Search Results (747)

Objective: To determine the incidence of recurrent ischemic stroke following percutaneous left atrial appendage closure in patients with previous thromboembolic events despite oral anticoagulation. Methods: We conducted a systematic review and meta-analysis of studies of any design reporting ischemic stroke recurrence after left atrial appendage closure in patients with prior ischemic stroke despite oral anticoagulation therapy. The literature search was conducted in MEDLINE, Embase, and the Cochrane Library for studies published between 1 January 2010 and 31 December 2025. Data on study design, population characteristics, indexed intervention, and outcomes were extracted from each included report. The primary outcome was ischemic stroke occurring after left atrial appendage closure, as defined by each individual study. A pooled incidence rate was estimated using a random-effects model to account for anticipated between-study heterogeneity. The study is registered in Open Science Framework. The Risk of Bias in Non-randomized Studies of Interventions assessment tool was used to assess the risk of bias. Results: Overall, eight studies of a total of 1091 patients met the eligibility criteria. Patients were elderly (mean age range 71.8 to 78.1 years), 33% to 53% were women, and thromboembolic risk was consistently high (mean CHA₂DS₂-VASc scores ≥ 5.0). The risk of bias across the included studies was either moderate or serious. Antithrombotic therapy after left atrial appendage closure varied considerably across the included studies. In one study, all patients were discharged on dual antiplatelet therapy, whereas in five studies >70% received oral anticoagulation alone or in combination with antiplatelet therapy at discharge. In six studies, antithrombotic therapy at follow-up was reported, with the proportion of patients on oral anticoagulation alone or in combination with antiplatelet therapy at follow-up ranging from 8.1% to 100% in individual studies. Follow-up duration ranged from 1.0 to 3.1 years. At a mean follow-up of 17.7 months the pooled incidence of the ischemic stroke recurrence rate following left atrial appendage closure was 3.1% per year (95% confidence interval 2.35–4.20%). Conclusions: Among elderly patients with prior ischemic stroke despite oral anticoagulation, the recurrence rate of ischemic stroke following left atrial appendage closure was 3.1% per year. Given the residual risk of stroke recurrence and the substantial heterogeneity in post-procedural antithrombotic management observed across studies, prospective randomized trials are urgently needed to define both the protective impact of left atrial appendage closure and the optimal antithrombotic strategy in this high-risk population. Full article

Background/Objectives: Hospital length of stay (LOS) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) may reflect baseline condition and underlying disease as well as procedure-related morbidity. We evaluated factors associated with prolonged hospital stay (PLOS) and the association of post-ERCP pancreatitis (PEP) with hospitalization duration. Methods: This retrospective single-center secondary analysis included 806 consecutive patients undergoing ERCP within 48 h of admission in 2019–2021. PLOS was defined as total LOS ≥ 12 days, corresponding to hospitalization above the 75th percentile. Modified Poisson regression estimated adjusted risk ratios (aRRs); LOS was also analyzed using negative binomial and median quantile regression. Sensitivity analyses used LOS > 7 and >14 days, a PLOS/death composite, and a PEP-excluded cohort. Results: Among 788 live discharges with complete LOS data, 176 (22.3%) met the PLOS criterion. In the primary Model A, emergency admission (aRR 3.01, 95% CI 2.01–4.51), cholangitis/postoperative indication (aRR 2.71, 95% CI 1.57–4.66), liver disease (aRR 1.85, 95% CI 1.10–3.12), and age (aRR 1.12 per 10 years, 95% CI 1.02–1.22) were associated with PLOS. PEP was associated with PLOS when added as a post-procedural exposure (aRR 2.34, 95% CI 1.67–3.29). Baseline associations were broadly preserved across sensitivity analyses. Conclusions: Prolonged hospitalization was associated mainly with acute clinical context, underlying disease, and patient characteristics. PEP was also associated with longer hospitalization, but this result should be interpreted cautiously because the historical PEP adjudication rule was not retained. Full article

