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Background Intracapsular femoral neck fractures in adults aged 40-60 years present a therapeutic challenge. Calcar buttress fixation using the biplane double-supported screw fixation (BDSF) concept serves to enhance load transfer through dual cortical support. This study aimed to evaluate the functional and radiological outcomes of calcar buttress BDSF fixation using a locking compression screw system in adults aged 40-60 years with intracapsular femoral neck fractures. Methods This prospective observational study was conducted at a tertiary care hospital from September 2022 to June 2024 and included adults aged 40-60 years with intracapsular femoral neck fractures presenting within three weeks of injury. All 25 patients underwent closed reduction and internal fixation using calcar buttress BDSF with a titanium locking compression screw system. Standardized rehabilitation included progressive weight-bearing from toe-touch at one week to full weight-bearing by 8-12 weeks. Patients were assessed at 1, 3, 6, and 12 months using the Harris Hip Score (HHS) and Visual Analogue Scale (VAS). Radiological union, Pauwels type-wise outcomes, and complications were recorded. Serial functional outcomes were compared using paired t-tests, and subgroup categorical comparisons were analyzed using Fisher's exact test, as appropriate. Results Mean age was 50.6 years (range 40-60 years); 16 of 25 patients (64.0%) were male. Falls accounted for 16 of 25 injuries (64.0%). Mean operative time was 58.8 minutes, with a mean intraoperative blood loss of 44 mL. Mean HHS improved significantly from 72.72 ± 7.22 at one month to 87.84 ± 7.30 at 12 months (p < 0.001). At 12 months, 14 of 25 patients (56.0%) achieved excellent outcomes, 7 of 25 (28.0%) achieved good outcomes, and 4 of 25 (16.0%) achieved fair outcomes; none had poor results. Mean VAS decreased from 8.04 ± 0.74 to 2.68 ± 1.38 (p < 0.001). Overall radiological union at 12 months was achieved in 24 of 25 patients (96.0%; 95% CI: 80.5%-99.3%). Union rates by Pauwels type were as follows: type 1, 4/4 (100.0%; 95% CI: 51.0%-100.0%); type 2, 11/12 (91.7%; 95% CI: 64.6%-98.5%); and type 3, 9/9 (100.0%; 95% CI: 70.1%-100.0%). Mean femoral neck shortening at 12 months was 5.3 ± 1.4 mm overall and was greatest in Pauwels type 3 fractures (6.5 ± 1.0 mm; p < 0.001). Conclusions Calcar-buttress BDSF fixation using a locking compression screw system may be considered a head-preserving fixation technique with encouraging early results for intracapsular femoral neck fractures in adults aged 40-60 years; however, the modest sample size and wide subgroup confidence intervals require cautious interpretation and preclude definitive comparative conclusions. Larger comparative studies are needed to confirm these findings.
To analyze the effects of cervical headgear (CHG) timing on costs and orthodontic outcome. Sixty-seven participants with Class II malocclusion were randomized into two groups. In the early group (EG, n = 33), CHG treatment began after the eruption of first upper molars. In the later-timed group (LG, n = 34), CHG treatment began nearly 2 years later. Orthodontic outcome was evaluated when CHG ended and at the end of follow-up using the Peer Assessment Rating (PAR) index and Little's Irregularity Index (LII). Costs were calculated using medical records, estimated chairside times and average personnel and material costs. The mean total costs including personnel and material costs during the follow-up were higher in the EG (€416) compared with the LG (€364) (p = 0.043). No statistically significant differences between the groups were found in the PAR and in the LII scores at the end of follow-up. The number of visits during CHG treatment was higher in the EG (13.3) compared with the LG (10.4) (p = 0.01). Earlier initiation of CHG treatment increased the personnel and material costs, number of appointments, and chairside time. Based on the PAR and in the LII scores, the orthodontic outcome of CHG treatment was equal regardless of the timing of the treatment. If orthodontic treatment during mixed-dentition stage is considered, it would be justified from an economic perspective to favor treatment during late mixed-dentition.
