Medicine

IntroductionCervical spondylotic myelopathy (CSM) surgery is frequently associated with residual neurological deficits, partly due to unrecognized dynamic spinal cord compression on conventional MRI. Current static imaging may miss position-dependent stenosis, resulting in insufficient or inappropriate decompression. This study aims to evaluate whether dynamic MRI-guided individualized surgery improves neurological outcomes compared to conventional MRI-based planning. ObjectivesThis study aims to examine the association between dynamic MRI-guided surgical planning and neurological recovery in cervical spondylotic myelopathy, and to evaluate its role in identifying responsible segments, avoiding excessive surgery, and improving clinical outcomes. MethodsThis single-center retrospective cohort study will include 300 patients who underwent cervical spine surgery between January 2020 and December 2025 at the First Affiliated Hospital of Guangxi University of Chinese Medicine. Patients will be categorized into the dynamic MRI-guided group (n=150) or conventional MRI-based group (n=150) based on preoperative imaging modality. 1:1 propensity score matching will be performed using age, sex, BMI, disease duration, baseline mJOA score, and number of compressed segments. The primary outcome is the rate of improvement in the mJOA score at 6 months postoperatively. Secondary outcomes include VAS, NDI, reoperation rate, and time to first complication. Between-group comparisons will use t-tests/Mann-Whitney U tests for continuous variables, {chi}{superscript 2} tests/Fishers exact tests for categorical variables, and Kaplan-Meier estimates with the log-rank test for time-to-event outcomes. A two-sided P<0.05 will be considered significant. Analyses will be performed using R software (version 4.4.1). Ethical approval was obtained from the Medical Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine (Approval No. 2025-080-KY-01) from February 06, 2026 to February 05, 2027. Expected outcomesWe hypothesize that dynamic MRI-guided surgical planning will improve neurological recovery and decompression accuracy in cervical spondylotic myelopathy, providing evidence for optimized preoperative imaging and precision spine surgery. Trial registrationChiCTR2600122088

Background The high mortality of septic shock demands novel adjunctive therapies. Shenfu Injection (SFI), a traditional Chinese medicine, shows potential but its mechanism remains unclear. Method s We conducted an open-label, randomized trial in 80 patients with septic shock. Patients received standard care with or without adjunctive SFI for 7 days. The primary outcome was 28-day mortality. Key secondary outcomes included inflammatory markers, lactate clearance, and vasopressor duration. Concurrently, network pharmacology analyzed SFIs bioactive components, predicted targets, and enriched pathways, with validation by molecular docking. Results The 28-day mortality was significantly lower in the SFI group (20.0% vs. 42.5%, P=0.030). SFI accelerated clinical improvement, evidenced by greater reductions in IL-6 and procalcitonin, higher 6-hour lactate clearance (35.2% vs. 18.5%, P<0.001), shorter vasopressor duration (48 vs. 72 hours, P<0.001), and more rapid SOFA score decline. Network pharmacology identified 145 SFI-septic shock common targets, with IL-6, SRC, and MAPK3 as central hubs. Pathway analysis revealed significant enrichment in TNF, PI3K-Akt, and IL-17 signaling pathways. Molecular docking confirmed strong binding of key SFI components (e.g., Ginsenoside Rh2) to core targets like IL-6. Conclusion s Adjunctive Shenfu Injection reduces mortality and improves clinical recovery in septic shock, potentially through a multi-target mechanism involving modulation of inflammatory and cellular signaling pathways. This integrative study provides both clinical evidence and a mechanistic framework supporting SFI's use. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800020435.

