Long-term Function Research Articles

Perioperative Anticholinergic Medication Use and Incident Dementia among Older Surgical Patients: a Retrospective Cohort Study using Real-World Data.

Inpatient anticholinergic medications have been associated with a higher likelihood of postoperative delirium in older adults. However, it remains unclear whether administering anticholinergic medications after surgery adversely affects long-term cognitive function. We aimed to evaluate the relationship between in-hospital anticholinergic medications and time to incident dementia in a cohort of older surgical patients. We also sought to determine whether the association between in-hospital anticholinergic drugs and dementia differed by sex and prehospital anticholinergic exposure. This was a retrospective analysis of electronic health record data from a regional health information exchange. The study population included patients aged 50 years and older who underwent major surgery requiring an inpatient stay between 2014 and 2021. Orders for anticholinergic medications were identified using the anticholinergic cognitive burden (ACB) scale. A Cox proportional hazards model was used to estimate the association between inpatient orders for strong anticholinergics and incident dementia after hospital discharge. Cause-specific hazards were modeled. Stratification and relative excess risk due to interaction (RERI) were used to investigate multiplicative and additive interaction, respectively. In total, 66,420 surgical encounters were analyzed. Approximately 90% of patients received one or more strong anticholinergics during hospitalization, and 3806 patients developed dementia during a median follow-up of 3.4years. The median time to dementia was 2.2years. Each one-order increase in inpatient anticholinergic medications was associated with a 0.60% increase in dementia risk (HR 1.006; 95% CI 1.003-1.008). This association was stronger among patients who were prescribed anticholinergics before hospitalization (RERI 0.10; 95% CI 0.08-1.12; p=0.0122). Perioperative anticholinergics may increase the risk of dementia after major surgery. Avoiding these medications in hospitalized older adults may improve long-term cognitive outcomes.

Impact of Silent Cerebral Embolism during and after Left Atrial Appendage Occlusion on Long-Term Cognitive Function.

Left atrial appendage occlusion (LAAO) was associated with a high incidence of procedure-related silent cerebral embolism (SCE). There are limited data regarding the long-term cognitive trajectory of patients undergoing LAAO. The aim of our study was to comprehensively assess the acute and long-term impact of SCE during and after LAAO. Consecutive patients with atrial fibrillation referred for LAAO from the First Affiliated Hospital with Nanjing Medical University between February 2021 and February 2023 were included. All patients underwent magnetic resonance imaging and cognitive assessments before and within 48 hours after the procedure. These evaluations were also repeated at 45-day, 3-month, 6-month, and 1-year follow up. Out of 75 patients included in the final analysis, 29 (38.7%) patients suffered from new SCE during LAAO. Patients with SCE exhibited a significant decline in cognitive function (Mini-Mental State Examination) immediately after the procedure (P<0.001), which was not reversible during 1-year follow-up (P<0.001). Additionally, with time going on, the gap in cognitive function between patients with and without SCE became wider (SCE × 1 year: B=-4.81 [95% CI, -5.58 to -4.05]; P<0.001). New-onset SCE was detected in 11 (14.7%) patients during the follow-up magnetic resonance imaging, which also showed a decline in cognitive function (P=0.004). The results in Montreal Cognitive Assessment scores were consistent with Mini-Mental State Examination. LAAO-related SCE is associated with a marked impairment in cognitive function immediately after the procedure and is irreversible over a 1-year follow-up. New magnetic resonance-detected SCE during follow-up after LAAO would also be associated with a decline in cognitive function.

Peripheral Transcriptomics in Acute and Long-Term Kidney Dysfunction in SARS-CoV2 Infection.

