Search Results (3,096)

Background/Objectives: Rural older adults are exposed to multiple chronic stressors that may heighten depressive symptoms, and these effects can be intensified by social disconnection, particularly in resource-constrained settings. This study examined whether global and dimension-specific perceived social support—an indicator of perceived social connection—mediates and/or buffers the association between perceived stress and depressive symptoms in rural older adults from northern Peru. Methods: A cross-sectional survey was conducted with 166 community-dwelling adults aged ≥60 years in a rural coastal district. Perceived stress (PSS-4), depressive symptoms (GDS-15), and perceived social support (MOS-SSS) were assessed. Regression-based mediation and moderation models with bootstrapped confidence intervals were estimated, adjusting for age, sex, marital status, education, income category, and chronic medical conditions. Results: Higher perceived stress was associated with greater depressive symptoms. Greater overall social support was associated with lower perceived stress and fewer depressive symptoms. Indirect effects supported a stress-process pathway for overall support, particularly socioemotional dimensions (positive social interaction and affectionate support). No buffering effect was observed for overall support; however, tangible (instrumental) support attenuated the association between stress and depressive symptoms. Conclusions: Mediation analyses supported an indirect pathway linking perceived stress to depressive symptoms via socioemotional support, whereas tangible (instrumental) support moderated the stress–depression association. Interventions that strengthen social connectedness and practical assistance may help protect mental health in rural older adults. Full article

Benzene-1,2,4-triyl tris(2-(3-carboxy-4-hydroxybenzenesulfonate) acetate) synthesis is an important step forward in the synthesis of multifunctional organic molecules, which have potential uses in material science and medical chemistry, among other domains. In analytical chemistry, it can also be utilized for metal ion determination. This work presents a thorough and methodical approach to the synthesis of this complicated trisulfonated aromatic ester, emphasizing the effectiveness and scaling possibilities of the methodology. Choosing the right precursors to ensure that each one would contribute to the intended molecular architecture was the first step in the synthesis process. In the initial stages of the synthesis process, oxyhydroquinone was reacted with chloroacetyl chloride for 20 h. As a result, benzene-1,2,4-triyl tris(2-chloroacetate) of triatomic phenol-oxyhydroquinone was formed. The resulting phenacetyl chloride was reacted with sodium sulfosalicylate in the presence of N,N-dimethylformamide (DMFA). Benzene-1,2,4-triyl tris(2-(3-carboxy-4-hydroxybenzenesulfonate) acetate) was formed. To obtain high yields and purity, careful adjustment of the reaction conditions that including temperature, solvent selection, and reagent ratios was required. The synthesized molecule was characterized using advanced spectroscopic techniques such as NMR, IR, and UV spectrometry, which confirmed its structural integrity and functional group configuration. Benzene-1,2,4-triyl tris(2-(3-carboxy-4-hydroxybenzenesulfonate) acetate), the resultant product, has special physicochemical characteristics. In particular, it is more soluble and has the potential to be a useful intermediate in organic synthesis. Because it has several reactive sites, preliminary research indicates that it may be useful in the development of new polymeric materials and as a possible ligand in coordination chemistry. Full article

