Lower Proportion Of Patients Research Articles

Postsurgical Outcomes of Mesial Temporal Lobe Epilepsy due to Hippocampal Sclerosis Associated with Calcified Neurocysticercosis.

The aim of this study was to analyze postsurgical outcomes for individuals with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) who underwent anterior temporal lobectomy, based on the presence of calcified neurocysticercosis (cNCC). A retrospective cross-sectional study was conducted on 89 patients with MTLE-HS who underwent anterior temporal lobectomy between January 2012 and December 2020 at a basic epilepsy surgery center located in Lima, Peru. We collected sociodemographic, clinical, and diagnostic information. The postsurgical results were analyzed using bivariate analysis according to the Engel classification. We included 89 individuals with a median age of 28 years (interquartile range [IQR]: 24-37), and more than half (55.1%) were male. Seventeen (19.1%) were diagnosed with cNCC. A greater number of patients with cNCC had lived in rural areas of Peru during their early life compared with those without cNCC (12 [70.6%] versus 26 [36.1%]; P = 0.010). Patients with cNCC exhibited a greater median frequency of focal to bilateral tonic-clonic seizures per month (1 [IQR: 0-2] versus 0 [0-0.5]; P = 0.009). Conversely, a lower proportion of patients with cNCC reported a history of an initial precipitating injury in comparison to the group without cNCC (4 [23.5%] versus 42 [58.3%]; P = 0.014). At the 1-year follow-up, most patients (82.4%) with cNCC were categorized as Engel IA. Similarly, at the 2-year follow-up, nine (75.0%) were classified as Engel IA. Our findings suggest that most patients diagnosed with cNCC exhibit favorable postsurgical outcomes, comparable to those without cNCC. Additionally, it can be postulated that cNCC may play a role as an initial precipitating injury.

Influence of disease course and comprehensive management on blood glucose level in children and adolescents with type 2 diabetes mellitus.

The aim of the present study was to evaluate the status of glycemic control, and assess the effects of the disease course and comprehensive management measures on the blood glucose level in children and adolescents with type 2 diabetes mellitus. The study collected the clinical data of type 2 diabetes patients in Beijing Children's Hospital from January 2015 to September 2020. Patients were grouped based on the disease course to compare their glycated hemoglobin (HbA1c) level, islet β-cell function, insulin resistance and comprehensive management measures. Of the 170 participants, the median disease course was 2.0 years (interquartile range [IQR] 1.0-4.0 years). The baseline HbA1c was 11.2% (IQR 9.2-12.4%). According to the grouping by the disease course, the median HbA1c was the lowest (5.7% [IQR 5.3-6.1%]) in the half-year course group and the highest in the 4-year course group (9.0 [IQR 6.8%-11.3%]). Compared with the group with a disease duration <2 years, patients in the >4 years group had a lower proportion of patients with HbA1c <7% (29.2% vs 66.2%), a lower homeostasis model assessment of β-cell function, and a lower proportion with a controlled diet, moderate-intensity exercise, regular follow up and no drug treatment. We deemed HbA1c as the dependent variable, and found that disease duration, homeostasis model assessment of β-cell function at follow up, continuous moderate-intensity exercise, regular review and treatment regimen were significant influencing factors for glycemic control. Children and adolescents with type 2 diabetes and a prolonged disease course showed poor glycemic control and decreased islet β-cell function. A good lifestyle, especially moderate-intensity exercise, can help such cases better control their blood glucose level.

The role of cannabis in bipolar disorder relapse: a prospective study of hospital acute readmissions

