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BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is difficult to diagnose and has a high mortality rate. We aimed to determine the qualitative and quantitative parameters of computed tomography (CT) that can determine patient prognosis and contribute to early diagnosis in order to reduce mortality. MATERIAL AND METHODS The biphasic CT images of 40 patients, mean age 72.7±12 years, 24 men (60%), 14 women 14 (40%), with a diagnosis of NOMI were analyzed retrospectively. Patients were divided into survivor and non-survivor groups. Qualitative CT parameters, consisting of vascular, intestinal, and mesenteric and peritoneal findings, comorbidities, and surgical resection were compared using Fisher's exact test. Quantitative CT parameters of superior mesenteric artery (SMA), celiac trunk, inferior vena cava (IVC), superior mesenteric vein (SMV) diameters, and intestinal wall density difference (delta HU) in arterial and venous phases were compared with patient prognosis by using ANOVA. RESULTS Pneumatosis intestinalis (P=0.012), paper-thin bowel wall (P=0.015), and pale mesentery (P=0.008) were higher in the non-survivor group. In the survivor group, mesentery congestion (P=0.003), bowel wall thickening (P=0.001), bowel wall enhancement (P=0.044), and enhancing mucosa and submucosa of bowel wall (P=0.042) were higher. The celiac trunk, SMA, SMV, IVC, and IMA diameters, artery wall density, and delta HU were statistically significantly lower in the non-survivor group. The IVC diameter was correlated with patient prognosis (P=0.000). CONCLUSIONS A systematic evaluation of CT parameters can make important contributions to the early diagnosis and management of patients with NOMI.

Laparoscopy, as the most frequently chosen surgical technique in the world, carries specific complications and distinctions in anesthetic management. Complications of laparoscopy, particularly perceptible as disorders of the physiology of the cardiovascular, respiratory, and nervous systems, are caused by the specific technical conditions required for this type of operation. To facilitate surgical access and to clarify the surgical field, it is necessary to create a splenic emphysema, consisting of filling the peritoneal cavity with carbon dioxide (CO₂). This results in an increase in intra-abdominal pressure (IAP) and increased diffusion of CO₂ into the blood, causing a state of hypercarbia. The impact of these disturbances is of great importance in the pathological functioning of the above-mentioned organ systems. The anesthetist, in addition to the need to induce a state of general anesthesia, must be aware of and understand the pathological impact of increased intracranial pressure (ICP) and hypercarbia to adjust patient monitoring accordingly and implement appropriate treatment targeting the specific complications occurring during laparoscopy. Complications and contraindications important from the anesthetist's point of view are also described. The 51 articles and reference texts were used for this purpose, which, combined with the authors' knowledge and experience, is intended to be a valuable resource for use by anesthesiology staff. This article aims to explain the effects of laparoscopy on human physiology and to compare and contrast methods of airway management, mechanical ventilation, the type of muscle relaxation used, and postoperative management in patients undergoing laparoscopic surgery.

BACKGROUND Complete placenta previa (CPP) is a life-threatening condition with increasing incidence worldwide. This retrospective study investigated the impact of prior cesarean delivery on pregnancy outcomes in women with CPP. MATERIAL AND METHODS The data of 476 patients with CPP who underwent cesarean delivery in a tertiary hospital in Shanghai, China, from January 2013 to December 2022 were retrospectively analyzed. Patients were divided into prior cesarean delivery and no-prior cesarean delivery groups. Diagnosis of CPP was confirmed by last preoperative ultrasound/MRI. Maternal characteristics, intrapartum conditions, maternal complications, and neonatal outcomes were compared between groups. Independent predictors of hemorrhage were analyzed by logistic regression analysis. RESULTS The prior cesarean delivery group had significantly higher maternal age (36 [3.7)] vs 34.2 [4.2)], P=0.012), rates of intraoperative bleeding (982.9 [202.9] vs 588.8 [134.2], P=0.001), hysterectomy (6.4% vs 0.9%, P=0.002), premature birth (60.9% vs 36.6%, P<0.001), and neonatal hospitalization (13.5% vs 6.3%, P=0.008). The no-prior cesarean delivery group had higher rates of assisted reproduction (30.0% vs 3.8%, P<0.001) and endometriosis history (14.1% vs 8.3%, P<0.001). Multivariate logistic regression showed a history of cesarean delivery (adjusted odds ratio (aOR) 1.67), 2 or more previous cesarean deliveries (aOR 5.22), anterior placenta (aOR 2.53), abnormal percreta (aOR 5.24), and antepartum bleeding (aOR 1.90) were strongly associated with massive hemorrhage (P<0.05). CONCLUSIONS Prior cesarean delivery increases risks of hemorrhage, hysterectomy, premature birth, and neonatal hospitalization in patients with CPP. Independent risk factors for hemorrhage in these patients include prior cesarean delivery (especially 2 or more), anterior placenta, abnormal placentation, and prenatal bleeding.

