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Objective This study investigated the factors associated with early implant failure. Material and methods This retrospective study was conducted on 3,247 implants in 2,061 patients. Patient-related and surgery-related factors, including smoking, sex, diabetes, bone grafting, implant length, implant width, implant design, adjacent teeth, and insertion torque, were manually retrieved and analyzed. Using univariate and multivariate analyses, a generalized estimating equation (GEE) model was employed to evaluate factors related to early implant failure. Results The mean age of the patients was 49.2 ± 15.0 (18–91) years. Ninety-nine implants failed during the healing period. Three factors were statistically significant regarding early implant failure: smoking (odds ratio [OR] = 7.060, P = 0.008), implant design (OR = 6.983, P = 0.008), and implant length (OR = 7.500, P = 0.006). Factors including diabetes, bone grafting, location, adjacent teeth (root canal therapy in the adjacent teeth and the distance between the implant and adjacent teeth), healing method, and insertion torque did not exhibit a significantly higher early implant failure rate. Ninety-three sites with failed implants received replantation, and six implants failed during the healing period. Conclusions This retrospective study identified three factors associated with early implant failure: smoking, implant design, and implant length. A prospective study with larger sample size is needed in the future. Clinical relevance: There is fierce debate on the factors influencing early implant failure (failure during the healing period) in the rehabilitation and restoration of oral function in partially edentulous patients.

Purpose Patients with end stage renal disease (ESRD) lose the capacity of renal potassium excretion and often suffer from persistent hyperkalemia, especially for those requiring maintenance hemodialysis (HD). Sodium zirconium cyclosilicate (SZC) is the most recently approved K + binding agent in China. It is reported SZC is an effective and well-tolerated treatment for pre-dialysis hyperkalemia in patients with ESRD undergoing adequate hemodialysis. We thus conducted a retrospective study to compare the therapeutic efficiency of SZC and sodium polystyrene sulfonate (SPS, another classic K + binding agent) on hyperkalemia in HD patients. Methods: 38 patients with persistent pre-dialysis hyperkalemia were included, and 18 patients were treated by SZC while 20 patients were treated by SPS. The changes of serum potassium level were followed up for 7 months. Results: We observed that the potassium reducing capacity of SZC and SPS were comparable at the first 3 months, but SZC displayed better long-term therapeutic effect. Conclusion: Our results supported that SZC is a good option for treatment of hard-controlled pre-dialysis hyperkalemia.

Background: For the treatment of long bone defects of the extremities caused by trauma, infection, tumors, and nonunion, it has been a challenge for clinical orthopedic surgeons. Bone transport technique have become the only way to treat bone defects. However, inevitable docking site complications related to bone transport technique have been reported by many studies. The purpose of this study was to evaluate risk factor of docking site complications of bone transport technique using Ilizarov method in the treatment of bone defect of lower extremity. Aim: The purpose of this study was to investigate the risk factors associated with docking site complication treated with Ilizarov bone transport technique in the treatment of tibial bone defect. Methods: The retrospective study including 103 patients who underwent bone transport for the treatment of large bone defect in tibia from October 2012 to October 2019. There were 90 male and 13 females with a mean age of 37 years (range 17-66years). The etiology of bone defect includes high-energy trauma in 25 cases, osteomyelitis in 61 and nonunion in 17. There were 19 cases in the proximal 1/3 of the diaphysis, middle 1/3 in 39 and distal 1/3 in 45 cases. There were 12 limbs in active infected state with sinus and drainage.17 patients suffered soft tissue defect after debridement. The mean bone defect was 6.6cm (range 3-13cm). Single bone transport in 80 cases, and double in 23 cases. The docking time, external fixation time, external fixation index, and docking site complications were documented and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the docking site complication of tibial bone defect treated with Ilizarov bone transport technique. The clinical outcomes were evaluated using Association for the Study and Application of the method of Ilizarov criteria (ASAMI) at last clinical visit. Results: 103 patients were followed up for (24-48) months, with an average of 27.5 months, The soft tissue were successfully managed by musculocutaneous flap transfer in 17 cases. However, multiple complications occurred in docking site, with an average of 0.53 complications per patient, an average of 0.16 minor complications and 0.38 major complications per patient. Delayed union in 22 cases (21.4%), axial deviation in 19 cases (18.4%) and soft tissue incarceration in 10 cases (9.7%). According to the results of logistic regression analysis, the distance of bone defect (P=0.001,OR=1.976), and distal 1/3 (P=0.01,OR =1.976) were are risk factors for delayed union. Bone defect distance (P< 0.001, OR = 1.981), external fixation time (P = 0.012, OR= 1.017) were risk factors for axial deviation. Soft tissue defect (P=0.047,OR =6.766) and the number previous operation (P=0.001, OR =2.920) were risk factors for soft tissue incarceration. Base on ASAMI bone score, bony result was excellent in 91 patients, good in 7, fair in 3 and poor in 2. The ASAMI functional result was excellent in 67 patients, good in 26, fair in 8, poor in 2. Conclusion: Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect distance, external fixation time, the number of previous operations, soft tissue defects and the distal 1/3 are risk factors for complications at the docking site, and clinicians should pay attention to them.

Background: Fixed functional appliances are used for correcting Skeletal Class II due to retrognathic mandible. Objectives: The current study's goal was to assess and contrast the skeletal, dental, and soft tissue changes produced by PowerScope and AdvanSync2. The null hypothesis was that there were no significant differences in the treatment effects of both the appliances. Material and methods: A retrospective study was conducted on growing 75 female subjects with skeletal class II malocclusion, divided into 3 groups: Group 1: 25 Subjects of AdvanSync2 (Mean age- 12.61±1.52years); Group 2: 25 subjects of PowerScope (Mean age- 12.23±1.32years) and Group 3: untreated class II control sample of 25 subjects (Mean age- 12.91±0.92years). Lateral cephalograms were traced at T0 (pretreatment) and T1 (post functional) for measuring various skeletal, dental, and soft tissue parameters. ANOVA and Post Hoc Tukey test was used for comparison between the groups. Results: Statistically significant changes were seen in skeletal, dental, and soft tissue parameters with both appliances compared with the control group. AdvanSync2 had statistically significant restrictive effects on the maxilla (p

Purpose This retrospective study aimed to explore the efficiency and untoward reaction of liposomal paclitaxel versus docetaxel for locally advanced nasopharyngeal carcinoma (NPC). Methods This study retrospectively enrolled 115 patients with NPC from our hospital from January 2018 to December 2021. Patients were divided into the liposomal paclitaxel (n = 71) and docetaxel groups (n = 44) following the neoadjuvant chemotherapy protocol. Objective response rate (ORR), progression-free survival (PFS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were compared between the two groups. Results ORR was significantly improved in the liposomal paclitaxel group than in the docetaxel group (62.0% versus 40.9%, P = 0.028). The 3-year PFS (PFS: 84.4% versus 77.5%, P = 0.303), LRFS (95.8% versus 94.4%, P = 0.810), DMFS (87.2% versus 84.9%, P = 0.648), and OS (90.7% versus 88.8%, P = 0.306) revealed no significance. The neutrophil-to-lymphocyte ratio (hazard ratio [HR]: 3.510; P = 0.039) and distant metastasis (HR: 4.384; P = 0.035) were regarded as the risk factors using multivariate regression analysis. Moreover, the incidence of leukopenia at levels 1–2 in the liposomal paclitaxel group was significantly lower than in the docetaxel group (28.1% versus 79.5%, P

Background Anemia has been a pervasive and constant public health crisis in India. Anemia’s prevalence in rural areas is 79% in children and 49.5% in women. A large survey of adolescent girls reported an anemia prevalence of 89%, of which 56% have iron deficiency anemia. The objectives of this study are to understand the prevalence of iron deficiency anemia in children and women from rural villages in India and the impact of a medication and health education intervention on hemoglobin levels, utilizing an existing local community structure of a boarding school. Methods Retrospective study of de-identified hemoglobin data originally collected during a public health clinical care investigation was performed to understand the prevalence of anemia in women and children in rural villages. Participants gave blood samples to measure hemoglobin levels. Analysis of health education and medication intervention consisting Albendazole 200 mg and Autrin Capsule tablets containing cyanocobalamin vitamin B12 (0.1% in gelatin), ferrous fumarate (98.6 mg of elemental iron), and folic acid with lemon water given to 275 female students at Kaneria Boarding School was performed to understand the impact of intervention on hemoglobin levels. Key Results Utilizing the World Health Organization (WHO) anemia classification, prevalence of moderate and severe anemia ranged 20-60% amongst women and children. Results from an interventional study showed a statistically and clinically significant increase in hemoglobin levels of 2.848 (pth grade and 2.423 (pth grade students. Conclusions Understanding the prevalence of anemia in rural regions in India is imperative to focusing therapies targeting iron deficiency anemia. Results of an interventional study utilizing existing community structures such as a school holds promise for future wide-scale iron deficiency anemia interventions.

