Insufficient correction of segmental lordosis is an important risk factor for adjacent segment disease (ASD). This study aimed to investigate the relationship between segmental lordosis-related parameters and ASD following lumbar facet joint fusion (FJF). A retrospective analysis was conducted on 29 patients who underwent revision surgery for ASD after posterior lumbar fusion at our institution between February 2014 and February 2024. A matched control group of 29 non-ASD patients was selected based on age at initial surgery, sex, fusion level, and follow-up duration. Preoperative, postoperative, and final follow-up lumbar radiographs were analyzed. Parameters assessed included lumbar lordosis (LL), segmental lordosis (SL), sacral slope (SS), and relative disc height of adjacent segments. General baseline characteristics, sagittal parameters before and after the initial surgery, and correction values of sagittal alignment were compared between the two groups. Parameters showing significant differences were further analyzed using binary logistic regression, and receiver operating characteristic (ROC) curves were used to determine predictive thresholds of independent risk factors for ASD. There were no significant differences in baseline characteristics between the two groups (p > 0.05). After the primary fusion surgery, LL, SS, and relative disc height were significantly lower in the ASD group compared with the control group (p < 0.05). Regarding sagittal correction, the relative change in SL (r△SL) was significantly smaller in the ASD group (p < 0.05), confirming insufficient local curvature reconstruction. Logistic regression identified r△SL as an independent risk factor for ASD (p = 0.004, OR = 0.976, 95% CI: 0.960-0.992). ROC curve analysis revealed an area under the curve (AUC) of 0.712 (95% CI: 0.580-0.844), with an optimal predictive threshold of 2.6% for r△SL. Insufficient correction of segmental lordosis is a key risk factor for ASD following lumbar facet joint fusion, and prioritizing the restoration of local sagittal alignment during surgery may effectively reduce the incidence of postoperative ASD.

Background Immunosenescence, characterized by the decline and restructuring of immune system components with age, affects both innate and adaptive immunity. The predictive value of soluble factors in immunosenescence remains unclear. Objective To investigate the predictive value of sCD28 (Soluble CD28), sCD40L (CD40 Ligand), sCD25 (Soluble CD25), IL-6 (Interleukin-6) and sPD-1 (Soluble Programmed Cell Death Protein 1) for immunosenescence in a general population, to evaluate their diagnostic potential using ROC curve analysis, including both individual and combined detection efficacy. Methods We analyzed 131 healthy individuals across four age groups: young (≤44 years, n = 34), middle-aged (45–60 years, n = 31), young-old (61–70 years, n = 38), and older (&amp;gt;70 years, n = 28). Serum levels of sCD28, sCD40L, sCD25, IL-6, and sPD-1 were measured using ELISA. Baseline characteristics and correlations were analyzed using SPSS 25.0. ROC analysis was performed to assess diagnostic potential, with a focus on both individual markers and the combined detection of sPD-1, IL-6, and sCD28. Results sPD-1, IL-6, and sCD28 levels positively correlated with age ( p &amp;lt; 0.05). IL-6 had the highest individual AUC (0.77, 95%CI: 0.69–0.85; sensitivity 71%, specificity 78% at 1.22 pg./mL). Combined detection of sPD-1, IL-6, and sCD28 improved diagnostic performance, with an AUC of 0.82 (95%CI: 0.76–0.90), sensitivity of 70%, and specificity of 80% at a cut-off of 0.43. Conclusion sPD-1, IL-6, and sCD28 are associated with immunosenescence and have diagnostic potential, with IL-6 showing the highest individual efficacy. Importantly, their combined detection enhances diagnostic accuracy for immunosenescence, highlighting their synergistic predictive value for immune aging.

