Efficacy of endoscopic decompression surgery for treatment of lumbar spinal stenosis.

Background: The overall aim of this study was to assess the effectiveness of endoscopic decompression for outcomes in patients with lumbar spinal stenosis (LSS). Methods: We conducted a retrospective cohort, single-institution study of n = 139 patients from 2019 to 2022 who underwent endoscopic decompression for LSS. The primary outcome was improvement of Oswestry Disability Index (ODI) between baseline and 12-month follow-up. Results: In the present sample (n = 139) the average age was 57.6 years (SD = 17.4, with even distribution of men (49%) vs. women (51%). In patients with LSS, lumbar disc herniation was the most common diagnosis in 49 patients followed by lumbar radiculopathy in 25 patients. Lumbar radicular pain was the 3rd most common diagnosis in 21 patients with all other diagnosis listed in Table S1. There was a significant improvement (i.e., decrease) in ODI following endoscopic decompression (mean change: -8.3, 95% CI: -9.4, -7.2, P < 0.001, Fig. 1). Prior lumbar spine surgery (P = 0.048), BMI (P = 0.053), and age (P = 0.022) were associated with changes in ODI. Nearly half (47%) of the sample had prior lumbar spine surgery. Those with prior lumbar spine surgery (-7.5, 95% CI: -8.3, -6.6) showed less improvement than those without prior lumbar spine surgery (-9.1, 95% CI: -10.9, -7.2, Fig. 2). For BMI, 23% had normal BMI while 24% were overweight and 53% were obese. Patients with normal BMI (-10.3, 95% CI: -13.4, -7.2) showed greater improvements compared to overweight (-7.9, 95% CI: -9.4, -6.4) and obese (-7.6, 95% CI: -9.0, -6.3, Fig. 3) patients. Patients under 40 years old (-10.2, 95% CI: -13.6, -6.8) showed greater improvements in ODI compared to those 40 years and older (-7.8, 95% CI: -8.6, -6.8, Fig. 4). Conclusions: In patients with lumbar spinal stenosis, endoscopic decompression was associated with reduced disability. Patients with no prior lumbar spine surgery, normal BMI, and who were under 40 years old showed greater improvements.

The Effectiveness of Hyperbaric Oxygen Treatment in Patients with Complex Regional Pain Syndrome: A Retrospective Case series.

Background: Complex regional pain syndrome (CRPS) presents as persistent regional pain, both spontaneous and triggered. The demand persists for innovative treatments that patients can endure with minimal adverse effects. Hyperbaric oxygen therapy (HBOT) emerges as a possible intervention in this regard. Methods: The main objective of this work is to retrospectively analyse a case series of patients diagnosed with CRPS treated in the Centre of Hyperbaric Medicine Ostrava over two years (period 2018-2019). The HBOT was applied at 2.0-2.4 absolute atmosphere (ATA) once a day. Results: A total of 83 patients with CRPS were treated with HBOT. 98% of cases reported pain, 92% reported limitation of movement of the affected limb, 87% had swelling of the limb, 41% had lividity and 70% had sensory problems. The mean number of HBOT exposures was 22.0 ± 7.1. At the end of HBOT treatment, 86% of cases had symptoms relief. The mean VAS value of pain at rest before the start of HBOT was 3.2±3.0, after treatment it was 1.6±1.9 (p<0.001). In a pain at activity it was 6.1±2.4 and 3.7±2.4 (p<0.001), respectively, at the end of HBOT. The value of the functional assessment of the limb was 7.0±2.0 and 4.3±2.4 (p<0.001), respectively, at the end of treatment. 79 cases were included in the end-of-treatment assessment. 23 cases (29%) were evaluated as large clinically significant response, 48 cases (61%) were evaluated as partial response with minimally important difference. The results showed larger clinical HBOT effect in cases of disease duration up to 3 and 6 months (p=0.029). Conclusions: The majority of patients improved pain and functional state of the affected limb. Our data also suggests the sooner after diagnosis of CRPS is HBOT started, the treatment has larger clinical effect. There was no serious HBOT-related complication or injury.

Effect of sonoprocessing on the quality of plant-based analog foods: Compatibility to sustainable development goals, drawbacks and limitations.

