Differences In Baseline Characteristics Research Articles

Sex differences in patients with working diagnosis of myocardial infarction with nonobstructive coronary arteries (MINOCA)

Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes 3–15% of all acute myocardial infarctions. Women are more frequently diagnosed with MINOCA, although the influence of sex on long-term outcomes is still unclear. In this study we aimed to compare sex-based differences in baseline characteristics and clinical outcomes in patients with suspected MINOCA. We have retrospectively analyzed 6063 patients diagnosed with MINOCA (3220 females and 2843 male patients) from combined 3 large polish registries (PL-ACS, SILCARD and AMI-PL). Male patients were significantly younger (63 (55–74) vs. 71 (61–79) years, p < 0.05) and less frequently diabetic (20.1% vs. 24.1%, p < 0.05). Mortality was significantly higher in male population (11.8% vs. 10.2%, p < 0.05 at 1 year and 17.6% vs. 15.0%, p < 0.05 at 3 years). Male sex was an independent predictor of both mortality (HR = 1.29; CI 1.11–1.51; p < 0.05) and myocardial infarction (HR = 1.39; CI 1.1–1.75, p < 0.05) at 3 years follow-up. All-cause readmission rates were similar in male and female patients both at 1 year (46.0% vs. 44.4, p = 0.2) and 3 years follow-up (56.4% vs. 56.5%, p = 0.93). However, cardiovascular readmissions were more prevalent in male patients at both timepoints (33.9% vs. 29.10%, p < 0.05 at 1 year, and 41.0% vs. 37.6%, p < 0.05 at 3 years). This large-scale registry-based analysis demonstrated higher 3 years rates of adverse events, including death and MI among male patients with suspected MINOCA.

Epidemiology, Ventilation Management, and Outcomes in Invasively Ventilated Coronavirus Disease 2019 Patients: An Analysis of Four Observational Studies in Four Countries on Two Continents.

Epidemiology, ventilator management, and outcomes in patients with acute respiratory distress syndrome (ARDS) because of coronavirus disease 2019 (COVID-19) have been described extensively but have never been compared between countries. We performed an individual patient data analysis of four observational studies to compare epidemiology, ventilator management, and outcomes. We used propensity score weighting to control for confounding factors. The analysis included 6,702 patients: 1,500 from Argentina, 844 from Brazil, 975 from the Netherlands, and 3,383 from Spain. There were substantial differences in baseline characteristics between countries. There were small differences in ventilation management. Intensive care unit mortality was higher in Argentina and Brazil compared with the Netherlands and Spain (59.6% and 56.6% versus 32.1% and 34.7%; P <0.001). The median number of days free from ventilation and alive at day 28 was equally low (0 [0-7], 0 [0-18], 1 [0-16], and 0 [0-16] days, respectively; P = 0.03), and the median number of days free from ventilation and alive at day 60 was higher in the Netherlands and Spain (0 [0-37], 0 [0-50], 33 [0-48], and 26 [0-48] days, respectively; P <0.001). Propensity score matching confirmed the outcome differences. Thus, the outcome of COVID-19 ARDS patients in Argentina and Brazil was substantially worse compared with that of patients in the Netherlands and Spain. It is unlikely that this results from differences in case mix or ventilation management.

Single Axillary Incision Versus Triple Lateral Chest Wall Incisions in Endoscopic Mastectomy for Gynecomastia: A Single-Center Retrospective Analysis with Propensity Score Matching.

