Patient Demographics Research Articles

Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review.

Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up. We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions. Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.

Influence of proximal femoral morphology on osteointegration of the AMIS uncemented femoral stem in modern hip arthroplasty

BackgroundIndications for total hip arthroplasty (THA) have evolved over recent decades, with a growing trend toward operating on younger and more active patients. With this shift in patient demographics, there has been a change in femoral stem designs and proximal femoral morphology encountered. This study aimed to evaluate the potential correlation between femoral stem osteointegration and proximal femoral morphology using the Dorr and Noble classifications.Materials and methodsWe conducted a retrospective review of 122 uncemented femoral stems (AMIstem Medacta, triple tapered). The demographic data analyzed included sex, age, stem size, and surgical indications. Preoperative radiographs were reviewed to determine the Dorr classification as well as the canal-to-calcar isthmus ratio, cortical index, and canal flare index. Postoperative radiographs were carefully reviewed to identify the presence of potential postoperative radiolucencies. Inter- and intra-observer agreements for these parameters were also analyzed.ResultsSignificant radiolucencies (> 2 mm) were found in 19.5% of the patients. Of all the variables analyzed, the cortical index was the only parameter significantly associated with the appearance of clinically significant radiolucency, with a threshold value of 0.62.ConclusionsThe appearance of radiolucencies is multi-factorial. Nevertheless, in this study, a high cortical index (> 0.62), representing the champagne flute morphology, was found to be associated with the development of significant radiolucencies.

Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia

Coronary heart disease (CHD) remains a leading cause of mortality in Indonesia, and coronary artery bypass graft (CABG) surgery is frequently employed to manage arterial blockages. Despite its efficacy, the recurrence of heart disease post-surgery is a significant concern, highlighting the need for a deeper understanding of its influencing factors. The aim of this study was to examine the factors associated with the incidence of heart disease recurrence after coronary bypass surgery. This study employed a prospective observational design, analyzing hospital claim data from Indonesia's Social Security Agency for Health, known as Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, from 2017 to 2022. The analysis included 5,947 patients who survived CABG surgery. Multivariable logistic regression was utilized to assess the relationship between patient demographics, comorbidities, socioeconomic status, and compliance with follow-up visits, as well as their impact on the recurrence of cardiovascular disease. The study found that 24.1% of patients experienced hospitalization recurrence. Patients with irregular follow-ups were less likely to experience recurrence (adjusted odds ratio (AOR): 0.63; 95%CI: 0.51–0.78). Other significant risk factors for recurrence included being self-employed (AOR: 2.09; 95%CI: 1.72–2.55), having comorbid conditions such as disorders of fluid, electrolyte, and acid-base balance (AOR: 3.55; 95%CI: 2.97–4.24), and experiencing cerebral infarction or stroke (AOR: 10.85; 95%CI: 8.24–14.29). In contrast, older age (AOR: 0.89; 95%CI: 0.88–0.91) and the presence of non-insulin-dependent diabetes mellitus (AOR: 0.35; 95%CI: 0.29–0.42) were associated with a lower risk of recurrence. Sex did not significantly influence the risk of recurrence (AOR: 1.18; 95%CI: 0.86–1.62). In conclusion, the study indicates a considerable rate of cardiovascular disease recurrence post-CABG in Indonesia, highlighting several key risk factors. Tailored postoperative management and strict adherence to follow-up protocols are essential for mitigating recurrence. These findings offer crucial insights for improving post-CABG health management strategies in Indonesia.

