Metabolic reconfiguration via bioenergetic repair of constructed wetlands: How magnesite transforms rhizosphere functionality in acid mine drainage treatment.

Healthy Days at Home after Emergency General Surgery: Shifting Towards Long-Term Patient-Centered Outcomes for Older Adults.

K777 promotes functional recovery after spinal cord injury via the PI3K/AKT signaling pathway.

Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic emergency that can rapidly progress to multiorgan failure and death if untreated. The role of extracorporeal membrane oxygenation (ECMO) in this setting is limited, and extracorporeal cardiopulmonary resuscitation (ECPR) has not been previously described. We report a case of a pregnant woman with suspected TTP who developed refractory pulseless electrical activity cardiac arrest before initiation of plasma exchange. Extracorporeal cardiopulmonary resuscitation with venoarterial ECMO was initiated despite profound thrombocytopenia (platelets 8,000/μL) as a bridge to definitive therapy, with rapid recovery of cardiac and renal function. She achieved full neurologic recovery and was discharged home without functional deficits. This case highlights the potential role of ECPR as a life-saving bridge in selected patients with TTP despite severe thrombocytopenia.

To evaluate the effects of multidisciplinary team (MDT) intervention on perioperative management, functional recovery, and psychological well-being in adolescents aged 14-18 years with limb or pelvic fractures. One hundred adolescents aged 14-18 years with limb or pelvic fractures, admitted between January 2018 and December 2023, were retrospectively divided into an MDT group ( n = 50) and a control group ( n = 50) according to whether they received MDT intervention. The MDT group received comprehensive perioperative management involving orthopedics, emergency, anesthesiology, rehabilitation, pediatrics, psychology, and surgical intensive care; the control group received standard perioperative management. Perioperative outcomes, pain scores, functional recovery, and psychological status were compared at predetermined time points. The MDT group had significantly shorter hospital stays and lower postoperative pain scores than the control group ( P < 0.05). Functional recovery was assessed using the short musculoskeletal function assessment (SMFA) and the CORE-Kids simplified score (CKSS), a 0-9 binary scale developed with reference to the CORE-Kids core outcome set. At 3 and 6 months, the MDT group showed significantly better SMFA and CKSS scores ( P < 0.05). At 12 months, no significant differences were observed. The MDT group also had significantly lower hospital anxiety and depression scale anxiety and depression scores on postoperative day 3 and at 12 months ( P < 0.05). MDT intervention improves perioperative pain control, promotes functional recovery, and enhances psychological well-being in adolescents with limb or pelvic fractures and may facilitate earlier return to daily life and school.

Integrated perioperative host-response optimization improves functional recovery and survival after ultra-low anterior resection: A randomized controlled trial.

The role of cognitive schemas in personal recovery, symptom severity, and functioning in schizophrenia-spectrum disorders.

Early mobilization (EM) has become essential for improved recovery after surgery, but its particular advantages in cardiac surgery populations have not been consistently reported. To systematically evaluate the effects of early mobilization on functional recovery outcomes, hospital length of stay, and safety profiles in patients undergoing cardiac surgery. The systematic search was performed in six databases (PubMed, Google Scholar, Cochrane CENTRAL, PEDro, Embase, and Web of Science). The search included studies published between January 1, 2015, and August 2025. Inclusion criteria were that the studies must look at interventions of early mobilization (within 48h of postoperative) in patients undergoing cardiac surgery, and the outcome measures may include functional capacity, length of stay in the hospital, or precautionary measures. Risk of Bias 2.0 (RoB 2) and Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) were used to evaluate the risk of bias. This review included 20 studies with 11,631 participants, 12 randomized controlled trials, four observational cohort studies, and four other study types. Most interventions were initiated within 24h after the operation. Functional recovery outcomes were predominantly favorable. Early mobilization improved 6-Minute Walk Test (6MWT) distance and functional independence scores in the majority of studies, whereas hospital length of stay results were inconsistent, with approximately half of the studies reporting significant reductions. The safety profiles were excellent throughout the studies, and few serious adverse events could be directly related to early mobilization. Subgroup analyses showed that Coronary Artery Bypass Grafting (CABG) had specific advantages, which were possible even in frail older patients. Early mobilization following cardiac surgery appears safe and is associated with improvements in functional recovery (e.g.,walking capacity and independence) and selected hospital outcomes (e.g.,length of stay), although the magnitude of benefit varies across studies. PROSPERO (CRD420251140353).

