Pediatric Anesthesia Exposure: Decoding Its Neurodevelopmental Implications and Navigating the Nuances.

General anesthesia is fundamental in pediatric medical interventions, but its potential neurodevelopmental impact on children has raised concerns, necessitating a thorough investigation. This systematic review aimed to assess the association between pediatric anesthesia exposure and neurodevelopmental outcomes, focusing on dosage effects and identifying high-risk groups. The study involved an extensive literature search across PubMed, Medline, and Google Scholar, selecting 40 relevant studies from an initial pool of 2,000, based on inclusion criteria that focused on children under 18 years exposed to anesthesia, excluding those with major comorbidities or perioperative physiological insults. It was observed that while a single exposure to anesthesia had minimal impact on general neurodevelopment, repeated or prolonged exposures posed greater concerns. Despite these findings, the study identified gaps in certain areas like adaptive behavior and sensory cognition due to limited data. The conclusion drawn is that although the evidence on anesthesia-induced neurotoxicity in children remains inconclusive, the implications of pediatric anesthesia exposure are significant enough to warrant careful consideration by healthcare professionals, who should balance the procedural benefits against the risks. This study also calls for future research to standardize methodologies and employ consistent, validated neurodevelopmental measurement tools.

Barriers Preventing Medical Trainees from Active Participation in Research Activities.

Background: Research has increasingly become important to career progression and a compulsory component in most medical programs. While medical trainees are consistently urged to undertake research endeavors, they frequently encounter obstacles at both personal and organizational levels that impede the pursuit of high-quality research. This study aims to identify the barriers and recommend successful interventions to increase research productivity amongst medical trainees. Methods: A descriptive cross-sectional survey was carried out among interns, residents, and fellows within a single hospital located in the emirate of Abu Dhabi, UAE. The survey included inquiries regarding perceived obstacles hindering engagement in research activities, factors driving motivation for research involvement, and the assessment of how research participation relates to their job in terms of relevance. Results: Fifty-seven medical trainees participated in the survey, reflecting a response rate of 53%. The survey highlighted common obstacles, notably including time constraints, insufficient statistical and methodology training, the weight of other educational commitments, as well as inadequate incentives and rewards. While a majority of participants expressed interest in engaging in research activities, the consensus was that more incentives and increased funding opportunities would significantly encourage their involvement. Conclusion: Implementing successful interventions such as allocating dedicated time for research, facilitating access to research mentors, and organizing training sessions have the potential to be effective strategies in fostering a thriving research culture and subsequently elevating research productivity of medical trainees.

Factors Associated with Health-Related Quality of Life Among Breast Cancer Survivors in Saudi Arabia: Cross-Sectional Study.

BACKGROUND: Assessment of health-related quality of life (HRQOL) is a major concern among breast cancer survivors. Little is known about HRQO and its determinants in Saudi women with breast cancer (BC). This study aimed to describe the HRQOL of Saudi women with breast cancer and the association between HRQO and sociodemographic and clinical variables. METHODS: This cross-sectional study involved 147 BC participants who completed the 36-item Short Form Health Survey (SF-36). Multivariable linear logistic regression analysis was conducted to determine factors associated with HRQOL. RESULTS: For the physical component scale, general health scored the highest (55.41±17.99) while, role physical function scored the lowest (48.61±22.51). The mean scores in the mental component were higher for social function (56.91±20.84), while the lowest score was observed for energy and vitality (49.62±20.84). Significant differences were observed in many SF-36 domains across the sociodemographic and clinical variables. Older age, having had a mastectomy as well as comorbid conditions, and receiving chemotherapy and hormonal therapy were associated with decreased HRQOL. However, being physically active, employed, and having more education were associated with higher HRQOL. CONCLUSION: HRQOL is generally poor among breast cancer survivors in Saudi Arabia, depending on a variety of factors. These findings highlight the need for routine QOL assessment. Furthermore, recognizing these predictors may play a key role in maximizing HRQOL for breast cancer participants.

Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study.

