Pediatric Gartland type III-IV extension-type supracondylar humeral fractures are associated with a risk of iatrogenic ulnar nerve injury during medial percutaneous pin insertion. The optimal technique for medial pin placement during crossed pin fixation remains debated. A retrospective case-control study was conducted involving 80 pediatric patients treated between September 2020 and September 2025. All patients had isolated closed extension-type Gartland III-IV supracondylar humeral fractures treated with two lateral and one medial crossed K-wires, with a minimum follow-up of 6 months. Patients were divided into the K-Hammer group, in which medial pinning was performed using a non-rotational K-Hammer-assisted technique with the elbow in 30°-60° extension, and the Freehand group, in which medial pinning was performed using conventional low-speed drilling with the elbow flexed at 90°. The primary outcome was symptomatic iatrogenic ulnar nerve injury within 2 weeks postoperatively. Secondary outcomes included medial pin attempts, operative time, radiographic alignment, elbow range of motion, Flynn functional grade, and postoperative complications. The K-Hammer group had significantly fewer medial pin attempts [1.0 (IQR: 1.0-1.0) vs. 2.0 (IQR: 1.0-2.0), P < 0.001] and shorter operative time (32.8 ± 6.9 vs. 37.9 ± 9.2 min, P = 0.006). Intraoperative pink pulseless hand rates were comparable (10.5% vs. 4.8%, P = 0.416), and all patients recovered radial pulse postoperatively. Iatrogenic ulnar nerve injury occurred in 0% (0/38) of the K-Hammer group vs. 11.9% (5/42) of the Freehand group (P = 0.056), corresponding to an exploratory absolute risk reduction (ARR) of 11.9% and a number needed to treat (NNT) of approximately 8.4. No secondary displacement or reoperation occurred in either group. Pinsite infection and myositis ossificans rates were low and similar. At a median follow-up of 7.5 months (IQR: 6.2-11.8; range: 6-36 months), radiographic and functional were comparable between groups. The K-Hammer technique improves operative efficiency, reduces pin insertion attempts, and demonstrates a favorable trend toward reduction in iatrogenic ulnar nerve injury risk (ARR 11.9%, NNT = 8.4), without compromising radiographic or functional outcomes. Although statistical significance was not reached (P = 0.056), likely due to limited sample size, these findings suggest it is a potential technical option for medial pin placement in severe pediatric supracondylar humeral fractures, warranting confirmation in larger prospective studies.
Postoperative cerebrospinal fluid (CSF) leakage remains one of the most challenging complications of transsphenoidal surgery (TSS). Numerous reconstruction techniques have been proposed, but none has been established as the gold standard. To address this issue, we standardized rigid sellar floor reconstruction using a hard buttress, based on the concept of counteracting the water-hammer effect of pulsatile CSF pressure. We retrospectively analyzed 1,168 consecutive TSS procedures for sellar lesions performed by a single surgeon between October 2004 and March 2024. Routine rigid reconstruction was implemented from January 2009 (Group B, n = 856) and compared with an earlier cohort without routine buttressing (Group A, n = 312). Reconstruction materials included autologous bone grafts, calcium phosphate cement, titanium mesh, and resorbable plates. Rigid reconstruction was performed in 885 cases, most commonly with autologous bone (n = 781), which proved most reliable. Calcium phosphate cement occasionally caused inflammatory change or graft dislodgement, and titanium mesh complicated reoperations. Postoperative CSF leakage requiring reoperation was significantly reduced from 2.88% in Group A to 0.47% in Group B (P = 0.002), despite a higher intraoperative leak rate in Group B (76.5% vs. 54.2%, P < 0.0001), particularly grade 3 leaks (30.4% vs. 11.2%, P < 0.0001). All postoperative leaks in Group B were attributable to inadequate buttressing. Rigid sellar floor reconstruction is a fundamental strategy-together with dural suturing and vascularized mucosal flaps-for safer and more extensive resections in modern TSS, supported by a physiological rationale based on the water-hammer effect.
