Retrospective Analysis Research Articles

SFlt-1/PlGF at 36 weeks’ gestation: association with spontaneous onset of labor and intrapartum fetal compromise in low-risk pregnancies

Prior evidence showed that placental dysfunction triggers spontaneous preterm or term births, and intrapartum fetal compromise, often requiring urgent delivery and exposing both fetus and mother to significant risks. Predicting spontaneous labor onset and intrapartum fetal compromise could improve obstetric management and outcomes, but this is currently difficult, particularly in low-risk population. The objective of this study is to examine whether placental dysfunction assessed at 36 weeks by the soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio, associates with interval to spontaneous onset of labor and intrapartum fetal compromise requiring cesarean delivery, in a routinely examined population. Retrospective analysis of prospectively collected data of women with singleton pregnancies undergoing routine assessment at 35+0-36+6 weeks' gestation at King's College Hospital (London, England). Using a General Linear Model the study examined outcomes related to the sFlt-1/PlGF ratio including the time interval from testing to spontaneous onset of labor, and the subsequent rate of fetal compromise requiring cesarean delivery. Patients undergoing induction of labor, and prelabour cesarean deliveries were excluded from the study.. Competing risks regression and Cox regression models were used to estimate the cumulative incidence and risk of the outcomes of interest RESULTS: In the screened population of 45,375 patients, 23,831 (52.5%) had spontaneous onset of labor and were included in the analysis. Cases with sFlt-1/PlGF ratio ˃50 vs. ≤50 delivered about one week earlier (39.2 vs. 40.0 weeks; p˂0.001). General linear model showed that greater sFlt-1/PlGF ratio associated with earlier spontaneous onset of labor (p<0.001), particularly in multiparous women A significant effects on sFlt-1/PlGF ratio values was, as expected, observed for those cases who developed preeclampsia and in women of advanced age.Cumulative incidence for spontaneous onset of labor was significantly higher in cases with sFlt-1/PlGF ˃50 vs. ≤50. Cox regression showed that the risk of spontaneous onset of labor increased with sFlt-1/PlGF ˃50 (hazard ratio [HR] 1.424; 95% CI 1.253-1.618; p˂0.001) and, as expected, the risk was mitigated over time from s-Flt-1/PlGF measurement to spontaneous labour onset (p˂0.001). Cases with vs. without intrapartum fetal compromise had higher mean sFlt-1/PlGF ratio (21.79 vs. 17.67; p˂0.001). Qualitative addition of fetal compromise to the general linear model showed higher sFlt-1/PlGF ratio in cases with, compared to those without, fetal compromise (p=0.014). Competing risks regression showed a positive dose-response effect for fetal compromise with increasing sFlt-1/PlGF ratios (p˂0.001). Above and below the optimal cut-off of 50 the quoted cumulative incidences were 6.7% vs. 4.7%, respectively (p<0.001). The effect of the sFlt-1/PlGF ratio remained significant even after adjusting for preeclampsia, which is a well-known major risk factor for fetal compromise. Finally, the proportion of cases with intrapartum fetal compromise having sFlt-1/PlGF ratio >50 decreased from 35% to 0% with advancing gestation. This study shows that increased sFlt1/PLGF ratio at 36 weeks associates with earlier gestational age at spontaneous onset of labor and higher rates of intrapartum fetal compromise. There are two major implications: sFlt1-/PLGF ratio ˃50 indicates imminent labor onset with about 40% mean risk increase and immediate clinical translation for term pregnancies monitoring. Additionally raising sFlt1-/PLGF ratios increase the risk of intrapartum fetal compromise, though outcome variability indicates reassessment within multi-marker models.

