Ulcerative colitis (UC) involves excessive inflammation, extracellular matrix remodelling and oxidative stress. Ethyl pyruvate (EP) exhibits anti-inflammatory effects, but the comparative efficacy of prophylactic versus therapeutic administration and timing-dependent molecular responses remains unclear. The objective of this work was to evaluate timing-dependent protective and therapeutic effects of EP in trinitrobenzene sulfonic acid (TNBS)-induced experimental colitis, focusing on inflammatory mediators, matrix metalloproteinases (MMPs), oxidative status and gene expression. Rats were randomly assigned to Control, EP, Colitis, Pre-colitis (EP before TNBS) and Post-colitis (EP after TNBS) groups. Colonic injury was assessed macroscopically and histopathologically. Tissue levels of matrix metalloproteinase (MMP)-2, MMP-9, interleukin (IL)-1, IL-17, IL-10, nuclear factor-κB (NF-κB), inducible nitric oxide synthase (iNOS) and total antioxidant capacity (TAC) were measured using ELISA kits. Gene expression of MMP-9, cytokines, NF-κB, high mobility group box 1 (HMGB1), iNOS and interferon-γ was analysed by quantitative real-time PCR. TNBS induced severe colonic injury with upregulation of pro-inflammatory cytokines, NF-κB signalling, MMP-2/9 and oxidative imbalance (P < 0.01). EP attenuated tissue damage in both prophylactic and therapeutic settings. Post-colitis (therapeutic) EP administration produced greater suppression of MMP-2, MMP-9, NF-κB, HMGB1 and iNOS, along with superior restoration of TAC (P < 0.05), indicating timing-dependent modulation of inflammatory and matrix degradation pathways. EP exerts both preventive and therapeutic effects in TNBS-induced colitis by suppressing inflammatory signalling, regulating extracellular matrix remodelling and enhancing antioxidant defences. Therapeutic administration is more effective than prophylactic treatment, highlighting the importance of timing in optimizing EP's efficacy in inflammatory bowel disease.
Mechanical ventilation goals include restoration of gas exchange, lung protection, and patient comfort. Improving patient comfort through synchronous patient-ventilator interaction represents a common clinical challenge in the management of these patients. Patient-ventilator discordance describes a mismatch between the patient's intrinsic respiratory timing and effort with the ventilatory support provided by the ventilator. Achieving concordance requires an understanding of physiologic principles related to the control of breathing, expertise in recognition of discordance using the pressure and flow waveforms, and an in-depth knowledge of ventilator operation. Discordance is a common occurrence in ventilated patients, and over the past two decades, the recognition of patient-ventilator discordance has improved with education, simulation, and advances in instrumentation. Despite these advances, the impact of patient-ventilator discordance remains controversial. Growing evidence suggests patient-ventilator discordance is associated with adverse outcomes including mortality, increased sedation requirements, and duration of mechanical ventilation, although a cause-and-effect relationship has not been clearly demonstrated. Discordance may simply be a marker of the severity of illness. However, the impact of discordance varies based on the type and timing of discordance, lung mechanics, and the magnitude of patient effort. Some types of discordance may have positive effects. This article aims to explore the pathophysiology and identification of patient-ventilator discordance related to timing.
This study aims to investigate the impact of early initiated rehabilitation on outcomes in patients with spinal cord injuries related to tumors. In this retrospective cohort study conducted between January 2015 and March 2021, a total of 31 patients with tumor-related spinal cord injury were assessed. Two patients were excluded due to incomplete clinical records, and the remaining 29 patients were divided into the early rehabilitation group (n=15; 8 males, 7 females; mean age: 45.53±16.73 years; range: 8 to 68 years) and the late rehabilitation group (n=14; 9 males, 5 females; mean age: 54.86±14.76 years; range: 28 to 78 years). Demographic and clinical characteristics, Functional Ambulation Category (FAC), and Barthel Index scores for outcome measurement were recorded. The neurological level of the patients was predominantly at the thoracic level. The majority of patients were in the American Spinal Injury Association D category. In the evaluation of treatment outcomes, a significant difference was observed within each group of FAC and Barthel Index scores before and after rehabilitation (p=0.034, p=0.002; p=0.007, p=0.005 in early and late rehabilitation groups). In the comparison of FAC and Barthel Index scores before and after rehabilitation between groups, there was a significant difference in favor of the late rehabilitation group in both scores, both before and after rehabilitation (respectively, before rehabilitation p=0.032, p=0.005; after rehabilitation p=0.026, p=0.003). However, there was no significant difference in the FAC difference and Barthel Index scores percentage changes between groups. This study demonstrates that functional outcomes improved with rehabilitation in patients with spinal cord injuries related to tumors. Although the timing of rehabilitation initiation did not result in significant differences in functional outcomes, early rehabilitation did not appear to increase the risk of surgery-related adverse events.
