Fisher's Test Research Articles

Does combination of urodynamic reduced bladder capacity and detrusor overactivity warrant spinal cord magnetic resonance imaging in children with persistan enuresis: a prospective study.

This study aims to evaluate the necessity of spinal cord magnetic resonance imaging (MRI) in children with persistent enuresis, specifically those presenting with urodynamically reduced bladder capacity (RBC) and detrusor overactivity (DO), in comparison to children with normal urodynamic findings. We evaluated 586 children admitted for bedwetting, all of whom received urotherapy and/or pharmacotherapy. Persistent enuresis, lasting for over one year, was identified in 134 patients who were subsequently re-evaluated for occult neurological conditions and recommended for urodynamic studies (UDS). In total, 92 patients provided informed consent and underwent UDS. Of these, 40 patients were divided into two cohorts based on UDS findings. All patients were over 6 years of age and had normal physical examinations. The first cohort consisted of 23 children RBC and DO, while the second cohort included 17 children with normal UDS findings. All participants underwent spinal cord MRI with a 3 Tesla scanner. Urodynamic and MRI results were compared using Fisher's chi-square test. The median age of the cohort was 11 years, with 26 (65%) of the patients being female. Spinal disorders were identified in 10 patients (25%), with 8 cases of spina bifida without neurological compression and 2 cases of tethered cord. In the RBC + DO cohort, 7 out of 23 patients (30.4%) were found to have spinal disorders, compared to 3 out of 17 patients (17.6%) in the normal UDS cohort, with no statistically significant difference between the groups (p > 0.05). When evaluating persistent enuresis nocturna, a combination of RBC and DO in children with nocturnal enuresis and daytime symptoms may warrant spinal cord MRI, though with limited cost-effectiveness.

Comparing the Functional Analysis of Baska® Mask with I-gel in Short Surgeries - A Prospective Randomized Trial.

We have compared sealing pressure, usability, and complications of two second-generation supraglottic airway devices-Baska® mask and I-gel. The study design involves prospective randomized controlled trial. The study was undertaken involving 44 patients of the American Society of Anesthesiologists physical status I and II, aged 20-70 years, who underwent surgical procedures of short duration under general anesthesia. Patients were randomly categorized into two groups of 22 each: Group B (Baska® mask) and Group I (I-gel). The main objective was to compare oropharyngeal leak pressure (OLP). Continuous variables were compared between the two groups using an unpaired t-test. Categorical variables were compared using the Chi-square test and insertion attempts using Fisher's exact test. Group B had significantly higher mean OLP (32.22 ± 2.52 cmH2O vs. 26.18 ± 2.42 cmH2O, P < 0.001). In Group I, 97.1% of patients had very easy insertion (Grade 1), 2.9% had easy insertion (Grade 2) and Group B had very easy insertion in 50% of patients, easy in 36.4%, and difficult in 13.6% of patients (P = 0.009). Group B took a longer time for successful insertion than Group I (39.89 ± 7.15 s vs. 28.19 ± 3.29 s, P < 0.001). For positive pressure ventilation, both I-gel and Baska® masks proved to be successful, with I-gel being easier and quicker to insert. It is possible to employ the Baska® mask with superior seal pressures as an alternative to endotracheal intubation in elective surgeries if there are no patient contraindications.

Comparison of outcomes in dogs undergoing hiatal hernia repair with and without use of a gastropexy: 41 cases (2012-2022).

To determine the difference in complication rate, gastrointestinal grade and requirement for ongoing medical and/or surgical management following hiatal hernia repair in dogs with and without gastropexy. Clinical records were reviewed retrospectively for dogs that had undergone surgical hiatal hernia repair at two veterinary referral centres between April 2012 and March 2022. Pre-operative grading of gastrointestinal signs and brachycephalic obstructive airway syndrome was performed. All dogs had an oesophagopexy and phrenoplasty. Referring primary veterinary practices and clients were contacted to obtain follow-up information. Fisher's exact tests and Mann Whitney tests were used to assess pre- and intra-operative similarities between groups. Wilcoxon signed rank tests were used to determine the changes in gastrointestinal grade at short- (<6 months) and long-term (>6 months) follow-up. Forty-one dogs which underwent oesophagopexy and phrenoplasty were included. Fifteen dogs had no gastropexy performed and 26 dogs had left-sided gastropexy performed. Dogs that underwent gastropexy(n=8, 29%, 95% CI: 13 to 51%) were significantly more likely to require further surgery related to the initial surgery or persistence of gastrointestinal signs compared to dogs that had no gastropexy (n=0, 0%, 95% CI: 0 to 18%) . This difference was not significant when dogs which had further surgery to address brachycephalic obstructive airway syndrome were excluded. Gastrointestinal grade significantly improved for both groups at both short- and long-term follow-up. There was no significant difference in overall complication rate, gastrointestinal grade or requirement for further medical treatment between groups. A left-sided gastropexy is not required for successful surgical repair of hiatal hernia in dogs provided oesophagopexy and phrenoplasty are performed.

