Excellent Functional Results Research Articles

Enhancing Pediatric Forearm Fracture Management: The Role of Extension Casting in Reducing Repeat Interventions

Background: Fractures of the forearm are common in the pediatric population, often requiring careful management to ensure optimal outcomes and minimize long-term complications. Among the various treatment modalities available, extension casting has emerged as a promising approach in pediatric forearm fracture management. Objective: The aim was to evaluate the effectiveness of extension casting in reducing the need for repeat interventions in pediatric forearm fractures. Methods: This study was a prospective cohort study conducted at the Department of Orthopaedics & Traumatology of Khwaja Yunus Ali Medical College & Hospital, Enayetpur, Sirajganj, from July 2020 to July 2023. A total of 60 pediatric patients, aged 5-12 years, with acute forearm fractures were enrolled. Different statistical methods were adopted in this study. All analyses were performed using SPSS version 25.0. Results: The study of 60 pediatric patients with forearm fractures showed a mean age of 8.2 years, with 60% males. Most fractures were in the middle third of the forearm (60%). At 12 weeks, 87% maintained satisfactory reduction. Only 10% required repeat interventions. PODCI scores indicated excellent functional recovery, low residual pain, and high satisfaction. Minor complications included skin irritation (6.7%) and transient nerve palsy (3.3%), with no long-term complications. Conclusion: The results of this study affirm the effectiveness and safety of extension casting in managing pediatric forearm fractures. This method not only ensures better maintenance of fracture reduction and reduces the need for repeat interventions but also yields excellent functional outcomes and low complication rates. J Rang Med Col. September 2024; Vol. 9, No. 2: 50-55

Primary Osseointegrated Free Flap in a Middle-Aged Oral Cancer Patient with Excellent Functional and Anatomical Outcomes: A Case Report

Squamous cell carcinoma (SCC) of the oral cavity is a significant global health concern, accounting for approximately 90% of all oral malignancies. This case report describes a 45-year-old male diagnosed with SCC of the right alveolus sulcus extending to the buccal mucosa. The treatment involved a multi-disciplinary team employing advanced planning and surgical techniques, including 3D Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) technology, for precise preoperative planning of the composite resection and reconstruction. This approach facilitated accurate mandibular resection, fibula flap harvest, and immediate dental implant placement, paving the way for future prosthetic rehabilitation. This report highlights the importance of comprehensive treatment planning and the integration of cutting-edge technologies in managing oral SCC. The outcome was a scarless, contoured face with excellent anatomical and functional outcomes.

Reconstruction of the Anterior Buccal Floor by a Nasolabial Flap: Report of a Case and Literature Review

Oral floor defects pose a significant challenge in reconstruction. The primary goal of reconstruction is to preserve tongue mobility, which allows for restoration of chewing, swallowing, and phonation. Current literature suggests that a nasolabial flap is a reliable treatment option for the reconstruction of this type of defect, with a low complication rate and excellent functional and aesthetic results. We present a patient who underwent resection of a gingivomandibular tumor. Due to his age, and the size of the defect, reconstruction was performed with a nasolabial flap. There were no postoperative complications. The purpose of this presentation is to demonstrate the use of the nasolabial flap for reconstruction of the floor of the mouth and to determine its advantages, disadvantages and interest compared to other surgical and microsurgical techniques.

Dual antiplatelet versus alteplase in anterior and posterior circulation minor stroke

ObjectiveThe Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy (DAPT) to alteplase in minor non-disabling stroke. This prespecified secondary analysis aimed...

Comparison of Percutaneous Techniques for Stabilization of Osteolytic Lesions of the Periacetabular Region Due to Metastatic Bone Disease.

