Short-term Outcomes In Patients Research Articles

BHSeP26 Abdominal wall reconstruction outcomes of the first 50 cases in a district general hospital

Abstract Background The purpose of this study was to evaluate the short-term clinical outcomes of patients undergoing reconstruction of abdominal wall following repair of complex hernias at a recently established unit. Methods This retrospective study included all patients who underwent abdominal wall reconstruction for complex incisional hernias between January 2022 and March 2024. Clinical data encompassing patient demographics, operative parameters, post-operative complications, length of hospital stay and 30-day mortality was analysed. Results 50 patients were included with a male to female ratio of 1:1. The median age of the participants was 62 (26–82). 25% of participants had a BMI of 35. The majority of hernias were approached with a vertical elliptical incision; Fleur de Lys incision was used in 1 case and abdominoplasty incision in 3 cases. The following reconstruction techniques were used: 27 patients underwent Rives Stoppa repair and 16 patients underwent Transversus Abdominis Muscle Release. 30% patients had Botulinum toxin injection pre-operatively. The types of mesh used included: Ultrapro 80 %, Phasix 16 % and Parietex 4 %. Complications included: Surgical site occurrence 6%, cardiorespiratory complications 10%, vascular complications 2% and bowel obstruction 4%. ICU admission included 3 out of 50 patients. Length of hospital stay in 90% patients was 5 days. 60% patients had a 6-monthly follow up where 1 recurrence was noted. Conclusion The early outcomes in our patients demonstrates the feasibility to achieve acceptable outcomes in a district general hospital, by following a multidisciplinary approach and optimising modifiable risk factors preoperatively.

Effect of β-blocker on clinical outcomes in patients with traumatic brain injury: a retrospective propensity-matched study

BackgroundTraumatic brain injury (TBI) represents a significant public health challenge due to its complex management. β-blockers may offer neuroprotective benefits, but their impact on TBI outcomes remains unclear. This study aims to evaluate the effect of β-blocker use on clinical outcomes in TBI patients.MethodsThis retrospective cohort study included adult TBI patients, categorized into β-blocker and non-β-blocker groups. Propensity score matching (PSM) was utilized to balance baseline characteristics. Mortality was assessed through the application of multivariable Cox regression models and Kaplan–Meier survival curves. Subgroup analyses examined the consistency of the results.ResultsA total of 1,516 patients were included in the study, with 750 receiving β-blocker therapy and 766 not receiving it. After PSM, 473 pairs of patients were matched. The analysis indicated that β-blockers significantly reduce 28-day mortality (HR 0.43, 95% CI: 0.31–0.60, P < 0.001). However, patients receiving β-blocker had considerably longer hospital stays (7.89 days vs. 5.45 days, P < 0.001) and ICU stays (2.94 days vs. 2.33 days, P < 0.001).Conclusionβ-blocker therapy is associated with improved short-term outcomes in patients with TBI, particularly in those with mild (GCS 13–15) and severe (GCS 3–8) TBI. However, no significant benefit was observed in patients with moderate TBI (GCS 9–12). This therapy may also prolong hospital and ICU stays.

P1034 Prognostic value of short-term endo-histological outcomes in moderate-to severe ulcerative colitis patients on tofacitinib treatment – prospective cohort study

