Mean Length Research Articles

Posterior Vault Distraction Osteogenesis for Craniosynostosis-Surgical Outcomes Over 12 Years.

Posterior vault distraction osteogenesis (PVDO) allows significant increase in intracranial volume but is associated with complications including cerebrospinal fluid (CSF) leaks, infection and device failure. The authors outline their outcomes over 12 years and the impact of PVDO on pre-existing Chiari malformation type 1 (CM). Retrospective review of all PVDOs in our unit over a period of 12 years from 2011 to 2023. Results: 51 patients. The mean age of surgery 9 months. The mean length of follow-up 72 months. 82% no complications, 12% dural tear with 2% CSF leak; 4% infection, 2% device failure, 10% blood transfusion. CM in 20% of patients-all are multisuture with 90% lambdoid synostosis involvement. CM is unchanged in the majority of patients post-PVDO. PVDO safe and effective with no re-do posterior vault expansions over 12 years. CM does not tend to resolve after PVDO and high-risk groups include multisuture and Crouzons.

Genomic-Inbreeding Landscape and Selection Signatures in the Polo Argentino Horse Breed.

Analyzing genetic variability and inbreeding trends is essential for effective breed management in animal populations. To this, the characterization of runs of homozygosity (ROH) provides a good genomic approach to study the phenomena. The Polo Argentino (PA) breed, globally recognized as the best adapted to playing polo, is known for its strong influence of Thoroughbreds, intense selective breeding, and extensive use of reproductive biotechnologies. This study investigates the PA's genomic variability, by characterizing the ROH landscape and identifying ROH islands (ROHi) as potential genomic footprints for the breed. PA horses (n = 506) were genotyped using EquineGGP™ array v5 (70 k). We calculated the inbreeding coefficient based on ROH (FROH-ancestral and recent) using a chromosomal approach. Finally, we identified genomic regions with increased ROH frequency (ROHi) and their associated genes. An average of 79.5 ROH per horse was detected, with a mean length of 4.6 Mb. The average FROH was 0.151, but most of them (54%) corresponded to ancestral inbreeding (ROH < 5.5 Mb). However, 4 ROHi were identified in ECA 1, 3, 7 and 17, containing 67 genes, some of which were related to behavior, neurodevelopment, and metabolic functions. This genomic analysis determined, for the first time, the length and location of homozygosity segments in the PA breed and identified ROHi associated with potential genomic regions and genes for positive selection in the breed.

Conversion of 2-dimensional to 3-dimensional mesh for resource-limited centres in developing countries.

In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost. We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group ( n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group ( n = 28), we used a standard polypropylene mesh with one-point suture fixation. All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings.

Awake Craniotomy for Eloquent Brain Arteriovenous Malformations: A Systematic Review and Individual Patient Data Meta-Analysis.

Arteriovenous Malformations (AVMs) pose a risk of neurologic deterioration, particularly when located in eloquent areas. While awake surgery is well-established for treating low-grade gliomas near eloquent areas, its efficacy for AVMs is less conclusively reported. This study conducted a systematic review and individual patient data (IPD) meta-analysis following Cochrane Collaboration and PRISMA guidelines. Literature searches were performed in Pubmed, Embase, and Web of Science. Eligible studies included case reports, case series, retrospective or prospective cohorts, and randomized trials evaluating Awake Craniotomy (AC) for AVMs. Single proportion analysis with 95% confidence intervals (CI) was utilized to pool the data. Case series and case reports were put together as a unique cohort. An analysis of 20 studies encompassing 287 patients was performed. The IPD cohort had 53 patients. The primary outcome pooled analysis indicated an 88% (CI 95% 81-95%; I2=63%) rate of total resection. Moreover, a rate of nearly 12% (CI 95% 5-19%; I2= 63%) of subtotal resection was observed. Furthermore, the analysis unveiled a 20% (95% CI, 13-28%; I2=58%) rate of postoperative neurological deficits, alongside a 6% (95% CI, 3-9%; I2=29%) rate of follow-up neurological deficits. The mean hospital stay was 4.13 (95% CI: 3.61-4.66; I2=73%) days. Awake craniotomy for eloquent AVMs showed promising results. A significant rate of postoperative neurological deficits was found, which was reduced at follow-up. A small mean length of hospitalization was also found. These results suggest that AC for AVMs should be considered in eloquent lesion cases.

