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Bilateral sacrospinous ligament fixation (BSSLF) is a well-established procedure for apical prolapse repair, yet surgical approaches and outcomes vary. This study presents the first large-cohort, long-term retrospective evaluation of BSSLF using the sling-like mesh Splentis®. We analyse anterior BSSLF (ABSSLF) outcomes without total hysterectomy and compare them with other surgical approaches used in clinical practice. A total of 391 patients treated with Splentis between 2012 and 2023 at two referral centres were stratified into group A (ABSSLF without total hysterectomy, n = 248) and group B (other approaches including posterior fixation and/or total hysterectomy, n = 143). Outcomes were evaluated at intermediate (1–3 years, n = 256) and long-term follow-up (> 3 years, n = 135). Primary endpoint was composite cure: Pelvic Organ Prolapse Quantification (POP-Q) point C < 0, absence of bulge symptoms and no retreatment. Secondary endpoints included POP-Q changes, patient-reported symptoms and complications. Overall cure was 90.3
Patient-ventilator asynchrony is highly prevalent during invasive mechanical ventilation, yet its detection at the bedside remains limited. Conventional waveform inspection is intermittent, operator-dependent, and insufficient to capture the complexity and temporal variability of patient-ventilator interaction. Automated systems based on advanced signal processing and artificial intelligence represent a paradigm shift, enabling continuous, objective, and scalable detection of asynchrony. Recent approaches highlight the value of entropy-based metrics to quantify the irregularity of ventilatory signals and capture subtle changes in respiratory variability. Similarly, the identification of asynchrony clusters, periods where multiple asynchronous events occur in succession, provides a clinically relevant framework to stratify severity and predict outcomes. These developments underscore the superiority of automated methods over human observation alone. From an implementation perspective, centralized monitoring architectures offer greater potential than stand-alone devices, as they allow multimodal integration, data aggregation, algorithm refinement, and interoperability across platforms. Looking forward, research must expand toward the fusion of ventilatory, hemodynamic, and neurological signals to provide a comprehensive picture of patient-ventilator interaction. Particular attention should be paid to the long-term consequences of poor synchrony, as evidence suggests that asynchronies may influence functional recovery and health-related quality of life well beyond intensive care unit discharge. Robust, standardized datasets will ultimately support the generation of synthetic data and patient-specific digital twins, paving the way for precision-guided, adaptive mechanical ventilation.
This document updates the scientific evidence and clinical practice regarding narrowband UVB phototherapy (NB-UVB) in dermatology. The review addresses indications, therapeutic regimens, safety aspects, combinations with systemic and biologic agents, and adaptation to special populations. NB-UVB remains a first-line therapy for psoriasis, vitiligo, atopic dermatitis, early mycosis fungoides, and photodermatoses due to its efficacy, safety, and cost-effectiveness. Emerging evidence supports its integration with next-generation systemic therapies. This update provides recommendations for its application in the era of targeted therapies, with an emphasis on efficiency and patient-centered care.
Penile fracture is classically a urological emergency requiring prompt surgical exploration. Diagnosis is typically clinical, and early repair is associated with better outcomes. However, with increasing access to high-resolution imaging (especially MRI) there is growing interest in its role for preoperative planning. We report the case of a 67-year-old man with no prior comorbidities who sustained penile trauma during intercourse. On examination, he presented with penile swelling and ecchymosis. MRI revealed a tear of the tunica albuginea in the right corpus cavernosum, with an adjacent hematoma at the penile base and surrounding edema. Surgical exploration was performed 72 hours post-injury. A 4 cm penoscrotal incision, targeted to the lesion identified on MRI, allowed direct access to the transverse tunical tear and hematoma. The defect was repaired with interrupted 2-0 Vicryl sutures and layered closure. Recovery was uneventful, and the patient resumed sexual activity six weeks later without complications. While standard management involves complete penile degloving, this case highlights the utility of MRI in guiding a focused, aesthetic approach. MRI enabled precise localization of the injury, allowing a smaller incision and reducing morbidity. Literature supports MRI’s high diagnostic accuracy and its growing role in individualized surgical planning. MRI can be a valuable adjunct in selected penile fracture cases, allowing for safe, less invasive, and cosmetically favorable surgical management when timely access is available. No conflict.