BACKGROUND Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that leads to rapid degeneration of nerves in the brain and spinal cord, with eventual loss of voluntary movements, including breathing. This retrospective study of medical record data from 105 US veterans diagnosed with ALS at the Oklahoma City VA Medical Center between 2010 and 2021 aimed to identify patient demographics, and the causes and places of death for these veterans. MATERIAL AND METHODS Data from 105 US veterans diagnosed with ALS by the El Escorial criteria and supported by neurophysiology testing was reviewed. The information about the place and cause of death was obtained from each patient's care provider and death certificate. Crude mortality rates (per 100 person-years) and standardized mortality ratios (SMRs) were calculated for the causes of death, by sex, age group, and location of death. RESULTS During the 11-year follow-up period, 80 (76.2%) veterans with ALS died. The mean (SD) follow-up time was 4.53 (4.55) years. Most of the deaths were due to respiratory failure and pneumonia (n=43, mortality rate=9.21 per 100 person-years). Most patients died at home (n=71, 88.7%). The annual crude mortality rate was 16.7 and the all-cause death SMR was 25.63 (95% CI, 20.32-31.55). CONCLUSIONS This study's findings are that in veterans with ALS, the main cause of death is respiratory disease (failure). The main location of death was the home, with their family members. The all-cause mortality rate among veterans with ALS was 26 times greater than for the general Oklahoma population.

In this article, we aim to review the diagnosis, classification, and treatment of acromioclavicular joint injury by mainly describing the progress of surgical treatment for acromioclavicular joint injury, providing a reference for clinical diagnosis and treatment. Acromioclavicular joint injury is a common sports injury, which is more common in male than in female patients. The mechanism of the injury is mainly caused by direct or indirect violence, which can be clearly diagnosed by radiography. According to the time after injury, it can be divided into acute injury and chronic injury. The Rockwood classification is the most commonly used classification in research. For Rockwood types V to VI, we treat with surgery, while the treatment options for type III are controversial and no consensus has been reached. Surgical treatment can be divided into open surgery and shoulder arthroscopy. The methods of open surgery can be divided into 3 categories: direct acromioclavicular joint fixation, coracoclavicular space suspension device fixation, and coracoclavicular ligament reconstruction. The shoulder arthroscopy method involves reconstruction of the coracoclavicular ligament under arthroscopy, combined with suture-button suspension fixation. For patients with Rockwood classification III and IV-VI, who have significant movement needs, surgery is the preferred treatment for acute acromioclavicular dislocation within 3 weeks. For patients with a chronic acromioclavicular dislocation or who do not respond to nonsurgical treatment, it is recommended to use wire suspension fixation combined with ligament to repair the damage. This article aims to review advances in the management of acromioclavicular joint injury.

BACKGROUND Adipose-derived stem cells (ASCs) from intra-articular adipose tissue of osteoarthritis (OA) and rheumatoid arthritis (RA) patients similarly regulate the proliferation of activated CD4⁺ T lymphocytes and exhibit comparable differentiation potential. This study aimed to assess the impact of ASCs from RA patients on CD4⁺ T cell activation and differentiation into Th17 and T regulatory (Treg) cells. MATERIAL AND METHODS Intra-articular adipose tissue samples were obtained from patients with RA and OA, who underwent knee replacement surgery. ASCs were isolated and cultured either with isolated CD4⁺ cells or with peripheral blood mononuclear cells. After culture, CD4⁺ T cell phenotype was evaluated by flow cytometry, and cytokine concentrations in culture supernatants were analyzed via ELISA. Blocking experiments were conducted to identify the soluble agents responsible for the immunomodulatory effects of ASCs. RESULTS RA- and OA-derived ASCs effectively modulated CD25 and CD69 expression on CD4⁺ cells. RA-derived ASCs failed to induce Tregs, decreased HLA-DR expression, and increased IL-35 production. RA- and OA-derived ASCs reduced TNF and IFN-γ production but increased IL-17 production. The immunomodulatory activities of ASCs were linked to the kynurenine pathway and prostaglandin E2. CONCLUSIONS This study indicates that ASCs modulate the phenotype of CD4⁺ T cells and influence the production of both pro-inflammatory and anti-inflammatory cytokines. However, ASCs from RA patients appear to have impaired immunomodulatory abilities, raising concerns about their therapeutic potential. Further research is needed to enhance our understanding of ASCs biology and their therapeutic utility.

BACKGROUND Bone cement displacement (BCD), which has received increasing attention from scholars, is a serious complication following vertebroplasty in patients with osteoporotic vertebral fractures (OVFs), and percutaneous kyphoplasty (PKP) might promote its occurrence. However, few studies have systematically explored the risk factors of BCD after PKP. This research aimed to study the risk factors for BCD following PKP. MATERIAL AND METHODS The clinical data of patients with OVFs treated with PKP from June 2016 to August 2022 in our department were retrospectively reviewed. Patients were categorized into the bone cement displacement group and the bone cement non-displacement group. Data on the subjects and their radiologic images were gathered for univariate analysis and binary logistic regression analysis. The receiver operating characteristic (ROC) curve and confusion matrix were utilized to assess the discrimination ability. RESULTS We included 181 patients, of which 12 had BCD after PKP. Binary logistic regression analysis revealed that independent risk factors associated with BCD after PKP were: high BMI, high restoration rate of the Cobb angle, high distance between the bone cement and the vertebral endplates, and presence of bone cement leakage. The ROC curve and confusion matrix indicates that logistic regression exhibited a strong predictive value for BCD. CONCLUSIONS Patients with a high BMI, a high restoration rate of the Cobb angle, a high distance between the bone cement and the vertebral endplates, and bone cement leakage have an increased risk of BCD after PKP.

