Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon types of soft tissue sarcomas. The occurrence of intracranial MPNSTs in the sellar region is exceedingly rare. A 37-year-old female, who had undergone transnasal surgery for a pituitary adenoma followed by adjuvant stereotactic radiotherapy 10 years earlier, was diagnosed with an intracranial MPNST in the sellar region. A second transnasal procedure successfully removed the lesion and was followed by proton therapy. Three months postoperatively, spontaneous cerebrospinal fluid (CSF) rhinorrhea occurred and was repaired through a third transnasal surgery. A CSF test revealed the presence of suspicious tumor cells. Subsequently, acute hydrocephalus developed and was urgently managed with a ventriculoperitoneal shunt. About 2 months later, the patient died due to intraspinal metastasis. Pathologically ambiguous lesions in the sellar region require meticulous observation, as MPNST can be erroneously diagnosed as a pituitary adenoma. Prompt surgical intervention provides the best opportunity for achieving complete resection, which remains the most effective treatment for MPNST. In addition to hematogenous metastasis, MPNST can also disseminate and implant via CSF, leading to recurrence. Acute hydrocephalus or intraspinal metastasis can significantly reduce overall survival. https://thejns.org/doi/10.3171/CASE24437.

BackgroundCavernous malformations are common vascular abnormalities of the central nervous system, but cavernous malformations of the cerebral aqueduct are rare. The choice of treatment is influenced by various factors.Case DescriptionWe report two cases of midbrain cavernous malformations. Both cases involved midbrain lesions obstructing the cerebral aqueduct, leading to obstructive hydrocephalus. The primary symptoms and complaints of the patients were related to hydrocephalus. Prior to surgery, patients underwent comprehensive imaging evaluations and received endoscopic third ventriculostomy rather than tumor resection. Both patients had favorable recoveries. We also reviewed the literature and discussed the choice of treatment strategies.ConclusionCavernous malformations are slow-progressing central nervous system lesions with a relatively benign natural course. When selecting a treatment strategy, clinicians should carefully consider the underlying cause of the patient’s primary symptoms and the specific objectives of the surgery. Avoiding overly aggressive resection that fails to address the main symptoms and potentially causes irreversible damage is crucial.

BACKGROUND:The body weight following bariatric surgery is a primary concern for both healthcare professionals and surgical candidates. However, it remains unclear whether variations in preoperative fat distribution influence weight loss outcomes. OBJECTIVE:The aim of this study was to evaluate the effect of abdominal fat distribution on postoperative weight loss and body mass index (BMI) reduction, and to clarify the role of different fat depots in weight loss outcomes. METHODS:Preoperative data from patients with overweight or obesity, along with their weight records at 1, 2 and 5 years following surgery, were retrospectively collected. Multiple levels of abdominal fat areas were measured using computerized tomography imaging. Statistical analyses included Pearson's correlation coefficients, multiple linear regressions, ridge regressions, decision tree regressions and paired t tests to evaluate the associations and influences. RESULTS:A total of 139 patients were initially included. The statistical analysis results indicated that umbilical subcutaneous adipose tissue (SAT) was an independent factor influencing weight and BMI loss at the 1-year follow-up (n = 67, p < 0.01). Furthermore, umbilical SAT demonstrated significant correlations with sustained BMI reduction over the long term. CONCLUSION:Umbilical SAT is a significant factor in postoperative weight and BMI loss. Patients with greater SAT may experience more substantial weight and BMI reductions following surgery, offering new insights into personalized weight loss strategies and alternative approaches for assisted weight loss.

