AimThis study aimed to evaluate and quantify the mechanical offloading methodological robustness of RCTs cited in the 2023 IWGDF interventions to enhance healing recommendations.MethodsA meta-research audit was conducted on 43 RCTs referenced in IWGDF guideline. A predefined framework assessed study characteristics, offloading system, adherence and activity monitoring, protocol implementation and symmetry, and mechanical offloading confounding risks. Trials were evaluated using a 10-point Offloading Quality Score (OQS), scale. Descriptive analyses and exploratory statistical tests) were performed.ResultsThe mean OQS was 2.07 (SD ± 2.83), with a median of 0 (IQR 0-4). Twenty-seven trials (62.79%) scored ≤2/10, while only three (7%) achieved scores ≥8/10. Offloading strategies were insufficiently described in 81.4% of studies, and adherence monitoring was absent in 88.4% of trials. Non-removable offloading devices were used in 7% of studies and were positively associated with higher OQS in regression analysis (β = 0.82, p < 0.001).ConclusionsMost RCTs underpinning the 2023 IWGDF recommendations demonstrate limited reporting and standardization of mechanical offloading. This may introduce unmeasured variability in mechanical exposure and could affect the interpretation of treatment effects. Future trials should standardize offloading protocols to improve internal validity and DFU research interpretation.

Swallowing and speech impairments are common in Parkinson's disease (PD) and can significantly affect health and quality of life. Traditional methods for assessing and managing these functions rely on in-person visits and large, expensive equipment, which are inaccessible to many patients. Recent advances in health technologies offer opportunities for remote monitoring and assessment, enabling early detection, personalized intervention, and longitudinal tracking of swallowing and speech deficits in PD. This review synthesizes evidence on current and emerging technologies designed to remotely capture key elements of swallowing and speech in patients with PD. We present studies that develop and use wearable uni- and multi-modal sensor-based approaches, biofeedback devices, acoustic analysis through smartphones, and haptic cueing aimed at improving aspects of swallowing and speech. Additionally, we examine the integration of artificial intelligence for automated signal processing and predictive modeling, emphasizing validation studies and clinical feasibility. Challenges related to usability, data quality, adherence, data security, and standardization are discussed alongside opportunities for telehealth-driven care models. By identifying technological innovations and evidence gaps, this review provides a roadmap for future research and clinical implementation of remote swallowing and speech assessment in PD. These advancements have the potential to transform care, reduce healthcare burden, and improve patient outcomes through scalable, non-invasive, and patient-centered solutions for the management of dysphagia and dysarthria in PD.

Infection with Helicobacter pylori is the major risk factor for gastric cancer worldwide; yet the exact mechanisms behind this link remain unclear. H. pylori-associated tissue changes often disrupt the gastric microbiome, enabling secondary gastric colonization by oral bacteria. Among these secondary colonizers, Fusobacterium species have documented associations with several gastrointestinal cancers. We found that both F. animalis and F. nucleatum invade cultured human gastric adenocarcinoma cells, but F. animalis exhibited higher adherence and invasion, and hypoxic conditions promoted higher bacterial survival. Both adherence and invasion were inhibited by exogenous GalNAc, a glycan commonly observed in membrane glycoproteins of adenocarcinoma cells and a target of the fusobacterial adhesin Fap2. Using a mouse model of stomach metaplasia, we found that F. animalis colonized gastric tissue only after metaplasia onset, growing in multispecies biofilms in the mucus layer, while F. nucleatum colonized neither healthy nor metaplastic gastric tissue. Metaplasia led to upregulation of Gal-GalNAc in the stomach, and reduced gastric acidity allowed higher F. animalis loads in this model. By contrast, inflammation and the presence of H. pylori did not significantly influence stomach colonization by F. animalis. Further assessment of additional Fusobacterium species and strains revealed that whereas all tested species can invade gastric cancer cells in vitro, only F. animalis and F. polymorphum robustly colonize the metaplastic gastric tissue of the mouse model similar to F. animalis. Overall, our data support a model in which H. pylori-induced metaplasia makes the stomach susceptible to secondary infection by other cancer-associated microbes, including some Fusobacterium species.IMPORTANCEHelicobacter pylori infection is the primary risk factor for gastric cancer worldwide, yet the underlying cancer-promoting mechanisms are not fully defined. Our study shows that metaplasia, a precancerous condition typically triggered by H. pylori and characterized by specific changes in gene expression and tissue remodeling, can enable secondary infection by other cancer-associated bacteria. Specifically, we found that certain species of the genus Fusobacterium, linked to several gastrointestinal cancers, colonize the stomach only after the onset of metaplasia. Metaplasia-associated changes in the stomach include altered surface sugars and reduced acidity, which together may create a more permissive environment for bacterial growth. Our findings support a model in which disruptions of gastric tissue architecture induced by chronic H. pylori infection facilitate colonization by other cancer-related bacteria, contributing to the growing body of evidence highlighting the role of bacteria in cancer development.

