Preoperative Diagnostic Factors Associated With Early MCID Achievement in BCTQ Outcomes Following Carpal Tunnel Release.

Biliverdin supplementation in perfusate and preservation solution attenuates ischemia-reperfusion injury in a rat donation-after-circulatory-death heart transplantation model.

The direct anterior approach (DAA) in total hip arthroplasty (THA) offers advantages in muscle preservation and early recovery but is challenged by a steep learning curve that may affect outcomes. This systematic review analyzed complication and reoperation rates during the learning phase of DAA in primary THA. A comprehensive search of PubMed,Cochrane Library, and Web of Science, was performed according to PRISMA guidelines. Studies reporting complications and reoperations during the DAA learning curve were included. Data on demographics, surgical volume, and adverse events were extracted. The primary outcomes were complication and reoperation prevalence with 95% confidence intervals (CI). Thirty-five studies encompassing 96,605 primary THAs met inclusion criteria. The overall complication prevalence during the learning curve was 2.75% (2,653/96,605; 95% CI: 2.65%-2.85%). The most frequent complications were aseptic loosening (22%), periprosthetic fracture (14%), dislocation (10%), and prosthetic joint infection (9%). The reoperation prevalence was 1.81% (1,743/96,605; 95% CI: 1.72%-1.90%), mainly due to aseptic loosening, infection, and fracture. Heterogeneity in surgeon experience and reporting limited comparability across studies. The adoption of DAA in THA is associated with a measurable learning curve characterized by increased complication and reoperation rates during early experience. Awareness of these risks, along with structured training and careful patient selection, is essential to mitigate early failures. Further prospective studies are needed to better define the learning curve threshold and standardize outcome reporting.

Nursing care in a patient with ischemic stroke undergoing endovascular thrombectomy: A case report

This study aimed to compare the effects of Del Nido cardioplegia (DNC) and conventional cold blood cardioplegia (CBC) on early myocardial functional recovery, as assessed by cardiac magnetic resonance imaging, in patients with reduced ejection fraction undergoing concomitant coronary artery bypass grafting (CABG) and mitral valve replacement (MVR). This single-center prospective study was conducted between April 2024 and January 2025 and included 42 patients with a left ventricular ejection fraction (LVEF) <45% who underwent concomitant CABG and MVR. The mean age was 62.2±10.6 years, and 69.0% (n=29) of the patients were male. Patients were divided into two groups according to the myocardial protection strategy used: CBC (n=23) and DNC (n=19). Preoperative demographic, laboratory, and echocardiographic data were collected, and CMR was performed approximately 1 week before surgery to establish baseline values. Intraoperative parameters, postoperative clinical, laboratory, and echocardiographic findings as well as follow-up CMR findings obtained 1 month postoperatively were analyzed and compared between the groups. The aortic cross-clamp time was significantly longer in the DNC group than in the CBC group (p=0.016), whereas the total volume of infused cardioplegia was comparable between the groups (p=0.323). Intraoperative blood transfusion requirements were significantly higher in the DNC group (p=0.013). Regarding myocardial recovery, the DNC group demonstrated superior biventricular improvement. Significant reductions in left ventricular end-diastolic volume (p<0.001) and end-systolic volume (p<0.001) indicated pronounced reverse remodeling and were accompanied by a modest increase in LVEF (p=0.046). Similarly, postoperative right ventricular (RV) function was significantly better in the DNC group (p=0.026), with a significant decrease in the RV end-systolic volume index (p=0.025), reflecting improved systolic emptying. Although in-hospital mortality was numerically higher in the DNC group (31.6% vs. 8.7%), the difference was not statistically significant (p=0.112). Importantly, all deaths were associated with refractory low cardiac output syndrome during the postoperative intensive care unit stay. CMR findings suggest that DNC may be a safe and effective myocardial protection strategy in patients with reduced LVEF undergoing CABG and MVR. Furthermore, DNC appeared superior to CBC in promoting early biventricular reverse remodeling in this study population. The higher mortality observed in the DNC group may be attributable to the small sample size, longer cross-clamp times, greater operative complexity, and potential selection bias.

Imageless kinematic versus CT-based functional alignment in robotic-assisted total knee arthroplasty: A propensity score-matched comparative study.

The effect of hip offset reconstruction on gait biomechanics following total hip arthroplasty for 12 months.

