BACKGROUND: Hypothermia is defined as a body core temperature below 35 °C and can be caused by internal or external stress. Primary hypothermia is caused by excessive exposure to low environmental temperature without any medical conditions prior to that. Secondary hypothermia is caused by alteration in thermoregulation by disease, trauma, surgery, drugs, or infections. The aim of the research is to investigate core temperature values in rats subjected to specific water temperatures at five different time points. It focuses on distinguishing between primary and secondary hypothermia in these rats.
METHODS: The total 21 Wistar rats were divided into three experimental groups as: Control group rats exposed only to hypothermic condition (n = 7); Alcohol + hypothermia (n = 7); and Benzodiazepines + hypothermia (n = 7). The temperature spots analyzed in the study were: normal core temperature, core temperature during injection of 0,3 ketamine, temperature of immersion and the temperature at the onset of hypothermia and temperature at the time of death.
RESULTS: In our study the comparative analysis of body temperatures at various time points following submersion in water revealed significant differences among the study groups treated with either alcohol or benzodiazepines and the control group. Notable differences were observed in baseline temperature, post-anesthesia induction temperature, and immediate post-submersion temperature. Specifically, significant differences were discovered among the alcohol and benzodiazepine groups (p < 0.001) and ranging from the alcohol and control groups (p < 0.001). The analysis of survival times following induced hypothermia revealed a statistically significant difference among the three experimental groups (p = 0.04), though subsequent post-hoc comparisons did not demonstrate significant differences in mean survival times.
CONCLUSIONS: There is a difference in survival time between primary and secondary hypothermia groups, depending on consumption and intoxication with alcohol or benzodiazepines. The analysis of survival times following induced hypothermia showed a statistically significant difference among the groups.

UNASSIGNED: The neck-preserving cementless short stem represents a valid therapeutic option for total hip replacement in high-functional-demand patients, but few studies are available about the use of modularity in the last-generation short stem. The aim of the study was to evaluate the mid-term survival of a specific implant design that combines partial collum short hip stem with neck modularity; assessing the functional status was the second endpoint.
UNASSIGNED: A retrospective single-center cohort study was conducted on 75 patients aged 35 to 80 years, with a minimum 6-year follow-up. Patients with neurological/rheumatic pathologies and previous hip surgeries were excluded. All the patients underwent total hip replacement with a short modular neck-preserving cementless hip stem. Clinical outcomes, complications, revisions, and the Western Ontario and McMaster Universities Osteoarthritis Index, Harris hip score, and Short Form 12-Item Health Survey (SF-12) questionnaires were evaluated. The results were compared with healthy population\'s data extracted from the literature, stratified by age.
UNASSIGNED: The Kaplan-Meier analysis revealed a 10-year implant survival rate of 96.7%, coupled with a revision rate of 1.3%. Results showed a Harris hip score and physical SF-12 significantly lower and a mental SF-12 higher when compared to healthy population. No statistically significant differences emerged when comparing groups based on neck modularity.
UNASSIGNED: The short modular neck-preserving cementless hip stem emerged as a reasonable choice for patients with elevated functional demands, ensuring good clinical outcomes while preserving bone integrity. The use of a modular neck in short stems didn\'t show any mechanical problems in the mid-term.

