Search Results (44,209)

Background/Objectives: The success of cardiopulmonary resuscitation relies on both technical and non-technical skills. Cognitive aids, such as checklists, have been shown to enhance technical performance in emergencies. The aim of this study was to evaluate the capabilities of a cognitive aid app (CA-App) in improving non-technical skills. Methods: In this single-centre randomised controlled trial, 62 teams, each consisting of an experienced physician and a specialised nurse, were randomised either to CA-App or control (No-App) groups performing cardiopulmonary resuscitation. The study was registered with the German Clinical Trials Register (DRKS) on 4 November 2025 (DRKS00038336). The primary outcome was the team leader’s performance in non-technical skills, assessed via the validated Team Emergency Assessment Measure (TEAM™) questionnaire by two raters. Secondary analyses examined TEAM™ subdomains (leadership, teamwork, task management) and the correlation between app usage duration and performance. Results: 62 out of 67 teams were finally randomised, with 31 teams in each group. The CA-App group demonstrated a marginally elevated median TEAM™ total score (83.33%) in comparison to the control group (79.33%), although this difference was not statistically significant (p = 0.190). The leadership subgroup score was significantly higher in the app group (p = 0.006). There was no significant correlation between the time spent using the app and improved team performance (r = 0.260, p = 0.166). Conclusions: The CA-App demonstrated potential for improving leadership skills, a critical component of non-technical skills in emergency scenarios. These findings highlight the potential capability of cognitive aids to improve non-technical skills and the need for further research to explore their optimal design and integration into clinical practice to enhance team performance and patient safety. Full article

Osteochondral allograft transplantation is a safe and effective surgical option for the treatment of large, focal, full-thickness chondral and osteochondral defects, particularly in young patients. We describe a low-cost new hybrid workstation for osteochondral allograft transplantation based on modified Ilizarov components and its clinical application in a patient with a large osteochondral femoral defect. The technique was applied in a 28-year-old male with chronic knee pain following two prior failed arthroscopic surgeries. Osteochondral allograft transplantation was performed using our modified workstation instrumentation. At the 8-month follow-up, MRI revealed excellent incorporation of the graft, and the patient reported ambulation without pain with return to physical activity. Our hybrid workstation presents a cost-effective alternative for graft preparation while maintaining a high standard of surgical care. Full article

Background: Lung cancer is the most common malignancy worldwide and has the highest mortality rate. Although therapeutic approaches have improved over recent years, the clinical efficacy of lung cancer treatment remains limited. Therefore, there is an urgent need to develop novel and effective immunotherapeutic strategies for lung cancer. Methods: In this study, we constructed a novel bacterial complex vaccine (Neo-BCV, hereafter referred to as BCV) and investigated its anti-tumor effects and underlying mechanisms in a murine lung cancer model. We further explored the role of the gut microbiota, bile acid metabolism, and T-cell function in BCV-mediated anti-tumor immunity. In addition, we performed a preliminary evaluation of the clinical safety of BCV in human subjects. Results: BCV treatment significantly enhanced the infiltration of CD4⁺ and CD8⁺ T cells into the tumor immune microenvironment and promoted the secretion of anti-tumor effector molecules. Mechanistically, BCV markedly increased the abundance of Lactobacillus reuteri (L. reuteri) in the gut microbiota and reduced serum levels of taurocholic acid (TCA). Further experiments confirmed that L. reuteri directly degrades TCA, and decreased TCA levels restored the effector functions of CD4⁺ and CD8⁺ T cells. Conclusions: This study demonstrates that BCV remodels the gut microbiota and enhances anti-tumor immunity by regulating the L. reuteri–TCA axis to restore T-cell function. This mechanism provides a new strategy for improving the tumor immune microenvironment and supports further investigation and development of BCV as a therapeutic candidate for lung cancer. Full article

