Long COVID-19 affects approximately 10-30% of individuals who are infected with SARS-CoV-2 and is associated with persistent functional impairment and reduced quality of life. The heterogeneous, multisystemic nature and nonspecific symptomatology of long COVID-19 makes its treatment challenging. This scoping review evaluates existing evidence on sympathetic and parasympathetic ganglion blocks as potential interventions for patients suffering from long COVID-19. Our primary objective was to assess the effectiveness of sympathetic and parasympathetic ganglion blocks in treating patients with long COVID-19 by identifying the most commonly reported symptoms, symptom response to different block regimens, and any adverse effects associated with these interventions. A scoping review. Outpatient clinics where patients received sympathetic blocks or parasympathetic blocks. A comprehensive search was conducted across PubMed, Embase, Cochrane CENTRAL, Web of Science, Google Scholar, and ClinicalTrials.gov using MeSH and free-text terms related to "long COVID-19," "post-COVID-19 syndrome," and "sympathetic ganglion blocks" and "parasympathetic blocks." Only English-language articles were included. Pre-print repositories and reference lists were also manually screened. A total of 22 articles covering 505 patients were included in this review. The most frequently studied symptoms were olfactory dysfunction, fatigue, headache, and cognitive disturbances. The most commonly utilized intervention was the stellate ganglion block. The available evidence suggests that the stellate ganglion block could be an effective treatment for dysautonomia symptoms and cognitive dysfunction related to long COVID-19. Sphenopalatine ganglion block may be an effective option to treat headaches in long COVID-19 patients who are refractory to other treatments. The significant existing variations in treatment regimens precluded our ability to do a quantitative analysis. Reporting bias from case reports and small observational studies should also be considered. Stellate ganglion blocks may offer therapeutic benefit for the dysautonomia and cognitive dysfunction associated with long COVID-19. Sphenopalatine ganglion blocks have shown promise in managing refractory headache symptoms in this population. Further well-designed, placebo-controlled randomized studies that employ validated outcome measures are required to establish the efficacy of sympathetic ganglion blocks in the treatment of long COVID-19.
We aimed to investigate the effects of the external oblique intercostal plane block (EOIPB) and subcostal transversus abdominis plane (TAP) block on postoperative pulmonary function in patients undergoing laparoscopic cholecystectomy. The primary outcome was spirometric pulmonary function test (PFT) results. Secondary outcomes included postoperative pain scores, opioid consumption, and postoperative recovery assessed using the Quality of Recovery (QoR)-15 questionnaire. A total of 102 patients aged 18-65 years with ASA physical status I-III who underwent elective laparoscopic cholecystectomy were included in this prospective observational study. According to the perioperative analgesia technique applied, patients were evaluated in three groups: Group Subcostal (n=34), Group EOIPB (n=34), and Group Control (n=34). After losses to follow-up, 90 patients were included in the final analysis. Preoperative and postoperative spirometric PFTs, postoperative pain scores, opioid consumption, and QoR-15 scores were recorded and compared among groups. Postoperative reductions in FVC, FEV1, predicted FEV1, and PEF values were observed in all groups but were significantly more pronounced in the Control group. At postoperative hour 1, pulmonary function parameters were significantly lower in the Control group compared with both block groups (p < 0.05). Predicted FEV1 at postoperative hour 1 was significantly higher in the EOIPB group than in Subcostal group (p = 0.003). Postoperative pain scores and opioid consumption were significantly lower in both block groups compared with the Control group (p < 0.05), whereas QoR-15 scores were significantly higher (p < 0.05). No significant differences were observed between the two block groups for most postoperative outcomes. Both EOIPB and subcostal TAP block were associated with attenuated decline in postoperative pulmonary function, reduced opioid consumption, and improved early postoperative recovery after laparoscopic cholecystectomy.
