Long-term Follow-up Results Research Articles

Frontal sinus mucosa suture closure technique for prevention of cerebrospinal fluid rhinorrhea after bifrontal craniotomy: long-term follow-up results.

Bifrontal craniotomy often involves the bony opening and mucosal disruption of the frontal sinus (FS), which can lead to cerebrospinal fluid (CSF) leakage and meningitis. These complications are particularly associated with surgical treatments for skull base tumors and anterior cerebral artery aneurysms. The authors initially reported on the basic technique in 2014 with 51 cases. This study presents a detailed description of their technique and postoperative management for sealing the exposed FS during bifrontal craniotomy, including long-term follow-up results and outcomes. To objectively evaluate the effectiveness of suturing FS mucosa in preventing CSF leakage during bilateral frontal craniotomy, the authors focused only on anterior cerebral artery aneurysms. This limitation was necessary as other conditions, like extensive tumors or trauma, might lack intact FS mucosa or require its removal due to infection. The records of 34 consecutive patients (median age 62.0 years, mean 60.4 years, range 33-78 years) who underwent bifrontal craniotomy for anterior cerebral artery aneurysms between January 2014 and December 2023 were retrospectively analyzed. All patients had bony opening and mucosal injury of the FS (with exposure to the nasal cavity) that required mucosal suturing. This technique for sealing the exposed FS involves careful dissection of the mucosa from the entire sinus, sterilization with iodine-soaked surgical cotton, and preparation for closure. After the microsurgical procedure is completed, the exposed mucosa is sealed with 6-0 nylon sutures and further secured with fibrin glue-soaked Gelfoam. The bony exposure is covered with an autologous bone flap created from the inner table of the craniotomy bone flap. Finally, the frontal periosteal flap is sutured to the frontal base dura mater. Patients were instructed not to blow their noses for 2 months postoperatively. Two patients experienced transient non-CSF leakage from the nasal cavity, likely due to irrigation fluid, which resolved within 2 days postoperatively. No recurrence was observed during a mean follow-up period of 52.8 ± 41.7 months (median 49 months, range 3-127 months). No cases of meningitis or other intracranial infections were reported. The long-term results demonstrate the sustained effectiveness of this technique in preventing postoperative complications related to FS exposure during bifrontal craniotomy.

Prognostic factors for long-term outcomes of bilateral pallidal deep brain stimulation in the treatment of Meige syndrome.

This study aimed to investigate the effects of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) on both motor and nonmotor symptoms in patients with Meige syndrome and to further explore prognostic factors for postoperative outcomes based on the long-term follow-up results. The authors retrospectively reviewed the medical records of a consecutive cohort of patients with refractory Meige syndrome who underwent GPi-DBS at their center from January 2016 to October 2023. Motor function, quality of life, neuropsychological status, and emotional state were assessed using standardized scales at baseline and every 3-6 months thereafter. Univariate and multivariate linear regression analyses were performed to identify independent risk factors affecting long-term motor function after GPi-DBS in patients with steady-state (stable) Meige syndrome. Fifty steady-state patients were ultimately included and assessed, with a mean follow-up duration of 62.9 ± 24.8 months. At the final postoperative evaluation, Burke-Fahn-Marsden Dystonia Rating Scale movement and disability scores showed improvements of 69% (p < 0.001) and 61% (p < 0.001), respectively. A significant improvement from baseline was observed in postoperative scores on the 36-item Short-Form General Health Survey. Throughout continuous neurostimulation, global cognitive function, neuropsychological status, and mood remained stable. Multivariate linear regression analysis revealed that longer disease duration (standardized β-coefficient -0.375, 95% CI -0.033 to -0.011; p < 0.001) and reduced volume of activated tissue within the sensorimotor subregion of the GPi (standardized β-coefficient 0.597, 95% CI 0.002-0.003; p < 0.001) were independently associated with worse long-term motor performance. Bilateral GPi-DBS is an effective, safe, and promising treatment option for intractable Meige syndrome and provides sustained benefits in motor function and quality of life without inducing cognitive or mood-related side effects. Early intervention and accurate electrode placement in the sensorimotor subregion of the GPi are essential for optimizing long-term therapeutic outcomes.

