جراحی عمومی
مقالهها، منابع و پژوهشهای تازه حوزه جراحی عمومی
ورود به زیرشاخهنقشه موضوعی
جستوجوی دقیقجراحی
حوزههای جراحی، بیهوشی و مراقبتهای پیرامون عمل
زیرشاخهها
برای رسیدن به فهرست متمرکزتر، یک مسیر تخصصی را انتخاب کنید.
ارتوپدی
مقالهها، منابع و پژوهشهای تازه حوزه ارتوپدی
ورود به زیرشاخهجراحی مغز و اعصاب
مقالهها، منابع و پژوهشهای تازه حوزه جراحی مغز و اعصاب
ورود به زیرشاخهجراحی قلب و قفسه سینه
مقالهها، منابع و پژوهشهای تازه حوزه جراحی قلب و قفسه سینه
ورود به زیرشاخهجراحی عروق
مقالهها، منابع و پژوهشهای تازه حوزه جراحی عروق
ورود به زیرشاخهاورولوژی
مقالهها، منابع و پژوهشهای تازه حوزه اورولوژی
ورود به زیرشاخهجراحی پلاستیک و ترمیمی
مقالهها، منابع و پژوهشهای تازه حوزه جراحی پلاستیک و ترمیمی
ورود به زیرشاخهپیوند اعضا
مقالهها، منابع و پژوهشهای تازه حوزه پیوند اعضا
ورود به زیرشاخهبیهوشی
مقالهها، منابع و پژوهشهای تازه حوزه بیهوشی
ورود به زیرشاخهمراقبتهای ویژه
مقالهها، منابع و پژوهشهای تازه حوزه مراقبتهای ویژه
ورود به زیرشاخهطب درد
مقالهها، منابع و پژوهشهای تازه حوزه طب درد
ورود به زیرشاخهتازهترین رکوردها
شواهد جراحی
PubMed2027
A New Combined Technique for Neophallus Elongation and Girth Enhancement for Metoidioplasty (Barroso Procedure): Total Corpora Mobilization with Martius Flap.
PURPOSE: Metoidioplasty is used in transmasculine gender-affirming surgery; however, limited neophallus length and girth remain significant challenges (1-4). We describe a combined technique using Total Corpora Mobilization (TCM) for elongation and a Martius flap for girth enhancement (5-9). MATERIALS AND METHODS: Fifteen transgender men underwent first-stage metoidioplasty with TCM and Martius flap between 2023 and 2026. The vestibular plate and urethra were mobilized, followed by circumferential clitoral degloving and suspensory ligament division. A pubic periosteal incision was made, and subperiosteal dissection was performed using bipolar cautery while preserving a portion of the periosteum attached to the corpora cavernosa. The urethra was further mobilized and the triangular ligament was divided, followed by lateral dissection of both corpora cavernosa and complete release from the crura. An oral mucosa graft was used to create the urethral plate. The preserved periosteum was fixed to the dorsal tunica albuginea, and a vascularized Martius flap harvested from the labia majora was secured over the corpora for girth augmentation. Scrotal flaps provided wound coverage. RESULTS: The index patient achieved a neophallus length of 6.4 cm, representing a 1.9 cm gain over the preoperative stretched clitoral length. Median length gain was 3.7 cm, and mean circumference increase was 1.6 cm. Glans perfusion and tactile sensitivity were preserved in all patients, with no vascular or sensory complications recorded. CONCLUSIONS: Combined TCM and Martius flap metoidioplasty is feasible and reproducible. By achieving corporal release beyond previously described techniques, TCM may meaningfully enhance neophallus projection while preserving perfusion and sensation. Larger cohorts and longer follow-up are required to confirm the durability and functional outcomes of this approach.
PubMed2027
Extraperitoneal Single-Port Robotic-Assisted Radical Cystectomy with Orthotopic Ne-obladder: Technique and Surgical Considerations.
INTRODUCTION: Radical cystectomy (RC) is the standard therapy for muscle-invasive bladder cancer (MIBC) and refractory high-risk non-muscle-invasive bladder cancer (1-3). Single-port robot-assisted radical cystectomy (RARC) offers notable minimally invasive advantages (4-6), whereas conventional transperitoneal approaches are associated with intestinal and gastrointestinal complications (7). This study evaluated an optimized extraperitoneal single-port RARC with orthotopic neobladder reconstruction for improved surgical safety and clinical outcomes. MATERIALS AND METHODS: A 57-year-old male presented with three months of intermittent painless gross hematuria. Pelvic CT revealed a bladder mass. Preoperative biopsy confirmed high-grade urothelial carcinoma with muscularis propria invasion, and the patient received gemcitabine-cisplatin neoadjuvant chemotherapy before radical surgery. Preoperative MRI identified a 3.2×2.9×2.6 cm bladder lesion without extravesical invasion or lymphadenopathy. During the procedure, the patient was placed in a supine position with buttocks elevated. A 5-cm infraumbilical single incision was made for da Vinci Xi-assisted extraperitoneal RARC, and a single-port multichannel device was deployed through the incision. Robotic instruments including a 30° endoscope, monopolar scissors, bipolar forceps, and a robotic stapler were arranged in a chopstick configuration. Via the extraperitoneal approach, we mobilized the bilateral ureters, bilateral vas deferens, and umbilical artery, dissected the bladder lateral ligaments with vascular ligation, and established a sufficient extraperitoneal working space. Bladder and prostate dissection was performed along the perivesical avascular plane, with careful protection and precise hemostasis of the dorsal venous complex. Standard pelvic lymphadenectomy was concurrently conducted during radical resection of the bladder and prostate (8). A segment of ileum was then harvested to construct an orthotopic neobladder (9), followed by anastomosis with the bilateral ureters and urethral stump. RESULTS: Operative time was 400 minutes with 200 mL blood loss and no transfusion. No perioperative complications occurred, and the patient was discharged on postoperative day 6. Pathological diagnosis was pT2aN0M0 with negative surgical margins and negative lymph nodes. The 12-month follow-up showed no tumor recurrence, normal renal function, complete daytime continence, and mild nocturnal incontinence requiring one nightly pad. CONCLUSIONS: Extraperitoneal single-port RARC with orthotopic neobladder reconstruction is a feasible minimally invasive procedure for MIBC. The optimized infraumbilical single-incision technique preserves peritoneal integrity and avoids intestinal mobilization, effectively reducing abdominal complications. It achieves reliable oncological results and improves patients' postoperative continence and quality of life.
PubMed2027
Revisiting the anatomy of the retroperitoneum and renal fascia. Aspects applied to ra-diology, laparoscopic and robotic surgery - a narrative review.
