Short Time Research Articles

P-658 Identification of novel biomarkers for the detection of polycystic ovary syndrome (PCOS) in adolescents and adult women

Abstract Study question Can novel biomarkers be identified to distinguish between PCOS-positive cases and healthy PCOS-negative controls in women as early as adolescence? Summary answer Meteorin-like protein (METRNL), fibroblast growth factor binding protein-1 (FGFBP1) and leukotriene A4 hydrolase (LTA4H) identified PCOS as early as adolescence, independent of PCOS phenotype. What is known already International evidence-based guidelines recommend use of the Rotterdam criteria for PCOS diagnosis. Despite this guidance, diagnosing PCOS can be extremely challenging due to the heterogeneity of clinical presentation, and further complicated in adolescence and young adulthood due to overlap between signs of physiologic changes during puberty and common symptoms of PCOS (e.g., menstrual irregularity, excess male hormones/androgens, multiple follicles in ovaries). Timely diagnosis of PCOS allowing for appropriate monitoring, follow up and early intervention may reduce the risk of associated comorbidities. An unmet need exists for biomarkers/alternative tools to support earlier diagnosis of PCOS in adolescents/adult women of reproductive age. Study design, size, duration This was a retrospective study (October 2020–June 2023) using banked samples from women with PCOS (confirmed per Rotterdam criteria) and healthy controls who had participated in previous studies sponsored by/in collaboration with Roche Diagnostics. Candidate biomarkers identified by exploratory proteomics analysis (Olink Proximity Extension Assay) were verified by ELISA and receiver operating characteristic-area under the curve (ROC-AUC) analysis for their ability to discriminate PCOS cases and controls in women aged 15-45 years. Participants/materials, setting, methods Top-performing biomarkers from Olink discovery (n = 51 PCOS phenotype A; n = 37 controls) were selected for further validation based on AUC >0.970, biological relevance for PCOS and commercial ELISA availability. Serum biomarker concentrations/biomarker ratios were determined and ROC-AUC analysis conducted in two validation cohorts (Cohort 1: n = 90 cases [phenotype A, n = 30; B, n = 20; C, n = 20; D, n = 20]; n = 47 controls; Cohort 2: n = 240 cases [15-19 years, n = 70; 20-24 years, n = 99; 25-40 years, n = 71]; n = 48 controls, median 26.0 years). Main results and the role of chance Serum METRNL concentrations were numerically lower, and FGFBP1 and LTA4H concentrations numerically higher, in PCOS cases compared with controls. All three biomarkers distinguished PCOS cases and controls, regardless of PCOS phenotype A-D (Cohort 1: AUCs 0.91-0.99 [METRNL], 0.84-0.88 [FGFBP1] and 0.76-0.90 [LTA4H]), and across different age groups in women of reproductive age (Cohort 2: 15-19, 20-24 and 25-40 years; AUCs 0.88, 0.91 and 0.96 [METRNL], respectively; 0.90, 0.88 and 0.91 [FGFBP1], respectively; 0.74, 0.70 and 0.78 [LTA4H], respectively). Compared with results for the individual biomarkers, combining FGFBP1 with METRNL, and LTA4H with METRNL, as biomarker ratios further improved the ability to distinguish PCOS cases and controls, independent of PCOS phenotype A-D (Cohort 1: AUCs 0.95-1.00 [FGFBP1:METRNL] and 0.97-0.99 [LTA4H:METRNL]) and across age groups (Cohort 2: 15-19, 20-24 and 25-40 years; AUCs 0.91, 0.96 and 0.98 [FGFBP1:METRNL], respectively, and 0.91, 0.91 and 0.97 [LTA4H:METRNL], respectively). Findings were not impacted by adjustment for baseline body mass index. METRNL, FGFBP1 and LTA4H are linked to biological mechanisms associated with clinical manifestations and underlying characteristics of PCOS, i.e., metabolic pathways, inflammation and ovarian function. While METRNL has been described previously in adult PCOS, FGFBP1 and LTA4H findings are novel in this context. Limitations, reasons for caution These findings in retrospective samples warrant validation in additional independent prospective cohorts, particularly in adolescents and young adult women. Wider implications of the findings Reliable diagnosis of PCOS in adolescents and young adult women represents an unmet medical need. METRNL, FGFBP1 and LTA4H have potential use as biomarkers to support the detection of PCOS in adolescents and adult women, potentially shortening time to diagnosis and allowing for earlier and targeted intervention. Trial registration number not applicable

