Short-term Outcomes Research Articles

Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer.

Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC. Retrospective case-control study. National database. Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes. 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (ORadj: 1.26, 95% CI: 1.00-1.58) than adult patients. These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.

Ischemic Stroke in Young Adults in India: Predictors of Recurrence and Functional Outcome.

Ischemic stroke (IS) in young is increasingly recognized as an important health problem in low- and middle-income countries (LMICs). Limited data is available from LMICs about the predictors of outcome and recurrence of IS in young. The study aims to assess the predictors of short-term and long-term functional outcome and the recurrence of the first-ever IS and transient ischemic attack in young. The clinical, radiological data, functional outcome, and recurrence of 569 IS patients aged 18-50 years were recorded. The etiological classification was done. The functional outcome was assessed using the modified Rankin scale (mRS), with a good outcome being mRS 0-2. Logistic regression was used to analyze the predictors of recurrence and outcome. The most common risk factors were hypertension (40.3%) and diabetes mellitus (34.3%). Stroke of undetermined etiology (33.6%) was the most common etiological subtype. Among the cardioembolic subtypes, rheumatic heart disease constituted 47.4%. A good functional outcome at 1 year was seen in 76.3%. While baseline stroke severity predicted both the 3-month and 1-year functional outcome, age ≥40 years and male gender predicted poor outcome at 1 year. The risk of recurrent strokes at 1 year was 2.5%. On multiple logistic regression analysis, diabetes mellitus independently predicted recurrent vascular events at 1 year (odds ratio = 2.43, 95% confidence interval 1.07-5.50). We found a good functional outcome with a relatively low recurrence at 1 year among young IS patients. Baseline stroke severity, age, and male gender predicted a poor 1-year functional outcome.

Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial.

While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511. DERR1-10.2196/60270.

A comparative analysis of the results of video-assisted thoracoscopic lobectomies and segmentectomies in patients with stage IA non-small cell lung cancer

Objective. To improve the results of surgical treatment of patients with stage IA NSCLC requiring thoracoscopic anatomical resections.Material and methods. One surgical team performed 132 thoracoscopic lobectomies and segmentectomies in one hospital between 2010 and 2020. This study was consecutive, non-randomized and retrospective.Patients after thoracoscopic lobectomies and segmentectomies for stage IA NSCLC were compared. Additionally, an analysis was performed in 4 subgroups of patients: lobectomy (n=45) and segmentectomy (n=21) with a tumor size up to 2 cm; lobectomy (n=55) and segmentectomy (n=11) with a tumor size from 2 to 3 cm.Results. The comparison groups are comparable in main clinical parameters. There was no mortality in both groups. There were no differences in the postoperative hospital day (6.0 and 6.2 days, p=0.58), the number of removed lymph nodes (9.2 and 9.9, p=0.52) and the percentage of complications (15.6% and 21.9%, p=0.75) when comparing segmentectomies and lobectomies.Differences in the groups were revealed in the length of the machine stitch: in lobectomy — 218.5 mm, in segmentectomy — 309.8 mm (p=0.0001). This pattern was the same in the subgroup analysis. In patients with a tumor from 2 to 3 cm, when removing a segment, the size of the mini-access was smaller than during lobectomy (3.3 cm and 4.0 cm, p=0.0087), and the persistent air leak was longer (6.8 and 2.9 days, p=0.0332).When analyzing long-term outcomes, no significant differences were found either in both group and subgroup analysis; however, there was a tendency towards an increase the overall five-year survival after segmentectomies compared with lobectomies in patients with tumor size ≤2 cm, while with tumor size from 2 to 3 cm, on the contrary, the best long-term results were found in patients operated on with thoracoscopic lobectomy.Conclusion. Thoracoscopic lobectomy and segmentectomy are safe and effective for stage IA NSCLC; the short-term outcomes of surgical treatment of patients with stage IA NSCLC after thoracoscopic lob- and segmentectomies with tumor size ≤2 cm are not significantly different; in patients with the tumor size from 2 to 3 cm, the persistent air leak after segmentectomies was significantly higher than after lobectomies (p=0.033); when evaluating long-term outcomes, no significant differences were found between the study groups and subgroups.

