Final Outcomes Research Articles

Surgical and Non-Surgical Approach for Tear Trough Correction: Fat Repositioning Versus Hyaluronic Acid Fillers

Objective: This paper compares two popular techniques for tear trough correction—fat repositioning and hyaluronic acid (HA) fillers—highlighting their efficacy, safety profiles, patient satisfaction, and associated complications. Methods: A narrative review of 20 studies comparing fat repositioning and HA fillers was conducted, focusing on parameters such as duration of results, volume restoration, complication rates, and patient satisfaction. Results: Fat repositioning provides long-lasting results but carries higher surgical risks compared with HA fillers. The transconjunctival approach is suitable for patients with minimal skin excess. The supraperiosteal plane allows for a quicker procedure and, despite postoperative edema and temporary irregular contouring, shows no difference in final cosmetic outcomes compared with other planes. Internal fixation reduces the risk of fat relapse and skin scarring but carries the risk of suboptimal positioning. HA fillers offer immediate, minimally invasive results but require periodic maintenance. The use of a cannula reduces the risk of vascular occlusion. Combining a high G’ filler for the midface with a low G’ with low hydrophilicity for the tear trough reduces the amount of filler needed and prolongs the results. Both surgical and non-surgical methods are effective, depending on patient needs and anatomical considerations. Conclusions: Fat repositioning is ideal for patients seeking long-term correction and are willing to undergo surgery, while HA fillers suit those preferring non-invasive treatments with customizable, short-term effects. Both techniques have pros and cons that must be matched to patient goals and conditions.

Challenges and Long-Term Outcomes of Cementless Total Hip Arthroplasty in Patients Under 30: A 24-Year Follow-Up Study with a Minimum 8-Year Follow-Up, Focused on Developmental Dysplasia of the Hip

Background: Total hip arthroplasty (THA) is a well-established and effective treatment for advanced osteoarthritis (OA) of the hip joint. While commonly performed in older patients, THA is increasingly used in younger individuals, especially in cases of secondary coxarthrosis. Technological advances have led to the development of specialized implants, which allow surgeons to address severe post-inflammatory or dysplastic deformities. Younger patients undergoing THA, often in their 20s or 30s, present higher functional expectations. Despite limited long-term studies, research indicates a higher rate of revision surgeries in this age group compared to older populations, making these procedures a unique challenge. Methods: This retrospective study analyzed 5263 primary total hip arthroplasties (THAs) performed at our center between May 1985 and December 2016. After excluding cemented and hybrid implants, as well as patients lost to follow-up or with other etiologies, 101 uncemented THA procedures in 92 patients aged 30 years or younger were included. The majority (64.4%) were due to dysplastic coxarthrosis (DDH), while avascular necrosis (26.7%) and juvenile rheumatoid arthritis (8.9%) accounted for the rest. The average patient age was 25.6 years, with a mean follow-up period of over 24 years. Surgical technique involved the anterolateral approach, with implants placed in the true acetabular region. Implants included Munich/Plasmacup, Mittelmeier, and P-M designs. Implant survival was estimated using the Kaplan–Meier estimator to determine the probability of implant longevity over the follow-up period. Outcomes were assessed using Merle d’Aubigné and Postel scores, modified by Charnley, alongside radiographic evaluations based on the Crowe, De Lee, and Gruen classifications. Results: Preoperatively radiological assessment of all hips was classified as grade IV according to the Kellgren–Lawrence scale. Over an average follow-up of 24 years, final outcomes using the modified Merle d’Aubigné and Postel (MAP) classification were excellent in 24%, good in 37%, satisfactory in 8%, and poor in 32% of cases. Results compared between DDH group and control group indicate significantly more poor results for the DDH group compared to the control group (p-value < 0.05). All poor outcomes were associated with prosthesis loosening, primarily involving P-M and Mittelmeier acetabular components. Complications included intraoperative fractures in five cases, peripheral nerve dysfunction in six cases, and heterotopic ossification in eight cases. Postoperative pain scores on the VAS scale improved from 6.8 to 1.7. The Kaplan–Meier estimator indicated 10-year survival rates of 85.2% for the entire prosthesis, with 69.8% survival at 15 years and 54.5% at 20 years. For each period the bio-functionality according to Kaplan–Meier estimator was in favor of the control group. Conclusions: Cementless THA in patients aged 30 or younger has demonstrated itself to be an efficacious treatment for hip osteoarthritis, yielding favorable bio-functional outcomes in both short- and long-term follow-up. Nevertheless, THA performed in the context of developmental dysplasia of the hip (DDH) carries a significantly elevated risk of postoperative complications, most notably aseptic loosening, which critically undermines implant survival rates. Given the young demographic and the anticipated prolonged functional lifespan of the prosthesis, there is an increased propensity for loosening over time, necessitating vigilant and sustained postoperative surveillance.