Longitudinal trajectories of treatment-course-associated biological aging predict treatment tolerance and survival after gastrointestinal cancer surgery.

Autologous nerve transplantation is currently recognized as the gold standard for treating severe peripheral nerve injuries in clinical practice. However, challenges such as a limited supply of donors, complications in the donor area, and the formation of neuromas necessitate the optimization of existing transplantation strategies. Additionally, the development of new and promising repair methods is a critical issue in the field of peripheral nerve research. The purpose of this article is to compare the advantages and disadvantages of autologous, allogeneic, decellularized nerve grafts, and cell-composite graft, as well as to summarize the differences in their prognostic factors and associated adverse events. The length, diameter, polarity, and sensory or motor origin of autografts all influence axonal regeneration. While pre-denaturation treatment can accelerate early regeneration, long-term functional outcomes of autografts do not show significant differences compared with fresh autologous grafts. For decellularized nerve grafts, defect length is identified as an independent risk factor, and the internal microenvironment (delayed angiogenesis, Schwann cell senescence, and reduced T-cell infiltration) is considered a key factor limiting long-segment regeneration. Additionally, the decellularization process (whether chemical, physical, or supercritical CO 2 ) affects the integrity of the extracellular matrix and the presence of immune residuals, which directly impacts axonal guidance and host integration. Common adverse events following autograft transplantation include donor site numbness, neuromas, and scarring. In contrast, adverse events associated with decellularized nerve graft transplantation may present as inflammatory reactions, excessive scar proliferation, and misalignment or reconnection of regenerating axons, which can lead to sensory-motor cross-innervation. To mitigate these issues, combining decellularized nerve grafts with autologous Schwann cells, mesenchymal stem cells, or induced pluripotent stem cell-derived cells may help bridge the gap with autografts. However, the fact that structural recovery does not necessarily lead to functional recovery needs further clarification. Future research should establish large animal models to replicate the limits of human regenerative capacity, use gene editing to enhance the phenotype and microenvironment of transplanted cells, and develop a mild combined decellularization process that maximizes the preservation of natural nerve grafts. Through multidimensional optimization, decellularized nerve grafts have the potential to ultimately replace autograft transplantation, enabling precise repair of individualized, long-segment, and complex nerve defects.

Volumetric muscle loss (VML) results in persistent functional and metabolic deficits, yet the influence of biological sex and ovarian hormones on these outcomes remains poorly understood. Here, we examined male, intact female, and ovariectomized (OVX) female mice at 12 wk following VML to determine how biological sex and the loss of ovarian hormones affect whole body metabolism, functional recovery, and tissue remodeling. Males postinjury relied on greater lipid oxidation postprandially, whereas females maintained robust carbohydrate oxidation and dynamic metabolic flexibility. The loss of ovarian hormones increased adiposity and impaired the sex-specific advantage in glucose responsiveness. Biological sex did not influence maximal isometric torque or contractile properties following VML, which accompanied similarities in mitochondrial content [i.e., citrate synthase, pyruvate dehydrogenase (PDH) activity]. Females exhibited greater complex II activity than males, whereas the loss of ovarian hormones decreased complex I and PDH activity. Despite comparable lipid accumulation in females with and without ovarian hormones, maximal isometric torque and contractile properties were impaired with the loss of ovarian hormones. Proximity to VML defect influenced lipid droplet proteins, specifically perilipin 2, though not affected by biological sex or ovarian hormone loss. Collectively, these findings indicate that sex-specific differences in substrate utilization and mitochondrial function, mediated in part by ovarian hormones, may underlie the divergent metabolic and functional trajectories following VML. These results highlight the importance of considering biological sex and ovarian hormones in preclinical studies and therapeutic strategies for regenerative interventions.NEW & NOTEWORTHY This study combined ovariectomy and volumetric muscle loss injury model to investigate if ovarian hormones play a protective role in females during the sequelae of traumatic skeletal muscle injury. The loss of ovarian hormones induces whole body and cellular metabolic inflexibility and worsened functional recovery, identifying ovarian hormones as key regulators of VML-induced metabolic pathophysiology.

