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Purpose of review: In this review, we discuss the role of endoscopic gallbladder drainage for acute cholecystitis in non-surgical candidates, describe technical aspects, clinical outcomes, and elaborate on considerations when determining which approach to adopt for a given patient.

Recent findings: Cholecystectomy remains the criterion standard for management of acute cholecystitis in patients who can safely undergo surgery. For non-surgical candidates, percutaneous cholecystostomy (PTC-GBD) has been the traditional strategy to drain and decompress the gallbladder. Advances in endoscopy have further expanded the nonsurgical interventions and approaches to cholecystitis. Both endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound guided gallbladder drainage (EUS-GBD) have become acceptable alternatives to PTC-GBD, with growing literature supporting their efficacy, safety and improved patient quality of life when compared to a percutaneous approach. Choosing the appropriate endoscopic technique for gallbladder drainage should be tailored to each patient, keeping in view the specific clinical scenarios, endoscopist preference and following a multi-disciplinary approach.

Lichen Planus is an inflammatory skin disease that has been reported to be associated with inflammatory diseases like Inflammatory Bowel Disease or with medication use such as sulfasalazine. We report a case of lichen planus in a 62-year-old patient with ulcerative colitis receiving sulfasalazine. Within three years of treatment, the patient developed an erythematous rash on her forehead and wrists, which gradually worsened and spread to her arms, forearms, neck, and upper back. Lichen planus was suspected and later confirmed through histopathological examination. Consequently, sulfasalazine was discontinued, leading to partial resolution of the skin lesions. Our case highlights the importance of a thorough patient interview, as the timeline of skin lesions in relation to medication use and disease activity.

Background: Primary axillary hyperhidrosis has limited noninvasive and effective treatment, and we present the use of sofpironium bromide as a promising treatment option. We aimed to assess the efficacy and safety of sofpironium in patients with primary hyperhidrosis.

Methods: We systematically searched the databases for Studies that assessed sofpironium bromide in patients with primary axillary hyperhidrosis. Methodological quality was determined using the Cochrane Risk of Bias Assessment tool and Newcastle-Ottowa scale.

Results: Five studies were included (752 patients). They used 5% sofpironium, except for one study that used 5%, 10%, and 15% sofpironium. Studies have shown a significant difference in the incidence of patients with an HDSS score of 1 or 2 ranging from 53.9% to 86.7% and reported a greater reduction in the mean change in the DLQI score in the sofpironium group. They also noted a more significant reduction in the total gravimetric weight of sweat in the sofpironium group. A 1.5 point or greater improvement in HDSM-Ax score ranged from 48.2% to 69.1%. Serious adverse events were not observed in the intervention group.

Conclusion: Sofpironium gel provides notable improvements in symptom severity, sweat reduction, and quality of life, with mostly mild localized adverse events.Hyperhidrosis is relatively common, affecting 4.8% of the US population and negatively affects physical, social, and psychological well-being.Sofpironium bromide is recently approved by the FDA for the treatment of primary axillary hyperhidrosisSofpironium bromide showed promising results in terms of safety and efficacy for treating hyperhidrosisWe systematically assessed the use of sofpironium gel reported in five studies (752 patients)Sofpironium gel provides notable improvements in symptom severity, sweat reduction and quality of life, with mostly mild localized adverse events.

Background: Rectal adenocarcinoma (READ) involves the dysregulated expression of alpha 2,8-Sialyltransferase1 (ST8Sia1) although its role during READ's progression is unclear.

Methods: The mRNA level of ST8Sia1 was analyzed based on The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), and Tumor Immune Estimation Resource (TIMER) 2.0. Furthermore, the prognostic and significance of ST8Sia1 in READ was assessed through Kaplan-Meier curve, univariate, multivariate Cox regression, and receiver operating characteristic (ROC) methods. The role of ST8Sia1 in the READ immune microenvironment was explored using ESTIMATE analysis and TIMER databases. Furthermore, the expression of ST8Sia1 in tissues was analyzed using real-time quantitative polymerase chain reaction (RT-qPCR), western blotting (WB), and immunohistochemistry (IHC). Perforin and Granzyme B secretion by CD8⁺ T cells, as well as tumor cell apoptosis, were detected after co-culturing CD8⁺ T cells with READ tumor cells and ST8Sia1-overexpression (ST8Sia1-OE) tumor cells. Furthermore, we examined the interaction between ST8Sia1 and TGF-β1 in READ cells.

