Transforaminal full-endoscopic spine surgery (TF-FESS) is a minimally invasive surgical procedure for lumbar spinal disease; however, it is technically demanding in patients with foraminal stenosis because of anatomical problems. This procedure has unique surgery-related complications, such as exiting nerve root injury, causing postoperative dysesthesia or muscle weakness, resulting in a poor clinical outcome. Therefore, we have to avoid this complication. The objective of this study was to analyze the morphology of the intervertebral foramen and assess the feasibility of TF-FESS. We retrospectively reviewed the multiplanar abdominal computed tomography (CT) scans obtained for 800 consecutive patients (400 consecutive males, 400 consecutive females) at our hospitals between January 2016 and December 2018. Patients with lumbar scoliosis (Cobb angle >5 degrees), spondylolisthesis, or vertebral fracture, as well as those with a history of lumbar spinal surgery, were excluded. We evaluated the average values for disc height, position of the superior articular process (SAP), foraminal distance, foraminal area, and SAP facet contact from L1/L2 to L5/S1 on both sides in reconstructed sagittal views. A total of 8,000 intervertebral foramina were analyzed. The correlation between the disc height and these parameters was assessed at each spinal level. At the L1/L2, L2/L3, L3/L4, L4/L5, and L5/S1 levels, the mean disc height was 5.4 mm, 6.4 mm, 7.1 mm, 7.1 mm, and 5.9 mm, respectively. The SAP position, as the distance above the line of the inferior margin of the upper vertebral body, decreased from L1/L2 to L3/L4 and increased from L3/L4 to L5/S1. The respective foraminal distances were the shortest at L4/L5. The foraminal area decreased toward the lower levels. The SAP facet contact was decreasing from L1/L2 to L4/L5. There was a negative correlation between the disc height and the SAP position, and positive correlations of disc height with the foraminal area and the SAP facet contact. The results of the SAP position, the foraminal distance, and the foraminal area suggest that TF-FESS would be technically more difficult at a lower intervertebral disc level because of resection of a larger amount of the SAP. Foraminal stenosis would develop easily when a disc has collapsed. About half of the facet contact could be maintained even if the SAP is resected completely during TF-FESS, especially at a lower lumbar level.

The Centers for Medicare and Medicaid Services (CMS) now require the collection of preoperative and postoperative patient-reported outcome measures (PROMs) for elective inpatient Medicare total joint arthroplasty procedures. There are concerns CMS will utilize the percentage of patients meeting the substantial clinical benefit (SCB) threshold in determining hospital reimbursement. However, understanding of what drives SCB achievement remains limited. Using a prospectively collected registry of total knee arthroplasty patients between January 2020 and June 2023, eligible patients were categorized into two groups, designated "improvement" and "nonimprovement," based on their attainment or lack of attainment of the established SCB threshold. Cohort demographics and preoperative/postoperative PROMs were compared. Cluster analyses were performed to evaluate for patient characteristics impacting SCB achievement status. In total, 1,240 of 1,860 patients (66.7%) completed preoperative and postoperative PROMs data and met inclusion criteria for this study. Patients achieving SCB represented 66.1% of included patients (820 of 1,240). There were very few demographic differences between "improvement" and "nonimprovement" groups; the improvement group was notable for more women (66.6 versus 58.3%, P = 0.02). Cluster analyses revealed characteristics associated with likely SCB achievement included younger age, non-White race, Hispanic/Latino ethnicity, lower level of education, and worse preoperative pain and functioning scores. The implication of PROMs and SCB in reimbursement within the CMS patient population has far-reaching consequences across the field of arthroplasty. We found that Medicaid insurance and lower education level (factors associated with lower socioeconomic status) were not associated with failure to achieve SCB. In addition, non-White race and Hispanic/Latino ethnicity were associated with SCB achievement, indicating that these policies may not be exacerbating existing inequities in arthroplasty care. Further work is necessary to maximize PROMs collection and SCB achievement while prioritizing patient outcomes. Prognostic level III.

