Search Results (8,045)

The safety of non-food products is embedded in the United Nations 2030 Agenda for Sustainable Development and the European Union (EU) framework, supporting health protection, responsible production and consumption, and market surveillance. The EU Rapid Alert System for dangerous non-food products, known as Safety Gate (formerly RAPEX), was established in 2005 to facilitate the exchange of information on products posing risks within the internal market. The aim of this study was to present the interdependencies reported in the Safety Gate system/RAPEX in 2005–2025, considering: product category, type of risk, country of origin, notifying country and year, as well as measures taken. The VOSviewer 1.6.20 and Statistica 13.3 were used. The results highlighted the following problems: toys from China with chemical, choking and injury risks; electrical appliances also from China with electric shock hazards; motor vehicles from Germany with injury risks; cosmetics from Italy with chemical and microbiological risks; and clothing from Turkey with suffocation risks. Reporting is expected to continue under existing regulatory frameworks, although changing the name of the system from RAPEX to “Safety Gate” may reduce its recognition. The findings highlight the need for targeted enforcement, improved risk profiling by product category and origin, and ongoing monitoring of emerging safety risks. Full article

Osteoradionecrosis of the jaw (ORNJ) remains one of the most severe late complications of head and neck radiotherapy. Current evidence suggests that ORNJ is a progressive and biologically heterogeneous disorder driven by microvascular injury, chronic hypoxia, oxidative stress, fibro-atrophic remodeling, impaired bone turnover, immune dysregulation, and systemic susceptibility factors. Within this complex pathogenic network, heat shock protein 27 (HSP27) emerges as a biologically plausible but unexplored mediator. HSP27 regulates multiple stress-response pathways, including redox homeostasis, cytoskeletal stabilization, endothelial protection, apoptosis control, fibroblast activation, and osteoblast–osteoclast function, all of which overlap with key mechanisms implicated in ORNJ. However, no studies have directly investigated HSP27 expression, activation, or functional significance in irradiated mandibular tissues or ORNJ-specific cohorts. This review summarizes current knowledge of ORNJ pathobiology, examines potential mechanistic links with HSP27, and outlines future research priorities involving biomarker development, tissue-level characterization, preclinical modeling, and therapeutic targeting. Integrating HSP27 into ORNJ research may improve understanding of pathogenesis, risk stratification, and the development of novel preventive and therapeutic strategies. Full article

Perioperative myocardial ischemia and myocardial injury after noncardiac surgery (MINS) remain prevalent contributors to postoperative morbidity and mortality. Recent advances, including high-sensitivity biomarkers and updated 2024 American Heart Association/American College of Cardiology (AHA/ACC) guidelines, have modified the clinical approach to preoperative ischemic evaluation. This review intends to synthesize contemporary evidence and provide a framework for perioperative ischemic workup. A narrative review of the current literature and major society guidelines was conducted, focusing on perioperative risk stratification, functional capacity assessment, biomarker utilization, noninvasive and invasive diagnostic modalities, and perioperative medical optimization strategies. Contemporary perioperative evaluation favors a stepwise, risk-based approach that uses clinical risk indices, functional capacity, and selective diagnostic testing. Biomarkers such as natriuretic peptides and cardiac troponins enhance risk prediction and enable the detection of MINS, which is strongly associated with increased mortality. Evidence does not support routine preoperative stress testing or prophylactic coronary revascularization in stable patients. Guideline-directed medical therapy, including sustained statin use and attentive management of antiplatelet and beta-blocker therapy, remains central to risk mitigation. Modern perioperative ischemic workup prioritizes individualized, evidence-based evaluation over routine testing. Integration of biomarkers, structured risk assessment, and multidisciplinary management may improve outcomes, though additional research is needed to define optimal strategies for detecting and treating MINS. Full article