P-123 Comparison of the performance of 3 models (iDAScore v1.0, KIDScore D5 v3, and NEQsi score) for predicting pregnancy after single blastocyst transfer

Abstract Study question What is the respective performance of an AI model, a morphokinetic model and an embryo morphology model for the prediction pregnancy after single blastocyst transfer? Summary answer KIDScore™ D5 v3, NEQsi score, and iDAScore™ v1.0 demonstrated similar performance in predicting biochemical pregnancy, clinical pregnancy, and live birth. What is known already Blastocyst selection for transfer currently mostly relies on Gardner’s morphological classification, which suffers from relatively limited predictive performance and interoperator variability. Both morphokinetic scores and the development of AI tools raised hope for improved embryo quality assessment in IVF. The NEQsi score is a very recently published digital transcription of the Gardner classification, allowing easier data categorization and comparison with other scores / models. The respective performance of these models / scores has hardly been reported up to now. Studying this in a setting with systematic single blastocyst policy allows avoiding biases related to patients’ selection. Study design, size, duration This is a retrospective monocentric study conducted in 2020-2022 on single blastocyst transfers after culture in a time-lapse incubator (Embryoscope©). All embryos with a known clinical outcome after fresh or frozen transfer and with KIDScore™ D5 v3, NEQsi score, and iDAScore™ v1.0 were included, regardless of the ART technique. Participants/materials, setting, methods All patients gave their consent for anonymous analysis of their clinical data. All scores were compared by conducting a One-way ANOVA test followed by a non-parametric Kruskal-Wallis test. A ROC curve was calculated for the prediction of both biochemical, clinical pregnancy and live birth. Main results and the role of chance 1888 single blastocyst transfers were performed in 1223 patients, 907 resulting in a biochemical pregnancy, 626 in a clinical pregnancy, and 495 in a live birth. The mean values were 7.00 (± 1.64) for the KIDscore, 7.99 (± 1.30) for the NEQsi, and 8.50 (± 1.00) for the iDAscore. The mean score values were significantly different between groups according to positive or negative clinical outcome (p < 0.0001 for all). The ROC curves showed that all 3 scores are predictive of a biochemical pregnancy (AUC KIDScore = 0.62; AUC NEQsi = 0.63; AUC iDAScore = 0.60), clinical pregnancy (AUC KIDScore = 0.64; AUC NEQsi = 0.65; AUC iDAScore = 0.61), and a live birth (AUC KIDScore = 0.62; AUC NEQsi = 0.63; AUC iDAScore = 0.60). These AUCs were not significantly different, and none of these scores appeared to be superior to the others in predicting live birth after single blastocyst transfer. Limitations, reasons for caution The retrospective and monocentric design calls for caution when generalizing these results. Wider implications of the findings The respective relevance of these scores in shortening time to pregnancy by ranking usable embryos within a cohort should be considered in further studies. Trial registration number not applicable

Fine-Tuned Large Language Model for Extracting Patients on Pretreatment for Lung Cancer from a Picture Archiving and Communication System Based on Radiological Reports.

