2-year Period Research Articles

Increased prevalence of cardiovascular-kidney-metabolic syndrome conditions during COVID-19: A propensity score-matched study

A recent presidential advisory from the AHA has introduced the term cardiovascular-kidney-metabolic (CKM) syndrome to describe the complex interplay among these health conditions. The aim of our study was to compare the prevalence of concurrent CKM syndrome components before and during the COVID-19 pandemic and identify associated risk factors. We conducted a study utilizing data from a real-world population obtained from a primary care database. The study cohort comprised a closed group followed over a 6-year period (2017–2022). A total of 81,051 individuals were included: 32,650 in the pre-pandemic period and 48,401 in the 2020–2022 triennium. After propensity-score matching for sex, age, and BMI, the study included 30,511 individuals for each period. A total of 3554 individuals were diagnosed with type 2 diabetes (T2D) in the pre-pandemic period, compared to 7430 during the pandemic. Hypertension, dyslipidemia, and obesity displayed significant increases in prevalence during the pandemic, and prediabetes had a particularly sharp rise of 170%. Age-stratified analyses revealed a higher burden of CKM conditions with advancing age. Our findings indicate a substantial increase in the prevalence of CKM syndrome conditions during the COVID-19 pandemic, with nearly half of the patients exhibiting one or more CKM syndrome components.

Interparental and Parent-Teen Relationships during Adolescence as Predictors of Intra- and Interpersonal Emotion Regulation in Young Adulthood.

Parents' contributions to their children's emotion regulation during adolescence has been a relatively understudied interpersonal context of development, even though parents' roles as sources of social and emotional learning persist from childhood into adolescence and the complexity of teens' lives grows during this time. This study aims to investigate the differential predictive utility of qualities and behaviors in interparental and parent-teen relationships during adolescence for predicting youths' development of intra- and interpersonal emotion regulation over a 13-year period. To assess these hypotheses, data were obtained from a longitudinal, multi-method, multi-informant study of 184 adolescents (107 Caucasian, 53 African American, and 24 mixed/other ethnicity; median family income of USD 40,000-60,000/year in 1999, equivalent to about USD 75,000-112,000/year when accounting for inflation) and their parents. The results provide support for a differential pattern of prediction; qualities of interparental relationships in early adolescence were significant predictors of young adult interpersonal emotion regulation, whereas behaviors in interparental and parent-teen relationships in late adolescence were significant predictors of both young adult positive intra- and interpersonal emotion regulation. Notably, some father-reported relationship predictors during late adolescence had unexpected relations with later intrapersonal emotion regulation. The results are discussed in terms of the helpfulness of these specific relationship factors during each part of adolescence for supporting positive intra- and interpersonal emotional regulation development.

Apex carnivores coping with metal(loid) pollution and oxidative stress: biological and environmental drivers of variation in kidney of European brown bear

Induction of oxidative stress and the associated lipid peroxidation is a prevalent mechanism through which certain metal(loid)s exert nephrotoxic effects in mammals. Research on the toxic impacts of metal(loid)s in free-ranging large mammals at high trophic positions is exceedingly rare, yet crucial for understanding environmental exposure scenarios relevant to both human and animal risk assessment. Renal cortex tissues (N=457) of free-ranging brown bears (Ursus arctos) from the Dinara-Pindos population sampled in Croatia were analysed herein for toxic metal(loid)s and the underlying biological and environmental drivers of variation, with their time trend monitored during the 2009-2022 period. In 28 individuals from the 2021-2022 period, we additionally investigated associations between metal(loid)s and oxidative stress and damage biomarkers in renal cortex cells. The principal generalized linear models used to approximate variations in biomarkers of oxidative stress and damage included non-essential As, Cd, Pb, Tl and U, and essential Co, Cu, Fe and Zn. Age class and season of sampling had no impact on biomarker levels, except for lipid peroxidation, LP (April ↑). Age, sex (females ↑), body condition index (↓) and season of sampling significantly influenced metal(loid)s levels. Non-specific mammalian thresholds were crossed for Cd and Pb toxicity in 1-16% and 2% of population, respectively. Renal levels of metal(loid) did not exhibit a clear trend over the 13-year period. The levels found in this study were higher than in sympatric carnivorous and herbivorous species, but in line with findings in ursids worldwide. Potential adverse health effects from environmental exposure in brown bears may arise from disruption of oxidative balance, as evidence clearly indicated associated changes in catalase activity (↑), glutathione content (↑), LP (↓), reactive oxygen species (↓), total antioxidant capacity (↑) in the renal cortex due to the presence of the most toxicologically relevant Cd and Pb.

