Nonsurgical Patients Research Articles

In-hospital management of non-surgical patients treated with gliflozins

In-hospital management of non-surgical patients treated with gliflozins

NCOG-12. TREATMENT AND MORTALITY OF PRIMARY BRAIN TUMORS: A SINGLE CENTER OBSERVATIONAL STUDY OF GLIOBLASTOMAS AND ASTROCYTOMAS

Abstract Glioblastoma multiforme (GBM) is a WHO grade IV malignant tumor with a relatively poor prognosis (median survival of 15 months). Astrocytomas are WHO grade I-III tumors with a better prognosis than GBM; their median survival ranging from 2-10 years. We assessed the response to various mainstay treatment modalities in patients with GBM and astrocytoma, expecting to find that surgery and stereotactic radiation (SRS) treatment confer greater survival benefits than non-surgical and whole brain radiation (WBRT) options. We analyzed 108 patients at St. Luke’s University Health Network (SLUHN) who were previously diagnosed with a primary brain tumor consistent with GBM (90) or astrocytoma (18) prior to January 1, 2023. Mainstays of treatment were surgery with or without different radiation modalities (WBRT and SRS, and WBRT+SRS). Glioblastoma typically affected older patients (65.5), had mostly single lobe involvement (86.7%), and was predominantly located in the frontal (41.1%) and temporal lobes (37.7%). Astrocytoma was slightly younger (51.2), less often single lobe (72.2%), and mostly involved the frontal (44.4%), temporal (44.4%), and parietal lobes (33.3%). GBM found the greatest benefit from WBRT (without co-occurring SRS) with an increase of 16.4 months to 20.2 months (p=.789). Surgery, regardless of radiation status, appeared to provide the greatest benefit for patients with astrocytoma increasing average lifespan from 36.7 months to 53.6 months (p=.181). Patients with glioblastoma that underwent surgery also had increased survival of 18.2 months compared with nonsurgical patients at 12 months (p=0.097). While we were interested to see the impact these treatment modalities had on patient survival, our sample size was small and our results lacked statistical significance. Future studies with greater sample sizes would help determine whether statistical significance is correlated with meaningful clinical outcomes.

Functional outcomes and healthcare utilization trends in postsurgical and nonsurgical patients following high-frequency (10 kHz) spinal cord stimulation therapy

IntroductionChronic low back pain (CLBP) is the leading cause of disability in the United States and is associated with a steadily increasing burden of healthcare expenditures. Given this trend, it is essential to evaluate interventions aimed at reducing disability and optimizing healthcare utilization (HCU) in affected populations. This study investigates the impact of prior spinal surgery on functional outcomes and HCU patterns following high-frequency (10 kHz) spinal cord stimulation (SCS) therapy.MethodsThis retrospective observational study included 160 subjects who underwent implantation of a 10 kHz SCS device. Participants were divided into surgical and non-surgical cohorts for comparative analysis. Pain relief was assessed using the Numeric Rating Scale (NRS), while disability levels were evaluated using the Oswestry Disability Index (ODI). HCU was examined through the frequency of emergency department (ED) visits, outpatient visits for interventional pain procedures, and opioid consumption measured in morphine milliequivalents (MME).ResultsNo statistically significant differences were observed between the surgical and non-surgical groups regarding pain relief and disability outcomes. Additionally, ED visits and outpatient visits for interventional pain procedures did not show significant differences between the two cohorts.DiscussionThis study represents the first comparative analysis of pain, disability, and HCU trends between surgical and non-surgical populations following 10 kHz SCS therapy. The results suggest that prior spinal surgery may not substantially affect the efficacy of 10 kHz SCS therapy in terms of pain relief, disability reduction, or HCU patterns.