This study aimed to investigate the performance of a fine-tuned large language model (LLM) in extracting patients on pretreatment for lung cancer from picture archiving and communication systems (PACS) and comparing it with that of radiologists. Patients whose radiological reports contained the term lung cancer (3111 for training, 124 for validation, and 288 for test) were included in this retrospective study. Based on clinical indication and diagnosis sections of the radiological report (used as input data), they were classified into four groups (used as reference data): group 0 (no lung cancer), group 1 (pretreatment lung cancer present), group 2 (after treatment for lung cancer), and group 3 (planning radiation therapy). Using the training and validation datasets, fine-tuning of the pretrained LLM was conducted ten times. Due to group imbalance, group 2 data were undersampled in the training. The performance of the best-performing model in the validation dataset was assessed in the independent test dataset. For testing purposes, two other radiologists (readers 1 and 2) were also involved in classifying radiological reports. The overall accuracy of the fine-tuned LLM, reader 1, and reader 2 was 0.983, 0.969, and 0.969, respectively. The sensitivity for differentiating group 0/1/2/3 by LLM, reader 1, and reader 2 was 1.000/0.948/0.991/1.000, 0.750/0.879/0.996/1.000, and 1.000/0.931/0.978/1.000, respectively. The time required for classification by LLM, reader 1, and reader 2 was 46s/2539s/1538s, respectively. Fine-tuned LLM effectively extracted patients on pretreatment for lung cancer from PACS with comparable performance to radiologists in a shorter time.

Fourier‐transform mid‐infrared spectroscopy for in vitro protein digestibility measurement of pulse crops

AbstractThe standard method of estimating in vitro protein digestibility, the protein digestibility corrected amino acid score (PDCAAS) assay, does not support the expected workflow of a pulse breeding program. This is mainly due to its low‐throughput design and long processing time (∼16–24 h) per sample. Fourier‐transform mid‐infrared (FT‐MIR) spectroscopy has been developed as a high‐throughput phenotyping tool to estimate protein digestibility in pulses. The mid‐infrared region representing the amide I band (1756.81–1586.27 cm−1) was utilized to perform chemometric modeling with partial least squares regression (PLSR) to estimate in vitro protein digestibility in dry pea (Pisum sativum L.), lentil (Lens culinaris Medik.), and chickpea (Cicer arietinum L.) flours. The root mean square error of predictions of the developed PLSR models for dry pea, lentil, and chickpea were 0.00039, 0.00024, and 0.00017, respectively. Phenotyping with the FT‐MIR approach is more rapid than with the PDCAAS assay and estimates protein digestibility from the flour of a single seed in a shorter time (∼1–2 min). The FT‐MIR approach is robust as the spectroscopic data are consistent and chemically fingerprint this nutritional trait. Accordingly, FT‐MIR can resolve the phenotypic bottleneck of pulse breeding related to in vitro protein digestibility measurements by enabling a high‐throughput phenotyping workflow.

A retrospective study of pre-operative fasting times prior to elective or emergency cesarean birth in a large maternity hospital: Lessons to be learned to minimize the fasting time.

When managing elective and emergency cesarean births in the same operating room, unpredictable variations in the start times of the cesareans can prolong fasting periods. The fasting times were retrospectively analyzed on 279 consecutive cesarean births at Helsinki University Women's Hospital, Finland, during January-February 2023. The fasting times were compared between the urgency groups and for elective cesareans according to their scheduled order on the operation list. The primary outcome was the difference in the fasting times for food and drink, while the secondary outcome was fasting for both food >12 h and fluids >4 h. The fasting times were compared by one-way ANOVA and chi-squared test, respectively. Dichotomous data are presented as unadjusted odds ratios (OR with 95% CI). Increasing urgency was associated with shorter fasting times. Fasting times for elective cesareans increased with the scheduled order on the daily list. The mean fasting periods (SD) increased from 10.55 h (SD=1.57) to 14.75 h (SD=2.02) from the first to the third cesarean of the day (p<0.01). The unadjusted odds ratio (95% CI) for fasting of the scheduled cesareans to exceed 12 h for solid foods and 4 h for clear fluids was 6.53 (95% CI: 2.67-15.9, p<0.001), for the third and fourth cesareans compared to the first two cesareans of the day. When elective and emergency cesareans are performed by the same team, the woman undergoing the third elective surgery of the day should be advised to have breakfast before 5 a.m. at home. While waiting for the operation, a carbohydrate drink should be offered to limit the fast.

Safety and Efficacy of Paxlovid in Pediatric Intensive Care Unit Patients with COVID-19.

