6-month Period Research Articles

Pulmonary Vein Isolation vs Sham Intervention in Symptomatic Atrial Fibrillation: The SHAM-PVI Randomized Clinical Trial.

There are concerns that pulmonary vein isolation for atrial fibrillation may have a profound placebo effect, but no double-blind randomized clinical trials have been conducted. To determine whether pulmonary vein isolation is more effective than a sham procedure for improving outcomes in atrial fibrillation. Double-blind randomized clinical trial conducted at 2 tertiary centers in the UK between January 2020 and March 2024 among patients with symptomatic paroxysmal or persistent atrial fibrillation. Major exclusion criteria included long-standing persistent atrial fibrillation, prior left atrium ablation, other arrhythmias requiring ablative therapy, a left atrium of 5.5 cm or larger, and ejection fraction of less than 35%. Participants were randomly assigned to receive pulmonary vein isolation with cryoablation (n = 64) or a sham procedure with phrenic nerve pacing (n = 62). The primary end point was atrial fibrillation burden at 6 months, excluding a 3-month blanking period. Secondary outcomes included quality-of-life measures, time to events, and safety. Atrial fibrillation burden was measured by an implantable loop recorder. A total of 126 participants were randomized (mean age, 66.8 years; 89 men [70.63%]; 20.63% with paroxysmal atrial fibrillation). The absolute mean atrial fibrillation burden change from baseline to 6 months was 60.31% in the ablation group and 35.0% in the sham group (geometric mean difference, 0.25; 95% CI, 0.15-0.42; P < .001). The estimated difference in the overall Atrial Fibrillation Effect on Quality of Life score at 6 months, favoring catheter ablation, was 18.39 points (95% CI, 11.48-25.30 points). The Short Form 36 general health score also improved substantially more with ablation, with an estimated difference of 9.27 points at 6 months (95% CI, 3.78-14.76 points). Pulmonary vein isolation resulted in a statistically significant and clinically important decrease in atrial fibrillation burden at 6 months, with substantial improvements in symptoms and quality of life, compared with a sham procedure. ClinicalTrials.gov Identifier: NCT04272762.

Endoscopic endonasal resection of olfactory tract hamartoma for pediatric epilepsy.

Non-hypothalamic glioneural hamartomas are rare entities known to cause medically refractory epilepsy. Olfactory bulb hamartomas, in particular, are exceptionally rare. We describe a case of an olfactory bulb hamartoma that was surgically resected at our institution. We also performed a literature review of all glioneural hamartomas and discuss the clinical presentation, diagnosis, and management of these lesions. Herein, we present the unusual case of a typically developing 17-year-old boy with a near life-long history of drug-resistant epilepsy, found to have a 0.8 × 1.0cm right olfactory bulb hamartoma. Endoscopic endonasal trans-cribriform resection of the lesion led to seizure freedom in the 6-month follow-up period (Engel class 1 outcome). Comprehensive literature review revealed only one other sporadic case, which was also successfully treated with total surgical resection. Our case of an olfactory bulb hamartoma adds to the limited literature currently available, illustrating key clinical characteristics of these exceedingly rare lesions and outlining an effective, minimally invasive, and low-morbidity treatment strategy.

Impact of recent criteria changes for the deferral criteria specific to men who have sex with men in France.

In 2016, France allowed men who have sex with men (MSM) to donate blood if they had not had sex with men in the previous 12 months. In April 2020, this restriction was relaxed to 4 months due to the lack of negative impact observed on blood safety. This study assesses the impact of reducing this deferral period on epidemiological surveillance indicators. This study compares infection surveillance indicators between two 30-month periods before (P1) and after (P2) this second deferral change. Overall, 79 donations tested positive for human immunodeficiency virus (HIV) (49 in P1 and 30 in P2), 322 for hepatitis C virus (HCV) (185 and 137), 622 for hepatitis B virus (HBV) (355 and 267) and 1684 for syphilis (799 and 885). Positive donation rates decreased between P1 and P2, except for syphilis: HIV (0.07/10,000 donations vs. 0.04; p > 0.5), HCV (0.25 vs. 0.20; p < 0.05), HBV (0.49 vs. 0.39; p < 0.01) and syphilis (1.10 vs. 1.29; p < 0.001). For all three viruses, residual risks of transmission by transfusion did not increase: HIV (1/7,800,000 donations vs. 1/10,500,000), HCV (1/25,200,000 vs. 1/47,300,000) and HBV (1/6,400,000 vs. 1/6,000,000). Reducing the deferral period for MSM in April 2020 did not negatively impact residual risks, which remained very low, or the rate of positive donations, except for syphilis, which requires careful monitoring. To ensure equal access to blood donation, MSM have been allowed to donate blood under the same conditions as other donors since March 2022 (i.e., no more than one sexual partner in the last 4 months).