Minimally invasive techniques for metastatic disease treatment in the periacetabular region of the pelvis have grown increasingly popular. Open surgical management of osteolytic lesions in the pelvis are associated with high perioperative complication rates that approach 30-36% and often require suspension of systemic treatment. Conservative measures, such as radiation treatment, can improve functional status in select patients while avoiding the morbidity of open surgical intervention; however, conservative measures do not address the problem of mechanical instability that can lead to pathologic fracture or loss of independence. Percutaneous techniques without fixation, including cementoplasty and ablation, can be performed by themselves or in combination with other modalities. When performed in combination, screw fixation and cement and/or ablation can provide an immediately stable, durable construct that can be used as a 'bridge' procedure to hip arthroplasty if desired. The newer technique of photodynamic balloon stabilization also offers immediate stability and allows for conversion to total hip arthroplasty, but lacks the long-term follow-up data of other modalities. Percutaneous techniques addressing periacetabular defects are less invasive and morbid than open treatment, have a variety of applications in select patients, and provide excellent functional results.

The impact of robotic surgery on the treatment of benign esophageal and gastric disease: early experience of a specialized unit.

Laparoscopic surgery is a well-established approach in the surgical treatment of reflux, hiatal hernia and esophageal motility disorders such as achalasia. Robotic platforms have only recently been incorporated in surgery for esophageal motility disorders and their exact value remains to be determined. In the present study, we present the preliminary results of our early experience with a case series of benign upper gastrointestinal diseases treated using the robotic system in our department. Data on all consecutive patients undergoing surgery for benign upper gastrointestinal tract (UGI) disease during the last 5years (01/2029-12/2023) was prospectively collected and retrospectively reviewed. All patients attended regular follow-up appointments. Patients with relapse or deterioration of their symptoms were referred for objective testing using high-resolution manometry and/or 24-h impedance pHmetry. A total of 34 patients were included in our series. Fourteen patients with achalasia underwent robotic Heller myotomy and modified Dor fundoplication, sixteen patients underwent hiatal hernia repair with fundoplication and four patients had a Nissen fundoplication for reflux esophagitis. The median postoperative Eckardt score of the patients treated for achalasia was 2 and a median GERD score of 1 was recorded for patients treated for reflux. Two patients with achalasia were evaluated with manometry due to temporary symptom relapse. The manometric findings were unremarkable. The incorporation of the robotic approach in the surgical treatment of benign UGI diseases is safe and feasible with excellent perioperative and postoperative functional results. Further experience and investigation will allow for reliable comparison to the laparoscopic approach.

Prolonged venous transit is associated with lower odds of excellent recovery after reperfusion in anterior large-vessel occlusion stroke.

Acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO) remains a leading cause of disability despite successful reperfusion therapies. Prolonged venous transit (PVT) has emerged as a potential prognostic imaging biomarker in AIS-LVO. We aimed to investigate whether PVT is associated with a decreased likelihood of excellent functional outcome (modified Rankin Scale [mRS] score of 0-1 at 90 days) after successful reperfusion. In our prospectively collected, retrospectively reviewed database, we analyzed data from 104 patients with AIS-LVO who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b/2c/3) between September 2017 and September 2022. PVT was defined as a time to maximum (Tmax) of ≥10 s in the superior sagittal sinus and/or torcula on computed tomography perfusion (CTP) imaging. Patients were categorized into PVT-positive (PVT+) and PVT-negative (PVT-) groups. The primary outcome was excellent functional recovery at 90 days. Of the 104 patients, 30 (29%) were PVT+. Excellent functional outcome was achieved in 38 patients (37%). PVT+ patients had a significantly lower rate of excellent recovery compared to PVT- patients (11% vs. 39%; p < 0.001). After adjusting for possible confounders, PVT positivity was independently associated with lower odds of excellent recovery (adjusted odds ratio 0.11, 95% confidence interval 0.02 to 0.48; p = 0.006). Among patients with AIS-LVO who achieved successful reperfusion, PVT positivity was independently associated with a decreased likelihood of excellent functional outcome at 90 days. Assessment of PVT on CTP may provide valuable prognostic information and aid in clinical decision making for patients with AIS-LVO.