Endoscopic mastectomy has gradually become an important surgical modality for the treatment of breast diseases, and is the preferred procedure for gynecomastia. However, endoscopic mastectomy presents challenges such as a steep learning curve, prolonged surgical duration, increased hospitalization costs, and high technical difficulty. This study aimed to evaluate the clinical efficacy and patient satisfaction of endoscopic mastectomy using a single axillary incision versus a triple lateral chest wall incision for gynecomastia. Patients were stratified into a single-port group and a three-port group based on the surgical approach. Propensity score matching was used for the nearest neighbor matching, adjusting baseline data differences at a 1:1 ratio, with a caliper value set at 0.2 to ensure comparability between the two groups. Clinical efficacy and patient satisfaction were compared after propensity score matching. A total of 36 pairs of patients were successfully matched after propensity score matching, with no differences in baseline characteristics (P > 0.05). Notably, the three-port group experienced longer surgical durations compared to the single-port group, alongside higher hospitalization costs (P < 0.05). There were no differences in surgical bleeding volume, postoperative drainage volume, extubation time, postoperative hospitalization time , surgical complications, visual analog scale pain scores, and recurrence rate (P > 0.05). After a 6-month follow-up, the vancouver scar scale assessment showed no differences in scar color, thickness, vascularity, softness, and total score (P > 0.05). Based on the BODY-Q questionnaire chest module scores, the single-port group showed better overall satisfaction in appearance (P = 0.038), especially in the smoothness of the chest wall, with significantly higher scores than the three-port group (P = 0.001). No differences were found in nipple symmetry, nipple sensation, and skin redundancy (P > 0.05). The single axillary incision endoscopic mastectomy demonstrated advantages in shorter surgical duration and lower hospitalization costs, while providing a smoother chest wall appearance, thereby enhancing overall patient satisfaction. Consequently, this surgical approach may arise as one of the preferred procedures for gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Association between neutrophil-albumin ratio and ultrasound-defined metabolic dysfunction-associated fatty liver disease in U.S. adults: evidence from NHANES 2017–2018

BackgroundMetabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly prevalent, and systemic inflammation markers may play a role in its pathogenesis. This study aimed to investigate the relationship between neutrophil-albumin ratio (NAR) and MAFLD.MethodsThis population-based study was performed using data from NHANES 2017–2018 and included 4526 individuals with a median age of 44 years old, and the males account for 46.13% (n = 2088). Ultrasound-defined MAFLD was diagnosed using a controlled attenuation parameter (CAP) threshold of ≥ 285 dB/m. Differences in baseline characteristics between patients with CAP ≥ 285 dB/m and < 285 dB/m were analyzed. A generalized additive model (GAM) and restricted cubic splines (RCS) were applied to explore the nonlinear relationship between NAR and CAP, followed by generalized linear models (GLMs). Threshold effect analysis was performed to identify the inflection point in the nonlinear relationship. CAP-related variables were ranked using XG Boost and random forest algorithms, and predictive models were developed and evaluated.ResultsThe study population included 1,503 patients with CAP ≥ 285 dB/m. NAR was significantly elevated in subjects with CAP ≥ 285 dB/m (P < 0.001), and nonlinear relationships between NAR and CAP were observed. NAR was positively associated with CAP in three GLMs, and this relationship remained after adjusting for confounding factors or dividing NAR into tertiles. Additionally, when NAR < 1.436, a one-unit rise in NAR was linked to a 3.304-fold increase in the risk of NAFLD (OR = 3.304, 95% CI: 2.649–4.122). The NAR-based random forest model showed the best predictive performance with AUC values of 0.978 (training) and 0.813 (validation).ConclusionNAR is positively associated with CAP, and the NAR-based random forest model is optimal for predicting MAFLD risk, highlighting the importance of NAR in predicting MAFLD.

High interindividual variability of indoxyl sulfate production identified by an oral tryptophan challenge test

Indoxyl sulfate (IS) has been implicated in the pathogenesis of cardiovascular diseases. IS is converted from indole, a metabolite of dietary tryptophan through the action of gut microbial tryptophanase, by two hepatic enzymes: CYP2E1 and SULT1A1. We hypothesized that the effect of tryptophan intake on IS production might differ from person to person. We enrolled 72 healthy persons (33 ± 7 years; 54.2% women) to undergo an oral tryptophan challenge test (OTCT), in which 7 blood samples were collected at 0, 4, 8, 12, 24, 36, and 48 h following oral administration of L-tryptophan 2000 mg. We observed high interindividual variability of IS production in the response to an OTCT. Twenty-four subjects in the lowest tertile of the baseline-adjusted area under the curve of IS were defined as low-IS producers, whereas 24 subjects in the highest tertile were defined as high-IS producers. There was no significant difference in baseline characteristics or CYP2E1 and SULT1A1-SNP genotyping distributions between the two IS-producing phenotypes. However, distinct differences in gut microbial composition were identified. In addition, the abundance of tryptophanase was significantly higher in the high-IS producers than in the low-IS producers (P = 0.01). The OTCT may serve as personalized dietary guidance. High-IS producers are more likely to be at greater risk of cardiovascular diseases and may benefit from consuming foods low in tryptophan. Potential clinical applications of the OTCT in precision nutrition warrant further investigation.