IntroductionWith the rapid changes of attitude, investigation and legislation around cannabis and its subproducts in the Western world, there is a need to profoundly examine the consequences of its use in the general population and, specifically, in people affected by mental disorders. There is a clear relationship between cannabis use and psychosis, but there is also growing evidence of its relationship with manic episodes (Sideli et al, 2019).A systematic review published by the CANMAT Task Force in 2022 examined again the relationship between cannabis use and bipolar disorder (BD), establishing association with worsened course and functioning of BD in frequent users (Tourjman et al., 2023). On the other hand, some recent papers have highlighted the role of the endocannabinoid system (ECS) in BD, suggesting even possible beneficial effects, mainly through the CB2 receptor (Arjmand et al, 2019).ObjectivesTo describe the impact of cannabis in the psychiatric readmission in BD and to approach the differences in course in cannabis users with regards to non-users.MethodsWe conducted a prospective cohort study including the patients admitted to our acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019 (including patients with one of both final diagnosis: BD or schizoaffective disorder). We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined.ResultsThe study, which included 309 patients, concluded that cannabis users were admitted and had the first episode at a younger age (p=0.005), a higher percentage of them did not have a previous diagnosis (p=0.026) nor a previous history of mental health issues (p=0.019) and it was more likely to be their first admission (p=0.011) and to suffer psychotic symptoms (p=0.002).As of treatment, the results were statistically significant regarding the fact that a lower proportion of patients had received previous psychiatric treatment (p=0.004) and previous electroconvulsive therapy (p=0.003). There was a higher chance of them being non-adherent with medication (p&lt;0.001) and to be administered extended-release antipsychotic treatment during admission (p&lt;0.001).The study did not find a statistically significant relationship with cannabis use and a higher rate of readmission in the 3 years of follow-up.ConclusionsAlthough a higher relapse rate could not be proven in our study, other previously identified factors related to a worse illness course (Sajatovic et al., 2009) did show a significant association with cannabis use, which could lead to one suggesting that our results are compatible with the actual evidence and that cannabis products are detrimental to people who suffer from BD and schizoaffective disorder.Disclosure of InterestNone Declared

All-Arthroscopic Supraspinatus and Infraspinatus Muscle Advancement Leads to High Healing Rate and Excellent Outcomes in Patients With Massive, Retracted Rotator Cuff Tears, Even in Patients With Pseudoparalysis

PurposeThe purpose of this study was to evaluate the clinical and radiographic outcomes of an all-arthroscopic rotator cuff repair technique involving muscle advancement and double-layer lasso loop (DLLL) repair for massive, retracted posterosuperior cuff tears. MethodsThis is a retrospective case series of patients with massive, retracted posterosuperior cuff tears who underwent the all-arthroscopic muscle advancement technique from March 2017 to September 2021, with minimum follow-up of 12 months. Key steps included suprascapular nerve release, advancement of supraspinatus and infraspinatus muscles, and DLLL repair. Preoperative and postoperative visual analogue scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California Los Angeles (UCLA) shoulder score, active range of motion (ROM), and strength were compared. Preoperative and postoperative structural radiological characteristics were analysed. ResultsForty-three shoulders in 38 patients were evaluated with mean follow-up of 18.8 months (range 12-55 months). Of the 43 shoulders, 4 repairs failed (9.3% retear rate). VAS, ASES, Constant, and UCLA scores significantly improved (p<0.001) in patients who demonstrated healing on postoperative MRI (n=39). ASES, Constant, and UCLA scores were significantly better in the healed group, with 100% exceeding MCIDs for ASES and UCLA scores, and 84.2% for Constant score. A lower proportion of patients in the retear group achieved MCIDs. Active ROM in all planes significantly improved for those who had healed repairs. (p<0.001). Relative strengths of abduction, supraspinatus, and infraspinatus were at least 90% of the contralateral side. Recovery rate of pseudoparalysis (7 patients) was 100%. ConclusionAll-arthroscopic muscle advancement, coupled with double-layer lasso loop repair, leads to a high healing rate with excellent clinical outcomes and recovery of strength to at least 90%, even in patients with pseudoparalysis.

Surgical stabilization of rib fractures: The impact of volume and the need for standardized indications

IntroductionWe aimed to examine impact of trauma center (TC) surgical stabilization of rib fracture (SSRF) volume on outcomes of patients undergoing SSRF. MethodsBlunt rib fracture patients who underwent SSRF were included from ACS-TQIP2017-2021. TCs were stratified according to tertiles of SSRF volume:low (LV), middle, and high (HV). Outcomes were time to SSRF, respiratory complications, prolonged ventilator use, mortality. Results16,872 patients were identified (LV:5470,HV:5836). Mean age was 56 years, 74% were male, median thorax-AIS was 3. HV centers had a lower proportion of patients with flail chest (HV41% vs LV50%), pulmonary contusion (HV44% vs LV52%) and had shorter time to SSRF(HV58 vs LV76 ​h), less respiratory complications (HV3.2% vs LV4.5%), prolonged ventilator use (HV15% vs LV26%), mortality (HV2% vs LV2.6%) (all p ​< ​0.05). On multivariable regression analysis, HV centers were independently associated with reduced time to SSRF(β ​= ​−18.77,95%CI ​= ​−21.30to-16.25), respiratory complications (OR ​= ​0.67,95%CI ​= ​0.49–0.94), prolonged ventilator use (OR ​= ​0.49,95%CI ​= ​0.41–0.59), but not mortality. ConclusionsHV SSRF centers have improved outcomes, however, there are variations in threshold for SSRF and indications must be standardized. Level of evidenceLevel III. Study typeTherapeutic/Care Management.

Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction?

Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction?

Robotic-assisted surgery for left-sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study.

There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS. Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models. A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21-0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26-0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26-0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033). The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.

Nasal Glucagon Reverses Insulin-induced Hypoglycemia With Less Rebound Hyperglycemia: Pooled Analysis of Clinical Trials.

Rebound hyperglycemia may occur following glucagon treatment for severe hypoglycemia. We assessed rebound hyperglycemia occurrence after nasal glucagon (NG) or injectable glucagon (IG) administration in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). This was a pooled analysis of 3 multicenter, randomized, open-label studies (NCT03339453, NCT03421379, NCT01994746) in patients ≥18 years with T1D or T2D with induced hypoglycemia. Proportions of patients achieving treatment success [blood glucose (BG) increase to ≥70 mg/dL or increase of ≥20 mg/dL from nadir within 15 and 30 minutes]; BG ≥70 mg/dL within 15 minutes; in-range BG (70-180 mg/dL) 1 to 2 and 1 to 4 hours postdose; and BG >180 mg/dL 1 to 2 and 1 to 4 hours postdose were compared. Incremental area under curve (iAUC) of BG >180 mg/dL and area under curve (AUC) of observed BG values postdose were analyzed. Safety was assessed in all studies. Higher proportions of patients had in-range BG with NG vs IG (1-2 hours: P = .0047; 1-4 hours: P = .0034). Lower proportions of patients had at least 1 BG value >180 mg/dL with NG vs IG (1-2 hours: P = .0034; 1-4 hours: P = .0068). iAUC and AUC were lower with NG vs IG (P = .025 and P < .0001). As expected, similar proportions of patients receiving NG or IG achieved treatment success at 15 and 30 minutes (97-100%). Most patients had BG ≥70 mg/dL within 15 minutes (93-96%). The safety profile was consistent with previous studies. This study demonstrated lower rebound hyperglycemia risk after NG treatment compared with IG. NCT03421379, NCT03339453, NCT01994746.

The association of disability conditions with access to minimally invasive general surgery

BackgroundDespite the high prevalence of disability conditions in the US, their association with access to minimally invasive surgery (MIS) remains under-characterized. ObjectiveTo understand the association of disability conditions with rates of MIS and describe nationwide temporal trends in MIS in patients with disability conditions. MethodsWe conducted a retrospective cohort study using the Nationwide Readmission Database (2016–2019). We included patients ≥18 years undergoing general surgery procedures. Our primary outcome was the impact of disability conditions on the rate of MIS. We performed 1:1 propensity matching, comparing patients with disability conditions with those without and adjusting for patient, procedure, and hospital characteristics. We performed a subgroup analysis among patients<65 years and with patients with each type of disability. We evaluated temporal trends of MIS in patients with disabilities. We identified predictors of undergoing MIS using mixed effects regression analysis. ResultsIn the propensity-matched comparison, a lower proportion of patients with disabilities had MIS. In the sub-group analyses, the rate of MIS was significantly lower in patients below 65 years with disabilities and among patients with motor and intellectual impairments. There was an increasing trend in the proportion of patients with disabilities undergoing MIS (p < 0.005). The regression analysis confirmed that the presence of a disability was associated with decreased odds of undergoing MIS. ConclusionsThis study characterizes the negative association of disability conditions with access to MIS. As the healthcare landscape evolves, considerations on how to equitably share new treatment modalities with a wide range of patient populations are necessary.

Assessment of Malaria Pharmacotherapeutic Outcomes in Children under 12 Years of Age among Three Health-care Facilities, Bayelsa, Nigeria

