Objective: While minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF) has shown superiority in key clinical metrics over the open approach, evidence regarding patient-reported outcomes remains limited. This study compared postoperative recovery trajectories and symptomatic improvement phases between MIS and open TLIF. Methods: This retrospective review included patients who underwent single-level MIS or open TLIF. Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS) for back and leg pain were collected preoperatively and postoperatively. Segmented regression analysis with mixed-effects modeling, allowing for identification of distinct recovery phases, compared symptomatic trends between approaches. Results: Of 324 patients (268 MIS, 56 open), baseline demographics were similar except for greater preoperative leg pain in the MIS group (NRS: 6.0 vs. 5.0, p = 0.027). A segmented regression model identified 4 ODI recovery phases: postoperative disability phase (PDP, day 0 to 13), early improvement phase (day 13 to 28), late improvement phase (day 28 to 110), and plateau phase (later than day 110). The MIS group exhibited significantly lower disability exacerbation during PDP (β = 0.93 vs. 1.42 points per day, p = 0.008). Additionally, the plateau of NRS back occurred significantly earlier in the MIS group than in the open group (MIS, 26.7 ± 2.6 days vs. open, 51.7 ± 6.6 days, p < 0.001). Conclusion MIS-TLIF resulted in lower postoperative disability during the first 2 weeks compared to the open approach. Furthermore, low back pain achieved an earlier plateau in back pain by about 4 weeks in the MIS approach.

Objective: Since coronavirus disease 2019 (COVID-19) vaccination began, abnormal uterine bleeding (AUB) has occurred at a high rate. This study assessed the association between COVID-19 vaccination and AUB. Methods: In this retrospective cohort study, we analyzed mobile application data on menstrual cycles to investigate differences in the prevalence, duration, and amount of intermenstrual bleeding (IMB) after COVID-19 vaccination. We also analyzed the duration of menstruation, menstrual cycle length, and associated symptoms after the COVID-19 vaccination. Additionally, we investigated the prevalence of IMB according to the vaccine type. Results: After vaccination, IMB prevalence increased to 3.35% (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.76; p<0.0001) and IMB duration increased by 0.43 days (95% CI, 0.25-0.60; p<0.0001). The proportion of respondents whose amount of IMB was heavier than regular menstruation increased (OR, 2.96; 95% CI, 1.47-5.93; p=0.002). Menstrual duration decreased by -0.01 days (95% CI, -0.023 to 0.003; p=0.114), and menstrual cycle length increased by 1.39 days (95% CI, 1.30-1.48; p<0.0001). The proportion of participants who answered that there was a difference in menstruation amount increased (OR, 1.52; 95% CI, 1.41-1.64; p<0.0001). The prevalence of IMB increased regardless of the vaccine type. Conclusion There were statistically significant differences in the prevalence, duration and amount of IMB, menstrual duration, menstrual cycle length, and menstrual amount after COVID-19 vaccination. However, these values were not clinically meaningful and could be regarded as within the normal menstruation range.

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.

Purpose: Gastrostomy granulomas frequently occur in pediatric patients with gastrostomy tubes, yet there is a notable lack of comprehensive data on the efficacy and safety of various treatment modalities. Commonly used treatments, such as silver nitrate, are often painful and require frequent clinic visits, posing challenges for patients and families. Additionally, research on home-based treatments is limited, despite their potential to offer more convenient and less painful alternatives. This study addresses the need for well-designed comparisons of different treatment options. Methods: We conducted a prospective, open-label study at the Children’s Hospital of San Antonio, enrolling 36 pediatric patients aged 6 months to 17 years with gastrostomy tubes.Patients were randomized into two groups: one treated with topical silver nitrate and the other with table salt, excluding those on chemotherapy or with immunologic disorders.Granuloma sizes were measured at the study’s start with blinded physicians analyzing photographs to assess size reduction, and parent satisfaction surveys were conducted to evaluate treatment acceptability and side effects. Results: The median reduction in granuloma size was significantly greater in the table salt group (3.12 mm) compared to the silver nitrate group (2.25 mm) (Wilcoxon p-value=0.04).Parental satisfaction and confidence were high in both groups, with minor, self-limited skin irritation reported as a side effect. Conclusion The study suggests that table salt could be a feasible, non-inferior, and costeffective alternative to silver nitrate for treating gastrostomy granulomas in pediatric patients. Further research with a larger sample size is necessary to validate these findings.

