Removal of desflurane vaporisers and staff training significantly reduces emissions of anaesthesia department: Study

Recent study focuses on the impact of reducing desflurane use in anaesthetic clinics to lower greenhouse gas emissions. By implementing interventions like dismounting desflurane vaporisers and educating staff members, the study aimed to assess the effectiveness of reducing emissions without restricting desflurane use. Conducted in a German university hospital over a 12-month period, the study found a significant reduction of 86% in hypnotic-related emissions per anaesthetic procedure compared to the year before interventions. Interestingly, there was already a 52.1% reduction in emissions in the year preceding the study. The study highlighted the importance of addressing the environmental impact of volatile anaesthetics like desflurane, which can contribute significantly to greenhouse gas emissions in healthcare settings.

Success of Emission Reduction

The findings indicated that removing desflurane vaporisers and providing staff education resulted in substantial emission reduction without compromising the quality of care. The study also observed a decrease in hypnotic-related costs by €14,549, with no significant changes in the use of sevoflurane or propofol. Moreover, the study emphasized the potential for rapid and substantial emission reductions through proactive measures in anaesthesiology departments. Notably, the elimination of desflurane usage led to a remarkable decrease in greenhouse gas emissions, highlighting the significance of addressing environmental concerns within healthcare systems.

Pharmacological Considerations and Economic Benefits

Furthermore, the study discussed the pharmacological differences between desflurane and sevoflurane, underscoring the need to consider alternatives that offer similar efficacy. The authors highlighted the economic benefits of reducing volatile anaesthetics consumption and emphasized the importance of timely implementation of strategies to mitigate greenhouse gas emissions. The study also addressed the limitations, such as the lack of a randomized control group and the influence of external factors like the COVID-19 pandemic on healthcare routines.

Conclusion and Implications

In conclusion, the study demonstrated that by implementing simple interventions like removing desflurane vaporisers and raising awareness among staff members, significant reductions in greenhouse gas emissions can be achieved in anaesthesia departments. The results underscore the importance of proactive measures to address environmental concerns and drive sustainable practices in healthcare settings, ultimately contributing to a greener and more cost-effective healthcare system.

Key Points

– The study aimed to reduce greenhouse gas emissions in anaesthetic clinics by implementing interventions like removing desflurane vaporisers and educating staff members.

– A significant reduction of 86% in hypnotic-related emissions per anaesthetic procedure was observed after implementing the interventions, showcasing the effectiveness of the approach.

– There was a substantial decrease in hypnotic-related costs by €14,549 without compromising the quality of care, demonstrating the economic benefits of emission reduction efforts.

– The study emphasized the importance of addressing the environmental impact of volatile anaesthetics like desflurane, which have a notable contribution to greenhouse gas emissions in healthcare settings. – Removal of desflurane vaporisers led to a remarkable decrease in greenhouse gas emissions, reinforcing the significance of proactive measures in anaesthesiology departments for emission reduction.

– The findings highlighted the need to consider alternatives with similar efficacy to desflurane, the economic benefits of reducing volatile anaesthetics usage, and the importance of timely implementation of strategies to mitigate greenhouse gas emissions in healthcare settings.

Reference –

Lehmann, F., Mader, J., Koch, C. et al. Minimising the usage of desflurane only by education and removal of the vaporisers – a before-and-after-trial. BMC Anesthesiol 25, 108 (2025). https://doi.org/10.1186/s12871-025-02982-7

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Diabetes Patients with Kidney Disease Face Higher Psoriasis Risk, Study Finds

South Korea: A Korean population-based study has revealed a significant association between chronic renal disease and an increased risk of psoriasis in diabetes patients. The findings showed that diabetic patients with chronic kidney disease (CKD) are at an increased risk of developing psoriasis.

“Among 840,000 participants, those with an eGFR below 30 faced a 17% higher risk, while severe proteinuria heightened the likelihood by up to 50%. These findings highlight the potential of eGFR and proteinuria as predictive markers, emphasizing the importance of early screening and proactive management,” the researchers reported in the Indian Journal of Dermatology, Venereology, and Leprology.

