BACKGROUND Administration of thrombolytics for acute ischemic stroke (AIS) via telemedicine has expanded in recent years at institutions without on-site neurology specialists. This helped to improve the care of stroke patients in rural areas. However, it is uncertain if telemedicine-administered thrombolytics is as safe and effective as in-person evaluation by neurology specialists. AIM The authors conducted a meta-analysis evaluating stroke metrics, safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics. METHODS PubMed, EMBASE, and Cochrane were searched for randomized clinical trials and observational cohort studies. The Mantel-Haenszel method or inverse variance, as applicable, were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio (RR) or standardized mean difference (SMD). Risk of bias was analyzed using the Newcastle-Ottawa Scale. Primary outcome examined was door-to-needle time (DTN). Secondary outcomes were symptomatic intracranial hemorrhage (sICH), mortality, and mRS ≤ 2. RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis. Of those, 34% (n = 794) received thrombolytics via telemedicine. Telemedicine was associated with a significantly longer mean DTN compared to in-person evaluation [SMD: 0.72 minutes; 95% confidence interval (CI) 0.22-1.22; P < 0.01], a similar rate of sICH [3.9% vs 4.2%; Odds ratio (OR): 0.75; 95%CI 0.42-1.37; P = 0.35], similar rate of mortality (13.2% vs 14.7%; OR: 0.87; 95%CI 0.47-1.63; P = 0.67), and comparable rate of favorable short-term functional outcome (46.8% vs 50.7%; OR: 0.79; 95%CI 0.41-1.53; P = 0.48). Risk of bias was low to moderate for each outcome. CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation. This difference in stroke metric does not affect safety or outcome. Further studies are needed to understand and address the underlying factors of the longer DTN time.

Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in older patients and an important contributor to cognitive decline and recurrent hemorrhagic stroke. Diagnosis of CAA is commonly based on MRI findings interpreted according to established criteria. Recently, the simplified Edinburgh criteria were proposed as a CT-based alternative to detect CAA in patients presenting with lobar ICH, potentially enabling faster diagnosis in emergency settings. The aim of this study was to evaluate the diagnostic accuracy of the simplified Edinburgh criteria in patients undergoing neurosurgical hematoma evacuation using histopathologically proven CAA as reference standard. We conducted a retrospective case-control study including all patients admitted to Hannover Medical School between February 2013 and December 2023 with lobar ICH who underwent hematoma evacuation. During surgery, brain tissue samples were collected and processed by β-amyloid (Aβ) immunohistochemistry and Congo red staining. Samples lacking intact vessel wall architecture were excluded. CAA severity was graded according to the Vonsattel rating. Preoperative cranial CT scans were analyzed by a board-certified neuroradiologist blinded to clinical and histologic information, applying the simplified Edinburgh criteria. Interrater reliability between a neuroradiologist, neurologist, and medical student was also assessed. Overall, 84 patients were included, of whom 58 had biopsy-proven CAA. The median age was 76 years (interquartile range 72-81) in the CAA-positive group and 69 years (interquartile range 54-76.5) in the CAA-negative group; women accounted for 57% and 35%, respectively. Substantial interrater agreement was observed when applying the simplified Edinburgh criteria. However, these criteria showed limited discrimination between CAA-positive and CAA-negative patients (area under the curve 0.617; 95% CI 0.486-0.749; sensitivity 64%; specificity 58%). Logistic regression adjusted for age significantly improved discrimination (area under the curve 0.784; 95% CI 0.662-0.905). Congo red staining alone demonstrated a sensitivity of only 65% compared with immunohistochemistry. Validation of the simplified Edinburgh criteria in patients with surgically treated ICH revealed limited diagnostic accuracy, emphasizing the need for histopathologic confirmation when available because imaging alone may not be sufficient for reliable CAA diagnosis in this population. Limitations include the retrospective design, single-center setting, and restriction to patients with surgically treated ICH. This study provides Class II evidence that the CT scan features of the simplified Edinburgh criteria have limited diagnostic accuracy to detect CAA in patients with lobar hematoma.