Hypothenar hammer syndrome (HHS) is characterized by ischemic symptoms of the hand related to a stenotic or occluded ulnar artery. The disease is considered rare, although there is evidence of underdiagnosis. Digital subtraction angiography (DSA) is the primary diagnostic tool, although staging is typically based on the Kaji classification, which captures most abnormalities, though some may be overlooked. This study proposes an all-encompassing angiographic classification system for HHS. In this multicenter retrospective case series, electronic medical records were searched for patients with HHS based on vascular abnormalities and clinical symptoms in three hospitals. Among all HHS cases, clinical symptoms and DSAs were collected and classified using the Kaji classification system. This system only encompasses the pathology of the ulnar artery. We propose to augment the system with aneurysmatic deformation and radial artery disease. A total of 80 patients with 91 affected hands were included. Most cases had stenotic and occlusive deformities, whereas 7 cases had an aneurysm in the ulnar artery. Three cases had concomitant occlusion of the radial artery. Overall, no significant associations were found between the type of stenosis and most prevalent symptoms, except for numbness (p = 0.009). A non-significant trend was observed of a higher prevalence of severe symptoms, such as necrosis, in patients with HHS with concomitant radial artery occlusion. Expanding the Kaji classification with aneurysmatic deformation and concomitant radial artery disease offers a more accurate and comprehensive classification system for HHS.
Immunotherapy for pancreatic cancer remains a formidable challenge due to the highly immunosuppressive tumor microenvironment (TME), characterized by dense stromal barriers and acidic niches that collectively restrict drug delivery and antitumor immunity. Here, we propose an "Alkaline-Hammer" strategy that combines pH modulation with alkaliptosis induction to overcome these obstacles. We engineered alkalizing sodium bicarbonate nanoparticles (JTC801-NaHCO3@TPGS NPs) using a thin-film hydration method. Upon delivery, these nanoparticles neutralize the acidic TME through sustained NaHCO3 release, while JTC801, a selective opioid receptor-like 1 (ORL1) antagonist, activates the NF-κB pathway to downregulate carbonic anhydrase IX (CA9). This dual action synergistically enhances intracellular alkalinization and induces alkaliptosis. Furthermore, we developed a laparoscopic intratumoral injection system to achieve precise delivery of JTC801-NaHCO3@TPGS NPs in orthotopic pancreatic tumor models. This strategy increased CD8+ T cells infiltration, reduced immunosuppressive populations (Tregs, MDSCs, and M2 macrophages), and elicited immunological memory, thereby converting immunologically "cold" tumors into "hot" ones without evident systemic toxicity. These findings underscore the potential of localized alkaliptosis induction as a promising immunotherapeutic approach for pancreatic cancer.
Erosion and fracture caused by repeated water-droplet impacts are often attributed to splash-mediated material removal, high-pressure impulsive loading, or cavitation. Yet, the mechanical response during the earliest instant of impact remains difficult to capture. Using a high-temporal-resolution polyvinylidene fluoride (PVDF) piezoelectric sensor combined with high-speed imaging, we directly measure substrate-coupled mechanical transients during a single water-droplet impact. A strong impulsive strain response appears within the first 2 ms after contact, followed by coherent 100-500 Hz oscillations at the water-solid interface during the first 20 ms, before any rebound occurs. The oscillation frequency is modulated by an effective interfacial stiffness, whereas the impulsive peak-to-peak response scales with droplet size and impact velocity. The experimentally captured signals provide direct experimental evidence of ultrafast substrate-coupled mechanical transients during droplet impact and establish a minimal inertial-capillary framework for understanding mechanical signatures that may contribute to low- to moderate-speed droplet-induced erosion and fatigue.
