Neurotoxicity is one of the complications of treatment of acute lymphoblastic leukemia (ALL) with chemotherapeutic agents. Detecting any adverse changes early and effectively is important, as neurotoxicity may be reversible at certain stages. Imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), can be helpful in visualizing neurotoxicity. Neurotoxicity usually occurs during the first 2 months of treatment, roughly the induction phase, and includes leukoencephalopathy, encephalopathy, and posterior reversible encephalopathy syndrome. Changes mainly take the form of reduced restrictive diffusion and periventricular hyperintensity in the subcortical white matter because of cytotoxic swelling caused by ALL treatment. Some previous studies have not considered simultaneous CT and MRI, making it difficult to assess their simultaneous utility. Imaging studies are not usually included in ALL treatment protocols. However, it would be worthwhile to introduce them into clinical practice to prevent complications after chemotherapy in children with ALL, to confirm or rule out neurotoxic complications of the central nervous system more quickly. Furthermore, due to the limited number of studies, it would be advisable to develop predictive models using CT and MRI images to predict the risk of neurological complications, allowing for early prevention in at-risk patients. Considering the above, the present study aimed to evaluate the utility of MRI and CT for identifying lesions associated with neurotoxicity caused by vincristine, methotrexate, and asparaginase in pediatric patients with ALL.

BACKGROUND Gestational diabetes mellitus (GDM) is a pregnancy complication associated with increased risks of metabolic disorders in mothers and their children. Interleukins (ILs) such as IL-10 and IL-37 play key roles in modulating inflammation during pregnancy. Exploration of their postpartum concentrations may help characterize the immunometabolic profile of women with a history of GDM. MATERIAL AND METHODS This study compared serum concentrations of IL-10 and IL-37 between postpartum women with GDM (n=30) and healthy controls (n=50) within the first few days after delivery. Correlation analyses were performed between IL levels and clinical variables, including gestational weight gain, physical activity, smoking, alcohol use, hydration status, body composition (assessed via bioimpedance), and family history of obesity or diabetes. RESULTS IL-37 concentrations were significantly lower in the GDM group than in controls. No significant differences in IL-10 levels were observed. In women with GDM, IL-10 showed key negative correlations with pre-pregnancy body mass index, total body weight, and extracellular-to-intracellular water ratio; IL-37 was negatively correlated with reported water intake and positively correlated with gestational age at delivery. CONCLUSIONS The altered IL profile observed in postpartum women with GDM, particularly reduced IL-37 levels, may reflect persistent low-grade inflammation. These findings support further investigation of IL-37 as a potential biomarker of immune dysregulation in the early postpartum period after GDM.

Six years ago, in December 2019, patients in Hubei Province, China, reported symptoms of atypical pneumonia that were unresponsive to treatment, and in Wuhan, an outbreak of similar cases was reported to the World Health Organization (WHO). On January 30, 2020, the WHO declared that COVID-19, caused by SARS-CoV-2, was a public health emergency of international concern (PHEIC). By November 2, 2025, the total number of COVID-19 cases reported to the WHO since 2020 was 778,900,250. On June 25, 2025, the WHO Technical Advisory Group on Virus Evolution (TAG-VE) reported a risk evaluation for two SARS-CoV-2 Omicron variants under monitoring (VUM), NB.1.8.1 (Nimbus) and XFG (Stratus). At the end of 2025, genomic analysis of the infecting SARS‑CoV‑2 virus identified them as the most common circulating viruses causing COVID-19. This editorial aims to highlight that, six years on from the initial reports of SARS-CoV-2 cases that led to the COVID-19 pandemic, complacency in infection control and surveillance has resulted in a concerning increase in infection from endemic Omicron variants, including NB.1.8.1 (Nimbus) and XFG (Stratus).