BACKGROUND: The use of Point-of-Care Ultrasound (POCUS) has become prevalent across a variety of clinical settings. Many healthcare professionals have started getting hands-on training. To evaluate the effectiveness of such training programs, this study aimed to assess a 4 day POCUS training course on healthcare providers' skills and knowledge acquisition. A secondary objective of this study is to gain valuable insights into the degree of perception, attitude, interest levels and perceived barriers of medical providers performing POCUS. METHODS: This is a prospective cohort study performed on healthcare providers in an integrated healthcare facility in Abu Dhabi undergoing the POCUS training course in February 2022. Course participants took a pre-course survey to evaluate their baseline knowledge, skills, confidence, perception, and interest in POCUS. The same survey was repeated immediately post-course. In total, seven healthcare professionals responded to the survey with a response rate of 53.8%. All data and information gathered were used to understand the effectiveness of POCUS training and gain insights into the degree of perception, interest and preparedness of POCUS among healthcare professionals in practice. RESULTS: Our results demonstrated that the brief POCUS course was effective in improving POCUS skills, knowledge and confidence amongst in-practice healthcare providers from varying medical specialties. The median skill score increased from 25% pre-course to 50% post-course. There is a notable increase in all skills scores after the POCUS training course with the greatest change in scores seen for adjusting 'gain and depth of image (54.84%), assessing VeXUS score (52.38%) and evaluating lung congestion (50%). The study also provided valuable insights into the perception, attitude, interest and potential barriers of POCUS implementation. Although significant barriers to POCUS are present including the lack of POCUS curriculum, what is challenging is lack of expertise and skills to perform POCUS. Therefore, medical providers must acquire prespecified skills to fully utilize POCUS effectively. CONCLUSION: The study confirmed the effectiveness of short POCUS training in improving the skills, knowledge and confidence of medical providers in practice. Healthcare professionals can master POCUS skills and techniques and gain confidence through brief training courses.

30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study.

OBJECTIVE: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. SUMMARY BACKGROUND DATA: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. METHODS: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. RESULTS: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. CONCLUSION: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.

Biochemical Profiling and Physicochemical and Biological Valorization of Iraqi Honey: A Comprehensive Analysis.

Our study aimed to analyze five monovarietal honeys from the Salah Eddine region in Iraq, focusing on physicochemical, antioxidant, and antimicrobial properties and polyphenolic compounds. Our objective was to evaluate the strengths and qualities of Iraqi honeys, ensuring compliance with the Codex Alimentarius standard for honey. The spectrophotometric analysis included assessments of reduced sugar (75.8-77.7%), fructose-to-glucose ratio (0.7-0.9%), sucrose (2.2-2.9%), HMF (17.23-18.87 mg/kg), and melanoidin content (0.25-0.44), which were all determined. The electrical conductivity (0.39-0.46 mS/cm) using a conductivity meter, pH (4.02-4.31), and mineral composition were determined in all samples using atomic absorption spectrometry. Antioxidant activities were spectrophotometrically determined, through DPPH free radical scavenging (7.87-95.62 mg/mL), as was the total antioxidant activity (14.26-22.15 mg AAE/g), with correlations established with biochemical constituents such as the total phenol content, highlighting the significant presence of Coumaric acid (0.38-2.34 µg/mL), Catechin (1.80-2.68 µg/mL), and Quercetin (0.30 µg/mL) using HPLC. The study also observed notable antimicrobial activities using Escherichia coli, Staphylococcus aureus, and Candida albicans on Mueller-Hinton agar as well as through diffusion technique. In conclusion, our findings, including the antioxidant and antimicrobial strengths, underscore the substantial potential of Iraqi honeys in mitigating damage and preventing the onset of various diseases, affirming their good quality and adherence to international honey standards.

Psychometric Properties and Factorial Analysis of the Arabic McGill-QoL Questionnaire in Breast Cancer.