Soft-tissue reconstruction of the distal leg, ankle, and foot remains challenging due to limited local tissue and compromised vascularity. Propeller perforator flaps have emerged over the past 2 decades as an alternative to free flaps, offering preservation of major vascular axes and reduced donor-site morbidity. However, clinical outcomes remain heterogeneous, and the reliability and functional benefits of PPFs are still debated. A PRISMA-2020-compliant systematic review (PROSPERO: CRD420251148124) was conducted through August 2025 across PubMed, MEDLINE, Embase, Ovid, and Web of Science. Eligible studies included observational designs, case series, and case reports on PPFs for lower-extremity reconstruction. Primary outcomes included flap survival, necrosis, venous congestion, infection, reoperation, functional recovery, and quality of life. The risk of bias was assessed using the Joanna Briggs Institute tools and the Newcastle-Ottawa Scale. Fifty-one studies (n = 1474 patients) met the inclusion. Trauma was the leading etiology (88%), with reconstructions most often involving the ankle/malleolar and heel regions. Posterior tibial and peroneal artery perforators were used in 74% of cases. Complete flap survival was reported in 47% of studies; partial necrosis in 28%, and total flap loss in 10%. Venous congestion was common but often self-limiting. Functional outcomes were inconsistently reported and generally favorable in fewer than half of the studies. Methodological quality was moderate to good in most reports. Propeller perforator flaps are a feasible reconstructive option for lower limb defects, although outcomes remain variable. Further prospective, comparative studies are needed to establish their long-term reliability and functional impact.

This study aimed to compare donor-site morbidity among three common major lower extremity free flaps: fibula (FFF), anterolateral thigh (ALT), and the medial sural perforator (MSAP) using an established patient-reported outcome measure (PROM), the Lower Extremity Functional Scale (LEFS). Patients who underwent head and neck reconstruction with either FFF, MSAP, or ALT were included. The primary outcome was functional recovery, assessed using the modified LEFS, a PROM measuring functional status, administered at multiple post-operative timepoints. Seventy-five patients were included in the analysis: 33 FFF, 22 MSAP and 20 ALT. Patients undergoing lower extremity free flap surgery overall recovered well. The LEFS scores at different time points demonstrated quicker recovery for the MSAP group, while ALT and FFF recovered later. After 360 days, the MSAP group also demonstrated improved functional outcomes compared to the ALT and FFF. Patients undergoing lower extremity free flap surgery recover well. The MSAP had the least donor-site morbidity. Donor-site morbidity should be considered when counseling patients.

Cancer survivorship is increasingly characterized by long-term treatment sequelae, including cardiometabolic disease, fatigue, sleep disturbance, psychological distress, and risk of second malignancies. As survivorship populations expand, there is growing recognition that traditional symptom-focused follow-up does not adequately address modifiable drivers of long-term morbidity. This review evaluates lifestyle medicine as a structured framework integrating physical activity, nutrition, sleep health, psychological well being, and substance cessation to improve survivorship outcomes across solid tumors and hematologic malignancies. Evidence from randomized trials, cohort studies, and consensus guidelines demonstrates that lifestyle interventions influence systemic inflammation, immune function, metabolic regulation, and functional capacity. Physical activity improves fatigue, cardiorespiratory fitness, and quality of life, while plant-forward dietary patterns are associated with improved survival outcomes. Sleep optimization and stress reduction interventions improve inflammatory signaling and psychological outcomes. Tobacco cessation and alcohol reduction reduce recurrence risk and mortality. Emerging literature highlights the relevance of cardiometabolic pathways and behavioral interventions as modifiable determinants of survivorship trajectories. Lifestyle medicine provides a biologically plausible and clinically actionable framework to address shared mechanisms underlying cancer recurrence, treatment toxicity, and chronic disease risk. Integration of multidisciplinary interventions and digital health tools may enable scalable survivorship models focused on prevention, functional recovery, and long-term health optimization. Future research should prioritize mechanistic studies and pragmatic trials evaluating multimodal interventions across diverse cancer populations.