The effect of self-perceived learning needs on self-regulated learning and learning outcomes in an EFL listening course

The present study explored how students’ self-perceived learning needs affected their self-regulated learning and academic achievements in an EFL listening course. The study was conducted at a stage when the intended learning objectives focused on word and phrase recognition, involving 87 Chinese college students. Self-perceived learning needs were quantified through a questionnaire, immediate learning outcomes were measured through quizzes in the course of the study, and academic achievements were measured at the beginning and end of the study. Path models that hypothesized different structural relationships among the variables were compared. The results revealed that the full effect of self-perceived learning needs on immediate outcomes could be decomposed into an indirect negative effect and a direct positive effect, attributed respectively to the descriptive and evaluative components of self-perception. The effect of self-perceived learning needs on final outcomes was mediated by immediate outcomes. Besides, qualitative evidence from six participants’ learning journals indicated that students who over-estimated their learning needs engaged more actively in the intended learning objectives, in line with the direct positive effect of self-perception on immediate outcomes. The study highlighted extra awareness of one’s learning needs as an enhancer of self-regulated learning and learning outcomes.

Anterior column realignment better restores sagittal alignment but carries higher risk of mechanical failures than lateral lumbar interbody fusion in patients with degenerative sagittal imbalance

Background of contextAnterior column realignment (ACR), a modified lateral lumbar interbody fusion (LLIF), is an emerging, less invasive technique that allows greater lordosis correction by releasing anterior longitudinal ligament. However, long-term results have been poorly documented with regard to mechanical failure, such as proximal junctional kyphosis (PJK) and rod fracture (RF), and clinical outcomes. PurposeTo compare the outcomes, primarily mechanical failure, in patients with degenerative sagittal imbalance (DSI) treated with ACR versus LLIF alone. Study design/settingRetrospective study Patient samplePatients ≥ 60 years of age; severe DSI defined by pelvic incidence (PI) - lumbar lordosis (LL) ≥ 20°; performance of ≥ 2-level LLIF; and ≥ 5 total fused levels including the sacrum. Outcome measuresMechanical failure such as PJK and RF; radiographic results; clinical outcomes MethodsEnrolled patients were divided into two groups, based on whether their anterior reconstruction was accomplished with ACR or LLIF alone: ACR and LLIF groups. Mechanical failures were compared between the two groups as a composite outcome including PJK and /or RF. PJK was defined as proximal junctional angle (PJA) >28° and Δ PJA >22°. Only RFs developing at the level with corresponding procedures (ACR or LLIF) were included in the analysis. Logistic regression was performed to compare the relative risk of mechanical failure between the ACR and LLIF groups. The radiographic and clinical outcomes were also compared between the groups. ResultsThe final study cohort consisted of 210 patients. The mean age was 69.6 years, and there were 190 females (90.5%). There were 124 patients in the ACR group and 86 patients in the LLIF group. Perioperative changes for all sagittal parameters were significantly greater in the ACR group than in the LLIF group. Overall mechanical failure rates were significantly higher in the ACR group than in the LLIF group (32.3% vs. 14.0%, P = 0.003). Multivariate regression analysis with adjusting potential confounders revealed that ACR carried a significantly higher risk of mechanical failure than LLIF (Odds ratio = 5.6, 95% confidence interval = 2.0 – 15.6, P < 0.001). The final clinical outcomes were worse in the ACR group than in the LLIF group. ConclusionACR restored the sagittal malalignment more powerfully than did LLIF. However, compared to the LLIF, ACR was associated with a greater risk of mechanical failures and revision surgery. The final clinical outcomes in the ACR group were inferior to those in the LLIF group. Therefore, ACR should be left as a last resort for the cases where it is expected that an adequate correction cannot be achieved using LLIF alone. If ACR has to be performed, it is necessary to establish feasible surgical strategies to avoid mechanical failures.

Microbiological Aspects and Clinical Impact of Lower Lung Field Tuberculosis: an Observational Cohort Study in Peru.