Background/Objectives: Oral mucosal injury is a frequent complication in oncologic and surgical settings, significantly affecting patient quality of life. Zinc L-carnosine (ZnC) is a cytoprotective compound with anti-inflammatory, antioxidant, and epithelial reparative properties. This systematic review evaluated its protective and healing effects on oral mucosa. Methods: A systematic search followed PRISMA guidelines was conducted across PubMed, Scopus, Web of Science, and Cochrane Library (2015–2026). Randomized and non-randomized controlled studies assessing ZnC in patients with or at risk of oral mucosal injury were included. Risk of bias was evaluated using RoB 2 and ROBINS-I tools. Meta-analyses were conducted under both common- and random-effects models. The certainty of evidence was evaluated according to the GRADE guidelines. Results: Eight studies (n = 544) were included. Six non-randomized studies showed moderate or serious risk of bias, while randomized trials presented some concerns. ZnC was administered in different formulations, including mouthwashes, lozenges, and mucoadhesive suspensions based on sodium alginate, polyacrylic acid, and carboxyvinyl polymer, and across different clinical settings. Meta-analysis showed a reduced incidence of severe oral mucositis (grade ≥3) under the Common Effect model (OR 0.48; 95% CI 0.32–0.72), although statistical significance was not maintained under random-effects models (OR 0.44; 95% CI 0.18–1.06). Similar results were observed for grade ≥2 mucositis. According to the GRADE assessment, the certainty of evidence was low for oral mucositis outcomes and very low for oral mucosal healing. Only one study suggested improved surgical wound healing. No serious adverse events were reported. Conclusions: ZnC may support oral mucosal protection and healing, particularly in preventing oral mucositis. However, substantial heterogeneity and limited high-quality randomized evidence restrict the strength of conclusions. Further well-designed randomized trials are needed. Full article

Introduction: High-Intensity Focused Ultrasound (HIFU) is a widely used non-invasive esthetic treatment for facial/neck rejuvenation, inducing thermal coagulation for neocollagenesis. Despite its general safety, its non-optimal application risks neurological adverse events like tinnitus, trigeminal neuralgia, and headaches. Materials and Methods: Out of a pool of 124 patients treated with HIFU (Dual Hi; Med & Tech, Occhiobello, Italy) by experienced esthetic clinicians, four patients developed neurological or otological disturbances, which are presented as descriptive clinical case reports. These included acute tinnitus, exacerbation of pre-existing tinnitus, trigeminal neuralgia during treatment, and post-procedural headaches. To contextualize the clinical findings, relevant published literature on neurological adverse events associated with esthetic HIFU was reviewed in a non-systematic manner using major scientific databases, and used to support descriptive clinical interpretation rather than formal systematic analysis. Results: Rare transient events include acute tinnitus post-HIFU; exacerbated pre-existing tinnitus; trigeminal neuralgia during a procedure; and post-session headaches. Potential mechanisms might include thermal and mechanical nerve injury adjacent to the superficial musculoaponeurotic system (SMAS); all cases resolved successfully through tailored approaches—spontaneous resolution, corticosteroids plus hyperbaric oxygen therapy, analgesics, or ibuprofen. Conclusions: Neurological adverse effects from esthetic HIFU are uncommon/self-limiting but underscore the need for operator training, anatomical expertise, and patient history screening. Standardized protocols are essential for safety. Full article

Lipomyelomeningocele (LMMC) is one of the most common forms of occult spinal dysraphism, with an estimated incidence of 3–6 per 100,000 live births, and microsurgical untethering remains the cornerstone of management for symptomatic and selected at-risk children. The operation is technically demanding: reported rates of long-term symptomatic re-tethering after partial resection still reach 15–25%, and the surgeon must balance adequate untethering against preservation of the placode and lumbosacral nerve roots. In this technical note, we present a stepwise, illustrated description of our institutional 14-step microsurgical technique for pediatric LMMC. Each step is anchored to a defined anatomical landmark, beginning with a midline skin incision planned away from the anal verge and proceeding through subtotal subcutaneous lipoma resection, identification of the dural penetration site, a limited rostral laminectomy over normal anatomy, dural opening with circumferential dissection of lipoma–dura–cord adhesions, exploitation of the arachnoid–dura plane, electrophysiologically guided debulking of the intradural lipoma, stimulation-controlled division of the fatty filum, pia-to-pia reconstruction of the placode with 8-0 monofilament suture, expansile duraplasty with an artificial dural substitute, and reinforced multilayered watertight closure. Technical pearls aimed at minimizing the risks of cord injury, cerebrospinal fluid leak, and postoperative re-tethering are highlighted at each stage, and the role of multimodal intraoperative neurophysiological monitoring is emphasized. This note is intended as a practical, image-anchored operative reference for pediatric neurosurgeons and trainees managing this challenging closed neural tube defect. Full article

