Introduction: The primary issue following lumbar discectomy for disc herniation is the risk of reherniation in the post-operative period. Many surgical techniques have been proposed to treat disc reherniation, however, the optimal one remains variable. This meta-analysis aimed to investigate the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the contributing factors. Materials and methods: Identification of published literature was performed on PubMed, Google Scholar, Scopus, and Web of Science databases. Studies published until 14 February 2024 reported the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the associated contributing factors. A random effects model was used to conduct Bayesian frequentist network meta-analysis and pair-wise meta-analysis, with the assessment based on standardised mean difference (SMD) and 95% confidence interval (CI). Results: Eleven studies published in 2012 − 2022 recruiting a total of 5195 patients were included in the meta-analysis. The prevalence of reherniation in ACD and control groups was 23.2% (95% CI: 18.2% − 28.1%) and 36.4% (95% CI: 28.2% − 44.5%), respectively. The moderator effect of sample size is significant for pooled data of the ACD group (p-mod=0.002), but not for the control group (pmod=0.278). After the adjustment with sample size, the prevalence rates were 13.6% (95% CI: 6.2% − 21.1%) and 29.6% (95% CI: 14.9% − 33.2%) for ACD and control groups, respectively. Conclusion: Comparatively to lumbar discectomy alone, using a Bone-anchored annular closure device following lumbar discectomy decreased the symptomatic reherniation rate and post-operative complications, as well as the necessity for subsequent surgeries.

BACKGROUND: Factor H and membrane inhibitor of reactive lysis (CD59) are key regulators of complement activation.Mesenchymal stem cells (MSCs) secrete Factor H and express CD59 to protect themselves from complement-mediated damage. Severe hypoxia found to decrease the survival chances of MSCs after transplantation; however, little is known about the impact of severe hypoxia on modulating the complement system activity and its effect on MSCs survival. Our study seeks to explore the effect of severe hypoxia on modulating the complement cascade in MSCs. METHODS: Human adipose tissue-derived MSCs (hAD-MSCs) were cultured under severe hypoxia using 400 lM Cobalt Chloride (CoCl2) for 48 h. The protein expressions of survival marker; Phosphoinositide 3-kinases (PI3K), and proapoptotic marker; Caspase-3 were assessed using western blotting. The level of complement system related factors; Factor H, CD59, C3b, iC3b, C5b, C9, and the complement membrane attack complex (MAC) were analyzed using Elisa assays, western blotting, and immunocytochemistry. RESULTS: Our results showed for the first time that severe hypoxia can significantly impair Factor H secretion and CD59 expression in MSCs. This has been associated with upregulation of MAC complex and increased level of cell lysis and apoptosis marked by downregulation of PI3K and upregulation of Annexin v and Caspase-3. CONCLUSION The loss of Factor H and CD59 in hypoxic MSCs can initiate their lysis and apoptosis mediated by activating MAC complex. Preserving the level of Factor H and CD59 in MSCs has significant clinical implication to increase their retention rate in hypoxic conditions and prolong their survival.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched a web-based data acquisition and reporting system (QISAR), which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

Background/Aims: Ineffective esophageal motility is the most frequent disorder of esophageal peristalsis. Symptoms may include dysphagia, chest pain, and heartburn. Our aims are to evaluate the long-term prognosis and determine if provocative tests during high-resolution esophageal manometry could predict the prognosis. Methods: We retrospectively assessed high resolution manometries performed between 2015-2018 in adult patients. Symptoms were evaluatedat baseline and at follow-up (median 39 months later) using the impact dysphagia questionnaire (IDQ-10), where a score ≥ 7 defined dysphagia, the gastroesophageal reflux disease questionnaire (GerdQ), where a score ≥ 9 defined symptoms of reflux disease and if the subject had chest pain ≥ once a week. Chicago classifications version 3.0 and 4.0 were used. The contractile reserve was assessed by identifying whether esophageal peristalsis normalized or not on solid bolus swallows and a rapid drink challenge was included. Results: Nine hundred and eighty investigations performed during the study period; 114 patients (11.6%) were identified with ineffective esophageal motility. The final study cohort consisted of 33 patients of which 42% had dysphagia at follow-up and 25% had chest pain at least once a week, 46% had reflux symptoms. Patients who normalized motility on solid bolus swallows reported less dysphagia upon follow-up (P = 0.012), nevertheless reported similar proportions of chest pain (P = 0.632), and reflux (P = 0.514).There were no associations between having dysphagia, chest pain, or reflux at follow-up, and abnormal findings on the rapid drinkchallenge (P > 0.05 for all). Conclusions Patients with ineffective esophageal motility continue to experience long-term esophageal symptoms at follow-up. Provocative testsseem to have the potential to partly predict the long-term prognosis of dysphagia.