Acute kidney injury (AKI) is common in SARS-CoV-2 infection and COVID-19, often leading to long-term kidney dysfunction. However, the transcriptomic features of AKI severity and its long-term effects are underexplored. We performed bulk RNA sequencing on peripheral blood mononuclear cells (PBMCs) from hospitalized SARS-CoV-2 patients and complemented these findings with proteomic data from the same cohort. We compared the functional enrichment findings with historical sepsis-AKI data and subsequently examined the association between molecular signatures and long-term kidney function changes. In 283 patients, 57 had mild AKI (stage 1) and 49 had severe AKI (stage 2 or 3). Following adjustments for age, sex, severity of infection, and pre-existing chronic kidney disease (CKD), we identified 6,432 differentially expressed genes (DEGs) in the severe AKI vs. control comparison, 840 in the mild AKI vs. control, and 1,213 in the severe vs. mild AKI comparison (FDR<0.05). Common pathways included unfolded protein response, cellular response to stress via eIF2, and IFN-g-mediated inflammatory response. Severe AKI was linked to pathways involved in mitochondrial dysfunction and endoplasmic reticulum stress. Proteomic analysis confirmed 40 established AKI and inflammation biomarkers, while gene-set enrichment of transcription regulators revealed additional biomarkers for severe AKI. Comparison with PBMC transcriptomics from sepsis-related AKI showed significant functional overlap (30%). Analysis of post-discharge eGFR data in 115 patients identified 177 DEGs for severe vs. control, 106 for mild vs. control, and 46 for severe vs. mild AKI. Key associations included kidney function decline related to carbohydrate and mitochondrial metabolism, inflammatory-response, and cardiovascular regulation. We demonstrate that severe AKI in SARS-CoV-2 infection is linked to mitochondrial dysfunction and ER stress. The functional overlap with sepsis-AKI suggests potential broader therapeutic applicability. Long-term kidney dysfunction is influenced by disruptions in cellular energy metabolism and immune response.

Patient-reported outcomes after immediate and delayed DIEP-flap breast reconstruction in the setting of post-mastectomy radiation therapy-results of the multicenter UMBRELLA breast cancer cohort.

Timing of Deep Inferior Epigastric artery Perforator (DIEP)-flap breast reconstruction in the context of post-mastectomy radiotherapy for breast cancer patients is topic of debate. We compared the impact of immediate (before radiotherapy) versus delayed (after radiotherapy) DIEP-flap breast reconstruction (IBR versus DBR) on short- and long-term patient-reported outcomes (PROs). Within the prospective, multicenter breast cancer cohort (UMBRELLA), we identified 88 women who underwent immediate or delayed DIEP-flap breast reconstruction and received PMRT. At 6 and 12months post-mastectomy, as well as on long-term (≥ 12months post-reconstruction) body image, breast symptoms, physical functioning, and pain were measured by EORTC-QLQ-30/BR23. Additionally, long-term evaluation included satisfaction with breast(s), physical well-being and self-reported adverse effects of radiation as measured by BREAST-Q, and late treatment toxicity. PROs were compared between groups using independent sample T-test. IBR was performed in 56 patients (64%) and DBR in 32 patients (36%), with 15 months of median time to reconstruction. At 6 and 12months post-mastectomy, better body image and physical functioning were observed after IBR. No statistically nor clinically relevant differences were observed in long-term EORTC and BREAST-Q outcomes (median follow-up 37-41months for IBR vs. 42-46months for DBR). Patients with IBR reported more fibrosis and movement restriction (median follow-up 29 vs. 61months, resp.). Long-term PROs were comparable for patients with IBR and DBR, despite more patient-reported fibrosis and movement restriction after IBR. Therefore, both treatment pathways can be considered when opting for autologous breast reconstruction in the setting of PMRT.

Mobilization of subcutaneous fascia contributes to the vascularization and function of acellular adipose matrix via formation of vascular matrix complex.

