F1000Research

Background. A recent meta-analysis by Dang et al. [1] concluded that enteral supplementation with docosahexaenoic acid (DHA), with or without arachidonic acid (ARA) did not significantly affect retinopathy of prematurity (ROP) outcomes in preterm infants. Of four eligible trials that supplemented both DHA and ARA, only two contributed to each ROP outcome analyzed, and severe ROP was not assessed. Methods. We replicated the eligibility criteria and search strategy of Dang et al., restricted to trials that supplemented both DHA and ARA, and reanalyzed three ROP endpoints (any ROP, ROP requiring treatment, and severe ROP [stage 3 and/or treated]) using complete outcome records from all eligible trials. Crude risk ratios (RR) were pooled by Mantel-Haenszel fixed-effect meta-analysis. Gestational age-adjusted odds ratios (adjOR) were pooled on the log scale by inverse-variance random-effects meta-analysis with restricted maximum likelihood (REML) estimation of between-study variance and Hartung-Knapp confidence intervals. Results. Five trials were included; one trial was identified in our replicated search but was excluded by Dang et al. without a stated rationale. The pooled estimate for any ROP was consistent with Dang et al. (RR 0.87 [95% CI 0.71-1.08]; adjOR 0.70 [0.46-1.08]). For ROP requiring treatment, the crude RR suggested a lower risk but did not reach statistical significance (RR 0.60 [0.35-1.04]), whereas the gestational age-adjusted estimate indicated lower odds (adjOR 0.47 [0.23-0.94]). For severe ROP, DHA+ARA supplementation produced a significant protective effect in both unadjusted and adjusted models (RR 0.56 [0.36-0.86]; adjOR 0.42 [0.19-0.96]). Conclusions. When all eligible trials contribute to each endpoint and severe ROP is included as an outcome, enteral DHA+ARA supplementation reduces severe ROP and is associated with lower odds of ROP requiring treatment after adjustment for gestational age. These findings differ from the conclusions of Dang et al. and support reconsideration of DHA+ARA supplementation as a strategy to reduce sight-threatening ROP in preterm infants.

Effective postoperative pain control is essential following laparoscopic cholecystectomy, yet the analgesic value of a standardised 150 mg preoperative dose of pregabalin has not been clearly established. This systematic review and meta-analysis synthesised evidence from seven randomised controlled trials published between 2008 and 2025 to evaluate the efficacy and safety of pregabalin when administered before surgery. Four trials reported 24-hour postoperative pain scores, and pooled analysis demonstrated that pregabalin significantly reduced pain compared with control (SMD = 0.80 lower; 95% CI, 1.42 to 0.18 lower; p = 0.01), although statistical heterogeneity was high (I-squared = 81%). Pregabalin also produced notable reductions in opioid consumption, including fentanyl (SMD = 1.24 lower; p = 0.002) and tramadol (SMD = 4.21 lower; p = 0.002), again with considerable variability across studies. Sedation was slightly increased but did not reach statistical significance, and there were no significant differences in postoperative nausea, vomiting, or headache. Sensitivity analyses supported the stability of these findings. Overall, the results indicate that a single 150 mg preoperative dose of pregabalin meaningfully reduces postoperative pain and opioid requirements following laparoscopic cholecystectomy while maintaining an acceptable safety profile, supporting its use as part of a multimodal analgesic strategy.

Background: Canadian biomedical core facilities (BCFs) provide researchers with access to advanced tools and unique technical expertise, essential for research. However, their role, sustainability, and impact remain poorly understood. We report on the evolution of model and existing state of Canadas 205 BCFs, examining challenges and benefits. Methods: Cross referencing of national databases by the Canadian Innovation Fund (CFI), and from data collected by the Canadian Network of Scientific Platforms (CNSP) allowed he identification of BCFs. Hand curation of these lists validated that cores are operational. To ensure cores not listed by CFI/CNSP were captured, research intensive institutions in Canada were independently searched to identify active cores. Results: There are currently 205 active and operational BCFs located across 9 provinces, which can be further stratified into 9 technical domains that describe the nature of services they provide. Quebec (80 cores) and Ontario (75 cores) have the highest confluence of BCFs, with Quebec having a higher ratio of cores per capita. Conclusions: While our data establishes the ubiquity of Canadian BCFs, we highlight substantial challenges including sustainability, governance, evaluation and the recognition of support for core scientists. Here, we establish a framework to address these challenges and to inform best practice, to optimize creation of impactful, accessible and functional biomedical core facilities.