Abstract Background Data are scarce on the deep remission of tofacitinib (TOFA) in moderate-to severe ulcerative colitis (UC), however, it can fundamentally change disease course and behaviour. Methods This was a prospective cohort study, assessing the short-term effectiveness of TOFA in UC patients. Baseline was the day of induction of TOFA. Clinical, biochemical, endoscopic and histological activities were assessed at baseline and at week 8 and 12, and we collected one-year treatment persistence. Primary outcome was week 12 histological remission (HR), defined as Nancy score<1 and endoscopic Mayo score (eMayo)≤1. Secondary outcomes were week 12 corticosteroid-free remission (CSFR), defined as clinical remission (CR; partial Mayo score [pMayo]<2 with a rectal bleeding subscore of 0) and C-reactive protein (CRP) ≤5 mg/L and endoscopic remission (eMayo score ≤1), furthermore, one-year treatment persistence were assessed. Data was handled by intention to treat analysis. We performed multivariable logistic, Cox-regression and linear regression models to control potential confounders and to reduce bias. The most reliable models were selected based on ROC analyzes with highest area under the curve (AUC). Results A total of 75 moderate-to severe UC patients (mean age 38.4 ± 12.1; male/female ratio 32/44) were involved in our prospective cohort study. In total, 7 patients (9.2%) achieved histological remission, while 20 patients (26.7%) achieved endoscopic remission. We found, that one-year treatment persistence was strongly influenced by week 12 endoscopic remission (β=3.79 [95% CI: 1.21 – 6.37]), but not by HR (β=1.58 [95% CI: -0.74 – 3.89]). In total, 34 patients (44.7%) were in CSFR at week 12, and higher baseline pMayo score decreased (OR=0.64 [95% CI: 0.43 – 0.94]), while albumin increased (OR=1.33 [95% CI: 1.01 – 1.76]) the chance of achieving the outcome (AUC = 0.93). Conclusion Based on our prospective cohort study, short-term HR is still a hard-to-reach endpoint in moderate-to-severe UC on TOFA. We found, that one-year treatment persistence is influenced by endoscopic mucosal healing, but not by HR, however, it should be enhanced, that as only a few patients achieved HR, the necessary statistical power was lacking.

Clinical features and short-term outcomes of bilateral sudden sensorineural hearing loss: an eight-year experience at a tertiary center

Background Sudden sensorineural hearing loss (SSNHL) typically affects one ear and is often linked to various underlying causes. However, bilateral SSNHL (BSSHL), where both ears are affected, is much rarer and presents a more severe clinical challenge. Aims/objectives To report the clinical features and short-term outcomes of patients with BSSHL. Material and methods The clinical features and outcomes of cases with BSSHL treated in between January 2016 and November 2024 were retrospectively analyzed. Results A total of 1212 cases with SSNHL were collected, and only 24 cases showed BSSHL (2.0%). The average hearing thresholds before treatment in the simultaneous onset group were significantly higher than that of the sequential onset group (p < .05). After prednisolone therapy, the effective rate of cases treated within 7 days was 18.2%, significantly higher than that of cases (0%) treated after 7 days (p < .05). Conclusions and significance BSSHL is more common in females and may be related to viral infection. Simultaneous BSSHL is more common than sequential BSSHL. Hearing loss in patients with simultaneous onset of BSSHL is more severe than those with sequential onset. Prednisolone treatment for BSSHL within 7 days is critical for recovery.

Isolated Tibial Tubercle Fracture With and Without Combined Patellar Tendon Avulsion: Early Outcomes, Complications, and Reoperations.

Tibial tubercle fractures (TTF) are uncommon injuries, comprising <3% of proximal tibial fractures. Rarely, they occur in conjunction with patellar tendon avulsion (PTA). We aimed to compare reoperation rates and short-term postoperative outcomes in patients with TTF versus combined injuries. A retrospective review of patients presenting to a single tertiary pediatric hospital with a TTF who underwent open treatment and fixation of tibial tuberosity fractures was performed. Demographics, operative details, injury patterns, complications, and postoperative milestones were analyzed. Operative reports were reviewed to identify concomitant PTA. Outcomes analyzed included reoperation rates, weeks to full weight-bearing (FWB), full range of motion (FROM), and return to sport (RTS). Patients with <4 months of clinical follow-up were excluded from the analysis. We identified 117 fractures in 111 patients (mean age: 13.75 ± 1.27, 5% female). One-hundred and one fractures were isolated TTF and 16 were combined TTF with PTA. There was no significant difference in secondary surgery (P=0.13) or complication rates (P=0.20). The duration in the hinged knee brace was significantly higher in the combined injury group (12.95 wk) than in the isolated injury group (9.77 wk) (P=0.0024). There was no significant difference in time to FWB (P=0.25), FROM (P=0.86) or time to RTS (P=0.40). No current postoperative guidelines exist for combined TTF and PTA. Our data suggest that combined injury can be largely managed similarly to isolated TTF. However, combined injuries may require a longer bracing period. Level II prognostic study.

