Search Results (5,448)

Intrabody cage augmentation has emerged as a minimally invasive technique for anterior column reconstruction in Kümmell disease and osteoporotic burst fractures. These osteoporotic conditions lead to progressive vertebral collapse, kyphosis, and instability. While cement augmentation provides rapid pain relief, it often fails to reliably restore sagittal balance or ensure biological integration in advanced stages of collapse. Although conventional anterior corpectomy with long-segment posterior fusion can achieve satisfactory deformity correction, these procedures are associated with substantial surgical morbidity. In contrast, screw fixation alone often fails to withstand anterior loading, resulting in loss of correction or hardware failure. By adapting standard interbody devices for off-label intravertebral use, this technique utilizes the intravertebral cleft as a natural cavity to restore vertebral height and sagittal alignment while preserving adjacent intervertebral discs and reducing stress on posterior instrumentation. The surgical technique involves transpedicular access, meticulous curettage of necrotic tissue, and insertion of a cage packed with osteoinductive material. This approach minimizes surgical trauma and operative time compared with conventional corpectomy procedures. Reported outcomes from retrospective series suggest promising pain relief, maintenance of correction, and low complication rates. Collectively, current evidence suggests that intrabody cage augmentation may serve as a potential, less invasive surgical option, acting as an intermediate approach between cement augmentation and corpectomy. However, as the existing evidence remains preliminary, high-quality prospective comparative studies are required to establish definitive indications and long-term efficacy. Full article

Background and Objectives: Chemoports are essential for long-term chemotherapy. They are typically inserted either by interventional radiologists in an interventional radiology (IR) suite or by surgeons in the operating room (OR). Although both approaches are widely used, it remains unclear whether the procedural setting affects complication rates. In this study, we compared the safety of chemoport implantation in IR and OR and evaluated the impact of patient-related factors. Materials and Methods: We retrospectively reviewed 737 adult patients who underwent chemoport placement between January 2021 and December 2023 at a single tertiary institution. Of these, 544 ports were inserted into IR suites and 193 in ORs. All IR procedures used fluoroscopic and ultrasound guidance, whereas OR procedures used ultrasound without intraoperative fluoroscopy. Complications were classified as early (≤30 d) or late (>30 d). Kaplan–Meier analysis and Cox regression analysis were used to assess complication-free survival and identify independent predictors. Results: A total of 45 complications (6.1%) occurred, including 25 infections (3.4%), 9 wound dehiscences (1.2%), and 11 malfunctions (1.5%). There were no significant differences in overall, early, or late complication rates between the IR and OR groups (p > 0.05). Kaplan–Meier analysis demonstrated comparable complication-free survival between the groups (log-rank p = 0.285). Cox regression analysis identified no independent predictors of complications, although higher BMI showed a borderline association (adjusted HR, 1.076; 95% CI, 1.000–1.158; p = 0.051). Conclusions: Chemoport implantation performed in IR suites is as safe as that in ORs, with similar early and late complication rates. Full article