Epidemiology of odontogenic tumours and selected cysts diagnosed at a single New Zealand oral pathology centre- A 15-year retrospective study.

This research aimed to investigate the relative frequency of odontogenic tumours (OT) and selected odontogenic cysts in a single oral pathology center in New Zealand from 2008 to 2023. Histopathological records from the Oral Pathology Centre, University of Otago (2008-2023) were examined to identify OT. Odontogenic keratocyst (OKC) and calcifying odontogenic cyst (COC), previously classified as OT were also included. Patient demographics, clinical details and histopathologic diagnoses were recorded. Data were analyzed using SPSS. Of the 34,225 biopsies over the 15-year period, 1.8% were identified as OTs, COC and OKCs and accounted for 47%, 1.5% and 51.5% respectively. The most prevalent OT types were odontoma (43.7%), ameloblastoma (27%) and cemento-ossifying fibroma (7.5%). Malignant OT, ameloblastic carcinoma, constituted 1.4% of OT. The average age at diagnosis for OKC, COC and OT patients were 48.2 ± 20.9, 33.7 ± 23.3 and 28.9 ± 19.3 years. Overall, male and mandibular site predilections were observed. Recurrence of OKC and ameloblastoma occurred in 15.2% and 13.7% of patients. The time for recurrence for OKC and Ameloblastoma were 61.7 ± 56.5 months and 122 ± 152 months respectively. The demographic features and range of OT, COC and OKC in New Zealand align with those of other western countries. The study also confirms need for long term follow up for patient with OKC and ameloblastoma.

The Burden of Injuries Associated With E-Bikes, Powered Scooters, Hoverboards, and Bicycles in the United States: 2019‒2022.

Objectives. To describe the national burden of injuries associated with e-bikes, bicycles, hoverboards, and powered scooters (micromobility devices) in the United States. Methods. We compared patterns and trends for 1 933 296 estimated injuries associated with micromobility devices from 2019 to 2022 using National Electronic Injury Surveillance System data. Results. The population-based rates of e-bike and powered scooter injuries increased by 293.0% and 88.0%, respectively. When reported, powered scooter injuries had the highest proportion for alcohol use (9.0%) compared with other modes, whereas e-bike injuries had the highest proportion for motor vehicle involvement (35.4%). Internal injuries were more likely among e-bike diagnoses than hoverboard and bicycle (P < .05), but fractures and concussions were more likely among hoverboard diagnoses compared with all other devices (P < .05). When helmet use was identified in clinical notes (20.3%), helmet usage was higher among e-bike injuries (43.8%) compared with powered scooter (34.8%) and hoverboard (30.3%) injuries but lower compared with bicycle injuries (48.7%). Conclusions. The incidence of severe e-bike and powered scooter injuries increased over the 4-year period. Public health stakeholders should focus on improved surveillance and prevention of injuries associated with electric micromobility devices. (Am J Public Health. 2024;114(12):1365-1374. https://doi.org/10.2105/AJPH.2024.307820).

