The impact of antidepressant use on surgical outcomes remains uncertain, particularly in breast reduction surgery, where risks of infection, wound complications, and bleeding may influence decision-making. To evaluate the association between preoperative antidepressant use and postoperative complications following breast reduction surgery. We performed a retrospective multicenter cohort study using the TriNetX Research Network. Adults who underwent bilateral breast reduction between 2010 and 2025 were stratified by recent antidepressant exposure. Propensity score matching balanced demographics, comorbidities, and laboratory values. Outcomes within 90 days included surgical-site infection, wound dehiscence, hematoma, seroma, sepsis, thromboembolism, composite complications, readmission, emergency-room visit, and opioid prescriptions. After matching, 7411 patients with antidepressant use were compared with 7411 controls. Antidepressant exposure was associated with increased risks of infection (5.1% vs. 4.1%; p = 0.006), wound dehiscence (4.1% vs. 2.8%; p < 0.001), and sepsis (0.4% vs. 0.2%; p = 0.031). Hematoma/seroma rates did not differ. Opioid prescribing was higher in antidepressant users (29.1% vs. 23.8%; p < 0.001). Class specific analyzes indicated that selective serotonin reuptake inhibitors carried a slightly higher risk than serotonin norepinephrine reuptake inhibitors. Patients with prescriptions for two or more antidepressants had higher rates of infection and overall complications than those on a single agent. Preoperative antidepressant exposure was associated with modest increases in infection, wound dehiscence, sepsis, and postoperative opioid prescribing after breast reduction surgery, whereas bleeding complications were not increased. These observational findings are hypothesis-generating and warrant further validation.
The impact of different mechanical ventilation modes on pulmonary outcomes following laparoscopic surgery in the Trendelenburg position remains unclear. This study aimed to compare the effects of two common ventilation modes on postoperative pulmonary complications (PPCs) in elderly patients undergoing such procedures. Elderly patients scheduled for laparoscopic surgery in the Trendelenburg position were randomly allocated to receive either pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV). Both groups were managed with a lung-protective ventilation strategy. The primary outcome was the incidence of PPCs within the first three postoperative days. Airway pressures, details enabling the calculation of respiratory system dynamic compliance (Cdyn) and arterial blood gas levels were also recorded at predetermined intraoperative time points: before anesthesia induction (T0); 10 min after tracheal intubation in the supine position without pneumoperitoneum (T1); 30 min (T2) and 60 min (T3) after establishing pneumoperitoneum and the Trendelenburg position; and at the end of surgery after returning to the supine position (T4). Compared with the VCV group (32.1%), the PCV group exhibited a significantly lower incidence of PPCs (13.0%; χ2 = 5.758, P = 0.016) (RR = 0.403, 95% CI: 0.183-0.888). Furthermore, patients managed with PCV exhibited significantly lower intraoperative airway pressures-including peak airway pressure (Ppeak), plateau pressure (Pplat), and driving pressure (ΔP)-as well as reduced dead space fraction (VD/VT) and arterial partial pressure of carbon dioxide (PaCO₂). Cdyn was higher in the PCV group. In elderly patients undergoing laparoscopic surgery in the Trendelenburg position, pressure-controlled ventilation was shown to improve Cdyn and was associated with a lower composite rate of postoperative pulmonary complications than volume-controlled ventilation. Whether these physiological advantages translate into clinically meaningful benefit requires confirmation in larger studies.
Current evidence supports the role of Immunonutrition Support (IMNS) to improve surgical outcomes in gastrointestinal (GI) cancer, but the optimal formula and prescription timing remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of IMNS on postoperative outcomes in patients with GI cancer. The systematic search was conducted in three databases (PubMed, Embase, Cochrane Library) in March 2024. The protocol was registered at PROSPERO under registration number CRD42024524537. Studies were selected based on the PICOS framework. Population: GI cancer patients; Intervention: immunonutrition support; Comparator: isonitrogenous and isocaloric supplementation, or standard care; Outcome: mortality, length of hospital stay, and postoperative complications; Study design: randomized controlled trial (RCT). Random-effects models were used to calculate pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). A total of 90 RCTs were included in the systematic review, with 55 eligible for meta-analysis. Data from 7,462 patients were analyzed. IMNS formula based on arginine, nucleotides, and omega-3 fatty acids, administered perioperatively, orally or enterally, significantly reduced the odds of anastomotic leak (OR 0.62; 95% CI 0.50-0.76), infectious complications (e.g., respiratory (OR 0.46; 95% CI 0.33-0.64), urinary (OR 0.58; 95% CI 0.38-0.89), wound (OR 0.67; 95% CI 0.46-0.98), and sepsis (OR 0.45; 95% CI 0.28-0.70), and shortened hospital stay by a mean of 2.47 days (95% CI -4.13 to -0.80). In contrast, omega-3 fatty acids alone did not improve postoperative morbidity. IMNS with arginine, nucleotides, and omega-3 fatty acids improves infection odds and hospital stay without a significant effect on overall survival, while omega-3 fatty acids alone did not decrease morbidity odds in GI cancer patients undergoing surgery.
