Good Outcome Research Articles

Assessing the long-term prognostic ability of the 70 gene expression signature MammaPrint in an Italian single-center prospective cohort study of early-stage intermediate-risk breast cancer patients

PurposeThe aim of this study was to assess the prognostic performance of the 70-gene signature, MammaPrint, in an Italian single-center prospective cohort of early-stage intermediate-risk breast cancer (BC) patients. MethodsA total of 195 eligible early BC cases were tested for genomic risk between 2006 – 2013. In this retrospective analysis, the association of genomic risk with distant metastasis-free survival (DMFS) and overall survival (OS) were assessed using Cox regression models, adjusting for clinical and pathological tumor characteristics. ResultsMammaPrint identified 118 (60.5%) patients with genomically Low Risk tumors and 77 (39.5%) patients with genomically High Risk tumors. Age, menopausal status, tumor size, receptor status, and nodal status were comparable between MammaPrint Risk categories. The median follow-up was 8.4 years for DMFS and 9.3 years for OS; 8-year follow-up was reported for both endpoints. The 8-year DMFS was 90.4% (95% CI 84.9 – 95.9) in patients with MammaPrint Low Risk tumors compared to 60.8% (95% CI 49.8 – 71.8) for patients with High Risk tumors. Patients with MammaPrint Low Risk tumors exhibited significantly superior 8-year OS (97.3%; 95% CI 94.4 – 100) compared with MammaPrint High Risk tumors (89.5%; 95% CI 82.6 – 96.4; p = 0.028). Multivariate analyses identified MammaPrint as significantly associated with 8-year DMFS and MammaPrint together with Progesterone Receptor positivity with 8-year OS. ConclusionThe prognostic performance of MammaPrint was demonstrated in early-stage clinically intermediate to high-risk BC patients. Moreover, patients with MammaPrint Low Risk tumors had good outcome regardless of treatment regimen, thus supporting personalized treatment choices.

Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning.

Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach. Using Organ Procurement and Transplantation Network-United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5mg/dL. Significant cluster characteristics were determined, and outcomes were compared. The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7-3.3) mg/dL. Cluster analysis was performed on 12356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re-transplant patients characterized Cluster 1. Cluster 2 was characterized by first-time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3-year patient death, and graft failure. Cluster 3 had a higher risk of death-censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient-, graft-, and death-censored graft survival at 1 and 3 years. Compared to non-AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non-AKI: 25.5%); however, there were comparable long-term outcomes specific to death-censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non-AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non-AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non-AKI: 86.0%). In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.

Clinical validation of the early embryo viability assessment system: Analysis for the blastocyst morphology and pregnancy outcomes

Objective: To determine the relationship between the early embryo viability assessment (EEVA) and blastocyst morphological parameters and pregnancy outcomes. Methods: This retrospective cohort study was conducted on 291 intracytoplasmic sperm injection cycles including 2 522 embryos with indications of prolonging embryo culture to the blastocyst stage in the Genea embryo review incubator, and 511 single vitrified- warmed blastocyst transfer cycles from January 2020 to June 2023. The EEVA system produced an EEVA score from E1 (best) to E5 (worse) for the potential of blastocyst formation. Blastocyst morphology was evaluated. The association between the EEVA score and each type of blastocyst morphology, implantation rate, clinical pregnancy, and ongoing pregnancy were assessed using generalized estimating equations. Results: The inner cell mass A (ICM A), trophectoderm A (TE A), blastocoele expansion degree of 3, 4, 5, 6, 7 rates were higher with lower the EEVA score. The adjusted odd ratio (aOR) (E5 vs E1) was 0.3 for ICM A, 0.174 for TE A and 0.210 for BL3, 4, 5, 6, 7 (all P<0.001), suggesting a significant association between lower EEVA scores and improved embryo quality. The implantation, clinical pregnancy, and ongoing pregnancy rate were also higher with lower the EEVA score. The aOR of E5 vs E1 was 0.245 for implantation, 0.185 for clinical pregnancy and 0.200 for ongoing pregnancy rate (P<0.001). Conclusions: There were associations between blastocyst morphology, pregnancy outcome and EEVA scores. The good blastocyst morphology and pregnancy outcomes are higher with lower the EEVA score.