Continuum of Light Sensitivity in Atopic Dermatitis: A Retrospective Analysis of 139 Cases in Scotland

BackgroundPrevious reports have characterized photosensitivity in atopic dermatitis (AD), but with differences in terminology and criteria. ObjectiveThis study aims to assess outcomes in 139 AD patients referred for photodiagnostic testing and to establish diagnostic criteria for photosensitivity in AD. MethodsClinical and photodiagnostic data were reviewed, categorizing photosensitivity into Photo-Exacerbated AD (PEAD), Photo-Sensitive AD (PSAD), and Chronic Actinic Dermatitis (CAD). ResultsOf the patient cohort, mean age was 42.6±16.7 years and 61.9% were male. PEAD patients (51.1%) had normal monochromator phototesting. PSAD patients (7.9%) displayed slight-to-moderate UVA sensitivity (≥30% of normal minimal erythema dose [MED]) and mostly normal/slightly reduced UVB MEDs (≥80% of normal MED). Conversely, 41% of patients had CAD and 93% of this group demonstrated significant UVB sensitivity, with very low UVB MEDs (<80% of normal MED) and/or very low UVA MEDs (<30% of normal MED). No significant differences in sex, age, or skin phototype were observed between groups. Serial phototesting revealed changes in photosensitivity status over time in eight patients. LimitationsSmall sample size and retrospective design. ConclusionsThis study highlights the heterogeneity of photosensitivity patterns in AD patients and the importance of follow-up assessments due to potential shifts in disease spectrum over time.

Microbiology and Epidemiology of Orbital Cellulitis in Pediatric and Young Adult Patients.

Using data from the large and geographically diverse Military Health System (MHS) beneficiary population, we aimed to characterize and update the epidemiology and microbiology of pediatric orbital cellulitis given previous data are limited to small, single-center studies. Following institutional review board approval, we performed a retrospective analysis using the Military Health System admissions, microbiology, and pharmacy data between June 2009 and September 2019. Patients less than 22 years of age with radiological confirmation of orbital cellulitis were included. Demographic data, presence of sinusitis, advanced imaging reports, blood and wound culture results with antibiotic susceptibilities, and antibiotic prescriptions were collected. Descriptive statistics were used to summarize demographic characteristics. Imaging findings were grouped by Chandler's stage (CS), an imaging-based measure of the progressive severity of orbital involvement. A Cochran-Armitage trend test was used to evaluate the relationship between CS and likelihood of positive confirmatory culture. There was a male predominance (66.9%) and 55.5% of subjects had comorbid sinusitis. Of the 130 subjects included, 33.8% had one or more positive cultures, 30.8% had a positive wound culture, and 4.6% had a positive blood culture. The most identified organism was coagulase-negative staphylococci (23.3%), followed by Staphylococcus aureus (18.9%), Streptococcus intermedius (17.8%), and strict anaerobes as a group (13.3%). Gram-negative organisms were rare. Twenty-five percent of S. aureus were methicillin-resistant. Clindamycin resistance was identified in 9% of all S. aureus, 50% of coagulase-negative staphylococci, and 25% of S. intermedius. Clindamycin plus ceftriaxone was the most prescribed empiric antibiotic regimen (36.2%). Likelihood of a positive culture significantly increased with advancing CS. Orbital cellulitis occurs most frequently in males with sinusitis. Likelihood of positive wound culture is increased with a more advanced CS. Staphylococcus and Streptococcus spp. and anaerobes are the most identified pathogens in orbital cellulitis, while gram-negative organisms are rare. Empiric antibiotic selection should include an anti-methicillin-resistant S. aureus agent combined with a broad-spectrum beta-lactam and anaerobic coverage.

Long-term spatiotemporal distribution characterization of atmospheric black carbon MERRA-2 concentration over China