Introduction Kidney transplantation remains the treatment of choice for end-stage kidney disease (ESKD) because of its excellent outcomes in terms of both graft and recipient survival. However, preserving the long-term health of living kidney donors represents a major challenge in nephrology. Rigorous post-donation follow-up is essential for the early detection of potential renal and cardiovascular complications and for ensuring donor safety. Methods We conducted a retrospective, descriptive, and analytical study over a 26-year period (1998-2024) at the Ibn Sina University Hospital Center in Rabat, Morocco. The study included all living-related kidney donors (LRKD) who underwent nephrectomy for kidney donation according to the Kidney Disease: Improving Global Outcomes (KDIGO) eligibility criteria. The primary objective was to evaluate the incidence of chronic kidney disease (CKD) after donation. Secondary objectives included the assessment of cardiovascular complications, particularly hypertension, and the identification of associated risk factors. Estimated glomerular filtration rate (eGFR) was used to monitor renal function over time. Quantitative variables were expressed as mean±standard deviation, while qualitative variables were presented as frequencies and percentages. Univariate and multivariate analyses were performed, with statistical significance set at p<0.05. Results A total of 154 LRKD were included, with a mean age of 43±12 years and a predominance of female donors (male-to-female ratio: 0.45). During follow-up, infectious complications were the most frequently observed adverse events, affecting 38 donors (24.6%), with recurrent urinary tract infections being the predominant manifestation, reported in 17 donors (11%). In addition, hypertension was diagnosed in 17 donors (11%), while CKD developed in eight donors (5.2%) A decline in eGFR below 60 mL/min/1.73 m² was observed in eight donors (5.2%), with no progression to ESKD. The mean serum creatinine at 20 years of follow-up was 82.3±18.56 µmol/L. Multivariate analysis identified advanced age, male sex, and baseline eGFR as significant predictors of post-donation CKD (p<0.001), whereas no factor was significantly associated with the occurrence of hypertension. In addition, six full-term pregnancies were reported among female donors, without maternal or fetal complications. Conclusion Our findings highlight the importance of rigorous and long-term medical follow-up in LRKD in order to anticipate late complications. Particular attention should be paid to male donors, who appear to be at higher risk of developing renal impairment. Post-donation follow-up should be individualized to ensure optimal management and preserve donor health over time.
Miyazaki syndrome is a rare and underrecognized complication of long-standing cerebrospinal fluid (CSF) diversion. It usually occurs in patients with chronic CSF overdrainage and is caused by enlargement of the cervical epidural venous plexus, which may compress the spinal cord and cause progressive myelopathy or radiculopathy. Because symptoms develop slowly and may resemble degenerative cervical myelopathy or other neurological conditions, diagnosis is often challenging. We report two illustrative cases from our institution. The first patient was a 57-year-old man with a ventriculoperitoneal (VP) shunt placed at birth for neonatal intraventricular hemorrhage (IVH), who developed progressive spastic paraparesis, sensory ataxia, and increasing wheelchair dependence over several years. MRI showed chronic intracranial hypotension with marked cervical venous engorgement and upper cervical cord compression. He underwent shunt revision with the addition of an anti-siphon device, followed by radiological resolution of venous engorgement and partial clinical improvement. The second patient was a 44-year-old woman with congenital hydrocephalus treated with shunting since childhood, who presented with worsening gait disturbance, recurrent falls, impaired hand coordination, orthostatic headaches, and radicular pain. Imaging showed venous congestion at C2 with cord compression and chronic CSF hypotension. Her shunt was revised with placement of a Codman CERTAS® Plus programmable valve and anti-siphon device (Integra LifeSciences, Princeton, NJ, USA), resulting in improved venous drainage, cord decompression, and meaningful clinical recovery. To place these cases in context, we performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review - registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251048122) - of case reports and case series on Miyazaki syndrome or overshunting-associated myelopathy through May 2025 using PubMed, the Cochrane Library, and Google Scholar. Study quality was assessed with Joanna Briggs Institute tools, and data were extracted on patient characteristics, shunt type, valve configuration, anti-siphon device use, symptom latency, imaging findings, treatment, and outcomes. Thirty-one studies, including 37 patients, met the eligibility criteria. The mean age was 43.9 years, and VP shunts were the most common shunt type. The most consistent imaging finding was cervical epidural venous plexus engorgement with cord compression, often associated with pachymeningeal enhancement and slit ventricles. The median interval from the last shunt procedure to symptom onset was 14 years, and valve adjustability did not significantly influence this latency. Most patients were treated by correcting CSF overdrainage through valve pressure adjustment, conversion to a programmable valve, and/or addition of an anti-siphon or gravitational device. All patients treated with an anti-siphon device improved, and earlier treatment was associated with better outcomes. These findings emphasize that Miyazaki syndrome should be considered in shunted patients with progressive myelopathy and imaging signs of intracranial hypotension or CSF overdrainage. Early recognition and correction of siphoning through valve optimization and anti-siphon device placement may reverse venous congestion, improve neurological function, and prevent permanent spinal cord injury.
