Multicenter Retrospective Analysis Research Articles

Artificial intelligence-based prediction of second stage duration in labor: a multicenter retrospective cohort analysis

Artificial intelligence-based prediction of second stage duration in labor: a multicenter retrospective cohort analysis

Impact of smoking on recurrence rates among wide-neck intracranial aneurysms treated with Woven EndoBridge: a multicenter retrospective study.

Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck IAs has not been evaluated. This study aimed to investigate the outcomes of WEB devices by smoking status. A retrospective multicenter analysis was conducted on the data of patients from 36 sites worldwide treated with the WEB device for intracranial saccular aneurysms. Patients were stratified based on smoking status (current, former, and never smokers). The Student t-test and chi-square test were performed for continuous and categorical variables, respectively. Multivariable logistic regression was used to adjust for confounders. Of 1376 patients with available smoking status, 504 were current smokers, 358 were former smokers, and 514 were never smokers. Upon adjusting for significant confounders, no association was found between smoking and recurrence outcomes (OR 1.39, 95% CI 0.69-2.80; p = 0.36), thromboembolic and hemorrhagic complications, and mortality among IAs treated with the WEB device. There was no statistically significant difference in outcomes between former and never smokers (OR 1.23, 95% CI 0.70-2.18; p = 0.46). The location of aneurysms differed between smoking groups, with former smokers having more anterior circulation aneurysms compared with current and never smokers (99.0% vs 96.9% vs 95.3%; p = 0.01). In terms of clinical symptoms, headache and dizziness were more common in the never smokers compared with current and former smokers (13.9% vs 8.9% vs 7.7%, p = 0.01). This large-scale study suggests no significant correlation between smoking and the recurrence of IAs treated with the WEB device. Biological studies are warranted to better understand the biological impact of smoking on the growth and rupture of treated IAs.

P-1164. Prevalence of invasive Candidiasis and antifungal resistance in neonates: a multicenter three-year retrospective analysis from two large Mexican NICUs

Abstract Background Candida infections are increasingly recognized as clinically relevant pathogens in NICUs, particularly among preterm and low birth-weight infants (LBWI). Due to the emergence of Fluconazole-resistant Candida spp, current treatment guidelines of neonatal invasive Candidiasis (IC) suggest Amphotericin B as first line therapy, leaving Fluconazole as an alternative agent. Microbiological surveillance focused on fungal etiologies in Mexican NICUs is scarce, which may lead to inappropriate antifungal use. Methods Retrospective multicenter study conducted in the NICUs of the two pediatric reference hospitals in NL, Mexico. Clinical and microbiological data of all newborns ≤28 days diagnosed with blood culture-proven invasive Candidiasis from 2021-2023 were collected. LBWIs were defined as newborns < 2500 g at birth, and very LBWI (VLBWI) as < 1500 g. Descriptive statistical analyses were performed to determine the frequency of Candida spp and frequency of antifungal resistance. Results During the studied period, 928 positive blood cultures were included. Only 38 blood cultures (4%) were positive for Candida spp. No outbreaks occurred during the studied period. Twenty one patients (75%) were preterm. Mean gestational age was 29 weeks. Most patients (55%) were VLBWI (Table 1). All episodes were classified as late-onset sepsis. The most common isolated species were C. albicans (45%), followed by C. glabrata (29%), and C. parapsilosis (16%). No Fluconazole resistance was observed (Table 2). Caspofungin resistance was found in 5 C. glabrata isolates and 1 C. albicans. No cases of endophthalmitis or endocarditis were documented. Conclusion We report a low prevalence of blood culture-proven neonatal IC (4%) in two large Mexican NICUs during the studied period. Most patients were LBWI. This is consistent with international data. C. albicans was the most common isolated species. Based on the local epidemiology in two large NICUs of NL Mx, Fluconazole may be considered as a first line antifungal agent instead of Amphotericin B. Local microbial epidemiology and antifungal susceptibility patterns should be considered for the empirical treatment. Disclosures All Authors: No reported disclosures

Patterns of reflux in patients with CEAP C2 disease compared to patients with C6 venous ulceration.

