Single-center Retrospective Cohort Research Articles

Pathophysiology of Hyponatremia in Preterm Infants with Relative Adrenal Insufficiency after the Early Neonatal Period.

Preterm infants often develop relative adrenal insufficiency (RAI) not only within the early neonatal period but also beyond this period. RAI is commonly accompanied by hyponatremia, but the pathogenesis of hyponatremia with RAI has not been clarified. This study aimed to investigate the pathophysiology of hyponatremia in infants with RAI. This is a single-centered retrospective cohort study. Preterm infants born at <30 weeks of gestation or birth weight <1,000 g were enrolled. They were divided into the RAI group and the non-RAI group. The data of serum and urine examination, the amount of sodium intake, and fractional excretion of sodium (FENa) were compared between the two groups. In the RAI group, data before and after the administration of hydrocortisone were also compared. Sixteen infants in the RAI group and 35 infants in the non-RAI group were included in the analysis. In the RAI group, hyponatremia was common and preceded other clinical symptoms, such as oliguria and decreased blood pressure, therefore, hyponatremia with RAI was not likely to be caused by dilution due to oliguria. There was no difference in the FENa between the two groups (adjusted for postconceptional age at examination), therefore, it is not likely that hyponatremia with RAI was mainly caused by excessive renal sodium loss. Since sodium intake was rather higher in the RAI group than in the non-RAI group, it is unlikely that insufficient sodium supplementation was the cause of RAI. Hyponatremia with RAI was considered to be likely caused by vascular hyperpermeability. Hyponatremia is a common symptom among preterm infants with RAI and its pathogenesis can be vascular hyperpermeability. · The pathogenesis of hyponatremia with RAI can be vascular hyperpermeability.. · Hyponatremia is common among preterm infants with RAI.. · Hyponatremia with RAI preceded other clinical symptoms..

Effect of standardized hypnotic bundles on insomnia during hospitalization and reducing fall rate: A single-center retrospective cohort study.

Although the use of benzodiazepine receptor agonists is a risk factor for falls and fractures, whether benzodiazepine-avoiding hypnotic bundles are beneficial in clinical settings remains unclear. A new hospital-wide standardized hypnotic bundle for insomnia, with suvorexant as the first choice, was created for clinical purposes. This single-center retrospective cohort study involved a pre-post design and adult inpatients who had had falls. The primary outcome was the total fall rate in the pre-post groups. Additionally, the level change in the fall-rate trend for each month at standardization of the new hypnotic bundle was analyzed. The numbers of hypnotic-related falls and injuries requiring treatment were evaluated. There were no differences in baseline characteristics between the two groups, except for patients with COVID-19. Overall, 31 736 patients were included in this study. The total number of falls was 924 (3.42‰) in the pre-standardization group and 837 (3.31‰) in the post-standardization group, with no significant difference. An interrupted time-series analysis of the level change in the fall rate revealed that the gap in trend at standardization was -11%, with no significance. Hypnotic-related falls were 300 (1.11‰) versus 213 (0.84‰), and the injury incidences were 251 (0.93‰) versus 181 (0.71‰) in the pre and post groups, respectively, showing a significant reduction. The standardization of the new hypnotic bundle for insomnia did not help achieve a significant reduction in total falls. However, our findings suggest that this bundle has the potential to reduce hypnotic-related falls and injuries in inpatients who have had falls. Geriatr Gerontol Int 2024; ••: ••-••.

Temporopolar blurring signifies abnormalities of white matter in mesial temporal lobe epilepsy.

