Single-center Prospective Study Research Articles

Apixaban removal during emergency surgery for type a acute aortic dissection. a prospective cohort study

Background: Acute type A aortic dissection (ATAAD) has a high mortality, and acute aortic repair is the only curative treatment. In patients treated with factor Xa (FXa) inhibitors, the risk of severe disease-related complications such as cardiac tamponade and hemodynamic shock must be balanced against the potential for severe perioperative bleeding. The aim was to study intraoperative changes in plasma levels of the FXa inhibitor apixaban when using hemoadsorption during acute thoracic aortic repair. Materials and Methods: This is a single-center prospective cohort study. Eight apixaban-treated patients presenting with ATAAD underwent acute thoracic aortic repair with intraoperative hemoadsorption with CytoSorb®. Apixaban concentrations were measured at the start of cardiopulmonary bypass (CPB), and after 5, 15, 30, 60 and 90 minutes of CPB, at CPB weaning, 30 minutes after CPB weaning and 24 hours postoperatively, using ultraperformance liquid chromatography mass spectrometry (UPLC-MS). Results: After 30 minutes of CPB with hemoadsorption, mean apixaban concentration (± SD) was reduced by 59% from 108 (± 69) µg/L to 44 (± 20) µg/L (P = 0.009). There was a further reduction to 37 (± 17) µg/L at CPB weaning (P = 0.008). Apixaban concentration displayed an increase to 56 (± 29) µg/L 24 hours postoperatively (P = 0.01). In-hospital mortality was 25%. Mean 24H chest tube drainage volume was 621 (± 136) mL. Conclusion: Intraoperative hemoadsorption lowers apixaban levels in patients undergoing emergency surgery for ATAAD. Further research is needed to determine its impact on perioperative bleeding complications and mortality.

Speech Assessments in Hypoplastic Cleft Maxilla Treated by Anterior Segmental Distraction Osteogenesis

Introduction: Cleft lip and palate (CLP) affect the craniofacial region, with significant implications for speech, hearing, feeding, and facial aesthetics. This study aimed to evaluate the impact of anterior maxillary segmental distraction osteogenesis (AMSDO) using an internal distractor on speech outcomes in CLP patients, assessed using the Pittsburgh Weighted Speech Scale (PWSS).Methodology: A single-center prospective study was conducted between March 2022 and April 2024. Twelve CLP patients with maxillary hypoplasia, aged 17.8 to 32.6 years, were included. Purposive sampling was done to include patients with complete unilateral or bilateral CLP who exhibited Class III skeletal relationships with reverse overjet greater than 7 mm. Speech assessments were conducted preoperatively (1-3 months before surgery) and postoperatively (5-7 months after distraction). Speech samples were recorded and evaluated by a licensed speech-language pathologist using the PWSS. Statistical analysis was performed using paired t-tests and Chi-square tests.Results: Significant improvements were observed in the total PWSS score (p = 0.03), nasality (p < 0.001), phonation (p < 0.001), and articulation errors (p = 0.004) postoperatively. No significant changes were seen in nasal emission and facial grimace. No correlation was found between the amount of distraction and speech outcomes. Unilateral cleft patients showed better outcomes than bilateral cleft patients, though not statistically significant.Conclusion: AMSDO significantly improves speech outcomes in CLP patients with maxillary hypoplasia. The PWSS is a reliable tool for assessing these changes. Further research with larger samples and longer follow-ups is warranted to confirm these findings.

Comparison of 3-month clinical outcomes between two enhanced monofocal intraocular lenses: A single-center prospective study.