Abstract Background: Malaria is Nigeria’s biggest public health problem, accounting for around 30% of all fatalities among children under 5 years, 25% of infant deaths, and 11% of maternal mortality. Aims and Objectives: The study aimed to identify the outcomes of malaria therapy in children under 12 who were admitted and managed at three health facilities in Bayelsa State, Nigeria, and if the treatment pattern adhered to standard guidelines. Materials and Methods: A detailed retrospective survey was designed, and a data collection instrument was utilized to obtain clinical, medical, and medication histories for children from the selected health facilities between January 2019 and June 2020. The survey collected data from 1312 children. The data were analyzed using a Chi-square test in SPSS version 23.0 and Microsoft Excel 2013. Results: From the data obtained, only 37.73% of the 1312 participants underwent a malaria parasite (MP) test. The most common diagnosis made at the Primary HealthCare Center (PHC) was acute/uncomplicated malaria (43.0%), followed by diarrhea (21.3%), and gastroenteritis (GET) with upper respiratory tract infection (15.7%). The most common diagnoses for Secondary HealthCare Center (SEC) and Federal/Tertiary HealthCare Center (FHI) were malaria with GET (22.5%) and severe malaria with meningitis (18.1%). The majority of patients were effectively handled and discharged, FHI (73.0%), SEC (91.1%), and PHC (94.0%). Other notable outcomes included patients’ task capacity and a temperature decreased to normal (TDN). Conclusion: There was a significant correlation between demographic data and treatment outcomes (P &lt; 0.05). Although the three health facilities provided competent patient management along with appropriate prescription trends for malaria and comorbidities, there was a low proportion of patients who received an MP test, particularly at the FHI.

Age and gender influence on clinical manifestations of thyroid-associated ophthalmopathy: a case series of 2479 Chinese patients.

Significant individual differences exist in the clinical manifestations of thyroid-associated ophthalmopathy (TAO). Age and gender have an impact on the presentation and severity of TAO. To evaluate the clinical characteristics of TAO patients, with particular consideration of their age and gender. Demographic and clinical data of 2479 TAO patients were collected. Patients were divided into 7 groups based on age: Group 1: ≤18 years old; Group 2: 19-29 years old; Group 3: 30-39 years old; Group 4: 40-49 years old; Group 5: 50-59 years old; Group 6: 60-69 years old; Group 7: ≥70 years old. Compared clinical manifestations among different groups and between males and females. In age group 1, the ratio of female to male TAO patients was 3.79, and in age group 7, it was 0.86. As age increased, there was a decline in the percentage of females (γ=-0.168, p<0.001). During the aging process, the proportion of TAO patients with unilateral involvement also gradually decreased (γ=-0.23, p<0.001). In addition, the proportion of TAO patients with upper eyelid retraction ≥2mm and exophthalmometry ≥17mm also decreased (γ=-0.158, p<0.001, γ=-0.23, p<0.001). In comparison to males, females with TAO showed a higher proportion of unilateral eye involvement and upper eyelid retraction ≥2mm (p=0.038, p<0.001). However, males had a higher proportion of exophthalmometry ≥17mm (p<0.001). The proportions of patients with eye movement disorder (γ=0.535, p<0.001), diplopia (γ=0.446, p<0.001), intraocular pressure (IOP) ≥30mmHg (γ=0.149, p<0.001), sight-threatening TAO (γ=0.479, p<0.001), and active TAO (γ=0.469, p<0.001) were positively correlated with age in TAO patients. Additionally, the proportion of male patients is higher than that of female patients. TAO Patients exhibit different clinical features depending on age and gender. In elderly and male patients, TAO tends to be more severe, with a higher prevalence of eye muscle involvement, IOP ≥30mmHg, active phases, and a lower proportion of patients with upper eyelid retraction ≥2mm. Elderly female patients also have a lower proportion of exophthalmometry ≥17mm.

Perioperative treatments for and postoperative activity of daily living of patients with early-stage breast cancer according to age group: A retrospective observational study

IntroductionThe number of older patients with breast cancer is increasing worldwide. However, no studies have clarified to what extent activities of daily living (ADL) decline in older patients after surgery. This study aimed to identify perioperative treatments and the proportion of patients with a postoperative decline in ADL among those with early-stage breast cancer, according to age groups (<65, 65–74, ≥75 years). Materials and methodsThis retrospective study used healthcare utilization data of women aged ≥40 years who were diagnosed with breast cancer in 431 Japanese hospitals. Patients who underwent breast conserving surgery and mastectomy at clinical stages 0–III were included. ADL were assessed using the Barthel index (100 points indicated independent ADL). ResultsOverall, 37,161 patients were analyzed, including 17,313 undergoing a breast conserving surgery and 19,848 undergoing a mastectomy. The difference in the proportion of patients with a postoperative decline in ADL between those in the <65-year and ≥75-year group who underwent mastectomy was approximately 1%. In each age group, a higher proportion of patients received adjuvant chemotherapy (9.4–27.5% for breast conserving surgery; 15.6–40.3% for mastectomy) than neoadjuvant chemotherapy (breast conserving surgery, 2.1–12.0%; mastectomy, 3.0–18.1%). A lower proportion of patients in the ≥75-year group underwent radiotherapy than that in the <65-year group. ConclusionPhysical burden of surgery was low in both younger and older patients. Low proportions of patients in the ≥75-year group who underwent surgery received neoadjuvant and adjuvant chemotherapy and adjuvant radiotherapy. Healthcare providers should inform this to patients.