Long-term follow-up results and complications of breast-conserving surgery using multilayer acellular dermal matrix: a retrospective study

Background The advantages of using an acellular dermal matrix (ADM) for implantbased breast reconstruction in breast cancer patients are well-documented across multiple studies. However, there have been no previous instances of using multilayered ADM for reconstruction following breast-conserving surgery (BCS). This study evaluated the outcomes of breast reconstruction employing multilayered ADM for volume replacement using a local glandular flap post-BCS, and aims to underscore the advantages of this surgical approach.Methods Breast cancer patients who underwent BCS using several layers of ADM from August 2016 to December 2019 were retrospectively reviewed. Only patients with at least 3 years of follow-up were included in this study. The anticipated postoperative complications were breast deformity, seroma, hematoma, and infection.Results Seventy-four patients were included in this study. Most patients experienced symptoms of hard palpation at the reconstruction site, which indicated the surface of the ADM inserted into the breast. Ten patients developed breast deformities, accounting for 13.5% of the cases, and required surgical correction. Other complications were less frequent: four patients (5.3%) had a confirmed seroma for 6 months or longer, two patients (2.6%) experienced fat necrosis, and one patient (1.3%) underwent re-operation to remove the ADM.Conclusions Reconstruction with a glandular flap and ADM following BCS is generally simpler and requires less surgical time compared to using a latissimus dorsi flap or other local flaps. Additionally, it avoids complications at the donor site, presenting a feasible surgical alternative for BCS in breasts with small defects.

Endomyocardial Biopsy: short- and long-term safety in myocarditis patients.

To assess the short-term and long-term outcomes of percutaneous endomyocardial biopsy (EMB) in patients with myocarditis and to identify the risk factors for EMB-related complications in this patient population. A retrospective analysis was conducted on 294 hospitalized patients with clinically suspected myocarditis at Tongji Hospital from October 2019 to October 2023, with a median follow-up duration of 18 months. Patients were divided into an EMB group (n = 151) and a non-EMB group (n = 143) based on whether they underwent EMB procedure. The incidence of endpoints was compared between the two groups, and the Kaplan-Meier survival curve was used to assess the survival rate without endpoints. Endpoints included major adverse cardiovascular events (MACE), ventricular enlargement, and decline in cardiac function. Multivariate logistic regression analysis was employed to evaluate the risk factors for EMB-related complications. The incidence of major short-term complications following EMB was 2.0% (3/151), while the incidence of minor complications was 9.3% (14/151). Multivariate risk regression analysis revealed that operative duration (OR: 1.101, 95% CI: 1.02-1.079, p < 0.05) and BNP levels (OR: 1.083, 95% CI: 0.931-1.26, p < 0.05) were associated with short-term complications following EMB. Compared to the non-EMB group, the EMB group had no significant increase in hospital stay (10 [8, 15] vs. 9 [7, 16], p = 0.27) and no significant decline in cardiac function. Long-term follow-up results showed that 8 patients (5.3%) in the EMB group experienced MACE, 14 patients (9.3%) had left ventricular enlargement, and 18 patients (11.9%) had a decline in left ventricular ejection fraction (LVEF) after discharge; in the non-EMB group, 12 patients (8.4%) experienced MACE, 30 patients (19.9%) had left ventricular enlargement, and 18 patients (11.9%) had a decline in LVEF after discharge. The Kaplan-Meier curve revealed a lower incidence of endpoint events in the EMB group (p < 0.05). In patients with myocarditis, EMB is associated with a risk of short-term complications, with higher levels of BNP and operative duration being independent risk factors for EMB-related complications. However, EMB does not adversely affect cardiac function or hospital stay during the inpatient period and may contribute to the improvement of long-term outcomes in patients with myocarditis.

Need of Treatment Modification During Entecavir Therapy in Patients with Chronic Hepatitis B: Long-Term Follow-Up Results for 120 Months

Need of Treatment Modification During Entecavir Therapy in Patients with Chronic Hepatitis B: Long-Term Follow-Up Results for 120 Months

Long-term follow-up result of short metaphyseal femoral stem in primary total hip arthroplasty: A retrospective study.