Black carbon (BC), a component of atmospheric aerosols, strongly adsorbs solar radiation, thereby influencing atmospheric stability and air quality. In this study, the spatiotemporal distribution, historical trends, and influencing factors of BC concentration in China from 1980 to 2020 have been investigated using MERRA-2 (Modern-era Retrospective Analysis for Research and Applications, Vision2) reanalysis dataset, population distribution, and industrial statistics data. The annual total MERRA-2 BC concentration in China (averaging 1.08 μg/m3 over the study period) exhibited three distinct phases: slow growth (1980–1999, 0.02 μg/m3/year), rapid growth (2000–2007, 0.61 μg/m3/year), and gradual decline (2008–2020, -0.014 μg/m3/year). The BC concentration was consistently higher in autumn and winter than in spring and summer, being lowest in July (9.6 μg/m3) and highest in December (14 μg/m3). Spatially, the annual average BC concentration from 1980 to 2020 followed the order: central Yangtze River region (3.14 μg/m3) > eastern coastal region (2.72 μg/m3) > northeastern region (1.40 μg/m3) > western riverine region (0.69 μg/m3) > northwestern frontier region (0.31 μg/m3). High BC-concentration areas, mainly in the central and eastern regions, correlate with regions of vigorous human activities and high industrialization levels, confirming that human activity markedly influences BC pollution. Since 2013, the implementation of emission control strategies and adjustments in the energy structure in China had led to a significant decline in BC concentration. By revealing the spatiotemporal distribution and trends of BC concentration in China, this study provides valuable scientific insights for atmospheric science, environmental protection, and air pollution.

Clinical features of pediatric femoral neck fractures and analysis of risk factors for avascular necrosis of the femoral head: A retrospective case-control study of 45 patients.

ObjectivesTo summarize the clinical features of pediatric femoral neck fractures and analyze the risk factors for avascular necrosis of the femoral head. MethodsA retrospective analysis of the case data of pediatric femoral neck fractures treated in our hospital from January 2010 to December 2022, including gender, age, fracture type, causative factors, and surgical details. The occurrence of avascular necrosis of the femoral head was recorded and risk factors were analyzed. ResultsFrom January 2010 to December 2022, a total of 45 cases of femoral neck fractures were treated in our hospital with a median age at onset of 93 months (IQR=81) and a median time from injury to surgery of 96 hours (IQR=46). Closed reduction was performed in 36 cases, while open reduction was performed in 9 cases. Avascular necrosis of the femoral head occurred in 29 cases postoperatively, while it did not occur in 16 cases. Increased time from injury to surgery and greater degree of fracture displacement were independent risk factors for avascular necrosis of the femoral head. The risk of avascular necrosis in Garden IV type femoral neck fractures was significantly higher than in Garden II and III type patients. An injury-to-surgery time exceeding 82.5 hours was identified as a critical threshold for the development of avascular necrosis of the femoral head. ConclusionPediatric femoral neck fractures have a low incidence rate and are mostly caused by high-energy trauma, often resulting in severe injuries. Therefore, actively maintaining stable vital signs and properly managing associated injuries, timely surgical intervention for femoral neck fractures, achieving good reduction and fixation of displaced fractures are crucial in the treatment of pediatric femoral neck fractures.

Perinatal outcomes of pregnancies with borderline oligohydramnios at term.

Introduction Limited evidence exists on borderline oligohydramnios. Our objective was to determine perinatal outcomes in uncomplicated term pregnancies with borderline oligohydramnios. Methods This retrospective analysis compared adverse perinatal outcomes among pregnancies during 2018-2022, between those with borderline oligohydramnios defined as amniotic fluid index (AFI) 5.1-8.0 cm, those with oligohydramnios (AFI ≤5 cm) and those with normal AFI (8.1-25 cm). The latter, matched one-to-one to the borderline oligohydramnios group, served as the control group. The outcomes compared included birthweight, cesarean delivery due to fetal distress, the presence of meconium-stained amniotic fluid, Apgar scores, neonatal intensive care unit admission and the occurrence of small-for-gestational-age (SGA) neonates. Results During the study period, 140 women had borderline oligohydramnios and 345 had oligohydramnios; the control group included 140 women. Borderline oligohydramnios was associated with increased rates of delivering SGA neonates (adjusted odds ratio (aOR) = 3.6, 95% confidence interval (CI) 1.1-11.6, p=0.034) and cesarean delivery due to fetal distress (aOR = 3.0, 95% CI 1.1-8.3, p=0.032). Rates of composite neonatal outcome (including at least one of the following: cesarean delivery due to fetal distress, meconium-stained amniotic fluid, 5-minute Apgar score &lt;7, umbilical artery pH &lt;7.15 or neonatal intensive care unit admission) were higher in both the borderline oligohydramnios (20.7%) and oligohydramnios (18.6%) groups compared to the control group (9.3%) (p=0.019). Conclusions Pregnancies with borderline oligohydramnios were associated with increased risks of delivering SGA neonates and requiring cesarean delivery due to fetal distress. These findings support considering closer antepartum surveillance for these pregnancies, especially for identifying abnormal fetal growth.