Diabetes mellitus (DM) is known to be associated with various complications, including kidney disease and inflammatory skin disorders such as psoriasis. Multiple studies have established a positive correlation between psoriasis and type 2 diabetes mellitus. Recognizing the psoriasis risk in diabetic patients is crucial, as it enables early intervention and provides valuable insights into the shared underlying mechanisms of both conditions.

Against the above background, Seung Ah Yoo, Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea, and colleagues examined psoriasis risk in diabetic patients based on estimated glomerular filtration rate (eGFR) and proteinuria levels using population-based data from Korea.

For this purpose, the researchers conducted a retrospective cohort study using nationwide data through exploratory data analysis. A total of 927,234 diabetic patients were included, excluding those under 20 years of age, individuals with pre-existing psoriasis or psoriasis diagnosed within one year, and cases with missing data. The primary outcome was the development of psoriasis, monitored over a follow-up period of 7.83 ± 1.68 years.

The study led to the following findings:

  • Among the 840,395 participants, 28,010 (3.33%) developed psoriasis.
  • Diabetic patients with severely reduced kidney function (eGFR < 30) had a 17.3% higher risk of psoriasis compared to those with normal kidney function (eGFR 60–90).
  • The presence of proteinuria further increased the risk of psoriasis, with higher proteinuria levels linked to greater risk.
  • Patients with moderate proteinuria (2+) had a 16.4% higher risk, while those with severe proteinuria (3+ and 4+) had a 43.3% and 50.8% higher risk, respectively, compared to those without proteinuria.

The researchers highlight that declining eGFR and worsening proteinuria significantly increase the risk of psoriasis in diabetic patients, emphasizing the need for early detection and intervention. Since psoriasis management becomes more challenging in individuals with impaired kidney function due to limitations in systemic immunosuppressive treatments, proactive monitoring of renal health is crucial. Additionally, CKD elevates mortality risk in psoriasis patients, further underscoring the importance of preventive strategies.

“While the study provides valuable insights, it does not assess psoriasis severity or consider the impact of oral hypoglycemic agents. Nonetheless, the findings support the role of eGFR and proteinuria as key predictive markers for targeted intervention,” the researchers wrote.

Reference:

Yoo SA, Sayo MIA, Lee JH. Association between chronic renal disease and psoriasis risk in diabetes patients: A Korean population-based study. Indian J Dermatol Venereol Leprol. 2025;91:152-7. doi: 10.25259/IJDVL_669_2023

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Recurrent Intracerebral Hemorrhage Often Strikes Close to Initial Site, Study Finds

Switzerland: A recent study published in JAMA Neurology has highlighted key factors influencing the recurrence of nontraumatic intracerebral hemorrhage (ICH), focusing on location and timing. The study revealed that approximately 46% of recurrent cases occurred in regions adjacent to the initial bleed. The average time to recurrence was 1.25 years for adjacent hemorrhages, notably shorter than the 2.21 years observed for remote recurrences.

“The findings also indicated that lobar ICH and cerebral amyloid angiopathy significantly increased the likelihood of adjacent recurrence, nearly doubling the risk. In contrast, cerebellar ICH was associated with a lower risk of recurrence. These results emphasize the influence of localized vasculopathic changes in the recurrence of ICH,” the researchers reported.

The researchers note that intracerebral hemorrhage, a severe type of stroke, often leads to long-term neurological impairments and increased mortality. While recurrence is a well-recognized challenge, understanding whether subsequent hemorrhages occur in the same or nearby locations remains crucial for clinical decision-making. Considering this, Martina B. Goeldlin, Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland, and colleagues aimed to evaluate the timing and location of recurrent ICH events about the initial ICH, distinguishing between adjacent ICH (adjICH) and remote ICH (remICH).

For this purpose, the researchers conducted a pooled analysis of individual cohort studies from 2002 to 2021, focusing on hospital-based European cohorts. The study included patients who had experienced at least two clinically distinguishable small vessel disease–related intracerebral hemorrhage (ICH) events. Data analysis was carried out from December 2023 to December 2024.

