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Erythromycin fermentation residue (EFR) represents a typical hazardous waste produced by the microbial pharmaceutical industry. Although electrolysis is promising for EFR disposal, its microbial threats remain unclear. Herein, metagenomics was coupled with the random forest technique to decipher the antibiotic resistance patterns of electrochemically treated EFR. Results showed that 95.75% of erythromycin could be removed in 2 hr. Electrolysis temporarily influenced EFR microbiota, where the relative abundances of Proteobacteria and Actinobacteria increased, while those of Fusobacteria, Firmicutes, and Bacteroidetes decreased. A total of 505 antibiotic resistance gene (ARG) subtypes encoding resistance to 21 antibiotic types and 150 mobile genetic elements (MGEs), mainly including plasmid (72) and transposase (52) were assembled in EFR. Significant linear regression models were identified among microbial richness, ARG subtypes, and MGE numbers (r2=0.50-0.81, p< 0.001). Physicochemical factors of EFR (Total nitrogen, total organic carbon, protein, and humus) regulated ARG and MGE assembly (%IncMSE value = 5.14-14.85). The core ARG, MGE, and microbe sets (93.08%-99.85%) successfully explained 89.71%-92.92% of total ARG and MGE abundances. Specifically, gene aph(3')-I, transposase tnpA, and Mycolicibacterium were the primary drivers of the resistance dissemination system. This study also proposes efficient resistance mitigation measures, and provides recommendations for future management of antibiotic fermentation residue.

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BACKGROUND AND AIMS: Current laboratory methods for opioid detection involve an initial screening with immunoassays which offers efficient but non-specific results and a subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation which offers accurate results but requires extensive sample preparation and turnaround time. Direct Analysis in Real Time (DART) tandem mass spectrometry is evaluated as an alternative approach for accurate opioid detection with efficient sample preparation and turnaround time. MATERIALS AND METHODS: DART-MS/MS was optimized by testing the method with varying temperatures, operation modes, extraction methods, hydrolysis times, and vortex times. The method was evaluated for 12 opioids by testing the analytical measurement range, percent carryover, precision studies, stability, and method-to-method comparison with LC-MS/MS. RESULTS: DART-MS/MS shows high sensitivity and specificity for the detection of 6-acetylmorphine, codeine, hydromorphone, oxymorphone, hydrocodone, naloxone, buprenorphine, norfentanyl, and fentanyl in urine samples. However, its performance was suboptimal for norbuprenorphine, morphine and oxycodone. CONCLUSION: In this proof-of-concept study, DART-MS/MS is evaluated for its rapid quantitative definitive testing of opioids drugs in urine. Further research is needed to expand its application to other areas of drug testing.

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Harmful algal blooms (HABs) have emerged as a critical global environmental and ecological concern. Timely and accurate monitoring of the prevalent bloom-forming genera is crucial for HAB management. Conventional microscope-based methods are time-consuming, labor-intensive, and specialized expertise-dependent, often making them impractical for large-scale surveillance. Molecular methods, such as metabarcoding, provide efficient technical solutions; however, the lack of competent PCR primers and further field validation present obstacles to their wide use. Here, we successfully developed Aphanizomenon-specific primers and validated the application of environmental DNA (eDNA) metabarcoding for field-based monitoring of Aphanizomenon in 37 sites across lentic and lotic freshwater ecosystems in Beijing. The sensitivity and specificity tests of newly developed primers demonstrated high performance - comprehensive recovery of biodiversity in Aphanizomenon communities and high ratios (>95%) of Aphanizomenon sequences in datasets. We observed significant correlations between the sequence abundance derived from eDNA metabarcoding and the total cell density determined through microscopic identification across all the sampling sites, both in the spring (r = 0.8086, p < 0.0001) and summer (r = 0.7902, p < 0.0001), thus validating the utility of eDNA metabarcoding based on the newly developed primers for monitoring in the field. Further, we identified key environmental variables that were primary drivers responsible for the spatiotemporal distribution of Aphanizomenon abundance. These variables included temperature, total nitrogen, and dissolved oxygen in lentic ecosystems, and total phosphorus in lotic ecosystems. The method developed and validated here offers an accurate, efficient, and high-throughput tool for the monitoring of Aphanizomenon blooms in freshwater ecosystems.

