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Background: In addition to surgical technology, successful liver transplantation (LT) depends on perioperative management, which needs an effective prognostic index. Therefore, a simplified and sensitive postoperative index for adult LT should be developed.

Methods: In total, 906 patients who underwent LT were included in this cross-sectional study. Univariate analysis was used to identify the independent risk factors for recipient survival. Multivariate logistic and stepwise regression analyses were used to construct and simplify the model design. Area under the curve (AUC) and Kaplan-Meier's (K-M) analysis demonstrated superiority of the new index. The postoperative survival score (POSS) index was further simplified via restricted cubic spline (RCS) analysis. Finally, the interpretation of the long-term mortality and subgroup analyses extended the application of the POSS index.

Results: Finally, a total of five factors (donor sex, recipient body mass index (BMI), total bilirubin (Tbil), international normalized ratio (INR) and total operative time) were identified as independent risk parameters and included in our POSS index. The AUCs of the original and simplified POSS indices were 0.764 and 0.723, respectively. Patients with high scores had poor short-term survival. Our index also functioned well in predicting long-term mortality, and it was more effective for patients with hepatitis B cirrhosis or hepatocellular carcinoma (HCC).

Conclusions: We constructed a simplified and effective postoperative survival scoring index to predict short-term complications and survival in adult LT patients.

Objectives: Unlike the commonly seen uphill esophageal varices in clinical practice, downhill esophageal varices are caused by obstruction of the superior vena cava and azygous venous system. The predominant causes of downhill esophageal varices are hemodialysis in end-stage renal disease patients and mediastinal malignancies. The cornerstone of the treatment for downhill esophageal varices is to address the underlying primary causes. Without this, patients may suffer from recurrent bleeding, and the bleeding can be fatal.

Methods: This review is primarily summarized through previous case reports. Meanwhile, it emphasizes the significance of case reports.

Results: Clinicians should be conscious that esophageal varices are not necessarily caused by liver cirrhosis or non-cirrhotic portal hypertension.

Conclusions: Specifically, when varices are only observed in the upper and middle esophagus, and the patient presents with evidence of superior vena cava obstruction, clinicians should be particularly vigilant for downhill esophageal varices. Moreover, a thorough investigation and definitive treatment of the underlying primary causes should be implemented.

Background: The impact of examined lymph node (LN) count on survival in cervical cancer remains understudied, with no consensus on the optimal number required.

Objectives: We aimed to investigate the role of LN count in postoperative pathological evaluation for cervical cancer patients undergoing surgery.

Methods: Data from the US SEER database and a retrospective Chinese cohort were analyzed. Multivariable logistic and Cox regression models assessed LN positivity detection and overall survival (OS), respectively. Smoothing spline curves and Chow tests identified structural change points in hazard ratios and LN-positive ratios.

Results: Among 14,133 SEER and 2,811 Chinese cases, higher LN counts correlated with increased detection of positive LNs (OR: 1.040, 95% CI: 1.019-1.062) and improved OS (HR: 0.990, 95% CI: 0.984-0.996). Structural change points occurred at 20 LNs for LN-negative patients and 13 LNs for LN-positive patients (both P < 0.001). An elevated LN-positive ratio (positive/examined LNs) strongly predicted worse OS (HR: 4.208; 95% CI: 1.454-12.181).

Conclusions: An increased number of examined LNs significantly contributes to the detection of positive LNs and improved patient survival. For patients with claimed LN-negative and LN-positive disease, a minimum examination of 20 and 13 LNs, respectively, is recommended to ensure adequate LN evaluation. The LN positive ratio is a strong prognostic indicator in patients with LN-positive disease.

