Charlson Comorbidity Index Research Articles

Association between muscular strength and sleep quality in older adults undergoing hemodialysis: a cross-sectional study.

Older adults undergoing hemodialysis experience improved survival rates but often suffer from sleep disorders, resulting in adverse health outcomes. This study aims to assess the association between handgrip strength (HGS), a key indicator of muscular strength, and sleep quality in older adults undergoing hemodialysis. This cross-sectional and analytical study assessed 150 older adults undergoing hemodialysis selected by simple randomization. Data on demographics, clinical parameters, HGS, and sleep quality (PSQI) were collected and analyzed using descriptive and inferential statistics with SPSS version 20. The mean age of the participants was 65.61 ± 4.07years. Mean mid-upper arm circumference (MUAC) and calf circumference (CC) were 29.59cm and 36.96cm, respectively. The mean HGS was 28.7 ± 8.55kg, with males exhibiting higher HGS (37.72 ± 6.17kg) than females (23.55 ± 5.38kg). The mean PSQI score was 6.71, with 54.1% reporting poor sleep quality. Sleep quality was significantly associated with income source, underlying diseases, Charlson Comorbidity Index (CCI), BMI, MUAC, CC, HGS, and blood levels of potassium and creatinine. A moderate negative correlation (r = -0.438, p < 0.001) was observed between HGS and PSQI scores, indicating better sleep quality with greater muscular strength. Elevated potassium levels increase the risk of poor sleep. Older adults undergoing hemodialysis frequently experience poor sleep quality, which is associated with lower muscular strength. These findings highlight the importance of implementing targeted interventions, such as strength-training programs, to improve muscular strength and, consequently, sleep quality in this vulnerable population.

Association between comorbidity indices and nursing home admission in patients with Alzheimer’s disease: a longitudinal observational study using the MEMORA cohort

BackgroundAlzheimer’s disease (AD) is among the leading cause of nursing home admission (NHA). Identifying potentially modifiable factors associated with the risk of NHA is crucial to reduce this risk in individuals with AD.ObjectiveWe aimed to assess the relationship between comorbidity burden, as measured by the Charlson comorbidity index, the multimorbidity-weighted index and the health related quality of life comorbidity index, and NHA in patients with AD.MethodsWe conducted an observational longitudinal study including patients from the MEMORA real-life cohort. Patients had to be aged 60 years or older, with a diagnosis of AD. The association between comorbidity indices and occurrence of NHA was assessed using Cox proportional-hazards models and competing-risks regressions considering mortality as a competing event. All analyses were adjusted for age, sex, educational level, stage of AD and the presence of neuropsychiatric symptoms.ResultsOverall, 488 AD patients were included (68.2% with dementia). There were 125 (26%) NHA that occurred during the follow-up, with a median time of 25 months until NHA. Higher level of comorbidity burden as measured by the three comorbidity indices was associated with higher risk of NHA compared to lower level of comorbidity burden. Similar findings were found after considering mortality as a competing event, with a HR of 2.41(95%CI:1.36–4.28, p = 0.003) for MWI, an HR of 1.96(95%CI:1.22–3.17, p = 0.006), and an HR of 1.68(95%CI:1.04–2.71, p = 0.034).ConclusionThe implementation of appropriate interventions that aim to improve the management of the comorbidity burden could help to reduce the risk of NHA in individuals with AD.

Fix and replace for acetabular fractures: a decade of outcomes.

Fix and replace is the combination of fixation and hip arthroplasty for the treatment of acetabular fractures. This technique is typically performed for elderly patients with complex fracture patterns, whereby fixation alone may not achieve a satisfactory result or allow early unrestricted weightbearing. This was a retrospective observational study of patients with acetabular fractures treated with fix and replace, identified from a locally maintained, prospectively collected database. Imaging and case notes were reviewed for patient and injury characteristics and outcomes. Between 2014 and 2024, 92 consecutive cases (91 patients) were identified with a median age of 78years. Operations performed with a single approach had a significantly lower mean anaesthetic time and intra-operative blood loss than dual approach (4.4h vs 5.0h, p = 0.043; 500ml vs 800ml, p = 0.036). There were 3 revisions for infection (3.3%) and 5 dislocations (5.4%), one of which was revised, with the other four treated successfully with manipulation only. Mortality rates were 12.5%, 30.9%, and 50% at 1, 3, and 5 years, respectively. Increasing age, dependent pre-operative mobility status, and increasing Charlson Comorbidity Index were all associated with all-time mortality risk (p < 0.001, p < 0.001, and p = 0.002, respectively). This is the largest series of its kind to date, providing additional information about typical patient and injury characteristics and expected outcomes. Due to the benefits of single rather than dual approach, this should be considered where possible using percutaneous techniques and acetabular component augmentation where required, to minimise operative time and blood loss.