Stenotrophomonas maltophilia bacteremia in hemato-oncological patients

Abstract Background Stenotrophomonas maltophilia is an increasingly common cause of bacteremia in immunocompromised patients, particularly those with underlying neutropenia. This study aims to characterize the clinical presentation, risk factors, and outcomes of Stenotrophomas maltophilia bacteremia in pediatric hemato-oncological patients. Methods We retrospectively reviewed the medical records of nine pediatric hemato-oncological patients who developed a cluster of Stenotrophomas maltophilia bacteremia at our institution from September to November in 2023. The identification and antibiotic susceptibility testing was performed by Vitek 2. Data collected included patient demographics, clinical presentation, underlying disease, treatment regimens, and outcomes. Results We identified nine cases of Stenotrophomas maltophilia bacteremia during the study period. The median age of the patients was 11 years (range 3-16 years), 7 were male. All patients had underlying hematologic malignancies (particularly acute lymphoblastic leukemia) and had profound neutropenia (ANC <100/mm3) at the time of bacteremia. The most common clinical presentation were fever (100%) and the most frequent risk factors were having a central venous catheter (CVC) (100%) and early chemotherapy treatment prior the diagnosis, median of 9 days (range 3-14 days). All patients received intravenous antibiotics, and the most commonly used agent was trimethoprim-sulfamethoxazole (TMP-SMX), the median duration of treatment was 12 days (range 7-16 days). The overall mortality rate was 11.1% on a patient with necrotizing fasciitis. Conclusion Stenotrophomas maltophilia bacteremia is a severe complication in pediatric hemato-oncological patients, considering its multidrug-resistance profile. The rise in Stenotrophomonas maltophilia isolations has triggered the implementation of outbreak investigation measures and exhibits the importance of an adequate control in central line care. Early diagnosis and appropriate antimicrobial therapy are crucial for improving outcomes.

Efficacy of Extranasal Neurostimulation for Patients With Neuropathic Corneal Pain: A Pilot Study

Purpose: Neuropathic corneal pain (NCP) has been recognized as a distinct disease, yet treatment options remain limited. The aim of this pilot study was to explore the effectiveness of extranasal neurostimulation (EXNS) as a potential pain relief strategy for individuals with the peripheral component of NCP. Methods: A retrospective study was performed to identify patients who were diagnosed with refractory peripheral or mixed NCP and subsequently underwent a single session of EXNS. Visual analog scale (VAS) was used to evaluate pain intensities in the office before and after 60 seconds of EXNS. Demographic information, changes in pain scores, and comorbidities were recorded, and their correlations with pain score changes were analyzed. Results: Twenty-two patients with a mean age of 48.91 ± 3.32 years were included. The average VAS score before EXNS was 5.59 ± 0.41, which was reduced to 2.59 ± 0.43 after EXNS, indicating a 54.88% reduction (P < 0.001). EXNS reduced VAS scores from 4.90 ± 0.72 to 1.60 ± 0.42 (68.40%) for 10 patients with peripheral NCP and from 6.17 ± 0.42 to 3.42 ± 0.62 (43.61%) for 12 patients with mixed (peripheral and central) NCP (P = 0.005 for both groups). Fourteen patients (63.63%) experienced an improvement of at least 50% in their pain scores, 2 patients (9.09%) showed an improvement between 30% and 49.9%, while 6 patients (27.27%) experienced an improvement of less than 30%. No correlations between the change in pain scores and patient demographics, as well as comorbidities were detected. Conclusions: EXNS may be used as an adjuvant therapy to ameliorate pain among patients with NCP with the peripheral pain component.

Physical Restraint Use in Hospitalized Patients: A Study of Routinely Collected Health Records Data.

The use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings. This study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation. The EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022. Hospitalized adults. Patient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets. Among 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%. Among adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.

Caregiver Impressions of Bracing and Its Association With Unsuccessful Outcomes Throughout the Ponseti Treatment.

