Patient Selection Criteria Research Articles

Mortality rates by therapeutic approaches for isolated severe tricuspid regurgitation: a systematic review

Abstract Background Managing isolated severe tricuspid regurgitation (TR) poses significant challenges, with questions recently arising about the efficacy of surgical and percutaneous therapies compared to conservative approaches in improving survival. Purpose This systematic review aims to evaluate the mortality associated with various treatment modalities for isolated severe TR. Methods A comprehensive search of medical databases was conducted. Studies reporting mortality of isolated TR at 1-year follow-up, with TR severity classified as moderate-to-severe or worse, were included. Exclusion criteria were TR associated with left-heart disease and combined procedures (treating other valves). The primary endpoint was all-cause mortality at 1-year, with secondary outcomes including in-hospital, 2 and 5 years mortality. Patients with isolated severe TR were categorized by management type: medical, percutaneous, or surgical. Percutaneous treatment included all types of transcatheter therapy (repair or replacement), and surgical interventions encompassed both repair and replacement procedures. Results Twenty-nine studies met the inclusion criteria. Mean age was 72 years among the 5970 patients managed medically, 77 years among the 1205 patients treated percutaneously, and 60 years among the 1754 patients managed surgically. In medically managed patients, 1-year, 2-year, and 5-year mortality rates were 23.6%, 32.5%, and 45.9% respectively. Among percutaneously managed patients, there was an in-hospital mortality of 2.5% and a 1-year mortality rate of 16.9%, which increased to 27.9% at 2 years. Surgically managed patients experienced an in-hospital mortality of 8.6% (p<0.001 compared to percutaneous treatment), with 1-year, 2-year, and 5-year mortality rates of 19.8%, 21.7% and 33.5%, respectively. Compared to medical management, both transcatheter therapy and surgical management demonstrated significantly lower mortality rates at 1 year (p<0.001 vs. percutaneous treatment; p=0.02 vs. surgery), with no significant differences between surgical and percutaneous treatment (p=0.16). At 2-year follow-up, patients undergoing surgical management exhibited significantly lower mortality compared to the other groups (p<0.001 vs. medical treatment; p=0.02 vs. percutaneous treatment), while mortality rates between medical and percutaneous treatment was not different (p=0.11). Conclusion The findings underscore the significant long-term mortality associated with isolated severe TR. While selection bias should be considered, invasive management, through either percutaneous or surgical interventions, demonstrates superior 1-year survival rates compared to medical management. Surgical therapy appears to offer the lowest long-term mortality in selected, operable patients, potentially due to their younger age. Further research is warranted to refine patient selection criteria and optimize therapeutic strategies to improve outcomes in the management of isolated TR.

Outcomes and complications of transvenous implantable cardioverter defibrillator systems in the pediatric population: a systematic review and meta-analysis