Background: Lipoprotein apheresis (LA) remains an important treatment option for patients with homozygous familial hypercholesterolemia (HoFH) who have persistently severe low- density lipoprotein cholesterol (LDL-C) elevation despite intensive lipid-lowering therapy. Therapeutic plasma exchange (TPE) may serve as a temporary alternative when selective LA is unavailable. Methods: This retrospective, single-center longitudinal observational study evaluated six patients with HoFH treated with double-filtration plasmapheresis (DFPP) between 2010 and 2023. During a temporary interruption in DFPP availability, two patients underwent TPE. Pre- and post-procedure lipid levels were evaluated using paired measurements. Results: A total of 476 DFPP and 20 TPE procedures were performed. During DFPP, the median reductions in total cholesterol and LDL-C were 64.44% [57.14–70.21] and 67.53% [59.53–73.86], respectively, while the median reductions in high-density lipoprotein cholesterol (HDL-C) and triglycerides were 40.00% [30.63–48.00] and 48.63% [35.38–57.66]. Among TPE procedures with paired measurements, the corresponding median reductions were 71.11% [65.52–72.69] for total cholesterol, 70.97% [67.14–73.72] for LDL-C, 67.08% [62.92–70.83] for HDL-C, and 55.73% [38.68–63.33] for triglycerides. No serious adverse events were observed during DFPP. TPE was discontinued in one patient after chills and subfebrile fever. Conclusions: Long-term DFPP was associated with substantial acute lipid reductions in patients with HoFH. TPE also produced marked acute lipid reductions in two patients when DFPP was unavailable. However, the limited number of TPE-treated patients, repeated procedures within the same individuals, and overlapping evolocumab exposure preclude conclusions regarding comparative efficacy or safety. TPE may be considered as an individualized interim option when selective lipoprotein apheresis is temporarily unavailable. Full article

Background: Radial artery spasm (RAS) is a major complication of transradial coronary angiography (TRA) that adversely affects procedural success and patient comfort. Although procedural anxiety and pain contribute to RAS development, prospective randomized controlled data on the effect of virtual reality (VR) on RAS are limited. This study aimed to evaluate the effects of VR on anxiety, pain, and RAS during TRA. Methods: In this prospective, single-center, randomized controlled trial, 236 patients undergoing elective TRA were randomized 1:1 to the VR or control group. Following prespecified post-randomization exclusions, 130 patients (65 per group) were included in the per-protocol analysis. The intervention group received standardized VR content throughout the procedure. The primary endpoint was clinically assessed RAS; secondary endpoints included pre- and post-procedural state anxiety (STAI-S) and post-procedural pain measured using the visual analog scale (VAS). Results: Clinically assessed RAS occurred less frequently in the VR group than in the control group (7.7% vs. 52.3%, p < 0.001). Post-procedural STAI-S and VAS scores were also lower in the VR group (both p < 0.001). In an exploratory multivariable model, post-procedural STAI-S (OR, 1.29; 95% CI, 1.13–1.47; p < 0.001) and VAS scores (OR, 3.44; 95% CI, 1.98–5.98; p < 0.001) were associated with RAS. Because these variables were measured after the procedure, temporal direction and mediation cannot be inferred. Conclusions: In this single-center per-protocol analysis, VR use was associated with lower post-procedural anxiety and pain and a lower incidence of clinically assessed RAS during TRA. The large effect estimate should be interpreted cautiously because the intervention could not be blinded, the endpoint included subjective clinical features, and substantial post-randomization exclusions limit generalizability. Multicenter trials with blinded or objective endpoint corroboration and intention-to-treat analyses are warranted. Full article

Background/Objectives: Atrial fibrillation and coronary artery disease frequently coexist in patients undergoing percutaneous left atrial appendage occlusion (LAAO), creating a complex therapeutic setting in which prevention of device-related thrombosis, cardioembolic events, and coronary ischemic complications must be balanced against a high or prohibitive bleeding risk. The optimal post-procedural antithrombotic regimen remains uncertain, particularly in patients with previous or recent percutaneous coronary intervention or acute coronary syndrome. Methods: This narrative review examines the rationale and current evidence supporting antithrombotic therapy after LAAO and integrates these data with contemporary strategies for abbreviated or de-escalated antiplatelet therapy after coronary intervention. Results: Device-related thrombosis occurs predominantly within the first 45–90 days after implantation, corresponding to the period of incomplete device endothelialisation, whereas thrombotic risk after coronary stenting or acute coronary syndrome is similarly greatest during the early phase and progressively declines thereafter. This temporal overlap supports an initially protective regimen followed by early treatment simplification whenever appropriate. We propose a pragmatic framework in which treatment intensity is determined by a global bleeding–thrombotic risk profile incorporating bleeding history, anaemia, comorbidities, frailty, coronary presentation, procedural complexity, and follow-up imaging. The approach includes predefined triggers for rapid de-escalation in the presence of relevant bleeding or haemoglobin decline and escalation when device-related thrombosis is detected. Conclusions: Current evidence remains heterogeneous and largely observational, the proposed algorithm should be considered a decision-support framework rather than a prescriptive pathway. Prospective randomised studies are needed to define the safest individualised regimen for patients with concomitant LAAO and coronary artery disease. Full article

