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

PARP inhibitors as maintenance therapy in ovarian cancer after platinum-sensitive recurrence: real-world experience from the Unicancer network

BACKGROUND

Based on results of randomized clinical trials, polyADP-ribose polymerase inhibitors (PARPi) have become the standard of care in patients with platinum-sensitive recurrent ovarian cancer (OvC) in patients responding to platinum chemotherapy. However, little is known about their impact on survival in a real-world setting.

PATIENTS AND METHODS

This retrospective French multicenter observational study included women with platinum-sensitive recurrent OvC (not limited to the first platinum-sensitive relapse) receiving PARPi as maintenance after response to platinum-based chemotherapy. They were compared to patients with similar characteristics undergoing observation after chemotherapy completion. Data were collected in the Ovarian Cancer Epidemiological Strategy and Medical Economics (ESME-OC) database between 2011 and 2021. We explored progression-free survival (PFS) and overall survival (OS) benefits with PARPi maintenance.

RESULTS

One hundred and twenty-three patients matching the selection criteria were included in the PARPi group and 397 patients in the control group. Median PFS was 19.9 months (95CI [15.0-21.9]) in the PARPi group vs 13.4 months (95CI [11.8-15.0]) in the control group, with a HR = 0.71 (95CI [0.55-0.93]), P = .01). Median OS was 82.0 months (95CI [48.6-Not Estimable]) in the PARPi group vs 44.7 months (95CI [38.8-53.7]) in the control group (HR = 0.47, 95CI [0.30-0.74], P < .001). Multivariate analyses including performance status, histological subtype, achievement of cytoreductive surgery at relapse, and platinum-free interval, confirmed the independent prognostic impact of PARPi treatment.

CONCLUSION

This first national study focusing on the efficacy of PARPi in a real-world population shows similar benefits than in randomized clinical trials, supporting their use in clinical routine practice.

DATABASE REGISTRATION

clinicaltrials.gov Identifier NCT03275298.

Accuracy of combining intraoral and facial scan in a single digital model of an orthodontic patient utilizing corresponding measurements on the model and on real photographs: A prospective cross-sectional study

OBJECTIVES

To validate the accuracy of integration of intraoral scan to the facial scan acquired by the EM3D application, utilising the Blue Sky Plan 4 software, creating a digital model of an orthodontic patient, by comparing the same linear measurements on real photographs and images from the digital model of the patient.

MATERIAL AND METHODS

Thirty patients (20 females and 10 males; age range 12-30years) undergoing orthodontic treatment with fixed appliances were recruited in this prospective cross-sectional study from December 2024 to February 2025. Five facial landmarks were marked on each patient: Tragion right, Cheilion right and left, Subnasale and Pronasale. Intraoral scan and facial scan were performed at the same appointment. Facial scan was conducted using an iPhone 13 Pro with the EM3D face scanning application which utilizes the iPhone's TrueDepth camera technology while the patient was smiling. The STL (Stereolithography) and OBG (Object) files (acquired from intraoral and facial scan respectively) were combined in a digital model using the Blue Sky Plan 4 software. Lateral and frontal photographs of the patient's face, while smiling, were also acquired. Eight linear measurements (Tragion right - bracket #11, Tragion right - incisal #11, Cheilion right - #13, Cheilion left - #13, Subnasale - #11, Subnasale - #21, Pronasale - #11, Pronasale - #21) were digitally performed on the real and digital photographs of the patients using the facial landmarks and certain points on teeth and braces. Paired sample t-test and Wilcoxon signed-rank test were used for statistical analysis.

RESULTS

Significantly statistical difference was detected only in one (Cheilion right - #13) measurement (P=0.004).

CONCLUSION

Combining intraoral and facial scan using a special software provides a clinically useful digital model of an orthodontic patient for diagnosis, treatment planning and outcome assessment.

Impact of glucagon-like peptide-1 receptor agonists on postoperative outcomes following ankle fracture open reduction and internal fixation

Glucagon-like peptide-1 receptor agonists (GLP-1RA) are quickly growing in popularity as effective tools in the management of diabetes and weight loss. Despite this increased usage, there is a paucity of literature investigating the use of GLP-1RA in patients with ankle fractures. This study aims to compare the outcomes of patients undergoing ankle fracture open reduction and internal fixation (ORIF) receiving therapy with GLP-1RA to those not receiving treatment. A retrospective analysis was performed utilizing the TriNetX research network to query patients who underwent ankle fracture ORIF between 2000-2024. Two cohorts were established according to preoperative GLP-1RA usage with 1:1 matching by propensity scores for demographics and comorbidities. Primary outcomes included the risk of postoperative complications (i.e. infection, sepsis, wound dehiscence, cellulitis, thrombosis, nonunion, reoperation, revision, etc.) at 30-days, 90-days, 1-year, and 5-years. There were 123,546 patients not taking GLP-1RA and 1,173 patients taking GLP-1RA who underwent ORIF for an ankle fracture, with propensity score matching resulting in two cohorts of 1,173 patients each. After matching, there were no significant differences in demographics or comorbidities, including a 75.6 % prevalence of diabetes mellitus and 68.7 % prevalence of overweight or obesity in both cohorts. At 30-days postoperatively, the no GLP-1RA cohort had a significantly higher rate of removal of hardware (Odds Ratio [OR] 1.953, 95 % Confidence Interval (CI) 1.062-3.591); no other complications demonstrated significant differences at 30-days, 90-days, 1-year, or 5-years postoperatively. These findings further underscore the low risk of preoperative GLP-1RA usage noted in other orthopaedic procedures.

Steeper tibial and meniscal slopes as predictive factors for ramp lesions in anterior cruciate ligament injuries

The relationship between ramp lesion (RL), tibial slope (TS), and meniscal slope (MS) remains inadequately explored. This study aims to investigate whether TS and MS are predictive factors for anterior cruciate ligament (ACL) injuries associated with RL, and to evaluate the performance of TS and MS in predicting RL, including determining optimal cut-off values. A retrospective cohort study was conducted on 253 patients who underwent ACL reconstruction. Magnetic resonance imaging was used to measure TS and MS on tibial plateaus. Logistic regression analyses determined associations between TS, MS, and RL. Receiver operating characteristic (ROC) curves evaluated predictive performance and cut-off values. A total of 65 cases (25.7%) were found to have RL. Significant differences in causes of injury, medial TS (MTS), medial MS (MMS), and bone bruises were observed between groups. In the unadjusted model and adjusted models, they showed significant (P < 0.001) associations for MTS (1.73-1.75) and MMS (OR range = 2.14-2.24). The AUC for MTS was 0.72 (95% CI 0.65-0.79, P < 0.001) with a cut-off value of 6.73°, for MMS was 0.80 (95% CI 0.74-0.86, P < 0.001) with a cut-off value of 4.03°, indicating good predictive performance. Larger MTS and MMS are significant predictive factors for RL in patients with ACL injury. Clinicians should closely monitor ACL injury patients with elevated MTS or MMS. Utilizing MTS or MMS as a predictive parameter shows promise for the identification of RL.

Balloon guide catheter impact on angiographic and clinical outcomes in distal medium vessel occlusion stroke thrombectomy

BACKGROUND

The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion stroke. However, the impact of BGC on angiographic and clinical outcomes in patients with distal medium vessel occlusion (DMVO) strokes undergoing MT has not been extensively investigated.

METHODS

This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients with anterior circulation DMVO due to middle cerebral artery (MCA) M3/M4 or anterior cerebral artery (ACA) A1/A2-3 were included. The cohort was divided into BGC and non-BGC groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used for comparison. The primary outcome was first pass effect (FPE) defined as modified treatment in cerebral infarction (mTICI) grade 2C/3 after single device pass.

RESULTS

Among 199 patients who were eligible for analysis, 81 (40.7%) were female. The median age was 69 (60-81) years, and National Institutes of Health Stroke Scale score was 13 (7-18). The BGC group (n=73) had higher rates of FPE (53.4% vs 13.7%; IPTW aOR 5.63, 95%CI (2.43 to 13.10), P<0.001) compared with the non-BGC group (n=126). The BGC group had higher rates of modified Rankin Scale (mRS) 0-1 (42.9% vs 27.1%; IPTW aOR 2.78, 95% CI (1.10 to 7.07), P=0.031), mRS 0-2 (60.3% vs 41.5%; IPTW aOR 4.31, 95% CI (1.66 to 11.19), P=0.003), and lower rates of mortality at 90-days (12.7% vs 25.4%; IPTW aOR 0.32, 95% CI (0.11 to 0.98), P=0.047) compared with the non-BGC group. The rates of successful reperfusion at the end of the procedure and symptomatic intracerebral hemorrhage were comparable between both groups.

CONCLUSION

The present study suggests that the use of BGC in DMVO undergoing MT may be associated with improved angiographic and clinical outcomes with no safety concerns. Prospective studies are warranted.

ALDH2 Deficiency and Alcohol Intake in the United States: Opportunity for Precision Cancer Prevention

BACKGROUND

Alcoholic beverages and the main metabolite of alcohol, acetaldehyde, are known carcinogens. A genetic variant in aldehyde dehydrogenase 2 (ALDH2, G>A, rs671) leads to decreased efficiency in metabolizing acetaldehyde and is associated with an increased cancer risk. As alcohol consumption is a modifiable risk factor for various cancers, the identification of ALDH2 deficiency presents an opportunity for precision cancer prevention.

METHODS

Our primary objectives were to examine the prevalence of ALDH2 deficiency and alcohol consumption behavior among affected individuals within a large, diverse US national cohort. The prevalence of ALDH2 deficiency was determined by examining the rs671 genotype among 311,290 participants within the All of Us Research Program. Relationships among self-reported alcohol consumption, sociodemographic factors, and the rs671 genotype were analyzed.

RESULTS

ALDH2 deficiency was most prevalent among individuals who identified as Asian, among whom 23.5% had at least one deficient ALDH2 allele compared with <2.5% in all other racial/ethnic groups. Among those with one and two deficient ALDH2 alleles, 61.2% and 24.4% reported drinking in the past year, respectively, and of these, 30.3% and 16.0% reported binge drinking. Multivariable analysis showed that ALDH2 genotype, sex, age, race, education, income, employment, marital status, and country of birth were associated with alcohol consumption behavior.

CONCLUSIONS

Most individuals with ALDH2 deficiency reported drinking alcohol in the past year, and consumption was associated with various sociodemographic variables, particularly sex, age, and country of birth.

IMPACT

Our findings suggest a significant opportunity for precision cancer prevention targeting the unique prevalence of ALDH2 deficiency among Asian Americans.

