Academic Center Hospital Research Articles

Assessment of Peri- and Postoperative Outcomes Following Apical Prolapse Repair in Octogenarians: A Retrospective Cohort Study.

To assess the risk of postoperative complications and unanticipated healthcare encounters in octogenarians compared to younger patients following apical prolapse repair. Retrospective cohort study. University-affiliated academic tertiary hospital center. Surgery for pelvic organ prolapse. Patients who underwent apical prolapse repair between 2009 and 2024. The cohort was divided into two groups: 1) Patients over the age of 80 (octogenarians); 2) patients aged 18 to 79 (younger cohort). Patients who underwent obliterative procedures or had missing complication data within 30 days postsurgery were excluded. A total of 481 patients were analyzed, including 136 octogenarians and 355 younger patients. Postoperative complications within 30 days were the primary outcome, while secondary outcomes included unanticipated healthcare encounters such as emergency department visits, clinic visits, and readmissions. Octogenarians had significantly higher frequency of comorbidities, such as hypertension (61.5% vs 28.1%, p < .001) and a history of deep vein thrombosis (6.7% vs 1.7%, p < .001), compared to younger patients. However, overall complication frequency within 30 days did not differ significantly between groups (7.4% vs 7.6%, p = .934). Specific complications varied, with octogenarians experiencing higher frequency of postoperative urinary retention (5.2% vs 0%, p < .001), and younger patients showing a higher likelihood of urinary tract infections (5.9% vs 0.7%, p = .013). Multivariate analysis identified prior abdominal surgery (OR: 2.20, 95% CI: 1.05-4.57, p = .036) and undergoing anterior repair (OR: 3.36, 95% CI: 1.27-8.89, p = .015) as predictors of complications within 30 days. No significant differences were observed in unanticipated healthcare encounters between groups. Apical prolapse repair in octogenarians is safe and feasible, with similar complication frequencies and healthcare encounters compared to younger patients. These findings suggest that age alone should not preclude surgical intervention in this population, though individualized risk assessment remains crucial.

Derivation and validation of generalized sepsis-induced acute respiratory failure phenotypes among critically ill patients: a retrospective study

BackgroundSeptic patients who develop acute respiratory failure (ARF) requiring mechanical ventilation represent a heterogenous subgroup of critically ill patients with widely variable clinical characteristics. Identifying distinct phenotypes of these patients may reveal insights about the broader heterogeneity in the clinical course of sepsis, considering multi-organ dynamics. We aimed to derive novel phenotypes of sepsis-induced ARF using observational clinical data and investigate the generalizability of the derived phenotypes.MethodsWe performed a multi-center retrospective study of ICU patients with sepsis who required mechanical ventilation for ≥ 24 h. Data from two different high-volume academic hospital centers were used, where all phenotypes were derived in MICU of Hospital-I (N = 3225). The derived phenotypes were validated in MICU of Hospital-II (N = 848), SICU of Hospital-I (N = 1112), and SICU of Hospital-II (N = 465). Clinical data from 24 h preceding intubation was used to derive distinct phenotypes using an explainable machine learning-based clustering model interpreted by clinical experts.ResultsFour distinct ARF phenotypes were identified: A (severe multi-organ dysfunction (MOD) with a high likelihood of kidney injury and heart failure), B (severe hypoxemic respiratory failure [median P/F = 123]), C (mild hypoxia [median P/F = 240]), and D (severe MOD with a high likelihood of hepatic injury, coagulopathy, and lactic acidosis). Patients in each phenotype showed differences in clinical course and mortality rates despite similarities in demographics and admission co-morbidities. The phenotypes were reproduced in external validation utilizing the MICU of Hospital-II and SICUs from Hospital-I and -II. Kaplan–Meier analysis showed significant difference in 28-day mortality across the phenotypes (p < 0.01) and consistent across MICU and SICU of both Hospital-I and -II. The phenotypes demonstrated differences in treatment effects associated with high positive end-expiratory pressure (PEEP) strategy.ConclusionThe phenotypes demonstrated unique patterns of organ injury and differences in clinical outcomes, which may help inform future research and clinical trial design for tailored management strategies.