Kajiado County ranks eighth in the country for adolescent pregnancy, with one in five teenagers between the ages of 15 and 19 (21.8%) likely to be pregnant or have begun having children. The objectives of the study were to establish the dietary practices and nutrition status of pregnant adolescents in Kajiado County. The study employed a cross-sectional analytical design in a target population of 196 pregnant adolescents living in Kajiado West, Ewauso and Keekonyoike wards which were randomly selected. Qualitative data was gathered through key informant interview guides with facility nurse in charge and head teacher/principal. Dietary data was collected using a 24-hour dietary recall questionnaire.Dietary diversity was established using the minimal dietary diversity questionnaire for women of reproductive age (MDD-W). Nutrisurvey software was to analyze dietary data. Married respondent was at 41.8% (40.8 users and 44.1% non-users) of ANC with a p-value of 0.212. Dietary energy intake was 1086.82 {+/-} 90.57kcals having RDA of 29.0% (users at 1105.72 {+/-}95.43 and RDA 29.6%, non-users 1070.12{+/-}8.36 with RDA of 28.4%). The Minimum Dietary Diversity (MDD-W) for Women of Reproductive Age 98.4% users was 68.3% of women who utilized antenatal care (ANC) services consumed foods and beverages from 5 or more food groups on the previous day, compared to only 31.7% non-users having a p-value 0.24. Respondent having (MUAC < 22 cm) indicates potential malnutrition or nutritional risk at 31.2% (users at 30.8% and non-users 32.2%) with a p-value 0.534.Overall mean hemoglobin level is 12.35g/dl with a standard deviation of 0.93g/dl having low ranges of < 11.5g/dl (users at 30 and non-users at 12) total of 42 adolescent. These findings underscore the urgent need for targeted interventions at increasing nutrient intake and dietary diversity among pregnant adolescents towards improved nutrition status.

Scientific computing has become a central component of modern scientific discovery. Yet many computational tools are developed by small, specialized teams under incentives that encourage the release of rapidly prototyped tooling without commensurate attention to engineering concerns, including performance and maintainability. These gaps are particularly visible in the life sciences, where the advent of high-throughput sequencing and molecular profiling has made the production and processing of datasets routine at scales that strain reliability and cost. Recently, LLM-based agents have become increasingly capable, with publicly available systems possessing both significant domain knowledge in many scientific fields and the ability to autonomously operate over complex and specialized codebases in pursuit of well-defined goals. Together, these developments create a practical opportunity for scientific computing. Many of the persistent weaknesses of the scientific computing ecosystem stem from technical debt and a shortage of sustained engineering labor and expertise. Here, we examine coding agents as a potential way to address these weaknesses: we present an exploratory field report of eight early case studies in the application of LLM agents to scientific computing across a range of project scopes, from lightweight maintenance tasks to full performance-oriented rewrites of scientific libraries, with a focus on the life sciences. Each of these case studies is accompanied by reflections from the individual or group responsible for the work, including lessons from the process. Overall, we find that the use of coding agents in scientific computing holds great promise for accelerating scientific research and increasing the reliability of critical systems, but that outstanding concerns remain, including responsibility and ownership for such projects, and we suggest collaboration and stewardship with existing maintainers when feasible.

Purpose The direct effect of iStent inject on intraocular pressure (IOP) in patients with glaucoma is difficult to quantify in pragmatic trials where rates of post-surgical IOP-lowering therapy differ between intervention groups. We aimed to quantify the causal effect of iStent inject on unmedicated IOP at 12- and 24-months post-surgery. Methods Adults with mild-to-moderate glaucoma were 1:1 randomised to receive cataract surgery with iStent inject or cataract surgery alone at an Australian hospital (2017-2020, NCT03106181). IOP-lowering medications were prescribed as per clinician discretion. An exploratory analysis was used to estimate the controlled direct effect of iStent inject on IOP, analogous to the effect expected if all participants had undergone medication washout prior to assessment. Results Ninety-five eyes from 80 people were included (67.4% male, mean age 73.0 years, mean baseline IOP 17.1 mmHg). IOP-lowering medication was required for 53% of eyes in each group at 12 months (n=76); at 24 months (n=86) it was required for 43% and 64% in the active and control groups, respectively. Mean IOP was similar between intervention groups at each outcome visit. The controlled direct effect favoured the iStent inject group at 12 months (-2.1-mmHg difference, 95% CI -4.0,-0.3) but was attenuated at 24 months (-0.5 mmHg-difference, 95% CI -2.6,1.6). Conclusion Although the iStent inject was estimated to have an effect on lowering unmedicated IOP at 12 months, this effect had largely disappeared by 24 months. Medication washout is recommended when safe and practical in future trials to estimate these direct effects with more certainty.

