This article comprehensively evaluates the energy, exergy, environmental, and economic performance of a hybrid system integrating a proton exchange membrane (PEM) electrolyzer with an organic Rankine cycle (ORC) driven by flat-plate solar collectors (FPSCs) (224.64 m2) under varying flow rates. Five flow rates were simulated in engineering equation solver (EES), yielding daily electricity outputs between 86.33 MJ and 91.52 MJ, equivalent to 2.676-2.837 GJ throughout July. Hydrogen production ranged from 414.35 to 439.30 g per day, resulting in 12.85-13.62 kg over the month. The highest hourly energy efficiencies varied from 23.82% to 21.71%, while the maximum exergetic efficiencies remained nearly constant at 6.70%-6.72%, indicating stable system behavior. The hybrid setup reduced CO2 emissions by 39.39-42.56 kg per day, totaling 1221.09-1984.31 kg in July. While the financial gain declined marginally as the flow rate increased from 10.90 USD to 10.15 USD per day, corresponding to 337.91-314.57 USD monthly, the system nevertheless indicated considerable operational and ecological advantages. The average monthly electricity generation across the evaluated flow rates was calculated as 1.974 GJ, corresponding to an average monthly revenue of 235.12 USD and an estimated annual revenue of 2,821 USD, with a simple payback period of 9.73 years.
Few studies have specifically investigated which muscles are involved in abnormal joint posture (AJP) due to muscle spasticity and should therefore be targeted for botulinum toxin injections. This gap has significant implications for treatment efficiency, safety, health economics, and sustainable healthcare. A 2000 to 2025 (July) PubMed search identified 3,488 articles, but only 7 articles met the criteria for providing a method to determine the muscles involved in AJP due to muscle spasticity. Of these, just 2 have proposed how to measure each muscle contribution and only 1 focused on identifying the muscle actually responsible for the observed AJP. There are many strategies for determining the muscles involved in spasticity-related AJP, but they are primarily based on inference. They draw on clinical skills, which incorporate descriptive and functional anatomy, knowledge of different muscle and joint structures, simple rules of biomechanics, determination of the exact phase of the movement involved, consideration of compensatory AJP in these motor control deficient patterns, and, of course, the patient's goals. Achieving the authors' proposed objective would enable the standardization of clinical practices, confirm the effectiveness of treatments for spasticity, particularly botulinum toxin, and ensure that the correct dose is injected in the right muscle.
Leucocytozoon spp. are common avian haemosporidian parasites that can cause clinical symptoms with lethal cases in poultry worldwide. However, leucocytozoonosis has not been reported in domestic ducks (Anas platyrhynchos domesticus) in Japan. Two adult domestic ducks maintained in a zoological garden in Japan became lethargic, exhibited labored breathing, and died in July 2024. These ducks had hemorrhages in the visceral organs with splenomegaly and hepatomegaly. Megaloschizonts of haemosporidia were histologically observed in the spleen and other organs. Partial sequences of Leucocytozoon mitochondrial cytochrome b gene DNA were determined and classified as lineages known to infect wild waterfowl (Anseriformes). To the best of our knowledge, this is the first known fatal case of leucocytozoonosis in domestic ducks in Japan.
To determine the outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes with anterior chamber intraocular lenses (ACIOLs). Retrospective chart review of DSEK procedures in eyes with ACIOLs from May 2006 to December 2024 and posterior chamber intraocular lenses (PCIOLs) from May 2006 to July 2020 (control group). Cox analysis of risk factors for secondary graft failure (SGF) was performed. A total of 132 and 608 DSEK procedures were performed in ACIOL and PCIOL groups with a median follow-up of 21.7 and 36.8 months, respectively (P < 0.01). There were no significant differences between the groups in the mean VA improvement, or incidence of primary graft failure, graft dislocation, endothelial rejection, or postop intraocular pressure elevation, although glaucoma surgery was more common in the ACIOL group (14.4% vs. 6.7%, P < 0.01). The incidences of SGF in the ACIOL and PCIOL groups were 0.14 and 0.13 per eye-year (P = 0.47) and 0.11 and 0.01 per eye-year (P < 0.01) in eyes with and without glaucoma, respectively. An ACIOL increased the risk of SGF in eyes without glaucoma [hazard ratio (HR): 6.5 (2-21.4)], with a trend toward significance in eyes with medically treated glaucoma [HR: 1.9 (0.8-4.7)] but not in eyes with prior glaucoma surgery. Prior graft failure [HR: 1.8 (1.2-2.7)] and endothelial rejection [HR: 2.2 (1.2-3.3)] also increased the risk of SGF. An ACIOL increases the risk of SGF after DSEK in eyes without glaucoma but not in eyes with prior glaucoma surgery. Therefore, IOL exchange should be considered before DSEK in eyes with an ACIOL and without prior glaucoma surgery.
