Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration

Gene prediction of the relationship between iron deficiency anemia and immune cells

BACKGROUND

Observational studies have shown a potential link between immune factors and the risk of iron deficiency anemia (IDA), yet the causal relationship between immune cells and IDA remains enigmatic. Herein, we used Mendelian randomization (MR) to assess whether this association is causal.

METHODS

We selected IDA genetic variants, including 8376 samples and 9810691 single nucleotide polymorphisms, and immune cells from a large open genome-wide association study (GWAS) for a bidirectional MR study. The primary method was inverse variance weighting (IVW), and auxiliary analyses were MR-Egger, weighted median, simple mode and weighted mode. The reliability of the results was subsequently verified by heterogeneity and sensitivity analysis.

RESULTS

IVW method showed that 19 types of immune cells may be the risk factors of IDA, whereas 15 types of immune cells are the protective factors of IDA. Reverse MR analysis suggested that immune cells from upstream etiology of IDA are not involved in follow-up immune activities. Next, we selected 731 immune cell types as the results. The research revealed that IDA may result in a rise in 23 kinds of immune cells and a reduction in 12 kinds of immune cells. In addition, sensitivity analysis demonstrated no evidence of heterogeneity or horizontal pleiotropy.

CONCLUSIONS

From a genetic standpoint, our study suggests that specific immune cells may be involved in the occurrence of IDA. Inversely, IDA may also contribute to immune dysfunction, thus guiding future clinical investigations.

Predictive value of systemic inflammatory response index in patients with erectile dysfunction on tadalafil unresponsive patients

BACKGROUND

Erectile dysfunction (ED) is a common disorder that significantly impacts quality of life, and phosphodiesterase type 5 inhibitors (PDE5is) such as tadalafil are one of the primary treatments. However, some patients remain unresponsive, necessitating further investigation.

OBJECTIVE

To investigate the association between systemic inflammatory response index (SIRI) and tadalafil unresponsiveness in erectile dysfunction patients.

METHODS

A total of 106 male patients who applied to the Andrology outpatient clinic with ED complaints between January and June 2024 were included in the study. Patients were started on daily tadalafil 5 mg therapy, and response was assessed after one month using the International Index of Erectile Function Erectile Function domain (IIEF-EF). SIRI values, calculated using neutrophil, monocyte, and lymphocyte counts, were compared between tadalafil-responsive and unresponsive groups.

RESULTS

Tadalafil unresponsiveness was observed in 48.1% of patients. Non-responders had significantly higher mean age(57.44 ± 12.52 vs. 47.22 ± 11.49, p < 0.001), BMI(27.22 ± 3.17 vs. 25.85 ± 2.92, p = 0.023), and SIRI values(1.33 ± 0.82 vs. 1.02 ± 0.40, p = 0.016) compared to responders. Multivariate analysis identified age(OR = 1,641, p = 0.001) and SIRI(OR = 2.420, p = 0.014) as independent predictors of tadalafil failure. ROC curve analysis revealed a SIRI cutoff of 1.03 (AUC = 0.617) with 69.1% sensitivity and 61.2% specificity.

CONCLUSION

Findings suggest that systemic inflammation plays a key role in ED pathophysiology and may impair PDE5i efficacy.

Optimizing hypertension management: the impact of drug class, socioeconomic factors, and simplified regimens on medication adherence. VATAHTA study

BACKGROUND

Medication adherence is essential for managing hypertension, yet many patients fail to follow prescribed treatments. This study examines the relationships between drug class, treatment complexity, socioeconomic factors, and adherence in hypertensive patients from Argentina.

METHODS

A multicentre, cross-sectional study was conducted with 1144 hypertensive patients from the Cuyo region. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). The impact of drug classes, number of prescribed drugs, dosing frequency, and socioeconomic factors (education, home ownership, employment status) on adherence was analysed using multivariate logistic regression. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated.

RESULTS

Patients on fixed-dose combinations demonstrated better adherence than those on monotherapy (OR 1.30, 95% CI: 1.15-1.45). Higher education (OR 1.20, 95% CI: 1.05-1.35) and home ownership (OR 1.15, 95% CI: 1.02-1.28) were associated with improved adherence, while unemployment was linked to reduced adherence. Patients taking more than three drugs showed lower adherence (OR 0.85, 95% CI: 0.75-0.95), and more frequent dosing (more than twice daily) was linked to reduced adherence (OR 0.78, 95% CI: 0.68-0.90). Beta-blockers (OR 2.5, 95% CI: 2.0-3.0) and potassium-sparing diuretics (OR 1.7, 95% CI: 1.3-2.1) were associated with the highest adherence, while ACE inhibitors such as ramipril (OR 0.75, 95% CI: 0.60-0.90) were linked to lower adherence.

CONCLUSION

Simplified regimens, particularly fixed-dose combinations, and the selection of drugs with favourable adherence profiles, like beta-blockers and potassium-sparing diuretics, can improve adherence. Addressing socioeconomic barriers should also be prioritized.

Isolated surgical valve replacement for tricuspid regurgitation: An international multicenter study

BACKGROUND

Although the management of tricuspid regurgitation during mitral surgery is standardized, the approach to patients with isolated tricuspid regurgitation is less clearly defined. This study examined the surgical outcomes of patients who underwent isolated surgical tricuspid valve replacement at 2 medical centers, providing insights into the postoperative and midterm outcomes.

METHODS

This retrospective observational study analyzed data from 2 tertiary cardiac surgery centers. All patients underwent isolated surgical tricuspid valve replacement between 2010 and 2023. The primary end point included 30-day and midterm survival. The secondary end points included postoperative and valve-related complications.

RESULTS

A total of 64 patients were included. The mean age was 58 ± 17 years, and 51.6% (33/64) were male patients. The median European System for Cardiac Operative Risk Evaluation II, TRISCORE, and Model for End-Stage Liver Disease scores were 2.16 [1.38-3.42], 3.00 [1.00-4.00], and 10.50 [9.00-16.25], respectively. More than 60% of the procedures were conducted on a beating heart. Thirty-day mortality was 7.8%. European System for Cardiac Operative Risk Evaluation II underestimated mortality, whereas the Model for End-Stage Liver Disease score was a more reliable predictor. Ten patients finally received a permanent pacemaker upon discharge. The overall survival rates at 1 and 6 years were 88.8 ± 4.0% and 80.3 ± 7.3%, respectively. Freedom from tricuspid valve reintervention rates at 1 and 6 years were 96.2 ± 2.6% and 75.0 ± 9.6%, respectively.

CONCLUSION

This study demonstrated that isolated surgical tricuspid valve replacement can be undertaken without exposing patients to an excessively high mortality risk. Risk assessment using specific scores may be useful in this regard. Nevertheless, these patients are at risk of postoperative complications, particularly permanent pacemaker implantation.

Close-to-Bedside Magnetic Resonance Imaging in the Neurocritical Care Unit: Descriptive Observational Study Exploring Patient Safety of a Novel Patient Transportation Method

Unstable patients in the neurocritical care unit (NCCU) need repeated diagnostic imaging. Intrahospital transports of such patients is hazardous where even small changes in physiology may lead to secondary brain injury. In this study we describe the workflow, safety aspects and reflect on our initial experience of close-to-bedside magnetic resonance (MR) imaging in the NCCU. A descriptive observational study was conducted to assess the safety of the transportation method and potential physiological changes associated with it. Eligible patients referred for MR imaging while in critical care at the NCCU between December 2021 and April 2022 were included. Physiological variables, including mean arterial pressure, heart rate, oxygen saturation, and fraction of inspired oxygen, were documented by critical care nurses before patient transfer, midway through MR scanning, and upon return to the NCCU bed. The suite's setup, including equipment and staffing, is detailed. Patient preparation and transportation procedures are described, emphasizing safety protocols. No main detrimental physiological changes occurred in patients undergoing close-to-bedside MR scanning included in our study (n = 45). No hazardous safety incidents occurred during the conduction of this study using this transportation approach. The concept of close-to-bedside MR imaging in the NCCU appears safe and minimizes numerous risks associated with intrahospital transports of unstable patients in neurocritical care. Safe access to repeated MR scanning of NCCU patients enables us to further advance the field of neurocritical care.

Relationship between myostatin, musclin, nutritional status, and functionality in older Colombian community-dwelling adults: A cross-sectional study

OBJECTIVES

Aging-associated body composition changes lead to a decrease in muscle mass and strength, affecting the functionality of older adults. Myostatin and musclin are myokines that regulate muscle metabolism and may modulate muscle changes during aging. Our objective was to determine the relationship between myostatin, musclin, and nutritional status with physical functionality in older adults.

METHODS

This was a cross-sectional study of a subsample of a stratified random sampling population survey in community-dwelling 60-90-year-old adults of both sexes. Serum myostatin and musclin concentrations were measured using MILLIPLEX technology (Merck Millipore, USA). Trained personnel recorded body mass index (BMI), and waist (WC), calf (CC), and arm (AC) circumferences as indicators of nutritional status. Functionality tests included handgrip strength (GS), walking speed (WS), and Advanced Activities of Daily Living.

RESULTS

Of 101 participants, 55.4% were women, 56.4% were between 60 and 69 years old, 53.5% had abdominal obesity, 23.8% had dynapenia, and 33.7% had low WS. Neither myostatin nor musclin showed significant changes from 60 to 90 years. In a multiple lineal regression model, myostatin showed an inverse correlation with BMI, CC, and AC in men (P < 0.05) but did not explain GS or WS. In a similar analysis, musclin and WC showed an inverse correlation with GS (P < 0.05). Moreover, myostatin was lower in the more physically active men (P < 0.05) but musclin did not show any relationship with the Advanced Activities of Daily Living scale.

CONCLUSIONS

Myostatin and musclin do not decrease with aging and are associated with nutritional and metabolic status. Musclin is associated with dynapenic obesity in older adults.

Associations between major depressive disorders and Parkinson's Disease and impact of their comorbidity sequence

BACKGROUND

The comorbidity of major depressive disorder (MDD) and Parkinson's disease (PD) were prevalent and has a profound impact on patients. However, whether this comorbidity results from specific pathological processes or a mutual cause-and-effect relationship was largely controversial. Additionally, although MDD can appear before or after PD, the health impact of the comorbidity sequence is poorly understood.

METHODS

We used mendelian randomization (MR) and UK biobank (UKB) cohort to explore the associations between MDD and PD. MR was also utilized to investigate potential confounders. By classifying UKB patients into MDD first and PD first groups, we evaluated the health impact of the comorbidity sequence using Cox regression.