This study aims to compare the 3-month clinical outcomes between two enhanced monofocal intraocular lenses (IOLs) following cataract surgery.Setting: Eye Clinic of Careggi University Hospital, Florence, Italy. Single-center prospective study. We included patients with cataract and corneal astigmatism less than 0.75 D, with no ocular comorbidities, who underwent unilateral cataract surgery with implantation of either the Tecnis Eyhance ICB00 (N = 25) or Evolux (N = 25) IOLs. Standard cataract procedures were performed without complications. The main outcome measures included uncorrected and corrected visual acuity at distance (4 m), intermediate (60 cm) and near (40 cm) at 3-month follow-up. Additionally, monocular defocus curves, aberrometric profiles, and perceptions of halo and glare were evaluated. The study involved 50 patients (26 male, 24 female) with a mean age of 68 ± 8 years. Preoperative characteristics were similar between the groups, and no intraoperative or postoperative complications were reported. Statistically significant differences were observed between the groups, with the Evolux IOL showing superior results (p < 0.05) in terms of uncorrected and corrected visual acuity at near, intermediate, and distance, as well as in aberrometric profiles (lower-order aberration root-mean-square [RMS], higher-order aberration RMS, spherical equivalent RMS, and point spread function) and defocus curves. Based on our experience, while both IOLs offer substantial visual performance for intermediate and distance vision, the Evolux IOL demonstrated superior mean visual outcomes and objective parameters at the 3-month follow-up compared to the Tecnis Eyhance IOL. This indicates a potential advantage of the Evolux IOL in providing better visual performance.

Efficacy of electrical stimulation of the zygomaticus muscle in complete facial paralysis: evidence from facial grading and automated image analysis

Surface Functional Electrical Stimulation (FES) is a well-studied intervention for multiple muscular disorders. However, it is still controversially discussed as a complementary therapy for complete facial paralysis. The aim of this intervention is to test a daily home-based ES concept as a pilot study regarding safety, feasibility, and effects on facial functionality and symmetry. In a prospective single-centre pilot study, 10 patients (median 61 years, denervation 130 d) with complete peripheral facial paralysis performed home-based FES of the affected lateral mouth region Stimulation parameters, facial paralysis scores and standardised photographs were assessed in monthly follow-ups. No serious adverse events appeared. Stimulation parameters could be constantly increased indicating effective muscle training while subjectively perceived functionality of the face improved. Thus, smile angle of the paralysed side improved as well. FES is a safe therapy model for application in facial nerve paralysis patients. A feasible stimulation protocol could be applied, which improved the functionality and symmetry of the stimulated facial region. A future controlled, randomised and double-blind follow-up study is needed to investigate these initial results in a further evolved replicable setting.

Functional Outcome Prediction of Acute Ischemic Stroke Based on the Oral and Gut Microbiota.

Although several studies have identified a distinct gut microbiota in individuals with acute ischemic stroke (AIS), there is a limited amount of research that has simultaneously investigated alterations in the oral and intestinal microbiota in AIS patients and their correlation with clinical prognosis. This was a prospective and observational single-center cohort study in which we included 160 AIS patients who were admitted within 24h after a stroke event. We collected oral and rectal swab samples for analysis using 16S rRNA high-throughput sequencing. Our study revealed that patients with unfavorable outcomes after AIS showed early disruptions in their oral and intestinal microbiota. Rectal swabs showed increased levels of facultatively anaerobic bacteria in patients with a poor prognosis, while the oral cavity exhibited higher levels of anaerobic and opportunistic pathogenic bacteria. By employing machine learning analysis, we found that the microbiota composition at both rectal and oral sites could predict early and long-term outcomes. Moreover, patients with a poor prognosis displayed increased oral bacterial colonization in the rectal microbiota and altered interactions between the oral and gut microbiota. This study reveals distinct rectal and oral bacteria that could predict unfavorable outcomes for AIS patients. Monitoring the microbiota of various body sites during the early stages after admission may hold prognostic value and inform personalized treatment strategies. The presence of oral bacteria colonizing the intestines during the acute phase of stroke could serve as an early indication of poor outcomes for AIS patients.

