BioMed Research International

ObjectiveTo evaluate the effects of glutamine supplementation combined with an exercise program on isokinetic performance, biochemical parameters, and muscle asymmetry indices in individuals undergoing rehabilitation following ACL reconstruction. DesignA 6-week randomized controlled trial was conducted, assigning participants to either a glutamine supplementation group (ExGln) or a placebo group (ExPla), both undergoing a standardized exercise program. SettingThe study was performed in a sports medicine facility with access to isokinetic testing and biochemical analysis. ParticipantsA total of 30 participants who had undergone ACL reconstruction surgery were included, with 15 in each group. MethodsPeak torque and muscle asymmetry of knee extensors and flexors were assessed via isokinetic testing. Biochemical analyses (glucose, lipid profile, liver enzymes) were conducted pre- and post-intervention. Wilcoxon and Mann-Whitney U tests were used for intra- and intergroup comparisons, respectively. ResultsThe ExGln group showed significant improvements in peak torque for the involved limb extensors (p=0.001) and flexors (p=0.001), as well as reductions in extensor and flexor asymmetry indices (p=0.001 and p=0.018, respectively). Additionally, significant reductions were observed in C-LDL, C-HDL, and triglycerides levels in the ExGln group (p=0.006, p=0.003, and p=0.003, respectively). The intergroup analysis indicated significant differences in alkaline phosphatase levels (p=0.031). No adverse effects were reported. ConclusionGlutamine supplementation combined with a structured exercise program significantly enhanced isokinetic performance and improved biochemical parameters, suggesting a beneficial role in postoperative rehabilitation following ACL reconstruction. Further studies with larger sample sizes are recommended to validate these findings.

Rapid prediction of the severity of acute coronary syndrome (ACS) is crucial for appropriate intervention in emergency department. Neutrophils (Neu), lymphocytes (Lym) and monocytes (Mon) and their ratios (Neu/Lym, NLR; Mon/Lym, MLR NeuxMon/Lym, SIRI) are acknowledged to be associated with the prediction of the severity and adverse outcome of ACS patients. Here, we analysed retrospectively eosinophils (Eos) and Eos-derived novel ratios (Neu/Eos, NER; Mon/Eos, MER; Neu x Mon/Eos, SIII; Neu/Eos x Lym, NEL; Mon/Eos x Lym, MEL; Neu x Mon/Eos x Lym, SV) of first admitted 1053 ACS patients within 24 hours of symptom onset to predict ST-segment elevation of myocardial infarction (STEMI), high Gensini score (H) and cardiac dysfunction (Killip Classification l to III grades). Results showed that Eos was significantly decreased in ST (n=227), Gensini (H) (n=311) and Killip I group (n=237) (P<0.05). All Eos-derived ratios (NER, MER, SIII, NEL, MEL, SV) were significantly higher with diagnostic severity (ST, Gensini (H), and Killip I group (P<0.05). ROC analysis revealed that SIII and SV predicted ST and Gensini (H) with high specificity and sensitivity, which were similar to that of NLR, MLR and SIRI. Conclusion: Eos and Eos-derived ratios, SIII and SV in particular, are strongly linked to the prediction of the severity of ACS, along with those of well-established leukocyte ratios. The new ratios of Eos hold significant importance in emergency department for quick evaluation of ACS patients.

PurposeFemale artistic swimmers successful competitive performance depends on several physical performance factors such as postural control, flexibility, muscle strength, and aerobic endurance. Flexibility is a highly important physical component that can directly impact successful performance. Pilates could be an appealing training modality to artistic swimmers due to the sports reliance on precise body control and synchronized movements. This study aimed to assess the impact of an 8-week Pilates training program on flexibility and sport-specific performance in young female artistic swimmers. MethodsEighteen competitive artistic swimmers aged 13 to 15 years (13.8{+/-}0.8 years) were randomly assigned to an experimental or control group. The experimental group executed a Pilates class, incorporating typical equipment exercises (small Pilates ball and bands), while the control group maintained their regular gym workout routine. Both groups had two training sessions per week for 60 minutes per session. Every athlete was evaluated on their ability to accomplish two basic figures in the water (Ariana, Rio). To evaluate all characteristics, univariate analyses of covariance (ANCOVA) were employed, with initial measurements as covariates and final measures as dependent variables. ResultsFlexibility exercises, splits (P =.028), bridge (P =.003), shoulders (P =.005), and figures (Ariana: P =.001, Rio: P =.003), demonstrated statistically significant differences in favour of the experimental group. However, there was no difference in knee flexibility across the groups (p=0.376). The covariate had a significant impact (p<.05) across all analyses. ConclusionThe findings suggest that Pilates training enhances flexibility and basic figure performance in young female artistic swimmers. Incorporating Pilates into training programs could be beneficial in improving flexibility and overall performance.

