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Traumatic brain injury (TBI) is a leading cause of disability and death in children. More than 30% of children presenting to the emergency department (ED) with head trauma undergo brain computed tomography (CT), the standard neuroimaging modality in acute evaluation of intracranial pathology. Conventional magnetic resonance imaging (MRI) provides a non-ionizing alternative with greater sensitivity for certain intracranial injuries but is infrequently used in acute TBI because of limited scanner access and longer scan duration. Rapid brain MRI protocols reduce scan time and can be completed without sedation, with diagnostic accuracy for TBI comparable to CT, yet real-world availability remains limited. Point-of-care, low-field MRI (POC LF-MRI) systems are a recent radiologic advance that are portable, require less infrastructure, and allow bedside neuroimaging, including in critically injured children who cannot be safely transported. However, critical knowledge gaps exist regarding the diagnostic accuracy and feasibility of POC LF-MRI for pediatric head trauma in emergency and critical care settings. Our research aims to (1) determine the accuracy of POC LF-MRI for neuroradiographic TBI and clinically important TBI compared to current clinical standard of care initial neuroimaging, (2) determine the accuracy of POC LF-MRI for neuroradiographic injury progression on repeat neuroimaging, and (3) determine feasibility metrics and balancing measures of POC LF-MRI, including order-to-scan time, scan duration, proportion of incomplete scans, and ED length-of-stay. We will conduct a prospective, single-center, observational diagnostic accuracy cohort study of children 7-17 years old with blunt head trauma who undergo standard-of-care neuroimaging. Children with MR-unsafe implants or metallic shrapnel and wards of the state will be excluded. POC LF-MRI will be obtained within a reasonable time window of clinical neuroimaging, with a flexible window up to 72 hours, either in the ED, inpatient unit, or intensive care unit (ICU). The primary outcome is neuroradiographic TBI, defined as any traumatic intracranial finding on neuroimaging. Secondary outcomes include clinically important TBI (defined as TBI-related neurosurgical intervention, endotracheal intubation >24 hours, death, or ≥2-night hospitalization) and neuroradiographic injury progression on repeat neuroimaging (yes/no). Feasibility outcomes include order-to-scan time, scan duration, proportion of incomplete scans, and ED length of stay, along with other operational and balancing measures. Accuracy will be determined using imaging-level analyses comparing POC LF-MRI with clinical standard-of-care neuroimaging, reporting sensitivity, specificity, predictive values, and likelihood ratios with 95% confidence intervals for neuroradiographic TBI, clinically important TBI, and neuroradiographic injury progression, including predefined non-inferiority criteria for sensitivity, subgroup analyses, descriptive analyses of feasibility metrics, and exploratory analyses addressing incomplete imaging and missing data. The project was funded in 2024, and enrollment will be completed in July 2026. Data analyses are expected to be completed by December 2026, and the primary study results will be submitted for publication in 2027. This study will evaluate accuracy and feasibility for POC LF-MRI in an important subset of pediatric trauma patients and will provide preliminary data to inform future multicenter studies evaluating POC LF-MRI for children with head trauma.
Sodium bicarbonate ringer's solution is a novel crystalloid fluid that can effectively replenish circulating blood volume, improve renal blood perfusion, and maintain the body's acid-base homeostasis. The objective of this study was to compare the effects of sodium bicarbonate ringer's solution and lactate ringer's solution on early postoperative renal function and prognosis in patients with traumatic brain injury (TBI). A single-center, randomized, parallel controlled clinical study. General Hospital of Northern Theater Command. We recruited 124 TBI patients and intended to conduct emergency open craniocerebral surgery from June 2025 to December 2025. Patients were randomly assigned to two groups (n = 62 each): SBRS group and LRS group (administer fluid replacement with Sodium bicarbonate ringer's solution. and Lactated ringer's solution respectively). The primary outcome was creatinine clearance rate(Ccr) at 3 days after surgery. Secondary outcomes encompassed blood lactate (Lac), serum potassium (K+), oxygenation