Search Results (29)

Background: Large language models (LLMs) are increasingly used in clinical medicine, yet their ability to interpret advanced intraoperative hemodynamic monitoring—particularly in the context of liver transplantation—remains largely unexplored. In this proof-of-concept study, we evaluated ChatGPT’s capacity to interpret multimodal hemodynamic data derived from both standard anesthesia monitoring and the PiCCO system. The study also employed a structured assessment instrument (ARQuAT), adapted through a Delphi-based process to evaluate LLM-generated clinical interpretations. Methods: Ten key surgical–hemodynamic phases of liver transplantation were identified using a modified Delphi approach to capture the major physiological transitions of the procedure. Sequential screenshots representing these phases were obtained from five liver transplant recipients, yielding a total of 50 images. Each screenshot, along with standardized clinical background information, was submitted to ChatGPT. Five expert anesthesiologists independently assessed the model’s responses using the modified ARQuAT tool, which includes six content-quality domains (Accuracy, Up-to-dateness, Contextual Consistency, Clinical Usability, Trustworthiness, Clarity) and a separate catastrophic Risk item. Descriptive statistics were calculated for domain-level performance. Inter-rater reliability (Kendall’s W) and internal consistency (Cronbach’s alpha, McDonald’s omega) were also analyzed. All statistical analyses and visualizations were performed using NumIQO. Results: ChatGPT demonstrated consistently high performance across all content-quality domains, with median scores ranging from 4.6 to 4.8 and more than 90% of all ratings classified as satisfactory. Lower scores appeared only in a small subset of frames associated with abrupt hemodynamic changes and did not indicate a recurring weakness in any specific domain. Catastrophic Risk exhibited a pronounced floor effect, with 86% of ratings scored as 0 and only three isolated high-risk assessments across the dataset. Internal consistency of the six ARQuAT content domains was excellent, while inter-rater agreement was modest, reflecting ceiling effects and tied ratings among evaluators. Conclusions: ChatGPT generated clinically acceptable, contextually aligned interpretations of complex intraoperative hemodynamic data in liver transplant recipients, with minimal evidence of unsafe recommendations. These findings suggest preliminary promise for LLM-assisted interpretation of advanced monitoring, while underscoring the need for future studies involving larger datasets, dynamic physiological inputs, and expanded evaluator groups. The reliability characteristics observed also provide initial support for further refinement and broader validation of the Delphi-derived ARQuAT framework. Full article

Prostate cancer remains a leading cause of cancer-related mortality and castration-resistant prostate cancer (CRPC) is a critical therapeutic challenge. This review establishes a conceptual framework analyzing ferroptosis vulnerability through two principles: “robustness through redundancy” in defense systems and the “evolutionary arms race” between androgen receptor (AR) signaling and oxidative resistance. We traced the evolutionary trajectory of hormone-sensitive diseases, where the AR coordinates ferroptosis defenses via SLC7A11, MBOAT2, and PEX10 regulation through progressive adaptations: AR-V7 splice variants that maintain defense independently of androgens, AR amplification conferring hypersensitivity, and AR-independent JMJD6-ATF4 bypass in SPOP-mutated tumors. This transforms ferroptosis from a static vulnerability to a stage-specific strategy. Novel approaches include menadione-based VPS34 targeting, which induces triaptosis through an oxidative endosomal catastrophe. We categorized the rational combinations mechanistically as vertical inhibition (multi-step targeting of single pathways), horizontal inhibition (synthetic lethality across parallel defenses), and vulnerability induction (creating exploitable dependencies). Ferroptosis-induced immunogenic cell death enables synergy with checkpoint inhibitors, potentially transforming immunologically “cold” prostate tumors. This review establishes ferroptosis targeting as a precision medicine paradigm exploiting the tension between the oxidative requirements of cancer cells and their evolved, yet architecturally vulnerable, defense systems, providing a framework for stage-specific, biomarker-guided interventions. Full article