Background: Thoracic sympathetic block (TSB) is an interventional pain management technique commonly used in the treatment of chronic pain conditions associated with sympathetic nervous system dysfunction. Its effectiveness in patients who are refractory to conservative therapies remains clinically important. This study aims to retrospectively evaluate the effectiveness and safety of fluoroscopy-guided thoracic sympathetic block in patients with chronic pain who did not achieve adequate relief with conservative treatment modalities. This study provides real-world 12-month follow-up data using both the Numeric Rating Scale and the McGill Pain Questionnaire to enable a multidimensional assessment of long-term treatment outcomes. Study Design: Retrospective. Methods: A total of 22 patients who presented to the Algology Polyclinic at Ankara University’s İbn-i Sina Hospital between 2017 and 2021, had undergone thoracic sympathetic block, had a NRS score of ≥7, and had completed the McGill Pain Questionnaire, were included in this study. Interventional procedures were performed under fluoroscopic guidance. NRS and MPQ scores were recorded before the procedure and at the 1st, 6th, and 12th months post-intervention. Statistical analysis was performed using the Paired Samples t-test. The primary outcome was the change in NRS score from baseline to 12 months after the procedure. Secondary outcomes included changes in NRS and MPQ scores. Results: Of the participants, 54.5% were diagnosed with CRPS, 27.3% with postherpetic neuralgia, and 18.2% with malignancy. The mean NRS score decreased significantly from 8.59 pre-intervention to 2.05 in the 12th month after the procedure (p < 0.001). Similarly, MPQ scores showed a significant reduction. No procedure-related complications were observed. Conclusions: Fluoroscopy-guided thoracic sympathetic block is a safe and effective interventional option for long-term pain control in patients with chronic pain syndromes, particularly those with complex regional pain syndrome, postherpetic neuralgia, and malignancy-related pain. Full article

Background: Glucagon-like peptide-1 (GLP-1)-based therapies offer significant cardiometabolic benefits. Obesity-related heart failure with preserved ejection fraction (HFpEF) arises from a complex interplay of increased lipids, chronic inflammation, and metabolic disturbances. These factors not only exacerbate the disease but also affect GLP-1 pathways, supporting the potential role of GLP-1-based therapies in targeting this condition. Objective: This review aimed to synthesize the current evidence on GLP-1-based therapy in HFpEF, focusing on mechanisms of action, clinical outcomes, and practical significance. Methodology: A narrative review using PubMed and Scopus was conducted, including studies published between January 2020 and March 2026. Evidence from randomized trials, pooled analyses, mechanistic studies, and observational data was incorporated. Results: GLP-1-based therapies, including semaglutide and tirzepatide, demonstrated significant improvements in symptoms, exercise capacity, and quality of life. These benefits are closely linked to weight loss, reduced inflammation, and improved congestion indices. Tirzepatide use has also been associated with a reduction in heart failure-related complications. The underlying mechanisms likely involve coordinated effects on metabolism, inflammation, hemodynamics, and cardiac remodeling. Current evidence suggests that its efficacy in improving morbidity rates is stronger than its efficacy in reducing mortality rates. Conclusions: GLP-1-based therapies offer a promising, phenotypically targeted approach to managing obesity-associated HFpEF. However, their long-term effects on mortality remain unclear, highlighting the need for further research. Further studies should refine patient selection and define optimal clinical integration. Full article

Survivors of childhood leukemia are at increased risk of long-term skeletal complications, including reduced bone mineral density (BMD). Vitamin D deficiency and genetic variations in the vitamin D receptor (VDR) gene are important factors influencing bone health, yet their combined effects remain insufficiently studied, particularly in North African populations. This case-control study included 130 survivors of childhood acute lymphoblastic leukemia (ALL) in remission (age range: 5–26 years) and 110 age- and sex-matched healthy controls recruited from Beni Messous Hospital. BMD was assessed at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry and expressed as z-scores. Serum 25-hydroxyvitamin D levels were measured, and VDR polymorphisms (FokI, ApaI, and BsmI) were analyzed using PCR-RFLP. Hypovitaminosis D was observed in 43.85% of patients at diagnosis and 23.07% after remission. Survivors had significantly lower BMD compared with controls at both the lumbar spine (z-score: −4.26 ± 0.75 vs. 0 ± 1, p < 0.001) and femoral neck (−3.78 ± 0.45 vs. 0 ± 1, p < 0.001). Reduced BMD for age was identified in 30% of patients. Variant genotypes TT (FokI), AA (BsmI), and CC (ApaI) were more frequent in patients and were associated with lower BMD (p < 0.0001). These findings suggest that hypovitaminosis D and VDR polymorphisms may be associated with bone health in survivors of childhood leukemia. The coexistence of these factors may contribute to interindividual variability in BMD. Full article