Subthalamic nucleus deep brain stimulation modulates speech graphs in patients with Parkinson’s disease

Graph theory enables a direct quantification of topological properties of any arbitrary network. Its application in neuroscience has unveiled topological changes of brain networks associated with various neurodegenerative diseases. This study used the graph theory to understand speech deficits in patients with Parkinson’s disease (PD). In particular, this study investigated the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the topology of speech graphs. Sixty patients with PD completed a standard semantic fluency test with DBS switched ON and OFF. A control group of sixty matched nonsurgical PD patients completed the test once. All verbal responses were recorded, transcripted, and transformed into directed speech graphs. Volumes of tissue activated (VTA) were estimated for three STN subregions, including sensorimotor, associative, and limbic parts. First, the patients with DBS OFF produced smaller and denser speech graphs than nonsurgical patients, showing fewer nodes, higher density, shorter diameter, and shorter average shortest path. Second, DBS partially reversed the effect of surgery, leading to larger and sparser speech graphs with more nodes, lower density, longer diameter, and longer average shortest path (ON versus OFF). Third, however, the left associative VTA negatively correlated with the DBS-induced diameter and average shortest path changes (ON versus OFF), suggesting that the patients with greater left associative STN stimulation tended to produce smaller and denser speech graphs. This study demonstrates that STN-DBS can partially restore the topological structure of speech graphs in PD patients. However, stimulating the left associative STN appears to disrupt speech graphs.

Value of Radiomics Features Extracted from Baseline CT Images in Predicting Overall Survival in Patients with Non-Surgical Pancreatic Ductal Adenocarcinoma: Incorporation of a Radiomics Score to a Multi-Parametric Nomogram to Predict One-Year Overall Survival

PurposeTo determine the value of radiomics features derived from baseline CT scans and volumetric measurements to predict overall survival in patients with non-surgical pancreatic ductal adenocarcinoma (PDAC) treated with FOLFIRINOX. MethodsIn this retrospective single-institution study, 131 patients with non-surgical PDAC who received FOLFIRINOX neoadjuvant chemotherapy between December 2012 and November 2021 were included. Pretreatment contrast-enhanced CT imaging was obtained for all patients prior to inclusion. The primary tumor was contoured by an expert radiologist with 25 years of experience. A total of 845 radiomics features, including first, second, and higher-order features, were extracted from the total tumor volume. A feature reduction pipeline was used to reduce the dimensionality of the data. The selected features were used to generate a radiomics score based on LASSO coefficients. A high-dimensional Cox model was generated based on the radiomics score and other quantitative and semantic imaging findings. ResultsFrom the 845 radiomics features extracted, 45 were significantly different between the tertiles. The following equation was used to generate a radiomics score: = SmallAreaEmphasis⁎-66.87801+LargeDependenceEmphasis ⁎-0.2345916. The radiomics score was significantly different between the three groups of the radiomics features (P = 0.034). The overall difference in survival was significant between the three groups (p = 0.02). The nomogram showed good calibration and showed significant differences among the patients when they were classified as tertiles (P <0.00). ConclusionRadiomics approaches have the potential to predict overall survival in non-surgical patients with pancreatic ductal adenocarcinoma, and the inclusion of semantic imaging findings and pathological data could further enhance prognostication in patients with PDAC.

Transitional care interventions improve quality of life in both surgical and non-surgical lung cancer patients: Insights from asubgroup analysis.

Transitional care interventions improve quality of life in both surgical and non-surgical lung cancer patients: Insights from asubgroup analysis.

An Overview of Reviews on Predictors of Neurorehabilitation in Surgical or Non-Surgical Patients with Brain Tumours

(1) Background. People suffering from brain cancer, regardless of histological tumour characteristics, often experience motor disturbances, cognitive–behavioural difficulty, language impairments, and functional and social limitations. The current treatment approach entails surgery and adjuvant therapy such as chemotherapy and radiotherapy combined with intensive rehabilitation. The primary focus of rehabilitation is usually motor and functional recovery, without specifically addressing the patient’s quality of life. The present systematic review identifies and evaluates the predictors of functional and cognitive rehabilitation outcomes and their influence on quality of life in adult patients with brain cancer. (2) Methods. Three electronic databases (PubMed, Elsevier, Cochrane) were searched for reviews about functional, cognitive, and quality-of-life outcomes in patients with central nervous system tumours, including articles published between January 2018 and May 2024. (3) Results. The search retrieved 399 records, 40 of which were reviewed. Five main areas of predictive factors were identified: diagnosis, therapy, complications, outcomes (in the motor, cognitive, and quality-of-life categories), and tailored rehabilitation. (4) Conclusions. These indicators may inform integrated care pathways for patients with primary central nervous system tumours.