Rich-club connections dynamics are associated with long-term outcomes in major depressive disorder.

Skeletal Muscle Mass and Quality in Peripheral Artery Disease: New Insights into Clinical Management and Therapeutic Optimization.

Open surgery is commonly used for treating benign bone tumours and tumour-like lesions near the joints of the extremities. However, inappropriate resection margins may lead to incomplete lesion removal and subsequent local recurrence, while overly extensive dissection aggravates soft tissue injury and compromises periarticular joint function. Although uniportal endoscopic technique have been well established in minimally invasive spinal surgery, their utilization in juxta-articular benign bone lesions remains poorly defined with unclear patient selection criteria and medium-term oncological performance. This retrospective study aimed to summarize the appropriate indications for uniportal endoscopic technique in the treatment of benign bone tumours and tumour-like lesions adjacent to limb joints and evaluate its oncological safety and local control outcomes. By comparing the differences between the uniportal endoscopic technique and open surgery in treating benign bone tumours and tumour-like lesions adjacent to limb joints, this study aims to investigate the feasibility of the uniportal endoscopic technique. More importantly, it aims to evaluate and discuss the indications of uniportal endoscopic technique, as well as the medium-term oncological efficacy and safety. A retrospective analysis was conducted on the clinical data of patients with benign bone tumours and tumour-like lesions near the joints of the extremities treated at the Affiliated Cancer Hospital of Chongqing University between October 2021 and December 2024. Among them, 53 patients were treated using the uniportal endoscopic technique, and 97 patients were treated using the open surgery. The follow-up period for all cases exceeded 12months. All cases had a definitive pathological diagnosis preoperatively. The lesion size (maximum diameter) was recorded for indication stratification. Primary study endpoints focused on medium-term oncological outcomes, including local recurrence rate and lesion clearance status evaluated by serial follow-up computed tomography (CT). Secondary perioperative indicators including operation time, intraoperative blood loss, postoperative complications, and preoperative and postoperative Visual Analogue Scale (VAS) scores were collected for comparison. Surgical outcomes were evaluated using the modified Macnab criteria. All 150 patients included in this study completed the follow-up examinations. During follow-up, adequate radical lesion clearance was confirmed on serial CT examinations in all patients, and no local recurrence was detected in both the uniportal endoscopic technique group and the open surgery group. All lesions enrolled in this study had a maximum diameter less than 5cm, and uniportal endoscopic technique achieved complete resection in these eligible cases, suggesting that a maximal diameter < 5cm represents a reasonable size indication for this endoscopic technique. Postoperative imaging examinations indicated satisfactory bone healing in all patients. The mean operation time was 140.02 ± 39.67min in the uniportal endoscopic technique group and 141.56 ± 36.90min in the open surgery group, with no statistically significant difference between the two groups (P > 0.05). Intraoperative blood loss was significantly lower in the uniportal endoscopic technique group compared with the open surgery group [20.00 (15.00) mL vs. 50.00 (50.00) mL; P < 0.001]. No postoperative complications occurred in either group. Intra-group comparison: The VAS scores at various postoperative time points were significantly lower compared to the preoperative scores in both groups (P < 0.05), indicating statistically significant improvement postoperatively. The results of the modified Macnab criteria at the final follow-up indicated significant improvement in clinical symptoms for all patients, suggesting postoperative pain relief, functional recovery, and improved quality of life. In conclusion, for juxta-articular benign bone tumours and tumour-like lesions with a maximum diameter less than 5cm, uniportal endoscopic technique achieves equivalent radical resection efficacy compared with open surgery under strict indication screening. No local recurrence was observed in either group during follow-up, which suggests the favourable oncological safety of the uniportal endoscopic technique. Although the uniportal endoscopic technique had advantages in several perioperative indicators, these minimally invasive benefits should not serve as the primary basis for surgical decision-making.