This review is intended to highlight the need for non-invasive and earlier therapies for diabetic retinal disease (DRD), one of the most common complications of diabetes, with a high and increasing socioeconomic burden. Due to the growing evidence regarding the key role of neurodegeneration in the earliest stages of the disease and the underlying pathophysiological mechanisms, the relevance of evaluating the potential efficacy of neuroprotective therapies is emphasized. More specifically, the review addresses the current state of a promising neuroprotective approach based on the inhibition of the enzyme dipeptidyl peptidase-4 (DPP-4) using specific inhibitors administered via eyedrops, which allow direct retinal action on the neurovascular unit. The review discusses the main preclinical findings of a therapeutic strategy based on one DPP-4 inhibitor, sitagliptin, against early DRD in different experimental animal models and in vitro studies. In summary, sitagliptin eyedrops exhibit neuroprotective, anti-inflammatory, and antioxidant properties while reducing glial activation, hyperpermeability of the blood–retinal barrier, and the formation of acellular capillaries, leading to a functional improvement of the diabetic retina. However, as sitagliptin efficacy has only been evaluated at the preclinical level, clinical studies are needed to validate the translational applicability and long-term efficacy of topical administration not only of sitagliptin but also of other DPP-4 inhibitors for treating retinal diseases in which neurodegeneration plays a pathogenic role. Full article

Sepsis is a life-threatening syndrome driven by a dysregulated host response to infection and is frequently complicated by sepsis-associated encephalopathy (SAE), which contributes to long-term cognitive and neuropsychiatric sequelae. Despite advances in critical care, effective targeted therapies for SAE remain limited. Aquaporin-4 (AQP4), the predominant astrocytic water channel, plays a central role in cerebral water homeostasis, neuroinflammatory signaling, and blood–brain barrier integrity, suggesting its potential involvement in sepsis-induced cerebral dysfunction and neurorepair processes. Polymicrobial sepsis was induced in C57BL/6J mice using the cecal ligation and puncture (CLP) model. AQP4 activity was pharmacologically modulated through either inhibition or facilitation following sepsis induction. Disease severity was assessed using physiological parameters and a modified murine sepsis score. Neurological outcomes were evaluated through standardized behavioral tests assessing locomotor activity, motor coordination, cognitive performance, and depressive-like behavior. Neuroinflammatory and neuronal changes were examined by immunohistochemical analyses of microglial activation (Iba1), astroglial reactivity (GFAP), neuronal integrity (NeuN), and AQP4 expression. Compared with AQP4 facilitation, pharmacological inhibition of AQP4 was associated with a more favorable clinical recovery profile, reflected by lower sepsis severity scores and a more favorable body weight trajectory during the recovery phase. Behavioral analyses demonstrated preserved cognitive function, enhanced motor coordination, and reduced depressive-like behavior in AQP4 inhibitor-treated mice compared with animals receiving AQP4 facilitation. At the histological level, the inhibitor-treated group showed lower microglial and astroglial activation and better preservation of neuronal markers than the facilitator-treated group, whereas AQP4 facilitation exacerbated neuroinflammatory responses and neuronal alterations. These findings highlight a dual, context-dependent role of AQP4 in sepsis-associated cerebral dysfunction. These findings suggest that AQP4 modulation influences sepsis-associated cerebral dysfunction in a context-dependent manner. Within our experimental design, AQP4 facilitation was associated with worse outcomes, whereas AQP4 inhibition was associated with a comparatively more favorable neurobehavioral and histological profile. Full article