Giant coronary artery aneurysms (CAA), entailing thrombosis, myocardial infarction, and sudden death, are the most severe and life-threatening complications of Kawasaki disease (KD). Giant aneurysms rarely regress and can later transform into stenoses. Data on dynamic follow-up are scarce in the literature. To evaluate clinical features and long-term outcomes of giant CAA in children with KD. A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region (2012-2023). CAA criteria according to the American Heart Association guidelines of 2017 were used: (1) Dilated coronary artery with diameter Z-score > 2 standard deviations (SD) but < 2.5 SD; (2) Small CAA with Z-score > 2.5 SD but < 5 SD; (3) Medium CAA with Z-score > 5 SD but < 10 SD; and (4) Giant CAA with Z-score > 10 SD or ≥ 8 mm. The mean age of children with coronary dilatation/aneurysms was 2.5 years, and the male-to-female ratio was 3:1. Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate (Z-score < 5 SD but > 2.0 SD) coronary dilatation (62.0% vs 21.0%, P = 0.019). Major cardiovascular events (myocardial infarction, coronary artery bypass grafting, acute coronary syndrome, ischemic cardiomyopathy, left ventricular aneurysm, and giant extracardiac aneurysm) occurred in 55.5% of patients who had giant CAA. At follow-up the complete regression of giant/medium CAA was observed in 58.0% and partial regression in 42.0% after a mean of 2.3 and 5.5 years, respectively. All thrombi detected by echocardiography, CT, and angiography in giant/medium CAA disappeared between 1 year and 5 years (mean: 15 months). All patients survived. Risk factors for giant CAA were male sex, early age, and cerebral dysfunction. Complete regression of giant coronary aneurysms occurred in 58.0% of patients after follow-up of 2.3 years.

BACKGROUND Systemic lupus erythematosus (SLE) patients are admitted to the intensive care unit (ICU) for disease flares and infections, both of which carry a high mortality risk. Studies characterizing the outcome predictors of SLE are few in the Asian continent. This study characterized the clinical profile, treatment, and outcome predictors of ICU admissions with SLE. AIM To ascertain the reasons for ICU admission among SLE patients and to explore outcome predictors in these patients. The primary outcome was ICU mortality. Secondary outcomes included need for ventilation, inotropes, renal replacement therapy, and length of ICU and hospital stay. METHODS A retrospective study of 77 SLE patients was conducted in the medical ICU of a tertiary care teaching hospital in India. Clinical features, treatment, and outcomes of patients admitted between January 2018 and December 2022 were recorded. Factors associated with mortality were explored using bivariate and multivariate logistic regression analysis and reported as adjusted odds ratios with 95% confidence intervals. RESULTS The mean (SD) age was 31.1 (10.3) years; 83.1% were female. The median (interquartile) duration of SLE before admission was 12 (1-60) months; SLE was newly diagnosed in the current admission in 23.4%. The median Acute Physiology and Chronic Health Evaluation II score was 16.3 (14.5-18.2) and similar among survivors and non-survivors; 32 had evidence of disease flare, 44 had an infection, and one patient had an intracranial bleed. ICU admission was for respiratory failure (46.7%), hemodynamic instability (32.5%), and status epilepticus (14.3%). Twenty-nine patients (37.7%) had autoimmune hemolytic anemia, and 11 (14.3%) had diffuse alveolar hemorrhage. Immunomodulation included corticosteroids (96.1%), cyclophosphamide (33.8%), mycophenolate (23.4%), plasma exchange (13%), and immunoglobulins (11.7%). All patients received broad-spectrum antibiotics. Respiratory support, inotropes, and renal replacement therapy were required in 93.5%, 51.7%, and 32.5%, respectively. ICU mortality was 50.7% (95% confidence interval: 39%-62%). The mean ± SD hospital length of stay was 18.9 ± 14.3 days. On multivariate analysis, only shock (P = 0.004) was independently associated with mortality. CONCLUSION Intercurrent infection and disease flare are common reasons for ICU admission in SLE patients. Despite multimodal therapy, mortality is high. Shock was independently associated with mortality.