Total hip arthroplasty (THA) has increased along with an increasing demand for improved quality of life. Combined with prolonged life expectancy, the number of revision surgeries is expected to increase. Stress shielding is a significant issue with traditional femoral stems used in THA, making revision surgeries particularly challenging in younger patients. This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems, which have the potential to alleviate these challenges and simplify revision surgeries. To evaluate the long-term outcomes of short-stem THA. A total of 124 hips that underwent THA using the short femoral stem (TRILOCK® Depuy) between May 2006 and November 2008 were included in this study. Patients were followed for a period of 15 years. Outcomes were assessed in terms of pain relief, hip joint range of motion, improvement in mobility, and functional outcomes using the modified Harris Hip Score, Oxford hip score, and Western Ontario and McMaster Universities Osteoarthritis index score. A total of 124 hips in 98 patients were evaluated. Significant improvements in functional outcomes were observed over the 15-year follow-up period, with no cases of subsidence, implant loosening, or complications necessitating revision surgery. The only complication reported was heterotopic ossification in 1 patient. Short metaphyseal stems provide better functional outcomes with early mobilization, and its long-term follow-up without subsidence, implant loosening, or proximal femoral bone loss simplifies revision surgery in younger patients.

Current Diagnostic, Counseling, and Treatment Options in Non-Severe and Severe Apparently Isolated Fetal Ventriculomegaly.

The widening of the vestibular dimension of lateral ventricles > 10 mm should be considered a symptom rather than a definitive diagnosis. In fact, fetal ventriculomegaly (VM) is a defect with 'multifaceted' clinical consequences in the child's further neurodevelopment. Isolated fetal ventriculomegaly can cause neurological defects ranging from mild neurodevelopmental delay to severe complications in the form of ongoing palliative care to the death of patients at various developmental periods. The spectrum of compilations often depends on the severity of the ventriculomegaly. In the prenatal period, the combined diagnostic tools include the following: ultrasound/MRI and genetic, infectious tests that form the basis of reliable counseling. We hypothesize that advances in the diagnostic process allow the identification of 'probably' isolated forms of severe VM (ISVM). The review authors electronically searched MEDLINE, EMBASE, and the Cochrane Library databases, describing the evidence-based validity and option of prenatal decompression for ISVM. The purpose of this review is to present the evolution of diagnostic techniques and views indicating the possibility and limitations of implementing prenatal decompression in severe ISVM. In conclusion, after reviewing the available data, we want to introduce the idea that perinatal centers are close to or have reached the necessary capability, expertise, and competence to perform ISVM decompression procedures. Endoscopic ventriculostomy of the third ventricle (ETV) appears to be promising, as it seems to be associated with minimal perinatal complications and better neurological outcomes for the newborn. However, long-term follow-up results for the neurodevelopment of patients who underwent ETV have not been reported. Looking ahead, randomized trials with the long-term neurodevelopmental follow-up of children who underwent prenatal decompression due to ISVM are needed.

Evaluation of pediatric spinal ependymomas: A 25-year retrospective observational study.

This study aims to evaluate the clinical and radiological features, histopathological characteristics, treatment modalities, and their effectiveness, as well as long-term follow-up results of pediatric spinal ependymomas treated at a single institution. In this retrospective study, medical records of 14 pediatric patients (3 females and 11 males) who were surgically treated for spinal ependymoma in our institution between 1995 and 2020 were reviewed. Data regarding age, gender, presenting symptoms and signs, radiological findings, postoperative status, extent of resection, histopathological grading, recurrence, tumor growth, seeding, and adjuvant treatment were collected and analyzed. Six patients had myxopapillary ependymoma, 7 patients had grade II ependymoma, and 1 had grade III ependymoma. Median age at diagnosis was 10.5 (range, 1-15) years. The most common presenting symptoms and signs were axial and radicular pain, paresis, and first motor neuron involvement. In 10 patients, gross total tumor resection was achieved. Five patients underwent additional surgeries for disease progression (recurrence or residual tumor growth). Most of the patients who had no disease progression were treated with gross total resection. Two patients experienced seeding. One patient who had a grade III tumor and did not achieve gross total resection died during follow-up. Pediatric spinal ependymomas are uncommon tumors with relatively benign course. Gross total resection should be the primary goal of surgery since it may prevent disease progression, and in case it fails, progression occurs later than those that were treated with subtotal resection.