Clubfoot is a common congenital foot deformity, occurring in about 1 in 1000 live births. The Ponseti method consists of weeks of manipulation and serial casting, followed by years of orthotic wear. Recurrent or relapse deformity following the Ponseti method remains a challenging problem for many patients. Many studies have attributed relapse to noncompliance with the treatment plan, particularly during the maintenance phase. Many patient risk factors have been studied and attributed to recurrent deformity, but less emphasis has been placed on aspects of the treatment method from the caregiver's perspective. From 2010 to 2014, 127 patients between 1 and 354 days old who had been diagnosed with clubfoot were recruited for the parent study. At the initial visit, and each subsequent follow-up, the primary caregiver was given a questionnaire that included 21 binary belief questions exploring his or her experience with the Ponseti method. Univariate analyses were performed to find any relationship with caregiver responses and either clinical recurrence of the deformity or overall failure of treatment. Of the recruited patients, 126 were enrolled in the parent study and 100 were able to complete the full 3-year follow-up. Patient demographics and characteristics (sex, race, family history of clubfoot, laterality, and severity of deformity) were similar. Statistical analysis of the questionnaire responses found that choosing "yes" for either "I don't feel the braces are necessary" or "I am not comfortable with applying and removing the braces" was associated with significantly increased risk of overall failure. Gathering insight from the caregiver's perspective can help identify barriers to treatment not recognized by the provider. Lack of comfortability with the orthosis and lack of understanding are associated with increased risk of overall failure. A better understanding of the caregiver's perspective on barriers to treatment could help guide the Ponseti method provider's educational efforts. Level III.

Robotic availability, not payor status, determines access to robotic emergency general surgery hernia repair in California and Florida.

Previous studies have demonstrated that access to robotic surgery is influenced by socioeconomic factors, including insurance status. The 2010 Affordable Care Act established an avenue for states to expand Medicaid coverage, which has increased access to surgical care for many conditions. We hypothesized that socioeconomic disparities in access to robotic repair of non-elective emergency general surgery (EGS) hernias are less prevalent in California, a Medicaid expansion state, compared to Florida, which has not adopted Medicaid expansion. The 2021 California and Florida State Inpatient Databases were used to identify all EGS admissions with an ICD-10 procedure code for ventral or inguinal hernia repair. Elective procedures and those with concurrent unrelated abdominal procedures were excluded. Patient demographics, comorbidity burden, payor status, and income quartile were abstracted. Aggregation of hospital data identified high-volume trauma, robotic, and EGS centers. There were 15,683 EGS hernia procedures of which 11% underwent robotic repair: 14% in Florida and 8% in California. On multivariable logistic regression, older age, male sex, lower income, and Medicare insurance were associated with reduced odds of robotic hernia repair in California, but not in Florida, despite an uninsured rate of 10%. The greatest predictor of robotic surgery in both states was treatment at a robotic surgery center. Overall, accounting for patient- and hospital-level factors, hernia surgeries in Florida were more likely to involve robotics (OR 1.61, CI 1.42-1.81, p < 0.001) compared to California. There were fewer disparities in access to EGS robotic hernia repairs in Florida than in California. This suggests that robotic surgery access for EGS hernia repairs is primarily determined by institutional adoption of robotic surgery, not income or payor status. Compared to California, Florida appears to have greater market penetration of robotic surgery, which has increased access to robotic EGS for all patients.

Ambulance offload performance, patient characteristics and disposition for patients offloaded to different areas of the emergency department.

Ambulance transfer of care (TOC) is a key performance indicator for New South Wales EDs, with 90% of ambulances to be offloaded within 30 min of arrival. Nepean Hospital ED has a number of strategies to improve TOC, including ambulatory areas where patients can be offloaded immediately. Offload data are supplied by ambulance and there is no study into its accuracy. The aim is to audit the accuracy of ambulance data of TOC compared to times recorded in the Nepean ED information system, and to examine TOC and patient demographics for different offload destinations. A retrospective observational study was performed for patients presenting by ambulance between 1 July and 31 December 2022. TOC was calculated from FirstNet and compared to ambulance data using a paired-sample t test. Patients were categorised by offload destination within the ED and examined for age, TOC, disposition and specialty team if admitted. TOC for ambulance and ED data was 60.8% versus 64.1%, respectively (difference 3.33%, P < 0.001). Patients offloaded to acute care were older, with 61.9% being >65 years; had a TOC of 37.3% compared to the resuscitation and ambulatory areas with TOC close to 90%; and were likely to be admitted with a 63.8% admission rate and 24.1% of admissions being under the geriatric service. Patients arriving by ambulance requiring an acute care bed were likely to be elderly and frail, and suffered substantial ambulance offload delays. Delays to ambulance offload for these patients is likely driven by acute care bed availability and access block.

Cross-Sectional Analysis of Patients Referred to a Tertiary Lymphatic Surgery Center.

Secondary lymphedema has become an increasingly common reason for referral to plastic surgery. Understanding referral patterns for lymphedema patients is crucial to optimizing care. Patients referred to plastic surgery for lymphedema at a lymphatic surgery center between January 2016 and 2023 were identified. Primary outcomes of interest included clinical lymphedema staging and characteristics, patient demographics, and referral sources. Secondary outcomes were prior lymphedema treatment, agreement between referring provider and plastic surgeon's diagnosis, and patient disposition after surgical evaluation. Descriptive statistics and multivariate logistic regression analysis were performed. A total of 285 patients with extremity edema were referred to plastic surgery; 60.0% of patients had prior malignancy, 45.6% of patients had undergone a prior lymph node procedure, and 40% had received radiation, while 56.8% of patients had previously seen occupational therapy. Body mass index (BMI, OR 1.09, p = 0.013), age (OR 1.25, p = 0.005), and prior physical oroccupational therapy (OR 1.23, p = 0.011) were associated with later stages of lymphedema upon presentation, while prior radiation (OR 0.79, p = 0.006) and malignancy (OR 0.85, p = 0.034) were associated with earlier stages of lymphedema. Self-referral (27.4%), primary care (17.9%), and medical oncology (14.7%) were the most common referral sources. Lymphedema was confirmed in 68.1% of referrals, and 28.5% of these patients proceeded to surgery. Patients were more likely to be operative candidates if referred by primary care (RR 2.1, p = 0.006) or occupational therapy (RR 4.6, p = 0.010). Referred patients ultimately undergo lymphedema surgery at relatively low rates, indicating that most referred patients are not ideal surgical candidates. Optimizing referral patterns through multidisciplinary education may enhance the referral process and improve access to lymphedema surgery.

Sarcopenia is associated with worse outcomes in patients with inflammatory bowel disease: insights from US national hospitalization data

Background Inflammatory bowel disease (IBD) is an inflammatory disorder associated with significant morbidity and mortality. Recent studies have reported sarcopenia as a significant factor affecting the quality of life and outcomes of these patients. Methods We used the National Inpatient Sample 2016–2020 to identify adult patients with IBD. The patients were stratified into two groups based on the presence of sarcopenia. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, ICU admission, and need for surgery. Multivariate logistic regression analysis was performed. Results A total of 1 524 820 IBD hospitalizations were included. Of these, 209 615 (9%) were noted to have sarcopenia. Patients with sarcopenia had a higher incidence of in-hospital mortality (4.2% vs. 1.2%, P &lt; 0.001), ICU admission (6.5% vs. 2.4%, P &lt; 0.001), and need for abdominal surgery (6.5% vs. 3.5%, P &lt; 0.001). After adjusting for confounders, the presence of sarcopenia was associated with higher odds of in-hospital mortality (adjusted odds ratio: 2.83, 95% confidence interval: 2.66–3.02, P &lt; 0.001) and additional worse outcomes. Conclusion Our study reports that the presence of sarcopenia was associated with an increased risk of death and the need for abdominal surgery. Preventative measures aimed at improving sarcopenia should be taken to prevent worse outcomes in this patient population.

Survival After Extracorporeal Cardiopulmonary Resuscitation Based on In-Hospital Cardiac Arrest and Cannulation Location: An Analysis of the Extracorporeal Life Support Organization Registry.

