Differences In Age Research Articles

Effects of gestational diabetes mellitus with different birth weight on genetic metabolism of newborns. A retrospective cohort study.

To investigate the effects of gestational diabetes mellitus (GDM) with different birth weights on neonatal genetic metabolism. 1252 patients with GDM diagnosed at Changzhou Maternal and Child Health Care Hospital from 2017 to 2021 were categorized into three groups: fetal growth restriction (G1), normal birth weight (G2), and macrosomia (G3). The levels of amino acids, free carnitine (CO) and acylcarnitine in neonates were detected using tandem mass spectrometry. There were no differences in age, height, predelivery weight or gravida across groups. G3 had the highest parity and fasting blood glucose levels (p < 0.0001). G1 exhibited the highest rates of cesarean section, neonatal asphyxia, and insulin utilization (p < 0.0001). Neonatal genetic metabolism analysis revealed that in G1 citrulline levels were the highest, with significantly elevated levels of leucineornithine and valine (p < 0.001). CO was also the highest (p < 0.001). The levels of isovalerylcarnitine, octanoylcarnitine and 18-carbodienoylcarnitine increased, while malonylcarnitine/3-hydroxy-butyrylcarnitine, hexadecanoylcarnitine, hexadecenoylcarnitine, 3-hydroxy-hexadecenoylcarnitine and 3-hydroxy-hexadecanoylcarnitine decreased (p < 0.05). In G2, methionine levels decreased (p < 0.001), whereas decenoylcarnitine, dodecanoylcarnitine, dodecenoylcarnitine and myristoylcarnitine levels increased (p < 0.001). In G3, proline decreased significantly (p < 0.001), and CO was the lowest (p < 0.001). Propionylcarnitine and octenoylcarnitine levels increased, whereas butyrylcarnitine decreased (p < 0.05). Gestational diabetes mellitus with different birth weights influences neonatal genetic metabolism in distinct ways. Therefore, neonatal screening for inherited metabolic disorders provides insights into the metabolic levels of offspring of patients with GDM in early life.

Preoperative CT-based Radiomics Model for Predicting Micropapillary/Solid Patterns in Stage I Peripheral Lung Invasive Adenocarcinoma: A Propensity Score Matching Study.

To develop and validate an accurate computed tomography-based radiomics model for predicting high-grade (micropapillary/solid) patterns in T1-stage lung invasive adenocarcinoma (IAC) after propensity score matching (PSM). We enrolled 546 participants from 2 cohorts with histologically diagnosed lung IAC after complete surgical resection between January 2020 and August 2021. The patients were divided into high-grade and non-high-grade groups and matched using PSM. Matched patient HRCT images were used to delineate regions of interest from tumors and extract radiomics features, and the random forest method was used to construct a radiomics model. The area under the receiver operating characteristic curve (area under the curve) was used to evaluate the model's performance, and external validation was performed to assess the model's generalizability. Before PSM, there was no statistically significant difference in age between the two groups, though nodule type and sex exhibited significant differences (P < 0.05) in both cohorts. After PSM, we matched 176 and 97 pairs of patients in the 2 cohorts. In both cohorts, sex and nodule type were equal between the two groups, with a higher percentage of males and solid nodules in both groups. Our model exhibited moderate predictive performance after PSM, with area under the curve values of 0.75 (95% CI: 0.70-0.80) and 0.71 (95% CI: 0.63-0.80) for the development and external validation cohorts, respectively. Although the nodule type compromised the validity of the model's performance, our results suggest that our acute computed tomography-based radiomics model could preoperatively predict micropapillary/solid patterns in patients with stage I lung IAC after PSM.

Wide-Awake Partial Fasciectomy for Dupuytren Contracture: A Nationwide Analysis of Adverse Events and Reimbursement