The rapid advancement of deep learning is significantly hindered by its vulnerability to adversarial attacks, a critical concern in sensitive domains like medicine where misclassification can have severe, irreversible consequences. This issue directly underscores prediction unreliability and is central to the goals of Explainable Artificial Intelligence (XAI) and Trustworthy AI. This study addresses this fundamental problem by evaluating the efficacy of denoising techniques against adversarial attacks on medical images. Our primary objective is to assess the performance of various denoising models. The authors generate a test set of adversarial medical images using the one-pixel attack method, which subtly modifies a minimal number of pixels to induce misclassification. The authors propose a novel autoencoder-based denoising model and evaluate it across four diverse medical image datasets: Derma, Pathology, OCT, and Chest. Denoising models were trained by introducing Impulse noise and subsequently tested on the adversarially attacked images, with effectiveness quantitatively evaluated using standard image quality metrics. The results demonstrate that the proposed denoising autoencoder model performs consistently well across all datasets. By mitigating catastrophic failures induced by sparse attacks, this work enhances system dependability and significantly contributes to the development of more robust and reliable deep learning applications for clinical practice. A key limitation is that the evaluation was confined to sparse, pixel-level attacks; robustness to dense, multi-pixel adversarial attacks, such as PGD or AutoAttack, is not guaranteed and requires future investigation. Full article

Wharton’s jelly (WJ), the mucoid connective tissue of the umbilical cord, provides essential protection to the umbilical vessels against mechanical stress. While research into WJ-derived stem cells for regenerative medicine has surged, the clinical significance of its in utero pathologies remains less explored. This review synthesizes the current literature on the pathophysiology of WJ abnormalities and their direct impact on fetal and neonatal outcomes. Pathologies are broadly categorized as quantitative (absence/reduction or excess/edema) and structural (pseudocysts, mucoid degeneration). A reduction or segmental absence of WJ critically compromises cord integrity, leading to vascular compression and is a direct cause of stillbirth, fetal growth restriction (FGR), and intrapartum distress. Conversely, excessive WJ or edema is associated with maternal diabetes and fetal hydrops and can also impair hemodynamics. Umbilical cord pseudocysts, arising from focal WJ degeneration, are significant markers for severe chromosomal abnormalities, particularly Trisomy 18 and 13, and other structural defects, especially when persistent or multiple. Sonographic measurement of WJ area shows promise as a surrogate for placental function, with decreased area correlating with placental pathology and FGR. However, significant diagnostic challenges persist, particularly the prenatal detection of segmental WJ absence, a “silent” pathology often discovered only after a catastrophic event. This review highlights the critical role of WJ integrity in determining perinatal outcomes and underscores the urgent need for improved diagnostic modalities and standardized management protocols to mitigate associated risks. Full article

At present, polypharmacy—which is the use of several medications to treat a single case at the same time—has become a fairly common medical practice, particularly in chronic illnesses or with older patients. But this relatively ‘faster’ form of treatment brings the problem of cumulative polypharmacy, which occurs when there is an increase in drug–drug interactions (DDIs) due to the large number of medicines taken. While the aftermath, such as the reduction in strength of medication taken or catastrophic and fatal responses to certain drugs, is clearly not worth the initial effort put into trying to ease the condition, attempting to resolve these issues requires excessive research. With these difficulties in mind, we describe our research that uses graph neural networks (GNNs) focused on DDI prediction by modeling drugs and their interactions in the form of graphs. The research is divided into two parts. In this research, the relevant literature is reviewed in order to understand how modern GNN-based algorithms can be applied for the detection of optimal drugs. Full article

