Retrospective Comparison Research Articles

Post-transplant cyclophosphamide versus anti-thymocyte globulin in haploidentical stem cell transplantation: a systematic review and meta-analysis.

Post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are mainstay prophylactic treatment options for graft-versus-host disease (GVHD), widely used in haploidentical stem cell transplantation. Due to a lack of prospective studies, a number of retrospective comparisons have yielded different conclusions as to which prophylaxis regimen is superior. We performed a meta-analysis of these studies to get more informed and comprehensive decisions from clinicians. Nine studies were eligible, and a total of 1674 patients were included. The combined hazard ratio (HR), relative risk (RR), and weighted mean difference (WMD) results demonstrated that, compared with ATG, PTCy demonstrated better overall survival (OS) (HR 0.7, 95% CI 0.51-0.97), leukemia-free survival (LFS) (HR 0.66, 95% CI 0.53-0.81), and GVHD-free/relapse-free survival (GRFS) (HR 0.79, 95% CI 0.65-0.97); faster lymphocyte reconstitution, lower risk of relapse (HR 0.69, 95% CI 0.53-0.9) and fungal infection (RR 0.23, 95% CI 0.07-0.79). However, neutrophil engraftment was delayed in the PTCy regimen group (WMD 3.29, 95% CI 2.49-4.10). No statistically significant differences were observed in the time to platelet engraftment, bacterial infection, or viral infection, including cytomegalovirus, polyomaviruses BK/JC and Epstein-Barr virus. Nor was any statistically significant difference observed in the incidences of II-IV acute-GVHD (aGVHD) (HR 0.81, 95% CI 0.62-1.05), III-IV aGVHD (HR 0.67, 95% CI 0.22-2.19) or severe chronic-GVHD (cGVHD) (RR 1.22, 95% CI 0.51-2.88), or non-relapse mortality (NRM) outcomes (HR 0.67, 95% CI 0.4-1.11). Therefore, in haploidentical transplantation, PTCy accelerates lymphocyte reconstitution, significantly reduces the risk of recurrence and fungal infection, and improves the OS, LFS and GRFS, compared with ATG, with no significant difference in the efficacy of preventing acute or severe cGVHD, or the risk of bacterial or viral infection.

Insulin dependence as an independent predictor of complications following surgical treatment of distal radius fracture.

Diabetes mellitus (DM) is a well-established risk factor for postoperative complications. Distal radius fractures (DRFs) are a common orthopedic injury and often require open reduction and internal fixation (ORIF). The rise of ORIF utilization warrants investigation into factors that may expose patients to postoperative complications following DRF ORIF. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for cases of DRF ORIF between 2015 and 2021. Cases were stratified into cohorts based on diabetes mellitus (DM) status. The DM cohort was further stratified into non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) groups. Bivariate logistic regression was performed to compare patient demographics, comorbidities, and 30-day postoperative complications. Multivariate logistic regressions were performed to identify associations between diabetes mellitus status and postoperative complications. A total of 27,761 cases of DRF ORIF were identified from 2015 to 2021. After exclusion criteria were applied, 25,971 cases remained, of which 2169 (8.4%) cases had DM and 23,802 (91.6%) cases were free of DM. Within the DM cohort, there were 1392 cases in the NIDDM subgroup and 777 cases in the IDDM subgroup. Relative to the cohort without diabetes, the IDDM cohort was independently associated with sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off mechanical ventilation, readmission, and nonhome discharge. Having IDDM was independently associated with higher rates of postoperative sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off ventilation, readmission, and nonhome discharge when compared to the cohort without diabetes following DRF ORIF. Level III; Retrospective cohort comparison; Prognosis study.

Primary versus secondary recurrent pregnancy losses: Clinical findings and live birth rate after comprehensive work-up and personalized management.