BackgroundAcute ischemic stroke (AIS) remains a significant cause of disability worldwide. Current treatments, primarily intravenous thrombolysis (IVT), are limited by narrow time windows and reperfusion injury, leading to suboptimal outcomes for many patients. Chuanzhi Tongluo (CZTL), a traditional Chinese medicine, has been preliminarily recognized as a novel cerebral protection agent in animal models. ObjectivesThis trial investigates the efficacy and safety of CZTL capsule in patients with AIS who are not eligible for IVT or who experience early neurological deterioration after IVT. Methods and designThe CONCERN trial is an investigator-initiated, prospective, multicenter, double-blind, parallel-control, randomized clinical study in China. An estimated 1,208 eligible participants will be consecutively randomized to receive CZTL capsule therapy or placebo in 1:1 ratio across approximately 70 stroke centers in China. All enrolled patients are orally administered 2 capsules of CZTL or placebo 3 times a day together with antiplatelet agents for 3 months. OutcomesThe primary endpoint is an excellent functional outcome, defined as a score of 0 or 1 on the mRS at 90 days. Lead safety endpoints included 90-day mortality and symptomatic intracranial hemorrhage within 48 hours. ConclusionsResults of CONCERN trial will determine the clinical efficacy and safety of the traditional Chinese medicine CZTL capsule in the treatment of AIS patients. Trial registry numberChiCTR2300074147 (www.chictr.org.cn).

Background: Previous studies have shown the benefit of dual antiplatelet therapy (DAPT) for acute minor ischemic stroke. Argatroban, is a thrombin inhibitor and is primarily used in patients with acute ischemic stroke experiencing early neurological deterioration. There is no study about the benefit of antiplatelet plus anticoagulant in this population. We aim to study the difference between the combination of argatroban and clopidogrel and DAPT in the outcomes of patients with acute minor ischemic stroke (AMIS, NIHSS <5) presenting within 72 hours after onset. Methods: Argatroban combined with clopidogrel versus aspirin combined with clopidogrel in Stroke (ACAP study) is an investigator-initiated, multicenter, prospective, randomized, open-label trial with blinded endpoint evaluation conducted at four centers in China. This trial will randomize 464 eligible patients with minor ischemic stroke of NIHSS 5 (232 in each arm) within 72 hours of the last known well to receive intravenous argatroban with clopidogrel (treatment group) or aspirin plus clopidogrel (control group). The primary outcome is the proportion of patients achieving excellent outcome, defined as a score of 0-1 on the modified Rankin scale, at 90 days. Conclusions: The ACAP trial will provide important data on the role of intravenous argatroban in patients with acute minor ischemic stroke presenting within 72 hours of last known well.

PurposeThis study aimed to examine the effects of formative and summative assessments on college students tennis performance and basic psychological needs. MethodsA total of 128 undergraduate students (64 males, 64 females; Mage = 19.22, SD = 0.91) participated in this study. Participants were cluster-randomized to either a formative assessment group (n = 64) or a summative assessment group (n = 64). The formative assessment intervention involved setting personalized learning goals and success criteria, administering periodic tests, and providing process-oriented and individualized feedback. The summative assessment intervention involved setting uniform goals for all students, offering instructor feedback only on common problems, and requiring students to practice independently after class without personalized guidance. Both interventions were implemented over 10 weeks, with one 90-minute session each week. Tennis skills and basic psychological needs (i.e., autonomy, competence, and relatedness) were assessed before and after the intervention. Tennis skills were reassessed 1 week after the intervention. Two-way mixed-effects analysis of variance (ANOVA) was used to examine the impact of group, time, and their interaction on tennis skills and basic psychological needs. ResultsThe results showed that the interaction between group and time was significant for all of the outcome variables. Simple effects analyses indicated that, at pre-test, the two groups did not differ significantly in tennis performance or in satisfaction of autonomy, competence, and relatedness (p > 0.05). At post-intervention, the formative assessment group demonstrated significantly better performance than the summative assessment group in tennis skills (MD = 3.50, 95% CI = [1.303, 5.697], p = 0.002), autonomy (MD = 2.44, 95% CI = [1.816, 3.059], p < 0.001), relatedness (MD = 1.33, 95% CI = [0.679, 1.977], p < 0.001), and competence (MD = 1.75, 95% CI = [1.046, 2.454], p < 0.001). At the 1-week follow-up session, the formative assessment group also showed significantly better tennis performance than the summative assessment group (MD = 6.81, 95% CI = [4.667, 8.958], p < 0.001). ConclusionFormative assessment was more effective than summative assessment in improving college students tennis performance and satisfying their basic psychological needs. These findings suggest that incorporating personalized goals, process-oriented evaluation, and individualized feedback into tennis instruction could promote both skill development and psychological outcomes in college physical education.