Approximately 40% of tuberculosis (TB) cases remain undiagnosed globally. Lower lung field tuberculosis (LLF TB) presents atypically and is often misidentified as other lung diseases, leading to diagnostic delays in resource-limited settings. It may contribute to increased TB transmission and mortality. We aimed to identify microbiological determinants of LLF TB and evaluate treatment responses to optimize care. We conducted an observational cohort study in Lima, Peru, enrolling adults with microbiologically confirmed pulmonary TB (PTB) diagnosed by GeneXpert MTB/RIF assay or sputum culture. Mycobacterium tuberculosis (MTB) lineage was determined using whole-genome sequencing (WGS). Due to the delayed chest radiograph (CXR) changes in LLF TB compared to non-LLF TB, we measured changes in the St. George's Respiratory Questionnaire (SGRQ) score at two-month treatment mark and evaluated World Health Organization (WHO)-specified final treatment outcomes. We used logistic regression to evaluate the associations between LLF TB and microbiological determinants and treatment outcomes. We used linear regression to assess whether the change in SGRQ scores over the first 2 months of treatment varied by LLF TB status. Among 1,316 PTB patients, 84 (6%) had LLF TB. Compared to non-LLF TB patients, LLF TB patients were more likely to be smear-negative (adjusted odds ratio [aOR] [95% CI]=2.04 [1.28-3.23], p=0.002) and to be infected with Lineage 2 (aOR [95% CI]= 1.95 (95% CI: 1.07 to 3.41; p=0.024). People with LLF TB had less improvement in SGRQ scores after two months of treatment (adjusted score difference [95% CI] = -6.29 [-10.99 to -1.59], p = 0.009), while they experienced better final outcomes compared to non-LLF TB patients, though this difference did not reach statistical significance (adjusted odds ratio [aOR] = 0.43 [95% CI: 0.13 to 1.05], p = 0.103). Patients with LLF TB are more likely than those with upper lung lesions to be sputum-negative on conventional tests, to be infected with Lineage 2, and to show less clinical improvement after treatment.

Phase I/II Investigator-Initiated Study of Olaparib and Temozolomide in SCLC: Final Analysis and CNS Outcomes.

Temozolomide plus PARP inhibition has shown promise in small cell lung cancer (SCLC). We previously reported outcomes from the first 50 patients (cohort 1) of a phase I/II trial of olaparib/temozolomide in recurrent SCLC. Here, we report a final analysis of this trial, including a second cohort with an alternate dosing strategy and an exploratory analysis of CNS-specific outcomes. This was an open-label phase I/II trial testing the combination of olaparib and temozolomide in relapsed SCLC. The primary endpoint was ORR. Secondary endpoints were safety, PFS, and OS. We tested escalating doses of olaparib/temozolomide across two cohorts, both of which had temozolomide dosed on D1-7 of each 21-days cycle. In previously published cohort 1, olaparib was dosed on D1-7; in cohort 2 olaparib was dosed continuously. Sixty-six patients were enrolled across the two cohorts, 50 in cohort 1 and 16 in cohort 2. The confirmed ORR of cohort 1 was 41.7% (20/48 evaluable), and the confirmed ORR of cohort 2 was 7% (1/14 evaluable; closed after dose escalation to enrollment for lack of observed efficacy). Among 15/66 patients (22.7%) with untreated brain metastases at enrollment, best overall intracranial response was CR in 6/15 patients, PR in 4/15 patients, and SD in 3/15 patients for a CNS disease control rate of 87% (95% CI: 59.5-98.3%). Olaparib/temozolomide may be effective in relapsed SCLC, especially for patients with CNS disease. Ongoing analyses regarding optimal dosing schedule will inform potential for future use of this combination in SCLC.

Bayesian Empirical Likelihood Regression for Semiparametric Estimation of Optimal Dynamic Treatment Regimes.

We propose a semiparametric approach to Bayesian modeling of dynamic treatment regimes that is built on a Bayesian likelihood-based regression estimation framework. Methods based on this framework exhibit a probabilistic coherence property that leads to accurate estimation of the optimal dynamic treatment regime. Unlike most Bayesian estimation methods, our proposed method avoids strong distributional assumptions for the intermediate and final outcomes by utilizing empirical likelihoods. Our proposed method allows for either linear, or more flexible forms of mean functions for the stagewise outcomes. A variational Bayes approximation is used for computation to avoid common pitfalls associated with Markov Chain Monte Carlo approaches coupled with empirical likelihood. Through simulations and analysis of the STAR*D sequential randomized trial data, our proposed method demonstrates superior accuracy over Q-learning and parametric Bayesian likelihood-based regression estimation, particularly when the parametric assumptions of regression error distributions may be potentially violated.