Objective: Serum 14-3-3eta are novel biomarkers of rheumatoid arthritis (RA). It is not clear whether 14-3-3eta may be present in other forms of inflammatory arthritis (IA). We evaluated the presence of 14-3-3eta as a diagnostic biomarker in the evaluation IA. Methods: A retrospective cohort study of adult patients who were evaluated for IA by a rheumatologist with a result for the lab test of 14-3-3eta was conducted. Results: Of 280 included patients, 30% were diagnosed with RA, 11% with psoriatic arthritis (PsA), and 59% with another condition. Twenty-four (9%) patients had positive results for 14-3-3eta. Fifty-two percent of positive patients were diagnosed with RA, with 48% having another diagnosis including axial spondyloarthritis, gout, Sjögren’s, undifferentiated IA, diabetic cheiroarthropathy, prostate cancer with bone metastasis, osteoarthritis, unspecified arthralgia. No patients with PsA had a positive value.RA patients had a higher value for 14-3-3eta compared to non-RA (5.44 [1.56~9.31] vs. 0.69 [0.40~0.98] ng/mL, p=0.03, square brackets are 95% confidence interval values). The mean value for the 14-3-3eta in seropositive RA trended higher than seronegative (8.0 [2.3~13.7] vs. 1.4 [0.4~2.4] ng/mL, p=0.06). In the RA cohort, elevated 14-3-3eta was associated with elevated erythrocyte sedimentation rate (odd ratio=6.62 [1.24~47.09], p<0.04), but not other variables. Conclusion 14-3-3eta may aid as a diagnostic biomarker of RA. However, it is not specific for RA, especially at low positive levels, and may be positive in other forms of IA. Ideal cutoff values need to be established for RA and non-RA conditions. It was not found in PsA.

Background: and Purpose Acute ischemic stroke (AIS) is a leading cause of disability worldwide. While intravenous thrombolysis is recommended within 4.5 hours of last known well (LKW) time, many patients present beyond this window. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating tenecteplase (TNK) administration in AIS patients within 4.5 to 24 hours of LKW. The primary outcomes assessed functional independence and ordinal modified Rankin Scale (mRS) shift at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Results: Three RCTs were included, comprising 1,054 patients (532 TNK and 522 standard medical therapy) with a mean age of 69 years, 59% males, and median baseline National Institutes of Health Stroke Scale score of 10.5. TNK treatment was associated with mRS 0–2 at 90 days (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.04–1.70, P=0.023), indicating a 33% higher likelihood of achieving functional independence. However, the ordinal mRS shift showed no significant difference (standardized mean difference: 0.01, 95% CI: -0.37–0.39, P=0.09). Safety outcomes indicated no difference in the rates of sICH (OR: 2.07, 95% CI: 0.86–5.00, P=0.1), and no difference in 90-day mortality (OR: 1.08, 95% CI: 0.76–1.53, P=0.67). Conclusion This meta-analysis suggests TNK might be safe and effective for selected AIS patients in the 4.5- to 24-hour time window, offering improved functional outcomes without a significant increase in hemorrhagic complications.

Background: s/Aims: To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD). Methods: A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series.All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis. Results: A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%–5.2%), CD II complications in 21.1% (14.6%–27.6%), CD III complications in 18.1% (9.3%–26.9%), CD IV complications in 2.7% (0.5%–4.9%), and CD V complications in 2.2% (0.2%–4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy. Conclusions PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

Background: Pneumatization of turbinates, also known as concha bullosa (CB), is associated with nasal septal deviation and sinonasal pathologies. This study aims to evaluate the performance of deep learning models in detecting CB in coronal cone-beam computed tomography (CBCT) images. Methods: Standardized coronal images were obtained from 203 CBCT scans (83 with CB and 119 without CB) from the radiology archives of a dental teaching hospital. These scans underwent preprocessing through a hybridized contrast enhancement (CE) method using discrete wavelet transform (DWT). Of the 203 CBCT images, 162 were randomly assigned to the training set and 41 to the testing set. Initially, the images were enhanced using a CE technique before being input into pre-trained deep learning models, namely ResNet50, ResNet101, and MobileNet. The features extracted by each model were then flattened and input into a random forest (RF) classifier. In the subsequent phase, the CE technique was refined by incorporating DWT. Results: CE-DWT-ResNet101-RF demonstrated the highest performance, achieving an accuracy of 91.7% and an area under the curve (AUC) of 98%. In contrast, CE-MobileNet-RF recorded the lowest accuracy at 82.46% and an AUC of 92%. The highest precision, recall, and F1 score (all 92%) were observed for CE-DWT-ResNet101-RF. Conclusion Deep learning models demonstrated high accuracy in detecting CB in CBCT images. However, to confirm these results, further studies involving larger sample sizes and various deep learning models are required.

Inflammatory myofibroblastic tumor (IMT) of the soft tissues of the neck is a rare pathological entity. We present the case of a 32-year-old patient who had a painful, slowly enlarging mass in the neck’s soft tissues. Radiological examination revealed a well-defined, dense lesion. The mass was surgically removed through local excision. Immunohistological analysis confirmed the diagnosis of IMT. After nearly 2 years of follow-up, there was no evidence of recurrence or distant metastases. In conclusion, although IMT of the soft tissues of the neck is uncommon, it should be considered in the differential diagnosis of neck tumors. Further research is necessary to understand the pathogenetic mechanisms of IMT, which could lead to the development of more effective treatments for this tumor.