Epiduroscopy in spinal stenosis. Description of the procedure and safety measures to reduce complications.

Aims: The aim of this observational study is to describe the use of epiduroscopy to decrease the enlargement of the ligamentum flavum (LF) in patients with spinal stenosis, as well as the selection of the appropriate patient and the safety measures that enhance procedural success.

Materials & Methods: We introduce the patient selection protocol, define the appropriate indication and the safety measures to use the epiduroscopy as a tool to decrease the size of the LF and increase space, reducing possible complications.

Results: Among patients included in the study, there were no cases of access difficulty or coccydynia, and one case of urinary incontinence occurred in a patient with Schizas grade D (very severe) stenosis.

Very late spinal accessory nerve to infraspinatus nerve transfer to restore glenohumeral external rotation in brachial plexus birth injury.

Background: Poor recovery of active glenohumeral external rotation (aGHER) after brachial plexus birth injury (BPBI) is common. Late spinal accessory nerve to infraspinatus motor branch (SAN-IS) transfer has been reported as effective. We investigated its efficacy in children over 4 years with BPBI.

Long-term outcomes following off-Pump coronary artery bypass grafting using only three in situ arterial grafts.

Objectives: Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) conduits can achieve good outcomes for multivessel lesions. This study evaluated early angiographic patency and outcomes following off-pump CABG (OPCAB) using only in situ BITA and right gastroepiploic artery (rGEA) grafts.

Methods: This retrospective analysis included patients undergoing OPCAB using only in situ skeletonized BITA and rGEA grafts (July 2007 to March 2019).

Doing more with less: a narrative review of recent evidence in diagnostic stewardship.

Purpose Of Review: Diagnostic stewardship (DS) aims to optimise the use of laboratory testing to improve patient care while reducing unnecessary tests. This review examines recent evidence on DS interventions to optimise the use of resources, focusing on three key areas: reducing unnecessary testing, maximising the impact of existing tests, and avoiding the overdiagnosis of hospital-acquired infections.

Recent Findings: Multiple interventions have demonstrated effectiveness in reducing unnecessary blood and urine culture testing, including clinical decision support tools, education programs, and multidisciplinary approaches.

The CONDUCT-AF trial: Rationale and design of a prospective, randomized, multicentre study comparing conduction system and biventricular pacing in patients undergoing atrioventricular node ablation for heart failure with atrial fibrillation.

Aims: There is a lack of data from randomized clinical trials comparing treatment outcomes between conduction system pacing (CSP) modalities and biventricular pacing (BVP) in symptomatic patients with refractory atrial fibrillation (AF) scheduled for atrioventricular node ablation (AVNA). The CONDUCT-AF investigates whether CSP is non-inferior to BVP in improving left ventricular ejection fraction (LVEF) and clinical outcomes in heart failure (HF) patients with symptomatic AF undergoing AVNA.

Methods: This study is an investigator-initiated, prospective, randomized, multicentre clinical trial conducted across 10 European centres, enrolling 82 patients with symptomatic AF, HF with reduced LVEF, and narrow QRS.

Bending stiffness and trackability of carotid stent delivery systems: Bench-top insights for neurointerventional practice.

BackgroundA stable guiding system is essential for successful carotid artery stenting (CAS), particularly when navigating tortuous aortic or supra-aortic anatomy. However, data on the mechanical behavior of stent delivery systems remain scarce.ObjectiveTo assess and compare the bending stiffness and trackability of five commercially available carotid stent delivery systems using bench-top experiments.

Using Theory-Based Frameworks to Identify Barriers and Enablers of Physicians' Telemedicine Adoption and Develop Intervention Strategies in China: Multicenter Qualitative Study.

Background: Telemedicine is developing rapidly, presenting new opportunities and challenges for physicians and patients. Limited research has examined physicians' behavior during the process of adopting telemedicine and related factors.

Objective: This study aimed to identify perceived barriers and enablers of physicians' adoption of telemedicine and to develop intervention strategies.

Pain, Agitation, Delirium, and Iatrogenic Withdrawal Syndrome Management in Children Who Are Critically Ill: Protocol for a European Clinical Practice Guideline Using the Grading of Recommendations Assessment, Development, and Evaluation Approach.

Background: In pediatric intensive care units, pain, sedation, delirium, and iatrogenic withdrawal syndrome (IWS) must be managed as interrelated conditions. Although clinical practice guidelines (CPGs) exist, new evidence needs to be incorporated, gaps in recommendations addressed, and recommendations adapted to the European context.

