BACKGROUND:Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic. METHODS:We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. RESULTS:A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography. CONCLUSION:In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access. EDITORIAL COMMENT:This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.
Background Musculoskeletal disorders represent a significant global health burden, frequently leading to chronic pain, functional impairment and disability. Conventional treatment modalities, including rehabilitation, pharmacotherapy and surgical intervention, are often associated with suboptimal outcomes and prolonged recovery. Adipose-derived stem cells (ADSCs) have gained considerable attention due to their regenerative capacity, accessibility and immunomodulatory properties. Preclinical studies of ADSCs have demonstrated promising effects in skeletal muscle regeneration. However, the evidence from human orthopaedic shoulder surgery remains inconclusive. This scoping review aims to map the process of adipose tissue-derived treatments in orthopaedic surgery, especially shoulder surgery.Methods and analysis A scoping review will be conducted using the Joanna Briggs Institute methodology to systematically map existing evidence on the clinical use of ADSCs in orthopaedic shoulder surgery. The search strategy will use the Population–Concept–Context framework and will be applied across four bibliographic databases (Embase, MEDLINE, CENTRAL and Scopus) and ClinicalTrials.gov, with additional grey literature searches. Studies will be limited to adults (≥18 years) undergoing shoulder surgery. Both clinical and patient-reported outcomes will be extracted. Article screening and data extraction will be performed independently by two reviewers using Covidence software, with discrepancies resolved through consensus or third-party arbitration.Discussion The extensive mapping will provide a comprehensive synthesis of current evidence on the application of ADSCs in orthopaedic surgery, including preparation methods, intraoperative techniques, postoperative follow-up and outcome measures. Special attention will be paid to heterogeneity in clinical practice, methodological limitations and reported patient-centred outcomes. This review will also identify gaps in the literature and inform future research priorities.Ethics and dissemination This scoping review does not require ethics approval, as we will only include information from previously conducted studies and will not involve human participants.
Interference in blood tests may cause falsely high or low results, potentially leading to misdiagnosis or erroneous treatment. Such interference may be related to antibodies or proteins in the blood, as well as medications, supplements, or sample handling. While some types of interference are detected automatically by laboratory systems, others remain unrecognised in routine practice. Clinicians should consider interference when laboratory results do not align with the clinical presentation or related test results and involve the laboratory to ensure correct interpretation, as argued in this review.
BACKGROUND:Ocrelizumab, a monoclonal antibody targeting CD20+ B cells, is a high-efficacy therapy for multiple sclerosis (MS). METHODS:Patients with relapse-onset MS treated with ocrelizumab, fingolimod, natalizumab or alemtuzumab for ≥6 months were identified from three registries: MSBase, OFSEP and Danish MS Registry. Pairwise comparisons were performed in the overall cohort and 14 predefined clinicodemographic subgroups based on sex, disease activity, MS duration, Expanded Disability Status Scale, prior therapy and reason for prior treatment cessation. Relapses, progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) were compared in pairwise-censored groups. RESULTS:Fingolimod was associated with a higher annualised relapse rate (ARR) (0.14 vs 0.06, p<0.001), relapse risk (HR 2.26, 95% CI 1.98 to 2.58), RAW (1.62, 1.08 to 2.43) and lower risk of disability improvement (0.78, 0.63 to 0.96) than ocrelizumab. Superiority of ocrelizumab over fingolimod on relapses was maintained in all subgroups. Natalizumab was associated with marginally higher ARR (0.10 vs 0.07, p<0.001), relapse risk (1.35, 1.16 to 1.57) and RAW (1.77, 1.07 to 2.94) than ocrelizumab. Alemtuzumab was associated with higher ARR (0.18 vs 0.12, p<0.001) and relapse risk (1.48, 1.25 to 1.76) than ocrelizumab, but there was no evidence for a difference in risk of RAW. There was no evidence for a difference on PIRA in any comparisons. Ocrelizumab was superior to natalizumab and alemtuzumab on relapses in patients who were not treatment-naïve, experienced disease activity on the prior therapy or stopped prior therapy due to lack of efficacy. CONCLUSIONS:Ocrelizumab provides superior control of relapses and RAW, especially among patients with prior on-treatment disease activity. Treatment of PIRA remains an unmet need.
Incisional and parastomal hernias are frequent and significant complications following abdominal surgery, leading to reduced quality of life and substantial healthcare costs. This review provides a comprehensive review of the latest international guidelines, including the 2022 EHS/AHS guideline on abdominal wall closure and the 2023 EHS Rapid Guideline on parastomal hernia prevention. Key recommendations include risk stratification of patients, the superiority of the small-bites fascial closure technique for midline closure, and the selective use of prophylactic mesh.