Arthroscopic Mobilization Techniques for Retracted Immobile Rotator Cuff Tears

The treatment of massive, retracted rotator cuff tears remains a significant challenge to orthopaedic surgeons. While debridement and partial repair has been described as a viable option, surgeons seeking to perform a complete repair often must employ advanced mobilization techniques to lateralize retracted immobile rotator cuff tissue. Tears that appear irreparable often may be effectively mobilized with elements of capsular release, anterior interval slide, or posterior interval slide. When rotator cuff tissue is mobilized to the medial aspect of the anatomic footprint, a low-tension repair can be performed with good clinical outcomes.

Midterm functional outcomes of synthetic cartilage implant (SCI) arthroplasty for hallux rigidus

Hallux rigidus is a common degenerative condition of first metatarso-phalangeal joint most commonly affecting patients above 50 years of age. The aim of our study is to evaluate the five-year results of synthetic cartilage implant (Cartiva) arthroplasty for hallux rigidus. A retrospective study of 70 patients who underwent synthetic cartilage implant interpositional arthroplasty were collected and analysed. Patients with Grade 3 to 4 hallux rigidus and who had failed conservative management were included. Patients who had previous forefoot surgery, hallux varus or valgus deformity of more than 250 and neuromuscular disease were excluded. Mean age at the time of operation was 63.4 years (range 42–84 years). The mean follow-up was 62.6 months. The functional evaluation was done using Manchester-Oxford Foot Questionnaire (MOxFQ). EQ-5D and EQVAS.86 patients were matriculated in the study with 70 patients being assessed at five years. The average preoperative MOxFQ score improved from 35.74 (31.44-40.04) to 19.11 (11.31- 26.91) at one year after surgery. The EQ-5D scores improved from preoperative average of 9.40 (8.14-10.66) to 4.26 (2.09-6.43) at one year. The preoperative EQVAS was 61.66 (51.25-72.07) to 71.45 (60.87-82.03 at one year. At five years follow up the average MOxFQ score was 17.6 (9.92-24.38), EQ-5D - 4.8 (2.26- 6.45) and EQVAS – 72.48 (62.40-82.56). Three patients had revision to first MTP fusion due to ongoing pain.Synthetic cartilage implant has demonstrated clinical efficacy and good functional outcomes at the end of five years for the treatment of Hallux rigidus.Level of Clinical Evidence: 4

The Innate Immune Landscape of dMMR/MSI Cancers Predicts the Outcome of Nivolumab Treatment: Results from the Drug Rediscovery Protocol.

The treatment efficacy of nivolumab was evaluated in patients with advanced, treatment-refractory solid mismatch repair deficiency/microsatellite-instable (dMMR/MSI) tumors, and in-depth biomarker analyses were performed to inform precision immunotherapy approaches. Patients with dMMR/MSI tumors who exhausted standard-of-care treatment options were enrolled in the Drug Rediscovery Protocol, a pan-cancer clinical trial that treats patients with cancer based on their tumor molecular profile with off-label anticancer drugs (NCT02925234). Patients received nivolumab (four cycles of 240 mg every 2 weeks, thereafter 480 mg every 4 weeks). The primary endpoint was clinical benefit (CB: objective response or stable disease ≥16 weeks). Whole-genome sequencing and RNA sequencing were performed on pretreatment tumor biopsies. A total of 130 evaluable patients were enrolled with 16 different cancer types. CB was observed in 62% [95% confidence interval (CI), 53-70], with an objective response in 45% (95% CI, 36-54). After a median follow-up of 14.5 months (95% CI, 13-19), the median progression-free survival was 18 months (95% CI, 9-not reached), and the median overall survival was not reached. Whereas CB was not, or only weakly, associated with markers of adaptive immune cell infiltration, CB was strongly associated with expression of a broad set of innate immune receptors/ligands. This clearly contrasted findings in melanoma, in which markers of adaptive immunity dominated the biomarker landscape. Nivolumab proved highly effective in advanced dMMR/MSI tumors. Expression of key innate immune receptors/ligands was the main predictor of a good treatment outcome, contrasting findings in melanoma and strengthening the rationale for tumor type-specific biomarkers for guiding immunotherapy.

