International braz j urol : official journal of the Brazilian Society of UrologyNaiwen Chen, Lichen Chen, Jinming Cai, Mingyue Tan, Dongliang Xu
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.
International braz j urol : official journal of the Brazilian Society of UrologyLuciano A Favorito
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.
International braz j urol : official journal of the Brazilian Society of UrologyMarcos Tobias-Machado, Ricardo C Brianson, John Eder Gamarra Bravo, Alcedir Raiser, Eliney Faria
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.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyO N Bobrovskaya, A D Skvortsova
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.
Renal failureKim Solez, Habba Mahal, Wisit Cheungpasitporn, Giuseppe Orlando
The purpose of this review is to summarize the most influential and conceptually significant publications from the past 2 years, including substantial 2026 publications, and to identify emerging directions likely to shape xenotransplantation and regenerative medicine in the near future. Advances in artificial intelligence (AI) now support more structured anticipation of future developments by integrating patterns across experimental, computational, and translational research. The field is approaching a potential inflection point in which increasingly capable AI systems, potentially approaching artificial general intelligence, may accelerate the design of stem-cell-derived tissues and progressively more complex organ constructs. In addition, scientific communication is evolving toward formats that support machine-assisted analysis and AI-driven knowledge synthesis. Multiple developments signal significant expansion across xenotransplantation and regenerative medicine, driven by innovations in gene editing, multimodal data integration, and AI-enabled prediction and decision-support systems. These advances will help to broaden access to transplantable organs and increase the scale and impact of the field across clinical practice, research, and workforce domains. Together, these trends suggest that AI-enabled regenerative and xenogeneic strategies may meaningfully reduce the organ shortage and support future progress toward precision-engineered organ replacement.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyMinjie Zhao, Xiaoyu Yang, Heding Zhang, Wenjing Hu, Xiaojuan Wang, Huimin Xing, Peng An
BACKGROUND: To investigate whether serum micro (miR)-145-5p for postoperative complications in patients with scarred uterus undergoing caesarean section, suggesting its potential as an adjunctive molecular biomarker for clinical preoperative risk assessment. METHODS: A total of 198 women were divided into high-expression and low-expression groups based on the mean relative serum miR-145-5p level. Pelvic floor function, vaginal microecology, and abdominal adhesion status were assessed, and postoperative complications were monitored. Spearman's rank correlation was used to analyse the correlation between miR-145-5p expression and scar scores, while Receiver operating characteristic (ROC) curves were employed to evaluate its predictive efficacy for complications. RESULTS: Serum miR-145-5p was negatively correlated with abdominal scar Patient-Observation Scar Assessment Scale (POSAS) scores. The level of miR-145-5p was lower in the moderate-to-severe pelvic floor dysfunction (PFD) group, vaginal microecological disorder group, abdominal adhesion group, and postoperative complication group compared with the corresponding control groups. ROC curve analysis showed that miR-145-5p had good predictive value for these complications. CONCLUSIONS: miR-145-5p is closely correlated with abdominal scar, PFD, vaginal microecological disorders, abdominal adhesions, and other postoperative complications in patients with scarred uterus after caesarean section, which may serve as a potential molecular biomarker for preoperative risk assessment.
The Libyan journal of medicineYuhang Yang, Ping Wang, Minshan Feng, Xunlu Yin, Aifeng Liu, Chengliang Zhong, Shengqiang Zhang, Futai Gong, Jian Liu, Zhiquan Wang, Bifeng Fu
BACKGROUND: Axial neck pain is a common manifestation of cervical degenerative disc disease (CDD). Rotation-traction manipulation (RTM) is widely used in China, but its comparative effectiveness and safety versus cervical traction remain uncertain. METHODS: In this prospective multicenter randomized controlled trial, 154 adults with CDD-related axial neck pain were randomized 1:1 to receive RTM (7 sessions over 2 weeks) or cervical traction (daily for 2 weeks). Outcomes were assessed at baseline, during treatment, and at 1 and 3 months after treatment. The primary outcome was pain intensity measured by the visual analogue scale (VAS); secondary outcomes were neck tenderness score (NTS) and cervical range of motion (ROM). Intention-to-treat analyses with multiple imputation were performed. RESULTS: All 154 randomized participants were included in the analyses, and 151 completed follow-up. Both groups showed significant improvement over time in VAS and ROM (both P < 0.001). Confirmatory mixed-effects analyses did not demonstrate significant between-group differences in VAS or ROM after adjustment for multiple comparisons. Exploratory analyses suggested that RTM provided faster improvement during the treatment phase and a small cumulative advantage in pain reduction, whereas cumulative ROM improvement did not differ significantly between groups. RTM was also associated with a faster reduction in neck tenderness severity. Adverse events were mild and infrequent, and no treatment-related radiographic deterioration was observed. CONCLUSIONS: Both RTM and cervical traction were associated with clinical improvement in patients with CDD-related axial neck pain. Confirmatory analyses did not demonstrate robust superiority of RTM for pain or cervical ROM, whereas exploratory analyses suggested faster early improvement and a small cumulative pain benefit with RTM. NTS findings should be interpreted cautiously because the tenderness score has not been formally validated. No serious adverse events were observed. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400082667. Registered retrospectively on 4 April 2024.