Maternal fever during labor analgesia may arise from infectious causes (such as chorioamnionitis) or noninfectious causes (such as epidural-related maternal fever [ERMF]). While chorioamnionitis is associated with neonatal outcomes, the impact of isolated ERMF remains controversial. This is due, in part, to the potential for occult intrauterine infection, which may not be clinically apparent during labor. Consequently, inadequate consideration of histological chorioamnionitis has limited the scope and validity of previous studies. This study aimed to evaluate the effects of ERMF on neonatal outcomes by excluding confirmed histological chorioamnionitis and minimizing suspected infection using predefined clinical criteria. This retrospective study included women with singleton term deliveries under labor analgesia between January 2017 and July 2023. Cases with fetal anomalies or growth restriction were excluded. Placental pathological examination was performed when any of the predefined risk-based criteria were met, irrespective of maternal fever: clinical suspicion of chorioamnionitis, prolonged rupture of membranes, and neonatal asphyxia. Among febrile cases, short-term neonatal outcomes were first compared between those with and without histological chorioamnionitis. Subsequently, outcomes were compared between mothers with intrapartum fever (≥38 °C) and those without fever using propensity score matching. Long-term infant development was assessed using a Maternal and Child Health Handbook-based questionnaire. Overall, 186 matched pairs were included. All matched covariate standardized mean differences were <0.1, confirming acceptable balance. Compared with the nonfever group, the fever group had longer mean ± standard deviation durations from rupture of membranes to delivery (12.9 ± 9.4 vs 8.7 ± 10.9 hours; difference 4.2 hours; 95% confidence interval [CI], 2.17-6.33), first stage of labor (13.2 ± 6.7 vs 9.6 ± 6.3 hours; difference 3.6 hours; 95% CI, 2.32-4.99), and duration of labor analgesia (14.9 ± 9.6 vs 8.6 ± 6.7 hours; difference 6.3 hours; 95% CI, 4.62-8.01), along with a higher incidence of fetal tachycardia (36.0 vs 10.7%; absolute risk difference 25.3%; 95% CI, 12.3-37.2). In contrast, maternal fever was not associated with adverse neonatal outcomes, including umbilical artery pH <7.2, Apgar score <7 at 1 and 5 minutes, or neonatal intensive care unit admission. Growth and developmental milestones assessed at long-term follow-up using the Maternal and Child Health Handbook questionnaire were within the normal range in both groups. Following exclusion of histological chorioamnionitis, ERMF was associated with prolonged labor and fetal tachycardia but was not associated with adverse short-term neonatal outcomes or impaired long-term development.
This article presents a harmonized dataset combining environmental and epidemiological indicators to monitor COVID-19 activity across Germany over 131 consecutive weeks (July 2022-December 2024). The dataset integrates population-weighted SARS-CoV-2 RNA concentrations from wastewater with four independent indicators derived from clinical and participatory surveillance systems: incidence estimates from the German notification system, self-reported incidence estimates from the GrippeWeb participatory system, incidence estimates derived from the combination of GrippeWeb acute respiratory infection data with virological SARS-CoV-2 positivity rates, and incidence estimates based on primary care COVID-19 diagnoses adjusted for healthcare-seeking behavior. All case-based indicators are provided as weekly incidence estimates per 100,000 inhabitants or active participants, where applicable, and are aligned to calendar weeks starting on Monday. Wastewater values represent viral loads measured in gene copies per litre of wastewater and summarize samples collected from the previous Thursday through the current Wednesday. The dataset allows for the assessment of relationships between wastewater signals and case-based indicators of disease activity. This article focuses on dataset construction, harmonization, and structural characteristics, including temporal alignment challenges, and outlines potential analytical use cases.