Neurodevelopmental outcomes in children prenatally exposed to opioid maintenance treatment: A population-based study.

Opioid maintenance treatment (OMT), with methadone or buprenorphine, is a key approach for managing opioid use disorder (OUD) during pregnancy. Despite buprenorphine's superior short-term outcomes, its long-term effects remain understudied. This study aims to evaluate the effects of prenatal OMT exposure on the incidence of childhood neurodevelopmental disorders (NDDs) considering timing effect. A retrospective cohort study using Rhode Island Medicaid data linked to vital statistics from 2008 to 2018 was conducted. The study included pregnancies having live birth from 2008 to 2016 with continuous Medicaid insurance and OUD diagnosis within 3 months preceding conception until delivery. At least one buprenorphine dispensing or a claim of methadone was required for exposure definition. Exposure was evaluated during early (0-90 days) or late (>90 days) gestation, or at any pregnancy phase. NDDs, including autism, attention-deficit/hyperactivity disorder (ADHD), learning disabilities, speech/language disorders, developmental coordination disorder, intellectual disability, and behavioral disorders, were identified using validated algorithms. Applying Cox proportional-hazard models with propensity score overlap weighting, adjusted hazard ratios (aHR) were calculated, mitigating potential confounders. Children were followed up from birth until NDD diagnosis, disenrollment, or study end. Of 416 mother-child dyads with OUD, 40% used methadone and 20% had buprenorphine exposure during pregnancy. NDDs were observed in 36% of children with early methadone exposure compared to 17% in the early buprenorphine exposed group (aHR: 2.75; 95% confidence interval [CI]: 1.42-5.35). Further comparison to late buprenorphine exposure, late methadone exposure was associated with higher NDD risk (aHR: 2.05; 95% CI: 1.09-3.86). Compared to unexposed group, children exposed to methadone during early and late periods showed higher NDD incidences (aHR: 2.33; 95% CI: 1.51-3.60 and aHR: 2.42; 95% CI: 1.54-3.80, respectively). The study suggests that buprenorphine is a good treatment option for OUD during pregnancy due to minimal long-term neurodevelopmental impacts on children. However, further extensive research is necessary to rule-out potential confounding.

Prognostic value of the fat-free mass index-based cachexia index in patients with colorectal cancer

Studies have shown that the cachexia index (CXI) is a useful predictor of cachexia in patients with colorectal cancer. However, the application of the CXI is limited stemming from the intricacy and additional cost of radiographic examinations. This study aimed to develop an easy-to-use and practical CXI based on fat-free mass index (FFMI-CXI) to evaluate the prognostic value of FFMI-CXI in CRC. A total of 656 patients with CRC were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) study. The FFMI-CXI was calculated as [FFMI (kg)/height (m)2 × serum albumin (g/L)]/neutrophil-lymphocyte ratio. The cutoff value for FFMI-CXI was determined through the analysis of ROC curves and Youden’s index for both male and female cohorts. Kaplan–Meier survival curves with log-rank tests were conducted to compare time–event relationships between different groups. Cox proportional hazards regression models incorporating both univariate and multivariate variables were employed to explore the independent prognostic factors associated with OS. Logistic regression analysis was performed to assess the association of the FFMI-CXI with secondary outcomes. The major outcome was 5-year overall survival (OS). Based on the cutoff values, 331 patients had low FFMI-CXI, and 325 patients had high FFMI-CXI. Patients in the low FFMI-CXI subgroup were significantly older and had advanced TNM stage, malnutrition, high systemic inflammation, long hospitalizations, high hospitalization costs, adverse short-term outcomes, and all-cause mortality. Multivariate Cox regression analyses revealed that FFMI-CXI (HR 0.47, 95% CI 0.33–0.66; p < 0.001) and TNM stage (HR 3.38, 95% CI 2.63–4.35; p < 0.001) were independently associated with OS in CRC patients. K-M survival curves revealed that the CRC patients with a high FFMI-CXI had significantly more favorable OS than those with low FFMI-CXI (62.84% vs. 84.31%; log-rank p < 0.001). Furthermore, the FFMI-CXI was valuable for predicting 90-day outcomes, malnutrition, cancer cachexia, length of hospitalization, and hospitalization expenses. This study revealed that the FFMI-CXI can be used as a prognostic indicator in patients with CRC. Patients with low FFMI-CXI should receive more attention.