Purpose: This study aimed to assess the psychometric properties of the Arabic McGill Quality of Life Questionnaire-Revised (MQOL-R) in breast cancer survivors. Patients and Methods: One-hundred-forty breast cancer survivors were recruited and completed the questionnaire. The construct validity was assessed using confirmatory factor analysis (CFA). MQOL-R scores were correlated with Global Health Status/QoL and functional subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for convergent validity. Reliability was estimated using Cronbach's alpha and intraclass correlation coefficients (ICC). Results: CFA reproduced a four-factor model (ie, physical, psychological, existential, and social) with good fit indices (comparative fitting index = 0.980; root mean square error of approximation = 0.091), with all items significantly loading on their respective subscales. The total MQOL-R scores were correlated with the global health status/QoL and functional subscales of the EORTC QLQ-C30 (r = -0.172, P < 0.01). Known-group validity was proven by different MQOL-R scores according to functional status (50.62 ± 6.35 vs 45.98 ± 7.19, P < 0.01). Reliability was supported by good internal consistency and high test-retest correlation coefficients for the Arabic MQOL-R and its subscales (ICC range, 0.83-0.95). Conclusion: The Arabic MQOL-R demonstrated adequate construct validity, factor structure, excellent test-retest reliability, and good internal consistency. This tool is valuable for assessing the quality of life in research and physical therapy rehabilitation settings among Arabic-speaking breast cancer survivors.

A decade in focus: mixed germ cell tumors with choriocarcinoma components.

Introduction: This 10-year registry review aimed to investigate the clinical behaviour and outcomes of mixed germ cell tumours with choriocarcinoma components, a rare and aggressive subtype of testicular cancer, in Saudi Arabia. The study explores the demographic characteristics of affected patients, tumour profiles, and the mortality rate associated with this malignancy. Methods: Utilizing data from the Saudi Cancer Registry, the authors identified 33 cases of mixed germ cell tumours with choriocarcinoma components among 1001 testicular cancer cases recorded between 2008 and 2017. Demographic information, including age, marital status, region of residency, year of diagnosis, and 10-year survival status, were collected. Tumour factors, such as the basis of diagnosis, origin site, behaviour, grade, extension, and laterality, were also analyzed. Results: The majority of cases (78.8%) occurred in the young age group (18-45 years), and most tumours (97%) originated in normally descended testes. Grade IV (undifferentiated anaplastic) tumours and distant metastasis were present in 45.5% of patients. All cases exhibited malignant tumour behaviour. The overall mortality rate was 15%, with a mean time from diagnosis to death of 7.72 months (range: 0.5-21.5 months). Conclusion: Mixed germ cell tumours with choriocarcinoma components are rare and tend to affect younger populations. These tumours demonstrate aggressive clinical behaviour, with a significant proportion presenting with high-grade lesions and metastasis at diagnosis. The observed mortality rate underscores the poor prognosis associated with this malignancy. Our study provides essential insights into the clinical characteristics of this rare tumour subtype in the Saudi Arabian population, emphasizing the need for further research to identify prognostic factors and optimize management strategies for affected patients.

Filaggrin gene variants among Saudi patients with ichthyosis vulgaris.

Ichthyoses are a heterogeneous group of cornification disorders. The most common form of ichthyoses is ichthyosis vulgaris (IV) ([OMIM] #146,700), which can be inherited as autosomal semi-dominant mutation in the filaggrin gene (FLG). We present the findings of a study involving 35 Saudi patients with a clinical diagnosis of ichthyosis vulgaris. For identifying the pathogenic mutation of their disease, we used Sanger sequencing analysis of the extracted DNA samples. We also identified the underlying 22 FLG variants, which have been seen before. However, the detected mutations do not involve the common p.R501* c. 2282del4 mutations reported in European populations. Indeed, we did not identify any statistical influence of the homozygous or heterozygous genotypes on the phenotype severity of the disease.

Atherosclerosis Potential Drug Targets: Current Scenario and Future Perspectives.