Combination of rituximab and low-dose glucocorticoids for idiopathic refractory nephrotic syndrome with MCD/FSGS: a single-center prospective cohort study

Background The treatment of idiopathic refractory nephrotic syndrome (IRNS) remains a difficult problem in clinical practice. This study aims to determine the efficacy and safety of combining low-dose glucocorticoids with rituximab in IRNS treatment. Methods This prospective, single-center cohort study enrolled 60 patients who were diagnosed with refractory IRNS with minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) and treated at First Affiliated Hospital of Sun Yat-sen University. All patients received a treatment regimen consisting of rituximab (375 mg/m2/week × 4) and low-dose glucocorticoids. Results 46 complete remissions and 4 partial remissions were observed within 6 months of treatment. Within 12 months of treatment, 48 patients achieved complete remission, and 4 achieved partial remission. The complete remission rate for steroid-dependent/frequently relapsing nephrotic syndrome was significantly higher than that for steroid-resistant nephrotic syndrome (88.24% vs. 33.33%, p < .01). Following up for 12 months, 16 patients relapsed, accounting for 30.76% of the total, with a mean time to relapse of 10.97 months. Compared with baseline data, 24-hour urine protein quantification, total cholesterol and triglycerides significantly decreased, while serum albumin, globulin and IgG significantly increased at 12 months after treatment. All follow-ups were without serious adverse events. Twenty-four patients experienced infusion-related adverse reactions, which could be relieved by slowing down the infusion rate or suspending the infusion. Nine patients experienced infection-related adverse reactions; six of them were relieved with antibiotic treatment, and 3 patients were controlled by symptomatic treatment. Conclusions Rituximab combined low-dose glucocorticoids therapy is effective and safe in idiopathic refractory nephrotic syndrome.

Infants < 90 days of age with late-onset sepsis display disturbances of the microbiome-immunity interplay.

We hypothesized that previously healthy infants < 90 days of age with late-onset sepsis (LOS) have disturbances of the gut microbiome with yet undefined specific immunological patterns. We performed a prospective single-center convenience sample study between January 2019 and July 2021 in a case-control design. Routine diagnostics included conventional cultures (blood, cerebrospinal fluid, urine), PCRs and inflammatory markers in infants aged < 90 days with clinical LOS. We additionally analyzed blood lymphocyte subsets including CD4 + CD25 + forkhead box protein (FoxP3)+ Tregs and performed 16S rRNA sequencing of stool samples, both compared to age-matched healthy controls. Results were adjusted for potential confounders that may influence microbial composition. 51 infants with fever and clinical LOS were enrolled. Bacterial sepsis was diagnosed in n = 24 (47.1%) and viral infection in n = 13 (25.5%) infants, whereas in 14 (27.3%) infants the cause of fever remained undetermined. When compared to healthy controls, the gut microbiome of LOS infants at disease onset was characterized by a shift in community composition, specifically, decreased abundance of B. longum and an increase of Bacteroidia spp. Intriguingly, the abundance of B. longum negatively correlated with the frequency of blood CD4-positive cells in healthy controls but not in infants with LOS. At one year of age, we observed microbiome differences in infants with history of LOS when compared to healthy controls, such as an increased gut microbial diversity. Our data suggest potential signatures of the microbiome-immunity interplay in infants with LOS, which should be investigated further as possible targets for prevention.

Deceleration of denervated facial muscle atrophy through functional electrical stimulation: a sonographic quantification in patients with facial nerve paralysis.

Functional Electrical Stimulation (FES) is an established intervention for a range of muscular and neurological disorders that has already been studied in numerous publications. However, its application to Peripheral Facial nerve Paralysis (PFP) still needs to be sufficiently investigated. As the first approach known to the authors, this study examines the effect of FES on the facial muscles in complete PFP using ultrasonography as a means of observation. In a prospective single-center observational pilot study, ten patients with complete PFP, confirmed by needle-electromyography (EMG), performed FES of the affected lateral mouth region at home twice daily for 20 minutes. The facial muscles' Cross-Sectional Area (CSA) was regularly assessed using sonographic quantification. While the CSA of most non-stimulated muscles decreased considerably during ongoing paralysis, a significant CSA increase of the Zygomaticus Muscle (ZYG), which was regularly subjected to FES, could be demonstrated. FES can halt the atrophy of denervated ZYG and potentially other facial muscles. Further investigations with a more significant patient collective are recommended. From now on, FES could be established as an additive method in the non-invasive treatment of PFP.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION.

To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. This is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety. Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. Virtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

Early progressive mobility to improve neurodevelopment of infants with severe bronchopulmonary dysplasia at a level IV neonatal intensive care unit: a prospective cohort study.