BACKGROUND: Effectiveness of candesartan in migraine prevention is supported by two randomized controlled trials. We aimed to assess the effectiveness, tolerability, and response predictors of candesartan in the preventive treatment of migraine.
METHODS: Observational, multicenter, prospective cohort study. The 50%, 75% and 30% responder rates, between weeks 8-12 and 20-24, were compared with the baseline. Treatment emergent adverse effects were systematically evaluated. Response predictors were estimated by multivariate regression models.
RESULTS: Eighty-six patients were included, 79.1% females, aged 39.5 (inter-quartile range [IQR] 26.3-50.3), with chronic migraine (43.0%), medication overuse headache (55.8%) and a median of two (inter-quartile range: 0.75-3) prior preventive treatments. At baseline patients had 14 (10-24) headache and 8 (5-11) migraine days per month. The 30%, 50% and 75% responder rates were 40%, 34.9% and 15.1% between weeks 8-12, and 48.8%, 36%, and 18.6% between weeks 20-24. Adverse effects were reported by 30 (34.9%) and 13 (15.1%) patients between weeks 0-12 and 12-24, leading to discontinuation in 15 (17.4%) patients. Chronic migraine, depression, headache days per month, medication overuse headache, and daily headache at baseline predicted the response between weeks 20-24.
CONCLUSIONS: Candesartan effectiveness and tolerability in migraine prevention was in line with the clinical trials\' efficacy.Trial registration: The study protocol is registered in ClinicalTrials.gov (NCT04138316).

UNASSIGNED: The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres.
UNASSIGNED: This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019).
UNASSIGNED: There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002).
UNASSIGNED: COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.

Without effective intervention, primary hyperoxaluria type 1 (PH1) causes oxalate-induced kidney damage, leading to end-stage kidney disease and serious complications throughout the body. Although PH1 carries a heavy burden that impacts quality of life, literature on the experiences of those living with PH1 and caring for patients with PH1 is limited. This study aimed to describe the diagnostic journey in PH1 and characterize patients\' and caregivers\' self-reported experiences throughout the disease course.
This was an observational study involving in-depth, semi-structured telephone interviews. Dominant trends were assessed using constant comparative analysis to identify themes in interviewees\' descriptions of their experiences. Individuals aged ≥ 12 years and caregivers of children aged 6-17 years with genetically confirmed PH1 were eligible. Informed consent/assent and ability to read and speak English were required.
Interviewees (16 patients, 12 caregivers) reported a prolonged diagnostic journey due to low disease awareness, among other factors. Upon diagnosis, PH1 was frequently symptomatic, typically involving kidney stone-related symptoms but also potentially symptoms arising beyond the kidneys. PH1 most commonly led to worry and social impairment in adolescents, impaired physical function in adults, and a range of impacts on caregivers. In late-stage disease, dialysis was the most burdensome aspect of living with PH1 (due to time requirements, limitations from living with a catheter, etc.), and this burden was exacerbated by the COVID-19 pandemic. Benefits desired from PH1 management included reductions in laboratory measures of oxalate burden, kidney stone and urination frequency, and oxalate-related skin ulcers.
PH1 greatly impacts patients\' and caregivers\' lives, primarily due to burdensome disease manifestations and associated emotional, physical, and practical impacts, as well as disease management challenges - particularly those related to dialysis in late-stage disease.

Although primary gastrointestinal non-Hodgkin lymphoma (GI NHL) is a rare hematopoietic malignancy, it is the most common extranodal site involved by lymphoma. Treatment methods are chosen based on many factors, including site of lesion, histopathology, symptoms, and patients\' choice.
UNASSIGNED: To evaluate the clinical characteristics, treatment results and prognosis for primary GI NHL in Vietnamese patients.
UNASSIGNED: This was a retrospective descriptive study on 126 patients with primary GI NHL treated at our hospital from 2010 to 2015. Data of all patients were collected and analyzed.
UNASSIGNED: B-cell non-Hodgkin\'s lymphoma was the major pathology with rate of 93.7%, in which Diffuse Large B-Cell Lymphoma type accounted for 58.7%, followed by Mucosa-associated lymphoid tissue lymphoma type 22.2%. Less common forms were cystic type, Burkitt\'s lymphoma, Mantle cell, T cell. The majority of patients receiving chemotherapy achieved a complete response, up to 70%. Overall survival and 5-year disease-free survival were 74.1% and 59.3%, respectively. Overall, stomach lymphoma had a longer survival rate than those in the small intestine. Factors including Eastern Cooperative Oncology Group score of 2-4, elevated Lactate Dehydrogenase levels at baseline, stage of widespread illness (III/IV), high malignancy histopathology, and lesion size of more than 10 cm were poor prognostic indicators.
UNASSIGNED: Gastric lesion was the most frequent site and has better prognosis than other locations. Other prognostic factors for overall survival included Eastern Cooperative Oncology Group score, Lactate Dehydrogenase levels, stage, histopathology, and lesion size.