BACKGROUND Total laparoscopic hysterectomy (TLH) is a minimal invasive procedure for benign, premalignant and early-stage malignant uterine conditions. Uterine manipulators are commonly used to facilitate uterine mobilizations and improve surgical exposure, but their necessity and potential impact on intraoperative and postoperative complications remain debated. Despite conflicting findings, evidence from large retrospective cohorts comparing manipulator-assisted versus manipulator-free TLH remains limited. The aim of this study is to compare intraoperative and postoperative outcomes of TLH performed with and without using uterine manipulators. MATERIAL AND METHODS A retrospective cohort analysis of consecutive TLH for benign, premalignant, and early-stage endometrial cancer indications was conducted. Patients were categorized by uterine manipulator use (manipulator group, n=244; manipulator-free group, n=166). Demographics, uterine weight, operative time, hemoglobin change, intraoperative injuries, and postoperative complications were extracted from electronic records. Statistical comparisons were performed using chi-square or Mann-Whitney U tests (P<0.05). RESULTS Baseline characteristics were comparable between the groups. Mean uterine weight was 349.55±324.35 g (range 44-1354 g) in the manipulator group and 356±324.42 g (range 47-1440 g) in the non-manipulator group (P=0.842). Mean operative time did not differ significantly (79.6±26.07 vs 76.6±25.16 min; P=0.259). Intraoperative complications, vaginal lacerations, postoperative complications rates (13.9% vs 12.7%; P=0.708), hemoglobin changes, and hospital stay were comparable. Vaginal cuff hematomas were rare and similar between groups; no dehiscence occurred. CONCLUSIONS Expert laparoscopic surgeons can safely perform TLH without the use of a uterine manipulator. This approach does not appear to increase the risk of morbidity, compared with the use of a manipulator.

Introduction Non–vitamin K antagonist oral anticoagulants (NOACs) are the first-line therapy to prevent ischaemic stroke in patients with atrial fibrillation (AF). However, studies on the effectiveness and safety of edoxaban for Chinese patients with AF, are limited. Methods We report the 1-year interim follow-up data on edoxaban use in Chinese patients with AF from the ETNA-AF-China (NCT04747496), a multicentre, prospective, observational study conducted in 89 centres across the Chinese Mainland, enrolling 5,001 patients with a total of 2-year follow-up. No adjustment for multiple testing was made; therefore, all P values must be interpreted in an exploratory or descriptive manner. Results Overall, 4,877 patients (60 mg edoxaban: 54.3%; 30 mg edoxaban: 45.7%) completed 1-year follow-up (mean age ± standard deviation: 70.3 ± 9.5 years; mean CHA 2 DS 2 -VASc score: 2.9 ± 1.4: mean HAS-BLED score: 1.8 ± 1.0). All-cause death occurred in 100 patients (annualised event rate: 2.30%/y), of whom 27 (0.62%/y) died from cardiovascular (CV) events. Annualised rates for major bleeding (45 patients [1.04%/y]), intracranial hemorrhage (ICH, nine patients [0.21%/y]), and major gastrointestinal bleeding (19 patients [0.44%/y]) were low. Patients receiving edoxaban 30 mg had numerically higher rates of all-cause death, CV death, and major bleeding than edoxaban 60 mg ( P &amp;lt; 0.05), potentially because of diverse baseline characteristics. Lower BMI, permanent AF type, history of major bleeding, and frailty identified as risk factors of all-cause death by multivariable Cox analysis. After 1 year, 73.1% patients continued edoxaban use without suspension, discontinuation of edoxaban, or switching to other doses of edoxaban/other NOACs. Conclusion In a large Chinese AF population, edoxaban showed low incidences of stroke and bleeding, notably major bleeding, ICH, major gastrointestinal bleeding, and CV mortalities, with the majority of patients still on edoxaban at the end of 1-year follow-up.

Robotic-Assisted Versus Laparoscopic-Assisted Colectomy: Findings on Short-Term Outcomes From A Multi-Institutional Propensity Score-Matched Study.

Background: Retrograde intrarenal surgery (RIRS) has become an established minimally invasive treatment for kidney stones, particularly in cases where extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy are unsuitable. However, stone-free (SF) outcomes vary, and identifying preoperative factors associated with success remains essential for improving patient selection and surgical planning. Objective: To identify factors associated with SF outcomes after RIRS and to develop a simple model-based clinical decision rule using preoperative variables. Materials and Methods: The present study was a retrospective study that included 114 patients who underwent RIRS. Baseline characteristics were compared between SF and non-stone-free (non-SF) groups. All variables were screened using bivariate logistic regression, and those with significant results were included in a multivariable analysis. Model performance was evaluated using standard statistical measures, and a simple decision rule was constructed from key preoperative factors. Results: Stone diameter was independently associated with SF outcomes (AOR 0.86, 95% CI 0.76 to 0.98, p=0.024). Prior open surgery (AOR 0.09, 95% CI 0.01 to 1.21, p=0.070) and log-transformed estimated blood loss (AOR 0.29, 95% CI 0.07 to 1.11, p=0.071) showed borderline associations. The final model demonstrated good discriminative performance (AUC 0.87) and acceptable calibration (Hosmer-Lemeshow, p=0.47). A simple decision rule incorporating kidney stone diameter and surgical history stratified patients into low- and high-risk groups, with residual fragment rates of 12.0% and 33.7%, respectively. Conclusion: Preoperative factors, particularly stone diameter and prior surgical history, play a key role in SF outcomes after RIRS. A simple clinical rule based on these variables may support risk stratification and guide patient counseling in routine practice.

