Single-center Retrospective Cohort Research Articles

Evaluation of the 2023 Duke-ISCVID criteria for infective endocarditis in patients referred to the Lund infective endocarditis team

Background The Duke criteria for diagnosing infective endocarditis (IE) were recently updated by the International Society for Cardiovascular Infectious Diseases (ISCVID) with the purpose of enhancing diagnostic specificity and sensitivity. This study investigated the performance of the Duke-ISCVID criteria in relation to previous criteria. Method This retrospective single centre cohort study included patients referred to the Lund IE Team (LIET) between 2017 and 2022, and compared episodes classified according to the 2000 modified Duke, European Society of Cardiology (ESC) 2015, and 2023 Duke-ISCVID criteria. The LIET's decision to treat episodes as IE served as the reference standard. Results The study cohort comprised 661 episodes of potential IE. The LIET classified 498 (75%) episodes as IE. The Duke-ISCVID criteria classified a slightly higher proportion of episodes as definite IE (56.4%) compared to the ESC 2015 criteria (54.9%), and the modified Duke (51.1%). The Duke-ISCVID criteria had higher sensitivity (72.5%) for definite IE compared to ESC 2015 (70.7%, p = .57) and modified Duke (66.1%, p = .033). The specificities were similar for the Duke-ISCVID criteria (92.6%), compared to ESC 2015 (93.9%, p = .83) and the modified Duke criteria (95.0%, p = .49). When considering both definite and possible IE positive, specificity for all criteria was low: 32.5% for the Duke-ISCVID criteria, 41.7% for ESC 2015 (p = .086), and 42.3% for modified Duke criteria (p = .11), while the sensitivity was not significantly lower. Discussion The Duke-ISCVID criteria demonstrated slightly improved sensitivity for diagnosing IE whereas specificity remained unchanged. Further refinement of the Duke-ISCVID criteria is needed to balance sensitivity and specificity.

Intraoperative hypotension and postoperative delirium in elderly male patients undergoing laryngectomy: a single-center retrospective cohort study

BackgroundPostoperative delirium (POD) is a common, transient postoperative cognitive dysfunction in elderly patients. The relationship between POD and intraoperative hypotension remains unclear. This study aims to determine if intraoperative hypotension predicts POD in elderly male patients undergoing laryngectomy. MethodsThis study included male patients over 65 years old who underwent laryngectomy between April 2018 and January 2022. The Confusion Assessment Method (CAM) was used to diagnose delirium. Intraoperative hypotension was defined as a Mean Arterial Pressure (MAP) during surgery that was less than 30% of the preoperative level for at least 30 minutes. The relationship between intraoperative hypotension and POD incidence was adjusted for patient demographics and surgery-related factors. ResultsOut of 428 male patients, 77 (18.0%) developed POD, and 166 (38.8%) experienced intraoperative hypotension. Surgery duration ≥ 300 minutes (OR = 1.873, 95% CI 1.041–3.241, p = 0.036), intraoperative hypotension (OR = 1.739, 95% CI 1.039–2.912, p = 0.035), and schooling (OR = 2.655, 95% CI 1.338–5.268) were independent risk factors for POD. The association between intraoperative hypotension and POD was significantly influenced by surgery duration (p for interaction = 0.008), with a stronger association in prolonged surgeries (adjusted OR = 4.902; 95% CI 1.816–13.230). ConclusionsIntraoperative hypotension and low education level are associated with an increased risk of POD in elderly male patients undergoing laryngectomy, especially with prolonged surgery duration.

Comparing right- versus left-first implantation in off-pump sequential double-lung transplantation: an observational cohort study.

