Search Results (103)

Background: Non-specific neck pain is associated with altered muscle mechanical properties, including increased stiffness. Radial extracorporeal shockwave therapy (rESWT) and orthopedic manual therapy (OMT) are commonly used interventions, although their combined effects on cervical muscle stiffness remain unclear. This study aimed to evaluate the short-term and within-session effects of adding rESWT to OMT on cervical muscle stiffness measured by means of shear wave elastography (SWE) in individuals with non-specific neck pain. Methods: A randomized controlled trial was conducted including 24 participants (mean age 34.36 years) allocated to an intervention group (IG, n = 12) or a control group (CG, n = 12). The IG received a combined protocol of rESWT (1500 impulses per point at 10 Hz, 2–4 bar) and OMT based on the Maitland concept, while the CG received OMT alone. Primary outcomes included cervical muscle stiffness assessed via SWE expressed in meters per second (m/s) and kilopascals (kPa). Secondary outcomes were pain intensity (VAS), pressure pain threshold (PPT), cervical range of motion (ROM), and shoulder elevation strength (SES). Treatment effects were estimated using ANCOVA adjusted for baseline values. Results: The combined intervention was associated with greater reductions in cervical muscle stiffness compared with the control group, with significant decreases in SWE values (m/s: β = −1.27, p < 0.001; kPa: β = −27.97, p < 0.001). Pain intensity was also reduced (β = −2.12, p = 0.012), while PPT increased (β = 18.84, p = 0.024). Improvements were observed in cervical extension ROM (β = 10.30, p = 0.014) and right SES (β = 3.85, p = 0.044). No significant differences were found for other ROM variables or left SES. Conclusions: The addition of rESWT to OMT was associated with greater short-term improvements in cervical muscle stiffness, pain intensity, and mechanical sensitivity compared with OMT alone in individuals with non-specific neck pain. However, these findings should be interpreted with caution due to the study limitations. Full article

Cardiogenic shock (CS) is the most lethal complication of acute myocardial infarction (AMI), with a 30-day mortality of approximately 40–50% despite early revascularization. Temporary mechanical circulatory support (tMCS) devices, including the intra-aortic balloon pump (IABP), microaxial flow pumps (MAFP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), are used as adjunctive therapy in refractory shock, but evidence of a survival benefit is limited and often conflicting. The IABP-SHOCK II trial found no 30-day mortality reduction with IABP, supporting a Class III (no benefit) recommendation, whereas the DanGer Shock trial reported a 12.7% absolute mortality reduction at 180 days with the MAFP Impella CP in highly selected patients. In contrast, the ECLS-SHOCK and ECMO-CS trials showed no improvement in survival with early VA-ECMO and noted high complication rates. Real-world data reveal significant disparities between trial populations and clinical practice, highlighting limitations of current evidence, since many AMI-CS patients are older, in more advanced shock or have multiple comorbidities and would not meet typical randomized controlled trial (RCT) inclusion criteria. In clinical practice, in-hospital mortality with IABP or VA-ECMO often exceeds 50–60%. Given the heterogeneity of AMI-CS, rapid identification of appropriate tMCS candidates and personalized therapy are essential. Management guided by individual patient profile, hemodynamic stage and neurological status, supported by multidisciplinary shock teams, may improve timely triage, device selection and outcomes. This review emphasizes the need for individualized, protocol-driven care within structured shock systems to optimize tMCS use in AMI-CS. Full article

