Cork University Hospital (Irish: Ospidéal na hOllscoile Corcaigh) is a large university teaching hospital in Wilton, Cork in Ireland. Its academic partner is University College Cork. It is the only Level 1 Trauma Centre in Ireland. It is a public hospital managed by the South/Southwest Hospital Group, a part of the Health Service Executive.
INTRODUCTION:Elective caesarean section is a common and painful procedure. Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare-centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia. METHODS:A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta-analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included. RESULTS:Sixty-one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50-100 μg or diamorphine 300 μg pre-operatively, and paracetamol, non-steroidal anti-inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs, with opioids used for rescue. The surgical technique should include a Joel-Cohen incision. The peritoneum should not be closed. DISCUSSION:An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up-to-date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long-acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques.
Background Fatigue, impaired sleep quality and daytime sleepiness, common in neurodegenerative and immune-mediated diseases, are debilitating and have serious societal and economic implications. Currently, measurement of these symptoms largely relies on self-reported questionnaires, which are burdensome for patients and lack sensitivity, granularity and reliability. Methods Building on a preceding feasibility study and qualification advice of the European Medicines Agency, the Clinical Observational Study of the European project Identifying Digital Endpoints to Assess FAtigue, Sleep and acTivities of daily living in Neurodegenerative disorders and Immune-mediated inflammatory diseases (IDEA-FAST) investigates the relationship between digital and clinical parameters of the target concepts of fatigue, reduced sleep quality and daytime sleepiness. Results Between 2022 and 2025, 2000 people are being recruited at 24 European sites – 500 with Parkinson's disease, 500 with inflammatory bowel disease, 200 with each of the following diseases: Huntington's disease, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and 200 healthy volunteers. Participants are followed over a 24-week period with four visits, each including a 1-week assessment phase at home using CE-certified digital health (including active and passive) technologies. The latter collect information on physical activity, physiology, cognition as well as social interaction and behaviour as core dimensions of the target concepts. Conclusion This study will help to develop reliable, valid and efficient digital endpoints of fatigue, impaired sleep quality and daytime sleepiness for use in future clinical studies and trials.
Background: Post-operative outcomes of cardiovascular surgery vary greatly among patients for a variety of reasons. While the specific reasons are often multifactorial and complex, certain machine learning methods are promising ways to both estimate mortality after surgery and elucidate important factors linked with mortality.Methods: Using the MIMIC-IV database, we identified 11,261 patients on the cardiovascular surgery unit. We estimated all-cause one-year mortality for each patient after their most recent operation. The dataset included patient demographics (including age, sex, and BMI), as well as the maximum and minimum common laboratory values measured prior to each surgery (including electrolytes, eGFR, and red cell distribution width).Results: Of the models tested, logistic regression outperformed all other approaches with respect to accuracy (p = 0.0075 with respect to a two-tailed t-test with the next strongest model). The model had an accuracy, sensitivity, and specificity of 85.07%, 82.89%, 85.19% respectively. Furthermore, features weighted heavily by the model are consistent with known predictors of mortality in the literature.Conclusion: Pre-operative laboratory values are effective predictors of all-cause one-year mortality post-cardiovascular surgery used in conjunction with machine learning. Renal function, red cell distribution width, leukocytosis, and erythrocyte indices appear to be important prognostic factors.
Uterine fibroids are the most common benign tumour of the female reproductive tract. For decades, surgery has been the standard treatment for symptomatic fibroids. However, minimally invasive options such as Uterine Artery Embolisation (UAE) have now emerged as a less invasive, but equally effective treatment. Despite this, access to UAE remains uneven worldwide. This cross-section from ten countries representing all inhabited continents across the globe, highlights several challenges that still exist, despite the abundance of evidence to support the long-term quality of life improvements for women treated with UAE. This narrative review considers enabling factors as well as barriers to treatment in each region, putting forward local strategies to improve access to UAE moving forward.
Objective Sepsis involves a transition from hyperinflammation to immunosuppression, with neutrophils playing a central role in both phases. However, the molecular basis of neutrophil-driven immunosuppression remains unclear. This study aimed to identify and validate hub genes regulating neutrophil immunosuppression in sepsis to uncover potential therapeutic targets. Methods Neutrophil transcriptomic datasets (GSE64457, GSE180387) from the GEO database were analyzed using WGCNA to identify modules correlated with sepsis progression, followed by GO/KEGG enrichment and PPI network construction. Candidate hub genes were validated through single-cell RNA sequencing of human peripheral blood neutrophils. A cecal ligation and puncture (CLP) murine sepsis model was further used to evaluate neutrophil-mediated immunosuppression via CD4+ T cell co-culture assays, with hub gene expression confirmed by Western blot analysis and qPCR. Results WGCNA identified immune-related modules strongly associated with sepsis progression, enriched in cytokine signaling, immune receptor activity, and neutrophil degranulation. Intersection analysis revealed 34 common genes, and PPI networks prioritized three hub genes: NFKBIZ, TNFAIP2, and CTSS. Single-cell analysis demonstrated distinct expression of these hub genes in immunosuppressive versus non-immunosuppressive neutrophils. In the CLP model, late-stage neutrophils (day 5) significantly suppressed CD4+ T cell proliferation compared to early-stage neutrophils (day 1, p < 0.01). Protein validation confirmed upregulation of NFKBIZ and downregulation of TNFAIP2 and CTSS in late-stage sepsis. Conclusion Integrated bioinformatics and experimental validation identified NFKBIZ, TNFAIP2, and CTSS as potential regulators of neutrophil immunosuppression in sepsis. Their dynamic expression highlights key mechanistic features associated with immune dysfunction and suggests new targets for reversing sepsis-induced immunoparalysis.