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Gastrointestinal cancer surgery commonly leads to postoperative complications and other adverse outcomes. While prehabilitation shows promise in reducing adverse postoperative outcomes, most hospitals have resource limitations that preclude its use as standard of care. Additionally, the need to expedite surgery from diagnosis often creates a narrow window for prehabilitation initiatives. Online, self-reported screening tools may address these challenges by facilitating early identification of high-risk patients and enabling targeted preoperative interventions, thereby allowing equitable allocation of limited resources. Therefore, the primary aim of this study is to evaluate the predictive utility of a tri-modal (physical, nutritional, psychological) screening tool for patients undergoing gastrointestinal cancer surgery. This prospective international cohort study will recruit 1214 adults undergoing elective gastrointestinal cancer surgery across 35 sites from 19 countries. Participants will complete an online screening tool developed through a comprehensive, multistep, predefined process. The screening tool comprises the Duke Activity Status Index, Patient-Generated Subjective Global Assessment Short Form and the Patient Health Questionnaire-4, in English, Spanish, French or Portuguese. These tools were selected based on a scoping review, followed by an international Delphi consensus process. The primary outcomes include rate of postoperative complications, major complications (Clavien-Dindo Classification grade III-V) and overall complication severity assessed by the Comprehensive Complications Index; all assessed 30 days postoperatively. Secondary outcomes include hospital length of stay, readmission rate within 30 days, discharge destination (home vs other), days at home and alive in 30 days postsurgery, 30-day all-cause mortality and 12-month survival. Primary analyses will establish optimal screening tool cut-points to stratify patients into clinically actionable risk categories for postoperative complications and examine the independent predictive value of these screening scores after adjusting for established clinical risk factors. This study has received ethical approval from the Sydney Local Health District Human Research and Ethics Committee (X25-0333 and 2025/ETH02465) and has been registered on the Open Science Framework (10.17605/OSF.IO/HVCGD). The results of Preoperative Risk Evaluation for Cancer Treatment will be submitted to reputable journals and presented at national and international conferences.
Ultrasound-assisted catheter-directed thrombolysis using the EkoSonic Endovascular System (EKOS) is an established treatment for intermediate high-risk pulmonary embolism (IHR-PE). However, the optimal timing of treatment initiation remains uncertain. Early right ventricular (RV) unloading may improve outcomes by reducing RV pressure overload and preventing haemodynamic deterioration. We conducted a retrospective multicentre analysis of patients with IHR-PE treated with EKOS at three tertiary centres. Patients were stratified by time from CT-confirmed diagnosis to EKOS initiation: early (<12 hours) versus delayed (>12 hours). Echocardiographic parameters included RV/left ventricular (LV) ratio, tricuspid annular plane systolic excursion (TAPSE), LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes were intensive care unit (ICU) length of stay, complications, bleeding events and in-hospital mortality. 3-month follow-up was available in two centres. Overall, 152 patients were included (early n=106; delayed n=46) in the study. Baseline characteristics were largely comparable, although dyspnoea New York Heart Association (NYHA) class II-III was more frequent in the early group (NYHA III: 73% vs 46%, p=0.001). Both groups showed significant improvements in RV/LV ratio, TAPSE, sPAP and LVEF (all p<0.001). Early treatment resulted in numerically greater RV functional improvement (Early Δ Discharge (D)-Admission (A) TAPSE early 4.86±5.14 mm vs delayed Δ D-A 3.5±5 mm), without statistically significant differences between groups. At 3-month follow-up, RV recovery measured by TAPSE was comparable. Early EKOS therapy was associated with a significantly shorter ICU stay (median 24 hours vs 45.5 hours, p=0.033), fewer PE-related complications (p=0.03), while procedure-related complications and in-hospital mortality did not differ. In IHR-PE, EKOS initiation within 12 hours is associated with a significantly shorter ICU stay and significantly less PE-related complications. These findings support early EKOS treatment strategies and warrant confirmation in prospective studies.
