People’s University

Clinically node-negative (cN0) neck management in cT1-T2 oral cavity squamous cell carcinoma continues to be a subject of controversy. The eighth edition AJCC has incorporated depth of invasion (DOI) as a significant factor in staging and consideration for possible neck dissection. Establishment of accurate DOI thresholds and their clinical relevance is crucial to maximize oncological outcomes with reduced unnecessary morbidity. A comprehensive analysis of clinical research assessing elective neck dissection (END) techniques in oral cavity cancers classified by DOI in cT1-T2N0 patients was carried out. The included studies reported occult nodal metastasis rates, overall survival, disease-specific survival, disease-free survival, and regional control. With hazard ratios favoring END for overall survival (HR 0.64; 95% CI 0.45-0.92) and disease-free survival (HR 0.45; 95% CI 0.34-0.59), elective neck dissection provided advantages in both survival and regional control. In a national registry, DOI ≥ 5 mm independently raised the risk of nodal failure (HR 2.099; 95% CI 1.346-3.271), while END enhanced neck control in comparison to observation (HR 1.749; 95% CI 1.141-2.680). With ROC-derived cut-offs like 4.59 mm producing positive predictive values for nodal metastasis up to 41.7%, diagnostic thresholds clustered around 4 mm. Under DOI guidance, elective neck dissection consistently showed oncologic benefit, with practical thresholds convergent around 4 mm for sites in the mixed oral cavity and 3 mm for high-risk subsites. The synthesized results confirmed that DOI is the primary determinant of END when combined with histopathologic and subsite-specific risk factors.

To evaluate the efficacy of 0.5% Bupivacaine and 4% Articaine when administered via inferior alveolar nerve block (IANB) in patients undergoing surgical management of mandibular fractures. The sample consisted of 40 participants, who required management of mandibular fractures. Patients receiving Bupivacaine required rescue analgesia significantly later (10.40 h) compared to those receiving Articaine (7.30 h), with a mean difference of 3.10 h (P < 0.001). This 42% delay in rescue analgesic requirement represents a clinically meaningful improvement in postoperative pain management, potentially reducing overall analgesic consumption and associated side effects while improving patient satisfaction scores.

Abstract Background: Anemia is a common comorbidity in patients with heart failure and is strongly associated with adverse clinical outcomes. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, specifically dapagliflozin, may improve anemia-related biomarkers. However, findings from individual trials have been inconsistent, leaving the magnitude and consistency of these effects unclear. Objective: Our study aims to clarify the effects of dapagliflozin on anemia in patients with heart failure. Methods: We conducted a systematic search of PubMed, Embase, Cochrane CENTRAL, and trial registries for randomized and non-randomized clinical trials. Outcomes included changes in hemoglobin, ferritin, transferrin saturation (TSAT), and serum iron. Mean differences (MD) and 95% confidence intervals (CIs) were pooled using random-effects models. We performed sensitivity analyses by sequentially excluding studies and assessed bias using Cochrane tools and ROBINS-I, grading evidence via GRADE. Results: Six studies (n=5,075) were included. Dapagliflozin significantly increased hemoglobin (MD 1.05; 95% CI 0.75–1.35; P &lt; 0.00001). Ferritin was significantly reduced (MD –14.50; 95% CI –22.13 to –6.86; P = 0.0002); sensitivity analyses excluding Bhaganagarapu et al. amplified this reduction (MD –23.37; 95% CI –34.57 to –12.17; P &lt; 0.00001). While TSAT changes were non-significant overall (MD 0.37), sensitivity analysis demonstrated a significant reduction (MD –1.36; 95% CI –2.37 to –0.35). Serum iron remained unchanged (MD –0.09). Evidence certainty was moderate-to-high for hemoglobin and ferritin but low for TSAT and serum iron. Conclusion: In heart failure patients, dapagliflozin reliably increases hemoglobin and decreases ferritin. While the primary analyses for transferrin saturation were non-significant, sensitivity testing revealed significant changes. These findings suggest that dapagliflozin may beneficially influence iron metabolism. However, further large-scale, dedicated trials are warranted to confirm these mechanisms.

Ionic liquids (ILs) formulated by mixing an organic chloride salt with AlCl₃ in a 1:2 molar ratio-classically, 1-ethyl-3-methylimidazolium chloride (EMImCl): AlCl₃ = 1:2- form Lewis-acidic "1:2 ionic liquids" in which the dominant anionic species is Al₂Cl₇^? in equilibrium with AlCl₄^?. These liquids show distinctive ion?solvent interactions that govern transport, reactivity, and interfacial phenomena in catalysis and electrochemistry (e.g., Al battery electrolytes and Al electrodeposition). This review synthesizes how acidity and speciation control solvation thermodynamics and dynamics, surveys experimental and computational probes (NMR, vibrational spectroscopy, solvatochromic scales, conductivity) and distills design rules for tuning solvation via composition, cation identity, and purposeful dilution.

The relationship between cigarette smoking intensity, cumulative exposure and metabolic syndrome remains inadequately characterized despite smoking being a known metabolic risk factor. Therefore, it is of interest to examine the association of smoking status, intensity and pack-years with metabolic syndrome and its individual components among 200 adults using standardized questionnaires and logistic regression analysis. Metabolic syndrome was present in 35.0% of participants and showed a progressive increase from never smokers (24.4%) to former smokers (35.0%) and current smokers (48.6%). Among current smokers, prevalence rose in a dose-dependent manner from light to heavy smoking and was accompanied by higher frequencies of central obesity, low HDL cholesterol and elevated triglycerides. Both smoking intensity and cumulative pack-year exposure were independently associated with a graded increase in the prevalence and odds of metabolic syndrome. By showing a distinct dose-dependent relationship between cigarette smoking intensity, cumulative pack-years, and metabolic syndrome instead of evaluating smoking status alone, the current study builds on previous research. In addition to highlighting cumulative smoking exposure as an independent and clinically significant predictor of metabolic syndrome, this offers more support for quantitative risk stratification.

Artificial intelligence (AI) is rapidly transforming healthcare around the world with its greatest potential in low- and middle-income countries (LMICs), which face workforce shortages, long travel distances, and limited diagnostic capability. AI is an equalizing agent in resource-limited environments, reinforcing the obligation for safe and responsible use for both patients and healthcare workers as highlighted in this perspective. For instance, patients from rural areas can use AI-enabled medication checkers, to identify possible drug interactions, explain side effects, and provide reliable information about known illnesses—with strong disclaimers against self-diagnosis or self-medication. For healthcare workers, AI can create efficiency in workflow, assist in the review of radiologic findings, and support task-shifting in overburdened health systems. This perspective also emphasizes the importance of AI literacy, ethical guidelines, and free continuing professional education (CME) offered by governments and policymakers to support equitable and context appropriate use. Thus, AI can provide a useful, responsible, demonstrably helpful force multiplier, augmenting healthcare capacity, patient safety, and access to quality care in low- and middle-income countries while giving providers helpful advantages in systems where they face overwhelming constraints of time and expertise.