Stroke causes neurological impairment through local plasticity mechanisms, such as synaptic sprouting, and large-scale network reorganization. Although poststroke Wallerian degeneration is well established, whether white matter (WM) tracts' remodel over time to support behavioral recovery remains controversial. We investigated whether longitudinal changes in WM microstructure and structural connectivity are coupled to poststroke behavior, and how structural connectivity reorganization relates to local disconnection microstructure. In this prospective cohort study (Washington University, St. Louis; 2016-2018), patients with first-time stroke underwent diffusion-weighted magnetic resonance imaging and behavioral assessments at 2 weeks and 3 months poststroke; healthy controls were assessed twice. Latent factorial analysis was applied to behavioral and microstructural data from diffusion tensor imaging and neurite orientation dispersion and density imaging. Primary measures were whole-brain structural connectivity gradient divergences computed from tractography, microstructural diffusion parameters extracted from both WM and cortical regions disconnected by the lesion, and behavioral factors. Linear mixed models (adjusted for sociodemographic values) assessed longitudinal changes, linear regression assessed brain-behavior associations, and machine learning algorithms assessed differences between healthy controls and stroke. Seventy-nine patients (age, 60±12 years; 43% female; diffusion-weighted magnetic resonance imaging: 48 at 2 weeks and 26 at 3 months) and 33 age-matched healthy controls were included. At 2 weeks, patients with stroke exhibited diffuse whole-brain alterations in WM organization. These widespread changes were closely linked to microstructural abnormalities in WM pathways disconnected by the lesion. Notably, WM degeneration progressed between 2 weeks and 3 months poststroke. Whole-brain structural connectivity alterations were associated with cognitive deficits acutely but not at 3 months, whereas microstructural parameters in disconnected tracts were primarily related to motor impairment. In patients with predominantly mild-severity stroke, we observed widespread and progressive alterations in WM microstructure that persists beyond the lesion and continues to evolve over time. Although acute structural disconnection relates to behavioral deficits, chronic WM degeneration appears largely uncoupled from functional recovery.

Plant-derived extracellular vesicles restore cellular energetics for peripheral nerve regeneration through glycolysis reprogramming.

Simultaneous bilateral total knee arthroplasty (BTKA) is avoided due to higher perioperative risk, favoring staged procedures. This study evaluated how the interval between staged TKAs affects patient-reported outcome measures (PROMs) and compared complications between the first and second procedures. We retrospectively reviewed patients undergoing primary, elective, staged, BTKAs at a high-volume academic center between 2011 and 2024. Intra- and perioperative data and complications were compared between the surgeries. Patients were stratified by interval: less than three months ("extremely short waiters"), three to six months, six to nine months, nine to 12 months, one to two years, two to five years, and greater than five years. The PROMs were compared across these groups. A total of 4,210 patients underwent 8,420 staged, BTKAs at a mean 21.4-month interval. The most common intervals were six to nine months (27.4%) and nine to 12 months (21.1%). Patients were more likely to return to the emergency department (22 versus 16, P = 0.030) and be readmitted (48 versus 26, P = 0.113) after the second surgery, primarily due to infection. Revision rates did not differ. "Extremely short waiters" had the greatest improvement in Patient-Reported Outcomes Measurements Information System Pain Intensity and interference scores nine months after the second TKA (change 13.4 and 15.1, P < 0.001). At three months following the second surgery, those who waited three to six months had the largest Knee Injury and Osteoarthritis Outcome Score for Joint Replacement score improvement (change 23.7, P = 0.004). At one year after the second surgery, "extremely short waiters" again showed the greatest reduction in Patient-Reported Outcomes Measurements Information System Pain Intensity (change 10.5, P = 0.007) and Interference (change 11.3, P < 0.001). The interval between surgeries significantly impacted PROMs, with shorter intervals associated with better pain relief and functional recovery. Surgical timing should be tailored to individual patient goals and recovery trajectories.