BACKGROUND Dilated cardiomyopathy (DCM) is characterized by chronic myocardial inflammation and remodeling. Polyunsaturated fatty acid-derived oxylipins are critical mediators of cardiac inflammation; their plasma profiles in DCM and diagnostic potential remain undefined. We aimed to comprehensively quantify plasma oxylipins in patients with DCM, identify dysregulated lipid pathways, and develop a noninvasive biomarker panel for disease classification. MATERIAL AND METHODS Seventy-three oxylipins were quantified by targeted ultra-high-performance liquid chromatography-tandem mass spectrometry in plasma samples from 30 patients with DCM and 30 age/sex-matched healthy controls. Differential metabolites were identified using Wilcoxon rank-sum tests, significance analysis of microarrays (SAM), and empirical Bayes analysis of microarrays (EBAM). Intersecting features defined a high-confidence signature. Ingenuity Pathway Analysis (IPA) detected enriched lipid mediator pathways. Diagnostic performance was evaluated with a support vector machine (SVM) model using hold-out validation. RESULTS Sixteen oxylipins significantly differed according to Wilcoxon testing. Overlap with SAM and EBAM identified 14 core metabolites dominated by lipoxygenase-derived hydroxyeicosatetraenoic acids, cyclooxygenase-derived prostaglandin E2, and cytochrome P450-derived hydroxyeicosapentaenoic acids, with concomitant suppression of pro-resolving mediators. IPA revealed activation of eicosanoid signaling, triggering receptor expressed on myeloid cells 1 signaling, and prostanoid biosynthesis. A 6-marker SVM panel (15-oxo-eicosatetraenoic acid, 9-hydroxyeicosatetraenoic acid, 6R-lipoxin A4, prostaglandin E2, 16-hydroxyeicosatetraenoic acid, and 18-hydroxyeicosapentaenoic acid) achieved an area under the curve of 0.876 (sensitivity 74.2%, specificity 75.9%). CONCLUSIONS DCM is associated with a dominant pro-inflammatory oxylipin milieu and impaired resolution signaling. The 6-oxylipin panel provides a noninvasive diagnostic tool and suggests lipid mediator pathways represent therapeutic targets in heart failure.

BACKGROUND This study examines the efficacy of biologically guided dose painting in Gamma Knife stereotactic radiosurgery (GKSRS) to improve radiographic response in patients with recurrent high-grade gliomas by increasing radiation dosage in functionally active tumor subregions identified through magnetic resonance spectroscopy (MRS) and T1-weighted perfusion magnetic resonance imaging (T1-PMRI). MATERIAL AND METHODS In this single-arm cohort of patients (n=23) with recurrent high-grade glioma, all patients previously treated with surgery, chemotherapy, and fractionated radiotherapy underwent GKSRS. Functional imaging (MRS and T1-weighted PMRI) delineated metabolically active ("aggressive") and less active ("passive") tumor regions. A modified radiosurgery plan prescribed 18 Gy to aggressive and 15 Gy to passive zones. For intra-patient comparison, a uniform-dose plan (plan 1, 16 Gy) was generated but not delivered. All statistical analyses were performed in Python 3.11 (SciPy-v1.11, statsmodels-v0.14, lifelines-v0.28) executed in Visual Studio Code 1.88 (Microsoft). RESULTS Across 23 patients, plan 2 vs plan 1 showed no significant change in whole-brain mean dose (P=0.716), integral dose (P=0.792), or V12 (P=0.583). Among 11 patients with follow-up imaging, K-trans decreased significantly (median, -18%; P=0.028; Wilcoxon) with a trend for initial area under the gadolinium concentration-time curve (IAUC; median, -22%; P=0.031 for table; overall P=0.08 for initial under curve analysis). Higher baseline K-trans correlated with greater K-trans reduction (r=-0.84, P=0.0012). CONCLUSIONS Using advanced MRI techniques (accounting for K-trans and IAUC on T1-PMRI, and MRS) to determine aggressive zones in salvage treatment for recurrent high-grade gliomas, and then focusing radiotherapy on these zones, can increase Gamma Knife efficiency without increasing the morbidity rate.