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The optimal timing of thoracic radiotherapy (RT) during concurrent chemoradiotherapy (CCRT) for small cell lung cancer (SCLC) remains controversial. This study aimed to evaluate treatment outcomes, prognostic factors, and the role of prophylactic cranial irradiation (PCI) according to thoracic RT timing in patients with limited-disease (LD) SCLC. A retrospective study was conducted on patients with SCLC diagnosed between 2018 and 2022. Survival outcomes, prognostic factors, treatment outcomes, and adverse events were assessed according to thoracic RT timing (early vs. late) and PCI use. Among 122 patients diagnosed with LD-SCLC, 99 who received CCRT were included in the analysis, comprising 74 patients in the early thoracic RT (ERT) and 25 in the late thoracic RT (LRT) group. After propensity score matching (PSM) based on RT timing, Kaplan-Meier survival analysis demonstrated that the ERT group had significantly longer median overall survival (OS) (20.0 vs. 12.0 months, P=0.041) and progression-free survival (PFS) (16.0 vs. 8.0 months, P=0.01) than the LRT group, whereas brain metastasis-free survival (BMFS) did not differ significantly (P=0.32). Following PSM according to PCI status, OS and PFS were comparable between groups; however, BMFS was significantly longer in the PCI group (P=0.048). In multivariate Cox analysis, both age and thoracic RT timing remained significant prognostic factors for OS and PFS. No statistically significant differences were observed in treatment response or treatment-related adverse events between groups. In patients with LD-SCLC treated with CCRT, ERT was associated with improved survival without a significant increase in treatment-related toxicity. Although PCI did not confer a clear survival benefit, it may reduce the risk of brain metastasis.
Perimenopause is a clinically distinct stage in which abnormal uterine bleeding, fibroids, adenomyosis, endometriosis, and adnexal pathology may require surgical evaluation. Management is complex because symptom burden and structural disease must be balanced against proximity to menopause, potential spontaneous improvement and the risks of undertreatment or overtreatment. This review summarizes evidence on complex benign gynecology in perimenopausal women, focusing on surgical timing, uterus-sparing and definitive procedures, and adnexal management. Recent data emphasize careful preoperative assessment of abnormal uterine bleeding because hormonal disturbance, structural pathology, and premalignant or malignant endometrial lesions may coexist. Evidence also supports individualized timing of definitive surgery, as earlier loss of ovarian function, particularly before age 45-50 years, may be associated with less favorable long-term cardiovascular outcomes. Opportunistic salpingectomy during indicated benign surgery is supported as an ovarian cancer prevention strategy that preserves ovarian hormonal function, whereas oophorectomy remains individualized. Management should be tailored to symptoms, pathology, malignancy risk, proximity to menopause and patient preference. Perimenopause-specific prospective studies are needed.
The circadian system coordinates daily physiology across nearly all tissues to temporally organize metabolism and maintain homeostasis. In the brain, circadian timing regulates neural activity, cellular function, and neuroimmune signaling, which is especially important during development. Yet, the ontogeny of circadian regulation during neurodevelopment remains poorly defined. Here, we characterized time-of-day variation in core clock and neuroimmune genes across multiple brain structures during early postnatal development, alongside circulating corticosterone concentrations. Using male and female C57BL mice housed in a standard light-dark cycle [12:12 light (150 lux)/dark (0 lux)], we measured the expression of Per1, Per2, and Rev-erbα in the suprachiasmatic nucleus, hippocampus, and medial prefrontal cortex, as well as in neuroimmune tissues (choroid plexus, meninges, and isolated microglia) across postnatal days (PND) 1-24. Across development, rhythms were seen in corticosterone concentrations and all brain regions, with increased amplitudes and gene-specific phase maturation toward adult-like timing by PND 24. Notably, the choroid plexus and meninges exhibited time-of-day differences in clock gene expression by PND 10-24. In contrast, isolated microglia did not display detectable time-of-day differences in clock gene expression; however, microglial phagocytic activity varied by time of day. Together, these findings demonstrate that circadian regulation of the brain emerges during the neonatal period, and the parameters of time-of-day differences are tissue- and gene-specific during development. In addition, functional rhythms may precede or occur independent of detectable transcriptional differences. This work establishes a developmental framework for circadian-neuroimmune interactions, with important implications for neuroimmune development and vulnerability. Given the neuroimmune system's role in shaping brain development, disruptions in these temporal processes may contribute to neurodevelopmental or mood disorders.
