Project Database Research Articles

Impact of Ex Vivo Lung Perfusion on Inpatient Cost: A Propensity Score-Matched Analysis of the US Nationwide Healthcare Cost and Utilization Project Database.

The goal of this study was to investigate the association between ex vivo lung perfusion (EVLP) use and inpatient hospitalization cost for lung transplantation in a nationwide sample. Lung transplantation patients in 2018-2020 Nationwide Readmissions Database (NRD) were grouped based on use of EVLP. The primary outcome was total inpatient hospitalization cost. 1:2 propensity score matching by EVLP status was performed followed by multivariable linear regression to determine the association between inpatient cost and EVLP while adjusting for pre-transplant hospital days, high volume EVLP center status, and propensity score. There were 3902 lung transplants and 118 (3%) were recipients of EVLP lungs. Among EVLP patients, the median cost was $871468 (IQR: $608671-1274392), compared to $846516 (IQR: $531462-1439267, p=0.871) among the total non-EVLP cohort. After 1:2 propensity score-matched cohort, recipients of EVLP lungs had longer median hospital length of stay (p=0.046). In the multivariable model using the matched sample, increased cost was not associated with EVLP use (p=0.783); however, high volume EVLP centers were associated with decreased cost (p=0.018). EVLP use was not associated with greater inpatient costs and may be favorable at high volume centers.

Intraoperative neuromonitoring is not a useful adjunct for Chiari malformation decompressive surgery: a cost-benefit and legal analysis.

Posterior fossa decompression is currently an operative treatment of choice for Chiari Malformation I (CM1). However, there is controversy surrounding the possible benefits of employing intraoperative neuromonitoring (INM) for this type of procedure. In addition to presenting our single-center experience on the use of INM, we analyze the cost associated with INM in Chiari Malformation (CM) decompression surgery using the Healthcare Cost and Utilization Project (HCUP) database and discuss the legal implications of somatosensory evoked potentials (SSEP) monitoring during decompression for CM1. We conducted a retrospective review of all patients undergoing CM1 decompression with SSEP neuromonitoring from 2011 to 2018. We collected patient characteristics, hospital charges, and surgical cost data from the HCUP database for patients undergoing CM decompression. Finally, we performed a review within the Thompson Reuters Westlaw Edge database for reported litigation involving INM for CM decompression. None of the 110 patients submitted to surgery for CM1 at our institution had any significant SSEP changes intraoperatively or developed post-operative neurological deterioration. There were higher mean total hospital charges and surgical costs associated with INM ($31,272) for patients who received INM compared to patients who did not receive INM ($24,112). A careful review of the Westlaw database with multiple-word search strategies revealed no reported medical malpractice claims regarding the absence of SSEP neuromonitoring in a CM decompression procedure. Using data collected at our institution and the HCUP national database, we showed that intraoperative neuromonitoring did not affect surgical planning and decision-making or post operative care, while adding unnecessary costs to CM decompression procedures. The absence of reported malpractice claims targeting the lack of neuromonitoring in CM cases suggests that SSEP neuromonitoring during CM may be unnecessary. We propose that neuromonitoring should not be used for routine CM decompression.

Transformer-generated atomic embeddings to enhance prediction accuracy of crystal properties with machine learning

Accelerating the discovery of novel crystal materials by machine learning is crucial for advancing various technologies from clean energy to information processing. The machine-learning models for prediction of materials properties require embedding atomic information, while traditional methods have limited effectiveness in enhancing prediction accuracy. Here, we proposed an atomic embedding strategy called universal atomic embeddings (UAEs) for their broad applicability as atomic fingerprints, and generated the UAE tensors based on the proposed CrystalTransformer model. By performing experiments on widely-used materials database, our CrystalTransformer-based UAEs (ct-UAEs) are shown to accurately capture complex atomic features, leading to a 14% improvement in prediction accuracy on CGCNN and 18% on ALIGNN when using formation energies as the target, based on the Materials Project database. We also demonstrated the good transferability of ct-UAEs across various databases. Based on the clustering analysis for multi-task ct-UAEs, the elements in the periodic table can be categorized with reasonable connections between atomic features and targeted crystal properties. After applying ct-UAEs to predict formation energy in hybrid perovskites database, we realized an improvement in accuracy, with a 34% boost in MEGNET and 16% in CGCNN, showcasing their potential as atomic fingerprints to address the data scarcity challenges.

