Association of the visceral adiposity index with prediabetes remission to normoglycemia in middle-aged and older Chinese adults: a prospective cohort study.

Incidence of Carpal Tunnel Syndrome After the Diagnosis of Ulnar Neuropathy.

IntroductionThe Modified Early Warning Score (MEWS) is a validated tool for the early identification of deteriorating patients; however, its utility in resource-limited surgical settings remains underexplored.MethodsWe conducted a prospective cohort study of 121 adult surgical inpatients residing on general wards at Kamuzu Central Hospital in Lilongwe, Malawi. Critical illness was defined using the Modified Early Warning Score (MEWS), with a score ≥5 indicating critical illness. Data were collected on a single day through standardized bedside assessments and chart reviews, capturing demographic and clinical information. Patients were followed up at day 7 and day 30 to determine mortality outcomes.ResultsOf the 121 patients, 15 (12.4%) met critical illness criteria. The median age of critically ill patients was 50 years (IQR = 23-64). Most patients meeting critical illness criteria (86.7%, n = 13) were managed on general wards. At days 7 and 30, in-hospital mortality rates were 5.0% (n = 6) and 9.9% (n = 12), respectively. Mortality rates were significantly higher among critically ill patients compared to non-critically ill patients at days 7 and 30: 20.0% vs 2.8% (P = 0.004) and 33.3% vs 6.6% (P = 0.001), respectively. In multivariable logistic regression analysis, the MEWS was the only significant predictor of 30-day mortality (OR = 1.62, 95% CI: 1.11-2.38, P = 0.013), with mortality probability approaching 40% at an MEWS of 10.ConclusionThe MEWS effectively identified high-risk surgical inpatients in our setting. Integrating the MEWS into surgical practice may improve outcomes for critically ill surgical patients.

Drug-induced sleep endoscopy with positive airway pressure (DISE-PAP) is a novel technique that allows for both qualitative visualization and quantitative measurement of upper airway collapsibility in patients with OSA. We sought to determine whether neck circumference and body mass index (BMI) impact the degree of upper airway collapsibility during DISE-PAP as measured via pharyngeal opening pressure (PhOP) as well as whether either variable had a measured cutoff point in predicting complete concentric collapse. This was a retrospective, consecutive cohort study of adult sleep-surgery patients at a tertiary care center from July 2021 to September 2023. Inclusion criteria were adults greater than 18 years of age with OSA (AHI ≥ 5) and a history of CPAP intolerance. All patients underwent DISE-PAP and were analyzed via VOTE scoring. 97 patients were included for neck circumference and 264 patients were included for BMI analysis. On average, the cohort was middle-aged (51.1 ± 15.1 years), obese (BMI 30.3 ± 4.6 kg/m2), male (70.5%), White (64.8%), with moderate-severe OSA (AHI 33.3 ± 26.2). A mild positive correlation was observed between both neck circumference and BMI and PhOP (Spearman correlation coefficient (SCC) = 0.310, p = 0.002 and SCC 0.237, p = 0.0001, respectively). Both neck circumference and BMI were poor individual predictors of CCC in this population, with no cutoff yielding a clinically meaningful positive predictive value. Larger neck circumference and higher BMI are associated with increased collapsibility of the upper airway as quantified by PhOP. Regarding complete concentric collapse, both variables, individually and combined, demonstrate poor predictive value.

Elective neck irradiation does not improve regional control or survival in pT3-T4N0 oral cavity SCC after high-yield neck dissection: A retrospective multicenter analysis.

