Background:Outcomes after total joint arthroplasty are influenced by various biopsychosocial factors, among which preoperative psychological status and personality traits play a crucial role. Given that personality traits - such as extroversion, psychoticism, anxiety, and neuroticism - represent a wider, enduring framework compared to transient mental states like depression and stress, their impact on surgical outcomes is significant. This systematic review aims to evaluate the influence of personality traits on clinical outcomes after total joint arthroplasty. Methods:PubMed, Web of Science, Scopus, and Embase were explored from initiation until May 2025. The inclusion terms were "personality traits," "total knee arthroplasty," and "total hip arthroplasty," along with related MeSH terms, with no boundaries for language. Backward reference citation searches were also conducted. Results:Finally, a total of 15 studies were included. Anxiety is one of the most substantial factors impacting the consequences of total joint arthroplasty. Although there is unsatisfactory evidence supporting pain reduction in extroverted individuals, extroversion has been associated with improved quality of life and postoperative functional outcomes. Additionally, neuroticism has a negative correlation with quality of life and is linked to increased pain levels. Pessimism is associated with greater pain, reduced knee function improvement, and increased activity limitations. Based on quality-of-life questionnaires, extroversion and melancholic traits were associated with higher scores. However, neuroticism showed a negative correlation with Short Form (SF)-36 scores. Conclusions:Pain was the most significant assessed outcome. A positive association was observed between pain and traits such as extroversion, neuroticism, pessimism, anxiety, depression, and persistence. Concerning quality of life, features like extroversion and melancholic temperament were associated with higher quality of life, whereas neuroticism had a negative correlation with SF-36. Based on these findings, considering personality and psychological factors can contribute to improving surgical outcomes, and preoperative counseling is recommended.
Introduction:Respiratory failure is a serious condition caused by impaired gas exchange, leading to hypoxemia or hypercapnia. Nasal high-flow therapy (NHFT) has emerged as an alternative to standard oxygen therapy (SOT). This meta-analysis evaluates the efficacy and safety of NHFT versus SOT by incorporating newly published trials to guide current clinical practice. Methods:This systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials (RCTs) comparing NHFT with SOT in acute respiratory failure were included. Primary outcomes were mortality and hospital stay. Data were pooled using a random-effects model in RevMan 5.4, and the certainty of evidence was assessed using GRADE. Results:Sixteen RCTs (n = 5805) were included. NHFT showed no significant difference in 28-day mortality [risk ratio (RR) = 1.00; 95% confidence interval (CI): 0.85-1.17] or 90-day mortality (RR = 0.87; 95% CI: 0.58-1.29), length of hospital stay, length of ICU stay, or need for intubation. Oxygen saturation improved with NHFT after sensitivity analysis. Certainty of evidence ranged from moderate to very low using GRADE assessment, with heterogeneity addressed by removing outlier studies. Conclusion:NHFT shows comparable safety and efficacy to SOT in acute hypoxemic respiratory failure, with no significant differences in mortality, length of hospital stay, or intubation rates. Oxygen saturation improved with NHFT, reflecting its physiological advantages. Variability in study design limits generalizability. These findings support the individualized use of NHFT. Future research should explore patient-specific benefits, standardize protocols, and assess long-term outcomes.
