Background: Mental disorders in terms of depression, anxiety, and stress are one of the major causes of burden globally. Over the last two decades, the use of plant-based substances in the treatment of mental disorders in combination or not with medication has increasingly attracted the interest of the scientific research community. However, even if there is a plethora of naturally occurring bioactive compounds, most of them have low bioavailability, rendering them unable to insert into the bloodstream to exert their biological activities. Methods: This is a comprehensive narrative review that critically summarizes and scrutinizes the new approaches to the treatment of mental disorders using curcumin, also highlighting its bioavailability properties. The most accurate were searched using effective and relevant keywords. Results: This narrative review reveals substantial evidence that curcumin can exert significant effects on several mental disorders. However, despite the low cost, the extensive and confirmed potency of curcumin and its involvement in signaling pathways and the scientifically confirmed data regarding its molecular mechanisms of action against mental disorders, this naturally occurring compound presents low oral bioavailability. Pharmaceutical technology has provided solutions to increase the bioavailability of curcumin. Combination with piperine, galactomannosides, liposomal formulation or nanoformulation overcomes the bioavailability and solubility disadvantages. Conclusions: Although curcumin demonstrates anti-anxiety, anti-depressive and anti-stress properties, studies on humans are limited and heterogeneous. Further research is highly recommended to determine the most functional formula, dose, duration, and possible side effects of curcumin on mental disorders in humans. Based on the current knowledge, the curcumin nanoformulation and Theracurmin, a form of colloidal submicroscopic particles, seem to be the most effective bioavailable formulations, which may be examined in future clinical human studies.

To apply different methods of diagnostic test accuracy network meta-analysis (DTA-NMA) in studies reporting results of five imaging tests for the diagnosis of suspected pulmonary embolism (PE): pulmonary angiography (PA), computed tomography angiography (CTPA), magnetic resonance angiography (MRA), planar ventilation/perfusion (V/Q) scintigraphy and single photon emission computed tomography ventilation/perfusion (SPECT V/Q). We searched four databases MEDLINE (via PubMed), Cochrane Central, Scopus and Epistemonikos from inception until June 2^nd, 2022 to identify systematic reviews (SRs) describing diagnostic accuracy of PA, CTPA, MRA, V/Q Scan and SPECT V/Q for suspected PE. Study-level data were extracted from them and pooled using one hierarchical meta-regression approach (HSROC) and two DTA-NMA models to compare accuracy estimates of different imaging tests. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We identified 13 SRs, synthesizing data from 33 primary studies and for 4 imaging tests (PA, CTPA, MRA and V/Q Scan). HSROC meta-regression model using PA as reference standard showed that MRA had the best overall diagnostic performance with sensitivity=0.93 (95% confidence interval (CI): 0.76, 1.00) and specificity=0.94 (95% CI: 0.84, 0.99). However, NMA-DTA models indicated that V/Q scan had the highest sensitivity while CTPA was most specific. Selecting a different DTA-NMA method to assess multiple diagnostic tests can potentially affect the estimates of diagnostic accuracy. There is no established method, but the choice depends on the data and familiarity with Bayesian setting.

Pyogenic flexor tenosynovitis is a severe infection of the upper limb. While early mild cases may be treated conservatively, surgical intervention remains the standard of care for more advanced presentations. Closed irrigation techniques, typically performed using angiocatheters, are increasingly preferred over open approaches. We present a simple and widely accessible modification of an angiocatheter intended to facilitate multidirectional irrigation during closed catheter washout. This report does not evaluate irrigation efficiency, and any potential advantages remain theoretical. In addition, we compile available references on instruments and modifications intended to improve irrigation efficiency. This modification is feasible but unvalidated, and any theoretical benefits regarding fluid distribution or irrigation efficiency remain speculative. Furthermore, this report consolidated multiple previously described modifications into a single reference source. Our modification is low-cost, reproducible, and easily performed using commonly available tools. While it may offer a practical option during surgery, its clinical, mechanical, and fluid-dynamic performance has not been evaluated. Further research is required to assess safety, efficacy, and optimal design parameters.