OBJECTIVESAlthough several systematic reviews attempted to compare supraglottic airway (SGA) and endotracheal intubation for or adults with out-of-hospital cardiac arrest (OHCA), the optimal airway management strategy remains debated. We conducted a systematic review and meta-analysis comparing supraglottic airway (SGA) devices and endotracheal intubation (ETI) as initial interventions in OHCA to clarify their relative clinical efficacy. DATA SOURCESWe retrieved relevant clinical trials from PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure(CNKI), as well as unpublished sources, from inception to October 10, 2025. STUDY SELECTIONWe included randomized controlled trials (RCTs) and non-randomized studies involving adult patients with OHCA who were assigned to supraglottic airway (SGA) versus endotracheal intubation for initial prehospital airway management. RESULTSOur systematic review and meta-analysis enrolled 9 randomized controlled trials and 23 non-randomized studies, involving 196,573 patients. Patients who received SGA were associated with higher incidence of return of spontaneous circulation (ROSC), (RCT RR = 1.17, 95% CI: [1.03,1.34], P = 0.016, I{superscript 2} = 48.5%), higher incidence of first-attempt success rates (RCT: RR = 1.31, 95% CI, [1.14-1.51], P = 0.0029. Non-RCTs: RR = 1.46, 95% CI: [1.26,1.70], P < 0.0001, I{superscript 2} = 83.1%), higher incidence of return of time to airway securement (RCT: MD = -2.30 min, 95% CI: [-3.54, -1.05], P = 0.0003, I{superscript 2} = 98.4%. Non-RCTs: MD = -2.86 min, 95% CI: [-3.62, -2.11], P < 0.0001, I{superscript 2} = 95.8%.). There is no difference in favorable neurological outcome (RCT: RR = 1.06, 95% CI: [0.84, 1.35], P = 0.6202, I{superscript 2} = 45.4%. Non-RCTs: RR = 0.94, 95% CI: [ 0.76, 1.18], P = 0.6198, I{superscript 2} = 74.2%.) and no difference in occurrence of regurgitation/aspiration (RR 1.03; 95% CI: [0.93, 1.14]; P=0.5426, I{superscript 2} = 0.0%). Additionally, trial sequential analysis was performed to validate these findings. CONCLUSIONFor adult patients experiencing out-of-hospital cardiac arrest (OHCA), initial airway management by using supraglottic airway (SGA) improves rate of return of spontaneous circulation (ROSC), enables faster airway placement, and achieves higher first-pass success rate when compared with endotracheal intubation. There is a high degree of certainty regarding the major outcomes.

BACKGROUNDDefibrillators constitute a critical component of emergency care for ventricular fibrillation and pulseless ventricular tachycardia. Advances in defibrillation technology point to the potential need for reassessing current defibrillation protection standards and associated resuscitation guidelines. OBJECTIVEThis study aimed to explore potential implications for future defibrillator requirements, defibrillation protection standards, and resuscitation guidelines based on the parameters of commercially available defibrillators. METHODSDefibrillator brands were identified from the registration records of the National Medical Products Administration, the U.S. Food and Drug Administration, and the European Database on Medical Devices. Key defibrillation parameters were collected from manufacturer-provided data. RESULTSAll studied devices employ biphasic waveforms, with biphasic truncated exponential (BTE) being the most common, followed by rectilinear biphasic (RB), and a smaller number using pulsed biphasic (PB). Except for PB devices, maximum output voltages are below 3 kV. While energy required for effective defibrillation decreased, some manufacturers retain an upper limit of 360 J. CONCLUSIONIncorporating biphasic waveforms into defibrillation protection tests may be appropriate. Adjustments to the requirements and guidelines of defibrillation voltage or energy could be considered, depending on market trends and future studies on efficacy.