Preoperative Predictors of Surgical Success for Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures

OBJECTIVETo investigate predictors of surgical success for patients undergoing robotic ureteral reconstruction (RUR) for ureteropelvic junction obstruction, proximal and middle ureteral stricture disease. METHODSWe retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all consecutive patients undergoing RUR for UPJO, proximal and/or middle ureteral stricture disease between 04/2012-12/2020. The specific reconstruction technique was determined by the primary surgeon based on clinical history and intraoperative findings. Patients were grouped according to whether they were surgical successful. Preoperative variables between both groups were compared using chi-square tests. All independent variables with associations of p<0.2 then underwent a binary logistic regression analysis to determine predictive variables of success for RUR (p≤0.05 was considered statistically significant). RESULTSOverall, 338 patients met inclusion criteria. Surgical success rates of RUR are shown in Table 1. Univariate analysis (Table 2) showed that there were a lower proportion of patients with diabetes (8.9% versus 25.7%, p<0.01) and a higher proportion of patients who underwent ureteral rest (74.3% versus 48.6%, p<0.01) in the surgical success group. Multivariate logistic regression analysis (Table 3) further revealed the odds of surgical success in patients without diabetes was 3.08 times (CI 1.26-7.54, p=0.01) the odds of success for patients with diabetes. The odds of surgical success in patients who underwent preoperative ureteral rest were 2.8 times (CI 1.35-5.83, p=0.01) the odds of success for patients who did not undergo preoperative ureteral rest. CONCLUSIONSurgical success of RUR for management of UPJO, proximal and middle ureteral strictures may be influenced by factors including preoperative ureteral rest and presence of diabetes.

Geriatric assessment-guided interventions for older adults with multiple myeloma: A feasibility and acceptability study

IntroductionGeriatric assessment (GA)-guided supportive care programs have been successful in improving treatment outcomes for older adults with solid-organ cancers. This study aimed to evaluate the feasibility of a GA-guided supportive care program among older adults treated for multiple myeloma (MM). Materials and MethodsThe study utilized an existing registry of adults with plasma cell disorders at the University of North Carolina. Patients with MM, aged 60 or older, and having a GA-identified deficit in one or more problem area were offered referrals to supportive care resources during routine visits. Problem areas included physical function deficits, polypharmacy, and anxiety or depression. Patients with physical function deficits were offered referral to physical therapy (PT), those with polypharmacy to an Oncology Clinical Pharmacist Practitioner (CPP), and those with mental health symptoms to the Comprehensive Cancer Support Program (CCSP). ResultsOf the 58 individuals identified as having at least one deficit on the GA, PT was the most commonly identified relevant resource (79%), followed by CPP visits (57%). Among individuals that were offered referral(s) to at least one new supportive care resource, the acceptance rate was 50%. Referral acceptance rates were highest among those recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%). DiscussionThe study examined the feasibility and acceptability of a referral program for supportive care resources among older adults with MM who have deficits on GA. The most commonly identified deficit was physical functioning, followed by polypharmacy and mental health. The study found that physical interventions and referrals to CPPs were the most accepted interventions. However, the low proportion of patients who accepted physical therapy referrals indicates the need for tailored and more personalized approaches. Further research is needed to explore the feasibility and impact of supportive care referral programs for older adults with MM.

A Retrospective Comparison of Clinical Efficacy between Multimodal Analgesia and Patient-Controlled Epidural Analgesia in Patients Undergoing Total Knee Arthroplasty.