Ethnic disparities in heart failure (HF) outcomes have been widely documented, but data from countries with universal healthcare systems, such as Israel, are limited. This study assessed whether long-term clinical outcomes differ between Jewish and non-Jewish patients hospitalized for acute decompensated heart failure (ADHF). We conducted a retrospective cohort study of adults hospitalized with ADHF at a tertiary medical center in Israel between 2007 and 2017. Patients were categorized by self-reported ethnicity. Baseline characteristics, in-hospital treatments, discharge medications, and clinical outcomes were compared. The primary outcome was 5-year all-cause mortality. Secondary outcomes included in-hospital mortality, 30-day readmission, 30-day mortality, 1-year mortality, and treatment patterns. Of 7,199 patients, 90.3% were Jewish and 9.7% non-Jewish. Non-Jewish patients were younger (median age 74 vs. 80 years, p < 0.001) and had higher rates of smoking and obesity. Most comorbidities, procedures, and discharge therapies were comparable. Unadjusted short-term outcomes were similar between groups. Although unadjusted 5-year survival appeared higher in non-Jews (p = 0.002), multivariable Cox regression showed that non-Jewish ethnicity was independently associated with increased 5-year mortality (HR 1.13, 95% CI 1.02-1.25, p = 0.021). In this large cohort of patients hospitalized with ADHF in Israel, non-Jewish ethnicity was independently associated with worse long-term survival despite younger age and similar in-hospital care. These findings underscore the need for targeted follow-up strategies to mitigate ethnic disparities in chronic HF outcomes.

Objective: To evaluate the feasibility, safety, and clinical outcomes of a hybrid surgical technique combining transvaginal hysterectomy, transvaginal polypropylene mesh placement, and laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP) and voiding dysfunction. Materials and Methods: The present study was a retrospective cohort study conducted at the Division of Urology, Siriraj Hospital, Thailand. Women aged 18 years and older with stage II or higher POP and concurrent lower urinary tract symptoms (LUTS) who underwent the hybrid procedure between September 2022 and September 2024 were included. Patients with neurological disorders, prior pelvic radiation, or incomplete clinical data were excluded. Preoperative assessment included medical history, POP-Q staging, and video-urodynamic studies. All procedures were performed by a single reconstructive urologist. Data on baseline characteristics, operative outcomes, and postoperative findings were analyzed. Results: Ten women met the inclusion criteria. Median age was 70 years (range of 66 to 80), and a mean BMI of 24.7 kg/m². All patients presented with obstructive voiding symptoms. A mixed urinary incontinence was observed in seven patients. Median operative time was 130 minutes (range of 80 to 225), and median estimated blood loss was 50 mL (range of 10 to 300). No major intraoperative complications occurred. Catheters were removed within two days postoperatively in all cases. At a median follow-up of 116.5 days (range of 64 to 389), all patients reported significant improvement in both LUTS and prolapse symptoms. Four patient experienced urgency urinary incontinence, which was well-controlled with medication. No mesh extrusion or recurrent prolapse was observed. Conclusion: This hybrid technique offers a safe, effective, and efficient approach for managing POP with voiding dysfunction. It achieves excellent anatomical restoration, symptom relief, and rapid recovery.

