Search Results (14,037)

Background and Objectives: Chronic non-specific neck pain (CNNP) is common among desk-based workers exposed to increased ergonomic risk and is accompanied by functional impairments. This study examined associations between exercise participation and pain intensity, upper-extremity disability, body awareness, and perceived sagittal trunk appearance in this population. Materials and Methods: This cross-sectional study included 250 of 512 screened desk-based workers with CNNP, pain severity ≥4/10, and a Rapid Upper Limb Assessment (RULA) score ≥ 3/7. Physical activity, upper-extremity disability, body awareness, perceived sagittal trunk appearance, and ergonomic risk were assessed using the IPAQ-SF, QuickDASH, Body Awareness Rating Questionnaire (BARQ), KyphoTAPS, and a video-call-based RULA. Results: Participants reporting exercise participation had lower QuickDASH scores (p = 0.003, d = −0.42) and higher BARQ total scores (p = 0.023, d = 0.33) than non-exercisers. BARQ function and awareness scores were higher in this group (p = 0.004 and p = 0.033), while pain severity, perceived sagittal trunk appearance, and ergonomic risk were similar between groups. QuickDASH scores were positively correlated with pain severity (rho = 0.636–0.727) and negatively correlated with BARQ total scores (rho = −0.477). RULA scores showed a weak positive correlation with general neck pain (rho = 0.288) (FDR-adjusted p < 0.002). Exploratory adjusted analyses showed that participants reporting regular exercise participation had lower QuickDASH and higher BARQ total scores than non-exercisers in all models. Participants reporting low-frequency exercise participation had lower QuickDASH scores than non-exercisers only in Model 4. Conclusions: Self-reported exercise participation may be associated with lower QuickDASH scores and higher BARQ total scores in desk-based workers with CNNP and increased ergonomic risk. Because maintaining consistent exercise participation can be challenging in occupational settings, future studies should investigate feasible exercise strategies to address pain-related, functional, and perceptual outcomes among occupational populations exposed to prolonged ergonomic loading. Full article

Background and Objectives: Transfusion-related immunomodulation (TRIM) is a recognized immunosuppressive phenomenon whose interaction with immune checkpoint blockade remains poorly defined. We evaluated the impact of erythrocyte suspension transfusion on survival and immune-related toxicity in patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab. Materials and Methods: This retrospective, multicenter study included 253 patients with metastatic NSCLC treated with nivolumab across five centers between April 2018 and March 2025. Patients who received a transfusion within three months before or during nivolumab therapy were compared with non-transfused patients. Survival was assessed using Kaplan–Meier and Cox regression analyses. Results: Forty-two patients (16.6%) received transfusion. Transfused patients had significantly shorter progression-free survival (PFS) (median 3.6 vs. 9.3 months; HR = 2.28, 95% CI 1.47–3.56, p < 0.001) and overall survival (OS) (median 5.8 vs. 16.3 months; HR = 2.76, 95% CI 1.86–4.11, p < 0.001). In multivariable analysis, transfusion was an independent predictor of both shorter PFS (HR = 2.288, 95% CI 1.470–3.561, p < 0.001) and shorter OS (HR = 2.351, 95% CI 1.565–3.533, p < 0.001), independent of transfusion volume. No statistically significant association was detected between transfusion status and the incidence of nivolumab-related toxicity (p = 0.585), although this analysis was likely underpowered, whereas nivolumab-related toxicity was an independent favorable prognostic factor. Conclusions: Erythrocyte transfusion independently predicted poorer survival but not immune-related toxicity in nivolumab-treated metastatic NSCLC, supporting more judicious transfusion practices during immunotherapy. Full article