To measure the feasibility of early progressive mobility (EPM) in intubated infants with severe bronchopulmonary dysplasia (BPD) and compare neurodevelopmental skill acquisition of these infants before and after implementation of a clinical EPM program. Single-center pre-post intervention prospective cohort study in a level IV Neonatal Intensive Care Unit (NICU) from 2019-2022. Bivariate tests compared EPM interventions and results of serial Test of Infant Motor Performance (TIMP) assessments in 32 intubated infants with severe BPD cared for during two epochs, before and after NICU-wide EPM implementation. Infants in epoch 2 experienced significantly more EPM interventions than infants in epoch 1. Infants in epoch 2 also had more advanced motor skills on the TIMP than infants in epoch 1. There were no unplanned extubations. We demonstrated successful implementation of EPM in this high-risk population with evidence of beneficial impacts on early motor development.

Uncemented reverse total shoulder arthroplasty: is it a safe option for elderly patients with proximal humerus fractures?

Reverse shoulder arthroplasty (RSA) is a common surgical procedure for elderly patients with proximal humerus fractures. Cement fixation of the humeral stem is considered the gold standard for this procedure. Due to the high prevalence of osteoporosis in this patient population, the risk of intraoperative fractures is increased when uncemented stems are used. Stem loosening is another concern of uncemented stems. However, the use of cement is associated with the risk of cement embolisation, impairment of tuberosity healing, and technical difficulties for later revisions. This study aimed (i) to evaluate the clinical and radiological outcomes of patients treated with uncemented RSA for proximal humerus fractures at two years postoperatively, and (ii) to compare these outcomes between patients with and without decreased low bone quality as measured by the deltoid tuberosity index. The single-centre prospective study included 54 shoulders (52 patients) with a proximal humerus fracture between 2019 and 2022. Enrolled were patients aged 65 and older with acute or secondary displaced three- or four-part fractures or head-split fractures treated with RSA using the same uncemented system and tubercula refixation. At 24 months post-surgery, clinical evaluations included range of motion (ROM), Constant-Murley Score (CS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Score. Radiological assessments evaluated scapular notching, radiolucent lines, and greater tuberosity healing. The mean age was 79 years (± 8), 87% were female, and 69% had osteoporotic fractures. At the two-year follow-up, the median SSV was 90% (IQR 80-95), the median CS Score was 76.5 (IQR 72-81), and the median ASES Score was 89.9 (IQR 82-93). The ROM measurements were: median active forward flexion 140° (IQR 120-160), median external rotation 30° (IQR 20-40), and median active internal rotation 6 (IQR 4-8). The greater tuberosity healing rate was 94.5%. Although osteoporotic fractures occurred more often in older patients (mean 81 vs. 72 years, respectively), no other significant differences were detected between the groups. One case of aseptic stem loosening occurred in the non-osteoporotic group. Even in osteoporotic proximal humerus fractures, cementless stems combined with tubercula refixation resulted in favourable outcomes and were not associated with increased complications.

Assessing the Use of a Training Model Using Immersive Virtual Reality for Sacrospinous Fixation Surgery: A Pilot Study.

Sacrospinous fixation (SSF) is a surgical complex procedure for uterovaginal prolapse that may result in pudendal plexus and vascular damage. The objective was to evaluate a training model using virtual reality to perform SSF. We conducted a prospective single-center pilot study in the university's academic innovation department in November 2023. We recruited 20 participants, 10 gynecology resident surgeons (group 1) and 10 experienced gynecology surgeons (group 2). The mean age was 26.6 ± 0.6years in group 1 and 39.7 ± 3.1years in group 2. The satisfaction rate reached 90% in both groups. A scale from 1 to 4 (1 = not-at-all, 4 = completely) was used to assess participants' perceptions. The realism of the simulation was rated at 3.3 ± 0.1 in group 1 and 3.5 ± 0.2 in group 2 (p = 0.41), the haptic feedback was rated at 2.0 ± 0.3 and 1.8 ± 0.3 (p = 0.66), the mean exercise time was 6.4 ± 1.3min and 4.8 ± 0.7min (p = 0.58), and the mean success rate was 70.8 ± 3.2% and 83.5 ± 6.8% (p = 0.14). In group 2, left and right instruments were placed at 2.6 ± 0.8mm and 2.9 ± 0.7mm from the target respectively, and in group 1 at 4.8 ± 0.7mm and 3.8 ± 0.5mm respectively. Participants reported greater comfort in performing sacrospinous fixation after simulation training (3.0 ± 0.2 versus 2.3 ± 0.3, p = 0.17). Our virtual reality simulation model is feasible and accurate for SSF training for both residents and experienced surgeons with a high level of satisfaction. Virtual reality simulation improves technical skills and promotes surgical comfort.