Abstract Background Implantable cardioverter defibrillators (ICDs) are an important therapy for prevention of sudden cardiac death (SCD). Data on transvenous (TV) ICD therapy rates, complications, and system survival in children ≤ 21 years is limited by absolute numbers and inclusion of adults with congenital heart disease. Purpose To determine ICD therapy rates and complications in pediatric patients ≤ 21 years of age. Methods A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline, Embase, PubMed Ahead-of-Print and in-process records, and Cochrane Database of Systematic Reviews were searched for full-text articles on pediatric ICD. Articles were assessed for inclusion by two authors via a consensus process; the exclusion criteria included: case reports, review articles, abstracts, editorials, articles not in English, articles solely on epicardial or subcutaneous leads, articles on unrelated topics, articles with <50% ICD leads, and articles with any patients >21 years old. Data were extracted by 1 author and verified by a 2nd author. Meta-analysis of aggregate data was performed, where possible. Random effects models were used for pooled inferences. All reported rates are annualized rates based on reported follow-up times in each study. Results Of 1325 articles, 23 met all inclusion and no exclusion criteria (Figure) representing 1700 patients implanted from 1987-2020. The average age of patients was 12.8 years (95% confidence interval [CI]: 11.9 – 13.7) with weight of 51.1 kg (95% CI: 42.2 – 60.0) (Table). Primary prevention was the indication in 56.4 % (95% CI: 45.0% – 67.7%). Only 14.8% (95% CI: 10.6% – 19.0%) of the patients had congenital heart disease while 22.6% (95% CI: 15.8% – 29.3%) had long QT syndrome. The annualized rate of appropriate shock was 7.0% (95% CI: 5.6% – 8.8%) and the rate of inappropriate shock was 4.8% (95% CI: 3.8% – 6.0%). Annualized rates of reported adverse events included lead failure: 2.3% (95% CI: 1.6% – 3.3%) and infection: 0.8% (95% CI: 0.4% – 1.6%), which could have led to system revision: 4.4% (95% CI: 2.1% – 9.4%). The all-cause mortality rate was 0.8% (95% CI: 0.6% – 1.2%) across 17 studies. In 9 studies with 719 patients, the heart transplant rate was 1.6% (95% CI: 0.6% – 3.9%). Conclusion In this first systematic review and meta-analysis of ICDs in pediatric patients, ICD therapy was effective for prevention of SCD with a 7.0% annualized rate of appropriate ICD shocks. This is comparable to the annualized rate of appropriate ICD shock for secondary prevention of SCD in adult randomized controlled trials. Most common adverse events in the pediatric population were lead failure and system revision. Further refinements in patient selection criteria for implantation and improvements in lead and device technology are needed for pediatric patients.FigureTable

Transanal total mesorectal excision: Understanding indications, managing complications, and effective prevention methods

AbstractTransanal total mesorectal excision (TaTME) has emerged as a surgical method for treating rectal malignancies in the middle and lower third of the rectum over the past 15 years. This approach was adopted because of the challenges encountered in secure total mesorectal excision (TME). Patient selection criteria and the rationale for TaTME have evolved, leading to improved oncological outcomes and patient quality of life. The procedure includes inserting a unique platform through the anus, forming a purse‐string closure, and endoscopically sealing the lower rectum. The mesorectum is then removed laparoscopically following a ‘down‐to‐up’ approach, finalised with a transabdominal laparoscopic phase and anastomosis. Pelvic anatomy complexity poses challenges, including potential injuries to the urinary tract, surgical site leakage, sinus damage, sagittal vein harm, nerve injury, carbon dioxide embolism, bowel function disturbance, sphincter mechanism issues, and rectal abscess formation. Proficient anatomy knowledge, precise surgical techniques, and advanced technologies contribute to their prevention. In conclusion, TaTME offers a promising approach to rectal surgery with satisfactory oncological outcomes. However, vigilance is required to eliminate potential complications.

Thursday, July 11, 20244:00 PM - 5:30 PM BP01 Presentation Time: 4:00 PM: Accelerated Partial Breast Irradiation Using Sole Interstitial Multicatheter Brachytherapy - GEC-ESTRO Phase 3 Trial: 10-year Results in Context of Current ASTRO and GEC-ESTRO Patient Selection Criteria

Thursday, July 11, 20244:00 PM - 5:30 PM BP01 Presentation Time: 4:00 PM: Accelerated Partial Breast Irradiation Using Sole Interstitial Multicatheter Brachytherapy - GEC-ESTRO Phase 3 Trial: 10-year Results in Context of Current ASTRO and GEC-ESTRO Patient Selection Criteria

Identifying the best candidate for focal therapy: a comprehensive review.