Objective Bladder neck contracture (BNC) is a challenging postoperative complication of transurethral resection of the prostate (TURP), especially in patients with small-volume prostates (&amp;lt;40 mL) who are at high risk. This retrospective study aimed to evaluate the efficacy and safety of local betamethasone injection in preventing BNC following TURP in this specific population. Methods Clinical data of 248 patients with small-volume benign prostatic hyperplasia (BPH) who underwent TURP at Zhuhai People's Hospital from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into two groups: the betamethasone injection group ( n = 128) receiving 8 mg betamethasone injected into the submucosal layer of the bladder neck (3, 6, 9, and 12 o'clock positions) during surgery, and the control group ( n = 120) undergoing TURP without betamethasone injection. All procedures were performed using standardized bipolar plasma TURP without bladder neck incision. Baseline characteristics, intraoperative parameters, and postoperative outcomes were collected. The primary endpoint was the incidence of BNC within 12 months of follow-up, diagnosed based on clinical symptoms, uroflowmetry (maximal urine flow &amp;lt;10 ml/sec), and cystoscopy. Secondary endpoints included the incidence of other postoperative complications. Results The baseline characteristics of the two groups were comparable (all p &amp;gt; 0.05). During the 12-month follow-up, the incidence of BNC in the betamethasone injection group was significantly lower than that in the control group (2.3% vs. 10.8%, p = 0.004). Multivariate logistic regression analysis identified local betamethasone injection as an independent protective factor against BNC (OR = 0.20, 95% CI: 0.06-0.69, p = 0.011), while prostate volume ≤30 mL was an independent risk factor (OR = 3.21, 95% CI: 1.08-9.53, p = 0.036). There were no significant differences in the incidence of other postoperative complications (urinary tract infection, secondary hemorrhage, urethral stricture, urinary incontinence) between the two groups (all p &amp;gt; 0.05).Conclusion: Local injection of betamethasone during TURP significantly reduces the incidence of BNC in patients with small-volume prostates without increasing perioperative complications. This intervention targets the inflammatory and fibrotic mechanisms underlying BNC and serves as a safe and effective adjuvant strategy to optimize surgical outcomes in this high-risk population.

As liver transplantation (LT) has become a key approach for managing end-stage hepatobiliary diseases, the high incidence of biliary complications, particularly biliary stricture, has emerged as a major challenge affecting the outcomes of liver transplantation. Our aim was to use the large cohort of cases from our center to analyze the safety and efficacy of the different types of biliary stents for biliary stricture after LT. Retrospective clinical data were collected from 101 patients who underwent ERCP treatment for biliary stricture after LT at the First Affiliated Hospital of Sun Yat-sen University. Patients were divided into two groups: the Multiple Plastic Stents Placement (MPS) group and the Fully Covered Self-Expanding Metal Stents (FCSEMS) group. A comparative analysis was conducted on the preoperative general data, stricture relief rate, stricture recurrence rate, number of ERCP interventions, total duration of stent placement and the incidence of postoperative ERCP- and stent-related complications between the two groups. There were no significant differences in the baseline characteristics between the two groups. In terms of efficacy, the FCSEMS group required remarkably fewer ERCP interventions to achieve stricture relief, fewer stents, and the markedly shorter total stent placement time. Additionally, the postoperative stricture relief rate in the FCSEMS group was higher than that in the MPS group, the postoperative stricture recurrence rate and stone formation rate in the FCSEMS group were also lower than those in the MPS group. However, these differences between two groups were no significant. No significant differences were observed between the two groups in terms of other complications such as postoperative cholangitis, bleeding, or perforation. FCSEMS is non-inferior to MPS in terms of complication rates, and offered the practical advantages of fewer ERCP interventions, fewer stents placed, and shorter procedure times.

To investigate the patterns of recurrence/metastasis and the clinical value of radiotherapy in local control for pediatric pancreatoblastoma. A retrospective analysis was conducted on 14 pediatric patients with pathologically confirmed pancreatoblastoma treated at our institution from June 2017 to June 2024. Clinical data, including baseline characteristics, surgical approaches, pathological staging, adjuvant therapies (chemotherapy/radiotherapy), recurrence/metastasis patterns, and subsequent interventions, were systematically collected. The impact of radiotherapy on local control was evaluated, with survival analysis performed using Kaplan-Meier methods, and prognostic factors analyzed via log-rank tests and Cox regression models. The median age of the entire cohort was 7 years (range, 3-13 years), with 4 cases of pancreatic head tumors and 10 cases of pancreatic body/tail tumors. At initial diagnosis, 57.1% (8/14) presented with regional lymph node metastasis, and 57.1% (8/14) had distant metastasis. The R0 resection rate during the first surgery was 57.1% (8/14), while R1/R2 resections accounted for 28.6% (4/14); 2 did not undergo surgery. With a median follow-up of 31 months, the overall survival rate was 78.6% (11/14). The recurrence/metastasis rate was 64.2% (9/14), with predominant patterns including tumor bed recurrence (3/9, 33.3%), regional lymph node metastasis (3/9, 66.7%), and liver metastasis (5/9, 55.6%). Multimodal therapies encompassed chemotherapy, secondary surgery, liver transplantation, and radiotherapy for metastatic lesions. In the radiotherapy group, the 1-year and 2-year local control rates were 100% and 88%, respectively. Log-rank test and Cox analysis identified failure to achieve R0 resection and regional lymph node metastasis as independent prognostic factors for inferior overall survival (P < 0.05). Other factors-including age, gender, presence of initial metastasis, initial liver/lung metastasis, number of recurrence/metastasis events, and radiotherapy-showed no significant correlation with overall survival. Regional lymph node metastasis and failure to achieve R0 resection are critical prognostic factors affecting long-term survival in pancreatoblastoma patients. Adjuvant radiotherapy significantly improves local control rates and may enhance survival outcomes in patients with positive margins or lymph node metastasis by strengthening local disease control, warranting further validation in prospective studies.