The single-center retrospective cohort study investigated underlying pathogenic mechanisms and clinical significance of patients with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS), in the presence/absence of gray-white matter abnormalities (usually called "blurring"; GMB) in ipsilateral temporopolar region (TPR) on MRI. The study involved 105 patients with unilateral TLE-HS (60 GMB+ and 45 GMB-) who underwent standard anterior temporal lobectomy, along with 61 healthy controls. Resected specimens were examined under light microscope. With combined T1-weighted and DTI data, we quantitatively compared large-scale morphometric features and exacted diffusion parameters of ipsilateral TPR-related superficial and deep white matter (WM) by atlas-based segmentation. Along-tract analysis was added to detect heterogeneous microstructural alterations at various points along deep WM tracts, which were categorized into inferior longitudinal fasciculus (ILF), uncinate fasciculus (UF), and temporal cingulum. Comparable seizure semiology and postoperative seizure outcome were found, while the GMB+ group had significantly higher rate of HS Type 1 and history of febrile seizures, contrasting with significantly lower proportion of interictal contralateral epileptiform discharges, HS Type 2, and increased wasteosomes in hippocampal specimens. Similar morphometric features but greater WM atrophy with more diffusion abnormalities of superficial WM was observed adjacent to ipsilateral TPR in the GMB+ group. Moreover, microstructural alterations resulting from temporopolar GMB were more localized in temporal cingulum while evenly and widely distributed along ILF and UF. Temporopolar GMB could signify more severe and widespread microstructural damage of white matter rather than a focal cortical lesion in TLE-HS, affecting selection of surgical procedures.

Comparison of robotic versus laparoscopic total gastrectomy for gastric cancer: A single-center retrospective cohort study in a Japanese high-volume center

BackgroundRobotic-assisted surgery has become increasingly popular worldwide in recent years. This study aimed to compare the surgical outcomes of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to figure out the advantages of RTG. MethodsThe eligible cases in this study were patients who underwent RTG or LTG for gastric adenocarcinoma at our hospital from January 2014 to December 2022. Propensity score matching (PSM) was employed to balance the underlying selection bias. Then, surgical outcomes of patients were analyzed to be compared. ResultsOverall, 255 patients (LTG: 178, RTG: 77) were included in this study. After PSM, 73 patients in each arm were assigned for analysis. Operation time was longer in the RTG than in the LTG (373 vs 336 min, p < 0.01). However, the RTG was associated with shorter postoperative hospital stays (8 vs 9 days, p = 0.04) and lower incidence of grade 3 or higher postoperative complications (1 % vs 11 %, p = 0.03). More lymph nodes were harvested in the RTG (59 vs 47, p < 0.01). ConclusionsAlthough RTG requires longer operation time, it has the potential to provide advantages to the patient such as quicker recovery, reduction in postoperative complication, or more yield number of lymph nodes. Regarding survival outcomes, further analysis with enough follow-up is needed.

The Influence of Adherence to a Mediterranean Diet on Decompensation in Patients with Chronic Heart Failure.

Chronic heart failure (CHF) is a major health problem, representing the main cause of hospitalization in people over 65 years of age. Several studies have associated the Mediterranean diet with a cardioprotective function, improving prognoses in patients with high cardiovascular risk. Our main objective is to determine whether higher adherence to the Mediterranean diet is associated with a lower severity of CHF, based on the number of decompensations and disease complications. This study was a single-center retrospective cohort study conducted at the Virgen del Rocío Hospital (Seville). Adherence to a Mediterranean diet was determined by the Mediterranean Diet Adherence Screener (MEDAS) in patients with chronic heart failure in a state of clinical stability, the number of decompensations in the 12 months before inclusion, cardiac biomarkers (NT-proBNP and CA125), evaluation of dyspnea, and quality of life assessment according to NYHA and KCCQ scales and analytical profiles. Seventy-two patients were included (35 with high adherence to the Mediterranean diet and 37 with low adherence). The mean age was 81.29 ± 0.86 years. A trend towards fewer decompensations (1.49 ± 0.14 vs. 1.92 ± 0.17, p = 0.054) and lower NT-proBNP values (2897.02 ± 617.16 vs. 5227.96 ± 1047.12; p = 0.088) was observed in patients with high adherence compared to those with low adherence to the Mediterranean diet. Our results suggest that patients with CHF and high adherence to the Mediterranean diet have a tendency towards an improved cardiac profile, indicated by fewer decompensations and lower NT-proBNP levels. Future clinical trials are needed to substantiate these hypotheses.

Short-term and Long-term Clinical Outcomes of Combined Caudate Lobectomy for Intrahepatic Cholangiocarcinoma Involving the Hepatic Hilus: A Propensity Score Analysis.