Despite the evidence supporting the use of focal therapy (FT) in patients with localized prostate cancer (PCa), considerable variability exists in the patient selection criteria across current studies. This study aims to review the most recent evidence concerning the optimal approach to patient selection for FT in PCa. PubMed database was systematically queried for studies reporting patient selection criteria in FT for PCa before December 31, 2023. After excluding non-relevant articles and a quality assessment, data were extracted, and results were described qualitatively. There is no level I evidence regarding the best patient selection approach for FT in patients with PCa. Current international multidisciplinary consensus statements recommend multiparametric magnetic resonance imaging (mpMRI) followed by MRI-targeted and systematic biopsy for all candidates. FT may be considered in clinically localized, intermediate risk (Gleason 3 + 4 and 4 + 3), and preferably unifocal disease. Patients should have an acceptable life expectancy. Those with prostate volume >50 ml and erectile dysfunction should not be excluded from FT. Prostate-specific antigen (PSA) level of < 20 (ideally < 10) ng/mL is recommended. However, the utility of other molecular and genomic biomarkers in patient selection for FT remains unknown. FT may be considered in well-selected patients with localized PCa. This review provides a comprehensive insight regarding the optimal approach for patient selection in FT.

Clinical and Electrocardiographic Predictors of Cardiac Resynchronization Therapy Response That Correlate with the 6 min Walking Test.

Background: Cardiac resynchronization therapy is an essential treatment for heart failure patients. Candidates typically have cardiomyopathy accompanied by delayed electrical activation in the left ventricular lateral wall, causing uncoordinated contractions and worsening heart failure. Heart failure severity can be assessed with functional tests: the cardiopulmonary test, which is a maximal exercise test, remains the gold standard, but the 6 min walk test has emerged as an easier, faster, and more comfortable alternative to be used by clinicians to adjust treatment protocols for cardiovascular and pulmonary conditions. Methods: This is a prospective observational study that included 69 patients from a single healthcare facility, and the purpose was to determine if the 6 min walk test results could be associated with changes in various electrocardiographic, clinical, functional, and demographic parameters. All the parameters and the 6 min walk distance were recorded at four key time moments: before the procedure and after 6, 9, and 12 months. The electrocardiographic parameters were obtained from the patients' electrocardiograms recorded in the four key moments and included variables such as QRS area, duration, percentage of biventricular pacing, and many others, while the functional variables included the monitored intraprocedural systolic blood pressure and the end-systolic left ventricular volume. We also aimed to check if clinical conditions such as diabetes and chronic kidney disease and demographic variables such as age or sex have any impact. Results and Conclusions: All this research was performed in order to identify which parameters hold a predictive value and can serve as future criteria for better patient selection and for defining a proper resynchronization outcome. The study shows that parameters such as diabetes and QRS duration have an impact over the 6 min walk distance. Also, newer variables such as the QRS area and the R/S ratio may represent a direction worth studying in order to predict the outcomes of cardiac resynchronization therapy.

Management of Extradural Dead Space During Cranioplasty—A Scoping Review

Background: Cranioplasty after craniectomy restores cerebral spinal fluid (CSF) flow dynamics, protects the brain from trauma, and restores skull contour. However, post-cranioplasty extradural dead space may persist, leading to infection and necessitating further surgical interventions. The purpose of this scoping review was to identify and analyze the existing peer-reviewed literature discussing the management of extra-dural dead space during cranioplasty. Methods: A systematic review of the literature was performed via searches of Embase, Cochrane, and PubMed in accordance with PRISMA guidelines. Included studies focused on managing extradural dead space in supratentorial cranioplasty using rigid implants or autologous bone. Studies solely using soft tissue repairs or non-primary studies were excluded. Data extraction covered study characteristics, management techniques, complications, and patient outcomes. Results: Out of 2196 articles, 135 underwent full-text review, and 28 were included, discussing 117 patients. Indications for dead space management included intractable infection (86%), syndrome of the trephined (25%), high-volume dead space (18%), persistent CSF leak (18%), and scarred dura (7%). Management techniques included muscle flaps (46%), omental flaps (14%), fat grafts (7%), and placement of non-organic materials (11%). Complications occurred in 32% of studies, including flap failure, hematoma, and CSF leak. Muscle flaps had a 22% complication rate but led to a high rate of infection resolution (97%). Conclusions: Managing extradural dead space with vascularized flaps during cranioplasty can reduce infection risk but may be associated with high complication rates. The lack of standardized practices and limited high-quality studies highlight the need for further research to establish the safety, efficacy, and best patient selection criteria for these techniques.