Estimating rates of change to interpret quantitative wastewater surveillance of disease trends

BackgroundWastewater monitoring data can be used to estimate disease trends to inform public health responses. One commonly estimated metric is the rate of change in pathogen quantity, which typically correlates with clinical surveillance in retrospective analyses. However, the accuracy of rate of change estimation approaches has not previously been evaluated. ObjectivesWe assessed the performance of approaches for estimating rates of change in wastewater pathogen loads by generating synthetic wastewater time series data for which rates of change were known. Each approach was also evaluated on real-world data. MethodsSmooth trends and their first derivatives were jointly sampled from Gaussian processes (GP) and independent errors were added to generate synthetic viral load measurements; the range hyperparameter and error variance were varied to produce nine simulation scenarios representing different potential disease patterns. The directions and magnitudes of the rate of change estimates from four estimation approaches (two established and two developed in this work) were compared to the GP first derivative to evaluate classification and quantitative accuracy. Each approach was also implemented for public SARS-CoV-2 wastewater monitoring data collected January 2021–May 2023 at 25 sites in North Carolina, USA. ResultsAll four approaches inconsistently identified the correct direction of the trend given by the sign of the GP first derivative. Across all nine simulated disease patterns, between a quarter and a half of all estimates indicated the wrong trend direction, regardless of estimation approach. The proportion of trends classified as plateaus (statistically indistinguishable from zero) for the North Carolina SARS-CoV-2 data varied considerably by estimation method but not by site. DiscussionOur results suggest that wastewater measurements alone might not provide sufficient data to reliably track disease trends in real-time. Instead, wastewater viral loads could be combined with additional public health surveillance data to improve predictions of other outcomes.

Takotsubo Syndrome and Gender Differences: Exploring Pathophysiological Mechanisms and Clinical Differences for a Personalized Approach in Patient Management.

Takotsubo syndrome (TTS), also known as the broken-heart syndrome, is a reversible condition typically observed in female patients presenting for acute coronary syndromes (ACS). Despite its increasing incidence, TTS often remains undiagnosed due to its overlap with ACS. The pathophysiology of TTS is complex and involves factors such as coronary vasospasm, microcirculatory dysfunction, increased catecholamine levels, and overactivity of the sympathetic nervous system. Diagnosing TTS requires a comprehensive approach, starting with clinical suspicion and progressing to both non-invasive and invasive multimodal tests guided by a specific diagnostic algorithm. Management of TTS should be personalized, considering potential complications, the presence or absence of coronary artery disease (CAD), diagnostic test results, and the patient's clinical course. The current data primarily derive from case series, retrospective analyses, prospective registries, and expert opinions. In recent years, there has been growing recognition of gender differences in the pathophysiology, presentation, and outcomes of TTS. This review provides an updated overview of gender disparities, highlighting the importance of tailored diagnostic and management strategies.

Early-stage lung cancer in the era of lung cancer screening: VA outperforms other insurance models

Lung cancer screening guidelines were introduced in the United States in 2013, with variable implementation. This study aimed to evaluate temporal diagnostic trends in non-small cell lung cancer (NSCLC) diagnosis since the introduction of these guidelines. This retrospective cohort analysis used the VA Corporate Data Warehouse and the National Cancer Database. We evaluated temporal trends in the distribution of NSCLC stage at the time of diagnosis, including differences based on insurance coverage type (including uninsured, privately insured, Medicare, Medicaid, and VA coverage) with adjustment for clinically relevant variables. Among 1,450,965 patients diagnosed from 2006-2020, the proportion of NSCLC cases diagnosed at Stage I increased in all insurance groups (by 12.74%, 2%, 0.25%, and 2.57% for the VA, Medicare, Private Insurance, and Medicaid, respectively). If all insurance systems achieved the unadjusted stage distribution seen in the Veterans Health Administration, an additional 45,684 patients would be diagnosed with Stage I NSCLC and 65,933 fewer patients would be diagnosed with stage IV disease. For patients with any form of insurance, there has been an increase in the proportion of early-stage NSCLC (Stage I and II) and a corresponding decrease in the proportion of Stage III and IV since the introduction of national lung cancer screening guidelines. As the largest integrated "single-payer" healthcare system in the US, the VA dramatically outperforms other insurance types, perhaps attributable to universal coverage and robust lung cancer screening programs.