Background There is no gold standard for the diagnosis of coagulation dysfunction in sepsis, and the use of the current scoring systems is still controversial. The purpose of this study was to externally validate and assess the discriminatory capacities of SIC, JAAM DIC, and ISTH overt DIC for outcomes among patients with sepsis and coagulation abnormalities. Methods This retrospective study included patients with sepsis and coagulation abnormalities admitted to the general wards and ICU in Ruijin Hospital, Shanghai Jiaotong University School of Medicine from 2017 through 2019. The SIC, JAAM DIC, and ISTH overt-DIC criteria were applied to data collection during admission. The relationship between each scoring system and 28-day all-cause mortality was observed. Results Among 452 patients (mean age, 65 [48,76] years), 306 [66.7%] were men, the median SOFA score was 6 [4, 9], and the median APACHE II score was 15 [11, 22]. A total of 132 patients (29.2%) died within 28 days. SIC was positive in 25.4% of the patients, 44.7% of the patients manifested with JAAM DIC, and 12.2% had ISTH overt-DIC. Both the diagnosis of SIC (AUROC, 0.779 [95% CI, 0.728–0.830], P P vs. ISTH overt-DIC, -0.003 [95% CI, -0.025-0.018], P = 0.766). It is remarkably, however, the SIC demonstrated greater calibration for 28-day all-cause mortality than ISTH overt-DIC (the coincidence of the calibration curve of the former is higher than that of the latter). The diagnosis of JAAM DIC was not independently associated with 28-day all-cause mortality in sepsis (RR, 1.115, [95% CI 0.660–1.182], P = 0.684). Conclusions Combined with the results of distinction and calibration, the SIC scoring system demonstrated superior prognostic prediction ability for 28-day all-cause mortality among patients with sepsis and coagulation abnormalities than either JAAM DIC or ISTH overt-DIC. (309 words)

Purpose: To compare the efficacy and safety of micropercutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS) in the treatment of single upper ureteral calculi larger than 10 mm. Methods: This is a retrospective study that incorporates medical record review with an outcomes management database.163 patients who underwent MPCNL and 137 patients who underwent FURS were identified from January 2017 to December 2021. Demographic data,operation time,hospitalization time,stone free rate and complication rate were collected and analyzed. Results: Preoperative general data of sex, age, BMI,serum creatinine, time of stone existence,stone hardness,stone diameter preoperative hydronephrosis and preoperative infection of the MPCNL group have no statistically significant difference with that of the FURS group.All of the MPCNL or FURS surgeries in two groups were successfully completed, with no one returned to opening or other surgery.Patients treated by MPCNL had significantly shorter operation time (49.6 vs 72.4 minutes;P＜0.001) but longer hospitalization time (9.1 vs 3.9days;P＜0.001) than those treated by FURS.Stone free rate in the MPCNL group was better than that of the FURS group(90.8% vs 71.5%;P＜0.001). There was no statistically significant difference in complication rate between two groups(13.5% vs 15.3%;P＝0.741). Conclusion: Both MPCNL and FURS are effective and safe surgical options for patients with single upper ureteral calculi larger than 10 mm. FURS had shorter hospitalization time than MPCNL,but with a relatively lower stone free rate and longer operation time.There was no significant differences between two groups in complication rate. Trial registration: No.

Objectives The aim of this study was to describe facial symmetry based on aesthetic units in normal Chinese young adults. Correlations between symmetries of soft tissue units and underlying bone was also investigated. Materials and methods A retrospective study was conducted on 96 data sets which included spiral CT and facial stereophotogrammetry. A landmark independent symmetry measurement based on original-mirror alignment was performed. The full face was divided into 14 facial aesthetic units. The root mean square (RMS) of each soft and bony unit was compared by the Wilcoxon test. The correlation between RMS of soft tissue and its underlying bone was investigated by spearman correlation analysis. Results The RMS of the soft tissue units and bony units varied from 0.64 ± 0.37 mm to 1.25 ± 0.76 mm and from 0.76 ± 0.37 mm to 1.75 ± 1.04 mm, respectively. The symmetry correlation coefficient of soft and underlying bony structure varied from 0.216 to 0.684. The highest correlation was in the zygomatic region (0.684), while the lowest in the periocular region (from 0.216 to 0.331). Conclusions It was suggested that the normal face is slightly asymmetric, and the symmetry of soft tissue is in correlation with underlying bony structure. Clinical Relevance The traditional principle of aesthetics units was applied in this study which make evaluating the facial symmetry more accurately. Meanwhile, the correlation analysis of the symmetry of facial soft and hard tissue provides a reference data for maxillofacial plastic surgery.

Background The objective of this retrospective study was to investigate the prognostic factors, patients' characteristics, and outcomes of adult patients with glioblastoma and to evaluate the impact of the disease on the mental health and emotional well-being of patients and their relatives. Materials and Methods The study included 98 adult patients with glioblastoma who underwent pre- and post-operative cognitive assessments using the Mini-Mental State Examination (MMSE). The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate and compare psychological symptoms of patients and their relatives over time. Seizures were seen in 45,9% of patients, and the mean age of the patients was 60,1 ± 13,8 years. The patients were evaluated at various time intervals before and after surgery, and the data were analyzed retrospectively. Results The study found that before surgery, the anxiety levels of caregivers were significantly higher than those of patients during all evaluation periods. Additionally, the depression scores of caregivers were significantly higher than those of patients only in the first month following the operation. There were no significant differences in depression scores between patients and caregivers in the other assessment intervals. The average cognitive level of patients, as assessed by the MMSE scale, was 22,4 before the operation and 20,91 after the operation. Conclusion Glioblastoma has a significant impact on the mental health and emotional well-being of both patients and their relatives. The study highlights the importance of providing early support to both patients and their relatives before surgery. The study's strength is that it focuses on an early time point, prior to surgery, where both patients and their relatives are already affected and may require additional support. The results of this study can help healthcare professionals to better understand the psychological impact of glioblastoma and provide more targeted support to patients and their caregivers.

Background Niemann-Pick disease type C (NP-C) is a rare neurovisceral lysosomal lipid storage disease characterized by progressive neurodegeneration and premature death. While miglustat can stabilize neurological manifestations in later onset forms of NP-C, its efficacy in the early-infantile neurological form has not been demonstrated. In this observational retrospective study, we compared long-term neurodevelopmental outcome and survival between an untreated and a treated group of early infantile NP-C patients. Method Data available on all NP-C patients with early infantile neurological onset diagnosed in France between 1990 and 2013 were compiled. Patients with incomplete data or who had died from a systemic perinatal, rapidly fatal form were excluded. Results Ten patients were included in the treated group (year of birth: 2006–2012), and 16 patients in the untreated group [born 1987–2005 (n=15), 2012 (n=1)]. The median age at neurological onset was 9 months (5–18) in the treated group, and 12 months (3–18) in the untreated group (p=0.22). Miglustat therapy was started at a median age of 24.5 months (9–29) and median duration was 30 months (11–56). Gastrointestinal adverse events were reported in 7/10 patients on miglustat. All patients developed loss of psychomotor acquisitions or additional neurological symptoms despite miglustat therapy. The ages of developmental milestones and neurological involvement did not significantly differ between the two groups. Four patients in the untreated group were lost to follow up. The 22 remaining patients had died by the end of the study and no patient survived beyond the age of 7.4 years. The median survival age was 4.42 years in the untreated group and 5.56 years in the treated group; the Kaplan-Meier survival curves were not significantly different (log-rank test: p=0.11). Conclusions Miglustat allowed no significant long-term neurodevelopmental improvement nor significant increase of survival in patients with early infantile NP-C.

Purpose This research aimed to compare recovery outcomes in patients undergoing total knee arthroplasty(TKA) with a half-course tourniquet using the midvastus(MV) approach and the medial parapatellar(MP) approach.Methods Patients receiving TKA treatment (MV or MP) were retrospectively recruited in this study between June 2019 to June 2022. The demographic, perioperative, and patient satisfaction data were collected and compared between MV and MP groups.Results A retrospective study of 112 patients who underwent total knee replacement between June 2019 and June 2022 was divided into two groups according to different surgical approaches, including the MV approach (59 cases) and the MP approach (53 cases). General data (age, sex, height, weight, BMI, education level, VAS score, HSS score), intraoperative data(incision length, operation time, intraoperative blood loss) and postoperative data(postoperative drainage volume, hemoglobin difference before and after surgery, time of first postoperative landing, postoperative hospital stay, VAS score and HSS score in the first week, one month and three months after surgery), as well as the number of blood transfusion cases, the number of surgical complications, and satisfaction were collected.Conclusions Both the midvastus approach and the medial parapatellar approach were able to complete the knee replacement and improve the patients’ knee function, and the medial femoral approach was beneficial for the patients’ early recovery, but there was no significant difference in knee function, complications, and satisfaction between the two groups at 3 months after surgery.

Background Laryngeal mask airway (LMA) may be considered by health care givers of level I-II hospitals for neonatal resuscitation in interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA in a large series of neonates who underwent postnatal transfer by an Italian regional transport service.Methods This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms and hospital charts.Results 64/3,252 transferred neonates (2%) received ventilation with a LMA, with increasing trend over time (p = 0.001). Most neonates were transferred after birth (97%) due to a respiratory or neurologic disease (95%). LMA was used before the transport (n = 60), during the transport (n = 1) or both (n = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the referral center.Conclusions In a large series of transferred neonates, LMA use was rare but increasing over time, and showed some heterogeneity among referring centers. However, LMA was safe and lifesaving in “cannot intubate, cannot oxygenate” situations. Future prospective, multicenter research may provide detailed insights on LMA use in neonates needing postnatal transport.

Although evaluation by digital examination of the cervix is the standard method used worldwide for evaluating the progress of delivery, it has a problem because it is subjective. Transperineal ultrasound (TPU) is used as an adjunct to digital evaluation for accurate assessment of the fetal descent and rotation of the advanced part of the fetus. This study aimed to clarify the impact of the introduction of TPU on perinatal outcomes at Mie university hospital. This retrospective study analyzed single pregnant women who underwent delivery management at our hospital between April 2020 and March 2021. Perinatal outcomes were compared between patients who were used TPU (TPU+ group) and those who were not used TPU (TPU- group). The angle of progression and head direction were measured. The rate of vaginal delivery was significantly increased, and the second stage of labor was significantly prolonged in the TPU+ group. There was a significant difference between termination in the latent phase occurred in 3/8 (38%) cases in the TPU+ group and 20/25 (80%) cases in the TPU- group. The rate of vaginal delivery may be increased by accurate evaluation of the progress of delivery with TPU.