Trans-sacral canalplasty (TSCP) is a minimally invasive epidural adhesiolysis technique positioned between conventional block therapy and open surgery. However, the relationship among MRI-defined levels of stenosis, epidurographic block patterns, and clinical effectiveness remains unclear. To investigate the clinical significance of mismatch between MRI-defined levels of stenosis and epidurographic block as well as to evaluate the short-term outcomes and feasibility of adhesiolysis in patients undergoing TSCP. A retrospective observational study. A university hospital in Japan and an affiliated institution. We reviewed all patients who underwent TSCP between October 2024 and August 2025. Baseline characteristics, diagnosis, surgical history, and minimum dural sac area at L3/4, L4/5, and L5/S (measured on MRI using ImageJ2) were assessed. Epidurography was performed to identify block levels, and cases were categorized as concordant (MRI-defined level of stenosis = block level) or discordant (mismatch). Discordant cases were subclassified into a "tail-stop" type (in which contrast stopped in a position caudal to the MRI-defined level of stenosis) and a "pass-through" type (in which these levels differed). Clinical effectiveness was defined as an improvement in low back pain or leg pain at one week after the procedure. Feasibility of adhesiolysis was also evaluated. Twenty-eight patients underwent TSCP during the study period. Nine (32.1%) showed concordance between MRI-defined levels of stenosis and epidurographic block sites, and 19 patients (67.9%) showed discordance (tail-stop, n = 11; pass-through, n = 8). Overall, 23 patients (82.1%) experienced clinical improvement. The effectiveness rate was 66.7% (6/9) in the concordance group and 89.5% (17/19) in the discordance group; however, the difference was not statistically significant (P = 0.290). In the discordance group, there was a significant difference in gender distribution between subgroups, with men predominating in the tail-stop subtype and women in the pass-through subtype (P = 0.024), but not in age, diagnosis, surgical history, or minimum dural sac area. Epidural dissection was successful in 21 patients (75.0%), with no significant difference between the effective and noneffective groups (73.9% vs 80.0%, P > 0.999). A single-center retrospective design, small sample size, and short-term follow-up of only one week. TSCP demonstrated favorable short-term clinical effectiveness, even in cases with mismatches between MRI and epidurographic findings. The feasibility of adhesiolysis may contribute to the clinical success of TSCP. Epidurographic mismatch should not be considered a contraindication for TSCP, and our findings support its role as a minimally invasive option for patients with degenerative disorders of the lumbar spine who are unsuitable for open surgery.
In the acute phase, aneurysmal subarachnoid hemorrhage headaches (SAHs) are often difficult to manage. Clinical guidelines advise utilizing multimodal pain management but do not make specific recommendations. We present a case of aneurysmal subarachnoid hemorrhage-related headache that was found to respond to greater occipital nerve blocks. A 35-year-old woman was admitted to the clinic for aneurysmal subarachnoid hemorrhage. When admitted, she reported severe headaches that were unresponsive to pain medication. After she received bilateral greater occipital nerve blocks, her pain was immediately reduced by 50%. Emerging evidence suggests that peripheral nerve blocks may serve as an effective mode of pain management for patients with aneurysmal subarachnoid hemorrhage-related headaches. Further research is needed to evaluate the effectiveness and safety of peripheral nerve blocks in this patient population.
The pericapsular nerve group (PENG) block is a novel regional technique that provides adequate postoperative analgesia without producing motor weakness during hip surgery. We sought to compare the postoperative analgesic effectiveness of the PENG block with varying concentrations of local anesthetic in total hip arthroplasty. Prospective, randomized, double-blind trial registered with the ClinicalTrials.gov (NCT04900116). Department of Anesthesiology, Istanbul University Faculty of Medicine, Istanbul, Turkey. Ninety-one patients aged 18-80 with an American Society of Anesthesiologists Physical Status Classification of I-III undergoing total hip arthroplasty under spinal anesthesia with a PENG block were included in this study. Patients were divided into 4 groups: Group One received 20 mL of 0.5% bupivacaine; Group 2 received 20 mL of 0.25% bupivacaine; Group 3 received 20 mL of 0.125% bupivacaine; and Group 4 received 20 mL of saline as a control. Visual Analog Scale pain scores, morphine consumption, nausea, vomiting, and quadriceps weakness were evaluated at postoperative hours 0 (the end of surgery), 6, 12, 24, and 48. In addition, we recorded the first ambulation time; breakthrough morphine need; hospitalization duration; patient and surgeon satisfaction; preoperative and postoperative first month Beck-depression scores; and any complications. Groups One and 2 had significantly lower Visual Analog Scale scores and morphine consumption than the control group (P = 0.001 and P = 0.001, respectively). Quadriceps weakness was significantly higher in Group One at postoperative hour 0 (P = 0.011). Nausea and vomiting were significantly lower in Group One than in the other groups at postoperative hours 12 and 24 (P = 0.007 and P = 0.027, respectively). The length of hospital stay was significantly shorter in Group One than in the control group (P = 0.048). This was a single-center study with no standardized quantitative measurement method for assessing quadriceps weakness. The PENG block with 20 mL of 0.5% bupivacaine in total hip arthroplasty provides effective postoperative analgesia by reducing opioid side effects and hospital stay, as evidenced by low pain scores and morphine consumption.