To investigate the biological functions of Tiller Angle Control 2 (TAC2) in Salix psammophila. In this study, TAC2 was cloned from Salix psammophila, and an overexpression and subcellular localization expression vector for the SpsTAC2 gene was constructed. The SpsTAC2 gene was overexpressed in Arabidopsis and analyzed for phenotypic changes. The subcellular localization of SpsTAC2 was analyzed via Agrobacterium-mediated transient expression in onion (Allium cepa L.) epidermal cells. Phenotypic characterization of SpsTAC2 overexpressing Arabidopsis strains revealed that the branching angle of the transgenic strains was significantly greater than that of the wild type, and the anatomical structures of the stems and hypocotyls of the transgenic strains indicated that the vascular system of the transgenic strains developed more slowly than did that of the wild type. The subcellular localization of the SpsTAC2 gene revealed that the localization signals of the SpsTAC2 gene were mainly in the nucleus, and weak signals also appeared in the cell membrane, suggesting that the SpsTAC2 gene was mainly expressed mainly in the nucleus, with a small amount of expression in the cell membrane. This findings suggest that the SpsTAC2 gene influences the development of the branching angle of plants and xylem, and exerts its effects mainly in the nucleus and membrane. This study can help to characterize the regulatory effect of the TAC gene on the branching angle and explore its effect on the branching angle and vascular system development, and also help to explore the possible molecular regulatory mechanism, which can provide a theoretical basis for further elucidation of the mechanism of action of the IGT gene family.

Objective: To explore the feasibility and efficacy of the modified technique of totally intracorporeal ileal conduit (IC) construction via vaginal approach following robot-assisted radical cystectomy (RARC) in females.

Methods: By comparing the perioperative outcomes of the modified technique with extracorporeal urinary diversion (ECUD), 31 females treated for bladder cancer with RARC and IC from May 2020 to December 2023 were retrospectively analyzed and divided into two groups: the ECUD group (10 patients) and the modified intracorporeal urinary diversion (MICUD group) (21 patients). The modified technique involved performing transvaginal natural orifice specimen extraction surgery (TV-NOSES) after RARC; followed by the transvaginal placement of an Endo-GIA stapler to manipulate the bowel for intracorporeal IC construction.

Results: Both groups' surgeries were successfully completed by the same surgeon and team. Patients in the MICUD group had shorter total operative time, lower postoperative pain scores, quicker recovery, and shorter hospital stays. The learning curve of the MICUD showed two phases: a learning phase (cases 1-7) and a proficiency phase (cases 8-21). The incidence of postoperative complications between the two groups was similar. The mean follow-up times were 29.3 months (ECUD group) and 22.6 months (MICUD group). In the MICUD group, there was one case of local tumor recurrence, two cases of distant metastasis, including one death from progression; in the ECUD group, one patient had distant metastasis and died from progression.

Conclusion: RARC with MICUD represents a safe, feasible and easy-to-learn minimally invasive surgical approach. Patients experience less trauma and faster recoveries.

Introduction: Alzheimer's disease is a developing public health concern in aging communities that affects a sizable section of the global population. The risk of Alzheimer's disease increases with age; it affects one-third of males and two-thirds of women^. This research attempts to assess the effect of nano-selenium and thymoquinone on Nrf2 gene expression levels in Alzheimer's disease (AD).

Methods: There were five identical groups of 50 albino male rats: a control group that was healthy; an AD positive control group; an AD group that received nano-selenium (5 mg/kg); an AD group that received thymoquinone (2 mg/kg); and an AD group that received both. The duration of treatment was 4 weeks. The levels of Nrf2 in brain tissues were evaluated using real-time PCR.

Results: Nrf2 mean expression levels in the nano-selenium-treated rats, the thymoquinone-treated rats, and the rats that were given both treatments all increased significantly compared to AD rats with no treatment.

Conclusions: This study showed that nano-selenium and thymoquinone elevated Nrf2 gene expression levels in AD.

Background: Including racial and ethnic minorities in clinical trials is essential for advancing health equity. Despite progress, trials often do not mirror patient population demographics.

Methods: The National Library of Medicine's Clinical Trials database was queried for phase III trials of lung, colorectal, breast, and prostate cancers. A reference population was identified from the Surveillance, Epidemiology, and End Result (SEER) database, covering 48% of the US population.

Results: Among 181 trials, race and ethnicity data were included in 86.7% and 60.2% of trials, respectively, with improving reporting over time. Participants were predominantly White (76.3%), followed by Asian/Pacific Islander (14.1%), Black/African American (4.5%), and American Indian/Alaska Native (0.6%). Hispanic/Latino constituted 6.4% of participants. The proportion of non-White groups increased from 19.4% in trials started before 2011 to 26.2% after 2015. Compared with SEER data, the percentages were lower for Asian/Pacific Islander across all cancers, Black/African American in breast and prostate cancers, American Indian or Alaska Native in colorectal, breast, and prostate cancers in US solely trials.

