Registry Study Research Articles (Page 1)

Accidental hypothermia is a rare condition, and it is reported to cause 2-5 deaths per 100,000 in European studies and at least 1,500 deaths in the United States annually. There is limited evidence concerning concomitant factors, clinical findings, prehospital care, and treatment methods related to patients who experience accidental hypothermia. This is a retrospective registry study with data consisting of patients over 18years of age who were admitted to Oulu University Hospital in Finland with accidental hypothermia. Data were collected for 12years (2008-2019). Patients were divided into survivors and non-survivors according to their 30-day survival. Of 315 initial patients, 241 were included in the final analysis: 206 survivors and 35 non-survivors. Alcohol abuse was the most common concomitant factor (49%), followed by age ≥ 65years (42%). Indoor exposure was the most common etiology among non-survivors while outdoor exposure was most common among survivors (37% vs. 64%, p < 0.001). Daytime EMS dispatch was associated with higher mortality than nighttime dispatch (18% vs. 3%, p = 0.007). Lower recorded temperatures on the scene (27.0°C vs. 30.1°C) and in the emergency department (27.4°C vs. 31.9°C) were associated with decreased survival rate (p < 0.001 for both). Overall 30-day mortality was low (15%) and survival after cardiac arrest was high (47%). According to multivariable logistic regression analysis for concomitant factors and hypothermia etiology, submersion (odds ratio 0.27, p = 0.038) and trauma (odds ratio 0.32, p = 0.084) decreased the chance of 30-day survival. Alcohol abuse and age ≥ 65years were two of the most common concomitant factors for accidental hypothermia. Non-survivors were generally older and more likely to be found indoors. They were most often found during daytime hours, and their recorded temperature was generally lower. Submersion and trauma were independent risk factors for mortality.

We assessed health-related quality of life (HRQoL) in 80 children with rare hereditary spastic paraplegias using the Caregiver Priorities and Child Health Index of Life with Disabilities and clinician-reported outcomes. HRQoL was consistently reduced, particularly in relation to motor, autonomic, and bulbar symptoms. Children with complex HSP phenotypes had lower scores than those with pure forms. Scores correlated with established clinical scales but declined with age only in HSP-SPG11 and HSP-ZFYVE26. These findings identify key determinants of reduced quality of life and highlight clinical targets for supportive interventions in childhood-onset hereditary spastic paraplegia. Trial Registration: Registry and Natural History Study for Early Onset Hereditary Spastic Paraplegia: NCT04712812.

Osteoarthritis (OA) is associated with joint pain and disability, with increasing prevalence and economic burden. This study explored non-steroidal anti-inflammatory drugs (NSAID) treatment patterns, gastrointestinal (GI) complications and burden of disease in patients with OA based on Nordic registry data, with emphasis on individuals aged 60 or younger. This non-interventional observational study analysed registry data from Norway, Finland, and Sweden. Adults with primary OA diagnosis in specialty care were matched 1:1 by age and sex with individuals of the general population. The primary outcome was NSAID treatment patterns, assessed by dispensations and daily defined doses (DDD) 1year before and after diagnosis. Secondary outcomes included prevalence of comorbidities, the incidence of GI complications, sick leave, and joint replacements. The study included 189,553 patients with OA from Norway, 341,548 from Sweden, and 218,253 from Finland, 34.1% to 40.4% aged ≤ 60. About half of patients had NSAIDs dispensed before and after diagnosis, (Norway 56.6% and 48.6%; Sweden 50.1% and 44.0%; Finland 58.8% and 58.2%), compared to about one-fifth of the matches (Norway 19.1% and 18.5%; Sweden 12.7% and 12.2%; Finland 22.5% and 21.7%). NSAID use increased with age until approximately 55years, then declined. After diagnosis, fewer patients had NSAID dispensations, but mean DDDs per prescription were generally higher. Secondary analyses showed a higher comorbidity burden, higher rates of GI complications, more sick leave days, and more joint replacements in patients with OA than in matched individuals. Across Nordic countries, patients with OA had more NSAID dispensations, and GI complications were more prevalent compared to matched individuals. Notably, this was already evident in younger patients under the age of 60, underscoring the need for comprehensive GI risk assessment for every patient with OA. The substantial burden of OA was also evidenced by considerable numbers of sick leave days and joint replacements.