Explore whether extracorporeal cardiopulmonary resuscitation (ECPR) mortality differs by in-hospital cardiac arrest location and whether moving patients for cannulation impacts outcome. Retrospective cohort study. ECPR hospitals that report data to the Extracorporeal Life Support Organization (ELSO). Patients having ECPR for in-hospital cardiac arrest between 2020 and 2023 with data in the ELSO registry. None. Patient demographics, comorbidities, pre-cardiac arrest conditions, pre-ECPR vasopressor use, cardiac arrest details, ECPR cannulation information, major complications, and in-hospital mortality were recorded. Multivariable logistic regression model was used to examine the associations between in-hospital mortality and 1) cardiac arrest location and 2) moving a patient for ECPR cannulation. A total of 2515 patients met enrollment criteria. The adjusted odds ratio (aOR) for mortality was increased in patients who had a cardiac arrest in the ICU (aOR, 1.85; 95% CI, 1.45-2.38; p < 0.001) and in patients who had a cardiac arrest in an acute care bed (aOR, 1.68; 95% CI, 1.09-2.58; p = 0.02) compared with the cardiac catheterization laboratory. Moving a patient for cannulation had no association with mortality (aOR, 0.70; 95% CI, 0.18-2.81; p = 0.62). Advanced patient age was associated with increased mortality. Specifically, patients 60-69 and patients 70 years old or older were more likely to die compared with patients younger than 30 years old (aOR, 1.71; 95% CI, 1.17-2.50; p = 0.006 and aOR, 2.27; 95% CI, 1.49-3.48; p < 0.001, respectively). ECPR patients who experienced cardiac arrest in the ICU and in acute care hospital beds had increased odds of mortality compared with other locations. Moving patients for ECPR cannulation was not associated with improved outcomes.

Impact of low-pressure pneumoperitoneum and deep neuromuscular blockade on surgeon satisfaction and patient outcomes in laparoscopic cholecystectomy patients: A prospective randomised controlled study.

The impact of laparoscopic surgery on homeostatic systems necessitates careful consideration of intra-abdominal pressure (IAP) management. This study investigated the effects of low-pressure pneumoperitoneum with deep neuromuscular blockade (NMB) on surgeon satisfaction, haemodynamics and post-operative outcomes in laparoscopic cholecystectomy patients. The study design involves prospective randomised control. Ninety patients were assigned to low (7-10 mmHg, n = 45) or normal (12-16 mmHg, n = 45) IAP groups. Deep NMB, guided by train-of-four monitoring, was administered. This study evaluated surgical rating scale scores, haemodynamics and post-operative outcomes through a literature review. A computer programme (IBM, SPSS) was used for statistical analysis. Chi-square and Mann-Whitney U tests were used to analyse patients' IAP levels, additional NMB requirements, surgical rating scale scores and numerical rating scales. Patient demographics and other intraoperative and post-operative variables were analysed with Student's t-test and the Mann-Whitney U test. Values of P < 0.05 were considered to indicate statistical significance. No significant demographic differences were observed. The low-pressure group exhibited lower post-operative pain (P < 0.01) and reduced analgesia requirements (P = 0.00). On analysis of the surgeon rating scale, no disparities were evident between the groups. NMB usage correlated with height and weight (P < 0.01). Heart rate showed no intergroup differences. The MAP measured after 15 min was lower in Group L, and the difference was significant (P = 0.023). The SAP measured after 30 min was lower in Group L, and the difference was significant (P = 0.017). Blood gas values and surgical field visibility were unaffected by the IAP. The positive correlations between NMB, height and weight aligned with previous research. This study highlights successful laparoscopic cholecystectomy under low IAP, deep NMB and favourable post-operative outcomes. Despite these limitations, the findings contribute to optimising laparoscopic surgical approaches.

