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Study Design.: Retrospective observational study. Objective.: To determine the proximity between the screw and endplate of the upper instrumented vertebra (UIV) using a cortical bone trajectory (CBT) screw as a predictive factor for radiographic adjacent segment degeneration (ASD) in patients surgically treated with transforaminal lumbar interbody fusion (TLIF) with CBT screws (CBT-TLIF) with lumbar spinal stenosis. Summary of Background Data.: The risk factors for radiographic ASD after CBT-TLIF remain unknown. Methods.: Among patients surgically treated with CBT-TLIF at a single institute, 239 consecutive patients (80 males and 159 females) were enrolled. ASD was defined by the presence of one or more of the following three radiologic criteria on the adjacent segment: >3 mm anteroposterior translation, >10° segmental kyphosis, or >50% loss of disc height comparing immediate postoperative and one-year follow-up radiographs. Clinical and radiological features associated with the development of ASD were retrospectively measured. Univariate and multivariate analyses were performed to identify risk factors associated with radiographic ASD. Results.: Radiographic ASD was observed in 71 (29.7%) cases at one-year postoperative follow-up. The preoperative Pfirrmann grade of the adjacent segment (>grade 2), multi-level fusion (>2 levels), and proximity between the tip of CBT screws and endplate on the UIV were significantly associated with radiographic ASD (OR = 3.98, 95% CI [1.06–15.05], P =0.042 versus OR = 3.03, 95% CI [1.00–9.14], P =0.049 versus OR = 0.53, 95% CI [0.40–0.72], P <0.001). The cut-off value of the distance between the tip of the screw and endplate on UIV for radiographic ASD was ~2.5 mm (right-sided CBT screw; cut-off value 2.48 mm/ left-sided CBT screw; cut-off value 2.465 mm). Conclusion.: Radiographic adjacent segment degeneration progression can occur when the cortical trajectory bone screw is close to the endplate of the upper instrumented vertebrae in patients with lumbar spinal stenosis undergoing fusion surgery. [ABSTRACT FROM AUTHOR]

Background: Ruxolitinib (RUX) is a JAK1/2 inhibitor approved for the therapy of myelofibrosis (MF) based on clinical trials including only intermediate2‐high risk (INT2/HIGH) patients. However, RUX is commonly used in intermediate‐1 (INT1) patients, with scarce information on responses and outcome. Methods: The authors investigated the benefit of RUX in 1055 MF patients, included in the "RUX‐MF" retrospective study. Results: At baseline (BL), 595 (56.2%) patients were at INT1‐risk according to DIPSS (PMF) or MYSEC‐PM (SMF). The spleen was palpable at <5 cm, between 5 and 10 cm, and >10 cm below costal margin in 5.9%, 47.4%, and 39.7% of patients, respectively; 300 (54.1%) were highly symptomatic (total symptom score ≥20). High‐molecular‐risk (HMR) mutations (IDH1/2, ASXL‐1, SRSF2, EZH2, U2AF1Q157) were detected in 77/167 patients. A total of 101 (19.2%) patients had ≥1 cytopenia (Hb < 10 g/dL: n.36; PLT <100 x 109/L: n = 43; white blood cells <4 x 109/L: n = 40). After 6 months on RUX, IWG‐MRT–defined spleen and symptoms response rates were 26.8% and 67.9%, respectively. In univariate analysis, predictors of SR at 6 months were no HMR mutations odds ratio [OR], 2.0, p =.05], no cytopenia (OR, 2.10; p =.01), and blasts <1% (OR, 1.91; p =.01). In multivariate analysis, absence of HMR maintained a significant association (OR, 2.1 [1.12–3.76]; p =.01). Conclusions: In INT1 patients, responses were more frequent and durable, whereas toxicity rates were lower compared to INT2/high‐risk patients. Presence of HMR mutations, cytopenia, and peripheral blasts identified less‐responsive INT1 patients, who may benefit for alternative therapeutic strategies. Overall survival and event‐free survival rates are significantly superior, whereas rate of ruxolitinib discontinuations is significantly lower in intermediate‐1 patients, confirming the benefits of ruxolitinib in patients with less advanced disease. [ABSTRACT FROM AUTHOR]

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• The prevalence of VD response to HUTT was 7 % with an increased prevalence during NTG phases. • Distribution of VD syncope was age-related, characterized by a peak after 69 years, mainly driven by male patients. • Advanced age was the only independent predictor of VD syncope. • Smoking and non-classical presentation of syncope reduced the probability of VD response to HUTT. The aim of our study was to evaluate the prevalence and clinical predictors of vasodepressor (VD) response during head-up tilt test (HUTT) in patients with history of syncope admitted to a tertiary referral syncope unit. We retrospectively evaluated all consecutive patients who underwent HUTT for suspected or established reflex syncope at our institution from March 1st, 2017, to June 1st, 2023. VD response was defined when syncope occurred during hypotension along with no or slight (< 10% bpm) decrease of heart rate. Univariate and multivariate analyses were performed to test the association of VD response to HUTT with a set of clinical covariates. 1780 patients (40 ± 19.9 years; 49.3% male) were included; among them, 1132 (63 %) showed a positive response to HUTT and 124 (7.0%) had a VD response. The prevalence of VD response showed a peak after 69 years (11.52% vs 6.18%; P = 0.0016), mainly driven by male patients (13.7% vs 4.9%; P < 0.0001). At multivariate analysis, age (OR: 1.15; P = 0.0026) was independently associated to HUTT-induced VD syncope; in contrast, smoking (OR: 0.33: P = 0.0009) and non-classical presentation of syncope (OR: 0.55; P = 0.0029) inversely correlated with VD syncope. VD response represents the less frequent responses among those induced by HUTT, accounting up to 7% of overall responses. A gender and age-related distribution has been shown. Advanced age was the only independent predictor of VD syncope; conversely, smoking and non-classical presentation of syncope reduced the probability of VD response to HUTT. [Display omitted] [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. The aims of this study were to estimate the genetic parameters of clinical mastitis (CM) and SCS traits, and to compare the performance of genetic evaluations of CM traits using univariate and bivariate analyses (CM-SCS). Data were edited according to the Udder Health Golden Standard harmonization, and then 6 CM traits and 6 SCS traits were considered, as the result of combining 3 lactation classifications (1, 2, ≥3) and 2 milking periods (early, late). The linear mixed animal models included the ratio of period at risk as a covariate, herd-year of calving, month of calving, and lactation-age as fixed effects, and the permanent environmental effect for traits of ≥3 lactations. Prevalence of CM in early lactation was similar regardless the lactation number (5%–6%), and the estimated heritabilities were 0.01. Prevalences in late lactation ranged from 10% to 24% and heritabilities ranged from 0.03 to 0.05. Estimated heritabilities of SCS ranged from 0.06 to 0.16 with univariate analyses. Somatic cell count (therefore its log-transformation SCS) showed a higher probability of correctly identifying healthy cows than infected cows but there was still up to 36% of healthy cows for which CM was not detected by SCS. Genetic correlations between CM-SCS traits ranged from 0.36 to 0.95, and SCS in lactation 3 and later did not add extra information to SCS in the second lactation for predicting CM. Regarding reliabilities of EBVs for CM traits, bivariate CM-SCS analyses led to substantial increases with respect to the single-trait model for sires (7%–12% more in first lactation and 16%–28% more for second lactation). Sire's rank correlations for CM between univariate and bivariate analyses (0.47–0.92) suggest that discarding sires could be more accurate than selecting candidates for sires of dams. We can conclude that SCS in first lactation could be useful to supplement CM data in first and second lactations to improve udder health genetic evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Although sudden death (SD) is a recognized complication of cardiac amyloidosis, there is scarce data about its incidence, mechanisms, and predictors. The aim of this study was to describe incidence of SD and to analyze possible risk factors. Methods: Consecutive patients with ATTR or AL cardiac amyloidosis evaluated at two European centers were identified. SD was defined as unexpected death in clinically stable patients. Cox proportional hazard regression was performed to assess risk factors in univariate analysis. Those statistically significant were then assessed through age-adjusted multivariate analysis. Results: Analysis included 784 patients, 569 with ATTR amyloidosis (mean age 74.1 ± 12.1 years) and 215 with AL amyloidosis (mean age 64.5 ± 10.8 years). After a median follow-up of 1.9 years, SD rate at 2 years was 1.8% in ATTR. Previous pacemaker implantation (PPM) was associated with increased risk after age-adjusted analysis (HR 4.97; 95%CI: 1.39–17.7; p = 0.01). SD rate in AL amyloidosis patients at 2 years was 8.0% after a median follow-up of 1.2 years. Betablockers and NYHA III-IV were independently associated with an increased risk after age-adjusted multivariate analysis (HR 7.06 95%CI (2.31–21.5) p = 0.001) and (HR 4.56 95%CI (1.51–13.8) p = 0.007) respectively. Conclusions: SD is more frequent in AL than in ATTR cardiac amyloidosis. SD is associated with different risk factors in both entities. [ABSTRACT FROM AUTHOR]

