Search Results (58)

Background: Autism spectrum disorder (ASD) is characterised by atypical behavioural and cognitive diversity, yet the neural underpinnings linking brain activity and individual presentations remain poorly understood. In this study, we investigated the relationship between resting-state functional magnetic resonance imaging (fMRI) signal complexity and intelligence (full-scale intelligence quotient (FIQ); verbal intelligence quotient (VIQ); and performance intelligence quotient (PIQ)) in male adults with ASD (n = 14) and matched neurotypical controls (n = 15). Methods: We used three complexity-based metrics: Hurst exponent (H), fuzzy approximate entropy (fApEn), and fuzzy sample entropy (fSampEn) to characterise resting-state fMRI signal dynamics, and correlated these measures with standardised intelligence scores. Results: Using a whole-brain measure, ASD participants showed significant negative correlations between PIQ and both fApEn and fSampEn, suggesting that increased neural irregularity may relate to reduced cognitive–perceptual performance in autistic individuals. No significant associations between entropy (fApEn and fSampEn) and PIQ were found in the control group. Group differences in brain–behaviour associations were confirmed through formal interaction testing using Fisher’s r-to-z transformation, which showed significantly stronger correlations in the ASD group. Complementary regression analyses with interaction terms further demonstrated that the entropy (fApEn and fSampEn) and PIQ relationship was significantly moderated by group, reinforcing evidence for autism-specific neural mechanisms underlying cognitive function. Conclusions: These findings provide insight into how cognitive functions in autism may not only reflect deficits but also an alternative neural strategy, suggesting that distinct temporal patterns may be associated with intelligence in ASD. These preliminary findings could inform clinical practice and influence health and social care policies, particularly in autism diagnosis and personalised support planning. Full article

Regionally metamorphosed, Neoproterozoic stratiform baryte deposits near Aberfeldy in the Grampian Highlands of Scotland, UK, contain barium-poor and barium-rich micas in the host rocks and mineralized strata, respectively. The barium-rich micas include muscovite, biotite, phlogopite, and chromium-bearing muscovite. They occur in schistose metasediments and metabasites, in barium-feldspar rocks, and in small amounts in baryte rock. An extensive study of micas in a range of lithologies using electron-probe micro-analysis found up to 10.86 wt% BaO in muscovite, 5.46 wt% in biotite, and 15.70 wt% in Ba-Cr muscovite, the latter containing up to 9.27 wt% Cr₂O₃. Compositions are comparable with Ba- and Ba-Cr-micas in other metamorphosed Sedimentary Exhalative deposits and barium-rich metasediments worldwide. In one baryte rock sample, disseminated crystals of an exotic Ba-V-Cr mica contain up to 12.33 wt% BaO and 10.82 wt% V₂O₃, compositionally similar to Ba-V micas in the Hemlo lode gold deposit, Ontario. Ba²⁺ incorporation is mainly by coupled substitution with Al³⁺ for K⁺ + Si⁴⁺ in the tetrahedral site. The extent of phengitic (Tschermakitic) substitution is typical of micas in amphibolite-facies metasediments. Similar Fe:Mg ratios in coexisting muscovite and biotite reflect partitioning of iron into sulphides and metamorphic equilibration, with rare exceptions in fine-grained rocks that exhibit millimetre-scale disequilibrium. Full article

