Better Outcomes For Patients Research Articles

Hydrocele in infants: surgical evaluation

Introduction: Hydrocele in infants is a condition characterized by fluid accumulation in the scrotum, often seen in newborns. This disorder, although often benign and self-limited, may require evaluation and, in some cases, surgical intervention. Understanding the factors associated with hydrocele, its clinical presentation, and therapeutic approach are essential to ensure appropriate management. The medical literature discusses the prevalence and implications of hydrocele, as well as guidelines for surgical evaluation in persistent cases, highlighting the importance of early identification and timely intervention. Methodology: The research followed the PRISMA checklist guidelines, using databases such as PubMed, Scielo, and Web of Science. Five descriptors were used: "hydrocele," "infants," "surgical evaluation," "treatment," and "clinical outcomes." Inclusion criteria included articles published in the last ten years, studies focused on infants, and that addressed the surgical evaluation of hydrocele. Conversely, exclusion criteria included non-systematic reviews, articles that did not specifically address the pediatric population, and studies with incomplete data. Results: The analysis revealed that most cases of hydrocele in infants resolve spontaneously, but surgery is recommended in cases of persistent or symptomatic hydrocele. The literature highlighted the importance of careful clinical evaluation and consideration of the risks and benefits of surgery. The main outcomes observed included surgical complication rates and parental satisfaction with the results. Conclusion: Hydrocele in infants requires a careful approach, taking into account both the often self-limiting nature of the condition and the potential associated complications. Surgical evaluation should be performed carefully, based on clinical guidelines and the experience of the medical team. The systematic review highlighted the importance of an individualized approach to each case, ensuring better outcomes for patients and their families.

Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial.

Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.89 [0.53-1.50]), but demonstrated significantly better outcomes in patients without OAC (EVT 4 [3-6] vs MM 5 [4-6], adjusted generalized odds ratio 1.87 [1.45-2.40], p = 0.02). The OAC group had higher comorbidities, including atrial fibrillation (70% vs 17%), congestive heart failure (28% vs 10%), and hypertension (87% vs 72%), suggesting increased frailty. However, the results were consistent after adjustment for these comorbidities, and was similar regardless of the type of OACs used. Whereas any hemorrhage rates were higher in the OAC group receiving EVT (86% in OAC vs 70% in no OAC), no parenchymal hemorrhage or symptomatic intracranial hemorrhage were observed with OAC use in both the EVT and MM arms. Although we did not find evidence that the effect was due to excess hemorrhage or confounded by underlying cardiac disease or older age, OAC use alone should not exclude patients from receiving EVT. Baseline comorbidities and ischemic injury extent should be considered while making individualized treatment decisions. ANN NEUROL 2024;96:887-894.

037. Outcomes of Management of Adult Patients with Acute Limb Ischemia Using Catheter-Directed Thrombolysis (CDT) and Thrombectomy: A Systematic Review

Background: Acute limb ischemia (ALI) is one of the arterial emergencies of sudden decrease in limb perfusion and poses a threat to limb viability. Immediate management is required for better prognosis of the patient. Treatment with Catheter-directed thrombolysis (CDT) and thrombectomy methods have their own advantages and disadvantages that require further study. Methods: The authors completed a descriptive systematic review of retrospective cohort studies and randomised controlled trials (RCTs) based on PRISMA guidelines, including studies that included CDT and thrombectomy interventions in patients with acute limb ischemia. Data were extracted on sample size, age, diagnosis, mechanism of intervention, treatment outcome and complications. Results: Of the 304 studies, the authors included 5 cohort studies and RCTs, with a total sample size of 5,781 samples aged 60-72 years. All studies used CDT method, compared with various thrombectomy (Percutaneous aspiration thrombectomy (PAT), Pharmacomechanical thrombectomy (PMT), Percutaneous mechanical thrombectomy (PMT), Catheter-based thrombectomy (CBT), and Operative embolectomy. It was found that therapeutic outcomes based on risk of amputation, mortality and complications did not show significant differences between the two groups, but hospitalisation duration outcomes appeared longer in patients with CDT than thrombectomy (p value 0.0001 and 0.000). Conclusion: ALI is a condition that requires immediate management to reopen arterial flow so that ischaemic conditions in the tissue can be avoided, various intervention methods either with medication (thrombolysis) or invasive procedures with thrombectomy are considered to provide good outcomes in patients.