In this paper, we utilize the 2019/20 Uganda National Household Survey data to answer three related questions: (i) To what extent did out-of-pocket payments (OOPs) for health care services exceed the threshold for household financial catastrophe amidst COVID-19? (ii) What is the impoverishing effect of OOPs for health care services on household welfare? (iii) What are the socioeconomic and demographic determinants of OOPs for health care services in Uganda? Leveraging three health expenditure thresholds (10%, 25%, and 40%), we run a Tobit model for “left-censored” health expenditures and quantile regressions, and we find that among households which incur any form of health care expense, 37.7%, 33.6%, and 28.7% spend more than 10%, 25%, and 40% of their non-food expenditures on health care, respectively. Their average OOP budget share exceeds the respective thresholds by 82.9, 78.0, and 75.8 percentage points. While, on average, household expenditures on medicine increased amidst the COVID-19 pandemic, expenditures on consultations, transport, traditional doctors’ medicines, and other unbroken hospital charges were reduced during the same period. We find that the comparatively low incidence and intensity of catastrophic health expenditures (CHEs) in the pandemic period was not necessarily due to low household health spending, but due to foregone and substituted care. Precisely, considering the entire weighted sample, about 22% of Ugandans did not seek medical care during the pandemic due to a lack of funds, compared to 18.6% in the pre-pandemic period. More Ugandans substituted medical care from health facilities with herbs and home remedies. We further find that a 10% increase in OOPs reduces household food consumption expenditures by 2.6%. This modality of health care financing, where households incur CHEs, keeps people in chronic poverty. Full article

Sepsis is a potentially catastrophic organ dysfunction arising from an infection-induced immunologic reaction leading to severe inflammation, progression of septic shock, and damage to body organs. Sepsis is marked by noticeable hepatotoxicity caused by activating oxidative stress, inflammation, and apoptotic mechanisms. Through Cecal Ligation and Puncture (CLP) in rats, our study is the first to investigate the potential preventive effect of the antihypertensive medicine “Nebivolol” on sepsis-induced hepatotoxicity at a molecular level. Six groups of sixty albino Wistar rats (male) were randomly assigned. Biochemical and oxidative stress markers of liver function were measured. Additionally, apoptosis- and inflammatory-related gene and protein expressions were examined. Finally, the liver tissues were examined for histological assessments. The hepatic architecture was considerably altered by CLP, which also resulted in marked elevations of blood aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total and direct bilirubin levels, and hepatic malondialdehyde (MDA). In contrast, it decreased serum albumin level, hepatic superoxide dismutase (SOD) activity, and glutathione (GSH) level. It also significantly elevated all hepatic inflammatory mediators (Interlukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), and Interlukin-1 beta (IL-1β)) and alleviated Interlukin-10 (IL-10). It magnified the expression of p-AKT/t-AKT, p-JNK1/2/t-JNK1/2, and p-p38/t-p38 proteins, raised Matrix Metalloproteinase 2/9 (MMP 2/9) and nuclear factor-kappa B (NF-κB) gene transcriptions, and lessened Vascular Endothelial Growth Factor (VEGF) gene expression. In contrast, Nebivolol administration dramatically mitigated all biochemical and histological changes obtained by CLP. The present finding demonstrated that Nebivolol succeeded, for the first time, in improving the hepatic injury obtained from CLP-evoked sepsis through modulating oxidative stress, inflammatory mediators, and apoptotic pathways through targeting the crosstalk between protein kinase B (AKT), NF-κB, and mitogen-activated protein kinase (MAPK), making Nebivolol a hopeful treatment for hepatic injury. Full article

Anxiety-based cognitive distortions pertaining to somatic perception (ABCD-SPs)—primarily catastrophizing, fear avoidance, and kinesiophobia—have been repeatedly linked to worsening chronic, non-cancer pain (CNCP) outcomes of increased disability, amplified pain, ineffective opioid use, and opioid misuse. Several studies have suggested that treating ABCD-SPs can improve pain outcomes, yet identification and targeting of ABCD-SPs are not part of the standard medical pain assessment and treatment plan. Utilizing a narrative review of proposed mechanisms, published patient perspectives, and study correlations connecting these cognitive distortions with CNCP outcomes, an approach for better practice in the delivery of standard medical CNCP care can be deduced and formulated into a Belief and Behavior Action Plan (BBAP) for medical clinicians treating CNCP to implement into initial and maintenance care planning. These recommendations require relatively few resources to implement and have the potential to disseminate more effective CNCP treatment on a large scale now and in the future with the new frontier of cognitive computing in medicine. Full article