Introduction: Multimorbidity and polypharmacy are associated with a higher number of potentially inappropriate medications (PIMs). The objective of this study was to determine the prevalence of PIMs and to identify associated factors. Methods: This is an observational retrospective study that analyzed the prevalence of at least one PIM by the 2019 updated Beers Criteria and the 2015 updated STOPP version 2 criteria in adults 65 years of age or older at their hospital admission during a period of 6 months; these data were compared to variables such as comorbidities, hospital length of stay, anticholinergic cognitive burden, and mortality. Descriptive analysis and logistic regression were used to identify prevalence and associated factors. Results: Data of 454 patients was analyzed. Prevalence of PIMs was 48.7% (n=221). The most frequent PIMs were central nervous system drugs (such as benzodiazepines) and proton pump inhibitors. Use of >5 drugs and age >75 years constituted independent risk factors for PIMs presentation. There was a higher anticholinergic burden score in patients presenting with PIMs. Presence of PIMs identified by STOPP criteria was an independent risk factor for mortality. Conclusions: A high prevalence of PIMs was demonstrated in this population, associated with polypharmacy and older age; besides, PIMs identified by STOPP were associated with higher mortality. The mean anticholinergic cognitive burden was higher in subjects who used at least one PIM.

Background To describe the outcomes of in-bag extraction tissue through the middle part incision of posterior vagina in laparoscopic myomectomy.Methods This was a retrospective study of patients with laparoscopic myomectomy who underwent the middle part incision of posterior vagina to extraction tissue in bag between January 2016 and December 2022. We collected and analyzed data about patients’ characteristics, main indication for surgery, and intra- and postoperative complications.There were 37 cases of vaginal delivery of pregnant women after operation, and there was no laceration of the incision of the posterior wall of the vagina after delivery.Results A total of 511women underwent transvaginal specimen retrieval after laparoscopic myomectomy (mean largest myoma diameter: 8.44 ± 3.56cm; mean specimen weight: 789.23 ± 276.97g; mean operative time: 129.01 ± 53.13minutes; mean blood loss: 175.99 ± 210.96 mL). Within 30-days, no fever, infection, or vaginal bleeding, and the vaginal incisions healed well after 30 days of outpatient review.There was no incisional hernia, pelvic infection and vaginal adhesions during follow-up 3 months after operation.Conclusions The middle part incision of posterior vagina and in-bag transvaginal extraction can be considered a feasible technique at laparoscopic myomectomy.

Objective This study aimed to evaluate the effect of female age on pregnancy outcomes of couples with PGT-A treatment and to find potential correlations or trends.Methods A multicenter retrospective study was conducted among women with pre-implantation testing for aneuploidy (PGT-A) cycles from three reproductive centers in China. They were divided into four groups according to female age (Group A: Results A total of 603 PGT-A cycles were included in the present study. There were 161, 256, 147, and 39 cycles in Group A, B, C, D, respectively. The CPR was 53.8% in Group D, which was decreased compared with Group A (60.2%), Group B (56.3%), and Group C (59.2%). The LBRs were 52.8%, 48.4%, 42.9%, and 41.0%, respectively. EMRs were 11.3%,9.7%,24.1%, 23.8%. And PBRs were 4.7%, 7.3%, 9.1%, and 25.0% in Group A, B, C, and D, respectively. The EMR and PBR showed significantly different among groups. Binary Logistic regression analysis indicated maternal age affects the live birth rate (OR 0.937, 95%CI 0.883–0.995), Early miscarriage rate (OR 1.148, 95%CI 1.033–1.275) and Preterm birth rate (OR 1.196, 95%CI 1.017–1.405).Conclusion As pregnancy outcomes tend to decrease with maternal age after euploid embryo transfer. The results indicated that endometrial receptivity, another key factor for embryo implantation, was affected by female age. During the ART treatment for women with advanced maternal age, we should not only pay attention to oocyte/embryos quality, but also emphasize endometrial receptivity.

Introduction: Remdesivir is an antiviral medication approved by the US Food and Drug Administration to combat COVID-19 infection in hospitalized patients. Although the adverse effects of Remdesivir are mainly unknown, data from randomized controlled trials have demonstrated its deleterious impact on several organ systems. Purpose: This study aims to describe the safety and efficacy of Remdesivir administration in a cohort of 586 patients admitted to a tertiary hospital in Qatar for COVID-19-related reasons. Methods: A retrospective study of 586 patients admitted with a diagnosis of COVID-19 and treated with Remdesivir were compared to 200 patients with COVID-19 who did not receive Remdesivir. Results: The rate of mechanical ventilation admission to the intensive care unit was comparable across the two groups (2.35% vs. 2%, p =.75). Death rates were comparable between the two groups (0.02% vs. 0.03%, p =.43). There was a mean reduction in heart rate within the first three days of antiviral therapy. Negligible variations in serum AST, ALT, ALP, and eGFR levels were detected. Remdesivir-treated patients had a significantly shorter hospital stay. Conclusion: Based on the limited data available regarding the adverse effects of Remdesivir, it is prudent to exercise caution by evaluating baseline parameters and avoiding concomitant use of potential cardio-, nephro-, or hepatotoxic drugs when using Remdesivir in patients hospitalized with COVID-19.

Background Home exercise plans are key to recovery from surgeries, but poor compliance limits the benefit. Though non-compliance can be up to 70% from previous research, digital health shows promise in improving compliance. This retrospective study compared pain, range of motion (ROM), and manipulation under anesthesia (MUA) complications after a total knee arthroplasty (TKA) from a clinic where one group used digital health and another did not. There is little previous research on this topic, so this study could show the benefits of digital health on joint replacement rehabilitation. Methods Patients were retrospectively selected from Summit Orthopedics TKA patients from 9/1/21 to 4/30/22. 41 patients used Recupe, a digital app that instructs and monitors home exercises along with live coaching with their TKA rehabillitation. 95 patients did not. Age, sex, and BMI between both groups were very similar. Results ROM improved significantly with the use of Recupe, improving to 120 degrees after 1 month - a key ROM level for functional use as indicated by studies. The non-recupe group improved to 112 degrees in the same timeframe. The need for MUA was significantly better for the Recupe group, where 2% required MUA versus 5% for the other group, indicating a lower risk of major complications. Pain averaged 2.34/10 for the Recupe group after 1 month versus 2.86/10 for the non-recupe group, though the decrease did not reach statistical significance. The Recupe group performed their exercises an average of 5.1 times per week. Conclusions The Recupe group and the Non-Recupe group both attended medical and physical therapy visits, so the significant differences in results are likely due to non-adherence of HEP by the Non-Recupe group. These results suggest that lengthened musculoskeletal recovery amongst workers may be due to non-adherence to their prescribed care plan, and that digital health may be an excellent way to improve their compliance. Clinical Significance Use of Recupe during rehabilitation after a Total Knee Arthroplasty results in significantly faster ROM improvement and significantly decreased risk of Manipulation Under Anesthesia. Pain was also decreased though not to statistical significance.

Purpose Controversy still exists regarding whether the sinus tarsi approach is able to effectively manage the Sanders type III fractures. The objective of this retrospective study was to describe and evaluate the clinical applications of the minimally invasive sinus tarsi approach and the extended lateral L-shaped approach for treating Sanders type III calcaneal fractures. Methods Between January 2012 and February 2015, 35 patients with calcaneal fractures(Sanders type III)treated in our trauma center were enrolled in this retrospective study. Surgeries were performed after improvement of soft tissue conditions. Either limited ORIF via sinus tarsi approach (minimally invasive group) or traditional ORIF via extended lateral L - shaped approach (traditional group) was performed on these patients. Clinical evaluation indicators including time to surgery, time for surgery, complications, subtalar joint stiffness, traumatic arthritis, SF-36, VAS, AOFAS score, Böhler's angle as well as Gissane's angle were recorded and compared between these two groups. Results The waiting time before surgery in minimally invasive group was significantly shorter than that in the traditional group. The mean operative time was significantly higher than that in the traditional group. No significant difference with respect to the AOFAS score, VAS score and SF-36 score between the groups was manifested. Subtalar stiffness occurred in 3 cases in the minimally invasive group, while 7 cases in the traditional group. 2 cases in traditional group and one case in the minimally invasive group presented with subtalar traumatic arthritis and the symptoms subsided after treatment. The difference regarding the Böhler angle and Gissane angle between groups were not statistically significant. Conclusion With the lower incidence of soft tissue complications and subtalar joint stiffness, minimally invasive treatment of calcaneal Sanders III fracture through the trans-tarsal sinus incision can be performed as one of the routine options.

