Analysis Of Outcomes Research Articles

Analysis of the clinical outcomes of fetal 6p22.1-p21.32 duplications signaled by non-invasive prenatal screening

To summarize the results of prenatal diagnosis and outcome of pregnancy of fetuses with a high risk for 6p22.1.1-p21.32 duplication signaled by non-invasive prenatal screening (NIPS). Clinical information, results of prenatal diagnosis and pregnancy for fetuses with a high risk for 6p22.1-p21.32 duplication were collected and analyzed. This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Ethic No. 2018-YB-08). Forty three pregnant women with a high risk for 6p22.1-p21.32 duplication were identified by NIPS, among whom 30 had accepted invasive prenatal diagnosis, and 27 fetuses were verified to be false positive. Three fetuses were found to have other chromosomal abnormalities, among whom two were rated to be likely benign CNV and 1 was rated to be likely pathogenic. Follow up of the 43 pregnant women revealed that 35 fetuses were normal after birth, 1 pregnancy was terminated, and 7 were lost to follow up. For pregnant women with a high risk for 6p22.1-p21.32 duplication signaled by NIPS, genetic counselor need to inform them the high false positive rate and recommend invasive prenatal diagnosis and/or ultrasound examination in order to reduce the psychological and economic burdens.

Dietary Inflammatory Index Is Differentially Associated With Cardiometabolic Health After Pregnancy on the Basis of Adverse Pregnancy Outcome Exposure.

Inflammatory diets may influence risk of cardiovascular disease. Subsequent cardiovascular disease is also influenced by adverse pregnancy outcomes (APOs) such as preterm birth, small-for-gestational-age birth, gestational diabetes, and hypertensive disorders of pregnancy. However, the associations between inflammatory diet, APOs, and cardiometabolic health remain unclear. We used data from the nuMoM2b (Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be) HHS (Heart Health Study) to assess the relationship between dietary quality and cardiometabolic health. We calculated Energy-Adjusted Dietary Inflammatory Index scores representing the inflammatory burden in a person's diet. We used linear regression to determine the association between Energy-Adjusted Dietary Inflammatory Index score and cardiometabolic outcomes. We performed stratified analyses for outcomes with a significant interaction between Energy-Adjusted Dietary Inflammatory Index and APO. Data were available from 3249 participants at a median of 3.1 years after delivery. Higher Energy-Adjusted Dietary Inflammatory Index scores were associated with higher body mass index (B=0.29 kg/m2 [95% CI, 0.16-0.42]), waist circumference (0.66 cm [95% CI, 0.39-0.93]), diastolic blood pressure (0.26 mm Hg [95% CI, 0.09-0.44]), mean arterial pressure (0.23 mm Hg [95% CI, 0.06-0.40]), triglycerides (2.11 mg/dL [95% CI, 1.05-3.18]), creatinine (2.78 mg/dL [95% CI, 1.13-4.44]), insulin (exp[B]=1.04 [95% CI, 1.03-1.05]) and C-reactive protein (exp[B]=1.07 [95% CI, 1.04-1.10]), and lower high-density lipoprotein cholesterol (-0.41 mg/dL [95% CI, -0.66 to -0.37]) (all P<0.01). Significant interactions with APO (P<0.05) were identified for body mass index and waist circumference, with stratified analysis revealing stronger associations for individuals with APOs. A more proinflammatory diet was associated with worse cardiometabolic health measures, and these relationships differed by a person's APO history. Further investigation should establish how dietary modifications after pregnancy may potentially mitigate cardiovascular disease risk.

Electronic Sepsis Screening Among Patients Admitted to Hospital Wards

Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness. To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients. In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021. An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening. The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile. Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile. Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality. ClinicalTrials.gov Identifier: NCT04078594.