Abstract Background and Objective: To investigate the efficacy of a new, proprietary high-resistance potato starch as a prebiotic in comparison to inulin and a control. Methods: In this prospective study, an intervention of 9 g of resistant potato starch (RPS, Potatodaat), inulin, or accessible corn starch was given to participants with mild to moderate indigestion for 30 days. Short chain fatty acid (SCFA) levels, changes to the gut microbiome, and changes in clinical symptoms of indigestion were assessed as primary outcomes. Results: Subjects in the RPS (n = 22), inulin (n = 23), and accessible corn starch (n = 22) groups demonstrated similarity in age, sex, and baseline parameters. At 30 days, the groups experienced 21.1%, 6.29%, and 9.15% increases in stool butyrate, respectively. Clinical symptoms like indigestion and flatulence showed greater improvement with the use of RPS compared to the other two groups. Conclusion: Consumption of high resistance potato starch helps improve stool SCFA levels along with clinical symptoms related to digestion, showing its better prebiotic potential as compared to inulin and accessible corn starch. The new high-resistance potato starch can be considered an effective replacement for inulin.

Introduction: The incidence of postoperative delirium (POD) is high in frail elderly patients who have undergone gastrointestinal surgery, and POD significantly increases the risk of complications and medical burden. Opioid-free anaesthesia (OFA) involves a multimodal analgesic strategy, which may help to reduce the risk of POD. However, relevant studies focusing on frail elderly patients are still limited. This study aims to investigate the effect of OFA on the occurrence of POD in frail elderly patients after gastrointestinal surgery. Methods: This single-centre, prospective, randomized controlled trial (RCT) will be conducted at the First Affiliated Hospital of Shandong First Medical University, China. A total of 44 frail elderly patients aged 65 years or older who plan to undergo elective gastrointestinal surgery (modified frailty index (mFI > 0.27) will be randomly assigned to either the OFA group (receiving dexmedetomidine, esmolol, and ketamine) or the opioid-based anaesthesia (OBA) group. The primary outcome is the incidence of POD within 7 days after surgery or at discharge. Secondary outcome measures include the perioperative stress response, inflammation, intraoperative haemodynamics, postoperative 30-day all-cause mortality, intraoperative haemodynamic changes, 15-item quality of recovery (QoR-15), and postoperative complications during hospitalization. This study focuses on frail elderly individuals (a high-risk population) and aims to investigate the potential benefits of the OFA strategy in reducing the incidence of POD by reducing exposure to opioids through multimodal analgesia. If positive results are obtained in this study, they may provide new evidence for optimizing the perioperative management of such patients. This study is a single-centre, prospective RCT, and the results can provide preliminary evidence for subsequent studies to be performed on a larger scale. Discussion: This study focuses on frail elderly individuals (a high-risk population) and aims to investigate the potential benefits of the OFA strategy in reducing the incidence of POD by reducing exposure to opioids through multimodal analgesia. If positive results are obtained in this study, they may provide new evidence for optimizing the perioperative management of such patients. This study is a single-centre, prospective RCT, and the results can provide preliminary evidence for subsequent studies to be performed on a larger scale. Trial registration: NCT07603596.

Background: An estimated 826 million people have avoidable near vision impairment (NVI) due to lack of access to near vision glasses for presbyopia. Glasses use, uptake and replacement is essential to sustained NVI correction. Here we explore the uptake of second and subsequent pairs of near vision glasses and the willingness to pay. Methods: In this cross-sectional survey, 276 individuals who received near vision glasses through eye health screening programs in Punjab province, Pakistan from 2020 to 2022, were surveyed between February and July 2025, i.e. 3-5 years later. Results: 92.0% (n=254) of respondents were still using near vision glasses: a purchased replacement (41.3%, n=114), a free replacement (30.8%, n=85), or the original pair (19.9%, n=55). Male gender, higher age, and personal income were strongly associated with purchasing additional pairs, while women and those economically dependent on others relied more on free provision (all p values <0.05). Accessibility, indicated by shorter travel times and awareness of supply sources, also played a significant role in sustained replacement. Over 98% of participants expected to obtain (purchase or receive) a new pair of glasses in the future, and over 94% of participants expected to purchase their next pair. The mean willingness-to-pay (WTP) was 353 PKR (95% CI: 327-379) // 1.25 USD (95% CI: 1.16-1.34), while the average reported price paid was 416.67 PKR // 1.47 USD (95% CI: 351.39-481.94)). Conclusion: Sustained use of near vision glasses remained high 3-5 years after initial provision. Many recipients had purchased replacements, and willingness and ability to pay were high among participants, suggesting potential for sustained demand beyond initial subsidized distribution.

