CRITICAL CARE

ICU patients with elevated ammonia without a clear hepatic etiology, to compare outcomes between those who received lactulose and those who did not. Retrospective observational study. Medical, surgical, and subspecialty intensive care units at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina between December 2012 and August 2016. Adults with ammonia levels above 50 μmol/L, excluding those with known chronic liver disease, inborn error of metabolism, active use of valproic acid...

Management of Elevated Ammonia Levels in ICU Patients: Lactulose vs. Non-Lactulose Treatment Outcomes | Wake Forest Baptist Medical Center Study

UROLOGY

Prostate MRI may improve risk stratification of Grade Group 1 prostate cancer beyond traditional NCCN risk groups.

MRI Refines Risk Stratification in Grade Group 1 Prostate Cancer

A study of Grade Group 1 prostate cancer found that NCCN risk groups predicted adverse pathology and recurrence before the MRI era, but showed limited prognostic value among patients evaluated with preoperative MRI. In the MRI era, age, PI-RADS findings and biopsy core positivity were associated with adverse pathology, supporting MRI and biopsy features for contemporary risk assessment.

BRCA alterations were more common in younger patients; BRCA2 homozygous deletion was linked to longer survival with olaparib.

BRCA Alterations and Olaparib Outcomes in Advanced Prostate Cancer

A Japanese genomic profiling study of 2,815 patients with advanced, therapy-resistant prostate cancer found deleterious BRCA alterations in 15.2% of patients, with higher rates among younger patients and those with a family history of breast or ovarian cancer. Among BRCA2-altered patients treated with olaparib, homozygous deletion was associated with longer overall survival than truncating variants.

Thyroidectomy after thermal ablation is feasible but may be technically more complex, with limited evidence on long-term risks.

Thyroidectomy After Thermal Ablation: Surgical Risks and Outcomes

A systematic review of nine retrospective studies involving 150 patients found that thyroidectomy after radiofrequency, laser or microwave ablation was feasible but could be technically more difficult. Prior ablation was associated with longer operative times and more severe adhesions, while permanent nerve or parathyroid complications were rarely reported. Evidence remains limited and heterogeneous.

Thin TDAP free flaps achieved successful scalp reconstruction after cancer excision, with all 14 flaps surviving.

Thin TDAP Flap for Scalp Reconstruction After Cancer Surgery

A retrospective study of 14 patients found that thin thoracodorsal artery perforator (TDAP) free flaps provided successful scalp reconstruction after malignant tumor excision. All 14 flaps survived, with one venous thrombosis successfully salvaged. The authors found the technique reliable and versatile, although a suitable perforator was not identified in two cases.

A higher IGF-1:IGFBP1 ratio was associated with improved survival in metastatic hormone-sensitive prostate cancer.

IGF-1:IGFBP1 Ratio and Survival in Metastatic Prostate Cancer

A post-hoc analysis of 845 ENZAMET participants with metastatic hormone-sensitive prostate cancer found that a higher baseline IGF-1:IGFBP1 ratio was associated with longer overall and clinical progression-free survival. However, the biomarker did not predict benefit from enzalutamide or docetaxel, suggesting prognostic rather than treatment-predictive value.

DENTISTRY

Post-print cleaning affected strength, conversion and translucency of 3D-printed dental crowns, depending on filler content.

Cleaning Protocols Affect 3D-Printed Dental Crown Performance

A study evaluating two 3D-printed definitive crown materials found that post-print cleaning protocols influenced flexural strength, degree of conversion and translucency differently according to filler content. A 5-second isopropyl alcohol wash generally preserved performance better, while longer IPA exposure reduced strength and optical properties in the higher-filled material.

GYNAECOLOGY - IVF

Chronic hypertension, elevated MAP and higher FMF risk predicted preterm preeclampsia despite low-dose aspirin prophylaxis.

Predictors of Preterm Preeclampsia Despite Aspirin Prophylaxis

A study of 2,919 high-risk pregnant women receiving low-dose aspirin found that chronic hypertension, elevated mean arterial pressure and higher first-trimester FMF triple-test risk were associated with preterm preeclampsia. Women with the highest estimated risk had substantially greater odds and earlier risk of preeclampsia, highlighting residual risk despite aspirin prophylaxis.