Efficacy of mechanical against manual method in cardiopulmonary resuscitation for out‑of‑hospital cardiac arrest: A meta‑analysis.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality worldwide, with the efficacy of cardiopulmonary resuscitation (CPR) methods playing a crucial role in patient outcomes. The present study aimed to compare the effectiveness of mechanical and manual CPR in OHCA, focusing on three outcomes: Return of spontaneous circulation (ROSC), survival to admission and survival till discharge. A comprehensive meta-analysis was conducted, incorporating 39 studies for ROSC, 28 for survival to admission, and 30 for survival till discharge, totalling 144,430, 130,499 and 162,088 participants, respectively. The quality of evidence was evaluated using the GRADE approach, assessing risk of bias, inconsistency, indirectness, imprecision and publication bias. Statistical analysis included pooled odds ratios (ORs) with 95% confidence intervals (CIs) and sensitivity analyses. For ROSC, the pooled OR was 1.09 (95% CI: 0.92-1.29), demonstrating no significant difference between mechanical and manual CPR. Survival to admission favoured mechanical CPR with a pooled OR of 1.25 (95% CI: 1.09-1.43). No conclusive difference was found for survival till discharge, with a pooled OR of 0.79 (95% CI: 0.61-1.02). Substantial heterogeneity was observed across outcomes. Evidence of potential publication bias was noted, particularly in the survival to admission outcome. The overall quality of evidence was graded as very low, mainly due to high heterogeneity and indirectness of evidence. The study suggests that mechanical CPR may improve short-term outcomes such as survival to admission in patients with OHCA but does not demonstrate a significant long-term survival benefit over manual CPR.

Laparoscopic and thoracoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation for esophageal cancer: a prospective multicenter case-series outcome

IntroductionTo mitigate gastroparesis as well as other post-operative complications, we undertook a prospective multicenter study to assess the feasibility, safety, and efficacy in the short-term outcomes of laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation.MethodsA prospective descriptive study on 37 patients with laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation from January 2019 to March 2023. The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated.ResultsIn our study, all patients were male, with dysphagia as the predominant symptom (45.9%). Esophageal cancer incidence was similar between middle and lower thirds. Nodules were the primary finding on esophagoscopy (48.6%). Preoperative pyloric dilation averaged 31.2 min without complications. Surgical duration ranged from 225 to 400 min (mean 305). Gastric tube fluid volume averaged 148.9 ± 110.66 ml per day. Among 34 post-operative cases underwent gastric transit scans, most had non-dilated stomachs with efficient pyloric drug circulation. Three cases required prolonged ventilation, precluding pyloric circulation scans. Four patients developed chylous fistula, one requiring chest tube embolization. Recurrent laryngeal nerve damage occurred in 10.8% of cases.ConclusionAfter evaluating esophageal cancer patients undergoing laparoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation, it was found that this procedure is safe, effective, and significantly reduces postoperative gastroparesis and related complications.

A randomized-controlled trial of parent-administered interventions to improve short-term motor outcomes in hospitalized very low birthweight infants.