Abstract Background: Stroke is a neurological disorder which is defined as the sudden onset of focused or global disruptions in functions of brain caused due to vascular issue which lasts more than 24 hours or sometimes leading to death. Objective: To determine the effects of multimodal balance training with and without auditory cues on balance, gait mobility, risk of fall and quality of life in patients with chronic stroke. Methodology: This randomized controlled trial, conducted at Islam Teaching Hospital and Idrees Hospital Cant. Sialkot, Pakistan, included 21 stroke survivors per group, 42 in total, (aged 45-70, 1-year post-stroke) using non-probability convenient sampling. Group A received multimodal balance training with auditory cues, while Group B received the same training without cues for 12 weeks. Exclusion criteria included respiratory or orthopedic conditions, cognitive disorders (MMSE < 24), aphasia, non-healing ulcers, or osteoporosis. Outcomes (Berg Balance Scale, Time Up and Go Test, Fall Efficacy Scale-International, Stroke Specific Quality of Life Scale) were assessed at baseline, 6 weeks, and 12 weeks. Results: Group A (with auditory cues) showed statistically significant improvements in balance (Berg Balance Scale: median 21 to 47.5, p < .001), gait mobility (Time Up and Go Test: median 26 to 11 seconds, p < .001), fall risk (Fall Efficacy Scale-International: median 61 to 17, p < .001), and quality of life (Stroke Specific Quality of Life Scale: median 91 to 176.5, p < .001) over 12 weeks, outperforming Group B (without auditory cues) in all measures (p < .001 for balance, gait, and fall risk; p = 0.001 and p < .001 for quality of life at 6 and 12 weeks, respectively). Conclusion: Chronic stroke treatments including multimodal balance training with auditory cues have demonstrated significant advantages over a 12-week therapy session. The results demonstrate significant improvements in balance, gait mobility, risk of fall, and quality of life in chronic stroke survivors. Abbreviations: MMBT (Multimodal Balance Training), MMBTwAC (Multimodal Balance Training with Auditory Cues, referring to Group A), RAS (Rhythmic Auditory Stimulation), RCT (Randomized Controlled Trial), MMSE (Mini-Mental State Examination), BBS (Berg Balance Scale), TUG (Time Up and Go Test), FES-I (Fall Efficacy Scale-International), SSQOL (Stroke-Specific Quality of Life Scale), SPSS (Statistical Package for the Social Sciences), SD (Standard Deviation), and MAS (Modified Ashworth Scale). Key words: Multimodal, Balance, Stroke, Gait, Berg Balance Scale (BBS) and Auditory cues.

Objectives: Explore feasibility and acceptability of upskilling a workforce to deliver a co-developed intervention, based on Acceptance and Commitment Therapy (ACT), to support psychological adjustment post-stroke targeting underserved groups. Design: Multi-site, single-arm feasibility study with embedded mixed-methods process evaluation (ISRCTN17628580). Setting: Four NHS community stroke services across England. Participants: 1. Stroke survivors [&ge;]18 years of age, [&ge;]4 months post-stroke, reporting psychological difficulties adjusting to stroke, able to consent and access remote group sessions in English; 2. Group facilitators from NHS stroke services, not ACT specialists. Intervention: WAterS-2: an eight-session, remotely-delivered ACT-informed group intervention. Outcome measures: Recruitment, fidelity, safety, acceptability and perceived value were assessed using fidelity checklists, post-intervention surveys and semi-structured interviews with stroke survivors and facilitators. Clinical outcomes including mood (HADS), wellbeing (ONS4), psychological flexibility (AAQ-ABI), measured post-group and three-months later. Results: Nineteen stroke survivors recruited (mean 9.6 months post-stroke; n=5 (26%) minoritised ethnicities; n=10 (52%) with aphasia). Thirteen facilitators - including two peer support workers - delivered the intervention with fidelity following structured training across four services. Drop-out was low (2/19; 11%); with 15 (79%) attending [&ge;]5/8 sessions. Remote data collection was feasible (79% follow-up completion), with no adverse events recorded. Acceptability was high: survivors valued peer connection, grounding and mindfulness practices. ACT metaphors were helpful for some but challenging for others, including some with aphasia. Online delivery was suitable but limited informal connection. Facilitators reported increased capability, incorporating ACT skills into routine care. NHS workforce pressures and geographically-constrained referral pathways limited recruitment reach. Conclusions: WAterS-2 is feasible, safe, acceptable and inclusive. A mixed workforce, including NHS peer support workers, can be upskilled to deliver with fidelity. Inclusion of underserved groups is achievable but requires active strategies beyond standard NHS referral routes. Findings inform a provisional logic model and a future pragmatic trial.