TREO Aortic Endograft Demonstrates Superior Aneurysmal Sac Regression Over Mid-Term Follow-up

IntroductionAneurysmal sac regression is a predictor of long-term outcomes after endovascular aneurysm repair (EVAR). This study aimed to compare a large cohort of TREO and non-TREO endografts over a mid-term follow-up and compare abdominal aortic aneurysm sac regression. The hypothesis was that TREO endografts have an increased sac regression by 24 mo. MethodsThis is a retrospective analysis of all EVARs completed at a single institution between 2015 and 2024. Clinical and imaging data were collected from an institutional database and patients’ records. The analysis included all TREO and age, sex, anticoagulation use and current smoking-matched non-TREO endografts that satisfied anatomic indications for use of the TREO graft. The primary outcomes were sac regression at 12 and 24 mo, and secondary outcomes were rates of mortality, endoleak, and reintervention. ResultsTwenty-one TREO grafts were matched to 68 non-TREO grafts. The groups were similar in demographics, comorbidities, and preoperative anatomy. Preoperative abdominal aortic aneurysm sac size was larger in the TREO cohort. The mean reduction in sac size in mm was greater in the TREO cohort compared to the non-TREO cohort (−12.6 ± 8.95 versus −7.83 ± 7.74 mm, P = 0.039) over the study period. Cox regression analysis identified the TREO stent graft to be associated with 1-y sac regression (hazard ratio = 2.42, P = 0.019). The incidence of all-cause endoleaks, reintervention, and mortality were similar between cohorts. ConclusionsThese findings suggest that the TREO endograft offers better mid-term outcomes with respect to sac regression with no differences in the incidence of endoleak, mortality, or reintervention.

POSTOPERATIVE OUTCOMES IN ANEMIC PATIENTS UNDERGOING CAROTID REVASCULARIZATION

Preoperative anemia is associated with worse postoperative morbidity and mortality following major vascular procedures. Limited research has examined the optimal method of carotid revascularization in anemic patients. Therefore, we aim to compare the postoperative outcomes following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR) among anemic patients. This is a retrospective review of anemic patients undergoing CEA, TFCAS, and TCAR in the Vascular Quality Initiative database between 2016-2023. We defined anemia as a preoperative hemoglobin level of <13 g/dL in men and <12 g/dL in women. The primary outcomes were 30-day mortality and in-hospital major adverse cardiac events (MACE). Logistic regression models were used for multivariate analyses. Our study included 40,383 (59.3%) CEA, 9,159 (13.5%) TFCAS, and 18,555 (27.3%) TCAR cases in anemic patients. TCAR patients were older and had more medical comorbidities than CEA and TFCAS patients. TCAR was associated with decreased 30-day mortality (aOR=0.45,95%CI:0.37-0.59],P<0.001), in-hospital MACE (aOR=0.58,95%CI:0.46-0.75,P<0.001) compared to TFCAS. Additionally, TCAR was associated with 20% reduction in the risk of 30-day mortality (aOR=0.80,95%CI:0.65-0.98,P=0.03), and similar risk of in-hospital MACE (aOR=0.86,95%CI:0.77-1.01, P=0.07) compared to CEA. Furthermore, TFCAS was associated with an increased risk of 30-day mortality (aOR= 2,95%CI: 1.5-2.68,P<0.001), in-hospital MACE (aOR=1.7,95% CI:1.4-2,P<0.001) compared to CEA. In this multi-institutional national retrospective analysis of a prospectively collected database, TFCAS is associated with a high risk of 30-day mortality and in-hospital MACE compared to CEA and TCAR in anemic patients. TCAR was associated with lower risk of 30-day mortality compared to CEA. These findings suggest TCAR as the optimal minimally invasive procedure for carotid revascularization in anemic patients.