Recurrent pregnancy loss (RPL), defined as two or more consecutive pregnancy losses before 24 weeks of gestation, affects up to 1%-2% of couples. Aim of this retrospective cohort study was to report the main causes and pregnancy outcomes of a cohort of women with RPL and the efficacy of a personalized work-up and treatment in terms of live birth rate. Women with primary (pRPL) and secondary (sRPL) RPL underwent a complete work-up and personalized therapeutic management. Data related to clinical findings and subsequent pregnancy outcomes were collected. A retrospective comparison between clinical findings and pregnancy outcomes of pRPL versus sRPL was performed by Mann-Whitney U or Chi-square test. Main findings after diagnostic work-up in pRPL (n = 157) versus sRPL (n = 138) couples were hormonal and metabolic factors (75% vs. 90%, p < 0.01), autoimmunity (52% vs. 59%, p = 0.2), acquired uterine/endometrial factors (43% vs. 34%, p = 0.2), vaginal and/or cervical infections (19% vs. 49%; p < 0.0001), congenital Mullerian anomalies (15% vs. 9%; p = 0.1), inherited thrombophilias (13% vs. 21%; p = 0.1), female karyotype abnormalities (2% vs. 2%; p = 0.9), sperm infections (27% vs. 22%; p = 0.1), abnormal semen analysis (17% vs. 14%; p = 0.1), male karyotype abnormalities (2% vs. 0%; p = 0.1). Higher pregnancy and fetal loss rate was observed in pRPL compared with sRPL (85% vs. 56%, p < 0.0001and 9% vs. 0%, p < 0.01, respectively). Higher live birth rate was found in pRLP versus sRPL women (76% vs. 56%, p < 0.001). Increased live birth rate was observed among pRPL women aged <40 years (OR 2.76; CI 1.36-5.64, p < 0.01) and/or with an AMH >1 ng/mL (OR 3.96; CI 1.34-12.52, p < 0.05). Among sRPL women, the age < 40 years was significantly associated to higher live birth rate (OR 3.23; 1.55-6.94, p < 0.01). RPL is a heterogeneous multifactorial syndrome. A customized management can lead to a good pregnancy outcome in more than a half of cases. Age <40 and AMH >1 ng/mL are the major positive predictors of live birth rate in RPL women.

Short-term efficacy and safety of upadacitinib combined with 308 excimer light versus upadacitinib alone and 308 excimer light alone in patients with progressing facial vitiligo.

Patients with progressing facial vitiligo who had been treated with upadacitinib, 308nm excimer light and upadacitinib combined with 308nm excimer light were selected for retrospective analysis and comparison of their efficacy and safety. Efficacy was evaluated using the Vitiligo Area Severity Index (VASI) and Dermatology Life Quality Index (DLQI) at baseline, after 8weeks, and after 20weeks. The progression of skin lesions was monitored through reflectance confocal microscopy (RCM), while adverse reactions were documented. In the combination treatment group, the average VASI at baseline was 0.875 ± 0.4111, which decreased to 0.56 ± 0.32 at week 8 and 0.23 ± 0.218 at week 20 of follow-up (F = 9.918, p = 0.001). RCM analysis indicated that cases achieving VASI100 showed restoration to normalcy regarding loss of integrity within the pigment ring in lesion areas. Although one patient experienced exacerbation of acne, this condition was manageable with topical medication. In contrast, the average VASI score in the 308nm excimer light group prior to treatment was recorded at 0.908 ± 0.334; by week twenty, it further declined to an average of 0.495 ± 0.4196. The differences observed were statistically significant (F = 28.644, p < 0.001). For patients in the upadacitinib group, the initial average VASI score was noted as being 0.825 ± 0.34; by twenty weeks it averaged approximately 0.53 ± 0.33; however, these differences did not reach statistical significance (F = 2.87, p = 0.14). The efficacy of the combined treatment group was significantly superior compared to both other groups (F = 3.927, p = 0.026). In conclusion, upadacitinib combined with308nm excimer light represents an effective therapeutic option for progressive facial vitiligo and is associated with fewer adverse reactions as well as improved quality of life for patients.