Background/Objectives: Evidence regarding the impact of COVID-19 vaccination on children and adolescents remains limited, particularly in Japan. Thus, this study aimed to estimate incidence rates of COVID-19-associated hospitalization by vaccination status and evaluate the association between COVID-19 vaccination and COVID-19-associated hospitalization among individuals aged 6 months to <18 years in Japan. Methods: We conducted a retrospective, population-based cohort study using linked health insurance claims data and municipal COVID-19 vaccination registry records from nine Japanese municipalities between 1 January 2022, and 31 March 2023, when the Omicron variant was dominant nationwide. Incidence rates of COVID-19-associated hospitalization were estimated among unvaccinated individuals and those who had received one dose (partially vaccinated) or at least two doses of an ancestral monovalent COVID-19 vaccine (fully vaccinated). Incidence rate ratios (IRRs) were calculated, adjusting for age group, sex, presence of underlying medical conditions, municipality, and calendar month. Results: Among 163,305 individuals, 93 COVID-19-associated hospitalizations were identified. Crude incidence rates were 4.5 (95% confidence interval [CI]: 3.6–5.6), 3.2 (95% CI: 0.1–18.0), and 2.3 (95% CI: 1.1–4.2) per 100,000 person-months in unvaccinated, partially, and fully vaccinated groups, respectively. The adjusted IRR for the fully vaccinated group was 0.429 (95% CI: 0.198–0.930). Among hospitalized patients, 30.1% had underlying medical conditions, and only 4.3% required oxygen administration during hospitalization. Conclusions: Receiving at least two doses of COVID-19 vaccine was associated with a lower incidence rate of COVID-19-associated hospitalization among children and adolescents during the Omicron-dominant period in Japan. Expanding vaccine uptake among eligible pediatric populations may help reduce the burden of severe disease. Full article

Background: Gustatory dysfunction represents an underrecognized complication that may influence dietary behaviors and metabolic control. Previous investigations have suggested alterations in taste in patients with diabetes, yet the relationship between disease duration and specific taste modalities remains incompletely characterized. Aim: This study aimed to (i) compare orosensory detection thresholds for lipid and sweet tastes between patients with recent type 2 diabetes mellitus (rT2DM) (duration ≤ 5 years) and chronic type 2 diabetes mellitus (cT2DM) (duration > 5 years), and (ii) determine whether diabetes duration is associated with alterations in chemosensory function in a North African population. Methods: A cross-sectional comparative pilot study was conducted at the National Institute of Nutrition and Food Technology in Tunis, Tunisia, from April to June 2021. Sixty-seven patients with type 2 diabetes mellitus (T2DM) receiving oral antidiabetic medication were recruited through systematic sampling and divided into two groups: rT2DM (n = 30, duration ≤ 5 years) and cT2DM (n = 37, duration > 5 years). Orosensory detection thresholds for lipid taste were assessed using eight ascending concentrations of linoleic acid ranging from 0.018 to 12 mmol/L. In contrast, sweet taste thresholds were evaluated using a sucrose concentration series ranging from 0.01 to 5 mmol/L. The three-alternative forced-choice method with an ascending-concentration presentation was employed for both taste modalities. Detection thresholds were defined as the lowest concentration at which participants correctly identified the taste quality. Results: Patients with cT2DM exhibited significantly elevated orosensory detection thresholds compared to those with rT2DM for both taste modalities tested. The median linoleic acid detection threshold was 6.000 mmol/L in cT2DM versus 0.058 mmol/L in rT2DM (p < 0.001), representing a 107-fold increase in detection threshold. For sweet taste, the median sucrose detection threshold was 1.0 mmol/L in cT2DM compared with 0.5 mmol/L in rT2DM (p < 0.001), indicating a 2-fold increase in the threshold. In the overall patient cohort, the duration of diabetes was positively correlated with both fat taste perception thresholds (r = 0.657, p < 0.001) and sweet taste perception thresholds (r = 0.466, p < 0.001). However, when analyses were performed by diabetes duration-based subgroups, these correlations were observed only for fat taste perception in cT2DM, with no statistically significant correlations found in rT2DM. In multivariate linear regression analyses adjusted for age, body mass index, and sex/gender, the duration of diabetes remained independently associated with fat and sweet taste perception. Conclusions: Extended T2DM duration is associated with substantial elevations in orosensory detection thresholds for both lipid and sweet tastes in a North African population. These findings suggest that disease chronicity may contribute to chemosensory impairment, potentially influencing dietary preferences and metabolic control in patients with diabetes. Full article

