Patients receiving kidney transplant experience immunosuppression, which increases the risk of bacterial, viral, fungal, and parasitic infections. Q fever is a potentially fatal infectious disease that affects immunocompromised renal transplant recipients and has implications in terms of severe consequences for the donor's kidney. A patient with acute Q fever infection following kidney transplantation was admitted to the Tsinghua Changgung Hospital in Beijing, China, in March 2021. Next-generation sequencing (NGS) was used to diagnose Q fever in the patient. Based on the patient's blood test, we detected , the causative agent of Q fever and a zoonotic disease that can manifest in acute or chronic forms in humans. Comprehensive data on clinical symptoms, blood tests, chest computed tomography (CT), NGS, Immunoglobulin G (IgG) antibody titer, and therapeutic efficacy associated with Q fever infection following renal transplantation in this patient were gathered. This is the first reported case of acute Q fever occurring in a Chinese renal transplant recipient detected using metagenomic NGS. This case underscores the need to consider acute Q fever as a possible differential diagnosis in kidney transplant recipients with fever of unknown origin.

The burdens of cardiovascular (CV) diseases and cardiotoxic side effects of cancer treatment in oncology patients are increasing in parallel. The European Society of Cardiology (ESC) 2022 Cardio-Oncology guidelines recommend the use of standardized risk stratification tools to determine the risk of cardiotoxicity associated with different anticancer treatment modalities and the severity of their complications. The use of the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) is essential for assessing risk prior to starting cancer treatment, and validation of these methods has been performed in patients receiving anthracyclines, human epidermal receptor 2 (HER2)-targeted therapies and breakpoint cluster region-abelson oncogene locus (BCR-ABL) inhibitors. The benefits of performing baseline CV risk assessment and stratification include early recognition of cardiotoxicities, personalisation of cancer treatment and monitoring strategies, and allocation of cardioprotection to those at the highest risk. This review summarizes the key points of risk stratification in these patients. The steps include identifying the target population, assessing nonmodifiable and modifiable CV risk factors, reviewing previous oncologic therapies and CV histories, and performing baseline investigations. In summary, this review aims to provide general physicians with a simple 7-step guide that will help steer and navigate them through cardiac risk evaluation of potentially cardiotoxic oncologic treatment strategies.

Research evidence has demonstrated a significant association between hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), but the causality and pattern of this link remain unexplored. Therefore, this study investigated the causal relationship between HCM and AF using a two-sample and bidirectional Mendelian randomization (MR) approach. Additionally, this assessed the role of cardiovascular proteins (CPs) associated with cardiovascular diseases between HCM and AF by applying a two-step MR analysis. Data for HCM, AF, and 90 CPs were obtained from the Finn Gen and IEU Open GWAS Project databases. MR-Egger, inverse variance weighting (IVW), weighted median estimator (WME), weighted mode, and simple mode were used to estimate causal inferences. Furthermore, Cochran's Q test, MR-Egger's intercept terms, and Leave-one-out methods determined the heterogeneity, horizontal pleiotropy, and sensitivity. Additionally, mediation effects were used to assess the role of CPs in the relationship between HCM and AF. Two-sample and bidirectional MR analysis revealed HCM as a risk factor for AF (odds ratio (OR) = 1.008, 95% confidence interval (CI): 1.001-1.016, = 0.029) and AF was found to increase the risk of developing HCM (OR = 1.145, 95% CI: 0.963-1.361, = 0.126). Moreover, Two-step MR analyses indicated that 5 CPs were causally associated with HCM; 12 CPs with AF and 1 CP (Melusin) with both HCM and AF. Additionally, Melusin was observed as a protective factor for both HCM and AF and may serve as a mediator variable for these two conditions (mediation effect 0.0004, mediation ratio 5.5178%, 95% CI: 5.4624-5.5731). HCM may increase the risk of developing AF, with Melusin serving as a mediator for this risk.

Advanced life support certification has traditionally been the gold standard of resuscitation training for doctors and has been shown to improve outcomes from cardiac arrest. In 2021, Health Education England removed named courses from mandatory Foundational Programme competencies, which has resulted in capping of reimbursement and reduced access to courses. This represents a drop in educational standards which is particularly concerning when the medical school curriculum has been shown to deliver inconsistent, poor-quality resuscitation training. Here we review the benefits and negatives of life support training, looking at both junior and senior clinicians with differing educational requirements.