RESULTS

Bidirectional MR and cohort study showed conflicting results. MR did not find associations between MDD followed by PD (odds ratio [OR] = 1.28, 95 % confidence interval [CI] = 0.85-1.94) or PD followed by MDD (OR = 0.99, 95 % CI = 0.97-1.01). However, the cohort study found a significant effect of MDD on PD (hazard ratio [HR] = 1.75, 95 % CI = 1.55-1.97) and PD on MDD (HR = 4.35, 95 % CI = 3.65-5.19). By performing MR on 4709 proteins, we identified ESD, LEAP2, NDRG3, NRXN3, and PLXNB2 as potential common causes of MDD and PD. Additionally, PD first group had higher risks of all-cause mortality (HR = 1.65, 95 % CI = 1.03-1.90), dementia (HR = 1.88, 95 % CI = 1.16-3.04), and aspiration pneumonia (HR = 1.89, 95 % CI = 1.09-3.27).

CONCLUSIONS

Our study suggested the comorbidity of MDD and PD is likely the result of certain pathological processes. Additionally, patients with PD first had higher risks of several adverse outcomes.

Gold vs. CAD/CAM ceramic partial-crowns: 20-year randomized clinical study

OBJECTIVES

Despite their widespread use, no systematic clinical long-term data are yet available comparing CAD/CAM partial ceramic crowns (PCCs) with cast gold partial crowns (CGPC). The null-hypothesis of this 20-year follow-up of a controlled prospective randomized split-mouth study was that CGPCs and PCCs reveal similar cumulative survival and clinical performance after 20 years of service.

METHODS

In this clinical study, 29 patients initially received one CGPC (Degulor-C) and one PCC (Vita-Mark-II/Cerec3). The 20-year follow-up examination was performed by two independent investigators using both, modified USPHS and FDI criteria. Kaplan-Meier survival rates were calculated including failures from patient-files. Non-parametrical statistics (χ2, log-rank(Mantel-Cox), α= 0.05) were applied.

RESULTS

Out of initially 29 patients, 19 patients and 36 restorations were considered for survival analysis revealing a cumulative survival of 69 % (CGPC) and 53 % (PCC), without statistically significant differences based on patient files. Regarding FDI and USPHS criteria, 11 patients (19 restorations) were available for clinical examination after a median (25-75 %) observation period of 238 (236-242) months (19.9 years). Within these 11 patients, 10 CGPC and 9 PCCs were still in service. All restorations showed ratings within the acceptable range exclusively (USPHS: Alpha for secondary caries, Alpha and Bravo for other criteria; FDI: scores 1-3). For USPHS criteria surface luster (p ≤ 0.002) and marginal discoloration (p ≤ 0.02), both CGPCs and PCCs, revealed significant deterioration over time. Additionally, marginal adaptation of PCCs deteriorated over time (p < 0.001) and was found significantly worse than that of CGPCs at 20-years (p = 0.003). In FDI criteria, CGPCs performed significantly better regarding surface staining (A2a; p = 0.047) and marginal adaptation (B6; p = 0.01) compared to PCCs.

CONCLUSIONS

All PCCs and CGPCs available for evaluation showed acceptable results after 20 years, with slight advantages for CGPCs in singular criteria. The present study is the first randomized controlled prospective study revealing that PCCs exhibit similar long-term cumulative survival as CGPCs with only slightly inferior performance and thus can be confidently recommended for long-term clinical application.

Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study

OBJECTIVE

Establishing the incidence and types of complications following surgical intervention for ARM, primarily after reconstruction. Patient- and treatment-related risk factors were also determined.

BACKGROUND

Postoperative complications of ARM surgery vary widely, with data predominantly derived from single-center retrospective studies with limited number of patients. Whether factors such as ARM type, associated congenital anomalies, prior enterostomy, or type of reconstructive surgery affect complication incidence remains unclear.

METHODS

This multicenter cohort study was performed using the ARM-Net registry with prospectively collected data. Enterostomy-related and post-reconstructive complications in patients who underwent reconstructive surgery before the age of five years were recorded. Patients with more than 25 % missing data, unknown sex, ARM type, or reconstruction date, or without (information on) reconstruction or complications, were excluded. Multivariable analyses identified independent risk factors for the development of complications.

RESULTS

A total of 2,043 patients were eligible for analysis. Complications after enterostomy formation and closure occurred in 25 % and 12 % of patients, respectively. Post-reconstructive complications occurred in 25 % of patients, with wound complications comprising half of the complications. In a multivariable analysis, recto-bladder neck fistula, any associated anomaly, and the LAARP procedure were identified as independent risk factors for post-reconstructive complications. In contrast, anoplasty and mini-PSARP reduce the risk of complications.

CONCLUSIONS

Post-reconstructive complications in ARM patients are common, and certain patient- and treatment-related characteristics affect postoperative outcomes. These results aid counselling and clinical decision-making, and may guide the operative planning of ARM types that are amenable to several different surgical approaches.

Risk of secondary myelodysplastic syndromes and acute myeloid leukaemia following poly(ADP-ribose) polymerase inhibitor treatment for advanced-stage recurrent ovarian cancer: A retrospective cohort study in England

BACKGROUND

Poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance therapies are used to treat advanced ovarian cancer in first line and recurrent settings. Because of concerns about associations between PARPi therapy and secondary cancers myelodysplastic syndrome (MDS) and acute myeloid leukaemia (AML), a meta-analysis of clinical trials was conducted, reporting MDS/AML incidence of 0.73 %; however, clinical trial populations are highly selective and may not reflect incidence in the wider population.

METHODS

This retrospective cohort study calculated incidence of MDS/AML within five years of completing first-line chemotherapy + /- PARPi maintenance for recurrent, advanced-stage ovarian cancer. Absolute and relative risks were calculated and compared to meta-analysis.

RESULTS

Of 11,531 included patients, 1529 received PARPi and 10,002 chemotherapy only. Absolute risk of MDS/AML was 0.3 % (n = 5/1529) for chemotherapy + PARPi maintenance therapy versus 0.1 % (n = 10/10,002) for chemotherapy alone. Relative risk was 2.97 (95 % CI 1.02, 8.68, p = 0.046) in patients receiving PARPi maintenance versus chemotherapy alone.

DISCUSSION

Relative risk of MDS/AML was greater in patients treated with PARPi; however, absolute risk was low in both treatment groups and lower than in the meta-analysis of trials. This analysis suggests small increased relative risk of MDS/AML associated with PARPi maintenance versus chemotherapy only, but not increased absolute risk.

Shared Decision-Making in Physical Therapist Care for People With Shoulder Problems: An Observer-Based Analysis of Audio-Recorded Consultations

OBJECTIVE

Despite the substantial diagnostic and therapeutic uncertainties in the decision-making process, it remains largely unclear to what extent shared decision-making (SDM) is applied in physical therapist care for people with shoulder problems. The purpose of our study was to determine to what extent SDM is part of the decision-making process in initial physical therapist consultations of people with shoulder problems and to identify factors associated with the level of SDM.

METHODS

In this cross-sectional study, the level of SDM was measured by assessing audio-recorded initial physical therapist consultations of people with shoulder problems using the 5-item Observing Patient Involvement in SDM tool (OPTION-5; 0-100, higher OPTION scores indicate higher level of SDM). Associations between the level of SDM and the characteristics of patients, physical therapists, and consultations were assessed using multilevel analysis.

RESULTS

A total of 100 initial physical therapist consultations of 41 participating physical therapists were included. The mean OPTION-5 score was 27 (range = 5-70). On none of the individual items of the OPTION-5, the highest score "exemplar effort" was observed. The multilevel analysis showed that 3 determinants were associated with higher level of SDM: younger age of the patient (b = -1.8; 95% CI = -3.1 to -0.4), longer duration of the consultation (b = 5.5; 95% CI = 2.7 to 8.3), and higher level of education of the physical therapist (b = 9.1; 95% CI = 2.7 to 15.4).

CONCLUSIONS

The level of SDM in daily physical therapist practice for people with shoulder problems leaves room for improvement. Future research should focus on strategies to improve the application of SDM in physical therapist care for people with shoulder problems. The determinants such as duration of the consultation, and the level of education of the physical therapist might provide guidance in developing these strategies for improving the application of SDM.

IMPACT

The findings of this study give insight into the limited application of SDM in physical therapy for people with shoulder problems. Duration of the consultations and level of education of the physical therapist impact the level of SDM.

Early ambulation following lower limb burn and surgery is associated with improved long-term functional outcome and reduced hospital length of stay: A longitudinal cohort study

INTRODUCTION

Ambulating early after lower limb burn surgery has been associated with a multitude of in-hospital and short-term benefits. However, long-term functional recovery following lower limb burns is poorly understood, especially if grafting surgery is required.

OBJECTIVES

This study aimed to explore the association between early ambulation following lower limb burn injury and surgery, long-term lower limb functional recovery and secondly, hospital length of stay (LOS).

METHODS

This retrospective longitudinal cohort study reported data from 1718 adult patients treated by a tertiary hospital burn center in Western Australia between February 2011 and December 2019 following a lower limb burn injury.

RESULTS

Comparable lower limb function outcomes were found at six weeks after injury regardless of burn severity or timing of ambulation. Early ambulation pathways were associated with the likelihood of achieving a better long-term functional recovery over the first year after burn. A positive association was also confirmed between early ambulation and hospital LOS. After adjustment, patients who ambulated early after burn and surgery had a LOS of 1.76 days less than patients who ambulated early after burn but late after surgery (IRR 1.22, 95 % CI:1.13-1.3, p < 0.001).

CONCLUSION

Early ambulation before the third day after lower limb burn injury and surgery was associated with improved long-term functional outcome trajectory to one year and reduced hospital LOS by of 1.76 days when patients ambulated early after surgery. Future investigations with larger, targeted samples of complex patients are warranted to explore the influence of early ambulation on the outcomes of multi-morbidity subgroups.