Efficacy of the Rezūm System for lower urinary tract symptoms in patients with benign prostatic hyperplasia: Long term results from a single centre prospective study.

Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS (p < 0.001), Qmax (p < 0.001), PVR (p < 0.001) and IPSS-QoL (p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. In conclusion, the study's findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment.

Comparison of ante- and postmortem ventricular wall thickness using echocardiography and autopsy findings.

In autopsy practice, the thickness of ventricular walls is one of the parameters used to identify cardiac hypertrophy. The presented study aimed to compare ante- and postmortem measurements of ventricular wall thickness, (i) to determine a postmortem standardized localization and dissection method for ventricular wall measurements, and (ii) to determine the ability of postmortem measurements in recognition of antemortem hypertrophy. A single-center prospective study was conducted at the Institute of Legal Medicine in Hamburg, Germany. Sixty hearts were dissected alternating by the inflow-outflow or short-axis method, and the ventricular walls were measured at different locations and compared with the echocardiographic values of the end-diastolic phase during life of these individuals. The results showed measurement differences between the autoptic and echocardiographic values-for the left ventricle between 3.3 and 5.2mm, for the right ventricle between 0.2 and 1.1mm, and for the septum between 1.3 and 1.4mm. Diagnostic performance of recognizing antemortem hypertrophy with postmortem measurement was poor, except for measuring the right ventricle and septum with the short-axis method (area under the ROC curve of 0.72 and 0.82, respectively). According to the results, cardiac changes may occur postmortem and need to be considered when used for diagnosing cardiac pathology. The postmortem diagnosis of left or right ventricular hypertrophy should always be made in conjunction with other, particularly cardiac, autopsy findings. An autoptic diagnosis of hypertrophy solely by a ventricular wall thickness > 15mm or > 5mm alone is not sufficient.

Clinical application of fly-thru in diagnosis of biliary obstructive diseases: feasibility, reproducibility, and diagnostic value.

To evaluate the feasibility, reproducibility, and diagnostic value in biliary obstructive diseases using Fly-Thru (FT) technique. In this single-center prospective study, patients with biliary obstruction who underwent both abdominal ultrasound and FT examinations were recruited between January 2013 and January 2023. 3D FT images (3D-FT) were reconstructed with FT volumetric data. Image quality was subjectively assessed by two radiologists independently. 3D-FT was used to determine the degree of biliary obstruction and compared with ultrasound-guided percutaneous transhepatic cholangiography (PTC). Diagnostic confidence level, diagnostic accuracy and diagnostic duration of the two radiologists using 2D-ultrasound (2D-US) alone and 2D-US combined with 3D-FT were recorded respectively and compared. 100 consecutive patients were enrolled (mean age: 59.6 ± 13.2 years; 52 men). All 3D-FT images were successfully reconstructed and most (75% and 66%) 3D-FT images were considered clear and highly useful for diagnosis with a good agreement (Kappa = 0.653). Benign lesions and malignancies presented differently in both 2D-US and 3D-FT imaging. 3D-FT was not inferior to PTC in determining the degree of biliary obstruction (p = 0.101), with the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and positive predictive value as 90.5%, 26.7%, 1.23, 0.36, 77.6%, 50.0% respectively. Combined with 2D-US, 3D-FT significantly increased the diagnostic confidence level and diagnostic accuracy of biliary obstructive diseases (all p < 0.01), especially for radiologists with less experience. Application of 3D-FT in diagnosis of biliary obstructive diseases was considered feasible and reproducible, with satisfactory diagnostic value and clinical importance.