Children with congenital or acquired cardiac disease are at increased risk for both ischemic and hemorrhagic stroke. This review covers the epidemiology, presentation, acute management, and outcomes of stroke in children with heart disease. The major advances in endovascular thrombectomy for adults with large vessel occlusions (LVOs) have had significant ramifications for children with cardioembolic stroke, who often present with LVO. Several large registry studies have shown that thrombectomy likely improves outcomes for children with LVO, including those with acquired or congenital heart disease. Improving both primary and secondary stroke prevention remains both vital and challenging; as more children with congenital heart disease survive into adulthood, studies show that they remain at increased risk for stroke and may be susceptible to earlier frailty and cognitive impairment. Children with cardiac disease have a lifelong increased risk of stroke. While new interventions such as thrombectomy may improve outcomes, more research is needed to improve long term neurologic outcomes in this population.

Rapid sequence intubation (RSI) is critical for airway management in emergency departments (ED). This study investigates sex-based differences in RSI outcomes, exploring how biological, pharmacological and psychosocial factors may influence intubation success and complications. Data from 5021 intubation episodes (January 2010-March 2017) across 42 EDs in Australia and New Zealand was analysed from the ANZEDAR study. Variables including intubation indications, patient factors and complications were stratified by sex. Multivariable logistic regression was used to identify factors associated with first-pass success (FPS) and complications. Males were more frequently intubated for trauma, while females had higher rates of medical indications such as overdose or stroke and had a higher shock index. Males had a higher predicted and observed difficult laryngoscopy and a lower FPS rate. Additionally, males had a higher overall complication rate, and more desaturation events. Females had a higher incidence of mainstem bronchus intubation. Despite a higher predicted difficulty in males, there were no significant differences in clinical practices such as positioning, use of video laryngoscopy or staff seniority. Sex-related differences were observed in this registry, with males experiencing lower FPS and more complications. These findings are exploratory; prospective studies should test whether sex-aware assessment and preparation improve process measures and patient outcomes.

Health literacy (HL) has been found to affect perceived information provision (PIP), satisfaction with information provision, and health-related quality of life (HRQoL) in patients with cancer. Patients with a rare cancer are confronted with challenges, such as a lack of information. The aim of this study was to explore the impact of HL on PIP, satisfaction with information provision, and on HRQoL in rare compared to common cancer patients.A population-based study was conducted using the PROFILES registry. Patients with rare (n = 385) and common (n = 1,692) cancer were included. Within group associations (low/medium HL, high HL, rare cancer, common cancer) were assessed. Regression analyses were used to assess associations between HL, PIP, satisfaction, and HRQoL, taking cancer group into account.Within the low/medium HL group, no statistically significant differences were found between rare and common cancer patients. Yet, within the high HL group, rare cancer patients scored significantly lower on all PIP-categories (except PIP-medical tests), satisfaction and HRQoL. Within the rare cancer group, patients with low/medium HL scored lower, compared to those with high HL, on PIP-medical tests and PIP-treatment, while within the common cancer group, patients with low/medium HL scored lower on all PIP-categories, satisfaction and HRQoL (all: p<0.05).Information needs might vary between patients with a different HL level and/or cancer group. Healthcare professionals should take individual needs into account, with a special focus on patients with a rare cancer and low/medium HL, in order to convey information in an understandable, patient-tailored way.