Objective:To explore the clinical efficacy of mini-incision oblique lumbar interbody fusion (OLIF) and anterolateral screw-rod fixation through the approach between the great vessels and the psoas muscle for the surgical treatment of L5 spondylolisthesis. Methods:From December 2019 to February 2021, patients with L5 spondylolisthesis undergoing OLIF51 (L5-S1 OLIF) using the OLIF25 (L2-5 OLIF) cage and anterolateral screw-rod fixation were enrolled in this retrospective study. The gender, age, BMI, BMD, operation time, intraoperative blood loss, intraoperative fluoroscopy, surgical segments, cage length and height, incision length, drainage removal time, hospitalization time, intraoperative and postoperative complications, and other relevant data of all patients were recorded. Visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the symptoms, signs, and neurological function of all patients before surgery and during postoperative follow-up. Results:There were 26 cases of L5 spondylolisthesis enrolled. The average operation time was 117.3 ± 13.0 minutes. The mean intraoperative fluoroscopy usage was 11 (8-19) times. The mean blood loss was 20 (10-55) mL, and the average incision length was 48.5 ± 3.7 mm. The drainage removal time was 2 (1-3) days. The mean hospital stay duration was 5 (3-6) days, and the follow-up duration was 29.8 ± 4.1 months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (P < 0.01), and the ODI significantly decreased from 73.2 ± 12.5% to 13.8 ± 4.3% 2 years after surgery (P < 0.01). Anterior intervertebral space height, posterior intervertebral space height, lumbar lordosis, and segmental lordotic angle significantly improved after surgery (P < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 20 segments (76.9%) and grade II in six segments (23.1%). No patients experienced any form of permanent iatrogenic nerve damage or major complications. Conclusion:This study introduces a promising novel approach for treating L5 spondylolisthesis using a mini-incision OLIF51 with a larger OLIF25 cage and anterolateral screw-rod fixation. This method may offer advantages such as reduced blood loss, rapid postoperative recovery, and enhanced support and biomechanical stability.
Background:Severe congenital heart disease often requires cardiopulmonary bypass (CPB) surgery. Preoperative hypoalbuminemia may adversely affect postoperative recovery; however, the dose-response relationship between preoperative serum albumin levels and early postoperative adverse events remains unclear. Methods:This retrospective cohort study included 1033 pediatric patients with congenital heart disease who underwent CPB surgery between 2018 and 2024. The primary exposure was the preoperative serum albumin level. The primary outcome was early postoperative adverse events, defined as a composite endpoint including mortality, reintubation, prolonged mechanical ventilation, and extended hospitalization. Patients without these events were classified as the non-adverse outcome group. Multivariable logistic regression models were used to evaluate the association between preoperative albumin levels and postoperative outcomes. Restricted cubic spline (RCS) analysis was performed to assess potential nonlinear relationships. Subgroup analyses based on relevant baseline characteristics were considered exploratory and hypothesis-generating. Results:In the fully adjusted model, compared with the lowest quartile, the second and fourth quartiles of preoperative albumin were associated with significantly lower risks of adverse postoperative outcomes, with odds ratios (ORs) of 0.542 (95% CI: 0.328-0.889) and 0.466 (95% CI: 0.268-0.795), respectively. RCS analysis demonstrated a gradual reduction in adverse outcome risk with increasing albumin levels, with the protective effect plateauing at approximately 40.65 g/L. When albumin levels were ≤40.65 g/L, each incremental increase was associated with a significantly reduced risk of adverse outcomes (OR = 0.864; 95% CI: 0.755-0.983; P = 0.030). Above this threshold, the association was no longer statistically significant (OR = 0.997; 95% CI: 0.885-1.120; P = 0.965). Conclusions:Preoperative serum albumin levels were nonlinearly associated with early postoperative adverse outcomes in pediatric patients undergoing congenital heart surgery. Higher albumin levels within the lower-to-mid physiological range were associated with improved postoperative outcomes, whereas further increases provided no additional apparent benefit. These findings are exploratory and require confirmation in prospective multicenter studies.
