Maciashenningsen5764

Ototoxicity and ocular toxicity screening are but two examples of specialty product lines that are often employed as Tier II or III nonclinical safety/hazard screening assessments. Compared to the regulatory guidelines that govern over standard toxicology or neurotoxicology programs, there is a paucity of regulatory strategies to address these specialized product lines. With respect to ototoxicity testing, we argue for the inclusion of the "least burdensome principles" adopted by the US FDA in providing the most pragmatic, efficient, and directed identification of potential harm to auditory function in the nonclinical safety arena. We argue for the exclusive use of the auditory brainstem response and the exclusion of the distortion product otoacoustic emissions (DPOAEs) in these Tiered II safety assessment programs. The inclusion of both are a burden on operational staff and, due to the extended episodes of anesthesia required to conduct both assays, this strategy poses a health and welfare concern for the selected animal species to be used. The DPOAE does not provide any sufficiently valid or reliable data above and beyond the gold standard ABR data, followed by complete oto-histopathology and cytocochleogram combination designs.

While mental disorder is an 'intrinsically social phenomenon', social psychiatry has been reportedly declining. Addressing public interests in social psychiatry was among the suggestions to address this decline. In recent years, public interest in social psychiatry can be explored using Google Trends, an increasingly important infodemiological tool.

This study determined changes in global online public interest in social psychiatry from January 2004 to December 2021 using Google search volumes.

Search query using this keyword, 'Social Psychiatry (Topic)', was made using the Explore feature of Google Trends. The Region and Time Filters were set to 'Worldwide' and January 2004 to December 2021, respectively. Afterward, the search volumes, country ranking, queries, and topics returned by the Google Trends system was described and compared.

There was a generally decreasing trend in search volumes for social psychiatry where it decreased almost 10 times between 2004 and 2021. Only 11 countries were listed in Google Trends' ranking with the top countries including Austria, Germany, and Switzerland. Search-related topics and queries were about social psychiatry related concepts, related academic discipline, human resources, social interventions, and education activities.

The findings suggest that there is a decreasing public interest in social psychiatry. To improve this, social psychiatry can address public expectation through improving its connection with allied social sciences, increasing its educational activities, and expanding its social intervention services.

The findings suggest that there is a decreasing public interest in social psychiatry. To improve this, social psychiatry can address public expectation through improving its connection with allied social sciences, increasing its educational activities, and expanding its social intervention services.Although many people report favourable attitudes towards organ donation, Hong Kong has one of the lowest rates of organ donation globally. The present study examined behavioural intention towards organ donation. A convenience sample of 225 Hong Kong Chinese adults (118 = female) aged 18-82 years were recruited to an online survey. Behavioural intention, attitudes, subjective norms, self-efficacy, knowledge and altruism were examined. ANOVA was conducted to examine key differences based on behavioural intention, regression then examined predictors of behavioural intention to donate before exploratory analysis examined the mediating role of subjective norms on the relationship between self-efficacy and behavioural intention. Findings revealed over one third (38%) of respondents were actively registered as organ donors. Women were significantly more likely to be registered as organ donors. Subjective norms and self-efficacy were strong predictors of behavioural intention to donate, and subjective norms significantly mediated the relationship between self-efficacy and behavioural intention to donate.

The clinical importance of aberrantly expressed microRNAs (miRNAs) in diagnosing inflammatory bowel disease (IBD) has not been well established, so was investigated in this systematic review and meta-analysis.

Articles in online databases from inception to March 17, 2021 were retrieved. Random effects meta-analysis was used to obtain sensitivity, specificity, positive (PLRs) and negative likelihood ratios (NLRs), diagnostic odds ratios (DORs), and areas under the curve (AUC) with 95% confidence intervals (CI) for IBD diagnosis.

Of 117 studies reporting altered miRNA expression in IBD included in the systematic review, 15 involving 937 patients with IBD and 707 controls, 22 miRNAs, and two miRNA panels were eligible for meta-analysis. Pooled analyses showed a moderate diagnostic accuracy for miRNAs in the IBD diagnosis, with a sensitivity of 0.80 (95% CI 0.79-0.82), specificity of 0.84 (95% CI 0.82-0.86), DOR of 21.19 (95% CI 13.90-32.31), and AUC of 0.89. Subgroup analyses revealed a better performance in patients with ulcerative colitis (AUC, 0.93) than Crohn's disease (AUC, 0.84). Consistent upregulation of miR-21, miR-16, and miR-192 in blood with a high-moderate diagnostic accuracy was found in at least two studies.

These findings suggest miRNAs are credible diagnostic biomarkers in IBD.

These findings suggest miRNAs are credible diagnostic biomarkers in IBD.

There are no widely accepted metrics to determine the optimal number and geographic distribution of trauma centers (TCs). We propose a Performance-based Assessment of Trauma System (PBATS) model to optimize the number and distribution of TCs in a region using key performance metrics.