IntroductionChronic kidney disease imposes a high clinical and economic burden on the Brazilian Unified Health System, and kidney transplantation offers the best prognosis. ObjectiveTo describe trends in living kidney (LD) donation in Brazil (2010-2023), analyzing the donor-recipient relationship and the operational stock-to-annual production ratio on the waiting list, and to compare hospital indicators and estimated patient and graft survival between LD and deceased-donor (DD) kidney transplants. MethodsDescriptive ecological time-series study using aggregated, publicly available data. ResultsThe waiting list increased by 15% (from 33,253 to 38,258), and the total number of transplants rose by 29% (from 4,656 to 6,047). Data showed an increase in deceased-donor transplants (from 3,001 to 5,189) and a decrease in LD transplants (from 1,655 to 858), with the LD share declining from 35.55% to 14.19% and the per-million-population rate falling from 8.8 to 4.2. Among LD, there was a relative decrease in related donors (from 82.80% to 71.21%), a relative increase in unrelated spouse donors (from 10.57% to 18.65%), and in other unrelated donors (from 6.63% to 10.14%). Comparatively, LD showed better descriptive performance on survival indicators and lower in-hospital mortality, length of stay, and mean Hospital Admission Authorization value. ConclusionThe findings indicate a need for strategies to sustain DD procurement and LD donation.

ObjectiveA comparative analysis was conducted on the rehabilitation effects of limb functions in patients with post-stroke yawning-induced parakinesia brachialis oscitansysis (PBO), patients without PBO, and patients whose PBO naturally disappeared after the onset of the disease. MethodsThe study included ischemic stroke patients diagnosed and treated in our hospital from March 2024 to June 2024. Patients were divided into two groups: the PBO group and the non-PBO group, based on whether PBO was administered. Propensity score matching was employed to account for all covariates and perform a 1:2 matching to balance the baseline characteristics of the two groups. The matched data were used for subsequent analysis to observe the Lovett scores and FMA scores of the two groups 3 months after the onset. For 33 patients with PBO, they were divided into two groups: the persistent group and the disappearing group, based on whether the PBO lasted for more than 1 month. The Lovett scores and FMA scores of the two groups were observed 3 months after the onset. ResultsAfter propensity score matching, there were 26 patients in the PBO group and 52 patients in the non-PBO group. The baseline characteristics of the two groups were basically balanced, and the difference was not statistically significant (P>0.05). Compared with the non-PBO group, the Lovett scores and FMA scores of the PBO group 3 months after the onset were higher, and the difference was statistically significant (P < 0.05). Compared with the PBO persistent group, the FMA score of the PBO disappearing group 3 months after the onset was higher than that of the persistent group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in Lovett muscle strength between the two groups (P > 0.05). ConclusionThe functional recovery of patients with PBO was better than that of patients without PBO manifestation 3 months after the initial diagnosis. Moreover, patients whose PBO appeared first and then disappeared had better functional recovery than those whose PBO persisted.

Background: Psychological readiness to return to sport and subjective knee function are critical outcomes following ACL reconstruction (ACLR), yet they do not always progress in parallel. An athlete may demonstrate high subjective knee function but low psychological readiness, suggesting a mental barrier to return, or conversely, report high readiness despite persistent functional limitations, raising concerns of overconfidence and reinjury risk. Understanding how these domains change together during recovery is essential for identifying mismatches that may require targeted intervention. Purpose: The purpose of this study is to examine the relationship between changes in psychological readiness (ACL-RSI) and subjective knee function (IKDC) from early to late recovery following ACLR. Study Design: Secondary analysis of prospectively collected data. Methods: Athletes (N = 48, Age at ACLR = 17.7 {+/-} 1.8 y) aged 15-25 years who underwent ACLR with an ipsilateral autograft, had a pre-injury MARX score > 8, and completed the ACL-RSI and IKDC questionnaires at 3.5 {+/-} 1 and 7 {+/-} 1 months post-ACLR were included. Percent changes in ACL-RSI and IKDC scores between early and late recovery were calculated. Spearman's rank correlation was used to examine the association between changes in psychological readiness and subjective knee function. Significance was set to p < .05. Results: The mean percent change in ACL-RSI was 40.7 {+/-} 57.1% and the mean percent change in IKDC was 24.8 {+/-} 18.1% from 3.5 {+/-} 1 months to 7 {+/-} 1 months post-ACLR. The percent changes in ACL-RSI and IKDC scores from 3.5 {+/-} 1 months to 7 {+/-} 1 months post-ACLR were moderately correlated ({rho} = 0.350 (95% CI [0.089, 0.584]), p = 0.012). Discussion: The main finding of this study was that subjective knee function and psychological readiness to return to sport changed in parallel from 3.5 to 7 months following ACLR. Clinicians can use this information regarding the concordant progression of psychological readiness to return to sport and subjective knee function to personalize ACL rehabilitation for future patients. Overall, clinicians can understand that if psychological readiness improves, subjective knee function will likely improve over the 3.5- to 7-month post-ACLR time frame, and vice versa. Therefore, focusing on both of these components at multiple time points during the recovery process may be influential to ensure the greatest likelihood of returning to sport in athletes following ACLR.