Historically, the perfusion-guided sequence suggests to first transplant the side with lowest lung perfusion. This sequence is thought to limit right ventricular afterload and prevent acute heart failure after first pneumonectomy. As a paradigm shift, we adopted the right-first implantation sequence, irrespective of lung perfusion. The right donor lung generally accommodates a larger proportion of the cardiac output. We hypothesized that the right-first sequence reduces the likelihood of oedema formation in the firstly transplanted graft during second-lung implantation. Our objective was to compare the perfusion-guided and right-first sequence for intraoperative extracorporeal membrane oxygenation (ECMO) need and primary graft dysfunction (PGD). A retrospective single-centre cohort study (2008-2021) including double-lung transplant cases (N = 696) started without ECMO was performed. Primary end-points were intraoperative ECMO cannulation and PGD grade 3 (PGD3) at 72 h. Secondary end-points were patient and chronic lung allograft dysfunction-free survival. In cases with native left lung perfusion ≤50% propensity score adjusted comparison of the perfusion-guided and right-first sequence was performed. When left lung perfusion was ≤50%, right-first implantation was done in 219 and left-first in 189 cases. Intraoperative escalation to ECMO support was observed in 10.96% of right-first versus 19.05% of left-first cases (odds ratio 0.448; 95% confidence interval 0.229-0.0.878; P = 0.0193). PGD3 at 72 h was observed in 8.02% of right-first versus 15.64% of left-first cases (0.566; 0.263-1.217; P = 0.1452). Right-first implantation did not affect patient or chronic lung allograft dysfunction-free survival. The right-first implantation sequence in off-pump double-lung transplantation reduces need for intraoperative ECMO cannulation with a trend towards less PGD grade 3.

Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery-A review of 148 cases.

Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap. A single-center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition, n = 116) and Group B (requiring preoperative intravenous inotropic therapy, n = 32). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected. Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post-cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between-group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5 h) and ICU stay (22 vs. 14 days). In-hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long-term survival analysis revealed a significant advantage for Group A. The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups. Local ethics committee, Medical Faculty, Justus-Liebig-University-Giessen (Trial Code Number: 216/14).

The Effect of Hemoadsorption with CytoSorb on Severe COVID-19 Complications

The aim of the study was to assess the effect of hemoadsorption with CytoSorb on the inflammatory response, respiratory failure, and mortality in patients with severe novel coronavirus infection.Materials and methods. A retrospective single-center cohort comparative study of hemoadsorbtion using the CytoSorb therapy included data from 124 COVID-19 ICU patients. Patients were divided into two groups: the study arm with hemoadsorption (group 1, N=93) and the control arm without hemoadsorption (group 2, N=31). Patients in group 1 had more severe respiratory failure at baseline, but were otherwise comparable to patients in group 2 in terms of clinical and demographic parameters.Results. After hemoadsorption, group 1 patients showed significant improvement in 9 of 13 monitored clinical, instrumental, and laboratory parameters: fever (P=0.005), lactate dehydrogenase (LDH) (P<0.001), C-reactive protein (CRP) (P<0.001), and IL-6 (P<0.001) levels, as well as an increase in SpO₂/FiO₂ ratio (P=0.041), leukocyte count (P<0.001) and lymphocyte count (P=0.003), as well as no significant changes in SOFA score (P=0.068). The only improvement seen in group 2 patients was a reduction in fever (P=0.003). Other significant changes in group 2 were unfavorable, such as a decrease in SpO₂/FiO₂ ratio (P=0.002), an increase in inspiratory oxygen fraction FiO₂ (P=0.001), leukocyte count (P<0.05), LDH (P=0.038), procalcitonin (P<0.001), and IL-6 (P=0.005), as well as an increase in SOFA score from 3.0 to 7.0 (95%CI, 3.0–9.0) (P=0.001). The all-cause hospital mortality rate was 37,63% in group 1 and 74.20% in group 2.Conclusion. The use of hemoadsorption with CytoSorb as a pathogenetic therapy targeting the hyperinflammatory response in the management algorithm of ICU patients with severe COVID-19 complications resulted in resolution of the inflammatory response and respiratory failure, as well as a significant reduction in mortality.