This review aims to provide a comprehensive analysis of the anatomy of the retroperitoneal and abdominal fascias. We analyzed papers published in the past 70 years in the databases of Pubmed, Embase and Scielo. We excluded case reports, editorials and opinions of specialists. Studies were excluded if they lacked clear anatomical descriptions of the fascias, if full-text access was unavailable, or if they were published in languages other than Portuguese, English, or Spanish. This narrative review addresses the anatomical integration, surgical techniques, and functional importance of the fascias. Renal fascia is a dense connective tissue encasing kidney, perirenal fat, adrenal gland; composed of anterior (Gerota's) and posterior (Zuckerkandl-related/renal) layers that fuse laterally and superiorly. Toldt fascia is a plane formed where the mesocolon (ascending or descending) fuses to the posterior parietal peritoneum / posterior abdominal wall. The lateroconal fascia is a lateral continuation of the renal fascia where anterior and posterior renal layers fuse to form a sheet toward the lateral abdominal wall and Fredet's fascia is a fusion plane between the visceral peritoneum of the hepatic flexure/transverse mesocolon and the anterior surface of the duodenum/pancreatic head (anterior to pancreatic head/duodenum) with a critical landmark in right colectomy.
PubMed2027
Robot-Assisted Partial Nephrectomy in a High-Complexity Renal Tumor in a Horseshoe Kidney.
INTRODUCTION: Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION: A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION: In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
PubMed2026
[The Legal Regulation of Refusal of Medical Organizations and Physicians From Giving Service of Interruption of Pregnancy (Abortion) to Women in Countries of World Community].
The problem of availability of abortion services for women in countries of world community is not only not losing its importance, but is undergoing new stage of actualization, since it has no clear understanding and is often raised in the context of solving demographic problems of aging society. At the same time, analysis reveals vulnerability of position of those using religious context in womans self-determination regarding disposal of her own body and right to refuse compulsion to terminate her pregnancy by physiological childbirth without her psychological, social and economic readiness and public support. Referring to various testimonies and sources, we appeal to necessity of working out common criteria to ensure womens access to medical care related to procedure of abortion in order to reduce mortality from diseases associated with self-abortions menacing live and health of women. The issues considered in the study may affect various spheres of social, medical and legal field and have wide area of practical implementation. The purpose of the study is to identify causes and to establish consequences of womens limited access to abortion services, as well as legal and ethical aspects of overcoming these restrictions.
PubMed2026
Anti-inflammatory agents after hip and shoulder arthroplasty: A systematic review and meta-analysis.
BACKGROUND: Postoperative inflammation after arthroplasty contributes to pain, delayed mobilization and prolonged hospitalization. Recent randomized trials have evaluated pharmacological anti-inflammatory strategies within contemporary enhanced recovery pathways, but evidence after hip and shoulder arthroplasty remains scattered across different drug classes and perioperative regimens. OBJECTIVES: To synthesize recent randomized controlled trial (RCT) evidence on perioperative anti-inflammatory agents after hip and shoulder arthroplasty. METHODS: PubMed, Embase, Cochrane Library and Web of Science were searched for English-language RCTs published from January 2020 to March 2026. The 2020-2026 window was selected to update evidence generated under modern arthroplasty, anesthesia, multimodal analgesia and enhanced recovery after surgery (ERAS) pathways. Eligible trials included adults undergoing hip or shoulder arthroplasty and compared corticosteroids, cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal anti-inflammatory drug (NSAID)-based/local anti-inflammatory regimens, or related anti-inflammatory interventions with placebo, saline, no treatment, or the same regimen without the target component. Weighted mean differences (WMDs) were pooled using random-effects models. RESULTS: Nine RCTs involving 800 patients were included. Anti-inflammatory interventions significantly reduced postoperative C-reactive protein (CRP) [WMD=-32.18, 95% confidence interval (CI) (-41.16, -23.21), P<0.001], interleukin-6 (IL-6) [WMD=-31.25, 95% CI (-41.79, -20.77), P<0.001], rest pain [WMD=-0.41, 95% CI (-0.58, -0.23), P<0.001], activity pain [WMD=-0.56, 95% CI (-0.83, -0.29), P<0.001] and hospital stay [WMD=-0.54, 95% CI (-0.92, -0.15), P=0.006]. CONCLUSION: Recent RCT evidence suggests that perioperative anti-inflammatory interventions can attenuate early inflammatory responses and improve short-term pain and recovery after hip and shoulder arthroplasty. Because data were limited and clinically heterogeneous, the findings should not be interpreted as evidence favoring a specific drug class, dose, route, or timing.
PubMed2026
ATI-2341 TFA promotes acquisition of epithelial-like immunophenotype in bone marrow mesenchymal stem cells and alleviates intrauterine adhesion in a rat model.
BACKGROUND: Intrauterine adhesion (IUA) is a common complication of endometrial injury. Bone marrow mesenchymal stem cells (BMSCs) have been implicated in endometrial repair, but strategies to enhance their therapeutic efficacy remain to be optimized. The C-X-C chemokine receptor type 4 (CXCR4)/C-X-C motif chemokine ligand 12 (CXCL12) axis plays a pivotal role in BMSC homing. OBJECTIVE: This study aimed to test the hypothesis that ATI-2341, a functionally selective allosteric regulator of CXCR4, enhances the therapeutic efficacy of BMSCs in a rat IUA model. METHODS: After establishing the endometrial injury model, rat BMSCs were extracted and treated with ATI-2341 TFA (100 ng/mL). IUA model rats were randomly divided into model control group, BMSCs group, BMSCs+ATI-2341 TFA group, BMSCs+PBS group and Positive control group (n=10 each). Endometrial thickness was assessed by hematoxylin and eosin (HE) staining; cell proliferation by the methyl thiazolyl tetrazolium (MTT) assay; matrix metalloproteinase-9 (MMP-9)/tissue inhibitor of metalloproteinase-1 (TIMP-1) protein expression by Western blot; and cytokeratin and vimentin expression by immunohistochemistry. RESULTS: ATI-2341 TFA-pre-treated BMSCs significantly increased endometrial thickness compared to untreated BMSCs (P < 0.05) or estrogen (P < 0.05). ATI-2341 TFA enhanced BMSC proliferation at 48 h (P < 0.05) and 72 h (P < 0.05). BMSCs exposed to ATI-2341 TFA or estrogen exhibited strong cytokeratin positivity and vimentin negativity. MMP-9 was downregulated (P < 0.05) and TIMP-1 upregulated (P < 0.05) in the ATI-2341 TFA group relative to controls. CONCLUSION: ATI-2341 TFA promotes acquisition of epithelial-like immunophenotype in BMSCs within the injured endometrial microenvironment and is associated with improved endometrial morphology in IUA rats. These findings provide preliminary evidence for the functional modulation of BMSCs by CXCR4-targeted therapy in endometrial repair.
PubMed2026
Concordance of Microbiological and Histopathological Examination of Bone Biopsies in Diagnosing Diabetic Foot Osteomyelitis, a Systematic Review.