Background: Natriuretic peptides, including B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), are established biomarkers of myocardial stress and circulatory overload. Although originally validated for diagnosis and exclusion of heart failure, their diagnostic and prognostic applications have expanded significantly in the context of critical illness. However, interpretation in critically ill patients is complicated by confounding factors such as systemic inflammation and renal dysfunction. Objective: This review synthesizes current evidence on the diagnostic, monitoring, and prognostic applications of natriuretic peptides in critically ill adults. It further outlines practical considerations, confounding variables, and emerging complementary biomarkers pertinent to clinical decision-making. Methods: A structured search of PubMed, Embase, and the Cochrane Library (January 2000 to October 2025) identified studies evaluating BNP, NT-proBNP, and atrial natriuretic peptide (ANP) in intensive care unit (ICU) patients. Eligible studies and review articles assessed diagnostic utility, volume status, hemodynamic monitoring, and prognostic performance. Narrative synthesis was employed using information obtained from eligible studies. Results: Twenty-four studies met the inclusion criteria. BNP and NT-proBNP facilitate differentiation between cardiogenic and noncardiogenic respiratory failure, identification of mixed shock states, and assessment of volume status when used in association with other modalities such as echocardiography and ultrasonography. Elevated natriuretic peptide concentrations consistently predict mortality, acute kidney injury, prolonged mechanical ventilation, and adverse outcomes in several disease states, including sepsis, acute respiratory distress syndrome [ARDS], postoperative cardiac dysfunction, and COVID-19-related critical illness. However, interpretation remains limited by confounders, including renal impairment, age, systemic inflammation, brain injury, mechanical ventilation, and right-ventricular strain/dysfunction. Conclusions: Natriuretic peptides serve as valuable adjuncts for diagnostic assessment, hemodynamic monitoring, and risk stratification in the ICU. When interpreted with attention to biological kinetics and clinical context, these biomarkers enhance multimodal monitoring and support individualized management. Future research should refine ICU-specific cutoffs and assess natriuretic peptide–guided therapeutic strategies in prospective multicenter trials. Full article

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is associated with adverse outcomes in sepsis, but risk stratification within MASLD remains insufficiently defined. We investigated whether an admission liver–metabolic phenotype framework combining cardiometabolic burden with liver injury/fibroinflammatory risk markers identifies clinically relevant organ-support vulnerability in community-acquired sepsis. Methods: This secondary analysis of the prospective SepsisFAT cohort (378 adults with community-acquired sepsis) classified patients into four phenotypes by cardiometabolic burden (≥2 of: diabetes, hypertension, dyslipidemia, BMI ≥ 30 kg/m²) and liver-risk positivity (FIB-4 ≥ 2.67, APRI ≥ 1.0, liver stiffness ≥ 10 kPa, or FAST ≥ 0.55). The primary outcome was acute kidney injury (AKI), while continuous renal replacement therapy (CRRT), other organ-support outcomes and in-hospital mortality were secondary endpoints. Results: Phenotype distribution was Low-risk 137 (36.2%), Cardiometabolic-only 84 (22.2%), Liver-dominant 88 (23.3%), and Mixed liver–cardiometabolic 69 (18.3%). AKI and CRRT increased across phenotypes (13.9% to 40.6% and 5.1% to 26.1%, respectively), and in-hospital mortality was highest in the Mixed phenotype (26.1%). After Firth-penalized adjustment for age, sex, and admission SOFA, the Mixed phenotype remained independently associated with AKI (aOR 2.82, 95% CI 1.37–5.90) and CRRT (aOR 3.87, 1.50–10.80), confirmed in non-renal SOFA and admission eGFR-adjusted sensitivity analyses. Cardiometabolic burden alone did not confer excess organ-support risk. The same gradient persisted within the MASLD subgroup. Conclusions: Admission liver–metabolic phenotyping identified a renal-vulnerable sepsis subgroup not captured by binary MASLD classification alone. These findings support prospective, multicenter external validation of liver–metabolic phenotyping as a pragmatic approach to renal risk stratification in community-acquired sepsis. Full article

