Search Results (41,437)

Background/Objectives: Dysphagia is common in tracheostomized patients with traumatic brain injury (TBI) and may be influenced by airway pathology and tracheostomy-related factors. This study investigated whether tracheostomy cannula type is independently associated with swallowing function and pharyngeal residue after accounting for airway stenosis and clinical variables. Methods: This retrospective observational study included 80 tracheostomized TBI patients using a speaking valve. Participants were grouped according to cannula type (non-fenestrated vs. fenestrated). Swallowing function was evaluated using Fiberoptic Endoscopic Evaluation of Swallowing (FEES), and pharyngeal residue severity was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Airway stenosis severity was graded using the Cotton–Meyer classification. Multivariable ordinal logistic regression analyses were performed to identify independent predictors of pharyngeal residue. Results: Higher pharyngeal residue scores were observed in the fenestrated cannula group under selected conditions, particularly for 5 mL liquid (p = 0.039) and 5 mL semi-solid boluses (p = 0.004) in the vallecular region, and for 5 mL semi-solid boluses in the pyriform sinuses (p < 0.001). Airway stenosis grade was strongly associated with increased pharyngeal residue and reduced SpO₂ levels (p < 0.001). In multivariable analyses, airway stenosis emerged as the factor most consistently associated with pharyngeal residue severity (e.g., OR = 4.909, 95% CI: 1.646–14.646, p = 0.004), whereas cannula type was not independently associated with most outcomes. Condition-specific associations were identified between fenestrated cannula use and pharyngeal residue in two models (vallecular residue for 5 mL semi-solid: OR = 0.354, 95% CI: 0.143–0.876, p = 0.025; pyriform sinus residue for 10 mL liquid: OR = 0.190, 95% CI: 0.073–0.495, p = 0.001); however, the direction of these associations differed from unadjusted comparisons, indicating prominent confounding by stenosis severity. Conclusions: FEES-estimated airway stenosis appeared to be the factor most consistently associated with pharyngeal residue severity in tracheostomized TBI patients, whereas the effect of cannula type appeared to be limited. Comprehensive airway assessment may therefore be important in dysphagia management. Full article

The sustainable transformation of idle built environments represents a critical pathway for advancing low-carbon development and achieving carbon neutrality targets. This study examines how idle rural building stocks may contribute to sustainable built environment systems through rural building repurposing and regeneration strategies. It introduces the concept of Green Rural Centers (GRCs), multifunctional facilities formed through the adaptive reuse of idle buildings that integrate low-carbon design, community services, and local economic functions. Within the proposed framework, GRCs are conceptually characterized as facilities that may: (1) achieve 50–70% reductions in operational energy demand through passive and renewable measures, (2) incorporate two or more community-oriented functions (e.g., education, governance, cultural services), and (3) demonstrate embodied carbon savings of ≥40% compared to demolition-and-rebuild scenarios. Grounded in fieldwork from Fujian Province, China, and aligned with national policies, the study evaluates spatial transformation, carbon mitigation, and institutional integration. Using a mixed-methods approach that combines scenario-based carbon-reduction estimation and appraisal, spatial analysis, comparative case studies, and policy evaluation, the findings indicate that retrofitting 30% of approximately 68,000 idle rural schools could achieve approximately 734,400 metric tons of cumulative CO₂ reduction by 2060 under the baseline scenario. Under conservative and ambitious implementation conditions, the estimated cumulative reductions are approximately 408,000 and 1,224,000 metric tons of CO₂, respectively. Sensitivity analysis shows that moderate improvements in retrofit quality or implementation rates significantly amplify emissions reduction outcomes. Beyond environmental performance, the proposed framework may also support community resilience, decentralized service provision, and socio-economic revitalization. This research reframes idle building stock as a strategic asset within sustainable built environment systems, policy-relevant exploratory framework potentially adaptable to comparable rural contexts. This study contributes to the sustainable built environment discourse by demonstrating how underutilized rural building stocks can function as broader low-carbon rural regeneration systems. Full article

Chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation, immune dysregulation, and increased susceptibility to infections. Obesity may influence these processes and has been proposed as a potential contributor to the so-called “obesity paradox”, although its effects on immune competence, viral burden, and survival are not yet fully understood. Seventy patients with severe to very severe COPD (GOLD stage 3–4) were stratified according to BMI (<30 vs. ≥30 kg/m²). Clinical and functional parameters were assessed together with biomarkers of oxidative stress, DNA damage, systemic inflammation, and T-cell subsets. A comprehensive viral panel, including Torque Teno virus (TTV), was also analyzed. Five-year survival was evaluated using Kaplan–Meier curves and Cox regression models. Patients with BMI ≥ 30 showed higher lymphocyte counts and increased CD4⁺ and CD8⁺ T-cell levels, accompanied by lower systemic inflammatory indices. No significant differences were observed in oxidative stress or DNA damage markers. In addition, TTV viremia (≥4 log₁₀ copies/mL) was more frequently observed among patients with lower BMI. Despite these differences, five-year survival did not significantly differ between the two groups. These findings suggest that BMI alone may have limited value as a predictor of outcomes in patients with advanced COPD. Conversely, immune-inflammatory indices and viral burden, particularly TTV viremia, could provide complementary information for risk assessment and may deserve further investigation as potential tools for personalized patient stratification. Full article

Background/Objectives: Absent septum pellucidum (ASP) is a rare fetal midline brain finding that may occur in isolation or alongside broader central nervous system (CNS) malformations, genetic disorders, or septo-optic dysplasia (SOD). Accurate prenatal diagnosis and counseling remain challenging because apparently isolated ASP may be reclassified following fetal magnetic resonance imaging (MRI), postnatal neuroimaging, or specialist assessment. This structured narrative review aimed to synthesize current evidence on prenatal imaging findings, associated anomalies, genetic evaluation, and postnatal outcomes in fetuses with ASP. Methods: This structured narrative review used PRISMA-informed reporting. PubMed and Google Scholar were searched for full-text English-language studies published from 2014 through the updated search date (8 June 2026). Data on gestational age at diagnosis, imaging classification, associated anomalies, genetic testing, postnatal assessment, and neurodevelopmental, ophthalmological, and endocrine outcomes were extracted. Study methodological quality was appraised using Joanna Briggs Institute tools. Results: Seven studies comprising 342 fetal ASP cases were included. Of these, 94 cases (27.5%) were classified as isolated ASP prenatally, but only 57 remained isolated postnatally when follow-up data were available. SOD was confirmed after birth in 11 of 94 (11.7%) fetuses with prenatally isolated ASP. As definitions, imaging protocols, genetic testing strategies, and follow-up duration differed substantially across studies, these pooled values are descriptive observations rather than formal quantitative estimates. Conclusions: ASP is a heterogeneous prenatal finding. The prognosis is most favorable when ASP remains isolated following a detailed prenatal and postnatal evaluation. Multidisciplinary follow-up involving fetal medicine, neuroradiology, genetics, ophthalmology, endocrinology, and neurology is essential for risk stratification and counseling. Full article