BACKGROUND: The global burden of atherosclerosis and its implication to cause coronary heart disease and ischemic cardiac problems is the most prevalent cause of morbidity and hospitalization. In the US, there has been an increase in the number of patients with cardiac problems in the last decade, and still remains the primary cause of death in Europe as well as in the US. OBJECTIVES: Even though therapeutic interventions and early diagnosis the formation of the fatty lesion and its subsequent steps are possible, the therapeutic management of the disease remains questionable when clinical data is observed. There is still scope for proper target identification and biomarker recognition, which can serve as a baseline to develop efficient pharmacological agent and delivery systems so that the disease incidence and prevalence can be controlled. The present article highlights the current pathophysiological state of the disease and emerging strategies that are applied to manage the disease. FINDINGS: This article gives an insight into the limitations of various conventionally used therapeutic agents for disease treatment. The emerging strategies that could prove efficacious in disease treatment. This article also gives an insight into current discoveries in the field of cellular and molecular biology, such as the genetic role in causing dyslipidemia and the role of immune cells and the role of non-coding small RNA, which can set the future direction to develop therapeutics interventions for atherosclerosis.

QbD Design, Formulation, Optimization and Evaluation of Trans-Tympanic Reverse Gelatination Gel of Norfloxacin: Investigating Gene-Gene Interactions to Enhance Therapeutic Efficacy.

Traditional otic drug delivery methods lack controlled release capabilities, making reverse gelatination gels a promising alternative. Reverse gelatination gels are colloidal systems that transition from a sol to a gel phase at the target site, providing controlled drug release over an extended period. Thermosensitive norfloxacin reverse gelatination gels were developed using a Quality by Design (QbD)-based optimization approach. The formulations were evaluated for their in vitro release profile, rheological behavior, visual appearance, pH, gelling time, and sol-gel transition temperature. The results show that the gelation temperatures of the formulations ranged from 33 to 37 °C, with gelling durations between 35 and 90 s. The drug content in the formulations was uniform, with entrapment efficiency ranging from 55% to 95%. Among the formulations, F10 exhibited the most favorable properties and was selected for a stability study lasting 60 days. Ex-vivo release data demonstrate that the F10 formulation achieved 95.6percentage of drug release at 360 min. This study successfully developed thermosensitive norfloxacin reverse gelatination gels using a QbD-based optimization approach. The selected formulation, F10, exhibited desirable properties in terms of gelling temperature, drug content, and release profile. These gels hold potential for the controlled delivery of norfloxacin in the treatment of ear infections.

Leveraging artificial intelligence and decision support systems in hospital-acquired pressure injuries prediction: A comprehensive review.

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) constitute a significant challenge harming thousands of people worldwide yearly. While various tools and methods are used to identify pressure injuries, artificial intelligence (AI) and decision support systems (DSS) can help to reduce HAPIs risks by proactively identifying patients at risk and preventing them before harming patients. OBJECTIVE: This paper comprehensively reviews AI and DSS applications for HAPIs prediction using Electronic Health Records (EHR), including a systematic literature review and bibliometric analysis. METHODS: A systematic literature review was conducted through PRISMA and bibliometric analysis. In February 2023, the search was performed using four electronic databases: SCOPIS, PubMed, EBSCO, and PMCID. Articles on using AI and DSS in the management of PIs were included. RESULTS: The search approach yielded 319 articles, 39 of which have been included and classified into 27 AI-related and 12 DSS-related categories. The years of publication varied from 2006 to 2023, with 40% of the studies taking place in the US. Most studies focused on using AI algorithms or DSS for HAPIs prediction in inpatient units using various types of data such as electronic health records, PI assessment scales, and expert knowledge-based and environmental data to identify the risk factors associated with HAPIs development. CONCLUSIONS: There is insufficient evidence in the existing literature concerning the real impact of AI or DSS on making decisions for HAPIs treatment or prevention. Most studies reviewed are solely hypothetical and retrospective prediction models, with no actual application in healthcare settings. The accuracy rates, prediction results, and intervention procedures suggested based on the prediction, on the other hand, should inspire researchers to combine both approaches with larger-scale data to bring a new venue for HAPIs prevention and to investigate and adopt the suggested solutions to the existing gaps in AI and DSS prediction methods.

Blockchain and COVID-19 pandemic: applications and challenges.