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This study aimed to assess the evaluation accuracy of an artificial intelligence (AI) algorithm using the hammering sound to assess initial press-fit fixation in cementless total hip arthroplasty (THA). The acoustic features of the hammering sounds during a press-fit cup fixation were recorded and analysed. 81 hips of 79 patients undergoing primary THA using the Trident HA acetabular system (Stryker, Kalamazoo, MI, USA) for treatment of osteoarthritis and osteonecrosis of the femoral head were included. After the fast Fourier transform analysis was performed on the hammering sound, 24 sound pressure (SP) features across 23 frequency bands were extracted and applied to binary classification. Support vector machine algorithms were used to classify the data using 2 models: Model A - SP only; Model B - SP + patient characteristics. Among the 81 hips in 79 patients, the hammering sound of 348 impacts of 70 successful press-fit of 1st attempts in 70 hips and 80 impacts of 16 failed attempts in 11hips were analysed. The area under the curve for the test data was 0.9554 in Model A and 1.0 in Model B. The accuracy (accuracy/sensitivity/specificity/positive predictive value/negative predictive value) of each model in the test data was as follows: Model A, 0.849/1.000/0.188/0.843/1.000 and Model B, 0.965/1.000/0.813/0.959/1.000. The accuracy of an AI algorithm using hammering sounds to judge the success of initial press-fit fixation in cementless cup in THA was relatively high. Our results imply the possibility of a practical application for such a system to assist surgeons during the procedure.
The application of shear thickening electrolytes (STEs) in batteries is hindered by the conventional trade-off, in which enhanced impact resistance comes at the cost of reduced ionic conductivity. Here, we overcome this barrier by introducing lithium sulfonate-functionalized mesoporous silica (M-SiO2-SO3Li) as a multifunctional filler. Unlike conventional fillers that impede ion transport, M-SiO2-SO3Li simultaneously induces shear thickening and enhances conductivity. At 15 wt.% loading, the electrolyte achieves a remarkable ionic conductivity of 10.73 mS cm-1, higher than that of filler-free traditional electrolytes (TE), by anchoring anions via the -SO3Li groups to increase the Li+ transference number. This synergy enables exceptional battery performance: Li||LFP cells demonstrate 97.0% capacity retention after 500 cycles, and LFP||Gr pouch full cells maintain 83.8% capacity after 200 cycles at 0.5 C. In impact tests, the robustness of this design is evident as the M-SiO2-SO3Li-based pouch cell withstands hammer drops that cause immediate failure in standard TE cells. Thus, this design strategy overcomes the performance trade-off, integrating high conductivity, long cycling life, and impact resistance, and provides a pathway for application across the liquid-based electrolyte family.
High-performance fiber materials, poly(p-phenylene-benzimidazole-terephthalamide) (PBIA) fibers, exhibit exceptional mechanical properties, and they are finding critical use in aerospace, ballistic protection, and other civilian areas. However, the insufficient orientation and weak lateral interactions of PBIA polymer chains limit their impact-resistant applications. In this work, we report a strategy that significantly enhances the dynamic mechanical properties of heterocyclic aramid fibers via in situ polymerization of graphene oxide (GO) and wet spinning, achieving an ultrahigh dynamic strength of 10.63 GPa, which exceeds that of PBIA fibers by 47.23%. To simultaneously enhance the strength and toughness of PBIA, an ether-group component was polymerized with GO, the dynamic toughness can reach 277.25 MJ m-3, which is 85.3% higher than that of PBIA fibers. The dynamic performance is attributed to improvements in contact area and interfacial energy. In laser-induced microparticle impact tests, the composite fiber exhibits a markedly higher specific energy dissipation power than other high-performance fibers. Importantly, large-scale and flexible fabrics were woven and exhibit superior impact resistance, highlighting the practical potential of these fibers, which showed a 40.46% higher load than PBIA fabrics in drop-hammer impact tests. This study presents a straightforward yet effective approach to enhancing the dynamic strength and toughness of PBIA fibers.