Background and Objectives: Adequate pain management during early rehabilitation is mandatory for improving the outcomes of patients undergoing total knee arthroplasty (TKA). Conventional pain management, mainly comprising opioids and epidural analgesia, may result in certain adverse effects such as dizziness, nausea, and motor blockade. We proposed a multimodal analgesic (MA) strategy involving the use of peripheral nerve block (NB), periarticular injection (PAI), and intravenous patient-controlled analgesia (IVPCA). This study compared the clinical efficacy and adverse effects of the proposed MA strategy and patient-controlled epidural analgesia (PCEA). Materials and Methods: We enrolled 118 patients who underwent TKA under spinal anesthesia. The patients followed either the MA protocol or received PCEA after surgery. The analgesic effect was examined using a numerical rating scale (NRS). The adverse effects experienced by the patients were recorded. Results: A lower proportion of patients in the MA group experienced motor blockade (6.45% vs. 22.98%) compared to those in the PCEA group on the first postoperative day. Furthermore, a lower proportion of patients in the MA group experienced numbness (18.52% vs. 43.33%) than those in the PCEA group on the first postoperative day. Conclusions: The MA strategy can be recommended for reducing the occurrence of motor blockade and numbness in patients following TKA. Therefore, the MA strategy ensures early rehabilitation while maintaining adequate pain relief.

Inflow control can be safely used in laparoscopic subsegmentectomy of the liver: a single-center 10-year experience

BackgroundSeveral techniques have been developed to reduce blood loss in liver resection. The half-Pringle and Pringle maneuvers are commonly used for inflow control. This study compared the outcomes of different inflow control techniques in laparoscopic subsegmentectomy.MethodsFrom October 2010 to December 2020, a total of 362 laparoscopic liver resections were performed by a single surgeon (C.C. Yong) in our institute. We retrospectively enrolled 133 patients who underwent laparoscopic subsegmentectomy during the same period. Perioperative and long-term outcomes were analyzed.ResultsThe 133 patients were divided into 3 groups: no inflow control (n = 49), half-Pringle maneuver (n = 46), and Pringle maneuver (n = 38). A lower proportion of patients with cirrhosis were included in the half-Pringle maneuver group (P = .02). Fewer patients in the half-Pringle maneuver group had undergone previous abdominal (P = .01) or liver (P = .02) surgery. The no inflow control group had more patients with tumors located in the anterolateral segments (P = .001). The no inflow control group had a shorter operation time (P < .001) and less blood loss (P = .03). The need for blood transfusion, morbidity, and hospital days did not differ among the 3 groups. The overall survival did not significantly differ among the 3 groups (P = .89).ConclusionsThe half-Pringle and Pringle maneuvers did not affect perioperative or long-term outcomes during laparoscopic subsegmentectomy. The inflow control maneuvers could be safely performed in laparoscopic subsegmentectomy.

Ambulance deployment without transport: a retrospective difference analysis for the description of emergency interventions without patient transport in Bavaria

BackgroundNot all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates.MethodThis is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups.ResultsOf 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved (“fire alarm system” 0.6%, “fire with emergency medical services” 5.4%) and “personal emergency response system active alarm” (18.6%). The highest transport rates were observed for emergencies involving “childbirth/delivery” (96.9%) and “trauma” (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98–2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to “fire alarm system” (9.0 min) and “personal emergency response system active alarm” (10.6 min).ConclusionThis study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed.Trial registration This paper is part of the study “Rettungswageneinsatz ohne Transport” [“Ambulance deployment without transport”] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.

The impact of COVID‐19 on the quality of stroke care in people with dementia and stroke: a comparison with stroke‐only controls

AbstractBackgroundThe COVID‐19 pandemic has had a significant impact on healthcare systems worldwide, with many hospitals struggling to maintain the same level of care as before the pandemic. As a result, there is concern that the quality of stroke care for patients with dementia diagnoses may have worsened during the pandemic. Therefore, our aim was to study how the COVID‐19 pandemic has affected the quality of stroke care for patients with dementia versus without dementia after suffering a stroke.MethodsWe conducted a register‐based study, retrieving data from the Swedish Stroke Register and The Swedish registry for cognitive/dementia disorders. We included adult patients diagnosed with/without? dementia who had also suffered a stroke between 2017 and 2022. The pre‐pandemic period was defined as January 1, 2017, to February 28, 2020, while the pandemic period was defined as March 1, 2020, to September 19, 2022. The quality indicators of care were defined as care provided at specialized stroke units and assessment for rehabilitation.ResultsThe study included 3205 patients with dementia and 32666 dementia‐free controls, all of whom suffered a stroke. The mean age at onset of stroke was 83 (±6.8) years for those with dementia and 74 (±15.1) years for those without. In addition, the dementia‐stroke group and stroke‐only group had 55% and 48% females, respectively. Compared to the pre‐pandemic period, a lower proportion of patients with dementia were admitted to specialized stroke units and received rehabilitation assessments during the pandemic period, with 64% versus 36% and 65% versus 36%, respectively. Additionally, a lower proportion of patients with dementia compared to stroke‐only controls were admitted to specialized stroke units (36% versus 45%) and received rehabilitation assessments (35% versus 44%) during the pandemic period.ConclusionsOur study indicate that the COVID‐19 pandemic had a negative impact on the quality of stroke care for patients with dementia as compared to stroke‐only controls. This was evidenced by the lower proportion of patients with dementia who were admitted for care to specialized stroke units and assessed for rehabilitation during the pandemic period, compared to the pre‐pandemic period.