Stenotrophomonas maltophilia bacteremia is an opportunistic infection associated with high mortality among intensive care unit (ICU) patients, largely due to intrinsic antimicrobial resistance and the severe underlying conditions of affected hosts. This study aimed to identify independent predictors of 28-day mortality, evaluate the prognostic value of laboratory biomarkers, and assess the impact of source control in ICU patients with S. maltophilia bacteremia. A retrospective single-center case–control study was conducted over a five-year period, including 148 ICU patients with S. maltophilia bacteremia and 1:1 matched non-S. maltophilia controls. Demographic, clinical, and laboratory data were analyzed using multivariate logistic regression to determine independent predictors of mortality, while receiver operating characteristic (ROC) analysis assessed the prognostic performance of selected biomarkers. Multivariate analysis identified shock (OR = 6.01; 95% CI: 3.13–11.56; p < 0.001), underlying malignancy (OR = 4.31; 95% CI: 1.44–12.96; p = 0.009), higher Sequential Organ Failure Assessment (SOFA) score (OR = 1.28; 95% CI: 1.16–1.41; p < 0.001), and elevated procalcitonin levels (OR = 1.014; 95% CI: 1.002–1.026; p = 0.019) as independent predictors of mortality. A multivariable prediction model incorporating age, SOFA score, shock, malignancy, procalcitonin, and lactate demonstrated good discriminative performance for predicting 28-day mortality (AUC = 0.817; p < 0.001). Source control was significantly associated with improved survival. These findings suggest that hemodynamic instability, malignancy, and severe organ dysfunction are major determinants of mortality in ICU patients with S. maltophilia bacteremia, and that multidimensional risk assessment models integrating clinical severity scores and biomarkers may facilitate early identification of high-risk patients and support targeted clinical management. Full article

Objective: Anxiety symptoms frequently occur alongside mood disorders and are associated with poorer clinical outcomes, highlighting the importance of early and accurate detection. This study evaluated the diagnostic accuracy and psychometric properties of the Anxious Distress Assessment Scale (ADS), a newly developed brief self-report instrument designed to detect anxious distress. Method: The study was conducted in two phases. Phase 1 involved the development of the ADS as a five-item instrument reflecting the DSM-5-TR anxious distress criteria. In Phase 2, 105 adults diagnosed with major depressive disorder (MDD) completed the ADS alongside the Generalized Anxiety Disorder-7 (GAD-7) and the Montgomery–Åsberg Depression Rating Scale (MADRS). Psychometric evaluation included internal consistency reliability (Cronbach’s α), analyses of convergent validity, and diagnostic accuracy assessment using correlation and receiver operating characteristic (ROC) analyses. Results: Anxious distress was highly prevalent, with 71% of participants meeting DSM-5-TR criteria. The ADS demonstrated strong diagnostic performance, with sensitivity of 88.0%, specificity of 90.0%, positive predictive value of 95.7%, and negative predictive value of 75.0%. ROC analysis yielded an area under the curve (AUC) of 0.97 (95% CI: 0.943–0.997), with an optimal cut-off score of ≥10. Internal consistency was excellent (Cronbach’s α = 0.897). Principal component analysis supported a unidimensional structure, accounting for 71.5% of the total variance, with all items loading above 0.80. The ADS also demonstrated strong convergent validity, correlating significantly with the GAD-7 (r = 0.82) and MADRS (r = 0.68). Conclusions: The ADS demonstrates promising psychometric properties, including strong reliability, meaningful convergent validity, and excellent diagnostic accuracy. Its brief format and direct alignment with DSM-5-TR anxious distress criteria support its potential utility as a practical screening tool in clinical settings. However, these findings should be interpreted in light of the study’s focus on English-speaking Malaysian adults with MDD recruited from a tertiary-care setting. Further validation across diagnostic groups, clinical contexts, and cultural and linguistic populations is warranted. Full article