Introduction Recurrent urethral stricture following failed optical internal urethrotomy (OIU) is a clinically challenging condition with limited prospective outcome data from South Asian tertiary care centres. Augmentation urethroplasty using buccal mucosal graft (BMG) is increasingly employed in this setting; however, its outcomes in patients with prior failed endoscopic management remain poorly characterised in the Indian literature. Methods This prospective study enrolled 20 male patients with recurrent urethral stricture following a minimum of two failed OIU procedures at a tertiary care centre in central India between September 2022 and September 2024. Pre- and post-operative International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) were recorded at one, three, and six months. Postoperative complications were graded using the Clavien-Dindo classification. Success was defined as Qmax ≥15 ml/second at six months without urethral re-intervention. Statistical analysis used the Wilcoxon signed-rank test, the Friedman test, and the one-sample Wilcoxon signed-rank test for Qmax assessment. Results Mean preoperative IPSS was 17.90 ± 1.86, falling to 3.33 ± 1.19 at six months (p<0.001, Wilcoxon signed-rank test). All patients had a preoperative Qmax below 10 ml/second; mean postoperative Qmax was 17.33 ± 2.14 ml/second at six months, representing a statistically significant improvement from baseline (p<0.001). The success rate at six months was 94.4% (17/18). BMG was used in 85% of patients; dorsal onlay was the predominant technique (80%). Major complications (Clavien-Dindo Grade 3) occurred in 10% of patients; 90% experienced no or minor complications. Conclusions BMG augmentation urethroplasty achieves high short-term success rates with significant symptomatic improvement and an acceptable complication profile in recurrent urethral stricture following failed OIU, supporting its role as the procedure of choice after failed endoscopic management.
Metabolic surgery has emerged as an important therapeutic option for the management of type 2 diabetes mellitus (T2DM) and obesity and has gained increasing clinical attention in recent years. Ongoing research has expanded the understanding of various surgical techniques and their therapeutic efficacy. Nevertheless, concerns related to postoperative diabetes recurrence and the prevention and management of procedure-related complications continue to constrain the routine application of metabolic surgery in T2DM care. This review provides a systematic overview of the principal metabolic surgical procedures primarily used in the management of T2DM, compares their efficacy, and examines the incidence and management of associated complications. In addition, preoperative predictors of surgical outcomes are evaluated, and long-term postoperative effectiveness is reviewed. By synthesizing recent evidence, this review aims to offer clinicians and researchers a coherent theoretical framework and practical insights to support the incorporation of metabolic surgery into comprehensive multimodal strategies for diabetes management.
Uterine smooth muscle tumours are primarily classified as benign leiomyomas or malignant leiomyosarcomas, with diagnosis based on cytologic atypia, mitotic activity, and tumour cell necrosis. Smooth muscle tumour of uncertain malignant potential (STUMP), a rare variant accounting for 2-5% of myomas, cannot be unequivocally classified as benign or malignant and most commonly affects women aged 45-55. The clinical presentation is similar to that of fibroids, and management is surgical, though standardized procedures are lacking due to the uncertain malignant potential. While prognosis is generally favourable, STUMP may recur, occasionally as leiomyosarcoma, highlighting the need for careful postoperative follow-up. This retrospective study included 12 patients with histopathologically confirmed STUMP treated between 2019 and 2024. Clinical data were analysed, and patients were followed until July 2025 to assess survival, recurrence, and outcomes. Twelve patients with histopathologically confirmed STUMP were analysed, with a median age of 44.5 years and a median tumour size of 6.25 cm. Most patients presented with heavy menstrual bleeding (50%) or a pelvic mass (42%). Surgical treatment included hysterectomy in 50% of cases and myomectomy in 42%, performed via laparotomy, laparoscopy, or transvaginal approaches. After a median follow-up of 44 months, no recurrences were observed. Smooth muscle tumour of uncertain malignant potential remains a rare uterine neoplasm of uncertain malignant potential, requiring postoperative histopathological confirmation, individualized management, and long-term surveillance due to its risk of recurrence or metastasis.