As populations age and cities become more densely populated, urbanicity is transforming neighborhood environments that influence healthy aging. However, how dementia mortality varies across the urbanicity gradient and how neighborhood conditions contribute to this pattern remain unknown. To examine dose-response associations of urbanicity with dementia mortality, quantify the extent to which neighborhood socioeconomic and environmental factors attenuate this pattern, and estimate potential deaths averted under feasible improvements in modifiable conditions. This prospective cohort study used person-level mortality data linked to the national census across 32 844 lower super output areas (ie, small census-based geographic areas) in England from March 2011 to February 2023. Individuals aged 16 years and older with National Health Service general practice registration in England were included. Data were analyzed from July 2025 to January 2026. Participants' residential addresses were linked to UK Census-based social and environmental data. Urbanicity was defined as neighborhood population density (persons per hectare), and neighborhood conditions included income, employment, education, crime, living environment, housing, and service accessibility. The primary outcome was mortality with dementia as the underlying cause, and the secondary outcome was mortality with dementia mentioned anywhere on the death certificate. Dose-response associations were examined using Cox proportional hazards models with hazard ratios and 95% CIs. Contribution of neighborhood conditions to these associations was assessed using the percentage of excess risk attenuated. Potential death averted under feasible improvements were estimated using parametric g-computation. A total of 40 948 445 individuals (mean [SD] age, 46.9 [19.3] years, 21 263 986 females [51.9%]; 1 190 069 Black [2.9%]; 1 091 312 Indian [2.7%]; 35 973 092 White [87.9%]) were followed up for a median (IQR) of 8.68 (4.47-11.90) years. There were 5 309 719 deaths, including 621 756 underlying-cause and 926 502 any-mention dementia deaths. Dementia mortality showed a curvilinear inverted U-shaped association with urbanicity, peaking at mid-urbanicity (around 20 to 40 persons per hectare) and declining at both extremes. This pattern was consistent across subgroups, dementia subtypes, and all-cause mortality. For mortality with dementia as the underlying cause, adjustment for all factors largely eliminated the gradient (≥71% attenuated), with accessibility and living environment contributing the most. Scenario analyses shifting both service accessibility and outdoor living environment from the lowest to the second quintile estimated 65 572 (95% CI, 42 036-88 783) dementia deaths averted (10.5% reduction), compared with 43 452 (95% CI, 24 214-62 775) deaths averted (7.0% reduction) for accessibility-only, and 22 700 (95% CI, 11 086-34 201) deaths averted (3.7% reduction) for living environment-only improvements. Estimated gains were larger in males, adults aged 45 to 54 years, residents of private households (vs residents of care homes), and Black residents living under a scenario of improvement to both accessibility and environment. In this cohort study, dementia mortality risk was greatest in mid-urbanicity and lower in dense urban cores and rural areas, and this gradient was largely attenuated by neighborhood conditions. These findings suggest that targeted improvements in modifiable neighborhood conditions may substantially reduce dementia mortality and advance equity, particularly in vulnerable communities.