BACKGROUND Patient monitoring systems are widely used in intensive care units (ICUs) to monitor patient's conditions. A high false alarm rate can lead to alarm fatigue among nurses, increasing workload and stress. This study aimed to improve the accuracy of arrhythmia detection by enhancing the noise detection algorithm in patient monitoring systems and to determine whether false alarm rate and workload decreased through clinical trials. MATERIAL AND METHODS Trials were conducted on adult patients in the ICU at Yongin Severance Hospital who required continuous electrocardiogram (ECG) monitoring for at least 2 days. After the first trial, the noise detection algorithm of the M50 (investigational device) was improved, and a second trial was conducted to evaluate its performance. Both trials followed the same study design. During the study period, M50 and MX700 (comparator device) were applied simultaneously for 3 days. Arrhythmia alarms were reviewed by an independent evaluator who assessed false alarms by comparing them with the ECG signals. False alarm rates were compared between trials using the chi-square (χ²) test. RESULTS The clinical trial was conducted through 2 separate trials, with 17 and 11 participants, respectively. A comparative analysis of false alarm rates of the investigational device demonstrated a reduction from 71.75% to 27.61%. Statistical analysis using the chi-square test indicated a P value of 0.000 (<0.001), confirming a statistically significant difference. CONCLUSIONS The results of 2 trials demonstrated reductions in false alarm rate and NASA-TLX score. These findings suggest that enhancing the noise detection algorithm in the patient monitoring system improved arrhythmia detection accuracy and helped reduce nurses' workload.

BACKGROUND Visual illusions provide insight into visual perception processes. We examined the McCollough effects (ME) and watercolor effects (WE) in patients with early Alzheimer disease (AD) and cognitively healthy older adults, and evaluated the influence of acetylcholinesterase inhibitors in the AD mild dementia (MD) stage. MATERIAL AND METHODS We included 28, 27, and 26 patients with MD, amnestic mild cognitive impairment (MCI), and normal cognition (control group), respectively. Participants completed the CDR, MMSE, ADAS-Cog 13, Ishihara test, and ME and WE evaluations. ME was evaluated by identifying chromatic changes in vertical, horizontal black, and white line patterns. WE was evaluated by identifying white or colored sections. RESULTS Regarding ME, white vertical lines appeared red, with no significant differences between groups (H=0.834, P=0.659). Differences were observed in perception of white horizontal lines as green (H=10.27, P=0.006). All in the control group, 25 of 27 in MCI group, and 22 of 28 in MD group reported seeing WE (Fisher exact 6.66, P=0.024). In binary logistic regression, cognitive tests and Ishihara results predicted perception of WE. Regarding MD, no significant differences were reported between patients taking or not taking acetylcholinesterase inhibitors (chi-square 0.749, P=0.38; P=0.19, P=1.00, respectively). CONCLUSIONS Perceptions of ME and WE differed significantly between cognitively normal participants and those with early AD, offering insights into the functional alterations of the visual system and ongoing neurodegeneration. The ME after-effect of red horizontal lines might represent very early AD changes, which could aid in a better understanding of AD visual perception.

BACKGROUND Intrauterine devices (IUDs) are widely used for contraception and are generally well tolerated. A rare complication is spontaneous fracture of the IUD while in situ. This study aimed to evaluate the prevalence of spontaneous IUD fractures and compare occurrence between 2 IUD types. MATERIAL AND METHODS This retrospective study included 463 women who underwent IUD insertion and follow-up between January 1, 2011, and December 31, 2021. Two IUDs were evaluated: Type 1, a copper IUD with a gold core (375 mm²), and Type 2, a copper IUD (300 mm²) without a gold core. Spontaneous fractures were identified based on symptoms or routine annual ultrasonography. Statistical analyses included descriptive statistics, normality testing, and comparisons using chi-square, t-tests, or Mann-Whitney U tests. A p value <0.05 was considered significant. RESULTS Among 463 patients, 183 used a Type 1 IUD and 280 used Type 2. Spontaneous fractures were observed in 12 of 183 Type 1 users (6.56%, 95% CI: 2.97-10.15%), while no fractures occurred among Type 2 users. Overall fracture prevalence was 2.59% (95% CI: 1.49-4.48%). Fractured arms were often located in the uterine cornua (n=9) and cervical canal (n=3). Fragments in the canal were removed using Novak extraction, while those in the cornua required hysteroscopy. CONCLUSIONS Spontaneous IUD fractures can occur without symptoms and must be considered during follow-up. Prompt recognition is essential to avoid complications. Hysteroscopy and Novak extraction are effective for fragment removal. Clinicians should consider routine ultrasonographic evaluation to detect asymptomatic IUD fractures, especially in users of Type 1 devices.