Background The contrast-enhanced ultrasound (CEUS) has been recently used for the assessment of cervical lymph node metastasis to guide the surgical operation in the patient with papillary thyroid carcinoma (PTC). However, the specificity and sensitivity of CEUS reported from previous studies is not consistent. The objective of this study was to evaluate the diagnostic value of CEUS to the metastasis of cervical lymph node in PTC patients based on the data from one regional central hospital. Methods The diagnostic value of CEUS in preoperative LNM of PTC patients was concluded by comparing the results of CEUS on lymph node status with postoperative pathology examination. In addition, this study conducted hierarchical analysis of PTC patients to explore whether tumor size, different lymph node regions, and hashimoto's thyroiditis have an influence on the assessment of CEUS. Results This research enrolled 965 PTC patients finally, including 266 male and 699 female patients with a mean age of 42.27±11.34 years. 527 patients were supposed to be clinical-node negative and 438 were clinical-node positive before surgery. The specificity, sensitivity, PPV, NPV and accuracy of CEUS in the assessment of LNM in PTC patients were 56.00%, 71.00%, 57.06%, 69.76% and 62.59% respectively. For central and lateral lymph node, the accuracy of CEUS in PTC patients were 49.43% and 54.30%, respectively. Besides, it was showed that the accuracy of CEUS in PTC patients with HT slightly dropped to 58.44%, and the accuracy of CEUS in PTC patients with non-HT in turns increased to 64.17%. The accuracy of CEUS in non-PTMC and PTMC patients were 65.68% and 61.24%, respectively. The accuracy of CEUS in predicting central lymph node metastases was statistically different in PTC patients with or without Hashimoto's thyroiditis(P＜0.001) in this study, but not in lateral lymph nodes (P=0.114). Conclusion The accuracy of CEUS on the assessment of LNM in PTC is not consistently satisfactory, especially for central lymph nodes, small tumor diameter, or the patient with HT. More diagnostic technologies for abnormal lymph node should be considered in PTC patients.

Background The aim of this study was to compare the functional and radiological outcomes between open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) with locking plate (LP) and intramedullary graft (IMG) for treatment of unstable proximal humerus fractures (PHFs). Methods Forty-seven patients with PHFs were treated with ORIF and MIPO techniques in 25 and 22 cases, respectively, and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibiae allografts were used for augmentation. Radiological evaluation included the change in neck-shaft angle (NSA) and humeral head height (HHH). Functional outcomes were assessed using DASH and absolute Constant-Murley Score (CSabs) with its derivatives: relative (CSrel) and individual relative (CSindiv). Results Mean follow-up period was 27.4 ± 16.2 months for ORIF and 29.6 ± 17.6 for MIPO group. Mean age was 60.5 ± 13.7 and 66.3 ± 11.7 years for ORIF and MIPO group, respectively. Functional outcomes showed insignificant difference between the groups: CSabs of 57.3 ± 21.2 in ORIF and 52.4 ± 18.9 in MIPO group, (p = 0.409); CSrel of 73 ± 24.1 in ORIF and 73.9 ± 23.4 in MIPO, (p = 0.897); CSindiv of 69.6 ± 24.8 in ORIF and 64 ± 25.5 in MIPO, (p = 0.428); DASH of 14.8 ± 12.5 in ORIF and 18.7 ± 14.5 in MIPO, (p = 0.324). There were no significant differences in radiological outcomes between the two groups: decrease of NSA was 7.8° ± 9.4° in ORIF and 8.2° ± 15.6° in MIPO, (p = 0.922). Decrease of HHH was 0.6 mm ± 5.5 mm in ORIF and 1.4 mm ± 2.6 mm in MIPO, (p = 0.380). Surgical time was 165.8 ± 77.6 min for ORIF and 84.7 ± 38.1 min for MIPO, with significant difference between the groups (p

Background Although the association between inadequate or excessive gestational weight gain (GWG) and adverse pregnancy outcomes has been investigated in China, most studies use the Institute of Medicine (IOM) guidelines, which might not be suitable for Chinese women characteristics. Besides, studies exploring association between GWG in the second trimester and pregnancy outcomes are relatively few. Methods A total of 976 cases of live-birth singleton pregnancies at the Shanghai General Hospital were included in this retrospective observational study. Patients were classified into three groups including GWG during 24 gestational weeks (G24WG) within, below and above the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022 (2022 Chinese GWG guidelines), which specifies the recommended value of weight gain of natural singleton pregnancy in China. Binary logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs) of adverse pregnancy outcomes among three G24WG groups. Results Of the 976 women analyzed, 12.6% had G24WG below the 2022 Chinese GWG guidelines, while 37.2% had G24WG above the 2022 Chinese GWG guidelines. Women with G24WG below the 2022 Chinese GWG guidelines had a higher risk of Small for Gestational Age (SGA, Adjusted OR = 2.690, 95% CI: 1.334–5.427, P = 0.006) and a lower risk of Large for Gestational Age (LGA, Adjusted OR = 0.435, 95% CI: 0.228–0.829, P = 0.011) than women who had G24WG within the 2022 Chinese GWG guidelines. Conclusions G24WG is a strong predictor of newborn anthropometric outcomes and help doctors provide appropriate nutritional counseling for pregnant women in China.

Objective: To retrospectively evaluate the radiological and clinical efficiency of internal fixation using CanSHS-hook plate for treatment of unstable displaced medial-end clavicle fractures. Methods: From July 2014 to August 2019, 11 patients who underwent open reduction and internal CanSHS-hook plate fixation for medial-end clavicle fractures were included in the present study. There were 9 male and 2 female patients, with the average age of 35.5±11.3 years (aging from 22 to 58 years old). All the patients received routine x-rays and computed tomogra­phy examinations to evaluate the fractures before CanSHS-hook plate fixation. During the operation, a standard anterior approach across the sternoclavicular joint to the clavicle was made. After the reduction, the fracture was fixed by CanSHS-hook plate provided by Canwell Corporation under a series of operation procedures. Postoperative follow-up including physical examination and x-ray evaluation was performed in order to evaluate both the radiological and clinical efficiency of the treatment. Exercises were introduced to patients after initial postoperative immobilization. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires were used to evaluate the shoulder function postoperatively. Complications of any patients were noted to evaluate the disadvantages of the hook plate. Results: All patients were followed up, with the average follow up period of 14.0±3.3 months (8-20 months). All the 11 cases were unilateral injuries. None of them were pathological fractures or open fractures. No intraoperative complications occurred during the operation. The mean DASH scores were 36.9±17.8, 11.7±5.4, and 7.6±5.0 at 1 month, 3 months postoperatively and the final follow up. There were no neurovascular injuries, mal-union or internal fixation failures. No wound hematoma or infection was obtained during follow up. All the fractures got bony union at the final follow up. The average time of bone union was 13.2±2.7 weeks (10-20 weeks). Postoperative complications included 2 patients complained of implant related discomfort during shoulder motion which disappeared after implant removal, and one delayed union which was healed after electromagnetic stimulation and oral administration of traditional Chinese Medicine. All patients were satisfied with their treatment outcome at the final follow-up. Conclusions: Although the procedures of planting the CanSHS-hook plate were more complicated than other implants, the fixation of hook plate seemed to be an effective and relatively safe method for patients with medial end clavicle fractures. We recommend this CanSHS-hook plate for tiny and/or comminuted medial end segments because its unique design.

Backgroud: Femoral neck fractures are associated with substantial morbidity and mortality for older adults. Total hip arthroplasty (THA) and hemiarthroplasty (HA) are widely used in elderly patients with displaced femoral neck fractures (DFNF), but there is still controversy refer to the optimal chose for the management of DFNF in active elderly patients. Methods：This is a retrospective cohort study that incorporates medical record review with an outcomes management database. 73 patients who underwent HA and 66 patients who underwent THA were identified from January 2015 to December 2017. Data of age, gender, BMI, comorbidity status, operation time, blood loss, hospitalization time, in-hospital complication were collected and analyzed. Follow-up clinical and radiographic examinations were performed at approximately five years,and hip complications,Harris Hip Score and EuroQol-5 Dimensions (EQ-5D) were assessed. Results: Preoperative general data of sex, age, BMI and charlson comorbidity score of THA group(n=55) has no statistically significant difference with that of HA group. Patients treated by THA had significantly longer operation time (105.5 vs 76.7 minutes;P＜0.001),more blood loss (524.1 vs 350.1ml;P＜0.001) and longer hospitalization time (15.8 vs 13.8 days;P＜0.001).There was no significant differences between two groups in complications(32.7% vs 25.8%,P=0.432). No patients died during the hospitalization. After five years,only 33 patients in the THA group and 34 patents in the HA group were still alive,and the fraction surviving were not statistically significant between two groups(60.0% vs 54.8%,P> 0.05). The differences in hip function in favor of THA appeared to increase after the five-year follow-up, and the difference was significant in terms of the total Harris hip score(81.3 vs 73.1, P＜0.001) as well as in the dimensions of pain(38.9 vs 35.9, P=0.033), function(33.7 vs 29.2, P=0.001),absence of deformity(4.0 vs 3.9, P=0.023) and range of motion(4.6 vs 4.2, P=0.008). There was no significant differences between groups in hip dislocation rate(6.1% vs 0.0%, P=0.239). The erosion rate of hip joint in the THA group was significantly lower than that of the HA group(0.0% vs 26.5%, P=0.002). The health-related quality of life, according to EQ-5D index score, was found to be higher(0.69 vs 0.63, P= 0.001) in the THA group than the HA group after five years. Conclusion: THA may be a preferred management option for active elderly patients over 75 years.The more extensive surgery of THA is not associated with higher in-hospital complication rate or mortality rate. These patients can benefit from THA in terms of hip function and quality of life. Trial registration: No.

Background Blood culture is a laboratory test designed to detect the presence of bacteria or fungi in the blood of patients suspected of blood stream infection. While speedy initiation of antibiotic treatment is a critical determinant of patient survival, it is recommended that sample for blood culture should be collected before initiation of antibiotic therapy. The present study assessed the effects of antibiotic treatment on blood culture negativity. Methods A retrospective observational study was conducted to review blood culture results from June 2021 to December 2022. Blood culture results from patients aged 0 to 60 years were examined. Blood culture results whose samples were obtained prior to antibiotic treatment were analysed in comparison to those obtained during antibiotic treatment. Altogether a total of 165 results from various wards were analysed. Results Out of 94 blood cultures tested prior to antibiotic treatment, 54 were negative reflecting a negativity rate of 57%. Furthermore, from 71 blood cultures analysed after initiating antibiotic treatment, 56 were negative, representing a negativity rate of 79% (56/71). Thus, blood samples collected post antibiotic treatment exhibited a higher blood culture negativity rate in comparison to blood samples collected before the onset of antibiotic treatment. Conclusions This study revealed that collecting blood culture samples after the start of antibiotic treatment promotes blood culture negativity. While prompt initiation of antibiotic therapy is vital for patient recovery and survival in sepsis or bacteraemia, we encourage the practice of collecting blood culture samples prior to the commencement of treatment.