Paxlovid (nirmatrelvir/ritonavir) has received endorsement from several guidelines for treating COVID-19 in adults, but its use in children is still uncertain. This study aimed to evaluate the safety and effectiveness of paxlovid in pediatric patients in the pediatric intensive care unit (PICU). A retrospective analysis was performed on children with COVID-19. The children who received paxlovid comprised the paxlovid group; otherwise, they were referred to as the control group. A total of 31 children were enrolled, with 12 and 19 participants assigned to the paxlovid and control groups, respectively. Approximately 35% had received vaccination against the novel coronavirus. The control group exhibited a significantly lower mean age in comparison to the paxlovid group (p < 0.001). However, no significant differences were observed between the groups in terms of other baseline data and biochemical indexes at admission. However, on the fifth day of drug administration, the paxlovid group exhibited a statistically significant decrease in temperature compared to the control group (p < 0.05). Additionally, the paxlovid group exhibited a significantly shorter conversion time to negativity for novel coronary genes in the respiratory tract (9.5 days) compared to the control group (16 days, p < 0.05). The administration of paxlovid did not result in any observed adverse reactions. Merely two patients exhibited a transient elevation in liver enzyme levels. The application of paxlovid in critically ill pediatric patients with COVID-19 can effectively control symptoms and promote virus clearance, demonstrating efficacy and a relatively low-risk profile.

Mini-Invasive Endoscope-Assisted Treatment of Metopic Craniosynostosis: 2-Dimensional Operative Video.

The surgical treatment of trigonocephaly has undergone significant evolution, with an increasing use of a minimally invasive technique. The endoscope-assisted metopic suturectomy is currently considered a valid surgical option for the correction of metopic craniosynostosis.1-5 In this video-article, we present our surgical technique performed on a 5-month-old patient with type III (Genitori's classification6) trigonocephaly. The computed tomography (CT) scan showed fusion of the metopic suture with bitemporal narrowing and hypotelorism. The patient underwent endoscope-assisted metopic suturectomy, the width of the suturectomy is 1 cm, and an Esmarch sheet was used to protect the dura mater while drilling. Bridging veins are coagulated under endoscopic vision. The suturectomy is considered complete when the nasal cartilages are exposed, deconnecting thus completely the orbits. The postoperative CT scan showed the extent of the suturectomy. The patient did not present any neurological deficit or complications after surgery and was discharged on postoperative day 2. No helmet was used postoperatively. The patient repeated a head CT at age 11 years after head trauma and was seen at consultation. Interestingly, once the bone gap created after the metopic suturectomy reossifies, the frontal sinus develops normally. The long-term result was quite satisfying. The advantages of the mini-invasive technique consist in a smaller surgical scar, lower blood loss, shorter surgical time, and shorter hospital stay with good long-term results. The parents provided written consent for the publication of the patient's picture, the institutional research board approved the submission of this video article. In the video, the tips, tricks, and pitfalls of the technique are discussed.

Ultra-broadband and Wide-angle Reflective Terahertz Polarization Conversion Metasurface based on Topology Optimization

Abstract Terahertz polarization conversion devices have significant potential applications in various fields such as terahertz imaging and spectroscopy. In this paper, we utilize genetic algorithms to topologically optimize the metasurface unit cells and design a reflective linear polarization conversion metasurface, which has ultra-broadband and wide-angle characteristics. By partitioning the metallic pattern layer into quadrants, the encoding length is effectively reduced, resulting in shorter optimization time. The research results indicate that the converter possesses a polarization conversion efficiency ratio higher than 90% and a relative bandwidth ratio of 125% in a range from 0.231 THz to 0.995 THz. Meanwhile, it can maintain excellent polarization conversion properties when the incident angle of terahertz wave is less than 45° and the polarization angle is less than 15°, demonstrating excellent practicality. New insights are provided for the design of terahertz wide-angle ultra-wideband polarization conversion devices, and the proposed metasurfce has potential applications in terahertz polarization imaging, spectroscopy and communication fields.

