Comparison Of Outcomes Research Articles

Comparison of visual outcomes in patients with cataracts and high myopia after implantation of a zonal refractive multifocal or diffractive bifocal intraocular lens

This study compares the optical quality of zonal refractive multifocal and diffractive bifocal intraocular lenses (IOLs) and visual outcomes after implantation in 93 patients(93 eyes) with cataracts and high myopia. A retrospective analysis was conducted to measure visual acuity at far, intermediate, and near distances, defocus curves, wavefront aberrations, modulation transfer function (MTF), a Quality of Vision questionnaire (QoV) and visual quality self-evaluation were examined at 3 months. The results demonstrated the ZMB group showed better uncorrected near visual acuity (P < 0.01), and the MF15 group showed better uncorrected intermediate visual acuity (P < 0.001). The ZMB group provided better MTF than the MF15 group (P < 0.01) but demonstrated a worse QoV score, especially for the severity of glare, halo, and starburst (P < 0.05). The satisfaction score and spectacle independence rate in the ZMB group were higher than in the MF15 group (P < 0.01). LS-313MF15 and TecnisZMB00 offered excellent visual restoration, stable distance visual acuity, and good subjective visual function.

Comparative Outcomes of Percutaneous K-Wires Versus Plate Fixation in the Treatment of Distal Radius Fractures: A Focus on Stability in Osteoporotic Patients and Both-Bone Distal End Fractures.

Background Distal radius fractures (DRFs) are commonly treated with percutaneous K-wire or plate fixation. The relative efficacy and stability of these methods, particularly in osteoporotic patients and in cases involving both distal radius and ulna fractures, remain subjects of clinical debate. Objective This study aims to compare the outcomes of percutaneous K-wire fixation versus plate fixation in patients with distal end radius fractures, focusing on postoperative stability in osteoporotic conditions and both-bone distal end fractures. Methods A total of 50 patients were retrospectively analysed and divided into two groups: 25 underwent percutaneous K-wire fixation, and 25 underwent plate fixation. Outcomes measured included bone healing time, complication rates, functional recovery using the DASH score, and radiological outcomes through standard X-ray imaging. Results Preliminary data suggest that plate fixation offers better stability, especially in osteoporotic patients and cases with both-bone involvement. Complications with K-wire fixation were more frequent in these subgroups. Conclusion Plate fixation may provide superior stability and functional outcomes in treating DRFs, particularly in complex cases involving osteoporosis or bone injuries. Further research with larger sample sizes and prospective design is recommended.

Radiotherapy as a metastasis directed therapy for liver oligometastases - comparative analysis between CT-guided interstitial HDR brachytherapy and two SBRT modalities performed on double-layer and single layer LINACs

IntroductionSurgical resection is gold standard for treatment of liver metastasis, locally ablative techniques including computer tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy (CT-BRT) and stereotactic body radiotherapy (SBRT) have gained prominence as alternatives, offering comparable outcomes in selected patients. We aim to compare CT-BRT and SBRT - based on dosimetric analysis.Material and methodsPatients who underwent CT-BRT for oligometastatic, ≤4cm liver metastases between 2018 and 2024 were eligible. SBRT plans for Halcyon (SBRTh) and TrueBeam (SBRTtb) were prepared virtually. In the CT-BRT group CTV was equal to PTV, for SBRTh and SBRTtb planning, a 5 mm margin was applied to CTV to create PTV. Dose calculation was carried out with the TG-43 algorithm for CT-BRT and Anisotropic Analytical Algorithm for SBRTh and SBRTtb group. Descriptive statistics were used to compare the data. The Wilcoxon pairwise order test was utilized to compare dependent groups.ResultsCT-BRT resulted in a more favorable dose distribution within PTVs for Dmean, D50, and D90, while SBRT showed better results for D98 and V27.5Gy. No significant differences were observed for V25Gy between CT-BRT and SBRTtb, but SBRTh favored over CT-BRT. For OARs, CT-BRT plans showed better values for V5, V10, and V11.6Gy in the uninvolved liver volume. There were no significant differences in dose distribution for the duodenum, bowel, and heart. SBRT modalities performed better in the kidney. CT-BRT had improved dose distribution in the esophagus, great vessels, ribs, skin, spinal cord, and stomach compared to SBRT.ConclusionsCT-BRT could be a viable alternative to SBRT for certain patients with liver malignancies.