Timely surgical intervention is crucial in trauma care, particularly in patients with hypotensive abdominal injuries. In South Korea, the regional trauma center system has adopted a quality metric mandating initiation of emergency surgery within 1 hour of emergency department (ED) arrival for such patients. We evaluated the impact of ED-to-surgery time on clinical outcomes in hypotensive abdominal trauma and assessed the appropriateness of the 1-hour threshold. This multicenter retrospective study included 425 trauma patients who underwent emergency abdominal surgery at 2 regional trauma centers between 2019 and 2022. Patients with an initial or lowest recorded systolic blood pressure (SBP) <90 mmHg were included. The primary outcome was in-hospital mortality; secondary outcomes included complications, intensive care unit stay, and total hospital stay. Patients were categorized into early (≤1 hour) and delayed (>1 hour) surgery groups. Statistical analyses included logistic regression, propensity score matching (PSM), receiver operating characteristic curve, and complication analysis by 30-minute intervals. We found that 243 patients (57.2%) underwent surgery within 1 hour. In-hospital mortality did not differ significantly between early and delayed groups. Age, Glasgow Coma Scale, lowest SBP, 4-hour RBC transfusion volume, and abdominal Abbreviated Injury Scale were independent mortality predictors. PSM confirmed no mortality difference by surgical timing. However, complication rates increased with surgical delays. While surgical delay was not associated with mortality, it was linked to increased complications. Future trauma quality metrics should incorporate refined patient stratification and evaluate the entire process aimed at restoring physiological instability, rather than relying on a strict 1-hour threshold.
No prior meta-analysis has systematically assessed efficacy and safety of C-type natriuretic peptide (CNP) analogs within the context of evolving understanding of FGFR3 biology and achondroplasia natural history. To evaluate the safety and efficacy of CNP analogs in children with achondroplasia and contextualize clinical outcomes and natural history. Systematic review of randomized control trials and real-world studies evaluating the safety and efficacy of CNP analogs (vosoritide and navepegritide) in children aged <18 years with genetically confirmed achondroplasia was performed. Coprimary outcomes of interest were adverse events (AEs) and changes from baseline in annualized growth velocity (AGV) at the end of the trials. Secondary outcomes included changes from baseline in height Z-score, standing height, and upper-to-lower body segment (ULS) ratio. Eleven studies (N = 542) were included, of which 4 RCTs (n = 326) with low overall risk of bias were meta-analyzed. Overall and serious AE rates were comparable between CNP analogs and placebo, except for higher relative risks of injection site reactions (1.65), urticaria (4.04), and swelling (3.57). C-type natriuretic peptide analogs significantly increased mean differences in AGV (1.36 cm/year; 95% CI: 1.05-1.68; P < .00001) and standing height (1.24 cm; 95% CI: 0.47-2.01; P = .002), without short-term effect on ULS ratio. Real-world studies demonstrated sustained growth benefits with infrequent serious AEs or treatment discontinuations. C-type natriuretic peptide analogs provide slight but statistically meaningful improvements in linear growth in children with achondroplasia with acceptable short-term safety profile. Long-term studies are needed to define optimal timing of therapy on adult height, functional outcomes, and achondroplasia-related complications.