Comparison of the efficacy and safety of ciprofol and propofol in sedating patients in the operating room and outside the operating room: a meta-analysis and systematic review

BackgroundAs a new type of intravenous anesthetic, ciprofol has the advantages of fast onset of action, fast recovery and high clearance rate. This study aimed to investigate the effectiveness and safety of ciprofol versus traditional propofol for anesthesia and sedation in and out of the operating room.MethodsWe searched the literature in PubMed, Web of Science, Cochrane Library, and Embase databases from January 2021 to December 2023. All clinical studies comparing the sedative effects of propofol and ciprofol, both inside and outside the operating room, were included in our trial. The main outcome measures were induction time and incidence of injection-site pain. Data are merged using risk ratio and standardized mean difference with 95% confidence interval. Subgroup analysis, meta-regression, sensitivity analysis, and publication bias were performed. The study protocol was prospectively registered with PROSPERO (CRD42023447747).ResultsA total of 15 randomized, controlled trials involving 2002 patients were included in this study. Compared with propofol, ciprofol has a longer induction time in the operating room but a shorter induction time in non-operating room settings. Ciprofol can effectively reduce the risk of injection-site pain and respiratory depression both inside and outside the operating room. In addition, the risk of drug-related hypotension induced with ciprofol in the operating room is lower, but the awakening time is also longer. Meta-regression analysis showed that neither age nor BMI were potential sources of heterogeneity. Funnel plot, egger and begg tests showed no significant publication bias. Sensitivity analyzes indicate that our results are robust and reliable.ConclusionCiprofol has absolute advantages in reducing the risk of injection-site pain and respiratory depression, both in and outside operating room. Intraoperative use of ciprofol reduces the risk of drug-related hypotension and may also reduce the risk of intraoperative physical movements. However, ciprofol may have longer induction and awakening time than propofol.

Enucleation for intestinal duplications: a comparative study with intestinal resection and anastomosis.

Duplication enucleation (DE) has been described as an alternative to intestinal resection with primary anastomosis (IRA) for intestinal duplications, but no comparative study exists. The aim of this study was to compare both surgical procedures for intestinal duplication. A retrospective study was performed, including all children treated for intestinal duplication (2005-2023). Patients that underwent DE were compared to those that underwent IRA. Statistical significance was determined using p < 0.05. Ethical approval was obtained. A total of 51 patients (median age: 5months) were treated for intestinal duplication, including 27 patients (53%) that underwent DE and 24 IRA (47%). A cystic image was detected prenatally in 19 patients (70%) with DE and 11 patients (46%) with IRA (p = 0.09). Enucleation was performed using laparoscopy in 7 patients (14%). Patients that underwent DE had shorter time to first feed (1 vs 3days, p = 0.0001) and length of stay (4 vs 6days, p < 0.0004) compared to IRA. A muscular layer was identified in 68% of intestinal resection specimens. Compared to intestinal resection with anastomosis, duplication enucleation is associated with decreased postoperative length of stay and delay to first feeds without increasing post-operative complications. Regarding histological analysis, enucleation seems feasible in most cases.

Comparing extracorporeal, semi-extracorporeal, and intracorporeal anastomosis in laparoscopic right hemicolectomy: introducing a bridging technique for colorectal surgeons.

Intracorporeal anastomosis (IA) in laparoscopic right hemicolectomy has been associated with faster recovery in bowel function compared to extracorporeal anastomosis (EA). However, the technical difficulty of laparoscopic suturing technique and intraabdominal fecal contamination hinder many surgeons from implementing such a procedure. We introduce and compare a bridging technique designated as "semi-extracorporeal" anastomosis (SEA), which embraces the advantages and amends the drawbacks of IA and EA. Between May 2016 and October 2022, 100 patients who underwent laparoscopic right hemicolectomy were analyzed. All patients who received laparoscopic right hemicolectomy underwent one of the 3 anastomosis methods (EA, SEA, and IA) by a single colorectal surgeon at a single tertiary care hospital. Data including perioperative parameters and postoperative outcomes were analyzed by each group. A total of 100 patients were reviewed. Thirty patients underwent EA; 50 and 20 patients underwent SEA and IA, respectively. Operation time (minute) was 170 (range, 100-285), 170 (range, 110-280), and 147.5 (range, 80-235) in EA, SEA, and IA, respectively (P = 0.010). Wound size was smaller in SEA and IA compared to EA (P < 0.001). IA was associated with a shorter time (day) to first flatus compared to SEA and EA (4 [range, 2-13] vs. 4 [range, 2-7] vs. 2.5 [range, 1-4], P < 0.001). Postoperative complication showed no statistical significance between the 3 groups. Semi-extracorporeal was an attractive bridging option for colorectal surgeons worrisome of the technical difficulty of IA while maintaining faster bowel recovery and smaller wound incisions compared to EA.