BACKGROUND: Diabetic foot osteomyelitis (DFO) is a serious complication of diabetic foot ulcers and is associated with increased risk of amputation, morbidity, and mortality. Bone biopsy remains the most definitive diagnostic modality, yet controversy persists over its diagnostic utility This study reviews the diagnostic concordance of histopathology and microbiology in bone biopsy specimens from patients with DFO and examines the clinical implications of the findings. METHODS: A systematic review was conducted using PubMed, Medline, CINHAL, Cochrane Library, and Google Scholar. Studies included adult patients with DFO in whom bone biopsy specimens underwent both histopathological and microbiological analysis. Five core studies met the eligibility criteria. Data on study design, setting, population, diagnostic methods, concordance rates, and outcomes were extracted and synthesized utilising a quantitative narrative synthesis. RESULTS: Across the five studies (n = 308 patients), histopathology and microbiology showed modest concordance, with mean rates of concordant positive results of 43.4% and common discordant findings. Histopathology demonstrated higher specificity, while microbiology had higher sensitivity, ranging from 70% to 83.9% but greater susceptibility to contamination. Positive histopathology was more strongly associated with the need for revision surgery or extended antibiotic therapy. DISCUSSION: Histopathology appears to offer superior diagnostic specificity, whereas microbiology provides valuable information for antimicrobial management. Frequent discordance underscores the importance of interpreting results in a clinical context. Further robust, prospective studies are needed to clarify the optimal diagnostic approach and standardise definitions.
PubMed2026
Corrigendum to: Bone marrow mesenchymal stem cells relieve rheumatoid arthritis by blocking JAK/STAT and TLR-4/NF-?B pathways.
The authors have informed the Pakistan Journal of Pharmaceutical Sciences (PJPS) of an error in Figure 5 of the published article. During the editorial revision process, an incorrect version of Figure 5 was inadvertently included in the final published version. The authors have confirmed that the extreme-right panel (panel D) should be removed and that the remaining panels constitute the corrected Figure 5. Accordingly, Figure 5 is corrected by removing panel D. No other part of the figure is modified. The caption of Figure 5 remains unchanged, and no other figures or content of the article require modification. This corrigendum records the correction to the published version of the article. The correction is limited to the removal of panel D from Figure 5.
PubMed2026
Intravenous lidocaine reduces the propofol EC50 for loss of consciousness and intraoperative anesthetic consumption in gynecological laparoscopy: A randomized controlled trial.
BACKGROUND: Intravenous lidocaine reduces propofol requirements and procedure-related adverse events. OBJECTIVES: The study aimed to test whether intravenous lidocaine would reduce the effect-site concentration of propofol required to achieve loss of consciousness and decrease propofol consumption during total intravenous anesthesia in gynecological laparoscopy. METHODS: This was a prospective, randomized, double-blind, placebo-controlled trial. Sixty patients were randomly allocated to receive either intravenous lidocaine (1.5 mg·kg-¹ bolus) followed by continuous infusion or an equal volume of saline. Propofol was administered via target-controlled infusion starting at an effect-site concentration of 3.5 μg/mL. The concentration was then adjusted in steps of 0.5 μg/mLaccording to Dixon's up-and-down sequential method: decreased if loss of consciousness was achieved, or increased if not. Loss of consciousness was defined as loss of response to verbal commands. The median effective concentration (EC50) of propofol for inducing loss of consciousness was calculated using the Dixon's up-and-down method. General anesthesia was maintained with propofol and remifentanil, guided by state entropy (target 40-60) and surgical pleth index (target 20-50). Drug consumption was normalized to anesthesia duration and body weight. RESULTS: The estimated EC50 of propofol for inducing loss of consciousness was significantly lower in the lidocaine group than in the saline group (3.32 μg/mL, 95% Confidence Interval (CI): 3.04-3.59 vs. 3.89 μg/mL, 95% CI: 3.50-4.28). Under the study protocol, the lidocaine group also required less propofol (8.62 mg·kg-1·h-1, 95% CI: 8.10-9.15 vs. 9.89 mg·kg-1·h-1, 95% CI: 9.05-10.73) and less remifentanil (0.23 μg·kg-1·min-1, 95% CI: 0.21-0.24 vs. 0.27 μg·kg-1·min-1, 95% CI: 0.24-0.30) compared with the saline group. CONCLUSION: Intravenous lidocaine reduced the propofol EC50 for Loss of Consciousness (LOC) and decreased intraoperative propofol and remifentanil consumptions in patients undergoing gynecological laparoscopy. These findings suggest a propofol- and opioid-sparing effect of intravenous lidocaine in this setting, although confirmation in larger multicenter trials is needed.
PubMed2026
Near-Peer Anatomy-Anchored Teaching.
BACKGROUND: The transition from pre-clinical to clinical medicine is challenging, particularly in applying anatomical knowledge to patient care. Reductions in dedicated anatomy teaching time have compounded this. Near-peer teaching may help address this gap by reducing hierarchy and enhancing psychological safety, though few programmes have explicitly targeted the pre-clinical to clinical transition through the integration of anatomy with clinical cases. APPROACH: A prospective educational evaluation examined a near-peer, case-based orthopaedic anatomy programme delivered to Year 4 medical students by Year 5 facilitators across four sessions. Knowledge acquisition was assessed using parallel pre- and post-session multiple-choice question (MCQ) sets compared using Wilcoxon signed-rank test and Cohen's dz. Student experience was evaluated using purpose-designed questionnaires. EVALUATION: Thirty-two matched pairs were available for analysis. Baseline anatomical confidence (mean 2.76/5) and ratings of placement-based anatomy teaching (mean 2.26/5) indicated clear unmet need. MCQ scores improved significantly from 5.0 to 7.0 out of 8 (mean 5.00 vs. 6.69, p < 0.001, Cohen's dz = 1.12). Post-session confidence improved to 4.03/5, facilitators were rated highly (mean 4.59/5), and 97% of students felt comfortable engaging with peer facilitators. IMPLICATIONS: This programme provides preliminary support for near-peer, case-based anatomy teaching as a promising approach to supporting the pre-clinical to clinical transition, demonstrating short-term improvements in MCQ performance, confidence and student satisfaction.
PubMed2026
Opioid Use and Family Members' Experiences of Opioids in Paediatric Cancer Pain Management: An Integrative Review.