Impact of Technological Advancements on Short-term Outcomes in Flap Reconstruction after Soft Tissue Sarcoma Resection: A Retrospective Comparative Analysis.

Soft tissue sarcomas (STS) are rare malignancies requiring extensive surgical resection, often leading to significant soft tissue defects. Flap reconstruction is crucial for restoring function and appearance. Recent reconstructive microsurgery advancements, including high-resolution indocyanine green (ICG) imaging and ultra-high frequency ultrasonography (UHFU), have revolutionized preoperative planning and intraoperative guidance. We aimed to compare the surgical procedures and short-term outcomes of patients undergoing immediate flap reconstruction before and after our department's adoption of these technologies. We retrospectively analyzed 276 patients who underwent immediate flap reconstruction post-sarcoma resection between May 2014 and December 2023. They were categorized into pre- and post-technology groups based on the introduction of ICG angiography and UHFU in July 2019. We collected demographic, surgical, and postoperative data and compared outcomes using Fisher's exact and t-tests. The muscle preservation rate at the donor site was significantly higher in the post-Tech than in the pre-Tech group (no muscle damage: 65% vs. 37%, incision muscle damage: 25% vs. 26%, and muscle resection: 10% vs. 37%; p < 0.01). The proportions of complications (21% vs. 36%, p = 0.01), flap complications (17% vs. 30%, p = 0.01), partial flap loss (5% vs. 17%, p < 0.01), and flap dehiscence (9% vs. 25%, p < 0.01) were low in the post-Tech group. In the stratified analysis of free-flap reconstruction, the post-Tech group had a shorter operative time (7:01 vs. 8:13, p = 0.03) and fewer takebacks due to compromised flap perfusion (4% vs. 15%, p = 0.03) compared with the pre-Tech group. The introduction of ICG angiography and UHFU has improved surgical outcomes in STS flap reconstructions. These technologies facilitate precise preoperative planning and intraoperative decision-making, resulting in reduced operative times, low complication rates, and enhanced muscle preservation at the donor site.

Association of Mobile Stroke Unit Care and Spending, Utilization, and Death in New York City.

Transport by mobile stroke units (MSUs), which provide access to computed tomography scanning and intravenous blood pressure medications and thrombolytics, reduces time to treatment and may improve short-term functional outcomes for patients with acute stroke. The longer-term clinical and financial impacts remain incompletely understood. The aim of the study was to determine whether MSU care is associated with better health, utilization, and spending outcomes for patients with suspected acute stroke. This was a retrospective, observational study of Medicare patients transported by MSUs versus traditional ambulances in New York City, from October 2016 to December 2019. The study included 167 Medicare patients with suspected acute stroke transported by MSU and 2518 propensity score-matched controls. Primary outcomes included length of stay and discharge destination at the index hospitalization, as well as risk of repeat hospitalization, number of emergency department visits, total costs of care, and death at 1 year. Of 167 patients (mean age, 79.9 years; 56.3% women) transported by an MSU for suspected acute stroke, 61.1% had an ischemic stroke/transient ischemic attack, 7.8% had an intracerebral hemorrhage, and 31.1% had a stroke mimic or other diagnosis. Compared with propensity score-matched control patients, MSU patients were significantly more likely to receive tissue-type plasminogen activator (49.9% versus 9.4%; difference, 37.5 percentage points [95% CI, 30.2-45.6]; P<0.001) but experienced similar lengths of stay (5.9 versus 6.7 days, P=0.13) and were similarly likely to be discharged to a skilled nursing facility (15.6% versus 15.1%, P=0.86). At 1 year, MSU patients had a mortality rate of 21.6%, and control patients had a mortality rate of 28.4%, although the difference did not reach statistical significance (difference, 6.8 percentage points [95% CI, -13.3 to 0.3]; P=0.058). They had similar rates of any repeat hospitalization (24% versus 23.2%, P=0.82) and emergency department visits without hospitalization (14% versus 12%, P=0.86), and there were no significant differences in total spending or specific types of spending. In this study of patients presenting with suspected acute stroke in New York City, transport by MSUs, compared with traditional ambulances, was associated with a trend toward a lower mortality rate at 1 year. Prospective trials and replication in other regions are warranted.