Objective Our aim was to assess the efficacy of ventriculoperitoneal shunt (VPS) for treating postoperative central nervous system infection (PCNSI) complicated with hydrocephalus and to identify factors associated with treatment failure. Materials and Methods We conducted a retrospective analysis of PCNSI patients with hydrocephalus treated by VPS at the Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, between December 2012 and January 2020. Functional recovery was evaluated during follow-up using the Glasgow Outcome Scale. Results A total of 29 patients (21 males, 8 females) were enrolled in the study (mean age: 56.4 ± 12.0 years, range: 18.0–77.0 years). Seventeen patients were treated successfully by VPS (58.6%). Among the 11 patients with shunt complications (37.9%), 8 (27.6%) presented with fever, 3 (10.3%) with shunt infection, and 3 (10.3%) with shunt obstruction. Univariate analysis identified low Glasgow Coma Scale (GCS) score (3–8) at the time of VPS and post-treatment fever as predictive of shunt failure. Conclusion VPS was effective for treating PCNSI complicated with hydrocephalus. However, patients with low GCS score at the time of VPS or fever post-treatment were at greater risk of shunt failure and poor outcome. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to analyze how rod characteristics, screw density and cages influence the incidence of mechanical complications compared to patient-related factors and alignment in adult spinal deformity instrumented T9-T11 to pelvis. Methods: Register data of 302 patients was analyzed. Relative lumbar lordosis (RLL) and relative sagittal alignment (RSA) was measured. Surgical data included rod characteristics, pedicle screw density and interbody cages. Univariate and multivariate logistic regression models were used. Results: Pseudarthrosis occurred in 24.1%. On univariate analysis Odds Ratio (OR) was 0.74 for ≥ 3 cages (p = 0.452), 0.48 for 4 rods (p = 0.008), 4.30 for high screw density (p = 0.001). Patient-related factors were non-significant. Multivariate OR was 0.59 for 4 rods (p = 0.084) and 4.67 for high screw density (p = 0.005). PJK/PJF occurred in 19.2%. Age > 60 had an OR 2.83 (p = 0.023), postoperative RSA malaligned OR 2.84 (p = 0.030), severely malaligned OR 6.54 (p < 0.001). Implant characteristics were non-significant. Multivariate OR was 1.26 for age > 60 (p = 0.657), 2.32 for malaligned RSA (p = 0.097), 5.69 for severely malaligned RSA (p = 0.001). Screw loosening occurred in 8.9%. Univariate OR was 0.95 for ≥ 3 cages (p = 0.920), 1.64 for 4 rods (p = 0.235), 0.25 for high screw density 1.5–2 (p = 0.011). Patient-related factors were non-significant. Multivariate OR for high screw density was 0.23 (p = 0.022). Conclusion: Four rods decrease the pseudarthrosis risk. Cages have a secondary role. High screw density doesn't prevent from pseudarthrosis. Postoperative malalignment is the main PJK/PJF risk factor. Age plays a secondary role. Implant characteristics have a minor influence. High screw density constructs have a lower risk for screw loosening. Level of evidence: 3-Retrospective register study. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify associated risk factors of distal adding-on phenomenon in Lenke 1A/B and 2A/B adolescent idiopathic scoliosis (AIS) patients and establish the corresponding prediction model. Methods: The clinical data of 119 Lenke 1A/B and 2A/B AIS patients were retrospectively analyzed. Preoperative, first erect (FE) radiographic parameters and radiographic parameters at the last follow-up were measured. Patients were divided into the adding-on group and the no adding-on group according to whether the adding-on phenomenon was observed at the last follow-up. Univariate analysis and multivariate logistic regression analysis were used to establish the corresponding prediction model. Results: Adding-on affected 39 (32.8%) patients at the last follow-up. Risser sign and 19 radiographic parameters showed significant differences between the two groups by univariate analysis. Stepwise logistic regression analysis found that the Risser sign and so on five predictor variable, and the nomogram was drawn. The calibration curve showed that the model fitted well. The area under the receiver operating characteristic (ROC) curve is 0.949. And the decision curve analysis curve model within the threshold range for interventions to improve clinical outcomes. There was no significant difference in SRS-22 scores between the two groups. Conclusions: This study established a prediction model with adding-on in Lenke 1A/B and 2A/B AIS patients. The nomogram contains five predictive variables, which can effectively predict the probability of adding-on phenomenon during follow-up, and may have greater clinical value for the treatment and prevention of adding-on phenomenon. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the frequency and the clinical relevance of thyroid disease in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients. Methods: A total of 305 AAV patients admitted to the Second Affiliated Hospital of Chongqing Medical University between October 2010 and December 2023 were analyzed. Demographic, clinical, and laboratory data were compared between AAV patients with and without thyroid disease. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with thyroid disease in AAV patients. Results: Among the 305 AAV patients, 52 (17.0%) had concurrent thyroid disease. In univariate analysis, gender, coronary artery disease, renal involvement, anti-Ro/SSA antibodies, anti-Ro52 antibodies, anti-thyroglobulin antibodies (TgAb), and anti-thyroid peroxidase antibodies (TPOAb) exhibited significant differences between AAV patients with and without thyroid disease (P < 0.05). Multivariate analysis revealed that female gender (odds ratio (OR) = 2.423, 95% confidence interval (95% CI) 1.241, 4.729; P = 0.009), concurrent coronary artery disease (OR = 2.998, 95% CI 1.280, 7.019; P = 0.011), and positive anti-Ro/SSA antibodies (OR = 4.697, 95% CI 1.960, 11.257; P = 0.001) were associated with thyroid disease in AAV patients. Conclusion: AAV patients have a higher incidence of thyroid disease. Regular monitoring of thyroid function is advised for AAV patients, particularly for women, those with coronary artery disease, and those who are positive for anti-Ro/SSA antibodies. Key Points • AAV patients have a higher incidence of thyroid disease. • The potential clinical relevance of AAV patients with thyroid disease was explored. • Regular monitoring of thyroid function is advised for AAV patients. [ABSTRACT FROM AUTHOR]

UK examining bodies are required to eliminate discrimination against people with protected characteristics. To achieve this in surgery, differential attainment (DA) in assessments used as gatekeepers to career progression must be ruled out. This study investigated the impact of disability status on the likelihood of success at national selection for Higher Surgical Training (HST). A retrospective cohort study of all UK graduates in the UKMED database (https://www.ukmed.ac.uk) who underwent selection for HST (ST3) from 2012 to 2019 (n = 2875). Univariate analysis identified differences in success rates at first-application. Logistic regression models identified whether disability was a predictor of success after adjusting for sociodemographic factors and prior MRCS performance. There was no significant difference in success rates between candidates with and without disabilities (all p > 0.05) for any surgical specialty. Disability status was not a statistically significant predictor of success. Female candidates were 25 % more likely to be successful (OR 1.25 [95%CI 1.05 to 1.49]) and Non-White candidates were 20 % less likely to be successful (OR 0.80 [95%CI 0.68 to 0.96]). Candidates who passed MRCS Part A and Part B at the first attempt were 49 % (OR 1.49 [95%CI 1.25 to 1.77]) and 90 % (OR 1.90 [95%CI 1.58 to 2.28]) more likely to be successful. No significant difference was found in the likelihood of being successful at HST selection for any surgical specialty between applicants with and without disabilities, regardless of type of disability. DA was identified between other sociodemographic groups which requires further exploration. • Investigates the impact of disability on success at surgical national selection. • Disability was not found to be a statistically significant predictor of success. • Differential attainment was identified between other sociodemographic groups. • Passing MRCS at the first attempt predicts national selection outcomes. [ABSTRACT FROM AUTHOR]

The study examines the characteristics and outcomes of foot-originating malignant bone tumors via Surveillance Epidemiology and End Results (SEER) database analysis. A retrospective review of 14,695 malignant bone tumor cases from 2000 to 2019 was conducted. Of the eligible cases, 147 (2.3 %) were foot-origin tumors, typically smaller and more commonly treated with surgery than those in other locations. These tumors were more frequently treated with surgical resection, with a higher proportion undergoing amputation. In contrast, foot-origin tumors were less often managed with chemotherapy and radiation. Foot-origin tumors exhibited higher survival rates compared to non-foot-origin tumors as shown in univariate analysis, although multivariate analysis did not reflect significant differences. Foot-originating malignant bone tumors tend to be smaller and are frequently surgically treated, correlating with favorable survival outcomes. These findings point to early detection as a potential factor in the improved survival rates, not necessarily the tumor's origin. [ABSTRACT FROM AUTHOR]

Background: Temporal trends of routinely obtained parameters may provide valuable information for predicting BSIs, but this association has not yet been established in LVAD patients. Methods: This retrospective analysis included data from 347 consecutive recipients of three rotary LVAD types. Study endpoints included the incidence of BSI, the association of temporal trends of routinely obtained blood biomarkers with the development of BSIs, the incidence of BSIs, and survival on LVAD support. Results: During follow‐up, 47.8% (n = 166) of the patients developed BSI. In multivariate analyses, the development of BSI was a significant predictor of mortality (HR 5.78, 95% CI 4.08–8.19, p < 0.0001). In univariate analyses, after adjusting for potential confounders, albumin (SHR 0.94, 95% CI 0.91–0.97, p < 0.00010), creatinine (SHR 1.49, 95% CI 1.03–2.15, p = 0.033), and C‐reactive protein (SHR 1.19, 95% CI 1.08–1.32, p = 0.0007) significantly predicted the development of BSIs during LVAD support. Notably, the strength of the association of parameter changes with the prediction of BSIs demonstrated a time‐dependent correlation in the cases of albumin (p = 0.045) and creatinine (p = 0.003). Conclusion: Bloodstream infections are highly prevalent among LVAD recipients and are independent predictors of mortality. Temporal biomarker trends significantly predict the development of BSIs. These findings suggest opportunities for interventions aiming to reduce the incidence of BSIs. [ABSTRACT FROM AUTHOR]