Utilization of Immediate Postpartum Contraception and Its Association with Interpregnancy Interval: 10-Year Experience at a Single Center.

Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI). Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics. A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001). We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception. · Immediate postpartum LARC access has increased over the past 10 years.. · Access to more methods of contraception allows patients more options for family planning.. · Increased utilization of LARC led to increased IPI and IDI..

Moderate burden amongst caregivers posthip arthroscopy linked to younger caregiver age and task load: A cross-sectional survey study.

To evaluate the burden experienced by primary informal caregivers of patients who have undergone hip arthroscopy and to identify factors that predict increased caregiver burden. A cross-sectional study was conducted at a single academic hospital centre, enroling caregivers of patients who underwent hip arthroscopy between November 2018 and November 2023. Caregiver burden was assessed using the Caregiver Burden Inventory (CBI) survey. Multivariable linear regression models were used to identify predictors of caregiver burden, with the global CBI score serving as the primary outcome measure. Secondarily, open-ended survey questions were analyzed qualitatively to elucidate specific challenges and facilitators of caregiving, as reported by the caregivers themselves. The study involved 99 eligible caregivers (mean [standard deviation] age; 47 [11] years), 58% were female, and 85% were relatives of the patient. The median global CBI score was 13.0 (interquartile range: 8.0-22.4), indicating a moderate burden. Regression analyses demonstrated that younger caregiver age and a higher number of caregiving tasks were significant predictors of increased global burden. Additionally, nonweightbearing status of patients, female gender of caregivers and working full-time statistically significantly increased specific dimensions of caregiver burden. This study highlights the meaningful burden faced by caregivers of patients undergoing hip arthroscopy, despite its minimally invasive nature and outpatient setting. Identified risk factors such as younger caregiver age, female gender of the caregiver, nonweight-bearing status and increased caregiving tasks suggest targeted areas for intervention. The qualitative analysis revealed that caregivers struggle with time management and physical and emotional strain, yet better communication and practical support from healthcare teams could help to alleviate these challenges. Level IV, prognostic study.

Prevalence of diagnosed pulmonary embolism in patients with chronic obstructive pulmonary disease exacerbation presenting at the emergency department of a large North American academic hospital center

Background The real prevalence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease exacerbation (COPDe) remains largely unknown, especially in North America. Our aim was to evaluate the prevalence of PE in patients with COPDe at a large academic Canadian hospital. Methods This is a retrospective cohort study of all adult patients with COPDe seen at the emergency department (ED) of The Ottawa Hospital, Ontario, Canada (June 2019-January 2022). The primary outcome was the prevalence of PE during the initial assessment and at 3 months. Secondary outcomes included prevalence of venous thromboembolism and mortality. Subgroup analyses based on the type of COPDe and the post-ED clinical setting were conducted. Results Of 1158 patients seen in the ED with COPDe, PE was diagnosed in 13 patients (1.1%; 95%CI 0.6%-1.9%). Five patients (5/1158; 0.4%) had a diagnosis of PE during initial assessment and 8/1141 (0.7%) patients were diagnosed with PE during the 3-month follow-up. The prevalence of PE did not differ based on the type of COPDe (p = 0.27) and was higher in patients admitted to the hospital compared to patients discharged from the ED (1.1% vs 0.0%; p = 0.01). Mortality was clinically but not statistically higher in patients with PE compared to patients without PE (15.4% vs 6.0%; p = 0.19). Conclusion Among patients with COPDe evaluated in the ED, the prevalence of diagnosed PE was low, but more than 60% of the PE were diagnosed during the 3-month follow-up. Further studies are needed to determine an appropriate diagnostic algorithm in this population.