The Evolvement of Session Design From Junior Age to Senior Peak Performance in World-Class Cross-Country Skiers.

To compare designs of training sessions applied by world-class cross-countryskiers during their most successful junior and senior season. Retrospective analysis of self-reported training characteristics (ie,training form, intensity, and exercise mode) among 8 male and 7 female world-class cross-country skiers was conducted. Total number of sessions (441 [71] vs 519 [34], P < .001, large effect) and mean duration (1.5 [0.1]h vs 1.7 [0.1]h, P < .001, moderate effect) increased from junior to senior age. More double-session days were performed at senior age (124 [50] vs 197 [29]d, P < .001, large). The number (310 [64] vs 393 [64], P < .001, large effect) and duration (1.3 [0.1]h vs 1.5 [0.1]h, P < .001, moderate effect) of low-intensity training sessions increased from junior to senior age. Regarding intensive training, most emphasis was put on high-intensity training sessions lasting 20 to 39minutes with <5-minute intervals at junior age, while 40 to 59minutes ofmoderate-intensity training with 5- to 9-minute intervals was predominant at senior age. More MIXED (combined moderate- and high-intensity) sessions (9 [7] vs 14 [7], P = .023, moderate effect) and longer races (0.5 [0.1]h vs 0.6 [0.1]h, P = 0.29, moderate effect) compensated for fewer high-intensity training sessions at senior age (36 [17] vs 25 [10], P = .027, moderate effect). Duration of strength-training sessions increased significantly (0.6 [0.1] vs 0.8 [0.2]h, P = 0.30, moderate effect), while other training forms remained unchanged. World-class cross-country skiers increased their training volume from junior to senior age primarily by more and longer low-intensity training sessions and more often training twice per day. Concurrently, the most frequent intensive sessions were modified from high- to moderate-intensity training, lasted longer, and contained longer intervals.

Characteristics and outcomes of children, adolescent, and young adult patients with myelodysplastic neoplasms: A single-center retrospective analysis

Myelodysplastic syndrome, or myelodysplastic neoplasms, are a rare finding in pediatric, adolescent, and young adult (AYA) patients. More literature is needed to highlight trends of survival or treatment resistance in subpopulations to improve treatment. Here we report a single center retrospective analysis of pediatric and AYA patients from 2000 to 2022 including molecular and cytogenetic data. Using the IPSS-R and IPSS-M, which have been reported exclusively in adults, and excluding patients with bone marrow failure syndromes, we analyzed 119 pediatric and AYA patients with myelodysplastic neoplasms. Therapy-related myelodysplastic neoplasms were present in 36 % of patients, and 31 % of patients developed acute myeloid leukemia. The 5-year overall survival (OS) rate for the entire cohort was 45 %. Contrary to young adults and older adults, mutations were not common in pediatrics. Those who underwent stem cell transplant (SCT)(at any time) had significantly longer median OS. Although SCT at any time improved OS in the de novo myelodysplastic neoplasm group, the choice of the initial treatment with intensive chemotherapy, hypomethylating agents, or SCT did not significantly alter OS. Median OS was shorter in the pediatric group (<18 years old) and longer for those with isolated deletion of 5q or TET2 mutation, but these were not significant findings. Median OS was significantly shorter in those with monosomy 7 or 7q deletion and those with therapy-related myelodysplastic neoplasms. These findings build on previously reported findings and encourage the use of SCT along with molecular and cytogenetic analysis.

Prevalence of metabolic comorbidities and viral co-infections in monoclonal gammopathy: a retrospective analysis.

Prevalence of metabolic comorbidities and viral co-infections in monoclonal gammopathy: a retrospective analysis.