Objective: This protocol describes the development of the first patient- and family-informed European guideline for managing pain, sedation, delirium, and IWS by the European Society of Paediatric and Neonatal Intensive Care.

Profiling the Chemical Exposomic Landscape of Esophageal Squamous Cell Carcinoma.

While the cancer genome is well-studied, the nongenetic exposome of cancer remains elusive, particularly for regionally prevalent cancers with poor prognosis. Here, by employing a combined knowledge- and data-driven strategy, we profile the chemical exposome of plasma from 53 healthy controls, 14 esophagitis and 101 esophageal squamous cell carcinoma (ESCC) patients, and 46 esophageal tissues across 12 Chinese provinces, integrating inorganic, endogenous, and exogenous chemicals. We first show that components of the ESCC chemical exposome mediate the relationship between ESCC-related dietary/lifestyle factors and clinic health status indicators.

Preterm Birth and Risk of Health Service Use, Morbidity, and Medication Needs at 5 Years.

Importance: Neonatal intensive care has advanced over recent decades, yet premature birth remains associated with increased neonatal mortality and morbidity.

Objective: To describe health service use, morbidity, and medication needs up to age 5 years in a contemporary cohort of children born preterm.

Design, Setting, And Participants: This population-based cohort study was conducted in British Columbia (BC), Canada, using health service and pharmacy data linked using provincial administrative databases.

An Evaluation of Mission and Vision Statements from NCI-designated Cancer Centers and Their Affiliated Hospitals.

Background: Effective communication of mission and vision statements (MVS) is important for medical institutions seeking to connect with patients, staff, and the community. This study assessed the composition, readability, and topics addressed within MVS among NCI-designated cancer centers and affiliated hospitals.

Methods: We extracted MVS data from institutional websites for 65 NCI-designated cancer centers and their affiliated hospitals.

Gadolinium-Enhanced Aneurysm Wall Imaging and Risk of Intracranial Aneurysm Growth or Rupture.

Importance: Recent longitudinal studies in patients with unruptured intracranial aneurysms (UIAs) suggested that aneurysm wall enhancement (AWE) on magnetic resonance imaging (MRI) predicts growth and rupture. However, because these studies were limited by small sample size and short follow-up duration, it remains unclear whether this radiological biomarker has predictive value for UIA instability.

Objective: To determine the 4-year risk of instability of UIAs with AWE and investigate whether AWE is an independent predictor of UIA instability.

Gonorrhea and Chlamydia Screening for Adolescents and Young Adults in Emergency Departments.

Importance: Adolescents account for almost half of the 2.5 million diagnosed sexually transmitted infections in the US annually, and the emergency department functions as the primary source of health care for many adolescents. No recommendations exist for emergency department gonorrhea and chlamydia screening.

Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: A Phase 3 Randomized Clinical Trial.

Importance: There is an unmet need for long-term, safe, effective, and hormone-free treatments for menopausal symptoms, including vasomotor symptoms (VMS) and sleep disturbances.

Objective: To evaluate the 52-week efficacy and safety of elinzanetant, a dual neurokinin-targeted therapy, for treating moderate to severe VMS associated with menopause.

Design, Setting, And Participants: OASIS-3 was a double-blind, placebo-controlled, randomized phase 3 clinical trial that was conducted at 83 sites in North America and Europe from August 27, 2021, to February 12, 2024, and included postmenopausal women aged 40 to 65 years who were seeking treatment for moderate to severe VMS (no requirement for a minimum number of VMS events per week).

Myo-inositol Supplementation to Prevent Pregnancy Complications in Polycystic Ovary Syndrome: A Randomized Clinical Trial.

Importance: Pregnant individuals with polycystic ovary syndrome (PCOS) present with a higher risk of pregnancy complications, including gestational diabetes, preeclampsia, and preterm birth. Myo-inositol supplementation may reduce these risks.

Objective: To determine whether daily supplementation with myo-inositol during pregnancy among individuals with PCOS reduces the risk of a composite outcome of gestational diabetes, preeclampsia, and preterm birth.

Downregulation of FOXC1 Modified by METTL3/YTHDF1 Axis Aggravates NLRP3-Mediated Inflammasomes Formation and Cell Pyroptosis in Epilepsy.

Epilepsy is a common chronic nervous system disease that threatens human health. However, the role of FOXC1 and its relations with pyroptosis have not been fully studied in epilepsy. Sprague-Dawley rats were obtained for constructing temporal lobe epilepsy (TLE) models.