Significant Clinical Differences Research Articles

Recovery quality of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery: A randomized trial

Study objectiveThis study aimed to investigate the effect of liposomal bupivacaine in transversus abdominis plane block (TAP) on recovery quality after cesarean delivery. DesignA randomized trial. SettingAn operating room, a post-anesthesia care unit, and a hospital ward. PatientsA total of 147 women scheduled for cesarean delivery under spinal anesthesia were enrolled and randomized to receive a TAP block with plain bupivacaine (bupivacaine group), liposomal bupivacaine (liposomal group), or a mixture of plain bupivacaine and liposomal bupivacaine (mixture group). InterventionsThe bupivacaine group received bilateral TAP blocks with plain bupivacaine 50 mg alone. The liposomal group received bilateral TAP blocks with liposomal bupivacaine 266 mg alone. The mixture group received bilateral TAP blocks with plain bupivacaine 50 mg followed by liposomal bupivacaine 266 mg. MeasurementsThe primary outcome was the Quality of Recovery−15 (QoR − 15) score assessed 24 h postoperatively. Secondary outcomes encompassed the QoR − 15 score at 48 h post-surgery, the VAS pain score at rest and with movement at 24, 48, and 72 h postoperatively, opioid consumption within the 0–24 h and 24–48 h periods following surgery, as well as patient's satisfaction with analgesic. Main resultsThe QoR − 15 score at 24 h postoperatively was significantly higher in both the liposomal group and the mixture group compared to the bupivacaine group. Specifically, the QoR − 15 score for the liposomal group versus the bupivacaine group (median [IQR]: 120 [107, 128] vs. 109 [104, 120]; median difference, 7; 95 % CI, 2 to 13; P = 0.011) and for the mixture group versus the bupivacaine group (median [IQR]: 122 [112, 128] vs. 109 [104, 120]; median difference, 9; 95 % CI, 4 to 14; P = 0.001). The QoR − 15 score in both the liposomal group and the mixture group were also higher than those in the bupivacaine group at 48 h postoperatively, though the difference was not clinically meaningful. Additionally, both the liposomal and mixture groups exhibited lower pain score at 24 h and 48 h postoperatively compared to the bupivacaine group, but no significant clinical differences were achieved in either pain scores or opioid consumption. Patients in both the liposomal and mixture groups reported higher satisfaction score with analgesia than those in the bupivacaine group. ConclusionsTAP block using either liposomal bupivacaine or a mixture of plain bupivacaine and liposomal bupivacaine provided superior quality of recovery at 24 h after cesarean delivery compared to using plain bupivacaine alone.

Association of rare variants in RNF213 with severe progression of intracranial artery stenosis in quasi-moyamoya disease.

The genetic basis underlying the pathophysiology of quasi-moyamoya disease (qMMD) is unclear. Herein, the authors aimed to comprehensively analyze genetic variants in qMMD and investigate their association with clinical phenotypes, focusing on RNF213 and other moyamoya angiopathy (MMA)-related genes. The authors evaluated 14 consecutive cases of qMMD, whose underlying conditions included autoimmune disease, head irradiation, meningitis/pachymeningitis, and Turner syndrome, and 9 cases of hyperthyroidism-associated MMD (hMMD). The frequencies of RNF213 p.Arg4810Lys in qMMD and hMMD were each compared to those in healthy controls and in patients with MMD. Whole-exome sequencing was performed, and rare variants (RVs) or damaging variants were analyzed in RNF213 and 36 MMA-related genes. The frequencies of p.Arg4810Lys were significantly higher in patients with qMMD (28.6%) and hMMD (33.3%) than in controls (1.1%; p < 0.001) and lower in the two former groups than in the MMD group (67.6%; p = 0.003 and 0.065, respectively). In qMMD, no significant clinical differences were observed based on the presence of p.Arg4810Lys. A novel RNF213 RV was identified in four cases with qMMD. These same cases also presented with significant worsening of intracranial main artery stenosis, which suggests a possible association between RNF213 RVs and the severe progression of qMMD. Among the 36 MMA-related genes, no variants correlated with specific phenotypes. While the clinical implications of p.Arg4810Lys in cases with qMMD were not identified, the study findings suggest a potential association between RNF213 RVs and the significant progression of intracranial artery stenosis. Genetic analysis should not focus solely on p.Arg4810Lys but instead consider a comprehensive analysis of RNF213 for more accurate clinical prognostication of qMMD.