Comparison of outcomes of index and interval laparoscopic cholecystectomy in mild biliary pancreatitis.

Objective: To compare the outcomes of index and interval laparoscopic cholecystectomy in mild biliary pancreatitis in terms of duration of hospital stay. Study Design: Randomized Controlled Trial. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: January 2023 till June 2023. Methods: Patients were being admitted with acute biliary pancreatitis and undergoing either index or interval cholecystectomy. BISAP scoring system was used for severity of ABP and mild cases were included. Study outcomes in both groups (index and interval cholecystectomy) were determined. For quantitative variables mean and standard deviation were calculated. Frequency and percentages were used to describe qualitative variables. Results: Total of 70 patients divided into two groups were included in this study. Mean age of the study population was 40.44+/-7.90 years. Fifty-three percent of the population had BMI in the overweight category. Mean BISAP score was 1.11+/-0.80. All of the patients included in the study had mild acute pancreatitis. The length of hospital stay was significantly associated with timing of surgery with p-values 0.045. Conclusion: The surgical outcomes of index and interval cholecystectomy in acute mild biliary pancreatitis are comparable. However, early cholecystectomy has shorter duration of hospital stay.

Comparison of outcome of Simple Excision vs Limberg Flap of pilonidal sinus in terms of post operative pain, operative time, wound infection and hospital stay.

Objective: To compare post operative pain, wound infection, intraoperative time and length of hospital stay in both groups of simple excision and Limberg flap. Study Design: Comparative Prospective study. Setting: CMA Teaching and Research Hospital/Azra Naheed Medical and Dental College, Lahore, Pakistan. Period: 1st September 2021 to 1st September 2023. Methods: After approval from the Institutional review board of Azra Naheed Medical &amp; Dental College/CMA Hospital, the sample was 120 patients was raised using non-convenience probability sampling divided into 2 groups. Group A patients underwent simple excision while Group B patients underwent Limberg flap Inclusion criteria include all the patients with age more than 13 years and diagnosed as case of pilonidal sinus. All the data was entered and processed by using SPSS 26. Comparison of two groups was done by apply independent sample t-test. A p-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 45.88 ± 9.78 years with minimum and maximum ages were 15 &amp; 59 year respectively. Mean post operative pain was 2.6 ± 1.9 in group A while 3.9 ± 2.7 in group B (p value = &lt;0.05). Similarly wound infection, duration of surgery and length of hospital stay were also less in group A patients as compared to group B patients. Conclusion: Simple excision of pilonidal sinus is better from Limberg flap in terms of post operative pain, wound infection, duration of surgery and length of hospital stay.

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements.

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms &amp; Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

Decompression without fusion in low-grade degenerative spondylolisthesis and stenosis patients: long-term patient-reported outcome

BackgroundOne-third of patients suffering from neurogenic claudication due to lumbar spinal stenosis have low-grade degenerative spondylolisthesis. Decompression in these patients is considered a risk factor for instability, and it remains unclear whether instrumented fusion should be added. This study aims to assess the long-term clinical outcomes of decompressive surgery without instrumented fusion in symptomatic spinal stenosis patients regardless of low-grade degenerative spondylolisthesis. MethodsIn this retrospective cohort study, lumbar spinal stenosis patients with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 spondylolisthesis and 200 randomly selected stenosis patients. Demographic characteristics, surgical technique, reoperation indication and incidence, and patient-reported outcome measures were assessed. ResultsAt long-term follow-up, the mean Oswestry Disability Index was 23.6 ±20.15 in the spondylolisthesis group and 23.4 ±20.9 (p=0.957) in the stenosis group. The EuroQol-5D was 0.74±0.28 and 0.75 ±0.24 (p=0.793) respectively. The Zurich Claudication Questionnaire score was 48.2% ±18.8 and 49.6% ±18.5 (p=0.646) respectively. After nine years of follow-up, comparable satisfaction rates are reported (69% of spondylolisthesis patients and 68% of stenosis patients (p=0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7 versus 6%). ConclusionThis cohort study demonstrated comparable satisfaction and clinical outcomes after decompressive surgery for symptomatic spinal stenosis in patients with and without grade 1 degenerative spondylolisthesis. Decompressive surgery can, therefore, be considered an effective treatment for symptomatic lumbar spinal stenosis, even if it is accompanied by degenerative spondylolisthesis. Therefore, routinely adding instrumented spondylodesis is not deemed necessary.