NEUROLOGY

Postoperative MAP was associated with PAPi and exploratory kidney outcomes after HeartMate 3 implantation, without defining an optimal target.

MAP and Outcomes After HeartMate 3 Implantation

A retrospective study of 75 HeartMate 3 recipients found that postoperative mean arterial pressure (MAP) was associated with pulmonary artery pulsatility index, while evidence for its relationship with cardiac output was less conclusive. Greater time below a mean perfusion pressure of 60 mmHg was associated with higher odds of acute kidney injury, although the findings were exploratory and did not establish an optimal MAP target.

PEDIATRICS

Psychological capital was linked to self-compassion and social support among siblings, regardless of developmental disability status.

Psychological Capital and Self-Compassion in Siblings

A study of 154 adults examined psychological capital, social support and self-compassion among siblings of people with and without developmental disabilities. Psychological capital was positively linked with social support and self-compassion and mediated their relationship. However, the two sibling groups showed no significant differences in these measures.

ORTHOPAEDICS

Nonhamstring grafts were linked to better patient-reported outcomes after ACL reconstruction, regardless of MCL injury status.

Graft Type and Outcomes After ACL Reconstruction With MCL Injury

A prospective multicenter study of 489 patients undergoing ACL reconstruction found that nonhamstring grafts were associated with higher IKDC, ACL-RSI and Subjective Knee Value scores than hamstring grafts. However, MCL injury status did not significantly modify the relationship between graft type and postoperative outcomes. No significant association was found with Tegner activity level.

PSYCHIATRY

A meta-analysis found no significant benefits of COSP for parenting, parent mental health or child outcomes.

Circle of Security-Parenting: Evidence From Randomized Trials

A preregistered meta-analysis of eight randomized trials involving 1,094 families found no statistically significant overall benefit of Circle of Security-Parenting (COSP) on parenting, parent mental health, child attachment security or behavior problems. The authors noted that 82% of included trials had some concerns about risk of bias, highlighting the need for stronger evidence.

LIPUS promoted uterine involution and reduced postpartum complications in a randomized trial, with laboratory data suggesting enhanced contractility.

LIPUS May Improve Uterine Involution After Delivery

A multicenter randomized trial of 1,058 women found that low-intensity pulsed ultrasound (LIPUS) was associated with greater uterine volume reduction, faster uterine involution, shorter lochia duration and fewer postpartum complications than sham treatment. Laboratory experiments suggested increased calcium influx and upregulation of endothelin-1 and oxytocin receptors may contribute to uterine contractions.

RHEUMATOLOGY

Deucravacitinib improved joint, skin and patient-reported outcomes in PsA, with sustained responses and no new safety signals.

Deucravacitinib Shows Sustained Efficacy in Psoriatic Arthritis

In the phase 3 POETYK PsA-2 trial of 729 patients with psoriatic arthritis, deucravacitinib significantly improved ACR20 response versus placebo at week 16 (54.2% vs 39.4%). Benefits extended to skin, physical function, quality of life and minimal disease activity, with responses maintained through week 52 and no new safety signals identified.

CARDIOLOGY

A global review highlights substantial VTE burden, regional variation and major gaps in epidemiological data worldwide.

Global VTE Burden Shows Major Regional Differences and Data Gaps

A multinational review found substantial regional variation in venous thromboembolism (VTE) incidence and outcomes, with reliable data available from only a limited number of countries. During 2012–2016, annual deep-vein thrombosis incidence ranged from 25.1 to 131.5 per 100,000 people. Pulmonary embolism mortality and recurrent VTE also varied, highlighting the need for standardized global surveillance.

Women with HDP showed persistent cardiovascular abnormalities during the first year postpartum, supporting extended surveillance.

Postpartum Cardiovascular Risk Persists After Hypertensive Pregnancy

A prospective study of 201 women found that those identified as high risk for pre-eclampsia and who developed hypertensive disorders of pregnancy had persistently higher blood pressure, vascular resistance and LV mass, with impaired cardiac function, during the first year postpartum. High-risk women without HDP showed earlier improvements, supporting longer-term postpartum cardiovascular monitoring.

Use of Lactulose to Treat...

Use of Lactulose to Treat Hyperammonemia in ICU Patients Without Chronic Liver Disease or Significant Hepatocellular Injury