AIM: To analyse the use of opioids in children with cancer and the experiences of their family members regarding opioids used in pain management to improve family nursing. DESIGN: An integrative review. METHODS: A systematic literature search was carried out in four databases (CINAHL, MEDLINE, PsycInfo and Scopus) in August 2023, and was subsequently updated to include studies up to the end of 2024. Sixteen peer-reviewed research articles met the inclusion criteria and were included in a quality appraisal and analysis. RESULTS: Of the wide range of opioids used to treat pain in children with cancer, morphine and fentanyl stood out as the most used. The prevalent routes of opioid administration was intravenous and enteral. Limited research has been conducted on the experiences of family members of children with cancer in the context of opioids used for pain management. Furthermore, there is a scarcity of studies that describe the experiences of siblings from the same perspective. Parental experiences were particularly described as concerns about and a desire to refuse opioid use, although satisfaction with opioid use was also described. CONCLUSIONS: Opioids are particularly significant in managing pain among children with cancer. Therefore, the use of opioids in this patient group should be comprehensively studied, and healthcare professionals should receive sufficient training. The experiences of parents conclude that they require sufficient information and guidance on the management of their children's severe pain and the analgesics used to treat it. The notable lack of research regarding the experiences of siblings in connection with the use of opioids for the management of a child's pain addresses the need for further research from these perspectives. More research on experiences during the different phases of cancer treatment is needed. Further research employing qualitative methods will be essential for enhancing family nursing.
PubMed2026
Prevalence of Hallux Valgus in Patients With Femoral Neck Fracture and Its Association With Postoperative Functional Outcomes.
BACKGROUND: Hallux valgus is a frequent forefoot deformity in older adults and has been linked to impaired balance, gait dysfunction, and increased fall risk. However, its prevalence among patients with femoral neck fracture and its association with postoperative functional outcomes remain unclear. METHODS: This single-center retrospective study included 235 patients aged ≥ 65 years with available radiographic data who underwent surgery for femoral neck fracture between 2022 and 2024. Hallux valgus was defined on weight-bearing radiographs as a hallux valgus angle (HVA) ≥ 20°. Functional outcomes were evaluated using the Functional Independence Measure (FIM) at 3 months postoperatively. Multivariable linear regression analysis was performed to determine whether hallux valgus was independently associated with motor FIM scores after adjustment for age, sex, surgical procedure, and cognitive function. RESULTS: Among the 235 patients with radiographic data, 178 (76%) were women, with a median age of 85 (77-90) years; 86% of patients underwent bipolar hemiarthroplasty. Hallux valgus was present in 55% (130/235), including 20% (47/235) with moderate-to-severe deformity (HVA ≥ 30°). Patients with hallux valgus had significantly lower motor FIM scores at 3 months than those without the deformity (p = 0.044), whereas cognitive and total FIM scores did not differ. In multivariable analysis, hallux valgus (HVA ≥ 20°) was independently associated with lower motor FIM scores (B = -5.92, 95% CI -10.95 to -0.89; p = 0.021). CONCLUSIONS: Hallux valgus is highly prevalent in patients with femoral neck fracture and is independently associated with lower postoperative motor function. Assessment of hallux valgus may provide additional insight into postoperative functional prognosis in this population.
PubMed2026
Therapeutic efficacy of naloxone hydrochloride combined with hemoperfusion in toxic acute renal failure via the oxidative stress/Nrf2 pathway.
BACKGROUND: Toxic acute renal failure (ARF) involves severe oxidative stress. The Nrf2 pathway is a key antioxidant defense mechanism. OBJECTIVES: To investigate whether naloxone combined with hemoperfusion alleviates oxidative injury via Nrf2 activation in toxic ARF. METHODS: In this single-center retrospective cohort study at Qiqihar Medical University Hospital, 67 patients were enrolled through medical record screening. The control group (n=39) received hemoperfusion alone; the observation group (n=28) received additional intravenous naloxone (0.8 mg bolus + 2.0 mg/24 h infusion for 7 days). Renal function and oxidative markers were assessed before treatment, at 24 h and day 7. Multivariate regression analysis was used to adjust for confounding factors. Separately, 30 rats were randomized into control, model and treatment groups (n=10 each). The treatment group received intraperitoneal naloxone (1.0 mg/kg) plus simulated hemoperfusion. RESULTS: After adjusting for baseline imbalances, combined therapy was independently associated with significant reductions in Scr and BUN in patients (adjusted β = -8.52, 95% CI: -12.37 to -4.67, P < 0.001) and with significant improvements in renal function and histopathology in rats. Combined therapy decreased tubular injury markers (β2-MG, KIM-1, NGAL, L-FABP) in rats. Mechanistically, it was associated with activation of the Nrf2/HO-1/NQO1 pathway, enhanced SOD activity and reduced MDA levels. Improvements were time-dependent (24 h to day 7). CONCLUSIONS: Naloxone combined with hemoperfusion activates the Nrf2 pathway, attenuates oxidative stress and improves renal function in toxic acute renal failure.
PubMed2026
Ultrasound-guided high-voltage vs conventional pulsed radiofrequency in elderly cervical radiculopathy: A randomized controlled trial.
BACKGROUND: Elderly patients with cervical radiculopathy present therapeutic challenges owing to comorbidities and medication-related risks. Long-term pharmacotherapy and surgical interventions are often suboptimal, necessitating evaluation of optimized pulsed radiofrequency strategies under image guidance. OBJECTIVES: This superiority trial compared the efficacy and safety of ultrasound-guided cervical nerve root high-voltage pulsed radiofrequency (HVP-PRF) versus conventional pulsed radiofrequency (C-PRF) for pain management in elderly patients with cervical radiculopathy. METHODS: This single-center, parallel-group, assessor-blinded randomized controlled trial enrolled patients aged 60-85 years with cervical radiculopathy, randomly assigned (1:1) to HVP-PRF (70 V) or C-PRF (45 V). Procedures were performed under ultrasound guidance with sensory/motor stimulation confirmation and temperature ≤42°C. The primary outcome was change in upper-limb radiating pain on the Numeric Rating Scale (ΔNRS) from baseline to 3 months. Secondary outcomes included Neck Disability Index (NDI), neck pain NRS, Patient Global Impression of Change, responder rates, rescue analgesia use, and adverse events. Follow-up occurred at 1 week, 1, and 3 months. RESULTS: A total of 104 patients were randomized and 101 received treatment. At 3 months, HVP-PRF demonstrated significantly greater radiating pain improvement versus C-PRF (adjusted mean difference 1.24, 95% CI 0.46-2.02, P=0.002). Functional improvement (NDI) was superior in the HVP-PRF group at 3 months (AMD 6.47, 95% CI 2.11-10.83, P=0.004). Responder rates (≥50% pain reduction) were higher with HVP-PRF at 3 months (68.75% vs. 42.22%, OR 3.01, P=0.011) and 6 months (65.22% vs. 43.18%, OR 2.52, P=0.035). Rescue analgesic use was lower in the HVP-PRF group during 1-3 months intervals (both P<0.05). Adverse event rates were comparable (27.45% vs. 32.00%). CONCLUSION: Under ultrasound visualization and electrical stimulation-based target confirmation with temperature control ≤42°C, HVP-PRF provided greater and more durable relief of upper limb radiating pain compared with C-PRF in elderly patients with cervical radiculopathy, with a comparable safety profile.
PubMed2026
Better to Be Lucky Than Good: How Clinicians and Patients Frame Medical Outcomes.