Aspartate aminotransferase to alanine aminotransferase ratio and short-term prognosis of patients with type 2 diabetes hospitalized for heart failure

IntroductionWe aimed to explore the prognostic value of the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio in non-surgical patients with type 2 diabetes hospitalized for heart failure.Material and methodsUsing a large electronic medical record-based cohort of diabetes in China (WECODe), we gathered data on non-surgical hospitalized patients with type 2 diabetes and heart failure from 2011 to 2019. Baseline AST/ALT ratio was calculated. The primary outcomes were all-cause death within 30 days after discharge, composite cardiac events, major acute kidney injury, and major systemic infection. A multivariable Cox proportional regression model was utilized to evaluate the association between the AST/ALT ratio and outcomes.ResultsThis retrospective cohort included 8,073 patients (39.4% women) with type 2 diabetes hospitalized for heart failure. The median age was 71 years. Higher AST/ALT ratio was associated with higher risks of poor endpoints (with per standard deviation increment in AST/ALT ratio, for death within 30 days after discharge: adjusted hazard ratio [HR], 1.35, 95% confidence interval [CI], 1.21 to 1.50; for composite cardiac events: HR, 1.18, 95% CI: 1.06 to 1.31). Compared to patients in the lowest quartile for the AST/ALT ratio, those in the highest quartile have elevated risk of death within 30 days after discharge and major systemic infection (HRs [95% CIs]: 1.61 [1.18 to 2.19] and 1.28 [1.06 to 1.56], respectively). Subgroup analyses and sensitivity analyses confirmed the robustness of the findings.ConclusionsType 2 diabetes patients hospitalized for heart failure with the AST/ALT ratio in the highest quartile face a poor short-term prognosis.

Comparison of Surgical and Non-Surgical Treatments for Proximal Humerus Fractures: A Cross-Sectional Study

Background: The proximal humerus fracture (PHF) is one of the most common fractures of the upper limbs. PHF is more common in older people, usually following a fall, whereas in younger people this form of fracture is typically caused by high-energy trauma. There are several treatment options for PHFs, including surgical and non-surgical procedures. Our aim was to compare the outcomes of surgical and non-surgical treatment methods in Iranian patients with PHFs. Methods: Sixty patients with PHFs participated in this single-center cross-sectional study. Medical records were reviewed and evaluated according to demographic characteristics, underlying diseases, type of treatment, complications, need for reintervention, and Constant score. Results: The mean age of the patients was 45.65 years. Among those older than 50 years, women significantly outnumbered men (66.7%, P = 0.009). Thirty-one patients received surgical treatment, while 29 patients received non surgical care. The Constant scores of patients who underwent surgery were considerably higher than those of non-surgical patients [mean ± standard deviation (SD): 80.41 ± 1.89 versus 69.82 ± 1.82, P = 0.009]. This significant relationship was observed only in the age group of 18 to 49 years. Conclusion: Overall, the complications arising from both surgical and nonsurgical treatments were not statistically significant; however, patients under the age of 50 and men had higher Constant scores, indicating better clinical outcomes.

Peripheral immune profiling of soft tissue sarcoma: perspectives for disease monitoring.