Serotonin Receptors Polymorphisms Are Associated With Cyclic Vomiting Syndrome.

Cyclic vomiting syndrome (CVS) is a disorder characterized by sudden, recurrent episodes of severe nausea and vomiting. The pathophysiology of CVS is not known but genetic factors that regulate emetic neurocircuitry have been proposed. The aim of this study was to investigate whether different variations in genes encoding serotonin receptors (HTRs) are associated with susceptibility to CVS and/or CVS symptoms. This case-control study included 70 patients with CVS:16 male and 54 female, and 2504 healthy controls from the 1000 Genomes Project database. Single-nucleotide polymorphisms (SNPs) in genes encoding serotonin receptors (HTR1B, HTR1D, HTR3B and HTR3C) and correlations between SNPs and the symptoms of CVS were determined. Our study discovered that patients with GG, AA and GG genotypes of HTR1B/D rs6296, rs6298 and rs6300, respectively, as well as the CC genotype of HTR3B rs176744 are associated with an increased risk (p < 0.001), whereas allele C in rs3788987 (HTR3B, p < 0.01) and allele A in rs6766410 (HTR3C, p < 0.05) were associated with a decreased risk of CVS. In addition, statistical analysis indicated that CVS patients with GA or AA genotypes of HTR1D rs676643 gene have a seven-fold increase in risk of depression compared to patients with GG genotype (p < 0.01). Our study revealed for the first time that variations in 5-HTR genes may contribute to CVS susceptibility and CVS-related symptoms.

Comparison of different microbiome analysis pipelines to validate their reproducibility of gastric mucosal microbiome composition.

Microbiome analysis has become a crucial tool for basic and translational research due to its potential for translation into clinical practice. However, there is ongoing controversy regarding the comparability of different bioinformatic analysis platforms and a lack of recognized standards, which might have an impact on the translational potential of results. This study investigates how the performance of different microbiome analysis platforms impacts the final results of mucosal microbiome signatures. Across five independent research groups, we compared three distinct and frequently used microbiome analysis bioinformatic packages (DADA2, MOTHUR, and QIIME2) on the same subset of fastQ files. The source data set encompassed 16S rRNA gene raw sequencing data (V1-V2) from gastric biopsy samples of clinically well-defined gastric cancer (GC) patients (n = 40; with and without Helicobacter pylori [H. pylori] infection) and controls (n = 39, with and without H. pylori infection). Independent of the applied protocol, H. pylori status, microbial diversity and relative bacterial abundance were reproducible across all platforms, although differences in performance were detected. Furthermore, alignment of the filtered sequences to the old and new taxonomic databases (i.e., Ribosomal Database Project, Greengenes, and SILVA) had only a limited impact on the taxonomic assignment and thus on global analytical outcomes. Taken together, our results clearly demonstrate that different microbiome analysis approaches from independent expert groups generate comparable results when applied to the same data set. This is crucial for interpreting respective studies and underscores the broader applicability of microbiome analysis in clinical research, provided that robust pipelines are utilized and thoroughly documented to ensure reproducibility.IMPORTANCEMicrobiome analysis is one of the most important tools for basic and translational research due to its potential for translation into clinical practice. However, there is an ongoing controversy about the comparability of different bioinformatic analysis platforms and a lack of recognized standards. In this study, we investigate how the performance of different microbiome analysis platforms affects the final results of mucosal microbiome signatures. Five independent research groups used three different and commonly used bioinformatics packages for microbiome analysis on the same data set and compared the results. This data set included microbiome sequencing data from gastric biopsy samples of GC patients. Regardless of the protocol used, Helicobacter pylori status, microbial diversity, and relative bacterial abundance were reproducible across all platforms. The results show that different microbiome analysis approaches provide comparable results. This is crucial for the interpretation of corresponding studies and underlines the broader applicability of microbiome analysis.

The Epidemiology and Treatment Outcomes of Facial Nerve Palsy Using a Population-Based Method.

