Annals of Medicine and Surgery最新文献

Sickle cell disease (SCD) is a major public health challenge in Africa, where the prevalence of the condition is high, and it contributes to significant morbidity and mortality, especially among children. Blood transfusions are a crucial therapeutic intervention for managing complications of SCD, such as severe anemia and stroke, which are common among affected individuals. However, many African countries face significant barriers in providing safe, adequate, and timely blood transfusions due to underdeveloped healthcare infrastructure, limited voluntary blood donations, and a shortage of trained healthcare professionals. This review explores the World Health Organization's (WHO) role in enhancing blood transfusion services for SCD patients in Africa, highlighting its advocacy efforts, policy development, infrastructure strengthening, and capacity-building initiatives. The WHO has been pivotal in advocating for the integration of blood transfusion services into national healthcare systems and developing guidelines for safe blood collection, storage, and distribution. Additionally, WHO has worked to promote voluntary blood donation campaigns, ensuring a steady and safe supply of blood products. WHO's efforts also include providing technical support to healthcare systems in Africa to improve blood transfusion infrastructure, increase public awareness about the importance of regular blood donation, and ensure that healthcare professionals are properly trained in transfusion medicine. These initiatives aim to enhance the quality and accessibility of blood transfusion services, ultimately improving outcomes for individuals living with SCD.

The rapid integration of artificial intelligence (AI) into neurosurgical practices in the United States is transforming how diagnoses are interpreted, how surgical plans are developed, and how guidance is provided during operations as clinical needs continue to grow. Models based on radiomics and the Food and Drug Administration approved tools for tumor segmentation, aneurysm identification, and spinal navigation are showing enhanced accuracy and decreased variability among observers, highlighting AI's potential for significant change. Nevertheless, there are major concerns about the opacity of black-box models, inaccurate outputs, and the increasing legal uncertainties arising from AI-related errors. Ethical challenges, such as the risk of clinician de-skilling, diminished professional autonomy, and exacerbated inequities in rural areas with limited access to imaging, complicate responsible deployment. This letter emphasizes the necessity for transparent validation processes, oversight led by clinicians, diverse and inclusive datasets, and improved regulatory protections. Requiring AI competency training and nationally reporting adverse events associated with AI are crucial to ensure that AI enhances clinical judgment rather than replacing it, thereby maintaining patient safety, equity, and professional integrity in neurosurgical decision-making.

Introduction: Diabetic neuropathy, a prevalent complication of diabetes mellitus (DM), often involves autonomic dysfunction, with the vagus nerve (VN) being an early target. High-resolution ultrasonography has emerged as a noninvasive tool to assess structural nerve changes, including cross-sectional area (CSA), as a potential biomarker for early diagnosis. This systematic review and meta-analysis, the first to synthesize evidence on VN CSA in diabetic neuropathy, evaluated its diagnostic utility and confounding factors.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Embase, and Web of Science yielded six studies encompassing 604 participants (347 diabetic patients and 257 controls).

Results: Pooled CSA showed no significant differences between diabetic neuropathy patients and controls for left VN (MD: -0.02 mm², 95% CI: -0.80-0.75, P = 0.95) or right VN (MD: -0.39 mm², 95% CI: -1.09-0.31, P = 0.28). However, excluding an outlier study revealed a significant right VN CSA increase in DM patients (MD: 0.26 mm², P < 0.01). Subgroup analyses indicated significant CSA differences in patients with BMI <27 kg/m², age >50 years, and DM duration <9 years. Substantial heterogeneity (I² > 95%) across studies underscores variability in ultrasound protocols and patient demographics.

Discussion: While VN CSA alone may not suffice as a standalone diagnostic biomarker, its role in specific subgroups and combined with functional assessments warrants exploration. Standardized imaging protocols and longitudinal studies are needed to clarify its clinical utility and pathophysiological implications in diabetic autonomic neuropathy.

Hereditary angioedema (HAE) presents a significant therapeutic challenge during pregnancy, a period often associated with increased attack frequency and severity. The management of HAE in pregnancy is complicated by physiological changes and limited fetal safety data for many prophylactic agents. Recent advancements in long-acting prophylaxis, particularly monoclonal antibodies targeting plasma kallikrein such as Navenibart (STAR-0215), offer a promising new therapeutic approach. With an extended half-life of up to 105 days, Navenibart enables infrequent dosing (every 3-6 months), potentially reducing treatment burden and improving coverage through critical gestational periods. However, its use in pregnant patients remains strictly investigational, as no clinical safety or efficacy data exist for this population. This article examines the emerging role of plasma kallikrein inhibitors in HAE prophylaxis during pregnancy, discusses the pharmacologic profile and potential advantages of Navenibart, and proposes cautious, preliminary clinical considerations within a shared decision-making framework. Multidisciplinary care and further research are urgently needed to establish safety and define the place of these agents in obstetric HAE management.