Factors associated with vision loss in idiopathic intracranial hypertension patients with severe papilledema.

Our aim was to compare factors associated with poor versus good visual outcomes in idiopathic intracranial hypertension (IIH) patients with severe papilledema at initial presentation. Retrospective review of consecutive IIH patients (1/1/2013-6/10/2023) with severe papilledema (Frisén grade 4-5 and/or atrophy in at least one eye); Patients were divided into "poor visual outcome" (poor visual acuity and constricted visual field in at least one eye) and "good visual outcome" (good visual acuity and only mild visual field changes in both eyes) at >6 months for medically-treated patients and >3 months follow-up for surgically-treated patients. We included 134 IIH patients with severe papilledema (70 had poor and 64 had good visual outcomes). No significant differences existed for age, gender, race, hypertension, haemoglobin, or cerebrospinal fluid opening pressure. The poor-outcome group had significantly greater BMI (mean 39.2 vs 35.1 kg/m2, p = 0.004), and worse initial HVF-MD (-20.04 vs -5.81 dB, p < 0.0001). Poor-outcome patients saw more prior health-care providers (4.7 vs 2.4, p < 0.0001), with delayed neuro-ophthalmology encounters (58.5 vs 15.2 weeks, p = 0.001). 41.4% of poor-outcome patients were initially seen in outside emergency departments (ED) (vs 14.1% of good-outcome patients, p = 0.0005), while only 27.1% were seen by eye-care providers (vs 53.1% of good-outcome patients, p = 0.0027). No poor-outcome patients initially consulted our institution's ED vs 7.8% of good-outcome patients. Although patients with poor visual outcome did not seek medical care later than good outcome patients, they had delayed diagnosis/treatment because of prior outside ED visits andlack of prior eye-care provider evaluations, suggesting that early diagnosis and specialized management of papilledema is essential for patients with symptoms of intracranial hypertension.

Short- and long-term outcomes of liver resection with hepatic vein reconstruction for liver tumors: A nationwide multicenter survey.

This study clarifies the short- and long-term outcomes of liver resection with hepatic vein (HV) reconstruction for liver tumors and identifies the risk factors for poor outcome. We contacted 263 specialized centers in Japan and collected data on this surgical procedure. Patient characteristics, surgical procedures, and outcomes were then analyzed. A total of 187 patients were enrolled from 36 institutions. Grade C post-hepatectomy liver failure (PHLF) and in-hospital mortality were 3.2% and 1.6%, respectively. The median overall survival (OS) and recurrence-free survival (RFS) were 49.9 and 9.8 months, respectively. Surgical outcomes, OS and RFS did not differ among three types of liver tumors, colorectal liver metastasis (CRLM) (n = 127), hepatocellular carcinoma (n = 27), and intrahepatic cholangiocarcinoma (n = 27). Patients with CRLM and seven or more courses of preoperative chemotherapy had significantly worse OS. Compared with HV reconstruction for securing liver remnant (LR) function (n = 148), reconstruction of the only main HV remaining in the LR (n = 39) had significantly worse short-term outcomes, but did not result in increased mortality, and showed equivalent OS and RFS. Liver resection with HV reconstruction can be achieved safely and contributes to a relatively good long-term outcome for patients with advanced liver malignancies.

A rare case of acute colonic pseudo-obstruction leading to colonic perforation in a ventilated patient with cerebrovascular accident

Acute pseudo-colonic obstruction in a patient with a functioning ileocecal valve can be risky, resulting in closed-loop obstruction, significant distention of the colon, and increased chances of colon perforation and ischemia if diagnosis and timely non-operative treatments are delayed. We report a case of acute pseudo-colonic obstruction with closed-loop obstruction, resulting in colon perforation in a ventilated patient with a cerebrovascular incident. The situation was promptly identified during the first assessment with a surgical consultation and imaging study, resulting in timely surgical intervention which included removing the diseased section of the right colon, creating an end ileostomy, and colostomy. The postoperative contrast study of the remaining colon and colonoscopy confirmed the pseudo-obstruction without finding any blockages in the distal colon and rectum. After the operation, the patient recovered well and was sent home. In conclusion, early clinical suspicion, diagnosis, and prompt management of a complicated ACPO result in a good patient outcome.

Complete vs culprit-lesion-only myocardial revascularization in patients with out-of-hospital cardiac arrest: insights from the multicentric "Lombardia CARe" registry

Abstract Background Out-of-hospital Cardiac Arrest (OHCA) is a potentially devastating complication of patients with Myocardial Infarction (MI). Multivessel Disease (MVD) is a frequent occurrence in this setting, being present in nearly half patients undergoing Coronary Angiography (CAG). We previously reported that, in case of MI complicated by OHCA and evidence of MVD, a complete myocardial revascularization, as compared to culprit-lesion-only revascularization, was associated with an improved 1-year survival and favorable neurological outcomes. We aimed to validate and confirm these results on a multicentric scale with a larger patient cohort. Methods This is a multicentric, prospective, observational study. We considered all the consecutive patients with OHCA and MI enrolled in the Lombardia CARe Registry from January 1st 2015 to December 31st 2022 who underwent CAG in 6 centers in Northen Italy. Results A total of 623 patients were included; of these, 403 underwent CAG. Median age was 64 years, and about 80% had no previous history of ischemic heart disease. Median ejection fraction (EF) at presentation was 40%. MVD was present in 186 (46.1%) patients and was subsequently treated with either complete (32.3%) or incomplete (67.7%) coronary revascularization. Left anterior descendent (LAD) artery was the culprit lesion in almost 1/3 of patients. The 1-year survival rate was 78.3% in the complete revascularization group and 42.9% in the culprit-lesion-only revascularization group (p-value &amp;lt; 0.001). After correction for factors that were predictors on univariate analysis, complete revascularization strategy was independently associated with a reduced risk of death [HR: 0.27 (95% CI: 0.01 to 0.739; p = 0.01] and death or unfavorable neurological outcome [HR: 0.23 (95% CI: 0.08 to 0.67); p = 0.007]. Conclusions Complete revascularization strategy was confirmed to be associated with an improvement of 1-year survival and with a good neurological outcome in patients resuscitated from OHCA. These results highlight the independent impact on survival of a complete coronary intervention strategy in patients with OHCA plus MVD.

Integrated immunogenomic analyses of single-cell and bulk profiling construct a T cell-related signature for predicting prognosis and treatment response in osteosarcoma

PurposesT cells play a crucial role as regulators of anti-tumor activity within the tumor microenvironment (TME) and are closely associated with the progression of osteosarcoma (OS). Nevertheless, the specific role of T cell-related genes (TCRGs) in the pathogenesis of OS remains unclear.MethodsFirst, we processed single-cell RNA sequencing (scRNA-seq) data of OS from the public databases and performed cell annotation. We identified highly variable genes in each cell type using the "FindAllMarkers" function, explored the distribution of different clusters, and investigated inter-cellular communication patterns via the "CellChat" framework. Then, we used multivariate Cox analysis to construct a TCRG and developed a nomogram to predict survival probabilities for OS patients. Finally, we validated the aforementioned results using various cell lines and investigated the immune cell infiltration, expression of immune checkpoints, chemotherapy sensitivity, and the efficacy of targeted therapies across different risk groups.ResultsFrom the scRNA-seq data, we identified 3,000 highly variable genes, presented the top 10 genes, and validated the expression of core genes across different cell lines.Moreover, our analysis delved into interactions between T cells and other cell types. Our analyses constructed a predictive T cell-related signature (TCRS) that incorporated these prognostic TCRGs, showing a clear prognostic separation between the high-risk and low-risk OS patient groups in multiple cohorts. Survival analysis indicated better outcomes for patients classified in the high-risk group. The low-risk group exhibited elevated levels of CD4 memory resting T cells, contrasting with the higher levels of macrophage M0 observed in the high-risk group via the CIBERSORT algorithm. Furthermore, we observed that the low-risk group exhibitedAQ1 significant up-regulation of immune checkpoint genes (ICGs) and lower Tumour Immune Dysfunction and Exclusion (TIDE) scores, suggesting that they may be suitable for immunotherapy. Conversely, the high-risk group appeared more responsive to chemotherapy and targeted therapies, according to our drug sensitivity analysis.ConclusionIn conclusion, our study identified TCRGs, constructed and validated a TCRS for OS, and assessed immune response and drug sensitivity in different risk groups of OS patients. These findings provide novel insights into personalized treatment strategies for OS, potentially guiding more effective therapeutic interventions.