Extended hepatectomy combined with caudate lobe resection has been approved for the radical resection of hilar cholangiocarcinoma. There was a lack of credible research on the clinical value of caudate lobectomy (CL) for intrahepatic cholangiocarcinoma involving the hepatic hilus when combined with hepatectomy. We aimed to compare the short-term and long-term outcomes of the combined procedure with those of only CL for curative resection of intrahepatic cholangiocarcinoma involving the hepatic hilus. This single-center retrospective cohort study of patients with hilar cholangiocarcinoma was conducted from January 2007 to December 2021. Patients who underwent radical resection were enrolled in this study. The short-term and long-term clinical outcomes of the groups were compared before and after propensity score matching (PSM). A total of 282 patients were included. There were no statistically significant differences in perioperative clinical outcomes between the CL group and the non-CL group before and after PSM. Compared to patients in the non-CL group, patients in the CL group had significantly longer overall survival before and after PSM (p=0.007 before PSM, p=0.033 after PSM). Moreover, compared to the non-CL group, the CL group had longer disease-free survival before and after PSM (p<0.001 before PSM, p=0.019 after PSM). The postoperative complications of the CL group were comparable to those of the non-CL group. CL improved the long-term survival of patients with intrahepatic cholangiocarcinoma involving the hepatic hilus when combined with hepatectomy. Therefore, hepatectomy combined with caudate lobe resection should be performed for patients with hilar cholangiocarcinoma.

Spine injuries among severely injured trauma patients: A retrospective single-center cohort study.

We aimed to determine the incidence and severity of spine injuries among severely injured trauma patients (Injury Severity Score (ISS)/New Injury Severity Score (NISS) > 15) treated in a single tertiary trauma center over 15 years. We also wanted to compare the demographics between patients with and without spine injuries and to determine the mortality of spine-injury patients. Data from the years 2006-2020 from the Helsinki Trauma Registry (HTR), a local trauma registry of the trauma unit of the Helsinki University Hospital (HUH), were reviewed. We divided patients into two groups, namely those with traumatic spine injury (TSI) and those without traumatic spine injury (N-TSI). TSI patients were further subdivided into groups according to the level of injury (cervical, thoracolumbar, or multilevel) and the presence of neurological symptoms. We included 2529 patients: 1336 (53%) had a TSI and 1193 (47%) had N-TSI. TSI patients were injured more frequently by a high-fall mechanism (37% vs 21%, p < 0.001). Among TSI patients, 38% of high-fall injuries were self-inflicted. High falls, young age, and female gender were overrepresented in spine-injury patients with a self-inflicted injury mechanism. Cervical spine-injury patients were mostly elderly persons injured by a low-energy mechanism. Unlike other severely injured trauma patients, severely injured trauma patients with spine injuries are more frequently injured by a high-fall mechanism and self-injury.

Lateral Meniscal Oblique Radial Tears Were Observed Concomitantly With Anterior Cruciate Ligament Tears in 6% of Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction

PurposeThis study aims to identify the incidence of LMORT concomitant with ACL tears in pediatric patients undergoing ACLR. MethodsA single-center retrospective cohort design was used to analyze all patients 18 years and younger undergoing ACL reconstruction between July 2017 and February 2023. Operative notes and intraoperative arthroscopic photos were analyzed to determine the incidence of LMORT. Two independent observers reviewed the images and reached agreement on LMORT incidence and classification of each tear. Demographic, clinical, and outcomes data were collected and analyzed. ResultsLateral meniscus oblique radial tears were identified in 19 of 310 (6.13%) adolescent and pediatric ACL reconstruction cases. Of these patients, 68.4% were male. All but one patient had signs of lateral meniscus injury on preoperative magnetic resonance imaging (MRI). Of the LMORT patients, seven (37%) had a type 1 tear, one (5%) had a type 2 tear, seven (37%) had a type 3 tear, and four (21%) had a type 4 tear. ConclusionsLateral meniscus oblique radial tears were observed concomitantly with ACL tears in 6% of pediatric patients undergoing ACLR. Clinical RelevanceAwareness and recognition of LMORT is important as the treatment paradigm for LMORT injuries continues to evolve.