Background: Long-term outcomes and prognostic factors of proton radiotherapy for locally advanced pancreatic cancer (LAPC) in the body and tail are still unknown. The aim of this study was to determine the prognostic factors after proton radiotherapy in a large group of patients with LAPC in the body and tail. Methods: The medical records of 200 patients with LAPC in the body and tail who underwent proton radiotherapy between February 2009 and January 2021 at the Hyogo Ion Beam Medical Center were retrospectively reviewed to identify prognostic factors that contribute to long-term survival. Results: The overall survival rate at 1- and 2-year after PT was 69.6% and 35.4% with a median overall survival of 18.4 months. The 1- and 2-year local progression-free, and progression-free survival rates were 84.3% and 68.0%, and 44.3% and 19.4%, respectively. In multivariate analysis, superior mesenteric artery (SMA) invasion (SMA only invasion vs. celiac artery only invasion; P=0.005: SMA and celiac artery invasion vs. celiac artery only invasion; P=0.008), carbohydrate antigen 19-9 (CA 19-9) level ≥ 231.9 U/mL (PP=0.004), and absence of concurrent chemotherapy (PConclusions: Proton radiotherapy for LAPC in the body and tail may be a valuable multidisciplinary treatment option. Patients with SMA invasion, higher pre-proton radiotherapy serum CA 19-9 level, anterior peripancreatic invasion, or no concurrent chemotherapy had worse overall survival because of worse distant metastasis-free survival, suggesting that distant metastases have a significant impact on overall survival in such patients. Trial registration: retrospectively registered

Background: Indocyanine green (ICG) aids in the visualization of the internal limiting membrane (ILM). Retinal damage from ICG dye toxicity has been reported through in vitro and in vivo studies. However, the clinical toxic effect of ICG during macular surgery has not been functionally evaluated. In this study, we evaluated functional changes in retinal sensitivity associated with ICG toxicity using microperimetry before and after ICG-assisted ILM peeling in patients with macular holes. Methods: ICG staining was performed only on the macular area below the horizontal line connecting the fovea and optic disc. ILM peeling was performed over the entire macular area inside the vascular arcade. Visual acuity assessment, spectral domain optical coherence tomography, and microperimetry were performed at baseline and one, three, and six months postoperatively. The mean retinal sensitivity of four macular areas was calculated and analyzed. Results: Eleven eyes were included. Macular holes were successfully closed in all patients. Six months postoperatively, retinal sensitivity improved insignificantly in Area 1 (ICG−/ILM−) and Area 2 (ICG−/ILM+) but decreased in Area 4 (ICG+/ILM−). Three months postoperatively, retinal sensitivity significantly decreased in Area 3 (ICG+/ILM+; 26.63 ± 1.80 vs. 25.52 ± 2.08 dB, p = 0.036). However, the statistical significance of this result was lost six months after the surgery (p = 0.059). Conclusions: Retinal sensitivity decreased three months after ICG-assisted ILM peeling. However, the statistical significance was lost six months after surgery. ICG staining can be performed with caution during macular hole surgery.

Objective To explore the risk factors and develop a predictive model for postpartum hemorrhage in twin pregnancies. Methods This retrospective cohort study included 2,045 patients who met the inclusion criteria for inpatient deliveries at Ningbo Women's and Children's Hospital from January 2018 to August 2022. The patients were randomly divided into training and testing cohorts by 7:3, LASS0 regression screening variables and dichotomous logistic multifactor analysis were applied in R language to determine independent risk factors for postpartum hemorrhage in twin births nomograms were drawn to validate and evaluate the predictive efficacy of the model. Results Multifactorial Logistic regression analysis showed maternal age, assisted reproduction, platelet count, fibrinogen level, albumin level, hypertensive disorders of pregnancy, placenta praevia, number of previous cesarean deliveries, number of previous intrauterine manipulation, and neonatal weight were independent risk factors for postpartum hemorrhage in twin births. The area under curve (AUC) for the training cohort was 0.810 [95%CI (0.781, 0.839)], with a sensitivity of 76.5%, specificity of 71.0%, and positive and negative predictive values of 0.358 and 0.935, respectively, while the AUC for the testing cohorts was 0.821 [95%CI (0.781, 0.860)], with a sensitivity of 80.9%, specificity of 69.49%, and positive predictive value and negative predictive value of 0.426 and 0.929. Conclusion The predictive model can effectively and quantitatively assess the risk of postpartum hemorrhage in twin pregnancies and help clinicians to take personalized preventive measures.

Study Design: Retrospective cohort study. Objectives: This study aims to describe the occurrence of vertebral fractures according to age, sex, cause, type of fracture, compromised level, treatment, and complications in adult individuals. Setting: A Chilean neurosurgery reference center. Methods: All patients ≥ 18 years old suffering from an acute vertebral fracture between 2017 and 2022 were included in this study. Demographical data, fracture characteristics and management were obtained from medical records. Results: In total, 175 individuals with vertebral fractures were identified. The highest percentages of vertebral fractures were concentrated in 2 periods of life: under 30 years of age (25.7%, N=45), and ≥ 65 years (30.9%, N=54). Mostly of these patients were men (56.6%). Over 90 percent of individuals had a traumatic vertebral fracture (90.2%), whereas 9.8% had a pathological vertebral fracture. The most frequent localization was in the Thoracolumbar region of the spine (58.3%), being the Burst fractures (A3 or A4) the most frequent types (47.4%). Sixty-two patients had a neurological deficit (35.4%), mostly paraparesis. Finally, spinal fusion, with or without decompression, was the most used surgical technique (52.1%), with almost 13% of complications, mainly due to surgical site infections. Conclusions: Worldwide distribution of data regarding characterization of vertebral fractures is heterogeneous, even in our own region. However, data on the subject in Latin America is scarce. Understanding the clinical and demographic characteristics of these patients will help to prevent injuries, deciding type of management, and aiming to reduce complications in cases of traumatic and non-traumatic spine injuries.

Background: Both the non-anatomical double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular tenodesis (LET) show superior performance in controlling the rotational stability of the knee. However there are few studies published to investigate the curative effect of non-anatomical DB ACLR combined with LET in high-grade pivot shift anterior cruciate ligament ruptures. This study aims to evaluate the short-term clinical and imaging results of the treatment program and summarize the advantages of the surgical technique. Method: All the 33 patients we reviewed in this study have accepted the non-anatomical DB ACLR with LET surgery from January 2018 to January 2022 in our Department of Orthopedics. Primary demographic data collected include gender (23 males and 10 females), age (16-37 years, average 23.5 years), BMI (21.8-31.2 kg/m2, average 25.7 kg/m2), follow-up period (12-18 months, average 15.2 months) and injury mechanism (25 sports Injuries and 8 traffic accidents). The assessment of clinical outcomes included pre- and post-operative physical examination, knee functional scores and imaging data. Result: All patients in this study were followed up with an average 16.8-month (range 12-26 months) follow-up period. 23 patients had a grade 3 pivot shift and 10 had a grade 2 pivot shift. Immediate postoperative pivot shift tests were all negative, and only one case had a grade 1 pivot shift at the final follow-up. All the cases preoperatively had a positive Lachman test and turned negative at the final follow-up. The average ROM improved from 63.2°± 17.9° to 132.8°±3.6 °at the last follow-up (pConclusion: Non-anatomical double-bundle anterior cruciate ligament reconstruction combined with modified lateral extra-articular tenodesis is a reliable and recommended treatment for anterior cruciate ligament rupture with high-grade pivot shift, showing a striking improvement in knee rotational Stability and function in the short-term follow-up.

Background Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine cancer with a high risk of early mortality (i.e., survival time less than 1 month). This study aimed to identify relevant risk factors and predict early mortality in SCLC patients. Methods A total of 27163 SCLC cases registered between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) data. Significant independent risk factors were identified by univariate and multivariate logistic regression analyses. Nomograms for all-causes and cancer-specific early death were constructed and evaluated. Results Age, sex, clinical stage, presence of metastasis (liver and lung), and absence of treatment (surgery, radiotherapy and chemotherapy) were identified for significant association with all-causes and cancer-specific early death. Nomograms based on these predictors exhibited high accuracy (area under ROC curve > 0.850) and potential clinical practicality in the prediction of early mortality. Conclusion We identified a set of factors associated with early mortality from SCLC and developed a clinically useful nomogram to predict high-risk patients. This nomogram could aid oncologists in the administration of individualized treatment regimens, potentially improving clinical outcomes of SCLC patients.