Epidemiological studies indicate that the involvement of the immune system in the pathogenesis of infections associated with chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD) remains unclear. This study aims to assess the potential causal link between infections associated with COPD, asthma, or ILD and immune system function. We conducted a two-sample Mendelian randomization analysis using publicly available genome-wide association study (GWAS) datasets. The causal relationship between immune cell signaling and susceptibility to infections related to COPD, asthma, and ILD was evaluated using inverse variance weighting (IVW), Mendelian randomization (MR)-Egger regression, weighted median, weighted mode, and simple mode approaches. To concurrently assess the causal impact of immune cell signaling on infection susceptibility associated with COPD, asthma, and ILD, a reverse Mendelian randomization analysis was also conducted. Genetic predisposition to elevated counts of circulating blood cells and their subpopulations demonstrated significant causal associations with a higher risk of COPD/asthma/ILD-related infections, as determined by IVW analysis. Specifically, genetically predicted increases in white blood cell count (odds ratio (OR) 1.08 [95% confidence interval (CI): 1.04-1.11], < 0.00001), neutrophil count (OR: 1.06 [95% CI: 1.02-1.10], = 0.00190), lymphocyte count (OR: 1.04 [95% CI: 1.01-1.07], = 0.01515), monocyte count (OR: 1.03 [95% CI: 1.01-1.06], = 0.00440), and eosinophil count (OR: 1.07 [95% CI: 1.04-1.10], = 0.00001) were causally correlated with an increased risk of these respiratory infections. Notably, four immunophenotypes were significantly associated with the risk of COPD/asthma/ILD-related infections: Human Leukocyte Antigen (HLA) DR NK% NK (OR: 0.98 [95% CI: 0.97-0.99], = 0.0004), CD66b on CD66b myeloid cell (OR: 0.98 [95% CI: 0.97-0.99], = 0.0007), HLA DR on CD14 monocyte (OR: 1.03 [95% CI: 1.01-1.04], = 0.0002), and HLA DR on CD33 HLA DR (OR: 1.03 [95% CI: 1.02-1.05], < 0.00001). The causal effect of COPD/asthma/ILD-related infections on Immunoglobulin D (IgD) expression in IgD CD38 and transitional B cells was estimated to be 0.64 (95% CI: 0.49-0.83, = 0.00091) and 0.70 (95% CI: 0.54-0.91, = 0.00727), respectively. Additionally, COPD/asthma/ILD-related infections demonstrated a significant causal effect on several B cell and T cell subpopulations: IgD CD38 % B cells, IgD CD38 AC, CD4 CD8 AC, IgD CD38 % lymphocyte, and TD CD4 AC, with the OR 1.54 (95% CI: 1.19-2.00, = 0.00113), 1.56 (95% CI: 1.16-2.10, = 0.00340), 1.60 (95% CI: 1.15-2.22, = 0.00478), 1.47 (95% CI: 1.12-1.92, = 0.00483) and 1.63 (95% CI: 1.14-2.34, = 0.00725), respectively. Our study reveals a causal association between altered circulating blood cell counts and specific immunophenotypes with the susceptibility to respiratory infections related to COPD, asthma, and ILD.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy. This retrospective study investigates the correlation between umbilical blood flow index and maternal-fetal outcomes in pregnant women with GDM, aiming to contribute to evidence-based risk assessment and management strategy in this high-risk obstetric population. This retrospective study recruited 119 pregnant women with GDM who were admitted to the Yichang Central People's Hospital, between January 2022 and January 2024. Based on the umbilical blood flow index, the study participants were divided into a normal umbilical blood flow (UBF) index group (n = 56) and a high UBF index group (n = 63). Colour Doppler ultrasound was used to assess umbilical blood flow, and relevant data on maternal, fetal, and neonatal outcomes were obtained from the hospital's electronic medical records. We observed that, compared to the normal UBF index group, the high UBF index group exhibited significantly higher rates of adverse pregnancy outcomes, including the cesarean section ( = 0.022), preterm delivery ( = 0.020), gestational hypertension ( = 0.019), neonatal hypoglycemia ( = 0.015), as well as increased incidence of neonatal complications such as respiratory distress syndrome ( = 0.009), neonatal jaundice ( = 0.022), neonatal intensive care unit (NICU) admission ( = 0.015), lower 5-minute Apgar scores ( = 0.013), and neonatal sepsis ( = 0.005). Furthermore, significant differences were observed in fetal biometric parameters and placental morphology between the two groups (fetal weight: = 0.003; estimated fetal weight percentile: = 0.017; femur length: = 0.018; placental weight: = 0.019; placental volume: = 0.021). Additionally, correlation analyses indicated significant associations between umbilical blood flow index and maternal and fetal outcomes ( < 0.05). We observed a significant correlation between umbilical blood flow indices and maternal and fetal outcomes in pregnant women with gestational diabetes mellitus, implying its utility as a non-invasive parameter for risk stratification and personalized management in this high-risk obstetric population.