Using Nomograms to Predict Patient Tolerance to High-Dose Cisplatin During Concurrent Chemoradiotherapy in Locoregionally Advanced Head and Neck Cancer.

Concurrent chemoradiotherapy (CCRT) with high-dose cisplatin is the standard treatment for locally advanced head and neck cancer (LA-HNC). However, some patients experience underdosing or severe side effects due to intolerance. That is, identifying patients who can tolerate high-dose cisplatin remains challenging. This study aims to develop a prediction nomogram to identify patients tolerating high cumulative cisplatin dose (CCD ≥ 200 mg/m2) during CCRT. The collected data of 1020 patients who received cisplatin-based definitive CCRT between 2010 and 2019 in a Taiwanese medical center were retrospectively reviewed. A prediction model was developed using stepwise multivariable logistic regression and evaluated for accuracy. A nomogram was created to predict the likelihood of completing a CCD ≥ 200 mg/m2, and its performance was assessed using various measures. The higher CCD group had better-experienced status and median body mass index than the lower CCD group (p < 0.001 for both comparisons). Univariate analysis identified several risk factors for high-dose cisplatin intolerance, including old age, tumor site, the nasopharynx, stage IV disease, Charlson Comorbidity Index (CCI) ≥ 3, and weekly cisplatin (p < 0.001 for all). Multivariate logistic regression analysis revealed that age, tumor site, stage IV disease, and hemoglobin level strongly predicted high-dose cisplatin intolerance. The nomogram showed good predictive accuracy with a Brier score of 0.18, C-index of 0.71, calibration curve slope of 0.95, and intercept of 0.2. Similar values were observed in the non-nasopharyngeal carcinoma subgroup. Our nomogram model identified patients who can tolerate higher cisplatin doses, showing predictive accuracy after internal validation. Developed using pretreatment characteristics like age, clinical stage, tumor size, and hemoglobin level, it predicts tolerability for CCD ≥ 200 mg/m2. This method helps select patients for high-dose cisplatin, enabling confident prescription of three-weekly or weekly dosing to improve survival outcomes. Further prospective research is needed for a comprehensive nomogram.

Clinical study of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for treatment of Neer three/four-part proximal humeral fractures in elderly

To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.

Influence of preoperative indwelling urinary catheter on outcomes of high-power holmium laser enucleation for very large prostate (≥ 200 mL).

to evaluate the impact of Indwelling Urinary Catheters (IUC) on perioperative and functional outcomes, as well as the safety profile, of High-Power HoLEP for the treatment of prostate gland volumes exceeding 200cc. A retrospective analysis was conducted on 237 patients with prostate volumes > 200cc who underwent HoLEP between January 2016 and December 2022. Patients were included based on specific criteria, such as an International Prostate Symptom Score (IPSS) > 7 and a maximum urinary flow rate (Qmax) < 15 mL/s. Patients were categorized into two groups: Group 1 included those with IUC prior to surgery, while Group 2 comprised patients without it. A total of 237 patients with prostate volumes exceeding 200cc underwent HoLEP, and were categorized into Group 1 (n = 63) and Group 2 (n = 174), with Group 1 exhibiting higher Charlson Comorbidity Index and BMI. Postoperative outcomes indicated a higher incidence of urinary tract infections in Group 1, as well as worse IPSS, Qmax, and PVR at 3 months; however, by the 1-year follow-up, both groups demonstrated comparable results. Longitudinal analysis revealed that both groups experienced significant functional and symptomatic improvements over time, with Group 2 showing rapid early gains that stabilized, whereas Group 1 exhibited continuous improvement from 3 months to 1 year. HoLEP is an effective treatment for very large prostate volumes in patients with IUC. Although these patients are at a higher risk for UTI and initial lower Qmax, these outcomes improve by one year.

The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: A nationwide prospective observational study.