Mental Wellbeing and its Determinants in People with Parkinson's Disease in Ethiopia: A Mixed-Method Study

Globally, the prevalence of Parkinson's disease (PD) is increasing at an unprecedented rate. Therefore, it is imperative to provide evidence on the mental well-being of individuals with PD and identify context-specific determinants in sub-Saharan Africa to inform future interventions. An explanatory sequential mixed-methods design was employed, recruiting 304 individuals with PD who were receiving follow-up treatment. The prevalence of poor mental well-being among participants was 72.5%. Psychiatric manifestations included depression with suicidal ideation, anxiety, poor sleep quality, cognitive impairment, psychotic symptoms, and emotional and behavioral changes. Stigma was significantly associated with poor mental well-being, with an adjusted odds ratio of 1.13 (95% CI: 1.07-1.203, P < 0.001). A framework illustrating the vicious cycle of PD-related stigma, discrimination, and its impact on mental well-being was developed. Routine screening and treatment of mental disorders, along with community awareness campaigns to reduce stigma, are strongly recommended.Plain language summaryParkinson's disease (PD) exerts a significant impact on mental well-being due to its disease process and associated social and economic consequences. Therefore, assessing the prevalence of poor mental well-being, identifying manifestations of mental illness, and examining context-specific determinants in sub-Saharan Africa are essential to informing current practices and future research. Findings from this study reveal that nearly three-fourths of individuals with PD experience poor mental well-being in Ethiopia. Additionally, they exhibit a range of psychiatric manifestations, including severe conditions such as hopelessness and suicidal ideation. PD-related stigma is an independent determinant of mental well-being. People with PD face significant stigma and discrimination, largely driven by societal misconceptions about the causes of the disease. Routine screening and treatment of mental disorders, alongside the integration of mental health care into routine PD management, are essential to addressing the mental health needs of individuals with PD. Community awareness initiatives on the causes of PD are critically needed to reduce stigma and promote mental well-being. Given the high burden of mental disorders and the impact of stigma and discrimination, mental health and psychosocial interventions should prioritize individuals with PD.

Relationship Between the Frequency of Energy Drink Consumption and Sleep Time by Sex Among Korean Adolescents: A Secondary Analysis Using National Survey Data

BACKGROUND

Energy drinks are becoming increasingly popular among adolescents despite potential adverse health effects. This study addresses the research question: "Is there an association between the frequency of energy drink consumption and insufficient sleep by sex?"

PURPOSE

This study aimed to assess the frequency of energy drink consumption by sex among Korean adolescents aged 12 to 18 years and investigate its relationship with insufficient sleep.

METHODS

We analyzed secondary data using data from the 18th Korea Youth Risk Behavior Survey (2022). The study included 36 361 middle- and high school students. Complex sample logistic regression analysis examined the relationship between energy drink consumption and insufficient sleep by sex.

RESULTS

Among the respondents, 9.0% of male and 9.2% of female students reported consuming energy drinks frequently. In complex sample logistic regression analyses, those who reported consuming frequent energy drinks had significantly higher odds of insufficient sleep than the no-consumption group, controlling for potential confounding variables (adjusted odds ratio (OR) 2.15, 95% confidence interval (CI) 1.76-2.61 in male students; adjusted OR 3.25, 95% CI 2.39-4.41 in female students). Notably, female students who frequently consume energy drinks pose a substantial concern regarding insufficient sleep.

CONCLUSIONS

Frequent energy drink consumption was associated with insufficient sleep time in both male and female adolescents. This highlights the need for public health policy interventions to reduce energy drink consumption and promote appropriate amounts of sleep among adolescents.

Importance of Limitation Sections in Clinical Research and Quality Improvement Manuscripts

A description of study limitations is a critical component of reporting research findings that can help future researchers and clinical teams improve patient outcomes.

Technical and Clinical Outcomes of 13 years of Endovascular Repair of Infrarenal, Atherosclerotic, Penetrating Aortic Ulcers

BACKGROUND

To report the technical and clinical outcomes of endovascular repair of all infrarenal, penetrating aortic ulcers (PAUs) that were treated at a single institution over a 13-year period.

METHODS

This is a single-center, retrospective observational study. All patients consecutively treated for atherosclerotic, infrarenal PAU were included between 2010 and 2023. Outcomes were technical success, overall survival, PAU-related death, freedom from secondary rupture, freedom from secondary interventions, freedom from aortic expansion >5 mm, freedom from type 1 and type 3 endoleak (EL), and freedom from stent graft migration, each at 30 days, 1 year, 2 years, and 5 years of follow-up. The study was registered at the German Clinical Trials Register (DRKS00028794).

RESULTS

Forty-seven patients were included (8 female patients, 17.0%) with a median age of 75.7 years (interquartile range (IQR): 70.2-81.0). The median maximum aortic diameter was 39.7 mm (IQR: 33.6-45.2). Overall, primary and secondary technical success was achieved in 42 of 47 (89.4%) and 46 of 47 patients (97.9%). Standard aortobiiliac endovascular aneurysm repair (EVAR) was the most frequent procedure in 25 patients (53.2%). An aortomonoiliac stent graft system was used in 5 patients (10.6%). The remaining 17 patients (36.2%) were treated using an aorto-aortic tube stent graft configuration. The median clinical follow-up was 5.1 years (IQR: 1.9-8.1) with a median imaging follow-up of 1.5 years (IQR: 0.4-5.0). Overall survival at 30 days, 1, 2, and 5 years of follow up was estimated at 100% (confidence interval (CI), 100%-100%), 95.4% (CI, 89.4%-100%), 87.9% (CI, 78.4%-98.4%), and 82.0% (70.7%-95.2%), respectively. There was 1 PAU-related death (2.1%). Freedom from secondary intervention at 30 days, 1, 2, and 5 years of follow-up was 93.6% (CI, 86.9-100%), 89.2% (CI, 80.6-98.6%), 81.5% (CI, 70.7-94.0%), and 75.2% (CI, 62.8-90.2%), respectively. No patient who underwent either preoperative (n = 1) or intraoperative embolization (N = 7) of lumbar arteries (LAs) and/or the inferior mesenteric artery (IMA) demonstrated type 2 EL during follow-up.

CONCLUSION

A variety of alternatives to standard aortobiiliac EVAR are required for endovascular PAU repair. To identify the optimal management strategy in these cases further studies are needed. Type 2 EL in abdominal PAU disease appears to be preventable by LA and/or IMA embolization.

Risk of bias tools for medication adherence research: RoBIAS and RoBOAS

AIMS

An unbiased means of documenting medication-taking is important to ensure quality evidence about adherence research and to accurately identify individuals at risk of suboptimal adherence for the development of targeted and effective interventions. Guidance to assist researchers in the understanding of risk of bias when conducting or reviewing adherence research is currently not available. To address this gap, tools to identify and gauge the magnitude of important biases that may impact adherence research have been developed.

METHODS

The Risk of Bias tool for Interventional Adherence Studies (RoBIAS) and the Risk of Bias tool for Observational Adherence Studies (RoBOAS) were constructed from a literature review of key adherence guidelines/frameworks, drafted initially through author consensus. The draft bias tools were piloted and evaluated with expert adherence researchers through an online survey platform to assess the internal consistency and agreement in responses, including gather "free text" feedback to improve the tool's utility.

RESULTS

Of the 121 approached reviewers, only 20 out of the 30 reviewers who consented to participate completed the piloting of the tools. Both tools are structured around four domains relating to: (i) study design, (ii) randomization (RoBIAS tool) and confounding factors (RoBOAS tool), (iii) adherence outcome measurement, and (iv) data analysis. Each domain consists of items/statements, mapped to specific biases relevant to adherence research and study designs, including a domain-based ranking scale to determine the appropriate risk of bias judgement.

CONCLUSIONS

The tools are intended to have utility when systematically reviewing adherence research and to inform the design of future adherence studies.

Ivacaftor-tezacaftor-elexacaftor, tezacaftor-ivacaftor and lumacaftor-ivacaftor for treating cystic fibrosis: a systematic review and economic evaluation

Background

Cystic fibrosis is a life-limiting genetic condition that affects over 9000 people in England. Cystic fibrosis is usually diagnosed through newborn screening and causes symptoms throughout the body, including the lungs and digestive system. Around 90% of individuals with cystic fibrosis have at least one copy of the F508del mutation on the cystic fibrosis transmembrane conductance regulator gene.

Objectives

To appraise the clinical effectiveness and cost-effectiveness of elexacaftor-tezacaftor-ivacaftor, tezacaftor-ivacaftor and lumacaftor-ivacaftor within their expected marketing authorisations for treating people with cystic fibrosis and at least one F508del mutation, compared with each other and with established clinical management before these treatments.

Methods

A de novo systematic literature review (search date February 2023) was conducted searching electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), bibliographies of relevant systematic literature reviews, clinical trial registers, recent conferences and evidence provided by Vertex Pharmaceuticals (Boston, MA, USA). Data on the following outcomes were summarised: acute change in per cent predicted forced expiratory volume in 1 second (change in weight-for-age z-score; and change in pulmonary exacerbation frequency requiring intravenous antibiotics. Network meta-analyses were conducted where head-to-head data were not available. Data from clinical trials and real-world evidence were examined to assess long-term effectiveness. A patient-level simulation model was developed to assess the cost-effectiveness of the three modulator treatments. The model employed a lifetime horizon and was developed from the perspective of the National Health Service.

Results

Data from 19 primary studies and 7 open-label extension studies were prioritised in the systematic literature review. Elexacaftor/tezacaftor/ivacaftor was associated with a statistically significant increase in predicted forced expiratory volume in 1 second and weight-for-age z-score and a reduction in pulmonary exacerbations compared with established clinical management, lumacaftor/ivacaftor and tezacaftor/ivacaftor, and also led to a reduction in the rate of predicted forced expiratory volume in 1 second decline relative to established clinical management, although the magnitude of this decrease was uncertain. Lumacaftor/ivacaftor and tezacaftor/ivacaftor were also associated with a statistically significant increase in predicted forced expiratory volume in 1 second and reduction in pulmonary exacerbations relative to established clinical management, but with a smaller effect size than elexacaftor/tezacaftor/ivacaftor. There was some evidence that tezacaftor/ivacaftor reduced the rate of predicted forced expiratory volume in 1 second decline relative to established clinical management, but little evidence that lumacaftor/ivacaftor reduced the rate of predicted forced expiratory volume in 1 second decline relative to established clinical management. The incremental cost-effectiveness ratios from the economic analysis were confidential. However, for all genotypes studied the incremental cost-effectiveness ratios were above what would be considered cost-effective based on the National Institute for Health and Care Excellence threshold of £20,000-30,000 per quality-adjusted life-year gained.

Conclusions

Despite the improved clinical benefits observed, none of the cystic fibrosis transmembrane conductance regulator gene modulators assessed would be considered cost-effective based on the National Institute for Health and Care Excellence threshold of £20,000-30,000 per quality-adjusted life-year gained. This is largely driven by the high acquisition costs of cystic fibrosis transmembrane conductance regulator gene modulator treatments.