The year 2020 has witnessed the emergence of coronavirus (COVID-19) that has rapidly spread and adversely affected the global economy, health, and human lives. The COVID-19 pandemic has exposed the limitations of existing healthcare systems regarding their inadequacy to timely and efficiently handle public health emergencies. A large portion of today's healthcare systems are centralized and fall short in providing necessary information security and privacy, data immutability, transparency, and traceability features to detect fraud related to COVID-19 vaccination certification, and anti-body testing. Blockchain technology can assist in combating the COVID-19 pandemic by ensuring safe and reliable medical supplies, accurate identification of virus hot spots, and establishing data provenance to verify the genuineness of personal protective equipment. This paper discusses the potential blockchain applications for the COVID-19 pandemic. It presents the high-level design of three blockchain-based systems to enable governments and medical professionals to efficiently handle health emergencies caused by COVID-19. It discusses the important ongoing blockchain-based research projects, use cases, and case studies to demonstrate the adoption of blockchain technology for COVID-19. Finally, it identifies and discusses future research challenges, along with their key causes and guidelines.

Association between non-communicable diseases and physical activity level in older adults visiting primary health care centers in Jizan, Saudi Arabia.

OBJECTIVES: To examine the association between the number of non-communicable diseases (NCDs) and physical activity (PA) in older adults visiting primary healthcare centers (PHCCs) in Jizan, Saudi Arabia. METHODS: This cross-sectional study was carried out on men and women aged ≥60 who visited PHCCs, Jizan City between June and September 2021. Eleven self-reported NCDs were identified and summed to produce a single score, and PA scores were calculated based on the self-reported PA Scale for the Elderly (PASE). Multiple linear regression models were used to examine the association between the number of NCDs and PA in the included population. RESULTS: In total, 94 participants were included in this study. Of these, 62 were men, and 32 were women. The mean age was 67.29±6.58 years, and the mean PASE score was 53.67±29.72. A significant negative association was found between the number of NCDs and PA, even after a fully adjusted analysis. CONCLUSION: This study found a significant inverse association between the number of NCDs and PA in older adults. In addition, age was associated with lower PA, even among older adults. PA should be recommended to older adults to prevent or reduce the number of NCDs. Future research should focus on examining cause-and-effect associations at a national level.

Cross-cultural adaptation and validation of the Arabic version of McGill quality of life: revised questionnaire in the patients with cancer.

PURPOSE: The aims of this study were to translate and culturally adapt the McGill Quality of Life Questionnaire-revised (MQOL-R) to modern standard Arabic and to examine its reliability, construct, and discriminative validity in Arab patients with cancer. MATERIALS AND METHODS: Translation and cultural adaptation of the English MQOL-R to modern standard Arabic were performed according to international guidelines. For psychometric evaluation, 125 participants with cancer were selected and completed the MQOL-R along with Global Health Status/QoL and functional subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and Eastern Cooperative Oncology Group performance status rating (ECOG-PS). The MQOL-R was tested for internal consistency, test-retest reliability, and construct validity. RESULTS: The Arabic MQOL-R questionnaire had adequate internal consistency with Cronbach's alphas between 0.75 and 0.91. Test-retest reliability was very strong (ICC2.1 =0.91 to 0.96, p < 0.001). As hypothesized, the Arabic MQOL-R subscales demonstrated moderate to excellent correlation with functional subscales of EORTC QLQ-C30, and moderate to good correlation with Global health status/QoL. CONCLUSION: The Arabic MQOL-R Questionnaire has adequate psychometric properties. Hence, it can be utilized in rehabilitation settings and research to measure health-related quality of life in the Arabic-speaking cancer population.IMPLICATIONS FOR REHABILITATIONThe Arabic version of McGill Quality of Life- Revised Questionnaire (MQOL-R) has been successfully translated, adapted, and validated into Modern Standard Arabic language.The Arabic MQOL-R is reliable and valid for measuring health-related quality of life in the Arabic-speaking cancer population.The Arabic MQOL-R can be used for clinical, rehabilitation and research purposes to evaluate the health-related quality of life in the Arabic-speaking cancer population.