Retrospective comparison of cortical bone trajectory and pedicle screw in lumbar fusion for patients over 80, including sagittal balance: a single-center study

BackgroundComparative studies of posterior lumbar interbody fusion with cortical bone trajectory and pedicle screw in older patients, particularly in those aged ≥ 80 years, are rare. This study aimed to retrospectively analyze the clinical and surgical outcomes following posterior lumbar interbody fusion with pedicle screw fixation compared to cortical bone trajectory in patients aged ≥ 80 years with degenerative lumbar spine disease.MethodsWe included 68 patients aged ≥ 80 years who underwent degenerative lumbar spinal surgery at our spine center between January 2011 and December 2020. Of these 68 patients, 24 and 44 underwent posterior lumbar interbody fusion with cortical bone trajectory and pedicle screw, respectively.ResultsThe Visual Analog Scale for back pain was significantly lower in the cortical bone trajectory group than in the pedicle screw group at 6 months postoperatively (P = 0.049). The Oswestry Disability Index was significantly lower in the cortical bone trajectory group than in the pedicle screw group at 6 months postoperatively (P = 0.05). The estimated blood loss and operation time were significantly lower in the cortical bone trajectory group than in the pedicle screw group (P = 0.017 and P < 0.001, respectively). Postoperative morbidity was also lower in the cortical bone trajectory group (P = 0.049).ConclusionsDespite these limitations, our study findings indicate that cortical bone trajectory is not inferior to posterior lumbar interbody fusion with pedicle screw fixation if there is a need for fusion in older patients aged ≥ 80 years.

Outcomes of Open Joint Surgery in Wilkes Grade III TMJ Internal Derangement Patients After Failure of Arthrocentesis and Conservative Therapy: A Retrospective Comparison Between Disc Repositioning and Discectomy

Outcomes of Open Joint Surgery in Wilkes Grade III TMJ Internal Derangement Patients After Failure of Arthrocentesis and Conservative Therapy: A Retrospective Comparison Between Disc Repositioning and Discectomy

Retrospective Comparison of Stiff Wire-Based 2D3D, Traditional 3D3D Image Fusion, and Non-Image Fusion Techniques and Their Role in Thoracic Aortic Endovascular Repair.

Objective: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. Methods: A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included. The dose area product and number of DSAs were considered as primary outcomes, while projection accuracy and image fusion accuracy were considered as secondary outcomes. Results: A total of 79 patient were included. They were allocated to non-image fusion (NIF, n = 40), 2D3D IF (n = 14), and 3D3D IF (n = 25) groups. DAP was significantly lower both in the NIF [1542.75 µGym2 (751.72-3351.25 µGym2), p = 0.011] and 2D3D IF [1320.1 µGym2 (858.57-2572.07 µGym2), p = 0.013 groups compared to the 3D3D [2758.61 µGym2 (2074.73-4772.9 µGym2)] cohort. In the Z3 subgroup, DAP was significantly lower in the 2D3D IF group compared to the 3D3D IF group [(1270.84 µGym2 (860.56-2144.69 µGym2) vs. 2735.76 µGym2 (1583.86-5077.23 µGym2), p = 0.044]. 2D3D image fusion was associated with a significantly lower number of pre-deployment angiographies compared to NIF [1 (1-1) vs. 2 (1-3), p = 0.031], which we used as a surrogate for contrast dose. Conclusions: The entire study population analysis showed a significantly lower DAP with 2D3D IF compared to 3D3D IF, while there was no significant difference compared to NIF. It seems that stiff wire-based 2D3D IF does not cost in terms of DAP compared to NIF, while it is more favorable compared to 3D3D IF. Additionally, simple Z3 TEVAR cases might be improved by implementing the stiff wire-based 2D3D technique as a result of decreased DAP compared to 3D3D IF and decreased contrast dose compared to NIF.

Immediate Full-Arch Restorations Supported by Conventional Implants Plus Uni- or Bilateral Zygomatic Implants: A Three to Five Years Retrospective Radiologic and Clinical Comparison.