Patients with substantial comorbidity burden are underrepresented in clinical trials on endovascular thrombectomy (EVT), despite being common in clinical routine care. Therefore, analysis of observational data is needed to evaluate how increasing comorbidity burden affects procedural success rate, complication rate, and clinical outcome following EVT. We conducted a register-based observational study involving pre-stroke functionally independent patients treated with EVT in Sweden 2015-2021. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI) and categorized as no (CCI 0), moderate (CCI 1), severe (CCI 2), and very severe (CCI ⩾3). The primary outcome was favorable 90-day outcome (modified Rankin Scale 0-2). Secondary outcomes included successful recanalization, and peri- and postoperative complications. Of 4735 included patients, 40% had no comorbidity (CCI 0), 15% had moderate (CCI 1), 21% had severe (CCI 2), and 24% had very severe comorbidity burden (CCI ⩾3). The yearly proportion of patients with very severe comorbidity burden increased from 16% to 30% during the study period. Increasing comorbidity levels were associated with decreased odds ratio (OR) of favorable outcome compared to patients without comorbidity: CCI 1 adjusted OR (aOR) 0.64, 95% CI 0.57-0.85; CCI 2 aOR 0.59, 95% CI 0.47-0.74; and CCI ⩾3 aOR 0.38, 95% CI 0.30-0.47, but there were no significant differences in successful recanalization rates. Patients with CCI 2 had higher OR for perioperative and postoperative complications (OR 1.43, 95% CI 1.09-1.88, and OR 1.41, 95% CI 1.15-1.71), and patients in the CCI ⩾3 group had higher OR of postoperative complications (OR 1.34, 95% CI 1.14-1.67), compared to patients in the CCI 0 group. Successful recanalization was associated with favorable functional outcome in all CCI-groups. Severe and very severe comorbidity burden are increasingly common among EVT-treated patients in routine healthcare and are linked to poorer outcomes. However, our results suggest that successful EVT is associated with functional independency, also in patients with severe and very severe comorbidity burden.

Bariatric Surgery and Risk of End-Stage Liver Disease in a Four-Country Cohort Study.

Metabolic dysfunction-associated steatotic liver disease can progress to end-stage liver disease. Whether bariatric surgery influences this risk is uncertain. This population-based cohort study included all patients with an obesity diagnosis between 1989 and 2020 according to the nationwide patient registries in Denmark, Finland, Norway, and Sweden. Bariatric surgery was compared with non-operative care for incidence and mortality in end-stage liver disease. Patients with a history of alcohol overconsumption or liver disease at baseline were excluded. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for sex, calendar year, diabetes, Charlson comorbidity index, and country. Among 654,409 participants with obesity, 86,356 (12.6%) underwent bariatric surgery. During a follow-up period of up to 31 years (median 7.3 years), bariatric surgery was followed by increased incidence (HR 1.23, 95% CI 1.11-1.37) and mortality (HR 1.93, 95% CI 1.56-2.38) in end-stage liver disease compared to non-operative care. The incidence decreased between 1 and 5years after bariatric surgery but thereafter increased. Censoring patients who developed specific liver diseases (not steatotic liver disease) or alcohol overconsumption during follow-up canceled the association (HR 0.92, 95% CI 0.70-1.06). The mortality in end-stage liver disease was similar after bariatric surgery compared to non-operative care within 1-5 years of follow-up, but thereafter more than twofold increased. Analyses restricted to gastric bypass showed similar associations regarding both incidence (HR 1.26, 95% CI 1.11-1.43) and mortality (HR 2.20, 95% CI 1.72-2.82) of end-stage liver disease. Bariatric surgery might be followed by an increased risk of end-stage liver disease.

Remdesivir associated with reduced mortality in hospitalized COVID-19 patients: treatment effectiveness using real-world data and natural language processing