Purpose/Objective: To evaluate the safety and failure patterns of consolidative hypofractionated thoracic radiotherapy (RT) following induction chemoimmunotherapy in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC). Materials/Methods: This retrospective study included 34 patients treated between 2019 and 2025. All patients received induction chemoimmunotherapy followed by consolidative hypofractionated RT based on multidisciplinary tumor board recommendations. The primary endpoint was local recurrence (LR); secondary endpoints were regional recurrence (RR), distant metastasis (DM), overall survival (OS), progression-free survival (PFS), and treatment-related toxicity. Results: Median age was 64 years, and median PD-L1 expression was 20%. Most patients had stage III disease; squamous cell carcinoma (56%) and adenocarcinoma (38%) were the predominant histologies. The most common systemic regimen was carboplatin/paclitaxel plus nivolumab, with a median of four induction cycles. Post-induction response was complete in 21%, partial in 62%, stable in 12%, and progressive in 6%. Median RT dose was 52.5 Gy in 15 fractions, and maintenance immunotherapy was administered in 79%. At a median follow-up of 16.7 months, using cumulative incidence functions with death treated as a competing event, the 1- and 2-year cumulative incidences of local failure were 6.9% and 14.7%, respectively. The corresponding cumulative incidences of regional failure were 10.2% and 18.8%, while distant metastasis incidences were 15.9% and 39.2%. No isolated local or regional recurrences occurred. One- and two-year OS rates were 86% and 81%, and corresponding PFS rates were 76% and 54%. No grade 4–5 RT-related toxicity occurred; one grade 5 immune-related pneumonitis was observed. Conclusions: Consolidative hypofractionated RT following chemoimmunotherapy appears feasible and associated with favorable outcomes, supporting further prospective investigation. Full article

Accurate assessment of postural sway is essential for evaluating balance disorders, rehabilitation outcomes, and fall risk. Traditional laboratory-based motion capture systems provide precise center-of-pressure (CoP) measurements, but are expensive, non-portable, and impractical for widespread clinical use. This study describes the development and testing (reliability and validity) of a portable three-dimensional (3D) camera system (Intel RealSense D415) for quantifying sway and balance. Test–retest reliability was evaluated in healthy adults (n = 10; 6 males, 4 females; mean age 22.3 ± 1.6 years), yielding intraclass correlation coefficients ICC = 0.84–0.86 (95% CI: 0.61–0.95). Concurrent validity, established against a laboratory-based optical motion capture system (Optotrak), demonstrated strong correlations with a mean absolute percentage error of 10.5% relative to Optotrak-derived path length measurements and high levels of agreement. Operating at 30 Hz with end-to-end latency of <40 ms, the RealSense-based system provides a reliable, valid, and portable alternative to lab-based systems. Low-cost markerless motion capture systems based on standard RGB cameras have been validated for postural risk assessment, showing good consistency with gold-standard Vicon systems. These preliminary findings suggest that the system shows promise as a low-cost alternative; however, further validation in clinical populations is required before clinical deployment. Full article

Background/Objective: Parental feeding practices play an important role in shaping children’s dietary intake, eating behaviours, and long-term health outcomes. Although several questionnaires assess feeding practices, few have been validated among socioeconomically disadvantaged populations, despite these groups being disproportionately affected by food insecurity and diet-related health inequities. This study assessed the structural validity and internal consistency of the Feeding Practices and Structure Questionnaire—Solid Feeding version (FPSQ-S)—among socioeconomically disadvantaged mothers and fathers of young children. Methods: Two cross-sectional online surveys were conducted with 178 mothers and 94 fathers of children aged 5–35 months living in disadvantaged households. Confirmatory factor analysis was used to examine the structural validity of the FPSQ-S. Internal consistency was assessed using Cronbach’s alpha and Hancock’s H coefficients. Results: The original six-factor FPSQ-S structure was retained and demonstrated acceptable overall model fit in this disadvantaged sample (CFI = 0.846, TLI = 0.821, RMSEA = 0.070). Internal consistency ranged from acceptable to excellent across subscales (Cronbach’s α = 0.63–0.93; Hancock’s H = 0.64–0.93). Most items loaded satisfactorily onto their intended constructs; however, two items within the Feeding on Demand construct demonstrated weak factor loadings, and this construct showed lower reliability than the remaining subscales Conclusions: This is the first study to evaluate the FPSQ-S among socioeconomically disadvantaged mothers and fathers of children aged 5–35 months. The FPSQ-S demonstrated acceptable structural validity and reliability. While the six-factor structure was largely supported, further refinement of the Feeding on Demand construct and additional psychometric evaluation are warranted. Full article