Apnea testing is an integral component of brain death (BD) assessments. The optimal method of Apnea Testing is currently not known. To describe the current use of apnea test methods, and compare the effect of the chosen apnea test method (passive oxygenation, continuous positive airway pressure [CPAP], or exogenous Co2) on safety and duration of apnea test in adult BD/death by neurologic criteria (DNC) organ donors. A prospective multicenter observational study. Seventy-four ICUs in Ontario, Canada, who participate in organ donation practices. All BD/DNC assessments in Ontario, Canada, from July 2023 to August 2024. None. Outcomes included the rate of apnea test attempts, completions, and adverse events. We also measured the incidence of each method used and the duration of the apnea test. During the 1-year study period, a total of 368 BD/DNC assessments were performed, of which 361 (98%) attempted an apnea test. Of the 361 apnea tests attempted, 236 (65%) used passive oxygenation (tracheal insufflation), 103 (29%) used CPAP-based methods, and 22 (6%) used exogenous Co2. Nine tests were not completed: seven were terminated due to adverse events (all with passive oxygenation; five hypoxemia, two hemodynamic instability) and two due to observed respiratory effort. All adverse events occurred with the passive oxygenation method (p = 0.20). No statistically significant differences were seen in apnea test duration between methods. The median test durations were 12 minutes (interquartile range [IQR], 10-17 min), 12 minutes (IQR, 8-15 min), and 15 minutes (IQR, 11-25 min) for passive oxygenation, positive pressure, and exogenous Co2, respectively. In this large multicenter study, passive oxygenation was associated with a nonsignificant increase in adverse events compared with CPAP-based and exogenous Co2 methods. Exogenous Co2 did not shorten apnea test time. These findings support further investigation of CPAP-based methods as an alternative approach to apnea testing and refinement of Co2 delivery parameters.
Methadone is a highly effective treatment for opioid use disorder (OUD). Yet its impact is constrained by low rates of treatment initiation and retention, driven in part by geographic inequalities in the availability of methadone-providing opioid treatment programs (OTPs) and restrictions on the types of clinical settings where methadone can be dispensed. In response, in July 2021, the Drug Enforcement Administration released a new rule allowing OTPs to dispense medications for OUD-including methadone-through mobile medication units (MMU) without the need for additional treatment waivers. We conducted interviews with 11 participants living in a residential substance use treatment facility in NYC and receiving methadone treatment (MT) from an MMU. Interview data were coded using Dedoose software based on a combination of inductive and deductive coding strategies, and guided by a thematic approach to explore patient's treatment experiences and perceptions. Participants described MMU as substantially reducing the logistical burden of treatment while also allowing patients to avoid problems associated with brick-and-mortar OTPs. Some raised minor complaints (i.e., additional waiting time on medication delivery days), yet participants framed these concerns within the context of their overall preference for MMU. Participants also expressed uncertainty about how methadone treatment would continue after leaving residential care, highlighting potential challenges in transitioning from mobile services to traditional clinic settings. Our findings provide qualitative evidence from patients' perspectives on how mobile methadone delivery can potentially reshape the logistical demands, treatment environments, and continuity-of-care challenges associated with methadone treatment in residential settings.
As population aging accelerates, elder abuse has become a public health concern. Although caregiver burden is recognized as an important risk factor for elder abuse, the psychological mechanisms underlying this association among nursing home caregivers remain unclear. This study aims to investigate the relationships among caregiver burden, well-being, negative coping, and elder abuse tendency, with a specific focus on the mediating effects of well-being and negative coping and the moderating role of care recipient dependency. A cross-sectional study was conducted, recruiting 858 caregivers from 108 nursing homes from July to August 2025 in Fujian Province, China, using a convenience sampling method. Data were collected using the Zarit Burden Interview (ZBI), Caregiver Abuse Screen (CASE), World Health Organization Five Well-Being Index (WHO-5), and the negative coping subscale of the Simplified Coping Style Questionnaire (SCSQ). Structural equation modeling (SEM) was used to test the parallel mediating effects of well-being and negative coping, and multi-group analysis was performed to examine the moderating role of care recipient dependency. Caregiver burden, well-being, negative coping, and elder abuse tendency were significantly correlated (all p < 0.001). Caregiver burden and negative coping were positive predictors of elder abuse tendency, whereas satisfaction with remuneration and well-being were negative predictors (all p < 0.05). Well-being (β = 0.090, p = 0.008) and negative coping (β = 0.072, p = 0.012) significantly mediated the relationship between caregiver burden and elder abuse tendency. Multi-group analysis revealed that care recipient dependency significantly moderated the direct path between caregiver burden and elder abuse tendency (Z = - 2.889, p = 0.004): caregiver burden significantly positively predicted elder abuse tendency in the higher-dependency group (β = 0.288, p = 0.001), but not in the lower-dependency group (β = -0.091, p = 0.289). Higher caregiver burden was associated with greater elder abuse tendency through pathways involving lower well-being and greater negative coping. Notably, a direct association between caregiver burden and elder abuse tendency was observed only among caregivers supporting higher-dependency older adults. These findings highlight the importance of strengthening caregivers' psychological resources and coping capacities, and may inform targeted support and management strategies in institutional care settings. Not applicable.