Background:Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplant cyclophosphamide (PTCy) has expanded donor availability for acute leukemia, yet the clinical relevance of emerging immunogenetic markers remains uncertain. This study investigated whether donor-recipient human leukocyte antigen (HLA)-B leader matching influences transplantation outcomes in adults with acute leukemia undergoing haplo-HSCT. Methods:This retrospective analytical cohort included consecutive adults (18-65 years) with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) who underwent their first haplo-HSCT at one of the most prominent referral hospitals between January 2008 and December 2022. HLA-B leader status was determined by exon 1 sequencing and classified as matched or mismatched between donor and recipient. Outcomes included overall survival (OS), disease-free survival, relapse incidence (RI), non-relapse mortality (NRM), engraftment, acute and chronic graft-versus-host disease (GVHD), and GVHD-free/relapse-free survival (GRFS). Kaplan-Meier methods, Cox regression, and competing-risk models were applied. Results:A total of 140 patients were analyzed (AML 67.9% and ALL 32.1%); 106 (75.7%) were HLA-B leader matched and 34 (24.3%) mismatched, with a median follow-up of 68 months among survivors. HLA-B leader mismatching was not associated with OS [multivariable hazard ratio (HR) = 1.02, 95% confidence interval (CI): 0.65-1.60; P = 0.937] or with NRM (HR 1.28; P = 0.34), and rates of acute GVHD (42.5% vs. 50.0%; P = 0.441) and chronic GVHD (25.5% vs. 29.4%; P = 0.65) were comparable between groups. Relapse was numerically lower in the mismatched group (11.8% vs. 24.5%; HR = 0.49, 95% CI: 0.17-1.41; P = 0.184). In multivariable analysis, age 25-40 years (HR = 1.67, 95% CI: 1.04-2.68; P = 0.034) and transplantation in CR2 or beyond (HR = 1.52, 95% CI: 1.01-2.84; P = 0.045) independently predicted inferior OS; acute GVHD was associated with reduced relapse risk (HR = 0.37, 95% CI: 0.16-0.86; P = 0.021). GRFS did not differ significantly by leader status (HR = 0.85; P = 0.47). Conclusion:In adults with acute leukemia undergoing PTCy-based haplo-HSCT, HLA-B leader matching was not associated with survival or GVHD. However, the observed trend toward lower relapse with leader mismatching, together with the protective association between acute GVHD and relapse, suggests a potential graft-versus-leukemia signal that warrants validation in larger cohorts.
The global neurosurgical literature is dominated by high-income countries, with low- and middle-income countries (LMICs) contributing minimally despite bearing the most significant share of the neurosurgical disease burden. Underrepresentation limits equitable knowledge dissemination and the relevance of guidelines. The objective of this review was to assess neurosurgical publication disparities, identify deterrents to LMIC participation, and outline initiatives that foster equity and inclusion in research. This narrative review synthesized evidence on global disparities in neurosurgical literature through a structured search of PubMed, Scopus, and Google Scholar (2010-2025). Eligible studies examined research output, authorship trends, publication barriers, or equity initiatives. Findings mapped bibliometric patterns, highlighted structural barriers, and synthesized strategies to promote equitable neurosurgical scholarship. More than two-thirds of neurosurgical reviews come from North America and Europe, whereas less than 10% come from Africa and South-East Asia. Barriers to publication include limited funding, high article processing charges, lack of mentorship, and weak institutional infrastructure. LMIC authors are often relegated to middle authorship, which decreases exposure and hinders academic advancement. Case studies from Africa, South Asia, and Latin America highlight progress in expanding the workforce and in training for specific areas, but persistent research inequities remain. Recent initiatives, such as AuthorAID, HINARI, African Neurosurgical Research Collaborative, and open-access waiver programs, have demonstrated measurable improvements in LMIC research output and authorial independence. Significant inequities persist in neurosurgical research. For sustainable solutions, there is an important need for structural reforms: expanded mentorship, equitable funding, inclusive editorial policies, and strengthened regional collaborations that ensure global neurosurgical research reflects diverse contexts and meaningfully contributes to worldwide patient care.
Introduction:Gallbladder and biliary tract cancer (GBTC) is a rare but aggressive malignancy with poor survival outcomes, mainly due to late-stage diagnosis and limited treatment options. Despite prominent global disparities in incidence and outcomes, comprehensive data on the GBTC burden in the Middle East and North Africa (MENA) region remain scarce. Materials and methods:We used Global Burden of Disease (GBD) 2021 data. We retrieved incidence, deaths, and DALYs, including crude and age-standardized rates per 100 000, with 95% uncertainty intervals for 21 MENA countries, the MENA region, and globally, stratified by year (1990-2021), sex, and age group. Results:In the MENA region, the age-standardized incidence rate (ASIR) remained at 1.4 per 100 000 in both 1990 and 2021 (-0.2% change), while globally it declined from 2.89 to 2.56 (-11.5%; 95% UI: -21.9 to -3.4). The age-standardized death rate (ASDR) decreased from 1.50 to 1.37 (-9.0%) in MENA versus 2.69 to 2.04 (-24.1%; 95% UI: -33.2 to -16.9) globally. The age-standardized DALY rate fell from 34.26 to 29.82 (-13.0%) in MENA and from 58.58 to 43.20 (-26.2%; 95% UI: -35.5 to -18.4) globally. Across years, females had higher age-standardized rates than males, rates increased with age, and the peak DALY rate shifted from 80-84 (1990) to 85-89 (2021). Conclusions:While the burden of GBTC has decreased in the MENA region and has consistently remained lower than the global average, there is considerable heterogeneity across countries in the region that warrants the attention of policymakers, particularly in countries with a higher burden of GBTC, such as Libya and the United Arab Emirates, and in countries with an increasing burden, such as Iran.