Researchers examined ICH location and underlying small vessel disease type, with adjacent ICH (adjICH) as the primary outcome and time to recurrence as the secondary outcome. Multivariable regression analyses were performed, adjusting for factors such as ICH location, cerebral amyloid angiopathy, hypertension, and antihypertensive treatment.

The key findings of the study were as follows:

  • The study included 733 patients with a median age of 72.4 years, of whom 47.2% were female.
  • 1,616 ICH events were recorded, including 733 initial (index) and 883 recurrent events, with patients experiencing up to six recurrences.
  • Over a median follow-up of 2.53 years, 46.4% of patients had adjacent ICH (adjICH), while 53.6% had remote ICH (remICH).
  • Among recurrent cases, 476 were adjICH, and 407 were remICH.
  • Lobar index ICH (aOR 2.08) and cerebral amyloid angiopathy (aOR 2.21) were linked to a higher risk of adjICH.
  • Cerebellar index ICH was associated with lower odds of adjICH (aOR 0.25).
  • The median time to recurrence was 1.25 years for adjICH and 2.21 years for remICH.
  • Previous lobar or convexity subarachnoid hemorrhage, adjICH, and a higher number of prior ICH events were independently linked to a shorter time to recurrence.

The researchers found that early recurrence and characteristics of cerebral amyloid angiopathy were strongly associated with adjacent ICH. Their findings indicate that regional, tissue-based factors may contribute to recurrence, with spatial and temporal clustering suggesting localized vulnerabilities.

“By identifying and targeting these vasculopathic changes, our study highlights potential novel treatment approaches to reduce the risk of recurrent ICH,” they concluded.

Reference:

Goeldlin MB, Fandler-Höfler S, Pezzini A, et al. Location and Timing of Recurrent, Nontraumatic Intracerebral Hemorrhage. JAMA Neurol. Published online March 03, 2025. doi:10.1001/jamaneurol.2025.0026

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Thrombocytopenia Linked to Worse Outcomes in Pneumonia, COPD, and Asthma: Study

A new study published in Cureus has identified that patients with pneumonia (PNA), asthma, and chronic obstructive pulmonary disease (COPD) who also have thrombocytopenia have much poorer in-hospital outcomes, such as increased mortality, increased hospital stays, and enhanced resource utilization. Thrombocytopenia, a condition of low platelet counts, is frequently seen in hospital patients, but its role in hospitalized patients for respiratory diseases has not been thoroughly investigated. This study was conducted by Christian S. and colleagues.

Data from the National Inpatient Sample Database were used from the years 2016 to 2020. Adult patients hospitalized with a principal diagnosis of PNA, COPD, or asthma were enrolled, and secondary diagnosis of thrombocytopenia was ascertained through ICD-10-CM codes. The main outcome measured was all-cause mortality, whereas secondary outcomes were length of stay, resource utilization, and hospital intubation. Statistical analysis was conducted with STATA v.13 using multivariate adjustment for variables such as age, gender, race, Charlson comorbidity index, location of the hospital, size, region, teaching status, and insurance status. Statistical significance was established at p<0.05.

Key Findings

  • 2,993,792 patients were admitted with PNA, and 148,260 (4.95%) of them had thrombocytopenia.

  • Of 2,637,483 admissions for COPD, 77,160 (2.92%) had thrombocytopenia.

  • Of 491,990 asthma admissions, 6,300 (1.28%) had thrombocytopenia.

Thrombocytopenia was strongly linked with increased in-hospital mortality in all three conditions:

  • PNA: Odds Ratio (OR) 2.31, p<0.001

  • COPD: OR 2.99, p<0.001

  • Asthma: OR 7.26, p<0.001

  • The patients with asthma and thrombocytopenia had 626% greater in-hospital mortality than the patients without thrombocytopenia.

  • Hospital stay was longer in the patients with thrombocytopenia in all conditions.

  • Resource use was much greater in the affected patients.

  • Intubation rates were higher in thrombocytopenic patients.