Background/Objectives: The relationship between body composition (BC), sarcopenia, and multiple sclerosis (MS) remains poorly understood. A high body mass index (BMI) is associated with a higher risk of MS and brain atrophy. However, limited data are available on BC in patients in the early stages of the disease. This study investigates differences in BC and sarcopenia between early-diagnosed patients with MS (pwMS) and healthy controls (HC), while exploring correlations with brain atrophy and biomarkers of oxidative stress and axonal injury. Methods: This project is part of BPS-ARMS, a cross-sectional study conducted in 2019–2022 at Verona University involving 51 participants aged 18–40 years, diagnosed with MS in the last two years, and currently not taking disease-modifying drugs. Seventeen (69% females) pwMS consented to be enrolled in this sub-study, matched by age and body mass index (BMI) to 17 HC; BC was assessed using Dual-Energy X-ray Absorptiometry (DXA). Collected variables included BMI, fat and lean mass, and sarcopenia index (SI). A brain MRI scan was performed in pwMS between 6 months before and 1 month after inclusion, to assess T2 lesion, normalized brain (NBV), white matter (WMV) and gray matter (GMV) volumes, and presence of gadolinium-enhancing (Gd+) lesions. Biomarker analysis was performed on blood samples collected at baseline. Oxidative stress was assessed as plasma gluthatione (GSH) and gluthatione disulphide (GSSG) levels and STAT1 phosphorylation at Tyr 701 (pSTAT) in peripheral blood cells, while axonal damage was measured as serum neurofilament light chain (NfL) levels. Results: A significantly lower SI was found in pwMS compared to HC (p = 0.038), particularly in female cases. In the pwMS group, WMV was inversely correlated with SI (p = 0.028) and lean body mass (p = 0.016). BMI was inversely correlated with WMV (r = −0.658, p = 0.02). A significant inverse correlation of plasma GSSG level was found with SI (r = −0.546, p = 0.023) and lean mass (r = −0.585, p = 0.014); the ratio of GSH over GSSG (GSH/GSSG) was directly correlated with SI (r = 0.518, p = 0.036) and lean mass (r = 0.568, p = 0.017). Conclusions: Patients with early-stage untreated MS and low-grade disability are more prone to sarcopenia than HC. Moreover, MS subjects with higher BMI show lower brain white matter volume and a lower global brain volume. Full article

Background: Several studies reveal an inverse relation between serum 25-hydroxyvitamin D [25(OH)D] concentration and the risk of acute ischemic stroke (AIS). The aim of this study was to determine relationships between 25(OH)D concentration and the course and outcomes of AIS treatment and the level of indices of inflammatory response to brain injury. Patients and Methods: Retrospective analysis of medical documentation of 1381 real-world AIS patients hospitalized in a single center between 1 January 2020 and 31 May 2025. Serum 25(OH)D level, several inflammatory indices, and clinical data were assessed. Results: Compared to patients in the lowest quartile of 25(OH)D concentration, those in the highest quartile had a shorter length of in-hospital stay, a lower risk of all-cause death, and a lower score for disability on a modified Rankin scale (mRS). Along with an increase in 25(OH)D quartiles, we found: a decrease in neutrophil count; a decrease in glucose, HbA1c, albumin, C-reactive protein (CRP), and CRP-to-albumin, -lymphocyte, -neutrophil, and -platelet ratios; lower neutrophil-to-lymphocyte and -albumin ratios, and lower systemic immune inflammation, and systemic inflammation response indices. In multifactorial logistic regression, the quartile of 25(OH)D (OR, 95% CI: 1.52, 1.09–2.12; p = 0.012) was the only variable to have a positive association with a mRS score ≤ 2 at discharge from hospital, and neutrophil-to-lymphocyte ratio, age, diabetes, and treatment with endovascular mechanical thrombectomy were biomarkers of poor functional status at discharge. Conclusions: Higher 25(OH)D concentration in AIS patients is related to better survival and a lower level of inflammatory response indices and disability at discharge. Full article