Introduction and importance:SpADMiSS syndrome (SPOUT1-Associated Developmental delay, Microcephaly, Seizures, and Short stature) is a recently described autosomal recessive neurodevelopmental disorder caused by biallelic variants in SPOUT1/CENP-32. The phenotypic spectrum of this condition is still evolving. Reporting novel clinical features and complex genetic architectures is essential to refine genotype-phenotype correlations, particularly in consanguineous populations. Case presentation:We describe a 5.5-year-old girl born to consanguineous parents who presented with refractory early-onset seizures, severe global developmental delay, growth failure, and microcephaly. Neuroimaging revealed marked cerebral atrophy and previously unreported bilateral basal ganglia calcification. The patient also developed bilateral cataracts requiring surgical intervention. Whole-exome sequencing identified a recurrent homozygous missense variant in SPOUT1/CENP-32 (c.292 G > A; p.Gly98Ser), confirming the diagnosis of SpADMiSS. In addition, homozygous pathogenic variants were detected in XYLT2 and EYS, indicating multilocus genetic disease. Clinical discussion:This case expands the phenotypic spectrum of SpADMiSS by documenting basal ganglia calcification, a feature not previously reported in affected individuals. The presence of early-onset cataracts and ocular involvement is best explained by concurrent pathogenic variants in XYLT2 and EYS, illustrating a blended phenotype due to multilocus inheritance. These findings highlight the importance of comprehensive genomic analysis in consanguineous families to avoid misattribution of clinical features to a single genetic disorder. Conclusion:We report a novel presentation of SpADMiSS syndrome associated with basal ganglia calcification and multilocus pathogenic variation. This case underscores the expanding neuroimaging phenotype of SPOUT1/CENP-32-related disease and emphasizes the critical role of whole-exome sequencing in accurately delineating complex phenotypes in consanguineous populations.
Introduction:Midline neck swellings that move with deglutition are commonly attributed to thyroid pathology. However, non-thyroidal cervical lesions may occasionally mimic thyroid nodules, leading to diagnostic uncertainty. Cervical schwannomas presenting in the thyroid bed region are uncommon and can closely resemble benign thyroid lesions on clinical examination and imaging. Case presentation:The authors report a case of a 55-year-old female who presented with a progressively enlarging anterior neck swelling associated with dysphagia. Clinical examination and ultrasonography suggested a benign thyroid nodule (TIRADS-2), and fine-needle aspiration cytology was inconclusive, favoring a colloid lesion. Surgical exploration, planned for thyroid pathology, unexpectedly revealed an extrathyroidal cervical mass, separate from the thyroid gland. Complete excision was performed, and histopathological evaluation confirmed the diagnosis of schwannoma. Discussion:Cervical schwannomas located adjacent to the thyroid gland pose significant diagnostic challenges due to their ability to mimic thyroid lesions. Imaging and cytology may be misleading, particularly when lesions demonstrate movement with deglutition. This case emphasizes the limitations of routine fine needle aspiration cytology and the importance of maintaining a broad differential diagnosis when evaluating thyroid-like neck swellings. Conclusion:This case underscores the need for heightened clinical suspicion of non-thyroidal etiologies in patients presenting with presumed thyroid nodules. Accurate diagnosis relies on a combination of careful surgical assessment and histopathological confirmation, helping to prevent unnecessary thyroid surgery and optimize patient outcomes.