The impact of an inclusion council in an independent community oncology practice.

e21018 Background: Mainly present in academic hospital centers, Diversity Equity, and Inclusion (DEI) efforts have been largely left out of private practice. We previously reported on the impact of DEI training at VOA after our initial launch of the Inclusion Council in August 2020. VOA’s Inclusion Council continues its mission to further advancements in promoting a safe inclusive environment in the private practice setting. Methods: The methodology employed involved the administration of an anonymous comprehensive nine-question survey by the VOA Inclusion Council to assess the effectiveness of its ongoing efforts since its inaugural launch in 2020. The survey was meticulously crafted to capture the nuanced insights from employees regarding their knowledge and perceptions of the Inclusion Council’s impact on workplace dynamics. The questions were designed to gauge the extent to which the Council has successfully fostered an inclusive environment, promoted diversity, and identified any potential challenges faced by employees. The survey was distributed to all employees, ensuring a diverse range of perspectives was considered. This methodological approach aimed to provide a robust understanding of the council’s effectiveness through the direct input of those within the organization, thereby contributing valuable data for the evaluation of its initiatives. Results: Summary of employee respondent’s views on Inclusion Council helping foster a culture of inclusion in the workplace. A total of 147 employees responded. 68% of respondents agreed or strongly agreed that the Inclusion Council helped foster a culture of inclusion in the workplace. Conclusions: An Inclusion Council, focused on DEI efforts, can help foster a culture of inclusion in the workplace. Veteran and new employees agreed the Inclusion Council has helped foster a culture of inclusion in our community oncology practice. [Table: see text]

Desire for Residency-Provided Education and Support for Fertility Concerns: An Institutional Survey

IntroductionMedical careers increase infertility risks and pregnancy complications. Residents often postpone pregnancy, contributing to these risks. Limited data exist regarding residents’ family planning concerns. This study aims to evaluate fertility concerns and family planning during residency via a survey of residents and attending physicians. MethodsAnonymous online surveys were distributed to all residents (n = 1030) and attending physicians (n = 1111) at a large, urban, single-campus academic hospital center. Data analysis was performed using chi-square analysis with significance at P < 0.05. ResultsTwo hundred nine residents and 111 attendings submitted responses. Most respondents were female (74.7%). Slightly more than one-quarter of respondents were from a surgical specialty (26.6%). Residents compared to attending physicians indicated a higher concern for infertility during (57.4% versus 38.3%, P = 0.006) and after residency (68.9% versus 51.9%, P = 0.011) and a greater concern about pregnancy complications (67.8% versus 38.0%, P < 0.001). Most respondents felt pregnancy could negatively affect their training (67.3%). Surgical respondents were more concerned about the negative effects on colleagues (68.8% versus 51.1%, P = 0.045). Residents considered oocyte preservation more (57.9% versus 20.3%, P < 0.001). Respondents in surgical specialties had more concerns for fertility after residency (72.6% versus 57.9%, P = 0.033). Those in surgical fields trended for consideration of oocyte preservation (53.4% versus 39.7%, P = 0.084). Most respondents reported a need for education on oocyte preservation during residency (94.5%). ConclusionsResidents have increasing concerns about fertility and family planning related to their training. In addition to more institutional and residency program support, residents desire dedicated fertility and family planning education, such as oocyte preservation, as part of their curriculum.

Hemangioma activity score evaluation in infantile hemangioma patients: a retrospective study

Introduction: Infantile hemangioma (IH) is a benign vascular tumor commonly found in children. Generally, no special therapy is required because spontaneous resolutions occur. However, in some cases, therapy is required due to the potential of complications. During therapy, the side effects and effectiveness of therapy must be evaluated. One of the assessment tools is the Hemangioma Activity Score (HAS). HAS is a simple and objective assessment to evaluate the successful treatment of IH by observing swelling, color, and ulceration. The use of HAS in Indonesia is still minimal. This study aims to evaluate HAS before and after therapy in IH patients at Dr. Soetomo General Academic Hospital and Surabaya Skin Centre. Methods: Twenty-seven patient medical records were selected based on the inclusion and exclusion criteria. This study is an analytic cross-sectional retrospective using consecutive sampling. The collected data were tested for suitability using Cohen's Kappa. Pre- and post-tests were carried out using the Shapiro-Wilk and Wilcoxon tests afterward. Results: Among 27 IH cases occurred in females (81.4%), with the youngest age of the patient being 1 month and the oldest being 8 years. The onset of lesions in all patients appeared before 1 year of age. The most frequent location for IH lesions was the facial area (51.8%), with a clinical manifestation being plaque (37%). The most common therapy used in this study was pulse dye laser (PDL) (48.1%). Analysis of the difference in HAS before and after therapy showed p value = 0.00, a statistically significant difference in HAS before and after therapy. Conclusions: The hemangioma activity score is an effective measurement tool for measuring the severity of IH and evaluating the effectiveness of therapy.

