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摘要： BACKGROUND: In the United States, firearm injuries are the leading cause of pediatric injury mortality. There is little information about anesthetic care and perioperative outcomes of children with firearm injuries. This study compares clinical characteristics, anesthesia care, and perioperative survival of pediatric patients with firearm and nonfirearm injuries. METHODS: We conducted a retrospective cohort study of injured patients <18 years admitted to a regional level 1 US pediatric trauma center between 2014 and 2022 who received anesthetic care within 2 hours of hospital arrival. Differences in clinical characteristics, anesthesia care including therapeutic intensity (arterial and central venous cannulation, blood product transfusion, vasopressor use, or hemostatic agent use) and outcomes (length of stay, mortality, and disposition) were examined between firearm and nonfirearm injury groups and by age groups. RESULTS: During the 9-year study period, pediatric firearm injury hospitalizations tripled, and 25.9% (69/266 trauma admissions) patients received emergency firearm injury anesthesia care. Six (8.8%) patients with firearm injuries were under 10 years. Polytrauma occurred in both firearm (7%) and nonfirearm injury (14%) groups. Compared to nonfirearm injuries, patients with firearm injuries were older (P < .0001), had fewer American Society of Anesthesiologists (ASA) physical status I (P = .03) and had more injuries with injury severity score (ISS) 16-25 (P < .01). Abdominal injury (P < .001) was more common than traumatic brain injury (TBI;P < .0001) across age groups but all children 1 to 4 years had profound (ISS >= 25) TBI. Time to anesthetic care was shorter (P < .001), arterial cannulation was more common (P < .02), estimated blood loss (P < .001) was greater, and massive transfusion (P < .0001) was more common during firearm injury anesthesia care. Etomidate (P = .01), midazolam (P < .01) and tranexamic acid (P < .01) use were more common and crystal

关键词： glioma   IDH1 typing   R1 rho$$ {R}_{1\rho } $$ dispersion   technical confounds  

关键词： nursing internship   self-efficacy   health   nursing education   Saudi Arabia   longitudinal study  

摘要： Introduction: Transitioning from academic education to clinical practice is challenging for newly graduated nurses. This study evaluated a 12-month culturally tailored internship on professional competence, self-efficacy, and perceived health among newly graduated Saudi ***: A longitudinal design with repeated measures was used to recruit 147 female Saudi newly graduated nurses who completed an internship program at two tertiary hospitals. Data were collected at beginning, 8 months, and completion of the program. The Nurse Professional Competence Scale-Short Form, General Self-Efficacy Scale, and self-reported health measures were used. Statistical analyses were conducted using analysis of variance (ANOVA) with post hoc ***: Significant improvements were found in professional competence, especially in leadership, documentation, and administrative skills. Value-based care competence remained high. Self-efficacy and perceived health were also ***: Culturally tailored internship programs are effective in enhancing newly graduated nurses' professional competence and perceived health. Such internship programs may effectively help to enhance training for practice-ready nurses.

关键词： Stomach neoplasms   Docetaxel   Oxaliplatin   S-1   Neoadjuvant therapy   Linitis plastica  

摘要： BackgroundLarge type 3 (>= 8 cm) and type 4 gastric cancers are associated with extremely poor prognoses. The phase III JCOG0501 trial, which evaluated neoadjuvant S-1 plus cisplatin, failed to demonstrate any survival benefits. Docetaxel, oxaliplatin, and S-1 (DOS) have been explored as more effective perioperative regimens for these *** patients had large type 3 or type 4 gastric cancer without distant metastases, except for positive peritoneal cytology (CY). Patients received three cycles of neoadjuvant DOS (docetaxel 40 mg/m2, oxaliplatin 100 mg/m2, and oral S-1 at 80 mg/m2/day for 14 days), followed by gastrectomy with >= D2 lymphadenectomy and one year of adjuvant docetaxel plus S-1. The primary endpoint was the 3 year progression-free survival (PFS) rate, with an expected value of 60% and a threshold of 45%. A one-sample log-rank test was performed with an alpha level of *** the 48 patients enrolled, 27 had type 4 tumors (56.2%), and 10 (20.8%) had CY1. Overall, 91.7% of patients completed neoadjuvant DOS. R0 resection rate was achieved in 89.6% of patients, a pathological response grade >= 1b in 66.7%, and negative CY conversion in 80.0%. The 3-year PFS rate was 37.5% (95% confidence interval [CI], 24.1-50.6%;80% CI 28.6-46.4%;p = 0.960), and the 3-year overall survival rate was 52.1% (95% CI 37.2-65.0%).ConclusionsAlthough neoadjuvant DOS therapy demonstrated favorable pathological responses, the 3-year PFS did not exceed the predefined threshold, and a survival benefit was not demonstrated.