Comparative clinical and radiographic results of three fixation systems for transverse subcapital osteotomy in treating hallux valgus

Objective: Compare three fixation models for Bosch osteotomy both clinically and radiographically.Methods: A retrospective comparative study was conducted on patients surgically treated for hallux valgus using Bosch osteotomywith three different fixation systems. The first group was treated with a temporary pin for three weeks; the second, received thesame pin plus a screw; and the third, used two screws without a pin. Radiographic analysis included the intermetatarsal angle,metatarsophalangeal angle, percentage of lateral shifting of the metatarsal head, dorsal or plantar migration of the metatarsal head,and consolidation time. Clinical evaluation was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale.Complications during follow-up were recorded.Results: Twenty hallux valgus were included in each group. No significant differences were found in radiographic evaluations amonggroups in the preoperative and final follow-up, except that the third group showed less loss of correction. There were no significantdifferences in consolidation times. Clinical improvements were observed in all three fixation systems, with no significant differencesamong them according to the AOFAS scale.Conclusion: No significant clinical or radiographic differences were observed among the three fixation systems, except that the groupusing two screws showed less loss of correction. Level of evidence IV; Therapeutic studies; Case series.

Weekly Vitamin D Supplementation to Prevent Acute Respiratory Infections in Young Children at Different Latitudes: A Randomized Controlled Trial

To evaluate the effectiveness of weekly vitamin D supplementation in reducing the number of acute respiratory infections (ARI) in preschool children. Randomized, double-blind, placebo-controlled trial in 303 children aged 1.5-3.5years from 2014 to 2105 in 3 Chilean cities at different latitudes: Santiago (33°S, n=101), Talcahuano (37°S, n=103), and Punta Arenas (53°S, n=99). Participants were allocated (1:1:1) to receive placebo, cholecalciferol (vitamin D3 (VD3)) 5600 IU/week (low-dose), or 11 200 IU/week (high-dose) for 6months. Primary outcome was parent-reported number of ARI; secondary outcomes included number of ARI hospitalizations, change of serum 25-hydroxyvitamin D (25(OH)D) and LL-37/cathelicidin levels, and adverse events. The mean age of participants was 26±6months; 45% were female. Baseline 25(OH)D was 24.9±6.1ng/ml, with 23% having 25(OH)D<20ng/ml. No significant baseline clinical or laboratory differences were observed among groups. Overall, 64% (n=194) completed study participation, without baseline differences between subjects lost to follow-up vs those completing participation or differences in completion rates across groups. After 6months, a dose-dependent increase in serum 25(OH)D was observed from the VD3 intervention (P<.001), with a higher proportion of subjects ending the trial with 25(OH)D<20ng/ml in the placebo group (30.8%) vs the low-dose (7.4%) and high-dose groups (5.1%). However, no group differences were observed in number of ARI (P=.85), ARI hospitalizations (P=.20), LL-37/cathelicidin change (P=.30), or adverse events (P=.41). While weekly VD3 supplementation, in doses equivalent to 800 IU and 1600 IU daily, was associated with improved 25(OH)D levels in preschoolers, we did not find a reduced number of ARI in this sample.

Prevalence and clinicopathological features of primary age-related tauopathy (PART): A large forensic autopsy study.

Primary age-related tauopathy (PART), often regarded as a minimally symptomatic pathology of old age, lacks comprehensive cohorts across various age groups. We examined PART prevalence and clinicopathologic features in 1589 forensic autopsy cases (≥40 years old, mean age±SD 70.2±14.2 years). PART cases meeting criteria for argyrophilic grain diseases (AGD) were AGD+PART (n=181). The remaining PART cases (n=719, 45.2%) were classified as comorbid conditions (PART-C, n=90) or no comorbid conditions (pure PART, n=629). Compared to controls (n=208), Alzheimer's disease (n=133), and AGD+PART, PART prevalence peaked in the individuals in their 60s (65.5%) and declined in the 80s (21.5%). No significant clinical background differences were found (excluding controls). However, PART-C in patients inclusive of age 80 had a higher suicide rate than pure PART (p<0.05), and AGD+PART showed more dementia (p<0.01) and suicide (p<0.05) than pure PART. Our results advocate a reevaluation of the PART concept and its diagnostic criteria. We investigated 1589 forensic autopsy cases to investigate the features of primary age-related tauopathy (PART). PART peaked in people in their 60s in our study. Many PART cases over 80s had comorbid pathologies in addition to neurofibrillary tangles pathology. Argyrophilic grain disease and Lewy pathology significantly affected dementia and suicide rates in PART. Our results suggest that the diagnostic criteria of PART need to be reconsidered.

