Objective:To analyze the current status of red blood cell transfusion in very preterm infants (VPI) (gestational age at birth <32 weeks) from Chinese Neonatal Network (CHNN) in 2022.Methods:This cross-sectional study was based on the CHNN VPI cohort. It included 6 985 VPI admitted to CHNN 89 participating centers within 24 hours after birth in 2022. VPI with major congenital anomalies or those transferred to non-CHNN centers for treatment or discharged against medical advice were excluded. VPI were categorized based on whether they received red blood cell transfusions, their gestational age at birth, the type of respiratory support received during transfusion, and whether the pre-transfusion hemoglobin levels exceeded the thresholds. General characteristics, red blood cell transfusion rates, number of transfusions, timing of the first transfusion, and pre-transfusion hemoglobin levels were compared among different groups. The incidence of adverse outcomes between the group of VPI who received transfusions above the threshold and those who received transfusions below the threshold were compared. Comparison among different groups was conducted using χ2 tests, Kruskal-Wallis H tests, Mann-Whitney U test, and so on. Trends by gestational age at birth were evaluated by Cochran-Armitage tests and Jonckheere-Terpstra tests for trend. Results:Among the 6 985 VPI, 3 865 cases(55.3%) were male, with a gestational age at birth of 30.0 (28.6, 31.0) weeks and a birth weight of (1 302±321) g. Overall, 3 617 cases (51.8%) received red blood cell transfusion, while 3 368 cases (48.2%) did not. The red blood cell transfusion rate was 51.8% (3 617/6 985), with rates of 77.7% (893/1 150) for those born before 28 weeks gestational age and 46.7% (2 724/5 835) for those born between 28 and 31 weeks gestational age. A total of 9 616 times red blood cell transfusions were administered to 3 617 VPI, with 632 times missing pre-transfusion hemoglobin data, and 8 984 times included in the analysis. Of the red blood cell transfusions, 25.6% (2 459/9 616) were administered when invasive respiratory support was required, 51.3% (4 934/9 616) were receiving non-invasive respiratory support, while 23.1% (2 223/9, 616) were given when no respiratory support was needed. Compared to the non-transfusion group, the red blood cell transfusion group had a higher rate of pregnancy-induced hypertension in mothers, lower rates of born via cesarean section and mother′s antenatal steroid administration, smaller gestational age, lower birth weight, a higher proportion of small-for-gestational-age, multiple births, and proportions of Apgar score at the 5 th minute after birth ≤3 (all P<0.05). They were also less likely to be female, born in hospital or undergo delayed cord clamping (all P<0.01). Additionally, higher transport risk index of physiologic stability score at admission were observed in the red blood cell transfusion group ( P<0.001). The number of red blood cell transfusion was 2 (1, 3) times, with the first transfusion occurring at an age of 18 (8, 29) days, and a pre-transfusion hemoglobin level of 97 (86, 109) g/L. For VPI ≤7 days of age, the pre-transfusion hemoglobin levels for invasive respiratory support, non-invasive respiratory support, or no respiratory support, respectively, with no statistically significant differences between groups ( H=5.59, P=0.061). For VPI aged 8 to 21 days and≥22 days, the levels with statistically differences between groups (both P<0.01). Red blood cell transfusions above recommended thresholds were observed in all respiratory support categories at different stages of life, with the highest prevalence in infants aged 8 to 21 days and≥22 days who did not require respiratory support, at 90.1% (264/273) and 91.1%(1 578/1 732), respectively. The rate of necrotizing enterocolitis was higher in the above-threshold group ( χ2=10.59, P=0.001), and the duration of hospital stay was longer in the above-threshold group ( Z=4.67, P<0.001) compared to the below-threshold group. Conclusions:In 2022, the red blood cell transfusion rate was relatively high among VPI from CHNN. Pre-transfusion hemoglobin levels frequently exceeded recommended transfusion thresholds.