Background: Single-institution studies demonstrate reduced cost and similar outcomes for wide-awake fasciectomy compared with those with standard anesthesia. This retrospective cohort study examines these findings on a national level, comparing adverse events and cost for partial fasciectomies performed wide-awake and with standard anesthesia. Methods: Partial fasciectomies were identified in the 2010-2022 PearlDiver database. Exclusion criteria were age younger than 18 years, &lt;2 years of follow-up, inpatient surgery, and previous needle aponeurotomy or collagenase injection. Patients were stratified by anesthesia type and then matched by age, sex, Elixhauser Comorbidity Index score, geographic region, insurance, and number of fingers treated. The following postoperative events were identified: intraoperative digital nerve/vessel injury; 30-day wound complications; emergency department visits and returns for admission; and repeat fasciectomy, needle aponeurotomy, and collagenase injection within 2 years postoperatively. Total surgical reimbursement was determined by insurance type. Results: Each matched cohort included 15,689 patients with no differences in age, sex, Elixhauser Comorbidity Index score, geographic region, insurance, or number of fingers treated. Patients with wide-awake surgery had fewer 30-day emergency department visits but no differences in intraoperative nerve/vessel injury, wound complications, or returns for admission. Wide-awake patients had slightly greater rate of subsequent interventions for Dupuytren contracture within 2 years of index surgery. Wide-awake surgery was associated with markedly reduced total reimbursement. Conclusion: There is much debate about and investigation of the costs and benefits of the different treatment modalities for Dupuytren contracture. The ability to perform fasciectomies wide-awake can reduce the cost of fasciectomy without sacrificing safety. This may play an important role in treatment decisions because fasciectomy is generally considered the benchmark, yet most expensive, treatment option.

A retrospective study of injectable versus inhalation anesthesia for umbilical surgery in Japanese black calves.

Umbilical diseases are associated with a decreased market value and increased mortality in calves, and laparotomy is often performed in the field. This retrospective study compared the effects of inhalation anesthesia (INH) and injection anesthesia (INJ) during the perioperative period. We analyzed the medical records of 57 Japanese black calves that underwent laparotomy for umbilical diseases (umbilical hernia and/or umbilical cord disease) between January 2017 and December 2023. The INH group (n = 38) received continuous isoflurane inhalation with pure oxygen as a carrier gas, while the INJ group (n = 19) received only injectable anesthesia (xylazine hydrochloride and pentobarbital sodium). We investigated sex, age at first examination, diagnosis, anesthetic method, anesthetic drugs and dosages, number of rescue doses, hospital stay duration, operation time, and prognosis. The number of rescue doses was defined as the number of times sedatives or analgesics (xylazine hydrochloride, pentobarbital sodium, and butorphanol tartrate) were injected during laparotomy. There were no differences in age at first examination (p = 0.8656) and hospital stay duration (p = 0.4646) between the groups. The INJ group required significantly more rescue doses (p < 0.0001) and had longer operation times (p = 0.0643) compared to the INH group. Postoperative prognosis was not significantly different between groups (p = 0.7026). Overall, INJ required multiple rescue doses, but the difference in the method of general anesthesia did not affect the hospital stay duration or prognosis.

Laparoscopic Versus Robotic Ventral Hernia Repair – An ACHQC Database 5-Year Analysis

IntroductionTo compare laparoscopic and ventral hernia repair (VHR) in the last 5 years in the United States utilizing the Abdominal Core Health Quality Collaborative (ACHQC) database.Materials and MethodsA retrospective review of prospectively collected data from the ACHQC database was performed to include all adult patients that underwent laparoscopic and robotic VHR in the last 5 years. Univariate analysis was performed to compare outcomes from laparoscopic and robotic-assisted approaches across perioperative and postoperative outcomes.ResultsACHQC database identified 11,096 patients with midline hernias who underwent VHR with mesh. The Laparoscopic group with patients from 2018 to 2023 (LAP) had 2,063 patients, and the robotic group (ROBO) had 9,033 patients. There was no difference in sex, age, BMI, DM, smoking status and COPD between groups. Median hernia width was 4 cm (IQR 2–6) in the ROBO group and 3 cm (IQR 2–5) in the LAP group (p &amp;lt; 0.001). Incisional hernia was higher in the ROBO group 5,259 (58%) versus 1,099 (53%) in the LAP group (p &amp;lt; 0.001). Recurrent hernia was more common in the ROBO group when compared with the LAP group (p &amp;lt; 0.001). Both groups had more permanent synthetic mesh. Retromuscular repair was higher in the ROBO group, 3,201 (37.6%) versus 68 (4.2%) in the LAP group (p &amp;lt; 0.001). The intraperitoneal repair was higher in the LAP group 1,363 (83%) versus 2,925 (34%) in the ROBO group (p &amp;lt; 0.001) Transversus Abdominis Release (TAR) was higher in the ROBO group 1,314 (14.5%) versus 5 (0.2%) in the LAP group (p &amp;lt; 0.001). Fascial closure was higher in the ROBO group (8,649; 96.5% versus 1,359; 67.3% in the LAP group p &amp;lt; 0.001). Regarding mesh fixation, regular suture was higher in the ROBO group 92% versus 61% in the LAP group (p &amp;lt; 0.001). Tacks (p &amp;lt; 0.001) was higher in the LAP group. The ROBO group had more patients with an operative time of 240+ minutes when compared with the LAP group (p &amp;lt; 0.001). There was no difference in 30-days readmission rates, recurrence, reoperation, overall postoperative complications, 30-day SSI, SSO, seroma and SSOPI between the groups.ConclusionThe Robotic approach was associated with more technically challenging ventral hernia repairs with low complication rates over time. However, no differences in postoperative complications were found between the groups.