index (OI), and base excess (BE) at the time of entering the operating room (T0), after induction (T1),at the end of surgery (T2),at 12 h after the end of surgery (T3).Clinical outcome assessment included duration of mechanical ventilation,length of ICU stay,total length of hospital stay,incidence of acute kidney injury (AKI),improvement rate of short-term prognosis. Compared with the LRS group (77.4 ± 7.3 mL/min), the SBRS group (79.7 ± 8.7 mL/min) had a statistically significant difference in Ccr at postoperative day 3, with a least squares mean difference of -2.36 (95% CI: -4.13, -0.59; P = 0.010). In addition, the SBRS group also demonstrated significant differences at postoperative day 1 and day 2 (79.8 ± 9.7,79.9 ± 9.6 mL/min vs 76.0 ± 9.0,75.6 ± 7.5 mL/min), with corresponding least squares mean differences of -3.88 (95% CI: -5.37, -2.40; P < 0.001) and - 4.34 (95% CI: -5.89, -2.79; P < 0.001), respectively.From T2 to T3, Lac in the LRS group (1.7 ± 0.7, 2.0 ± 0.6 mmol/L) were significantly higher than that in the SBRS group (1.5 ± 0.7, 1.6 ± 0.7 mmol/L), with corresponding least squares mean differences of 0.30 (95% CI: 0.05, 0.55; P = 0.039) and 0.38 (95% CI: 0.13, 0.62; P = 0.003), respectively. At T2, K+ in the LRS group (3.58 ± 0.52 mmol/L) was significantly higher than that in the SBRS group (3.52 ± 0.50 mmol/L), with least squares mean differences of 0.14 (95% CI: 0.04, 0.24; P = 0.011).Other outcomes didn't show statistical differences. Compared with Lactated ringer's solution, Sodium bicarbonate ringer's solution used for perioperative fluid therapy in patients with TBI can better promote the early recovery of postoperative renal function, and this solution can significantly reduce blood lactate levels,yet this advantage does not translate into a significant impact on patients' postoperative clinical outcomes. This study therefore provides new evidence for fluid selection in perioperative volume therapy for TBI patients, however, the level of supporting evidence is limited, and further research in larger-scale multicenter trials is warranted. www.chictr.org.cn (Registration number ChiCTR2500102850, Registration date May 21, 2025).
After pancreaticoduodenectomy, perioperative neurocognitive disorders (PND) are a common complication. Parecoxib, a selective cyclooxygenase-2 inhibitor, is used for its analgesic and antiinflammatory effects, but its impact on postoperative anxiety and cognitive function is not clear. The patients undergoing laparoscopic pancreaticoduodenectomy at the Second Hospital of Hebei Medical University were enrolled in the study from November 1, 2020 to September 30, 2022 in this randomized controlled trial. Patients were randomly divided into Group P who received 20 mg of parecoxib intravenously 10 minutes before anesthesia and at the end of surgery and Group C who received an equal volume of normal saline at the same times. Primary outcomes included the effect of parecoxib on anxiety, cognitive impairment, and postoperative intestinal function recovery, with the incidence of PND calculated using the Z-value method. Secondary outcomes included pain control, length of hospital stay, postoperative recovery, complication rates, and analgesic use. 80 patients were enrolled and randomly divided into 2 groups of 40 equally: there were no significant differences in postoperative flatus passage, defecation time, hospital stay, or complication rates (P > .05). In terms of postoperative anxiety, the experimental group had significantly lower State Anxiety Inventory scores at 24 hours postoperatively (T2) (P < .05). Cognitive function, measured by Montreal Cognitive Assessment scores, did not show significant differences; however, cognitive decline was less pronounced in the experimental group. PND rates were 5% (2/40) in the experimental group versus 12.5% (5/40) in the control group, suggesting a possible clinical tendency toward reduced incidence, although the difference did not reach statistical significance. The rates of PND at 24 hours (T2) and 7 days (T3) postoperatively were 10% (4/40) and 5% (2/40) for the experimental group, compared to 15% (6/40) and 12.5% (5/40) for the control group using the Z-value method, Although the between-group differences did not reach statistical significance, a lower incidence was observed in the parecoxib group, suggesting a possible clinical tendency. Parecoxib, when used with pancreaticoduodenectomy, alleviates postoperative anxiety and neurocognitive disorders without affecting postoperative intestinal function recovery or increasing the incidence of postoperative complications.