Combined Penetrating Keratoplasty and Vitrectomy: Long-Term Follow-Up Results.

Purpose: To assess the long-term outcomes of combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV). Methods: A retrospective review of eyes that underwent combined surgery followed for 12 months or longer. Demographic data, indications for surgery, and pre-/post-surgical eye examinations were retrieved. Results: Thirteen consecutive eyes (13 patients) were enrolled. The mean age was 51.5 ± 20.5 years, and the mean follow-up time was 67 ± 36.9 months. All cases had severe corneal opacity. Indications for surgery included retinal detachment (76.9%), dropped lens (7.7%), dropped intraocular lens (7.7%), and endophthalmitis with corneal abscess (7.7%). Visual acuity improved in 46.1% of the cases, though in most cases visual acuity remained low, and decreased in 23% of the cases. In 23% of the cases (3 eyes), ambulatory vision was achieved for more than 12 months and in 15.4% for three years. Silicone oil tamponade was used in all cases of retinal detachment (10 eyes). Of these eyes, at the final follow-up, four eyes were attached, two eyes were partially attached, and corneal opacity prevented retinal visualization in three eyes. One eye was eviscerated and one eye developed phthisis. Postoperatively, 61.5% of the cases underwent repeated PKP for graft decompensation. At the final visit, graft failure was observed in 75% of the cases. Conclusions: The long-term follow-up of eyes that underwent combined PKP and PPV supports this technique in complex cases for eye and vision preservation. The main problem after combined surgery is the long-term survival of the corneal graft which may require repeated PKP surgeries. With this approach, in 23% of the cases, ambulatory vision was maintained for more than 12 months.

Comparison of hand-assisted laparoscopic adrenalectomy vs. laparoscopic adrenalectomy for large pheochromocytomas: a retrospective study.

It remains uncertain whether hand-assisted laparoscopic adrenalectomy (HAL) has advantages in treating large pheochromocytomas (PHEOs). This study aimed to assess the feasibility and safety of HAL compared to laparoscopic adrenalectomy (LA). We conducted a retrospective study on patients with PHEOs ≥6 cm who received HAL (n=16) and LA (n=20) at Shandong Provincial Hospital from January 2020 to January 2023. The two groups were balanced into 8 pairs using propensity score matching (PSM). Perioperative parameters and long-term follow-up outcomes were compared between the two groups. After adjusting for balance through PSM, patients in the HAL group had shorter operation time (105.00±18.52 vs. 147.50±7.07 minutes, P<0.001), faster bowel recovery days (1.0 vs. 2.0 days, P=0.043), and shorter postoperative hospital stays (5.00 vs. 7.50 days, P=0.01). The differences in blood pressure improvement within 3 months postoperatively, and recurrence and metastasis between the two groups (75.00% vs. 62.50%, P>0.99; 12.50% vs. 12.50%, P>0.99) were not statistically significant. This study suggested that HAL was feasible and safe for patients with large PHEOs. Both HAL and LA showed comparable perioperative and long-term follow-up results.

Outcome more than 20 years after surgery for ulnar nerve compression at the elbow

Ulnar nerve entrapment at the elbow is a common neurological entrapment neuropathy. Previous research has shown that surgical treatment can be highly successful. Only a few studies have reported on long-term outcome after surgery. In this study, we report on the long-term follow-up after surgery for ulnar nerve compression at the elbow. We performed a long-term follow-up study, more than 20 years after surgery, for ulnar neuropathy at the elbow. We also compared 2 methods: simple decompression and anterior subcutaneous transposition. A short outcome questionnaire, adapted from Novak etal., was sent to retrieve data on the long-term follow-up outcomes. 39 patients were included in this study. At long-term follow-up, there was no significant difference in outcome compared to outcome at 1-year follow-up. We may conclude that the surgical treatment is also successful in the long term.

Long-term cerebrovascular outcomes of patients undergoing percutaneous patent foramen ovale closure in observational studies: a systematic review and meta-analysis.