To assess the association between elevated sFlt-1/PlGF ratio and adverse neonatal outcomes in pregnancies with suspected preeclampsia. Retrospective cohort study. A tertiary centre in Hong Kong. 162 singleton neonates delivered between January 2020 and May 2023 from pregnancies complicated by suspected preeclampsia and sFlt-1/PlGF taken within 4 weeks before delivery. Pregnant women with suspected preeclampsia were recruited with analysis of serum Flt-1 and PlGF. Neonatal outcomes were compared between neonates from pregnancies with sFlt-1/PlGF ratio ≥ 85 (high-risk group) and < 85 (low-risk group). Neonatal outcomes including growth, respiratory, gastrointestinal, and metabolic complications. Logistic regression analysis showed that after adjustment for gestational age, preeclampsia and newborn sex, sFlt-1/PlGF ratio ≥ 85 was significantly associated with small-for-gestation (SGA; aOR = 2.52, 95% C.I. = 1.12-5.60), feeding intolerance (aOR = 3.03, 95% C.I. = 1.01-9.09), need for parenteral nutrition (PN; aOR = 11.19, 95% C.I. = 2.23-56.29), prolonged PN (aOR = 6.92, 95% C.I. = 1.43-33.39), hospitalisation over 7 and 30 days (aOR = 3.62, 95% C.I. = 1.20-10.87 and aOR = 7.04, 95% C.I. = 1.08-45.80 respectively). Linear regression showed a significant association between sFlt-1/PlGF ratio and duration of respiratory support, PN and duration of hospital stay. An elevated maternal sFlt-1/PlGF ratio within 4 weeks of delivery is significantly associated with adverse neonatal outcomes including SGA, gastrointestinal complications, prolonged parenteral nutrition and prolonged hospitalisation.

Diquat poisoning is common in Asia and the optimal enhanced elimination strategy is unknown. This study aimed to evaluate the clinical value of plasma diquat concentrations in guiding personalized extracorporeal treatment regimens for patients with acute diquat poisoning. This multi-center retrospective cohort study included 163 patients with acute diquat poisoning admitted between February 2022 and July 2023. Patients were divided into three groups based on plasma diquat concentrations measured upon presentation to the emergency department: low (<100 μg/L), medium (100-1,000 μg/L), and high (≥1,000 μg/L). The evaluated extracorporeal treatment regimens included hemoperfusion alone and a combination of hemoperfusion with continuous veno-venous hemodiafiltration. Kaplan-Meier survival curves were used to estimate cumulative survival probabilities, with survival probabilities compared using log-rank tests. All 66 patients survived in the low concentration group, regardless of the extracorporeal treatment used. In the medium and high concentration groups, five patients who refused extracorporeal treatment died, whereas 92 patients who received extracorporeal treatment had a case fatality rate of 48.9%. In the high concentration group, patients receiving hemoperfusion combined with continuous veno-venous hemodiafiltration had a case fatality rate of 76.7% and better survival probabilities, compared to hemoperfusion-only patients, which had no survivors. Additionally, among those treated with a combination of hemoperfusion and continuous veno-venous hemodiafiltration, the time interval from the end of hemoperfusion session to the initiation of continuous veno-venous hemodiafiltration was, on average, shorter for survivors than deaths (3.7 h versus 4.7 h). This retrospective observational study of diquat poisoned patients highlights the potential for personalized extracorporeal treatment regimens using an initial plasma diquat concentration. Future randomized trials are warranted to evaluate the optimal use of extracorporeal treatments. Obtaining plasma diquat concentrations may be of great value for guiding extracorporeal treatment regimens to improve prognosis in patients with acute diquat poisoning.

This study aims to assess the effectiveness and safety of carotid artery stenting (CAS) as a method for reducing the risk of stroke in patients with carotid stenosis (CS). This retrospective cohort study analyzed all patients with internal carotid artery (ICA) stenosis who underwent CAS at a single neurointerventional center from January 2016 to September 2022. Patients with concurrent intracranial stenosis, previous CEA, interfering neurological disorders, or incomplete data were excluded. Preoperative evaluations included comprehensive clinical assessments, and CAS procedures were conducted without embolic protection devices (EPDs). Postoperative monitoring involved intensive care unit (ICU) observation and MRI in selected cases. The study included 91 patients (mean age 69.2±10.2y, 65.9% male). The right ICA was involved in 46 patients and the left in 45 patients. The degree of stenosis significantly decreased from 80.58±12.53% to 16.61±9.54% post-CAS. Early neurological complications were observed in 5.4% of patients. Transient bradycardia during the procedure was common but resolved with atropine. One patient experienced prolonged bradycardia, but it resolved without lasting effects. Two patients had transient contralateral paresis postprocedure; one showed diffusion restriction on MRI but both recovered fully. Severe complications included one death due to intracranial hemorrhage and one case of hemiplegia with partial recovery over 3 months. Follow-up ultrasound in 30 patients showed no instances of restenosis. CAS significantly reduces CS and potentially aids in stroke prevention. The findings suggest that CAS without EPDs may achieve similar early outcomes, particularly in regions with limited EPD access.

