Search Results (111)

Background: Percutaneous vertebroplasty (PVP) is often performed under monitored anesthesia care (MAC) using a combination of propofol and remifentanil. However, the effects of different remifentanil effect-site concentrations (Ce) combined with propofol on perioperative outcomes in this procedure have not been reported. Methods: In this prospective, randomized controlled study, 80 patients scheduled for single-level PVP under MAC were enrolled. Participants were randomly assigned to receive propofol (Ce: 2.0 mcg/mL) combined with either a low (1.0 ng/mL; Group 1) or high (2.0 ng/mL; Group 2) remifentanil Ce. The primary outcome was the incidence of intraoperative patient movement; secondary outcomes included hemodynamic stability, perioperative adverse events, anesthetic consumption, frequency of dose adjustments, postoperative recovery, and anesthesia satisfaction. Results: Group 2 exhibited significantly fewer episodes of patient movement during the procedure and better intraoperative hemodynamic stability. Additionally, fewer upward adjustments in remifentanil infusion were observed in Group 2. Although the total propofol consumption was similar between the groups, Group 2 required a significantly lower propofol Ce to achieve adequate sedation. Surgeon satisfaction with anesthesia was also significantly higher in Group 2. Conclusions: Using a higher remifentanil Ce (2.0 ng/mL) in combination with propofol during PVP under MAC reduces patient movement and improves intraoperative hemodynamic stability without increasing adverse events. This regimen may thereby enhance procedural efficiency and surgeon satisfaction during vertebral interventions. Full article

Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, dσ*/dt_max, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to assess if dσ*/dt_max could predict adverse outcomes in patients with severe mitral regurgitation (MR). Methodology: We studied dσ*/dt_max in a cohort of 127 patients with isolated severe primary MR and preserved LVEF ≥ 60%. Patients with prior valvular intervention or concurrent valvular disease were excluded. We tested dσ*/dt_max against a composite of adverse outcomes including all-cause mortality, heart failure hospitalization, and mitral valve intervention. Results: The cohort had a mean age of 58 years old and was predominantly male. Of the 127 patients, eight (6.3%) needed subsequent hospitalization for heart failure, while 30 (23.6%) and 11 (8.7%) patients underwent mitral valve repair and replacement, respectively, And 14 (11.0%) passed away. Of the patients (n = 54 (42.5%)) who had an adverse outcome during follow-up, dσ*/dt_max demonstrated an independent association with composite adverse outcome, including its individual components. On ROC analysis, a cut-off of 2.15 s⁻¹ was identified. Based on this cut-off, dσ*/dt_max retained an independent association with composite adverse outcome after adjusting for covariates including age, sex, ischemic heart disease, pulmonary artery systolic pressure, and left ventricular end systolic diameter. Conclusions: In patients with severe primary MR and preserved LVEF, reduced dσ*/dt_max was an independent predictor of adverse outcomes. It can be a useful addition to the armamentarium for assessing patients with severe MR. Full article

Background: Previous studies have shown that ventilation strategies used in general anesthesia influence perioperative outcomes of video-assisted thoracoscopic surgery (VATS). This study investigated the perioperative effects of non-intubated anesthesia (NIA) versus intubated anesthesia (IA) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing VATS. Methods: This retrospective cohort study analyzed patients who underwent elective VATS for early-stage NSCLC between January 2015 and December 2022. Patients were categorized into the NIA and IA groups based on the ventilation strategies during general anesthesia. Comprehensive outcome data, including intraoperative and postoperative variables, were compared between the two groups. Univariate and multivariate logistic regression models were used to assess the odds ratios for conversion from NIA to IA. Results: A total of 372 patients who received NIA and 1560 who received IA for VATS were eligible for analysis. After propensity score matching, 336 patients were included in each group. In the matched analysis, patients who received NIA demonstrated favorable perioperative outcomes, including reduced opioid consumption, lower postoperative complication rates, and shorter hospital stays, compared to those who received IA. Additionally, patients with a lower baseline oxygen saturation and those who experienced intraoperative pulmonary and cardiovascular adverse events had a higher risk of conversion from NIA to IA. Conclusions: NIA during VATS in patients with early-stage NSCLC was associated with superior perioperative outcomes. Prospective studies are warranted to further evaluate the impact of NIA on perioperative outcomes in this patient population. Full article