ObjectivesTo investigate the epidemiology of acute sports-related upper-extremity injuries in young athletes, with a particular focus on the frequency, anatomical distribution, injury types, and mechanisms of digit injuries. MethodsThis single-center retrospective observational study included athletes aged [&le;]22 years who sustained acute sports-related upper-extremity injuries between January 2017 and November 2025. Digit injuries were defined as injuries involving the thumb and fingers at or distal to the metacarpophalangeal joint. Injury characteristics, mechanisms, and sports categories were analyzed using descriptive statistics. ResultsA total of 1,219 acute sports-related upper-extremity injuries were analyzed. Digit injuries were the most common injury location, accounting for 412 cases (33.8%), followed by shoulder (30.7%), elbow (17.5%), wrist (14.4%), and palm injuries (3.6%). Jammed finger was the most frequent injury type, comprising 64.8% of digit injuries, followed by fractures (20.1%) and dislocations (5.3%). Most injuries were caused by contact mechanisms (90.3%), with ball contact being the predominant cause (49.5%). Ball sports accounted for 85.4% of all digit injuries. ConclusionsDigit injuries represent the most frequent acute sports-related upper-extremity injuries in athletes aged [&le;]22 years, with jammed finger accounting for the majority of cases. Most injuries were associated with ball contact, highlighting the need for preventive strategies and appropriate initial management for digit injuries in young athletes.

Background Postoperative sleep disorder, a frequently observed complication, is associated with heightened pain sensitivity, exacerbated inflammatory reactions, and compromised tissue repair. Sufentanil, a highly selective -opioid receptor agonist, is widely used in patient-controlled intravenous analgesia (PCIA) and has been associated with reduced sleep efficiency. Oxycodone, as a /{kappa} dual receptor agonist, has shown a lower incidence of adverse effects in clinical practice. Despite these pharmacological differences, the comparative effects of oxycodone- versus sufentanil-based PCIA on postoperative sleep remain poorly characterized. Recent advances in wearable devices demonstrate strong agreement with polysomnography (PSG) in intergroup comparisons of sleep efficiency and total sleep time, enabling continuous, non-invasive, multi-night sleep monitoring and offering a viable alternative for clinical postoperative sleep research. Hence, we design this clinical trial to compare postoperative sleep efficiency between patients receiving oxycodone-based versus sufentanil-based PCIA under wearable sleep monitoring. Methods This study is a randomized, double-blind, placebo-controlled trial that was conducted at a single center. A sample size of 68 patients was determined through calculation, and these patients will be randomly assigned to either the oxycodone group or the sufentanil group. Sleep monitoring was initiated using a wristband device one day before surgery after recruitment. The sleep quality data at different setting time will be monitored. All patients will be followed up by blinded evaluators at baseline and 1, 2, and 30 days after the intervention. The follow-up included pain scores, postoperative complications and adverse events, etc. Discussion By integrating a modern photoelectric device with first-line analgesics, we hope the result of the study will inform perioperative sleep management, guide clinical analgesic selection, and improve patient recovery quality.