Objective: Executive function correlates with the parasympathetic nervous system (PNS) based on static heart rate variability (HRV) measurements. Our study advances this understanding by employing dynamic assessments of the PNS to explore and quantify its relationship with inhibitory control (IC). Methods: We recruited 31 men aged 20–35 years. We monitored their electrocardiogram (ECG) signals during the administration of the Conners’ Continuous Performance Test-II (CCPT-II) on a weekly basis over 2 weeks. HRV analysis was performed on ECG-derived RR intervals using 5-minute windows, each overlapping for the next 4 minutes to establish 1-minute intervals. For each time window, the HRV metrics extracted were: mean RR intervals, standard deviation of NN intervals (SDNN), low-frequency power with logarithm (lnLF), and high-frequency power with logarithm (lnHF). Each value was correlated with detectability and compared to the corresponding baseline value at t0. Results: Compared with the baseline level, SDNN and lnLF showed marked decreases during CCPT-II. The mean values of HRV showed significant correlation with d’, including mean SDNN (R=0.474, p=0.012), mean lnLF (R=0.390, p=0.045), and mean lnHF (R=0.400, p=0.032). In the 14th time window, the significant correlations included SDNN (R=0.578, p=0.002), lnLF (R=0.493, p=0.012), and lnHF (R=0.432, p=0.031). Significant correlation between d’ and HRV parameters emerged only during the initial CCPT-II. Conclusion A significant correlation between PNS and IC was observed in the first session alone. The IC in the repeated CCPT-II needs to consider the broader neural network.

Objective: The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism. Methods: We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test. Results: Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness). Conclusion This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.

Background: In traditional medicine, the Shimshin-6 formulation, which consists of Rheum undulatum L., Hippophae rhamnoides L., Zingiber officinalie Roscoe, Saussurea Lappa C.B.Clark, Sal ammoniacum, Tronae veneni, is recommended for women experiencing menstrual retention disorders. In recent years, Shimshin-6 has been widely used to promote postpartum uterine involution for women and our study aimed to evaluate and determine the acute and chronic toxicity effects of Shimshin-6. Aim: To evaluate and substantiate the acute and chronic toxicity effects of Shimshin-6. Materials and Methods: The acute toxicity of Shimshin-6 was evaluated using the rapid method described by V.B. Prozorovsky (1978) by administering intraperitoneal injections of the medicinal extract in white mice to determine the lethal dose. The active dose was determined following the methodology of I.P. Zapadnyuk (1983). Chronic toxicity was evaluated in Wistar rats according to the OECD 407 (2008) guidelines. The test animals were administered Shimshin-6 in tablet form (90 mg/kg and 180 mg/kg) and decoction form (tang) (162 mg/kg) daily for 60 days. At the end of the experiment, biochemical and complete blood analyses were conducted, along with histopathological examination of major organs. The study was conducted with ethical approval granted by the Ethics Committee of the Mongolian National University of Medical Sciences (MNUMS) on October 25, 2024. Results: The LD50 for Shimshin-6 tablets was 4.47 (3.39–5.1) g/kg, indicating low acute toxicity based on the K.K. Sidorov classification. The LD50 for the decoction form was 8.1 (7.1–9.4) g/kg, suggesting it is non-toxic. Regarding chronic toxicity, platelet count was significantly reduced compared to the healthy control group: Shimshin-6 tablet group: 46% reduction at 90 mg/kg and 29.7% reduction at 180 mg/kg. Shimshin-6 decoction group: 60.5% reduction at 162 mg/ kg. Additionally, hemoglobin levels in the decoction group (162 mg/kg) decreased by 15.7% (p<0.05). Biochemical analysis showed a 36.3% reduction in total cholesterol (LDL-C) levels in the tablet group (180 mg/kg) and decoction group (162 mg/kg) compared to the control (p<0.05). Conclusion Shimshin-6 tablets showed low acute toxicity in experimental mice. However, long-term administration may lead to a reduction in platelet count.