To update the epidemiological patterns of facial nerve palsy (FNP) in Olmsted County, MN. A retrospective chart review using the Rochester Epidemiology Project database was conducted. Patients aged ≥18 years receiving a diagnosis of FNP within the Rochester Epidemiology Project database from the years 2000 to 2010 were included in the study. Data collected included age, gender, cause of FNP, degree of paralysis, medical and/or surgical management, and outcomes. Overall incidence rates were determined using gender-specific population figures for Olmsted County. Incidence trends were compared with previous Rochester Epidemiology Project studies. The most common cause for FNP was Bell palsy (70.3% of cases). The overall incidence rate for Bell palsy in Olmsted County from 2000 to 2010 was 39.9 (95% CI, 36.1-43.7) per 100,000 person-years. This is an absolute increase of 14.9 per 100,000 person-years and a 60% relative increase in Bell palsy compared with a previous study performed at Mayo Clinic using the Rochester Epidemiology Project database population data from 1968 to 1982. Patients were infrequently evaluated by an ophthalmologist (8.4% of cases), and surgical intervention to address ophthalmic sequelae was rare (1.7% of cases). The incidence of Bell palsy has increased dramatically over previous studies, which has occurred in the setting of declining herpes simplex virus type 1 seropositivity trends and increasing herpes zoster incidence in the United States. Few patients with FNP are referred to ophthalmologists, which may represent a gap in care for both acute and long-term ophthalmic sequelae.

Liver Injury as a Risk Factor for Post-Traumatic Venous Thromboembolism.

Venous thromboembolism (VTE) remains a major source of morbidity and mortality in severely injured patients despite current methods of risk stratification and prophylaxis, suggesting incomplete understanding of VTE risk factors. Given the liver's role in coagulation, we hypothesized that liver injury (LI) is associated with increased rates of VTE in severely injured patients. The American College of Surgeons Trauma Quality Improvement Project database (TQIP) 2017-2021 was retrospectively reviewed for patients with a maximum abdominal Abbreviated Injury Score (AIS) ≥ 4 with or without LI. Transfers, burns, all deaths, and patients < 18 years of age were excluded. Logistic regression was performed to assess the independent effect of LI on development of pulmonary embolism (PE) and deep venous thrombosis (DVT) while controlling for potential confounding variables. In 44,506 patients, there were 1,736 (3.9%) 890 (2.0%), and 18,642 patients (41.9%) with DVT, PE, and LI, respectively. After controlling for potential confounders, LI was independently associated with PE (aOR 1.279 [95% CI 1.088-1.504]) but was not associated with DVT (aOR 1.011 [95% CI 0.897-1.140]). In severely injured patients, LI is an independent predictor of PE, but not DVT, suggesting LI is the source of either emboli or a more complex locally prothrombotic focus leading to downstream thrombi in the lung without causing upstream systemic venous thrombi. Further work should focus on elucidation of mechanisms including the portal venous blood coagulation profile, endothelial injury in the liver, and the potential for stasis of venous blood traversing an injured liver as well as the role for including LI in VTE risk stratification.

Relationships Among Comorbidities, Disease Severity, and Hospitalization Duration in the United States Using the Healthcare Cost and Utilization Project (HCUP) Database

Background/Objectives: Hospital length of stay (LOS) is widely analyzed and serves as a benchmark for assessing changes during hospitalization. This study introduced a method to estimate patients’ LOS and highlighted the variations in LOS among individuals with or without multiple chronic conditions (MCCs) and across different levels of disease severity, using data from the 2016 National Inpatient Sample in the United States. Methods: To analyze the factors influencing LOS, a multinomial logistic regression model was employed, demonstrating its effectiveness in estimating and predicting expected LOS. Factors such as demographic characteristics, MCCs, and disease severity were strongly linked to LOS. Results: The overall prevalence of MCCs exceeded 66%, rising to over 90% among elderly patients and more than 88% among those with severe diseases. LOS distribution was primarily concentrated within the first month following admission: over 13% of patients were discharged within a day, over 85% within a week, and more than 99% within a month. Multinomial logistic regression analysis showed that LOS was significantly influenced by age, disease severity, and the presence of MCCs. Older patients, especially those with MCCs, had significantly longer LOSs compared to younger patients without MCCs. Conclusions: LOS tended to increase with age and higher disease severity, particularly in patients with MCCs. Multinomial logistic regression revealed that patients over 65 and those with high disease severity (severity score 4) had significantly longer LOS. Shorter LOS was more frequent among patients under 65 years old, those without MCC, and those with low disease severity, whereas longer LOS was commonly observed in patients with MCCs or high disease severity.