Background: Multisystem inflammatory syndrome in children (MIS-C) was recognized in 2020 as a post-infectious hyperinflammatory condition occurring 2–6 weeks after SARS-CoV-2 infection. While large studies from Europe and North America have described its clinical spectrum and outcomes, evidence from the Middle East remains limited. MIS-C shares features with Kawasaki disease (KD), including persistent fever, mucocutaneous manifestations, and cardiac involvement, but differs in age distribution, gastrointestinal involvement, and patterns of cardiac injury. Objective: To map the reported Middle Eastern evidence on the clinical and laboratory phenotype, Kawasaki-like manifestations, cardiovascular involvement, management, short-term outcomes, and evidence gaps in children with MIS-C. Methods: A scoping review was conducted using the Arksey and O’Malley framework, guided by Joanna Briggs Institute methodology and reported according to PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science, and the WHO COVID-19 database were searched for studies published from 1 December 2020 through 30 September 2025. Two reviewers independently screened records in Rayyan and charted data using standardized forms. Findings were synthesized descriptively; numerical ranges reflect values reported across selected contributing studies and are not pooled regional estimates. Results: Twenty-seven original clinical studies met the eligibility criteria, including case reports, case series, and observational cohorts from the UAE, Saudi Arabia, Qatar, Jordan, and multinational Middle Eastern collaborations. Across the included reports, affected children were generally older than the typical classic Kawasaki disease population. Gastrointestinal symptoms were commonly reported, and myocardial dysfunction was reported more frequently than coronary artery abnormalities. Most patients received intravenous immunoglobulin, often combined with corticosteroids. Short-term outcomes were generally favorable, but the evidence was heterogeneous and follow-up was limited. No meta-analysis was performed. Conclusions: The available Middle Eastern literature suggests that MIS-C commonly presents in school-aged children with gastrointestinal, mucocutaneous, and myocardial involvement. These patterns are descriptive rather than definitive because the evidence is predominantly retrospective, geographically uneven, and methodologically heterogeneous. The principal contribution of this review is to map the regional literature and identify priorities for prospective, standardized, multicenter studies and long-term follow-up. Full article

Nanomaterials are increasingly used in manufacturing, medicine, consumer products, and environmental technologies due to their unique physicochemical properties. Although these materials offer substantial technological and societal benefits, their widespread use has raised concerns about potential health risks. Of particular importance is exposure during pregnancy, as certain nanoparticles can cross the placental barrier and reach the developing embryo. Fetal tissues are highly sensitive to environmental insults, so maternal exposure to nanoparticles may disrupt normal development and increase the risk of abnormal pregnancy outcomes. This review examines the current understanding of nanoparticle-induced developmental toxicity, with a focus on the vulnerability of the maternal–fetal unit. We discuss the structure and function of the placental barrier and the mechanisms that enable nanoparticle transfer from mother to fetus. Particular attention is given to how nanoparticle characteristics, including size, shape, composition, and surface chemistry, influence biodistribution, placental transport, tissue accumulation, and toxicity. We summarize the major molecular and cellular mechanisms implicated in fetotoxicity, highlighting oxidative stress, apoptosis, autophagy, and DNA damage as recurring pathways identified across experimental studies. These interconnected processes contribute to placental dysfunction, impaired fetal growth, developmental abnormalities, and adverse pregnancy outcomes. We also compare findings across different classes of nanoparticles, including metal, metal oxide, carbon-based, and polymeric nanomaterials, identifying both shared toxicological mechanisms and material-specific effects. Evidence from animal models demonstrates that susceptibility varies according to nanoparticle properties, exposure conditions, and species, underscoring the complexity of nanoparticle–biological interactions and the limitations of extrapolating experimental findings directly to humans. Overall, the available evidence indicates that nanoparticle exposure during pregnancy represents a potential risk to fetal health, although important knowledge gaps remain regarding human exposure and long-term developmental outcomes. A better understanding of the mechanisms underlying nanoparticle-induced fetotoxicity is essential for improving human health risk assessment, refining experimental models, informing regulatory policies, and supporting the safe-by-design development of nanomaterials. Such knowledge will help ensure the responsible application of nanotechnology while minimizing potential risks during pregnancy. Finally, this review is distinguished by its integrated analysis of how the chemical characteristics of nanoparticles govern placental transfer and the mechanistic pathways of fetotoxicity across multiple nanomaterial classes, providing a unified framework that connects material properties with their potential for abnormal fetal development and adverse pregnancy outcomes. Full article

