Timing Of Intervention Research Articles

Ablation and laparoscopic adrenalectomy: Balancing efficacy and safety in the treatment of benign adrenal gland tumors: A systematic review and meta-analysis

BackgroundAldosterone-producing adenomas cause hypertension in 5–10 % of cases. Laparoscopic adrenalectomy is the gold standard treatment for early-stage adrenal gland tumors, but minimally invasive procedures, such as ablative techniques can also be applied. Therefore, we aimed to compare laparoscopic adrenalectomy and ablation techniques in terms of efficacy and safety in the treatment of benign adrenal gland tumors. Materials and methodsWe conducted a systematic search in five databases and included studies comparing the efficacy and safety of ablation techniques and laparoscopic adrenalectomy. We calculated odds ratios (ORs) for eligible studies with binary outcomes, and mean differences (MD) with 95 % confidence intervals (CI) for continuous outcomes. ResultsFive studies focusing on aldosterone-producing adenomas were included in our review. A total of 119 patients at 14 centers underwent ablation, and 161 patients had laparoscopic adrenalectomy. The complication rates (OR: 0.98, CI: 0.35–2.69) were similar in both groups, but among complications, hypertensive crisis (OR: 8.13; CI: 1.14–58.11) was more frequent in the ablative group, and even the success rate of interventions - the resolution of hypertension (OR: 0.30, CI: 0.16–0.56) - was lower in this group. On the other hand, the advantage of ablation was shorter intervention time (MD: 75.64 min; CI: 6.33–144.95), shorter hospital stay (MD: 1.6 days; CI: 0.88–2.31), and less perioperative blood loss (MD: 43.55 ml; CI: 12.07–75.04) compared to laparoscopy. ConclusionLaparoscopic adrenalectomy is still the best therapeutic approach, but ablation can be an appropriate alternative option for the treatment of aldosterone-producing adrenal gland tumors.

Preliminary experience of the isolate left subclavian artery in-situ fenestration during 'zone 2' thoracic endovascular aortic repair.

To evaluate the results of isolated left subclavian artery in-situ fenestration (ISF) during 'zone 2' thoracic endovascular aortic repair (TEVAR) using a new adjustable needle puncturing device system. It is a multicentre, retrospective, physician-initiated cohort study of patients treated from 28 July 2021 to 3 April 2024. Inclusion criteria were isolate left subclavian artery revascularization for elective or urgent/emergent 'zone 2' TEVAR. The primary outcome was technical success and freedom from ISF TEVAR-related reintervention or endoleak. We treated 50 patients: 28 (56.0%) atherosclerotic thoracic aneurysms, 12 (24.0%) type B aortic dissection and 10 (20.0%) penetrating aortic ulcers. Elective intervention was carried out in 46 (92.0%) cases. ISF was successful in all cases, with a procedural primary technical success in 47 (94.0%) cases. The median time of intervention was 184 min (interquartile range 135-220) with a median fenestration time of 20 min (interquartile range 13-35). Operative mortality did not occur. We observed 1 case of spinal cord ischaemia and 2 cases of bilateral posterior non-disabling stroke. Mortality at 30 days occurred in 1 (2.0%) patient (not aorta-related). The median follow-up was 4 months (interquartile range 1-12.25). Bridging stent graft patency was 100% with no ISF-related endoleak. ISF-related reintervention was never required. ISF TEVAR using the Ankura™-II device with the self-centring adjustable needle system showed high technical success, promising stability and stable aortic-related outcomes. Owing to these results, it represents a safe and effective alternative for standard 'zone 2' TEVAR.

Evolution and governance of online public opinion during COVID-19: a hybrid approach using communication visualization, SIR modeling, and simulation validation

IntroductionThis study investigates the mechanisms of public opinion dissemination and governance strategies during public health events, using a two-stage SIR model informed by the Information Cascade Theory.MethodsThe research employs Gephi visual analysis to identify principal nodes of public opinion and combines model simulations with dynamic propagation analysis to verify the model's precision and applicability.ResultsThe findings reveal that pivotal information nodes significantly accelerate the spread of public opinion, while ordinary nodes contribute to the natural attenuation of public discourse due to their strong spontaneous recovery capabilities. The simulation analysis further identifies the optimal timing for government intervention, particularly during the initial and peak phases of public opinion dissemination.DiscussionBased on the results, the study recommends strategies to strengthen the management of key opinion nodes, enhance public information literacy, optimize policy implementation, and utilize simulation tools to assist in public opinion management. These recommendations offer valuable theoretical and practical insights for managing public opinion during public health events.