The study aimed to compare the short-term outcomes (3.7±0.4yrs) of full-arch immediately loaded fixed maxillary prostheses supported by conventional and unilateral single zygomatic implants versus those supported by conventional and bilateral single zygomatic implants. A retrospective analysis was conducted on patients suffering severe bone loss in the posterior area of the maxilla. The success of zygomatic implants was defined following Offset-Rhinosinusitis-Infection-Stability (ORIS) criteria. The criteria used to define success of standard dental implants were absence of mobility, pain, discomfort/neurologic disorder, and of persistent or chronic infection. The level of significance was 0.01. Thirty-eight patients received 2-5 standard implants plus two zygomatic implants (bilateral), whereas 10 patients had 3-5 standard implants plus a single zygomatic implant (unilateral). The cumulative success rate for standard implants was 99% and 97.3%, respectively, in the bilateral and unilateral groups. Four patients showed symptoms of acute rhinosinusitis (R-criterion): 1 in the unilateral and 3 in the bilateral group. Following the O-criterion, just 2 dental implants in the bilateral group showed a success grade 1. One zygomatic implant, belonging to the group bilateral, developed peri-implant mucositis with a success grade 3 (I-criterion). All zygomatic implants were checked individually and did not show either any signs of mobility or rotation after applying forces to the implant (S-criterion). The ORIS criteria divided the implants into three groups according to the success grades I,II,III: 32,36,8 for the bilateral, and 6,1,3 for the unilateral group, with no significant difference between the two groups. No zygomatic implant failure occurred so that the same zygomatic implant success rate (100%) was recorded for both groups. A prosthetic failure was registered in the unilateral group. The overall prosthesis success rates were 89.5% and 70%, respectively, in the bilateral and unilateral groups. A high degree of success was achieved for both groups treated with zygomatic implants, although in group unilateral there was one failure of a standard dental implant placed in the posterior area. This suggested that the use of zygomatic implants could provide adequate support to the fixed full-arch prostheses even in the configuration with a single unilateral zygomatic implant.

Response to José Antionio Arellano et al. to their comments on our article “A single-center retrospective comparison of muscle versus cutaneous free flaps for posterior elbow defect reconstruction”

Response to José Antionio Arellano et al. to their comments on our article “A single-center retrospective comparison of muscle versus cutaneous free flaps for posterior elbow defect reconstruction”

Sacral Neuromodulation Reprogramming Rates: Understanding Office-Based Requirement.

Sacral neuromodulation (SNM) is a procedure with the advantage of reprogramming for discomfort or inadequate symptom control. The aims of this study were to investigate the rates of office-based SNM programming in a large multisite cohort and to examine differences based on implantation indication. The TriNetX database was utilized for retrospective cohort comparison using International Classification of Diseases, Tenth Revision, and Current Procedural Terminology (CPT) codes. Cohort selection included female adults with a diagnosis of urinary retention, urgency urinary incontinence, and/or fecal incontinence (FI) at time of implantation. The primary outcome was the rate of SNM reprogramming CPT per individual from 6 weeks to 5 years postimplantation. Secondary outcomes included demographic comparisons, incidence, and survival curves for patients with SNM reprogramming identified with CPT codes. Further comparisons were completed between implantation diagnoses of grouped urinary (urgency and retention) versus fecal indications. A total of 9,501 patients meet inclusion criteria with a mean of age 62.1 ± 14.9 years (range, 18-90). Office-based SNM reprogramming was identified in 31.5%. The probability of never having reprogramming at 5 years was 52.5%. The mean number of reprogramming sessions was 2.5 ± 2.1. Approximately half (48%) of the patients with FI also had a diagnosis of urgency urinary incontinence, and approximately 25% had urinary retention. The probability of never having reprogramming was 55% and higher in patients with a fecal incontinence indication than those with only urinary indications at 50%, P < 0.001. Office-based SNM reprogramming occurs in 31.5% of patients with implants, and rates are likely underreported. Patients with any FI diagnosis have a higher risk of requiring reprogramming.

Implementation of Billing for Patient Portal Messages as E-visits in a Large Integrated Health System.