Risk Factors for Acute Intraoperative Bradycardia in Patients Undergoing Gender-affirming Mastectomy

Purpose: Gender-affirming mastectomy surgery is highly desired within both transmasculine and nonbinary patient populations. The development of cardiac arrhythmias has been reported within this population. Acute intraoperative bradycardia in patients undergoing gender-affirming mastectomy has not been well described previously. This study aimed to describe the frequency of acute intraoperative relative bradycardia in patients undergoing gender-affirming mastectomies and identify potential risk factors that contribute to its occurrence. Methods: A retrospective review was performed for all patients who underwent gender-affirming mastectomy at a single institution. Data regarding patient demographics, comorbidities, and perioperative course were collected. Patients were separated into those who did and did not develop acute intraoperative bradycardia. The definition of relative intraoperative bradycardia was a heart rate below sixty beats per minute. Logistic regression was performed to determine which variables were predictive of bradycardia. Results: A total of 337 patients underwent gender-affirming mastectomy between January 2018 and January 2023. Of these patients, 144 (42.7%) experienced acute intraoperative relative bradycardia, with 97 (67.4%) requiring anesthetic intervention and 5 (3.5%) requiring halting or abortion of surgery. Two patients (1.4%) required compressions for asystole. Fluoxetine as an outpatient medication (OR: 2.63, P = .002) and harvest of a nipple graft (OR: 2.77, P = .018) were associated with a significantly increased risk of developing acute intraoperative bradycardia. Conclusion: Acute intraoperative relative bradycardia may be a unique phenomenon in patients undergoing gender-affirming mastectomies due to variables specific to this patient population. A future study comparing patients undergoing gender-affirming mastectomy to those undergoing elective breast surgeries is forthcoming to assess further risk factors.

Impacts of age and BMI on vancomycin model choice in a Bayesian software: Lessons from a very large multi-site retrospective study.

Model-informed precision dosing (MIPD) optimizes drug doses based on pharmacokinetic (PK) model predictions, necessitating careful selection of models tailored to patient characteristics. This study evaluates the predictive performance of various vancomycin PK models across diverse age and BMI categories, drawing insights from a large multi-site database. Adults receiving vancomycin intravenous therapy at United States health systems between January 1, 2022, and December 31, 2023, were included. Patient demographics, vancomycin administration records, and therapeutic drug monitoring levels (TDMs) were collected from the InsightRX database. Age and body mass index (BMI)-based subgroups were formed to assess model performance, with predictions made iteratively. The optimal model for each age-BMI subgroup was chosen based on predefined criteria: models were filtered for mean percentage error (MPE) ≤ 20% and normalized root mean squared error (RMSE) < 8 mg/L, and then the most accurate among them was selected. A total of 384,876 treatment courses across 155 US health systems were analyzed, contributing 841,604 TDMs. Eleven models were compared, showing varying accuracy across age-BMI categories (41%-73%), with higher accuracy observed once TDMs were available for Bayesian estimates of individual PK parameters. Models performed more poorly in younger adults compared to older adults, and the optimal model differed depending on age-BMI categories and prediction methods. Notably, in the a priori period, the Colin model performed best in adults aged 18-64 years across most BMI categories; the Goti/Tong model performed best in the older, non-obese adults; and the Hughes model performed best in many of the obese categories. Our study identifies specific vancomycin PK models that demonstrate superior predictions across age-BMI categories in MIPD applications. Our findings underscore the importance of tailored model selection for vancomycin management, especially highlighting the need for improved models in younger adult patients. Further research into the clinical implications of model performance is warranted to enhance patient care outcomes.

A novel anterior approach toward robotic radical prostatectomy is associated with earlier continence recovery than the conventional approach.