Proteomic landscape profiling of primary prostate cancer reveals a 16-protein panel for prognosis prediction

Prostate cancer (PCa) is the most common malignant tumor in men. Currently, there are few prognosis indicators for predicting PCa outcomes and guiding treatments. Here, we perform comprehensive proteomic profiling of 918 tissue specimens from 306 Chinese patients with PCa using data-independent acquisition mass spectrometry (DIA-MS). We identify over 10,000 proteins and define three molecular subtypes of PCa with significant clinical and proteomic differences. We develop a 16-protein panel that effectively predicts biochemical recurrence (BCR) for patients with PCa, which is validated in six published datasets andone additional 99-biopsy-sample cohort by targeted proteomics. Interestingly, this 16-protein panel effectively predicts BCR across different International Society of Urological Pathology (ISUP) grades and pathological stages and outperforms the D'Amico risk classification system in BCR prediction. Furthermore, double knockout of NUDT5 and SEPTIN8, two components from the 16-protein panel, significantly suppresses the PCa cells to proliferate, invade, and migrate, suggesting the combination of NUDT5 and SEPTIN8 may provide new approaches for PCa treatment.

Comparative Analysis of Demographic Characteristics, Management, and Outcomes in Primary Versus Secondary Spontaneous Pneumothorax.

This study aimed to explore the differences between primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) in demographic and clinical features, management trends, and outcomes, alongside assessing recurrence risk factors in spontaneous pneumothorax (SP) patients. This retrospective cohort study at New Damietta Hospital, Al-Azhar University, examined data from adults diagnosed with SP, differentiating between PSP and SSP types based on clinical and radiological criteria, to analyze demographics, clinical characteristics, management strategies, and outcomes. In a study of 170 patients, 42.94% were diagnosed with PSP and 57.06% with SSP, showing significant differences in age distribution (P=0.042) and smoking habits (P<0.001 for both tobacco and cannabis). Management approaches varied, with conservative methods more common in PSP (15.07%) and surgical interventions following intercostal tube (ICT) drainage significantly higher in SSP (40.21%, P=0.001). Length of hospital stay (LOS) and recurrence rates were significantly higher in SSP than PSP (P<0.001 for LOS; P=0.001 for recurrence), with postoperative complications and in-hospital mortality occurring exclusively in SSP (P=0.054 for complications, P<0.001 for mortality). Risk factors for recurrence included older age, presence of blebs/bullae (P<0.001), and lower hemoglobin and hematocrit levels (P=0.009 and P=0.008, respectively), with thoracic drainage duration longer in recurrent cases (P=0.008). Smoking status significantly impacted recurrence risk, with current smokers showing a higher risk compared to never-smokers (P=0.012). This study highlights significant demographic, clinical, and management differences between primary and secondary spontaneous pneumothorax, underscoring the importance of tailored treatment strategies to improve patient outcomes. Key findings include the impact of smoking status on recurrence risk and the necessity for individualized management plans, especially in SSP patients who exhibit higher rates of recurrence, longer hospital stays, and greater morbidity.

Fall Risk Screening in Older Adult Patients on Chronic Opioid Therapy: A Quality Improvement Project.

Many older adults prescribed opioid pain medications may be at increased risk of falls. As a quality improvement (QI) initiative, the University of Utah Sugar House clinic initiated a 9-month fall risk screening pilot for older adult patients on chronic opioids. This QI project sought to determine the feasibility of adding screening to a busy clinical practice, examine risk of falls in this patient cohort, and examine whether there were significant clinical and demographic differences between the patients who did or did not receive screening. We observed whether conventionally understood fall risk factors, including higher opioid doses, concurrent benzodiazepine prescription, and age, correlate with high fall risk. After the screening initiative, we determined that it was possible to significantly increase fall risk screening rates with prompts in Electronic Health Record (EHR). This cohort's fall risk screening increased from 18% to 33%. In the patients who were screened, 43% were found to be at high risk of falls. We did not see a correlation with high fall risk and patients taking higher doses of opioids or concurrent benzodiazepine prescriptions. These findings emphasize the need for consistent screening in primary care because review of the medication list alone is not a reliable predictor of fall risk.