BACKGROUND: The four co-circulating and immunologically interactive dengue virus serotypes (DENV1-4) pose a unique challenge to vaccine design because sub-protective immunity can increase the risk of severe dengue disease. Existing dengue vaccines have lower efficacy in DENV seronegative individuals but higher efficacy in DENV exposed individuals. There is an urgent need to identify immunological measures that are strongly associated with protection against viral replication and disease following sequential exposure to distinct serotypes.
METHODS: This is a phase 1 trial wherein healthy adults with neutralizing antibodies to zero (seronegative), one non-DENV3 (heterotypic), or more than one (polytypic) DENV serotype will be vaccinated with the live attenuated DENV3 monovalent vaccine rDEN3Δ30/31-7164. We will examine how pre-vaccine host immunity influences the safety and immunogenicity of DENV3 vaccination in a non-endemic population. We hypothesize that the vaccine will be safe and well tolerated, and all groups will have a significant increase in the DENV1-4 neutralizing antibody geometric mean titer between days 0 and 28. Compared to the seronegative group, the polytypic group will have lower mean peak vaccine viremia, due to protection conferred by prior DENV exposure, while the heterotypic group will have higher mean peak viremia, due to mild enhancement. Secondary and exploratory endpoints include characterizing serological, innate, and adaptive cell responses; evaluating proviral or antiviral contributions of DENV-infected cells; and immunologically profiling the transcriptome, surface proteins, and B and T cell receptor sequences and affinities of single cells in both peripheral blood and draining lymph nodes sampled via serial image-guided fine needle aspiration.
CONCLUSIONS: This trial will compare the immune responses after primary, secondary, and tertiary DENV exposure in naturally infected humans living in non-endemic areas. By evaluating dengue vaccines in a new population and modeling the induction of cross-serotypic immunity, this work may inform vaccine evaluation and broaden potential target populations.
BACKGROUND: NCT05691530 registered on January 20, 2023.

Cementless fixation is gaining popularity for primary total knee arthroplasties (TKAs). The prior 5-year results of our randomized clinical trial that included 3 different tibial designs found minimal differences. The purpose of the current study was to investigate the 10-year results in the same cohort.
Between 2003 and 2006, 389 primary TKAs were randomized: traditional modular cemented tibia (135); hybrid (cemented baseplate with uncemented pegs) monoblock tibia (128); and cementless monoblock tibia (126). Implant survivorships, radiographs, and clinical outcomes were analyzed. Mean age at TKA was 68 years (range, 41 to 85), 46% were male, and mean body mass index was 32 (range, 21 to 59). The mean follow-up was 10 years.
The 10-year survivorship free of any revision was similar between the hybrid monoblock and cementless monoblock groups at 96%, but lower (89%) for the traditional modular cemented tibia (P = .05). The traditional modular cemented tibia group had significantly more revisions for aseptic tibial loosening than the other 2 groups (7 versus 0%) at 10 years (P = .003). The traditional modular cemented tibia group had significantly more nonprogressive radiolucent lines than the hybrid and cementless monoblock groups (24, 12, and 9%, respectively). Clinical outcomes were similar and excellent between all 3 groups.
Cementless and hybrid monoblock tibial components have excellent implant survivorship (96%) with no cases of aseptic tibial loosening to date. The traditional cemented modular tibial group had a 7% cumulative incidence of aseptic loosening at 10 years.
Level I, Prospective Randomized Control Trial.