Academic setbacks are common in college, yet instructor responses to poor performance vary widely and may shape students’ motivation, emotional reactions, and perceptions of faculty support. Prior work suggests that supportive communication matters, but less is known about which types of messages students prefer after academic failure or whether faculty accurately anticipate these preferences. The present research examined how college students and instructors evaluate different instructor responses to a disappointing exam grade and assessed alignment between student preferences and faculty perceptions. Using a mixed-methods design, college instructors and undergraduate students responded to parallel vignette scenarios involving a poor exam outcome and rated brief instructor comments representing three response types: solution-focused, emotional validation, and interpersonal affirmation. Participants also provided open-ended responses describing what they would say to a student or want to hear from an instructor. Across two studies, students rated affirmation as most effective, validation as moderately helpful, and solution-focused responses as least effective, despite perceiving solution-focused comments as most common in actual classrooms. Faculty in our sample rated validation and affirmation as more effective than solution-focused responses but primarily generated strategy-focused advice in their own responses. Faculty correctly anticipated students’ preference for encouragement but rarely offered such messages. These findings point to a gap between what faculty believe students value and what they typically communicate following academic setbacks, suggesting that incorporating brief affirming and emotionally responsive messages may strengthen student–teacher relationships by signaling care, understanding, and support in moments of academic difficulty. Full article

Background/Objectives: The efficacy and time-dependent pattern of consolidation immunotherapy after induction chemoimmunotherapy and radiotherapy remain unclear in unresectable stage III non-small cell lung cancer (NSCLC). This study evaluated the efficacy and temporal pattern of consolidation immunotherapy in this population. Methods: This dual-center retrospective cohort study included patients with unresectable stage III NSCLC who achieved disease control after induction chemoimmunotherapy followed by definitive radiotherapy. To reduce potential immortal time bias, only patients who remained alive and progression-free within 2 months after radiotherapy were included. Patients were grouped according to receipt of consolidation immunotherapy. Survival outcomes were analyzed using stabilized inverse probability of treatment weighting, multivariable Cox regression, sequential landmark Cox analysis, and landmark restricted mean survival time analysis. Results: Among 170 eligible patients, 65 received consolidation immunotherapy and 105 did not. After a median follow-up of 33 months, consolidation immunotherapy was associated with longer PFS (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.35–0.78, p = 0.001) and OS (HR: 0.35, 95% CI: 0.18–0.65, p < 0.001). These benefits remained significant after weighting, and multivariable analysis identified consolidation immunotherapy as an independent predictor of improved PFS. Exploratory sequential landmark Cox and restricted mean survival time analyses suggested that the survival benefit was more evident during the early treatment period, particularly around 8–10 months. Conclusions: Consolidation immunotherapy was associated with improved survival, and its benefit appeared more evident during the early treatment period, particularly around 8–10 months. The optimal treatment duration requires further prospective validation. Full article