Background: Obesity affects nearly a billion people globally and is associated with various health consequences.Current anti-obesity medications primarily target appetite, but drug candidates that modulate energy expenditure (EE) and substrate utilization based on respiratory exchange ratio (RER) are also essential to continuously improve the treatment modalities for people living with obesity. Selecting appropriate animal models and methods is crucial to improving translational value in preclinical research. While pig obesity models provide a relevant alternative to rodent models due to their similarities to humans, little is known about the assessment and translatability of EE in pigs. The aim of this study was to evaluate the translatability of minipigs for assessing the effect of EE-modulating drugs using indirect calorimetry and three positive control compounds that have known effects on EE and/or RER in humans. The study consisted of five sub-studies: Sub-study 1 assessed EE and RER based on sex (male/female) and diet (chow/high-fat diet) with and without correction for body composition; Sub-studies 2–4 evaluated changes in EE and RER after treatment with three positive control compounds: 2,4-dinitrophenol, DNP; a glucagon receptor agonist, GCG-RA; and a melanocortin receptor 4 agonist, MC4-RA; and sub-study 5 established three predictive equations for resting metabolic rate. Results: Sub-study 1 resulted in detectable differences in EE and RER based on diet/body sizes (P-value < 0.0001), while EE adjusted for body composition resulted in differences based on sex (P-value < 0.0001). Sub-studies 2–4 revealed that the three pharmacological interventions known to affect EE in humans, DNP, GCG-RA, and MC4-RA, showed similar effects in the Göttingen Minipigs by significantly increasing EE by 26.1% (P-value: 0.0014), 21.3% (P-value: 0.0491), and 25.4% (P-value: 0.0013), respectively, emphasizing the translational value of the model. In substudy 5, three predictive equations were established for RMR based on body composition, demographic and anthropometric measurements, and the most accurate equation based on all variables. All three equations demonstrated acceptable accuracy (adjusted ­R2 : 0.73–0.85). Conclusions The present study qualifies the use of Göttingen Minipigs for investigating EE in preclinical research and provides a framework for conducting such research.

Endoscopic spine surgery (ESS) is growing in popularity worldwide. An expanding body of literature demonstrates rapid functional recovery with reduced morbidity compared to open techniques. Both full endoscopic spine surgery, or uniportal endoscopy, and unilateral biportal endoscopy (UBE) can be employed in conjunction with various navigation and enabling technologies for assistance with localization of anatomic orientation and assessment of the intraoperative target spinal pathology. This review article describes various navigation technologies in ESS, including 2-dimensional (2D) fluoroscopic imaging, 2D fluoroscopic navigation, 3-dimensional C-arm navigation, augmented reality, and spinal robotics. Employment of enabling navigation and emerging technology with the registration of patient-specific anatomy enables clear delineation of anatomic landmarks and facilitation of a successful procedure. Additionally, avoidance of common pitfalls during use of navigation systems in ESS is discussed in this review.

Objective: This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS). Methods: A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics. Results: A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS. Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.

Purpose: The aim of this study was to examine whether a combined exercise (EX), including aerobic, resistance, and inspiratory muscle training, reduces fatigue and dyspnea, improves physical fitness, and if increased physical fitness after exercise is associated with attenuating symptoms in young adults with mild long coronavirus disease (COVID) symptoms. Methods: Twenty-eight young adults (aged 23±4 years) with long COVID were randomly assigned to either the EX group (n=14), which underwent aerobic, resistance, and inspiratory muscle training three times per week for 8 weeks, or the control (CON) group (n=14). Symptoms of dyspnea and fatigue were assessed using self-report questionnaires.Cardiorespiratory fitness was directly measured during cardiopulmonary exercise testing, while muscle strength was measured by isokinetic muscle testing. These variables were measured before and after the exercise intervention. Results: Compared to the CON group, the EX group showed improvements in symptoms of fatigue and dyspnea, maximal oxygen consumption (VO2peak ), and peak torque, with significant interaction effects observed (p＜ 0.05). The EX group exhibited a mean difference of 2.9 mL/kg/min in VO2peak (95% confidence interval [CI], 1.8−4.0) and 13.0 Nm (95% CI, 6.1−19.8) in peak torque compared to the CON group (p＜0.05). Improvements in VO2peak were negatively associated with attenuations in both fatigue and dyspnea after the exercise intervention (p＜0.05). Conclusion These findings indicate that EX training can effectively alleviate symptoms and improve physical fitness in young adults with mild long COVID. Structured exercise training may serve as an effective intervention to improve the health of those with long COVID.

