Postoperative Decline Research Articles

Assessment of cognitive function after surgery for colorectal cancer—a scoping review

ObjectiveColorectal cancer is primarily treated with surgery. Major surgery and older age are risk factors associated with postoperative decline in cognitive function. In clinical research, a wide range of instruments...

NCOG-32. RELATIONSHIPS BETWEEN INTRAOPERATIVE TASK-BASED GAMMA BAND ELECTROCORTICOGRAMS, DIRECT ELECTRICAL STIMULATION, AND COGNITIVE-LINGUISTIC OUTCOME FOLLOWING AWAKE BRAIN TUMOR RESECTION

Abstract BACKGROUND As an adjunct to direct electrical stimulation (DES), intraoperative electrocorticography (ECoG) can aid detection of language-eloquent cortex. However, it is unclear how surgical impact upon mapping findings relates to cognitive-linguistic outcomes. METHODS Ten patients underwent awake craniotomy for tumor resection with ECoG and DES language mapping. Mapping utilized iPad stimulus presentation coupled to an electrode array capable of both recording ECoG activity and delivering DES. Time-frequency gamma band activations were visualized (Early, Long, Late, Double Peak) for 3 naming paradigms (Object, Action, Auditory). DES was also conducted for each task. Mapping results were overlayed on postoperative MRI to examine proximity to parenchymal trauma (cavity, sulcal displacement). Patients completed cognitive-linguistic testing [WAB-R (N=3) or Neuropsychological Assessment (N=7)] prior to surgery and <2 months postoperatively. Patients with persisting aphasia at 6-month follow-up were also identified. RESULTS Postoperative language decline was found in 50% of patients, with 30% showing worsening (>1SD) in Naming and Phonemic Fluency, and 60% in Semantic Fluency. Surgery impacted ECoG features in 60% of patients and DES arrest sites in 30%. A trend was observed where Early and Late Object naming ECoG features were associated with Semantic Fluency decline [rpb(5)=-.69, p=.067]. Arrest during Auditory naming DES <1 cm of surgical effect was associated with decline in Abstraction [rpb(5)=-.83, p=.042; FET, p=.029] and Semantic Fluency [rpb(5)=-.87, p=.012; FET, p=.024]. Excluding the 3 transsulcal surgeries, arrest during Auditory naming DES <1 cm of resection was associated with general language decline [FET, p=.047]. All 3 patients with persisting aphasia had Auditory naming arrest <1 cm of resection and 2/3 patients had Object naming ECoG features resected. CONCLUSIONS While preliminary, results suggest that surgical proximity to ECoG and DES mapping results may inform risk of surgically-acquired cognitive-linguistic decline. Findings support the potential of multimethod-multitask intraoperative language mapping.

BOLDly Going Where Few Researchers Have Gone Before-Leveraging Language-Related Hippocampal Activations to Predict Postoperative Memory Decline.

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Boston Naming Test as a Screening Tool for Early Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery.

The Boston naming test (BNT), as a simple, fast, and easily administered neuropsychological test, was demonstrated to be useful in detecting language function. In this study, BNT was investigated whether it could be a screening tool for early postoperative cognitive dysfunction (POCD). This prospective observational cohort study included 132 major noncardiac surgery patients and 81 nonsurgical controls. All participants underwent a mini-mental state examination (MMSE) and BNT 1 day before and 7 days after surgery. Early POCD was assessed by reliable change index and control group results. Seven days after surgery, among 132 patients, POCD was detected in 30 (22.7%) patients (95% CI, 15.5%-30.0%) based on MMSE, and 45 (34.1%) patients (95% CI, 26.3%-41.9%) were found with postoperative language function decline based on BNT and MMSE. Agreement between the BNT spontaneous naming and MMSE total scoring was moderate (Kappa .523), and the sensitivity of BNT spontaneous naming for detecting early POCD was .767. Further analysis showed that areas under receiver operating characteristics curves (AUC) did not show statistically significant differences when BNT spontaneous naming (AUC .862) was compared with MMSE language functional subtests (AUC .889), or non-language functional subtests (AUC .933). This study indicates the feasibility of implementing the BNT spontaneous naming test to screen early POCD in elderly patients after major noncardiac surgery.