Risk factors for rifampicin-susceptible and isoniazid-resistant tuberculosis in adult patients with type 2 diabetes mellitus in Nanjing

ObjectiveGlobally, Tuberculosis(TB) with type 2 diabetes mellitus (T2DM) is becoming increasingly serious, especially the emergence of rifampicin-susceptible and isoniazid-resistant tuberculosis (Hr-TB), which increases the difficulty of treatment and the burden of disease. Therefore, this single-center retrospective cohort study analyzed risk factors of Hr-TB in adult patients with T2DM and pulmonary tuberculosis (PTB) in Nanjing to guide clinical practice and improve the long-term prognosis of patients.MethodsThe clinical data of 279 adult inpatients diagnosed with culture-positive PTB and T2DM in the Second Hospital of Nanjing from January 2019 and December 2021 were collected. According to the drug susceptibility testing (DST) results, 44 patients with Hr-TB were categorized as the Hr-TB group, while the remaining 235 patients with drug-susceptible tuberculosis (DS-TB) were classified as DS-TB group. Hierarchical logistic regression was employed for multivariate analysis to identify variables associated with Hr-TB in patients with T2DM.ResultsThere were no significant differences in age, sex, body mass index (BMI), smoking, drinking, ethnicity, education level, or comorbidities between the DS-TB and Hr-TB groups. Multivariate logistic regression analysis revealed that, history of previous tuberculosis treatment (OR = 2.348, 95%CI: 1.025 ~ 5.379, P = 0.044), poor FPG control (OR = 2.402, 95%CI: 1.208 ~ 4.776, P = 0.012), and serum iron levels ≥ 14.3µmol/l (OR = 2.808, 95%CI: 1.334 ~ 5.910, P = 0.007) are independent risk factors for Hr-TB in adult patients with T2DM in Nanjing. Within the cohort, 241 patients were Newly treatment tuberculosis patients, and among them, poor FPG control (OR = 2.296, 95%CI: 1.073 ~ 4.915, P = 0.032), and serum iron levels ≥ 14.3µmol/l (OR = 2.418, 95%CI: 1.048 ~ 5.577, P = 0.038) were identified as risk factors for Hr-TB.ConclusionPoor fasting glycemic control and serum iron levels ≥ 14.3µmol/L are independent risk factors for the development of Hr-TB in adults with T2DM and PTB, moreover, the contribution of these as risk factors were more pronounced in the newly treatment tuberculosis patients subgroup than patients with a history of previous tuberculosis treatment. History of previous tuberculosis treatment was also found to be a risk factor for Hr-TB in adults with T2DM.

Relationship Between Dipper/Non-Dipper Pattern and Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Geriatric Patients with Hypertension

Objective: Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are inflammatory markers associated with poor prognoses. Non-dipper hypertension (HT) is linked to a higher risk for cardiovascular events. This study aims to investigate the association between NLR and PLR in geriatric patients with dipper and non-dipper HT. Materials and Methods: A total of 124 geriatric patients with HT were included in the study. Based on ambulatory blood pressure monitoring, patients were categorized into two groups: non-dippers (n=62, Group 1) and dippers (n=62, Group 2). NLR and PLR were calculated by dividing the absolute neutrophil and platelet counts, respectively, by the absolute lymphocyte count. Results: There were no significant differences in sex, age, chronic conditions and smoking between the two groups (p&gt;0.005). The NLR was 1.96±0.66 in group 1 and 1.67±0.68 in group 2 (p:0.005). The PLR was 146±42.2 in group 1 and 115±34.2 in group 2 (p:0.001). The NLR and PLR were significantly higher in non-dippers compared to dippers (p

ASSESSMENT OF KNOWLEDGE, ATTITUDES, AND PRACTICES REGARDING ANTIBIOTIC USE AND RESISTANCE AMONG COMMUNITY PHARMACISTS IN SANA’A (YEMEN)