Premature infants are at increased risk for cerebral palsy (CP). Early interventions with a motor focus and administered by parents may improve motor outcomes. Secondary study evaluating the short-term motor outcomes and risk for CP in very low birthweight (VLBW) infants randomized to multimodal interventions with a motor focus provided by parents versus usual care. Randomized controlled trial (intervention vs. usual care (control group)). Infants (<32 weeks' gestational age (GA) and/or <1500 grams birthweight) born between March 2019 and October 2020. Short-term motor outcomes and risk for CP was evaluated using the Hammersmith Infant Neurological Evaluation (HINE, primary motor outcome), the General Movement Assessment (GMA) and the Test of Infant Motor Performance (TIMP) at 3 months' postmenstrual age (PMA). 70 participants were enrolled (GA 28.3±2.7 weeks, birthweight 1139.2±376.6 grams, 64.3% male). The in-person follow-up rate was 73%, lower than expected, in part due to COVID-19 restrictions, resulting in 25 infants (intervention) and 26 infants (control) with outcome data available for analysis. There was not a significant difference in the HINE, GMA or TIMP at 3 months' PMA between groups. Multimodal interventions with a motor focus and provided by parents need further investigation to determine if they can improve short-term motor outcomes in VLBW infants. These interventions are evidence-based and the evaluation of broader implementation into routine care is also needed.

Experience-based transition to robotic surgery in an experienced program in minimally invasive hepatobiliary surgery.

The adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program. Data on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023. Historical cohorts from the institutional experiences for comparison were hand-assisted (HALS) and purely laparoscopic procedures (PLS). Inverse probability of treatment weighting and propensity score matching were employed to compare outcomes between PLS and robotic resections. The learning curve for robotic surgeries was evaluated by the cumulative sum method. In this study, 454 patients were enrolled (113 robotic surgeries, 157 HALS, and 184 PLS). The posterosuperior segments resections were significantly higher in the robotic group (47.8%) compared to PLS (31.5%) and HALS (35.7%). There were no conversions in the robotic group, in PLS 2.7% and HALS 3.8%. The degree of difficulty according to the median of the IWATE score and IMM score was significantly higher in the robot group (p < 0.001 and p = 0.008, respectively). No significant differences in short-term outcomes were observed between robotic procedures and PLS in a matched subset of patients. Operative efficiency and blood loss improved significantly after the 75th robotic surgery patient, with high-difficulty cases (IWATE ≥ 10) incorporated from the beginning. This study suggests that robotic liver surgery in units with prior experience in minimally invasive liver surgery offers benefits, such as a lower conversion rate and a higher rate of successful difficult resections.

Short-Term Outcomes of High-Density Porous Polyethylene Orthoses for Chin and Gonial Angle Augmentation.

This retrospective observational study evaluated 100 patients over 18years. Data on age, sex, aesthetic complaints, surgery types, and postoperative complications were collected and analyzed using the two-proportion z-test and descriptive statistics in RStudio 4.3.3. All patients with neuropraxia underwent neurosensory evaluation. The average age was 35.92years for males and 33.71years for females, with a male predominance (76%). Aesthetic complaints were prevalent in 72% of patients (p < 0.01). Chin surgery was performed on 56% of patients, jaw angle surgery on 17%, and both on 39%. Complications included one case of suture dehiscence, three wound infections, and four transient cases of paresthesia, all resolving within 30days. Overall, patient satisfaction with outcomes was high. High-density porous polyethylene implants proved effective and safe in enhancing facial aesthetics and correcting mandibular deformities. Further research should focus on long-term outcomes to consolidate these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Neonatal Survival and Outcomes following Periviable Rupture of Membranes.

