Timing Of Intervention Research Articles

Timing Matters: Ultra-Early and Early versus Late Thromboprophyaxis Following Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.

Spontaneous intracerebral hemorrhage (ICH) represents a critical and potentially devastating medical event resulting from the rupture of intracerebral vessels. Patients afflicted with ICH face an increased risk of venous thromboembolism (VTE) due to factors such as immobility. However, determining the ideal timing for initiating venous thromboembolism thromboprophylaxis (TP) remains uncertain, as it may carry the potential risk of exacerbating hematoma expansion. Thus, our objective was to ascertain the optimal timing for initiating TP following ICH through a comprehensive systematic review and meta-analysis.This systematic review and meta-analysis were performed following the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines, considering outcomes based on the time of intervention: Ultra early (UEPT) < 24h, Early (EPT) < 48h, Late (LPT) > 48h to perform an analysis on hematoma expansion and mortality.Of 2.777 Hematoma expansion was not more frequent in the 440 patients receiving UEPT/EPT (n = 440) versus 565 receiving LPT (Odds ratio (OR) 0.94 (95% CI; 0.62 to 1.43; I2 = 0%)). Similarly, mortality was not lower in the 293 received UEPT or EPT versus 477 receiving LPT (OR 0.63 (95% CI; 0.39 to 1.0; I2 = 0%).This study, through a systematic review and meta-analysis, conclusively found no difference in intracranial hematoma expansion and/or increased mortality between the use of heparin in the early thromboprophylaxis (< 48h) group compared to the late thromboprophylaxis (> 48h) group. Implementing this approach in the management of spontaneous cerebral hemorrhage could facilitate progress towards more optimal care protocols.

A seed or soil problem in early endometriosis: stromal cell origin drives cellular invasion and coupling over mesothelial cell origin

To study the role of the mesothelial cells in early endometriosis lesion formation by assessing in vitro cell to cell communication and invasion of endometrial cells across a mesothelial cell monolayer, with both cell types derived from both endometriosis and control patients. Laboratory based experimental study SETTING: University hospital and laboratory PATIENT(S): Consenting reproductive aged women who underwent laparoscopy for gynecologic reasons and were confirmed to either have endometriosis with pathology tissue diagnosis (n=8) or no endometriosis (n=8) at the time of surgery INTERVENTION: Primary stromal cells cultured from endometrial pipelle biopsies and primary mesothelial cells cultured from peritoneal explants were utilized in trans-mesothelial invasion assays and gap junction coupling assays. Comparison of potential for lesion formation, using in vitro models, of both primary endometrial and mesothelial cells from endometriosis and control patients, establishing the former as the primary disease driver. When comparing mesothelial cells from control patients to mesothelial cells from endometriosis patients, there was no significant difference in the amount of stromal cell invasion across either barrier. In contrast, when comparing stromal cell origin, the amount of invasion by endometriosis stromal cells was greater than control stromal cells regardless of whether the mesothelial cell monolayer was derived from disease or control patients. Additionally, primary mesothelial cells induced more gap junction coupling, a requirement for invasion, in stromal cells from endometriosis than control patients, again independent of mesothelial origin. The notable exception was mesothelial cells derived from endometriotic lesion affected areas that showed depressed ability to support invasion. While both endometrial and mesothelial cells need to function for establishment of endometriosis lesions, the endometrium seems to be the key player, serving as an ideal target for diagnostic strategies and therapeutic intervention. This notion is consistent with prior studies, however we are the first to directly test both primary mesothelial and endometrial cells from endometriosis and control patients to compare propensities for mesothelial invasion.

The Kids Heart BioBank: supporting 20 years of patient care and research into CHD.