Background: Radical cystectomy (RC) remains associated with substantial perioperative morbidity despite advances in minimally invasive surgery and reconstructive techniques. Comparisons between intracorporeal reconstruction, robotic-assisted approaches, and urinary diversion strategies are frequently confounded by clinical heterogeneity and patient selection. This study aimed to perform a stratified surgical systematic review evaluating perioperative outcomes across distinct reconstructive pathways following RC. Methods: A PRISMA-guided systematic review identified comparative studies evaluating intracorporeal versus extracorporeal/open orthotopic neobladder reconstruction, robotic-assisted versus open radical cystectomy in frail patients undergoing ureterocutaneostomy, and ileal conduit versus orthotopic urinary diversion. Analyses were performed within predefined clinical modules to preserve surgical context. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), complemented by rare-event sensitivity analyses and exploratory absolute risk metrics, including number needed to treat or harm (NNT/NNH). Continuous outcomes such as estimated blood loss and length of hospital stay were assessed descriptively. Results: Three comparative observational cohorts met inclusion criteria. Intracorporeal neobladder reconstruction and robotic-assisted cystectomy demonstrated consistent reductions in transfusion rates and favourable trends in perioperative morbidity. In frail patient populations, robotic surgery showed reduced intraoperative burden without increased readmission or mortality. Ileal conduit diversion was associated with increased wound-related complications and infectious outcomes; however, these findings likely reflect baseline differences in patient frailty and selection. Rare-event sensitivity analyses confirmed directional consistency of treatment effects despite wide confidence intervals. Integration of absolute risk differences and NNT/NNH metrics provided clinically interpretable context for stratified outcomes. Conclusions: Minimally invasive and intracorporeal strategies following radical cystectomy may reduce perioperative burden, whereas diversion type primarily influences complication patterns rather than overall morbidity. A stratified analytical framework integrating relative and absolute effect measures may offer a more clinically meaningful approach to evaluating reconstructive strategies in heterogeneous surgical populations. Full article

Background/Objectives: Extracorporeal membrane oxygenation (ECMO) is increasingly used in adult critical care, but tracheostomy during ECMO remains controversial because of bleeding risk, anticoagulation exposure, and variability in patient selection. This systematic review evaluated the safety, timing, and clinical outcomes of tracheostomy in adult patients receiving ECMO. Methods: A systematic search of PubMed/MEDLINE was supplemented by additional searches in the Cochrane Library/CENTRAL and Scopus to identify studies evaluating tracheostomy in adult ECMO patients. The review was conducted according to PRISMA 2020 guidelines. After database searching and screening, 13 observational studies were included in the qualitative synthesis. Results: Across 13 studies encompassing 1918 patients, tracheostomy during ECMO was feasible and was not associated with procedure-related mortality. Bleeding was the main procedural complication, with reported rates varying according to study design, ECMO configuration, timing of tracheostomy, anticoagulation management, and bleeding definitions. Tracheostomy performed during active ECMO support was generally associated with a higher burden of bleeding or minor procedure-related complications than tracheostomy performed after decannulation. Tracheostomy was performed using percutaneous, surgical, open, or hybrid techniques, although comparative evidence between approaches remained limited. Early tracheostomy was associated with shorter ECMO duration, shorter mechanical ventilation, or improved clinical outcomes in selected cohorts, but timing definitions and outcome measures were heterogeneous. Conclusions: Tracheostomy during ECMO may support airway management, sedation reduction, and ventilatory progression, particularly in prolonged ECMO courses, but it carries a relevant bleeding and transfusion burden. Timing, anticoagulation management, patient selection, ECMO configuration, and procedural technique are likely to influence the risk-benefit balance. Prospective studies are needed to standardize definitions, compare techniques, and clarify optimal timing strategies. Full article

Background: Although various laparoscopic techniques are available for pediatric hernia repair, the learning curve for laparoscopic intracorporeal sac transection with purse-string suture (LIST-PS) has not yet been established. Considering that intracorporeal suturing is technically more challenging than extracorporeal knotting, an objective assessment of surgical competence is crucial. The study aimed to evaluate the learning curve and safety profile of LIST-PS performed by a single surgeon in a large series of pediatric patients. Methods: A retrospective analysis of 469 pediatric patients treated between March 2019 and December 2025 was conducted. The learning curve was assessed using the cumulative sum (CUSUM) analysis of operative times. The cohort was divided into phases 1 (learning) and 2 (proficiency) based on the CUSUM peak. Additionally, a high-risk subgroup (preterm infants aged < 1 year) was compared with a control group to evaluate the impact of patient complexity on surgical progress. Results: The mean patient age was 3.4 ± 3.5 years, and 29.4% were born prematurely. The CUSUM analysis identified a peak at case 233, marking the transition to proficiency. The mean operative time decreased significantly from 70.6 ± 26.3 min in phase 1 to 52.0 ± 16.5 min in phase 2 (p < 0.001). Despite the reduction in operative time, the recurrence rate remained stable at 1.7% in both phases (p > 0.999). In a subgroup analysis, the high-risk group (preterm infants and infants < 1 year) required longer operative times (73.5 ± 32.8 min vs. 57.7 ± 19.2 min; p < 0.001) but showed no significant difference in recurrence compared to the control group (0.96% vs. 1.92%; p = 0.691). Conclusions: Technical proficiency in LIST-PS was achieved after 233 cases. Although high-risk patients consistently required more time, the surgeon’s improvement followed a parallel trajectory across all risk levels, maintaining high surgical safety throughout the learning process. Full article