We encountered a male infant with extremely low birth weight born at 22 weeks and 0 days of gestational age in the toilet at home. He was resuscitated with chest compression and bag-valve-mask ventilation by the emergency medical service crew and was transported to our institution 50 minutes after birth. The patient was intubated and given intratracheal artificial surfactant after admission. After he recovered from the initial hypotensive phase, we maintained the blood pressure at an appropriate level using nitroglycerin to avoid cerebral overcirculation. He was discharged home at 170 days of life with no signs of intraventricular hemorrhage or periventricular leukomalacia. His overall developmental quotient at one year and seven months of corrected age was 104, and he showed no apparent developmental delay. This case demonstrates that appropriate medical management can save the lives of extremely preterm infants born outside medical institutions.
Depression is prevalent and debilitating. Although interventions exist, they are rarely delivered in accessible, scalable ways that retain their effectiveness. Cognitive behavioral immersion (CBI) is a coach-led cognitive behavioral skills program delivered in social virtual worlds that offers a potential solution. This parallel-group, web-based randomized controlled superiority trial compared CBI accessed via virtual reality headsets (CBI-VR) or flat-screen devices (CBI-FS) to a delayed access control. Inclusion criteria included a clinical level of depression symptoms, age ≥18 years, able and willing to give informed consent, access to a computer with an internet connection, and ability to speak and read English. Eligible participants were randomized using a random number generation script in a 1:1:1 ratio to conditions. CBI consisted of 8 weekly 1-hour groups led by coaches who taught cognitive behavioral skills. The intervention lasted 8 weeks; follow-up lasted 6 months. The primary outcome was depression symptoms; secondary outcomes were anxiety symptoms and quality of life. Recruitment and study procedures were conducted online. Outcomes were assessed through electronic self-report questionnaires. The study was unblinded. Hierarchical linear modeling was used to examine differences in rates of change among conditions. We explored the sense of presence as a potential mediator of intervention response. Participants were recruited from February 2024 to January 2025; n=102 were randomized to each condition. Participants randomized to CBI-VR and CBI-FS attended an average of 5 intervention sessions. Primary analyses included all participants in the intent-to-treat sample that completed ≥2 outcome surveys to estimate within-person change (CBI-VR: n=98; CBI-FS: n=86; control: n=102). CBI-VR showed faster reductions in depressive and anxiety symptoms than either CBI-FS (depression: β=.21; 95% CI 0.02-0.40; P=.03 and anxiety: β=.20, 95% CI 0.03-0.38; P=.02) or the control (depression: β=.31, 95% CI 0.13-0.48; P<.001 and anxiety: β=.18, 95% CI 0.01-0.34; P=.03) across the 8-week intervention, with improvements largely maintained over the 6-month follow-up. CBI-VR also showed greater improvements in general quality of life (β=-1.02; 95% CI -1.63 to -0.40; P=.001) and psychological well-being (β=-1.01, 95% CI -1.44 to -0.59; P<.001) than the control from pre- to postintervention. The sense of physical presence in the environment was associated with CBI-VR's effects on depression symptoms (ab=-0.85, 95% CI -1.71 to -0.15). No adverse effects occurred in any group. This study evaluated the efficacy of an innovative coach-led cognitive behavioral skills group delivered via VR. To our knowledge, our trial is the first to demonstrate that CBI delivered via VR is effective. These findings extend prior work on digital cognitive behavioral therapy by supporting CBI-VR as an effective and viable intervention package for depression and anxiety symptoms. These findings may help inform future research on suitable technology that can help bridge mental health care gaps.
