Long-term Outcomes Research Articles

Effects of immediate extubation in the operating room on long-term outcomes in living donor liver transplantation: a retrospective cohort study

Background: Living-donor liver transplantation (LDLT) is a viable alternative to deceased-donor liver transplantation. Enhanced recovery after surgery protocols that include early extubation offer short-term benefits; however, the effect of immediate extubation in the operating room (OR) on long-term outcomes in patients undergoing LDLT remains unknown. We hypothesized that immediate OR extubation is associated with improved long-term outcomes in patients undergoing LDLT.Methods: This retrospective cohort study included 205 patients who underwent LDLT. The patients were classified based on the extubation location as OREX (those extubated in the OR) or NOREX (those extubated in the intensive care unit [ICU]). The primary outcome was overall survival (OS), while secondary outcomes included ICU stay, hospital stay duration, and various postoperative outcomes.Results: Among the 205 patients, 98 (47.8%) underwent extubation in the OR after LDLT. Univariate analysis revealed that OR extubation did not significantly affect OS (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.24–1.05; P = 0.066). Furthermore, multivariate analysis revealed no statistically significant association between OR extubation and OS (HR: 0.79, 95% CI: 0.35–1.80; P = 0.580). However, OR extubation was significantly associated with a lower incidence of 30-day composite complications and shorter ICU and hospital stays. Multivariate analysis indicated that higher preoperative platelet counts, increased serum creatinine levels, and a longer surgery duration were associated with poorer OS.Conclusions: Immediate OR extubation following LDLT surgery was associated with fewer 30-day composite complications and shorter ICU and hospital stays; however, it did not significantly improve OS compared with ICU extubation.

Managing persistent neonatal hyperinsulinemic hypoglycemia: Insights from nesidioblastosis research

Background: Persistent neonatal hyperinsulinemic hypoglycemia (PNHH), frequently associated with nesidioblastosis, poses significant diagnostic and therapeutic challenges due to dysregulated insulin secretion. Congenital hyperinsulinism (CHI), the primary cause of PNHH, exhibits diverse genetic and phenotypic presentations, necessitating tailored management strategies. This review integrates insights from 20 studies, examining genetic, therapeutic, and psychosocial dimensions of CHI. Objectives: To evaluate genotype-phenotype correlations and their implications for therapeutic outcomes in CHI, compare long-term medical and surgical outcomes, and identify risk factors affecting growth, metabolism, and neurodevelopment. Additionally, the study explores effective strategies to address the psychosocial and dietary challenges associated with CHI. Methods: A systematic review of 20 studies, encompassing over 2,000 patients, was conducted. Diagnostic criteria included genetic analyses of mutations in KATP channel genes (ABCC8, KCNJ11), GLUD1, and HNF4A, along with imaging and histopathological assessments. Treatment efficacy, long-term outcomes, and the impact of caregiver burden were analyzed. Data were synthesized into thematic categories, supported by statistical and qualitative assessments. Results: Dominant KATP mutations exhibited high responsiveness to diazoxide (70%), whereas recessive mutations necessitated surgical interventions, particularly near-total pancreatectomy. Focal CHI resolved hypoglycemia effectively with lesionectomy, whereas diffuse CHI presented ongoing risks, including diabetes and neurodevelopmental impairments. Personalized dietary strategies, such as high-protein diets and gastrostomy feeding, were effective in stabilizing glucose levels. Psychological stress in caregivers emerged as a significant concern, emphasizing the need for supportive interventions. Emerging therapies like lanreotide showed promise in refractory CHI cases. Discussion: The findings align with prior research, confirming the role of genetic mutations in determining treatment responsiveness. Surgical interventions, though effective in resolving hypoglycemia, carry long-term metabolic risks. Recent advances in genetic diagnostics and personalized medical therapies highlight opportunities for optimizing outcomes. However, caregiver burden and psychosocial challenges remain underexplored areas that require structured support systems. Conclusion: Managing CHI necessitates a multidisciplinary approach, integrating genetic insights, advanced therapies, and psychosocial support. Continued research is essential to develop innovative solutions for refractory CHI cases and to improve long-term outcomes for patients and families.

Long-term visual outcomes and side effects of ruthenium plaque brachytherapy in 310 eyes with small choroidal melanoma

Background/aimsTo report the long-term visual outcomes and side effects in patients with small choroidal melanoma (CM) undergoing ruthenium-106 (Ru-106) plaque brachytherapy.MethodsRetrospective, interventional, consecutive series of small CM ≤2.5 mm in...