Mid-term results of intra-articular calcaneal fractures treated with minimally invasive two-point distractor

Summary Background Displaced intra-articular calcaneal fractures are a complication-ridden injury to treat and there are various treatment techniques to address this injury. The aim of this study was to evaluate the mid-term outcome of a percutaneous two-point distractor technique in patients with displaced intra-articular calcaneal fractures. Methods A retrospective data analysis of patients with intra-articular calcaneal fractures treated in a level 1 trauma center was conducted. The patients were subsequently invited for a follow-up visit to assess the mid-term outcome. The Böhler’s and Gissane’s angles, the American Orthopaedic Foot &amp; Ankle Society hindfoot score, the Maryland foot score and a visual analog scale for pain were measured preoperatively and postoperatively and after at least 6 years to assess the radiological and functional outcome. Results Of the patients 59 completed the study with a mean follow-up of 76 months after surgery. The mean American Orthopedic Foot and Ankle Society hindfoot score at the last follow-up visit was 81, the mean Maryland foot score was 78. There were three cases (5%) of superficial wound complications and secondary arthrodesis of the subtalar joint was performed in five patients (8%). Conclusion The low rates of postoperative infections and secondary arthrodesis in this study underline the good to excellent mid-term functional results for a minimally invasive technique.

MEDIAL PLANTAR ARTERY FLAP FOR RECONSTRUCTION OF HEEL PAD DEFECTS

Introduction: Soft-tissue injury of heel pad is challenging to deal with due to limited reconstructive options. Masquelet and Romana described medial plantar artery flap to reconstruct heel pad with like with like tissue and with lesser donor-site morbidity. Materials and Methods: The study includes 10 patients with soft tissue defects of the heel pad who presented between 2022- 2024. The patients were followed up for a maximum period of 2 years. Results: Ten patients with soft tissue defects of the heel underwent medial plantar artery flap were included in the study. Conclusion: The medial plantar artery flap is a suitable option for the reconstruction of soft tissue defects in the weight-bearing portion of the heel, resulting in excellent functional outcomes. Source of support: Nil Conflict of interest: None.

Safety and efficacy of intravenous recombinant human prourokinase for acute ischaemic stroke within 4·5 h after stroke onset (PROST-2): a phase 3, open-label, non-inferiority, randomised controlled trial

Intra-arterial prourokinase has been shown to be a promising thrombolytic agent in patients with acute ischaemic stroke. Given the global shortage of thrombolytics, we aimed to assess the non-inferiority of intravenous recombinant human prourokinase compared with alteplase in patients with acute ischaemic stroke who were ineligible for or who refused endovascular thrombectomy. PROST-2 was a phase 3, open-label, non-inferiority, randomised controlled trial conducted at 61 hospitals in China. Patients older than 18 years with acute ischaemic stroke, who were ineligible for or who refused endovascular thrombectomy, were randomly assigned in a 1:1 ratio within 4·5 h of stroke onset to receive intravenous recombinant human prourokinase (15 mg bolus followed by 20 mg infusion within 30 min) or intravenous alteplase (0·9 mg per kg, maximum dose 90 mg; 10% bolus followed by remainder as infusion over 60 min). The primary efficacy outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days, assessed via masked review in the intention-to-treat population, with a non-inferiority margin for the risk ratio of 0·93. The primary safety outcome was the incidence of symptomatic intracranial haemorrhage within 36 h. This trial is registered with ClinicalTrials.gov (NCT05700591) and is now completed. Between Jan 29, 2023, and March 14, 2024, 1552 patients were randomly assigned: 775 received recombinant human prourokinase and 777 received alteplase. The primary outcome of a modified Rankin Scale score of 0 or 1 at 90 days was reached by 558 (72·0%) of 775 patients in the recombinant human prourokinase group versus 534 (68·7%) of 777 in the alteplase group (risk ratio 1·04 [95% CI 0·98 to 1·10]; p<0·0001 for non-inferiority). The frequency of symptomatic intracranial haemorrhage within 36 h was lower in the recombinant human prourokinase group than in the alteplase group (two [0·3%] of 770 patients vs ten [1·3%] of 775, risk difference -1·0 percentage points [95% CI -2·1 to -0·1]; p=0·021), as was the incidence of major bleeding at 7 days (four [0·5%] vs 16 [2·1%]; -1·5 percentage points (-2·8 to -0·4); p=0·0072). All-cause mortality within 7 days did not differ between groups (five [0·6%] deaths in the recombinant human prourokinase group vs 13 [1·7%] in the alteplase group; risk difference -1·0 percentage points; 95% CI -2·3 to 0·1]; p=0·060). In our trial, recombinant human prourokinase was shown to be non-inferior to alteplase for achieving excellent functional outcome, with no difference between groups in safety endpoints. These findings support the use of recombinant human prourokinase as a viable alternative to alteplase for patients with ischaemic stroke who are eligible for intravenous thrombolysis therapy but ineligible for or who have refused endovascular thrombectomy. Tasly Biopharmaceuticals, National Key R&D Program of China, National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, and Beijing Municipal Science & Technology Commission. For the Chinese translation of the abstract see Supplementary Materials section.

