The cofactors potentially affecting exercise performance after COVID-19 are still incompletely investigated. The contribution of several clinical and demographic variables to the exercise capacity measured with the 6-min walk test was assessed in multivariable analyses that used the absolute distance walked in 6 min (6MWD) and an impaired performance (6MWD < 60% of the predicted value) as study outcomes. The variables considered were age, sex, preexisting comorbidities, COVID-19 severity, pandemic phase, treatments administered in acute phase, SARS-CoV-2 vaccination, reinfection, time from acute infection, and presence of 30 persisting symptoms. The mean 6MWD recorded among 686 patients at a mean interval of 184 days from COVID-19 was 474 m, with 8.3% of them presenting values below 60% of the predicted value. 6MWD was affected by sex, comorbidities, COVID-19 severity, and some persisting symptoms. The estimated effect sizes were -29.9 m for severe/critical acute disease, between -26 and -87 m for six comorbidities (atrial fibrillation, renal failure, chronic liver disease, chronic pulmonary disease, ischemic heart disease, diabetes) and between -21 and -99 m for four persisting symptoms (nausea/vomiting, paresthesia, depressed mood, dyspnea). The 6MWD increased by 2.6 m per month elapsed from acute infection. A 6MWD < 60% was associated with female sex, more intensive respiratory support, four comorbidities (atrial fibrillation, renal failure, chronic pulmonary disease and ischemic heart disease), and two persisting symptoms (nausea/vomiting and palpitations/tachycardia). Exercise performance after COVID-19 is affected by multiple factors, with estimated effect sizes that are clinically relevant. The results also suggest some spontaneous improvement over time.

Chemotherapy-induced nausea and vomiting (CINV) has been studied for decades, yet the overall scope and evolution of this literature have not been quantified. We conducted a cross-sectional survey of primary research articles on CINV published from database inception through January 2026, categorizing studies by chemotherapy emetogenicity. Nearly 3000 studies were identified, with publication output peaking in the 2010s and focusing predominantly on highly emetogenic regimens. These trends reflect historical clinical priorities and advances in antiemetic therapy.

Gastrointestinal polyps are associated with risks such as bleeding, intussusception, obstruction and malignancy, necessitating removal. Technological advancements in endoscopic and laparoscopic surgery have introduced minimally invasive options like laparoscopic intragastric surgery (LIGS), especially beneficial for polyps that cannot be resected endoscopically. This report presents a 37-year-old male patient with Peutz-Jeghers Syndrome who exhibited symptoms of nausea, vomiting and weight loss. Endoscopy and computed tomography imaging revealed obstructive polyps in the bulbus and gastric cardia. The patient underwent single-port LIGS with preoperative botulinum toxin injection to facilitate pyloric opening. This combined approach allowed effective lesion resection without requiring extensive gastric resection. Pathology confirmed a hamartomatous polyp in the bulbus and high-grade dysplasia with negative margin in the gastric cardia. LIGS, particularly with botulinum toxin assistance, appears to be a safe and effective method for excising intraluminal lesions in complex anatomical areas, such as the duodenal bulbus and cardia.

Trastuzumab deruxtecan is a life-saving but costly therapy for HER2-positive cancers. While dose rounding strategies have been proposed to reduce drug waste, their safety and cost-saving potential in real-world Chinese patients remain understudied. This study aimed to evaluate the cost savings of dose rounding for trastuzumab deruxtecan in China and compare the safety profiles of upward rounding, downward rounding, and no rounding groups. We conducted a retrospective real-world study of patients receiving trastuzumab deruxtecan between 2024 and 2025. Drug waste, cost savings, and dose deviations were calculated for each administration. Adverse events including nausea, vomiting, fatigue, and hematologic toxicities were compared across the three groups. Among 141 patients with 829 administrations, dose rounding down led to a cost saving of CNY 897, 840, while dose rounding up avoided 4, 368.3 mg of drug waste. Dose deviations ranged from 0.10% to 9.97%, well within the 10% acceptable limit. The incidence and severity of adverse events were comparable across groups, with no statistically significant differences observed. These findings indicate that dose rounding of trastuzumab deruxtecan to the nearest full vial, within a 10% deviation range, can significantly reduce drug waste and pharmacy costs without compromising safety. This strategy is both safe and feasible in Chinese patients and provides preliminary evidence for cautious implementation, pending validation in larger studies.

