Journal of International Medical Research最新文献

{"title":"Navigating lupus with ease: A patient-driven mobile application for improved self-management.","authors":"Khadijeh Moulaei, Reza Khajouei, Fatemeh Dinari, Leila Ahmadian","doi":"10.1177/03000605261495189","DOIUrl":"https://doi.org/10.1177/03000605261495189","url":null,"abstract":"<p><p>BackgroundLupus can affect various aspects of patients' lives, including family relationships, daily activities, work, and independence, because of inflammation and disease-related complications. Self-management applications are among the potential solutions for controlling and managing these complications. Therefore, this study aimed to design and evaluate a mobile-based application for self-management among patients with lupus.MethodsThis study was conducted in two phases. In the first phase, a systematic review was conducted to identify the information needs of patients and the required capabilities of the application. The identified information needs and capabilities were then confirmed by 12 patients with lupus and six rheumatologists. In the second phase, based on the information and capabilities confirmed in the previous phase, an application prototype was developed and evaluated. To evaluate the application, eight patients with lupus used the application for 1 week. SPSS version 23 was used to analyze the data obtained from both phases.ResultsAccording to the opinions of patients and physicians, 61 of 70 information items and capabilities met the predefined 75% inclusion threshold and were considered for application design, whereas nine items that scored below this threshold were excluded. The application included four domains: user profile, lifestyle, disease management and control, and application capabilities. Patients rated the usability of the application as good, with a mean score of 7.5 out of 9.ConclusionThe application developed in this study demonstrated good usability and has the potential to support self-management and self-care among patients with lupus. However, longer-term studies involving larger and more diverse samples are needed to assess sustained use and potential clinical impact.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261495189"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chromosomal aberrations associated with reproductive disorders and growth/developmental abnormalities: A single-center retrospective study from Wuzhou, Guangxi Zhuang Autonomous Region, China.","authors":"Shengjin Ming, Yao Huang, Ying Huang, Wenyue Wu, Jinping Zhong, Wenli Xu, Xiao Huang","doi":"10.1177/03000605261493752","DOIUrl":"https://doi.org/10.1177/03000605261493752","url":null,"abstract":"<p><p>ObjectiveTo characterize the spectrum, frequency, and age-related distribution of chromosomal aberrations in patients with reproductive disorders and growth/developmental abnormalities in the Wuzhou area of Guangxi, China, and to explore the association of these aberrations with sex hormone profiles.MethodsWe retrospectively performed peripheral blood G-banding karyotype analyses for 4377 patients referred to Wuzhou Gongren Hospital between January 2014 and December 2025. The patients were stratified into four indication groups: (a) adverse obstetric history (n = 1813); (b) male primary infertility (n = 1330); (c) female primary infertility (n = 853); and (d) growth/developmental abnormalities (n = 381). Sex hormone levels were compared between balanced structural rearrangement carriers, patients with sex chromosome aberrations, and age-matched normal karyotype controls.ResultsDetection rates differed markedly across indications. The rate was 24.7% (95% confidence interval: 20.6%-29.2%) for growth/developmental abnormalities, 3.8% (2.9%-4.9%) for male primary infertility, 2.2% (1.6%-3.0%) for adverse obstetric history, and 0.9% (0.5%-1.8%) for female primary infertility (overall: 4.4%, 192/4377). All aberrations in the adverse obstetric history group were balanced structural rearrangements (reciprocal translocations, 60.0%; Robertsonian translocations, 27.5%; and inversions, 12.5%). 47,XXY predominated in male infertility (60.0%) and 45,X in female infertility (50.0%), whereas trisomy 21 accounted for 72.3% of the aberrations in the growth/developmental group. Autosomal aneuploidies and partial deletions/duplications were mostly diagnosed in infancy and were associated with severe phenotypes, whereas sex chromosome aberrations were detected across all ages and exhibited milder phenotypes. Balanced structural rearrangement carriers had hormone profiles comparable with those of normal karyotype controls, whereas patients with sex chromosome aberrations had elevated follicle-stimulating hormone and luteinizing hormone levels and decreased estradiol levels, with additionally reduced testosterone levels in male participants (all <i>p</i> < 0.05).ConclusionsThe chromosomal aberration yield in the Wuzhou area is strongly indication-dependent-highest for growth/developmental abnormalities (trisomy 21) and male primary infertility (47,XXY), intermediate for adverse obstetric history (balanced structural rearrangement), and low for female primary infertility. These findings support indication-directed karyotype analysis for genetic counseling and birth defect prevention; in addition, patients with sex chromosome aberrations warrant endocrine evaluation and long-term follow-up.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261493752"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of alcohol abstinence on hepatic enzymes: A clinical analysis at the rehabilitation center of Kathmandu.","authors":"Sanjay Singh, Sachita Barma, Mukesh Kl Das, Gajendra Bahadur Bhuju","doi":"10.1177/03000605261490827","DOIUrl":"https://doi.org/10.1177/03000605261490827","url":null,"abstract":"<p><p>ObjectiveAlcoholic liver disease is a major cause of liver-related mortality, accounting for approximately half of cirrhosis-related deaths. This study aimed to evaluate the impact of alcohol abstinence on liver enzyme alterations.MethodsThis prospective cohort study was conducted over 8 months at Amrita Foundation, Kathmandu, and involved patients with alcohol dependence syndrome who had confirmed alcoholic liver disease. A structured questionnaire was used for data collection. Descriptive and inferential statistics were performed.ResultThe study included 96 patients with alcohol dependence syndrome, of whom 72 were diagnosed with alcoholic liver disease. Age was positively correlated with alcohol consumption and duration of alcohol consumption. After 1 month of abstinence, elevated liver enzyme levels began to normalize, with alkaline phosphatase decreasing from 161.69 ± 79.084 to 89.90 ± 51.109, alanine aminotransferase from 156.60 ± 75.59 to 55.20 ± 25.944, and aspartate aminotransferase from 159.50 ± 72.959 to 62.20 ± 30.77. Bilirubin levels also decreased from 1.6940 ± 0.59 to 1.33 ± 0.445 compared with baseline values, indicating an improvement in liver function. The findings showed significant reductions in liver enzyme levels after abstinence (p < 0.001). Correlation analysis demonstrated strong positive relationships (p < 0.001) between pre- and post-abstinence levels of liver enzymes and bilirubin, with alkaline phosphatase showing the highest correlation (r = 0.94), followed by bilirubin (r = 0.87), aspartate aminotransferase (r = 0.84), and alanine aminotransferase (r = 0.78).ConclusionAlcohol abstinence resulted in significant biochemical remission in patients with alcoholic liver disease, as evidenced by marked reductions in liver enzyme and bilirubin levels within 1 month. These findings underscore sustained abstinence as a cornerstone of effective management of alcoholic liver disease. They also highlight the potential for liver recovery, the impact of chronic alcohol consumption, and the importance of rehabilitation support.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261490827"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary mycotoxin levels in children with Crohn's disease: A pilot case-control study.","authors":"Kai Zheng, Ning Shen, Zhongqin Jin, Jie Zhang, Jian Huang, Bin Xue, Jie Wang","doi":"10.1177/03000605261492991","DOIUrl":"https://doi.org/10.1177/03000605261492991","url":null,"abstract":"<p><p>ObjectiveThis pilot case-control study aimed to preliminarily explore the potential association between urinary levels of zearalenone and the risk of Crohn's disease in a pediatric cohort.MethodsThis pilot case-control study was conducted in China. The participants included 32 pediatric patients with newly diagnosed or relapsed Crohn's disease (cases) and 30 healthy controls. Urinary concentrations of zearalenone were quantified using a validated high-performance liquid chromatography-tandem mass spectrometry method. Data were analyzed using the Mann-Whitney U test for group comparisons, and receiver operating characteristic analysis was performed to evaluate the preliminary discriminatory performance of zearalenone.ResultsUrinary zearalenone concentrations were significantly higher in children with Crohn's disease than in healthy controls (median 0.33 vs. 0.16 pg/mL, <i>p</i> < 0.001). Receiver operating characteristic analysis yielded an area under the curve of 0.92 (95% confidence interval: 0.85-1.00) for zearalenone, indicating good exploratory discriminatory ability.ConclusionsThese exploratory findings suggest a preliminary link between elevated urinary zearalenone levels and pediatric Crohn's disease risk, potentially associated with its estrogenic properties. Given the pilot nature and limited sample size of this study, further large-scale longitudinal research is warranted to validate these observations and clarify the underlying biological mechanisms.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261492991"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application value of the albumin-to-globulin ratio in patients with wasp stings: A retrospective cohort study.","authors":"Jinqiu Qin, Qiulin Li, Yuanyuan Zhu, Zongxian Li, Chaoyu Huang, Hongshuai Zheng, Faquan Lin","doi":"10.1177/03000605261494900","DOIUrl":"https://doi.org/10.1177/03000605261494900","url":null,"abstract":"<p><p>ObjectiveTo evaluate the clinical utility of the admission albumin-to-globulin ratio for assessing disease severity and predicting prognosis in patients with wasp stings.MethodsThis retrospective cohort study enrolled 161 hospitalized patients categorized into mild, moderate, and severe groups according to the 2018 Chinese Expert Consensus Criteria. Baseline characteristics, admission albumin-to-globulin ratio, and inflammatory markers were compared among the severity groups. Spearman correlation analysis was used to assess associations between the albumin-to-globulin ratio and clinical parameters. Multivariable logistic regression was performed to identify independent risk factors for poor prognosis, multiple organ dysfunction syndrome, and acute kidney injury. Receiver operating characteristic curve analysis was used to evaluate the predictive performance of admission albumin-to-globulin ratio and its coefficient of variation.ResultsAdmission albumin-to-globulin ratio was significantly lower in the severe group (p < 0.05) and negatively correlated with white blood cell count, C-reactive protein, procalcitonin, and serum amyloid A. Decreased albumin-to-globulin ratio and elevated coefficient of variation of the albumin-to-globulin ratio were independent risk factors for multiple organ dysfunction syndrome and acute kidney injury. Admission albumin-to-globulin ratio demonstrated strong diagnostic efficacy, with areas under the curve of 0.822 for multiple organ dysfunction syndrome and 0.860 for acute kidney injury. The combination of albumin-to-globulin ratio with coefficient of variation of the albumin-to-globulin ratio significantly improved the areas under the curve for multiple organ dysfunction syndrome prediction to 0.934 (95% confidence interval: 0.854-0.978), yielding 89.29% sensitivity and 82.00% specificity. Admission albumin-to-globulin ratio provides early risk stratification tool, whereas coefficient of variation of the albumin-to-globulin ratio reflects dynamic changes during hospitalization and provides complementary prognostic information. Furthermore, patients with an admission albumin-to-globulin ratio ≤1.1 exhibited significantly higher incidences of acute kidney injury, multiple organ dysfunction syndrome, hepatic dysfunction, and coagulopathy (p < 0.001).ConclusionsAdmission albumin-to-globulin ratio is a simple, effective biomarker for risk stratification in patients with wasp sting. Integrating static admission albumin-to-globulin ratio with dynamic coefficient of variation of the albumin-to-globulin ratio enhances predictive accuracy and may support incorporation of these measures into routine clinical protocols to facilitate early identification of high-risk individuals and guide intensive interventions.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494900"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot prospective cohort study: Changes in circulating T-lymphocyte subsets during steroid therapy in patients with nephrotic syndrome.","authors":"Yu Shan, Zhifen Xie","doi":"10.1177/03000605261493753","DOIUrl":"https://doi.org/10.1177/03000605261493753","url":null,"abstract":"<p><p>ObjectiveGlucocorticoids are used to treat nephrotic syndrome; however, some patients develop resistance. T-lymphocyte subsets are involved in immune regulation and may be associated with disease progression and treatment response. The current prospective pilot cohort study explored T-cell immune phenotypes associated with steroid responsiveness in patients with nephrotic syndrome.MethodsEleven patients newly diagnosed with nephrotic syndrome between 2023 and 2024, classified as steroid-sensitive or steroid-resistant based on treatment outcomes, and 14 healthy volunteers were enrolled. Peripheral blood samples were collected at diagnosis (baseline), at weeks 4 and 8 after hormone therapy, and during monthly follow-up visits. T-cell subsets and T-cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) expression were analyzed using flow cytometry. Differences were identified by performing variance analysis, and correlations were assessed by performing linear regression.ResultsCD3⁺ CD8⁺ T cells differed between steroid-resistant patients and both steroid-responsive patients and controls (<i>p</i> < 0.05). The proportion of CD3⁺ TIM-3⁺ T cells differed between controls and steroid-sensitive patients (<i>p</i> < 0.001). Steroid treatment was associated with an increase in CD3⁺ TIM-3⁺ T cells and a potential negative correlation with albumin levels in steroid-sensitive patients.ConclusionsT-cell immune phenotypes, particularly TIM-3-expressing T cells, may be associated with steroid responsiveness in nephrotic syndrome. The current findings provide preliminary evidence for potential laboratory markers related to immune regulation.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261493753"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between eating practices during hemodialysis and nutritional status, dialysis adequacy, intradialytic hypotension, and mental health: A cross-sectional study in Palestine.","authors":"Mimas Arman, Manal Badrasawi","doi":"10.1177/03000605261489327","DOIUrl":"10.1177/03000605261489327","url":null,"abstract":"<p><p>ObjectiveThe main objective of this study was to evaluate the association between eating practices and nutritional status, clinical outcome, intradialytic hypotension, adequate dialysis, and mental health among adults undergoing hemodialysis at An-Najah National University Hospital.MethodsThis study employed an observational and cross-sectional design. Data collection was conducted from July to October 2024. The study enrolled 155 adult patients undergoing hemodialysis at An-Najah University Hospital. Data on sociodemographic characteristics, medical history, dialysis-related information, nutritional status, dietary intake practices, and mental health were collected via face-to-face interviews. The patients' eating practices during dialysis, presence of symptoms, minimum mean arterial pressure, and dialysis adequacy were assessed for three sessions.ResultsThe study included 155 patients undergoing hemodialysis, of whom 66.5% were male and 79.4% reported eating during dialysis. Based on the self-reported data, eating during dialysis was not associated with nutritional status or mental health status. Similarly, observational data revealed no association between eating during dialysis and presence of symptoms, decrease in blood pressure, and adequacy of dialysis.ConclusionsBased on self-reported data, there was no association between eating habits during dialysis and nutrition or mental health status. Observational data additionally revealed no association between eating during dialysis and adequate dialysis, presence of symptoms, or decrease in blood pressure.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261489327"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of recovery profiles after anesthesia with remimazolam and flumazenil versus propofol for short-duration gynecological surgery: A prospective, randomized, single-blind trial.","authors":"Yoon Sook Lee, Youngsoo Park, Young Ha Park, Sunwoo Kim, Eunsu Choi","doi":"10.1177/03000605261495755","DOIUrl":"10.1177/03000605261495755","url":null,"abstract":"<p><p>ObjectiveThis study aimed to compare the recovery profiles after anesthesia with remimazolam reversed by flumazenil versus propofol among patients undergoing short-duration gynecological surgeries.MethodsIn this prospective, single-blind, randomized trial, 86 patients were assigned to either the propofol group (n = 43, received propofol and remifentanil) or the remimazolam group (n = 43, received remimazolam and remifentanil). At the end of the surgery, patients in the propofol group received 2 mg/kg sugammadex, whereas those in the remimazolam group received 2 mg/kg sugammadex combined with 200 μg flumazenil. Recovery was measured across immediate, intermediate, and long-term phases.ResultsEye-opening and extubation times were significantly shorter in the remimazolam group (<i>p</i> < .001). However, the the postanesthetic care unit stay times were significantly longer in this group due to institutional safety protocols (<i>p</i> < .001). No statistical differences were found in the Quality of Recovery-15 K scores or other long-term recovery profiles at 4 h or 1 day postoperatively.ConclusionsRemimazolam-flumazenil significantly improved immediate recovery; however, its effects on the broader recovery trajectory were not significantly different from those of propofol, the most commonly used drug. Although Quality of Recovery-15 K scores were numerically higher in the remimazolam group, the difference was not statistically significant.<b>Trial registration:</b> Clinical Research Information Service (CRIS), KCT0008314.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261495755"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of probiotic and synbiotic supplementation on fibrinogen and plasminogen activator inhibitor-1 concentrations: A Grading of Recommendations Assessment, Development and Evaluation-based systematic review and meta-analysis.","authors":"Omolbanin Sargazi Aval, Marzieh Feyzpour, Asma Rashki, Samira Sadat Ghalishourani, Kosar Shahnazi, Nashmil Omar Abdullah, Horieh Shojaan, Reza Hashemi, Mohammed M Hussien M Raouf, Masood Shekarchizadeh","doi":"10.1177/03000605261494342","DOIUrl":"10.1177/03000605261494342","url":null,"abstract":"<p><p>ObjectiveElevated fibrinogen and plasminogen activator inhibitor-1 concentrations are associated with impaired fibrinolysis and increased