Transvaginal natural orifice specimen extraction surgery for left-sided colorectal resection: A single-centre cohort study.

Transvaginal natural orifice specimen extraction surgery (NOSES) is an innovative and feasible approach for left-sided colorectal resections in females. This study aimed to report our experience with transvaginal NOSES for left-sided laparoscopic colorectal resections. We analysed data for all patients with transvaginal extraction performed for left-sided laparoscopic colorectal resections between 2011 and 2021 at a tertiary teaching hospital in Taiwan. The 18 post-menopausal patients were of a mean age of 69.2 ± 10.14 years. The lesions were located at the descending ( n = 5), sigmoid colon ( n = 12) and rectum ( n = 1). The operative time was 262.5 ± 83.91 min, and the blood loss was 34 ± 35.98 mL. All patients had an end-to-end anastomosis, and the anastomotic height was 15.06 ± 8.57 cm. Two patients received diversion stoma. The mean length of hospital stay was 5.1 days (standard deviation ± 2.42; range: 3-12 days). There were no cases of clinical infection. The pathology was malignancy ( n = 14, 77.8%), diverticulitis ( n = 2, 11.2%) and benign ( n = 2, 11.2%). In cancers, they were Stage I ( n = 1, 7.1%), IIa ( n = 1, 7.1%), IIIb ( n = 15, 78.7%) and IV ( n = 1, 7.1%). Malignant specimens ( n = 14) were mostly moderately differentiated ( n = 11, 78.6%), with two poorly differentiated (14.3%) and one well-differentiated (7.1%). The lymph nodes harvested were 16.1 ± 8.11. The widest dimension of the lesion was 3.43 cm ± 1.28 (range: 1.5-6) and the length of the specimen was 14.69 cm ± 5.01 (range: 8-27). Transvaginal NOSES is safe and feasible for left-sided colorectal resection. Factors to consider are the characteristics of the specimen, anal canal and vagina.

Functional outcomes of lower limb reconstruction using vascularised fibula following oncological resection

Objectives: To assess the functional outcomes of patients undergoing lower limb reconstruction with vascularised fibula following tumour resection in a tertiary care setting. Method: The single-centre, retrospective, observational study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised data from January 1, 2017, to December 31, 2022, of patients who underwent lower limb reconstruction with vascularised fibula following oncological resection. Functional outcome was assessed using Musculoskeletal Tumour Society score. Data was analysed using SPSS 26. Results: Of the 31 patients with mean age 18.2+9.9 years, 18(58%) were females and 13(42%) were males. Mean follow-up time was 3.8+3.4 years. Mean length of bony defect was 15.3+5.1cm. Mean length of fibular graft harvested was 20.0+5.9cm. The mean Musculoskeletal Tumour Society score was 26.7+2.8. Mean score was higher in foot defects recreated with single barrel fibula 29.3+1.0 compared to tibial defects 27.2+3.3. Minor wound-related complications were encountered in 5(16.1%) patients. Conclusion: Vascularised fibula was found to be an ideal option for the reconstruction of post-oncological treatment defects in the lower limb. Key Words: Lower extremity, Fibula, Free tissue flaps, Limb salvage, Autografts.

A Smartphone App for the Management of Postoperative Home Recovery After Thoracic Surgery Procedures: A Pilot Study Using the Care4Today™ App.