Diabetes is a chronic lifelong condition that requires consistent self-care and daily lifestyle adjustments. Effective disease management involves regular blood glucose monitoring and ongoing nursing support. Inadequate education and poor self-management are key factors contributing to increased mortality among diabetic individuals. Providing personalized guidance and behavioral interventions through continuous nursing care is crucial for achieving optimal glycemic control and fostering positive societal outcomes. This study aimed to evaluate the impact of an Omaha System-based continuous nursing model, implemented through the "Internet+" framework, on enhancing self-health management skills, glycemic control, and treatment adherence among patients with type 2 diabetes mellitus (T2DM). This retrospective study analyzed clinical data of T2DM patients who visited the diabetes health management clinic of Zhang Ye People's Hospital affiliated to Hexi University between December 2023 and May 2024. Participants were categorized into intervention and control groups based on whether they received the "Internet+"-enabled Omaha System continuous nursing care model. Variables, including demographic characteristics, self-management behaviors, cognitive abilities, environmental factors, glycemic control indicators, and treatment adherence (medication compliance, dietary compliance, lifestyle adherence, and follow-up punctuality), were assessed and compared at baseline, 1 month, and 3 months post-intervention. The study included 52 patients in the intervention group and 68 in the control group. Baseline characteristics revealed no significant differences between the two groups ( > 0.05). At 1 and 3 months post-intervention, the intervention group exhibited significant improvements in self-management behaviors, cognitive abilities, environmental factors, and overall scores compared to baseline and the control group ( < 0.05). Fasting plasma glucose (FPG) levels were also significantly reduced in the intervention group compared to baseline and the control group ( < 0.05). 3 months post-intervention, the intervention group demonstrated significantly higher adherence rates to dietary recommendations, healthy lifestyle practices, and treatment compliance compared to the control group ( < 0.05). The "Internet+"-based Omaha System continuous nursing model significantly enhances self-health management capabilities, stabilizes glycemic control, and promotes adherence to healthy behaviors among patients with T2DM. These findings highlight the potential of the model for broader clinical application in diabetes management.

An 80-year-old lady had a history of progressive swallowing difficulty over several years with significant weight loss, but prior investigations in several medical departments proved negative. Neurological assessment noted her complaint of impaired feeling for food in her mouth and examination showed impaired corneal reflexes and facial sensory function. Blink reflex electrodiagnostic testing was consistent with a diagnosis of facial onset sensory and motor neuronopathy (FOSMN). This article raises awareness of the diagnosis, investigation and treatment of FOSMN.

Hypertension (HT) is a prevalent medical condition showing an increasing incidence rate in various populations over recent years. Long-term hypertension increases the risk of the occurrence of hypertensive nephropathy (HTN), which is also a health-threatening disorder. Given that very little is known about the pathogenesis of HTN, this study was designed to identify disease biomarkers, which enable early diagnosis of the disease, through the utilization of high-throughput untargeted metabolomics strategies. The participants of this study were patients admitted to The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, who were randomly divided into three groups: Normal group (n = 11), HT group (n = 10), and HTN group (n = 12). Urine exosomes were extracted, purified, and subjected to untargeted metabolomics analysis. Differential metabolites and their significantly enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified. The least absolute shrinkage and selection operator (LASSO) regression analysis was then employed to establish a diagnostic model for early-stage HTN. Finally, logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify biomarkers related to early HTN. Orthogonal partial least squares-discriminant analysis (OPLS-DA) revealed significant differences in the metabolic profiles of the three patient groups. Compared to subjects of the Normal group, the HT and HTN groups exhibited significantly upregulated and downregulated profiles of differential metabolites, respectively. LASSO regression analysis results indicated that 4-hydroxyphenylacetic acid, bilirubin, uracil, and iminodiacetic acid are potential biomarkers for HTN or HT. With untargeted metabolomics analysis, we successfully identified differential metabolites in HTN. A further LASSO regression analysis revealed that four key metabolites, namely 4-hydroxyphenylacetic acid, bilirubin, uracil, and iminodiacetic acid, hold promise for the diagnosis of early-stage HTN.