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Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

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Objetivo: analisar o empoderamento estrutural de enfermeiros em um hospital de alta complexidade. Métodos: estudo quantitativo, analítico e transversal, realizado com 93 enfermeiros, utilizando um questionário sociodemográfico e ocupacional e o Questionário de Condições de Eficácia no Trabalho II. Os dados foram coletados entre fevereiro e março de 2023. A análise dos dados deu-se por meio de estatística descritiva, teste de Kolgomorov-Smirnov, teste do qui-quadrado e regressão de Poisson. Resultados: os enfermeiros apresentaram nível moderado de empoderamento estrutural, com média de 20,67 (p<0,000). O componente mais pontuado foi a oportunidade (4,22 dp±0,80). Não foram encontradas diferenças significativas nos níveis de empoderamento estrutural relacionadas às unidades de trabalho (p-Valor 0,381), vínculo empregatício (p-Valor 0,352) e grau de instrução (p-Valor 0,839). O modelo de regressão de Poisson indica que tanto pode haver altos ou baixos níveis de empoderamento a depender do setor. Conclusão: os enfermeiros demonstraram possuir níveis moderados de empoderamento estrutural.

Objective: to analyze the structural empowerment of nurses in a high-complexity hospital. Methods: a quantitative, analytical, cross-sectional study was carried out with 93 nurses, using a sociodemographic and occupational questionnaire and the Questionnaire of Conditions of Effectiveness at Work II. The data was collected between February and March 2023. The data was analyzed using descriptive statistics, the Kolgomorov-Smirnov test, the chi-square test, and Poisson regression. Results: the nurses had a moderate structural empowerment level, with a mean of 20.67 (p<0.000). The highest scoring component was opportunity (4.22 sd±0.80). No significant differences were found in the structural empowerment levels related to work units (p-Value 0.381), employment relationship (p-Value 0.352) and education level (p-Value 0.839). The Poisson regression model indicates that there can be either high or low empowerment levels depending on the sector. Conclusion: nurses showed moderate structural empowerment levels.

Objetivo: analizar el empoderamiento estructural del enfermero en un hospital de alta complejidad. Métodos: estudio cuantitativo, analítico y transversal, realizado con 93 enfermeros, utilizando un cuestionario sociodemográfico y ocupacional y el Cuestionario de Condiciones de Efectividad en el Trabajo II. Los datos se recolectaron entre febrero y marzo de 2023. El análisis de los datos se realizó mediante estadística descriptiva, prueba de Kolgomorov-Smirnov, prueba de chi-cuadrado y regresión de Poisson. Resultados: los enfermeros presentaron un nivel moderado de empoderamiento estructural, la media fue de 20,67 (p<0,000). El componente con mayor puntaje fue oportunidad (4,22 DE±0,80). No se encontraron diferencias significativas en los niveles de empoderamiento estructural relacionados con las unidades de trabajo (valor p 0,381), la relación laboral (valor p 0,352) y el nivel de formación (valor p 0,839). El modelo de regresión de Poisson indica que pueden existir niveles altos o bajos de empoderamiento dependiendo del sector. Conclusión: los enfermeros demostraron niveles moderados de empoderamiento estructural.

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BACKGROUND: Optimal blood pressure management during endovascular stroke treatment is not certain. We hypothesized that time or proportion of intraprocedural systolic blood pressure spent in a range around admission blood pressure might be associated with better clinical outcome. METHODS: We conducted a retrospective observational study at a single center at a university hospital, which included patients from August 2018 to September 2020 suffering from acute ischemic stroke with anterior circulation vessel occlusion and treated with endovascular therapy. Time and proportion of procedure time where systolic blood pressure (SBP) was near the baseline SBP on admission (bSBP) were used as exposure variables. The primary outcome was the occurrence of mRS score 0-2 three months after stroke. The primary analysis was performed by fitting a logistic regression model adjusted for baseline NIHSS, pre-stroke mRS, mTICI score, intubation, age and sex. RESULTS: We included 589 patients in the analysis. Mean (SD) age was 76 (12) years, 315 were women (53%) and mean (SD) NIHSS score at admission was 15 (7.5). Mean (SD) bSBP was 167 (28) mmHg and mean (SD) intraprocedural SBP was 147 (21) mmHg. The proportion of time where intraprocedural SBP was in range of bSBP ± 20% was associated with a slightly higher odds of achieving favorable outcome (adjusted OR, 1.007; 95% CI, 1.0003-1.013). CONCLUSION: A higher proportion of intraprocedural time with systolic blood pressure in range of ± 20% of the admission level is associated with higher odds of favorable functional outcome. TRIAL REGISTRATION: Not applicable.