Background: Traumatic brain injury (TBI) is a global healthcare problem, and post-traumatic amnesia (PTA) is a known predictor of long-term and societal outcomes. However, factors influencing PTA recovery during the inpatient rehabilitation phase remain underexplored, particularly in Asian populations. Objective: To identify factors associated with PTA duration and emergence during inpatient rehabilitation and examine their impact on functional outcomes. Materials and Methods: We conducted a retrospective, single-center cohort study over a 7-year period among patients with acute TBI who were admitted to an inpatient rehabilitation hospital. Outcomes included PTA emergence and duration, discharge Functional Independence Measure (FIM), rehabilitation length of stay, and Glasgow Outcome Scale (GOS) at ≥1 year. Results: A total of 100 patients were analyzed. In an adjusted Cox regression, age ≥ 55 years (Hazard Ratio [HR] 0.47) and non-infective medical complications during rehabilitation (HR 0.31) were associated with reduced likelihood of PTA emergence, while mild admission GCS (13–15; HR 4.80) and epidural hemorrhage (EDH) (HR 2.00) were associated with PTA emergence. PTA non-emergence was associated with approximately a 20-point lower discharge FIM total score (adjusted model, p < 0.001). A PTA duration of ≥90 days was associated with a lower total discharge FIM score by approximately 45 points compared with those with a PTA duration of <28 days (p < 0.001). PTA emergence was associated with better GOS at ≥1 year (odds ratio [OR] 3.92, p = 0.02). Conclusion: Both acute injury characteristics and intra-rehabilitation factors were associated with PTA recovery functional outcomes. PTA emergence, beyond PTA duration, was strongly associated with discharge functional status and long-term global outcome, supporting the clinical value of PTA in prognostication, rehabilitation planning, and goal setting. Full article

Background: Optimizing pregnancy outcomes while minimizing gonadotropin exposure and treatment burden remains a major goal in ovulation induction for intrauterine insemination (IUI), particularly for patients with polycystic ovary syndrome (PCOS) or high ovarian reserve. Sequential protocols combining early letrozole with late-onset recombinant FSH (rFSH) have been proposed to enhance efficiency while reducing medication requirements. However, real-world comparative data adjusting for baseline differences are limited. Methods: This retrospective comparative cohort study included 764 IUI cycles performed between January 2022 and October 2025. Cycles were stimulated either with conventional rFSH (n = 372) or letrozole plus late-onset rFSH (n = 392). The primary outcome was pregnancy per cycle, defined by a positive serum β-hCG. Secondary outcomes included clinical pregnancy, total gonadotropin dose, endometrial thickness, cycle cancelation, and obstetric outcomes. Confounding was addressed using multivariable logistic regression, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and doubly robust estimation. Results: The crude pregnancy rate was higher in the letrozole plus late rFSH group compared with conventional rFSH (14.8% vs. 9.9%, p = 0.042). Women in the sequential stimulation group had higher AMH levels, higher antral follicle counts, and a higher prevalence of PCOS (32.4% vs. 16.3%, p = 0.001). After adjustment for age, ovarian reserve, and other baseline characteristics using regression, PSM, and IPTW, the stimulation protocol was not independently associated with pregnancy (adjusted OR 1.09, 95% CI 0.68–1.74; p = 0.657). Female age remained the strongest predictor of pregnancy (adjusted OR 0.70 per year increase; p < 0.001). The sequential protocol required a significantly lower total gonadotropin dose (median 375 IU vs. 750 IU; p < 0.001) while maintaining comparable cycle cancellation and safety outcomes. Conclusions: Sequential stimulation with letrozole plus late-onset rFSH achieves pregnancy outcomes comparable to conventional rFSH stimulation while significantly reducing gonadotropin requirements. After adjustment for PCOS status and ovarian reserve, the protocol itself did not independently influence pregnancy, suggesting that crude differences reflected baseline imbalances rather than true treatment effects. This approach represents a clinically efficient, gonadotropin-sparing option for IUI, particularly in patients at risk for excessive ovarian response. Full article

Background/Objectives: Alcohol septal ablation (ASA) is an established interventional therapy for patients with obstructive hypertrophic cardiomyopathy (OHCM) who remain symptomatic despite optimal medical treatment. Nevertheless, 10–20% of patients fail to achieve a satisfactory hemodynamic or clinical response, highlighting the need for improved patient selection. Given that mitral valve (MV) morphology plays a central role in left ventricular outflow tract (LVOT) obstruction, we aimed to evaluate the impact of MV anatomical parameters on ASA outcomes. Methods: We retrospectively analyzed 38 OHCM patients who underwent ASA and had complete echocardiographic data before and at 6-month follow-up. Patients were stratified into responders (n = 32, defined as >50% reduction in LVOT pressure gradient and/or residual LVOT gradient < 50 mmHg) and non-responders (n = 6, <50% reduction or persistent gradient ≥ 50 mmHg), consistent with criteria used in previous ASA outcome studies. MV parameters—including redundant anterior mitral leaflet (AML) length, posterior mitral leaflet (PML) projection, and anterior displacement of the coaptation point (AML/PML projection ratio)—were compared between groups. Results: Non-responders demonstrated significantly greater AML redundancy (13.16 ± 1.72 vs. 9.96 ± 1.99 mm, p < 0.001), larger PML projection (18.5 ± 3.78 vs. 13.65 ± 3.8 mm, p = 0.006), and lower AML/PML projection ratio (0.80 ± 0.15 vs. 1.34 ± 0.45, p = 0.007). These parameters were associated with reduced post-procedural LVOT gradient reduction in univariate logistic regression (p = 0.01, p = 0.027, p = 0.015, respectively). Multivariate modeling was not pursued due to collinearity among MV parameters and the limited number of non-responder events, which precluded robust adjustment. Conclusions: Mitral valve morphological features—particularly redundant AML, greater PML projection, and anterior displacement of the coaptation point—were associated with suboptimal ASA outcomes in univariate analysis. These data emphasize the need for comprehensive MV imaging in pre-procedural assessment. Integrating MV morphology into current selection algorithms may refine ASA patient selection and improve long-term success rates. Full article

Background/Objectives: Inflammation may play a critical role in the pathogenesis of gestational diabetes mellitus (GDM). However, evidence linking early-pregnancy cytokines to subsequent GDM risk remains inconsistent, with most prior research focusing only on CRP, IL6, and TNFα. In this study, we expand on prior work by evaluating a broader range of immune markers and assessing sociodemographic factors as potential moderators. Methods: Data from a prospective U.S. pregnancy cohort (n = 308) were analyzed. Twenty cytokines were quantified in maternal first-trimester plasma using the MILLIPLEX High-Sensitivity Human Cytokine Magnetic Bead Panel. One-hour oral glucose (50 g) tolerance test (OGTT) values assessed at an average gestational age of 27.7 weeks (SD = 2.9) and GDM diagnosis were abstracted from medical records. Multivariable linear and logistic regression models were used to examine associations between cytokines and 1 h 50 g OGTT levels or GDM diagnosis, adjusting for key sociodemographic factors. Interactions terms were included to evaluate whether sociodemographic factors moderated cytokine–GDM relationships. Results: Sixteen women (5.1%) were diagnosed with GDM. Higher first-trimester high-sensitivity-IL6 levels were significantly associated with increased 1 h 50 g OGTT values (b = 3.76; 95% CI: 0.21, 7.32; p = 0.04) and greater odds of GDM (OR = 2.36; 95% CI: 1.17, 4.77; p = 0.02). These associations were more pronounced among Non-Hispanic White women compared to Non-Hispanic Black women (p for interaction = 0.03) and potentially those with normal weight or underweight during early pregnancy compared to overweight or obese women (p for interaction = 0.08). Conclusions: Elevated inflammatory markers, particularly high-sensitivity IL6, in early pregnancy are linked to impaired glucose metabolism and increased GDM risk later in pregnancy. These relationships appeared stronger in Non-Hispanic White women and women with normal weight or underweight during early pregnancy, underscoring the potential to develop serology-based early identification and prevention strategies. Full article