Psychogenic non-epileptic seizures in individuals with intellectual disability/borderline cognitive function: Characterization through a comparison study

PurposeWe set out to characterize psychogenic non-epileptic seizures (PNES) in individuals with either intellectual disability (ID) or borderline intellectual function (BIF) in comparison to those with normal cognitive function. We aimed to identify differences between the two groups to improve clinical management protocols. MethodsWe conducted a retrospective, observational, single-center study. The medical records of individuals (aged ≥ 14 years) diagnosed with PNES, confirmed through video-electroencephalography (vEEG) at a specialized epilepsy center between January 2008 and December 2021, were reviewed. We restricted our study to individuals who underwent comprehensive neuropsychological evaluations. Furthermore, demographic, clinical, and neuropsychological data with potential prognostic indicators, alongside the reevaluation of vEEG recordings were studied. We compared two study groups based on intelligence quotient (IQ): individuals without ID (IQ≥85; n = 25) and those with either mild ID or BIF (n = 25). ResultsNo statistically significant clinical differences were observed between the two groups. Individuals with mild ID/BIF didn't show a longer diagnostic delay, and the prescription of inappropriate antiseizure medications (ASMs) was comparable in both cohorts. Most individuals with mild ID/BIF were treated with behavioral psychotherapeutic approaches with similar outcomes in both subgroups. ConclusionsIndividuals with mild ID/BIF and PNES don't differ in clinical management. Demographic and clinical data, as well as semiology, were comparable to those of individuals with normal cognitive function. Cognitive behavioral therapy (CBT) appears to be an effective treatment approach for individuals with and without mild ID/BIF. Further studies are needed to validate and ascertain their possible applicability in individuals with moderate/severe ID.

Primary central nervous system vasculitis with intracranial aneurysm

BackgroundUnruptured intracranial aneurysms (UIAs) are rarely reported in primary central nervous system vasculitis (PCNSV). In this study we described the clinical findings, response to therapy, and outcomes of UIA in a large cohort of PCNSV patients. MethodsWe retrospectively studied 216 consecutive patients with PCNSV, selected by predetermined diagnostic criteria, who were seen during a 40-year period. UIAs were identified on cerebral angiography. The clinical, laboratory, radiologic and pathologic findings, management, and outcomes of patients with UIA were described and compared with those without UIA. Results12/216 (5.5 %) PCNSV patients had at least one UIA. Two patients underwent biopsies; one yielded negative results, while the other showed necrotizing vasculitis. Eleven patients had evidence of UIA on angiogram at diagnosis. One patient developed an aneurysm during the follow-up associated with a worsening of vasculitic radiological findings. The most common presenting symptom for PCNSV in the setting of UIA was headache (67 %), followed by persistent neurologic deficit or stroke (50 %). Most patients with UIA presented with multiple cerebral infarcts on MRI (67 %), one patient had subarachnoid hemorrhage, and one left parieto-occipital intracerebral hematoma, both unrelated to the aneurysm. Black blood imaging was performed in 4 patients and 2 showed segmental circumferential mural enhancement involving multiple vessels. Two patients had 2 UIAs, while the other 10 had 1. The most frequent UIA location was internal carotid artery (50 %), followed by anterior cerebral artery (21 %). Ten of the UIAs were < 5 mm in diameter, and 3 were 5–7 mm in diameter; the size was not available for one. All UIAs were unchanged in size and configuration during follow-up (median: 18.5 months; range 1–151 months) and no new aneurysms were detected. Compared to the 204 patients with PCNSV without a UIA, no significant clinical differences were observed, except for a reduced disability at last follow-up (p = 0.038). ConclusionsUIAs uncommonly occur in PCNSV.

Impact of the IDEA Collaboration Study on Real-World Practice Patterns of Adjuvant Chemotherapy in Patients With Stage III Colon Cancer: A Population-Based Study.