To assess how diagnostic pathways affect clinical outcomes and healthcare costs among older adults diagnosed with colorectal cancer (CRC). Many CRC cases in the United State are diagnosed during an emergency presentation, which have been linked to worse outcomes. Understanding how diagnostic routes may impact a cancer diagnosis may be critical for improving care. We analyzed SEER-Medicare data (2005-2019) for patients aged ≥ 65 years with CRC. Diagnostic routes were classified as screening, inpatient/outpatient (IP/OP), or emergency presentation (ER) based on encounters within 30-day to 6-months before diagnosis. Multivariable regression evaluated associations between route and outcomes. Among 79,251 CRC patients (colon: 72.4%, rectum: 27.6%), diagnoses occurred via ER (13.7%), IP/OP (60.6%), and screening (25.7%). Compared with screened patients, ER-diagnosed patients were older (median age: 79 vs. 75), had higher comorbidity (22.5% vs. 8.1%), and lower income (29.1% vs. 23.9%). ER diagnosis was associated with urgent surgery (59.7% vs. 20.1%), complications (29.8% vs. 14.2%), extended stay (37.2% vs. 14%), inpatient mortality (7.4% vs. 2.1%), lower discharge to home (32.2% vs. 62.4%), and higher 90-day mortality (16.8% vs. 5%). Multivariable analysis confirmed ER diagnosis as the strongest predictor of stage IV disease (OR 1.75, 95% CI: 1.66-1.84), urgent surgery (OR 5.14, 95%CI: 4.83-5.48), and 90-day mortality (OR 1.80, 95%CI: 1.62-1.99; all p < 0.001). Costs were higher for ER versus screening: index surgery ($13,802 vs. $11,458) and postoperative care ($9,470 vs. $3,655). Emergency CRC diagnosis was associated with worse outcomes and higher costs, emphasizing the need for targeted screening and earlier detection strategies.
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, behavioral disturbances, and loss of functional independence. As the global prevalence of AD continues to rise, traditional episodic care models are increasingly inadequate for providing continuous and individualized support. Wearable electronic devices offer a potential alternative by enabling non-invasive, real-time monitoring in everyday settings. This systematic review synthesizes current evidence on the applications, reported outcomes, and implementation challenges of wearable and wearable-adjacent technologies in AD care. A systematic literature search was conducted in September 2025 across five databases: PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, using keywords and MeSH terms related to wearable electronic devices, smart glasses, smartwatches, and Alzheimer's disease. The review protocol was prospectively registered in PROSPERO (CRD420251158703). Two independent reviewers screened records and extracted data in accordance with PRISMA 2020 guidelines. Methodological quality was assessed using a validated 10-item appraisal tool. Of 1399 identified records, ten studies met the eligibility criteria. For structured synthesis, the included technologies were organized into four architectural categories: body area network-based sensor systems, augmented reality smart glasses, hybrid wearable-mobile platforms, and wearable-adjacent assistive technologies. Across studies, the included technologies were applied to physiological monitoring, mobility and gait assessment, cognitive and spatial support, and caregiver communication. Findings suggest preliminary feasibility across these domains; however, small sample sizes, heterogeneous outcome measures, and predominantly early-phase study designs limit the strength of available evidence. Current evidence suggests that wearable and wearable-adjacent technologies may contribute to multiple aspects of AD care, particularly in home-based settings. Translation into routine practice requires prospective, adequately powered studies with standardized outcome frameworks, alongside regulatory alignment and patient-caregiver co-design to address persistent usability barriers.
Ischemia-reperfusion injury contributes to continued infarct growth despite successful recanalization. Ischemic postconditioning (IPostC) reduces infarct size in preclinical models, but its therapeutic effect as an adjunct to endovascular thrombectomy remains uncertain. We investigated whether IPostC performed after successful recanalization reduces infarct growth in patients with acute ischemic stroke. This single-center, prospective, randomized, open-label trial with blinded end point assessment was conducted at Tianjin Huanhu Hospital between September 2024 and May 2025. Patients with acute ischemic stroke who underwent endovascular thrombectomy within 24 hours of symptom onset or last known well, had a baseline National Institutes of Health Stroke Scale score ≥6 and a prestroke modified Rankin Scale score ≤2, and achieved successful recanalization after endovascular thrombectomy were randomly assigned to the IPostC or control group. IPostC consisted of 4 cycles of 2-minute balloon inflation followed by 2-minute deflation, with the balloon positioned at the original intracranial arterial occlusion site. The primary outcome was infarct growth from baseline to 48-hour magnetic resonance imaging (MRI). Secondary outcomes included infarct volume on immediate postprocedure MRI (within 2 hours) and on 48-hour MRI; early infarct growth and late infarct growth; serial National Institutes of Health Stroke Scale scores during hospitalization; and modified Rankin Scale score at 90 days. Primary and secondary outcomes were analyzed in the intention-to-treat population using unadjusted between-group comparisons. Sixty patients were enrolled, with 30 randomly assigned to each group. Infarct growth from baseline to 48-hour MRI was lower with IPostC than with control (median difference, -8.7 mL [95% CI, -17.1 to -1.4]; P=0.015). In the serial MRI subgroup (n=30; 15 per group), early infarct growth was also lower with IPostC (median difference, -3.2 mL [95% CI, -8.7 to -0.1]; P=0.045). Patients in the IPostC group had a lower National Institutes of Health Stroke Scale score at 24 hours (median difference, -3.0 [95% CI, -5.0 to -1.0]; P=0.005). The 90-day modified Rankin Scale distribution did not differ significantly between groups (common odds ratio, 1.1 [95% CI, 0.4-2.6]; P=0.921). In this pilot randomized trial, IPostC performed after successful recanalization reduced infarct growth in patients with acute ischemic stroke due to large-vessel occlusion. These findings require confirmation in larger randomized trials. URL: https://www.clinicaltrials.gov; Unique identifier: NCT06545734.