Journal of medical economicsPatrik Zamecnik, Jürgen Feuerstein, Michael Berghahn, Jelle Barentsz
BACKGROUND AND OBJECTIVE: Accurate nodal staging in intermediate- to high-risk prostate cancer (PCa) is crucial for treatment decisions. While extended pelvic lymph node dissection (ePLND) is the standard, it is invasive and has a low diagnostic yield. A 2019 analysis suggested that non-invasive imaging such as PSMA-PET/CT and ferumoxtran-enhanced macrophage-MRI (m-MRI) is cost-effective, but at the possible expense of a small QALY loss compared to ePLND, based on limited evidence. Recent Phase 3 trials have provided new data, prompting a reevaluation. Therefore, the aim of this article is to update a model with recent trial data to assess the cost-effectiveness of m-MRI and PSMA-PET/CT versus ePLND in Germany. MATERIAL AND METHODS: We adapted a Markov model to simulate lifetime outcomes for men with intermediate- to high-risk PCa from a German insurer's perspective, with costs updated to 2025 level. Diagnostic accuracy data were derived from recent multicenter trials. Costs and QALYs were calculated using a 3% discount rate. Sensitivity analyses tested uncertainties. A practical interactive online-tool is provided for clinical decision-making and research purposes, which can incorporate various input data (https://macrophage-mri.app). RESULTS: Both imaging options were dominant over ePLND (€37,855; 18.11 QALYs). PSMA-PET/CT was €7,869 cheaper and gained 0.800 QALYs; m-MRI was €9,985 cheaper and gained 0.990 QALYs. m-MRI was superior, saving €2,116 and gaining 0.19 QALYs over PSMA-PET/CT. The probabilistic analysis showed that m-MRI was optimal over 95% of the time at an €80,000/QALY threshold; the probability of PSMA-PET/CT being optimal was less than 5%. CONCLUSIONS: An imaging-first approach outperforms routine ePLND, with m-MRI as a cost-effective option. PSMA-PET/CT's low sensitivity limits its usefulness, though it is still cheaper than ePLND. These results support including m-MRI in guidelines for initial staging.