53743 Real-world Dupilumab Continuation in US Adults with Atopic Dermatitis Over a 24-month Period

53743 Real-world Dupilumab Continuation in US Adults with Atopic Dermatitis Over a 24-month Period

Knowledge attitude and practice of antibiotic use among medical students in Bangladesh: A cross-sectional study.

Antibiotic misuse represent a significant global health challenge, with medical students positioned as key figures in promoting responsible antibiotic usage. This study investigates the knowledge, attitudes, and practices (KAP) regarding antibiotic use among medical students in Bangladesh, aiming to identify areas for targeted educational and policy interventions. This cross-sectional survey was conducted among 501 medical students across various years of study in Bangladesh, collecting data over a 3-month period. The survey assessed antibiotic knowledge, usage practices, and attitudes towards misuse, employing descriptive statistics and multiple logistic regression analyses to explore associations between students' demographic characteristics and their KAP towards antibiotics. Significance was assigned at p-value < 0.05. In our study involving 501 medical students from four medical colleges in Bangladesh, we achieved a 76% response rate. Among the participants, 78.24% correctly identified antibiotics' effectiveness against bacterial infections, but 45.71% were uncertain about their efficacy against viral infections. Notably, 21.20% reported self-prescribing antibiotics, predominantly sourced from physician prescriptions (54.89%). The most common reason for antibiotic use was fever (19.02%). Senior students were less likely to have good knowledge compared to junior students, and urban students demonstrated a higher likelihood of good knowledge and positive attitude towards antibiotic resistance. This study highlights the critical need for educational reforms and antimicrobial stewardship among medical students in Bangladesh to combat antibiotic misuse and mitigate antimicrobial resistance.

Feasibility of aging in place clinics in low income senior housing

The purpose of this study was to describe the feasibility of implementing interdisciplinary senior housing clinics. Feasibility was based on evidence of resident participation, services provided, improvement in clinical outcomes and sustaining clinics over time. Data were collected prospectively in four senior housing communities which included approximately 375 residents 60 years of age and older. Over the 12-month implementation period, 228 residents were seen, 61 % of all residents. We gave 131 immunizations, checked 576 blood pressures, completed 92 foot care treatments, 69 hearing evaluations and cerumen removal, completed 16 advance directives, 119 Annual Wellness Visits, and 13 assessments for acute medical problems. Overall, 87 individuals (38 %) had a decrease in their blood pressures, 121 (54 %) maintained their pressures and 19 (8 %) had increases in blood pressures. We reached over half of the residents living in these communities and estimated we could financially maintain the clinics with reimbursement based on billing.

Effectiveness of patisiran after switching from tafamidis for the treatment of hereditary transthyretin-mediated amyloidosis with polyneuropathy.

Hereditary transthyretin-mediated amyloidosis with polyneuropathy (ATTRv-PN [v for variant]) is a rare, progressive disease associated with multisystemic impairments. This study assessed the real-world outcomes of patients with ATTRv-PN who switched from tafamidis to patisiran, as well as the reasons for the treatment switch. This was a retrospective chart review study at a large expert referral center. Data were extracted from medical charts of patients with ATTRv-PN who switched from tafamidis to patisiran on or before 30 August 2019. Data elements included demographic and clinical characteristics, rationale for switch, and disease measures evaluated from tafamidis initiation through the 12-month patisiran treatment period. Among the 24 patients with ATTRv-PN included in the study, 50.0% had a V30M variant, and the mean (SD) age was 67.3 (8.0) years. During tafamidis treatment (mean [SD] = 30.1 [17.5] months) before switching to patisiran, patients worsened across multiple polyneuropathy measures, including walking ability, Neuropathy Impairment Score, and autonomic function. Neuropathic disease progression on tafamidis was the principal reason for switching to patisiran. After 12 months on patisiran (mean [SD] = 11.7 [1.4] months), patients experienced attenuated disease progression or improvement in the aforementioned measures of polyneuropathy. Switching from tafamidis to patisiran attenuated the rate of functional decline, and most patients experienced stabilization or improvement of at least one polyneuropathy measure within 12 months of patisiran treatment. Timely switch from tafamidis to patisiran can be beneficial to avoid rapid disease progression in patients with ATTRv-PN.