Low visceral fat volume and hypoalbuminemia as prognostic markers in hospitalized patients with coronavirus disease 2019 during the Omicron variant epidemic

Background&AimsThe rate of severe cases of coronavirus disease 2019 (COVID-19) has decreased since the Omicron variant became epidemic. Visceral fat volume was a risk factor for COVID-19 severity with prior prevalent variants, but whether visceral fat volume remains a risk factor for the Omicron variant is unclear. We investigated the associations of clinical factors including visceral fat volume with severity and mortality among hospitalized patients with COVID-19 during the Omicron variant epidemic. MethodsThis was a single-center retrospective cohort study conducted at the Teikyo University Hospital in Japan. We included hospitalized patients with COVID-19 during the Omicron variant epidemic who underwent computed tomography of the abdomen. Clinical data were obtained from the medical records and visceral fat area (VFA) was measured using a 3-dimensional image analysis system volume analyzer. Severity was determined by the presence or absence of oxygen supplementation. ResultsAmong the 226 patients, 66 patients showed moderate severity and 29 patients were non-survivors. Hypoalbuminemia was associated with severity (odds ratio [OR] 3.93, 95% confidence interval [CI] 1.91–8.07; p=0.0002), and hypoalbuminemia (OR 8.38, 95%CI 2.37–29.58; p=0.0010) and low VFA (OR 3.40, 95%CI 1.15–10.06; p=0.027) were associated with mortality. Decision tree analysis showed that mortality rate in the hypoalbuminemia and low-VFA group (37.3%) was significantly higher than in other groups (p≤0.01). ConclusionsLow visceral fat volume and hypoalbuminemia were associated with mortality in hospitalized patients with COVID-19 during the Omicron variant epidemic. Classification by VFA and serum albumin may allow simple prediction of mortality risk among hospitalized patients with COVID-19.

Contusion expansion, low platelet count andbifrontal contusions are associated with worse patient outcome following traumatic brain injury-a retrospective single-center study.

Cortical contusions are common in moderate-severe traumatic brain injury (TBI). Cortical contusions often expand, potentially causing neuro-worsening several hours to days post-trauma. While contusion expansion (CE) may affect outcome, potential clinical and radiological markers that can predict CE have been insufficiently explored. In the present single-center retrospective observational cohort study, we evaluated clinical outcome by the Glasgow Outcome Scale extended (GOSE) scale and evaluated risk factor for CE. Adult TBI patients > 18years of age, and of all injury severities, were included. Main variables of interest were low platelet count, defined as < 150 × 109/L, presence of bifrontal contusions and CE, defined as absolute contusion volume increase in cm3. Factors associated with CE and clinical outcome according to GOSE were analyzed. Between 2012-2022, 272 patients were included. Contusion size on admission correlated positively with CE, as did the Marshall and Rotterdam radiological classification scores. Bifrontal contusions were significantly larger at admission, experienced larger CE, and had a worse outcome than contusions in other locations. Patients with a platelet count < 150 × 109/L experienced a greater volume CE and had a worse outcome when compared to patients with a normal platelet count. In a multivariate analysis, CE remained significantly associated with a poor outcome six months post- injury. Contusion volume at admission, Marshall CT classification and Rotterdam CT score, positively correlated to CE. Bifrontal contusions and a platelet count < 150 × 109/L were associated with CE, and a poor clinical outcome. Large CE volumes were associated with a worse clinical outcome, and CE was per se associated with outcome in a multivariate analysis. Management of these risk factors for CE in the acute post-injury setting may be needed to attenuate contusion expansion and to improve clinical outcome in TBI patients suffering from cortical contusion injuries.

Impact of cardiac rehabilitation exercise frequency on exercise capacity in patients with coronary artery disease: a retrospective study

ABSTRACT Cardiac rehabilitation (CR) significantly improves cardiovascular outcomes in patients with coronary artery disease (CAD). International guidelines vary in the minimum recommended frequency of supervised exercise from 1 to 3 sessions per week. This is the first study in the Middle East and North African regions assessing the impact of 2 versus 3 days/week of supervised exercise on peak exercise capacity in patients with CAD. Single-center retrospective cohort study involving 362 patients enrolled in the only CR center in the State of Qatar. Only high-quality data was included by strict evaluation of compliance to the exercise intervention. Fifty patients who underwent a symptom-limited exercise test before and after CR were included (31 patients on 2 days/week, 19 on 3 days/week). No significant differences were observed in baseline characteristics between groups. Exercise intervention differed significantly between groups in exercise training frequency (2 days/week: 1.97 ± 0.2 vs. 3 days/week: 2.7 ± 0.3; p < 0.00). Peak exercise capacity as peak metabolic equivalents of task (MET) significantly increased in both groups (2 days/week: Pre 8.3 ± 2.4 vs. Post 9.4 ± 2.9, p-value 0.00; 3 days/week: Pre 7.4 ± 1.6 vs. Post 8.4 ± 2.0, p-value 0.00). No significant difference was observed between groups for change in Peak Exercise Capacity (2 days/week 1.1 ± 1.1 vs. 3 days/week 1.0 ± 0.9, p = 0.87). When the total number of exercise sessions is equal, supervised exercise frequencies of 2 and 3 days/week may significantly and equally improve peak exercise capacity in patients with CAD.