PURPOSE: Understanding the specific tumor characteristics associated with detectable circulating tumor DNA (ctDNA) in patients with renal cell carcinoma (RCC) is critical for informing future studies aiming to establish the clinical utility of such testing. We characterized the pathologic and clinical features associated with preoperatively detectable ctDNA in patients with renal masses suspicious for RCC. METHODS: Consecutive patients who underwent partial or radical nephrectomy for nonmetastatic suspected RCC (cT1b-T3) during 2022-2023 had prospectively collected tumor-informed ctDNA analyses conducted preoperatively and postoperatively. Descriptive statistics and univariate analyses were used to describe the study findings. RESULTS: Sixty-nine patients with a median age of 62 years (IQR, 51-70) and a median follow-up time of 7 months (IQR, 3-11) had 205 ctDNA samples collected for analysis. Thirty-nine (61%) had preoperative detectable ctDNA of 64 patients. Postoperative ctDNA status was available for 47 patients, and three (6%) had detectable ctDNA. Two had inferior vena cava (IVC) involvement, and one developed metastatic disease. Subgroup analysis of solely malignant RCC (n = 65) revealed that patients with preoperative detectable ctDNA had a higher pathologic stage (P =.001), larger tumors (7 v 4.5 cm; P =.001), higher tumor complexity (P =.022), and increased rates of tumor grades 3-4 (P =.038). All patients with gross renal vein or IVC involvement (n = 9) and those with lymphovascular invasion (n = 6) on pathology had detectable preoperative ctDNA. On univariate analysis, high tumor complexity, larger tumors, and tumor grades 3-4 were found to be predictors of preoperatively detectable ctDNA status. CONCLUSION: Preoperative ctDNA was detectable in 61% of patients with nonmetastatic RCC, and it correlated with clinically relevant features. Clinical trials should consider incorporating both preoperative and postoperative ctDNA analyses to augment prediction of disease recurrence and to refine treatment decision making. [ABSTRACT FROM AUTHOR]

Purpose: We measured corticosteroid medication adherence (CMA) in sarcoidosis patients and analyzed if demographic and clinical factors, beliefs about medications, corticosteroid side-effects, psychosocial status, and the doctor-patient relationship were associated with corticosteroid adherence. Methods: Sarcoidosis patients receiving corticosteroids were eligible to participate. CMA was measured using the Medication Adherence Response Scale-10 (MARS-10), a validated patient reported outcome measure (PRO). Data collection included patient demographics and clinical variables to assess their sarcoidosis phenotype. The patients were administered additional PROs concerning their psychosocial status, beliefs about medication use, corticosteroid side-effects and the strength of their doctor-patient relationship. Results: 132 patients were enrolled. Their mean prednisone dose was 9.9 ± 7.5 mg/day. 75% (99/132) were adherent with corticosteroids (MARS-10 ≥ 6) and 25% (33/132) were nonadherent (MARS-10 < 6). All demographic features, education level, and annual family income were not associated with CMA. Most clinical variables including spirometry, use of additional sarcoidosis drugs, number of organs involved with sarcoidosis were not associated with CMA. Almost all PROs including a better attitude toward medication use, less psychological issues, less corticosteroid side-effects, and a stronger doctor-patient relationship were associated with better CMA. A multi-logistic regression found that patient-doctor communication and the patient's intrinsic beliefs about the use of medications remained associated with CMA. Conclusion: We found no significant relationship between demographic or socioeconomic factors and CMA. Few clinical factors were associated with CMA. In a univariate analysis, CMA was associated with physician-doctor communication, beliefs about medication use, psychological/emotional issues, and corticosteroid side-effects. Only the first two of these factors remained associated with CMA in a multi-logistic analysis. These data suggest that CMA is heavily influenced by sarcoidosis patient beliefs about medications, and less so by patient demographics. [ABSTRACT FROM AUTHOR]

The association of AA with malignancies has been a scope of controversy as the current literature is highly inconsistent in this regard. To evaluate the association between AA and hematological malignancies (HMs) and solid malignancies (SMs) using a large-scale, real-life computerized database. A cross-sectional study was conducted to compare the prevalence of HMs and SMs among patients with AA relative to age-, sex-, and ethnicity-matched control subjects. Chi-square and t-tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. The study included 51,561 patients with AA and 51,410 controls. AA was significantly associated with HMs (adjusted OR, 1.27; 95% CI, 1.07–1.51; P = 0.006). This association was more robust among patients with late-onset AA (≥ 50 years; OR, 1.33; 95% CI, 1.04–1.71; P = 0.025). On the other hand, AA was not found to be significantly associated with SM (adjusted OR, 0.97; 95% CI, 0.88–1.06; P = 0.487), excluding among patients with alopecia totalis and universalis (OR, 2.10; 95% CI, 1.03–4.27; P = 0.036). In a granular analysis including 5 HMs and 18 SMs, non-Hodgkin lymphoma was the only malignancy that proved positively associated with AA (adjusted OR, 1.32; 95% CI, 1.03–1.69; P = 0.028). AA is associated with HMs but not SMs. Further research is warranted to validate our observations in other study cohorts. [ABSTRACT FROM AUTHOR]

Background: Ureteropelvic junction (UPJ) obstruction is the leading cause of pediatric hydronephrosis. While open pyeloplasty is highly effective, a small proportion of children experience recurrent ureteropelvic junction obstruction (UPJO) necessitating repeat intervention. We aimed to identify potential risk factors for pyeloplasty failure. Methods: We prospectively followed 126 children undergoing open Anderson-Hynes pyeloplasty between 2019 and 2021. Demographic, clinical, anatomical, procedural, and postoperative variables were recorded. Patients were monitored for recurrence, defined as worsening hydronephrosis and/or symptoms with diuretic renogram confirmation. Univariate and multivariate analysis identified factors associated with recurrence. Results: Median age at pyeloplasty was 17 months, left side was affected in 58% and 73.8% were male. At mean 28.8 months follow-up, UPJO recurred in 9 patients (7%). The only factor significantly associated with recurrence was prolonged postoperative urinary drain leakage, specifically recurrence occurred in 50% (3/6) of cases with prolonged leakage versus 5% (6/120) without (p = 0.005). Conclusions: Open pediatric pyeloplasty has a high success rate, yet a minority of patients will experience recurrence necessitating re-intervention. Prolonged urine leakage was the sole predictor of failed repair in our cohort, likely due to inflammation and perianastomotic scarring. Meticulous surgical technique and prompt leak management are vital to optimize pyeloplasty outcomes. Children at higher risk warrant close monitoring to enable early detection and renal salvage. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objective: To determine patient, defect, and surgical factors associated with facial reconstructive outcomes. Methods: Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015-2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of reconstruction, and postoperative complications and revisions were collected. Data was analyzed with multivariable logistic regressions. Results: 245 defects in 220 patients (median age 66 years, 143 (65%) female) were included. Most were located on the nose (68%), and median size was 3.0 cm2 (IQR 1.32-7.5 cm2). Defect size over 10 cm2 (OR 5.176, 95% CI 1.353-19.808) and two-staged melolabial flaps (OR 4.021, 95% CI 1.525-10.603) were associated with complications after univariate analysis. Nasal tip defects (OR 2.324, 95% CI 1.076-5.019) were associated with minor revisions. Major revisions were associated with nasal sidewall (OR 2.873, 95% CI 1.125-7.336) and tip (OR 2.780, 95% CI 1.145-6.749) defects, ear cartilage grafts (OR 3.373, 95% CI 1.382-8.231), two-staged paramedian forehead flaps (OR 19.273, 95% CI 6.864-54.112), and delayed reconstruction over 14 days (OR 5.727, 95% CI 1.298-25.281). On multivariable analysis, defect size over 10 cm2 (aOR 4.972, 95% CI 1.286-19.073) and two-staged melolabial flaps (aOR 4.575, 95% CI 1.628-12.857) were independently associated with complications, while two-staged paramedian forehead flaps (aOR 14.421, 95% CI 3.976-52.310) were independently associated with major revisions. Conclusions: More complex reconstructions with larger defects and interpolated flaps were associated with revision surgery and complications of facial reconstruction following MMS. [ABSTRACT FROM AUTHOR]

Background and aims: Microscopic colitis has been increasingly recognized as a cause of chronic diarrhoea. We aimed to characterize the role of disease-related factors and treatments on the clinical outcomes of microscopic colitis. Methods: We retrospectively reviewed the medical records of patients with microscopic colitis who were treated at the University of Chicago and Oregon Health & Science University between August 2010 and May 2016. Patient characteristics and treatments were evaluated as predictors of clinical outcomes using univariate and multivariate analyses. Clinical remission was defined as no symptoms associated with microscopic colitis based on physician assessment and histologic remission was defined as no evidence of histological inflammation of microscopic colitis. Results: Seventy-two patients with microscopic colitis were included in the study (28 with lymphocytic colitis and 44 with collagenous colitis). Non-steroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors were used in 23 (31.9%), 14 (19.4%) and 15 (20.8%), respectively, at the time of diagnosis. Among 46 patients with adequate follow-up data, 25 (54.3%) patients achieved clinical remission. Response to budesonide (p = .0002) and achieving histologic remission (p = .0008) were associated with clinical remission on univariate analysis. On multivariate analysis, budesonide response (p = .0052) was associated with clinical remission (odds ratio 25.00, 95% confidence interval 2.63-238.10). Among 22 patients who underwent a follow-up colonoscopy, five patients (22.7%) achieved histologic remission. All patients with histologic remission maintained clinical remission without medication, whereas only two patients (11.8%) were able to discontinue medical therapy when histologic inflammation was present (p = .0002). Conclusions: In the present cohort of patients with microscopic colitis, a favourable response to budesonide was significantly associated with long-term clinical remission, and all patients achieving histological remission were able to maintain clinical remission without further medical therapy. Larger studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