Radiofrequency-powered and inductively coupled semi-implanted pacemakers offered an early alternative to battery-powered implantable pulse generators by transferring energy across intact skin to a small, implanted receiver. This review summarizes key clinical and engineering developments from the first reported radiofrequency-powered pacing in 1959 through subsequent refinements and commercial implementations, including the Cutler-Hammer and Cordis Transicor RF systems, and it places these efforts alongside the Abrams/Lightwood inductively coupled device commercialized by Joseph Lucas Ltd. These systems reduced implanted size and allowed external servicing, but they imposed major human factors and safety constraints because pacing depended on correct placement and continuous operation of external hardware. As implantable-grade batteries, hermetic packaging, and lead technology improved, fully implantable pacemakers became clinically dominant. The historical experience nonetheless established durable principles of transcutaneous energy transfer that continue to inform modern externally powered implantable therapies where brief interruptions are clinically tolerable.
In our daily lives we encounter a myriad of things with which we interact when navigating our environment. Mental representations of these things are computed and stored in our brains to be manipulated in support of cognition. Several proposals have been put forth on how such representations are organized in the brain - and specifically within ventral temporal cortex (VTC), which is thought to support object recognition. Some propose that the organization of mental representations tracks the animacy status of target stimuli in a continuous way: high-animacy stimuli (e.g., chimps) are represented farther from artifacts (e.g., hammers) than low-animacy stimuli (e.g., lobsters). Others emphasize the role of different dimensions in the organization of mental representations, including real-object size, shape, texture and material properties, and graspability. Here we used functional magnetic resonance imaging (fMRI) and multivariate approaches to test the role of these dimensions as organizing principles of object information in VTC. We show that pattern discriminability between different categories of objects does not seem to follow differences in animacy status in any continuous way. Moreover, graspability and haptic texture properties are better predictors of representational content within VTC than animacy and real-object size. Our results align with evidence that object processing depends on bidirectional functional coupling between parietal regions involved in manipulation and grasping and VTC regions involved in material/texture processing. This supports a multidimensional account of object representations in VTC, where action-relevant and haptic/material properties contribute strongly to representational structure, potentially through interactions with distal regions involved in object-directed action.
Disturbance events and subsequent management practices significantly shape the ecological legacies of affected sites. This study evaluated the impacts of a 2022 derecho and the subsequent forest management on forest structure and arthropod diversity by comparing affected forests at Fogwell Forest Nature Preserve and Fox Island County Park with control forests at Blue Cast Springs and Hammer Wald Nature Preserves. Arthropod communities were sampled using pitfall traps, while forest structure was assessed through detailed surveys of understory, midstory, and overstory vegetation. Results indicated a decrease in overall arthropod diversity across all sites since 2016, variably attributed to forest maturation, climatic variability, and the 2022 disturbance, with some taxa showing declines, such as Formicidae and Curculionidae. Fogwell exhibited a significant decline in arthropod diversity, likely linked to the derecho, while Fox Island's diversity aligned more closely with undisturbed control sites. Notable midstory reductions were observed across sites over time, especially at Fox Island, due to harvest and storm impacts. Meanwhile, overstory diversity varied between properties. Regression modeling revealed that forest management practices at Fox Island may have mitigated the disturbance's effects, aiding arthropod recovery. All in all, these findings highlight the importance of forest management strategies in influencing biodiversity and ecological recovery post-disturbance.