BACKGROUND This retrospective study of 44 patients requiring removable functional dental appliances aimed to compare the use of a maxillary expansion device, twinblock/monoblock, face mask, and chincup on maxillary sinus dimensions, mandibular anterior region bone density (MABD), and mandibular condyle head bone formation (MCBF) using panoramic radiography. MATERIAL AND METHODS The patients were divided into 4 groups based on the treatment modalities used: group A, maxillary expansion device (n=11); group B, twinblock/monoblock (n=11); group C, face mask (n=11); and group D, chincup (n=11). MABD and MCBF were assessed using the fractal analysis method, while maxillary sinus dimensions were compared using the ImageJ program. Different groups of patients were tested by the Mann-Whitney U test, with Bonferroni correction. RESULTS Group A showed an increase in MABD, MCBF, and average maxillary sinus indentation base length (MSIL) and a decrease in average planar base length (MSPL) and maxillary sinus area (MSA) (P<0.05). Group B showed an increase in MABD, MSIL, MSPL, MSA, and MCBF (P<0.05). Group C showed an increase in MABD, MSIL, MSPL, and MCBF, with a decrease in MSA (P>0.05). Group D showed an increase in MCBF, MABD, MSIL, and MSA, with a decrease in MSPL at the end of treatment, compared with pretreatment (P<0.05). CONCLUSIONS Orthodontic treatment with different removable functional dental appliances has varying effects on the mandible and maxilla. Possible changes in the maxilla and mandible should be considered before treatments with removable functional dental appliances.

BACKGROUND Hepple stage V osteochondral injuries of the talus include subchondral cyst formation, secondary degenerative change, and secondary osteoarthritis. This retrospective study aimed to compare perioperative outcomes from iliac periosteal bone autografting and talus non-weight-bearing surgery in 162 patients with Hepple V osteochondral injuries of the talus. MATERIAL AND METHODS According to the inclusion criteria, 162 eligible patients were selected for analysis and divided into an iliac periosteal bone autograft group (n=82) and a talus non-weight-bearing group (n=80) according to the surgical methods. General data and data on perioperative conditions, complications, intraoperative fluoroscopy times, preoperative and postoperative visual analog scale (VAS) for pain, ankle-hindfoot scoring system (AOFAS Ankle-Hindfoot Scale), and plantar flexion and extension range of motion were collected to assess ankle joint function and were compared between groups. RESULTS The comparison of perioperative results between the 2 groups showed that the incision length (P=0.000), operation time (P=0.000), and length of hospital stay (P=0.000) in the iliac periosteal bone autograft group were longer than those in the talus non-weight-bearing group. The intraoperative blood loss in the anterior group was greater than that in non-weight-bearing group (P=0.000). Regarding complications, there were more cases of donor site paresthesia (P=0.014) and postoperative pain aggravation in the iliac periosteal bone autograft group than in the non-weight-bearing group. CONCLUSIONS In patients with Hepple V osteochondral injury of the talus, the incision length, operation time, and length of hospital stay in the talus non-weight-bearing group were shorter, there was less intraoperative blood loss, and there were fewer postoperative complications. In the short term, bone transplantation in the talus non-weight-bearing group was more "minimally invasive" and the postoperative recovery was better than in the iliac periosteal bone allograft group.

Arecoline hydrobromide (AH) is an active alkaloid found in betel nut. AH was first extensively employed for treatment of tapeworm infection in dogs in Australia. In the last 2 decades, AH has gained increasing attention due to its multiple and notable pharmacological activities in various diseases, including: acaricidal activity against cattle ticks; anticataract activity; therapeutic and alleviating effects against diabetes complications, including male reproductive damage and cataract; treatment of rheumatoid arthritis (RA); and protection against gastric ulcer. In addition, AH may have potassium channel inhibitory activity, regulate of CYP2B (Cytochrome P450 2B) expression, and regulate mRNA expression of hepatorenal transporters. In terms of toxicity, the data showed that AH may have sub-chronic, long-term and acute toxicities, and teratogenic effects. Additionally, in pharmacokinetic studies, rapid LC-MS/MS methods have been applied to determine AH or arecoline quantitatively. In summary, the above studies suggested that AH may have considerable application prospects and great potential value in clinical practice in the future, but limitations of current studies and new challenges in AH were also be discussed, and future development directions were suggested in toxicities and pharmacokinetics. This article aims to review the pharmacological activity, pharmacokinetics, and toxicity of the natural alkaloid, arecoline hydrobromide.