BACKGROUND Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory syndrome. The immunopathology of cytotoxic lymphocytes in sHLH is complex and differs from primary HLH. This study aimed to characterize the distribution and perforin expression of key cytotoxic lymphocyte subsets in sHLH and assess their clinical and longitudinal significance. MATERIAL AND METHODS In this single-center observational study, peripheral blood from 19 patients with newly diagnosed sHLH and 10 healthy controls was analyzed using multi-color flow cytometry. Proportions of NK cells, CD8⁺ T cells, and CD56⁺ T cells, along with intracellular perforin expression, were quantified. Six patients were re-assessed after achieving complete response. RESULTS Compared with controls, sHLH patients showed a significantly lower proportion of NK cells, while the percentage of perforin-expressing CD56⁺ T cells was significantly increased. Among sHLH subtypes, NK-cell proportion was significantly lower in lymphoma-associated HLH than in non-lymphoma cases. Longitudinally, CD8⁺ T-cell proportion decreased significantly in patients in remission. NK-cell proportion correlated positively with fibrinogen, a key diagnostic and disease activity marker. Perforin expression in CD56⁺ T cells correlated negatively with alanine aminotransferase, while perforin in CD8⁺ T cells correlated positively with soluble interleukin-2 receptor. CONCLUSIONS sHLH exhibits a distinct immunological profile characterized by reduced NK-cell proportion and increased perforin expression in CD56⁺ T cells, diverging from the primary HLH model. These findings suggest that monitoring cytotoxic lymphocyte dynamics may be valuable for assessing disease activity and treatment response in sHLH, although further validation in larger cohorts is warranted.

BACKGROUND Obstructive sleep apnea (OSA) is associated with increased risk of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause and OSA-related mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify and compare predictors of all-cause and OSA-related mortality over 5, 10, and 15 years of follow-up. MATERIAL AND METHODS In this single-center study conducted at our Sleep Medicine Department between 2005 and 2019, 4025 patients with suspected OSA underwent polysomnography and were enrolled in this longitudinal study. Patients were categorized based on their mortality status, with a follow-up time of up to 15 years, and the cause of death if applicable. Based on the underlying cause of death, we identified 2 study groups: all-cause mortality (n=853) and OSA-related mortality (n=460). We performed Cox regression analyses to evaluate predictors of mortality. RESULTS Prevalence of OSA was high - 75.6% in the cohort: 929 patients with mild OSA (23.1%), 770 with moderate OSA (19.1%), and 1343 with severe OSA (33.4%). Survival rates were 89.7%, 81.9%, and 78.8% at 5, 10, and 15 years, respectively. Cardiovascular causes dominated mortality (33.3%), followed by cancer (26.5%). We compared the apnea-hypopnea index (AHI) a well-known, widely used metric for indicating the severity of OSA, in 0-5, 0-10, and 0-15 years of observation of all-cause mortality and OSA-related mortality. Comparing the AHI during rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, and total sleep time (TST), AHIREM was associated with a higher mortality risk than AHINREM and AHITST. Sleepiness (HR 1.17 95% CI: 1.09-1.26), episodes of stroke (HR 1.77 95% CI: 1.38-2.28), and use of new oral anticoagulants (HR 1.71 95% CI: 1.21-2.43) were associated with mortality at 15 years. CONCLUSIONS OSA management requires a holistic approach that extends beyond AHI, integrating clinical symptoms, comorbidities, and polysomnographic indices.