Postmenopausal osteoporosis (PMOP) is a common metabolic disorder in middle-aged and older women, leading to fractures, disability, and increased mortality. Current treatments include bisphosphonates (BPs), calcitonin (CT), vitamin D (VD), and acupuncture (Acu), often used in combination, but comparative evidence on different combined strategies remain limited. To systematically compare the efficacy and safety of acupuncture combined with various medications for PMOP, supporting evidence-based clinical decisions. We searched eight databases from inception to April 11, 2026 for randomized controlled trials (RCTs) evaluating acupuncture plus pharmacotherapy for PMOP. Primary outcomes included lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD), clinical efficacy, Traditional Chinese Medicine (TCM) syndrome scores, and Visual Analog Scale (VAS) pain scores. Secondary outcomes were procollagen type I N-terminal propeptide (PINP), C-terminal telopeptide (CTX), estradiol (E2), alkaline phosphatase (ALP), and osteocalcin (OCN). A Bayesian network meta-analysis was performed, ranking treatments by surface under the cumulative ranking curve (SUCRA). We included 112 RCTs (9, 908 patients, 83 treatment strategies). For LS-BMD, Calcitriol (Cal)_Electroacupuncture (ElecAcu) ranked highest. For FN-BMD, CT_VD_Traditional Chinese Medicine (TCM)_Fire dragon moxibustion (FDMox) (without BP) and CT_VD_BP_TCM_Acu (with BP) were best. TCM_Acu showed the best clinical efficacy. For TCM syndrome total score, CT_VD_ Du-moxibustion (DuMox) ranked lowest. For low back pain, TCM_Acu (without BP) and CT_VD_BP_Acu_Moxibustion (Mox) (with BP) were best. CT_VD_BP_Acu_Point Application Therapy (Pat) ranked lowest for VAS. CT_VD_BP_Acupoint injection (AcuInj) produced the lowest PINP, CT_VD_TCM_Acu the lowest CTX, and CT_VD_BP_TCM_Acupoint catgut embedding (ACE) the highest E2. For ALP, CT_VD_BP_Acu ranked lowest with BP, and CT_VD_Mox highest without BP. For OCN, CT_VD_Mox ranked highest without BP, and CT_VD_BP_TCM_Acu_Mox highest with BP. Acupuncture combined with pharmacotherapy offers differential benefits across efficacy outcomes in PMOP. However, fracture data were nearly absent (only one trial reported two hip fractures) and follow-up was short (≤12 months), limiting any inference on fracture prevention. Treatment selection should be individualized based on therapeutic priorities and patient characteristics, supporting personalized integrative management strategies. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251233374.