Study registration

This study is registered as PROSPERO CRD42023399583.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135829) and is published in full in Health Technology Assessment; Vol. 29, No. 19. See the NIHR Funding and Awards website for further award information.

Fracture of the Anteromedial Facet of the Coronoid is More Common Than Previously Thought in Combined Fractures of the Coronoid and Radial Head

BACKGROUND

The terrible triad injury involves an ulnohumeral dislocation, radial head fracture, and coronoid process fracture. According to traditional teaching, these injuries are strongly associated with anterolateral coronoid tip fractures and can be addressed via a lateral approach to the elbow. However, recent small clinical series suggest that some terrible triad injuries have larger coronoid fractures involving the anteromedial facet. It is important to understand how often these larger coronoid fractures occur because anteromedial facet fractures may need a different approach and different implants for fixation. An improved understanding of coronoid fracture morphology in terrible triad injuries may help surgeons construct a surgical plan.

QUESTIONS/PURPOSES

To better define coronoid fracture morphology in combined coronoid and radial head fractures, we therefore asked: What is the distribution of anterolateral facet versus anteromedial facet coronoid fragments in combined coronoid and radial head fractures without an ulnar shaft fracture?

METHODS

This retrospective, multicenter descriptive study evaluated preoperative CT scans from adult patients (18 years or older) diagnosed with combined coronoid and radial head fractures. Between February 2014 and March 2023, we identified 10,016 adult patients with elbow or forearm injuries who underwent CT scans. Among these patients, we considered those diagnosed with combined coronoid and radial head fractures without an ulnar shaft fracture based on elbow CT scans performed within 4 weeks of the injury as potentially eligible. During that time, elbow CT scans were generally ordered to assess complex fractures, confirm diagnoses when radiographs were inconclusive, evaluate joint involvement, or plan for surgical interventions. Based on that, 2% (175 of 10,016) were eligible; a further 0.001% (8 of 10,016) were excluded because of preexisting elbow pathology, prior surgery, or low-quality CT images (including slice thickness greater than 2 mm, motion artifacts, and incomplete visualization of the osseous structure of the elbow and all its articulations), leaving 2% (167 of 10,016) for analysis. The mean age was 50 ± 15 years, and more than half of the patients were female (54% [90 of 167]). Coronoid fractures in patients with combined coronoid and radial head fractures were classified using the O'Driscoll classification into three types: Type 1 (anterolateral tip fractures), Type 2 (anteromedial facet fractures), and Type 3 (base fractures). Each type was further subcategorized based on specific fracture characteristics. Two of three trained researchers independently classified the coronoid fracture type of each patient using radiographs, two-dimensional (2D) CT scans, three-dimensional (3D) CT scans, and intraoperative findings, with interrater reliability assessed by the Cohen kappa, yielding a substantial agreement value of 0.658. Disagreements were resolved through discussions with a fellowship-trained orthopaedic trauma surgeon.

RESULTS

Sixty-five percent (109 of 167) of patients had a Type 1 anterolateral coronoid tip fracture, 30% (50 of 167) had a Type 2 anteromedial facet fracture, and 5% (8 of 167) had a Type 3 basal fracture.

CONCLUSION

Surgeons should recognize that anteromedial facet involvement in coronoid fractures is more prevalent in combined coronoid and radial head fractures than previously appreciated. Future research should investigate whether these anteromedial fractures are more likely to need an additional medial approach to improve patient outcomes.

CLINICAL RELEVANCE

This study suggests that anteromedial facet involvement is more common than traditionally recognized in terrible triad injuries, and surgeons should be prepared to address a larger fragment when treating these injuries.

The Movement Competency Screen Shows Improved Injury Predictive Ability Compared With the Functional Movement Screen in Ballet and Contemporary Dance Populations: A Critically Appraised Topic

CLINICAL SCENARIO

Ballet dancers exhibit a high risk of musculoskeletal injuries with around 75% of all injuries attributed to overuse injuries. The high prevalence of chronic injuries suggests contributions caused by abnormal biomechanics in combination with repetitive stress common to ballet. Traditional sports settings implement movement screening tools including the Movement Competency Screen (MCS) and functional movement screen (FMS) to identify factors predisposing athletes to injury. However, unique training demands and movement patterns of ballet and contemporary pose challenges for fundamental movement screenings. Identifying relationships between movement screening scores and injury incidence in dancers may allow for early injury risk factors detection and injury prevention programs implementation to reduce overall injury rate.

CLINICAL QUESTION

Does implementation of the MCS improve prediction of injury incidence compared with use of the FMS™ in collegiate, preprofessional, and professional ballet, and contemporary dancers?

SUMMARY OF KEY FINDINGS

Three studies met the inclusion criteria for critical appraisal. One study utilized the MCS while the other 2 implemented the FMS™ to assess ballet and modern dancers. These studies concluded the MCS may predict injury when implemented as a preseason screening in ballet and contemporary. The FMS™ did not demonstrate predictive capability for injuries in ballet and contemporary dancers.

CLINICAL BOTTOM LINE

While the MCS shows injury prediction potential, a dance-specific movement screening more accurately representing dance-related movement patterns may improve validity in this population. Continuation and standardization of dance injury research is imperative to understand movement compensations predisposing individuals to injury and injury prevention measures.

RECOMMENDATION

Grade B evidence suggests potential predictive ability of the MCS in identifying dance-related injury, while no association exists between the FMS™ and dance injuries. Additional research regarding dance-specific movement application to functional screenings shows potential for accurate and reliable injury prediction methods for ballet and modern dancers.

Prevalence of postoperative pulmonary complications in recipients of liver transplantation with abnormal preoperative spirometry

ObjectiveTo determine the incidence of postoperative pulmonary complications in liver transplantation recipients with abnormal preoperative spirometry.MethodsA retrospective observational study was conducted among 210 patients with abnormal preoperative spirometry who underwent living donor liver transplantation between April 2012 and January 2024. Liver transplantation recipients were divided into two groups based on the spirometry diagnosis of restrictive lung disease or obstructive lung disease. The incidence of postoperative pulmonary complications and impact on patient outcomes were assessed in terms of length of stay in the intensive care unit, total length of stay in the hospital, time on the ventilator, duration of surgery, noninvasive ventilator dependence, reintubation rate, hospital-acquired infection, mortality, and arterial blood gas analysis.ResultsThe incidence of postoperative pulmonary complications was approximately 91.2% in liver transplantation recipients with abnormal preoperative spirometry. The length of stay in the intensive care unit, total length of stay in the hospital, duration of surgery, noninvasive ventilator dependence, reintubation rate, mortality, and hospital-acquired infections did not notably differ between recipients with restrictive lung disease (n = 189) and obstructive lung disease (n = 21).DiscussionAbnormal spirometry resulted in an increased incidence of postoperative pulmonary complications. However, the study suggests that the effects of abnormal spirometry were similar after liver transplantation.ConclusionPreexisting restrictive and obstructive lung diseases are associated with similar risks in liver transplantation recipients. However, as our study had fewer patients with obstructive lung disease, future research should include a comparable number of patients with restrictive and obstructive lung diseases to produce robust data on postoperative complications within this group for liver transplantation.

It May Not Be the Smartest Thing to Do, but Sometimes It's the Only Option: A Longitudinal Mixed-Methods Study of Analgesic Use in Youth Elite Athletes

OBJECTIVES: To (1) compare analgesic use over 36 weeks between endurance athletes, technical athletes, and team athletes, and (2) explore experiences and sociocultural factors impacting analgesic use. DESIGN: Longitudinal mixed-methods study METHODS: Six hundred eighty-nine youth elite athletes (44% girls/women, 15-20 years) provided weekly reports on number of days with analgesic use, reasons for use, and types of analgesics used for 36 weeks. Prevalence and frequency of analgesic use was compared between athletes from team sports, endurance sports, and technical sports using mixed-effects logistic and Poisson regression models. Reasons and types of analgesics used were compared between groups using Chi-square tests. Nine focus group interviews with 32 participants were conducted and analyzed using thematic analysis. RESULTS: There were no differences in odds of analgesic use between endurance athletes (reference group), technical athletes (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.65, 1.37), and team athletes (OR, 0.88; 95% CI: 0.62, 1.25). Similarly, there were no differences in rate of analgesic use between endurance athletes (reference group), technical athletes (incidence rate ratio [IRR], 0.97; 95% CI: 0.87, 1.07), or team athletes (IRR, 1.03; 95% CI: 0.94, 1.14). Reasons for use varied between groups, while the types of analgesics used were similar. Sociocultural factors impacting analgesic use included considering the potential consequences of using analgesics for pain and injury, and feeling responsible for team performance. CONCLUSION: Analgesics were commonly used among youth elite athletes in Denmark. Analgesic use generally did not vary between team athletes, endurance athletes, and technical athletes. Several norms, values, and structures in sports environments impacted analgesic use. J Orthop Sports Phys Ther 2025;55(5):1-11. Epub 3 April 2025. doi:10.2519/jospt.2025.13015.

Association between diabetes self-management education attendance, hospital admissions and mortality in type 2 diabetes: A cohort analysis protocol

INTRODUCTION

Type 2 diabetes is associated with excess hospital admissions and increased mortality. Structured diabetes self-management education (DSME) is recommended internationally and is associated with improved self-management skills, well-being and minor improvements in glycated haemoglobin (HBA1c), but does it reduce hospital admissions or prevent premature mortality? Our aim is to examine the relationship between DSME attendance, hospitalisations, mortality and 3-point major adverse cardiovascular events (MACE) in people with type 2 diabetes to inform future healthcare policy and diabetes care.

METHODS AND ANALYSIS

This protocol details a 10-year retrospective open cohort study of patients aged over 18 years old who have a clinical diagnosis of type 2 diabetes and were registered to an English GP practice from 29 March 2011 to 29 March 2021 and have attended DSME. Patients in the 'ever' cohort will be matched at baseline for age, sex, age at diagnosis and diabetes duration, to those who have 'never' attended DSME. Data will be identified via the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics Admitted Patient Care data, Office for National Statistics death registrations and patient Index of Multiple Deprivation deciles. Patients will be followed-up through serial cross-sections. Multiple imputation will be considered to manage covariates where data are >12-months from baseline or are not expected to be missing at random. Cox proportional hazard regression and time to event modelling adjusted a priori for cofounding during multivariate analysis will be used.

ETHICS AND DISSEMINATION

This study was approved by CPRD (24_003744). Study findings will be disseminated through peer-reviewed publications and international conferences.