How safe is lung transplantation in patients of 65 years or older? A single-center retrospective cohort

IntroductionWith increasing experience in high-volume centers, age alone should not be an absolute contra-indication to lung transplantation (LT) but be considered as part of the patient's initial characteristics. The objective of this study is to provide early and long-term outcomes of LT in recipients aged 65 or older, compared with their younger counterparts. MethodsThis is a retrospective study, including all patients undergoing LT in Bichat Hospital (Paris, France) from January 2014 to March 2019. Two groups were defined depending on the patients’ age when they were transplanted: patients older than 65 were defined as the “elderly group” and patients younger than 65 years old were defined as the « younger group ». Primary endpoint was 90-day mortality. Secondary endpoints included 1-year mortality, 1-year FEV1 (forced expiratory volume in one second), and 5-year overall survival. ResultsFrom September 2014 to March 2019, 22 patients were included in the “elderly group” and 213 were included in the « younger group ». The elderly group had more single LT (SLT) (82% vs. 29%, p < 0.001), with a shorter cold ischemic time (243 min vs. 310 min, p = 0.001) and a lower rate of early humoral rejection (9% vs. 30%, p = 0.045) compared to the younger group. Ninety-day mortality was not significantly different between elderly and younger group (9% vs. 14%, p = 0.95, respectively), nor were 1-year mortality (23% vs. 25%, p = 0.9, respectively) and 5-year overall survival. Six months after LT, FEV1 was significantly better in the elderly group compared to the younger group (77.0% vs. 65.5%, p = 0.037 respectively), but the difference did not reach statistical significance after one year (78.5 vs. 68.3%, p = 0.18 respectively). ConclusionElderly patients underwent more frequently single LT, and achieved similar short and long term postoperative outcomes compared to their younger counterparts. LT for patients 65 years or older should be routinely considered when carefully selected.

Medically assisted reproduction (MAR) with sperm donation: Comparison of the profiles and medical pathways of unmarried women and women in heterosexual couples

Research questionThe legislation allowing unmarried women to undergo medically assisted reproduction (MAR) with sperm donation was adopted in France on August 2, 2021. This major advancement, and its impact on French society, led us to a closer examination of the requests made by unmarried women and the outcomes of ART attempts. DesignA retrospective single center cohort study was conducted in a fertility center in Paris, France. All unmarried women and women in heterosexual couple seeking for MAR using sperm donation between September 2021 and October 2022 were included. Medical and socio-demographic data, as well as details and outcomes of MAR attempts were analyzed until October 31, 2023. ResultsTwo hundred seventy-two unmarried women and 76 women in heterosexual couple were included. Results were compared between the two groups. Unmarried women were significantly older, with a significant decrease in anti-Müllerian hormone (AMH) and antral follicle count (AFC). They also exhibited a higher prevalence of gynecological pathologies associated with infertility, such as endometriosis. Unmarried women were more likely to work in intermediate occupations, whereas women in heterosexual couple more often had employee status. Among unmarried women who had undergone at least one MAR attempt by October 31, 2023, significantly lower cumulative early and ongoing pregnancy rates were observed. ConclusionsFemale age appears to play a major role in the likehood of pregnancy and live birth. It is therefore crucial to inform women initiating the process of MAR with sperm donation that success is not guaranteed.

Neurosarcoidosis of the trigeminal nerve: clinical accompaniments, radiographic findings, and association with neuralgia.