Machine Learning Models Leveraging Smartphone-Based Patient Mobility Data Can Accurately Predict Functional Outcomes After Spine Surgery.

Objective: The development of adjacent segment disease or the progression of spondylosis following the surgical treatment of spinal stenosis and spondylolisthesis is well documented and can lead to subsequent functional decline after a successful index surgery. The early detection of negative inflection points during patients' functional recovery can improve timely intervention. In this study, we developed machine learning (ML) models to predict the occurrence of post-operative decline in patient mobility. Methods: Patients receiving spine surgery for degenerative spinal stenosis or spondylolisthesis were retroactively consented and enrolled. Activity data (steps-per-day) previously recorded across a 4-year peri-operative were collected alongside relevant clinical and demographic variables. Logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost) ML models were constructed and trained on 80% of the dataset and validated using the remaining 20%. The study's primary endpoint was the models' ability to predict post-operative decline in patient mobility. Results: A total of 75 patients were included. Following training, RF and XGBoost models achieved accuracy values of 86.7% (sensitivity 80%, specificity 90%) and 80% (sensitivity 60%, specificity 90%), respectively, in predicting post-operative functional decline. The LR model was the least effective with an accuracy of 73.3% (sensitivity 50%, specificity 88.8%). Receiver operating characteristic curves showed an area under the curve of 0.80 for RF, 0.70 for XGBoost, and 0.69 for LR. Conclusions: ML models trained on activity data collected from smartphones successfully forecast functional decline in post-operative activity following spine surgery. These results lay the groundwork for the future integration of ML into the surgeon's toolbox for prognostication and surgical planning.

Comparison of diagnostic yields, operative times, and post-operative hemorrhage between twist drill versus burr hole craniotomy approaches for stereotactic needle brain biopsy.

Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0min (IQR 49-83) versus 35.5min (IQR 26-54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique.

How well can simple clinical features predict long-term language recovery after left-hemisphere glioma surgery?

Long-term language recovery after left-hemisphere glioma surgery varies substantially across patients. We investigated how well it can be predicted using clinical variables such as the postoperative decline in language processing, tumor grade, resection volume and location, extent of resection, and intraoperative language mapping. Beyond predicting the overall recovery, we examined which domains of language processing are most prone to persistent deficits. Fifty-nine patients with left-hemisphere gliomas completed the Russian Aphasia Test (RAT) before surgery, immediately after surgery, and at follow-up three to seventeen months after surgery. We modeled their average language score (Generalized Aphasia Quotient, GAQ) at follow-up using a cross-validated multiple linear regression and calculated the number of patients showing persistent deficits in each subtest of the RAT. The difference between GAQ scores at follow-up and before surgery was not significant at the group level but varied substantially across patients (mean -1.3%, range -34.2-9.2%). Our best-performing model predicted the follow-up GAQ scores with the mean absolute error of 3.5% (cross-validated R2 = 0.15). A greater decline in language processing immediately after surgery predicted worse recovery, whereas intraoperative language mapping predicted better recovery. Deficits in sentence repetition, verb production, verb and sentence comprehension, and object naming most often persisted at follow-up. The postoperative decline in language processing and intraoperative language mapping explain a substantial amount of variability in long-term language recovery. Verbal working memory and lexical retrieval, particularly that of verbs, are most prone to persistent deficits.

Outcomes of Trabeculectomy and Predictors of Success in Patients of African Ancestry with Primary Open Angle Glaucoma.

To investigate outcomes of trabeculectomy ab externo in African ancestry primary open-angle glaucoma (POAG) patients, and to analyze the impact of demographic and phenotypic factors on surgical success and complication rates. A retrospective case-control study enrolled 63 eyes of 55 POAG cases who underwent trabeculectomy ab externo. Data on demographics, family glaucoma history, surgical specifics, and pre/postoperative measures (intraocular pressure, visual acuity, visual field, medication usage, complications within one year) were collected. Analysis included linear/logistic regression models adjusting for inter-eye correlation. Trabeculectomy yielded success without additional medication in 46%, qualified success with medication in 22%, and surgical failure necessitating further intervention in 32% within one year. Subjects experienced reduction in intraocular pressure (IOP) (46%), daily glaucoma medication (73%), and eye drop usage (67%) 1-year post-trabeculectomy (all P<0.001). However, there was a postoperative decline of 56% in visual acuity (VA) (P<0.001) and a significant worsening of visual field parameters, including a 14% decrease in mean deviation (P=0.02) and a 19% decrease in visual field index (P=0.004). Top of FormBottom of Form59% of patient eyes experienced complications within one year of surgery. Univariate analysis of predictive factors for surgical outcomes revealed that younger age at surgery (P=0.01) and family history of glaucoma (P=0.046) were predictive of lower rates of surgical success. Multivariable analysis revealed worse preoperative VA (OR 0.79 per 0.1 LogMAR increases, P=0.02) was associated with lower likelihood of surgical success. This study underscores the low rates of trabeculectomy success and high rates of complications in an African ancestry population with POAG. While the procedure exhibited positive effects on IOP control and medication reduction, our analysis found that multiple factors, particularly age, family history, and worse preoperative VA play crucial roles in influencing surgical success. Trabeculectomy in African ancestry individuals with primary open-angle glaucoma shows a 46% success rate and frequent complications, indicating that younger age and family history are significant predictors of surgical failure in this high-risk population.

Meta-analysis of clinical outcomes of robot-assisted partial nephrectomy and classical open partial nephrectomy.

Robotic-assisted partial nephrectomy (RAPN) has emerged as a promising alternative to classical partial nephrectomy (CPN). This study aimed to compare the outcomes of RAPN and CPN for treating localized renal tumors through a meta-analysis of available literature. Chinese databases, such as CNKI, Chinese Science and Technology Periodicals Database (VIP), and Wanfang Full-text Database, were searched using Chinese search terms, and all published articles on PubMed and Web of Science were searched using English search terms. Articles on Localized Renal Tumors were included. RevMan5.3 software was used for meta-analysis. The funnel plots were drawn using Stata software to assess publication bias. This study aimed to identify the differences between robotic-assisted partial nephrectomy and classic partial nephrectomy in patients with localized renal tumors. In total, 67 articles with 17677 patients were included. The results demonstrate the advantages of RAPN over CPN for localized renal tumors. Compared to CPN and RAPN had significant differences in intraoperative blood loss, hospital stay duration, incidence of perioperative complications, and proportion of patients requiring blood transfusion. Regarding surgical outcomes, RAPN showed more favorable results regarding the incidence of positive resection margins, postoperative decline in glomerular filtration rate (GFR), postoperative local recurrence rate, and proportion of Trifecta achieved. However, there was no significant difference between RAPN and CPN regarding 5-year tumor-specific survival rates. The study suggests that robotic-assisted partial nephrectomy is a viable alternative to classic surgery for renal tumors. The strengths of this study are the use of a comprehensive search strategy and the inclusion of studies published in both English and Chinese. The limitations of this study are the small sample size and the need for long-term follow-up data. RAPN and CPN have similar overall survival outcomes for treating localized renal tumors. However, RAPN may offer advantages in terms of perioperative outcomes and preservation of renal function. Further studies are needed to confirm these findings and to identify the optimal surgical approach for individual patients.

MEF2C Alleviates Postoperative Cognitive Dysfunction by Repressing Ferroptosis.

Ferroptosis, a form of programmed cell death featured by lipid peroxidation, has been proposed as a potential etiology for postoperative cognitive dysfunction (POCD). Myocyte-specific enhancer factor 2C (MEF2C), a transcription factor expressed in various brain cell types, has been implicated in cognitive disorders. This study sought to ascertain whether MEF2C governs postoperative cognitive capacity by affecting ferroptosis. Transcriptomic analysis of public data was used to identify MEF2C as a candidate differentially expressed gene in the hippocampus of POCD mice. The POCD mouse model was established via aseptic laparotomy under isoflurane anesthesia after treatment with recombinant adeno-associated virus 9 (AAV9)-mediated overexpression of MEF2C and/or the glutathione peroxidase 4 (GPX4) inhibitor RSL3. Cognitive performance, Nissl staining, and ferroptosis-related parameters were assessed. Dual-luciferase reporter gene assays and chromatin immunoprecipitation assays were implemented to elucidate the mechanism by which MEF2C transcriptionally activates GPX4. MEF2C mRNA and protein levels decreased in the mouse hippocampus following anesthesia and surgery. MEF2C overexpression ameliorated postoperative memory decline, hindered lipid peroxidation and iron accumulation, and enhanced antioxidant capacity, which were reversed by RSL3. Additionally, MEF2C was found to directly bind to the Gpx4 promoter and activate its transcription. Our findings suggest that MEF2C may be a promising therapeutic target for POCD through its negative modulation of ferroptosis.