Objectives: This study aims to assess pharmacists’ knowledge, attitudes, and practices regarding over-the-counter antimicrobial use and antimicrobial resistance. Methods: We conducted a cross-sectional descriptive study using a self-administered questionnaire for pharmacists in Sana’a city, Yemen. Results: An arithmetic mean of 2.5 and a standard deviation of 1.25 rated the level of knowledge among community pharmacists in Sana’a, Yemen, concerning antibiotic use and resistance as low. We rated the attitudes toward antibiotic use and resistance among community pharmacists in Sana’a, Yemen, at a medium level, with an arithmetic mean of 3.18 and a standard deviation of 1.25. In addition, we rated the rate of practices concerning antibiotic use and resistance among community pharmacists in Sana’a (Yemen) as medium, with an arithmetic mean of 2.7 and a standard deviation of 1.08. We observed no notable differences in age, educational level, or years of experience among community pharmacists; however, we identified a significant difference in gender at a level of 0.003. There is no significant correlation between the age, educational level, years of experience, gender, and knowledge variables of community pharmacists. There exists a notable correlation between gender and attitude, alongside a weak inverse correlation between gender and practice variables. Conclusion: Community pharmacists in Sana’a, Yemen, rated their knowledge, attitudes, and practices regarding antibiotic use and resistance poorly, with an arithmetic mean of 2.5 and a standard deviation of 1.25. Community pharmacists in Sana’a, Yemen, assessed their attitudes toward antibiotic use and resistance as moderate, with a mean score of 3.18 and a standard deviation of 1.25. Ultimately, at the 0.05 significance level, there is no statistically significant correlation between the average responses of community pharmacists regarding the research variables (age, educational level, years of experience, gender) and their association with knowledge variables. We observe a statistically significant correlation between the gender variable and attitude, with a significance level of 0.005. A weak inverse correlation exists between gender and practice variables. A statistically significant correlation exists between knowledge and practice.

High Risk of Persistence and Risk of Dysplasia after Ultrashort Barrett's Diagnosis.

The management of ultrashort (< 1cm) Barrett's esophagus (BE) remains unclear. We aimed to determine the prevalence of ultrashort BE (USBE) at index diagnosis, identify factors associated with persistent BE after USBE diagnosis, and identify risk of dysplasia after initial USBE in a population of United States veterans. This was a retrospective cohort study at the Veterans Affairs hospital in Houston, TX of consecutive patients with new BE diagnosis from 11/1990 to 6/2022 with follow-up through 4/2023. Using a pathology database, we identified patients with a new USBE diagnosis and any subsequent follow up EGD. We examined the association of sociodemographic and clinical risk factors of persistent USBE cohort compared to longer length segment BE and those with a negative follow up EGD after index USBE with chi-square tests and logistic regression models. Lastly, we calculated the prevalence and incidence of any dysplasia in persistent BE after USBE at index diagnosis compared to BE≥1cm. We excluded patients without at least 1 follow up endoscopy. Of 739 patients with BE, 167 (22.6%) had USBE on index EGD. Of those with index USBE, 86 (51.5%) had persistent BE and 67 (40.1%) had negative IM on follow up EGD. There was a greater proportion of non-Hispanic white and Hispanic than non-Hispanic black patients with persistent BE after index USBE and the negative follow up EGD cohorts (p=0.012), but no significant difference in age, sex, smoking status, alcohol status, and body mass index (BMI) between the two groups. White race (adjusted aOR 3.80; 95% CI 1.35-10.7) and Hispanic ethnicity (aOR 4.85; 95% CI 1.19-19.7; ref: non-Hispanic black) were associated with an increased likelihood of persistent BE. During 3,880.7 person-years of follow-up, 112 patients (10 persistent BE after index USBE) developed definite dysplasia/neoplasia. The incidence rate of definite dysplasia/neoplasia was 19.5 per 1,000 person-years (95% CI, 10.5-36.3 per 1,000 person-years) in those with persistent BE after USBE and 33.8 per 1,000 person-years (95% CI, 27.9-41.1 per 1,000 person-years) in those with longer segment BE (p-value by log-rank test=0.23; hazard ratio 0.67; 95% CI, 0.35-1.29). We did not identify any significant predictors of dysplasia in persistent BE after index endoscopy with USBE. The prevalence of persistent BE after index USBE is high, and there is a risk of developing dysplasia/neoplasia in persistent BE after USBE. We were unable to detect a difference in the risk of dysplasia/neoplasia between persistent BE after index USBE and BE ≥1cm on index endoscopy in a cohort of United States veterans. White race and Hispanic ethnicity are associated with persistent BE after index USBE and may be target demographics for surveillance.

The attitudes of transgender and gender-diverse adolescents and their parents regarding fertility, parenthood, and fertility preservation before the start of puberty suppression or gender-affirming hormone therapy.

The attitudes of transgender and gender-diverse adolescents and their parents regarding fertility, parenthood, and fertility preservation before the start of puberty suppression or gender-affirming hormone therapy.