Prognostic impact of one-year permanent pacemaker implantation after mitral valve surgery with the Cox-maze procedure.

This study aimed to evaluate the prognostic impact of permanent pacemaker (PPM) implantation within the first year after mitral valve (MV) surgery combined with the Cox-maze procedure, focusing on long-term outcomes, including overall mortality, infective endocarditis (IE), and ischaemic stroke. We conducted a retrospective cohort study using data from the National Health Insurance Service (NHIS) in South Korea, identifying 10,127 patients who underwent MV surgery with the Cox-maze procedure between 2005 and 2020. Patients were classified into the PPM and non-PPM groups based on PPM implantation within one year postoperatively. The primary outcome was overall mortality, and secondary outcomes included risk factors for overall mortality, IE and ischaemic stroke. Multivariable Cox proportional hazards regression and Fine-Gray competing risk models were utilized for statistical analysis. Of the total cohort, 178 patients (1.76%) underwent PPM implantation. The overall mortality during the follow-up period was 20.5%, with no significant difference between the PPM and non-PPM groups. PPM implantation was not a significant risk factor for overall mortality (Hazard ratio [HR], 0.825; 95% confidence interval [CI], 0.598-1.140; p = 0.244) or ischaemic stroke. However, PPM implantation was associated with a significantly increased risk of IE (HR, 2.015; 95% CI, 1.179-3.442; p = 0.010). PPM implantation within the first year after MV surgery with the Cox-maze procedure does not significantly impact long-term mortality or ischaemic stroke risk but is associated with an increased risk of IE. The Cox-maze procedure remains advisable for patients with atrial fibrillation undergoing MV surgery.

Predictors for Development of Asphyxiated Neonates Treated With Therapeutic Hypothermia.

To describe the long-term neurodevelopmental outcomes of asphyxiated neonates treated with hypothermia in association with neonatal magnetic resonance imaging (MRI) findings. We evaluated, retrospectively, clinical and radiological single-centre data at 0, 2, and 5 years of age of 53 asphyxiated neonates born between 2005 and 2015. Neonatal cranial MRI was re-evaluated using the Weeke score ranging from 0 (normal finding) to 55 (cerebral devastation) by a single neuroradiologist blinded to patient outcomes. Neurodevelopmental outcomes were evaluated using the Bayley Scales of Infant Development (BSID) at 2 years, and tests assessing intellectual performance at 5 years of age. Of the 191 asphyxiated neonates treated with hypothermia, 53 returned for their 5-year follow-up. There were 10 children with MRI scores ≥ 10, all of whom had epilepsy, 9 had severe cognitive impairment, and 9 had cerebral palsy. In contrast, MRI scores < 10 were poorly predictive of later development. BSID at 2 years of age showed good correlation with IQ scores at 5 years of age (Rs = 0.58, p < 0.001). The Weeke score can be used to identify severely impaired children in the neonatal period. In contrast, the neurocognitive test results at 2 years of age were indicative of mild or moderate impairment at 5 years of age.

Prediction of long-term drug-free outcomes in ACPA-positive and ACPA-negative rheumatoid arthritis by combined clinical and ultrasound assessment of residual disease: a 5-year prospective study

ObjectiveTo delineate, within the framework of current clinical practice and criteria, the sustainability of first-line immuno-suppressive treatment discontinuation in rheumatoid arthritis (RA) and the impact of residual disease in remission...

Impact of cardiac position, morphology and operative technique on long-term fontan outcomes in heterotaxy.