Priority areas for outcomes improvement among older adults undergoing inpatient general surgery inclusive of geriatric-pertinent complications.

Comprehensive studies on priority areas for improving geriatric surgery outcomes, inclusive of geriatric-pertinent data, are limited. The ACS NSQIP geriatric database (2014-2018) was used to abstract older adults (≥65years) undergoing inpatient general surgery procedures. Thirty-day complication, functional decline, and mortality rates were analyzed, with a focus on two geriatric-pertinent complications: delirium and new/worsening pressure ulcers. There were 9062 patients; 41.9% were ≥75years. Mean age was 73.9years. The majority of patients were female (54.0%), White (77.7%), and had independent functional status before surgery (94.0%). Overall 30-day complication, functional decline, and mortality rates were 33.6%, 34.5%, and 3.5%, respectively; failure to the rescue rate was 9.7%. Including geriatric-pertinent complications increased the overall complication rate by 20.4%. Delirium emerged as the leading complication (11.9%), followed by bleeding (11.1%), and wound-related complications (10.1%); these three accounted for 53.7% of complications. Delirium and pressure ulcers were associated with a >50% rate of postoperative functional decline (52.0% and 71.4%, respectively); pressure ulcers were also notable for a 25.5% failure to the rescue rate. Both were also among complications most likely to occur following the 3 most common procedures (colorectal surgery, pancreatic resections, and exploratory laparotomy), which overall accounted for approximately 79.6% of complications, 73.4% of patients experiencing functional decline, and 82.3% of mortality. Delirium is the leading complication among older adults undergoing inpatient surgery. Overall, a small number of complications and procedure groups account for most surgical morbidity and mortality among older adults and thus constitute priority areas for outcomes improvement.

Development and Internal Validation of Machine Learning to Predict Postoperative Worse Functional Status after Surgical Treatment for Thoracic Spinal Stenosis.

BACKGROUND The objective of this study was to develop and validate machine learning (ML) algorithms to predict the 30-day and 6-month risk of deteriorating functional status following surgical treatment for thoracic spinal stenosis (TSS). We aimed to provide surgeons with tools to identify patients with TSS who have a higher risk of postoperative functional decline. MATERIAL AND METHODS The records of 327 patients with TSS who completed both follow-up visits were analyzed. Our primary endpoint was the dichotomized change in the perioperative Japanese Orthopedic Association (JOA) score, categorized based on whether it deteriorated or not. The models were developed using Naïve Bays, LightGBM, XGBoost, logistic regression, and random forest classification models. The model performance was assessed by accuracy and the c-statistic. ML algorithms were trained, optimized, and tested. RESULTS The best-performing algorithms for predicting functional decline at 30 days and 6 months after TSS surgery were XGBoost (accuracy=88.17%, c-statistic=0.83) and Naïve Bays (accuracy=86.03%, c-statistic=0.80). Both algorithms presented good calibration and discrimination in our testing data. We identified several significant predictors, including poor quality of intraoperative SSEP/MEP baseline, poor quality of preoperative SSEP, duration of symptoms, operated level, and motor dysfunction of the lower extremity. CONCLUSIONS The best-performing algorithms for predicting functional decline at 30 days and 6 months after TSS surgery were XGBoost (accuracy=88.17%, c-statistic=0.83) and Naïve Bays (accuracy=86.03%, c-statistic=0.80). Both algorithms presented good calibration and discrimination in our testing data. We identified several significant predictors, including poor quality of intraoperative SSEP/MEP baseline, poor quality of preoperative SSEP, duration of symptoms, operated level, and motor dysfunction of the lower extremity.

Comprehensive Geriatric Assessment, Treatment Decisions, and Outcomes in Older Patients Eligible for Pancreatic Surgery.