Patient-provider communication through the patient portal has markedly increased in recent years. Some health care facilities implemented programs to enable providers to bill for responding to patient-initiated messages that require substantive medical decision making through an e-visit. To evaluate the effect of billing eligible patient-initiated portal messages as e-visits using a mixed-methods approach. Retrospective observational pre-post comparison and prospective survey. Large integrated health system with sites in 4 U.S. states. Patients initiating portal message threads and health system providers completing an online survey. E-visit billing was implemented 18 August 2023. The volume of patient-initiated medical advice message threads pre- versus postimplementation of e-visit billing was compared. Health system provider perceptions of e-visit billing were assessed using an online survey. In the 6 months after e-visit billing implementation (18 August 2023 through 18 February 2024), the volume of patient-initiated medical advice message threads decreased by 8.8% (from 1 813 818 to 1 653 708) compared with the same dates the year prior (P = 0.002). A total of 5183 (0.3%) medical advice messages were billed. There was no difference in 7-day use of emergency services (emergency department visits or hospitalizations) in patients who proceeded with sending a message versus those that did not send a message after viewing the billing disclaimer on the patient portal. Providers reported overall acceptance of e-visit billing but expressed concerns about increased workload with the current process. Cannot assess changes in other forms of contact, including telephone calls. These findings suggest that implementation of e-visit billing was associated with a modest decrease in patient-initiated portal message volume and was overall acceptable to providers in a large integrated health system. None.

Meniscal tear analysis in anterior cruciate ligament rupture: A retrospective comparison of early versus delayed intervention.

Combined anterior cruciate ligament (ACL) and meniscal tear patterns and their effect on knee stability have been widely researched, however, their evolution and repairability from time of injury have been scarcely addressed. When addressed with delay, meniscal lesions associated with ACL tears may increase in severity and irreparability. This study aims to investigate the incidence, rate and pattern of meniscus tears in the context of ACL deficient knees and to assess the meniscal condition in early versus late ACL reconstruction (ACLR). The hypothesis was that an increased time between trauma and ACLR was associated with different meniscal tear patterns. Between 2012 and 2022, ACL reconstruction was performed in 1,840 cases. Out of the reviewed 1,317 ACLR's 726 exhibited concomitant meniscal lesions. The mean age was 32 years ±10. Meniscal tear status was evaluated during arthroscopy according to the ISAKOS classification. Patients were divided into 2 groups according to injury-to-surgery time: <2 months (116; 16%) and >2 months (610; 84%). Vertical meniscal lesion was the prevalent pattern regardless of the meniscus involved and the time from injury to ACLR, accounting for 50 to 76% of the patients. No significant difference was found comparing patterns rates between early and delayed treatment groups for both compartments. There was a significant difference in the distribution of circumferential areas of meniscal tears when comparing the medial with the lateral compartment. However, no significant difference in circumferential distribution of medial or lateral meniscus tears are present when performing surgery within or beyond 2 months. There was no difference in meniscal tear patterns between early and delayed ACLR. The most frequent meniscal tear pattern was the vertical tear. No difference was found in circumferential distribution of meniscal tears between early and delayed ACLR. However, the circumferential distribution of meniscal tears was different comparing medial and lateral meniscus. III.

Stereotactic ablative radiotherapy for pulmonary metastasis from sarcoma: a retrospective comparison with metastasectomy.

Recent studies report excellent local control (LC) and favorable toxicities of stereotactic ablative radiotherapy (SABR) for pulmonary metastasis (PM) from sarcoma. This study compared the LC and survival of SABR and metastasectomy for sarcoma PM. We analyzed the LC rates of 54 PMs treated with SABR between 2008 and 2022. For survival analysis, we compared 14 patients who received SABR as first-line treatment with 61 patients who underwent metastatectomy. For SABR-treated PMs, a median total dose of 55Gy (range, 48-60) was administered over 3-10 fractions. Median follow-up for LC in SABR-treated PMs was 19.2months (range, 0.8-124.0), and the 2-year LC rate was 92.2%. No patients experienced toxicities of grade 3 or higher. The median age of the patients in the survival analysis was 73years (range, 42-83) in the SABR group and 54years (range, 19-78) in the metastasectomy group (p < 0.001). PMs in the "gray zone" were more common in the SABR group (35.7%) than in the metastasectomy group (8.2%) (p = 0.029). The median follow-up for survival analysis was 44.8months (interquartile range, 21.5-66.4). The 3-year rates of LC and overall survival were 92.3% and 57.3% in the SABR group and 89.2% and 75.9% in the metastasectomy group (p = 0.807, 0.224), respectively. The out-of-field intrapulmonary failure-free survival and extrapulmonary systemic failure-free survival rates at 3years were not significantly different (p = 0.673, 0.386). SABR for sarcoma PM demonstrated excellent LC with acceptable toxicity. Survival rates of SABR were comparable to those of metastasectomy.