Impact of COVID-19 pandemic on Carbon Ion Radiotherapy in Japan: a Japanese National Registry Study

PurposeThis study aimed to investigate the impact of the COVID-19 pandemic on carbon ion radiotherapy (CIRT) in Japan by evaluating patient numbers and treatment trends from 2019–2022. Patients and MethodsData from five CIRT facilities were analyzed, encompassing a total of 13,224 patients treated over the 4-year period. Patient demographics, cancer types, treatment protocols, and adherence to national health insurance coverage were examined. The study period was divided into unaffected (2019), significantly affected (2020–2021), and post-stabilization (2022) phases, corresponding to progression of the pandemic. For monthly analysis, the period during which a state of emergency was declared by the Japanese government was defined as the pandemic period. ResultsProstate cancer comprised the majority of CIRT cases (62.4%), followed by hepatocellular carcinoma, bone and soft tissue tumors, locally advanced pancreatic cancer, and non-squamous cell carcinoma of the head and neck. Despite the pandemic, the annual reduction in CIRT patients remained <5%, suggesting treatment continuity. Analysis of monthly treatment figures revealed a significant reduction in the number of patients with non-prostate cancers treated during the state of emergency, while a reduction in the number of prostate cancer treatments was observed approximately 6 months later. Although the number of COVID-19 patients continued to increase after 2022, the number of patients receiving CIRT increased after the state of emergency was declared. ConclusionAlthough there was a reduction in monthly CIRT patient numbers during the COVID-19 pandemic, yearly analysis revealed that this amounted to <5%.

Bone Regrowth After Frontal Burr Hole Craniostomy: Natural History of 14-mm and 20-mm Burr Holes and Implications for Postoperative Trans-Burr Hole Ultrasound

BACKGROUND AND OBJECTIVE: Burr hole craniostomy is performed for ventriculoperitoneal shunt insertion and endoscopic third ventriculostomy in patients with cerebrospinal fluid disorders. These burr holes are increasingly being used as windows for postoperative ultrasound, an investigational alternative to computed tomography or MRI for follow-up imaging of ventricular caliber. However, bone regrowth reduces ultrasound visibility, and little is known about burr hole regrowth rates in adults. Our study evaluates burr hole regrowth patterns and implications for transcranial ultrasound imaging. METHODS: We retrospectively analyzed 101 consecutive patients who had frontal burr hole craniostomy for new ventriculoperitoneal shunt insertion or endoscopic third ventriculostomy over a 3-year period. A mix of standard 14-mm burr holes and expanded 20-mm burr holes were used. Burr hole bone regrowth was assessed using serial follow-up computed tomography scans. Linear and logistic regression analyses examined if bone regrowth correlated with any clinical variables. RESULTS: There was wide variability in rate and degree of burr hole regrowth. The average percentage closure was 25% at 6 months, with minimal additional closure over the following 18 months. The mean residual diameter for 14-mm and 20-mm burr holes stabilized around 9.4 mm and 15.4 mm, respectively. Bone regrowth was not associated with patient characteristics, including age, sex, skull thickness, or etiology of cerebrospinal fluid disorder. Rate of bone regrowth was similar between both cohorts. CONCLUSION: Bone regrowth after burr hole craniostomy is common, even in elderly patients, occurring rapidly within the first 6 to 12 months and subsequently stabilizing. It is frequently severe enough to restrict ultrasound visualization. Regrowth could not be predicted with any investigated variables, so uniform techniques are needed to block regrowth to allow for longitudinal ultrasound imaging, such as full-thickness cylindrical burr hole implants.

The rate of ileostomy site incisional hernias: more common than we think?

Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort. A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site. 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6kg/m2. 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001). We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.

Impact of metabolic and bariatric surgery on weight loss and insulin requirements in type 1 and insulin-treated type 2 diabetes.

Metabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin-treated type 2 diabetes (T2D) patients over a 5-year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin-treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin-treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin-treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG.

Using an Intraoperative Stress Exam to Direct Treatment in Posterior Femoral Head Fracture-Dislocations.