A minimally invasive modified revolving-door flap for surgical reconstruction of concha and antihelix defects

Skin cancers affecting the concha and antihelix are quite common, because of anterior auricular projection from the head and subsequent actinic exposure, leading to the need for effective ear reconstruction post-surgery. Various methods such as skin grafts, free tissue transplantation, and local flaps have been used. This study introduces a refined technique for concha-antihelix defect reconstruction, based on a minimally invasive modification of the revolving-door flap procedure. Here, a fasciocutaneous flap technique involving minimal posterior auricular muscle contribution is used, particularly suitable for anterior skin and cartilage defects. The study included 75 patients with nonmelanocytic skin carcinoma on the ear's anterior surface, in which we evaluated patient's and surgeon's satisfaction with a visual analogue scale and discussed the surgical technique and its advantages and indications. The technique demonstrated excellent cosmetic and functional outcomes, effectively hiding donor-site deformities and ensuring patient and surgeon contentment. This approach allows for one-stage reconstruction under local anesthesia, reducing costs, surgery time, and recovery period. The procedure provides high-quality tissue for reconstruction with low complication risks, making it an optimal choice for wide conchal and antihelix defect repairs due to its proximity to the affected area and the reliable, swift nature of the method.

Successful use of PRGF-endoret® and ILM peeling for full thickness macular hole in MacTel type 2: A case report and review of literature.

To describe the successful use of plasma rich in growth factors (PRGF-Endoret®) and internal limiting membrane peeling for full thickness macular hole in Macular Telangiectasia type 2. A case report of a full thickness macular hole (FTMH) associated with Macular Telangiectasia (MacTel) type 2 is described. 25-G vitrectomy with internal limiting membrane (ILM) peeling and use of (PRGF-Endoret®) was performed. Several ophthalmological visits were conducted and multiple diagnostic tests were carried out including optical coherence tomography (OCT) and fluorescein angiography. A 72-year-old man under follow-up for MacTel type 2 presented with worsening vision in his left eye, with a best visual corrected acuity (BVCA) of 20/80. OCT demonstrated a FTMH in the left eye measuring 264 µm. A 25-gauge pars plana vitrectomy surgery was performed with ILM peeling, use of PRGF-Endoret® and tamponade with 20% sulfur hexafluoride (SF6). Three weeks after surgery, complete anatomical closure was observed with a BVCA of 20/40, which improved to 20/25 one year after the surgery. The use of PRGF associated with ILM peeling may be a useful tool in the treatment of macular holes associated with MacTel Type 2 with excellent anatomical and functional outcomes.

A 2-Stage 6 Toe-to-Hand Transfer for the Reconstruction of Bilateral Digitless Hands.

Reconstruction of metacarpal hands remains a challenging problem for hand surgeons. In this case report, we present a middle-aged female patient with bilateral Wei Type IIB metacarpal hands secondary to severe burn injuries following a motor vehicle accident. The patient underwent a 2-stage reconstruction with big, second, and third toes transfer in each hand to restore tripod pinch. Long-term follow-up demonstrated excellent functional outcomes, with independence with all activities of daily living and minimal donor site morbidity. This is the first report of a 2-stage 6 toe-to-hand transfer in a patient with bilateral metacarpal hands. Approaching this patient's reconstruction in only 2 stages allowed for a successful outcome with fewer operations and less surgical morbidity.

