Unraveling the miRNA Puzzle in Atherosclerosis: Revolutionizing Diagnosis, Prognosis, and Therapeutic Approaches.

PURPOSE OF REVIEW: To eradicate atherosclerotic diseases, novel biomarkers, and future therapy targets must reveal the burden of early atherosclerosis (AS), which occurs before life-threatening unstable plaques form. The chemical and biological features of microRNAs (miRNAs) make them interesting biomarkers for numerous diseases. We summarized the latest research on miRNA regulatory mechanisms in AS progression studies, which may help us use miRNAs as biomarkers and treatments for difficult-to-treat diseases. RECENT FINDINGS: Recent research has demonstrated that miRNAs have a regulatory function in the observed changes in gene and protein expression during atherogenesis, the process that leads to atherosclerosis. Several miRNAs play a role in the development of atherosclerosis, and these miRNAs could potentially serve as non-invasive biomarkers for atherosclerosis in various regions of the body. These miRNAs have the potential to serve as biomarkers and targets for early treatment of atherosclerosis. The start and development of AS require different miRNAs. It reviews new research on miRNAs affecting endothelium, vascular smooth muscle, vascular inflammation, lipid retention, and cholesterol metabolism in AS. A miRNA gene expression profile circulates with AS everywhere. AS therapies include lipid metabolism, inflammation reduction, and oxidative stress inhibition. Clinical use of miRNAs requires tremendous progress. We think tiny miRNAs can enable personalized treatment.

Postoperative pain, recovery and discharge after robot-assisted laparoscopic prostatectomy: A multicentre, single blinded, randomised controlled trial.

BACKGROUND: General anaesthesia is standard of care for patients undergoing robot assisted laparoscopic prostatectomy (RALP). However, postoperative pain and bladder discomfort remains an issue, and optimising pain management could improve recovery and promote earlier home discharge. The main objective of this trial was to evaluate if patients receiving spinal anaesthesia are more frequently home ready at 8 pm on the same day compared with multimodal pain management following RALP under general anaesthesia. METHODS: This pragmatic, randomised controlled, multicentre trial was performed between January 2019 to December 2021. Patients undergoing RALP under general anaesthesia were randomised to either multimodal analgesia using parecoxib and morphine intra-operatively (Group GM) or spinal anaesthesia with bupivacaine and sufentanil (Group GS). The primary aim, home readiness, was assessed using a post-anaesthesia discharge scoring system. RESULTS: Of 202 patients analysed, 27% patients reached home readiness criteria after 12 h, 46% after 24 h and 79% after 48 h, without differences between the groups. Urge to pass urine was greater in group GM than in group GS (p ⟨0.001) and lasted for a median of two hours in both groups. More patients expressed satisfaction with postoperative care in group GS (p ⟨0.001). No other significant differences were found between the groups. DISCUSSION: We found no difference in time to home readiness between the groups. Approximately one-fourth of the patients achieved home readiness the same day after surgery without difference between the groups. Fewer patients had urge, and patient satisfaction was greater in group GS.

Comparative Study Between Single-limb Versus One-and-a-Half Hip Spica Cast in Fracture Femur in Young Children.

INTRODUCTION: Femoral fractures account for ∼1% to 2% of all pediatric bone injuries and are a common occurrence in children. The conservative approach, employing either a single or one-and-a-half spica casts, has been traditionally favored, yielding satisfactory outcomes in select cases. This study aims to compare both procedures regarding functional and radiologic outcomes, complications, and parents' satisfaction. METHODS: In this randomized controlled trial, we enrolled 84 pediatric patients, aged between 2 and 6 years, presenting with femoral fractures. Participants were randomly allocated into 2 groups; one receiving single-limb spica cast fixation (n=42) and the other receiving one-and-a-half spica cast fixation (n=42). We assessed postprocedural functional and radiologic outcomes. Other evaluations focused on parental ease in maintaining hygiene for the casted child, the child's mobility capabilities including standing and crawling, and the incidence of skin complications. RESULTS: No significant variance was observed between the 2 groups concerning the time to bone union, and the overall complication rates. Parental satisfaction was notably higher in the single-limb spica group, particularly regarding the ease of maintaining hygiene for the casted child and the child's mobility while encased in the cast (P<0.001). Furthermore, a significant correlation was identified between the one-and-a-half spica application and the increased occurrence of skin pressure ulcers (P<0.001). CONCLUSION: Both single-limb and one-and-a-half spica cast applications demonstrated comparable results in functional and radiologic outcomes, as well as in complication rates. However, parents favored the single-limb method due to its facilitation of a more manageable lifestyle for both the child and their parents. These considerations suggest that the single-limb hip spica cast fixation may be preferable in managing pediatric femoral fractures. LEVEL OF EVIDENCE: Level II.