Anxiety and disease awareness in individuals with heredity for abdominal aortic aneurysm

ObjectiveThe psychological consequences of being aware of an increased risk of developing abdominal aortic aneurysm as a first-degree relative of a person with abdominal aortic aneurysm are hitherto unexplored. This study investigates the awareness of heritability and anxiety in male and female adult offspring of abdominal aortic aneurysm patients compared to controls. Health-related quality of life among participants with aortic pathology was compared to participants with normal aortic diameters.MethodsThis was a cross-sectional point prevalence study based on the participants examined in the Detecting Abdominal Aortic Aneurysm in First Degree Relatives Trial (DAAAD; 752 adult offspring, 756 matched controls), 2020-2022. Questionnaires about health-related quality of life and study-specific questions regarding awareness of heritability were collected prior to the aortic ultrasound.ResultsAttendance rate was higher among individuals with heredity compared to controls (67% vs. 52%, p < 0.001). Of 1508 adult offspring examined, 65% reported having a close relative with abdominal aortic aneurysm (6% in controls). Female adult offspring reported higher awareness of heritability than controls (38% vs. 12%, p < 0.001), as did males (32% vs. 8%, p < 0.001). A slight majority of participants with awareness reported anxiety (54% of female offspring; 51% of male). There were no measured differences in health-related quality of life between the groups when standard health-related quality of life instruments were used.ConclusionThe higher-than-expected proportion of adult offspring with awareness of heritability and anxiety about such risk indicates that we fail to communicate risk to this group appropriately via the current channels of information within the healthcare system. This calls for the development of dedicated strategies for improved communication of abdominal aortic aneurysm risk to patients and their next of kin.

The effect of three different angles of the working seat on lumbar spine curvatures and comfort: An observational study

OBJECTIVE

The purpose of this study was to verify the influence of three different seat inclinations for work as measured by comfort and changes in vertebral curvatures for the position of work.

METHODS

The kinematic analysis was recorded at the vertebral levels of T5, T10, L3 and S2 to measure the lumbar and thoracic-lumbar angles. The seat allowed adjustments of the angles (0o, 15o and 30o) and the Likert scale was used to assess the subjects' level of comfort. Each data collection session was performed in a 60-min period. The statistical analysis compared groups through multivariate analysis of variance considering the factors: gender, seat angles and instant. As dependent variable, the comfort level, spine angles were considered.

RESULTS

We included 32 healthy subjects with aged 18-25 years. Male present bigger thoracic-lumbar angles and smaller lumbar angles. Male present more comfort levels. The seat inclination at 30° causes less thoracic-lumbar angle and less comfort, whereas the seat angle at 0o causes less lumbar angle. There are several and frequent variations in the spine curvatures along a 60-min period and, after 27 min in sitting posture there was a gradual decrease in the comfort level, independent on the angle of seat inclination.

CONCLUSIONS

The best inclination of the seat was that maybe it is between 0° and 15°, since the results show that in both analysis, the thoracic-lumbar and lumbar angles, and, comfort level, the inclination of 30° seems to be inadequate.

Conducting descriptive epidemiology and causal inference studies using observational data: A 10-point primer for stroke researchers

Routinely-collected health data and emerging data-linkage capabilities provide researchers and clinicians with rich opportunities to answer important research questions by conducting observational studies. We provide stroke researchers with 10 important points to consider and implement to ensure the validity and interpretability of descriptive epidemiology and causal inference studies based on observational data. We discuss different types of observational studies and biases that may arise in such studies. We review types of causal effects and the use of Target Trial emulation and Directed Acyclic Graphs to improve validity of observational studies. We also illustrate appropriate and inappropriate use of covariate adjustment for the analyses of observational studies and review the methods for estimating the effects of treatments, interventions, and exposures in causal inference studies. Finally, we provide recommendations for clinical researchers and journal manuscript reviewers in stroke domain and beyond for the appropriate use and reporting of these methods.

Chronic pain in ICU survivors: Potential risk factors and relationship with post-traumatic stress disorder symptoms and health related quality of life

OBJECTIVES

To identify patient characteristics and clinical factors during ICU hospitalization potentially associated with chronic pain occurrence, and to determine its relationship with symptoms of post-traumatic stress disorder (PTSD) and health-related quality of life (HRQoL) at three time points after ICU discharge.

METHODS

Adult ICU survivors were enrolled in a prospective, repeated measures study. The study was carried out in two phases. Phase I was conducted during the first 5 days of survivors' ICU hospitalization where patient characteristics and clinical data were collected. Phase II was conducted via telephone interviews after 3 (T1), 6 (T2) and 12 (T3) months post-ICU discharge, where pain, PTSD-related symptoms, and HRQoL were assessed with the Numeric Rating Scale (NRS), Davidson Trauma Scale (DTS), and 36-Item Short Form Survey version 2 (SF-36v2), respectively.

RESULTS

Data from 59 survivors were analysed, 69.5% of whom were males. The sample's mean age was 52.7 (SD 18.9) years and 62.7% of them reported NRS>3 at T1, indicating chronic pain. After adjusting for sex, age, and APACHE II score, chronic pain was significantly associated with: (a) length of stay in the ICU (OR=1.42; 95%CI: 1.03-1.95; p=0.030) and (b) clinically relevant symptoms of PTSD at T1 (OR=10.04; 95%CI: 2.44-41.24; p=0.001) and T2 (OR=11.90; 95%CI: 1.28-110.49; p=0.029). Lower SF-36v2 scores in all domains at T1, several domains at T2, and two domains at T3 were significantly associated with CP occurrence.

CONCLUSIONS

Of the patient characteristics and clinical factors analysed, only longer length of stay in ICU was significantly associated with higher odds of chronic pain occurrence, which in turn was linked to PTSD-related symptoms and lower HRQoL after ICU discharge.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinical interventions aimed at optimizing ICU length of stay, such as the implementation of early mobility programs and multidisciplinary rehabilitation, may support prevention of chronic pain occurrence and improve long-term outcomes.

Educational attainment as a potential effect modifier of alcohol use and 100% alcohol-attributable mortality in the United States-A longitudinal analysis of mortality linked survey data from 1997 to 2018

AIMS

To measure effects between educational attainment and alcohol use as a driver of unequal alcohol-attributable mortality.

DESIGN

Nation-wide cohort study using a longitudinal design, linking data from the 1997-2018 National Health Interview Survey to mortality data of the National Death Index in 2019. The study has an average follow-up time of 10.7 years (SD = 6.4).

SETTING

United States.

PARTICIPANTS

Nationally representative sample of adults aged 25 years and older.

MEASUREMENTS

The outcome was time to 100% alcohol-attributable mortality, censored or last presumed alive by 31 December 2019. Socioeconomic status was operationalized via educational attainment; alcohol use was self-reported and operationalized using a categorical measure with lifetime abstainers as reference category.

FINDINGS

Of a total of 562 632 adults, 901 (635 men and 266 women) died during follow-up from a 100% alcohol-attributable cause of death [15 per 100 000 person years (PY)]. We found a strong interaction effect between low education and Category III alcohol use (>60 g and >40 g per day for men and women, respectively), which was of additive nature as shown by the Aalen's additive hazards model, with 83.68 additional deaths per 100 000 PY (95% confidence interval = 16.48-150.87) found in individuals with low education with Category III drinking compared with a situation when there was no interaction between the two risk factors. A large and statistically significant relative excess risk due to interaction (RERI) of 32.05 from the Cox model supported the interaction. For individuals with low education, the risk associated with Category III drinking was double that for those with high education.

CONCLUSIONS

In the United States, people with combined low education and high alcohol consumption (>60 g/day for men, >40 g/day for women) appear to have a higher risk of 100% alcohol-attributable mortality compared with other combinations of educational attainment and drinking.

De-escalated surgery following neoadjuvant chemoimmunotherapy for locally advanced oral squamous cell carcinoma: A retrospective cohort study

BACKGROUND

There remains considerable debate regarding whether the extent of surgery can be reduced in oral squamous cell carcinoma (OSCC) with significant tumor shrinkage after neoadjuvant chemoimmunotherapy. This study aims to report the feasibility and oncological safety of de-escalated surgery (DES) following neoadjuvant chemoimmunotherapy in locally advanced OSCC.

MATERIALS AND METHODS

We collected clinical data of patients with locally advanced OSCC (T3-4 N0-3 M0) treated at our cancer center between November 2019 and July 2023 who received platinum-based doublet chemotherapy combined with a PD-1 inhibitor followed by DES. DES was defined as surgery performed according to the extent of residual tumor after neoadjuvant therapy. Tumor response, flap reconstruction/mandibulectomy exemption rates, event-free survival (EFS), and overall survival (OS) were assessed.

RESULTS

A total of 111 patients were included, with tumors located in the tongue (73/111, 65.8 %), buccal-lip mucosa (15/111, 13.5 %), mandibular gingiva - floor of mouth (15/111, 13.5 %), and maxillary gingiva - hard palate (8/111, 7.2 %). The objective response rate (ORR) was 77.5 %, with a pathological complete response (pCR) rate of 40.5 %. Flap reconstruction was exempted in 80 (72.1 %) of patients. Among the 96 patients initially planned for mandibulectomy, 68 patients (70.8 %) were exempted from mandibulectomy. With a median follow-up of 27 months, the estimated 1-, 2-, and 3-year EFS rates were 90.1 %, 84.4 %, and 80.9 %, respectively. The estimated 1-, 2-, and 3-year OS rates were 97.3 %, 93.1 %, and 91.3 %, respectively.

CONCLUSION

Opting for DES after neoadjuvant chemoimmunotherapy appears to be feasible, with satisfactory oncological safety in OSCC patients.

Health promotion for blood donors: A scoping review

Background

Health promotion aims to prevent chronic diseases and alleviate their impact on individuals' well-being. It involves empowering both individuals and communities to actively uphold optimal health. Although blood banks conventionally centre on blood donation functions, an untapped potential lies in leveraging these institutions for health enhancement through prioritized health promotion initiatives. The objective of this study is to explore how blood banks can contribute to the well-being of blood donors by integrating preventive measures as part of health promotion initiatives within their operations.

Study design

Literature review.

Methods

Literature Search in CINAHL, Embase, PubMed and Web of Science was conducted. Arksey and O'Malley (2015) framework was used with incorporated recommendations stated by Levac, Colquhoun, and O'Brien (2010) following an iterative process of six stages, starting with identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarizing, and reporting the results, and consult experts.

Results

The 20 incorporated studies showed a range of health screenings and health promoting activities, that expand the traditional scope of blood bank addressing blood-related conditions, encompassing assessments for conditions related to blood as well as health screenings. These screenings included examinations for cancer and diabetes, with the predominant focus being on cardiovascular risk assessment.

