AI risk assessment for CVD effective non-invasive alternative: Study

A new study published in the Npj Digital Medicine journal revealed how the risk assessment system cardiovascular disease (rpCVD) technique may be used to assess CVD risk in primary care settings more quickly, easily, and non-invasively without requiring more involved clinical tests.

The real-world adoption of CVD risk assessment remains below ideal, even though there are well-validated instruments for assessing this risk, such as the pooled cohort equations (PCE) for American populations and the QRISK3 and SCORE2 for European populations. This project evaluated an automated retinal photography and artificial intelligence (AI)-based rpCVD in primary care settings in Australia for real-world accuracy (primary result), practicality, and acceptance (secondary objectives).

For this study participants were selected from 2 general practice clinics in Victoria, Australia, who were between the ages of 45 and 70 and had recently completed all or part of a CVD risk assessment. The participants gave their assent, underwent retinal imaging with an automated fundus camera, and a deep learning system produced a rpCVD risk score. The World Health Organization’s (WHO) CVD risk score, which takes into account clinical risk variables including age and sex, was compared to this score.

Using data from the UK Biobank, the prediction accuracy of the WHO CVD risk scores and rpCVD risk scores for 10-year incident CVD occurrences was examined. The accuracy of each system was measured using the area under the receiver operating characteristic curve (AUC). A survey was used to gauge participant satisfaction, and the proportion of people having pictures good enough to generate a rpCVD risk score was used to calculate the imaging success rate.

A 93.9% imaging success rate was achieved by assigning a rpCVD risk score to 339 out of the 361 individuals. There was a moderate association between the WHO CVD risk scores and the rpCVD risk scores.

In spite of this, the WHO CVD risk score (AUC = 0.693, 95% CI: 0.680-0.707) and the rpCVD system, which only uses retinal pictures, showed comparable accuracy in predicting 10-year incident CVD (AUC = 0.672, 95% CI: 0.658-0.686). Nearly, 87.5% of general practitioners (GPs) and 92.5% of participants expressed satisfaction with the system, indicating high levels of satisfaction.

Using just retinal photos, the automated rpCVD system showed predicted accuracy on par with the WHO CVD risk score, which takes into account a number of clinical parameters, including age, which is the most heavily weighted factor for predicting CVD. Overall, the automated rpCVD screening method is viable and well accepted in Australian primary care, as this study shows. 

Source:

Hu, W., Lin, Z., Clark, M., Henwood, J., Shang, X., Chen, R., Kiburg, K., Zhang, L., Ge, Z., van Wijngaarden, P., Zhu, Z., & He, M. (2025). Real-world feasibility, accuracy and acceptability of automated retinal photography and AI-based cardiovascular disease risk assessment in Australian primary care settings: a pragmatic trial. Npj Digital Medicine, 8(1), 122. https://doi.org/10.1038/s41746-025-01436-1

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Diet rich in omega-3 fatty acids may help ward off short sightedness in children: Research

A diet rich in omega-3 fatty acids, found predominantly in fish oils, may help ward off the development of short sightedness (myopia) in children, while a high intake of saturated fats, found in foods such as butter, palm oil, and red meat, may boost the risk of the condition, finds research published online in the British Journal of Ophthalmology.

The global prevalence of myopia is rising, especially in East Asia, and it’s predicted that around half of the world’s population will be affected by 2050, note the researchers.

Risk factors are thought to include excessive screen time and too little time spent outdoors, as well as inherited susceptibility, they explain.

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs), which can only be obtained from the diet, are thought to improve/prevent several chronic eye conditions, including dry eye disease and age-related macular degeneration. But whether they can help ward off myopia isn’t clear as studies to date have been experimental and haven’t included people.

To explore this further, the researchers drew on 1005 Chinese 6-8 year olds, randomly recruited from the population based Hong Kong Children Eye Study, which is tracking the development of eye conditions and potential risk factors.

The children’s eyesight was assessed and their regular diet measured by a food frequency questionnaire, completed with the help of their parents. This included 280 food items categorised into 10 groups: bread/cereals/pasta/rice/noodles; vegetables and legumes; fruit; meat; fish; eggs; milk and dairy products; drinks; dim sum/snacks/fats/oils; and soups.

