Level (Czechia)

BackgroundDecision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries.AimThis consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings.MethodsUsing the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval.ResultsICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection.ConclusionsAdvanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon’s visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures.Graphical abstract

Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression (P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.

Parasomnia is a neurological disorder that refers to abnormal behavior during sleep. This disease has received increasing attention and research over the past few decades. In the 1950s, the symptoms of parasomnia were first described and further studied. This paper describes the three classifications of parasomnias, and details the symptoms and treatment options for these three classifications. By reading and analyzing the previous literature, it can be concluded that the types of parasomnia can be roughly divided into circadian dysrhythmia sleep disorder, sleep apnea syndrome, and restless leg syndrome. Circadian dysrhythmia sleep disorder is characterized by late sleep, insufficient or excessive sleep duration, resulting in daytime fatigue, a lack of concentration, and other symptoms. The treatment method is light therapy. The main symptom of sleep apnea is that breathing stops during sleep, resulting in a lack of oxygen supply. The treatment is to improve the maxillofacial structure through surgery to reduce the problem of dyspnea. The most obvious symptom of restless leg syndrome is discomfort and unbearable numbness in the lower legs and feet while sleeping. There are three ways to treat this condition. A more non-pharmacological treatment is to do some exercise to reduce the discomfort of the leg muscles, a medical treatment is to give the patient levodopa, and if the syndrome is caused by a lack of iron in the body, iron supplementation is sufficient.

BackgroundMesenchymal stromal cells (MSCs) are excessively investigated in the context of inflammation-driven diseases, but the clinical results are often moderate. MSCs are naturally activated by inflammatory signals, which lead to the secretion of immune inhibitory factors in inflamed tissues. Many work groups try to improve the therapeutic outcome of MSCs by genetic modification and the constitutive overexpression of immune modulatory transgenes. However, the ectopic secretion of immune inhibitory transgenes increases the chances of infections, and constitutive transgene expression is not necessary for chronic diseases undergoing different inflammatory stages.MethodsWe designed and tested inflammation-induced promoters to control transgene expression from integrating lentiviral vectors in human umbilical cord MSCs. Therefore, we investigated different combinations of general transcription factor elements to achieve a minimal promoter with low basal activity. The best candidates were combined with interferon-induced GAS or ISRE DNA motifs. The constructs with the highest transgene expression upon addition of pro-inflammatory cytokines were compared to vectorized promoters from inflammation-induced genes (CD317, CXCL9, CXCL10, CXCL11 and IDO1). Finally, we investigated IL10 as a potential immune inhibitory transgene by transcriptome analyses, ELISA and in an acute lung injury mouse model.ResultsThe synthetic promoters achieved a high and specific transgene expression upon IFN-γ addition. However, the CXCL11 promoter showed synergistic activity upon IFN-γ, TNF-α and IL1-β treatment and surpassed the transgene expression height of all tested promoters in the study. We observed in transcriptome analyses that IL10 has no effect on MSCs and in ELISA that IL10 is only secreted by our genetically modified and activated CXCL11-IL10-MSCs. Finally, transplanted CXCL11-IL10-MSCs increased CD19+ and CD4+ lymphoid cells, and decreased CD11b+ Ly6g myeloid cells in an ALI mouse model.ConclusionThese results provide new insights into MSC inflammatory activation and the subsequent translation into a tool for a tailored expression of transgenes in inflammatory microenvironments. The newly developed promoter elements are potentially interesting for other inflamed tissues, and can be combined with other elements or used in other cell types.