Global Trends and Perspectives on Dental Fragment Reattachment (1988-2024): A Bibliometric and Altmetric Review.

Fragment reattachment in traumatic injuries is notable for its excellent esthetic, morphological, and functional results. The aim of this study was to investigate the scientific history and trends in publications on dental fragment reattachment through a bibliometric and altmetric analysis. The search was conducted in October 2024 using Web of Science. Two researchers selected articles and extracted key study characteristics. Collaborative networks were generated using VOSviewer software. Dimensions was consulted to measure altmetric data. The Spearman correlation was used. A total of 129 articles were included. The most cited article received 160 citations. Studies were published between 1988 and 2024. The leading journal was Dental Traumatology (n = 55). Case reports (n = 63) were the most frequent study design. The majority of studies aimed at clinical case follow-up (n = 71), with coronal fractures being most commonly reported (n = 96). Young patients were most affected in the selected studies (n = 49). Tewari N stood out (n = 8). The All India Institute of Medical Sciences was prominent with seven articles. Brazil was the most prevalent country (n = 29), and Asia was the most frequent continent (n = 57). Vosviewer demonstrated collaborations among authors. According to Dimensions, significant mentions were identified on Mendeley, followed by X users. This bibliometric analysis provides a comprehensive description of the technique of fragments reattachment in traumatized teeth, which has been studied for over 36 years. Studies on this technique primarily rely on case reports describing follow-up in young patients. Intervention studies and systematic reviews are recommended. Additionally, more studies in Africa, Oceania, and North America are encouraged.

Partial penectomy with reconstruction using a split-thickness skin graft: a multicenter experience.

Penile cancer is a relatively rare neoplasm in developed countries, with the majority of newly diagnosed cases presenting as organ-confined, with a 5-year survival rate of 90%. Therefore, it is crucial to consider the impact of penile tumor resection on sexual and urinary function. Regrettably, the literature is devoid of comprehensive, step-by-step video instructions for the surgical procedure of partial penectomy with reconstruction using a split-thickness skin graft (0.3 mm). This study aimed to demonstrate a step-by-step video of the partial penectomy technique with reconstruction using a split-thickness skin graft and to present the outcomes of this procedure. This multicenter study was initiated in April 2019 and completed in February 2023, enrolling 54 male patients who underwent partial penectomy and reconstruction using a split-thickness skin graft (0.3 mm). The study collected data on the local recurrence rates, overall survival, sexual and voiding functions and complications. The average patient age was 61.26 years old (range: 26-82 years). Following penile-sparing surgery, a substantial proportion of patients exhibited favorable results. Among the 54 patients, 37 (68.5%) were classified as sexually active and 50 (92.6%) demonstrated good voiding function. Excellent cosmetic outcomes were achieved in 52 patients (96.3%), and the average size of the negative resection margins was 4.75±4.162 mm (range: 0.5 to 20 mm). Notably, no positive margins were observed. Patient outcomes depend on the tumor stage and histologic grade rather than the size of the surgical margin. Partial penectomy with reconstruction using a split-thickness skin graft has excellent oncological, functional, and cosmetic outcomes.

Association of Pretreatment Perfusion Imaging Parameters With 90-Day Excellent Functional Outcomes in Anterior Circulation Distal Medium Vessel Occlusion Stroke.

