Comparison Of Long-term Outcomes Research Articles

Comparison of Long-term Outcomes of Scleral-fixated IOL: Sutured vs. Suture-less Fixation

Purpose: This study compared the long-term outcomes and complications associated with sutured and suture-less scleral fixed intraocular lenses (SFIOLs), the two primary surgical techniques for scleral fixation of IOLs.Methods: A total of 90 patients were included in the study with 46 in the sutured group and 44 in the suture-less group. These patients underwent SFIOL between January 2019 and June 2023 due to IOL dislocation, aphakia, or crystalline lens dislocation. Collected data included age, gender, axial length, operative time, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive value, refractive error, ocular residual astigmatism, IOL dislocation, recurrent IOL dislocation, IOL tilt, and IOL iris capture. Changes from preoperative status to 1 year postoperatively were assessed.Results: No significant differences were found between the sutured and suture-less groups regarding preoperative BCVA, IOP, and refractive values. However, the suture-less group demonstrated significantly better BCVA at both 1 week and 1 month postoperatively compared to the sutured group (<i>p</i> = 0.010, 0.015, respectively). The refractive error in the suture-less group was also significantly lower at 1 week postoperatively (<i>p</i> = 0.020). Ocular residual astigmatism was consistently lower in the suture-less group across all postoperative intervals (<i>p</i> < 0.001). While the suture-less group showed a shorter average surgical time, there was greater variability in operative duration (<i>p</i> < 0.001, 0.024, respectively). Additionally, a longer axial length was associated with an increased incidence of IOL iris capture (<i>p</i> = 0.004).Conclusions: Suture-less SFIOL is associated with shorter operative times, although with greater variability. Patients in the suture-less group experienced faster BCVA improvement, reduced refractive error, and lower ocular residual astigmatism compared to those in the sutured group.

Intra-individual comparison of long-term outcomes between combined and indirect bypass surgery in adult moyamoya disease

PurposeBypass surgery is regarded as the standard treatment option for symptomatic and hemodynamically unstable moyamoya disease (MMD). However, there is ongoing debate about the most effective type of bypass surgery. We aimed to analyze the long-term outcomes of combined and indirect bypasses for MMD patients through intra-individual comparisons.MethodsOf the 896 patients who underwent 1084 bypass surgeries between 2007 and 2021, 24 patients with MMD who underwent combined bypass on one side and indirect bypass on the other side were ultimately enrolled in this study. Clinical, angiographic and hemodynamic outcomes were retrospectively evaluated.ResultsThree asymptomatic strokes (12.5%) occurred within 30 postoperative days in each group. Postoperative strokes after 30 days occurred in 3 patients (12.5%) with 3 hemorrhagic events and 1 cerebral infarction, only in indirect bypass, while no stroke occurred in hemispheres treated with combined bypass. The revascularization area relative to supratentorial area was significantly greater in combined bypass than in indirect bypass, both in short-term and long-term periods (64.9% versus 43.9% in short-term and 75.7% versus 54.9% in long-term; P < .001, respectively). Hemodynamic outcomes showed significantly greater increases in acetazolamide-challenged cerebral blood flow (CBFacz) during short-term follow-up (P = .04) and in both basal CBF (CBFbas) and CBFacz during long-term follow-up (P = .014 and P = .009, respectively) in combined bypass than in indirect bypass.ConclusionCombined bypass may be a more effective treatment option for MMD based on its higher revascularization area and favorable hemodynamic results compared to indirect bypass in the same patient.