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

ObjectivesThe purpose of this pilot study was to obtain baseline quantitative pupillometry (QP) measurements before and after catheter-directed cerebral angiography (DCA) to explore the hypothesis that cerebral angiography is an...

Deep Learning Based Blood Abnormalities Detection As a Tool for Vexas Syndrome Screening

Introduction The VEXAS syndrome (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) described in 2020 caused by mutations of the UBA1 gene, displayed a large pleomorphic array of clinical and biological features. Nevertheless, these criteria do not allow to discriminate VEXAS from other myeloid malignancies on complete blood count + differential, notably due to the absence of peripheral blood characterization of the disease. This study aimed at singling out dysplastic features indicative of VEXAS among peripheral blood (PB) polymorphonuclears (PMN) from VEXAS patients compared to healthy patients and myelodysplastic (MDS) patients. As such task is tedious and subject to operator bias, a multicentric dataset has been used to design a deep learning algorithm for automatic detection of these features, finally tested on an external validation cohort. Patient, material and methods Patients written consents were obtained and five academic centers (number from 1 to 5) were involved in this 3 steps study. Firstly, 3 academic centers (number 1 to 3) enrolled 20 patients distributed as follow: 9 patients with UBA1 mut and 6 patients UBA1 wt with no other genetic mutation as well as 5 samples from MDS patients. A total of 25 PB smears and especially PMN images were gathered and screened for various abnormalities. Two independent morphologists blindly quantified PMN predefined characteristics. This dataset of 2,824 multilabelled PMN was evaluated and tested by a two-sample Wilcoxon Rank Sum test for statistical significance between UBA1 mut and the others. Secondly, in order to automate the detection of these significant features on PMN images, a convolutional neural network (CNN) was trained using a multicentric image dataset gathered from 4 academic centers (number 2 to 5). Patients were selected based on clinical and biological symptoms suggesting VEXAS syndrome, namely fever, skin lesions, chondrites, vasculitis and/or anemia. After evaluation of the UBA1 mutation status, this multicentric cohort was separated into confirmed VEXAS (n = 19) and UBA1 WT (n=20). A total of 6,615 annotated PMN images were collected from DI systems (Cellavision ®, Lund, Sweden) with 1 to 12 PB smears per patient, yielding a 48 UBA1 mut and 33 UBA1 wt smears. All patients were males, the median age was 74 year-old (IQR 67-77) and that of control patients 72 year- old (61-79). Finally, the CNN was evaluated on an external cohort from another academic hospital (center 1), including inflammatory patients, and patients screened for VEXAS syndrome for a total cohort of 15 patients and 1,887 images. Results Four specific abnomalities were observed in PMNs from VEXAS patients as compared with healthy or myelodysplastic controls. The automatic recognition of anomalies was then cast in a multilabel classification task, where each PMN image could be assigned to one or more labels during interference. In order to take into account this specificity, a CNN was trained, composed of different layers of convolutions and pooling (Figure1). The model was set-up to output an independent binary prediction for the presence or absence of each of the four anomalies of interest. Automatic detection of these 4 anomalies by the proposed model yielded area under the curve (AUC) of 0.827; 0.837; 0.927 and 0.947 (Figure 2). Regarding the general performance on the external validation cohort, the CNN achieved a Hamming loss of 0.141, and macro and micro F1 scores of 0.588 and 0.668 respectively. Discussion This study suggests that computer-assisted analysis of PB smears, focusing on suspected VEXAS cases, could provide valuable insights to determine which patients should undergo molecular testing. A deep-learning approach leveraging previously identified peripheral blood indicators and automatic analyzers is thus presented, which can help hematologists orient their suspicion before initiating further analysis.