Acute ischemic strokes caused by distal medium vessel occlusions (DMVO) represent a significant proportion of all stroke cases, yet the predictors of excellent functional outcomes in these patients remain poorly understood. This study aims to identify pretreatment computed tomography perfusion (CTP) parameters associated with excellent functional outcomes, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days, in patients with anterior circulation DMVO. We conducted a retrospective multicenter study involving patients with anterior DMVO, from three stroke centers within the Johns Hopkins Medical Enterprise. Baseline demographic, clinical, and imaging data were collected, with CTP parameters analyzed using RAPIDAI software. Univariable and multivariable logistic regression models were used to identify predictors of excellent outcomes. Receiver operating characteristic (ROC) curves were constructed to assess the predictive accuracy of CTP parameters. Among the 82 patients (median age, 71 years; 57% female), occlusions were located in the M2 segment in 89%, M3 in 8.5%, and A2 in 2.4%. IVT was administered to 37% of patients, and EVT was attempted in 59%. Excellent outcomes at 90 days were achieved in 45% of patients. In univariate analysis, white race (OR, 4.14; 95% CI, 1.66-10.9; P=0.003), higher CBV index (OR per 0.1-unit change, 1.45; 95% CI, 1.08-2.05; P=0.022), and lower relative cerebral blood flow (rCBF < 20%) volumes (OR, 0.91; 95% CI, 0.81-0.98; P=0.038) were significantly associated with excellent outcomes. In multivariate analysis adjusting for age, sex, race, IVT administration, EVT attempted, dyslipidemia, and premorbid mRS, higher CBV index remained a significant independent predictor (OR per 0.1-unit change, 1.72; 95% CI, 1.14-2.81; P=0.017), and lower rCBF < 20% volume was associated with better outcomes (OR, 0.91; 95% CI, 0.80-0.98; P=0.05). The multivariate model demonstrated good predictive performance (area under the ROC curve, 80%; 95% CI, 70%-90%; P < 0.001). In patients with anterior circulation DMVO, a higher CBV index on pretreatment CTP is an independent predictor of excellent functional outcomes at 90 days. These findings suggest that CTP parameters, particularly the CBV index, may be useful in prognostic assessment for this stroke population. Further studies are needed to validate these results and optimize therapeutic approaches. ABC＝ definition; XYZ＝ definition.

Paediatric Hand Fractures - A Review.

Paediatric hand fractures account for approximately 25% of hand-related emergency department visits, making them the second most common childhood fractures after distal forearm fractures. These injuries are more prevalent in boys and peak ages between 9 and 14 years. Hand fractures in children are primarily caused by crushing injuries and, increasingly in older children, by sports-related activities. The little finger (52%) and thumb (23%) are the most frequently fractured digits, with phalangeal fractures, especially of the proximal phalanx, being common. Metacarpal fractures are more prevalent in adolescents (13-16 years) compared to younger children. Accurate diagnosis in the paediatric population is complicated by difficult clinical examinations and the presence of growth plates, leading to an 8% misdiagnosis rate, mainly due to misinterpretation of the ossification centres and physes. High-quality radiographic evaluation combined with a thorough clinical assessment is critical for correct diagnosis and appropriate management. The robust periosteum and high remodelling potential of paediatric bones allow most hand fractures to be managed non-operatively with splinting or casting. However, fractures with significant angulation, rotation, intra-articular involvement or open wounds may require surgical intervention, such as closed or open reduction and internal fixation with Kirschner wires. Most paediatric hand fractures heal well with excellent functional outcomes due to the high remodelling capacity of paediatric bones. Early mobilisation and appropriate immobilisation are key to preventing stiffness. Despite the generally favourable prognosis, certain fractures remain challenging to diagnose and treat, highlighting the need for specialised care. The aim of this review article is to discuss the epidemiology, fracture patterns, diagnostic challenges and management strategies essential for optimising functional outcomes and minimising long-term complications in treating paediatric hand fractures. Level of Evidence: Level V (Therapeutic).

Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials.