Periampullary cancer has a poor prognosis. Surgical resection is a potentially curative but high-risk treatment. Comprehensive geriatric assessment (CGA) can inform treatment decisions, but has not yet been evaluated in older patients eligible for pancreatic surgery. This prospective observational study included patients ≥ 70 years of age eligible for pancreatic surgery. Frailty was defined as impairment in at least two of five domains: somatic, psychological, functional, nutritional, and social. Outcomes included postoperative complications, functional decline, and mortality. Of the 88 patients included, 87 had a complete CGA. Sixty-five patients (75%) were frail and 22 (25%) were non-frail. Frail patients were more likely to receive nonsurgical treatment (43.1% vs. 9.1% p = 0.004). Fifty-seven patients underwent surgery, of which 52 (59%) underwent pancreaticoduodenectomy. The incidence of postoperative delirium was three times higher in frail patients (29.7% vs. 0%, p = 0.005). The risk of mortality was three times higher in frail patients (HR: 3.36, 95% CI: 1.43-7.89, p = 0.006). Frailty is common in older patients eligible for pancreatic surgery and is associated with treatment decision, a higher incidence of delirium and a three times higher risk of all-cause mortality. CGA can contribute to shared decision-making and optimize perioperative care in older patients.

Impact of the Hospital Frailty Risk Score on Outcomes After Transcatheter Aortic Valve Replacement in Late Elderly Patients.

Prognostic prediction using objective indices is needed to optimize the indications for transcatheter aortic valve replacement (TAVR). We evaluated the impact of the Hospital Frailty Risk Score (HFRS), an International Classification of Diseases (ICD)-based frailty index, on the prognosis after TAVR in the late elderly. We identified patients aged ≥75 years undergoing TAVR from April 2014 to September 2020 from the Shizuoka Kokuho Database (SKDB). Cox logistic regression analysis was performed to examine predictors of long-term mortality. We also evaluated the relationship between HFRS categories (low risk: <5, intermediate risk: 5-15, high risk: >15) and functional decline. This study involved 607 patients (189 (31.1%) men) with a mean age of 85.0 years. During the median follow-up period of 20 months, survival significantly differed among HFRS categories (survival at two years; low (HFRS <5): 88.9%, intermediate (HFRS 5-15): 82.6%, high (HFRS >15): 67.7%; log-rank p = 0.002). In the multivariate regression model, male sex (hazard ratio (HR): 2.15, 95% confidence interval (CI): 1.42-3.24), preoperative care needs level of ≥3 (HR: 2.43, 95% CI: 1.17-5.06), and HFRS (HR: 1.07, 95% CI: 1.03-1.12) were significant predictors of mortality. Functional decline-free survival significantly differed among HFRS categories (event-free survival at two years; low: 79.4%, intermediate: 75.2%, high: 50.8%; log-rank p = 0.001). The HFRS is a predictor of long-term mortality after TAVR in the late elderly and is associated with postoperative functional decline. The HFRS can provide additional information for decision-making regarding treatment strategies for the late elderly.

Long-Term Outcomes (10 Years) of Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Repair.

The purpose of this study was to evaluate the 10-year results of sacrospinous ligament suspension as primary repair for apical prolapse and to evaluate long-term side effects. A retrospective study analyzed 10-year follow-up after prolapse repair using sacrospinous ligament suspension. A subjective recurrence was identified as the postoperative occurrence of swelling symptoms based on a particular item on the Italian Prolapse Quality of Life (P-QoL) questionnaire. An objective recurrence was defined as a postoperative decline to stage II or below in any compartment based on the POP-Q system or the requirement for additional surgery. The assessment of postoperative subjective satisfaction was conducted using the Patient Global Impression of Improvement (PGI-I) score. In total, 40 patients underwent sacrospinous ligament fixation. Objective recurrence was remarkably high, as it was observed in 17 (56.7%) patients. Subjective recurrence was reported by ten (33.3%) women, and reintervention occurred in two (6.7%) of patients. From the point of view of quality of life, according to the PGI-I, twenty-three (76.7%) patients described some degree of improvement after surgery, four (13.3%) described their status as unmodified, and three (10%) reported some form of worsening after primary treatment. Transvaginal repair with sacrospinous fixation is a long-lasting option for prolapse repair, with improvement in every POP-q parameter. Some degree of anterior recurrence, recurrence of symptoms with swelling, or an overall worsening of quality of life after surgery is possible.