Structural characterization of cholesterol-rich nanoemulsion (LDE)

Cholesterol-rich nanoemulsion (LDE) can carry chemotherapeutic agents in the circulation and can concentrate those agents in the neoplastic and inflammatory tissues. This method improves the biodistribution of the drug and reduces toxicity. However, the structural stability of LDE particles, without or with associated drugs, has not been extensively investigated. The aim of the present study is to investigate the structural stability of LDE and LDE associated to paclitaxel, etoposide or methotrexate in aqueous solution over time by small-angle X-ray scattering (SAXS and Ultra SAXS) and dynamic light scattering (DLS). The results show that LDE and LDE associated with those chemotherapeutic agents had reproducible and stable particle diameter, physical structure, and aggregation behavior over 3-month observation period. As estimated from both DLS and Ultra-SAXS methods, performed at pre-established intervals, the average particle diameter of LDE alone was approx. 32nm, of LDE-paclitaxel was 31nm, of LDE-methotrexate was 35nm and of LDE-etoposide was 36nm. Ultra-SAXS analysis showed that LDE nanoparticles were quasi-spherical, and SAXS showed that drug molecules inside the particles showed a layered-like organization. Formulations of LDE with associated PTX, ETO or MTX were successfully tested in animal experiments and in patients with cancer or with cardiovascular disease, showing markedly low toxicity, good tolerability and possible superior pharmacological action. Our results may be useful for ensuing clinical trials of this novel Nanomedicine tool, by strengthening the knowledge of the structural aspects of those LDE formulations.

Trial to compare mixed-use (multi-use and single-use) intermittent catheter management with single-use management over 12 months (The MultICath Trial): protocol for a non-inferiority randomised controlled trial

IntroductionEvaluating the safety and acceptability of reusing catheters for intermittent catheterisation (IC) is one of the top 10 continence research priorities identified by the UK James Lind Alliance Priority Setting...

Nutritional status of khat (Catha-edulis) chewing adult males in Nakawa division, Kampala city, Uganda

Khat (Catha edulis) also known as “Mairungi” in Uganda, is a green shrub whose leaves are chewed in social gatherings and designated hotspots mainly for its euphoric effect. The socio-economic and health impacts of khat have been previously reported. However, the nutritional implications of khat chewing need to be investigated. A cross-sectional study with a descriptive approach was done to assess the nutritional status of adult male users of khat in the Nakawa division, Kampala city. Using chain sampling, khat users and hot spots were mapped, identified, and listed. Using simple random sampling, 100 khat users were targeted to consent for structured interviews and an assessment of nutritional status over a 3-month persuasion period. Anthropometric data were used to compute the Body Mass Index (BMI) and dietary information was assessed based on food groups consumed and thresholds of Recommended Dietary Allowances (RDA). The degree of relationship among variables was statistically evaluated using, chi-square analyses and the ANOVA test. Statistical significance was considered at P &lt; 0.05. Confidentiality was observed by the use of anonymous questionnaires and coded datasheets. The majority of khat users chewed khat daily 56.0% and mixed khat chewing with other intoxicants such as alcohol 35.0%, cigarettes 15.0%, and cannabis 12.0%. The main driver towards khat chewing in Nakawa was peer pressure 60.0%. The Dietary Diversity Score (DDS) was low, medium and high among 20.0%, 57.0% and 23.0% of khat users, respectively. The DDS was significantly associated with the hours spent on khat chewing X2(4) 10.156, P = 0.025 with most users spending more than four hours, and the frequency of khat chewing X2(4)14.423, P = 0.038. Of the 100 respondents, 26.0% were underweight and 3.0% were overweight. The BMI was significantly associated with age P = 0.029, marital status P = 0.023, frequency of khat chewing P = 0.038, the number of meals P = 0.013 and the dietary diversity scores P &lt; 0.001 in khat users. Khat chewing and its associated habits predispose khat users to a double jeopardy of malnutrition and non-communicable diseases (NCDs). There should be tighter control of khat use through policy and legislation with community-based measures to regulate its demand and supply. Key words: Khat Chewing, Mairungi, Nutritional Status, Body Mass Index, Nakawa, Uganda