Prediction the Occurrence of Thalassemia With Hematological Phenotype by Diagnosis of Abnormal HbA1c.

The current investigation aims to analyze the occurrence of thalassemia in patients who participated in hemoglobin A1c (HbA1c) testing in clinical laboratory showing high hemoglobin F (HbF) level (≥ 1.5%) or abnormal Hb peak and predict the main influence factors by using different statistical models. The current investigation is a single-center retrospective cohort study. HbA1c concentration was detected by using TOSOH HLC-723G8 glycated hemoglobin analyzer. SNaPshot SNP (Single Nucleotide Polymorphism) typing and AccuCopy technology were employed to detect mutations in thalassemia-related pathogenic genes. A total of 126 patients endured high HbF levels or abnormal Hb peak during HbA1c detection, and 66.7% of subjects (n = 84) showed thalassemia mutations. Three heterozygosity mutations, including c.52A>T (p.K18*), c.-78A>G, and c.126_129delCTTT(p.F42Lfs*19) present in HBB gene, were also identified. --SEA/αα mutation demonstrated the youngest ages (p < 0.001). 17 M (p < 0.001) and 41/42 M (p < 0.01) mutations with β-thalassemia showed higher HbF levels compared with patients without thalassemia mutations. Except for -α3.7, mutations in thalassemia showed lower levels of mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) compared with patients without thalassemia mutations. Patients with thalassemia mutations showed younger age (p < 0.001), lower Hb (p < 0.001), MCV and MCH levels (p < 0.001), higher red blood cell (RBC)count (p < 0.001), and platelet distribution width (PDW) level (p = 0.007) than patients without thalassemia mutations. Three statistical models indicate MCV is the most valuable independent factor for predicting thalassemia and ROC (receiver operating characteristic) curves analysis of AUC (Area Under the Curve) of 0.855 (95% CI [0.787-0.923], p < 0.001) with MCV. High HbF level (≥ 1.5%) or abnormal Hb peak present in HbA1c testing indicated high incident rate of thalassemia. MCV is the most valuable independent predicting factor for subjects having thalassemia.

A Comparison of Clinical and Laboratory Features of Crimean-Congo Hemorrhagic Fever in Children and Adults: A Retrospective Single-Center Cohort Study and Literature Review

A Comparison of Clinical and Laboratory Features of Crimean-Congo Hemorrhagic Fever in Children and Adults: A Retrospective Single-Center Cohort Study and Literature Review

Fracture-related infections after osteosynthesis for hip fracture are associated with higher mortality: A retrospective single-center cohort study.

Fracture-related infections (FRIs) after osteosynthesis for hip fractures have not been thoroughly investigated. Our primary aim was to assess the association between FRIs and mortality after osteosynthesis for hip fracture. Secondary aims were to investigate the incidence, microbiology, and general epidemiological aspects of these FRIs. This retrospective single-center study included 1,455 patients > 18 years old with non-pathological hip fractures treated with osteosynthesis between 2015 and 2019. Medical records were reviewed and FRIs were diagnosed based on current consensus criteria. The follow-up period was 2 years. Mortality was estimated using Kaplan-Meier survival analysis. Cox regression analyses were performed to investigate the potential association between FRIs, as a time-dependent variable, and increased mortality. The median age for the entire cohort was 83 (interquartile range 75-89) years and 69% were females. At the 2-year follow-up mark, the crude mortality rate was 33% in the non-FRI group and 69% (11 of 16 patients) in the FRI group. Cox regression analysis assessing mortality risk revealed a hazard ratio of 3.5 (95% confidence interval [CI] 1.9-6.4) when adjusted for confounders. The incidence of FRI was 1.1% (16 of 1,455 patients).Staphylococcus aureuswas the most common pathogen. Most FRI patients (94%) required at least 1 revision and 56% underwent ≥ 2 revision. We found an association between FRIs after hip fracture osteosynthesis and increased mortality, underscoring the critical need for FRI prevention measures in this frail patient group. The incidence and microbiological findings were consistent with previous studies.