Extensor Tendon Repair.

Extensor tendon injuries are a common condition that hand surgeons must be prepared to treat. The area of extensor tendon injury can traditionally be broken down into 9 zones. Physical examination is the best way to diagnose extensor tendon injury with a loss of active extension in the injured digit. The tenodesis effect may be utilized to aid in diagnosis: wrist flexion should cause passive extension at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints if the extensor tendon is in continuity. Repair of extensor tendon injuries depends on the zone of injury and the thickness of the tendon, which determines its ability to hold core sutures. For zone-I and II injuries, several "figure of 8" buried sutures can be utilized or a running type of suture may be employed. For zone-III to VII injuries, 1 or 2 core sutures and a supplementary running suture can be utilized. Several alternative techniques have been previously described. These include variations in the number of core strands, repair configuration, and suture caliber, as well as the use of epitendinous repair. Alternative treatments also include nonoperative treatment, which is typically reserved for partial tendon injuries and for patients who are unable to tolerate a surgical procedure. The techniques that we describe are tailored to the thickness of the tendon. Running sutures are applicable to any zone, whereas core sutures are best utilized in zones III through VII. The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish compared with the other techniques, and was found to have good to excellent clinical results in a study of lacerations in zones IV and V1,2. Repair of extensor tendon lacerations has demonstrated good long-term outcomes if performed in a timely manner after injury. A previous study showed good to excellent function in up to 64% of acute extensor tendon repairs, more fingers lost the ability to flex fully than lost the ability to extend3. Systematic reviews have suggested that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting4. The Elson test should be performed under a digital nerve block in order to properly assess the integrity of the central slip.In distal zone I and III injuries, suture anchors or bone tunnels may be utilized when there is no remaining tendon on the distal end of the laceration.When preparing the tendon ends for repair, it is important to handle the tendon delicately-preferably through the cut end of the tendon rather than the tendon itself.In zone-VII injuries, the injured tendon may lie beneath the extensor retinaculum. In such cases, windowing of the extensor retinaculum may decrease adhesion formation and facilitate repair. MCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangealIP = interphalangealROM = range of motionRMS = relative motion splintRIHM = running interlocking horizontal mattress.

A Breast Sharing Technique using the pedicled IMAP flap for Delayed Breast Reconstruction and Contralateral Symmetrising Mammaplasty: A case series and evolution of the surgical technique in selected patients.

IntroductionThe ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety. Patients and methodsBetween April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed. ResultsIn all cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5,6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option. ConclusionsThe breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using ICG imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low and thus the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction. Level of EvidenceLevel IV

Thrombectomy Outcomes for Anterior Circulation Stroke in the 6-24 h Time Window Solely Based On NCCT and CTA: ASingle Center Study.