A 15. században a humanista irányzatnak köszönhetően megjelentek az egyes régiókról készült földrajzleírások, amelyek vagy önálló kötetként (gondolhatunk itt Georg Reicherstorferr Chorographia Moldaviae vagy Chorographia Transilvaniae című művére), vagy a humanista konvenciókat követve az adott ország történelméről írott nagy átfogó munka tudományos bevezetőjeként születtek meg (például Ransanus Epithoméjának második és harmadik fejezete). Ilyen jellegű írások I. Ferdinánd udvari történetírójának, a neves bécsi humanistának, Wolfgang Laziusnak a repertoárjából sem hiányoznak. Latin nyelven született chorográfiái az Interpretatio chorographiae utriusque Austriae (Ausztriáról szóló leírás), Regni Hungariae archaeologiae libri tres (Magyarország chorográfia), Descriptio Daciae sive Transylvaniae (Erdély-leírás), német nyelven íródott Magyarország-leírása a Des Khünigreichs Hungern.A fenti chorográfiák közül csak a Regni Hungariae archaeologiae libri tresszel kívánok foglalkozni, annak is csupán egyetlen kérdéskörére fókuszál az esszé, milyen forrás(oka)t használt fel Lazius magyar őstörténetet és a középkort illetően. Az osztrák humanista forrásait illetően rendkívül precíz több helyen is találkozhatunk nála olyan forrásmegjelölésekkel, mint „Plinius libro quarto capite duodecimo” vagy „Herodianus graecus author libro sexto”. Ám, ha a magyar történeti forrásokra történő hivatkozást nézzük, akkor az olvasónak be kell érnie az annales Hungarici vagy az annales Hungarorum megjelöléssel.Tanulmányommal egy izgalmas nyomozásra invitálom az olvasót, ahol arra keressük a választ, ki(k) vagy melyik mű(vek) Lazius magyar történelemre vonatkozó forrása(i).

Abstract Growing accountability measures as well as a persistent achievement gap adversely impacting Black, Latino, English Language Learners, special education, economically disadvantaged, and other marginalized student groups has contributed to increased scrutiny related to public education in the United States. This growing scrutiny has brought a concurrent evaluation of influencing factors in P-12 education, including school leadership. In an effort to better meet the needs of schools and an increasingly diverse student population this chapter, which is based on a qualitative study conducted by Gray et al. (2020) and focuses on exemplary university-based principal preparation programs (PPP) across the United States, explores cost-effective and novel considerations for PPP modification. Specific focus has been given to the curricular, pedagogical, experiential, and coaching elements within these exemplary programs with the ultimate goal of guiding and influencing the redesign of university-based principal preparation programs. Critical to the identification and categorization of these key elements is the evaluation of where and how social justice-based and culturally responsive leadership converges with each program’s design and implementation. This multi-faceted analysis presents a foundation and framework for a new principal preparation program that successfully marries rigorous and authentic learning experiences with a comprehensive approach to culturally responsive school leadership. The resulting recommendations provide a blueprint for the design and implementation of a responsive principal preparation program that meets the needs of aspiring leaders and the diverse communities they will serve.

Unique aspects of neonatal renal physiology enhance the occurrence of Acute Kidney Injury (AKI) as a complication of neonatal sepsis. The study sought to determine prevalence of AKI and its characteristics in neonates with suspected sepsis. A cross-sectional study was conducted at Kenyatta National Hospital among neonates aged 0-28 days. AKI was defined as serum creatinine of more than 100µmmol/l. Among 332 neonates included 120 had AKI giving a prevalence of 36.1% (95% CI 31 to 41.6). Based on RIFLE criteria the commonest AKI presentation was Failure 72 (62.6%, 95% CI 53.6 to 71.6), followed by Injury 26 (22.6%, 95% CI 14.8 to 30.4) and then Risk 17 (14.8%, 95% CI 8.2 to 21.3). AKI was more common in neonates with suspected late onset sepsis (p=0.004). Maternal fever in the preceding week to delivery and presence of either puerperal sepsis or post-partum hemorrhage were significantly associated with severe AKI (p=0.004 and p=0.038). Prevalence of AKI was high; those with suspected late onset sepsis were more likely to develop AKI compared to early onset sepsis. Presence of maternal fever preceding delivery and presence of either puerperal sepsis or postpartum hemorrhage were associated with severe forms of AKI.

