Objective: To compare the outcome of rectal and surface electrode stimulation, when performed concomitantly with routine anal sphincter (AS) exercises and bio-feedback training, in children who have received corrective surgery to address Hirschsprung disease (HD). Methods: Sixty-seven patients (pediatric) who underwent corrective surgery due to HD were randomly assigned to Group A (rectal electrode, n=34) or Group B (surface electrode, n=33). The two groups were given the same protocols of AS and bio-feedback training. The Pediatric Quality of Life Inventory (PedsQL), Bowel Function Score (BFS), Pediatric Incontinence and Constipation Scoring System Scale (PICSS) were measured at baseline, post intervention and follow-up. Results: There were significant improvements in both groups over time across all outcomes. PedsQL increased (d=0.42–1.28, η²p up to 0.37), BFS improved notably (d=1.21, η²p=0.35), and PICSS decreased (d up to 1.15, η²p=0.33). The greatest gains occurred from baseline to follow-up, with smaller but significant changes from post-treatment to follow-up, indicating sustained effects. Conclusion Electrical stimulation with rectal electrodes, combined with AS exercises and bio-feedback training, is a major way of improving bowel functioning, continence and quality of life in Hirschsprung child. Such results highlight the promise of multimodal rehabilitation and should be supported by additional multicenter studies.

Background: Orthognathic surgery has become increasingly accurate with the integration of computerized technologies. This study aimed to evaluate the accuracy of custom-made plates in transferring the three-dimensional virtual plan to intraoperative maxillary repositioning. Methods: This study included 10 patients. A digital surgical simulation technique was used for preoperative planning. The surgical components— osteotomy/plates, locating guides, and customized titanium plates—were fabricated using computer-aided design and manufacturing techniques, replacing the need for a surgical splint. Postoperative outcomes were assessed using unaltered anatomical landmarks from the preoperative virtual plan. Absolute discrepancies in translational and rotational movements between the planned and actual postoperative positions were measured through superimposition analysis. This evaluation assessed the precision of custom-made plates in transferring the virtual surgical plan, identifying deviations in the cephalocaudal, mediolateral, and anteroposterior directions that could influence functional and esthetic outcomes. Results: No statistically significant differences were observed for any landmarks across the axial, coronal, and sagittal planes. The greatest variability was noted at the posterior nasal spine landmark in the axial plane (1.7 mm), compared with the coronal (0.9 mm) and sagittal (0.5 mm) planes. Conclusion Customized titanium plates effectively transferred the virtual surgical plan for maxillary repositioning without the need for an occlusal splint. However, potential posterior interference should be considered during surgical execution.

Background: Global longitudinal strain (GLS) is a valuable tool for assessing left ventricular (LV) systolic function, detecting subclinical dysfunction earlier than classic ejection fraction. Two-dimensional speckle-tracking echocar‑ diography (2D-STE) is widely used due to its accessibility and high temporal resolution, whereas feature-tracking cardiac magnetic resonance (FT-CMR) offers superior spatial resolution and reproducibility. In this study, we assess the relationships between longitudinal strain measurements obtained by 2D-STE and FT-CMR in patients with chronic ischemic heart disease (IHD). Methods: Fifty-five patients with IHD and left ventricular ejection fraction (LVEF) ≤ 49% underwent 2D-STE and FTCMR at least 3 months after an acute coronary event. Global and segmental longitudinal strain for all 17 myocardial segments was measured using both modalities. Pearson correlation and Bland–Altman analysis were used to assess correlation and agreement, respectively. Results: GLS showed a strong correlation between 2D-STE and FT-CMR (r = 0.793, P < 0.001), with a mean difference of 0.98% and limits of agreement from –3.2% to + 5.1%. Segmental strain demonstrated greater variability (r = 0.03 to 0.47), with the best agreement in mid and apical segments and greatest discrepancies at the basal level. Conclusions In patients with IHD and reduced LVEF, GLS obtained by FT-CMR and 2D-STE showed strong correla‑ tion and acceptable overall agreement. However, the relatively wide limits of agreement and variability in segmental strain, particularly in basal regions, indicate that the two methods are not fully interchangeable for individual assess‑ ment and follow-up. Both techniques reflect similar physiological trends but differ in absolute values, requiring cau‑ tion in regional strain interpretation.