Since perfusion imaging may be unavailable in smaller hospitals, alternative imaging selection methods for acute ischemic stroke can improve outcomes and optimize resources. This study assessed the safety and effectiveness of using imaging criteria other than DEFUSE3 and DAWN for thrombectomy beyond 6 h from symptom onset in patients stroke in the anterior circulation. This is aretrospective, single-center analysis of consecutive patients with large vessel occlusion in the anterior circulation undergoing thrombectomy. Patients were categorized into two groups based on the collateral status (moderate collaterals and good collaterals). Among 198 patients, 106 (54%) met the inclusion criteria and were analyzed. Good collateral status was observed in 78 (74%) patients. Patients with good collaterals showed significantly lower mRS scores at discharge and at 90days compared to their counterparts with moderate collateral status (4 (3-4) vs.4 (4-5); p = 0.001 and 2 (0-4) vs.6 (3-6); p < 0.001, respectively). More patients with good collateral status achieved favorable outcomes at 90days compared to those with moderate status (48 (61.5%) vs.5 (17.9%); p < 0.001). Good collaterals were an independent predictor of good clinical outcomes at 90days (OR = 1.31, 95% CI: 1.13-1.53, p < 0.001). Selecting patients for endovascular treatment of acute ischemic stroke using non-contrast CT and CT angiography shows 90-day outcomes similar to the DAWN and DEFUSE-3trials. Using collateral status on CT angiography can predict favorable outcomes after mechanical thrombectomy in resource-limited settings where perfusion imaging is unavailable.

Proximal Hamstring Avulsions: Surgical Versus Conservative Treatment Using a Shared Decision-Making Strategy

Background: Surgical treatment of patients with proximal hamstring avulsions provides good results; however, less is known about the outcome in patients who are offered conservative treatment. Purpose: To investigate the effect of surgical or conservative treatment (decided by a shared decision strategy) of proximal hamstring avulsions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 24 patients with magnetic resonance imaging–verified proximal hamstring avulsion were included and had either surgical treatment (11 patients, 45% women; mean age, 50 ± 16 years) or conservative treatment (13 patients, 46% women; mean age, 50 ± 17 years). At baseline, 6 months and 12 months, all patients answered the Perth Hamstring Assessment Tool (PHAT) (0-100 scale) and Hip Sports Activity Scale (0-8 scale). Patients had their maximal hip extension strength and maximal strength at 30° and 90° of knee flexion measured in newton meters per kilogram using a handheld dynamometer. A minimal important change in PHAT was considered &gt;7 points and a minimal important change in strength was considered &gt;0.15 N·m/kg, respectively. Results: The surgical group had a shorter time from injury to initiation of treatment compared with the conservative group (median: 15 vs 64 days; P = .02). The surgical group had a greater amount of retraction of the tendons compared with the conservative group (3 vs 2 cm; P = .04). From baseline to 12-month follow-up, the surgical and conservative groups improved their mean PHAT scores (35 points [95 CI, 24-45 points] and 20 points [95% CI, 9-31 points], respectively) reaching a median of 79 points (interquartile range [IQR], 66-95 points) in the surgical group and 75 points (IQR, 66-85 points) in the conservative group at the 12-month follow-up. Their Hip Sports Activity Scale levels at 12 months were 3 points (95% CI, 1-4 points) and 1 point (95% CI, 0-3 points) (not significant). Furthermore, the surgical and conservative groups improved their maximal hip extension strength by 0.61 N·m/kg (IQR, 0.42-0.80 N·m/kg) and 0.62 N·m/kg (IQR, 0.13-1.10 N·m/kg), respectively. Their maximal knee flexion strength at 30° improved by 0.52 N·m/kg (IQR, 0.29-0.74 N·m/kg) and 0.32 N·m/kg (IQR, 0.12-0.52 N·m/kg) and their maximal knee flexion strength at 90° improved by 0.28 N·m/kg (IQR, 0.19-0.37 N·m/kg) and 0.22 N·m/kg (IQR, 0.02-0.41 N·m/kg). At the 12-month follow-up, the side-to-side difference in maximal muscle strength was 6% and 7%, respectively, during hip extension and 19% to 25% and 16% to 17%, respectively, during knee flexion. Conclusion: Twelve months after treatment of proximal hamstring avulsion, good clinical outcomes were seen when using a shared decision strategy regardless of whether the strategy led to surgical or conservative treatment.

A majority of the patient achieved both patient-acceptable symptom state and minimal clinically important difference of International Knee Documentation Committee Subjective Knee Form score at one year after anatomical double-bundle anterior cruciate ligament reconstruction

ObjectivesThere is a paucity of data about clinical outcomes after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the concepts of patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID). The aim of the present study was to evaluate the one-year clinical outcomes of patients who underwent DB-ACLR using PASS and MCID. MethodsAchievement of PASS and MCID were retrospectively evaluated for 298 (mean age 26.9 years; 145 men/153 women) and 214 patients (mean age 23.9 years; 114 males/100 females), respectively, who underwent primary DB-ACLR using a hamstring autograft. For patients who achieved PASS or MCID, demographics, preoperative, and postoperative data were statistically analyzed. ResultsOf 298 patients, 254 (85.2 %) achieved International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) PASS, and 191 out of 214 patients (88.8 %) achieved MCID. The dichotomous logistic regression analyses to assess the achievement of PASS showed that younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93–0.99; P = 0.013), male sex (OR, 2.2; 95% CI, 1.08-4.83; P = 0.030), and better one-year quadriceps strength symmetry (OR, 1.05; 95% CI, 1.03-1.07; P < 0.001) were independent predictors of PASS achievement. For MCID, preoperative IKDC-SKF score below the 50th percentile (OR, 14.39; 95% CI, 2.90-71.25; P = 0.001) and better one-year quadriceps strength symmetry (OR, 1.035; 95% CI, 1.007-1.064; P = 0.014) were independent predictors for MCID achievement. ConclusionsMore than 85 % of the patients achieved PASS and MCID for the IKDC-SKF score one year after undergoing DB-ACLR with hamstring tendon autograft. Better quadriceps strength symmetry at one year contributed to the achievement of both PASS and MCID. Rehabilitation dedicated to quadriceps strength recovery may be important for achieving good clinical outcomes after DB-ACLR. Level of evidenceIV, retrospective cohort.

Short-term outcomes of dogs and cats undergoing lung lobectomy using either a self-ligating loop or a thoracoabdominal stapler.

To assess clinical outcomes of lung lobectomies in dogs and cats using either self-ligating loops (SLLs) or thoracoabdominal (TA) staplers, aiming to inform sample size calculations for future superiority trials. Retrospective study. A total of 72 dogs and 15 cats. Records from January 2003 to October 2023 at a single institution were reviewed. Cases with lung lobectomy performed via TA stapler or SLL with a minimum 14-day postoperative follow-up were included. Pre-, intra-, and postoperative data were collected, with outcomes of interest including the frequency of intra- and postoperative complications. Outcome comparisons between techniques were performed to inform sample size calculations. A total of 101 lung lobectomies were performed. The TA stapler was used in 83 (82.2%) and the SLL in 18 (17.8%) lung lobectomies. Intraoperative complications were identified in 14/101 lung lobectomies (13.9%), including intraoperative hemorrhage in 12/101 lobectomies (11.8%) and air leakage in 2/101 lobectomies (1.9%). Postoperative complications were identified in 12/87 cases (13.8%), including 4 (4.6%) catastrophic complications and 5 (5.8%) major complications. All intra- and postoperative complications occurred in cases having undergone stapled lung lobectomy; however, no differences were identified between surgical technique and either intraoperative (p = .069) or postoperative complications (p = .112). A sample size of 103 lobectomies per technique group would be required for appropriate evaluation. Lung lobectomy using either surgical technique provided a good short-term outcome in this population. Self-ligating loop lung lobectomy provided a comparable alternative to stapled lung lobectomy. Further studies are needed to assess technique superiority.

Association of serum glucose/potassium index levels with poor long-term prognosis in patients with Aneurysmal Subarachnoid Hemorrhage