Effects on Cardiac Dimensions and Peak Oxygen Uptake After Long-Term Deconditioning in Elite Athletes

This longitudinal observational study aimed to determine if ventricular dimensions of the athlete's heart remain balanced and proportional to peak oxygen uptake (VO2peak) following long-term deconditioning in elite athletes. Fourteen mixed-type male athletes (7 soccer, 7 handball players) were prospectively evaluated with cardiac magnetic resonance imaging and cardiopulmonary exercise testing while active at elite level and after retirement. Athletes were cross-sectionally compared to 14 age-matched controls at baseline and follow-up. Statistical analysis was performed using nonparametric tests. Descriptive statistics are presented as median [Q1, Q3]. Since baseline, athletes reported continued elite sports for 5 [2, 9] years followed by retirement for 12 [7, 14] years. Left ventricular end-diastolic volume (LVEDV) decreased by 17% (261 mL to 222 mL, p < 0.001). Right ventricular end-diastolic volume (RVEDV) decreased by 14% (266 mL to 232 mL, p < 0.001). Left atrial end-systolic volume decreased by 16% (94 mL to 82 mL, p < 0.05). Peak oxygen uptake (VO2peak) decreased by 17% (3.96 L/min to 3.37 L/min, p < 0.001). There were no differences between athletes after retirement compared to controls. LVEDV and RVEDV were balanced in athletes at baseline (rs = 0.92, p < 0.001) and follow-up (rs = 0.92, p < 0.001). LVEDV and RVEDV indexed to VO2peak remained unchanged after deconditioning. Exercise-induced cardiac remodeling was reversible after long-term deconditioning in this cohort of elite athletes. LVEDV and RVEDV decreased and remained balanced and proportional to VO2peak. This study indicates that cardiac adaptations to sports are physiological. However, more research is needed to investigate the reversibility of exercise-induced cardiac remodeling in disciplines with higher demands on endurance performance.

Incidence and Risk Factors of Interval and Screen-Detected Breast Cancer

Importance

Mammographic screening is the only proven method for early detection and mortality reduction of breast cancer (BC). However, many patients are missed at prior screening; thus, they receive their diagnosis between the interval of screening rounds, called interval cancer (IntCa). Some IntCas are fast growing between screening rounds.

Objective

To investigate the incidence and proportion of IntCa and screen-detected breast cancer (ScrCa) and identify factors associated with IntCa.

Design, Setting, and Participants

This population-based cohort study was conducted from January 1989 to March 2020, with follow-up until 2020 and a mean (SD) follow-up of 13 (8.3) years. The statistical analysis was performed from February 2023 to June 2024. It included cancer-free women (N = 527 144) residing in Stockholm, Sweden, who were invited to undergo mammography screening (aged 40-74 years) during 1989 to 2020. An additional cohort of women were included who were participating in the Karolinska Mammography Project for Risk Prediction of Breast Cancer study and had mammography data available.

Exposures

Family cancer history (defined from the Swedish Multi-Generation Register and Cancer Register), mammographic density, and various demographic, reproductive, and other factors (multiple Swedish registers).

Main Outcomes and Measures

Incidence of ScrCa and IntCa (defined from the Swedish Cancer Register in conjunction with individual screening histories).

Results

A total of 29 049 women (5.5%) received a diagnosis of BC, of whom 10 631 (2.0%) had ScrCa and 4369 (0.8%) IntCa. ScrCa and IntCa incidences increased during the period. The proportion of IntCa among screened patients with BC was around 30%, which decreased with older age. Factors associated with increased risk of IntCa included older age at first childbirth, higher education level, hormone replacement therapy, and higher mammographic density. Risk estimates of family cancer history on IntCa were family history of BC (hazard ratio [HR], 1.85; 95% CI, 1.72-1.99), family history of IntCa (HR, 2.92; 95% CI, 2.39-3.55), and hereditary breast and ovarian cancers (HR, 1.45; 95% CI, 1.36-1.54), with risk further elevated with the number of relatives who received a diagnosis when younger than the median age. Women with IntCa were more likely to have estrogen receptor (ER)-negative cancers than women with ScrCa (22% vs 11%), and having family history of ER-negative BC was associated with 3-fold risk for ER-negative IntCa.

Conclusions and Relevance

The results of this cohort study suggest that IntCa rates have not decreased with age-based screening, and implementing risk-based screening considering IntCa-specific risk factors is necessary for improving outcomes.

Modulation Effect of Physical Activity on Sleep Quality and Mental Hyperactivity in Higher-Education Students

Objectives: The present study seeks to analyze the relationships between the intensity of physical activity, mental hyperactivity and sleep quality. A comparative, descriptive and exploratory study was carried out. Methods: A sample of 1907 university students belonging to the degree of Physiotherapy and Physical Activity and Sport Sciences was used. The International Physical Activity and Mental Hyperactivity Questionnaires were used. The scale used was the Pittsburgh sleep quality index. The proposed model analyzes the relationships of physical activity with mental hyperactivity and various sleep-related factors. Results: The following fit indices were evaluated: Chi-Square = 80.242; Degrees of Freedom = 3; Incremental Fit Index = 0.951, Comparative Fit Index = 0.977; Normed Fit Index = 0.946; Root Mean Square Error of Approximation = 0.071. The values obtained show the good fit of the theoretical model. Statistically significant differences are observed (p < 0.05) in the causal relationship of mental hyperactivity with the personal assessment of sleep as a function of the intensity of physical activity. A greater effect of light (β = 0.671) compared to moderate- (β = 0.428) or vigorous-intensity (β = 0.343) physical activity in personal sleep assessment is evident. Statistically significant differences were also observed in the causal relationship of mental hyperactivity with the time to fall asleep (p < 0.05). Light physical activity (β = 0.479) has a greater causal relationship with time to fall asleep than moderate- (β = 0.302) or vigorous-intensity (β = 0.413) physical activity. Conclusions: Based on the results obtained, it is concluded that the intensity with which physical activity is performed has a modulating effect on sleep quality and mental hyperactivity.

High muscle-to-fat ratio predicts slow muscle strength decline in middle-aged and older adults: Longitudinal aging study of Taipei

BACKGROUND

Handgrip strength is a vital marker of muscle function and predictor of health outcomes in older adults. This study investigated the relationship between the muscle-to-fat ratio and 3-year decrease in handgrip strength in community-dwelling adults aged ≥50 years.

METHODS

Data were obtained from the Longitudinal Aging Study of Taipei (LAST), a cohort study of adults aged 50 years and older. Measurements from two waves, 3 years apart, were analyzed. Demographics, laboratory data, and handgrip strength data were collected. Appendicular skeletal muscle mass was assessed using bioimpedance analysis, and the relative appendicular skeletal muscle mass index was calculated by dividing appendicular muscle mass by height squared. The muscle-to-fat ratio was derived by dividing appendicular muscle mass by total body fat. Handgrip strength decrease was divided into quartiles; slow decliners experienced the smallest decrease, whereas rapid decliners had the greatest decrease. Associations between the muscle-to-fat ratio and other risk factors were analyzed.

RESULTS

Over 3 years, the Charlson Comorbidity Index, medication use, waist-to-hip ratio, and fat percentage increased, whereas skeletal muscle mass, the muscle-to-fat ratio, and handgrip strength decreased. Rapid decliners were less likely to be male (21.6% vs 33.3%, p = 0.008) or alcohol drinkers (53.8% vs 66.2%, p = 0.01) and had lower skeletal muscle mass (6.3 ± 0.9 vs 6.6 ± 1.0, p = 0.006) and muscle-to-fat ratios (1.0 ± 0.4 vs 1.1 ± 0.5, p = 0.004) but greater fat percentages (30.4 ± 6.6 vs 29.0 ± 7.6, p = 0.045). A greater muscle-to-fat ratio (odds ratio [OR] = 3.751, p = 0.047), greater physical activity (OR = 1.694, p = 0.04), and lower glycated hemoglobin (HbA1c; OR = 0.61, p = 0.008) reduced the risk of rapid decline.

CONCLUSION

The muscle-to-fat ratio, together with physical activity and glycemic control, predicts a decrease in handgrip strength, highlighting its potential as a biomarker of intrinsic capacity and muscle-fat interplay. Further research is needed to explore the underlying biological mechanisms involved.

Possibility of preventing intra-abdominal infection by lymph node mapping with indocyanine green in robotic gastrectomy

BACKGROUND

Intra-abdominal infection can be an onerous and fatal complication of radical gastrectomy for gastric cancer. High drain amylase levels are closely related to pancreatic damage and intra-abdominal infection. We aimed to investigate whether robotic radical gastrectomy with lymph node mapping by indocyanine green tracer reduces drain amylase levels.

METHODS

Between March 2019 and July 2024, patients at our institution with clinical tumor stage cT1-T4a, N0/+, M0, and possibly treatable gastric cancer were enrolled in this study and divided into the indocyanine green group or the non-indocyanine green group based on the use of indocyanine green. One day before surgery, the patients in the indocyanine green group underwent endoscopic peritumoral injection of indocyanine green into the submucosa. Drain amylase levels on postoperative days 1 and 3, postoperative intra-abdominal infection, and perioperative outcomes were compared between the 2 groups.

RESULTS

There were no significant differences in patient background and pathologic factors between the 2 groups. Drain amylase levels on postoperative days 1 and 3 were significantly lower in the indocyanine green group than in the non-indocyanine green group, and postoperative hospital stay was shorter. The incidence of intra-abdominal infection was also significantly lower in the indocyanine green group than in the non-indocyanine green group. However, multivariate analysis of intra-abdominal infection showed a drain amylase level of 200 IU/L or higher on postoperative day 3 to be an independent risk factor for postoperative intra-abdominal infection, whereas indocyanine green use was not.

CONCLUSION

This study showed the clinical usefulness of robotic radical gastrectomy with lymph node mapping by indocyanine green. This procedure can reduce drain amylase levels and consequently may reduce the incidence of intra-abdominal infection.

Angular alignment, rotational profile, and joint range of motion in the lower limb of typically developing children from 7-16 years of age: a cross-sectional study

BACKGROUND AND PURPOSE

 We aimed to update reference intervals for anthropometric parameters for the passive joint range of motion (ROM), rotational profile, and angular alignment of the lower limb in typically developing children (TDC), to compare the association of the variables age, left-right sidedness, body mass index (BMI), and sex.

METHODS

 We conducted a cross-sectional study in a convenience sample of TDC from the 1st, 5th, and 9th grades (6-17 years) in a randomized selection of Danish primary schools. We examined the anthropometric parameters in a non-clinical setting. Descriptive statistics were used to characterize the data. To explore potential differences across the variables, we utilized Bonferroni-corrected Welch's 2-sample t-tests, one-way analysis of means, and univariable linear regression.

RESULTS

 We analyzed the associations between the variables and the anthropometric parameters in 501 TDC, aged 6 to 17 years. We found a statistically significant, but not clinically meaningful decrease in ROM for the hip, knee, and ankle as well as decreased femoral anteversion and increased tibial torsion with increasing age, but no association with sex or sidedness. However, several associations between BMI and ROM measurements were statistically significant and potentially clinically meaningful, with ROM decreasing by approximately 0.4° to 1.2° per unit increase in BMI, particularly for hip, knee, and ankle flexion movements.