Hemoglobin A1c is a central biomarker for long-term glycemic control and a key predictor of diabetes-related complications. The COVID-19 pandemic disrupted routine healthcare delivery and introduced potential metabolic effects of SARS-CoV-2 infection, yet the long-term impact of COVID-19 on glycemic trajectories in individuals with diabetes remains unclear. In this retrospective study, we leveraged harmonized electronic health record data from the National Clinical Cohort Collaborative to evaluate changes in HbA1c before and after documented SARS-CoV-2 infection in adults with diabetes (n = 93,320). Patients were required to have repeated HbA1c measurements pre- and post-infection and stable exposure to key antihyperglycemic medications. A paired statistical analysis was used to identify individuals with statistically significant post-infection changes in HbA1c. We then developed and evaluated multiple supervised machine learning classifiers using an 80/20 train–test split and cross-validation to assess demographic, clinical, and structural factors associated with significant glycemic change. Most patients (71%) did not experience a statistically significant change in average HbA1c following COVID-19 infection, and among those who did, decreases were more common than increases. A random forest classifier achieved the best overall performance, and feature importance and SHAP analyses highlighted body mass index, insulin use, age, and socioeconomic proxies as key contributors. These findings suggest that while COVID-19 infection does not substantially alter long-term glycemic control for most patients with diabetes, individual-level clinical and structural factors influence post-infection glycemic variability. Full article

Acute chest syndrome (ACS) is a common pulmonary complication in children with sickle cell disease, defined by a new pulmonary infiltrate on imaging accompanied by fever and/or respiratory symptoms. ACS pathophysiology is multifactorial and incompletely understood, involving vaso-occlusion, pulmonary infarction, inflammation, hypoventilation, and infection—the latter being a frequent trigger in children. While most pediatric cases are mild, ACS can be life-threatening and requires prompt diagnosis and management to prevent progression into respiratory failure. Mild cases are managed with pain control, IV hydration, empiric antibiotics, incentive spirometry and supplemental oxygen when needed. More severe cases may require simple or exchange transfusion to reduce hemoglobin S levels and limit further vaso-occlusion. ACS is associated with neurologic events and long-term pulmonary complications, making prevention a clinical priority. Disease-modifying therapies include hydroxyurea and chronic transfusion. This review summarizes current evidence on the pathophysiology, risk factors, clinical presentation, diagnosis, acute management and preventative therapies for ACS in children. Full article

Background and Objectives: Collared, triple-tapered femoral stems have gained increasing popularity in primary total hip arthroplasty (THA) due to their stable metaphyseal fixation and ability to restore native hip biomechanics. This study evaluated the short-term clinical and functional outcomes of a novel collared triple-tapered femoral stem design in primary THA. Materials and Methods: This was a retrospective review of all patients who underwent primary, elective THA using a collared, triple-tapered femoral system at a single, urban, high-volume, academic hospital between September 2024 and February 2025. All procedures were performed by fellowship-trained arthroplasty surgeons. A total of 101 patients (102 hips) with a median follow-up of 1.1 years (range, 1.0 to 1.4 years) were included. Results: Most procedures were performed for primary osteoarthritis (96%). Mean operative time, from skin incision to skin closure, was 93 min, and most femoral stems implanted had a high offset (89%). Most patients were discharged home (96%), with a mean length of stay of 27 h. Within 90 days, three patients were readmitted for surgery-related reasons: one for superficial wound dehiscence, and two for periprosthetic joint infection (PJI). One PJI was treated with irrigation and debridement, antibiotics, and implant retention (DAIR) two months after primary THA. The other required a DAIR three weeks after primary THA, followed by a single-stage revision one week later. No dislocations, periprosthetic fractures, mechanical failures, or aseptic revisions of the femoral stem occurred. All stems were well-fixed at the latest follow-up, with no aseptic loosening observed. Mean Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) improvement was 15.0 points at six weeks, 25.2 points at three months, and 45.3 points at one year. Conclusions: Our results support encouraging early outcomes with no femoral aseptic complications observed using this novel collared, triple-tapered femoral system. A longer follow-up period is needed to assess mid- and long-term durability. Full article