BackgroundIn the endoscopic endonasal approach skull base surgery repair and reconstruction of the base of the skull is a critical step. Free mucosal flaps are primarily used to repair low-flow cerebrospinal fluid (CSF) leaks, whereas they are not adequate in the face of high-flow CSF leaks. We propose a modified approach-termed the “Fishing method”-which utilizes free mucosal flaps in combination with absorbable sutures and an artificial dura to reverse-plug the defect, to repair high-flow CSF leaks with a clear point of origin.ObjectiveTo investigate the application of the “Fishing method” to repair high-flow CSF leaks caused by large diaphragma sellae rupture and small dura leak that occur unexpectedly during endoscopic endonasal sellae area surgery.MethodsA retrospective analysis was conducted including 15 patients with unexpected intraoperative high-flow cerebrospinal fluid leaks. The “Fishing method” was applied to reconstruct and repair the skull base in these patients, and the results were evaluated.ResultsIn 10 cases of large diaphragma sellae rupture that occurred during pituitary adenomas resection, all 10 patients were successfully repaired in a single operation using the “Fishing method”, with no cerebrospinal fluid nasal leakage (100%); in 5 cases of small dura ruptures that occurred during chordoma resection, 4 patients underwent successful repair in a single operation, with no cerebrospinal fluid nasal leakage occurring in 80% of cases, resulting in an overall success rate of 93.3%.ConclusionThe “Fishing method” is a reliable technique for skull base reconstruction and serves as an effective solution for high-flow CSF leaks caused by unexpected large diaphragma sellae rupture or a small dura leak occurring intraoperatively.

BACKGROUND:Chronic subdural hematoma (CSDH) is a common condition in elderly patients, typically diagnosed through neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). Cases of subdural lymphoma mimicking chronic subdural hematoma are exceedingly rare and present significant diagnostic challenges for emergency physicians. CASE PRESENTATION:A 71-year-old female patient with subdural lymphoma was initially diagnosed with CSDH based on her medical history, clinical presentation, and neuroimaging findings. However, postoperative pathology revealed diffuse subdural lymphoma. Although the patient's symptoms initially improved following standard lymphoma treatment, the disease recurred within 14 months of follow-up. The patient ultimately succumbed to malignant intracranial hypertension 15 months after discharge. CONCLUSIONS:This article discusses the neuroimaging findings, histological features, and treatment strategies of this case, while reviewing the limited number of similar cases reported since 2000. Based on the diagnostic and therapeutic experience of this case, it is recommended that when a patient's clinical presentation deviates from that of typical chronic subdural hematoma, supplementary MRI with diffusion-weighted imaging (DWI) should be considered to aid in differential diagnosis.

Hirschsprung‑associated enterocolitis (HAEC) represents a severe complication of Hirschsprung disease, characterized by intestinal barrier dysfunction and life‑threatening inflammation. The present study systematically reviews the updated molecular mechanisms underlying HAEC pathogenesis, with particular focus on the tight junction (TJ) proteins claudin, occludin and zonula occludens protein 1 (ZO‑1) and their interactions with the actin cytoskeleton. The present review demonstrates that dysregulation of claudin family members, particularly upregulation of pore‑forming claudin‑2 and downregulation of barrier‑forming claudin‑4, disrupts intestinal homeostasis. Occludin undergoes cytokine‑mediated endocytosis through myosin light chain kinase (MLCK)/NF‑κB signaling, while ZO‑1 dysfunction impairs mechanical coupling between TJs and actin filaments. Furthermore, the present review identifies that inflammatory mediators, such as IL‑1β, TNF‑α and IFN‑γ, trigger actin cytoskeleton remodeling via the cofilin phosphorylation cycle and the Rho‑associated protein kinase/MLCK pathway, establishing a cycle of barrier breakdown. Importantly, the present review highlights the lipocalin 10/slingshot homologue 1/cofilin axis and TJ‑cytoskeleton interactions as mechanistic targets for future intervention in HAEC treatment. These findings provide a comprehensive mechanistic framework for understanding HAEC pathogenesis and offer novel targets for clinical intervention.