IntroductionHeat exchanger (HE) integrity is vital for patient safety during cardiopulmonary bypass (CPB), as failures can lead to severe complications including haemolysis and toxemia. While manufacturers mandate pre-use integrity testing, adherence and methods vary significantly. This study aimed to identify current practices across Australia and New Zealand and assess the mechanical efficacy of manufacturers recommended testing protocols.MethodsA telephone survey was conducted of the most senior perfusionist available at all 80 cardiac surgical hospitals in Australia and New Zealand regarding HE testing customs and known failures. Simultaneously, an in vitro assessment measured the pressures generated by two common heater cooler units (HCUs)- the 3T and HCU40, in conjunction with oxygenator and cardioplegia HEs to evaluate the generated pressures during usage.ResultsNine unverified historical HE failure events were recalled by surveyed senior perfusionists across the region. While 100% of programs were successfully surveyed, only 49% complete perfusion teams consistently perform pre-clinical integrity testing. Of those that test, the most common method (82%) is running water through the HE, as per manufacturers instructions. However, in vitro data revealed that while the HCU40 maintains positive pressure, the 3T HCU generates negative pressure at the HE outlet during use. This negative pressure gradient creates a theoretical risk of masking defects near the outlet during a standard 'water-run' test, as a positive pressure gradient is not uniformly maintained across the HE. Such an occurrence would render the manufacturers "water-run" test insufficient for detecting defects near the outlet.ConclusionCurrent HE testing practices are non-uniform and often limited by logistical barriers. Reliance on fluid-based testing is hemodynamically flawed in certain HCU configurations. To enhance adherence and safety, manufacturers should validate gas pressure testing for end users, and perfusion departments should adopt standardised, positive-pressure testing protocols and documented emergency failure algorithms.

Background Coronary artery bypass grafting (CABG) triggers inflammatory and catabolic responses, increasing the risk of postoperative nutritional deficits. Whey protein isolate (WPI) may improve recovery and muscle strength. This study evaluated the impact of early postoperative WPI-based supplementation on nutritional outcomes among CABG patients. Methodology This open-label, single-arm, prospective real-world study enrolled 200 adult patients undergoing CABG at two tertiary care centres in India. Patients received a WPI-based oral nutritional supplement starting 24-48 hours post-surgery and continued for 30 days post-discharge. Outcomes included protein and calorie adequacy, nutritional status, change in weight, hand-grip strength, safety, and patient and physician experiences with the WPI-based nutritional supplement. Data were analysed using appropriate parametric and nonparametric tests. Results Of the 200 patients enrolled, 182 (91.0%) completed the study. They were included in the intent-to-treat (ITT) group, while 119 (59.5%) adhered to the protocol, completed the 30-day follow-up visit, and were included in the per-protocol (PP) group. Compared with the day of supplement initiation (Visit 1), the proportion of patients achieving calorie and protein adequacy at the end of the study (EOS) increased significantly (calorie adequacy: ITT (n = 34, 18.7%) vs. (n = 143, 81.3%); PP (n = 3, 2.5%) vs. (n = 105, 88.2%); protein adequacy: ITT (n = 41, 22.5%) vs. (n = 140, 76.9%); PP (n = 5, 5.0%) vs. (n = 99, 83.2%); all P < 0.001). An increase in weight was observed in both groups (P < 0.05), with a greater proportion of patients experiencing weight gain in the PP group (n = 60, 50.0%) than in the ITT group (n = 55, 30.0%) at EOS. Hand-grip strength (HGS) also improved from the day of discharge (Visit 3) to EOS (HGS weak: ITT (n = 130, 71.4%) vs. (n = 71, 39.0%) (P < 0.001); PP (n = 85, 71.4%) vs. (n = 38, 31.9%) (P < 0.001); HGS normal: ITT (n = 43, 23.6%) vs. (n = 85, 46.7%) (P < 0.001); PP (n = 31, 26.1%) vs. (n = 65, 54.6%) (P < 0.001); HGS strong: ITT (n = 9, 5.0%) vs. (n = 26, 14.3%) (P < 0.05); PP (n = 3, 2.5%) vs. (n = 16, 13.5%) (P < 0.05)). No related safety events were recorded. Conclusions Early WPI-based oral supplementation initiated within 48 hours post-CABG and continued for 30 days increases protein and calorie adequacy, nutritional outcomes, supported weight gain, and supported muscle strength recovery without safety concerns. These findings support incorporating early protein supplementation into postoperative care protocols.

The carotid region represents critical neurovascular spaces of the anterolateral neck, where a precise three-dimensional understanding of vascular, neural, and fascial relationships is essential for safe cervical surgery. This article describes a standardized, step-by-step cadaveric dissection protocol linking consistent anatomical landmarks to their surgical relevance. Unilateral dissections were performed on a formalin-preserved adult human cadaver using standard gross anatomical techniques. Specimens were dissected from superficial to deep layers according to a six-step sequence based on classical anatomical methodology, The protocol outlines: surface landmark identification; subplatysmal dissection and sternocleidomastoid muscle mobilization; exposure of the internal jugular vein and Farabeuf's triangle; management of venous tributaries and carotid sheath opening; carotid bifurcation exposure; and mapping of adjacent neural structures including the hypoglossal and vagus nerves, ansa cervicalis, and carotid body. This standardized cadaveric framework provides a structured approach to mastering the complex three-dimensional anatomy of the carotid region, serving as a practical educational reference for vascular, head and neck, and cervical spine surgery.