BackgroundRemdesivir (RDV) was the first antiviral approved for mild–to–moderate COVID-19 and for those patients at risk for progression to severe disease after clinical trials supported its association with improved outcomes. Real-world evidence (RWE) generated by artificial intelligence techniques could potentially expedite the validation of new treatments in future health crises. We aimed to use natural language processing (NLP) and machine learning (ML) to assess the impact of RDV on COVID19-associated outcomes including time to discharge and in-hospital mortality.MethodsUsing EHRead®, an NLP technology including SNOMED-CT terminology that extracts unstructured clinical information from electronic health records (EHR), we retrospectively examined hospitalized COVID-19 patients with moderate-to-severe pneumonia in three Spanish hospitals between January 2021 and March 2022. Among RDV eligible patients, treated (RDV+) vs untreated (RDV‒) patients were compared after propensity score matching (PSM; 1:3.3 ratio) based on age, sex, Charlson comorbidity index, COVID-19 vaccination status, other COVID-19 treatment, hospital, and variant period. Cox proportional hazards models and Kaplan–Meier plots were used to assess statistical differences between groups.ResultsAmong 7,651,773 EHRs from 84,408 patients, 6,756 patients were detected with moderate-to-severe COVID-19 pneumonia during the study period. The study population was defined with 4,882 (72.3%) RDV eligible patients. The median age was 72 years and 57.3% were male. A total of 812 (16.6%) patients were classified as RDV+ and were matched to 2,703 RDV‒ patients (from a total of 4,070 RDV‒). After PSM, all covariates had an absolute mean standardized difference of less than 10%. The hazard ratio for in-hospital mortality at 28 days was 0.73 (95% confidence interval, CI, 0.56 to 0.96, p = 0.022) with RDV‒ as the reference group. Risk difference and risk ratio at 28 days was 2.7% and 0.76, respectively, both favoring the RDV+ group. No differences were found in length of hospital stay since RDV eligibility between groups.ConclusionsUsing NLP and ML we were able to generate RWE on the effectiveness of RDV in COVID-19 patients, confirming the potential of using this methodology to measure the effectiveness of treatments in pandemics. Our results show that using RDV in hospitalized patients with moderate-to-severe pneumonia is associated with significantly reduced inpatient mortality. Adherence to clinical guideline recommendations has prognostic implications and emerging technologies in identifying eligible patients for treatment and avoiding missed opportunities during public health crises are needed.

The relationship between comorbidities, physical inactivity, kinesiophobia and physical performance in hypertensive individuals: a cross-sectional study

BackgroundHypertension is a prevalent chronic condition accompanied by comorbidities that negatively affect health outcomes. Comorbid conditions in hypertensive individuals may contribute to increased physical inactivity, heightened levels of kinesiophobia, and diminished physical performance. This study aimed to investigate the relationships among Charlson Comorbidity Index (CCI). scores, kinesiophobia, physical activity levels, and physical performance in hypertensive individuals.MethodsA cross-sectional study included 186 hypertensive participants aged ≥ 40 years. CCI was utilized to assess comorbidities, and physical activity levels were evaluated with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Kinesiophobia was measured using the Tampa Kinesiophobia Scale (TKS)., and physical performance was evaluated through the 30-Second Sit-to-Stand Test (STS-30). and the Five Times Sit-to-Stand Test (FT-STS). Spearman correlation analysis was performed to assess relationships among variables.ResultsThe majority of participants (88.7%) exhibited kinesiophobia, and 93.5% were physically inactive. A significant but positive weak correlation were found between CCI and TKS (r = 0.239, p = 0.002). A significant but weak negative correlation were observed between CCI and STS-30 (r=-0.264, p = 0.001), while a weak positive correlation was observed CCI and FT-STS (r = 0.227, p = 0.005) among inactive individuals. A weak negative correlation was also found between IPAQ-SF and CCI in inactive participants (r=-0.184, p = 0.020). No significant correlations were found in active individuals. The effect sizes for these correlations ranged from moderate to small, suggesting a meaningful, but limited, impact of comorbidities on physical inactivity and kinesiophobia.ConclusionsComorbidities (CCI) were significantly associated with kinesiophobia and physical performance in inactive hypertensive individuals. These findings highlight the need for patient-centered targeted interventions addressing comorbidities to enhance physical activity, management kinesiophobia and improve physical performance in this population.

A Novel Serum Inflammation Risk-Index (SIRI-RT)-Driven Nomogram for Predicting Secondary Malignancy Outcomes Post-Radiotherapy

Radiation is often used as the primary treatment for a range of cancers. Nonetheless, its ability to trigger secondary tumors has emerged as a significant issue. Therefore, gaining insight into and predicting radiation-induced secondary cancers is essential for enhancing the long-term prognosis of cancer survivors. Background and Objectives: Previous studies have identified several factors; however, research on the use of serum-based inflammatory markers as prognostic tools for predicting radiation-induced secondary malignancies is limited. Investigating the potential of serum-based inflammation prognostic scores could provide a minimally invasive and affordable method for the early prediction of secondary malignancies. Methods: We retrospectively analyzed a patient cohort with radiation-induced secondary malignancy from the electronic database MIMIC-IV to investigate whether a serum-based inflammatory marker score can serve as a predictive tool. Results: This study seeks not only to assess the efficacy of the risk score, but also to develop a clinical utility tool nomogram for predicting the occurrence of radiation-induced secondary cancers. A RISM of 4.28% was observed in a cohort from the MIMIC-IV database using SIRI-RT as a risk index, with the Charlson comorbidity index, chemotherapy, and creatinine levels as significant confounding risk factors. Conclusions: Our study suggests that elevated serum-based inflammation prognostic scores and the nomogram developed herein can be used to predict a greater likelihood of developing secondary malignancies following radiation therapy.