Traditional in-person handovers from the Post-Anaesthesia Care Unit (PACU) to inpatient wards often require PACU nurses to leave their post-operative patients for extended periods, which may delay the handover and management of other patients awaiting transfer. Alternatively, the PACU nurse-in-charge may hand over patient information to another individual to assist with in-person handover in the inpatient ward. Multiple care transitions increase the risk of omission of critical handover information, which compromises patient safety. A Virtual Nursing Handover (VNH) model may address these workflow and safety challenges by enabling direct, real-time communication between PACU and ward nurses, while reducing unnecessary staff movement. To evaluate the safety, feasibility, and usability of a VNH from the PACU to the inpatient ward. This process innovation study was underpinned by the Technology Acceptance Model (TAM). A three-component evaluation was conducted to assess the safety, feasibility, and usability of a VNH from the PACU to the inpatient ward. The study was undertaken in an acute care hospital in Singapore between October and November 2024. Handover safety was evaluated using structured audits based on the Queensland Health Handover Audit Tool, aligned with National Safety and Quality Health Service standards. The tool comprised 17 items assessing handover completeness and safety, along with additional open-ended questions to capture technical quality and notable observations. Feasibility was assessed using implementation metrics, including handover duration, adherence to the intended workflow, and technical reliability. Usability was evaluated using the System Usability Scale (SUS) administered to PACU and ward nurses, supplemented by qualitative feedback. Consistent with the TAM, safety and feasibility were interpreted as indicators of perceived usefulness, while usability reflected perceived ease of use. Quantitative data were analysed using SPSS version 26.0, and qualitative data were analysed thematically. A total of 31 handover safety audits were conducted. Adherence to handover safety standards was high, with all audits meeting at least 15 of the 17 audit criteria (≥ 88%). The VNH demonstrated high feasibility, resulting in an estimated time saving of approximately 4.7 h per day for PACU nurses. No major technical failures were observed, and handovers were conducted as intended. In contrast, system usability was rated below average, with a mean SUS score of 41.9. VNH from the PACU to the inpatient ward was safe and feasible in routine clinical practice; however, suboptimal usability may limit technology acceptance. Further system refinement is required to improve user experience and support sustained adoption.
Alarm fatigue caused by frequent or false alarms poses a persistent threat to patient safety. Despite technological progress, alarm acoustics remain largely unchanged and are often perceived as disruptive. To address this, Philips redesigned its patient monitoring alarm sounds through a user-centered approach aimed at improving priority differentiation and reducing emotional strain. This study provides insights into human-technology interaction by examining anesthesia providers' experiences with the original and updated alarms, with a focus on emotional responses, usability, and guidance for the user-centered design of future clinical alarm systems. This single-center qualitative study involved anesthesia providers who completed an online questionnaire before and after the implementation of the updated Philips alarms. Only those who completed the pre-implementation phase participated in the postimplementation phase. The questionnaire included 4 open-ended questions addressing perceptions of the current alarm sounds, suggestions for improvement, design expectations, and attitudes toward an alarm-free operating room. Responses were analyzed using thematic analysis to identify key usability and emotional response themes. A total of 90 eligible anesthesia providers participated in the preimplementation phase, and 77 (85.6%) participated in the postimplementation phase. Positive emotional responses increased in the postimplementation phase, whereas concerns regarding alarm functionality also became more prominent. Before the introduction of the updated alarm sounds, participants predominantly called for softer sounds. Following implementation, the most frequently expressed concern shifted to the need for clearer prioritization of alarms. Across both phases, the primary expectation remained the alarms' ability to effectively capture attention. The concept of an alarm-free operating room elicited concerns about increased workload and potential risks to patient safety. The redesigned alarm sounds were perceived more positively in terms of emotional acceptance; however, they did not improve the recognition of alarm priority. The modest acoustic changes did not address the broader issue of alarm overload. Suggestions such as visual-only alerts for low-priority alarms show potential but must be balanced with patient safety standards. Future alarm development should combine user feedback with expert-driven and evidence-based approaches to improve both usability and clinical effectiveness.
Clinical evidence on obturator nerve involvement after supra-inguinal fascia iliaca compartment block (SFICB) is limited. This study aimed to investigate whether a 40-mL SFICB reliably anesthetizes the obturator nerve and whether the addition of a selective obturator nerve block (ONB) improves postoperative analgesia in patients undergoing total knee arthroplasty. In this randomized, double-blind, active-controlled trial, 84 patients who underwent total knee arthroplasty were randomized to receive SFICB (40 mL of 0.5% ropivacaine) plus either active (10 mL of 0.5% ropivacaine) or placebo (10 mL of normal saline) ONBs. Spinal anesthesia and postoperative analgesia were standardized. Two primary outcomes were (1) the success rate of ONB, measured 45 min after block completion, and (2) equivalent intravenous morphine consumption during the first 24 h postoperatively, tested following a predefined fixed-sequence procedure. Secondary outcomes included post-block sensorimotor function, pain scores, rescue analgesic use, patient satisfaction, sleep quality, recovery quality, and adverse effects within 48 h postoperatively. The success rate of ONB was significantly higher in the ONB group than in the placebo group (97.6% vs 2.4%; risk difference, 95.2%; 95% confidence interval, 81.2%-98.0%; P < 0.001). Equivalent intravenous morphine consumption during the first 24 h postoperatively did not differ significantly between the ONB and placebo groups (6.8 [2.5, 11.5] vs 7.8 [4.6, 17.5] mg; median difference, -2.5; 95% confidence interval, -5.0 to 0.5; P = 0.156). No differences were observed in the secondary outcomes, except for a greater reduction in adductor strength in the ONB group. An SFICB with 40 mL of 0.5% ropivacaine rarely anesthetized the obturator nerve. The addition of a selective ONB did not improve postoperative analgesia or recovery quality within 48 h after total knee arthroplasty. Further studies are needed to define the minimum effective SFICB volume that reliably involves the femoral and lateral femoral cutaneous nerves. ChiCTR2300073558.