Cranial neuropathy is a principal disease manifestation of neurosarcoidosis, but many forms remain poorly described, including trigeminal nerve disease despite its frequency in reported cohorts (5-12%). Herein, we characterize the clinical course of patients with neurosarcoidosis involving the trigeminal nerve. A single-center retrospective cohort analysis of patients with biopsy-proven sarcoidosis involving the trigeminal nerve was conducted between 1/1/2000-3/7/2023. The trigeminal nerve was affected in 14/245 (5.7%) patients, being clinically symptomatic in 5/245 (2.0%) and asymptomatic with radiographic involvement in 9/245 (3.7%). 14/14 (100.0%) patients had systemic sarcoidosis. In the symptomatic group, trigeminal neuropathy was an inaugural feature in 4/5 (80.0%), unilateral in 5/5 (100.0%) with the V1 subdivision most affected (4/5, 80.0%), and associated with neuralgia in 2/5 (40.0%). On MRI, the cisternal nerve roots (9/14, 64.3%), Meckel's cave (7/14, 50.0%), and cavernous sinus (5/14, 35.7%) were most commonly affected, and 14/14 (100.0%) patients had extra-trigeminal neuroinflammation on cranial MRI. CSF was abnormal in at least one dimension in 11/12 (91.7%) tested. All three treated patients with symptomatic trigeminal neuropathy responded to immunomodulatory treatment, and symptomatic treatments for trigeminal neuralgia were helpful in two patients. After a median follow-up period of 63 months, the median modified Rankin scale score was 1 for both subgroups. Neurosarcoidosis may involve any portion of the trigeminal apparatus, and when affected, it frequently demonstrates a mismatch in radiographic involvement from its clinical manifestations of facial numbness and pain, and typically occurs in association with other clinical or radiographic manifestations of neurosarcoidosis.

Clinical and functional outcomes of locked plating vs. cerclage compression wiring for AO type C patellar fractures– a retrospective single-center cohort study

Abstract Purpose Although “tension-band wiring” is still commonly used to stabilize patellar fractures, the technique has recently been scrutinized due to biomechanical insufficiency. Consequently, the AO Foundation renamed the principle to compression cerclage wiring (CCW). Several studies propose favorable outcomes when utilizing locked plating (LP). This study aims to compare outcome of CCW and LP for complex patellar fractures. Methods A retrospective, single-center cohort study was performed on patients who underwent operative treatment for (AO 34 C-Type) patellar fractures between April 2013 and March 2023. Patients with a 12 month follow up were included. We grouped and compared patients based on the applied treatment strategy: group LP vs. group CCW. Primary outcome parameters included implant-related complications and revision surgeries. Secondary outcomes were length of stay, return to work and 12 months functional outcome (Lysholm score). Odd ratios for complications and revisions were calculated using the conditional Maximum Likelihood Estimate. The threshold for statistical significance was set at p &lt; 0.05. Results Of 145 patients, 63 could be included (group LP: n = 23 and group CCW: n = 40). Fractures in group LP were significantly more complex in regard to AO Classification (p &lt; 0.001), number of fragments (p &lt; 0.001) and degree of comminution (p &lt; 0.001), yet odds of complications were significantly lower in group LP (OR: 0.147; 95%CI: 0.015–0.742; p = 0.009). K-wire migration was the most common complication in group CCW (20%). Odds of revision surgery were significantly lower in group LP (OR: 0.000; 95%CI: 0.000-1.120; p = 0.041). The average Lysholm score at one year was favorable in both groups (89.8; SD: 11.9 in group LP and 90.6; SD: 9.3 in group CCW; n.s.). Conclusion In our study cohort, LP was routinely chosen for more complex fracture morphologies; nevertheless the data implies that LP may be considered as the superior fixation technique in regard to complications and revision operations. Especially, K-wire migration occurs frequently after CCW. The one year functional outcome was comparable between the groups, with both demonstrating good results. Prospective randomized studies are indicated to validate our findings.

Efficacy of Closed-Incision Negative Pressure Wound Therapy in Reducing Postoperative Complications in Breast Reconstruction After Radiotherapy: A Propensity Score Analysis.