Background: Intraoperative vascular injuries during elective hip and knee arthroplasty are uncommon but limb-threatening complications. Real-world evidence on emergency on-call vascular management in this setting remains limited. We aimed to identify the intraoperative ischemia time threshold associated with progression to a more severe ischemic presentation (Rutherford IIb) at vascular consultation, in order to support early multidisciplinary activation and prevent irreversible ischemic limb damage. As a secondary aim, we described the clinical spectrum, treatment strategies, and 30-day outcomes of patients managed by a 24 h on-call vascular service (in-hospital coverage during working hours, formal on-call rota out of hours). Non-ischaemic events recorded in the series (e.g., isolated venous injuries and haemorrhagic complications) are documented as part of the overall clinical spectrum but were not the subject of specific time-related analysis. Methods: Single-centre retrospective analysis of 33 consecutive patients undergoing emergency vascular intervention for vascular injury during elective total knee (TKA) or total hip arthroplasty (THA) at a tertiary orthopaedic referral centre in Milan, Italy (January 2023—December 2025). The primary analytical objective was to identify the intraoperative ischemia time threshold associated with Rutherford IIb presentation at vascular consultation; 30-day limb salvage was the primary clinical outcome. Secondary outcomes included technical success, primary 30-day patency, postoperative ankle–brachial index (ABI), length of stay, and Clavien–Dindo complications. Non-ischaemic events (including isolated venous injuries and haemorrhagic complications) are documented as part of the clinical spectrum but were not subject to specific time-related analysis. Receiver operating characteristic (ROC) analysis assessed the discriminative role of intraoperative ischemia time for a Rutherford IIb presentation; univariate logistic regression explored predictors of postoperative complications. Results: Thirty-three patients (mean age 76.3 ± 6.3 years; 54.5% female; ≥2 comorbidities in 81.8%) underwent emergency vascular repair after TKA (60.6%) or THA (39.4%). Injuries were mixed arteriovenous (54.5%), purely venous (24.2%), or purely arterial (21.2%). Mean call-to-incision time was 45.4 ± 11.3 min. In the 25 ischemic cases, the mean intraoperative ischemia time was 130.4 ± 18.7 min. ROC analysis identified an optimal cut-off of 131 min for Rutherford IIb (AUC 0.851, 95% CI 0.679–0.982; p < 0.001), with sensitivity 81.8% and specificity 85.7%. Median ischemia time was significantly higher in IIb than IIa cases (144 vs. 124.5 min; p = 0.003). Technical success and 30-day limb salvage were 100% (95% CI 89.6–100); mean postoperative ABI 0.89 ± 0.03; primary 30-day patency 88.0% (95% CI 70.0–95.8), with secondary patency 100%. All postoperative complications were Clavien–Dindo grade 1; no Clavien–Dindo ≥ 2 events and no 30-day mortality were observed. Conclusions: A dedicated 24 h on-call vascular service achieves excellent 30-day limb salvage and patency in iatrogenic vascular injuries occurring during arthroplasty. An intraoperative ischemia threshold of 131 min identifies higher-risk presentations and supports rapid multidisciplinary activation in high-volume orthopaedic centres. Full article

Inflammatory bowel disease (IBD) represents a growing global health threat that markedly increases colorectal cancer risk, yet conventional immunosuppressive agents achieve mucosal healing in only a limited subset of patients. M2-polarized macrophages have been recognized as crucial regulators of mucosal repair through their ability to maintain intestinal microenvironment homeostasis. Here, we investigated the potential effects and mechanisms of macrophage-derived exosomes (Exos) on epithelial barrier function in a murine model of IBD. Murine colitis was induced by intrarectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS), followed by treatment with Exos isolated from IL-33-treated macrophages (IL-33-Exos) or untreated macrophages (PBS-Exos). Our findings showed that IL-33-Exos markedly ameliorated inflammatory intestinal mucosal injury and improved intestinal barrier dysfunction. Concurrently, IL-33-Exos mitigated intestinal epithelial cell damage, thereby preserving intestinal mucosal integrity. Mechanistic studies revealed that the beneficial effects of IL-33-Exos were implicated in upregulation of Wnt/β-catenin signaling in intestinal epithelial cells. Translationally, these findings suggest that IL-33-Exos may promote epithelial repair in experimental colitis, offering a novel therapeutic avenue for clinical management of inflammatory bowel disease. Full article