Designing and piloting a sequential multiple assignment randomized trial for opioid prevention among youth in the legal system.

Youth in the legal system are vulnerable to initiation and escalation of opioid use. The transition period during which a young person is released from the institutional setting to the community is a critical window of opportunity for preventive intervention targeting the uptake and intensification of opioid and other drug use. Adaptive preventive interventions are a promising approach to systematically varying the timing and intensity of substance use preventive interventions for these youth. This pilot study of 30 youth (97% young men; 37% White; Mage = 18.34, SD = 1.84) examined the feasibility and acceptability of adaptive and nonadaptive preventive interventions that incorporate components of the Adolescent Community Reinforcement Approach with Assertive Continuing Care, Trauma Affect Regulation: Guide for Education and Treatment, and Motivational Interviewing using the Sequential Multiple Assignment Randomized Trial study design. Participants completed assessments at baseline, 1-month postrelease, and 2-months postrelease. Enrollment rate was 65%. Nearly three-quarters (73%) of enrolled youth had substance use disorder at intake. Moreover, 60% of enrolled participants completed the 2-month postrelease follow-up assessment. Participants reported high satisfaction with the interventionist interactions, and 95% indicated they would recommend the program to other youth. The pilot study revealed the need for several adaptations to study and intervention protocols. This pilot study provides evidence of the feasibility of a research-practice partnership with state juvenile rehabilitation facilities, successful recruitment of youth involved in the legal system, and feasibility and acceptability of adaptive preventive interventions spanning pre- and post-release for legal system-involved youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

ThP8.11 - Causes of delay to surgical interventions in patients with transient ischaemic attack and stroke

Abstract Aims The UK National Institute for Health and Care Excellence (NICE) guidelines and vascular society of surgery Great Britain and Ireland (VSGBI) emphasize the importance of scheduling carotid endarterectomy (CEA) within 2 weeks of symptom onset to reduce the risk of recurrent stroke. However the National vascular Surgery report for 2023 showed that this target was met in only 52% of patients. This study aimed to examine the possible causes of these delays. Methods This study analysed patient or hospital-derived factors impacting the timing of surgical intervention for patients with symptomatic carotid disease. A retrospective database was established to gather data on CEAs performed during an 8-month interval (January to August 2023) at a major teaching hospital. Results 36 patients underwent CEA; 13 (36.1%) received the procedure within 2 weeks of symptom onset, while 23 (63.9%) experienced delays. The main reasons for not meeting the two-week timeframe were associated with surgical scheduling, patient presentation, and referral processes. Specifically, among the 23 patients facing delays, 10 (43.5%) were due to surgical scheduling, 6 (26.1%) encountered delays in presenting to medical services, 5 (21.7%) were affected by delayed patient referral or review, and 2 (8.7%) were from lack of patient fitness. None however ended up with recurrent stroke while awaiting surgery on best medical management. Conclusions Prompt surgical intervention can reduce the risk of recurrent strokes. 63.9% of CEAs encountered delays, primarily associated with surgical scheduling. Prioritised pooled lists may be the answer.

The Role of Global Longitudinal Strain in the Follow-Up of Asymptomatic Patients with Chronic Primary Mitral Regurgitation.