Conclusions: Reporting and enrollment of racial and ethnic minorities in trials remain inadequate but improving. To enhance diversity, real-world data are warranted to identify recruitment goals by better assessing the geographic distribution within the patient population.

Background: Shoulder dystocia, a challenging condition for obstetricians, poses significant risks to both maternal and neonatal health, including maternal postpartum hemorrhage, neonatal hypoxia, and brachial plexus injury. Despite being unpredictable and unpreventable, effective management can mitigate these risks. Miscommunication and poor leadership are responsible for 72% of medical errors, which further highlights the importance of robust leadership skills in obstetric emergencies.

Research design and methods: A qualitative study involving 20 participants through structured interviews assessed preferred leadership styles in managing shoulder dystocia.

Results: Findings revealed that 55% of participants favored quantum leadership. Other preferences included laissez-faire by one anesthesiologist and democratic by two midwives. However, all participants acknowledged the efficacy of the seven quantum leadership skills in managing shoulder dystocia. Discussion emphasized that traditional leadership styles are less effective compared to quantum leadership in managing the complexities of shoulder dystocia. The quantum Ob-Wheel, consisting of 12 milestones, integrates these seven interdependent skills to guide the management process.

Conclusions: Despite the limited sample size of this study, it is worth noting that, given the unpredictable nature of shoulder dystocia, clinicians should be prepared for its occurrence during any birth, with quantum leadership providing a strategic advantage in such scenarios.

Purpose: Human amniotic fluid stem cells (hAFSCs) have shown significant regenerative potential in treating hair loss, wound healing, and tissue repair. This study aims to evaluate the effects of human amniotic fluid (hAF) on hair follicle (HF) regeneration and immune system modulation.

Materials and Methods: The hAF used was pooled, acellular, and gamma-irradiated to standardize its contents and enhance its stability. Both irradiated (FAFI) and non-irradiated (FAF) hAF were assessed for their efficacy and safety in promoting hair growth and modulating immune responses in a rat model of hair loss. The study examined HF regeneration, transition to the anagen phase, and macrophage polarization from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype.

Results: Both FAF and FAFI treatments significantly increased HF density, with FAFI exhibiting enhanced effects. Histological analysis demonstrated improved HF regeneration, increased M2 macrophages, and reduced collagen fiber deposition in treated areas. Gamma irradiation likely improved the efficacy of FAFI by stabilizing active components and inhibiting protease activity.

Conclusions: Irradiated hAF is a safe and effective therapeutic candidate for alopecia and HF growth disorders. These findings support further evaluation of hAF in clinical trials to validate its potential for hair regeneration therapies.

Background: There is a global consensus that respiratory tract infections are the major causes of morbidity and mortality among children. In this study, we aimed to compare the clinical and epidemiological characteristics of respiratory syncytial virus (RSV), influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among children admitted to hospital with acute respiratory infections. We also opted to identify the predictors of paediatric intensive care unit (PICU) admission.

Methods: In this study, a retrospective investigation and analysis of 423 children who were admitted to Abha Maternity and Children Hospital, in the southern region of Saudi Arabia, between January and December 2022 were conducted.

Results: The median age of these children was 16.5 months (Q1-Q3: 6-46.3). It was observed that the infectivity levels of RSV, SARS-CoV-2, influenza A and influenza B infections peaked in early to mid-September, mid-July, May and June, and October, respectively. There was a statistically significant difference in the total WBC counts between RSV and influenza B (p = 0.035) and SARS-CoV-2 and influenza B (p = 0.013). Moreover, there was a statistically significant difference in the absolute lymphocyte count between influenza A and RSV (p = 0.002). The median number of days in hospital was 6 days (Q1-Q3: 4-10). Patients with RSV infection required a significantly longer hospital stay, with a median of 8 days (Q1-Q3: 4-10). The factors associated with the likelihood of PICU admission for all study participants were congenital heart disease (odds ratio (OR) = 2.9, 95% confidence intervals (CI) [1.4-6.1]), RSV (OR = 2.3, 95% CI [1.3-4.1]) and age <6 months (OR = 2.0, 95% CI [1.2-3.4]).

Conclusions: RSV was identified as the most common pathogen causing acute lower respiratory infections among the studied patients. One of the more significant findings to emerge from this study is the seasonal changes in RSV and influenza infections, which mandates further research.