Patent foramen ovale (PFO) closure is recommended for patients who experienced a cryptogenic stroke attributable to PFO. Although few randomized control trials (RCTs) have captured long-term effectiveness of PFO closure, observational data has been abundant. This is the first systematic review of observational studies determining incidence of long-term adverse outcomes in adults who underwent transcatheter PFO closure, with comparisons to findings from RCTs. Medline, Cochrane, and Embase databases were searched from inception to October 2023. Only observational studies with ≥4 years of mean or median follow-up were included. A meta-analysis was conducted to calculate the incidence of recurrent stroke after PFO closure. After reviewing 2,432 records, 13 prospective and 12 retrospective cohort studies were included. Average follow-up lengths ranged from 4 to 12.3 years, and sample sizes from 75 to 1,533 participants. The average age ranged between 43.5-63.0, and 24.0-72.8% patients had an atrial septal aneurysm. The incidence of stroke was 0.34 per 100 person-years (I2 = 67%). This was similar to rates from four RCTs that were used for comparison (0.35 per 100 person-years, I2= 51%). There was a significant improvement in heterogeneity once the study with one of the largest follow-up was removed. Real-world PFO closure studies with long-term follow-up report similar outcomes as RCTs which is important considering the exclusion of several important populations from trials. Future observational studies should include more rigorous reporting of follow-up strategies and explore different long-term adverse outcomes.

Oncologic impact of technical difficulties during the early experience with laparoscopic surgery for colorectal cancer: long-term follow-up results of a prospective cohort study

Oncologic impact of technical difficulties during the early experience with laparoscopic surgery for colorectal cancer: long-term follow-up results of a prospective cohort study

Safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of distal intracranial aneurysms: A single-center experience

ObjectiveTo investigate the effectiveness, safety, and efficacy of Atlas stents in the treatment of distal intracranial aneurysms (IAs). MethodsWe retrospectively analyzed patients with IAs who underwent stent-assisted coiling (SAC) from January 2018 to January 2022 and divided them into two groups: distal IAs treated with Atlas SAC and wide-necked aneurysms in other locations treated with SAC. The clinical data, imaging data, and postoperative follow-up data for the two groups of patients during hospitalization were collected. ResultsFifteen patients were included in the distal IA group, and 332 patients were included in the non-distal IA group. The baseline data for the two groups of patients were compared, and significant differences in aneurysm locations, whether the aneurysm had ruptured, and the width of the aneurysm neck were found between the two groups. In the distal IA group, all stents were successfully placed and released during the operation. No aneurysm rupture occurred during the operation. Immediate postoperative digital subtraction angiography (DSA) showed complete embolization of the aneurysm in 10 patients. Ischemic complications occurred perioperatively in two patients. The postoperative follow-up showed a poor prognosis (modified Rankin scale (mRs) > 2) in three patients and aneurysm recurrence in one patient. No significant differences in the treatment effect, surgical complications, or follow-up results were found between the two groups. ConclusionIn this series, the use of Atlas SAC for the treatment of distal IAs was not associated with higher complication rates, and shows satisfactory long-term occlusion rates and follow-up results.

A new clinical classification of congenital biliary dilatation - HUAXI CBD classification.

Current biliary dilatation (BD) classifications are complex and based on cases including secondary BD, leading to unclear distinctions. Notably, congenital and secondary BD differ in etiology, symptoms, and prognosis. To propose a more concise and more suitable classification of congenital biliary dilatation (CBD), and exploring the feasibility and effectiveness of this classification in diagnosis and treatment. Based on the preoperative imaging data of patients with CBD admitted to the Department of Pediatric Surgery of West China Hospital of Sichuan University, from January 2015 to December 2018, a new classification of CBD was accomplished according to the site of bile duct dilatation lesions, which was named HUAXI CBD classification. The CBD was classified into 4 types: type I (distal extra-hepatic bile duct dilatation), type II (distal extra-hepatic combined with right and left primary hepatic bile duct dilatation), type III (extra-hepatic combined with secondary and above hepatic bile duct dilatation), and type IV (intra-hepatic bile duct dilatation). Meanwhile, the feasibility and reliability of the HUAXI CBD classification were analyzed by analyzing the clinical treatment strategies, perioperative complications and long-term follow-up results of different subtypes. A total of 300 patients with CBD were included in this study. According to the HUAXI CBD classification method, 240 cases were type I, 48 cases were type II, 10 cases were type III, and 2 cases were type IV. After treatment, patients with type I had a normal hepatobiliary function after surgery and a good prognosis; patients with type II had good recovery of liver function in 37 cases (77.1%), but 11 cases (22.9%) had postoperative complications during follow-up; patients with type III and IV had high incidence of cholangitis (6/10, 2/2, respectively) and choledocholithiasis (5/10, 2/2, respectively) after surgery, especially those with diffuse intrahepatic dilatation having a poor prognosis, eventually developing cirrhosis and necessitating liver transplantation. The HUAXI CBD classification is consistent with treatment principles, concise and easy to remember, and more suitable for CBD clinical application.