The cause of most CHD is unknown and considered complex, implicating genetic and environmental factors in disease causation. The Kids Heart BioBank was established in 2003 to accelerate genetic investigations into CHD. Recruitment includes patients undergoing interventions for CHD at The Children's Hospital at Westmead. Informed consent is obtained from parents/guardians, and blood is collected at the time of cardiac intervention from which DNA is extracted and stored. Associated detailed clinical information and a family history are stored in the purpose-designed database. To date, the Kids Heart BioBank contains biospecimens and associated clinical information from over 4,900 patients with CHD and their families. Two-thirds (64.1%) of probands have been included in research studies with 28.9% of participants who underwent genomic sequencing receiving a molecular diagnosis with direct clinical utility. The value of this resource to patients and families is highlighted by the high consent rate (94.6%) and the low withdrawal of consent rate (0.4%). The Kids Heart BioBank has supported many large national and international collaborations and contributed significantly to CHD research. The Kids Heart BioBank is an invaluable resource and, together with other similar resources, the resulting research has paved the way for clinical genetic testing options for CHD patients, previously not possible. With research in the field moving away from diagnosing monogenic disease, the Kids Heart BioBank is ideally placed to support the next chapter of research efforts into complex disease mechanisms, requiring large patient cohorts with detailed phenotypic information.

Optimal timing of invasive intervention for high-risk non-ST-segment-elevation myocardial infarction patients.

To compare the immediate, early, and delayed percutaneous coronary intervention (PCI) strategies in non-ST-segment-elevation myocardial infarction (NSTEMI) patients with high-risk. Medical records of patients treated at the Daping Hospital, Third Military Medical University, Chongqing, China between 2011 and 2021 were retrospectively reviewed. Only patients with complete available information were included. All patients assigned into three groups based on the timing of PCI including immediate (< 2 h), early (2-24 h) and delayed (≥ 24 h) intervention. Multivariable Cox hazards regression and simpler nonlinear models were performed. A total of 657 patients were included in the study. The median follow-up length was 3.29 (interquartile range: 1.45-4.85) years. Early PCI strategy improved the major adverse cardiac event (MACE) outcome compared to the immediate or delayed PCI strategy. Early PCI, diabetes mellitus, and left main or/and left anterior descending or/and left circumflex stenosis or/and right coronary artery ≥ 99% were predictors for MACE outcome. The optimal timing range for PCI to reduce MACE risk is 3-14 h post-admission. For high-risk NSTEMI patients, early PCI reduced primary clinical outcomes compared to immediate or delayed PCI, and the optimal timing range was 3-14 h post-admission. Delayed PCI was superior for NSTEMI with chronic kidney injury. Delayed invasive strategy was helpful to reduce the incidence of MACE for high-risk NSTEMI with chronic kidney injury. An immediate PCI strategy might increase the rate of MACE.

Factors influencing the achievement of early surgery in proximal femoral fractures under a Japanese incentive policy

BackgroundProximal femoral fractures in geriatric patients are a major challenge in orthopedics, often leading to major functional impairment. Early surgical intervention is crucial for improving patient recovery and overall health outcomes. Thus, Japan’s Ministry of Health, Labour and Welfare initiated a reimbursement policy in April 2022 to encourage early surgery for these fractures in patients aged ≥ 75 years. This study investigated the impact of this policy on early surgery rates in Japan and identified factors influencing the timing of surgical interventions. MethodsWe retrospectively analyzed the data of patients who underwent surgery for proximal femoral fractures at our institution between April 2022 and March 2023. Patients were categorized into two groups based on the timing of surgery relative to the injury: ≤48 h and >48 h. Demographic and clinical data, including age, sex, fracture type, and various health- and admission-related factors, were assessed. ResultsOf the 192 patients, 152 were included in the study. Among them, 38% underwent early surgery (≤48 hours), and 15% of the patients arrived more than 48 h post-injury. Significant differences were found in admission routes and residence types between the groups. The ≤48 h group had shorter intervals from injury to admission and surgery than the >48 h group. Factors such as the admission process, day of the week, and C-reactive protein levels significantly influenced the timing of surgery. ConclusionsAfter introducing incentives for early surgery in Japan, 38% of patients with proximal femoral fractures underwent surgery within 48 h of injury. Factors contributing to patients not receiving early surgery included transport from another hospital, weekend hospitalization, and elevated CRP levels. These findings suggest that achieving surgery within 48 h of injury is challenging through hospital efforts alone, and the time criteria might be more appropriate if changed to “admission to surgery.”