Glaucomatous retinal ganglion cells: death and protection.

Glaucoma is a group of diseases characterized by progressive optic nerve degeneration, with the characteristic pathological change being death of retinal ganglion cells (RGCs), which ultimately causes visual field loss and irreversible blindness. Elevated intraocular pressure (IOP) remains the most important risk factor for glaucoma, but the exact mechanism responsible for the death of RGCs is currently unknown. Neurotrophic factor deficiency, impaired mitochondrial structure and function, disrupted axonal transport, disturbed Ca2+ homeostasis, and activation of apoptotic and autophagic pathways play important roles in RGC death in glaucoma. This review was conducted using Web of Science, PubMed, Project, and other databases to summarize the relevant mechanisms of death of RGCs in glaucoma, in addition to outlining protective treatments to improve the degradation of RGCs.

Hospitalization Trends and Healthcare Resource Utilization for Fecal Impactions in Pediatric Patients with Functional Constipation.

Objectives: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients. For healthcare resource utilization, we analyzed the length of hospital stays and total hospital charges, adjusted for inflation. Results: A total of 23,570 admissions due to fecal impactions in children between the years 2011 and 2019 were analyzed, contributing to 0.18% of the total pediatric admissions. Hospitalization rates nearly doubled from 2011 (0.15%) to 2019 (0.29%). The mean hospitalization charges also trended upwards from 15,234 USD in 2011 to 22,487 USD in 2019. The inflation-adjusted annual rate of increase in hospital charges during this period was 5.9% per year. Aggressive fecal disimpaction procedures (either manual or surgical) were performed in approximately 3% of these admissions. Multivariate regression showed that older children (13-18 years of age) were more likely to require aggressive disimpaction. Female children, those with Hispanic ethnicity, and those with obesity were less likely to be associated with the need for disimpaction. Conclusions: Hospitalizations for fecal impaction have increased significantly over the past decade, creating a substantial burden on healthcare resources. Our study highlights the importance of aggressive outpatient management strategies with close follow-up for fecal impactions, which will potentially minimize these hospitalizations.

Demographic and lifestyle characteristics impact lifetime prevalence of owner-reported intervertebral disc disease: 43,517 companion dogs in the United States.

Intervertebral disc disease (IVDD) is a debilitating spinal condition that has been well studied among Dachshunds. However, little is known about IVDD prevalence across other dog breeds and associated lifestyle risk factors. The purpose of this study was to identify lifetime prevalence, demographic, and lifestyle factors associated with IVDD among a large population of companion dogs in the US. An observational cross-sectional study was conducted with the Dog Aging Project database. Companion dogs enrolled between December 26, 2019, and December 31, 2022, were included. The primary outcome was lifetime prevalence of owner-reported IVDD (OR-IVDD). Associations between OR-IVDD, demographic, and lifestyle factors were evaluated with multivariate logistic regression. 43,517 dogs (female, 49.6% [21,582 of 43,517]; purebred, 50.3% [21,910 of 43,517]) were included in the study. Lifetime prevalence of OR-IVDD was 1.2% (520 of 43,517). On adjusted analysis, male (OR, 1.36; 95% CI, 1.13 to 1.64), purebred (OR, 1.66; 95% CI, 1.37 to 2.01), toy and small (OR, 1.85; 95% CI, 1.51 to 2.27), and overweight (OR, 1.67; 95% CI, 1.38 to 2.01) dogs had increased odds of OR-IVDD. Lifestyle factors associated with reduced odds of OR-IVDD include higher daily active time, being on a commercial diet, and regular use of a staircase. Dachshunds had the highest lifetime prevalence of OR-IVDD (15.3% [83 of 541]). Among purebred dogs, French Bulldogs had the highest odds of OR-IVDD (OR, 21.1; 95% CI, 12.5 to 35.8) on adjusted analysis. Owner-reported IVDD is impacted by demographic and lifestyle factors such as breed status, daily active time, and staircase use. An increased focus on breed-specific research of French Bulldogs would be beneficial considering breed popularity and lifetime prevalence of OR-IVDD. Further longitudinal research is needed to assist with clinical decision-making and lifestyle recommendations.