Long-Term Comparative Outcomes of Short Implants Versus Maxillary Sinus Elevation in Posterior Maxilla Rehabilitation

Background: Vertical atrophy of the maxilla has traditionally been treated with sinus lift procedures and implant placement, performed in one or two surgical stages. Subsequently, the transcrestal sinus lift technique was introduced, offering distinct advantages in terms of indications and reduced morbidity. Most recently, short implants have emerged as a valid alternative to these procedures, even in cases of severe horizontal resorption, allowing for direct placement in many cases. This study was designed to assess the clinical outcomes of short implant placement in alveolar ridges with severe bone atrophy, compared with conventional-length implants placed in areas undergoing conventional sinus elevation. Methods: A retrospective split-mouth study was conducted to compare conventional sinus elevation with standard-length implants versus short implants for addressing vertical bone atrophy in the posterior maxilla. The primary variable was the variation in the marginal bone level. The secondary variables were implant survival and complications. The evaluation of the statistical significance of the difference in categorical variables was accomplished by Chi-squared test or Fisher’s exact test. The comparison between the study groups in continuous variables was performed using Wilcoxon test. The statistical significance was set at p-value &lt; 0.05. Results: The study sample consisted of 24 patients and a total of 73 dental implants. The lateral sinus elevation group (LSEG) included 39 implants, while the short implants group (SIG) included 32 implants. All prostheses were screw-retained. Changes in marginal bone levels indicated a marginal bone loss of less than 0.5 mm in both groups, with no statistically significant difference. In the LSEG, two cases of mucositis were identified, attributed to improper use of an interdental brush. Additionally, two cases of prosthetic screw fracture were reported in the LSEG as technical complications. Conclusions: Long-term outcome data have provided evidence that the use of short implants is comparable to a state-of-the-art procedure (sinus grafting and placement of implants) regarding implant survival, marginal bone remodeling, and complication rates.

Long-Term Outcomes of an Infliximab-First Versus Vedolizumab-First Treatment Strategy in Biologic-Naïve Patients With Ulcerative Colitis.

Although studies have compared on-treatment effectiveness of infliximab and vedolizumab in patients with ulcerative colitis (UC), there has been limited comparison of treatment sequencing and long-term patient-centred outcomes. To compare infliximab-first and vedolizumab-first strategy in biologic-naïve patients with UC. We conducted a retrospective cohort study in biologic-naïve patients with UC who were treated first with either infliximab or vedolizumab between 2015 and 2021 and followed over 30 months following initiation. Primary outcomes were the number of hospitalisations, corticosteroid courses and serious infections with either strategy (regardless of switch to alternative therapies) within 30 months. We matched the groups 1:1 through cardinality matching, and fit logistic and zero-inflated negative binomial models to compare outcomes. We included 181 patients (94 vedolizumab-first and 87 infliximab-first treatment strategy). Of these, 144 were matched 1:1. There was no significant difference in the incidence of IBD-related hospitalisations (incidence rate ratio [IRR], 1.98 [95% CI, 0.64-6.10]), corticosteroid courses (0.66 [0.38-1.15]) and serious infections (5.26 [0.62-45.45]), with comparable incidence of medication switches to alternative advanced therapies (1.08 [0.42-2.81]). At 30 months, there was no difference in proportion of patients in clinical remission (69.4% vs. 76.4%; p = 0.45) and endoscopic remission (55.6% vs. 65.3%; p = 0.36). In patients with UC, long-term effectiveness and safety outcomes are comparable with infliximab-first and vedolizumab-first treatment strategies at 30 months. This can help to guide selection of treatment strategies in patients with UC.

A Comparative Assessment of Clinical Outcomes Using Cyanoacrylate Glue versus Subcuticular Sutures in Cosmetic Procedures at a Tertiary Care Center: Evaluation Based on the Southampton Scoring System.