Glucose management in intensive care unit (ICU) patients often relies on point of care (POC) blood glucose measurements. An increasing number of randomized clinical trials (RCTs) have investigated continuous glucose monitoring (CGM) compared to POC, but effects on patient-important outcomes are uncertain. We systematically searched PubMed, Embase, CENTRAL, CINAHL and Web of Science. All reporting was done according to the PRISMA guideline. We included RCTs in ICU patients comparing the effects of CGM versus POC on glycemic and clinical outcomes. We performed meta-analyses, Trial Sequential Analysis, and assessed the certainty of the evidence using GRADE. We identified 1271 records and included 18 RCTs comparing CGM versus POC with a total of 2027 participants; 15 trials with 1600 participants reported on mortality (relative risk 0.61, 95% CI 0.35-1.04; very low certainty evidence) and 14 trials with 1515 participants on hypoglycemia (relative risk 0.44, 95% CI 0.23 to 0.82; very low certainty evidence). None of our remaining secondary outcomes were reported in the trials. We identified potential benefits of CGM versus POC on glycemic process outcomes; however, we did not evaluate certainty of evidence. CGM used for glucose management in ICU patients may reduce mortality and hypoglycemia, but the evidence is very uncertain. Sufficiently powered trials at low risk of bias are needed to confirm potential beneficial effects. This meta-analysis reports the available literature on continuous versus intermittent monitoring of blood glucose in critically ill patients. The authors found that the available evidence was very uncertain, although continuous monitoring might improve outcomes. It is likely that this is partially due to lack of standardization of measurements and different management strategies. It is possible that the question is best answered with a larger trial with a well-defined treatment protocol.
Postoperative sleep is closely associated with recovery among patients undergoing surgery. This study aimed to analyze the research status and developmental trends in postoperative sleep between 2014 and 2024. Publications were retrieved from the Web of Science Core Collection. Microsoft Excel and VOSviewer were used to analyze the papers in terms of publication trends, countries, institutions, authors, journals, and keywords. A total of 964 papers were obtained for the bibliometric analysis. The number of publications on this topic has increased gradually over the last 10 years. Zhu Junchao was the most prolific author in the field, and Chung Frances had the most citations. China had the most publications, followed by the United States. Scientific institutions in China, such as China Medical University and Capital Medical University, have led the way in terms of publication numbers. A total of 40 journals have published at least 5 papers. BMC Anesthesiology, with 19 publications, ranked first in publication count. The papers published in the British Journal of Anaesthesia, Journal of Clinical Anesthesia, Anesthesia and Analgesia, Journal of Pain, and Journal of Sleep Medicine had higher citation counts on average. The high-frequency keywords were "sleep quality," "postoperative pain," "quality of life," and "surgery," while "lung cancer," "enhanced recovery after surgery," "breast cancer," and "dexamethasone" emerged as new topics in this area. There has emerged a large body of literature on postoperative sleep over the past 10 years. Authors and organizations from China are leading contributors, followed by those from the United States. Anesthesiology is a critical discipline in this field. Postoperative pain is closely related to postoperative sleep and has become a major research focus. Recent studies have mainly focused on lung cancer and breast cancer surgeries. Enhanced recovery after surgery has become an emerging keyword.
Dysarthria is defined as a motor speech disorder that can cause major communication problems. Meticulous assessment of this disorder is crucial for adequate therapeutic follow-up. To Provide tunisian speech therapists with an almost complete tool for the evaluation of dysarthria. A single-center study adapted and validated the Dysarthria Clinical Evaluation Battery BECD 2019 in 135 dysarthric patients and 135 adult controls at different stages. Comparison of scores between all samples showed significance, hence the sensitivity of the tool. Construct validity was carried out with the help of expert neurologists and speech therapists. Cronbach's alpha coefficient revealed a value of 0.7, indicating good internal consistency of the scale. The ROC curves of the different tests guided us in leaving the same threshold scores of the original battery. Our study provided a dysarthria assessment tool, adapted to the Tunisian context, promoting a standardized clinical evaluation in order to harmonize communication amongclinicians.
