Anna Kasperczuk

Variability in motor evoked potential (MEP) alarm thresholds limits interpretation of intraoperative monitoring during intradural extramedullary (IDEM) tumor surgery. We aimed to compare predefined MEP thresholds for predicting postoperative neurological decline. PubMed, Embase, and Cochrane were searched from inception to 9 November 2025 for studies evaluating MEP accuracy in predicting postoperative motor deficits. Studies assessing MEP within multimodal intraoperative neurophysiological monitoring (mIONM) for predicting neurological deficits were also analyzed. MEP thresholds and diagnostic contingency data were extracted. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUROC) were calculated for complete MEP amplitude loss and 50%-, 70%-, and 80%-level MEP amplitude decline categories. AUROC confidence intervals and p-values were obtained using study-level bootstrap resampling when feasible. Sixteen studies were included. In separate-threshold MEP analyses, 50%-level, 70%-level, and complete MEP amplitude loss criteria significantly predicted short-term motor deficits, whereas 50%- and 70%-level thresholds significantly predicted long-term motor deficits. The 50%-level threshold showed the most favorable short-term profile, with 94.1% sensitivity and 98.4% specificity. In sensitivity analysis, the pooled 70%/80%-level high-threshold group also showed significant diagnostic performance for short- and long-term motor deficit prediction. Within mIONM, the 50%-level threshold showed the most favorable point estimates, although formal testing was unavailable for short-term performance. Significant mIONM diagnostic performance was shown for complete MEP amplitude loss in short-term evaluation and for the 50%-level threshold in long-term evaluation. The 50%-level MEP amplitude decline threshold showed the most favorable profile for short-term motor deficit prediction in MEP-based analyses and favorable estimates within mIONM. Higher thresholds retained diagnostic utility. These findings should be interpreted cautiously because of differences in sample size, tumor location, histology, and outcome reporting between threshold groups.

The role of intraoperative neurophysiological monitoring (IONM) in intradural extramedullary (IDEM) tumor surgery remains unestablished. Therefore, the purpose of this study was to systematically review and meta-analyze the recent literature on the accuracy of IONM in the resection of IDEM tumors. The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane databases were searched for English-language papers published from inception until February 19, 2025. The study was found eligible if it reported the complete data on the accuracy of motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), D-wave monitoring, or multimodal IONM (mIONM – defined as a combination of more than one of the abovementioned modalities) in patients with IDEM tumors. Each modality’s accuracy was evaluated using the Hierarchical Summary Receiver Operating Characteristic (HSROC) curve for predicting short-term (immediate postoperative) and long-term postoperative deficits (minimum of 3 months after discharge). From a total of 3220 papers, 16 studies met the eligibility criteria. Additionally, one study was found based on references analysis, resulting in the inclusion of 17 papers. MEPs significantly predicted the occurrence of both short-term (AUROC = 0.72; p < 0.0001) and long-term (AUROC = 0.91; p = 0.006) new motor deficits. Conversely, D-wave failed to accurately predict motor deficits (AUROC = 0.83; p = 0.1094, and AUROC = 0 in the short- and long-term observation, respectively). Similarly, SSEPs showed low accuracy in predicting short-term (AUROC = 0.55; p = 0.7461) and long-term (AUROC = 0.53; p = 0.3953) sensory deficits. Conversely, mIONM was found to accurately predict short-term (AUROC = 0.75; p = 0.001) and long-term (AUROC = 0.70; p = 0.005) new neurological deficits. MEPs and mIONM constitute the sole modalities that can accurately predict motor and neurological deficits, respectively. Contrarily, the low sensitivity of SSEPs for predicting sensory deficits underlines its efficacy in IDEM tumor surgery. Although D-wave did not achieve satisfactory accuracy, its application seems reasonable to prevent permanent motor deficits.

