To investigate the perinatal outcomes of SR using radiofrequency ablation (RFA) in MC pregnancies, identified factors affecting these outcomes, and assessed the associated learning curve. This retrospective cohort study included all consecutive MC pregnancies that required RFA from September 2013 to April 2023 at our institution. The perinatal outcomes were compared on the basis of various indications, and binary logistic regression analysis was performed to identify the risk factors for cotwin loss. Clinical datas of two periods (2013-2018 vs. 2019-2023) were compared to demonstrate the learning curve. The 107 cases composed of 40 (37.4 %) twin-twin transfusion syndrome (TTTS), 17 (15.9 %) selective intrauterine growth restriction (sFGR), 12 (11.2 %) twin reversed arterial perfusion sequence (TRAPS), 25 (23.4 %) fetal discordant anomalies, 10 (9.3 %) elective fetal reduction (EFR), and three (2.8 %) twin anemia polycythemia sequence (TAPS) cases. The overall live birth rate for cotwins was 83.2 %. The earliest gestational age at delivery was noted in the TTTS group (p=0.021). The procedure-to-delivery interval was the shortest in the TTTS group and the longest in the EFR group (p<0.001). Comparing the 2013-2018 period with the 2019-2023 period, we noted a significant increase in the live birth rate (p=0.01) and the procedure-to-delivery interval (p=0.003), mainly due to improved outcomes in TTTS cases. RFA for SR is a safe and effective method for managing complicated MC pregnancies. The type of indication affects postoperative perinatal outcomes, with TTTS showing the most adverse effects. With the increasing number of cases and accumulation of experiences with simultaneous enhancement of technique proficiency, the postprocedural outcomes can be further improved.

The impact of early antibiotics on mortality in patients with suspected sepsis in the emergency department (ED) remains debated, particularly in patients with less severe presentations or before infection confirmation. To evaluate the association between time to antibiotic administration and 28-day in-hospital mortality among patients with suspected sepsis in the ED. Post hoc analysis of the 1-bundle emergency department trial, a multicenter, stepped-wedge cluster-randomized controlled trial conducted in 23 EDs in France and Spain. A total of 872 patients with suspected sepsis were included between June 2022 and September 2023. All patients with available data on antibiotic administration were analyzed, and a subgroup of patients with no hypotension was also assessed. Time to antibiotic administration. The effect of time to fluid resuscitation was also assessed. The primary outcome was in-hospital mortality at 28 days. Secondary outcomes included all-cause 28-day mortality, ICU length of stay, number of days without vasopressors at day 28, and change in Sequential Organ Failure Assessment score at 72 h. Among 872 patients (mean age 66 years; 41% female), 859 had available data on antibiotic administration (primary analysis) and 791 (92%) received antibiotics. The median time to antibiotic administration was 61 min (IQR 14-169), with 457 patients (58%) receiving antibiotics within 1 h. In-hospital mortality at 28 days was 14.7% for patients who did not received antibiotic within 1 h versus 9.6% for patients who did [adjusted odds ratio (aOR) 2.00 (1.24-3.23)]. There was an aOR of 1.06 (1.02-1.1) for each hour of delay for antibiotic administration. This effect was confirmed in patients without hypotension [aOR 2.02 (1.08-3.76) for patients who received antibiotics beyond 1 h]. Time to fluid resuscitation was not associated with 28-day in-hospital mortality. In patients with suspected sepsis presenting to the ED antibiotic administration beyond 1 h was associated with a two-fold increased 28-day in-hospital mortality. This effect persisted in patients without hypotension.

Breast cancer is the most common malignant tumor among women in the world. According to data from the World Health Organization, in 2020, there were approximately 2.26 million new breast cancer cases worldwide, accounting for 11.7% of all new cancer cases. In recent years, with the rapid development of molecular biology and gene detection technology, the research on advanced breast cancer continues to deepen, and the treatment methods are constantly enriched. Gene targeted therapy significantly prolongs the survival period of patients with advanced breast cancer, which is of great significance for molecular pathological diagnosis, targeted drug selection and treatment mode optimization of patients with advanced breast cancer. Based on the development of literature and clinical research, the consensus expert committee formulated the "Expert consensus on clinical application of next-generation sequencing in advanced breast cancer (2024 edition)". Compared with the "Chinese Expert Consensus on Hot Issues of Gene Testing for Advanced breast cancer (2021)", the 2024 consensus adopts new evidence-based medical evidence, aiming to provide more comprehensive gene testing information for patients with advanced breast cancer, so as to develop more accurate treatment strategies.