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Background and Objective: Inadequate risk assessment and a lack of risk monitoring are common deficiencies in clinical laboratory, and are also the main causes of biosafety incidents. Therefore, we summarized the experience of implementing adequate risk assessment and maintaining risk monitoring, and established a procedure for continuously improving biosafety management. Methods: Learning from our laboratory's experience in implementing risk assessment, risk response, and risk monitoring before and during the COVID-19 epidemic, we summarized the procedures for fully identifying risks, accurately evaluating risks, maintaining risk monitoring, establishing and regular reviewing safety indicators. On this basis, we established a system for continuously improving biosafety management through risk monitoring and reviewing safety indicator. Results: We identified a total of 30 unacceptable risks prior to the COVID-19 pandemic, and developed and implemented appropriate risk control measures. After risk control, residual risks were acceptable, and no biosafety incidents have occurred. During the COVID-19 pandemic, after multiple risk monitoring, we identified ten new risks, three ineffective risk control measures, and multiple control measures for excessive protection. Then, we timely adjusted risk control measures to avoid laboratory personnel infection and excessive protection. Meanwhile, We established eight safety indicators and identified two improvement opportunities through regular reviews. Conclusion: Adequate risk identification and accurate risk assessment are particularly important for effectively controlling biosafety risks. Biosafety management should be continuously improved to deal with ineffective and excessive protection caused by various changes in experimental activities. Continuous improvement of biosafety management can be achieved through risk monitoring, regular review of safety indicators, and management reviews. This study will help laboratory managers to fully and accurately assess risks, as well as update risks and their control measures through risk monitoring, and the continuous improvement procedure established in the study has certain reference value for laboratories to effectively respond to emerging infectious diseases and avoid excessive protection.

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Iatrogenic coronary artery fistula (CAF) can occur following acute myocardial infarction, percutaneous coronary intervention (PCI) procedures, and heart surgery. Iatrogenic CAF linked to PCI has a low incidence rate. Early diagnosis and treatment are crucial when an iatrogenic fistula develops, as it may lead to cardiac tamponade, myocardial infarction, or death. In this report, we present a case of iatrogenic CAF secondary to coronary perforation caused by guidewire-induced trauma, followed by stent implantation and balloon inflation in the context of acute coronary syndrome (ACS). It was successfully managed through prolonged balloon inflation within the previously implanted stent just prior to the rupture zone.

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Traumatic brain injury (TBI) is a significant global public health issue, heavily impacting human health, especially in low-and middle-income areas. Despite numerous guidelines and consensus statements, TBI fatality rates remain high. The pathogenesis of severe TBI is closely linked to rising intracranial pressure (ICP). Elevated intracranial pressure can lead to cerebral herniation, resulting in respiratory and circulatory collapse, and ultimately, death. Managing intracranial pressure (ICP) is crucial in neuro-intensive care. Timely diagnosis and precise treatment of elevated ICP are essential. ICP monitoring provides real-time insights into a patient's condition, offering invaluable guidance for comprehensive management. ICP monitoring and standardization can effectively reduce secondary nerve damage, lowering morbidity and mortality rates. Accurately assessing and using true ICP values to manage TBI patients still depends on doctors' clinical experience. This review discusses: (a) Epidemiological disparities of traumatic brain injuries across countries with different income levels worldwide; (b) The significance and function of ICP monitoring; (c) Current status and challenges of ICP monitoring; (d) The impact of decompressive craniectomy on reducing intracranial pressure; and (e) Management of TBI in diverse income countries. We suggest a thorough evaluation of ICP monitoring, head CT findings, and GCS scores before deciding on decompressive craniectomy. Personalized treatment should be emphasized to assess the need for surgical decompression in TBI patients, offering crucial insights for clinical decision-making.