Background and Objectives: Pulsed radiofrequency (PRF) of the cervical medial branches is a non-destructive neuromodulatory option for chronic cervical facet joint pain, yet evidence regarding the durability of clinical response and factors associated with sustained benefit remains limited. This study aimed to characterize the 6-month trajectory of pain and disability after fluoroscopy-guided cervical medial branch PRF and to explore baseline factors associated with meaningful pain relief (MPR). Materials and Methods: In this retrospective single-center cohort study, 75 patients with chronic cervical facet joint pain who achieved ≥50% temporary pain relief following a diagnostic medial branch block underwent fluoroscopy-guided cervical medial branch PRF, followed by injection of local anesthetic and corticosteroid at the treated levels. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores were evaluated at baseline and at 1, 3, and 6 months. MPR was defined as ≥50% reduction in NRS from baseline. Global Perceived Effect (GPE) and changes in analgesic medication use were assessed as complementary clinical outcomes. An exploratory multivariable logistic regression analysis was performed to examine factors independently associated with MPR at 6 months. Results: Median NRS scores decreased from 7.0 at baseline to 4.0, 4.0, and 5.0 at 1, 3, and 6 months, respectively, while median NDI scores decreased from 30.0 to 14.0, 16.0, and 20.0 (both overall p < 0.001). Despite sustained improvement relative to baseline, MPR progressively declined from 57.3% at 1 month to 49.3% at 3 months and 36.0% at 6 months (overall p < 0.001). Favorable GPE and reduced analgesic medication use showed parallel declines, supporting attenuation of overall clinical benefit over time. In the exploratory multivariable model, fibromyalgia was independently associated with 75% lower odds of 6-month MPR (OR = 0.25, 95% CI: 0.088–0.709; p = 0.009). Age, sex, and baseline NRS were not significantly associated with 6-month MPR. No serious acute periprocedural adverse events were documented during the 2 h observation period. Conclusions: Fluoroscopy-guided cervical medial branch PRF, combined with post-procedural corticosteroid and local anesthetic administration, was associated with clinically meaningful improvements in both pain and neck-related disability, with the greatest benefit during the first 3 months and partial attenuation by 6 months. The progressive decline across pain response, patient-reported global improvement, and analgesic-use outcomes highlights the time-dependent nature of the benefit associated with the combined intervention. Fibromyalgia was independently associated with substantially lower odds of 6-month MPR in this exploratory analysis; this association should be interpreted cautiously and requires prospective validation before it can inform patient selection, although it may be relevant when counseling patients regarding the durability of response. Full article

Frailty, cognitive impairment, depression, functional dependency, low physical performance, and undernutrition are highly prevalent in older adults referred for cancer treatment, cardiovascular interventions, neurological therapies, and orthopaedic surgery, and each independently predicts treatment toxicity, post-procedural complications, and mortality. Comprehensive Geriatric Assessment (CGA) is the most accurate predictor of treatment outcomes in older patients, yet it remains structurally absent from most speciality pathways, contributing to overtreatment of biologically frail patients and undertreatment of biologically robust ones. In this Viewpoint, we propose and operationalise the FIT–FRAIL–DISABLE multidimensional geriatric stratification model as a conceptual framework for translating CGA findings into proportional, speciality-specific treatment recommendations across oncology, cardiology, neurogeriatrics, and orthogeriatrics. The model integrates six validated CGA instruments—the Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale (GDS-15), basic and instrumental Activities of Daily Living (ADL, IADL), the Short Physical Performance Battery (SPPB), and the Mini Nutritional Assessment Short Form (MNA-SF)—into three actionable categories (FIT, FRAIL, DISABLE) aligned with full-intensity, risk-adapted, and symptom-focused care, and is explicitly positioned in relation to the deficit-based frailty paradigm and the WHO Intrinsic Capacity (ICOPE) framework, which it complements rather than replaces. We specify a provisional, a priori decision rule for combining domain scores and describe how each stratification category should inform—but not dictate—goal-concordant treatment intensity within a shared decision-making process. FIT–FRAIL–DISABLE is presented as a proposed, hypothesis-generating framework: its composite thresholds and domain weighting have not yet been empirically derived, and the model has not undergone prospective validation. Retrospective calibration on existing CGA cohorts and prospective multicentre validation are being designed within the GERIA-NET research consortium. If validated, the framework has the potential to reduce both overtreatment-related harm and undertreatment-related therapeutic deprivation in older adults undergoing active treatment. Full article