OBJECTIVE To guide treatment of adults with rotator cuff tendinopathy (RoCuTe) by evaluating the relative efficacy of treatments, benchmarked against minimal intervention, for the co-primary outcomes of pain, function and quality-of-life (QoL) across short, medium, and long-term follow-up. DESIGN Systematic review with Bayesian predictive and network meta-analyses for synthesising complex interventions, guided by stakeholder involvement. FUNDING Private Physiotherapy Education Foundation (UK) Silver Jubilee Award. DATA SOURCES PubMed, Embase, Web of Science, CINAHL, and SPORTDiscus, searched to 22/8/2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES High-quality (PEDro score equal or above 7) randomised controlled trials comparing any intervention with another active or minimal intervention for patients clinically diagnosed with RoCuTe of either traumatic or insidious presentation; and reporting outcomes for pain, function and/or QoL. METHODS Title and abstract screening, full-text screening, and quality assessments were completed by two reviewers. Data extraction used the Elicit AI tool and was manually checked. Interventions were classified by treatment focus. Guided by patient and public involvement, pooled results from active interventions at short (1 to 12 weeks included), mid (>12 weeks to <12 months) and long-term (12 months included or more) were calculated for the primary analysis using Bayesian predictive meta-analysis models of within group change scores. Outcomes were benchmarked against an empirically derived minimal-intervention comparator (wait-and-see or sham). As a secondary analysis, network meta-analyses were conducted to synthesise relative effects and provide comparative rankings of active interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence evaluated using GRADE. RESULTS We retained and analysed 140 high-quality studies that included 10,260 patients, 55.9% female, with a mean age of 48 (SD 8) years. Minimal interventions were associated with small short-term improvements, modest medium-term improvements and some regression in the long-term; in pain (0 to 100 scale: short=2.6; mid=23.3; long=21.1), function (standardised mean change (SMC): short=0.13; mid=0.87; long=0.76), and QoL (SMC: short=0.05; mid=0.33). At all timepoints, all active interventions with sufficient data were superior to minimal intervention for pain (0 to 100 scale: short = 18.1 to 37.9 [14 categories]; mid = 25.8 to 34.8 [8 categories]; long = 30.8 to 45.0 [6 categories]), function (SMC: short = 1.1 to 2.4 [14 categories]; mid = 1.1 to 2.0 [11 categories]; long = 1.0 to 1.8 [10 categories]), and QoL (short = 0.8 to 1.7 [7 categories]; mid = 0.9 to 1.8 [6 categories]). Certainty varied widely. Accordingly, three recommendation groups were defined based on the availability of comparative evidence and presence of higher-certainty findings. The strongest recommendation group included strengthening, range-of-motion exercises, complex interventions and movement pattern retraining. CONCLUSIONS A range of active treatments were superior to minimal intervention at each time point, so a wait-and-see approach should not be used, even in in the short-term. The most credible evidence was for interventions with a focus on strengthening, range-of-motion exercises, movement pattern retraining, and complex interventions. Clinicians should prioritise active management and deploy personalised clinical reasoning to tailor treatment to patient preferences and the available resources. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42024584126

Bubble continuous positive airway pressure (bCPAP) is a low-cost respiratory support device that has demonstrated different outcomes for children with severe pneumonia in different settings. Some differences in outcomes may be attributable to implementation factors (e.g., patient monitoring and feeding practices). We aimed to characterize bCPAP reach, implementation fidelity, and safety outcomes for children with severe pneumonia in Pakistan. We conducted a prospective cohort study at Aga Khan University Hospital and Abbasi Shaheed Hospital from February through May 2025. We enrolled children 1-59 months who met WHO criteria for severe pneumonia within 24 hours of presentation to the emergency department. Participants were followed daily via chart review, caregiver survey, and physical exam through discharge, transfer, or death. We reported the proportion of children receiving bCPAP ("reach") and constructed a mixed-effects, multinomial logistic regression model with robust standard errors to report: fidelity (child location in a highly monitored area, continuous monitoring, avoidance of unplanned disruptions to bCPAP, and avoidance of oral feeding); safety (aspiration events and pneumothorax); bCPAP failure (death, respiratory support escalation, or leaving against medical advice); and in-hospital mortality. Of 165 children with severe pneumonia, 88 (53%) received bCPAP over 141 bCPAP days. The average predicted probabilities (95% CI) of our fidelity measures were: 85% (78-92%) for location in a highly monitored area; 56% (51-60%) for continuous monitoring; 66% (57-75%) for continuous bCPAP without disruptions; 46% (36-55%) for avoidance of oral feeding while on bCPAP. Among children receiving bCPAP, 9 (10%) experienced an aspiration event, 1 (2.2%) experienced a pneumothorax; 19 (22%) experienced bCPAP treatment failure. One child (1.1%) died; 6 (6.8%) required respiratory support escalation; 14 (16%) left against medical advice. We identified several gaps in bCPAP reach and fidelity. These may be modifiable by individual-and team-targeted strategies to reduce bCPAP-related complications and pneumonia-related child deaths.