Background: Hepatocellular carcinoma (HCC) has a poor long-term prognosis due to high recurrence and cirrhosis-related mortality, even after potentially curative treatments such as liver transplantation (LT), surgical resection, or ablation. This study aimed to identify factors associated with ≥10-year survival in HCC patients. Methods: A retrospective cohort study was conducted among HCC patients diagnosed between 2004 and 2022 using the National Cancer Database. Multivariable Cox regression was used to identify predictors of overall survival, and logistic regression was used to identify predictors of ≥10-year survival. Results: Among 249,600 HCC patients, 177,585 (71.2%) died within 5 years, 8613 (3.5%) died at 5–10 years, 54,988 (22.0%) were alive with <10 years of follow-up, and 8219 (3.3%) survived ≥10 years. LT, resection, and ablation were performed in 6.6%, 9.3%, and 11% of patients, respectively. Compared with ablation as the reference group, LT [adjusted odds ratio (aOR) 11.96, 95% confidence interval (CI): 11.27–13.29] and resection (aOR: 2.83, 95% CI: 2.57–3.08) increased the odds of ≥10-year survival, while non-curative treatments reduced the odds compared with ablation (aOR: 0.50, 95% CI: 0.47–0.55). Cox regression results were consistent with the logistic model, confirming the association. Decision tree analysis confirmed LT as the dominant determinant of long-term survival. Black individuals were associated with lower odds of ≥10-year survival (aOR: 0.88, 95% CI: 0.820–0.96) and decreased likelihood of receiving LT (aOR: 0.73, 95% CI: 0.55–0.96). Conclusions: LT offers the best chance of ≥10-year survival in HCC. Ensuring equitable access is essential, especially for Black patients who have lower transplant rates and worse outcomes.

Low positive affect as a predictor of mortality in pulmonary arterial hypertension: A Taiwanese cohort study integrating psychological and clinical risk factors.

Long-Term Changes in Health-Related Quality of Life and Economic Burden After a SARS-CoV-2 Infection: Analysis of the Long COVID Prospective Cohort Study in Nairobi.

Innovation in magnetic resonance imaging (MRI) is often focused on achieving higher magnetic field strengths, allowing for increased sensitivity and image resolution. Although many clinical settings have access to 1.5 T or 3.0 T MRI systems, 7.0 T systems are becoming more common and human research magnets as high as 11.7 T are in use (Boulant et al. Nature Methods, 2024, 21, 2013–2016). However, higher field is not always better. For example, higher magnetic fields experience more significant variations (B0 and B1 field inhomogeneities) that can introduce image artefacts. High magnetic fields also come at a high price, with the rule of thumb that the price scales directly with the field strength. To increase accessibility and have a broader health impact, the use of low-field MRI systems is being investigated in clinical populations ranging from stroke (Bhat et al. Journal of Magnetic Resonance Imaging, 2021, 54, 372–390) to pregnancy (Aviles Verdera et al. Radiology, 2023, 309, e223050). In this issue of BJOG, Bansal et al. used a 0.55 T MRI to image the cervix in late gestation in 97 low-risk pregnancies as part of the MiBirth study. This prospective cohort study, run by a multidisciplinary team and a Patient and Public Involvement group, aimed to use a combination of imaging modalities (ultrasound, MRI) and relevant anatomy (uterus, cervix, pelvis, placenta and foetus) to predict the mode of birth. In this work, the authors assessed the feasibility of using low-field MRI to provide measurements of cervical remodelling. They found their image reconstruction and automated segmentation protocols were of good quality, with high inter-rater reliability for cervical length, volume, and internal and external os diameters. A larger cervical stroma volume during late gestation, suggesting failure to remodel, was associated with an increased risk of caesarean section. Although knowledge about the possible mode of delivery is important in preparation for the birth experience, there is still much work to be done to accurately predict adverse birth outcomes (e.g., preterm birth) using MRI. The potential benefits of this study are twofold. First, compared with ultrasound, MRI may be able to detect more subtle changes in cervical morphology and provide details of cervical microstructure and hydration (Oláh, BJOG, 1994, 101, 255–257). Second, low-field MRI has several advantages including reduced image artefacts, the potential for a larger bore size to accommodate pregnant individuals and a lower cost. With the rising price and uncertainty of cryogen availability (liquid nitrogen and liquid helium), another advantage of low-field MRI systems is that they do not require superconducting magnets and therefore can be cryogen-free. They may also be designed to be portable, allowing the system to be brought to the bedside and increasing accessibility to this advanced medical imaging modality. Future areas of research should include a longitudinal study design in a cohort at high risk for preterm birth. Almost 70% of the participants were White and imaged at one hospital. Future studies should focus on using low-field MRI in more diverse populations and settings. In tandem with clinical studies using low-field MRI systems, biomedical engineers and imaging physicists must continue to develop software and hardware solutions (e.g., denoising methods and low-noise electronics) to improve the image quality at low fields. This may usher in a new and exciting era of initial screening and monitoring during pregnancy using low-field MRI. The author takes full responsibility for this article. The author has nothing to report. The author declares no conflicts of interest. The author has nothing to report.

