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.

Purpose: To assess the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic immune-inflammation response index (SIRI) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods: One hundred seven patients were retrospectively enrolled. Chi-square (χ 2 ) tests were adopted to assess the association of the inflammatory ratios and indexes to clinical risk factors. Overall survival (OS), metastasis-free survival (MFS), local, lymph node, and contralateral recurrence-free survival (RFS) were estimated by the Kaplan–Meier method and the corresponding curves were compared using log-rank test. Univariate and multivariate survival analysis were performed using general linear models to identify risk factors for prognosis. Results: NLR, MLR, PLR, SII, and SIRI were predictive of OS (p=0.024, p=0.025, p=0.004, p=0.006, and p=0.03, respectively). Besides, PLR was predictive of local (p<0.001) and lymph node RFS (p=0.014) and SII was associated to lymph node and contralateral RFS prediction (p=0.034 and p=0.023, respectively). All candidate markers adding high NLR+high MLR+high PLR combination were independent risk factors of OS. PLR was an independent risk factor of local and lymph node RFS whereas the above cited combination and NLR were independent prognosticators of local and contralateral RFS respectively. All markers were correlated to poor postoperative clinical characteristics mainly pathological grade (p<0.05). Conclusions Preoperative NLR, MLR, PLR, SII, and SIRI were associated with higher pathologic features and worse oncological outcomes in patients treated with RNU for UTUC.

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.

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: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

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

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. Materials and Methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT’s future use, despite pending guidelines support. Conclusions This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment.