Background: Evidence comparing endovascular therapy and open surgery for aorto-iliac occlusive disease remains limited, particularly for early complications, resource use, and sex-specific outcomes. Patients and methods: We conducted a retrospective nationwide cohort study using the 2023 German inpatient dataset. Adult hospitalisations with major endovascular or open aorto-iliac reconstructive procedures and arterial occlusive disease were included. Hospitalisations with aneurysm, dissection, or combined procedure codes were excluded. Outcomes included in-hospital mortality, myocardial infarction, ischaemic stroke, major adverse cardiovascular and cerebrovascular events (MACCE), complications, length of stay, and reimbursement. Adjusted estimates were obtained employing a doubly robust estimator using machine learning algorithms and were stratified by sex. Results: Among 2,710 hospitalisations, 1,923 (71.0%) underwent open surgery and 787 (29.0%) endovascular therapy; 41.3% involved women. Endovascular therapy was associated with lower adjusted risks of in-hospital mortality (RR .44, 95% CI .31-.64), MACCE (RR .47, 95% CI .34-.64), acute kidney injury (RR .38, 95% CI .29-.50), major bleeding (RR .36, 95% CI .25-.51), prolonged ventilation (RR .28, 95% CI .18-.43), and SAEs (RR .46, 95% CI .33-.65). Length of stay was shorter after endovascular therapy (-8.57 days, 95% CI -9.63 to -7.52), while reimbursement did not differ significantly. Sex-stratified estimates were more pronounced in men but exploratory without interaction testing. Conclusions: Endovascular therapy was associated with lower in-hospital morbidity and mortality and shorter hospital stay than open surgery, with similar reimbursement. Case-based data lacked longitudinal follow-up and detailed clinical, anatomical and treatment-selection information, limiting causal and patient-level interpretation.

Chronic limb-threatening ischemia (CLTI) carries 1-year mortality of 20% to 25%, comparable with many solid-organ malignancies. Technically successful revascularization, defined by anatomical patency, does not reliably deliver pain relief, restored function, or sustained quality of life. This narrative review synthesizes landmark randomized trials (BEST-CLI, BASIL-1, BASIL-2) and current European and United States guidelines, grading every claim with a scheme in which population indirectness downgrades design strength. We examine 4 domains of morbidity persisting after anatomically successful revascularization: mechanistically heterogeneous pain; functional and quality-of-life decline; psychological burden; and sustained health care use, including chronic opioid use (approximately 35%), unhealed wounds at 1 year (10%-32%), and unplanned 30-day readmission (approximately 25%). No patient-reported outcome measure has been validated specifically for CLTI or used as a co-primary trial endpoint. We propose an accountability gap: the under-measured transfer of unresolved morbidity from vascular services to primary care. We state it as a falsifiable prediction about the discrimination of patency rather than prevalence, with a pre-specified effect size, explicit treatment of death as a competing risk, and a core outcome battery justified against COSMIN criteria. Patient co-production is the indispensable next step.

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 p < 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.

Surgical indications for lumbar spine disorders should not be determined solely based on degenerative or stenotic magnetic resonance imaging findings. This article discusses how orthopedic spine surgeons evaluate lumbar pathology in collaboration with neurologists. The central issue is whether the patient's symptoms, neurological findings, and imaging abnormalities can be used to identify the responsible lesion that is likely to improve after surgery. Differential diagnoses, including cervical or thoracic myelopathy, peripheral neuropathy, motor neuron disease, vascular claudication, hip disease, tumors, and infection, must be considered, particularly in older patients with multiple coexisting disorders. The article also outlines orthopedic perspectives that influence surgical decision-making, including spinal instability, sagittal and coronal alignment, bone quality, frailty, sarcopenia, walking ability, and postoperative activities of daily living. The choice between decompression alone and decompression with fusion was reviewed together with perioperative management, rehabilitation, patient explanation, and shared decision-making. Complementary collaboration between orthopedic surgeons and neurologists may help clarify the responsible lesion, optimize referral timing, and avoid undertreatment and overtreatment.

Lower-limb numbness, pain, and weakness are common clinical complaints that require differentiation between cauda equina or radicular lesions associated with lumbar spinal disease and peripheral nerve disorders. Because degenerative findings on lumbar imaging are common, particularly among older adults, the responsible lesion should not be determined based on imaging findings alone. In this context, neurological examination contributes to anatomical localization and is central to the differential diagnosis. Particular emphasis is placed on interpreting muscle weakness and sensory disturbance according to myotomal, dermatomal, and peripheral nerve distributions. Other neurological findings, including gait disturbance, neurogenic claudication, bladder or bowel dysfunction, nerve stretch signs, and reflex changes, also provide important clues for localization. This review further addresses common diagnostic challenges encountered in daily practice, including differentiation of L5 radiculopathy from fibular neuropathy in patients with foot drop, distinction between cauda equina lesions and polyneuropathy, recognition of immune-mediated polyradiculoneuropathies, and identification of amyotrophic lateral sclerosis when it mimics lumbar spinal disease. Ancillary tests such as nerve conduction studies, needle electromyography, somatosensory evoked potentials, nerve ultrasound, and imaging should be interpreted in relation to the lesion localization suggested by neurological examination.

In patients presenting with numbness, sensory disturbances, or motor deficits in the upper extremities, it is important to differentiate between cervical spinal cord or nerve root disorders and peripheral neuropathies. This article discusses the key points for distinguishing C8 spinal cord segment and nerve root disorders from peripheral neuropathies, particularly ulnar neuropathy and posterior interosseous nerve palsy. A comprehensive evaluation of the patterns of muscle weakness, distribution of sensory disturbances, and electrophysiological findings is essential, with careful consideration also given to the coexistence of cervical spine lesions and peripheral neuropathies. Furthermore, when the preoperative diagnosis does not correspond with the postoperative course, inflammatory or neoplastic diseases of the spinal nerves and other conditions should also be considered in the differential diagnosis, and collaboration with a neurologist is recommended.

Accurate lesion localization is a fundamental component of neurological diagnosis. This review describes how neurological examination can be used to differentiate cervical spinal cord lesions, cervical radiculopathy, brachial plexopathy, and peripheral nerve disorders in patients presenting with upper-limb sensory and motor symptoms. Particular attention is given to the distribution of sensory impairment, tendon reflex abnormalities, and patterns of muscle weakness. The characteristic clinical features of cervical spondylotic myelopathy, cervical radiculopathy, brachial plexus disorders, and entrapment neuropathies are summarized, together with practical considerations for anatomical localization. Common clinical scenarios, including wrist drop, finger drop, dorsal interosseous muscle atrophy, and radial or ulnar-sided hand numbness, are discussed to illustrate the diagnostic approach. Neurological examination remains essential for lesion localization and should be integrated with electrophysiological and imaging studies to achieve an accurate diagnosis.

Enhanced Recovery After Surgery (ERAS), as the plan A and standard for perioperative management, has shifted the focus from routine nutritional support toward the early identification and targeted management of high-risk patients. The new ICD-11 code for undernutrition offers an opportunity to better identify and characterize surgical patients at nutritional risk, while also potentially improving clinical recognition, acceptance of nutritional risk as a relevant perioperative condition, and reimbursement for targeted nutritional interventions. Early preoperative interventions should be considered. While short-term nutritional conditioning over 10-14 days primarily aims to correct nutritional and metabolic deficits, multimodal prehabilitation ideally requires 3-6 weeks to achieve meaningful improvements in physical fitness, functional capacity, and physiological reserve, particularly in patients undergoing major surgery after neoadjuvant therapy. Perioperative targeted strategies include carbohydrate loading (CHO drinks), immunomodulation, omega-3-fatty acids, hydroxymethylbutyrate, and probiotics or synbiotics. While parenteral nutrition is generally not required in low-risk patients with an uncomplicated recovery, the indication for supplemental (peripheral) parenteral nutrition should not be missed in high-risk patients with inadequate oral or enteral intake. Structured postoperative, post-discharge nutritional monitoring and rehabilitation should be integrated more consistently, especially in patients with eventful and complicated clinical courses.