Regenerative biomaterials are commonly used for soft-tissue repair in both pre-clinical and clinical settings, but their effectiveness is often limited by poor regenerative outcomes and volume loss. Efficient vascularization is crucial for the long-term survival and function of these biomaterials in vivo. Despite numerous pro-vascularization strategies developed over the past decades, the fundamental mechanisms of vascularization in regenerative biomaterials remain largely unexplored. In this study, we employed matrix-tracing, vessel-tracing, cell-tracing, and matrix analysis techniques, etc. to investigate the vascularization process of acellular adipose matrix (AAM) implants in a murine model. Here, we show that the mobilization of subcutaneous fascia contributes to the vascularization in AAM implants. Tracing techniques revealed that the subcutaneous fascia migrates to encase the AAM implants, bringing along fascia-embedded blood vessels, thus forming a vascular matrix complex (VMC) on the implant surface. Restricting fascia mobilization or removing fascia tissue significantly reduced AAM vascularization and hindered the regenerative process, leading to implant collapse at a later stage. Notably, VMC exhibited a dynamic matrix remodeling process closely aligned with implant vascularization. Our findings highlight the crucial role of subcutaneous fascia mobility in facilitating the vascularization of AAM implants, offering a novel direction and target for guaranteeing long-term survival and function of regenerative biomaterials in vivo.

Effects of ileal conduit length on long-term kidney function decline after total pelvic exenteration for colorectal cancer.

Understanding of kidney function decline (KFD) after pelvic exenteration (PE) for colorectal cancer remains limited, and the effects of a long ileal conduit (IC) on kidney disorders are unclear. The aim of this study was to investigate long-term kidney function following PE in colorectal cancer and to evaluate the effects of IC length on KFD. This was a retrospective, single-centre cohort study. KFD was defined as a decline in estimated glomerular filtration rate (eGFR) of ≥30% compared with preoperative data. IC length was measured from a postoperative computed tomography scan. The primary endpoint was the number of patients with KFD 5 years after surgery. The rate of decline of eGFR, cumulative KFD incidence and correlation between IC length and rate of decline of eGFR were also analysed. The patients were divided into two groups (short IC and long IC) based on an IC length of 20 cm. Forty-three patients were included in the analysis. Fourteen (33%) and 29 (67%) patients were included in the short- and long-IC groups, respectively. The long-IC group was significantly more likely to be diagnosed with KFD within 5 years than the short-IC group (51% vs. 14%, p = 0.023). Multivariate analyses revealed that a longer IC was identified as an independent risk factor for KFD (hazard ratio 4.140, 95% CI 1.035-16.560, p = 0.045). Pearson's correlation and linear regression analyses demonstrated a significant association between IC length and rate of decline of eGFR (r = 0.466, p = 0.002). A significant number of patients with colorectal cancer have decreased kidney function after PE. A longer conduit may impair kidney function.

Long-term bowel function following delayed coloanal anastomosis: Analysis of a multicentric cohort study (GRECCAR).

Alteration of bowel function after delayed coloanal anastomosis (DCAA) might be a limitation to its utilization. Our aim was to assess the long-term bowel function of DCAA in a large multicentric cohort. All patients who underwent DCAA interventions at 29 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Low anterior resection syndrome (LARS) score or confection of a stoma due to poor bowel function was assessed in eligible patients. Good bowel function was defined by the preservation of bowel continuity with no LARS or a minor LARS. Among the 385 eligible patients to assess long-term bowel continuity, 63% (n = 243) responded to the questionnaire or had a definitive stoma because of poor bowel function. After a median follow-up of 32 months, good bowel function was reported by 60% (n = 146) of patients (with no LARS 36% and minor LARS 24%), whereas 40% of patients (n = 146) had a poor bowel function including major LARS (36%) and definitive stoma due to poor bowel function (4%). No variables tested were predictive of a poor bowel function after DCAA, including a history of pelvic radiotherapy (P = 0.722), salvage DCAA after failure of a previous anastomosis (P = 0.755), presence of a diverting stoma (P = 0.556), occurrence of an anastomotic leakage (P = 0.416) and time interval from the DCAA to the bowel function assessment (P = 0.350). No LARS or minor LARS was reached for 60% of patients after DCAA. Less than 5% of patients received a definitive stoma due to a poor bowel function.

Middle-age cerebral small vessel disease and cognitive function in later life: a population-based prospective cohort study.