Chronic pelvic pain (CPP) affects approximately 26% of women and significantly impacts quality of life. Common causes include dysmenorrhea and pelvic floor dysfunction. Transcutaneous electrical nerve stimulation (TENS) is widely used for pain relief to inhibit pain transmission and stimulate endogenous opioid release. The aim of this study is to evaluate the effectiveness of TENS in the rehabilitation of pelvic pain in women through randomised controlled trials (RCTs). A systematic search was conducted in PubMed and ClinicalTrials.gov databases using the terms "transcutaneous electrical nerve stimulation", "pelvic pain", and "pelvic floor", selecting RCTs published between 2020 and 2025. Inclusion criteria followed the PICO framework, targeting adult women with CPP and TENS as the intervention. Studies involving males, pregnancy, or without full texts were excluded. PRISMA guidelines were followed; study quality was assessed using the Cochrane risk of bias tool. Four RCTs met the inclusion criteria; they involved 281 participants. Three studies focused on primary dysmenorrhea (PD) and one on vestibulodynia. All studies reported a significant reduction in pain following TENS treatment, assessed by the visual analogue scale or numeric rating scale, with some studies also noting reduced analgesic consumption. However, improvements in secondary outcomes such as sexual function and pelvic floor muscle strength were inconsistent. Transcutaneous electrical nerve stimulation appears to be an effective, safe, and non-invasive modality for reducing pelvic pain in women, especially in cases of PD and vestibulodynia. Evidence remains limited by heterogeneity in study protocols and outcome measures. Further high-quality RCTs are needed for standardized protocols and broader rehabilitative outcomes, including functional and quality-of-life improvements.
To investigate patient characteristics, operative patterns, and postoperative complications to aid in the discussion of the safety profile of pars plana vitrectomy (PPV) for visually symptomatic floaters. Preoperative characteristics, intraoperative techniques, and postoperative outcomes were reviewed for patients receiving PPV for floaters. Data were collected on the postoperative course, including incidence, timing, and management of complications. Clinical and surgical data on 413 eyes of 288 patients were analyzed (362 complete operative reports available for review). The mean (±SD) age of patients was 65.8 ± 9.6 years. A total of 125 patients (43.4%) underwent PPV for floaters in both eyes. Most eyes were pseudophakic (n = 315, 76.3%), and most had a posterior vitreous detachment (PVD) (n = 364, 88.1%) at the time of PPV. Only 30 eyes (8.3%) had PVD induced at the time of vitrectomy. Most eyes underwent 25-gauge PPV (n = 367, 98.9%). Sub-Tenon block anesthesia was administered with most procedures (n = 329, 90.9%), and most eyes received postprocedure subconjunctival antibiotics (n = 334, 91.3%). Intraoperative endolaser was performed in 34/362 eyes (9.4%). Most eyes underwent sutureless surgery (n = 337, 93.1%), and the majority received aqueous/balanced salt solution tamponade (n = 300, 82.6%). After the procedure, 279 eyes (67.6%) had more than 6 months of follow-up, with 382 eyes (92.5%) achieving a best-corrected visual acuity of 20/20 to 20/30. The most severe complication was endophthalmitis, which was encountered in 5 eyes (1.2%). Vitreous hemorrhage (VH) occurred in 23 eyes (5.6%), and postoperative retinal tear/retinal detachment (RD) occurred in 7 eyes (1.7%). This is the largest retrospective case series describing operative patterns and outcomes associated with PPV for floaters. Rates of serious postoperative complications, including endophthalmitis, VH, and retinal tear/RD requiring surgery, were low. Certain surgical patterns were associated with higher rates of complications. In carefully selected patients counseled on serious complications, PPV for floaters is relatively safe and achieves good visual outcomes.
Describe trends in real-world BRCA and homologous recombination deficiency (HRD) testing rates among patients with advanced epithelial ovarian cancer (EOC). In this US-nationwide electronic health record-derived deidentified database study, eligible adult patients diagnosed with OC on/after 1 January 2016 had stage III/IV EOC at diagnosis, and initiated 1L platinum-based chemotherapy (1 January 2017-30 June 2023 [index date]). Results were descriptive. Among 2135 patients, 66.0% received BRCA and/or HRD testing before the final 1L chemotherapy dose. BRCA/HRD testing was higher among patients receiving chemotherapy-bevacizumab (78.6%) versus chemotherapy alone (60.6%). BRCA/HRD testing rates increased from 2017 to 2023. BRCA/HRD testing rates were lower among patients who were older (aged ≥75 years), had stage IV disease at diagnosis, were Black/African American, had nonserous epithelial histology, had an Eastern Cooperative Oncology Group performance status score of ≥2, and had no evidence of cytoreductive surgery. Real-world BRCA/HRD testing rates increased from 2017 to 2023 among US patients with EOC. Subgroups often underserved in US healthcare settings had lower testing rates, possibly preventing some from receiving optimal treatments. Increasing provider education and support for biomarker testing and improving patient access may help reduce differences and improve treatment outcomes. Why was the study done?Doctors use tests to look for changes in cancer-related genes, such as BRCA, to help choose the best treatments for people with advanced ovarian cancer. Some patients may benefit from targeted medicines based on these results. This study looked at how often these tests are used in real-world practice in the United States.What did the researchers do and find?The study included over 2,000 adults with advanced ovarian cancer treated between 2017 and 2023. It examined when patients received genetic testing and whether testing rates changed over time or differed between groups. Overall, testing increased during this period and more than half of patients were tested before completing their last dose of chemotherapy. However, not all patients were tested equally. Testing was less common in older patients, Black/African American patients, those with more advanced disease, and those with lower income.What do the results mean?Although testing rates are improving, some groups are still less likely to receive these important tests. This means that they may miss the opportunity to receive treatments that could work better for them.What is the objective influence on the wider field?Improving access to testing can help ensure that all patients have the best chance to receive the most appropriate treatment, which may improve outcomes in ovarian cancer.