Operative Treatment of Jones Fractures (OTA Type 87,5.2A) is not Associated with Earlier Clinical or Radiographic Healing

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The purpose of this study was to compare the time to radiographic and clinical healing between patients with metadiaphyseal metatarsal fractures (True Jones) treated operatively and those treated nonoperatively. Methods: This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital center with Jones fractures between December 2012 and April 2022. Jones fractures were defined as 5th metatarsal base fractures occurring in the proximal metadiaphyseal region, just distal to the articulation of the 4th and 5th metatarsals on the oblique radiographic view (Zone 3). Information regarding patient demographics, injury mechanism, clinical presentation, management, and time to healing was collected. A fracture was defined as clinically healed when the patient had returned to their baseline ambulatory status without pain and there was an absence of tenderness to palpation on physical examination. Radiographic healing was defined as the presence of complete osseous consolidation. A total of 2,466 patients presented with 5th metatarsal fractures during the study period. Results: Among all 5th metatarsal fractures, 170 patients (6.9%) were classified as “true Jones” fractures. The mean age of patients presenting with Jones fractures was 46.1 +/- 18.6 years, and 65.8% were female. 19.9% were treated operatively (92.9% with screw fixation and 7.1% with ORIF), and 80.1% were treated nonoperatively. 95.9% of patients with Jones fractures went on to heal with no difference in time to radiographic healing (p = 0.296) or clinical healing between both groups (p = 0.228). Furthermore, there was no difference between groups with respect to the proportion of patients who developed delayed radiographic union with incomplete osseous healing at 6 months post-injury (9.3% in the nonoperative group versus 10.7% in the operative group, p = 0.098). Conclusion: Contrary to popular opinion, operative treatment of true Jones fractures was not associated with faster or more reliable radiographic union or time to clinical healing compared to patients treated nonoperatively. The overall rate of nonunion in true Jones fractures was found to be lower than previously described, and there was no evidence of any difference in nonunion rate with operative treatment compared to nonoperative management.

Key conditions for the successful implementation of evidence-based practice in concurrent disorder nursing care with the ECHO® model: Insights from a mixed-methods study

BackgroundPeople with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions. ObjectiveTo understand how an ECHO program for concurrent disorder management impacts nurses’ competency development and clinical practice and uncover key conditions for successful uptake and implementation. DesignA convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology. Setting and participantsAn ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study. MethodsOnline surveys completed by the participating nurses (N = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup (n = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena. ResultsWe identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one's professional role; and (6) Organizational support. ConclusionsOutcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses’ competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.

Utilization of Transcriptomic Profiling to Identify Molecular Markers Predicting Successful Recovery Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis.

Successful recovery from chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) can be characterized by minimal presence of symptoms and absence of disease on endoscopy. However, molecular markers of surgical success remain to be characterized. These could allow for better tailoring of perioperative therapy. This study aims to identify novel molecular markers associated with surgery responsive patient. Prospective cohort study. Single academic hospital center. One hundred eighteen consecutive patients with CRS at high risk of recurrence after surgery were followed prospectively following ESS in an academic medical center. Symptomatic and endoscopic outcomes were assessed at 4 months, with success rigorously defined subjectively as minimal or no symptoms (no symptom greater than 1 on an ordinal scale of 0-3) and objectively by the absence of nasal polyposis on sinus cavity endoscopy and Lund-Kennedy endoscopic edema score no greater than 1. Samples were obtained at the time of surgery and at 4-month postoperatively. Changes associated with surgery were determined by gene expression profiling using Affymetrix's Clariom S Human HT arrays. Successful ESS was characterized by a mild upregulation in Type 1 inflammation, upregulation of cell cycle progression, and epithelial barrier and proliferation-associated genes and pathways. ESS failure was associated to very high levels of Type 1 inflammation along with downregulation of epithelial barrier function and regeneration genes and pathways. Successful recovery from ESS involves restoration of epithelial function and regulated activation of Type 1 inflammation. Excessively elevated Type 1 inflammation is associated with epithelial barrier dysfunction.

Advanced Age Impacts Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Upper tract urothelial carcinoma is rare but has a poor prognosis. Prognostic factors have been extensively studied in order to provide the best possible management for patients. We have aimed to investigate commonly available factors predictive of recurrence and survival in this patient population at high risk of death and recurrence, with an emphasis on the effects of age (using a cutoff of 70 years) on survival outcomes. From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant. We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer). This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.

Resting-State Cerebral Hemodynamics is Associated With Problem Behaviors in Pediatric Sleep-Disordered Breathing.