Foot alterations have been identified in the literature as a significant risk factor for falls in older adults. However, the contribution of specific types of alterations, such as digital deformities and skin alterations, has not been studied in detail. These findings highlight the importance of improving understanding of podiatric factors that contribute to fall risk. This study aimed to identify which podiatric alterations, such as hyperkeratosis, corns, reduced plantar fat pad, onychomycosis, heel xerosis, and digital deformities, including hallux valgus (HAV), claw toes, supraductus toes, infraductus toes, hammer toes, and quintus varus, are most predictive of fall risk in older adults, both with and without diabetes mellitus. An analytical, cross-sectional, retrospective study was conducted on 85 individuals over 60 years of age. Foot deformities and dermatological alterations were recorded, and fall risk was assessed using the Tinetti balance and gait scale. Statistical analyses included bivariate tests and binary logistic regression to identify predictors of fall risk. The mean age of participants was 71 years; 66% were women, and 46% had type 2 diabetes mellitus. Overall, 66% of participants had a moderate-to-high risk of falling, and a significant association was observed between fall risk and the presence of diabetes (p = 0.048). Logistic regression analysis revealed that reduced plantar fat pad (p = 0.007) and heel xerosis (p = 0.038) were significantly associated with fall risk, irrespective of the presence of diabetes. Podiatric alterations, particularly reduced plantar fat pad and heel xerosis, are strong predictors of fall risk in older adults, irrespective of the presence of diabetes. Foot health assessment should be considered a core component of multidisciplinary fall prevention programmes, reinforcing the crucial role of podiatrists in geriatric care to reduce fall risk.
Hydraulic transients in drag-based in-pipe turbines during sudden operational changes can induce pressure pulsations, water hammer, cavitation, and column separation in pipeline components located both upstream and downstream of the turbine. Additionally, the torque imposed on turbine blades is a critical concern, as frequent operational changes can accelerate blade fatigue and potentially lead to structural failure. This study integrates the Method of Characteristics (MOC) and Computational Fluid Dynamics (CFD) to model transient phenomena resulting from the abrupt stoppage of a hydrodynamic in-pipe turbine. The analysis evaluates how varying deceleration rates influence pressure surges, pressure pulsations, and torque amplification on blades across different blade counts. The results demonstrate that stoppage time significantly affects torque escalation and confirm that turbine blade count strongly influences the magnitude of pressure surges during transient events. Detailed scenario analyses further reveal that specific configurations exhibit greater susceptibility to extreme pressure fluctuations, thereby creating substantial operational and reliability challenges.
Enhanced Recovery After Surgery (ERAS) Society guidelines provide procedure-specific, evidence-based recommendations for perioperative care. Many interventions fall within anaesthesiology, yet the extent to which they reflect cross-speciality principles remains unclear. The objective of this systematic review was to identify a universal anaesthesiological core across ERAS guidelines. All ERAS Society guidelines were screened for eligibility. Guidelines were excluded if they had no practical anaesthesiological recommendations, had been superseded, or were not intended for standard hospital settings. A classification of 45 anaesthesiological umbrella terms was developed through pilot extraction and Delphi consensus. Two reviewers independently extracted recommendations and their strength. Methodological quality was assessed using Appraisal of Guidelines for Research and Evaluation II (AGREE II). Umbrella terms were classified as consistent (>80%), mostly consistent (60-80%), mixed (20-60%), or sparse (≤20%). Of 39 publications, 24 guidelines (2013-2025) were included. Anaesthesiological involvement was identifiable in 23 out of 24 guidelines. Of the 45 umbrella terms, eight were consistent, 10 mostly consistent, 16 mixed, and 11 sparse. The consistent domains were: multimodal analgesia, fasting, thromboprophylaxis, antimicrobial prophylaxis, nutrition, temperature and fluid management, and surgery-specific recommendations. The mean AGREE II score was 76%, highest for scope and purpose and clarity of presentation and lowest for stakeholder involvement. Despite procedural heterogeneity, a consistent anaesthesiological core is identifiable within the ERAS guidelines. Cross-guideline consistency identifies the priority domains for cross-speciality implementation, whereas recommendation strength independently indicates the confidence with which guidance transposes onto local practice; high-frequency, mixed-strength domains, notably fluid management, preoperative carbohydrate administration and preanaesthetic medication, warrant structured local appraisal. The study protocol: Open Science Framework (DOI: 10.17605/OSF.IO/CBWDT).