Task-oriented grasp planning poses complex challenges in modern robotics, requiring the precise determination of the grasping pose of a robotic arm to grasp objects with a high level of manipulability while avoiding hardware constraints, such as joint limits, joint over-speeds, and singularities. This paper introduces a novel manipulability-aware (M-aware) grasp planning and motion control system for seven-degree-of-freedom (7-DoF) redundant dual-arm robots to achieve task-oriented grasping with optimal manipulability. The proposed system consists of two subsystems: (1) M-aware grasp planning; and (2) M-aware motion control. The former predicts task-oriented grasp candidates from an RGB-D image and selects the best grasping pose among the candidates. The latter enables the robot to select an appropriate arm to perform the grasping task while maintaining a high level of manipulability. To achieve this goal, we propose a new manipulability evaluation function to evaluate the manipulability score (M-score) of a given robot arm configuration with respect to a desired grasping pose to ensure safe grasping actions and avoid its joint limits and singularities. Experimental results demonstrate that our system can autonomously detect the graspable areas of a target object, select an appropriate grasping pose, grasp the target with a high level of manipulability, and achieve an average success rate of about 98.6%. Full article

A 40-year-old woman who had obstetric history of one vaginal delivery and two surgical abortions to terminate early pregnancy received regular prenatal care without any systemic maternal diseases. During the detailed second trimester ultrasound, a homogenous adhesion-induced pseudocystic lesion of 8.6 × 7.4 cm was found between the inlet of the endocervix and the uterine cavity in the lower segment of the uterus. There was a clear septum with an inlet of about 2.6 cm near the right lower segment of the uterus. Transvaginal sonography showed a cervical length of 3.29 cm without dilatation. No gross fetal anomalies were found. Sometimes, the fetal head or limbs moved into this cystic space. At 36 3/7 weeks of gestation, a cesarean section was arranged for fetal breech presentation and pre-labor rupture of the membrane. After the delivery of the baby and its placenta, there was no obvious septum in the uterine cavity but only a very short fibrous tissue from the posterior wall of uterus, which could be destroyed when the baby was delivered. No adverse outcomes for the mother or the neonate were observed. Full article

Alzheimer’s disease (AD), a leading neurodegenerative disorder, is closely associated with the accumulation of amyloid-beta (Aβ) peptides in the brain. The enzyme β-secretase (BACE1), pivotal in Aβ production, represents a promising therapeutic target for AD. While bioactive peptides derived from food protein hydrolysates have neuroprotective properties, their inhibitory effects on BACE1 remain largely unexplored. In this study, we evaluated the inhibitory potential of protein hydrolysates from gliadin, whey, and casein proteins prepared using bromelain, papain, and thermolysin. Through in vitro and cellular assays, bromelain-hydrolyzed gliadin (G-Bro) emerged as the most potent BACE1 inhibitor, with an IC₅₀ of 0.408 mg/mL. G-Bro significantly reduced BACE1 expression and amyloid precursor protein (APP) processing in N2a/PS/APP cell cultures, suggesting its potential to attenuate Aβ aggregation. The unique peptide profile of G-Bro likely contributes to its inhibitory effect, with proline residues disrupting β-sheets, lysine residues introducing positive charges that hinder aggregation, hydrophobic residues stabilizing binding interactions, and glutamine residues enhancing solubility and stability. These findings highlight gliadin hydrolysates, particularly G-Bro, as potential natural BACE1 inhibitors with applications in dietary interventions for AD prevention. However, further studies are warranted to elucidate specific peptide interactions and their bioactivity in neural pathways to better understand their therapeutic potential. Full article