Perspectives of osteopathic medical students on preclinical urology exposure: a single institution cross-sectional survey.

There is an increasing number of medical school graduates opting for surgical specialties, and the osteopathic applicant match rate for urology is lower than that of allopathic applicants. Factors influencing this may include alack of interest, perceived challenges in matching into urology, insufficient urology mentorship, limited research opportunities, and inadequate osteopathic representation in urology. The objective of this survey is to assess osteopathic medical students' perspectives on pursuing urology and enhancing preclinical exposure to and knowledge of urology. A 20-question survey addressing experiences andthe factors influencing osteopathic medical students' specialty selection and their interest in and perception of urology was designed by the investigators on Research Electronic Data Capture (REDCap) software. This survey was distributed via email listserv to all current osteopathic medical students attending Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine over 2months. Responses were collected and analyzed utilizing Fisher's exact test. Among 150 respondents, 91 % found mentors crucial in selecting a medical specialty, 95 % emphasized the importance of early exposure, and 68 % lacked familiarity with urology, with more M1 students unfamiliar with urology compared to M2 (70.4 % vs. 59 %). A larger proportion of combined M1 and M2 (preclinical) students are considering urology as a specialty compared to M3 and M4 (clinical) students who are actively on rotations (56.5 % vs. 28.6 %; p=0.0064). Also, a greater percentage of males are considering urology compared to females (64.2 % vs. 42.7 %; p=0.0164). Among those considering urology (n=75), 57.3 % lack awareness of urology's scope, and 84 % report no preclinical discussions with urologists. Those students who report that they are considering urology value early exposure significantly more than others (98.7 % vs. 78.7 %; p=0.0001). They also express greater interest in having acore urology course (73.3 % vs. 38.7 %; p<0.0001). More urology-considering students are interested in extracurricular urology-related workshops, seminars, or conferences (61.3 % vs. 17.3 %; p<0.0001). Students who are considering urology as a specialty show greater interest in having a mentorship program (85.3 % vs. 28 %; p<0.0001). Results suggested that increased urology exposure during the preclinical years is important. Urology elective offerings and urology mentorship are of high interest among those considering urology. However, additional investigation is needed to determine the impact ofpreclinical urology curricula implementation on urology match outcomes.

Evaluating the impact of loperamide on irinotecan-induced adverse events: a disproportionality analysis of data from the World Health Organization pharmacovigilance database (VigiBase).

SN-38, the active metabolite of irinotecan, may cause adverse events necessitating treatment discontinuation and management. Diarrhea, which is treated with loperamide, is one such event. However, loperamide may delay SN-38 elimination, causing more adverse events. Therefore, understanding the adverse events caused by symptomatic drugs is crucial for safe drug therapy. This study aimed to assess the association between loperamide and irinotecan-induced adverse events. We analyzed data up to December 2022 from VigiBase, the World Health Organization's adverse event database. The study used reporting odds ratios (RORs) to evaluate the associations between concomitant medications and irinotecan-induced adverse events. Fisher's exact probability test was used to analyze the adverse events. Logistic regression analysis was performed to identify associated adverse event signals. Of the 32,520,983 cases analyzed, 57,454 involved the use of irinotecan. Among these, 1589 (2.8%) patients were co-treated with loperamide. Signals for neutropenia (ROR 1.37, 95% confidence interval (CI) 1.20-1.57, p < 0.001), anemia (ROR 1.81, 95% CI 1.43-2.30, p < 0.001), and alopecia (ROR 1.89, 95% CI 1.30-2.74, p < 0.01) were detected with concomitant loperamide. Multivariate logistic regression analysis confirmed that concomitant loperamide use was associated with signals for neutropenia, anemia, and alopecia. Our results suggest that loperamide increases the risk of irinotecan-induced adverse events and enhances irinotecan toxicity. The study methodology may be useful for predicting adverse event risk when choosing symptomatic therapy drugs during irinotecan use.