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely recommended for the treatment of acute (low) back pain, despite modest effectiveness and well-known safety concerns, particularly in older patients. Pridinol is a centrally acting antispasmodic with a mechanism-oriented approach targeting muscle spasm, a key component of acute back pain. While a previous real-world analysis demonstrated a significantly better tolerability and effectiveness of pridinol compared with NSAIDs, age-dependent effects have not yet been systematically evaluated. Objective: To assess the age dependency of effectiveness, safety, and tolerability of pridinol versus NSAIDs in patients with acute (low) back pain under real-world conditions, based on already available data. Methods: This secondary analysis used propensity score-matched real-world data from the German Pain e-Registry (PROVIDENCE study; EUPAS identifier: 49718). A total of 934 patients with acute (low) back pain treated for four weeks with either pridinol (n = 467) or NSAIDs (n = 467) were stratified by age (<65 vs. ≥65 years). Outcomes included the incidence of adverse drug reactions (ADRs), ADR-related treatment discontinuations, time to ADR occurrence, and clinically meaningful improvement in pain-related disability (≥50% reduction in modified Pain Disability Index). Analyses were performed within and between age strata. Results: Overall, ADRs were reported by 9.0% of pridinol-treated patients and 20.8% of NSAID-treated patients (p < 0.001). In the pridinol cohort, ADR rates were virtually identical in patients <65 and ≥65 years (8.9% vs. 9.2%; p = 0.940). In contrast, NSAID-treated patients showed a pronounced age-related increase in ADR incidence (17.3% vs. 32.1%; p < 0.001). ADR-related treatment discontinuation rates under NSAIDs increased markedly with age (5.9% vs. 21.1%; p < 0.001), whereas rates under pridinol remained low and age independent (3.1% vs. 4.6%; p = 0.447). Gastrointestinal and cardiovascular ADRs were the main contributors to the age-related risk increase under NSAIDs, while corresponding events under pridinol were rare across age groups. Clinically meaningful improvement in pain-related disability was achieved with pridinol/NSAIDs in 91.9/48.0% (<65 years) and 88.1/47.7% (≥65 years; p < 0.001 for both). Conclusions: Age is a major modifier of NSAID-related risk but not of pridinol tolerability in acute (low) back pain. While NSAID-associated ADRs and treatment discontinuations increase substantially in patients aged 65 years or older, pridinol demonstrates a stable, age-independent safety profile combined with significantly better functional outcomes. These findings suggest that, particularly in older patients, mechanism-oriented alternatives such as pridinol may offer a more favorable benefit–risk profile than NSAIDs. Full article

Background/Objectives: Childhood overweight and obesity represent a major global public health challenge, with increasing prevalence and significant long-term metabolic, cardiovascular, and psychosocial consequences. Standard pediatric weight-management strategies based on lifestyle modification often achieve modest and variable results, highlighting the need for more personalized and scalable approaches. Artificial intelligence (AI) has emerged as a promising tool to enhance prevention, early risk stratification, and management of pediatric overweight and obesity. Methods: This narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science for English-language studies published up to January 2026. The main search terms included “artificial intelligence”, “machine learning”, and “deep learning”, combined with “child”, “adolescent”, “pediatric”, “childhood obesity”, “pediatric overweight”, “body mass index”, “weight management”, “nutrition”, “diet”, “physical activity”, “lifestyle”, and “behavior change”. After title/abstract and full-text screening according to predefined eligibility criteria, the included studies were qualitatively synthesized and grouped by main application domains. The initial database search identified 412 records. After removal of 96 duplicates, 316 records were screened by title and abstract. Full-text assessment was subsequently performed for 175 potentially eligible articles. Following this evaluation, 51 studies met the eligibility criteria and were retained from the database search. Additional relevant articles were identified through manual screening of reference lists and related reviews, resulting in the final set of studies included in the narrative synthesis. Results: The review identified five main domains of AI application in pediatric weight management: risk assessment and prediction, dietary assessment and nutritional support, physical activity and lifestyle monitoring, behavioral and psychological support, and clinical decision support. Across the included literature, AI-based approaches were most frequently applied to predictive modeling using longitudinal BMI or growth trajectories, birth characteristics, parental BMI, sleep duration, physical activity, sedentary behavior, and family or socioeconomic factors. However, the evidence base was largely composed of observational and predictive-modeling studies, whereas interventional studies, real-world implementation studies, and long-term pediatric weight-outcome data remained limited. Conclusions: This narrative review indicates that AI has potential as a complementary tool within multidisciplinary, family-centered pediatric weight-management pathways, particularly for early risk stratification, personalized monitoring, and behavioral support. However, the findings also highlight that current evidence remains mainly exploratory and predictive rather than interventional. Further longitudinal, real-world, and ethically grounded research is required to confirm effectiveness, safety, clinical usefulness, and equitable implementation in pediatric populations. Full article