Background: Although survival rates for patients with malignant bone tumors have improved significantly, complications following tumor resection and limb-sparing reconstruction remain a major clinical challenge, particularly in young individuals. Intercalary resection often results in large bone defects, necessitating complex reconstructions. Fibula grafts offer biological advantages; however, their long-term outcomes, especially regarding mechanical complications and comprehensive patient-reported well-being, require further detailed exploration, particularly in cohorts utilizing non-vascularized grafts. Objective: This retrospective study evaluated the complication rates, bone hypertrophy, limb function, and quality of life following non-vascularized fibular graft reconstruction for malignant bone tumors in a single-center cohort. This study offers insights into long-term success and patient well-being, with a particular focus on correlations with systemic therapy and defect size, factors that remain insufficiently explored in the current literature. Methods: In this single-center retrospective study, twenty-four non-vascularized fibular grafts were used to reconstruct intercalary bone defects following malignant tumor resection. Complications were categorized using the Clavien–Dindo classification. Graft hypertrophy was evaluated according to the method described by Weiland and de Boer. Functional outcomes were assessed using the MSTSs and TESSs, while quality of life was measured using the SF-36 questionnaire. Notably, the cohort analyzed represents a relatively large single-center series focusing exclusively on the outcomes of non-vascularized fibular grafts. Results: Our findings revealed significant rates of mechanical complications, with osteosynthesis material failure occurring in 50.0% of cases, pseudarthrosis in 47.6%, and fractures of the fibular grafts in 38.1% of cases. Importantly, there were significant correlations between mechanical complications and systemic therapy (p = 0.017), as well as between defect size and fractures (p = 0.013), identifying critical risk factors. Despite these considerable complication rates, patients achieved satisfactory limb function (MSTS: 74 ± 17; TESS: 83 ± 15) and quality of life scores comparable to national norms, with notably higher mental health indices, highlighting their psychological resilience. Conclusions: Non-vascularized fibular graft reconstruction, despite high mechanical complication rates, significantly facilitates long-term functional recovery and psychological well-being. These findings emphasize the necessity of risk-adapted surgical strategies and long-term follow-up protocols to mitigate complications, optimize long-term function, and ultimately advance patient-centered care. Full article

Degenerative disc disease is a leading cause of chronic low back pain and disability worldwide, and current treatments primarily address symptoms rather than the underlying biological degeneration of the intervertebral disc. Mesenchymal stem cells (MSCs) have emerged as a promising regenerative approach due to their capacity for differentiation, immunomodulation, and secretion of bioactive factors that promote tissue repair. This review summarises findings from experimental and clinical studies investigating the therapeutic potential of MSC-based therapies for intervertebral disc regeneration, with particular focus on translational challenges that limit their clinical application. Preclinical studies generally show that MSC implantation can enhance extracellular matrix production, improve disc hydration, and modulate inflammatory processes within degenerated discs. Early clinical trials report improvements in pain and functional outcomes; however, consistent structural regeneration has not been reliably demonstrated. The limited clinical translation of MSC therapy is associated with several key challenges, including poor cell survival in the harsh disc microenvironment, variability in cell sources and manufacturing protocols, inadequate cell retention following intradiscal injection, and a lack of standardised outcome measures. In addition, regulatory and manufacturing barriers further complicate the development of reproducible and scalable MSC-based therapies. Although MSC-based therapies represent a promising strategy for the biological treatment of intervertebral disc degeneration, further research is required to improve cell survival, optimise delivery systems, standardise manufacturing procedures, and conduct large-scale controlled clinical trials to establish long-term safety and efficacy. Addressing these translational barriers will be essential for the successful integration of MSC-based therapies into clinical practice. Full article