Background: Social support refers to the psychosocial resources available through interpersonal contacts and social networks, which help reduce complications and improve quality of life. It also decreases absenteeism from medical appointments, supports lifestyle changes, and plays a key role in self-management. Evidence on social support among diabetic patients in Ethiopia is limited; therefore, this study aimed to assess its level and associated factors.

Objective: This study assessed the level of social support and associated factors among diabetic patients.

Study design: This was an institution-based cross-sectional study design.

Methods: An institution-based cross-sectional study was conducted, and data were collected from 386 diabetic patients using a systematic random sampling technique. The validated Oslo Social Support Scale was applied to measure the level of social support. The study was conducted March 20 to April 20, 2023 GC. Bivariate and multivariate ordinal logistic regression analyses were performed to identify factors associated with social support. Statistical significance was set at a P-value <0.05.

Result: This study found that 24.35% (95% CI: 19.9%-27.9%) of the participants had a strong level of social support, and 45.34% (95% CI: 40.5%-50.32%) moderate social support. In multivariable ordinal logistic regression, age, gender, residence, marital status, occupation, and the presence of health insurance were found to be significant predictors of the level of social support.

Conclusion: Nearly half of the participants reported a moderate level of social support, while about one-fourth had strong social support. Sociodemographic factors such as age, gender, residence, marital status, occupation, and health insurance status significantly influenced the level of social support. Healthcare providers should incorporate social support assessment into routine care to assist individuals with low support. In addition, regional health offices should implement strategies to strengthen social support. Future research should include qualitative and longitudinal studies to better understand patients' lived experiences and changes in social support over time.

The rise of predatory journals threatens the integrity of academic publishing by exploiting open-access models and bypassing rigorous peer review. The lack of standardized criteria complicates their identification. This study systematically reviews existing predatory journal lists, assessing their effectiveness in enhancing transparency and safeguarding scholarly publishing. This systematic review adhered to PRISMA guidelines, including lists identifying predatory journals from peer-reviewed sources or reputable organizations. Using relevant keywords, a comprehensive search was conducted across academic databases (PubMed, Web of Science, Scopus, DOAJ), grey literature, and publisher websites. Key variables extracted included governance, accessibility, update mechanisms, and identification criteria. A comparative analysis assessed transparency, evaluation processes, and gaps such as historical tracking and evolving criteria. Descriptive statistics, including frequency, percentage, median, and range, were calculated using SPSS Version 26.0. Ten lists identifying predatory journals were analyzed; six (60.0%) were established after 2017, and nine (90.0%) were publicly accessible. The majority (seven, 70.0%) covered journals and publishers, with nine (90.0%) relying on a manual review process for identification. Delisting criteria were unclear in eight (80.0%) of the lists. Most lists (six, 60.0%) were available in database format . In terms of updating frequency, one list (10.0%) was updated daily, and six lists (60.0%) did not specify their update frequency. While these lists help identify fraudulent publishing practices, criteria, updates, and delisting inconsistencies reduce their reliability. Standardized methodologies, transparency, and sustained efforts are needed to keep them relevant, ensuring they safeguard academic integrity and guide researchers toward credible publishing.

Background: Cervical cancer remains one of the most common gynecological malignancies worldwide, with epigenetic RNA modifications playing a critical role in its development. This study aims to investigate the role of fat mass and obesity-associated protein (FTO) in cervical cancer progression and its impact on N6-methyladenosine (m6A) RNA methylation, focusing on Fibroblast Growth Factor 2 (FGF2) as a key downstream mediator.

Methods: We analyzed FTO expression in adjacent normal and cervical cancer tissues by using immunohistochemistry (IHC), Western blot, and q-PCR. We also examined FTO expression and m6A modification levels in cervical cancer cell lines versus control cell lines. To investigate the impact of FTO overexpression and knockdown on cell proliferation and apoptosis, a series of functional assays, including CCK-8, flow cytometry, and immunofluorescence staining, were carried out. Furthermore, we investigated the regulation of FGF2 by FTO using the GEPIA database, qRT-PCR, and Western blot.

Results: There was a notable elevation of FTO expression in cervical cancer tissues as opposed to the adjacent normal tissues. Increased levels of FTO protein and mRNA were detected in tumor tissues, along with reduced m6A modification levels of FTO mRNA. Cervical cancer cells showed higher FTO expression and decreased m6A modification compared to control cell lines. Enhanced FTO expression in HeLa cells resulted in lower global m6A levels, increased cell proliferation, and reduced apoptosis. Conversely, FTO knockdown led to reduced cell proliferation, reduced FGF2 mRNA and protein levels, diminished lactate production, and impaired cell proliferation, and increased apoptosis.

Conclusion: FTO significantly influences cervical cancer progression, at least in part, through m6A modification of FGF2, thereby affecting downstream signaling. Targeting FTO and its downstream effectors holds potential as a therapeutic strategy for cervical cancer treatment.