Neck rescue encompasses a variety of techniques and terms used to describe direct access to the trachea to allow delivery of oxygen into the airway, typically in the context of a 'can't intubate, can't oxygenate' (CICO) scenario. Anaesthetists rely on CICO simulation exercises to obtain competency in neck rescue using commercially available plastic airway models. Recently, innovations in three-dimensional (3D)-printed airway models and 'symbiotic culture of bacteria and yeast' (SCOBY) skins have been trialled for CICO training. We undertook a study to compare the fidelity of a 3D-printed airway model and SCOBY skin model with a commercially available plastic and foam model (Crico-Trainer 'Frova', VBM-Medizintechnik GmbH, Sulz am Neckar, Germany) trialled by 27 volunteer anaesthesia specialists and trainees. Study participants performed neck rescue on all model variants and provided structured feedback. The 3D-printed model with SCOBY skin was found to have the highest fidelity for neck rescue training and was the model preferred by most participants. Model fidelity, environmental impact, and ethical considerations were rated as important or very important by participants. Further studies are needed to confirm these findings in other hospital settings.

BACKGROUND: Migraine burden is over twice as high among females than males. Although sex differences are recognized in migraine, robust sex-specific guidance for management remains limited. OBJECTIVE: To systematically review and synthesize current evidence on sex-related clinical differences in migraine, including treatment outcomes and reproductive management, and to provide evidence-based or expert consensus recommendations where high-quality data are lacking. METHODS: A systematic literature review using the PICO framework addressed 24 sex-specific questions across three domains: (1) biological sex differences across the lifespan, (2) sex-specific variations in treatment outcomes, and (3) fertility and reproduction-related management. To address anticipated evidence gaps, a structured Delphi consensus process complemented the review. The protocol was registered in PROSPERO (CRD420251058438). RESULTS: Thirty-seven studies informed 10 evidence summaries. Acute and preventive anti-CGRP therapies seem to show similar efficacy between sexes. For menstrual-related migraine attacks (MM), triptans and lasmiditan are effective, with frovatriptan being recommended for short-term prevention; long-term prevention include topiramate and anti-CGRP mAbs. In pregnancy triptans, greater occipital nerve (GON) blocks, and onabotulinumtoxinA are safe, with GON blocks showing potential efficacy. During breastfeeding, triptans appear to be safe. Anti-CGRP mAbs are equally effective in pre and postmenopausal women. Expert consensus emphasizes the influence of hormonal transitions on migraine expression across sexes and supports the use of acetaminophen, antiemetics, magnesium, NSAIDs, steroids, beta-blockers, amitriptyline, and calcium channel blockers as generally safe in WOCBP and during pregnancy, although some agents have trimester-specific limitations. Efficacy was noted for acetaminophen, sumatriptan, antiemetics, magnesium, propranolol, amitriptyline, and onabotulinumtoxinA. During breastfeeding, acetaminophen, NSAIDs, domperidone, prochlorperazine, magnesium, caffeine, beta-blockers, tricyclics, onabotulinumtoxinA, and GON blocks were considered safe. CONCLUSIONS: Evidence is limited, but sex (likely mediated by sex hormones) influence the clinical course of migraine, and likely treatment response. Limitations include absence of sex-specific analyses in older trials, underrepresentation of men, and scarce reproductive safety data. Integrating sex-based analyses and broadening trial inclusion and more reproductive safety evidence are essential for personalized, equitable migraine care.

Tetrahydrocarbazole (THCz) is a privileged scaffold validated by clinically approved drugs such as ondansetron, frovatriptan, and ramatroban and exhibits diverse bioactivities including antimicrobial, antitumor, antidiabetic, and neuroprotective effects. Despite extensive structure-activity relationship (SAR) studies, a systematic integration of findings across different therapeutic targets has been lacking. This review provides a comprehensive SAR dissection of THCz derivatives across key targets (bacterial sliding clamp, BTK, HDAC, AMPK, etc.), analyzing how modifications at key positions of the core scaffold (N-9, C-1, and C-6) influence potency and selectivity. Notably, we highlight four emerging design paradigms: pharmacophore hybridization, conformational constraint, cross-target SAR decoding, and precision intervention. By consolidating fragmented knowledge into a practical cross-target SAR matrix, this review offers a strategic framework for the rational design of next-generation THCz-based therapeutics.

The US experiences significant excess mortality compared to peer countries. The literature indicates that a similar disadvantage affects morbidity and, more generally, the prevalence of risk factors for major diseases within the US population. In this study, we assess the impact of multi-morbidity at death on the mortality gap between the US and three other high-income countries with comparable data, namely France, Italy, and Spain. The study relies on an analysis of the multiple cause-of-death information available on all death certificates for 2017, used to classify morbid processes leading to death into three categories: simple, multi-morbid, and ill-defined. The results show disproportionately high rates of multi-morbid processes in the US compared with the other three countries. Multi-morbid processes contribute 51% of the US gap in life expectancy at birth with Italy, 73% with Spain, and 75% with France, with a particular concentration at ages 20-85 years. The prevalence of multi-morbid processes in the US is consistent with the hypothesis that multiple factors, rather than a single culprit, are at play in the disadvantage in mortality and it could explain, at least in part, the extraordinarily high cost of health care in this country.

The Frova Intubating Introducer is widely used in airway management, although it carries risks such as barotrauma and airway injury, especially when over-inserted (>26cm) or used for oxygen delivery (>2 L/min). We report a case of a 70-year-old woman with a substernal goiter and chronic obstructive pulmonary disease who developed bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema after open thyroidectomy and extubation over a Frova catheter. Emergent reintubation and chest drainage were required. Although a tracheal tear was suspected, it was not confirmed. The patient recovered fully with conservative treatment. Our report highlights the need for caution when using airway exchange catheters in patients with challenging anatomical airways and close post-extubation monitoring.

There is no published experience with frovatriptan during breastfeeding. If frovatriptan is required by the mother of an older infant, it is not a reason to discontinue breastfeeding, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.[1]