Endocrine Characteristics and Obstetric Outcomes of PCOS Patients with Successful IVF and Non-IVF Pregnancies.

Background/Objective: Infertility affects an estimated 40-50% of women with polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility, but only a small proportion of the patients require in vitro fertilization (IVF) therapy. Both PCOS and IVF are associated with an increased risk of obstetric complications. To compare preconception endocrine profiles and symptoms, as well as obstetric outcomes of PCOS patients who achieved successful pregnancies with and without IVF treatment. Methods: A single-center retrospective cohort study was conducted. Data spanning from 2012 to 2019 were compiled from patients with PCOS who visited the Gynecologic Endocrinology Unit and the Infertility Unit at the Department of Obstetrics and Gynecology, University of Debrecen. Patients diagnosed with PCOS who had had at least one successful delivery beyond the 23rd gestational week at the department were eligible for inclusion in the study. Results: Fifteen percent of the 206 pregnancies leading to successful deliveries of 232 newborns in our cohort conceived with IVF. A one year increase in the maternal age increased the odds of being in the IVF group by 22% (OR: 1.222, 95% confidence interval, CI: 1.11-1.35, p < 0.001). Baseline DHEAS and androstenedione levels were significantly lower in the IVF group as compared to the non-IVF group: 1 μmol/L increase in the DHEAS level decreased the odds of being in the IVF group by 18% (OR: 0.82, 95% CI: 0.66-1.01, p = 0.06), and 1 μg/L increase in the serum androstenedione concentration decreased the same odds by 42% (OR: 0.58, 95% CI: 0.33-1.02, p = 0.056). DHEAS levels <6.5 μmol/L had an OR 3.86 (95% CI 1.10-13.50, p = 0.04) and LH/FSH ratio <1.3 had an OR 3.58 (95% CI 1.18-10.81, p = 0.03) for being in the IVF group. The birth weight (3069 ± 683 g vs. 3362 ± 638 g, p = 0.02) and the gestational age (37.23 ± 2.55 vs. 38.54 ± 2.28 weeks, p = 0.004) were significantly lower in the IVF group, but in the singleton subgroups, no significant differences could be found. Birth weight percentiles showed no significant difference in either subgroup. In the IVF group, both preterm delivery (29% vs. 8.3%, OR 4.53, 95% CI 1.75-11.70, p = 0.002; singleton subgroup: 17.4% vs. 6.3%, OR 3.12, 95% CI 0.89-10.92, p = 0.07) and cesarean section (71% vs. 43.2%, OR 3.22, 95% CI 1.40-7.40, p = 0.006; singleton subgroup: 65.2% vs. 42.4%, OR 2.55, 95% CI 1.02-6.35, p = 0.04) were more frequent than in the non-IVF group. Gestational diabetes and preeclampsia were not significantly different in the IVF and non-IVF groups. Conclusions: In PCOS patients with successful pregnancies, those who conceive with IVF seem to be different in their baseline hormone levels and symptoms from the non-IVF group. Adverse obstetric outcomes are more common in the IVF group, and some of these differences persist when adjusting for singleton pregnancies and maternal age, too.

Structural social determinants of health as barriers to liver transplant waitlisting