The Role and Effectiveness of School Social Workers in Addressing Bullying in China

The Chinese government has been working hard since 2006 to professionalize and legitimize social work, especially in schools. The occurrence of school bullying and the insufficient reaction from educational institutions and guardians are factors that lead to the inefficient implementation of social work interventions. Comparing with the United States, Chinese social workers face a number of difficulties, such as poor pay, little prospects for professional advancement, and social undervaluation.Through a detailed analysis of intervention strategies and outcomes, the article highlights the contributions of social workers in creating safer school environments. It also identifies the barriers hindering their effectiveness and offers recommendations for enhancing their roles within schools. Future research is suggested to focus on gathering first-hand data from diverse geographical regions across China, with an emphasis on longitudinal and comparative studies to better understand the impact of social work in varying educational and cultural contexts.

Exploring Sex Differences in Outcomes of Dual Antiplatelet Therapy for Patients With Noncardioembolic Mild-to-Moderate Ischemic Stroke or High-Risk Transient Ischemic Attack: A Propensity-Matched Analysis of the READAPT Study Cohort.

Sex may impact clinical outcomes in patients with stroke treated with dual antiplatelet therapy (DAPT). We aimed to investigate the sex differences in the short-term outcomes of DAPT within a real-world population of patients with noncardioembolic mild-to-moderate ischemic stroke or high-risk transient ischemic attack. We performed a propensity score-matched analysis from a prospective multicentric cohort study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]) by including patients with noncardioembolic mild-to-moderate stroke (National Institutes of Health Stroke Scale score of 0-10) or high-risk transient ischemic attack (age, blood pressure, clinical features, duration of transient ischemic attack, presence of diabetes [ABCD2] ≥4) who initiated DAPT within 48 hours of symptom onset. The primary effectiveness outcome was the 90-day risk of new ischemic stroke or other vascular events. The secondary effectiveness outcomes were the 90-day modified Rankin Scale score ordinal shift, vascular and all-cause mortality, and 24-hour early neurological improvement or deterioration. The safety outcomes included the 90-day risk of moderate-to-severe and any bleeding, symptomatic intracranial hemorrhage, and 24-hour hemorrhagic transformation. Outcomes were compared between sexes using Cox and generalized ordinal logistic regression analyses, along with calculating risk differences and ratios. From 2278 patients in the READAPT study cohort, we included 1643 mild-to-moderate strokes or high-risk transient ischemic attacks treated with DAPT (mean age, 69.8±12.0 years; 34.3% women). We matched 531 women and men. The 90-day risk of new ischemic stroke or other vascular events was significantly lower among women than men (hazard ratio, 0.53 [95% CI, 0.28-0.99]; P=0.039). There were no significant differences in secondary effectiveness outcomes. The 90-day risk of safety outcomes was extremely low and did not differ between women and men (moderate-to-severe bleedings: 0.4% versus 0.8%; P=0.413; symptomatic intracranial hemorrhage: 0.2% versus 0.4%; P=0.563). Subgroup analysis for primary effectiveness outcome showed a lower 90-day risk of new ischemic stroke or other vascular events among women aged <50 years, baseline National Institutes of Health Stroke Scale score of 0 to 5, prestroke modified Rankin Scale score <2, large artery atherosclerosis cause, and no diabetes. Our findings suggest that women with noncardioembolic mild-to-moderate stroke or high-risk transient ischemic attack treated with DAPT may have lower short-term risk of recurrent ischemic events than men. Further research is needed to understand the mechanisms behind potential sex-based differences in outcomes after DAPT use. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05476081.

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage.