Renal failureYue Yuan, Siyuan Lei, Aoyi Duan, Jiansheng Li
Sepsis remains a leading cause of mortality worldwide, and extracorporeal blood purification has been widely implemented despite ongoing uncertainty regarding its survival benefit. We conducted an umbrella review of 42 systematic reviews and meta-analyses evaluating mortality across major extracorporeal blood purification modalities. Mortality estimates generally favored extracorporeal blood purification over conventional care, but effect sizes and consistency varied substantially by modality, and the overall certainty of evidence for mortality was low. At the review level, polymyxin B hemoperfusion showed a relatively consistent direction toward lower mortality, whereas renal replacement therapy-based strategies were typically closer to the null. However, most included reviews were of low or critically low methodological quality, with downgrading driven by risk of bias, inconsistency, and potential publication bias. Therefore, these findings should be interpreted cautiously and should not be considered definitive evidence of survival benefit. They highlight persistent evidentiary fragility and underscore the need for rigorously designed, phenotype-informed trials to clarify modality-specific effects in sepsis.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansMaría De la Calle, Eva Manuela Pena-Burgos, Sara Ruiz Martínez, Ana Gallardo Navarro, Jose Luis Bartha
INTRODUCTION: Fetal presentation of the first twin plays a key role in delivery planning. While vertex presentation is considered favorable for vaginal delivery, presentation changes may occur during the third trimester. However, the factors influencing these changes-particularly in relation to chorionicity-remain poorly defined. MATERIAL AND METHODS: This was a retrospective cohort study including 263 twin pregnancies (166 dichorionic diamniotic (DCDA), 97 monochorionic diamniotic (MCDA)) followed at a tertiary center between 2000 and 2025. Third-trimester ultrasounds were performed at 32 weeks and prior to delivery. We evaluated changes in the presentation of the first twin and analyzed variables that may be associated with fetal dynamics or stability, including parity, amniotic fluid volume, placental location, estimated fetal weight, and second twin presentation. RESULTS: The first twin maintained the same presentation in 53.6% of DCDA and 57.7% of MCDA pregnancies. Among those initially non-vertex, a spontaneous change to vertex presentation occurred in 53.4% of DCDA and 71.4% of MCDA cases. No statistically significant associations were found between presentation changes and the maternal or ultrasound-related variables studied. When vertex presentation was observed in the third trimester, it remained stable in over 95% of cases. CONCLUSIONS: The presentation of the first twin remains dynamic throughout until delivery, especially in non-vertex cases. However, a vertex presentation after 32 weeks is highly predictive of stability until delivery. Serial third-trimester ultrasound are essential for accurate delivery planning and should guide shared decision-making with expectant parents.
Journal of investigative surgery : the official journal of the Academy of Surgical ResearchXiaoyin Tang, Bingwei Lu, Min Ding, Yan Lin, Ping Li
PURPOSE: To evaluate the reduction in ablated lesion volume after ultrasound-guided percutaneous radiofrequency ablation (RFA) for benign breast tumors and identify factors associated with shrinkage. METHODS: This retrospective study included 64 patients (244 benign breast tumors) treated with RFA from December 2014 to February 2021. All tumors were biopsy confirmed before ablation. Follow-up at 1, 3, 6, and 12 months measured nodule volume changes and recorded complications, with analyses at the individual nodule level. RESULTS: All patients were discharged within 24h without major events. Grade I pain occurred in two patients (3.13%), with no higher-grade complications observed. The complete ablation rate at 1 month was 98.77% (241/244). At 12 months, lesion volume decreased significantly (p < 0.001), with a mean volume reduction ratio (VRR) of 97.14% and a complete sonographic disappearance rate of 81.97% (200/244). Multiple mixed-effect linear regression showed that lesions with a maximum diameter > 20 mm and an absence of blood vessels within 5 mm of the nodule were significantly associated with a lower 12-month VRR. CONCLUSIONS: Ultrasound-guided RFA is safe and effective for benign breast tumors. Ablated lesions effectively shrink, with nodule size and the presence of blood vessels around the nodules being associated with the 12-month VRR.
Annals of medicineMeng Yuan, Si-Jin Lv, Meng-Ru Wu, Yu-Chen Lu, Min-Hao Zhang, Jian-Hua He
BACKGROUND: Postoperative pain after thoracic surgery remains common and challenging. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive neuromodulation technique with potential analgesic effects. This study aimed to evaluate the efficacy and safety of taVNS for postoperative pain management in patients undergoing thoracoscopic partial lung resection. METHODS: Adults undergoing thoracoscopic partial lung resection were randomized to active or sham taVNS. The primary outcome was cough pain intensity at 48h post-surgery, assessed by Numeric Rating Scale (NRS). Secondary outcomes included cough pain at 24h and 72h, resting pain, moderate-to-severe pain incidence, opioid consumption, quality of recovery, postoperative pulmonary complications , chest tube duration, hospital stay, postoperative nausea/vomiting, and adverse events. RESULTS: Among 119 analyzed patients (active n = 60, sham n = 59), active taVNS reduced cough pain scores at 24h, 48h, and 72h postoperatively, as well as resting pain (p < 0.05). It also lowered the incidence of moderate-to-severe cough pain at 24h and 48h, reduced cumulative postoperative opioid use at 24h and 72h, and decreased rescue analgesia on postoperative day 3 (p < 0.05). Active taVNS was associated with a lower incidence of postoperative pneumothorax (p < 0.05). No serious adverse events occurred. CONCLUSION: Perioperative taVNS was associated with a modest analgesic benefit and reduced postoperative opioid requirements after thoracoscopic partial lung resection. The observed reduction in postoperative pneumothorax requires cautious interpretation, and further multicenter trials are needed to determine its clinical utility.