Background: The COVID-19 pandemic has substantially impacted healthcare systems and obstetric practices worldwide. Labor induction is a common procedure for preventing obstetric complications in high-risk populations. This study evaluated perinatal outcomes of labor induction using a modified management protocol in a tertiary care center during the COVID-19 pandemic. Methods: We conducted a retrospective study by reviewing electronic structured delivery records of women who underwent elective labor induction between June 2020 and October 2022. We analyzed maternal characteristics, maternal outcomes, and neonatal outcomes during the pre-pandemic (June 2020 to May 2021) and pandemic periods (May 2021 to October 2022). Results: The study included 976 cases: 325 pregnancies in the pre-pandemic group and 651 in the pandemic group. The pandemic group showed earlier gestational age at delivery (39 vs. 40 weeks, p < 0.01) and lower body mass index (27.1 vs. 27.5 kg/m², p = 0.03). During the pandemic period, we observed a significant increase in labor induction cases and a decrease in cesarean sections. Neonatal outcomes, including Apgar scores and intensive care admissions, showed no significant differences between groups. Subgroup analysis identified advanced maternal age (OR = 1.08; 95% CI = 1.03–1.14; p < 0.01) and primiparity (OR = 5.24; 95% CI = 2.75–9.99; p < 0.01) as independent risk factors for cesarean delivery. Conclusions: Even under modified protocols for labor induction during the COVID-19 pandemic, more pregnancies underwent labor induction while achieving a significant reduction in cesarean sections. Advanced maternal age and primiparity were identified as independent risk factors associated with cesarean delivery. Full article

The emergence of endometriosis-associated clear cell carcinoma (CCC) within the abdominal wall is a notably rare phenomenon. This condition predominantly impacts females who have previously undergone surgical interventions, including hysterectomy or caesarean section (C-section), with the malignant transformation of endometriosis within the post-surgical abdominal scar posited as a likely mechanism. Herein, we delineate a distinctive case of endometriosis-associated CCC emanating from the abdominal wall. The therapeutic approach for the patient encompassed surgical resection, complemented by a regimen of adjuvant chemotherapy, radiotherapy, immunotherapy, and targeted therapy. Despite these measures, the patient experienced disease progression, manifested by bilateral inguinal lymph node involvement and metastasis to the left femoral bone. Advanced molecular diagnostics, specifically next-generation sequencing (NGS) of the resected specimen, identified a targetable PIK3CA E726K mutation. Subsequent treatment with alpelisib and everolimus was initiated, culminating in a sustained complete response. Full article

Traditional door mechanisms in public spaces, such as knob locks and standard handles, require manual contact, making them prone to contamination and posing significant health risks. To address the critical need for a safer and more hygienic solution, this study aimed to develop an innovative foot-operated door mechanism that is accessible and intuitive for all users. The study applies the Theory of Inventive Problem Solving (TRIZ), ergonomic principles, and universal design to develop the foot-operated mechanism, while using Importance–Performance Analysis (IPA) and the Kano model to evaluate user satisfaction and identify design improvements. The foot-operated mechanism developed in this study features internal and external pedals for seamless door operation, a secure locking system, and color-coded indicators for clear occupancy status communication, ensuring both ease of use and privacy. The design significantly enhances hygiene by minimizing manual contact and improves user convenience, as confirmed through the IPA-Kano analysis. This mechanism not only provides a practical and effective solution to contamination risks but also demonstrates versatility, making it suitable for various public spaces and accessible to a wide range of users. This study represents a significant contribution to public infrastructure by providing a safer, more hygienic, and sustainable solution for door operation in public spaces. Full article