Untreated sleep-disordered breathing (SDB) is associated with problem behaviors in children. The neurological basis for this relationship is unknown. We used functional near-infrared spectroscopy (fNIRS) to assess the relationship between cerebral hemodynamics of the frontal lobe of the brain and problem behaviors in children with SDB. Cross-sectional. Urban tertiary care academic children's hospital and affiliated sleep center. We enrolled children with SDB aged 5 to 16 years old referred for polysomnography. We measured fNIRS-derived cerebral hemodynamics within the frontal lobe during polysomnography. We assessed parent-reported problem behaviors using the Behavioral Response Inventory of Executive Function Second Edition (BRIEF-2). We compared the relationships between (i) the instability in cerebral perfusion in the frontal lobe measured fNIRS, (ii) SDB severity using apnea-hypopnea index (AHI), and (iii) BRIEF-2 clinical scales using Pearson correlation (r). A p < .05 was considered significant. A total of 54 children were included. The average age was 7.8 (95% confidence interval, 7.0-8.7) years; 26 (48%) were boys and 25 (46%) were Black. The mean AHI was 9.9 (5.7-14.1). There is a statistically significant inverse relationship between the coefficient of variation of perfusion in the frontal lobe and BRIEF-2 clinical scales (range of r = 0.24-0.49, range of p = .076 to <.001). The correlations between AHI and BRIEF-2 scales were not statistically significant. These results provide preliminary evidence for fNIRS as a child-friendly biomarker for the assessment of adverse outcomes of SDB.

Efficacy Of Quadratus Lumborum Blocks (QLBs) in Robotic Nephrectomy: A Retrospective Study.

Abdominal blocks such as quadratus lumborum block (QLB) have been used as an effective analgesic in abdominal surgeries. However, their efficacy in kidney surgery remains unknown.To the best of our knowledge, there are no clinical studies exploring the relationship between QLBs and post-operative opioid consumption in robotic laparoscopic nephrectomy. To assess the analgesic efficacy of QLB and its impact on perioperative opioid consumption in robotic laparoscopic nephrectomy. A retrospective chart review was conducted by querying the electronic medical record system of a 2,200-bed tertiary academic hospital center in New York City. The primary measured outcome was postoperative morphine milligram equivalents (MME) consumption for the first 24 hours. Secondary outcomes include intra-operative MME as well as postoperative pain scores measured on a visual analogue scale (VAS) scale at 2, 6, 12, 18, and 24 hours postoperatively. The mean total postoperative MME in the posterior QLB (pQLB) group was 11 in the QLB group(interquartile range (IQR) 4, 18) and 15 in the control group (IQR 5.6, 28) . There was a significant reduction in intraoperative MME in the QLB group in comparison to the control group. This reduction was not seen in postoperative MME. There was no significant difference in pain scores at any of the measured time points up to 24 hours postoperatively. Our study provides compelling support that ultrasound guided QLB significantly decreased intraoperative opioid requirements but did not have the same effect on postoperative opioid requirements following robotic kidney surgeries in the context of an enhanced recovery after surgery (ERAS) pathway.

A new DLK1 defect in a family with idiopathic central precocious puberty: elucidation of the male phenotype.

We aimed to investigate a cohort of female and male patients with idiopathic central precocious puberty (CPP), negative for Makorin Ring Finger Protein 3 (MKRN3) defect, by molecular screening for Delta-like 1 homolog (DLK1) defects. DLK1 is an imprinted gene, whose mutations have been described as a rare cause of CPP in girls and adult women with precocious menarche, obesity and metabolic derangement. We enrolled 14 girls with familial CPP and 13 boys with familial or sporadic CPP from multiple academic hospital centers. Gene sequencing of DLK1 gene was performed. Circulating levels of DLK1 were measured and clinical and biochemical characteristics were described in those with DLK1 defects. A novel heterozygous mutation in DLK1, c.288_289insC (p.Cys97Leufs*16), was identified in a male proband, his sister and their father. Age at onset of puberty was in line with previous reports in the girl and 8years in the boy. The father with untreated CPP showed short stature. No metabolic derangement was present in the father except hypercholesterolemia. Undetectable Dlk1 serum levels indicated the complete lack of protein production in the three affected patients. A DLK1 defect has been identified for the first time in a boy, underscoring the importance of genetic testing in males with idiopathic or sporadic CPP. The short stature reported by his untreated father suggests the need for timely diagnosis and treatment of subjects with DLK1 defects.