To examine the results of a treatment algorithm incorporating an EUA performed intraoperatively after fixation of the femoral head through a Smith Petersen approach to determine need for posterior wall or capsule repair. Design: Retrospective review. Two Level 1 trauma centers. All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017-2022. Injuries were classified according to the Pipkin system. The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty. Studied were 63 males and 22 females with mean age 32.5 (range 18-71). 79 of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included 7 patients with wall involvement >20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow up, 16 of 65 (26.4%) developed radiographic evidence of AVN and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to total hip arthroplasty over the study period. When comparing patients with a single exposure with those with additional KL exposure, they did not vary in their rate of AVN (27.1% vs. 0.0%, P=0.3228), HO formation (30.5% vs. 50.0%, P=0.3788), or conversion to total hip arthroplasty (10.2% vs. 16.7%, P=0.510). This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA accurately identifies residual instability. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

How to Teach an "Old Dog" New Tricks: Improving Clinical Efficiency in a Well-Established Cochlear Implant Program.

To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program. Tertiary referral center. CI candidates and CI users. Implementation of a new CI service delivery model. CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden. De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists' schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019-2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our program's CI utilization rate and reduced our role as a barrier to CI care. If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.

Residual C-peptide is associated with new and persistent impaired awareness of hypoglycaemia in type 1 diabetes

AimsTo describe the change in impaired awareness of hypoglycaemia (IAH) over time and to identify factors associated with this change in the Dutch Type 1 Diabetes biomarkers cohort (NCT04977635). MethodsA prospective cohort of type 1 diabetes patients, with C-peptide <300 pmol/L, who had completed the Clarke questionnaire, to determine IAH status, at baseline and after 2 years. Changes in awareness status were defined and compares as follows: unchanged normal awareness (NAH) versus unchanged IAH, new IAH versus reversal of IAH. Multivariate logistic regression models were fitted using forward and backward stepwise selection using a 0.10 P-value cut-off, and stepwise backward selection using AIC criteria. ResultsA total of 431 out of 611 participants were included. The baseline prevalence of IAH was 17 % and 20 % after 2 years. The incidence proportion of new IAH and reversal of IAH were, 9.5 % and 31 %, respectively. For every 2.7-fold increase in C-peptide, the odds of IAH decrease by 58 %. A 1-unit increase in BMI over the 2-year follow-up period is associated with a 5.27-fold increase in the odds of reversing IAH. ConclusionsHigher C-peptide levels are protective against new IAH, and an increase in BMI over time is associated with the reversal of IAH.

Measuring transboundary disease spread - ASF in wild boars straddling Piedmont and Liguria

The aim of this paper is to describe the impact, dynamics and risk factors of the incursion of the African Swine Fever (ASF) virus detected in early 2022 in the wild boar population straddling Piedmont and Liguria, 24 months after its emergence.A study area of 4,162.2 square kilometres, comprising 234 municipalities in Liguria and Piedmont (north-western Italy), along with an external buffer zone, was considered. The epidemiological units were wild boars tested for ASF using real-time PCR between late December 2021 and December 31, 2023. The data were obtained from passive and active surveillance. Conventional methodologies were applied in the analysis of time series of tests, cases, or prevalence rates of positive animals. Maps were used to visualise and compare the monitoring activities, the location of cases and municipal standardised prevalence ratios. Clustering of high and low trends was studied by semester using a space-time permutation model. Risk factors analysis was based on multivariate Poisson regression modelling.Over the 2-year study period, the epidemic's spread was closely monitored by testing 10,412 wild boars (25% of them from passive surveillance). Probability of disease detection was 10.9 times higher among found dead animals compared with animals tested in active surveillance. Difficulties in carcass searching led to heterogeneities in surveillance sensitivity achieved locally and inherent uncertainties. A total of 1,165 wild boars that tested positive for ASF have been detected in 125 municipalities across three provinces. The outbreak has expanded over time and exhibited an increasing trend, with an epidemic doubling time of 10.7 months. There was seasonality, with an increasing trend from summer to spring. Prevalence rates followed the same temporal pattern. Significant low and high clusters respectively indicated endemic episodes in the interior areas of virus circulation and an ongoing invasion of surrounding regions.The characteristics of this outbreak align with the cycle of wild boar habitat transmission observed in other outbreaks across Europe. The measures implemented were not sufficient to stop the epidemic: however, targeted interventions such as depopulation campaigns, reinforcement of physical barriers and increased biosecurity measures have prevented local spillover to domestic pigs and partially hindered the advance of the disease. In addition, the shown seasonality of the disease, likely can enhance control measures. The ongoing studies of the local wild boar populations and the evolution the epidemic along with the lessons learned so far will improve the efficiency and effectiveness of efforts to limit and ultimately eradicate the disease.