Background/Objectives: In patients with chronic primary mitral regurgitation (MR), postoperative persistent left ventricular (LV) dysfunction underlines the lack of a sensitive parameter that can identify subclinical LV dysfunction and optimize the timing of intervention. Left ventricular global longitudinal strain (LV-GLS) is a measure of the longitudinal left ventricular systolic function, with prognostic significance. Its role in the follow-up of asymptomatic patients with MR is, however, poorly defined. The aim of this study was to assess the relative changes in LV-GLS in a cohort of MR patients and to correlate these changes with the need for intervention during a follow-up period. Methods: We conducted a prospective study on a cohort of 218 patients, divided into three subgroups according to MR severity (mild, moderate, severe). LV-GLS was measured at baseline and every six months during a median follow-up period of 30 months. The composite endpoint was the occurrence of heart failure symptoms, hospitalization for heart failure, LVEF < 60%, LVEDD > 45 mm, new onset atrial fibrillation, or cardiovascular death. Results: Patients with moderate and severe MR had a significantly lower GLS at baseline than those with mild MR (19.5% and 19.1% versus 22.3%, p < 0.01) despite a normal LVEF in all subgroups. The relative decrease in LV-GLS occurred earlier (at 12 months vs. 24 months) and was more evident in patients with moderate and severe MR (13.6% and 14.5%, respectively) versus patients with mild MR (6.72%). The baseline LV-GLS being under 18% and a relative decrease of over 10% in GLS were independent predictors of a composite outcome (HR = 1.59, CI 95% 1.17-2.86; HR = 1.74, CI 95% 1.2-2.91, p < 0.01). Conclusions: LV-GLS is a valuable monitoring tool for asymptomatic MR patients, a relative decrease > 10% in GLS may be predictive for the need for valve intervention.

Is Chronic Pelvic Inflammatory Disease an Exclusively Medical Gynecological Disease, or It May Be a Surgical Challenge?

Pelvic inflammatory disease is an infectious condition affecting women’s upper genital tract, including the uterus, fallopian tubes, and ovaries. It primarily arises from an infection that spreads upward from the lower genital area. The relationship between chronic pelvic pain and coexisting conditions is a key focus in its diagnosis and treatment. This type of pain is also considered a form of reflex dystrophy, involving both neurological and psychological components, the first line treatment consists in antibiotherapy. For patients with complex or severe pelvic abscesses, surgical intervention may be considered in selected cases. The primary surgical techniques employed are open and laparoscopic surgery, both aimed for abscess removal. MRI or Doppler ultrasonography may be employed when there is a suspicion of adnexal torsion, adenomyosis or deep pelvic endometriosis, especially if the ultrasound results are unclear or inconclusive Laparoscopic surgery has increasingly become favored by both healthcare professionals and patients. Moreover, laparoscopy has emerged as the most valuable tool for diagnosing chronic pelvic pain. The approach to treating pelvic abscesses in women of reproductive age depends greatly on clinical assessments, individual patient factors, and the desire to preserve fertility. However, laparoscopy may present technical difficulties in patients with severe pelvic abscesses, particularly those with extensive adhesions or a closed-off pelvic area, requiring advanced surgical expertise. Women with associated conditions such as endometriosis often experience a more severe form of pelvic inflammatory disease, which is less responsive to antibiotics and more frequently requires surgical resolution. The surgical treatment should be performed individualized to the clinical condition of the patient and the time of intervention must be carefully chosen.

Long-term evaluation of psychosocial impact and stuttering severity after intensive stuttering therapy.

The purpose of this study was to assess the long-term stability of objective and subjective psychosocial improvements and fluency more than 10 years after participation in an intensive stuttering therapy camp. Ten former participants in intensive stuttering therapy (IST; mean age at time of intervention 14; 2 years) participated in this study. Outcomes of the IST at that time were assessed with the Stuttering Severity Instrument (SSI-3; Riley, 1994) and a questionnaire to measure the psychosocial impact of stuttering. A semi-structured video call and a general questionnaire for the long-term evaluation were used to gauge the participants' perceptions of the IST. These follow-up data were compared to the therapy outcomes reported by Cook (2011, 2013). Therapy effects on the severity of stuttering and psychosocial impact were stable over the follow-up period of more than 10 years. Moreover, scores for psychosocial impact and severity of stuttering further decreased from the end of the IST to the long-term evaluation. The intensive time and the periodically offered follow-up treatments were described as particularly positive by the participants. Intensive stuttering therapy in childhood or adolescence can have a long-term positive effect on both internal and external stuttering symptoms.