Background/Objectives: Functional vulnerability may identify older adults hospitalized with Crohn’s disease flares who are at increased risk for adverse outcomes, but its prognostic significance in this setting remains incompletely defined. We evaluated the association between administratively defined functional vulnerability, identified using administrative diagnostic codes, and short-term clinical outcomes among adults aged ≥65 years hospitalized with Crohn’s disease flares. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Research Network through February 2026. Functional vulnerability was identified using ICD-10-CM codes for frailty, sarcopenia, cachexia, abnormal weight loss, muscle weakness, gait/mobility abnormalities, or reduced mobility within 12 months before or during the index hospitalization. Patients coded only for nonspecific weakness or fatigue were excluded from the functional vulnerability cohort. Patients underwent 1:1 propensity score matching using demographic, comorbidity, Crohn’s disease-related, medication, nutritional, and laboratory variables. The primary outcome was 30-day all-cause mortality. Results: Among 18,420 eligible patients, 2846 met criteria for functional vulnerability, and 15,574 did not. After matching, 2720 patients remained in each cohort. Functional vulnerability was associated with higher 30-day mortality (RR 1.61, 95% CI 1.21–2.14), 90-day mortality (RR 1.40, 95% CI 1.14–1.72), bowel surgery (RR 1.29, 95% CI 1.07–1.56), sepsis (RR 1.41, 95% CI 1.18–1.68), acute kidney injury (RR 1.26, 95% CI 1.10–1.44), ICU admission (RR 1.32, 95% CI 1.13–1.55), TPN use (RR 1.47, 95% CI 1.20–1.79), and 90-day readmission (RR 1.17, 95% CI 1.07–1.29). Functionally vulnerable patients also had longer hospital stays (8.9 vs. 6.7 days; mean difference 2.2 days, 95% CI 1.9–2.5). Conclusions: Administratively defined functional vulnerability identified through diagnostic coding was associated with worse short-term outcomes among older adults hospitalized with Crohn’s disease flares. Although functional vulnerability is a recognized predictor of adverse outcomes across hospitalized populations broadly, these findings quantify its prognostic significance specifically in Crohn’s disease flare hospitalizations and suggest that functional vulnerability may identify a high-risk geriatric IBD phenotype that could benefit from early multidisciplinary assessment, nutritional optimization, rehabilitation planning, and post-discharge care coordination. Full article

Background/Objectives: Robotic-assisted bronchoscopy has emerged as an advanced technique for the evaluation of peripheral pulmonary lesions, offering improved navigation and targeting accuracy. While several studies investigating other diagnostic modalities have identified factors associated with higher diagnostic yield, such determinants remain poorly defined for shape-sensing robotic-assisted bronchoscopy (ssRAB). This study therefore aimed to identify predictors of diagnostic yield in robotic bronchoscopy. Methods: This retrospective single-center study included all consecutive patients who underwent ssRAB (ION^TM system, Intuitive Surgical, Sunnyvale, CA, USA) between August 2024 and March 2026. Lung nodules undergoing marker placement only or procedures performed without cone-beam CT (CBCT) guidance were excluded. Collected variables included demographic characteristics, lesion size, lesion density (solid, part-solid, ground-glass), biopsy modality, and number of biopsy samples obtained. Diagnostic yield was defined as a definitive pathological diagnosis of the target lesion. Predictors of diagnostic success were assessed using univariable logistic regression. Results: In total, 111 pulmonary nodules were included in the analysis. The overall diagnostic yield was 88.3% (98/111). The mean patient age was 64.94 ± 7.9 years, with a predominance of female patients (58.4%). No significant associations were observed between diagnostic yield and lesion size (odds ratio [OR] 1.014 per mm; p = 0.764), lesion density (p = 0.892), or biopsy instrument (p = 0.835). However, an increased number of biopsy samples showed a positive association with diagnostic yield, showing a statistical trend (OR 1.22 per additional sample; p = 0.084). Conclusions: Robotic-assisted bronchoscopy provides a high diagnostic yield for peripheral pulmonary lesions. The number of biopsy samples appears to be the most relevant modifiable factor influencing diagnostic success, underscoring the importance of adequate tissue acquisition. In contrast, lesion characteristics and biopsy modality did not significantly affect outcomes in this cohort. Full article