Automatic machine learning accurately predicts the efficacy of immunotherapy for patients with inoperable advanced non-small cell lung cancer using a computed tomography-based radiomics model.

Patients with advanced non-small cell lung cancer (NSCLC) have varying responses to immunotherapy, but there are no reliable, accepted biomarkers to accurately predict its therapeutic efficacy. The present study aimed to construct individualized models through automatic machine learning (autoML) to predict the efficacy of immunotherapy in patients with inoperable advanced NSCLC. A total of 63 eligible participants were included and randomized into training and validation groups. Radiomics features were extracted from the volumes of interest of the tumor circled in the preprocessed computed tomography (CT) images. Golden feature, clinical, radiomics, and fusion models were generated using a combination of various algorithms through autoML. The models were evaluated using a multi-class receiver operating characteristic curve. In total, 1,219 radiomics features were extracted from regions of interest. The ensemble algorithm demonstrated superior performance in model construction. In the training cohort, the fusion model exhibited the highest accuracy at 0.84, with an area under the curve (AUC) of 0.89-0.98. In the validation cohort, the radiomics model had the highest accuracy at 0.89, with an AUC of 0.98-1.00; its prediction performance in the partial response subgroup outperformed that in both the clinical and radiomics models. Patients with low rad scores achieved improved progression-free survival (PFS); (median PFS 16.2 vs. 13.4, P = 0.009). autoML accurately and robustly predicted the short-term outcomes of patients with inoperable NSCLC treated with immune checkpoint inhibitor immunotherapy by constructing CT-based radiomics models, confirming it as a powerful tool to assist in the individualized management of patients with advanced NSCLC. This article highlights that autoML promotes the accuracy and efficiency of feature selection and model construction. The radiomics model generated by autoML predicted the efficacy of immunotherapy in patients with advanced NSCLC effectively. This may provide a rapid and non-invasive method for making personalized clinical decisions.

Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: SABIHA Score.

In the context of acute cardiogenic pulmonary edema (ACPE), a frequently encountered medical emergency associated with high early mortality rates, there is a need to predict short-term outcomes for risk stratification.Our aim was to derive and validate a model, a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests, that allows accurate prediction of short-term mortality in individuals experiencing ACPE. This retrospective cohort study included 1088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio, facilitating comprehensive examination and validation of prognostic model. Independent predictors of mortality (p<0.05) from the multivariable model were included in the risk score. The discriminant ability of the score was tested by ROC analysis. In the derivation cohort (n=623), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring 0 and 1. The SABIHA score provided a good calibration with a concordance index of 0.879 (95% CI: 0.821-0.937). While the probability of short-term mortality was 80.0% in the high risk group, this rate was only 3.3% in the low risk group. This score also performed well on the validation set. A simple clinical score consisting of routinely obtained variables can be used in risk stratification to predict short-term outcomes in patients with ACPE.