Superior orbital sulcus hollowness is a common aesthetic concern that may result from structural changes, trauma, or excessive fat removal during upper blepharoplasty, and it can be further exacerbated by age-related orbital remodeling. Traditional corrective approaches such as fat redistribution and autologous fat grafting carry limitations, including graft atrophy and the risk of embolic complications. This study evaluated the safety and outcomes of superior orbital sulcus correction using a medial-pedicled preseptal orbicularis oculi muscle flap. This retrospective study analyzed 481 patients who underwent upper blepharoplasty between January 2017 and June 2024, of whom 45 received additional correction of superior orbital sulcus hollowness with a medial-pedicled preseptal orbicularis oculi muscle flap. Exclusion criteria included male sex, previous upper eyelid surgery, levator dehiscence, less than six months of follow-up, and refusal to complete the FACE-Q Adverse Effects questionnaire. The mean follow-up duration was 8 months, and the mean patient age was 51.4 years. Postoperative complications and patient-reported outcomes were evaluated and compared with those of patients undergoing conventional upper blepharoplasty. Early postoperative complications, including transient lagophthalmos and edema, were self-limiting. In the conventional blepharoplasty group, 16 patients developed medial canthal scarring, with four requiring revision. In the flap group, transient supraorbital hypoesthesia occurred in 71% of patients and resolved within a few months, and no cases of flap necrosis were observed. Statistical analysis using the Mann-Whitney U test demonstrated no significant difference in FACE-Q scores between the two groups (U = 8828.0, p = 0.251). The medial-pedicled preseptal orbicularis oculi muscle flap appears to be a safe, reproducible, and anatomically sound technique for selected patients with superior orbital sulcus hollowness. Although the relatively uniform flap volume may not fully correct the deformity in all cases and patient numbers were limited, this method provides a promising alternative to fat grafting without adding long-term complications, with the potential to enhance aesthetic outcomes and patient satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Percutaneous endoscopic lumbar discectomy (PELD) is a preferred minimally invasive surgery for lumbar disc herniation (LDH); however, postoperative recurrence, nerve root damage, and hyperesthesia continue to present key clinical challenges. Chitosan represents a novel preventive approach against postoperative complications. This study aimed to assess the clinical efficacy of ultrasound-guided percutaneous endoscopic interlaminar discectomy (PEID) plus medical chitosan in treating lumbar 4-5 disc herniation (L4-5 LDH). Totally, 200 L4-5 LDH patients were prospectively recruited and randomly divided into the control group (ultrasound-guided PEID) and observation group (ultrasound-guided PEID plus medical chitosan). Low back and leg pain and lumbar dysfunction were assessed preoperatively and postoperatively using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA). Efficacy and postoperative complications were evaluated according to the modified MacNab criteria. Logistic regression analyses identified the risk factors. Mann-Whitney U test was used for inter-group comparisons, and the Kruskal-Wallis test for timepoint comparisons. The two groups showed significant differences in pre-treatment Pfirrmann classification and operation time. As time progressed, patients exhibited reduced VAS and ODI scores and increased JOA scores postoperatively. Significant differences were observed in VAS, JOA, and ODI scores in the observation group at 2 weeks postoperatively. The observation group demonstrated superior treatment efficacy and a lower complication incidence than the control group. Age, disease course, and postoperative bleeding were independent risk factors affecting clinical efficacy of ultrasound-guided PEID plus chitosan. Ultrasound-guided PEID plus medical chitosan reduces postoperative pain and perioperative complications, demonstrating superior clinical efficacy.
Migration is one of the most feared complications following lip filler. The use of a specific filler with a high degree of elasticity and cohesiveness could be the key to solve the problem if injections are performed in the correct anatomical plane. The purpose of this study was to describe the authors' 5-year experience with a new concept of lip filling, iLips. This reproducible approach combines elasticity and cohesiveness of a 25,5 mg/ml filler injected through superficial micro-tunnels in a virtual space between orbicularis muscle and mucosa creating a tridimensional net that respects lip dynamic also leading to a low risk of filler migration. A total of 4583 consecutive patients who underwent lip filler with iLips technique were enrolled in this prospective study. An objective evaluation on the aesthetic results was obtained by a jury composed of 3 external plastic surgeons using Lip Fullness Merz scale. PROMs were investigated through FACE-Q administration to the patients ("Psychological function", "Satisfaction with outcome" and "Satisfaction with lips" scales). Statistical analysis was performed through Prism10. Complications were reported. t-test with Welch's correction showed an improvement in Lip Fullness Merz score both in upper and lower lip (p<0.05). A similar trend was shown also for "Psychological function", "Satisfaction with outcome" and "Satisfaction with lips" mean values after the procedure. Just 2 cases of major vascular complications were reported. iLips ® seem to be a safe, highly reproducible, effective and satisfying approach for lip augmentation positively impacting also the patient's psychological sphere. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Parotidectomy for benign tumors requires meticulous facial nerve preservation, yet the optimal dissection technique between anterograde dissection (AD) and retrograde dissection (RD) remains uncertain, prompting this updated meta-analysis comparing their outcomes. Twenty-one studies (1632 patients) were included. Outcomes comprised operative parameters, postoperative complications, and facial nerve recovery. Pooled effects were estimated using odds ratios (ORs) and mean differences with 95% confidence intervals (CIs). RD significantly reduced transient facial nerve palsy versus AD (OR, 0.73; 95% CI, 0.54-0.98), with no difference in permanent palsy. Recovery was similar at 1, 6, and 12 months, although AD showed faster recovery at 3 months. Other complications were comparable. RD was associated with shorter operative time, less blood loss, and smaller resected tissue volume. Subgroup analysis indicated reduced transient palsy mainly in superficial parotidectomy. RD offers advantages over AD, particularly in superficial parotidectomy, though further randomized trials are warranted.
Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) is increasingly adopted as a standard of care. This systematic review and meta-analysis assess the safety and effectiveness of SDD compared with conventional inpatient (IP) management. A literature search was conducted in accordance with PRISMA guidelines using PubMed/MEDLINE, Embase, Web of Science, and Scopus databases up to February 2025, including only comparative studies reporting on SDD versus IP RARP. The primary endpoint was postoperative complication rates. Secondary endpoints included 30-day readmission rates, unplanned postoperative visits, and patient-reported satisfaction. Subgroup analysis focused on studies involving single-port (SP) robotic platforms. Nineteen studies were included, encompassing 11 211 SDD and 114 999 IP cases. Overall complication rates were lower in the SDD group (odds ratio [OR]: 0.65, 95% confidence intervals [CI]: 0.50-0.84, p < 0.001). The pooled OR favored the outpatient group for both minor and major complications (OR: 0.52, 95% CI: 0.28-0.98, p = 0.042). No significant differences were found in 30-d readmissions (OR: 0.89, 95% CI: 0.77-1.02, p = 0.082), unplanned visits (odds OR: 0.61, 95% CI: 0.35-1.07, p = 0.081), or continence recovery. In the SP subgroup, no differences were observed in major complications (OR: 0.71, 95% CI: 0.39-1.29; p = 0.7) or readmission rates (OR: 1.88, 95% CI: 0.56-6.39, p = 0.3). The main limitation was the retrospective design of most studies. The available evidence does not allow reliable causal comparisons between SDD and inpatient care after RARP; however, perioperative outcomes within SDD cohorts appear acceptable, supporting the feasibility of SDD in carefully selected patients.
Mucous membrane pemphigoid (MMP) is a rare autoimmune subepidermal blistering disorder predominantly affecting mucosal surfaces, including the oral cavity, ocular, nasal, tracheal, and esophageal epithelia. This disease frequently induces irreversible scarring, with severe manifestations potentially causing blindness, airway stenosis, and life-threatening complications. Consequently, early detection, accurate diagnosis, and prompt therapeutic intervention are critical for patients' outcomes. Diagnostic and therapeutic challenges arise from atypical initial presentations, limited sensitivity of immunological assays, and adverse effects associated with conventional therapies such as glucocorticoids and immunosuppressive agents. These limitations necessitate enhanced clinical recognition and proactive management to mitigate complications and reduce mortality. 黏膜类天疱疮（mucous membrane pemphigoid，MMP）是一种主要累及口腔、眼、鼻、气管、食管等黏膜部位的罕见自身免疫性表皮下疱病。本病常导致不可逆的瘢痕形成，严重者可致失明、气道狭窄等并发症发生，进而危及生命。因此，本病的早期发现、诊断和及时治疗对患者至关重要。由于患者疾病初期不典型的临床表现，免疫学检查灵敏度有限，传统治疗如糖皮质激素、免疫抑制剂的副作用，增加了本病的诊治难度。因此，需要临床医生提高对本病的认识、早期干预本病，进而降低并发症和病死率。本文梳理了与MMP严重程度相关的潜在因素，并对MMP的治疗进展进行阐述，进而提高临床医生对本病的关注，并及时采取有效的治疗措施预防并发症的发生，改善患者预后。.