Background/Objectives: In recent years, the use of smartphones has significantly increased among populations of almost every age. The aim of our work is to analyze the impact of an application (app) that follows up with the progress of a patient who underwent a thoracic surgery procedure in the first 30 days after discharge. Methods: We prospectively analyzed all the patients included in the pilot study from March 2023 to September 2023. The Care4Today™ app was downloaded and activated by the patient preoperatively. From the day of discharge, the app sent questions related to pain perception, breathing capacity, general clinical conditions, problems with surgical wound and quality of life. In the case of negative responses, clinical staff received an email with an orange (medium problem) or red (serious problem) alert. Results: Among the 96 patients who were included, 82 eventually downloaded and used the app. The mean age of the patients was 60.7 years (range 19-80), and 43 (52.4%) were female. Minimally invasive techniques (VATS or RATS) were used in 76 cases (92.7%). The mean length of in-hospital stay was 5.3 days. Malignancy was the reason for surgery in 66 cases (80.5%). The answer rate was 75.8%. A total of 698 orange alerts and 52 red alerts were sent by the app. Re-hospitalization was needed in two cases (only one case related to our surgical procedure). The app was globally judged as useful in the management of convalescence (with an average rating of 7.4 out of 10). Age was not related to the completion rate of answers. Conclusions: The use of the app Care4Today could prevent unexpected re-hospitalization and possible complications. The patients appreciated the use of this tool, and they found it useful for safer postoperative recovery. No difference according to the patients' age was found regarding the use of the app.

Determining articulation parameters using the Avantis 3D software, considering the individual hinge axis position

BACKGROUND: Axiography (condylography) is used to assess the temporomandibular joints (TMJ) function and obtain individual articulator settings. Creating a virtual patient with TMJ dysfunction and determining its individual articulation parameters considerably simplify the procedure and accelerate the diagnosis for further rehabilitation. AIM: To assess the potential of a virtual articulation system using the Avantis 3D software for determining angular parameters of mandibular movement, considering the individual hinge axis position. MATERIALS AND METHODS: The clinical phase of the study included 25 volunteers aged 18–30 years, without complaints of TMJ dysfunction, previous orthodontic treatment, and malocclusion. All volunteers underwent electronic condylography (axiography) using the CADIAX Diagnostic device; the movement of mandible heads during protrusion and mediotrusion was analyzed. The individual values of sagittal condylar inclination (SCI) and Bennett angle on the left and right were obtained. The individual hinge axis was determined, and special radiopaque markers were placed on the skin in the projection of its rotation. Additional markers were placed on the lower edge of the left orbital cavity. Using these markers, cone beam computed tomography (CBCT) was performed in all volunteers, with a 17.5×20.0 matrix size, to create a 3D project, compare CBCT findings with virtual dental models, and generate a reference plane. Virtual occlusion measurements were obtained in terminal positions (protrusion and laterotrusion) using the Trios 3 Basic Pod intraoral scanner. The Avantis 3D software was then used to create 3D scenes based on the obtained measurements and CBCT of the skull. The mean length of each path registered for virtual articulator settings in the Avantis 3D software was approximately 3 mm. The interarticular distance used for the analysis was recalculated using the Avantis 3D software to be equal to the standard intercondylar distance of the articulator, which is 110 mm. Individual SCI and Bennett angle values were obtained for all study subjects. The experimental phase involved phantom models installed in a fully adjustable articulator Reference SL. CBCT was performed with an installed articulator and a maxillary cast, in a zero position, with closed center locks, which was matched to the maxilla present in the CT scan, and a 3D scene was created to measure SCI and Bennett angle values. After detecting the articulator’s hinge axis, electronic measurements of movement were taken, with a predefined SCI of 20–60° (increment 5°) and Bennett angle increments of 6, 12, and 20°. The results were assessed for a path of 3 mm. RESULTS: The mean difference between the compared determination methods of angular parameters obtained during the experimental phase of the study was 3.20±7.22° for the left SCI; 2.09±9.75° for the right SCI; 5.50±11.26° for the left Bennett angle, and 6.40±6.29° for the right Bennett angle. The mean difference between the compared determination methods of angular parameters obtained during the clinical phase of the study was 11.80±6.86° for the left SCI; 12.10±6.08° for the right SCI; 13.0±9.89° for the left Bennett angle, and 10.70±11.48° for the right Bennett angle. CONCLUSION: Both approaches for determining angular parameters can be recommended for use in real-world dental practice. When sophisticated, expensive equipment is not available, a virtual articulation system in the Avantis 3D software can be used as a more simple and affordable technique of measuring angular parameters.

Respiratory Diseases with High Occupational Fraction in Italy: Results from the Italian Hospital Discharge Registry (2010-2021).