Mendelian Randomization Study Reveals Causal Pathways for Hypertrophic Cardiomyopathy, Cardiovascular Proteins, and Atrial Fibrillation.

Aims/Background Research evidence has demonstrated a significant association between hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), but the causality and pattern of this link remain unexplored. Therefore, this study investigated the causal relationship between HCM and AF using a two-sample and bidirectional Mendelian randomization (MR) approach. Additionally, this assessed the role of cardiovascular proteins (CPs) associated with cardiovascular diseases between HCM and AF by applying a two-step MR analysis. Methods Data for HCM, AF, and 90 CPs were obtained from the Finn Gen and IEU Open GWAS Project databases. MR-Egger, inverse variance weighting (IVW), weighted median estimator (WME), weighted mode, and simple mode were used to estimate causal inferences. Furthermore, Cochran's Q test, MR-Egger's intercept terms, and Leave-one-out methods determined the heterogeneity, horizontal pleiotropy, and sensitivity. Additionally, mediation effects were used to assess the role of CPs in the relationship between HCM and AF. Results Two-sample and bidirectional MR analysis revealed HCM as a risk factor for AF (odds ratio (OR) = 1.008, 95% confidence interval (CI): 1.001-1.016, p = 0.029) and AF was found to increase the risk of developing HCM (OR = 1.145, 95% CI: 0.963-1.361, p = 0.126). Moreover, Two-step MR analyses indicated that 5 CPs were causally associated with HCM; 12 CPs with AF and 1 CP (Melusin) with both HCM and AF. Additionally, Melusin was observed as a protective factor for both HCM and AF and may serve as a mediator variable for these two conditions (mediation effect 0.0004, mediation ratio 5.5178%, 95% CI: 5.4624-5.5731). Conclusion HCM may increase the risk of developing AF, with Melusin serving as a mediator for this risk.

Phylotypr: an R package for classifying DNA sequences.

The phylotypr R package implements the popular naive Bayesian classification algorithm that is frequently used to classify 16S rRNA and other gene sequences to taxonomic lineages. A companion data package, phylotyprrefdata, also provides numerous versions of taxonomic databases from the Ribosomal Database Project, SILVA, and greengenes.

Doing Less Later: Seniorization of General Surgery Resident Operative Experience in the Entrustable Professional Activities at Veterans Affairs Hospitals.

Identify changes in general surgery resident autonomy and resident postgraduate year (PGY) level in Entrustable Professional Activity (EPA) cases over time. Retrospective cohort study. United States Veterans Affairs (VA) hospital system, 2004 to 2020. All patients undergoing operations in any of the 12 general surgery EPAs with identifiable operative components captured by the VA Surgical Quality Improvement Project database from 2004 to 2020. 452,549 cases were identified. Between 2004 and 2020, there was a 61.4% decrease in resident-performed cases and a 14.3% decrease in attending-assisted cases, with a concomitant 51.8% increase in attending-performed cases. All EPAs experienced a statistically significant decrease in resident autonomy over the study period, and a net transfer of cases from resident-performed to attending-performed. About 7 of 12 EPAs had significant increases in the resident PGY level of attending-assisted cases over the study period: abdominal wall hernia, benign/malignant breast, benign/malignant colon, cutaneous/subcutaneous neoplasm, gallbladder disease, inguinal hernia, and soft tissue infection. About 3 EPAs had significant increases in the resident PGY of resident-performed cases: abdominal wall hernia, benign/malignant breast, and inguinal hernia. Many of these changes represented seniorization of the operative experience by 3 to 12 months. There has been a continual decrease in resident operative autonomy across all general surgery EPAs at the VA. Furthermore, many EPA cases have shifted to more senior residents over time, delaying or deferring autonomous completion of these cases during training. Although these data were drawn from the VA system, the results likely reflect a continued decrease in autonomy for resident surgeons in other settings as well. As general surgery adapts to a competency-based educational model, action is needed to stabilize these changes for sustainable graduate surgical education.