Bridging the Gap: Evaluating Discrepancies in Disease Knowledge and Expectations between Patients and Physicians in Hematologic Malignancies

Background: The management of patients with hematologic malignancies involves a variety of therapeutic options, each with distinct goals and probabilities of cure. Studies have revealed a discordance, exceeding 80%, between patients' and doctors' perceptions about the likelihood of cure, with patients often exhibiting a more optimistic outlook. Furthermore, differences in priorities and expectations between physicians and patients can contribute to this disparity. However, there is limited information on factors associated with increased doctor-patient discrepancy. Methods: The aim of this cross-sectional study is to determine the concordance between patients and their physicians on issues related to their disease knowledge, expectations of cure, and treatment priorities at a tertiary care center in a resource-limited academic center. Participants included patients aged 18 years and older with a diagnosis of acute leukemia (AL), chronic leukemia (CL), lymphoma, or myelodysplastic syndrome (MDS) currently undergoing active treatment. Data were collected through surveys conducted with both the patients and their attending physicians. In cases where a resident/fellow attended the patient, both the resident and the attending physician in charge of the clinic were interviewed. Concordance of expectations between doctors and patients and correlation with clinical and sociodemographic variables were analyzed. Discrepancy between doctor and patient was considered when the difference in perceived probability of cure exceeded 20%, with the probability stratified every 10% (ranging from &amp;lt;10% to &amp;gt;90%). Results: A total of 113 patients were interviewed, comprising 33.6% patients with lymphomas, 30.1% with AL, 20.4% with CL, and 15.9% with MDS (see Table 1). Among the respondents, 57.5% correctly identified the name of their disease, 31.9% had partial knowledge, and 10.6% were unaware. Factors associated with complete knowledge of the disease name included age &amp;lt;50 years (72.0% vs. 46.0%, odds ratio (OR) 0.33 (95% CI 0.15-0.73), p=0.013) and diagnosis (AL 76.5%, CL 56.5%, MDS 55.6%, lymphoma 42.1 %, p=0.05). Only 65.5% identified their disease as malignant, while 15.0% considered it non-malignant, and 19.5% were unsure or declined to respond. A lower proportion of patients &amp;lt;50 years (51.4%, p=0.003) and those with CL or MDS (MDS 27.7%, CL 52.2%, AL 73.5% and lymphomas 84.2%; p&amp;lt;0.001) viewed their disease as malignant. Regarding self-perceived knowledge of the disease, 83% of patients considered their information to be sufficient or complete, while 17% perceived it as inadequate or incomplete. In contrast, doctors believed that 65.8% of patients had sufficient or complete knowledge, and 34.2% had little or very incomplete information. Concordance between patients and attending physicians was 63.4% for the perception of disease knowledge and 66.7% between patients and the residents directly attending to them. Among the 89 patients who provided information on their probability of cure, the concordance with the attending physician was 20.2%. In 40.4% of the cases, the doctor believed the probability of cure was &amp;lt;10%, whereas no patient perceived their probability of cure as &amp;lt;10%, and only one patient (0.9%) considered it to be between 10-19%. Agreement on the perception of probability of cure was higher for patients with acute leukemia (37.0%) and lymphoma (19.4%) compared to those with chronic leukemia (12.5%) and MDS (0%), p = 0.027. Patients with concordance had a median age of 39 years (18-82), while those with discordance had a median age of 52 (18-89), p = 0.018; with an OR for concordance in those &amp;gt; 50 years of 4.783 (95% CI 1.43-15.99) (see Table 1). Figure 1 illustrates the treatment priorities for patients and physicians. Conclusions: This study highlights a significant discrepancy between patients' and physicians' expectations regarding prognosis in hematologic malignancies, despite the majority of patients considering their disease knowledge to be sufficient or complete. Addressing expectations and treatment priorities should be integral to the therapy selection process and warrant more thorough discussion in outpatient clinics.