Sonoprocessing (US), as one of the most well-known and widely used green processing techniques, has tremendous benefits to be used in the food industry. The urgent call for global sustainable food production encourages the usage of such techniques more often and effectively. Using ultrasound as a hurdle technology synergistically with other green methods is crucial to improving the efficiency of the protein shift as well as the number of plant-based analog foods (PBAFs) against conventional products. It was revealed that the US has a significant impact when used as an assistant tool with other green technologies rather than being used alone. It increases the protein extraction efficiencies from plant biomasses, improves the techno-functional properties of food compounds, and makes them more applicable for industrial-scale alternative food production in the circular economy. The US aligns well with the objectives outlined in the UN's Sustainable Development Goals (SDGs), and Planetary Boundaries (PBs) framework, demonstrating promising outcomes in life cycle assessment. However, several challenges such as uncontrolled complex matrix effect, free radical formation, uncontrolled microbial growth/germination or off-flavor formation, removal of aromatic compounds, and Maillard reaction, are revealed in an increased number of studies, all of which need to be considered. In addition to a variety of advantages, this review also discusses the drawbacks and limitations of US focusing on PBAF production.

Principal components analysis on genes related to inflammasome complex and microglial activation in the hypothalamus of obese mice treated with semaglutide (GLP-1 analog).

We studied the effect of semaglutide (glucagon-like peptide type 1 agonist) on hypothalamic pro-inflammatory genes in diet-induced obese mice. Male C57BL/6J mice were fed a control (C) or high-fat (HF) diet for 16 weeks, then divided into six groups and maintained for an additional four-week study: C, C+semaglutide (CS), C pair-feeding (CP), HF, HF+semaglutide (HFS), and HF pair-feeding (HFP).Weight gain (WG), food efficiency (FE), and plasmatic biochemistry were determined. The hypothalamus was removed and prepared for molecular analysis. Semaglutide reduced WG and FE in the HF group. High cytokines levels (tumor necrosis factor alpha, TNF alpha, monocyte chemoattractant protein 1, MCP1, and Resistin) in HF mice were reduced in HFS mice. High pro-inflammatory gene expressions were seen in HF (toll-like receptor 4, Tlr4; Mcp1; interleukin 6, Il6; Tnfa), inflammasome complex (Pirina domain-containing receptor 3, Nlrp3; Caspase 1, Il1b, Il18), and microglial activation (ionized calcium-binding adapter molecule 1, Iba1; cluster differentiation 68, Cd68; argirase 1, Arg1) but mitigated in HFS. The principal components analysis (PCA) based on these markers in a PC1 x PC2 scatterplot put HF and HFP together but far away from a cluster formed by C and HFS, indicating little significance of weight loss (HFP) but decisive action of semaglutide (HFS) in the results. In conclusion, semaglutide benefits hypothalamic pro-inflammatory genes, inflammasome complex, and microglial activation independent of the weight loss effect. Since GLP-1 receptor agonists such as semaglutide are already indicated to treat obesity and diabetes, the potential translational effects on neuroinflammation should be considered.

The association between dietary antioxidant quality score and intensity and frequency of migraine headaches among women: a cross-sectional study.

BACKGROUND: Migraine is an episodic disorder and a frequent form of headache. An impaired balance between free radical production and an impaired antioxidant defense system leading to oxidative damage may play a major role in migraine etiology. We sought to investigate whether dietary antioxidant quality score (DAQS) is associated with migraine intensity and frequency among women suffering from migraine. METHODS: This cross-sectional study was conducted on 265 women. The data related to anthropometric measures and dietary intake were collected. DAQS score was calculated based on FFQ (food frequency questionnaire) vs. the reference daily intake (RDI) quantity. To measure migraine intensity, the migraine disability assessment questionnaire (MIDAS) and visual analog scale (VAS) were used. The frequency of headaches was defined as the days the participants had headaches in the last month and a 30-day headache diary was used. RESULTS: The results of the study demonstrated that VAS, MIDAS, and frequency of headaches were reduced significantly from the low DAQS (poor quality of antioxidants) to high DAQS (high quality of antioxidants) after adjusting covariates. Also, multinomial regression showed there was an inverse association between higher DAQS and the frequency of headaches. In the adjusted model, subjects with the higher DAQS were 69% less likely to have moderate migraine disability, compared with those with the lower DAQS. Linear regression showed, there was an inverse association between vitamin C intake and the grades of pain severity.َAlso in a crude model, a negative association was found between vitamin E and the frequency of headaches. CONCLUSION: In conclusion, Participants with higher DAQS had lower migraine intensity and headache frequency. In addition, the consumption of vitamin C may potentially associate with decreasing the severity of headaches. Dietary antioxidants should be monitored closely in individuals suffering from migraine.

Open label, interventional, single arm multicentric clinical study to analyze the potency of VELNEZ nasal pack, post-nasal surgery.

Background: Nasal packs are central to nasal surgeries. Primarily, these packs function by controlling bleeding, modulating pain and reducing adhesions postsurgery. However, the major setback of the currently used conventional nasal packs is the unbearable pain the patient undergoes upon removal of these packs. To overcome this shortcoming a variety of biodegradable packs have emerged. This study was aimed at evaluating the safety, efficacy and tolerability of VELNEZ nasal packs. VELNEZ, a patented Datt Mediproducts Pvt. Ltd. nasal pack, is one of its kind biodegradable composite that fragments within a few days of application. Methods: Eighty patients were included in an open label, interventional, single arm clinical study using clinical endpoints to investigate the safety and efficacy of nasal pack VELNEZ. The patients were questioned using a visual analog scale from discharge day to 28th postoperative day (9 follow-up visits) at regular intervals. The standardized questionnaires for hemorrhage control, relief from postoperative pain, moderate obstruction, and pain were used. Results: A total of 76 patients were enrolled in the study and 74 patients completed the study. VELNEZ nasal pack played a significant role in controlling hemorrhage and reducing postoperative pain. The average hemorrhage control time was 7.49 ± 3.90 min with only 34.24% of population complaining of pain on the sixth day of surgery (follow-up 4). Forteen days postsurgery only 10.95% of subject population complained of postoperative pain. This biodegradable composite has an average fragmentation time of 4.7 days in the nasal cavity. In addition, this study did not observe any postoperative adverse events or serious adverse events. Conclusion: VELNEZ, a fragmentable nasal pack, is comfortable, safe, and effective against postsurgery bleeding and pain.

Development and characterization of fibrous high moisture extrudates based on pea protein isolate and whey protein.

BACKGROUND: Construction of meat analogs based on pea protein isolate (PPI) alone by high moisture extrusion (HME) is diffocult as a result of the lack of anisotropic structures. In the present study, 0%-15% of whey protein (WP) was introduced to PPI to make hybrid blends, which were used to construct HME extrudates. RESULTS: WP enhanced the hardness, adhesive, cohesiveness and gumminess of the extrudates and facilitated the formation of a distinct anisotropic structure of PPI. The fibrous degrees of the extrudates containing 10% and 15% WP were around 1.50. The addition of WP, which has more -SH groups, increased the disulfide bonds and hydrogen bonding in the extrudates, leading to a denser cross-linked structure. Particle size distribution and Fourier transform infrared analysis showed that WP induced more compact structured aggregates and more ß-sheet structures in the extrudates. Furthermore, the higher hydration capacity of WP may also help form a dilute melt and generate a more pronounced plug flow, assisting the formation of fiber structures of PPI. CONCLUSION: The present study demonstrates that WP is a potential modifier, which could be used to improve the structure of PPI-based meat analogs. © 2024 Society of Chemical Industry.

Assessment of head-mounted display for exoscopic neurosurgery.

Background: Head-mounted display (HMD) arises as an alternative display system for surgery. This study aimed to assess the utility of a stereoscopic HMD for exoscopic neurosurgery. Methods: The leading operator and assistants were asked to assess the various aspects of the HMD characteristics compared to the monitor display using a visual analog scale (VAS)-based questionnaire. The VAS score ranged from 0 to 10 (0, HMD was significantly inferior to the monitor; 5, HMD and monitor display were equal; and 10, HMD was significantly superior to the monitor). Results: The surgeons and assistants used and evaluated HMD in seven exoscopic surgeries: three tumor removal, one aneurysm clipping, one anterior cervical discectomy and fusion, and two cervical laminectomy surgeries. The leading operators' assessment of HMD-based surgery was not different from monitor-based surgery; however, the assistants evaluated the field of view, overall image quality, and the assisting procedure as better in MHD-based surgery than monitor-based surgery (P = 0.039, 0.045, and 0.013, respectively). Conclusion: HMD-based exoscopic neurosurgery can be performed at a similar quality as monitor-based surgery. Surgical assistants may benefit from using HMD-based surgery.

A Case of Cotyledonoid-Dissecting Leiomyoma - The Utility of Laparoscopic Biopsy and Gonadotropin-Releasing Hormone Analogs.

Cotyledonoid-dissecting leiomyoma, a very unusual form of uterine leiomyoma, often leads to misdiagnosis as a malignant tumor. Here, we describe a case of a 45-year-old nulliparous woman who underwent a laparoscopic biopsy of a large pelvic mass consisting of multiple flaps. Histologically, the mass was composed of smooth muscle fascicle nodules separated by hydropic connective tissue, and exhibited extensive stromal hyalinization. The tumor was diagnosed as a cotyledonoid-dissecting leiomyoma based on the laparoscopic, pathological, and image findings. Prior to performing radical laparotomy, two courses of leuprorelin were administered in anticipation of tumor reduction and hypoperfusion, and the tumor size reduced remarkably. We demonstrated the utility of laparoscopic biopsy, considering its minimal invasiveness and diagnostic accuracy. Furthermore, the preoperative use of Gonadotropin-releasing hormone (GnRH) analogs to reduce surgical stress may be useful for treating cotyledonoid-dissecting leiomyomas.

Visualization of lignification in flax stem cell walls with novel click-compatible monolignol analogs.

Introduction: As an essential part of plant cell walls, lignin provides mechanical support for plant growth, enhances water transport, and helps to defend against pathogens. As the most abundant natural aromatic-based renewable resource on earth, its biosynthesis has always been a research focus, and it is still currently under study. Methods: In this study, the p-coumaryl alcohol analog (HALK) and the coniferyl alcohol analog (GALK) containing an alkyne group at the ortho position were synthesized and applied to lignification in vivo and in vitro. The incorporation of these novel lignin monomers was observed via fluorescence imaging. Results and Discussion: It was found that the two monolignol analogs could be incorporated in dehydrogenated polymers (DHPs) in vitro and in flax cell walls in vivo. The results showed that as the cultivation time and precursor concentration varied, the deposition of H and G-type lignin exhibited differences in deposition mode. At the subcellular scale, the deposited lignin first appears in the cell corner and the middle lamella, and then gradually appears on the cell walls. Furthermore, lignin was also found in bast fiber. It was demonstrated that these new molecules could provide high-resolution localization of lignin during polymerization.

Tailoring the Compositions and Nanostructures of Trimetallic Prussian Blue Analog-Derived Carbides for Water Oxidation.

The electrochemical splitting of water for hydrogen production faces a major challenge due to its anodic oxygen evolution reaction (OER), necessitating research on the rational design and facile synthesis of OER catalysts to enhance catalytic activity and stability. This study proposes a ligand-induced MOF-on-MOF approach to fabricate various trimetallic MnFeCo-based Prussian blue analog (PBA) nanostructures. The addition of [Fe(CN)6]3- transforms them from cuboids with protruding corners (MnFeCoPBA-I) to core-shell configurations (MnFeCoPBA-II), and finally to hollow structures (MnFeCoPBA-III). After pyrolysis at 800 °C, they are converted into corresponding PBA-derived carbon nanomaterials, featuring uniformly dispersed Mn2Co2C nanoparticles. A comparative analysis demonstrates that the Fe addition enhances catalytic activity, while Mn-doped materials exhibit excellent stability. Specifically, the optimized MnFeCoNC-I-800 demonstrates outstanding OER performance in 1.0 m KOH solution, with an overpotential of 318 mV at 10 mA cm-2, maintaining stability for up to 150 h. Theoretical calculations elucidate synergistic interactions between Fe dopants and the Mn2Co2C matrix, reducing barriers for oxygen intermediates and improving intrinsic OER activity. These findings offer valuable insights into the structure-morphology relationships of MOF precursors, advancing the development of highly active and stable MOF-derived OER catalysts for practical applications.

Step-By-Step Procedure to Identify Previously Unknown Compounds by LC-QTOF-MS Exemplified by an Intoxication With the Methaqualone Analog SL-164.

In September 2019, a 22-year-old man with a history of drug abuse presented to the hospital with altered mental status. Due to a suspected drug overdose, a blood sample taken on admission and a urine sample collected 30 h thereafter were submitted to our laboratory to test for illegal drugs, pharmaceutical substances, and designer drugs. During the routine toxicological analysis of the serum sample, morphine and phenobarbital were identified by liquid chromatography-quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS). Additionally, two compounds showing identical accurate masses and isotope ratios as the designer benzodiazepine diclazepam and the benzodiazepine lormetazepam were found. However, retention times differed significantly from the expected values, and the acquired MS/MS spectra did not match the library entries of the two compounds, indicating the presence of two previously unknown substances. After further investigation, SL-164 (5-chloro-3-(4-chloro-2-methylphenyl)-2-methyl-4(3H)-quinazolinone), a methaqualone analog, which has recently emerged on the research chemical market, and its hydroxy metabolite were tentatively identified by accurate mass, isotope matching, and plausible fragmentation. However, for unequivocal confirmation and quantification, a reference standard is required. As no reference material was available by the end of 2019, SL-164 was obtained from an online shop, and its identity and purity (97.8%) were confirmed by nuclear magnetic resonance spectroscopy. The subsequent quantitative analysis revealed a concentration of 390 ng/mL SL-164 in serum. In the urine sample, the parent compound was not detected, but three suspected monohydroxylated metabolites were found. This example shows that LC-QTOF-MS is a powerful approach for the (tentative) identification of unknown compounds in biological matrices.

Successful Administration of Kampo Medicine and Acupuncture Treatment to Improve Erythromelalgia: A Case Report.

Erythromelalgia is a rare disease characterized by a triad of recurrent burning pain, redness with pain, and hot flashes in the legs during attacks. We report the case of a 40-year-old woman who suffered from refractory erythromelalgia for 15 years and was successfully managed with Kampo medicine and acupuncture. Her pain was refractory to seven types of oral medications and intravenous lidocaine injections. Byakkokaninjinto was also administered for concomitant polydipsia in addition to acupuncture, unseiin, orengedokuto, and sokeikakketsuto. Because erythromelalgia has no established treatment, traditional Kampo medicine combined with acupuncture may help improve the quality of life of affected patients.

Snn and sound: a comprehensive review of spiking neural networks in sound.

The rapid advancement of AI and machine learning has significantly enhanced sound and acoustic recognition technologies, moving beyond traditional models to more sophisticated neural network-based methods. Among these, Spiking Neural Networks (SNNs) are particularly noteworthy. SNNs mimic biological neurons and operate on principles similar to the human brain, using analog computing mechanisms. This capability allows for efficient sound processing with low power consumption and minimal latency, ideal for real-time applications in embedded systems. This paper reviews recent developments in SNNs for sound recognition, underscoring their potential to overcome the limitations of digital computing and suggesting directions for future research. The unique attributes of SNNs could lead to breakthroughs in mimicking human auditory processing more closely.

Functional benefits of continuous vs. categorical listening strategies on the neural encoding and perception of noise-degraded speech.

Acoustic information in speech changes continuously, yet listeners form discrete perceptual categories to ease the demands of perception. Being a more continuous/gradient as opposed to a more discrete/categorical listener may be further advantageous for understanding speech in noise by increasing perceptual flexibility and resolving ambiguity. The degree to which a listener's responses to a continuum of speech sounds are categorical versus continuous can be quantified using visual analog scaling (VAS) during speech labeling tasks. Here, we recorded event-related brain potentials (ERPs) to vowels along an acoustic-phonetic continuum (/u/ to /a/) while listeners categorized phonemes in both clean and noise conditions. Behavior was assessed using standard two alternative forced choice (2AFC) and VAS paradigms to evaluate categorization under task structures that promote discrete vs. continuous hearing, respectively. Behaviorally, identification curves were steeper under 2AFC vs. VAS categorization but were relatively immune to noise, suggesting robust access to abstract, phonetic categories even under signal degradation. Behavioral slopes were correlated with listeners' QuickSIN scores; shallower slopes corresponded with better speech in noise performance, suggesting a perceptual advantage to noise degraded speech comprehension conferred by a more gradient listening strategy. At the neural level, P2 amplitudes and latencies of the ERPs were modulated by task and noise; VAS responses were larger and showed greater noise-related latency delays than 2AFC responses. More gradient responders had smaller shifts in ERP latency with noise, suggesting their neural encoding of speech was more resilient to noise degradation. Interestingly, source-resolved ERPs showed that more gradient listening was also correlated with stronger neural responses in left superior temporal gyrus. Our results demonstrate that listening strategy modulates the categorical organization of speech and behavioral success, with more continuous/gradient listening being advantageous to sentential speech in noise perception.

Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of "G-Date".

BACKGROUND: Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV. OBJECTIVE: This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors. METHODS: To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm's usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts. RESULTS: This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025. CONCLUSIONS: We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population.

Fluorofentanyl and Novel Synthetic Opioids in Accidental Overdose Deaths.

One of the quickest-growing subclasses of novel psychoactive substances is novel synthetic opioids (NSO), which are categorized as fentanyl analogs (fentalogs) or non-fentanyl opioids that bind to the mu-opioid receptor. Increased detections of NSO have been observed in the United States. However, limited information on their prevalence outside of the East Coast is available. This study details the prevalence of NSO, specifically fluorofentanyl, in the biological and drug paraphernalia specimens of accidental overdose deaths in San Francisco in 2022. A recently developed and validated LC-MS-MS method was utilized for the analysis of over 250 NSO. Out of the 649 accidental overdose deaths in 2022, 617 cases were available for blood analysis, with at least one NSO detected in 48 cases (7.8%). Fentalogs were detected in all 48 cases, with fluorofentanyl being detected in 40 cases. In postmortem femoral blood, estimated concentrations of fluorofentanyl ranged from 0.1 to 8.9 ng/mL, and 0.05 to 85 ng/mL in urine. Polysubstance use with NSO was seen with fentanyl (89.6%), methamphetamine (70.8%), cocaine (33.3%), and heroin (18.8%). NSO, mainly, fluorofentanyl were observed in matched drug paraphernalia. This report documents the migration of fluorofentanyl to the West Coast, specifically California.

Laparoscopic repair vs open repair for perforated peptic ulcers: Quality of life assessment.

PURPOSE: Studies reporting patient-centered outcomes, including quality of life and satisfaction, in perforated peptic ulcer (PPU) treatment are insufficient. This study was designed to assess the relative efficacy of laparoscopic repair (LR) as opposed to open surgical repair (OR) in the treatment of and its impact on quality of life. METHODS: This investigation performed a retrospective review of patients who underwent treatment for PPU at a secondary care hospital between January 2017 and April 2020. Patients were categorized into 2 separate groups according to the type of surgical procedure received: LR and OR. Comparisons were made based on a variety of factors, such as demographic data, intra- and postoperative metrics, pain control, patient contentment, and quality of life indicators. RESULTS: In the analysis, there were no statistically significant differences in demographic or clinical characteristics between the LR (n = 35) and OR (n = 62) groups (P > .05). Conversely, the rates of incisional hernia and surgical site infection were significantly greater in the OR group (P < .05). Moreover, the LR exhibited benefits such as a shorter length of hospital stay (P < .05), more rapid resumption of a normal diet, and fewer surgical site infections-factors that contributed to a lower rate of overall postoperative complications. According to the quality-of-life questionnaire, the LR group exhibited significantly greater scores for physical function, role, pain, and general health by the 30th postoperative day (P = .003, P < .001, P = .006, and P = .001, respectively), and by the 1-year follow-up, the LR group showed substantial improvements in physical function, physical role, emotional role, pain and general health (P = .047, P = .004, P = .039, P = .001, and P = .021, respectively), indicating its effectiveness in patient recovery and quality of life enhancement after surgery. CONCLUSION: This study showed that LR could provide certain benefits in managing PPUs, such as reduced lengths of hospital stay and lower incidences of surgical site infections. Although LR reported promising directions in patient satisfaction and quality of life indicators, the limited duration of postoperative monitoring necessitates caution in broadly applying these results.