To clarify survival for infants affected by periviable prolonged preterm premature rupture of membranes (PPROM) in the military health system (MHS). To add to current literature on outcomes following expectant management, including long-term neurodevelopment outcomes. Retrospective matched cohort review of six level 3 military neonatal intensive care units (NICUs; 2010-2020). Cases were matched 1:1 with control infants, matched by location, gender, gestational age (within 1 week), birth weight (within 300 g), and rupture of membranes (ROM) within 24 hours of delivery. Follow-up data were obtained for each infant through 48 months' corrected age or age of last documented health visit in a military treatment facility. Forty-nine infants met inclusion criteria. Mean ROM for cohort infants was 20.7 weeks, with mean latency period of 34.6 days and mean gestational age at delivery of 25.7 weeks. Cohort infants had a mean birth weight of 919 g. Cohort survival to NICU discharge was 75.5 versus 77.6% of controls (p = 0.81). Statistically significant short-term outcomes: oligohydramnios or anhydramnios at delivery (p < 0.0001), pulmonary hypertension (p = 0.0003), and high-frequency ventilation (p = 0.004) were higher in cohort infants. No differences were found regarding rates of early sepsis, intraventricular hemorrhage, surgical necrotizing enterocolitis, oxygen at 36 weeks or at discharge. No statistical difference in long-term outcomes at 18 to 48 months of age or incidence of autism, cerebral palsy, attention deficit hyperactivity disorder, or asthma. Cohort survival to discharge in the MHS was 75.5%, higher than previously reported and not different from matched controls. Infants born after periviable PPROM should deliver at centers with access to high-frequency ventilation and ability to manage pulmonary hypertension. There was no difference in long-term neurodevelopment between the groups. · Survival to NICU discharge is similar between infants exposed to periviable PPROM and controls.. · Cohort survival to discharge was 75.5%, higher than previously reported in recent literature.. · Infant with periviable PPROM should delivery at centers capable of managing pulmonary complications..

Impact of a novel-covered colonic stent in obstructive colon cancer.

Although the short-term outcomes of bridge-to-surgery (BTS) procedures using self-expandable metal stents are favorable, concerns remain regarding worsened prognosis due to tissue injury in the tumor area. Herein, we describe a newly developed covered stent, the Kawasumi Jabara colonic stent™, designed to reduce tissue damage/injury associated with stent-related complications in BTS procedures. This study aimed to evaluate the efficacy and safety of the Kawasumi Jabara colonic stent as a BTS for obstructive colorectal cancer (OCC). This multicenter retrospective observational study included 44 OCC patients who underwent BTS with stents at four facilities between September 2020 and November 2022. The groups of patients receiving the Kawasumi Jabara and non-covered colonic stents were designated Groups C and NC, respectively. Treatment outcomes related to stent placement and surgery were compared using propensity score matching (PSM) analysis. Groups NC and C (n = 34 and 10, respectively) showed no significant differences in sex, age, tumor location, histological type, Colorectal Obstruction Scoring System (CROSS) score, or cStage; however, the stent placement duration was shorter in Group C. No significant differences were found in terms of the technical and clinical success rates for stent placement. Stent dislocation was observed in 0 and 2 cases in Groups C and NC, respectively. PSM analysis between eight cases, each from Groups C and NC, revealed no significant differences in stent-related or surgical outcomes between the groups. However, regarding the gross injury score in the resected specimens, Group C had a lower score than Group NC (1.8 vs. 5.5), and the proportion of pathological tissue injury involving deeper layers was also lower in Group C (37.5% vs. 100%). Compared to conventional non-covered stents, the Kawasumi Jabara colonic stent™ demonstrated favorable safety during stent insertion, retention, and surgery, with only mild tissue injury.

Long-term comparative outcomes in patients undergoing transcatheter aortic valve implantation with self-expanding valves versus balloon-expandable valves

ABSTRACT Background This study aimed to compare long-term clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) with self-expanding (SEV) valve versus balloon-expandable valve (BEV), with a minimum follow-up period of five years. Materials and Methods Utilizing a prospectively maintained database, this observational study identified patients who underwent TAVI using either SEV or BEV for severe aortic stenosis and were followed for at least five years. Clinical outcomes encompassed both 30-day post-TAVI outcomes and long-term outcomes, including all-cause mortality, cardiovascular mortality, structural valve deterioration (SVD), heart failure related hospitalization, bioprosthetic valve failure, and valve related hospitalization and complications. Results A total of 74 patients were included in this study, with 64 patients in the SEV group and 10 patients in the BEV group. The median follow-up duration was 6.8 years, ranging from 5.0 to 10.2 years. Throughout the post-TAVI period, the SEV group consistently demonstrated a lower mean pressure gradient than the BEV group. No significant differences were observed between the two groups in terms of short-term or long-term outcomes. Within the study, four patients encountered moderate or severe SVD and one experienced thrombosis, and no cases of bioprosthetic valve failure or endocarditis were observed. Conclusions This study revealed that SEV and BEV demonstrated comparable long-term outcomes in patients undergoing TAVI, including all-cause and cardiovascular mortality, as well as the risk of SVD.