Accuracy, precision and diagnostic accuracy of oral thermometry in pediatric patients

PurposeTo determine the accuracy and precision of oral thermometry in pediatric patients, along with its sensitivity and specificity for detecting fever and hypothermia, with rectal thermometry as reference standard. Design and methodsThis method-comparison study enrolled patients aged between 6 and 17 years, admitted to the surgical ward during a 21-month period. KD-2150 and IVAC Temp Plus II were used for oral and rectal temperature measurements respectively. Fever and hypothermia were defined as core temperature ≥ 38.0 °C and ≤ 35.9 °C respectively. Accuracy and precision of oral thermometry were determined by the Bland-Altman method. Sensitivity, specificity, positive and negative predictive value, and correct classification of oral temperature cutoffs for detecting fever and hypothermia were calculated. ResultsBased on power analysis, 100 pediatric patients were enrolled. The mean difference between oral and rectal temperatures was −0.34 °C, with 95 % limits of agreement ranging between −0.52 and −0.16. Sensitivity and specificity of oral thermometry for detecting fever were 0.50 and 1.0 respectively; its sensitivity and specificity for detecting hypothermia were 1.0 and 0.88 respectively. The oral temperature value of 37.6 °C provided excellent sensitivity for detecting fever, while the value of 35.7 °C provided optimal sensitivity and specificity for detecting hypothermia. ConclusionsOral thermometry had low sensitivity for detecting fever and suboptimal specificity for detecting hypothermia; thus, temperature values <38.0 °C and < 36.0 °C cannot exclude fever and confirm hypothermia respectively with high certainty. Practice implicationsDiagnostic accuracy of oral thermometry can be improved by the use of oral temperature thresholds <38.0 °C for detecting fever and < 35.9 °C for detecting hypothermia.

Acanthamoeba as a protective reservoir for Pseudomonas aeruginosa in a clinical environment.

Pseudomonas aeruginosa is a growing concern in healthcare associated infections and poses significant risk to those with serious underlying health conditions. The antimicrobial resistance traits of the pathogen and ability to form biofilms make effective mitigation and disinfection strategies difficult. Added to this challenge is the role that free-living amoebae such as Acanthamoeba play in the detection, disinfection, and transmission of P. aeruginosa. P. aeruginosa can survive intracellularly within amoebae, which has the potential to limit detectability and permit transmission into high-risk areas. Herein, we have screened for the presence of Acanthamoeba species and P. aeruginosa within a functioning general hospital in Scotland using a culture and molecular approach, noting their presence at several sites over a 4-month period, particularly within floor drains connecting patient rooms. In addition, microbiome analysis revealed amoebae harbour a unique microbial community comprised primarily of Pseudomonas species that were not readily detected using microbiome sequencing techniques on environmental swabs. Having demonstrated that both organisms were consistently present in hospital settings, we investigated the relationship between Acanthamoeba and P. aeruginosa in the laboratory, showing that i) Acanthamoeba growth rate is increased in the presence of Pseudomonas biofilms and viable Pseudomonas persist within the amoebae and ii) hydrogen peroxide-based disinfectants are significantly less effective against an isolate of P. aeruginosa in the presence of Acanthamoeba than when the bacteria are incubated alone. These findings suggest that amoebae, and other protists, can influence the detection and persistence of P. aeruginosa in high-risk areas and should be considered when implementing mitigation strategies.

Porn or Partner Arousal? When It Comes to Romantic Relationships, Not All Sexual Arousal Is Equal: A Prospective Study.