Comparison of endovascular infrapopliteal revascularisation strategies based on the angiosome model in diabetics with CLTI.

Background: Infrapopliteal endovascular interventions (EVT) strategies in diabetic patients are still in debate because the lesions are more likely to be diffuse with a different pattern of collateral arteries ranging from reduced to normal caliber. The aim of this all-comers study was to analyse the outcome of two different infrapopliteal EVT strategies (Group I: angiosome-based direct revascularization - DR vs. Group II: complete (direct + indirect) revascularization strategy - CR) in diabetic patients with chronic limb-threatening ischemia (CLTI) in 2 time-periods. Furthermore we analysed the outcome if DR or CR failed and only indirect revascularization (IR) or no revascularization was possible. Both groups were differentiated in patients with collaterals, defined as an intact pedal arch (immediate or after pedal PTA). Patients and methods: The database includes 91 consecutive EVT with two intrapopliteal interventional strategies performed in 68 diabetic patients (pts. 24 female, 44 male, mean age 73±10 years) between 2013-2016 and 2017-2022. Positive clinical outcome was defined as wound healing with or w/o minor amputation, combined with a symptom improvement to Rutherford category 0 or 1 after 6 months. The clinical outcome proportions were compared using the Fisher's exact test. Results: Successful DR (59%) and successful CR (47%) strategy demonstrated a similar positive clinical outcome (92.6% vs. 90.5%; p=0.594). Indirect revascularization (Group I: 26%; Group II: 44%) showed a significantly lower positive outcome in comparison to a successful DR as well as CR strategy (33.3% vs. 92.6%, p=0.0003; 40% vs 90.5%, p=0.001). IR outcome improved by the presence of collaterals (66.7% vs. 30.8%). Conclusions: In case of successful intervention, both strategies (DR and CR) yielded a similarly high proportion of positive clinical outcome. The role of collaterals and the pedal arch on the clinical outcome are important in patients in whom only IR was possible.

Investigating patient satisfaction with a hand therapy telehealth service during COVID-19.

Throughout the COVID-19 pandemic, outpatient hand therapy services were restricted. The use of telehealth was adopted to continue to provide care to patients with hand injuries. This survey aims to investigate patient satisfaction with hand therapy delivered via telehealth in a NSW public tertiary referral metropolitan setting and explore whether this differs for specific hand injury/conditions and treatments offered. Patients using hand therapy services via telehealth between 28 June 2021 and 27 May 2022 responded to a bespoke electronic survey. Participants were grouped depending on their particular injury/condition and treatment received. Analysis was conducted using MS Excel, and correlations were determined by using Fisher's exact test. No consumers were involved in the study design or analysis. Sixty-eight of 262 patients responded to the survey (26% response rate). Overall results showed high patient satisfaction (n = 55, 81%) with hand therapy delivered via telehealth with most patients agreeing that telehealth should be offered going forward (n = 59, 87%). Benefits reported by patients included convenience, reduced travel time and parking issues, and time saving. Patients receiving therapy for 'finger thumb bony injury with K wires' demonstrated a statistically significant association of lower satisfaction with telehealth (n = 3, 43%, P = 0.02). Patients receiving wound care over telehealth were just as satisfied with their experience (n = 15, 82%) as overall results (n = 55, 81%). The survey suggests that patients are satisfied with their experience of telehealth for hand therapy. Patients with finger thumb bony injuries with k wires may be less suitable for telehealth. Wound care appears to be well received over telehealth in a hand therapy population. There is little evidence to guide hand therapists in which conditions or injuries patients find can be managed well with telehealth. Patients who answered a survey about their experience with telehealth for their hand therapy management overall reported satisfaction with the experience. Some patients had undergone surgery for broken fingers and thumbs using wires to hold the bone together while it healed. These patients were less likely to find telehealth satisfactory for their hand therapy care. Most patients requiring wound care over telehealth found this satisfactory.

Prevalence of Malnutrition and Micronutrient Deficiencies in Older Adults with Ulcerative Colitis.