Background: This study explores the potential of food industry by-products, such as plant peels, stems, and slags, as valuable sources of lignocellulosic material (LCM), which contains 25-40% xylan. These underutilized resources, often discarded as waste, hold the promise of sustainable applications in biotechnology. By safely extracting xylooligosaccharides (XOS) from LCM biomass, the value of these materials can be significantly enhanced, contributing to green production and supporting sustainable development. XOS, recognized for its prebiotic activity, has been shown to promote the growth of beneficial gut bacteria, making it a vital research area in the fields of food science, medicine, and technology. Aim: To extract and characterize oligosaccharides derived from by-products of the food industry, evaluate their physicochemical properties, and investigate selected biological activities. Materials and Methods: This study utilized microwave pretreatment and enzymatic hydrolysis to isolate and purify XOS from wheat bran and brewers’ spent grains (BSG), provided by Altan Taria LLC and APU CoL, respectively. Microwave irradiation at 200°C for 5 minutes was employed as a pretreatment step, followed by hydrolysis using commercial xylanase (Thermomyces lanuginosus, recombinant Aspergillus oryzae, 2500 BXU/g) at 55°C for 24 hours. The resulting hydrolysate underwent filtration with activated carbon and ethanol precipitation to yield purified XOS. Analytical methods, including FTIR spectroscopy, TLC and HPLC, were used for structural and compositional analysis of the purified oligosaccharides. In vitro tests evaluated the ability of XOS to support the growth of beneficial gut bacteria, including Bifidobacterium spp., Lactobacillus fermentum (ATCC 9338), and Lactobacillus casei (ATCC 344), using XOS-enriched media. Additionally, in vivo studies were conducted on rats to determine the biological effects of XOS on gut microbiota. Results: The results demonstrated that prolonged enzymatic hydrolysis for more than 10 hours, using 0.25 g of xylanase per 100 g of substrate, resulted in optimal yields. XOS purity was measured at 87.6% with an 8.1 g yield from wheat bran and 89% purity with a 7.2 g yield from brewers’ spent grains. Structural analysis confirmed the presence of xylobiose, xylotriose, and xylotetraose, with xylotetraose being the most abundant component in WBP-XOS (47.5%), and xylobiose dominating BGS’s derived XOS (47.8%). Biological effects revealed that wheat bran-derived XOS significantly supported the growth of Bifidobacterium spp. and L. fermentum (ATCC 9338) in a concentration-dependent manner, whereas no significant effect was observed on L. casei (ATCC 344). In vivo studies confirmed that XOS consumption increased populations of Bifidobacterium spp. and Akkermansia muciniphila spp. in gut microbiota (p<0.05). Furthermore, XOS consumption reduced plasma cholesterol, triglycerides, and LDL-C levels while increasing HDL-C levels, demonstrating metabolic benefits. Conclusion This research establishes that XOS with prebiotic activity can be efficiently extracted and purified from food industry by-products using microwave-assisted enzymatic hydrolysis. This approach highlights the potential of utilizing agricultural and industrial waste for producing functional prebiotics, contributing to sustainable practices and offering valuable applications in health and nutrition.

Objective: Mortality surveillance was established in the state of Victoria just before the COVID-19 pandemic. Here, we describe the establishment of this surveillance system, justify the modelling approach selected, and provide examples of how the interpretation of changes in mortality rates during the pandemic was influenced by the model chosen. Methods: Registered deaths occurring in Victoria from 1 January 2015 to 31 December 2020 were sourced from the Victoria Death Index. Observed mortality rates were compared to a raw historical 5-year mean and to predicted means estimated from a seasonal robust regression. Differences between the observed mortality rate and the historical mean (delta-MR) and excess mortality rate from the observed and predicted rates were assessed. Results: There were 20 375 COVID-19 cases notified in Victoria as of 31 December 2020, of whom 748 (3.7%) died. Victorians aged >=85 years experienced the highest case fatality ratio (34%). Mean observed mortality rates in 2020 (MR: 11.6; 95% confidence interval [CI]: 11.4, 11.9) were slightly reduced when compared with the annual rate expected using the historical mean method (mean MR: 12.2; 95% CI: 12.1, 12.3; delta-MR: -0.57; 95% CI: -0.77, -0.38), but not from the rate expected using the robust regression (estimated MR: 11.7; 95% prediction interval [PI]: 11.5, 11.9; EMR: -0.05; 95% CI: -0.26, 0.16). The two methods yielded opposing interpretations for some causes, including cardiovascular and cancer mortality. Discussion: Interpretation of how pandemic restrictions impacted mortality in Victoria in 2020 is influenced by the method of estimation. Time-series approaches are preferential because they account for population trends in mortality over time.

Background: Research on lactic acid bacteria has confirmed how specific strains possess probiotic properties and impart unique sensory characteristics to food products. The use of probiotic lactic acid bacteria in many food products, thus confers various health benefits to humans when they are frequently consumed in adequate amounts. Aim: To determine the effect of lactic acid bacteria on the growth of tomatoes. Materials and Methods: The lactic acid bacteria were cultured using the Lactobacillus medium from whipping cream and Dandelion (Taraxacum mongolicum) and identified using the MALDI-TOF MS automated microbial identification analyzer. A solution was prepared using Lactobacillus delbrueckii isolated from whipping cream and Lactobacillus gasseri isolated from Dandelion (10^7CFU/ml), and sterilized tomato seeds were watered for 10 days with the solution, while sterilized distilled water was used as a control. The germination rate of the seeds and the root length were measured and recorded every day. Results: The solution of L.delbrueckii bacteria isolated from cream germinated 100% of the seeds, which is 4% higher than the control seeds, while the solution of L.gasseri bacteria isolated from Dandelion germinated 100%, supporting 4% higher than the control seeds. Seedlings irrigated with the L.delbrueckii bacterial solution exhibited an average length of 10.3cm, which was 1.3cm longer than the control (P=0.003), indicating a statistically significant difference. Similarly, those treated with the L.gasseri solution had an average length of 11.5cm, 2.5cm longer than the control (P=0.005), also demonstrating statistical significance. Conclusion The application of the lactic acid bacterial solution significantly enhanced both the germination of tomato seeds and the growth of the plants compared to the control solution.