Parotid sialocele is a challenging complication following major salivary gland surgery. Traditional conservative management often fails, while revision surgery carries a high risk of iatrogenic facial nerve injury. This retrospective, single-center case series evaluated the clinical efficacy and safety of ultrasound-guided Botulinum Toxin Type A (BoNT-A) infiltration in eight consecutive patients presenting with post-surgical parotid sialoceles. The protocol comprised complete ultrasound-guided evacuative aspiration followed by intraglandular injections of OnabotulinumtoxinA into functional parenchyma using a standardized grid mapping technique. Dosage was individualized based on the sonographic estimation of the residual volume of glandular tissue. Post-procedure care included a soft diet, temporary avoidance of sialagogues, and strict avoidance of local massage for 24 h. Complete clinical and sonographic resolution was achieved in all 8 treated cases within a mean interval of 10 days post-injection. Follow-up at 3 months confirmed no recurrences or late-onset complications. No local or systemic adverse events were recorded. In this preliminary case series, ultrasound-guided intraglandular BoNT-A injection represented a safe and encouraging minimally invasive second-line option for post-surgical parotid sialoceles. Full article

Left atrial appendage closure has emerged as an established nonpharmacological strategy for stroke prevention in selected patients with atrial fibrillation, particularly those in whom long-term oral anticoagulation is problematic. Its contemporary role, however, is defined by a central tension between procedural precision and clinical uncertainty. Advances in multimodality imaging, including transesophageal echocardiography, cardiac computed tomography, three-dimensional echocardiography, fusion imaging, and emerging computational tools, now allow highly accurate assessment of left atrial appendage anatomy, device sizing, intraprocedural guidance, and postprocedural surveillance. These techniques are essential to minimize peri-device leak, device-related thrombus, and other procedure-related complications in a structure characterized by marked interindividual variability. At the same time, the randomized evidence base remains nuanced. Early warfarin-era trials established the feasibility of LAAC, whereas contemporary comparisons with direct oral anticoagulants and best available medical therapy have yielded more heterogeneous results, reflecting differences in patient selection, comparator regimens, and endpoint design. Taken together, the available data support LAAC as a reasonable option in carefully selected patients at elevated bleeding risk or with limited tolerance for chronic anticoagulation, but not as a universal substitute for oral anticoagulant therapy. Future progress will depend on more refined phenotyping, standardized imaging pathways, and longer-term comparative data to better define which patients derive the greatest net clinical benefit from LAAC. Full article

Canonical vascular diagrams do not capture patient-specific differences in vessel identity, course, depth, calibre, branching, adjacency, dynamic behaviour, or post-procedural route. This targeted narrative review with purposive publication selection had two objectives: to synthesise vascular anatomical evidence relevant to nursing and health professions practice and education, and to use that synthesis to propose an action-oriented conceptual framework. PubMed/MEDLINE and the Web of Science Core Collection were searched from inception to 2 August 2026. After exact DOI and normalised-title deduplication, 1683 unique records underwent title/abstract inspection and keyword-assisted prioritisation; 56 information-rich human anatomical, ultrasonographic, clinical, educational, and sentinel case publications were purposively retained for full-text evidence charting and narrative synthesis. The synthesis identified six interpretive anatomy-to-risk mechanisms: possible vessel misidentification, unsafe neurovascular adjacency, device–vessel mismatch, dynamic positional change, misinterpretation of anomalous central routes, and loss of patient-specific anatomical knowledge between encounters. These categories are qualitative synthesis outputs, not frequency estimates or causal effects. The literature informed VASC-N—Verify; Assess; Scan and distinguish; Choose, adapt, and confirm; and Note, notify, and nurture learning—as an author-developed conceptual framework of proposed observable behaviours. A preliminary Nursing Actionability Test and minimum reporting checklist were also developed. Patient-specific vascular anatomy becomes educationally and clinically relevant when recognition may change a decision, support proportionate verification or escalation, preserve future access, or strengthen assessment. VASC-N and the accompanying tools have not been validated; prospective content-validity, feasibility, reliability, educational-transfer, and clinical-outcome studies are required. Full article