Background: The right ventricular free wall longitudinal strain to pulmonary arterial systolic pressure (RVFWLS/PASP) ratio is an emerging echocardiographic index for evaluating right ventricular–pulmonary artery (RV-PA) coupling. This study aimed to evaluate its prognostic significance and incremental value in risk stratification for patients with pulmonary arterial hypertension (PAH). Methods: We conducted a retrospective–prospective cohort study of 149 adult PAH patients (87 idiopathic PAH and 62 connective tissue disease-associated PAH). RVFWLS was measured via speckle tracking echocardiography, and PASP was estimated using Doppler. The primary endpoint was event-free survival, defined as the first occurrence of all-cause mortality, lung transplantation, or rehospitalization for right heart failure. Kaplan–Meier and multivariate Cox regression analyses were performed to identify independent predictors. Results: During a median follow-up of 32 months, 78 primary events occurred. Patients in the lower RVFWLS/PASP group (<0.246%/mmHg) exhibited significantly worse exercise capacity, higher NT-proBNP levels, and poorer hemodynamics compared with the higher group (≥0.246%/mmHg) (all p < 0.001). The event-free survival rate for the composite endpoint was significantly lower in the group with reduced RVFWLS/PASP compared with that observed in the higher RVFWLS/PASP group (log-rank p < 0.05). Multivariate Cox regression analysis demonstrated RVFWLS/PASP ≥ 0.246%/mmHg was independently predictive of reduced risk for the primary endpoint (HR = 0.46, 95%CI 0.23–0.93, p < 0.05). Moreover, RVFWLS/PASP facilitated additional risk stratification among patients classified as low risk based on established models (FPHN, COMPERA 2.0, and REVEAL Lite 2). Conclusions: RVFWLS/PASP is a robust, independent determinant of long-term prognosis in patients with PAH. As a noninvasive measure of RV-PA coupling, it provides significant incremental value for clinical risk assessment and treatment monitoring. Full article

Background: Artificial intelligence-based computer-aided detection (AI-CAD) systems are increasingly being used in endovascular practice to support time-sensitive detection, triage and prioritization tasks in imaging and procedural workflows. Despite rapid technological advancements and expanding regulatory clearances, the translation to lasting clinical benefit varies. Objective: This narrative review synthesizes AI-CAD applications in endovascular interventions and proposes an evaluation-oriented framework to support responsible clinical translation; this framework emphasizes detection-specific metrics, external validation, bias-aware assessment, and workflow integration. Methods: A structured narrative review was conducted using targeted searches in PubMed, Google Scholar, and IEEE Xplore (2020–2026); this review was supported by an examination of US FDA device databases and citation tracking. Evidence was assessed using a pragmatic hierarchical classification framework based on regulatory status and validation rigor. Results: AI-CAD applications were mapped across four main endovascular domains: neurovascular interventions (e.g., large vessel occlusion triage), coronary interventions (CCTA-based stenosis detection and intravascular imaging support), aortic interventions/EVAR (endoleak detection and sac monitoring), and peripheral interventions (lesion detection and angiographic decision support). Across the domains, performance reporting was heterogeneous and often relied on retrospective, single-center assessments. Key barriers to clinical readiness included acquisition variability and dataset shift due to artifacts, limited multicenter validation, annotation variability, and human–AI workflow factors. Evaluation priorities included whether to assess at the lesion level or case level, false positive burden and calibration, external validation under real-world heterogeneity, and clinical impact measures such as treatment timing and procedural decision-making. Conclusions: AI-CAD systems hold significant potential for improving endovascular care; however, clinical readiness depends on rigorous, endovascular feature-specific assessment and transparent reporting, beyond retrospective accuracy. The proposed evidence level framework and assessment checklist provide practical tools for distinguishing mature technologies from research prototypes and guiding future validation, implementation, and post-market monitoring. Full article