Background and Objectives: Adolescent pregnancy is associated with biological, behavioral, and healthcare-related vulnerabilities that are incompletely captured by structured datasets. This study aimed to characterize selected maternal vulnerability indicators derived from narrative clinical documentation and to examine their exploratory associations with documented prenatal care deficiency and neonatal outcomes. Materials and Methods: We conducted a retrospective cohort study including 759 singleton adolescent pregnancies managed at a Romanian secondary obstetric center between 2020 and 2024. Narrative clinical observations were reviewed to extract maternal vulnerability indicators, including smoking, anemia, infection, hypertensive disorders, obesity, Rh incompatibility, and documented prenatal care deficiency. Associations between extracted variables, documented prenatal care deficiency, and neonatal outcomes were evaluated using contingency analyses, Kendall’s tau-b correlations, and multivariable logistic regression models. Results: Among pregnancies with available narrative observations, documented prenatal care deficiency was identified in 612/692 (88.4%), maternal anemia in 207/692 (29.9%), and smoking during pregnancy in 186/692 (26.9%). Validation performance differed across categories, with a sensitivity of 57.1% (95% CI 18.4–90.1%) for hypertensive disorders and wide confidence intervals for rare categories. Correlations between extracted variables were weak, indicating limited clustering of maternal risk factors. Hypertensive disorders (aOR 0.31, 95% CI 0.10–0.95, p = 0.038) and maternal obesity (aOR 0.39, 95% CI 0.16–0.98, p = 0.044) were associated with lower odds of documented prenatal care deficiency. Significant neonatal associations were observed primarily for low birth weight. Hypertensive disorders were independently associated with increased odds of low birth weight (aOR 3.56, 95% CI 1.33–9.54, p = 0.011), whereas documented maternal anemia was associated with lower observed odds of LBW (aOR 0.45, 95% CI 0.24–0.82, p = 0.009). No significant associations were identified for preterm birth or Apgar score < 7 at 5 min. Conclusions: Narrative clinical documentation allowed the identification of heterogeneous maternal vulnerability indicators that showed weak interrelationships and selective associations with prenatal surveillance patterns and low birth weight. These exploratory findings should be interpreted in the context of healthcare engagement and documentation practices. Full article

Postoperative atrial fibrillation (POAF) after cardiac surgery is often managed as a transient inpatient arrhythmia, yet recurrent or silent atrial fibrillation (AF) after discharge may identify persistent atrial vulnerability. This issue is particularly relevant in cancer survivors, whose thrombotic and bleeding risks vary according to cancer activity, treatment exposure, thrombocytopenia, frailty and planned procedures. For this narrative review, PubMed/MEDLINE and Scopus were searched from inception to 16 June 2026, with Google Scholar used for supplementary citation tracking. A total of 50 publications were included in the final narrative synthesis. Direct evidence at the intersection of cancer, cardiac surgery, POAF and digital monitoring remains limited. Accordingly, the proposed “Digital Cancer-POAF Survivorship Pathway” is presented as a conceptual, hypothesis-generating framework, rather than a validated clinical algorithm. Its distinctive contribution is to connect cancer-state phenotyping and treatment-specific arrhythmic risk with post-discharge rhythm surveillance, electrocardiogram (ECG) confirmation, multidisciplinary interpretation, data governance and outcomes for prospective validation. Digital monitoring may increase AF detection; however, whether it reduces stroke, bleeding, readmission, or healthcare utilisation in this population is unknown. Neither a low detected AF burden nor the absence of AF during finite monitoring has been validated as an independent basis for anticoagulation decisions. Full article