Cystic echinococcosis (CE) is a zoonotic infection caused by Echinococcus granulosus, primarily involving the liver and lungs. Cardiac involvement is rare (0.5%-2% of cases), and cerebral complications from cardiac CE are exceptionally uncommon but often fatal. A 19-year-old Afghan male with significant zoonotic exposures presented with progressive left flank pain, fever, nausea, and vomiting. Laboratory studies revealed elevated liver enzymes and thrombocytopenia. Thoracoabdominal computed tomography (CT) demonstrated a multiseptate hepatic hydatid cyst in segment III, and unexpectedly revealed a concomitant cardiac hydatid cyst in the right ventricle, which was further characterized by transthoracic echocardiography. The patient was scheduled for cardiac surgery and initiated on preoperative albendazole. However, hours before the procedure, he acutely developed right-sided hemiparesis and loss of consciousness. Emergent brain CT revealed an intracerebral hemorrhage (ICH) in the left middle cerebral artery (MCA) territory with intraventricular extension. Despite external ventricular drain placement, the patient died shortly thereafter. This case represents a rare fatal outcome of cardiac CE originating in the right ventricle, where cerebral embolization was the probable cause of the left MCA territory ICH. It underscores the critical need for high clinical suspicion of cardiac involvement in all CE patients and emphasizes the urgency of early surgical intervention to prevent catastrophic neurological sequelae.

Caecal bascule is the rarest form of caecal volvulus, representing 5%-20% of caecal volvulus cases and accounting for 0.2% of intestinal obstructions. Diagnosis can be delayed due to non-specific clinical and radiological features, increasing the risk of ischaemia or perforation. Herein, we report the case of a 70-year-old woman who presented with vague right iliac fossa (RIF) pain, nausea and bilious vomiting. Computed tomography (CT) of the abdomen and pelvis demonstrated a mesenteric 'whirl sign' concerning for a volvulus. Emergency laparoscopy demonstrated a distended caecum (C) folded anteriorly without torsion, consistent with caecal bascule. A right hemicolectomy with primary anastomosis was performed. The postoperative course was complicated by a small non-drainable collection, managed conservatively with antibiotics. Histopathology showed mild vascular congestion with normal architecture and no ischaemia, malignancy or inflammatory bowel disease. This case highlights the diagnostic challenge of caecal bascule and the importance of timely surgical intervention.

Orthopedic anesthesia necessitates the real-time integration of rapidly changing physiological states, specific interventions, and contextual narratives to avert hypotension, postoperative nausea and vomiting, and uncontrolled pain. We present Ortho PeriFT, a multimodal transformer that integrates perioperative prediction, therapeutic recommendations, and continuous monitoring with a calibrated uncertainty. The encoder was designed to align with clinical time scales by processing second-level waveform patches and minute-level numerical data, alongside medication and event tokens and extended clinical text, with optional prompts from preoperative imaging. Self-supervised pre-training on extensive clinical time series was followed by multitask fine-tuning for the primary endpoints. A constrained Decision Transformer suggests titrations of fluids, vasopressors, and anesthetic depth under guideline-aware action masks, with all outputs accompanied by conformal risk intervals to allow abstention when confidence is low. Across both internal and external cohorts, Ortho PeriFT enhanced discrimination and precision-recall for all primary outcomes compared to robust classical and neural baselines, reduced calibration error and negative log-likelihood, and maintained narrow uncertainty bands. Off-policy estimators indicate higher counterfactual utility than clinician behavior and behavior cloning while ensuring zero-guardrail violations. Streaming analyses demonstrated earlier warnings at matched false alarm rates, and performance generalized across orthopedic subtypes with stable calibration across demographic strata. Attribution maps and prototype trajectory retrieval offer case-based rationales that are aligned with clinical reasoning. These findings illustrate that a hierarchical, safety-aware, and interpretable transformer can provide accurate risk estimates, actionable therapeutic suggestions, and timely alerts for orthopedic anesthesia within a unified framework.

Median arcuate ligament syndrome (MALS) is a rare clinical condition caused by extrinsic compression of the celiac artery by the median arcuate ligament of the diaphragm. Clinically, patients typically present with postprandial epigastric pain, nausea, vomiting, and progressive weight loss. Diagnosis requires findings of celiac artery compression using appropriate imaging modalities. The primary goal of treatment is surgical release of the median arcuate ligament to relieve compression of the celiac artery. In this case report, we present the robotic surgical management of a patient with MALS.