Malnutrition is associated with adverse surgical and oncologic outcomes. This work aims to evaluate the prevalence of malnutrition and vitamin deficiency, as well as completion of preoperative evaluation of nutritional status, in patients with ovarian cancer. A retrospective single-institution cohort study of patients undergoing surgery for newly diagnosed ovarian cancer between January 1, 2018 and July 1, 2024 was performed. Malnutrition was defined as: albumin ≤3.0 g/dL, prealbumin ≤18 mg/dL or Malnutrition Screening Tool (MST) ≥2. Vitamin deficiencies and insufficiencies were defined in accordance with our high-risk surgical encounter clinic guidelines. Evaluation of nutrition status was defined as the documentation of MST, albumin, prealbumin or vitamin levels within 90 days of surgery. 235 patients met inclusion criteria, with median age 61 and body mass index 27 kg/m2. Most patients had advanced stage disease (145,61.7%). All patients had documentation of the MST, and 219 (93.2%) had any nutritional lab evaluation, with albumin assessment being most common (196, 83.4%). Of the 235 patients, 114 (48.5%) met criteria for malnutrition. Among the fewer patients who underwent vitamin deficiency workup (140, 60.0%), vitamin C and D abnormalities were found in 12/100 (12.0%) and 34/105 (32.4%) patients, respectively. Vitamin C and D insufficiencies were found in 48/100 (48.0%) and 72/105 (68.6%). Vitamin B12 and folate deficiencies occurred in 24/124 (19.4%) and 11/119 (9.3%) patients, respectively. Malnutrition and vitamin abnormalities are common among patients with ovarian cancer. Comprehensive and standardized preoperative evaluation of nutritional status and vitamin deficiency is recommended.
To identify the clinical characteristics associated with initial TNFi nonresponse in JSpA patients METHODS: Retrospective analysis of JSpA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry between July 2015 and January 2019 and their response to first TNFi agent. JSpA population included enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Demographic and disease characteristics were compared at baseline visits prior to TNFi start and at time of initial TNFi non-response or the visit closest to 6 months following TNFi start for the responders. 286 patients met inclusion criteria; 168 were TNFi responders and 118 were TNFi nonresponders. Median time to TNFi non-response was 8.9 months (IQR: 5.3, 14.2 months). Median age at TNFi start was similar for non-responders (13.9y) and responders (13.8y, p=0.91). Non-responders were more likely to be female, 61.9% vs 48.2% (p=0.02), have higher BMI , 21.6 vs 19.2 (p=0.02) and longer symptom duration, 2.2y vs 1.4y, (p=0.04) compared to responders. Non-responders had more clinical sacroiliitis and higher patient global assessment (PtGA) at baseline visit compared to responders (p=0.004, p=0.007, respectively). The majority were secondary non-responders (N=113/118; 96%). Most patients switched to 2nd TNFi (60.2%) following initial TNFi non-response. Most nonresponders to TNFi had secondary nonresponse. JSpA patients who did not respond to initial TNFi were more likely to be female, have longer symptom duration prior to starting a TNFi, clinical sacroiliitis, and higher BMI and PtGA scores at baseline. Patients with these features should be monitored more carefully for treatment response.