Chronic subdural hematoma (CSDH) is a chronic hemorrhagic lesion caused by the accumulation of blood between the arachnoid mater and the dura mater. Currently, the most commonly used surgical approach for CSDH is burr hole craniotomy. However, this procedure employs a blind technique, making the cerebral cortex susceptible to injury. The use of a subdural catheter guidance device combined with burr hole drainage in the treatment of CSDH can prevent intraoperative cerebral cortex damage and reduce its potential impact. This study retrospectively analyzed a total of 518 patients with CSDH who underwent surgical treatment at the hospital. Of these, 361 were male (69.69%) and 157 were female (30.31%), with a median age of 59.5 years (range: 12 – 92 years). All patients underwent preoperative head computed tomography and/or magnetic resonance imaging scans, which revealed crescent-shaped mixed-density or iso-dense shadows beneath the inner table of the skull. Informed consent for the burr hole decompression procedure was obtained from all patients. Subsequently, the 518 patients were randomly divided into two groups: The control group (undergoing the procedure without a “guidance device”) and the experimental group (undergoing the procedure with a “guidance device”). All patients provided consent for the publication of their clinical details and related images. In the control group, 274 patients with CSDH were treated, among whom 6 cases had post-operative cortical injury complications, with an incidence rate of 2.19%. In the experimental group, 244 patients with CSDH were treated, and no cortical injury complications occurred post-operatively, with an incidence rate of 0. Fisher’s exact test (two-tailed) showed p=0.0427, indicating a significant reduction in cortical injury complications with the use of the guidance device. In addition, the conditional maximum-likelihood estimate (CMLE) odds ratio for Fisher’s exact test was 0, with a 95% confidence interval ranging from 0.0 to 0.9447, further reflecting the relationship between the relevant factors. This indicates that incorporating a subdural catheter guidance device during burr hole drainage for CSDH can assist surgeons in avoiding damage to the cerebral cortex.

[This retracts the article DOI: 10.3892/ol.2019.10690.].

Craniopharyngiomas are rare tumors of the central nervous system that typically present with symptoms such as headache and visual impairment, and those reflecting endocrine abnormalities, which seriously affect the quality of life of patients. Patients with craniopharyngiomas are at higher cardiometabolic risk, defined as conditions favoring the development of type 2 diabetes and cardiovascular disease. However, the underlying common pathogenic mechanisms of craniopharyngiomas and type 2 diabetes are not clear. Especially due to the difficulty of conducting in vitro or in vivo experiments on craniopharyngioma, we thought the common pathway analysis between craniopharyngioma and type 2 diabetes based on bioinformatics is a powerful and feasible method. In the present study, using public datasets (GSE94349, GSE68015, GSE38642 and GSE41762) obtained from the GEO database, the gene expression associated with adamantinomatous craniopharyngioma, a subtype of craniopharyngioma, and type 2 diabetes were analyzed using a bioinformatic approach. We found 11 hub genes using a protein-protein interaction network analysis. Of these, seven (DKK1, MMP12, KRT14, PLAU, WNT5B, IKBKB, and FGF19) were also identified by least absolute shrinkage and selection operator analysis. Finally, single-gene validation and receptor operating characteristic analysis revealed that four of these genes (MMP12, PLAU, KRT14, and DKK1) may be involved in the common pathogenetic mechanism of adamantinomatous craniopharyngioma and type 2 diabetes. In addition, we have characterized the differences in immune cell infiltration that characterize these two diseases, providing a reference for further research.

PURPOSE:This study aims to assess thalamocortical tract fiber injury using diffusion-tensor imaging (DTI) and to characterize metabolic alterations in the dorsal thalamus with proton magnetic resonance spectroscopy (MRS) in patients with cervical spondylotic myelopathy (CSM). METHODS:A prospective study involved 98 CSM patients and 66 age-matched controls without neurological disease, recruited from May 2021 to December 2021. Neurological function was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. DTI and MRS were analyzed by 2 experienced radiologists, with statistical analysis performed via SPSS (v.26), including t-tests, chi-square tests, and Pearson's correlation. RESULTS:DTI revealed significantly lower fractional anisotropy (FA) and higher radial and axial diffusivity in the bilateral postcentral gyrus of CSM patients compared to controls (P < 0.001). MRS showed decreased ratios of N-acetylaspartate (NAA)/creatinine (Cr), choline (Cho)/Cr, and myo-inositol (mI)/Cr in the dorsal thalamus of CSM patients (P < 0.001). Correlation analysis indicated a moderate association between mJOA scores and NAA/Cr and mI/Cr ratios, and a weaker correlation with FA and Cho/Cr. CONCLUSION:CSM patients exhibit significant thalamocortical disruptions and metabolic changes in the dorsal thalamus, correlating with clinical severity. These findings suggest that DTI and MRS could provide valuable insights into the extent of neural damage in CSM.