The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration showed no significant clinical difference in outcomes in patients with stage III colon cancer (CC) treated with 3 versus 6 months of oxaliplatin-based adjuvant chemotherapy (O-ACT). We aimed to assess change in real-world practice patterns before and after publication of the IDEA study. This retrospective cohort study included patients age ≥18 years with stage III CC diagnosed between January 1, 2012, and December 31, 2020. Eligible patients received >1 dose of ACT between March 20, 2012, and May 10, 2021 inclusive. They were categorized into pre-IDEA (diagnosed before March 31, 2018) and post-IDEA (diagnosed on or after April 1, 2018) groups. The primary outcome was the median duration and type of ACT and factors associated with a shorter duration. Secondary outcomes were 2-year overall survival (OS) and cancer-specific survival (CSS). In total, 740 patients were included (median age, 64 years, range, 27-90; 52.7% male). 48.8% had pT4 and/or pN2 disease. 77% received O-ACT. In the post-IDEA era, capecitabine plus oxaliplatin (CAPOX) ACT use increased (22.8%-50.7%, P < .001), and median duration of treatment was significantly shorter (2.7 v 4.8 months, P < .001). Factors associated with shorter O-ACT duration included diagnosis in the post-IDEA era (odds ratio, 2.08, P = .002), absence of pT4 and/or pN2 disease (hazard ratio [HR], 1.71, P = .01), and receipt of CAPOX (HR, 2.58, P < .001). Two-year OS and CSS were comparable between pre- and post-IDEA eras (OS 95% v 94%; CSS 96% v 96%). Our study shows that the results of the IDEA trial have been largely adopted in clinical practice with shorter duration of ACT in low-risk stage III CC.

Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks.

Nonfatal suicidality is the most robust predictor of suicide death. However, only ~10% of those who survive an attempt go on to die by suicide. Moreover, ~50% of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of risks leading to suicide death. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidality (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB.

Kinesio Taping as an alternative therapy for limited mandibular mobility with pain in female patients with temporomandibular disorders: A randomized controlled trial.

Kinesio Taping (KT) is a non-invasive therapy commonly used in physiotherapy (PT). However, the available data on its effectiveness in patients with symptomatic temporomandibular disorders (TMD) remains scarce and contradictory. The aim of the study was to evaluate the analgesic and myorelaxant effects of KT in TMD patients with limited mandibular mobility. A single-blind randomized controlled trial was conducted among female patients aged 20-45 years with Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) group Ib, using a parallel group design and equal randomization (1:1). All patients underwent surface electromyography (sEMG) of the masseter muscle (MAS), pain intensity was assessed using a Numeric Rating Scale (NRS), and temporomandibular joint mobility was measured before and after 6 and 12 days of treatment. The Perceived Stress Scale (PSS-10) questionnaire was administered on the first and last days of treatment. Statistical analysis was performed using analysis of variance (ANOVA). Mauchly's sphericity test determined changes over time and between groups for variables with a normal distribution. Bonferroni's correction was used for post hoc multiple comparisons. Variables with a non-normal distribution were analyzed using the nparLD package and multiple comparison post hoc test, while correlations were assessed using Spearman's coefficient. Each treatment had a significant effect on the bioelectrical sEMG parameters (p = 0.05). Kinesio Taping had a superior analgesic effect compared to the controls (p < 0.001). The combination of KT with therapeutic exercise (TE) proved to be a more effective therapy for improving the maximal mouth opening (MMO) and reducing perceived stress than monotherapy (p < 0.001). Minimally significant clinical differences were observed for sEMG, MMO and PSS-10 parameters after both therapies. Kinesio Taping combined with TE may be considered an effective complementary noninvasive treatment modality for TMD, either as a stand-alone or as part of the therapeutic process in patients experiencing pain and limited mandibular ROM. Additionally, the use of KT and TE was found to have a beneficial effect on perceived stress levels.

Multiple telescopic stenting versus single flow diverter for the treatment of vertebral artery dissecting aneurysm.

Reconstruction methods, including stent-assisted coiling, multiple telescopic stents, and flow diverters, are preferred modalities for the treatment of unruptured vertebral artery dissecting aneurysms (VADAs). We aimed to compare the clinical outcomes between two reconstructive flow diversion techniques: single flow diverter (FD) device and multiple telescopic stenting (TS). We retrospectively reviewed the clinical data of 39 patients with unruptured VADAs. Of these, 17 patients were treated with multiple TS and 22 with a single FD device. Aneurysm characteristics and clinical outcomes were compared between the two groups. All aneurysms included in this study successfully achieved flow diversion, regardless of the treatment modality and duration. However, the mean procedure duration to complete the diversion was shorter in the FD group. Subgroup analysis in TS group showed that there were no significant clinical differences between the low-profile visualized intraluminal support and Enterprise stents, except for the mean procedure duration. Both the single FD and multiple TS methods showed excellent angiographic and clinical outcomes in the treatment of unruptured VADAs. However, single FD required a shorter procedure duration and was associated with faster achievement of complete flow diversion.