Conclusion

This review highlights the implementation of health initiatives by blood banks, focusing on improving well-being and preventing diseases. These initiatives have the potential to act as gateways for community-based interventions and possibilities for enhancing both the blood supply and individual health. The effectiveness of these interventions is contingent upon the context of each blood bank and its target donor group. Therefore, tailoring interventions to align with specific contexts and facilitating factors is crucial for optimizing health promotion efforts tailored to the diverse needs of different donor groups.

Mendelian randomization in hepatology: A review of principles, opportunities, and challenges

Mendelian randomization has become a popular tool to assess causal relationships using existing observational data. While randomized controlled trials are considered the gold standard for establishing causality between exposures and outcomes, it is not always feasible to conduct a trial. Mendelian randomization is a causal inference method that uses observational data to infer causal relationships by using genetic variation as a surrogate for the exposure of interest. Publications using the approach have increased dramatically in recent years, including in the field of hepatology. In this concise review, we describe the concepts, assumptions, and interpretation of Mendelian randomization as related to studies in hepatology. We focus on the strengths and weaknesses of the approach for a non-statistical audience, using an illustrative example to assess the causal relationship between body mass index and NAFLD.

Research methods in genetic counseling: Statistical approaches and resources

The continuing evolution of the genetic counseling profession necessitates an ongoing reflection on the perceived validity and role of our research in the larger systems we operate in. Despite our need for an analytically inclined professional culture and decision-making process, many genetic counselors may not have the training or support needed to ensure such rigor. In this special issue of the Journal of Genetic Counseling, authors were tasked with providing methodological foundations for genetic counselors navigating various phases of research, to improve the quality of our research output and to incorporate our findings into decision-making in healthcare and non-healthcare settings. In this manuscript, we describe various statistical approaches in lay terms and provide resources for genetic counselors new and seasoned alike. We hope to ease some of the trepidation in applying statistical approaches to genetic counseling research and provide resources to increase the analytical confidence of our workforce. This can increase the validity of the analyses and findings disseminated within and beyond our profession. First, we review some history and foundations of statistical practices that inform study design, sampling, data collection, analysis, and interpretation. Next, we highlight how different study designs inform the choice of data analysis and provide resources for statistical strategy choice. Finally, we provide resources on how to interpret statistical test results, recommend best practices, and highlight common but avoidable misconceptions in statistical interpretation. We hope this review provides a framework for novices in quantitative methodology and provides the language needed to collaborate with analytical/statistical colleagues.

Timing of Medication Treatment in Children 3-5-Years-old with ADHD: A PEDSnet Study

Importance

Early identification and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in preschool-age children is important for mitigating social-emotional and academic problems. Clinical practice guidelines recommend first-line behavior intervention before considering medication treatment for children 4-5-years-old.

Objective

To assess variation in rates of ADHD identification and rates and timing of medication treatment in children 3-5-years-old in primary care settings across eight US pediatric health systems and to identify patient factors associated with the time from diagnosis to prescription.

Design

Retrospective cohort study of electronic health records.

Setting

Primary care clinics affiliated with eight academic institutions participating in the PEDSnet Clinical Research Network.

Participants

Children 3-5-years-old seen in primary care between 2016-2023.

Exposure

ADHD diagnosis at age 4-5 years.

Main Outcomes and Measures

Outcomes: (1) rate of ADHD diagnosis; (2) rate of stimulant and non-stimulant prescription after diagnosis before age 7, (3) time from first ADHD-related diagnosis (including symptom-level diagnoses) to medication prescription. Independent variables: institution, year of diagnosis, patient age, sex, race/ethnicity, medical insurance, and presence of comorbidities.

Results

Of 712,478 children seen in primary care at ages 3-5 years, 9,708 (1.4%) received an ADHD diagnosis at age 4-5 years (range 0.5-3.1% across institutions). Of those with ADHD, 76.4% (n=7414) were male, 39.0% (n=3782) were White. Of 9,708 preschool-age children with ADHD, 68.2% (6624) were prescribed ADHD medications before age 7, 42.2% (n=4092) were prescribed medications within 30 days of the first documentation of an ADHD-related diagnosis (range 26.0-49.0% across institution). Asian (aHR 0.50, CI 0.38-0.65), Hispanic (aHR 0.75, CI 0.70-0.81), and Black (aHR 0.90, CI 0.85-0.96) children with ADHD were less likely to be prescribed medication early compared to White children. Older (aHR 1.64, CI 1.57-1.72), male (aHR 1.74, CI 1.11-1.24) and publicly insured (aHR 1.10, CI 1.04-1.17) patients were more likely to be prescribed medication early compared to younger, female and privately insured patients, respectively.

Conclusion and Relevance

Many preschool-age children with ADHD seen in primary care in 8 large pediatric health systems were prescribed medications at or shortly after the first documented diagnosis. Future analysis of clinical documentation is needed to understand the reasoning behind early prescription patterns.

Relationships between body composition and firefighter occupational performance: A systematic review and meta-analysis

BackgroundFirefighters face substantial physical demands in their profession, executing a range of challenging tasks under variable and high-stress conditions. Understanding the relationship between body composition and occupational performance tests (OPTs) can help to prepare both current and aspiring firefighters for the physical demands of the job.ObjectiveTo evaluate the relationship between body composition and the completion of firefighting OPTs.MethodsThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies utilized career or firefighter recruits and examined the association of measures of body composition, body fat percentage (BF%), fat-free mass (FFM), fat mass (FM) and body mass index (BMI), with OPT outcomes. The meta-analysis synthesized correlation coefficients via a random-effects model.ResultsThe systematic review included 26 studies. Body composition was assessed through a mix of laboratory and field tests. Twenty studies featured an OPT circuit with simulated fire suppression and rescue tasks. Pooled correlations between time to complete an OPT with fat free mass, body fat%, and body mass index were r̅ = -0.61, r̅ = 0.46, and r̅ = 0.10, respectively. For individual firefighting tasks, pooled correlations were generally strongest for FFM, followed by BF%, with weakest correlations observed for BMI.ConclusionsThe literature indicates that greater FFM and lower BF% are beneficial for the performance of firefighting OPTs, highlighting the importance of focusing on specific body composition measures for firefighter capabilities. The findings can be used to inform body composition screening and training programs designed to optimize firefighters' ability to perform occupational duties.

Efficacy of Mirabegron and Propiverine Combination in the Treatment of Refractory Overactive Bladder

INTRODUCTION AND HYPOTHESIS

The aim of this study is to evaluate the effectiveness and safety of mirabegron + propiverine combination in the treatment of overactive bladder (OAB) resistant to anticholinergic agent or beta-3 agonist treatment.

METHOD

Patients who presented with OAB symptoms between March 2019 and August 2023 and did not respond to anticholinergic or beta-3 agonist treatment were included in the study. All patients were recommended to use mirabegron 50 mg (Betmiga, Astellas Pharma, Japan) and propiverine 30 mg (Mictonorm SR, 30 mg, Recordati Pharmaceuticals, Italy) once a day. Patients' symptoms were evaluated with OABSS and bladder diary 3 months after treatment. Side effects and satisfaction rates were recorded.

RESULTS

A total of 320 patients were included in the study. One-year data of a total of 264 patients were examined. After 1 year of treatment, the patients' OABSS score, mean daily micturition frequency according to the bladder diary, frequency of urge incontinence, nocturia, and number of pads decreased compared to before treatment (p < 0.001 for each). After 1 year, 62.1% (164/264) of patients benefited from the mirabegron + propiverine combination. The most common side effects were dry mouth in 43 patients (16.3%) and constipation in 59 patients (22.3%).

CONCLUSION

Mirabegron + propiverine treatment is an effective and reliable treatment option in the treatment of OAB resistant to medical monotherapy. With this combination treatment to be used before botulinum toxin application in the treatment of resistant OAB, the number of patients who will receive Botox may decrease.

Effects of Perioperative Fluid Resuscitation on the Need for Renal Replacement Therapy in the Damage Control Laparotomy for Trauma

BackgroundMinimizing crystalloid intravenous fluid (IVF) is a core tenet of damage control resuscitation strategies in trauma. However, there is a lingering notion that such fluid-restrictive strategies may cause acute kidney injury (AKI). We hypothesized that perioperative crystalloid administration volume was not associated with the need for renal replacement therapy (RRT) after damage control laparotomy (DCL).MethodsA retrospective analysis was performed at an urban level 1 trauma center from 2019 to 2022. Risk factors for the need for RRT were evaluated using univariate and multiple logistic regression analyses.ResultsAmong 279 included patients, most were male (77%), the median Injury Severity Score (ISS) was 25 (IQR: 17-34), and overall mortality was 7%. 30 (10.7%) received RRT. The volume of perioperative IVF given in the first 24 hours was 5.3 L for patients without RRT vs 7.3 L for patients who received RRT (P = 0.01). Both packed red blood cell (PRBC) transfusion (6 units vs 17 units, P < 0.0001) and ISS (24 vs 32, P < 0.0001) were also significantly different between groups. After multivariable logistic regression (MLR) adjustment, the need for RRT was associated only with ISS (AOR 1.05, 95% CI 1.01-1.08, P = 0.01) and PRBC transfusion volume in the first 24 hours (AOR 1.09, 95% CI 1.05-1.12, P < 0.0001).DiscussionThe need for RRT for critically injured patients undergoing DCL was not associated with perioperative crystalloid administration volume. Only injury severity markers and surrogates were independently associated with the need for RRT. Concern for AKI should not limit the use of contemporary damage control resuscitation strategies.

Krackow suturing combined with the suture-bridge technique versus Kirschner-wire tension band combined with patellar cerclage for the treatment of inferior pole patella fracture: a retrospective comparative study

BACKGROUND

Krackow suturing and suture bridge technique was compared with Kirschner-Wire (K-wire) tension band and patella cerclage for the fixation of inferior pole patella fracture.

METHODS

This was a retrospective study of 47 patients with inferior pole patella fractures who underwent fixation procedures at our hospital between January 2019 and May 2022, of whom 25 had Krackow suturing combined with the suture-bridge technique (GROUP 1), and 22 received a K-wire tension band combined with patellar cerclage (GROUP 2). We compared the operative time, reoperation rate, Böstman score, knee range of motion (ROM), fracture-healing time, Insall-Salvati index, complications and hospital expenses between the two groups.