T1b gastric cancer, characterized by tumor invasion into the submucosa, presents a therapeutic dilemma regarding the need for adjuvant therapy owing to varying rates of lymph node metastasis (LNM). This study aimed to develop and validate comprehensive nomogram models for predicting LNM risk and long-term survival outcomes in patients with T1b gastric cancer. A retrospective cohort study was conducted on 362 patients with pathologically confirmed T1b gastric cancer who underwent radical gastrectomy with D2 lymph node dissection at a single institution between 2014 and 2024. Patients were stratified into LN+ (lymph node-positive) and LN- (lymph node-negative) groups. Multivariate logistic regression identified independent risk factors for LNM, while Cox proportional hazards models assessed prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Nomogram models were constructed and internally validated using bootstrap resampling. Among 362 patients, 92 (25.4%) had LNM. Independent predictors of LNM included tumor size ≥ 3 cm (odds ratio [OR] 2.84, 95% confidence interval [CI]: 1.62-4.98, p < 0.001), lymphovascular invasion (OR 4.21, 95% CI: 2.45-7.23, p < 0.001), poor differentiation (OR 3.12, 95% CI: 1.78-5.47, p < 0.001), and perineural invasion (OR 2.56, 95% CI: 1.23-5.32, p = 0.012). The LNM prediction nomogram showed excellent discrimination (area under the curve [AUC] 0.843, 95% CI: 0.801-0.885) and calibration. The integrated survival nomogram incorporating LNM risk demonstrated superior predictive performance for 5-year OS (C-index 0.782) compared with traditional staging (C-index 0.681). Decision curve analysis confirmed clinical utility across relevant threshold probabilities. Our validated nomogram models provide accurate individualized predictions for LNM risk and long-term survival in patients with T1b gastric cancer, potentially guiding personalized treatment decisions regarding adjuvant therapy and extent of lymphadenectomy.

Cross-Population Validation of the Pediatric CKD Risk-Prediction Tool.

Maternal cortisol may influence pregnancy outcomes, including preterm birth (PTB), though evidence remains inconsistent. To investigate the association between early pregnancy cortisol, perceived stress, and adverse pregnancy outcomes. A prospective cohort study. Of 432 multigravida women categorized by prior PTB history (high-risk vs. low-risk), 202 were analyzed who were at 11-13 gestational weeks with standardized afternoon saliva collection (14:00-18:00). Saliva samples and stress questionnaires were collected. Pregnancy outcomes were compared between women with high and low salivary cortisol levels. Mean salivary cortisol levels were compared between high- and low-risk groups, as well as between women with and without selected pregnancy complications. High-risk women had significantly higher mean cortisol (0.193 μg/dL vs. 0.144 μg/dL, p-value = 0.004). and 3.29-fold higher odds of elevated cortisol (aOR = 3.29, 95% CI: 1.55-6.96, p-value = 0.002). PTB rates were 21.4% in high-risk vs. 3.5%in low-risk women (p-value<0.001), high cortisol levels were not significantly predictive of current PTB in multivariable models (p-value = 0.099), despite high odds ratios (3.14). However, high cortisol levels were significantly associated with gestational hypertension (GHTN) (100% vs. 23.5%, p-value = 0.014) and fetal malformations (62.5% vs. 23.1%, p-value = 0.024). No association was found between perceived stress and cortisol levels. Early pregnancy cortisol is significantly elevated in women with a history of PTB, reflecting HPA axis dysregulation. While not a reliable predictor for recurrent PTB at 11-13 gestational weeks, high cortisol is associated with GHTN and malformations, suggesting it may serve as a marker for specific adverse outcomes.

Open Distal Phalanx Tuft Fractures in Fingertip Injuries: A Retrospective Cohort Study Comparing Kirschner Wire Fixation Versus Conservative Management.