BACKGROUND Hyperuricemia in patients undergoing maintenance hemodialysis (MHD) has been associated with an increased risk of cardiovascular disease, although its role remains controversial. This study aims to evaluate the prevalence of hyperuricemia and its association with cardiovascular disease risk factors among patients undergoing MHD in Southwest China. MATERIAL AND METHODS This study included 99 patients who underwent MHD at the Blood Purification Center of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. We statistically analyzed the general characteristics, physical indicators, biochemical markers, and cardiac ultrasound parameters. We examined the correlation between serum uric acid levels and cardiovascular risk factors. RESULTS Logistic regression analysis revealed that heavy smoking and higher abdominal fat thickness, waist circumference, and systolic blood pressure were significantly associated with elevated serum uric acid levels. Multivariate linear regression analysis revealed that, compared with patients with normal uric acid levels, those with elevated levels showed gradual increases in triglycerides, C-reactive protein, parathyroid hormone, homocysteine, left ventricular posterior wall thickness, interventricular septum thickness, and left ventricular end-diastolic diameter. In contrast, high-density lipoprotein cholesterol levels and left ventricular ejection fraction progressively decreased. CONCLUSIONS In patients undergoing maintenance hemodialysis, hyperuricemia is closely associated with heavy smoking and abdominal obesity. These associations may increase cardiovascular risk through multiple pathways, including changes in biochemical markers (eg, triglycerides, C-reactive protein) and alterations in cardiac structure. Moreover, this risk increased proportionally with higher serum uric acid levels.

BACKGROUND Percutaneous kyphoplasty and vertebroplasty are the most commonly used minimally invasive procedures for Kümmell disease. However, they are not always effective in treating Kümmell disease with segmental instability. This study aimed to evaluate the efficacy of short-segment bone cement-augmented pedicle screw fixation combined with bone grafting in the treatment of Kümmell disease with segmental instability. MATERIAL AND METHODS The study included 23 patients treated with short-segment bone cement-augmented pedicle screw fixation combined with bone grafting between January 2021 and January 2024. The Oswestry Disability Index (ODI), visual analog scale (VAS) score, vertebral anterior height, and kyphotic Cobb angle were evaluated. The operation time, hospital stay, intraoperative blood loss, and complications were recorded. RESULTS The VAS scores, ODI scores, vertebral anterior height, and kyphotic Cobb angles showed statistically significant differences between before and 1 week after surgery and between before surgery and at final follow-up (P<0.05). VAS and ODI at the final follow-up were lower than those measured 1 week postoperatively (P<0.05), but no significant difference was found in the vertebral anterior height and kyphotic Cobb angle (P>0.05). Twenty-one patients (91.3%) had achieved solid fusion at final follow-up. No serious complications were observed in any of the cases. CONCLUSIONS Short-segment bone cement-augmented pedicle screw fixation combined with bone grafting is a safe and effective treatment for Kümmell disease with segmental instability. This approach can achieve significant pain relief and functional improvement, provide satisfactory correction of kyphosis and vertebral height restoration, and result in a low complication rate.

BACKGROUND Surface conditioning methods play a critical role in enhancing adhesion by creating micro-mechanical and chemical bonds between resin cement and ceramics. This study aimed to evaluate the effects of different surface treatments on micro-tensile bond strength (MTBS) between resin cement and glass-infiltrated zirconia (GLZR), as well as surface changes in topography, roughness, and elemental properties assessed by energy-dispersive X-ray analysis (EDAX). MATERIAL AND METHODS Thirty GLZR blocks were fabricated and divided into 3 groups (n=10) according to the applied surface treatment: laboratory grit-blasting (LGB), laboratory silica coating (LSC), and hydrofluoric acid etching (HFAE). After treatment, specimens were bonded to composite blocks with resin cement, and MTBS was tested using a universal testing machine. Surface roughness was measured; morphological and elemental changes were examined by scanning electron microscopy (SEM) and EDAX. RESULTS The LSC group exhibited the highest MTBS (28.23±1.53 MPa), followed by the LGB group (20.27±2.33 MPa) and the HFAE group (10.41±1.46 MPa). Surface roughness was highest in the LGB group (Ra=9.34±1.23 μm). SEM analysis revealed prominent crater formation in the LGB and LSC groups, whereas the HFAE group showed minimal topographic change. EDAX indicated increased silica content in the LSC group and reduced zirconia content in the LGB group; these findings were linked to enhanced chemical bonding. CONCLUSIONS Among the tested surface treatments, laboratory silica coating significantly improved both surface chemistry and MTBS, making it the most effective method for strengthening resin-zirconia adhesion.