<div>Abstract<p>In view of safety concerns surrounding the use of pharmaceuticals such as nonsteroidal anti-inflammatory drugs and tamoxifen as cancer chemopreventive agents, potentially innocuous phytochemicals derived from the diet are considered attractive alternatives. However, results from cancer chemoprevention trials of dietary agents have been disappointing to date, as promising activities observed in rodent models and cells <i>in vitro</i> have not translated into clinical success. This may be partly due to the development process for these agents, which is complex for a number of reasons; the definitive end point, inhibition of carcinogenesis, requires large numbers of individuals followed-up over many years. Furthermore, whereas biomarkers are frequently used as surrogate efficacy end points to expedite the process, biomarker assessment and validation has proven difficult because dietary agents exert multiple actions with an unknown hierarchy of biological importance. These factors have made determining the dose for clinical investigation extremely challenging, and at present, there are no defined strategies for rationally identifying the most appropriate doses. In this commentary, the complexities involved in the development of dietary chemoprevention agents are discussed, and a tentative route towards selection of the optimal clinical dose is proposed. The approach highlights the need to conduct long-term preclinical studies with realistic concentrations that are achievable in human tissues and the importance of efficacy biomarkers that are intrinsically linked to the key mechanisms of action. A more logical design of studies should increase the likelihood that the encouraging preclinical results observed for many phytochemicals translate into tangible clinical benefit.</p></div>

Background.Obstructive sleep apnoea (OSA) is considered positional (POSA) when sleep disordered breathing (SDB) events occur predominantly in supine position.Scarce data from Indian sub-continent regarding POSA are available.Methods.Records of patients who underwent two nights of nocturnal polysomnography (PSG) from January 2018 to June 2019 in the Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh were evaluated.Patients were diagnosed as POSA if apnoea-hypopnoea index (AHI) was ≥5/h and supine AHI was at least two times higher than non-supine AHI (NSAHI). Results.Of the 130 patients studied, 100 were diagnosed as OSA; of these 68 PSG studies were analysed.Fourteen of the 68 (20.6%) had POSA.Both groups were similar in age, gender, body mass index (BMI) and quality of sleep.Mean AHI (P=0.001),NSAHI (P<0.001),right AHI (P=0.002),oxygen desaturation index (ODI) (P=0.007),number of subjects with oxygen saturation measured by pulse oximetry (SpO 2 ) <90% (P=0.032) and <80% (P=0.031) and percentage of total sleep time (TST) with SpO 2 <90% (P=0.031) was significantly lesser in POSA than non-POSA patients.Mean minimum SpO 2 was significantly higher in POSA than non-POSA (P=0.025).Post continuous positive airway pressure (CPAP) trial, though average CPAP pressures differed significantly (P=0.001),resultant AHI and other PSG parameters in the two groups were not statistically different, suggesting adequate response to treatment. Conclusions.Identification of POSA is a key step for further studies aimed at deciphering wide array of issues which can be associated with this entity.

Mammary Analogue Secretory Carcinomas (MASCs) are rare slow growing salivary gland tumors that mimic the histological and genetic features of secretory carcinoma, a rare tumor of the breast. In this article, we present the case of a 24-year-old woman diagnosed as a case of mammary analogue secretory carcinoma. The patient underwent left superficial parotidectomy to excise the parotid mass. A multilobulated solid cum cystic mass of around 60 x 50 mm was excised with clear margins with preservation of the facial nerve. The lesion demonstrated an infiltrative pattern extending beyond the capsule of the tumor and immunohistochemical stains were positive for Cytokeratin AE1/AE3, Cytokeratin 7, SOX-10, and Mammaglobin. Due to vague clinical presentation and lack of certain imaging, MASC is a challenging definitive diagnosis to make, and less than 100 cases of MASCs have been reported in existing literature and management guidelines for the tumor are not yet clearly defined. We aim to help improve upon the existing knowledge base by reporting this rare case and lay down future groundwork for larger studies involving MASCs