Objective: Intrathecal morphine (ITM) has been administered in recent years to provide postoperative pain control in non-obstetric surgery; however, current research has limited consideration of the recommendations for regular, basic analgesia from clinical guidelines when exploring its efficacy. This systematic review and meta-analysis aimed to compare ITM against alternative methods of analgesia in the presence of multimodal analgesia, for reducing pain scores within the first 24 h postoperatively. Secondary outcomes included postoperative opioid consumption, incidence of opioid-related effects, and time to mobilisation. Methods: Database searches and screening identified 11 trials for inclusion in this review. Pain scores were compared by meta-analysis at 6, 12, and 24 h postoperatively at rest and on movement, with sub-analysis of systemic versus regional techniques. Results: The data found no significant difference between ITM and active comparators for reducing pain scores at rest or on movement at any of the time intervals explored. Sub-analysis demonstrated that regional techniques may provide superior analgesia at 24 h at rest (MD = −1.19; 95% CI [−1.73, −0.66], p < 0.001, I² = 0%) and on movement (MD = 1.27 [0.44, 2.10], p = 0.003, I² = 0%). Cumulative opioid consumption was reduced in ITM groups (MD = −11.61 [−18.73, −4.50], p = 0.001, I² = 95%), with significantly increased risk of pruritus (p < 0.001) but not nausea and vomiting (p = 0.93). There was no evidence of respiratory depression. Conclusions: This meta-analysis was unable to demonstrate any significant benefit to postoperative pain relief with the use of ITM but may suggest that it is as a viable option compared to other active modalities. However, this meta-analysis was limited by a low quantity and quality of data from which to draw conclusions and demonstrated high statistical fragility. We believe this highlights a significant gap in the current literature on ITM. Full article

Background/Objectives: For healthcare institutions developing a robotic programme, delivering value for patients, clinicians, and payers is key. However, the impact on the surgeon, training pathways, and logistics are often overlooked. We conducted a study on the impact of robotic surgery on surgeons, access to robotic surgical training, and factors associated with developing a successful robotic programme. Method: In our international mixed-methods study, a customised web-based survey was circulated to gynaecological oncologists. The Wilcoxon rank-sum test and Fisher’s exact test, tested the hypothesis of the differences in continuous and categorical variables. Multiple linear regression was used to model the effect of variables on outcomes adjusting for gender, age, and postgraduate experience. Outcomes included situational awareness, surgeon fatigue/stress, and the surgical learning curve. Qualitative data were collected via in-depth semi-structured interviews using an inductive theoretical framework to explore access to surgical training and logistical considerations in the development of a successful robotic programme. Results: In total, 94%, 45%, and 48% of survey respondents (n = 152) stated that robotic surgery was less physically tiring/mentally tiring/stressful in comparison to laparoscopic surgery. Our data suggest gender differences in the robotics learning curve with men six times more likely to state robotic surgery had negatively impacted their situational awareness in the operating theatre (OR = 6.35, p ≤ 0.001) and 2.5 times more likely to state it had negatively impacted their surgical ability due to lack of haptic feedback in comparison to women (OR = 2.62, p = 0.046). Women were more risk-averse in case selection, but there were no self-reported differences in the intra-operative complication rates between male and female surgeons (OR = 1, p = 0.1). In total, 22/25 robotically trained surgeons interviewed did not follow a structured curriculum of learning. Low and middle income country centres had less access to robotic surgery. The success of robotic programmes was measured by the number of cases performed per annum, with 74% of survey respondents stating that introducing robotics increased the proportion of surgeries performed by minimal access surgery. There was a distinct lack of knowledge on the environmental impact of robotic surgery. Conclusions: Whilst robotic surgery is considered a landmark innovation in surgery, it must be responsibly implemented through effective training and waste minimisation, which must be a key metric in measuring the success of robotic programmes. Full article

Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, and complications necessitate exploring alternative methods. This narrative review examined recent advances in perioperative analgesic strategies in thoracic surgery, focusing on regional anesthetic techniques like paravertebral blocks (PVBs), erector spinae plane blocks (ESPBs), intercostal blocks, and serratus anterior blocks. Each approach was evaluated for efficacy, safety, and impact on patient outcomes. PVB can provide effective unilateral analgesia with fewer systemic complications compared to epidurals. ESPB provides analgesia through a superficial, ultrasound-guided approach, minimizing risks and offering an alternative for various thoracic procedures. Intercostal blocks are effective but are limited by the need for multiple injections, increasing the complication risks. Serratus anterior blocks, targeting intercostal and thoracic nerves, show promise in managing lateral thoracic wall pain with a low complication rate. Advancements in surgical techniques including minimally invasive approaches further optimize pain control and recovery. A multimodal analgesic approach combining regional anesthesia and systemic therapies enhances outcomes by addressing somatic and visceral pain components. Despite the efficacy of epidural analgesia, alternative regional techniques offer comparable pain relief with fewer complications, suggesting their growing role in thoracic surgery. Collaborative efforts between surgical, anesthetic, and emergency teams are crucial for tailoring pain management strategies to individual patients, improving recovery and reducing long-term morbidity. Future research should continue exploring these methods to refine their application and broaden their accessibility. Full article