BACKGROUND Acute cerebral infarction significantly impacts patients' physical, cognitive, and psychological health. Evidence-based nursing (EBN) interventions offer a patient-centered approach to address these multifaceted challenges. This study evaluated the effectiveness of EBN in improving psychological outcomes, cognitive function, independence in daily living, and quality of life in patients with acute cerebral infarction. MATERIAL AND METHODS A retrospective study was conducted on 256 patients with acute cerebral infarction between January 2022 and December 2023. Patients were assigned to either the control group (routine care, n=126) or the observation group (EBN care, n=130). Clinical outcomes, including Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Chinese version of the Mini-Mental State Assessment (CMMS), Activities of Daily Living (ADL), and World Health Organization Quality of Life Assessment (WHOQOL-BREF) scores, were compared before and after intervention. Statistical analyses were performed using SPSS version 27.0, with significance set at P<0.05. RESULTS The observation group demonstrated significantly greater improvements across all measured outcomes compared to the control group (P<0.05). Post-intervention HAMD and HAMA scores decreased substantially in the observation group, indicating reduced psychological distress. Similarly, CMMS and ADL scores improved markedly, reflecting enhanced cognitive function and greater independence. Quality-of-life scores across physical, social, psychological, and environmental domains were significantly higher in the observation group. CONCLUSIONS EBN interventions significantly improve psychological outcomes, cognitive function, daily living independence, and quality of life in patients with acute cerebral infarction. These findings support the integration of EBN into routine stroke care to optimize patient recovery and overall prognosis.

BACKGROUND The choice of prosthetic valve for surgical mitral valve replacement (SMVR) remains a clinical challenge, particularly in balancing long-term survival with anticoagulation risk and prosthesis durability. In Taiwan, newer-generation tissue valves were introduced in recent years, providing additional options for patients and clinicians. MATERIAL AND METHODS We conducted a nationwide, retrospective cohort study using Taiwan's National Health Insurance Research Database from 2000 to 2017. Adult patients who underwent SMVR were categorized based on the prosthesis type: mechanical valve (MV), porcine bioprosthetic valve (PV), or newer-generation durable-tissue valve (DV). Propensity-score matching (PSM) was applied to minimize baseline differences. Outcomes analyzed included all-cause mortality, index hospitalization cost, length of hospital stay, and re-operation rates within 3 years. RESULTS Among 10 406 patients (5301 MV, 4300 PV, 805 DV), the DV group was older than in the MV group but younger and healthier than in the PV group. After PSM, DV was associated with significantly lower all-cause mortality compared to PV (HR: 0.61; 95% CI: 0.50-0.74; P<0.001) and MV (HR: 0.72; 95% CI: 0.60-0.88; P=0.002). Hospitalization costs and length of stay were highest for PV, moderate for DV, and lowest for MV. Within 3 years, DV showed the lowest re-operation rate (0.75%) compared to MV (1.96%; OR: 2.66, 95% CI: 1.17-6.09) and PV (3.21%; OR: 4.42, 95% CI: 1.94-10.03). CONCLUSIONS In this retrospective cohort, newer durable-tissue valves were associated with favorable early survival, lower short-term re-operation rates, and moderate hospitalization costs compared to older prostheses. However, the limited follow-up, potential confounding, heterogeneity of valve models, and era-related improvements in care preclude definitive conclusions about long-term durability or superiority. These real-world findings highlight the need for individualized prosthesis selection and longer-term prospective studies to confirm these observations.