In stages II and III hormone receptor positive (HR+) breast cancer, selecting patients for primary surgery (PS) or neoadjuvant therapy remains challenging. This study assessed the occurrence of minimally invasive surgery in the case of PS, neoadjuvant endocrine therapy (NET), and neoadjuvant chemotherapy (NACT). This cohort study included women diagnosed with stages II and III, HR+ breast cancer in 2020-2022 in the Netherlands. Women with positive human epidermal growth factor receptor 2 (HER2+) cancer were excluded. Outcomes focused on surgical techniques and additional treatment. Of the 7809 patients, 4046 (51.8%) underwent PS, 956 (12.2%) received NET and 2807 (35.9%) NACT. NET patients were older (median: 71 years [33-94]), while NACT patients had larger tumors and more lymph node involvement (p < .001). Breast-conserving surgery (BCS) was the first procedure in 2153 (53.2%) PS women, in 694 (72.6%) NET women and 1564 (55.7%) NACT cases. There was no difference regarding free surgical margins in NET versus NACT patients (p = .421). After adjusting for T-stage, BCS occurred significantly more frequently after NET (p < .001). Minimal invasive surgery on the axilla was common after NET (83.9%) and NACT (81.5%). In the PS group, 85% received adjuvant systemic therapy. Optimizing patient selection for neoadjuvant strategies could reduce surgical morbidity. NET was frequently associated with BCS, showed comparable surgical margin outcomes to NACT, and contributed to reduced axillary surgery. These findings suggest that NET is an effective strategy, compared to PS, to facilitate less invasive surgery on the breast and axilla, in HR+/HER2-, stages II and III breast cancer.

Background: In the U.S., acute myocardial infarction (AMI) mortality remained higher in women than in men after 1984 but declined markedly in the past decade. However, long-term sex-specific trends in MI incidence and outcomes remain unclear in Asian populations. In Japan, where rapid aging is ongoing, women with AMI often present with atypical symptoms, potentially leading to delayed care and under-treatment. Despite these concerns, few registry studies have continuously monitored sex disparities in AMI over an extended period Objective: This study aimed to investigate the 40-year trends in AMI incidence and in-hospital mortality in Japan, with a focus on sex differences. Methods: We analyzed data from the Miyagi AMI Registry, a comprehensive regional hospital-based registry covering the entire Miyagi Prefecture in northeastern Japan (population approximately 2.3 million), which has collected detailed clinical data on all hospitalized patients with AMI since 1979. A total of 38,410 patients (28,286 men and 10,124 women) were included between 1984 and 2023. Analyses were conducted separately for two periods: 1984–2003 and 2004–2023. Results: The age-adjusted incidence of AMI (/100,000 persons/year) in men significantly increased during the early period (from 53.0 to 79.4, P&lt;0.05), but remained unchanged in the later period (from 79.4 to 70.2). In contrast, the incidence in women remained stable in the early period (from 16.8 to 23.6) and significantly declined in the later period (from 23.6 to 14.4, P&lt;0.05). Throughout the 40 years, the incidence was consistently lower in women than in men, with the sex disparity widening in recent years ( Figure 1 ). Age-adjusted in-hospital cardiac mortality significantly declined in both men (from 25.6% to 12.0%) and women (from 10.3% to 5.4%) during the early period (P&lt;0.01 for both), but remained unchanged in the later period. Notably, women consistently had higher in-hospital mortality than men across all four decades ( Figure 2 ). Between 2000 and 2023, women experienced longer delays from symptom onset to hospital admission, a higher prevalence of heart failure on admission (P&lt;0.01), and lower rates of percutaneous coronary intervention compared with men (P&lt;0.01 for both) ( Figure 3 ). Conclusion: This 40-year study revealed persistent sex disparities in AMI care in Japan. Women consistently faced delayed treatment and higher in-hospital mortality, underscoring the need for greater awareness and sex-specific strategies.