Characteristics and Management of Pediatric Benign Intraosseous Mandibular Tumors: A 10-Years Prospective Study.

Background: The management of intraosseous mandibular tumors in children is challenging. This study investigated clinical and pathological characteristics, surgical treatment, and outcome of pediatric benign intraosseous mandibular tumors. Materials and Methods: A prospective study included patients under 18 years presenting with benign intraosseous mandibular tumors that were surgically managed. Clinical and surgical data were collected and statistically analyzed. Results: The study included 84 patients (38 males and 46 females): 66.7% had non-odontogenic tumors and 33.3% had odontogenic tumors. The most common non-odontogenic tumors were central giant cell granulomas (31%). The most common odontogenic tumors were odontomas (9.5%). Conservative surgery and radical resection were performed equally. Curettage was the commonest treatment modality (27.4%). Fifty percentage of cases required reconstruction, which was done by costochondral rib graft (42.9%) and free fibula flap (7.1%). One patient had recurrence. All cases got good functional and aesthetic results. Conclusion: Non-odontogenic tumors were more common than odontogenic tumors. Central giant cell granulomas were the most common non-odontogenic tumors, while odontomas were the most common odontogenic tumors. Treatment depended on type, size, and aggressiveness. Pediatric mandibular reconstruction with costochondral rib grafts was simple and satisfactory. Microsurgical reconstruction had high success rates. Appropriate management achieved good aesthetic and functional outcomes.

Measurement properties of the Arabic version of the pediatric functional assessment of chronic illness therapy-fatigue in children with cancer.

BACKGROUND: The pediatric Functional Assessment of Chronic Illness Therapy-Fatigue (PedsFACIT-F) measures fatigue in various clinical settings. OBJECTIVE: To verify the measurement properties of the Arabic version (PedsFACIT-F-Ar) in patients with cancer. METHODS: In this cross-sectional validation study, the PedsFACIT-F and the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) were administered to 114 participants (74 boys and 40 girls) aged 8-18. Exploratory factor analysis was used to test the structural validity of PedsFACIT-F-Ar. Its construct validity was investigated using the hypothesis testing method to predict a moderate correlation (rho ⩾ 0.4) with the PedsQL-MFS domains and the total score. Its reliability was also tested. RESULTS: The PedsFACIT-F-Ar is a two-factor model that explains 67.38% of the total variance. It is significantly correlated with PedsQL-MFS (rho > 0.84). It displayed excellent internal consistency (Cronbach's α= 0.93) and test-retest reliability (ICC2.1= 0.99; 95% CI: 0.96-0.99). Bland-Altman's analysis revealed the absence of a systematic error between the two test sessions. The standard error of measurement, minimal detectable change (MDC95), and MDC% were 0.92, 2.56 points, and 2.88%, respectively, with no floor or ceiling effects. CONCLUSIONS: The PedsFACIT-F-Ar demonstrated excellent psychometric properties. The findings suggest the clinical usefulness of this scale.

Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results.

BACKGROUND: Bile duct injury (BDI) is one of the serious complications of cholecystectomy procedures, which has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigation. The standard treatment of major BDI is hepaticojejunostomy (HJ). Surgical outcomes depend on many factors, including the severity of the injury, the surgeons' experiences, the patient's condition, and the reconstruction time. The authors aimed to assess the impact of reconstruction time and abdominal sepsis control on the reconstruction success rate. METHODS: This is a multicenter, multi-arm, parallel-group, randomized trial that included all consecutive patients treated with HJ for major post-cholecystectomy BDI from February 2014 to January 2022. Patients were randomized according to the time of reconstruction by HJ and abdominal sepsis control into group A (early reconstruction without sepsis control), group B (early reconstruction with sepsis control), and group C (delayed reconstruction). The primary outcome was successful reconstruction rate, while blood loss, HJ diameter, operative time, drainage amount, drain and stent duration, postoperative liver function tests, morbidity and mortality, number of admissions and interventions, hospital stay, total cost, and patient QoL were considered secondary outcomes. RESULTS: Three hundred twenty one patients from three centres were randomized into three groups. Forty-four patients were excluded from the analysis, leaving 277 patients for intention to treat analysis. With univariate analysis, older age, male gender, laparoscopic cholecystectomy, conversion to open cholecystectomy, failure of intraoperative BDI recognition, Strasberg E4 classification, uncontrolled abdominal sepsis, secondary repair, end-to-side anastomosis, diameter of HJ (< 8 mm), non-stented anastomosis, and major complications were risk factors for successful reconstruction. With multivariate analysis, conversion to open cholecystectomy, uncontrolled sepsis, secondary repair, the small diameter of HJ, and non-stented anastomosis were the independent risk factors for the successful reconstruction. Also, group B patients showed decreased admission and intervention rates, decreased hospital stay, decreased total cost, and early improved patient QoL. CONCLUSION: Early reconstruction after abdominal sepsis control can be done safely at any time with comparable results for delayed reconstruction in addition to decreased total cost and improved patient QoL.