The Kahramanmaraş earthquake that occurred in Türkiye in 2023 affected 14 million people, resulting in 53,537 deaths and more than 100,000 injuries. In large-scale disasters, it is crucial to rapidly initiate complex treatment processes in hospitals equipped with tertiary intensive care units following the initial on-site response. In this study, we aimed to retrospectively analyze the types of trauma and the associated surgical and medical treatments of patients affected by the earthquake who were admitted to our level 3 intensive care unit. Our objective was to contribute to future disaster preparedness planning in healthcare institutions and to improve intensive care treatment strategies. This retrospective single-center study was conducted at Mersin City Training and Research Hospital. Clinical data of patients treated in the tertiary intensive care unit were reviewed. The recorded variables included demographic characteristics, time of hospital admission, length of hospital stay, complete blood count, creatine kinase, myoglobin, albumin levels, liver and renal func-tion tests, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, type of trauma, presence of crush syndrome and acute kidney injury, surgical interventions and types of surgery, renal replacement therapy, blood transfusion, fluid therapy, nutritional support, requirement for mechanical ventilation, psychiatric support, hyperbaric oxygen therapy, mortality, and referral to another hospital. A total of 80 patients were included in the study; 53.8% were female, and the mean age was 49.93 years. The overall mortality rate was 22.5%. The mean age was higher in the mortality group, and lymphocyte count was also significantly higher in this group. The proportion of patients receiving renal replacement therapy was greater in the mortality group compared to survivors (p=0.035). Eleven patients died within the first five days of admission, and 13 of the deceased patients had acute kidney injury. Mechanical ventilation and total parenteral nutrition were more frequently required in the mortality group. Advanced age, the need for total parenteral nutrition, renal replacement therapy, and mechanical ventilation were identified as predictors of mortality among trauma patients followed in a tertiary intensive care unit. Türkiye'de 2023 yılında meydana gelen Kahramanmaraş depremi 14 milyon insanı etkilemiştir. Deprem 53.537 kişinin ölümüne ve 100.000'den fazla yaralının geride kalmasına neden olmuştur. Bu tür büyük afetlerde, sahada ilk müdahaleyi takiben gelişmiş yoğun bakım ünitesine sahip hastanelerde komplike tedavi süreçlerinin hızla başlatılması çok önemlidir. Bu çalışmada, depremden etkilenen ve 3. seviye yoğun bakım ünitemize kabul edilen hastaların travma türlerini, ilişkili cerrahi ve tıbbi tedavilerini retrospektif olarak analiz etmeyi planladık. Sonuç olarak, sağlık kurumlarında doğal afetlere yönelik hazırlıklar ve yoğun bakım ünitesindeki tedavi stratejileri hakkında ileriye dönük yapılacak planlamalara ilham olmayı amaçladık Bu retrospektif tek merkezli çalışma, Mersin Şehir Eğitim ve Araştırma Hastanesi'nin üçüncü basamak yoğun bakım ünitesinde tedavi gören hastaların klinik bilgilerinin toplandığı bir çalışmadır. Hastaların demografik verileri, hastaneye geliş zamanı, hastanede kalış süresi, tam kan sayımı, kreatin kinaz, miyoglobin, albümin düzeyleri, karaciğer ve böbrek fonksiyon testleri, APACHE II skoru, travma tipi, ezilme sendromu, akut böbrek hasarı varlığı, cerrahi girişim, cerrahi tipleri, renal replasman tedavisi, kan transfüzyonu, sıvı tedavisi, beslenme desteği, mekanik ventilasyon ihtiyacı, psikiyatrik destek, hiperbarik oksijen tedavisi, mortalite, başka bir hastaneye sevk edilme durumları kaydedildi. Bu çalışmaya %53.8'i kadın olan ve yaş ortalaması 49.93 olan 80 hasta dahil edilmiştir. Mortalite oranı %22.5 olup ortalama yaş daha yüksektir, aynı şekilde lenfosit sayısı da anlamlı derecede yüksek bulunmuştur. Mortalite grubunda renal replasman tedavisi alan hasta yüzdesi sağ kalan gruba göre daha yüksekti. (p=0.035) Ölen hastaların 13'ünde akut böbrek hasarı mevcuttu ve 11 hasta ilk beş gün içinde öldü. Mekanik ventilasyon ve total parenteral beslenme uygulanan hastalar ölüm grubunda daha yaygındı. Üçüncü basamak yoğun bakım ünitesinde takip edilen travma hastalarında ileri yaş, total parenteral beslenme, renal replasman tedavisi ve mekanik ventilasyon varlığı mortalite için prediktör olarak bulunmuştur.