Fatigue, anxiety, and cognitive effects in neurosurgical patients: a prospective multicenter longitudinal study.

Existing studies on postoperative fatigue (POF) following neurosurgery are generally small, retrospective, and lack longitudinal data. Despite frequent associations with temporary cognitive impairment and mood disorders, the precise relationship remains unclear. This study investigated POF following neurosurgery and its association with anxiety, depression, and cognitive impairment. This prospective multicenter study enrolled patients undergoing elective or semi-elective cranial or spinal surgery at four centers. Assessments including the Fatigue Severity Scale (FSS), Christensen Fatigue Scale, visual analog scale for pain, Cognitive Failures Questionnaire (CFQ), and Hospital Anxiety and Depression Scale (HADS) were conducted preoperatively and 1 week, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Changes in scores over time were analyzed using random-effects models, while the relationship between FSS score and anxiety, depression, and CFQ scores was analyzed using linear regression. Baseline characteristics including antiepileptic drug use, Charlson Comorbidity Index, and complications were collected. From 2017 to 2022, 247 patients were recruited, with 182 (92 cranial, 90 spinal) patients included in the final analysis. Overall, 59% of cranial surgery patients experienced fatigue at baseline, with an average increase in FSS score of 0.46 (95% CI -0.12 to 0.72, p = 0.01) at 1 week compared with preoperatively. The FSS score reverted to baseline at 6 weeks. Of spinal surgery patients, 68% reported fatigue at baseline. They had no significant increase in FSS score postoperatively but demonstrated improvement by 6 weeks, which was sustained up to 12 months. Preoperative fatigue and depression predicted increased POF. Cranial surgery patients had worse depression at 1 week postoperatively before returning to baseline at 6 weeks. Depression in spinal surgery patients did not worsen postoperatively but rather improved from 6 weeks to 12 months. Anxiety improved in both cohorts postoperatively. CFQ scores improved at 1 and 6 weeks and then returned to preoperative levels in both cohorts. Elevated HADS scores (≥ 8) correlated with a 6-point higher CFQ score. Postoperative pain significantly influenced POF, anxiety, and depression, with POF associated with anxiety, depression, and cognitive impairment. Cranial surgery patients experienced transiently heightened POF at 1 week, reverting to baseline, while spinal surgery patients had improved POF from 6 weeks onward. Preoperative fatigue and depression predicted worse POF, which in turn was associated with increased anxiety, depression, and cognitive dysfunction. Postoperative pain also had a major influence on these symptoms.

Salvage robotic-assisted radical cystectomy is safe in patients with history of pelvic irradiation

Abstract Objectives To describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting of prior pelvic radiotherapy. Materials and methods We analyzed our prospective cystectomy database for patients who underwent robotic-assisted radical cystectomy for bladder cancer after radiotherapy between 2018 and 2022. Demographic information and data regarding preoperative factors including stage of disease, preoperative hydronephrosis, and history of pelvic radiotherapy were collected via review of electronic medical records. All operations were performed by 1 of 2 experienced urologists using the da Vinci X, Xi, or Si surgical platforms. Results Ten patients were identified for this study. The median age of participants was 73.5 years (range, 41–84 years). The median American society of anesthesiologists classification score was 3 (range, 3–4). The median Charlson Comorbidity Index was 6 (range, 2–12). Among the patients, 4 out of 10 patients (40%) had muscle invasive bladder cancer before salvage surgery. Intracorporeal ileal conduit urinary diversion was performed in 8 patients, whereas 2 patients underwent intracorporeal neobladder formation. Median intraoperative blood loss was 250 mL (range, 150–600 mL), and median operative duration was 390 minutes (range, 195–450 minutes). The overall 30-day complication rate was 60% with a Clavien-Dindo grade ≥3 complication rate of 15%. Perioperative mortality was 0%. Median duration of follow-up was 210 days (range, 60–1580 days). Conclusions This series describing the outcomes of salvage robotic-assisted radical cystectomy using total intracorporeal urinary diversion demonstrates the safety of this technique. Further studies with long-term follow-up, including oncological outcomes, are required to support the widespread adoption of this procedure.