Identifying Growth Hormone Deficiency in Brain-Injured Patients: The Quality of Life Scale-99.

Traumatic brain injury (TBI) is frequently associated with hypopituitarism. The hypothalamic-pituitary axis appears to be susceptible to the same forces that cause injury to the parenchyma of the brain. Following even a mild TBI (mTBI), patients may suffer transient or permanent decreases in anterior pituitary hormones, including somatotropin (growth hormone [GH]), gonadotropins (luteinizing hormone and follicle-stimulating hormone), thyrotropin, and adrenocorticotropic hormone, with the most frequent long-term deficiency being GH deficiency (GHD). GHD is common after mTBI and is often the cause of persistent post-concussive symptoms a year or more post-injury. GHD is known to cause physical and cognitive fatigue, cognitive inefficiency, metabolic changes, and a range of psychological symptoms. Confusing the picture is that some symptoms of GHD are also common to brain injury itself. To facilitate the detection of GHD when comorbid with TBI, we utilized a new symptom inventory, the Quality-of-Life Scale-99 (QoLS-99), and administered it to a cohort of chronic TBI subjects with and without GHD, distinguished using the insulin tolerance test (ITT). Between 2018 and 2023, 371 patients completed the QoLS-99, of which 263 underwent GH testing with the ITT. Of these 263 patients, 136 (52%) were diagnosed with GHD. A retrospective comparison of QoLS-99 scores found that loss of libido (p < 0.006), a reliance on sleep aids (p < 0.011), and feeling overweight (p < 0.015) were the strongest univariate predictors of GHD. Most survey items did not elicit a significant difference in response between the GHD groups, and for those that did, effect sizes were mild to moderate. Still, initial findings demonstrate strong predictive value in a subset of survey items (i.e., GHD symptoms) that are most discriminating in the sample of patients with TBI. A multivariate prediction model using this subset of questions was able to differentiate GHD status in patients with TBI, correctly identifying 88% of GHD cases with a 37% false positive rate. Based on these findings, we recommend that clinicians inquire about libido, insomnia, and body image as potential markers for GHD. Furthermore, given the amenability of patients with GHD to growth hormone replacement therapy, we strongly encourage clinicians and basic scientists to develop interventions for the large and underserved population of patients with TBI with comorbid GHD.

Retrospective Comparison of Outcomes and Cost of Virtual Versus Center-Based Cardiac Rehabilitation Programs.

Despite robust evidence supporting an association with improved outcomes in eligible patients, cardiac rehabilitation (CR) remains underused, with a minority of eligible patients participating. Virtual cardiac rehabilitation (VCR) has been proposed as an alternative to traditional center-based CR (CBCR) to improve usage rates. However, data supporting the efficacy and cost-effectiveness of VCR are limited. In the present study, we compared the outcomes and cost of a VCR versus traditional CBCR program. In a retrospective cohort study comparing VCR versus CBCR, CBCR data were collected from a period of January 2018 to September 2023. VCR data were collected from program initiation in July 2021 to September 2023. Primary health outcomes measured were 1-year mortality rates, recurrent myocardial infarction, all-cause hospital readmission, and emergency department visits. Primary cost outcomes were analyzed as cost ratios related to VCR versus CBCR assessing total medical costs allowed, pharmacy costs, and total costs of care over the 12 months post-CR enrollment. VCR was associated with a significant reduction in 1-year all-cause hospital readmission (incident rate ratio [IRR], 0.616 [95% CI, 0.489-0.777], P<0.001) and ED admission (IRR, 0.557 [95% CI, 0.452-0.687], P<0.001) at 1 year. The IRR of myocardial infarction and all-cause mortality did not significantly differ between VCR and CBCR. In addition, VCR was associated with significant reductions in medically related (cost ratio, 0.814 [95% CI, 0.690-0.960], P=0.0144) and total costs allowed (cost ratio, 0.838 [95% CI, 0.725-0.970], P=0.0176). VCR is a viable alternative to CBCR with at least comparable efficacy and cost, and as such, represents a key mechanism for improving access to and participation in CR for eligible patients.