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has failed to demonstrate mortality benefit in randomised controlled trials of cardiogenic shock. We aimed to determine whether a novel ‘Hemi-ECMO’ configuration, involving aortic occlusion to isolate the left ventricle from the VA-ECMO circuit, improves cardiac haemodynamics. We utilised a pulsatile biventricular mock circulatory loop with variable contractility to compare standard VA-ECMO with Hemi-ECMO support under left ventricular or biventricular failure conditions. When averaged across all pump speeds, mean left atrial pressure was significantly reduced with Hemi-ECMO compared to VA-ECMO (21.11 ± 1.32 mmHg vs. 26.53 ± 0.87 mmHg, p < 0.001), with more pronounced benefit at higher pump speeds. Aortic ejection increased with Hemi-ECMO at higher pump speeds: 0.14 ± 0.03 vs. 0.00 ± 0.00 L/min (p = 0.002) at 3000 revolutions per minute (RPM). Aortic ejection was greater with Hemi-ECMO in the descending aorta compared to the ascending aorta position (0.27 ± 0.03 L/min vs. 0.17 ± 0.05 L/min, p = 0.015). In conclusion, Hemi-ECMO demonstrates significant haemodynamic advantages in severe cardiogenic shock, including reductions in mean left atrial pressure and increases in aortic ejection, with greater benefits when positioned in the descending aorta. Further in vivo studies are warranted to assess clinical viability. Full article

Background/Objectives: The main cause of death in patients with chronic kidney disease (CKD) is of cardiovascular origin. Entropy-based analysis of physiological signals reflects system irregularity, complexity, and adaptive capacity. Amplitude-aware permutation entropy (AAPE) is a signal analysis method suitable for assessing complex cardiovascular dynamics, and growing evidence suggests that measures of physiological signal variability and complexity may have prognostic value. This study aimed to evaluate whether AAPE can predict mortality in CKD patients undergoing hemodialysis (HD), with and without diabetes. The aim of this study was to assess whether AAPE analysis of cardiovascular signals following the administration of a glucose bolus directly into the extracorporeal circuit during hemodialysis (HD)—a method originally used to treat intradialytic hypotension and to study the kinetics of glucose, insulin, and C-peptide in patients with and without type 2 diabetes—can predict mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD), both with and without diabetes. Methods: After seven years of follow-up, mortality outcomes were analyzed in relation to AAPE-derived parameters. Results: Higher mortality was associated with smaller differences in AAPE of mean arterial pressure (MAP) and diastolic arterial pressure (DIA) before and after intravenous glucose administration (p = 0.009 and p = 0.016, respectively). Higher tonicity was associated with higher survival (p = 0.01). Additionally, greater reductions in AAPE of systolic arterial pressure (SYS) and larger differences in AAPE of ejection time (EJT) and total peripheral resistance (TPR) were associated with increased mortality. Conclusions: These findings suggest that entropy analysis reflects cardiovascular adaptability and may serve as a prognostic biomarker in HD patients. Full article

Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT patients and compare it with physical and medical treatments Methods: In this retrospective study, 372 patients diagnosed with CIAT between 2019 and 2023 were evaluated. The patients were divided into two groups: those who received only physical/medical therapy (Group 1) and those who underwent a combination of ESWT and physical/medical therapy (Group 2). Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS) scores. The severity of the disease was determined through magnetic resonance imaging (MRI). Group comparisons were conducted using the independent samples t-test and Fisher’s exact test, while changes over time were assessed with repeated measures ANOVA. Correlation analyses were evaluated using Pearson and Spearman correlation coefficients. Results: Significant improvement in AOFAS and VAS scores was observed in both groups by the third month (p < 0.01). However, at 6 and 12 months, ESWT did not demonstrate superiority over physical/medical treatment. Correlation analysis showed a positive relationship between baseline AOFAS scores and functional improvement, while higher initial VAS scores correlated with greater post-treatment pain reduction. Cardiovascular risk factors negatively impacted both functional recovery and pain reduction (p < 0.05). Although patient satisfaction was higher in the ESWT group, the difference was not statistically significant. Conclusions: ESWT may provide short-term pain relief and functional improvement in CIAT but does not offer a long-term advantage over physical/medical treatment. The placebo effect may contribute to early positive outcomes. These findings do not support ESWT as a routine treatment for CIAT. Full article

Background: Chronic plantar fasciitis refractory to conservative treatment is a frequent cause of persistent heel pain and functional limitation. Although radial extracorporeal shock wave therapy (rESWT) has shown potential benefit, the relationship between clinical improvement and structural ultrasonographic changes remains unclear. The aim of this study was to evaluate the clinical, functional, and ultrasonographic outcomes associated with rESWT in patients with refractory plantar fasciitis. Methods: We conducted a prospective observational single-center study including 287 patients with plantar fasciitis refractory to conservative treatment for at least 6 months and confirmed by ultrasonography (plantar fascia thickness >4 mm). All patients received four weekly sessions of rESWT. Pain intensity (visual analog scale [VAS]), foot function (Foot Function Index [FFI]), quality of life (EQ-5D), and plantar fascia thickness were assessed at baseline and 3 months after treatment. Results: Significant improvements were observed in pain (mean VAS change, −3.73 points), function (mean FFI-disability change, −32.37 points), and quality of life (improvement in at least one EQ-5D dimension in 81.5% of patients) (all p < 0.001). The mean reduction in plantar fascia thickness was 0.14 mm. Most responders (71.8%) showed clinical improvement despite the absence of a relevant structural change, defined as a reduction in plantar fascia thickness <0.5 mm. In multivariate analysis, physically demanding occupations were associated with a lower probability of response (odds ratio, 0.32; 95% confidence interval, 0.17–0.63). The prognostic model showed moderate discrimination (area under the curve, 0.71). Conclusions: In this observational cohort, rESWT was associated with improvements in pain, function, and quality of life in patients with refractory plantar fasciitis. Clinical improvement frequently occurred despite minimal changes in plantar fascia thickness, suggesting that ultrasonographic thickness may not adequately reflect symptomatic evolution. However, the absence of a control group prevents causal interpretation of these findings. Full article

Background: Valproic acid (VPA) poisoning has a dynamic clinical course and may require extracorporeal toxin removal (ECTR) in severe cases. Intermittent hemodialysis is the preferred ECTR technique; however, clinical experience with expanded hemodialysis (HDx) using medium cut-off (MCO) membranes in acute VPA intoxication is scarce. We describe a case of severe VPA poisoning managed with intermittent HDx and outline the clinical rationale and kinetic response. Case Report: A 54-year-old woman presented to the emergency department after accidental presumably ingesting approximately 4 g of VPA, with depressed consciousness (Glasgow Coma Scale 7) and metabolic acidosis (pH 7.10, HCO₃⁻ 13 mmol/L, PCO₂ 50 mmHg, lactate 2.8 mmol/L, ionized calcium 0.8 mmol/L, elevated anion gap). Initial plasma VPA was 262.99 µg/mL, ammonia was 14 µmol/L, and cranial computed tomography showed no acute abnormalities. ECTR was initiated in the intensive care unit as intermittent HDx using an MCO dialyzer for 4 h. Serial VPA concentrations were obtained before treatment, at 2 h, and at the end of the session to guide real-time prescription adjustment, with an increase in blood flow from 200 to 230 mL/min. Results: VPA decreased from 262.99 µg/mL pre-HD to 141.48 µg/mL at 2 h (46.2% reduction) and 97.81 µg/mL at 4 h (62.8% reduction), with clear improvement in the level of consciousness. A mild post-dialysis rebound was observed (100.07 µg/mL at 14 h). The patient recovered without additional ECTR and was discharged with normalized VPA levels on follow-up. Conclusions: In this patient, intermittent HDx with an MCO membrane was feasible, well tolerated, and associated with rapid VPA clearance and neurological recovery. Serial drug monitoring enabled bedside optimization of the dialysis prescription and post-treatment evaluation. A single HDx session was sufficient, and VPA therapy was safely reintroduced under close monitoring. Full article