The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear. We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months. Secondary outcomes included 12-month functional independence as assessed with the Functional Independence Measure (FIM; scores range from 18 to 126) and quality of life as assessed with the EuroQolfive-dimension, five-level (EQ-5D-5L) utility index (scores range from -0.1 to 0.95) and a visual analogue scale (VAS; scores range from 0 to 100); on each assessment, higher scores indicate better health status or quality of life. A total of 742 patients underwent randomization at 23 centers. The analysis of the primary outcome at 12 months included 725 patients (97.7%). An unfavorable neurologic outcome occurred in 122 of 364 patients (33.5%) in the liberal-strategy group and in 136 of 361 patients (37.7%) in the restrictive-strategy group (risk ratio, 0.88; 95% confidence interval [CI], 0.72 to 1.09; P = 0.22). The mean (±SD) FIM score was 82.8±54.6 in the liberal-strategy group and 79.8±54.5 in the restrictive-strategy group (mean difference, 3.01; 95% CI, -5.49 to 11.51). The mean EQ-5D-5L utility index score was 0.5±0.4 in both groups (mean difference, 0.02; 95% CI, -0.04 to 0.09). The mean VAS score was 52.1±37.5 in the liberal-strategy group and 50±37.1 in the restrictive-strategy group (mean difference, 2.08; 95% CI, -3.76 to 7.93). The incidence of adverse events was similar in the two groups. In patients with aneurysmal subarachnoid hemorrhage and anemia, a liberal transfusion strategy did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy. (Funded by the Canadian Institutes of Health Research and others; SAHARA ClinicalTrials.gov number, NCT03309579.).

Incentives for pregnant mothers during antenatal care for better maternal and neonatal health outcomes in low and middle income countries: A Systematic Review and Meta-Analysis

Background Universal access to maternal, newborn, and child healthcare is essential for achieving Sustainable Development Goal 3, but the effectiveness of various incentive-based programs for pregnant mothers in low- and middle-income countries (LMICs) remains uncertain. Objective of this systematic review was to determine if incentive-based interventions influenced maternal and neonatal health outcomes. Methods We conducted a search in various databases from inception. All incentive-based interventional studies conducted on pregnant women in LMICs were included. Evidence from the included trials was synthesized using risk ratios (RRs) to compare the outcomes between groups receiving incentives and not receiving incentives. The meta-analysis was conducted using random-effects model. We assessed the quality of the included studies using the Cochrane Risk of Bias 2.0 tool and reviewed the collected data to determine its suitability for meta-analysis. This study is registered in PROSPERO (CRD42021247681). Results Of the 3,897 records that were identified, 11 met eligibility criteria, all of which exhibited varying degrees of risk of bias, ranging from high to some concerns. Analysis of maternal outcomes across studies revealed no significant differences in the likelihood of delivering at a healthcare facility (RR 1.13, 95% CI: 0.86 to 1.47) and in frequency of prenatal care (RR 0.99, 95% CI: 0.88 to 1.12) between intervention and control groups. However, high levels of statistical heterogeneity were observed for both outcomes indicating variability among study results. Similarly, analysis of tetanus vaccine coverage showed no significant difference between groups (RR 1.00, 95% CI: 0.92 to 1.08), with moderate statistical heterogeneity observed. Conclusion The maternal and neonatal outcomes examined in this review did not have any significant differences in intervention group when compared to the control group. The interventions to address maternal health concerns need to follow a multifactorial approach. There is a need for extensive primary research studies in the future.

Peningkatan motivasi belajar siswa melalui pembelajaran berdiferensiasi dengan menggunakan media pembelajaran Google-Sites

Although differentiated learning has been recognized as an effective approach to meeting diverse learning needs in the classroom, it is challenging to use learning media that are interesting and efficient for all students, as is found by teachers. This study explores the impact of using Google Sites learning media in increasing students' learning motivation through a differentiated approach in the classroom. This research was conducted as classroom action research involving the students of Class VII A in SMP Negeri 9 Yogyakarta. This study was undertaken within two cycles, in which every cycle had stages of planning, implementation, observation, and reflection. Data collection methods included observation, interview, and analysis of learning outcomes. The results showed a significant increase in students' learning motivation after implementing the differentiation approach by using Google sites as learning media. The practical implication of this study is that using technology in learning differentiation can increase students' participation and overall interest in learning.