This study aimed to assess the outcomes of heterotaxy patients undergone the Fontan operation, focusing on morphological features and surgical techniques. Eighty-two consecutive heterotaxy patients who underwent the Fontan operation from 1985 to 2021 were compared to 150 patients with tricuspid atresia (TA) and 144 patients with hypoplastic left heart syndrome (HLHS). The Kaplan-Meier method and Cox proportional hazard model were used to analyze transplant-free survival and predictor of outcomes. The 20-year transplant-free survival rates were comparable between Right Atrial Isomerism (RAI, n = 45) and Left Atrial Isomerism (LAI, n = 37) (RAI vs LAI, 76% [95% confidence interval, 57-87%] vs 68% [47-82%], p = 0.22), although more pulmonary vein interventions at Fontan were needed in RAI. Surgical techniques included extracardiac conduit in 66%, intra-atrial conduit in 9%, lateral tunnel in 18% of the cases. Cardiac position and apicocaval juxtaposition did not influence outcomes, but the inferior vena cava (IVC)-contralateral PA Fontan was associated with 100% survival, while the IVC-ipsilateral PA Fontan at the cardiac apex showed a 67% [34-87%] survival rate at 20 years. In-hospital mortality was higher in heterotaxy (9.8% [5-19%]) compared to TA (1.3% [0.3-5.3%], p < 0.01) and HLHS (2.8% [1.1-7.3%], p = 0.02), with no early death after 2000 in any group. The 20-year transplant-free survival in heterotaxy (72% [59-82%]) was similar to that in HLHS (80% [69-87%], p = 0.11). Various routing techniques can be successfully applied to overcome anatomical challenges in heterotaxy. Despite higher in-hospital mortality, overall survival was similar to HLHS. RAI had comparable survival to LAI with more pulmonary vein interventions at Fontan.

LONG-TERM PROGNOSIS OF NON-CELIAC ENTEROPATHIES AND A SCORE TO IDENTIFY PATIENTS WITH POOR OUTCOMES: A 30-YEAR MULTICENTER LONGITUDINAL STUDY.

Long-term prognosis of non-celiac enteropathies (NCEs) is poorly understood. We aimed to evaluate long-term outcomes and develop a prognostic score for NCEs. NCEs patients from an international multicenter cohort (4 Italian centers,1 UK, 1 French,1 Norwegian,1 USA,1 Indian) followed-up over 30 years were enrolled. Complications and mortality were analysed with Kaplan-Meier curves, standardized mortality ratios (SMR) and multivariate Cox regression. A clinical score to identify patients at risk of poor outcomes was developed. 261 patients were enrolled (144F, mean age at diagnosis 49±18 years, median follow-up 70 months, IQR 24-109). The most common etiologies were idiopathic villous atrophy (39%), drug-related (17%), common variable immune-deficiency (15%), infectious (10%) and autoimmune enteropathy (9%). 5-year and 10-year complication-free survival were 89% and 77%, respectively, while 5-year and 10-year overall survival were 88% and 74%, respectively. Causes of death included sepsis/major infections (22%), lymphoproliferative disorders (22%), solid-organ malignancies (12%), cardiovascular/metabolic disease (10%), and was unknown in 33%. Mortality was increased in NCEs compared with the general population (SMR 3.17, 95%CI 2.24-4.34). Older age at diagnosis (p<0.001), anemia (HR 2.53,95%CI 1.33-4.80,p<0.01), lack of clinical (HR 3.21,95%CI 1.68-6.18,p<0.01) and histological response (HR 2.14,95%CI 1.08-4.23,p=0.04) were independent predictors of mortality at Cox regression. A 5-point score was developed to identify high-risk patients: very low risk (0pts), low risk (1-2pts), intermediate risk (3pts) and high risk (4-5pts), with 10-year survival rates of 100%, 87%, 62% and 16%, respectively. Mortality in NCEs is increased due to complications and lack of response to current therapies. We developed a clinical score to personalise follow-up. Targeted treatments are needed to improve outcomes.

Smoking's Impact on 30-Day Complications in Mesh and Nonmesh Prolapse Surgery.

Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood. This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used. We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use. Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24). Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.

Long-Term Outcomes of Jugular Paragangliomas Undergoing Gamma Knife Radiosurgery: A Single Center Experience.