The Vecta 46 intermediate catheter for mechanical thrombectomy of distal medium vessel occlusions: A single-center experience.

With emerging evidence supporting the clinical efficacy and safety of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs), MT devices specifically designed to navigate through smaller caliber and more delicate tortuous distal cerebrovasculature are required. This study describes our single-center experience using the AXS Vecta 46 intermediate catheter for first-line thromboaspiration of DMVOs. We identified all patients who underwent MT using the Vecta 46 for first-line thromboaspiration for primary or secondary DMVOs. We collected baseline clinical data, angiographic and clinical outcomes, as well as procedural complications. The primary outcome in question was the rate of successful recanalization, which was defined as a modified Thrombolysis in Cerebral Infarction score of ≥2b. We identified 43 patients who underwent MT using the Vecta 46 catheter for thromboaspiration of 54 DMVOs. Intervened vessels included the M2 (23/54), M3 (19/54), and M4 (6/54) branches of the middle cerebral artery, A2 (1/54), A3 (1/54), and A4 (1/54) branches of the anterior cerebral artery, and P1 (1/54), P2 (1/54), and P4 (1/54) branches of the posterior cerebral artery. The median number of passes for primary DMVOs was 2 (IQR: 1-3) and 1 (IQR: 1-1.25) for secondary DMVOs. The rate of successful recanalization was 100% (18/18) for primary DMVOs and 80.6% (29/36) for secondary DMVOs. First-pass effect (FPE) was noted in 55.6% (30/54) of all primary and secondary DMVO cases. Improved short-term clinical outcomes were observed in both the primary (National Institute of Health Stroke Scale [NIHSS] shift: -5 [IQR: -14.25 to -0.25]) and secondary (NIHSS shift: -5 [IQR: -10 to -2]) DMVO groups. A total of six patients died during their hospitalization, though none were deemed procedural-related. Our study demonstrates the safety and efficacy of the Vecta 46 intermediate catheter for thromboaspiration of both primary and secondary DMVOs, achieving high rates of successful recanalization and FPE.

Long-term outcomes of intravenous corticosteroid pulse therapy for rapidly progressive alopecia areata: A single-center retrospective analysis of 106 cases and usefulness evaluation of a scoring system originally designed for half-year efficacy prediction for extended periods.

Intravenous corticosteroid pulse therapy (IVPT) has been preferentially conducted for rapidly progressive alopecia areata (RP-AA); however, the evaluation of long-term outcomes has been insufficient. In this study, 106 IVPT-treated RP-AA patients (36 males and 70 females) who were followed up for more than 1 year and up to 6.8 years were retrospectively analyzed. The mean observation period was 1137.8 ± 587.9 days (range 380-2490). The mean severity of alopecia tool (SALT) score before IVPT was 21.3 ± 23.4 but whole-scalp hair loss was observed in all cases after the intervention, suggesting that IVPT was performed soon after the onset. With additional interventions represented by intralesional triamcinolone acetonide injection with or without topical potent corticosteroid for those who insufficiently responded at 6 months after IVPT, 64.2%, 14.2%, and 21.7% of the patients respectively achieved good response (GR; SALT score ≤25), moderate response (MR; 25 < SALT score <75), and poor response (PR; 75 ≤ SALT score) 1 year after IVPT. On the final evaluation, the proportions of patients with GR, MR, and PR were 79 (74.5%), 7 (6.6%), and 20 (18.9%). Sixteen patients achieved and maintained full hair regrowth with IVPT alone until the end of observation. A previously reported scoring system for the short-term outcome prediction was shown to be useful for distinguishing the final-point GR responders from PR responders (P = 0.003). Of note, 21 patients were found to have some symptoms suggestive of the existence of preceding infectious diseases and tended to relapse. The revised scoring system adding the absence of preceding infectious diseases as one factor successfully predicted the occurrence of the relapse in our cohort (P = 0.002). Taken together, previously unreported real-world efficacy of IVPT to RP-AA was elucidated with the invention of a tool putatively enabling optimal long-term management.