Intakes of energy, carbohydrate, proteins, total fat, saturated fats, monounsaturated fats, PUFAs, cholesterol, iron, calcium, vitamins A and C, fibre, starch, sugar and nutrients were then calculated, based on the questionnaire responses.

The amount of time the children spent outdoors in leisure and during sports activities, reading and writing, and on screens during weekdays and at the weekend was calculated from validated questionnaire responses.

In all, around a quarter of the children (276; 27.5%) had myopia. Higher dietary intake of omega-3 fatty acids was associated with a lower risk of the condition.

Axial length-measurement of the eye from the cornea at the front to the retina at the back, and an indicator of myopia progression—was longest in the 25% of children with the lowest dietary intake of omega-3 fatty acids, after accounting for influential factors, including age, sex, weight (BMI), the amount of time spent in close work and outdoors, and parental myopia.

It was shortest in the 25% of children with the highest dietary intake of omega-3 fatty acids.

Similarly, cycloplegic spherical equivalent (SE), which measures refractive error, such as the degree of shortsightedness, was highest in those with the lowest omega-3 fatty acid intake and lowest in those with the highest intake.

But these findings were reversed for the 25% of children with the highest saturated fat intake, compared with the 25% of those with the lowest. None of the other nutrients was associated with either measure or myopia.

This is an observational study, and as such, can’t establish causal and temporal factors. And the researchers acknowledge that food frequency questionnaires rely on recall and only provide a snapshot in time of diet. Nor was there objective evidence of nutritional intake from blood samples.

The prevalence of myopia in Hong Kong is also among the highest in the world. And whether the findings might apply to other ethnic groups with different lifestyles and less myopia remains to be verified, they add.

But omega-3 fatty acids may suppress myopia by increasing blood flow through the choroid, a vascular layer in the eye, responsible for delivering nutrients and oxygen, and so staving off scleral hypoxia-oxygen deficiency in the white of the eye and a key factor in the development of shortsightedness, they suggest.

And they conclude: “This study provides the human evidence that higher dietary ω-3 PUFA intake is associated with shorter axial length and less myopic refraction, highlighting ω-3 PUFAs as a potential protective dietary factor against myopia development.”

Reference:

Dietary omega-3 polyunsaturated fatty acids as a protective factor of myopia: the Hong Kong Children Eye Study Doi: 10.1136/bjo-2024-326872

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Er:YAG Laser Plus 60s Acid Etch Restores Bonding in Fluorotic Enamel: Study

According to a new study use of an Er:YAG laser at 100 mJ/30 Hz combined with 60 seconds of acid etching produces excellent adhesion for attachments on fluorotic enamel — restoring bond strength to levels comparable with healthy enamel while avoiding over-etching damage. The researchers found that this approach avoids the risk of over-etching, which can damage enamel structure, while still achieving strong adhesion for orthodontic attachments. Dental fluorosis can alter the mineralization of enamel, making it more resistant to acid etching and reducing bond strength for orthodontic brackets or attachments. Standard etching protocols often fail to achieve optimal adhesion, and aggressive etching may compromise the enamel surface. In this study, the laser-plus-acid combination created an ideal surface texture for micromechanical interlocking without excessive enamel loss. The findings suggest that this protocol could offer clinicians a predictable and safe way to manage bonding challenges in patients with dental fluorosis. By fine-tuning the laser energy and etching duration, the researchers were able to overcome the adhesion limitations of fluorotic enamel while preserving tooth integrity. The authors note that further clinical trials are needed to confirm these in vitro results and evaluate long-term bond durability under oral conditions. If validated, this method could improve treatment outcomes in orthodontics, particularly in regions where fluorosis prevalence is high.

Reference:
Xia R, Lei J, Luo M, Xiao Y (2025) Effects of Er: YAG laser and acid etching on bond strength of clear aligner attachments to fluorotic enamel. PLoS One 20(8): e0328937. https://doi.org/10.1371/journal.pone.0328937

Keywords:

Er:YAG laser, dental fluorosis, acid etching, enamel bonding, orthodontics, attachment adhesion, surface preparation

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Iontophoresis and low-dye taping are effective conservative interventions for plantar fasciitis: study

Plantar fasciitis (PF) is a frequent cause of heel pain, affecting approximately 10% of the population. Conservative treatments such as iontophoresis and low-dye taping (LDT) are widely used to alleviate symptoms, often providing short-term pain relief.