Predicting loss of independence among geriatric patients following gastrointestinal surgery

BackgroundWhile existing risk calculators focus on mortality and complications, elderly patients are concerned with how operations will affect their quality of life, especially their independence. We sought to develop a novel clinically relevant and easy-to-use score to predict elderly patients’ loss of independence after gastrointestinal surgery.MethodsThis retrospective cohort study included patients age ≥ 65 years enrolled in the American College of Surgeons National Surgical Quality Improvement Program database and Geriatric Pilot Project who underwent pancreatic, colorectal, or hepatic surgery (January 1, 2014- December 31, 2018). Primary outcome was loss of independence – discharge to facility other than home and decline in functional status. Patients from 2014 to 2017 comprised the training data set. A logistic regression (LR) model was generated using variables with p < 0.2 from the univariable analysis. The six factors most predictive of the outcome composed the short LR model and scoring system. The scoring system was validated with data from 2018.ResultsOf 6,510 operations, 841 patients (13%) lost independence. Training and validation datasets had 5,232 (80%) and 1,278 (20%) patients, respectively. The six most impactful factors in predicting loss of independence were age, preoperative mobility aid use, American Society of Anesthesiologists classification, preoperative albumin, non-elective surgery, and race (all OR > 1.83; p < 0.001). The odds ratio of each of these factors were used to create a sixteen-point scoring system. The scoring system demonstrated satisfactory discrimination and calibration across the training and validation datasets, with Receiver Operating Characteristic Area Under the Curve 0.78 in both and Hosmer-Lemeshow statistic of 0.16 and 0.34, respectively.ConclusionsThis novel scoring system predicts loss of independence for geriatric patients after gastrointestinal operations. Using readily available variables, this tool can be applied in the urgent setting and can contribute to elderly patients and their family discussions related to loss of independence prior to high-risk gastrointestinal operations. The applicability of this scoring tool to additional surgical sub-specialties and external validation should be explored in future studies.

Validation and Recalibration of a Model for Predicting Surgical-Site Infection After Pelvic Organ Prolapse Surgery.

The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery. This study utilized a previously validated model for predicting post-POP surgery SSI within 90days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database. Discriminatory performance was assessed via the c-statistic and calibration was assessed using calibration curves. Methods of recalibration in the large and logistic recalibration were used to update the models. The PHD contained 420,277 POP procedures meeting the inclusion criteria and 1.6% resulted in SSI. The NSQIP dataset contained 62,553 POP surgeries and 1.4% resulted in SSI. Discrimination of the original model was comparable with that seen in the initial validation (c-statistic = 0.57 in PHD, 0.59 in NSQIP vs 0.60 in the original Medicare data). Recalibration greatly improved model calibration when evaluated in NSQIP data. A previously developed model for predicting SSI after POP surgery demonstrated stable discriminatory ability when externally validated on the PHD and NSQIP databases. Model recalibration was necessary to improve prediction. Prospective studies are needed to validate the clinical utility of such a model.

International youth football research developments: A CiteSpace-based bibliometric analysis.

With the vigorous development of football, research on youth football has garnered significant attention from scholars, leading to an increase in published findings. However, there is currently no comprehensive retrospective study that examines the status, hotspots, and trends of research in this field. This study employed Cite Space, a visual bibliometric software, to systematically review and analyze 1637 articles from the Web of Science (WOS) and China Knowledge Infrastructure Project (CNKI) databases up to January 2024. The primary objective was to examine the sources, authors, institutions, regions, citations, as well as keywords, and clustering of these articles to identify the global research hotspots and trends in youth football. The study concluded that the number of research articles in this field has been decreasing annually, and the research hotspots are exhibiting a gradual downward trend. The primary research institutions are comprehensive universities, supplemented by research centers and hospitals. The United States, the United Kingdom, Spain, and China have produced substantial research results in this area, and collaboration among researchers is relatively strong, indicating a positive development trajectory. Current research hotspots include sports monitoring and evaluation, sports injury and risk, talent identification and development, sports performance, the integration of sports and education, school football, and youth training systems. This finding provides a comprehensive overview of the research landscape in this field and presents opportunities for researchers to pursue further in-depth investigations.

Body Mass Index and Complication Rates Among Patients Undergoing Gender-Affirming Surgeries: An Analysis of the National Surgical Quality Improvement Project Database.