Sodium-Glucose Co-Transporter 2 Inhibitors: Mechanism of Action and Efficacy in Non-Diabetic Kidney Disease from Bench to Bed-Side.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are currently available for the management of type 2 diabetes mellitus. SGLT2i acts by inhibiting renal SGLT2, thereby increasing glucosuria and lowering serum glucose. Recent trials are emerging supporting a role for SGLT2i irrespective of the diabetic status pointing towards that SGLT2i have other mechanisms of actions beyond blood sugar control. In this review, we will shed light on the role of this group of medications that act as SGLT2i in non-diabetics focusing on pre-clinical and clinical data highlighting the mechanism of renoprotection and effects of SGLT2i in the non-diabetic kidneys.

A Case Report of Isolated Cervical Ligament Rupture With Hyper-Pronation Injury: Specific MRI Protocol and Surgical Reconstruction.

Background: The aim of this case report is to present a case of chronic cervical ligament tear and instability, which occurred by an unusual work injury with an eversion/hyper-pronation mechanism in contrast to the usual mechanism of inversion. The ligament was reconstructed using an allograft with satisfactory results up to 30 months after surgery. A new magnetic resonance imaging protocol (MRI) was developed to better evaluate the cervical ligament/graft. Conclusion: In diagnosis of foot sprains, a specific ligament injury should always be sought. In this case, physical examination producing tenderness at the location of the cervical ligament and correlating this with an oblique intercolumn stress test that reproduced pain with apprehension and gross instability supported the diagnosis. Retrospectively applying anatomic knowledge to the earlier MRI findings of bone marrow edema at the insertion points of the cervical ligament on the talus and calcaneus was important in confirming the diagnosis. To better evaluate the cervical ligament allograft tendon reconstruction, a novel volumetric MRI sequence was developed which may prove helpful to also diagnose cervical ligament injuries in future cases. Anatomic reconstruction of the cervical ligament provided satisfactory clinical and radiographic results at 30-month follow-up.Level of Evidence: V.

A Case Report of Brodie's Abscess of the Cuboid Treated by Anatomic Antibiotic-Cement Spacer.

Background: A case of chronic osteomyelitis with Brodie's abscess of the cuboid caused by a wooden foreign body penetrating the plantar foot. Total cuboidectomy was carried out with implantation of an anatomically molded antibiotic-impregnated cement spacer with culture-specific postoperative intravenous antibiotics. At six months of follow-up, the patient was completely asymptomatic without evidence of a recurrence of infection. Final radiographs also didn't show spacer migration or surrounding bone erosions. The spacer obviated the need for any foot fusion which preserved foot biomechanics. The patient didn't need to use any braces or insoles. Conclusion: Osteomyelitis should always be on the differential list of lytic lesions of the tarsal bones, especially if there is a history of prior foot trauma. In this case, cuboid excision and placement of an antibiotic-impregnated cement spacer provided sustained relief of symptoms without evidence of recurrence or complications for six months.Level of Evidence: V.

Development of electrochemical sensors for quick detection of environmental (soil and water) NPK ions.

All over the world, technology is becoming more and more prevalent in agriculture. Different types of instruments are already being used in this sector. For the time being, every farmer is trying to produce more crops on a piece of land. Eventually, soil loses its nutrients; however, to grow more crops, farmers use more fertilizers without knowing the proper conditions of the soil in real time. To overcome this issue, many scientists have recently focused on developing electrochemical sensors to detect macronutrients, i.e., nitrogen (N), phosphorus (P), and potassium (K), in soil or water rapidly. In this review, we focus mainly on the recent developments in electrochemical sensors used for the detection of nutrients (NPK) in different types of samples. As it is outlined, the use of smart and portable electrochemical sensors can be helpful for the reduction of excess fertilizer and can play a vital role in maintaining suitable conditions in soils and water. We are optimistic that this review can guide researchers in the development of a portable and suitable NPK detection system for soil nutrients.

Trauma-Informed Care as a Universal Precaution: A Brief, Case-Based, Educational Primer Featuring Role-Playing and Individual Self-Reflection Exercises.