Laparoscopic Shull Technique for Uterine Prolapse and Risk of Recurrences: A Retrospective Comparison with Vaginal Hysterectomy.

The objective was to compare the vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms. This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS). The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group.Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001). Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP.

Derivation of the carbon dioxide total column in the atmosphere from satellite-based infrared fourier-transform spectrometer IKFS–2 measurements: analysis and application experience

The paper discusses the use of a new version of the regression technique for derivation the total content of carbon dioxide in the atmosphere XCO2 (column-averaged dry-air mole fraction) from measurements of the infrared Fourier-transform spectrometer IKFS–2 installed on board Russian meteorological satellite Meteor-M No. 2. To evaluate the accuracy of satellite-based XCO2 estimates the retrospective comparison was made with data from ground-based spectroscopic measurements at Peterhof site of St. Petersburg State University as well as with aircraft measurements of the V. E. Zuev Institute of Atmospheric Optics (IOA) in the area of the Novosibirsk Reservoir conducted in 2019-2022. A brief description of the regression technique modifications is given made to improve the accuracy of satellite – based XCO2 estimates. In particular, to compensate for the effect of changes in the IKFS-2 characteristics during a long flight, the XCO2 estimates calibration is realized using ground - based XCO2 measurements at the NOAA Observatory on Mauna Loa volcano (island of Hawaii). After calibration and cloud scenes filtering, the discrepancy between satellite estimates and ground-based / aircraft measurements is characterized by root mean square deviation of ~4 ppm or 1% of the CO2 total content. In order to accelerate the adjustment of the regression technique, used for estimating XCO2, to IKFS-2 data on new satellites, it is reasonable to use XCO2 observations at the TCCON terrestrial network in addition to conventional contact measurements of CO2 concentrations. Along with this, it seems rational to use the cryogenic film thickness on the glass of the IKFS-2 photodetector, characterizing the state of the instrument, as additional predictor in the regression model.

Clinical Outcomes of Shifting from Transfemoral-First to Transradial-First Approach in Carotid Artery Stenting: A Retrospective Two-Timeframe Comparison at a Single Center.

Objective: Carotid artery stenting (CAS) has traditionally been performed using the transfemoral approach (TFA). Recently, the transradial approach (TRA) has gained attention for its lower invasiveness and reduced complication risk. This study compares outcomes between two access strategy timeframes, TFA-first and TRA-first, to evaluate how this shift influences outcomes in a real-world setting. Methods: A retrospective analysis of 85 CAS procedures was conducted at our institution from October 2018 to September 2024, categorizing them into TFA-first (n = 42) and TRA-first (n = 43) periods. The primary endpoint was access-related complications and 30-day perioperative events, including stroke, myocardial infarction, and mortality. The secondary endpoints included target lesion access success rate, frequency of access route conversions, procedural time, and hospital length of stay. Results: Baseline characteristics, including age, sex, symptomatic status, stenosis severity, plaque characteristics, and anatomical considerations, were comparable between groups. In the TFA-first period, 88% of procedures utilized TFA, and TRA was not used at all, while the remaining 12% employed the transbrachial approach (TBA). In the TRA-first period, 23% of procedures employed TFA, 60% utilized TRA, and 16% relied on TBA (p < 0.01). Both groups achieved a similar rate of target lesion access success (98% each) with only one conversion per group. The primary endpoint was significantly lower in the TRA-first group (0%) compared to the TFA-first group (10%, p = 0.04), primarily due to reduced access-site complications. Additionally, the median hospital stay was shorter in the TRA-first group at 6 days compared to 10 days (p = 0.02). Conclusions: Adopting a TRA-first strategy over TFA in CAS leads to better outcomes by improving access-site safety and reducing hospital stays. Developing TRA-specific devices could further expand the applicability of TRA in CAS.