The present research aims to examine whether the questions in the Program for the International Student Assessment (PISA) 2009 reading literacy instrument display differential item functioning (DIF) among the Turkish, French, and American samples based on univariate and multivariate matching techniques before and after the total score, which is the matching variable, is purified of the items flagged with DIF. The study is a correlational survey model research, and the participants of the study consist of 4459 Turkish, French, and American students who took booklets 1, 3, 4, and 6 in the PISA 2009 reading literacy measure. Univariate and multivariate (bivariate, trivariate, and quadrivariate) DIF analyses were performed through logistic regression before and after purifying the matching variable off the items displaying DIF. Literature was used to detect extra matching variables, and multiple linear regression analysis was carried out. As a result of the analyses, it was discovered that using extra matching variables apart from the total score reduces type I errors. It was also concluded that the exclusion of DIF items (removal of items with DIF) while calculating the total score led to variation in the number of questions detected as DIF and DIF levels of the items, although it did not yield consistent results. [ABSTRACT FROM AUTHOR]

Background Nodal factors are important predictors of prognosis for papillary thyroid carcinoma (PTC), but their synergistic effect is not well understood. We aimed to explore their synergy in predicting recurrence of clinical N1b (cN1b) PTC. Methods Patients who underwent surgery for cN1b PTC from 2013 to 2017 were enrolled. The association between nodal factors and recurrence was assessed using Cox proportional hazards regression models. Interaction and stratified analyses were conducted according to significant nodal factors. Results Of 1067 cN1b PTC patients included, all nodal factors (bilateral metastasis, largest dimension > 3 cm, micro and gross extranodal extension (mENE, gENE), number of metastatic lymph nodes [MLN], lymph node yield [LNY], and ratio LNR]) were significantly associated with all site and nodal recurrence in the univariate analysis (all P <.05). Multivariate analyses revealed largest dimension > 3 cm, gENE and LNR > 0.21 were associated with elevated both all site (hazard ratio [HR] [95% CI], 2.58 [1.67-4.00], 1.87 [1.26-3.01], 1.68 [1.11-2.42], all P <.01) and nodal recurrences (HR [95% CI], 2.63 [1.67-4.13], 1.90 [1.15-3.12], 1.76 [1.17-2.66], all P <.01). LNR and gENE had interactive effect (all site recurrence: P for interaction =.009; nodal recurrence: P for interaction =.02). LNR was significantly associated with recurrence in patients without gENE (HR [95% CI], all site recurrence: 2.41 [1.50-3.87]; nodal recurrence: 2.51 [1.52-4.14], all P <.001), while when gENE appeared, LNR was no longer associated with recurrence (HR [95% CI], all site recurrence: 0.81 [0.43-1.54], P =.53; nodal recurrence: 0.85 [0.43-1.67], P =.64). Conclusion Nodal factors have synergistic effect in predicting recurrence in cN1b PTC patients. Increasing lymph nodes harvest may only decrease recurrence in patients without gENE, while not in gENE patients. [ABSTRACT FROM AUTHOR]

Purpose: Grade 3 meningiomas, although rare, are associated with high morbidity and mortality. The respective impacts of extent of surgical resection and adjuvant radiotherapy are still debated. Moreover, anaplastic meningiomas are studied in heterogenous cohort of de novo and progressive anaplastic tumors. Methods: We conducted a retrospective multicentric study on patients operated from a de novo anaplastic meningioma between 1999 and 2021. A centralized pathological review using 2016 WHO criteria was performed for all cases. Patients with history of radiotherapy or NF2-related Schwannomatosis were excluded. Results: Sixty-five patients were included in the study. Median progression free survival was 23 months and median overall survival was 2 years. Neither quality of resection nor adjuvant radiotherapy alone were predictive of better overall survival. Progression free survival were impacted by combination of gross-total resection and adjuvant radiotherapy (HR = 0.47 CI95% = [0.24–0.92], p = 0.027) and age at diagnosis (HR = 2.92 CI95% = [1.38–6.21], p = 0.005) in univariate analyses. Within anaplastic tumors, those graded on mitosis number had a poorer prognosis than those graded on overt anaplasia. Among anaplastic tumors with high mitotic score (> 20/10HPF), progression free survival were impacted by postoperative radiotherapy (HR = 0.44 CI95% = [0.22–0.88], p = 0.020) and gross total resection and adjuvant radiotherapy association (HR = 0.44 CI95% = [0.21–0.90], p = 0.024) in univariate analyses. Conclusion: Simpson grade didn't show any impact on overall survival. Gross total resection + adjuvant radiotherapy favorably impacted progression free survival in our cohort of de novo anaplastic meningiomas. [ABSTRACT FROM AUTHOR]

Percutaneous balloon ganglyolysis (PBG) for trigeminal neuralgia (TN) is an inexpensive and minimally invasive treatment modality that is effective and safe. While there are reports of its efficacy, there is still a lack of evidence of which patients are at a higher risk of treatment failures and needing retreatment. We performed a retrospective study at a major academic institution from 2012 to 2023, including TN patients who underwent PBG procedures to evaluate predictors of retreatment. Patients without imaging available from the PBG were excluded. Fifty-two patients who underwent 83 procedures in total were included in the analysis. All patients had typical TN and were primarily female (59.6%), with a median age of 61.5 years. Immediately after PBG, 42.3% had pain resolution, and 57.7% had improved but persistent pain. 30.8% underwent retreatment with PBG in a median of 32 months. From multiple factors assessed, TN disease duration ≤ 6 months and trigeminal nerve enhancement on pre-operative MRI were identified as significant retreatment predictors on univariate analysis. However, after performing logistic regression, only TN disease duration ≤ 6 months remained significant OR 3.99 (95% CI 1.59–10.0; p = 0.003). This was further confirmed in a Kaplan-Meier survival analysis, which showed that patients with TN duration ≤ 6 months require retreatment earlier (22 vs. 41 months; p = 0.01). Retreatment after PBG occurs roughly in a third of patients, and TN disease duration of ≤ 6 months is an important predictor in this study. Further studies should be performed to confirm these findings, which may impact treatment considerations in the future. [ABSTRACT FROM AUTHOR]

Background Objective Animals Methods Results Conclusion Although most cats with feline infectious peritonitis (FIP) respond to treatment with remdesivir or GS‐441524 or both with uneventful clinical courses, some die despite treatment.Identify predictive factors associated with short‐term mortality in cats with FIP treated with IV remdesivir or PO GS‐441524 or both.A total of 108 client‐owned cats with FIP.Retrospective multicenter study using data collected from medical records. Factors associated with short‐term mortality, defined as death within 84 days, were identified. Univariate analysis a t‐test, Mann‐Whitney U test, or Fisher's exact test and multivariate logistic regression were performed to assess patient characteristics and clinicopathological variables between survivors and nonsurvivors.The short‐term mortality rate was 12.0% (95% confidence interval [CI], 6.6%‐19.7%). Univariate analysis identified plasma lactate dehydrogenase activity (LDH; P < .001) and bilirubin concentration (P = .001) as being significantly increased in nonsurvivors, whereas concentrations of albumin (P = .003), total protein (P = .03), sodium (P = .005), and potassium (P = .005) were significantly lower. Additionally, nonsurvivors were significantly less likely to be febrile (≥39.4°C; P = .006). Of these variables, only plasma LDH activity ≥323 U/L, a cut‐point determined by receiver operating characteristic curve analysis, was significantly associated with short‐term mortality by multivariate analysis (odds ratio, 15.30; 95% CI, 1.18‐198.00; P = .04).Increased plasma LDH activity might be useful for predicting short‐term mortality, guiding monitoring, and establishing prognosis in cats with FIP. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusions To assess the relationships between dihydroergotamine (DHE) pharmacokinetic (PK) parameters, clinical efficacy, and nausea incidence to determine a DHE PK profile that optimizes efficacy while minimizing adverse events (AEs), particularly nausea.Dihydroergotamine is a widely used option for the acute treatment of migraine. Although multiple DHE dosage forms, with varying PK and AE profiles, have been evaluated in randomized controlled trials (RCTs), the relationships between PK profile, efficacy, and the common DHE‐related AE, nausea, have not been comprehensively evaluated.A literature search identified RCTs evaluating the efficacy (2‐h pain relief [2hPR]) of different DHE dosage forms. The PK profiles for these DHE dosage forms were determined from published literature. Univariate regression analyses were performed to determine the PK parameters that best predicted 2hPR across DHE dosage forms. The relationship between maximum plasma concentration (Cmax) and nausea incidence for various dosage forms was determined from published Phase 1 trials.The literature search identified nine RCTs with DHE dosage forms that reported 2hPR: DHE liquid nasal spray (four studies), DHE administered subcutaneously (three), and DHE administered via oral pulmonary inhalation (two). The DHE PK parameters that best predicted 2hPR rates were Cmax and area under the curve from time zero to 0.5 h post‐dose (AUC0‐0.5h) (R2 = 0.59 for each). Across Phase 1 trials, nausea incidence was minimal when Cmax was <2500 pg/mL but increased in a log‐linear manner when Cmax exceeded ~2500 pg/mL.The maximum concentration and AUC over the first 30 min following DHE administration were associated with increasing rates of 2hPR and a Cmax below ~2500 pg/mL was associated with low incidences of nausea. We suggest that this may be an optimal profile for a DHE delivery form. Further research to test this hypothesis is warranted. [ABSTRACT FROM AUTHOR]

