Citations

Abstract We report an eightfold increase in sulbactam-durlobactam MICs in a carbapenem-resistant Acinetobacter baumannii cerebrospinal fluid isolate recovered after 14 days of sulbactam-durlobactam plus meropenem therapy. Treatment-emergent mutations in the AdeFGH efflux system were identified, accompanied by a 166-fold increase in adeG expression. Efflux pump inhibition restored sulbactam-durlobactam susceptibility.

Abstract We describe a case of a child with macrolide-resistant Mycobacterium abscessus who initially had clinical improvement on a dual β-lactam regimen but continued to have positive cultures. Suitable phages active against the bacterial strain were identified, administered both systemically and directly to the ear, and were associated with microbiological remission.

Background: Heart transplantation (HT) remains the definitive therapy for end-stage heart failure, yet rejection and cardiac allograft vasculopathy (CAV) continue to limit long-term outcomes. Beyond donor-specific HLA antibodies, non-HLA antibodies, particularly anti-angiotensin II type 1 receptor antibodies (AT1R-Abs), have been implicated in allograft injury, but published findings are heterogeneous. Aim: The aim of this study is to systematically evaluate the evidence linking AT1R gene expression and anti-AT1R antibodies with key post-heart transplant outcomes. Methods: We conducted a systematic review in accordance with PRISMA guidelines. Scopus, PubMed, Web of Science, and the Cochrane Library were searched (December 2025) for cohort and case–control studies evaluating AT1R gene expression and/or AT1R-Ab status in HT recipients and their association with post-transplant outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the NIH Quality Assessment Tool. Results: Twelve studies encompassing 951 recipients met the inclusion criteria. Five studies evaluated AT1R mRNA expression, reporting variable patterns: several observed reduced AT1R/AT2R transcription after transplantation without clear clinical correlation, whereas others associated higher donor or recipient AT1R expression with transplant coronary artery disease and recurrent rejection. AT1R-Ab prevalence varied widely and appeared to increase after mechanical circulatory support, with substantial seroconversion reported during LVAD support in initially antibody-negative patients. Associations between AT1R-Ab and acute cellular rejection and antibody-mediated rejection were inconsistent across studies, and survival findings were inconclusive; however, some reports linked elevated AT1R-Abs to poorer long-term freedom from adverse events. Evidence regarding CAV was mixed, with signals of increased vasculopathy risk in some cohorts but not others. Conclusions: Current evidence suggests a potential role for AT1R expression and AT1R-Abs in cardiac allograft dysfunction, including rejection phenotypes and vasculopathy. Larger prospective studies with harmonized testing strategies are needed to define clinically meaningful AT1R-Ab cutoffs and clarify their utility in risk stratification and targeted therapeutic trials.

Extracorporeal magnetotransduction therapy (EMTT) is a high-energy electromagnetic modality that delivers field strengths of 80–150 mT, effective transduction power > 60 kT/s, and dual-frequency architecture with pulse repetition near 8 Hz and oscillations of 100–300 kHz. This prospective pilot study evaluated pain and functional outcomes in patients with symptomatic midfoot osteoarthritis (OA). Eight patients (13 feet; five bilateral and three unilateral cases) with radiographic Kellgren–Lawrence (KL) grade 3 or 4 midfoot OA received eight EMTT sessions over four weeks. Outcomes were measured at baseline, after the eighth treatment at four weeks, and at 3-month and 6-month follow-up using the 0–10 Visual Analog Scale (VAS) and Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL). VAS demonstrated a significant overall effect of time (F(3,36) = 3.93, p = 0.016), with mean scores decreasing from 4.15 ± 1.63 at baseline to 2.62 ± 1.98 at 3 months and 3.00 ± 2.08 at 6 months. Bonferroni-adjusted baseline-to-follow-up contrasts approached significance at 3 months (p = 0.067) and were not significant at 6 months (p = 0.150). FAAM-ADL improved significantly over time (F(3,30) = 13.76, p < 0.001), increasing from 61.7% ± 9.9% at baseline to 81.8% ± 11.1% at 6 months. No treatment-related adverse events were observed; one participant proceeded to surgery by 6 months and was classified as a treatment failure. These preliminary findings suggest that EMTT is safe and may provide clinically meaningful functional improvement in selected patients with midfoot OA; larger sham-controlled trials are needed.

Purpose: To describe the refractive results of cataract surgery in patients with high corneal astigmatism treated with implantation of custom-made toric intraocular lenses (IOLs). Methods: This retrospective cohort analysis of eyes implanted with high-cylinder (≥6.75 diopters [D]) custom-made toric IOLs was conducted at Rabin Medical Center, Petach Tikva, Israel. A control group of eyes implanted with standard toric IOLs (1.50 to 3.75 D) was also included. Postoperative IOL misalignment, uncorrected distance visual acuity (UDVA), residual refractive astigmatism (RA), and the prediction error (PE) of the toric IOL calculation using the Barrett Toric Calculator were assessed. Results: Twenty-two eyes of 22 patients were included. The mean ± standard deviation toric power was 9.67 ± 3.51 D (range: 6.75 to 19.00 D). Diagnoses included pellucid marginal degeneration (n = 7), keratoconus (n = 4), post-keratoplasty astigmatism (n = 3), and previous pterygium excision (n = 2). The mean postoperative UDVA was 0.28 ± 0.19 logarithm of the minimum angle of resolution (Snellen: 20/38). Mean absolute astigmatism decreased from 7.88 ± 3.15 D preoperatively (corneal) to 0.76 ± 0.87 D postoperatively (refractive) ( P < .001). One eye required redialing due to a 17° misalignment. Compared with the control group (41 eyes), the high-cylinder toric IOL group showed a slightly lower UDVA (20/30, P = .024) and a non-significant trend toward higher RA (0.58 ± 0.50, P = .930), as well as a significantly worse RA-PE, in both vector magnitude (1.47 vs. 0.62, P = .027) and vector dispersion (total bivariate variance 2.67 vs 0.40, px < 0.001 and py = 0.006). Conclusions: Customized high-cylinder toric IOLs significantly improve UDVA and reduce RA in eyes with extreme corneal astigmatism. Although slightly inferior to standard toric IOLs, they provide an effective treatment option for astigmatic correction in complex corneal pathologies with a central and relatively regular astigmatic component.