To explore the risk of osteoporotic fractures in lymphoma patients compared with that in the general Swedish population. Fracture risk was evaluated in a retrospective cohort comprising lymphoma patients (aged ≥ 18years) diagnosed between 2000 and 2018 (n = 36,864), as recorded in the Swedish Lymphoma Register, and a matched cohort from the general population (n = 368,082). The risk of major osteoporotic fracture (MOF) overall (n = 1009, 60% women) and specifically hip fracture (n = 594) within 18months of lymphoma diagnosis was greater in the overall cohort of lymphoma patients than in the matched cohort [incidence rate ratio (IRR) of MOF 1.14 (95% CI 1.07-1.21) and hip fracture 1.14 (95% CI 1.05-1.24), respectively], with a particularly pronounced increase observed in the 51-60 age group [IRR MOF 1.64 (95% CI 1.47-2.27), hip fracture 2.60 (95% CI 1.85-3.63)]. The IRRs for MOF and hip fracture in patients with diffuse large B cell lymphoma were 1.27 (95% CI 1.14-1.42) and 1.24 (95% CI 1.07-1.44), respectively. At 15years postdiagnosis, the risk of MOF and hip fracture among lymphoma patients was nearly equivalent to that of the general population. Compared with those of matched controls, the incidence of osteoporotic fractures among lymphoma patients within 18months after lymphoma diagnosis was significantly greater. The risk was especially increased in the 51-60-year age group.

Backgrounds: Recent advances in treatment have improved outcomes in patients with cerebrovascular accidents (CVA). Out-of-hospital cardiac arrest (OHCA) secondary to CVA is relatively uncommon, and data in this clinical scenario are scarce. In this study, we aimed to evaluate temporal trends and outcomes of OHCA with and without CVA. Methods: Using a nationwide registry database from 2005 to 2022 in Japan, a cohort of 2,070,743 patients with OHCA were included in the present study and divided into two groups according to the presence or absence of CVA as an etiology of OHCA. Major endpoints of interest included prehospital return of spontaneous circulation (ROSC) and overall and neurologically favorable (cerebral performance category score of 1 or 2) survival at 1 month. Temporal trends between the CVA and non-CVA groups were also evaluated. Results: Of the 2,070,743 patients, 70,419 (3.4%) had CVA as an etiology of OHCA. In the non-CVA group, the major etiologies were cardiac causes (59.9%), trauma (11.8%), and malignancy (6.7%). As compared to the non-CVA group, patients in the CVA group were younger and had a significantly lower proportion of initial shockable rhythm. Although the probability of prehospital ROSC was higher, 1-month overall and neurologically favorable survival rates were significantly lower in the CVA group than in the non-CVA group (Table). The probability of ROSC has increased in both CVA and non-CVA groups from 2005 to 2022, while overall and neurologically favorable survival have stagnated in both groups during the study period (Figure). In multivariable analysis, a significant interaction between group (CVA vs. non-CVA) and year was observed for ROSC (interaction term: odds ratio [OR] 13.81, 95% confidence interval [CI] 1.02–1.03; P &lt; 0.0001). This association was markedly attenuated for 1-month survival (OR 2.55, 95% CI 1.00–1.02; P = 0.011), and no significant difference was found in neurologically favorable survival trends between the groups (OR 1.85, 95% CI 0.99–1.02; P = 0.064). Conclusions: In this nationwide registry study in Japan, CVA-related OHCA was uncommon, with a proportion of 3.4%. Although the probability of prehospital ROSC was twofold higher, overall and neurologically favorable survival rates were lower in the CVA group than in the non-CVA group. The substantial improvement in ROSC was observed in the CVA group during the study period, which was not translated into better clinical outcomes.

Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is commonly used as a bridge to heart transplantation in patients with cardiogenic shock. The addition of a percutaneous microaxial left ventricular assist device such as Impella to ECMO (ECPELLA), has been proposed to enhance unloading of the left ventricle and improve systemic perfusion. Despite increasing use, the impact of ECPELLA on post-transplant outcomes remains uncertain. Methods: We performed a retrospective cohort study using data from the United Network for Organ Sharing (UNOS) registry to evaluate outcomes of adult patients (aged ≥18 years) who underwent orthotopic heart transplantation between 2018 and 2022, while receiving ECMO support at the time of transplant. Patients were stratified based on support modality into ECPELLA (defined by concurrent use of ECMO and Impella) and ECMO alone. The primary outcome was one-year post-transplant survival. Secondary outcomes included 30-day survival and post operative length of hospital stay. Statistical comparisons were conducted using chi-square or Fisher’s exact tests for categorical variables and the Mann–Whitney U test for continuous variables. Survival was analyzed using Kaplan–Meier estimates and the log-rank test. Results: A total of 197 patients met the inclusion criteria, comprising 41 patients (20.8%) in the ECPELLA group and 156 patients (79.2%) in the ECMO-alone group. Baseline demographics including age, sex, and race, were comparable between the two cohorts. Among ECPELLA recipients, the most commonly used device was the Impella CP, utilized in 25 patients (61%). One-year survival rates were comparable: 87.3% in the ECPELLA cohort versus 86.5% in the ECMO-alone group (HR- 0.90; 95% CI 0.33–2.43; p=0.82). The median hospital length of stay was shorter among ECPELLA recipients (19.0 days [IQR, 15.5–30.5]) compared with the ECMO-alone cohort (22.5 days [IQR, 16.0–34.0]), though this difference was not statistically significant (p=0.31). Conclusions In this national registry analysis, the addition of Impella to ECMO support at the time of heart transplantation was not associated with improved survival or early postoperative outcomes. Although ECPELLA may offer theoretical hemodynamic advantages, its use did not confer measurable clinical benefit over ECMO alone in this cohort. Prospective studies are warranted to further clarify the role of combined support in this patient population.

Introduction/Background: Renal denervation (RDN) is an upcoming interventional procedure for resistant hypertension. However, most major RDN trials have disproportionality in enrolled participants, with limited representation of Black, Asian, or Hispanic populations. Whether RDN efficacy varies across ethnic groups, or if underrepresentation hinders generalizability, remains a critical question in cardiovascular research. Research Questions/Hypothesis: We evaluated the level of racial and ethnic representation in RDN trials and explored differences in systolic blood pressure (SBP) reduction across ethnic subgroups. We hypothesized that both disparities in enrollment and potential outcome differences would be evident. Methods/Approach: A meta-review was conducted of six studies with available ethnic subgroup data: SYMPLICITY HTN-3, REQUIRE Trial, SPYRAL HTN-OFF MED, RADIANCE-HTN TRIO, SYMPLICITY Global Registry (Asian cohort), and a Chinese RDN registry study. We extracted SBP outcomes by ethnicity (Black, Asian, White) when reported, and recorded sample sizes and responder trends. Due to heterogeneity and limited quantitative subgroup data, a pooled mean difference was not calculated. Instead, descriptive synthesis and cross-study comparisons were performed. Results/Data: Ethnic subgroup reporting was limited across RDN trials. SYMPLICITY HTN-3 included 24% Black patients with SBP reduction of –12.5 mmHg vs –15.5 mmHg in White patients; no significant interaction reported. REQUIRE (100% Asian) showed modest SBP drop of –6.6 mmHg with no superiority over sham. The SYMPLICITY Global Registry (&gt;800 Asians) showed consistent SBP reductions of about 15 mmHg. The Chinese Registry reported SBP reductions (–10 to –20 mmHg) without a comparator. SPYRAL HTN-OFF MED and RADIANCE-HTN TRIO lacked ethnicity-stratified data and enrolled mostly White/European cohorts. Minority representation and subgroup analyses were limited, restricting comparative conclusions. Conclusion(s): This review highlights a critical gap in both representation and reporting of ethnic subgroup outcomes in RDN trials. Available data suggest that RDN is effective in Asian and Black patients, but sample sizes and statistical rigor remain insufficient to confirm differential efficacy. Greater inclusion and mandatory ethnicity-stratified analyses in future trials are essential to ensure equitable, evidence-based use of RDN across diverse populations.