Timing of Intervention in Symptomatic Carotid Artery Stenosis

Symptomatic carotid artery stenosis is defined as an acute neurologic deficit (transient ischemic attack or stroke) occurring in the last six months that is ipsilateral to an extracranial carotid artery with at least 50% stenosis. Previous studies have identified the benefit of surgical intervention on symptomatic carotid stenosis, but the ideal timing is less clear. The timing of intervention must balance the risk of perioperative stroke and death (higher during the hyperacute period within 48 hours) and the risk of recurrent stroke while waiting to intervene, particularly if delayed beyond 14 days. Several factors such as acuity of neurological deficit, degree of stenosis or contralateral occlusion, and other comorbidities, may contribute to the risk of perioperative stroke or death when intervening within the acute period. The Society for Vascular Surgery recommends carotid endarterectomy as the intervention for symptomatic carotid artery stenosis, but recent studies have shown that transcarotid revascularization may also have similar outcomes.

Awareness of Current Surgical Practice for Congenital Scoliosis and Optimal Timing of Treatment Among Physicians and Patients' Families in Saudi Arabia.

Congenital scoliosis (CS) is a developmental spinal deformity characterized by an abnormal curvature of the spine, affecting one in 1,000 births. The mainstay of treatment involves either observation or surgery in significant curve progression. The optimal timing of surgical intervention is debated, with early intervention preferred. Therefore, understanding physicians' and patients' families' perspectives is crucial for optimizing surgical outcomes in CS. To assess the awareness and knowledge of physicians and patients' families regarding current, as well as new surgical practices and the optimal timing of treatment for CS. A cross-sectional study was conducted in Saudi Arabia using an online self-administered questionnaire distributed through social media platforms and neurosurgery clinics. Levels of awareness were assessed by a knowledge-scoring system. The study involved 403 participants, primarily patients' families (85.1%, N = 343) and physicians (14.9%, N = 60). The results show that physicians had a significantly higher correct response than patients' families regarding the ideal age for surgical correction of CS, the timing of surgical intervention whether before or after maturity, and the role of conservative management, as evident from statistically significant p-values of <0.001, 0.031, and <0.001, respectively. On the contrary, patients' families excelled in understanding interventions irrespective of symptomatic status if Cobb's angle is 40 degrees or above, with a statistically significant p-value of 0.031. Both groups exhibited a good level of overall knowledge, as evidenced by mean awareness scores of 12.18 and 11.64, respectively. Additionally, physicians had a statistically significanthigher level of awareness compared to patients' families, with a p-value of (0.014). However, both groups demonstrated poor knowledge of the latest techniques, including distraction-based magnetically controlled growing rods (MCGRs), growth-guided modern Luque trolleys, and posterior dynamic deformity correction (ApiFix). The mean awareness score of both physicians and patients' families indicates a good level of knowledge. However, both groups exhibited poor knowledge in relation to the optimal timing of treatment and new surgical techniques.

Has robot-assisted pyeloplasty reached outcome parity with laparoscopic pyeloplasty in children

Ureteropelvic Junction Obstruction (UPJO), is a major cause of pathological hydronephrosis in children. Minimally invasive surgery (MIS), including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), has gained popularity due to its known advantages. LP faces technical difficulties and a steep learning curve. RALP has overcome these limitations, making it safer and more effective for children. The study aims to assess the safety and effectiveness of LP and RALP in infants weighing ≤15kg. This is a retrospective analysis (2010-2022). The study included pediatric patients who had a confirmed diagnosis of UPJO and weighed ≤15kg. The patients were divided into two groups: LP and RALP. The study evaluated preoperative, intraoperative, perioperative, and follow-up data, including complications. Success was defined as no worsening of hydronephrosis on postoperative ultrasound in the first year of follow-up. The total patients were 94: 42 in the LP group, and 52 in the RALP group. The median age at the intervention was 17.5 months (LAP group) versus 29 months (RALP group) (p=0.01). The median weight at the time of intervention was 9.5Kg (LP group), and 11.6Kg (RALP group) (p=0.44). The median operative time was significantly longer in the LP group: 245min versus 125.5min in the RALP group (p=0.001). The median length of hospitalization was comparable: 4.3 days (LP group) and 3.5 days (RALP group) (p=0.42). No intraoperative complications were reported in either group. There were no statistically significant differences regarding postoperative complications. During follow-up, all patients remained asymptomatic, with no episodes of urinary tract infection or abdominal pain, and none of them had a recurrence of UPJ obstruction. Consequently, the two techniques are equally effective and safe in the short term. Both procedures offer excellent outcomes with comparable postoperative complications. LOS was similar for both groups, with no intraoperative complications or conversions, and a non-significant increase in postoperative complications. A notable finding was the significant difference in operation times between the procedures, emphasizing the importance of reduced surgical time in pediatric patients for minimizing anesthetic and intubation durations. For the absence of intra- and postoperative complications and recurrences, RALP is as effective as LP in pyeloplasty in children weighing 15kg or less. This finding reinforces the idea that RALP can be safely executed, benefiting from its advanced technology and the learning curve, for patients of any age regarding pyeloplasty for UPJO.