Nutritional changes in patients undergoing hemodialysis who develop COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) is known to deteriorate nutrition in the general population. However, the influence of COVID-19 on the nutritional status of patients undergoing maintenance hemodialysis remains unclear.MethodsA retrospective study was conducted in a hospital that had an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 was diagnosed using an antigen test, and the subjects were divided into COVID-19 and control groups. Data on body mass index, biochemistry measurements, geriatric nutritional risk index (GNRI), functional oral intake scale, and nutritional intake were collected from medical records. A generalized linear mixed model was used to analyze the interaction of time × group for these parameters between the two groups.ResultsThe study included 28 participants, 16 of whom belonged to the COVID-19 group. There were no significant differences in baseline characteristics, except for serum creatinine level, among the groups. In the COVID-19 group, 63% exhibited anorexia and 50% experienced vomiting/nausea. Nutritional support or dietary consultations were provided to nine patients. Significant declines were observed in serum albumin level, total iron binding capacity, energy intake, and GNRI in the COVID-19 group, and these nutritional parameters recovered within 1 month following the resolution of the infection.ConclusionsCOVID-19 deteriorated nutritional status in patients undergoing hemodialysis. More proactive nutritional support may help maintain the nutritional status of patients undergoing hemodialysis during COVID-19 infection and could lead to a better prognosis.

Surgery for Olecranon Fractures in the Elderly (SOFIE): Results of the SOFIE Randomized Controlled Trial.

The financial and resource burden of management of olecranon fractures in the elderly is likely to increase with an aging population. There is limited evidence guiding treatment choice in this cohort. This study aimed to determine whether operative treatment of displaced olecranon fractures in elderly patients provides superior 12-month functional outcomes compared to nonoperative treatment. A multicenter pragmatic randomized controlled trial was conducted across 24 hospitals in Australia and New Zealand. Patients aged ≥75 years presenting with an acute (within 14 days), displaced, closed, isolated olecranon fracture were included. Operative treatment involved reduction and stabilization using tension band wiring or plate fixation. Nonoperative treatment consisted of a sling for comfort and early movement as tolerated. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes were the DASH score at 3 months and pain, quality of life, Mayo Elbow Performance Score (MEPS), active elbow range of motion, and complication rate at 3 and 12 months. Data were analyzed based on an intention-to-treat principle, with sensitivity analyses using as-treated groups. Sixty participants were randomized, 27 to the operative group (mean age and standard deviation [SD], 83 ± 5.8 years; 22 [81%] females) and 33 to the nonoperative group (mean age, 82 ± 4.5 years; 23 [70%] females), with no significant difference in baseline characteristics. There was no significant difference (mean difference, -6.6; 95% confidence interval [CI] = -14.9 to 1.8; p = 0.12) in the mean DASH scores at 12 months (the primary outcome) between the operative (12.3 ± 14) and nonoperative (18.9 ± 18) groups. Although active elbow extension was significantly superior in the operative group at 12 months, no other secondary outcome differed significantly between groups at 12 months. The study found no significant difference in DASH scores at 12 months between the operative and nonoperative groups. This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Impact of pathological complete response on survival in gastric cancer after neoadjuvant chemotherapy: a propensity score matching analysis

PurposeThe survival benefits of neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC) patients are inconsistent. This study aims to investigate how different tumor regression grades (TRG) influence the survival gains associated with NAC treatment.MethodsThis study compared the treatment outcomes of patients who underwent CSC (neoadjuvant chemotherapy – surgery – adjuvant chemotherapy) with those receiving traditional SC (surgery – adjuvant chemotherapy) treatment. Propensity score matching (PSM) was employed to minimize potential biases arising from differences in baseline characteristics and intervention factors between the treatment groups. After PSM, the CSC cohort was stratified according to TRGs, and their survival outcomes were compared to assess the impact of TRGs on survival gains associated with NAC.ResultsBefore PSM, a total of 506 patients were enrolled: 291 in the CSC cohort and 215 in the SC cohort. The CSC cohort had a lower 3-year survival rate (3Y-SR) than the SC cohort (64.6% vs. 76%). In the CSC cohort, patients who achieved pathological complete response (pCR, 12.1%, 26/215) demonstrated significantly improved 3Y-SR (95.5%). After PSM, 110 patients were matched in each cohort. The 3Y-SR was similar between the CSC cohort (68.3%) and the SC cohort (63.6%). In the CSC cohort, 12.7% (14/110) of patients achieved pCR. Subgroup analysis revealed that the pCR subgroup (3Y-SR 100%) was the only subgroup within the CSC cohort that maintained significantly improved survival compared to the SC cohort. Better tumor differentiation was the only pre-treatment factor significantly associated with achieving pCR (p < 0.001).ConclusionIn this retrospective study, LAGC patients who achieved pCR after NAC demonstrated significantly better survival outcomes compared to other response groups. The study found tumor differentiation was a potential predictor of pCR.