Research has been conducted investigating the neuronal pathways responsible for the generation of chronic neuropathic pain, including the components of it in conditions such as chronic post-surgical pain, phantom limb pain, and cluster headaches. Forming part of the management of such conditions, capsaicin as a molecule has proven effective. This review has investigated the central nervous system modifications exhibited in such conditions and the pharmacological mechanisms of capsaicin relevant to this. The current paradigm for explaining topical capsaicin-induced analgesia is that TRPV1-mediated calcium ion influx induces calpain, in turn causing axonal ablation and functional defunctionalisation in the PNS (Peripheral Nervous System). Demonstrated through the analysis of existing data, this review demonstrates the changes seen in the CNS (Central Nervous System) in chronic neuropathic pain, as well as some of the evidence for capsaicin modulation on the CNS. Further supporting this, the specific molecular mechanisms of capsaicin-induced analgesia will also be explored, including the action of TRPV1, as well as discussing the further need for clinical research into this area of uncertainty due to the limited specific data with suitable parameters. Further research this review identified as potentially useful in this field included fMRI (functional Magnetic Resonance Imaging) studies, though more specific observational studies of patients who have already been administered capsaicin as a current treatment may prove helpful in studying the modification of the CNS in the long term. Full article

Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics’ impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature. Full article

Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings. Full article

High-dimensional radiomics features derived from pre-treatment positron emission tomography (PET) images offer prognostic insights for patients with head and neck squamous cell carcinoma (HNSCC). Using 124 PET radiomics features and clinical variables (age, sex, stage of cancer, site of cancer) from a cohort of 232 patients, we evaluated four survival models—penalized Cox model, random forest, gradient boosted model and support vector machine—to predict all-cause mortality (ACM), locoregional recurrence/residual disease (LR) and distant metastasis (DM) probability during 36, 24 and 24 months of follow-up, respectively. We developed models with five-fold cross-validation, selected the best-performing model for each outcome based on the concordance index (C-statistic) and the integrated Brier score (IBS) and validated them in an independent cohort of 102 patients. The penalized Cox model demonstrated better performance for ACM (C-statistic = 0.70, IBS = 0.12) and DM (C-statistic = 0.70, IBS = 0.08) while the random forest model displayed better performance for LR (C-statistic = 0.76, IBS = 0.07). We conclude that the ML-based prognostic model can aid clinicians in quantifying prognosis and determining effective treatment strategies, thereby improving favorable outcomes in HNSCC patients. Full article

Background/Objectives: Hip fractures exert a substantial burden on hospital systems. Within Scotland 20% of the population resides rurally, warranting investigation of how this impacts prompt access to surgical care. This study aims to determine whether indirect hospital admission via hospital transfer affects the likelihood of surgical management within 36 h for hip fracture patients. Methods: A retrospective cohort study was performed. This used Scottish Hip Fracture Audit data including patients aged ≥50 split into two propensity matched groups based on their transfer status. Descriptive analysis compared patient characteristics. Regression assessed achieving surgery within 36 h of admission in the unmatched and matched cohorts. Secondary outcomes included time to surgery, mortality, mobilization, returning to residence and length of stay. A sensitivity analysis was undertaken to assess for residual confounding effects. Results: The unmatched analysis included 20,132 patients. Transfer patients were younger (p = 0.007) and less-comorbid (p < 0.001). In the matched population, 711 (63.6%) transfer patients had surgery with 36 h of presentation to hospital, compared to 852 (75.3%) non-transfer patients. Transfer patients had 43% reduced odds of timely surgery (OR (95% CI) 0.57 (0.48 to 0.69); p < 0.001). No disparities emerged in mortality, mobilisation or returning to residence., Transfer patients experienced a significant increase in length of stay in hospital (median (IQR) 16 (8 to 33) vs. 13 (8 to 30); p = 0.024). Conclusions: Hospital transfer is associated with significantly reduced odds of timely surgery, a longer time to surgery and longer length of stay. Development of structured network pathways that minimize delay to transfer are required to potentially optimize outcomes and reduce associated cost. Full article