BackgroundSnakebite is a neglected tropical disease with a high burden in South Asia, particularly India. Acute kidney injury (AKI) is one of the most serious complications of snake envenomation, which has significant morbidity, mortality and risk of chronic kidney disease (CKD). The present study aimed to evaluate the incidence, predictors, and outcomes of snakebite-associated AKI (SBE-AKI) in a tertiary care centre. MethodsWe retrospectively analysed 325 patients with snakebite envenomation, admitted to our institution. Demographic, clinical, laboratory, and treatment variables were compared between patients with and without AKI. AKI was staged according to KDIGO criteria. Renal biopsy was performed in selected patients. Outcomes assessed included recovery, Progression to CKD, and mortality. ResultsOf the 325 patients, 79 (32.1%) developed AKI. Patients with AKI were significantly younger (mean age 34 vs. 45 years, p = 0.001). Delay in anti-snake venom (ASV) administration (18 vs. 6 hrs, p = 0.001), need for inotropes (41.8% vs. 14.2%, p = 0.001), and mechanical ventilation (36.7% vs. 6.9%, p = 0.001) were strong predictors. Proteinuria was more frequent in AKI (80% vs. 32.5%). Among AKI patients, 57% had stage 3 AKI; 39.2% required dialysis. Biopsy (n=8) showed acute tubular necrosis in 37.5% and cortical necrosis in 25%. Outcomes included 77.2% recovery, 6.3% progression to CKD, and 16.5% mortality. ConclusionSBE-AKI is a common and serious complication of snakebite. Delay in ASV administration, hemodynamic instability, proteinuria, advanced AKI stage and cortical necrosis predict poor outcomes. Early ASV, timely dialysis, and long-term nephrology follow-up are essential to improve survival and reduce CKD progression.

BackgroundCatheter-related bloodstream infection (CRBSI) is a major cause of morbidity and mortality among patients undergoing hemodialysis (HD), particularly in low- and middle-income settings where non-tunneled hemodialysis catheters (NTHC) are widely used. Local epidemiological data are essential to guide preventive and therapeutic strategies. ObjectivesTo determine the prevalence, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CRBSI in patients undergoing HD via internal jugular NTHC at a tertiary care center in South India. MethodsThis retrospective observational study included adults initiated on HD using internal jugular NTHC between January 2017 and December 2023. Patients with pre-existing infections or catheters inserted elsewhere were excluded. CRBSI was defined using KDOQI criteria. Demographic, clinical, laboratory, microbiological, and outcome data were analyzed. Logistic regression identified risk factors, and receiver operating characteristic (ROC) analysis evaluated predictors of adverse outcomes. ResultsAmong 396 patients (mean age 56.3 {+/-} 14 years; 70.4% male), 65 (16.4%) developed CRBSI, with an incidence of 4.7 per 1000 catheter days. Emergency HD initiation (OR 14.86, p < 0.001) and access failure (OR 2.71, p = 0.004) significantly increased CRBSI risk, while planned initiation for uremic symptoms was protective. Patients with CRBSI had lower serum albumin and higher leukocyte counts. Gram-negative organisms predominated (53.8%), with Klebsiella pneumoniae being the most common isolate. High resistance was observed to {beta}-lactam/{beta}-lactamase inhibitor combinations and carbapenems. Gram-negative CRBSI was associated with significantly higher odds of hospitalization, ICU admission, inotropic support, and mortality. ROC analysis showed good predictive ability for adverse outcomes (AUC 0.73-0.77). ConclusionsCRBSI remains a significant complication of NTHC-based HD. Predominant Gram-negative infections with high antimicrobial resistance are associated with worse clinical outcomes, underscoring the need for early permanent access creation, strict catheter care, and robust antibiotic stewardship.