Abstract Background: Pediatric respiratory infections are a leading cause of morbidity and mortality globally, representing a major health challenge in children. Research Gap: Despite extensive studies on epidemiology, clinical management, and specific pathogens, no bibliometric analysis has systematically evaluated the most influential research in this field. Objectives: This study aimed to evaluate the characteristics of the top 50 most-cited articles on pediatric respiratory infections and to identify emerging research trends. Methods: The Web of Science database was searched without publication year restrictions. Independent reviewers screened studies based on predefined inclusion and exclusion criteria. Data were extracted using a standardized form, including study details. Results: The 50 most-cited articles ranged from 34 to 384 citations and showed a right-skewed distribution with a sharp drop after the top ten. Publication years ranged from 1978 to 2021, with over half published in the 2010s. Articles appeared in 31 journals, with Pediatrics contributing five. Leading countries were the United States (18%), China (12%), and Canada (10%), with research largely concentrated in high-income regions and limited multicenter collaboration. Cohort studies dominated (66%), while randomized trials (12%) and reviews/meta-analyses (16%) were less common. Research clustered around three themes: clinical outcomes (e.g., pneumonia, bronchiolitis); viral etiology/diagnostics (e.g., RSV, SARS-CoV-2); and antimicrobial stewardship. Conclusion: Over the past decades, pediatric respiratory infection research has developed but remains unbalanced, relying heavily on observational evidence from high-income countries, with limited randomized trials, systematic reviews, multicenter collaborations, and LMIC-led studies. These findings provide insights that may direct researchers to identify potential focal points and guide future research in the field.

Background. People with lived/living experience of health conditions, as well as caregivers, are increasingly engaged in research. This study aimed to develop and pilot test a new tool measuring the impact of lived/living experience engagement on the research. The measure is called the Measure of Engagement Tool for Research and lived Experience (METRE). Method. We conducted a qualitative descriptive study among 28 people with lived/living experience and caregivers and 12 academic researchers to understand the impacts of engagement. Using the findings, we drafted the METRE. We pilot tested the METRE among 13 people with lived/living experience and caregivers and 10 academic researchers. Insights were used to refine the scale. Results. Qualitatively, participants identified multiple domains of impact of engagement on research, which guided scale development. Pilot testing of the draft METRE revealed it being straightforward to complete, providing a thorough evaluation of the impact of engagement. However, some areas of improvement were recommended. The draft items showed acceptable preliminary performance. Conclusions. An assessment tool is now available to assess the impact of lived/living experience engagement on the research. Additional research is required to evaluate its psychometric properties. Tools to evaluate the impact of engagement on research will help advance the science of engagement and support engaged research teams in their work.

Introduction Recent respiratory illness, especially influenza, may trigger acute cardiac events via elevated inflammatory mediators. During the 2018 influenza season in Bangladesh, this study examined whether recent acute clinical respiratory illness (CRI) or laboratory-confirmed influenza was associated with elevated hs-CRP and IL-6, linked to acute cardiac events. Methods A total of 139 participants aged [&ge;]40 were recruited from a Dhaka cardiac hospital: 70 with acute myocardial infarction (AMI), 30 with other acute cardiac events, and 39 healthy individuals. CRI was defined as fever with cough and/or respiratory symptoms within seven days. Respiratory swabs were tested for influenza, and blood was analyzed for hs-CRP and IL-6. Results Median hs-CRP and IL-6 were higher in participants with CRI or influenza but not significantly. Cardiac patients had elevated hs-CRP (9.98 mg/L in other cardiac; 4.86 mg/L in AMI vs. 1.73 mg/L in healthy) and IL-6 (0.1 pg/mL in other cardiac; 0.145 pg/mL in AMI vs. 0.08 pg/mL in healthy) (p<0.001). CRI was not significantly associated with elevated hs-CRP or IL-6, though influenza in healthy participants was linked to higher IL-6. Cardiac patients had a higher risk of hs-CRP [&ge;]3 mg/L and elevated IL-6. Conclusion Cardiac patients showed significantly increased inflammatory markers, but CRI was not clearly linked to inflammation. Further research should assess biomarker utility for early cardiac risk.