Effect of Genetic Ancestry on Phenotypes and Genotypes in Papillary Thyroid Cancer.

Thyroid cancer (THCA) is a prevalent health burden, and unpacking its biological and social determinants is a public health priority. Previous studies have reported inconsistent findings regarding the effects of race and ethnicity on the incidence and presentation of THCA. It remains unclear whether racial differences manifest at the molecular level. By harnessing the Cancer Genome Atlas papillary THCA dataset, this study derived genetic ancestry estimates from single nucleotide polymorphism array genotyping and exome sequencing data. Five ancestral groups (Europeans, East Asians, Africans, Native/Latin Americans, and South Asians) were included for analysis. We found a good agreement between genetic ancestry and reported race (Cramer's V = 0.730). Although differences in tumor size and patient age were observed, overall survival, progression-free interval, and disease-free interval were similar across the ancestral groups. Furthermore, the distribution of oncogenic drivers did not significantly differ among these groups. Weighted gene co-expression network analysis identified several ancestry-associated signatures. In conclusion, this study suggests that hereditary ancestral traits likely have little biological significance in papillary THCA. Instead, racial disparities in this type of cancer may be attributed to lifestyle factors, environmental exposures, and social and political power asymmetries in society and healthcare infrastructure.

Differences in Age, Stage and Biology of Breast Cancer Presentations at A Private Breast Unit in Johannesburg Before and During The COVID-19 Pandemic.

Prior to the 2020 Coronavirus disease 2019 (COVID-19) pandemic, breast cancer (BC) was already a major healthcare concern globally, including in South Africa (SA). The pandemic forced adjustments in BC management and may have also impacted BC presentation characteristics due to social behavior changes. The aim of this study was to describe BC presentations before and during the COVID-19 pandemic at a single facility in SA. A retrospective record review was conducted to compare BC presentations before and during the COVID-19 pandemic. The "before" period spanned 11 January 2019 to 31 March 2020 and the "during" period spanned 1 April 2020 to 20 December 2021. The variables analysed included patient age, BC stage at presentation, and tumor biology. A total of 731 patients were seen in the "before" period, and 636 in the "during" period. While there was a significant (p<0.0001) decrease in the mean number of patients who presented to the unit per month during the pandemic, no significant differences were observed in age, BC stage at presentation, or tumor biology between the two study periods. Despite a significant reduction in new BC cases during the COVID-19 pandemic in SA, patient age, BC stage, and tumor biology remained unchanged. The rapid implementation of digital tools for healthcare management is likely to have played an important role in maintaining patient access to care.

Observational Study of Curative Effects Between Complete Video-Assisted Thoracoscopic Surgery and Conservative Treatment for Multiple Rib Fractures in Non-Frail Chests.

Multiple rib fractures (MRFs) are common injuries and result in serious morbidity and mortality after trauma. Complete video-assisted thoracoscopic surgery (c-VATS) has been increasingly used in the treatment of MRFs. This study was to compare the clinical effects of c-VATS and conservative treatment for MRFs. 60 patients with MRFs without flail chest were selected. Patients were divided into a c-VATS group (30 cases) and a conservative treatment group (30 cases). In the c-VATS group, patients were operated on with the internal fixation of rib fracture with complete video-assisted thoracoscopic surgery. Patients in the conservative treatment group were given symptomatic treatment measures such as oxygen therapy, fluid replacement, pain relief, rib band fixation, closed chest drainage, and drug anti-infection therapy. These treatment-related indexes were retrospectively analyzed, including abbreviated injury scale (AIS) score, visual analog scale (VAS) of pain score, blood gas analysis, lung function, hospitalization cost, and fracture healing after discharge. There were no significant differences in age, sex, number of fractures, or AIS score between the two groups. Blood gas analysis and pulmonary function indices showed better improvement in the c-VATS group (p<0.05). The VAS pain score was 3.42±0.54 in the c-VATS group and 4.98±1.01 in the conservative group, indicating better pain control in the c-VATS group (p<0.05). Hospitalization time was shorter in the c-VATS group (9.54±2.61days) compared to the conservative group (12.64±3.54days) (p<0.05). Three months after discharge, follow-up evaluations revealed that the c-VATS group exhibited significantly better fracture healing (96.67%) compared to the conservative treatment group (80%) (p<0.05). The average hospitalization cost in the c-VATS group (35,689±7361) was significantly higher than that in the conservative treatment group (12,624±3638) (p<0.05). In treating MRFs, c-VATS with internal fixation resulted in significant improvements in lung function, shorter pain duration, and a lower rate of fracture malunion. c-VATS with internal fixation represents a feasible, safe, and minimally invasive surgical approach for the treatment of MRFs, which is worthy of clinical promotion.