While electroconvulsive therapy (ECT) is an effective treatment for depression, patient responses vary. In addition, there is a lack of guidance in making treatment decisions for patients with an initial nonresponsive trajectory. In this study, we aimed to identify distinct latent patient trajectories and explore outcomes among patients who had not responded after 9 treatments but who continued therapy. In this register-based cohort study, including 344 patients (61% female), we applied a latent class mixed model to identify latent patient trajectories and investigated variables associated with class affiliation in a multinomial regression analysis. We also identified nonresponders at treatment 9 and investigated final outcomes in a logistic regression model. Three latent classes were identified, all of which showed improvement, although classes 2 and 3 showed faster and steeper symptom reduction, with mean Montgomery-Åsberg Depression Rating Scale (MADRS) scores post-ECT of 9.8 and 5.3, respectively. Class 1 showed a shallower response pattern, with a mean MADRS score post-ECT of 20.9; variables associated with affiliation to this class were longer duration of depressive episode, nonpsychotic depression, lower age, and lower baseline depression level. Of nonresponders to ECT at session 9, 44.9% achieved final response and 17.9% achieved remission; female sex and lower age groups (<60) were associated with higher odds of final nonresponse. Our study supports ECT as an effective treatment for depression, while highlighting the existence of distinct response trajectories. A significant proportion of patients with an initial nonresponse trajectory may still benefit from continued ECT. Our findings reinforce the importance of individualized treatment decisions guided by clinical response and close monitoring.

Associations of Estrogen Receptor 1 and Vitamin D Receptor Gene Polymorphisms with Bone Resorption During Pregnancy and Early Postpartum in a Mexican Cohort.

Impact of Mental Training on the stress of anaesthesiology residents before performing obstetrical epidural analgesia: A prospective randomised educational trial.

The combined use of Veno-venous extracorporeal membrane oxygenation (VV-ECMO) and damage-control laparotomy/open abdomen (DCL/OA) is not well described in the literature. We hypothesized that the mortality with concurrent VV-ECMO and DCL/OA would not be statistically different from that reported for either intervention alone. Patients managed with a DCL/OA and VV-ECMO from March 2014 through March 2022 were retrospectively reviewed from a prospectively collected database at a single quaternary care center. The primary outcome was in-hospital mortality. Survivor and nonsurvivor cohorts were compared using univariate and bivariate analyses with a priori significance at p ≤ 0.05. A multivariable regression analyses was performed to identify independent predictors of mortality. Fifty-two patients were managed with VV-ECMO and concurrent DCL/OA. The majority of patients were male (58%), with a mean (SD) age of 41 (14) years. The primary indication for VV-ECMO was acute respiratory distress syndrome/pneumonia (83%). The primary indications for DCL/OA were abdominal compartment syndrome (37%) and trauma (19%). Sixty percent of the patients underwent VV-ECMO cannulation after DCL/OA. Survival at hospital discharge was 58%. Survivors had a lower mean Sequential Organ Failure Assessment score (12 vs. 14, p = 0.02), higher mean Respiratory ECMO Survival Prediction score (3.5 vs. 1.1, p = 0.004), lower mean preoperative lactic acid level (4 vs. 7, p = 0.04) and were more likely to receive anticoagulation while on VV-ECMO (70% vs. 30%, p = 0.012) than nonsurvivors. Postdischarge, survival rates at 3, 6, 9, and 12 months were 90%, 72%, 69%, and 62%, respectively. After adjusting for confounders, the use of anticoagulation (odds ratio, 0.08; 95% confidence interval, 0.01-0.42) and a higher Respiratory ECMO Survival Prediction score (odds ratio, 0.71; 95% confidence interval, 0.53-0.95) were associated with decreased mortality. Relatively favorable outcomes are often achieved in acute care surgery patients treated with concomitant VV-ECMO and DCL/OA. Veno-venous extracorporeal membrane oxygenation should not be considered a contraindication to DCL/OA and vice versa. ( J Trauma Acute Care Surg . 2026;101: 136-144. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Retrospective Cohort Study; Level III.

Carbohydrate antigen 19-9 (CA19-9) has limited utility in the ∼10% of patients with pancreatic ductal adenocarcinoma (PDAC) who are Lewis-negative CA19-9 "nonproducers" (FUT3-null). This study aims to define the prognosis of FUT3-null PDAC and establish a CA19-9 cutoff that can help identify this subgroup in clinical practice. Germline whole-exome sequencing was performed in a multicenter cohort of 615 patients with PDAC to determine FUT2/FUT3 genotypes. Receiver operating characteristic (ROC) analysis identified the optimal CA19-9 cutoff for FUT3-null status. Maximally selected rank statistics were used to derive CA19-9 cutoffs that best stratified overall survival (OS) in a training set (n = 307) and were tested in a validation set (n = 308). FUT3-null patients had similar demographics except for a lower median baseline CA19-9 level (2.4 vs. 496 U/mL in FUT3-intact patients) and a comparable median OS (13.5 months) to FUT3-intact patients with CA19-9 >200 U/mL (12.9 months). ROC analysis identified 7 U/mL as the optimal CA19-9 cutoff for FUT3-null (positive predictive value 95.1%; accuracy 87.9%). Using CA19-9 cutoffs of 7 and 200 U/mL (without genotyping), patients were stratified into four prognostic groups: >7 to 37 U/mL (median OS, 23.2 months), >37 to 200 U/mL (median OS, 22 months), >200 U/mL (median OS, 12.8 months), and ≤7 U/mL (likely FUT3-null; median OS, 13.5 months; P < 0.001). Findings were consistent in multivariable Cox models. CA19-9 nonproducers whose outcomes are comparable with those with CA19-9 >200 U/mL represent a high-risk subgroup. CA19-9 ≤7 U/mL is a practical surrogate for identifying these patients. When genotyping is unavailable, a dual-threshold model (≤7 and >200 U/mL) improves risk stratification.