cardiovascular and thrombotic risk. Although probiotic and synbiotic supplementation may influence inflammatory and hemostatic pathways, their effects on these biomarkers remain uncertain. This systematic review and meta-analysis of randomized controlled trials evaluated the effects of probiotic and synbiotic supplementation on plasma concentrations of fibrinogen and plasminogen activator inhibitor-1.MethodsThis systematic review and meta-analysis included randomized controlled trials conducted in adults, irrespective of health status. PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through June 2025. Trials comparing oral probiotic or synbiotic supplementation with placebo or no intervention and reporting fibrinogen or plasminogen activator inhibitor-1 concentrations were included. Pooled estimates with 95% confidence intervals were calculated using the Hartung-Knapp-Sidik-Jonkman random-effects model. Heterogeneity was assessed using I², and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. The review was not prospectively registered; following completion of the review, it was retrospectively registered with the Open Science Framework on 5 September 2026 (Registration DOI: 10.17605/OSF.IO/R3Y82).ResultsFifteen randomized controlled trials involving 892 participants were included. Probiotic or synbiotic supplementation did not significantly reduce fibrinogen (mean difference = -0.15, 95% confidence interval: -0.48 to 0.18; <i>p</i> = 0.34) or plasminogen activator inhibitor-1 concentrations (mean difference = -0.47, 95% confidence interval: -1.58 to 0.65; <i>p</i> = 0.33). Subgroup analyses and meta-regression did not reveal significant effect modification. The certainty of the evidence was low because of inconsistency and imprecision.ConclusionWe found no significant reduction in fibrinogen or plasminogen activator inhibitor-1 concentrations with probiotic or synbiotic supplementation. Given the low certainty of evidence and heterogeneity across trials, further high-quality randomized controlled trials are needed to identify whether specific formulations or patient groups are associated with improvements in these hemostatic and fibrinolytic biomarkers.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494342"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragm-sparing regional anesthesia for arthroscopic shoulder surgery: From interscalene block to goal-directed analgesia: A narrative review.","authors":"Ali Ahiskalioglu, Sandeep Diwan, Ahmet Emre Paksoy, Ahmet Murat Yayik, Oğuz Gundoğdu, Mehmet Akif Yilmaz, Yunus Emre Karapinar, Serkan Tulgar, Alessandro De Cassai, Yavuz Gürkan","doi":"10.1177/03000605261492573","DOIUrl":"https://doi.org/10.1177/03000605261492573","url":null,"abstract":"<p><p>Arthroscopic shoulder surgery remains one of the most challenging areas of regional anesthesia. Unlike many other joints, the shoulder is supplied by a complex and overlapping sensory network, making it difficult to achieve consistent analgesia with selective nerve blockade. For decades, the interscalene brachial plexus block has been considered the benchmark technique because of its reliable and profound analgesic efficacy. However, its benefits come at the cost of frequent phrenic nerve blockade and hemidiaphragmatic dysfunction, a limitation that becomes increasingly important in an aging surgical population with reduced respiratory reserve. At the same time, perioperative goals have evolved. Modern arthroscopic shoulder surgery is no longer focused solely on pain relief; preservation of respiratory function, early mobilization, rapid recovery, and patient-centered outcomes have become equally important. These changing priorities have stimulated growing interest in diaphragm-sparing regional anesthesia techniques that seek to balance analgesic efficacy with physiological preservation. This narrative review explores the anatomical basis of arthroscopic shoulder analgesia, the strengths and limitations of conventional interscalene block, and the expanding body of evidence supporting diaphragm-sparing alternatives. Current literature suggests that techniques such as superior trunk block, costoclavicular block, combined suprascapular and axillary nerve blocks, erector spinae plane block, serratus posterior superior intercostal plane block, and other selective approaches may substantially reduce respiratory impairment while providing clinically meaningful analgesia. Although none has completely replaced the interscalene block, the direction of contemporary evidence increasingly favors individualized block selection based on patient characteristics, respiratory risk, and surgical requirements. Rather than replacing a single gold standard, diaphragm-sparing strategies are redefining shoulder regional anesthesia within a goal-directed and patient-centered framework.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261492573"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}