Interstitial lung diseases (ILDs) are a heterogeneous group of disorders with complex etiologies and nonspecific clinical manifestations, often requiring histopathological confirmation for accurate diagnosis. Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive alternative to surgical lung biopsy (SLB) for obtaining lung tissue, yet its role in multidisciplinary discussion (MDD) remains underevaluated. This study aimed to assess the diagnostic yield and safety of TBLC when integrated into MDD for diagnosing ILDs. A retrospective dual-center study was conducted on 208 patients with undiagnosed ILDs who underwent TBLC at Shanghai Chest Hospital and Fuzhou Pulmonary Hospital from May 2021 to December 2024. TBLC procedures were performed under general anesthesia, with samples evaluated by pathologists and integrated into MDD involving pulmonologists, radiologists, and rheumatologists. Diagnostic yield, complication rates, and concordance were analyzed. TBLC achieved a histological diagnostic yield of 88.9% (185/208 cases), which improved to 97.6% (203/208 cases) after MDD. The most common diagnosis was hypersensitivity pneumonitis (HP, 18.3%) followed by idiopathic nonspecific interstitial pneumonia (iNSIP, 15.4%). Complications were rare, with pneumothorax occurring in 5.3% of cases and moderate bleeding in 3.4%. No procedure-related mortality was observed. TBLC is a safe and effective diagnostic tool for ILDs, with high diagnostic yield when integrated into MDD. TBLC reduces the need for SLB while maintaining low complication rates. These findings support TBLC as a valuable component of the MDD approach for ILDs. The role of transbronchial lung cryobiopsy (TBLC) in multidisciplinary discussion (MDD) for interstitial lung diseases (ILDs): a dual-center retrospective studyBackground Interstitial lung disease (ILD) is often difficult to diagnose and may require a lung tissue sample. Surgical biopsy is effective but invasive. A less invasive procedure, called transbronchial lung cryobiopsy (TBLC), is now available, but its value in a team-based diagnostic approach needs further confirmation. Objective This study evaluated how effective and safe TBLC is when its results are reviewed by a multidisciplinary team (MDD) for diagnosing ILD. Methods We reviewed data from 208 patients with undiagnosed ILD at two hospitals in China. All patients underwent TBLC. Their biopsy results were then discussed by a team of lung specialists, radiologists, and pathologists to reach a final diagnosis. Key Results TBLC alone provided a clear histological diagnosis in 88.9% of cases. After the multidisciplinary team discussion (MDD), a final diagnosis was reached in 97.6% of cases. The most common final diagnoses were Hypersensitivity Pneumonitis and Idiopathic Nonspecific Interstitial Pneumonia. The procedure was safe: pneumothorax occurred in 5.3% and moderate bleeding in 3.4% of patients. No deaths were related to the procedure. Conclusion Transbronchial lung cryobiopsy (TBLC) is a safe and effective diagnostic tool for ILD. When its results are integrated into a multidisciplinary team discussion, the diagnostic success rate is very high. This supports TBLC as a valuable alternative to more invasive surgical biopsy.
Pulmonary aspiration of gastric contents is a serious clinical complication, particularly in patients receiving enteral nutrition or undergoing anesthesia. Gastric residual volume (GRV) is a commonly used surrogate marker that can identify delayed gastric emptying and enteral nutrition intolerance, both of which may increase the risk of aspiration. Traditional methods for measuring GRV are invasive and lack standardization. Point-of-care ultrasound (PoCUS) has emerged as a promising, noninvasive bedside alternative. Despite its growing clinical use, there is still no consolidated guidance on PoCUS procedures for GRV assessment in adult patients. This scoping review aims to map and synthesize the available evidence on procedural techniques, interpretation criteria, and decision-making applications related to PoCUS for GRV assessment. This scoping review will follow the JBI Collaboration methodology and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols extension for Scoping Reviews) guidelines. The PCC (population, concept, and context) mnemonic guided the formulation of the research question. Systematic searches will be conducted in MEDLINE, CINAHL, Embase, Scopus, Cochrane Library, and LILACS, as well as in gray literature sources. Eligible sources will include primary studies, reviews, and clinical guidelines focused on PoCUS for GRV assessment in adults (aged ≥18 years). Two independent reviewers will perform study screening and data extraction. The synthesis will be structured using the I-AIM (indication, acquisition, interpretation, and medical decision-making) framework. Results will be summarized narratively, in tables, and through visual representations such as flowcharts and conceptual diagrams. This protocol was registered on the Open Science Framework registry on August 21, 2025. The literature search began on April 3, 2026, with study selection and data extraction planned for May 2026. The final results are expected to be submitted for publication in July 2026. As this is a protocol study, no results are available yet. This review will identify and categorize the procedures, technical parameters, and clinical applications of PoCUS for GRV assessment in adult patients. By mapping the existing evidence, the findings may inform future research, educational curricula, and the development of clinical guidelines for nurses. In addition, the review will highlight methodological gaps and variations in practice that may affect the safe and effective use of PoCUS across diverse health care settings.