Occupational respiratory diseases represent a major public health concern worldwide. This study analyses the hospitalization costs and characteristics of four major occupational respiratory diseases: malignant mesothelioma (MM), sinonasal cancer (SNC), pneumoconiosis (PN), and hypersensitivity pneumonitis (HP). The findings are situated within the context of Italy's population trends and healthcare system, offering insights into the economic and clinical burden of these diseases. This retrospective, population-based study examines Italian hospitalizations for MM, SNC, PN, and HP during the period 2010-2021. The primary outcomes were the number of hospitalizations, length of stay, and associated cost. Costs were derived from charges linked to diagnosis-related groups (version 24) and major diagnostic category coding systems. Though the Italian population is rapidly aging, the annual number and rate of hospitalizations declined by 35% over the study period. SNC hospitalizations aligned with the overall trend, PN and MM experienced faster declines, whereas HP admissions remained steady. MM emerged as the most resource-intensive (EUR 25 million yearly, with 86% attributable to occupation), followed by PN (EUR 10 million, entirely occupational), SNC (EUR 5 million, with EUR 650,000 occupational), and HP (EUR 2 million, with EUR 370,000 occupational). All studied diseases had an average length of stay exceeding the national one. The SNC admissions were the shortest (6.5 days) and least expensive (EUR 3647). In contrast, MM, PN, and HP had a mean length of stay exceeding 10 days, with admission costs averaging EUR 4700 for MM and EUR 4000 for PN and HP. The median age was the highest for PN (78 years) and MM (71 years), while SNC and HP patients had a median age of approximately 65 years. Consistent with their anticipated benefits, Italian workplace health regulations over the last three decades, including the 1992 asbestos ban and D.lgs. 81/2008, are associated with significant reductions in the hospitalization burden and an increased median age at discharge for MM and PN. In contrast, fewer conclusions can be drawn for SNC and HP due to their lower occupational fractions (10-20%). This finding suggests adding an occupational exposure flag in hospital records for acknowledged occupational diseases to enhance surveillance. Finally, this study provides the first estimate of the occupational fraction of hospitalization costs for the studied diseases in Italy.

Impact of comorbid asthma and determinant factors on the clinical outcomes of coronavirus disease 2019 in Ethiopia

BackgroundSeveral comorbid diseases were associated with worse clinical outcomes of COVID-19. However, the impact of comorbid asthma on the clinical outcomes of COVID-19 is not known in Ethiopia.ObjectiveTo assess the impact of asthma and determinant factors on the clinical outcomes of COVID-2019 in Ethiopia.MethodA retrospective cohort study involving 702 COVID-19 patients from March 13, 2020, to January 30, 2022. Data were collected on patients’ sociodemographic, clinical characteristics, drug-related, and clinical outcomes variables. Data were entered into Epi-Data version 4.6 and exported to SPSS version 25 for analysis.ResultsAmong a total of 702 COVID-19 patients, 132 (18.8%) had asthma. There were no significant mortality rate and respiratory failure differences between COVID-19 patients with comorbid asthma (13.6 vs. 13%, p = 0.930 and 36.4 vs. 21.4%, p = 0.100), respectively. However, the mean length of hospital stay for COVID-19 patients with comorbid asthma was significantly longer than those without asthma (14.78 vs. 12.86 days, p = 0.050). Asthma was not an independent predictor for COVID-19 mortality (p = 0.930 and respiratory failure (0.108). However, age (p = 0.027), rural (p = 0.016), and Charlson comorbidity index score (CCI) score [1 (p = 0.012), 2 (p = 0.019), and ≥3 (p = 0.027)] were found to be significantly associated with COVID-19 mortality. Similarly, rural residence (p = 0.001), fever (p = 0.008), fatigue (p = 0.030), and CCI score [1 (p ≤ 0.001), 2 (p ≤ 0.001) and ≥3 (p = 0.001)] were found to be significantly associated with COVID-19 respiratory failure.ConclusionIn this study, asthma had no significant impact on COVID-19 mortality and respiratory failure. However, age, CCI score (1, 2, and ≥3), and rural residence were found to be significantly associated with COVID-19 mortality.

Temporal Changes in PROMs Improvement and Recovery Kinetics Following Transforaminal Endoscopic Lumbar Discectomy.