Background and importanceActivation of emergency medical services (EMS) is recommended for timely reperfusion therapy for acute ischemic stroke (AIS). The association of EMS utilization and time intervals from hospital arrival to a series of necessary procedures before reperfusion therapy was rarely investigated. ObjectiveThe objective of this study is to investigate the association of EMS utilization with the time intervals from hospital arrival to therapy in patients with AIS. DesignObservational study. Settings and participantsMedical records for AIS in all emergency departments in Beijing were obtained from January 2018 to December 2021. Intervention or exposurePatients transported by ambulance were defined as the EMS group, whereas others as the non-EMS group. Outcome measures and analysisDoor-to-imaging time (DIT), door-to-needle time (DTN) and door-to-puncture time (DTP) were compared between the two groups. Main resultsThere were 11 190 (46%) and 13 106 (54%) AIS patients in the EMS and non-EMS groups. Compared with the non-EMS group, patients in the EMS group were more likely to receive intravenous thrombolysis or endovascular therapy (OR, 1.81; 95% CI, 1.68-1.94). For intravenous thrombolysis therapy, the DIT, ITN (time in minutes from obtaining the first brain imaging to tPA delivery) and DTN times in the EMS group were significantly shorter with time differences between the two groups of -1.1 (95% CI, -1.1 to -1.1) min, -2.6 (-2.6 to -2.6) min, and -3.7 (-3.8, -3.7) min, respectively. The proportion of DIT <= 25 min, DTN <= 45 min or DTN <= 60 min was significantly higher in the EMS group (OR, 1.03, 95% CI, 1.02-1.05; 1.11, 1.07-1.14; 1.05, 1.03-1.07). For endovascular therapy, the differences in DIT, ITP (time in minutes from obtaining the first brain imaging to groin puncture) and DTP times between the EMS and non-EMS groups were +1.1 (1.0-1.2) min, -3.8 (-4.2 to -3.5) min, -2.7 (-3.1 to -2.4) min, respectively, but no significant association was observed between EMS usage and the proportion of DIT <= 25 min or DTP <= 90 min. ConclusionIn this observational study, the use of EMS for patient with AIS was associated with a shorter time from hospital arrival to intravenous thrombolysis and endovascular therapy.

BackgroundTo investigate the practicality of emergency surgical and conservative medical treatments in patients with giant nodular goiter complicated by severe coronavirus disease 2019 (COVID-19)-related respiratory distress, evaluate the prognosis based on the two interventions, and explore the diagnosis and treatment plan of COVID-19-related respiratory distress in patients with giant nodular goiter.MethodsFour cases were retrospectively collected. Among them, two cases underwent emergency surgery, one case was treated with conservative treatment, whereas the fourth case underwent emergency surgery after failure of conservative therapy.ResultsDyspnea was significantly improved postoperatively, and the endotracheal tube was successfully removed 10.5 h after the operation, but inflammatory markers were greatly enhanced as compared to the preoperative values, patients with different degrees of fever, cough, and other discomforts postoperatively. Case 1 showed complete remission of all symptoms after 3 weeks, while case 2 displayed fever, cough, drowsiness, and other symptoms after the discharge and was eventually readmitted. In case 3, the conservative COVID-19 treatment marginally improved the pulmonary infection, fever, and other symptoms, but cough and other discomforts were persistent, along with delirium in later stages. Moreover, case 4 reported extubation failure after undergoing treatment with the standard new coronary pneumonia regimen in the tracheal intubation state; however, the patient was successfully weaned and extubated 9 days after emergency surgery to relieve the obstruction.ConclusionOur preliminary exploration suggested that patients with giant nodular goiter and respiratory tract obstruction post-acute COVID-19 infection can undergo early surgery after surgical tolerance evaluation for a better prognosis.