Cerebral small vessel disease (cSVD) is a major pathologic substrate of vascular contribution to cognitive impairment. However, population based long-term longitudinal cognitive function data in relation to cSVD are rare. We investigated the relationship between cSVD and cognitive decline over time in middle-aged through elderly population. This prospective cohort study was conducted in a community-based adult population (avg. age 58.5±6.4) who underwent both magnetic resonance imaging (MRI) and comprehensive neuropsychological tests at baseline (2011-2014). The participants were followed-up with the same neuropsychological test battery 4-yearly in two more cycles (in 2015-2018 and 2019-2022). A total of 2454 participants who were free of dementia and cerebrovascular disease at baseline with cognitive function testing at least 2 time points over the time were analyzed. Data analysis was performed from May 1, 2023 to January 31, 2024. SVD was defined by the presence of any of the visible MRI markers (age-related white matter change, lacunes and cerebral microbleeds) at baseline. The main outcomes were multivariable adjusted mean differences of cognitive test performances by cSVD groups over time. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol-coding, Trail Making Test-A, and Stroop Test. To examine the relationship between cSVD and cognitive function, we used linear mixed model for repeated measurements to compare the means (95% CIs) by cSVD groups. Of the total, 908 (37.0%) participants had cSVD on MRI reading at baseline. By location, cSVD were mostly found in the frontal lobe followed by basal ganglia area of the brain. None of the cognitive test scores, except Trail Making Test-A, were significantly different between the cSVD groups at baseline. At 8-year follow-up, participants without cSVD performed significantly better than participants with cSVD in Stroop-color reading [Mean difference 1.19 (95% CI: 0.02-2.36), p=0.0451] and visual reproduction-recognition [Mean difference 0.11 (95% CI: 0.01-0.21), p=0.0221]. While no other cognitive tests showed any differential changes by cSVD groups, logical memory (Story Recall Tests) increased and Stroop-word reading decreased over time in both cSVD groups almost identically. Silent cSVD was independently associated with decline in executive functioning over 8-year follow-up period in this Korean middle-aged through elderly general population. Future studies considering wider spectrum of cSVD and longer follow-up durations may help predict further cognitive outcomes. This study was funded by the Korea Centers for Disease Control and Prevention.

PGAM5 promotes RIPK1-PANoptosome activity by phosphorylating and activating RIPK1 to mediate PANoptosis after subarachnoid hemorrhage in rats

Neuronal death plays a crucial role in early brain injury after subarachnoid hemorrhage (SAH). PANoptosis is a programmed form of cell death regulated by the PANoptosome, which possesses key characteristics of pyroptosis, apoptosis and necroptosis. Phosphoglycerate mutase family member 5 (PGAM5) has specific phosphatase activity that phosphorylates or dephosphorylates serine and threonine residues on bound proteins such as receptor-interacting protein kinase 1 (RIPK1), which are involved in programmed cell death. This study aimed to explore whether PANoptosis occurs after subarachnoid hemorrhage and to investigate the role of PGAM5 in early brain injury after SAH. A monofilament perforation SAH model in Sprague–Dawley rats was established, and PGAM5 siRNA (siPGAM5) was administered via intracerebroventricular injection 48 h before SAH modeling. The efficacy of siPGAM5 treatment was assessed via neurological scoring, and the impact of siPGAM5 on PANoptosis was evaluated via Western blotting, TUNEL staining and ELISA. To investigate its potential mechanism, the RIPK1 activator birinapant was administered intraperitoneally 0.5 h after SAH. The role of RIPK in PGAM5-mediated PANoptosis was evaluated by Western blotting and coimmunoprecipitation. Our findings indicate that PANoptosis occurs in neurons after SAH and that reducing PGAM5 in the cytosol after SAH can reduce PANoptosis and enhance the short-term and long-term neurological functions of SAH rats. Mechanistically, we discovered that PGAM5 can directly bind to and phosphorylate and activate RIPK1 (ser 166), triggering the assembly of the RIPK1-PANoptosome complex. In conclusion, our study revealed that the increased PGAM5 in the mitochondria-free cytosol after SAH can bind to and activate RIPK1 (ser 166), driving the assembly of the RIPK1-PANoptosome and mediating PANoptosis after SAH. PGAM5 and PANoptosis might be novel therapeutic targets for SAH.