CONCLUSION

 Anthropometric parameters remain clinically stable after 7 years of age and are affected only by the BMI but not sex or age. We found a statistically significant but not clinically relevant decrease in torsion and joint ROM with increasing age.

Comparison between the chin position of male and female untreated growing Class I subjects: a mixed-longitudinal study

OBJECTIVES

To evaluate the position of the chin of untreated male and female Class I growing subjects.

MATERIALS AND METHODS

A sample of 51 growing Class I subjects, 29 male and 22 female, from 7 to 16 years of age, was studied. The total number of 359 lateral cephalograms included at least one cephalogram for each subject taken in the early mixed dentition (younger than 10 years), one in late mixed dentition (between 10 and 12 years), and one in the permanent dentition phase (older than 12 years old).

RESULTS

Descriptive statistics for the X component (horizontal) and Y component (vertical) of the cephalometric landmark Gnathion (Gn) were recorded. Student t-tests showed no differences between male and female growing subjects for the X component (horizontal), but significant differences for the Y component (vertical).

CONCLUSIONS

Displacement of the mandible over the timeframe studied differs between male and female untreated subjects. Although most of the orthodontic literature addresses such differences as an anteroposterior phenomenon, this study found that the difference is mainly due to the vertical, and not horizontal, component of such displacement.

State-Level Tax Policy, Cancer Screening, and Mortality Rates in the US

Importance

The Healthy People 2030 initiative has set national cancer screening targets for breast, colon, and cervical cancers, as well as aims for reducing cancer mortality. State-level tax policy is an underappreciated social determinant of health that may improve cancer screening and mortality rates.

Objective

To define the association of tax revenue and tax progressivity with state-level cancer screening and mortality.

Design, Setting, and Participants

This ecologic, population-based, cross-sectional study assessed cancer screening (2020 and 2022) and mortality rates (1999-2021) in the US relative to state-level tax revenue (1997-2019) and tax progressivity (2002, 2009, 2012, 2014, and 2018) with a 2-year lag. The study included 50 states through 23 years with state-years used as the unit of analysis. Cancer screening rates were derived from the Centers for Disease Control and Prevention (CDC) Population Level Analysis and Community Estimates database. State-level cancer-related death and population counts were derived from the CDC Wide-Ranging Online Data for Epidemiologic Research database. Data analysis occurred from September to January 2024.

Exposure

State-level tax policy was proxied by tax revenue per capita and the Suits index of tax progressivity, with progressive taxation equaling lower tax burden for more disadvantaged populations.

Main Outcomes and Measures

Outcomes included screening rates for colon, breast, and cervical cancer, as well as mortality rates for all malignant neoplasms and malignant neoplasms with guideline-recommended screening. Multivariable models were adjusted for tax-related, socioeconomic, and demographic variables.

Results

In total, 1150 state-years were included in the analysis. Median (IQR) tax revenue per capita was $4432 ($3862-$5210), and the median (IQR) number of cancer-related deaths was 8341 (3150-13 585) across all state-years. Of note, each $1000 increase in tax revenue per capita was associated with a 1.61% (95% CI, 0.50%-2.73%) increase in colorectal cancer screening, 2.17% (95% CI, 1.39%-2.96%) increase in breast cancer screening, and 0.72% (95% CI, 0.34%-1.10%) increase in cervical cancer screening rate. For malignant neoplasms with guideline-recommended screening, each $1000 increase in tax revenue per capita was associated with a decreased cancer mortality rate among White (adjusted incidence rate ratio, 0.95, 95% CI, 0.93-0.98), but not racial and ethnic minority (adjusted incidence rate ratio, 0.99, 95% CI, 0.97-1.02) populations.

Conclusions and Relevance

In this cross-sectional study, tax policy was associated with increased state-level cancer screening rates, as well as decreased cancer mortality rates, which mostly benefited White populations, suggesting that state-level policies may contribute to bridging ongoing cancer care gaps.

Clinical decision support as an implementation strategy to expand identification and administration of treatment of opioid use disorder in the emergency department

INTRODUCTION

US opioid overdoses and deaths continue to increase, despite historic national investment to mitigate risk and improve access to evidence-based treatment. Unfortunately, implementation of emergency department (ED) buprenorphine - an effective medical treatment for opioid use disorder (OUD) - has been limited. Our objective was to assess the effectiveness of an electronic health record (EHR)-integrated, interruptive clinical decision support (CDS) tool to improve rates of ED initiated OUD treatment.

METHODS

This is an observational, pre-post study of a CDS tool designed to identify and facilitate treatment of patients with OUD using electronic health record data. Patients were included if treated at our urban, academic ED between May 1, 2022, and November 8, 2023. The CDS triggered based on a rules-based algorithm using routinely collected EHR data which were identified from a previously validated EHR OUD phenotype. Outcomes are organized under a modified RE-AIM framework, with the primary outcome, Effectiveness, measured by the proportion of OUD patients receiving buprenorphine (administered/prescribed; filled prescriptions). Secondary outcomes include patient Reach, clinician Adoption, and fidelity to Implementation. Chi Square tests and Bayesian structural time-series models evaluate differences in outcomes before and after CDS implementation (CausalImpact package v1.3.0 in R v4.4.0).

RESULTS

There were 171,221 total ED visits during the study period. Patient characteristics before and after CDS implementation were similar. CDS triggered in 4.7 % (2754/58,173) of encounters after initiation of intervention, reaching 116 unique emergency medicine providers and 2566 ED patients. Clinicians adopted the CDS, accessing the OUD treatment pathway link or ordering a social work consult for substance use, in 27 % (1266/4746) of CDS alerts. When compared to the pre-implementation period, CDS implementation was associated with increased buprenorphine administration in the ED by 31 % (95 % CI: 16-47 %, p = 0.001), buprenorphine prescribing from the ED by 20 % (95 % CI: 5-38 %, p = 0.007), and the buprenorphine fill rate at an affiliated ED pharmacy by 17 % (95 % CI: 1-36 %, p = 0.017).

CONCLUSIONS

Implementation of an EHR-integrated, CDS was associated with increased ED buprenorphine administration, prescribing, and prescription fills among ED patients with OUD. Further efforts are needed to assess maintenance strategies that improve adoption, minimize interruptiveness, and optimize workflow congruence.

Evolving impact of the COVID-19 pandemic in chronic dialysis recipients in France

BACKGROUND

This observational study aimed to assess the impact of the pandemic on the way kidney transplantation, survival, and vaccination evolved in chronic dialysis recipients (CDR) over the course of the COVID-19 pandemic waves and inter-waves.

METHODS

Using the French national health claims database, incident persons with end-stage kidney disease in the years 2015 to 2021 treated with dialysis were followed up until 31 December, 2022. Kidney transplantation and survival in the pandemic sub-periods compared to the pre-pandemic period were investigated using longitudinal models with time-dependent covariates. In addition, the impact of cumulative doses of COVID-19 vaccine on hospitalization and survival was studied, comparing CDR and matched controls.

RESULTS

Here, we show that the follow-ups of the 71,583 CDR and the 143,166 controls totalize 639,341 person-years (CDR: 184,909; controls: 454,432). The likelihood of receiving a kidney transplant is lower in all pandemic sub-periods. The 3 waves are associated with a higher risk of death (hazard ratio (HR [95% confidence interval]): 1.19 [1.13-1.27], 1.19 [1.15-1.23], and 1.12 [1.07-1.17], respectively). While vaccine coverage declines with each booster dose, receiving these doses is associated with a lower risk of COVID-19-related hospitalization (0.66 [0.56-0.77], 0.83 [0.72-0.94] for 1st booster versus 2nd dose and 2nd booster versus 1st booster, respectively) and death (corresponding HR: 0.55 [0.51-0.59], 0.88 [0.83-0.95]).

CONCLUSIONS

The evolving patterns in mortality and vaccination outcomes are similar in CDR and controls, suggesting that the impact of the pandemic on CDR is not specific to kidney disease per se.

Evaluation of pathological complete response rates in breast cancer patients undergoing neoadjuvant therapy

Objective

This study aims to assess the rate of pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant therapy and to explore its correlation with clinical, molecular, and prognostic factors.

Methods

We conducted this retrospective observational study at Liga Contra o Câncer, a major public oncology reference center in Northeast Brazil. We included patients diagnosed with breast cancer who initiated neoadjuvant therapy between June 2018 and June 2019. Patients with a history of recurrent breast cancer or those who did not undergo surgery were excluded. The primary outcome was the pCR rate, with secondary outcomes including Overall Survival (OS), Disease-Free Survival (DFS), mortality, and disease recurrence. Follow-up extended until August 2022. We performed multivariate Cox regression analysis to correlate outcomes with predetermined variables.

Results

Of the 292 included patients, 63 (21.6%) achieved pCR. The mean follow-up duration was 42.8 months. Multivariate logistic regression analysis revealed an association between pCR and the AC-TH regimen [OR = 2.4; 95%CI = 1.13 - 5.24; p=0.023], as well as between pCR and HER2-positive tumors [OR 2.49; 95% CI = 1.14 - 5.86; p=0.028]. Complete pathological response was associated with higher DFS [HR 0.33; 95%CI 0.13-0.86; p=0.024].

Conclusion

Neoadjuvant therapy demonstrated significant efficacy in achieving pathological response in breast cancer patients. We observed a strong association between the AC-TH regimen, HER2-positive status, and pCR.

Supernumerary Teeth in the Anterior Maxilla of Non-Syndromic Children and Adolescents: A Retrospective Study Based on Cone-Beam Computed Tomography Scans

Background/Objectives: The aim of this retrospective study was to investigate the supernumerary teeth located in the anterior region of the maxilla of non-syndromic Greek children and adolescents, as well as their possible correlation with demographic characteristics and radiographic findings. Methods: The study sample comprised cone-beam computed tomography (CBCT) scans from 224 children and adolescents aged up to 18 years. The following parameters were studied: location of supernumerary teeth in the anterior maxillary area, their morphology, their relationship to adjacent anatomical structures and adjacent teeth, and potential implications. Results: Out of the 224 cases 26 (11.6%) presented supernumerary teeth. There was higher prevalence in males than females (61.5% versus 38.5%, respectively). Among the 26 participants diagnosed with supernumerary teeth, one supernumerary tooth was found in 80.8% of children/adolescents, while 19.2% had two supernumerary teeth. The vast majority of supernumerary teeth were impacted (92.3%), and their morphology in 57.7% of cases was conical. A total of 38.5% of cases had normal orientation, 26.9% inverted orientation, 19.2% horizontal orientation, and 15.4% other. The localization was palatal in 84.6%, and the area of localization for 50% of cases was the midline. Conclusions: The prevalence of supernumerary teeth in the studied sample of Greek children and adolescents was 11.6% and tended to appear as single, impacted, conical, and with normal orientation. However, these results should be interpreted with caution, due to the limitations in the sampling strategy and the restricted generalizability of this study. The need for further research to enhance broader applicability for different populations is highlighted. These findings are instrumental for a more comprehensive understanding of the prevalence of supernumerary teeth, contributing to more accurate and individualized dental treatment planning in children and adolescents. This will help to avoid future issues in the patient's dentition.