Lung cancer surgery is associated with significant postoperative morbidity (15%-40%) and mortality (2%-5%), with considerable interhospital variability. This study conducts the first national longitudinal analysis of performance trajectories in lung cancer surgery using advanced trajectory modelling approaches to understand temporal dynamics of quality evolution across hospitals. We included all adult patients (French national hospital database, n=56 299; 148 hospitals) who underwent lung resection for primary lung cancer in 2020-2024. The primary outcome was severe complications including major postoperative complications and 30-day mortality. Annual logistic regression models incorporating clinical and procedural variables calculated risk-adjusted rates (RAR) for each hospital. Hospitals were classified using funnel plots corrected for overdispersion. Hidden Markov Models estimated transition probabilities between performance categories, while group-based multitrajectory models identified subgroups of hospitals sharing similar evolution profiles, stratified by activity volume (low, <43; medium, 43-100; high, >100 procedures/year). Predictive models demonstrated excellent stable discrimination (mean area under the ROC curve=0.890). Markov models revealed strong performance inertia (persistence probabilities ≥78%). Trajectory analysis identified a complex non-linear relationship between volume and quality. Medium-volume hospitals showed optimal improvement trajectories (45.4-45.8% RAR reduction). Conversely, some low-volume centres experienced catastrophic deterioration (843% RAR increase), while paradoxically, a subgroup of high-volume hospitals also showed concerning performance degradation (151% increase). This study demonstrates heterogeneous performance trajectories in French lung cancer surgery, challenging the assumption that high-volume alone guarantees quality and suggesting organisational complexity challenges. This study shows the value of implementing systematic outcome monitoring using existing administrative data to target quality improvement interventions and reduce inter-hospital performance variations.
Patients with multiple myeloma undergoing dorsal spinal instrumentation for malignant spinal lesions remain at high risk for postoperative complications and limited survival. Acute kidney injury (AKI) is common in myeloma and after major surgery, but its prognostic relevance in surgically treated myeloma patients and its association with subsequent CT-based body composition and bone density trajectories, remains insufficiently defined. We performed a retrospective cohort study of consecutive multiple myeloma patients undergoing dorsal spinal instrumentation between 2011 and 2024 at a tertiary referral center. Postoperative AKI was defined and staged according to KDIGO criteria based on serum creatinine changes within 7 postoperative days. Clinical outcomes included overall survival (OS), surgical site infection (SSI), and length of hospital stay (LOHS). CT-based morphometry was assessed on non-contrast whole-body CT at L3 level on a preoperative baseline scan (tCT1) and a postoperative follow-up scan. The follow-up CT scan (tCT2) was obtained approximately 9 months postoperatively as part of routine oncologic follow-up or clinical indication rather than a fixed imaging schedule, reflecting real-world clinical practice. The mean interval between tCT1 and tCT2 was 9.1 ± 1.2 months. Analysis included skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue (VAT), and vertebral trabecular bone status assessed by Hounsfield Units (HU). Multivariable Cox regression, logistic regression, and log-linear regression were used to evaluate the independent association of AKI with OS, SSI, and LOHS, adjusting for clinically relevant covariates. 59 patients were included (median age 69.0 years; 40.7% female); postoperative AKI occurred in 16 patients (27.1%). AKI was associated with significantly worse OS (median 224 vs. 396 days without AKI; log-rank p = 0.01), with progressively shorter OS across KDIGO stages. In multivariable Cox regression, AKI remained independently associated with worse OS (adjusted hazard ratio 2.35, 95% CI 1.22-4.54; p = 0.011). AKI was also associated with higher SSI rates (63% vs. 12%; p < 0.01) and longer LOHS (median 29 (IQR 8) vs. 19 (IQR 9) days; p < 0.001). After adjustment for age, sex, preoperative ECOG, and Charlson Comorbidity Index, AKI remained independently associated with higher SSI rates (adjusted odds ratio 3.20, 95% CI 1.11-9.26; p = 0.031) and prolonged hospitalization (LOS ratio 1.34, 95% CI 1.06-1.69; p = 0.014). Longitudinal CT analyses demonstrated significantly greater postoperative declines in the AKI group versus no AKI for SMI (median - 44.6% vs. -18.5%; p < 0.001), SMD (- 20.5% vs. -9.2%; p = 0.02), VAT (- 29.1% vs. -24.1%; p < 0.001), and HU (- 46.2% vs. -37.7%; p < 0.001). In multiple myeloma patients undergoing dorsal spinal instrumentation, postoperative AKI is independently associated with reduced survival, increased postoperative morbidity, and accelerated loss of muscle quantity, muscle quality, visceral fat, and vertebral bone density. These findings highlight AKI as a clinically meaningful systemic event with downstream catabolic consequences and support intensified perioperative nephroprotective and multidisciplinary supportive strategies in this high-risk population.