Aurora Castro‑Mendez et al conducted a systematic review to compare the efficacy of iontophoresis (with 5% acetic acid, 0.4% dexamethasone, dexamethasone and lidocaine, or placebo) versus low-dye taping (LDT) in treating plantar fasciitis. Additionally, it evaluated the combined effect of iontophoresis and LDT application.

A systematic search was conducted in Scopus, PubMed, Web of Science, CINAHL, and the Cochrane Library databases, following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Inclusion and exclusion criteria were predefined. Two independent reviewers screened and extracted data from eligible studies, assessing their quality. Included studies comprised randomized controlled trials, non-randomized clinical trials, case–control studies, systematic reviews, and meta-analyses. The review protocol was registered with PROSPERO.

Key findings of the study were:

• Eight studies published between 1997 and 2018 were included, providing a moderate level of evidence.

• Both iontophoresis (with the specified agents) and low-dye taping, alone or combined, were associated with statistically significant reductions in pain scores compared to baseline.

The authors concluded – “Iontophoresis and low-dye taping are effective conservative treatments for reducing foot pain in adults with plantar fasciitis. However, evidence from this review suggests that the combined use of iontophoresis and LDT provides superior pain relief compared to either treatment alone. Among the substances used, 5% acetic acid appears to be the most effective when applied via iontophoresis.

Nevertheless, the current body of research is limited by heterogeneity in methodologies, small sample sizes, and short-term follow-up. Future studies should aim to standardize treatment protocols, use consistent outcome measures, and include larger populations with long-term follow-up to better assess the durability of therapeutic effects.”

Further reading:

Comparative Effectiveness of Iontophoresis vs. Low Dye Taping in Plantar Fasciitis: A Systematic Review

Aurora Castro‑Mendez et al

Indian Journal of Orthopaedics

https://doi.org/10.1007/s43465-025-01477-4

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Fertility-Related Factors May Predict Osteoporosis Risk in Postmenopausal Women, claims research

Researchers have discovered in a new study that infertility, miscarriage, stillbirth, and having fewer children might raise the risk of osteoporosis among women undergoing natural menopause. The large international study concluded that these reproductive factors for health are independently linked to bone loss in older age, and that age at natural menopause doesn’t entirely account for these associations. These results indicate that reproductive history may be an important factor in the early recognition of women who are at high risk for osteoporosis, and in steering preventive measures to minimize long-term morbidity. The study was conducted by LIANG Chen and fellow researchers published in the journal of Fertility and Sterility.

This research, undertaken under the auspices of the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE), combined data from 141,222 naturally postmenopausal women from five cohorts. It was designed to test two overarching hypotheses: whether reproductive difficulties like infertility, miscarriage, stillbirth, and low parity are related to elevated risk of osteoporosis, and whether menopausal age might explain these relationships.

This pooled analysis employed retrospective and prospective data from five cohorts from around the world who belonged to the InterLACE consortium. Excluding women who had undergone unnatural menopause and those for whom reproductive history, osteoporosis status, and covariates were incomplete, the researchers included only those women who met these criteria. Major exposures to infertility, miscarriage, stillbirth, and parity were reported by participants themselves.

Diagnoses of osteoporosis were derived from various sources of data, such as surveys, hospital discharge records, death registers, primary care data, and records of drug use. Cox regression models were used by researchers to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between factors related to fertility and osteoporosis risk. Models were also adjusted for key covariates including race, age, education, smoking, alcohol consumption, BMI, physical activity, and age at menarche, with a further step adjusting for age at natural menopause as a time-varying covariate.

Key Findings

Modest but persistent elevated risks of osteoporosis in women with unfavorable reproductive histories were found by the study:

  • Infertility history was linked with a 16% increased risk of osteoporosis (HR=1.16, 95% CI: 1.13–1.19).

  • Women with three or more miscarriages had 17% increased risk (HR=1.17, 95% CI: 1.05–1.30).

  • Those who had stillbirth had 14% increased risk (HR=1.14, 95% CI: 1.10–1.17).