To determine the incidence of hospital-acquired bloodstream infections (BSI), Ventilator-Associated Pneumonias (VAP) and the impact of Infectious Diseases (ID) referral on outcomes using data from the ACORN HAI surveillance network. Adults hospitalized ≥48 h in a tertiary hospital (3/2023-3/2024) were prospectively included if HA-BSI and VAP criteria were met. ID referral was defined as formal referral to, or consultation with an ID specialist. Clinical, laboratory parameters, and 28-day outcomes were collected. The incidence of HA-BSI and VAP was calculated using the number of patients with HA-BSI or VAP as numerator, and total hospitalized adult patients as denominator; incidence density per 1000 patient-days was computed using infection episodes as numerator, and total patient-days as denominator. Among 115 patients (mean age 62.4 ± 18.1 years), 58.3% were male, and 33. 91% diabetic. HA-BSI incidence density was higher compared to VAP (1.03 vs. 46 per 1000 patient-days). Mortality (BSI 24.7%, VAP 50%, combined infection 57.1%) differed across infection types. Majority of infection episodes were referred to ID (119/143, 83.21%). Although late referrals (9/143, 6.29%), had numerically higher mortality and prolonged hospitalization, these were not statistically significant. The timing of ID referral had no statistically significant association with clinical and functional outcomes, mortality, and length of stay. Overall HA-BSI and VAP rates were low, but still associated with high mortality and prolonged hospitalization. ID referral was not associated with better outcomes in this small study.
Aging is known to influence recovery following spinal cord injury (SCI) however its specific impact on locomotor outcomes remains underexplored. Understanding these age-related differences is critical for developing targeted rehabilitation strategies and improving the translational relevance of SCI research. This systematic review aimed to evaluate the effect of aging on locomotor recovery in animal models of traumatic SCI. A systematic search of MEDLINE and Embase was conducted to identify studies assessing the impact of aging on post-SCI locomotor outcomes. Inclusion criteria encompassed preclinical studies comparing locomotor recovery between young and aged animals following SCI. Extracted data included sample characteristics, SCI model, locomotor outcome measures, timing of evaluation, and key findings. Risk of bias was assessed using the SYRCLE checklist. Of 3,118 unique records screened, nine studies met inclusion criteria. Included animals were grouped into young (mean 2.5 months), intermediate (mean 11.4 months), and aged (mean 21.5 months) categories, with individual ages ranging from 4 weeks to 28 months. Six studies used rats and three studies used mice. In total, more than 340 animals were studied. SCI models included cord contusion (6/9, 66.7%), hemisection (2/9, 22.2%), and clip compression (1/9, 11.1%). Seven (7/9, 77.8%) studies employed the Basso, Beattie, Bresnahan (BBB) locomotor score as the primary outcome measure. Older animals demonstrated significantly lower BBB scores post-injury compared to younger counterparts in 100% (7/7) of studies using this outcome. Other measures of locomotor outcomes included the Basso Mouse Scale, CatWalk, and Digigait. Notably, one study reported that pre-injury and post-injury exercise improved locomotor recovery in aged rats to levels comparable with young rats. Aging is associated with poorer locomotor recovery following traumatic SCI in preclinical models. These findings underscore the importance of age as a biological variable in SCI research and suggest that rehabilitative interventions, such as exercise, may have potential to mitigate age-related deficits. Future studies should seek to define the mechanistic pathways underlying impaired recovery with age and evaluate targeted therapies that enhance neuroplasticity and functional recovery. https://www.crd.york.ac.uk/PROSPERO/view/CRD42022230021.
Durability of surgical treatment is important to patients, providers, and payors. In addition to its effect on clinical outcomes and patient satisfaction, durability is a critical factor in evaluating the cost-effectiveness of care. One- and two-level lumbar fusion surgeries are among the most common spine procedures. The purpose of this study was to determine the prevalence, timing, and indications for revision surgery following short-segment lumbar fusions. A single-institution, multisurgeon database was retrospectively reviewed for patients who underwent one- or two-level lumbar fusion between 2014 and 2018, with a minimum of four years of follow-up. Patients with surgery for trauma, tumor, or infection were excluded. Of the 5051 consecutive patients included, 64.5% (n = 3258) underwent one-level and 35.5% (n = 1793) underwent two-level fusion. Demographic data, surgical characteristics, and indications for revision surgery were collected through electronic medical record review. A total of 772 patients (15%) underwent unplanned lumbar revision surgery. The most common indications were adjacent segment disease (n = 288, 6%) at a mean of 1053 days postoperatively and nonunion (n = 207, 4%) at a mean of 649 days. Other causes of revision surgery included infection (2%), implant reposition (<1%), repeat decompression (<1%), hematoma evacuation (<1%), and revision durotomy repair (<1%). Revision surgery rates were similar between one- and two-level fusions (P = 0.073). One- and two-level lumbar fusion procedures demonstrated high durability with an overall revision surgery rate of 15%. The most common indications for revision surgery are adjacent segment disease and nonunion. These findings may inform surgical planning, guide preoperative counseling, and support future quality-improvement efforts.