Results: ST8Sia1 exhibited excellent diagnostic capability for READ, with positive correlations to immune response and negative correlations to tumor purity. Increased levels of perforin and Granzyme B from CD8⁺ T cells were observed in vitro, enhancing tumor cell apoptosis. ST8Sia1 interacts with TGF-β1, mediating its inhibitory effects on READ development.

Conclusions: ST8Sia1 is a potential diagnostic biomarker and therapeutic target for READ, enhancing CD8⁺ T cell function and possibly improving patient outcomes through cellular immunotherapy.

Background: To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

Methods: Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

Results: A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (P_trend = 0.04) and alcohol-associated AP (P_trend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (P_trend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (P_trend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (P_trend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (P_trend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

Conclusions: Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

Objective: The aim of this study is to explore the utilization of diverse cross-sectional assessment templates for typical diseases in educating novice nurses in neurology departments.

Methods: Between January and December 2019, all registered nurses who had worked for less than 10 years at our center, were enrolled in this retrospective study. They were divided into the observation (18 nurses) and control (17 nurses) groups. The control group received training on various cross-sectional assessments for typical diseases. A comparative analysis was conducted on clinical work ability, nursing quality, adverse events, and patient satisfaction between the two groups.

Results: A total of 35 nurses participated in this study. The work ability score for nurses in the observation group was 97.42 ± 2.02 points, demonstrating a significant increase compared to the control group (92.17 ± 1.72 points) (p < 0.001). Regarding the quality of care provided to critically ill patients, the observation group demonstrated a significantly higher score of 95.82 ± 1.31 points compared to the control group, which scored 87.70 ± 3.15 points (p < 0.001). The number of adverse events within one year after admission was notably lower in the observation group, with 8 cases, compared to 23 cases in the control group (p = 0.006). Additionally, nurses in the observation group achieved a higher patient satisfaction score compared to the control group (97.23 ± 1.78 vs. 92.19 ± 1.49 points, p < 0.001).

Conclusion: The utilization of diverse cross-sectional assessment templates and instructional videos for typical diseases in the training of novice nurses in the neurology department enhanced nursing quality, improved clinical practical abilities, and improved patient safety.

Objectives: This study expolored the relationship between perivascular adipose tissue (PVAT) radiomic features derived from coronary computed tomography angiography (CCTA) and the presence of coronary artery plaques. It aimed to determine whether PVAT radiomic could non-invasively assess vascular inflammation associated with plaque presence.

Methods: In this retrospective cohort study, data from patients undergoing coronary artery examination between May 2021 and December 2022 were analyzed. Demographics, clinical data, plaque location and stenosis severity were recorded. PVAT radiomic features were extracted using PyRadiomics with key features selected using Least Absolute Shrinkage and Selection Operator (LASSO) and recursive feature elimination (RFE) to create a radiomics signature (RadScore).Stepwise logistic regression identified clinical predictors. Predictive models (clinical, radiomics-based and combined) were constructed to differentiate plaque-containing segments from normal ones. The final model was presented as a nomogram and evaluated using calibration curves, ROC analysis and decision curve analysis.

Results: Analysis included 208 coronary segments from 102 patients. The RadScore achieved an Area Under the Curve (AUC) of 0.897 (95% CI: 0.88-0.92) in the training set and 0.717 (95% CI: 0.63-0.81) in the validation set. The combined model (RadScore + Clinic) demonstrated improved performance with an AUC of 0.783 (95% CI: 0.69-0.87) in the validation set and 0.903 (95% CI: 0.83-0.98) in an independent test set. Both RadScore and combined models significantly outperformed the clinical model (p < .001). The nomogram integrating clinical and radiomics features showed robust calibration and discrimination (c-index: 0.825 in training, 0.907 in testing).

Conclusion: CCTA-based PVAT radiomics effectively distinguished coronary artery segments with and without plaques. The combined model and nomogram demostrated clinical utility, offering a novel approach for early diagnosis and risk stratification in coronary heart disease.

