Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent, often Type 2-mediated inflammatory disease that markedly impairs quality of life. While dupilumab provides rapid improvement, there is limited evidence on long-term outcomes beyond 2 years, and the clinical impact of dosing-interval extension remains unclear. We therefore set out to evaluate long-term real-world outcomes of dupilumab therapy in CRSwNP and assess the effectiveness and safety of dosing-interval extension after achieving disease control. This retrospective single-center cohort included 224 adults with CRSwNP (37% with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease) treated with dupilumab for up to 4.5 years with outcomes modeled to 5 years. Longitudinal changes in polyp size, symptom burden, olfaction, asthma control, and Type 2 biomarkers were analyzed using mixed-effects models. Outcomes were then compared between patients who maintained standard 2-week dosing and those who voluntarily extended dosing intervals after achieving stable control. Dupilumab led to significant improvements in polyp burden, olfactory function, and quality of life peaking within 6 months, with sustained benefit through 5 years according to longitudinal modeling. Forty percent of patients extended dosing intervals without loss of efficacy and reported fewer treatment-related adverse events. Overall, 16% experienced side effects, most commonly musculoskeletal complaints, followed by skin reactions and injection site reactions. Long-term dupilumab therapy provided durable disease control and excellent safety. Personalized dosing-interval extension maintained efficacy and reduced treatment burden, supporting its potential role in optimizing long-term management of CRSwNP, especially in patients with troublesome side effects.

Since its introduction in 1974, the artificial urinary sphincter (AUS) has been considered the gold standard for treatment of moderate to severe male stress urinary incontinence. This article provides an overview of perioperative management and long-term outcomes, offering an evidence-based foundation for clinical practice. Current evidence on patient selection, preoperative diagnostics, surgical techniques, long-term outcomes, and management of complications was reviewed, based on recent studies, multicenter cohorts, and registry data. The implantation of an AUS generally results in high continence rates and substantial improvement in quality of life. Perioperative risk factors, including prior radiotherapy, diabetes mellitus, or previous urethral procedures, increase the likelihood of postoperative complications such as infections, urethral erosions, or mechanical failure. Specialized centers with extensive experience achieve better functional outcomes and lower revision rates. Despite potential complications, most patients report sustained satisfaction and an improved quality of life following AUS implantation. The AUS is an effective treatment option for moderate to severe stress urinary incontinence. Perioperative risk assessment, specialized implantation techniques, and treatment in experienced centers are crucial for therapeutic success. Prospective registry and multicenter data provide valuable guidance for evidence-based patient selection, complication management, and of long-term outcome optimization.

Childhood-onset cardiomyopathies are rare and not well characterised. This study aimed to describe the clinical features of a paediatric cohort with primary cardiomyopathies, with a particular focus on aetiology and both short- and long-term outcomes. A retrospective descriptive study was conducted, including patients diagnosed with primary cardiomyopathies before the age of 18. Clinical presentation, aetiology, and outcomes were analysed for each morphological subtype of cardiomyopathy. A total of 76 patients met the inclusion criteria. Dilated cardiomyopathy was the most common subtype (48.6%), followed by hypertrophic (31.5%), left ventricular non-compaction (10.5%), restrictive (5.2%), and arrhythmogenic cardiomyopathy (3.9%). The mean age at diagnosis was 6.3 ± 5.6 years, with a slight female predominance (56.6%). The rate of genetic diagnosis was 25.6%; the most commonly identified pathogenic or likely pathogenic variants were in MYH7, FLNC, TTN, and MYBPC3, across different morphological subtypes. A total of 94.7% of patients received at least one cardiovascular medication, and 9.2% received intracardiac devices. The overall mortality rate was 22.3%, and the heart transplant rate was 15.7%. These findings highlight the heterogeneous aetiology of paediatric cardiomyopathies and the variability in outcomes according to morphological, genetic, and clinical subtypes. The results underscore the importance of individualised evaluation and management for affected patients.