Evolution of the Guided Direct Composite Resin Technique in Restorative Dentistry: A Systematic Review.

This systematic review aims to understand the limitations and benefits of the guided direct restorative technique, to optimize the final outcomes, considering the evolution from analog to digital, including planning, the diversification of guides, and the different resins employed. A search was conducted in the electronic databases PubMed, Cochrane, and through manual searches, initiated in May 2023 and updated in April 2024. The following search strategy was used: ((injectable composite resin) OR (direct pressed composite)) OR (3D-guided), utilizing the PICO framework. Initially, 739 articles were retrieved. After applying inclusion and exclusion criteria, 33 studies were considered suitable for data extraction, including 12 in vitro studies and 21 case reports or technique descriptions. The articles focused on comparisons of techniques, flowable, heated, and conventional resins, as well as various technique reports with variations in guides, materials, and planning, potentially aiding clinicians in more effective and safer execution of this restorative technique. The utilization of digital workflows presents greater solutions to the challenges of the guided direct restorative technique. Understanding the properties of the resins used is crucial for the results and should be chosen according to the patient's needs. A guided direct restorative procedure can deliver previously planned dental treatment based on individualized planning. This method ensures greater reproducibility in aesthetics and occlusion, resulting in superior quality work for the patient.

Early clubfoot recurrence can lead to more frequent and earlier second recurrences.

The frequency of multiple clubfoot recurrences following Ponseti casting and the effect on final outcomes have not been well studied. This study aims to evaluate the effect of early recurrence (during the first 2 years) on the timing and rate of subsequent recurrences. A retrospective review was conducted of children treated with Ponseti casting at a single institution from 2002 to 2023 with minimum follow-up until age 5. Patients who required comprehensive soft tissue surgery to obtain initial correction were excluded. Patient-Reported Outcomes Measurement Information System data were collected when available. A total of 86 patients were included; 69.8% (60) had idiopathic clubfoot. Average follow-up was 5.8 years. Early recurrence (recurrence before age 2) occurred in 26.7% (23). The rate of late recurrence (recurrence after age 2) was higher in the early recurrence group, 73.9% (17) vs. 39.7% (25), P = 0.005. Survival analysis revealed that patients with early recurrence experience late recurrence at a younger age of 3.9 vs. 6.7 years, P ≤ 0.001. The early recurrence group experienced more frequent recurrences, with a median of 3 [interquartile range (IQR): 1-5] total recurrences vs. 0 (IQR: 0-1), P ≤ 0.001. Patients with early recurrence had lower final mobility scores, 40.83 ± 10.88 vs. 48.00 ± 10.60, P = 0.029. In conclusion, this study suggests that early clubfoot recurrence leads to more frequent subsequent recurrence and earlier second recurrence. Patients with early recurrence had comparatively lower outcome scores, primarily due to multiple recurrences. Care providers could use this knowledge to educate parents about the natural history of recurrent clubfeet and emphasize the importance of brace compliance and routine monitoring.

Application of Two-Dimensional NMR for Quantitative Analysis of Viscosity in Medium–High-Porosity-and-Permeability Sandstones in North China Oilfields

The viscosity of crude oil plays a pivotal role in the exploration and development of oil fields. The predominant reliance on laboratory measurements, which are constrained by manual expertise, represents a significant limitation in terms of efficiency. Two-dimensional nuclear magnetic resonance (NMR) logging offers a number of advantages over traditional methods. It is capable of providing faster measurement rates, as well as insights into fluid properties, which can facilitate timely adjustments in oil and gas development strategies. This study focuses on the loose sandstone reservoirs with high porosity and permeability containing heavy oil in the Huabei oilfield. Two-dimensional nuclear magnetic resonance (NMR) measurements and analyses were conducted on saturated rocks with different-viscosity crude oils and varying oil saturation levels, in both natural and artificial rock samples. This study elucidates the distribution patterns of different-viscosity crude oils within the two-dimensional NMR spectra. Furthermore, the T1 and T2 peak values of the extracted oil signals were employed to establish a model correlating oil viscosity with NMR parameters. Consequently, a criterion for determining oil viscosity based on two-dimensional NMR was formulated, providing a novel approach for estimating oil viscosity. The application of this technique in the BQ well group of the Huabei oilfield region yielded an average relative error of 15% between the actual oil viscosity and the computed results. Furthermore, the consistency between the oil types and the oil discrimination chart confirms the reliability of the method. The final outcomes meet the precision requirements for practical log interpretation and demonstrate the excellent performance of two-dimensional nuclear magnetic resonance (NMR) logging in calculating oil viscosity. The findings of this study have significant implications for subsequent exploration and development endeavors in the research area’s oilfields.

Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry

BACKGROUND Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study investigates the impact of primary reperfusion techniques—stent retriever classic, stent retriever combination with aspiration, and direct aspiration—on procedural and clinical outcomes at different occlusion sites. METHODS Using data from the ASSIST registry, a prospective multinational initiative, patients with anterior circulation acute ischemic stroke with large vessel occlusions (n = 1477) were included. Three primary occlusion sites—M1 segment of the middle cerebral artery, M2 segment of the middle cerebral artery, and the internal carotid artery—were studied. Univariate tests and multivariable logistic regression models were used to assess associations between reperfusion techniques and procedural and clinical outcomes, including the expanded thrombolysis in cerebral infarction score and the modified Rankin Scale, stratified by occlusion site. RESULTS Achieving expanded thrombolysis in cerebral infarction ≥2c after first pass was lower in internal carotid artery occlusions (18.2%, P &lt;0.0001) with direct aspiration alone compared with stent retriever classic (38.2%) or stent retriever combination with aspiration (43.3%), while no differences were seen for M1 segment of the middle cerebral artery ( P = 0.77) and M2 segment of the middle cerebral artery ( P = 0.29) occlusions. Bailout maneuvers, which were more frequent in the direct aspiration group for all occlusion sites, did not result in longer procedure times or different final recanalization outcomes in direct aspiration compared with stent retriever classic or stent retriever combination with aspiration. Overall, there were no differences in the rate of patients with modified Rankin Scale scores of 0–2 at 90 days. No differences in safety outcomes were observed. CONCLUSIONS This study provides insight into the complex relationship between reperfusion techniques and occlusion sites in patients with acute ischemic stroke and shows that certain techniques have advantages in certain occlusion sites. As the field evolves, further research is warranted to refine our understanding of these dynamics and inform clinical practice.

Supra-pectineal quadrilateral buttress plating versus infra-pectineal plating in the management of quadrilateral plate fractures: A randomized controlled trial.

Management of quadrilateral plate fractures is technically demanding and requires specific fixation techniques. Infra-pectineal plating is the gold standard method of fixation. However, we recorded a high incidence of medial wall displacement and reoperations. Therefore, the aim of our study was to identify whether supra-pectineal quadrilateral buttress plating provides much more rigid fixation with a better functional and radiological outcome or not. The authors conducted this prospective, randomized control, single-blinded study at a level 1 single trauma centre. Between March 2022 and June 2023, 34 patients with quadrilateral plate fractures had anterior fixation, either via the anatomical QLP (17 cases) or infra-pectineal plating (17 cases) (Groups A and B, respectively). The radiological and clinical outcomes, as well as residual medial wall displacement, were the primary outcomes. The mean follow-up was 14.47months in group A and 15.24months in group B. In group A, the mean operative time (p = 0.02) was shorter, and the mean blood loss (p < 0.001) was significantly lower. However last follow-up showed no statistically significant differences as regards residual medial wall displacement (p = 1.0), final radiological (p = 0.86), and clinical outcomes (p = 1.0). Authors concluded that the anatomical QLP made it easier to reduce and fix acetabular fractures with a displaced medial wall. This was done by using multidirectional screws in the posterior column through its infra-pectineal extension and a strong screw purchase aimed at the posterior column through its supra-pectineal part. The two groups were similar in terms of final radiological and clinical outcomes, as well as residual medial wall displacement rates. However, the QLP had less morbidity than the classic infra-pectineal plating (shorter operation time and less blood loss).

Equilibria and the protomodel of the Sun’s atmosphere by Karl Schwarzschild in hindsight

The concepts of radiative and adiabatic equilibria, introduced by Karl Schwarzschild in his seminal paper Ueber das Gleichgewicht der Sonnenatmosphäre published in January 1906, are the founding blocks of the theory of radiative transfer, stellar structure, and solar physics. Careful reading of the paper and its later English translation reveals small formal inaccuracies and ambiguities but with no consequences whatsoever for the final outcomes and conclusions. This paper offers their adjustments with respective derivations using contemporary formalism and sets Schwarzschild’s paper in context with a historical and modern perspective. Particular attention is paid to Schwarzschild’s largely forgotten limb-darkening formula for adiabatic equilibrium. The paper also reproduces Schwarzschild’s radiative equilibrium protomodel of the Sun’s atmosphere in graphical form and compares it with modern models presented in some of the most cited papers in stellar and solar physics.