Surgical timing and long-term outcomes in patients with severe haemorrhagic spinal cord cavernous malformations

BackgroundSurgical resection of the lesions remains the main treatment method for most symptomatic spinal cord cavernous malformations (SCCMs) to eliminate the occupation and associated subsequent lifelong haemorrhagic risk. However, the...

Surgical management of iSGS in pregnant patients: Survey among North American expertise centers

ObjectiveTo identify, group and document the surgical management of idiopathic subglottic stenosis (iSGS) in pregnant women among North American centers with expertise in the treatment of airway stenosis. BackgroundIdiopathic subglottic stenosis is a rare airway disease that primarily affects women in their third to fifth decade of life. Symptoms of iSGS often worsen during pregnancy and can present as a threat to optimal maternal and fetal health; however there is a lack of evidence addressing the management of iSGS in pregnancy. Study designCross-Sectional Survey Study. MethodsA twenty-four question survey was designed to query the surgical management, ventilation, and perioperative considerations for pregnant patients with iSGS. Twenty-nine North American academic tertiary care centers with airway surgery expertise were identified. A designated surrogate for each center was contacted by email to distribute and obtain results of the survey. Results17 centers responded. Most centers include differences in perioperative assessment such as frequency of consultation with a maternal/fetal medicine specialist. There is occasional use of a tocometer and rarely a non-stress test. Ventilation with intermittent jet ventilation or high-flow nasal cannula is favored. The surgical protocols include positional modifications, with pregnant patients in the left lateral decubitus position. The preferred timing for intervention is in the second or third trimester. ConclusionThis is the first national survey describing surgical and perioperative considerations for the pregnant patient with iSGS among centers with airway expertise in the United States and Canada.

The Effect of Modified Early Warning Score (MEWS) and Nursing Guide Application on Postoperative Patient Outcomes: A Randomized Controlled Study

The aim of this study is to determine the effect of nursing guide application (NGA) on patient outcomes in patients followed up according to the modified early warning score (MEWS) in the postoperative period. A randomized controlled clinical trial. The sample of the study consisted of 252 patients who underwent surgical intervention under general anesthesia in a university hospital between July 29, 2022, and October 31, 2022. Results showed that the development of complications was less in the study group (SG) compared to the control group (CG) during anesthesia (P=.027), in the postanesthesia care unit (PACU) (P=.017), and in the clinic (P=.001). It was found that the duration of stay in PACU in the CG was significantly shorter than in the study group (P<.001), and as the duration of stay in PACU in CG decreased, the MEWS increased (r=-0.201, P=.024). We found that there were fewer patients transferred to the intensive care unit (ICU) after PACU (P=.007), the MEWS was lower, and the number of nursing interventions applied to patients was higher (P<.05). In patients followed up according to MEWS, NGA had a positive effect on preventing the development of complications and shortening the intervention time for complications, decreasing ICUadmission, decreasing MEWS and increasing the number of nursing interventions. Based on the results, it may be recommended to use MEWS+NGA in the early postoperative period as it positively affects patient outcomes.

Does intramedullary K-wire buried under the skin justify the treatment for both-bone forearm fracture in children? : A descriptive analytical study