关键词： Amberlyst-15   Quinoxaline   Pyrrole   Oxidative cyclization   Recyclable catalyst  

摘要： Herein, we have developed an Amberlyst-15-catalyzed oxidative cyclization strategy for the synthesis of biologically active pyrrolo[1,2-a]quinoxaline scaffolds. The advantages of the present protocol include catalyst recovery and reuse, along with simpler reaction conditions compared to previously reported methods. © 2025. Thieme. All rights reserved.

关键词： clones   flow cytometry   sensitivity   specificity   T-cell lymphoma   T-cell receptor  

摘要： Objectives To determine the diagnostic value of disclosing monotypic T-cell populations by expression analysis of the constant region 1 of T-cell receptor beta (TRBC1) by flow cytometry, for the detection of T-cell neoplasms, in a routine hematopathology practice *** A panel of antibodies ECD-CD16/PECy5.5-CD4/PECy7-CD2/APCAF700-CD7/KO-CD8/FITC-TCR gamma delta/PE-TRBC1/APC-CD26/APC-CD57/APC-CD30/APCH7-CD45/BV421-CD3 was applied. One thousand and twenty-nine cases investigated during 26 months were reviewed and categorized as monotypic or polytypic depending on the expression of TRBC1 in all identifiable CD3+ T-cell *** Although TRBC1 restriction proved to be sensitive (90.7%) with a high negative predictive value (99.1%), in some T-cell neoplasms, particularly those with significant inflammation, including angioimmunoblastic T-cell lymphoma, monotypic T-cells were not detected. The specificity was high (95.6%) albeit with a modest positive predictive value (67.1%), reflecting T-cell clones of uncertain significance (T-CUS) without T-cell neoplasm. Of these clones, 53.6% exhibited a T-cell large granular lymphocytic leukemia-like phenotype, most commonly found in the peripheral blood or bone marrow, while others were identified in association with unrelated primary tumors or other comorbidities. Seventy-nine percent of the T-CUS cases remained stable over time during 1-77 months of *** Including TRBC1 antibodies in a routine flow cytometry panel facilitates the identification of T-cell neoplasms. The analysis must be interpreted within its clinical context since T-cell lymphomas with a small and sometimes surface CD3-negative neoplastic T cell population, may display normal patterns of TRBC1-expression with a background of reactive T cells. Conversely, monotypic T-cells can be found in the absence of T-cell neoplasm.

关键词： Equations   Glomerular filtration rate   Performance   Kidney disease   Type 1 diabetes   Youth  

摘要： Background Diabetic kidney disease (DKD) is the primary cause of kidney failure in type 1 diabetes (T1D). Early identification of subclinical DKD is based on albuminuria and glomerular filtration rate (GFR). However, no GFR equations have been validated in youth with T1D. This study evaluates the performance of GFR equations in youth with T1D. Methods We compared a direct measure of GFR (mGFR) via plasma clearance of exogenous inulin, with estimated GFR (eGFR). eGFR was calculated with the following equations: Full-Age Spectrum (FAS-height and FAS-age);revised Lund-Malm & ouml;(LM-Rev);European Kidney Function Consortium (EKFC);Chronic Kidney Disease Epidemiology Collaboration, 2009 (CKD-EPI 2009);CKD-EPI 2021 (revised CKD-EPI 2009 without race adjustment);CKD-EPI40 (revised CKD-EPI 2021 with age-adjusted creatinine);Chronic Kidney Disease in Children (CKiD);CKiD Under 25 (sex-dependent);CKiD Under 25 (age- and sex-dependent);and Improving Renal Complications in Adolescents with Type 2 Diabetes through Research (iCARE). Bland-Altman analysis estimated performance (bias and accuracy (P10 and P30)). Results In total, 141 children and adolescents at a mean age of 13.5 +/- 3.3 years (range 6.2-18.5) and diabetes duration 5.7 +/- 1.6 years were included. Their mean serum creatinine was 45.6 +/- 12.1 mu mol/L (0.52 +/- 0.14 mg/dL) and mGFR 142.3 +/- 25.0 mL/min/1.73 m(2). For the whole population, FAS-height (bias = 8.37 mL/min/1.73 m(2);P30 = 85.1%) and CKiD (bias = 11.9 mL/min/1.73 m(2);P30 = 81.6%) performed best. These equations also outperformed others in subgroups (females, age groups < 11 years and 11-15.9 years). In contrast, CKiD in males (bias = 5.23 mL/min/1.73 m(2);P30 = 81.0%) and CKD-EPI 2009 in the 16-18.5 years subgroup (bias = -0.04 mL/min/1.73 m(2);P30 = 84.6%) were top performers. Conclusions Subgroups of children and adolescents with T1D may benefit from different eGFR equations for accurate subclinical DKD evaluation.