The effect of acupuncture on gastrointestinal recovery after abdominal surgery: a narrative review from clinical trials.

Abdominal surgery is a critical surgery, with more and more attention being paid to postoperative life quality and associated complications in recent years. Among these complications, postoperative gastrointestinal dysfunction is the most common complication of abdominal surgery. Acupuncture therapy is a treatment approach based on the Traditional Chinese Medicine theory, and its feasibility in aiding gastrointestinal recovery after abdominal surgery is supported by both Traditional Chinese Medicine theory and animal experiments. A lot of clinical research has been conducted to evaluate its efficacy, albeit with limitations, and at preliminary stages. Moreover, intervention timing, acupoint selection, and patient benefits should also be considered in clinical practices. This article summarizes the progress of clinical research on acupuncture therapy in gastrointestinal recovery after abdominal surgery and discusses related issues and operations, with the aim to provide new insights and prospects for the incorporation of acupuncture into the Enhanced Recovery After Surgery protocol.

Comparative analysis of early versus late surgical intervention for lumbosacral hemivertebra: a minimum 2-year follow-up retrospective study

BACKGROUND CONTEXTLumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups. PURPOSETo evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results. STUDY DESIGNRetrospective analysis. PATIENT SAMPLEWe retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years. OUTCOME MEASUREThe following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters. METHODSFrom 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (>6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected. RESULTSCompared to Group L, Group E exhibited a lower intraoperative blood loss (p<.001), higher final main curve correction rate (p=.037), smaller post-op compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate post-op (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006). CONCLUSIONThis study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.

Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study.

The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis. A retrospective consecutive case-series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle-hindfoot score and VAS pain score between preoperative measures and those at the final follow-up were conducted using paired t-tests or paired Wilcoxon rank-sum tests. The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%. One-stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.

Timing of percutaneous coronary intervention and risk of new-onset acute ischemic stroke in non-ST elevation myocardial infarction: A retrospective cohort study insight into the National Inpatient Sample Database (2016-2019).

For patients with high-risk non-ST elevation myocardial infarction (NSTEMI), current guidelines recommend an early invasive strategy within 24 h. New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of PCI and the risk of NAIS in NSTEMI is poorly defined. Patients with NSTEMI who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (<24 h), medium (24-72 h), and late (>72 h) PCI. Multivariate logistic regression models were used to determine the association between timing of PCI and NAIS. Among 633,115 weighted hospitalizations, patients in the late PCI group had a higher incidence of NAIS (1.3%) than those in the early (0.67%) and medium (0.71%) PCI groups. Patients undergoing late PCI were older, more likely to be female, and had a greater incidence of comorbidities (e.g., diabetes mellitus, chronic pulmonary and renal illness, and atrial fibrillation) than those undergoing early or medium PCI. After adjustment, only late PCI was significantly associated with a 54% increased NAIS risk (adjusted odds ratio: 1.54 [95% confidence interval: 1.29-1.84]). Additionally, there was heterogeneity in the magnitude of risk by age and sex. Younger people (<65 years) (p for interaction <0.001) and men (interaction-value p = 0.040) were more likely to encounter NAIS. Late PCI was associated with a higher risk of NAIS than early PCI, particularly among men and those aged <65 years.

