Rad51 is a conserved eukaryotic protein that mediates the homologous recombination repair of DNA double-strand breaks that occur during mitosis and meiosis. In addition, Rad51 promotes mitochondrial DNA synthesis when replication stress is increased. Rad51 also regulates cell cycle progression by preserving the G2/M transition in embryonic stem cells. In this study, we report a novel function of Rad51 in regulating mitochondrial activity during in vitro maturation of mouse oocytes. Suppression of Rad51 by injection of Rad51 dsRNA into germinal vesicle-stage oocytes resulted in arrest of meiosis in metaphase I. Rad51-depleted oocytes showed chromosome misalignment and failures in spindle aggregation, affecting the completion of cytokinesis. We found that Rad51 depletion was accompanied by decreased ATP production and mitochondrial membrane potential and increased DNA degradation. We further demonstrated that the mitochondrial defect activated autophagy in Rad51-depleted oocytes. Taken together, we concluded that Rad51 functions to safeguard mitochondrial integrity during the meiotic maturation of oocytes.

Background: Endotracheal tube (ETT) with a tapered-shaped cuff had an improved sealing effect when compared to ETTs with a conventional cylindrical-shaped cuff. Positional change and neck movement typically displace an ETT and change the intracuff pressure. The aim of the current study was to compare the ETT cuff pressure in the TaperGuard ETT vs the conventional ETT after a change from the supine, neutral position to the extension of the neck and semi-Fowler position for thyroid surgery. Methods: This prospective, randomized clinical trial included 50 patients undergoing thyroidectomy. Patients were randomly allocated into one of the 2 groups: tracheal intubation with the TaperGuard ETT or with a conventional ETT. The ETT cuff was inflated with air and the ETT cuff pressure was set initially at 20 cmH₂O using a calibrated cuff manometer. ETT cuff pressure and distance from carina to ETT tip were measured at supine and semi-Fowler positions with neck extension. Results: After the position change, the ETT tip migrated cephalad and cuff pressure increased in the majority of cases. ETT cuff pressure was significantly higher in the TaperGuard group than the conventional group (28.0 ± 6.6 cmH₂O and 22.8 ± 4.5 cmH₂O, respectively, P = .001). The degree of cephalad displacement of the ETT tip was comparable between the 2 groups (19.4 ± 6.31 mm in TaperGuard group and 21.9 ± 6.9 mm in conventional group, P = .12). Conclusions: After the position change from supine to hyperextension of the neck, the ETT cuff pressure was higher in the TaperGuard ETT than in the conventional ETT, although the extent of displacement of the ETT was comparable between the 2 groups.

Background Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial. Objective We explored the therapeutic effects of radiofrequency on FJS using a network meta-analysis (NMA). Evidence review A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials (RCTs) that compared radiofrequency with other treatments (sham procedures, facet joint corticosteroid injection, and conservative treatment) for FJS. We searched PubMed, Embase, Web of Science, the Cochrane Database, and handsearching. The primary outcomes were pain score and Oswestry Disability Index (ODI). Statistical analysis included conventional pairwise meta-analysis and NMA using the frequentist method. Findings The treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. The search yielded 25 RCTs (1969 patients) and a mixed quality regarding the risk of bias, with most studies exhibiting a low risk of bias for most domains. Endoscopic neurotomy consistently ranked highest in terms of pain reduction and ODI score improvement at 1, 3, 6, and 12 months. At 1 and 6 months, endoscopic neurotomy had the highest SUCRA value for pain reduction (0.833 and 0.860, respectively), followed by medial branch thermal radiofrequency. Conclusions This NMA demonstrates that endoscopic neurotomy is the most effective treatment for lumbar FJS, providing superior and sustained pain relief and functional improvement compared with other treatments. Further, high-quality RCTs are needed to confirm these findings and address the existing limitations. PROSPERO registration number CRD42024524657.

Background: Despite laparoscopic cholecystectomy (LC) is a commonly performed operation under ambulatory setting, significant postoperative pain is still a major concern. The ultrasound-guided subcostal approach of transversus abdominis plane (sTAP) blocks and wound infiltration (WI) are both widely practiced techniques to reduce postoperative pain in patients undergoing LC. Although these methods have been shown to relieve postoperative pain effectively, the relative analgesic efficacy between ultrasound-guided sTAP blocks and WI is not well known. Methods: We searched PubMed, EMBASE, and CENTRAL to identify all randomized controlled trials (RCTs) comparing ultrasound-guided sTAP block versus WI for postoperative pain control in adult patients undergone LC. The search was performed until May 2023. Primary outcome was defined as 24-hour cumulative opioid consumption. Secondary outcomes were postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV). Results: Finally, 6 RCTs were included, and data from 314 participants were retrieved. Postoperative 24-hour opioid consumption was significantly lower in ultrasound-guided sTAP group than in the WI group with a mean difference of −6.67 (95% confidence interval: −9.39 to − 3.95). The ultrasound-guided sTAP group also showed significantly lower pain scores. Incidence of PONV did not significantly differ between the 2 groups. Conclusions: We conclude that there is low to moderate evidence to advocate that ultrasound-guided sTAP block has better analgesic effects than WI in patients undergoing LC. Further trials are needed with robust methodology and clearly defined outcomes.

Background Lumbar radicular pain (LRP) and/or lower back pain is a challenging condition, particularly in cases refractory to conservative treatments like epidural steroid injections (ESI). Pulsed radiofrequency (PRF) to the dorsal root ganglion and epidural neuroplasty techniques are emerging as alternative interventional treatments. However, there are no direct comparison studies between PRF and epidural neuroplasty, leading to uncertainty in optimal treatment selection. Objective This network meta-analysis (NMA) aims to indirectly compare the efficacy of PRF and epidural neuroplasty techniques in managing LRP. Evidence review We conducted a systematic review and NMA of randomized controlled trials (RCTs) comparing PRF, epidural neuroplasty, and conservative treatments, including ESI and sham procedures. Data sources included PubMed, Cochrane Central, Embase, and Web of Science up to December 31, 2024. Inclusion criteria comprised RCTs evaluating adult patients with lumbar radicular pain from disc herniation, spinal stenosis, or failed back surgery syndrome. Two reviewers independently extracted data on study design, interventions, outcomes, and risk of bias. The primary outcome was pain reduction at 1, 3, 6, and 12 months post-treatment. The secondary outcome was disability reduction, measured by the Oswestry Disability Index (ODI). A frequentist random-effects model was used for data synthesis, and the certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Prediction intervals were not calculated due to data limitations, which is acknowledged as a limitation. Findings 14 RCTs comprising 1229 patients were included. At 1 month, there was no significant difference between PRF and epidural neuroplasty. At 3 months, epidural neuroplasty showed significant advantages over PRF (mean difference: −1.47, 95% CI −2.73 to −0.46); however, the certainty of evidence for this comparison was rated low. Similar trends were observed at 6 and 12 months, but the confidence in these estimates remained low to very low. For ODI, no significant differences were found at time points, and the certainty of evidence was moderate to very low across comparisons. Conclusion PRF and epidural neuroplasty may offer comparable long-term pain and disability outcomes for patients with lumbar radicular pain, but the overall certainty of evidence was low to very low, limiting confident clinical recommendations. These findings highlight the need for high-quality, head-to-head trials to better inform interventional treatment strategies for LRP.

Rationale: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management. Patient concerns: A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%. Diagnosis: Endotracheal tube was directed toward the tracheal wall, causing airway obstruction. Interventions: THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation. Outcomes: The patient’s oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9. Lessons: THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.