Researchers concluded that PNA, COPD, and asthma patients with thrombocytopenia have significantly poorer hospital outcomes, such as increased mortality, increased length of stay, greater resource use, and increased rates of intubation. The results highlight the necessity for additional studies to see if the resolution of thrombocytopenia can abate these risks and enhance patient outcomes overall.

Reference:

Siochi, C., Durodola, B., Ali, F., Patel, V. K., Nwachukwu, C., Lerman, B., Canuto Miller, A., & Jesmajian, S. (2025). Impact of thrombocytopenia on outcomes in hospitalized patients with pneumonia, chronic obstructive pulmonary disease, and asthma: A nationwide study (2016–2020). Cureus. https://doi.org/10.7759/cureus.80037

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Tranexamic Acid in Trauma: Case of a Young Woman Highlights Risk of Acute Renal Cortical Necrosis

France: A recent case published in BMC Nephrology highlights the possible role of tranexamic acid (TXA) in precipitating acute bilateral renal cortical necrosis (RCN) in a young trauma patient, raising concerns about its administration, especially in the presence of additional thrombotic risk factors.

The researchers note that TXA is used widely as an antifibrinolytic agent in managing postpartum hemorrhage and severe traumatic bleeding. However, its potential association with renal cortical necrosis remains unclear, with only a few reported cases in non-obstetric settings. Previous reports on TXA-induced RCN suggest a rapid onset of acute kidney injury (AKI), with most cases requiring hemodialysis. The recovery of renal function varies, with some patients remaining dialysis-dependent.

Manal Mazloum, University of Montpellier, Montpellier, France, and colleagues describe the case of a 24-year-old woman with no prior medical history who was admitted to intensive care following a high-energy car accident. Despite stable hemodynamics and the absence of active arterial hemorrhage, she received an initial 1 g dose of TXA along with supportive therapy. Shortly after administration, her blood pressure dropped, necessitating norepinephrine support, which was quickly tapered. Laboratory investigations ruled out disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA), but 48 hours later, she developed AKI with anuria and rising serum creatinine levels, requiring hemodialysis.

A contrast-enhanced CT scan revealed diffuse cortical enhancement defects in both kidneys, confirming the diagnosis of acute bilateral RCN. According to the authors, some cortical areas remained perfused, particularly in the subcapsular and juxtamedullary regions. Over time, her renal function partially recovered, and she was weaned off dialysis after two months. However, at one-year follow-up, her estimated glomerular filtration rate (eGFR) remained at 40 ml/min/1.73 m².

“The involvement of TXA in RCN development remains a subject of debate, particularly in trauma patients with concurrent bleeding. While TXA has been shown to reduce mortality in trauma patients, its prothrombotic effects cannot be ignored,” the researchers wrote. “In this case, several factors point toward TXA as a potential culprit, given the relatively mild bleeding, stable hemodynamics, and the exclusion of other thrombotic conditions. Additionally, the patient was on hormonal contraception, which may have contributed to the thrombotic event.”

“This case highlights the importance of considering TXA’s potential risks, particularly in patients with additional thrombotic risk factors. It also underscores the predictive value of kidney imaging in assessing RCN severity and guiding prognosis. To mitigate the risk of severe renal complications, further research is needed to establish clear guidelines for TXA use in non-obstetric bleeding scenarios,” they concluded.

Reference:

Berri, J., Quintrec Donnette, M., Millet, I. et al. Tranexamic acid-induced acute bilateral renal cortical necrosis in a young trauma patient: a case report and literature review. BMC Nephrol 26, 95 (2025). https://doi.org/10.1186/s12882-025-03982-y

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Music-based therapy may improve depressive symptoms in people with dementia, suggests study

A new Cochrane review has found evidence that music-based therapy may benefit people living with dementia, particularly by improving symptoms of depression.

Dementia is a collective term for progressive degenerative brain syndromes that affect memory, thinking, behaviour and emotion. Alzheimer’s Disease International reported that there were 55 million people with dementia worldwide in 2019, a figure predicted to increase to 139 million by 2050. While some medicines are available, the therapeutic use of music is considered a relatively simple and inexpensive approach that remains accessible even in the later stages of dementia.

The research team from several institutions in the Netherlands examined evidence from 30 studies involving 1,720 people. The studies investigated the effects of music-based therapeutic interventions on emotional well-being including quality of life, mood disturbance, behavioural problems, social behaviour, and cognition. Most participants were in care homes, with interventions delivered either individually or in group settings.

The trials were primarily conducted in high-income countries, including Australia, Taiwan, the US, and various European countries. Almost all the therapies included active elements (such as playing instruments), often combined with receptive elements (such as listening to live music provided by a therapist).

“This review increases our understanding of the effects of music therapy and strengthens the case for incorporating music in dementia care, particularly in care home settings,” says lead author Jenny van der Steen from Leiden University Medical Center and Radboudumc Alzheimer Center. “Music therapy offers benefits beyond those of other group activities, helping to support mood and behaviour in a way that is engaging and accessible, even in later stages of dementia. Care home managers should consider integrating structured musical sessions as part of a person-centred approach to dementia care.”

The findings suggest that music-based therapy probably improves depressive symptoms and may improve overall behavioural problems by the end of treatment. Music therapy is unlikely to significantly impact agitation, aggression, emotional well-being, or cognition but, when compared to other interventions, there is some evidence that it may improve social behaviour and could decrease anxiety.

Long-term effects, beyond four weeks after treatment, may be smaller but remain uncertain due to the limited number of trials monitoring effects after treatment ends.

The review also highlights the growing recognition of non-pharmacological interventions in dementia care.

“Music therapy is a drug-free way of helping people feel less sad and less anxious,” says co-author Annemieke Vink from ArtEZ University of the Arts who has first-hand experience delivering music therapy to people with dementia. “We hope that the higher quality of recent studies and increasing evidence-base will result in more attention being given to music therapy and other non-pharmacological approaches.”

She continues, “Looking at the effect sizes, music therapy is a reasonable alternative to pharmacological approaches and is much more person-centred.”

The review underscores the need for further research into the long-term effects of music-based therapy particularly in community settings. Much of the existing evidence comes from care homes, so expanding studies to community-based environments could provide valuable insights into how music therapy can be integrated into everyday life for people living with dementia.

Reference:

Music-based therapy may improve depressive symptoms in people with dementia, Cochrane Database of Systematic Reviews (2025). DOI: 10.1002/14651858.CD003477.

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Add on Calcium Cyclotriphosphate to Hydrogen Peroxide Bleaching Gels May Minimize Enamel Damage: Study Finds

Brazil: Researchers have found in a new study that the addition of calcium-substituted sodium trimetaphosphate (CaNaTMP) to 17.5% and 35% hydrogen peroxide (HP) bleaching gels improves safety and biocompatibility by minimizing enamel damage. The findings were published online in the Journal of Dentistry. 

Hydrogen peroxide is widely used in dental bleaching treatments but is often associated with adverse effects such as mineral loss, increased surface roughness, and morphological alterations in enamel. Additionally, the diffusion of hydrogen peroxide through the enamel and dentin can pose risks to the underlying dental structures. To mitigate these concerns, Alberto Carlos Botazzo Delbem, Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil, and colleagues aimed to synthesize and assess the in vitro effects of different concentrations (0.25%, 0.5%, and 1%) of CaNaTMP incorporated into 17.5% and 35% hydrogen peroxide (HP) whitening formulations on enamel color change, microhardness, morphology, surface roughness, mineral content, and the transamelodentinal diffusion of HP.

For this purpose, the researchers allocated 288 enamel/dentin discs into eight groups based on the bleaching gel composition, incorporating 35% or 17.5% hydrogen peroxide with or without varying concentrations (0.25%, 0.5%, and 1%) of calcium-substituted sodium trimetaphosphate.

The gels were applied for 40 minutes over three weekly sessions. Assessments included color change (ΔE, ΔE00, ΔWID), surface hardness (SH), surface roughness (Ra), enamel mineral content, and transamelodentinal diffusion of HP. Enamel surface characteristics were analyzed using Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray (EDX). Data were evaluated using ANOVA and the Student-Newman-Keuls test.