Comparison of clinical efficacy between reconstruction of the superior acromioclavicular ligament with acellular dermal allografts and clavicular hook plate in acromioclavicular dislocations

Purposes: We aimed to compare the clinical efficacy of superior acromioclavicular ligament reconstruction (SALR) using acellular dermal allograft with that of clavicular hook plate fixation (HP) in patients with acromioclavicular (AC) dislocations. We hypothesized that the SALR could provide more stability than hook plate. Methods: Twenty-two cases of acute AC joint dislocation between November 2021 to December 2023 were retrospectively reviewed. All patients were divided into 2 groups based on the treatment with SALR (12 cases) or HP (10 cases). Patients were evaluated radiologically and clinically using coracoclavicular distance and ratio, pain visual analogue scale (PVAS), Single Assessment Numerical Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) at postoperative 3 months and 1 year. We evaluated whether patient achieve MCID of PVAS at the last visit, based on the minimal clinically important differences (MCIDs) of PVAS. Results: The SALR group showed a lower rate of reduction loss (8.3 % vs. 40.0 %) and similar clinical outcomes compared to the hook plate group. Initial SANE score was statistically significantly lower in SALR group (SANE: SALR, 45.8 ± 20.7; HP, 68.0 ± 15.5, p = 0.009), but there were no significant differences in final clinical outcomes, including PVAS, ASES, and SANE scores. Conclusion: SALR with acellular dermal allograft demonstrates comparable clinical outcomes to hook plate fixation and may offer a viable alternative, especially in complicated cases. Study Design: Case series; Level of evidence, 4.

Randomised trial of three treatments for amblyopia: Vision therapy and patching, perceptual learning and patching alone.

Active vision therapy for amblyopia shows good results, but there is no standard vision therapy protocol. This study compared the results of three treatments, two combining patching with active therapy and one with patching alone, in a sample of children with amblyopia. Two protocols have been developed: (a) perceptual learning with a computer game designed to favour the medium-to-high spatial frequency-tuned achromatic mechanisms of parvocellular origin and (b) vision therapy with a specific protocol and 2-h patching. The third treatment group used patching only. Fifty-two amblyopic children (aged 4-12 years), were randomly assigned to three monocular treatment groups: 2-h patching (n = 18), monocular perceptual learning (n = 17) and 2-h patching plus vision therapy (n = 17). Visual outcomes were analysed after 3 months and compared with a control group (n = 36) of subjects with normal vision. Visual acuity (VA) and stereoacuity (STA) improved significantly after treatment for the three groups with the best results for patching plus vision therapy, followed by monocular perceptual learning, with patching only least effective. Change in the interocular difference in VA was significant for monocular perceptual learning, followed by patching. Differences in STA between groups were not significant. For VA and interocular differences, the final outcomes were influenced by the baseline VA and interocular difference, respectively, with greater improvements in subjects with poorer initial values. Visual acuity and STA improved with the two most active treatments, that is, vision therapy followed by perceptual learning. Patching alone showed the worst outcome. These results suggest that vision therapy should include monocular accommodative exercises, ocular motility and central fixation exercises where the fovea is more active.

Exploring the use of wearable sensors for assessing risk factors during orthopedic surgeries: A protocol for data collection

During orthopedic surgeries, surgeons are generally exposed to prolonged periods of standing, awkward and sustained body postures, and forceful movements, which can increase the likelihood of developing work-related musculoskeletal disorders (WRMSD). Therefore, this study proposes a protocol to measure parameters related to physical risk factors contributing to lower limb WRMSD, during orthopedic surgery procedures. The protocol development was preceded by an initial phase of understanding and specifying the context of use, followed by pre-tests in laboratory environment. It integrates a motion capture system, using inertial measurement units (IMU) to collect posture data from hip, knee, and ankle, and electromyography system (EMG) to measure and record data from muscle activity of biceps femoris, rectus femoris, and gastrocnemius lateralis. Pre-tests provided insights for protocol optimization, estimating a 3-hour data collection session per surgery due to sensor battery limitations, streamlining the process by placing EMG sensors before IMU and refining thigh sensor placement strategies. The protocol presents an opportunity for a real-time and quantitative approach to monitor surgeon's exposure to risk factors contributing to lower limb WRMSD while performing surgical procedures. Two months after pre-tests, the protocol implementation began in a real work context. The study's final outcomes fall outside the paper's scope.