ObjectiveTo compare the efficacy and safety of etomidate versus ketamine as induction agents for rapid sequence intubation in critically ill adults, focusing on 28-day mortality and post-intubation hypotension. Data SourcesPubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2026. Reference lists of included studies were also manually screened. Study SelectionWe included randomized controlled trials (RCTs) comparing single-dose intravenous ketamine versus etomidate for emergency rapid sequence intubation in critically ill adults ([&ge;] 18 years) in non-operating room settings (e.g., intensive care unit or emergency department). Data ExtractionTwo investigators independently screened records, extracted data using a standardized form and assessed the risk of bias using the RoB 2 tool. The certainty of evidence was evaluated using the GRADE framework. Data SynthesisSix RCTs comprising 4,108 patients (2,046 assigned to ketamine and 2,062 to etomidate) were included. The pooled analysis showed no statistically significant difference in 28-day mortality between the ketamine and etomidate groups (39.0% vs. 40.3%; relative risk [RR] 0.96; 95% CI, 0.89-1.03; p=0.29; I{superscript 2}=11%). In a prespecified subgroup analysis of patients with sepsis (n=1,546), mortality also did not differ significantly (RR 0.94; 95% CI, 0.86-1.03). However, ketamine was associated with a statistically significant increase in the incidence of post-intubation hypotension (14.2% vs. 11.3%; RR 1.25; 95% CI, 1.01-1.53; p=0.04; I{superscript 2}=0%). No significant differences were observed regarding peri-intubation cardiac arrest, first-attempt intubation success, or ventilator- and intensive care unit-free days. ConclusionsThere is no statistical difference in 28-day mortality between etomidate and ketamine for emergency intubation in critically ill adults, including those with sepsis. The higher incidence of post-intubation hypotension with ketamine suggests etomidate presents a more favorable hemodynamic safety profile in this setting. Key pointsO_ST_ABSQuestionC_ST_ABSDoes the choice between etomidate and ketamine for emergency intubation in critically ill patients impact 28-day mortality? FindingsIn this systematic review and meta-analysis of randomized controlled trials, there was no statistically significant difference in 28-day mortality between patients induced with ketamine (39.0%) and those induced with etomidate (40.3%). MeaningThe use of etomidate versus ketamine for rapid sequence intubation does not alter 28-day mortality, indicating that the choice of induction agent should be individualized.

IntroductionPatients with type 2 diabetes mellitus (T2DM) are at increased risk of coronary artery disease and frequently undergo coronary angiography or percutaneous coronary intervention. Although risk factors for post-contrast acute kidney injury (PC-AKI) are well defined, effective preventive strategies remain limited. MethodsThis multicenter observational cohort study included 975 patients aged 18-75 years who underwent coronary angiography and/or percutaneous coronary intervention with iodinated contrast between June 2023 and June 2024. All patients received standardized intravenous hydration. Participants were grouped according to chronic sodium-glucose co-transporter-2 (SGLT2) inhibitor use ([&ge;]3 months). PC-AKI was defined as a [&ge;]25% or [&ge;]0.5 mg/dL increase in serum creatinine within 48-72 hours after contrast exposure. ResultsThe mean age was 59.2 {+/-} 11.7 years, and 70.8% were male; 16.9% were using SGLT2 inhibitors. PC-AKI occurred in 7.3% of patients, and 0.7% required renal replacement therapy. In univariate analysis, advanced age, diabetes, hypertension, heart failure, diuretic use, and elevated urea, creatinine, potassium, and uric acid levels were associated with PC-AKI. Higher eGFR, albumin, sodium levels, and SGLT2 inhibitor use were inversely associated. In multivariate analysis, age [&ge;]65.5 years (OR 4.53), diabetes (OR 2.49), and uric acid >6.75 mg/dL (OR 2.34) remained independent risk factors, while eGFR >81.5 mL/min/1.73 m2 (OR 0.38), sodium >137.5 mmol/L (OR 0.36), and SGLT2 inhibitor use (OR 0.09) were independently protective. ConclusionBeyond established cardioprotective and renoprotective effects, SGLT2 inhibitors may reduce the risk of PC-AKI in patients with T2DM, potentially through decreased renal oxygen consumption and attenuation of contrast-induced hypoxic injury.

BackgroundEarly laparoscopic cholecystectomy (ELC) is the standard treatment for acute calculous cholecystitis (ACC), but difficult laparoscopic cholecystectomy (DLC) remains a challenge. Predicting DLC and ACC severity is crucial for clinical decision-making. MethodsThis retrospective single-center study included 198 ACC patients who underwent ELC. Preoperative clinical, laboratory, and imaging data were analyzed. DLC was defined by operative time >90 min, conversion, or subtotal cholecystectomy. ACC severity was graded using TG18. Multivariate logistic regression identified independent predictors. ResultsDLC occurred in 81 (40.9%) patients; 102 (51.5%) had severe ACC. Serum cholinesterase (ChE) and CRP were independent predictors of DLC. CRP and male sex independently predicted ACC severity. Other markers (e.g., NLR, PCT) were not independently associated. ConclusionPreoperative ChE and CRP levels are reliable predictors of DLC, while CRP and male sex predict ACC severity. These findings support their use in risk stratification and surgical planning.

Sepsis is a complex condition with a time-dependent evolution. Longitudinal biomarker dynamics could help us to better characterise sepsis. We hypothesised that the kinetics of biomarkers are associated with sepsis and with the intensity of organ dysfunction, and may have predictive capacity for patient survival. This single-centre, prospective, observational study included adult patients presenting to the Emergency Department (ED) with suspected infection. Patients were included in the study if they had a National Early Warning Score 2 (NEWS 2) of 3 or higher. Blood samples were obtained at baseline, 4hs and 24 hs. Linear mixed models were constructed to analyse the association between biomarker concentrations over time, sepsis diagnosis and organ dysfunction severity. Joint models were used to evaluate the predictive ability of individual biomarker kinetics during the first 24 hours for in-hospital mortality Of 214 screened patients, 173 patients were analysed, and 137 (79%) developed sepsis. Linear mixed models revealed time-dependent decreases in IL10 ({beta} -0.016, 95%CI -0.028 to -0.004), IL1RN ({beta} -0.014, 95%CI -0.024 to -0.004), and IL6 ({beta} -0.012, 95%CI -0.024 to 0.00). Sepsis was associated with higher IL1RN ({beta} 0.378, 95%CI 0.153-0.603), and TNFRSF1A ({beta} 0.40, 95%CI 0.21-0.58); only models evaluating IL6 showed significant interaction between sepsis and time ({beta} -0.14, 95%CI -0.028 to 0.00). SOFA correlated with elevated IL10 ({beta} 0.048, 95%CI 0.021-0.075), IL1RN ({beta} 0.044, 95%CI 0.017-0.071), CCL2 ({beta} 0.046, 95%CI 0.021-0.071), TNFRSF1A ({beta} 0.050, 95%CI 0.030-0.070), and PCT ({beta} 2.63, 95%CI 1.32-3.93); the interaction between SOFA score and time was significant only for IL6 ({beta} -0.003, 95%CI -0.005 to -0.001). Joint survival models (adjusted for age and highest SOFA) identified IL8 (HR 0.655, 95% CrI 0.582-0.728), TNFRSF1A (HR 0.505, 95% CrI 0.419-0.682), and PCT (HR 1.004, 95% CrI 1.001-1.008) as predictors. ConclusionSepsis diagnosis and severity of organ dysfunction may be associated with higher levels and kinetic values of inflammatory biomarkers such as IL1RN and TNFRSF1A. IL6 levels showed a significant association for the interaction of time with both sepsis diagnosis and SOFA score. TNFRSF1A, IL8 and PCT dynamics were found to be associated with survival and could be useful in developing prognosis tools.

