Native distal femur fractures (DFF) pose a significant challenge. The rates of fixation failure and nonunion range from 10 to 50
Kidney Disease: Improving Global Outcomes (KDIGO) updated its clinical practice guideline for the management of glomerular diseases in 2021, more than a decade after the first glomerular diseases guideline was published, reflecting slow progress in drug development. But since then, novel therapies for several glomerular diseases have been successfully tested and approved by regulatory agencies, none more so than IgA nephropathy (IgAN). To keep pace with new therapies, the IgAN guideline was updated again in 2025. After this revision came to press, 3 additional IgAN treatments received accelerated approval by the US Food and Drug Administration. Because the presumptive mechanisms of action of 2 of these new therapies are mechanistically different from those of previously approved drugs, the KDIGO IgAN Work Group felt that a brief commentary outlining where the new therapies may fit into the overall IgAN treatment strategy was warranted in lieu of a full guideline update, pending additional evidence for these and other therapies.
BACKGROUND:Uncertainties persist regarding the allocation of apical lymph nodes in colorectal cancer, the approaches to lymph node dissection and mesocolic excision, which may contribute to inconsistent surgical practices. The aim of this study is to assess surgeons' practices in lymph node dissection and mesocolic excision approaches and to identify areas lacking standardization. METHODS:A multinational pilot survey of 22 colorectal surgeons from 6 countries was conducted during the FICARE colorectal meeting. The survey consisted of 21 Likert-scale questions on surgical practices and lymph node allocation in colorectal cancer surgery. RESULTS:Majority of the respondents (90.9%) recognized conceptual differences in apical lymph node stratification between right- and left-sided colon cancers, whereas D3 LND for left-sided cancer should include mesocolic tissue along the inferior mesenteric artery from its origin to the last sigmoid artery. Complete lymph node dissection requires excision of mesocolic tissue along inferior mesenteric artery for left colon cancer and superior mesenteric artery for right colon cancer according to 81.8% of respondents. At the same time, 95.5% agreed that intermediate and paracolic lymph nodes are located within a 10-cm resection margin proximally and distally from tumor, while 81.9% of respondents supported the concept of tumor-specific mesocolic excision to be sufficient enough for adequate paracolic and intermediate lymph node dissection. CONCLUSIONS:A multinational snapshot showed an existing contraindication in surgeons' perception of lymph node stratification and the variability in mesocolic excision and LND. Further Delphi consensus is needed to prove the suggested concepts.
Introduction. Parkinson's disease (PD) is a progressive neurodegenerative disorder that directly impacts motor processes, including phonation. Objective. To analyze acoustic, perceptual, and self-assessment vocal parameters in PD patients according to the stage of disease progression. Method. An observational, descriptive, cross-sectional study was conducted with a non-probabilistic convenience sample of 42 subjects classified according to the Hoehn and Yahr scale. Acoustic parameters (fundamental frequency, formants, spectral slope) and the degree of dysphonia (Yanagihara scale) were assessed using Praat software and evaluated by an expert committee. Perceptual characteristics (GRBAS scale) and self-perceived voice handicap (VHI-30 questionnaire) were also evaluated. Results. An average F0 of 163 Hz was observed in men and 172 Hz in women, with a reduction in F1 in both sexes, a reduction in F2 in women, a reduction in F3 in men, and an increase in F4 in both. The spectral slope was -3.54 in men and -3.63 in women. Eighty-three percent of participants were classified as Yanagihara grades 1 and 2, and 34 reported mild vocal impairment. Alterations in acoustic parameters and vocal quality were observed in individuals with Parkinson's disease at different stages of the disease; however, these differences were not statistically significant. Conclusion. Further research in this area should include a larger sample size that includes greater representation of subjects in the early and advanced stages of the disease.
Background: Accurately estimating resting energy expenditure (REE) in critically ill obese patients remains a significant clinical challenge, as predictive equations are consistently inadequate. Metabolic heterogeneity across obesity classes and the role of substrate utilization are insufficiently characterized. Objective: To evaluate the impact of different weight-normalization methods on the interpretation of REE and to identify independent metabolic determinants of weight-adjusted energy expenditure in critically ill patients with obesity. Methods: Bicentric cross-sectional study of 148 critically ill adults with obesity undergoing indirect calorimetry. REE normalized by actual body weight (REE/kg), ideal body weight (REE/IBW), and adjusted body weight (REE/AdjBW) was calculated. Multivariable models with robust standard errors (HC3), stratified analyses by obesity class (I-III) with a Chow test, and internal validation were performed using 10-fold cross-validation and bootstrap resampling (1000 iterations). Results: Absolute REE did not differ significantly between BMI categories (p = 0.679), while REE/kg progressively decreased from normal weight (27.8 kcal/kg/day) to class III obesity (16.9 kcal/kg/day; p < 0.001). The respiratory quotient (RQ) emerged as the most robust independent correlate of adjusted REE (β = -13 to -15 kcal·kg-1·day-1; p < 0.001), whereas clinical severity scores (SOFA, APACHE II) and comorbidity (Charlson) did not show significant associations. Stratified analyses revealed significant structural heterogeneity between obesity classes (F = 4.545, p = 0.0001), with no significant predictors identified in class III obesity, likely reflecting limited statistical power in this subgroup. Conclusions: Normalizing REE using different weight indices fundamentally alters its metabolic interpretation. RQ surpasses traditional clinical scores as a correlate of adjusted REE, consistent with a phenotype of metabolic inflexibility. The heterogeneity between obesity classes underscores the need for individualized indirect calorimetry rather than reliance on predictive equations.
