Tag: pubmed

Acta Anaesthesiol Scand. 2026 Mar;70(3):e70191. doi: 10.1111/aas.70191.

ABSTRACT

BACKGROUND: Vasopressors are often introduced in severe burn patients who respond poorly to fluid resuscitation to maintain adequate blood pressure and avoid fluid creep. This study aims to characterise these patients and explore potential correlations between vasopressor use and patient outcomes.

METHODS: Medical records from 2010 to 2023 for patients aged ≥ 18 years with burns ≥ 20% of the total body surface area (TBSA) were extracted from the TriNetX Research Network, a global federated health research platform aggregating de-identified electronic health records. The patients were divided into two groups: those who received vasopressors within the first 2 days of hospitalisation and those who did not. Statistical analysis included Cramér-von Mises and χ² test, with significance set at p < 0.05. Propensity score matching (PSM) in a 1:1 ratio was applied for the variables age, sex, pre-existing comorbidities (hypertension, diabetes, chronic heart disease, chronic lung disease, chronic kidney disease, and alcohol or opioid addiction), presence of inhalation injury, %TBSA burned, and burn injury year. Odds ratios (OR) for outcomes were calculated, with p-values adjusted for multiple testing using the Benjamini-Hochberg correction.

RESULTS: Of 6872 included patients, 17.7% received vasopressors within the first two days of hospitalisation. These patients were older, had more comorbidities and sustained more severe burns. After PSM we included 1206 patients in both cohorts (VP+ and VP-). Acute kidney injury occurred within 3 days in 51.0% of the VP+ group and 28.4% in VP- (OR 2.62, 95% CI: 2.20-3.11). VP+ patients also had higher rates of sepsis (30.8% vs. 22.9%, OR 1.50, 95% CI: 1.25-1.81) and higher mortality (45.1% vs. 32.7%, OR 1.69, 95% CI: 1.43-2.01) within 30 days following hospitalisation.

CONCLUSION: While vasopressors are frequently administered as part of burn resuscitation, their use was associated with higher rates of early acute kidney injury and an increased 30-day mortality rate.

EDITORIAL COMMENT: Potent vasopressor use to support the circulation is commonly combined with fluid resuscitation in modern intensive care, and this is a prominent aspect of care in major burn cases. In this retrospective analysis of a commercial, de-identified health care dataset (primarily from US hospitals or health systems), matched cases over 14 recent years were analysed by early vasopressor use (or not) and then for important outcomes including mortality. Vasopressor use was associated with some complications and negative outcomes, though there are likely many factors which may contribute to negative outcomes which were not included in this analysis.

PMID:41603062 | DOI:10.1111/aas.70191

Front Neurol. 2026 Jan 12;16:1760868. doi: 10.3389/fneur.2025.1760868. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate the efficacy and safety of low-dose urokinase combined with papaverin administered via superselective ophthalmic artery thrombolysis in patients with non-arteritic central retinal artery occlusion (CRAO).

METHODS: A retrospective analysis was conducted on the clinical data of 20 CRAO patients who underwent ophthalmic artery thrombolysis at our hospital between December 2023 and July 2025. All procedures were performed under local anesthesia via femoral artery puncture and catheterization. A sequential injection of 400,000 IU urokinase followed by 30 mg papaverine was administered into the ophthalmic artery. Best-corrected visual acuity (BCVA, expressed in logMAR) was assessed pre- and post-operatively, and adverse events were recorded.

RESULTS: The median time from symptom onset to treatment was 7.25 h (IQR: 2.00-20.50). The mean preoperative BCVA in the affected eye was 2.38 ± 0.93 logMAR, which significantly improved to 0.33 ± 0.26 logMAR postoperatively (p < 0.001). The median improvement in BCVA was 2.54 logMAR units (IQR: 0.84-2.78). Although a statistically significant difference persisted between the postoperative visual acuity of the affected eye and that of the contralateral healthy eye (0.28 ± 0.26 logMAR) (p = 0.002), the median difference was only 0.075 logMAR, suggesting limited clinical significance. No serious adverse events, such as hemorrhage or cerebral infarction, occurred in any patient.

CONCLUSION: Low-dose urokinase combined with papaverine via ophthalmic artery thrombolysis significantly improved visual acuity with a favorable safety profile in carefully selected CRAO patients, demonstrating potential for clinical application.

PMID:41603002 | PMC:PMC12832333 | DOI:10.3389/fneur.2025.1760868

Front Neurol. 2026 Jan 12;16:1753257. doi: 10.3389/fneur.2025.1753257. eCollection 2025.