Background: Ageing profoundly alters endocrine regulation and nutrient metabolism, predisposing older adults to thyroid dysfunction. Iodine, an essential micronutrient, lies at the center of this vulnerability due to its narrow physiological range and multiple interactions with nutrition, medications, renal function, and, presumably, gut microbiota. Objective: This narrative review integrates evidence on how ageing modifies iodine–thyroid homeostasis, emphasizing the roles of dietary intake, pharmacologic exposures, microbiota composition, and age-related metabolic alterations that influence iodine handling and thyroid hormone economy. Main Findings: Physiological ageing reduces renal iodine clearance, thyroidal reserve, and peripheral hormone conversion, while chronic inflammation and multimorbidity increase susceptibility to both iodine deficiency and excess. Polypharmacy, including amiodarone, lithium, and proton pump inhibitors, further destabilizes thyroid function. Age-related dysbiosis may impair micronutrient absorption and immune tolerance, linking gut ecology to thyroid autoimmunity. The gut microbiota may influence thyroid function through immune and metabolic pathways, although current evidence in older adults remains limited. Together, these factors shift the balance between iodine intake and utilization, heightening the risk of subclinical or overt hypothyroidism in older adults. Conclusions: Overall, variations in iodine intake emerge as one of the main determinants of thyroid dysfunction in ageing with nutritional, pharmacologic, and other modifiers primarily influencing iodine-related thyroid vulnerability. The adoption of age-adjusted thyroid reference ranges and preventive monitoring can reduce overtreatment and improve metabolic resilience in later life. Full article

Objectives: Personalized medicine is gaining rapid attention over the current drug prescription approach of ‘one-size-fits-all’. Three-dimensional (3D) printing is one such product development technique that has the potential to transform the pharmaceutical and biomedical sectors. Methods: To establish the future of 3D printing in mainstream pharmacy practice, initially, pharmaceutical preclinical and clinical scientific databases (peer-reviewed articles, patents, and marketed products) over the past 10 years were critically scrutinized. Additionally, to provide context, we developed a hypothetical case study illustrating the capabilities of the 3D printing super-compounding pharmacy in personalized patient care, emphasizing the critical role of pharmacists in this process. Results: Acknowledging the potential of 3D printing in pharmacy practice, this review effectively summarizes the advances and opportunities of pharmaceutically feasible 3D printing methods, as well as the challenges in translating this technology into a future super-compounding pharmacy facility. Furthermore, the review highlights the promising capabilities of such pharmaceutical 3D printers in enabling on-site printing of 3D medicines tailored to individual needs, which may range from dose adjustments to multidrug single tablets (polypills). Conclusions: We believe that 3D printing technology has the potential to revolutionize precision and personalized medication approaches in pharmacy practice, which will significantly benefit patient healthcare outcomes. Additionally, the adoption of such technology in pharmacies will lead to a reinvention of the role of pharmacists, thereby creating more job opportunities. Ultimately, 3D printing will create a new paradigm of super-compounding pharmacy practice, providing a new sense of excitement for those looking to enter the pharmacy profession. Full article