CEAP categorizes patients based on disease progression and severity. Whether disease severity is associated with specific patterns of reflux is currently unknown. We hypothesize that patterns of reflux in patients with C2 and C5/6 disease will differ. Multi-center retrospective cohort analysis. From January 2015 to December 2020, we performed a retrospective review of reflux patterns in 21 335 patients and 31 727 limbs in symptomatic patients with C2 or C5/6 disease. Patterns of reflux in Great (GSV), Small (SSV), Deep and Perforators (Perf), were analyzed in patients with and without junctional reflux. The GSV and SSV were divided into six and three segments respectively. The number of perforators with reflux were categorized as 1-3 above and below-knee and deep system reflux was divided into three segments. Of the 21 335 patients the average age and female/male distribution was the following: C2 (54.13 ± 13.82, 21 410/5047), C5/6 (64.75 ± 14.75, 1514/1755) (p ≤ .001). When SFJ reflux is present, 6-segment GSV reflux was most prevalent (C2, 14.85% vs C5/6, 27.50). Without junctional reflux, above knee reflux was more common in C2 disease, while below knee reflux was more common in C5/6 disease (p ≤ .01). Three segment SSV reflux was more prevalent in C2 patients (26.67% vs 16.27%, p ≤ .001). Below knee perforator reflux was more prevalent in C5/6 patients (79.56% vs 73.53%, p ≤ .01). Combined CFV/FV/POPV reflux was more prevalent in C5/6 patients (38.5% vs 20.5%, p ≤ .001). The presence of junctional reflux is more closely associated with disease location (above- vs below-knee) than with disease classification. SFJ reflux is more likely to present with extensive above knee disease. Isolated below-knee reflux is more significantly associated with C5/6 disease, independent of junctional reflux. Conversely, isolated above-knee superficial reflux is significantly associated with C2 disease and junctional reflux.

P-1143. Etiology and resistance phenotypes of blood-culture proven neonatal sepsis from two large NICUs in Mexico: a multicenter three-year retrospective analysis

Abstract Background Neonatal sepsis is a significant cause of morbidity and mortality in newborns. Etiology depends on multiple factors, particularly regional epidemiology. Current international guidelines are based on data from developed countries, which may not reflect the situation of developing regions. Microbiological surveillance in Mexican NICUs is limited, which may lead to inappropriate antimicrobial use. Methods This is a retrospective multicenter study conducted in two NICUs from NL, Mexico (2021-2023). Clinical and microbiological data on ≤28-day newborns with blood culture-proven neonatal sepsis were collected. Neonatal sepsis was classified as early (≤3 days) and late onset ( >3 days). Descriptive statistical analyses were performed to assess microbiologic etiologies, as well as clinically-relevant resistance phenotypes (VITEK® 2). Results A total of 928 blood cultures from 775 patients were included. 49.0% were preterm. Mean gestational age was 35.2. Most episodes (66.9%) were classified as late-onset sepsis (Table 1). Staphylococcaceae were the most commonly identified family (48.6%). Coagulase-negative Staphylococci were the most common group (42.7%), being S. epidermidis the most common. Gram-negative bacilli were the second most common cause of neonatal sepsis (33.7 %), mostly due to K. pneumoniae (12.7%). Low prevalence of GBS was observed (3.0%). Fungal (4.1%) and enterococcal (5.2%) isolations were uncommon. The prevalence of ESBL-producing Enterobacterales were 39.4%; MRSA was 30.2% (Table 2). 4 cases (1.4%) of carbapenem-resistant Enterobacterales (CRE) and 2 cases (0.7%) of AmpC Enterobacterales were identified. Notably, 5 cases (10.4%) of vancomycin-resistant Enterococci (VRE) were identified. Conclusion The study reported clinical and microbiological data of blood culture-proven neonatal sepsis. In contrast with U.S. data, this study showed a lower prevalence of GBS and a significant presence of Gram-negative pathogens, alongside notable resistance profiles such as ESBL-producing Enterobacterales and VRE. Antimicrobial surveillance in developing regions is necessary in order to recognize the most common etiologies and develop treatment guidelines according to local epidemiology. VRE is a worldwide concern and should be closely monitored. Disclosures All Authors: No reported disclosures

HEW score-a tool for the homogenisation of donor registrations to the DSO : Multicentre retrospective analysis of three university hospitals