To examine the association between debridement timing and infection, readmission, and reoperation in open upper-limb fractures. Retrospective cohort study. Academic Level 1 trauma center. All patients with open upper limb fractures involving the humerus (AO/OTA 1), radius or ulna (AO/OTA 2), scapula (AO/OTA 14), or clavicle (AO/OTA 15) treated at a single academic Level I trauma center between 2014 and 2023 were included. Exclusions were isolated hand injuries, primary amputation, death before surgery, and incomplete records. Patients were grouped based on time to debridement: ≤24 hours, 24-48 hours, and >48 hours. Multivariable logistic regression models adjusted for American Society of Anesthesiologists grade, Gustilo-Anderson classification, and Injury Severity Score (ISS) evaluated the association between timing and 30-day readmission, 90-day readmission, 1-year reoperation, and infection. The study included 297 patients [mean age 44.7 years (SD 22.5); 66.9% male]. Baseline demographics were similar across time-to-debridement groups (≤24 hours, n = 154; 24-48 hours, n = 83; >48 hours, n = 60) with no significant differences in age, sex, or ISS (all P > 0.05). Debridement within 24 hours occurred in 154 of 297 patients (51.9%), and 60 of 297 patients (20.2%) experienced delays >48 hours. Outcome rates were 30-day readmission in 18 of 297 patients (6.1%), 90-day readmission in 21 of 297 patients (7.1%), reoperation within 1 year in 44 of 297 patients (14.8%), and postoperative infection in 13 of 297 patients (4.4%). No statistically significant association was observed between debridement timing and 30-day readmission ( P = 0.72), 90-day readmission ( P = 0.83), 1-year reoperation ( P = 0.11), or infection ( P = 0.39). Within the studied intervals (≤24, 24-48, and >48 hours), debridement timing up to and including delays >48 hours was not significantly associated with readmission, reoperation within 1 year, or postoperative infection in open upper limb fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

This study aimed to investigate long-term prevalence of nutrition impact symptoms, such as appetite and eating-related issues that may impede food intake, in patients with minorand majorburn injuries. In this prospective longitudinal cohort study, 60 adults participated. Two questionnaires, the Disease-Related Appetite Questionnaire (DRAQ-burn) and the Eating Symptom Questionnaire (ESQ-burn), were completed during follow-up visits at 6 and 12 months post trauma. Median burn extent was 4.5% in the minor burn group and 24.0% in the major burn group. At six months, the median number of symptoms reported in DRAQ-burn was 2.0 for all patients; at 12 months, it was 1.0 for minor burns and 1.5 for major burns. Reported symptoms in the ESQ-burn remained stable at a median of 1.0 across both time points and burn severities. Most frequently reported symptoms included fluctuation in appetite/eating, never/rarely feeling hungry, tiredness affecting appetite/eating, and nausea. No statistically significant differences were found between burn severity groups or over time. Overall, although the nutrition impact symptoms were reported to be more mild than severe in nature, they persisted for up to a year post burn, highlighting the need for ongoing nutritional follow-up to mitigate the risk of malnutrition.

To determine whether baseline retinal and choriocapillaris (CC) vascular features measured by OCT angiography (OCTA) can predict diabetic retinopathy (DR) progression or visual acuity (VA) decline in a multiethnic longitudinal cohort. Prospective longitudinal cohort study. A total of 309 eyes from 192 patients with type 2 diabetes mellitus were recruited from a tertiary eye center in Singapore. All participants underwent 3 × 3 mm swept-source OCTA imaging at baseline. Quantitative vascular parameters-including vessel density (VD), perfusion density (PD), and CC flow deficit percentage-were obtained from the superficial and deep retinal layers and from the CC. Larger retinal arterioles and venules were analyzed separately from capillary networks. Diabetic retinopathy progression was defined as a ≥2-step increase on the ETDRS severity scale over 2 years, while VA decline was defined as >1-line reduction in best-corrected VA. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were used to evaluate predictive performance. Progression of DR and VA decline over 2 years, as predicted by baseline OCTA metrics. Over 2 years, 49 eyes (15.9%) demonstrated DR progression. Significant predictors in the superficial layer included larger foveal avascular zone (FAZ) area (odds ratio [OR] = 6.612; P = 0.034), longer perimeter (OR = 1.583; P = 0.002), poorer circularity (OR = 3.23; P = 0.019), higher large-vessel PD (OR = 1.561; P < 0.001) and VD (OR = 2.878; P < 0.001), and lower whole-vessel VD (OR = 0.798; P = 0.010). Adding FAZ perimeter and large-vessel VD improved prediction accuracy (AUC increased from 0.709-0.822). For VA loss, higher superficial large-vessel PD (OR = 1.609; P = 0.002) and lower capillary PD (OR 0.8; P = 0.010) were significant predictors, improving AUC from 0.602 to 0.702. Enlargement and irregularity of the FAZ, along with increased superficial large VD, independently predict DR progression. Incorporating FAZ and large-vessel OCTA parameters enhances prediction models for both DR worsening and vision decline in patients with diabetes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Clinical value of peritoneal signs and computed tomography in hemodynamically stable patients with abdominal gunshot wounds.