RESULTS

The average follow-up period was 23.1 ± 5.8 months. The complication and reoperation rates in the GROUP 2 were significantly higher than those in the GROUP 1 (P = 0.023 and P < 0.001). While the GROUP 1 has lower hospital expenses than GROUP 2 (P < 0.001). However, significant differences were not found regarding the Böstman score, knee ROM, Insall-Salvati index, fracture-healing time, and operation time between the two groups.

CONCLUSIONS

Both Krackow suturing combined with the suture-bridge technique and the K-wire tension band technique can achieve comparable clinical efficacy in stably fixing inferior patellar pole fractures, subsequently allowing an early commencement of rehabilitation exercise, while the suture-bridge technique can also reduce the incidence of complications, hospital expenses and the need for reoperation surgery.

TRIAL REGISTRATION

This study was registered on https://www.chictr.org.cn (registration No. ChiCTR2300072069, 2023/06/01, retrospectively registered). Informed consent was obtained from all individual participants included in the study.

Prognostic significance of the number of hepatic lesions in multifocal intrahepatic cholangiocarcinoma after radical resection: an IPTW propensity-score analysis

BACKGROUND

Multifocal hepatic lesions represent a distinctive subgroup within intrahepatic cholangiocarcinoma(iCCA), the management of these patients remains controversial. This study aimed to compare the survival of intrahepatic cholangiocarcinoma (iCCA) with different numbers of hepatic lesions and select patients benefiting most from surgery in multifocal iCCA.

METHODS

A cohort of 354 consecutive iCCA patients were included. Based on the number of hepatic lesions, patients were classified as follows: solitary tumors (type I), 2 or 3 hepatic lesions in the same-sided hepatic lobe (type II), and more than three hepatic lesions in the same-sided hepatic lobe (type III). Stabilized inverse probability treatment weighting (IPTW) was conducted for accurate prognosis comparisons. Furthermore, the long-term prognosis was compared between different American Joint Committee on Cancer.

RESULTS

Among all patients, multifocal iCCA presented significantly worse overall survival (OS) and recurrence-free survival (RFS) than solitary tumor (p < 0.001 and p < 0.001), 11.9% (n = 42), and 14.4% (n = 51) patients were classified into type II, and type III, respectively. After IPTW, type II exhibited similar while type III exhibited worse RFS and OS to type I cohort (solitary tumors) (p < 0.001and p < 0.001). Multivariable Cox analysis also identified type III tumors as an independent risk factor for OS (HR 1.95, 95% CI:1.33-2.87, p < 0.001). Among AJCC stage II (T2N0M0) patients, multifocal iCCA presented significantly worse OS than solitary tumors (vascular invasion) (p = 0.018), and type II exhibited similar while type III exhibited worse OS than solitary tumors (p = 0.500 and p = 0.040). Compared with stage III patients, type II exhibited better while type III exhibited similar OS (p < 0.001 and p = 0.300).

CONCLUSIONS

Multifocal iCCA presented a significantly worse prognosis, the number of hepatic lesions significantly influenced the prognosis of multifocal iCCA. Patients with type II tumors may derive comparable oncological benefits from surgery compared with solitary tumors, radical surgery still be strongly recommended as the preferred treatment.

Oncology Biomarkers, Clinical Characteristics, and Survival Outcomes in Colorectal Cancer Patients with Spinal Metastases Undergoing Spinal Surgery: Insights from a Retrospective Cohort Study

Objectives: This study aims to identify clinical characteristics and biomarkers influencing survival outcomes in colorectal cancer (CRC) patients with spinal metastases. Methods: We conducted a retrospective cohort study involving 27 patients treated for CRC-derived spinal metastases at Johns Hopkins Hospital. Data on demographics, biomarker profiles of the primary colorectal tumor site, surgical outcomes, and survival were collected. Neurological function was assessed pre- and postoperatively using Frankel scores. Survival outcomes included overall survival (OS) and post-metastasis survival. Results: The median age of the patients was 58 years, with 63% being women. The sacral spine was the most frequently involved site (59.3%), followed by the thoracic and lumbar regions. Most patients (89%) already had extraspinal metastases, predominantly in the lungs. Biomarker analysis showed microsatellite stability in 63% of patients and CDX2 (Caudal-type homeobox 2) expression in 37%. Laminectomy was performed in 85% of cases and sacrectomy in 55.6%, leading to postoperative improvements in ambulatory function and neurological status. The main indications included local recurrence of the tumor and neurological deficits attributed to the impinging tumor. The median overall survival was 4.9 years, while the median post-metastasis survival was 3.0 years. Univariable analysis revealed that CK20 expression (p = 0.041) and spinal tumor recurrence (p = 0.045) were significantly associated with shorter post-metastasis survival. Conclusions: This study highlights the prognostic importance of CK20 expression and spinal tumor recurrence in CRC patients diagnosed with spinal metastases. Surgical intervention significantly improved neurological outcomes, enhancing patient quality of life. Further research with larger cohorts is needed to confirm these findings and optimize treatment strategies for this challenging patient population.

Obstructive Sleep Apnea as a Potentiator of Primary Open Angle Glaucoma and Necessity for Interventional Therapy

PURPOSE

To evaluate the rate of progression of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnea (OSA) compared to non-OSA mild-moderate POAG comparators and to assess the utilization of surgical and laser intervention.

DESIGN

A retrospective cohort study of the TriNetX US Collaborative network was conducted by analyzing international electronic health record (EHR) data from January 2004 to October 2024.

PARTICIPANTS

Patients in the TriNetX US Collaborative Network with a diagnosis of mild-moderate POAG, stratified with respect to OSA status.

METHODS

Patients were assessed for outcomes at 3-, 5-, and 10 years. Propensity score matching (PSM) was conducted between cohorts matched for baseline demographics, comorbidities, and medication use. Odds ratios (OR) and 95% confidence intervals (CI) were subsequently calculated.

MAIN OUTCOME MEASURES

Risk of development of severe POAG.

RESULTS

After PSM, 5,277 patients with, and 5,277 patients without OSA were included in final analysis. At 3 (OR 2.791, 95% CI: 2.289 - 3.403), 5 (OR 2.300, 95% CI: 1.947 - 2.717), and 10 years (OR: 2.198, 95% CI: 1.873 - 2.578), the OSA cohort demonstrated significantly higher odds of developing severe POAG compared to the non-OSA comparators. Secondary outcomes of minimally-invasive glaucoma surgery (MIGS) and trabeculectomy surgery yielded no significant difference between both cohorts (P > 0.05) at all follow-up times. However, laser therapy and tube shunt surgery demonstrated a significantly greater incidence in the OSA cohort at each time point.

CONCLUSIONS

The rate of glaucoma surgery appears similar between POAG patients with and without OSA, despite those with OSA demonstrating a greater risk for rapid progression and vision loss. Future practice patterns should pay special attention to OSA patients and consider offering more aggressive or earlier intervention, which may aid in limiting disease progression.

Association between atherogenicity indices and prediabetes: a 5-year retrospective cohort study in a general Chinese physical examination population

BACKGROUND AND OBJECTIVE

Atherogenicity indices have emerged as promising markers for cardiometabolic disorders, yet their relationship with prediabetes risk remains unclear. This study aimed to comprehensively evaluate the associations between six atherogenicity indices and prediabetes risk in a Chinese population, and explore the predictive value of these atherosclerotic parameters for prediabetes.

METHODS

This retrospective cohort study included 97,151 participants from 32 healthcare centers across China, with a median follow-up of 2.99 (2.13, 3.95) years. Six atherogenicity indices were calculated: Castelli's Risk Index-I (CRI-I), Castelli's Risk Index-II (CRI-II), Atherogenic Index of Plasma (AIP), Atherogenic Index (AI), Lipoprotein Combine Index (LCI), and Cholesterol Index (CHOLINDEX). To address the natural relationships between the atherogenicity indices and risk of prediabetes, we applied Cox proportional hazards regression with cubic spline functions and smooth curve fitting, using a recursive algorithm to calculate inflection points. Machine learning approach (XGBoost and Boruta methods) to address the high collinearity among indices and assess their relative importance, combined with time-dependent ROC analysis to evaluate the predictive performance at 3-, 4-, and 5-year follow-up.

RESULTS

During follow-up, 11,199 participants developed prediabetes (incidence rate: 3.71 per 100 person-years). Significant nonlinear associations were observed between all atherogenicity indices and prediabetes risk. Through Z-score standardization of atherogenicity indices and comprehensive Cox proportional hazards regression and advanced machine learning techniques, we identified AIP as the most significant predictor of prediabetes [HR = 1.057 (95% CI 1.035-1.080, P < 0.0001)], with LCI emerging as a secondary important marker [HR = 1.020 (95% CI 1.002-1.038, P = 0.0267)]. Our innovative XGBoost and Boruta analysis uniquely validated these findings, providing robust evidence of AIP and LCI's critical role in prediabetes risk assessment. Time-dependent ROC analysis further validated these findings, with LCI and AIP demonstrating comparable discrimination, with overlapping AUC ranges of 0.5952-0.6082. Notably, the combined indices model achieved enhanced predictive performance (AUC: 0.6753) compared to individual indices, suggesting the potential benefit of using multiple atherogenicity indices for prediabetes risk prediction.

CONCLUSION

This study identifies statistically significant associations between atherogenicity indices and prediabetes risk, highlighting their nonlinear relationships and combined effects. While the predictive performance of these indices is modest (AUC 0.55-0.68), these findings may contribute to improved risk stratification when incorporated into comprehensive assessment strategies.

Postoperative symptom network analysis in non-small cell lung cancer patients: a cross-sectional study

OBJECTIVE

To investigate the incidence and severity of symptoms in postoperative non-small-cell lung cancer patients undergoing thoracoscopic surgery, construct a symptom network, and analyze centrality indicators of the network to identify core symptoms and provide a basis for precise symptom management.

METHODS

A convenience sampling method was used to select postoperative NSCLC patients from the Department of Thoracic Surgery at the First Affiliated Hospital of Army Medical University between September 2024 and December 2024. The Chinese version of the Anderson Symptom Inventory Core Symptom Module and the revised Lung Cancer-Specific Symptom Module were used to survey the incidence and severity of symptoms. A symptom network was constructed with R software with the EBICgloss function and Spearman correlation analysis, and the centrality indicators were then calculated.

RESULTS

In total, 404 questionnaires were distributed, and 367 valid questionnaires were returned (effective response rate, 90.8%). The top three symptoms in terms of incidence and severity during the postoperative hospitalization of NSCLC patients were pain (100%), fatigue (99%), and shortness of breath (98%). The results of the centrality indicators of the symptom network revealed that the top three symptoms in terms of strength centrality were shortness of breath (rs = 5.44), fatigue (rs = 5.43), and pain (rs = 5.34).