QuantiFERON® Monitor Test as a Potential Tool for Stratifying Patients by Infection Risk and Tailoring Follow-Up Care in Lung Transplant Recipients: A Single-Center Retrospective Experience

Background: Lung transplantation is a life-saving option for patients with end-stage respiratory diseases, but risk of infections remains critical for ensuring long-term organ function. This study aimed to assess immune recovery in lung transplant recipients by measuring IFN-γ levels using the QuantiFERON Monitor Test (QFM). Results were correlated with episodes of infection and organ rejection to explore the assay’s predictive potential. Methods: A retrospective study was conducted on 15 lung transplant recipients at the Lung Transplant Centre of Turin (Città della Salute e della Scienza di Torino, Italy) between December 2019 and January 2023. Patients were divided into a High Infection (HI) group (with &gt;3 infections) and Low Infection (LI) group (with ≤3 infections). QFM assays were performed after 18 months post-transplant. Results: HI patients had lower QFM levels compared to LI (68.84 ± 21.98 vs. 380.54 ± 104.64 UI/mL, p = 0.033). A QFM value &lt;89.5 UI/mL was associated with increased infection risk (p &lt; 0.05). Patients with lower QFM levels also exhibited higher rates of MRSA bacteremia during hospitalization (50% HI vs. 0% LI, p = 0.04). No differences were observed in acute or chronic rejection rates, but LI patients showed more frequent alveolar neutrophilia at the fourth month post-transplant (0% HI vs. 55.5% LI, p = 0.04). Conclusion: lower QFM values were associated with higher infection risk, highlighting the assay’s potential for immune monitoring. In this study, a QFM value of 89.5 UI/mL showed good predictive accuracy for infections beyond 18 months. Further studies are needed to refine QFM’s role in post-transplant care.

Long-term effects of attention deficit hyperactivity disorder (ADHD) on social functioning and health care outcomes.

Research on the long-term effects of treatment for attention deficit hyperactivity disorder (ADHD) on educational and social outcomes is limited. This study aims to evaluate long-term social functioning outcomes in patients with ADHD and the potential effects of pharmacological treatment for ADHD. We used National Patient Registry data from 1995 to 2016 to identify patients diagnosed with ADHD and those collecting ADHD medication. Eligible patients were under 30 years old or had reached 30 between 2005 and 2016, ensuring a minimum 10-year observation period. A case-control design was applied, matching ADHD patients in a ratio of 1:4 with the general population based on age, sex, and residential municipality at the index year. Patients with ADHD experienced substantial socioeconomic difficulties, indicated by increased direct health care costs, higher rates of psychiatric comorbidities, and greater co-medication use compared with controls. No association was found between adherence to ADHD medication and completion of education at age 30 years. Adherence to ADHD medication appeared to negatively impact employment status at age 30, confounded by the severity of psychiatric comorbidity. Despite available treatments, patients with ADHD lag in achieving social functioning outcomes. Further research is needed to better understand how to support patients with ADHD in order to close the gaps in health and socioeconomic status.

Long-term motor function and quality of life outcomes in patients with alpha-mannosidosis: Data from two velmanase alfa extension studies over 10 years

Long-term motor function and quality of life outcomes in patients with alpha-mannosidosis: Data from two velmanase alfa extension studies over 10 years

Treatment with UX111 gene therapy rapidly reduced heparan sulfate (HS) exposure in cerebrospinal fluid (CSF) and improved long-term cognitive function in children with mucopolysaccharidosis type IIIA (MPS IIIA)

Treatment with UX111 gene therapy rapidly reduced heparan sulfate (HS) exposure in cerebrospinal fluid (CSF) and improved long-term cognitive function in children with mucopolysaccharidosis type IIIA (MPS IIIA)

Liquid Metal-Based Conductive Nerve Guidance Conduit Combined With Electrical Stimulation Boosts Peripheral Nerve Repair.