Stroke is a leading cause of mortality and disability worldwide. The pan-immune-inflammation value (PIV) has emerged as a composite marker of systemic immune-inflammatory status. We aimed to investigate the association of PIV with mortality in US adults with a history of stroke. We analyzed 1948 participants in the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Baseline PIV was calculated from routine blood counts as (neutrophils × platelets × monocytes ÷ lymphocytes). Mortality outcomes were ascertained through linked death records. A generalized additive model incorporating restricted cubic splines was employed to characterize the dose-response relationship between PIV and mortality risk. When statistically significant nonlinearity was detected in the exposure-outcome association, a two-piecewise Cox proportional hazards model was applied to estimate hazard ratios for each segment. Among 1948 participants, 904 deaths (46.4%) occurred over a median follow-up of 75 months; the mean age was 66.8 ± 13.3 years. PIV exhibited a statistically significant J-shaped association with all-cause mortality (p = 0.001), with an inflection point ≈ 133.8. Below this threshold, each 100-unit increase in PIV was associated with a 53% reduction in mortality hazard (HR: 0.47; 95% confidence interval (CI): 0.30-0.75; p < 0.01). Above it, each 100-unit increase corresponded to a 9% increase in mortality hazard (HR: 1.09; 95% CI: 1.05-1.12; p < 0.001). In categorical analyses, using PIV 180-220 as the reference range, participants with PIV > 220 had a significantly higher risk of all-cause mortality (HR: 1.47; 95% CI: 1.14-1.89; p = 0.002). Among US stroke survivors, both abnormally low and high PIV levels were associated with an increased risk of mortality in a J-shaped pattern. As a composite index derived from routine blood counts, PIV may serve as an accessible candidate indicator for risk assessment in stroke survivors, though prospective studies are needed to validate these findings and elucidate the underlying mechanisms.
We aim to delve into the characteristics of endogenous endophthalmitis caused by Klebsiella pneumoniae, focusing on the clinical manifestations, systemic risk factors, sources of the microorganism, and treatment outcomes among patients in our clinical series. All patients exhibited the classic symptoms of eye pain, redness, and reduced vision, with discernible risk factors of diabetes mellitus. In all cases, there were identifiable sources of bacteremia, most prominently liver abscess, followed by pneumonia and hand abscess. From the vitreous, positive cultures were obtained in all five cases, and all patients demonstrated bacteremia with positive Klebsiella growth. Late-stage unsalvageable presentations were observed in three cases, necessitating evisceration of the eye. One patient succumbed to sepsis with multiorgan failure. Despite prompt management of Klebsiella endophthalmitis, all patients in this clinical series had unfavorable visual or survival outcomes. Prevention in the form of good systemic control in patients with diabetes is crucial to prevent this life and sight-threatening complication.
From 19 meta-analyses comparing active bona fide treatments, Flückiger et al. (2026) recently calculated a between-group effect size (SMD) of -0.17 for primary outcomes and of -0.16 for secondary outcomes. They suggested using these effect sizes as empirically derived non-inferiority margins. However, Flückiger et al.'s approach is conceptually problematic and lacks empirical support. Without a rationale, empirically found differences between active treatments cannot per se be regarded as non-inferiority margins.