Hemophilic arthropathy remains the leading morbidity in hemophilia despite modern prophylaxis, and early joint damage may be missed by routine exams. This study explored T2* MRI as a noninvasive biomarker of hemosiderin deposition in pediatric hemophilia. Four children with severe hemophilia A or moderate-to-severe hemophilia B underwent T2* MRI after persistent joint symptoms. One patient demonstrated shortened T2* relaxation (9 ms) with structural joint pathology, while three showed higher values (22-26 ms) without pathology. Despite low bleeding rates and joint scores, T2* MRI identified occult damage, supporting its potential for early, personalized intervention in pediatric hemophilia populations globally.
Adjuvant pembrolizumab improves disease-free and overall survival among patients with resected clear-cell renal-cell carcinoma. The hypoxia-inducible factor 2α inhibitor belzutifan has activity in advanced disease. Adjuvant pembrolizumab with belzutifan may further improve outcomes in patients with clear-cell renal-cell carcinoma at increased risk for recurrence. In this phase 3, double-blind trial, we randomly assigned participants in a 1:1 ratio to receive intravenous pembrolizumab at a dose of 400 mg every 6 weeks (≤9 doses) and either daily oral belzutifan at a dose of 120 mg (pembrolizumab-belzutifan) or placebo (pembrolizumab-placebo) for up to 1 year. The primary end point was disease-free survival as assessed by the investigator; secondary end points included overall survival and safety. A total of 921 participants were assigned to receive pembrolizumab-belzutifan and 920 were assigned to receive pembrolizumab-placebo. The median time from randomization to the data-cutoff date (August 23, 2025) was 28.4 months (range, 15.0 to 40.1). Disease-free survival was significantly higher with pembrolizumab-belzutifan than with pembrolizumab-placebo (hazard ratio for disease recurrence or death, 0.72; 95% confidence interval [CI], 0.59 to 0.87; two-sided P<0.001); the estimated 24-month disease-free survival was 80.7% and 73.7%, respectively. At this interim analysis with 29% of the final-analysis events observed, overall survival did not differ significantly between the groups (hazard ratio for death, 0.78; 95% CI, 0.51 to 1.19; two-sided P = 0.24); the estimated 24-month overall survival was 96.2% with pembrolizumab-belzutifan and 95.7% with pembrolizumab-placebo. Adverse events of grade 3 or higher occurred in 52.1% of the participants who received pembrolizumab-belzutifan and in 30.2% of those who received pembrolizumab-placebo. Treatment with pembrolizumab-belzutifan led to significantly higher disease-free survival, with a greater risk of grade 3 or higher toxic effects, than treatment with pembrolizumab monotherapy after nephrectomy in participants with clear-cell renal-cell carcinoma at increased risk for recurrence. (Funded by Merck Sharp and Dohme, a subsidiary of Merck [Rahway, NJ]; LITESPARK-022 ClinicalTrials.gov number, NCT05239728.).
We aimed to evaluate the ex-vivo early-phase spatial drug distribution of intravitreally applied bevacizumab and vancomycin in human and porcine eyes with a native vitreous body compared to vitrectomized eyes filled with balanced salt solution (BSS), silicone oils and a hyaluronic acid-based vitreous body substitute hydrogel. Porcine eyes were vitrectomized minutes post-mortem and filled with BSS, silicone oil, or hydrogel. Native non-vitrectomized human and porcine eyes served as controls. Intravitreal injections consisted of either bevacizumab or vancomycin labeled with Gallium-68 (68-Ga). Positron emission computer tomography (PET-CT) imaging of cadaver eyes was performed for up to six hours after injection followed by qualitative depiction and quantification of intravitreal distribution of the labeled drugs. Radioactive labeling with 68-Ga and subsequent purification of bevacizumab and vancomycin was successfully applied. Vitrectomized eyes presented an increased early spatial spread of both tested drugs compared to native vitreous body (intravitreal bevacizumab filled volume 36.5% vs. 16.5% [P < 0.0001], intravitreal vancomycin filled volume 31.8% vs. 12.0% [P = 0.0146] after injection). Bevacizumab tended to show a faster diffusion in native vitreous body compared to vancomycin. Bevacizumab appeared not to be soluble in silicone oil. Diffusion within a vitreous body replacement hydrogel is slower compared to BSS-filled eyes in the early phase. Ophthalmic surgical interventions and used endotamponades have a significant impact on early phase spatial diffusion within the vitreous cavity. Based on these preliminary results, early phase diffusion of protein drugs within a hyaluronic acid-based hydrogel is comparable to the native vitreous body.