Characteristics of Inherited Metabolic Disorders Following Kidney Transplantation: A 13-Year Observational Study

Background and Objectives: Inherited metabolic disorders (IMDs), primarily cystinosis, Fabry disease, and methylmalonic acidemia (MMA), are genetic conditions that typically result in multi-organ disease manifestations. Kidney function progressively deteriorates in many cases, with patients eventually reaching end-stage kidney disease (ESKD) and requiring renal replacement therapy. Kidney transplantation has been deemed the optimal renal replacement therapy option to achieve long-term survival in patients with IMD. Whilst improved long-term survival is expected, the patterns of clinical evolution for IMD after transplantation remain largely unknown. Methods: Our group conducted a retrospective observational study that included 37 adult patients with IMD (11 with cystinosis, 20 with Fabry disease, and 6 with MMA). The study evaluated the clinical status and progression of these patients following kidney transplantation between January 2010 and December 2023. Results: This generally resulted in good graft outcomes for patients with IMD. Standard immunosuppression regimes included tacrolimus, mycophenolate mofetil, and prednisolone. The mean graft survival duration was noted to be 12 years in patients with cystinosis, 11 years in patients with Fabry disease, and 7 years in patients with MMA. Suboptimal outcomes were noted with grafts of cadaveric origin and poor adherence to the prescribed post-transplant immunosuppression regime. A greater extra-renal morbidity burden was associated with a reduced duration of graft function and increased mortality in patients with IMD. Conclusions: Our findings emphasise the need for a multi-disciplinary approach in the care of IMD patients following kidney transplantation.

Cedecea lapagei as an emerging extensively drug-resistant microorganism: A case report in a patient with pleural empyema and literature review

Cedecea lapagei is a Gram-negative bacterium that belongs to the Enterobacteriaceae family and is said to be pathogenic for humans. Herein, we report a case of extensively drug-resistant C. lapagei in a patient with pleural empyema and offer a literature review of the already documented case reports on individuals infected with C. lapagei. A 60-year-old female patient was brought to the emergency department at AIIMS Bathinda with a history of breathing difficulty since one day after she sustained multiple injuries from a road accident. She was diagnosed with pleural empyema. Subsequently, an intercostal drain tube was inserted into the patient, and the drain content was sent for culture, which revealed growth of C. lapagei. Our literature retrieval work gathered a total of 13 relevant cases. In conclusion, early identification of C. lapagei and administering suitable treatment is important for good patient outcome.

Exploring the role of ketogenic diet in ADPKD treatment: A promising avenue

Dear Editor, This letter intends to highlight the importance of the keto diet in the treatment and slowing the progression of Autosomal Dominant Polycystic Kidney Disease (ADPKD). We aim to increase awareness about this newly advertised nutrition plan for ADPKD patients. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a disease that continuously expands multiple cysts in both kidneys. Clinical symptoms (Flanks pain, haematuria, hypertension) mostly develop in the fourth decade of life and around 50% of almost 12 million worldwide affected people will go into end-stage renal disease (ESRD) in their sixth decade of life.1 In 2015, EMA approved the use of Vasopressin receptor antagonists, i.e., tolvaptan, for the treatment of ADPKD in adults with CKD stages 1-3 and with rapidly progressive disease.2 However, these drugs are associated with side effects such as transient extracellular volume reduction and continuous symptoms of increased aquaresis, liver toxicity, avoiding pregnancy and breastfeeding and drug interactions.2 Moreover, strict criteria for patient selection such as GFR values, changes in GFR, patient age and cost-effectiveness needed to be fulfilled before commencing this particular therapy.2 The ongoing advancements in medical sciences have recently provided evidence that introducing the keto diet in patients with ADPKD can lead to a decline in the reduction rate of GFR and to a reduced rate of increasing kidney volume.3,4 A small study published in November 2023 compared the effects of the keto diet (KD) with control and water fasting groups.5 KD group surprisingly showed a decrease in height-adjusted total kidney volume by 0.55% and height-adjusted total liver volume by 4.7%.5 The most important observed effect was an increase in eGFR by 5.5% compared to the other groups, which showed a decrease in eGFR.5 Serum levels of Beta Hydroxy Butyrate were used to evaluate the ketosis state.5 The most commonly reported side effect was transiently occurring keto flu. However, one patient developed appendicitis and one patient also had nephrolithiasis.5 This three-month duration study overall shows good outcomes in ADPKD patients. We encourage physicians and the broader community of nephrologists to prioritise and carry out larger-scale randomised controlled trials based on the previously mentioned study using the keto diet in the management of ADPKD patients. This will require not only the aggressive participation of physicians in carrying out the research study but also the active education of the general public about this newly introduced nutrition plan. ---Continue