IntroductionThe glucose/potassium index (GPI) has been reported as a predictor biomarker of in-hospital complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). ObjectivesTo determine the association between GPI and functional outcome at 3–6 months after discharge in patients diagnosed with aSAH in a Peruvian referral hospital during 2018–2021. Materials and MethodsWe conducted a retrospective cohort observational study with a secondary database in patients with aSAH during 2018–2021 in a Peruvian referral hospital. We evaluated the relationship between GPI values and motor functionality from 3 m to 6 months post-discharge, using a Poisson family generalized linear model with Log link function and robust variance according to categorization of good and poor outcome. We considered a value of p<0.05 as statistically significant. We used restricted cubic splines with five nodes to evaluate the linear correlation between the 2 main variables. Results212 patients were included in the analysis. 21.1 % and 19.3 % had poor outcome at 3 and 6 months after discharge, respectively. Multivariate analysis showed that GPI was not associated with poor outcome at 3 (RR=0.999; 95 %CI=0.979–1.018) or 6 months after discharge (RR=0.979; 95 %CI=0.979–1.020). On the other hand, Splines plots showed no correlation between GPI and modified Rankin. ConclusionsDespite the usefulness of GPI to prognosticate in-hospital complications, its association with functional outcome is inconclusive.

Increased rate of anoxic brain damage with laryngeal tube compared to endotracheal intubation in patients with shockable out-of-hospital cardiac arrest – Experience from the HAnnover COoling REgistry (HACORE)

BackgroundSupraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet. MethodsWe analysed 452 OHCA-patients with shockable-rhythms from the HAnnover COoling REgistry (HACORE) who had return of spontaneous circulation prior to transport. Of those, 405 patients received primary airway management by endotracheal intubation (ETI) and 47 by LT. Patients were afterwards treated according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) applying a strict post-resuscitation management including therapeutic hypothermia and avoiding routine prognostication. ResultsWhile mortality in this group was moderate with both airway strategies (ETI 29 % vs LT 34 %, p = 0.487), the rate of anoxic brain damage was much higher in the LT compared to the ETI group (38 % vs 21 %, p = 0.011). Survivors in the ETI group were more likely to have good neurological outcome (cerebral performance category 1&2) compared to the LT group (35 % vs 17 %, p = 0.013). Pneumonia was more common in the LT vs ETI group (81 % vs 53 %, p < 0.001). ConclusionsWhile the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.

Braids and beyond: a comprehensive study on pipeline device braid stability from PREMIER data

BackgroundThe pipeline embolization device (PED) has been increasingly used to treat brain aneurysms; however, concerns have been raised about braid stability with newer drawn filled tubing technology devices.ObjectiveTo evaluate braid...

Preoperative interhemispheric coherence as a potential predictive marker for seizure outcome after total corpus callosotomy in nonlesional generalized epilepsy: a scalp EEG study.

Corpus callosotomy (CC) is one of the palliative epilepsy surgical procedures available for nonlesional generalized epilepsy, but it is more invasive than other palliative surgical procedures. The main challenge is proper selection of suitable patients for CC. Coherence analysis is a method for evaluating brain connectivity, but the correlation between preoperative coherence and surgical outcomes has not previously been clarified. The authors aimed to evaluate correlations between preoperative interhemispheric coherence and surgical outcome in patients with nonlesional generalized epilepsy. This retrospective study investigated patients with nonlesional generalized epilepsy who underwent total CC. The authors collected data for patients with good seizure outcome (Oguni classification A or B) and bad seizure outcome (Oguni classification D). For coherence analysis, the authors selected a period without interictal discharges. Preoperative interhemispheric coherence values from 8 pairs of symmetrically opposite scalp electrodes were computed across 5 frequency bands. Then, the authors evaluated correlations between coherence and surgical outcomes. Forty patients were included (19 males and 21 females). The mean (range) age at the time of surgery was 5.1 (1-18) years. Seizure outcomes were good in 15 patients and bad in the other 25 patients. Age at onset of epilepsy, duration of epilepsy before surgery, age at time of surgery, and presence of epileptic spasm did not differ significantly between patients with good and bad seizure outcomes (p = 0.36, p = 0.14, p = 0.10, and p = 0.20, respectively). Significant correlations were identified between higher Fp1-Fp2 interhemispheric coherence values in the delta, theta, and alpha frequency bands and bad surgical outcomes (p = 0.0397, p = 0.0322, and p = 0.0476, respectively). The receiver operating characteristic curves of the Fp1-Fp2 coherence values in these frequency bands showed areas under the curve of 67%, 69%, and 67%, respectively. The optimal cutoff values for Fp1-Fp2 interhemispheric coherence to predict surgical outcomes were 55.6 for delta (66.7% sensitivity and 72.0% specificity), 55.9 for theta (60.0% sensitivity and 76.0% specificity), and 50.3 for alpha (53.3% sensitivity and 84.0% specificity). This is the first study to identify potential predictive factors for surgical outcomes based on preoperative interhemispheric coherence in nonlesional generalized epilepsy. Higher coherence between Fp1-Fp2 in the delta, theta, and alpha frequencies correlated with bad seizure outcome after CC.