Exploring the Scalability of 5G-Enabled E-Learning Platforms in Rural Areas

Background. The rise of 5G technology offers the potential to revolutionize e-learning, particularly in rural areas where access to high-quality educational resources has historically been limited. Despite the promise of improved connectivity, the scalability and impact of 5G-enabled e-learning platforms in these regions remain underexplored. Purpose. This study aims to assess the feasibility and scalability of implementing 5G-enabled e-learning platforms in rural areas and to evaluate their effectiveness in enhancing educational access and outcomes. Method. The research employs a mixed-method approach, combining quantitative analysis of internet connectivity, user engagement, and learning outcomes with qualitative interviews from educators and students. Data was collected from five rural regions across three countries where 5G infrastructure was recently introduced. The study measured improvements in e-learning adoption rates, student engagement, and academic performance over a 12-month period. Results. Results indicate that 5G-enabled e-learning platforms significantly improved both access to education and student engagement, with a 30% increase in platform adoption and a 25% improvement in student performance. Educators also reported more dynamic and interactive learning experiences. However, challenges related to infrastructure costs and digital literacy were noted, which could limit scalability in certain regions. Conclusion. In conclusion, the study demonstrates the potential of 5G technology to scale e-learning platforms in rural areas, improving educational access and outcomes. Nonetheless, addressing challenges such as infrastructure costs and digital literacy is critical for ensuring long-term scalability and success.

Long-term outcomes of carotid endarterectomy with eversion technique in patients with an open circle of Willis: A multicenter registry study.

Carotid endarterectomy (CEA) is a surgery aimed at removing atherosclerotic plaque from the carotid artery. There are classical and eversion CEA techniques. The eversion technique is the most popular because it does not require the use of implants. Eversion CEA is also associated with a lower risk of restenosis in the late postoperative period. During the surgery, the carotid artery is clamped and blood flow to the brain comes from the contralateral carotid artery and vertebral arteries. However, if the circle of Willis (COW) is not closed, compensatory mechanisms for protecting the brain are reduced, which can lead to the development of an intraoperative stroke. To analysis of in-hospital and long-term CEA outcomes in patients with different types of closed and non-closed COW. This is a multicenter Russian study. In the period from 2010 to 2020. 641 eversion CEA were performed. Depending on the type of structure of the COW, six groups of patients were formed: Type 1 - Closed posterior part (CRS) - in the presence of the posterior communicating (PCOMA) and P1 segment of the posterior cerebral (PCA) arteries; Type 2 - Intermediate type of structure of the posterior part (ISRP) - with hypoplasia of PCOMA or PCA; Type 3 - Open back part (OBP) - in the absence of PCOMA or PCA; Type 4 - Closed anterior part (CFS) - in the presence of the anterior communicating artery (ACOMA) and the A1 segment of the anterior cerebral artery (ACA); Type 5 - Intermediate type of anterior part structure (IFPS) - with ACOMA or ACA hypoplasia; Type 6 - Open Front Section (OFS) - in the absence of ACOMA or ACA. The long-term follow-up period was 107.3 ± 14.6 months. The end points of the study were death, ischemic stroke, transient ischemic attack (TIA), myocardial infarction (MI), ICA thrombosis, hemodynamically significant restenosis of the internal carotid artery, bleeding, and combined endpoint (death + ischemic stroke + TIA + MI).The type of distribution was determined using the Kolmogorov-Smirnov criterion. Group comparisons were performed using the Kruskal-Wallis and Pearson chi-square tests. Differences were assessed as significant at p < .05. According to clinical and demographic characteristics, the majority of patients were male and elderly. In 20% of cases, patients had a history of MI and/or stroke/TIA. Diabetes mellitus was diagnosed in 10%. There were no significant differences between groups in EuroSCOREII. In the long-term postoperative period, the largest number of deaths occurred in groups 5 and 6 (13 (45.1%) and 12 (30.1%)). The majority of strokes were diagnosed in groups 3 (OBP) and 5 (IFPS) (7 (13.5%) and 9 (17.6%)). The highest value of the combined end point (death + stroke/TIA + MI) was obtained in groups 3 (OBP), 5 (IFPS), and 6 (OFS) (23 (44.2%), 26 (50.1%), and 23 (58.9%)). The eversion technique of carotid endarterectomy for carotid artery stenosis is the most preferred. The greatest number of complications of eversion CEA in the hospital and long-term follow-up periods is observed in patients with OBP, IFPS, and OFS. In the presence of an unstable plaque, a temporary shunt can be used, which will exclude the pharmacological increase in blood pressure and the associated risk of embolization.

