Surgery after neoadjuvant immunochemotherapy versus immuno-chemoradiotherapy in patients with cN3 non-small cell lung cancer: A cohort study in two academic centers.

To identify factors associated with secondary surgery for velopharyngeal insufficiency in children following primary palatoplasty. A retrospective review was conducted of children with cleft palate who were seen at a single academic center between August 2014 and April 2024 and underwent primary palatoplasty. Demographic and clinical data were collected, and the need for and number of secondary velopharyngeal surgeries were recorded. Univariate analyses and multivariate logistic regression were used to identify associated factors. Of 251 children who underwent primary palatoplasty, 27 (10.8%) required secondary velopharyngeal surgery. Univariate analyses revealed no association between secondary surgery and cleft type, presence of a syndrome, or timing of palatoplasty. Multivariate logistic regression controlling for race, insurance type, age at primary palatoplasty, and presence of 22q11.2 microdeletion syndrome revealed private insurance was associated with decreased odds of secondary velopharyngeal surgery (OR = 0.230, 95% CI: 0.069-0.765, p = 0.017), whereas Asian race was associated with increased odds (OR = 5.853, 95% CI: 1.105-30.998, p = 0.038). Among those requiring velopharyngeal surgery, 74.1% underwent one procedure and 25.9% underwent two. The presence of 22q11.2 microdeletion syndrome was significantly associated with needing two surgeries (p = 0.042), while female sex was associated with requiring only one surgery (p = 0.006). Clinical and sociodemographic factors were predictive of secondary velopharyngeal surgery following primary palatoplasty, with different risk factors associated with the need for more than one procedure. Larger studies are warranted to corroborate these findings and guide risk stratification and family counseling.

Recurrence patterns in primary urethral carcinoma: Prognostic impact of inguinal and pelvic lymphadenectomy.

To assess the diagnostic accuracy of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT for detecting obstructive and non-obstructive coronary in-stent restenosis (ISR), using invasive coronary angiography (ICA) as the reference. Consecutive patients with coronary stents who underwent clinically indicated coronary CT angiography (CCTA) on a dual-source PCD-CT were retrospectively identified from two academic centers. All UHR scans were reconstructed at 0.2mm and 0.4mm slice thickness, the latter served as an energy-integrating detector CT-like proxy. Series were assessed for the presence of non-obstructive (<50%) and obstructive (≥50%) ISR, with diagnostic accuracy validated against ICA in the overall cohort and in a sub-analysis of stents<3 mm in diameter. Fifty patients (16.0% women; 70.9±10.8years) with 106 coronary stents were included. ICA identified 17 non-obstructive and 27 obstructive ISR. Non-obstructive ISR was detected in 10 stents on 0.2mm UHR and 14 on 0.4mm EID-like standard-resolution reconstructions.Obstructive ISR was described in 26 (0.2mm) vs. 32 (0.4mm) stents, respectively. The proportion of evaluable stents increased from 91.5% based on 0.4mm to 99.1% with 0.2mm UHR. Compared with standard-resolution images, 0.2-mm UHR improved non-obstructive ISR sensitivity (90.5%vs82.9%), specificity (100.0%vs78.5%), and accuracy (96.2%vs80.2%); and in obstructive ISR, specificity (98.7%vs82.3%), positive predictive value (96.3%vs64.1%), and accuracy (98.1%vs84.9%). Thin-slice UHR achieved higher accuracy in small-caliber stents (<3mm), for both non-obstructive (94.1vs73.5%) and obstructive ISR (94.1%vs79.4%). UHR PCD-CT demonstrated excellent diagnostic accuracy and significant improvements in ISR detection compared to the quasi-standard reconstructions, including non-obstructive and small-caliber stent ISR.

Utilization Trends and Surgical Outcomes of Technology-Assisted Total Hip Arthroplasty in the United States From 2014 Through 2024.