The Role of a Community Surgeon in the Care of Hepatopancreatobiliary Patients: Short-Term Outcomes and Learning Curve.

Background Owing to the well-established volume-outcome relationship, hepatopancreatobiliary (HPB) surgery is commonly regionalized to academic, teaching hospitals. However, regionalization is associated with decreased access for some populations in need, as well as geographic and financial barriers for patients. If high surgeon and institutional volumes can be achieved, the community, non-teaching HPB surgical practice could help alleviate some issues associated with regionalization. The HPB experience of a community surgeon immediately after surgical oncology training was reviewed, hypothesizing that high volumes with acceptable short-term outcomes could be achieved, although a learning curve may be observed. Materials and methods Electronic medical records from 2013 to 2023 were reviewed. Data included patient demographics, perioperative details, pathology, complications, and deaths over 90 postoperative days. Perioperative quality metrics were assessed for trends over time in pancreaticoduodenectomy (PD) and liver resection subgroups. Results A total of 295 patients underwent 176 (59.7%) pancreatic and 119 (40.3%) hepatobiliary operations. The most common operations were PD (n=87; 49.4%) and partial hepatic lobectomy (n=56; 41.1%). In the pancreas group, morbidity was 25% (n=44), and mortality was 4.5% (n=8). In the hepatobiliary group, morbidity and mortality were 19.3% (n=23) and 5.0% (n=6), respectively. Within the PD and liver resection subgroups, operative time, estimated blood loss, and hospital length of stay (LOS) trended downward over time, with LOS decreasing significantly. Conclusion High HPB volumes with acceptable short-term outcomes can be achieved by a solo practitioner in the community, non-teaching setting. For PDs and liver resections, perioperative metrics trended downward over time, illustrating the learning curve encountered after training.

Optimal survival analyses with prevalent and incident patients.

Period-prevalent cohorts are often used for their cost-saving potential in epidemiological studies of survival outcomes. Under this design, prevalent patients allow for evaluations of long-term survival outcomes without the need for long follow-up, whereas incident patients allow for evaluations of short-term survival outcomes without the issue of left-truncation. In most period-prevalent survival analyses from the existing literature, patients have been recruited to achieve an overall sample size, with little attention given to the relative frequencies of prevalent and incident patients and their statistical implications. Furthermore, there are no existing methods available to rigorously quantify the impact of these relative frequencies on estimation and inference and incorporate this information into study design strategies. To address these gaps, we develop an approach to identify the optimal mix of prevalent and incident patients that maximizes precision over the entire estimated survival curve, subject to a flexible weighting scheme. In addition, we prove that inference based on the weighted log-rank test or Cox proportional hazards model is most powerful with an entirely prevalent or incident cohort, and we derive theoretical formulas to determine the optimal choice. Simulations confirm the validity of the proposed optimization criteria and show that substantial efficiency gains can be achieved by recruiting the optimal mix of prevalent and incident patients. The proposed methods are applied to assess waitlist outcomes among kidney transplant candidates.

Short-term Clinical Outcomes of COVID-19 Patients Hospitalized with Chronic Obstructive Pulmonary Disease and Asthma in Three Tertiary Level Hospitals in Bangladesh