Modern Aspects of Endovascular Thrombectomy of Acute Ischemic Stroke. Selection Criteria for Endovascular Thrombectomy. Prediction Of Treatment Outcomes

Endovascular thrombectomy (ET) effectively and safely recanalizes the occluded artery and restores the ischemic area in patients with acute ischemic stroke (IS), improving the clinical prognosis of stroke in the anterior and posterior circulation system, expanding the time therapeutic window from no more than 6 to 24 hours, greatly increasing the chances of functional independence and survival. However, some patients develop an unfavorable postoperative outcome, complications and “ineffectiveness” of revascularization. The thrombectomy result depends not only on the patient selection criteria, timing and success of the procedure, but on many other factors as well. Despite the advances in stroke treatment, the issues of neuroimaging and patient selection for ET remain relevant; the pathophysiological mechanisms of the influence of some factors on the effectiveness of the procedure are not completely clear; the causes of “uneffective” revascularization, unfavorable outcome and mortality after ET are unclear. An analysis of global experience in treating ischemic stroke with ET showed the heterogeneity of the patient selection criteria, clinical and neuroimaging variables, prognostic factors and treatment outcomes, which makes it difficult to draw a general conclusion and requires further targeted research. The article discusses the issues of patient selection, pathophysiological mechanisms of the influence of some risk factors on the outcome of ischemic stroke and the causes of unfavorable outcome and death after ET.

Day case laparoscopic cholecystectomy: a review of patient selection factors and identification of potential barriers to same-day discharge.

Day-case laparoscopic cholecystectomy (DCLC) is a useful tool for minimizing hospital admissions and prolonged presurgical wait times in suitable patient cohorts. There have been many international studies to support this finding and an increasing interest has grown in implementation in Australia. This review aims to provide clarity how to best implement this tool in gallbladder disease patient demographic. This literature review evaluates studies on day-case cholecystectomy procedures, focusing on patient factors, procedural aspects, surgical morbidity, and systemic implications. It explores inclusion and exclusion criteria for day-case suitability, factors influencing same-day discharge, reasons for hospital admission, pain management, patient quality of life, patient satisfaction, and cost implications. DCLC, when selected judiciously, is a safe alternative to overnight stay procedures for cholecystectomy with comparable surgical outcomes and patient satisfaction, affirming its viability. Strict patient selection criteria can aid in optimizing the successful implementation procedure, reducing unexpected admissions and readmissions and we have demonstrated useful criteria for guidance in establishing day-case laparoscopic cholecystectomy protocol at a hospital.

Comparative long-term oncological outcomes of intraoperative radiotherapy vs. whole-breast irradiation in early breast cancer: a single institute study.

Intraoperative radiation therapy (IORT) and whole breast irradiation (WBI) are both effective adjuvant radiotherapy methods for ductal carcinoma in situ (DCIS) or early-stage breast cancer (BC) patients undergoing breast-conserving surgery (BCS). We aim to evaluate the long-term oncological efficacy and refine patient selection criteria based on our findings. Female patients who underwent either IORT or WBI from January 2016 to December 2019, with a minimum follow-up of 12 months were collected. IORT was administered as a single fraction of 20 Gray (Gy) to the lumpectomy cavity using the Axxent electronic brachytherapy system, while WBI consisted of a standard fractionation of 50 Gy in 25 fractions, along with a reduced boost of 10 Gy. The clinicopathologic characteristics and oncological outcomes were retrospectively analyzed. A total of 247 patients were enrolled, comprising 164 with BC and 83 with DCIS. Among them, 112 underwent IORT, and 135 received WBI after BCS. The median age was 62.2 years, with median tumor sizes of 1.5cm for BC and 1.2cm for DCIS. At a median follow-up of 64.6 months, IORT demonstrated 11 locoregional recurrences (LRR), 1 metastasis, and 1 death, compared to 4 LRR, 5 metastases, and 2 deaths in the WBI group. WBI yielded significantly higher locoregional control (97.0% vs. 90.2%, p = 0.033), although metastasis-free (96.3% vs. 99.1%, p = 0.166) and overall survival rates (98.4% vs. 99%, p = 0.688) did not differ. The LRR rate was significantly higher in the IORT group among the DCIS or BC patients (p = 0.043). The hazard ratio for locoregional recurrence significantly increased in estrogen-receptor-negative (ER-) patients in both univariate analysis (HR = 4.98, 95% CI = 1.76-14.09, p = 0.002) and multivariate analysis (HR = 40.88, 95% CI = 1.29-1297.84, p = 0.035). Additionally, IORT was associated with increased LRR in the multivariate analysis (HR = 4.71, 95% CI = 1.16-19.06, p = 0.030). At a long-term follow-up, the LRR rate was higher in the BCS followed by IORT, without significant differences in metastasis-free or overall survival rates. Our data confirmed the importance of exclusion ER- patients for IORT.