Background/Objectives: Early-onset high myopia (eoHM), defined as high myopia manifesting before 10 years of age, is largely attributed to genetic defects. This study aimed to investigate the genetic underpinnings of eoHM in a cohort of Chinese patients. Methods: We recruited 64 Chinese patients with eoHM. Comprehensive clinical evaluations were performed, and whole exome sequencing (WES) was conducted to identify potential pathogenic variants. The genetic findings were analyzed and correlated with the clinical phenotypes. Results: A total of 64 unrelated Chinese patients with suspected early-onset high myopia were initially recruited. Following whole exome sequencing (WES) and variant annotation, final 37 patients with variants in known myopia-associated genes were included in the analytical cohort. The mean age of onset for the cohort was 5 years (IQR, 4–7), with a mean spherical equivalent refraction of −7 D (IQR, (−8)–(−6)). Genetic analysis revealed variants in 28 known myopia-associated genes. We identified pathogenic or likely pathogenic variants in 11 of the 37 patients (29.7%, 95%CI: 0.1737–0.4590), while the overall diagnostic yield was 17.2% (11/64, 95%CI: 0.0970–0.2839) in initial 64 recruited patients. These genes included seven well-established eoHM-related genes, such as ARR3, CACNA1F, P4HA2, TRPM1, COL11A1, COL2A1, and PAX6. Additionally, variants of uncertain significance (VUS) in seven other candidate genes were detected in patients with eoHM. Conclusions: Our findings expand the genetic spectrum of eoHM and reinforce the critical role of genetic testing in its etiological diagnosis and clinical management. Observed patterns of genotype–phenotype associations are descriptive and should be considered hypothesis-generating, requiring validation in larger cohorts. Additionally, we identify several candidate genes that may serve as prospective biomarkers, though these findings require validation in larger cohorts and functional studies. Full article

Background: Proton pump inhibitors (PPIs) are widely used to prevent acid-related complications, yet concerns persist about infectious harm. Observational studies have linked PPIs to Clostridioides difficile infection (CDI) and pneumonia whereas randomized controlled trials (RCTs) consistently show reductions in upper gastrointestinal bleeding. We therefore conducted a systematic review and meta-analysis restricted to randomized controlled trials to evaluate whether PPIs increase the risk of CDI, and to assess pneumonia and gastrointestinal bleeding to contextualize net clinical benefit. Methods: A comprehensive search of randomized controlled trials (RCTs) was conducted using several databases including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and SCOPUS until July 2025. All published English-language RCTs that met the inclusion criteria were included. Random-effects models were utilized to calculate pooled odds ratios (ORs) with 95% confidence intervals. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool, and heterogeneity was quantified using I² statistics. Analysis was performed using STATA version 18 and RevMan 5.3. Results: Across eight RCTs (n = 30,019), PPIs did not increase C. difficile infection versus placebo (OR 1.29, 95% CI 0.82–2.02; p = 0.27; I² = 16%) with leave-one-out (LOO) analyses showing stable estimates. In six trials reporting pneumonia, there was no significant difference between groups (OR 1.00, 95% CI 0.92–1.09; p = 0.99; I² = 0%). For clinically important upper GI bleeding (seven trials), PPIs were associated with a statistically significant lower risk when compared to placebo (OR 0.51, 95% CI 0.27–0.94; p = 0.03; I² = 56%). Conclusions: Across randomized trials with follow-up ranging from 30 days to 3 years, PPI prophylaxis significantly reduced upper gastrointestinal bleeding without increasing the risk of CDI or pneumonia. These findings support the use of PPIs for prophylaxis when clinically indicated, while recognizing that larger trials are needed to better assess rare adverse events. Full article

Background: Gastrointestinal (GI) cancers remain a major global health concern, where timely and accurate interpretation of endoscopic findings plays a decisive role in patient outcomes. In recent years, deep learning–based decision support systems have shown considerable potential in assisting GI diagnosis; however, their broader adoption is often limited by patient privacy regulations, uneven data availability, and the fragmented nature of clinical data across institutions. Federated learning (FL) offers a practical solution by enabling collaborative model training while keeping patient data local to each hospital. Methods: Vision Transformers (ViTs) are particularly well suited for endoscopic image analysis due to their ability to capture long-range contextual information. Nevertheless, their high computational and communication costs pose a significant challenge in federated settings, especially when data distributions vary across clients. To address this issue, we propose a privacy-preserving federated framework that combines ViTs with a Clinical-Entropy Guided Quantum Evolutionary Algorithm (CEQEA) for adaptive token pruning. The CEQEA leverages the diagnostic diversity of each client’s local dataset to guide population initialization, evolutionary updates, and mutation strength, allowing the pruning strategy to adapt naturally to different clinical profiles. Results: The proposed framework was evaluated on curated upper- and lower-GI tract subsets of the HyperKVASIR dataset under realistic non-IID federated conditions. On the final test sets, the model achieved a mean micro-averaged accuracy of 92.33% for lower-GI classification and 90.19% for upper-GI classification, while maintaining high specificity across all diagnostic classes. At the same time, the adaptive pruning strategy reduced the number of tokens processed by approximately 40% and decreased the number of required federated communication rounds by 33% compared to ViT-based federated baselines. Conclusions: Overall, these results indicate that entropy-aware, quantum-inspired evolutionary optimization can effectively balance diagnostic performance and efficiency, making transformer-based models more practical for privacy-preserving, multi-institutional gastrointestinal endoscopy. Full article