Initial Experience With Robotic Liver Resection in the United States.

This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.

Assessment of clinical performance of universal adhesives versus other adhesive systems: A systematic review and meta-analysis of clinical trials

Universal adhesives (UAs) often exhibit comparable or even superior bond strength to traditional adhesive systems, ensuring reliable and long-lasting adhesion between the resin composite and the tooth structure. Therefore, this study aimed to assess the clinical performance of UAs compared to other adhesive systems in direct resin composite restorations through a systematic review and meta-analysis. Two reviewers executed a literature search in five electronic databases: PubMed, EMBASE, Scopus, Web of Science, and Scielo. Clinical trials comparing the clinical evaluation of resin composite restorations in Class I, Class II, or Class V cavities placed with an universal adhesive (UA) system against resin composite restorations placed with another non-UA system were included in the review. An analysis was carried out using Review Manager software version 5.3.5 (London, England, United Kingdom). Standardized effect sizes with 95% confidence intervals were calculated to allow comparisons between different interventions and different outcomes. The methodological quality of each study was assessed using the Cochrane RoB2 tool for randomized clinical trials. A total of 2331 potentially relevant studies were identified. After title and abstract examination, 14 studies remained in the systematic review. From these, a total of 11 studies were included in the meta-analysis. The retention rates of resin composite restorations after 6 months showed no significant difference between total-etch (TE, p=0.83), or self-etch (SE, p=0.78) adhesives and UAs applied in TE and SE modes (p&gt;0.05). However, UAs applied in selective-enamel etching (SEE) mode demonstrated superior clinical performance compared to other adhesives (p=0.01), particularly TE adhesives (p=0.02). Similarly, after &gt;12 months of follow-up, there were no significant differences in retention rates among different adhesive modes (p&gt;0.05). Additionally, the incidence of secondary caries did not significantly differ across adhesive modes at both 6-month and &gt;12-month evaluations (p&gt;0.05). This systematic review and meta-analysis suggested that UAs demonstrate comparable clinical performance to TE and SE adhesive systems in direct resin composite restorations, particularly in terms of restoration retention rates and the incidence of secondary caries. UAs applied in SEE mode exhibited superior clinical outcomes compared to other adhesive systems. These findings indicate that UAs can be considered a viable alternative to traditional adhesive systems in clinical practice, offering flexibility in application while maintaining comparable long-term outcomes.

The Long-Term Results of Proximal Gastrectomy for Proximal Gastric Cancer: A Propensity Score Matching Analysis Based on SEER Database.

Proximal gastrectomy (PG) is one of function-preserving gastrectomy (FPG). In this study, we compared the long-term results of proximal gastric cancer (PGC) patients undergoing proximal gastrectomy and total gastrectomy (TG). Patients diagnosed with PGC and receiving PG or TG between 2004 and 2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was applied to minimize confounding factors. Kaplan-Meier analysis and log-rank test were used to compare overall survival (OS) and cancer-specific survival (CSS) between the PG and TG groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS. A total of 3916 patients were recruited according to the inclusion and exclusion criteria, with 2614 undergoing PG and 1302 undergoing TG. After 1:1 PSM matching, 912 pairs of data were included for analysis. Before PSM matching, PG group tended to have better OS and CSS outcomes. However, after PSM matching, both surgical approaches showed similar long-term results. PG for PGC yields comparable long-term outcomes to TG and demonstrates safety in terms of oncologic outcomes.