The nutritional status and consequences of malnutrition among older adults with ulcerative colitis (UC) are not known. We conducted a retrospective study of patients 65years ≥ with Ulcerative colitis (UC). Malnutrition was defined using the European Society for Clinical Nutrition and Metabolism (ESPEN) definition. Eight micronutrients and nutrition-related outcomes were measured. The Saskatchewan Inflammatory Bowel Disease-Nutrition Risk Tool was utilized to identify patients at risk for malnutrition. Data were summarized using descriptive statistics. Characteristics of patients with and without malnutrition were compared using Chi-Square test or Fisher's exact tests (analysis of variance for age). Two-hundred and ninety patients with a mean age of 73.4years were included. 54% of patients had moderate-to-severe UC, with 52% receiving advanced therapy. Fifty-one patients (18%) met criteria for malnutrition, 17% were moderate-high risk for malnutrition, and 87% were low risk. Two-hundred and twenty patients (76%) had at least one micronutrient deficiency: 38% vitamin D, 43% iron, and 11% B12. Half of patients had osteoporosis or osteopenia (49%), however, only 39% of high-risk patients had undergone a DEXA scan. The majority of patients were not found to have malnutrition, however, the prevalence of micronutrient deficiencies among older adults with UC was high. This population is at particularly high risk for bone-related disease, yet a significant proportion of patients are not undergoing guideline-directed bone density testing. These findings illustrate the need for regular screening for malnutrition, micronutrient deficiency, and bone-related disease in older adults with UC.

Evaluation of β-Blocker-Induced Bradyarrhythmia Using an Analysis of the Japanese Adverse Drug Event Report Database.

β-Adrenergic receptor blockers (β-blockers) are used to treat hypertension, ischemic heart disease, chronic heart failure, and tachyarrhythmia. The main side effects of treatment include bradycardia, atrioventricular block, and hypotension. Bradycardia may result in pacemaker implantation as well as the discontinuation of β-blockers. Bradycardia is difficult to confirm at a single institution because it diagnosed only by symptoms when electrocardiogram (ECG) are not routinely performed. Previous studies reported an increase in bradycardia in heart failure patients treated with β-blockers; however, limited information is currently available for non-heart failure patients. Bradycardia induced by β-blockers has not yet been comprehensively examined. Therefore, the present study investigated data on the incidence and duration of bradyarrhythmia caused by β-blockers using the Japanese Adverse Drug Event Report database (JADER). Cases of adverse effects associated with this medication were extracted from JADER and Fisher's exact test was performed to assess whether each β-blocker caused bradyarrhythmia. In addition, only data from patients who reported bradyarrhythmia after β-blocker treatment were extracted, and the Weibull distribution was used to analyze the time-to-onset of bradyarrhythmia. Thirteen β-blockers caused bradyarrhythmia and signals were observed for 12 drugs, except nadolol. Bradyarrhythmia induced by oral β-blockers was more likely to be of the early failure type, and developed within 2 months of treatment initiation with most β-blockers. A comprehensive analysis of bradyarrhythmia with β-blockers suggests that careful monitoring is needed, particularly early in the initiation of treatment.

Clinical and Humanistic Burden of IgAN in Adult Patients: A Global Real-World Survey.

Immunoglobulin A nephropathy (IgAN) is a chronic, progressive kidney disease in which proteinuria, reduced estimated glomerular filtration rate (eGFR), pain and fatigue are common. How symptoms interact and impact patient quality of life (QoL) in real-world practice is poorly studied. This study investigated how patient and physician symptom perceptions differ and how proteinuria and eGFR correlate with pain, fatigue, and QoL in adult IgAN patients. Data were drawn from the Adelphi IgAN Disease Specific Programme™, a cross-sectional survey of physicians and their biopsy confirmed IgAN patients in China, France, Germany, Italy, Spain, the United Kingdom, United States, and Japan, from June-October 2021. Physicians provided demographics and clinical characteristics, including pain and fatigue severity. The same patients completed a self-completion form containing questions on symptom severity, the EQ-5D-5L, Kidney Disease Quality of Life, and Work Productivity and Activity Impairment questionnaires. Symptom scores were grouped by severity and patients grouped by proteinuria and eGFR. Analysis of variance, chi-squared or Fisher's exact tests were performed as appropriate and Dunn's multiple comparisons with Bonferroni adjustment for pair-wise comparisons. Overall, 1515 patients were included (mean [standard deviation] age: 43 [15] years, 60% [n=903] male, 70% [n=1020/1459] diagnosed >1 year ago). Pain was reported by 46% (n=374) of physicians and 47% (n=384) of patients and fatigue by 65% (n=530) of physicians and 76% (n=620) of patients. Both pain and fatigue increased with increased proteinuria and reduced eGFR (all p<0.001). Finally, patients with increased proteinuria and reduced eGFR experienced worse (p<0.05) QoL and work productivity across all measures (except work absenteeism). Patients with higher proteinuria and lower eGFR face higher symptom burden and reduced QoL than their counterparts. Physicians underestimated fatigue levels faced by patients. In order to improve QoL, more effective treatments are needed to prevent high proteinuria and preserve eGFR.