Outpatient Management Protocol for Uncomplicated Diverticulitis: A 3-Year Monocentric Experience in a Tertiary Hospital.

Background/Objectives: The management of acute uncomplicated diverticulitis (AUD) has shifted towards outpatient care in the last decade, challenging the traditional inpatient approach. We aimed to analyze the safety and feasibility of a structured outpatient treatment pathway for AUD in a tertiary hospital. Methods: We conducted a retrospective observational cohort analysis of patients who underwent outpatient management for AUD at the Geneva University Hospitals from 2019 to 2021. Patient demographics, selection criteria, treatment protocols, and outcomes were analyzed. Results: Two-hundred and twenty patients were included in the outpatient cohort. Four patients (1.8%) required hospitalization due to the failure of outpatient management, whereas the majority of patients (116 patients, 98.2%) experienced a successful resolution of their symptoms without hospitalization. In a univariate analysis, factors associated with treatment failure included elevated white blood cell counts at admission (14 G/l vs. 10.6 G/l, p = 0.049) and the first follow-up appointment, (10.7 G/l vs. 7.4 G/l, p = 0.011) and the presence of free air on their CT scan (25% vs. 2,3%, p = 0.033). In a multivariate analysis, the presence of free air was the only identified risk factor for unsuccessful outpatient management (p = 0.05). We observed high rates of follow-up compliance (99.1%). Conclusion: Under the condition of a warranted outpatient follow-up appointment and with adequate selection criteria, outpatient management appears to be an effective approach for most patients with AUD, emphasizing the importance of tailored therapeutic interventions and vigilant clinical assessments for optimal outcomes.

Long-term efficacy (at and beyond 1 year) of gastric peroral endoscopic myotomy for refractory gastroparesis: A systematic review and meta-analysis.

Although gastric peroral endoscopic myotomy (G-POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long-term data on its effectiveness are lacking. We conducted a systematic review and meta-analysis including observational studies assessing long-term efficacy after G-POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1-year after G-POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification. Thirteen studies, involving 952 patients with refractory GP undergoing G-POEM, were eligible. The pooled 1 year-clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I2 = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I2 = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1-year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I2 = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I2 = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I2 = 0%). G-POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long-term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G-POEM outcomes more accurately.

Investigating the feasibility and potential of combining industry AMR monitoring systems: a comparison with WHO GLASS.