Tuberous sclerosis complex (TSC) is a genetic multisystem disorder with a high prevalence of drug-resistant epilepsy (DRE), significantly affecting patients' quality of life. For patients with TSC lacking localizing epileptogenic tuber, resective surgery is often not feasible. Vagus nerve stimulation (VNS) has been proposed as an alternative surgical therapy, although robust evidence in TSC-related DRE remains limited. A prospective cohort study was conducted between December 2019 and July 2024 across multiple epilepsy centers in China. Seventy patients with TSC-related DRE were enrolled, all lacking resectable epileptogenic tubers on multidisciplinary evaluation and ineligible for resective surgery. Participants were divided into VNS (n = 20) and medication-only (n = 50) groups based on actual treatment, and followed for up to 3 years. Seizure outcomes, anti-seizure medication use, IQ, and quality of life were evaluated longitudinally. The VNS group demonstrated significantly higher response rates at 1-, 2-, and 3-year follow-ups (65%-75%) compared to the medical treatment group (31%-36%). Median and average seizure frequency reductions were also greater in the VNS group. VNS was associated with significantly higher treatment response than medication, with the relative risk (RR) of response being 1.81 (95% confidence interval [CI]: 1.22-2.67), 2.21 (95% CI: 1.42-3.44), and 2.42 (95% CI: 1.49-3.93) at 1-, 2-, and 3-year follow-ups (p < 0.01). Seizure recurrence was significantly lower in the VNS group (p < 0.01). Moreover, VNS treatment led to significant reductions in anti-seizure medication (ASM) use and improvement in intelligence quotient and quality of life at the 2-year follow-up. Treatment modality was the only independent predictor of clinical response. VNS was well tolerated, with only mild surgical complications and no permanent adverse events reported. VNS significantly improves seizure control, cognitive outcomes, and quality of life, with a favorable safety profile. These findings support VNS as an effective and safe alternative for this specific TSC population. Future randomized controlled trials are warranted to further validate these results.
Low enrollment threatens the sustainability of China's voluntary health insurance system. Limited health insurance literacy and numeracy may create a cognitive barrier to informed decision-making regarding enrollment. This study aims to identify latent profiles of health insurance literacy and numeracy, and to evaluate their associations with Supplementary Voluntary Health Insurance (SVHI) enrollment. A cross-sectional survey utilizing face-to-face computer-assisted personal interviews was conducted between July and August 2024 across three Chinese provinces (Shandong, Henan, and Sichuan). Using multistage stratified sampling, 1,326 valid responses were collected from residents aged 18 years or older (out of 1,359 approached). Health insurance literacy was assessed using a validated scale comprising self-rated abilities and an objective knowledge quiz, while numeracy was measured via an adapted 3-item General Numeracy Scale. Latent profile analysis identified unobserved cognitive subgroups. Multivariable logistic regression with robust standard errors evaluated the associations between latent profiles and SVHI enrollment, adjusting for relevant covariates. A total of 1,326 participants were included in the analysis, of whom 369 (27.8%) were male and 610 (46.0%) were aged between 18 and 44 years. Of the participants, 195 (14.7%) had an education level of elementary school or lower. Three distinct cognitive profiles were identified: Profile 1 ("High health insurance literacy, High numeracy", 32.9%), Profile 2 ("High health insurance literacy, Low numeracy", 52.0%), and Profile 3 ("Low health insurance literacy, Low numeracy", 15.1%). In multivariable logistic regression, participants in profile 1 (OR = 2.14; 95% CI, 1.23-3.70) and profile 2 (OR = 2.40; 95% CI, 1.43-4.02) were significantly more likely to enroll in SVHI than those in Profile 3. This study found that distinct cognitive profiles of health insurance literacy and numeracy were associated with SVHI enrollment. Individuals with low health insurance literacy and low numeracy were significantly less likely to enroll in SVHI than those with higher levels of both. These findings may inform targeted communication and support strategies to improve equitable access to SVHI among populations with lower health insurance literacy and numeracy.