Introduction: COVID-19 pandemic placed unprecedented strain on hospital resources and manpower. This study assesses the impact of Malaysia’s nationwide lockdown on the incidence, types, severity, and outcomes of emergency general surgery (EGS) cases at a tertiary care hospital. Methods: This retrospective cohort study analysed the data of patients who underwent EGS procedures for the period 2017 and 2021. Results: During the pandemic period, there was a 48.3% reduction in EGS cases (n=889) compared to the pre-pandemic period (n=1720). Significant reductions were observed in surgeries for appendicitis, soft tissue infection, colorectal, urology, peptic ulcer, and vascular disorders in the COVID period. Conversely, procedures for biliary disorders and hernia complications increased by 7.4% and 5.5%, respectively. Length of hospital stay increased by 57.8% for patients with small bowel disorders, while ICU/HDU admissions rose by 43.5% for colorectal cases (P < 0.05). There was no significant difference in mortality rates between the two periods. Conclusions The overall reduction in EGS procedures during the COVID-19 period was consistent with global trends. Despite the challenges posed by the pandemic, the outcomes related to duration of stay, ICU/HDU utilisation, and mortality remained comparable to the pre-pandemic period. These findings highlight the adaptability of healthcare professionals in maintaining continuity and quality of emergency surgical care during a crisis.
Acute Care Surgery ; COVID-19 ; Pandemics

Methods: This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI. Results: Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups. Conclusions Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.

Background and Objectives: The timing of the reinstitution of warfarin after cesarean section (CS) delivery was not adequately addressed in the literature. This study aims to evaluate the risks of early versus late initiation of warfarin post-CS in patients with mechanical heart valves. Methods: This randomized, open-label cohort study included 114 pregnant women with mechanical heart valves planned to be delivered by CS at or after 28 weeks of gestation.Patients were randomly divided into two groups: Day-2-group, where warfarin was started on day 2, and Day-5-group, where warfarin was started on day 5 after CS. Maternal postoperative bleeding complications, mechanical valve thrombosis, need for blood transfusion or reoperation, and maternal mortality were identified. Results: Ten women (8.8%) had 11 bleeding complications, of whom 2 patients (20%) had intraperitoneal hemorrhage (none in Day-2-group and 2 in Day-5-group), 3 patients (30%) had subcutaneous hematoma (none in Day-2-group and 3 in Day-5-group), and 6 patients (60%) had sub-rectus hematoma (3 in Day-2-group and 3 in Day-5-group). No mechanical valve thrombosis, other thromboembolic events, or in-hospital maternal mortality were reported. Conclusion Despite the small number of events, the bleeding risk was lower in the group with early post-CS warfarin introduction than in the group with late warfarin introduction in patients with prosthetic heart valves.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