Differential genomic profiling of the progesterone receptor (PR) negative and estrogen receptor (ER) low metastatic breast cancer subtypes through circulating tumor DNA: A TNBC-like disease subtype?

1039 Background: ER positive/HER2 negative metastatic breast cancer (MBC) is typically regarded as a single entity, although significant clinical differences are often observed, especially in the ER low subgroup (ER&lt;10% regardless of PR status). This study aims to investigate genomic differences among HER2 negative subtypes (i.e., ERlow, PRpos [ER &gt;10%/PRpositve], PRneg [ER &gt;10%/PRnegative], triple negative [TNBC]) through circulating tumor DNA (ctDNA) next-generation sequencing (NGS). Methods: The study analyzed a retrospective cohort of 879 patients (pts) with HER2 negative MBC with ctDNA testing using the Guardant360 NGS panel within a large multicenter academic consortium. ER, PR and HER2 status was defined based on the most updated biopsy. Associations across single nucleotide and copy number variations (SNVs and CNVs) and ER/PR status were tested by multinomial logistic regression in terms of Relative Risk Ratio (RRR), adjusting for significant clinical characteristics (i.e., lines of treatment, metastatic sites, histology). Oncogenic pathway was defined based on reference (1). Prognosis was analyzed through Cox regression for overall survival (OS) defined from time of ctDNA collection. Results: Among the 879 analyzed pts, PRpos was the most prevalent subtype (N:420, 48%), followed by PRneg (N:216, 24%), TNBC (N:209, 24%), and ERlow (N:34, 4%). Compared to PRpos, lobular MBC was less common in TNBC (RRR: 0.33, P=0.001), while lung involvement was more frequent in TNBC (RRR: 1.53, P=0.019), and liver involvement in PRneg (RRR: 1.44, P=0.035). In contrast, bone metastases were less common in TNBC and ERlow (RRR: 0.26, P&lt;0.001 and RRR: 0.45, P=0.03, respectively). After multivariable analysis, ERlow and TNBC were associated with a higher incidence of TP53 SNVs (RRR: 5.42, P&lt;0.001 and RRR: 3.08, P=0.007, respectively) and a lower incidence of ESR1 SNVs (RRR: 0.23, P=0.025 and not detected, respectively). TNBC exhibited significantly fewer PIK3CA SNVs (RRR: 0.41, P=0.005) and CCND1 CNVs (RRR: 0.20, P=0.009), along with a higher frequency of CCNE1 CNVs (RRR: 6.47, P&lt;0.001). PRneg had a lower incidence of ESR1 SNVs (RRR: 0.52, P=0.013) and more frequent FGFR1 CNVs (RRR: 2.61, P=0.004). Similar results were observed across oncogenic pathways. Compared to PRpos, OS analysis indicated poorer outcomes across all subgroups (PRneg HR: 1.29 P = 0.035, TNBC HR: 1.96 P&lt;0.001, ERlow HR: 2.32 P&lt;0.001). Conclusions: This study highlights several clinical and molecular similarities between TNBC and ERlow MBC, while suggesting specific endocrine resistance mechanisms in PRneg that are less reliant on ESR1 and more exposed to alternative mechanisms such as FGFR1 amplification. These findings underscore the importance of more precise disease subtyping to inform future drug development trials. 1. Sanchez-Vega F et al, Cell. 2018.

GET-UP Trial 1-year results: long-term impact of an early mobilization protocol on functional performance after surgery for chronic subdural hematoma.