Background: Hypertrophic cardiomyopathy (HCM) is a common genetic heart condition with a variable risk of sudden cardiac death (SCD) and heart failure. Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) reflects myocardial fibrosis and has been linked to adverse outcomes. However, individual studies use different LGE thresholds and patient groups. Methods: We performed a systematic review and meta-analysis of peer-reviewed studies published from January 2010 to June 2025. We searched PubMed, EMBASE, and Cochrane Library for observational cohort and registry studies reporting quantitative LGE measurements (percentage of left ventricular mass) and clinical endpoints in adult HCM patients. Eligible studies had at least 12 months of follow-up, reported hazard ratios (HRs) with 95% confidence intervals (CIs) comparing high versus low LGE burden, and enrolled patients ≥18 years old. We identified five studies (Bruder et al. 2010; O’Hanlon et al. 2010; Patel et al. 2012; Chan et al. 2014; Weng et al. 2016). Two reviewers independently extracted data on study design, LGE protocol, LGE threshold, sample size, and endpoints (SCD, ventricular arrhythmias, or heart failure events). Log-transformed HRs and standard errors were calculated from reported CIs. A DerSimonian–Laird random-effects model pooled logHRs. Inter-study heterogeneity was assessed by the I 2 statistic. Results: The combined dataset included 1,323 HCM patients with LGE measurements. Individual study HRs for high LGE burden ranged from 2.75 to 4.80. The pooled HR for SCD or malignant arrhythmias in patients with higher LGE burden was 3.49 (95% CI: 2.57–4.74; p &lt; 0.001), indicating a 3.5-fold increased risk compared with low LGE. Heterogeneity was moderate (I &lt;span style="font-size:10.8333px"&gt;2&lt;/span&gt; = 40%). Sensitivity analysis, excluding any single study, did not materially change the pooled estimate. Conclusions: In adult HCM patients, higher LGE extent is strongly associated with increased risk of SCD or ventricular arrhythmias. These findings support integrating quantitative LGE assessment into clinical risk stratification to guide implantable cardioverter-defibrillator decisions and patient counselling. Future studies should standardise LGE measurement protocols and investigate how LGE interacts with other risk factors.

Introduction: Underrepresentation in clinical trials remains a significant obstacle to achieving equitable healthcare outcomes. In an effort to promote transparency and inclusivity, Congress enacted the Final Rule for Clinical Trials Registration and Results Information Submission (42 CFR Part 11) in January 2017, mandating the reporting of race and ethnicity data on ClinicalTrials.gov. This study examines demographic trends in enrollment for transthyretin amyloid cardiomyopathy (ATTR-CM) clinical trials. Hypothesis: We hypothesize that a significant difference exists between the demographic composition of patients diagnosed with ATTR-CM and those enrolled in U.S.-based clinical trials. Methods: A systematic review of ClinicalTrials.gov was conducted using the search terms “Transthyretin Amyloid Cardiomyopathy,” “Cardiac Amyloidosis,” and “Amyloidosis Cardiac.” Inclusion criteria were U.S.-based studies completed since 2018 with publicly available results. Extracted demographic data included sex, age, and race/ethnicity. An enrollment fraction (EF), the ratio of clinical trial participants to the estimated U.S. disease prevalence, was calculated for gender and race using data from the Cardiac Amyloidosis Registry Study (CARS). Due to limited data, EF calculations were only feasible for participants identifying as White or Black. Statistical analyses were performed using Python. Results: Of 264 identified trials, 17 met the inclusion criteria, 11,786 participants (8,578 males and 3,208 females; male-to-female ratio approximately 3:1). The average participant age was 61 years. Racial and ethnic composition was as follows: White 54%, Black 6.2%, Asian 5.2%, Latino 2.1%, Native Hawaiian or Pacific Islander 0.01%, Native American 0.02%, and Unknown 27.4%. Chi-squared analysis revealed that the EF for White participants was significantly higher than for Black participants (5.85 vs. 0.62; p &lt; 0.05). Male participants also had a higher EF than females (0.12 vs. 0.05; p &lt; 0.05). Conclusion: Despite the 2017 Final Rule, ATTR-CM clinical trials continue to show significant racial and gender disparities. This limits the generalizability of findings and equitable treatment access. Future strategies should prioritize culturally sensitive recruitment, community engagement, and stronger policy enforcement to promote inclusive trial designs.