Background: Several comorbidities including chronic obstructive pulmonary disease (COPD) or bronchial asthma have been found associated with COVID-19 cases. But it remains unclear which of the comorbidities are associated with worse outcomes of the patients. Objectives: This study was carried out to determine the clinical outcomes of hospitalized COVID-19 patients with COPD or asthma. Methodology: This prospective study was carried out at Respiratory Medicine unit of Monno Medical College and Hospital, Manikganj, from April 2020 to December 2022. Admitted COVID-19 patients, suffering from COPD or bronchial asthma, were enrolled purposively upon fulfilling the inclusion and exclusion criteria. The patients were divided into two groups with associated comorbidities: Group A suffering from COPD and Group B suffering from Asthma. Data were collected from the patients on variables of interest using a semi-structured questionnaire. Results: Among the 144 enrolled patients, 96(66.67%) in group A were suffering from COPD and the other 48 (33.33%) in group B had bronchial asthma. In this study, 41(42.7%) patients in Group A exhibited &gt;25% lung field involvement in the high-resolution computed tomography (CT) chest imaging, compared to only 10(20.8%) in COVID-19 patients in Group B, and this difference in distribution was statistically significant (p=0.026). The COVID-19 patients in Group A were more severe to critically ill (45, 46.9%), compared to patients in Group B (12, 25.0%) with a p value of 0.011. Group A study subjects required intensive care unit (ICU) admission (49, 51.0%) more than the group B participants (16, 33.3%), which was also found statistically significant (p&lt;0.05). Nearly one-fifth (17, 17.7%) of the patients died among the Group A, compared to only 2(4.2%) mortality observed in Group B (p=0.024). The COVID-19 patients with COPD were found significantly associated with the risk of &gt;25% lung field involvement, severe to critical illness, ICU admission, invasive mechanical ventilation, and death (all p values &lt;0.05). Conclusion: The comorbidity of COPD was found to increase the risk of disease severity and adverse outcomes in COVID-19patients significantly. It also heightened the risk of lung field involvement, exceeding 25% more severe disease and increased mortality rates compared to individuals with bronchial asthma. Journal of Monno Medical College December, 2023; 9 (2):47-52

Health dialogue intervention versus opportunistic screening in primary care for type 2 diabetes and cardiovascular disease prevention in settings with low socioeconomic status (DETECT): study protocol for a pragmatic cluster-randomized trial

BackgroundMeta-analyses of randomized trials suggest that health checks and health promotion interventions targeting behavior change in primary care do not prevent cardiovascular morbidity and mortality in the general population. However, whether such interventions are more effective in high-risk populations, such as people living in low socioeconomic settings, remains unclear, as they have been poorly represented in previous trials. Therefore, we aim to evaluate the effectiveness, cost-effectiveness, and implementation of systematic screening followed by an individually oriented, lifestyle-focused, health dialogue intervention for prevention of type 2 diabetes and cardiovascular disease, as compared to opportunistic screening, in primary care in socioeconomically disadvantaged areas.MethodsUsing an overall pragmatic approach and a cluster-randomized design with two arms, we aim to enroll 3000 participants aged 50–59 years from 30 primary care centers (PCCs) with an above-average level of Care Need Index in Stockholm Region, Sweden. PCCs will be randomized (1:1) either to a health dialogue intervention, which includes inviting enlisted patients to a systematic screening of risk factors followed by an individually oriented lifestyle-focused health dialogue, or to opportunistic screening, which includes screening patients for a smaller set of risk factors during an appointment at their PCC taking place for other reasons. The main outcome will be change in systolic blood pressure during 6- and 12-month follow-ups. Additional short-term outcomes will be changes in other biological risk factors, health-related quality-of-life, and lifestyle habits, as well as process and implementation outcomes, and unintended side effects. The long-term effect on type 2 diabetes and cardiovascular disease incidence and mortality will be examined using regional and nationwide registers. Changes in systolic blood pressure and other health outcomes will be analyzed using mixed-effect generalized linear modeling and mixed-effect Cox regression to capture variability between and within PCCs. A health economic evaluation will assess resource use and costs in the short- and long-term.DiscussionThis trial of lifestyle-focused health dialogues and opportunistic screening in primary care in socioeconomically disadvantaged areas in the largest region of Sweden has the potential to yield valuable insights that could support evidence-based policymaking.Trial registrationClinicalTrials.gov (NCT06067178). Prospectively registered September 27, 2023.