Background: Diabetes contributes to a spectrum of complications encompassing microvascular and macrovascular disorders. This study aimed to explore the correlation between distal sensorimotor polyneuropathy (DSPN) severity and heightened carotid atherosclerosis among individuals with type 2 diabetes mellitus (T2DM). Method: Participants underwent comprehensive assessments including nerve conduction studies (NCS), Toronto Clinical Neuropathy Score (TCNS) evaluations, assessment of cardiometabolic risk factors, and carotid sonography studies covering dynamic and morphological parameters. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) in both the common carotid artery (CCA) and internal carotid artery (ICA), carotid intima-media thickness (IMT), and carotid plaque score (CPS) were also measured. Peripheral nerve function severity was assessed using composite amplitude scores (CAS) derived from NCS. Results: Individuals with DSPN exhibited lower EDV in the CCA and ICA (p < 0.0001 and p = 0.002), higher PI and RI in both CCA and ICA (all p < 0.0001), and higher CPS (p = 0.002). They also demonstrated a higher prevalence of retinopathy as an underlying condition, higher index HbA1c, and reduced estimated glomerular filtration rate (eGFR) (all p < 0.0001). Multiple linear regression analysis revealed significant associations where eGFR, ICA-PI, index HbA1c, waist circumference, and age were correlated with CAS. Meanwhile, diabetes duration, waist circumference, age, and index HbA1c showed significant associations with TCNS. Conclusions: Our study suggests that individuals with T2DM who exhibit more severe carotid atherosclerosis may not only be at increased risk of developing DSPN but also may experience greater severity of DSPN. PI in both the CCA and ICA, along with the CPS, serve as surrogate biomarkers for DSPN severity. Full article

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) affects patients after recovering from acute coronavirus disease 2019 (COVID-19). This study investigates the impact of SARS-CoV-2 vaccination on PASC symptoms in children in Taiwan during the Omicron pandemic. Methods: We enrolled children under 18 years with PASC symptoms persisting for more than 4 weeks. Data collected included demographics, clinical information, vaccination status, and symptom persistence. We used logistic regression models to compare symptoms in the acute and post-COVID-19 phases and to assess the association between vaccination and these symptoms. Results: Among 500 PASC children, 292 (58.4%) were vaccinated, 282 (52.8%) were male, and the mean (SD) age was 7.6 (4.6) years. Vaccinated individuals exhibited higher odds of experiencing symptoms in the previous acute phase, such as cough (adjusted odds ratio [AOR] = 1.57; 95% confidence interval [CI]: 1.02–2.42), rhinorrhea/nasal congestion (AOR = 1.74; 95% CI: 1.13–2.67), sneezing (AOR = 1.68; 95% CI: 1.02–2.76), sputum production (AOR = 1.91; 95% CI: 1.15–3.19), headache/dizziness (AOR = 1.73; 95% CI: 1.04–2.87), and muscle soreness (AOR = 2.33; 95% CI: 1.13–4.80). In contrast, there were lower odds of experiencing abdominal pain (AOR = 0.49; 95% CI: 0.25–0.94) and diarrhea (AOR = 0.37; 95% CI: 0.17–0.78) in children who had received vaccination during the post-COVID-19 phase. Conclusions: This study revealed clinical features and vaccination effects in PASC children in Taiwan. Vaccination may reduce some gastrointestinal symptoms in the post-COVID-19 phase. Full article

This study investigated the effects of certain roselle (Hibiscus sabdariffa Linnaeus) extraction methods on various functional properties, including the antioxidant and antiglycation capacities and bacterial growth inhibition. Roselle anthocyanins were extracted using water and ethanol solvents at different temperatures and concentrations. The results revealed that the extraction rate increased with higher temperatures and ethanol concentrations (p < 0.05). Ethanol extracts exhibited higher total organic acid and total anthocyanin contents compared to water extracts, while water extracts showed higher total saccharide, total polyphenol, and total flavonoid contents (p < 0.05). Furthermore, the water extracts demonstrated superior Trolox equivalent antioxidant capacity (TEAC) values, while the ethanol extracts exhibited better 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging ability, antiglycation capacity, and bacterial growth inhibition. A Pearson correlation analysis revealed strong associations between specific components and functional properties, such as a positive correlation between the total anthocyanin content and antiglycation capacity (R² = 0.9862). A principal component analysis and agglomerative hierarchical clustering highlighted distinct clusters of water and ethanol extracts, indicating solvent-dependent variations in functional properties. This study assessed roselle extraction models for antioxidant, antiglycation, and antibacterial activities, which could be used for the development of functional alcoholic or non-alcoholic beverages. Full article