Health care practices rarely assess or assist patients with social risks, thereby missing a crucial aspect of medical care. To assess the prevalence of social risks among adolescents and young adults (AYAs) with and without a history of cancer within an integrated US health system. This cross-sectional study analyzed data from AYA (aged 15-40 years) members of Kaiser Permanente Northwest (Oregon and Washington) who completed a social risk screener between January 1, 2022, and December 31, 2024. Cancer history identified via electronic health records. Four patient-reported social risk domains (financial hardship, food insecurity, housing instability, and transportation difficulties) were assessed as binary (yes or no) indicators. A composite binary variable was created to reflect the presence or absence of any social risk. Descriptive statistics and multivariable logistic regression models were used to compare prevalence and identify associated factors. Of 96 127 AYA patients (6.2% aged 15-19 years, 37.4% aged 20-29 years, and 56.4% aged 30 to 40 years; 63.3% female; 13.0% identifying as Hispanic, 63.4% as non-Hispanic White, and 23.6% as non-Hispanic other race and ethnicity), 1239 (1.3%) had a history of cancer, and these patients compared with those without cancer were older (aged 30-40 years, 82.6% vs 56.0%), were more likely to be female (81.4% vs 63.1%) and non-Hispanic White (74.3% vs 63.3%), and had more comorbidities (8.8% vs 3.9%). No significant differences were observed in household income, education level, or neighborhood deprivation between groups. Thirty percent of patients with cancer and 33% without cancer reported experiencing at least 1 social risk. Financial hardship was the most common issue, followed by food insecurity, housing instability, and transportation difficulties. Higher odds of social risks were observed among patients aged 20 to 29 years (odds ratio [OR], 1.58 [95% CI, 1.54-1.63]) and those with 3 or more comorbidities (OR, 1.79 [95% CI, 1.67-1.92]), prior medical financial assistance (OR, 2.10 [95% CI 1.99-2.22]), or identifying as Hispanic (OR, 1.14 [95% CI, 1.09-1.19]). Lower odds were found among female patients (OR, 0.91 [95% CI, 0.88-0.94]), commercially insured patients (OR, 0.32 [95% CI, 0.31-0.34]), longer Kaiser Permanente Northwest membership (OR, 0.99 [95% CI, 0.99-0.99]), and residents of less-deprived neighborhoods (neighborhood deprivation index [NDI] quartile 1: OR, 0.65 [95% CI, 0.62-0.67]; NDI quartile 2: OR, 0.74 [95% CI, 0.71-0.77]; NDI quartile 3: OR, 0.81; 95% CI, 0.78-0.84). This cross-sectional study found that regardless of cancer history, AYA patients may experience a high burden of social risks. These findings support the need to routinely assess and address social risks in AYA populations to improve equity in health care. Future research should investigate the association of social risks with health care use and long-term outcomes.

Physical activity levels significantly declined within 3months post-discharge among children and adolescents with heart disease. Factors including intention, intention-behavior gap, self-efficacy, and Kinesiophobia significantly influenced their behavior, while the role of parental support increased after 3months. Therefore, enhancing intention and self-efficacy while reducing Kinesiophobia is essential to promote physical activity during the early post-discharge period. Family support must be reinforced during home rehabilitation to maintain physical activity continuity and improve long-term outcomes. • Regular physical activity is essential for the rehabilitation of children and adolescents with heart disease; however, current evidence consistently demonstrates that their physical activity levels are suboptimal, contributing to unfavorable long-term outcomes. • Known determinants of physical activity in this population encompass both familial factors and individual-level factors. Nevertheless, these identified factors account for less than 15% of the variance in physical activity behavior. •A significant intention-behavior gap exists in this population and represents a distinct barrier to physical activity; however, baselinephysical activity is not a significant predictor of whether individuals will enter the intention-behavior gap group. •Kinesiophobia is a prominent and independent barrier to physical activity among children and adolescents with heart disease,whereas parental support serves as a key and stable facilitator, exhibiting a strengthening protective effect against the characteristicpost-discharge decline in physical activity.