Background General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial. Objective The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions. Methods A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants’ identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression. Results In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825). Conclusions Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM.

Introduction:Hypermucoviscous Klebsiella pneumoniae (HmKp) poses an emerging and highly pathogenic global health threat. This study aimed to investigate the clinical and genomic characteristics of HmKp isolates to better understand the virulence mechanisms of the hypermucoviscous (HMV) phenotype.Methods:From May 2018 to August 2021, 203 non-repeat K. pneumoniae isolates causing invasive infections were collected from a hospital in Beijing, China. Isolates were divided into HmKp (n=90, 44.3%) and non-HmKp (n=113, 55.7%) groups according to string test results.Results:Multivariate regression showed that diabetes mellitus (odds ratio [OR]=2.20, 95% confidence interval (CI): 1.20-4.05, p=0.010) and liver abscess (OR=2.93, CI 95%:1.29-7.03, p=0.012) were associated with HmKp infections. K. pneumoniae was highly diverse, comprising 87 sequence types (STs) and 54 serotypes. Among HmKp isolates, ST23 was the most frequent ST (25/90, 27.8%), and the most prevalent serotypes were KL2 (31/90, 34.4%) and KL1 (27/90, 30.0%). Thirteen virulence genes were located on the capsular polysaccharide synthesis region of KL1 strains. HmKp isolates were sensitive to multiple antibiotics but carried more SHV-type extended spectrum β-lactamase (ESBL) resistance genes (p<0.05), suggesting that the emergence of ESBL-mediated multidrug resistance in HmKp should be monitored carefully during treatment. Phylogenetic analysis disclosed that HmKp isolates were highly diverse. Comparative genomic analysis confirmed that the HMV phenotype is a plasmid-encoded virulence factor. Seventeen HmKp genes were highly associated with HmKp, and included rmpAC, 7 iron-acquisition-related genes, and pagO, which may promote liver abscess formation.Discussion:This investigation provides insight into the mechanisms producing the HMV phenotype.

Objective:This study aimed to establish and validate a prediction model for clinical outcomes in patients with prolonged disorders of consciousness (pDOC).Methods:A total of 170 patients with pDOC enrolled in our rehabilitation unit were included and divided into training (n = 119) and validation sets (n = 51). Independent predictors for improved clinical outcomes were identified by univariate and multivariate logistic regression analyses, and a nomogram model was established. The nomogram performance was quantified using receiver operating curve (ROC) and calibration curves in the training and validated sets. A decision curve analysis (DCA) was performed to evaluate the clinical usefulness of this nomogram model.Results:Univariate and multivariate logistic regression analyses indicated that age, diagnosis at entry, serum albumin (g/L), and pupillary reflex were the independent prognostic factors that were used to construct the nomogram. The area under the curve in the training and validation sets was 0.845 and 0.801, respectively. This nomogram model showed good calibration with good consistency between the actual and predicted probabilities of improved outcomes. The DCA demonstrated a higher net benefit in clinical decision-making compared to treating all or none.Conclusion:Several feasible, cost-effective prognostic variables that are widely available in hospitals can provide an efficient and accurate prediction model for improved clinical outcomes and support clinicians to offer suitable clinical care and decision-making to patients with pDOC and their family members.

肝内外胆管结石病是亚洲常见的疾病,在我国,肝内外胆管结石病占各类胆石病的9.2％-14.3％[1],而胆道感染、胆管狭窄和肝实质纤维化等并发症使其成为一个复杂而棘手的临床问题[2].随着病情的进展,反复发作的胆管炎可导致肝实质破坏,进而引起胆汁性肝硬化甚至胆管癌[3].