Development of a Rapid and Fully Automated Factor VIII-Inhibitor Assay, Insensitive for Emicizumab, and a Lowest Level of Quantification of 0.2BU/mL

BackgroundFactor VIII inhibitors are measured using labour and resource expensive Nijmegen or Bethesda assays, which lack sensitivity for low-titre-inhibitors, and show high variations in quality surveys, mainly because of manual assay procedures. MethodsA new rapid, fully automated, factor VIII inhibitor assay is presented, the core of which is use of full-length recombinant FVIII (rFVIII) (Kovaltry®) as inhibitor substrate instead of plasma FVIII, resulting in rapid binding of inhibitors to rFVIII due to absence of VWF. Dramatic shortening of incubation time facilitated full automation on an analyser capable of three subsequent sample dilution steps and three reagent additions. Equal volume mixtures of sample and rFVIII (1.0 U/mL) were incubated 10 minutes/37°C, whereafter remaining FVIII-activity was analysed with a kinetic chromogenic assay, allowing inhibitor-activity calculation without preceding FVIII-activity calibration, using a Ceveron s100 analyser. ResultsMean titre in 60 non-haemophiliacs was 0.0BU/mL (SD 0.1), yielding a Limit-of-Blank of 0.1BU/mL and Lower-Limit-of-Quantification of 0.2BU/mL. Analyses were performed with the new method and a Nijmegen Assay in 28 inhibitor-positive clinical samples, 14 containing emicizumab and 14 without. Correlation coefficient in emicizumab-free type-I-inhibitor samples was r=1.0. Emicizumab dependency of the method was excluded in spiking experiments with inhibitor-positive-samples. Reproducibility was tested by analysing seven samples in three laboratories on five days, twice daily; CV of all samples were <15%. ConclusionWe present development data of a sensitive and specific, rapid, automated FVIII inhibitor assay generating results within 20 minutes, is less resource intensive than standard assays, with potential to improve assay variability.

Catalyst-free Approach to Dihydropyrimidones Using Glycerol/Ethyl Lactate as a Recyclable and Biodegradable Promoting Medium

Abstract: A variety of dihydropyrimidone compounds were synthesised using an effective one-pot, multicomponent, environmentally friendly reaction of aromatic aldehydes, urea/thiourea, ethyl acetoacetate, and glycerol/ethyl lactate. To the best of our knowledge, this is the first catalyst-free strategy for the synthesis of this key scaffold with medicinal chemistry applications. Other significant aspects of the current approach consist of the employment of glycerol/ethyl lactate as a biodegradable and environmentally friendly reaction medium-cum-promoter, the use of easily available substrates, moderate reaction conditions, ease of use, a wide substrate scope, a short reaction time, easy workup, and excellent yields, and atom efficiency, which make the disclosed procedure an excellent alternative to existing methods.

An Identification Method for Anomaly Types of Active Distribution Network Based on Data Mining

With the increasing penetration of distributed generators (DGs) and the growing demand for reliable power sources, it has become imperative to promptly identify anomalies in active distribution networks (ADNs). Additionally, anomaly identification is also crucial to assisting in targeting maintenance to handle failures after the action of relay protections. This study presents a highly accurate and rapidly responsive approach to identifying anomalies in ADNs. The proposed method uses three layers of intricately interconnected modules. In the first module, an iterative clustering layer is devised to process the original data. In the second module, an association rule layer is designed to identify hidden patterns based on the types of anomalies and the post-fault voltage. In the third module, a regression training layer is employed to train accurate identification models. The case study utilizes data samples collected by an IEEE 33-bus system with distributed generations as well as post-fault data from a practical distribution network. The results of comparative tests demonstrate that the proposed data-mining structure achieves reliable performance with high identification accuracy and short reaction times, indicating its ability to be applied to the state awareness system of ADNs.