Lumbar disc herniation (LDH) is rare in juveniles and may present atypically, potentially delaying referral for neurosurgical evaluation. We aimed to assess diagnostic and treatment delays and to evaluate short-term surgical outcomes in pediatric patients undergoing microdiscectomy for LDH at our department over a 10-year period. We retrospectively reviewed consecutive patients under 18 years of age who underwent microdiscectomy for LDH at our institution between 2015 and 2025. Clinical presentation, timing of imaging and surgery, and postoperative outcomes were analyzed. Twenty-one patients were included (mean age 14.6 ± 2.1 years, 57% females). Median body mass index (BMI) was 21.2 (range 18.7-36.9). All patients presented with low back pain, and 92.5% had radicular symptoms. The median time from symptom onset to MRI was 6 months (range 0-12 months), and to surgery 12 months (range 0-36 months). Most patients (90.5%) were operated at one level; L4/L5 and L5/S1 were the most commonly affected levels. At 3 months after surgery, 95.2% of patients reported improvement of back pain, while all patients experienced relief of radicular symptoms. In our cohort of pediatric patients with LDH, short-term outcomes following microdiscectomy were generally favorable despite substantial delays in diagnosis and referral for surgical treatment. These findings may suggest that, unlike in adults, prolonged symptom duration does not necessarily compromise recovery in children, although this should be interpreted with caution given the limited sample size and follow-up period. Nevertheless, increased awareness of pediatric LDH could facilitate earlier neurosurgical evaluation, streamline care pathways, and potentially further optimize patient management.
To investigate whether gut microbiota characteristics are associated with surgical intervention status in preterm infants with necrotizing enterocolitis (NEC) and to evaluate their potential discriminatory value for surgical risk stratification. This retrospective study included 56 preterm infants with NEC admitted to Northwest Women's and Children's Hospital between May 2020 and May 2023, including 33 managed non-surgically and 23 who underwent surgery, as well as 30 preterm infants without NEC as controls. Blood samples were collected to measure prostaglandin E2 (PGE2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP). Fecal samples were subjected to 16S rRNA gene sequencing to assess microbial diversity and taxonomic composition. Sequencing quality was evaluated using rarefaction analysis, β-diversity differences were tested by PERMANOVA, and differential taxa were further reanalyzed using CLR transformation with FDR correction. Associations between gut microbiota indicators and surgical intervention were analyzed using multivariable logistic regression adjusted for clinically relevant covariates, including gestational age, birth weight, postnatal age at NEC diagnosis, Bell stage, antibiotic exposure, feeding type, length of hospital stay, and probiotic use. Receiver operating characteristic (ROC) curves were used to evaluate discriminatory performance for distinguishing surgical NEC from non-surgical NEC within this retrospective cohort. No significant differences were observed among the three groups in sex, mode of delivery, 1-min Apgar score, or maternal complications (all P > 0.05). In contrast, gestational age was lower in the NEC groups than in controls, and infants in the surgical group had a younger postnatal age at NEC diagnosis, a higher proportion of Bell stage III disease, and more frequent exposure to prolonged antibiotic treatment and formula-predominant feeding. The proportion of meconium-stained amniotic fluid was also significantly higher in the surgical group (47.8% vs. 18.2% and 6.7%, P = 0.001). Compared with the non-surgical and control groups, the surgical group showed significantly higher levels of IL-6, IL-10, CRP, and TNF-α (all P < 0.001), along with lower microbial diversity as indicated by reduced Chao and Shannon indices (both P < 0.001). At the taxonomic level, the surgical group exhibited lower relative abundances of Firmicutes, γ-Proteobacteria, Bifidobacterium, and Lactobacillus, but higher relative abundances of Proteobacteria, Salmonella, and Clostridium (all P < 0.001). In multivariable analysis adjusted for gestational age, birth weight, postnatal age at diagnosis, Bell stage, antibiotic exposure, feeding type, length of hospital stay, and probiotic use, Bifidobacterium (adjusted OR 0.63, 95% CI 0.44-0.89), Chao index (adjusted OR 0.72, 95% CI 0.56-0.93), and Shannon index (adjusted OR 0.68, 95% CI 0.49-0.94) remained inversely associated with surgical intervention, whereas Proteobacteria (adjusted OR 1.34, 95% CI 1.08-1.67) and Clostridium (adjusted OR 1.51, 95% CI 1.12-2.04) remained positively associated with surgery (all P < 0.05). The combined model incorporating Firmicutes, Proteobacteria, γ-Proteobacteria, and Clostridium achieved an AUC of 0.904 (95% CI 0.823-0.985), with 78.62% sensitivity and 88.54% specificity. Gut microbiota dysbiosis in preterm infants with NEC was associated with surgical intervention status, and part of these associations remained significant after adjustment for key clinical covariates. A combined microbiota-based model showed potential discriminatory value for surgical risk stratification within this retrospective cohort; however, because groups were defined according to final treatment outcome, these findings should not be interpreted as evidence of true prospective prediction or guidance of surgical timing. These findings require confirmation in larger prospective multicenter studies.