Background/Objectives: Family caregivers of individuals with dementia frequently experience substantial psychological distress, yet their emotional responses are heterogeneous. Depression, anxiety and psychological well-being may co-occur in distinct patterns, and socio-economic resources such as education and income are often hypothesized to buffer caregiver distress. This study aimed to identify latent psychological profiles among dementia caregivers and to examine whether education and income moderate the association between affective symptoms and well-being. Methods: A cross-sectional study was conducted with 73 family caregivers of dementia patients attending the Neurology–Psychiatry Department of C.F.2 Clinical Hospital, Bucharest (November 2023–April 2024). Participants completed the PHQ-9 (depression), the COVI Anxiety Scale and Ryff’s Psychological Well-Being Scales. Care recipients’ cognitive status was extracted from medical records using the MMSE. Gaussian Mixture Modeling was used for latent profile analysis (LPA). Between-profile differences were examined using one-way ANOVAs and Tukey post-hoc tests and Pearson correlations were used to assess associations between affective symptoms and psychological well-being, and examined whether education and income were associated with profile membership and psychological well-being. Results: LPA supported a three-profile solution: (1) lower depressive symptoms with moderate anxiety (33%), (2) severe combined depression and anxiety (18%) and (3) moderately severe depression with severe anxiety (49%). Profiles differed significantly in depressive symptom severity, whereas anxiety severity did not differ significantly across profiles. Caregivers in Profile 3 (moderately severe depression–severe anxiety) reported significantly higher overall psychological well-being than those in Profile 1 (moderate depression–moderate anxiety). In contrast, caregivers in Profile 2 (severe depression–severe anxiety), who exhibited the highest affective symptom burden, showed intermediate levels of overall well-being, with comparatively lower scores on specific dimensions such as purpose in life. Depressive symptoms were weakly but significantly associated with autonomy and self-acceptance, whereas anxiety symptoms showed no significant associations with psychological well-being. Education level and household income were not significantly associated with profile membership or psychological well-being. Conclusions: Family caregivers of individuals with dementia can be meaningfully described as forming three exploratory psychological profiles characterized by different configurations of depressive and anxiety symptoms. These findings indicate that caregiver distress does not follow a simple severity gradient and that psychological well-being is not solely determined by symptom burden. Socio-economic characteristics did not account for differences in caregiver adjustment, underscoring the importance of individualized psychological assessment and tailored interventions to support caregiver mental health. Full article

Background: Primary Biliary Cholangitis (PBC) requires early diagnosis and specialized management to prevent progression to cirrhosis. This study evaluates the awareness levels of Turkish physicians from various specialties regarding the clinical features, diagnostic criteria, and current treatment protocols of PBC. Methods: A multi-regional cross-sectional survey was conducted with 269 physicians across Türkiye. Knowledge levels were assessed through a 28-item instrument covering epidemiology, diagnosis and therapy. Data distribution was non-normal (Skewness: −1.296, Kurtosis: 2.857), necessitating the use of the Kruskal–Wallis H test and Dunn–Bonferroni post hoc procedure for inter-group comparisons. Internal consistency was confirmed with a Cronbach’s alpha of 0.80. Results: The overall mean awareness score was 62.6%. Item-level analysis revealed a near-universal understanding of the non-mandatory role of liver biopsy in diagnosis (99.1%) yet identified a critical knowledge gap regarding second-line therapies, particularly the use of steroids (6.8%). Significant disparities were observed among specialties (p < 0.001). Gastroenterologists (Median: 91.07%) and gastroenterology fellows (Median: 85.71%) exhibited significantly higher proficiency compared to general practitioners (64.29%) and family medicine residents (67.86%). Internal medicine specialists outperformed primary care providers, while no significant differences were found among other subgroups after Bonferroni adjustment. Conclusions: Professional specialization is the primary determinant of PBC awareness. While core diagnostic knowledge is stable, significant gaps exist in pharmacological management among non-specialists. Targeted medical education for primary care physicians is essential to ensure timely referral and optimize patient outcomes. Full article

Extended Reality (XR) technologies have matured into powerful tools for training in high-stakes domains, from emergency response to search and rescue. Yet current systems often struggle to balance real-time AI-driven personalisation with the need for human oversight and calibrated trust. This article synthesizes the programmatic contributions of a multi-study doctoral project to advance a design-and-evaluation framework for trustworthy adaptive XR training. Across six studies, we explored (i) recommender-driven scenario adaptation based on multimodal performance and physiological signals, (ii) persuasive dashboards for trainers, (iii) architectures for AI-supported XR training in medical mass-casualty contexts, (iv) theoretical and practical integration of Human-in-the-Loop (HITL) supervision, (v) user trust and over-reliance in the face of misleading AI suggestions, and (vi) the role of interaction modality in shaping workload, explainability, and trust in human–robot collaboration. Together, these investigations show how adaptive policies, transparent explanation, and adjustable autonomy can be orchestrated into a single adaptation loop that maintains trainee engagement, improves learning outcomes, and preserves trainer agency. We conclude with design guidelines and a research agenda for extending trustworthy XR training into safety-critical environments. Full article