Contemporary Use of Post-Dilatation for Stent Optimization During Percutaneous Coronary Intervention; Results From the Netherlands Heart Registration.

Post-dilatation after stenting with a non-compliant (NC) balloon can be used to improve overall percutaneous coronary intervention (PCI) result. Due to lack of evidence on the effect of post-dilatation on adverse clinical endpoints there is no consensus whether post-dilatation should be used routinely. The aim of the current study was to determine the contemporary practice of post-dilatation. This study included patients from the Netherlands Heart Registration who underwent PCI between the 4th quarter of 2020 and the 3rd quarter of 2021. The primary endpoint was the rate of post-dilatation with a NC balloon. Secondary endpoints included differences in baseline and procedural characteristics of patients that received post-dilatation and patients that did not receive post-dilatation. Out of 12,960 patients from 11 hospitals, 49.9% underwent post-dilatation. There was a variety in post-dilatation between hospitals ranging from 29.3% to 82.7% and among operators ranging from 15.9% to 90.5%. Post-dilatation was used less frequent in patients presenting with ST-elevation myocardial infarction or out of hospital cardiac arrest. Multivessel and left main PCI, long stent length and use of intracoronary imaging and calcium modification were associated with increased use of post-dilatation. When imaging was used, the percentage of post-dilatation was 79.4%. In the Netherlands, stent optimization with post-dilatation using NC balloon is performed in only half of the patients undergoing PCI, with variations in frequency across centres and operators. Post-dilatation is more often used in cases of complex PCI and when intracoronary imaging or calcium modification techniques are used.

The effect of probiotic administration on the severity of menopausal symptoms and mental health of postmenopausal women: a triple-blind randomized controlled trial in the West of Iran.

Menopausal symptoms are a reproductive health issue for women. Some studies have suggested that the use of probiotics may alleviate the severity of menopausal symptoms and mental health status. This study aimed to evaluate the effect of probiotic administration on the severity of menopausal symptoms and improve mental health in postmenopausal women in Hamadan, Western Iran. A triple-blind randomized controlled trial was conducted from February 20, 2023, to August 23, 2023, at the Comprehensive Health Service Centers in Hamadan City, Western Iran. Participants were randomized to intervention and control groups. The participants in the intervention group were administered probiotic supplements in 200 mg daily capsules for 6 weeks, and those in the control group received 200 mg daily capsules containing starch powder for 6 weeks. The primary outcomes were measured using the Menopausal Rating Scale and Depression Anxiety and Stress Scale questionnaires at baseline, week 3, and week 6. A total of 84 women took part in the study, with 42 individuals assigned to each of the intervention and control groups, respectively. The findings indicated no significant differences in baseline characteristics between the study groups (P > 0.05). The results indicated that the study outcomes changed differently over time between the two groups. The participants in the intervention group exhibited greater improvements in depressive symptoms, anxiety, and stress symptoms, as well as in physical, psychological, and urogenital symptoms at both week 3 and week 6, compared with the control group (P < 0.05). This study provides evidence regarding potential treatment effects of probiotics consumption in alleviating physical and mental symptoms related to menopause. Further multicenter and large-scale clinical trials with longer follow-up are recommended.

Burden of Infections in Early Life and Risk of Infections and Systemic Antibiotics Use in Childhood