Background and Objectives: This retrospective cohort study aimed to evaluate the association between sagittal tibial tunnel angle and radiological and clinical outcomes following transtibial pull-out repair of medial meniscus posterior root tears. Materials and Methods: A total of 81 patients who underwent arthroscopic transtibial pull-out repair between January 2022 and October 2025 and had a minimum follow-up of 6 months were retrospectively evaluated. Demographic, clinical, radiological, and functional data were analyzed. Meniscal extrusion, hip–knee–ankle angle, mechanical axis deviation, sagittal and coronal tunnel angles, International Knee Documentation Committee (IKDC) score, and Numeric Pain Rating Scale (NPRS) score were assessed preoperatively and at 6 months postoperatively. Receiver operating characteristic (ROC) analysis was performed to explore the ability of sagittal tibial tunnel angle to discriminate achievement of the patient acceptable symptom state (PASS) based on the postoperative IKDC score. The ROC-derived 51.5° value was considered an exploratory, cohort-specific threshold. For secondary between-group comparisons, patients were classified into two groups according to sagittal tibial tunnel angle: ≤51.5° and >51.5°. Results: The cohort included 56 female patients, and the mean age was 50.0 ± 9.97 years. Receiver operating characteristic analysis identified 51.5° as the exploratory cohort-specific threshold, with an area under the curve of 0.754, sensitivity of 77.8%, and specificity of 68.9%. Patients with a sagittal tunnel angle >51.5° had lower postoperative meniscal extrusion than those with an angle ≤51.5° (3.0 mm versus 4.0 mm, p < 0.001), greater reduction in meniscal extrusion (1.10 mm versus 0.3 mm, p < 0.001), higher postoperative IKDC (71.62 ± 10.69 versus 53.0 ± 15.44, p < 0.001), and lower postoperative NPRS scores (1 versus 4, p < 0.001). Achievement of the patient acceptable symptom state was also more frequent in the >51.5° group (66.7% vs. 17.9%, p < 0.001). Conclusions: A greater sagittal tibial tunnel angle measured on 6-month postoperative MRI was associated with lower concurrent meniscal extrusion, higher functional scores, and lower pain scores following transtibial pull-out repair. However, the retrospective design and short follow-up period limit causal and long-term interpretation. The cohort-derived 51.5° threshold should be considered exploratory and requires external validation before clinical application. Full article

Background and Objectives: Urinary tract infections are common in clinical practice, but in hospital settings, especially among older and catheterized patients, the microbial ecology and resistance burden may differ substantially from community-acquired infections. Local surveillance is therefore essential to support appropriate empirical treatment and antimicrobial stewardship. The objective is to describe the microbiological epidemiology of urinary isolates in a tertiary hospital and evaluate temporal trends in antimicrobial resistance among the most frequently isolated microorganisms. Materials and Methods: This retrospective observational study analyzed microbiology laboratory data from Tor Vergata University Hospital, Rome, Italy, collected from January 2022 to June 2025. After WHONET-based deduplication using a 30-day repeat-isolate rule, 5788 deduplicated urinary isolates and 85,888 microorganism–drug associations were included. Descriptive analyses, cumulative antibiograms/antimycograms, and quarterly resistance trends were assessed using univariable and multivariable regression analyses. Results: The population was predominantly elderly, inpatient, and catheter-exposed. Gram-negative organisms predominated, followed by Gram-positive bacteria and fungi. The most frequent isolates were E. coli, K. pneumoniae, E. faecalis, and C. albicans. Although microorganism distribution remained broadly stable over time, resistance increased in several clinically relevant organism–drug combinations, especially among major Enterobacterales. Conclusions: In this high-complexity hospital population, urinary isolates showed a relatively stable microorganism distribution but progressive changes in susceptibility among selected urinary isolates. These findings support setting-specific microbiological surveillance and stewardship-informed empirical treatment strategies. Full article

Background and Objectives: The aim of this study was to evaluate the volume of dental tissue removed during conventional versus microscope-assisted coronal access cavity preparation by an undergraduate student in extracted mandibular incisors, and to compare the volumetric assessment capabilities of cone beam computed tomography (CBCT) and intraoral scanner (IOS) for this application. Materials and Methods: Thirty extracted mandibular incisors were randomly allocated to two equal groups: Group 1 (G1), access cavity preparation without magnification; and Group 2 (G2), access cavity preparation with the aid of an operating microscope. Volumetric analysis was performed using CBCT (RAYSCAN^® Alpha Plus 130) and an intraoral scanner (3Shape TRIOS^® 3) before and after access cavity preparation. Volume loss was calculated for each group. Differences in groups were assessed using the independent-samples Student’s t-test for CBCT data and the Mann–Whitney U test for IOS data. Reproducibility between methods was evaluated using the intraclass correlation coefficient (ICC). Results: The CBCT analysis revealed significantly greater tissue loss in G1 (mean 14.93 mm³, SD 4.42) than in G2 (mean 7.64 mm³, SD 2.72) (mean difference 7.29 mm³, 95% CI, 4.54–10.04; p < 0.001; Cohen’s d = 1.99, 95% CI, 1.10–2.88). The IOS analysis did not detect a statistically significant between-group difference (G1: mean 5.37 mm³ vs. G2: mean 4.55 mm³; p = 0.436). The ICC for volume loss between methods was 0.011 (95% CI: −0.150 to 0.237), below the threshold conventionally used to indicate acceptable reliability; because CBCT and IOS did not sample identical anatomical extents, this should be interpreted as limited agreement specific to the present protocols rather than general evidence of poor concordance between the two imaging methods. Conclusions: Within the limitations of this exploratory, single-operator in vitro study, microscope-assisted access cavity preparation resulted in significantly less CBCT-measured volumetric tissue loss than conventional access in mandibular incisors. Full article