Experience in performing multivisceral resections for pelvic cancer

Background. Treatment of patients with locally advanced pelvic cancer remains challenging. The use of modern surgical techniques has expanded the feasibilities of performing multivisceral resections (MVR) in this category of patients. However, the postoperative period in patients who have undergone MVR is associated with a high risk of developing postoperative complications. The purpose of the study was to assess the short-term and long-term treatment outcomes in patients with locally advanced and multiple-primary pelvic cancer. Material and Methods. From 2009 to 2021, 114 patients treated in the clinics of Cancer Research Institute of Tomsk National Research Medical Center underwent MVR for primary or recurrent rectal cancer (n=40, 35.1 % and n=4, 3.5 %, respectively), female reproductive cancer (endometrial cancer: n=18, 17.1 % and recurrent ovarian cancer: n=18, 17.1 %), primary and recurrent bladder cancer (n=15, 13.2 % and n=2, 1.8 %, respectively), synchronous multiple primary pelvic tumors (n=8, 7.0 %) and extraorgan mesenchymal tumors of the pelvis (n=4, 3.5 %). Paraneoplastic complications were observed in 31 (27.2 %) patients. Invasion to more than 2 adjacent pelvic organs was diagnosed in 52 (45.4 %) cases. Total pelvic evisceration (TPE) was performed in 9 (7.9 %) patients, including 5 (4.4 %) patients who underwent TPE for primary rectal cancer with extensive local spread and 4 (3.5 %) patients who underwent TPE for multiple primary cancer: 2 (1.75 %) for synchronous primary rectal cancer and bladder cancer and 2 (1.75 %) for primary rectal cancer and recurrent bladder cancer. MVR for rectal cancer was the most common (n=101, 88.6 %). Resections with the formation of colorectal anastomosis were performed in 75 (65.8 %) cases and obstructive resections of the rectum were performed in 14 (12.5 %) cases. Urinary tract surgeries were performed in 66 (57.5 %) cases. One-stage plastic surgery of the resected segment as a transposition of one or both ureters into the bottom of the bladder was performed in 22 (19.3 %) cases. Heterotopic and orthotopic plastic surgery of the bladder was performed in 19 (16.6 %) and 5 (4.4 %) cases, respectively. Combined uterine extirpations, including vaginal resection, were performed in 52 (45.4 %) cases. Grade III postoperative complications according to the Clavien–Dindo classification occurred in 18.4 % of cases. Urological complications were the most common (8.7 %). Postoperative mortality rate was 0.8 %. The assessment of the long-term outcomes was carried out using the example of patients with rectal cancer (n=45), as the most homogeneous and largest subgroup. The overall 3-year survival rate was 71.1 % and the relapse-free 3-year survival rate was 60.0 %. Conclusion. Treatment of locally advanced pelvic cancer requires extensive surgeries performed by a multidisciplinary team of surgeons. The immediate results can be assessed as satisfactory. In case of resection of the urinary tract as a component of MVR, regardless of the primary localization of the tumor, primary plastic surgery of the bladder and/or ureters is preferable. Long-term outcomes allow us to consider MVR as a method of choice in the treatment of this group of patients.

Reversible Cerebral Vasoconstriction Syndrome: A Retrospective study from South India.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of stroke characterized by headache, seizures, focal deficits, or encephalopathy. Very little is known about this rare condition from the Indian subcontinent. Here, we present the clinical and imaging characteristics and short-term outcomes of RCVS patients from South India. A single-center retrospective study of all consecutive subjects with a clinical-radiological diagnosis of RCVS from January 2014 to December 2023 with a 3-month completed follow-up was conducted. The clinical features, vascular imaging patterns, and outcomes of patients with ischemic and hemorrhagic forms of RCVS were compared. Of the 22 patients who fulfilled Calabrese et al.'s criteria for RCVS, the majority were women with a mean age of 47.59 (±13.55) years. While headache was the most common presenting symptom in our cohort (18/22, 81.81%), 14/22 (63.6%) developed focal neurologic deficits during the course of illness. Four of 22 patients (18%) did not report headaches during the course of illness. The most common imaging finding at presentation was cortical subarachnoid hemorrhage (SAH) in 9/22 (40.9%), followed by infarcts in 6/22, (27.2%), while 12/22 (54.5%) patients developed new ischemic lesions on repeat imaging. Ischemic and hemorrhagic presentations of RCVS did not differ in terms of clinical presentation or outcome. All patients with ischemic lesions showed diffuse vasospasm on imaging, while those with SAH had both diffuse and focal vascular abnormalities. We present the largest single series of RCVS from India, with a favorable short-term outcome. Although the most common vascular abnormality is diffuse vasospasm, it can remain focal in a quarter of patients.

Utilization and outcomes of life-supporting interventions in older ICU patients in Japan: a nationwide registry study.

The purpose of this study is to describe the implementation of life-supporting interventions and the short-term outcomes of older patients in ICUs in Japan. All adult patients admitted to ICUs participating in the Japanese Intensive Care Patient Database (JIPAD) from April 1, 2015, to March 31, 2022, were eligible for inclusion. Information, including life-supporting interventions, was retrieved from the database. Patients were divided into six age groups. The primary outcome of interest was the proportion of receiving a composite of the following interventions: mechanical ventilation, continuous renal replacement therapy, and veno-venous or veno-arterial extracorporeal membrane oxygenation. Data of a total of 233,093 patients were analyzed. The median age was 71years, with 18.2% of the patients in their 80s, 5303 patients in their 90s (2.3%), and 67 patients in their 100s. Many life-supporting interventions were provided to older patients. The proportion of patients older than 90years who received the composite interventions decreased from 40.4% in 18-59 to 27.6% in 90-99. Non-invasive ventilation (NIV) use increased with age, resulting in a consistent proportion of patients receiving either NIV or mechanical ventilation until their 90s. ICU mortality for patients aged 80years or older was 5.6%, and hospital mortality for this age group was 12.9%. Approximately half of the patients in their 80s and 60% of those older than 90 years did not return home. Although life-supporting interventions tended to decrease with age, a considerable number of patients of advanced age still received these interventions.