Effect of design and surgical parameters variations in mobile-bearing versus fixed-bearing unicompartmental knee arthroplasty: A finite element analysis.

Unicompartmental knee arthroplasty (UKAs) are available in the market as fixed- and mobile-bearing (FB and MB) and can be characterised by a different set of design parameters in terms of geometries, materials and surgical approaches, with overall good clinical outcomes. However, clear biomechanical evidence concerning the consequences of variations of these features on knee biomechanics is still lacking; therefore, the present study aims to perform a sensitivity analysis to see which outcomes are affected by these variations. For both MB-UKA and FB-UKA, five design and surgical parameters were defined (bearing insert thickness, tibial component material, implant components friction coefficient, antero-posterior slope angle and level of tibial bone resection). Two control models were defined based on standard configurations for both implants. Finite element analysis was chosen to perform this study, and different parameter combinations (216 models in total) were implemented and tested at both 0° and 90° of flexion, using a previously validated finite element knee model. The results were then evaluated in terms of bone and polyethylene Von Mises stress and tibio-femoral contact area. Bearing thickness, tibial bone cut and slope angle were found to be the most sensitive parameters for both types of UKAs. Specifically, changes in these parameters in the FB-UKA appeared to induce more significant variations in the polyethylene insert (both in terms of polyethylene stress and contact area), while in the MB-UKA, these changes influenced bone stress distribution more. Surgical parameters returned to have a more significant influence than material and friction variations; furthermore, the outcomes most affected by parameter variations were the insert-related ones for FB-UKA while for the MB-UKA were the ones regarding tibial bone stresses. Not Applicable.

Visual, Refractive, Functional, and Patient Satisfaction Outcomes After Implantation of a New Trifocal Diffractive Intraocular Lens.

To describe the visual, refractive, functional, and patient satisfaction outcomes of the Clareon® PanOptix® trifocal intraocular lens (IOL). This was a prospective longitudinal descriptive study. Patients who underwent cataract surgery with implantation of Clareon® PanOptix® (Alcon Laboratories, Inc.) were included. Monocular refractive outcomes and visual acuity at distance, intermediate, and near were evaluated 1- and 6-months post-op. Binocular contrast sensitivity (M&S® Technologies), binocular defocus curve, and patient satisfaction with the IOL Satisfaction (IOLSAT) and Questionnaire for Visual Disturbance (QUVID) questionaries were assessed at 6-month post-op. Seventy-six Clareon® PanOptix® were implanted bilaterally in 38 patients. The mean age of the patients was 67.63±5.18 years. At 1-month post-op, the monocular Corrected Distance Visual Acuity (CDVA), CIVA and CNVA were 0.00±0.09, 0.02±0.17, and 0.12±0.12 LogMAR, respectively, and CDVA and CNVA were stable at 6-month post-op (p>0.05). No statistical differences were found in post-op spherical equivalent at 1 and 6 months (-0.08±0.27 D and -0.05±0.24 D; p=0.351). A 100% of eyes were within ±0.5 D at 1 month and 6-month post-op. Binocular defocus curve shows three peaks of maximum visual acuity (VA) at 0D (-0.04±0.08 LogMAR), at -1.50D, and -2.50 D (0.01±0.10 LogMAR and 0.03±0.07 LogMAR, respectively). Contrast sensitivity decreased at high spatial frequencies. In patient satisfaction, IOLSAT questionary reveals 78.94% patients "Never" or "Rarely" Needing Glasses and according QUVID questionnaire, 100% of patients report no hazy vision. The PanOptix® IOL platform with the new material Clareon® provides good visual outcomes for distance, intermediate, and near vision, with adequate contrast sensitivity and low visual disturbances.