Background and Objectives: Residual filling material may persist on the walls of oval root canals after mechanical retreatment, and the influence of sodium hypochlorite (NaOCl) concentration and supplementary irrigation procedures on its removal remains unclear. This laboratory study used scanning electron microscopy (SEM) to evaluate the effects of three NaOCl concentrations and five final irrigation protocols on residual filling material in retreated oval canals of mandibular premolars. The protocols tested were conventional needle irrigation (CNI), EDDY, passive ultrasonic irrigation (PUI), XP-endo Finisher R (XPFR), and Shock Wave Enhanced Emission Photoacoustic Streaming (SWEEPS). Materials and Methods: One hundred twenty extracted mandibular premolars with a single root and an oval canal were instrumented with Reciproc R25 and filled with CeraSeal and a matching gutta-percha cone using the single-cone technique. Root canal retreatment was performed using ProTaper Universal Retreatment instruments followed by Reciproc R40. The teeth were then distributed among 15 experimental subgroups according to the final irrigation protocol and NaOCl concentration used: 2.5%, 5.25%, or 8.25% (n = 8). After irrigation, each root was divided longitudinally, and one undamaged canal half was randomly chosen for SEM evaluation. Residual filling material was scored in the coronal, middle, and apical regions using an ordinal scale ranging from 1 to 5. Examiner agreement was determined with quadratically weighted Cohen’s kappa, while treatment effects were examined using a cumulative link mixed model (CLMM). Results: Residual filling material scores differed significantly according to the final irrigation protocol (p < 0.001) and root canal region (p = 0.007), but not according to NaOCl concentration (p = 0.236). The interaction between protocol and canal region was also significant (p = 0.036). In the overall comparisons, CNI produced the highest scores, whereas SWEEPS produced the lowest, and EDDY, PUI, and XPFR did not differ significantly from one another. Apical scores were higher than coronal and middle scores in the EDDY, PUI, and SWEEPS protocols, while XPFR showed no significant variation among canal regions. Conclusions: Residual filling material scores after retreatment were influenced by the final irrigation protocol and root canal region, whereas NaOCl concentration had no significant main effect. SWEEPS resulted in the lowest overall residual filling material scores and CNI in the highest, while EDDY, PUI, and XPFR showed comparable overall performance, although protocol performance varied across root canal regions. Full article