Comparison of sexual function between laparoscopic lateral suspension and laparoscopic sacrocervicopexy with the use of the PISQ-IR questionnaire

Introduction and hypothesisWe aimed to analyze the quality of sexual life of patients with apical vaginal wall prolapse who had undergone laparoscopic lateral suspension (LLS) and laparoscopic sacrocolpopexy (LSC).MethodsWe performed a secondary analysis of sexual outcomes of a previous randomized control trial comparing LLS and LSC in 89 women with symptomatic POP stage ≥ II. We evaluated sexually active (SA) and non-sexually active women (NSA) using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA-Revised (PISQ-IR). Women were reviewed over a period of 1 year post-surgery.ResultsAnalysis of the entire PISQ-IR questionnaire indicates that surgical treatment of POP resulted in an improvement of the quality of sexual life in 21 (80.76%) in the group of sexually active women after LSC and in 20 (83.33%) in the group of SA patients after LLS. In both groups of patients, dyspareunia was not observed.ConclusionIn conclusion, the quality of sexual life in SA group of patients improved significantly after both surgical procedures. The quality of sexual life of surveyed women significantly improved after curing POP symptoms.

Retrospective Cohort Study of Perioperative Complications in Symptomatic and Asymptomatic Children Testing SARS-CoV-2-Positive Within 21 Days Before Surgery.

COVID-19 increases anesthetic risk in children, but understanding of complication differences by symptom presence and severity is limited. We hypothesized that symptomatic COVID-19+ children, especially with lower respiratory symptoms, would have higher perioperative complications than asymptomatic patients and that complications would be higher in all patients diagnosed < 6 days before anesthesia. This single-center, retrospective cohort study reviewed records of children < 18 years old undergoing surgery with general anesthesia from March 1, 2020, to March 1, 2022, who tested COVID-19+. A total of 225 patients who tested positive ≤ 10 days before anesthesia were analyzed for the primary outcome, and an additional 298 patients who tested positive ≤ 21 days before anesthesia were analyzed for secondary outcomes. Data on demographics, comorbidities, vaccination, preoperative and perioperative care, complications, and mortality were collected. Primary outcome analysis used univariate regression; secondary outcome analysis used analysis of variance. Primary Outcome: Symptomatic patients were more likely to experience postoperative respiratory complications (OR: 3.53, 1.18-10.6, p = 0.024), require postoperative medications (OR: 7.64, 2.29-25.51, p = 0.001), and require postoperative oxygen support (OR: 2.62, 1.19-5.79, p = 0.017) versus asymptomatic patients. Those with upper respiratory symptoms were less likely to require postoperative medications (OR: 0.1, 0.01-0.89, p = 0.039) and oxygen support (OR: 0.08, 0.01-0.45, p = 0.004) versus those with lower respiratory symptoms. Patients testing COVID-19+ < 6 days before anesthesia had longer PACU stays (p < 0.001) and more postoperative respiratory complications (p = 0.001), medication use (p = 0.038), and oxygen use (p = 0.002) versus other groups. Preoperative symptoms, especially of the lower respiratory tract, increased the risk for perioperative complications in children diagnosed with COVID-19 within 10 days of surgery. The presence of symptoms, particularly of the lower respiratory tract, should be strongly considered in the shared decision-making process between providers and families when discussing the potential delay of procedures in the setting of COVID-19.