To advance robotic radical prostatectomy, we developed a novel anterior approach that uses a peritoneal incision created between the umbilical ligaments to develop the Retzius space and thus spares vessels that surround the bladder and prostate, with the space being closed after prostatectomy and vesicourethral anastomosis. This approach may improve continence recovery. We investigated continence recovery following the novel anterior approach compared to after the conventional anterior approach. We retrospectively reviewed 516 patients who underwent robotic radical prostatectomy from January 2019 to July 2023. We compared continence recovery following our novel anterior approach (N = 282) to that after conventional anterior approach (N = 234), and we compared the oncological outcomes and safety profiles of the two groups. Patient demographics did not differ significantly between the two groups. Continence recovery in patients undergoing the novel anterior approach was significantly better than that of patients treated via the conventional approach (hazard ratio: 1.651, 95% confidence interval: 1.325-2.057, p < 0.0001). Use of the novel anterior approach in addition to nerve sparing and preservation of the detrusor apron independently predicted continence, and the mixture of these three techniques afforded excellent continence recovery (1- and 2-year total continence rate of 81.1% and 93.7%). Neither the biochemical recurrence-free survival nor the complication rate differed significantly between the two groups. Our novel anterior approach may improve continence recovery compared to the conventional anterior approach, without compromising the oncological outcomes. Prospective comparative studies are necessary to confirm the benefits of this approach.

Postoperative Outcomes of Enucleation without Closure of the Conjunctiva

Purpose: To evaluate the long-term outcomes of enucleation without conjunctival closure in a large patient cohort. Methods: A retrospective chart review was conducted from January 2011 to January 2024, examining 144 eyes of 143 patients who underwent enucleation without conjunctival closure by a single oculoplastic surgeon. Data collected included patient demographics, indications for surgery, implant types, and complications. Results: This study included 144 eyes from 143 patients undergoing enucleation without conjunctival closure. Patients had a mean age of 46.47 years (SD: 19.76; range: 4–92 years), with a mean follow-up of 14.66 months (range: 2–142 months). Indications for enucleation included blind painful eyes for a variety of reasons (e.g., endophthalmitis, end-stage glaucoma, irreparable corneal graft failure, irreparable corneal melt, and intraocular tumors, etc.) which was the most common reason in our practice (72.92%). Porous polyethylene spheres (86.11%) and polymethyl methacrylate spheres (13.89%) were the primary implants used, with no observed implant complications. Three cases (2.08%) developed conjunctival cysts post-trauma. Conclusions: Enucleation without conjunctival closure in an otherwise normal eye with no evidence of severe conjunctival shrinkage appears to be a safe and effective procedure with a low complication rate comparable to traditional techniques involving suture-based conjunctival approximation. Meticulous closure of Tenon’s capsule may be sufficient to prevent implant-related complications. This approach could potentially reduce surgical time and simplify the enucleation procedure without compromising patient outcomes.

Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research.

First-line therapy for most intracranial dural arteriovenous fistulas (dAVFs) is endovascular embolization, but some require microsurgical ligation due to limited endovascular accessibility, anticipated lower cure rates, or unacceptable risk profiles. We investigated the most common surgically treated dAVF locations and the approaches and outcomes of each. The Consortium for Dural Arteriovenous Fistula Outcomes Research database was retrospectively reviewed. Patients who underwent dAVF microsurgical ligation were included. Patient demographics, angiographic information, surgical details, and postoperative outcomes were collected. The 5 most common surgically treated dAVF locations were analyzed about used surgical approaches and postoperative outcomes. Univariate analyses were performed with statistical significance set at a threshold of P < .05. In total, 248 patients in the Consortium for Dural Arteriovenous Fistula Outcomes Research database met inclusion criteria. The 5 most common surgically treated dAVF locations were tentorial, anterior cranial fossa (ACF), transverse-sigmoid sinus (TSS), convexity/superior sagittal sinus (SSS), and torcular. Most tentorial dAVFs were approached using a suboccipital, lateral supracerebellar infratentorial approach (39.3%); extended retrosigmoid approach (ERS) (25%); or posterior subtemporal approach (19.6%). All ACF dAVFs used a subfrontal approach; 5.3% also included an anterior interhemispheric approach. Most TSS dAVFs were ligated via ERS (31.3%) or subtemporal (31.3%) approaches. All convexity/SSS dAVFs used an interhemispheric approach. All torcular dAVFs used the suboccipital, lateral supracerebellar infratentorial approach, with 10.5% undergoing simultaneous ERS craniotomy. Angiographic occlusion rates after microsurgery were 85.5%, 100%, 75.8%, 79.2%, and 73.7% for tentorial, ACF, TSS, convexity/SSS, and torcular dAVFs, respectively (P = .02); the permanent neurological complication rates were 1.8%, 2.6%, 9.1%, 0%, and 0% (P = .31). There were no statistically significant differences in development of complications (P = .08) or Modified Rankin Scale at the last follow-up (P = .11) by fistula location. Although endovascular embolization is the first-line treatment for most intracranial dAVFs, surgical ligation is an important alternative. ACF and tentorial fistulas particularly demonstrate high rates of postoperative obliteration.

