a select population to allow for somatic growth and gestational maturation. It results in a decrease in the total number of sternotomies.

Assessing the Impact of Smartphone Use on Neck Pain and Related Symptoms Among Residents in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: The widespread adoption of smartphones has transformed global communication but raised health concerns like Text Neck Syndrome - a musculoskeletal condition arising from prolonged device use, causing discomfort in the cervical spine. This study investigates its prevalence and associated factors among smartphone users in Jeddah, Saudi Arabia, focusing on usage patterns, symptoms, and awareness. METHODS: This cross-sectional online survey was conducted from June 1 to June 30, 2024. Data on demographics, smartphone habits, symptoms, and Text Neck Syndrome awareness were collected using a structured questionnaire. Statistical analysis involved descriptive statistics and chi-square tests. RESULTS: The study included 421 participants, predominantly female (279, 66.3%) and Saudi nationals (397, 94.3%). The largest age group was 21-40 years (308, 73.2%), and most were single (251, 59.6%) with a college degree (236, 56.1%). Over 42.0% of participants used smartphones for more than five hours daily, with 39.4% adopting a 30-degree neck posture. The most prevalent symptoms reported were neck pain (272, 64.6%), headaches (203, 48.2%), and shoulder pain (178, 42.3%). Awareness of Text Neck Syndrome was reported by 197 participants (46.8%), but only 60 (14.3%) had been diagnosed. Concerns about long-term complications such as osteoporosis (105, 24.9%) and prolapsed intervertebral disc (120, 28.5%) were expressed. Despite these concerns, 97.9% of participants hesitated to reduce smartphone usage due to reported symptoms. CONCLUSION: This study highlights the significant musculoskeletal impact of smartphone use in Jeddah, underscoring the need for interventions promoting ergonomic practices and increasing awareness about associated risks. Public health strategies should focus on promoting ergonomic practices and educating users about preventive measures.

Seven-Year Experience of Intramural Surgery in the Middle East: A Safety and Feasibility Analysis.

Background: Intramural surgery techniques, particularly esophageal peroral endoscopic myotomy (E-POEM), gastric peroral endoscopic myotomy (G-POEM), and peroral endoscopic myotomy for Zenker's (Z-POEM), have emerged as forefront minimally invasive endoscopic procedures. While several studies have reported on the outcomes in North America and Asia, evidence in the Middle East and North Africa remains limited. This study aims to evaluate the feasibility and safety of intramural surgery techniques within this region. Methods: This retrospective cohort study was conducted with approval from the institutional review board. All patients who underwent esophageal peroral endoscopic myotomy, gastric peroral endoscopic myotomy, and peroral endoscopic myotomy for Zenker's from January 2016 to August 2023 were included. Results: In total, 119 patients underwent intramural surgery procedures during this period. The esophageal peroral endoscopic myotomy group had 81 (68%) patients, the gastric peroral endoscopic myotomy had 34 (28.6%) patients, and the peroral endoscopic myotomy for Zenker's had 4 (3.4%) patients. The full cohort was 48.7% female, with a mean overall age of 40.5 years. The mean overall body mass index was 27.5 kg/m2. The chief complaint was dysphagia (n = 80, 67.2%). All cases were successfully completed endoscopically. During the first 30 days, the most common complications were nausea/vomiting requiring admission (n = 4, 4.76%) and pneumomediastinum (n = 2, 2.38%). At a follow-up of 19 months, there were four mortalities; the causes of death were cardiac arrest (three cases) and end-stage prostate cancer (one case). Conclusions: Intramural surgery techniques are safe and technically feasible with low complication rates. Our study suggests that clinical success in the Middle East and Northern Africa population is comparable to larger international series.

Urinary Metabolite Diagnostic and Prognostic Liquid Biopsy Biomarkers of Lung Cancer in Nonsmokers and Tobacco Smokers.

PURPOSE: Nonsmokers account for 10% to 13% of all lung cancer cases in the United States. Etiology is attributed to multiple risk factors including exposure to secondhand smoking, asbestos, environmental pollution, and radon, but these exposures are not within the current eligibility criteria for early lung cancer screening by low-dose CT (LDCT). EXPERIMENTAL DESIGN: Urine samples were collected from two independent cohorts comprising 846 participants (exploratory cohort) and 505 participants (validation cohort). The cancer urinary biomarkers, creatine riboside (CR) and N-acetylneuraminic acid (NANA), were analyzed and quantified using liquid chromatography-mass spectrometry to determine if nonsmoker cases can be distinguished from sex and age-matched controls in comparison with tobacco smoker cases and controls, potentially leading to more precise eligibility criteria for LDCT screening. RESULTS: Urinary levels of CR and NANA were significantly higher and comparable in nonsmokers and tobacco smoker cases than population controls in both cohorts. Receiver operating characteristic analysis for combined CR and NANA levels in nonsmokers of the exploratory cohort resulted in better predictive performance with the AUC of 0.94, whereas the validation cohort nonsmokers had an AUC of 0.80. Kaplan-Meier survival curves showed that high levels of CR and NANA were associated with increased cancer-specific death in nonsmokers as well as tobacco smoker cases in both cohorts. CONCLUSIONS: Measuring CR and NANA in urine liquid biopsies could identify nonsmokers at high risk for lung cancer as candidates for LDCT screening and warrant prospective studies of these biomarkers.

Economic policy uncertainty and financial system efficiency.

Economic policy uncertainty (EPU) adversely affects financial system functioning with potentially critical repercussions for economies and corporations worldwide. Financial system efficiency (FSE) has a vital influence on fostering optimal economic growth and development; however, the impact of EPU on FSE remains under-explored. This study investigates the effect of EPU on FSE along with its components financial institution efficiency (FIE) and financial market efficiency (FME). Using data from 22 countries over a 20-year period (2002-2021), our analysis reveals a significant negative effect of EPU on FSE, FIE and FME. Notably, our split-sample analysis highlights the accentuated adverse effects of EPU in high-EPU regimes, emphasising the importance of vigilance during periods of elevated policy uncertainty. We conduct a series of sensitivity tests, including alternative measures of EPU, FSE, FIE and FME, and apply two-stage least squares and two-step dynamic system generalised method of moments estimators and introduce additional control variables. These tests consistently reaffirm the core conclusions of our study. Finally, we discuss the implications of our findings for policymakers.