Background and Objectives: Dual-mobility cups are commonly used to reduce instability after total hip arthroplasty (THA) for femoral neck fracture (FNF), but their advantage over contemporary large-head standard cups remains uncertain. This registry study compared revision-related survival estimates up to 10 years among monoblock dual-mobility cups, modular dual-mobility constructs, and standard cups with femoral heads ≥ 36 mm in cementless THA for FNF. Materials and Methods: We retrospectively analyzed regional residents undergoing cementless, non-metal-on-metal primary THA for FNF. The cohort included 4827 THAs: 1220 monoblock dual-mobility cups, 408 modular dual-mobility constructs, and 3199 standard cups with ≥36 mm heads. Groups differed in age and sex distribution, with modular dual mobility used in older patients and both dual-mobility constructs used more often in women. Kaplan–Meier analysis estimated survival up to 10 years using aseptic failure and revision for dislocation/instability as endpoints. Cox models estimated adjusted hazard ratios, and cumulative incidence of aseptic failure was assessed with death as a competing event. Results: Kaplan–Meier-estimated 10-year aseptic failure-free survival was 94.4% for monoblock dual mobility, 96.8% for modular dual mobility, and 95.4% for standard cups (p = 0.815). Cup construct was not independently associated with aseptic failure: compared with standard cups, the HR was 1.12 for monoblock dual mobility (95% CI, 0.75–1.67) and 1.34 for modular dual mobility (95% CI, 0.71–2.52). Kaplan–Meier-estimated 10-year survival free from revision for dislocation/instability was 99.6%, 99.2%, and 99.3%, respectively (p = 0.620), with no independent effect of cup construct. Male sex increased the risk of both aseptic failure and revision for dislocation/instability. Periprosthetic fracture was the leading cause of aseptic revision in both dual-mobility groups, whereas failures were more evenly distributed in the standard cup group. Death-adjusted cumulative incidence of aseptic failure was similar across constructs (p = 0.919). Conclusions: Neither monoblock nor modular dual mobility improved revision-related outcomes compared with standard cups using femoral heads ≥ 36 mm. Late survival estimates, particularly for modular dual mobility, should be interpreted cautiously because of the limited number of patients remaining at risk. Full article

Background and Objectives: Critically ill surgical patients frequently fail to achieve prescribed enteral nutrition targets because of feeding interruptions and variability in conventional physician-directed feeding practices. Although volume-based feeding (VBF) has been proposed to improve nutritional delivery, concerns remain regarding refeeding syndrome and gastrointestinal intolerance. The aim of this study was to evaluate whether a Volume-Based Plus (VBF+) protocol integrating volume-targeted feeding with mandatory refeeding risk stratification and a standardized semi-elemental enteral formula improves nutritional delivery without increasing gastrointestinal or metabolic complications. Materials and Methods: We conducted an ambispective before-and-after implementation study (retrospective control phase, prospective intervention phase) in the surgical intensive care unit of a tertiary care center between January 2023 and March 2026. Ninety-six patients requiring enteral nutrition for ≥3 days were enrolled (48 control and 48 intervention). Both groups underwent the same refeeding risk stratification to guide feeding strategy, while the intervention group additionally received the standardized VBF+ protocol with risk-stratified caloric advancement and volume-based compensation for feeding interruptions, and a standardized semi-elemental enteral formula. The primary outcomes were median daily caloric delivery (% of target) and mean daily protein delivery (g/kg/day). Multivariable regression analyses adjusted for Nutritional Assessment Form (NAF), APACHE II score, and Charlson Comorbidity Index (CCI) were performed. Results: The VBF+ protocol was independently associated with higher caloric delivery (β = 31.2 percentage points, 95% CI 17.6 to 44.8; p < 0.001) and higher protein delivery (β = 0.168 g/kg/day, 95% CI 0.040–0.297; p = 0.011). Longitudinal analysis showed a significantly faster increase in protein delivery in the intervention group (p < 0.001), while the group-by-time interaction for caloric delivery did not reach statistical significance (p = 0.073). Rates of gastrointestinal intolerance and metabolic complications were comparable between groups; as VBF+ bundled the compensatory algorithm with a semi-elemental formula, this gastrointestinal benefit is hypothesis-generating. Conclusions: In this before-and-after study, the VBF+ bundle protocol was associated with improved caloric and protein delivery and reduced gastrointestinal intolerance; because the algorithm and formula were not evaluated independently, the gastrointestinal benefit remains hypothesis-generating and requires confirmation in randomized trials. Full article