Abstract Objective: Glaucoma is a chronic disorder that impairs ocular health and may exacerbate ocular surface disease leading to tear film instability, dry eye symptoms and decreased quality of life. This study compared changes in tear quantity among glaucoma subjects living with and without diabetes mellitus, attending an eye clinic in Nigeria. Methods: A comparative cross sectional research design was used. 157 subjects which comprised 74 glaucoma subjects living with diabetes mellitus and 83 glaucoma subjects living without diabetes mellitus participated in the study. Tear quantity assessment included the Schirmer I test and tear meniscus height (TMH) measurement. Descriptive statistics, independent samples t-test and Chi-square test were used to examine the data at 0.05 level of significance. Results: Glaucoma subjects living with diabetes mellitus showed substantially decreased tear production (11.4 +/- 6.8 mm) compared with glaucoma subjects living without diabetes mellitus (19.6 +/- 9.6 mm; p < 0.001). Tear meniscus height in glaucoma subjects living with diabetes mellitus (0.8 +/- 0.3 mm) was significantly greater than in subjects living without diabetes mellitus (0.7 +/- 0.3 mm; p = 0.034). Conclusion: Diabetes mellitus dramatically deteriorates the ocular surface function in glaucoma subjects by decreasing tear production, altering the tear meniscus height and increasing the severity of ocular surface symptoms. Routine glaucoma care, especially in patients with diabetes mellitus, should include a full ocular surface evaluation including Schirmer I test, TBUT, TMH, and OSDI assessment to allow early detection and management of ocular surface disease, better treatment adherence, and improved visual outcomes. Keywords: Glaucoma, Diabetes Mellitus, Tear production, Tear Meniscus Height, Ocular Surface Disease.

Background Given the close anatomical proximity of the eye and its adnexae to the cranium, ocular injury frequently coexists with head trauma. However, specific factors predisposing patients with head injury to ocular involvement in Uganda remain poorly defined. Objective This study aimed to determine the factors associated with ocular injury among patients with head injury at Mulago National Referral Hospital (MNRH), a tertiary referral facility in Kampala, Uganda. Methods We conducted a cross-sectional study among 383 adult patients admitted with head injury to the Accidents and Emergency Department of MNRH from 15/05/2025 to 30/07/2025. All participants underwent a standardized ophthalmic evaluation. Bivariable and multivariable Poisson regression analyses were used to identify factors associated with ocular injury, reported as adjusted prevalence ratios (APR). Results Ocular injury was identified in 268 of 383 patients (70.0%; 95% CI: 65.1-74.5). On multivariable analysis, age 26-44 years (APR 1.18; 95% CI: 1.11-1.43; p=0.013), commercial motorcyclist (boda-boda rider) occupation (APR 1.25; 95% CI: 1.06-1.47; p=0.007), road traffic accident mechanism of injury (APR 1.19; 95% CI: 1.02-1.38; p=0.03), severe head injury (APR 1.70; 95% CI: 1.44-2.01; p<0.0001), and the presence of facial fractures (APR 1.61; 95% CI: 1.44-1.81; p<0.0001) significantly increased the likelihood of ocular injury. Conversely, intracranial hemorrhagic lesions were inversely associated with ocular injury (APR 0.80; 95% CI: 0.68-0.93; p=0.004). Conclusion Ocular injuries are common among patients with head injury. Patients aged 26 to 44 years, commercial motorcyclist occupation, road traffic injury, severe head injury, and facial fractures have a higher risk of ocular injury. We recommend prioritizing ophthalmic evaluation of for patients admitted with head injury to minimize preventable visual impairment.