Arthropod-borne viruses (arboviruses) are RNA viruses that depend on transmission to humans and other vertebrates through the bites of infected mosquitoes, ticks, and sand flies. On March 31, 2022, the World Health Organization (WHO) Global Arbovirus Initiative identified the need for risk mapping as a crucial source of evidence for arbovirus disease surveillance and provided updated recommendations to improve current management. On May 20, 2025, the 78th World Health Assembly of the WHO adopted the Pandemic Agreement to highlight the importance of pandemic preparedness. The arbovirus diseases dengue, chikungunya, Zika, and yellow fever have been identified as an escalating global threat in urbanized areas, as indicated by new global risk maps for Aedes-borne arboviruses. On July 4, 2025, the WHO published its first global guidelines for managing infections by the four most significant arboviruses: dengue virus, chikungunya virus, Zika virus, and yellow fever virus. This article aims to review the changing global distribution of arbovirus transmission, the increased risk to human health from arbovirus diseases, and the potential for both epidemics and future pandemics, which have led to recent WHO recommendations and warrant the inclusion of arbovirus diseases as candidates for Disease X.

BACKGROUND Postoperative delirium affects recovery. Dexmedetomidine shows promise in reducing it, but the ideal dose is unclear. MATERIAL AND METHODS We performed a systematic review of randomized controlled trials and meta-analyses. Studies from PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Only trials involving adults (≥18 years) were considered. The effectiveness of high (loading dose, >0.5 µg/kg) and low doses (loading dose, ≤0.5 µg/kg) of dexmedetomidine in preventing delirium was examined, along with the incidence of delirium and adverse events like hypotension and bradycardia. RESULTS High-dose dexmedetomidine was associated with a lower delirium incidence compared to low-dose. The incidence of bradycardia or hypotension did not differ significantly between the 2 groups. However, some included studies had small sample sizes, focused on intraoperative use, or had potential data bias and heterogeneity in the low-dose group. CONCLUSIONS High-dose dexmedetomidine may be more effective in reducing postoperative delirium without increasing the risk of bradycardia or hypotension. But due to study limitations, more randomized controlled trials are required to confirm these findings.

BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) has a with high incidence rate and a high mortality rate in elderly patients, and inflammation plays an important role. As a useful inflammatory marker, the relationship between the inflammatory burden index (IBI) and in-hospital death of elderly patients with NSTEMI remains unclear. The aim of this study was to investigate the predictive value of IBI for in-hospital death in elderly patients with NSTEMI. MATERIAL AND METHODS This single-center study retrospectively enrolled patients diagnosed with NSTEMI between February 2021 and February 2025. All patients were ≥75 years old and did not receive percutaneous coronary intervention (PCI) treatment during hospitalization. Patients were divided into 2 groups according to whether cardiogenic death occurred during hospitalization. IBI was calculated as the product of C-reactive protein and the neutrophil-to-lymphocyte ratio. RESULTS This study enrolled a total of 418 patients, with a mean age of 79.60±3.67 years. During the hospitalization period, cardiogenic death occurred in 43 (10.3%) patients. After adjusting for possible confounding factors, multivariate logistic regression analysis showed that IBI (OR=2.22, 95% CI: 1.64-3.00) was an independent risk factor for in-hospital death in elderly patients with NSTEMI. Restricted cubic spline suggested a non-linear dose-response relationship between IBI and in-hospital death. The results of ROC showed that the area under the curve of IBI was 0.760. CONCLUSIONS In elderly patients with NSTEMI, IBI demonstrated an independent association with in-hospital mortality, with modest discriminatory performance. There is a non-linear dose-response relationship between IBI and in-hospital death in elderly patients with NSTEMI.