To evaluate the in vitro optical quality of intraocular lenses (IOLs) implanted into the novel fixOflex device, a capsular bag stabilization concept. Five monofocal (AcrySof IQ SN60WF) and five trifocal (AcrySof IQ PanOptix) IOLs of the same dioptric power were assessed in a laboratory setting before and after implantation into five fixOflex devices. Optical quality was analyzed using modulation transfer function (MTF) and forward light scatter (straylight) across clinically relevant aperture sizes and spatial frequencies. Vertical and horizontal IOL decentration within the device was also quantified. Implantation into the fixOflex preserved the high optical quality of the IOLs. Changes in MTF were minimal and not statistically significant (P > 0.1) across all focus distances, spatial frequencies, and aperture sizes. The fixation clips caused a slight increase in straylight (0.10 log(s) at a 5.5-mm pupil), which remained well below clinically relevant thresholds. The device provided high IOL centration, with decentration below 0.03 mm along the clip axis and below 0.25 mm along the haptic axis, without significant tilt. Implantation of monofocal and multifocal IOLs into the fixOflex device preserved their high optical quality and provided stable centration under controlled laboratory conditions. These findings provide a translational basis for considering the fixOflex as a stabilizing platform for decentration-sensitive IOL designs, supporting clinical evaluation in patient populations.
Treatment for Ménière's disease remains a subject of debate. A surgical technique in which the endolymphatic duct is blocked was proposed as a new treatment modality for patients with intractable Ménière's disease, but a double-blind trial was lacking. Therefore, the aim of this double-blind trial was to assess whether EDB is more effective than ESD in patients with intractable Ménière's disease. This is a double-blind, randomised, multicentre trial comparing endolymphatic duct blockage (EDB) to endolymphatic sac decompression (ESD). Patients had unilateral, active Ménière's disease despite treatment with at least two corticosteroid injections. All patients were recruited from two university and five non-university hospitals in the Netherlands. During surgery, patients were randomly assigned to either the EDB or ESD group. Following surgery, patients were followed for 1 year, with both physical visits and an app in which attacks could be reported. Both patients and investigators were blinded throughout the follow-up period. The primary outcome was freedom from vertigo attacks at 12 months, defined as no attacks during the preceding 6 months. Secondary outcome measures included attack incidence, quality of life, dizziness, tinnitus, and inner ear function. Analyses were performed according to the intention-to-treat principle. This trial was registered in the ISRCTN registry (registered 24-02-2021, https://www.isrctn.com/ISRCTN12074571). Between 23 June 2021 and 12 September 2023, 75 patients with definite Ménière's disease were enrolled; 39 underwent EDB, while 36 underwent ESD. No loss to follow-up was recorded. At 12 months, 23/39 (59%) patients in the EDB group and 24/36 (67%) in the ESD group were free from vertigo attacks (OR 0.72, 95% CI 0.28-1.84; p = 0.65). Secondary outcomes, including quality of life, dizziness, tinnitus, and hearing function did not differ between groups. Higher baseline patients expectations were associated with treatment success. Three serious adverse events occurred (one in the EDB group, two in the ESD group) and no deaths were reported. This trial does not demonstrate a benefit of EDB over ESD for patients with refractory Ménière's disease. Given the comparable outcomes between groups, EDB should not be preferred over ESD. The association between baseline expectations and outcome suggests that non-specific treatment effects may contribute to perceived benefit. Future studies should consider inclusion of a non-surgical or sham-surgery control to more definitely determine the effect of this type of surgery, although such trials would be challenging. Dutch National Healthcare Institute and ZonMw ('Veelbelovende Zorg' grant).