DSD-related attitudes and beliefs held by pediatric endocrinologists and urologists: Insights from the North American disorders/differences of sex development (DSD) clinician survey

Disorders/Differences of Sex Development (DSD) encompass congenital conditions with atypical development of chromosomal, gonadal, or anatomical sex. Due to the rarity and complexity of these conditions, strong evidence for clinical practices is scarce, leading to controversies in management. This study, part of a broader project, examines changes over time in the attitudes and beliefs of DSD healthcare providers, focusing on factors contributing to patients' life satisfaction and the influence of medical specialty, gender, and age. Participants included active members of the Pediatric Endocrine Society (PES) and the Societies for Pediatric Urology (SPU) at three time points: 2003-2004 (T1), 2010-2011 (T2), and 2020 (T3). A survey covering predictors of patient life satisfaction, attitudes and beliefs regarding DSD care and outcomes, and participant characteristics was administered. Data were analyzed using descriptive statistics and Generalized Estimating Equations (GEE). Demographics: Participation rates were 56% (PES) and 64.7% (SPU) at T1, 41.1% (PES) and 52.3% (SPU) at T2, and 25.6% (PES) and 51.2% (SPU) at T3. Most participants were male (T1: 70.6%, T2: 61.7%, T3: 70.6%). Factors Affecting Life Satisfaction: Both endocrinologists and urologists ranked "gender identity consistent with assigned sex" as most important. Over time, the endorsement of some factors, such as performing genital surgery at Centers of Excellence, increased, while others, like the influence of prenatal androgen exposure determining gender identity, varied by specialty and gender. Attitudes and Beliefs: Across 18 statements, responses indicated three clusters with strong agreement, moderate agreement, and strong disagreement. Statements on the importance of family background and avoiding gender discordance were consistently endorsed, while those on delaying hypospadias repair until consent were least endorsed. The study highlights variability in beliefs about DSD management over time, influenced by specialty, gender, and age. Despite consensus on some care principles, discrepancies remain, particularly regarding the impact of prenatal androgens and the timing of surgical interventions. These findings underscore the need for regular interdisciplinary communication to align clinical practices with evidence-based guidelines and address subjective beliefs. The survey illustrates evolving perspectives among DSD healthcare providers, emphasizing the need for continued dialogue and education to bridge gaps between clinical evidence and practice. Collaborative efforts, such as the international I-DSD and the U.S. DSD Translational Research Network, are crucial for advancing patient-centered care in this field.

Evaluation of the Suture Pull-Out Technique in Anterior Cruciate Ligament Avulsion Fractures at Different Weeks Post-fracture.

Background Anterior cruciate ligament (ACL) avulsion fractures often necessitate surgical intervention, with various fixation techniques available. Among these, the arthroscopic suture pull-out technique has gained attention as a promising approach. However, the influence of surgical timing on patient outcomes remains insufficiently studied. This study aims to evaluate the efficacy of the arthroscopic suture pull-out technique for ACL tibial avulsion fractures and assess how the timing of surgical intervention affects functional outcomes. Methodology This study was conducted at our hospital from November 2020 to October 2022. A total of 17 patients aged 21 to 41 years with isolated ACL avulsion fractures and no additional injuries or osteoarthritis were included. Participants were divided into three groups based on the interval from injury to surgery (one, two, or three weeks). The surgical procedure involved the suture pull-out technique. Postoperative management included immobilization, isometric exercises, and gradual weight-bearing. Functional outcomes were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lachman test at 6, 10, and 14 months, along with radiological evaluations. Results Significant functional improvements were observed in all groups, with postoperative Lysholm, IKDC, and Tegner scores showing notable enhancements compared to preoperative values. No significant differences were found among the groups regarding the timing of surgery, indicating that delays within the first three weeks did not adversely impact outcomes. Most patients achieved a full range of motion. Two minor postoperative complications were reported, namely, one case of arthrofibrosis and one case of persistent laxity. Conclusions The arthroscopic suture pull-out technique is effective and reliable for ACL tibial avulsion fixation. The timing of surgery within the first three weeks does not significantly affect functional outcomes. Future research with larger sample sizes and longer follow-ups is recommended to further validate these findings and optimize surgical strategies.

Research priorities for progressive pulmonary fibrosis in the UK

IntroductionHealth research bodies recommend patient involvement and engagement in research and healthcare planning, although their implementation is not yet widespread. This deficiency extends to progressive pulmonary fibrosis (PPF), where crucial...