Reduced Subclone Diversity in Clonal Cytopenia of Undetermined Significance Compared to Myelodysplastic Syndrome

Introduction: Clonal cytopenias of undetermined significance (CCUS) and myelodysplastic syndromes (MDS) represent a disease continuum that are distinguished by the presence of dysplasia in &amp;gt;10% of blood cells. However, morphologic dysplasia is subject to high inter-observer variability, suggesting that dysplasia may not be ideal to differentiate CCUS from MDS. Defining the clonal architecture of samples from cytopenic patients may provide a more accurate objective measure of disease status than dysplasia. We hypothesize that the number and size of subclones is reduced in patients with CCUS compared to MDS, suggesting that increased subclonal diversity is a hallmark of higher-risk disease. Methods: We performed whole genome sequencing with higher exome coverage (eWGS) on bone marrow (n=58) or peripheral blood (n=4) and paired normal DNA from baseline banked samples from patients with CCUS (n=13), MDS (n=29; IPSS-R very low/low [3], intermediate [5], high/very high [19], no score [2]), and secondary AML (sAML) (n=20), including 32 previously reported patients, to define clonal architecture. Putative somatic variants, including 76 genes that are recurrently mutated in myeloid neoplasms, were validated in hematopoietic and paired normal samples, and available serial samples (n=23), using orthogonal target enrichment sequencing platforms achieving higher coverage (~600-1000x). Clonality of validated somatic mutations was defined using SciClone. Results: The absolute neutrophil count, hemoglobin, and platelet counts trended lower in MDS vs CCUS patients (median, 1.3 vs 2 K/ul [ns]; 9.3 vs 11.35 g/dL [p&amp;lt;0.01]; 63 vs 109.5 K/uL [ns], respectively). The ages and median number of total validated somatic mutations identified by eWGS at baseline was similar for CCUS (n=428), MDS (n=300), and sAML patients (n=420.5). We first defined the founding clone (i.e., the dominant clone with the highest median variant allele frequency [VAF]) and subclones. While the number of total clones per sample was not different between CCUS, MDS, and sAML (median, n=3 for each), the median VAF of all the mutations present in the founding clone (i.e., measure of the maximal molecular disease burden) was significantly lower in CCUS (21.3%) compared to MDS (39.2%, p&amp;lt;0.05) and sAML samples (45.2%, p&amp;lt;0.001), but MDS and sAML were not different (p=0.2) (Figure 1A). In contrast, there was no significant difference in the median VAF of subclones in CCUS and MDS samples (13.4% vs 16.8%), which were both lower than sAML (25.3%, p&amp;lt;= 0.01). However, the proportion of patients with no subclones (i.e., only the founding clone detected) was higher for CCUS (5/13 [38.5%]) compared to MDS and sAML (4/29 [13.8%] and 0/20 [0%], respectively, p 0.0006), suggesting that CCUS samples have reduced subclonal diversity compared to MDS. Consistent with this, genes commonly mutated in subclones occurred less frequently in CCUS vs MDS samples, including activated signaling (0/13 vs 6/29) and transcription factor genes (3/13 vs 9/29, respectively). Nine CCUS patients had serial samples sequenced (median 2 serial samples, range 1-5) at a median follow-up of 539 days (range, 84-4066 days). In CCUS patients with serial samples, there was minimal change in the founding clone (0.16%, range -3.7-23.9%) or the subclone median VAFs (0.2%, range -22.4-22.2%), with only 2 patients having a founding clone or subclone VAF increase of &amp;gt;5%. UPN 529198 had the acquisition of a new SRSF2(P95H)-mutant subclone 4066 days after initial banking but remained with stable cytopenias and no MDS (Figure 1B). One CCUS patient developed MDS 70 days after banking with a blast count that increased from 2% to 15% but had a negligible change in the founding clone VAF (2.8% increase). However, 3 subclones did increase in size (max VAF increase of 6.1%). In summary, while the total number of mutations is similar between CCUS, MDS and sAML samples, the clonal architecture varies across diseases. CCUS has a lower total molecular disease burden and a lower proportion of patients with a subclone compared to MDS patients in our cohort. The data suggest that defining clonal architecture and incorporating subclonal complexity in the evaluation of cytopenic patients could provide an objective measure to characterize and monitor disease burden rather than relying on the presence or absence of dysplasia, especially when considering the diagnosis of CCUS and lower-risk MDS.