RAVE checklist: Recommendations for overcoming challenges in retrospective safety studies of automated driving systems

Objective The public, regulators, and domain experts alike seek to understand the effect of deployed SAE level 4 automated driving system (ADS) technologies on safety. The recent expansion of ADS technology deployments is paving the way for early stage safety impact evaluations, whereby the observational data from both an ADS and a representative benchmark fleet are compared to quantify safety performance. Methods In January 2024; a working group of experts across academia, insurance, and industry came together in Washington, DC to discuss the current and future challenges in performing such evaluations. A subset of this working group then met, virtually, on multiple occasions to produce this paper. Results This paper presents the RAVE (Retrospective Automated Vehicle Evaluation) checklist, a set of fifteen recommendations for performing and evaluating retrospective ADS performance comparisons. The recommendations are centered around the concepts of (1) quality and validity, (2) transparency, and (3) interpretation. Conclusion Over time, it is anticipated there will be a large and varied body of work evaluating the observed performance of these ADS fleets. Establishing and promoting good scientific practices benefits the work of stakeholders, many of whom may not be subject matter experts. This working group’s intentions are to: i) strengthen individual research studies and ii) make the at-large community more informed on how to evaluate this collective body of work.

Survival Outcomes with Regorafenib and/or Trifluridine/Tipiracil Sequencing to Rechallenge with Third-Line Regimens in Metastatic Colorectal Cancer: A Multicenter Retrospective Real-World Subgroup Comparison from the ReTrITA Study.

There is ongoing discussion around the optimal course of treatment for metastatic colorectal cancer (mCRC) following the second line. Trifluridine/tipiracil (T) and regorafenib (R) have been the mainstay of therapy in this situation, as they both increased overall survival (OS) in comparison to a placebo. Despite the paucity of evidence, therapy rechallenge is also recognized as an option for practical use. In the third-line scenario of mCRC, we planned to investigate the survival outcomes using (T) and (R), both with and without prior rechallenge treatment. Between 2012 and 2023, we examined the medical records of 1156 patients with refractory mCRC who were enrolled in the multicenter retrospective ReTrITA study. We then separated the patients into two cohorts based on the rechallenge therapy that was given before regorafenib and/or trifluridine/tipiracil at 17 Italian centres. A total of 981 patients underwent T and/or R therapy, while 175 patients had therapy rechallenge before T and/or R. The median overall survival (mOS) for patients treated with T/R and R/T sequences in the rechallenge therapy cohort was 14.5 months and 17.6 months, respectively (p = 0.1955). A statistically significant survival benefit was observed in patients who received monotheraphy with R (mOS: 6 months) compared to the T group (mOS: 4.2 months) (p = 0.0332). In the same cohort, a median progression-free survival (mPFS) benefit was demonstrated in favour of the R/T group (11.3 months) vs. 9 months of the reverse sequence (p = 0.4004). In the no-rechallenge cohort, the mOS was statistically longer in the R/T sequence than in the T/R sequence (16.2 months vs. 12.3 months, respectively; p = 0.0014). In terms of the mPFS, we saw the same significant result for the adoption of R/T treatment (11.5 months vs. 8.4 months, respectively; p < 0.0001). The two monotherapy groups did not reveal any significant differences. This study suggests that rechallenge therapy may improve survival rates in the third-line treatment of mCRC, particularly if it is administered before sequential R/T treatment. This could allow for the extension of mCRC treatment choices until prospective studies are finished or randomised trials are performed.