Self-consistent field theory simulations of rod-coil diblock copolymers in slit confinement present significant numerical challenges due to sharp density gradients near hard walls. To rigorously resolve these systems utilizing the Gaussian and wormlike chain models, a hybrid spectral-compact finite difference scheme is developed on a non-uniform Chebyshev-Gauss-Lobatto grid. Shen's Chebyshev spectral method is employed for the flexible blocks. For the semiflexible blocks, a second-order upwind compact scheme together with an L-stable TR-BDF2 contour-stepping algorithm is adopted. This hybrid framework effectively suppresses spurious numerical oscillations. This unconditionally stable formulation strictly preserves propagator non-negativity and achieves up to a two-orders-of-magnitude speedup over uniform-grid implementations while maintaining linear spatial scaling. Simulations utilizing this advanced framework under neutral wall conditions reveal that the confining walls naturally induce preferential wetting of the semiflexible blocks at the impenetrable boundaries. As the incompressibility penalty increases, the compressible system progressively approaches the incompressible limit. For the selected physical parameters, decreasing the slit width induces a sequence of structural transitions from a smectic-C morphology with three internal periods (SC3) to morphologies with two and one internal periods (SC2 and SC1), and ultimately to a highly compressed smectic-P morphology (SP1). The equilibrium thickness of these confined structures deviates from exact integer multiples of the bulk spatial period. This deviation arises from the volume compensation associated with boundary depletion layers, together with adjustments in the molecular tilt angle and the degree of molecular interdigitation.
A transversus abdominis plane block provides reliable abdominal wall analgesia, but which adjuvants best sustain its effect remains debated. By facilitating diffusion of local anesthetics, hyaluronidase may improve block quality. This study evaluated the safety and efficacy of 2 hyaluronidase doses added to bupivacaine for bilateral transversus abdominis plane blocks in patients having a cesarean delivery. A prospective, randomized, double-blind, controlled clinical trial. Benha University Hospital, Arab Republic of Egypt, from May 2023 through February 2024. A double-blind, controlled randomized trial was performed with 114 patients having elective cesarean delivery. The patients were allocated equally into 3 arms: Group I (bupivacaine alone), Group II (bupivacaine plus 750 IU hyaluronidase), and Group III (bupivacaine plus 1500 IU hyaluronidase). The time to first rescue analgesia served as the primary outcome. Secondary outcomes encompassed 24-hour morphine requirements, Visual Analog Scale pain score at rest and on coughing, patient satisfaction, hemodynamics, and adverse events. Analyses employed the appropriate statistical tests (parametric or nonparametric), with subsequent post hoc comparisons for significant findings. Both hyaluronidase groups had significant prolonged analgesia (median 8.1 hours and 9.6 hours) compared to the control group (5.8 hours) (P < 0.001). Morphine requirements over the first postprocedure 24 hours diminished significantly (P < 0.001); Groups II and III had lower pain scores at rest and on coughing between postprocedure hours 2 and 12 (all P < 0.05). Patient satisfaction increased with hyaluronidase (P = 0.0039). No group differences were observed for adverse events, including postoperative nausea and vomiting or local anesthetic toxicity. This single-center trial with 24-hour follow-up may restrict generalizability and long-term safety assessment; also only 2 hyaluronidase doses were examined. Adding hyaluronidase to bupivacaine for transversus abdominis plane block enhances analgesic duration and quality without compromising safety in patients having cesarean delivery. Both high and low doses appear equally effective, suggesting that even lower doses are sufficient for optimal effect.
Chronic low back pain is notoriously challenging to diagnose and manage, especially when imaging fails to reveal a cause. Superior cluneal nerve entrapment is an increasingly recognized, but often overlooked, source of pain that can mimic lumbosacral radiculopathy. We describe a 43-year-old woman with longstanding chronic low back pain unresponsive to physical therapy, extracorporeal shockwave therapy, and targeted sacroiliac joint injections. A physical examination revealed focal tenderness along the posterior iliac crest, a positive Tinel sign, and pain over the iliac crest. Lumbar magnetic resonance imaging was unremarkable. She underwent fluoroscopic and ultrasound-guided superior cluneal nerve blocks in separate sessions; each block produced immediate and complete pain resolution. Superior cluneal nerve entrapment should be considered when a patient has axial low back pain with negative imaging. Ultrasound-guided superior cluneal nerve blocks are a safe and effective alternative to fluoroscopic guidance, offering real-time visualization without radiation exposure.