Background:Free tissue transfer is the cornerstone of complex maxillofacial reconstruction, offering high success rates (90-95%) but carrying the risk of devastating flap failure in 1.5-5.8% of cases. When failure occurs, it necessitates urgent, strategic decision-making to mitigate morbidity and preserve oncological and functional outcomes. Objective:This review aims to synthesize current evidence on the principles, decision-making frameworks, and outcomes of salvage surgery following free-flap failure in the maxillofacial region. Methods/findings:A comprehensive narrative review was conducted, integrating data from clinical studies, case series, and systematic reviews published between 2000 and 2024. Key themes included the etiology and timing of flap failure (predominantly venous thrombosis within 48 hours), the critical distinction between flap salvage and salvage surgery, and a multifactorial decision matrix incorporating patient, defect, oncologic, and institutional factors. Reconstructive options range from second free flaps (success rates ~67-73%) and pedicled flaps (e.g., pectoralis major) to prosthetic rehabilitation. Immediate salvage is preferred in stable patients, whereas a staged "bridge and stage" approach using negative pressure wound therapy is safer in compromised settings. Functional outcomes vary by site and technique, but salvage surgery can significantly reduce pain and improve quality of life, with curative potential in select oncologic recurrences. Conclusion:Free-flap failure, while uncommon, demands a systematic, individualized, and multidisciplinary response. With timely intervention and an appropriate reconstructive strategy - whether microvascular, pedicled, or prosthetic - salvage surgery can successfully restore form, function, and hope, transforming a surgical crisis into a manageable clinical challenge.
Heart failure (HF) is a complex syndrome with high morbidity and mortality. Despite advancements in treatment, its management remains a challenge. The objective of this study was to map the scientific landscape of artificial intelligence (AI) applications in HF management through a bibliometric analysis. Data were retrieved from the Web of Science Core Collection. Keywords related to AI and HF were used to identify relevant research articles. Various bibliometric tools, such as Biblioshiny, VOS viewer, and CiteSpace, were used for quantitative trends, collaboration networks, and thematic areas, which were assessed. A total of 1332 studies were included in the final analysis. Publication trends show a sharp increase in AI research related to HF from 2016 onward, with 317 studies published in 2025. The most frequent keywords in the field were heart failure (n = 599), machine learning (n = 516), and AI (n = 225). Other significant keywords included mortality (n = 201), diagnosis (n = 168), and risk (n = 162). Cluster analysis identified major research themes, including Cardiac & Cardiovascular Systems, Computer Science - Interdisciplinary Applications, Computer Science - Artificial Intelligence, Health Care Sciences & Services, Radiology, Nuclear Medicine & Medical Imaging, Cell Biology, Medical Informatics, Endocrinology & Metabolism, and Neurosciences. AI has rapidly become a central tool in HF management, with significant contributions from leading countries and institutions. However, further global collaboration and standardized reporting frameworks are needed to ensure the equitable translation of these technologies into clinical practice.
Background:Multiple myeloma (MM) carries substantial risks of venous thromboembolism (VTE), pathological fractures, acute kidney injury (AKI), and death. Statins possess anti-inflammatory, immunomodulatory, and anti-thrombotic properties that may reduce these complications, yet their associations with several key MM outcomes have not been evaluated simultaneously in a single real-world cohort. Objectives:To evaluate the association between post-diagnosis statin exposure and 5-year all-cause mortality, VTE, pathological fractures, and AKI in MM. Methods:We conducted a retrospective cohort study in the TriNetX Linked network (query date: 16 January 2026). Adults with MM were classified by statin exposure on or after diagnosis. We applied 1:1 propensity score matching on 59 baseline covariates. Outcomes were assessed from day 1 through 5 years using Kaplan-Meier methods and Cox proportional hazards models. To assess robustness to unmeasured confounding, E-values were calculated for effect estimates and their confidence interval (CI) limits. Results:Among 43 543 adults with MM, 8756 had post-diagnosis statin exposure. After matching, 7167 patients remained in each cohort with strong covariate balance. Statin exposure was associated with lower 5-year mortality [17.5% vs. 26.0%; hazard ratio (HR) = 0.591, 95% CI: 0.549-0.635], VTE (9.2% vs. 12.0%; HR = 0.688, 95% CI: 0.617-0.767), and pathological fractures (4.6% vs. 7.6%; HR = 0.541, 95% CI: 0.469-0.623). AKI risk was similar in absolute terms (19.3% vs. 19.7%; P = 0.606), although time-to-event analysis identified a modest hazard reduction (HR = 0.900, 95% CI: 0.825-0.981). Findings were robust to unmeasured confounding based on E-values. Conclusions:In this propensity score-matched electronic health record cohort study, statin exposure after MM diagnosis was associated with improved 5-year survival and fewer VTEs and pathological fractures, with a modest time-to-event benefit for AKI. Prospective studies should evaluate statin initiation as an adjunct strategy in MM management.