High-quality targeted temperature management combined with decompressive craniectomy in patients with poor-grade aneurysmal subarachnoid hemorrhage: a secondary analysis of a multicenter prospective study.

The effect of targeted temperature management (TTM) combined with decompressive craniectomy (DC) on poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has not been previously addressed in the literature. This study aims to investigate the therapeutic outcomes of the combination of TTM and DC in patients with poor-grade aSAH. This study represents a secondary analysis of the Multicenter Clinical Research on Targeted Temperature Management of Poor-grade Aneurysmal Subarachnoid Hemorrhage (High-Quality TTM for PaSAH), a multicenter prospective study conducted in China. The High-Quality TTM for PaSAH study enrolled patients aged 18 years and older who were transported to the intensive care units (ICU) of three tertiary care hospitals in China between April 2022 and April 2024. Among these patients, those who underwent DC were included in the present analysis. Patients were divided into two groups: the DC-alone group and the TTM combined with the DC (TTM-DC) group. The DC-alone group maintained normothermia. The TTM-DC group used automated devices with a temperature feedback system (TFS). TTM was initiated with core temperatures between 36°C-37°C immediately after diagnosing poor-grade aSAH, and concurrent emergency aneurysm repair. This was followed by a rapid induction to 34°C-35°C, maintained for a minimum of 72 h. Subsequently, a slow rewarming process reached 36°C-37°C, which was maintained for at least 48 h. Primary outcomes were evaluated using the Modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included the Glasgow Coma Scale (GCS) at discharge, ICU stay duration, length of hospitalization, proportion of external ventricular drainage (EVD), mechanical ventilation time, tracheostomy, midline shift, hydrocephalus, and delayed cerebral ischemia (DCI) on the 7th day. Safety outcomes comprised the incidence of pneumonia, myocardial infarction, stress hyperglycemia, thrombocytopenia, acute liver injury, hypokalemia, hypoproteinemia, and death at 90 days. Of the 141 patients enrolled in the High-Quality TTM for PaSAH study, 43 (25 in the TTM-DC group and 18 in the DC-alone group) were eligible for this secondary analysis. The TTM-DC group had a higher proportion of favorable outcomes (mRS 0-3: 56% vs. 22%, aOR 5.97, 95%CI 0.96-52.2, p = 0.071). After propensity score matching, the TTM combined with DC improved favorable outcome at 3 months (mRS 0-3: 61% vs. 22%, OR 5.50, 95%CI 1.36-26.3, p = 0.022). In addition, the TTM-DC group increased GCS score at discharge compared with the DC-alone group (9 vs. 3, β 2.58, 95%CI 0.32-4.84, p = 0.032). The incidence of safety outcomes was not increased in the TTM-DC group. TTM combined with DC can improve clinical conditions at discharge and ameliorate short-term neurological outcomes in poor-grade aSAH patients. TTM should be considered one of the main treatments for poor-grade aSAH patients who underwent DC.

Intravenous Steroids Do Not Improve Short-Term Outcomes of Patients With Crohn's Disease Presenting With an Acute Small Bowel Obstruction.