Studying the tumor microenvironment and surrounding lymph nodes is the main focus of current immunological research on soft tissue sarcomas (STS). However, due to the restricted opportunity to examine tumor samples, alternative approaches are required to evaluate immune responses in non-surgical patients. Therefore, the purpose of this study was to evaluate the peripheral immune profile of STS patients, characterize patients accordingly and explore the impact of peripheral immunotypes on patient survival. Blood samples were collected from 55 STS patients and age-matched healthy donors (HD) controls. Deep immunophenotyping and gene expression analysis of whole blood was analyzed using multiparametric flow cytometry and real-time RT-qPCR, respectively. Using xMAP technology, proteomic analysis was also carried out on plasma samples. Unsupervised clustering analysis was used to classify patients based on their immune profiles to further analyze the impact of peripheral immunotypes on patient survival. Significant differences were found between STS patients and HD controls. It was found a contraction of B cells and CD4 T cells compartment, along with decreased expression levels of ICOSLG and CD40LG; a major contribution of suppressor factors, as increased frequency of M-MDSC and memory Tregs, increased expression levels of ARG1, and increased plasma levels of IL-10, soluble VISTA and soluble TIMD-4; and a compromised cytotoxic potential associated with NK and CD8 T cells, namely decreased frequency of CD56dim NK cells, and decreased levels of PRF1, GZMB, and KLRK1. In addition, the patients were classified into three peripheral immunotype groups: "immune-high," "immune-intermediate," and "immune-low." Furthermore, it was found a correlation between these immunotypes and patient survival. Patients classified as "immune-high" exhibited higher levels of immune-related factors linked to cytotoxic/effector activity and longer survival times, whereas patients classified as "immune-low" displayed higher levels of immune factors associated with immunosuppression and shorter survival times. In conclusion, it can be suggested that STS patients have a compromised systemic immunity, and the correlation between immunotypes and survival emphasizes the importance of studying peripheral blood samples in STS. Assessing the peripheral immune response holds promise as a useful method for monitoring and forecasting outcomes in STS.

Real-world usage pattern, effectiveness and safety of oral tramadol/dexketoprofen trometamol fixed-dose combination in moderate-to-severe acute pain in Asia: a prospective, multicentre, observational study

ObjectivesThis study aims to determine the usage pattern, effectiveness and safety of oral tramadol 75 mg and dexketoprofen trometamol 25 mg fixed-dose combination (TRAM/DKP FDC) in the short-term treatment of...

Primary Prevention of Cancer-Associated Thrombosis: Current Perspectives.

Over the past two decades, the incidence of cancer-associated thrombosis (CAT) has increased. It is nowadays a common and often serious complication among patients with cancer. Although medical thromboprophylaxis is recommended for most surgical and nonsurgical cancer patients, it has been infrequently used in ambulatory patients with cancer because of the burden of treatment and concerns about bleeding. However, various risk assessment scores are now available and randomized placebo-controlled trials have established the efficacy of low-molecular-weight heparin or the direct oral Xa inhibitors rivaroxaban and apixaban in ambulatory patients with cancer at high risk of venous thromboembolism (VTE). This review provides an overview of (1) primary thromboprophylaxis in the setting of hospitalized surgical and medical patients, (2) extended thromboprophylaxis after hospital discharge, (3) performance of risk assessment tools for CAT, and (4) primary thromboprophylaxis in ambulatory patients with cancer. The aim is to provide support to physicians in identifying ambulatory patients with cancer at high VTE risk who benefit most from medical thromboprophylaxis according to current recommendations from international guidelines.

18F]FDG PET for mapping the cerebral glucose metabolic characteristics of drug-sensitive and drug-resistant epilepsy in pediatric patients.

This study aimed to investigate [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG PET) mapping for cerebral glucose metabolism in drug-sensitive and drug-resistant pediatric epilepsy patients. This retrospective study enrolled 40 patients and 25 controls. Patients were categorized into drug-sensitive epilepsy (n = 22) and drug-resistant epilepsy (n = 18) according to the seizure frequency at follow-up. All patients underwent two [18F]FDG PET scans separated by a minimum of one year. Absolute asymmetry index (|AI|) was calculated for assessing metabolic differences and changes in epileptic foci. Statistical Parametric Mapping (SPM) was utilized to reveal voxel-wise metabolic characteristics and alterations throughout the brain. Network analysis based on graph theory was used to investigate network-level differences between the two patient groups. The drug-sensitive group showed a lower |AI| at both baseline (P = 0.038) and follow-up (P = 0.003) PET scans than the drug-resistant group. |AI| decreased in the drug-sensitive group and increased in the drug-resistant group across scans, but these trends were not statistically significant (P = 0.240 and P = 0.450, respectively). Both groups exhibited hypometabolism at baseline. The drug-sensitive group showed less hypometabolic brain regions than the drug-resistant group. The drug-sensitive maintained stable level of hypometabolism between the two scans, whereas the drug-resistant group showed an increasing hypometabolism. Network analysis demonstrated that the drug-sensitive group had a higher global efficiency, average degree, and clustering, along with a shorter characteristic path length compared to the drug-resistant group. For the first time, this study revealed in vivo cerebral glucose metabolic pattern of nonsurgical pediatric epilepsy patients treated by antiepileptic drugs. Especially, drug-resistant epilepsy patients represented significantly extensive and progressive hypometabolism with inefficient brain network connectivity compared with drug-sensitive epilepsy. [18F]FDG PET imaging may be a potential visual approach for theranostics of epilepsy patients.

Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon

The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03–1.23), 1.47 (95% CI 1.07–2.03), 1.96 (95% CI 1.40–2.74), 1.05 (95% CI 1.03–1.08) for each unit increase, and 1.62 (95% CI 1.16–2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29–3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14–1.43) for each 10-year increase, 1.64 (95% CI 1.07–2.52), 2.35 (95% CI 1.14–4.83), 1.88 (95% CI 1.03–3.44), 6.73 (95% CI 4.08–11.09), 2.31 (95% CI 1.52–3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31–180 days after ICU discharge were 3.13 (95% CI 1.84–5.31) and 1.69 (95% CI 0.99–2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.

Inequalities in colon cancer treatment in Uruguay: Does age have a say?

125 Background: Colorectal cancer (CRC) is the second most diagnosed cancer in men and women in Uruguay. Survival from CRC is known to be worse in those aged 65 years and older, despite more than 70% of cases occurring in this age group. It has been said that elderly cancer patients are often under-treated compared to younger ones, and that this unequal access to treatment in practice, despite universal access in theory, accounts for at least some of the reported survival difference. A better understanding of age-related inequalities in treatment would help to inform interventions to improve cancer control, therefore a retrospective study was undertaken to investigate if there are age-related inequalities in CRC care in Uruguay. Methods: Data on age, sex, tumor site and stage and treatments received (cancer-directed surgery and chemotherapy) were obtained for 1372 patients diagnosed with CRC. Likelihood of receipt of 1) cancer-directed surgery, 2) chemotherapy in surgical patients, 3) chemotherapy in non-surgical patients by age, adjusting for sex, cancer stage, was examined. Results: More than two-thirds (67%) of our population were aged 60 years or older at diagnosis and a slightly higher proportion were men (53%). Seventy six percent received cancer directed surgery, either in a curative or palliative intent. When analyzing patients with stage I-III cancers, 81% of patients received curative intent surgery. Those in the oldest age group (80+ years) were significantly less likely to be operated than those in the &lt;60 years age group (p 0.002) specially if the tumor was in the sub peritoneal rectum. In relation to receipt of chemotherapy in surgical patients, similar age patterns were observed, although in a much more extreme manner (p &lt;0.001). Increasing age was also strongly associated with reduced likelihood of receiving systemic therapy, with a higher percentage of patients &lt;60 years old receiving at least palliative chemotherapy in comparison to the 80+ year age group (p &lt;0,001). No differences in relation to gender or tumour location were observed. Conclusions: Age remains a major factor in treatment decisions. Research is needed both to identify the most effective treatment for colon cancer in older populations and to understand clinicians’ decision-making processes to ensure equitable access.

Factors influencing hematoma expansion in delayed brain CT scans of patients with traumatic Epidural Hematoma.