The combination of nerve guide conduits (NGCs) and electrical stimulation (ES) is an effective treatment for peripheral nerve injury (PNI). Flexible conductive materials with mechanical properties similar to those of biological tissues have been shown to have better long-term biointegration and functionality than rigid conductive materials. In this study, liquid metal (LM)-based conductive polycaprolactone/gelatin/polypyrrole/LM (PCL/Gel/PPy/LM, PGPL) NGC was combined with exogenous ES to repair PNI. PGPL membranes had good hydrophilicity, degradability, and mechanical properties, and its conductivity reached 0.66 ± 0.02 S/m. Invitro studies showed that the combination of PGPL membranes and ES (2 Hz, 100 mV/cm, 30 min/d) could significantly increase the expression of neuromarkers and had a better pro-neural differentiation effect. Invivo studies demonstrated that PGPL NGCs in combination with ES (2 Hz, 200 mV/mm, 30 min/d) could effectively promote morphological reconstruction and functional recovery of the sciatic nerve in rats. At 3 months post-surgery, PGPL NGCs combined with ES restored the nerve conduction velocity to 73.85% ± 5.45% of the normal value. The LM-based NGCs prepared in this study could effectively repair long sciatic nerve defects, which may further expand the application of LM in the field of nerve tissue engineering.

Long-term results of total pancreatectomy and autologous islet transplantation for chronic pancreatitis: total pancreatectomy with autologous islet transplantation (TPAIT) preserves long-term islet graft functions in 10-year follow-up

Long-term results of total pancreatectomy and autologous islet transplantation for chronic pancreatitis: total pancreatectomy with autologous islet transplantation (TPAIT) preserves long-term islet graft functions in 10-year follow-up

Abstract TMP61: Ixodes ricinus-Contact Phase Inhibitor (Ir-CPI) reduces neutrophil-mediated injury and promotes recovery following intracerebral hemorrhage in a mouse model

Introduction: Secondary brain injury following intracerebral hemorrhage (ICH) is largely driven by neuroinflammation, which is exacerbated by neutrophil infiltration and their release of neutrophil extracellular traps (NETs). This process disrupts the blood-brain barrier and increases neuronal death. The present study investigates the efficacy of Ir-CPI, an inhibitor of neutrophil-mediated thromboinflammation, in reducing neutrophil-driven damage and promoting functional recovery post-ICH. Methods: ICH was induced in mice via bacterial collagenase injection into the right striatum. Mice were then treated with either PBS, Ir-CPI or enoxaparin. Treatments were administered intravenously immediately after stroke. Cerebral lesion and hemorrhage volumes were assessed up to 14 days by MRI. Neutrophil infiltration, NET release, and neuronal degeneration were evaluated histologically. Functional recovery was assessed using the Corner test and the Bederson’s scale. Results: After ICH induction, Ir-CPI did not increase cerebral lesion or hemorrhage volumes compared to PBS. Ir-CPI resulted in lower hemorrhage volumes than the enoxaparin group on Day 1. By Day 14, the volume of hemorrhage in the Ir-CPI group was significantly reduced in comparison to Day 1. Additionally, Ir-CPI decreased neutrophil infiltration and NETs release in the hemorrhagic area, along with a reduction in neuronal degeneration. In contrast, enoxaparin had no significant impact on reducing neutrophils or neuronal damage. Functional recovery was superior in the Ir-CPI group, with the Corner test showing a significant improvement from Day 1 to Day 5 compared to the PBS and enoxaparin groups. By Day 14, the Ir-CPI group's performance did not significantly differ from baseline, indicating enhanced long-term motor function and spatial awareness. The Bederson’s score also demonstrated a significant improvement in the Ir-CPI group, with lower scores between Day 1 and Day 5 compared to the other groups, thereby highlighting Ir-CPI's effectiveness in reducing neurological deficits. Conclusions: Ir-CPI is a promising therapeutic agent for patients suffering from ICH, exhibiting both safety and efficacy in reducing neutrophil-driven brain damage and enhancing functional recovery. These findings indicate that Ir-CPI may be beneficial in mitigating secondary brain injury and improving patient outcomes following ICH. The potential of Ir-CPI is currently being evaluated in the Phase IIa BIRCH trial (NCT05970224).

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.

Self-powered Biomedical Devices: biology, materials, and their interfaces.