Patients with non-small cell lung cancer (NSCLC) show a low survival rate, owing to the lack of early diagnostic method and high invasiveness. Long non-coding RNA MAPKAPK5-AS1 that regulates tumor genesis and progression through multiple signals, is upregulated and involved in the growth and apoptosis in lung adenocarcinoma (LUAD). To investigate whether MAPKAPK5-AS1 affected the malignant progression of NSCLC. The levels of MAPKAPK5-AS1, miR-490-3p and HMGB2 in lung cancer were first analyzed through StarBase website, and confirmed by a quantitative reverse transcriptase-PCR (qRT-PCR) assay. The biological functions of NSCLC cells were examined by CCK-8, 5-ethynyl-2ʹ-deoxyuridine (EdU) and flow cytometry assays. The potential binding sequences lncRNA-miRNA and miRNA-mRNA were predicted by StarBase software and verified via dual luciferase reporter experiment. The effects of MAPKAPK5-AS1 on tumor growth were evaluated in a xenografted mice model. The expression of MAPKAPK5-AS1 was upregulated in tumor tissues from NSCLC patients. Patients with high expression of MAPKAPK5-AS1 had higher tumor size, advanced TNM stage, higher incidence of lymph node and distant metastasis, and shorter overall survival. Knockdown of MAPKAPK5-AS1 inhibited the proliferation, induced apoptosis and blocked epithelial mesenchymal transformation (EMT) of NSCLC cells. Mechanically, MAPKAPK5-AS1 could upregulate the HMGB2 level in NSCLC cells through competitively binding to miR-490-3p. MiR-490-3p inhibitor reversed the roles of MAPKAPK5-AS1 knockdown on tumor cell proliferation, apoptosis and EMT. Also, HMGB2 knockdown suppressed tumor cell malignant phenotypes. Furthermore, interference of MAPKAPK5-AS1 slowed NSCLC tumor growth in vivo. Knockdown of MAPKAPK5-AS1 inhibited the aggressive tumor phenotypes through miR-490-3p/HMGB2 axis in NSCLC. MAPKAPK5-AS1/miR-490-3p/HMGB2 might be potential biomarkers or therapeutic targets for NSCLC.

Introduction: Classic hemodialysis schedules present inadequate middle-molecular-weight toxin clearance due to limitations of membrane-based separation processes. Accumulation of uremic retention solutes may result in specific symptoms (e.g., pruritus) and may affect clinical outcome and patient’s quality of life. Hemoperfusion (HP) is a blood purification modality based on adsorption that can overcome such limitations, and thus, it may be interesting to test the efficacy of at least one session per week of HP combined with hemodialysis. This is a randomized, open-label trial, controlled, multicenter clinical study to investigate the effect of long-term HP combined with hemodialysis on middle-molecular-weight toxins and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods: 438 MHD patients from 37 HD centers in China with end-stage kidney disease (63.9% males, mean age 51 years) suffering from chronic intractable pruritus were enrolled in the study. Eligible patients were randomized into four groups: low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), HP + LFHD, and HP + HFHD at a 1:1:1:1 ratio. Beta-2 microglobulin (β2M) and parathyroid hormone (PTH) were measured at baseline, 3–6, and 12 months. At the same time points, the pruritus score was evaluated. The primary outcome was the reduction of β2M and PTH, while the secondary outcome was the reduction of the pruritus score. Results: In the two groups HP + LFHD and HP + HFHD, there was a significant decrease of β2M and PTH levels after 12 months compared to the control groups. No significant differences were noted between HP + LFHD and HP + HFHD. Pruritus score reduction was 63% in the HP + LFHD group and 51% in the HP + HFHD group, respectively. Conclusion: The long-term HP + HD can reduce β2M and PTH levels and improve pruritus in MHD patients independently on the use of high- or low-flux dialyzers, showing that the results are linked to the effect of adsorption.