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PurposeSepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis.MethodsWe undertook a post hoc analysis of the 251 patients with sepsis enrolled in a trial that compared conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary end point for the current analysis was 90-day mortality. Key secondary outcomes were cause-specific mortality, ICU and hospital length of stay, ventilator-free days, vasopressor-free days, and the proportion of patients receiving renal replacement therapy in the ICU.ResultsPatients with sepsis allocated to conservative oxygen therapy spent less time in the ICU with an SpO2 ≥ 97% (23.5 h [interquartile range (IQR) 8–70] vs. 47 h [IQR 11–93], absolute difference, 23 h; 95% CI 8–38), and more time receiving an FiO2 of 0.21 than patients allocated to usual oxygen therapy (20.5 h [IQR 1–79] vs. 0 h [IQR 0–10], absolute difference, 20 h; 95% CI 14–26). At 90-days, 47 of 130 patients (36.2%) assigned to conservative oxygen and 35 of 120 patients (29.2%) assigned to usual oxygen had died (absolute difference, 7 percentage points; 95% CI − 4.6 to 18.6% points; P = 0.24; interaction P = 0.35 for sepsis vs. non-sepsis). There were no statistically significant differences between groups for secondary outcomes but point estimates of treatment effects consistently favored usual oxygen therapy.ConclusionsPoint estimates for the treatment effect of conservative oxygen therapy on 90-day mortality raise the possibility of clinically important harm with this intervention in patients with sepsis; however, our post hoc analysis was not powered to detect the effects suggested and our data do not exclude clinically important benefit or harm from conservative oxygen therapy in this patient group.Clinical Trials RegistryICU-ROX Australian and New Zealand Clinical Trials Registry number ACTRN12615000957594.

Background Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre- and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures. Trial registration www.trialregister.nl , NTR7248. Registered May 31, 2018.

Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

Pelvic organ prolapse (POP) is a prevalent pelvic floor disorder affecting a large proportion of parous and aging women worldwide. While surgical intervention is generally reserved for advanced prolapse, conservative approaches remain essential for the management of early-stage disease. Flat magnetic stimulation (FMS), a novel non-invasive modality, has shown promising results in pelvic floor rehabilitation for urinary incontinence, but its role in prolapse treatment remains insufficiently investigated. This study aimed to evaluate anatomical and patient-reported outcomes in women with mild POP undergoing FMS therapy. This retrospective observational study included 87 women with stage ≤ 2 POP, classified according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Participants underwent eight FMS sessions, each lasting 25 min, over four weeks using the Dr. Arnold device (DEKA, Calenzano, Italy). Pre- and post-treatment evaluations included standardized POP-Q measurements and the Patient Global Impression of Improvement (PGI-I) questionnaire. Statistical analyses were performed using paired -tests, with significance set at < 0.05. Statistically significant improvements were observed in the anterior vaginal compartment, with mean Aa values improving from -0.3 ± 1.2 to -0.7 ± 1.3 (mean difference -0.4 cm; 95% CI -0.8 to -0.03; = 0.03; Cohen's d = 0.31) and mean Ba values from -0.3 ± 1.3 to -0.7 ± 1.3 (mean difference -0.4 cm; 95% CI -0.8 to -0.02; = 0.04; Cohen's d = 0.30). No significant changes were found at other POP-Q landmarks. According to PGI-I results, 90.8% of participants reported symptom improvements, and 37.9% described their condition as \"very much improved\" or \"much improved.\" No adverse events occurred, and treatment compliance was 100%. FMS seems to be a safe, well-tolerated, and potentially effective conservative therapy strategy for mild POP, offering both objective anatomical benefits and high subjective satisfaction. Further randomized controlled trials with longer follow-up are required to validate these findings and clarify the long-term role of FMS in the management of pelvic floor dysfunction.