Surgical management of lumbar degenerative diseases (LDD) in octogenarians requires balancing effective neural decompression against diminishing physiological reserves. While general anesthesia (GA)-based endoscopic techniques (ENDO-GA) are highly effective, they often impose excessive systemic stress on frail patients. Conversely, percutaneous endoscopic lumbar discectomy under local anesthesia (PELD-LA) provides targeted decompression while mitigating these GA-associated risks. Given the scarcity of direct comparisons in this fragile population, this study evaluates the safety and efficacy of PELD-LA versus ENDO-GA. We retrospectively analyzed 100 consecutive octogenarians treated for LDD between January 2021 and December 2024. Patients were stratified into two specific surgical strategy groups: targeted decompression via PELD-LA (n=54) and extensive decompression via ENDO-GA (utilizing UBE or Delta techniques, n=46). To minimize selection bias, a 1:1 Propensity Score Matching (PSM) was conducted using specific covariates (age, sex, comorbidities, and ASA classification), yielding 39 matched pairs (n=78). Primary outcomes assessed perioperative safety and recovery efficiency (complications, PONV, ambulation time, and length of hospital stay).Secondary outcomes evaluated postoperative clinical efficacy (VAS and ODI at 3 months, and modified MacNab criteria at 12 months postoperatively). After propensity score matching, baseline characteristics were well-balanced between the two groups. Perioperatively, the PELD-LA group exhibited significantly shorter operative times (97 vs 150 min, P<0.001), earlier ambulation (48 vs 72 h, P<0.001), and reduced length of hospital stay (9 vs 14 days, P<0.001) compared to the ENDO-GA group. Clinically, despite a smaller "targeted" decompression range, PELD-LA achieved long-term efficacy (MacNab criteria: 94.9% vs 94.9%, P=1.000) comparable to extensive decompression, while demonstrating superior early pain relief and functional improvement (VAS and ODI) at 3 months postoperatively (P<0.01). Crucially, the overall complication rate was significantly lower in the PELD-LA group (30.8% vs 82.1%, P<0.001), primarily driven by a marked reduction in postoperative nausea and vomiting (PONV) (23.1% vs 66.7%, P<0.001). Within our short-to-medium-term observation period, PELD-LA delivered clinical efficacy comparable to GA-based endoscopic procedures for octogenarians, while significantly reducing perioperative complications and accelerating recovery. Crucially, we do not assert that PELD-LA is universally superior; rather, we emphasize the importance of tailored patient selection. For frail patients with limited physiological reserve, PELD-LA serves as a physiologically rational strategy, balancing targeted decompression with the preservation of systemic stability.
Arthrofibrosis (AF) is a common pathological condition characterized by joint dysfunction. However, traditional non-invasive external fixation methods are difficult to maintain on the small limbs of rats. This study aimed to develop a novel, non-invasive, and stable rat model of knee arthrofibrosis using a thermoplastic polymer resin. Sixty male Sprague-Dawley rats were randomly assigned into a Sham group and immobilization groups (1, 2, 4, and 6 weeks). Utilizing the material's property of being malleable at high temperatures and rigid at room temperature, a custom-fitted "thigh-crus-trunk" external fixation device was fabricated to immobilize the knee at 135° of flexion. Total, arthrogenic, and myogenic contractures were assessed by measuring the range of motion (ROM). Histopathological changes were evaluated using H&E and Masson's trichrome staining. The expression of fibrotic markers (α-smooth muscle actin, α-SMA and collagen type I alpha 1 chain, COL1A1) in synovial tissues was detected via immunohistochemistry, RT-qPCR, and Western blotting. Biosafety was assessed through histological and serum biochemical analyses of major organs. Prolonged immobilization resulted in a significant decrease in knee ROM, while joint capsule thickness, synovial hyperplasia, and collagen deposition increased, stabilizing after 4 weeks. Analysis revealed that myogenic contracture predominated in the first 2 weeks, whereas arthrogenic contracture became dominant in the later stage. Molecular analysis confirmed a time-dependent upregulation of α-SMA and COL1A1 in synovial tissues. Furthermore, no abnormalities were observed in major organs or serum biochemical indices, indicating favorable biosafety. A novel non-invasive rat model of knee arthrofibrosis was successfully established using thermoplastic polymer resin. This device is cost-effective, user-friendly, stable, and biocompatible. It effectively simulates immobilization-induced joint contracture without surgical trauma, serving as a valuable model for future arthrofibrosis research.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