Background Septic shock is a life-threatening condition that can lead to organ dysfunction and death. In the ICU, monitoring of cardiac index (CI) is commonly used to guide management and predict outcomes in septic shock patients. However, there is a lack of research on the association between CI and the risk of mortality in this patient population. Therefore, the aim of this study was to investigate the relationship between different levels of CI and mortality in septic shock patients. Methods Data analysis was obtained from the MIMIC-IV version 2.0 database. Sepsis and septic shock were primarily defined by sepsis-3, the third international consensus on sepsis and septic shock. CI was computed using cardiac output (CO) and body surface area (BSA). To evaluate the incidence of CI with respect to each endpoint (7-, 14-, 21-, and 28-day mortality), a restricted cubic spline curve function (RCS) was used. Analyses of KM curves, cox regression, and logistic regression were conducted separately to determine the relationship between various CI and 28-day mortality. Results This study included 1498 patients with septic shock. A U-shaped relationship between CI levels and risk of mortality in septic shock was found by RCS analysis (p 2 were associated with a mortality hazard ratio (HR) 2,n = 150), CI normal group (CI:1.85–2.80 L/min/m2, n = 904), and the high group(CI > 2.80 L/min/m2,n = 444). The KM curves, COX regression, and logistic regression analysis showed that the survival rate the of CI normal group was higher than the other groups. The risk factors of the low CI group, and high CI with ICU 28-day mortality were HR = 1.87 (95% CI: 1.01–3.49), and HR = 1.93 (95% CI: 1.26–2.97), respectively. Conclusion This study found that a cardiac index (CI) of 1.85–2.80 L/min/m2 was associated with the lowest risk of mortality in patients with septic shock. CIs that were lower or higher than this range were associated with an increased risk of mortality.

Background:The incidence of trauma has increased year by year, which has become one of the most common causes of death, however, different regions and countries adopt different modes of treatment. The purpose of this study was to explore the effect of the establishment of a graded trauma emergency system on the success rate of treatment for patients with severe multiple injuries in Jiangxi Province, China, which is mountainous and geographically extensive. Methods: A retrospective multi-center case-control study was used to analyze the effect of the three-level trauma emergency center system on the success rate of severe multiple injuries in Jiangxi Province, China. The study subjects were 1834 patients with severe multiple injuries admitted before and after the establishment of 9 Jiangxi provincial level 1 trauma emergency centers from January 2016 to June 2022, 1588 patients with severe multiple injuries admitted before and after the establishment of 15 Jiangxi provincial level 2 trauma emergency centers from November 2018 to June 2022, and 3044 patients with severe multiple injuries admitted before and after the establishment of 47 Jiangxi provincial level 3 trauma emergency centers from September 2018 to August 2022. The patients admitted after the establishment of Jiangxi Provincial trauma emergency center were taken as the study group, and the patients admitted before the establishment of Jiangxi Provincial trauma emergency center were taken as the control group. The general information, ISS (Injury sever score), the time from visiting to completing computed tomography (CT) examination, the time from the issuance of a blood transfusion application f to the start of blood transfusion (the preparation time for emergency blood transfusion) , the time from visiting to enter the operating room for patients who required emergency surgery, the length of stay in ICU, the length of stay in hospitaland prognosis were compared between the two groups. Mann-Whitney U tests were used for non-parametric continuous data, and the chi-square test was used to compare the counting data. Results: There was no significant difference in gender, age, ISS score and the mechanism of injury between the research group and the control group in different levels trauma emergency centers (P> 0.05). In the level 1 trauma emergency center, compared with the control group, the time from visiting to complete CT examination (P=0.001) and the preparation time for emergency blood transfusion (P=0.003) were markedly shortened in the research group, as well as the time from visiting to the operating room (P=0.008). However, the cure success rate of the research group was increased significantly than that in the control group (83.60% vs 68.66%, P< 0.001). In line with this, in the level 2 trauma emergency center, compared with the control group, the above three kinds of time are significantly shortened than that in the research group (PP=0.029). However, in the level 3 trauma emergency center, there was no statistical difference in the time from visiting to completion of CT examination between the two groups (P=0.529), while the preparation time for emergency blood transfusion (P< 0.001) was obviously shortened in the research group, as was the time from visiting to the operating room (P< 0.001), the cure success rate was higher significantly than the control group (61.97% vs 57.98%, P=0.027). In addition, we found that after the establishment of the trauma emergency center, the higher the level of trauma emergency centers, the higher the cure success rate for patients with severe multiple，which was 83.60%，67.76%，61.97% in level 1, level 2 and level 3 trauma emergency center，respectively。 Conclusions: In Jiangxi Province, China, with its extensive and mountainous terrain, its three-level trauma emergency center system can significantly shorten the first time of rescue, improve the treatment efficiency in hospital, and thus achieve the improvement of the success rate of treatment for patients of severe multiple injuries.

Introduction: Transcatheter mitral valve repair (TMVR) with the MitraClip device is a widely performed procedure for both primary and secondary mitral regurgitation. Several studies have assessed outcomes of TMVR in subpopulations with different comorbidities. However, there is no data on the safety and outcomes of TMVR in patients with rheumatoid arthritis (RA), which is a known independent risk factor for cardiovascular disease. Methods: We performed a retrospective analysis using data from the Nationwide Inpatient Sample (NIS) database from 2016-2019 to assess the outcomes of TMVR in patients with RA vs. without RA. Our primary outcome was in-hospital mortality following TMVR. Our secondary outcomes included the association of pre-specified comorbidities with in-hospital mortality and rates of post-procedural complications between RA vs. without RA groups. Results: A total of 4,176 patients were included in analysis (85 with RA, 4091 without RA). Our results showed no significant difference in mortality between patients with versus without RA (OR 0.798, p = 0.825). Patients with underlying diabetes had significantly increased mortality following TMVR (OR 1.843, p = 0.027). Patients with underlying CABG had significantly lower mortality following TMVR (OR 0.439, p = 0.047). Multivariate regression analysis of in-hospital complications showed no significant difference in complications between the RA vs. without RA groups. Conclusion: Our data shows no increased risk of in-hospital mortality or complications in patients with RA following TMVR.

Objective: Patients with oral and maxillofacial flap reconstruction often need clinical blood transfusion treatment due to massive blood loss. With the increasing limitations of allogeneic blood transfusion (ABT), acute normovolemic hemodilution (ANH) is being considered by doctors because of its advantages. By comparing the differences in blood index changes and postoperative complications of patients receiving ABT or ANH during reconstruction and repair of oral and maxillofacial tumor flaps, the purpose is to provide a reference for the clinical application of ANH. Methods: The clinical data of 276 patients who received oral and maxillofacial flap reconstruction from September 25, 2017, to October 11, 2021, in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, were retrospectively analyzed. According to the mode of intraoperative blood transfusion, the patients were divided into the ABT group and the ANH group. The differences in blood indexes change and the incidence of postoperative complications between two groups were statistically analyzed. Results: Of the 276 patients with ANH (124/276) and ABT (152/276), there were no differences in Δ Hb, Δ PT, Δ FIB (P>0.05), while Δ WBC, Δ PLT, Δ APTT and Δ D-dimer were significantly different (P0.05), post-PT (OR=1.953, 95% CI: 1.232~3.095, P=0.004) was an independent factor of wound infection, BMI (OR=0.089, 95% CI: 0.017~0.462) and ASA grade (OR=6.373, 95% CI: 1.681~24.163) were independent factors of lung infection (P

Introduction Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED) worldwide. There is paucity of data describing epidemiology, outcomes, and cost of acute poisoning. Up-to-date information about poisoning pattern is imperative for accurate diagnosis and effective management. This study therefore investigates the epidemiology, poison pattern and associated cost of acute poisoning in Qatar. Method A retrospective review of electronic health records of 397 patients admitted due to poisoning at the ED from January 2015 - December 2019. Demographic characteristics, incidence, clinical characteristics, cause of exposure, outcomes, and cost associated with acute poisoning were included. Frequency and percentages were calculated for categorical variable and mean and SD for continuous variables, relation between sociodemographic characters and poisoning profile was assessed using Chi-square. P-value less than 0.5 was considered statistically significant. A micro-costing approach using the cost of each resource was applied for the cost calculations. Result The incidence of acute poisoning was found to be 178 patients per 100,000 patients. Females (56%), and children below 14 years (44.3%) accounted for the largest proportion. The majority of the exposures were accidental and therapeutic agents (64.2%) were the most common toxic agents. The mean length of stay in the hospital was found to be 1.84 ± 0.81 and most patients (76.6) were discharged within the first 8 hours of the ED admission. A statistically significant difference was found between age groups and type of toxins (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001) and length of stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008) while general wards accounted for the least (USD 57,709). Conclusion The study demonstrates unintentional poisoning due to pharmacological agents was common among infants and children. The findings of this study will assist in the development of educational and preventative programs to minimise the exposure to toxic agents. Further studies exploring the impact of medical toxicology services, potential risk factors and post discharge monitoring of poisoning are highly warranted.

Background With the emergence of new COVID-19 variants (Omicron BA.5.2.48 and B.7.14), predicting the mortality of infected patients has become increasingly challenging due to the continuous mutation of the virus. Existing models have shown poor performance and limited clinical utility. This study aims to identify the independent risk factors and develop a practical predictive model for mortality among patients infected with new COVID-19 variants.Methods Demographic, clinical, and laboratory data of COVID-19 patients were retrospectively collected at our hospital between December 22, 2022, and February 15, 2023. Logistic regression (LR), decision tree (DT), and Extreme Gradient Boosting (XGBoost) models were developed to predict mortality. Those models were separately visualized via nomogram, decision trees, and Shapley Additive Explanations (SHAP). To evaluate those models, accuracy, sensitivity, specificity, precision, Youden’s index, and area under curve (AUC, 95% CI) were calculated.Results A total of 987 cases with new COVID-19 variants (Omicron BA.5.2.48 and B.7.14) were eventually included, among them, 153 (15.5%) died. Noninvasive ventilation, intubation, myoglobin, INR, age, number of diagnoses, respiratory, pulse, neutrophil, and albumin were the most important predictors of mortality among new COVID-19 variants. The AUC of LR, DT, and XGBoost models were 0.959, 0.878, and 0.961, respectively. The diagnostic accuracy was 0.926 for LR, 0.913 for DT, and 0.977 for XGBoost. XGBoost model had the highest sensitivity (0.983) and specificity (0.940).Conclusion Our study developed and validated three practical models for predicting mortality in patients with new COVID-19 variants. All models performed well, and XGBoost was the best-performing model.