Liver fibrosis is a shared pathological phenotype of chronic liver diseases of diverse etiologies, including viral hepatitis, alcohol-associated liver disease and metabolic dysfunction-associated steatohepatitis (MASH), as well as cholestatic liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis, and may progress to cirrhosis, hepatic decompensation and hepatocellular carcinoma. Despite advances in etiological treatments, effective therapies for established fibrosis remain limited. Increasing evidence indicates that liver fibrosis is a dynamic and potentially reversible process. The Wnt/β-catenin pathway is central to both liver regeneration and fibrogenesis and has traditionally been interpreted in terms of quantitative activation. Recent studies demonstrate that β-catenin-dependent transcription is qualitatively regulated by its nuclear coactivators, CREB-binding protein (CBP) and p300. CBP- and p300-associated transcriptional programmes exert distinct biological effects, promoting fibrogenic or regenerative states, respectively. These findings support a broader conceptual framework in which liver fibrosis can be viewed as a transcriptionally regulated and potentially reversible pathological state. In this review, we first summarize the molecular basis of canonical Wnt/β-catenin signalling and its transcriptional regulation by CBP and p300. Then, we discuss the pathophysiological relevance of CBP- versus p300-dependent β-catenin transcription in liver fibrosis of various etiologies, including cholestatic injury, and review experimental and early clinical evidence suggesting that selective modulation of CBP-associated transcription may promote early functional recovery, potentially preceding measurable regression of fibrotic burden. We close by considering implications for clinical trial design and the importance of function-oriented endpoints in antifibrotic drug development.

Functional outcome of long stem cemented hemiarthroplasty in the management of unstable pertrochanteric femur fractures in geriatric patients.

Intra-operative femoral condyle fractures during primary total knee arthroplasty: Incidence, risk patterns, and early outcomes in an Asian cohort.

Comparison of postoperative recovery indicators between stereoelectroencephalography and subdural grid electrode implantation for drug-resistant epilepsy.

Pre-Transplant Mechanical Support Strategy Determines Early Graft Recovery After Heart Transplantation: Insights from Cardiac Power Output Index Trajectories

To investigate whether preoperative muscle characteristics measured on CT scans could predict early ambulation capacity after hip fracture surgery. Retrospective cohort study. Single level I academic trauma center. Patients aged ≥55 years who underwent surgical fixation for hip fractures (OTA/AO types 31A, 31B) between January 2015 and December 2024 were included. Inclusion required preoperative CT imaging and documented ambulation assessments at postoperative day 1 (POD1) and discharge. Patients with neuromuscular disorders affecting muscle mass were excluded. The primary outcome was distance walked (feet) during physical therapy at POD1 and discharge. Preoperative CT scans were opportunistically analyzed for muscle quality (Hounsfield units) and size (cross-sectional area) in psoas, gluteal, and quadriceps muscles. Associations were analyzed using linear mixed-effects models adjusted for body mass index, Charlson Comorbidity Index, preinjury wheelchair use, time to surgery, and fixation method. A total of 140 patients (mean age 75 ± 8 years, 59% female) contributed 210 ambulation observations. Ambulation improved from 0 (IQR 0-20) feet at POD1 to 20 (IQR 0-86) feet at discharge ( P < 0.001). In the fully adjusted mixed-effects model, quadriceps quality was the only muscle metric that independently predicted ambulation (β = 0.042, 95% CI: 0.012-0.072, P = 0.007; marginal R 2 = 0.272). Among clinical covariates, higher body mass index was associated with reduced ambulation (β = -0.060, P = 0.029); Charlson Index was not significant (β = -0.062, P = 0.189). No other muscle quality (gluteus medius, gluteus maximus, psoas; all P > 0.16) or size metric (all P > 0.33) reached significance. In patients after hip fracture surgery, preoperative quadriceps muscle quality was the primary muscle-based predictor of early postoperative ambulation. Muscle quality outperformed size in predicting early functional recovery. Opportunistic CT-based Hounsfield units assessment identified patients at risk of limited early mobilization. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The coronal plane alignment of the knee (CPAK) classification provides an objective framework to describe alignment changes after total knee arthroplasty (TKA). Although preserving the native phenotype improves intraoperative soft-tissue balance in varus and neutral knees, its functional benefits remain uncertain. We therefore evaluated whether preserving the preoperative CPAK phenotype in varus and neutral knees is associated with superior early postoperative gait patterns following TKA. We prospectively enrolled 44 patients who had varus and neutral coronal alignment who underwent robotic-assisted TKA performed by five fellowship-trained surgeons. Spatiotemporal gait parameters were evaluated preoperatively and at six weeks postoperatively using a pressure mat that captured velocity, cadence, step length, and support time. Patients were grouped according to whether their postoperative alignment preserved or altered their native CPAK phenotype, as measured in long-leg biplane radiographs. Between-group differences were assessed using analysis of covariance adjusted for confounding and baseline gait values. Of the 44 patients, 21 (47.7%) had their native CPAK phenotype preserved, and 23 (52.3%) experienced a phenotype change. Preserving CPAK was associated with significantly faster postoperative walking velocity (+11.7 cm/s, P = 0.01), higher cadence (+7.0 steps/minute, P = 0.02), longer single-limb support (+1.5%, P = 0.003), and shorter step time (P = 0.02) compared with patients whose CPAK phenotype changed. Preoperative-to-postoperative gait changes analysis further confirmed this pattern: the changed group demonstrated significant reductions in walking velocity (P = 0.04) and cadence (P = 0.01), along with increased step time (P = 0.02), whereas the unchanged group showed significant improvements in step length (P = 0.02), greater single-limb support (P < 0.01), and reduced double-limb support (P < 0.01). Preserving the native CPAK phenotype after TKA is associated with improved early gait metrics, suggesting a potential biomechanical advantage of restoring constitutional alignment. These findings should be confirmed in larger cohorts with longer-term follow-up.