Estimated glomerular filtration rate (eGFR) based on cystatin C and creatinine often yields discordant results. Although the eGFR difference, defined as cystatin C-based eGFR minus creatinine-based eGFR, has been proposed as a marker of risk for adverse clinical outcomes, its association with postoperative complications and mortality remains unclear. This study aimed to investigate whether the eGFR difference is associated with postoperative complication and mortality risks. Using data from the UK Biobank, the primary analysis included 26,065 participants with baseline serum creatinine and cystatin C levels who had surgery within 1 year of recruitment. Extended analyses included 241,006 participants who had major surgeries during the follow-up period (median follow-up, 13.7 years). Primary outcomes were 30-day postoperative complications and 90-day all-cause mortality. Sensitivity and subgroup analyses were performed. In the primary analysis, restricted cubic spline modeling revealed an L-shaped association, with a threshold near -15 mL min-1 1.73 m-2. Compared with a neutral eGFR difference (≥ - 15 mL min-1 1.73 m-2), a highly negative eGFR difference (<-15 mL min-1 1.73 m-2) was associated with increased risks of complications (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.38 to 2.08, P < 0.001) and mortality (OR = 2.29, 95% CI: 1.59 to 3.32, P < 0.001) in the unadjusted models. These associations remained significant after full adjustment (complications: OR = 1.60, 95% CI: 1.28 to 2.01, P < 0.001; mortality: OR = 1.96, 95% CI: 1.27 to 3.00, P = 0.002). Similar associations were observed in the extended analyses of participants having major surgery during follow-up (complications: OR = 1.23, 95% CI: 1.17 to 1.30, P < 0.001; mortality: OR = 1.50, 95% CI: 1.39 to 1.63, P < 0.001). Findings were consistent across sensitivity and subgroup analyses, with the associations attenuated for complications (OR = 1.36, 95% CI: 1.07-1.73, P = 0.01) and mortality (OR = 1.22, 95% CI: 0.79-1.89, P = 0.37) in fully adjusted models that included cystatin C-based instead of creatinine-based eGFR. A highly negative eGFR difference was independently associated with increased risks of postoperative complications and mortality. The findings likely reflect a combination of more accurate assessment of eGFR by cystatin C as well as non-GFR determinants of circulating creatinine and cystatin C concentrations.
The aim of this study was to identify and assess factors associated with nurse anesthetist competency in Finland, South Korea, Taiwan, and the United States. A cross-sectional design was used. The Anesthesia Nursing Competence Scale consisting of seven competencies was utilized: ethics, patient risk management, technological skills, collaboration, medication, optimizing anesthesia care, and anesthesia knowledge (0 = not competent at all, 10 = excellent competence). The data were collected via an online survey (N = 582) in 2024. Data analysis included correlation tests, t-tests, and linear regression analysis. The highest-rated competencies varied by country: collaboration in Finland (9.31 ± 0.68), medication in Taiwan (9.01 ± 1.19), and ethics in the United States (9.58 ± 0.84). However, anesthesia knowledge was the lowest-rated competency across all countries. Age, educational level, and work experience showed a positive correlation with competency and education level was identified as the most important factor influencing anesthesia nursing competency. Assessing these competencies as outcomes of nursing education in an international context remains crucial for promoting global standards in the education and practice of nurse anesthetists. Strengthening international collaboration in anesthesia nursing education and establishing standardized competency assessments could further promote high quality practices and ensure quality patient care.
It remains a challenge to obtain well-preserved tissue samples from deceased patients as access to regular autopsy is limited. Minimally invasive autopsy (MIA) is a potential alternative to the complete diagnostic autopsy because of its efficacy in providing non-autolyzed tissue samples and its increased acceptability amongst the bereaved. The study follows an exploratory, prospective design without any kind of intervention. Inclusion criteria are deceased adults (≥ 18 years), confirmed signs of death, uncertain or multifactorial cause of death, present or previous infection, and permission from next of kin to perform MIA, defined by ultrasound (US)-guided samples from the heart, lungs, liver, spleen, and kidneys using a TruCut semi-automatic coaxial needle (14G; 16 cm length). Tissue samples, fixed in BiopSafe 20 mL formalin test tubes, are sent for pathological evaluation. The primary outcome is the achievement of well-preserved tissue samples, representative of the target organ and suitable for histopathological evaluation and diagnosis. An exploratory outcome is to establish the degree of clinico-pathological discrepancies between pre-mortem clinical status and post-mortem pathological descriptions. This investigator-initiated study is designed to validate the feasibility of MIA to enable fast-track post-mortem evaluation in an ICU environment.