Abstract The pandemic worsened mental health conditions, especially for those with concurrent severe mental illness and substance use disorders (SMI/SUD). Studies have noted increased rates of psychotropic drugs prescription in the general population during the pandemic, serving as a proxy for worsened mental health. Investigating prescription trends among individuals with SMI/SUD would be of interest due to their high morbidity and high reliance of these drugs. This study aimed to examine the impact of the COVID-19 pandemic on the prescribing of psychotropic drugs in this group of patients. We conducted a retrospective cohort study using national register data from 2019 to 2021. A graphical approach and descriptive statistics were employed to analyse the prescribing of seven psychotropic drugs over time. Negative binominal regression analysis compared changes in prescriptions from pre-pandemic to pandemic periods. Prescription patterns among individuals with SMI/SUD remained generally stable during the pandemic, except for marginally increased prescription of antipsychotics (IRR 1.06, 95% CI 1.04–1.13) and anxiolytics (IRR 1.08, 95% CI 1.03–1.14) compared to pre-pandemic levels. The stability indicates efficient management and possibly changes in health behaviours amidst the COVID-19 pandemic. The findings indicate that despite the challenges of adapting health services during a global crisis, patients in Norway were able to maintain stable levels of psychotropic drug use among individuals with SMI/SUD.

The goal of this study was to determine the difference in participant understanding, satisfaction, timing and, preference between video consent and written informed consent in a pediatric rheumatology research setting. Participants were randomized to receive either video consent or written informed consent for a registry study. After completing the first consent method, they completed a comprehension and satisfaction questionnaire. Then they received the alternate consent method and completed a second set of questionnaires. Bayesian non-parametric tests determined the difference in comprehension, satisfaction, timing and preference between video consent and written informed consent. Ninety-nine caregivers and 76 patients were randomized into video consent (n = 88) and written informed consent (n = 87) groups. Comprehension (Max = 12) and satisfaction (Max = 5) were high in both groups. There was moderate evidence supporting no difference in comprehension (medianvideo consent = 11 and medianwritten informed consent = 10) and satisfaction (medianvideo consent = 4 and medianwritten informed consent = 5) between video consent and written informed consent (BF10 = 0.225 and 0.32, respectively). The median time to complete video consent and written informed consent was 408 (95% Credible Interval (CrI): 397–412) and 360 (95% CrI: 329–391) seconds, respectively. There was decisive evidence that video consent increased the time of consent (in our sample by 48 seconds) compared to written informed consent (BF10 = 713). There was decisive evidence for participants preferring video consent over written informed consent (BF10 = 2.307x1011) as they thought it was easier to follow. Overall, participant understanding and satisfaction were comparable between video consent and written informed consent. Even though video consent was slightly less time efficient compared to written informed consent, video consent was highly preferred by caregivers and patients, supporting its use to obtain informed consent.