Functional Status after Ventral Hernia Repair: Longitudinal Trends and the Limits of Improvement.

This research was targeted to investigate the efficacy of vestibular rehabilitation therapy (VRT) for patients with benign paroxysmal positional vertigo (BPPV) experiencing residual symptoms after repositioning, and to examine subtype-specific differences between posterior canal BPPV (pc-BPPV) and horizontal canal BPPV (hc-BPPV). A prospective, stratified randomized controlled design was used, enrolling patients with BPPV who exhibited residual symptoms [Dizziness Handicap Inventory (DHI) ≥20 points] following repositioning between January 2024 and January 2025. Following standardized repositioning (modified Epley maneuver for pc-BPPV, Gufoni/Barbecue maneuver for hc-BPPV), patients were stratified by subtype and randomized into a VRT group and a control group. The VRT group received combined sequential VRT treatment with medication (betahistine hydrochloride+ginkgolide), incorporating traditional vestibulo-ocular reflex (VOR) adaptation training (eg, adaptive head movements) and habituation training for positional vertigo (eg, modified Brandt-Daroff training) over 28 days. The control group was given medication alone. The DHI, visual analogue scale (VAS), balance function (static closed-eye standing ≥60s), and dynamic visual acuity (DVA, horizontal head movement) at baseline, 14 days and 28 days were evaluated. This study included 207 BPPV patients with residual symptoms after repositioning (110 in the control group and 97 in the VRT group). The overall efficacy of the VRT group was significantly better than that of the control group, as evidenced by lower 28-day DHI (18.00 vs. 28.00, P<0.001) and VAS (1.60±1.40 vs. 3.46±1.45, P<0.001), higher balance compliance rate (88.7% vs. 61.8%, P<0.001) and DVA improvement (3 lines vs. 1 line, P=0.001). Subgroup analysis revealed that core efficacy were generally consistent between pc-BPPV and hc-BPPV in the VRT group, but subtype-specific differences emerged: pc-BPPV demonstrated faster early vertigo relief (ΔDHI_14d, P=0.030), while hc-BPPV showed superior DVA improvement (P=0.009). Within the control group, pc-BPPV demonstrated more pronounced early vertigo relief (ΔVAS_14d, P<0.001) and long-term disability improvement (ΔDHI_28d, P=0.021) during spontaneous recovery. VRT could remodel this difference, eliminating the long-term disadvantage of hc-BPPV and transforming the early advantage of pc-BPPV into rapid disability improvement. VRT significantly improves residual symptoms in BPPV after repositioning. Subtype-specific differences exist between pc-BPPV and hc-BPPV in early VRT efficacy and functional recovery dimensions, providing evidence for precision rehabilitation classification.

Delta-beta coupling during social stress and recovery in infancy: An EEG study using the Face to Face Still-Face paradigm.

In its early years, the UN Decade on Ecosystem Restoration has mobilized unprecedented global commitments. Yet, measuring restoration success remains contested, particularly in megadiverse countries where the absence of standardized indicators and assessment protocols often leads to subjective decisions by environmental agencies. Here, we present a core set of leading indicators developed through a pioneering Brazil-led science-policy collaboration between environmental agencies and research institutions. The indicators capture early vegetation recovery within four years and whether restoration trajectories are sustained or at risk of reversal. The initiative also establishes a framework that bridges science and policy to deliver practical monitoring tools. It offers a model for other megadiverse countries with complex governance, showing how simple, standardized indicators can translate restoration pledges into measurable results for the UN Decade.

Physical function in lung transplant recipients: Clinical implications and rehabilitation strategies.

Intrinsic regeneration mechanisms of murine lacrimal gland epithelial cells for therapeutic applications in aqueous-deficient dry eye disease.