Changes in mobility after community-based prosthesis fitting and rehabilitation in people with major lower limb amputations: a cohort study

ObjectiveTo investigate changes in mobility in adults with recent major lower limb amputation participating in community-based rehabilitation. Second, to assess the impact of amputation level (transtibial versus transfemoral) on mobility changes.DesignCohort study.SettingRehabilitation Centre in Copenhagen Municipality.SubjectsA total of 265 individuals with recent major lower limb amputations were prospectively recruited into a cohort from 2008 to 2022 as part of routine practice.MethodsFour physiotherapists collected data on age, sex, level of amputation (transtibial/transfemoral) and assessed mobility at start of walking out of parallel handrail (baseline) and at the end (follow-up) of rehabilitation. Mobility was assessed with the Timed-Up-and-Go test, 10-Meter Walk test, and 2-Minute Walk test. The impact of amputation level was analyzed using multivariable linear regression adjusted for age and sex.ResultsA total of 199 individuals (153 men) mean age of 64.9 (standard deviation 12.2) years had baseline and follow-up mobility data and were eligible for the study. Mobility significantly improved on all tests for individuals with both amputation levels after community rehabilitation. Multivariable analysis showed that individuals with transfemoral amputations on average improved with 17.9 seconds more (95% confidence interval: 12.7-23.1) than transtibial completing the Timed-Up-and-Go test. Contrary, transtibial walked 0.11 meter/second faster (95% confidence interval: 0.02-0.20) and 7.2 meters (95% confidence interval: -1.4 to 15.8) longer in the 10-Meter Walk test and 2-Minute Walk test respectively than transfemoral amputees.ConclusionAdults with lower limb amputations improved their mobility significantly from baseline to follow-up. Individuals with transfemoral amputations improved more than transtibial amputations on functional mobility.

Researcher's Guide for the Preparation of Tables

Almost all scientific articles include tables, but there is little guidance on how to prepare tables. Authors should enhance the focus on the tables' data-ink, the essential information, and minimizing the no-data-ink, nonessential elements. The six principles of Gestalt on human perception can also be applied to the table to increase readability. Through this review, we provide a practical guide and an overview of how to prepare readable, informative tables. The five steps for the preparation of tables include (1) tables with a clear purpose; (2) using a universal layout; (3) selecting relevant data for Table 1 versus other tables; (4) simplifying variables by categorizing, standardizing, and reducing; and (5) enhancing the readability of numbers and decimals. This results in informative tables that contain data, serving a specific purpose for the reader and increasing readability.

Sutureless aortic valve and post-operative atrial fibrillation: Five-year outcomes from a propensity matched cohort study

BACKGROUND

The Perceval Sorin S (perceval valve) is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic valve replacement (AVR).

AIM

To compare five-year post-operative outcomes in a cohort undergoing isolated AVR with the perceval valve to a contemporary cohort undergoing surgical AVR with a sutured bioprosthesis.

METHODS

This study was a retrospective, cohort study at a single tertiary unit. Between 2017 and 2023, 982 suitable patients were identified. 174 Perceval valve replacements were matched to 174 sutured valve replacements. Cohort characteristics, intra-operative details, and post-operative outcomes were compared between the two groups.

RESULTS

Time under the aortic cross-clamp (P < 0.001), time on the cardiopulmonary bypass (P < 0.001) and total operative time (P < 0.001) were significantly reduced in the Perceval group. Patients in the Perceval valve group were at a lower risk of postoperative pneumonia [odds ratio (OR) = 0.53 (0.29-0.94)] and atrial fibrillation [OR = 0.58 (0.36-0.93)]. After propensity-matching, all-cause mortality did not significantly differ between the two groups in the five-year follow-up period. Larger valve sizes conferred an increased risk of mortality (P = 0.020).

CONCLUSION

Sutureless surgical AVR (SAVR) is a safe and efficient alternative to SAVR with a sutured bioprosthesis, and may confer a reduced risk of post-operative atrial fibrillation. Clinician tendency towards 'oversizing' sutureless aortic valves translates into adverse clinical outcomes. Less time on the cardiopulmonary bypass circuit allows for the treatment of otherwise high-risk patients.

Attitude, knowledge, and practice of medical students and pediatric physicians towards blood pressure measurement and hypertension in children: The impact of educational sessions

Accurate blood pressure measurement in pediatric patients is crucial for the proper diagnosis and management of hypertension in children. Understanding the level of attitude, knowledge, and practices (AKP) of medical students and physicians on pediatric blood pressure (BP) measurement and hypertension is essential. This is to assess their awareness of this subject which is often overlooked and where research is lacking. This study aims to evaluate the extent of AKP, among medical students and pediatric doctors regarding hypertension and BP measurement in children, and to determine the impact of educational sessions on their AKP. In a cross-sectional study, a self-designed questionnaire composed of several questions about AKP was prepared and validated. After obtaining informed consent, the questionnaire was distributed online to medical students and pediatric physicians with 168 responses, 140 medical students, and 28 pediatric physicians. This was followed by an educational awareness session about measuring blood pressure and hypertension in children. After the session, a post-awareness questionnaire was administered, gathering 145 responses. The average scores for AKP were calculated, and pre- and post-awareness session responses were compared within each group, P < .05 was regarded as significant. Among the medical students, 53.6% were somewhat aware of pediatric hypertension; 29.3% measured BP during their pediatric course, and 85% did not participate in pediatric hypertension education. Among physicians, 12.5% were exposed to pediatric patients with hypertension in the past year, 25% never measured BP in routine pediatric visits, and only 25% used normative BP tables. Average scores (out of 5) for attitude, knowledge, and practices were 3.57 (0.55), 2.51 (0.71), and 2.42 (0.68), respectively, with significantly higher scores in post-educational session, 4.56 (0.47), 4.06 (0.72), and 4.25 (0.76), respectively. The AKP among medical students and pediatric physicians regarding pediatric hypertension are inadequate, ranging from little to moderate. The impact of educational sessions is significant and very useful and should be incorporated into the teaching of medical students especially in the last years of study and ground meetings of pediatric physicians.

One-Year Outcome After Endovascular Thrombectomy for Basilar Artery Occlusion With Mild Deficits

BACKGROUND

The long-term benefits of endovascular thrombectomy (EVT) for basilar artery occlusion (BAO) in patients with low National Institutes of Health Stroke Scale scores upon admission remain unclear. This study aimed to compare the 1-year clinical follow-up outcomes of best medical management (BMM) alone versus BMM plus EVT.

METHODS

Patients with BAO and admission National Institutes of Health Stroke Scale score of ≤10 at 65 stroke centers in China from December 2015 to June 2022 were retrospectively enrolled. The primary outcome was favorable functional outcome (a modified Rankin Scale score of 0-3 at 1 year). Early (door-to-puncture time ≤120 minutes) and late EVT (door-to-puncture time >120 minutes) classifications were defined as surrogates for comparing initial treatment with EVT versus late (potentially rescue) EVT after initially being treated with BMM only. Multivariable logistic regression and propensity score matching analyses were used to assess the association between treatment and outcomes.

RESULTS

Among 1232 patients who had 1-year follow-up data, 856 (69.5%) were male, and the mean (SD) age was 65 (12) years. After adjustment for confounders, there were no significant differences between EVT and BMM in favorable functional outcome (odds ratio, 0.96 [95% CI, 0.71-1.29]; P=0.778). The cumulative 1-year mortality rate was 16.4% in the EVT group versus 13.7% in the BMM group (odds ratio, 1.23 [95% CI, 0.86-1.77]; P=0.262). Predefined subgroup analyses revealed that late EVT was inferior to early EVT (odds ratio, 0.47 [95% CI, 0.28-0.79]; P=0.005), while no significant difference was observed between BMM and early EVT in 1-year outcomes (odds ratio, 0.87 [95% CI, 0.63-1.21]; P=0.421).

CONCLUSIONS

In this long-term follow-up study among patients with BAO admitted with a National Institutes of Health Stroke Scale score of ≤10, there were no significant differences in functional outcomes and mortality at 1 year between BMM plus EVT and BMM alone.

Prevalence of violence against health care workers among agitated patients in an urban emergency department

OBJECTIVE

Violence is a common hazard for those working in emergency departments (EDs), yet it remains understudied. We describe a prospectively derived estimate of the prevalence of violence against health care workers among agitated patients in an ED.

METHODS

This was a secondary analysis of two prospective, observational studies of patients receiving care in a dedicated portion of the ED meant primarily to observe patients with intoxication. We collected detailed data for patients with agitation, defined as a score of +1 or higher using the altered mental status scale, an ordinal agitation scale from -4 (coma) to 0 (normal) to +4 (most agitated). Trained observers present in the ED 24/7 recorded whether each encounter involved verbal abuse, threat of violence, or a violent act against a health care worker. The primary outcome was the occurrence of assault as defined by state statute (threat of violence or violent act). We compare observed events to those formally reported to the hospital.

RESULTS

From 17,873 encounters screened there were 4609 (25.8%) in which the patient had agitation. Alcohol or drug intoxication was present in 4108 (89.1%) encounters. The number of encounters with assault was 937 (20.3%, 95% confidence interval [CI] 19.1%-21.5%), which included 802 encounters (17.4%, 95% CI 16.3%-18.5%) with a threat of violence and 362 encounters (7.9%, 95% CI 7.1%-8.7%) with a violent act. Verbal abuse occurred in 1786 encounters (38.8%, 95% CI 37.3%-40.2%). Events were formally reported to the hospital in 9/1786 (0.5%) instances of verbal abuse and in 224/362 (61.9%) instances of a violent act.

CONCLUSIONS

Verbal abuse, threats of assault, and violent acts occurred frequently in ED patients with agitation and were underreported.

Association Between Vascular NOTCH3 Aggregation and Disease Severity in a CADASIL Cohort - Implications for NOTCH3 Variant-Specific Disease Prediction

OBJECTIVE

Vascular NOTCH3 protein ectodomain aggregation is a pathological hallmark of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a monogenic small vessel disease typically caused by cysteine-altering variants in NOTCH3. Given their high population frequency, these NOTCH3 variants are an important genetic contributor to stroke and vascular dementia worldwide. Disease severity in CADASIL is highly variable and is mainly determined by the position of the pathogenic NOTCH3 variant in the NOTCH3 ectodomain. Here, we aimed to investigate the association between NOTCH3 aggregation load in skin vessels, cysteine-altering NOTCH3 variants, and disease severity in a prospective cohort study of 212 patients with CADASIL with 39 distinct cysteine-altering NOTCH3 variants.