Unhealed wounds and persistent perineal sinuses (PPS) may occur in as many as one third of patients after proctectomy for Crohn's disease. The management of these conditions remains a significant challenge, particularly in the context of inflammatory bowel disease (IBD), with existing therapies plagued by high failure rates. This systematic review of the literature assessed the efficacy of medical and surgical therapy for PPS closure in IBD. Secondary aims included review of classification systems used for PPS. A literature search was conducted using Medline, Embase and Cochrane databases on 17 December 2024. The review was registered on PROSPERO (CRD42024622582). Inclusion criteria were adult patients with IBD and PPS or unhealed wounds following proctectomy. We excluded abstract-only publications, case reports, cancer and paediatric cohorts. Two reviewers independently screened abstracts and full texts and extracted data. The primary outcome was clinical healing rate. Secondary outcomes included classification systems used to describe PPS. Risk of bias was assessed. Of 496 records identified, following removal of duplicates, 489 abstracts were screened, and 60 full text articles assessed for eligibility. Of 25 articles included in the final analysis, 23 were case series or retrospective cohort studies, and all were at high risk of bias. No randomised controlled trials were identified. Five articles (including two of the case series) described classification systems for PPS. Interventions included hyperbaric oxygen therapy, Karydakis flap, cleft closure, omentoplasty, skin grafting, gracilis and rectus abdominis flap, platelet-derived growth factor, curettage, lay open and excision of sinuses. Reported healing rates ranged from 30% to 100%. Heterogeneity in the reporting of outcomes, as well as the interventions performed precluded meta-analysis. The published evidence for treatment of PPS in IBD consists of low-quality evidence case series with high risk of bias. There is a need for standardised outcome reporting and high-quality, prospective studies to establish effective treatment algorithms.

Spinal Cord Injuries (SCI) greatly affect physical independence, especially in older Veterans. While the Functional Independence Measure (FIM) is widely used in rehabilitation, it lacks consideration of SCI-specific needs such as ventilation, wheelchair use, and bowel/bladder management. The Spinal Cord Independence Measure-Version III (SCIM-III) was developed to address these gaps, but its effectiveness has not been studied in the veteran population, which is typically older, predominantly male, and has higher comorbidity rates. This study examined the concurrent validity, responsiveness, and predictive value of FIM and SCIM-III for length of stay (LOS) and discharge destinations in older Veterans with SCI. This retrospective cohort study used data from an acute rehabilitation program (March 2021-May 2023) and included 33 adults (≥18 years) with a recent SCI (≤1 year) and a minimum one-week admission. Collected data included demographics, AIS level, injury type/duration, length of stay, and discharge destination. The SCIM-III demonstrated acceptable concurrent validity with the FIM, and both the FIM and SCIM-III were responsive to change. Neither measure was a significant predictor of discharge outcome. The SCIM-III admission score significantly predicted LOS, whereas the FIM admission total score did not significantly predict LOS. SCIM-III demonstrates acceptable concurrent validity and responsiveness to change when compared with FIM. Only the SCIM-III admission scores predicted LOS. These initial findings suggest the utility of the SCIM-III for improving clinical care and discharge planning among Veterans.

This study evaluates the clinical feasibility and perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for adnexal procedures, with particular emphasis on postoperative sexual function and dyspareunia. A retrospective cohort study was conducted at İzmir City Hospital between October 2023 and June 2025, including reproductive-aged patients without future fertility desire, an intact uterus, and indications for bilateral salpingectomy for gynecologic cancer prophylaxis. Patients underwent either vNOTES or conventional laparoscopic salpingectomy. Perioperative outcomes-including operative time, blood loss, complications, analgesic use, hospital stay, conversion to laparotomy, hemoglobin change, and pain scores at six and 24 hours-were compared. Postoperative sexual function was assessed using the Female Sexual Function Index (FSFI) and Couple Satisfaction Index-16 (CSI-16) at three and six months. Dyspareunia was evaluated using a standardized surgeon-designed questionnaire. A total of 467 patients were analyzed (vNOTES: 233; laparoscopy: 234). vNOTES was associated with significantly shorter operative time, reduced intraoperative blood loss, lower postoperative pain scores, and decreased analgesic requirements. No conversions to laparotomy occurred in either group. FSFI and CSI-16 scores showed no significant differences between groups at six months, and dyspareunia rates were comparable. vNOTES salpingectomy demonstrates perioperative advantages over laparoscopy without adversely affecting sexual function. It represents a safe and effective alternative for appropriately selected patients.