A high infection burden in early childhood is common and a risk factor for later disease development. However, longitudinal birth cohort studies investigating early-life infection burden and later risk of infection and antibiotic episodes are lacking. To investigate whether early-life infection burden is associated with a later risk of infection and systemic antibiotic treatment episodes in childhood. This longitudinal cohort study of children from birth to age 10 or 13 years included data from the Danish population-based Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) birth cohort between November 2008 to November 2010. Children were monitored for infection diagnoses and systemic antibiotic prescriptions from national databases until February 1, 2024, by which time they had completed the age 10- or 13-year visit. Children with immune deficiencies or congenital diseases were excluded. Daily diary-registered common infection episodes of cold, acute otitis media, tonsillitis, pneumonia, gastroenteritis, and fever episodes from birth to 3 years. After age 3 years, the incidence of moderate to severe infection diagnoses and systemic antibiotic prescriptions were estimated using adjusted incidence rate ratios (AIRRs) calculated from quasi-Poisson regression models. All analyses were adjusted for social and environmental confounders. A total of 614 children (317 male [51.6%]) with diary data from birth to 3 years had completed follow-up until age 10 or 13 years. No differences in baseline characteristics between the children having vs not having available diary data were noted. Children with a high vs low burden of diary-registered infections between birth and 3 years (ie, equal to and above vs below the median of 16) had an increased risk of later moderate to severe infections (181 vs 87 episodes; AIRR, 2.39; 95% CI, 1.52-3.89) and systemic antibiotic treatments (799 vs 623 episodes; AIRR, 1.34; 95% CI, 1.07-1.68) until age 10 or 13 years. Each diary infection episode also increased the later risk of moderate to severe infections (AIRR, 1.05; 95% CI, 1.02-1.08) and systemic antibiotic treatments (AIRR, 1.02; 95% CI, 1.01-1.04). Subtype analyses showed significant associations between each cold, acute otitis media, pneumonia, gastroenteritis, and fever episode between birth and 3 years and risk of later moderate to severe infections or systemic antibiotic treatments. This longitudinal cohort study suggests that early-life infection burden may continue throughout childhood and is associated with later antibiotic treatments independent of social and environmental risk factors. These findings are important for prognosis and follow-up of children experiencing a high burden of common infections in early life.

Incidence and antecedents of emergent suicidal ideation and behavior among Veterans with serious mental illness receiving intensive case management.

Veterans with serious mental illness (SMI; i.e., schizophrenia-spectrum disorders, major mood disorders, post-traumatic stress disorder) are a high-risk group for suicide and little is known about those with emergent suicidal ideation and/or behavior. The primary study aim was to examine the six-month incidence and baseline antecedents of emergent suicidal ideation and/or behavior (suicidal ideation and/or behavior at six-month follow-up but not at enrollment) in Veterans with SMI enrolled in the Veterans Health Administration's (VHA) community-based treatment program (i.e., Intensive Community Mental Health Recovery [ICMHR]). A second, exploratory aim was to examine six-month follow-up ICMHR service use (e.g., frequency of contact with Veteran, type of services provided) in those with emergent suicidal ideation and/or behavior. National ICMHR program evaluation data from 2000 to 2013 were analyzed for Veterans with enrollment and six-month follow-up assessments (n=9921). Analyses examined differences in baseline characteristics and ICMHR service use in those with emergent suicidal ideation and/or behavior compared to those with other suicidal ideation and/or behavior patterns (i.e., none [at either timepoint], improved [present at enrollment but not at follow-up], persistent [present at both timepoints]). Results showed that 1.7% (n=167) of the sample had emergent suicidal ideation and/or behavior. Some suicidal ideation and/or behavior groups differed significantly from the emergent suicidal ideation and/or behavior group on odds of: lifetime hospitalizations, baseline subjective distress, affective disorder diagnosis, and baseline quality of life. Overall, historical and current clinical factors and quality of life should be assessed in this population given their association with emergent suicidal ideation and/or behavior.

An automated method of streamlining waiting list by clinical risk fast-tracking for patients awaiting TAVR: SWIFT TAVR algorithm.

Transcatheter aortic valve replacement (TAVR) is increasingly in demand for treating severe aortic stenosis in a variety of surgical risk profiles. This means increasing wait times and elevated morbidity and mortality on the waitlist. To address this, we developed the SWIFT TAVR algorithm to prioritize patients based on clinical risk and reduce wait times. The SWIFT algorithm, implemented in Microsoft Excel, calculates a clinical risk score from three parameters: left ventricular ejection fraction (LVEF), peak aortic valve gradient, and syncope. Scores categorize patients into four prioritisation profiles: high (9-10 points), intermediate (4-8 points), low (2-3 points), and minimal (0-1 point). The study prospectively applied the SWIFT algorithm to patients in 2022 (SWIFT group) and retrospectively to a 2021 cohort (CONTROL group). Outcomes measured were wait times from consultation to procedure and major adverse cardiac events (MACE) while awaiting TAVR. A total of 228 patients were included (117 SWIFT, 111 CONTROL). There was no significant difference in baseline characteristics between groups (p>0.05). Overall wait times were significantly shorter in the SWIFT group (21 vs 28weeks, p<0.001), particularly for high-risk patients (12 vs 31weeks, p<0.001). MACE rates were similar (9% vs 10%, p=0.722). The SWIFT algorithm significantly reduced wait times, particularly for high-risk patients, without increasing MACE rates. This automated, risk-based prioritisation tool improves equity and efficiency in TAVR waitlist management and is globally applicable. Further randomized studies are warranted to validate these findings.

