Objective: Early-onset scoliosis (EOS) poses a significant therapeutic dilemma, as progressive spinal curvature during early growth can compromise thoracic development and pulmonary function. The growing-rod domino technique has emerged as an important surgical strategy, allowing serial deformity correction while preserving spinal growth and reducing the need for repeated surgical interventions. Methods: We report a technical case study of a 9-year-old girl with idiopathic EOS who presented with a right thoracic Cobb angle of 107° and a compensatory lumbar curve of 62°, Risser stage 0, and a restrictive pulmonary pattern (forced vital capacity 72% predicted). Under general anesthesia with continuous neurophysiological monitoring, rod constructs were anchored proximally at T2–4 and distally at L3–4 using unilateral pedicle screws. The rods were contoured to maintain sagittal balance and tunneled submuscularly. A 20-mm intraoperative distraction was performed. Postoperative management included early mobilization, outpatient magnetic lengthening, and serial radiographic assessments. Results: Intraoperative distraction reduced the thoracic and lumbar curves to 42° and 20°, respectively, with stable somatosensory evoked potential and motor evoked potential signals maintained throughout the procedure. The patient was extubated without complications, mobilized on postoperative day 2, and discharged on postoperative day 4. At 6-month follow-up, outpatient growing-rod activations achieved an additional 5 mm of spinal length. Radiographs confirmed sustained deformity correction, preserved spinal growth, and intact instrumentation. No perioperative or follow-up complications, including infection, implant failure, or autofusion, were observed. Clinically, the patient demonstrated improved trunk symmetry and respiratory function. Conclusion Growing-rod constructs using the domino technique provide a safe, effective, and patient-centered approach for the management of severe EOS. By achieving meaningful deformity correction while allowing continued spinal growth and reducing overall surgical burden, the growing-rod domino technique represents a valuable treatment option in skeletally immature patients, enabling deferral of definitive fusion until skeletal maturity.

Purpose: Diagnostic errors contribute to patient safety risks, often arising from cognitive failures in clinical reasoning. Preceptorship is thought to improve residents’ clinical reasoning. The aim of this study was to evaluate the effect of a preceptorship program on clinical reasoning among pediatric residents. Methods: This randomized controlled trial was conducted from March 2025 to May 2025 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. All pediatric residents were randomly allocated into two groups. The intervention group received a scheduled preceptorship program, while the control group continued with standard supervision. After 8 weeks, clinical reasoning skills were assessed using the Script Concordance Test (SCT). Data were analyzed using comparation test. End-of-program questionnaires were also reported. Results: Total 41 residents completed the study. Baseline characteristics did not differ between groups (p>0.05). Mean overall SCT scores ranged from 55% to 90% of the maximum possible score. Among 14 topics, hematology & oncology was the only topic that showed a significant difference in SCT scores between the intervention group (median, 14.28; interquartile range [IQR], 12.78–15.08) and the control group (median, 12.75; IQR, 11.49–13.63). Participants reported that preceptorship made learning more structured and interactive but noted barriers including busy preceptor schedules and lack of standardized teaching materials. Conclusion The preceptorship program resulted in a significant improvement in only one topic, which may reflect suboptimal implementation of the intervention. Despite this, participants reported positive perceptions, indicating good acceptability. More intensive and consistent preceptorship may be required to achieve measurable improvements in clinical reasoning.

We reviewed our experience using transulnar access (TUA) to obtain intraoperative cerebral angiography during prone surgery for vascular pathology, where conventional transfemoral and transradial access can be difficult. Ten consecutive patients treated between April 2020 and August 2025 were included. Ulnar artery access was obtained in the supine position before the patient was turned prone for surgery, and angiography was performed after the procedure without repositioning. Eight patients had arteriovenous malformations and 2 had dural arteriovenous fistulas. In all cases, intraoperative angiography was successfully completed through the ulnar artery. The mean ulnar artery diameter was 2.4 mm, indicating adequate vessel size for catheterization, and mean fluoroscopy time was 7.5 minutes. No immediate access-site complications occurred, and no case required conversion to another access route. These findings suggest that TUA is technically feasible and may provide a practical option for intraoperative cerebral angiography when prone positioning limits access to traditional arterial sites. Although the study is limited by its small sample size and retrospective design, the consistent procedural success supports further investigation.

Elastofibroma dorsi is a rare, benign soft tissue tumor that typically arises in the infrascapular region. Although it is often asymptomatic, some patients experience pain or a snapping sensation during shoulder movement, which warrants surgical excision. We report a symptomatic case in a middle-aged male patient, highlighting the diagnostic imaging features and surgical management of this condition.