Impact of Location of Residence and Distance to Cancer Centre on Medical Oncology Consultation and Neoadjuvant Chemotherapy for Triple-Negative and HER2-Positive Breast Cancer.

Despite consensus guidelines, most patients with early-stage triple-negative (TN) and HER2-positive (HER2+) breast cancer do not see a medical oncologist prior to surgery and do not receive neoadjuvant chemotherapy (NAC). To understand barriers to care, we aimed to characterize the relationship between geography (region of residence and cancer centre proximity) and receipt of a pre-treatment medical oncology consultation and NAC for patients with TN and HER2+ breast cancer. Using linked administrative datasets in Ontario, Canada, we performed a retrospective population-based analysis of women diagnosed with stage I-III TN or HER2+ breast cancer from 2012 to 2020. The outcomes were a pre-treatment medical oncology consultation and the initiation of NAC. We created choropleth maps to assess the distribution of the outcomes and cancer centres across census divisions. To assess the relationship between distance to the nearest cancer centre and outcomes, we performed multivariable regression analyses adjusted for relevant factors, including tumour extent and nodal status. Of 14,647 patients, 29.9% received a pre-treatment medical oncology consultation and 77.7% received NAC. Mapping demonstrated high interregional variability, ranging across census divisions from 12.5% to 64.3% for medical oncology consultation and from 8.8% to 64.3% for NAC. In the full cohort, compared to a distance of ≤5 km from the nearest cancer centre, only 10-25 km was significantly associated with lower odds of NAC (OR 0.83, 95% CI 0.70-0.99). Greater distances were not associated with pre-treatment medical oncology consultation. The interregional variability in medical oncology consultation and NAC for patients with TN and HER2+ breast cancer suggests that regional and/or provider practice patterns underlie discrepancies in the referral for and receipt of NAC. These findings can inform interventions to improve equitable access to NAC for eligible patients.

Pancreatic trauma with surgical indication. Case series in three centers in Montevideo-Uruguay

Introduction: Pancreatic trauma is a rare event in 0.5-8% of trauma patients, with high morbidity and mortality (8.6-15%). Diagnosis is generally difficult, so clinical suspicion must be high. Associated visceral injuries are the rule. The challenge lies, in addition to the diagnosis, in making a correct classification of these lesions, which will have therapeutic implications that directly influence the morbidity and mortality of this pathology. Objective: To report a series of cases of patients with pancreatic trauma who required surgery. Methods: A retrospective observational analysis was carried out on patients with open or closed abdominal trauma undergoing surgery who presented pancreatic injury. Results: A series of 5 clinical cases of traumatic pancreatic injuries are described, in which penetrating trauma predominates. All required surgical treatment due to the presence of hemodynamic instability and open trauma with evisceration of intra-abdominal organs. Treatment was individualized, using different surgical techniques depending on the degree of pancreatic injury and hemodynamic status. Of the complications, pancreatic fistula was the most frequent and there were no deaths in the series of cases presented.

Distal Triceps Tendon Repair in Strength Athletes Leads to Satisfactory Return to Sports: A Retrospective Analysis of 22 Cases.

Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5-3 months and 4-6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes.

Usage of Tranexamic Acid for Total Hip Arthroplasty: A Matched Cohort Analysis of 144,344 Patients.