The study led to the following findings:

  • All bleaching gels induced significant color changes after treatment, with comparable ΔE, ΔE00, and ΔWID values across groups.
  • Mineral loss (SH, gHAp × cm⁻³ × µm), surface roughness (Ra), and HP diffusion were highest with the 35% HP gel and lowest in groups containing CaNaTMP, particularly at 1%.
  • SEM/EDX analysis showed no visible surface alterations in the 17.5% HP group, while the 1% CaNaTMP-containing group exhibited prominent amorphous apatite precipitation.
  • Adding CaNaTMP, especially at 0.5% and 1%, to the 35% HP gel minimized surface changes.

The researchers demonstrated that incorporating CaNaTMP into 17.5% and 35% HP bleaching gels effectively reduced mineral loss, surface roughness, and enamel morphology alterations while limiting trans-amelodentinal diffusion of H₂O₂, without affecting bleaching efficacy. The protective effects were more pronounced with 1% CaNaTMP, particularly in preserving enamel integrity.

“By enhancing the safety and biocompatibility of bleaching gels, this approach offers a promising strategy for minimizing enamel damage. The combination of 17.5% HP with 1% CaNaTMP emerged as a safer and effective whitening option, improving patient comfort during treatment,” the researchers concluded.

Reference:

Nunes, G. P., Batista, G. D. F., De Toledo, P. T. A., Martins, T. P., Alves, R. D. O., Fernandes, A. V. P., & Delbem, A. C. B. (2025). Synthesis and application of calcium cyclotriphosphate in bleaching formulations: Effects on dental enamel properties. Journal of Dentistry, 155, 105614. https://doi.org/10.1016/j.jdent.2025.105614

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Raising Hypotension Treatment Thresholds during surgery fails to impact Postoperative Outcomes: Study

In a meta-analysis of randomized controlled trials focusing on the incidence of common postoperative complications with different treatment thresholds of hypotension, researchers aimed to address the controversy surrounding the optimal management of intraoperative hypotension. The study involved a systematic search of databases for studies conducted between 2014 and 2024 that compared various treatment thresholds of hypotension (low, moderate, and high) in non-cardiac, non-obstetric surgeries. Eight randomized controlled trials with 9108 participants were included in the analysis. The findings revealed no significant differences in postoperative complications between groups with moderate and high mean arterial pressure treatment thresholds. Length of hospital stay also showed no significant variance between the groups. The meta-analysis was limited by the lack of data on lower treatment thresholds of mean arterial pressure.

Importance of Hypotension Management

The study highlighted the importance of managing intraoperative hypotension due to its association with severe complications such as organ ischemia. Current therapeutic approaches involve the administration of vasoactive agents and fluid therapy to maintain hemodynamic stability. The results emphasized the necessity of careful control of hypotension treatment duration to ensure patient safety.

Optimal Threshold Uncertainty

Although the study confirmed the absence of significant differences in postoperative complications between moderate and high treatment thresholds, the optimal threshold for hypotension management remains uncertain. Further research is needed to clarify the impact of different treatment thresholds on clinical outcomes.

The study faced limitations regarding the individualized blood pressure thresholds in some studies, leading to challenges in establishing fixed criteria for grouping. Additionally, variability in clinical settings and the need for long-term follow-up data to assess the impact of various blood pressure thresholds on outcomes were highlighted as important considerations for future research.

Conclusion and Further Exploration

In conclusion, this meta-analysis suggested that a moderate treatment threshold of hypotension did not significantly differ in postoperative complications compared to a high treatment threshold. However, the study emphasized the importance of further exploration to address heterogeneity and the necessity of long-term follow-up data in assessing the impact of different blood pressure thresholds.

Key Points

– A meta-analysis of eight randomized controlled trials was conducted to investigate the impact of different treatment thresholds of hypotension on postoperative complications in non-cardiac, non-obstetric surgeries.

– The study found no significant differences in postoperative complications or length of hospital stay between groups with moderate and high mean arterial pressure treatment thresholds.

– Managing intraoperative hypotension is crucial due to its association with severe complications like organ ischemia, with current approaches utilizing vasoactive agents and fluid therapy to maintain hemodynamic stability.