Retrospective cohort study. to analyze trends in PROMs improvement and recovery kinetics following transforaminal endoscopic lumbar discectomy and foraminotomy (TELD). As TELDs become an increasingly common alternative to fusions for lateral disc herniations, it is important to understand patients' postoperative recovery timelines to manage patient expectations. Although studies have shown improvement after TELD compared to preoperative baseline, there is a paucity of information regarding rate of postoperative improvement. Patients who underwent primary one- or two-level TELD for far lateral disc herniations with a minimum of 6-month follow-up were included. Outcomes included: patient reported outcome measures (PROMs), including Oswestry Disability Index (ODI), 12-Item Short Form Survey Physical Component Score (SF-12 PCS), and Visual Analog Scale (VAS) for back and leg; PROMs minimally clinically important difference (MCID); global rating of change (GRC); and return to activities. Timepoints included were preoperative, 2 weeks, 6 weeks, 12 weeks, 6 months. Trends in improvement were plotted on graphs and with P values displayed in tables. 51 patients were included. Mean operative time was 68.4±23.0 minutes and mean length of stay was 9.6±10.5 hours. There were statistically significant improvements in VAS back and leg at 2 weeks and 6 weeks, with a plateau after 6 weeks. ODI and SF-12 PCS did not experience statistically significant improvement until 6 weeks, which was also the point of plateau. VAS leg MCID and GRC peaked at 6 weeks. All patients returned to driving and discontinued opioids, and most patients returned to work. Median days to return to driving, work, and discontinue opioids were 8, 35, and 1, respectively. Patients can expect the majority of postoperative improvement to occur within 6 weeks, after which improvements tend to plateau. Around 75% of patients feel better compared to preoperative at 6 months. TELD may therefore spare some patients of a more invasive fusion initially. 3.

Similar efficacy of intra-articular hyaluronic acid injections and other biologically active injections in patients with early stages knee osteoarthritis: a level I meta-analysis.

The present meta-analysis compared the efficacy of intra-articular hyaluronic acid (HA) injections in patients with early to mild knee osteoarthritis (OA) (Kellgren Lawrence I-II) versus other commonly injected biologically active compounds using patient-reported outcome measures (PROMs). The outcomes of interest were the visual analogue scale (VAS) and the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores. This study was conducted according to the 2020 PRISMA statement. In April 2024, PubMed, Web of Science, Google Scholar, and Embase were accessed without time constraints. All the randomised controlled trials (RCTs) investigating the efficacy of intra-articular HA injections in the early stages of knee OA were accessed. Data concerning the VAS, WOMAC, and related subscales were collected at baseline and the last follow-up. Only studies clearly stated the degrees of advancement of OA using the Kellgren-Lawrence scoring system were used. The literature search resulted in four RCTs (390 patients). The mean length of the last follow-up was 7.5 ± 3.0months. 72.3% (282 of 390) of the patients were women. The mean age of the patients was 58.1 ± 3.2years, and the mean BMI was 27.3 ± 3.2kg/m2. At the last follow-up, no difference was found between HA and the control group in VAS, WOMAC, and related subscales. In patients with early to mild knee osteoarthritis, the current level of evidence suggests that intra-articular injections using HA performed similarly to other biologically active compounds commonly injected in the knee joint for a minimum of three months. Level I, meta-analysis.

Quadriceps tendon autograft diameters are routinely above 8 mm, and preoperative size estimation before anterior cruciate ligament reconstruction may not be necessary for this graft type: A systematic review.