Efforts to estimate the global burden of antimicrobial resistance (AMR) have highlighted gaps in existing surveillance systems. Data gathered from hospital networks globally by pharmaceutical industries to monitor antibiotic efficacy in different bacteria represent an underused source of information to complete our knowledge of AMR burden.. We analysed available industry monitoring systems to assess to which extent combining them could help fill the gaps in our current understanding of AMR levels and trends. We analysed six industry monitoring systems (ATLAS, GEARS, SIDERO-WT, KEYSTONE, DREAM, and SOAR) obtained from the Vivli platform and reviewed their respective isolates collection and analysis protocols. Using the R software, we designed a pipeline to harmonise and combine these into a single dataset. We assessed the reliability of resistance estimates from these sources by comparing the combined dataset to the publicly available subset of WHO GLASS for shared bacteria-antibiotic-country-year combinations. Combined, the industry monitoring systems cover 18 years (4 years for GLASS), 85 countries (71), 412 bacterial species (8), and 75 antibiotics (25). Although all industry systems followed a similar centralised testing approach, the patient selection protocol and associated sampling period were unclear. Over all reported years and countries, E.coli, K. pneumoniae and S. aureus resistance rates were in >65% of cases within 0.1 of the corresponding estimate in GLASS. We did not identify systemic bias towards resistance in industry systems compared to GLASS. High agreement values for available comparisons with GLASS suggest that data for other bacteria-antibiotic-country-year combinations only present in industry systems could complement GLASS; however, for this purpose patient and isolate selection criteria must first be clarified to understand the representativeness of industry systems. This additional source of information on resistance levels could help clinicians and stakeholders prioritize testing and select appropriate antibiotics in settings with limited surveillance data.

Primary ACL repair in a selected patient cohort: A prospective single cohort study

BackgroundAnterior cruciate ligament (ACL) tears are common knee injuries, particularly in physically active individuals. While ACL reconstruction (ACL-R) is the standard treatment, it has notable limitations. Recent interest in primary ACL repair offers a potential alternative, especially for specific tear types and patient demographics. PurposeTo evaluate the outcomes of primary ACL repair in a selected patient cohort with strict inclusion and exclusion criteria, focusing on the survival of the procedure, functional outcomes, and factors influencing success rates. MethodsThis prospective single cohort study included 61 patients who underwent primary ACL repair between June 2016 and June 2022. Patients were 50 years or younger, with recent ACL injuries and no previous knee surgeries or multiligament injuries. The primary outcomes were the survival of the repair beyond two years, measured by revision rates, and functional outcomes assessed using the Lysholm knee score, Tegner activity scale, and Lachmeter stability measurements. ResultsFifty-four patients completed a minimum follow-up of three years (average 49.6 months). The overall success rate was 82.2 %, with Sherman type 1 tears showing significantly fewer failures compared to type 2 (4.3 % vs. 31.8 %). The mean Lysholm score for successful repairs was 96, and the Tegner score dropped from a pre-injury average of 6 to 5. Adolescents had the highest failure rate (50 %), while other age groups showed better outcomes. The mean side-to-side difference in stability was 1.4 mm, favoring the control side. ConclusionPrimary ACL repair is a viable option for selected patients, particularly those with Sherman type 1 tears. While age and tear type significantly affect outcomes, the procedure shows promising results with high functional scores in successful repairs. Further research with larger cohorts and extended follow-ups is necessary to validate these findings and refine patient selection criteria. Primary ACL repair offers a less invasive alternative to ACL reconstruction, with potential for comparable outcome.

THE AGE-ADJUSTED CHARLSON COMORBIDITY INDEX FOR ACETABULAR FRACTURES IN OLDER ADULTS

This study aimed to analyze factors of comorbidity in older patients with acetabular fracture to know the role of disease in the treatment of this population. Design: Retrospective Cohort Study. Single Level 2 Trauma Center. Patient Selection Criteria: A prospective database of acetabular fractures in patients over 55 years between January 2011 and January 2021 was studied. The exclusion criteria were age, pathological fracture, associated pelvic or hip fracture, follow-up of less than one year, and not having a computed tomography. Outcome Measures and Comparisons: Patients were categorised as low (0-2), intermediate (3-4) or high (≥5) risk according to the age-adjusted Charlson Comorbidity Index (ACCI). The primary outcomes were risk of complications, number of complications and mortality at one year according to the ACCI scale. The difference between the pre-fracture Clinical Frailty Scale (CFS) and the one year follow-up was also analysed. Descriptive and multivariable regression analyses were performed and ROC curves were constructed. A total of 119 patients with acetabular fracture were collected. Ninety-eight out of those met inclusion criteria for our study. In regard to ACCI groups, 22% were low-risk, 26% were intermediate-risk, and 52% were high-risk. Statistically significant differences were found according to age, sex, mechanism of injury, treatment type, surgical treatment type, Clinical Frailty Scale (CFS) score, readmissions, complications, and mortality. ROC curves showed an association between ACCI and CFS in terms of complications and mortality, with the exception of unadjusted Charlson Comorbidity Index. On the multivariable regression analysis, associations were found between ACCI and presence of complications (OR 1.37, 95%CI 1.06-1.77, p=0.015) and mortality (OR 1.32, 95%CI 1.04-1.67, p=0.025) and between CFS and complications (OR 2.01, 95%CI 1.30-3.11, p=0.001) and mortality (OR 1.59, 95%CI 1.08-2.35, p=0.019). No statistical correlation was established between ASA and complications or mortality. Presurgical ACCI and CFS scales may serve as a risk assessment method in treatment decision-making for patients with acetabular fracture. An association is observed between patients with a pre-fracture ACCI score ≥ 5 (high-risk) and a pre-fracture CFS score > 4 (mild frailty) and mortality and complications at one year. Prognostic. Retrospective cohort study.

Examining Historical Data to Inform Future Preparedness: Systematic Review of the Effects of Prone Positioning on Oxygen Levels in Nonintubated COVID-19 Patients

Abstract Over time, there has been a significant increase in the utilization of prone positioning (PP) as a strategy to improve oxygen levels in patients requiring mechanical ventilation for the management of acute respiratory distress syndrome. PP has emerged as a potential intervention for enhancing oxygenation in nonintubated patients with COVID-19. The current systematic review aims to assess existing evidence regarding the impact of PP on oxygen parameters in this patient population. Understanding the effectiveness and possible advantages of PP in optimizing oxygenation could contribute to enhanced management strategies for COVID-19 cases, particularly those that do not require invasive mechanical ventilation. Comprehensive search was conducted using electronic databases to identify the relevant studies, covering the period of 2019–2023. A two-part tool was employed to address five specific domains alongside other potential biases. Quality assessment of diagnostic accuracy studies was undertaken using a risk of bias. In a present systematic review, 15 studies were included. The findings suggest that PP had a notable influence on oxygen parameters. The PP was a beneficial intervention for nonintubated patients of COVID-19 in terms of improving oxygen parameters. The evidence suggests that PP can contribute to enhanced oxygenation in patients. Further research is necessary for a better understanding of optimal techniques, patient selection criteria, and long-term outcomes linked with PP.

Incidence of Ipsilateral Femoral Neck and Shaft Fractures in Pediatric and Adolescent Patients

OBJECTIVES: To identify the incidence, patient characteristics, and effectiveness of radiographic screening methods for detecting ipsilateral femoral neck and shaft fractures in pediatric and adolescent trauma patients. METHODS: Design: Retrospective cohort study. Setting: This study was conducted at a tertiary pediatric trauma hospital. Patient Selection Criteria: Patients younger than 18 years treated for a femoral shaft fracture between 2004 and 2018 were reviewed. Pathologic (metabolic bone disease or bone lesion), periprosthetic, and penetrating traumatic femoral shaft fractures were excluded. Outcome Measurements and Comparisons: Patient demographics, mechanisms of injury, treatment methods, and associated injuries were analyzed. Pretreatment x-rays and computed tomography (CT) scans were reviewed for the identification of ipsilateral femoral neck and shaft fractures. RESULTS: Among the 840 pediatric patients included in this study, 4 patients (0.5%) sustained ipsilateral femoral neck and shaft fractures. All the femoral neck fractures were observed in adolescents (aged 13–17 years) and involved in high-energy traumas. In adolescents involved in high-energy trauma, the incidence increased to 1.7%. Pretreatment sensitivity of both x-rays and CT scans was only 50% for the detection of femoral neck fractures. CONCLUSIONS: This study reveals that ipsilateral femoral neck and shaft fractures in pediatric patients are rare, occurring in adolescents involved in high-energy trauma. The findings suggest the need for a selective, rather than routine, use of CT scans based on the patient's age and the mechanism of injury. The use of alternative imaging methods such as magnetic resonance imaging should be considered to balance diagnostic accuracy while minimizing radiation exposure. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Variability of the Microbiota in Chronic Rhinosinusitis: A Scoping Review.