CTNI-47. A PHASE 1, RANDOMIZED, PERIOPERATIVE TRIAL OF VORASIDENIB AND IVOSIDENIB IN IDH1-MUTANT DIFFUSE GLIOMA: UPDATED RESULTS

Abstract BACKGROUND Vorasidenib (VOR) and ivosidenib (IVO) showed clinical activity in subjects with isocitrate dehydrogenase mutant (mIDH) gliomas. We evaluated both agents in a phase 1, randomized, open-label perioperative trial (NCT03343197). Pharmacodynamics, pharmacokinetics, and preliminary objective response rate (ORR) data as of 29-April-2020 were previously reported (Mellinghoff et al. Nat Med. 2023). Progression-free survival (PFS) data were not mature at publication time. We report here longer-term follow-up results, including mature PFS. METHODS Participants with grade 2/3 non-enhancing mIDH1 R132H mutant gliomas were randomized to VOR (50 or 10 mg QD), IVO (500 or 250 mg BID), or no treatment (control) for 4 weeks prior to planned surgery, with the option to continue treatment with VOR or IVO post-surgery. Secondary objectives included PFS, ORR assessed by Investigator in the post-surgery period, and safety profile of VOR and IVO. RESULTS Enrollment completed in April-2019. 49 participants were randomized, of which 46 participants (24 oligodendroglioma, 20 astrocytoma, 1 anaplastic oligodendroglioma, 1 anaplastic oligoastrocytoma) received treatment with either VOR (N=24) or IVO (N=22) after surgery. As of 23-September-2023 data cutoff, 11 (46%) and 5 (20%) participants remain on treatment for VOR and IVO, respectively. Median (range) post-operative treatment duration was 44.7 months (0.9–62.7) for VOR, 23.9 months (0–62.7) for IVO. Median (95% CI) PFS was 41.4 months (9.3, NE) for VOR and 38.6 months (18.3, NE) for IVO. ORR per Response Assessment in Neuro-Oncology in low-grade gliomas (RANO-LGG) was 46% for VOR and 27% for IVO. Longer safety follow up will also be presented. CONCLUSION These results provide further evidence of prolonged response using IVO and VOR immediately following surgery in predominantly non-enhancing gliomas. This longer-term follow-up is consistent with Phase 3 INDIGO study results where VOR demonstrated PFS benefit with manageable safety compared with placebo in participants with non-enhancing mIDH gliomas.

CTNI-14. RADIOTHERAPY VERSUS TMZ FOR HIGH-RISK LOW-GRADE GLIOMA. FINAL RESULTS AFTER MEDIAN FOLLOW-UP OF 13 YEARS OF PHASE III EORTC/NCIC-CTG/TROG/MRC-CTU (EORTC 22033-26033) STUDY