– Despite confirming the lack of differences in complications between moderate and high treatment thresholds, the optimal threshold for hypotension management remains uncertain, calling for further research for clarity on clinical outcomes.

– Study limitations included challenges in establishing fixed criteria for grouping due to individualized blood pressure thresholds in some studies, as well as the importance of long-term follow-up data to evaluate the impact of blood pressure thresholds on outcomes.

– The meta-analysis suggested that a moderate treatment threshold of hypotension did not significantly differ in postoperative complications compared to a high treatment threshold, highlighting the need for future exploration to address heterogeneity and the importance of long-term follow-up data in assessing different blood pressure thresholds’ impact.

Reference –

Guan-Chao Qin et al. (2025). Intraoperative Hypotension And Postoperative Risks In Non-Cardiac Surgery: A Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-02976-5

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Fresh Embryo Transfer Yields Higher Live Birth Rates Than Freeze-All Strategy in Women with Low IVF Prognosis: Study

China: A randomized clinical trial conducted at fertility centers in China assessed live birth rates following fresh versus frozen embryo transfers in women with a low probability of in vitro fertilization (IVF) success. Published in The BMJ, the study found that 40% of women who underwent fresh embryo transfer had a viable live birth, compared to 32% in the frozen embryo transfer group. The fresh transfer group demonstrated higher pregnancy rates and a greater cumulative live birth rate within one year of randomization.

The approach of freezing all viable embryos before transferring them to the uterus, known as the “freeze-all strategy,” has gained widespread use in in vitro fertilization over the past decade. However, it may not be the most suitable option for everyone. Considering this, Daimin Wei, Key Laboratory of Reproductive Endocrinology, Ministry of Education, Shandong University, Jinan, China, and colleagues aimed to evaluate whether a freeze-all strategy enhances the likelihood of live birth compared to fresh embryo transfer in women with a low prognosis for IVF treatment.

For this purpose, the researchers conducted a multicentre, randomised controlled trial across nine fertility centers in China, involving 838 women with a low IVF prognosis. Participants, defined by poor ovarian reserve or retrieval of ≤9 oocytes, were randomly assigned to either a frozen or fresh embryo transfer group. The frozen group underwent embryo cryopreservation for later transfer, while the fresh group received embryo transfer immediately after oocyte retrieval.

The primary outcome was live birth at ≥28 weeks gestation. The secondary outcomes included clinical pregnancy rates, pregnancy loss, ectopic pregnancy, birth weight, maternal and neonatal complications, and cumulative live birth rates within one year of randomisation.

The key findings of the study were as follows:

  • The live birth rate was lower in the frozen embryo transfer group (32%, 132 of 419) than in the fresh embryo transfer group (40%, 168 of 419) (relative ratio: 0.79).
  • The clinical pregnancy rate was lower in the frozen embryo transfer group (39%, 164 of 419) compared to the fresh embryo transfer group (47%, 197 of 419) (relative ratio: 0.83).
  • The cumulative live birth rate was lower in the frozen embryo transfer group (44%, 185 of 419) than in the fresh embryo transfer group (51%, 215 of 419) (relative ratio: 0.86).
  • No significant differences were observed in birth weight, obstetric complications, or neonatal morbidities between the two groups.

The researchers found that fresh embryo transfer may be a more suitable option for women with a low prognosis for IVF, as it resulted in a higher live birth rate compared to the freeze-all strategy. Unlike previous findings in women with a good prognosis, this study demonstrated that a freeze-all approach led to lower live birth rates in this specific patient group.

“The results do not support the routine use of the freeze-all strategy in women with a low prognosis. To determine their impact on reproductive outcomes, further research is needed to evaluate treatment strategies that delay fresh embryo transfer, such as accumulating embryos through back-to-back cycles or performing routine preimplantation genetic testing for aneuploidy,” the researchers concluded.