The persistently low number of postmortem organ donations in Germany has repeatedly led to political discussions and most recently to the amendment of the Transplantation Act with the strengthening of the role of the transplantation officer and the introduction of aregister to document the will to donate. The background to these decisions was the assumption that arelevant proportion of potential organ donors in hospitals were being overlooked and not reported. However, due to the lack of guidelines as to when apotential organ donor must be reported to the DSO ("Deutsche Stiftung Organspende"), the existing data is only of limited validity. The transplantation officers of the university hospitals in North Rhine-Westphalia (NRW) therefore agreed on the HEW score (brain function loss-suitability-will) presented here as ashared standard for reporting potential organ donors. Assigning the scores from 1to 3to each of the three included attributes results in ascore of 111 to 333, and reporting to the DSO is recommended if the threshold value of 213 is exceeded. For implementation, the HEW scores of the cases determined by TransplantCheck from the university hospitals in Bonn, Essen and Düsseldorf from 2022 were collected retrospectively and presented in this paper. Overall, the number of cases to be reported according to the HEW score was 13.5% below the number of cases actually reported at all three sites (126 vs. 109). In all three centres, the refusal rate was high at 54.5-64.9%. The HEW score represents atool for the detailed recording and standardised reporting of potential organ donors and can enable homogenised reporting behaviour as adata basis for future improvement approaches.

Comparative Analysis of the Efficacy of Four Different Surgical Modalities in the Treatment of Cesarean Scar Pregnancy: A Multicenter Retrospective Study.

This study explored the effects of four different surgical methods in the treatment of cesarean scar pregnancy (CSP). In this multicenter retrospective analysis of 359 patients, the surgical indices, the time taken for the serum human chorionic gonadotropin level to return to normal, the recovery time of menstruation, and the incidence of postoperative adverse reactions were comparatively analyzed. The clinical efficacies of various preoperative treatment methods to block the blood supply to CSP tissues and those of four different surgical methods to treat CSP, namely, curettage, hysteroscopic surgery, laparoscopic surgery, and vaginal surgery, were evaluated in this study. Hysteroscopic pregnancy tissue removal in patients with typeI CSP was found to be associated with low cost, rapid postoperative recovery, and a low incidence of postsurgical complications. Among patients with typeII-III CSP, the operation success rate (96.97% for typeII and 88.46% for typeIII) in those who underwent uterine artery embolization + curettage was lower than that in patients from the other groups (all 100%). Among patients with typeIII CSP who underwent transvaginal ligation of the descending uterine artery + hysteroscopic removal of the pregnancy tissues, three patients (12.5%) underwent hysteroscopic surgery under transumbilical single-port laparoscopic surveillance so as to avoid uterine perforation considering that the pregnancy tissue was only 1mm away from the uterine plasma membrane layer. Hysteroscopic surgery without pretreatment can be adopted for patients with typeI CSP. In contrast, patients with typeII and III CSP should be initially pretreated with vascular ligation to prevent intraoperative bleeding, followed by laparoscopic or vaginal surgery. Clinical Trial Registry Number ChiCTR2000040357.

P0999 Efficacy and safety of different biologics in first line therapy in Crohn’s disease: a multicentric retrospective comparative analysis

Abstract Background Biological therapy is the most important pathogenic treatment in moderate to severe Crohn’s disease (CD), but there are few studies in the literature that compare the effectiveness and safety of several biological drugs. The aim of this study is to compare efficacy and safety of different biologics as first line therapy in CD. Methods 326 patients from 6 Gastroenterology departments from Bucharest, Iasi and Cluj treated between 2006 and 2024 were included in the study. 47 were excluded because they received only Mesalazine. 279 were included in the final analysis. The main outcomes were: clinical response at 12 weeks of treatment (complete response = clinical remission, partial response= decrease of CDAI ≥ 25% of the initial value without remission or primary non-response) and serious adverse events leading to therapy discontinuation. Results The main characteristics of the studied patients are shown in the table 1. Median therapy duration was 48 months (3÷330). 47% of patients received Adalimumab, 42% were treated with Infliximab, and in 9% Ustekinumab was given. The flowchart of the study is presented in the Figure 1. The complete response rate was similar for the 3 biologics studied: 70%, the non-response rate was also similar: 8%, but persistence on therapy at 2 years was better for Ustekinumab (62%) and Adalimumab (40% ), compared to Infliximab (34%) (p=0.03). Serious adverse events leading to therapy discontinuation were more frequent in those treated with Infliximab (10%) compared to Adalimumab (3%) and Ustekinumab (6%) (p=NS). Because only 25 individuals received Ustekinumab in first line, predictive factors for complete clinical response were searched only for Infliximab and Adalimumab. Good predictive factors of response to Infliximab were: absence of perianal disease (p=0.003), low value of CDAI at initiation (p<0.001), increased hemoglobin level (p=0.01), lack of stricturing behavior (p=0.02), short interval from diagnosis to start of therapy (p=0.04). Several prognostic factors for a good response to Adalimumab were identified: absence of perianal disease (p=0.03), low CRP at initiation (p=0.006), non-stricturing behavior (p=0.02), short interval between symptom onset and therapy initiation (p=0.001). Conclusion All three biological agents used in real life for Crohns’ disease therapy show similar efficacy, with a complete response rate of aprox.70% and a nonresponse rate of 8%, but persistence on therapy at 2 years was significantly better for Ustekinumab (62%) and Adalimumab (40% ), compared to Infliximab (34%). Serious adverse events leading to therapy discontinuation were more frequent in patients treated with Infliximab (10%) compared to those who received Ustekinumab (6%) or Adalimumab (3%).