Background/Aims: Panenteric gastrointestinal dysmotility in diabetic gastroenteropathy remains incompletely understood. We aim to (1) compare gastrointestinal transit times, contractile activity, and pH levels between individuals with and without diabetic gastroenteropathy and (2) investigate associations between symptoms and contractile activity. Methods: We compared 37 healthy individuals to 68 individuals with diabetic gastroenteropathy. Gastrointestinal segmental transit times, contractile activity, and pH were measured with SmartPill. The Gastroparesis Cardinal Symptom Index and the Gastrointestinal Symptom Rating Scale were used to evaluate symptoms. Results: Compared to controls, individuals with diabetic gastroenteropathy had prolonged median gastric emptying time (3.3 [IQR, 2.5-4.4] vs 2.5 [IQR, 1.9-3.6] hours, P = 0.023), antroduodenal transition time (23 [IQR, 8-52] vs 11 [IQR, 2-25] minutes, P = 0.015), colonic transit times (36.0 [IQR, 17.3-53.5) vs 20.8 [IQR, 14.0-28.8] hours, P = 0.004), and whole-gut transit time (46.1 [IQR, 24.3-72.9] vs 28.7 [IQR, 22.0-42.7] hours, P = 0.002). The diabetes group had lower antral contraction frequency (1.5 [IQR, 0.9-2.1] vs 2.5 [IQR, 1.5-3.9] contractions per minute, P = 0.004) and sum of amplitudes (1941 [1377-2763] vs 2975 [1734-5337] mmHg, P = 0.004).In contrast, the diabetes group had higher colonic sum of amplitudes and area under the contraction curve. The antral contraction frequency was unassociated with gastrointestinal symptoms. Still, the overall stomach contraction frequency increased by 30% (P < 0.001) and 15% (P = 0.003) in individuals with diabetes for each incremental increase in nausea and reflux scores, respectively. Conclusions Gastrointestinal transit times, as well as antral and colonic contractile activity, differed between individuals with diabetic gastroenteropathy and controls. The overall gastric contraction frequency was associated with symptom severity.

Background/Aims: Gastric dysrhythmias, loss of normal 3 cycles per minute (CPM) gastric myoelectrical activity (GMA), and variable loss of interstitial cells of Cajal are reported both in gastroparesis (GP) and functional dyspepsia (FD). We hypothesize that the patients with GP, and FD with normal gastric emptying (NGE) and delayed gastric emptying (DGE) may vary in symptom severity, and GMA profiles. Methods: Symptoms and their severity were evaluated by gastroparesis cardinal symptom index (GCSI), Abell scoring, short-form Nepean dyspepsia index (SF-NDI), the World Health Organization quality of life, and Rome IV subtyping for FD. Solid-meal gastric emptying was assessed by nuclear scintigraphy. Water load satiety test (WLST)-based electrogastrography determined GMA. Results: Patients with GP (n = 40) had higher GCSI than those with FD (n = 39; [12 DGE, 27 NGE] (2.79 [2.17-3.33] vs 1.67 [0.83-2.61] vs 0.83 [0.55-1.93]; P < 0.001, in GP vs FD-NGE vs FD-DGE, respectively), severe Abell grade (Grade III in 17 [43%] vs 0% vs 0%, in GP vs FD-NGE vs FD-DGE, respectively), severe SF-NDI (80.5 [63.5-102.5] vs 50 [27-91] vs 30 [21.25-45.5]); and poor QOL. Sixteen (40%) GP had impaired gastric accommodation (< 238 mL). Post-WLST 3 CPM normal/hypernormal GMA was observed in 17 (42%), 18 (67%), and 5 (42%) patients with GP, FD (NGE), and FD (DGE), respectively; and 3 CPM hyponormal in remaining patients in each group.Post-WLST dysrhythmia was comparable. Conclusions WLST-electrogastrography coupled with GE study may distinguish between normal/dysrhythmic GMA revealing pathophysiologicalphenotypes of GP and FD. Analysing extent of power change in normogastric, and dysrhythmic frequencies may comprehensively elucidate disease severity.

Background/Aims: Pediatric patients with suspected gastroparesis often undergo antroduodenal manometry (ADM) and gastric emptying scintigraphy (GES) for diagnostic purposes. However, it is unknown if delayed gastric emptying (DGE) correlates with manometric findings. This study evaluates whether ADM parameters differ between normal and abnormal GES in pediatric patients. Methods: Data from pediatric patients undergoing ADM and GES at Nationwide Children’s Hospital from 2011-2020 were retrospectively reviewed. Manometry parameters including motility index (Ln [sum of amplitudes × number of contractions + 1]), number of antral contractions, and direction of the phase III migrating motor complex (MMC) were compared to GES results from age-matched patients with DGE (n = 32) and normal gastric emptying (NGE) (n = 32) of similar sex, body mass index, and weight. Results: Children with DGE had a lower post-prandial antral motility index and antral contraction number than those with NGE (9.4 vs 11.2, P = 0.005; 21.8 vs 49.6, P < 0.001). The gastric emptying percentage at 4 hours was lower in patients with retrograde phase III (59.2% vs 83.9%,P = 0.022) and in those without an antral component in the fasting phase III of the migrating motor complex (70.3% vs 86.5%, P = 0.003). Post-prandial antral hypomotility occurred more frequently in the DGE group than in the NGE group (41% vs 9%, P = 0.008). Conclusions ADM findings differ between children with DGE and NGE. Children with DGE are more likely to have abnormal fasting phase III patterns and decreased post-prandial antral activity during ADM testing.