Notions of good or bad luck sit uncomfortably in contemporary medical practice defined by efforts to control life through biomedical knowledge and skilled expertise. Yet, talk about luck is common in healthcare to explain medical courses of action. Framing medical results as fortunate or unfortunate bridges the gap between predicted probabilities and variation in individual cases without undermining scientific neutrality. Luck mediates between the rational ideal of biomedical determinism that does not easily account for variable health outcomes and the magical invocation of faith or fate that denotes a moral judgement. Drawing from ethnographic studies of heart transplantation and fertility medicine, we find that luck is employed as an anticipatory frame to guide decision-making in medicine and as a retroactive frame to justify unlikely outcomes. Invoking luck primes patients for the possibility of a favourable outcome and inserts a positive bias in medical care. The analysis underlines how luck frames in healthcare can shift attention away from structural reasons for disparate outcomes, attempt to absolve healthcare providers of blame from medical errors and promote continuing treatment. These findings indicate that focusing on when healthcare providers and patients invoke luck reveals the scope and limits of medical power and control.
PubMed2026
Bone marrow mesenchymal stem cells relieve rheumatoid arthritis by blocking JAK/STAT and TLR-4/NF-κB pathways.
BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by synovial inflammation and joint destruction. Bone marrow mesenchymal stem cells (BMSCs) have shown therapeutic potential in RA, but the underlying mechanisms remain poorly understood. OBJECTIVES: To investigate the effects of BMSCs on human RA fibroblast-like synovial MH7A cells and complete Freund's adjuvant (CFA)-induced arthritis in rats and to explore the involvement of the JAK/STAT and TLR-4/NF-κB signaling pathways. METHODS: BMSCs were isolated and co-cultured with MH7A cells. CFA-induced arthritis rat models were established. MH7A cell viability, inflammatory cytokine levels, paw withdrawal thermal latency (PWTL), gait parameters and the expression of JAK/STAT and TLR-4/NF-κB pathway-related genes and proteins were assessed. RESULTS: In-vitro, BMSC co-culture significantly inhibited MH7A cell viability and reduced TNF-α, IL-6 and IL-8 levels. BMSC treatment also downregulated the expression of JAK2, p-JAK2, STAT3, p-STAT3, TLR4, P65 and p-P65 in MH7A cells. In-vivo, BMSC administration improved PWTL and gait parameters, reduced serum inflammatory cytokine levels and suppressed the expression of JAK/STAT and TLR-4/NF-κB pathway components in synovial tissues of CFA-induced arthritic rats. CONCLUSION: BMSCs alleviate RA by inhibiting inflammatory responses in vitro and in vivo and the underlying mechanism may involve blockade of the JAK/STAT and TLR-4/NF-κB signaling pathways.
PubMed2026
Comparison of Pain and Quality-of-Life Outcomes Following Bipolar Versus Monopolar Pulsed Radiofrequency Treatment for Chronic Lumbosacral Radicular Pain: An Observational Study.
OBJECTIVE: Pulsed radiofrequency of the dorsal root ganglion (DRG) is an established treatment for chronic lumbosacral radicular pain, yet comparative evidence on monopolar versus bipolar configurations, particularly regarding quality-of-life outcomes, remains limited. This study aims to compare the analgesic and quality-of-life effects of bipolar versus monopolar pulsed radiofrequency of the lumbosacral DRG. METHODS: We conducted a mixed retrospective and prospective observational review of 143 patients with chronic radicular pain due to lumbosacral disc herniation who underwent DRG pulsed radiofrequency in 2022 and 2023. Patients received either bipolar (n = 79) or monopolar pulsed radiofrequency (n = 64). Pain intensity was recorded using the Numeric Rating Scale at baseline and at 1st, 2nd, and 6th month post-procedure. Quality of life was assessed with Short Form-36 (SF-36) at baseline and 6 months. Any potential complications were recorded to evaluate the safety of procedures. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. All patients exhibited significant reductions in pain scores over time (p < 0.001). However, bipolar pulsed radiofrequency produced significantly greater pain relief at all follow-up points, with mean pain scores at 6 months of 2.32 versus 4.78 in the monopolar group (p < 0.001). At 6 months, bipolar pulsed radiofrequency also resulted in significantly higher SF-36 scores across all eight domains and in total score (583.61 vs. 425.29, p < 0.001). DISCUSSION: Bipolar pulsed radiofrequency of the lumbosacral DRG was associated with greater improvements in pain and quality of life compared with the monopolar modality in patients with chronic lumbosacral radicular pain. These show the potential of bipolar PRF to enhance clinical and functional outcomes in this population.
PubMed2026
Comparison of the Validity and Reliability of Five Pressure Injury Risk Scales in Intensive Care.
BACKGROUND: The lack of consensus on the best pressure injury (PI) risk assessment tools demonstrates the need for further comparative research to identify the most effective options for intensive care unit (ICU) populations. AIM: This study compared the predictive validity and reliability of five PI risk assessment tools in adult ICU patients. STUDY DESIGN: A prospective cohort study was conducted with patients aged ≥ 18 years, admitted to the ICUs for at least 24 h and without pre-existing PI. Five tools (Braden Scale, CALCULATE, Cubbin & Jackson, EVARUCI and Sunderland) were used daily to assess PI risk until either a PI developed or the participant was discharged, died or completed 21 days in the ICUs. The main outcome measures included area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, relative risk and reliability. RESULTS: Of the 150 participants, 40 (26.7%) developed PIs. None of the five tools demonstrated good predictive accuracy. AUC values ranged from 0.605 to 0.692 across the five tools, with none exceeding the predefined threshold of 0.70. Participants classified as high risk by Sunderland, Cubbin & Jackson and EVARUCI had a 3.0, 2.5 and 2.1 times higher risk, respectively, of developing a PI. Cubbin & Jackson was the only tool to achieve acceptable reliability values in Cronbach's alpha, intraclass correlation coefficient (ICC) and Cohen's weighted kappa. CONCLUSIONS: High-risk classification using the Sunderland, Cubbin & Jackson and EVARUCI scales was more strongly associated with subsequent PI development than classification using the other tools. Reliability findings varied across parameters, with Cubbin & Jackson being the only tool to meet acceptable thresholds across all assessed reliability measures. RELEVANCE TO CLINICAL PRACTICE: PI assessment in ICU patients should integrate validated tools with clinical judgement to address patient-specific and device-related risk factors.
PubMed2026
Concurrent Long Thoracic and Lateral Cutaneous Intercostal Nerve Entrapment After Chest Tube Thoracostomy Causing Scapular Winging and Chest Wall Pain: Diagnosis With Ultrasound and Treatment With Hydrodissection.