The Geriatric Nutritional Risk Index (GNRI) is an effective tool for identifying malnutrition, and helps monitor the prognosis of patients undergoing maintenance hemodialysis. However, the association between the GNRI and cardiovascular or all-cause mortality in hemodialysis patients remains unclear. Therefore, this study investigated the correlation of the GNRI with all-cause and cardiovascular mortality in patients undergoing maintenance hemodialysis. This study included 402 incident hemodialysis patients. Based on the first-dialysis GNRI quartile, the patients were divided into four groups: N1 (GNRI ≤85.04), N2 (GNRI 85.05-91.04), N3 (91.05-96.49), N4 (GNRI ≥96.5) groups. The risk of all-cause and cardiovascular mortality among the different GNRI groups was compared using the Kaplan-Meier survival curve analysis through log-rank tests. Furthermore, Cox regression analysis was used to assess the association between the GNRI groups and all-cause mortality. Additionally, the predictive capability of the GNRI groups on the prognosis was evaluated by employing receiver operating characteristic (ROC) curve analysis. Patients in the N1 group exhibited a significantly higher risk of all-cause mortality ( < 0.001) and cardiovascular mortality ( = 0.004) compared to the other groups. ROC curve analysis revealed that GNRI, age, and serum creatinine had moderate predictive value for mortality, with GNRI indicating an area under the curve (AUC) of 0.605 for all-cause mortality and 0.565 for cardiovascular mortality. Moreover, the N2 and N3 groups had a significantly reduced risk of cardiovascular mortality compared to the N1 group. A lower GNRI is closely associated with a higher risk of all-cause and cardiovascular mortality in hemodialysis patients.

Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes, yet the correlation between ICP and the neutrophil-to-lymphocyte ratio (NLR) remains unclear. This study aims to investigate the diagnostic value of NLR in ICP. In this retrospective case-control study, 113 patients with ICP treated in Beilun District People's Hospital from January 2020 to December 2022 were recruited and categorized as the ICP group, and 209 healthy pregnant women treated during the same period were selected as the control group. The levels of NLR and mean platelet volume (MPV) were compared between the two groups. The NLR of patients with different ICP severity were compared. Logistic regression model was used to analyze the relationship between relevant indicators and ICP. The capability of NLR in predicting ICP was evaluated using receiver operating characteristic (ROC) curves. There were significant differences in age, neutrophil count, lymphocyte count, platelet count, MPV, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), NLR, and serum total bile acid (sTBA) among all groups ( < 0.05). The NLR in the severe ICP group was significantly higher than that in the mild ICP group ( < 0.05). Logistic regression analysis showed that MPV (odds ratio [OR] = 1.247) and NLR (OR = 1.885) were independent factors influencing the occurrence of ICP ( < 0.05). ROC curve analysis showed that the area under the curve (AUC) for both mild ICP and severe ICP was 0.679 and 0.869, respectively, substantiating the diagnostic value of NLR. NLR can be used as an auxiliary indicator in the diagnosis of ICP and has important clinical value in predicting adverse pregnancy outcomes in ICP patients.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are emerging as an important class of drugs in the management of Type 2 Diabetes Mellitus (T2DM) and obesity. There are rising concerns of pulmonary aspiration with these medications due to drug-induced gastroparesis. While definitive association is uncertain, it is essential to be prudent and manage these patients as per the current evidence and recommendations.