Upper tract urothelial carcinoma (UTUC) is aggressive, and whether a history of urinary tract stones influences survival after radical nephroureterectomy (RNU) is unclear. To determine the association between urinary stone history and oncological outcomes in patients with UTUC undergoing RNU. This multicenter retrospective cohort study was part of the Taiwan UTUC Registry Study, a multicenter registry encompassing 21 tertiary and regional hospitals throughout Taiwan. Medical records from September 1, 1988, to December 31, 2023, were reviewed; follow-up continued through December 31, 2024, and data were analyzed from January 15 to March 30, 2025. Participants were adults with histologically confirmed UTUC who underwent RNU. Documented history of urinary tract stones identified via medical records. Primary outcomes were cancer-specific survival (CSS) and disease-free survival (DFS). Secondary outcomes were overall survival (OS) and bladder recurrence-free survival (BRFS). Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards models adjusted with overlap weighting. Of 5824 registry patients, 3414 patients (mean [SD] age, 68.2 [10.5] years; 1957 female [57.3%]) met inclusion criteria. Among these, 169 (4.9%) had a history of urinary stones. Median (IQR) follow-up was 53.86 (23.72-92.50) months. Patients with history of urinary stones, compared with those without, had higher rates of metastasis (25 patients [14.8%] vs 233 patients [7.2%]) and UTUC-specific death (47 patients [27.8%] vs 599 patients [18.5%]). After overlap weighting, stone history was independently associated with worse CSS (HR, 1.83; 95% CI, 1.35-2.47; P < .001) and DFS (HR, 1.69; 95% CI, 1.29-2.21; P < .001). Stone history was not significantly associated with OS (HR, 1.18; 95% CI, 0.94-1.48) or BRFS (HR, 1.09; 95% CI, 0.86-1.37). In this cohort study of patients with UTUC who underwent radical nephroureterectomy, a history of urinary tract stones was associated with inferior CSS and DFS, suggesting that patients with UTUC and stone history may represent a higher-risk subgroup that could warrant intensified surveillance and consideration of tailored adjuvant therapy.

Trajectories of patients receiving kidney replacement therapy (KRT), including transitions between hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx), may vary across patient sub-groups and have not yet been investigated in Europe. This study aimed to: (1) describe the number of shifts across KRT modalities; and (2) characterize the most frequent patient trajectories, including the direction of shifts across KRT modalities, the duration spent on each modality, and patient events, including death. Data of adult patients (≥20 years) who initiated KRT between 2004-2013 were extracted from the European Renal Association (ERA) Registry database and patients were followed for 10 years from the moment of KRT initiation. Results were stratified by age, sex, primary renal disease (PRD), country, and initial KRT modality. Among 289,323 patients, more than two-thirds (69.6%) remained on their initial KRT modality until death or the end of 10 years follow-up, but younger patients and patients who initiated with PD had more shifts across KRT modalities than others. Overall, the most frequent patient trajectories were HD followed by death (53.4%), HD to KTx (10.2%), remaining on HD for 10 years (5.6%), PD followed by death (4.4%), and PD to KTx (2.9%). The most frequent patient trajectories differed between age and PRD groups, and across European countries, but not between women and men. The number and direction of shifts across KRT modalities varied by age, PRD, country, and initial KRT modality, but not by sex. Future research should further investigate trajectories of patient sub-groups that stood out, including young HD patients who died on their initial KRT modality and those who remained on HD for 10 years without undergoing KTx.

Effects of testosterone deficiency and therapy on the cardiometabolic syndrome in men.

This study compared the demographics and outcomes of patients with Parkinson's disease (PD) undergoing total knee arthroplasty (TKA) to those without PD. Additionally, it aimed to assess the impact of implant design on TKA survival in PD patients. Using data from the Emilia Romagna Registry of Orthopedic Prosthetic Implants, 551 TKA procedures in patients with PD were identified and compared to 52,022 TKAs in patients without PD. Kaplan-Meier survivorship analysis was used to compare implant survival, with revision surgery as the endpoint. Cox multivariate analysis was performed to assess the influence of age, gender, PD diagnosis, and implant design on implant failure. The average age of PD patients was 72.2 years, with 66.2% being female. Implant survival was significantly lower in the PD group compared to the control group (p < 0.001). At 13 years, the survival rate was 88.8% in the PD group and 94.3% in the control group. PD patients had a 2.7 times higher risk of implant failure after adjusting for age and gender. Constrained implant designs were associated with a 1.7 times higher risk of failure compared to non-constrained designs in PD patients. PD negatively affects implant survival in patients undergoing TKA. Careful consideration should be given to patient selection and implant design in this patient population.