Latarjet procedure: open with screws or arthroscopic with cortical-buttons? A retrospective cohort comparison of outcomes and complications

Latarjet procedure: open with screws or arthroscopic with cortical-buttons? A retrospective cohort comparison of outcomes and complications

Indication-based analysis of laser interstitial thermal therapy: a propensity score-matched comparison of outcomes for brain tumor versus epilepsy indications.

Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to ablate abnormal tissue in a targeted fashion. It is most commonly used to treat epileptic foci, brain tumors, and radiation necrosis. This study aimed to compare immediate postoperative outcomes between these indications. This study analyzed clinical data from the Nationwide Readmissions Database (NRD) from 2016 to 2019 and identified 2234 patients who underwent LITT procedures using ICD-10 codes. The authors analyzed patient demographics, complications, discharge disposition, readmission rates, and mortality. Following propensity score matching, 317 patients treated for epilepsy and 323 patients treated for brain tumors were compared. The mean ages were similar (epilepsy: 45.7 vs tumor: 49.0 years, p = 0.55), as were the proportions of female patients (epilepsy: 45.4% vs tumor: 52.9%, p = 0.83), all-payer costs (p = 0.81), income quartiles (p = 0.58), insurance types (p = 0.70), frailty rates (p = 0.85), and comorbid disease burdens as assessed by ECI score (p = 0.73). No significant differences were observed in rates of hemorrhage (p = 0.1), pulmonary embolism (p = 0.32), or infection (p = 0.16). However, the tumor cohort had higher rates of deep vein thrombosis (3.4% vs < 3.15%, p = 0.045), nonroutine discharge (26.6% vs 16.4%, p = 0.04), and 1-year hospital readmission (32.5% vs 18.6%, p = 0.006). One-year mortality rates were similar (tumor: 3.4% vs epilepsy: < 3.15%, p = 0.08). While postoperative complications and 1-year mortality rates were similar among patients undergoing LITT for epilepsy and brain tumors, the tumor cohort experienced higher rates of deep vein thrombosis, nonroutine discharge, and 1-year hospital readmission.

Does Functional Status Predict Worse 30-D Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms? A Propensity-Score Matched Study From ACS-NSQIP Targeted Database From 2012 to 2022

IntroductionIn patients undergoing endovascular aneurysm repair (EVAR), existing studies have identified an association between dependent functional status (DFS) and poorer outcomes after EVAR. However, noted limitations, especially the lack of differentiation between ruptured and nonruptured abdominal aortic aneurysm (AAA), potentially affect the extrapolation of these findings to specific patient groups. Thus, this study aimed to evaluate the association between functional status and 30-d outcomes after EVAR in ruptured and nonruptured AAA patients separately. MethodsPatients who underwent infrarenal EVAR were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012-2022. Patients with DFS and those with independent functional status (IFS) were stratified into the two study cohorts. In nonruptured AAA, a 1:1 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distal extent of the aneurysm, anesthesia, and concomitant procedures between patients with DFS and IFS. The sample size for ruptured patients with AAA was too small for meaningful statistical analysis so only qualitative description was provided. Thirty-d postoperative mortality and morbidities of EVAR were assessed. ResultsFor nonruptured cases, there were 380 (2.55%) DFS and 14,545 (97.45%) patients with IFS, where 453 patients with IFS were matched to the DFS cohort. For ruptured AAA, there were 17 (6.39%) DFS and 249 (93.61%) IFS. After matching, nonruptured DFS and patients with IFS had similar 30-d mortality rates (2.37% vs 2.11%, P = 1.00). However, patients with DFS had a higher risk of bleeding requiring transfusion (18.42% vs 11.84%, P = 0.01) and longer length of stay (median 3.00 [Q1 1.00, Q3 6.00] vs median 2.00 [Q1 1.00, Q3 4.00] d, P < 0.01). All other outcomes, including major adverse cardiovascular events, cardiac complications, stroke, pulmonary complications, renal complications, sepsis, venous thromboembolism, wound complications, lower extremity ischemia, ischemic colitis, postoperative ruptured aneurysm, unplanned reoperation, 30-d readmission, were not different between patients with DFS and IFS. Qualitatively, ruptured patients with DFS had higher crude rates of 30-d mortality and morbidities compared to patients with IFS. ConclusionsContrary to previous literature, patients with DFS with nonruptured AAA undergoing EVAR were found to have largely comparable outcomes to patients with IFS, although extra attention should be paid to postoperative bleeding.

P205 Comparative outcomes of partial vs. radical nephrectomy for localized renal carcinomas: Insights from real-world data

P205 Comparative outcomes of partial vs. radical nephrectomy for localized renal carcinomas: Insights from real-world data

Biliary Reconstruction with Hepaticoduodenostomy Versus Hepaticojejunostomy After Choledochal Cyst Resection: A Narrative Review

Choledochal cysts (CCs), a congenital anomaly resulting in the abnormal dilation of the biliary ductal system, are most often identified in patients younger than 10 years of age. Regardless of clinical presentation, the cornerstone of therapy for CCs is complete surgical excision with reconstruction with either hepaticoduodenostomy or hepaticojejunostomy. Although both procedures are used by surgeons for the correction of CCs, evidence on clinical outcomes following both approaches is inconclusive as to which may offer superior reconstruction. This narrative review aims to compare the current literature regarding both approaches by evaluating their anatomic and operative considerations, as well as their perioperative, postoperative, and long-term outcomes. Future studies should closely focus on long-term, comparative outcomes, including the risk of biliary malignancy, and refine techniques to minimize complications, such as biliary reflux and bowel obstruction, in order to improve care for pediatric patients undergoing treatment for CCs.

Comparison between gas insufflation and gasless techniques for endoscopic transaxillary thyroidectomy

ObjectiveThis study aimed to compare clinical outcomes and prognosis of endoscopic thyroidectomy via axillary approach using insufflation and gasless methods.MethodsRetrospective analysis included patients undergoing endoscopic thyroidectomy at our institution from June 2022 to October 2023. Patients were categorized into insufflation and gasless groups. Analysis compared surgical time, blood loss, drainage volume, tube removal time, hospital stay, complications, pain score, and incision satisfaction.Results73 patients (48 insufflation, 25 gasless) were analyzed. Insufflation technique showed significantly superior outcomes: shorter surgery duration, reduced drainage volume, earlier tube removal, shorter hospital stay, and higher incision satisfaction (all P &amp;lt; 0.05). Postoperative pain (VAS) was lower in insufflation group on first day, but no significant difference on seventh day. No significant differences in blood loss or complications were observed.ConclusionInsufflation technique offers advantages over gasless method including shorter operation time, reduced drainage, earlier tube removal, and shorter hospital stays, with comparable outcomes in pain and incision satisfaction.

Comparison of The Postoperative Outcomes of Surgical Lateral Internal Sphincterotomy and Botulinum Toxin Injection in Patients Presenting With Chronic Anal Fissure At CMH, Rawalpindi

Objective: To compare the postoperative outcomes in Lateral Internal Sphincterotomy Group and in Botulinum toxin injection Group in patients managed for chronic anal fissure. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2021 to Feb 2022. Methodology: All patients of either gender, aged 30 to 70 years, who had presented to CMH, were included in this study. Block randomization was done to allocate half of them to Lateral Internal Sphincterotomy and half to Botulinum toxin injection. Patients in both Groups were followed for four weeks to assess and compare various short and long term post-surgical outcomes. Results: There were 82 patients in total with 41 in each treatment arm. In the Lateral Internal Sphincterotomy Group, 35 85(37%) of the patients reported postoperative pain relief at 24 hours, 39(95.12%) patients healed, only 2(4.88%) patients had a recurrence. In the Botulinum toxin Group, 29(70.73%) reported postoperative pain relief at 24 hours, 35(85.37%) patients healed, whereas 6(4.63%) had a recurrence. There was no statistical difference in any parameter between either Group. Conclusion: Both methods did not show any statistically significant difference in post-operative outcomes thus other parameters like patient’s choice, cost and expertise may be considered in treatment of chronic anal fissure.