Implant-based breast reconstruction following radiotherapy can lead to significant postoperative complications. Closed-incision negative pressure wound therapy (ciNPWT) has emerged as a potential intervention to reduce these complications. To assess the effectiveness of ciNPWT in reducing postoperative complications in patients undergoing implant-based breast reconstruction after radiotherapy. A retrospective single-center cohort study was conducted, including patients who underwent implant-based breast reconstruction after mastectomy and radiotherapy between January 1, 2015, and December 31, 2022. We utilized a procedure-level analysis model with patients contributing distinct observations for multiple procedures. Our primary outcome measures included fluid collection, infection, and wound complications. Propensity score analysis was employed to adjust for potential confounders, such as BMI, smoking history, and diabetes history, creating a balanced comparison between the ciNPWT-treated and untreated groups. In our study of 301 breast reconstructions postradiotherapy from 2015 to 2022, encompassing 218 unique patients, we found significant benefits of ciNPWT. During an average of 2.2-year follow-up, the ciNPWT group demonstrated no infections, contrasting with a 10.4% rate in the non-ciNPWT group (P < .0001). Wound complications were also significantly lower in the ciNPWT group (1.9% vs 11.2%; P = .00848). Demographic differences were adjusted using inverse probability of treatment weights. The findings suggest ciNPWT's promising role in enhancing postoperative outcomes in breast reconstruction postradiotherapy. Our study suggests that the use of ciNPWT in implant-based breast reconstruction postradiotherapy can potentially reduce postoperative complications. This intervention can improve patient outcomes and may offer cost-saving benefits in the long run.

54707 Lichen planus pemphigoides – A retrospective single-center cohort over two decades and comparison of idiopathic vs. drug-induced cases

54707 Lichen planus pemphigoides – A retrospective single-center cohort over two decades and comparison of idiopathic vs. drug-induced cases

P.206: The reasons for potential donor ineligibility in living donor kidney transplants at the Libyan transplant Authority. A Retrospective single centre cohort study.

P.206: The reasons for potential donor ineligibility in living donor kidney transplants at the Libyan transplant Authority. A Retrospective single centre cohort study.

Comparison of Duplex Ultrasound and Digital Subtraction Angiography for Assessing Tibial Vessel Disease.

Background Duplex ultrasonography (DUS) is readily available and often used as the first diagnostic test for patients with peripheral artery diseases (PADs). PAD is a disease that affects the general population but more commonly affects diabetics.To date, the role of DUS in the assessment of tibial vessel disease is inconclusive at best. The goal of our study is to assess the validity of DUS in characterizing the presence and severity of tibial diseasesvia comparison with digital subtraction angiography (DSA) findings. Methods This is a single-center retrospective cohort study analyzing three arterial segments (anterior tibial, posterior tibial, and fibular arteries) in patients who received a duplex study followed by DSA within a 30-day period. All arterial segments were graded from normal (Grade 0) to occluded (Grade 4), based on duplex interpretationand directly compared to direct visualization findings from DSA. Using statistical methods, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DUS were determined. Results A total of 171 tibial vessel segments from 57 enrolled subjects with critical limb ischemia symptoms were analyzed in this study. The agreement between both modalities was poor (Kappa=0.19, p < 0.05), with DUS demonstrating a significant underestimation of vessel pathologies. This is also reflected by the overall sub-optimal sensitivity (23%), specificity (84%), PPV (69%), and NPV (41%) in DUS when compared to DSA results as the gold standard. Conclusion Significant disagreements were noted in this study between DUS and DSA findings, primarilysignificant underestimation of tibial vessel disease by the DUS when compared with the DSA. Caution is advised in the clinical application of DUS in patients with chronic limb-threatening ischemia (CLTI) symptoms and multi-segment tibial vessels due to its demonstrated limitations in this study.