Which Intravenous Isotonic Fluid Offers Better Outcomes for Patients with a Brain Injury?

Administering intravenous fluids is a common therapy for critically ill patients. Isotonic crystalloid solutions, such as saline or balanced solutions, are frequently used for intravenous fluid therapy. The choice between saline or a balanced crystalloid has been a significant question in critical care medicine. Recent large randomized controlled trials (RCTs) have investigated whether balanced crystalloids yield better outcomes in general or specific critical care populations, and many of them have confirmed this hypothesis. Although the broad eligibility criteria of these RCTs suggest applicability to neurocritical care patients, it is important to discuss whether using balanced crystalloids, as opposed to saline, would benefit patients who primarily have neurological disorders or diseases. This review considers the relevance of this question, weighs the pros and cons of the two fluid types, examines available data, and anticipates results from ongoing RCTs to guide clinicians in selecting the optimal fluid for patients with brain injury.

Overlap of spike and ripple propagation onset predicts surgical outcome in epilepsy.

Interictal biomarkers are critical for identifying the epileptogenic focus. However, spikes and ripples lack specificity while fast ripples lack sensitivity. These biomarkers propagate from more epileptogenic onset to areas of spread. The pathophysiological mechanism of these propagations is elusive. Here, we examine zones where spikes and high frequency oscillations co-occur (SHFO), the spatiotemporal propagations of spikes, ripples, and fast ripples, and evaluate the spike-ripple onset overlap (SRO) as an epilepsy biomarker. We retrospectively analyzed intracranial EEG data from 41 patients with drug-resistant epilepsy. We mapped propagations of spikes, ripples, and fast ripples, and identified their onset and spread zones, as well as SHFO and SRO. We then estimated the SRO prognostic value in predicting surgical outcome and compared it to onset and spread zones of spike, ripple, and fast ripple propagations, and SHFO. We detected spikes and ripples in all patients and fast ripples in 12 patients (29%). We observed spike and ripple propagations in 40 (98%) patients. Spike and ripple onsets overlapped in 35 (85%) patients. In good outcome patients, SRO showed higher specificity and precision (p < 0.05) in predicting resection compared to onset and zones of spikes, ripples, and SHFO. Only SRO resection predicted outcome (p = 0.01) with positive and negative predictive values of 82% and 57%, respectively. SRO is a specific and precise biomarker of the epileptogenic zone whose removal predicts outcome. SRO is present in most patients with drug-resistant epilepsy. Such a biomarker may reduce prolonged intracranial monitoring and improve outcome.

PDOC-10 LIMITATIONS IN POST OPERATIVE- ADJUVANT CARE OF PATIENTS WITH BRAIN TUMOURS-A CASE OF SUPRATENTORIAL MEDULLOBLASTOMA IN A PAEDIATRIC PATIENT

Abstract OBJECTIVE To highlight the challenges and limitations in accessing post-operative adjuvant care of patients with brain tumours in Zimbabwe and implications on patient outcomes and to discuss potential strategies to overcome these challenges. METHODS This is a case report on a 6 year old patient with a supratentorial medulloblastoma to demonstrate the challenges encountered on accessing post-operative adjuvant care at a Central hospital in Harare. RESULTS The patient had a near total resection of the tumour done and was managed in the Intensive care unit for 1 week. HE was discharged to the general ward for another week and eventually referred to the paediatric oncologists after a histological diagnosis of a supratentorial medulloblastoma was made. Patient received cycles of chemotherapy but failed to raise money for adjuvant radiotherapy. Patient returned 5 months later with the tumour having recurred. CONCLUSION Limitations in post-operative adjuvant care may have a negative impact on the overall patient outcomes, in this case lack of access to radiotherapy. Medulloblastomas are responsive to radiotherapy and their prognosis improves significantly with a combination of surgical resection and radiotherapy. Addressing these limitations at different levels involving government and non-governmental organizations helps in mitigating inaccessibility of radiotherapy to radio-sensitive brain tumours patients after surgical resection. This case report brings out the urgent need to implement cheaper and sustainable options to address challenges in post-operative adjuvant care in order to get good patient outcomes.