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With the increasing prevalence of tumors, effective symptom management has emerged as a cornerstone of patient care. While surgical interventions remain pivotal, non-surgical nursing methods have gained prominence in providing relief from pain, discomfort, and other tumor-related symptoms. This review delves into the various non-surgical approaches employed, emphasizing tumor sedation and analgesia. We discuss the array of non-pharmacological and pharmacological strategies, shedding light on their indications, contraindications, and potential side effects. Furthermore, the importance of addressing individual differences in pain perception and the ethical considerations in symptom management are highlighted. We conclude by providing insights into the recent innovations in the field, emphasizing the need for personalized and comprehensive care to enhance patients' quality of life. Tumor sedation, Tumor analgesia, Non-surgical nursing care, Pain management, Non-pharmacological interventions, Palliative care, Recent innovations, Symptom management.

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Objectives: Safety reports are core components of secure medical systems, but their significance have remained obscure, mostly owing to limited quantitative approaches other than the numbers of reports. In 2005, we developed "management levels" and their equally converted points (p) of scores, which indicated the grades of required correspondences of medical systems. Moreover, products of those scores multiplied by risk levels (equally converted scores), "total scores" were also proposed for weighting harmful events from biphasic aspects; severity of patient damage and the required levels of correspondence as medical systems. In this study, we assessed this scoring system using extensive longitudinal experience. Methods: Risk, management and total scores were retrospectively surveyed between 2012 and 2022 when a consistent reporting system had worked throughout the study period. Results: The aforementioned three scores inconsistently decreased along with a decrease in number of safety reports from 2,445 to 1,194 cases, or 2,069 to 1,052 cases/105 admitted patients (c/pap) in eleven years. Of the scores, the most prominent decrease was found in the management scores from 2,164 to 1,070 points/pap (p/pap). The risk and total scores had decreased even more modestly: from 1,879 to 1,484 p/pap, and 5,470 to 4,007 p/pap, respectively. When compared with the proportion (%) of risk and management levels in 2012, risk level 0 decreased, and risk level 1 and 3a increased in 2022. However, the proportion of management levels did not change during this period. Conclusion: The proposed scoring system showed that the cumulative severity of patient damage did not worsen, or decrease in some years accompanied by decreasing correspondence levels of the medical system, although the numbers of reports also decreased. These findings show the appropriateness of the on-going safety activities of this hospital even when restricted to reported events. However, their effectiveness including unreported events, requires further study.

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Introduction: To describe the technique, safety profile, and outcomes of performing pars plana vitrectomy (PPV) without intravenous (IV) anesthesia. Methods: This retrospective single-surgeon study comprised patients who had PPV without IV sedation between September 2018 and April 2022. Patients elected to undergo PPV without sedation or with oral sedation via sublingual triazolam administered 30 minutes preoperatively. Sub-Tenon bupivacaine and lidocaine were administered at the initiation of each case. A circulating nurse monitored patient vitals and electrocardiogram tracings without anesthesiologist support. Adverse events (AEs), visual acuity (VA), supplemental block administration, and reoperation rates were documented. Results: A total of 357 PPVs in 319 patients (mean age 68.75 ± 11.17 years [SD]; range, 36.82-98.57) were performed for surgical indications including vitreous floaters, intraocular lens or cataract surgery complications, retinal detachment, vitreous hemorrhage, and epiretinal membrane. Twenty-three cases were performed without sedation, and 334 were performed with oral sedation. For eyes with a follow-up longer than 1 month (n = 324), the preoperative VA of 0.68 ± 0.77 logMAR improved to 0.31 ± 0.46 logMAR postoperatively (P < .01). No intraoperative complications, systemic AEs, need to cease surgery prematurely, or conversion to IV sedation occurred. Five eyes (1.77%) required intraoperative supplemental sub-Tenon block administration, and 95% of patients who had a reoperation (n = 10) or fellow-eye surgery (n = 28) requested the same method of anesthesia without IV sedation. Conclusions: Vitreoretinal surgery with a sub-Tenon block and oral sedation can be safely performed without the support of an anesthesiologist. Additional trials are needed to further quantify patient comfort, surgeon experience, and complication rates.