Interventional Radiology (IR) is increasingly integrated into multidisciplinary care pathways and requires organizational models capable of coordinating procedural appropriateness, patient safety, professional responsibilities, and resource allocation across hospital networks. This study aimed to develop a context-specific, pre-implementation, document-based organizational framework for the planned activation of an oncology-oriented angiographic suite at the Presidio Ospedaliero “Mons. R. Dimiccoli” of Barletta within the Azienda Sanitaria Locale Barletta–Andria–Trani (ASL BT) dual-hospital network. The framework was developed through structured analysis of institutional planning and governance documents, document-based contextual assessment of the two hospital sites, and systematic translation of identified organizational requirements into structural, procedural, governance, safety, and monitoring components. The model was conceptually organized according to the Structure–Process–Outcome framework and normatively aligned with selected international standards relevant to healthcare quality management, risk management, occupational safety, medical-device-related quality processes, and organizational governance. Its theoretical contribution consists of operationalizing the Structure–Process–Outcome model within the pre-implementation design of a network-based IR service, rather than testing, modifying, or validating the theory itself. The resulting framework differentiates emergency and time-dependent IR activity, maintained at the Andria site, from planned elective oncology-oriented angiographic activity at Barletta. It defines network allocation criteria, procedural scope, governance responsibilities, structural and professional requirements, standardized pre-, intra-, and post-procedural pathways, safety architecture, and prospective quality and performance indicators. No post-implementation clinical or organizational outcomes were evaluated, and the framework has not undergone external validation. It should therefore be interpreted as a context-specific service-design model whose feasibility, performance, and applicability to other healthcare settings require prospective evaluation and local adaptation. Full article

Periodontal disease is highly prevalent in dogs and is closely associated with the composition and functional characteristics of the oral microbiome. However, clinical evidence regarding the efficacy of targeted canine probiotics in preventing post-procedural plaque accumulation remains critically limited, representing a significant knowledge gap in veterinary dentistry. In this randomized pilot study, the aim was to evaluate the efficacy of probiotic supplementation in reducing dental calculus accumulation and alleviating clinical signs of oral inflammation in dogs. Statistically significant differences were observed between the study and control groups for all evaluated oral health parameters. The Gingival Bleeding Index (GBI) was considerably lower in the probiotic-treated group than in the control group (p = 0.008). Similarly, significant differences were found for the Dental Plaque Index (p = 0.020) and the Dental Calculus Index (p = 0.018). These results indicate that, after 56 days of probiotic administration, the dogs receiving the probiotic preparation exhibited noticeably better oral health than those in the control group. These observed clinical effects may be consistent with mechanisms proposed in the previous probiotic literature, such as competitive inhibition of biofilm-forming bacteria; however, direct microbiome modulation was not experimentally assessed in this study. The results suggest that probiotic supplementation may represent a promising adjunctive strategy in canine dental prophylaxis by limiting dental calculus accumulation and reducing clinical signs of oral inflammation. These findings provide preliminary clinical evidence of a potential adjunctive benefit, suggesting that post-procedural probiotic administration may support plaque control and help alleviate early signs of oral inflammation in dogs. Full article