Pedicled Anterolateral Thigh Flap (ALT) for Vulva Reconstruction: Journey to a New Horizon

AbstractSurgery for vulval malignancies necessitates extensive resection necessitating the use of musculocutaneous grafts. We present one such case where the patient needed both a V–Y plasty and an anterolateral thigh flap to ensure a tension-free repair. She underwent a partial deep vulvectomy followed by V–Y plasty and ALT flap. The procedure has been described in detail along with intraoperative photographs. She recovered uneventfully and is receiving post-operative adjuvant radiotherapy. We would like to highlight this “additional skill” of plastic surgery which will empower surgeons to undertake radical surgeries to ensure the best outcomes for patients.

Oscillatory and nonoscillatory sleep electroencephalographic biomarkers of the epileptic network.

In addition to the oscillatory brain activity, the nonoscillatory (scale-free) components of the background electroencephalogram (EEG) may provide further information about the complexity of the underlying neuronal network. As epilepsy is considered a network disease, such scale-free metrics might help to delineate the epileptic network. Here, we performed an analysis of the sleep oscillatory (spindle, slow wave, and rhythmic spectral power) and nonoscillatory (H exponent) intracranial EEG using multiple interictal features to estimate whether and how they deviate from normalcy in 38 adults with drug-resistant epilepsy. To quantify intracranial EEG abnormalities within and outside the seizure onset areas, patients' values were adjusted based on normative maps derived from the open-access Montreal Neurological Institute open iEEG Atlas. In a subset of 29 patients who underwent resective surgery, we estimated the predictive value of these features to identify the epileptogenic zone in those with a good postsurgical outcome. We found that distinct sleep oscillatory and nonoscillatory metrics behave differently across the epileptic network, with the strongest differences observed for (1) a reduction in spindle activity (spindle rates and rhythmic sigma power in the 10-16 Hz band), (2) a higher rhythmic gamma power (30-80 Hz), and (3) a higher H exponent (steeper 1/f slope). As expected, epileptic spikes were also highest in the seizure onset areas. Furthermore, in surgical patients, the H exponent achieved the highest performance (balanced accuracy of .76) for classifying resected versus nonresected channels in good outcome patients. This work suggests that nonoscillatory components of the intracranial EEG signal could serve as promising interictal sleep candidates of epileptogenicity in patients with drug-resistant epilepsy. Our findings further advance the understanding of epilepsy as a disease, whereby absence or loss of sleep physiology may provide information complementary to pathological epileptic processes.

Improving risk stratification for 2022 European LeukemiaNet favorable-risk patients with acute myeloid leukemia

Assignment of patients diagnosed with acute myeloid leukemia (AML) to the 2022 European LeukemiaNet (ELN) Favorable genetic-risk group has important clinical implications, as allogeneic stem-cell transplantation in first complete remission (CR) is not advised due to a relatively good outcome of patients receiving chemotherapy alone and transplant-associated mortality. However, not all Favorable genetic-risk patients experience long-term relapse-free survival (RFS), making recognition of patients who would most likely be cured of high importance. We analyzed 297 patients aged <60 years with de novo AML classified as 2022 ELN Favorable genetic-risk who achieved a CR and had RNA-seq and gene mutation data from diagnostic samples available (Alliance trial A152010). To identify prognostically relevant transcripts that can distinguish patients cured from patients susceptible to lower- or higher-risk of relapse or death, we fit a regularized mixture cure model (MCM), where RNA-seq expression values were our candidate covariates. To validate the identified transcripts, we analyzed 75 patients with de novo AML aged <60 years included in the 2022 ELN Favorable genetic-risk group who achieved a CR in an independent test set from Gene Expression Omnibus (GSE37642). Our MCM identified 145 transcripts associated with cure, or long-term RFS, and 149 transcripts associated with latency, or shorter-term time-to-relapse. The area under the curve and C-statistic were, respectively, 0.946 and 0.856 for our training and 0.877 and 0.857 for our test sets. Our results suggest that the Favorable-risk group includes distinct transcriptionally defined subgroups with different biological properties, which may be useful for refining this genetic-risk category.

