Background:. The prevention of peritendinous adhesions after tendon repair is a significant challenge in hand surgery. To our best knowledge, this is the very first study using MatriDerm and a wraparound technique. Our study was a prospective, double-blinded, randomized case-control study using MatriDerm as an adhesion barrier after primary repair of the flexor digitorum profundus tendon of the human hand in zone II. Methods:. We evaluated 38 patients with flexor digitorum profundus injuries. All tendons were repaired using core and circumferential sutures. Randomization was double-blinded, with participants being divided into 2 groups of 19 patients. In the first group, the repaired site was wrapped in MatriDerm, whereas in the second, the site was repaired without MatriDerm. Clinical and functional results were evaluated using the total active movement (TAM) assessment, ultrasound, and visual analog pain scale. Results:. The MatriDerm group showed a mean TAM of 82.1%, whereas that of the control group was 66.11%. According to the statistical Mann-Whitney U test, results with MatriDerm were significantly higher compared with the control group, with a medium effect size (exact P = 0.014, P < 0.05, Pearson r = 0.36). Adhesion formation according to ultrasound and pain scores was similar between the control and MatriDerm groups. Conclusions:. Our prospective, double-blinded, randomized clinical study showed significantly better TAM outcomes in repaired tendons wrapped in MatriDerm. The promising results of this novel MatriDerm application in zone II flexor tendon repair should undergo wider, adequately powered clinical trials in the future.
Purpose Among head and neck squamous cell carcinomas (HNSCCs), oropharyngeal cancer (OPC) was historically thought to be a homogenous entity, mainly caused by excessive alcohol and tobacco consumption. However, the discovery of human papillomavirus (HPV) infection as an independent risk factor for the development of OPC has led to changes in diagnostics and treatment of this cancer. HPV-positive OPC is associated with improved survival and reduced recurrence rates compared to similar stage HPV-negative OPC and HNSCC in general. These favorable outcomes have led the medical and scientific communities to consider de-escalation treatment options in this specific population to spare patients from unnecessary toxicity, without compromising survival. This comment aimed to critically evaluate de-intensification treatment strategies in HPV-related OPC and to propose future treatment approaches as well as trial design. Methods A review of the literature was performed. Results Among nine published non-surgical de-intensification trials, only three studies had a comparison head-to-head with the standard of care, with two trials demonstrating clear inferiority of de-escalating treatment option (cetuximab-based radiotherapy). Additionally, there has been significant heterogeneity among induction chemotherapy (IC) protocols in de-escalating studies. Also, the toxicity among these studies varies in terms of the manner of reporting (physician vs patient-reported adverse events). Conclusions Data obtained with de-intensified strategies should only serve to help select an appropriate experimental arm for a randomized controlled trial phase III comparison against cisplatin and 70 Gy of radiotherapy. Without a proper randomized trial, there remains the possibility of compromising survival, which raises ethical questions about conducting any de-escalation trial.
BACKGROUND:Intravenous amino acids (AA) reduce acute kidney injury (AKI) in adult patients undergoing cardiac surgery. Because the optimal duration of AA infusion is unknown, we investigated the effect of AA infusion duration on AKI and survival. METHODS:In a secondary post hoc analysis of the PROTECTION randomised double-blind placebo-controlled trial, we divided patients into brief (≤48 h) or prolonged (>48 h but ≤72 h) AA infusion. The primary objective was to assess whether the direction of the effects on AKI and ICU mortality was consistent across subgroups. RESULTS:A total of 3481/3511 patients had available data. Brief and prolonged AA infusion had similar magnitude and direction of effect on AKI (interaction P=0.89), with a risk reduction of 3.8% (25% to 21%) and 5.7% (44% to 38%), respectively. Brief AA infusion showed a reduction in the use of renal replacement therapy, whereas prolonged infusion showed no effect. The effects of AA on intensive care unit mortality were discordant (a reduction from 1.9% to 1.0% in the brief infusion group, and an increase from 2.5% to 3.5% in the prolonged infusion group; interaction P=0.04). CONCLUSIONS:The effect of AA on AKI was consistent across subgroups, whereas they had opposing effects on survival in patients receiving brief or prolonged study drug infusion and in favour of the brief infusion group. Although these results are hypothesis generating, centres that are following European guidelines and PROTECTION trial results and are implementing AA in clinical practice should consider AA infusion lasting ≤48 h. CLINICAL TRIAL REGISTRATION:NCT03709264.
Rosacea is increasingly recognized as a complex inflammatory disorder extending beyond isolated cutaneous pathology, involving dysregulated interactions between the skin, gastrointestinal system, and central nervous system. The skin–gut–brain axis has emerged as a relevant conceptual framework for understanding this multifactorial disease, integrating gut microbiota dysbiosis, neuroimmune signaling, autonomic nervous system dysfunction, and stress-related mechanisms. The aim of this narrative hypothesis-driven overview is to reframe rosacea as a neuroimmune disorder in which central nervous system involvement plays an active regulatory role, rather than as a purely peripheral or dermatological condition. We synthesize the mechanistically relevant evidence linking gastrointestinal inflammation and microbial imbalance with neurogenic inflammation, mast cell activation, sebaceous gland dysfunction, and aberrant innate immune responses in the skin, with particular emphasis on neurovascular and trigeminal pathways. A key novelty of this perspective lies in highlighting brain-centered mechanisms, including central sensitization, autonomic dysregulation, and stress-related neural modulation, as integral components of the skin–gut–brain axis in rosacea. By integrating peripheral and central processes, we propose rosacea as a model condition for studying neuroimmune dysregulation across interconnected regulatory systems. Finally, we discuss the clinical and translational implications of this framework and outline future research directions, focusing on autonomic regulation, patient stratification, and personalized, multidisciplinary therapeutic approaches.
Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with insulin resistance and metabolic disturbances. Sex hormone-binding globulin (SHBG) is closely linked to metabolic regulation and has been shown to differ between individuals with and without MASLD. Objective: This study aimed to investigate the associations between SHBG and MASLD and their relationships with insulin resistance, body mass index (BMI), age, and sex in a combined male-female cohort. Patients and Methods: We studied 98 men and 54 women with MASLD and 74 men and 55 women without MASLD (aged 25-64 years). Participants underwent abdominal ultrasonography and fasting blood sampling, including measurements of glucose, liver enzymes, lipids, insulin, SHBG, estradiol, and testosterone. Results: SHBG levels were lower in individuals with MASLD than in controls, with a more pronounced reduction in women. MASLD status was associated with an approximately 10 nmol/L lower SHBG concentration (p < 0.0001; gender × MASLD interaction p = 0.0462). Higher estradiol levels were associated with higher SHBG concentrations (p = 0.0009), although this association differed by sex (gender × log-estradiol interaction p = 0.0147). Older age and higher total cholesterol levels were associated with higher SHBG levels, whereas higher triglyceride levels were associated with lower SHBG levels. Conclusions: SHBG showed significant associations with MASLD and with key metabolic and hormonal factors, including BMI, age, and sex. Inclusion of both men and women extends prior male-only research and provides a broader characterisation of sex-specific associations in MASLD.