Graphene Nanoribbon Field Effect Transistor Simulations for the Detection of Sugar Molecules: Semi-Empirical Modeling.

Graphene has remarkable characteristics that make it a potential candidate for optoelectronics and electronics applications. Graphene is a sensitive material that reacts to any physical variation in its environment. Due to its extremely low intrinsic electrical noise, graphene can detect even a single molecule in its proximity. This feature makes graphene a potential candidate for identifying a wide range of organic and inorganic compounds. Graphene and its derivatives are considered one of the best materials to detect sugar molecules due to their electronic properties. Graphene has low intrinsic noise, making it an ideal membrane for detecting low concentrations of sugar molecules. In this work, a graphene nanoribbon field effect transistor (GNR-FET) is designed and utilized to identify sugar molecules such as fructose, xylose, and glucose. The variation in the current of the GNR-FET in the presence of each of the sugar molecules is utilized as the detection signal. The designed GNR-FET shows a clear change in the device density of states, transmission spectrum, and current in the presence of each of the sugar molecules. The simulated sensor is made of a pair of metallic zigzag graphene nanoribbons (ZGNR) joint via a channel of armchair graphene nanoribbon (AGNR) and a gate. The Quantumwise Atomistix Toolkit (ATK) is used to design and conduct the nanoscale simulations of the GNR-FET. Semi-empirical modeling, along with non-equilibrium Green's functional theory (SE + NEGF), is used to develop and study the designed sensor. This article suggests that the designed GNR transistor has the potential to identify each of the sugar molecules in real time with high accuracy.

Early Postoperative Computed Tomography Scan Air Distribution Predicts Postoperative CSF Leak in Endoscopic Skull Base Surgery.

BACKGROUND: Cerebrospinal fluid (CSF) leak remains the primary concern of endoscopic skull base surgery (ESBS). Pneumocephalus seen in postoperative images has been linked to CSF leak in some reports; however, few studies have looked at the extent to which it is indicative of CSF leak. In the current study, we aim to examine the size and location of post-ESBS pneumocephalus in the early postoperative period and determine their association with postoperative CSF leak. METHODS: Patients undergoing ESBS in a 5-year period were included. All patients underwent brain computed tomography scan within the first 24 postoperative hours. Computed tomography scans were reviewed by a neurosurgeon and a radiologist and have been classified based on the size and location of pneumocephalus. Patients were followed in the postoperative period for clinical signs of CSF leak and managed accordingly. RESULTS: Out of 120 patients, 86 patients met the inclusion criteria. Thirty-five patients (41%) had no pneumocephalus on day one postoperative imaging, while 51 patients (59%) had pneumocephalus with different sizes and distributions. Eleven of 86 patients developed CSF leak. Of the 11 patients, 5 patients (45%) had grade 4 pneumocephalus (P value = 0.02). Patients with multiple locations of pneumocephalus were more likely to develop CSF leak (P value = 0.01). CONCLUSIONS: In post-ESBS patients, both the volume and location of the pneumocephalus are potentially predictive of CSF leak. In patients with a larger volume of intra-axial air and/or multiple air locations, an impending CSF leak should be anticipated.