Background/Objectives: Frontal sinus fractures are uncommon injuries that may cause persistent aesthetic deformity when the anterior wall is comminuted, as small irregular fragments are difficult to stabilize with conventional osteosynthesis alone. Methods: We describe a point-of-care digital workflow combining 3D planning/printing and cyanoacrylate-assisted fixation for an isolated comminuted anterior frontal sinus wall fracture. A young adult presented with a depressed forehead contour after assault; computed tomography confirmed at least four displaced fragments. Results: A two-part 3D-printed biomodel was manufactured in-house to visualize the defect and guide extracorporeal reconstruction. Through a coronal approach, fragments were mobilized and anatomically reassembled using the biomodel as a reference; sinonasal drainage was preserved and sinus obliteration was not required. Because fragment size and geometry limited screw purchase, a modified N-butyl-2-cyanoacrylate adhesive (Glubran 2) was applied as an adjunct to maintain reduction, followed by reinforcement with titanium microplates. Postoperative recovery was uneventful, with immediate restoration of forehead contour and no early complications; postoperative imaging confirmed satisfactory alignment. Conclusions: This case supports the feasibility of integrating point-of-care 3D biomodeling with cyanoacrylate as a coadjuvant to microplate fixation in selected comminuted frontal sinus fractures to enhance fragment handling and contour restoration. Full article

Background: Rotator cuff tendinopathy is a major cause of shoulder pain and disability. Focused extracorporeal shockwave therapy (ESWT) is an established conservative treatment option; however, the predictive factors influencing the treatment response remain poorly characterized. Objectives: To identify clinical, demographic, and metabolic predictors of pain reduction and functional improvement at four months following focused ESWT in patients with supraspinatus tendinopathy, with the goal of informing individualized treatment planning and early prognostic counseling. Methods: This retrospective cohort study analyzed patients with supraspinatus tendinopathy (calcific and non-calcific) treated with focused ESWT at a university rehabilitation center between June 2020 and December 2025. Outcomes were assessed at baseline and 4-month follow-up using the Visual Analog Scale (VAS), Roles and Maudsley, and Constant–Murley scores. Change score analysis with covariate adjustment and backward stepwise selection were performed to identify predictors of clinical improvement. Results: A total of 239 patients (97 males [40.6%], 142 females [59.4%]; mean age 60.2 ± 11.5 years; mean BMI 25.5 ± 4.0 kg/m²) were included, of whom 101 (42.3%) had calcific tendinopathy. Significant improvements were observed in all outcomes: VAS decreased from 6.50 ± 1.35 to 3.96 ± 2.09 (p < 0.001; Cohen’s d = 1.24), and Constant–Murley score increased from 60.38 ± 14.53 to 75.88 ± 15.52 (p < 0.001; Cohen’s d = 1.07). Patient-reported satisfaction (Roles and Maudsley score) showed a 91.2% success rate (excellent or good outcomes). Regression analysis identified baseline severity as the strongest predictor of improvement in all models. BMI emerged as a significant predictor of functional recovery (β = −0.95, p < 0.001 for Constant–Murley change), with each 1 kg/m² increase associated with approximately 1-point less improvement. Conclusions: Baseline clinical severity and body mass index were consistent predictors of ESWT effectiveness in rotator cuff tendinopathy. A lower BMI was associated with greater functional improvement, highlighting a potentially modifiable factor for treatment optimization. These findings support personalized treatment planning and early prognostic counseling in clinical practices. Full article