Pickleball and the Rising Incidence of Achilles Tendon Injuries in the Elderly.

With its rising popularity of pickleball, particularly in the aging population, comes concern for potential injuries that previously rarely affected this patient cohort. The purpose of this study was to investigate the trends of pickleball-related Achilles tendon injuries. A retrospective case series was performed to determine the trends associated with pickleball-related Achilles tendon injuries over the last 10 years. A database search of all Achilles tendon ruptures (ICD-10 S86.0) presenting to a large, multistate, subspecialty referral orthopaedic clinic between January 2013 and June 2023 were identified and included in the study. Pickleball-related injuries were identified via query and confirmed with manual chart review. The incidence of pickleball-related injuries, as well as patient demographics and rate of surgery was determined and compared with the total population during that time period. A total of 2684 patients who suffered an Achilles tendon injury between January 2013 and June 2023 were identified, with 43 patients meeting the inclusion criteria for pickleball-related Achilles tendon ruptures. The number and overall incidence of pickleball-related Achilles tendon injuries has been increasing since 2016, excluding 2020 where there was a large decrease likely due to the COVID-19 epidemic. Pickleball was associated with older age at time of injury (64.5 vs 48.6, P < .001) as well as a lower BMI (26.6 vs 29.4, P < .001). In addition, patients who sustained a pickleball-related Achilles tendon injury were more likely to undergo surgery (67.4% vs 45.4%, P = .008). The rising popularity of pickleball and its associated injuries poses a significant risk to the aging population, with Achilles tendon injuries occurring in older individuals and resulting in a higher likelihood of undergoing surgery. IV; retrospective case-series.

An instantly applicable machine learning model for extraprostatic extension prediction in prostate cancer: A post-hoc analysis of the RAPID 68Ga-PSMA PET/MRI trial

Radical prostatectomy (RP) is a common first-line treatment for patients with localized prostate cancer (PCa), with nerve-sparing techniques recommended to minimize adverse effects on quality of life. Accurate pre-operative detection of extraprostatic extension (EPE) remains difficult, often resulting in suboptimal treatment choices. Machine learning (ML) has the potential to improve pre-operative EPE detection through the integration of multimodal data, but its clinical adoption is hindered by implementation complexities and explainability issues. This study conducted a post-hoc analysis of a prospective clinical trial (NCT02659527) involving patients who underwent [68Ga]Ga-PSMA-11 PET/MRI from 2014 to 2019. Only the clinically used parameters were collected, including PET-derived features, blood-based markers, histology-derived parameters, and patient demographics. ML models were developed using either only non-invasive features or a combination of non-invasive and invasive features for EPE detection and were compared to conventional PET image readings. Among the 77 patients included in the study, 44 (57%) had EPE based on post-surgical findings. The ML models outperformed traditional PET image readings in diagnostic accuracy, with the explainable boosting machine (EBM) model achieving an AUC of 0.88. The ML model incorporating invasive features showed superior predictive ability for EPE compared to visual clinical assessments (AUC 0.88 vs. 0.71, p 0.02), while the difference between the ML model with non-invasive features and clinical assessments was not significant (AUC 0.83 vs. 0.71, p 0.34). Explainable ML models utilizing routinely acquired clinical data can greatly enhance the pre-operative detection of EPE in PCa patients, potentially leading to more accurate clinical staging, better treatment decisions, and improved patient outcomes. Please click on the 'PDF' for the full abstract!