Objective: More active anticoagulation prevention and treatment has reduced the incidence of perioperative deep vein thrombosis (DVT) in patients with bone trauma effectively, but the incidence is still relatively high. According to the Caprini score, all patients undergoing major orthopedic surgery were defined as the high-risk group for DVT. Further risk stratification of DVT high-risk groups remains a challenge. Therefore, the Caprini score most commonly used in the perioperative period is not applicable to orthopaedic patients. We attempt to establish a specialized model to predict postoperative DVT risk in patients with femoral fracture. Methods: We collected the clinical data of 513 patients undergoing femoral fracture surgery in our hospital from May 2018 to December 2019. According to the independent risk factors of DVT obtained by univariate and multivariate logistic regression analysis, the corresponding nomogram model was established and verified internally. The discriminative capacity of nomogram was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC). The calibration curve used to verify model consistency was the fitted line between predicted and actual incidences. The clinical validity of the nomogram model was assessed using decision curve analysis (DCA) which could quantify the net benefit of different risk threshold probabilities. Bootstrap method was applied to the internal validation of the nomogram model. Furthermore, we compared the Caprini score and nomogram. Results: The Caprini scores of subjects ranged from 5 to 17 points. The incidence of DVT was not positively correlated with the Caprini score. The predictors of the nomogram model included 10 risk factors such as age, hypoalbuminemia, multiple trauma, perioperative red blood cell infusion, etc. Compared with the Caprini scale (AUC=0.571,95% CI: 0.479~0.623), the calibration accuracy and identification ability of nomogram were higher (AUC=0.865,95% CI:0.780~0.935). The decision curve analysis (DCA) indicated the clinical effectiveness of nomogram was higher than the Caprini score. Conclusions: The nomogram was established to effectively predict postoperative DVT in patients with femoral fracture. More specialized DVT risk assessment models should be established for early identification and individualized prevention strategies to further reduce the incidence.

Background In this study, we evaluated the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as replacement strategy of conventionally fractionated radiation therapy in stage III non-small cell lung cancer (NSCLC) patients unfit for concurrent chemoradiation therapy (CRT). Methods We analyzed the clinical outcomes in patients with unresectable stage III NSCLC who received SBRT from January 1, 2013 to December 31, 2018. Both induction and consolidation chemotherapy were allowed. The survival rates and toxicities were calculated using the Kaplan-Meier method, and potential risk factors were investigated by multivariate Cox regression. Results A total of 213 consecutive patients who had received SBRT were enrolled. The median overall survival (OS) and progression-free survival (PFS) were 36.5 months and 16.1 months respectively. The estimated 1-, 2-, 3-, and 5-year OS rates were 90.6%, 73.7%, 52.0% and 24.9%, respectively and the corresponding PFS rates were 69.5%, 25.4%, 15.0%, and 10.0%, respectively. Treatment failures were largely (n=151, 70.9%) distant metastases, with low rates of local (n=74, 34.74%) and regional (n=76, 35.68%) recurrences. In 13.1% patients (n=28), ≥ grade (G) 3 toxicities were identified, including radiation pneumonia (n=20, 9.4%) and bronchopulmonary hemorrhage (n=8, 3.8%). None of the patients suffered from ≥G 3 late toxic effects. Compared with patients with peripheral tumors, patients with central tumors had lower median OS (P﹤0.001) and the biological effective dose (BED) was not a predictor for OS. Conclusions SBRT combined with chemotherapy for stage III NSCLC produced favorable treatment outcomes with acceptable toxicity. For patients with central tumors, an appropriate BED reduction can be considered. Further studies are warranted. Trial registration Retrospectively registered.

Aims: The use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased but occasions for dislocations and treatment, course and the outcome after dislocation are rarely evaluated. Therefore, in this study we aim to give an overview of dislocations after THA by DAA. Material and methods: We retrospectively analyzed all patients who had THA by DAA for osteoarthritis (OA) between 2014 and 2019 with 1-year follow-up in our hospital. We studied occasions and risk factors and compared outcome of hip function at 1-year follow-up by use of the Oxford Hip Score (OHS) for patients with and without dislocation. Results: A total of 2933 patients were included. Dislocation rate was 0.7% (n=21). 15 patients had a single dislocation, 6 patients had a second dislocation (29%) of which 1 had a third dislocation. Of the dislocations, 81% (17/21) were in the anterior direction and 86% (18/21) were in the first postoperative month. Most dislocations took place when patients were sitting, sitting and turning or getting up from a chair (n=9). Patients with a dislocation had a higher Body Mass Index than those without a dislocation (29.6 vs 27.0 kg/m2, 95% CI -4.4 to -0.7, p=0.007). Five patients had revision surgery (24%). OHS at 1y-FU (42 vs 44, 95% CI -1.2 to 5.2, p=0.25) and mean change (16 vs 18, 96% CI -2.1 to 7.3, p=0.22) did not significantly differ between patients with or without dislocation. Conclusion: Dislocation rate after THA by DAA is low and causes vary. Outcomes after dislocation can still be satisfying, as Oxford Hip Scores at 1-year follow-up were comparable for those with and without dislocation, especially for those with conservative treatment. These findings may support shared decision in treatment strategies and information for patients with a dislocation.

Background Sentinel node biopsy (SNB) has become a critical part of standard surgical treatment for melanoma with no metastatic evidence. According to MSLT-II and DeCOG-SLT trials, for patients with positive sentinel nodes, immediate complete lymph node dissection (CLND) didn’t bring further benefit for patients’ survival. Argument remains among Chinese population with domination of acral subtypes whether CLND can be omitted. This study aims to investigate the impact of immediate CLND for SN positivity on relapse-free survival (RFS) in Chinese melanoma patients.Material and Methods Patients with acral or cutaneous melanoma of clinical stage I-II receiving SNB procedure and then detected with nodal micrometastasis were retrospectively identified at Fudan University Cancer Center (FUSCC) from January 2017 to December 2021. Clinicopathologic features and prognostic factors for RFS were analyzed.Results Among 381 patients who received SNB in the last five years, 130 (34%) cases with positive SN micrometastasis detected were identified in our study. 99 patients underwent immediate CLND while the other patients received observation alone. Among patients received CLND, the NSN positive rate was 22.2%. There were slightly less N1 stage in the CLND group compared to the non-CLND group, although the difference didn’t reach statistical significance (P = 0.075). There was no significant difference in RFS between the two groups (P = 0.184).Conclusions Immediate CLND didn’t bring further RFS benefit after an observation for Chinese melanoma with SN micrometastasis in real clinical practice, even for patients with acral subtype or more tumor burden such as thick Breslow invasion and ulceration.

Background: Acute pancreatitis in pregnancy (APIP) with organ failure (OF) is a rare but serious disease. Here, we describe the primary characteristics associated with APIP, and explore potential predictors for early recognition of OF among the patients. Methods: A total of 3154 patients with AP from January 2018 to December 2021 were retrospectively reviewed. After screening, we enrolled 49 patients with APIP and 184 non-pregnant AP patients. Clinical characteristics and blood biochemical information were assessed using IBM SPSS 26.0 software and the rms package in R. Results: The most primary cause of APIP was hypertriglyceridemia (59.2%), while respiratory failure (46.9%) was the main type in all OF patients. Age, hemoglobin (Hb), hematocrit (HCT), aminotransferase (ALT), creatinine (Cr), blood urea nitrogen (BUN), albumin (ALB) and sodium ion (Na+) in the pregnant group were lower than in the non-pregnant group (PConclusions: APIP was highly correlated with hypertriglyceridemia and respiratory failure. Higher BMI was a distinguishing feature of OF-APIP patients. The data indicate that close monitoring of BUN, TG and TC levels is essential for early prevention of OF in APIP patients.

Background Eptinezumab-jjmr is a humanized IgG1 immunoglobulin monoclonal antibody administered intravenously as a preventative migraine treatment. Previously conducted randomized, double-blind, placebo-controlled trials exhibited significant reduction in monthly migraine frequency among adults experiencing episodic and chronic migraine. The present study seeks to expand upon the current findings and evaluate Eptinezumab-jjmr’s efficacy as a preventative migraine treatment for chronic and episodic migraine patients in the United Arab Emirates. This study is intended to represent the first real-world evidence study and will hopefully serve as a valuable complement to the existing literature on the subject.Methods This was a retrospective, observational, and exploratory study. The participants included within the study were adult (≥ 18 years) patients diagnosed with either episodic or chronic migraine. Patients were categorized according to their history of previous preventative treatment failure. For the final assessment of treatment efficacy, we included only patients with a minimum of 6 months of clinical follow-up data. Patients were assessed at baseline for their monthly migraine frequency and assessed again at months 3 and 6. The primary objective was to evaluate the efficacy of Eptinezumab-jjmr in reducing migraine frequency among chronic and episodic migraine patients.Results 100 participants were identified, of whom 53 patients completed the study protocol to month 6. 40 (75.5%) were female, 46 (86.8%) were Emirati locals, and 16 (30.2%) were pharmaceutically naïve, having never tried any prior preventative therapy. Additionally, 25 (47.2%) patients met the criteria for chronic migraine (CM), whereas the remaining 28 (52.8%) were diagnosed with episodic migraine (EM). The baseline monthly migraine frequency (MMD) was 12.2 (4.97) days across all participants, 15.6 (3.97) for CM patients, and 9.25 (3.76) for EM patients; by month 6, these frequencies reduced to 3.66 (4.21), 4.76 (5.32), and 2.68 (2.61), respectively. Overall, 58.5% of those enrolled experienced > 75% reduction in MMD frequency by month 6.Conclusion Patients enrolled in this trial experienced clinically significant reductions in MMD by month 6. Eptinezumab-jjmr was well tolerated with only one AE of note.