Comparison of the Effectiveness of Endometrial Scratching in Follicular and Luteal Phases in Pregnancy Rate of Frozen Embryo Transfer Candidate Women

Background: Endometrial scratching (ES) has been reported as a strategy to improve the outcome of IVF. Considering that the follicular phase and luteal phase have their specific characteristics and hormonal secretions, we investigated whether scratching in different phases affects a woman's chances of becoming pregnant following frozen embryo transfer. Methods: A total of 300 frozen embryo transfer candidate women with normal cavities and good embryo quality were randomly divided into two groups: group A with ES in the follicular phase and group B with ES in the luteal phase. In both groups, endometrial scratching was performed before IVF. The rate of pregnancy and baseline characteristics, such as age, education, and embryo quality, were compared between the two groups. Results: Our results showed no significant differences in baseline characteristics between the groups. Furthermore, no significant differences were observed between the women who underwent ES in the follicular phase and those in the luteal phase for the outcome of IVF and chemical or clinical pregnancies. Conclusion: ES in different phases of the cycle preceding frozen embryo transfer did not affect the outcome of pregnancy.

Changes in Recovery Capital Among Patients Receiving Buprenorphine Treatment for Opioid Use Disorder in a Telehealth Setting.

Medications for the treatment of opioid use disorder (MOUD) such as buprenorphine are the most effective treatment available for OUD; yet, beyond drug testing results and retention in care, systematically measured clinical outcomes have proven elusive. There is growing interest in integrating systematic monitoring of patient-reported outcomes and measurement-based care as strategies to improve patients' success in treatment. We analyzed changes in recovery capital assessed via the Brief Assessment of Recovery Capital (BARC-10) from baseline to 30-120 days post-intake among patients initiating buprenorphine treatment from May to October 2023 at Ophelia, a telehealth MOUD provider, who were retained for ≥90 days. Differences in baseline characteristics were assessed between patients with and without high "remission-predictive" baseline scores (≥47) using chi-squared and t-tests. Changes in scores from baseline to follow-up were assessed using paired t-tests. In all, 791 patients initiated treatment during the study period, 742 (93.8%) of whom had a baseline BARC-10 score, 542 (73.0%) of whom were retained in treatment for ≥90 days, and 477 of whom (88.0%) had a follow-up BARC-10 score and represent the analysis sample. Older patients, those not requiring buprenorphine induction, and those not using heroin or fentanyl at intake were more likely to have remission-predictive baseline BARC-10 scores (P < .05). Patients with remission-predictive baseline scores (n = 257) had a mean increase of 1.4 (SD = 5.9) from 52.7 (SD = 4.1) (P < .001), and 234 (91%) sustained remission-predictive scores throughout the assessment period. Patients without remission-predictive baseline scores (n = 220) had a mean increase of 9.2 (SD = 8.2) from 38.4 (SD = 6.6) (P < .001), and 129 (59.0%) achieved a remission-predictive score at follow-up. Most patients had increased or sustained already high levels of recovery capital, an established predictor of sustained remission. Further research is required to better understand variability across patients and how it may relate to long-term outcomes.

Retrospective Analysis: Exploring Transfusion Thresholds' Impact on Patients with Sepsis and Renal Failure.