Background/Objectives: Osteonecrosis of the femoral head is a progressive disease that frequently leads to femoral head collapse and secondary osteoarthritis. Although total hip arthroplasty provides reliable outcomes, its use in younger patients is limited due to concerns regarding implant longevity. Joint-preserving procedures such as core decompression have been widely used; however, their efficacy remains controversial. This study aims to evaluate a combined approach using arthroscopy-assisted core decompression and an osteoconductive bone substitute. Methods: This study is designed as a single-center, externally controlled trial conducted at Tohoku University Hospital. Patients with osteonecrosis of the femoral head (Japanese Investigation Committee Stage 1–3B, Type B–C2) will undergo arthroscopy-assisted core decompression combined with octacalcium phosphate/gelatin composite implantation. A total of 25 patients will be prospectively enrolled. Outcomes will be compared with a propensity score-matched historical control cohort. The primary outcome is disease progression within 1 year, defined as radiographic progression or conversion to total hip arthroplasty. Secondary outcomes include radiographic changes, clinical outcomes, and bone remodeling assessed by computed tomography. Expected Results: This study is expected to provide preliminary clinical evidence regarding the feasibility and potential effectiveness of arthroscopy-assisted core decompression combined with octacalcium phosphate/gelatin composite implantation for osteonecrosis of the femoral head. The intervention may promote bone remodeling and contribute to the prevention of femoral head collapse. Conclusions: The findings of this study may contribute to the development of improved minimally invasive joint-preserving treatment strategies for osteonecrosis of the femoral head and provide a basis for future large-scale clinical trials. Full article

Objectives: To compare an endoscopically guided, modified in-office internal superior laryngeal nerve (iSLN) percutaneous steroid injection technique with a traditional landmark-guided percutaneous approach for refractory chronic cough. Methods: Single-centre retrospective comparative cohort study of those with chronic cough >8 weeks adjudicated as neurogenic/hypersensitivity-related after structured evaluation and management of common aetiologies. Consecutive patients treated at a tertiary laryngology service from January 2021 to January 2025 were identified. Patients underwent either landmark-guided percutaneous iSLN block (unmodified) or iSLN percutaneous block under flexible nasolaryngoscopic visualisation (modified), enabling real-time confirmation of needle position and routine bilateral treatment with partial superficial laryngeal mucosal instillation. Primary outcome was patient-reported improvement (Y/N; 1–10 severity scale). Secondary outcomes included Leicester Cough Questionnaire, Cough Severity Index, Newcastle Laryngeal Hypersensitivity Questionnaire, Reflux Severity Index, Voice Handicap Index-10, repeat procedures, and adverse events. Results: Of 142 patients (median age 62.8 years; 75% female), 65 underwent landmark-guided injection and 77 underwent the modified endoscopically guided technique. At most recent follow-up, global improvement was reported by 84.4% (65/77) in the modified cohort versus 47.7% (31/65) in the unmodified cohort. Median symptom reduction was greater with the modified approach (77.8% (IQR 61.3–86.6)) than among unmodified responders (50.3% (IQR 25.0–75.0)). Across all validated patient-reported outcome measures, the modified technique demonstrated more pronounced improvement than the landmark-guided approach. Minor adverse events were uncommon (modified = 6.5%, unmodified = 4.6%). Conclusions: Endoscopically guided modified iSLN steroid injection with routine bilateral targeting is associated with greater patient-reported improvement and superior validated cough outcomes than landmark-guided injection, without added significant risk. Full article