Traffic crash severity modeling is an important and promising aspect of road safety research. It aims to assess how key human-, vehicle-, roadway-, and environment-related factors interact to shape severity outcomes of crashes. Existing studies in this regard have predominantly relied on traditional statistical methods and simple machine learning approaches. While statistical analysis techniques are often based on unrealistic underlying assumptions, conventional machine learning models often suffer from interpretability issues. This study proposes an interpretable crash severity prediction framework that combines machine learning and deep learning models with post hoc explainability using SHAP. The research utilizes crash data from a rapidly developing region of Qassim in the Kingdom of Saudi Arabia. Crash severity was classified into three groups: fatal, injury, and property damage only (PDO). Four predictive models were developed and evaluated. These include: Random Forest (RF), Support Vector Machine (SVM), Feedforward Neural Network (FFNN), and Gradient-Boosting Machine (GBM). Various performance metrics, including accuracy, balanced accuracy, macro F1-score, and ROC–AUC, were used to assess the model. Descriptive statistical analysis showed that speeding, head-on collisions, wrong-way driving, blown-out tires, and driver fatigue are the major causes of fatal injuries. Empirical results revealed that the proposed prediction models achieved an accuracy ranging between 0.94 and 0.96 for the test data, with the RF model slightly outperforming the other models. Model interpretability analysis indicated that crash severity is significantly influenced by parameters such as crash cause, type, speed, and roadway type. The proposed framework demonstrated the effectiveness of machine learning (ML) and deep learning (DL) approaches for crash severity prediction and provides practical insights to support roadway safety interventions and policy development aimed at reducing severe and fatal crashes. Full article

Background: Normalized strength outcomes and limb symmetry indices (LSIs) are widely used but poorly characterized across testing conditions, and it is unclear if these vary by sex. This study aimed, first, to investigate sex-related differences in normalized knee flexor strength and LSI values across multiple strength-testing conditions in healthy recreational athletes, and, second, to descriptively examine associations among strength outcomes obtained under different testing conditions within female and male participants. Methods: In this cross-sectional study, 52 healthy, recreationally active adults (26 females and 26 males) underwent bilateral knee flexor strength testing using three force plate-based isometric assessments, one static dynamometer-based isometric assessment, and three isokinetic dynamometer-based assessments. Differences were analyzed with a mixed analysis of variance (ANOVA), and associations were assessed using Pearson correlations. Results: Males showed higher normalized knee flexor strength than females across all testing conditions (main effect of sex: p < 0.001; partial η² = 0.334–0.371), with the magnitude of these sex-related differences varying across testing conditions (sex-by-testing condition interaction: p < 0.001; partial η² = 0.215–0.230). LSI values did not differ by sex (p = 0.896) and remained consistent across testing conditions (p = 0.385). Correlations were generally stronger within force plate-based and isokinetic dynamometer-based assessments (r = 0.528–0.922) than between different testing conditions. Conclusions: Sex-related differences were observed for normalized knee flexor strength but not for LSI values. Strength outcomes obtained under different testing conditions should not be considered directly interchangeable. Full article

Background: Catheter-associated urinary tract infections (CAUTIs) are a major concern in patients with long-term indwelling urinary catheters, especially those with neurogenic bladder. This study assessed whether proactive cystoscopic removal of bladder debris reduces symptomatic UTI incidence and catheter blockage. Methods: This prospective, self-selected cohort study was conducted between January 2022 and December 2025 at a tertiary center in Taiwan. Enrollment occurred from January 2022 to June 2024, with follow-up completed by December 2025. Patients chose standard CDC-guided care (control, n = 63) or standard care plus flexible cystoscopy every 3 months for gentle low-volume evacuation (<100 mL normal saline) of dependent bladder debris (intervention, n = 141). Inverse probability of treatment weighting (IPTW) was used to address selection bias. Symptomatic UTIs were prospectively recorded using strict criteria. Cumulative incidence was analyzed with Kaplan–Meier methods and multivariable Cox regression. Results: After IPTW, baseline characteristics were well balanced. Median follow-up was 26 months (IQR 18–34). The incidence of catheter blockage was significantly lower in the intervention group (7.8% vs. 22.2%, p = 0.004). In the overall cohort, the reduction in symptomatic UTI incidence did not reach statistical significance (49.2% vs. 36.9%, p = 0.092). In the pre-specified spinal cord injury (SCI) subgroup (n = 71), the intervention was associated with improved UTI-free survival (log-rank p = 0.03; adjusted HR 0.52, 95% CI 0.28–0.96, p = 0.037; treatment × SCI interaction p = 0.042). All adverse events were Clavien–Dindo Grade I. No major complications occurred. Conclusions: Proactive gentle cystoscopic debris removal was associated with reduced catheter blockage. A signal toward lower symptomatic UTI risk was observed in the SCI subgroup, but not in the overall cohort. Due to the self-selected design and residual confounding, these findings are hypothesis-generating. Full article