The proposed PBATS approach relies on well-established mathematical programming approach to minimize the number of level I (LI) and level II (LII) TCs required in a region, constrained by prespecified system-related under-triage (srUT) and over-triage (srOT) rates and TC volume. To illustrate PBATS, we collected 6002 matched (linked) records from the 2012 Ohio Trauma and EMS registries. The PBATS-suggested network was compared to the 2012 Ohio network and also to the configuration proposed by the Needs-Based Assessment of Trauma System (NBATS) tool.

For this data, PBATS suggested 14 LI/II TCs with a slightly different geographic distribution compared to the 2012 network with 21 LI and LII TC, for the same srUT≈.2 and srOT≈.52. To achieve UT ≤ .05, PBATS suggested 23 LI/II TCs with a significantly different distribution. The NBATS suggested fewer TCs (12 LI/II) than the Ohio 2012 network.

The PBATS approach can generate a geographically optimized network of TCs to achieve prespecified performance characteristics such as srUT rate, srOT rate, and TC volume. Such a solution may provide a useful data-driven standard, which can be used to drive incremental system changes and guide policy decisions.

The PBATS approach can generate a geographically optimized network of TCs to achieve prespecified performance characteristics such as srUT rate, srOT rate, and TC volume. Such a solution may provide a useful data-driven standard, which can be used to drive incremental system changes and guide policy decisions.A 66-year-old man was reported to have persistent chest pain for 4 hours after accidentally swallowing a fishbone. An isolated esophageal foreign body (EFB) was suspected in the community hospital. In our center, an emergency chest CT scan revealed an EFB in the upper part of the esophagus of the patient which penetrated the left esophageal wall as well as the distal aortic arch. However, the experience of the treatment strategy for this lesion is still not enough available. Considering the surgical trauma and the risk associated with advanced age of the patient, the option for open surgery was waived. In addition, there was also a risk of sudden death due to aortic rupture that could occur after direct removal of the fishbone. Therefore, emergency thoracic endovascular aortic repair was performed and the fishbone was removed under an endoscope. The patient successfully pulled through without any discomfort, with no complications.Background There are two approaches to single-incision laparoscopic appendectomy (SILA) intracorporeal (Intra) and extracorporeal (Extra). However, the differences in the efficacy between these procedures remain unclear. Thus, this systematic review and meta-analysis aimed to compare the safety and usefulness of these techniques with those of conventional laparoscopic appendectomy (CLA) in children. Methods A systematic literature search was performed using the PubMed, CENTRAL, and Scopus databases. Studies comparing outcomes of "Intra-SILA and CLA" or "Extra-SILA and CLA" in children aged less then 18 years were included. Operative time, hospitalization duration, wound infection, intra-abdominal infection, conversion to open, additional ports, and narcotic doses were evaluated. Results Overall, 20 studies (six randomized controlled trials [RCTs], one prospective non-RCT, and 13 retrospective cohort studies) (Intra-SILA 322, CLA 791 cases; Extra-SILA 1318, CLA 1313 cases) were included. Compared with CLA, Extra-SILA was associated with a shorter operative time (mean difference, -9.79 minutes; 95% confidence interval [CI], -18.34 to -1.24) and lower incidence of intra-abdominal infection (3.3% versus 4.6%, odds ratio [OR], 0.52; 95% CI, 0.33 to 0.82) and a higher rate of additional port (13.6% versus 0%, OR, 43.93; 95% CI, 14.79 to 130.50). Meanwhile, the outcomes of Intra-SILA were comparable with those of CLA. However, the participants in the Intra-SILA group received significantly lower doses of narcotics than those in the CLA group. Conclusion Although the evidence was insufficient, both Intra- and Extra-SILA were comparable to CLA with respect to safety. Extra-SILA seems to have an advantage of a shorter operative time, but additional ports may be required.Background This study aims to review laparoscopic repair techniques of Morgagni hernias at a tertiary referral center. Methods This retrospective study includes pediatric patients who underwent laparoscopic repair of Morgagni hernia between March 2004 and March 2021. The patients' demographics, presenting symptoms, operative approach, and postoperative outcomes were recorded. Results Fourteen patients underwent laparoscopic repair of Morgagni hernia. The mean age at the time of operation was 24.7 months. Defect closing techniques were intracorporeal knot tying (n 2), extracorporeal knot tying, and subcutaneous knot placement (n 10), combination with intracorporeal continuous suturing and several extracorporeal intermittent sutures (n 2). Different approaches were used during removal of the needle from the insertion point in the extracorporeal knot tying intracorporeally, using a laparoscopic needle holder (n 6), with an 18-gauge injector tip (n 1), and extracorporeally with suture passer forceps (n 3). In the intracorporeal knot tying technique, the mean operation time was 127 minutes (range 90-180 minutes). In the extracorporeal knot tying technique, the mean operation time was 75 minutes (range 30-180 minutes). The mean operation time in the technique that used suture passer forceps for removing the needle from the same point of insertion was 40 minutes. selleck chemical There was no intraoperative complication. Conclusions In the laparoscopic repair of Morgagni hernia, full-thickness anterior abdominal wall repair with interrupted sutures that are tied extracorporeally in the subcutaneous tissue by separated minor skin incisions is the easy approach. Using suture passer forceps during removal of the needle facilitates this technique and shortens the operation time.