Abstract Objectives Youth with type 1 diabetes (T1D) and obesity face challenges in achieving optimal glycemic control and experience higher risk for long-term complications. While glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown weight and glycemic benefits in adults with type 1 diabetes, data in pediatric populations are scarce. We report here changes in glycemia, weight, and insulin doses in youth with T1D and obesity prescribed GLP-1RA. Methods We conducted a single-center retrospective observational study of adolescents and young adults (ages 10–20) with T1D and obesity prescribed GLP-1RA (liraglutide, exenatide, dulaglutide, semaglutide, or tirzepatide) between 2019 and 2024. Data collected included HbA1c, body weight, BMI, total daily insulin dose (TDD), and continuous glucose monitoring (CGM) metrics. Linear mixed effects models assessed changes over time, adjusting for age and gender. Results Among 24 patients (75 % female, 67 % public insurance, 88 % CGM users, 67 % insulin pump users), 12 months of GLP-1RA treatment led to significant reductions in weight (−9.49 kg, p&lt;0.0001), BMI (−3.69 kg/m 2 , p&lt;0.0001), and BMI Z-score (−0.30, p=0.04). CGM time-in-range increased by +7.96 % (p=0.08), and time above range (180–250 mg/dL) decreased by −3.04 % (p=0.06). TDD among pump users declined by −21.42 % (p=0.002). After approximately 16 months, HbA1c decreased by −0.81 % (p=0.04). Side effects were mainly gastrointestinal and transient. Conclusions This first longitudinal report of GLP-1RA use in youth with T1D and obesity shows clinically meaningful improvements in weight, glycemia, and insulin requirements, supporting the potential role of GLP-1RA as adjunct therapy. Larger prospective studies are needed to guide clinical practice.

Despite the widespread success of total joint arthroplasty (TJA), the impact of chronic immunosuppressant therapy on TJA outcomes remains unclear. This study aimed to evaluate the heterogeneous effects of various immunosuppressants on major postoperative complications in patients undergoing TJA. We conducted a retrospective cohort study using the 2022 National Surgical Quality Improvement Program, which included 114,498 patients with TJA. Patients were categorized based on immunosuppressant use, including anti-rejection drugs, biological disease-modifying antirheumatic drugs (DMARDs), corticosteroids, synthetic DMARDs, and combination therapies. Major postoperative complications, such as cerebrovascular accident, cardiac arrest, myocardial infarction, septic shock, sepsis, pulmonary embolism, deep vein thrombosis, organ/deep space surgical site infection, return to the operating room, and readmission, were treated as a composite variable. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated using multivariable logistic regression to assess the risk of major complications associated with each immunosuppressant category compared to non-immunosuppressant users. Of 114,498 TJA patients, 5,018 (4.4%) were receiving chronic immunosuppressant therapy. The incidence of major complications was higher among immunosuppressant users compared with non-users (10.44% vs 6.37%). Multivariable analysis revealed significantly increased risks of major postoperative complications for patients on immunosuppressants, with the highest risks observed in those on anti-rejection therapy (aOR: 1.96, 95% CI 1.29-2.98, p = 0.002), combination therapies (aOR: 1.83, 95% CI 1.45-2.3, p < 0.001), and corticosteroids (aOR: 1.58, 95% CI 1.28-1.96, p < 0.001). This study provides the first comprehensive national-level analysis of class-specific immunosuppressant effects on TJA outcomes. Our study revealed that chronic immunosuppressant use significantly increased odds of major postoperative complications in TJA patients, with the highest risks associated with anti-rejection therapies, combination therapies, and corticosteroids. These findings underscore the need for optimized perioperative risk stratification, and tailored management strategies to mitigate adverse outcomes in TJA patients on chronic immunosuppressant therapy. Retrospective Cohort Study.