Background: The use of pediatric non-operating room anesthesia (NORA) has increased substantially, yet information regarding current practices in Saudi Arabia remains limited. This study assessed pediatric NORA practices, resources, and reported complications among anesthesiologists in Saudi Arabia. Methods: A cross-sectional online survey was conducted among anesthesiologists practicing in Saudi Arabia. The questionnaire collected information on participant characteristics, indications for pediatric NORA, patient selection criteria, staffing patterns, infrastructure and equipment availability, anesthetic and monitoring practices, recovery arrangements, and post-procedural complications. Results: A total of 234 anesthesiologists participated. Magnetic resonance imaging (97.9%) and computed tomography (85.5%) were the most common indications. Most participants accepted patients with American Society of Anesthesiologists physical status I–III (65.8%) and reported no age restrictions (62.8%). Hospital infrastructure was considered appropriate by 85.0% of respondents. Pulse oximetry (99.6%), electrocardiography (93.2%), capnography (91.5%), and noninvasive blood pressure monitoring (89.7%) were widely used. General anesthesia (80.8%) and deep sedation (70.1%) were the most frequently used techniques. Propofol (88.9%), midazolam (82.5%), and ketamine (73.9%) were the most used sedative agents. Recovery most frequently occurred in dedicated recovery rooms (88.9%). The complications most frequently reported by respondents were delayed recovery (35.5%), agitation or delirium (27.4%), cough (21.8%), and nausea or vomiting (17.5%). Conclusions: Pediatric NORA in Saudi Arabia is commonly performed for imaging procedures and is generally supported by appropriate infrastructure and monitoring practices. Nevertheless, variations in resource availability highlight opportunities for further standardization and quality improvement. Full article

Routine husbandry procedures in sheep induce significant and prolonged pain and inflammation, which often exceeds the duration of action of current commercially available analgesics. Mavacoxib is a selective cyclooxygenase-2 (COX-2) inhibitor approved for canine osteoarthritis treatment. With a half-life exceeding two weeks in dogs, mavacoxib may represent a candidate for investigating whether extended-duration analgesia can be achieved in sheep and more closely aligned with the duration of post-procedural inflammation and pain. This article examines the physiological and behavioural indicators of sheep pain, the limitations of current analgesic strategies, and the pharmacological rationale for mavacoxib as a candidate for pain management in sheep. Further research into its pharmacokinetics, efficacy, and safety in sheep is essential to improve welfare and overcome practical barriers to analgesia in extensive grazing systems. Full article

Background/Objectives: Electrolyte disturbances are common in patients with Acute Ischemic Stroke (AIS) and may influence clinical outcomes. However, the prognostic significance of peri-procedural electrolyte changes in patients undergoing mechanical thrombectomy remains insufficiently investigated. This study aimed to evaluate the associations of pre- and post-procedural serum electrolyte levels and peri-procedural electrolyte changes with 90-day mortality in patients with AIS treated with mechanical thrombectomy. Methods: This retrospective observational study included 274 adult patients with anterior circulation large-vessel occlusion who underwent mechanical thrombectomy between February 2017 and February 2026. Serum sodium (Na), potassium (K), chloride (Cl), and calcium (Ca) levels were recorded before thrombectomy and within the first hour after the procedure. Peri-procedural electrolyte changes (Δ) were calculated as post-procedural minus pre-procedural values. Clinical, imaging, laboratory, and procedural variables associated with 90-day mortality were evaluated using univariate and multivariable logistic regression analyses. Results: Of the 274 patients, 67 (24.5%) died within 90 days. Post-procedural serum Na levels were significantly lower in the mortality group than in the survival group (p = 0.030). No significant associations were observed between 90-day mortality and pre-procedural electrolyte levels or peri-procedural electrolyte changes. In the multivariable analysis, higher admission National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.001), symptomatic intracranial hemorrhage (p < 0.001), higher admission glucose levels (p = 0.003), and higher triglyceride levels (p = 0.046) were independently associated with increased 90-day mortality, whereas successful reperfusion (TICI 2b–3) (p = 0.011) and higher post-procedural serum Na levels (OR = 0.851, 95% CI: 0.749–0.968; p = 0.014) were independently associated with reduced odds of 90-day mortality. The addition of post-procedural serum Na to the base model resulted in a modest increase in discrimination (AUC 0.800 to 0.812; ΔAUC = 0.012), which was not statistically significant (DeLong p = 0.454). Conclusions: Among the peri-procedural electrolyte parameters evaluated, only post-procedural serum Na was independently associated with 90-day mortality after mechanical thrombectomy. However, adding post-procedural serum Na to established clinical, procedural, and metabolic predictors did not significantly improve model discrimination. These findings suggest that post-procedural serum Na may represent an associated prognostic marker, while its incremental predictive utility beyond established predictors remains unproven. Full article