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Introduction: Pain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions. Methods: In this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidenced-based conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9). Results: FRP participants with clinically elevated catastrophizing at baseline (PCS ≥30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2 = 15.56, p < 0.001), satisfaction with function (COPM-SS mean delta -2.50, CHI2 = 7.42, p = 0.007), pain (NRS mean delta 2.7), mood (PHQ-9 mean delta 1.87, p = 0.002), and catastrophizing (PCS mean delta 4.16, p < 0.001). Subgroup analysis revealed racial disparities in pain scores, and exploratory analysis showed a trend toward reducing opiate consumption. Discussion: Despite the known association of adverse outcomes with high catastrophizing, FRP participation was associated with increased productive engagement, reduced pain, reduced maladaptive thought processes, and improved mood. Although causation and efficacy cannot be established from a retrospective design, this is the first study to identify functional improvement in patients with high-impact chronic pain and clinically relevant high pain catastrophizing who participate in an IPP combining conventional and complementary rehabilitation with psychoeducation. These enriched therapeutic encounters may enhance the treatment process by promoting trust, empathy, collaboration, and beneficial reframing of patients' experiences, expectations, and goals.

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Coccidioidomycosis and histoplasmosis are endemic mycoses caused by the Coccidioides species and Histoplasma capsulatum, respectively. While these fungal infections are often associated with immunocompromised individuals, they pose significant risks to immunocompetent hosts. This review comprehensively analyzes these infections in immunocompetent individuals, focusing on clinical features, diagnostic approaches, and management strategies. The current understanding of coccidioidomycosis and histoplasmosis in immunocompetent individuals includes their clinical presentations, diagnostic methodologies, and treatment options. A literature review encompassed recent studies, clinical guidelines, and expert opinions. Data were analyzed to highlight critical aspects of the clinical manifestations, diagnostic processes, and management of these infections in immunocompetent patients. Coccidioidomycosis typically presents with pulmonary symptoms that may range from mild to severe and can include chronic and disseminated forms. Histoplasmosis also presents a spectrum of pulmonary symptoms with the potential for extrapulmonary dissemination. Diagnostic approaches for both infections involve clinical evaluation, serological tests, culture, and imaging studies. Management strategies include antifungal therapies such as fluconazole and itraconazole for coccidioidomycosis and itraconazole and amphotericin B for histoplasmosis, with treatment duration and monitoring tailored to the severity of the infection. Coccidioidomycosis and histoplasmosis can significantly affect immunocompetent individuals, with clinical presentations varying widely from mild to severe. Accurate diagnosis and appropriate management are crucial for optimal outcomes. This review underscores the importance of awareness and timely intervention in managing these endemic mycoses and highlights the need for continued research into better diagnostic and therapeutic approaches.

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Pulmonary embolism (PE) occurs when thrombi from deep vein thrombosis dislodge and obstruct pulmonary arteries, raising pulmonary artery pressure and straining the right ventricle. This strain can lead to right ventricular dysfunction (RVD), characterized by reduced cardiac output, impaired contractility, and potential development of chronic thromboembolic pulmonary hypertension. Clinically, PE may present with symptoms such as dyspnea, pleuritic chest pain, and tachycardia. Diagnosis is typically confirmed through computed tomography pulmonary angiography, biomarkers like D-dimer and cardiac troponins, and clinical scoring systems. Acute management focuses on hemodynamic support, including intravenous fluids and vasopressors, and may involve anticoagulation with low-molecular-weight heparin or direct oral anticoagulants. Severe cases may require systemic anticoagulation, catheter-directed techniques, and surgeries like pulmonary endarterectomy. Long-term management involves continued anticoagulation tailored to individual risk factors, with ongoing monitoring to prevent recurrence. Effective early diagnosis and management are crucial, as severe PE can significantly increase mortality and lead to serious complications. This review explores the pathophysiology, diagnosis, and management of PE and RVD.