Background: Pancreatic metastasis from renal cell carcinoma (PMRCC) is unusual and there is no consensus on its treatment. The present study aims to evaluate the clinical outcomes of surgical resection for PMRCC. Methods: PubMed and Web of Science were searched for Eligible studies from January 1980 to January 2024. Individual-patient data were pooled. Results: A total of 436 participants were identified. The morbidity and 90-day mortality were 38.1% and 3.4%, respectively. Post-pancreatectomy recurrence occurred in 44.1% of the patients. The overall median survival was 116 months, with a 3-, 5- and 10-year survival rate of 85.3%, 76.6%, and 46.5% respectively. On univariate analysis, repeat metastasectomy was associated with a significantly better prognosis (P =0.003). Conclusion: These data suggest that surgical resection is a safe and effective therapeutic option for PMRCC. Repeat metastasectomy is positively suggested for recurrent disease provided all metastases can be removed curatively. Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD42024525218. [ABSTRACT FROM AUTHOR]

Purpose: To test to what degree retinal fluid (RF) after the loading phase and at the end of year 1 predicts long-term functional outcomes in neovascular macular degeneration (nAMD), as do macular (MA) atrophy, treatment density and treatment interval extension. Methods: In this retrospective single-center cohort study, a consecutive series of eyes with treatment-naïve nAMD followed under a treat-and-extend (T&E) protocol followed over ≥2 years. Best-corrected visual acuity (BCVA), presence of retinal fluid (RF) and macular atrophy (MA) were registered along with central retinal thickness (CRT) and treatment density over time. The relationship between these variables was tested by regression analysis. Results: A total of 433 eyes were followed for 4.9 ± 2.2 years. A series of univariate analyses were run to select the covariates for the final multivariate regression model. CRT after loading, time to dryness, intraretinal fluid and MA after one year were found to predict visual function over 2 to 5 years. A final regression model was adjusted for visual acuity (VA) at baseline and showed that CRT after loading was predictive only in the short term (2 years) and that MA had the greatest predictive value for VA after 2 to 5 years. Intraretinal fluid (IRF) significantly predicted VA only after 4 years. The final regression model explained 21 to 32% of the variation in VA. Conclusions: In this large retrospective cohort, the presence of MA after one year was the strongest predictor of VA after 2 to 5 years, explaining a vision loss of 13 to 20 letters. The presence of IRF and SRF at any point of time had a comparably weak predictive potential for the outcomes over 5 and more years. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Esophagectomy with lymphadenectomy is the primary treatment for esophageal squamous cell carcinoma (ESCC). However, intensive dissection of lymph nodes (LNs) along the recurrent laryngeal nerve (RLN) is associated with RLN palsy and pulmonary complications leading to poor survival. Therefore, this study aimed identify the risk factors for LNs metastasis along the RLN in patients with ESCC.The present study included 168 patients with lower thoracic esophageal and esophagogastric junction (EGJ) squamous cell carcinoma who underwent esophagectomy with total mediastinal lymphadenectomy at Kobe University Hospital. Left/Right cervical paraesophageal (101 L/R), left/right recurrent nerve (106 recL/R), and left tracheobronchial LNs (106 tbL) were defined as LNs along the RLN. We evaluated the pathological distance between the proximal tumor boundary and the EGJ using images of the fixed specimen (PB‐EGJ length).LN metastasis along the RLN was observed in 19 (11%) patients. The percentage of patients with a longer PB‐EGJ length and cLNs metastasis was higher in the LNs metastasis along the RLN positive‐group than in the RLN‐negative group (p = 0.0075 and p = 0.013, respectively). The incidence of LNs metastasis along the RLN was 0% (95% confidence interval [CI] = 0–7.7%) when the PB‐EGJ length was <4 cm. Univariate analysis showed that patients with cLNs metastasis negative had a low risk for LNs metastasis along the RLN (odds ratio = 0.26 and 95% CI = 0.083–0.82).Patients with a PB‐EGJ length <4 cm and negative for cLNs metastasis may be candidates for the omission of lymphadenectomy along the RLN. [ABSTRACT FROM AUTHOR]

Background: Previous research has raised concerns regarding inconsistencies between reported and pre-specified outcomes in randomized controlled trials (RCTs) across various biomedical disciplines. However, studies examining whether similar discrepancies exist in RCTs focusing on gastrointestinal and liver diseases are limited. This study aimed to assess the extent of discrepancies between registered and published primary outcomes in RCTs featured in journals specializing in gastroenterology and hepatology. Methods: We retrospectively retrieved RCTs published between January 1, 2017 and December 31, 2021 in the top three journals from each quartile ranking of the 2020 Journal Citation Reports within the "Gastroenterology and Hepatology" subcategory. We extracted data on trial characteristics, registration details, and pre-specified versus published primary outcomes. Pre-specified primary outcomes were retrieved from the World Health Organization's International Clinical Trials Registry Platform. Only trials reporting specific primary outcomes were included in analyzing primary outcome discrepancies. We also assessed whether there was a potential reporting bias that deemed to favor statistically significant outcomes. Statistical analyses included chi-square tests, Fisher's exact tests, univariate analyses, and logistic regression. Results: Of 362 articles identified, 312 (86.2%) were registered, and 79.8% of the registrations (249 out of 312) were prospective. Among the 285 trials reporting primary outcomes, 76 (26.7%) exhibited at least one discrepancy between registered and published primary outcomes. The most common discrepancies included different assessment times for the primary outcome (n = 32, 42.1%), omitting the registered primary outcome in publications (n = 21, 27.6%), and reporting the registered secondary outcomes as primary outcomes (n = 13, 17.1%). Univariate analyses revealed that primary outcome discrepancies were lower in the publication year 2020 compared to year 2021 (OR = 0.267, 95% CI: 0.101, 0.706, p = 0.008). Among the 76 studies with primary outcome discrepancies, 20 (26.3%) studies were retrospectively registered, and 32 (57.1%) of the prospectively registered trials with primary outcome discrepancies showed statistically significant results. However, no significant differences were found between journal quartiles regarding primary outcome consistency and potential reporting bias (p = 0.14 and p = 0.28, respectively). Conclusions: This study highlights the disparities between registered and published primary outcomes in RCTs within gastroenterology and hepatology journals. Attention to factors such as the timing of primary outcome assessments in published trials and the consistency between registered and published primary outcomes is crucial. Enhanced scrutiny from journal editors and peer reviewers during the review process is necessary to ensure the reliability of gastrointestinal and hepatic trials. [ABSTRACT FROM AUTHOR]

This paper provides an in-depth discussion of the vibration and noise problems of integrated water tanks in new energy vehicles, which are directly related to the safety and ride comfort of the vehicle. In order to deeply understand the vibration mechanism of the water tank and evaluate the damping effect of different structures, this paper determines the frequency response excitation source of the water tank through experiments, and simulates the finite element model of the water tank using software. Through finite element analysis and modal analysis, the paper studied the vibration characteristics of the water tank in detail and compared the effect of different structures on the vibration-damping effect. This paper focuses on analyzing the effects of honeycomb structure size parameters (height, wall thickness, and side length) on the vibration of the water tank. The results show that there are modal differences between the tank with coolant and the cavity tank, and these differences lead to changes in the modal vibration pattern of the whole tank. Harmonic response analysis revealed that the displacement of the right wall was as high as 5.83 × 10−6mm and the vibration acceleration reached 0.37m/s2, both of which were the maximum values observed. Therefore, the right wall surface was identified as the critical region for vibration optimization. The honeycomb structure has more prominent advantages in vibration damping. Univariate analysis of the honeycomb structure concluded that an increase in the honeycomb height significantly increased the structural stiffness and effectively reduced the amplitude of vibration, with the damping effect particularly pronounced when the height exceeded 8mm. [ABSTRACT FROM AUTHOR]