Focal therapy has emerged as a proposed middle path in localized prostate cancer, positioned between active surveillance and radical whole-gland treatment. Its appeal lies in treating the dominant clinically significant lesion while preserving uninvolved prostate tissue and adjacent structures important for urinary, sexual, and bowel function. However, this promise must be interpreted cautiously. Prostate cancer is frequently multifocal; imaging and biopsy can miss clinically significant disease, ablation margins cannot be examined in the same manner as surgical margins, and long-term comparative oncologic data remain less mature than those supporting established treatment strategies. This editorial argues that focal therapy should not be viewed as an unrestricted third standard or as a simple compromise between observation and radical treatment. Instead, its responsible use depends on structured stewardship: careful patient selection, concordant magnetic resonance imaging (MRI) and biopsy findings, transparent counseling about uncertainty, planned surveillance using prostate-specific antigen, imaging, and biopsy, and explicit salvage planning before treatment. Focal therapy may be most defensible in selected men with limited-volume, MRI-visible, clinically significant localized disease who understand the need for close follow-up and accept that further treatment may be required. The central question is therefore not only whether focal therapy is technically feasible, but whether the surrounding clinical pathway is sufficiently rigorous to protect oncologic safety while pursuing functional preservation.
Introduction:Anomalies of the appendix are very rare, occurring only in 0.004% to 0.009% of appendectomy cases. Among these, appendiceal duplication represents a particularly unusual finding. We are presenting a case of an appendicular lump with an appendix having two bases converging into one body and tip. Case presentation:A 50 year-old female presented to a tertiary care center in Nepal with chief complaints of abdominal pain for 3 days and vomiting for 3 days. The abdominal pain was acute in onset, sharp, and aching, located in the right iliac region. Ultrasonography revealed that the appendix was dilated at the region of the tip and body (approximately 9-10 mm) with a normal-appearing base. The patient was planned for an interval open appendectomy for an appendicular lump. Intraoperatively, the appendix was found to have two luminal bases with a single tip and body. Discussion:Partial duplication of the appendix with an inverted Y-shaped configuration is an exceptionally rare anatomical anomaly. Such duplications are mostly discovered incidentally during surgery. Their clinical significance lies in their potential to cause diagnostic confusion and incomplete management if unrecognized. Conclusion:This case highlights the importance of careful intraoperative examination of the cecal region during appendectomy procedures to avoid missed diagnoses, repeated surgeries, and potential medicolegal implications.
Acute appendicitis is one of the most common causes of emergency abdominal surgery, yet clinicians continue to face difficulties in predicting disease severity, interpreting laboratory biomarkers, and explaining heterogeneous clinical presentations. Current classification systems primarily rely on severity-based progression models or etiology-based disease subtypes; however, both approaches incompletely explain the frequent discordance observed between pathological severity, systemic inflammatory response, microbiological findings, and clinical course. This conceptual limitation contributes to inconsistent biomarker performance and variability in study design across the appendicitis literature. In this conceptual review, we analyze the limitations of existing severity- and etiology-based frameworks and synthesize clinicopathological, microbiological, and biomarker evidence into an integrated multidimensional model of acute appendicitis. The proposed framework conceptualizes the disease along three interacting but partially independent axes: etiologic substrate, local pathological severity, and host systemic response. The etiologic substrate describes the initiating mechanism of appendiceal inflammation, local pathological severity reflects the extent of structural tissue injury, and host systemic response determines the magnitude of inflammatory amplification and biomarker expression. Recognizing host response as an independent modulating dimension provides a biologically plausible explanation for discordant biomarker findings and heterogeneous clinical trajectories. By reframing acute appendicitis as a multidimensional disease process rather than a binary entity or simple temporal continuum, this framework offers a coherent conceptual basis for improved interpretation of biomarkers, better study design, and more precise clinicopathological correlation. Adoption of such integrative models may ultimately support improved risk stratification and biologically informed management strategies in patients with acute appendicitis.