Introduction Cosmetic surgery has advanced significantly, with wound closure techniques crucial for determining aesthetic and healing outcomes. Recently, cyanoacrylate glue and subcuticular sutures have gained attention for their unique benefits in cosmetic procedures. Cyanoacrylate glue, a non-invasive tissue adhesive, facilitates faster wound closure with minimal trauma, while subcuticular sutures offer durable, concealed closures, particularly suited for areas under mechanical stress. This study uses the Southampton scoring system to compare these techniques, evaluating clinical outcomes, complications, and patient satisfaction to guide optimal wound closure methods in cosmetic surgery. Methods This prospective observational study at a tertiary care center compared wound closure outcomes using cyanoacrylate glue and subcuticular sutures in 50 patients undergoing cosmetic procedures.Patients aged 18-65 with no wound healing disorders or chronic skin conditions were included, while those with active infections, on immunosuppressive therapy, or allergic to cyanoacrylate were excluded. Patients were evenly divided into two groups: one receiving cyanoacrylate glue and the other subcuticular sutures. The same surgical team performed all procedures. Wound healing was assessed using the Southampton scoring system on days 1, 7, and 30 postoperatively. Secondary outcomes included pain (visual analog scale), healing time, and complication rates. Patient satisfaction was evaluated at the 30-day follow-up. Statistical analysis was conducted using SPSS software, with significance set at p<0.05. Results The study evaluated 50 patients (split equally between cyanoacrylate glue and subcuticular sutures groups) undergoing cosmetic procedures, focusing on postoperative wound healing using the Southampton scoring system. On postoperative day 7, infection rates were significantly lower with cyanoacrylate glue (8% Grade 1a, 4% Grade 1c, and no Grade 2b) than with subcuticular sutures (16% Grade 1a, 12% Grade 1c, and 4% Grade 2b; p=0.000). Additionally, cyanoacrylate glue reduced operative time, with its non-invasive nature contributing to higher patient satisfaction scores. However, both techniques yielded comparable long-term cosmetic outcomes, with no significant differences in scar appearance after 30 days. Overall, each technique demonstrated unique strengths, influencing clinical outcomes and patient satisfaction. Conclusion The study highlights the respective benefits and limitations of cyanoacrylate glue and subcuticular sutures, offering insights to aid cosmetic surgeons in making informed decisions tailored to individual patient needs. These findings can ultimately improve short-term recovery and long-term patient satisfaction with cosmetic outcomes. The use of the Southampton scoring system facilitated a standardized evaluation, providing valuable data on the effectiveness of each wound closure method in various surgical contexts.

Long-Term Outcomes of Laparoscopic Anatomical versus Non-Anatomical Liver Resection for Hepatocellular Carcinoma.

The objective of this study was to investigate the long-term outcomes between laparoscopic anatomical liver resection (LAR) and laparoscopic non-anatomical liver resection (LNAR) in patients with hepatocellular carcinoma (HCC). In this single-center retrospective cohort study, 1773 patients, from January 2009 to December 2017, were assessed for inclusion. After exclusions, 661 patients were included: 304 patients received LAR and 357 patients received LNAR. Propensity score matching (PSM) with 1:1 ratio was used to eliminate the selection bias between LAR and LNAR groups. The Kaplan-Meier and Cox models were used for survival analysis. After PSM, 250 patients were in LAR or LNAR group, respectively. The overall survival (OS) had no significant difference between LAR and LNAR by Kaplan-Meier analysis. While, LAR had better disease-free survival (DFS) compared with LNAR (Log-rank P=0.035). The cumulative 5-year DFS rates were 48% for LAR, and 38% for LNAR. By Cox analysis, LAR was an independent risk factor of DFS (HR=1.308, P=0.030). In subgroup analysis for tumor size ≤ 5 cm, 207 patients were in LAR or LNAR subgroup after PSM. LAR had better DFS compared with LNAR (Log-rank P=0.033). LAR was an independent risk factor of DFS (HR=1.333, P=0.036). The cumulative 5-year DFS rates were 50% for LAR, and 39% for LNAR. In another subgroup analysis for tumor size > 5 cm, 43 patients were in LAR or LNAR subgroup after PSM. The DFS had no significant difference between LAR and LNAR (Log-rank P=0.912). LAR is preferred for HCC patients with tumor size ≤5cm compared with LNAR because of the better DFS. For patients with tumor size >5cm, LAR and LNAR might be alternative procedures with comparable long-term outcomes.

Long-term outcomes of minimally invasive direct coronary artery bypass vs second generation drug eluting stent for management of isolated left anterior descending artery disease.