Intravenous (IV) steroids are commonly used to treat acute flares of Crohn's disease (CD). However, it is unclear if they are beneficial in the setting of uncomplicated small bowel obstruction (SBO). We sought to examine if IV steroid administration improved short-term outcomes in patients with CD hospitalized for acute, uncomplicated SBO across three New York City hospital systems. This retrospective study included patients ≥ 18 years old admitted between January 1, 2011, and December 31, 2019, with Crohn's disease and an admission diagnosis of uncomplicated acute SBO, defined as cases without adhesions, fistula, phlegmon, and sepsis. Primary endpoints (length of stay and frequency of surgery) were compared between patients who received IV steroids upon admission and those who did not. Our analysis included 674 unique patients. Ninety-two (14%) received IV steroids, and 582 (86%) did not. IV steroid use did not result in shorter hospital stays (median days [IQR]: 3.0 (2.0-5.5) days vs 3.0 (2.0-6.0) days in the no-steroid group, P = .65) or reduce the need for surgery (4 patients (4.4%) vs 28 patients (4.8%) in the no-steroid group, P = .85). Sex, age, disease duration, concomitant biologic therapy, and NG tube placement did not independently contribute to either outcome. These findings suggest that IV steroid administration for uncomplicated SBO in CD patients does not decrease hospital length of stay or need for surgery. Further research may help identify specific obstruction patterns or other therapies associated with different outcomes.

DITTO: A Visual Digital Twin for Interventions and Temporal Treatment Outcomes in Head and Neck Cancer.

Digital twin models are of high interest to Head and Neck Cancer (HNC) oncologists, who have to navigate a series of complex treatment decisions that weigh the efficacy of tumor control against toxicity and mortality risks. Evaluating individual risk profiles necessitates a deeper understanding of the interplay between different factors such as patient health, spatial tumor location and spread, and risk of subsequent toxicities that can not be adequately captured through simple heuristics. To support clinicians in better understanding tradeoffs when deciding on treatment courses, we developed DITTO, a digital-twin and visual computing system that allows clinicians to analyze detailed risk profiles for each patient, and decide on a treatment plan. DITTO relies on a sequential Deep Reinforcement Learning digital twin (DT) to deliver personalized risk of both long-term and short-term disease outcome and toxicity risk for HNC patients. Based on a participatory collaborative design alongside oncologists, we also implement several visual explainability methods to promote clinical trust and encourage healthy skepticism when using our system. We evaluate the efficacy of DITTO through quantitative evaluation of performance and case studies with qualitative feedback. Finally, we discuss design lessons for developing clinical visual XAI applications for clinical end users.

Quantitative liver function imaging and whole genome sequencing - Effective modalities for a new era in personalised decision-making for operable colorectal liver metastases?

The optimal strategy for patients with colorectal liver metastases (CRLM) is unclear. The Precision1 prospective, observational trial assessed whether pre-operative functional imaging and whole genome sequencing (WGS), could enhance individualized decision-making. Patients with CRLM considered for hepatectomy were recruited. In addition to standard staging, patients underwent a quantitative multiparametric MRI (mpMRI) scan, to assess liver function. Use of mpMRI to aid surgical decision-making, was prospectively recorded, as were short-term clinical outcomes in patients who underwent hepatectomy. In the first 45 patients, WGS was performed on blood and liver tumour samples collected per-operatively. 95 mpMRI scans were performed in 84 patients, who underwent 87 resections. The mpMRI scan affected surgical decision-making in 41% (39/95) of scans, with 11 undergoing dual-vein embolization, 16 undergoing more conservative parenchymal-sparing surgery, 11 having more extensive surgery, and one patient following a low calorie diet pre-operatively. There were significant (Clavien-Dindo grades 3/4) complications in 5% of patients, no Grade C post-hepatectomy liver failure, and zero 90-day mortality. WGS suggested additional therapeutic options and prognostic factors for 22 of 35 (63%) evaluable patients. Precision1 shows mpMRI can aid surgical decision-making, and optimise clinical outcomes. WGS provides additional information, to further enhance personalised decision-making.

Association of C-Reactive Protein with Short-Term Outcomes in Spontaneous Intracerebral Hemorrhage Patients with or without Infection: From a Large-Scale Nationwide Longitudinal Registry

Association of C-Reactive Protein with Short-Term Outcomes in Spontaneous Intracerebral Hemorrhage Patients with or without Infection: From a Large-Scale Nationwide Longitudinal Registry

C-Reactive Protein Levels and Outcomes in Infarct-Related Cardiogenic Shock: Data from the ECLS-SHOCK Trial.