Enabling Inclusion: An Analysis of Positive and Negative Outcomes of Discretionary Work Arrangements for Employees With Disabilities

Enabling Inclusion: An Analysis of Positive and Negative Outcomes of Discretionary Work Arrangements for Employees With Disabilities

P47 Pregnancy outcomes in women exposed to guselkumab: review of cases reported to the manufacturer’s global safety database

Abstract Data on the use of biologics during pregnancy are limited. Guselkumab, a human IgG1λ monoclonal antibody approved for the treatment of moderate-to-severe psoriasis (PsO) and active psoriatic arthritis (PsA), is in clinical development for the treatment of inflammatory bowel disease (IBD). As IgG1λ antibodies can cross the placental barrier, we assessed pregnancy outcomes in pregnant women exposed to guselkumab. Cumulative data from the Janssen Global Safety Database reported through 12 July 2023 were summarized descriptively for medically confirmed and unconfirmed pregnancies with maternal exposure to guselkumab &amp;lt;3 months before conception, during or after first trimester (T1 or T2/T3), or any time during confirmed pregnancy. Pregnancy outcomes included live births with/without congenital anomalies; spontaneous abortions; elective terminations, stillbirths, or unspecified abortions with/without fetal defects; fetal deaths; ectopic pregnancies; induced/missed abortions; or ongoing pregnancies having no reported outcome. Cumulative through 12 July 2023, 590 pregnancy events [including twins (2); triplets (1)] in 586 guselkumab-exposed women were reported prospectively (N = 505) or retrospectively (N = 85). In cases with indication reported, most were PsO [90.0% (371/412)]; others included PsA [2.2% (9/412)], both PsO and PsA [3.4% (14/412)], and IBD [1.5% (6/412)]. In cases with data on the timing of guselkumab exposure, 14.3% (27/189) had exposure before conception, 77.8% (147/189) during T1, 5.3% (10/189) during T2/T3, and 2.6% (5/189) any time during pregnancy. Mean guselkumab exposure duration before pregnancy in known cases (N = 158) was 385 days (median, 238; range = 0–1717 days). Mean maternal age (N = 349) was 32.0 years (median, 32 years; range = 19–56 years). Outcomes were reported for 30.2% (178/590) of pregnancy events, including live birth [63.5% (113/178)]; spontaneous abortion [22.5% (40/178)]; elective termination (no fetal defects or unknown) [6.7% (12/178)]; ectopic pregnancy [3.4% (6/178)]; induced abortion [1.1% (2/178)]; fetal death [1.1% (2/178)]; and 1 event each (0.6%) of elective termination with fetal defect, missed abortion, and unspecified abortion with fetal defects. In pregnancy cases with known outcomes, rates of live births, spontaneous and elective/induced abortions, and congenital anomalies in women exposed to guselkumab ≤3 months before/during pregnancy are consistent with rates reported for the US general population, suggesting no apparent impact of guselkumab on pregnancy outcomes. Despite incomplete data on pregnancy outcomes, maternal age statistics, concomitant medication use, other risk factors, and duration of guselkumab exposure, these findings represent the most robust analysis of maternal guselkumab-exposed pregnancy outcomes to date. Additional evidence is needed to increase our understanding of the effects of guselkumab exposure on pregnancy outcomes across disease indications.

Predictive analysis of economic and clinical outcomes in total knee arthroplasty: Identifying high-risk patients for increased costs and length of stay.

The purpose of this study was to predict high-risk patients who experience significant increases in hospital charges and length of stay (LOS) following specific postoperative complications. This study analyzed over two million patients from the Nationwide Inpatient Sample database undergoing elective total knee arthroplasty (TKA) for primary osteoarthritis. Baseline demographics, clinical characteristics and incidence of postoperative complications were examined. A neural network model was utilized to predict high-risk patients who fall into the top 25% for both LOS and total hospital charges after complications such as sepsis or surgical site infection (SSI). The most common complications were blood loss anaemia (14.6%), acute kidney injury (1.6%) and urinary tract infection (0.9%). Patients with complications incurred significantly higher total charges (mean $66,804) and longer LOS (mean 2.9 days) compared to those without complications (mean $58,545 and 2.1 days, respectively). The neural network model demonstrated strong predictive performance, with an area under the curve of 0.83 for the training set and 0.78 for the testing set. Key complications like sepsis and SSIs significantly impacted hospital charges and LOS. For example, a 57-year-old patient with diabetes and sepsis had a 100% probability of being in the top 25% for both total charges and LOS. Postoperative complications in TKA patients significantly increase hospital charges and LOS. The neural network model effectively predicted high-risk patients after specific complications occurred, offering a potential tool for improving patient management and resource allocation. Level III.