The contribution of health care to environmental and climate crises is significant, under-addressed, and with consequences for human health. This editorial is a call to action. Focusing on pharmaceuticals as a major environmental threat, we examine pharmaceutical impacts across their lifecycle, summarising greenhouse gas emissions, pollution, and biodiversity loss, and outlining challenges and opportunities to reduce this impact. We urge health care decision-makers and providers to urgently consider environmental factors in their decision-making relating to both policy, and practice, promoting actions such as rational prescribing, non-pharmaceutical interventions, and research and advocacy for sustainable production, procurement, and use.

Artificial intelligence (AI), with advantages such as automatic feature extraction and high data processing capacity and being unaffected by fatigue, can accurately analyze images obtained from colonoscopy, assess the quality of bowel preparation, and reduce the subjectivity of the operating physician, which may help to achieve standardization and normalization of colonoscopy. In this study, we aimed to explore the value of using an AI-driven intestinal image recognition model to evaluate intestinal preparation before colonoscopy. In this retrospective analysis, we analyzed the clinical data of 98 patients who underwent colonoscopy in Nantong First People's Hospital from May 2023 to October 2023. Among them, 47 cases were evaluated based on the intestinal preparation map and the last fecal characteristics (Regular group), and 51 cases were evaluated using an AI-driven intestinal image recognition model (AI group). The duration of colonoscopy examination, intestinal cleanliness, incidence of adverse reactions, and satisfaction with intestinal preparation of the two groups were analyzed. The time for colonoscopy in the AI group was shorter than that in the Regular group, and the intestinal cleanliness score in the AI group was higher than that in the Regular group ( < 0.05). The incidence of adverse reactions in the AI group (3.92%) was lower than that in the Regular group (10.64%), but the difference was not statistically significant ( > 0.05). The satisfaction rate of intestinal preparation in the AI group (96.08%) was comparable to that of the Regular group (82.98%) ( > 0.05). Compared with the assessment based solely on the intestinal preparation map and the last fecal characteristics, the application of AI intestinal image recognition model in intestinal preparation before colonoscopy can shorten the time of colonoscopy and improve intestinal cleanliness, but with comparable patient satisfaction and safety.

Predictive algorithms have myriad potential clinical decision-making implications from prognostic counselling to improving clinical trial efficiency. Large observational (or "real world") cohorts are a common data source for the development and evaluation of such tools. There is significant optimism regarding the benefits and use cases for risk-based care, but there is a notable disparity between the volume of clinical prediction models published and implementation into healthcare systems that drive and realise patient benefit. Considering the perspective of a clinician or clinical researcher that may encounter clinical predictive algorithms in the near future as a user or developer, this editorial: (1) discusses the ways in which prediction models built using observational data could inform better clinical decisions; (2) summarises the main steps in producing a model with special focus on key appraisal factors; and (3) highlights recent work driving evolution in the ways that we should conceptualise, build and evaluate these tools.

Overactive bladder (OAB) is a prevalent chronic condition affecting approximately 12% of adults, with incidence increasing with age. While pharmacological and behavioural therapies are standard treatments, their efficacy is often limited by side effects and poor adherence. This study aimed to compare the therapeutic effects of precision magnetic stimulation guided by motor-evoked potential with general magnetic therapy in patients with OAB. This randomized controlled trial included 45 patients diagnosed with OAB at The Second Affiliated Hospital of Zhejiang Chinese Medicine University between January 2022 and September 2022. Participants were randomly divided into Group 1 (n = 15) which received bladder training (BT) alone, Group 2 (n = 15) received BT combined with general magnetic therapy, and Group 3 (n = 15) received BT combined with precision magnetic therapy. Clinical efficacy was evaluated using the Overactive Bladder Symptom Score (OABSS), urination diaries, initial bladder volume, and maximum bladder volume before and after treatment. At the end of the intervention, Groups 2 and 3 demonstrated significant improvements in OABSS scores, urgency of urination, initial bladder volume, and maximum bladder volume compared to Group 1 ( < 0.05). Group 3 exhibited superior urination frequency and initial bladder volume improvements compared to Group 2 ( < 0.05). General magnetic therapy combined with BT and precision magnetic therapy combined with BT were more effective than BT alone in treating OAB. While there were no significant differences between the two magnetic stimulation methods in terms of OABSS scores, urgent urination, nocturnal urination, or maximum bladder volume, precision magnetic therapy showed greater efficacy in reducing urination frequency and improving initial bladder volume. These findings suggest that precision magnetic therapy offers an enhanced therapeutic benefit. Chinese Clinical Trial Registry (ChiCTR2400087888).