Management of Strangulated Inguinal Hernias in People Aged 60 Years and Over at the Prefectural Hospital of Kissidougou, Republic of Guinea-Conakry

Introduction: Strangulated inguinal hernias in the elderly remain a real public health problem due to their risk of intestinal necrosis leading to a high rate of morbidity and mortality. The objective of our study was to evaluate the management of strangulated inguinal hernias in people aged 60 and over at the prefectural hospital of Kissidougou. Methods: This was a retrospective descriptive study over a 3-year period from January 1, 2018 to December 31, 2020. The material consisted of all the files of patients operated on for a strangulated inguinal hernia in the elderly during the study period. Results: During this study period, we recorded 76 files of patients operated on for HIE in the elderly, i.e. a frequency of 3.34% compared to the types of hernias. The average age of our patients was 70.46 years with extremes of 60 years and 83 years. 88% of patients were male with a sex ratio of 7.4. Farmers were the most affected, i.e. 32.89%. HBP and diabetes were the main associated pathologies with 51.32% and 34.21% respectively. General anesthesia was used in all our patients. The BASSINI technique was performed in 100% of cases. The evolution was favorable in 80.26%. The case fatality rate was 3.95%. The average length of hospitalization of our patients was 8.38 days. Conclusion: Improving the prognosis of these patients would require early diagnosis and especially early management of all cases of simple inguinal hernias.

Epidemiologic Study of Myasthenia Gravis in the Elderly US Population: A Longitudinal Analysis of the Medicare Claims Database, 2006-2019.

Epidemiologic studies suggest increasing incidence and prevalence of myasthenia gravis (MG) among the elderly population outside the United States. We aimed to provide an estimation of MG incidence and prevalence and their trend among the Medicare Fee-For-Service (FFS)-covered elderly US population. We performed a retrospective longitudinal study using Medicare claims data (2006-2019). Study-eligible beneficiaries were aged 65 years and older, had at least 1 month of FFS Part A/B coverage, and were without any health maintenance organization insurance coverage. Study-eligible beneficiaries were aggregated into 2-year periods from 2006-2007 through 2018-2019. MG cases were ascertained using a validated algorithm of 2 MG claims within each 2-year period, from 2 outpatient office visits or a combination of 1 inpatient admission and 1 outpatient office visit, separated by ≥ 28 days. Period prevalence was calculated from MG-ascertained cases divided by FFS Part A/B beneficiaries and reported as cases per 100,000 population. Incident cases were determined among MG prevalent cases if the initial MG claim occurred in that period after a full calendar year since coverage initiation. Incidence was calculated as case counts per 100,000 at-risk beneficiary person-years (PYs) in each period excluding 2006-2007. Trends of prevalence and incidence over time were examined with Poisson regression. All-cause mortality of each 2-year period was calculated. The period prevalence of MG increased from 81 to 119 per 100,000 FFS A/B population from 2006-2007 to 2018-2019 (p < 0.001). Increasing trends of prevalence were observed in all sex (male/female), age (65-69/70-74/75-79/80+), race/ethnic (African American/Asian/Hispanics of any race/non-Hispanic White/other), and census region (Northeast/Midwest/South/West) subgroups. MG incidence increased from 12.2 to 13.3 per 100,000 PYs from 2008-2009 to 2018-2019 (p < 0.05). Increasing incidence trends were significant in the following subgroups: men and women; all age groups except 75-79 years; White non-Hispanic race; Northeast, Midwest, and South census regions. All-cause mortality among MG beneficiaries was stable from 6.26 deaths per 100 PYs in 2006-2007 to 5.67 in 2018-2019 (p = 0.18). Increasing trends in MG prevalence and incidence in the elderly US population, with variation in rates of certain subgroups, are confirmed in this 14-year period.