Analysis of long-term outcomes after surgical treatment of patients with complicated forms of colon cancer

The aim of the study. To evaluate long-term outcomes in patients who underwent surgery due to complications of colon cancer in a general surgical hospital. Materials and methods. The study group included 71 (100 %) patients with complicated forms of colon cancer. Radical surgical interventions were performed in 48 (67.6 %) patients, palliative cytoreductive operations – in 18 (25.4 %) hospitalized patients, symptomatic – in 5 (7.0 %) patients. Results. In the postoperative period, only 37 (58.7 %) patients sought help from an oncologist at the third level of medical care. The remaining 26 (41.3 %) patients refused to consult an oncologist and specific treatments for whatever reason. Conclusions. Of the 37 (58.7 %) operated patients who sought oncological care, a chemotherapy course was initiated for 19 (51.4 %), dynamic follow-up without specific treatments was recommended for 7 (18.9 %) patients and symptomatic treatments according to the standards of palliative medical care – for 9 (24.3 %). During the follow-up period, among 43 (68.3 %) patients with non-metastatic cancer, 6 (14.0 %) of the operated patients had local recurrences, 8 (18.6 %) – regional, and 12 (27.9 %) – distant ones. In 17 (39.5 %) patients, no findings on recurrent colon cancer were revealed. Cumulative 1-year and 3-year survival rates in this category of patients were 56.3 ± 5.9 % and 38.0 ± 5.8 %, respectively.

Robotic versus open pancreatoduodenectomy for periampullary neoplasm: a propensity matched analysis of peri-operative and oncologic outcomes.

Though open pancreatoduodenectomy (OPD) is the gold standard, robotic pancreatoduodenectomy (RPD) is on the rise due to its technical ease with robotic armamentarium and claim to decrease morbidity in the perioperative period. This study compares the perioperative and oncologic outcomes of RPD performed for periampullary neoplasms (PANs) with OPD. This is a retrospective study conducted from January 2018 to December 2023 for all the patients who underwent either OPD or RPD for PANs. Demographic, peri-operative outcomes and oncological parameters [disease-free survival (DFS) and overall survival (OS)] were analysed and compared. The two groups were matched using 1:1 propensity score matching (PSM) to reduce the risk of confounding. A hundred patients were analysed (30 in RPD and 70 in OPD), and both groups were similar in demographic characteristics. Post-operative morbidity in terms of clinically relevant pancreatic fistula, post-pancreatectomy haemorrhage, delayed gastric emptying and overall Clavien-Dindo ≥ Grade 3 complications were similar in both groups. Surgical site infection (SSI) was significantly higher in the OPD group compared to RPD (31.4% vs. 6.7, p = 0.008); however, the median postoperative hospital stay was similar in both groups. After PSM (26 patients in each group), the RPD group had significantly more operative time (480min vs. 360min, p = 0.007) less blood loss (250ml vs. 400ml, p = 0.004), and similar SSI [2(7.7%) vs. 6(23.1%), p = 0.178). The R0 resection rate, lymph nodal yield, lymph nodal positivity, DFS and OS were similar in both groups. The robotic approach for PD is technically safe and feasible with equivalent resection quality and oncological outcomes compared to the open approach. RPD has equivalent postoperative morbidity, DFS and OS.

Innovations in Medical Education in Gastrointestinal Surgery Using Interactive Anatomical Tables