Differentiated thyroid cancer (DTC) has a favorable prognosis. As indeterminate nodes are common, distinguishing recurrent and persistent DTC remains challenging. Previous studies have not specifically focused on prognosis between recurrent and persistent DTC. Thus, we aimed to compare prognosis and oncologic characteristics of two groups. This retrospective cohort study was conducted at a single tertiary care institution, enrolling 265 patients (recurrent: 109, persistent: 156) who underwent re-operation from November 1, 1999 to August 31, 2018 due to structural diseases. Those with distant metastasis at the time of initial diagnosis were excluded. Clinical and oncologic characteristics, patterns of lymph node (LN) metastasis, disease-free survival (DFS), and overall survival (OS) were compared between two groups. The time zero used for DFS is the time of the second operation. Recurrent DTC exhibited higher incidence of central LN metastasis (p-value = 0.003), infield recurrence (p-value < 0.001), and distant metastasis (p-value < 0.001). In contrast, persistent DTC showed more lateral LN metastasis (p-value = 0.003) and outfield recurrence (p-value < 0.001). The most common site of neck LN metastasis was ipsilateral level VI/VII (51.4%) for recurrent DTC and ipsilateral level IV (43.0%) for persistent DTC. Ten-year DFS was significantly lower for recurrent DTC (41.0%) than for persistent DTC (67.9%) (p-value < 0.001). Recurrent DTC, older age, higher total metastatic LN at the second operation (first re-operation), and R1/R2 resection at the second operation were associated with decreased DFS. OS isn't significantly different between recurrent and persistent DTC (p-value = 0.160). : Recurrent DTC has poorer DFS than persistent DTC, although OS isn't significantly different.

Patients with ulcerative colitis (UC) have an elevated thromboembolic risk. The comparative risks associated with advanced therapies (ADTs) remain unclear. In this retrospective cohort study, we utilized the Japanese Medical Data Vision claims database to assess patients with UC who initiated treatment with tumor necrosis factor (TNF) inhibitors, vedolizumab, or tofacitinib. We evaluated the cumulative incidence and hazard ratios (HRs) for venous thromboembolisms (VTEs), cardiovascular events (CVEs), and major adverse cardiovascular events (MACEs). The tofacitinib dose was modeled as a time-varying covariate. In total, 8125 TNF inhibitor users, 1218 tofacitinib users, and 2469 vedolizumab users were analyzed. Compared with TNF inhibitors, vedolizumab was associated with a lower risk of VTE (HR ,50, 95% CI 0.30-0.81) and CVE (HR 0.47, 95% CI, 0.27-0.81), with no difference in MACE. Tofacitinib 5 mg and 10 mg administration twice daily (BID) showed no significant differences vs TNF inhibitors, though point estimates were lower at 5 mg and higher at 10 mg. Concomitant 5-aminosalicylic acid was associated with a lower incidence of VTE. Vedolizumab demonstrated a favorable thromboembolic and cardiovascular safety profile compared with TNF inhibitors, whereas tofacitinib did not increase the risk at either dose. Concomitant 5-aminosalicylic acid may have a preventive effect against VTE. These findings may aid therapeutic decision-making for UC patients with elevated thrombotic risk.

To understand medication adherence and associated healthcare costs of patients with early Alzheimer's disease (AD). This retrospective cohort study used the Axon Registry® linked with claims data to examine medication adherence of U.S. patients with early AD (mild cognitive impairment [MCI] and mild dementia due to AD) from 2015 to 2022. Medication adherence was quantified by the proportion of days covered (PDC) over a one-year follow-up, and adherence rate was defined at a PDC ≥ 80%. Patient comorbidities and healthcare costs were described. Of 333 patients included, 213 (64%) were female with a median (IQR) age 79 (72-83) years. Patients had a mean (SD) of 2.3 (2.1) comorbidities and took a mean (SD) of 3.0 (1.5) medications. Weighted-average PDC across medications was 74.4% with 7 out of 10 medication classes having a medication adherence rate lower than 60%. DPP-4 inhibitors had the highest medication adherence rate (66.67% of patients), and memantine had the lowest (39.13% of patients). Annual median (IQR) medical and pharmacy costs per-patient were $5,268 ($1,808-$14,651) and $658 ($187-$2,736), respectively. Patients with early AD had multiple comorbidities and took multiple medications. Suboptimal medication adherence and high healthcare costs were observed.