Weight loss in patients with severe obesity after bariatric surgery-the potential role of the chrono-nutrition, chronotype and the circadian misalignment: A study protocol of the ChronoWise prospective cohort.

Despite the potential effectiveness of bariatric surgery in promoting weight loss, a considerable proportion of patients still face the challenge of achieving optimal post-surgery outcomes. The timing of eating, in addition to the content of what is eaten, as well as chronotype and social jetlag (a marker of circadian misalignment), have been implicated in weight regulation. However, the current understanding of these chrono-related behaviours in individuals undergoing bariatric surgery is still scarce. Thus, this study aims to evaluate the role of chrono-nutrition, chronotype, and circadian misalignment in the weight-loss trajectory among individuals living with severe obesity who underwent bariatric surgery. The ChronoWise project is a prospective single-centre cohort study designed to follow patients experiencing bariatric surgery at the Santo António Local Health Unit (ULSSA), Porto, Portugal. Participants will be recruited and evaluated at pre-surgery and followed-up over 3 and 6 months after surgery. The baseline evaluation will be conducted face-to-face during the hospital stay and by telephone or video call on the subsequent evaluations, following standard procedures. Data collection includes sociodemographics, food intake, chrono-nutrition behaviours, sleep time behaviour, sleep quality, screen time, physical activity and exercise behaviours, anthropometric measurements, and biochemical parameters. The 'Munich Chronotype Questionnaire' will be used to assess chronotype and social jet lag. Chrono-nutrition dimensions will be measured by the 'Chrononutrition Profile-Questionnaire' in all evaluations. Weight and height will be self-reported and retrieved from medical registries. trajectories of weight-loss will be obtained. This study will add important evidence on the role of chrono-nutrition, chronotype and social jetlag profile in weight-loss outcomes after bariatric surgery. Identifying novel approaches to change the paradigm of post-surgical weight management towards a tailored treatment aligned with circadian rhythm may be useful to strengthen the existing treatments and improve patients' response to bariatric surgery.

Utilizing retinal arteriole/venule ratio to estimate intracranial pressure

PurposeIntracranial pressure (ICP) control is important to avoid secondary brain injury in patients with intracranial pathologies. Current methods for measuring ICP are invasive and carry risks of infection and hemorrhage. Previously we found correlation between ICP and the arteriole-venous ratio (A/V ratio) of retinal vessels in an outpatient setting. This study investigated the usability of fundoscopy for non-invasive ICP estimation with the addition of intraocular pressure (IOP) in patients in a neuro-intensive care unit (NICU).MethodsThis single-center prospective cohort study was conducted at the NICU of Odense University Hospital from September 2020 to May 2021. Adult patients with a Glasgow Coma Score of 8 or less, who underwent invasive pressure neuromonitoring were included. Fundoscopy videos were captured daily and analyzed using deep learning algorithms. The A/V ratio was calculated and correlated with ICP. The data was analyzed using mixed-effect linear regression models.ResultsForty patients were enrolled. Fifteen were included in the final analysis. ICP ranged from -1 to 31 mmHg (mean: 10.9, SD: 5.7), and IOP ranged from 4 to 13 mmHg (mean: 7.4, SD: 2.1). The A/V ratio showed a significant negative correlation with ICP > 15 mmHg (regression slope: -0.0659, 95%-CI: [-0.0665;-0.0653], p < 0.001). No significant change in A/V ratio was observed for ICP ≤ 15 mmHg. A similar significant correlation was found for ICP > IOP (regression slope: -0.0055, 95%-CI: [-0.0062;-0.0048], p < 0.001). Taking the IOP into account did not improve the model. The sensitivity analysis showed a sensitivity of 80.08% and a specificity of 22.51%, with an AUC of 0.6389.ConclusionIn line with our previous work, non-invasive fundoscopy is a potential tool for detecting elevated ICP. However, challenges such as image quality and diagnostic specificity remains. Further research with larger, multi-center studies are needed to validate the utility. Standardization may enhance the technique's clinical applicability.