Background: Epigenetics, the study of reversible changes in gene expression without altering the underlying DNA sequence, is increasingly applied in medical, commercial, and policy contexts. Yet, little is known about how this emerging science is communicated to the public. The purpose of this study was to examine communication strategies, sources, and modalities in epigenetic-related videos on YouTube- the most accessed platform for informal science education. Methods: We conducted a mixed-methods content analysis of 294 YouTube videos on epigenetics by conducting a keyword-based search on October 17, 2023. Video transcripts and meta-data were coded using a codebook developed both deductively and inductively. Qualitative analysis examined how communication strategies were used within videos and identified emergent themes (RQ1). Quantitative analyses examined the frequency of video and channel characteristics (RQ2), and presentation modalities (RQ3). Results: Findings reveal poor alignment with science communication best practices (RQ1): over 92% of videos failed to acknowledge scientific uncertainty, the comprehensibility level exceeded the recommended 8th-grade level (e.g., average readability grade 10.7), and professional research organizations were notably absent. Narrators were mostly male (56.7%) and white-presenting (73.7%) (RQ2). The majority of the videos used multi-modal strategies (e.g., visual texts mixed with animation and voice-over narration) to communicate epigenetic information (RQ3). Conclusion: Findings highlight the need for professional research organizations to be more proactive in public epigenetic communication efforts. Increasing narrator demographic diversity could broaden audience reach. Evidence-based communication tools are needed for health or science communicators discussing epigenetics on social media.

ABSTRACT Background: Post-traumatic elbow stiffness is a recognised complication following orthopaedic trauma surgery, occurring in 10-15% of trauma patients sustaining injuries. Pain remains the primary barrier to physiotherapy compliance, with surgical arthrolysis carrying recurrence rates of up to 34%. The supraclavicular brachial plexus block, referred to as the 'spinal of the arm', provides anaesthesia and analgesia to the entire upper limb below the shoulder. A structured non-surgical approach combining continuous catheter analgesia with timed rehabilitation was identified as an unmet need in this patient group. Methods: A single-centre retrospective observational study was conducted on data of patients treated for post-surgical upper limb stiffness between January 2022 and April 2026. Of 30 patients identified, 28 with elbow involvement formed the primary analysis group following exclusion of 2 patients with isolated wrist stiffness and complex regional pain syndrome. Ultrasound- guided supraclavicular brachial plexus catheters were inserted using the Contiplex system. Patients received 0.5% Bupivacaine (10-15ml) for initial blockade, followed by daily top-up doses of 0.2% Ropivacaine(20ml) given 30 minutes prior to structured physiotherapy and CPM sessions for up to 5 days. The primary outcome was change in arc of elbow motion in degrees, measured by the attending orthopaedic consultant using standard goniometry. Results: Complete pre- and post- intervention data were available for all 28 patients. Mean pre-intervention arc of elbow motion was 39.1{degrees}(SD+/-23.2{degrees}), improving to 104.2{degrees}(SD+/- 30.0{degrees}) post-intervention. Mean improvement was 65.1{degrees}(SD+/- 30.6{degrees} ); 95% CI 53.8{degrees} to 76.4{degrees} ; range 10{degrees}-140{degrees} ; paired t-test t=-11.27, p<0.0001). Mean catheter duration was 5.2 days (SD+/- 1.3). Five patients (17.9%) experienced mechanical catheter complications- 3 dislodgements, 1 kinking and 1 block failure- with no episodes of Local Anaesthetic Systemic toxicity, infection or neurological deficit. Conclusion: Continuous supraclavicular brachial plexus catheter analgesia represents a promising, minimally invasive rehabilitation tool for post-surgical elbow stiffness - achieving statistically and clinically meaningful Range of Motion (ROM) improvement through targeted regional analgesia, without the need for surgical intervention. These findings support prospective evaluation of this protocol as a primary non-surgical rehabilitation strategy.