To determine the relationship between body mass index (BMI) and complication rates among patients undergoing gender-affirming surgeries (GAS). The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2015 to 2021. Patients who underwent a GAS were identified using International Classification of Diseases Ninth (ICD-9) and Tenth (ICD-10) codes. Current Procedural Terminology (CPT) codes were organized within 6 GAS subgroups: masculinizing top, masculinizing bottom, feminizing top, feminizing bottom, head and neck, and voice procedures. BMI was classified as underweight, healthy weight, overweight, or obese classes I-III using the Center for Disease Control and Prevention ranges. Demographic data included sex, age, race, and ethnicity. Descriptive statistics were used to characterize the study sample, and hierarchical logistic regression was used to examine the association between GAS, BMI, and surgical complications. Among the 6771 cases, the majority had a BMI categorized as healthy weight (33.5%) or overweight (30.5%). Smaller proportions had obesity class I (18.6%), class II (8.4%), or class III (6.2%); 1.9% were underweight. BMI was not a significant predictor of complications among those undergoing masculinizing and feminizing top surgeries or head and neck surgeries. Among participants undergoing masculinizing bottom surgery, those with class 1 obesity were 70% less likely to have surgical complications compared to those with a healthy weight. For those undergoing feminizing bottom surgeries, participants with class 1 obesity were 3.3 times more likely to have surgical complications compared to those with a healthy weight. BMI is commonly used to determine GAS eligibility, yet its utility in predicting complications is uncertain. Healthcare providers should consider the patient's overall health status when assessing GAS eligibility rather than relying on BMI alone.

The impact of the war in Ukraine on the prevalence of MDR/RR-TB in Poland.

The 2022 invasion of Ukraine by the Russian Federation triggered a refugee crisis, affecting the multidrug-/rifampicin-resistant TB (MDR/RR-TB) prevalence in neighbouring countries. This study examines the epidemiological trends and characteristics of MDR/RR-TB patients in Poland, focusing on the relative contribution of Ukrainian refugees. Data from the Polish National Tuberculosis Registry and EPIC Project database, covering MDR/RR-TB cases reported between 2010 and Q1 2024, were analysed. The study included 794 MDR/RR-TB cases, showing a demographic shift post-2022. During the 10-year period up to 2021, a median of 48 MDR/RR-TB cases were reported annually in Poland. After 2022, these numbers doubled: 104 cases were reported in 2022 and 101 cases in 2023. Simultaneously, the number of Ukrainian MDR/RR-TB patients increased from 77 (13%) during 2010-2021 to 127 (58%) from 2022 to Q1 2024. Poland is observing an increased number of cases of MDR/RR-TB associated with the large number of displaced Ukrainian citizens who are now residing in Poland. There is a need to monitor the epidemiology of MDR/RR-TB and seek optimal screening and management strategies for TB among refugees from countries with high MDR/RR-TB incidence in Poland and Europe.

Use of individualized starting dose and niraparib hematologic adverse event management costs in ovarian cancer.

Aim: To understand the impact of the niraparib individualized starting dose (ISD), compared with fixed starting dose (FSD), on the cost of hematologic adverse event (AE) management from a US payer perspective. Methods: The frequencies of grade ≥3 hematologic AEs that occurred in >1% of patients treated with niraparib were obtained from the primary analysis results of the phase III PRIMA/ENGOT-OV26/GOG-3012 trial. US unit costs for each grade ≥3 AE in the base case were obtained from the 2017 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project database; unit costs were adjusted to 2020 US dollars. AE management costs per patient were calculated by multiplying AE unit cost by the frequency of each AE by niraparib starting dose. Because AEs were assumed to occur independently of one another, costs were added to derive the total cost. Results: For niraparib, the estimated AE management cost per patient was lower for the ISD than the FSD for all hematologic AEs (FSD vs ISD: thrombocytopenia, $4701.87 vs $1921.89; anemia, $2784.00 vs $1760.59; platelet count decreased, $2103.47 vs $922.51; neutropenia, $2112.50 vs $1369.56; neutrophil count decreased, $1285.87 vs $770.38). The total mean calculated AE management cost per patient was $12,987.71 with the FSD and $6744.93 with the ISD. Conclusion: For niraparib, the cost of managing hematologic AEs in the US was reduced by almost half with the ISD compared with the FSD. The cost reduction and improvements in safety associated with the niraparib ISD support its use in clinical practice.