Evaluation of Hepatocellular Carcinoma Surveillance with Contrast-enhanced MRI in a High-Risk Western European Cohort

AimTo investigate the utilization of MRI using a MRI liver protocol with extracellular contrast-enhanced series for hepatocellular carcinoma (HCC) surveillance in high-risk patients. MethodsConsecutive high-risk patients of a western European cohort who underwent repeated liver MRI for HCC screening were included. Lesions were registered according to the Liver Reporting & Data System (LIRADS) 2018. HCC was staged as very early stage HCC (BCLC stage 0) and more advanced stages of HCC (BCLC stage A-D). Differences in time interval between MRI's for BCLC stage 0 and stage A-D were calculated with the Mann-Whitney U test. The HCC cumulative incidence at one-, three- and five years was calculated with the Kaplan Meier estimator. ResultsFrom 2010 to 2019 a total of 240 patients were included (71% male; median age: 57 years; IQR: 50-64 years) with 1350 MRI's. Most patients (83 %) had cirrhosis with hepatitis C as the most common underlying cause. Patients underwent on average four MRI's (IQR: 3-7). Forty-two patients (17.5%) developed HCC (52 HCC lesions: 43 LIRADS-5, eight LIRADS-4, and one LIRADS-TIV). Eighteen patients (43%) had BCLC stage 0 HCC with a significant shorter screening time interval (10 months; IQR: 6-21) compared to patients with BCLC stage A-D (21 months; IQR: 10-32) (p = 0.03). Thirty seven percent of patients with a LIRADS-3 lesion (n=43) showed HCC development within twelve months (median: 7.4 months). One, three- and five-year HCC cumulative incidence in cirrhotic patients was 1%, 10% and 17%, respectively. ConclusionHigh-risk patients who underwent surveillance with contrast-enhanced MRI developed HCC in 17.5 % during a follow up period of over 4 years median. Very early stage HCC was seen in compensated cirrhosis after a median time interval of 10 months. Later stages of HCC were related to prolonged screening time interval (median 21 months).

Comparison of Interfacility Transfer of Critically Ill Pediatric Patients by Helicopter Versus Ground Ambulance in a Remote and Rural Domain

ObjectiveSince 2018, Thailand's helicopter emergency medical service (HEMS) has been used to transport critically ill pediatric patients from Tak Province's community hospitals to the tertiary care hospital. This article describes a pilot study to look at the feasibility of comparing mortality rates and complications during transport. MethodsThis retrospective pilot study used data from the medical records of the referring and receiving hospitals. Participants were critically ill patients under 18 years of age who were transferred between facilities using HEMS or ground emergency medical services (GEMS) between January 2018 and December 2022. HEMS transported 9 patients, whereas GEMS transported 52. ResultsThe predominant age group was newborns. Respiratory-related conditions were the most common diagnoses. The majority of patients underwent intubation and displayed abnormal respiratory rates and levels of consciousness before flight. Approximately one third were hypotensive or required vasoactive drugs. Cardiac arrest requiring cardiopulmonary resuscitation was the most common significant complication during transport in the HEMS group (22.2%). Meanwhile, changing hospital destination because of an unstable patient condition was the most common complication during transport in the GEMS group (3.9%). Hypotension was the most common complication upon arrival at the receiving hospital in both groups (25% versus 8%). HEMS demonstrated shorter transport times. ConclusionHEMS reduced transport times compared with GEMS. However, there was a higher incidence of cardiac arrest requiring cardiopulmonary resuscitation during transfer and hypotension upon arrival.

Added Value of a Robotic-assisted Bronchoscopy Platform in Cone Beam Computed Tomography-guided Bronchoscopy for the Diagnosis of Pulmonary Parenchymal Lesions.