BACKGROUND: Caudal block is widely employed in pediatric lower abdominal surgeries and adult anorectal surgical by its simplicity of operation, reliable efficacy, and high safety. Previous studies have found that the dose of ropivacaine for Caudal block in adults exhibits gender differences. However, it remains unclear whether such differences in the median effective concentration (EC50) of ropivacaine also exist in the elderly population . METHODS: This is a double-blind, prospective study, We enrolled patients aged 60-80 years with ASA physical status I-? who were scheduled for anorectal surgery under caudal anesthesia, and allocated them to 2 study groups according to their gender. Each participant received a single injection of 20mL ropivacaine. Using Dixons up-and-down sequential allocation, the initial concentration of ropivacaine was set at 0.35% and the subsequent concentrations were determined by the analgesic response of the previous patients to the pinprick testing. The concentration change was 0.025%. The EC50 of ropivacaine in each group was determined using the the up-and-down method and probit regression. The primary outcome was the EC50 (95% confidence interval [CI]) of the 2 groups. Data on the surgical time, analgesic duration, and adverse events during surgery were also recorded. RESULTS: This study included a total of 40 elderly patients (20 male and 20 female). The EC50 of ropivacaine for caudal block in elderly male patients was 0.263% (95% CI: 0.179%-0.311%), while that in elderly female patients was 0.281% (95% CI: 0.161%-0.353%). The EC50 of ropivacaine for caudal block in elderly female patients was approximately 6.4% higher than that in elderly male patients. CONCLUSIONS: There is a significant gender difference in the EC50 of ropivacaine for caudal block among the elderly, with elderly female requiring a higher EC50 than male.

Background: Dietary supplements (DS) are extensively used in Pakistan, frequently in conjunction with prescription medicines. Pharmacists are well positioned for patient counsesling due to their accessibility. However, their ability to provide evidence-based counseling remains uncertain due to their varying knowledge and training, especially in low- and middle-income countries (LMICs), including Pakistan. The study assessed pharmacists' knowledge, attitudes, and practices (KAP) regarding DS counseling and identified gaps requiring intervention. Methods: A cross-sectional study was conducted among 256 registered pharmacists in Lahore, Pakistan. Data were collected using a validated, self-administered questionnaire assessing knowledge, attitudes, and counseling practices concerning dietary supplements over a period of six months i.e., July to December 2025. Statistical analyses were performed using SPSS version 27. A p-value of < 0.05 was considered statistically significant. Results: Mean age was 31.0 {+/-} 6.2 years, with male predominance (56.3%), Doctor of Pharmacy degree (75.0%), community pharmacy practice (62.5%), and 1-5 years of experience (48.4%). Mean knowledge score was 6.18 {+/-} 1.71, with most (76.6%) exhibiting moderate knowledge. Mean attitude score was 7.01 {+/-} 1.94, with 91.4% demonstrating positive attitudes. Mean practice score was 7.91 {+/-} 2.93, with 68% exhibiting good counseling practices. Knowledge scores were significantly higher among female pharmacists (6.96 {+/-} 1.52 vs. 5.57 {+/-} 1.61, p=0.001), urban residents (6.39 {+/-} 1.61 vs. 4.37 {+/-} 1.30, p<0.001), and clinical pharmacists (7.10 {+/-} 1.68, p=0.001). Conclusion: Pharmacists practicing in Lahore, Pakistan demonstrated positive attitudes but moderate knowledge and inconsistent counseling practices. Key gaps were identified in drug-supplement interaction knowledge and counseling practices. These findings underscore the need for organized education, continued training, and regulatory supervision to improve counseling practices of dietary supplements.

Background: DNA methylation is an epigenetic modification that regulates gene expression in response to environmental exposures. We measured differential DNA methylation levels in blood before after general anesthesia and surgery in participants with and without postoperative delirium (POD) and postoperative neurocognitive disorder (PNCD). Methods: Blood sampling, delirium assessment and cognitive testing were prospectively performed at baseline before non-cardiac, non-neurologic surgery, and at 24 hours (24h) and 6 weeks (6wk) thereafter in 94 participants comprising 13 with POD and 81 without POD, and 40 with PNCD and 54 without PNCD 6wk after surgery who were matched for age and sex in the INTUIT and MADCO cohorts. DNA methylation was assessed using the Illumina Infinium MethylationEPIC Beadchip. Results: 132 differentially methylated positions (DMPs) annotated to 198 differentially methylated genes (DMGs) were identified in 94 participants 24h after surgery compared to baseline with a local false discovery rate (LFDR) <0.05 including CHRNB1, LGALS1, SMAD4, RYR2, CHST11, CDC25B, OBSCN, ABHD16A. No DMPs were identified between samples collected at baseline compared to 6wk after surgery. In baseline samples, 8 DMPs annotated to 12 DMGs were identified between participants who did and did not develop POD including MBTD1, BID, PPAN, ANGPTL6, PHF21B, and RBM5. In 24h samples, 87 DMPs annotated to 91 DMGs were identified between participants with and without POD including CLEC19A, FILIP1, ERICH1, PSENEN, SLC6A3, and TMEM196. In 6wk samples, 1 DMP annotated to FILIP1 and LOC124901509 in participants with and without POD. No DMPs in baseline, 24h or 6wk blood samples were identified between patients with and without PNCD at 6k after surgery. Conclusions: Differential DNA methylation levels are present throughout the genome 24h after anesthesia and surgery. Differential DNA methylation levels before surgery and at 24h after surgery distinguishes patients with and without POD. Differential DNA methylation levels were not identified between baseline and 6wk after surgery in the entire cohort, or between patients with and without PNCD at 6 weeks.