To identify values of reported quadriceps tendon (QT) autograft diameter and length in anterior cruciate ligament reconstruction (ACLR), and to identify methods to predict these parameters. A search was conducted across three databases from inception to 30 March 2024. Data on study characteristics, demographics, anthropometric data, imaging techniques, and QT autograft or harvested QT tendon parameters were extracted. Values quantifying the statistical strength of associations between imaging or anthropometric characteristics and graft or tendon parameters as well as for associations between these parameters and postoperative outcomes were recorded. A total of 3633 patients were included. The weighted mean QT autograft diameter and length were 8.9 (standard deviation [SD]: 0.7, range: 7.8-10.4) mm and 8.1 (SD: 1.3, range: 5.6-9.3) cm, respectively. A total of 93.8% of studies that reported mean QT autograft diameter found a value of 8 mm or greater. The QT groups had similar or significantly greater mean autograft diameter compared to the hamstring tendon (HT) groups in 91.7% of studies that reported significance. Regarding MRI measurements, 71.4% of the correlation coefficients reported showed a moderate positive correlation, 28.6% showed a low positive correlation and 14.3% showed a high positive correlation. Regarding anthropometric characteristics, 33.3% and 16.7%, 16.7% and 14.3% of studies that reported on the relationship between QT autograft diameter and height, weight, body mass index or age, respectively, found a low positive statistically significant correlation. Only statistically nonsignificant associations were reported between QT autograft parameters and post-operative outcomes and complications. QT autografts used in ACLR have a mean diameter of 8 mm or greater and are consistently larger than HT autografts. Preoperative MRI measurements are better than anthropometric characteristics at predicting QT autograft parameters; however, preoperative prediction may not be necessary for this graft type. QT autograft parameters were not found to be significantly associated with any post-operative complication or outcome. Level IV.

Comparative performance of marking of small-diameter peripheral lung neoplasms by preoperative transthoracic use of methylene blue preparations and placement of an anchor marker system

The study compared marking of small-diameter peripheral lung neoplasms by preoperative transthoracic use of 1% aqueous methylene blue solution and placement of an anchor marker system. The study evaluated the results of treatment of 36 patients with pulmonary nodules, including 27 men and 9 women aged 52 to 76 years, who were examined and treated at the Surgical Clinic of the S.M. Kirov Military Medical Academy in 2020-2023. Marking of small-diameter peripheral lung neoplasms by transthoracic use of 1% aqueous methylene blue solution made possible to detect abnormalities and lesions and perform a biopsy in 73.3% of cases. The duration of the diagnostic procedures was 30 [20-40] minutes. No postoperative complications were reported. The mean length of stay in this group of patients was 8 [6; 12] patient days. Placement of an anchor marker system allowed detection and verification of lung lesions in 95% of cases. In addition, the duration of videothoracoscopic biopsies was also 30 [20-40] minutes. No complications or deaths were reported. The mean length of stay was 7 [5; 11] patient days. The use of anchor markers to label small peripheral pulmonary nodules in the preoperative phase has some significant advantages compared with dye injection techniques, such as shorter duration of lesion mapping (p = 0.046) and less manipulation complications (p = 0.04), as well as a higher frequency of lesion detection during minimally invasive procedures. When comparing various techniques for marking pulmonary lesions, it was found that mapping of small-diameter peripheral pulmonary infiltrates using anchor markers is characterized by high performance, greater safety, facilitates intraoperative navigation for biopsy of small-diameter peripheral pulmonary neoplasms, and is superior than transthoracic use of 1% aqueous methylene blue in terms of rates of detection of pulmonary nodules during minimally invasive procedures, duration of manipulation, and complication rates.

Syntactic Growth of Adolescent Boys With Fragile X Syndrome or Down Syndrome: A Longitudinal Study.

The current study addresses a gap in the literature regarding syntactic development of adolescent boys with fragile X syndrome (FXS) and Down syndrome (DS). Specifically, we ask whether syntactic skills plateau or continue to change during adolescence for these groups and whether the profile of syntactic change differs between boys with FXS and those with DS. Participants were 38 boys with FXS (with and without autism) and 20 boys with DS between the ages of 10 and 16 years, as well as 33 boys who were neurotypical between the ages of 3 and 8 years at study entry. Trained examiners evaluated the participants annually for four consecutive years. The evaluation included standardized language assessments and a conversational language sample, which was analyzed using mean length of utterance-morphemes and the Index of Productive Syntax. For each measure, we fit a series of candidate models, including the intercept-only model and models with nonverbal cognition and maternal IQ as moderators. We then used Akaike's information criteria-corrected to determine which model in a candidate set had the most empirical evidence. Our between-groups results indicated that FXS and DS have distinct syntactic profiles. However, our growth analyses and moderator analyses yielded mixed results. For most measures, the most likely models suggest that there is no plateau in the growth of syntactic skills for boys with FXS or DS and that nonverbal cognition is associated with the rate of change. These results suggest that syntactic change continues to occur throughout adolescence for boys with FXS or DS. The results also indicate that the growth profiles are distinct between the two groups. Future research with more participants from more diverse backgrounds would add more clarity to these findings. https://doi.org/10.23641/asha.27984548.