The COVID-19 pandemic has been associated with a substantial number of deaths, exposing many individuals to bereavement under particularly adverse circumstances, as public health restrictions often prevented individuals from engaging in customary farewell and mourning practices. In this context, the development of interventions capable of mitigating the psychological impact of grief is of critical importance. This mixed-methods study, with a predominantly qualitative design, aimed to develop and pilot-test a group intervention grounded in cognitive-narrative theory for individuals experiencing bereavement during the COVID-19 pandemic, in Portugal. Four patients aged between 18 and 65 years (M = 49.25; SD = 21.24) participated in the 6-week intervention, between July and August 2022. Quantitative data were collected using the Grief and Meaning Reconstruction Inventory, the Prolonged Grief Assessment Instrument, and the Hospital Anxiety and Depression Scale, with pre- and post-intervention comparisons. To assess the intervention process, participants completed an individual evaluation form, and a group interview was conducted at the end of the intervention. The results indicated a clinically significant reduction in feelings of emptiness and loss of meaning in most participants, with improved meaning-making related to the loss. The thematic analysis performed on the qualitative data highlighted the strengths of the intervention (e.g., adjustment to grief and sharing) and some areas for improvement (e.g., more regular feedback and group composition). Despite limitations, particularly the small sample size, the findings are promising and support further evaluation of this intervention in larger samples of individuals diagnosed with prolonged grief. Full article

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to synthesize current evidence on the role of vitamin B12 deficiency in the diagnostic evaluation of GDD, with a focus on clinical phenotype, risk factors, biomarkers, treatment outcomes, and practical integration into contemporary diagnostic algorithms. Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, and Web of Science was performed to identify clinical studies, case series, reviews, and guideline documents addressing pediatric vitamin B12 deficiency and neurodevelopmental delay. Results: Vitamin B12 deficiency in early childhood is most commonly associated with maternal deficiency and exclusive breastfeeding without adequate supplementation. Evidence from recent clinical and observational studies indicates that vitamin B12 deficiency may present with nonspecific neurological symptoms, including developmental regression, hypotonia, and feeding difficulties. Incorporating vitamin B12 assessment—using serum vitamin B12, holotranscobalamin, methylmalonic acid, and homocysteine—into early diagnostic algorithms for GDD may facilitate timely identification of a treatable cause of neurodevelopmental impairment. The proposed diagnostic framework emphasizes early biochemical evaluation in infants with unexplained developmental delay, thereby supporting prompt treatment during a critical window of neurological reversibility. Conclusions: Targeted assessment of vitamin B12 status in children with GDD, together with evaluation of maternal status, represents a clinically relevant approach to identifying a potentially preventable and treatable cause of neurodevelopmental impairment. Integration of functional biomarkers into diagnostic pathways and the development of pediatric-specific reference standards are key priorities for future research and clinical practice. Full article

Inadvertent perioperative hypothermia increases susceptibility to surgical site infection (SSI) through impaired immune function, reduced oxidative killing, and altered collagen deposition. We performed a narrative review of recent clinical and translational studies evaluating active thermal management for SSI prevention, with emphasis on forced-air warming (FAW) and conductive systems, and on high-risk settings (prolonged surgery, elevated BMI, and pediatric patients). Across studies, active warming more reliably maintains intraoperative normothermia than passive insulation; however, evidence for a consistent reduction in SSI rates is strongest in vulnerable cohorts and lengthy procedures and remains heterogeneous across specialties. FAW demonstrates high warming efficiency, yet its use in implant-based operations continues to be debated because of potential airflow disruption and bacterial mobilization concerns. The literature increasingly supports precision approaches, including pre-warming protocols, improved perioperative temperature monitoring, and predictive models to identify patients at greatest risk of hypothermia. In conclusion, effective SSI prevention requires procedure- and patient-specific thermal strategies, selecting devices that balance warming performance with sterility considerations while integrating perioperative risk stratification and real-time monitoring. Full article