Background Perioperative Patient Blood Management (PBM), a patient-centred, evidence-based approach to improve outcomes by preserving and optimising a patient own blood, remains unimplemented in most low- and middle-income countries. Few studies have assessed health-system readiness for PBM implementation, anaemia management, or transfusion practices in sub-Saharan Africa. This study provides a pre-implementation baseline assessment of perioperative PBM readiness in Ethiopia. Materials and Method A mixed-methods approach evaluated 12 public hospitals in Addis Ababa, with the PBM Facility Assessment Tool to determine readiness scores. Data from 1,236 surgical patients assessed anaemia, transfusions, and predictors. Interviews with clinicians, blood bank staff, and policymakers explored decision-making and barriers. Findings were integrated through triangulation. Results The composite PBM-FAT score was 6.6 (SD, 0.7) (range 5.5-7.5); however, this reflects general perioperative and transfusion-service infrastructure rather than PBM-specific capability. Domain analysis revealed critical gaps: 75% of facilities lacked intravenous iron, viscoelastic testing was absent in all, and 66.7% lacked point-of-care haemoglobin testing. Fibrinogen and haematinic tests were rarely available (66-92% never tested). Preoperative anaemia was documented in 7.1% of patients, a minimum estimate reflecting detection failure due to non-systematic haemoglobin testing, and perioperative transfusion occurred in 2.4%, more consistent with supply rationing than with optimised clinical practice. Independent transfusion predictors included cancer surgery (AOR 11.28, 95% CI 3.00-42.36) and blood loss greater or equal to 500 mL (AOR 9.76, 95% CI 3.94-24.17). Interviews revealed blood shortages, the absence of national PBM governance, transfusion as the default treatment for anaemia, and highly variable thresholds. Conclusion Ethiopian hospitals have functional transfusion services but lack the anaemia management pathways, diagnostics, therapeutics, and governance structures required for Patient Blood Management. PBM is not yet operationalised as a patient-centred, preventive care strategy. Priority implementation steps, aligned with the WHO 2024 PBM guidance, include systematic preoperative haemoglobin screening, access to intravenous iron, blood utilisation governance, and a national PBM framework to improve patient outcomes. Keywords: Patient blood management; anaemia; blood transfusion; perioperative care; Ethiopia, health system

Background: Open science (OS) offers opportunities to address challenges in the editorial and peer review processes of traditional, complementary, and integrative medicine (TCIM) journals. This study assessed TCIM journal editors' perceptions of OS and the perceived benefits and challenges of integrating OS into editorial and peer review processes. Methods: A cross-sectional survey was distributed to editors-in-chief, associate editors, and editorial board members of 115 TCIM journals. The survey examined demographics, current use and familiarity with OS, perceived advantages and obstacles, and future perspectives on OS in academic publishing. Quantitative data were analyzed descriptively, and qualitative data were examined using thematic analysis. Results: A total of 267 respondents completed the survey, with most identifying as faculty members or academic research staff (n = 201/335, 60.0%). Most respondents were familiar (n = 128/212, 60.3%) or very familiar (n = 64/212, 30.2%) with OS practices, although many had received no formal OS training (n = 94/210, 44.8%). Respondents were most familiar with open access (n = 131/213, 61.5%) and preprints (n = 92/211, 43.6%). Among the seven OS practices examined, open access was viewed most favorably, with many considering it "very important" (n = 97/206, 47.1%) and strongly agreeing that it enhances the accessibility of research findings (n = 118/195, 60.5%). Conclusion: Most respondents were familiar with OS but held varying perceptions regarding the importance, advantages, and disadvantages of different OS practices. These findings may inform the development and implementation of evidence-based practices and policies that meet the needs of the TCIM research community.