Follow-Up Outcomes of Children, Adolescents, and Young People on Darunavir-Based Third-Line Antiretroviral Therapy: Observational Cohort From 9 African Countries.

We assessed clinical outcomes among children, adolescents, and people younger than 25 years on darunavir-based antiretroviral therapy (ART) in 9 sub-Saharan African countries. Third-line ART centers in Cameroon, Eswatini, Kenya, Lesotho, Nigeria, Rwanda, Uganda, Zambia, and Zimbabwe. From January 2019 to December 2022, we collected data from a cohort of children, adolescents, and young people receiving third-line ART from 9 sub-Saharan African countries. Data on treatment continuity, viral suppression, death, and clinic transfers were extracted from medical records and summarized. Cox proportional hazards models were used to identify factors independently associated with retention in care. Of 871 participants enrolled, the median age was 14.8 (range: 0.2-24.7) years and 488 (56.0%) were male; 809 (92.9%) [median duration of follow-up of 28.3 months (interquartile range: 17.5-45.2)] had final outcomes after initiating third-line ART. Of these, 711 (87.9%) were alive and in care at the end of study follow-up, 29 (3.6%) died, 30 (3.7%) were transferred to other facilities, and 39 (4.8%) were lost to follow-up. Retention in care was less likely among male patients compared with female patients [aHR: 0.85, 95% confidence interval: 0.72 to 1.0] and in 10-14-year-old children compared with younger children. Adolescents (15-19 years old) had higher mortality compared with children younger than 10 years (aSHR: 4.20, 95% confidence interval: 1.37 to 12.87). Viral suppression was seen in 345/433 (79.7%), 249/320 (77.8%), and 546/674 (81.0%) patients with results at 6 months, 12 months, and study end, respectively. A high proportion of children and young people receiving third-line ART in sub-Saharan Africa remain in care and attain viral suppression during follow-up.

Ultra-Widefield Fluorescein Angiographic Features Influencing Visual Prognosis in Coats Disease.

To investigate the retinal vascular abnormalities in both affected and fellow eyes of presumed unilateral Coats disease patients using ultra-widefield fluorescein angiography (UWF-FA) and their association with visual prognosis. A retrospective review of medical records was conducted on 30 patients diagnosed with presumed unilateral Coats disease, who were evaluated with UWF-FA from March 2003 to May 2024 at a tertiary referral hospital. Clinical features and multimodal imaging findings were evaluated, and factors related to final visual outcomes were analyzed. All 30 patients were diagnosed with presumed unilateral Coats disease at presentation, comprising 11 childhood-onset (36.7%) and 19 adult-onset patients (63.3%). Retinal vascular telangiectasia was observed in 51.7% of the fellow eyes. The extent of telangiectasia and exudate in the affected eyes did not significantly correlate with the extent of telangiectasia in the fellow eyes. In the more affected eyes, the childhood-onset group had a significantly greater extent of capillary dropout compared to the adult-onset group (5.0 clock hours vs. 2.8 clock hours, p = 0.023). In the fellow eyes, telangiectasia tended to be more frequent in the childhood-onset group, without statistical significance (63.6% vs. 44.4%, p = 0.160). In the multivariable regression analysis, the final best-corrected visual acuity (BCVA) in the more affected eyes was significantly associated with initial BCVA. The mean extent of telangiectasia in the temporal and nasal quadrants (odds ratio, 12.759; p = 0.043) and the initial BCVA of the more affected eyes (odds ratio, 11.841; p = 0.024) were identified as prognostic factors for final moderate to severe visual loss (Snellen BCVA <20 / 66). About half of the presumed unilateral Coats disease cases exhibited features of the bilateral disease. Visual prognosis is associated with the peripheral retinal telangiectasia in the temporal and nasal quadrants as well as initial BCVA in the affected eyes while it is not associated with retinal vascular abnormalities in the fellow eyes.

Clinical Features and Visual Outcome of Infectious Keratitis Associated with Orthokeratology Lens in Korean Pediatric Patients.