Abstract BACKGROUND We previously reported on progression-free survival of our randomized phase 3 trial [Lancet Oncol. 2016;17:1521-1532]. Here we report results of long-term follow-up (FU) including overall survival (OS) and molecular subgroup analyses. METHODS 487 patients were randomized between 2005-2012 to either standard radiotherapy (RT, 50.4 Gy/ 28 fractions) or primary dose-dense temozolomide [TMZ] chemotherapy (75 mg/m² daily x 21/28 days, up to 12 cycles). Treatment at progression was at investigators discretion and commonly included cross-over to the alternative treatment modality. RESULTS At a median follow-up of 13 years, 68% of patients had died. Median age at inclusion was 45 years (range 18-75), 96% had a performance status of 0-1. There was no significant difference in PFS nor OS: PFS was 3.6 years (95% CI: 3.0-4.1) and 3.1 years (95% CI: 2.7-3.6), HR 1.12 (95% CI: 0.92-1.36); OS 6.6 years (95% CI: 5.8-7.5) and 8.0 years (95% CI: 6.9-9.1), HR 0.87 (95% CI: 0.69-1.09), for RT or TMZ, respectively. Subgroup analyses were performed for patients when available tissue allowed for molecular analyses (n=351/487,73%). In astrocytoma, IDHmt/1p/19q non-codeleted (n = 178), median OS with RT was 6.6 years (95% CI: 5.3-7.6) and with TMZ was 6.7 years (95% CI: 5.7-8.0); HR 0.98 (95% CI: 0.67-1.44). For oligodendroglioma, IDHmt/codeleted (n = 109) median OS with RT was 12.9 years (95% CI: 9.4 - NE) and with TMZ 14.9 years (95% CI: 10.1 - NE); HR 1.01 (95% CI: 0.56-1.81). For a heterogenous group of IDHwt tumors (n = 64), median OS with RT was 2.5 years (95% CI: 1.8-3.3) and with TMZ 4.7 years (95% CI: 2.2-7.2); HR 0.37 (95% CI: 0.18-0.77). CONCLUSIONS Primary treatment with RT or TMZ provided comparable PFS and OS. Choice of primary treatment can be tailored to individual tumor characteristics and patient preference.

Long-Term Outcomes of Tension-Free Vaginal Tape Procedures in Argentine Women: Our First Report After 20 Years.

Transvaginal tape is currently a stress urinary incontinence (SUI) treatment with recommendation grade A in accordance with the 7th International Consultation on Incontinence. The main aim of the present study was to evaluate objective and subjective outcomes of tension-free vaginal tape (TVT) 20 years after our medical group started to use it. A second aim was to describe the voiding phase and the immediate, medium-term, and late complications of TVT procedures. This is a retrospective cohort study that included patients diagnosed with SUI who received TVT treatment in a tertiary care hospital in Argentina from 1999 to 2003. Objective outcomes were recorded in a medical visit by means of urogynecological examination, which included a cough stress test with a comfortably full bladder and uroflowmetry. Subjective outcomes were assessed using quality-of-life questionnaires and questions addressed to the patient, regarding whether the patient felt cured and would recommend surgery. A total of 74 patients with an average follow-up of 18years were evaluated. Most of the patients evaluated (96.8%) were objectively continent in the long term, 95.3% reported feeling cured, and 97.6% would recommend surgery. The complications were similar to those reported in the literature. No cases of voiding disorder were found in the long-term follow-up. Tension-free vaginal tape is a minimally invasive, safe, and effective surgical technique, with a high objective and subjective cure rate, a low rate of complications related to the mesh or aging, and good results in long-term follow-up.