Spinal cord injury (SCI) is a catastrophic condition that disrupts neurons within the spinal cord, leading to severe motor and sensory deficits. While current treatments can alleviate pain, they do not promote neural regeneration or functional recovery. Three-dimensional (3D) bioprinting offers promising solutions for SCI repair by enabling the creation of complex neural tissue constructs. This review provides a comprehensive overview of 3D bioprinting techniques, bioinks, and stem cell applications in SCI repair. Additionally, it highlights recent advancements in 3D bioprinted scaffolds, including the integration of conductive materials, the incorporation of bioactive molecules like neurotrophic factors, drugs, and exosomes, and the design of innovative structures such as multi-channel and axial scaffolds. These innovative strategies in 3D bioprinting can offer a comprehensive approach to optimizing the spinal cord microenvironment, advancing SCI repair. This review highlights a comprehensive understanding of the current state of 3D bioprinting in SCI repair, offering insights into future directions in the field of regenerative medicine. Full article

Hospital-acquired antibiotic-resistant pneumonia is one of the major causes of mortality around the world that pose a catastrophic threat. Pseudomonas aeruginosa is one of the most significant opportunistic pathogens responsible for hospital-acquired pneumonia and gained resistance to the majority of conventional antibiotics. There is an urgent need for antibiotic alternatives to control drug-resistant pneumonia and other related respiratory infections. In the present study, we explored the antibacterial potential of cineole in combination with homeopathic medicines against biofilm-forming drug-resistant P. aeruginosa. Out of 26 selected and screened homeopathic medicines, Hypericum Perforatum (HyPer) was found to eradicate biofilm-forming drug-resistant P. aeruginosa most effectively when used in combination with cineole. Interestingly, the synergistic action of HyPer and cineole was also found to be similarly effective against planktonic cells of P. aeruginosa. Further, the potential synergistic killing mechanisms of cineole and HyPer were determined by analyzing zeta membrane potential, outer membrane permeability, and DNA release from P. aeruginosa cells upon treatment with cineole and HyPer. Additionally, molecular docking analysis revealed strong binding affinities of hypericin (an active ingredient of HyPer) with the PqsA (a quorum sensing protein) of P. aeruginosa. Overall, our findings revealed the potential synergistic action of cineole and HyPer against biofilm-forming drug-resistant P. aeruginosa. Cineole and HyPer could be used in combination with other bronchodilators as inhalers to control the biofilm-forming drug-resistant P. aeruginosa. Full article

The use of radar technology for non-contact measurement of vital parameters is increasingly being examined in scientific studies. Based on a systematic literature search in the PubMed, German National Library, Austrian Library Network (Union Catalog), Swiss National Library and Common Library Network databases, the accuracy of heart rate and/or respiratory rate measurements by means of radar technology was analyzed. In 37% of the included studies on the measurement of the respiratory rate and in 48% of those on the measurement of the heart rate, the maximum deviation was 5%. For a tolerated deviation of 10%, the corresponding percentages were 85% and 87%, respectively. However, the quantitative comparability of the results available in the current literature is very limited due to a variety of variables. The elimination of the problem of confounding variables and the continuation of the tendency to focus on the algorithm applied will continue to constitute a central topic of radar-based vital parameter measurement. Promising fields of application of research can be found in particular in areas that require non-contact measurements. This includes infection events, emergency medicine, disaster situations and major catastrophic incidents. Full article