Neurological Complications After Transcatheter Aortic Valve Replacement: A Review.

Transcatheter aortic valve replacement (TAVR) has become the dominant procedural modality for aortic valve replacement in the United States. The reported rates of neurological complications in patients undergoing TAVR have changed over time and are dependent on diagnostic definitions and modalities. Most strokes after TAVR are likely embolic in origin, and the incidence of stroke has decreased over time. Studies have yielded conflicting results when comparing stroke rates between TAVR and surgical aortic valve replacement (SAVR), especially due to differences in diagnostic criteria and neurocognitive testing. In this narrative review, we summarize the available data on the incidence of stroke, delirium, and cognitive decline after TAVR and highlight potential areas in need of future research. We also discuss silent cerebral ischemic lesions (SCILs) and their association with a decline in postoperative neurocognitive status after TAVR. Finally, we describe that the risk of delirium and postoperative decline is increased when nonfemoral access routes are used, and we highlight the need for standardized imaging and valid, repeatable methodologies to assess cognitive changes after TAVR.

Progressive Loss of Acromioclavicular Joint Reduction Correlated with Progressive Clavicular Tunnel Widening after Coracoclavicular Stabilization in Acute High-Grade Acromioclavicular Joint Injury.

Objectives: This study aimed to compare 24-month radiographic follow-ups of clavicular tunnel widenings (CTWs) and coracoclavicular distances (CCDs) and examine correlations between these measurements in patients following combined coracoclavicular stabilization and acromioclavicular capsule repair in treatment of acute high-grade acromioclavicular joint injury. Methods: This retrospective study reviewed the records of patients with acute Rockwood type V acromioclavicular joint injury who underwent surgery within 3 weeks after their injury. All patients had follow-ups at 3 and 6 months and 1 and 2 years. The CTWs were measured on anteroposterior radiographs between the medial and lateral borders at the superior, middle and inferior levels of the tunnels. On anteroposterior radiographs of both clavicles, the CCDs were measured at the shortest distance between the upper border of the coracoid process and the inferior border of the clavicle and reported as the CCD ratio, which was defined as the ratio of the affected and unaffected clavicles. At the final follow-ups, clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) scores. Results: This study included seventeen men and six women with a mean age of 47.26 ± 10.68 years. At the final follow-ups, the mean ASES score of all patients was 95.28 ± 3.62. We found a significant correlation between the increase in the CTWs and the increase in the CCD ratios (Spearman's rho correlation coefficient range 0.578-0.647, all p-values < 0.001). Conclusions: We found long-term postoperative widening of the clavicular tunnels, which correlated positively with a gradual postoperative decline in the acromioclavicular joint alignment reductions.

Associations of Resilience, Perceived Control of Health, and Depression with Geriatric Outcomes after Surgery.

To identify if depression, resilience, and perceived control of health are related to 2.5-year mortality and instrumental activities of daily living (IADL) decline among older adults after surgery. The relationships of psychosocial factors with postoperative mortality and IADL decline among older adults are understudied. We identified 3778 community-dwelling older adults in the Health and Retirement Study (HRS) with Medicare claims for surgery (mean [SD] age: 75.4 [7.8] years, 53.9% women, and 86.0% non-Hispanic White). We assessed associations of depression, resilience, and perceived control of health with 2.5-year postoperative mortality and IADL decline using cox and modified Poisson regression analyses, adjusting for sociodemographic and health variables. The incidence of 2.5-year postoperative mortality was 18.5% and IADL decline was 9.4%. Depression was associated with a higher incidence and adjusted hazard [95% CI] of mortality (26% vs. 16%, aHR:1.2[0.9, 1.5]), but high resilience was associated with a lower incidence and adjusted hazard of mortality (9% vs. 21%, aHR:0.6[0.5, 0.8]). Those with depression had higher incidence and adjusted relative risk [95% CI] of IADL decline (17% vs. 7%, aRR:1.6[1.2, 2.2]), but lower incidence and adjusted relative risk of IADL decline was identified for those with high resilience (4% vs. 11%, aRR:0.6[0.4, 1.0]) and high perceived control of health (7% vs. 10%, aRR:0.6[0.4, 1.0]). While depression confers greater risk of mortality and IADL decline, higher resilience and perceived control of health may be protective. Addressing psychosocial factors in the peri-operative period may improve outcomes among older adults.