Background Open wedge high tibial osteotomy (OWHTO) has been widely established as a safe surgical procedure for medial compartmental knee osteoarthritis. However, concerns remain regarding the progression of patellofemoral (PF) osteoarthritis following surgery. Recent advances in 3D-MRI analysis have enabled quantitative cartilage thickness measurement. We hypothesized that OWHTO would result in measurable decreases in the PF joint cartilage thickness, predominantly medially and detectable using quantitative 3D-MRI. This study evaluated the clinical utility of quantitative 3D-MRI for assessing PF joint cartilage changes before and after OWHTO. Methods Patients were included if they had undergone OWHTO without lateral retinacular release for medial osteoarthritis and had both the preoperative and post–hardware-removal 3D-MRI datasets required for this analysis. Radiographic evaluations were performed before and after OWHTO. Trochlear and patellar cartilage thicknesses were measured from 3D-MRI images at both time points. Changes exceeding 0.1 mm (the validated measurement precision threshold) were considered significant. To assess cartilage loss location, each 3D image was divided into medial, central, and lateral thirds. Superimposed images were observed to determine spatial correspondence of the cartilage defects. Results In total, 13 knees from 13 patients (median age 55 [32–74] years) were evaluated. Postoperatively, patellar height and lateral tilt significantly decreased (p &lt; 0.001 for both). Of these 13 cases, 7 (54%) showed thickness reductions exceeding 0.1 mm in the trochlear cartilage, and 7 cases showed reductions in the patellar cartilage, with 4 cases showing reductions in both. All cases demonstrated predominantly medial thickness decreases (p = 0.008). Of the 3 cases with patellar cartilage defects, 2 cases showed spatial correspondence with trochlear defects. Conclusions Quantitative 3D-MRI analysis revealed significant cartilage thickness decreases after OWHTO, predominantly in the medial aspect of the PF joint. This method proved useful for evaluating postoperative PF joint changes and detecting cartilage defect locations.

Robotic surgery for rectal cancer is popular, but persuasive evidence of long-term oncological outcomes in real-world populations is still lacking. This retrospective cohort study emulated the target trial to compare surgical quality and long-term oncological outcomes between robotic and conventional laparoscopic surgery for middle and low rectal cancer in real-world populations. Patients were consecutively enrolled from a multicenter cohort database in Shanghai, China, with middle or low rectal adenocarcinoma, cT1-T3 N0-N1 or ycT1-T3 Nx, no distant metastasis. Eligible patients were classified into robotic or laparoscopic groups and propensity score matched at a 1:1 ratio. The primary endpoint was 3-year disease-free survival rate. From 3742 eligible patients, 2702 were included in primary analyses after matching: 1351 in robotic group and 1351 in laparoscopic group. The median follow-up time was 42.4months (interquartile range=39.5-45.3). The robotic group had higher 3-year disease-free survival rate (86.7% vs. 83.3%, p=0.017, unadjusted hazard ratio [HR]=0.800, 95% confidence interval [CI]=0.666-0.961, adjusted HR=0.786, 95% CI=0.654-0.945). The robotic group also had lower 3-year locoregional recurrence rate (2.2% vs. 4.7%, p=0.001), lower 30-day postoperative complication rate (14.3% vs. 19.5%, p < 0.001), lower abdominoperineal resection rate (7.5% vs. 12.4%, p < 0.001), and lower circumferential resection margin positivity rate (2.2% vs. 4.2%, p=0.005). No significant difference in 3-year overall survival rate was observed (96.4% vs. 95.5%, p=0.063). Compared with conventional laparoscopic surgery, robotic surgery significantly improved long-term oncological outcomes and short-term recovery of middle and low rectal cancer in real-world populations.