Objective: To analyze the epidemiological and clinical characteristics of pertussis in children diagnosed at the Affiliated Children's Hospital of Fudan University in Shanghai in 2024, as well as the antimicrobial resistance patterns of Bordetella pertussis. Methods: Demographic information and vaccination status were collected from the pertussis cases confirmed by nucleic acid testing at the Children's Hospital of Fudan University in 2024. Clinical data from all hospitalized pertussis cases and a portion of outpatient pertussis cases were collected to analyze their clinical characteristics. Bordetella pertussis was isolated from nasopharyngeal swab specimens of some cases, and antimicrobial susceptibility was tested. Results: Among the 9 899 cases diagnosed in 2024, 5 272 were males and 4 627 were females. The peak epidemic season occurred from April to July. Children aged 4-10 years accounted for 7 744 cases (78.2%). Among 6 947 cases with available vaccination records, 6 676 (96.1%) had completed the full course of pertussis vaccination. A total of 2 085 pertussis patients were included for analysis of clinical characteristics, including 1 779 outpatient cases and all 306 hospitalized cases. The incidence rates of paroxysmal cough, whoop, cyanosis, apnea, fever, and white blood cell counts ≥20×10⁹/L in hospitalized patients were 94.8%, 35.0%, 24.2%, 21.6%, 44.8%, and 26.1%, respectively, all significantly higher than those in outpatient cases (75.0%, 14.6%, 1.7%, 1.3%, 23.5%, and 4.0%; all P<0.001). The proportions of complications and co-infections in hospitalized patients were 64.1% and 70.6%, respectively, also significantly higher than those in outpatient cases (19.3% and 13.8%; both P<0.001). Among both outpatient and hospitalized patients, infants under 7 months were more prone to whoop, cyanosis, apnea, post-tussive vomiting, and peripheral white blood cell counts≥20×10⁹/L compared to those older than 7 months, with statistical significance (all P<0.001). The hospitalization rates were highest among infants aged 0~2 months at 64.8% (83/128). The median length of hospital stay [M (Q1, Q3)] was 3.5 (2.5, 5.5) days, and the median hospitalization cost [M (Q1, Q3)] was RMB 8 351.6 (6 934.6, 12 086.4) among hospitalized cases. There were 14 severe cases (4.6 %), including 2 deaths. Twelve severe cases were unvaccinated, of which 9 were infants aged 0~2 months. The average length of hospital stay for severe cases was (30.7±17.7) days, with a median average cost [M (Q1, Q3)] of RMB 107 996.2 (42 066.9, 133 530.9). Based on minimum inhibitory concentration (MIC) testing of 166 Bordetella pertussis isolates, 165 (99.4%) exhibited high-level resistance to azithromycin (MIC>256.000 μg/ml). The isolates remained susceptible in vitro to trimethoprim-sulfamethoxazole, levofloxacin, ceftazidime, cefoperazone-sulbactam, and doxycycline. Conclusion: Children aged 4-10 years are the primary affected group during the 2024 pertussis outbreak in Shanghai. Unvaccinated infants under 2 months of age are at high risk for severe disease. Empirical use of macrolides for pertussis treatment is not recommended. 目的： 分析2024年上海市复旦大学附属儿科医院诊断的儿童百日咳的流行病学和临床特征，以及百日咳鲍特菌的耐药模式。 方法： 收集2024年复旦大学附属儿科医院核酸检测确诊的百日咳患者的人口学信息和疫苗接种信息；同时收集2024年全部住院和部分门诊确诊百日咳患者的临床资料，分析其临床特点。采集部分患者的鼻咽拭子标本进行百日咳鲍特菌培养和药物敏感性检测。 结果： 2024年共确诊9 899 例百日咳患者，其中男5 272例，女4 627例；4~7月为流行高峰季节；78.2%的患者为4~10岁儿童（7 744例）；有疫苗接种信息的6 947例患者中，6 676例（96.1%）完成全程百日咳疫苗接种。共2 085例百日咳患者分析其临床特点，包括1 779例门诊和306 例住院患者。其中住院患者痉挛性咳嗽、鸡鸣样尾声、青紫发作、呼吸暂停、发热、外周血白细胞计数≥20×109/L的发生率分别为94.8%、35.0%、24.2%、21.6%、44.8%、26.1%，均高于门诊患者的75.0%、14.6%、1.7%、1.3%、23.5%、4.0%（均P<0.001）；住院患者合并并发症、混合感染的比例分别为64.1%、70.6%，均高于门诊患者的19.3%、13.8%（均P<0.001）。门诊和住院患者中，7月龄以下婴幼儿较7月龄以上均更易发生鸡鸣样尾声、青紫发作、呼吸暂停、咳嗽后呕吐、外周血白细胞计数≥20×109/L，统计学有差异（均P<0.001）。0~2月龄婴幼儿住院率较高为64.8%（83/128）；住院患者住院天数M（Q1，Q3）为3.5（2.5，5.5）d，住院医疗费用M（Q1，Q3）为8 351.6（6 934.6，12 086.4）元。14例（4.6%）为重症，其中2例死亡；12例未接种疫苗，其中9例为0~2月龄婴儿；重症患者平均住院日为（30.7±17.7）d，住院医疗费用M（Q1，Q3）为107 996.2（42 066.9，133 530.9）元。166株百日咳鲍特菌分离株的最低抑菌浓度检测，165株（99.4%）对阿奇霉素高水平耐药（MIC>256.000 μg/ml），对甲氧苄啶-磺胺甲恶唑、左氧氟沙星、头孢他啶、头孢哌酮/舒巴坦、多西环素体外敏感。 结论： 4~10岁儿童是2024年上海地区百日咳暴发时期的主要发病人群，2月龄以下未接种疫苗婴儿是重症病例高危人群。不推荐经验使用大环内酯类药物治疗百日咳。.
