The Influence of Patient Persona and Affective Framing on Management Recommendations of ChatGPT, Gemini and Claude for Unruptured Intracranial Aneurysms: A Comparative Benchmarking Study

Abstract: Patients increasingly consult large language models (LLMs) before specialist review and may do so in widely differing emotional registers. We examined whether re-casting an unruptured intracranial aneurysm (UIA) case from a third-person vignette into a first-person patient account, with anxiety about treatment or non-treatment, alters the recommendations LLMs return. Sixty-seven UIA cases previously discussed at our multidisciplinary team (MDT) were presented to Claude Opus 4.6, ChatGPT-5.4 and Gemini 3 Pro Thinking under four conditions: third-person vignette (3P), neutral first-person (1PN), and first-person accounts anxious about treatment (1PAT) or non-treatment (1PANT). Each case was submitted five times (4,020 prompts). Majority recommendations were benchmarked against MDT consensus (Cohen's κ, McNemar), tested for directional asymmetry (Bowker), classified as progressive or regressive, and linguistically analysed. Concordance with MDT was fair-to-moderate (71.6-80.0%; κ 0.34-0.51). ChatGPT over-treated under all conditions (p = 0.001-0.013) and Gemini over-treated only at 3P baseline (p = 0.001), abolished under first-person framing. Claude showed no directional preference. First-person framing drove significant clipping-to-coiling migration in Gemini and ChatGPT (p = 0.001 and 0.015). Claude alone hedged under treatment-directed anxiety (p = 0.002). Anxiety-induced shifts were predominantly regressive. Gemini under rupture-anxiety combined the highest empathy-opener rate (85%), highest confidence-marker density and lowest hedging density of any cell, a sycophantic phenotype invisible to categorical analysis. Patient persona and affective framing measurably and model-specifically alter LLM recommendations for UIAs, with anxiety-induced shifts moving models away from rather than toward expert consensus. Clinicians should anticipate AI-shaped expectations varying with a patient's emotional state and counsel against framing-induced advice. This study was retrospectively registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/HCU6D).

Narayan A
Mariajoseph F
Farooq M
Praeger A
Moore J

Humans
Intracranial Aneurysm
Large Language Models
Benchmarking
Female
Male
Generative Artificial Intelligence
Middle Aged
Adult
Aged


Absorbable versus non-absorbable suture in percutaneous laparoscopic inguinal hernia repair in children: a systematic review and meta-analysis

Abstract: The optimal suture material for laparoscopic inguinal hernia repair in children remains controversial. This study aimed to compare the outcomes of absorbable sutures (AS) versus non-absorbable sutures (NAS), focusing on recurrence and suture-related complications. A systematic literature search was conducted in PubMed, Web of Science, and the Cochrane Library. Studies comparing AS and NAS in pediatric patients were included. Meta-analyses were performed using fixed- or random-effects models to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Four studies comprising 2803 patients in the AS group and 3507 in the NAS group were included. No significant differences were observed between AS and NAS for postoperative hydrocele (OR = 5.12, 95% CI 0.61-42.67; P = 0.13) or wound infection (OR = 0.94, 95% CI 0.44-2.01; P = 0.91). Suture knot reaction was significantly lower in the AS group (OR = 0.03, 95% CI 0.01-0.15; P < 0.0001). However, recurrence risk was significantly higher in the AS group (OR = 7.80, 95% CI 2.14-28.45; P = 0.002). Absorbable sutures significantly reduce suture knot reactions but are associated with a higher risk of recurrence compared to non-absorbable sutures. No significant differences were found for hydrocele or wound infection. Suture selection should balance these risks based on clinical priorities.

Humans
Hernia, Inguinal
Sutures
Laparoscopy
Herniorrhaphy
Child
Recurrence
Suture Techniques
Absorbable Implants
Postoperative Complications
Treatment Outcome

Journal Article
Systematic Review
Meta-Analysis
Comparative Study


Impact of fixation method on avascular necrosis in talar neck fractures: a retrospective analysis

Abstract: To compare clinical outcomes and complication rates between plate with independent screw fixation versus screw fixation alone in the management of talar neck fractures (AO/OTA 81.2), with a primary focus on avascular necrosis (AVN). A retrospective review was performed of adult patients who underwent operative fixation of talar neck fractures at a single Level I trauma center between 2017 and 2022, with a minimum follow-up of 3 months. Patients were divided into screw fixation alone (S) and plate with independent screw fixation (PS) groups. The primary outcome was avascular necrosis (AVN). Secondary outcomes included fracture union, post-traumatic arthrosis (PTA), infection, and unplanned reoperation. Multivariable logistic regression was performed to identify factors associated with AVN. Seventy patients were included (33 S, 37 PS) with no differences in baseline demographics, comorbidities, or injury characteristics (p > 0.05). Union rates were similar between groups (p = 0.23). The incidence of AVN was significantly higher in the S group compared to the PS group (52% vs 22%, p = 0.01). There were no differences in rates of PTA, infection, or reoperation (p > 0.05). On multivariable analysis, plate fixation was associated with a significantly lower likelihood of AVN (OR 0.16, 95% CI 0.03-0.70; p < 0.01). In this retrospective cohort, plate with independent screw fixation was associated with a significantly lower risk of avascular necrosis compared to screw fixation alone in talar neck fractures, while maintaining similar union and complication rates.

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Page BE
Rechter GR
Nasir BA
Yawman JP
Jacobs ED
Langford JR
Haidukewych GJ
Shaath MK

Humans
Talus
Retrospective Studies
Female
Osteonecrosis
Male
Fracture Fixation, Internal
Bone Screws
Middle Aged
Adult
Bone Plates
Postoperative Complications
Fractures, Bone
Reoperation


Suicide risk among urinary bladder cancer patients compared with the standard population: a nationwide study in Sweden

Abstract: To assess the risk of suicide after a diagnosis of urinary bladder cancer (UBC) compared with the standard population and to identify potential risk factors and time dependence associated with suicide in patients with UBC. We used data from the Bladder Cancer Data Base Sweden 2.0 (BladderBaSe), including all individuals aged 18 years or older, diagnosed with UBC between 1997 and 2019. Suicides were identified using ICD-10 codes X60-X84. We compared the number of suicides identified in BladderBaSe with the expected number in a Swedish standard population of the same age and sex distribution during the same period.  Outcome measurements: The risk of suicide was determined using standardized mortality ratios (SMR) with 95% confidence intervals (CI). Among 53,298 patients with UBC included in our study, 106 suicides were identified compared with an expected 66 in the standard population (SMR: 1.6; 95% CI: 1.31-1.93). The risk of suicide was highest within the first 4 weeks after diagnosis (SMR: 4.66; 95% CI: 2.48-7.97), in patients with advanced UBC (SMR: 5.64; 95% CI: 2.06-12.3), those receiving palliative treatment (SMR: 5.03; 95% CI: 2.51-9.01), and those living alone (SMR: 2.87; 95% CI: 2.22 - 3.66). The suicide risk among UBC patients is significantly elevated and shaped by multiple factors, with the highest risk observed in the first 4 weeks from diagnosis. Healthcare providers should maintain heightened vigilance for suicidal ideation, particularly during the critical period immediately following diagnosis, to ensure timely support and intervention.

Hawez L
Bergengren O
Ahlberg M
Garmo H
Van Hemelrijck M
Nyberg UK
Gardmark T
Holmberg L
Liedberg F
Bill-Axelson A

Humans
Sweden
Female
Male
Urinary Bladder Neoplasms
Aged
Middle Aged
Suicide
Risk Factors
Adult
Aged, 80 and over


Women's Work and its Effects on Personal Wellbeing and Satisfaction with Life: A Cross-Sectional Comparative Study

Abstract: Women's participation in the workforce has increased substantially, raising important questions about how employment is associated with their subjective well-being and satisfaction with life. This study aimed to assess differences in personal well-being and life satisfaction between working and non-working women and to identify their significant socio-demographic and occupational predictors. A cross-sectional comparative study was conducted among 402 women (192 working, 210 non-working) attending outpatient clinics at Mansoura University and primary healthcare centers. Data were collected using an interviewer-administered questionnaire covering sociodemographic factors, occupational characteristics, the Personal Well-being Index-Adult (PWI-A), and the Life Satisfaction Scale(LSS). Bivariate and binary logistic regression analyses identified the independent predictors. Working women reported significantly higher well-being (PWI-A: 72.06 ± 13.03) and life satisfaction (LSS: 21.52 ± 5.76) than non-working women (PWI-A: 67.42 ± 10.14; LSS: 17.55 ± 5.91). University education (AOR = 2.81) and sufficient income (AOR = 2.94) were strong predictors of higher wellbeing. Subjective well-being (AOR = 21.67) was a significant predictor of life satisfaction. Among working women, professional (AOR = 4.76) and administrative/technical occupations (AOR = 7.40), and absence of shift work (AOR = 6.53) were associated with better wellbeing. Shorter working hours (≤40 h/week; AOR = 14.34) were linked to higher life satisfaction. In Mansoura, working women exhibit higher subjective well-being and life satisfaction than non-working women. These outcomes were associated with education, income, and occupational conditions. Improving work conditions may contribute to better well-being among working women.

Mohammed H
Awaad A
El-Gilany AH
Abdelraouf S
El-Refaay E

Humans
Female
Cross-Sectional Studies
Personal Satisfaction
Adult
Psychological Well-Being
Women, Working
Middle Aged
Surveys and Questionnaires
Employment
Working Conditions


Enhancing Diagnostic Precision in Fuchs Dystrophy: Comparative Evaluation of REVO HR and FC130 OCT Systems

Abstract: To compare the diagnostic performance of two anterior segment optical coherence tomography devices, REVO FC130 and REVO HR, in patients with Fuchs endothelial corneal dystrophy (FECD). This prospective cross-sectional study included 33 patients with FECD. Each patient was imaged with both devices. Eleven corneal features were graded independently by two evaluators. A third grader resolved disagreements. Agreement between graders and between devices was quantified by calculating the proportion of concordant assessments, including agreement for both detected and non-detected features, with corresponding 95% confidence intervals. REVO HR provided better visualization of key corneal structures, including Descemet's membrane, Bowman's layer, and hyperreflective basal changes. Hyperreflective basal features were detected 11 times more often with REVO HR. Bowman's layer was identified 2.06 times more frequently with REVO HR compared to REVO FC130. Interoperator agreement was high for REVO HR (PropOverall ≥ 0.97 in 10 of 11 features). FC130 showed lower and more variable agreement, especially in low-contrast regions. Interdevice comparisons indicated systematic differences in detection capability. REVO HR showed higher sensitivity and reproducibility in detecting corneal microstructural changes in FECD. Improved image resolution allows better identification of subtle abnormalities, which may support more accurate disease staging and better timing of surgical intervention. For follow-up, the same OCT device should be used consistently. This study demonstrates that improved OCT resolution enhances detection of corneal microstructural abnormalities in Fuchs endothelial corneal dystrophy, improving diagnostic precision, disease staging, and clinical decision-making in routine clinical practice.

Translational vision science & technology

Szkodny D
Wylegala A
Potrawa P
Wylegala E

Humans
Tomography, Optical Coherence
Fuchs' Endothelial Dystrophy
Cross-Sectional Studies
Female
Prospective Studies
Male
Aged
Middle Aged
Reproducibility of Results
Cornea


Global spatial errors and local feature errors drive oculomotor learning

Abstract: Systematic intra-saccadic displacements of the saccade target object induce oculomotor learning. This type of manipulation remains undetected because of saccadic suppression of displacement. The subtle intra-saccadic manipulation causes the target object to appear at a retinal position that is inconsistent with the computed displacement of visual space during the saccade, leading to the computation of a postdicted motor error and corresponding adaptive changes to the saccade amplitude and the perceived location of objects in space. Adaptive changes to the saccade amplitude or direction have also been observed following obvious intra-saccadic manipulations, but very little is known about the characteristics of this learning process or its underlying mechanisms. The current study therefore compares oculomotor learning in response to subtle and obvious changes of the stimulus display. By measuring their effect on object localization and saccade gain, we were able to show that two different kinds of sensory error can induce oculomotor learning: a global spatial error and a local feature error. While experiencing the former leads to the typical adaptation-induced shift in perceived object location, experiencing the latter does not. On top of that, we demonstrate that adaptive adjustments to the oculomotor behavior do not necessarily rely on those sensory errors. Instead, the overt oculomotor behavior minimizes a task error.

Humans
Saccades
Photic Stimulation
Space Perception
Learning
Adaptation, Physiological
Male
Adult


Retrieval-Augmented Large Language Model Counseling for Continuous Glucose Monitoring in Diabetes: Source-Masked Multirater Comparative Evaluation

Abstract: Continuous glucose monitoring (CGM) is central to diabetes care, but explaining CGM patterns consistently and empathetically remains time-intensive in clinical practice. Large language model (LLM)-based systems may support patient-facing interpretation of CGM data, but evidence remains limited for retrieval-grounded tools evaluated against clinician-authored responses in counseling scenarios. The system was intended for CGM interpretation and communication support rather than autonomous therapeutic decision-making. This study aimed to evaluate whether a retrieval-grounded LLM-based conversational agent (CA) could support patient understanding of CGM data and preparation for diabetes consultations by generating responses to questions arising during CGM-informed diabetes counseling, with quality comparable to clinician-authored responses. We developed a scaffolded LLM-based CA for CGM interpretation and diabetes counseling support. The system was designed to provide plain-language explanations of CGM patterns and responses to diabetes management questions while avoiding directive or individualized medical advice, such as recommending medication initiation, dose adjustment, or regimen changes. Around 12 CGM-informed cases, each comprising a deidentified CGM trace, a synthetic patient vignette, and accompanying CGM visual materials, were constructed from using available clinical datasets. Between October 2025 and February 2026, 6 senior UK diabetes clinicians each reviewed 2 assigned cases and answered 24 questions (12 per case). In a source-masked multirater evaluation, each CA-generated and clinician-authored response was independently rated by 3 clinicians on 6 quality dimensions, including clinical accuracy, guideline adherence, actionability, personalization, communication clarity, and empathy. Safety flags and perceived source labels were also recorded. The primary analysis used linear mixed effects models with random intercepts for case and rater. A total of 288 unique responses (144 CA and 144 clinician responses) were evaluated, generating 864 ratings. CA-generated responses received higher quality scores than clinician-authored responses under controlled vignette-based conditions, with mean scores of 4.37 (SD 0.57) versus 3.58 (SD 0.90) and an estimated mean difference of 0.782 points on a 5-point scale (95% CI 0.692-0.872; P<.001). This pattern was observed across all 6 categories of patient questions. The largest estimated differences were for empathy (mean difference 1.062, 95% CI 0.948-1.177) and actionability (0.992, 95% CI 0.877-1.106). Safety flag distributions were similar between CA and clinician responses, with major concerns rare in both groups (n=3, 0.7% each). Although CA responses were longer, additional analyses adjusting for word count did not indicate that response length explained the overall quality difference. Scaffolded LLM-based systems may have value as adjunct tools for CGM review, patient education, and preconsultation preparation by supporting standardized explanatory tasks. However, these findings should be interpreted in light of the vignette-based design, restricted datasets, and a small clinician panel, and they do not establish suitability for autonomous therapeutic decision-making, medication adjustment, or unsupervised real-world use. Prospective validation in clinical workflows is needed before implementation.

Guo Z
Lai A
Korakas E
Vagenas A
Ahamed I
Albor C
Zhang H
Healy J
Li K

Humans
Large Language Models
Continuous Glucose Monitoring
Diabetes Mellitus
Counseling


A Retrospective Comparative Study of Early and Mid-to Long-Term Clinical Efficacy and Spinopelvic Sagittal Alignment After Multisegment PLIF with Different Degrees of Sagittal Correction

Abstract: This study compared radiographic spinopelvic alignment parameters and clinical outcomes after multisegment posterior lumbar interbody fusion (PLIF) with different degrees of sagittal correction in multilevel degenerative lumbar spine disease. We retrospectively reviewed adults who underwent three-segment PLIF (L2-L5 or L3-S1) between January 2020 and August 2021. Patients were stratified post hoc by achieved change in fused-segment lordosis (ΔSL) from preoperative to early postoperative radiographs (ΔSL ≤5° vs >5°). Spinopelvic parameters (SL, lumbar lordosis [LL], pelvic tilt [PT], sacral slope [SS], pelvic incidence [PI], PI-LL) and patient-reported outcomes (Visual Analog Scale [VAS], Oswestry Disability Index [ODI]) were assessed preoperatively and at follow-up (≥2 years). A total of 157 patients were included (Group A, n = 85; Group B, n = 72) with comparable baseline parameters. At 1 month and 1 year, SL was higher in Group B. At final follow-up, Group B showed more favorable alignment (higher SL/LL and lower PT/PI-LL) and better VAS/ODI than Group A (all p < 0.05). Postoperative complications were similar, except for a higher ileus rate in Group B (p = 0.024). A larger achieved ΔSL was associated with improved mid-to long-term spinopelvic alignment parameters and better final follow-up patient-reported outcomes. This potential benefit may occur at the expense of worse early postoperative symptoms; prospective studies with predefined correction targets are warranted.

Journal of investigative surgery : the official journal of the Academy of Surgical Research

Humans
Retrospective Studies
Spinal Fusion
Female
Lumbar Vertebrae
Lordosis
Male
Middle Aged
Treatment Outcome
Aged
Follow-Up Studies
Radiography
Patient Reported Outcome Measures
Time Factors
Postoperative Complications


Comparison of Self-Report and Structured Clinical Interview Scores for the Assessment of the Level of Personality Functioning Scale

Abstract: This study addresses the need for an examination of the criterion validity of a highly popular self-report instrument which is used to gain a quick first impression of personality dysfunction: the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0). To this end, the relationship between LPFS-BF 2.0 scores and SCID-5-AMPD-I scores rated by trained clinicians was investigated in a clinical Norwegian sample (N = 155). Moreover, we investigated the relationship between the Norwegian version of the LPFS-BF 2.0 and other self-report instruments (the WSAS, GAD-7, and PHQ-9). Correlations, a linear regression model, as well as sensitivity and specificity for cut-off values proposed in the literature, were estimated. The results of the linear regression analysis with SCID-5-AMPD-I scores as the dependent variable, showed a strong and significant relationship between LPFS-BF 2.0 scores and SCID-5-AMPD-I scores, also when controlling for other variables. The LPFS-BF 2.0 showed moderate to high correlations with all other instruments. The sensitivity values for cut-off scores suggested in the literature for the LPFS-BF 2.0 were too low. In sum, we found support for the concurrent and criterion validity of the LPFS-BF 2.0. Additionally, we tentatively suggest that the cut-off values currently in use may need to be lowered.

Paap MCS
Germans Selvik S
Buer Christensen T
Nysæter TE
Eikenaes I
Hummelen B

Humans
Female
Male
Personality Disorders
Self Report
Adult
Norway
Middle Aged
Psychometrics
Interview, Psychological
Reproducibility of Results
Young Adult
Sensitivity and Specificity
Adolescent
Psychiatric Status Rating Scales
Aged


Dose-response relationship of prophylactic norepinephrine infusion for prevention of spinal anesthesia-induced hypotension during caesarean delivery: A comparative study of normal weight and obese parturients

Abstract: Obese parturients are at increased risk of spinal anesthesia-induced hypotension during cesarean delivery, but optimal prophylactic norepinephrine dosing remains unclear. In this randomized, double-blind, dose-response study, 200 parturients undergoing elective cesarean delivery were stratified into obese (BMI ≥30 kg/m²) and normal weight (BMI 18.5-24.9 kg/m²) groups. Within each group, patients received norepinephrine infusion at 0.02-0.06 µg·kg⁻¹·min⁻¹. Standardized combined spinal-epidural anesthesia with 16 mg hyperbaric ropivacaine was used, and infusion was started immediately after spinal injection. Hypotension was defined as SBP <90 mmHg or >20% decrease from baseline, and success as absence of hypotension. Probit regression was used to estimate ED50 and ED95. ED50 and ED95 were 0.022 (95% CI 0.015-0.029) and 0.051 (0.041-0.061) µg·kg⁻¹·min⁻¹ in normal weight, compared with 0.036 (0.029-0.043) and 0.080 (0.058-0.102) µg·kg⁻¹·min⁻¹ in obese parturients. The relative potency ratio was 1.597 (95% CI 1.007-2.187; P=0.013). Neonatal outcomes and maternal adverse effects were comparable. Obese parturients require higher weight-adjusted norepinephrine infusion rates to prevent spinal anesthesia-induced hypotension during cesarean delivery.

Chen X
Gao Z
Jiao C
Wang J
Sun L
Qian X
Liu S

Humans
Female
Cesarean Section
Pregnancy
Anesthesia, Spinal
Norepinephrine
Adult
Hypotension
Double-Blind Method
Obesity
Dose-Response Relationship, Drug
Vasoconstrictor Agents
Anesthesia, Obstetrical

Journal Article
Randomized Controlled Trial
Comparative Study


Comparative study on the effects of high-intensity focused ultrasound (HIFU) and laparoscopic myomectomy on ovarian function and endometrial receptivity in patients with uterine fibroids

Abstract: To compare the effects of high-intensity focused ultrasound (HIFU) ablation and laparoscopic myomectomy on ovarian function and endometrial receptivity in patients with uterine fibroids. In this prospective, non-randomized cohort study, 60 patients with uterine fibroids were either treated with HIFU (n = 30) or laparoscopic myomectomy (n = 30) based on patient preference after standardized counseling. Ovarian function and endometrial receptivity were evaluated preoperatively and at 1, 3, and 6 months post‑treatment. Ovarian reserve was assessed using anti‑Müllerian hormone (AMH), sex hormone levels of luteinizing hormone (LH), follicle‑stimulating hormone (FSH), estradiol (E2), and antral follicle count (AFC). Endometrial receptivity was evaluated using endometrial thickness and vascular indices, including endometrial artery resistance index (RI), pulsatility index (PI), and the systolic/diastolic velocity ratio (S/D). Regarding endometrial receptivity, the HIFU group exhibited significantly greater endometrial thickness at the 1‑month follow‑up compared to the laparoscopic group (mean difference: 1.5 mm, 95% CI: 0.6 to 2.4 mm; Cohen's d = 0.72, p < 0.05). Both groups showed a reduction in PI after treatment, though the change was not statistically significant. RI and S/D ratios were comparable between the two groups at any time point (p > 0.05). Both HIFU and laparoscopic myomectomy preserved ovarian function in patients with uterine fibroids. HIFU was associated with faster short-term endometrial recovery at 1 month post-treatment, but no differences in ovarian function or other receptivity markers were observed between the two groups of patients. Randomized trials with pregnancy outcomes are needed before clinical recommendations can be made.

International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group

Huang R
Wang Y
Song Y
Duan X
Wu S
Zhang X
Wu S
Guo H

High-Intensity Focused Ultrasound Ablation


Clinical outcomes and efficacy of piezosurgery compared to conventional surgery for cyst enucleation: A systematic review

Abstract: Cyst enucleation is a common procedure performed in oral and maxillofacial surgery to remove cystic lesions. Conventional surgical techniques have traditionally been used for this purpose. However, piezosurgery, a relatively new technology, has gained popularity in recent years. This systematic review aims to compare the efficacy, safety and clinical outcomes of piezosurgery and conventional surgery for cyst enucleation.A comprehensive literature search was conducted using electronic databases, including PubMed, EBSCOhost, Scopus, ProQuest, and ScienceDirect. Studies published from inception up to May 2023 were included. Randomized controlled trials (RCTs) comparing piezosurgery with conventional surgery for cyst enucleation were considered. The primary outcomes included surgical duration, intraoperative bleeding, postoperative complications, and healing outcomes. Secondary outcomes comprised postoperative pain, edema and recurrence. The quality of the included studies was assessed using the revised Cochrane risk of bias tool for RCTs (RoB 2.0).The initial search identified 160 relevant articles, of which 6 studies met the inclusion criteria. Piezosurgery was shown to have a longer operation time, but higher visibility and a similar ease of operation. Clinical outcomes showed less postoperative pain, swelling and trismus in the piezosurgery group.This systematic review suggests that piezosurgery is a promising alternative to conventional surgery for cyst enucleation, offering advantages in terms of reduced surgical duration, intraoperative bleeding, postoperative pain, and edema, as well as proven not to cause any recurrence. However, further well-designed RCTs with larger sample sizes are warranted to validate these findings and evaluate long-term outcomes.

Ghassani UP
Lintong LA
Paramita S
Sulistyani LD
Latief MA

Humans
Piezosurgery
Treatment Outcome
Cysts
Postoperative Complications

Journal Article
Systematic Review
Comparative Study
Review


Negative pressure wound therapy versus conventional tie-over dressing for split-thickness skin graft fixation: A retrospective comparative study with defect size-based subgroup analysis

Abstract: BackgroundSplit-thickness skin grafting (STSG) is commonly used for traumatic soft-tissue defects; however, graft instability and suboptimal scar outcomes remain concerns. Negative pressure wound therapy (NPWT) has emerged as an alternative fixation method to the conventional tie-over dressing. This study compared clinical outcomes between NPWT and tie-over fixation and evaluated whether defect size influenced their comparative effectiveness.MethodsSeventy-five patients who underwent STSG for traumatic soft-tissue defects between March 2020 and February 2025 were retrospectively reviewed. Patients were divided according to fixation method into NPWT (n = 38) and tie-over dressing groups (n = 37). Outcomes included operative time, complete graft-take rate, postoperative complications, and Vancouver Scar Scale (VSS) scores at 2 weeks and 6 months. Subgroup analysis was performed according to defect size (<100 cm2 vs ≥100 cm2).ResultsAt 2 weeks postoperatively, the NPWT group demonstrated significantly lower VSS scores for vascularity, pliability, and height compared with the tie-over group (p < 0.05). At 6 months, significantly lower pliability scores were observed in the NPWT group; in the ≥100 cm2 subgroup, NPWT also showed a significantly lower height score (p < 0.05). Operative time was significantly shorter in the NPWT group than in the tie-over group (p < 0.001). Complete graft-take rates were comparable overall; however, in defects ≥100 cm2, NPWT achieved a significantly higher complete graft-take rate (p = 0.048).ConclusionsNPWT was associated with shorter operative time and early scar-related outcomes, particularly in larger defects. However, given the retrospective design and limited subgroup size, these findings should be interpreted cautiously, and NPWT may be considered as a useful option in selected mechanically demanding cases rather than a universal fixation method.

Journal of orthopaedic surgery (Hong Kong)

Humans
Negative-Pressure Wound Therapy
Retrospective Studies
Skin Transplantation
Female
Male
Adult
Middle Aged
Bandages
Soft Tissue Injuries
Treatment Outcome


Diagnostic accuracy of clinical examination versus MRI for meniscal tears: a systematic review and meta-analysis

Abstract: Meniscal tears are a common cause of knee morbidity and a frequent indication for arthroscopy. Whether clinical examination, magnetic resonance imaging (MRI), or both should be the first-line diagnostic test remains contested. We searched PubMed, CINAHL Complete, Medline, and Web of Science for paired-design studies in adults in which every patient underwent both composite clinical examination and MRI, with arthroscopy as the reference standard. Ten studies (1643 knees) met our inclusion criteria. Risk of bias was assessed with QUADAS-2; estimates were pooled with a random-effects model. For medial meniscal tears, MRI achieved pooled sensitivity of 90% and specificity of 91%; composite clinical examination achieved 85% sensitivity and 95% specificity. For lateral meniscal tears, MRI yielded 81% sensitivity and 82% specificity; composite clinical examination yielded 75% sensitivity and 93% specificity. Whether composite clinical examination is interchangeable with MRI as a first-line test; reduced MRI specificity in degenerative meniscal lesions and osteoarthritic knees; and the operator-dependence of clinical examination and the lack of a standardized composite-examination protocol. Composite clinical examination by an experienced clinician retains diagnostic value alongside MRI. Paired-design synthesis with arthroscopic verification gives less biased estimates of comparative accuracy than unpaired designs. Standardization of composite clinical examination protocols; consistent reporting of examiner experience; stratification of MRI accuracy by field strength and pulse sequence; and cost-effectiveness evaluation of clinical-examination-first diagnostic pathways.

Rana R
Mehan N
Hassan R
Gohil Y
Tyagi A
Maffulli N

Humans
Magnetic Resonance Imaging
Tibial Meniscus Injuries
Physical Examination
Sensitivity and Specificity
Arthroscopy
Knee Injuries
Menisci, Tibial


Evaluating the impact of blue-filtering intraocular lenses on macular oxidative stress: A comparative analysis of 8-hydroxy-2'-deoxyguanosine levels in the retinal tissue of donor eyes

Abstract: To evaluate the impact of blue-filtering intraocular lenses (BFIOLs) on retinal oxidative stress by comparing 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in the macular retina and submacular retinal pigment epithelium (RPE) of donor eyes with BFIOLs and non-BFIOLs. Cross-sectional laboratory study using postmortem human donor eyes. Fifty-eight eyes from 39 donors were categorized as BFIOL (n = 16), non-BFIOL (n = 24), or phakic (n = 18). Macular retina and submacular RPE were dissected, genomic DNA extracted, and 8-OHdG quantified using ELISA. 8-OHdG levels were compared across lens groups, and associations with age and sex were examined. Submacular RPE had higher 8-OHdG levels than the macular retina (0.95 vs 0.44 ng/mL; P < 0.0001). No significant differences in 8-OHdG were observed between BFIOL and non-BFIOL eyes in either tissue (all P ≥ 0.09). Age was not associated with 8-OHdG, whereas male donors showed higher RPE 8-OHdG levels than female donors (P = 0.03). Macular retinal and RPE 8-OHdG levels did not differ significantly by IOL type. These biochemical observations, considered alongside existing clinical data, suggest that any retinal protective effect of BFIOLs on oxidative DNA damage is likely to be modest.

Sevugamurthi K
Sivashanmugam P
Jaju S
Janani PS
Sakthivel V
Kumar N
Elamurugan V
Pandian J
Amarakoon S
Berendschot TTJM
Narendran S

Humans
Oxidative Stress
Male
Female
8-Hydroxy-2'-Deoxyguanosine
Cross-Sectional Studies
Tissue Donors
Middle Aged
Lenses, Intraocular
Aged
Retinal Pigment Epithelium
Enzyme-Linked Immunosorbent Assay
Blue Light
Macula Lutea
Deoxyguanosine
Adult
Biomarkers


Diagnostic Yield and Molecular Testing Adequacy of Transbronchial Cryoprobe Biopsy Versus Needle Aspiration in Robotic Bronchoscopy

Abstract: In the AQuIRE trial, most cases (83.6%) did not involve transbronchial needle aspiration (TBNA), often underutilized due to challenges in accessing peripheral pulmonary lesions (PPLs). Advances in robotic bronchoscopy with shape-sensing technology (ssRAB) have mitigated these challenges, but the optimal number of needle and cryoprobe passes for reliable diagnosis remains undefined. This retrospective study compares the diagnostic yield (DY) of TBNA and transbronchial cryoprobe biopsy (TBCB) and their adequacy for molecular testing in PPLs. We performed a retrospective analysis of 166 patients who underwent ssRAB with both TBNA and TBCB from May to August 2024. Fisher exact tests and McNemar χ2 tests were used to compare prevalence differences in DY and molecular testing adequacy between discordant cases. Odds ratios (OR) and 95% CIs of associations between the number of passes and diagnostic yield and rates of obtaining adequate samples for molecular testing were obtained using generalized linear mixed models (GLMMs) with a logit link. TBCB demonstrated a higher diagnostic rate than TBNA (89% vs. 80%, OR=2.04, 95% CI=1.06-4.03; P=0.032), as well as better rates of obtaining samples adequate for molecular testing (60% vs. 20%, OR=5.94, 95% CI=2.31-16.38, P<0.001). TBCB provided diagnostic yields in 55% (χ2=9.33, P=0.002) of cases where TBNA failed to provide a diagnosis and was able to obtain adequate samples for molecular testing in 42% (χ2=15.06, P<0.001) of cases where TBNA was unable to. TBCB suggests a higher diagnostic yield and higher cellular adequacy for molecular testing compared with TBNA, underscoring its potential value as a reliable and versatile diagnostic tool in PPLs.

Journal of bronchology & interventional pulmonology

Odeh T
Hegde V
Chen M
Haworth S
Postigo M

Humans
Bronchoscopy
Retrospective Studies
Female
Male
Middle Aged
Aged
Robotic Surgical Procedures
Biopsy, Needle
Lung Neoplasms


A Comparative Study of Depression and Insomnia among Patients on Continuous Ambulatory Peritoneal Dialysis versus Hemodialysis

Abstract: Depression and insomnia are common yet under-recognized comorbidities in end-stage kidney disease (ESKD) patients on dialysis. Comparative data on their prevalence between hemodialysis (HD) and peritoneal dialysis (PD) are limited. To compare the prevalence and severity of depression and insomnia in patients undergoing HD and PD and identify clinical and biochemical correlates. A multicenter, cross-sectional study was conducted across armed forces hospitals in Northern India from November 2024 to January 2025. Adult ESKD patients on HD or PD were assessed using the Patient Health Questionnaire-9 (PHQ-9) for depression. Insomnia was assessed using a response to a battery of questions. Demographic, clinical, and laboratory data were analyzed. Of 188 patients screened (HD 105, PD 83), 51 HD (48.6%) and 37 PD (44.6%) patients had PHQ-9 scores ≥5, indicating depression. Most had mild depression (HD 25.7%; PD 22.6%). Moderately severe depression was present in a small number, with no difference between the dialysis modalities. Insomnia prevalence was comparable (HD 24.7%; PD 22.6%). Severe depression was associated with lower hemoglobin and albumin, especially in PD (albumin: 2.38 vs 3.10 gm/dL, p = 0.03). Depression and insomnia are highly prevalent but underrecognized in dialysis patients. Dialysis modality did not affect the prevalence of depression or insomnia. Lower hemoglobin and albumin correlate with severe depressive symptoms.

The Journal of the Association of Physicians of India

Singh JI
Sangha SS
Datt B
Kumar S
Batta G
Akal RS
Ghosh I
Srivastava S
Dogra PM
Pannu KK

Sleep Initiation and Maintenance Disorders

Peritoneal Dialysis, Continuous Ambulatory

Journal Article
Comparative Study
Multicenter Study


Sex-Related Quality of Life After Totally Extraperitoneal Versus Lichtenstein Inguinal Hernia Repair: A Randomized Controlled Trial

Abstract: Comparative randomized evidence specifically evaluating totally extraperitoneal (TEP) and Lichtenstein repair is limited. This study compared sex-related and general health-related quality of life following these two techniques. In this prospective randomized controlled trial, sexually active adult men with primary uncomplicated inguinal hernias were randomized to TEP or open Lichtenstein repair. The primary endpoint was pain during sexual activity at 1 year, measured using the Sexual Inguinal Hernia Questionnaire (SexIHQ). Secondary outcomes included additional SexIHQ domains and health-related quality of life measured by the 36-Item Short Form Health Survey (SF-36). A total of 105 patients were analyzed, including 50 undergoing TEP and 55 undergoing open repair. Baseline demographic, clinical, SF-36, and SexIHQ measures were comparable between groups. At 1 year, pain during sexual activity was reported less frequently after TEP than after open repair (16.0% vs. 43.6%; risk ratio 0.37, 95% CI 0.18-0.74; p = 0.003). Among patients reporting pain during sexual activity, the degree of impairment in sexual activity did not differ significantly between groups. SF-36 scores at 1 year were significantly higher after TEP across all measured domains. TEP repair was associated with a lower rate of pain during sexual activity at 1 year compared with Lichtenstein repair. However, other SexIHQ domains were not significantly different. These findings suggest a possible benefit of avoiding anterior inguinal canal dissection, but do not establish broad superiority of TEP for overall sexual function.

Maurya S
Silodia A
Kothiya P
Yadav SK
Sharma D

Humans
Hernia, Inguinal
Quality of Life
Male
Prospective Studies
Middle Aged
Herniorrhaphy
Adult
Postoperative Pain
Treatment Outcome
Sexual Behavior
Aged
Surveys and Questionnaires


Single-Port Versus Multiport Robotic Right Colectomy: Short-Term Outcomes and Impact of Extraction-Site Location on Postoperative Pain

Abstract: Robotic right hemicolectomy has been widely adopted, but the impact of extraction-site location on postoperative pain in single-port (SP) surgery remains unclear. We aimed to compare short-term outcomes between SP and multiport robotic surgery and to evaluate postoperative wound pain according to extraction-site location. This retrospective single-center study included 49 consecutive patients who underwent robotic right hemicolectomy (January 2024-December 2025): 25 in the SP group and 24 in the Xi group. Postoperative pain was assessed using the cumulative pain score (sum of daily maximum NRS values, POD1-POD7). Pain outcomes were compared among SP_P (Pfannenstiel, n = 13), SP_Umb (umbilical, n = 12), and Xi_P (Pfannenstiel, n = 22). Perioperative and oncological outcomes were comparable between the groups. The SP group had significantly shorter operative time (244 vs. 309 min, p = 0.0013) and console time (167 vs. 239 min, p = 0.0014). Postoperative pain differed significantly among the three subgroups (p = 0.0049). Pairwise comparisons showed significantly lower pain in SP_P than in SP_Umb (p = 0.0062), with no significant difference for the other two comparisons. The difference between SP_P and SP_Umb remained significant after adjusting for anastomotic technique and surgical procedure in multiple regression analysis. SP-assisted right hemicolectomy was safe, with short-term outcomes comparable to the Xi platform. These findings suggest that postoperative pain following robotic right hemicolectomy may be influenced not only by the number of abdominal ports but also by the location of the extraction incision.

Nishikawa Y
Mori T
Hara M
Kageyama Y
Bando Y
Jikihara S
Nishigori T
Hata K

Humans
Colectomy
Robotic Surgical Procedures
Retrospective Studies
Postoperative Pain
Female
Male
Middle Aged
Aged
Treatment Outcome
Operative Time
Colonic Neoplasms
Pain Measurement


Comparative Bibliometric Analysis of Chinese and English Articles on Freezing of Gait in Parkinson's Disease

Abstract: Objective To compare research hotspots and development trends regarding freezing of gait in Parkinson's disease between Chinese and English articles,thus providing reference for related studies in China. Methods The articles about freezing of gait in Parkinson's disease that were published from 2001 to 2025 was retrieved from the China National Knowledge Infrastructure,Wanfang Data,VIP,and Web of Science Core Collection.Visual analyses were conducted on the distribution of countries,authors,institutions,and keywords. Results A total of 177 Chinese articles and 1 095 English articles were included.The global annual number of published articles showed an overall upward trend with fluctuations.The articles in Chinese maintained steady growth while those in English slightly declined over the past three years.The United States led in the number of published articles,followed by China and Italy.The authors and institutions of Chinese articles exhibited greater independence than those of English articles.Current research hotspots on freezing of gait in Parkinson's disease focus on pathogenesis,assessment methods,and treatment strategies.Chinese articles emphasize clinical interventions,while English articles prioritize mechanism exploration and emerging physical therapies. Conclusions The research on freezing of gait in Parkinson's disease remains active,though differences exist in research focus between Chinese and English articles.Compared with Chinese articles,English articles reported early on freezing of gait in Parkinson's disease.In the future,China should deepen international exchanges and cooperation to actively draw on advanced findings and experience and work jointly to achieve breakthrough progress in both research and clinical practice,ultimately improving patients' quality of life.

Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae

Liu J
Wang QQ
Chen MY
Zhang XY
Wang Q
Weng H
Chen JP
Xu GH

Parkinson Disease
Humans
Bibliometrics
China
Gait Disorders, Neurologic
Gait
East Asian People


Nodular Necrotizing Fibroblastic Sarcoma and Myxoinflammatory Fibroblastic Sarcoma: A Comparative Clinicopathological, Molecular, and Epigenetic Study

Abstract: There is morphological overlap between nodular necrotizing fibroblastic sarcoma (NNFS) and myxoinflammatory fibroblastic sarcoma (MIFS). Whether they represent neoplasms within the same tumor spectrum remains unclear. We performed a comparative clinicopathological, molecular, and epigenetic study of these two tumors. We analyzed the clinicopathological features, immunophenotypes, and molecular profiles of three cases each of NNFS and MIFS. DNA methylation profiling was also performed. All three NNFS cases were located in the trunk, presenting as well-circumscribed subcutaneous nodules with central necrosis, whereas the three MIFS cases all arose in acral sites with an infiltrative or ill-defined growth pattern. Morphologically, both NNFS and MIFS were characterized by large polygonal to epithelioid cells with virocyte-like, ganglion cell-like, or Reed-Sternberg-like appearance. Unlike MIFS, NNFS did not exhibit prominent myxoid stroma or vacuolated pseudolipoblasts. On immunohistochemistry, NNFS cases uniformly showed focal positivity for pancytokeratin (AE1/AE3), whereas MIFS cases exhibited variable CD34 expression. Molecular analysis identified YAP1::MAML2 fusions in all three NNFS cases, while a BRAF rearrangement was detected in one of the three MIFS cases. DNA methylation profiling demonstrated that NNFS and MIFS cases clustered together forming a distinct group. Although NNFS and MIFS each harbor unique genetic alterations, our DNA methylation profiling demonstrates a potential relationship between these two morphologically similar entities.

Humans
Fibrosarcoma
Female
DNA Methylation
Male
Epigenesis, Genetic
Middle Aged
Myxosarcoma
Aged
Adult


Electromyographic findings and frailty in hemodialysis vs peritoneal dialysis patients

Abstract: To compare the effects of hemodialysis (HD) and peritoneal dialysis (PD) on peripheral nervous system function and frailty in non-diabetic end-stage renal disease (ESRD) patients. This prospective, single-center, cross-sectional study consecutively enrolled 88 non-diabetic ESRD patients (HD: n = 45, PD: n = 43) receiving dialysis for ≥3 months at Bursa City Hospital between 1 May and 16 September 2025. All underwent neurological examination and nerve conduction studies. Frailty was assessed using the Fried Frailty Phenotype (FFP), classifying patients as robust (0), pre-frail (1-2) or frail (≥3). Multivariable linear regression identified independent correlates of frailty score. Median age was 57 (HD) versus 52 years (PD) (p = 0.077). HD patients had higher potassium (5.1 ± 0.7 vs 4.7 ± 0.6 mmol/L, p = 0.025) and ferritin (763 vs 406.5 ng/mL, p < 0.001) and a trend toward higher CRP (8.1 vs 3.2 mg/L, p = 0.075). PD patients showed better dialysis adequacy (Kt/V 1.9 vs 1.6, p < 0.001) and a trend toward higher sural sensory conduction velocity (54 vs 48 m/s, p = 0.052). Axonal polyneuropathy predominated (37.5%), without difference between modalities. Median FFP score was 1 in both groups (p = 0.705), but frailty-category distribution differed (frail: HD 20.0% vs PD 6.9%, p = 0.047). Univariately, CRP correlated with frailty in HD (rs = 0.31, p = 0.038); age (rs = 0.34, p = 0.041), hemoglobin (rs = 0.39, p = 0.014) and Kt/V (rs = -0.37, p = 0.027) correlated in PD. In multivariable regression, CRP remained an independent correlate (B = 0.017, 95% CI 0.001-0.033, p = 0.042). Although median FFP scores were similar, frailty distribution and its correlates differed by modality - inflammation in HD, age, and dialysis adequacy in PD. These hypothesis-generating findings warrant larger multicenter evaluation.

Usta M
Şeker A
Gönüllü S
Hüzmeli C
Ortaç H

Humans
Female
Male
Peritoneal Dialysis
Middle Aged
Kidney Failure, Chronic
Cross-Sectional Studies
Renal Dialysis
Prospective Studies
Frailty
Electromyography
Nerve Conduction Studies
Adult
Aged
Neural Conduction


Comparative Cardiovascular Safety and Exploratory Bleeding Outcomes of Ibrutinib, Acalabrutinib, and Zanubrutinib in Mantle Cell Lymphoma: A Propensity Score-Matched Real-World Analysis

Abstract: Bruton tyrosine kinase inhibitors are central to the treatment of relapsed or refractory mantle cell lymphoma, but cardiovascular and bleeding toxicities influence treatment selection. Ibrutinib has been associated with atrial fibrillation/flutter and other cardiovascular adverse events, whereas second-generation covalent BTK inhibitors were developed to improve kinase selectivity and tolerability. Mantle cell lymphoma-specific real-world comparative safety data across ibrutinib, acalabrutinib, and zanubrutinib remain limited. To compare cardiovascular and bleeding outcomes among patients with mantle cell lymphoma treated with ibrutinib, acalabrutinib, or zanubrutinib. We conducted a retrospective propensity score-matched TriNetX cohort study of patients with mantle cell lymphoma treated with ibrutinib, acalabrutinib, or zanubrutinib. Alternate BTK inhibitor exposure and prior recorded outcomes were excluded. Outcomes included newly recorded atrial fibrillation/flutter, heart failure, and gastrointestinal bleeding. Matching included demographics, comorbidities, cardiovascular risk factors, anthracycline exposure, and antithrombotic use. After matching, the 365-day cohorts included 738 patients per group for acalabrutinib versus ibrutinib, 522 per group for zanubrutinib versus ibrutinib, and 532 per group for acalabrutinib versus zanubrutinib. Newly recorded atrial fibrillation/flutter was lower with acalabrutinib than ibrutinib, 4.5% versus 12.0%, RR 0.371, HR 0.387, and with zanubrutinib than ibrutinib, 5.0% versus 12.3%, RR 0.408, HR 0.421. Atrial fibrillation/flutter rates were similar between acalabrutinib and zanubrutinib, 4.0% versus 5.7%, RR 0.704, HR 0.714. Heart failure did not differ statistically, and 180-day sensitivity analyses were consistent. Exploratory gastrointestinal bleeding was higher with ibrutinib than acalabrutinib, 4.3% versus 2.2%, and numerically higher with ibrutinib than zanubrutinib, 4.7% versus 3.3%; acalabrutinib-versus-zanubrutinib gastrointestinal bleeding output was unavailable. Ibrutinib was associated with a higher risk of atrial fibrillation/flutter than acalabrutinib or zanubrutinib. These findings may support individualized BTK inhibitor selection, particularly among patients with baseline cardiovascular risk.

Humans
Adenine
Piperidines
Benzamides
Lymphoma, Mantle-Cell
Pyrazines
Female
Male
Retrospective Studies
Propensity Score
Aged
Hemorrhage
Pyrimidines
Pyrazoles
Middle Aged
Atrial Fibrillation
Protein Kinase Inhibitors
Cardiovascular Diseases


Cost-effectiveness and patient-reported outcomes of combined versus isolated robotic rectal and pelvic organ prolapse repair: A multicentre prospective cohort study

Abstract: Rectal prolapse (RP) and pelvic organ prolapse (POP) frequently coexist, yet are often evaluated and treated separately. This study aimed to compare patient-reported outcomes and cost-effectiveness of combined versus isolated robotic prolapse repair. We conducted a prospective multicentre cohort study across three tertiary pelvic floor centres. Women undergoing robotic rectal prolapse repair (rRP), robotic pelvic organ prolapse repair (rPOP) or combined robotic repair (rRP + rPOP) were included. Validated patient-reported outcome measures were collected at baseline and 12 months. Health utility was derived from EQ-5D-3L and used to calculate quality-adjusted life years (QALYs). A trial-based cost-effectiveness analysis was performed from the healthcare sector perspective. A theoretical cohort was modelled to examine staged versus combined repair in patients with multicompartment prolapse. Forty-seven patients were included (rRP n = 14, rPOP n = 16, rRP + rPOP n = 17). All groups demonstrated significant improvement in pelvic floor symptoms and quality of life at 12 months. Improvements across bowel, bladder and prolapse-related domains were greatest in the combined repair group. Health utility gains were observed in all cohorts. In patients with multicompartment prolapse, combined robotic repair was cost-effective, whereas staged procedures were associated with higher cumulative costs without proportional gains in QALYs. Within robotic prolapse surgery, combined rectal and pelvic organ prolapse repair provides the most comprehensive symptom improvement and represents a cost-effective strategy when both compartments are symptomatic. These findings support systematic evaluation for multicompartment prolapse and multidisciplinary surgical planning.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

Wallace SL
Ogilvie JW Jr
Bordeianou L
Earley M
Platte R
Weinstein MM
Sokol ER
Enemchukwu EA
Mishra K
Gurland BH

Humans
Female
Pelvic Organ Prolapse
Patient Reported Outcome Measures
Prospective Studies
Rectal Prolapse
Cost-Benefit Analysis
Robotic Surgical Procedures
Aged
Middle Aged
Cost-Effectiveness Analysis
Quality of Life
Quality-Adjusted Life Years
Treatment Outcome
Colorectal Surgical Procedures

Journal Article
Multicenter Study
Comparative Study


A single species, different repeatomes? Genomic plasticity in Passiflora foetida L. complex and comparative insights across the subgenus Passiflora

Abstract: The genus Passiflora L. comprises approximately 650 species, and exhibits high diversity in the Neotropics, especially the subgenus Passiflora. Several species of this subgenus have an abundant repetitive fraction, consistent with their increased genome sizes. However, the repetitive DNA fraction of Passiflora foetida (n = 10), sister to the other species of the subgenus (n = 9) and the species with the smallest genome, has not yet been described in detail. In addition, this species comprises a complex of morphological varieties with a wide geographical distribution. The aim of this study was to characterize its repeatome variability in comparison to other species in section Dysosmia and other sections in the same subgenus, and to investigate whether it may reflect the high variability reported for this species complex. The results showed that P. foetida has a proportion of repetitive DNA fraction in part consistent with its small genome size, but with marked intraspecific variation. The LTR Ty1/copia retrotransposons were the most abundant, as in the other species of the subgenus, but Ty3/gypsy represented a much smaller fraction compared to the others. The variation observed within P. foetida was greater than that detected among Dysosmia species. Satellite DNAs were partly unique and partly similar to species from different subgenera, supporting its phylogenetic position. In addition, one Dysosmia-specific satellite showed a proximal chromosomal location, making it the first candidate of a centromeric repeat for the genus, despite its variation in abundance among chromosomes.

Chromosome research : an international journal on the molecular, supramolecular and evolutionary aspects of chromosome biology

Monteiro A
Sader MA
Nascimento J
Luna G
Imig DC
Pedrosa-Harand A

Passiflora
Genome, Plant
Repetitive Sequences, Nucleic Acid
Retroelements
Phylogeny
Species Specificity
DNA, Plant
Genetic Variation
Chromosomes, Plant
Evolution, Molecular


Prevention of ureteral stone migration during percutaneous nephrolithotomy: a randomized controlled trial

Abstract: With the increasing adoption of totally tubeless percutaneous nephrolithotomy (ttPCNL), prevention of stone fragment migration into the ureter has gained clinical importance. This study aimed to compare the incidence of ureteral fragment migration at the end of PCNL using a 5 Fr open-ended ureteral catheter (5FrUC) versus an occlusion balloon catheter (OBC). In this IRB-approved randomized controlled trial, 108 eligible patients were randomized 1:1 to either the 5FrUC or OBC group and 99 were included in the final analysis. The primary outcome, ureteral fragment migration, was defined as the presence of any stone fragment ≥ 1 mm between the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), confirmed by ureteroscopy at the conclusion of PCNL. Baseline demographics, stone characteristics, and operative parameters were comparable between groups, confirming effective randomization. Ureteral fragments were detected in 10 patients (10%): 7 with a single fragment, 2 with two fragments, and 1 with more than three fragments. The median fragment size was 2 mm (range, 1-4 mm). The incidence of ureteral fragments was significantly higher in the 5FrUC group compared with the OBC group (17% vs. 4%, p = 0.03). Logistic regression analysis demonstrated that OBC use reduced the risk of ureteral fragment migration by approximately 80% compared with 5FrUC (OR = 0.204, 95%CI 0.041-1.001, p = 0.05). Greater total stone burden, larger stone volume, higher Guy's stone score, and presence of full staghorn calculi were also associated with fragment migration. Use of an occlusion balloon catheter significantly reduced ureteral fragment migration compared with a 5 Fr open-ended ureteral catheter, achieving prevention in 96% of cases. Although the clinical impact of residual ureteral fragments remains uncertain, these findings support consideration of OBC use, particularly in ttPCNL procedures.

Savin Z
Garden E
Gupta K
Serna JS
Frangopoulos E
Durbhakula V
Gupta KR
Kaphle S
Malhotra V
Hamlani A
Gallante B
Atallah WM
Gupta M

Humans
Nephrolithotomy, Percutaneous
Female
Ureteral Calculi
Male
Middle Aged
Adult
Foreign-Body Migration
Intraoperative Complications
Aged


[Comparative study on efficacy and mechanism of stone-epiphytic and living tree-epiphytic Dendrobium nobile against alcohol-induced gastric ulcers in rats based on serum metabolomics]

Abstract: This study investigated the differences in protective effects of aqueous extracts from stone-epiphytic and living tree-epiphytic Dendrobium nobile on alcohol-induced gastric ulcers in rats, and elucidated the scientific connotation of the traditional assertion that "Dendrobium grown on stones is superior" from the perspectives of material basis and pharmacodynamics. The chemical profiles of aqueous extracts from the two cultivation modes were compared. Rats were randomly divided into control group, model group, omeprazole group, low-and high-dose stone-epiphytic D. nobile(LSE, HSE) groups, and low-and high-dose living tree-epiphytic D. nobile(LLT, HLT) groups. An acute gastric ulcer model in SD rats was established by intragastric administration of absolute ethanol. Gastric mucosal injury index, ulcer inhibition rate, and gastric juice pH were determined. Histopathological changes in gastric tissue were observed by hematoxylin-eosin(HE) and Alcian blue-periodic acid-Schiff(AB-PAS) staining. The expression of tight junction proteins zonula occludens-1(ZO-1) and occludin was detected by immunohistochemistry. Levels of oxidative stress markers, including malondialdehyde(MDA), superoxide dismutase(SOD), and nitric oxide(NO), as well as interleukin-6(IL-6), interleukin-1β(IL-1β), and interferon-γ(IFN-γ) in serum and gastric tissue were measured. Non-targeted metabolomics was further employed to identify absorbed constituents in serum, screen differential metabolites, and perform pathway enrichment analysis, thereby systematically evaluating the material basis and pharmacodynamic differences between the two cultivation modes of D. nobile. The results showed that the aqueous extracts from both cultivation modes contained largely similar types of chemical constituents, including flavonoids, alkaloids, terpenoids and terpenoid glycosides, glycosides, and phenolic amides. However, the relative contents of alkaloid and terpenoid components in both aqueous extracts and absorbed serum samples were higher in stone-epiphytic D. nobile than in living tree-epiphytic samples. Compared with the model group, gastric mucosal injury was significantly alleviated in all treatment groups, with the HSE group showing the highest ulcer inhibition rate. Histopathological observations further indicated that HSE was superior to HLT in maintaining gastric mucosal structural integrity and promoting mucus secretion. Compared with the model group, HSE significantly upregulated the expression of ZO-1 and occludin, effectively reduced MDA and NO levels, and increased SOD activity in gastric tissue, while decreasing the levels of IL-6, IL-1β, and IFN-γ in serum and gastric tissue. Serum metabolomics analysis further showed that HSE mainly exerted protective effects by regulating glycerophospholipid metabolism and glycosylphosphatidylinositol(GPI)-anchor biosynthesis pathways, whereas HLT mainly affected primary bile acid biosynthesis and lysine degradation pathways. These results indicate that both stone-epiphytic and living tree-epiphytic D. nobile exert protective effects against alcohol-induced gastric ulcers. However, the efficacy of stone-epiphytic D. nobile is significantly superior. This advantage may be closely related to the higher relative contents of alkaloid and terpenoid components in both aqueous extracts and absorbed serum samples, as well as its stronger antioxidant and anti-inflammatory activities, better protection of gastric mucosal barrier integrity, and more pronounced regulation of specific metabolic pathways. These findings provide modern pharmacodynamic evidence for the traditional assertion that "Dendrobium grown on stones is superior".

Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica

Ding HY
Gou HY
Meng JN
You Q
Chen L
Chen HP
Hu Y
Liu YP

Animals
Dendrobium
Stomach Ulcer
Rats
Rats, Sprague-Dawley
Male
Ethanol
Metabolomics
Gastric Mucosa
Humans
Drugs, Chinese Herbal
Superoxide Dismutase

Journal Article
Comparative Study
English Abstract


[Comparative analysis of quality differences between post-cocoon and normally harvested Whitmania pigra materials based on a multi-dimensional "activity-component" integrated evaluation]

Abstract: This study focused on Whitmania pigra to establish a multi-dimensional "activity-component" evaluation system. The quality differences between medicinal materials harvested after cocoon production and those harvested under normal conditions were systematically compared in terms of in vitro/in vivo pharmacodynamic effects and chemical compositions. The results showed that although W. pigra harvested after cocoon production complied with the standards specified in the Chinese Pharmacopoeia(2025 edition), its antithrombin activity(P<0.05) and soluble protein content(P<0.001) were significantly lower than those of normally harvested W. pigra. In vivo pharmacodynamic experiments demonstrated that the group treated with post-cocoon harvested W. pigra exhibited significantly inferior effects in inhibiting the black tail length and black tail rate of rats, as well as in improving plasma antithrombotic indices including prothrombin time(PT, P<0.05), activated partial thromboplastin time(APTT, P<0.05), D-dimer(P<0.05), and P-selectin(P<0.01), compared with the normal harvest group. Furthermore, HPLC fingerprinting combined with principal component analysis(PCA), cluster analysis(CA), and orthogonal partial least squares-discriminant analysis(OPLS-DA) confirmed the differences between normally harvested and post-cocoon harvested W. pigra, and seven key differential characteristic components such as uracil and hypoxanthine were identified. In conclusion, the in vitro/in vivo pharmacological activities and content of bioactive components in W. pigra harvested after cocoon production are reduced, resulting in a significant decline in medicinal quality. Accordingly, such medicinal materials are not recommended to be used as decoction pieces in clinical practice.

Feng XC
Lu MY
Li Z
Fang H
Zhang YQ
Wang LN
Jiang Q

Animals
Leeches
Male
Rats
Quality Control
Rats, Sprague-Dawley


[Comparative research on efficacy of high-pressure Schisandrae Chinensis Fructus decoction pieces and traditional decoction pieces on nonalcoholic fatty liver disease mice based on gut microbiota and metabolomics]

Abstract: This paper aims to evaluate the feasibility of clinical application of high-pressure Schisandrae Chinensis Fructus decoction pieces(HPSCH) compared with that of traditional Schisandrae Chinensis Fructus decoction pieces(SCH), based on the efficacy of mice with nonalcoholic fatty liver disease(NAFLD) induced by a high-fat diet. The optimal preparation process of HPSCH was investigated by using schisandrin content and total extractive yield as indices. After one week of adaptive feeding, C57BL/6 mice were assigned to a normal control group, while the remaining mice were fed an HFD for eight weeks to establish the NAFLD mouse model. After being successfully modeled, the mice were divided into a blank control group, blank administration group, simple model group, fenofibrate group, SCH group, and HPSCH group. All groups were administered by intragastric administration for four weeks. Body weight changes of mice were recorded, and liver indices were calculated. The levels of blood lipid and liver function index in the serum of mice were measured. Hepatic histopathological changes were observed by using hematoxylin-eosin(HE) staining and oil red O staining. Mice's feces were collected, and the 16S rDNA high-throughput sequencing method was employed to analyze changes in the gut microbiota of mice. Untargeted lipidomic analysis of the liver was conducted by using liquid chromatography-mass spectrometry(LC-MS), and principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA) were adopted to screen and identify differential metabolites. Kyoto Encyclopedia of Genes and Genomes(KEGG) database was used to perform relevant pathway analysis. Integrated analyses of gut microbiota and differential metabolites were performed to compare the similarities and differences in efficacy of HPSCH and SCH. The results show that both the HPSCH group and SCH group exert similar effects on biochemical indices in serum and hepatic pathological changes, lipid metabolism can be regulated, and liver injury in NAFLD mice can be improved. The two groups show similar changes in microbial abundance, trending toward the blank control group and maintaining intestinal homeostasis. Compared with those of the simple model group, the differential metabolites and metabolic pathways of both the HPSCH group and SCH group show similarity, and the differential metabolites are mainly triglycerides, diglycerides, phosphatidylcholines, phosphatidylglycerols, and so on. Metabolic pathways include glycerophospholipid metabolism, choline metabolism, retrograde endocannabinoid signaling, thermogenic lipolysis, and so on. This indicates that HPSCH and SCH share common advantages in improving hepatic function in mice and achieve comparable effects. HPSCH can improve blood lipid and liver function indices in NAFLD mice, attaining the therapeutic effect through the regulation of gut microbiota and lipid metabolism. Notably, HPSCH achieved the same efficacy as SCH at half the conventional dose, demonstrating its feasibility for clinical application. Moreover, the application of HPSCH may contribute to the conservation of medicinal resources.

DU Y
Fan XY
Zeng S
Yang J
Li GY
Liu T
Xu YL

Animals
Non-alcoholic Fatty Liver Disease
Schisandra
Mice
Drugs, Chinese Herbal
Male
Mice, Inbred C57BL
Gastrointestinal Microbiome
Metabolomics
Liver
Disease Models, Animal
Humans
Diet, High-Fat


Comparative study of endostatin levels in preeclampsia pregnancy and normal pregnancy

Abstract: The primary objective was to compare endostatin levels between patients with preeclampsia and those with normal pregnancies. The secondary objectives comprised comparing endostatin levels in early-onset preeclampsia, late-onset preeclampsia, and normal pregnancies, as well as comparing pregnancy and neonatal outcomes between preeclampsia and normal pregnancies. This cross-sectional analytic study included 68 patients with preeclampsia and 68 normal pregnancies. The groups were matched for gestational age. The study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, from July 2024 to July 2025. Blood samples were collected in non-heparinized tubes and stored at -80 °C until assayed. Maternal endostatin levels were measured using enzyme-linked immunosorbent assays (ELISA). Maternal and neonatal outcomes were recorded. The median serum endostatin level in patients with preeclampsia was not significantly different from that in normal pregnancies (3.45 vs. 4.32 ng/ml, p = 0.304). The median endostatin levels in early-onset preeclampsia and late-onset preeclampsia did not differ from those in normal pregnancies at the same gestational age (2.84 vs. 7.09 ng/ml, p = 0.05, and 3.86 vs. 4.26 ng/ml, p = 0.845, respectively). Patients with preeclampsia had a higher rate of cesarean delivery (63.2% vs. 41.2%, p = 0.01) and a higher rate of composite maternal complications (16.2% vs. 1.5%, p = 0.004) compared to normal pregnancies. Preeclampsia patients had lower neonatal birth weight (2,419 ± 655 vs. 2,903 ± 507 g, p < 0.001) and longer neonatal lengths of stay (median 5 vs. 4 days, p = 0.01) than those in normal pregnancy. The endostatin level in patients with preeclampsia was not statistically different from that in normal pregnancies. These research findings refute the hypothesis that serum endostatin levels are higher in preeclampsia. Therefore, serum endostatin levels may not be a reliable biomarker for predicting preeclampsia in this population. Preeclampsia is associated with adverse maternal and neonatal outcomes.

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

Humans
Female
Pregnancy
Pre-Eclampsia
Endostatins
Adult
Cross-Sectional Studies
Pregnancy Outcome
Case-Control Studies
Infant, Newborn
Biomarkers
Gestational Age


[Comparison of statin and antiplatelet therapy adherence in primary and secondary cardiovascular prevention patients]

Abstract: According to epidemiological data from Hungary, cardiovascular diseases cause the greatest loss of health among the population and are responsible for a significant proportion of premature deaths. This reinforces the health policy position that cardiovascular prevention, including improving medication adherence, must be given top priority in patient care. Long-term survival in patients who have experienced acute coronary syndrome depends heavily on medication adherence, particularly regarding statins and anticoagulants; however, domestic surveys indicate deficiencies in the use of preventive medications. The aim of our study was to compare the attitudes and beliefs regarding antiplatelet agents and cholesterol-lowering drugs among patients in the secondary prevention group who underwent percutaneous coronary intervention and those in the primary prevention control group, using the Beliefs about Medicines Questionnaire (BMQ). A cross-sectional, questionnaire-based study included 162 secondary prevention patients and 136 primary prevention patients who had undergone percutaneous coronary intervention. Medication attitudes were measured using the specific and general dimensions of the BMQ, and SPSS 27.0 was used for statistical analysis. Among patients in the secondary prevention group, both drug groups were characterized by lower levels of concern and more accepting attitudes, whereas in the primary prevention group, sceptical (p<0.05) and ambivalent attitudes were more common (p<0.001). Based on the analysis of respondents by attitude group and the examination of the BMQ's general subscales, percutaneous coronary intervention significantly influenced beliefs regarding medications. This change was clinically significant in terms of treatment adherence (p<0.001) Discussion and conclusion: Patients who have undergone percutaneous coronary intervention have more favourable attitudes toward medication, which highlights the role of targeted education and psychoeducation in improving adherence in the non-intervention population. However, adherence in the secondary prevention group cannot be considered optimal either, therefore further targeted education is warranted in this patient group as well. Orv Hetil. 2026; 167(31): 1238-1247.


[Comparison of the side effect profiles of compounds with central muscle-relaxing effect]

Abstract: In addition to other conditions involving increased muscle spasms, centrally acting muscle relaxants (guaifenesin, tolperisone, methocarbamol, chlorzoxazone, diazepam, baclofen and tizanidin) provide relief for a significant proportion of patients suffering from low back pain. Of these, tolperisone has recently been restricted by official decision due to the high incidence of anaphylactic reactions associated with its use. The aim of our work is to analyze the frequency of side effects of this group of drugs in order to help clinicians choose the appropriate medication. According to data from the World Health Organization, tolperisone is considered a safe drug, except for the aforementioned serious allergic side effect. Mortality (including suicide) associated with the administration of these medicines is the highest among the reported side effects for diazepam, followed by tizanidine and methocarbamol. Ineffectiveness was most commonly reported for guaifenesin, followed by baclofen and tizanidine. Tolperisone was the most favorable drug in terms of both mortality and ineffectiveness. We present in detail the gastrointestinal, major neurological, and psychiatric side effects that make it difficult, and in some cases impossible, to take the drugs, and we also mention the disturbing skin and eye symptoms. Orv Hetil. 2026; 167(31): 1224-1230.

Humans
Muscle Relaxants, Central
Tolperisone
Guaifenesin

Journal Article
Review
Comparative Study
English Abstract


Midterm outcomes of complex clubfoot treated with the modified Ponseti method: A comparative study of primary and referred cases

Abstract: This study aims to evaluate the midterm clinical outcomes of patients with complex clubfoot treated using the Ponseti method and to assess the sustainability of deformity correction over time. Between January 2016 and January 2021, a total of 38 feet in 26 patients with complex clubfoot treated using the modified Ponseti method were retrospectively analyzed. The patients were divided into two groups: those treated entirely in our institution (study center group) and those referred from external centers after unsuccessful initial treatment (external center group). Clinical severity was assessed using the Pirani score, and ankle dorsiflexion (DF) was measured during follow-up. Functional outcomes were evaluated using the Pirani-Based Score (PBS) and the Oxford Ankle Foot Questionnaire (OxAFQ). Relapse rates, additional procedures, and treatment success were analyzed. Independent predictors of outcomes were identified. Of a total of 26 patients included in the study, 2 were male and 24 were female with a mean age of 6.78 ± 1.29 (range, 5 to 8) years. Of these patients, 14 (53.8%) had unilateral involvement, while 12 (46.2%) had bilateral deformity. The external clinic group presented at a significantly later age than the study center group (p < 0.001), while baseline deformity severity was comparable. Pirani scores and DF measurements improved significantly in both groups, with no intergroup differences during follow-up (p > 0.05). Functional outcomes showed a significant difference in PBS scores, which were higher in the external clinic group (p = 0.045), indicating worse functional performance, while the OxAFQ scores were similar between groups (p = 0.911). Relapse rates were higher in the own clinic group but did not reach statistical significance (p = 0.254). Multivariate analysis revealed that age was the only independent predictor of treatment success (odds ratio [OR] = 2.067, p = 0.019), while referral status was not an independent determinant. The modified Ponseti method provides effective midterm correction in complex clubfoot regardless of referral status. Although referred patients present later and may demonstrate worse functional outcomes, referral source does not independently influence treatment success. Early recognition and appropriate application of modified Ponseti principles remain critical for optimal outcomes.

Dolap MA
Kaptan AY
Bal T
Çetin BV
Bozkurt C
Işıkyıldız M
Altay MA

Humans
Clubfoot
Retrospective Studies
Female
Male
Treatment Outcome
Child, Preschool
Child
Casts, Surgical
Referral and Consultation
Recurrence


Thumb carpometacarpal osteoarthritis: Arthrodesis versus trapeziectomy with ligament reconstruction and tendon interposition

Abstract: In this study, we aimed to compare the clinical and radiological outcomes of patients undergoing arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) for thumb carpometacarpal (CMC) osteoarthritis and to investigate whether patient-specific decision-making could offer advantages over LRTI or arthrodesis as a surgical approach. Between August 2014 and January 2025, a total of 40 patients who underwent surgical treatment for thumb CMC osteoarthritis were retrospectively analyzed. The patients were divided into two groups as the T + LRTI group (n = 22) and arthrodesis group (n = 18). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), grip strength (kg), and pinch strength (kg) measurements. Of the patients, 7 were male and 33 were female with a mean age of 62.9 ± 6.5 years in T + LRTI group, 60.1 ± 7.4 years in arthrodesis group (range, 40 to 75 years). Both groups demonstrated significant improvement in VAS and QuickDASH scores postoperatively (p < 0.001). The mean postoperative VAS scores were 2.7 ± 2.0 in the T + LRTI group and 1.9 ± 0.9 in the arthrodesis group (p = 0.267), while QuickDASH scores were 26.4 ± 17.3 and 19.1 ± 3.2, respectively (p = 0.085). No significant differences were observed in grip strength (p = 0.358), palmar pinch (p = 0.104) and key pinch strength (p = 0.097) between the groups. The overall complication rate was 12.5% in both groups, indicating no statistically significant difference (p = 0.642). Our study results suggest that both T + LRTI and arthrodesis provide effective and comparable pain relief and functional outcomes in the surgical management of thumb CMC osteoarthritis and can be considered reliable surgical options.

Aldemir C
Ozturk T
Ertem H
Aydın Y
Zengin EC
Piskin A
Erpala F
Sener M

Humans
Osteoarthritis
Female
Male
Middle Aged
Arthrodesis
Thumb
Retrospective Studies
Carpometacarpal Joints
Trapezium Bone
Aged
Ligaments, Articular
Treatment Outcome
Tendons
Hand Strength
Adult
Plastic Surgery Procedures
Pinch Strength


Biomechanical comparison of three fixation methods under axial loading in proximal humerus fractures with medial metaphyseal defect

Abstract: This study aims to compare the biomechanical performance of three different surgical fixation techniques in the treatment of proximal humerus fractures with medial metaphyseal defects. A total of 24 synthetic humerus bone models were used and equally divided into three groups (n = 8 per group). A standardized unstable proximal humerus fracture model with a medial metaphyseal cortical defect extending to the surgical neck was created using a three-dimensional (3D)-printed osteotomy guide. Group 1 received fixation with a lateral anatomical locking plate. Group 2 was treated with a combination of a lateral anatomical plate and a medial buttress plate (dual plating). Group 3 underwent fixation with an intramedullary nail (IMN); in this group, four specimens had distal locking with an endopin (Group 3a), and the other four with static screws (Group 3b). All specimens were subjected to axial loading until failure. Forces at the onset of failure and complete failure were recorded, and fracture patterns were documented. In Groups 1 and 2, transverse fractures consistently occurred at the level of the most distal screw of the lateral plate. In Group 3, failure was observed either proximally or distally at the nail tip, including butterfly fragment formation and metaphyseal collapse. Group 2 exhibited the highest resistance to axial loading, followed by Group 1 and Group 3, with statistically significant differences between all groups (p = 0.043, p = 0.0003, p < 0.00001). No significant difference was found between subgroups 3a and 3b (p > 0.05). Our study results indicate that double plating provides the greatest axial stability in proximal humerus fractures with medial metaphyseal defects, supporting its use in fracture patterns with medial column deficiency. However, as fixation choice should be guided by patient-specific factors and surgical feasibility, these findings should be interpreted in the context of experimental conditions and loading limitations.

Akyürek M
Koraman E
Çelik A
Iyetin Y
Kösters C
Türkmen I

Biomechanical Phenomena
Bone Plates
Humans
Shoulder Fractures
Fracture Fixation, Internal
Bone Screws
Weight-Bearing
Fracture Fixation, Intramedullary
Models, Anatomic
Bone Nails


Comparative biomechanical evaluation of medial support plating in Pauwels type III femoral neck fractures: A finite element analysis

Abstract: This study aims to evaluate the biomechanical contribution of medial support plating compared to isolated screws and to determine the impact of plate design (one-third tubular vs. mini-plate) and distal screw configuration (unicortical vs. bicortical) on construct stability. Five finite element models were analyzed in this study: three cannulated screws (CS) alone (control), and CS augmented with either a one-third tubular plate or a 2.4-mm mini-plate. For the plated models, the distal fragment was fixed using either unicortical or bicortical screws to isolate the effect of cortical purchase. A 1,400 N axial load was applied to simulate the single-leg stance phase of gait. Fracture micromotion, femoral head displacement, and von Mises stress distribution were recorded. Medial support plating substantially improved construct stability compared to screws alone, reducing femoral head displacement and fracture gap movement. Notably, no significant biomechanical differences were observed between unicortical and bicortical fixation configurations for either plate type. Both the one-third tubular plate and the 2.4-mm mini-plate provided equivalent rigidity. Although mini-plates exhibited higher internal stress concentrations, values remained below the yield strength of the material. Bicortical fixation provided no additional mechanical advantage over unicortical fixation in improving construct stability or reducing implant stress. Therefore, the primary determinant of stability is the medial buttress effect itself; once this is established, neither the plate profile nor the screw length significantly alters the biomechanical outcome, suggesting that unicortical fixation with low-profile plates provides sufficient mechanical stability.

Kalem M
Kısmet M
Ertan MB
Şahin E
Kocaoğlu H

Finite Element Analysis
Bone Plates
Humans
Biomechanical Phenomena
Bone Screws
Fracture Fixation, Internal
Femoral Neck Fractures
Stress, Mechanical
Prosthesis Design

Journal Article
Comparative Study
Evaluation Study


A comparative analysis of arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation for tibial plateau fractures

Abstract: This study aims to investigate whether arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) provided more favorable early functional recovery and reduced surgical trauma compared to traditional open reduction and internal fixation (ORIF). A total of 84 patients with Schatzker type I-IV tibial plateau fractures treated between January 2021 and January 2024 were retrospectively analyzed. The MIPPO group (n = 41) underwent arthroscopy-assisted reduction plus MIPPO, while the ORIF group (n = 43) received conventional ORIF. Allocation was chronological, with ORIF predominant in the first two years and MIPPO in the latter two years. Operative parameters, postoperative drainage, radiographic outcomes (Rasmussen radiological score), functional recovery (Hospital for Special Surgery [HSS] score), range of motion (ROM), fracture healing time, hospital stay, and complications were compared. Of a total of 84 patients, 28 were male and 56 were female of 49.4 ± 9.0 (range, 27 to 69) years. The arthroscopy-assisted MIPPO group had significantly longer operative time (96.0 ± 18.2 vs. 84.0 ± 13.9 min, p = 0.001) but shorter incision length (3.9 ± 0.7 vs. 6.2 ± 0.9 cm, p < 0.001), less intraoperative blood loss (56.5 ± 9.6 vs. 72.6 ± 10.1 mL, p < 0.001), and lower postoperative drainage volume (47.1 ± 7.5 vs. 59.0 ± 7.0 mL, p < 0.001) than the ORIF group. The arthroscopy-assisted MIPPO group also achieved higher Rasmussen radiological scores (15.4 ± 1.4 vs. 14.0 ± 1.6, p < 0.001) and better HSS scores at one, three, and six months postoperatively (all p < 0.001). At six months postoperatively, the MIPPO group also demonstrated significantly improved knee ROM (118.5° ± 8.2° vs. 107.3° ± 9.1°, p < 0.001), a difference exceeding the clinically meaningful threshold for activities of daily living. However, no significant differences were found in hospital stay (p = 0.051), fracture healing time (11.4 ± 1.3 vs. 11.1 ± 1.3 weeks, p = 0.340), or the excellent-and-good rate of HSS score at final follow-up (95.1% vs. 97.7%, p = 0.746). Complication rates were similar between the groups (p = 1.000). For Schatzker type I-IV tibial plateau fractures, arthroscopy-assisted MIPPO provides more favorable early functional recovery and radiological reduction quality compared to conventional ORIF, with less surgical trauma and comparable early functional recovery and similar complication rates during follow-up. Although operative time is longer, this minimally invasive approach is a safe and effective option for managing these complex fractures. Its principal advantage is accelerated early recovery, particularly in knee ROM, enabling patients to reach clinically meaningful thresholds for activities of daily living sooner.

Humans
Tibial Plateau Fractures
Female
Arthroscopy
Adult
Fracture Fixation, Internal
Male
Middle Aged
Retrospective Studies
Bone Plates
Aged
Open Fracture Reduction
Minimally Invasive Surgical Procedures
Fracture Healing
Treatment Outcome
Range of Motion, Articular
Recovery of Function


Comparative efficacy of conventional rehabilitation, balance acupuncture combined with conventional rehabilitation and additional unconscious proprioception training for chronic ankle instability: A randomized-controlled clinical study

Abstract: This study aims to compare the efficacy of conventional rehabilitation alone, conventional rehabilitation combined with balance acupuncture (BA) and conventional rehabilitation plus BA and unconscious proprioception training in chronic ankle instability (CAI) patients. This single-center, parallel-group, assessor-blinded randomized-controlled trial included a total of 120 CAI patients between October 2022 and October 2024. The patients were randomly assigned to control (n = 40), BA (n = 40), and combination therapy (CT, (n = 40) groups. All groups received six weeks of intervention (6 days/week): the control group received conventional rehabilitation, the BA group received conventional rehabilitation + BA and the CT group received conventional rehabilitation + BA + unconscious proprioception training. Unconscious proprioception training was defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. Assessments were conducted before and after treatment using a three-dimensional gait analysis system, a balance function testing and training system, and the Star Excursion Balance Test (SEBT). There was no statistically significant difference in age and sex among the groups (p > 0.05). In addition, disease duration and number of previous sprains were comparable among the groups (p > 0.05). Following the six-week intervention, all three groups showed significant improvements in gait parameters, balance function and SEBT scores compared to baseline (p < 0.05). The CT group exhibited significantly greater improvements in gait speed, cadence, movement length, movement ellipse area and SEBT scores than the BA group (p < 0.05), whereas the BA group outperformed the control group in all outcome measures (p < 0.05). No adverse reactions were reported in any group. The integration of BA and unconscious proprioception training may offer additional benefits for improving gait and balance in CAI patients compared to conventional rehabilitation plus BA or conventional rehabilitation alone. Based on these preliminary findings, the combined approach shows potential clinical value for targeted populations with CAI.

Liu N
Wang M
Meng Q
Wang M
Shang K
Bi YL
Jiang X
Li J
Chen J
Feng S
Zhai H

Humans
Male
Female
Joint Instability
Postural Balance
Adult
Proprioception
Treatment Outcome
Acupuncture Therapy
Combined Modality Therapy
Chronic Disease
Ankle Joint
Young Adult
Single-Blind Method
Exercise Therapy


The impact of reoperation after bipolar hemiarthroplasty for femoral neck fracture: A matched cohort comparison between septic and nonseptic causes

Abstract: This study aims to compare the rates of medical complication and mortality following initial bipolar hemiarthroplasty (bHA) and reoperation procedures, as well as between different causes of reoperation (nonseptic vs. septic). The retrospective study included 118 patients undergoing reoperation after bHA for femoral neck fractures between January 2002 and December 2022. The primary outcomes included in-hospital complications, readmission, and mortality events, while secondary outcomes included length of hospital stay, transfusion rates, and estimated blood loss. These outcomes were compared between each patient's initial bHA and their subsequent reoperation procedure. The two cohorts were matched using propensity scores based on age, sex, and Charlson Comorbidity Index to compare outcomes between nonseptic and septic causes of reoperation. Of the 118 patients, 64 were male and 54 were female. The mean age was 77.8 ± 7.9 years, with a range of 61 to 98 years. The in-hospital complication rate was higher after reoperation than after initial bHA (15.3% vs. 1.7%, p < 0.001). Conversely, the readmission rate was higher after the initial procedure (60.2% vs. 23.7%, p < 0.001), mainly due to surgical complications. Patients undergoing reoperation had longer hospital stays, higher transfusion requirements, and more frequently received general anesthesia compared to the initial procedure (p < 0.05). In the matched cohort, septic group had higher in-hospital complication rates than the nonseptic group (23.5% vs. 3.9%, p = 0.004), while readmission and mortality rates were comparable. Reoperations after bHA carry a higher risk of medical complications. This risk is particularly pronounced in cases related to septic conditions, underscoring the greater impact of reoperation and careful clinical attention.

Chang WL
Chang CY
Wang JC
Tsai SW
Chen CF
Wu PK
Chen WM

Humans
Reoperation
Female
Femoral Neck Fractures
Male
Hemiarthroplasty
Retrospective Studies
Postoperative Complications
Aged, 80 and over
Aged
Middle Aged
Length of Stay
Patient Readmission
Blood Transfusion
Sepsis
Proximal Femoral Fractures


Investigating the efficacy of acupoint acupuncture combined with rehabilitation training in knee osteoarthritis treatment: A prospective comparative study informed by systematic acupoint analysis

Abstract: This study aims to investigate the clinical effect of acupuncture combined with rehabilitation training in the treatment of knee osteoarthritis (KOA) under unified acupoint intervention. In this prospective, comparative study informed by systematic acupoint analysis, the literature related to acupuncture for KOA treatment was retrieved from public databases and the core acupoints were analyzed using the Traditional Chinese Medicine Inheritance Calculation System (TCMICS) software. Eighty-four patients were selected as the participants, and the clinical effect (total efficacy rate), Numeric Rating Scale (NRS) for pain score, American Knee Society Score (AKSS) for knee joint function and the self-care ability score for daily living activities were used to evaluate the treatment effect. The curative effect index was calculated using the AKSS scores. After analyzing the core acupoints, we selected the Dubi, Zusanli, Yanglingquan, Xuehai, Neixiyan and Liang Qiu acupoints for the acupuncture treatment. The patients were divided into a control group (n = 42 patients undergoing rehabilitation training) and an intervention group (n = 42 patients undergoing acupuncture combined with rehabilitation training). The control group consisted of 15 male and 27 female, with a mean age of 62.90 ± 11.531 (range, 40 to 78) years. The mean course of the disease was 4.07 ± 1.841 years. The intervention group consisted of 16 male and 26 female, with a mean age of 63.95 ± 10.613 (range, 41 to 79) years and a mean disease course of 4.76 ± 2.328 years. There was no significant difference between the groups before treatment (p > 0.05). After acupuncture treatment, the 92.85% total efficacy rate (n = 39) was significantly higher than the 73.80% (n = 31) in the control group. The mean AKSS of the control and intervention groups were 64.17 ± 11.148 and 66.67 ± 17.795, respectively, and the mean knee joint articulation scores were 57.40 ± 8.925 and 54.10 ± 10.150 in the two groups, respectively. Following treatment, the scores of knee joint function and knee joint articulation in the intervention group were higher than those in the control group (p < 0.05). For AKSS, the mean difference of the control group was 6.030, and the proportion of patients who reached the improvement of minimum clinically significant difference (MCID) standard was 80.95%. The mean difference of the intervention group was 10.98, and the proportion of patients who reached MCID was 100%. Following treatment, the self-care ability score in the intervention group were higher than those in the control group (p < 0.05). For modified Barthel Index (MBI), the mean difference of the control group and intervention group were 6.446 and 6.225, all accounting for 100%. The mean NRS scores were significantly decreased from 5.19 ± 1.042 to 1.93 ± 0.640 after one month of acupuncture treatment. Our study results suggest that acupuncture combined with rehabilitation training based on data mining can relieve patients' pain, accelerate the recovery of their knee joint function and improve their daily living ability, demonstrating high clinical value in practice.

Li Y
Yu J
Liu Y
Zhu L
Zhang Y
Jin M
Wu C
Li S
Fu L
Zheng L
Xu S
Jin Y

Humans
Prospective Studies
Female
Osteoarthritis, Knee
Middle Aged
Acupuncture Therapy
Male
Treatment Outcome
Acupuncture Points
Activities of Daily Living
Aged
Pain Measurement
Recovery of Function
Combined Modality Therapy
Knee Joint
Exercise Therapy


Minimum 10-year outcomes of highly cross-linked polyethylene in total hip arthroplasty for hip dysplasia: Effect of cup inclination in a matched comparative study

Abstract: This study aims to compare the long-term outcome of highly cross-linked polyethylene (HXLPE) in hip dysplasia with osteonecrosis of the femoral head (ONFH) and evaluate the effect of cup inclination on HXLPE wear after total hip arthroplasty (THA) during a minimum 10-year follow-up. Between January 2000 and December 2012, a total of 124 patients who underwent primary THA for hip dysplasia or ONFH with a minimum 10-year follow-up were retrospectively analyzed. A total of 62 patients were successfully matched between the two groups (ONFH group, n = 62 and hip dysplasia group, n = 62). Primary outcomes included acetabular cup inclination, anteversion, and wear rates of HXLPE. Based on cup inclination, both groups were divided into three subgroups, classified as (1) ≤ 45°, (2) < 45° to < 50°, and (3) ≥ 55°. Secondary outcomes included the clinical score and radiographic findings of osteolysis, implant loosening, stress shielding, and heterotopic ossification. Kaplan-Meier curve and Cox regression test were used to compare the implant survivorship in the full cohort prior to exclusion and matching (178 hip dysplasia and 397 ONFH patients). There was no significant difference in survival rate without revision of prosthesis at 10-year between two groups (hip dysplasia: 94.7%, 95% confidence interval [CI]: 91.1% to 98.4% vs. ONFH: 95.7% (95% CI: 93.3% to 98.2%) (p = 0.4) Cup inclination was significantly steeper in the hip dysplasia group (47.6°, 95% CI: 46.0° to 49.3°) than in the ONFH group (43.9°, 95% CI: 42.3° to 45.5°) (p = 0.002). Steep cup inclination (> 55°) was significantly more frequent in the hip dysplasia group (11.3%, 7/62) than in the ONFH group (6.5%, 4/62; p = 0.006). However, wear rates of HXLPE were not significantly different between groups, and no correlation was found between cup inclination and HXLPE wear rate. No progressive osteolysis or prosthetic loosening was observed during follow-up. Although patients with hip dysplasia demonstrated a steeper mean cup inclination and a higher incidence of steep cup positioning compared to those with ONFH, implant survivorship remained comparable between groups in the overall cohort. In the matched cohort analysis, HXLPE wear rates and clinical outcomes were also comparable between the groups. These findings suggest that, despite technical challenges in acetabular positioning, the use of HXLPE in THA for hip dysplasia provides satisfactory long-term performance and may alleviate concerns regarding cup inclination-related wear.

Humans
Arthroplasty, Replacement, Hip
Hip Prosthesis
Retrospective Studies
Female
Male
Femur Head Necrosis
Prosthesis Failure
Treatment Outcome
Polyethylene
Middle Aged
Prosthesis Design
Adult
Kaplan-Meier Estimate
Proportional Hazards Models
Time Factors
Hip Joint
Hip Dislocation
Acetabulum
Aged
Radiography