Seasonal variation in axial elongation in children with orthokeratology treatment.

To investigate seasonal variations in changes of axial length (AL) among myopic children wearing orthokeratology (ortho-K) lenses. The data of 600 children receiving ortho-K treatment, aged 7-13 years, were collected retrospectively. Data were classified as 'summer' or 'winter' based on the midpoint of the 6-month period between visits. For each interval, AL from the right eye was used for statistical analysis. Paired sample t-tests were used to compare the seasonal differences in AL. Furthermore, the relationship between seasonal differences in AL, age and initial AL was analysed using Pearson correlation and multiple regression analysis, respectively. The AL at 1 year after the initial ortho-K treatment was 24.96 ± 0.85 mm, representing an increase of 0.19 ± 0.15 mm. The semi-annual axial elongation was 0.07 ± 0.09 and 0.12 ± 0.09 mm for the summer and winter, respectively (p < 0.001). Linear regression analysis revealed that the control of axial growth in the summer was better than in the winter (β = -0.05, p < 0.001). A similar seasonal pattern was found among children aged 7-12 years as well as for those with an initial AL < 26 mm (but not in children aged 13 years). The inhibition of axial growth by ortho-K treatment in the summer months is superior to that seen in the winter. Seasonal differences decrease with age and the initial AL.

Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the repair of osteoporotic thoracolumbar vertebral compression fractures

BackgroundOsteoporotic vertebral fractures and their complications pose increasing risks to the elderly. The purpose of this study was to evaluate the clinical efficacy of unilateral percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures (OVCF) by assessing postoperative cement distribution.ObjectiveThis study aimed to investigate the impact of cement distribution on the efficacy of vertebral compression fracture repair to provide effective preventive and therapeutic measures, prevent postoperative vertebral re-fracture, and improve surgical outcomes.MethodsA total of 170 patients who underwent unilateral percutaneous vertebroplasty at our hospital from January 2020 to December 2022 were selected. Based on the postoperative X-ray cement distribution morphology, they were divided into the good distribution group (n = 87) and the poor dispersion group (n = 83). The basic information of patients, surgery-related indicators including operation time, total hospitalization costs, postoperative hospitalization time, cement injection volume, visual analog scale (VAS) for back pain, Oswestry Disability Index (ODI) for back pain, vertebral height restoration rate, local kyphotic angle of the vertebra, and incidence of re-fracture of injured and adjacent vertebrae were compared between the two groups, and the follow-up results of all patients were recorded.ResultsThere were no significant differences in age, gender, body mass index, fracture days, menopausal age of female patients, bone density T value, medical history, smoking history, alcohol history, and surgical segments between the two groups (P > 0.05). The VAS scores for back pain at 1 month and 1 year postoperatively were significantly lower in the good distribution group than in the poor dispersion group, with statistical significance (P < 0.05). The good distribution group had a significantly lower incidence of re-fracture of injured vertebrae and overall fracture incidence than the poor dispersion group (P < 0.05). There were no statistically significant differences in operation time, cement dosage, cement leakage, postoperative hospitalization time, adjacent vertebral fractures, postoperative vertebral height restoration rate, VAS scores for back pain at preoperative and 1 week postoperative, and ODI at preoperative, 1 week, 1 month, and 1 year postoperative between the two groups (P > 0.05).ConclusionCompared with the poor dispersion group, patients in the cement distribution group achieved better short-term clinical efficacy, and long-term prognosis effects are still under observation. Moreover, the cement good distribution group significantly reduced the incidence of re-fracture of injured vertebrae and overall fracture incidence, thereby achieving better surgical outcomes.