To report a single-center experience of subretinal voretigene neparvovec-rzyl (VN) gene therapy for Arabian Gulf patients with autosomal recessive RPE65-related inherited retinal dystrophy. Retrospective case series. Nine patients (6 families; 3 males) with RPE65-related retinal dystrophy who underwent VN gene therapy (pars plana vitrectomy and subretinal injection) at Cleveland Clinic Abu Dhabi between 2020-2024. Pre and post operative best corrected visual acuity (BCVA), ophthalmic examination, full-field stimulus threshold (FST), and multimodal retinal imaging (photography, optical coherence tomography, short-wave autofluorescence). BCVA, clinical findings, FST, multimodal imaging. Eight patients were Emirati and one was Bahraini. All were treated bilaterally. Age at first eye treatment ranged from 11 to 56 years (mean 24.2) and second eye treatment was 7-11 days later. No intraoperative surgical complications occurred. Follow up after treatment ranged from 13 to 71 months (mean 38.8 months). Postoperative systemic steroid withdrawal-related effects and transient intraocular pressure elevation were observed in one patient each. Two patients developed lens opacities that were not visually significant. All eyes of all patients developed postoperative CRA. At last follow-up, BCVA improved in five patients (55.6%), remained stable in two (22.2%), and reduced in two (22.2%) who had progressive central CRA. FST improved in all but the two oldest at treatment (41 and 56 years old), who showed some decline. VN treatment improved scotopic vision (FST) in all patients treated before 40 years old and often improved BCVA. Postoperative CRA was universal; ethnicity and sunny climate may have been contributing factors. The possibility of postoperative BCVA loss related to central CRA is an important preoperative counseling point, particularly when preoperative BCVA is functionally useful.
Objective: To investigate the surgical approach for the resection of complex tumors located on the lateral side of the pelvic floor. Methods: A retrospective analysis was conducted on 24 patients with complex tumors on the lateral side of the pelvic floor who were treated at The First Affiliated Hospital of Zhengzhou University from April 2023 to April 2025. Among the 24 patients, there were 16 cases of aggressive pelvic myxoma of the pelvic floor (including 10 recurrent cases), 6 cases of soft tissue sarcoma (4 recurrent cases), and 2 cases of nerve sheath tumor. The perineal lateral arc-shaped incision was used as the primary approach in all surgeries, with some patients receiving an auxiliary abdominal incision. The operation time, intraoperative blood loss, R0 resection rate of the tumor, wound healing, and the impact of the incision on postoperative defecation, urination and lower limb function were analyzed. Results: The median operation time of the perineal lateral arc-shaped incision approach was 60 minutes (range: 35-180 min), and the median intraoperative blood loss was 130 ml (range: 20-600 ml) and the R0 resection rate was 100.0% (26/26). Primary healing of the perineal lateral incision was achieved in 21 cases, and secondary healing in 3 cases. No postoperative defecation or urination dysfunction was observed, and all patients had normal lower limb function postoperatively. Conclusion: The perineal lateral arc-shaped incision can effectively improve the resection rate of complex tumors on the lateral side of the pelvic floor, reduces surgical risks, and is not associated with significant postoperative complications. 目的： 探讨盆底侧方型复杂肿瘤切除的手术入路方法。 方法： 回顾性分析2023年4月至2025年4月在郑州大学第一附属医院诊治的24例盆底侧方型复杂肿瘤患者的临床资料，24例患者中，盆底血管侵袭性黏液瘤16例（其中复发型10例），软组织肉瘤6例（复发型4例），神经鞘瘤2例。所有手术均采用会阴侧弧形切口为主，部分患者给予辅助腹部切口。分析该手术方法的手术时间、术中出血量、肿瘤R0切除率、切口的愈合情况以及切口对患者术后排尿、排便及下肢功能的影响。 结果： 会阴侧弧形切口手术入路中位手术时间为60（35～180）min，术中中位出血量130（20～600）ml，肿瘤R0切除率为100.0%（26/26）。会阴侧方型切口Ⅰ期愈合21例，Ⅱ期愈合3例。术后患者无排尿、排便功能障碍，下肢功能均无异常。 结论： 会阴侧弧形切口能有效提高盆底侧方型复杂肿瘤切除率，降低手术风险，无明显手术后并发症。.