The background for establishing and verifying a dehydration prediction model for elderly patients with post-stroke dysphagia (PSD) based on General Utility for Latent Process (GULP) is as follows: For elderly patients with PSD, GULP technology is utilized to build a dehydration prediction model. This aims to improve the accuracy of dehydration risk assessment and provide clinical intervention, thereby offering a scientific basis and enhancing patient prognosis. This research highlights the innovative application of GULP technology in constructing complex medical prediction models and addresses the special health needs of elderly stroke patients. Based on GULP criteria, the study aims to establish and validate a dehydration prediction model for elderly patients with dysphagia following a stroke. Two hundred patients with post-stroke dysphagia treated at Beijing Rehabilitation Hospital Affiliated with Capital Medical University, from January 2020 to December 2023, were selected retrospectively. The patients were randomly matched at a ratio of 1:4 to establish a verification group (n = 40) and a modelling group (n = 160). Based on the occurrence of dehydration, the modelling group patients were divided into two groups: the dehydration group (n = 55) and the non-dehydration group (n = 105). Univariate and multivariate logistic regression analyses were used to identify the influencing factors of dehydration in elderly patients with dysphagia after a stroke, and to establish a predictive model based on GULP. The predictive value of the model was evaluated using receiver operating characteristic (ROC) curve analysis. The results of univariate and multivariate logistic regression analyses showed significant differences in age, lesion location, muscle strength grade, homocysteine (Hcy), and swallowing function score ( < 0.05). When these influencing factors were included in the model, the slope of the calibration curve in both the training set and the validation set was close to 1, indicating that the predicted dehydration risk was consistent with the actual risk. ROC analysis results revealed that in the training set, the model predicted dehydration in elderly post-stroke patients with dysphagia with an area under the curve (AUC) of 0.934, a standard error of 0.034, and a 95% confidence interval (CI) of 0.916 to 0.981. The optimal cutoff value was 0.78, yielding a sensitivity of 88.84% and a specificity of 90.00%. In the validation set, the AUC was 0.867 with a standard error of 0.025 and a 95% CI of 0.694 to 0.934. The optimal cutoff value here was 0.66, with a sensitivity of 80.16% and a specificity of 85.94%. This study successfully established and validated a GULP-based dehydration prediction model for elderly patients with dysphagia following a stroke, demonstrating high application value.

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are commonly prescribed in diabetes mellitus and increasingly for cardiorenal protection. They carry the risk of euglycaemic diabetic ketoacidosis (eDKA). Guidelines around the perioperative handling of these medications are limited and some evidence suggests that withholding them can lead to more surgical complications and poorer glycaemic control. This article gives an overview of arguments for and against withholding SGLT-2 inhibitors in the perioperative period.

A novel exercise protocol for cardiac rehabilitation aerobic (CRA) has been developed by Hebei Sport University, demonstrating efficacy in patients with coronary heart disease (CHD). The objective of this study was to evaluate the impact of CRA on precise cardiac rehabilitation (CR) for CHD patients presenting with stable angina pectoris. The study cohort comprised patients with stable angina who were categorized into three groups: the CRA group (n = 35), the power bicycles (PB) group (n = 34), and the control group (n = 43). In addition to standard treatment, the CRA group underwent a 12-week CRA-based CR intervention, while the PB group participated in a similar program centered on PB exercise, and the control group received only standard treatment. At the end of the 12-week intervention, significant differences were observed among the groups in several physiological parameters, including systolic blood pressure (SBP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), Glycated Haemoglobin (Hb-A1c), peak oxygen uptake (Peak VO), anaerobic threshold (AT), and Peak VO/heart rate (HR) ( < 0.05). Both the CRA and PB groups showed significant reductions in SBP, FBG, TG, TC, LDL, and Hb-A1c compared to the control group ( < 0.05). Additionally, both groups exhibited significant improvements in Peak VO, AT, and Peak VO/HR ( < 0.05). Intra-group analysis revealed that the CRA group showed significant improvements from baseline to post-intervention in SBP, diastolic blood pressure (DBP), FBG, TG, TC, high-density lipoprotein (HDL), LDL, Hb-A1c, Peak VO, AT, and Peak VO/HR ( < 0.05). Similarly, the PB group demonstrated significant improvements across these parameters ( < 0.05). Both CRA and PB exercises are safe and effective for achieving precise CR in patients with CHD. A 12-week CRA intervention, conducted three times per week for 30 minutes per session, significantly improves cardiopulmonary function and biochemical makers in patients with stable angina. These improvements are comparable to those achieved through PB exercise in precise CR.