The red cell distribution width (RDW) is a recognized prognostic marker in sepsis, yet its dynamic changes over time and their relationship with outcomes remain unexplored. This study aimed to identify distinct RDW trajectories during the early phase of sepsis and evaluate their association with mortality. We conducted a retrospective cohort study using data from the MIMIC-IV database (n=3,813) as the derivation cohort and from the First Affiliated Hospital of Kunming Medical University (n=467) for external validation. Sepsis patients with at least seven RDW measurements within the first ten days of hospitalization were included. Group-based trajectory modeling (GBTM) was employed to identify RDW trajectories. A three-trajectory model was selected based on model fit indices and clinical interpretability: Trajectory 1 (Slow-Decrease, 32.97%), Trajectory 2 (Slow-Increase, 43.30%), and Trajectory 3 (Fluctuating-Rapid Decrease, 23.73%). In the our study, Cox models adjusted for confounders revealed that, compared to Trajectory 1, Trajectory 3 was independently associated with significantly increased 30-day (HR 1.47, 95% CI 1.17-1.84) and 90-day mortality (HR 1.54, 95% CI 1.25-1.88). Conversely, Trajectory 2 was associated with the most favorable survival rates. Kaplan-Meier analysis consistently showed the highest mortality in the Trajectory 3 group. External validation confirmed the models robustness and the consistent prognostic value of the identified trajectories. We conclude that dynamic RDW trajectories, readily identifiable from routine clinical data, provide significant prognostic information beyond single-time-point measurements and can aid in the risk stratification of sepsis patients.

Commercially available disposable products such as cell culture utensils and catheters do not necessarily possess sufficient quality for in vitro fertilization (IVF), from the perspective of pyrogen contamination. We aimed to comprehensively analyze the pyrogen contamination status, including bacterial endotoxins, of the products used for IVF in assisted reproductive technology (ART) and improve their cleanliness using a new sterilization technology. Pyrogen contamination levels were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike bacterial endotoxin tests. Pyrogen inactivation tests were performed using low-temperature ozone/hydrogen peroxide gas treatment. The residual hydrogen peroxide was colorimetrically quantified, and the effectiveness of its removal by drying treatment was evaluated using germ cell viability as an indicator. Significant amounts of pyrogen, from 0.014 to 1.110 EU/product, were detected in seven of the twenty products. Pyrogen contamination levels were reduced below the detection limit by ozone/hydrogen peroxide gas sterilization. Hydrogen peroxide remained on the surface of the GPS dish but was reduced to a level that did not affect human sperm viability and embryo development after drying at 80{degrees}C for 24 h following sterilization. These products may carry a potential risk of reducing ART success rates, and pyrogen contamination levels may exceed the previously reported allowable level of 0.01-0.02 EU/mL in human IVF during actual use. Our study suggests that the manufacturing of products free from pyrogens and without adverse effects on germ cells is possible using ozone/hydrogen peroxide gas sterilization and subsequent drying technologies.

ContextACL injury prevention in young athletes has traditionally relied on a dichotomous classification of contact versus noncontact mechanisms; however, this framework may not adequately capture the movement processes underlying many injuries. ObjectiveTo classify ACL injury mechanisms in athletes aged [&le;]22 years with a specific focus on landing-related movements and to examine their associations with sport contact characteristics and age. DesignRetrospective observational study. SettingSingle sports injury clinic. Patients or Other ParticipantsA total of 151 athletes aged [&le;]22 years (mean age, 17.7 {+/-} 2.1 years) diagnosed with ACL injury between January 2017 and November 2025. Main Outcome Measure(s)ACL injury mechanisms were classified as landing-related without contact (L), landing-related with contact (Lc), or direct contact injury (C). Landing-related injuries (L + Lc) were compared with direct contact injuries. Multivariable logistic regression was used to identify factors associated with landing-related injury. ResultsLanding-related injuries accounted for 123 cases (81.5%), including 88 noncontact and 35 contact-related landing injuries, whereas direct contact injuries occurred in 24 cases (15.9%). Athletes with direct contact injuries were significantly older than those with landing-related injuries (19.2 {+/-} 1.7 vs 17.5 {+/-} 2.5 years, p = 0.03). In multivariable analysis, participation in noncollision sports was strongly associated with landing-related injury (odds ratio [OR] = 9.80; 95% confidence interval [CI] = 3.03-31.5; p < 0.001), whereas increasing age was inversely associated with landing-related injury (OR per year = 0.71; 95% CI = 0.56-0.90). Sex was not independently associated with injury mechanism. ConclusionsMost ACL injuries in athletes aged [&le;]22 years occurred through landing-related mechanisms, regardless of contact. These findings highlight insufficient control of landing and foot contact as a fundamental mechanism of ACL injury in young athletes and support prevention strategies focused on movement quality during sport-specific tasks. Key Points{blacksquare} Most ACL injuries in athletes aged [&le;]22 years occurred during landing or foot contact, regardless of whether external contact was present. {blacksquare}Noncollision sports and younger age were strongly associated with landing-related ACL injury mechanisms. {blacksquare}ACL injury prevention in young athletes should prioritize improving landing and foot contact control rather than focusing solely on contact characteristics.