This study aimed to compare the long-term outcomes in a propensity matched population receiving either minimally invasive direct coronary artery bypass (MIDCAB) using left internal thoracic artery (LITA) to the left anterior descending artery (LAD) or percutaneous coronary intervention using second generation everolismus-eluting stents (DES-PCI) in patients treated for isolated proximal LAD stenosis. Between January 2012 and December 2017, 421 patients with a nonemergency status undergoing primary isolated proximal LAD revascularization were retrospectively analyzed and were divided into two groups: 111 patients receiving MIDCAB LITA to LAD and 310 patients receiving DES-PCI. Propensity score matching selected 111 pairs and both groups were comparable for all baseline characteristics and well balanced. In the matched cohort, median follow-up time was 5.19 years (interquartile range, 3.50-6.96). MIDCAB and DES-PCI had comparable long-term outcomes in terms of mortality (Hazard ratio (HR) stratified on matched pairs: 1.60; 95 %CI; 0.58-4.37; P = 0.36), stroke (HR stratified on matched pairs: 0.44; 95 %CI; 0.04-5.13; P = 0.51) and major adverse cardiac and cerebral events (MACCE) (HR stratified on matched pairs:0.57; 95 %CI; 0.26-1.22; P = 0.14). However, MIDCAB was associated with reduced incidence of myocardial infarction (MI) (HR stratified on matched pairs:0.46; 95 %CI; 0.15-0.0.56; P = 0.001) as well as reduced incidence of target vessel repeat revascularization (TVR) (HR stratified on matched pairs: 0.12; 95 %CI; 0.0.01-0.92; P = 0.015). MIDCAB LITA-LAD offers superior freedom from MI rate and TVR with similar mortality, stroke and MACCE compared with second generation DES-PCI in the treatment of isolated proximal LAD disease.

Long-Term Outcomes of True versus Non-True Coronary Bifurcation Lesions Treated with Bioresorbable Polymer Sirolimus-Eluting Ultimaster Stent under Intravascular Imaging Guidance.

Limited evidence exists regarding the long-term outcomes of true vs. non-true coronary bifurcation lesions (CBLs) treated with current-generation drug-eluting stents and intravascular imaging guidance. The SCVC (Sapporo Cardiovascular Clinic) registry was a prospective, single-center, all-comers registry enrolling 1,727 consecutive patients treated with bioresorbable polymer sirolimus-eluting stent (BP-SES) under complete imaging guidance. From this registry, 440 patients with CBLs (25.5%) were analyzed. Patients were categorized into the true and non-true CBL groups according to the Medina classification (n=234 and 206, respectively). The primary endpoint was the cumulative incidence of target vessel failure (TVF; a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization. One-stent strategy was predominantly chosen for both the true and non-true CBL groups (93.9% and 96.2%, respectively). During the median follow-up of 5.4 years, the cumulative incidence of TVF did not differ between true and non-true CBL groups after adjustment for baseline differences (five-year incidence; 22.0% vs. 17.7%, adjusted hazard ratio, 1.27 [95% confidence interval: 0.79-2.05]; P=0.32). Although the Medina 0.0.1 lesions were very rare (1.1%), they had the highest rate of TVF among the Medina subtypes. Final kissing balloon inflation technique was associated with a lower incidence of TVF (P=0.036). In conclusion, imaging-guided PCI with BP-SES resulted in comparable long-term clinical outcomes between true and non-true CBLs, primarily using the one-stent technique.

Loco-regional relapse pattern and timing after segmentectomy in patients with c-IA non-small cell lung cancer.