ABSTRACT: Despite its growing popularity, the implementation of Trauma-Informed Care (TIC) in standard medical practices remains insufficient. A workshop, featuring role-playing scenarios and individual self-reflection exercises, was developed to enhance compassion among health care providers. The workshop was created by a multidisciplinary team of community pediatricians, pediatric intensivists, psychologists, and palliative care physicians, was structured around key elements and principles of TIC, and was based on actual patient encounters. The 90-minute session included didactics, role-playing, writing and self-reflection exercises, and large-group debriefings, and it was presented at two academic meetings. It is currently available as an open-sourced, freely accessible website. The workshop was attended by individuals with varying levels of training and experience. Of approximated 80 participants, 39 responded to surveys about baseline knowledge and workshop satisfaction, and 24 completed self-perceived pre- and postknowledge surveys. Nearly 90% had limited prior exposure to TIC. All rated the workshop highly, with no significant differences based on workshop facilitation. Nearly 95% felt that they learned something that would impact their day-to-day practices. Self-perceived pre-post knowledge showed statistically significant improvements. This workshop is feasible and can potentially increase health care professionals' capacity to care, decrease moral injury, and alleviate burnout from difficult cases.

Sustainable synthesis of magnetic petroleum coke/nonanyl chitosan composite for efficient removal of o-nitrophenol.

Worldwide industrialization has grown at a rapid pace, contaminating water resources, particularly with phenolic pollutants that pose a risk to aquatic systems and human health. The goal of this study is to create an inexpensive magnetic composite that can effectively remove nitrophenol (o-NP) using adsorptive means. In this instance, a nonanyl chitosan (N-Cs) derivative was synthesized and then combined with activated petroleum coke (AP-coke) and magnetic Fe3O4 to boost its adsorbability towards o-NP and to facilitate its separation. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffractometer (XRD), Vibrating sample magnetometer (VSM), X-ray photoelectron spectroscopy (XPS), and zeta potential were employed to characterize the magnetic composite. The experimental results indicated that the Fe3O4/AP-coke/N-Cs composite possesses a greater affinity toward o-NP with a maximal efficiency reached 88% compared to 22.8, 31.2, and 45.8% for Fe3O4, AP-coke and N-Cs, respectively. The equilibrium adsorption data coincided with the Langmuir, Freundlich, and Temkin isotherm models, with a maximum adsorption capacity of 291.55 mg/g at pH 6, whereas the pseudo second order kinetic model offered the best fit to the experimental data. Besides, the developed adsorbent preserved satisfactory adsorption characteristics after reuse for five successive cycles. The proposed adsorption mechanism involves the H-bonding, π-π interaction, hydrophobic interactions and electron donor-acceptor interactions. These findings hypothesize that the constructed magnetic composite could efficiently remove nitrophenols from polluted water with high performance and ease-separation.

Synergistic effect of potential alpha-amylase inhibitors from Egyptian propolis with acarbose using in silico and in vitro combination analysis.

BACKGROUND: Type 2 Diabetes mellitus (DM) is an affliction impacting the quality of life of millions of people worldwide. An approach used in the management of Type 2 DM involves the use of the carbohydrate-hydrolyzing enzyme inhibitor, acarbose. Although acarbose has long been the go-to drug in this key approach, it has become apparent that its side effects negatively impact patient adherence and subsequently, therapeutic outcomes. Similar to acarbose in its mechanism of action, bee propolis, a unique natural adhesive biomass consisting of biologically active metabolites, has been found to have antidiabetic potential through its inhibition of α-amylase. To minimize the need for ultimately novel agents while simultaneously aiming to decrease the side effects of acarbose and enhance its efficacy, combination drug therapy has become a promising pharmacotherapeutic strategy and a focal point of this study. METHODS: Computer-aided molecular docking and molecular dynamics (MD) simulations accompanied by in vitro testing were used to mine novel, pharmacologically active chemical entities from Egyptian propolis to combat Type 2 DM. Glide docking was utilized for a structure-based virtual screening of the largest in-house library of Egyptian propolis metabolites gathered from literature, in addition to GC-MS analysis of the propolis sample under investigation. Thereafter, combination analysis by means of fixed-ratio combinations of acarbose with propolis and the top chosen propolis-derived phytoligand was implemented. RESULTS: Aucubin, identified for the first time in propolis worldwide and kaempferol were the most promising virtual hits. Subsequent in vitro α-amylase inhibitory assay demonstrated the ability of these hits to significantly inhibit the enzyme in a dose-dependent manner with an IC50 of 2.37 ± 0.02 mM and 4.84 ± 0.14 mM, respectively. The binary combination of acarbose with each of propolis and kaempferol displayed maximal synergy at lower effect levels. Molecular docking and MD simulations revealed a cooperative binding mode between kaempferol and acarbose within the active site. CONCLUSION: The suggested strategy seems imperative to ensure a steady supply of new therapeutic entities sourced from Egyptian propolis to regress the development of DM. Further pharmacological in vivo investigations are required to confirm the potent antidiabetic potential of the studied combination.

Paraspinous Sagittal Shift (PSSS): a novel approach for transmuscular quadratus lumborum block for hip surgery analgesia - four cases report / Paraespinhoso Sagital (PES): nova técnica no bloqueio transmuscular do quadrado lombar para analgesia em cirurgia de quadril - relato de quatro casos

Abstract Background: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients. Methods: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique. Results: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases. Conclusions: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.

Resumo Justificativa: O controle efetivo da dor é essencial para a reabilitação bem-sucedida e melhor recuperação após artroplastia. O bloqueio do quadrado lombar tem sido descrito principalmente para cirurgia abdominal, mas recentemente também tem sido usado para pacientes submetidos a cirurgia de quadril. Método: Na série de casos a seguir, sugerimos modificação na técnica do bloqueio transmuscular do quadrado lombar descrita como bloqueio do Quadrado Lombar Paraespinhoso Sagital (PES). Nossa hipótese é de que a técnica permitiria melhor dispersão do anestésico local para as raízes dos nervos lombares. Tal técnica envolve acesso craniocaudal para injeção do anestésico local entre os músculos quadrado lombar e psoas maior atrás da Fáscia Toracolombar Anterior (FTLA) no nível de L4. Os casos foram submetidos a anestesia geral combinada a técnica modificada PES para bloqueio do quadrado lombar via injeção única ou cateter. Resultados: Verificou-se que a distribuição sensorial do bloqueio nos quatro pacientes estudados cobriu a área entre os dermátomos T11-12 e L4-5. A dispersão do anestésico injetado foi confirmada via fluoroscopia A-P da coluna lombo-sacral após injeção, em dois casos, de solução de anestésico local e contraste no plano entre os músculos quadrado lombar e psoas maior. Conclusões: A técnica PES para bloqueio transmuscular do quadrado lombar pode ser benéfica como componente da analgesia multimodal para cirurgias de quadril. A técnica pode ser alternativa segura para bloqueio do compartimento psoas; entretanto, estudos comparativos futuros são recomendados. A técnica PES para bloqueio transmuscular do quadrado lombar pode também fornecer acesso fácil para inserção do cateter.

Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial / Papel da ecocardiografia na redução do tempo de reversão do choque no choque séptico pediátrico: ensaio controlado randomizado

Abstract Objective: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. Methods: A prospective study conducted in the pediatric intensive care unit of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography-guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes. Results: Shock reversal was significantly higher in the study group (89% vs. 67%), with significantly reduced shock reversal time (3.3 vs. 4.5 days). Pediatric intensive care unit stay in the study group was significantly shorter (8 ± 3 vs. 14 ± 10 days). Mortality due to unresolved shock was significantly lower in the study group. Fluid overload was significantly lower in the study group (11% vs. 44%). In the study group, inotropes were used more frequently (89% vs. 67%) and initiated earlier (12[0.5-24] vs. 24[6-72] h) with lower maximum vasopressor inotrope score (120[30-325] vs. 170[80-395]), revealing predominant use of milrinone (62% vs. 22%). Conclusion: Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment, allowing a timely management and resulting in shock reversal time reduction among children with septic shock.

Resumo Objetivo: Avaliar o papel da ecocardiografia na redução do tempo de reversão do choque no choque séptico pediátrico. Métodos: Estudo prospectivo conduzido em uma UTIP de um hospital universitário de cuidados terciários de setembro de 2013 a maio de 2016. Foram randomizados 90 pacientes com choque séptico na proporção 1:1 para comparar a terapia guiada por ecocardiografia em série com a terapia padrão no grupo de controle com relação ao curso clínico, tratamento oportuno e resultados. Resultados: A reversão do choque foi significativamente maior no grupo de estudo (89% em comparação com 67%) com redução significativa do tempo de reversão do choque (3,3 em comparação com 4,5 dias). A permanência na UTIP no grupo de estudo foi significativamente mais curta (8 ± 3 em comparação com 14 ± 10 dias). A mortalidade devido ao choque não resolvido foi significativamente menor no grupo de estudo. A sobrecarga de fluidos foi significativamente menor no grupo de estudo (11% em comparação com 44%). No grupo de estudo, os inotrópicos foram usados com mais frequência (89% em comparação com 67%) e foram administrados antecipadamente (12 [0,5-24] em comparação com 24 [6-72] horas) e o menor escore inotrópico máximo dos vasopressores (120 [30-325] em comparação com 170 [80-395]) revela o uso predominante de milrinona (62% em comparação com 22%). Conclusão: A ecocardiografia em série forneceu dados fundamentais para o reconhecimento precoce da disfunção miocárdica séptica e hipovolemia não evidente na avaliação clínica, possibilitou o manejo tempestivamente adequado e resultou na redução do tempo de reversão do choque entre crianças com choque séptico.