Social determinants of health, both individual and structural, impact access to liver transplantation (LT). We aimed to evaluate the association between structural social determinants of health (SSDoH) and individual-level psychosocial factors (as measured by the Stanford Integrated Psychosocial Assessment for Transplant, SIPAT score) on failure to waitlist for LT. We conducted a single-center retrospective cohort study of 2762 patients evaluated for LT. SSDoH exposures included the Social Deprivation Index (SDI), the proportion of households on cash public assistance or supplemental nutrition assistance (% public assistance), and distance to the transplant center. Neighborhood SDI score in the highest quartile (OR 1.32, 95 % CI 1.07–1.63) and % on public assistance in the highest quartile (OR 1.41, 95 % CI 1.14–1.75) were associated with increased odds of not being waitlisted for LT. These associations remained significant after adjusting for individual psychosocial risk using SIPAT scores (≥21, high psychosocial risk). Highest quartile neighborhood SDI (OR 1.70, 95 % CI 1.13–2.54) and the highest quartile of % on public assistance (OR 1.67, 95 % CI 1.11–2.53) were also associated with increased odds of failure to waitlist for psychosocial reasons. However, these associations were no longer significant after adjusting for individual SIPAT scores. High-risk SIPAT scores were more prevalent in neighborhoods with the highest quartile of SSDoH measures. Transplant centers can design initiatives to build individual psychosocial support to mitigate the impact of structural barriers.

An integrated machine learning model enhances delayed graft function prediction in pediatric renal transplantation from deceased donors

BackgroundKidney transplantation is the optimal renal replacement therapy for children with end-stage renal disease; however, delayed graft function (DGF), a common post-operative complication, may negatively impact the long-term outcomes of both the graft and the pediatric recipient. However, there is limited research on DGF in pediatric kidney transplant recipients. This study aims to develop a predictive model for the risk of DGF occurrence after pediatric kidney transplantation by integrating donor and recipient characteristics and utilizing machine learning algorithms, ultimately providing guidance for clinical decision-making.MethodsThis single-center retrospective cohort study includes all recipients under 18 years of age who underwent single-donor kidney transplantation at our hospital between 2016 and 2023, along with their corresponding donors. Demographic, clinical, and laboratory examination data were collected from both donors and recipients. Univariate logistic regression models and differential analysis were employed to identify features associated with DGF. Subsequently, a risk score for predicting DGF occurrence (DGF-RS) was constructed based on machine learning combinations. Model performance was evaluated using the receiver operating characteristic curves, decision curve analysis (DCA), and other methods.ResultsThe study included a total of 140 pediatric kidney transplant recipients, among whom 37 (26.4%) developed DGF. Univariate analysis revealed that high-density lipoprotein cholesterol (HDLC), donor after circulatory death (DCD), warm ischemia time (WIT), cold ischemia time (CIT), gender match, and donor creatinine were significantly associated with DGF (P < 0.05). Based on these six features, the random forest model (mtry = 5, 75%p) exhibited the best predictive performance among 97 machine learning models, with the area under the curve values reaching 0.983, 1, and 0.905 for the entire cohort, training set, and validation set, respectively. This model significantly outperformed single indicators. The DCA curve confirmed the clinical utility of this model.ConclusionsIn this study, we developed a machine learning-based predictive model for DGF following pediatric kidney transplantation, termed DGF-RS, which integrates both donor and recipient characteristics. The model demonstrated excellent predictive accuracy and provides essential guidance for clinical decision-making. These findings contribute to our understanding of the pathogenesis of DGF.

Long-Term Patency Rates of Portal Vein/Superior Mesenteric Vein Reconstruction after Pancreatic Resection for Pancreatic Tumors: Single-Center Experience.

To achieve an R0 resection margin in patients with locally advanced pancreatic ductal adenocarcinoma, high-volume pancreatic centers standardly incorporate portal vein or superior mesenteric vein resection. However, there is currently no consensus on the optimal reconstructive approach. Postoperative venous thrombosis or stenosis can significantly increase patient morbidity or mortality. The objective of this study was to report the long-term patency rate of portal/superior mesenteric vein reconstruction, as well as to identify potential predictors of postoperative venous thrombosis/stenosis. A single-center retrospective cohort analysis was conducted on patients undergoing pancreatic resection due to pancreatic tumor. The patency of the vascular reconstruction was assessed by routine surveillance using computed tomographic imaging at 3, 6, 9, and 12 months after surgery. A total of 297 pancreatic resections were performed with 53 patients undergoing concomitant venous resection. Among these, 26.4% (N = 14) had primary closure, 22.7% (N = 12) underwent an end-to-end anastomosis, and 50.9% (N = 27) received an interposition graft reconstruction. At the 1-year follow up, 90.2% (N = 37) of patients with venous reconstruction had a fully patent vein. The analysis did not reveal any statistically significant perioperative or postoperative factors associated with an increased risk of reconstruction thrombosis. While our study confirms a high long-term patency rate of 90.2% at 1 year, it underscores the necessity for a randomized controlled trial to determine the optimal method of venous reconstruction in pancreatic surgery.