To investigate the clinical features and visual outcome of infectious keratitis associated with orthokeratology (Ortho-K) lens in Korean pediatric patients. We retrospectively reviewed medical records of patients diagnosed with Ortho-K lens-related infectious keratitis from June 2005 to April 2020 at a tertiary referral hospital. Patients' demographics, clinical features, microbiological evaluation, and treatment methods were assessed, and factors related to final visual outcomes were analyzed. The study included 26 eyes from 26 patients (19 female and 7 male patients; mean age, 11.9 years), with an average Ortho-K lens wear duration of 33.7 ± 21.2 months. The highest number of cases occurred in summer (11 of 26 cases, 42.3%). Central or paracentral corneal lesions were observed in 25 cases (96.2%), with a mean corneal epithelial defect size of 5.13 mm2. Pseudomonas aeruginosa was the most commonly isolated organism (n = 5), followed by Serratia marcescens (n = 4). All patients responded to medical treatment without needing surgical intervention. 72% of cases achieved favorable visual outcomes (Snellen best-corrected visual acuity [BCVA] >6 / 12), while 8% experienced severe visual impairment (Snellen BCVA ≤6 / 60) due to residual central corneal opacities. Multivariable analysis showed that non-summer seasons (p = 0.043), duration from symptom onset to presentation (p = 0.040), and corneal epithelial defect size (p = 0.002) were significantly associated with final logarithm of the minimum angle of resolution BCVA. Failed autorefraction at presentation due to an Ortho-K-related infectious keratitis lesion was a significant predictor of poor final visual outcome (Snellen BCVA ≤6 / 12; odds ratio, 38.995; p = 0.030). Ortho-K lens-related infectious keratitis can lead to permanent corneal opacities and potentially devastating visual outcomes in children. Delayed time to presentation, large corneal lesions, failure of autorefraction, and non-summer seasons were associated with poorer outcomes. Proper education and early detection would be key to safe use of orthokeratology lenses in pediatric patients.

Capmatinib in MET exon 14-mutated non-small-cell lung cancer: final results from the open-label, phase 2 GEOMETRY mono-1 trial

Capmatinib has previously shown activity in treatment-naive and previously treated patients with non-small-cell lung cancer (NSCLC) and a MET exon 14-skipping mutation (METex14). Here, we report the final outcomes from the phase 2 GEOMETRY mono-1 study with an aim to provide further evidence for the activity of capmatinib. In this non-randomised, multi-cohort, open-label, phase 2 trial conducted in 152 centres and hospitals in 25 countries, with patients treated in 95 centres in 20 countries, eligible patients (aged ≥18 years) with MET-dysregulated, EGFR wild-type, and ALK rearrangement-negative advanced NSCLC (stage IIIB/IV) and an Eastern Cooperative Oncology Group performance status of 0 or 1 were assigned to cohorts (1a, 1b, 2, 3, 4, 5a, 5b, 6 and 7) based on their MET status (METex14 or MET amplification) and previous therapy lines. Patients received capmatinib (400 mg orally twice daily) in 21-day treatment cycles. The primary endpoint was overall response rate by blinded independent central review per Response Evaluation Criteria in Solid Tumours version 1.1 and was performed on the full analysis set (all patients who received at least one dose of capmatinib). Previous reports of this study had published interim or primary data for cohorts 1-7. Here, we report the final clinical outcomes from all METex14 cohorts (4, 5b, 6, and 7) and safety from all study cohorts (1-7). The trial is registered with ClinicalTrials.gov, NCT02414139, and has been completed. Of 373 treated patients enrolled from June 11, 2015, to March 12, 2020, 160 (97 [61%] female) patients had METex14 NSCLC and were enrolled in four cohorts: 60 treatment-naive (cohorts 5b and 7) and 100 previously treated (cohorts 4 and 6). The overall median study follow-up was 46·4 months (IQR 41·8-65·4) for the treatment-naïve patients and 66·9 months (56·7-73·9) for previously treated patients, respectively. Overall responses were recorded in 41 (68%; 95% CI 55·0-79·7) of 60 treatment-naive patients and 44 (44%; 95% CI 34·1-54·3) of 100 previously treated patients. In all 373 treated patients, the most common treatment-related adverse events were peripheral oedema (n=174; 47%), nausea (n=130; 35%), increased blood creatinine (n=78; 21%), and vomiting (n=74; 20%). Grade 3-4 serious adverse events occurred in 164 (44%) patients, dyspnoea being the most common (18 patients [5%]). Treatment-related deaths occurred in four (1%) patients (one each of cardiac arrest, hepatitis, organising pneumonia, and pneumonitis). No new safety signals were reported. These long-term results support METex14 as a targetable oncogenic driver in NSCLC and add to the evidence supporting capmatinib as a targeted treatment option for treatment-naive and previously treated patients with METex14 NSCLC. Novartis Pharmaceuticals.