Perioperative acute pain remains a major challenge because conventional analgesic strategies are often limited by inadequate efficacy and opioid-related adverse effects. Ultrasound-guided fascial plane blocks (FPBs) have become important components of multimodal analgesia. This review summarizes the mechanisms, clinical efficacy, safety, and future directions of major FPBs, including transversus abdominis plane, quadratus lumborum, and serratus anterior plane blocks, and discusses the emerging role of artificial intelligence (AI). PubMed, Embase, and the Cochrane Library were searched for relevant studies published up to December 2023. Clinical trials, meta-analyses, and mechanistic studies were reviewed, with emphasis on analgesic efficacy, opioid-sparing effects, safety, and AI-assisted applications. Current evidence indicates that ultrasound-guided FPBs provide effective truncal analgesia, reduce postoperative pain and opioid consumption, and may improve recovery while maintaining favorable safety profiles in selected settings. However, clinical benefits vary according to block type, surgical procedure, and comparator regimen. Adjuvants and continuous catheter techniques may prolong analgesia, whereas AI-assisted systems show promise for image interpretation and training. Ultrasound-guided FPBs are valuable components of perioperative multimodal analgesia and may improve analgesic quality while reducing opioid requirements.
Primary erythromelalgia (PE) is a rare, hereditary disorder characterized by chronic burning pain in the extremities and commonly linked to mutations in the SCN9A gene. The management of erythromelalgia-associated pain remains challenging, since there are currently no standardized guidelines for the treatment thereof due to the rare and refractory nature of the disorder. A 17-year-old boy with SCN9A-related PE presented with intractable bilateral lower extremity pain complicated by ulcerations and osteomyelitis. After not responding to multiple medications and interventions, he experienced significant relief upon receiving a popliteal sciatic nerve block effected with lidocaine and triamcinolone. Afterward, peripheral nerve stimulation (PNS) was implanted, leading to lasting pain relief, improved functionality, and wound healing for the patient. PNS offers a promising treatment for refractory PE, warranting further investigation to establish the role of this technique in managing this challenging condition.
Pain management following total knee arthroplasty (TKA) is critical for enhancing outcomes such as minimizing opioid consumption and hospital stay, overall function, and rehabilitation. To evaluate the effectiveness of combined intrathecal dexmedetomidine (ITD) and adductor canal block (ACB) in relieving post TKA pain. Double-blind, randomized controlled trial. KafrElsheikh University, Kafrelsheikh, Arab Republic of Egypt. A total of 75 patients, aged 18 to 75, who underwent TKA under spinal anesthesia participated in this double-blind, randomized controlled trial.. Three equal sets of patients were formed. Group ITD patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg of dexmedetomidine (DEX) in 0.5 mL (total volume 3.5 mL) and an ACB with 20 mL of 0.9% saline. Group ACB patients received an intrathecal injection containing 15 mg of hyperbaric bupivacaine along with 0.5 mL of saline and an ACB with 20 mL of 0.25% bupivacaine. Group ITD+ACB patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg in 0.5 mL of DEX and an ACB using 20 mL of 0.25% bupivacaine. The amount of morphine taken in the first postoperative 48 hours was the primary outcome. Compared to Group ITD and Group ACB, the total amount of morphine needed in the first postoperative 24 and 48 hours was significantly lower in Group ITD+ACB, and in group ACB compared to group ITD (P < 0.05). Visual Analog Scale pain scores were markedly reduced in Group ITD+ACB and in Group ACB than in Group ITD at postoperative 4 hours (P = 0.018 and P = 0.041, respectively); in Group ITD+ACB than in Group ITD and Group ACB at postoperative 8 hours (P = 0.005 and P = 0.011, respectively); and in Group ITD+ACB compared to Group ITD at postoperative 12 hours (P = 0.005). The time to the first rescue analgesic was notably longer in Group ITD+ACB compared to Group ITD and Group ACB (P value < 0.05)and in Group ACB compared to Group ITD (P < 0.001). Side effects were similar in all 3 groups. Our trial had a relatively limited sample size and was conducted at a single center. Combined ITD and ACB were superior in TKA postoperative pain management and required decreased postoperative analgesia without significant side effects compared to ACB alone or ITD alone.