Objective: To evaluate the protective effects of fulvic acid against amoxicillin-clavulanateinduced hepatotoxicity using biochemical, histopathological, immunohistochemical, functional, and bioinformatic analyses. Methods: Twenty-eight male Wistar rats were randomly assigned to 4 groups (n = 7/ group): sham (saline), amoxicillin-clavulanate (10 mg/kg/day), fulvic acid (100 mg/kg/ day), and combined treatment. Treatments were administered orally for 21 days. Liver injury and oxidative stress were assessed by serum alanine aminotransferase, aspartate aminotransferase, malondialdehyde, total antioxidant status, and total oxidant status; tissue injury was assessed histologically. Apoptosis was evaluated by immunohistochemistry for BAX and BCL2. Hepatic detoxification capacity was assessed by a caffeine clearance test.In silico analyses predicted molecular targets of fulvic acid and enriched pathways. Results: Amoxicillin-clavulanate increased transaminases, oxidative stress markers, and proapoptotic signaling and induced vascular congestion and sinusoidal dilatation.Co-treatment with fulvic acid improved serum biomarkers, reduced histological injury, downregulated BAX, and restored BCL2 staining intensity. In silico analysis identified predicted fulvic-acid targets enriched in metabolic and proliferation-related pathways. Conclusions and Relevance: Fulvic acid attenuated amoxicillin-clavulanate-induced hepatotoxicity, consistent with antioxidant and antiapoptotic mechanisms. Further studies are warranted to define dose-response relationships and translational potential.

Abstract Background: Sarcopenia and frailty are common geriatric syndromes that may contribute to mild cognitive impairment (MCI). Evidence regarding the independent roles of individual sarcopenia components and frailty in MCI remains limited in low- and middle-income countries. This study evaluated the association between sarcopenia components, frailty, and MCI among older adults in Indonesia. Methods: An ambispective cohort study was conducted among adults aged ≥60 years attending the Geriatric Outpatient Clinic of Dr. Cipto Mangunkusumo National General Hospital, Jakarta. Sarcopenia components were assessed using SARC-Calf (low muscle mass indicator), handgrip strength, and the five-times sit-to-stand test. Frailty was evaluated using the FRAIL scale. Cognitive function was assessed using the Rapid Cognitive Screening. Multivariate log-binomial or Poisson regression with robust variance was used to estimate adjusted risk ratios (RRs) for MCI. Results: A total of 121 participants (median age 74 years; 68.6% female) were included, with an MCI prevalence of 21.5%. After adjustment for confounders, low muscle mass indicator (RR 2.206; 95% CI 1.045–4.652) and low muscle strength (RR 3.006; 95% CI 1.202–7.517) were independently associated with MCI. Low physical performance (RR 1.773; 95% CI 0.796–3.773) and frailty (RR 1.086; 95% CI 0.377–3.134) were not significantly associated with MCI. Conclusion: Low muscle mass indicators and reduced muscle strength were independently associated with MCI, supporting the integration of simple sarcopenia screening tools into routine geriatric cognitive assessment.
sarcopenia ; frailty ; mild cognitive impairment ; rapid cognitive screening

Abstract Vitamin D deficiency is a significant health issue, particularly among office workers. This literature review emphasizes the availability of evidence on vitamin D deficiency and its impacts on musculoskeletal health and immune functions, especially amongst office workers. A literature search of PubMed, Scopus, and Web of Science identified relevant studies on the relationship between vitamin D status and musculoskeletal health and infection risks, highlighting the prevalence of vitamin D deficiency in office workers due to limited sunlight exposure and sedentary lifestyles. The risks of osteoporosis, muscle weakness, and musculoskeletal pain, as well as impaired immune system function, are carefully examined. Potential intervention strategies include implementing work schedules allowing for outdoor breaks, providing access to vitamin D-fortified foods or supplements, and routine screening for vitamin D levels. Addressing the low level of vitamin D in office workers is essential for promoting musculoskeletal health, supporting immune functions, and enhancing workforce productivity. This review underscores the need for further research and the implementation of evidence-based interventions to mitigate the impact of vitamin D deficiency in this population.
Vitamin D deficiency ; office workers ; musculoskeletal ; Immunity