The introduction of digital technologies into the learning process for medical university students represents a new paradigm in medical education since high level of criteria for assessing the quality of learning of a medical student require the application of modern technologies in training fundamental disciplines and, in particular, anatomy. Thanks to virtual technologies, conditions are created for modeling and integrating the student into conditions close to real ones, which increases the interest and involvement of students in the educational process and, as a result, a subjective improvement in the process of assimilation of the material. Traditional education based on dissection materials cannot fully provide for the massive training of students, as biological materials cannot be restored or preserved and are quickly damaged. 3D models are devoid of these limitations.Aim: to evaluate the effectiveness of digital dissection in the educational trajectory of clinical anatomy using interactive anatomical tables and the need of students for the active use of these aids.Materials and methods. Four groups of students were formed: three groups were studying the material using various anatomical tables and one group used the traditional method. To control the effectiveness of the educational process, before the start of training, entrance testing was conducted in all groups. At the end of classes on individual topics, participants completed exit testing, as well as a questionnaire.Results. The analysis of learning outcomes shows a significantly higher level of absorption of the material among students in groups where 3D anatomical models were used during classes. This indicates that students’ subjective experience of the learning process has improved due to their increased involvement in the class and their interest in innovative teaching methods.Conclusion. We plan to study learning outcomes in more detail to identify any differences in the formation of general and professional competencies among students. This information will help us make informed decisions about the widespread use of anatomical models in educational practice.

PEDESTRIAN SAFETY AND SECURITY FOR FEMALE USERS IN URBAN ALLEYS: A SYSTEMATIC REVIEW

The world's rapid urbanization has led to the emergence of hundreds of alleys between towering skyscrapers. Nowadays, there is numerous safety issues associated with urban alleys and people often associate these alleys with dirt, crime and fear. Consequently, using urban alleys hinders people-especially women-from obtaining basic essentials for safety. Numerous studies have indicated that women perceive cities differently than males and they typically feel more uneasy in public places. The purpose of this article is to investigate strategies and features that can enhance the safety of female pedestrians in urban alleys. After thoroughly examining the Web of Science and Scopus databases, 45 publications were identified. These articles were selected by incorporating keywords such as urban alleys, safety, female users and relevant keywords. The review encompasses information on data collection methods, sample strategies, data analysis and outcome analysis. The study reveals that physical factors, social, psychological and crime prevention factors also influence how women use urban alleys. Nevertheless, women's perceptions of the safety of urban alleys are significantly influenced by physical factors. Ultimately, these findings provide managers, planners and urban designers with valuable insights to establish a foundation for safer urban settings.

A retrospective analysis of clinical features, management and outcomes in dogs and cats with Eastern Brown Snake envenomation (2016-2022).

Australian Eastern brown snakes (Pseudonaja textilis) can cause venom-induced consumptive coagulopathy (VICC) in envenomated dogs and cats due to toxin-induced consumption of clotting factors. The objective of this study was to describe presenting clinical signs, prevalence of VICC and haemorrhage, VICC resolution timelines and patient outcomes in a population of dogs and cats with Eastern brown snake envenomation (EBSE). Data from dogs and cats presenting with EBSE were retrospectively evaluated. Univariable and multivariable analyses were performed to test predictor variable effects on outcomes. Animals who were euthanased for financial reasons on presentation were excluded from treatment and outcome analysis. Two-hundred and forty dogs and 98 cats were included. On presentation, 66% (159/240) of dogs had lower motor neuropathy (LMN), 31% (74/240) had preparalytic collapse and 30% (72/240) had signs of haemorrhage. In cats, 94% (92/98) had LMN, and only 5% (5/98) had haemorrhage. Ninety-two percent of dogs (209/226) and cats (81/88) were diagnosed with VICC on presentation and median time to normalisation of coagulation tests was 24 hours. Median hospitalisation length was 1.5 days for dogs (lower quartile [LQ]-upper quartile [UQ]: 1.0-3.0) and 2 days for cats (LQ - UQ: 1.0-2.5). Dogs presenting with LMN and no history of preparalytic collapse had significantly longer hospitalisation times (median 2.25 vs. 1.0 days, P-value <0.001; median 2.0 vs. 1.0 days, P-value <0.001 respectively). Odds of survival was lower in dogs with LMN (odds ratio [OR]: 0.23) and in the pooled multivariable analysis of dogs and cats with haemorrhage (OR: 0.39). The administration of antivenom overall was found to confer a survival advantage; however analysis failed to show increased odds of survival with administration of more than 4000 units. Overall, 89% (187/210) of dogs and 75% (58/77) of cats survived to discharge.