Bladder Endometriosis: Symptoms and Pregnancy Outcomes

ObjectiveTo investigate the clinical features of bladder endometriosis and factors associated with urinary symptoms, pregnancy outcomes, and long-term effects of symptom relief and recurrence. DesignA single-center retrospective cohort study. SettingA tertiary referral hospital. ParticipantsForty-seven patients who were surgically confirmed to have bladder endometriosis at Peking Union Medical College Hospital between January 2012 and December 2023 were included in this study. InterventionsA retrospective study of the clinical and pathological features and reproductive outcomes in patients with bladder endometriosis. Measurements and Main ResultsAmong 47 patients with bladder endometriosis, 27 (57.4%) presented with urinary symptoms, including urinary frequency, urgency, dysuria, and hematuria. Patients with urinary symptoms were more likely to have previous cesarean sections (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.1–19.2, p = .032) and experience dysmenorrhea compared to those without (p = .008, OR 5.3, 95% CI 1.5–18.8). Anterior compartment obliteration was another factor associated with urinary symptoms (OR 7.2, 95% CI 1.3–40.4, p = .016). Bladder lesions located within 1 cm of the ureteral orifice (OR 7.2, 95% CI 1.3–40.4, p = .020) and the deeper invasive layer of lesions (mucosal layer, OR 6.1, 95% CI 1.4–25.8, p = .009) were also found to be associated with symptoms. Regarding reproductive outcomes, 12 patients desired to conceive. Of the patients who desired pregnancy, 66.7% achieved pregnancy; 5 spontaneously and 3 after IVF treatment. The miscarriage rate among patients with bladder endometriosis was 25.0% in the age range of 27–40 years. Additionally, all patients experienced symptom relief after one year of follow-up. Only two patients experienced bladder endometriosis recurrence. ConclusionsPrevious cesarean section, dysmenorrhea, anterior compartment obliteration, lesion in the trigone, and mucosal layer invasion were identified as factors associated with urinary symptoms. Although some patients conceived successfully after surgery, disentangling the independent effect of bladder endometriosis on fertility remains challenging.

Obstetric outcomes in the expectant management of cesarean scar pregnancy with fetal heart activity: a single-center retrospective cohort study.

Cesarean scar pregnancy (CSP) is a high-risk complication characterized by the implantation of a pregnancy within a cesarean scar resulting from a previous delivery. Currently, clinical indicators guiding the expectant management of patients with CSP are lacking. We thus aimed to evaluate pregnancy and neonatal outcomes among women who underwent expectant CSP management and to investigate whether sonographic signs correlated with obstetric outcomes. We retrospective reviewed the electronic medical records and first-trimester transvaginal ultrasonography reports of consecutive patients diagnosed with CSP in the first trimester at the West China Second University Hospital from January 1, 2010 to December 31, 2022. Pregnancy outcomes (emergency surgery, blood loss, and rescue) and neonatal outcomes (gestational age at delivery, neonatal weight, and Apgar scores) were examined. A binary logistic regression analysis was conducted to identify independent risk factors that could predict severe complications. The final analysis included 54 patients. The mean age of the pregnant women was 34±4 years. Among the 54 patients, 14 (25.9%) did not progress to 20 weeks of gestation. Pregnancy continued beyond 20 weeks in 40 patients, with 37 live births (92.5%) and 3 stillbirths (7.5%). Moreover, 7 (17.5%) and 33 (82.5%) patients delivered before and after 34 weeks, respectively. Placenta accreta spectrum (PAS) and placenta previa were confirmed in 29 (72.5%) and 17 (42.5%) patients, respectively. Hysterectomy, emergency cesarean section, and rescue surgery were performed in 5 (12.5%), 15 (37.5%), and 22 (55.5%) patients, respectively. Patients with a visible niche were significantly more likely to have preterm labor, PAS, placenta previa, low-birth-weight newborns, higher blood loss, intraoperative rescue, blood transfusion, and first-trimester vaginal bleeding than were those without one (all P values <0.05). Our study showed that expectant management of CSP to achieve live birth might be feasible. Patients with a visible niche exhibited worse outcomes, with a higher incidence of severe delivery complications.