Background: Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current evidence for the operative management of paediatric TSAFs. Methods: A search was carried out across four databases: MEDLINE, Embase, Scopus, and Google Scholar. Studies discussing the outcomes of the surgical management of paediatric TSAFs since 2000 were included. Results: Of 38 studies included for review, 13 studies reported outcomes of TSAF patients undergoing screw fixation only, and 12 studies used suture fixation only. In total, 976 patients underwent arthroscopic reduction and internal fixation (ARIF), and 203 patients underwent open reduction and internal fixation (ORIF). The risk of arthrofibrosis with the use of ARIF (p = 0.45) and screws (p = 0.74) for TSAF repair was not significant. There was a significantly increased risk of knee instability (p < 0.0001), reoperation (p = 0.01), and post-operative pain (p = 0.007) with screw fixation compared to sutures. Conclusions: While the overall benefits of sutures over screws and ARIF over ORIF are unclear, there is clear preference for ARIF and suture fixation for TSAF repair in practice. We recommend large-scale comparative studies to delineate long-term outcomes for various TSAF fixation techniques. Full article

Introduction: Surgery is the cornerstone of ovarian cancer treatment. However, surgery and perioperative inflammation have been described as potentially pro-metastagenic. In various animal models and other human cancers, intraoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have a positive impact on patient outcomes. Materials and methods: In this unicentric retrospective study, we provide an exploratory analysis of the safety and potential benefit of intraoperative administration of ketorolac on the outcome of patients undergoing surgery for ovarian cancer. The study population included all patients who were given a diagnosis of ovarian, fallopian tube or peritoneal cancer by the multidisciplinary oncology committee (MOC) of the Cliniques universitaires Saint-Luc between 2015 and 2020. Results: We included 166 patients in our analyses, with a median follow-up of 21.8 months. Both progression-free survival and overall survival were superior in patients who received an intraoperative injection of ketorolac (34.4 months of progression-free survival in the ketorolac group versus 21.5 months in the non-ketorolac group (p = 0.002), and median overall survival was not reached in either group but there was significantly higher survival in the ketorolac group (p = 0.004)). We also performed subgroup analyses to minimise bias due to imbalance between groups on factors that could influence patient survival, and the group of patients receiving ketorolac systematically showed a better outcome. Uni- and multivariate analyses confirmed that administration of ketorolac intraoperatively was associated with better progression-free survival (HR = 0.47 on univariate analysis and 0.43 on multivariate analysis, p = 0.003 and 0.023, respectively). In terms of complications, there were no differences between the two groups, either intraoperatively or postoperatively. Conclusion: Our study has shown a favourable association between the use of ketorolac during surgery and the postoperative progression of ovarian cancer in a group of 166 patients, without any rise in intra- or postoperative complications. These encouraging results point to the need for a prospective study to confirm the benefit of intraoperative administration of ketorolac in ovarian cancer surgery. Full article

In this study, an exploratory model was tested to investigate the mediating role of gastrointestinal-specific anxiety and perceived disability in the relation between disease activity and the outcomes of quality of life and depression in patients with inflammatory bowel disease (IBD). In a cross-sectional design, data from an online survey of patients with IBD (over the age of 16) recruited through a UK-based IBD charity were used to test a model of serial mediation. Measures targeted disease activity (self-reported), gastrointestinal-specific anxiety (Visceral Sensitivity Index), perceived disability (Perceived Disability Scale), IBD-specific quality of life (UK Inflammatory Bowel Disease Questionnaire), and depression (Depression subscale of the Depression, Anxiety, and Stress Scale). The theoretical model was investigated using model 6 of the PROCESS macro for SPSS. Bootstrapped 95% confidence intervals were constructed for each estimate A total of 320 participants provided valid responses to the survey. Gastrointestinal-specific anxiety and perceived disability were found to serially mediate the relationship between disease activity and quality of life (95%CI = −0.80 to −0.19) and disease activity and depression (95%CI = 0.13 to 0.59). Findings suggested that the effect of multiple psychosocial variables in the experience of people living with IBD and its respective outcomes should be taken into account when planning treatment. The theoretical and clinical implications of these findings are discussed. Full article