Efficacy and safety of collagenase Clostridium histolyticum in men who have sex with men.

Application of FORDISC for estimating ancestry and stature in a modern population from the Brazilian Northeast

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face delayed and disparate medical care. Given the growing visibility and recognition of the LGBTQ+ community in the United States, ensuring that neurosurgeons are trained to provide affirming, informed care is increasingly important to improve their outcomes. This study aimed to assess the level of comfort and knowledge of resident and attending neurosurgeons in providing care to LGBTQ+ patients. We conducted a survey across 9 US academic neurosurgery centers assessing 3 domains: training, preparation, and knowledge; clinical practice experience; and comfort or competence in LGBTQ+ care. Responses were measured on a 5-point Likert scale. Linear regression was used to assess the relationship between knowledge and comfort/competence. In addition, a mediation analysis was performed to determine the extent to which clinical practice experience affected the relationship between knowledge and comfort/competence. Eighty-seven neurosurgeons (35 residents and 52 attendings) completed the survey. For every 1-point increase in training, preparation, or knowledge, there was a 0.31-point increase in perceived comfort and competence [95% CI 0.24-0.39, P < .01]. Attendings reported less comfort than residents in caring for lesbian, gay, and bisexual patients, inquiring about sexual orientation, and being identified as LGBTQ-competent providers. Clinical practice experience mediated the relationship between physician training and knowledge and the respondent's perceived competence and comfort [Sobel test, 2.62; P < .01]. In addition, physicians rated their knowledge (3.68 vs 3.38, P < .01), perceived comfort/competence (4.41 vs 4.29, P < .01), and clinical experience (4.41 vs 4.11, P < .01) in caring for lesbian, gay, and bisexual individuals significantly higher than that of transgender individuals. Neurosurgeons reported limited knowledge, comfort, and competence in LGBTQ+ care, particularly for transgender individuals. However, training and experience improve these findings. Therefore, strengthening training programs to better prepare neurosurgeons for affirming LGBTQ+ care could create an inclusive and equitable healthcare environment.

To evaluate whether protein supplementation improves mobility recovery, nutritional markers, mortality rates, and postoperative complications in elderly patients after proximal femoral fractures. Prospective, randomized, double-blind, placebo-controlled clinical trial. Tertiary academic orthopaedic centers. Adults 60 years and older with radiographically confirmed proximal femoral fractures (OTA/AO 31-A1, 31-A2, 31-A3,31-B1, 31-B2, and 31-B3) requiring surgery were eligible. Exclusion criteria included prior supplement use, periprosthetic fractures, renal impairment, severe systemic disease, or contraindications to supplementation. Participants were randomized to receive either a creatine- and HMB-enriched protein supplement or an isocaloric maltodextrin placebo, administered once daily for 1 month. The primary outcome was mobility recovery measured using the Parker Mobility Score (PMS), compared between groups at 1 and 6 months. Secondary outcomes included serum albumin, hemoglobin, lymphocyte count, total protein, mortality, and postoperative complications. Planned comparisons evaluated biochemical changes from baseline to 1 month, mortality across 6 months, and complications within 1 month. The intervention group (N = 40) had a mean age of 72.3 ± 8.7 years (range: 60-88), with 52.5% men, while the control group (N = 40) had a mean age of 73.2 ± 8.9 years (range: 60-90), with 42.5% men. Baseline demographic characteristics were comparable between the 2 groups. At 1 month, the intervention group showed higher PMS (4.83 ± 0.85 vs. 2.65 ± 0.63; P < 0.001), with no difference at 6 months (6.33 ± 2.4 vs. 6.19 ± 2.9; P = 0.859).At 1 month, albumin normalization was observed in all patients in the intervention group compared with 85% of patients in the control group; however, this difference did not remain statistically significant after Bonferroni adjustment (adjusted P = 0.219). Other nutritional markers showed no significant intergroup differences (all adjusted P > 0.05). Supplementation was associated with a lower 6-month mortality rate (HR 4.5; 95% CI, 1.12-18.26; P = 0.034). Complication rates within 1 month were similar between groups (N = 4 vs. N = 8; P = 0.20). In elderly patients with hip fracture, creatine- and HMB-enriched protein supplement improved early mobility, accelerated albumin normalization, and was associated with lower 6-month mortality, without affecting complication rates. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Effect of Allogenic Blood Transfusion on Oncologic Outcomes in Locally Advanced Kidney Cancer.