CONCLUSION

Postoperative NSCLC patients experience various symptoms, with shortness of breath being the core symptom. Targeted intervention strategies are needed to improve the efficiency and accuracy of symptom management, reduce the symptom burden on patients, and increase their quality of life.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry (NO. ChiCTR2500096720), registered on 5 February 2025, retrospectively registered.

Disability pension among androgenic-anabolic steroid users

AIM

To examine the association between androgenic-anabolic steroid (AAS) use and the risk of being granted a permanent disability pension.

METHODS

This cohort study included 1189 Danish males, penalized under an antidoping programme for AAS use in fitness centres between 2006 and 2018. These individuals were paired with 59,450 control participants from the general population, matching them based on age, sex and inclusion date. The follow-up period extended until autumn 2022. The study measured the incidence of disability pension awards over the follow-up period. We adjusted for ethnic origin, educational level, Charlson comorbidity index, and psychiatric disorders at baseline, given their potential influence.

RESULTS

During follow-up, 57 AAS users and 1458 control participants were granted disability pension. Thus, AAS users showed a nearly twofold higher risk of becoming disabled compared with controls (unadjusted hazard ratio 1.95, 95% confidence interval 1.50-2.54). After adjustments, the risk of disability remained statistically significant (adjusted hazard ratio 1.57, 95% confidence interval 1.18-2.08).

CONCLUSIONS

AAS use is significantly associated with an increased risk of disability pension award, meaning that these individuals are deemed to have lost their working ability permanently.

Periosteal-guided bone regeneration on severely damaged sockets with simultaneous implant placement: The cortical shield cross-sectional study

BACKGROUND

Bone regeneration and simultaneous implant placement in severely damaged sockets are challenging and may require multiple grafting. Periosteal-guided bone regeneration enhances osteogenesis and wound healing shortening immediate and delay implant protocols. Clinical outcomes of a group of individuals that entered a longitudinal clinical trial from 2019 to 2021 are reported describing a novel surgical approach of simultaneous reconstruction and implant placement.

METHODS AND RESULTS

Eight individuals requiring an implant and presenting severe facial bone loss were followed for 2-4 years (37-month average) after the completion of a 12-month longitudinal clinical trial NCT04827693. Socket reconstruction and simultaneous implant placement were performed by encasing the implant in a customized shield of autogenous cortical bone. Peri-implant tissues and pink esthetics data were assessed following established success criteria. Mean healing time, before second stage surgery, after implant placement and reconstruction, was 12.5 ± 0.9 weeks (range: 12-14 weeks). Success rates were 100% at 2-4 years. Cone beam computed tomography (CBCT) data showed stable facial cortical bone >2.1 mm in thickness. Pink esthetic scores (PESs) were above optimal (9.5 ± 0.5, range: 9-10), with no significant difference between delayed and immediate individuals (p > 0.05). Facial implant transparency at follow-up was absent and all had a band of keratinized tissue >2 mm with healthy probing depths ranging from 3 to 4 mm.

CONCLUSION

Facial bone regeneration and simultaneous implant placement are feasible through periosteal-guided bone regeneration after a short healing period in severely damaged sockets following immediate or delay protocols. The assisted regenerated intrasocket bone provides high pink esthetics and functional implant stability.

KEY POINTS

Regeneration and simultaneous implant placement of severely damaged sockets is feasible. Periosteal-guide bone regeneration can shorten healing times. Teeth with fragile alveolar foundation can be successfully reconstructed achieving high pink esthetics.

PLAIN LANGUAGE SUMMARY

Simultaneous dental implant placement and bone regeneration are possible in severely damaged sockets that require reconstruction achieving, after a short healing period, highly esthetic outcomes.

Sex-specific progression of Parkinson's disease: A longitudinal mixed-models analysis

BackgroundDespite its relevance, the clinical progression of motor- and non-motor symptoms associated with Parkinson's disease (PD) is poorly described and understood, particularly in relation to sex-specific differences in clinical progression.ObjectiveIdentification of differential aspects in disease progression in men and women with PD.MethodsLinear mixed-model analyses of 802 people with typical PD from the Luxembourg Parkinson's study's prospective cohort (median time of follow-up = three years). We estimated the effect of time and its moderation by sex (alpha ≤ 0.05), including confidence intervals, for the following outcomes: MDS-UPDRS I-IV, Starkstein Apathy Scale, Beck Depression Inventory, Montreal Cognitive Assessment (MoCA), Sniffin' sticks, bodily discomfort, rapid eye movement sleep behavior disorder questionnaire, PD Sleep Scale (PDSS), Munich Dysphagia Test-PD, Functional Mobility Composite Score, and the MDS-based tremor and postural instability and gait disturbances scale. In addition, the marginal means illustrated the symptoms' trajectories in men and women. Men and women had similar age.ResultsOverall, we observed a slower progression (interaction effect) in women compared to men, especially for MoCA (-0.159, 95%CI [-0.272, -0.046], p = 0.006), PDSS (-0.716, 95%CI [-1.229, -0.203], p = 0.006), PIGD (0.133, 95%CI [0.025 0.241], p = 0.016), and MDS-UPDRS II (0.346, 95%CI [0.120, 0.572], p = 0.003). The finding for MDS-UPDRS II was significant (FWER of 5%) after adjustment for multiple comparisons (Bonferroni-Holm).ConclusionsNext to the further exploration of sex-specific progression, interventions, proactive monitoring and communication strategies tailored to the symptoms progression and needs of men and women need to be developed.

Early versus delayed silo closure in gastroschisis: a retrospective study

BACKGROUND

A well accepted approach to the management of gastroschisis is gradual reduction of the herniated viscera using preformed silos followed by surgical closure of the abdominal wall defect. However, if the abdominal wall closure is delayed for a longer duration than necessary, it may increase morbidities. We sought to compare the outcomes of infants undergoing silo reduction whose abdominal wall defect was closed ≤ 5 days versus > 5 days after birth.

METHODS

Retrospective cohort study (January-2010 to December-2020).

RESULTS

One-hundred-and-nine infants who were managed using primary silo with staged reduction were included. Median gestation was 36.2 (interquartile range, IQR: 35.2, 37) weeks. Ten infants had complex gastroschisis. Thirty-four infants underwent early-closure of abdominal wall defect and 75 had delayed closure. Mortality rate was 2.7% (3/109; one in early and two in delayed closure). The median age at full feeds was 24.5 days (IQR 17.5, 30) in the delayed-closure group vs 15 (12.5, 22.5) in the early-closure group. The median hospital stay was 32 days (IQR 23, 43) vs 19 (15, 30) days. On multivariable analysis, delayed closure (Exponentiated regression coefficient ERC 1.40, 95% confidence interval CI: 1.05, 1.86, P = 0.020) and complex gastroschisis (ERC 2.03; 95% CI: 1.11, 3.72, P = 0.021) were associated with longer time to reach full feeds. Same factors were associated with longer duration of hospital stay.

CONCLUSIONS

Gradual reduction using silos achieved excellent outcomes in neonates with gastroschisis. Completing the silo reduction and closing the abdominal wall within five days could further improve their outcomes.

Registered nurses' perceptions of their leadership close to older adults in municipal home healthcare: a cross-sectional questionnaire study

BACKGROUND

Registered nurses lead the nursing care close to older adults in home healthcare. It is expected that there will be an increased need for home healthcare. In addition, more advanced care is now being performed in home healthcare, leading to increased demands for registered nurses. Therefore, the aims of this study are to explore and compare registered nurses' perceptions of their leadership close to older adults in municipal home healthcare, as well as to correlate their perceptions with age and work experience.

METHODS

This study is a part of a larger web-based questionnaire survey, with a non-experimental and cross-sectional design. Descriptive and analytical statistics were used. A total of n = 71 registered nurses leading close to older adults participated, in seven municipalities in two geographic areas in Sweden.

RESULTS

The registered nurses perceived their ability as leaders close to older adults as high. The registered nurses had neither low or high trust in care staff's competence. They perceived to have space and access neither in a low or high degree in their work to develop sufficient competence in leadership and having nursing responsibility on an organisational level. Registered nurses' perceptions of their leadership differed depending on whether they had a specialist education or not; those with specialist education perceived to a higher degree that they could apply their professional experience in their work; interact with the older adult and their next of kin; assess individual needs and based on a holistic view of the older adult, create good relationships with the older adults' next of kin.

CONCLUSIONS

Registered nurses' specialist education may strengthen their leadership in home healthcare. Further research is needed to gain new knowledge of registered nurses' leadership in home healthcare, as well as care staff's' experiences of registered nurses' leadership in municipal home healthcare.

Neurologic symptoms as first manifestation of primary cardiac tumors

INTRODUCTION

Primary cardiac tumors are very infrequent, usually benign, and occasionally present with neurological symptoms.

METHODS

We retrospectively analyzed a series of 107 patients diagnosed of primary cardiac tumors who underwent cardiac surgery between 1994 and 2024.

RESULTS

Stroke was the debut form of tumor in 14 patients. Multiple ischemic lesions on neuroimaging were identified in 50% of patients, but no aneurysms or brain tumor metastases were observed at the time of diagnosis. Neurological symptoms were more frequent in patients with villous tumors (33.3 vs. 7.2%) (p=0.001), regardless of tumor diameter. In the multivariate analysis, patients with neurological debut presented NYHA I functional class (RR: 11.9; 95% CI [2.3-60.5]; p=0.003) and villous tumor morphology (RR: 6.78; 95% CI [1.8-25.3]; p=0.004). No patient underwent reperfusion treatment and surgical excision of the tumor was performed (median stroke-surgery: 19 days) without early postoperative or late neurological complications during follow-up.

CONCLUSIONS

Neurological symptoms can be the first manifestation of primary cardiac tumors in patients with good functional class and a history of multiple peripheral embolisms. Villous morphology favors neurological manifestations of embolic origin, despite tumor size. Late neurological complications, due to brain aneurysms or tumor metastases, are extremely rare and have not seen in our series.

Emergency inguinal hernia surgery: A proposed update to the clinical guidelines algorithm

INTRODUCTION

Management strategies for acute irreducible hernias vary, with recent debates on the role of manual reduction versus immediate surgery. This study aimed to identify preoperative risk factors for bowel resection in acute irreducible inguinal hernias.