  • No live births: HR=1.20 (95% CI: 1.15–1.25)

  • One live birth: HR=1.15 (95% CI: 1.14–1.16)

This big international study verifies that infertility, habitual miscarriage, stillbirth, and low parity are associated with higher risk of osteoporosis in naturally postmenopausal women. These relationships remained significant even after controlling for age at menopause, indicating an independent contribution of reproductive factors in bone health. Physicians can think of these reproductive markers as preliminary indicators for osteoporosis risk assessment and individualized prevention measures.

Reference:

Chen, L. I. A. N. G., Chung, H.-F., Anderson, D. J., VAN DER Schouw, Y. T., Avis, N. E., Karvonen-Gutierrez, C. A., Dobson, A. J., & Mishra, G. D. (2025). The association of infertility, miscarriage, stillbirth, and parity with osteoporosis: a pooled analysis of five cohort studies. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2025.07.382

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Ureteroscopy and Shockwave Lithotripsy exhibit Similar kidney stone Clearance: JAMA

A new study published in the Journal of American Medical Association found that despite shockwave lithotripsy and ureteroscopy having comparable kidney stone clearance rates, patients felt that shockwave lithotripsy was a superior overall experience.

Despite the ambiguity and equal weight of guidelines for shockwave lithotripsy and ureteroscopy, ureteroscopy is the most common treatment for kidney and ureteral stones in children and adolescents. Thus, to assess stone clearance and patient-reported outcomes following ureteroscopy or shockwave lithotripsy, this study was carried out in children and adolescents.

The patients were recruited for this nonrandomized clinical research at 31 US and Canadian medical facilities between March 16, 2020, and July 31, 2023. The patients with ureteral stones, kidney stones, or both who were between the ages of 8 and 21 were included. The last day of follow-up was October 15, 2023.

6 (±2) weeks following surgery, the main result was the stone removal measured by standardized ultrasonography. Stone clearance was assessed per kidney or ureter using logistic regression, and estimated stone clearance rates were produced for each operation using inverse probability weighting and random intercepts each location.

A total of 1,142 patients (690 females [60.4%]) with a median age of 15.6 years (IQR, 12.6-17.3 years) were included in this research. Regarding race and ethnicity, 884 patients (77.4%) were White, 130 patients (11.4%) were Hispanic, and 41 patients (3.6%) were Black.

A median stone size of 6.0 mm (IQR, 4.0-9.0 mm) was found in 1069 kidneys or ureters treated by 124 urologists using ureteroscopy and shockwave lithotripsy (n = 953 and 189 patients), respectively.

Almost, 841 operations for 767 patients (80.4%) undergoing ureteroscopy and 6 procedures for 5 patients (2.6%) undergoing shockwave lithotripsy involved the placement of ureteral stents at the time of index surgery.

In 105 patients who had shockwave lithotripsy (67.5% [95% CI, 61.0%-74.1%]) and 474 patients who had ureteroscopy (71.2% [95% CI, 63.8%-78.5%]), stone removal was achieved; however, this difference was not statistically significant (risk difference, 3.6% [95% CI, −6.2% to 13.5%]).

One week following surgery, ureteroscopy caused more urinary symptoms (symptom score difference, 3.9 [95% CI, 1.2-6.7]) and discomfort interference (T-score difference, 5.0 [95% CI, 2.3-7.8]) than shockwave lithotripsy.

In the week after surgery, ureteroscopy patients missed more coursework (risk difference: 21.3% [95% CI: 9.7%-32.8%]) and caregivers missed more work (risk difference: 23.0% [95% CI: 11.0%-35.0%]). Overall, improved patient-reported outcomes were linked to shockwave lithotripsy. 

Reference:

Tasian, G. E., Chu, D. I., Nelson, C. P., DeFoor, W. R., Ziemba, J. B., Huang, J., Luan, X., Kurtz, M., Ching, C. B., Dangle, P., Schaeffer, A. J., Sturm, R., Wu, W., Bayne, C., Fernandez, N., Chua, M. E., DeMarco, R., Ellsworth, P., Augelli, B., … Meenakshi-Sundaram, B. (2025). Ureteroscopy vs shockwave lithotripsy to remove kidney stones in children and adolescents: A nonrandomized clinical trial: A nonrandomized clinical trial. JAMA Network Open, 8(8). https://doi.org/10.1001/jamanetworkopen.2025.25789

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tsRNAs emerge as powerful non-invasive biomarkers in liquid biopsy, reveals research

A new review highlights the transformative potential of transfer RNA-derived small RNAs (tsRNAs) in the field of liquid biopsy, emphasizing their role as promising biomarkers for a wide range of diseases, particularly cancers. These non-coding RNA fragments, originating from mature or precursor tRNAs, are detectable in diverse body fluids-including blood plasma, saliva, urine, semen, and cerebrospinal fluid-and exhibit remarkable stability, even in challenging biological environments.

The article presents tsRNAs as a rising star in precision medicine, with significant diagnostic and prognostic value. Found in both plasma and serum, tsRNAs offer disease-specific expression patterns and correlate with key clinical features such as tumor stage, metastasis, and patient survival. In breast cancer, certain circulating tsRNAs are associated with improved prognostic accuracy compared to traditional markers, while in lung cancer, tsRNA signatures have helped differentiate between early and advanced stages. tsRNAs have also shown promise in gastrointestinal, ovarian, pancreatic, renal, and bladder cancers, as well as in conditions like nonalcoholic fatty liver disease, systemic lupus erythematosus, infertility, and neurodegenerative disorders.

A notable advantage of tsRNAs is their presence across multiple biofluids, enabling non-invasive sampling that is more accessible and less risky than tissue biopsies. This versatility opens up opportunities for early detection, disease monitoring, and treatment stratification. Importantly, tsRNAs demonstrate unique expression profiles distinct from similar small RNA classes like miRNAs, reinforcing their biological relevance and clinical utility.

The article also discusses challenges such as inconsistent nomenclature, variation in sample preparation, and the need for optimized detection platforms like PANDORA-seq. It calls for standardized analytical frameworks to enable consistent cross-study comparisons and emphasizes the importance of accounting for age-related and tissue-specific variation in tsRNA expression.

Reference:

Qinglin Wang, Zehao Pan, Si Liang, Yuanjian Shi, Gaochao Dong, Lin Xu, Qixing Mao, Feng Jiang, Transfer RNA-derived small RNAs (tsRNAs): A rising star in liquid biopsy, Genes & Diseases, https://doi.org/10.1016/j.gendis.2025.101608.

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Losing weight before IVF may increase chance of pregnancy: Study

A systematic review and meta-analysis of randomized controlled trials (RCTs) assessed whether weight loss interventions before in vitro fertilization (IVF) improved reproductive outcomes. The review found that weight loss interventions before IVF could increase the chances of pregnancy, especially in unassisted conception, although the effect on live births was unclear. The findings are published in Annals of Internal Medicine.

Researchers from the University of Oxford reviewed 12 RCTs comprising 1,921 patients conducted between 1980 through 27 of May 2025. Inclusion criteria included studies conducted on women at least 18 years old with a BMI of 27 kg/m2 or greater who were seeking IVF with or without intracytoplasmic sperm injection treatment for infertility. Outcomes of interest were number of participants achieving pregnancy without IVF (unassisted pregnancy), with IVF (treatment-induced pregnancy), overall (unassisted plus treatment-induced) and those delivering a live infant.

The researchers found that participants were typically women in their early 30s with a median baseline BMI of 33.6 kg/m2. Weight loss interventions studied included low-energy diets, an exercise program accompanied by healthy eating advice, and pharmacotherapy accompanied by diet and physical activity advice. Overall, weight loss interventions before IVF were associated with greater unassisted pregnancy rates. Evidence was inconclusive on the effect of weight loss interventions on treatment-induced pregnancies. Evidence on the association between weight loss interventions before IVF and live births was uncertain, although there was moderate certainty of no association with pregnancy loss.

The findings suggest that weight loss interventions before IVF increase total pregnancies, mainly through an increase in unassisted pregnancy rates. However, further high-quality clinical trials testing different weight loss interventions, particularly those known to achieve greatest weight losses (e.g. low-energy total diet replacement programs) are needed.

Reference:

Moscho Michalopoulou, Susan Ann Jebb, Alice Hobson, et al. The Effect of Weight Loss Before In Vitro Fertilization on Reproductive Outcomes in Women With Obesity: A Systematic Review and Meta-analysis. Ann Intern Med. [Epub 12 August 2025]. doi:10.7326/ANNALS-24-01025.

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Double Relief: Study evaluates Synergistic Effects of Hydromorphone and Ropivacaine in Thoracoscopic Surgery

Recently published clinical trial aimed to evaluate the efficacy of hydromorphone as an adjunct to ropivacaine in serratus anterior plane block (SAPB) for postoperative analgesia and inflammatory response management in patients undergoing video-assisted thoracoscopic surgery (VATS).

Methodology

Patients aged 20-75 with American Society of Anesthesiologists classification I or II were randomized into three groups: Hydromorphone-Ropivacaine SAPB (HR), Ropivacaine SAPB (R), and control (C). Randomization used Excel-generated integers, ensuring blinding throughout the study. A total of 129 patients were identified, with 120 included in the final analysis. VAS scores were recorded at 2, 6, 12, 24, and 48 hours post-surgery, while inflammatory markers (CRP, IL-6, TNF-α) were measured preoperatively and at 24 and 48 hours post-surgery.

Key Findings

Postoperative Pain Relief: Group HR exhibited significantly lower VAS scores than Group C at all measured intervals, particularly at 6 hours post-surgery, where it scored 2.00 (IQR: 2.00) compared to Group C’s 3.00 (IQR: 3.00) (P < 0.001). The HR group showed enhanced pain control throughout the recovery period.

Opioid Consumption: Total opioid consumption and the need for rescue analgesia were significantly reduced in Groups R and HR when compared to Group C. Specifically, HR group had a lower requirement for patient-controlled intravenous analgesia (PCIA) activations (P < 0.001).

Inflammatory Response: The combination of hydromorphone and ropivacaine significantly attenuated postoperative inflammatory markers, with CRP levels being markedly lower in Group HR at 24 and 48 hours compared to Group C (P < 0.001).

Hemodynamic Stability: No significant intraoperative hemodynamic disturbances were attributed to the analgesic techniques, and major postoperative complications were absent.

Limitations

The study was conducted at a single center, potentially limiting the generalizability of findings. Long-term follow-up data was not collected, leaving the long-term effects of the hydromorphone-ropivacaine combination uncertain. Further investigation is needed to compare SAPB with traditional analgesic methods like thoracic epidural analgesia.

Conclusion

The addition of hydromorphone to ropivacaine in SAPB markedly improved postoperative pain management and reduced inflammatory responses in patients undergoing VATS, reinforcing its potential as an effective analgesic strategy. Future research should explore the long-term outcomes and optimal dosing strategies for hydromorphone in SAPB.

Key Points

Analgesic Efficacy: The combination of hydromorphone and ropivacaine in serratus anterior plane block (SAPB) resulted in significantly lower Visual Analog Scale (VAS) pain scores at all assessed time intervals compared to the control group, with the most notable improvement observed at 6 hours post-surgery.

Reduced Opioid Use: Patients receiving the hydromorphone-ropivacaine combination demonstrated a statistically significant reduction in total opioid consumption and need for rescue analgesia, specifically showing fewer activations of patient-controlled intravenous analgesia (PCIA) compared to the control group.

Inflammatory Marker Reduction: The treatment group receiving hydromorphone and ropivacaine showed a marked decrease in inflammatory markers, such as C-reactive protein (CRP), at 24 and 48 hours post-surgery, indicating an enhanced anti-inflammatory response.

Safety Profile: The analgesic techniques employed did not result in significant intraoperative hemodynamic disturbances, and no major postoperative complications were reported, suggesting a favorable safety profile for the combination therapy.

Study Limitations: Generalizability may be constrained as the trial was conducted at a single center, and the absence of long-term follow-up data raises questions about the sustained effects of the hydromorphone-ropivacaine combination.

Future Research Directions: Further studies are recommended to assess long-term outcomes associated with hydromorphone in SAPB and to investigate optimal dosing strategies while potentially comparing SAPB with established analgesic methods such as thoracic epidural analgesia.

Reference –

Xuefeng Chen et al. (2025). The Impact Of Hydromorphone Combined With Ropivacaine In Serratus Anterior Plane Block On Postoperative Pain In Patients Undergoing Video-Assisted Thoracoscopic Pulmonary Lobectomy: A Randomized, Double-Blind Clinical Trial. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03101-2.