BACKGROUND: Chest tube thoracostomy may cause iatrogenic nerve injury, resulting in persistent pain and functional impairment. Long thoracic nerve (LTN) palsy after chest tube placement has been described, but concurrent involvement of the LTN and the lateral cutaneous branch of an intercostal nerve (LCIN) appears to be rarely reported. We describe a patient with persistent post-thoracostomy chest wall pain and scapular winging in whom musculoskeletal ultrasonography identified entrapment of both nerves. CASE PRESENTATION: A 43-year-old man presented with severe left shoulder and chest wall pain 6 months after chest tube placement for traumatic hemopneumothorax. Examination demonstrated focal tenderness, dysesthesia, and mechanical allodynia at the chest tube scar, along with medial/inferior scapular winging during serratus anterior provocative testing. Shoulder range of motion was full on examination; however, forward flexion beyond 15° markedly aggravated pain, resulting in pain-related reluctance to move the shoulder. Manual muscle testing was 4+/5 before treatment because pain limited force generation. Musculoskeletal ultrasound demonstrated focal abnormality of the LTN where it pierced the axillary fascia over the sixth rib, with loss of fascicular definition and reduced glide, and tethering/thickening of the LCIN within scar tissue at the prior tube insertion site. Symptom reproduction with sonopalpation supported the clinical relevance of both findings. INTERVENTION AND RESULTS: Ultrasound-guided hydrodissection using 5% dextrose in water was performed around both nerves. A total of approximately 40 mL of 5% dextrose in water was used, with 20 mL administered per nerve. Immediately after the first procedure, pain improved from NRS 9/10 to 2/10, with marked reduction in pain during shoulder movement, including forward flexion. The patient subsequently underwent 5 treatment sessions at 2-week intervals over 10 weeks. During follow-up, manual muscle testing improved to 5/5 without pain, scapular winging was no longer evident on provocative testing, and the Shoulder Pain and Disability Index improved from pain/disability scores of 25/15 to 6/4. At the sixth follow-up visit, pain and function were satisfactory, and the patient elected continued monitoring without further intervention. At 1-year follow-up, treatment efficacy remained sustained without recurrence. CONCLUSION: In patients with persistent shoulder or chest wall pain after chest tube thoracostomy, iatrogenic peripheral nerve entrapment should be considered. This case highlights the value of a focused neuromuscular examination and musculoskeletal ultrasound for identifying concurrent motor and sensory nerve involvement and suggests that ultrasound-guided hydrodissection may be a useful minimally invasive treatment. Because electrodiagnostic studies were not performed, the findings are most consistent with entrapment/neurapraxia with dynamic tethering rather than electrodiagnostically proven axonal palsy.
PubMed2026
Cross-Sectional Survey of Critical Care Provision in Ministry of Health Hospitals in Zambia.
BACKGROUND: Critical care is an essential component of universal health care; however, its provision in low- and middle-income countries remains poorly understood. Although Zambia has expanded critical care services over the last 15 years, national evidence regarding workforce capacity, infrastructure and service provision remains limited. AIMS: To evaluate critical care workforce, service provision and patient case mix across Ministry of Health hospitals in Zambia. STUDY DESIGN: A cross-sectional survey was administered across 14 public hospitals with critical care units across Zambia, representing all 10 provinces. Data were collected via an e-survey questionnaire instrument. Descriptive statistical analysis was conducted using SPSS. Ethics approval was obtained prior to the study. RESULTS: All hospitals responded (n = 14/14, 100% response rate), accounting for a capacity of 131 critical care beds. Only 28.6% of hospitals had 24-h intensivist coverage, whereas all had registered critical care nurses. Equipment availability varied, with universal access to ventilators and monitors but limited access to syringe pumps and inconsistent availability of functional CT scanners. Over a 7-day period, 121 admissions were recorded, predominantly medical (29%), surgical (24.8%) and trauma-related (19.8%). Paediatric cases accounted for 40% of admissions. Formal admission and discharge protocols were present in fewer than half of the hospitals. CONCLUSION: The study provides the first national overview of public critical care provision in Zambia and provides a snapshot of current provision. The findings highlight urgent areas for capacity strengthening. RELEVANCE TO CLINICAL PRACTICE: Findings are similar to other studies within the sub-Saharan region and highlight the need to strengthen workforce training, particularly in critical and paediatric care, improve access to essential equipment and standardise care protocols to enhance patient safety and outcomes. The study demonstrates the importance of strengthening the multidisciplinary critical care workforce.
PubMed2026
Distance Hands-On Training Versus Video Instruction for Flexible Laryngeal Mask Airway Management: A Protocol for a Multicenter Randomized Controlled Trial.
BACKGROUND: Flexible laryngeal mask airway (fLMA) management is an important but technically demanding airway skill, particularly for novice physicians. Distance hands-on training may provide a scalable alternative when access to face-to-face simulation is limited, but evidence demonstrating transfer of such training to clinical performance in patients remains scarce. This trial aims to compare distance hands-on training with standardized video instruction for novice physicians learning fLMA management. METHODS: This is a prospective, multicenter, parallel-group, rater-blinded, superiority randomized controlled trial conducted at three tertiary hospitals in China. Thirty novice physician participants will be randomized 1:1 to either distance hands-on training or video instruction. Both groups will receive identical standardized theoretical materials, a procedural demonstration video, and a written checklist. The distance hands-on training group will additionally receive remotely supervised deliberate practice using an airway task trainer with real-time instructor feedback. After training, each physician participant will perform fLMA management in two adult patient participants under direct supervision by experienced anesthesiologists. Clinical performance will be video-recorded and independently assessed by two blinded raters using the Flexible LMA Airway Management Global Rating Scale, for which validity evidence was established in a preceding study. Secondary outcomes include procedural success, insertion time, ventilation parameters, fLMA positioning, procedure-related complications, learning progression, and physician participant satisfaction. DISCUSSION: This trial will evaluate whether structured distance hands-on training improves clinical procedural performance beyond standardized video instruction. By combining randomized educational intervention, multicenter clinical assessment, blinded video-based rating, and patient-based outcome evaluation, the study aims to provide evidence on the transfer of distance simulation training to clinical airway management. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2600121867.
PubMed2026
Effects of Subjective and Objective Sleep Measures on Diurnal Variation in Pain Intensity Among Patients With Chronic Pain: Implications for Time-of-Day-Dependent Pain Management.
OBJECTIVE: This study aimed to examine the effects of subjective insomnia severity and objective sleep efficiency (SE) on diurnal variation in pain intensity among patients with chronic pain. METHODS: Forty-four community-dwelling patients with chronic pain lasting more than three months were enrolled. Pain intensity was recorded using a visual analog scale at six time points per day over three consecutive days. Subjective sleep was assessed once using the Athens Insomnia Scale (AIS), and objective SE was derived from three days of actigraphy recordings. Linear mixed-effects models included pain intensity as the dependent variable; AIS score, sleep efficiency, time of day, and their interactions as fixed effects, as well as participant ID as a random effect. RESULTS: Significant main effects of time (F = 4.84, p < 0.001) and the AIS score (F = 7.58, p = 0.009) were observed. Significant interactions were found between SE and time of day (F = 3.64, p = 0.003), as well as between the AIS score and time of day (F = 2.55, p = 0.027). Higher AIS scores were associated with greater pain intensity, particularly in the morning. Higher SE was associated with higher pain intensity upon waking but lower pain intensity in the evening. CONCLUSION: In this exploratory study, subjective insomnia severity showed a consistent association with diurnal variation in pain intensity, whereas SE was associated with pain intensity in a time-of-day-dependent manner. These findings, which should be interpreted as hypothesis-generating rather than definitive, suggest that subjective and objective sleep measures capture distinct aspects of time-of-day-dependent pain variation and may inform individualized approaches to pain management, including patient education and rehabilitation planning.