Association of vitamin D status with the immune response in active pulmonary tuberculosis patients with chronic pulmonary aspergillosis.

Migraine headache is a common primary headache disorder which is multifactorial in origin. On the other hand, iron deficiency anemia causes metabolic abnormalities in the brain which leads to a reduction in neuronal activities. The study was designed to determine the association between iron deficiency anemia and migraine. This was a case-control study which was conducted among patients attending at the outpatient department of Neurology of Mymensingh Medical College Hospital with migraine headache fulfilling the International Headache Society criteria and non-Migraine age and sex matched healthy individuals from November 2019 to April 2021. Total 155 migraine patients (case) and 155 non-migraine healthy individuals (control) were included in this study. After signing the informed written consent, the blood samples were collected for complete blood count and serum ferritin level. The study result showed that iron deficiency anemia was more common in migraine patients than non-migraine healthy individuals (p<0.001). In female patients, serum hemoglobin and ferritin level were significantly low in migraine (p<0.001 and p<0.001 respectably) but in male patients only serum ferritin level was significantly low (p=0.001). There is also an association between severity of migraine attack and iron deficiency anemia (p=0.042). The patients with severe headache had lower serum hemoglobin and ferritin level which were statistically significant (p=0.005 and p<0.01 respectably). The study observed an association between iron-deficiency anemia, serum hemoglobin and ferritin levels with migraine. Therefore, iron deficiency anemia may be investigated in migraine patients and iron supplements might be an effective treatment in patients with migraine.

Comparison of demographic and clinical features in adolescent-onset vs. adult-onset bipolar disorder an analysis of BIPAS Phase II data.

Risk factors and serum amino acid metabolic profiles of patients with type 1 diabetes and concomitant mild cognitive impairment: A cross-sectional study.

To investigate the effects of a sleep intervention (Sleep-Opt) compared with an attention control intervention (Healthy Living) on glycemic targets and psychological outcomes in adults with type 1diabetes (T1D). Adults with T1D and short (<6.5 h/night) or irregular (variability of sleep duration ≥1 h) sleep were randomly assigned to either the Sleep-Opt (n = 73) or Healthy Living control (n = 71) intervention, both of which were remotely delivered in eight sessions for 12 weeks. Primary (A1C, continuous glucose monitoring [CGM], and objective sleep) and secondary (psychological and subjective sleep) outcomes were collected at baseline and 6, 12, and 24 weeks, with 12 weeks being a primary end point. A1C and CGM parameters at 12 weeks indicated no significant differences between groups. Sleep duration increased at 6 weeks in both groups, but no significant differences were observed between groups at any time point. Sleep-Opt participants had reduced diabetes distress (median difference -0.18 [95% CI -0.35, -0.01]) and improved subjective sleep quality (-0.96 [-0.17, -0.23]) compared with the Healthy Living group at 6 weeks but not at other time points. A significant interaction was found suggesting the effect of the intervention depended on baseline A1C level. At 12 weeks, the Sleep-Opt group with baseline A1C ≥7% had a lower A1C level than the Healthy Living group (marginal mean -0.32% [95% CI -0,64%, -0.005%]; -3.5 [95% CI -7.0, -0.1] mmol/mol; P = 0.047). Sleep-Opt did not improve glycemic targets or sleep parameters, although sleep improved in both intervention groups. Glycemic benefits were observed in participants with suboptimal A1C, suggesting a possible role of sleep intervention in this patient group.