Malaria remains one of the leading causes of death worldwide, particularly in Africa, where various control interventions such as case management, insecticide-treated nets (ITNs), intermittent preventive treatment in pregnant women and infants, and indoor residual spraying (IRS) have been implemented. Insecticide resistance in malaria vectors poses a major challenge to vector control efforts. This study assessed the insecticide resistance status of Anopheles gambiae s.l. populations in rice agroecosystems of Anambra State, Nigeria. Mosquito larvae were sampled from four rice-farming clusters in Anambra state, reared to adulthood at the National Arbovirus and Vector Research Center (NAVRC) and tested using the WHO susceptibility bioassay against four insecticides namely dichloro-diphenyl-trichloroethane (DDT), pirimiphos-methyl, bendiocarb, and deltamethrin. Knockdown resistance (kdr) mutations were also analyzed. Results revealed confirmed resistance to DDT and deltamethrin, likely due to past agricultural use of DDT and cross-resistance with pyrethroids, which are widely used in ITNs and IRS. However, An. gambiae s.l. populations remained susceptible to bendiocarb and pirimiphos-methyl, except in Umunze, where resistance to pirimiphos-methyl was detected. The L1014F kdr mutation was detected at varying frequencies across locations, a key genetic marker for resistance to pyrethroids and DDT, in both An. gambiae s.s. and An. coluzzii. These findings highlight the importance of continuous insecticide resistance monitoring in rice agroecosystems, improved pesticide regulations and the implementation of integrated vector control management to slow down the spread of resistance in malaria vectors in Anambra

Aedes aegypti and Aedes albopictus mosquitoes are the primary vectors of tropical diseases, including dengue fever (DHF), chikungunya, and Zika, particularly in tropical regions such as Malaysia. Vector control efforts are now increasingly focused on biological and environmentally friendly approaches, one of which is using insect growth regulator (IGR)-based insecticides such as pyriproxyfen. Pyriproxyfen works by disrupting the metamorphosis process of mosquito larvae into adults without causing direct death, but it is effective in inhibiting the emergence of adult mosquitoes by more than 90%, depending on the dose and environmental conditions. This study evaluated the concentration-dependent effects of pyriproxyfen on laboratory and field populations of Aedes spp. Laboratory strains exhibited 100% adult mortality at 1.04 ppm (Ae. aegypti) and 1.08 ppm (Ae. albopictus), whereas field populations required 1.15 – 1.71 ppm depending on locality. LC50 values were lowest in laboratory strains (0.267 ppm for Ae. aegypti and 0.236 ppm for Ae. albopictus), while field strains ranged from 0.326 to 0.571 ppm. LC95 values followed a similar trend, with 1.026 ppm (Ae. aegypti) and 1.107 ppm (Ae. albopictus) in laboratory strains. Inhibition of emergence (IE%) was high in laboratory strains, reaching 97.89% at 0.50 ppm in Ae. aegypti and 63.54% at 0.50 ppm in Ae. albopictus. Field populations required higher concentrations for similar suppression, with IE% ranging from 17.68 – 98.23% in Ae. aegypti and 13.14- 98.24% in Ae. albopictus, peaking at 1.50 ppm. From this finding, it is suggested that pyriproxyfen effectively inhibits adult emergence in both laboratory and field populations, with laboratory strains more sensitive at lower concentrations and field strains responding at higher doses. These results provide strong evidence for pyriproxyfen as an effective, adaptive, and sustainable component of integrated vector management in Malaysia.

OBJECTIVE: To explore the potential apoptotic mechanisms of 3 Morchella extracts (Morchella conica, Morchella esculenta and Morchella delicosa) on breast and colon cancer cell lines using apoptotic biomarkers. METHODS: Human breast cell line (MCF-7) and colon cancer cell line (SW-480) were treated with methanol and ethanol extracts of 3 Morchella species with concentration ranging from 0.0625 to 2 mg/mL. After that their effects on gene expression of apoptosis related markers (pro-apoptotic markers including Bax, caspase-3, caspase-7, and caspase-9, and the antiapoptotic marker including Bcl-2) were determined using reverse transcription polymerase chain reaction. RESULTS: All Morchella extracts reduced breast and colon cancer cells proliferation at half inhibitory concentration (IC₅₀) of 0.02 ±0.01 to 0.68 ±0.30 mg/mL. As expected, all Morchella extracts significantly increased gene expressions of Bax, caspase-3, caspase-7, and caspase-9 and downregulated the gene expression of Bcl-2 in MCF-7 and SW-480 cell lines (P<0.05). CONCLUSIONS Morchella extracts demonstrated significant anti-proliferative activity against breast and colon cancer cell lines via an apoptosis induction mechanism. Anticancer activity of Morchella extracts and activation of apoptosis in breast and colon cancer cells suggest that it may be used to develop chemotherapeutic agents against cancer in future.
Humans ; Apoptosis/genetics* ; Colonic Neoplasms/drug therapy* ; Breast Neoplasms/drug therapy* ; Cell Line, Tumor ; Cell Proliferation/drug effects* ; Plant Extracts/pharmacology* ; Gene Expression Regulation, Neoplastic/drug effects* ; MCF-7 Cells ; Ascomycota/chemistry*