Little is known about the role of subjective sexual arousal within romantic relationships. The current paper addresses this limitation using a prospective study design that investigates the direct associations between subjective sexual arousal induced by a romantic partner (partner arousal) and arousal induced by pornography (porn arousal) on changes in relational outcomes. A total of 309 participants who were in a current romantic relationship completed measures of partner and porn arousal as well as relational outcomes (i.e., sexual satisfaction and relationship quality and stability) at baseline (T1) and completed a second assessment of relational outcomes 2months later (T2). Partner arousal was found to have no significant associations with changes in relational outcomes; however, porn arousal was associated with significant declines in sexual satisfaction and relationship quality and stability over a 2-month period. This paper is the first to examine how feeling sexually aroused by porn may impact relational outcomes for those in romantic relationships.

Integrating causal pathway diagrams into practice facilitation to address colorectal cancer screening disparities in primary care.

Colorectal cancer (CRC) is the second leading cause of cancer death and the second most common cancer diagnosis among the Hispanic population in the United States. However, CRC screening prevalence remains lower among Hispanic adults than among non-Hispanic white adults. To reduce CRC screening disparities, efforts to implement CRC screening evidence-based interventions in primary care organizations (PCOs) must consider their potential effect on existing screening disparities. More research is needed to understand how to leverage existing implementation science methodologies to improve health disparities. The Coaching to Improve Colorectal Cancer Screening Equity (CoachIQ) pilot study explores whether integrating two implementation science tools, Causal Pathway Diagrams and practice facilitation, is a feasible and effective way to address CRC screening disparities among Hispanic patients. We used a quasi-experimental, mixed methods design to evaluate feasibility and assess initial signals of effectiveness of the CoachIQ approach. Three PCOs received coaching from CoachIQ practice facilitators over a 12-month period. Three non-equivalent comparison group PCOs received coaching during the same period as participants in a state quality improvement program. We conducted descriptive analyses of screening rates and coaching activities. The CoachIQ practice facilitators discussed equity, facilitated prioritization of QI activities, and reviewed CRC screening disparities during a higher proportion of coaching encounters than the comparison group practice facilitator. While the mean overall CRC screening rate in the comparison PCOs increased from 34 to 41%, the mean CRC screening rate for Hispanic patients did not increase from 30%. In contrast, the mean overall CRC screening rate at the CoachIQ PCOs increased from 41 to 44%, and the mean CRC screening rate for Hispanic patients increased from 35 to 39%. The CoachIQ program merges two implementation science methodologies, practice facilitation and causal pathway diagrams, to help PCOs focus quality improvement efforts on improving CRC screening while also reducing screening disparities. Results from this pilot study demonstrate key differences between CoachIQ facilitation and standard facilitation, and point to the potential of the CoachIQ approach to decrease disparities in CRC screening.

The effect of single versus multiple piezocisions on the rate of canine retraction: a randomized controlled trial.

Piezocision is a minimally invasive surgical method aiming to accelerate tooth movement. However, its effect was found to be transient, appertaining to the regional acceleratory phenomenon (RAP). Hence, the aim of the study was to evaluate the effect of single and multiple piezocisions on the rate of orthodontic tooth movement (OTM). Moreover, the impact of both protocols on canine tipping and orthodontically induced inflammatory root resorption (OIIRR) has been assessed. Thirty indicated patients for the therapeutic extraction of maxillary first premolars were enlisted in this split-mouth study, and they were randomly split into two equal groups, each including 15 subjects. In the Single Application Group (SAG), one side of the maxillary arch arbitrarily received a single piezocision before the onset of canine retraction, whereas in the Multiple Application Group (MAG), piezocisions were randomly performed on one side, three times on a monthly basis, over the 12-week study period. The contralateral sides of both groups served as the controls. Canine retraction was carried out bilaterally using nickel-titanium closed-coil springs, delivering 150g of force, and the rate of tooth movement, as well as canine tipping were evaluated on a monthly basis, over a 3-month period. Cone-bean computed tomography scans were also conducted pre- and post- canine retraction, and OIIRR was assessed using Malmgren Index. The reported outcomes revealed a significant increase in the amount of canine retraction, canine tipping, as well as root resorption scores on the experimental sides in both groups SAG and MAG post-retraction (p < 0.001). However, upon comparing the experimental sides in both groups, non-significant differences have been observed between them regarding all the assessed outcomes (p > 0.05). Single and multiple piezocisions effectively accelerate OTM in comparison to conventional orthodontic treatment, with relative outcomes reported by both intervention frequencies. Accordingly, single piezocision is recommended as an adjunct to OTM. Furthermore, significant tooth tipping as well as a significantly higher root resorption risk accompanies both single and multiple piezocision applications in conjunction with OTM. Clinicaltrials.gov TRIAL REGISTRATION NUMBER: NCT05782088 DATE OF REGISTRATION: 23/03/2023 "Retrospectively registered". URL: https://clinicaltrials.gov/ct2/show/NCT05782088.