Introduction The application of robot-assisted surgical technology in treating brainstem hemorrhage has garnered increasing attention. Treatments such as stereotactic hematoma aspiration and neuroendoscopic surgery are becoming more prevalent in China. The aim of this study is to provide a detailed comparative analysis of the clinical effects of robot-assisted puncture technology versus traditional conservative treatment, offering a scientific basis for optimizing treatment plans and improving patient outcomes. Methods A retrospective observational study was conducted from January 2019 to December 2023 at a single neurosurgery center. A total of 138 patients with severe brainstem hemorrhage were included, with 103 in the conservative treatment group and 35 in the robot-assisted puncture group.ROSA robot-assisted brainstem hemorrhage drainage is a precise neurosurgical procedure involving pre-surgical evaluations and examinations, including cranial CT, to determine the hemorrhage’s location, extent, and severity. Baseline data was extracted from the hospital’s electronic medical record system, including demographics, medical history, and clinical characteristics. Statistical analysis was performed to compare outcomes between the two treatment groups. Results The baseline characteristics of the patients in both groups were similar, with no significant differences in age, gender, smoking history, alcohol consumption, or other relevant factors. The median stay time was longer in the robot-assisted group (21.0 days) compared to the conservative group (15.0 days), with a significant difference ( p  = 0.004). The median cost of hospitalization was also higher in the robot-assisted group (105231.0 yuan) compared to the conservative group (55221.5 yuan), with a significant difference ( p  < 0.001). The mortality rate of the robot assisted group was significantly lower than that of the conservative treatment group, and the difference was significant. Additionally, the robot-assisted group had a lower discharge hematoma volume and a trend towards better clinical outcomes, as measured by the Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) scores. Discussion The results suggest that robot-assisted puncture technology may offer improved clinical outcomes in patients with brainstem hemorrhage compared to traditional conservative treatment. The precision and accuracy of the ROSA robot may contribute to better hematoma drainage and reduced complications. While the cost of hospitalization was higher in the robot-assisted group, the potential for improved patient outcomes and reduced long-term healthcare costs should be considered when evaluating the cost-effectiveness of this treatment approach. Further research is needed to validate these findings in larger, multicenter studies and to explore the potential benefits of robot-assisted treatment in different subpopulations of patients with brainstem hemorrhage. Conclusion This study provides preliminary evidence that robot-assisted puncture technology may offer improved clinical outcomes in patients with brainstem hemorrhage compared to traditional conservative treatment. The precision and accuracy of the ROSA robot may contribute to better hematoma drainage and reduced complications, although the higher cost of hospitalization should be taken into account. Future research is needed to further validate these findings and explore the potential benefits of this innovative treatment approach.

Background and Objectives: Sesamoiditis is a painful and functionally limiting condition that affects the sesamoid bones of the hallux, frequently seen in athletic populations. Despite its clinical relevance, there are no standardised guidelines for its conservative management. This systematic review aims to evaluate the effectiveness of conservative treatments for sesamoiditis by summarising individual-level data from published studies. Materials and Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, ISI/Web of Science, and PEDro (Physiotherapy Evidence Database) up to December 2024 in accordance with PRISMA 2020 guidelines and following a protocol specifically devised for rare or underrepresented medical conditions. Eligible studies included case reports and case series involving patients aged ≥16 years who were conservatively treated for clinically and/or radiologically diagnosed sesamoiditis. Data on patient demographics, diagnosis, type and duration of treatment, pain- (Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS)) and function-related (Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS)) outcomes, and return to activity were extracted. Study quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Pooled effect sizes were computed where applicable. Results: Out of 2380 initial records, 11 studies comprising 59 patients (29 females) were included. Treatments varied widely, including orthotics, corticosteroid injections, physical therapy, and biologic approaches such as concentrated bone marrow aspirate (CBMA). VAS scores improved in 66% of cases. NRS scores returned to baseline in some patients after initial improvement, revealing recurrence. FAAM and FAOS subscales showed functional improvements, particularly in sports-specific domains. Return to activity varied: in a case series, 45.4% resumed pain-free sports participation, while others remained symptomatic. Conclusions: Conservative treatment options for sesamoiditis showed variable effectiveness with promising outcomes in selected patients. Corticosteroid injections and orthotics appeared beneficial, but high recurrence and limited functional recovery persisted in some cases. Standardised treatment protocols and high-quality prospective studies are needed to improve clinical decision-making and optimise non-surgical management.

Background A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center. Methods A retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated. Results In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years ( p  = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach. Conclusion Our cohort represents one of the largest Central European single-center experiences available in the literature. NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. This rate was quite constant over 17 years ( p  = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management.

Hepato-pancreato-biliary (HPB) injuries can be extremely challenging to manage. This scoping review (8438 citations) offers a number of recommendations. If diagnosis and therapy are rapid, patients with major hepatic injuries who present in physiologic extremis have high survival rates despite prolonged hospital stays. Nonoperative management of major liver injuries, as diagnosed using computed tomography, is typically successful. Adjuncts (e.g., angioembolization, laparoscopic washouts, biliary stents) are essential in managing high-grade injuries. Injury to the extrahepatic biliary tree is rare. Cholecystectomy is indicated for all gallbladder trauma. Full-thickness common bile duct injuries require a hepaticojejunostomy, although damage control remains closed suction drainage. Injuries to the pancreatic head often involve concurrent trauma to regional vasculature. Damage control necessitates drainage after stopping hemorrhage. Injury to the left pancreas commonly requires a distal pancreatectomy. Outcomes for high-grade pancreatic and liver injuries are improved by involving an HPB team. Complications are multidisciplinary and should be managed without delay.