BACKGROUND Physical activity (PA) is essential for individuals with Parkinson's disease (PD) to maintain functional independence and quality of life. However, difficulties in accurately measuring PA complicate the identification of effective and beneficial interventions. Understanding the discrepancies between self-reported and objectively measured PA is critical for clinical practice. This study compared self-reported and objectively measured PA among people with PD, considering their participation in functional physical rehabilitation (FPR). MATERIAL AND METHODS The International Physical Activity Questionnaire and Actigraph GT3X+ were used to measure PA. Patients with PD (n=47) in stages II or III of the disease according to the Hoehn and Yahr scale, aged 64.37±7.12 years, with disease duration of 6.29±4.02 years were divided into 2 groups: participating (Group A) and not participating (Group B) in FPR. The FPR program combined motor symptom-targeted therapy with task-oriented training to improve functional independence and quality of life. RESULTS Comparing self-reported weekly PA with the objective showed statistically significant differences (P<0.05) in both groups - the self-reported PA was 8.61% higher in Group A and 56.70% higher in Group B. In Group A, declared PA was higher than the objective in all intensity zones: by 19.50% in high, by 10.52% in moderate, and by 7.35% in low. In Group B, declared PA was higher than the objective by 250% in high-intensity, by 90.66% in moderate-intensity, and by 48.32% in low-intensity. CONCLUSIONS We found significant differences between self-reported and objectively measured PA in people with PD, based on their participation in FPR. Participation in FPR seems to improve the accuracy of PA self-assessment, demonstrating the importance of objective PA measurement in clinical practice.

Chronic diseases such as asthma, which affect many children, require ongoing monitoring to identify agents that worsen morbidity and cause molecular changes. Asthma is a health condition with genetic and environmental influences. While the molecular mechanisms are still under investigation, the environmental component remains a pivotal part of understanding and managing the disease. The environment largely influences the development of asthma. Therefore, to obtain essential data regarding the effect of environmental exposure, it is vital to use omics science, such as exposomics. Accordingly, the purpose of this review was to collect the most essential information on asthma, with emphasis on early childhood asthma, and to provide an introduction to the role of environmental exposure in relation to asthma, with a background of exposomics. The exposome has recently become a vital interdisciplinary concept, focusing on identifying how environmental agents influence health and disease throughout a person's life. Consequently, exposomics is the study of the exposome, encompassing measurements of environmental exposure and the associated biological reactions. In addition, attention has been focused on examples of potential environmental pollutants to which children may be exposed in their immediate surroundings, including phthalates, polycyclic aromatic hydrocarbons, per- and polyfluoroalkyl substances, and secondhand smoke. Finally, this review highlights the role of exposomics studies in pediatric asthma in 3 areas: clinical, analytical, and environmental. In summary, in this article, we aim to review the potential effects of the exposome, or multiple environmental factors, on childhood asthma.

BACKGROUND The optimal antithrombotic regimen for patients with atrial fibrillation (AF) and multivessel disease undergoing complex percutaneous coronary intervention (PCI) remains controversial, particularly with high ischemic and complex coronary anatomy. MATERIAL AND METHODS We retrospectively recruited 56 AF patients with SYNTAX scores >22 who underwent PCI January 2018-December 2023. Patients were grouped by antithrombotic strategy 1 year after PCI, as follows: oral anticoagulant (OAC) alone (monotherapy group, n=32) or OAC plus antiplatelet therapy (APT; dual-therapy group, n=24). RESULTS Baseline demographics, comorbidities, and coronary disease severity were comparable. At 1-year follow-up, composite endpoint rates were significantly higher in the dual-therapy group (66.7%) than monotherapy group (28.1%, P=0.006). Revascularization rates were notably higher in the dual-therapy group (50.0% vs 12.5%, P=0.003), including target lesion (33.3% vs 9.4%, P=0.041) and target vessel revascularization (37.5% vs 9.4%, P=0.019). One year after index PCI, continued dual therapy was associated with a significantly increased risk of revascularization (HR: 4.003, 95% CI: 1.287-12.450, P=0.017) in univariate Cox regression analysis. CONCLUSIONS In AF patients with complex coronary artery disease, continuation of OAC plus APT beyond 1 year after PCI was associated with higher adverse clinical outcomes and greater need for repeat revascularization, compared with OAC alone, suggesting long-term OAC monotherapy represents a safer and equally effective alternative for selected high-risk patients. However, given the retrospective design and limited sample size of our study, OAC monotherapy warrants prospective validation in AF patients with complex PCI, as our retrospective results should be regarded as hypothesis-generating.