Are patient factors associated with real-world antibody-drug conjugate outcomes in gynecologic cancers?

Impact of cranial irradiation on the clinical presentation of cerebral cavernous malformations.

Pulmonary artery enlargement predicts mortality on low-dose lung cancer screening CT.

There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice.

Computed tomography Hounsfield units (HUs) estimate bone mineral density, but their predictive value for total shoulder arthroplasty (TSA) mechanical complications is unknown. This study assessed whether glenoid HU (gHU) can be used to predict mechanical complication risk. In this retrospective cohort study at a single tertiary academic center (January 2011-April 2024), pre-operative computed tomography scans from 250 TSAs in 233 patients were independently reviewed by 3 interdisciplinary reviewers to measure gHU. Mechanical complications, including periprosthetic or intraoperative fractures and aseptic implant loosening, were identified and stratified by gHU. Inter-rater reliability was assessed with the intraclass correlation coefficient. Receiver operating characteristic analysis identified optimal gHU thresholds. Risk-group comparisons used chi-square tests and multivariable logistic regression. Among 250 TSAs in 233 patients, intraclass correlation coefficient for gHU measurement was 0.90 (95% confidence interval 0.87-0.92). Receiver operating characteristic analysis yielded a cutoff of 177 HU (area under the curve 0.59; sensitivity 39%; specificity 81%). Mechanical complications occurred in 29% of cases with gHU <177 vs. 13% with gHU ≥177 (P = .008; adjusted P = .02). Patients with gHU <110 had the highest risk (57% vs. 14%; P < .001; adjusted P = .002). Pre-operative gHU measurements can help to predict increased risk of mechanical complications after TSA. A gHU threshold of 177 HU identifies patients at elevated risk, while gHU <110 marks the highest-risk group.

Malignant serous effusions (MSEs), including pleural, pericardial, and peritoneal effusions, are common in advanced lung adenocarcinoma (LUAD). However, integrated clinicopathologic, molecular, treatment, and outcome data across effusion sites remain incompletely defined. This study retrospectively analyzed 120 cytology-confirmed LUAD-associated MSE cases from a single academic center by integrating gross fluid features, cytopathology, immunohistochemistry, targeted next-generation sequencing (NGS), systemic therapy, and clinical outcomes, including survival from first malignant effusion (SME) and overall survival (OS). Effusions were pleural (85 of 120; 70.8%), pericardial (28 of 120; 23.3%), and peritoneal (7 of 120; 5.8%). Median SME was 3.8 months, and was shortest in the small peritoneal effusion subgroup (1.0 months). OS differed by site, with pericardial involvement showing the shortest OS (6.1 months). Thyroid transcription factor 1 (TTF-1) was positive in 72.5% of cases. Programmed death ligand 1 (PD-L1) testing (n=85) showed a tumor proportion score (TPS) of ≥1% in 80% of cases and TPS of ≥50% in 36.5% of cases. Molecular profiling was completed in 111 of 120 cases (92.5%) by identifying TP53 mutations in 47 of 111 (42.3%) and actionable driver alterations in 42.3% of cases, most commonly involving EGFR, KRAS, BRAF, ALK, and ROS1. TTF-1 positivity was associated with higher rates of actionable driver alterations and higher PD-L1 expression. PD-L1 negativity, TTF-1 negativity, and an absence of actionable driver alterations were associated with shorter SME and OS. Dual TTF-1/PD-L1 negativity defined the poorest risk subgroup (median SME, 1.2 months; median OS, 1.4 months). Multivariable analysis confirmed that TTF-1 negativity and a lack of actionable drivers remained independently adverse. Among treated patients, immunotherapy-based regimens were associated with the longest SME (6.7 months), whereas tyrosine kinase inhibitor-based therapy was associated with the longest OS (26.0 months). Integration of cytology, immunophenotype, genomics, and treatment delineates distinct prognostic subsets in LUAD with MSE. The absence of actionable driver alterations and TTF-1 negativity remains an independent adverse prognostic factor, with dual TTF-1/PD-L1-negative MSE showing particularly poor SME and OS.