Background/Objectives: Point-of-care ultrasound (POCUS) is increasingly used in intensive care units (ICUs) as a rapid bedside diagnostic tool supporting timely clinical assessment. The impact of nurse-performed POCUS on clinical management, procedural performance, and professional practice in adult ICUs has not yet been systematically synthesized. This review aimed to evaluate the integration of nurse-performed POCUS into nursing care and its effects on technical, decision-making, and professional outcomes. Methods: A systematic review was conducted in accordance with PRISMA 2020 and the JBI Manual for Evidence Synthesis. PubMed, Scopus, CINAHL, and Web of Science were searched without time restrictions. Original studies were included if they involved adult ICU patients and evaluated POCUS performed by nurses, reporting clinical, procedural, or professional outcomes. Methodological quality was assessed using JBI and MMAT checklists according to study design. Results: Eleven studies were included. The results were synthesized into four primary domains: (1) support for the clinical decision-making process, (2) technical performance and procedural outcomes, (3) diagnostic accuracy, and (4) professional autonomy, training, and sustainability of competencies. Nurse-performed POCUS was associated with management changes in 26–67% of assessments and improved first-attempt success in ultrasound-guided peripheral venous access. Diagnostic accuracy was acceptable when supported by structured training, with no reported increase in complications. Conclusions: Nurse-performed POCUS in adult ICUs appears safe and practice-enhancing, supporting decision-making and selected procedural outcomes. Further multi-center controlled studies are required to clarify its impact on major clinical endpoints and long-term outcomes. Full article

Diabetes mellitus is a chronic disease with complex progression dynamics. This study introduces a fractional order compartmental model based on the Caputo derivative, a singular-kernel derivative, to describe disease progression across four compartments: susceptible, insulin-resistant, diabetic without complications, and diabetic with complications. The model is novel for integrating memory effects into disease-stage transitions while maintaining dimensional consistency. Key mathematical properties, including existence, uniqueness, positivity, boundedness, equilibrium analysis, and both local and global stability, are established. Ulam–Hyers stability is also examined to evaluate the robustness of the model solutions. Numerical approximations are obtained using the Adomian Decomposition Method and its Laplace variant. Simulations indicate that lower fractional orders enhance memory effects, slow disease progression, and influence long-term dynamics. These results demonstrate that the proposed approach provides a flexible and robust framework for studying chronic disease progression and makes a meaningful contribution to the literature on fractional diabetes models. Full article

Intensive care unit-acquired weakness (ICUAW) is a common and devastating complication in critically ill patients admitted to the intensive care unit (ICU). ICUAW is characterized by profound skeletal and respiratory muscle weakness and degeneration, as well as peripheral nerve dysfunction. The condition is further categorized into three primary diagnoses: critical illness myopathy (CIM), which affects skeletal muscles, critical illness polyneuropathy (CIP), which affects peripheral nerves, and critical illness polyneuromyopathy (CIPNM), which exhibits features of both CIM and CIP. Although the pathophysiology of ICUAW remains poorly understood, several risk factors have been identified, including female sex, advanced age, prolonged mechanical ventilation, extended ICU stay, prolonged immobilization, multiorgan failure, shock, infection, and other factors related to critical illness and its treatment. Currently, ICUAW is diagnosed after the onset of critical illness, and only once all other possible causes of generalized weakness have been excluded. The most commonly used assessments for suspected ICUAW are the Medical Research Council sum score (MRC-SS) and handgrip dynamometry. However, these tools require active patient participation and are, therefore, impractical for many ICU patients. Non-volitional testing methods, including electromyography (EMG) and nerve conduction studies, can be used to evaluate ICUAW, but these tests are invasive and require specialized training and resources. Due to the lack of effective diagnostic tools and an incomplete understanding of disease mechanisms, management of ICUAW is largely restricted to physical rehabilitation. ICUAW is associated with high morbidity and mortality, and survivors often experience long-term disability and reduced quality of life following hospital discharge. Future areas of research, including biomarker analysis and risk prediction modeling, may enable earlier diagnosis and intervention in critically ill patients. This review summarizes potential diagnostic tools, current management strategies, and short- and long-term prognosis and identifies emerging areas of research aimed at improving outcomes for critically ill patients with suspected ICUAW. Full article