Advanced paranasal sinuses osteomas: a retrospective multicentric analysis on surgical management outcomes and intra- and postsurgical complications.

This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit. A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications. The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra- and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone. This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.

Retrospective multicenter analysis of the Trenza Embolization Device for endovascular therapy of intracranial aneurysms: initial results and short-term follow-up

BackgroundIntrasaccular devices are increasingly used in endovascular therapy of intracranial aneurysms, in particular wide-necked and ruptured aneurysms. The Trenza Embolization Device (TED) is an innovative intrasaccular device for medium- to...

Multicenter Retrospective Analysis of Pediatric Differentiated Thyroid Carcinoma: Treatment Practices and Outcomes Prior to Pediatric American Thyroid Association Guidelines Implementation.

Differentiated thyroid carcinoma (DTC) is the most common pediatric thyroid malignancy, with papillary thyroid carcinoma (PTC) representing 90% of the cases. In 2015, the American Thyroid Association (ATA) developed management guidelines for pediatric DTC. Patients less than 21years of age diagnosed with DTC between 2000 and 2015 at Texas Children's Hospital, Seattle Children's Hospital, Children's Healthcare of Atlanta, Children's Hospital Colorado, and Nationwide Children's Hospital were retrospectively analyzed to evaluate treatment practices before the implementation of the ATA guidelines. We included 216 pediatric patients with DTC. A majority were female (76%) with a median age at diagnosis of 14.8years. Neck swelling (56%) and palpable nodules (49%) were common presenting symptoms. Diagnostic evaluations typically included thyroid ultrasound, with common features being microcalcifications (47.7%) and hypoechogenicity (39.0%). Fine-needle aspiration cytology confirmed diagnosis in 50.5%. The majority of patients underwent total thyroidectomy (78.7%) and lymph node dissection (75.5%). ATA risk stratification was low, intermediate, and high risk in 111 (51.4%), 29 (13.4%), and 76 patients (35.2%), respectively. Upfront radioactive iodine (RAI) was administered in 83%. At 1-year follow-up, 46% were disease-free (66% low risk, 59% intermediate risk, and 13% high risk). The 5-year progression-free survival for low, intermediate, and high risk were 86%, 53%, and 43%, respectively. The disease-related overall survival was 100%. Prior to the introduction of the ATA guidelines, a majority of patients underwent total thyroidectomy with lymph node dissection followed by RAI. Selective use of RAI for low-risk disease as recommended in the current guidelines may be appropriate.

Incidence of seroma and postoperative complications after breast surgery before and during the Covid-19 pandemic: results from a retrospective multicenter analysis

BackgroundIn recent years, there has been a growing number of case reports documenting delayed seroma in patients with a history of breast surgery and reconstruction. The occurrence of these seromas has been associated with prior SARS-CoV-2 infection or SARS-CoV-2 vaccination. So far, there are few systematic analyses on postoperative complications in breast surgery since the emergence of the SARS-CoV-2 pandemic.Study designWe conducted a multicenter retrospective analysis to assess the incidence of postoperative complications in two major university breast care centers in Germany during the SARS-CoV-2 pandemic (August 1st, 2021, to January 31st, 2022) compared to a reference period (August 1st, 2019, to January 31st, 2020) before the pandemic.ResultsA total of 987 patients were included in this retrospective analysis, with 492 patients during the SARS-CoV-2 pandemic and 495 patients in the reference period. There was no significant difference in the incidence rate of seroma after breast surgery. However, complications such as erythema, wound infection, and wound healing disorders were notably more frequent during the SARS-CoV-2 pandemic. Multivariate analysis revealed that increasing patient age, smoking, breast implant reconstruction, axillary lymph node dissection, and previous radiation were significant clinical risk factors for seroma development.ConclusionWhile our findings did not indicate an elevated incidence of seroma during the SARS-CoV-2 pandemic, we observed increased rates of erythema, wound healing disorders, and wound infection. Additional real-world evidence is needed for understanding both early and late complications following breast surgery in the context of the ongoing SARS-CoV-2 endemic.