Background/Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a multifactorial condition often refractory to standard medical therapy. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a mechanism-oriented option; however, prior reviews reported substantial heterogeneity, potentially due to pooling different wave-generator modalities despite their distinct physical properties. This study synthesized randomized evidence on Li-ESWT for CP/CPPS and explored a wave-generator modality as a prespecified effect modifier. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 2015 to 31 October 2025 (date of last search) for randomized controlled trials (INPLASY: 2025120064). Eligible studies compared Li-ESWT (focused, radial, or multifocal) with sham or standard medical therapy (SMT). The primary outcome was total NIH-CPSI at the follow-up closest to 12 weeks. Pooled effects were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by wave-generator modality and therapy strategy (monotherapy vs add-on to SMT). Results: Eight RCTs (n = 455) were included. Li-ESWT significantly improved total NIH-CPSI versus the control (WMD −8.46; 95% CI −12.12 to −4.79; I² = 94.8%). Benefits were observed in both monotherapy and the add-on to SMT trials. By modality, focused devices showed consistent effects (WMD −6.59; I² = 0.0%), whereas radial devices showed an imprecise estimate with extreme heterogeneity (WMD −10.38; 95% CI −21.33 to +0.57; I² = 98.2%). Multifocal devices showed a significant benefit (WMD −10.84; I² = 81.0%). Improvements were mainly driven by pain-domain reduction. Conclusions: Li-ESWT provides clinically meaningful symptom relief in CP/CPPS, predominantly through pain reduction. Modality- and strategy-based subgroup findings are exploratory given substantial heterogeneity, limited trials, and no head-to-head comparisons; focused devices showed consistent effects, whereas estimates for radial and multifocal devices warrant cautious interpretation. Full article

Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality despite decades of progress in ventilatory support. Mechanical ventilation, while essential for oxygenation, may exacerbate lung injury through excessive mechanical power delivery, even when using lung-protective strategies. Extracorporeal carbon dioxide removal (ECCO₂R) was conceived to enable “ultra-protective” ventilation, allowing for further reductions in tidal volume and respiratory rate by selectively removing CO₂ at low extracorporeal blood flows, typically between 0.3 and 1.0 L/min. This physiological decoupling of ventilation and gas exchange aims to mitigate ventilator-induced lung injury (VILI) while maintaining adequate acid–base homeostasis. Although early physiological studies demonstrated feasibility, large, randomized trials have failed to show a survival benefit and have raised concerns about bleeding and technical complications. Recent evidence suggests that these neutral outcomes may stem from the biological and physiological heterogeneity of ARDS rather than from inefficacy of the intervention itself. Patients with high driving pressures, poor compliance, or hyperinflammatory phenotypes may derive greater benefit from ECCO₂R-mediated mechanical unloading. Ongoing technological improvements, including circuit miniaturization, enhanced biocompatibility, and integration with renal replacement therapy, have improved safety and feasibility, yet the procedure remains complex and resource-intensive. Future research should focus on phenotype-enriched trials and the integration of ECCO₂R into precision ventilation frameworks. Ultimately, ECCO₂R should be regarded not as a universal therapy for ARDS but as a targeted physiological tool for selected patients in experienced centers. Full article

Background: Renal impairment is a frequent and severe complication of multiple myeloma, most commonly caused by light-chain cast nephropathy. Therapeutic plasma exchange (TPE) has been proposed as an adjunctive approach to rapidly reduce circulating free light chains; however, its clinical benefit remains controversial. Methods: We retrospectively analyzed 71 patients treated between 2013 and 2023, of whom 30 received TPE in addition to anti-myeloma therapy and 41 received anti-myeloma therapy alone. Renal outcomes were assessed within a predefined early treatment window encompassing the first 4–6 cycles of therapy. Renal response was defined as a ≥50% reduction in serum creatinine and/or dialysis independence. Multivariable logistic regression and sensitivity analyses were performed to adjust for baseline imbalances, including renal function and anti-myeloma backbone therapy. Results: Although renal function improved significantly over time in both groups, renal response rates were comparable between patients treated with and without TPE (40% vs. 36.6%). In multivariable analysis, TPE was not independently associated with renal response. Importantly, in a sensitivity analyses restricted to patients receiving bortezomib-based regimens, the addition of TPE remained unassociated with improved renal outcomes. Conclusions: In this real-world cohort, adjunctive TPE did not confer a significant advantage in renal recovery or dialysis independence beyond contemporary anti-myeloma therapy. These findings indicate that renal recovery is predominantly driven by effective anti-myeloma treatment rather than extracorporeal light-chain removal. Full article