Background:Postoperative pneumonia (POP) remains a major cause of morbidity after lung cancer surgery. The role of perioperative antibiotic prophylaxis (PAP), particularly the choice of antibiotics and their adjustment to bronchial colonization, is still debated. Methods:We conducted a prospective, double-blind, comparative study including 200 patients with primary lung malignancy undergoing lung resection. Patients received either cefazolin or amoxicillin-clavulanic acid as PAP. Preoperative bronchial colonization was assessed before surgery. The primary outcomes were the incidence of POP according to the antibiotic regimen and colonization status. Results:The cohort comprised 200 patients (median age 68 years, range 44-83; 48.5% women). POP occurred in 47 patients (23.5%). Of these, 23 (21.5%) had received cefazolin and 24 (25.8%) amoxicillin-clavulanic acid, with no significant difference between regimens. Colonization was detected in 178 patients (89.0%), including 36 (20.2%) with potentially pathogenic microorganisms (PPMs). POP incidence was similar in non-colonized (22.7%), colonized (23.6%), and PPM-colonized patients (25.0%) (all P ≥ 0.51). Only one patient (0.5%) died within 30 days, unrelated to pneumonia. Conclusions:In this prospective comparative study, POP after lung cancer surgery did not significantly differ according to the prophylactic antibiotic regimen or colonization status. However, given the relatively small number of patients with PPM colonization and the single-center design, these findings should be interpreted cautiously. Standard perioperative prophylaxis with cefazolin appears appropriate, while routine preoperative colonization screening may not be necessary. Further studies are needed to better define risk-adapted preventive strategies.
Mechanical thrombectomy (MT) is an established treatment for acute ischemic stroke (AIS) due to large vessel occlusion. However, evidence from multiple systematic reviews and meta-analyses varies across patient populations and clinical subgroups. This umbrella review aimed to synthesize and critically appraise the existing evidence on the efficacy and safety of MT in AIS. An umbrella review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews were searched from inception to December 2025. Eligible reviews evaluated MT, with or without intravenous thrombolysis (IVT), in adults with AIS and reported outcomes including functional independence, mortality, recanalization, or hemorrhagic complications. Methodological quality was assessed using the AMSTAR-2 tool. Ten systematic reviews and meta-analyses published between 2015 and 2025 were included and were rated as high-to-moderate methodological quality. MT was consistently associated with improved functional independence and higher recanalization rates compared with standard medical therapy or IVT alone. Mortality outcomes were heterogeneous, with some reviews demonstrating reduced mortality and others showing no significant difference. Safety analyses generally showed no significant increase in symptomatic intracranial hemorrhage, although increased hemorrhagic risk was reported in certain populations, including anticoagulated and thrombocytopenic patients. Overall, current evidence from high- to moderate-quality systematic reviews supports the efficacy of MT in improving functional outcomes and recanalization in AIS. However, this umbrella review identifies persistent uncertainty across key clinical subgroups and highlights inconsistencies in mortality and safety outcomes.