The Rare Entity of Basaloid Thymic Carcinoma: A Multicentric Retrospective Analysis from the Italian Collaborative Group for ThYmic MalignanciEs (TYME).

thymic basaloid carcinoma (BTC) is an extremely rare tumor, and very little data are available on BTC's biology, clinical behavior, drug sensitivity, and patient outcomes. We performed a retrospective observational study on patients diagnosed with BTC in 11 referral centers of TYME. All BTC diagnoses were reviewed by the referring pathologist. Twenty-eight patients were identified. A total of 22/28 patients were included. Eighteen patients had TNM stage I-III disease, and all underwent surgery; three patients received preoperative chemotherapy, and 10 patients received adjuvant radiotherapy. With a median follow-up of 46 (1-133) months, median overall survival (mOS) and median relapse-free survival were not reached. At 48 months, OS was 77% (95%CI 43-92), and DFS was 63% (95%CI 30-83). The median OS of the 4 patients diagnosed with metastatic disease was 7 months. Six patients received first-line systemic treatment for metastatic disease, and all showed tumor responses. Anti-tumor activity was also observed with an anti-VEGFR TKI and a multi-TKI inhibitor combined with an anti-PD1 antibody. Next-generation sequencing performed in three tumor samples did not identify actionable alterations or microsatellite instability. BTC is an extremely rare tumor that usually presents as a localized disease. Patients diagnosed with stage I-III disease can achieve long-term DFS, and efforts should be made to perform radical surgical resection combined with perioperative treatment whenever appropriate. Patients with advanced disease progression have a poor prognosis despite a high response rate to systemic treatments.

Evaluation of the Toxicity and Outcomes of the Combination of Midostaurin and CLAG-M in Patients With FLT3-Mutated Acute Myeloid Leukemia (AML): A Multicenter Retrospective Analysis.

Addition of midostaurin to standard "7+3" (cytarabine and anthracycline) significantly prolongs overall and event-free survival. At University of Washington/Fred Hutchinson Cancer Center (UW/FHCC), the standard regimen for newly diagnosed (ND) and relapsed/refractory (R/R) AML is cladribine, high-dose cytarabine, GCSF, and mitoxantrone (CLAG-M); midostaurin is added if FLT3-mutated. There is limited data on the use of FLT3-inhibitors with high-dose cytarabine regimens in AML. This study aimed to evaluate the safety and efficacy of the combination of midostaurin with CLAG-M versus midostaurin plus 7+3 in FLT3-mutated AML patients. This is a retrospective, multicenter review including FLT3-mutated AML patients undergoing (re)induction chemotherapy with either CLAG-M or 7+3 at UW/FHCC, Oregon Health & Science University, and Swedish Cancer Institute. The primary outcome was incidence of adverse events. Secondary outcomes included disease response per ELN2017 criteria and 28-day mortality. Excluded were patients on clinical trials or who started midostaurin 30 days after chemotherapy. Eighty patients treated from September 2016 to December 2023 were included; 36 patients received CLAG-M, and 44 patients 7+3. Baseline characteristics were similar across all institutions. Adverse event rates were similar between the 2 cohorts, except diarrhea and bleeding which were more common in the 7+3 cohort. The rate of complete remission (CR) plus CR with incomplete blood count recovery did not significantly differ between the 2 cohorts: CLAG-M, 86% versus 7+3, 70% (P = 0.11). The toxicity profile of CLAG-M combined with midostaurin is comparable with the combination of 7+3 with midostaurin, and induces high remissions rates in adults with FLT3-mutated AML.

Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Complications After Axillary Lymph Node Dissection in Breast Cancer Patients: A Multicenter Retrospective Analysis.