Prevention of respiratory complications in patients at risk of adverse respiratory events by perioperative nitric oxide delivery during cardiac surgery under cardiopulmonary bypass: a single-center prospective randomized study

Prevention of respiratory complications in patients at risk of adverse respiratory events by perioperative nitric oxide delivery during cardiac surgery under cardiopulmonary bypass: a single-center prospective randomized study

Study of Molecular Markers in Glioma and Their Association with Clinicopathological Features.

Central nervous system tumors are a major cause of morbidity and mortality worldwide. The most prevalent type of primary brain tumor is glioma. The exploration of significant genetic, epigenetic, and transcriptional abnormalities has not only improved our understanding of glioma pathogenesis but has also revealed that these molecular alterations can serve as useful diagnostic markers for more precise classification and are linked to better treatment response and prognosis. Hence, incorporating molecular markers into routine tumor classification is a major priority in modern glioma diagnostics. The aim is to assess the mutation status of isocitrate dehydrogenase (IDH)-1, alpha-thalassemia/mental retardation syndrome X-linked (ATRX), and tumor protein 53 in glioma, and look for their association with various clinicopathological features. A single-center prospective cohort study, where all biopsies of glioma (January 2019 to July 2020) were evaluated, and immunohistochemistry was performed to assess the expression of IDH-1, ATRX, p53, and Ki-67 index. The data were analyzed using IBM SPSS-24 software. Immunohistochemistry was performed in 123 consecutive cases of glioma. IDH-1 mutation was noted in 54 (43.9%) cases and these patients frequently presented with "seizures" (P = 0.006). The expression was maximum in World Health Organization (WHO) grade 2 tumors (65.4%) (P < 0.001), with the highest frequency in oligodendrogliomas (100% in WHO grade 2 and 3). Furthermore, these tumors showed lower proliferative indices (P = 0.001). ATRX mutation was noted in 59 (48%) and p53 overexpression was noted in 76 (61.8%) cases. These mutations were significantly associated with astrocytic phenotype (P = 0.03). Molecular characterization of glioma is an important step in modern glioma diagnostics and immunohistochemistry can play an important role. IDH-1 mutation is commonly observed in adults, frontal lobe location, patients presenting with seizures, and WHO grade 2 tumors with the highest frequencies in oligodendrogliomas. ATRX and p53 can be used as surrogate markers for tumors of astrocytic lineage.

Three-Dimensional Volume Ultrasound Assessment of Cesarean Scar Niche and Cervix in Pregnant Women: A Reproducibility Study.

To assess the reproducibility of standardized 3-dimensional (3D) ultrasound volume analysis of the dimensions and the position of cesarean birth (CB) scar niche relative to the cervix in pregnant women. This prospective single-center study in women with 1 previous CB ≥8 cm cervical dilatation acquired ultrasound volumes between 11 and 24 weeks' gestation in a mid-sagittal plane. Two experienced operators processed the volumes using virtual organ computer-aided analysis. A CB scar niche was defined as an indentation at the scar site of ≥2 mm in depth. Niche and cervix volumes were calculated using manual contouring. Agreement for categorical variables was expressed using intraclass correlation coefficient (ICC). The Bland-Altman method was used to assess numerical variable reproducibility. To achieve the desired statistical power, 52 participants were included. The intraobserver agreement on niche classification relative to the internal os was 100%, with an interobserver kappa coefficient of 0.98 (95% confidence interval [CI] 0.97-0.99, P < .05). The intraobserver ICC for niche volume was 0.94 (95% CI 0.90-0.96; P < .001), with a mean difference of -15.32 mm3 (±109.32). The interobserver ICC was 0.78 (95% CI 0.62-0.87; P < .001), with a mean difference of -21.57 mm3 (±202.01). The ICC for niche/cervix volume ratio were 0.94 (95% CI 0.90-0.96; P < .001) and 0.79 (95% CI 0.63-0.87; P < .001) for intra- and interobserver reproducibility, respectively. This study demonstrates that 3D CB scar sonographic features are highly reproducible in pregnant women with a history of advanced labor CB. The validated protocol can guide future research on the association with subsequent adverse pregnancy outcomes.