Sepsis with renal failure is a common condition in intensive care units (ICUs) and is associated with poor prognosis. A unified consensus on the optimal transfusion hemoglobin concentration threshold is needed to improve outcomes. This study investigated the effects of different transfusion thresholds during hospitalization on the prognosis of patients with sepsis and renal failure. A total of 2,972 patients were included in this study. By using the Medical Information Mart for Intensive Care (MIMIC-IV) database, data from patients with sepsis and renal failure were screened and divided into a low-threshold group (Hb ≤ 7 g/dL) and a high-threshold group (Hb > 7 g/dL) based on the average hemoglobin (Hb) level 24 hours before transfusion. Univariate and multivariate Cox regression analyses and inverse probability weighting were used to compare in-hospital and ICU mortality rates between the two groups. Additionally, 30-day, 60-day, and 90-day survival rates, length of hospital stay, and ICU stay duration were evaluated. Statistically significant differences in baseline characteristics were observed between the two groups. After propensity score matching to eliminate baseline characteristic differences, it was found that among the Cau¬casian population a higher transfusion threshold significantly reduced the risk of in-hospital mortality (HR, 0.774; 95% CI: 0.613 - 0.978, p < 0.05). For patients with sepsis and renal failure, transfusion thresholds should be determined by considering the patient's race to achieve individualized transfusion strategies.

Association of Grit and Resilience With Short-Term Post-Transplant Outcomes in Lung Allograft Recipients.

The importance of mental toughness on lung transplant outcomes is unknown. We performed a pilot study to assess whether pretransplant grit and resilience are associated with short-term posttransplant outcomes. We enrolled 31 lung transplant candidates, of whom 7 (26%) had greater mental toughness, defined as the upper tertile for both grit and resilience within our cohort. There were no differences in baseline characteristics between patients with higher and lower mental toughness. Greater mental toughness was associated with a shorter hospital length of stay (LOS) [12 days (interquartile range, IQR 10-12) vs. 17 days (IQR 14-24), p = 0.02] and reduced posttraumatic stress severity [median 0 (IQR 0-2) vs. 6.5 (IQR 4-9), p < 0.01]. On multivariable analyses adjusting for age and Duke Activity Status Index, greater mental toughness was associated with a shorter hospital LOS [beta = -11.96 (95% CI 0.05-23.86), p < 0.05] and reduced PTSD [beta = -10.7 (95% CI -21.6-0.04), p = 0.053]. Lung transplant candidates with greater mental toughness may have improved short-term outcomes.

Valve-sparing versus bio-Bentall aortic root replacement in patients aged 60-75 years: Survival, Reintervention and Aortic Regurgitation.

Valve-sparing root replacement(VSRR) with the David technique is an established therapy for aortic root pathology in young patients. The aim of this study was to evaluate short and long-term outcomes between VSRR and aortic root replacement(ARR) with a biological-valved conduit in sexagenarians. A multicenter retrospective review from 2002-2022 identified 299-sexagenarians undergoing aortic root surgery, among whom 82(27.4%) underwent VSRR and 217(72.6%) bio-Bentall. Inverse probability of treatment weighting(IPTW) was applied to balance clinical variables. Median follow-up was 15-years[12-18 years]. Endpoints of the study were in-hospital mortality, long-term survival, freedom from reintervention and recurrence of at-least-moderate AR. There were no major differences in baseline characteristics. The incidence of bicuspid valves(VSRR 4.9% vs ARR 19%), severe AR(42% vs 51%), type-A aortic dissection(1.2% vs 6.9%), and reoperation(4% vs 23%) were higher in ARR. Following IPTW, there was no difference in in-hospital mortality(VSRR 1.2% vs ARR 4.6%,p=0.3). The incidence of neurologic complications(p=0.003), and permanent pacemaker(PPM) implantation(p=0.022) were significantly higher in the bio-Bentall group. After IPTW, 10-year survival did not differ between VSRR(87%) and ARR(80%)(p=0.176). However, cardiac-survival was significantly higher in VSRR patients(98% vs 92%,p=0.018), with deaths mainly due to infective endocarditis and end-stage heart failure(HF). Regarding reoperation/recurrence of at-least-moderate AR, no difference was reported among groups at 10-years, with only 1-patient undergoing reintervention following bio-Bentall(p=0.117). David and bio-Bentall procedures have low in-hospital mortality and good long-term survival in sexagenarians. VSRR is associated with improved long-term cardiac-survival, lower rates of infective endocarditis, PPM-implantation and HF-episodes, with similar rates of reintervention/recurrence of moderate AR.

Combined Short-Long Axis Versus Medial Oblique Axis for Internal Jugular Vein Cannulation: A Prospective Single-Blinded Randomized Clinical Trial.