Morphological analysis of the trigeminal nerve in trigeminal neuralgia using the nerve's centerline and multiple cross-sections of a 3D model.

Morphological changes such as angulation and torsion of the trigeminal nerve have been reported to cause trigeminal neuralgia (TN). The authors sought to quantify and objectively evaluate the morphological changes of the trigeminal nerve and to elucidate the cause of TN. The authors retrospectively analyzed the cases of patients with primary TN who had undergone microvascular decompression at a single facility between January 2016 and December 2022 and had both single-artery compression and a good postoperative outcome. The authors performed segmentation of the trigeminal nerve by using the patients' pre- and postoperative high-resolution MR images, and they then created a 3D model. The centerline of the trigeminal nerve was obtained using volume skeletonization, and the authors created multiple cross-sectional images by reslicing the 3D model perpendicular to the centerline. The parameters analyzed were as follows: the 1) centerline length; 2) centerline curvature; 3) centerline torsion; 4) cross-sectional area; 5) cross-sectional flattening ratio; and 6) cross-sectional long-axis angle. Comparisons were made for each parameter between the affected and unaffected side and between preoperative and postoperative trigeminal nerve findings. After exclusions, 70 of the 127 patients who underwent microvascular decompression during the study period were included in the analysis. In the preoperative images, the trigeminal nerve on the affected side had a significantly longer centerline length (p = 0.0003), greater curvature (p = 0.0012), smaller cross-sectional area (p < 0.0001), and greater flattening ratio (p = 0.0059) than the unaffected side. On the affected side, the preoperative trigeminal nerve had a significantly longer centerline length (p < 0.0001), greater curvature (p = 0.0028), and smaller cross-sectional area (p < 0.0001) compared to the postoperative trigeminal nerve. It is possible to analyze the morphological changes of the trigeminal nerve by using this method. In the preoperative trigeminal nerve on the affected side, the centerline is long and curved, and the cross-sectional area is small and flat. Further analyses may help clarify the pathophysiology, aid in diagnoses, and predict the efficacy of treatment.

Clinical and radiographic results of internal fixation of quadrilateral plate fractures of acetabulum.

Quadrilateral plate (QLP) is a relatively thin bony structure located below the pelvic brim proximal to the hip joint, so management of its fractures is challenging. Evaluation of the functional and radiological outcomes of internal fixation of quadrilateral plate acetabular fractures; comparison of two methods of fracture fixation. A prospective multicentric study including 30 patients who underwent open reduction and internal fixation of QLP fractures through modified Stoppa approach. Patients were divided into two groups according to the method of fixation (anatomical QLP plate vs suprapectineal and infrapectineal plates). Post-operative quality of reduction was evaluated using Matta score. Radiographical assessment according Matta's grading criteria and clinical outcome assessment using the Harris Hip Score (HHS) were repeated at follow-up and at one year to assess displacement. Mean age of patients was 34.9 ± 12.1years. After one year follow-up, clinically mean HHS was 88. ± 5.74. Radiologically post-operative reduction quality was anatomical in 21 (70%) patients, satisfactory in eight (26.7%) patients and unsatisfactory in one (3.3%) patient. Matta's grading at the last follow-up was excellent in 21 (70%) patients, good in six (20%), fair in two (6.7%) patients and poor in one (3.3%) patient. No significant difference was recorded between the two groups in terms of radiographical and clinical results and rate of complications. Accurate reduction of quadrilateral plate fracture with secure fixation through modified Stoppa approach provides good and reproducible outcomes with few complications regardless the type of the implant.