International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia GroupMichał Kazanowski, Paweł Lesiak, Jędrzej Wierzbicki, Bartosz Kapturkiewicz, Paweł Maciejewski, Marcin Pawłowski, Krzysztof Szewczyk, Tomasz Jastrzębski, Marek …
INTRODUCTION: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is used for selected peritoneal malignancies but carries substantial perioperative physiological stress. Acute kidney injury (AKI) is clinically relevant, yet data on its incidence and postoperative timing remain heterogeneous. METHODS: We performed a retrospective single-center cohort study of consecutive adults undergoing CRS-HIPEC between 2014 and 2024. AKI was defined using KDIGO serum creatinine criteria assessed from postoperative day (POD) 1 to POD 5. Baseline, oncologic and treatment related variables were compared according to AKI status. Exploratory multivariable logistic regression assessed associations between routinely available variables and postoperative AKI. Secondary outcomes included length of stay and exploratory overall survival. RESULTS: Among 308 cases, AKI occurred in 70 cases (22.7%). Stage 1 AKI occurred in 45 cases (14.6%), stage 2 in 18 cases (5.8%) and stage 3 in 7 cases (2.3%). Renal replacement therapy was required in 2 cases (0.6%). Peak serum creatinine occurred on POD 1 to POD 2 in 64.3% of cases, while 35.7% peaked on POD 3 to POD 5. Median length of stay was 7.5 days [IQR 6.5 to 9.6] in the AKI group and 7.4 days [IQR 6.5 to 8.8] in the non-AKI group (p = 0.0998). In exploratory multivariable analysis, no included variable was significantly associated with AKI; PCI showed a non-significant association (OR 1.04 per point, p = 0.11). CONCLUSIONS: AKI was frequent after CRS-HIPEC, and more than one third of cases peaked beyond the first 48 h. These findings support postoperative renal surveillance through POD 5.
International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia GroupJae-Seong Lee, Kye-Hwa Lee
BACKGROUND: Since its introduction in 2010, Ultrasound-guided High-Intensity Focused Ultrasound (USgHIFU) has rapidly expanded in South Korea, despite the absence of widely accepted standardized clinical protocols. This study evaluated the long-term clinical outcomes of USgHIFU and proposed a standardized MRI-integrated treatment framework incorporating MRI-based planning, treatment verification, and structured follow-up. METHODS: In this retrospective analysis, we included 2,992 patients (1,620 with uterine fibroids and 1,372 with adenomyosis) treated with USgHIFU between 2010 and 2025. Therapeutic efficacy was assessed using non-perfused volume (NPV) ratio, volume reduction rates (VRR), and reintervention rates. Long-term durability, defined as freedom from reintervention, was evaluated using Kaplan-Meier analysis in 476 patients with follow-up durations of 3-9.7 years. RESULTS: Immediate post-treatment contrast-enhanced MRI demonstrated a mean NPV ratio of 86.5 ± 7.2%, with 94.2% of patients achieving an NPV ratio ≥ 80%. At 12 months, the mean VRRs were 77.4% and 61.4% for fibroids and adenomyosis, respectively. In the long-term follow-up subset (n = 476), volume reduction was maintained and then increased, reaching 78.8% for fibroids and 66.3% for adenomyosis at 3-9.7 years. Freedom from reintervention was 99.1% at 12 months, 98.4% at 3 years, and 97.6% at 9.7 years. No major complications were observed after implementation of the standardized treatment framework. CONCLUSION: Standardized USgHIFU treatment, achieving an NPV ratio ≥ 80%, is associated with sustained long-term clinical outcomes and a favorable safety profile. These findings support the clinical value of a standardized MRI-integrated treatment framework and may contribute to future clinical standardization of USgHIFU practice.
Renal failureShuo Li, Yan Huang, Meiran Cao, Jingfu Wang
Background: The tubular atrophy/interstitial fibrosis (T) lesions of the Oxford Classification is a key prognostic determinant in IgA nephropathy (IgAN). The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an emerging lipid marker, but its link with renal histologic damage in IgAN is unknown.Methods: This cross-sectional and retrospective study investigated the relationship between NHHR and T lesions in 400 biopsy-proven IgAN patients. Participants were divided into NHHR quartiles. The association between NHHR and T lesions was assessed using Spearman's rank correlation analysis, binary logistic regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) curve analysis, and subgroup analysis.Results: Compared to the lowest quartile (Q1), the highest NHHR quartile (Q4) showed significantly adverse clinical profiles and a higher prevalence of T1/T2 lesions (p < 0.05). NHHR was positively correlated with T lesions (r = 0.229, p < 0.001). Multivariate logistic regression analysis identified elevated NHHR and reduced estimated glomerular filtration rate (eGFR) as independent risk factors for T1/T2 lesions. RCS analysis demonstrated a linear association between NHHR and the risk of T1/T2 lesions (p for nonlinearity = 0.343). The ROC curve analysis yielded an area under the curve (AUC) of 0.635 for NHHR alone (optimal cutoff value = 3.54, sensitivity = 58.2%, specificity = 63.6%), and the composite NHHR+eGFR model achieved an AUC of 0.814. Subgroup analysis showed a consistent association between NHHR and the risk of T1/T2 lesions across all subgroups, with no significant interaction effects.Conclusion: Elevated NHHR is an independent risk factor for the progression of T lesions in patients with IgAN.
International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia GroupYezhao Li, Tianquan Cai, Zhengfeng Huang, Hongzhi Yang
OBJECTIVE: Microwave ablation (MWA) is a minimally invasive therapy for liver metastases. Image guidance, primarily ultrasound (US) and computed tomography (CT), is critical for precision, but their comparative safety profiles remain debated. This study aims to compare the incidence and severity of complications between US-guided and CT-guided MWA in patients with liver metastases. METHODS: After propensity score matching (PSM), retrospective analysis of 120 patients (2022-2024) undergoing US-guided (n = 60) or CT-guided (n = 60) MWA at a single tertiary referral center. Complications were classified using the Clavien-Dindo system. Statistical analysis included Student's t test, χ2 tests, and logistic regression. RESULTS: Major complications (Clavien-Dindo ≥ III) occurred in 5% of US-guided vs. 13.3% of CT-guided cases (p = 0.04). US guidance correlated with fewer pneumothoraxes (0% vs. 8.3%, p = 0.02) and reduced radiation exposure (p < 0.001). There was no statistically significant difference in the 12-month local tumor progression (LTP) rate between the two groups (p = 0.79). CONCLUSION: US-guided MWA demonstrates comparable tumor control to CT guidance with fewer complications and avoids radiation exposure, supporting its preferential use for high-risk patients.
Journal of psychosomatic obstetrics and gynaecologyJorina Holtrop, Amber A A Ten Buuren, Noralie N Schonewille, Carlinde W Broeks, Maria G van Pampus, Birit F P Broekman
OBJECTIVE: Maternal mental health during pregnancy may influence obstetric outcomes. This study examines associations between psychiatric vulnerability [PV]-defined as current or past psychiatric disorder-and mode of delivery and its indication. METHODS: A retrospective cohort study was conducted in a large Dutch maternity hospital. Primiparous women aged ≥ 18 with singleton pregnancies were included between January 2015 and March 2020. RESULTS: In total, 705 women with and 837 women without PV were included. No differences in delivery method were found between these groups. However, women using psychotropic medication had significantly higher odds of undergoing an assisted vaginal delivery [AVD] than a spontaneous vaginal delivery [SVD] (aOR = 2.00). Indications related to maternal mental health for unplanned caesarean section [CS] were exclusively observed in the group with PV (3.4%). No differences were observed in obstetric or fetal indications. CONCLUSIONS: Although mode of delivery did not differ between women with and without PV, women using psychotropic medications had higher risks for undergoing an AVD than a SVD. Only in a small proportion of women with PV, maternal mental health constituted an indication for unplanned CS. Further research is warranted to better understand the intersection of PV and psychotropic medication on delivery method.
BACKGROUND: Globally, more than 230 million girls and women have undergone female genital mutilation/cutting (FGM/C). It is estimated that about one-fourth of them reside in East Africa. Studies highlight educational attainment as one of the major factors contributing to the practice. OBJECTIVE: This study aimed to assess maternal education-related inequality in FGM/C among daughters aged 0-14 years by using Demographic and Health Survey (DHS) data (2016-2022) from three East African countries. METHODS: Stata version 17 was used for the data analysis. We analyzed pooled, nationally representative DHS data (2016-2022) from three East African countries (Ethiopia, Kenya, and Tanzania), involving a weighted sample of 23,596 daughters. Maternal education-related inequality was measured using the Erreygers Normalized Concentration Index. A decomposition analysis was conducted to determine the percentage contribution of maternal and household-level factors to the observed inequality. RESULTS: The findings revealed a pro-low-education distribution of the practice, with an Erreygers index of -0.126 (p < 0.001), indicating that FGM/C is significantly concentrated among daughters of less educated mothers. Decomposition analysis showed that maternal education accounted for the largest share of the observed inequality (42.51%), followed by maternal FGM/C status (23.79%), non-exposure to media (22.58%), rural residence (13.86%), and maternal age < 18 years at first cohabitation (8.7%), whereas the wealth index narrowed the inequality by 23.44%. CONCLUSIONS: FGM/C is disproportionately concentrated among daughters of less educated mothers. The observed inequality was largely shaped by maternal factors, indicating that limited educational attainment and intergenerational transmission play a substantial role in sustaining FGM/C among daughters.
The Libyan journal of medicineAli Robaian AlQahtani
Fractured instrument retrieval remains one of the most challenging aspects of endodontics, with reported incidence rates ranging from 0.3% to 12%. This complication is particularly common with nickel‒titanium (NiTi) rotary files used in curved canals. Instrument separation hinders effective canal disinfection, compromises the quality of obturation, and may necessitate additional interventions such as bypassing, retrieval, or surgical management. Conventional retrieval techniques often lead to dentin loss, compromising root structure. The use of dental operating microscopes and their integration with ultrasonic troughs, microtubes, and specialized retrieval kits, including loop devices, has significantly enhanced the predictability of retrieval procedures while minimizing the loss of tooth structure. However, the effectiveness of these methods remains highly dependent on operator skill. Numerous innovations are continually emerging to facilitate retrieval, with recent attention on magnetic fields. Studies on such emerging devices utilizing magnetic and electromagnetic attraction have introduced a promising new direction for further exploration. This review aims to provide a comprehensive, evidence-based perspective to guide clinical decision-making and keep practitioners updated about the latest advancements in minimally invasive retrieval techniques in endodontic practice.
Gynecological endocrinology : the official journal of the International Society of Gynecological EndocrinologyElene Asanidze, Alla Vash-Margita, Besik Asanidze, Mariam Kharaishvili, Maia Chiokadze, Ana Jibladze, Jenaro Kristesashvili
Peripheral precocious puberty (PPP) is a rare condition in early childhood, particularly among girls under 3 years of age. One cause of PPP is functional ovarian cysts that secrete estrogen at levels sufficient to trigger the development of premature secondary sexual characteristics. Unilateral ovarian agenesis is an uncommon congenital anomaly. The coexistence of both conditions in a single patient is extremely rare and poses unique diagnostic and management challenges. We report the case of a 2-year and 10-month-old girl presenting with concurrent breast development, pubarche, and recurrent vaginal bleeding. Pelvic imaging revealed a cyst in the left ovary and agenesis of the right ovary. Laparoscopy confirmed absence of the right ovary and ipsilateral fallopian tube. Based on clinical, hormonal, and radiologic findings, a diagnosis of PPP due to a functional ovarian cyst was made. Given the rapid progression of symptoms, increase in cyst size, and concern for torsion, a short observation period of three months was followed by ovarian-preserving laparoscopic cystectomy. Histopathology confirmed a benign follicular cyst. Postoperatively, the patient experienced partial regression of pubertal signs and complete resolution of vaginal bleeding. This case highlights the importance of individualized decision-making in managing PPP,especially in the presence of congenital anomalies.