Abstract Anatomy is fundamental to clinical competence. However, reduced contact hours, limited cadaveric access and difficulties with technological integration raise concerns about students’ preparedness and development. The current study evaluated various practices, student perceptions, challenges, teaching quality and quantity of UK medicine anatomy education. A national cross-sectional survey was distributed to final-year medical students at 40 UK medical schools to assess teaching quality, student satisfaction, confidence and theimpact of emerging technologies and challenges associated with anatomy education. 628 students responded and 55.3% (n=347) preferred a curriculum integrating traditional teaching and emerging technologies,73.3% (n=460) were dissatisfied with teaching quantity and continuity, and 42.7% (n=268) were dissatisfied with teaching breadth and quality. Satisfaction was significantly higher for users of 3D imaging software (Users Mean=3.63 vs. Non-users=3.28;p&lt;0.001,rrb=0.172) and 3D printed simulation models (3.59 vs. 3.23;p&lt;0.001,rrb=0.181), despite familiarity among 32.3% (n=203) and 27.9% (n=175), respectively. 3D imaging software was most recognised (59.2%, n=372), followed by 3D printed simulation models (55.4%,n=348) and VR/AR (32.3%,n=203). Satisfaction was high for continuous teaching across ≥3 years (F(3,624)=24.91,p&lt;0.001) Kruskal-Wallis H test showed significant variation in perceived importance of anatomy across specialties (H(5)=75.99,p&lt;0.0001), with Surgery rating it highest (Median=5.0) and GP/Medicine lower (Median=4.0). Students are dissatisfied with the current curriculum content, structure and provision of anatomy teaching. Emerging technologies could enhance satisfaction, address limitations of cadaveric dissection and extend teaching beyond the classroom. Collaborative efforts among anatomists, clinicians and academics are essential in standardising clinically curricula and sound technological integration (VR/AR/3D models).

Objectives To explore the outcomes among patients treated with TAVI (transcatheter aortic valve implantation) in the COMPARE-TAVI 1 trial by age groups and sex. Design Cohort study. Setting Three Danish university hospitals. Participants Patients treated with TAVI in the COMPARE-TAVI 1 trial (N=1030), 60 (5.8%), 337 (32.7%), 592 (57.5%) and 41 (4.0%) were in the four age groups, < 70, 70–79, 80–89 and 90+ years while 414 (40.2%) and 616 (59.8%) were of female and male sex. Interventions Transfemoral TAVI with balloon-expandable valves (Sapien or Myval) performed between June 2020 and November 2023. Outcome measures Post hoc analyses of trial secondary outcomes that include end-point committee-adjudicated outcomes. Results In the four age groups, 1-year mortality rates were 8.3%, 5.6%, 5.6% and 7.3% while it was 5.8% in both sexes. Across the four age groups, 1-year stroke rates were 6.7%, 1.8%, 3.2% and 4.9%, and 5.1% among females and 4.7% among males. In the four age groups, 1-year new pacemaker rates were 7.5%, 15%, 19% and 13% while it was 15% among females and 18% among males. Females had smaller annuli than males and their gradients were higher and the effective orifice area lower after TAVI but their frequency of prosthesis-patient mismatch was similar at 1 year. Conclusion While comorbidity levels varied between groups, clinical outcomes were similar across age groups and between sexes. Trial registration number NCT04443023 .

BACKGROUND: Intraventricular hemorrhage and subarachnoid hemorrhage are associated with neuroinflammation and increased morbidity and mortality. Rapid clearance of blood from the cerebrospinal fluid space may mitigate neuroinflammatory cascades and improve clinical outcomes. This systematic review and meta-analysis aimed to compare the clinical effectiveness of active cerebrospinal fluid exchange, including neuroendoscopic lavage and IRRAflow systems, versus external ventricular drainage in patients with intraventricular hemorrhage or subarachnoid hemorrhage. METHODS: The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and thoroughly assessed databases, including PubMed, Embase, Scopus, Cochrane, and Web of Science, up to September 18, 2025. Statistical analysis, both fixed-effect and random-effect model analyses, was performed by the Comprehensive Meta-Analysis software. In addition, the Cochran Q test was conducted to determine the statistical heterogeneity. In terms of low heterogeneity, the fixed-effect model is reported. RESULTS: This review included 7 studies with a total sample size of 834. Our analysis showed that active cerebrospinal fluid exchange was associated with significantly higher hematoma clearance (odds ratio, 2.72 [95% CI, 1.22–6.08]; P =0.015), better functional outcomes (odds ratio, 1.66 [95% CI, 1.12–2.48]; P =0.012), lower shunt dependency (odds ratio, 0.22 [95% CI, 0.10–0.50]; P <0.001), and reduced infection rates (odds ratio, 0.22 [95% CI, 0.12–0.42]; P <0.001). Subgroup analysis showed that neuroendoscopic lavage was most effective for hematoma clearance, while IRRAflow reduced infection rates. Also, younger patients had better neurological recovery. CONCLUSIONS: Active cerebrospinal fluid exchange techniques demonstrated superior outcomes over external ventricular drainage in managing intraventricular hemorrhage and subarachnoid hemorrhage, particularly in clot resolution and neurological recovery. Large-scale trials are warranted.