METHODS

NOTCH3 aggregation load in skin vessels was determined by calculating the NOTCH3 score; the fraction of skin vessel wall area positive for NOTCH3 staining. Variant-specific NOTCH3 scores were calculated for variants present in 10 or more participants, by averaging the NOTCH3 scores of individuals with that distinct variant. The associations between the NOTCH3 score, NOTCH3 variants, and neuroimaging and clinical outcomes were investigated using multivariable linear mixed models, Cox regression, and mediation analyses.

RESULTS

The NOTCH3 score was significantly associated with lifetime stroke probability and small vessel disease neuroimaging outcomes, but not with age. Variant-specific NOTCH3 scores reflected differences in disease severity associated with distinct NOTCH3 variants.

INTERPRETATION

These findings suggest that differences in NOTCH3 aggregation propensity underlie the differences in disease severity associated with NOTCH3 cysteine-altering variants, and show that NOTCH3-variant specific NOTCH3 scores can contribute to improved individualized disease prediction in CADASIL. ANN NEUROL 2025.

What should be documented for an anterior shoulder dislocation? A Delphi study

BACKGROUND

Standardised consensus-based documentation following anterior shoulder dislocation in the ED might improve clinical quality, reduce heterogeneity in research and reduce workload. The aim of this study was to determine important elements and the extent of variability for the ED documentation following anterior shoulder dislocation.

METHODS

An expert panel of physicians who perform the documentation (emergency physicians) of diagnosis and management of anterior shoulder dislocation and those who may read it (orthopaedic surgeons and general practitioners) was recruited in a three-round Delphi design between May and November 2022. Important elements were identified for history, physical examination, additional examinations, reduction technique and miscellaneous. These were rated on a 0-9 Likert scale. Consensus was reached when ≥80% scored 7-9. Another, independent, outcome was high variability in opinion, defined as at least one score between 1 and 3 and one score between 7 and 9 on an item after the third round.

RESULTS

The expert panel consisted of 22 emergency physicians, 5 general practitioners and 3 orthopaedic surgeons. In the first round, 85 elements were identified, and consensus on importance was reached in 22 out of the 85 elements: medical history (5 out of 30), physical examination (5 out of 18), additional examinations (5 out of 9), reduction (5 out of 17) and miscellaneous (2 out of 11). High variability in importance was seen in 79 (93%) out of the 85 elements after the third round.

CONCLUSION

A consensus on 22 out of the 85 elements was reached and could be included in the ED documentation on anterior shoulder dislocation. Regardless of this consensus, high variability was observed in almost all the elements, highlighting the difference in opinions. Nevertheless, these elements could facilitate more concise communication among healthcare professionals and could facilitate homogenous datasets.

Inflammatory Indices and CA 125: A New Approach to Distinguish Ovarian Carcinoma and Borderline Tumors in Suspicious Ovarian Neoplasms from a Retrospective Observational Multicentric Study

Background and Objectives: This study aimed to evaluate the diagnostic potential of systemic inflammatory indices such as Systemic Inflammation Response Index (SIRI) and Systemic Inflammatory Response (SIR). These were assessed in combination with CA 125 to distinguish ovarian carcinoma (OC) from borderline ovarian tumors (BOT) in patients with suspicious adnexal masses. Materials and Methods: A retrospective multicenter observational study including patients undergoing surgery for suspected ovarian neoplasms was conducted. Inclusion criteria required preoperative blood sampling for inflammatory markers and CA 125. SIR-125 and SIRI-125 were developed by combining SIR and SIRI with CA 125 levels. Diagnostic performance was assessed using ROC curve analysis and linear regression models. Results: A total of 63 patients (42 BOT, 21 OC) were analyzed. OC patients exhibited significantly higher SIR-125 and SIRI-125 values (p < 0.001). ROC analysis demonstrated good diagnostic accuracy, with AUCs of 0.83 (SIR-125) and 0.82 (SIRI-125). SIR-125 showed higher specificity (0.83), while SIRI-125 had superior sensitivity (0.86). Conclusions: SIR-125 and SIRI-125 enhance diagnostic differentiation between OC and BOT, providing a simple, cost-effective preoperative tool. Future prospective studies are needed to validate these findings in broader patient populations.

Prevalence of EGFR Mutations in Vietnamese Patients with Resected Early Stage Non-Small Cell Lung Cancer: EARLY-EGFR Study

Introduction

Comprehensive profiling of mutations in the EGFR gene is vital for selecting patients eligible for EGFR targeted therapies.

Methods

We investigated the prevalence of EGFR mutations and treatment patterns in patients with early stage non-small cell lung cancer (NSCLC) in Vietnam as a part of EARLY-EGFR (Clinical Trial Identifier: NCT04742192), a global, real-world study. Consecutive patients with surgically resected stage IA-IIIB, non-squamous NSCLC were diagnosed from August 2021 to June 2022 and were prospectively enrolled from November 2021 to July 2022.

Results

A total 200 patients (age: median [range], 60.0 [30.0-80.0] years) were enrolled from 3 centers; 56.0% were males and 64.0% never smoked. The prevalence of EGFR mutations was 51.0% (102/200) including deletions in exon-19 (49.0%) and exon-21 L858R mutations (33.3%). Females (73.9%, 65/88), patients aged ≥60 years (52.5%, 53/101), nonsmokers (61.2%, 63/103) and those with stage I (55.8%, 67/120) had higher prevalence of EGFR mutations. Multivariate analysis (adjusted odds ratio [aOR]) showed EGFR mutations to be significantly associated (p < 0.05) with female gender (aOR = 5.90), age ≥60 years (aOR = 1.05), and stage III disease (vs stage I) (aOR = 0.30).

Conclusion

These results underscore the need for EGFR testing early in management algorithm of NSCLC in Vietnam to identify patients eligible for targeted therapy in concordance with international guidelines.

Investigating CAR-T Treatment Access for Multiple Myeloma Patients Using Real-World Evidence

Objective

Multiple myeloma (MM) is the second most common hematologic malignancy in the U.S., with Black patients being diagnosed at twice the rate of White patients. MM treatment options are limited and ineffective, but CAR-T therapies show promise. However, their limited availability results in disparities in access. This study aimed to explore disparities in Multiple Myeloma disease risk and CAR-T therapy access.

Methods

Our study included a population-based cohort of 12,360 patients diagnosed with Multiple Myeloma who received more than one cancer therapy extracted from the University of California Health Data Warehouse (UCHDW) between January 2021 and November 2024. Regression models were used to compute odds ratio (OR) and 95% confidence intervals (CI) associating disease severity, UC-Location, and baseline demographics with CAR-T therapy access. The GPT-4 inference model was prompted with a zero-shot learning approach to analyze UCSF clinical notes with the following objectives: (1) Was CAR-T discussed? [yes/no], (2) Is the patient eligible for CAR-T? [yes/no/unclear], and (3) Provide the rationale for the eligibility determination.

Results

Our study included 12,360 patients (mean age 68.5 years, SD 12.8 years) treated for multiple myeloma across the University of California Health System, 320 of which received CAR-T (Table-1). Overall, 51.6% of MM patients identified as Male, and 48.4% as Female. Disease Severity was measured by the International Staging System (ISS) and was distributed by ISS Stage: I (65.3%), II (24.4%), III (2.8%), and None (7.5%). Patients treated at UC-1 (49.3%), and UC-2 (50.0%) were primarily diagnosed with Stage II, while patients at UC-3 (55.5%) were primarily diagnosed with Stage I. Our model indicated that patients who identified as Black or African American (OR= 0.33, [95% CI, 0.17-0.62) were less likely to receive CAR-T therapy when compared to White patients. Patients treated at UC-3 with predominantly Black or African American patients (OR = 0.42, [95% CI, 0.30-0.59]) were less likely to receive CAR-T therapy when compared to UC-1. We identified CAR-T eligibility for 270 UCSF patients and found those who identified as other Pacific Islander had the highest rate of eligibility without discussions at 50%, followed by Black or African American (4.2%), Asian (3.2%), and White (0.6%).

Conclusion and Relevance

This study emphasizes the influence of race and UC-Location on disparities in CAR-T therapy access.

Evaluation of changes in price, volume and expenditure of PD-1 drugs following the government reimbursement negotiation in China: a multiple-treatment period interrupted time series analysis

Background

Government reimbursement negotiation (GRN) is an important policy tool to increase the accessibility of drugs. In China, the impact of GRN implementation on programmed death-1 (PD-1) drugs price, procurement volume, and expenditure is unknown.

Methods

This study used a multiple-treatment period interrupted time series design covering the period from the first-time recorded in Chinese Medical Economic Information database to 2022 to examine changes in hospital procurement price, volume and expenditure of PD-1 drugs after the implementation of GRN in China. Data were obtained from 698 public hospitals of 30 provinces in China.

Results

A total of four PD-1 drugs have been selected in the National Reimbursement Drug List via GRN between March 2019 and 2022. After the implementation of the first-time GRN, the prices of all PD-1 drugs decreased significantly, with Camrelizumab experiencing the largest reduction in price and the largest increase in volume and expenditure. The Camrelizumab's price decreased by 1151.75 Chinese Yuan (CNY) (β2 = -1151.75; 95% confidence interval (CI) = -1254.534, 1048.96), volume increased by 159.549 thousand defined daily doses (β2 = 159.549; 95% CI = 119.12, 199.979) and expenditure increased by 11.172 million CNY (β2 = 11.172; 95% CI = 1.653, 20.692). Following the implementation of the second-time of GRN, Sintilimab showed the largest decrease in price, with price decreased by 164.099 CNY (β4 = -164.099; 95% CI = -171.867, 156.331), Tislelizumab had the largest increase in volume and expenditure, with the volume increased by 102.185 thousand defined daily doses (β4 = 102.185; 95% CI = 47.862, 156.509) and expenditure increased by 4.119 million CNY (β4 = 4.119; 95% CI = -3.808, 12.047).

Conclusions

The GRN policy improved the accessibility and affordability of PD-1 drugs. Health insurance policy-makers need to consider the legitimate interests of PD-1 drug manufacturers while ensuring the sustainability of the basic health insurance fund.

Comparison of anticoagulation reversal strategies for warfarin associated acute gastrointestinal bleeding

OBJECTIVE

Gastrointestinal bleeding (GIB) is a common complication associated with warfarin use. However, the optimal approach for anticoagulation reversal-whether with prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), vitamin K (intravenous or oral), or no reversal-remains unclear as current literature and society guidelines do not provide definitive recommendations.

METHODS

A retrospective analysis of emergency department patients with warfarin-associated GIB who presented to an academic health system was performed, comparing reversal with PCC, FFP, vitamin K only, or no reversal agent. The primary outcome was 30-day all-cause mortality. Secondary outcomes included rebleeding events and 30-day thrombotic events. Standardized guidelines for reporting were followed (STROBE).