Effect of fluency disorders on academic achievement of children at school age

BackgroundCommunication disorders pose significant barriers to interpersonal relationships during the school years. Children affected by stuttering experience lower self-esteem and struggle to form positive social connections when compared to their peers without speech difficulties. This study aimed to assess how fluency disorders impact the academic performance of school-age children.MethodsThis case-control study was conducted on 50 children aged 6 to 10.5 years with IQ ≥ 90, including both males and females. Participants were equally divided into two groups: the stutterer cases group (n = 25) and the control group (n = 25). All participants underwent a three-phase diagnostic protocol consisting of elementary diagnostic procedures (comprehensive history taking and clinical examinations), followed by clinical diagnostic aids including auditory perceptual evaluation with documentation, Illinois Test of Psycholinguistic Abilities (ITPA) to assess linguistic strengths and weaknesses, Arabic version of Stuttering Severity Instrument (SSI) to evaluate stuttering severity, and Arabic Dyslexia Assessment Test (ADAT) to assess dyslexia risk, with lower scores indicating higher risk. Additional instrumental diagnostic measures were implemented when clinically indicated.ResultsThe demographic analysis showed no significant differences in age between the case and control groups. Gender distribution differed notably, with males being more prevalent in the case group. Dyslexia was present in 44.0% of patients in the case group compared to 24.0% in the control group. Analysis revealed a correlation between stuttering severity and dyslexia. Additionally, a significant negative correlation was found between stuttering severity and mean Illinois test scores.ConclusionsWhile stuttering did not significantly affect educational achievement in learners who stutter (LWS) in comparison to the control group. Higher stuttering severity was associated with increased rates of dyslexia. Furthermore, among stutterers with dyslexia, there was a significant correlation between the severity of stuttering and the intensity of dyslexia symptoms.

Current Diagnosis and Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Review Including a Comparison of Characteristics in Europe and Japan

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a disease entity characterized by systemic vasculitis positive for ANCAs, which often leads to severe organ damage such as diffuse bronchoalveolar hemorrhage and rapidly progressive glomerulonephritis. It is known that the incidence and characteristics of AAV vary depending on region, and differences in the peak age of onset, the ratio of positive rates of MPO-ANCA to PR3-ANCA, and occurrence rates of GPA and MPA may have resulted in different approaches to clinical practice. It may also be necessary to modify therapeutic strategies according to ethnic factors. Avacopan is a therapeutic option recently recommended for the management of AAV; however, the rate of severe liver injuries associated with avacopan was reported to be relatively high in the Japanese population. In this review, we introduce current globally recognized knowledge on the diagnosis and treatment of AAV, including a comparison of patient characteristics and clinical practice between Europe and Japan obtained from the recent literature.

A Novel Surgical Technique for Post-traumatic Syringomyelia Progressing to the Medulla Oblongata: Evidence of Upward Drainage of Central Canal Fluid Within the Spinal Cord.

The exact pathways of fluid outflow within the central canal (CC) of the spinal cord are not completely understood. The best management approach for patients with post-traumatic syringomyelia that progresses to the cranial end of the CC, also known as post-traumatic syringobulbia (PT-syringobulbia), is still a topic of debate. This study aims to introduce a new surgical indication for the foramen magnum and foramen of Magendie dredging (FMDD) procedure in patients with PT-syringobulbia and prospectively assess its surgical outcomes. The study included 15 consecutive patients with symptomatic PT-syringobulbia who underwent the FMMD procedure and 20 patients who underwent traditional arachnolysis. The surgical procedure included decompression of the foramen magnum, removal of all potential intradural factors, and clearance of any possible obstructions at the foramen magnum and the foramen of Magendie. The major presenting symptoms or signs were assessed in terms of symptom improvement, stabilization, or deterioration. Preoperative MRI and postoperative MRI were used to assess syringobulbia resolution. The mean follow-up period was 24 months (range 12-60 months). Twelve patients showed clinical improvement, and 3 were stable. The mean length of the syrinx observed on preoperative MRI was 17.3 spinal levels, and the mean syringobulbia/medulla oblongata index was 69%. The mean syringobulbia/medulla oblongata index observed on postoperative MRI was 29%. The values were significantly lower than the preoperative values (P < .01). Statistical analysis revealed no significant differences in age, sex, or initial clinical/radiological presentation between the FMMD and arachnolysis groups (P > .05). However, the FMMD group showed superior outcomes compared with the arachnolysis group, including better clinical improvement, syringomyelia regression, lower complication rates, and reduced revision surgery rates (P < .01). FMMD emerges as a potentially safe and effective surgical strategy for post-traumatic syringobulbia by restoring physiological fluid outflow through the cranial end of CC in midterm follow-up.