In recent years, machine learning (ML) has been increasingly used in many fields, including medicine. Magnetic resonance imaging (MRI) is a non-invasive and effective diagnostic technique; however, manual image analysis is time-consuming and prone to human variability. In response, ML models have been developed to support MRI analysis, particularly in segmentation and classification tasks. This work presents an updated narrative review of ML applications in brain MRI, with a focus on tumor classification and segmentation. A literature search was conducted in PubMed and Scopus databases and Mendeley Catalog (MC)—a publicly accessible bibliographic catalog linked to Elsevier’s Scopus indexing system—covering the period from January 2020 to April 2025. The included studies focused on patients with primary or secondary brain neoplasms and applied machine learning techniques to MRI data for classification or segmentation purposes. Only original research articles written in English and reporting model validation were considered. Studies using animal models, non-imaging data, lacking proper validation, or without accessible full texts (e.g., abstract-only records or publications unavailable through institutional access) were excluded. In total, 108 studies met all inclusion criteria and were analyzed qualitatively. In general, models based on convolutional neural networks (CNNs) were found to dominate current research due to their ability to extract spatial features directly from imaging data. Reported classification accuracies ranged from 95% to 99%, while Dice coefficients for segmentation tasks varied between 0.83 and 0.94. Hybrid architectures (e.g., CNN-SVM, CNN-LSTM) achieved strong results in both classification and segmentation tasks, with accuracies above 95% and Dice scores around 0.90. Transformer-based models, such as the Swin Transformer, reached the highest performance, up to 99.9%. Despite high reported accuracy, challenges remain regarding overfitting, generalization to real-world clinical data, and lack of standardized evaluation protocols. Transfer learning and data augmentation were frequently applied to mitigate limited data availability, while radiomics-based models introduced new avenues for personalized diagnostics. ML has demonstrated substantial potential in enhancing brain MRI analysis and supporting clinical decision-making. Nevertheless, further progress requires rigorous clinical validation, methodological standardization, and comparative benchmarking to bridge the gap between research settings and practical deployment.

Background/Aims: The effectiveness of nafamostat for treating acute pancreatitis (AP) remains questionable. It was hypothesized that the administration of lidocaine would increase the penetration of nafamostat into the pancreas and improve its efficacy. This study evaluated the efficacy of combined management with nafamostat and lidocaine in the treatment of AP. Materials and Methods: Mild edematous AP was induced with cerulein in Wistar rats, which were distributed among 3 interventional cohorts: (1) a lidocaine cohort, with a regional intraarterial infusion of 1% lidocaine solution, (2) a lidocaine nafamostat group, with a regional intraarterial infusion of 1% lidocaine solution followed by the infusion of nafamostat mesylate, and (3) an NaCl group, with a regional intraarterial infusion of 0.9% sodium chloride solution. Following 4, 8, and 12 hours after drug administration, serum amylase and lipase levels were tested. Rats were euthanized, and the pancreas was removed for histopathological examination. Results: A total of 16 rats were analyzed: 6 in the lidocaine group, 5 in the lidocaine–nafamostat group, and 5 in the NaCl group. Post treatment amylase and lipase levels were comparable between the groups. The NaCl group had more prevalent signs of chronic inflam mation in the pancreatic tissue and adipose tissue than both the lidocaine and lidocaine–nafamostat groups. Conclusion: The addition of nafamostat mesylate did not show superiority over lidocaine alone in the treatment of AP. Considering the prolonged observation period and self-healing tendency of mild edematous AP, both lidocaine and nafamostat do not impact treatment outcomes. However, both drugs may reduce the inflammatory and necrotic processes triggered by AP. Cite this article as: Antkowiak R, Antkowiak Ł, Arent Z, et al. Regional arterial infusion of nafamostat mesylate and lidocaine in the treatment of cerulein-induced acute pancreatitis in rats. Turk J Gastroenterol. Published online September 10, 2025. doi:10.5152/ tjg.2025.24493.

Occupational stress is a critical human factor that affects efficiency, safety, and the continuity of operational processes, particularly in high-risk professions such as uniformed services. The aim of this study was to develop and validate an interpretable decision support system (DSS) for the early pre-screening of employees exhibiting symptoms of post-traumatic stress disorder (PTSD). To this end, the J48 decision tree algorithm was applied to extract classification rules based on psychological symptoms defined in the DSM-5. The performance of the J48 model was compared with Support Vector Machine and Random Forest algorithms. Among the evaluated models, J48 demonstrated the highest overall effectiveness, achieving top results across all key metrics, including an F1-score of 0.976 and a ROC Area of 0.987. The generated classification rules ensure model transparency and interpretability – features essential for practical implementation in organizational occupational health procedures. The proposed tool contributes to the field of human factors engineering by offering a practical solution for managing mental health risks, ultimately supporting improved safety and operational performance in organizational settings.

Introduction: Since the voice is uniquely tied to gender identity, it constitutes a considerable factor in the transition process of transgender individuals. Aim: We aimed to analyze the long-term durability of Wendler glottoplasty (WG) acoustic outcomes in transgender women and juxtapose the objective results with voice-related quality of life (QoL) assessment and gender perception in telephone communication. Methods: We retrospectively reviewed the records of 7 transgender women who underwent WG, self-assessed their voice-related QoL, and participated in the telephone test. Long-term results were compared with data acquired preoperatively and at short-term follow-up, as well as with the age-matched control group of 7 cisgender males and 7 cisgender females. The speech samples of transfeminine individuals and cisgender controls were judged by 64 cisgender listeners. Results: After an average of 18.63 months, a persistent, significant increase in fundamental frequency, speaking fundamental frequency, and lower limit of the frequency range of spoken voice was observed, with the values being comparable to cisgender female controls. Despite a significant long-term improvement in the emotional domain of the Voice Handicap Index, the remaining voice-related QoL scores deteriorated compared to the short-term evaluation. The gender of transfeminine individuals was significantly more often incorrectly attributed compared to cisgender controls. The percentage of voice ratings as a female was not correlated with the acoustic measures, self-assessed vocal femininity, and satisfaction with WG results. Conclusions: Despite the long-term durability of acoustic changes after WG, the gradual reduction of the initially improved voice-related QoL suggests the need for multidisciplinary management. The acoustic measures cannot guarantee voice attribution as female by external evaluators, indicating the beneficial role of perceptual assessment in analyzing WG outcomes.