Introduction: Surgical treatment including intramedullary K wire fixation is desirable for unstable pediatric both bone fracture to avoid angulation, rotational deformity and refracture ensuring optimal functional outcomes. However, it is debatable to leave free end of K wire exposed or to bury underneath the skin. The aim of the study is to assess the functional outcomes and complications after intramedullary K wire buried under the skin for pediatric both bone fracture. Method: This is a prospective analytical study performed from 15 August 2021 to 15 February 2023. This study included unstable closed diaphyseal forearm facture in children aged between 5 and 13 years treated with intramedullary K wires which were buried inside the skin. Study variables included demographical profiles, fracture pattern, time for surgical intervention, Modified Flynn et al criteria, time to unite the fracture and any associated complications). Results: Mean age of the patient in our study was 8.70±2.17 years. Average time required to unite the fracture was 3.15±0.62 months. Thirty-Four (97.2%) patients had excellent outcomes; one (2.8%) patient had good functional outcomes based on Modified Flynn et al criteria. Nine (25.7%) patients had bursa formation at proximal aspect of ulnar K wire while one patient (2.8%) had superficial infection at olecranon site. Conclusion: Intramedullary K wire for pediatric diaphyseal both bone fractures is excellent surgical technique. Even though controversy exist between exposed K wires and those buried underneath the skin, buried K wires have reasonable advantages and less side effects in terms of infection and overall functional outcomes. Keywords: Both bone; Bury; Forearm fracture; Functional outcomes; Intramedullary K wire

The feasibility and effectiveness of remote cognitive training on cognitive function and work performance in workers.

We aimed to determine whether remote cognitive training (CT) is feasible and has the potential to improve cognitive function and work performance in Japanese workers. From June to September 2020, this intervention time series study enrolled workers aged 18-65 years from 10 companies located in a metropolitan area of Japan. Cognitive function tests and self-administered questionnaires were completed by the participants three times: at baseline, after 12 weeks of CT, and after a further 12 weeks following cessation. We measured work performance with the question: "How would you rate your performance (compared with your optimum performance) over the past 4 weeks?" Responses were made via a visual analog scale (0-100). Cognitive function was assessed using the THINC-integrated tool, which is a brief, objective computerized cognitive assessment battery. For our computerized remote CT intervention, BrainHQ was used on the basis of our scientific rationale and the empirical literature. We recommended three 20-min sessions of BrainHQ per week and sent participants three reminders. In total, 119 participants were recruited to this study. Only 22.7% of the subjects achieved the recommended training time of 720 min over 12 weeks. The median training time was used to divide participants into long and short- training groups. The long-training group showed a greater improvement in attention and executive function than the short-training group but there was no significant improvement in work performance after CT compared to baseline. Our results suggest that although remote CT was not feasible enough, the effects on cognitive function can be expected by increasing training time and motivation.

The Effect of Healthy Boba Pearl Drink on Post-Prandial Glucose

This study was a randomized controlled trial using a repeated experimental design with a pre-test and a post-test control group. The study subjects were women of childbearing age, aged 20‒30 years, with no diagnosed chronic diseases and with baseline fasting blood glucose levels less than 125 mg/dL. Participants were randomly assigned to treatment and control groups. The treatment group received 350 mL of healthy boba drink, while the control group received 350 mL of commercial boba drink. The healthy boba drink was made by mixing 67 mL of fresh milk, 133 mL of soy milk, 1 g of stevia sweetener, 100 g of red dragon fruit, and 40 g of healthy boba pearls. It contained 215 kcal of energy, 8.82 g of protein, 8.90 g of fat, 30.78 g of carbohydrate, and 1,808 g of fiber. Each group had an initial fasting blood glucose levels measurement before the intervention, and postprandial glucose levels were measured at the end of the intervention (one time of intervention). The collected data were analyzed univariately to analyze the effect of treatment on postprandial glucose using the independent t-test. The result indicated that the subjects in the treatment group and 96.2% of the subjects in the control group had fasting glucose levels less than 126 mg/dL. Both participants in the control and treatment groups had postprandial glucose levels less than 200 mg/dL. The mean glucose level was 89.49 mg/dL in the treatment group and 92.57 mg/dL in the control group. The study results showed that the treatment group that consumed the healthy boba drink had a lower average postprandial glucose level than the control group. The statistical test results showed that there was a significant effect of healthy boba drink consumption on postprandial glucose levels in the treatment group (p&lt;0.000). It is concluded that the healthy boba drink intervention had a significant effect (p&lt;0.000) on lowering blood glucose by 5.82 mg/dL after the initial treatment. The results of this study are a major first step for future work to develop a healthier boba drink.

Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery

PurposeTiming of surgical intervention in glaucoma is crucial to preserving sight. While ocular characteristics that increase surgical risk are known, the impact of neighborhood-level social risk factors such as the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) on time to glaucoma surgery is unknown. The objective of this study was to evaluate the association between SVI or ADI scores and the timing of glaucoma surgical intervention. DesignRetrospective cohort study. MethodsAdult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry (SAP) data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time (AFT) models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record. ResultsA total of 10,553 eyes from 6,934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3±13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0±2.1 years, with time to surgery of 3.2±1.9 years. Multivariable AFT models demonstrated that higher mean intraocular pressure (time ratio (TR) 0.27 per 5 mmHg higher; 95% CI: 0.23-0.31, p<0.001), faster SAP rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, p<0.001), moderate (TR 0.69; 95% CI: 0.56-0.85, p<0.001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, p<0.001), and thinner central corneal thickness (TR 0.85 per 50µm thinner; 95% CI: 0.77-0.95, p=0.003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, p=0.006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, p=0.037) and 4 (TR 1.11; 95% CI: 1.03-1.19, p=0.006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, p=0.002). ConclusionsResidence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.

Empowering paramedics to save teeth: a comprehensive assessment of their knowledge and skills in managing dental traumas

Aims: Dental traumas are prevalent injury types worldwide, and the time of the first intervention is crucial for a favorable prognosis. Paramedics are often the first to arrive at the scene of dental trauma. The significance of paramedics’ knowledge of dental trauma cannot be overstated, yet studies on this subject are limited. This study aims to assess the level of dental trauma knowledge among paramedics. Methods: A Google Forms link measuring dental trauma knowledge level consisting of 17 questions was sent to 1576 participants via WhatsApp. The forms were fully and consistently completed by 300 participants (19.3%). The data collected through Google Forms were imported into Microsoft Excel for statistical analysis. Statistical Analysis: The Mann-Whitney U test was used to determine whether there was a difference between the categories. The Kruskal-Wallis H test was used to determine whether there was a difference between the categories of the qualitative variable and more than two categories in the quantitative variable since average distribution as sumptions were not met. The statistical significance level was taken as 0.05. Results: There are 300 paramedics, with 159 males and 141 females. 87% of the participants did not receive any training regarding dental trauma. According to 85.3% of paramedics, dental traumas are considered an emergency situation. The most important type of dental trauma is avulsion. Only 21.7% of paramedics knew reimplantation was possible, while 78.4% believed that a dentist should do it. Research shows that 38.4% of paramedics prefer using a sterile sponge when storing avulsed teeth, while 10.7% prefer milk. 82.7% of the paramedics reported lacking the knowledge to handle dental traumas, and 84% expressed interest in receiving training. Conclusion: The research revealed that paramedics have insufficient knowledge regarding dental trauma. Most participants stated their preference not to intervene in cases of dental trauma. They believed that a dentist or emergency physician should handle it.

A method for assessing the operational status of a microseismic monitoring system using energy distribution changes of observed data

Abstract The operational status of geophones plays a pivotal role in ensuring the accuracy and reliability of microseismic monitoring systems. However, conventional techniques used to evaluate the operational status of geophones require human intervention or significant time delays. To address this issue, we propose a method for online monitoring of geophone status using observed data obtained from a microseismic system. First, the energy features of the preprocessed observation data are extracted via wavelet packet decomposition. Subsequently, the distribution parameters of energy features are obtained through log-logistic distribution fitting. These parameters are then applied to a change-point detection model, enabling the online monitoring of seismic geophones. In addition, we select a long short-term memory network to classify the operational status of the geophones, which is trained using the obtained energy distribution data and the time-frequency characteristics of the observed data. The experimental results indicate that the model achieves an accuracy of 98.33%, surpassing the 89.58% accuracy of the support vector machine. The proposed method not only contributes to online monitoring and precise determination of the operating status of detectors, but also has enormous application potential in other fields that require monitoring and evaluating the operating status of instruments.

