Journal of Clinical Medicine

ObjectiveTo analyze the experience of the last six years with ECMO in Uncontrolled Donation after Circulatory Death (uDCD), assessing the clinical and logistical factors that determine donation effectiveness and the viability of retrieved organs, with the nurse perfusionist as the central figure in organ perfusion. MethodsRetrospective observational study of uDCD procedures performed at Hospital Clinic de Barcelona between June 2019 and October 2025. ResultsOf 184 out-of-hospital ECMO-CPR acti...

BackgroundEffective postoperative analgesia is therefore critical for patients undergoing thoracoscopic surgery. Ultrasound-guided erector spinae plane block (ESPB) has demonstrated efficacy in reducing postoperative pain following thoracoscopic procedures; however, limited research exists regarding the minimum effective volume (MEV) of local anesthetic required. This study employed the biased coin up-and-down sequential method (BCD-UDM) to determine the MEV of 0.5% ropivacaine for ESPB in patie...

BackgroundIntraoperative opioid administration for cardiac surgery varies greatly, with most of this variability arising from anesthesiologist and institutional practices. Anesthesiologists administer intraoperative opioids via intermittent boluses and continuous infusions. Real-world data have shown infusion administration to be a strong determinant of high intraoperative opioid exposure, but whether bolus or infusion administration of sufentanil affects post-operative outcomes is unknown. Met...

BackgroundAlthough transnasal transsphenoidal (TNTS) resection is the standard treatment for pituitary adenomas, the procedure carries a risk of hypothalamic-pituitary-adrenal (HPA) axis disruption. This potential for hypocortisolism often prompts the empiric use of perioperative steroids to mitigate hemodynamic instability. However, there is a paucity of data strictly correlating serum cortisol concentrations with intraoperative blood pressure fluctuations. This study sought to evaluate the rel...

BackgroundPost-anesthetic tracheal extubation can lead to critical adverse events (AEs) in children due to their intolerance to hypoxia. However, evidence from pediatric studies on the factors associated with safe tracheal extubation is limited. We will investigate the incidence and risk factors of AEs associated with tracheal extubation using real-world data from Japan. This study aims to test the following hypotheses: extubation-related AEs are associated with (a) several indicative signs of c...

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 io...

BACKGROUNDThe optimal surgical strategy for subacute and chronic DeBakey type I aortic dissection remains controversial. This multicenter study compared early outcomes and long-term survival between total arch replacement (TAR) with a frozen elephant trunk (FET) and conventional non-FET repair. METHODSWe retrospectively analyzed 452 patients who underwent surgery for subacute or chronic DeBakey type I aortic dissection at seven high-volume aortic centers between 2015 and 2023. Of these, 320 pat...

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 undergoi...

Background: Cesarean section is one of the most commonly performed surgical procedures worldwide and is frequently associated with moderate to severe postoperative pain. While overall pain after cesarean delivery is well described, evidence comparing pain intensity and analgesic use between primary and repeat cesarean sections remains limited. Objective: To compare postoperative pain severity and total analgesic consumption within the first 24 hours among women undergoing primary versus repeat c...

BackgroundArthroscopic rotator cuff repair (RCR) is a common surgical intervention used to address rotator cuff-related pain after other conservative interventions have been exhausted. With a continuing increase in procedures, evidence-based outcomes research is needed to identify key parameters of postoperative rehabilitation planning. ObjectiveWe aim to identify rehabilitation planning factors leading to better outcomes while also providing clinicians with reference data to describe the magni...

BackgroundThe acquisition of laparoscopic skills is a key component of modern pediatric surgical training, yet structured hands-on exposure remains limited. Conventional box training is widely used but may be constrained by suboptimal visualization and ergonomics. Virtual reality (VR)-based approaches offer immersive visual perspectives and may enhance skill acquisition, motivation, and ergonomic performance. However, robust comparative data on VR-assisted versus conventional laparoscopic traini...

BackgroundUterine atony ([~]70%), lacerations ([~]20%) and placenta-related problems ([~]10%) are assumed main reasons for postpartum hemorrhage genesis. Coagulation components predictive for postpartum blood loss can be identified prepartum and before traditionally assumed main reasons are observed. ObjectivesTo better understand postpartum hemorrhage genesis, we prospectively researched prepartum clinical information, presence of assumed main reasons and peripartum coagulation changes in part...

BackgroundPostoperative delirium is a common complication in surgical patients, and is associated with a multitude of negative outcomes, including mortality, dementia, and increased healthcare costs. Therefore, a better understanding of what factors contribute to postoperative delirium, especially those that can be easily obtained, is important. MethodsWe conducted a retrospective cohort study using patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Adult patient...

BackgroundBone fractures represent a growing public health concern worldwide, yet national epidemiological assessments remain limited in Brazil. Understanding temporal trends, demographic disparities, and geographic heterogeneity is essential to guide prevention, resource allocation, and trauma-care planning. ObjectiveTo characterize the epidemiological profile of bone-fracture-related hospitalizations and mortality in Brazil between 2015 and 2024, analyzing trends by sex, age, fracture type, a...

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 cholecystecto...

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 transplan...

BackgroundOptical Coherence Tomography Angiography (OCTA) provides high-resolution visualization of retinal microvasculature, with vascular density (VD) serving as a one of the key quantitative metrics. However, VD measurements are highly sensitive to image binarization step, and no standardized approach exists. MethodsWe analyzed 51 OCTA scans (human and porcine) using 29 binarization algorithms, including global and local thresholding techniques from ImageJ and DoxaPy, as well as Random Walke...

Despite significant advancements in diagnostic methodologies, the fundamental approach to venous blood collection has remained largely unchanged since its widespread adoption in the mid-20th century. This stagnation poses considerable challenges, particularly in scenarios involving difficult venous access (DVA). The Bloody-Easy (BE) device represents a novel, passive, low-volume blood collection system engineered to optimize phlebotomy outcomes, especially in these challenging clinical contexts....

INTRODUCTIONRisks for postoperative cognitive dysfunction remain poorly understood. Traditional cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are used for perioperative cognitive evaluation but have limited scope, whereas comprehensive in-person testing poses problems for long-term follow up. METHODSThis prospective cohort study assesses the feasibility of using a remotely performed comprehensive neurocognitive test batte...

BackgroundImmune checkpoint inhibitor (ICI)-associated acute interstitial nephritis (ICI-AIN) has emerged as a common cause of acute kidney injury (AKI). However, acute tubular necrosis (ATN) may present with similar clinical features yet requires fundamentally different management. Robust data on the prevalence of ATN among patients with suspected ICI-AIN are limited. The aim of this study was to determine the prevalence of ATN in patients with suspected ICI-AIN and to estimate the risk of diag...