Epidural hematoma (EDH) is a type of intracranial hematoma commonly observed in trauma patients. This research aims to evaluate the factors contributing to the expansion of traumatic epidural hematoma (EDH). This retrospective cohort study examined traumatic patients with EDH admitted to Taleqani Hospital, a prominent Western Trauma Center in Iran, from 2018 to 2023. Patients underwent an initial CT scan, and non-surgical patients received a delayed CT scan approximately 5 hours after the initial scan. Data analysis was performed using SPSS version 25 software. The study included 274 brain trauma patients with epidural hematoma. Among these patients, 142 (51.8%) did not undergo surgery, and 121 (85.2%) of the non-surgical patients were male. Motor vehicle accidents (MVAs) were the primary cause of EDH in 127 (46.4%) patients. The mean (±standard deviation) initial hematoma size was 8.86 (±9.71), and the mean (±standard deviation) delayed CT scan size was 8.12 (±8.10). In crude linear regression Two variables, namely Hematoma volume in the initial CT scan (P less than 0.001) and Mixed Density (P=0.007), were found to significantly impact the increase in hematoma size in delayed CT scans of non-surgical patients. But in the adjusted linear regression model, only the Hematoma volume in primary CT scan, was significant (P less 0.001). The R Square values were 0.72. The identification of key variables influencing hematoma volume in delayed CT scans has the potential to guide more effective interventions, thereby improving patient outcomes and reducing trauma-related mortality.

Segmental range-of-motion by vertebral level in fused and unfused patients with adolescent idiopathic scoliosis: a systematic review of the literature.

This study aims to understand global and segmental spinal ROM in surgical and nonsurgical AIS patients. This systematic review examined segmental vertebral ROM in AIS patients using PubMed, SPORTDiscus, MEDLINE, and Web of Science until October 8th, 2023. Inclusion criteria were articles on segmental motion in AIS patients, both operative and non-operative, under 18years old. Seventeen articles met eligibility criteria from 2511 initially retrieved. All patients (n = 996) had AIS (549 non-operative; 447 were operative), with a frequency-weighted mean age of 15.1 ± 1.6years and a baseline Cobb angle of 51.4 ± 13.3 degrees. Studies showed heterogenous segmental flexibility in the unfused spine, with the apical curve and upper thoracic segments being more rigid and lower segments more flexible at -5 disk segments from the apex. Most studies showed a predictable loss of motion in fused spinal regions postoperatively and a variable loss of global motion depending on the LIV and number of fused segments. A 7° global loss of total trunk flexion per level was observed with increasingly caudal LIV, starting at L1. Anterior vertebral body tethering (AVBT) preserved motion post-surgery but reduced coronal plane motion. AVBT saw less motion loss compared to posterior spinal fusion (PSF) but had higher revision and complication rates. Preservation of spinal segments correlated with improved motion postoperatively. Increasing caudal LIV in PSF showed sagittal flexion loss. AVBT preserved more sagittal ROM than PSF but increased coronal motion loss, complications, and revision rates, with the largest benefit at LIV L4. Data on segmental motion are limited and further research on postoperative segmental ROM is required.

Maternal, Fetal and Infant outcomes Associated with Bariatric Surgery

Objective: The purpose of this study was to determine the association between bariatric surgery and maternal, fetal and infant outcomes. Summary Background Data: Obesity during pregnancy is a risk factor for adverse pregnancy outcomes. Bariatric surgery is the most effective weight loss treatment but the impact of bariatric surgery on pregnancy outcomes remains poorly characterised. Methods: This was a population-based, matched cohort study of prospective databases in Ontario, Canada. Patients with obesity who received bariatric surgery from 2010 to 2016 and subsequently became pregnant matched on multiple factors to non-surgical pregnant patients with obesity. The primary outcomes of interest were the incidence included of gestational diabetes, preeclampsia/HELLP syndrome, small for gestational age (SGA), large for gestational age (LGA), and a composite of severe fetal/infant morbidity/mortality. Multivariable regression evaluated outcomes. Results: 680 patients who underwent bariatric surgery and later became pregnant were matched to 2002 pregnant patients with obesity. Gestational diabetes occurred in 8.7% of the surgery group and 18.8% of the non-surgical group (adjusted OR (aOR) 0.29, 95%CI 0.21-0.40, P&lt;0.001). A lower incidence of preeclampsia/HELLP was observed post-surgery (aOR 0.20, 95%CI 0.13-0.31, P&lt;0.001). Bariatric surgery impacted SGA (aOR 2.74, 95%CI 2.04–3.70, P&lt;0.001) and LGA (aOR 0.25, 95%CI 0.18-0.36, P&lt;0.001). There were no observed associations between bariatric surgery and any adverse fetal or infant outcomes. A lower composite severe fetal/infant morbidity/mortality was observed post-surgery (aOR 0.73, 95%CI 0.54-0.97, P&lt;0.05). Conclusions: Pregnancy after bariatric surgery appears safe and was associated with a reduced risk of several obesity related adverse pregnancy outcomes.