Short- and long-term outcomes of adrenalectomy for primary aldosteronism in a single UK center: rear-mirror view

Abstract Purpose Primary aldosteronism (PA), which is the commonest cause of secondary hypertension, can be cured by unilateral adrenalectomy. We report the short-and long-term outcomes after adrenalectomy performed at a single UK center over a period of 24 years. Methods Retrospective analysis of biochemical (potassium, aldosterone, renin, and ARR) radiological (CT/MRI, AVS, and nuclear scans), and clinical (surgical complications, blood pressure, and number of antihypertensive medications) short-and long-terms outcomes in patients who underwent adrenalectomy for PA between 1998 and 2021. Standardized PASO and Clavien-Dindo criteria to assess biochemical, clinical, and surgical outcomes were used. Results A total of 82 patients were treated via adrenalectomy for PA over a 24-year period. Short-term follow-up data (within 3 months after surgery) was available for all 82 patients (M45, F37, mean age 51.7 years): 24 of them were followed up for at least 60 months (range 60 to 72 months) and 77 (93.9%) patients had laparoscopic surgery (one conversion). Seven patients had postoperative complications classified as Clavien-Dindo II (4), IIIa(1) and IVa(2). Median LOS was 2.5 days (1–12). Complete and partial clinical success was achieved in 29 and 58.3% and 41.7 and 45.8% of patients in the short and the long term, respectively. Clinical benefit was observed in 88% of patients. Complete biochemical success was achieved in 95.8% of patients in the short and the long term. Conclusion Unilateral adrenalectomy in patients with PA showed clinical benefit in 88% and achieved biochemical cure in almost all of them. Our data suggest that these benefits persisted for at least 5 years.

Synthesis of Self-Assembled Nanostructured Cisplatin Using the RESS Process

Background/Objectives: The primary goal of our research is to develop a process to prepare an aqueous dispersion of Cisplatin, an important anticancer drug, with increased solubility and storage stability. Method: In this context, we report the use of a customized RESS process for the synthesis of a novel, amber-colored and viscous aqueous cisplatin solution, an important anticancer drug, which we have denoted as “liquid” cisplatin. Results: Using specialized liquid cell in situ transmission electron microscopy (Liquid in situ TEM) and Raman spectroscopy, we demonstrated that “liquid” cisplatin comprises a bi-modal distribution of a highly solvated network of stable cisplatin nanoclusters in water and exhibited 27 times greater water solubility than standard cisplatin. More importantly, “liquid” cisplatin was stable at ambient conditions for over two years. Extensive analytical characterization of “liquid” cisplatin confirmed that it retained the original chemical identity of cisplatin. Cell viability and apoptosis studies on human lung adenocarcinoma A549 cells provided compelling evidence that “liquid” cisplatin demonstrated a more sustained anticancer effect compared to standard cisplatin. Conclusions: Aqueous cisplatin solubility was increased by 27X in the “liquid” cisplatin medium which retained its bio efficacy over a 2-year period. Our experimental results suggest the possibility of developing non-invasive and highly effective novel cisplatin drug-delivery platforms.