Integrating biomedical electronic devices holds profound promise for advancements in healthcare and enhancing individuals' quality of life. However, the persistent challenges associated with the traditional batteries' limited lifespan and bulkiness hinder these devices' long-term functionality and consistent power supply. Here, we delve into the biology and material interfaces in self-powered medical devices by summarizing the intrinsic electric demands in humans, analyzing material and biological mechanisms for electricity generation and storage, and discussing the pathways toward self-chargeable powering. As a result, the current challenges in material designs and biological integrations emerged to shape the future directions in advancing self-powered medical devices. This paper calls on the community to integrate biology and material science to develop self-powering medical devices and improve their clinical prospects.&#xD.

Patient-reported long-term sexual morbidity in prostate cancer survivors treated with external beam radiation therapy alone or combined with high-dose-rate brachytherapy

Background: Prostate cancer can be treated with external beam radiation therapy (EBRT) alone or combined with high-dose-rate brachytherapy (HDR-BT+), usually with additional hormonal treatment (HT). The aim of this long-term cross-sectional study was to compare patient-reported sexual function, hormonal symptoms and quality of life (QoL) after EBRT-only or HDR-BT+. Methods: In 2016, minimum 5 years after treatment, men treated with HDR-BT+ (n = 248) or EBRT-only (n = 91) responded to a questionnaire containing the Expanded Prostate Cancer Index Composite (EPIC)-26 and the Short Form-12 (SF-12). Results: Median age at time of answering the questionnaire was 74 years (range 54–86). The majority in the HDR-BT+ group received HT for ≥ 2 years compared to 1/3rd in the EBRT-only group. In crude analyses, the sexual domain summary score (DSS) was significantly higher in the HDR-BT+ compared to the EBRT-only group (32.3 vs. 24.1). All sexual items were significantly better in the HDR-BT+ group except sexual problem. Significantly less fatigue was seen in the HDR-BT+ group despite longer duration of HT. Physical and mental health were similar in both groups. When adjusted for possible confounders, the differences between treatment groups were no longer statistically significant. Only age was significantly associated with lower sexual scores. Low hormonal DSS was significantly associated with decreased QoL. Conclusion: Patients treated with HDR-BT+ had not worse long-term sexual function than men treated with EBRT-only. However, this difference disappeared when adjusted for possible confounders. Thus, the interplay of age, HT and fatigue indicates a strong impact on both QoL and sexual function.

Different sides of craniotomy for anteriorly superiorly projecting anterior communicating artery aneurysm clipping: outcome and long-term cognitive function: A single-center retrospective study.

We explored the impact of various craniotomy approaches on the outcomes and long-term cognitive function of microsurgical clipping for superiorly projecting anterior communicating artery (ACoA) aneurysms. We retrospectively analyzed 127 superiorly projected ACoA aneurysms underwent microsurgical clipping between January 2014 and January 2022. Patients were categorized into two types: type 1 (70 patients), characterized by the posterior positioning of the ipsilateral A2 segment (open A2 plane side), and type 2 (57 patients), characterized by the anterior positioning of the ipsilateral A2 segment (closed A2 plane side). The analysis focused on clinical outcomes (modified Rankin Scale score, mRS) and long-term cognitive function (Montreal Cognitive Assessment, MoCA). No significant differences in initial attributes were observed between the two groups. No differences in mRS (P = 0.483), cognitive impairment (P = 0.190), or severe cognitive impairment (P = 0.332) between the two groups. Furthermore, no significant differences in delayed cerebral ischemia (P = 0.852), delayed bleeding (P = 0.912), or intraoperative rupture (P = 0.141) between the two groups. However, the occurrence of MoCA subcategories of postponed memory items (P < 0.05) and conceptualization items (P < 0.05) demonstrated a significant decrease on the accessible A2 plane side during a shorter operative time (P = 0.03) and reduced gyrus rectus aspiration frequency (P = 0.000). The anterior position of the A2 segment can offer better visualization of the aneurysm dome, bilateral A2, and AcoA, leading to reduced operative time and gyrus rectus aspiration frequency, potentially enhancing long-term cognitive function.