Background and Objectives: Although breast surgery has undergone a drastic de-escalation in recent decades, axillary dissection is still indicated in some selected cases. Unfortunately, in 3-85% of cases, complications such as seroma formation occur, highlighting the need for more accurate hemostasis systems. The aim of this study is to evaluate the effectiveness of absorbable polysaccharide hemostatic such as HaemocerTM in preventing postoperative seroma. Materials and Methods: Patients referred to two surgery centers for a diagnosed breast cancer and candidates for axillary lymph node dissection were retrospectively evaluated and included in Group A (treated with HaemocerTM) and B (control group). The primary endpoints were the drain output after 48 h, the daily amount just before the removal, and the duration of axillary drainage placement. Secondary endpoints included the presence of seroma at the ultrasound (US) follow-up, significant blood loss, hematoma, the duration of surgery, and postsurgical complications. Results: The drain output within 48 h was 196 ± 93 vs. 286 ± 38 mL in Groups A and B, respectively (p = 0.013). The daily output before the removal was 40 ± 7 mL in Group A and 47 ± 2 mL in Group B (p = 0.049). The duration of axillary drainage placement was shorter in the experimental group (7 ± 3 days) compared to the control group (10 ± 1 days) with a statistically significant difference (0.037). During the US follow-up, on days 7, 15, and 30, the number of patients affected by seroma and the volumes were lower in the experimental group. Conclusions: The adsorbable hemostatic powder proved to be effective both in reducing the volume of drained fluid postoperatively and in decreasing the number and volume of reported seromas during the US follow-up.

Is mesh related morbidity the real thread in ventral rectopexy? Results of a retrospective international multicentre comparative analysis of biologic versus synthetic mesh.

Ventral mesh rectopexy (VMR) is an established surgical treatment for rectal prolapse and outlet obstruction. In contrast to continental Europe, in the UK and US the use of synthetic mesh has been abandoned in favour of biologic mesh, due to concerns regarding mesh related morbidity. The current study investigated if either material is superior, in terms of clinical recurrence and mesh related complications. VMRs performed between March 2012 and July 2022 in three international pelvic floor centres were prospectively collected and retrospectively analysed, to look at the rate of complications and need for further therapy, including reoperation. A total of 360 patients were included in the study (140 biologic mesh (bm) / 220 synthetic mesh (sm)). Postoperative complication occurred in 5.7% in bmVMR (5% minor [Clavien-Dindo I and II] and 0.7% major [Clavien-Dindo > = III]) and in 10.9% in smVMR (9.1% minor and 1.8% major) (p = 0.28). Oral laxatives were necessary in 31% after bmVMR and in 35% after smVMR (p = 0.49). Rectal laxatives were used in 11% after bmVMR and in 7% after smVMR (p = 0.34). Clinical recurrence appeared in 9% bmVMR and in 5% smVMR (p = 0.20). Mean time to clinical recurrence in bmVMR was 20.9 (5 to 58) months and in smVMR 20.2 (0-55) months (p = 0.75). Mean overall follow-up time was 18.4 (0-96) months. Reoperation rate due to clinical recurrence was 6.11% in the bmVMR group versus 2.75% in the smVMR group (p = 0.16). No mesh associated complications such as symptomatic erosion or fistulation occurred in either group. VMR using biologic mesh was equally safe to that using synthetic mesh, with no difference in clinical recurrence rate. No mesh-associated morbidity was observed in either group.

Sacubitril/Valsartan for Blood Pressure Lowering in Non-Dialysis-Dependent Chronic Kidney Disease Stage 3-5 Patients With Hypertension: A Multicenter Clinical Study.

To assess the effectiveness and safety of Sacubitril/Valsartan in reducing blood pressure in individuals with non-dialysis-dependent chronic kidney disease (NDD-CKD) Stage 3-5 complicated by hypertension. This study was a multicenter retrospective analysis conducted from March 1, 2022 to March 31, 2024, involving adult patients with NDD-CKD Stage 3-5 and hypertension, who received Sacubitril/Valsartan either as a monotherapy or in addition to current antihypertensive treatments that were insufficient. The main outcomes measured were blood pressure control, changes in blood pressure and laboratory parameters within 8 weeks post-treatment initiation, and incidence of adverse events. The study included a total of 459 individuals with NDD-CKD Stage 3-5 and hypertension. At the study endpoint, mean systolic blood pressure, diastolic blood pressure, and pulse pressure were markedly reduced compared to baseline (all p < 0.001). The average blood pressure reductions were 12.17 (4.66, 22.00), 6.00 (0.67, 12.66), and 6.67 (0.08, 14.00) mmHg, respectively. Throughout the study period, 96 patients (20.92%) with NDD-CKD Stage 3-5 developed worsening renal function, 15 patients (3.27%) developed hyperkalemia, and 49 patients (10.68%) experienced symptomatic hypotension. Overall, there were no significant differences in the changes in serum creatinine, estimated glomerular filtration rate, and serum potassium before and after treatment (p = 0.28, p = 0.91, p = 0.61, respectively). Sacubitril/Valsartan significantly lowers blood pressure in patients with NDD-CKD Stage 3-5 complicated by hypertension, with good safety profiles. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2400086079.

European multicentre analysis of the implementation of robotic complete mesocolic excision for right-sided colon tumours.

Complete mesocolic excision (CME) is an oncologically driven technique for treating right colon cancer. While laparoscopic CME is technically demanding and has been associated with more complications, the robotic approach might reduce morbidity. The aim of this study was to assess the safety of stepwise implementation of robotic CME. A multicentre retrospective analysis of prospectively collected data on robotic right colectomy was performed at five European tertiary centres. Patients were classified for type of surgery: R-RHC (standard right colectomy), R-impCME (learning cases towards robotic CME defined as R-RHC with one but not all the hallmarks of CME) or R-CME (robotic CME). Primary outcomes were overall and severe 30-day complication rates before and after propensity score matching (PSM) analysis. Five hundred and fifty-one consecutive patients undergoing robotic surgery for (pre)malignant lesions of the right colon between 2010 and 2020 were included: R-RHC (n = 101), R-impCME (n = 135) and R-CME (n = 315). Baseline characteristics differed for American Society of Anesthesiologists score (p = 0.0012) and preoperative diagnosis of adenocarcinoma (p < 0.001). Procedure time increased by surgical complexity (p < 0.001). Vascular event rates did not differ, with no superior mesenteric vein injuries. Conversion, complication and anastomotic leak rates, time to flatus/soft diet and length of stay (LOS) did not differ. While R-RHC was performed for a lower rate of malignancies (p < 0.001), lymph node yield was significantly higher in R-CME (p < 0.001). After PSM, analyses on 186 patients documented no differences in overall and severe 30-day complication rate, conversion rate, LOS or 30-day mortality. R-CME can be implemented without increasing the overall or 30-day severe complication rate.

Endovascular Treatment of Infected Aortic Aneurysms: A Retrospective Multicenter Analysis from the GORE®GREAT Registry Study

Objective: The Global Registry for Endovascular Aortic Treatment (GREAT), which is a retrospective sponsored registry (W.L Gore &amp; Associates; Flagstaff – AZ; USA), was queried to evaluate the outcomes of infected aortic aneurysms (inf-AAs) after abdominal (EVAR) or thoracic endovascular aortic repair (TEVAR). Methods: This is a multicenter, observational cohort study. For the current study, all patients were treated only with the standard GORE® devices for INFAA. Primary graft infections, aorto-enteric fistulae, and graft-enteric fistulae were excluded, as well as cases that did not meet the predefined criteria of an inf-AA. All serious adverse events within 30 days of the procedure were documented by sites. Primary outcomes were early (≤ 30 days) and late survival, and freedom from endograft infection. Results: Thirty-one (0.6% of the entire GREAT cohort) patients met the inclusion criteria and were included: 23 (74.2%) were males and 8 (25.8%) females. The mean age was 72 years ± 11 (range, 49-92). This included 26 (83.9%) abdominal inf-AAs and 5 (16.1%) thoracic inf-AAs. Operative-related mortality occurred in 1 (3.2%) patient. Immediate conversion to open surgical repair was not required. Mean follow-up was 23.6 ± 15 months (range, 1-49): estimated survival rate was 80% (95%CI, 60.8-90.5) at 12 months, and 53.2% (95%CI, 30.0-71.1) at 48 months. Secondary aortic rupture as well as endograft explanation was also not reported. Conclusion: Endovascular treatment of inf-AA is feasible and effective. While endograft infection was not detected during the follow-up, long-term results from GREAT registry may reveal how durable T/EVAR could be for inf-AAs.

Discordance Between Spine-Hip and Paretic-Nonparetic Hip Bone Mineral Density in Hemiplegic Stroke Patients: A Multicenter Retrospective Study

Objective: To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.Methods: This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.Results: The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p&lt;0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%–0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931–1.003, p&lt;0.05).Conclusion: Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.