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Background: The pericapsular nerve group (PENG) block offers effective postoperative pain relief following hip fracture surgery. This research investigated three doses of bupivacaine, all administered in the same total volume, for performing ultrasound-guided PENG blocks during hip fracture procedures. Methods: This randomized, double-blinded clinical trial was conducted on 135 patients aged between 18 and 70 years of both sexes who underwent hip fracture surgeries. Participants were randomized into three groups (n = 45). Ultrasound-guided PENG block was applied, the groups received 20 mL of local anesthetics. The first group received 0.5% bupivacaine, the second group received 0.375% bupivacaine, and the third group received 0.25% bupivacaine. The following parameters were recorded: onset of sensory block, resting NRS after passively raising the limb by 15° half an hour post-procedure, quality of recovery score (QoR-15) at 24 h postoperative. Results: The 0.25% bupivacaine group exhibited a longer sensory block onset than the other groups (p ≤ .05). Significant differences were demonstrated between the groups regarding the time to 1st analgesia (p = .033) and total morphine consumption (p = .025). NRS at baseline and T30 post-block did not show significant differences between the studied groups. No significant differences were detected postoperatively in rest and dynamic NRS (p ≤ .05). Patient satisfaction, QoR-15 score, and ease of spinal positioning did not differ between the groups. Conclusion: Compared to 0.25% bupivacaine, PENG block with 0.5% and 0.375% bupivacaine provided a rapid onset sensory block, delayed first analgesic requirements, and reduced total morphine consumption after hip surgeries. Protocol Registration: The trial was registered at the clinicaltrials.gov with study number (Trial ID: NCT05788458).

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Background: Thoracic aortic endovascular repair (TEVAR) is the primary treatment for Stanford type B aortic dissection (type B AD). However, patients often encounter significant difficulties post-TEVAR that endanger their safety when transitioning from hospital- to home-based care. Moreover, information on the ideal transitional care for patients with type B AD post-TEVAR is scarce in China. This single-masked randomized clinical trial aimed to assess the effectiveness of the Assess, Advise, Agree, Assist, and Arrange (5As) model-based transitional care in improving discharge preparation level and transitional care quality post-TEVAR among patients with type B AD in China. Methods: This study was conducted at a hospital in China between January 2021 and October 2021. Patients with type B AD were randomly divided into intervention and control groups. Participants in the intervention group received the 5As model-based transitional nursing care. The 5As model is an evidence-based intervention strategy comprising: (1) Assess: assessing the preoperative cardiovascular risk behavior of patients with AD. (2) Advise: making suggestions according to the risk behaviors of the patients. (3) Agree: reaching a consensus on goals and action plans by making decisions with the patients and their families. (4) Assist: assisting patients in solving obstacles to implementing health plans. (5) Arrange: arranging follow-up visits according to the actual situation of the patients and guiding them in adhering to a schedule. The control group received the usual nursing care for the same duration and number of follow-up visits. A trained research nurse collected all the baseline data of the patients on admission, assessed discharge readiness level (using the Readiness for Hospital Discharge Scale) on the day of discharge, and collected transitional quality of care (by the Care Transition Measure-15) data on day 30 after discharge. Results: Overall, 72 patients with type B AD were recruited. Discharge readiness level and transitional care quality in the intervention group were significantly superior to those in the control group. Conclusions: This study showed that the 5As model-based transitional care program can effectively promote discharge readiness and transitional care quality of patients with type B AD post-TEVAR. Clinical Trial Registration: The Chinese Clinical Trial Registry Center: ChiCTR2200060797 (https://www.chictr.org.cn/showproj.html?proj=167403).