Hippocampal activations obtained during language fMRI tasks: A complementary tool for predicting postoperative memory prognosis

In medial temporal lobe epilepsy (MTLE), the benefits of surgery must be balanced against the risk of post-operative memory decline. Prediction of postoperative outcomes based on functional magnetic resonance imaging (fMRI) tasks is increasingly common but remains uncertain. The aim of this retrospective study was to determine whether hippocampal activations elicited by fMRI language tasks could enhance or refine memory fMRI in MTLE patients candidates to surgery. Forty-six patients were included: 30 right and 16 left MTLE, mostly with hippocampal sclerosis. Preoperative assessment included neuropsychological tests and fMRI with language (syntactic verbal fluency) and memory tasks (encoding, delayed, and immediate recognition of images of objects). Thirty patients underwent surgery and had neuropsychological evaluations one year after surgery. Worsening was defined as a degradation of more than 10 % in postoperative forgetting scores compared to preoperative scores in verbal, non-verbal and global memory. Memory fMRI had the best sensitivity with hippocampal activations obtained in 95 % of patients, versus 65 % with language fMRI. Considering the patients who elicited an hippocampal activation, language fMRI led to 80 %, 65 % and 85 % of correct predictions for respectively global, verbal and non verbal memory (versus 71 %, 64 % and 68 % with memory fMRI). Memory and language fMRI predictions outperformed those made by neuropsychological tests. In summary, language fMRI was less sensitive than memory fMRI to elicit hippocampal activations but when it did, the proportion of correct memory predictions was better. Moreover, it proved to be an independent predictive factor regardless of the side of the epileptic focus. Given the ease of setting up a language task in fMRI, we recommend the systematic combination of memory and language tasks to predict the post-operative memory outcome of MTLE patients undergoing epilepsy surgery.

Kidney function assessment using cystatin C and serum creatinine in heart transplantation recipients: Implications for valganciclovir dosing

BackgroundAmong heart transplantation (HT) recipients, the accuracy of serum creatinine (sCr)-based estimated glomerular filtration rate (eGFR) may be limited by fluctuations in extrarenal variables (e.g., muscle mass). Cystatin C (cysC) is less influenced by muscle mass; however, obesity and steroid use may increase cysC levels. Herein, we: i) longitudinally compared changes in eGFRcysC and eGFRsCr among HT recipients; ii) investigated the association of body mass index (BMI), steroid use and muscle mass with discrepancies between eGFRs; and iii) explored the implications of eGFRcysC use on valganciclovir (VGC) dosing. MethodscysC and sCr were measured in 294 blood samples obtained from 80 HT recipients. Intra-individual differences between eGFRs (eGFRdiffcysC-sCr) were calculated. Negative eGFRdiffcysC-sCr values correspond to eGFRsCr > eGFRcysC and positive values to eGFRcysC > eGFRsCr. In a patient subset (n=21), pectoralis muscle measures were derived from computed tomography scans. ResultsMarked differences between eGFRcysC and eGFRsCr were observed, particularly early post-HT (1-week post-HT, median eGFRdiffcysC-sCr -28 ml/min/1.73 m2). eGFRcysC demonstrated stability following a transient post-operative decline, while eGFRsCr decreased in the first year post-HT. Lower BMI and higher prednisone dose displayed a modest association with more negative eGFRdiffcysC-sCr values. Conversely, pectoralis muscle measures indicative of greater muscle mass and better tissue quality exhibited a stronger association with more positive eGFRdiffcysC-sCr values. The use of eGFRcysC would have led to VGC dose adjustment in 46% of samples, predominantly resulting in dose reduction. ConclusionsAmong HT recipients, eGFRcysC and eGFRsCr markedly differ with implications for VGC dosing. The observed discrepancies may reflect changes in body composition and steroid use.