RESULTS

Of 815 patients, within 12 h of presentation, 10.7 % received reversal with PCC (with or without vitamin K), 12.9 % with FFP (with or without vitamin K), and 34.9 % with vitamin K alone; 41.5 % of patients received no reversal agent. Compared to all other groups, patients receiving PCC had significantly higher 30-day mortality (18.4 % [PCC] vs 5.7 % [FFP] vs 4.6 % [vitamin K] vs 5.6 % [no reversal], p < 0.001), which remained significant after adjusting for hemodynamic instability and ICU admission. There were no significant differences in rates of thrombotic event within 30 days (3.4 % vs 3.8 % vs 1.4 % vs 1.2 %, p = 0.20).

CONCLUSIONS

Patients who received PCC had a threefold increase in mortality compared to FFP, vitamin K alone, or no reversal, even after adjusting for severity of the bleeding. Further research is necessary to understand factors leading to this observed mortality difference among patients with warfarin related GIB.

Improvement in Quality of Life, Pain and Function After Total and Unicompartmental Knee Replacement: A Secondary Analysis of 12-Month Post-Operative Outcomes

Objectives: To investigate variables associated with improvement in quality of life (QOL) after primary knee replacement. QOL outcomes between individuals undergoing total knee replacement (TKR) and unicompartmental knee replacement (UKR) were compared. Materials and Methods: Participants were adults (n = 497) undergoing TKR or UKR for osteoarthritis between January 2017 and October 2020 in a large publicly funded tertiary hospital in New Zealand. Participants completed patient-reported outcome measures of QOL, pain and function, preoperatively, 6 and 12 months postoperatively. Results: QOL improved pre- to postoperatively for both TKR and UKR groups, and the main QOL gains for both groups were evident in the first 6 months after joint replacement. Notably, QOL did not differ between groups at any assessment point (p > 0.05). Improvement in QOL was more correlated with improved pain and function than with person factors such as demographics and comorbidity burden (p < 0.01). Conclusions: This study adds to a growing literature showing that knee replacement contributes to substantial improvements in QOL outcomes. Future QOL outcome research in the knee replacement population should consider using more precise measures of function to better understand the impacts of these factors on QOL improvement.

A systematic review and meta-analysis of pharmacological methods to manipulate experimentally induced secondary hypersensitivity

ABSTRACT

Understanding the physiology of specific clinical features of persistent pain, such as secondary hypersensitivity, is crucial for developing effective treatments. This systematic review and meta-analysis investigated the effects of pharmacological manipulations on the magnitude (primary outcome) and surface area (secondary outcome) of experimentally induced secondary hypersensitivity. Following Cochrane Collaboration guidelines and a published and registered protocol, we conducted an electronic search on February 7, 2024. After screening articles in duplicate, we included 117 articles, consisting of 222 datasets. Risk of bias assessments identified potential flaws in methodological quality. Datasets were pooled by the mechanism of action of the manipulation and by outcome. Effect sizes were estimated using standardised mean difference (SMD). Most datasets (207 of 222) had an unclear risk of performance and detection bias for inadequate reporting of blinding procedures. Thirteen different methods were used to induce, and 23 different drug classes were used to manipulate secondary hypersensitivity. The pooled SMDs [95% CI] suggested that alpha-2-delta subunit of voltage-gated calcium channel ligands reduced both the magnitude (-0.24 [-0.39; -0.08]) and surface area (-0.38 [-0.59; -0.18]) of secondary hypersensitivity, and that both N-methyl-D-aspartate receptor antagonists (-0.36 [-0.55; -0.17]) and voltage-gated sodium channel blockers (-1.02 [-1.63; -0.42]) reduced only the surface area of secondary hypersensitivity. These results suggest a need to understand and compare the physiological underpinnings of magnitude and area of secondary hypersensitivity, and to clarify the relative importance of magnitude vs anatomical spread (ie, surface area) of secondary hypersensitivity to people living with pain.

Risk correlates of cardiovascular diseases, diabetes, and periodontal diseases: a cross-sectional study in India

BACKGROUND

Quantifying shared risk factors among periodontal disease (PD), cardiovascular disease (CVD), type 2 diabetes (DM2) can bolster Common Risk Factor Approach (CRFA), enabling integration of PD prevention into non-communicable disease (NCD) prevention strategies. The objective of the study is to assess extent of overlap of shared risk factors between CVD, DM2, PD.

MATERIALS AND METHODS

This is an analytical cross-sectional study conducted at a tertiary care medical and dental teaching hospital in South India, from July 2022 to April 2024. Study included 600 participants (ages 18-75) divided into three groups: Group A: DM2, CVD, or both and PD; Group B: DM2 or CVD; and Group C: PD alone. Various demographic, metabolic, habit related, dietary and periodontal disease severity related risk factors were evaluated in the study.

RESULTS

Among 600 participants, 55.5% were male, 58.8% were under 50 years. Statistically significant odds ratios (ORs) for shared risk factors between Group A and Group B were observed for age > 50 (0.58), sedentary lifestyle (0.43), fat intake > 41 g/d (1.87), HbA1C ≥ 6.5% (0.56), FBS > 126 mg/dL (2.35) and family history of NCDs (9.8). For Group A versus Group C, statistically significant ORs were seen for age > 50 (0.55), HbA1c 5.7%-6.4% (0.34), triglycerides > 150 mg/dL (0.04), education (0.52), alcohol use (1.53) and poor oral hygiene (3.01). Severity of periodontal disease assessed using PSR, HbA1c, triglycerides, fat intake, age, education, obesity were identified as vital shared risk factors. CONCLUSION AND RELEVANCE: Age, education, obesity, PSR, HbA1c, triglycerides emerged as significant shared risk factors. Integrating these factors into surveillance tools may enhance NCD and PD risk identification, supporting CRFA-based healthcare approach.

TRIAL REGISTRATION

CTRI/ 2022/06/043279 registered on 15th of June 2022.

Evolution of Untreated Moderate Mitral Regurgitation After Transcatheter Aortic Valve Implantation

Background and Objectives: Associated mitral regurgitation (MR) is frequently observed during transcatheter aortic valve implantation (TAVI). The progression of moderate MR remains undetermined, given uncertain clinical significance and natural history. This study aims to assess the evolution of moderate MR following TAVI. Materials and Methods: Between 2018 and 2023, 1476 patients underwent TAVI. We excluded those with previous aortic or mitral valve interventions, endocarditis, concomitant percutaneous coronary intervention, or emergent procedures. Patients with severe aortic or tricuspid regurgitation or significant mitral stenosis were excluded. Ultimately, only patients with moderate MR were included, resulting in a final population of 154 patients. Results: Mean age was 81.4 ± 7.8 years, 48.1% (74/154) were female, and 48.1% (74/154) were functional MR. There was one surgical conversion due to annular rupture. Thirty-day mortality was 1.9% (3/154). Postoperative echocardiography showed 38 (24.7%) patients with none/trace MR, 91 (59.1%) with mild MR, 22 (14.3%) with moderate MR, and 3 (1.9%) with severe MR. Finally, according to the echocardiographic follow-up [median follow-up 1.0 (IQR: 0.1-1.2) years], 20.1% (31/154) had no/trace MR, 39.6% (61/154) had mild MR, 35.7% (55/154) had moderate MR, and 4.5% (7/154) had severe MR. Overall, 67 (43.5%) patients had any MR grade progression, 62 (40.3%) had stable disease, and 25 (16.2%) had any MR grade reduction at the last follow-up from the operation. No difference in MR evolution was seen between functional and primary MR. Conclusions: Concomitant moderate MR during TAVI has a variable evolution over time. A more detailed characterization of patients with preoperative moderate MR undergoing TAVI is necessary to identify those with a disease progression risk.

Endovascular treatment for cerebral venous thrombosis: a multicenter study in China

BACKGROUND

Endovascular treatment (EVT) is gaining popularity for the management of severe forms of cerebral venous thrombosis (CVT), but the evidence supporting its efficacy and safety is limited.

METHODS

This multicenter study included patients with CVT admitted to 104 hospitals in 31 provinces/cities in China between January 2018 and June 2022. Propensity score weighting models were used to adjust baseline confounding variables to determine the association of EVT on the primary outcome of good functional status, defined as score 0 - 1 on the modified Rankin Scale after hospital discharge.

RESULTS

Of 3063 patients identified through hospital records searches, 2774 adults [age (42 ± 15.8) years, female 50.3%] fulfilled eligibility criteria and agreed to be included, of whom 449 (16.2%) received EVT and 2325 (83.8%) received standard care. There was no significant difference between the EVT group and the standard care group in terms of the possibility of good functional recovery [weighted risk ratio = 1.00, 95% confidence interval (CI) 0.96 - 1.03]. Similarly, there was no difference in the likelihood of death at hospital discharge (weighted risk ratio = 1.91, 95% CI 0.91 - 3.68). In subgroup analysis, the possibility of good functional recovery was lower in patients with intracerebral hemorrhage (weighted risk ratio = 0.88, 95% CI 0.79 - 0.98; P for interaction = 0.01) and seizures (weighted risk ratio = 0.86, 95% CI 0.76 - 0.95; P for interaction = 0.03).

CONCLUSION

In this large nationwide study, EVT was not associated with improved functional outcomes compared to standard care in patients with CVT.

Clinical Significance of Blood Cell-Derived Inflammation Markers in Assessing Potential Early and Late Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review

Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor influencing cancer progression and postoperative outcomes. This systematic review evaluates the clinical significance of blood cell-derived inflammatory markers in predicting early and late postoperative complications in CRC patients. Methods: We included studies involving adult patients (≥18 years) with histologically confirmed colorectal cancer, for whom elective radical surgery was performed, as well as at least one of the considered blood-based inflammatory biomarkers (NLR, PLR, SII, or LMR) documented in relation to outcomes. Results: After removing duplicates, 19 studies published between 2016 and 2025 were included in the qualitative analysis. A total of 7023 patients who underwent elective curative surgery for colorectal cancer were analyzed, with mean age varying widely between 47.3 and 74.6 years. Preoperative NLR values were significantly correlated with severe complications, IAI, AL, and overall complications in 13 out of 19 studies (68.4%), with a cutoff value between 2.21 and 4, while early postoperative NLR values were predictive for AL. Late postoperative complications, such as recurrence and overall survival, were also associated with elevated preoperative NLR and PLR values. However, variability in study designs, patient populations, and cutoff values for these indices contributed to inconsistent findings. Conclusions: Blood cell-derived inflammatory markers offer a valuable, non-invasive tool for assessing postoperative risks in patients with CRC. New design nomograms or risk scores that include, beside blood cell-derived inflammation markers, other relevant data, could ensure an optimal predictive value that could be easily used in clinical practice for personalized risk management in patients with colorectal cancer.