Skull base defects often manifest as meningocele/meningoencephalocele or cerebrospinal fluid (CSF) leaks. Ventral and lateral skull base defects are effectively treated endoscopically and microscopically using various approaches. This case series study analyzes the utility and efficacy of post-aural soft tissue and temporalis fascia grafts in repairing small (<1 cm) skull base defects. Five out of six patients (83.33%) achieved successful defect closure. Patients were followed for donor site morbidity, postoperative CSF leak, and/or recurrent meningocele. One patient experienced reconstruction failure and developed a CSF leak eight months after surgery. The results suggest that TF grafts combined with post-aural soft tissue may be effectively used to repair small skull base defects without significant donor site morbidity.

Randomized clinical trials are important in both clinical and academic stroke communities with increasing numbers of new design concepts emerging. One of the “less traditional” designs that have gained increasing interest in the last decade is non-inferiority trials. Whilst the concept might appear straightforward, the design and interpretation of non-inferiority trials can be challenging. In this review, we will use exemplars from clinical trials in the stroke field to provide an overview of the advantages and limitations of non-inferiority trials and how they should be interpreted in stroke research.

Background: and Purpose In the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial, treatment with nerinetide was associated with improved outcomes in patients who did not receive intravenous alteplase. We compared the effect of nerinetide on clinical outcomes in patients without concurrent intravenous alteplase treatment within different patient subgroups. Methods: ESCAPE-NA1 was a multicenter randomized trial in which acute stroke patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) >4 undergoing endovascular treatment (EVT) were randomized to intravenous nerinetide or placebo. The primary outcome was independence (modified Rankin Scale [mRS] score 0–2) at 90 days. We assessed baseline, clinical, and imaging variables as predictors of outcome and for evidence of treatment effect modification. We constructed two multivariable models using variables known prior to randomization and variables known immediately post-EVT procedure to provide adjusted estimates of effect. We assessed for evidence of treatment effect modification using multiplicative interaction terms within each model. Results: Four hundred forty-six patients were included in the analysis. Clinical outcomes were better in patients randomized to the nerinetide arm (mRS 0–2: 59.4% vs. 49.8%). There was possible treatment effect modification by ASPECTS score; patients with ASPECTS 8–10 showed a larger treatment effect compared to those with lower ASPECTS score. Younger age, lower NIHSS score, lower baseline serum glucose, absence of atrial fibrillation at baseline, higher ASPECTS score, middle cerebral artery (vs. internal carotid artery) occlusion, use of conscious or no sedation (vs. general anesthesia), and faster treatment were all predictors of favorable outcome. Conclusion Patients in the nerinetide arm who were not treated with concurrent alteplase showed improved clinical outcomes and the treatment effect was larger among patients with favorable ASPECTS profiles.

Objectives: This study proposes a mobile-based explainable artificial intelligence (XAI) platform designed for diagnosing febrile illnesses. Methods: We integrated the interpretability offered by local interpretable model-agnostic explanations (LIME) and the explainability provided by generative pre-trained transformers (GPT) to bridge the gap in understanding and trust often created by machine learning models in critical healthcare decision-making. The developed system employed random forest for disease diagnosis, LIME for interpretation of the results, and GPT-3.5 for generating explanations in easy-to-understand language. Results: Our model demonstrated robust performance in detecting malaria, achieving precision, recall, and F1-scores of 85%, 91%, and 88%, respectively. It performed moderately well in detecting urinary tract and respiratory tract infections, with precision, recall, and F1-scores of 80%, 65%, and 72%, and 77%, 68%, and 72%, respectively, maintaining an effective balance between sensitivity and specificity. However, the model exhibited limitations in detecting typhoid fever and human immunodeficiency virus/acquired immune deficiency syndrome, achieving lower precision, recall, and F1-scores of 69%, 53%, and 60%, and 75%, 39%, and 51%, respectively. These results indicate missed true-positive cases, necessitating further model fine-tuning. LIME and GPT-3.5 were integrated to enhance transparency and provide natural language explanations, thereby aiding decision-making and improving user comprehension of the diagnoses. Conclusions The LIME plots revealed key symptoms influencing the diagnoses, with bitter taste in the mouth and fever showing the highest negative influence on predictions, and GPT-3.5 provided natural language explanations that increased the reliability and trustworthiness of the system, promoting improved patient outcomes and reducing the healthcare burden.

Objectives: A growing number of health professional institutions around the world are embracing innovative technologies to increase student engagement, primarily to improve clinical and simulated learning experiences. Didactic learning is an essential component of dental and medical curricula. However, limited research is available regarding the implementation of technology-infused teaching in classroom settings. We developed self-paced interactive learning content using the HTML5 Package (H5P) to promote student engagement in a didactic course within a dental hygiene program. Methods: A total of 52 interactive artifacts were created and administered to students as supplementary learning material. A descriptive study was conducted to explore student perceptions and engagement with the H5P content, as well as to evaluate the impact of these artifacts on academic performance. Results: Students performed significantly better on exam questions associated with interactive H5P content posted in the learning management system compared to other questions. Most students were highly engaged with the H5P content during the week leading up to each summative assessment. However, two of the three students with the highest course grades demonstrated consistent engagement with this content throughout the course. Conclusions Our results highlight the effectiveness of interactive content created using the H5P platform in fostering student engagement. The development of self-paced interactive materials may benefit various aspects of didactic teaching, including both synchronous and asynchronous online learning.

Background: Recent studies recommended that addition of dietary modifications notably the low FODMAP (Fructo-Oligosaccharides, Di-, Monosaccharides, And Polyols) diet and regular aerobic exercise can provide effective symptom control in functional dyspepsia (FD). This study assessed the combined effects of low FODMAP diet and regular aerobic exercise on dyspeptic symptoms in patients with FD. Methods: This prospective randomized controlled trial was conducted among patients with FD where eligible participants were assigned in a 1:1 ratio to either the intervention group (a low FODMAP diet and a regular aerobic exercise along with conventional therapy) or the control group (conventional therapy alone) for 24 weeks. The Structured Assessment of Gastrointestinal symptom (SAGIS) score for assessing the gastrointestinal symptoms and the Short Form Nepean Dyspepsia Index (SF-NDI) for analyzing health-related quality of life (HRQOL) done at baseline, 12 and 24 weeks. Results: Overall, 70 patients were included in this study, 35 each in both arm with the mean ± standard deviation age of the patients was 43 ± 10 years. At baseline, the mean SAGIS score for the intervention arm was 54 ± 12.5 and the control arm was 50 ± 10 where the scores were comparable between the two groups. After 12 weeks, there was a significant change in the epigastric symptoms from baseline between both arms was –3.571 ± 1.044. Further, the mean difference of SAGIS score was –3.571 ± 1.044 (90% confidence interval [CI] –5.668 to –1.475, P = 0.001) and SF-NDI of –12.086 ± 1.394 (90% CI –14.892 to –9.280, P < 0.001). Thus, there was a statistically significant reduction in the SAGIS score and SF-NDI from baseline in the intervention arm when compared to the control arm (P < 0.05). Conclusion The combination of a low FODMAP diet and regular aerobic exercise was effective in reducing epigastric symptoms and improved the quality of life among individuals with FD compared with conventional therapy alone.

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.