To provide a comprehensive review of the biological rationale, clinical evidence, and practical perioperative management of immunotherapy for the head and neck surgeon. Standard treatment for resectable head and neck squamous cell carcinoma (HNSCC) has reached a survival plateau, with over 50% of patients experiencing recurrence. The integration of immune checkpoint inhibitors (ICIs) into the neoadjuvant window represents a paradigm shift toward biologically adapted surgical intervention. Neoadjuvant immunotherapy capitalizes on an intact immune substrate to create an in situ vaccine, avoiding the post-surgical immune desert that limits adjuvant efficacy. Emerging phase III data confirm that perioperative ICI significantly improves event-free survival. Successful implementation requires the surgeon to navigate unique diagnostic challenges, such as distinguishing rare but anatomically risky pseudoprogression from true progression. While combination therapies (chemoimmunotherapy or immunoradiotherapy) yield higher pathologic complete response rates, they also increase toxicity. Intraoperatively, ICI monotherapy generally preserves tissue planes without increasing surgical delays or major wound complications. Standard biomarkers like PD-L1 and TMB, alongside emerging tools such as liquid biopsy (ctDNA), are essential for patient selection and dynamic monitoring. The transition to neoadjuvant immunotherapy facilitates future surgical de-escalation and function-preserving approaches. To optimize outcomes, the modern surgeon must act as a surgical immunologist, interpreting translational data to guide real-time operative planning.
Chimeric antigen receptor (CAR)-T cell therapy has emerged as a revolutionary treatment for hematologic malignancies and solid tumors. Multiple approved products and ongoing clinical trials have demonstrated its remarkable antitumor efficacy. However, its clinical application is severely limited by prominent cardiotoxicity, which is closely associated with high morbidity and mortality, posing an urgent clinical challenge. This review systematically elucidates the pathophysiological mechanisms underlying CAR-T cell therapy-induced cardiotoxicity, which can be primarily categorized into acute and long-term adverse effects. Acute cardiotoxicity is driven by cytokine release syndrome (CRS) through macrophage and monocyte activation, endothelial dysfunction, and subsequent myocardial injury, leading to hypotension, reduced left ventricular ejection fraction, and cardiac arrhythmias. Long-term cardiotoxicity is mainly caused by B-cell aplasia-induced immune deficiency and secondary hemophagocytic lymphohistiocytosis, which trigger infectious complications, myocardial ischemia, and apoptosis. We have further summarized clinical pharmacological interventions for such cardiotoxicity, including interleukin (IL)-6 receptor antagonists (tocilizumab), interferon-γ inhibitors (emapalumab), and Janus kinase inhibitors (ruxolitinib). However, none of these drugs can completely alleviate CRS or CAR-T cell therapy-induced cardiotoxicity in all patients. Preclinical agents targeting inflammatory cytokines (IL-1β, tumor necrosis factor-α) and signaling pathways have shown efficacy in ameliorating cardiotoxicity in various animal models. These findings provide novel directions and drug candidates for the treatment of CAR-T cell therapy-induced myocardial toxicity. This review provides a comprehensive theoretical basis for optimizing cardiovascular safety management and developing novel targeted interventions for CAR-T cell therapy.
Acute inflammation, when unresolved, can lead to complications that impair tissue repair and therapeutic outcomes. In this study, we employed a model of lipopolysaccharide (LPS)-induced acute subcutaneous abdominal inflammation in mice to investigate the modulatory effects of elastic compression. LPS administration elicited a robust inflammatory response, characterized by increased leukocyte infiltration, edema, and upregulation of pro-inflammatory mediators. Elastic compression significantly attenuated this response, reducing leukocyte counts in subcutaneous lavage, histological inflammatory infiltrates, and the expression of key pro-inflammatory genes and proteins, including NF-κB, IL-1β, and TNF-α, at both 24 and 72 hours post-induction. Mechanistically, these effects may result from the compressive force altering microvascular dynamics and modulating macrophage polarization and mechanotransduction pathways, including TLR4 and integrin signaling. Additionally, compression preserved redox homeostasis, as indicated by stable oxidative stress markers and antioxidant responses. To our knowledge, this is the first study to demonstrate that elastic compression modulates inflammation at molecular, cellular, and tissue levels in an acute inflammation model. These findings support the therapeutic potential of elastic compression as a non-pharmacological strategy for managing acute inflammation, with possible applications in postoperative care, traumatic edema, and other soft tissue inflammatory conditions. Further translational and clinical studies are warranted to validate these outcomes and guide evidence-based application protocols. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .