BACKGROUND:Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure. METHODS:In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28. RESULTS:A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, -0.05 percentage points; 95% confidence interval [CI], -4.21 to 4.10; P = 0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, -5.93 percentage points; 95% CI, -11.78 to -0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group. CONCLUSIONS:Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28. (Funded by the French Ministry of Health and Fisher and Paykel Healthcare; SOHO ClinicalTrials.gov number, NCT04468126.).
PURPOSE:This European Society of Sports Traumatology, Knee Surgery and Arthroscopy-European Hip Preservation Associates-European Sports Medicine Association (ESSKA-EHPA-ESMA) formal consensus aims to provide evidence- and expert opinion-based recommendations for the terminology, clinical examination and imaging concerning the assessment of athletes and physically active adults with hip and groin pain. METHODS:The 'ESSKA Formal Consensus' methodology, involving a rigorous, iterative peer review process, was utilized. A multidisciplinary group of 57 experts from 22 countries formed a steering group (15 experts), rating group (20 experts) and reader group (22 experts). The steering group developed 13 questions, including four conclusive questions, across three domains: terminology, clinical examination and imaging. Statements were graded A (high-level scientific evidence) to D (expert opinion) and scored 1-9 according to the level of agreement by the rating group. The reader group assessed statements for clarity and geographic adaptability. RESULTS:Median ratings for the 13 statements ranged from 8 to 9 out of 9. Strong agreement was recorded for five questions, relative agreement for five questions, and three questions remained uncertain. All statements were graded C. Recommended terminology includes adductor, iliopsoas, inguinal, pubic and hip joint-related groin pain. Clinical examination should include gait assessment, Trendelenburg's test, palpation and resistance testing of relevant muscle groups, hip range of motion and the flexion, adduction, internal rotation (FADIR) test. Imaging examinations are neither fully sensitive or specific and should always be used in conjunction with history and examination. Depending on the suspected pathology, plain radiographs or ultrasonography should be used as first-line investigations, with magnetic resonance imaging, computed tomography and diagnostic hip injections reserved as second-line investigations. CONCLUSION:This consensus provides a structured reference frame for the terminology, examination and imaging for athletes and physically active adults with hip and groin pain. Different and combined aetiologies for hip and groin pain exist, and therefore consistent terminology and systematic clinical examination are essential. Red flags must not be ignored, and imaging must be interpreted alongside history and examination findings. LEVEL OF EVIDENCE:Level I.
BACKGROUND:Olfactory dysfunction is highly prevalent worldwide and linked to major neurologic and psychiatric disorders. Electrical stimulation of the olfactory bulb (OB) and olfactory tract (OT) has emerged as a potential therapeutic approach to restore olfactory percepts and possibly improve associated conditions. OBJECTIVE:This study aimed to systematically review preclinical and clinical electrical stimulation studies of the OB and OT, evaluate their relevance for olfactory prosthesis development, and identify key technical and translational requirements for clinical implementation. MATERIALS AND METHODS:Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, PubMed, EMBASE, and Web of Science were searched until December 31, 2025. Eligible studies reported in vivo electrical stimulation of the OB or OT in mammals. A narrative synthesis of the data was undertaken. RESULTS:Overall, 42 studies were included (38 animal, four human). Critically for prosthesis development, all four human studies successfully elicited olfactory perceptions through OB/OT stimulation. In rodent anosmia models, electrical stimulation evoked spatially selective neural responses, with animals indicating discrimination between stimulation sites spaced as close as 250 μm-establishing proof of principle for encoding distinct odor percepts. Stimulation parameters significantly influenced outcomes: Spatially targeted, patterned stimulation produced odor-like responses and supported associative learning, whereas diffuse, high-frequency stimulation modulated mood and memory circuits. The OB/OT's extensive connectivity to limbic structures offers potential therapeutic benefits beyond smell restoration, although this requires careful parameter optimization. CONCLUSION:OB and OT stimulation are accessible neuromodulation targets with promising but context-dependent effects. Translation requires standardized protocols, large-mammal validation, and early-phase adult human studies.
Background: Hepatic portal venous gas is often considered a marker of advanced mesenteric ischemia but can also result from severe intra-abdominal infections. Case summary: We report a 77-year-old man presenting with septic shock 6 weeks after pancreaticoduodenectomy for pancreatic cancer. Initial computed tomography (CT) revealed a liver abscess and pneumobilia; broad-spectrum antibiotics were started. Within 24 hours, the patient deteriorated to refractory shock with lactate 12 mmol/L. Repeat CT showed massive HPVG, mesenteric venous gas, gastric and ileal pneumatosis and persistent liver abscess without vascular thrombosis. Emergency laparotomy excluded mesenteric ischemia; the abscess was drained. Despite aggressive resuscitation and extended antimicrobial therapy, the patient died 36 hours after admission. HPVG originated from intralesional gas production by Klebsiella aerogenes, Klebsiella oxytoca and Clostridium perfringens. Conclusions: This case highlights that HPVG is not specific to ischemia and may indicate fulminant infection. In septic shock with HPVG, immediate coverage for Enterobacterales and anaerobes and rapid source control are essential.