Assessment of MMP levels in reversible and irreversible pulpitis and a randomized controlled trial comparing clinical success of two different calcium-silicate cements in pulpotomy treatment of primary molars with an 18-month follow-up.

Matrix metalloproteinases (MMPs) are critical enzymes involved in the remodeling and defense mechanisms of dental pulp tissue. While their role in permanent teeth has been extensively studied, research focusing on MMPs in primary teeth remains limited. This gap highlights the need for further investigations to understand the specific contributions of MMPs to pulpal defense in primary teeth. Moreover, the clinical efficacy of Biodentine as a pulpotomy material in primary teeth warrants further exploration through well-designed studies to establish its success and long-term outcomes in pediatric dentistry. This study aims to compare the expression levels of MMP-2, MMP-8, and MMP-9 in cases of reversible and irreversible pulpitis. Additionally, it seeks to evaluate the clinical success of Mineral Trioxide Aggregate (MTA) and Biodentine when used as pulpotomy agents in primary molars. By analyzing the differential expression of these MMPs, the study will contribute to a better understanding of their role in pulpal inflammation and the potential therapeutic outcomes of MTA and Biodentine in primary molars. In this parallel randomized controlled trial, 63 mandibular primary second molars were assigned to two main groups: Group 1, consisting of 42 teeth diagnosed with reversible pulpitis, and Group 2, consisting of 21 teeth diagnosed with irreversible pulpitis. Group 1 was further divided into two randomized subgroups, each containing 21 teeth. The expression levels of MMP-2, MMP-8, and MMP-9 were evaluated in all samples. Pulpotomy treatments were performed using MTA and Biodentine in Group 1. Clinical and radiographic evaluations were conducted over an 18-month follow-up period. Statistical analyses were carried out using The Kolmogorov-Smirnov test, t-test and Fisher's exact test (p < 0.05). The study revealed that MMP-2 and MMP-9 expression levels were significantly elevated in specimens with irreversible pulpitis (p = 0.01), indicating a potential correlation between these matrix metalloproteinases and the severity of pulpal inflammation. However, no significant difference was observed in the clinical success rates of pulpotomies performed with MTA and Biodentine, suggesting that both materials are equally effective in the treatment of primary molars with reversible pulpitis. The expression of MMP-2 and MMP-9 in pulpal blood presents a promising biomarker for assessing the degree of pulpal inflammation in primary teeth, offering a potentially valuable diagnostic tool. Additionally, the clinical success of Biodentine in pulpotomy procedures supports its viability as an effective alternative to MTA, providing a reliable option. The study protocol has been registered with an ID: NCT05145686. Registration Date: 9th November 2021.

Relations between adolescent perceptions of household chaos and externalizing and internalizing behaviors in low- and middle-income families.

A large body of literature has established that chaos in the home environment, characterized by high levels of disorganization, lack of household routine, crowding, noise, and unpredictability, undermines social-emotional and behavioral development in early childhood. It is less clear whether household chaos is linked to elevated risk for behavior problems in adolescence. The aims of this study were 3fold: (1) characterize the variability of adolescent and caregiver reports of household chaos over time; (2) examine associations among caregiver and adolescent reports of chaos over a 9-month period; (3) consider how between- and within- individual variability in household chaos predicts adolescent externalizing and internalizing problems. This study drew data from the Family Income Dynamics study, a 9-month longitudinal study. Participants included 104 adolescents between 14 and 16 years old (55% female; M age = 14.85) and their caregiver (92% female) from low- and middle-income families. Results showed that adolescent-reports of household chaos were more variable over time compared to caregivers' reports. Adolescent-reports of household chaos had positive within- and between-level associations with externalizing problems and between-level associations with internalizing, while caregiver-reports of chaos had no links to behavior. This work highlights the importance of adolescents' own perceptions of household chaos when considering its links to adolescent development.