This study aimed to evaluate the effects of the scalp nerve block (SNB) on surgical outcomes and postoperative complications in the subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. This retrospective cohort study analyzed data from 121 adult patients (≥18 years) who underwent STN-DBS surgery at a tertiary teaching hospital in Fuzhou, China, between November 2, 2017, and April 4, 2024. Patients were divided chronologically into two groups: local anesthesia (LA) alone (2017-2020, n=50) and LA combined with SNB (2020-2024, n=71). The primary outcome was the incidence of pulmonary infection within 7 days post-surgery. Secondary outcomes included other complications, microelectrode recordings, and anesthesia and surgery time parameters. Data were analyzed using univariate and multivariate logistic regression. Compared with the LA group, the LA+SNB group had a significantly shorter intracranial electrode implantation duration (123.97 ± 39.76 min vs. 181.74 ± 53.57 min, p < 0.001) and a lower rate of postoperative pulmonary infection (11.3% vs. 32.0%, p = 0.005). In univariate analysis, SNB was associated with a lower risk of pulmonary infection (OR = 0.262, 95% CI: 0.102-0.675, p = 0.006). However, in multivariate analysis adjusting for anesthetic method, duration of DBS, and tracheal extubation time, the association between SNB and pulmonary infection was no longer statistically significant (OR = 0.426, 95% CI: 0.138-1.315, p = 0.138), whereas tracheal extubation time remained an independent predictor (OR = 1.026 per minute, 95% CI: 1.009-1.045, p = 0.004). LA+SNB was associated with improved perioperative outcomes during STN-DBS surgery, including shorter operative time, reduced PACU stay, lower unadjusted pulmonary infection rates, and decreased intracranial air volume. However, only tracheal extubation time, rather than SNB itself, remained an independent predictor of pulmonary infection in multivariate analysis. Temporal confounding and selection bias are inherent limitations.
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Transcatheter aortic valve implantation (TAVI) has become a well-established treatment for patients with severe aortic stenosis who are at intermediate or high surgical risk. Despite procedural advances, post-procedural conduction disturbances remain among the most common complications, particularly new-onset left bundle branch block (LBBB). This study aimed to investigate the impact of balloon pre- and post-dilatation on the cardiac conduction system during TAVI. A retrospective analysis was conducted on 447 consecutive patients who underwent successful TAVI between June 2021 and June 2025. After excluding patients with baseline bundle branch block or permanent pacemaker rhythm, 282 patients were included. Standard 12-lead electrocardiograms were evaluated before and after TAVI. Post-procedural QRS prolongation was defined as QRS >120 ms, and logistic regression analysis was performed to identify predictors. The mean age was 76.5 ± 6.9 years, and 63.8% of patients were female. Larger prosthesis diameter (OR = 1.173, 95% CI 1.082-1.271; P < .001) and post-dilatation (OR = 2.147, 95% CI 1.235-3.733; P = .007) were independently associated with QRS prolongation. Post-dilatation specifically correlated with new-onset LBBB but not with right bundle branch block (RBBB), intraventricular conduction delay, or high-grade atrioventricular (AV) block. No significant predictors were identified for permanent pacemaker implantation. Balloon post-dilatation during TAVI is an independent risk factor for the development of new-onset LBBB. Patients with pre-existing conduction abnormalities, such as RBBB or first-degree AVr block, should be monitored closely after post-dilatation, as LBBB may adversely affect left ventricular function and long-term clinical outcomes.
Receptor-mediated interactions at liquid-liquid interfaces offer a powerful strategy for detection of trace contaminants. To enable selective sensing, these methods leverage polymeric surfactants to transduce molecular recognitions into measurable changes in interfacial tension (IFT). Therefore, establishing the structure-property relationships of polymeric surfactants under relevant conditions is crucial for advancing practical implementations. To this end, we test the hypothesis that surface-activity of polymeric surfactants is governed primarily by the chemistry of the hydrophilic block. Specifically, we investigate the colloidal properties and interfacial properties of two amphiphilic diblock copolymers (BCPs), poly(styrene)-block-poly(acrylic acid) (PS-b-PAA) and poly(styrene)-block-poly(4-vinylpyridine) (PS-b-P4VP), under different aqueous conditions. We demonstrate that postpolymerization modification of PS-b-PAA with amino acids with varying hydrophilic properties strongly influences the IFT. Our results indicate that the addition of hydrophilic and ionic amino acids leads to larger reduction of interfacial tension and reduction in aggregation but also increases sensitivity to varying pH values and nonspecific interactions with dissolved ions in complex matrices, such as synthetic groundwater (SGW). In contrast, addition of hydrophobic amino acids leads to stable IFT values, indicative of higher tolerance to the presence of dissolved ions. We anticipate that these findings will advance further design of polymeric surfactants for selective interfacial sensing and enable the development of robust sensors for environmental monitoring.
