To investigate the effect of half-time cooling via single arm immersion in carbonated water (CO2WI) during intermittent exercise in the heat (34.63 ± 0.49 °C, 54.2 ± 1.8
Spinal spondylosis – including degenerative disc disease, facet arthropathy, and stenosis – is a leading cause of chronic spinal pain. Regenerative biologics such as platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal cell therapies are increasingly used, yet evidence remains inconsistent. This systematic review synthesizes randomized controlled trials (RCTs) evaluating biologic injections for degenerative spinal conditions. MEDLINE, Embase, and Cochrane CENTRAL databases were searched from inception to September 22, 2025. Only RCTs evaluating PRP, BMAC, mesenchymal stem/stromal cells (MSCs), or mesenchymal precursor cells (MPCs) for degenerative spinal pain were included. Outcomes included pain, function, imaging, and adverse events. Risk of bias was assessed using Cochrane RoB 2. Thirteen RCTs met eligibility. For lumbar radiculopathy, four trials showed that corticosteroids provided faster early relief, but PRP produced significantly greater improvement at 3–6 months, with higher proportions achieving clinically meaningful pain and ODI reduction. In facetogenic pain, lumbar facet PRP surpassed steroids at 6 months, whereas cervical facet outcomes were similar across groups. Evidence for intradiscal PRP was mixed: one large RCT showed no benefit versus saline; smaller trials reported delayed functional gains. While autologous BMAC and MSC preparations did not demonstrate superiority over sham controls for primary pain and functional outcomes (Levi 2025, Vadalà 2025), allogeneic MPCs demonstrated significant, durable improvements in both pain and disability compared to saline through 36 months, particularly when delivered in a hyaluronic acid vehicle (Amirdelfan 2021). In contrast, a large multicenter RCT demonstrated that allogeneic MPCs significantly increased the proportion of patients achieving ≥ 10–15-point ODI improvement and durable pain reduction over 12–36 months (Amirdelfan 2021). Across all studies, adverse events were minimal, though one case of spondylodiscitis followed intradiscal PRP. PRP provides durable mid-term benefit for lumbar radiculopathy and lumbar facet pain, while intradiscal PRP, BMAC, and autologous MSCs show limited efficacy. Allogeneic MPCs are the most promising cell-based therapy but remain investigational. Standardization of biologic preparation and larger, multicenter RCTs are needed.
Fusion surgery, where laparoscopic techniques are purposefully integrated into robotic surgery, is a novel approach that can be used in colorectal surgery. However, a standard definition and practical guidance are lacking. Therefore, this study aimed to generate consensus to standardise the definition of fusion surgery and consequently raise awareness of fusion surgical approaches and their appropriate use cases. We conducted a two-round modified Delphi study with 17 colorectal surgeons from Asia–Pacific (5 Steering Committee [SC]; 12 Expert Panellists [EP]). Statements were drafted by the SC based on clinical experience, published literature and comments from the EP. The EP rated these statements anonymously on a 5-point Likert scale. A virtual expert meeting was held between voting rounds to discuss the statements. Consensus was predefined as ≥ 75
Surgical simulation has evolved significantly, transitioning from basic models to advanced virtual reality (VR) platforms, addressing the limitations of cadaveric training such as cost, availability, and ethical concerns. VR offers a risk-free, immersive environment for trainees to practice complex procedures, providing real-time feedback and objective performance metrics. Despite its potential, VR applications in Otolaryngology (ENT), particularly temporal bone surgery, remain underexplored due to anatomical complexity and specialty size. The primary hypothesis of this pilot trial was that VR simulation would achieve comparable technical performance to cadaveric dissection, while enhancing self-perceived competency. As a pilot study, no pre-specified non-inferiority margin was established; statistical non-significance was interpreted as potential equivalence requiring validation in a powered trial. This study presents the development and pilot evaluation of a VR-based temporal bone dissection simulator, comparing its efficacy against traditional cadaveric training. A single-centre crossover trial involving 14 ENT residents was conducted, with participants randomized into two arms: one starting with VR simulation (VRS) and the other with cadaveric dissection (CD). The VR platform, developed in collaboration with I3 Simulations, incorporated haptic feedback, real-time performance tracking, and scaffolded learning modules. Outcomes were assessed using pre- and post-simulation questionnaires, System Usability Scale (SUS), Technology Acceptance Model (TAM), and Zirkle grading for procedural accuracy. Results demonstrated a 26.7
Background The burden of gastric cancer remains substantial in Asia. Gastric premalignant conditions, including chronic atrophic gastritis, intestinal metaplasia and dysplasia, are important intermediate stages in the gastric carcinogenesis cascade. The sojourn time allows endoscopic surveillance to have a pivotal role in early detection and timely intervention.Objective This task force was commissioned by the Asian Pacific Association of Gastroenterology to formulate recommendations for the surveillance and management of Helicobacter pylori associated gastric premalignant conditions in the region.Design A systematic literature review was conducted across multiple databases, including PubMed, Cochrane Library and Embase, focusing on studies related to gastric premalignant conditions and their surveillance, particularly from Asia. The evidence quality and strength of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results These recommendations address four key aspects of gastric premalignant condition surveillance: (1) epidemiology and risk factors; (2) endoscopic and histopathological diagnosis; (3) risk stratification and endoscopic surveillance strategies; and (4) management strategies. 28 statements were made after multiple rounds of voting by experts. The statements offer a comprehensive, evidence based framework designed to assist clinicians in the Asia Pacific region on the early detection and management of gastric premalignant conditions.Conclusion These statements aim to provide a structured, evidence based surveillance framework for clinical practice in the Asia Pacific region, while also identifying priority areas for future research.