Cone beam computed tomography (CBCT)-guided bronchoscopic sampling of peripheral pulmonary lesions (PPLs) is associated with superior diagnostic outcomes. However, the added value of a robotic-assisted bronchoscopy platform in CBCT-guided diagnostic procedures is unknown. We performed a retrospective review of 100 consecutive PPLs sampled using conventional flexible bronchoscopy under CBCT guidance (FB-CBCT) and 100 consecutive PPLs sampled using an electromagnetic navigation-guided robotic-assisted bronchoscopy platform under CBCT guidance (RB-CBCT). Patient demographics, PPL features, procedural characteristics, and procedural outcomes were compared between the 2 cohorts. Patient and PPL characteristics were similar between the FB-CBCT and RB-CBCT cohorts, and there were no significant differences in diagnostic yield (88% vs. 90% for RB-CBCT, P=0.822) or incidence of complications between the 2 groups. As compared with FB-CBCT cases, RB-CBCT cases were significantly shorter (median 58 min vs. 92 min, P<0.0001) and used significantly less diagnostic radiation (median dose area product 5114 µGy•m2 vs. 8755 µGy•m2, P<0.0001). CBCT-guided bronchoscopy with or without a robotic-assisted bronchoscopy platform is a safe and effective method for sampling PPLs, although the integration of a robotic-assisted platform was associated with significantly shorter procedure times and significantly less radiation exposure.

Quality Assessment of a Virtual Post Offer Placement Assessment in Employee Occupational Health Services.

The rise in remote work and increased access to technology allows opportunity for virtual onboarding. The aim of this project was to assess the quality of virtual onboarding versus the traditional in-person onboarding. A multidisciplinary team utilized a survey to evaluate staff and new hire candidate satisfaction with the in-person versus virtual Post Offer Placement Assessment (POPA). The virtual POPA process maintained a high-level of quality and satisfaction among new hire healthcare candidates compared to in-person onboarding, with shorter appointment times. Employee Occupational Health Services (EOHS) staff and new hire candidates reported a preference for the virtual POPA process over traditional in-person onboarding. The virtual POPA option reduced the length of appointments and maintained satisfaction and quality of service.

Scapholunate Ligament Reconstruction With Internal Brace Augmentation Techniques for Chronic Scapholunate Dissociation: A Clinical Follow-up Study.

The scapholunate ligament is the most important stabilizer of the scapholunate articulation. The management of chronic irreversible injuries of this ligament in the absence of preexisting arthritis of the wrist joint remains controversial. Recently, surgeons introduced a novel surgical technique using an internal brace (IB). Several biomechanical studies on this technique have been conducted using cadavers; however, very few studies have discussed the results in detail in actual clinical practice. Therefore, herein, we investigated the radiological and functional results of patients who underwent IB augmentation as a treatment for chronic scapholunate dissociation. This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured. The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions ( P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions ( P < 0.05) except for extension ( P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions ( P < 0.05) except for extension ( P = 0.602) and clenched fist ( P = 0.556). This angle improved after reconstruction in all wrist positions except for extension ( P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively). This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.

Minimally invasive versus open pyeloplasty in pediatric population: Comparative retrospective study in tertiary centre

Background: Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. The incidence is around 1: 750–1500 live births. The standard treatment for (UPJO) is open pyeloplasty (OP) with a high success rate of 90%–95%. In the last 20 years, minimal invasive pyeloplasty (MIP) became an excellent alternative technique to OP which was historically the standard of care. Materials and Methods: The study participants were male and female patients aged 14 years old or less who had undergone open/minimally invasive pyeloplasty during 2015–2020 and who had at least 1-year follow-up after surgery. The data were collected retrospectively from patients’ charts. The patients were categorized into two cohort groups: OP and on the other arm minimally invasive pyeloplasty (robotic/laparoscopic) comparing the outcomes as a 1ry endpoint. 2ry endpoints were hospital stay, duration of surgery, and anteroposterior diameter of renal ultrasound. Results: A total of 133 patients were included in the study. Eighty-four underwent MIP while 49 patients underwent OP. 1ry endpoint was the success rate in both groups. The success rate was 94% (n: 79) and 98% (n: 48) in patients who underwent MIP and OP, respectively. P &lt;0.05 is considered significant. Conclusion: Open and minimally invasive pyeloplasty are comparable in terms of success rate. However, OP was associated with shorter hospital stays and shorter operative times.