Background/Objectives: Breast cancer screening such as mammography supports earlier detection, but variability in interpretation can still lead to missed cancers and avoidable follow-up testing. We evaluated ChatGPT-5.2 Thinking (OpenAI) as a stand-alone model for examination-level malignancy classification on standard bilateral mammography views in a biopsy-referred cohort, compared with breast radiologists, and assessed laterality performance. Methods: We conducted a retrospective, multicenter diagnostic-accuracy study across breast imaging centers in Saudi Arabia. From an upstream screened cohort (n = 1225), we constructed a biopsy-referred test set of 100 mammography examinations (four 2D views per exam: bilateral CC and MLO; 400 images), including 61 biopsy-confirmed malignancies and 39 biopsy-negative controls, with pathology as the reference standard. Radiologists were blinded to pathology and AI outputs and assigned BI-RADS (0–5) and suspected laterality. ChatGPT-5.2 interpreted the same de-identified views using a BI-RADS-guided prompt to generate BI-RADS and laterality. The sensitivity, specificity, accuracy, and laterality concordance were then estimated. Results: ChatGPT-5.2 had higher sensitivity than radiologists (95.08% vs. 81.97%) but markedly lower specificity (10.26% vs. 56.41%), resulting in lower overall accuracy (62.00% vs. 72.00%). The AI produced 58 true positives, 35 false positives, and 3 false negatives, while radiologists produced 50 true positives, 17 false positives, and 11 false negatives. Laterality accuracy among malignant examinations was 60.66%. Conclusions: In this pathology-anchored, biopsy-referred evaluation, ChatGPT-5.2 identified more cancers but generated substantially more false-positive classifications and showed only moderate breast-side localization. These findings support use as a concurrent aid or prioritization tool rather than a stand-alone reader and motivate efforts to improve specificity and laterality before prospective validation. Full article

Introduction: Spondyloenchondrodysplasia with immune dysregulation (SPENCDI) is a rare autosomal recessive disorder caused by biallelic variants in the tartrate-resistant acid phosphatase 5 (ACP5) and characterized by variable skeletal, immunological, and neurological manifestations. Because early skeletal abnormalities may be subtle, diagnosis can be challenging in infancy. Materials and methods: We conducted a detailed clinical, immunological, radiological, and molecular evaluation of an infant with early-onset cytopenia, recurrent infections, seizures, and developmental delay. Genomic analysis was performed using whole exome sequencing (WES) and copy number variation sequencing (CNV-seq). In addition, we performed a structured narrative review of published ACP5-related SPENCDI cases to summarize the clinical spectrum and the currently reported use of Janus kinase (JAK) inhibitors. Results: Genomic analysis identified an ACP5 stop-gain variant (c.311G>A; p.Trp104*) with an apparently homozygous signal on WES. Re-evaluation of the copy-number data demonstrated an overlapping heterozygous 19p13.2–p13.13 deletion encompassing ACP5, indicating biallelic ACP5 defects consisting of a sequence variant on one allele and deletion of the other allele. Clinically, the patient showed prominent extra-osseous manifestations, including impaired T- and NK-cell cytotoxicity, before the emergence of definite radiographic skeletal abnormalities. Our literature review showed that skeletal abnormalities were repeatedly documented across published ACP5-related SPENCDI reports, although radiographic changes were often subtle and could be preceded by immune manifestations. Reported use of JAK inhibitors suggests potential benefit for immune dysregulation in selected patients, whereas the neurological response remains uncertain. Conclusions: This study reports a novel ACP5 variant and expands the known phenotypic spectrum of SPENCDI. SPENCDI should be considered in children with unexplained immune dysfunction and developmental delay, and suggestive neuroimaging findings, even when overt skeletal deformities are absent. Early genetic testing and targeted skeletal imaging may facilitate diagnosis. Full article