Background Totally endoscopic aortic root (AR) surgery via right anterior minithoracotomy (RAMT) may reduce surgical trauma and accelerate recovery compared with full sternotomy (FS). However, the approach is technically demanding due to limited access and anatomical complexity. This study compares early clinical outcomes and quality of life (QoL) after RAMT versus FS to evaluate the feasibility and safety of the totally endoscopic approach. Methods This single-center, retrospective study included 149 patients underwent AR surgery via RAMT (n=74) or FS (n=75) between January 2021 and March 2026. Patients with aortic dissection, infective endocarditis, redo surgery, concomitant procedures, or arch replacement were excluded. Operative outcomes, postoperative recovery, 30-day and 1-year mortality were analyzed. QoL was assessed using the Short Form-8 (SF-8) questionnaire. Results The median age was 60.0 years, and 79.9% of patients were male. Bentall procedure was performed in 84.6% of patients, 15.4% underwent a David procedure. Compared with FS-AR, RAMT-AR was associated with shorter median operative time (147.0 vs. 178.0 min; p<0.001), lower median chest drainage volume (650.0 vs. 850.0 mL; p<0.001), and shorter median ICU stay (24.0 vs. 25.0 h; p=0.008) and hospital stay (6.0 vs. 8.0 days; p=0.028). Overall, 30-day and 1-year mortality was 0.7%. SF-8 analysis demonstrated significantly higher physical and mental component scores in RAMT-AR patients. Conclusion In specialized centers, totally endoscopic AR surgery via RAMT is a safe and feasible minimally invasive approach associated with favorable early outcomes and a potential benefit in postoperative physical and mental QoL by reducing surgical trauma.

Abstract Objective. To determine the incidence and identify independent clinical predictors of emergence delirium (ED) in children aged 2-12 years. Material and methods. A prospective observational study included 56 children aged 2-12 years undergoing elective surgery under general anaesthesia. Preoperative anxiety (m-YPAS), induction behaviour (4 point scale), anaesthesia duration, opioid use, and postoperative pain (FLACC) were assessed. ED was diagnosed when the maximum PAED score was [&ge;]12. Results. The incidence of ED was 55.4% (31/56). Univariate analysis with false discovery rate (FDR) correction identified significant associations with ED for anaesthesia duration (q=0.002), induction behaviour (q=0.007), and surgery type (q=0.027). Multivariable logistic regression revealed three independent predictors: induction behaviour (category 3 vs 1) - odds ratio (OR) 14.2 (95% CI 2.6-78.1); anaesthesia duration (per minute) - OR 1.07 (95% CI 1.02-1.13); opioid use - OR 12.1 (95% CI 1.3-113.0). The model showed good discriminatory ability: area under the ROC curve (AUC) = 0.83 (95% CI 0.72-0.94). Conclusion. Emergence delirium in children aged 2-12 years without pharmacological premedication occurs in 55.4% of cases. The strongest independent predictors are adverse induction behaviour, longer anaesthesia duration, and intraoperative opioid use. The derived model can be used for personalised risk stratification of ED. Keywords: emergence delirium; children; risk factors; PAED; prediction model.

Background: Post-dural puncture headache (PDPH) affects up to 11.2% of patients after neuraxial anesthesia. The sphenopalatine ganglion block (SPGB) is a promising minimally invasive intervention, but high-quality randomized trial data are limited. We conducted a pilot randomized controlled trial to assess feasibility and inform a future definitive trial. Methods: Twenty-six patients with PDPH following accidental dural puncture with 17G Tuohy needles were randomized to conservative management (bed rest, hydration) or SPGB (bilateral intranasal 2% lidocaine). Primary outcomes were feasibility (recruitment, retention, protocol adherence). Secondary outcomes included pain intensity (Numeric Rating Scale, NRS 0-10) at 30 minutes, 12 hours, and 24 hours; rescue analgesia requirements; mobilization time; and adverse events. Results: Feasibility was confirmed: 100% recruitment of target sample, 100% retention, 100% protocol adherence. At 30 minutes, all SPGB patients reported complete pain resolution (NRS=0) versus median NRS 3 (IQR 2) in controls (p<0.001), though this finding is limited by lack of blinding and baseline assessment. No SPGB patients required rescue analgesia or experienced adverse events. Conservative group patients had prolonged hospitalization (46%). Sample size calculation for a definitive trial (90% power, =0.05) yields 120 participants (60/group). Conclusions: A definitive RCT comparing SPGB to conservative management for PDPH is feasible. Preliminary efficacy data suggest rapid analgesia with SPGB, but rigorous confirmation in a sham-controlled trial is required. Trial registration: ClinicalTrials.gov -NCT07494383 (retrospectively registered). Keywords: Post-dural puncture headache, sphenopalatine ganglion block, pilot study, feasibility, regional anesthesia, randomized controlled trial