Expandable Versus Static Cages for Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spondylosis

Objective: Expandable cages have been used in lumbar interbody fusion in recent years. These cages allow a customizable fit within the intervertebral space, enabling surgeons to restore alignment and disc height. Various types of expandable cages are currently available. However, the benefits of expandable titanium cages remain unclear, with limited evidence.Methods: This prospective, single-center cohort study enrolled patients undergoing transforaminal lumbar interbody fusion with expandable or static cages by a single surgeon. Titanium expandable cages were used in the intervention group, while polyetheretherketone static cages were applied in the control group. The clinical and radiological outcomes were evaluated preoperatively and at 1, 3, and 6 months postoperatively. The fusion rate assessed by dynamic radiography was significantly higher for the expandable cage group than in the static cage group at a 6-month follow-up (95% vs. 65%). The radiological outcomes, including disc height index, segmental lordosis, and lumbar lordosis, were similar in the 2 groups. There was no significant difference in the subsidence rate.Results: There were 20 patients in each group, with similar patient characteristics. The visual analogue scales for back and leg pain significantly improved in both groups. There were no significant differences between the groups in clinical outcomes.Conclusion: The expanded cages led to comparable outcomes. The subsidence rate of the titanium expandable cages was similar to that of the static cages. The newly designed expandable cage may accelerate fusion by reducing iatrogenic injuries to the endplate.

Comparison of Intracranial Hemorrhage and Clinical Outcomes Among Patients Undergoing Mechanical Thrombectomy with and without Thrombolytic Therapy

Comparison of Intracranial Hemorrhage and Clinical Outcomes Among Patients Undergoing Mechanical Thrombectomy with and without Thrombolytic Therapy

Lethal Prostate Cancer in Mexico: Data from the Can.Prost Mexican Registry and a Project for Early Detection

Introduction: Epidemiological data are crucial for adopting primary and secondary prevention strategies and to develop screening protocols against prostate cancer (PCa). Despite the comprehensive characterization of PCa across White and Black men, there is a lack of data from the Mexican population. This manuscript presents data from the Can.Prost registry that captures PCa trends over the past two decades in Mexico City; furthermore, we aimed to compare clinical differences and oncological outcomes before and after the promotion of early detection actions through a campaign against PCa that occurred in 2014. Methods: A retrospective observational study on newly diagnosed Mexican PCa patients was carried out at the Instituto Nacional de Cancerología (INCan) in Mexico City. During 2014 and 2015, a project for the early diagnosis of PCa (“OPUS program”) was launched in the aforementioned tertiary hospital. Starting at the age of 45 years, all men were invited for a PSA measurement and a specialist urologist consultation. All individuals with clinical or biochemical suspicion of PCa (PSA &gt; 4 ng/mL), in the context of age and prostate volume, underwent ultrasound-guided transrectal prostate biopsy. Then, patients with pathologically confirmed prostate cancer were stratified according to the year of diagnosis: Group A accounted for those diagnosed between 2000 and 2014 and Group B for those patients diagnosed in the timeframe of 2015–2021. Comparisons of PCa characteristics, treatment modalities and oncologic outcomes between Group A and B were performed. Results: Overall, we collected data from 2759 PCa patients from 2000 to 2021. The median PSA at baseline was 32 ng/mL, and 25% had a family history of PCa. Overall, 25.8% were asymptomatic and 46% had a non-metastatic presentation. After the OPUS campaign, PSA at diagnosis was significantly lower across all age groups. The incidence of PCa diagnosis in asymptomatic men was higher (31.4% vs. 19.9%) and a higher proportion of men were diagnosed with organ-confined, palpable disease (46% vs. 28%) (p &lt; 0.001). The rate of patients eligible for active/radical treatment was higher after the OPUS campaign (patients who received surgery increased from 12.78% to 32.41%; patients who underwent radiation increased from 28.38% to 49.61%). The proportion of patients diagnosed with non-clinically significant disease was negligible and remained stable across time. Conclusions: PCa in Mexican patients displays aggressive features at diagnosis, whereas the rate of non-significant disease is negligible. The introduction of early detection strategies may lead to lower symptomatic and metastatic PCa and higher opportunities for radical treatment. This emphasizes the need for public awareness and for adjustment of screening strategies to the peculiarities of the Mexican population.