Bracing is the primary non-operative treatment for adolescent idiopathic scoliosis (AIS), with in-brace correction (IBC) being a key predictor of long-term success. Although BMI has been linked to bracing outcomes, it fails to capture important aspects of body habitus, such as fat distribution and torso shape, that influence brace fit and force transmission. This study aims to evaluate a novel radiographic measure, the lateral waist-to-height (WH) ratio, as a more accurate predictor of IBC in AIS patients. A retrospective review of AIS patients treated with Rigo-style braces between 2014 and 2024 at a single institution was conducted. Thoracolumbar (TL) height and waist width at the iliac crest were measured on AP and lateral radiographs to calculate WH ratios. Linear regression evaluated associations between IBC and BMI, WH ratios, and TL height change. Multivariate regression adjusted for major curve angle and curve apex. The study included 209 females (mean age 11.4±2.1y, BMI 17.7±2.8). Mean pre-brace major curve angle was 28.2±7.3 degrees, with average IBC of 64.8%±31.6%. Lateral WH ratio correlated positively with IBC (R=0.21, P=0.014), representing a weak but statistically significant correlation. By contrast, BMI and AP ratio did not demonstrate significant associations with IBC. In multivariate analysis, both major curve angle (P<0.001) and lateral WH ratio (P=0.009) were independent predictors of IBC. Lateral WH ratio offers a more holistic representation of body habitus than BMI and is independently associated with in-brace correction. These findings suggest that the lateral WH ratio may provide additional insight into brace fit and initial correction, warranting further study to determine its potential role in predicting long-term bracing outcomes in AIS. Level III.

Persistent negative symptoms (PNS), defined as negative symptoms of at least moderate severity that endure over time and are not attributable to other psychopathological dimensions such as depression or parkinsonism, have been associated with poor functional outcomes in schizophrenia, in both chronic stages and in the early phases of the disorder. This post-hoc analysis of a large cohort of schizophrenia spectrum disorder patients within their first 7 years of illness, enrolled in the European Long-acting Antipsychotics in Schizophrenia Trial (EULAST), aimed to: 1) confirm prior findings about the prevalence and clinical impact of unconfounded persistent negative symptoms (PNS) on dropout rates and psychosocial functioning after 12 and 18 months of treatment; and 2) explore the prevalence of enduring negative symptoms (E-NS), defined as persistent negative symptoms either confounded or unconfounded by depression or parkinsonism, and their influence on functional outcome. At week 0, 60.6% of patients exhibited at least one negative symptom of moderate severity. Among them, 42.8% met criteria for unconfounded negative symptoms. After 1 year, the frequency of PNS and E-NS was 7.9% and 15%, respectively, with a prospective consistency around 32%. PNS subjects had similar levels of functioning at week 0 (d = -0.179, p = 0.194), but worse functioning after 12 (d = -0.697, p = 0.028) and 18 (d = -0.676, p = 0.024) months of treatment, as compared to those with negative symptoms of similar severity at baseline that did not persist (non-persistent negative symptoms, N-PNS). No difference among groups was observed in drop-out rates. The comparison between the E-NS and N-PNS groups revealed the same functional outcome differences observed in the PNS versus N-PNS comparison. Our findings confirm that long-term persistence of negative symptoms, both primary and secondary, contributes to poor functional outcome. Future research should focus on identifying predictors of symptom persistence to guide the development of targeted interventions aimed at improving long-term functional outcomes in this patient population.

Despite the widespread use of ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC), many patients remain at risk for progression. Emerging data suggest that normalization of alkaline phosphatase (ALP) and total bilirubin (TB) - particularly when TB <0.6 times the upper limit of normal (xULN) - is associated with improved outcomes compared to ALP reduction to <1.5 xULN. This study investigated the association between ALP normalization in response to UDCA and long-term clinical outcomes in a real-world cohort of patients with PBC. We compared complication-free survival in patients achieving an ALP >ULN and <1.5 xULN (adequate response) to those with an ALP <ULN on UDCA monotherapy. Complication-free survival was defined as the absence of serious liver-related clinical events. Restricted mean survival time was used to quantify survival time gained. Patients achieving normal ALP and/or TB ≤0.6 xULN demonstrated significantly improved complication-free survival compared to those with an adequate ALP response. Event-free survival was extended by 1.34 years (95% CI:0.56, 2.11; p=0.001) for ALP normalization alone, 3.7 years (95% CI:3.11, 4.29; p< 0.001) for TB ≤ 0.6 xULN, and 4.51 years (95% CI:4.13, 4.88; p<0.001) for those meeting both criteria. The risk of severe clinical events was reduced in patients achieving ALP normalization (HR 0.34; 95% CI:0.15, 0.80; p=0.01), TB ≤ 0.6 × ULN (HR 0.23; 95% CI:0.09, 0.55; p=0.001), or both (HR 0.14; 95% CI:0.05, 0.38; p<0.001). High-risk patients, defined by LSM ≥10 kPa or clinical, histological, or laboratory evidence of cirrhosis or portal hypertension, derived the greatest benefit. Achieving normal ALP and TB ≤0.6xULN is associated with significantly improved complication-free survival, particularly in high-risk patients. These findings highlight the potential of biochemical thresholds as a meaningful therapeutic goal in PBC management.