Trajectory of Non-suicidal Self-Injury among adolescents with borderline personality disorder over a 5-year period

Trajectory of Non-suicidal Self-Injury among adolescents with borderline personality disorder over a 5-year period

A Rare Collision of Endometrioid Adenocarcinoma and Second Recurrent Low-Grade Endometrial Stromal Sarcoma 8 Years After Hysterectomy: A Case Report and Literature Review

Low grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy of mesenchymal origin in the female reproductive system, which has the characteristic of late recurrence. Endometrial carcinoma is a group of epithelial tumors, and is one of the most common gynecological malignancies among women worldwide. The coexistence of LG-ESS and endometrial carcinoma is extremely rare, and there is no relevant report about the collision of endometrial carcinoma and recurrent LG-ESS currently. In the present study, we report a tumor of recurrent LG-ESS accompanied with endometrioid adenocarcinoma in a young patient 8 years after hysterectomy. She was first diagnosed with LG-ESS at the age of 19 and received fertility-sparing therapy. During the 13-year follow-up period, she successfully delivered and experienced two recurrences of LG-ESS, and an unexpected endometrioid adenocarcinoma component was found in the second recurrent tumor. Adjuvant chemotherapy and endocrine therapy were administrated to the patient after completely removing the tumor, and no sign of disease recurrence or metastasis were found 7 months after the last surgery. This study emphasizes the importance of long-term management of LG-ESS and brings new insights to clinicians and pathologists about collision tumors involving recurrent tumor.

Deucravacitinib in Plaque Psoriasis: 4-year Safety and Efficacy Results from the Phase 3 POETYK PSO-1, PSO-2, and LTE Trials

Introduction: Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, is approved in multiple countries for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. Deucravacitinib was superior to placebo and apremilast in the global, 52-week, phase 3 POETYK PSO-1 and PSO-2 parent trials in moderate to severe plaque psoriasis. Upon completion, patients could enroll in the ongoing POETYK long-term extension (LTE) trial. Here, deucravacitinib safety/efficacy are reported through 4 years. Methods: PSO-1/PSO-2 randomized patients 1:2:1 to oral placebo, deucravacitinib 6 mg once daily, or apremilast 30 mg twice daily. At Week 52, patients enrolled in the LTE received open-label deucravacitinib. Safety was evaluated in patients receiving ≥1 deucravacitinib dose. Exposure-adjusted incidence rate (EAIR) per 100 person-years (PY) was used to assess adverse events (AEs). Efficacy outcomes included PASI 75, PASI 90, and sPGA 0/1 and were analyzed using mNRI in LTE patients receiving continuous deucravacitinib from Day 1 of the parent trials. Results: 1519 patients received ≥1 deucravacitinib dose; cumulative exposure was 4392.8 PY. EAIRs/100 PY were decreased/comparable from the 1-year to 4-year cumulative period, respectively, for AEs (229.2, 131.7), serious AEs (5.7, 5.0), deaths (0.2, 0.3), discontinuation due to AEs (4.4, 2.2), herpes zoster (0.8, 0.6), malignancies (1.0, 0.9), major adverse cardiovascular events (0.3, 0.3), and venous thromboembolism (0.2, 0.1). Clinical response rates with continuous deucravacitinib (n=513) were maintained from Year 3 (PASI 75, 73.8% [95% CI, 69.6-78.0]; PASI 90, 49.0% [44.4-53.7]; sPGA 0/1, 55.2% [50.5-59.9]) to Year 4 (PASI 75, 71.7% [67.0-76.3]; PASI 90, 47.5% [42.6-52.4]; sPGA 0/1, 57.2% [52.1-62.2]) by mNRI. Conclusion: Deucravacitinib demonstrated a safety profile through 4 years consistent with 3 years with no emergence of new or long-term safety signals. Efficacy was maintained through 4 years in patients receiving continuous deucravacitinib from Day 1 in PSO-1/PSO-2.