ABSTRACT

BACKGROUND: This study sought to characterize sex-specific treatment effects by comparing clinical outcomes between men and women undergoing EVT.

METHODS: Analyses were based on the DEVT, RESCUE BT, and MARVEL databases. Men and women were matched using propensity score matching (PSM). The primary outcome was defined as the 90-day ordinal modified Rankin Scale score (mRS) distribution. Secondary outcomes included the favorite outcome (mRS 0 to 3), functional independence (mRS 0 to 2), and excellent outcome (mRS 0 to 1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality.

RESULTS: Of 2,862 patients, 1,221 (42.7%) were women and 1,641 (57.3%) were men. After adjusting for covariates, there were no sex differences in 90-day ordinal mRS distribution (median [interquartile range], 3 [1-6] versus 3 [1-5], common odds ratio [OR], 1.02 [0.89-1.18], p = 0.741). The secondary outcomes demonstrated consistency with the primary findings, and the safety outcomes remained stable across men and women. After 1:1 PSM, the results remained consistent with the adjusted outcomes described above.

CONCLUSION: This pooled analysis demonstrated that no statistically significant differences were observed between men and women in clinical or safety outcomes following EVT for anterior circulation LVO. Furthermore, there was no evidence of interaction between sex and predefined subgroups in terms of treatment effect modification for EVT outcomes.

PMID:41602998 | PMC:PMC12832441 | DOI:10.3389/fneur.2025.1753257

Front Neurol. 2026 Jan 12;16:1769992. doi: 10.3389/fneur.2025.1769992. eCollection 2025.

ABSTRACT

[This corrects the article DOI: 10.3389/fneur.2025.1634369.].

PMID:41602994 | PMC:PMC12832513 | DOI:10.3389/fneur.2025.1769992

Front Neurol. 2026 Jan 12;16:1673716. doi: 10.3389/fneur.2025.1673716. eCollection 2025.

ABSTRACT

OBJECTIVE: This research aimed to assess the effectiveness of electroacupuncture in treating post-stroke dysphagia (PSD) and to investigate the optimal stimulation parameters.

METHODS: We conducted a comprehensive review of eight databases: PubMed, Web of Science, Cochrane Library, Embase, CBM, CNKI, Wan Fang, and VIP. Randomized controlled trials (RCTs) on electroacupuncture for the treatment of PSD published between the inception of these databases and March 19, 2025, were integrated. The treatment’s effectiveness was evaluated using several outcome indicators, including the Video Fluoroscopic Swallow Study (VFSS) and the Water Swallowing Test (WST), which collectively assess swallowing function. Two independent reviewers performed risk of bias (ROB 2) evaluations, frequency of use for electroacupuncture parameter combinations through the R language (version 4.5.1), and data analysis using Review Manager (RevMan) version 5.4 and Stata SE 18.

RESULTS: This analysis encompassed a total of 30 RCTs that involved 2,290 patients. The research demonstrated an overall efficiency of (RR = 1.29, 95% CI: 1.23-1.34, p < 0.0001; I² = 13%, fixed-effects model). The mean differences for the various scales were as follows: VFSS (MD = 1.67, 95% CI: 1.26-2.09, p < 0.01; I² = 57%, random effects model). WST (MD = -0.75, 95% CI: -0.93 to -0.57, p < 0.01; I² = 54%, random effects model). Aspiration pneumonia (RR = 0.41, 95% CI: 0.25 to 0.68, p = 0.0005; I² = 8%, fixed effect model). Subgroup analysis revealed significant disparities between the various waveforms (Dense-sparse wave (Ds-W): RR = 1.58, p = 0.003 < 0.01) and the distinctions among the top three combinations of electroacupuncture parameter usage frequency (≥ 30 min + Ds-W, ≥ 30 min + Continuous Wave (C-W), and ≥ 30 min + Intermittent Wave (I-W) groups) were statistically significant (≥ 30 min + Ds-W: RR = 1.55, p = 0.03 < 0.05). In addition, there were no statistically significant differences between the other electroacupuncture parameter subgroups, which included the stimulation frequency and single treatment time (p > 0.05).