A standardized Boswellia serrata extract shows improvements in knee osteoarthritis within five days-a double-blind, randomized, three-arm, parallel-group, multi-center, placebo-controlled trial.

Background: Boswellin® Super is a standardized extract of Boswellia serrata Roxb gum resin, standardized to contain 30% 3-acetyl-11-keto-ß-boswellic acid along with other ß-boswellic acids (BSE). A randomized, double-blind, placebo-controlled clinical trial was conducted at two doses of BSE to understand its safety and efficacy in supporting joint health and improving mobility and symptoms of osteoarthritis (OA) of the knee. Methods: Based on the inclusion/exclusion criteria, 105 newly diagnosed participants with degenerative hypertrophy OA were recruited and randomized into Placebo, BSE-150 mg or BSE-300 mg (n = 35 in each group) to receive either 150 mg or 300 mg BSE or a placebo tablet twice a day for 90 days. All the participants were evaluated for pain and physical function using the standard tools including the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne Functional Index (LFI), EuroQol- 5 Dimension (EQ-5D) quality of life, 6-min walk test at day 0, days 5, 30, 60 and 90 of treatment. Additionally, the circulating levels of inflammatory biomarkers, tumor necrosis factor-α (TNFα), high-sensitive C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were evaluated. Safety was evaluated by blood biochemical, hematological analysis, urinary analyses and by monitoring adverse events throughout the study. Results: Ninety-eight subjects completed the study. Improvements in pain scores were observed as early as 5 days after the start of the supplement in the BSE-150 and BSE-300 groups. By 90 days, the VAS pain score reduced by 45.3% and 61.9%, WOMAC- total score improved by 68.5% and 73.6% in the BSE-150 and BSE-300 groups respectively. WOMAC pain (70.2%, 73.9%, WOMAC stiffness (65.6%,68.9%), WOMAC function (68.8%,74.2%), LFI severity (50%,53.3%), decreased and EQ5D (56.9%, 62.9%) and distance walked in 6 minutes (21.2%, 21.9%) improved in the BSE-150 and BSE-300 groups in 90 days. Further, the levels of TNFα, hs-CRP, and IL-6 were found to decrease in the serum in BSE-supplemented participants. No significant adverse events were recorded during the study. Conclusion: The study confirms that Boswellin® Super can be used as a safe and effective supplement to support joint health and mobility in the management of osteoarthritis. Clinical Trial Registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzU2Nzc=&Enc=&userName=CTRI, identifier CTRI/2022/11/047397.

ß-d-N4-hydroxycytidine, a metabolite of molnupiravir, exhibits in vitro antiviral activity against rabies virus.

Rabies is a fatal neurological disorder caused by rabies virus (RABV) infection. Approximately 60,000 patients die from rabies annually, and there are no effective treatments for this disease. Nucleoside analogs are employed as antiviral drugs based on their broad antiviral spectrum, and certain nucleoside analogs have been reported to exhibit anti-RABV activity. The nucleoside analog ß-d-N4-hydroxycytidine (NHC) has antiviral effects against a range of RNA viruses. Molnupiravir (MPV), a prodrug of NHC, is clinically used as an oral antiviral drug for coronavirus infections. Despite its broad-spectrum activity, the antiviral activity of NHC against RABV remains unclear. In this study, we reveal that NHC exhibits comparable in vitro anti-RABV activity as ribavirin and favipiravir (also known as T-705) with a 90% effective concentration of 6 µM in mouse neuroblastoma cells. NHC reduced viral loads in neuronal and nonneuronal cells in a dose-dependent manner. Both laboratory and field RABVs (fixed and street strains, respectively) were susceptible to NHC. However, no increase in survival or reduction in viral titers in the brain was observed in RABV-infected mice treated prophylactically with MPV. These findings highlight the potential and challenges of NHC in the treatment of RABV infection.