Long-term clinical and radiographic outcomes of Michigan-type stabilization splint therapy on patients with temporomandibular joint degenerative joint disease: a CBCT-based retrospective cohort study.

Nonacute subdural hematoma (NASDH) is associated with cognitive dysfunction and decline. Middle meningeal artery embolization (MMAE) has shown efficacy in reducing NASDH recurrence and promoting hematoma resorption, but its potential impact on long-term cognitive outcomes is unexplored. This study aims to determine whether standalone MMAE is associated with reduced dementia risk compared with conservative management (CM) in dementia-free patients with nonsurgical NASDH. This was a multicenter retrospective cohort study using the TriNetX US collaborative research network database. Adult patients with newly diagnosed NASDH who did not undergo surgical drainage were included. Patients with known dementia at the time of NASDH diagnosis were excluded. Patients who underwent standalone MMAE were compared with those who underwent CM only. The primary outcome was new-onset dementia during a 5-year study follow-up period. Secondary outcomes included all-cause mortality. One-to-one propensity score matching was performed to account for confounding and indication bias. Outcomes were compared using time-to-event analyses with Kaplan-Meier curves and Cox proportional hazards models. Of 175 868 patients with nonsurgical NASDH, 1991 underwent MMAE. After propensity score matching, 1972 patients remained in each group with similar baseline characteristics (all absolute standardized differences <0.10). Mean follow-up was 704 days for MMAE patients and 818 days for CM patients. Compared with CM, MMAE was associated with significantly lower 5-year probability of incident dementia (6.0% versus 11.4%; P<0.001; hazard ratio 0.55 [95% CI, 0.40-0.77]), representing a 45% reduction in risk. MMAE was also associated with significantly lower all-cause mortality (25.1% versus 32.1%; P=0.001). Among nonsurgical, dementia-free patients with NASDH, standalone MMAE was associated with significantly reduced incident dementia risk compared with CM. These findings suggest MMAE may provide neurocognitive benefits beyond preventing hematoma progression, potentially through promoting hematoma resorption and preserving cortical integrity. Prospective studies are needed to confirm these hypothesis-generating observations and establish causality.

The safety and efficacy of direct oral anticoagulants (DOACs) in patients with left ventricular assist devices (LVADs) remain uncertain because of limited comparative data with warfarin. Are DOACs a safe and effective alternative to warfarin in patients with durable LVADs? A retrospective cohort study using the TriNetX database was conducted. Adults with LVADs prescribed DOACs or warfarin were included. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included thromboembolic events, major bleeding, and blood transfusion requirements. Among 3726 patients with LVAD, 79 received DOACs and 3647 received warfarin. After matching, 77 patients remained in each group. At 5 years, all-cause mortality was significantly lower in the DOAC group compared to warfarin (13% vs. 30%, P < 0.001). Rates of thromboembolism and major bleeding were similar, while blood transfusion needs were lower in the DOAC group (13% vs. 22.1%). In this multicenter cohort, DOACs were associated with improved long-term survival and comparable safety outcomes relative to warfarin in LVAD patients. These findings suggest DOACs may be a viable alternative, but larger prospective studies are warranted.

