Background: s/Aims: The definition of textbook outcome (TO) for liver surgery in patients with intrahepatic cholangiocarcinoma (ICC) varies depending on the data and TO model utilized in the study. This study aimed to clarify the separate estimation of TO in relation to its negative predictors, using two validated TO models for ICC surgery. Methods: We assessed the rates of achieving TO and failure of TO for both models in liver resection. Independent predictors of nonTO were identified through logistic regression and validated using AUC estimation. Results: TO was achieved in a similar proportion of patients across both models: 40% and 43%. The TO models did not differ in preoperative data affecting TO achievement. Independent predictors of non-TO for both models included tumor size > 10 cm,, open surgical approach, and biliary resection. TO achievement significantly differed among sub-groups that were homogeneous concerning the opposing values of the independent predictors, regardless of the TO model. The ratio of the frequency of negative predictors in the TO and non-TO groups, referred to as the TO coefficient, determines the likelihood of achieving TO given the presence of that predictor. Predictors were ranked by their negative impact on TO achievement, from the highest risk of TO failure (tumor size > 10 cm) to the lowest risk (open approach). Conclusions Independent predictors of non-TO may improve the transparency of TO assessment and reduce biases related to unaccounted negative prognostic factors. The impact of these independent predictors on TO realization can be estimated and ranked using TO coefficient calculations.

Purpose: Professional identity (PI) formation occurs over time through immersive social—digital and in-person—interactions. While digital social interactions may support the PI formation of medical students, their influence remains underexplored. This study aimed to describe the patterns and intensity of social media use and analyze its association with PI. Methods: This quantitative cross-sectional study was conducted at a private medical school in Jakarta, Indonesia. All undergraduate medical students were invited to participate in this study. Data were collected using the Social Networking Activity Intensity Scale (SNAIS) and the MacLeod Clark Professional Identity Scale (MCPIS-9) questionnaire. Data were analyzed descriptively and statistically. Results: A total of 451 students participated in this study. Participants reported moderate overall social media use intensity (mean SNAIS=2.96±0.51), with higher use for entertainment than social interaction. The mean MCPIS-9 score was 3.76±0.44. Content engagement, measured using a content engagement index (CEI) reflecting the intensity of engagement with educational and informational content across selected social media activities, was generally low and driven mainly by browsing behaviors (CEI=0.51±0.64). Weak but significant correlations were observed between CEI and MCPIS-9 (ρ=0.139, p=0.003) and between SNAIS and MCPIS-9 (r=0.102, p=0.030). One-way analysis of variance revealed significant differences in MCPIS-9 scores by duration of use for WhatsApp and X, but not for other platforms. Conclusion Participants mainly used social media for entertainment purposes. Social media use intensity and content engagement showed weak but significant associations with PI.

Objective: We aimed to identify predictors of short- and long-term sustained remission in early rheumatoid arthritis (eRA) and very early rheumatoid arthritis (veRA), and to assess their relevance within the joint accumulation model paradigm. Methods: This retrospective real-world cohort study included adult Colombian RA patients. Based on symptom onset, patients were classified as eRA (≤12 months) or veRA (≤3 months). Sustained remission was defined using Clinical Disease Activity Index (CDAI) thresholds maintained for ≥6 months (short-term) and ≥24 months (long-term). Predictors were identified using robust Poisson regression. Results: In eRA, short-term remission was more likely in antinuclear antibodies (ANA)-positive patients (risk ratio [RR]: 3.29, 95% confidence intervals [CI]: 1.38~7.83) and less likely in those with higher baseline Health Assessment Questionnaire (HAQ) (RR: 0.48, 95% CI: 0.29~0.78). Long-term remission was more frequent in males (RR: 2.67, 95% CI: 1.11~6.46) and in patients with lower baseline Simple Disease Activity Index (SDAI) (RR: 0.92, 95% CI: 0.85~0.99). In veRA, short-term remission was negatively associated with anti-citrullinated protein antibodies (ACPA) (RR: 0.74, 95% CI: 0.58~0.93), swollen joint count (RR: 0.52, 95% CI: 0.27~1.00), and patient global assessment (RR: 0.61, 95% CI: 0.40~0.93). Long-term remission was associated with higher rheumatoid factor levels (RR: 1.76, 95% CI: 1.20~2.56), lower tender joint counts (RR: 0.71, 95% CI: 0.55~0.92), and slower joint accumulation rates (RR: 0.51, 95% CI: 0.29~0.90). These findings were consistent among disease-modifying anti-rheumatic drug (DMARD)-naïve patients. Conclusion Distinct predictors of remission in eRA and veRA underscore the need for stage-specific treatment strategies. Our findings provide real-world evidence supporting the joint accumulation model and highlight the potential to optimize outcomes through tailored time-sensitive interventions.