CONCLUSION: Electroacupuncture, in conjunction with dysphagia training, is more effective than a solitary treatment in patients with PSD. Furthermore, applying waveforms with Ds-W might enhance the effectiveness of electroacupuncture for PSD. However, the higher risk of bias (ROB) in the included trials indicates that the quality of evidence for the outcomes of these assessments may be jeopardized. Thus, further high-quality clinical trials are urgently required to evaluate the efficacy and effectiveness of electroacupuncture parameters (waveforms) in the treatment of PSD, ultimately increasing the total level of evidence (PROSPERO registration number: CRD420251014881, https://www.crd.york.ac.uk/prospero/).

PMID:41602993 | PMC:PMC12832666 | DOI:10.3389/fneur.2025.1673716

BMC Public Health. 2026 Jan 27. doi: 10.1186/s12889-026-26280-0. Online ahead of print.

NO ABSTRACT

PMID:41593591 | DOI:10.1186/s12889-026-26280-0

BMC Nurs. 2026 Jan 27. doi: 10.1186/s12912-026-04307-6. Online ahead of print.

ABSTRACT

BACKGROUND: Occupational exposure of healthcare workers to antineoplastic drugs can be prevented through the consistent use of protective measures. Despite clear scientific evidence of exposure risks, adherence to safety standards and use of personal protective equipment remain insufficient. The most frequently cited barriers include lack of training, weak safety culture, and inconsistent institutional policies. Training interventions have been shown to improve knowledge, attitudes, and performance related to safe handling.

METHODS: This study evaluated the effectiveness of an educational intervention on factors influencing the use of personal protective equipment among nurses who administer antineoplastic drugs, guided by the “Factors Predicting Use of Hazardous Drug Safe Handling Precautions” model. A single-group, before-and-after comparative design was applied. The study included 67 nurses from internal medicine, adult oncology, and pediatric oncology departments of a university hospital in western Turkey. Data were collected using the Hazardous Drug Handling Questionnaire before and three months after the intervention. The program was structured according to national and international guidelines and based on Pender’s Health Promotion Model. Statistical analyses were conducted using paired sample t-tests and McNemar’s test.

RESULTS: The intervention led to significant improvements in knowledge of hazardous drug risks, self-efficacy, perceived risk, interpersonal modeling, and frequency of personal protective equipment use (p < 0.05). No significant changes were observed in perceived barriers, interpersonal norms, or perceived conflict of interest. Nurses’ perceptions of workplace safety climate declined slightly after training (p = 0.047). Reports of the presence of written procedures and spill kits in units increased significantly. Moreover, the proportion of nurses associating health problems with occupational exposure nearly doubled after the intervention.

CONCLUSION: The educational intervention effectively enhanced individual-level determinants of safe handling behaviors. However, the limited impact on organizational-level factors indicates that training alone cannot ensure sustained behavior change. These findings highlight the need for institutional strategies that include leadership engagement and supportive policies. Strengthening nurses’ competencies and self-efficacy in personal protective equipment contributes to building a safety-oriented workplace culture and supports the delivery of safe, high-quality nursing care.

PMID:41593583 | DOI:10.1186/s12912-026-04307-6

BMC Ophthalmol. 2026 Jan 27. doi: 10.1186/s12886-026-04640-z. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the relationship between systemic fibrosis markers, including the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) and the Fibrosis-4 Index (FIB-4), and the development of proliferative vitreoretinopathy (PVR).

METHODS: The medical records of patients who underwent surgery for rhegmatogenous retinal detachment between January 2019 and October 2025 were retrospectively reviewed. A total of 394 participants were included and divided into three groups: PVR-positive retinal detachment group (PVR (+) RD; n = 150), PVR-negative retinal detachment group (PVR (-) RD; n = 175), and a healthy control group (n = 69). APRI and FIB-4 scores were calculated using preoperative complete blood count and liver function test parameters. Demographic data and clinical characteristics of the patients were recorded.

RESULTS: The mean age of the 394 participants included in the study was 59.9 ± 13.2 years (range: 22-89 years). Of the patients, 184 (46.7%) were female, and 210 (53.3%) were male. Although the mean FIB-4 and APRI values tended to be higher in the PVR (+) group compared with the PVR (-) and control groups, no statistically significant differences were observed (p = 0.062 and p = 0.835, respectively). In multivariate logistic regression analysis, longer symptom duration was independently associated with an increased risk of proliferative vitreoretinopathy (OR = 1.04, 95% CI: 1.02-1.06; p = 0.001). Diabetes mellitus was also identified as an independent risk factor for PVR development (OR = 2.51, 95% CI: 1.22-5.17; p = 0.013), and inferior rhegmatogenous retinal detachment was significantly associated with PVR (OR = 0.48, 95% CI: 0.25-0.93; p = 0.029).