Background: The prevalence of lumbar disc herniation (LDH) is increasing, and the associated pain and functional limitations severely impact patients' quality of life. Daoyin, a traditional Chinese exercise, has a history of thousands of years in managing musculoskeletal pain. However, its application in LDH has not been sufficiently investigated, and there is a notable scarcity of rigorous randomized controlled trials (RCTs). This paper outlines the protocol for an RCT based on the theory of goal attainment (TGA), which aims to investigate whether Daoyin is more effective than other exercise therapies in improving symptoms in patients with LDH. Methods: We conducted a 6-week RCT in which participants were randomly assigned to either Daoyin or core stability exercise (CSE). During the first two weeks, the participants performed their assigned exercises five times per week. Outcome data were collected at baseline, week 2, and week 6. The primary outcome was pain intensity at 6 weeks, which was assessed via the visual analogue scale (VAS). The secondary outcomes included the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI), the MOS 36-item Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), surface electromyography (sEMG), gait analysis, and electroencephalography (EEG). A generalized estimating equation (GEE) model will be used to analyse longitudinal changes and between-group differences. Discussion: This trial seeks to assess the efficacy of Daoyin for LDH and to elucidate its underlying neuromuscular mechanisms. Should the intervention prove feasible, the findings will inform the design of a subsequent large-scale RCT and are expected to contribute to a solid evidence base for the broader clinical application of Daoyin. Trial registration: https://itmctr.ccebtcm.org.cn/, Registration number (ITMCTR2025001239).

Background: Platinum-based chemotherapy is known to cause severe and debilitating hearing loss, but unlike cisplatin, the true incidence of carboplatin-induced hearing loss remains unclear. We evaluated functional hearing outcomes in children receiving carboplatin to determine the incidence and severity of ototoxicity. Procedure: We identified a large cohort of children with cancer treated with carboplatin and graded their audiograms using the SIOP ototoxicity scale. Patients with inadequate audiological follow-up, prior hearing loss, or exposure to cisplatin were excluded. Fishers exact test, logistic regression, and ROC analyses were performed to investigate associations of demographic, treatment, and exposure-related risk factors with incidence of hearing loss. Results: 200 patients were included, all of whom had been treated with carboplatin. Only nine (4.5%) patients developed clinically significant hearing loss (SIOP grade [&ge;]2). Younger age at first exposure to carboplatin was the only significant predictor of hearing loss (OR = 0.7888, p=0.0241). Age [&le;]28 months was significantly associated with hearing loss (OR 12.37, p=0.0042). No other risk factors or exposures were statistically significant. Conclusions: Clinically significant carboplatin-associated hearing loss was uncommon (incidence 4.5%). We show that young age is the single-most important risk factor for hearing loss; of nine children who developed hearing loss, eight were aged [&le;]28 months. Children below this age have twelve-fold higher odds of developing hearing loss compared to those above this age (OR 12.37). These findings will allow physicians to provide more appropriate counselling to families regarding ototoxic risk and support intensified hearing surveillance in young children.