Background/Objectives: Targeted muscle reinnervation and regenerative peripheral nerve interface procedures have emerged as effective techniques for reducing post-amputation pain and preventing symptomatic neuroma formation. However, the optimal timing of these procedures remains debated. This study aims to compare complication and reoperation rates between acute and delayed advanced nerve interface procedures in lower-extremity amputees. Methods: A retrospective cohort study was conducted including 74 patients who underwent acute or delayed targeted muscle reinnervation and/or regenerative peripheral nerve interface procedures between 2019 and 2025 at a tertiary academic medical center. Procedures performed concurrently with amputation or during early-stage reconstruction were classified as acute, whereas procedures performed more than one month after amputation were classified as delayed interventions. The primary outcome was postoperative surgical complications occurring within one year. Mann–Whitney U and chi-square tests were used for group comparisons. Univariable and multivariable logistic regression analyses were performed to identify factors associated with surgical complications, adjusting for potential confounders. A p-value < 0.05 was considered statistically significant. Results: Of 80 limbs, 47 (58.8%) underwent acute and 33 (41.3%) underwent delayed procedures. One-year complication rates were 23.4% in the acute group, and 12.1% in the delayed group, with wound-related complications predominantly occurring in patients undergoing amputation for infection or vascular disease. Unexpected reoperation rates were 19.1% for acute and 12.1% for delayed interventions. On univariable and multivariable analyses, early procedures demonstrated higher odds of surgical complications. However, these associations did not reach statistical significance and were limited by baseline differences in patient comorbidity and etiology. Conclusions: Early advanced nerve interface procedures were performed in more medically complex patients and were associated with higher observed rates of surgical complications, whereas delayed procedures were associated with a higher incidence of recurrent symptomatic neuromas. These findings underscore the importance of patient selection, etiology of amputation, and surgical context, rather than timing alone, when determining the optimal approach to nerve interface reconstruction following lower-extremity amputation. Full article

Background/Objective: Ketorolac is an effective alternative and addition to opioids for postoperative pain control; however, there is concern of perioperative bleeding risk with its use. Within gynecology, this risk has not yet been explored in the context of hysterectomy. This study aimed to evaluate the risk of postoperative bleeding complications with ketorolac administration in the context of hysterectomy. Methods: This was a retrospective cohort study that included all patients who underwent hysterectomy for benign indications between 2015 and 2024 at a quaternary care academic hospital. Inclusion criteria were any type of hysterectomy during the study period, while exclusion criteria were malignancy and peripartum status. Complication data for up to thirty days post operation were collected. Multivariable regression analysis, including age, American Society of Anesthesiology category, use of celecoxib before surgery, anticoagulant treatment, uterus size, surgical approach, increased surgical complexity, and lysis of adhesions, was performed to identify the adjusted odds of postoperative bleeding complications. The primary outcome was a composite of any postoperative bleeding complications by use of postoperative ketorolac, including postoperative transfusion, readmission, or reoperation for bleeding. Results: In total, 4236 patients underwent hysterectomy for benign indications during our study period, of which 76% (n = 3236) received ketorolac postoperatively. The composite postoperative bleeding rate was lower in the ketorolac group (2.1% vs. 4.1%, p = 0.001). There was no association between ketorolac use and risk of postoperative bleeding in multivariable regression analysis (aOR 1.02, 95% CI 0.36–2.88). There was no difference in overall intraoperative or perioperative complications (p = 0.070 for both). Major perioperative complications were less likely in the ketorolac group (p = 0.046). Additionally, there were no differences in postoperative complications except for ileus, which was less likely in the ketorolac group (p = 0.034). Conclusions: Ketorolac administration was not associated with a higher risk of bleeding complications after hysterectomy, including when celecoxib was used preoperatively as part of an enhanced recovery protocol. It may safely be administered as an opioid-sparing pain medication in this setting. Full article