PubMed2026
Electronic Patient-Reported Health-Related Quality of Life Trajectories in ICU Survivors: A Multicentre Pilot Study-Within-a-Trial Protocol.
BACKGROUND: Patient-important outcomes beyond mortality, particularly health-related quality of life (HRQoL), are frequently used in intensive care unit (ICU) trials. However, HRQoL assessment remains challenging due to methodological complexities, including poorly defined recovery trajectories, lack of consensus on measurement instruments, complexity of statistical analysis, and missing data. Electronic patient-reported outcomes (ePROs) may improve data collection and efficiency, though their feasibility in ICU survivors is uncertain. METHODS: This protocol outlines a longitudinal, multicentre pilot study-within-a-trial aimed at evaluating the feasibility of ePRO-based HRQoL follow-up and exploring a trajectory-based approach to HRQoL characterisation after critical illness. We plan to enrol 100 participants already undergoing 180-day HRQoL follow-up in the Intensive Care Platform Trial (INCEPT) to complete monthly EQ-5D-5L surveys delivered by text messages from 6 to 12 months after randomisation. Feasibility outcomes include enrolment and response rate, time to completion, reminder-dependency, attrition pattern, agreement between modes of collection, and accessibility. Agreement between telephone- and ePRO-based assessments at 180 days will be evaluated at the group and at the individual level. Longitudinal EQ-5D-5L index values and visual analogue scale trajectories will be analysed using area-under-the-curve methods based on linear interpolation. Scenario-based sensitivity analyses will assess the potential impact of unobserved mortality among dropouts. DISCUSSION: We hypothesise that ePRO-based repeated assessments of HRQoL will support the goal of optimised data collection methods, while ensuring resources control. Moreover, identification of a candidate approach to HRQoL characterisation may shed light into the full recovery trajectory of ICU survivors and improve the interpretation and clinical relevance of HRQoL outcome assessments.
PubMed2026
Evaluating Meaningful Patient and Public Involvement in Intensive Care Research-A PEIRS-22 Survey.
BACKGROUND: Patient and public involvement (PPI) is increasingly recommended in health research to enhance relevance, quality and implementation of findings. In intensive care research, involving patients, family members and healthcare professionals may help ensure that research addresses outcomes that are meaningful to those affected by critical illness. AIM: This study aimed to assess the level of meaningful PPI engagement during the development of a core outcome set (COS) for general intensive care unit (ICU) patients in Denmark. STUDY DESIGN: A cross-sectional survey using the Danish version of the Patient Engagement in Research Scale (PEIRS-22) was conducted between December 2024 and January 2025. We invited all members (patients, family, healthcare professionals and researchers) of five research panels, established in 2021 to support COS development across Danish university hospitals (N = 46). PEIRS-22 total scores range from 1 to 100, with higher scores indicating greater meaningful engagement (scores ≥ 70.1 were considered meaningful). Descriptive statistics, item-level analyses and non-parametric comparisons between participant roles were performed. RESULTS: Thirty-seven of 46 participants responded (80.4%): 27.0% (n = 10) were patients/family, 46.0% (n = 17) healthcare professionals and 27.0% (n = 10) researchers. The median PEIRS-22 total score was 78 (IQR 68-93), with 72.0% (n = 27) scoring ≥ 70.1. Engagement differed statistically significant by role (p = 0.004), with researchers reporting the highest scores (median 97), followed by patients/family (89), while healthcare professionals reported lower scores (74). CONCLUSION: PPI in COS development for general ICU patients was perceived as meaningful overall. However, differences across stakeholder groups and lower achievement of advanced engagement elements suggest opportunities to strengthen shared decision-making, role clarity and perceived relevance, particularly among healthcare professionals. Meaningful involvement of patients, families and clinicians may support the development of more patient-centred intensive care research and outcomes that better reflect the priorities of those affected by critical illness. RELEVANCE TO CLINICAL PRACTICE: Meaningful PPI can help ensure that intensive care research reflects the priorities of patients and families. Clear roles, clinical relevance, and opportunities to influence decisions may strengthen engagement, particularly among healthcare professionals. Critical care nurses may play an important role in facilitating collaboration between patients, families, clinicians, and researchers.
PubMed2026
Exploring Proximal and Distal Ultrasound-Guided Greater Occipital Nerve Block Approaches in Migraine: A Systematic Review and Meta-Analysis.
OBJECTIVE: To evaluate the effectiveness and safety of proximal and distal ultrasound-guided greater occipital nerve block (US-GONB) in patients with migraine. METHODS: PubMed, Scopus, Web of Science, and the Cochrane Library were searched up to July 2025. Studies assessing US-GONB in migraine were included. Data were pooled using a random-effects model and expressed as mean difference (MD) with 95% confidence intervals (CI). Subgroup analyses were conducted based on the injection site. RESULTS: Twelve studies (658 patients) were included. US-GONB significantly reduced pain intensity (MD = -3.48 points, 95% CI [-3.84, -3.11]), monthly headache frequency (MD = -9.12 days, 95% CI [-11.65, -6.58]), headache duration (MD = -18.98 h, 95% CI [-26.86, -11.11]), and monthly analgesic use (MD = -10.01, 95% CI [-12.91, -7.11]). No significant subgroup difference was observed in pain intensity between injection sites. For monthly headache frequency, a significant subgroup difference was observed, with the proximal subgroup demonstrating numerically larger reductions than the distal subgroup (-10.83 vs. -6.36 days; p = 0.006). Adverse events were generally mild and transient: loss of pinprick sensation occurred in 80% of proximal vs. 100% of distal injections, dizziness in 22.7% vs. 3.9%, moderate-to-severe migraine attacks in 20.1% vs. 12.9%, and cerebellar-like symptoms in 12.5% vs. 0%, respectively. Vasovagal syncope (9.1%) and local pain (8.1%) were reported only in proximal injections. CONCLUSIONS: US-GONB appears to be a safe and effective intervention for migraine, significantly improving pain and headache burden. Proximal injections may be associated with greater reductions in headache frequency; however, these findings were based on indirect comparisons. Further comparative trials are warranted to optimize anatomical targeting.
PubMed2026
Identification of Prognostic Factors and Regulatory Pathways in Porto-Sinusoidal Vascular Disorder.