Clinical efficacy of Ni-Ti memory alloy four-corner arthrodesis concentrator in the treatment of scaphoid nonunion advanced collapse: a follow-up of over 10 years.

Exploring the therapeutic effects of Ni-Ti shape memory alloy four-corner arthrodesis concentrator (NT-FCAC) in treating scaphoid nonunion advanced collapse (SNAC) and providing a decade-long follow-up report. Twenty-six patients with SNAC underwent scaphoidectomy, along with four-corner arthrodesis fusion involving the capitate, lunate, triquetrum, and hamate, using NT-MFCAC. Grip strength was measured using a Jamar dynamometer, while wrist joint mobility was assessed using a goniometer. Preoperative and postoperative assessments were conducted using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire to monitor limb functionality restoration. Pain levels at the wrist joint were evaluated using the visual analog scale (VAS). Postoperative wrist bone fusion status was assessed through anteroposterior and lateral radiographs of the wrist joint. After a 3-month postoperative period, all 26 patients exhibited osseous union at the wrist joint. Over a follow-up spanning 10-15 years, no severe postoperative complications were observed in any patient. Grip strength in the affected side of all patients recovered to 81.96% compared to the healthy side, while wrist joint mobility in the affected side reached over 60% of the healthy side's functionality. VAS scores decreased significantly from 5.85 ± 0.73 preoperatively to 0.19 ± 0.40 at the final follow-up; Quick DASH scores reduced from 69.88 ± 5.12 preoperatively to 6.30 ± 1.25 at final follow-up. Statistically significant differences were noted in VAS and Quick DASH scores for all patients (p < 0.05). However, beyond 60 months postoperatively, subsequent follow-ups did not yield statistically significant differences in VAS and Quick DASH scores for all patients (p > 0.05). Utilizing NT-FCAC for SNAC treated with four-corner arthrodesis fusion results in a high rate of wrist bone fusion, preserving a significant portion of wrist joint function and exhibiting favorable long-term outcomes. This approach is suitable for treating patients with SNAC requiring four-corner arthrodesis fusion.

Comparison of perioperative bleeding risk between direct oral anticoagulants in transurethral resection of prostate.

To evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP). This was a single-centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no-AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic-related morbidity were captured within a 3-month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no-AC, and DOAC groups were analysed with two-sided t-test, and chi-square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability-weighted treatment effect analysis to evaluate bleeding risk. There were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for >14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no-AC vs AC: 0.4% vs 2.7%, P = 0.01). This is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding-related complications than rivaroxaban.

Macular thickness fluctuations and visual acuity outcomes after intravitreal dexamethasone implant for diabetic macular edema.

To assess macular thickness fluctuations and their association with visual acuity (VA) outcomes in eyes with diabetic macular edema (DME) treated with intravitreal dexamethasone (DEX) implant. The standard deviation (SD) of all post-baseline central subfield thicknesses (CST) recorded over a 12-month period after the first injection of DEX implant was used to quantify CST fluctuations. Linear regression models were used to identify factors associated with the VA at 12 months (measured with the Early Treatment of Diabetic Retinopathy Study (ETDRS) score), and predictors of CST SD. A retrospective review of 80 eyes of 80 patients treated with DEX implant for DME revealed a CST SD of 75.3 ± 50.3 μm. The CST SD was negatively associated with the VA at 12 months (-7.7 EDTRS letters for each 100-µm increase in CST SD, p=0.01), while changes in CST from baseline did not show any significant association. Eyes were stratified into quartiles based on the CST SD and a difference by -14.2 letters in VA at 12 months was observed between the first and fourth quartiles (p <0.001). Significant predictors of CST SD included the baseline VA (-12.0 μm for each 10-letter increase, p=0.02), and the number of DEX injections received (n=17.1, p=0.03). Greater fluctuations in retinal thickness were found to be associated with poorer visual outcomes in eyes with DME treated with DEX implant. Analyzing the CST SD could be a more predictive indicator of visual prognosis than individual measurements of the CST.