METHODS

A retrospective cohort study included patients from 2 university hospitals who underwent emergency surgery for acute irreducible hernias between January 2010 and December 2018.

RESULTS

Out of a total of 652 patients, 15% required intestinal resection; females, older individuals, and those with comorbidities were more likely to undergo resection. Multivariate analysis identified patients with femoral hernia (OR 2.272; 95%CI 1.275-4.047; P = .005) and preoperative intestinal obstruction (OR 8.071; 95%CI 4.331-15.043; P < .001). Patients needing resection experienced higher postoperative complication rates and longer hospital stays.

DISCUSSION

Femoral hernia and preoperative intestinal obstruction were independent predictors of bowel resection in acute irreducible hernias. Incorporating these factors into decision-making algorithms may improve patient outcomes and optimize surgical management.

Hazardous alcohol use: a cross-sectional study of cardiology patients in Sweden

BACKGROUND

Alcohol use is understudied in cardiology settings. We investigated the prevalence of hazardous alcohol use and probable dependence among cardiology patients.

METHODS

Cross-sectional study in three regions of Sweden. Alcohol use was assessed using the AUDIT-10 questionnaire. We defined hazardous alcohol use as: AUDIT-10 ≥ 6 for women or ≥ 8 for men (primary definition) and probable dependence as AUDIT-10 ≥ 13 for women or ≥ 15 for men. We examined associations using logistic regression.

RESULTS

We included 1107 participants (median age = 73 years; range = 18-102; 66% men). The prevalence of hazardous alcohol use was 7.8% (95%CI = 6.2-9.3, primary definition) and 0.9% (95%CI = 0.3-1.5) had probable alcohol dependence. We found increased odds of hazardous alcohol use in: age groups 18-39 years (OR = 4.90, 95%CI = 1.41-17.08) and 40-64 years (OR = 4.02, 95%CI = 1.69-9.67) compared to ≥80 years; a city compared to a small town (OR = 2.44, 95%CI = 1.02-5.84); participants with unhealthy diets (OR = 2.37, 95%CI = 1.36-4.13), and overweight participants (OR = 2.25, 95%CI = 1.23-4.12).

CONCLUSIONS

Hazardous alcohol use affected about one in 12 cardiology patients. However, less than 1 in 100 had probable alcohol dependence. Findings suggest that many cardiology patients with hazardous alcohol use are appropriate for brief interventions, and may not require more intensive alcohol dependence treatments.

Factors Influencing the Information Support Provided by Health Care Professionals to Patients in a Dialysis Center Regarding Kidney Transplantation: A Nationwide Study

For patients undergoing renal replacement therapy, kidney transplantation (KTx) is the preferred therapeutic method. The aim of this study was to investigate selected factors affecting the information support provided by healthcare professional to patients in dialysis center regarding KTx. A multiple logistic regression was carried out to assess the relationship between information support, socio-demographic factors, life satisfaction (Satisfaction with Life Scale), self-esteem (Self-Esteem Scale), perceived self-efficacy (General Self-Efficacy), attitude, knowledge about organ transplantation. Of the 1,093 respondents aged 22-72 years, 501 respondents (45.8%) always informed patients about the possibility of treatment with KTx. Physicians vs. nurses (OR = 1.79; Cl 95%: 1.48-2.16), and those who supported legalization of unspecified living kidney donation in Poland (OR = 1.30; Cl 95%: 1.07-1.59) and believed that blood donation is safe (OR = 1.29; Cl 95%: 1.12-1.47) were more likely to provide informational support. Knowledge level (OR = 1.32; Cl 95%: 1.18-1.47) and self-esteem (OR = 1.06; Cl95%: 1.03-1.10) correlated positively with information support. Male participants were less likely to provide informational support than females (OR = 0.78; Cl 95%: 0.62-0.99). The results reveal inadequate information provided by healthcare professional to patients about KTx. This highlights the urgent need for comprehensive educational programs.

Current status of temporomandibular disorders education in U.S. predoctoral dental curricula: A nationwide survey

OBJECTIVE

Studies have highlighted variability and deficiencies in temporomandibular disorders (TMD) predoctoral education, with limited student clinical exposure. However, no research has examined changes following CODA inclusion of TMD instruction in predoctoral curricula. We investigated current scope, instructional modalities, and extent of TMD curricula in U.S. predoctoral dental programs.

METHODS

A 17-item REDCapTM survey was distributed in September-October 2024 to deans/associate deans of academic affairs at 72 CODA-accredited U.S. predoctoral dental schools, investigating TMD curricula, modalities, and extent.

RESULTS

All 33 responding programs (53.2% response rate) included TMD instruction. Formal teaching accounted for 70.6±24.9% of instruction, while patient exposure constituted 22.5±21.0%. Programs dedicated 15.7±7.1 h on average (range 4-34) to TMD instruction . About 25.0% of programs had no board-certified orofacial pain (OFP) specialist on faculty. Instruction was mostly provided by OFP (75.8%), oral medicine specialists (36.4%), prosthodontists (30.3%), and oral surgeons (27.3%). Most programs (87.9%) treated TMD patients, yet 9.1% reported no student clinical exposure to these patients. In programs offering clinical exposure, patient interactions included direct evaluation and treatment (60.6%), rotations in OFP clinics (42.4%), observation (36.4%), or elective courses (3.0%). Management of OFP patients expanded to neuropathic pain (54.5%) and primary headache (33.3%), especially among programs with OFP specialists on faculty.

CONCLUSIONS

TMD instruction varies widely across responding programs, but recent curricula have expanded instructional hours, broadened scope, and increased opportunities for patient interaction compared to previous reports.

Maximum likelihood estimation of age-specific incidence rate from prevalence

Usually, age-specific incidence rates of chronic diseases are estimated from longitudinal studies that follow participants over time and record incident cases. However, these studies can be cost- and time-expensive and are prone to loss to follow up. An alternative method allows incidence estimation based on aggregated data from (cross-sectional) prevalence and mortality studies using relations between incidence, prevalence and mortality described by the illness-death model and a related partial differential equation. Currently, adequate options for the assessment of the accuracy of the achieved incidence estimates are missing and bootstrap resampling methods are used instead. Therefore, we developed novel ways to estimate incidence rates based on the maximum likelihood principle with corresponding confidence intervals. Historical data about breathlessness in British coal miners and diabetes in Germany are used to illustrate the applicability of this method in scenarios with non-differential and differential mortality. We have two scenarios of available data in the case of differential mortality: mortality of diseased and all-cause mortality, or all-cause mortality and mortality rate ratio. Our results show that estimation of incidence rates and corresponding confidence intervals of chronic conditions based on aggregated data with the maximum likelihood method using a binomial likelihood function is possible and can replace resampling techniques.

Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill - An analysis of the SWECRIT cohort

PURPOSE

Assess if cystatin C-derived measures of kidney function are associated with mortality in septic- and non-septic intensive care unit (ICU) patients.

METHODS

Data from adult patients staying >24 h in four ICUs in Sweden from November 2015-December 2018 included. Outcomes were mortality and need for renal replacement therapy (RRT) due to acute kidney injury. Associations between cystatin C-estimated glomerular filtration rate (eGFRcys) and shrunken pore syndrome (SPS) and outcomes were assessed with Cox-regression in unadjusted and analyses adjusted for sex, age, illness severity, chronic kidney disease and creatinine. SPS was defined as a ratio between eGFRcys and eGFRcreatinine <0.6.

RESULTS

In total, 4455 patients were included in the analysis, of which 32 % had sepsis. SPS was present in 7.4 % of the cohort, and 90-day mortality was 30.8 %. In sepsis- and non-sepsis patients, SPS and eGFRcys were associated with 90-day-, 1-year mortality and RRT in unadjusted analyses. In an adjusted analysis, SPS was associated with 1-year mortality in sepsis patients (hazard ratio [HR] 1.4, 95 % CI 1.1-1.9, p = 0.021), and eGFRcys was associated with RRT in both sepsis and non-sepsis patients (HR 3.1, 95 % CI 1.6-6.0, p < 0.001, eGFRcys <20 vs ≥60 ml/min/1.73m2). No other associations between eGFRcys, SPS and mortality were detected in adjusted analyses.

CONCLUSION

Our finding that SPS is more robustly associated with mortality in sepsis patients than in non-sepsis patients suggests that the association between SPS and mortality may depend on underlying pathophysiology. A cystatin C-based estimate of GFR is independently associated with RRT in sepsis and non-sepsis.

Bedside ultrasound-guided genicular nerve block with corticosteroids and lignocaine for knee osteoarthritis improves pain and participation, and is safe in inpatient rehabilitation: a retrospective case series

Background

Knee osteoarthritis (OA) is a common joint disorder that causes significant pain and disability. It can affect individuals undergoing inpatient rehabilitation, interfering with their participation in therapy and clinical improvement. While there are various treatment options available for this condition, such as the intra-articular corticosteroid injection, not all patients are suitable and symptoms may persist despite multimodal analgesia. The ultrasound-guided genicular nerve block (US GNB) induces analgesia by targeting the genicular nerves around the knee, and has emerged as a safe and effective intervention option. This is the first effort to document its application in the inpatient rehabilitation setting.

Methods

This was a retrospective case series. We reviewed the medical records of inpatients undergoing rehabilitation who underwent the US GNB for disabling knee OA between July 1, 2022, and August 31, 2023. The primary outcome was improvement in rehabilitation participation based on physiotherapist notes in the week following the procedure. Secondary outcomes were pain by visual analogue scale (VAS), ambulation distance, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), at pre-discharge, 1-month, and 3-month follow-up timepoints. Safety and adverse events were also retrospectively reviewed.

Results

Nine patients were consented for recruitment in our study. Eight of them showed improvement in pain and/or participation in therapy. There were significant improvements in VAS scores (median change -3) and improvements in ambulation distance (median increase 8 m) between pre-injection and pre-discharge phases. However, these did not persist at the longer follow-up visits. There were no serious adverse events although 3 patients had recurrent pain at later dates, and required further procedures or surgical referral.

Conclusions

The US GNB is safe to perform for inpatients undergoing rehabilitation who experience pain from knee OA. We found that in nearly all patients, there was clinical improvement in their pain and participation in therapy. It can be an effective alternative when other analgesia options are less desirable or available, and can help to keep patients progressing on the road to recovery.