Cardiac involvement in dengue ranges from transient, self-limited changes to life-threatening dysfunction. In children with severe dengue, early identification of electrocardiographic (ECG) abnormalities may inform risk and management. This study evaluated the pattern of ECG changes and their association with outcomes in pediatric severe dengue. We conducted a prospective observational study over one year in the pediatric wards and PICU of a tertiary care hospital. Children aged 1-18 years meeting WHO 2014 criteria for severe dengue and positive for NS1 and/or immunoglobulin M were enrolled. A 12-lead ECG was performed within 24 h of severe dengue diagnosis. Data were analyzed using Chi-square or Fisher's exact test (significance 0.05). Eighty children were included (mean age: 9.73 ± 5.08 years; 69% of males). Predominant clinical features were fever (85%), abdominal pain (47.5%), and vomiting (46.3%). Thrombocytopenia occurred in 92.5%, and liver function derangement in 50%. ECG was abnormal in 24/80 (30%): sinus tachycardia 66.7%, ST-T changes 45.8%, sinus bradycardia 37.5%, PR prolongation 29.2%, and other changes (arrhythmias, QRS alterations, and heart block) 20.8%. Overall, 95% were discharged, 3.8% developed MODS, and 1.3% died. About one-third of children with severe dengue had early ECG abnormalities, most commonly sinus tachycardia and ST-T changes. While ECG abnormalities overall did not predict mortality or MODS, arrhythmias, conduction/QRS abnormalities, and heart block were linked to longer hospitalization, suggesting increased morbidity and recovery time. Résumé Contexte:L’atteinte cardiaque dans la dengue varie de modifications transitoires et spontanément résolutives à des dysfonctions potentiellement mortelles. Chez les enfants atteints de dengue sévère, l’identification précoce des anomalies électrocardiographiques (ECG) peut contribuer à l’évaluation du risque et à la prise en charge. Cette étude a évalué le profil des anomalies ECG ainsi que leur association avec les issues cliniques dans la dengue sévère pédiatrique.Matériels et méthodes:Nous avons mené une étude observationnelle prospective pendant une année dans les services de pédiatrie et l’unité de soins intensifs pédiatriques d’un hôpital tertiaire. Les enfants âgés de 1 à 18 ans répondant aux critères OMS 2014 de dengue sévère et positifs pour l’antigène NS1 et/ou les immunoglobulines M ont été inclus. Un ECG à 12 dérivations a été réalisé dans les 24 heures suivant le diagnostic de dengue sévère. Les données ont été analysées à l’aide du test du Chi carré ou du test exact de Fisher (seuil de significativité: 0,05).Résultats:Quatre-vingts enfants ont été inclus (âge moyen: 9,73 ± 5,08 ans ; 69 % de garçons). Les principales manifestations cliniques étaient la fièvre (85 %), les douleurs abdominales (47,5 %) et les vomissements (46,3 %). Une thrombopénie a été observée chez 92,5 % des patients et des anomalies du bilan hépatique chez 50 %. L’ECG était anormal chez 24/80 enfants (30 %): tachycardie sinusale dans 66,7 %, modifications ST-T dans 45,8 %, bradycardie sinusale dans 37,5 %, allongement de l’intervalle PR dans 29,2 %, et autres anomalies (arythmies, altérations du QRS et bloc auriculo-ventriculaire) dans 20,8 %. Globalement, 95 % des patients sont sortis guéris, 3,8 % ont développé un syndrome de défaillance multiviscérale (MODS) et 1,3 % sont décédés.Conclusions:Environ un tiers des enfants atteints de dengue sévère présentaient des anomalies ECG précoces, les plus fréquentes étant la tachycardie sinusale et les modifications ST-T. Bien que les anomalies ECG dans leur ensemble ne prédisent ni la mortalité ni le MODS, les arythmies, les troubles de conduction/anomalies du QRS et les blocs cardiaques étaient associés à une hospitalisation prolongée, suggérant une morbidité accrue et un temps de récupération plus long.