BACKGROUND AND AIMS: Porto-sinusoidal vascular disorder (PSVD) is a rare liver condition characterized by specific histological features primarily affecting the hepatic sinusoidal and periportal vasculature, in the absence of cirrhosis. This study aimed to identify prognostic factors and regulatory pathways associated with PSVD by integrating transcriptomic and clinical data. METHODS: A total of 114 PSVD patients were included, with 74 followed longitudinally for liver-related events. RNA sequencing was performed on 21 liver samples and compared to six histologically normal livers. Associations between clinical parameters, such as liver-to-spleen volume ratio (LSVR) and fibrosis stage, with liver-related events were assessed. Transcriptomic analyses, including co-expression and cell deconvolution, were conducted based on these parameters. RESULTS: Among the 114 patients, 32 (28.1%) underwent liver transplantation at diagnosis. LSVR strongly correlated with fibrosis stage, which was significantly associated with liver transplantation (per 1-stage increase: adjusted OR, 14.88; 95% CI: 3.72-59.58). Over a mean follow-up of 6.7 years in the longitudinal cohort, 12 patients (16.2%) experienced liver-related events. LSVR was identified as a significant prognostic marker, with an optimal cut-off value of 1.33 for predicting liver-related events. Transcriptomic analysis based on LSVR and fibrosis stage revealed distinct gene expression patterns and cellular changes in PSVD, including shifts in liver sinusoidal endothelial cell (LSEC) distribution, an increased hepatic stellate cell population, and upregulation of IL-6 signalling, without changes in immune cell composition as the disease progresses. CONCLUSIONS: This study identified LSVR as a novel prognostic marker in PSVD and suggests that IL-6 trans-signalling-induced endotheliopathy in LSECs may play a role in the proinflammatory and fibrotic changes associated with disease progression.
PubMed2026
Influence of Albumin Treatment Duration on Outcome of Terlipressin Therapy in Patients With HRS-AKI.
BACKGROUND AND AIMS: Volume expansion with albumin is recommended to establish a diagnosis of hepatorenal syndrome-acute kidney injury (HRS-AKI). The optimal duration of albumin administration is debated and requires balancing the risk of overtreatment with the need for timely diagnosis and treatment. Therefore, this study aimed to compare the impact of different albumin treatment durations on terlipressin response and the prognosis of patients with HRS-AKI treated with terlipressin and albumin. METHODS: This multicenter, retrospective secondary analysis included patients with suspected HRS-AKI who were treated with terlipressin and albumin at 12 German centers. One hundred forty five patients were available for further analysis. The cohort was dichotomized into patients treated with albumin for < 24 h and for 24-60 h before initiation of terlipressin. Patients were followed for treatment response to terlipressin, need for haemodialysis (HD), survival, or liver transplantation (LT). RESULTS: Median MELD score of the cohort was 25 [IQR 21; 31]. During follow-up, 59 patients (40.7%) achieved a complete response to treatment with terlipressin, and 96 patients (66.2%) died or received an LT. Response rates to terlipressin therapy did not differ between albumin treatment groups (< 24 h vs. 24-60 h). In multivariable competing risk models, treatment duration of albumin was not associated with any response to terlipressin, considering death and LT as competing events. Of note, albumin treatment duration did not affect HD-/LT-free survival. CONCLUSION: Extending albumin treatment beyond 24 h had no impact on treatment response to terlipressin and albumin or HD-/LT-free survival in patients with HRS-AKI. CLINICAL TRIAL NUMBER: NCT06161766.
PubMed2026
Key Characteristics and Mechanisms in Ventilator Weaning of Adult Intensive Care Patients-A Qualitative Study With Healthcare Professionals.
BACKGROUND: Weaning from mechanical ventilation appears to be a complex intervention as defined by the Medical Research Council Framework. However, there is a lack of theoretical insights into ventilator weaning, and the underlying causal mechanisms have not yet been uncovered sufficiently. To understand its complexity in theory and develop it in practice, a program theory is currently being developed in a multi-method study. AIM: To identify key characteristics and mechanisms in ventilator weaning of adult intensive care patients. STUDY DESIGN: In this sub-study, we conducted semi-structured group discussions and workshops with 29 healthcare professionals in intensive care over 3 days in 2025 in Germany, using a qualitative design. The data were collected using audio recordings, field notes and photographs. After transcription, a deductive-inductive thematic analysis was performed. FINDINGS: The analysis revealed four principal themes: (1) complexity of ventilator weaning, (2) outcomes, (3) interventions and (4) links and relationships. The first theme combines factors such as definition and delimitation, dynamics, structure and individualization, which together describe the inherent complexity. The second theme covers different endpoints during the process, including preconditions and postconditions as well as intermediate, immediate and ultimate outcomes. The third theme comprises direct and indirect interventions, as well as nonprogram external factors. The fourth theme explores the connections between interventions, outcomes and contextual factors. CONCLUSION: The findings of this study support the understanding that ventilator weaning is a complex intervention. The identified interaction of the various interventions, outcomes and contextual factors needs to be theoretically organized and evaluated in future studies. RELEVANCE TO CLINICAL PRACTICE: Identifying the interactions between key characteristics in this process can improve HCPs' sensitivity to the effects of their own actions. A theoretical understanding of the mechanisms underlying ventilator weaning enables the targeted development and evaluation of a complex weaning intervention. TRIAL REGISTRATION: Open Science Framework YGJ3T; https://doi.org/10.17605/OSF.IO/YGJ3T, registered on 14 May 2025.
PubMed2026
Management of Neuropathic Pain in Complex Regional Pain Syndrome: A Comprehensive Review.
OBJECTIVE: Complex regional pain syndrome (CRPS) is a complex and multifaceted condition in which pain may be neuropathic, nociplastic, nociceptive, or mixed in nature. This review aims to summarize the available pharmacological and non-pharmacological strategies for managing neuropathic pain in CRPS Types I and II. METHODS: Scopus, PubMed, Cochrane Library, and Google Scholar were searched for randomized controlled trials, meta-analyses, case series, and case reports addressing the management of CRPS, with a focus on neuropathic pain. Studies were analyzed from the perspective of pharmacological and non-pharmacological approaches, with attention to differences between CRPS Type I and II. RESULTS: Gabapentin (Level 1 evidence) and physiotherapy (Level 2 evidence) showed the strongest support among the treatments reviewed. Evidence remains limited or inconsistent for other pharmacological options (e.g., anticonvulsants other than gabapentin, opioids, antidepressants, ketamine, botulinum toxin) and for non-pharmacological interventions (e.g., mirror therapy, spinal cord stimulation, acupuncture). No significant differences in treatment efficacy were identified between CRPS Type I and II. CONCLUSION: Given the complex and heterogeneous nature of CRPS, a multimodal, individualized treatment approach is recommended. Further well-structured studies are needed to strengthen the evidence base for the management of neuropathic pain in CRPS.