Jugular paragangliomas (JPG) pose a surgical challenge because of their vascularity and complex location. Stereotactic radiosurgery (SRS) offers a minimally invasive management for patients with JPG. Our aim was to evaluate outcomes of Gamma Knife radiosurgery (GKRS) for the treatment of JPG over the long term. We reviewed our 3.5-decade 17 800 patients' GKRS database. Clinical behavior, treatment parameters, tumor control, complications, and functional status were assessed. Forty patients (median = 56 years [range, 18-88], women = 24) with 40 JPG were included. There were 28 primary and 12 adjuvant GKRS. The median margin dose was 13.5 Gy (range, 12-18) delivered at 50% isodose line. Among patients with adjuvant GKRS, there were more staged-volume SRS (2 sessions) (n = 1 vs n = 3, P = .035) associated with larger tumor volume [3.5 cc (1.1-26.7) vs 10.2 cc (3.3-45.9), (P = .038) and increased V12Gy (P = .031). Better House-Brackmann grade (P = .008) and Gardner-Robertson hearing class (P < .001) before GKRS correlated with better facial nerve function and unchanged cochlear nerve function after treatment, respectively. During an overall median follow-up of 69.7 months (range, 6.0-339.3 months), symptom control and preserved functionality were achieved in 39 patients (97.5%). Tumor control was obtained in 38 patients (95%) (regression = 23, stable = 15) after SRS. The 5-, 10-, and 15-year progression-free survival rates were all 100% after primary GKRS and 91.7%, 83.3%, and 83.3% for adjuvant GKRS (P = .101). Larger (≥10 cc) tumor volumes (HR: 1.35 [95% CI: 1.11-1.70], P = .013) and mFisch Di2 (HR: 1.40 [95% CI: 1.18-1.64], P = .016) were associated with worse progression-free survival. One patient required a second GKRS after asymptomatic progression with no further growth. One patient with 2 failed surgical resections died 8 months after adjuvant GKRS related to tumor progression and hydrocephalus. As a minimally invasive management, GKRS proved to be a safe and effective treatment of JPG. GKRS should be considered both as an optimal primary management and as an early adjuvant strategy for residual or recurrent tumors after initial resection.

Inadequate Therapy Response on Advanced Therapy in Ulcerative Colitis Adult Patients: A Retrospective Analysis of German Health Claims Data.

The treatment landscape for active ulcerative colitis is rapidly evolving and current real-world evidence on response to advanced therapy is limited. This study aimed to determine indicators of inadequate therapeutic response among patients with ulcerative colitis in Germany initiating advanced therapy. This retrospective analysis used German claims data (2015-2022) from adult patients (≥18years). The prevalence and incidence of ulcerative colitis (ICD-10-GM: K51.X) were estimated. Inadequate response to therapy was evaluated in patients initiating advanced therapy based on eight predefined indicators observed for 12months following dispensation of index treatment. Mean ulcerative colitis patient age in 2016-2022 ranged from 49.6 to 51.5years, 47.6%-48.3% were female. Administrative prevalence ranged from 0.45% in 2016 to 0.53% in 2022. The number of patients initiating advanced treatment ranged from 157 to 347 across the study years (3.2%-4.9% of overall treated study population). On average from 2016-2021, 78.8% had inadequate response in the 12months following index treatment. Common indicators included prolonged use of corticosteroids (46.2%) and augmentation with conventional therapies (43.9%). Adult ulcerative colitis patients showed a high prevalence of inadequate response to advanced therapies. Our findings reveal a need for improved UC advanced therapy options, providing insight into inadequate response patterns. This may help identify patients who could benefit from a change in therapy to improve long-term outcomes.

Information needs in vascular access decision-making: A qualitative study of patient and clinical stakeholder perspectives.

The information and decision support needs required to embed a patient-centred strategy are challenging, as several haemodialysis vascular access strategies are possible with significant differences in short- and long-term outcomes of potential treatment options. We aimed to explore and describe stakeholder perspectives on information needs when making decisions about vascular access (VA) for haemodialysis. We performed thematic analysis of seven (six online, one in person) focus group discussions including transcripts, post-it phrases and text responses with 14 patients and 12 vascular access professionals (four nephrologists, three surgeons and five nurses - Vascular access nurse specialists/Education and dialysis nurses) who participated in at total of six online and one in person focus group. All patients had experience of haemodialysis and 50% had experience with at least one other modality of RRT. Ten patients had experience of more than one VA modality and 4/14 had experience of AVG, 13/14 had experience of AVF and 8/14 had experience of TCVC. We identified four semantic themes and two latent themes. The themes and their subthemes reflected information needs of patients when making vascular access decisions: Knowledge, Risks and Benefits of Relevant options, long-term treatment strategy and Personal Impact of VA. The latent themes, identified across all stakeholders, were of the need for consistent and trustworthy information. All recent vascular access guidelines propose a shared decision-making approach to vascular access. The ability to implement this in practice carries an information need for both patients and clinicians. This study describes a framework model which can be applied during co-design and assessment of vascular access educational resources to facilitate a patient centred perspective.

Diet-Microbiome-ENS connection: Impact of the Cafeteria Diet.