Labiaplasty is the most frequently performed female genital cosmetic surgery worldwide, with indications extending beyond aesthetics to functional and psychosocial concerns. Labia minora elongation is frequently accompanied by clitoral prepuce prominence, yet this remains overlooked in surgical planning. This study describes a surgical technique integrating labia minora reduction with clitoral prepuce contouring and reports outcomes in a retrospective cohort. Women who underwent labiaplasty between 2018 and 2023 were contacted, and 132 of 185 (71.3%) returned anonymous questionnaires addressing motivations, perioperative experience, satisfaction, self-esteem, body image, and sexual function. The procedure was performed predominantly in an outpatient setting under local anesthesia. Excision and hemostasis were performed using the Fraxx System with ultrafine cutting and bipolar tips. The "Y technique" was employed in 103 cases, particularly when clitoral prepuce prominence accompanied labia minora elongation. In the remaining 29, labiaplasty was performed without prepuce correction or with an alternative technique. Motivations included dissatisfaction with aesthetics, discomfort, and embarrassment; over one-third reported all three. The perioperative experience was favorable, with most patients reporting the procedure as less painful and more tolerable than expected. No major complications occurred; postoperative effects included minor wound dehiscence and occasional requests for aesthetic revision procedures. Patients reported significant reductions in dissatisfaction with genital appearance. Outpatient labiaplasty under local anesthesia is safe, feasible, and well accepted, offering privacy and comfort. The "Y technique" adds value by being simple, reproducible, and delivering excellent functional, psychosocial, and aesthetic outcomes through simultaneous correction of labial and clitoral prepuce prominence.

Elastic Stable Intramedullary Nailing (ESIN) is a common treatment for pediatric tibial fractures, especially in standard diaphyseal fracture patterns and normal body mass index (BMI). However, ESIN may be technically limited in complex fracture morphologies (AO 42B-C, 43A2-A3) and in heavier children. Minimally Invasive Plate Osteosynthesis (MIPO), a technique widely embraced in adult orthopaedic trauma, may provide more stable fixation in these challenging scenarios through mini-incisions, indirect reduction strategies, and a stable "sliding plate" construct that preserves fracture biology. To compare clinical and radiographic outcomes of MIPO versus ESIN in diaphyseal AO 42B-C and extra-articular distal AO 43A2-A3 fractures. Single-center, retrospective cohort over 7 years, including skeletally immature patients (6 to 15y) with diaphyseal AO/OTA 42B-C or extra-articular distal AO/OTA 43A2-A3 fractures. Intra-articular distal (43B-C) and physeal injuries were excluded. Primary outcomes were time to radiographic union and major complications (deep infection, loss of alignment requiring unplanned surgery, and implant bending/migration). Secondary outcomes included return to full sport, minor complications (superficial irritation/entry-site), residual deformity >5 degrees, and shortening >1cm. Fifty-eight children were analyzed (MIPO n=25; ESIN n=33). Union occurred sooner after MIPO (10.6±1.8wk) than ESIN (15.8±2.5wk) (P <0.001). Return to full sport was earlier with MIPO (13.3±1.7wk) versus ESIN (20.6±2.4wk) (P <0.001). Major complications occurred in 6/25 (24%) after MIPO and 10/33 (30%) after ESIN (P=0.41); unplanned reoperations were 0/25 (0%) with MIPO and 8/33 (24%) with ESIN. Minor complications were comparable (40% vs. 42%, P=0.61), as was residual deformity >5 degrees (24% vs. 27%, P=0.564). Findings were directionally consistent in overweight children. For complex extra-articular tibial fractures (42B-C; 43A2-A3), MIPO yielded faster union, earlier return to sport, and fewer reoperations than ESIN. Simple mid-diaphyseal fractures in lightweight children may still be managed nonoperatively or with standard ESIN. Level III.

Pancreatoduodenectomy (PD) is a complex procedure associated with up to 20-30% morbidity and 1-2% mortality. In the present study, we aimed to evaluate the outcomes of PD in patients with cirrhotic liver and assessed predictors of perioperative morbidity and mortality. This is a retrospective study from a prospectively maintained database. Amongst the patients who underwent PD between January 2013 till June 2024, only patients who had underlying cirrhotic liver were included in the study. A total of 24 patients were included. On binary logistic regression history of pancreatitis in the preoperative period (OD-25.8), stent block (OD-64.9), cholangitis (OD-273), and preoperative platelets less than 1.37(OD-40), preoperative INR more than 1.31(OD-40) and platelets count on POD1 less than 1.23 lakhs (OD-40) were associated with mortality. Patients with clinically significant portal hypertension with thrombocytopenia and a deranged coagulation profile are associated with a high risk of mortality.