Sonographic Characteristics of ≥7 mm Gallbladder Polyps: A Retrospective Analysis.

To describe the sonographic characteristics of gallbladder polyps measuring ≥7 mm focusing on echogenicity, correlate with surgical pathology when available, and assess stability in size over time. This retrospective study used a natural language processing application to screen ultrasound (US) reports between January 1, 2012, and December 31, 2020, that contained the words "gallbladder polyp" or "polyps." Reports were reviewed to identify polyps ≥7 mm. The most hyperechoic components of the polyps were compared to the adjacent inner wall of the gallbladder and categorized as more echogenic, isoechoic, and less echogenic. Other sonographic characteristics such as heterogeneity, sessile configuration, vascularity, multiplicity, presence of gallstones, and wall thickening were recorded. Surgical pathology reports were reviewed when available. Polyps in nonsurgical patients with ≥48-month US follow-up and ≤1 mm/year growth rate were characterized as benign. Clinical outcomes were followed until December 31, 2023. Review of 4897 reports yielded 550 reports in 450 patients with polyps ≥7 mm. Surgical pathology reports were available in 22.0% (99/450) of patients; 96 (97%) had non-neoplastic etiologies and 3 (3.0%) neoplastic. There were no malignancies. All of the neoplastic polyps and 56.1% (87/155) of non-neoplastic polyps had components more echogenic than the adjacent inner wall. There were no deaths related to the polyps. The vast majority of gallbladder polyps are benign. In our large series of gallbladder polyps, we found that increased echogenicity is a nonspecific feature, found in slightly more than half of benign but also in all neoplastic polyps. Our findings support current Society of Radiologists in Ultrasound consensus guidelines.

In Vivo Quantification of Ascending Thoracic Aortic Aneurysm Wall Stretch Using MRI: Relationship to Repair Threshold Diameter and Ex Vivo Wall Failure Behavior.

Ascending thoracic aortic aneurysms (aTAAs) can lead to life-threatening dissection and rupture. Recent studies have highlighted aTAA mechanical properties as relevant factors associated with progression. The aim of this study was to quantify in vivo aortic wall stretch in healthy participants and aTAA patients using displacement encoding with stimulated echoes (DENSE) magnetic resonance imaging. Moreover, aTAA wall stretch between surgical and nonsurgical patients was investigated. Finally, DENSE measurements were compared to reference-standard mechanical testing on aTAA specimens from surgical repairs. In total, 18 subjects were recruited, six healthy participants and 12 aTAA patients, for this prospective study. Electrocardiogram-gated DENSE imaging was performed to measure systole-diastole wall stretch, as well as the ratio of aTAA stretch to unaffected descending thoracic aorta stretch. Free-breathing and breath-hold DENSE protocols were used. Uniaxial tensile testing-measured indices were correlated to DENSE measurements in five harvested specimens. in vivo aortic wall stretch was significantly lower in aTAA compared to healthy subjects (1.75±1.44% versus 5.28±1.92%, respectively, P = 0.0004). There was no correlation between stretch and maximum aTAA diameter (P = 0.56). The ratio of aTAA to unaffected thoracic aorta wall stretch was significantly lower in surgical candidates compared to nonsurgical candidates (0.993±0.011 versus 1.017±0.016, respectively, P = 0.0442). Finally, in vivo aTAA wall stretch correlated to wall failure stress and peak modulus of the intima (P = 0.017 and P = 0.034, respectively), while the stretch ratio correlated to whole-wall thickness failure stretch and stress (P = 0.013 and P = 0.040, respectively). Aortic DENSE has the potential to assess differences in aTAA mechanical properties and progressions.