Online Adaptive Proton Therapy Facilitated by Artificial Intelligence–Based Autosegmentation in Pencil Beam Scanning Proton Therapy

PurposeOnline adaptive proton therapy (oAPT) is essential to address interfractional anatomical changes in patients receiving pencil beam scanning proton therapy (PBSPT). Artificial intelligence (AI)-based auto-segmentation can increase the efficiency and accuracy. Linear energy transfer (LET)-based biological effect evaluation can potentially mitigate possible adverse events caused by high LET. New spot arrangement based on the verification CT (vCT) can further improve the re-plan quality. We propose an oAPT workflow that incorporates all these functionalities and validate its clinical implementation feasibility with prostate patients. Methods and MaterialsAI-based auto-segmentation tool AccuContourTM (Manteia, Xiamen, China) was seamlessly integrated into oAPT. Initial spot arrangement tool on the vCT for re-optimization was implemented using raytracing. An LET-based biological effect evaluation tool was developed to assess the overlap region of high dose and high LET in selected OARs. Eleven prostate cancer patients were retrospectively selected to verify the efficacy and efficiency of the proposed oAPT workflow. The time cost of each component in the workflow was recorded for analysis. ResultsThe verification plan showed significant degradation of the CTV coverage and rectum and bladder sparing due to the interfractional anatomical changes. Re-optimization on the vCT resulted in great improvement of the plan quality. No overlap regions of high dose and high LET distributions were observed in bladder or rectum in re-plans. 3D Gamma analyses in PSQA confirmed the accuracy of the re-plan doses before delivery (Gamma passing rate = 99.57 ± 0.46%), and after delivery (98.59 ± 1.29%). The robustness of the re-plans passed all clinical requirements. The average time for the complete execution of the workflow was 9.12 ± 0.85 minutes, excluding manual intervention time. ConclusionThe AI-facilitated oAPT workflow was demonstrated to be both efficient and effective by generating a re-plan that significantly improved the plan quality in prostate cancer treated with PBSPT.

Effect of physical exercise on postoperative shoulder mobility and upper limb function in patients with breast cancer: a systematic review and meta-analysis.

The shoulder pain and reduced range of motion caused by breast cancer seriously affect the quality of life of women. Such persistent impairments can escalate into chronic pain, diminished muscle strength, lymphedema, and compromised cardiorespiratory health potentially culminating in permanent disability. This systematic review aims to evaluate how physical exercise impacts shoulder mobility and upper limb function in breast cancer patients post-surgery, examining various aspects of exercise such as type, intensity, duration, frequency, and intervention timing to determine the influence on outcomes. A comprehensive search was conducted across seven databases up to April 16, 2024. Two reviewers independently assessed randomized controlled trials (RCTs) focusing on the effects of physical exercise on postoperative outcomes in breast cancer patients. Quality was assessed using the Cochrane risk of bias tool, with meta-analyses and publication bias tests performed via RevMan5.4, and evidence quality evaluated using GRADEPro. Effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twenty studies (25 RCTs involving 2,171 patients) were included for both the systematic review and the meta-analysis. Meta-analysis confirmed that physical exercise significantly enhanced shoulder flexion (SMD =0.59; 95% CI: 0.32, 0.86; P<0.001) and abduction (SMD =1.01; 95% CI: 0.43, 1.60; P<0.001) in postoperative patients, and improved upper limb function (SMD =0.87; 95% CI: 0.48, 1.26; P<0.001). Subgroup analyses indicated that comprehensive exercise, particularly when performed ≤3 times a week or over 8-12 weeks, was most effective for improving shoulder flexion, while shorter durations (<8 weeks) and similar frequencies were optimal for abduction. Resistance exercises, especially when started early (<2 weeks post-surgery), showed significant benefits for upper limb function. The included studies were of moderate to high quality, though some lacked detailed reporting on blinding or allocation concealment. Analysis suggests that the timing of intervention initiation, along with exercise type and frequency, may contribute to observed variations in outcomes. Evidence quality assessments did not reveal significant issues with indirectness or imprecision, and no significant publication bias was detected. Given the low heterogeneity and absence of significant downgrade factors, intermediate evidence quality was assigned for upper limb function and shoulder abduction, with high quality for shoulder flexion. Physical exercise is notably effective in enhancing both upper limb function and shoulder mobility in breast cancer patients, with the timing and frequency of exercise interventions influencing these improvements. This provides valuable evidence for clinical rehabilitation strategies.