The interplay between diet-induced obesity and gastrointestinal dysfunction is an evolving area of research with far-reaching implications for understanding the gutbrain axis interactions. In their study, Ramírez-Maldonado et al. employ a cafeteria (CAF) diet model to investigate the effects on gut microbiota, enteric nervous system (ENS) integrity and function, and gastrointestinal motility in mice. Their work provides notable insights while also presenting opportunities for further exploration. The findings highlight early shifts in gut microbiota composition, notably increased Clostridia and Proteobacteria populations, and their association with ENS remodeling and motility impairment. This innovative use of a CAF diet strengthens the relevance of the model to real-world dietary patterns. Future studies will determine the mechanisms linking these microbial changes to neuronal dysfunction, particularly in terms of excitability deficits. The longitudinal approach is a commendable aspect of the study, yet certain dimensions, such as sex-specific responses and long-term outcomes, are underexplored. Further emphasis on these factors could provide a more nuanced understanding of the dietary effects on gastrointestinal health. While inflammation is identified as a mediator, more in-depth analysis of the pathways involved would help substantiate its role in ENS remodeling. Overall, this study makes a valuable contribution to the field, offering a solid foundation for future research. Expanding on the mechanistic insights and addressing the outlined gaps could further the translational relevance of these findings in tackling obesity-related gastrointestinal disorders.

Retraction Note: Comment on, "Longterm outcome and quality of life after CNS cavernoma resection: eloquent vs. noneloquent areas".

Retraction Note: Comment on, "Longterm outcome and quality of life after CNS cavernoma resection: eloquent vs. noneloquent areas".

Surgical Outcomes in Unicoronal Synostosis-A 23-Year Experience From a Single Supraregional Craniofacial Unit.

Unicoronal synostosis is a rare condition leading to anterior plagiocephaly with facial scoliosis and deformation of the anterior cranial fossa. Fronto-orbital advancement and remodelling (FOAR) is the standard of care for management, aiming to normalise the brow shape and position while ameliorating the risk of raised intracranial pressure (ICP) throughout childhood. Published long-term surgical outcome data for unicoronal synostosis is lacking. The authors present our series of 151 cases of FOAR for unicoronal synostosis between January 2000 and January 2023. The average age at surgery was 22.7 months, with an average follow-up of 87 months. Ninety-six patients (66.2%) had no comorbidity. Nineteen (13.1%) had named genetic or chromosomal disorders. There was a 33.1% dural tear rate with no related postoperative CSF leak. Ninety-three patients (67.8%) had a blood transfusion with average donor exposure <1. The total early complication rate was 8.6% most commonly infection and wound dehiscence at 3.4% and 2.8%, respectively. The most common late complication was temporal recession in 30 (20.1%) patients and 3 of these patients required revision surgery. None of our patients required investigation for, or treatment of, raised ICP after the primary surgery. There were no life-threatening complications or mortalities. The authors compare our results to a previous publication on trigonocephaly patients and other available published data. The authors present our recommendations, which include support for a supraregionalized service that encompasses high-volume workload and multidisciplinary care.

Impact of changes in primary care attachment: a scoping review

ObjectivesPrimary care attachment represents an inclusive, equitable and cost-effective way of enhancing health outcomes globally. However, the growing shortage of family physicians threatens to disrupt patient–provider relationships. Understanding the consequences...

Clinical performance of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear: a systematic review and meta-analysis.

To evaluate short, mid and long-term clinical outcomes and patients' satisfaction of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear. Furthermore, materials were analyzed to identify their influences on clinical results. Search was conducted in PubMed, Cochrane Central Register of Controlled Trial, Embase, Web of science and Scopus until December 19, 2024. Randomized clinical trials (RCT), cohort studies and case series with at least mean period of 3years were included. The revised Cochrane risk of bias tool, Newcastle-Ottawa scale and Joanna Briggs Institute Critical Appraisal were used to evaluate the quality of RCT, cohort studies and case series. Meta-analysis and Poisson regression were conducted. Ten studies in this review included three case series, six cohort studies and one RCT with three low, six moderate risks and one some concerns. Annual failure rates (AFRs) and annual complication rates (ACRs) of direct composite restorations were 0-6.2% and 1.0%-4.2%, respectively. AFRs of indirect restorations were 0%-0.5%. Overall ACRs of indirect restorations fabricated by traditional indirect resin composites, polymer-infiltrated ceramic-network, resin nanoceramics and ceramics were at 1.6%-15.1%, 0.7%-4.8%, 0.5%-5.0% and 0.2%-1.1%, respectively. The estimated AFRs of direct composites, resin nanoceramics and ceramics were 0.64%, 0.13% and 0.04% respectively. Significantly lowest AFRs of ceramic was found after mid-term follow-up with incidence rate ratios of direct composites, resin nanoceramics and ceramics being 1: 0.68 (P = 0.60): 0.001 (P < 0.05). The estimated ACRs of the three materials were 2.16%, 2.14% and 0.62%. Overall AFRs of restorations using different techniques were 0%-0.5%. Overall ACRs of direct and indirect techniques were 1.1%-2.2% and 0.2%-4.8%, respectively. Overall ACRs of hybrid technique were 0.5% to 15.1%. Restoration fracture was the most predominant complication regardless of materials. High appreciation was expressed by patient reported outcomes measures. Minimally invasive full-mouth rehabilitation for patients with moderate to severe tooth wear presented good clinical performance apart from traditional indirect resin composite used in posterior teeth. Minimally invasive full-mouth rehabilitation should be strongly advocated for the patients with moderately and severely worn dentition.