Purpose The number of older adult patients with uterine cervical cancer is continuously increasing in Japan. This study aimed to investigate the patient characteristics, treatment outcomes, and adverse effects (AEs) of older adult patients with cervical cancer.Methods We retrospectively analyzed 89 patients who had undergone definitive radiation therapy (RT). Based on patient age at the time of study inclusion, patients were divided into the older (≥ 75 years [n = 21]) and younger (Results Histological type (adenocarcinoma) was associated with OS, whereas average Hb concentration during treatment was associated with PFS in older adult patients. Moreover, the external beam RT field, concurrent chemotherapy dose, and overall treatment time were not associated with a worsening of ECOG PS among older adult patients. Acute AEs of grade ≥ 3 were significantly more common in the younger adult group; however, three of the older adult patients (14%) had Grade 3 leukopenia, and two were concurrently receiving ≥ 200 mg of cisplatin.Conclusion Concurrent chemoradiation therapy may cause severe leukopenia in older adult patients; therefore, it should be considered carefully in older adult patients with cervical cancer.

Background & Aims Anticoagulation therapy is recommended during the acute or subacute stage for patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PAHSOS). Transjugular intrahepatic portosystemic shunt (TIPS) is suggested as step-up treatment when patients have no response to anticoagulants. However, the efficacy of TIPS in patients who do not respond to anticoagulants needs more evidence. The aim of this study was to evaluate the effect of TIPS in PA-HSOS patients with no response to initial anticoagulation treatment. Methods We retrospectively enrolled PA-HSOS patients diagnosed based on the ‘Nanjing criteria’ between January 2013 and September 2020 from four hospitals, and all of them had no response to initial short-term anticoagulation therapy. Then, depending on the next treatment option, these patients were divided into the TIPS treatment group and the anticoagulation therapy group. The baseline information and clinical characteristics were collected and recorded. Liver transplant-free survival in both groups was the primary study endpoint and the risk factors for patient death were further analyzed. Results A total of 473 PA-HSOS patients from four hospitals were included in the study, and 99 patients were enrolled according to the inclusion and exclusion criteria. Of these, 63 patients were in the TIPS group and 36 were in the anticoagulation therapy group. In the anticoagulation therapy group, 25 patients received continuous anticoagulation treatment until the end of the study, and 11 patients did not respond to the prolonged anticoagulation therapy and turned to TIPS therapy halfway through treatment. There were 17 deaths during the median follow-up time of 32.5 months. The different choices of treatment (TIPS or continuous anticoagulation therapy), age, aspartate aminotransferase (AST), and serum total bilirubin (STB) were independent risk factors for predicting death. The patients in the TIPS group had a significantly higher transplant-free survival than those in the continuous anticoagulation therapy group (P=0.028). The prognosis of the mild and moderate patients treated with TIPS was better than that of the severe patients according to Drum Tower Severity Scoring (DTSS), a novel PA-HSOS severity grading criteria, while the severe patients did not show significant benefit with TIPS treatment. Conclusions TIPS treatment can improve the transplant-free survival rate in PA-HSOS patients who have failed short-term anticoagulation therapy, and patients with DTSS of mild and moderate grade could benefit from TIPS.

Background Immune thrombocytopenia (ITP) is an autoimmune hemorrhagic disease characterized by increased platelet destruction and impaired thrombopoiesis. Platelet indices changes depending on the morphology and volume of platelets. Serum lipids have been found to affect platelet formation and activity in certain diseases, thus induce the corresponding variation of platelet indices.Methods Mendelian randomization (MR) analysis was performed based on databases. The clinical data from 457 ITP patients were retrospectively collected and analyzed, including platelet indices, serum lipids, hemorrhage and therapeutic response.Results MR analysis showed low high-density-lipoprotein-cholesterol (HDL-C), low apolipoprotein A-1, high triglyceride (TG) and high apolipoprotein B (ApoB) causing high platelet distribution width (PDW); high low-density-lipoprotein-cholesterol (LDL-C) increasing mean platelet volume (MPV). In ITP, there were positive correlations between platelet count with TG, PDW with HDL-C and ApoB, and plateletcrit with TG and non-esterified fatty acid, and the correlation had gender differences. Bleeding scores were negatively corelated with cholesterol and LDL-C. LDL-C and homocysteine were risk factors for therapeutic response.Conclusions Serum lipids, especially cholesterol were tightly correlated with platelet indices, hemorrhage and therapeutic effects in ITP patients. These results provide clinical references for the management of serum lipids, and highlight the necessity to further explore the relationship between lipids and pathogenesis of ITP.Trial registration: No: NCT05095896, October 14, 2021, retrospectively registered.

Objective: To investigate the effect of growth hormone on low-prognosis patients who were diagnosed by POSEIDON criteria. Methods: Poor ovarian reserve patients were included if their AMH Results: A total of 574 cycles (155 in GH group, 419 in Control group) were analyzed. For all the poor ovarian reserve patients, there were no significant differences between GH and control group, in aspects of HMG dosage, duration of HMG, the number of oocytes retrieved, the number of 2PN, the number of embryos, transferrable embryos ,good-quality embryos, clinical pregnancy rate, miscarriage rate and clinical live birth rate. In stratified analysis, the variables of G4 were not significantly different, and in G3, duration of HMG (8.11±1.86vs. 8.80±1.98, P﹤0.05) was significantly different. Further study on non-first cycle patients, a total of 274 cycles (122 in GH group, 152 in Control group) were analyzed, there were no differences between GH group and control group, in aspects of HMG dosage, duration of HMG, the number of oocytes retrieved, the number of 2PN, the number of embryos, transferrable embryos ,good-quality embryos, clinical pregnancy rate, miscarriage rate and clinical live birth rate. In stratified analysis, the variables of G3’ were not significantly different. In G4’, duration of HMG (8.74±2.31 vs. 7.90±2.56, P﹤0.05) was significantly different, the number of oocytes retrieved(8.74±2.31 vs. 7.90±2.56, P﹤0.05), clinical pregnancy rate(22.97% vs. 8.45%, P﹤0.05), and clinical live birth rate(14.86% vs. 4.23%, P﹤0.05) were significantly different between GH and control groups. The outcomes of linear regression and logistic regression analysis were approximately consistent with that of Chi square test. Conclusions: GH co-treatment with the mild stimulation protocol in poor ovarian reserve patients who reached or were older than 35 years old, and failed in at least one previous cycle, could significantly increase the number of oocytes retrieved, clinical pregnancy rate and live birth rate.

Background: Infantile hemangioma is one of the most common benign soft tissue tumors in infants. The pathogenesis of infantile hemangioma remains unclear and twin studies regarding its incidence may help clarify disease pathogenesis. Thus, this study aimed to analyze the clinical characteristics of infantile hemangioma in twin patients and discuss its clinical incidence. Methods: We retrospectively analyzed the data of 83 pairs of twins with infantile hemangioma admitted to the Guangdong Provincial Women and Children Hospital and Henan Provincial People's Hospital between May 2016 and May 2022. Thirty-one pairs of twins among whom both developed infantile hemangioma and 52 pairs of twins among whom only one twin was affected were included. Analysis was performed using the Spearman correlation. Additionally, we analyzed the influence of factors such as sex, twin zygosity, preterm birth, birth weight, and assisted reproduction on the clinical characteristics of twins. Results: We observed that disease occurrence in both twins correlated with assisted reproduction (χ2= 13. 102, P0.05) and total birth weight of twins (t=-3.369, P>0.05) were not correlated with infantile hemangioma. However, among twins, the ones with lesser birth weight were more likely to develop infantile hemangioma. Conclusions: The clinical characteristics of infantile hemangioma in twins were consistent with their epidemiological characteristics. Female sex, preterm birth, less birth weight, and assisted reproduction increased the probability of morbidity in twins. Analysis of the characteristics of infantile hemangioma in twins may assist further research and clinical treatment.

Backgroud To explore whether monitoring of non-invasive urine oxygen tension (PuO2) for 3 consecutive days can reflect renal medulla microcirculation injury early and whether changes in PuO2 (△PuO2) have reliable early diagnostic value for sepsis-associated acute kidney injury (SA-AKI). Methods Twenty-four patients who were hospitalised for more than 48 h in our hospital and were diagnosed with sepsis were retrospectively divided into non-SA-AKI group and SA-AKI group according to the occurrence of acute kidney injury (AKI). The general and oxygen metabolism data of the two groups were compared. The results of urine analysis (PuO2, PuCO2, and urinary lactic acid) for 3 consecutive days were compared with common clinical kidney injury indices, and a changing trend was observed. Results In the PICU, a total of 24 patients with sepsis were included (14 males, 58.33%; mean age, 5 years), with 15 cases in the non-SA-AKI group and 9 cases in the SA-AKI group, with incidence of SA-AKI being 37.5%. PuO2 gradually decreased from D0 to D2 in the SA-AKI group; PuCO2 increased naturally. The variation trend of PuO2 was statistically significant in D1-D0, D2-D0, and D2-D1 (PConclusions Three consecutive days of PuO2 monitoring can reflect early renal medullary microcirculation injury, and △PuO2 has early diagnostic value for SA-AKI.