ObjectivesTo compare the treatments used for the first episode of lupus nephritis (LN) in two Latin American cohorts (historical and contemporary) over a 25-year period, and their associations with clinical outcomes.MethodsPatients with biopsy-confirmed first LN episode were classified as non-proliferative (class V) or proliferative (classes III/IV). Sociodemographic, clinical, and treatment variables were described. Propensity score matching was used to examine the associations with four outcomes: mortality, damage accrual (SDI), hospitalization, and end-stage renal disease (ESRD).ResultsA total of 532 SLE patients were included: 362 from GLADEL 1.0 (historical cohort) and 170 from GLADEL 2.0. (contemporary). Compared to GLADEL 1.0, patients in GLADEL 2.0 received lower doses of oral glucocorticoids (GC), more frequently GC pulses and antimalarials but less frequently cyclophosphamide. An increase in the use of mycophenolate mofetil and other immunosuppressants was also observed. In the logistic regression models, SDI was associated with baseline SDI and GC pulses, whereas belonging to the GLADEL 2.0 was a protective factor. Mortality was associated with Mestizo ethnicity and partial health coverage; antimalarial was identified as a protective factor. Hospitalizations were associated with baseline SLEDAI and SDI, follow-up time, and lower educational level. Belonging to the GLADEL 2.0 cohort was protective against the occurrence of ESRD.ConclusionsPatients in the contemporary cohort benefited from advances in treatment strategies, with less cumulative damage and progression to ESRD, although mortality remained unchanged. These improvements likely reflect the increased use of newer therapies, more targeted approaches, in line with current treatment guidelines, and better access to specialized care.

Maternal digit ratio (2D:4D), autistic traits, and autism spectrum disorder in offspring: A case-control study.

To assess the perceived effectiveness of the school nurse services through students' responses and to examine whether there is a detectable relationship between the students' subjective health status and the school nurse's service delivery. We conducted our cross-sectional, quantitative research in the West Transdanubian region of Hungary using convenience sampling among high school students (n = 429). Given the non-probability sampling, the findings may not be generalizable to all student populations. Data were collected using standardized (SF-36, EQ-VAS, questions on the prevalence of subjective health complaints from the HBSC survey) and a self-developed questionnaire. Chi-square tests, correlation analyses and multivariable linear regression analyses were performed using SPSS Statistics 27.0 software. Students reported a higher level of health-related knowledge received from the school nurse, along with better perceived applicability of this knowledge in everyday life (p < 0.05). Nearly three quarters of respondents indicated that the school nurse's activities contributed to the development of their health-related attitudes and this perception showed a statistically significant association with both the quantitative and qualitative evaluation of the care provided (p < 0.05). Higher ratings of the perceived effectiveness of school nursing activities were associated with more favourable self-rated mental health and a lower level of reported health complaints; however, these associations were weak in magnitude. The results revealed statistically significant but weak associations between perceived school nurse services and selected indicators of students' self-rated health status. Due to the cross-sectional design and the use of self-reported data, causal inferences cannot be drawn. Nonetheless, the findings suggest that more favourable quantitative and qualitative evaluations of the care provided are linked to higher perceived effectiveness of school nurse activities. Further research on quality indicators of school nurse services and approaches tailored to students' needs may be warranted. The observed associations between students' perceptions of school nurse services and their health perceptions underscore the importance of continuous professional development for school nurses. This may include advanced training in health education and communication skills to further support the perceived effectiveness of their activities. What problem did the study address? We addressed the perceived effectiveness of school nurse services from the perspective of students and examined whether there is a detectable relationship between students' subjective health status and the services provided by school nurses. What were the main findings? The study found that higher levels of health-related knowledge reported as being provided by the school nurse were associated with more favourable student ratings of the applicability of this knowledge in everyday life. Students who reported more positive experiences with school nurse activities also tended to report more favourable health perceptions, which were reflected in the indicators used to evaluate the services. In addition, higher perceived effectiveness of school nurse services was associated with more favourable self-reported mental health and vitality, as well as a lower level of reported health complaints. Where and on whom will the research have an impact? The findings may be particularly relevant for school nurses, as they highlight the importance of their role and the potential need for continuous attention to service quality from the students' perspective. They may also be informative for students and school communities by underscoring that health education and services provided by school nurses are associated with more favourable self-reported health perceptions and overall well-being. No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study beyond students' participation as anonymous questionnaire respondents.