Transitions from Regional to Widespread Pain in Urologic Chronic Pelvic Pain Syndrome (UCPPS): A MAPP II Research Network Study.

Chimeric antigen receptor (CAR) T-cell therapy enriched for a memory-like phenotype may persist and function longer than a non-enriched product, thereby improving duration of response (DOR). We conducted a phase 1 study with bb21217 (NCT03274219), an anti-B-cell maturation antigen CAR T-cell therapy manufactured in the presence of bb007 (phosphoinositide 3-kinase inhibitor) to enrich for T cells with a memory-like phenotype, in patients with relapsed/refractory multiple myeloma (N=72). No new safety concerns were raised with bb21217 therapy (three cases each of grade ≥3 CRS and grade ≥3 neurotoxicity were observed). The objective response rate was 69.4% and median DOR was 23.8 (95% confidence interval, 16.8-34.8) months. Analysis of drug product established an association between early memory phenotype and robust expansion and depth of response. Examination of baseline characteristics indicated that tumor burden and prior therapies influenced DOR. The generation of CAR T cells early in a disease course when tumor burden is lower and source material exhibits a more naïve phenotype may maximize the clinical benefit potential of the drug product.

The Hidden Burden of Polysensitization in Allergic Rhinitis: A Propensity-Matched Real-World Analysis of Subcutaneous Immunotherapy.

Robotic-assisted navigation systems for the localization of nonvisible and nonpalpable pulmonary nodules have demonstrated feasibility and safety in preclinical animal studies; however, clinical evidence supporting their practical application remains limited. This study aims to evaluate the safety and feasibility of using a robotic-assisted system for computed tomography (CT)-guided percutaneous localization of lung nodules. A total of 137 consecutive patients with 155 nodules were included in the final analysis, all of whom underwent percutaneous hook-wire localization using a novel robotic-assisted optical navigation system. The baseline characteristics of patients and nodules, localization procedure findings, and exploratory outcomes of the correlations between pulmonary nodule features and localization procedure findings were analyzed. The localization success rate was 100%. With the assistance of the robotic-assisted optical navigation system, the median number of needle adjustments per target was 0 (ranging from 0 to 2) in this study, with a mean deviation of 1.49 ± 1.93mm. The mean intervention time was 8.24 ± 1.77min during the robotic-assisted process. Notably, there was no significant change in the accuracy influenced by the location, type, size of nodules, distance to pleura, and decubitus positions. Localization-related complications occurred in 13 (8.39%) out of 155 targets, including 3 (1.94%) minor hemorrhages and 10 (6.45%) minor pneumothoraxes, and no dislodgement was observed in any of the cases. All surgeries were successfully performed with a mean time interval between nodule localization and surgery of 133.67 ± 103.36min. This prospective, single-center, single-arm clinical study suggests both feasibility and safety of an innovative robotic-assisted optical navigation system for the CT-guided percutaneous localization of pulmonary nodules using hook-wire technique, as well as satisfactory accuracy during the needle placement.