UNASSIGNED: Stewart-Treves Syndrome in Primary Limb Lymphedema (STS-PLE) is an extremely rare malignant tumor. A retrospective analysis was conducted to elucidate the relationship between magnetic resonance imaging (MRI) findings and signs compared to pathology.
UNASSIGNED: Seven patients with STS-PLE were enrolled at Beijing Shijitan Hospital, Capital Medical University, from June 2008 to March 2022. All cases were examined by MRI. The surgical specimens were subjected to histopathological and immunohistochemical staining for CD31, CD34, D2-40, and Ki-67.
UNASSIGNED: There were two different types of MRI findings. One was mass shape (STS-PLE I type) in three male patients, and the other was the \"trash ice\" d sign (STS-PLE II type) observed in four female patients. The average duration of lymphedema (DL) of STS-PLE I type (18 months) was shorter than that of STS-PLE II type (31 months). The prognosis for the STS-PLE I type was worse than that for the STS-PLE II type. Regarding overall survival (OS), the STS-PLE I type (17.3 months) was three times shorter than that of the STS-PLE II type (54.5 months). For STS-PLE I type, the older the STS-PLE onset, the shorter the OS. However, there was no significant correlation in STS-PLE II type. MRI was compared to histological results to provide an explanation for the differences in MR signal changes, especially on T2WI. Against a background of dense tumor cells, the richer the lumen of immature vessels and clefts, the higher the T2WI MRI signal (taking muscle signal as the internal reference standard) and the worse the prognosis, and vice versa. We also found that younger patients with a lower Ki-67 index (<16%) had better OS, especially for the STS-PLE I type. Those with stronger positive expression of CD31 or CD34 had shorter OS. However, the expression of D2-40 was positive in nearly all cases, and seemed not to be associated with prognosis.
UNASSIGNED: In lymphedema, the richer the lumen of immature vessels and clefts based on dense tumor cells, the higher the T2WI signal on the MRI. In adolescent patients, the tumor often showed a \"trash ice\" sign (STS-PLE II-type) and prognosis was better than for the STS-PLE I type. While in middle-aged and older patients, tumors showed a mass shape (STS-PLE I type). The expression of immunohistochemical indicators (CD31, CD34, and KI-67) correlated with clinical prognosis, especially decreased Ki-67 expression. In this study, we determined it was possible to predict prognosis comparing MRI findings with pathological results.

UNASSIGNED: In our institution, computed tomography (CT)-guided percutaneous cryoablation has been performed in patients with malignant lung tumors under local anesthesia. This study aimed to examine the feasibility and safety of percutaneous cryoablation for the treatment of malignant lung tumors.
UNASSIGNED: From July 2002 to December 2016, 227 patients (56 with primary lung cancer and 171 with metastatic lung tumor) underwent percutaneous cryoablation for the treatment of malignant lung tumors using a cryosurgical unit at our institution. Demographic factors, duration of post-treatment hospitalization, and adverse event and mortality rates were retrospectively investigated in 366 treatment sessions targeting 609 lesions.
UNASSIGNED: The median diameter of the targeted tumor was 1.3 cm. All the cryoablation procedures were completed under local anesthesia, and the median duration of post-treatment hospitalization was two days. Adverse events (grade 2 or higher) were observed in 79 sessions (21.6%), with pneumothorax being the most common. In five sessions (1.4%), patients had grade 3 adverse events. There was no 30-day mortality; however, there were two 60-day mortality (0.5%) due to acute exacerbation of interstitial pneumonia. In multivariate analysis, independent predictors of adverse events were comorbid interstitial pneumonia [odds ratio (OR) =2.20; 95% confidence interval (CI): 1.04-4.64] and no history of pulmonary resection on the treated side (OR =3.04; 95% CI: 1.65-5.62).
UNASSIGNED: Cryoablation is a feasible and safe treatment for malignant lung tumors with acceptable adverse event rates. However, the mortality risk in patients with comorbid interstitial pneumonia should be fully recognized.