Extracorporeal membrane oxygenation (ECMO) is increasingly being utilized for life-threatening cardiac and/or respiratory failure refractory to conventional treatment. Acute kidney injury (AKI) and fluid balance disorders commonly occur both before and during ECMO, with approximately half of cases receiving treatment with continuous renal replacement therapy (CRRT). Acute kidney injury, fluid balance disorders, and CRRT influence both short- and long-term outcomes in this population. The 36th Acute Disease Quality Initiative (ADQI) meeting was held in June 2025 to develop multidisciplinary international expert recommendations for AKI, fluid balance, and CRRT during ECMO across the age spectrum. This work encompassed five working groups: 1) epidemiology, risk factors, and outcomes of AKI and CRRT, 2) fluid management and outcomes, 3) indications for CRRT and fluid removal during ECMO, 4) best practices for performing CRRT during ECMO, and 5) biomarkers, extracorporeal blood purification, and drug pharmacokinetics and pharmacodynamics. As part of this work, knowledge gaps and research priorities were identified.
Chronic kidney disease (CKD) and metabolic dysfunction–associated steatotic liver disease (MASLD) have been associated with an increased risk of cardiovascular disease. This study seeks to examine the prognostic value of the coexistence of CKD and MASLD in patients presenting with acute myocardial infarction (AMI). This cohort study describes the clinical characteristics and long-term outcomes of patients following AMI, stratified by the presence of CKD and MASLD. A Kaplan–Meier curve was constructed for 30-day mortality. Cox regression analysis was used to investigate independent predictors of long-term all-cause mortality, adjusted for age, sex, ethnicity, previous AMI, AMI type, and left ventricular ejection fraction (LVEF). A total of 6757 patients with AMI were examined. Those with coexisting CKD and MASLD (CKD(+)/MASLD(+)) had the highest rates of obesity (97.7
To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. In total, 188 (39.0
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.
Although early laparoscopic cholecystectomy is the gold standard for acute calculous cholecystitis, its safety in patients presenting more than seven days after symptom onset remains debated. Concerns over increased surgical difficulty and complication rates often results in delaying cholecystectomy, yet evidence supporting this seven-day threshold is lacking. Therefore, this study evaluated the safety of early laparoscopic cholecystectomy in patients operated within versus beyond seven days of symptom onset. This international retrospective cohort included patients who underwent early laparoscopic cholecystectomy for acute calculous cholecystitis at two high-volume centers between 2015 and 2021. Patients were categorized by symptom duration: ≤ 7 days or > 7 days. Multivariable analyses compared major complications (bile duct injury/leakage, bowel injury, bleeding, or postoperative complication Clavien-Dindo grade ≥ 3a), conversions, operative time, and postoperative hospital stay. A total of 1421 patients were included. Of these, 1312 patients (92