Bovine mastitis is a polymicrobial disease characterised by inflammation of the udders of dairy and beef cattle. The infection has huge implications to health and welfare of animals, impacting milk and beef production and costing up to EUR 32 billion annually to the dairy industry, globally. Bacterial communities associated with the disease include representative species from Staphylococcus, Streptococcus, Enterococcus, Actinomyces, Aerococcus, Escherichia, Klebsiella and Proteus. Conventional treatment relies on antibiotics, but antimicrobial resistance, declining antibiotic innovations and biofilm production negatively impact therapeutic efficacy. Bacteriophages (phages) are viruses which effectively target and lyse bacteria with extreme specificity and can be a valuable supplement or replacement to antibiotics for bovine mastitis. In this review, we provide an overview of the etiology of bovine mastitis, the advantages of phage therapy over chemical antibiotics for the strains and research work conducted in the area in various model systems to support phage deployment in the dairy industry. We emphasise work on phage isolation procedures from samples obtained from mastitic and non-mastitic sources, characterisation and efficacy testing of single and multiple phages as standalone treatments or adjuncts to probiotics in various in vitro, ex vivo and in vivo bovine mastitis infection models. Furthermore, we highlight the areas where improvements can be made with focus on phage cocktail optimisation, formulation, and genetic engineering to improve delivery, stability, efficacy, and safety in cattle. Phage therapy is becoming more attractive in clinical medicine and agriculture and thus, could mitigate the impending catastrophe of antimicrobial resistance in the dairy sector. Full article

Among all available antimicrobials, antibiotics hold a prime position in the treatment of infectious diseases. However, the emergence of antimicrobial resistance (AMR) has posed a serious threat to the effectiveness of antibiotics, resulting in increased morbidity, mortality, and escalation in healthcare costs causing a global health crisis. The overuse and misuse of antibiotics in global healthcare setups have accelerated the development and spread of AMR, leading to the emergence of multidrug-resistant (MDR) pathogens, which further limits treatment options. This creates a critical need to explore alternative approaches to combat bacterial infections. Phytochemicals have gained attention as a potential source of alternative medicine to address the challenge of AMR. Phytochemicals are structurally and functionally diverse and have multitarget antimicrobial effects, disrupting essential cellular activities. Given the promising results of plant-based antimicrobials, coupled with the slow discovery of novel antibiotics, it has become highly imperative to explore the vast repository of phytocompounds to overcome the looming catastrophe of AMR. This review summarizes the emergence of AMR towards existing antibiotics and potent phytochemicals having antimicrobial activities, along with a comprehensive overview of 123 Himalayan medicinal plants reported to possess antimicrobial phytocompounds, thus compiling the existing information that will help researchers in the exploration of phytochemicals to combat AMR. Full article

The utilization of rescue blankets in pre-hospital emergency medicine exceeds protection from hypothermia and enhanced visibility by far. In this narrative review, we focus on emphasizing the alternative applications of these fascinating multifunctional tools in the pre-hospital setting. A literature search in PubMed^® and Web of Science^TM yielded 100 results (last update was on 8 July 2022), a total number of 26 of which were included in this narrative review. Nine articles assessing alternative functions of rescue blanket were further evaluated and described in more detail. In addition, we performed various experimental and observational trials to test the functionality of rescue practice in mountain emergency medicine. Newly fabricated rescue blankets proved to possess impressive robustness. We evaluated rescue blankets in their applicability to not only protect from hypothermia, but also as practical tools to treat catastrophic hemorrhage and bleeding limbs, to perform open pneumothorax chest seals in sucking chest wounds, to prevent damage to unprotected eyes on the glacier and as alternative instruments for transportation in the inaccessible areas. Rescue blankets are important rescue equipment in alpine and wilderness emergencies with multifunctional applications, and must be part of every personal medical kit. Full article

The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the “arm endurance” test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R² = 0.33), functionality (model 2: p < 0.001, R = 0.50, R² = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R² = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R² = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R² = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP. Full article