Organ/space surgical site infection (SSI) are common after pancreaticoduodenectomy (PD). There is limited research on the clinical impact of intraoperative lavage fluid contamination in patients undergoing PD. One hundred five patients who underwent PD between August 2022 and July 2023 were retrospectively enrolled. The intraoperative bile and peritoneal lavage were collected for bacterial culture. Postoperative drainage bacterial cultures were performed every 2–3 days thereafter until drains were all removed. The bacteria isolated from intraoperative lavage fluid, intraoperative bile, and postoperative drainage fluid were examined in detail. The risk factors associated with positive intraoperative lavage fluid culture were analyzed through both univariate and multivariate analyses. Organ/space SSI occurred in 59(56.2%) of the 105 patients. The positivity rates of cultures in intraoperative lavage fluid, intraoperative bile, and postoperative drainage fluid were found to be 41.0%, 67.6%, and 84.8%, respectively. Patients with positive intraoperative lavage fluid culture had a significantly higher occurrence of organ/space SSI compared to the negative group (69.0% vs. 29.4%, P < 0.001). Preoperative biliary drainage (PBD) was identified as the only independent risk factor for the contamination of intraoperative lavage fluid (OR = 7.687, 95% CI: 2.164–27.300, P = 0.002). K. pneumoniae was the most common isolates both in the intraoperative lavage fluid and postoperative drainage fluid. Intraoperative lavage fluid contamination closely correlated with organ/space SSI after PD. Meanwhile, PBD was the only risk factor for the contamination of intraoperative lavage fluid. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop postsurgical progression/hyperprogression recurrence (type III-IV recurrence) prediction models for hepatocellular carcinoma (HCC) patients with macroscopic vascular invasion (MaVI) and to guide treatment strategies in the accurate healthcare era. Patients and methods: 393 HCC patients with MaVI from two central hospitals made up the entire study population. In developmental (290 patients) and validation (103 patients) cohorts, all patients were randomized into one or the other. Two prediction models for type III-IV recurrence were developed, based on the findings of univariate and multivariate analysis in the development cohort, and multidimensional verification was carried out in both cohorts. Results: The postoperative recurrence rate of type III-IV in 393 HCC patients with MaVI was 70.9%. Young age, large tumor size (≥ 10 cm), node number, incomplete tumor capsule, postoperative complications, and high Ki67 index were the independent risk factors for relapse of type III-IV. In the development cohort, two nomograms (pre- and postoperative) had the Area Under the ROC curve (AUC) of 0.827 and 0.891, respectively. The two nomograms performed well, according to multidimensional verification methods such as clinical impact curves, decision curve analysis (DCA), and calibration curves. The validation cohort saw similar encouraging results. Both nomograms could separate patients into two distinct prognosis subgroups with ideal cutoff values of 170.3 presurgery and 175.0 postsurgery (both P < 0.05). Conclusion: We constructed two novel and potentially clinically valuable models for predicting type III-IV recurrence. These two models can develop strategies for treating those suffering from HCC with MaVI owing to their strong prediction performance and availability. [ABSTRACT FROM AUTHOR]

Latent-cause inference is the process of identifying features of the environment that have caused an outcome. This problem is especially important in social settings where individuals may not make equal contributions to the outcomes they achieve together. Here, we designed a novel task in which participants inferred which of two characters was more likely to have been responsible for outcomes achieved by working together. Using computational modeling, univariate and multivariate analysis of human fMRI, and continuous theta-burst stimulation, we identified two brain regions that solved the task. Notably, as each outcome occurred, it was possible to decode the inference of its cause (the responsible character) from hippocampal activity. Activity in dorsomedial prefrontal cortex (dmPFC) updated estimates of association between cause—responsible character—and the outcome. Disruption of dmPFC activity impaired participants' ability to update their estimate as a function of inferred responsibility but spared their ability to infer responsibility. • Hippocampus tracks evidence for causes of outcomes during social interaction • Hippocampal activity reflects inference of cause • dmPFC activity updates estimates of association between cause and outcome • Hippocampus-dmPFC interaction is critical for inference-dependent update Using a combination of neural recording and disruption, Mahmoodi, Luo, and colleagues identify a hippocampal-prefrontal circuit for inferring the latent cause of an outcome and updating the association between the inferred cause and the outcome. Hippocampal activity reflects inference itself, while dorsomedial prefrontal cortex activity reflects updating. [ABSTRACT FROM AUTHOR]

Introduction: Patients with myasthenia gravis (MG) display strong treatment heterogeneity. Recent studies have indicated that low-dose steroids or immunosuppressants are effective. However, factors affecting the add-on of non-corticosteroid immunosuppressants to corticosteroids remain unknown. Method: Consecutive patients with MG were retrospectively reviewed from May 15, 2015, to December 29, 2020. We included one group of patients with steroid treatment alone and another group who transitioned to non-steroid immunosuppressant therapy. Clinical features of the included patients were analyzed. Univariate and multivariate Cox regression models were used to identify potential influential factors. Results: A total of 107 patients with MG were analyzed, including 66 receiving corticosteroid treatment alone and 41 who subsequently also received non-corticosteroid immunosuppressant therapy. Eight potential factors were primarily selected in univariate analysis (Ps < 0.1). Achieving minimal symptom expression (MSE) within 6 months (HR: 4.424, 95%CI: 2.102–11.865), body mass index (BMI) (HR: 0.385, 95% CI: 0.186–0.797), quantitative MG (QMG) bulbar muscle score (HR: 1.553, 95% CI: 1.140–2.118), disease duration (HR: 0.987, 95% CI: 0.977–0.997) and relapse (HR: 2.638, 95% CI: 1.031–6.750) were finally identified as potential influencing factors. Discussion: We found multifactorial clinical factors were highly associated with the add-on of non-steroid immunosuppressants after steroid treatment in patients with MG. Achieving MSE within 6 months, BMI, QMG bulbar muscle score at baseline before steroid treatment, disease duration, and disease relapse may represent crucial influencing factors, which should be considered to improve the long-term prognosis for patients with MG in future studies and practice. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid cancer (PTC) with lymph node metastasis (LNM) is associated with an increased risk of postoperative recurrence. Understanding the clinical characteristics of PTC patients can help surgeons assess the likelihood of LNM. This study aims to identify risk factors for LNM in PTC patients. Methods: We retrospectively analyzed clinical data from 2,428 patients diagnosed with PTC who underwent initial thyroid surgery in our single center. Risk factors related to central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and skip metastasis were investigated by univariate and multivariate binary logistic regression analyses. Results: Univariate analysis revealed that the following factors were associated with an increased likelihood of CLNM (P<0.05): male gender, age < 45 years, maximal axial diameter (MAD) > 1 cm, body mass index (BMI) ≥ 28 kg/m² and multifocality. Univariate analysis also revealed that patients with age < 45 years, MAD > 1 cm, BMI ≥ 28 kg/m², multifocality, and CLNM demonstrated a higher propensity for LLNM (P<0.05). Lower pole tumors were more likely to have CLNM than upper pole tumors, while upper pole tumors were more prone to present LLNM (P<0.05) and skip metastasis (P<0.05). Multivariable binary logistic regression analysis identified that gender (odds ratio [OR], 1.732; 95% CI, 2.113–2.577; P < 0.001), age (OR, 1.905; 95% CI, 1.596–2.273; P < 0.001), MAD (OR, 4.639; 95% CI, 3.639–5.913; P < 0.001), and multifocality (OR, 1.860; 95% CI, 1.453–2.381; P < 0.001) were independent risk factors for CLNM and MAD (OR, 5.289; 95% CI, 3.777–7.404; P<0.001), multifocality (OR, 1.858; 95% CI, 1.248–2.766; P=0.002), and CLNM (OR, 5.030; 95% CI, 3.347–7.561; P<0.001) for LLNM. Conclusion: Despite the overall postoperative recurrence rate in PTC patients is low, identifying risk factors such as male gender, age < 45 years, MAD > 1 cm, multifocality, and CLNM can help predict LNM. In specific cases, selective lymphadenectomy in the central or lateral neck area may be warranted. [ABSTRACT FROM AUTHOR]

The Nuss procedure is the most common corrective surgery for pectus excavatum. We analyzed treatment outcomes and complication rates in 1238 patients treated with the Nuss procedure from 2002 to 2021, focusing on the number of corrective bars used. Using Propensity Score Matching based on age, sex, BMI, pre-operative FEV1, and the Haller index, we created two groups: 546 patients with a single bar and 546 with two bars. Both groups achieved similar correction effects (Haller index: single bar = 2.58 vs. two bars = 2.56; p = 0.65). In the univariate analysis, in the two-bar group, the postoperative complications were observed more often (28.6% vs. 15.4%, p < 0.001), including pneumothorax (11.2% vs. 6.2%, p < 0.001), hemothorax (3.7% vs. 0.7%, p < 0.001), additional drainage (13.7% vs. 5.3%, p < 0.001), the need for thoracentesis (8.6% vs. 2.9%, p < 0.001), bar displacement (3.8% vs. 0.7%, p < 0.001), pleural effusion (10.6% vs. 3.1%, p < 0.001), and fever (6.6% vs. 3.8%, p < 0.041). In the logistic regression, two bars significantly increased the risk of postoperative complications (p = 0.019), including hematoma (p = 0.036), pleural effusion (p = 0.002), and the need for thoracentesis (p = 0.013). Using two corrective bars during the Nuss procedure is associated with a higher rate of postoperative complications but similar corrective results. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate whether the morphology of the duodenal major papilla is linked to transpancreatic precut sphincterotomy (TPS) failure. Methods: We conducted a retrospective review of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at our institution. The inclusion criteria involved patients with a naïve major duodenal papilla who required TPS due to difficult biliary cannulation. Papilla morphology was classified using Haraldsson's system, as follows: regular (Type 1), small (Type 2), protruding or pendulous (Type 3), and creased or ridged (Type 4). The analysis focused on identifying risk factors for TPS failure and related complications. Results: A total of 103 cases were analyzed, with an overall TPS success rate of 85.44%. There were no significant differences in age, gender, ERCP indications, or the prevalence of juxtapupillary diverticula across the four papilla types. The TPS failure rates by papilla type were Type 1 (10.53%), Type 2 (0%), Type 3 (16.67%), and Type 4 (28%). Type 4 papilla had a significantly higher failure rate compared to Type 1 and Type 2 in the univariate analysis (p = 0.028), but this was not statistically significant in the multivariate analysis (p = 0.052). Age emerged as an independent risk factor for TPS failure. Conclusions: Duodenal papilla morphology may influence the success rate of TPS, with advanced age being a key risk factor for failure. Identifying high-risk factors such as Type 4 papilla and older age can help endoscopists adjust their techniques early, potentially improving outcomes and minimizing complications. [ABSTRACT FROM AUTHOR]