Background: Chronic conditions, especially pain conditions, have a very significant impact on quality of life and on workplaces. Workplace interventions for chronic conditions are heterogenous, multidimensional, and sometimes poorly evidenced. The Joint Action for Chronic Disease Plus (CHRODIS Plus), including The CHRODIS Plus Workbox on Employment and Chronic Conditions (CPWEC), aimed to combat this, prevent chronic disease and multimorbidity, and influence policy in Europe. However, the supporting evidence behind CHRODIS Plus has not been formally assessed. Methods: A scoping review was carried out; Embase, MEDLINE, and CINAHL were searched for literature related to CHRODIS Plus and pain. Title and abstract and full-text screening were carried out in duplicate and independently. Additionally, CHRODIS Plus authors were approached for unpublished data. Secondly, the search was broadened to CHRODIS Plus and pain-causing conditions. Grey literature was also searched. Appropriateness appraisal was derived from the Trial Forge Guidance. Systematic reviews, on which CPWEC was based, were appraised using the A Measurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. Results: The initial search yielded two results, of which zero were suitable to be included in the scoping review. The second, broader search revealed 14 results; however, none were deemed suitable for inclusion. AMSTAR 2 scores revealed that the three systematic reviews influencing CPWEC were of varying quality (from critically low to moderate). Conclusions: CPWEC is based on heterogenous reviews of varying quality. However, comparable tools are designed using alternative forms of evidence. Further research evaluating the post-implementation efficacy of the tool is needed. Full article

Background: Human-centric artificial intelligence (HCAI) aims to provide support systems that can act as peer companions to an expert in a specific domain, by simulating their way of thinking and decision-making in solving real-life problems. The gynaecological artificial intelligence diagnostics (GAID) assistant is such a system. Based on artificial intelligence (AI) argumentation technology, it was developed to incorporate, as much as possible, a complete representation of the medical knowledge in gynaecology and to become a real-life tool that will practically enhance the quality of healthcare services and reduce stress for the clinician. Our study aimed to evaluate GAIDS’ efficacy and accuracy in assisting the working expert gynaecologist during day-to-day clinical practice. Methods: Knowledge-based systems utilize a knowledge base (theory) which holds evidence-based rules (“IF-THEN” statements) that are used to prove whether a conclusion (such as a disease, medication or treatment) is possible or not, given a set of input data. This approach uses argumentation frameworks, where rules act as claims that support a specific decision (arguments) and argue for its dominance over others. The result is a set of admissible arguments which support the final decision and explain its cause. Results: Based on seven different subcategories of gynaecological presentations—bleeding, endocrinology, cancer, pelvic pain, urogynaecology, sexually transmitted infections and vulva pathology in fifty patients—GAID demonstrates an average overall closeness accuracy of zero point eighty-seven. Since the system provides explanations for supporting a diagnosis against other possible diseases, this evaluation process further allowed for a learning process of modular improvement in the system of the diagnostic discrepancies between the system and the specialist. Conclusions: GAID successfully demonstrates an average accuracy of zero point eighty-seven when measuring the closeness of the system’s diagnosis to that of the senior consultant. The system further provides meaningful and helpful explanations for its diagnoses that can help clinicians to develop an increasing level of trust towards the system. It also provides a practical database, which can be used as a structured history-taking assistant and a friendly, patient record-keeper, while improving precision by providing a full list of differential diagnoses. Importantly, the design and implementation of the system facilitates its continuous development with a set methodology that allows minimal revision of the system in the face of new information. Further large-scale studies are required to evaluate GAID more thoroughly and to identify its limiting boundaries. Full article