Robotic trans-abdominal retromuscular hernia repair for medium-sized midline hernias: midterm outcomes and surgical site occurrence (SSO) analysis in 120 patients.

Robotic surgery has become a popular method for treating ventral hernias due to its promising peri-operative outcomes. However, the long-term results of this approach are still unclear. In this study, 120 patients underwent robotic trans-abdominal retromuscular mesh placement (r-TARM) with a mean follow-up period of 18.1months. This study aims to evaluate the feasibility of the robotic approach reporting peri-operative and midterm outcomes. Additionally, we examined possible risk factors that may contribute to the development of surgical site occurrences (SSOs). Between January 2021 and September 2023, 120 patients underwent r-TARM for midline hernias, including 39 primary, 71 incisional, and 10 recurrent cases. A retrospective analysis was performed. A logistic regression model was used to identify possible patient risk factors for SSO development. The average operative time was 153.5 ± 47.2min, and there were no open or laparoscopic approach conversions. The mean length of hospital stay was 1.9 ± 0.9 days. We observed SSO in 16 patients (13.3%). One patient (0.8%) required angiographic embolization due to post-operative parietal bleeding. The mean follow-up time was 18.1 ± 7.8months, and we observed hernia recurrence in only one (0.8%) patient. The logistic regression model did not identify any possible risk factors for SSO. r-TARM is a safe and effective method for treating ventral hernias not requiring posterior component separation. Our results indicate that patient and hernia characteristics were not predictive of SSO. Midterm outcomes are encouraging, though longer follow-up is needed.

A Comparative Study on the Growth and Mortality of Rohu fish, Labeo rohita of the Halda River (Wild) and Induced Hatchery (Artificial) Sources

The growth and mortality rates of Labeo rohitaom the Halda River strain and the hatchery strain were studied under identical water quality and environmental conditions to identify the better performer. 250 Rohu fish fries from the Halda River and the hatchery were reared for this experiment. The rearing trial was performed for 14 weeks in 12 m3 net cages, each with three replica sets in an earthen pond. Fishes were sampled weekly for measuring body weight and length. The final mean weight was significantly higher in the Halda strain (57.46 ± 22.91 g) compared to the hatchery strain (24.20 ± 7.61 g) (p &lt; 0.05), with weight gain in the Halda strain more than twice that of the hatchery strain. In most sampling stages, the growth rate of Labeo rohita was significantly higher (p &lt; 0.05) in the Halda strain. The final mean length was also greater in the Halda strain (13.07 ± 1.63 cm) compared to the hatchery strain (10 ± 1.08 cm). Mortality rates were lower in the Halda strain (15.60%) than that of the hatchery strain (31.20%) over the 14 weeks. These findings suggest that the Halda strain significantly outperforms the hatchery strain in growth and survival under controlled conditions. Chittagong Univ. J. B. Sci. Vol. 12 (1 &amp; 2): 83-90, 2024

Personalized Mobile App-Based Program for Preparation and Recovery After Radical Prostatectomy: Initial Evidence for Improved Outcomes From a Prospective Nonrandomized Study.