Type 1 Diabetes/Hidradenitis Suppurativa Comorbidity—A Population-Based Study

Background: Type 1 diabetes (T1D) and hidradenitis suppurativa (HS) share several metabolic and inflammatory dysfunctions. Prior studies of the potential link between the diseases either lacked validated T1D diagnoses or established only an indirect association. This study sought to determine the odds of HS developing in patients with a validated diagnosis of T1D and to characterize the clinical features of HS/T1D comorbidity. Methods: A population-based nested case-control study was conducted including patients with HS and controls matched 5:1 for age, sex, and primary care clinic. T1D was diagnosed using a specialized algorithm, achieving 90% accuracy. Diagnostic validity was confirmed by diabetes specialists who manually reviewed a random subset of the files. Unadjusted and adjusted odds ratios (OR/aOR) were calculated to determine the odds of incident HS in patients with T1D. Results: The study included 10,919 patients with HS and 53,314 controls. A history of T1D was associated with an elevated odds of new-onset HS (OR 1.80 95% CI (1.30–2.40), p &lt; 0.001), even after adjusting for demographics and metabolic and autoimmune comorbidities (aORs &gt; 1.7, p &lt; 0.001). Patients with HS/T1D comorbidity had higher proportions of autoimmune conditions than patients with HS alone (p &lt; 0.001) and a higher mean Charlson Comorbidity Index score than both patients with HS alone (3.5 vs. 0.9, p &lt; 0.001) and T1D alone (3.5 vs. 2.2, p = 0.004). Conclusions: T1D is associated with higher odds of the subsequent development of HS. Awareness of HS/T1D comorbidity is recommended owing to the elevated burden of metabolic and autoimmune conditions.

Racial/Ethnic Disparities in Lung Cancer Surgery Outcomes in the USA

Background/Objectives: Sparse data exist identifying racial/ethnic outcome disparities among patients with lung cancer, specifically regarding healthcare utilization patterns, such as emergency department visits and outpatient follow-ups. We aimed to utilize our large, multicenter, and ethnically diverse integrated health system to assess for such disparities among patients undergoing pulmonary resections for lung cancer. Methods: The cohort comprised all patients undergoing pulmonary resections for lung cancer at our integrated health system from 1 January 2016 to 31 December 2020. Outcomes including the length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day overall mortality were compared by race/ethnicity. Multivariable logistic and linear models adjusted for age, sex, body mass index (BMI), Charlson Comorbidity Index scores, procedure approach, neighborhood deprivation index (NDI), cancer stage, receipt of adjuvant chemotherapy, and insurance. Results: Of the 645 included patients, non-Hispanic White patients tended to be older and live in the least deprived neighborhoods. Among each race/ethnicity, the percentage of patients insured by Medicaid was highest among Asian patients. On bivariate analysis, only the outcome of surgical outpatient appointments within 30 days had differing distributions by race/ethnicity with no other significant associations between race/ethnicity and other outcomes; however, multivariable analysis showed Asian patients having lower odds of 30d-ED (adjusted odds ratio 0.51; 95% CI 0.27–0.98) while those with Medicaid insurance had higher odds of 30d-ED (adjusted odds ratio 3.29; 95% CI 1.26–8.59). Conclusions: Despite parity across clinical outcomes, some patient encounter-related differences still exist within our system. To better understand racial/ethnic disparities in care, systems must track such disparities in addition to clinical outcomes.

ILD: Monozytenverhältnis als ergänzender Biomarker für die Prognose

Background: The ILD-GAP scoring system is known to be useful in predicting prognosis in patients with interstitial lung disease (ILD). An elevated monocyte count was associated with increased risks of IPF poor prognosis. We examined whether the ILD-GAP scoring system combined with the monocyte ratio (ILD-GAPM) is superior to the conventional ILD-GAP model in predicting ILD prognosis. Methods: In patients with ILD treated between April 2013 and April 2017, we were retrospectively assessed the relationships between baseline clinical parameters, including age, sex, Charlson Comorbidity Index score (CCIS), ILD diagnosis, blood biomarkers, pulmonary function test results, and disease outcomes. In ILD patients were included idiopathic pulmonary fibrosis (IPF), idiopathic nonspecific interstitial pneumonia (iNSIP), collagen vascular disease-related interstitial pneumonia (CVD-IP), chronic hypersensitivity pneumonitis (CHP), and unclassifiable ILD (UC-ILD). We also assessed the ability to predict prognosis was compared between the ILD-GAP and ILD-GAPM models. Results: A total of 179 patients (mean age, 73 years) were assessed. All of them were taken pulmonary function test, including percentage predicted diffusion capacity for carbon monoxide. ILD patients included 56 IPF cases, 112 iNSIP and CVD-IP cases, 6 CHP cases and 5 UC-ILD cases. ILD-GAPM provided a greater area under the receiver-operating characteristic curve (0.747) than ILD-GAP (0.710) for predicting 3-year ILD-related events. Furthermore, the log-rank test showed that the Kaplan-Meier curves in ILD-GAPM were significantly different by stage (P = 0.015), but not by stage in ILD-GAP (P = 0.074).