Background: Despite the high recurrence rate of non‐muscle‐invasive bladder cancer (NMIBC), there are limitations in accurately predicting recurrence after transurethral resection of bladder tumor (TURBT) based on clinicopathological factors alone. However, prediction of recurrence using biomolecular characteristics of bladder tumors has not been applied to clinical practice. The objective of this study was to establish a new gene expression scoring system for identifying patients at high risk of recurrence. Methods: NMIBC and normal bladder samples were subjected to microarray analysis to obtain gene expression profiles. We identified 6 genes that were specifically upregulated in bladder cancer and also in recurrent cases. All patients were randomly grouped into a discovery cohort (n = 59) and a validation cohort (n = 30). Gene expression score (GES) was defined as the mean Z‐score of the 6 genes specific for recurrent bladder cancer. Results: The intravesical recurrence rate of the high GES group (n = 38) was higher than the low GES group (n = 21). GES was significantly associated with recurrence‐free survival in the validation cohort as well. In prognostic analysis, the European Organization for Research and Treatment of Cancer (EORTC) risk classification was not related to recurrence after TURBT in either univariate or multivariate analysis. On the other hand, the GES we developed was an independent factor for recurrence in NMIBC. Conclusions: A novel gene expression scoring system was shown to predict recurrence in NMIBC patients after TURBT and might be helpful in clinical decision‐making for NMIBC patients. [ABSTRACT FROM AUTHOR]

To examine the morphological impact of deep learning (DL)-quantified biomarkers on point-wise sensitivity (PWS) using microperimetry (MP) and optical coherence tomography (OCT) in intermediate AMD (iAMD). Patients with iAMD were examined by OCT (Spectralis). DL-based algorithms quantified ellipsoid zone (EZ)-thickness, hyperreflective foci (HRF) and drusen volume. Outer nuclear layer (ONL)-thickness and subretinal drusenoid deposits (SDD) were quantified by human experts. All patients completed four MP examinations using an identical custom 45 stimuli grid on MP-3 (NIDEK) and MAIA (CenterVue). MP stimuli were co-registered with corresponding OCT using image registration algorithms. Multivariable mixed-effect models were calculated. 3.600 PWS from 20 eyes of 20 patients were analyzed. Decreased EZ thickness, decreased ONL thickness, increased HRF and increased drusen volume had a significant negative effect on PWS (all p < 0.001) with significant interaction with eccentricity (p < 0.001). Mean PWS was 26.25 ± 3.43 dB on MP3 and 22.63 ± 3.69 dB on MAIA. Univariate analyses revealed a negative association of PWS and SDD (p < 0.001). Subclinical changes in EZ integrity, HRF and drusen volume are quantifiable structural biomarkers associated with reduced retinal function. Topographic co-registration between structure on OCT volumes and sensitivity in MP broadens the understanding of pathognomonic biomarkers with potential for evaluation of quantifiable functional endpoints. [ABSTRACT FROM AUTHOR]

We aimed to assess the factors affecting patient outcomes in multiple stent placements over a 10-year period. The single-center study included 1,200 patients who had multiple stents implanted at least twice or more. Participants were divided into the adverse outcomes as endpoints (n = 204 [17%]) and control groups. Univariate and multivariate analyses of stent-related adverse events risk during 10 years and logistic regression analysis of the adverse outcomes risk factors were performed. Univariate analysis revealed the impact of acute coronary syndrome (ACS), diabetes mellitus, hypertriglyceridemia, cumulative lesions in the left anterior descending (LAD) and left circumflex (LCX) arteries, number of stents in the LAD, LCX, and right coronary artery (RCA), presence of multiple coronary artery lesions, total number of stents used, and intervals between the first and second and between the fourth and fifth implantations. For secondary stent implantation, significant factors in univariate analysis included the number of LAD and LCX lesions, stents in LAD, LCX, and RCA, extent of coronary lesions, ACS, hypertension, diabetes, and total stent count. Many factors affect the outcomes in this patient group over time. Reducing the need for frequent percutaneous coronary intervention and considering the number of stents implanted are essential to improving outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Methods Results Conclusions Guidance and outcomes of coronary ischemia assessment (IA) in those with structural heart disease (SHD), presenting with monomorphic ventricular tachycardia (MMVT) is unclear.To assess the impact of IA on arrhythmic and non‐arrhythmic outcomes in those with SHD.Patients presenting with MMVT over a 6‐year period to a tertiary center were retrospectively analyzed. Propensity score‐matched analysis was performed comparing those undergoing IA to those who did not. The primary endpoint was a composite of VT recurrence, appropriate ICD therapy, heart failure hospitalization, and death. Secondary analysis of the individual components of the composite was performed. Kaplan–Meier, univariate and multivariate analysis was performed to compare the two groups and derive predictors of poor outcomes.Two hundred and seventeen patients (57.6% ICM) were analyzed. 55.8% underwent IA. Following propensity score‐matching, 120 patients remained. At 12 months, freedom from the primary endpoint was 68.3% of those undergoing IA versus 43.3% who did not, p < 0.001, multivariate HR 0.56 (0.34–0.92). This was driven by a reduction in all‐cause mortality, with a 12‐month survival of 98.3% in those undergoing IA versus 86.5% in those not undergoing IA (p < 0.01). Coronary intervention was associated with a significantly higher event‐free 12‐month survival compared to those who did not undergo intervention (82.4% vs 51.5%, respectively, p = 0.01).Patients with SHD presenting MMVT who undergo an IA have significantly improved freedom from VT recurrence, appropriate ICD therapies, HF hospitalization, and death compared to those who do not, driven by a reduction in mortality. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort. Objective. The purpose of this study was to compare the efficacy of cefazolin versus vancomycin for perioperative infection prophylaxis. Summary of Background Data. The relative efficacy of cefazolin alternatives for perioperative infection prophylaxis is poorly understood. Materials and Methods. This study was a single-center multisurgeon retrospective review of all patients undergoing primary spine surgery from an institutional registry. Postoperative infection was defined by the combination of three criteria: irrigation and debridement within 3 months of the index procedure, clinical suspicion for infection, and positive intraoperative cultures. Microbiology records for all infections were reviewed to assess the infectious organism and organism susceptibilities. Univariate and multivariate analyses were performed. Results. A total of 10, 122 patients met inclusion criteria. The overall incidence of infection was 0.78%, with an incidence of 0.73% in patients who received cefazolin and 2.03% in patients who received vancomycin (OR: 2.83, 95% CI: 1.35-5.91, P = 0.004). Use of IV vancomycin (OR: 2.83, 95% CI: 1.35-5.91, P = 0.006), BMI (MD: 1.56, 95% CI: 0.32-2.79, P = 0.014), presence of a fusion (OR: 1.62, 95% CI: 1.04-2.52, P = 0.033), and operative time (MD: 42.04, 95% CI: 16.88-67.21, P = 0.001) were significant risk factors in the univariate analysis. In the multivariate analysis, only noncefazolin antibiotics (OR: 2.48, 95% CI: 1.18-5.22, P = 0.017) and BMI (MD: 1.56, 95% CI: 0.32-2.79, P = 0.026) remained significant independent risk factors. Neither IV antibiotic regimen nor topical vancomycin significantly impacted Gram type, organism type, or antibiotic resistance (P> 0.05). The most common reason for antibiosis with vancomycin was a penicillin allergy (75.0%). Conclusions. Prophylactic antibiosis with IV vancomycin leads to a 2.5 times higher risk of infection compared with IV cefazolin in primary spine surgery. We recommend the routine use of IV cefazolin for infection prophylaxis, and caution against the elective use of alternative regimens like IV vancomycin unless clinically warranted. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) is a common issue among adult males. The Composite Dietary Antioxidant Index (CDAI) reflects anti-inflammatory levels and has been linked to various diseases, but its relationship with ED is unclear. Materials and methods: This cross-sectional study utilised comprehensive data on clinical factors from the 2001–2004 National Health and Nutrition Examination Survey (NHANES). To investigate the link between variables and ED, we used multivariate regression analysis, univariate analysis, and subgroup analysis. The linear relationship between CDAI and ED was investigated by dose-response curve analysis. For sensitivity analysis, propensity score matching (PSM) was utilised to exclude the influence of potential confounders. Finally, we investigated the association between CDAI and ED using threshold effects analysis. Results: We included in our research a total of 2896 persons with data on CDAI from NHANES 2001–2004. Among these, 2,098 participants were thought to be free of ED, whereas 798 participants had ED. We found that compared to the ED group, men in the non-ED group had higher levels of CDAI (p < 0.0001 before PSM and p = 0.0145 after PSM). Additionally, after adjusting for covariates, it was found that an elevated CDAI was associated with a reduced incidence of ED [OR = 0.65(p = 0.001) before PSM and OR = 0.62(p = 0.002) after PSM]. Subgroup analysis indicated stronger associations in high-risk groups, and dose-response curves confirmed a linear negative correlation between CDAI and ED. Conclusions: This study revealed a negative linear relationship between CDAI and the incidence of ED. The CDAI can be used as an indicator for assessing ED risk and for ED prevention. [ABSTRACT FROM AUTHOR]