Gunshot Wounds to the Head: 29 Cases of Monocenter Children's Trauma Hospital Experience and Predictor Scales in Pediatric Population

Gunshot wounds to the head (GSWTH) in children remain an underexplored area, and all clinical guidelines extrapolated from adult experiences. A key challenge in treating these patients is age stratification, as pediatric survival rates are notably higher than in adults. The objective of the study is to compare 2 groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions. A single-center retrospective cohort study was conducted. Patient records of individuals (from birth to 18years old) with craniocerebral injuries caused by GSWTH and treated at Morozov Children's City Hospital between 1992 and 2015 were comprehensively reviewed. Data analysis included clinical presentation, computed tomography scan findings, injury site and trajectory, Glasgow Coma Scale and Glasgow Outcome Scale scores, and the St. Louis Scale. A total of 29 pediatric patients (79% male, 21% female, median age 8years) with GSWTH were analyzed. The mortality rate was 17%. A transventricular wound trajectory was found in 17% of patients and was associated with a poor prognosis (P < 0.001). The Glasgow Coma Scale showed insufficient specificity in injury severity assessment. A multiple logistic regression model predicting injury severity based on bullet type, gender, and time to admission had an accuracy of 80%, while a Decision Tree model improved accuracy to 96.6%. A stacking model combining multiple logistic regression and Decision Tree increased sensitivity to 87.5% and explained 65.5% of the variance. The findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.

MRI-guided transrectal prostate laser ablation for benign prostatic hypertrophy: a retrospective cohort study.

To investigate whether MRI-guided transrectal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH. This single-center retrospective cohort study evaluated men who underwent MRI-guided transrectal laser ablation for BPH between February 2017 and July 2021. Age, prostate-specific antigen, prostate volume, prior surgical BPH treatments if any, International Prostate Symptom Score (IPSS) and Sexual Health Inventory of Men (SHIM) were collected. The primary outcome measures assessed were change in IPSS and SHIM 6, 12 and 24 months after laser ablation and adverse events. Fifty-two patients were included, having completed at least one follow-up survey. The mean patient age was 62.9 ± 5.7 years, and mean prostate volume was 80.2 ± 39.2 cc. Eighteen patients (34.6%) had received a prior BPH treatment. The IPSS scores dropped an average of 16.7 ± 7.0 (p < 0.001), 16.9 ± 7.5 (p < 0.001) and 17.1 ± 7.2 (p < 0.001) points from baseline at 6, 12 and 24 months, respectively. There was no statistically significant difference in IPSS score drop between patients who had received a prior BPH procedure and those who had not (p = 0.628). The SHIM scores showed a statistically insignificant increase at all time points. Nineteen patients (36.5%) reported a complication. There were 12 grade II complications (23%) and seven grade I complications (13.5%). There were no grade III or higher complications. Transrectal MRI-guided focal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH, with a significant improvement in symptom severity after 2 years.

Differences in Injury Patterns and Delays in Care-Seeking Behaviors in the Anabaptist Population

BACKGROUND: The lifestyle differences of Anabaptists and their views on health care may yield different injury patterns than standard populations and require a customized approach to injury prevention and health care delivery. OBJECTIVE: To identify differences in injury patterns and delays in care-seeking behaviors among the Anabaptists in Wisconsin. METHODS: This single-center retrospective cohort study was conducted from (23 years) January 1, 2000, to December 31, 2023. Local Trauma Registry data collected patient demographics, injury details, morbidity outcomes, in-hospital mortality, and preexisting comorbidity. Anabaptist trauma patients were isolated by confirmed identification in the Trauma Registry. The analysis utilized both descriptive statistics and a logistic regression model with the outcome of Anabaptist. RESULTS: A total of 14,431 patients were included in the analysis; 81 (0.4%) were confirmed as Anabaptist. The Anabaptist population showed a higher likelihood of helicopter transportation (odds ratio [OR] 4.64, p &lt; .01) and an activation of Pediatric Level I (OR 4.07, p &lt; .01). As the emergency department shock index increased by one unit, the odds of being Anabaptist increased by 9.87 (p &lt; .01). The injury mechanisms that were associated with the Anabaptist population included buggy collisions (OR 312.58, p &lt; .01), caught or crushed (OR 5.21, p = .01), machinery (OR 5.38, p &lt; .01), near drowning (OR 14.09, p &lt; .01), scooter (OR 13.93, p = .04), and woodworking (OR 12.81, p = .01). CONCLUSIONS: This study identified differences in injury patterns and delays in care-seeking behaviors in the Anabaptist population.