Background Neoadjuvant chemotherapy combined with immunotherapy results in high pathologic response rates in locally advanced oral and oropharyngeal cancer (OC/OPC). It is unclear if patients with clinical T3-4 (cT3-4) OC/OPC at initial diagnosis can safely omit adjuvant radiotherapy (ART) after significant pathological downstaging. Methods This retrospective cohort study included cT3–4 OC/OPC patients who achieved a major pathologic response (MPR) after neoadjuvant immunochemotherapy between July 2019 and May 2024. Patients were categorized by whether they received ART. Propensity score matching was used to balance baseline characteristics. Local recurrence-free survival (LRFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were compared between cohorts. Results A total of 247 patients were eligible, with a median follow-up of 31 months (IQR, 20-41). The 2-year survival outcomes were favorable: LRFS 93.4%, LRRFS 85.0%, DMFS 95.6%, and OS 93.0%. In the matched cohorts (74 pairs), ART significantly improved 2-year LRFS (100% vs. 85.5%, p = 0.001), and LRRFS (91.5% vs. 77.5%, p = 0.014), but not DMFS (96.4% vs. 95.6%, p = 0.740), and OS (96.5% vs. 90.0%, p = 0.093). These benefits remained significant among patients with ypT0–2 tumors after matching. Conclusions Omitting ART in patients with cT3–4 OC/OPC who achieve MPR after neoadjuvant immunochemotherapy and surgery significantly compromises oncological outcomes. Further investigation is necessary to optimize adaptive de-escalation strategies for this population.

Background: Postpartum haemorrhage (PPH) is the major cause of maternal death worldwide, significantly in poor countries, like Asia, Africa. In our country PPH is the major cause of maternal mortality (about 80%). Global studies for decades showed that maternal mortality following PPH is due to uterine atony following vaginal delivery, caesarean section delivery and use of uterotonic drugs are the choice for both prevention and treatment of PPH. This study aims to evaluate the use and efficacy of intrauterine misoprostol versus oxytocin alone, in controlling postpartum haemorrhage due to atonic uterus amongst women with undergone Caesarean section in a tertiary care hospital setting of Bangladesh. Material and Methods: This randomized clinical trial was done in the Department of Obstetrics &amp; Gynecology, Eastern Medical college Hospital, Cumilla, Bangladesh between January 2022 to December 2022. A total of 100 participants were randomly selected from all patients who admitted for elective cesarean section within this period. In this, the study group (Group A=50), received only intrauterine misoprostol after placental delivery. On the other hand, in control group (Group B=50) received routine intravenous Oxytocin alone. Results: There were no significant differences in baseline characteristics between the two groups. Group A (misoprostol) showed significantly lower preoperative, post-operative, and total blood loss compared to Group B (oxytocin). Post-operative hemoglobin and hematocrit levels were significantly higher in Group A (p&lt;0.01 and p&lt;0.001, respectively). Additionally, Group A required fewer additional uterotonics and had a lower incidence of side effects, with no major differences in the type of adverse effects between the groups. Conclusion: This study concluded that intrauterine misoprostol is more effective than intravenous oxytocin in reducing blood loss and maintaining better postoperative hemoglobin and hematocrit levels during cesarean section, with fewer additional uterotonic requirements and minimal side effects. Eastern Med Coll J. July 2025; 10 (2): 111-115

Background: Total knee arthroplasty (TKA) effectively relieves pain in end-stage osteoarthritis, yet a proportion of patients remain dissatisfied despite advances in surgical technique. Medial-congruent (MC) bearings are designed to recreate native medial-pivot kinematics, which depend on appropriate medial compartment soft tissue tension. Robotic-assisted TKA (RA-TKA) has been shown to improve the accuracy and soft tissue balance. However, evidence of its additional benefits in MC TKA remains limited. Methods: We retrospectively identified consecutive primary TKAs with the same MC bearing performed between April 2022 and June 2024 at a tertiary center. After performing 1:1 propensity score matching to reduce baseline imbalance, 36 patients who received RA-TKA and 36 who underwent manual TKA (M-TKA) were included. Primary outcomes were evaluated with the 12-month Oxford Knee Score (OKS) and KOOS-JR. Secondary outcomes included radiographic alignment parameters, outlier rates, operative time, liner thickness, and hospital stay. Results: Baseline characteristics and liner thickness were comparable, and operative time was longer in the RA-TKA group than in the M-TKA group. Both RA-TKA and M-TKA produced significant 12-month improvements in OKS and KOOS-JR with no difference in mean scores. RA-TKA had fewer posterior tibial slope outliers (mean slope 4.3° ± 1.8 vs. 5.9° ± 3.1; outlier rate 16.7% vs. 41.7%; p = 0.02), whereas coronal alignment parameters did not differ between groups. Conclusions: RA-TKA with MC bearing provides functional outcomes comparable to M-TKA and may decrease sagittal alignment variability; long-term follow-up studies are needed to determine whether this potential benefit translates into sustained functional gains or improved implant survivorship.