Reference:

Wei D, Sun Y, Zhao H, Yan J, Zhou H, Gong F, Zhang A, Wang Z, Jin L, Bao H, Zhao S, Xiao Z, Qin Y, Geng L, Cui L, Sheng Y, Sun M, Liu P, Ding L, Liu H, Wu K, Li Y, Lu Y, Xu B, Xu B, Zhang L, Zhang H, Legro RS, Chen ZJ. Frozen versus fresh embryo transfer in women with low prognosis for in vitro fertilisation treatment: pragmatic, multicentre, randomised controlled trial. BMJ. 2025 Jan 29;388:e081474. doi: 10.1136/bmj-2024-081474. PMID: 39880462; PMCID: PMC11778674.

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Women with Non-Malignant Gynecological Diseases Face Increased Cardiovascular and Cerebrovascular Risk: Study Finds

Australia: A new systematic review and meta-analysis of over 3.2 million individuals has revealed a potential link between non-malignant gynecological diseases (NMGDs) and an increased risk of cardiovascular or cerebrovascular disease (C/CVD).

“Non-malignant gynecological diseases were linked to a 28% higher risk of cardiovascular or cerebrovascular disease (SRR = 1.28). The risk was even more pronounced for ischemic heart disease, with a 41% increase, especially in individuals with endometriosis and polycystic ovary syndrome,” the researchers reported in the BMJ Journal Heart. These findings highlight the importance of cardiovascular risk assessment in women with NMGDs.

The researchers note that cardiovascular disease remains the leading cause of death worldwide. Non-malignant gynecological diseases impact overall health and well-being and contribute to an increased risk of cardiovascular or cerebrovascular disease, emphasizing the need for further investigation into this potential association. To fill this knowledge gap, Giorgia Elisabeth Colombo, Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Lugano, Switzerland, and colleagues aimed to compile all available epidemiological studies on the link between chronic NMGD and C/CVD. As the first meta-analysis on this association, it offers novel and comprehensive insights into the overall relationship and subgroup-specific risks.

For this purpose, the researchers conducted a comprehensive search across seven databases for relevant studies up to April 21, 2024. They included observational studies that reported risk estimates for the association between NMGD and C/CVD. Two independent reviewers extracted the data, and random effects models were used to calculate the summary relative risk (SRR). The composite C/CVD outcome included ischemic heart disease, cerebrovascular disease, heart failure, and peripheral vascular disease. Study quality and risk of bias were assessed using the ROBINS-I tool.

Key Findings:

  • A total of 6,639 studies were screened, out of which 59 were reviewed in full, and 28 were included in the final analysis, covering 3,271,242 individuals.
  • More than half (53.5%) of the studies were assessed as having a ‘serious’ or ‘critical’ risk of bias.
  • Individuals with NMGD had a significantly higher risk of composite C/CVD, with low heterogeneity among studies (SRR 1.28; n=16 studies, I²=65.3%).
  • The risk of ischemic heart disease was elevated (SRR 1.41; n=21 studies, I²=73.7%).
  • The likelihood of cerebrovascular disease was also increased (SRR 1.33; n=16 studies, I²=91.5%).
  • Subgroup analyses revealed a higher risk of C/CVD and its components in individuals with a history of endometriosis or polycystic ovary syndrome.

The researchers found a significant association between NMGD and C/CVD across all studies, though individual estimates varied. They emphasized the need for rigorous study designs, better harmonization of NMGD and C/CVD definitions, and a deeper understanding of risk variations among subpopulations. Highlighting the clinical relevance, the researchers urged physicians to consider this association for early risk assessment and prevention strategies.

“Our findings emphasize the necessity of prospective longitudinal research to further evaluate these risks, which could drive the development of targeted primary prevention strategies and improve patient outcomes,” they concluded.

Reference:

Colombo GE, Mahamat-Saleh Y, Armour M, Madan K, Sabag A, Kvaskoff M, Missmer SA, Condous G, Pathan F, Leonardi M. Non-malignant gynaecological disease and risk of cardiovascular or cerebrovascular disease: a systematic review and meta-analysis. Heart. 2025 Feb 24:heartjnl-2024-324675. doi: 10.1136/heartjnl-2024-324675. Epub ahead of print. PMID: 39993911.

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