Optimized versus conventional trigger threshold for pancreatic phase image acquisition using dual-energy CT at 40-keV: a randomized controlled trial.

To evaluate the impact of optimized trigger threshold on 40-keV pancreatic phase images acquired with a dual-energy CT (DECT) protocol. A cohort of 69 consecutive participants (median age, 72 years) undergoing a pancreatic protocol DECT examination between September to December 2021 were prospectively randomized into two protocols: conventional trigger threshold of 100 HU (Group A, n = 34) and optimized trigger threshold of 30 HU (Group B, n = 35). Pancreatic phase image acquisition was performed with fixed delay of 20s from the trigger threshold. Two radiologists assessed the 40-keV pancreatic phase images for scan timing adequacy using a binary scale (adequate or inadequate). The proportions of these classifications were compared in the two groups using the Fisher's test. The median times to achieve the aortic attenuation of 30 HU and 100 HU were 16.3s and 22.3s in Group A, respectively, and was 17.8s for 30 HU in Group B. The median time difference from 30 HU to 100 HU was 4.5s in Group A. The scan timing adequacies of pancreatic phase images were classified as adequate (50.0% and 74.3%) or inadequate (50.0% and 25.7%) in Group A and Group B (P = 0.049). An optimized trigger threshold of 30 HU allows consistent acquisition of adequate pancreatic phase images compared to the conventional trigger threshold of 100 HU for pancreatic protocol DECT at 40-keV which might lead to improved pancreatic lesion conspicuity.

Examining cardiac toxicity in HER2-positive breast cancer patients using trastuzumab and its influencing factors at Iran Hospital.

Trastuzumab is primarily utilized in the treatment of patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer. This study aimed to investigate the incidence of cardiac toxicity associated with trastuzumab in HER2-positive breast cancer patients at Iran Hospital in 2023, as well as the factors influencing this toxicity. In this cross-sectional study, 200 patients diagnosed with HER2-positive breast cancer and receiving trastuzumab were included. The criteria for heart failure in this study were defined as an ejection fraction (EF) of less than 50% or a decrease of greater than 10% in EF. Descriptive statistics, the chi-square statistical test, Fisher's exact test, and logistic regression analyses were employed to assess the variables. A p-value of less than 0.05 was deemed statistically significant. The mean age of the participants was 51.5 ± 2.5 years. The odds ratio (OR) for the variable of anthracyclines was 1.3 (95% CI: 1.2-1.4); for opium use, the OR was 2.7 (95% CI: 0.9-8.5); for diabetes, the OR was 2.7 (95% CI: 1.2-5.9); for ischemic heart disease, the OR was 3.5 (95% CI: 1.6-7.7); and for hypertension, the OR was 4.8 (95% CI: 2.1-10.7). The OR for obesity was 1.45 (95% CI: 1.01-2.18), and the OR for age was 1.10 (95% CI: 1.01-1.12). No statistically significant association was found between opium use and cardiotoxicity (p = 0.07). This research contributes to the identification of factors that may predict responses to anthracyclines and the potential for cardiotoxicities. Ultimately, this information could inform the development of more personalized treatment strategies.

The Effect of Glucagon-like-Peptide-1 Receptor Agonists on Diabetic Retinopathy Progression, Central Subfield Thickness, and Response to Intravitreal Injections.