Segmentectomy has been recognized as the standard procedure for small peripheral lung cancer; however, it has been shown that loco-regional relapse is more common with segmentectomy than with lobectomy. This study aims to investigate the long-term outcomes and loco-regional relapse patterns in patients with clinical stage IA (c-IA) non-small cell lung cancer (NSCLC) after segmentectomy and compare them with those after lobectomy. We retrospectively compared the long-term outcomes of 115 patients who underwent segmentectomy for c-IA NSCLC with those of 292 patients who underwent lobectomy between January 2008 and December 2015. Segmentectomy was indicated intentionally or chosen in patients who were considered intolerable to lobectomy. New isolated growing lung lesions were defined as relapses if they were not diagnosed with a second primary lung cancer. The median observation period was 2,150 days. The 10-year overall survival (OS) rates and relapse-free survival (RFS) rates of the two groups were similar: 79.4% and 68.7% for segmentectomy, and 68.2% and 61.2% for lobectomy. Even after propensity score matching, no significant differences were observed in the OS and RFS rates between the groups. The segmentectomy group had a higher loco-regional relapse rate (14% vs. 8%), including the surgical margin, remnant lobe, ipsilateral lung, mediastinal lymph node, and ipsilateral dissemination; however, no relapse was observed in the ipsilateral hilar lymph node. Loco-regional relapse occurred significantly later after segmentectomy than after lobectomy (median: 1,246 vs. 512 days, P=0.03), especially four years after segmentectomy. Loco-regional relapse occurred even when the tumor diameter was <1.0 cm. Most patients with loco-regional relapse had solid-dominant tumors. Segmentectomy, both intentional and compromised, showed comparable long-term outcomes to lobectomy; however, loco-regional relapse can develop in a later phase than lobectomy, requiring careful follow-up.

Comparative Efficacy and Long-Term Outcomes of Beta-Blockers Alone or in Combination With Angiotensin-Converting Enzyme (ACE) Inhibitors in Chronic Heart Failure: A Systematic Review

Comparative Efficacy and Long-Term Outcomes of Beta-Blockers Alone or in Combination With Angiotensin-Converting Enzyme (ACE) Inhibitors in Chronic Heart Failure: A Systematic Review

Abstract 4139177: Five-Year Clinical Outcomes of Balloon-Expandable versus Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Small Aortic Annulus

Introduction: Self-expanding transcatheter aortic valves (SEV) have reportedly better hemodynamic outcomes, and similar clinical outcomes compared to balloon-expanding valves (BEV) at 1 year in patients with a small aortic annulus based on results from the SMART trial. Head-to-head comparison of long-term clinical outcomes, however, is lacking. Objectives: To compare the long-term (5 years) echocardiographic and cardiovascular outcomes in BEV versus SEV in patients with small aortic annulus undergoing transcatheter aortic valve replacement (TAVR). Methodology: The RESOLVE registry included consecutive patients who underwent TAVR and survived up to 30 days at Cedars-Sinai Medical Center with either BEV or SEV from 2015 to 2020, with clinical variables obtained from the STS/TVT registry. CT core lab analysis identified patients with a small aortic annulus (&lt;430 mm 2 ), who were systematically followed up with clinical exams and echocardiography until December 2023. The primary outcome was a composite of all-cause mortality, stroke or transient ischemic attack, or heart failure hospitalization at 5 years. Results: Out of 1392 patients, a total of 423 met criteria for small aortic annulus (345 BEV, 78 SEV), with a median follow-up of 5 years (4-6 years). There were no significant differences in baseline sociodemographic and clinical characteristics between the BEV and SEV groups. (Figure 1) The post-TAVR invasive aortic valve mean gradient were similar in both groups [Median (IQR): BEV:3(1-5.8), SEV: 3.4(0.4-6.6), p 0.58], while echocardiographic gradients were higher in BEV group [Median (IQR): BEV:12 (9-15), SEV:8(6-11), p&lt;0.001)].There was no significant difference in primary outcome at 5 years in Cox multivariable regression analysis (HR:1.21, 95% CI 0.81-1.82, p 0.33) (Figure 2). There were no significant differences in other clinical endpoints at 5 years, although patients with SEV had lower echocardiographic gradients and higher indexed effective orifice area. (Figure 2-3) Conclusion: Post-TAVR invasive aortic valve gradients were similar between BEV and SEV, despite higher echocardiographic transaortic gradients in BEV patients. We found no significant difference in 5-year clinical outcomes between patients who received TAVR with BEV or SEV.