The impact of systemic inflammation in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The present ECLS-SHOCK sub-study investigates the association of C-reactive protein (CRP) levels with short-term outcomes in patients with AMI-CS. Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of CRP levels on admission, as well as the effect of extracorporeal life support (ECLS), stratified by CRP levels, was tested with regard to the primary endpoint of 30-day all-cause mortality. In 371 patients with AMI-CS and available CRP level on baseline, the median CRP level was 18.0 mg/L. Patients with CRP levels in the highest tertile were older and less often resuscitated from cardiac arrest. The highest tertile (i.e., CRP >61.0 mg/L) was associated with an increased risk of 30-day all-cause mortality compared to patients with lower CRP levels (lowest tertile: ≤5.0 mg/L) (adjusted Odds Ratio (OR): 3.54; 95% confidence interval (CI) 1.88-6.68; p=0.001). The use of ECLS did not reduce 30-day all-cause mortality, irrespective of CRP levels on admission. The additional inclusion of CRP to the IABP-SHOCK II score was associated with a slight improvement of the prediction of 30-days all-cause mortality (area under the curve (AUC): 0.74; 95% CI 0.68-0.79). Higher CRP levels were independently associated with the risk of 30-day all-cause mortality in AMI-CS. The additional inclusion of CRP to a validated CS risk score may further improve the prediction of short-term prognosis.

Laryngopharyngeal reflux leads to adverse short-term outcomes of vocal fold polyp patients after office-based transnasal vocal fold polypectomy.

This study aimed to explore the influence of laryngopharyngeal reflux on the features of vocal fold polyps and prognosis after office-based transnasal vocal fold polypectomy. Eighty-four vocal fold polyp patients were retrospectively analysed. Patients were assigned to laryngopharyngeal reflux or non-laryngopharyngeal reflux groups using pre-operative Reflux Symptom Score-12. The laryngopharyngeal reflux group had significantly higher pre-operative Reflux Sign Assessment scores, worse lifestyle and worse eating habits than the non-laryngopharyngeal reflux group. After office-based transnasal vocal fold polypectomy, the Reflux Symptom Score-12 and Reflux Sign Assessment score decreased in both groups, although the laryngopharyngeal reflux group still had higher values. The non-laryngopharyngeal reflux group had better vocal fold morphology recovery than the laryngopharyngeal reflux group. Multivariate logistic regression analysis demonstrated that smoking and a higher pre-operative Reflux Symptom Score-12 score were independent risk factors for poor prognosis. Laryngopharyngeal reflux is detrimental to vocal fold recovery of vocal fold polyp patients following office-based transnasal vocal fold polypectomy. For vocal fold polyp patients with laryngopharyngeal reflux, lifestyle and diet guidance should be focused.

Comparison of endoscopic and laparoscopic resection of gastric gastrointestinal stromal tumors: A propensity score-matched study.

Endoscopic resection (ER) and laparoscopic resection (LR) have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors (gGISTs) (2-5 cm), but there are no selection criteria for their application. To provide a reference for the development of standardized treatment strategies for gGISTs. Clinical baseline characteristics, histopathological results, and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed. Propensity score matching (PSM) was employed to achieve balance in baseline characteristics of the two groups. Among 206 patients, 135 were in the ER group and 71 in the LR group. The ER group had significantly smaller tumors [3.5 cm (3.0-4.0 cm) vs 4.2 cm (3.3-5.0 cm), P < 0.001] and different tumor locations (P = 0.048). After PSM, 59 pairs of patients were balanced. After matching, the baseline characteristics of the ER and LR groups did not differ significantly from each other. Compared with LR, ER had faster recovery of diet (P = 0.046) and fewer postoperative symptoms (P = 0.040). LR achieved a higher complete resection rate (P < 0.001) and shorter operation time (P < 0.001). No significant differences were observed in postoperative hospital stay (P = 0.478), hospital costs (P = 0.469), complication rates (P > 0.999), pathological features (mitosis, P = 0.262; National Institutes of Health risk classification, P = 0.145), recurrence rates (P = 0.476), or mortality rates (P = 0.611). Both ER and LR are safe and effective treatments for gGISTs. ER has less postoperative pain and faster recovery, while LR has a higher rate of complete resection.