Objectives: To examine the effects of glucagon-like-peptide-1 receptor agonists (GLP1-RAs) on diabetic retinopathy (DR) progression, visual acuity (VA), central subfield thickness (CST), and response to intravitreal injections (IVIs) in the Hadassah ophthalmological cohort. Methods: Of 4500 Hadassah patients with DR, 146 had a documented first course of GLP1-RA treatment lasting at least a year along with ophthalmological follow-up. Of these, 35 underwent at least two optical coherence tomography (OCT) exams with a one-year interval. These 35 GLP1-RA-naïve patients were compared to a control group of 31 patients with DR who did not receive GLP1-RA treatment. We compared demographics, medical records, ocular data, and OCT characteristics between the two study groups. Results: At baseline, patients who received GLP1-RA treatment had a significantly higher prevalence of retinal detachment and vitreous hemorrhage, as well as a higher (though not statistically significant) prevalence of cardiovascular comorbidities compared to the control group. At the end of the follow-up period, the GLP1-RA group had a higher prevalence of DR progression compared to controls (3/19 vs. 0/20, respectively; p = 0.106, Fisher's exact test), but also showed a better response to IVIs (27/35 vs. 17/31, respectively; unadjusted OR: 2.78, p = 0.058; 95% CI: [0.963, 8.020], Pearson's chi-square test). However, vitreous hemorrhage and hyperreflective retinal foci were confounding factors (adjusted IVI response OR: 1.76, p = 0.229, 95% CI: [0.553, 5.650], logistic regression). No significant differences were observed between the two groups in terms of change in visual acuity (-0.135 vs. -0.063 logMAR, respectively; p = 0.664, Student's t-test) or CST (-13.49 vs. -30.13 μm; p = 0.464, Student's t-test). Conclusions: This study presents preliminary findings showing no significant differences in DR progression, visual acuity, and CST between patients treated with GLP1-RA and control patients. Moreover, GLP1-RA therapy was not significantly associated with improved IVI response, with ocular parameters acting as confounding factors.

Efficacy of vital pulp therapy for carious pulp injury in permanent teeth: a study protocol for an open-label randomized controlled noninferiority trial.

Vital pulp therapy (VPT) has recently been reported as an effective approach for preventing and treating carious pulp injury in permanent teeth. Compared with root canal treatment (RCT), which involves complete removal of the pulp tissue, VPT effectively maintains pulp vitality and retains the physiological functions of the pulp. In the research pool, large-scale randomized controlled trials evaluating the treatment outcome of VPT using calcium silicate cements and RCT in cariously exposed permanent teeth are lacking. Here, we present a monocentric clinical protocol to compare the effects of VPT using iRoot BP Plus (Innovative Bioceramix, Vancouver, BC, Canada) as a pulp-capping material with RCT. The proposed trial is an open-label, single-centre, randomized, controlled, noninferiority trial. In total, 462 patients will be included in this trial according to the following criteria: adult patients (18-50years old), pulp exposure during the treatment of deep caries in mature permanent teeth, a diagnosis of reversible or partially irreversible pulpitis without apical translucency on X-ray, without periodontitis or systemic disease. Patients with signed informed consent forms will be enrolled and randomly divided into two groups (VPT and RCT) with a balanced treatment allocation (1:1). Clinical evaluations will be conducted at baseline and at 3, 6, 12, and 24months after treatment, with the potential for extension. The primary outcome measure will be the duration of success. The secondary outcomes will include the success rate at the 1-year follow-up and any adverse reactions. The Kaplan‒Meier method and log-rank test will be used to compare the duration of success of both treatments. For other outcomes, the χ2 test or Fisher's exact test will be used for categorical variables, and the t test or Mann‒Whitney U test will be used for continuous variables to assess the differences between groups. The results of this trial will provide a clinical reference for selecting treatments for carious pulp injuries in permanent teeth. ClinicalTrials.gov ChiCTR2100051369. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org.cn ). Registered on 21 September 2021.

Can "LITE" Procedure Combined With a Short Course Antibiotic Treatment Be Effective in Treating the Chronic PJI?-A Prospective Randomized Controlled Trial.

The prevailing treatment for chronic periprosthetic joint infection (PJI) is a two-stage exchange, yet the optimal duration of antibiotic therapy following this procedure remains a topic of debate. This study aimed to determine whether a short course of postoperative antibiotic therapy can maintain infection control rates following a long interval two-stage exchange (LITE) for PJI. We conducted a prospective study enrolling patients with chronic PJI who underwent the LITE procedure at our institution from April 2018 to November 2021. Patients were randomly assigned to receive either a long course (12 weeks) or short course (2 weeks) of postoperative antibiotics. The pathogens, antibiotics, inflammatory markers, antibiotic-related complications, cases of reinfection, or re-operation were recorded. Continuous variables were analyzed using the two-sample t-test or Mann-Whitney U test, and categorical variables were analyzed using Fisher's exact tests. Kaplan-Meier survival analysis was used to compare infection control rates. A total of 60 patients with chronic PJI who completed the LITE procedure were included in the study (30 patients per group). All patients were followed for a minimum of 24 months (mean 39.2 ± 13.0 months). We observed that the infection control rate in the short-course group was not inferior to that in the long-course group (96.7% vs. 96.7%, p = 1.000). For patients with chronic PJI undergoing the LITE procedure, a 2-week course of postoperative antibiotics suffices to maintain infection control rates. Chinese Clinical Trial Registry: ChiCTR1900027089.