Bronchopleural fistula management in a pediatric patient requiring extracorporeal membrane oxygenation.

Bronchopleural fistula (BPF) is a connection between the bronchus and pleural cavity. It is associated with high morbidity and mortality and management of BPF has not been well described in the pediatric population. We describe a 2-year-old girl who presented with fever and increased work of breathing, found to have atypical hemolytic uremic syndrome and Streptococcus necrotizing pneumonia with development of persistent air leak due to bronchopleural fistulas requiring extracorporeal membrane oxygenation (ECMO). Three endobronchial valves were placed with successful resolution of bronchopleural fistulas. She required tracheostomy for chronic respiratory failure and endobronchial valves were eventually removed. Approximately 3.5 months after discharge to acute care rehabilitation, tracheostomy was successfully decannulated. This case highlights the successful use of endobronchial valves for resolution of BPF while on ECMO as well as the importance of further studies on optimal candidates, timing and duration of intervention in addition to sequelae of endobronchial valve placement.

Early intervention in Hirschsprung’s disease: effects on enterocolitis and surgical outcomes

BackgroundThe timing of surgical intervention for Hirschsprung’s disease (HSCR) has been a topic of continued discussion. The objective of this study was to evaluate the significance of age at surgery in the management of HSCR by conducting a comparative analysis of the correlation between surgical age and midterm outcomes.MethodsWe conducted a retrospective analysis of children with HSCR who underwent one-stage laparoscopic assisted pull-through surgery with modified Swenson technology at our hospital between 2015 and 2019. The study population was stratified into two groups based on surgical age: patients who underwent surgery within a period of less than 3 months and those who underwent surgery between 3 and 12 months. The basic conditions, complications at 3–7 years after surgery, anal function (Rintala scale) and quality of life (PedsQLTM4.0) were compared between the groups.ResultsA total of 235 children (196 males and 39 females) were included in the study. No statistically significant differences in postoperative bowel function (P = 0.968) or quality of life (P = 0.32) were found between the two groups. However, there was a significant reduction in the incidence of Hirschsprung-associated enterocolitis (HAEC) among individuals under the age of three months prior to undergoing surgical intervention (69.1%) compared to the incidence observed postsurgery (30.9%). This difference was statistically significant (P < 0.001).ConclusionIn the current study, the age at which surgery was performed did not exhibit a discernible inclination towards influencing mid-term anal function or quality of life. Early surgical intervention can effectively diminish the occurrence of HAEC, minimize the extent of bowel resection, and expedite the duration of the surgical procedure.

Exploring the effects of a graduate level trauma-informed care education program for child welfare professionals

The national child welfare agency in Ireland identified the integration of trauma-informed practices as a service need, in the current significantly challenging practice climate. A promising program that meets the need of child welfare professionals to support need has been developed and is reported on in this paper. This study aimed to evaluate the effects of a newly developed post-graduate level trauma-informed care program for professionals in the national child welfare agency in Ireland. Study participants were 41 child welfare professionals that included front-line practitioners, supervisors, and senior managers. A pretest–posttest study design was used, data was collected over three-time points to measure the effects of the program on pre-defined outcomes of Trauma-informed Knowledge, Professional Self-efficacy, Professional Quality of Life, and Intention to Leave. Statistically significant positives effects were found in trauma-informed knowledge, professional confidence, burn-out and compassion fatigue/secondary traumatic stress, with effect sizes ranging from medium-large to large (η2=.133toη2=.721) across the intervention time period. The positive impacts arising from the program were sustained for 3 months post-intervention. The results of this initial evaluation are promising in supporting child welfare professionals’ capacity to integrate trauma-informed practices and addressing the need for trauma informed practitioners. The need for further research is highlighted.

Outcome of treatment modalities for spontaneous esophageal rupture: a meta-analysis and case series.

Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity. To describe our institution's experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options. We enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. We also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before April 1, 2024, for inclusion in the meta-analysis. This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, we obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% confidence interval [CI]: 0.08-0.15). The combined re-intervention rate was 11% (95% CI: 0.05-0.19). The combined immediate mortality was 6% (95% CI: 0.04-0.09) after primary closure, 14% (95% CI: 0.02-0.32) after T-tube drain repair, 2% (95% CI: 0.00-0.15) after esophagectomy, 8% (95% CI: 0.03-0.15) after stent placement, and 22% (95% CI: 0.03-0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01-0.08), whereas that in patients initiating treatment > 24 h later was 12% (95% CI: 0.08-0.18). Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.

Early Valve Surgery for Endocarditis After Acute Embolic Stroke

BackgroundPatients with active endocarditis often suffer acute stroke, with increased risk for hemorrhagic conversion at the time of valve repair or replacement. Controversy persists about timing of operative intervention. MethodsAn institutional Society of Thoracic Surgeons database of all patients with endocarditis was reviewed for patients undergoing valve surgery (2016-2024). Electronic medical records were reviewed for detailed stroke information and longitudinal follow-up. Descriptive statistics and Kaplan-Meier survival curves evaluated outcomes and survival. ResultsOperations for acute active infective endocarditis were performed in 656 patients. Preoperative stroke occurred in 98 patients (14.9%); 86 strokes (87.8%) were embolic, and 16 patients (18.6%) had microhemorrhagic and 12 (12.2%) had hemorrhagic strokes. Median time between preoperative stroke diagnosis and surgery was 5.5 days. The overall incidence of postoperative stroke was 2.1% (14 of 656), with no statistically significant difference in postoperative stroke between patients with vs without preoperative stroke (n = 4 of 98 [4.1%] vs n = 10 of 558 [1.8%]; P = .148). However, the proportion of patients with postoperative hemorrhagic strokes was higher in the preoperative stroke group (3.1% vs 0.5%, P = .016). Finally, of patients with preoperative stroke, early surgery ≤72 hours (n= 38 [38.8%]) was not associated with increased stroke (2.6% vs 5.0%, P = .564). ConclusionsThese contemporary data highlight the feasibility of an early valve surgery strategy for acute endocarditis in the setting of acute stroke, with noninferior postoperative stroke risk.

Effectiveness of Reading Interventions on Literacy Skills for Chinese Children with and Without Dyslexia: a Meta-analysis of Randomized Controlled Trials

This meta-analysis synthesizes 49 standardized mean-change differences between control and treatment groups as effect sizes from 28 independent studies, investigating the efficacy of existing reading interventions on literacy skills for Chinese children. Six potentially important moderators were considered in this study. These moderators included intervention outcome, intervention method, intervention timing, participant type, intervention form, and intervention implementer. Overall, the existing reading intervention significantly impacted Chinese children’s literacy achievement (g = 0.68). Different intervention methods showed somehow different effects on literacy outcomes. Specifically, fluency training (g = 1.78) appeared as the most effective intervention method with a large effect. Working memory training (g = 0.80), phonological training (g = 0.69), orthographic training (g = 0.70), and morphological training (g = 0.66) had significant and medium effects on improving literacy skills of Chinese children. In addition, reading intervention improved literacy skills of older children (g = 0.90) and younger children (g = 0.63) comparably. However, children with dyslexia (g = 0.87) seemed to benefit more than typically developing children (g = 0.49) from reading interventions. Reading interventions seemed to have a better effect on word spelling (g = 0.93) than word reading (g = 0.63). Interventions delivered in group (g = 0.78) seemed to be more effective than interventions delivered individually (g = 0.45). Children gained more from interventions administered by researchers (g = 0.85) or combined implementers (g = 1.11) than by parents (g = 0.27). These findings suggest that appropriate reading interventions are effective and essential for improving the literacy outcomes of Chinese children, but the efficacy might be different depending on the intervention methods, children’s literacy status, outcome measures, and intervention settings.