Purpose: To prepare a polyglycolic acid-loaded mitomycin drug (MMC-ATS-@PLGA) to inhibit scar proliferation after glaucoma filtering surgery (GFS) via an anti-inflammatory mechanism that minimally affected intraocular pressure, which provided another therapeutic strategy for this disease.

Methods: We first detected the physicochemical properties of MMC-ATS-@PLGA. Next, we tested the biosafety of MMC-ATS-@PLGA in vivo and in vitro. Then, we assessed the therapeutic effects of MMC-ATS-@PLGA by laboratory and clinical examinations.

Results: In this study, we synthesized a new type of nanomedicine (MMC-ATS-@PLGA) with good stability and biocompatibility for inhibiting scar proliferation after GFS. The break-up time (BUT), Schimer test and intraocular pressure changes in GFS rabbits before and after treatment with MMC-ATS-@PLGA were not significantly different. Three weeks after GFS, the MMC-ATS-@PLGA group displayed significant decreases in nuclear volume, corneal cell oedema, type I and III collagen fibre expression, normal organelle morphology and collagen fibre arrangement. Compared with those in the FML and MMC groups, the α-SMA, CTGF and type III collagen fibres in the MMC-ATS-@PLGA group decreased more significantly, indicating that MMC-ATS-@PLGA can effectively inhibit the expression of these inflammatory factors during the inhibition of scar proliferation after GFS.

Conclusion: We successfully synthesized MMC-ATS-@PLGA, which could effectively inhibit scar proliferation after GFS via anti-inflammatory effects but had little effect on intraocular pressure. This new type of nanomedicine has good biosafety and stability and is worthy of further exploration in clinical practice.

Investigating the dynamic response of human tympanic membranes (TMs) exposed to blasts requires full-field-of-view and three-dimensional (3D) methodologies. Our paper introduces a system that combines high-speed 3D digital image correlation (HS 3D-DIC) and Schlieren imaging (HS-SI) with a custom-designed shock tube for generating blast waves. This integrated system allows us to measure TM surface motions under intense transient loading, capturing full-field-of-view shape deformations exceeding 100 μm with a temporal resolution of 10 μs. System characterization encompasses (i) measuring the shock tube's output levels and repeatability, (ii) assessment of the spatial and temporal resolutions of the imaging techniques, and (iii) identification of overall system limitations. Optimizing these factors is crucial for improving the reliability of our system to ensure the accurate measurement of deformations. To assess our shock tube's reliability in generating repeated blast waves, we instrumented it with high-pressure (HP) and high-frequency (HF) pressure sensors along the blast wave pathway to record overpressure waveforms and compared them with Schlieren imaging visualized blast waves. We validate our HS 3D-DIC measured deformations by comparing them with deformations measured using single-point laser Doppler vibrometry (LDV), establishing a comprehensive assessment of the TM's dynamic response and potential fracture mechanics under blast. Finally, we test our approach with 3D-printed TM-like samples and a real cadaveric human TM. This methodology lays the groundwork for further investigations of blast-related auditory damage and the invention of more effective protective and medical solutions.

To determine behind armor blunt trauma (BABT) injury criteria, experiments have been conducted by launching blunt projectiles at live swine at velocities up to 65 meters per second (m/s) using one type of indenter design. To ensure the generalizability of the developed injury criteria, additional tests with different indenter designs are needed. The objectives of this study were to evaluate the kinematics and injury parameters from two indenter designs using human body finite element modeling. The simulation matrix consisted of chord and cylindrical shape indenter designs with two different masses of 150 and 230 grams. They were used to impact the liver and lung regions at velocities of 30 and 60 m/s using a human body model. Rib and lung strains from lung impacts and rib strain and liver strain energy densities (SED) from liver impacts were used to evaluate the design variables of mass and shape. Both designs played a role in skeletal and organ injury parameters. Analysis revealed an increased susceptibility for skeletal and organ traumas with the high mass indenter during high velocity impacts. The cylindrical indenter may be protective for organ injuries due to the larger area of loading on the ribcage compared to the chord indenter. Results from the chord indenter may serve as a conservative estimate of injury criteria.