eHealth can help replicate the benefits of conventional surgical prehabilitation programs and overcome organizational constraints related to human resources and health care-related costs. We aimed to assess the impact of an optimized perioperative program using a personalized mobile app designed for preparation and recovery after radical prostatectomy (RP). We report on a series of 122 consecutive robot-assisted RP before and after the implementation of the betty.care app (cohort A: standard of care, n=60; cohort B: optimized program, n=62). The primary end point was continence recovery, defined as "0 or 1 safety pad per day" at 6 weeks after surgery. Secondary end points were length of stay, same-day discharge, complications, readmissions, and number of days alive and out of hospital within 30 days from surgery. Both cohorts were comparable in terms of age, prostate-specific antigen, prostate volume, and disease aggressiveness. Intraoperative parameters (lymph node dissection, operative time, and bilateral nerve-sparing surgery) were comparable in both groups, except for blood loss, which was significantly higher in cohort B (182 vs 125 cc; P=.008). The 6-week continence rate was improved in cohort B in both univariable and multivariable analyses (92% vs 75%; P=.01). There were trends favoring cohort B for all secondary end points with a minimal 30% benefit compared with cohort A. Grade 2 or more complications occurred less frequently in cohort B (13% vs 3.2%; P=.042). Same-day discharge and readmission rates were 35% and 53% (P=.043), and 3.3% and 1.6% (P=.54) in cohorts A and B, respectively. Mean length of stay was reduced by 0.2 days in cohort B (0.58 vs 0.78 days; P=.10). The main limitation was the absence of randomization. The implementation of a mobile app that provides a holistic approach to the perioperative period, integrating prehabilitation, rehabilitation, and remote monitoring, could lead to the improvement of important functional outcomes after RP and could replicate an on-site prehabilitation program. Multicenter validation is needed.

The Age-Friendly Learning Healthcare System: Replicating electronic health record based documentation metrics for 4Ms care.

University of Utah Health (UUH) is an academic medical center that achieved "committed to care excellence" in age-friendly care in 2021 and has a long-standing culture of quality improvement central to a learning health system. University of California San Francisco (UCSF) developed electronic health record (EHR) documentation metrics for inpatient assessment of the 4Ms (What Matters, Medication, Mentation, and Mobility) based on the Institute for Healthcare Improvement's recommended care practice for an Age-Friendly Healthcare System. In partnership with UCSF, we replicated the assessment and action EHR metrics with local adaptations for each of the 4Ms at UUH. The UCSF team shared 4Ms documentation metrics and Structured Query Language code used to assess 4Ms care at UCSF. At UUH, this code was adapted for a different relational database management system and local clinical context. We assessed 4Ms care, individual M, and composite measures of all 4Ms, for all patients aged 65 and older admitted to UU Hospital between January 1, 2019 and December 31, 2021. We conducted a clinical validation of individual patient cases to confirm accuracy of 4Ms queries. In the 3-year study period, 16,489 qualifying patients, mean age 74.2, were admitted to UU Hospital in a total of 25,070 admissions with mean length of stay of 6.08 days. We were able to replicate 14 of the 16 EHR metrics of individual 4Ms developed at UCSF and five composite measures. For the composite measure addressing completeness of 4Ms care, 50% of patient encounters had all 4Ms administered during their encounter. Indicators of the completeness of 4Ms care can be measured using EHR data to validate implementation of the 4Ms at multiple academic medical centers. Key lessons to support future scaled-up assessments include the importance of adapting EHR measures to local activities and involving expert data analysts.

Runs of homozygosity assessment using reduced representation sequencing highlight the evidence of random mating in emu (Dromaius novaehollandiae).

The domestication of emu (Dromaius novaehollandiae) began in the 1970s, but their productive characteristics have not undergone significant genetic enhancement. This study investigated the inbreeding and genetic diversity of 50 emus from various farms in Japan using Double digest restriction-site associated DNA sequencing (ddRAD-seq) markers. Single nucleotide polymorphism (SNP) calling revealed 171 975 high-quality SNPs while runs of homozygosity (ROH) analysis identified 1843 homozygous segments, with an average of 36.86 ROH per individual and a mean genome length of 27 Mb under ROH. The majority (86%) of ROH were short (0.5-1 Mb), indicating ancient or remote inbreeding. The average genomic inbreeding coefficient (FROH) was 0.0228, suggesting nearly no inbreeding. Overlapping ROH regions were identified, with top consensus regions found on chromosomes 8 and Z. Seven candidate genes related to egg production, feather development, and energy metabolism were annotated in these regions. The findings highlight the prevalence of genetic diversity and low inbreeding levels in the studied emu population. This research highlights the potentiality of random mating in genetic management and conservation of emus. Further studies should focus on enhancing productive traits through selective breeding while preserving genetic diversity to ensure the sustainable growth of the emu farming.