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Background: The relationship between disseminated intravascular coagulation (DIC) profiles and survival or neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients is well known. In contrast, the relationship between DIC profiles and neurological outcomes in patients with in-hospital cardiac arrest (IHCA) remains unclear. This study sought to examine the correlation between DIC profiles and neurological outcomes in IHCA patients. Methods: A retrospective observational study was conducted on comatose adult IHCA patients treated with targeted temperature management between January 2017 and December 2022. DIC profiles were used to calculate the DIC score, and were measured immediately after the return of spontaneous circulation (ROSC). The primary endpoint was a poor neurological outcome at six months, defined by cerebral performance in categories 3, 4, or 5. Multivariate analysis was used to evaluate the association between DIC profiles and poor neurological outcomes. Results: The study included 136 patients, of which 107 (78.7%) patients demonstrated poor neurological outcomes. These patients had higher fibrinogen (3.2 g/L vs. 2.3 g/L) and fibrin degradation product levels (50.7 mg/L vs. 30.1 mg/L) and lower anti-thrombin III (ATIII) levels (65.7% vs. 82.3%). The DIC score did not differ between the good and poor outcome groups. In multivariable analysis, fibrinogen (odds ratio [OR], 1.009; 95% confidence intervals [CI], 1.003-1.016) and ATIII levels (OR, 0.965; 95% CI, 0.942-0.989) were independently associated with poor neurological outcomes. Conclusions: Decreased fibrinogen and ATIII levels after ROSC were an independent risk factor for unfavorable neurological outcomes in IHCA. The DIC score is unlikely to play a significant role in IHCA prognosis in contrast to OHCA.

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Objectives: Teledentistry could be effective in managing oral health through the provision of oral hygiene instruction and diagnostic services. This study aimed to assess the perception and usefulness of teledentistry in Japanese long-term care facilities. Methods: We conducted a questionnaire survey to compare related factors of the usefulness of teledentistry and identify issues in its implementation. We chose 1000 facilities using a stratified random sampling method. The questionnaires were sent to the facilities in August 2021 and collected in December of the same year. Responses to the questionnaire items regarding the usefulness of teledentistry for oral management were divided into three groups according to the answer: perceiving teledentistry as "useful," "not useful," or "neither," including facilities that do not currently use teledentistry. Results: In total, 26.1% (261) responded to the questionnaire, and among these, 184 facilities answered the question regarding the usefulness of teledentistry. Only two of these facilities implemented teledentistry. Facilities with dental hygienists (p = 0.040) and those that receive insured medical treatment: reimbursement for oral feeding maintenance II (p = 0.040) tended to perceive teledentistry as useful in the management of patients with coronavirus disease. The higher the number of services that responded to the question "what kind of services do you think can be provided via teledentistry?" the higher the percentage of "useful" responses. Conclusions: Although only a few facilities use teledentistry, many long-term care facilities perceive it as useful even without using it. The presence of dental hygienists and interprofessional work done with reimbursement for oral feeding maintenance II contributed to the perception of the usefulness of teledentistry in long-term care facilities.

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Basal cell carcinoma (BCC) is a low-grade malignant tumor that if properly managed has an excellent prognosis. Development of BCC outside the skin areas exposed to sun rays is infrequent. Giant BCC is a rare entity, especially in unexposed areas of the body. It carries a considerable implication on patients' quality of life because of the risk of being a source of infection that may progress to severe sepsis and/or metastasis. An old female presented with a long-standing solitary lesion measuring 7.5x6 cm overlaying the lumber 4-5 vertebral region about 2.5 cm from the line of the sacral promontory. No lymph nodes or distant metastases were detected. For many years, it was misdiagnosed by other physicians as eczema, psoriasis, and fungal infection and accordingly failed to respond to treatment. A histopathological examination of lesional punch biopsy assured the diagnosis of giant superficially spreading BCC. The lesion was excised with a circumferential safety margin of about 5 mm. During the follow-up period of 4 years, no recurrence was detected. Despite being a long-standing Giant basal cell carcinoma (GBCC) in a sun-hidden skin area, the growth behaved as a locally malignant lesion without metastasizing. A wide local surgical excision of the GBCC with 5 mm safety margins was feasible, safe, and with a good aesthetic outcome. Importantly, family practitioners should avoid such missed cases through accuracy in their diagnosis and early referral of any atypical cases to a dermatologist.

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