The role of embolization in iliopsoas hematoma (IPH) remains unclear, and there are no specific guidelines regarding the optimal timing of this procedure. This study aimed to assess the effect of embolization on 30-day mortality in patients with IPH. This retrospective multicenter study included patients with Computed Tomography (CT)-confirmed IPH and active arterial bleeding between January 2017 and December 2023 in the first center and between January 2015 and July 2020 in the second center. Clinical, biological, imaging and procedural data were retrospectively collected. Embolization was performed by interventional radiologists, and procedural details were recorded. The effect of embolization on 30-day mortality was assessed using propensity score matching and Cox regression analyses. A total of 146 patients with CT-confirmed IPH and active bleeding were included. The 30-day mortality rate was 40/146 (27%). Mortality rates were 15/51 (29%), 14/52 (27%), and 11/43 (26%) for conservative management, embolization, and surgery, respectively (P = 0.84). No significant difference in 30-day mortality was observed before or after propensity score matching. In multivariable analysis, a delay ≥ 3 h between CT and embolization and anticoagulation reversal therapy administration were independently associated with higher 30-day mortality (hazard ratio [HR], 8.69; 95% CI, 1.02-72.24; P = 0.046 and HR, 4.69; 95% CI, 1.03-21.39; P = 0.047, respectively). In this multicenter cohort, embolization did not improve 30-day survival. However, among embolized patients, shorter CT-to-embolization delays were associated with better outcomes, suggesting that when embolization is chosen, it should be performed promptly.
Regional nerve blocks may improve perioperative pain control in pediatric patients undergoing thoracic surgery, potentially minimizing opioid use and improving outcomes. We sought to understand the association between regional block and opioid use postoperatively in pediatric patients undergoing the Nuss procedure for pectus excavatum. We performed a single-site retrospective cohort study of patients ≤18 years-old between May 2021 and July 2024. Patients with a diagnosis of pectus excavatum and meeting standard criteria for candidacy for surgical correction who underwent minimally invasive repair of pectus excavatum via Nuss procedure were included. All patients underwent cryoablation and received either erector spinae plane blocks with liposomal bupivacaine (LB) or plain bupivacaine or ropivacaine. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between perioperative regional block and opioid use as determined by morphine milligram equivalents (MME). During the study period, 82 patients were included. The average age was 15 years (SD 1.6) and patients were majority male (83%, n = 68). A total of 39 patients (48%) underwent perioperative blocks using LB. Total MME was significantly higher in the plain bupivacaine/ropivacaine group (183 versus 78, P < 0.001). Evaluation of total MME consumption by postoperative day demonstrated significantly higher opioid and opioid-equivalent use in the plain bupivacaine/ropivacaine group for all time points (P < 0.001 postoperative day #0-2). No difference was seen in hospital length of stay between groups. These findings suggest erector spinae plane blocks with LB may be considered an effective alternative for perioperative analgesia in pediatric thoracic surgery patients.
The efficacy and safety of various dural sealants for dural closure have been evaluated in randomized controlled trials (RCTs). However, their associations with postcraniotomy complications remain to be compared. A Bayesian network meta-analysis (BNMA) was designed on the basis of studies published in PubMed, Embase, the Cochrane Library, Scopus, and Web of Science through July 9, 2025. Quality assessment was conducted using the National Institutes of Health (NIH) scale. BNMA was performed in R 4.5.1 with the "GeMTC" package, with SUCRA values and league tables generated to display comprehensive pairwise comparisons among different sealants. The certainty of evidence for each network estimate was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. Eleven studies (3094 patients who underwent craniotomy) were included. TissuePatchDural (RR = 0.03, 95% CrI (0.0007, 0.42), SUCRA = 90.52%), autologous materials (RR = 0.09, 95% CrI (0.003, 0.69), SUCRA = 73.07%) and synthetic hydrogels (RR = 0.16, 95% CrI (0.04, 0.48), SUCRA = 59.68%) had 95% CrIs excluding 1, suggesting a lower risk of postcraniotomy cerebrospinal fluid leakage than for conventional closure alone. Autologous materials showed a favorable probability for meningitis prevention (RR = 0.13, 95% CrI (0.02, 0.74), SUCRA = 82.70%). The SUCRA values indicated favorable probabilities for TissuePatchDural to prevent surgical site infection and pseudomeningocele and for autologous materials to reduce the risk of unplanned interventions, although these secondary outcomes lacked statistical significance. The results of this BNMA suggest that compared with conventional closure alone, TissuePatchDural has a greater probability of reducing cerebrospinal fluid leakage, whereas autologous materials showed favorable efficacy signals for postoperative meningitis.