De-escalation strategies have gained increasing attention for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). We previously introduced an approach using upfront neoadjuvant chemotherapy (NAC) to facilitate less invasive surgery and potentially omit postoperative radiotherapy (PORT) or chemoradiotherapy (POCRT). This study evaluated the long-term outcomes and late toxicities of NAC followed by surgery after a 5-year follow-up. We retrospectively analyzed 41 patients with resectable HPV-positive OPSCC who received NAC followed by primary tumor resection, with or without neck dissection. Patients were treated with triplet NAC comprising either docetaxel, cisplatin, and 5-fluorouracil (TPF) or carboplatin, paclitaxel, and cetuximab. A pathological complete response (pCR) at both the primary site and lymph nodes was achieved in 25 patients (61.0%), and PORT/POCRT was required in 6 patients (14.6%). Among the 36 patients who received NAC-TPF, the number of TPF cycles administered in the pCR group was significantly higher than in the non-pCR group (p = 0.0401). The median follow-up period was 5.3years, with 5-year overall and progression-free survival rates of 92.4% and 80.1%, respectively. Recurrence occurred in 25% of the non-pCR group and 8% of the pCR group. All patients resumed oral intake without nutritional intervention within 35days after treatment, and no severe late toxicities impairing daily life were observed. Long-term follow-up demonstrated that NAC followed by surgery-aimed at achieving less invasive procedures and avoiding PORT/POCRT-is feasible and promising in terms of survival and late toxicities in patients with resectable HPV-associated OPSCC.

Timely identification of acute brain injury (ABI) in children receiving extracorporeal membrane oxygenation (ECMO) support is critical for early neuroprotective interventions. To determine if elevations in plasma glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau levels in children receiving ECMO precede new ABI confirmed by neuroimaging, and if they are associated with mortality and functional outcomes. This was a prospective observational cohort study conducted from 2019 to 2023, with 18-month follow-up completed in 2025. Children aged 2 days to younger than 18 years at ECMO cannulation were recruited from 11 US children's hospitals. Study data were analyzed from May to August 2025. GFAP, NfL, and tau measured in plasma samples collected serially during the ECMO course. Unfavorable short-term outcome was a composite of in-hospital mortality or discharge Pediatric Cerebral Performance Category score of 3 or greater with decline of at least 1 point from baseline. Unfavorable long-term outcome was a composite of mortality or Vineland Adaptive Behavior Scales, third edition, composite score less than 85 at 18 months after ECMO. This study included 219 participants (224 ECMO courses; 1089 serial blood samples). Median age was 11 months (IQR, 30 days-9 years), and 121 (54%) were male. Among 60 ECMO courses with new ABI during the ECMO course, GFAP and NfL levels increased significantly, by 6.4% (95% CI, 1.4%-11.6%) and 16.1% (95% CI, 10.5%-22.0%), respectively, for each 24 hours preceding neuroimaging diagnosis of new ABI. Geometric means for GFAP, NfL, and tau were all significantly higher in those with unfavorable vs favorable outcome at hospital discharge for both the first sample receiving ECMO and peak levels during ECMO support. A 2-fold increase in GFAP and NfL levels from first sample receiving ECMO was significantly associated with unfavorable outcome after adjusting for baseline GFAP and NfL levels, age, and ECMO indication (GFAP adjusted hazard ratio [aHR], 1.48; 95% CI, 1.22-1.79; NfL aHR, 1.43; 95% CI, 1.14-1.79). Similar models for tau showed no significant association with outcomes. Results suggest that GFAP and NfL may be promising candidates for real-time neurologic monitoring in children receiving ECMO and may aid in diagnosis, association with outcomes, and potentially guiding neuroprotective strategies.

The impact of intervention timing, etiology, and revascularization strategy on acute mesenteric ischemia outcomes.

Long-term treatment outcomes among AIDS patients with and without talaromycosis: A retrospective study.

Transcatheter aortic valve replacement in patients with cancer: A 10-year registry analysis of early and long-term mortality outcomes.

Long-term outcomes from a multicentre study of HDR monotherapy with a single fraction of 19Gy for localized prostate cancer.

Operative Considerations and Long-Term Outcomes after Resection of Primary Inferior Vena Cava Leiomyosarcomas with Caval Reconstruction.

SESA syndrome: synthesizing evidence and proposing diagnostic criteria and severity grading-a scoping review.

Analysis of prognostic factors in acute encephalopathy with biphasic seizures and late reduced diffusion: a retrospective study on MRI findings and the treatments.