Characteristics associated with anterior ischemic optic neuropathy (AION) in giant cell arteritis (GCA).

Giant cell arteritis (GCA) is the most common vasculitis and can result in blindness due to anterior ischemic optic neuropathy (AION). Little is known about which patients with GCA are at higher risk of AION.We did a retrospective chart review to compare demographics, past medical history, labs and imaging of GCA patients with and without AION. All patients at the University of Washington who were diagnosed with GCA by a rheumatologist, had a vascular ultrasound and met classification criteria for GCA were included. AION was diagnosed by an ophthalmologist. To compare demographics, symptoms, presentation imaging and lab findings, we used Pearson Chi-square, Fisher's exact test and t-tests to compare GCA patients with and without AION. 91 patients with GCA without vision loss were compared to 15 patients with GCA and AION.The AION group had significantly more men (p=0.03) and elevated C-reactive protein (CRP) as compared to the non-AION group (p = 0.04). Rates of hypertension, smoking, erythrocyte sedimentation rate (ESR) and classification scores were similar. Vascular ultrasound showed similar rates of small and large vessel vasculitis, but the AION group had higher halo scores, with the AION group having a mean score of 5 and patients with GCA and without AION having a mean score of 3 (p < 0.01). Older men with GCA and more than three halos on vascular ultrasound imaging of GC may be at higher risk of AION. Key Points • This is the first paper to incorporate the use of vascular ultrasound in comparing patients with anterior ischemic optic neuropathy (AION) to those without giant cell arteritis (GCA). • Male sex is associated with AION despite GCA being more common in women. • Older age and higher CRP are associated with AION. • GCA patients with AION had a higher halo score than GCA patients without AION.

Endoscopic surgery for squamous cell carcinoma in the nasal cavity and ethmoid sinus: A retrospective observational study

ObjectiveReports of endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus are limited. Herein, we present a comprehensive account of the results obtained from performing endoscopic surgery based on the concept of en bloc resection. MethodsThis was a retrospective observational study of patients who underwent nasal endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus at a hospital between July 2018 and December 2021. Primary endpoints were overall survival, relapse-free survival, and local recurrence-free survival. Data on tumor stage, tumor site of origin, postoperative treatment, and papilloma-related status were reviewed. Statistical analyses included the Kaplan–Meier method, Cox regression analysis, and Fisher's exact test. ResultsTwenty-two patients with a median age of 62 (range 27–84) years, comprising 15 male and 7 female, were included in this study, and the median duration of observation was 2.1 (range 0.6–4.3) years. The 2-year overall survival, relapse-free survival, and recurrence-free survival rates were 91.0%, 69.9%, and 79.0%, respectively. Cancer of the nasal cavity was significantly superior to that of the ethmoid sinus in terms of local recurrence-free survival (p = 0.03). The patients who underwent postoperative treatment had significantly worse recurrence-free survival rates than those who did not receive postoperative treatment (p = 0.03). ConclusionsThis study examined the results of the endoscopic treatment for squamous cell carcinoma of the nasal cavity and ethmoid sinus with the concept of en bloc resection. Patients with ethmoid sinus carcinoma had a greater risk for local recurrence, and the prognosis for patients requiring postoperative treatment was poor.

The Effects of the COVID-19 Pandemic on Pediatric Orthopedic Injuries: A Single-Center Retrospective Study.