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A Gentle Approach: Study Evaluates Efficacy of Medical Management for Missed Miscarriage

Recent study evaluates the efficacy of mifepristone and misoprostol as a medical management option for missed miscarriage, aiming to identify significant risk factors affecting treatment success. Missed miscarriage, identified when a nonviable pregnancy is retained in the uterus, commonly leads to management via expectant, medical, or surgical means, with medical management increasingly favored for its safety and cost-effectiveness.

Research Methodology

The retrospective case-control study analyzed 163 patients diagnosed with missed miscarriage, employing logistic regression to isolate factors influencing treatment success. The primary outcome was the spontaneous passage of the gestational sac within 24 hours of administering misoprostol, emphasizing the efficiency of the medical regimen.

Key Findings

Findings indicate several demographic and clinical variables significantly correlate with medication management outcomes. High gravidity (more than three pregnancies) increased the likelihood of unsuccessful treatment by 3.67 times, while a history of parity and prior miscarriage escalated risks by 2.29 times and 2.09 times, respectively. Additionally, prior uterine surgery, particularly cesarean sections, was associated with a 2.94-fold increase in unsuccessful management. Importantly, the necessity for additional misoprostol doses did not improve success rates, suggesting that the administration dosage may not be the central determinant of efficacy.

Environmental Factors

Meteorological factors were also assessed, revealing that average visibility over four days was linked to treatment outcomes, stressing an intriguing interplay between environmental conditions and medical efficacy. Initial univariable regressions flagged visibility as statistically significant, which multivariable analysis later affirmed as independent of gestational age, reinforcing the need for personalized treatment considerations.

Discussion of Efficacy

Despite mifepristone and misoprostol’s reported efficacy, with previous literature indicating success rates of 83% to 93.3%, results found significant variability due to varying clinical factors. The study posits that not only previous obstetric history but also environmental exposure may influence uterine responsiveness, suggesting further exploration is warranted in broader populations.

Limitations and Future Research

Limitations include the retrospective nature of the study and the potential exclusion of other relevant factors like socioeconomic status and individual lifestyle variables that could confound results. Recommendations for future research emphasize the necessity of prospective multicenter trials with larger sample sizes to validate these findings, aiming toward enhancing clinical guidelines to optimize individualized management strategies for patients facing missed miscarriage.

Key Points

– -Efficacy of Medical Management-: The study assesses mifepristone and misoprostol as a medical management approach for missed miscarriage, favorably contrasted against expectant and surgical methods, emphasizing their safety profile and cost-effectiveness when managing nonviable pregnancies retained in the uterus.

– -Demographic and Clinical Correlates-: Logistic regression analysis on 163 diagnosed cases identified significant risk factors that negatively impacted treatment outcomes, including high gravidity (>3 pregnancies), history of parity, and prior miscarriage, increasing unsuccessful treatment probabilities by 3.67, 2.29, and 2.09 times, respectively. Additionally, prior uterine surgeries, notably cesarean sections, raised the odds of unsuccessful management by 2.94 times.

– -Efficacy of Misoprostol Dosage-: The requirement for additional doses of misoprostol was not associated with improved success rates, challenging the assumption that dosage quantity is the principal factor affecting the efficiency of the medical regimen for missed miscarriage.

– -Influence of Environmental Conditions-: Analysis of environmental factors, specifically average visibility over a four-day period, was shown to correlate with treatment outcomes, suggesting a previously unexamined interaction between meteorological conditions and uterine response to medical management.

– -Variability in Success Rates-: Despite documented success rates of mifepristone and misoprostol ranging from 83% to 93.3%, significant variability was observed based on the demographic and clinical characteristics of the patients, indicating that individualized treatment protocols may be necessary to improve efficacy.

– -Study Limitations and Research Directions-: The retrospective nature limits data interpretation and possible confounding effects of omitted variables such as socioeconomic status and lifestyle. Future research should focus on prospective multicenter trials with larger populations to further corroborate the findings and refine clinical guidelines for the management of missed miscarriage.

Reference –

Huiyuan Wang et al. (2025). Factors Related To Successful Medication Management With Mifepristone And Misoprostol In Missed Miscarriage: A Retrospective Case-Control Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07662-5.

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