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder globally. Crisaborole, a nonsteroidal topical phosphodiesterase 4 inhibitor (PDE4i), has been utilized in treating AD. Crisaborole regulates the production of inflammatory cytokines, which are usually overactive among AD patients. Therefore, this study aimed to explore the efficacy and safety of crisaborole in treating AD in patients aged ≤18 years. A literature search was performed across PubMed, MEDLINE, Embase, Cochrane, and Google Scholar. The inclusion criteria involved primary studies evaluating the effect of crisaborole in treating dermatitis, articles exploring the use of crisaborole in AD patients below 18 years (>two years), and articles published in English between 2000 and 2022. However, the studies evaluating AD in adult patients, those reporting treatments other than crisaborole, those published before 2000, and articles written in languages other than English were excluded from this analysis. Furthermore, secondary data sources such as case reports, newspaper articles, magazines, and other systematic reviews and meta-analyses were excluded. A meta-analysis was conducted using RevMan 5.4. The risk of bias in the manuscripts was assessed using the Cochrane tool. The I-square test statistic was used to determine heterogeneity, and Egger's test was used to evaluate publication bias. Ten studies met the eligibility criteria and were included in the final analysis. Most of the studies exhibited a low risk of bias with no publication bias. Meta-analysis indicated a significant difference in the number of patients attaining Investigator Static Global Assessment (ISGA) success at day 29, with significantly higher patients in the crisaborole group than in the vehicle group (odds ratio (OR) 1.56, 95% CI 1.24 to 1.96; I = 77%; = 0.0001). Similarly, pruritus improvement was significant between the two cohorts at day 29, indicating significantly higher heterogeneity (OR 1.70, 95% CI 1.10 to 2.63; I = 91%; = 0.02). Furthermore, the safety profiling of the treatments was insignificant, demonstrating no statistical difference in the treatment-emergent adverse events (TEAEs) between the two groups with high heterogeneity (OR 0.53, 95% CI 0.14 to 1.98; I = 99%; = 0.35). Crisaborole demonstrates substantial efficacy in treating mild to moderate AD compared to vehicle therapies, as it reduces the signs and symptoms of the disease. Furthermore, crisaborole is well tolerated and has an acceptable safety profile in treating mild to moderate AD patients.

Previous research has shown that smoking tobacco is associated with changes or differences in brain volume and cortical thickness, resulting in a smaller brain volume and decreased cortical thickness in smokers compared with non-smokers. However, the effects of smokeless tobacco on brain volume and cortical thickness remain unclear. This study aimed to investigate whether the use of shammah, a nicotine-containing smokeless tobacco popular in Middle Eastern countries, is associated with differences in brain volume and thickness compared with non-users and to assess the influence of shammah quantity and type on these effects. Male shammah users (aged 20 to 47 years, n = 30) and non-users (n = 39) underwent 1.5T magnetic resonance imaging (MRI) scans, and cortical brain volumes and thicknesses were measured using FreeSurfer. Significant differences were found in the volume of the right pallidum ( = 0.02), total pallidum ( = 0.02), total ventricle ( = 0.02), middle posterior corpus callosum ( = 0.04), and brainstem ( = 0.02) between shammah users and non-users. Furthermore, yellow shammah users exhibited smaller volumes in the right lateral ventricle ( = 0.02), total lateral ventricle ( = 0.03), and right putamen ( = 0.02) compared with users of other types of shammah. Regarding cortical thickness, significant differences were observed in the right medial orbito-frontal thickness ( = 0.03), left rostral middle frontal thickness ( = 0.03), and right rostral anterior cingulate thickness ( = 0.04). These findings shed light on the potential neurobiological effects of shammah use, particularly the yellow shammah, and highlighting the need for further research to fully understand its implications for brain structure and function.