The current European Stroke Organisation expedited recommendation on tenecteplase (TNK) for acute ischemic stroke (AIS) advocates that TNK 0.25 mg/kg can be used alternatively to alteplase (tissue plasminogen activator [TPA]) for AIS of <4.5 hours duration, based on a meta-analytical approach establishing noninferiority. Since the publication of these guidelines, 4 additional randomized controlled clinical trials (RCTs) have provided further insight. We conducted an updated systematic review and meta-analysis including all available RCTs that investigated efficacy and safety of TNK 0.25 mg/kg compared with TPA for the treatment of AIS within 4.5 hours of onset. The primary outcome was defined as the excellent functional outcome at 3 months (modified Rankin Scale [mRS] score 0-1), whereas good functional outcome (mRS score 0-2), reduced disability at 3 months (≥1-point reduction across all mRS scores), symptomatic intracranial hemorrhage (sICH), and 3-month mortality were evaluated as secondary outcomes. Pooled estimates were calculated with random-effects model. A prespecified subgroup analysis was performed stratifying for TNK formulation, that is, original TNK vs biocopy: recombinant human TNK tissue-type plasminogen activator that is available in China and has a different production process. Eleven RCTs were included comprising a total of 3,788 patients treated with TNK vs 3,757 patients treated with TPA. TNK was associated with higher likelihood of excellent functional outcome (risk ratio [RR] 1.05, 95% CI 1.01-1.10; p = 0.012; I2 = 0%; risk difference 2.95%; 95% CI 0.76%-5.14%; p = 0.008; I2 = 0%) and reduced disability at 3 months (common odds ratio 1.10, 95% CI 1.01-1.19; p = 0.034; I2 = 0%) compared with TPA while good functional outcome (RR 1.03, 95% CI 0.99-1.07; p = 0.142; I2 = 28%) was similar between the groups. Regarding safety outcomes, similar rates of sICH (RR 1.12, 95% CI 0.83-1.53; p = 0.456; I2 = 0%) and 3-month mortality (RR 0.97, 95% CI 0.82-1.15; p = 0.727; I2 = 12%) were observed. When stratified for TNK regimen (original vs biocopy), statistical significance in achieving an excellent functional outcome at 3 months was retained for the original TNK (RR 1.05, 95% CI 1.00-1.10; p = 0.044; I2 = 0%). The updated meta-analysis confirms similar safety between TNK 0.25 mg/kg and TPA, while showing that TNK is superior to TPA regarding excellent functional outcome and reduced disability at 3 months. These findings support transitioning to TNK in clinical practice.

Comparative analysis of risk factors and clinical outcomes in young patients with acute ischemic and hemorrhagic stroke

BackgroundStroke is a leading cause of death and disability worldwide and has significant socioeconomic impacts, particularly among young adults. This study focused on young adults (18–55 years) who experienced acute ischemic (AIS) or hemorrhagic stroke (HS) in Zanjan, Iran.MethodsA retrospective registry-based analysis was conducted using data from the Vali-e-Asr Hospital Stroke Center. A total of 5345 stroke patients were recorded between March 2016 and June 2023, and 616 young stroke survivors were included. Baseline demographic data, stroke risk factor data, functional status (modified Rankin scale (mRS) score, stroke severity (NIHSS score), treatment history, and mortality were analyzed. The statistical analyses included chi-square tests, independent t tests, and logistic regression.ResultsThe cohort comprised 525 AIS (85.23%) and 91 HS (14.77%) patients. Significant differences were observed between groups in terms of atrial fibrillation incidence, antiplatelet treatment history, hypertension, previous smoking, and recent stroke history. HS patients had a higher baseline NIHSS score (12.90 ± 6.04 vs. 7.69 ± 8.56, p < 0.05). In-hospital and three-month mortality rates were significantly greater in the HS group. Factors significantly associated with in-hospital mortality included hemorrhagic stroke, female sex, higher NIHSS score, and current smoking status. Lower odds of achieving excellent functional outcomes and functional independence at three months were noted for HS patients, influenced by NIHSS scores and prior health conditions.ConclusionYoung stroke patients, particularly those with hemorrhagic stroke, have higher mortality and poorer outcomes. The key risk factors included stroke type, NIHSS score, smoking status, and sex. Identifying and managing these factors could improve patient outcomes.

Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women

PurposeTo investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.MethodsFrom a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.ResultsThe study involved 146 patients with the median age 60 years (IQR, 51–66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.ConclusionsRobot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.