This study aimed to determine the efficacy of low molecular weight heparin (LMWH) and lidocaine combined with LMWH for improving the course of acute pancreatitis (AP). A total of 30 rats were divided into three groups: the NaCl group, which received an intraarterial infusion of 0.9% sodium chloride; the Heparin group, which received a subcutaneous injection of LMWH; and the Lidocaine–Heparin group, which received an intraarterial infusion of 1% lidocaine, with subsequent subcutaneous injection of LMWH. AP was triggered using 80 μg/kg body weight of cerulein. Serum amylase and lipase levels were evaluated before induction of AP (measurement 0 – M0), after triggering AP (measurement 1 – M1), 1 h (measurement 2 – M2), 3 h (measurement 3 – M3), and 5 h (measurement 4 – M4) after treatment. After euthanasia, pancreatic tissues were collected for pathological analysis. No intergroup differences in serum amylase and lipase levels were observed between the NaCl and Heparin groups in all post-treatment evaluation points (M2, M3, and M4). Conversely, the Lidocaine–Heparin group showed significantly lower amylase values than the NaCl and Heparin groups in all post-treatment evaluation points. Furthermore, the Lidocaine–Heparin group showed significantly lower lipase values compared with the NaCl group in the first post-treatment evaluation point (M2), as well as compared with the Heparin group in the first (M2) and second (M3) post-treatment evaluation points. No significant intergroup differences were observed in pathological pancreatic tissue evaluation. Subcutaneous injection of LMWH did not impact the natural course of AP. However, the addition of intraarterially administered 1% lidocaine solution significantly reduced the severity of AP.

Purpose: This paper examines the role of employee motivation in effective business management. It also explores the impact of financial and non-financial motivators on employee engagement. Design/methodology/approach: The research used a quantitative methodology and an online survey of 102 individuals. Statistical analyses, including variance analysis and correlation analysis, were conducted to identify significant patterns and differences in motivation levels. Findings: Financial motivators, particularly bonuses for achieving targets, were identified as the most effective. Non-financial motivators, such as flexible work schedules and additional days off, also showed high effectiveness in enhancing motivation. Significant differences in motivation levels were observed by gender, age, and length of service. Research limitations/implications: The study is limited to a specific demographic and geographic scope. Future research could explore diverse cultural and occupational contexts. Practical implications: Combining financial and non-financial motivators can effectively increase employee satisfaction and engagement. Social implications: Fostering effective motivation practices contributes to stronger family company relationships. Companies adopting such strategies set benchmarks for the best workplace. Originality/value: This study provides insights into the balance of financial and non-financial motivators in shaping employee motivation. It offers actionable recommendations for HR managers and organisational leaders.

INPLASY2024110020 Factors influencing the intensity of parathyroid gland autofluorescence in near-infrared autofluorescence devices: a systematic review and meta-analysis Keywords: Parathyroid glan…

Neuromuscular blocking agents are a crucial pharmacological element of general anesthesia. Decades of observations and scientific studies have resulted in the identification of many risks associated with the uncontrolled use of neuromuscular blocking agents during general anesthesia or an incomplete reversal of neuromuscular blockade in the postoperative period. Residual relaxation and acute postoperative respiratory depression are the most serious consequences. Cyclic recommendations have been developed by anesthesiology societies from many European countries as well as from the United States and New Zealand. The newest recommendations from the American Society of Anesthesiologists and the European Society of Anesthesiology were published in 2023. These publications contain very detailed recommendations for monitoring the dosage of skeletal muscle relaxants in the different stages of anesthesia—induction, maintenance and recovery, and the postoperative period. Additionally, there are recommendations for various special situations (for example, rapid sequence induction) and patient populations (for example, those with organ failure, obesity, etc.). The guidelines also refer to pharmacological drugs for reversing the neuromuscular transmission blockade. Despite the development of several editions of recommendations for monitoring neuromuscular blockade, observational and survey data indicate that their practical implementation is very limited. The aim of this review was to present the professional, technical, and technological factors that limit the implementation of these recommendations in order to improve the implementation of the guidelines and increase the quality of anesthesiological procedures and perioperative safety.