Opioid use disorder (OUD), cannabis use disorder (CUD) and cocaine use disorder have been associated with a range of adverse health outcomes, including certain ocular manifestations; however, their impact on diabetic retinopathy (DR) remains insufficiently explored. This study aimed to measure the association between OUD, CUD and cocaine use disorder and the risk of DR among patients with type 2 diabetes mellitus (T2DM). Propensity-score-matched retrospective cohort study. This study used the TriNetX US Collaborative Network to access electronic health records (EHRs), including data on demographics, diagnoses, medication use and laboratory results. A total of 131 088 adult patients with T2DM and comorbid OUD, CUD or cocaine use disorder, and 131 088 adult patients with T2DM without these conditions, were identified following propensity score matching. The primary outcome was the risk of DR evaluated over a 5-year follow-up period. The risks of various DR subtypes and diabetic macular edema (DME) were also assessed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Over a 5-year follow-up period, patients with T2DM comorbid with OUD, CUD or cocaine use disorder had a statistically significantly higher risk of developing DR [HR (95% CI) =2.90 (2.55-3.30), P < 0.00] compared with those without any drug use disorder. Drug use disorders were also associated with elevated risks of vision-threatening diabetic retinopathy (VTDR) [HR (95% CI) =2.78 (2.24-3.46), P < 0.00], non-proliferative diabetic retinopathy (NPDR) [HR (95% CI) =3.10 (2.61-3.68), P < 0.00], proliferative diabetic retinopathy (PDR) [HR (95% CI) =3.17 (2.26-4.45), P < 0.00] and DME [HR (95% CI) =2.64 (2.04-3.42), P < 0.00] among patients with T2DM. Opioid use disorder, cannabis use disorder and cocaine use disorder appear to be associated with an elevated risk of diabetic retinopathy among patients with type 2 diabetes mellitus.

This study aimed to assess the burden and outcomes of human metapneumovirus (hMPV) infection in older patients. This is a monocentric, retrospective cohort study that included all patients aged ≥65 years who were diagnosed with an hMPV infection between December 2017 and March 2024. The primary outcome was overall mortality at 12 months. We identified 155 patients; the median age was 79 years (interquartile range 71-87 years). At baseline, upper respiratory tract infections (URTI) were diagnosed in 81 patients (52.3%). Sixty-seven (43.2%), 14 (9%), and 37 (23.8%) episodes of cardiac, respiratory, and renal decompensation occurred, respectively, following hMPV infection. Overall survival rates were 83% (76-88) at 3 months and 71% (61-78) at 12 months. Survival at 3 and 12 months was 68%/57% in lower respiratory tract infection (LRTI) with an organ decompensation, 87%/82% in LRTI without organ decompensation, 84%/62% in URTI with an organ decompensation, and 92%/83% in URTI patients without organ decompensation (log-rank P = 0.0159). The Charlson Comorbidity Index (1.20 [1.01-1.41]), chronic renal disease requiring dialysis (4.04 [1.07-15.25]), and loss of autonomy reflected by an Activities of Daily Living score <4 (2.87 [1.30-6.35]) were independently associated with 12-month mortality beyond LRTI and decompensation (2.95 [1.12-7.79]). The burden of hMPV infections in the elderly is significant, particularly due to decompensation of comorbidities.

Surgical Approach Does Not Influence Instability Risk in Primary Total Hip Arthroplasty With Monobloc Dual Mobility Cup.