Comparative long-term outcomes of Petit-Morel versus overhead traction methods versus immediate closed reduction for late-detected developmental dysplasia of the hip: A systematic review.

This study aimed to compare the clinical and radiographic outcomes of traction to assist reduction in patients with late-detected developmental dislocation of the hip using the Petit-Morel technique versus the Bryant overhead traction technique, and to compare the clinical and radiographic outcomes of these two traction techniques with immediate closed reduction. A comprehensive systematic search of the MEDLINE/PubMed, EMBASE, and Web of Science databases was performed to identify relevant studies. Studies on Petit-Morel and overhead traction techniques and immediate closed reduction were then screened, selected, and data collected; included studies were assessed using the Methodological Index for Non-Randomized Studies criteria. In total, 22 studies met the inclusion criteria. The Petit-Morel group had a successful reduction rate of 87% while the overhead traction group had a successful reduction rate of 67.1%, and the immediate closed reduction group had a successful reduction rate of 78.4% (Petit-Morel versus overhead traction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001, Petit-Morel versus immediate closed reduction, p = 0.021). The Petit-Morel group had an overall avascular necrosis rate of 2.7%, compared to 10.6% for overhead traction and 21.5% for immediate closed reduction (Petit-Morel versus overhead traction, p = 0.001; Petit-Morel versus immediate closed reduction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001). The Petit-Morel group achieved a satisfaction rate of 86.4% according to the Severin classification, as compared to 71.2% in the overhead traction group and 76.4% in the immediate closed reduction group (Petit-Morel versus overhead traction, p < 0.001; Petit-Morel versus immediate closed reduction, p = 0.018; overhead traction versus immediate closed reduction, p = 0.195). Petit-Morel and overhead traction techniques did not outperform immediate closed reduction in terms of redislocation rates, and radiological satisfaction, the Petit-Morel technique, has lower clinically significant avascular necrosis rates than overhead traction and immediate closed reduction. Level III.

Cervical Lordosis Correction and Segmental Height in Anterior Cervical Surgeries; The Role of Implant Choice

This study aims to compare the impact of 3 surgical techniques-stand-alone cage placement (SAC), anterior cervical plate (ACP) fixation, and total disc replacement (TDR)-on cervical lordosis restoration and segmental height after anterior cervical discectomy at C5-6 level. To eliminate the effect of lordosis between different levels, patients operated on at the same level were included in the study. Restoring cervical lordosis is crucial for improving patient outcomes, including pain reduction and preventing mechanical complications. A retrospective screening of 89 patients who underwent single-level C5-6 surgery between 2011 and 2021 was analyzed. Patients were categorized into 3 groups based on the surgical technique used: SAC, ACP, or TDR. Lordotic angles and segmental heights were measured preoperatively, first-month follow-up, and at the 24-month follow-up. Statistical analysis was conducted using the Wilcoxon Signed Rank test and ANOVA, with a significance threshold set at P < 0.05. All 3 techniques resulted in significant early and late postoperative increases in both global and segmental lordosis. The early postoperative height gain was most pronounced in the ACP group. However, no significant differences in lordosis or height preservation were observed among the groups at the 24-month follow-up. These findings align with previous studies, indicating comparable long-term outcomes across these surgical approaches. SAC placement, ACP fixation, and TDR, all effectively restore cervical lordosis and segmental height after anterior cervical discectomy at the C5-6 level. Despite early differences, the long-term results were similar, suggesting that the choice of technique should be based on individual patient needs and specific surgical considerations.

Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children.

Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method. Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared. The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients. PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

Comparison of Long-Term Outcomes of Double Unit Cord Blood Versus Haploidentical Donor Transplantation in Adult Patients With Acute Lymphoblastic Leukemia Regarding KIR-Ligand Mismatch

BackgroundAlthough human-leukocyte antigen-matched sibling donor or matched unrelated donor is preferred as a conventional donor, 30%-50% of recipients lack matched sibling donor or matched unrelated donor. In such cases, haploidentical donor or cord blood are commonly considered as alternative donor sources. In addition to donor source, NK cell alloreactivity due to human-leukocyte antigen-mismatch setting is another important factor that may affect outcomes in alternative-donor HCT, possibly through graft-versus-leukemia effect. However, a limited number of studies have evaluated the impacts of these factors, focusing on adult acute lymphoblastic leukemia (ALL). ObjectivesThe objective of this study is to assess the effects of donor source and killer cell immunoglobulin-like receptor ligand mismatch (KIRL-MM) on transplantation outcomes of alternative-donor HCT, with a special focus on adult ALL. Study DesignWe retrospectively compared clinical outcomes between haploidentical donor transplantation ((HIDT), n = 47) and double unit cord blood transplantation ((DCBT), n = 134) in adult patients with ALL. Patients received fludarabine and busulfan-based reduced toxicity conditioning with antithymocyte globulin before HIDT and TBI-based myeloablative conditioning before DCBT. KIR ligands of recipients and donors were determined using a web-based calculator, and KIRL-MM was evaluated based on the KIR ligand missing. For DCBT, donor KIR ligand groups were defined by using the dominant CB unit after engraftment. ResultsCumulative incidences of acute and chronic graft-versus-host disease (GVHD) were similar between HIDT and DCBT, regardless of severity grades. After median follow-up duration of 39.4 months, DCBT showed higher 3-year nonrelapse mortality (NRM) than HIDT (22.8% vs. 9.0%; P = .038), whereas the cumulative incidence of relapse (CIR) was significantly higher in HIDT than DCBT (47.9% vs. 18.9%; P < .001). Estimated 3-year disease-free survival (DFS) was comparable (DCBT 58.5% vs. HIDT 44.3%; P = .106). GVH direction KIRL-MM showed lower incidence of acute GVHD in both HIDT and DCBT. However, GVH direction KIRL-MM was associated with poorer 3-year DFS (37.2% vs. 66.0%; P = .008) only in the DCBT subgroup, mostly due to specifically higher NRM rate (35.0% vs. 18.4%; P = 0.057). ConclusionOur study continues to support the usefulness of DCBT in the HIDT-dominant era and suggests potential ways to improve survival outcomes of DCBT.

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.

Oncologic outcomes of three-dimensional navigation-guided segmentectomy for early-stage non-small cell lung cancer >2-3 cm

BackgroundThe outcomes of segmentectomy for small (≤2 cm) non-small cell lung cancer (NSCLC) have been well demonstrated. This study aimed to investigate whether segmentectomy could achieve comparable oncologic outcomes with lobectomy for >2-3 cm lung cancer. MethodsPatients who underwent segmentectomy or lobectomy for NSCLC >2-3 cm were retrospectively screened. Segmentectomy was performed under the guidance of three-dimensional computed tomographic bronchography and angiography (3D-CTBA). The log-rank test, Cox hazard proportional regression, and propensity score matching analyses were adopted for prognostic evaluation. ResultsAmong the 430 eligible patients, segmentectomy and lobectomy were performed for 103 and 327 patients, respectively. The median follow-up time was 60.2 months. No postoperative 90-day mortality occurred. There was no significant difference in postoperative complication (grade ≥2) between lobectomy and segmentectomy (19.3% vs 16.5%, P=0.629). At 1 year or longer postoperatively, the difference in the median FEV1 and FVC reduction between the two groups was 2.3% (P<0.001) and 2.4% (P=0.028), respectively. The proportion of locoregional recurrence was 1.9% after segmentectomy and 1.8% after lobectomy. After propensity score matching, segmentectomy (n=87) conferred a similar prognosis as lobectomy (5-year DFS: 89.1% vs. 91.8%; 5-year OS: 93.3% vs. 93.0%). Further subgroup analyses showed that segmentectomy achieved comparable long-term outcomes to lobectomy even for pure solid tumors (DFS: P=0.850; OS: P=0.720) or for tumors with a solid component size >2 cm (DFS: P=0.640; OS: P=0.800). ConclusionThe 3D-CTBA guided segmentectomy could achieve equivalent long-term outcomes to lobectomy for selected cT1N0M0 NSCLC with a tumor size >2 but ≤ 3 cm.