Previous literature suggested the advantage of combined short-long axis (CSLA) technique to avoid posterior wall puncture during internal jugular vein (IJV) cannulation. The purpose of this study is to define the best ultrasound-guided IJV cannulation technique regarding the success rate in the first trial of insertion, time to successful central line placement, number of attempts, procedural complications, and operator satisfaction. Single-blinded, prospective randomized clinical trial. Elective cardiac surgeries in a tertiary care center. One hundred seventy-eight elective cardiac surgery patients older than 18 years accepted to participate in the study and signed the informed consent. Patients were randomized into two equal groups: medial oblique axis and CSLA. During the technique, vein dimensions, patient characteristics, technique duration, posterior wall puncture, number of attempts, complications, and operator satisfaction were documented. Apart from body weight, there were no significant differences in baseline characteristics between both groups. Compared to the CSLA, the medial oblique approach showed significantly higher first-trial success rate (92.1% v 75.0%, p = 0.002), less time for successful insertion (mean ± SD, 60.9 ± 54.9 seconds v 110.7 ± 101.6 seconds, p < 0.001), accomplishment with fewer attempts (mean ± SD, 1.09 ± 0.28 v 1.44 ± 0.81, p < 0.001), and higher operator satisfaction (mean ± SD, 4.45 ± 0.92 v 3.46 ± 1.32, p < 0.001). No significant difference in complications, including posterior wall puncture (p = 0.469), was noted between both groups. This study demonstrated the medial oblique axis approach was superior to the CSLA approach regarding first-trial success rate, time to successful line placement, number of attempts, and operator satisfaction when used during elective cannulation of the IJV. However, regarding the incidence of complications, there was no advantage of one approach over the other. Further research is needed to confirm these results among specific groups of operators, with awake patients and in emergent situations.

Reduction of the Douleur Neuropathique 4 (DN4) Score in the Supraclavicular Nerve Separation and Disability of the Arm Shoulder and Hand (DASH) Score Third Month and Sixth Month Post Open Reduction Internal Fixation of Clavicular Fracture

Introduction: Clavicle fractures are common injuries to the scapular girdle, with fractures in the middle third of the clavicle being the most prevalent. Non-operative treatment is often used but can lead to unsatisfactory outcomes, including pain, malunion, and thoracic outlet syndrome. As a result, operative fixation using Open Reduction and Internal Fixation (ORIF) Plate and Screw (ORIF PS) has gained popularity. Postoperative complications such as numbness around the surgical incision are frequently observed. This study aims to evaluate the differences in functional outcomes in patients with clavicle fractures post ORIF PS using the preserved supraclavicular nerve and non-preserved supraclavicular nerve methods, assessed by the Disability of the Arm Shoulder and Hand (DASH) score and Douleur Neuropathique 4 (DN4) score at 3 and 6 months post-operation. Methods: This cohort study used medical records data from patients with middle third clavicle fractures at RSUP Prof. Dr. IGNG Ngoerah. Patients were divided into two groups: preserved supraclavicular nerve and non-preserved supraclavicular nerve. Data were collected at 3 and 6 months post-operation to evaluate DASH and DN4 scores. Statistical analysis was performed using SPSS version 25.0, with the Kolmogorov-Smirnov test for normality and appropriate hypothesis tests based on data distribution. Results: This study involved 51 patients with clavicle fractures undergoing ORIF PS surgery. There were no significant differences in baseline characteristics between the two groups. At three months, the difference in DN4 scores between the preserved and non-preserved groups was not statistically significant (p=0.347). However, at six months, the preserved group showed significantly lower DN4 scores (p=0.012). The DASH scores at three months showed a significant difference between the two groups (p&lt;0.001), with the preserved group showing better scores. At six months, the difference in DASH scores was not significant (p=0.210). Longitudinal analysis showed significant reductions in DASH and DN4 scores between three and six months in both groups. Discussion: This study demonstrates that preserving the supraclavicular nerve during ORIF clavicle surgery provides significant benefits in reducing neuropathic pain and improving arm function in the long term. These findings support the importance of this approach in clavicle fracture surgeries to reduce complications and enhance functional outcomes. Conclusion: Preserving the supraclavicular nerve during ORIF clavicle surgery can significantly reduce neuropathic pain and improve arm function in the long term. These findings emphasize the importance of this approach in clinical practice to improve patient outcomes following clavicle fracture surgery. Keywords: Clavicular fracture, Douleur Neuropathique 4 score, supraclavicular nerve separation, DN4 score, DASH score, ORIF.