To evaluate the efficacy and outcomes of extracorporeal shockwave therapy (ESWT) for bone pathologies including fractures, osteonecrosis/avascular necrosis, bone stress injury (BSI), medial tibial stress syndrome (MTSS), and bone marrow edema syndrome (BMES). Systematic review. Search performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of 3 databases: Cochrane Library, Embase (Elsevier), and PubMed (NLM). Studies included randomized controlled trials, cohort studies, case series, and case reports that investigated the efficacy of ESWT for the management of BSI, BMES, MTSS, delayed or nonunion fracture, or osteonecrosis/avascular necrosis of bone. Fifty-three studies with 1835 adult patients (608 women, 910 men, 317 unspecified) were included. Studies were defined using Oxford level of evidence rating: 7 level I (13.2%), 4 level II (7.5%), 4 level III (7.5%), 24 level IV (45.2%), and 14 level V (26.4%). Four of 7 level I studies showed similar effectiveness of ESWT compared with surgery for the treatment of long bone nonunion fractures (n = 1) and early stage osteonecrosis of the femoral head (n = 1), exercise program for MTSS (n = 1), and medication management for BMES (n = 1). Efficacy for management of BSI had lower level of evidence. Twenty-two studies reported on safety with no significant adverse events. The limited high-level studies suggest ESWT may offer an effective noninvasive treatment of most bone pathologies with favorable safety profile. Additional high-quality studies particularly in BSI may inform use of ESWT for bone pathologies.

What are the most disruptive publications in shoulder surgery?

Objective To investigate the role and potential mechanism of CD200 in the pathogenesis of preeclampsia (PE) and to clarify its potential value as a biomarker candidate and possible therapeutic target for PE. Methods This retrospective study enrolled 57 patients with PE and 49 women with normal full-term pregnancies. Clinical data were collected, and serum biomarkers were measured. The GSE93839 dataset was utilized to screen for differentially expressed genes in PE placental tissues. Hematoxylin-eosin (HE) staining, immunohistochemistry (IHC), and immunofluorescence (IF) techniques were employed to analyze the expression and localization characteristics of CD200 in placental tissues. Exploratory path analysis was conducted to investigate potential indirect associations between CD200 expression and PE through serum biomarkers. Results Bioinformatics analysis identified CD200 as a candidate downregulated gene associated with PE. Immunohistochemistry revealed a significantly lower expression level of CD200 in the placental tissues of PE patients (p &amp;lt; 0.05). Immunofluorescence experiments demonstrated co-localization of CD200 with CD68 + macrophages, suggesting a potential association with macrophage-related immune regulation at the maternal-fetal interface. Exploratory path analysis revealed statistically significant indirect associations between CD200 expression and PE through serum biomarkers, including high-density lipoprotein cholesterol (HDL-C), albumin, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB (CK-MB) (p &amp;lt; 0.05). Conclusion The expression of CD200 is significantly downregulated in the placental tissues of PE patients. This alteration may induce immune imbalance at the maternal-fetal interface and placental dysfunction, and may also be linked to the systemic pathological injury process in PE through its associations with multiple serum biomarkers.

Early Assessment of Risk Factors for Emergence Delirium in Adult Patients Undergoing General Anesthesia: A Cross-Sectional Correlational Study.

Sexually transmitted infections (STIs) remain a major public health challenge, particularly in low- and middle-income countries where surveillance and routine screening are limited. In Central Africa, data on Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Mycoplasma hominis, and Neisseria gonorrhoeae remain scarce, despite their role in infertility, adverse pregnancy outcomes, and potential contribution to antimicrobial resistance. This study aims to determine the prevalence of these bacteria and identify risk factors among women in the West Region of Cameroon and neighboring city of N'Djamena in Chad. A total of 1246 participants were enrolled. Endocervical swabs were analyzed by multiplex qPCR to detect the five pathogens. Sociodemographic, sexual behavioral, and clinical characteristics were collected and assessed to identify risk factors for infection. The prevalence of C. trachomatis, M. genitalium, U. urealyticum, M. hominis and N. gonorrhoeae was 2.96%, 15.40%, 24.87%, 9.55% and 20.14% respectively. Living apart (OR = 5.02) and polygamy (OR = 2.13) were significantly associated with M. genitalium infection. N. gonorrhoeae was associated with Semi-Bantu ethnicity, lower education level, alcohol consumption, vaginal bleeding, occasional condom use, and dyspareunia. It was also observed among women reporting anal sex (21.81%), substance use before sex (33.33%), and sex work (26.35%). The high prevalence of STIs in Cameroon and Chad highlights the urgent need to strengthen surveillance, implement systematic screening, and expand access to effective treatment. Our results showed the necessity of integrating STI prevention into reproductive health services and promoting cross-border collaboration to mitigate the spread of infections and antimicrobial resistance.