Drugs and pesticide residues in broiler feed can compromise the therapeutic and production benefits of antibiotic (ANT) application and affect gene expression. In this study, we analyzed the expression of 13 key pancreatic genes and blood physiology parameters after administering one maximum residue limit of herbicide glyphosate (GLY), two ANTs, and one anticoccidial drug (AD). A total of 260 Ross 308 broilers aged 1‍-‍40 d were divided into the following four groups of 65 birds each: control group, which was fed the main diet (MD), and three experimental groups, which were fed MD supplemented with GLY, GLY+ANTs (enrofloxacin and colistin methanesulfonate), and GLY+AD (ammonium maduramicin), respectively. The results showed that the addition of GLY, GLY+ANTs, and GLY+AD caused significant changes in the expression of several genes of physiological and economic importance. In particular, genes related to inflammation and apoptosis (interleukin 6 (IL6), prostaglandin-endoperoxide synthase 2 (PTGS2), and caspase 6 (CASP6)) were downregulated by up to 99.1%, and those related to antioxidant protection (catalase (CAT), superoxide dismutase 1 (SOD1) and peroxiredoxin 6 (PRDX6)) by up to 98.6%, compared to controls. There was also a significant decline in the values of immunological characteristics in the blood serum observed in the experimental groups, and certain changes in gene expression were concordant with changes in the functioning of the pancreas and blood. The changes revealed in gene expression and blood indices in response to GLY, ANTs, and AD provide insights into the possible mechanisms of action of these agents at the molecular level. Specifically, these changes may be indicative of physiological mechanisms to overcome the negative effects of GLY, GLY+ANTs, and GLY+AD in broilers.
Animals ; Glyphosate ; Glycine/administration & dosage* ; Chickens/blood* ; Pancreas/metabolism* ; Anti-Bacterial Agents/pharmacology* ; Animal Feed ; Gene Expression/drug effects* ; Herbicides

Timor-Leste was rabies-free until March 2024. Since then, detections in dogs and human cases have occurred in a growing number of municipalities. Access to vaccines and rabies immunoglobulin needs to be increased by strengthening vaccine supply, integrating into routine immunization programmes and increasing awareness of the risk of rabies.

Purpose: Addressing health inequities is an integral part of contemporary medical education (ME), yet traditional lecture-based formats often fail to develop students’ deeper understanding and engagement. This study examined how a project-based learning (PjBL) approach influenced students’ learning experiences related to health equity. Methods: This was a qualitative phenomenology study. We designed an elective course on health equity using the PjBL approach and active learning methods. All participating students were asked to complete a group project aimed at addressing a specific health inequity issue from the surrounding community. Data were collected through reflective writing at the end of the course and analyzed using deductive thematic analysis. Twenty-seven codings were identified from 259 meaningful quotes (interrater agreement 99.62%) and grouped into four categories: character, role, competence, and learning experience. Results: Three major themes emerged from data analysis: (1) key learning experiences during the ME course (active learning, role-modeling, collaborative learning, comprehensive learning, and affective learning); (2) topics that facilitated students’ understanding of health inequities and physicians’ roles, particularly in addressing health inequities in Indonesia; and (3) the influence of the ME course on students’ outlook and beliefs. Conclusion Although this study did not introduce a novel method of instruction, it underscores the value of PjBL in enhancing students’ capacity to understand and tackle health inequities.

Purpose: To review the current evidence on the efficacy and safety of sutureless amniotic membrane transplantation (AMT) for promoting corneal epithelialization in delayed corneal healing disorders. Methods: A comprehensive search was conducted for studies published from January 2003 to December 2023. The inclusion criteria were studies that focused on delayed corneal healing (including persistent epithelial defect, dry eye disease, corneal ulcer, chemical injury, recalcitrant keratitis, or others), observed corneal re-epithelialization as the outcome, with the use of sutureless AM graft. Studies that reported sutureless AM combined with cyanoacrylate or fibrin glue were excluded. Results: A total of 14 studies met the inclusion and exclusion criteria. The most common technique for sutureless AM on the cornea was self-retained cryopreserved AMT. The result of sutureless AMT in various delayed corneal healing disorders showed complete corneal epithelialization occurred in most patients (64.4%) which ranged from 3 to 43 days. There was a low rate of adverse events (pain, 2.9%; displaced AM or lost ring, 1.7%) and complications (sterile infiltrate, 1.8%; corneal perforation, 0.6%; ring trauma, 0.4%; central corneal scarring, 0.2%). Conclusions Sutureless AMT promotes complete corneal epithelialization. It is easier for multiple application, more comfortable, and has a lower risk of suture-related complications. Overall, sutureless AMT is effective and safe for a variety of corneal delayed healing disorders.