The use of facet joint interventions for spinal pain management increased rapidly between 2000 and 2010, followed by slower growth from 2010 to 2019. Post-COVID analyses demonstrated a marked decline in facet joint interventions despite an increasing prevalence of chronic pain among traditional Medicare beneficiaries after 2019, together with multiple contributing factors over time, including enactment of the Affordable Care Act, COVID-19, the Inflation Reduction Act, and other influences. This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. traditional Medicare population across multiple periods from 2000 to 2024. A retrospective cohort study evaluating utilization trends and influencing factors for facet joint interventions in the fee-for-service (FFS) traditional Medicare population in the United States from 2000 to 2024. Data were derived from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2024). Utilization rates per 100,000 Medicare beneficiaries, percentage of change, and geometric average changes were calculated. Facet joint intervention utilization increased rapidly from 2000 to 2010 (15.5% annually), slowed from 2010 to 2019 (4.2% annually), and declined from 2019 to 2024 (-6.1% annually). Episodes followed similar patterns but declined less steeply than procedures (-6.7% vs. -27.1%). By 2024, service rates had returned to approximately 2012 levels (5,016 vs 5,046 per 100,000 beneficiaries). From 2000 to 2010, lumbar and cervical/thoracic facet joint blocks and radiofrequency ablation procedures increased substantially (13.5%-24.6% annually), followed by slower growth from 2010 to 2019 (2.8%-11.0%), a sharp pandemic-related decline from 2019 to 2020 (10.6%-17.4%), and partial recovery with modest growth or stabilization through 2024. Between 2019 and 2024, the episode ratio of facet joint nerve blocks to radiofrequency ablation declined from 1.9 to 1.7 for lumbar procedures and from 2.4 to 2.0 for cervical procedures, attributed to the mandatory radiofrequency policy. Interventional pain-related specialties accounted for the majority of facet joint procedures, increasing their share from 87.3% in 2010 to 95% by 2024, while surgical specialties declined from 4.8% to 2.0%. During the same period, the site of service shifted modestly from office settings (50.7% to 48.8%) and hospital outpatient departments (HOPD) (declining to 20.5%) toward ambulatory surgery centers (ASCs) (25.6% to 30.6%). These findings reflect increasing specialization, recent reductions in treatment intensity, and the influence of policy changes, Medicare Advantage shifts, and broader system pressures on pain management. The analysis was limited to the FFS traditional Medicare population and data availability through 2024, excluding utilization patterns for Medicare Advantage Plans, which covered 54% of Medicare enrollees in 2024. As with other retrospective claims-based studies, inherent limitations related to coding and administrative data apply. This retrospective analysis demonstrates a substantial decline in facet joint intervention episodes, with an overall reduction of 6.7% per 100,000 Medicare beneficiaries and an annual decline rate of 1.4% for episodes from 2019 to 2024. In contrast, services or procedures declined more markedly, with an overall reduction of 27.1% and an annual decline rate of 6.1% per 100,000 Medicare beneficiaries.
Radiolabeled heterodimeric peptides have emerged as a highly promising targeting strategy for PET imaging due to their superior binding properties. The Human epidermal growth factor receptor 2 (HER2)- and Arg-Gly-Asp (RGD)-targeting moieties bind to HER2 and integrin αvβ3, respectively, receptors that are both overexpressed in many different types of tumors. This study focuses on the synthesis and evaluation of the heterodimeric radioligand [68Ga]Ga-DOTA-HER2-RGD for PET imaging of the breast cancers-bearing mouse models that overexpress HER2 and/or integrin αvβ3. The heterodimeric radiopeptide was successfully synthesized and radiolabeled with 68Ga, achieving a radiochemical purity of > 95%. The receptor-binding properties and tumor-targeting efficacy were evaluated in vitro and in vivo using three breast cancer cell lines-MDA-MB-435 S (high HER2, high αvβ3), MDA-MB-231 (high HER2, low αvβ3), and MCF-7 (low HER2, low αvβ3)-and their respective xenograft models. Flow cytometry verified the cell-surface expression profiles of HER2 and integrin αvβ3 in all three cell types. In vitro cell studies showed that the MDA-MB-435 S cell line exhibited the highest uptake of [68Ga]Ga-HER2-RGD, followed by MDA-MB-231 and MCF-7. High specificity was demonstrated in blocking studies using excess unlabeled HER2-RGD. Competitive binding assays revealed that [68Ga]Ga-HER2-RGD exhibited high binding affinity, with an IC50 value of 12.9 nM. Micro-PET/CT imaging revealed a significant accumulation of [68Ga]Ga-HER2-RGD in MDA-MB-435 S xenografts, with no or very low uptake in nontarget organs and tissues. Consistent with the in vitro findings, the tumor-to-nontumor ratios across the three xenograft models followed the order: MDA-MB-435 S > MDA-MB-231 > MCF-7. A significant decrease in [68Ga]Ga-HER2-RGD uptake in the MDA-MB-435 S xenografts was observed after the administration of blocking amount of HER2-RGD. [68Ga]Ga-HER2-RGD demonstrates specific dual-receptor-targeting properties towards HER2 and integrin αvβ3, as evidenced by in vitro and in vivo studies. This radiopeptide shows promise as a novel PET agent for the noninvasive visualization of HER2 and/or integrin αvβ3 expression in breast cancer, and is capable of semi-quantitatively evaluating the expression levels of HER2 and/or integrin αvβ3 to a certain extent.
This review examines the use of polymer solutions for in-situ subsurface remediation, with a focus on their rheological behavior and implications for contaminant removal. The in-situ remediation of subsurface contamination is often constrained by aquifer heterogeneity, preferential flow, and limited reagent contact with trapped contaminants. Polymer solutions, particularly shear-thinning biopolymers such as xanthan gum (XG), have emerged as promising tools to overcome these challenges. Originally adapted from enhanced oil recovery applications, their unique rheological properties allow high injectivity near the well while promoting mobility control farther into the formation. This enables more stable displacement fronts, suppression of viscous fingering, and enhanced crossflow into low-permeability zones, thereby improving Non-Aqueous Phase Liquids (NAPLs) recovery while also enhancing contaminant removal and amendment delivery in low-permeability regions of heterogeneous media. Beyond direct displacement, polymers may act as carriers for a wide range of remedial amendments, including oxidants, reducers, electron donors, surfactants, and nanoparticles, improving their placement, persistence, and effectiveness. Yield-stress and densified formulations further expand applications by blocking preferential pathways or counteracting buoyancy forces in gravity-dominated systems. Field demonstrations confirm these benefits: Polymer-amended oxidants and electron donors have produced larger swept volumes, more homogeneous propagation, and longer remanence than water-based solutions, with electrical resistivity tomography and coring providing direct evidence of improved distribution and contact. Industrial-scale applications have also shown that formulation and injectivity must be carefully balanced to avoid excessive pressures, fracturing, or reagent incompatibility. Continued integration of laboratory rheology, numerical models, and field validation will be essential to fully realize polymers as multifunctional technologies for contaminant displacement, amendment delivery, and unwanted flow blocking. With growing field evidence, polymer solutions are poised to become central to the design of predictable, durable, and site-specific remediation strategies.
Immune checkpoint inhibitors (ICIs) have transformed oncologic care but can trigger a spectrum of immune-related adverse events. The triad of myocarditis, myositis, and myasthenia gravis, termed MMM overlap syndrome, is a rare but life-threatening complication. Reports have predominantly involved melanoma and lung cancer; cases of endometrial carcinoma have rarely been described. A 77-year-old woman with stage IV serous endometrial carcinoma presented 24 days after a single dose of carboplatin, paclitaxel, and pembrolizumab, with progressive weakness, ptosis, diplopia, and respiratory compromise. Initial evaluation revealed creatine kinase (CK) of 13,000 IU/L, peak high-sensitivity troponin I of 15,000 ng/L, a new right bundle branch block (RBBB) with intermittent high-degree atrioventricular (AV) block, transaminitis, and thyrotoxicosis, indicating concurrent four-organ toxicity. Acetylcholine receptor (AChR), MuSK, and LRP4 antibodies were all negative, consistent with seronegative ICI-induced myasthenia gravis. She was treated with pulse corticosteroids and plasma exchange (PLEX), with rituximab added after the second session for an inadequate response. Persistent myocarditis with sustained troponin elevation prompted further escalation to abatacept and ruxolitinib. Symptoms and serum biomarkers subsequently improved, and she was discharged on continued corticosteroids and ruxolitinib with a planned graded taper. To our knowledge, this is the second reported case of MMM overlap syndrome in endometrial carcinoma and the first implicating pembrolizumab in this malignancy. The case is distinguished by refractory disease requiring four sequential lines of immunosuppression, concurrent immune-mediated hepatitis and thyroiditis, and a seronegative myasthenia gravis profile, consistent with the more heterogeneous, non-antibody-mediated mechanisms increasingly recognized in ICI-induced disease. It informs treatment escalation in refractory cases and underscores three principles essential to managing this high-mortality syndrome: early recognition, systematic screening for all syndromic components once any one is identified, and timely escalation through multiple lines of immunosuppression when disease proves refractory.