Study design A retrospective case control study Objective To predict proximal junctional kyphosis (PJK) risk by normalizing individual vertebral bone strength using the ratio of vertebral Hounsfield unit (HU) values around the upper instrumented vertebrae (UIV). Summary of background data PJK poses a significant challenge in treating patients after adult spinal deformity (ASD) surgery. While the vertebral body HU value is associated with PJK risk, the optimal threshold remains unclear, and a relative assessment of HU values within individuals has not been conducted. Methods Data on patients who underwent corrective fusion of the middle to lower thoracic region of the pelvis for ASD were assessed. The 126 patients were categorized into PJK and non-PJK groups. We compared the patients' backgrounds, vertebral body HU, and junctional HU ratio, defined as the HU value of UIV+1 divided by the HU value of UIV (HUUIV+1/HUUIV). The UIV+2/UIV+1 HU ratio was calculated similarly. Results The PJK and non-PJK groups included 30 and 96 patients, respectively. After propensity score matching, 28 patients from each group were analyzed. HU values at UIV+2 and UIV+1 (117.0 {+/-} 46.6 vs 145.1 {+/-} 45.9, p=0.018, and 105.5 {+/-} 36.2 vs 147.3 {+/-} 44.9, p<0.001, respectively) were lower in the PJK group. Junctional HU ratio was significantly lower in the PJK group (0.88 {+/-} 0.18 vs 1.13 {+/-} 0.25, p<0.001), and receiver operating characteristic analysis showed that the junctional HU ratio had the highest discriminative ability (area under the curve 0.812). At the optimal cutoff value (HU ratio of 0.905), the sensitivity and specificity for PJK were 64.3% and 89.3%, respectively. Conclusions A low junctional HU ratio was strongly associated with PJK after ASD surgery. This parameter reflects the bone strength mismatch at the proximal junction and may help improve preoperative risk assessment and UIV selection.

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of global mortality, with persistent lung inflammation contributing to disease progression. This inflammation is partly associated with reduced levels of histone deacetylase 2 (HDAC2). Previous studies suggest that Vitamin D may modulate HDAC2 levels. This study aimed to evaluate the effect of Vitamin D supplementation on HDAC2 expression in stable COPD patients. This experimental study aimed to evaluate the effect of vitamin D supplementation on HDAC2 expression in stable COPD patients at Jemursari Islamic Hospital. Methods: Five COPD patients received a daily dose of 5000 IU of Vitamin D for three months. Serum levels of 25(OH)D3 and HDAC2 were measured before and after the intervention. Results: Vitamin D supplementation resulted in a significant increase in both 25(OH)D and HDAC2 levels. Pulmonary function parameters showed an increasing trend, however, no statistically significant differences were observed. Conclusion: Vitamin D supplementation was associated with increased HDAC2 levels, suggesting a potential anti-inflammatory effect. However, no significant improvement in pulmonary function was observed. Further studies are needed to determine its clinical impact.

Objective: A questionnaire survey was conducted on the willingness and demand for acupuncture treatment in patients with malignant tumors, and the possible factors affecting patients' willingness and demand for acupuncture treatment were explored. Methods: A voluntary, anonymous survey was conducted between February and May 2025 among patients with malignant tumors aged 18 years and older who visited Beijing Cancer Hospital. The questionnaire included 16 questions addressing three dimensions:current medical purposes,Traditional Chinese Medicine(TCM) literacy, and acupuncture treatment needs.The questionnaire was posted online and completed by respondents using a smartphone interface. Results: A total of 511 valid questionnaires were retrieved in the survey, and 481 patients(94.1%) are willing to receive acupuncture treatment. Among the 481 patients willing to receive acupuncture treatment, the top five symptoms they hoped to improve with acupuncture were: disturbed sleep (245 participants, 50.9%); pain (229 participants, 47.6%); fatigue (177 participants, 36.8%); numbness (165 participants, 34.3%); and poor appetite (144 participants, 29.9%). Among patients who chose to "explicitly accept" acupuncture treatment and those who "accepted acupuncture treatment upon doctor's recommendation", 55% and 56% respectively had good knowledge of traditional Chinese medicine (TCM) culture. In contrast, this proportion was only 36.7% among patients who refused acupuncture treatment, and the difference was statistically significant (P<0.05). The survey results also show that Female patients reported significantly higher demands for pain relief and improved sleep than male patients, with statistically significant differences (P<0.05). Furthermore, those aged 18-45 and with better TCM literacy were more likely to desire acupuncture to improve sleep, with statistically significant differences (P<0.05). Conclusion: Differences in TCM literacy can influence patients' willingness to choose acupuncture treatment. Strengthening patient health education and improving TCM literacy will help increase cancer patients' willingness to choose TCM acupuncture treatment, thereby enabling them to benefit from acupuncture. For patients aged 18-45, those with good TCM literacy female with high acupuncture needs, acupuncture treatment may be recommended as a priority.