To examine the benefit of cochlear implantation (CI) in pediatric patients with a history of temporal bone fracture resulting in single-sided deafness (SSD). Retrospective chart review. Two tertiary academic centers. Pediatric patients less than 18 years of age with SSD secondary to temporal bone fracture who underwent CI from 2012 to 2022. CI. Postoperative audiometric testing. Seven subjects were identified (median age: 10years (y); Q1 to Q3: 5 to 16y). Median time from temporal bone trauma to CI was 7 months (mo) (Q1 to Q3: 3 to 7mo) and 85% had otic capsule involvement. Subjects were followed for a median length of 12 months (Q1 to Q3: 6 to 24mo) after CI. All patients achieved full electrode insertion, though 2 required scala vestibuli insertion due to ossification of the scala tympani (one of whom had a history of meningitis after temporal bone fracture). Postoperative audiometric testing revealed variable speech perception outcomes with 4 of 7 obtaining open or closed set speech perception and 3 of 7 obtaining only sound awareness. No postoperative complications occurred. CI is a feasible intervention for SSD following pediatric temporal bone fractures, but outcomes are variable. Early evaluation and timely CI, ideally within 6 months of temporal bone fracture, may optimize outcomes. Cochlear ossification, either as a result of otic capsule fracture or subsequent meningitis, may lead to suboptimal outcomes.

Impact of time to endovascular securement on outcomes in aneurysmal subarachnoid hemorrhage.

Optic nerve sheath enhancement (ONSE) on MRI is associated with a range of pathological conditions but may also occur in individuals without optic nerve disease. This study aimed to determine the prevalence, sensitivity, and specificity of ONSE among patients with and without known optic nerve pathology and to assess the impact of MRI field strength and demographic factors on ONSE interpretation. This retrospective study included 115 patients with either known pathologic enhancement or no pathology who underwent MRI of the orbits between January 2010 and June 2023 at a single academic center. MRI scans were reviewed by a blinded neuroradiologist for presence or absence of ONSE. Patient demographics and MRI technical details, including field strength (1.5T or 3T), were recorded. Diagnostic performance metrics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], accuracy) were calculated overall and stratified by MRI strength. Among 115 patients (median age 63.2 years, 68% female, 90% White), ONSE was falsely identified in 7% of controls and missed in 13% of cases with known pathology. Overall, ONSE detection yielded a sensitivity of 87% and specificity of 93%. For 3T MRI, sensitivity was 100% and specificity was 90%; for 1.5T MRI, sensitivity was 75% and specificity 95%. PPV remained low across all groups, with highest NPV seen in 3T imaging (100%). No significant influence of age, sex, or race on ONSE detection was observed. ONSE can be seen in a small proportion of patients without optic nerve pathology and may be missed in subtle disease, emphasizing the importance of clinical correlation. Higher field strength MRI may improve sensitivity for detecting pathologic ONSE but can have false positives. These findings underscore the need for cautious interpretation of ONSE, particularly in asymptomatic individuals or in the context of high-resolution imaging.

Deep Learning-Derived Body Composition Analysis Predicts Long-Term Mortality After Transcatheter Aortic Valve Replacement.