Axillary artery access considerations in Impella 5.5insertion: Insights from exclusive axillary approach forsuccessful support.

The Impella 5.5® is commonly inserted via the axillary artery (AX) in patients with cardiogenic shock. The right AX has traditionally been preferred to avoid crossing the aortic arch, and a minimum diameter of 7 mm has been recommended to accommodate the device (21 Fr). There is limited data on choice of laterality of access and AX size required, both in terms of technicality of the procedure as well as outcomes. We performed a single-center retrospective cohort analysis of patients who underwent Impella 5.5® implantation between December 2020 and February 2024 (N = 75). Data including demographics and outcomes were stratified both by diameter (small, <7 mm vs. normal, ≥7 mm) and laterality of access (right vs. left). Adverse events included stroke, limb ischemia, procedural bleeding or infection, and unplanned explant due to complications. Delivery time was defined as time from advancing the first wire to activation of the device. AX approach was attempted in all (N = 74) but one requiring innominate access, with a technical success rate of 95.9% (N = 71/74). The mean age was 58.8 ± 13.3 years, with 81.1% males. The median delivery time was 7.0 (25th, 75th percentiles: 4.0, 11.5) min with a median support duration of 13 (7.7, 24) days. Ten patients (13.5%) had a small AX, with a mean diameter of 6.3 ± 0.5 mm and were more likely to be younger compared to the normal AX group. Fifty-nine patients (79.7%) had insertion via the right AX. Median delivery time was comparable across all groups (small, 5.4 [3.5, 10.9] vs. normal, 7 [4.0, 12.1] min, p = 0.59) and (right, 10.4 [5.3, 15.2] vs. left, 6 [3.7, 10.4] min, p = 0.35). There was no difference between the rates of stroke, ischemia, bleeding, or infection when comparing by size or laterality. Survival to discharge was 59.5%, with 21.1% mortality on support, all in patients with a normal AX diameter, but with no difference between right versus left. In our study, laterality and a small diameter of AX access did not affect outcomes of Impella 5.5®, with a similar safety profile.

Workplace violence against healthcare workers in the emergency department — a 10-year retrospective single-center cohort study

BackgroundMedical staff are regularly confronted with workplace violence (WPV), which poses a threat to the safety of both staff and patients. Structured de-escalation training (DET) for Emergency Department (ED) staff has been shown to positively affect the reporting of WPV incidents and possibly reduce its impact. This study aimed to describe the development of incidence rates, causes, means, targets, locations, responses, and the time of WPV events. Additionally, it explored the effect of the staff trained in DET on the objective and subjective severity of the respective WPV events.MethodsIn a retrospective, single-center cohort study, we analyzed ten years of WPV events using the data of Staff Observation Aggression Scale-Revised (SOAS-R) score (ranging from 0 to 22) in a tertiary ED from 2014 to 2023. The events were documented by ED staff and stored in the electronic health record (EHR).ResultsBetween 2014 and 2023, 160 staff members recorded 859 incidents, noting an average perceived severity of 5.78 (SD = 2.65) and SOAS-R score of 11.18 (SD = 4.21). Trends showed a non-significant rise in incident rates per 10,000 patients over time. The WPV events were most frequently reported by nursing staff, and the cause of the aggression was most often not discernible (n = 353, 54.56%). In total, n = 273 (31.78%) of the WPV events were categorized as severe, and the most frequent target of the aggressive behavior was the staff. WPV events occurred most frequently in the traumatology section and the detoxification rooms. While the majority of events could be addressed with verbal interventions, more forceful interventions were performed significantly more often for higher severity WPV events. More WPV events occurred during off-hours and were of a significantly higher objective and subjective severity. Overall, the presence of staff with completed DET led to significantly higher SOAS-R scores and higher perceived severity.ConclusionThe findings underline the relevance of WPV events in the high-risk environment of an ED. The analyzed data suggest that DET significantly fostered the awareness of WPV. While most events can be addressed with verbal interventions, WPV remains a concern that needs to be addressed through organizational measures and further research.