Gamma-hydroxybutyrate (GHB) withdrawal is an uncommon but potentially severe syndrome which may not respond to benzodiazepines, with no clear guidelines for treatment escalation. This systematic review examines the evidence of barbiturates as alternative or adjunct therapies in managing GHB withdrawal. PubMed was searched for articles published from 1964-2025 using terms related to GHB, its precursors, withdrawal, and barbiturates. Two independent reviewers screened articles, with a third resolving discrepancies. English-language primary reports involving barbiturate use for GHB withdrawal in humans were included; reviews were excluded. Of 1,398 articles identified, 16 were included, describing 30 cases. Data were analyzed using descriptive statistics and narrative synthesis. Phenobarbital was commonly used (n = 26), with daily doses from 30-1200 mg and cumulative doses from 60-8500 mg. Barbiturates were generally initiated after inadequate response to benzodiazepines, although no consistent thresholds for escalation were identified. Barbiturate use was not associated with complications and in several cases provided rapid symptom resolution. Comparisons and conclusions were limited by incomplete and inconsistent reporting of patient characteristics, interventions, and outcomes; co-administered treatments; and non-standardized dosing across small, heterogenous, retrospective studies (primarily case reports) describing patients with severe withdrawal. Controlled studies are needed to establish evidence-based protocols, including dosing, timing, and safety considerations.
Cauda equina syndrome (CES) is an uncommon but severe neurological condition resulting from compression of the lumbosacral nerve roots, leading to motor, sensory, and autonomic dysfunction. Despite its low incidence, CES carries a high risk of permanent disability and medico-legal consequences due to the narrow therapeutic window for intervention. This narrative review synthesizes current evidence on the anatomical basis, pathophysiology, etiology, clinical presentation, diagnostic pathways, classification systems, and management strategies for CES. Particular emphasis is placed on the prognostic distinction between incomplete CES (CES-I) and CES with urinary retention (CES-R), as well as the ongoing debate surrounding the optimal timing of surgical decompression. Long-term outcomes, rehabilitation principles, and emerging neuroprotective strategies are also discussed. Early recognition, prompt imaging, and urgent decompression remain central to improving neurological recovery and quality of life in affected patients.
This policy brief examines the consequences of criminal records, with emphasis on employability research, employment initiatives, and reform recommendations. In the UK, individuals with criminal records-particularly those convicted of violent or sexual offences-remain systematically excluded from the labour market. Employment is one of the strongest predictors of desistance from crime, social stability, and psychological wellbeing following criminal justice involvement. Despite legislative safeguards and well-intentioned initiatives, employment outcomes following release remain persistently low. We argue that reform must move beyond disclosure timing alone and toward structured, evidence-led hiring practices that reflect actual risk, rehabilitation, and proportionality. Without such reform, current approaches risk entrenching stigma, wasting public resources, and undermining reintegration goals.
Membrane sweeping is a common but still invasive procedure offered to hasten labour in prolonged pregnancy. Rising labour induction rates have increased the use of interventions like membrane sweeping, though its impact on women's experiences remains unclear. To explore women lived experiences of membrane sweeping in a tertiary Italian maternity unit and identify their informational needs. Twenty women ≥40+0 to 41+6 weeks' gestation who underwent membrane sweeping were interviewed in-hospital 24-48 h postpartum. Semi-structured interviews (mean 18 min) were analysed with combined inductive-deductive content analysis. Three themes emerged i) clarity and timing of information ii) baseline knowledge and information-seeking behaviour iii) physical and emotional experience of the procedure in relation to the onset of labour. In addition, some women reported the procedure as painful or required further pharmacological induction of labour, adding a layer of dissatisfaction in their narrations. However, most women stated that they would undergo membrane sweeping again in a future pregnancy. When embedded in shared decision-making, membrane sweeping can be a well-accepted initial induction option. Moreover, structured antenatal education could be recommended.