Background and Objectives: Few cases of spontaneous evisceration through umbilical hernia (UH) in adult patients have been reported in the literature. Although uncommon, it is a potentially life-threatening surgical emergency. This scoping review aimed to map the published cases and summarize the reported clinical settings, precipitating factors, pathophysiologic mechanisms, management strategies, and outcomes. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. The search was conducted through PubMed/MEDLINE and Scopus using the strings (“spontaneous evisceration” OR “spontaneous bowel evisceration” OR “umbilical hernia rupture” OR “umbilical hernia evisceration” OR “bowel evisceration umbilical” OR “umbilical evisceration” OR “bowel evisceration” OR “umbilical eventration”). Reports describing spontaneous evisceration of abdominal content through an UH in adult patients were included, whereas pediatric cases, non-umbilical eviscerations, traumatic eviscerations, animal studies, duplicates, and reports without extractable clinical data were excluded. Results: From the initial 2623 records identified, after thorough screening and reference tracking of the selected publications, 47 relevant reports for a total of 49 patients were identified. Cirrhosis was reported in 26 patients (53%), umbilical skin changes before the evisceration in 33 (67%), and death in 10 (20%). Conclusions: The available evidence suggests that spontaneous evisceration through UH is a surgical emergency that should be viewed not merely as a local mechanical event, but as the result of a multistep process involving chronic pressure overload, tissue fragility, and systemic decompensation, frequently in the setting of cirrhosis with ascites. Urgent repair is usually required, but the role of mesh reinforcement remains unclear and should be individualized according to contamination, defect size, patient condition, and ascites control. Full article

Background: The interaction between COVID-19 vaccination and immune checkpoint inhibitor (ICI) therapy in advanced non-small cell lung cancer (NSCLC) remains incompletely characterized. Methods: Retrospective cohort study of 139 patients with stage IV NSCLC treated with first-line ICI-based therapy, stratified by vaccination status and total doses received (0–1 vs. ≥2). Progression-free (PFS) and overall survival (OS) were analyzed by Kaplan–Meier and Cox regression; logistic regression explored factors associated with treatment-related toxicity. Results: Vaccinated patients had longer median PFS (13.0 vs. 11.0 months) and OS (29.0 vs. 24.0 months; both p < 0.001). In multivariable models these associations were attenuated and of borderline significance (OS HR = 0.83, 95% CI 0.69–0.99; PFS HR = 0.79, 95% CI 0.62–0.99). Outcomes were also more favorable with ≥2 doses (median PFS 14.0 vs. 12.0 months, p = 0.001; median OS 30.0 vs. 24.0 months, p < 0.001), and tumor mutational status was the strongest independent predictor of survival. In an exploratory model, ≥2 doses were associated with higher odds of any-grade toxicity (OR = 2.47, p = 0.037); events were predominantly low grade, with no Grade 4 or 5 toxicity. Conclusions: COVID-19 vaccination was associated with improved PFS and OS in stage IV NSCLC receiving first-line ICI therapy, with a dose-related pattern. The association was attenuated after adjustment for tumor biology and is hypothesis-generating. These findings support the safety and potential clinical relevance of vaccination in this population and underline the need for structured monitoring during immunotherapy. Prospective validation is required. Full article

Background and Objectives: Severe traumatic limb injuries, particularly those involving extensive soft tissue damage, present significant challenges in clinical management. Thus, we aimed to critically assess the effectiveness of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for severe traumatic limb injuries. Materials and Methods: For this systematic review and meta-analysis, we conducted a systematic search of MEDLINE/PubMed, Embase, and the Cochrane Library for studies published up to 7 March 2026. We included studies evaluating the effectiveness of adjunctive HBOT in patients with severe limb injuries. The prespecified primary outcome was complete wound healing, while secondary outcomes included time to wound healing, wound necrosis, length of hospital stay (LOS), and wound infection. Risk of bias was assessed using the ROBINS-I tool for observational studies and the Cochrane RoB 2.0 for randomized controlled trials (RCTs). Results: Seven studies (three RCTs and four observational) were included. A high risk of bias was identified in two RCTs, and a serious risk of bias was noted across all four observational studies. Complete wound healing was reported in one randomized trial and favored HBOT, but the certainty of evidence was very low. The time to wound healing did not differ between the HBOT and control groups (MD, −1.44; 95% CI, −6.70 to 3.82, I² = 0%). The LOS did not differ between the HBOT and control groups (MD, −3.39; 95% CI, −14.74 to 7.79, I² = 94%). However, wound infection rates were lower in the HBOT group compared to the control group (OR, 0.31; 95% CI, 0.22–0.45, I² = 20%). Similarly, wound necrosis rates were reduced in the HBOT group (OR, 0.23; 95% CI, 0.12–0.45, I² = 41%). Conclusions: Evidence is insufficient to determine whether HBOT improves complete wound healing. Although HBOT may reduce wound infection and necrosis, the certainty of evidence was low to very low. Full article