Paracetamol and adverse cardiovascular outcomes in patients with heart failure

Abstract Background Paracetamol is the most widely used pain killer worldwide, yet its potential influence on cardiovascular events among patients with heart failure (HF) remains unclear. Thus, this study aims to investigate both the short-term and long-term effects of paracetamol use on all-cause mortality and cardiovascular events in HF patients. Methods Using the previously validated territory-wide clinical information registry, paracetamol use was identified among all eligible patients with HF (N = 211,409) from 2000 to 2020. A case-crossover design was used to investigate the associations between short-term use of paracetamols and all-cause mortality and cardiovascular outcomes. Defined daily dose (DDD) was used to evaluate the dose-response relationship. Additionally, the marginal structural design was applied to model paracetamol use as a time-varying exposure and evaluate its long-term effects during the follow-up period. Results Of all eligible subjects, the mean age was 73.2±12.3 years, and 43.6% was male. Over a median follow-up of 10.5 years (interquartile range: 5.7-15.8), 113,258 (53.6%) patients were re-hospitalised for HF, HF-related death occurred in 11,892 (5.6%) patients, incident myocardial infarction (MI) in 28223 (13.3%) patients, incident stroke in 26458 (12.5%) patients, cardiovascular death (CVD) in 72,175 (34.1%) patients and all-cause death in 123,505 (58.4%) patients. Associating HF rehospitalisation to previous paracetamol exposure using the case-crossover design displayed an elevated risk (OR 3.62, 95% CI 3.53-3.71). Associations were similar for MI (OR 5.77, 95% CI 5.50-6.05), stroke (OR 2.37, 95% CI 2.25-2.49), HF-related death (OR 1.86, 95% CI 1.75-1.98), CVD (OR 3.64, 95% CI 3.55-3.73), and all-cause mortality (OR 3.32, 95% CI 3.26-3.39). Moreover, compared with paracetamol users taking the reference dose, users of low, medium and high doses of paracetamol had 16%, 17% and 52% higher risk of HF rehospitalisation. During the long-term follow-up, the average weighted hazard ratio (HR) for HF rehospitalisation in paracetamol users was 2.48 (95% CI 2.46–2.50) as compared with paracetamol non-users after accounting for all-cause mortality as a competing risk. Similarly, the average weighted HR for incident MI or stroke was 2.71 (2.62-2.81) and 3.45 (3.34-3.57), respectively. However, neutral results were shown for HF-related death, CVD and all-cause mortality. Conclusion The use of paracetamol among patients with HF is common. Paracetamol was associated with adverse cardiovascular outcomes both in short-term and long-term follow-up with a dose-response relationship, while its impact on long-term mortality remained neutral. Future randomized controlled trials or experimental studies are warranted to gain a comprehensive understanding of the underlying mechanisms driving such associations between paracetamol and adverse cardiovascular outcomes.

Prognostic role of remnant cholesterol and traditional cardiovascular risk factors in young adults: results of long-term follow-up of a cohort of 30-year-old norwegians

Abstract Background There are limited data on the prevalence and impact of traditional cardiovascular (CV) risk factors among young adults. In addition, more knowledge on novel CV risk factors is needed to explain the residual risk beyond that of the traditional risk factors. Increasing evidence suggest a causal role of remnant cholesterol (RC) in the development of atherosclerotic cardiovascular disease (CVD) and subsequent clinical events. However, the role of RC in young adults is unresolved. Purpose We aimed to evaluate the prevalence of traditional risk factors and the respective sex-differences in young adults, as well as their association with long-term CV events. Further, we hypothesized that higher RC concentrations are associated with impaired CV prognosis. Methods In year 2000, all 30-year-old inhabitants of our city were invited to a cross-sectional study including assessment of health status, anthropometric measurements, and non-fasting blood samples. RC was calculated as total cholesterol minus (LDL-C + HDL-C). Long-term clinical follow-up was performed through linkage with mandatory national registries, 22 years after inclusion. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalization for unstable angina and coronary revascularization. Results A total of 5950 individuals were included (56% women). At baseline, men displayed significantly higher systolic and diastolic blood pressure, total cholesterol, LDL-C and triglycerides, as compared with women (Table 1). Also, men had higher levels of RC (Table 1). During a mean follow-up time of 22 years, 108 events (1.8%) occurred. In multivariable Cox regression analysis, non-West-European ancestry (adjusted [a] HR 1.76, 95% confidence interval [CI] 1.03-2.99), diabetes mellitus (aHR 6.39, 95% CI 2.52-16.2), systolic blood pressure (aHR 1.03, 95% CI 1.01-1.04), and LDL-cholesterol (aHR 1.37, 95% CI 1.11-1.68) were associated with an increased risk of CV events during long-term follow-up. Female gender was associated with a reduced risk of CV events (aHR 0.38, 95% CI 0.23-0.64), whereas smoking status did not show any significant association. RC was identified as a significant predictor of CV events (aHR 1.55, 95% CI 1.11-2.18, per 1.0 mmol/L increase). The highest RC quartile (mean RC: 1.1 mmol/L), had the highest event rate (Figure 1, p&amp;lt;0.001 with log-rank test). Conclusion This study uncovers significant sex-differences in modifiable CV risk factors among young adults at the age of 30, which are associated with increased risk for long-term CV events. Interestingly, increasing concentrations of RC at the age of 30 were strongly associated with impaired long-term CV outcome and should be accounted for in early risk prediction.Baseline characteristics.Remnant cholesterol and CVD events.