This study aimed to investigate how age at surgery influences outcomes in teenage patients with adolescent idiopathic scoliosis (AIS), addressing the gap in comparative analysis within the adolescent years.In this retrospective cohort study, patients with AIS who underwent posterior spinal fusion were divided into two groups: less than 14 years (Y-14) and greater than or equal to 14 years (O-14). Inclusion criteria were Lenke Type 1A curve, scoliosis angle between 45 and 80°, and minimum 2-year follow-up. Radiographic parameters, correction rates, and Scoliosis Research Society-22 (SRS-22) scores were compared. Univariable and multivariable regression analyses identified factors associated with curve correction.The study included 168 patients (Y-14, n = 37; O-14, n = 131). The Y-14 group demonstrated significantly larger preoperative main thoracic curves (59.7 vs. 53.3°) and greater flexibility (52.9 vs. 46.4%). The Y-14 group achieved higher correction rates both immediately after surgery (83.3 vs. 77.5%) and at 2-year follow-up (82.3 vs. 75.6%), maintaining more favorable main thoracic curve correction over time (final follow-up: 10.2 vs. 12.9°). SRS-22 scores showed no significant differences between groups. In univariable analysis, age, height, weight, main thoracic bending, and flexibility were significantly associated with main thoracic curve correction. Multivariable analysis identified age as an independent predictor of correction.Patients who underwent AIS surgery before age 14 demonstrated superior radiographic outcomes and maintained better correction over time than those who underwent the surgery at 14 years or older, while SRS-22 clinical outcomes were similar between the groups. These findings suggest that surgical timing within adolescence influences radiographic correction in AIS. Level III.
The field of surgical treatment for valvular heart disease (VHD) has progressed rapidly in 2025. This review aims to summarize the year's key research, focusing on comparisons of mainstream techniques for aortic, mitral, and tricuspid valve diseases, innovations in repair techniques, and advances in emerging technologies, to provide evidence-based support for individualized clinical decision-making. A structured search of PubMed database was performed to identify randomized controlled trials (RCTs), registry studies, and meta-analyses published in 2025, and the evidence was synthesized narratively. In the aortic valve arena, long-term follow-up from the PARTNER 3 and Evolut Low Risk trials confirmed the non-inferiority of transcatheter aortic valve replacement (TAVR) in low-risk patients. However, real-world data suggested higher long-term risks with TAVR in patients with bicuspid aortic valves (BAV) and younger patients, whereas women demonstrated greater benefit. The indication for early intervention in asymptomatic severe aortic stenosis (AS) was reinforced. Aortic valve repair and the Ross procedure accumulated more robust evidence for long-term survival and quality of life in younger patients. In the mitral valve domain, the MITRACURE study highlighted gaps between real-world practice and guidelines, including delayed referral and suboptimal repair rates for mitral regurgitation (MR). The advantages of repair for degenerative disease were further solidified, though techniques for posterior leaflet prolapse and management strategies for atrial functional regurgitation (AFMR) require optimization. Transcatheter edge-to-edge repair (TEER) was increasingly used in high-risk patients but yielded inferior long-term outcomes compared to surgery, and surgical rescue after failed TEER carried high risk. For the tricuspid valve, comparative effectiveness of transcatheter vs. surgical repair and the timing of intervention emerged as key research foci. Emerging technologies such as polymer valves, partial heart transplantation, and artificial intelligence (AI)-assisted analysis demonstrated preliminary potential. The 2025 evidence reinforces a paradigm shift from risk-score-based decision-making toward individualized valve care. Transcatheter techniques have expanded their indications, but surgery remains irreplaceable in young, low-risk, and BAV patients, as well as in degenerative MR. Real-world gaps in guideline adherence, delayed referral, and suboptimal repair rates require urgent attention. Emerging technologies show early promise, although their long term durability and clinical value await further validation.