Evidence on timing for mobilization after chronic subdural hematoma (cSDH) surgery is heterogeneous, and practices differ considerably among neurosurgical centers. The Impact of an Early Out-of-Bed Paradigm in Postoperative Outcomes of Chronic Subdural Hematomas: GET-UP Randomized Prospective Trial (GET-UP Trial) is a randomized clinical trial comparing a postoperative early mobilization protocol to bed rest. Previously reported results at clinical discharge and 1 month after surgery indicated a decreased risk of medical complications in the early mobilization group. Herein, the authors report outcomes at the 1-year follow-up. The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. Between January 2019 and August 2021, a total of 208 patients were recruited and randomized to either an early mobilization group, in which patients began elevation of the head of the bed within the first 12 hours after surgery, or to a bed rest group, in which patients remained recumbent for 48 hours. Outcomes assessed at the 1-year follow-up included functional status as measured by the Glasgow Outcome Scale-Extended (GOSE) and repeat surgery for hematoma recurrence (surgical recurrence). A total of 203 patients completed 1 year of follow-up: 101 in the bed rest group and 102 in the early mobilization group. No significant baseline pre-randomization clinical differences were observed between the two management groups. At 1 year after surgery, a favorable functional outcome, defined as a GOSE score ≥ 5, was observed in 59 patients (58.4%) in the bed rest group and 78 (76.5%) in the early mobilization group (p = 0.006). Death occurred in 25 patients (24.8%) in the bed rest group and 16 (15.7%) in the early mobilization group (p = 0.108). Surgical recurrence was noted in 6 patients (5.9%) in the bed rest group and 7 (6.9%) in the early mobilization group (p = 0.788). Multivariate analysis showed an independent association between early mobilization and an increase in favorable functional outcomes (OR 2.006, 95% CI 1.076-3.739, p = 0.028). The GET-UP Trial is the first randomized clinical trial assessing the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Regarding functional results 1 year after surgery, early mobilization was associated with an improvement in functional outcomes without an increase in surgical recurrence. These findings support the preference for an early mobilization protocol in cSDH patients over mandatory bed rest strategies.

Beyond the patella: Treatment of cam femoroacetabular impingement syndrome improves anterior knee pain

ObjectivesThis study aimed to investigate if there is a relationship between cam femoroacetabular impingement syndrome (cam-FAIS) and chronic anterior knee pain (AKP). MethodsThis is a pilot retrospective review of 12 AKP patients with no structural anomalies in the patellofemoral joint and no skeletal malalignment in the lower limbs. All the patients were resistant to proper conservative treatment for AKP (AKP-R). Subsequently, these patients developed pain in the ipsilateral hip several months later, and upon evaluation, were diagnosed with cam-FAIS. Arthroscopic femoral osteoplasty and labral repair were performed and clinical follow-up of hip and knee pain and function (Kujala Score and Non-arthritic Hip Score -NAHS-) was carried out. ResultsAll the patients showed improvement in the knee and hip pain scores with a statistically significant clinical difference in all of them at 69 months follow up (range: 18 to 115) except one patient without improvement in the groin VAS score post-operatively. Visual analogical scale (VAS) of knee pain improved from 6.3 (range: 5 to 8) to a postoperative 0.5 (range: 0 to 3.5), (p ​< ​0.001). The VAS of groin pain improved from 4.4 (range: 2 to 8) to a postoperative 0.9 (range: 0 to 3), (p ​< ​0.001). NAHS improved from a preoperative 67.9 (range: 28.7 to 100) to a postoperative 88 (range: 70 to 100), (p ​< ​0.015) and knee Kujala's score improved from a preoperative 48.7 (range: 22 to 71) to a postoperative 96 (range: 91 to 100), (p ​< ​0.001). ConclusionThis study's principal finding suggests an association between cam-FAIS and AKP-R in young patients who exhibit normal knee imaging and lower limbs skeletal alignment. Addressing cam-FAIS in these cases leads to resolution of both groin and knee pain, resulting in improved functional outcomes for both joints. Study designRetrospective cohort series with a single contemporaneous long-term follow-up. Level of EvidenceIV.

Computed Tomography and Dual-Energy X-Ray Asorptiometry body composition parameter harmonisation to universalise adipose tissue measurements in a population-based cross-sectional study.