Neurological Soft Signs at Presentation in Patients With Pediatric Acute-Onset Neuropsychiatric Syndrome

Studies of brain imaging and movements during rapid eye movement sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings that commonly present among patients with PANS could improve diagnostic accuracy. To evaluate the prevalence of neurological soft signs (NSSs) that may be associated with basal ganglia dysfunction among youths presenting with PANS and assess whether clinical characteristics of PANS correlate with NSSs that may be associated with basal ganglia dysfunction. This cohort study included 135 new patients who met strict PANS criteria and were evaluated at the Stanford Children's Immune Behavioral Health Clinic between November 1, 2014, and March 1, 2020. Data on these patients were retrospectively reviewed between December 13, 2020, and September 25, 2023. Sixteen patients were excluded because they had no neurological examination within the first 3 visits and within 3 months of clinical presentation. Statistical analysis was conducted between September 26, 2023, and November 22, 2024. The following NSSs that may be associated with basal ganglia dysfunction were recorded from medical record review: (1) glabellar tap reflex, (2) tongue movements, (3) milkmaid's grip, (4) choreiform movements, (5) spooning, and (6) overflow movements. Data from prospectively collected symptoms and impairment scales (Global Impairment Score [GIS; score range, 1-100, with higher scores indicating greater impairment] and Caregiver Burden Inventory [score range, 0-96, with higher scores indicating greater caregiver burden]) were included. The study included 119 patients; the mean (SD) age at PANS onset was 8.2 (3.6) years, the mean (SD) age at initial presentation was 10.4 (3.6) years, and 66 (55.5%) were boys. At least 1 NSS that may be associated with basal ganglia dysfunction was observed in 95 patients (79.8%); the mean (SD) number of NSSs was 2.1 (1.6). Patients with 4 or more NSSs had higher GISs (mean [SD] score, 56.0 [22.6] vs 40.6 [26.7]; P = .05) and more symptoms (mean [SD] number, 15.1 [4.9] vs 11.5 [4.2]; P = .008) than patients with 0 NSSs. There was no significant difference in age at visit or in Caregiver Burden Inventory score. On Poisson and linear regression, the number of NSSs was associated with global impairment, with 1 more sign increasing the GIS by 2.86 (95% CI, 0.09-5.62; P = .04), and with the number of symptoms, with 1 more sign increasing the number of symptoms by 5% (1.05; 95% CI, 1.02-1.08; P = .002), but not with age or duration of PANS at presentation. This cohort study of patients with PANS found a high prevalence of NSSs that may be associated with basal ganglia dysfunction and an association between these NSSs and disease severity that was not associated with younger age. PANS may have a unique profile, suggesting that targeted neurological examinations may support PANS diagnosis.

Effect of interspinous ligament fluid sign on postoperative outcome of single-level lumbar interbody fusion.

This study aims to investigate the relationship between interspinous ligament fluid (ISF) sign and low back pain, and the effect of ISF on the outcome of lumbar interbody fusion (LIF). This retrospective analysis evaluated patients who underwent single-level LIF for lumbar degeneration from January 2012 to December 2019. Patients were divided into ISF (+) and ISF (-) groups based on preoperative lumbar MRI. Data collected included demographic information, surgical data, preoperative and postoperative VAS and ODI scores, and surgical satisfaction. Imaging data assessed intervertebral disc degeneration, lumbar spondylolisthesis, and stability of surgical segments. Differences in VAS, ODI, and satisfaction scores before and after surgery were compared, and regression analysis identified imaging factors linked to residual low back pain. Two-sided p < 0.05 was considered statistically significant. A total of 328 patients participated in the study, with 108 in the ISF (+) group and 220 in the ISF (-) group. There were no significant differences in mean age, BMI, sex ratio, hypertension, or diabetes rates between the groups. However, the ISF (+) group had a significantly longer hospital stay (16.13 ± 6.83 days) compared to the ISF (-) group (14.51 ± 6.59 days) (p = 0.040). No significant differences were found in operative level, operation time, intraoperative blood loss, or complication rates. At 1 and 3 months postoperatively, VAS scores for low back pain were significantly higher in the ISF (+) group than in the ISF (-) group (p < 0.001 for both). ODI scores showed no significant differences at any postoperative time point (p > 0.05). A significant difference was observed in the proportion of patients with residual low back pain at both 1 and 3 months post-surgery, with more patients in the ISF (+) group reporting pain. Residual low back pain at 1 and 3 months post-surgery positively correlated with a positive ISF sign at the preoperative fusion level (R = 0.213, p < 0.001; R = 0.123, p = 0.025). Logistic regression analysis indicated that a positive ISF sign at the preoperative fusion level was an independent risk factor for residual low back pain at both 1 month and 3 months post-surgery [OR (95% CI) = 2.528 (1.552, 4.118), p < 0.001; OR (95% CI) = 2.146 (1.076, 4.277), p = 0.030]. A positive ISF sign observed at the fusion level may significantly influence the outcomes of lumbar fusion procedures. Specifically, the presence of a positive ISF sign is associated with an elevated risk of unfavorable early postoperative results following lumbar fusion. Furthermore, patients exhibiting a positive ISF sign are more likely to experience residual low back pain during the early postoperative phase compared to those with a negative ISF sign.