BACKGROUND: Previous studies have demonstrated that short-term exposure to ambient particulate matter elevates the risk of ischemic stroke in major urban areas of various countries. However, there is a notable gap in research focusing on remote areas inhabited by ethnic minorities and the cumulative effects of air pollutants. Our study conducted in the area aims to explore the potential association between ischemic stroke and air pollutants and contribute to improving health outcomes among the community. METHODS: This retrospective observational study was conducted at the Xing'an League People's Hospital in Inner Mongolia. The medical records of 4,288 patients admitted for IS between November 1, 2019, and October 31, 2020, were reviewed. Data on demographics (age and sex), air pollutants (PM₁₀, PM_2.5, NO₂, NO, CO, and O₃), and meteorological factors (daily average temperature, daily average wind speed, and daily average atmosphere pressure) were collected and analyzed. The statistical analysis included descriptive statistics, Poisson distribution analysis to evaluate the adverse effects of atmospheric pollutants on daily hospitalizations, and subgroup analysis to determine whether gender and age could modify the impact on hospitalizations. RESULTS: A substantial correlation was revealed in single-day lags model. The peak delayed effects of PM₁₀, PM_2.5, SO₂, and NO₂ were observed at lag8 (PM₁₀ (OR = 1.016, 95%CI 1.002, 1.030), PM_2.5 (OR = 1.027, 95%CI 1.007, 1.048), SO₂ (OR = 1.153, 95%CI 1.040, 279) and NO₂ (OR = 1.054, 95%CI 1.005, 1.105)) while males exhibited a consistent trend from lag0 to lag8 (PM₁₀ (OR = 1.035, 95%CI 1.018, 1.053), PM_2.5 (OR = 1.056, 95%CI 1.030, 1.082), SO₂ (OR = 1.220, 95%CI 1.072, 1.389), NO₂ (OR = 1.126, 95%CI 1.061, 1.120), CO (OR = 10.059, 95%CI 1.697, 59.638) and O₃ (OR = 0.972, 95%CI 0.946, 0.999)). When gender and age were considered, a positive impact was also observed after three days cumulative effect in males. CONCLUSIONS There is a significant cumulative effect of exposure to air pollution on IS hospital admissions, especially the males and patients under the age of 65. Our results also suggested that a notable association between CO and NO₂ in two-pollutant models.
Humans ; Male ; Female ; Air Pollution/analysis* ; China/epidemiology* ; Retrospective Studies ; Middle Aged ; Air Pollutants/analysis* ; Aged ; Particulate Matter/analysis* ; Hospitalization/statistics & numerical data* ; Adult ; Ischemic Stroke/chemically induced* ; Environmental Exposure/adverse effects* ; Aged, 80 and over

Coronavirus disease 2019 (COVID-19) is a multi-system disease that can lead to various severe complications. Acute limb ischemia (ALI) has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis. However, the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood. Hypercoagulability and thrombosis are considered important mechanisms, but we also emphasize the roles of vasospasm, hypoxia, and acidosis in the pathogenesis of the disease. The angiotensin-converting enzyme 2 (ACE2) pathway, inflammation, and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19. Furthermore, we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic, age, and gender perspectives based on our analysis of molecular mechanisms. Additionally, we summarize therapeutic approaches such as use of the interleukin-6 (IL-6) blocker tocilizumab, calcium channel blockers, and angiotensin-converting enzyme inhibitors, providing insights for the future treatment of coronavirus-associated limb ischemic diseases.
Humans ; COVID-19/physiopathology* ; Ischemia/etiology* ; SARS-CoV-2 ; Extremities/blood supply* ; Risk Factors ; Interleukin-6/antagonists & inhibitors* ; Acute Disease ; Angiotensin-Converting Enzyme 2

Purpose: To create a computer-aided prediction (CAP) system to predict Wilms tumor (WT) responsiveness to preoperative chemotherapy (PC) using pre-therapy contrast-enhanced computed tomography (CECT). Materials and Methods: A single-center database was reviewed for children <18 years diagnosed with WT and received PC between 2001 and 2021. Patients were excluded if pre- and post-PC CECT were not retrievable. According to the Response Evaluation Criteria in Solid Tumors criteria, volumetric response was considered favorable if PC resulted in ≥30% tumor volume reduction.Histological response was considered favorable if post-nephrectomy specimens had ≥66% necrosis. Four steps were used to create the prediction model: tumor delineation; extraction of shape, texture and functionality-based features; integration of the extracted features and selection of the prediction model with the highest diagnostic performance. K-fold cross-validation allowed the presentation of all data in the training and testing phases. Results: A total of 63 tumors in 54 patients were used to train and test the prediction model. Patients were treated with 4–8 weeks of vincristine/actinomycin-D combination. Favorable volumetric and histologic responses were achieved in 46 tumors (73.0%) and 38 tumors (60.3%), respectively. Among machine learning classifiers, support vector machine had the best diagnostic performance with an accuracy, sensitivity, and specificity of 95.24%, 95.65%, and 94.12% for volumetric and 84.13%, 89.47%, 88% for histologic response prediction. Conclusions Based on pre-therapy CECT, CAP systems can help identify WT that are less likely to respond to PC with excellent accuracy. These tumors can be offered upfront surgery, avoiding the cons of PC.