To harmonise computed tomography (CT) and dual-energy x-ray absorptiometry (DXA) body composition measurements allowing easy conversion in longitudinal assessments and across cohorts to assess cardiometabolic risk and disease. Retrospective cross-sectional observational study from 1996 to 2008 included participants in the Pennington Center Longitudinal Study (PCLS) (N = 1967; 571 African American/1396 White). Anthropometrics, whole-body DXA and abdominal CT images were obtained. Multi-layer segmentation techniques (Analyze; Rochester, MN) quantified visceral adipose tissue (VAT). Clinical biomarkers were obtained from routine blood samples. Linear models were used to predict CT-VAT from DXA-VAT and examine the effects of traditional biomarkers on cross-sectional-VAT. Predicted CT-VAT was highly associated with measured CT-VAT using ordinary least square linear regression analysis and random forest models (R2 = 0.84; 0.94, respectively, p < .0001). Model stratification effects showed low variability between races and sexes. Overall, associations between measured CT-VAT and DXA-predicted CT-VAT were good (R2 > 0.7) or excellent (R2 > 0.8) and improved for all stratification groups except African American men using random forest models. The clinical effects on measured CT-VAT and DXA-VAT showed no significant clinical difference in the measured adipose tissue areas (mean difference = 0.22 cm2). Random forest modelling seamlessly predicts CT-VAT from measured DXA-VAT to a degree of accuracy that falls within the bounds of universally accepted standard error.

Video-based exergaming versus conventional rehabilitation on balance in pediatric brain tumor survivors: a randomized clinical trial

Balance problems are widely reported in Pediatric Brain Tumor Survivors (PBTS) due to tumor localization and the side effects of medical treatment. This study investigates the effects of conventional versus video-based games exercise training (exergaming) on balance in PBTS. The present study was a randomized controlled trial. The study included 23 PBTS who were randomized to a Video-Based balance exergaming Group (VBG) or Conventional balance exercise training Group (CG). In both groups, the interventions were targeted to the balance function and balance exercise training was administered twice a week for 8 weeks. VBG exercised using selected Nintendo Wii Fit Plus® balance games while CG received a specially designed balance training using conventional physiotherapy methods. The primary outcome was the balance tests (Timed Up and Go and Nintendo® Wii™ Center of Gravity: COG), and the secondary outcomes were the functional tests (10-m walking, 2-min walking, 5-step climb/descent/times), and disease effect test (PedsQL Brain Tumor Module). The outcomes were assessed before and after the intervention. At baseline, no significant clinical and outcome assessment differences existed between both groups except for COG (p = 0.0495). After training, overall scores for balance, functional, disease effect tests significantly improved in VBG (p < 0.05) while progress observed in CG was not significant (p > 0.05). Video-based balance exergaming was found effective and more so than conventional balance exercise training in PBTS. Greater effectiveness of exergaming is thought to be due to increased motivation and effort of the children who are more attracted to gaming than conventional exercising. Exergaming could be beneficial both in clinical and home settings with physiotherapist supervision and may reduce the costs of treatment while improving their health-related quality of life.

Performances of acute kidney injury biomarkers vary according to sex.

Before implementing individualized strategies to treat acute kidney injury (AKI), identifying clusters of patients with divergent pathophysiological mechanisms, diagnosis criteria or outcomes is of the utmost importance. Here we studied sex-related molecular mechanisms in cardiac bypass (CBP) surgery patients developing AKI. We compared the characteristics of 1170 patients referred for CBP surgery using multivariate logistic regression and propensity score-based analysis. Performances of the candidate urinary biomarkers at <4h post-surgery, urinary neutrophil gelatinase-associated lipocalin (uNGAL), [IGFBP7]·[TIMP-2] product (NephroCheck) and a recently developed AKI signature of 204 urinary peptides (AKI204) to predict AKI were compared in both sexes. Incidence (∼25%) and severity of AKI were similar in men and women, even after adjustment for the usual risk factors of AKI, including baseline estimated glomerular filtration rate, age, diabetes mellitus, length of CBP and red blood cell transfusion. However, at the molecular level, performances of uNGAL, NephroCheck and AKI204 to predict AKI strongly diverged between men and women. In the full cohort, as well as in subgroups of men and women, the multimarker AKI204 signature outperformed uNGAL and NephroCheck and predicted the development of AKI significantly better in women than in men. Analysis of AKI204 at the single-peptide level suggested divergences of AKI mechanisms between sexes due to increased kidney inflammation in women (increased abundance of urinary fragments of osteopontin and uromodulin). In patients referred for CBP surgery, significant clinical and biological differences between men and women as well as sexual dimorphism of AKI biomarker performances were identified. The urinary peptide signature points to sex-related molecular mechanisms underlying AKI.