The COVID-19 pandemic has had a profound effect on the pediatric population worldwide. The consequences of the lockdown and the reallocation of hospital resources have caused notable changes in the presentation of pediatric orthopedic injuries. Through our use of patient records, we were able to display the epidemiological trends, as well as analyze the changes in the type and mechanism of various injuries. Our purpose is to further understand the considerable effects of the COVID-19 pandemic on pediatric orthopedic trauma and help guide the allocation of future healthcare resources. We conducted a retrospective cohort study on pediatric patients admitted for any orthopedic injury over a 3-year period (September 2018 to August 2021) at a Midwest level 1 trauma center. Cases were stratified into two groups based on the United States' COVID-19 lockdown (19 March 2020): Pre-COVID-19 cases were any cases prior to the lockdown and Intra-COVID-19 which are cases following the lockdown. Numerical data and categorical variables were summarized and differences between the case groups were examined using either two-Proportion Z-Test, Independent Two-Sample t-test, Pearson's chi-squared, or Fisher's exact tests. A total of 3179 pediatric orthopedic referrals occurred between the Pre-COVID-19 and Intra-COVID-19 study periods. We observed a general decrease in orthopedic injuries following the COVID-19 lockdowns with 1235 injuries compared to 1606 Pre-COVID-19. Patterns in the locations of injuries changed; notably, fractures of the humerus, tibia, and fibula decreased significantly (p < 0.05). Several mechanisms of injuries decreased significantly following the onset of COVID-19 including injuries caused by monkey bars, basketball, and automobiles (p < 0.01). There was a significant increase in the overall injury severity during the Intra-COVID-19 period (p < 0.05). Although there was a reduction in acute orthopedic trauma referrals, many injury mechanisms displayed similar trends regardless of restrictions. We clinically observed an overall increase in the severity of pediatric orthopedic injuries during the COVID-19 pandemic.

Comprehensive gut microbiota composition and microbial interactions among the three age groups.

There is a growing interest in studying the microbiota associated with aging by integrating multiple longevity researches while minimizing the influence of confounding factors. Here, we reprocessed metagenomic sequencing data from four different aging research studies and evaluated potential confounding factors in order to minimize the batch effect. Subsequently, we detected the diversity and abundance of the gut microbiome in three different age cohorts. Out of 1053 different bacteria species, only four showed substantial depletion across different age groups: Ligilactobacillus ruminis, Turicibacter sp. H121, Blautia massiliensis, and Anaerostipes hadrus. Archaea accumulated more in young individuals compared to elderly and centenarians. Candida albicans was more prevalent in centenarians, but Nakaseomyces glabratus (also known as Candida glabrata) was more common in elderly adults. Shuimuvirus IME207 showed a significant increase in centenarians compared to both control groups. In addition, we utilized a Fisher's exact test to investigate topological properties of differentially abundant microbiota in the co-occurrence network of each age group. Microbial signatures specific to different age stages were identified based on the condition: the reads showing differential abundance were higher compared to the other age groups. Lastly, we selected Methanosarcina sp. Kolksee for the Y group, Prevotella copri for the E group and Shuimuvirus IME207 for the C group as representatives of age-related characteristics to study how their interactions change during the aging process. Our results provide crucial insights into the gut microbiome's ecological dynamics in relation to the aging process.

Left aortic arch and aberrant right subclavian artery in children: spectrum of symptoms and response to surgical intervention.

Children with left aortic arch and aberrant right subclavian artery may present with either respiratory or swallowing symptoms beyond the classically described solid-food dysphagia. We describe the clinical features and outcomes of children undergoing surgical repair of an aberrant right subclavian artery. This was a retrospective review of children undergoing repair of an aberrant right subclavian artery between 2017 and 2022. Primary outcome was symptom improvement. Pre- and post-operative questionnaires were used to assess dysphagia (PEDI-EAT-10) and respiratory symptoms (PEDI-TBM-7). Paired t-test and Fisher's exact test were used to analyse symptom resolution. Secondary outcomes included perioperative outcomes, complications, and length of stay. Twenty children, median age 2 years (IQR 1-11), were included. All presented with swallowing symptoms, and 14 (70%) also experienced respiratory symptoms. Statistically significant improvements in symptoms were reported for both respiratory and swallowing symptoms. Paired (pre- and post-op) PEDI-EAT-10 and PEDI-TBM-7 scores were obtained for nine patients, resulting in mean (± SD) scores decreasing (improvement in symptoms) from 19.9 (± 9.3) to 2.4 (± 2.5) p = 0.001, and 8.7 (± 4.7) to 2.8 (± 4.0) p = 0.006, respectively. Reoperation was required in one patient due to persistent dysphagia from an oesophageal stricture. Other complications included lymphatic drainage (n = 4) and transient left vocal cord hypomobility (n = 1). Children with a left aortic arch with aberrant right subclavian artery can present with oesophageal and respiratory symptoms beyond solid food dysphagia. A thorough multidisciplinary evaluation is imperative to identify patients who can benefit from surgical repair, which appears to be safe and effective.