545. HIATAL HERNIA RECURRENCE: IS OBSTRUCTIVE SLEEP APNEA A RISK FACTOR?

Abstract Background A plausible mechanism explaining how obstructive sleep apnea (OSA) triggers gastroesophageal reflux disease (GERD) through hiatal hernia (HH) has been proposed but also ignored in clinical practice. We sought to determine if there were differences in the prevalence of OSA between patients undergoing redo-HH repair and a matched cohort undergoing primary HH repair. Methods After IRB approval, we conducted a single-center retrospective cohort study. A prospectively maintained database was queried to retrieve clinical information of all the patients who underwent HH repair by a foregut surgeon between September 2016 and July 2023. The first group included patients who underwent redo-HH repair due to HH recurrence, and the second group included patients who underwent primary HH repair. Matching was performed in a 1:2 ratio using a propensity-score method based on age, sex, body mass index (BMI), history of chronic respiratory conditions other than OSA, history of smoking, and alcohol abuse. Results During the study period, 63 patients underwent redo-HH repair, and 370 underwent primary HH repair. After matching, 57 patients in the redo-HH repair and 114 in the primary HH repair were included, and all covariates showed adequate balance (Table 1). Patients undergoing redo-HH repair had a slightly higher prevalence of OSA compared to those who underwent primary repair (22.8% [CI95:11.91-33.7%] vs. 14.0% [CI95:7.7-20.4%], χ2 = 2.076, p=0.150). Conclusion Despite not reaching statistical significance, a relatively higher prevalence of OSA among patients undergoing redo-HH was found. Our study was limited by the retrospective design and inability to characterize the severity of OSA as well as patient compliance to treatment. Future prospective studies assessing this potential causality should be undertaken.

Prothrombin complex concentrate for direct factor Xa inhibitor-associated bleeding or before urgent surgery

IntroductionFactor Xa inhibitor (FXaI)-associated bleeding events are common and associated with substantial morbidity. Systematic evaluation of widely available, effective, and affordable FXaI bleed management strategies is needed. Materials and methodsWe conducted a single-center retrospective cohort study of FXaI-treated patients presenting to a tertiary academic medical center from January 2018 to May 2019 who received 25–50 IU/kg 4F-PCC for either FXaI-associated major bleeding or urgent surgery. The primary outcome was hemostatic efficacy, and the safety outcome was the 30-day risk of thromboembolism. ResultsPCC was used to treat FXaI-associated bleeding in 83 cases (79.1 %) and was given before urgent surgery in 22 cases (20.9 %). Sixty-six patients were on apixaban, 38 were on rivaroxaban and one patient was on edoxaban. Intracranial hemorrhage (ICH) and gastrointestinal bleeding accounted for most bleeds (74.7 %). Median interval between last DOAC intake and presentation to triage was 9 h [IQR 5.3–14.8] and median PCC dosing was 40.0 IU/kg [IQR 28.5–46.6]. Forty-two patients (40.0 %) had pre-PCC FXaI levels drawn with median FXaI levels of 114.5 ng/mL [IQR 70.0–175.0]. Effective hemostasis occurred in 66.7 % [95%CI 55.4–76.3] of patients receiving PCC for bleeding and surgical hemostasis was rated as normal in 95.5 % (95%CI 76.5–100.0) for patients having urgent surgery. The 30-day risk of thromboembolism was 7.6 % [95%CI 3.7–14.5] and 22.9 % [95%CI 15.8–31.8] of patients died. ConclusionsPCC for FXaI-associated bleeding was associated with hemostatic efficacy in two-thirds of patients and thromboembolic events were uncommon. PCC represents a promising treatment strategy for FXaI-associated bleeding.