Background: The literature is inconclusive regarding the potential complications of tranexamic acid (TXA), an antifibrinolytic drug, for total hip arthroplasty (THA). The purpose of this study is to compare complication rates and patient outcomes between THA patients administered TXA vs. THA patients not administered TXA. Methods: The TriNetX Research network was utilized to generate a cohort of adult patients who underwent THA between 2003 and 2024. These patients were categorized into two subgroups for the retrospective analysis: (1) patients who received TXA 24 h prior to THA (TXA), and (2) patients who did not receive TXA 24 h prior to total hip arthroplasty (no-TXA). The follow-up period was 30 and 90 days. Results: At 30 days following THA, the TXA patients had a reduced risk of transfusion (risk ratio (RR): 0.412; 95% confidence intervals (CI): 0.374, 0.453), reduced risk of DVT (RR: 0.856; CI: 0.768, 0.953), reduced risk of joint infection (RR: 0.808; CI: 0.710, 0.920), but a higher rate of periprosthetic fracture (RR: 1.234; CI: 1.065, 1.429) compared to patients who did not receive TXA. At 90 days following THA, TXA patients had a reduced risk of transfusion (RR: 0.446; CI: 0.408, 0.487), DVT (RR: 0.847; CI: 0.776, 0.924), and periprosthetic joint infection (RR: 0.894; CI: 0.815, 0.982) compared to patients who did not receive TXA. Patients who received TXA had higher rates of periprosthetic fracture (RR: 1.219; CI: 1.088, 1.365), acute postoperative anemia (RR: 1.222; CI: 1.171, 1.276), deep surgical site infection (SSI) (RR: 1.706; CI: 1.117, 2.605), and superficial SSI (RR: 1.950; CI: 1.567, 2.428) compared to patients who did not receive TXA. Conclusions: Patients receiving TXA prior to THA exhibited significantly reduced the prevalence of blood transfusions, DVT, and periprosthetic joint infection following THA. However, superficial SSI and periprosthetic fracture were seen with higher rates in the TXA cohort than in the no-TXA cohort.

Association between Heat Vulnerability Index and Stroke Severity.

Socioeconomically disadvantaged neighborhoods are particularly vulnerable to heat-related illnesses. We aim to investigate the association between the heat vulnerability index (HVI), an established neighborhood-level metric of heat-related mortality risk, and acute ischemic stroke (AIS) severity. We conducted a retrospective analysis of consecutive AIS admissions to a comprehensive stroke center between 2012 and 2021. Stroke severity was defined upon admission based on the National Institutes of Health Stroke Scale (NIHSS). Demographic, socioeconomic, and clinical characteristics were extracted from electronic health records. HVI status was assigned using residential ZIP codes. Multivariable logistic regression analyses were performed. Of 3429 AIS admissions, 1123 (32.8%) were from high-HVI (scores 4-5) neighborhoods and 868 (25.3%) had severe stroke (NIHSS score ≥ 10). In the multivariable regression model with stepwise selection, a high HVI was independently associated with severe stroke (adjusted odds ratio: 1.40 [95% confidence interval 1.16-1.69]). The association between a high HVI and severe stroke underscores the importance of targeting policy interventions to mitigate heat-related illness in socioeconomically disadvantaged neighborhoods.

Postoperative urinary retention by void trial methodology following radical hysterectomy for cervical cancer

ObjectivesRadical hysterectomy is the standard of care for management of early-stage cervical cancer and is associated with postoperative urinary retention. No clear consensus exists regarding optimal voiding trial methodology for mitigating postoperative urinary retention. Our objective was to evaluate the association between type of postoperative voiding trial and risk of urinary retention after radical hysterectomy for cervical cancer. MethodsWe conducted a retrospective analysis of patients undergoing radical hysterectomy for apparent early-stage cervical cancer (FIGO 2018 Stage IA2-IB2) between January 2014 and February 2023. We compared incidence of urinary retention and perioperative outcomes based on method of postoperative voiding trial (timed, autofill, or backfill). Multivariate logistic regression was used to determine association of type of void trial with absence of urinary retention within 30 days postoperatively. ResultsOf the 115 patients identified, 48 (41.8%) patients completed a timed void trial, 40 (34.7%) an autofill void trial, and 27 (23.5%) a backfill void trial. 44.3% of patients developed postoperative urinary retention with no differences based on void trial (p = 0.17). Urinary retention was more likely to resolve by 7 (p = 0.012) and 30 days (p = 0.01) for patients undergoing backfill voiding trials, compared to other trials. In multivariate models, backfill void trial was associated with absence of 30-day urinary retention, compared to other trials (aOR 15.1; 95% C.I. 1.5–154.9). ConclusionsRates of urinary retention following radical hysterectomy do not differ based on postoperative void trial methodology. A backfill void trial following radical hysterectomy may lead to increased rates of resolution of postoperative urinary retention.