Human Immunodeficiency Virus Is Associated With Poor Overall Survival Among Patients With Head and Neck Cancer.

Head and neck squamous cell cancer (HNSCC) occurs at higher rates among persons with HIV (PWH). This study compares the impact of sociodemographic and clinicopathologic characteristics on outcomes among PWH-HNSCC compared with HNSCC patients without HIV. Patient data from HNSCC individuals were collected at a single academic hospital center between 2002 and 2018. Forty-eight patients with HIV (HIV-HNSCC) and 2894 HNSCC patients without HIV were included. Multivariate analysis determined predictors of survival using Cox proportional hazards regression model. HIV-positive and -negative tumors were analyzed by quantitative immunofluorescence for expression of CD4, CD8, CD20 and PD-L1. HIV-HNSCC patients had a lower median overall survival than HNSCC patients without HIV (34 [18-84] vs 94 [86-103] months; P < .001). In multivariate analysis that included age, sex, race/ethnicity, stage, site, tobacco use, time to treatment initiation, and insurance status, HIV was an independent predictor of poorer survival, with a hazard ratio of 1.98 (95% CI: 1.32-2.97; P < .001). PWH with human papillomavirus (HPV)-positive oropharyngeal tumors also had worse prognosis than HPV-positive oropharyngeal tumors in the population without HIV (P < .001). The tumor microenvironment among HIV-HNSCC patients revealed lower intratumoral CD8 infiltration among HIV+ HPV+ tumors compared with HIV- HPV+ tumors (P = .04). HIV-HNSCC patients had worse prognosis than the non-HIV population, with HIV being an independent predictor of poor clinical outcomes when accounting for important sociodemographic and clinicopathologic factors. Our findings highlight differences in tumor biology that require further detailed characterization in large cohorts and increased inclusion of PWH in immunotherapy trials.

A surgeon’s dress code – the patients’ perspective

The dress code for surgeons has evolved over time from formal suit-and-tie to crisp white coat, and currently to various forms of smart-casual attire; however, there is no stipulated or rigid uniform guideline. It is important to explore and discuss the various forms of attire in relation to patients' ideals and perceptions of a surgeon. An observational study in the form of a paper-based questionnaire was carried out at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Academic Hospital (CHBAH) and Wits Donald Gordon Medical Centre (WDGMC). Seven questions (Q1-Q7) were posed with various dress categories to select from in each question, namely: formal, smart, smart-casual and scrubs. Descriptive analysis of the survey responses, and the determination of the association between survey responses and a) hospital, b) gender, c) age group was performed. Fisher's exact test was used where the requirements for the chi-square test could not be met. Attire groups with n < 15 were not analysed. The strength of the associations was measured by Cramer's V and the phi coefficient respectively. Data analysis was carried out using SAS v9.4 for Windows. A 5% significance level was used. A total of 387 questionnaires were filled out with a total of 376 fully completed and eligible samples in consenting participants of 18 years and older. In all seven questions, scrubs were the preferred attire. Overall, for Q1-Q5 and Q7, after scrubs, smart was the next most popular attire. For Q6, after scrubs, smart, smart-casual and formal were all popular, indicating some leeway on weekends and public holidays. There was a significant association between each of the responses to the question and hospital (p < 0.0001). At CHBAH, patients preferred scrubs more and smart attire less, compared to CMJAH and WDGMC. At CMJAH, preference for formal attire was greater when compared to the other two hospitals. Overall, patients preferred their surgeons to be dressed in scrubs as this attire easily identified surgeons and instilled confidence in the wearer.

EE363 Long Term Costs Assessment of Oral Therapies for Patients With Relapsing Multiple Sclerosis Based on the Evidence From a Large Real-World Study – Application to a Portuguese National Academic Hospital Center

EE363 Long Term Costs Assessment of Oral Therapies for Patients With Relapsing Multiple Sclerosis Based on the Evidence From a Large Real-World Study – Application to a Portuguese National Academic Hospital Center