Propensity Score Matching Analysis on Risk Factors and Their Diagnostic Value of Frailty in Elderly Patients With Cerebral Infarction.

Cerebral infarction is an acute ischemic cerebrovascular disease; elderly patients with cerebral infarction often have frailty syndrome. Therefore, the aim of this study was to analyze the risk factors and their diagnostic value of frailty in elderly patients with cerebral infarction. In this retrospective cohort study, the medical records (from October 2017 to September 2020) of patients with cerebral infarction (n=395) were analyzed. According to different frailty statuses, patients were divided into the health group (n=166) and the prefrailty group (n=229). The diagnostic value of various parameters for the occurrence of pre-frailty was assessed by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). The risk factors were analyzed by single-factor and multi-factor analyses. Interleukin-6 (IL-6, P<0.001), C-reactive protein (CRP), prealbumin (PA, P<0.001), albumin (ALB, P<0.001), and brain natriuretic peptide (BNP, P<0.001) had higher diagnostic value for the occurrence of prefrailty in elderly patients with cerebral infarction. Single-factor and multi-factor analysis results revealed that the length of stay (LOS), comorbidity with nervous system diseases, high Charlson comorbidity index (CCI), high National Institute of Health stroke scale score, IL-6, BNP, ALB, PA, and creatine kinase might risk the factors for prefrailty occurrence (P<0.05). After the elimination of interference factors, LOS, high CCI, IL-6, and ALB were confirmed to be key risk factors for the occurrence of prefrailty (P<0.05). LOS, high CCI, IL-6, and ALB are the underlying risk factors for the occurrence of prefrailty in elderly patients with cerebral infarction, which provides a theoretical basis for clinical disease diagnosis.

A new framework for tailoring laparoscopic cholecystectomy: Integrating preoperative clinical factors with surgical difficulty based on the Tokyo Guidelines 2018.

The Tokyo Guidelines 2018 introduced the Surgical Difficulty Score (TGDS18) to assess laparoscopic cholecystectomy (LC) difficulty based on intraoperative findings. This study aimed to predict surgical difficulty preoperatively using clinical factors correlated with TGDS18. Of 369 LC cases for cholecystitis (Jan 2014-Jul 2024), 106 with operative video data were analyzed. Multivariate analysis of 69 with preoperative CT (≤14 days) evaluated the association between preoperative clinical findings and TGDS18 sub-scores (around the gallbladder, Calot's triangle, gallbladder bed, additional findings, unrelated to inflammation). TGDS18 was positively correlated with operative time, blood loss, and hospital stay (all p < .001). Patients undergoing subtotal cholecystectomy had higher TGDS18 scores (median 20, p < .001). Six preoperative findings strongly associated with TGDS18 sub-scores were identified: calcified stone in cystic duct, TG18 Grade ≥2, preoperative gallbladder drainage, urgent operation, pericholecystic inflammation, and age-adjusted Charlson comorbidity index ≥7. The rate of subtotal cholecystectomy increased with the number of findings linked to the "Calot's triangle" sub-score-cystic duct stone and TG18 Grade ≥2. (0% with no findings, 8% with one finding, and 23% with both, p = .009). Similarly, the risk of cholecystectomy requiring the posterior wall left can be predicted by the number of clinical findings related to the 'Gallbladder bed' sub-score (p = .009). The clinical findings linked to TGDS18 allow tailored preoperative strategies for acute cholecystitis.

Prevalence of Popliteal Artery Variants in Free Tissue Transfer for Limb Salvage: A 12-Year Vasculoplastic Experience.