An Evaluation of The Older Persons Presentation To The Emergency Department (ED) Following A Fall/Syncope/Presyncope

Abstract Background Falls events are a leading reason for presentations to the ED, particularly in older adults. Often these events are unwitnessed and unexplained. Therefore, there is strong consensus that the management of unexplained falls should be evaluated in a similar fashion to syncope as outlined by the World Falls and European Society of Cardiology guidelines. Methods The aim of this study was to evaluate adherence with current falls/syncope guidelines. Consecutive patients over the age of 75 who presented with a fall or syncope to a university teaching hospital in October 2023 were included. Data was collected on diagnostics completed (ECG, CT Brain, Carotid Doppler Ultrasound, EEG, pro BNP, Troponin, Echocardiogram, and External loop recorder), whether specialist falls review was performed, and readmission within 6 months. Completion of diagnostic tests were compared between those who were and were not reviewed by a specialist service using the Chi squared test. Results Falls/syncope/presyncope comprised 17.5% (160/913) of presentations of older people to the ED. Overall, 43% (n=68) had an ECG completed, 15% (n=23) had a pro BNP, and 24% (n=38) had a troponin level measured, 11% (n=17) had an Echo performed, and 10% (n=16) had prolonged cardiac monitoring (R test), 47% (n=74) had a CT Brain performed. Among those who were reviewed by a specialist falls service, (39% n= 62) completion of recommended investigations was significantly higher; ECG (69% v 26%, p&amp;lt;0.01), pro BNP (24% v 8.3%, p&amp;lt;0.01), echocardiogram (21% v 4.2%, p&amp;lt;0.01), cardiac monitoring (18% v 5.2%, p&amp;lt;0.01). Conclusion Falls and syncope are common presentations to the ED among older adults. Patients who were seen by a specialist falls team were more likely to have the appropriate diagnostics complete. Therefore, a specialist falls/syncope pathway led by a specialist falls service in the ED could result in better outcomes for patients.

Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database.

This research aimed to systematically uncover the metastatic characteristics and survival rates of lung cancer subtypes and to evaluate the impact of surgery at the primary tumor site on cancer-specific survival in DM lung cancer. We used the Surveillance, Epidemiology, and End Results (SEER) database (2010-2019) to identify primary lung cancers with DM at presentation (M1). Kaplan-Meier (KM) survival curves were generated and compared utilizing log-rank tests. Cox regression methods were employed to determine hazard ratios (HR) and 95% confidence intervals related to CSS factors. Inverse probability of treatment weighting (IPTW) was applied to reduce bias. We analyzed 77,827 M1 lung cancer cases, with 41.22% having DM at presentation. Bone metastasis was most common in ADC, ASC, SCC, LCC; brain in LCNEC; liver in SCLC. Lung was common in TC + AC and SCC. Long-term survival was best in TC + AC and worst in SCLC (p < 0.001). Male gender, age < 50, primary tumor site (main bronchus, lower lobe), large tumor diameter, ADC/SCLC/SCC pathology, and regional lymph node involvement were significant risk factors for multiorgan metastasis. Age ≥ 50, male, large tumor diameter, positive lymph nodes, and multiorgan metastases were associated with lower CSS. In contrast, radiotherapy, chemotherapy, systemic therapy, and surgery were associated with higher CSS rates. Primary tumor resection improved survival in lung cancer patients (excluding small cell lung cancer, SCLC) with single organ metastases (KM log rank p < 0.001, HR = 0.6165; 95% CI (0.5468-0.6951)), especially in brain (p < 0.001, HR = 0.6467; 95% CI (0.5505-0.7596)) and bone (p = 0.182, HR = 0.6289; p < 0.01), but not in liver or intrapulmonary metastases after IPTW. Significant differences in DM patterns and corresponding survival rates exist among lung cancer subtypes. Primary tumor resection improves survival in lung cancer patients (excluding small cell lung cancer, SCLC) with single organ metastases, with better outcomes in patients with brain and bone metastases, while no significant benefit was seen in patients with liver and intrapulmonary metastases.

A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia

Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management. Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles. Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.