CONCLUSION: The APRI and FIB-4 indices did not reveal a statistically significant difference in distinguishing the development of proliferative vitreoretinopathy. These findings support that the pathogenesis of PVR is primarily driven by inflammatory and fibroproliferative processes occurring within the local vitreoretinal microenvironment rather than by systemic fibrosis.

PMID:41593573 | DOI:10.1186/s12886-026-04640-z

BMC Nephrol. 2026 Jan 27. doi: 10.1186/s12882-026-04758-8. Online ahead of print.

ABSTRACT

BACKGROUND: Comparison of a patient’s abnormal serum creatinine result to an earlier value is fundamental to differentiating Acute Kidney Injury (AKI) from Chronic Kidney Disease (CKD), and is the first step in electronic AKI detection systems. For those patients in whom a baseline serum creatinine is unavailable, some systems generate a warning message to highlight the elevated serum creatinine but without distinguishing AKI from CKD (a “?AKI?CKD” warning). We aimed to determine demographic characteristics of this group, the proportion who had a first presentation of AKI, their clinical outcomes, and how these alert messages translate into subsequent biochemical testing and follow-up.

METHODS: We performed a retrospective cohort analysis of adult patients with serum creatinine testing at University Hospitals of Leicester during 2019. Using the NHS England AKI detection algorithm, we identified patients with AKI Warning Test Scores (WTS) and “?AKI?CKD” warnings. The “?AKI?CKD” cohort was classified as probable AKI, probable CKD, or no follow-up result, based on subsequent serum creatinine measurements. Survival (90-day and 1-year) was analysed with Kaplan-Meier methods.

RESULTS: Among 3,464 patients with “?AKI?CKD” warnings, 8.5% were probable AKI, 59.4% probable CKD, and 32.0% had no follow-up test. Probable AKI patients were younger (median age 71 versus 76 years) and more often hospitalised at warning time (56% versus 15%). One-year survival was lower in probable AKI (72%) compared to probable CKD (88%) or no follow-up (89%). Probable AKI survival was similar to AKI WTS stage 1 but better than stages 2-3. Extending baseline serum creatinine look-back to 426 days changed categorisation minimally (≤ 2%).

CONCLUSIONS: These findings highlight that the major feature of the “?AKI?CKD” classification is not simply misclassification between AKI and CKD, but the variability of clinical response, with one-third of patients receiving no subsequent serum creatinine test. Most patients flagged as “?AKI?CKD” likely have CKD rather than AKI, and this, coupled with comparable outcomes of the probable AKI group to early-stage AKI, suggests minimal missed population-level AKI detection. However, one-third lacked follow-up testing, highlighting missed opportunities to identify CKD.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41593551 | DOI:10.1186/s12882-026-04758-8

BMC Infect Dis. 2026 Jan 27. doi: 10.1186/s12879-026-12590-6. Online ahead of print.

ABSTRACT

BACKGROUND: Eradicating hepatitis C virus (HCV) with direct-acting antivirals (DAAs) reduces hepatocellular carcinoma (HCC) risk, but its impact on post-hepatectomy outcomes remains uncertain. We evaluated whether achieving sustained virological response (SVR) improves prognosis in HCV-related HCC after curative hepatectomy.

METHODS: This retrospective cohort study included HCV-related HCC patients undergoing hepatectomy (2017-2024). Patients were stratified by SVR status: DAA-treated Group (achieved SVR post-DAA) and Untreated Group (no treatment). Kaplan-Meier analysis compared recurrence-free survival (RFS) and overall survival (OS); Cox regression identified prognostic factors.

RESULTS: Among 75 patients undergoing curative hepatectomy, the DAA-treated Group demonstrated significantly superior 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates compared to the Untreated Group (p < 0.01). Multivariate analysis indicated that SVR was significantly associated with improved outcomes for both endpoints (p < 0.01). Exploratory stratified analysis indicated that while SVR conferred a robust survival benefit in HBV-negative patients (p < 0.01), this advantage did not reach statistical significance in the HBV-coinfected subgroup. Notably, the prognostic value of SVR was rigorously validated through propensity score matching (n = 52) and a 3-month landmark analysis designed to mitigate immortal time bias; both sensitivity analyses consistently confirmed that SVR was associated with significant improvements in OS and RFS (p < 0.05).

CONCLUSION: Successful eradication of HCV via DAA therapy significantly enhances post-hepatectomy survival and mitigates recurrence risks.

PMID:41593527 | DOI:10.1186/s12879-026-12590-6