Aortic valve repair in adults: long-term clinical outcomes and echocardiographic evolution in different valve repair techniques.

Aortic valve repair/sparing have been established as effective treatments for aortic regurgitation and/or aortic aneurysms. However, concerns remain regarding long-term durability, reproducibility, and patient selection. This study aims to asses long-term clinical and echocardiographic outcomes, with a focus on aortic regurgitation grade and left ventricular ejection fraction evolution, in adults undergoing these procedures. Adult patients in the Heart Valve Society Aortic Valve Database, undergoing any aortic valve repair/sparing technique were included. Time-to-event analyses were used for clinical outcomes and mixed-effects-models for left ventricular ejection fraction and aortic regurgitation evolution. Techniques: isolated valve repair (GROUP-1), ascending aortic replacement +valve repair (GROUP-2), partial-root replacement +/-valve repair (GROUP-3), and valve-sparing root replacement +/-valve repair (GROUP-4). Survival at 10-years was comparable to the general population in each group. The 10-year cumulative incidence of reintervention was 19.5%(95%CI:16.70-22.40%) in GROUP-1 [Including only double external annuloplasty in GROUP-1, reintervention was not significantly different between techniques (p = 0.112)], 13.8% (95%CI: 10.10-18.10%) in GROUP-2, 12.7%(95%CI:5.50-22.90%) in GROUP-3, and 8.5%(95%CI:7.00-10.10%) in GROUP-4 (p < 0.001). Severe preoperative aortic regurgitation grade [HR: 1.95(95%CI:1.19-3.21),p<0.001] and left ventricular end-diastolic diameter [HR:1.03(95%CI:1.00-1.05),p<0.001] were predictive of reintervention in GROUP-4, patch use was a predictor in all groups. Predicted left ventricular ejection fraction (%) initially increased(p < 0.001) and then stabilized. This study found that aortic valve repair/sparing techniques provide a viable and effective treatment option that should be considered for all eligible patients with aortic regurgitation and/or aortic root/ascending aortic aneurysms, given their potential to restore life expectancy and provide good hemodynamic outcomes with an acceptable hazard of reintervention.

Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies.

Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs. Women diagnosed with fetal anomalies (N = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes. Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not. The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health. · Pregnant women with fetal anomalies face poor mental health.. · Resilience is negatively related to poor mental health.. · Perception of severity impacts mental health symptoms..

An online case-based radiology course improves veterinary students' day one competency in small animal radiographic interpretation.

Accurate radiographic interpretation is an important day one skill. A case-based radiology course (CBC) demonstrated better learning outcomes than a lecture-based course (LBC) immediately and after a one-semester period. The aim of this study was to compare long-term learning outcomes of both groups. Veterinary students who took both the CBC and LBC during their fourth or fifth semesters (n = 21) were compared to students who only completed the LBC (n = 17) regarding their ability to interpret small animal radiographs and write radiology reports at graduation (end of ninth semester). Students who completed the CBC scored better on both radiology reports than LBC students. All students reported similar frequency and role in interpreting radiographs during clinical training. However, students who took the CBC were more confident in their ability to interpret radiographs. Students who completed the CBC may have had more interest in radiology or may have been more self-motivated to learn radiology. However, there were no measured differences in CBC and LBC students' self-reported role or frequency of reading radiographs during clinical training. Introducing a CBC in students' fourth or fifth semester improved students' competency in radiographic interpretation and report writing upon graduation 2 years later. This study supports active learning methods in teaching radiology and the use of case-based learning in the preclinical phase.