Sequencing and ranking patterns of morphological dental features radiographically assessed for human identification

BACKGROUND

Highly distinctive patterns can result from the combination of dental features. These features are related to dental treatment, morphology or pathological conditions, and in human identification they can be optimally assessed by means of radiographic analysis. This study aimed to classify dental features and rank them based on distinctiveness.

METHODS

The sample consisted of panoramic radiographs (n = 7212) of females (58,07 %) and males (41;93 %) between 12 e 22.99 years. The permanent teeth, except third molars, were analyzed in each radiograph. A 28-digit sequence was created with the following dental features: non-restored, missing, restored, presenting root dilaceration, impacted, rotated teeth.

RESULTS

This study detected 2792 dental patterns (39 % of distinctiveness). The most common pattern was "all non-restored teeth" - corresponding to 30.4 % in males and 26.5 % in females. When a single tooth with rotation occurred, it decreased to 1 % the odds of finding an equal pattern. In general, males had a higher chance of presenting non-restored teeth compared to females (p < 0.05).

CONCLUSIONS

The distinctiveness of dental patterns was almost twice as high in the mandible compared to the maxilla. Distinctiveness increased with age with the occurrence of less non-restored teeth. Forensic odontologists must be prepared to assess radiographic features related to tooth morphology, especially in mass disasters that involve dental human identification of young individuals.

Types of strabismus and strabismus surgery after retinal detachment repair: a health registry database analysis

PURPOSE

To examine the rate of diplopia, strabismus, and interventions for strabismus after pneumatic retinopexy, scleral buckle, and pars plana vitrectomy with and without scleral buckle for primary repair of rhegmatogenous retinal detachment (RRD).

METHODS

This retrospective cohort study draws on deidentified EHR data of over 126 million patients in the TriNetX Analytics platform, a federated health research network. Subjects were assigned to three cohorts: pneumatic retinopexy (PR) alone, scleral buckle (SB) alone, or pars plana vitrectomy with or without scleral buckle (PPV+/-SB). Univariate analyses and propensity score matching (PSM) sensitivity analyses were conducted. Main outcomes were the risk of diplopia, strabismus, sensorimotor examination, or strabismus interventions, including chemodenervation or surgery. Kaplan-Meier analysis was performed.

RESULTS

A total of 25,169 subjects were identified: PR (n = 1,646), SB (n = 3,658), and PPV+/-SB (n = 19,865). SB had the highest rates of diplopia (2.73%) and strabismus (1.79%), followed by PPV+/-SB (diplopia, 2.28%; strabismus, 1.46%) and PR (diplopia, 1.54%; strabismus, 0.612%). SB and PPV+/-SB had a significantly higher risk of diplopia (P < 0.01) and strabismus (P < 0.001) compared to PR. No significant differences were observed between PPV+/-SB and SB (P = 0.106 and P = 0.139). Kaplan-Meier analysis indicated SB had the highest hazard during the first year after surgery. Strabismus interventions were rare, with surgery in ≤0.27% of the SB cohort, 0.22% of the PPV+/-SB cohort, and ≤0.61% of the PR cohort. No subjects underwent chemodenervation.

CONCLUSIONS

The risk of diplopia and strabismus after RRD treatments is low. SB carries the highest risk, followed by PPV+/-SB and PR. These findings support informed decision making in selecting RRD repair techniques.

Photon-Counting CT-Angiography to Assess Intracranial Stents and Flow Diverters in Comparison to Digital Subtraction Angiography

PURPOSE

Photon-Counting Detector CT is characterized by enhanced image post-processing capabilities. The diagnostic accuracy of PCD-CT angiography (PCD-CTA) in assessing intracranial stents (ICS) and flow diverters (FD) has yet to be compared with digital subtraction angiography (DSA).

METHODS

Retrospective analysis of all consecutive patients who underwent ICS or FD implantation between April 2023 and May 2024. Polyenergetic images, along with virtual monoenergetic imaging (VMI), pure lumen (PL) and iodine (IOD) reconstructions were assessed by three readers using a 5-point Likert scale and defined regions of interest (ROIs). A blinded analysis was performed to identify relevant lumen reduction. The diagnostic accuracy of PCD-CTA was compared to DSA by calculating the area under the receiver operating characteristic curve.

RESULTS

A total of 18 patients (mean age 59 ± 13 years; 14 women) with 14 implanted ICS and 10 FD were analyzed. Across all pairwise comparisons, pooled VMI reconstructions demonstrated higher ratings and signal-to-noise ratios compared to IOD, PL and UHR reconstructions (p < 0.001 for all comparisons). In the pooled assessment of DSA of in-stent vessel lumen 18 (11%) of the 162 vessel segments and 6 (33%) of the 18 patients presented relevant narrowing of the in-stent vessel lumen. The sensitivity of PCD-CTA for detecting stenosis was 100% (18 of 18 in-stent vessel segments), while specificity was 89% (128/144 in-stent vessel segments). All readers reported a 100% negative predictive value (128/128 in-stent vessel segments).

CONCLUSION

Photon-Counting Detector CT might provide a reliable assessment of intracranial vessels following stent or flow diverter implantation comparable to DSA in many cases.

Comparative evaluation of oral microbiologic profile in children with Type 1 Diabetes Mellitus versus healthy controls and its relation to oral health status

BACKGROUND

Oral health is a key indicator of one's overall health and is vitally affected by systemic diseases. A bidirectional relationship is assumed to exist between oral health and Type 1 Diabetes Mellitus. Differences in oral cariogenic microbes and their relation to metabolic control show inconsistent results. Additionally, the relation between diabetes and dental caries is inconclusive. The aim of the present study is to investigate the relation of oral health to microbiologic profile in youngsters with Type 1 Diabetes Mellitus.

METHODS

Sixty-three children were recruited including 22 diabetic children with poor glycemic control, 18 diabetic children with good glycemic control and 23 non-diabetic children. Oral health status was assessed using Caries Assessment Spectrum and Treatment (CAST) and oral hygiene index simplified (OHIS). Salivary and plaque samples were collected and microbiologically analyzed for identification and live colony counting of Mutans Streptococci, Lactobacilli, and different Candida species. The relation of different oral pathogen types and abundances with caries status and diabetes severity was assessed.

RESULTS

Salivary Mutans Streptococci were isolated at the rate of 82.5%, lactobacilli at the rate of 74.6%, C. albicans at the rate of 58.7%, and other Candida species collectively at the rate of 46%. The occurrence of salivary Mutans Streptococci was significantly higher in uncontrolled cases compared to healthy subjects. Salivary C. albicans occurred at a significantly lower frequency among controlled cases. C. dubliniensis and C. tropicalis occurred more frequently in the saliva of children with poor glycemic control. We observed higher counts of plaque Mutans Streptococci in children with poorer oral hygiene and poorer glycemic control. Both salivary and plaque C. albicans counts were higher in worse caries status regardless of glycemic status. Salivary Lactobacillus count appears as a marker of caries status.

CONCLUSION

Although diabetes did not show significant effect on increasing risk of dental caries, the oral microbiologic profile was different among healthy and diabetic children and was affected by the level of glycemic control.

A multicenter survey of pediatric caudal epidural anesthesia practices in resource-limited settings

Caudal epidural blocks are commonly used anesthesia techniques in children. This multicenter study used an interviewer-administered questionnaire in 28 hospitals to describe pediatric caudal epidural anesthesia practice in the Palestinian healthcare system. Devices used to access the epidural space, methods used to ensure the accuracy of access to the epidural space, methods used to ensure asepsis, local anesthetics, additives, and adjuncts used in pediatric caudal epidural blocks were collected. Responses were obtained from 162 anesthesiologists (response rate = 68.9%). Hollow needles were used to access the epidural space and catheters were used to administer local anesthetics, additives, and adjuncts in the epidural space. Aspiration before injection was the most frequently reported method to ensure accurate placement of needles, catheters, local anesthetics, additives, and adjuncts in the epidural space. Bupivacaine was the most commonly injected local anesthetic. During single short caudal epidural blocks, 57.4% of the anesthesiologists reported adhering to full aseptic techniques. The findings revealed significant variations in the practices of pediatric caudal epidural blocks. These variations could be associated with resource limitations, access to materials, local anesthetics, additives, and adjuncts. Developing and adopting evidence-based guidelines might promote congruence in pediatric caudal epidural anesthesia practices.

Acetaminophen and Acetaminophen-Opioid Combination Prescribing Trends Among Hospitalized Children, Adolescents, and Young Adults with Cancer

Purpose

Acetaminophen ( APAP ) is a ubiquitous antipyretic and analgesic used in children in the United States ( US ), including those with cancer. The effects of US Food & Drug Administration ( FDA ) guidance on APAP prescribing have been described for healthy adults and children; however, APAP use patterns in children with cancer are unknown. Considering their increased risk of liver injury, APAP's potential for causing hepatoxicity, and FDA guidance changes, this study examined the recent evolution of APAP use in children with cancer.

Methods

This retrospective, multi-center analysis extracted APAP prescribing data from the Pediatric Health Information System® ( PHIS ). Eligible children were aged 0-26 years, had a cancer diagnosis per International Classification of Diseases ( ICD ) codes, and were prescribed a chemotherapeutic. APAP and APAP-opioid combination prescribing were assessed at hospital, regional, and national levels. Changes in APAP and APAP-opioid combination use rates were assessed using the non-parametric Mann-Kendall test.

Findings

PHIS records for the complete years of 2004-2021 yielded 388,364 inpatient encounters for 50,779 unique patients. Of these, 87.3% of patients received APAP. Although APAP-opioid combination use was infrequent overall, children receiving APAP were more likely to receive an APAP-opioid combination medication (N=25,880, 13.4%, p < 0.001) compared to those who did not receive APAP. Among specialty children's hospitals, national APAP use was stable over the study period. Regionally, APAP use increased among hospitals in the Northeast. APAP-opioid combination use decreased nationally with regional variation. In contrast to the steady decline in other regions, Southern APAP-opioid combination use was consistently elevated before declining in 2014.

Implications

This article describes acetaminophen and acetaminophen-opioid prescribing trends among children with cancer in the United States. These trends are key to help clinicians assess changes in pain management strategies over time, contextualize analgesic exposure and efficacy, and provide a foundation for future studies in drug safety. Extensive acetaminophen use can affect liver health, and further work is needed to evaluate acetaminophen exposure in children with cancer.

Data Statement

Deidentified data were obtained and evaluated under an IRB-approved protocol. Due to privacy requirements, the data are not available to be shared.