Objectives: Compare Anterior Cruciate Ligament (ACL) Return to Sport after Injury (ACL-RSI) scores over time following ACL reconstruction (ACLR) between male and female patients aged 15 to 25 years with primary ACL injuries and ACL reinjuries. Design: Retrospective cohort design. Setting: Sports physical therapy clinics. Participants: 332 patients aged 15-25 years who underwent ACLR following either primary ACL injury or ACL reinjury, either contralateral or ipsilateral graft reinjury, and had at least one observation of the ACL-RSI. Main Outcome Measures: ACL-RSI score. Results: ACL-RSI scores significantly increased over time post- ACLR (p < .001), males reported significantly higher scores compared to females (p < .001), and patients with contralateral ACL reinjury demonstrated higher scores than those with ipsilateral ACL graft reinjury (p = .006), though there was no difference in scores between patients with primary ACL injury and ACL reinjury. A significant interaction effect of sex and injury status was also observed (p = .009), generally demonstrating that females had lower psychological readiness compared to males across injury statuses. Conclusions: ACL-RSI following ACLR varies based on biological sex and time post-ACLR, though ACL reinjury, independent of the reinjured leg, does not appear to effect scores compared to primary ACL injury.

Optimal blood pressure (BP) management following endovascular treatment (EVT) for acute ischemic stroke (AIS) secondary to intracranial large vessel occlusion remains unestablished. The randomized HOPE trial (Hemodynamic Optimization of Cerebral Perfusion after Successful Endovascular Therapy in Patients with Acute Ischemic Stroke) (NCT04892511) seeks to determine if a strategy of hemodynamic optimization using different systolic BP targets, tailored to the degree of final recanalization, is superior to standard BP management in improving functional outcomes for these patients. This document outlines the final Statistical Analysis Plan (SAP) for the trial. This plan will be executed after the last follow-up is complete and the dataset has been locked.

ObjectiveWe aimed to do an updated meta- analysis comparing outcomes of mechanical thrombectomy (MT) associated with standard medical treatment (SMT), compared to SMT alone, in adult patients with acute ischemic stroke (AIS) due to medium or distal vessel occlusion (MDVO). MethodologyWe systematically searched PubMed, LILACS, Scielo, Cochrane, and ClinicalTrials.gov databases. Randomized controlled trials (RCTs), retrospective cohort studies, and systematic reviews with meta-analysis comparing MT+SMT with SMT alone in adults with AIS due to MDVO, evaluating at least one of the outcomes of interest, were included. The evaluated outcomes were functional recovery (modified Rankin Scale [mRS] 0-1 and mRS 0-2) at 90 days, all-cause mortality at 90 days, and the occurrence of intracranial hemorrhage (ICH). Risk of bias was assessed using RoB 2, Newcastle-Ottawa, and AMSTAR 2 tools. Heterogeneity was assessed with Chi{superscript 2} and I{superscript 2}, and publication bias with funnel plots and Egger/Begg tests. ResultsTwelve studies (4 RCTs, 7 cohorts, 1 systematic review) were included. Meta-analyses showed no significant difference between MT+SMT and SMT alone for: mRS 0-1 (Excellent Recovery), mRS 0-2 (Good Recovery), mortality at 90 days, and Symptomatic Intracranial Hemorrhage. ConclusionCurrent evidence, combining RCTs and observational studies, does not support the routine use of MT over SMT alone for MDVO in terms of functional improvement at 90 days (mRS 0-1 or 0-2). Non-significant trends towards increased mortality and sICH risk with MT were observed, with considerable heterogeneity for sICH. KEY MESSAGESeveral randomized controlled trials (RCTs) have demonstrated the benefit of mechanical thrombectomy associated with standard medical treatment (SMT), in patients with IS caused by large vessel occlusion (LVO). There for the boundaries of MT began to be questioned, raising the possibility of performing it for medium and distal vessel occlusions (MDVO). As a result of this study, there was no evidence to support the use of MT over SMT alone for MDVO, therefore the therapeutic decisions should remain individualized and further research is crucial to define the exact role of the MT.