Popliteal artery variants (PAVs) are anatomical deviations of the popliteal artery's branching pattern and should be considered in microsurgical planning for patients undergoing lower extremity (LE) free tissue transfer (FTT). However, there is a significant lack of FTT literature in this patient population. Thus, this study presents our 12-year experience with LE FTT in patients with PAV.Patients receiving LE FTT reconstruction from July 2011 to March 2024 were reviewed. Preoperative angiograms were reviewed by a single vascular surgeon, and the presence of PAV was identified and classified as IIIA, IIIB, or IIIC. Primary outcomes were flap success and limb salvage.A total of 339 LE FTT were performed in 331 patients. A total of 32 patients (9.4%) had PAV, accounting for a total of 34 LE FTT. Class IIIA was the most common category (n = 20, 58.8%) followed by IIIB (n = 8, 23.5%) and IIIC (n = 6, 11.7%). Median age and body mass index were 63.5 (interquartile range [IQR]: 22.5) years and 27.4 (IQR: 10.3) kg/m2. The median Charlson Comorbidity Index was 5 (IQR: 2.5), with prevalent rates of diabetes (n = 18/32, 56.3%) and peripheral artery disease (n = 16/32, 50.0%). Median wound area was 71.0 (IQR: 80.0) cm2. Flap success rate was 100% (n = 34/34). At a median follow-up of 12.8 (IQR: 22.6) months, limb salvage was 97.1% (n = 33/34) and mortality was 6.3% (n = 2/32).In this large population of LE FTT, PAV occurs in almost 1 out of 10 patients. Essential to flap success and limb salvage is appropriate preoperative vascular imaging with arteriography, as the presence of PAV changes microsurgical intraoperative planning and technical considerations.

Validation of CHADS2 and CHA2DS2, and CCI scores for predicting mortality in hemodialysis patients: A retrospective study from a resource-limited setting

Background: Limited tools are available to predict the mortality outcome in chronic kidney disease (CKD) patients. Recently, the Charlson Comorbidity Index (CCI), CHADS2, and CHA2DS2 scores were used to evaluate mortality among these patients. However, the effectiveness of these scoring systems for predicting mortality in hemodialysis (HD) patients remains unclear, and comparative data are limited. This study aimed to assess the utility of the CHADS2, CHA2DS2, and CCI scores in predicting mortality among HD patients in a resource-limited setting. Patients and Methods: This retrospective study, conducted from March 2018 to September 2023, included 447 HD patients from the Nephrology Center of Al-Thora General Hospital in Yemen. The Kaplan–Meier and log-rank tests were used to evaluate and compare survival curves, and the proportional Cox hazard model was used to investigate the factors associated with mortality. CCI, CHADS2, and CHA2DS2 scores were calculated for each patient and categorized into three groups based on their scores: 0–1, 2–3, and &gt;4. The correlation between these scores and mortality was analyzed using receiver operating characteristic (ROC) curves and multivariate analysis. Results: The mean age of the patients was 48.9 ± 16.3 years, with 73 (16.3%) over the age of 65 and 21 (4.7%) over the age of 74. Among the cohort, 258 (57.7%) were male, and 189 (42.3%) were female, with the majority (n = 393, 87.9%) residing in Ibb city. The mean follow-up duration was 40.2 ± 13.7 months, and 97 patients (22%) had died by the end of the study. The median survival duration was 48 months, with 1-, 3-, and 5-year survival rates of 94%, 82%, and 69%, respectively. The mean scores for CHA2DS2, CHADS2, and CCI were 2.50 ± 1.45, 1.63 ± 1.03, and 3.98 ± 3.73, respectively. On multivariate analysis, residence outside Ibb city (HR: 0.38; 95% CI: 0.19–0.79, p = 0.009), positive HBV infection (HR: 3.46; 95% CI: 2.10–5.71, p &lt; 0.001), history of diabetes mellitus (HR: 12.47; 95% CI: 2.86–54.27, p = 0.001), and history of the rheumatologic disease (HR: 518.05; 95% CI: 117.10–2291.84, p &lt; 0.001) were the predictors of all-cause mortality. The areas under the ROC curve (AUC) for CCI, CHA2DS2, and CHADS2 scores were 0.991 (95% CI: 0.977–0.9), 0.829 (95% CI: 0.791–0.863), and 0.737 (95% CI: 0.694–0.777), respectively, indicating high predictive value for the CCI score (sensitivity: 100%, specificity: 93.4%), moderate predictive value for CHA2DS2 (sensitivity: 82.47%, specificity: 74.57%), and low predictive value for CHADS2 (sensitivity: 51.55%, specificity: 93.71%). Conclusion: Our findings suggest that CCI, CHADS2, and CHA2DS2 scores can help predict mortality in newly admitted HD patients. Furthermore, factors such as residence outside Ibb city, positive HBV infection, history of diabetes mellitus, and history of rheumatologic disease, were the predictors of all-cause mortality in these patients.