Chronic rhinosinusitis (CRS) is characterized by a persistent inflammation of the nasal and paranasal sinus mucosa that could be potentially linked to a dysregulation between the microbiota and the immune system. We aim to explore general, methodological, and microbiological aspects of microbiota research in CRS compared to disease-free individuals. Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science. All studies comparing the composition of the resident microbiota of the sinonasal cavities in 2 groups: CRS and normal participants. We conducted systematic study selection, data extraction, and analysis first using the title and abstract, and then the full texts based on predefined inclusion and exclusion criteria. Compiled and presented findings include sampling site and technique, and microbiological results such as the relative abundance and the variability of the composition of the microbiota in both groups. Twenty-seven studies, using genomic identification with 16s RNA were analyzed. Case definitions primarily followed EPOS or AAO-HNS guidelines, with endoscopic swabs (82%), and middle meatus sampling (74%) being prevalent techniques. Despite relative abundance variability, patterns emerged across studies, indicating an increase in Haemophilus (19%) and Pseudomonas (11%), and decrease in Propionibacterium (15%) and Anaerococcus (11%). Another pattern was observed, showing a decreased alpha diversity (6/19; 22%) in CRS compared to normal individuals. While variations exist among studies, analysis of CRS microbiota suggests an association with dysbiosis, potentially contributing to chronic inflammation. Future research must prioritize standardized criteria for diagnostics and patient selection, fostering a more comprehensive understanding of CRS microbiota.

Piloting a PREMs and PROMs longitudinal survey on the integration of healthcare services for patients living with hepatitis C in Tuscany region: study protocol

IntroductionPatient-reported measures are an invaluable resource for health systems to improve the quality of healthcare services. Patients with hepatitis C virus (HCV) are an under-represented group within the stream of...

The potential of EZH2 expression to facilitate treatment choice in stage II colorectal adenocarcinoma.

The current selection criteria of patients with stage II colorectal carcinoma (CRC) suitable for adjuvant therapy are not satisfactory. Enhancer of zeste homolog 2 (EZH2) has been demonstrated to be over-expressed in CRC. However, data regarding the role of EZH2 in CRC survival remains controversial, and little is known about it in stage II CRC. Thus, we conducted this study to investigate the clinical significance of EZH2 expression in stage II CRC. Cases with stage II CRC resected between 2015 and 2018 were retrospectively reviewed. EZH2 expression was analyzed by immunohistochemistry using tissue microarrays. The relationship between EZH2 expression and clinicopathological variables was analyzed. Survival curves were estimated by the Kaplan-Meier approach. We found high EZH2 expression in 134 of 221 analyzable stage II tumors (60.63%). No significant associations were observed between EZH2 expression and common clinicopathological factors. Survival analyses showed that cases receiving surgery alone had inferior overall survival (OS) than those receiving surgery and chemotherapy (P=0.0075) in stage II CRC with high EZH2 expression, however, metastasis-free survival (MFS) was similar between these two subgroups. Treatment choice had no impact on the survival of stage II CRC with low EZH2 expression. The OS of stage II CRC with high EZH2 expression improved more strikingly with surgery and adjuvant chemotherapy than with surgery alone, which suggests the potential of EZH2 expression as a biomarker to help identify a subgroup of early-stage CRC benefiting from surgery and adjuvant chemotherapy. More large-scale studies are warranted to corroborate this finding and to further evaluate the predictive nature of EZH2.