Patients with obstructive sleep apnea (OSA), restless legs syndrome (RLS), or both may exhibit varied manifestations of depressive and anxiety symptomatology, reflecting the complex interplay between sleep disturbances, neurotransmitter imbalances, and psychosocial stressors in these often overlapping conditions. The aim of this study was to compare depressive and anxiety symptomatology, insomnia severity, and sleepiness in these conditions. Patients were enrolled and subdivided into those with OSA, RLS, and OSA + RLS. All were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), Insomnia Severity Index, and Epworth Sleepiness Scale. A total of 159 patients were enrolled, with OSA (n = 85), RLS (n = 11), and OSA + RLS (n = 63). A significant difference was observed for PHQ-9 (higher in patients with RLS, associated or not with OSA); however, the groups also differed for age (older in RLS) and apnea-hypopnea index (AHI) (higher in OSA). The group difference in PHQ-9 persisted also after ruling out the confounding effects of age and AHI. Our study highlights the significant burden of depressive symptomatology in patients with OSA, RLS, or both. RLS patients consistently exhibited higher levels of depressive symptomatology compared with OSA patients, emphasizing the need for comprehensive assessment and tailored management strategies targeting both sleep-related and psychiatric symptoms in this population.

ABSTRACT Objectives Determining the prevalence of different shoulder subclassification-based diagnoses using a defined exclusion-type diagnostic algorithm. Analyzing the relationships between cervical contribution and other shoulder diagnoses. Methods A proposal of a shoulder pain diagnosis based on functional subclassification was carried out in all subjects. The included diagnoses were cervical contribution, acromioclavicular joint pain, stiff shoulder, atraumatic unstable shoulder, rotator cuff-related shoulder pain, and ‘Others’. Each diagnosis was based on a defined exclusion-type diagnostic algorithm. Cervical contribution was considered if a > 30% shoulder symptom modification in pain intensity was recorded after a cervical spine screening. Since a > 30% change in symptoms does not definitively indicate a categorical diagnosis, cervical contribution was presumed to potentially coexist with other diagnostic labels in these cases. If there was a complete (100%) resolution of shoulder symptoms after the cervical spine screening, cervical contribution was deemed the sole diagnosis. Results Sixty subjects were analyzed. Rotator cuff-related shoulder pain was the most prevalent diagnosis (36.7%, n = 22), followed by stiff shoulder, being present in 30% (n = 18) of subjects. Cervical contribution (13.3%, n = 8), atraumatic unstable shoulder (11.7%, n = 7), others (6.7%, n = 4) and acromioclavicular joint pain (1,7%, n = 1) completed the results. In patients diagnosed with rotator cuff-related shoulder pain, cervical contribution coexisted in 71,4% of them. Thus, a statistically significant association between cervical contribution and rotator cuff-related shoulder pain was found (p = 0,002). This association was not observed in any of the other diagnoses. Discussions/Conclusions Rotator cuff-related shoulder pain was the most prevalent diagnosis, followed by stiff shoulder and cervical contribution. Cervical contribution may coexist with other diagnoses or even be considered as a unique diagnosis itself. Patients diagnosed with rotator cuff-related shoulder pain are more likely to have cervical contribution.

Hypomagnesemia early diagnosis and consequently early, timely magnesium supplementation is of utmost benefit, but it often goes underdiagnosed. The objective was to show and monitor an intervention to identify hypomagnesemia in patients with arrhythmia. A cross-sectional study was designed in the laboratory. In primary care patients, the Laboratory Information System would automatically add a serum magnesium test when sample availability is present in any request when a diagnosis of arrhythmia is made. We counted the number of detected patients with hypomagnesemia (serum magnesium <1.7mg/dL, <0.7mmol/L), and calculated the cost in reagent of each identified case. In 430 patients with arrhythmia, serum magnesium was measured, and 41 (9.5%) had hypomagnesemia results. One patient showed severe hypomagnesemia values (<1.2mg/dL and <0.49mmol/L). Patients with a deficit were significantly (P<0.01) older than the total group of patients with normal magnesium values (66.3±13.2 versus 61.6±12.5). Each case represented a cost of 3.15€ in reagent. The automated computer-based intervention to identify patients with hypomagnesemia was useful and affordable, given the cost per detected case.