Ten-year comparative long-term outcomes of PCI versus CABG in multi-vessel coronary artery disease

Abstract Background While coronary artery bypass grafting (CABG) is the standard treatment for patients with multi-vessel coronary artery disease (CAD), percutaneous coronary intervention (PCI) has been an alternative approach. The study aims to evaluate the long-term outcomes of PCI versus CABG in treating patients with CAD. Methods A total of 9569 patients with CAD (age 68.60±12.24 years, 81.7% men) who underwent PCI (n=7429) or CABG (n=1635) were retrospectively recruited from January 2000 to December 2014 at a tertiary medical center. Propensity score-matched analysis were conducted. The primary outcome was all-cause mortality during a 10-year follow-up duration. Results During a median follow-up duration of 6.97±4.54 years, there were 1634 deaths. Crudely, there was no difference in 10-year mortality between PCI and CABG groups (26.3% vs. 23.02%; P= 0.135). After accounting for age, renal function, previous myocardial infarction, and heart failure, the 10-year survival rate remained similar between the two groups. The subgroup analysis showed inferior outcomes with PCI than CABG if any bare-mental stent (BMS) was used (10-year risk of mortality 36.1% vs. 24.7%; P= 0.032). In addition, CABG was also associated with better survival than PCI in diabetic subjects (10-year risk of mortality 24.9% vs. 30.9%, P=0.086). In contrast, PCI demonstrated superior long-term benefits in subjects with left main (LM) and single-vessel disease, whereas CABG showed better long-term outcomes for individuals with left main (LM) and multivessel disease. Conclusions PCI demonstrated comparable long-term outcomes with CABG in treating subjects with CAD when purely drug-eluting stents were used. Any use of BMS is not encouraged to treat patients with left main or multivessel CAD. In contrast, PCI was related to superior long-term survival among patients with LM and single-vessel disease.

An international comparison of Long-term Care Facility outcomes during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic has had huge repercussions for public health internationally and different countries had different outcomes based on preconceived policy interventions. Lessons influencing future policy have been learned, notably how best to manage vulnerable populations, particularly those living in long-term care facilities (LTCFs). In Ireland LTCF residents accounted for 56% of deaths during the first wave of the pandemic and it is imperative to establish the causes of this. International research has highlighted how factors including county incidence rate, facility size, occupancy, LTCF ownership and compliance with health inspection regulations influenced LTCF COVID-19 outcomes. The aim of this research is to explore the impact of these factors in an Irish context and compare to best international standards. Methods The main outcome considered was deaths per 100 beds. Data on crude mortality were available for 580 Irish LTCFs up to 28 May 2020. Data regarding occupancy, ownership, facility size and compliance with regulations were obtained for these LTCFs from a novel dataset of 1130 available LTCF regulatory inspection reports between 2018- 2022. Regression analysis was carried out to show how LTCF mortality was predicted by examined variables. Results The most significant predictor of deaths from COVID-19 in Irish LTCFs resulting from this research was LTCF occupancy (Odds ratio:1.029, significance &amp;lt;0.001). Regional community incidence, in concordance with international literature was also an important factor. Other stated predictors in this model were either non-significant or only marginally significant. These results are analysed in conversation with international research of the same variables. Conclusions To protect LTCF residents for potential future pandemics, attention should be paid to monitoring and suppressing local incidence rates and moves should be implemented towards designing smaller facilities with individual rooms for vulnerable residents. Key messages • Irish long-term care pandemic mortality was predicted by high occupancy of facilities and high regional COVID-19 incidence. • Comparing International COVID-19 outcomes in long-term care facilities can provide guidelines for the future.