Background:Postoperative nausea and vomiting (PONV) is a common complication that adversely affects patient recovery and satisfaction after surgery. Globally, PONV affects 20-30% of surgical patients and up to 70-80% in high-risk groups. In Ethiopia, reported incidences vary, but a comprehensive assessment is lacking. Objective:This systematic review and meta-analysis aimed to determine the pooled prevalence of PONV and identify associated risk factors among surgical patients in Ethiopia. Methods:A systematic search identified nine cross-sectional studies published between 2020 and 2024, including 2935 participants from various Ethiopian regions. Data on PONV prevalence and associated risk factors were extracted. A random-effects meta-analysis was performed to calculate pooled prevalence and odds ratios (ORs). Heterogeneity was assessed using the I 2 statistic, and publication bias was evaluated with Egger's test. Results:The pooled prevalence of PONV in Ethiopia was 28.1% (95% CI: 22.5-35.1%), with significant heterogeneity observed (I 2 = 93.4%). Subgroup analyses revealed variations by region, type of surgical procedure, and anesthetic technique. The meta-analysis identified several significant risk factors for PONV: female sex (OR = 4.66, 95% CI: 2.81-7.73), history of previous PONV (OR = 6.59, 95% CI: 3.27-13.30), intraoperative or postoperative opioid use (OR = 3.39, 95% CI: 2.35-4.90), history of motion sickness (OR = 4.13, 95% CI: 2.72-5.43), and longer duration of surgery (OR = 6.72, 95% CI: 5.52-8.19). Conclusion:PONV remains a significant postoperative complication in Ethiopia, with several key risk factors identified. These findings support targeted risk assessment and prevention strategies to improve patient outcomes. Further research is needed to explore additional risk factors and optimize management in resource-limited settings.
Ovarian cancer is a highly heterogeneous malignancy with complex molecular underpinnings that extend beyond genomic mutations to encompass transcriptomic and epigenomic alterations. Advances in next-generation sequencing and bioinformatics have enabled comprehensive profiling of gene expression patterns, non-coding RNAs, DNA methylation, histone modifications, and chromatin accessibility, offering novel insights into ovarian tumor biology. Transcriptomic analyses reveal dysregulated coding and non-coding RNA networks, while epigenomic studies uncover epigenetic modifications that regulate gene expression and chromatin structure, together shaping the cancer phenotype. The integration of transcriptomic and epigenomic data through sophisticated bioinformatics pipelines allows the identification of key regulatory networks and molecular subtypes, enhancing our understanding of ovarian cancer heterogeneity and progression. Bioinformatics tools facilitate differential expression analysis, epigenetic mapping, and multi-omics data integration, revealing potential biomarkers and therapeutic targets. These approaches have also illuminated mechanisms of chemoresistance and immune evasion, providing avenues for personalized therapy and improved patient stratification. Datasets will be critical to harness the full potential of transcriptomic and epigenomic research. Ultimately, bioinformatics-driven insights into the ovarian cancer transcriptome and epigenome promise to inform early diagnosis, prognostication, and the development of targeted therapies, advancing precision oncology in this lethal.
Background:Obesity remains a major global health challenge, driving demand for effective pharmacotherapies. Cagrilintide, a once-weekly amylin receptor agonist, and its fixed-dose combination with semaglutide (CagriSema) represent novel therapeutic approaches. This systematic review and meta-analysis evaluated their efficacy and safety in adults with overweight or obesity. Methods:Four databases were searched from inception to March 2026. Eligible randomized controlled trials (RCTs) assessed Cagrilintide monotherapy or CagriSema versus placebo. Outcomes included percentage and absolute body weight change, waist circumference, blood pressure, HbA1c, and adverse events. Data were pooled using random-effects models in RevMan, with results expressed as mean differences (MD) or risk ratios (RR) with 95% confidence intervals. Results:Four RCTs encompassing 5425 participants were included. Cagrilintide monotherapy produced significant reductions in body weight (MD: -6.08%; MD: -5.89 kg) and blood pressure, without meaningful HbA1c improvement. CagriSema significantly reduced body weight (MD: -5.98%; MD: -4.68 kg), waist circumference (MD: -10.91 cm), systolic blood pressure, and HbA1c. Both treatments showed modest but statistically significant increases in adverse events. Substantial heterogeneity was observed across most outcomes. Conclusion:Cagrilintide-based therapies produce clinically meaningful weight loss and cardiometabolic improvements. CagriSema demonstrates additional glycemic benefits over monotherapy. Larger, longer-duration trials are needed to confirm long-term efficacy and safety.