We hypothesized and investigated whether prenatal exposure to preeclampsia (PE) would simultaneously affect perinatal cardiovascular features and angiotensin system expressions. This prospective study was composed of mother-neonate dyads with (n = 49) and without maternal preeclampsia (n = 48) in a single tertiary medical center. The neonates exposed to PE had significantly larger relative sizes for the left and right coronary arteries and a higher cord plasma level of aminopeptidase-N, which positively correlated with the maternal diastolic blood pressures and determined the relative sizes of the left and right coronary arteries, whereas the encoding aminopeptidase-N (ANPEP) mRNA level in the PE cord blood leukocytes was significantly decreased, positively correlated with the neonatal systolic blood pressures (SBPs), and negatively correlated with the cord plasma-induced endothelial vascular cell adhesion molecule-1 mRNA levels. The PE cord plasma significantly induced higher endothelial mRNA levels of angiotensin II type 1 receptor (AT1R) and AT4R, whereas in the umbilical arteries, the protein expressions of AT2R and AT4R were significantly decreased in the PE group. The endothelial AT1R mRNA level positively determined the maternal SBPs, and the AT4R mRNA level positively determined the neonatal chamber size and cardiac output. In conclusion, PE may influence perinatal angiotensin system and cardiovascular manifestations of neonates across placentae. Intriguing correlations between these two warrant further mechanistic investigation. Full article

This study aimed to investigate whether baroreflex sensitivity (BRS) could serve as a reliable metric for assessing cardiovascular autonomic neuropathy (CAN) and concurrently act as a surrogate biomarker for evaluating the severity of arterial stiffness and CAN in individuals diagnosed with type 2 diabetes mellitus (T2DM). Participants underwent brachial–ankle pulse wave velocity (baPWV) as well as autonomic function evaluations encompassing the Sudoscan-based modified composite autonomic scoring scale (CASS), baroreflex sensitivity, and heart rate variability in time domains and frequency domains. Linear regression analysis was performed to evaluate the influence of independent variables on baPWV and modified CASS. Participants with higher baPWV values were older, with longer diabetes duration, lower body weight, body mass index, waist circumference, elevated systolic and diastolic blood pressure, and mean arterial blood pressure. They also exhibited a higher prevalence of retinopathy as the underlying disease and reduced estimated glomerular filtration rate. Multiple linear regression analysis revealed that age and BRS were significantly associated with baPWV while diabetes duration, UACR, and BRS were significantly associated with modified CASS. Our study confirms the significant association of BRS with baPWV and modified CASS in T2DM, highlighting its pivotal role in linking microvascular and macrovascular complications. This supports BRS as a surrogate marker for assessing both the severity of arterial stiffness and cardiovascular autonomic neuropathy in T2DM, enabling the early identification of complications. Full article

A 36-year-old woman, gravida 3, para 1 (previous cesarean section), with one medical abortion, and no history of systemic diseases presented an unremarkable medical history during prenatal visits. The final prenatal ultrasound at 38 weeks of gestation showed a vertex presentation, a weight of 2600 g, a normal amniotic fluid level, and the placenta located on the posterior wall of the uterus. Fetal cardiotocography conducted before delivery reported a reactive heart rate without decelerations. The Doppler wave analysis of the fetal umbilical artery was normal (the ratio of peak-systolic flow velocity to the end-diastolic flow velocity was 2.5) without the absence or reversal of end-diastolic velocity. The total score of the fetal biophysical profile by ultrasound was 8. The night before the scheduled cesarean section, she experienced heightened anxiety and was unable to sleep, noting “crazy” fetal movements throughout the night. During the cesarean section, it was discovered that the umbilical cord was wrapped around the newborn’s legs, resembling ankle shackles. The fetal weight was 2740 g, and Apgar scores were 9 at the first minute and 10 at the fifth minute. The motility of the neonatal legs was normal without cyanosis or neurological adverse outcomes. Full article