Racial and ethnic minority patients have higher rates of adverse ischemic events following percutaneous coronary intervention. The impact of these disparities on the efficacy of drug-coated balloon (DCB) angioplasty for in-stent restenosis is unclear. We aimed to evaluate the comparative efficacy of DCB angioplasty among racial and ethnic minority patients presenting with in-stent restenosis. This was a prespecified analysis of the AGENT IDE (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA [Percutaneous Transluminal Coronary Angioplasty] Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis) trial which randomized patients with in-stent restenosis (2:1) to treatment with AGENT paclitaxel-coated balloon or conventional balloon angioplasty. The primary outcome was 1-year target lesion failure (composite of ischemia-driven target lesion revascularization, target vessel myocardial infarction, and cardiac death). Baseline clinical characteristics and outcomes were compared in minority patients versus non-Hispanic White patients and interaction terms used to determine if DCB efficacy was influenced by race or ethnicity. Of the 406 patients treated with DCB, 103 (25%) self-identified as minority patients (30.1% Black, 25.2% Hispanic/Latino, 8.7% Asian), and 303 (75%) as non-Hispanic White patients. Minority patients were younger (66 versus 69 years, P=0.003). There were no differences in 1-year target lesion failure (15.0% versus 18.9%; hazard ratio [HR], 0.79 [95% CI, 0.44-1.39]; P=0.41) or target lesion revascularization (11.1% versus 13.7%; HR, 0.80 [95% CI, 0.41-1.56]; P=0.51) between subgroups, including after adjustment for imbalances in baseline characteristics (adjusted odds ratio for target lesion failure 0.71 [95% CI, 0.37-1.34]). Both groups derived similar DCB benefit, with no significant treatment by race and ethnicity interaction (P-interaction >0.30 for all end points). In this prespecified analysis of the AGENT IDE trial, 1-year outcomes following DCB angioplasty were comparable between minority and non-Hispanic White patients. Although wide CIs limited the exclusion of clinically meaningful differences in outcomes between these groups, the relative efficacy of DCB versus balloon angioplasty was consistent across race and ethnicity. Registration: ClinicalTrials.gov; Identifier: NCT04647253. URL: https://www.clinicaltrials.gov/study/NCT04647253.

BACKGROUND Low anterior resection syndrome (LARS) is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer. Evidence-based interventions for the concurrent psychological burden are limited. Electroacupuncture has been proposed as a potential adjunctive therapy, but its psychological benefits remain inadequately studied. AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS, and to explore its potential advantages in psychologically vulnerable subgroups. METHODS We conducted a retrospective, controlled study involving 100 patients with moderate to severe LARS (LARS score ≥ 21) treated at two tertiary hospitals in China between January 2022 and December 2024. Patients received either standard postoperative care alone (n = 50) or in combination with a standardized 4-week electroacupuncture protocol (n = 50). Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale (HADS), Body Image Scale (BIS), General Self-Efficacy Scale, Perceived Social Support Scale (PSSS), LARS score, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points. The primary endpoint was emotional remission, defined as a ≥ 3-point reduction in HADS-Anxiety subscale (HADS-A). Analyses included repeated-measures comparisons, Kaplan-Meier survival curves, Cox regression models, and subgroup-interaction testing. RESULTS At baseline, demographic, surgical, and psychosocial characteristics were comparable among groups. By week 4, patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety (HADS-A: 4.8 ± 2.6 vs 7.3 ± 3.0; P &lt; 0.001), depression, and body-image disturbance (BIS: 8.7 ± 3.6 vs 11.9 ± 4.2; P &lt; 0.001), alongside enhanced coping capacity (Brief Coping Orientation to Problems Experienced), perceived social support (PSSS), and bowel function (LARS score). Emotional remission - defined as a ≥ 3-point HADS-A reduction - was achieved more rapidly in the electroacupuncture group, as confirmed by Kaplan-Meier analysis (log-rank P &lt; 0.001; odds ratio = 4.7). Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery. Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety (HADS-A ≥ 8), elevated body-image disturbance (BIS ≥ 12), or low perceived social support (PSSS &lt; 60), with consistent interaction effects (P for interaction &lt; 0.05 across subgroups). CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS. Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.