Purpose: We compared surgical complications after laser prostatic photovaporization in anticoagulated versus non-anticoagulated patients. Methods: A propensity score was calculated and patients were matched, to compare postoperative complications using the Clavien-Dindo classification between the anticoagulated and non-anticoagulated groups. We also identified factors associated with complications, and perform an analysis of secondary endpoint with categories of urological complications. Results: We included all patients that benefited a photovaporization between 2013 and 2022, either 811 patients, reducing to 245 after propensity score matching for anticoagulation. After propensity score matching, there were no differences in baseline characteristics between groups. Ninety five patients (38%) were receiving anticoagulants; 162 (66%) had an ASA score ≥ 3. Among 86 patients (35%) who experienced complications within 3 months postoperatively, 92% had a Clavien Dindo score ≤ 2. By multivariate analysis, anticoagulation was not statistically significant, the only significant risk factor for complications was ASA score ≥ 3 (Odds ratio (OR) 2.2; 95% confidence interval (CI) [1.2–4.1]). Secondary endpoint analysis for hematuria found ASA score of 3 or higher and anticoagulant treatment statistically significant in univariate and multivariate analysis, with OR of 2.9 (95% CI [1.1–7.4]) and OR of 3.5 (95% CI [1.7–7.5]), respectively. Conclusion: Green light laser photovaporization of the prostate demonstrates significant safety, even in frail patients on anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Since the development of tremelimumab plus durvalumab (Dur/Tre) for unresectable hepatocellular carcinoma (uHCC), it has been used as not only an initial but also later line treatment in clinical practice. This study aimed to elucidate clinical prognostic factors for progression‐free survival (PFS) in Dur/Tre treatment cases.Enrolled were 183 uHCC patients treated with Dur/Tre from 2023 to May 2024 (median age, 74 years; male patients, 152; Child–Pugh class A:B, 150:33; Barcelona Clinic Liver Cancer stage B:C, 59:124; initial line use, 64). Clinical factors with prognostic influence on PFS in these patients were retrospectively evaluated.The median observation period was 7.2 months (interquartile range, 3.2–10.4). History of atezolizumab plus bevacizumab (Atz/Bev) treatment was the only significant prognostic factor for PFS at introduction of Dur/Tre in multivariate analysis (hazard ratio 2.040, p = 0.028) (median PFS: without vs. with = 5.6 vs. 2.7 months, p < 0.001). Although immune‐mediated adverse events (imAE) occurrence was only significant in univariate analysis, when objective response and disease control rates were examined according to imAE positivity (any grade) at the time of analysis, those were noted in 14.4% and 39.2%, respectively, of patients without imAE, while in patients with imAE (any grade), they were noted in 18.2% and 56.1%, respectively (p = 0.523 and p = 0.038, respectively).History of Atz/Bev treatment may be an independent clinical factor for poor PFS at Dur/Tre introduction. [ABSTRACT FROM AUTHOR]

Background: We found that a subset of patients with monoclonal gammopathy exhibited hypercalcemia without apparent causes or clinical manifestations In a cohort of 289 monoclonal gammopathy patients, 2.4% presented with such atypical hypercalcemia, with one notable case exhibiting normal ionized calcium levels, suggesting the presence of pseudohypercalcemia. Objective: The aim of this study is to elucidate the factors contributing to pseudohypercalcemia in monoclonal gammopathy and to develop a novel globulin-corrected calcium formula for clinical application. Methods: This observational study enrolled 110 monoclonal gammopathy patients from our center. An additional 33 patients were recruited to validate the newly proposed formula. Univariate analysis identified potential risk factors. And multivariate logistic regression identified definitive influential factors. The determined influential factors were utilized to develop a formula by multiple linear regression, which was validated by a paired t-test and the Youden index. Results: This study found that globulin was a risk factor for pseudohypercalcemia. It revealed that pseudohypercalcemia should be considered in patients with globulin levels ≥61 g/L (P =0.014). Both albumin and globulin were confirmed as independent factors associated with bound calcium. Given that, we developed a formula to correct ionized calcium levels, which was consistent with ionized calcium tested by blood gas analysis. The diagnostic accuracy of the new formula (Youden index is 0.906) is better than the traditional formula (Youden index is 0.906). Interestingly, all monoclonal immunoglobulin types, except for light chains, showed an equal propensity to develop pseudohypercalcemia (P =0.306). It also showed a linear correlation between IgA, IgG, and IgM and bound calcium. Conclusion: This study confirmed that elevated globulin affects serum total calcium and offered the threshold of globulin ≥ 61 g/L in the differential diagnosis of peudohypercalcemia from hypercalcemia. The new formula based on albumin and globulin was developed, which was verified to be better than the traditional formula for correctly diagnosing hypercalcemia. In addition, we found that neither light chains nor heavy chains of monoclonal immunoglobulin alone can result in pseudohypercalcemia. [ABSTRACT FROM AUTHOR]

Background: The association of lipoprotein-associated phospholipase A2 (Lp-PLA2) with various cardiovascular events has been well-established. However, the exploration of its potential involvement in Chronic obstructive pulmonary disease (COPD) is currently limited. Therefore, our study aims to examine the relationship between Lp-PLA2 and pulmonary conditions, including emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction, to provide further evidence of a possible association with COPD development. Methods: Using data from the Southwest Hospital Health Management Center, spanning January 2013 to July 2024, we analyze relationship of serum Lp-PLA2 levels with diffuse pulmonary emphysema and pulmonary functions. In univariate analysis, group differences were assessed with t-tests for numerical variables and Chi-square tests for categorical data. Variables found to be statistically significant (two-sided P < 0.05) in univariate analysis were subsequently included as covariates in multivariate analysis, performed using a binary logistic regression model. Odds ratios and 95% confidence intervals were calculated to assess the differences. Results: We established 2 case-control populations: the Imaging population (1056 subjects, mean age 57.666 ± 8.700 years old, 89.9% male) selected from 24,670 initial records, and the Pulmonary Function population (279 subjects, mean age 52.082 ± 11.473 years old, 71.4% male) selected from 1868 initial records. Univariate analysis revealed that serum Lp-PLA2 levels were significantly higher in patients with diffuse pulmonary emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction compared to those without (454.682 ± 141.382U/L vs. 423.330 ± 140.658U/L, P < 0.001; 475.059 ± 157.181U/L vs. 420.824 ± 142.119U/L, P = 0.006; 475.31 ± 148.980U/L vs. 439.036 ± 157.977U/L, P = 0.049, respectively). Multivariate analysis further showed higher Lp-PLA2 levels were associated with increased risks of diffuse pulmonary emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction. Using Lp-PLA2 ≤ 300 U/L as reference, odds ratios for the aforementioned conditions showed a gradually increasing trend with every 100U/L increase in Lp-PLA2 levels. Conclusions: Our preliminary study suggests that Lp-PLA2 is independently associated with diffuse pulmonary emphysema, obstructive ventilatory dysfunction as well as small airway dysfunction, which are commonly seen in COPD development. These findings indicated a possible association between Lp-PLA2 and COPD, though further validation is needed in a large cohort of COPD patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the value of multiple indicators in the evaluation of risk factors for intestinal adhesion (IA) after appendectomy in children with acute appendicitis (AA). Methods: A retrospective study was conducted on 608 patients who underwent appendectomy in the Department of Pediatric Surgery, Children's Medical Center of Jilin Province from January 2017 to April 2023, with a one-year follow-up period to record the occurrence of IA after appendectomy. Univariate and multivariate analysis were used to screen the risk factors of postoperative IA, and a prediction model was established to predict postoperative IA. Results: There were 527 patients in the non-IA group and 81 patients in the IA group. Binary Logistic regression was used to determine the strength of correlation with postoperative intestinal adhesion. The risk factors identified were as follows: DS ≥ 43 h (OR = 3.903, 5points), CRP ≥ 65 mg/L (OR = 3.424, 4.5points), PCT ≥ 0.9 µg/L (OR = 8.683, 8points), Surgical duration ≥ 100 min (OR = 6.457, 7points), Appendiceal perforation (OR = 6.073, 6.5points), Postoperative exhaust time ≥ 55 h (OR = 14.483, 10points). After test, the nomogram drawn based on binary logistic regression can obtain good prediction efficiency. In the training set, the area under the curve was 0.960, the sensitivity was 0.898, and the specificity was 0.905. In the test set, the area under the curve was 0.957, the sensitivity was 0.864, and the specificity was 0.906. Conclusion: Postoperative exhaust time ≥ 55 h has a high risk of IA after appendicitis surgery in children. Early recovery of intestinal peristalsis function is essential. This scoring model is a novel and promising method for predicting postoperative IA. [ABSTRACT FROM AUTHOR]

Background: Pain is a relatively common complication after hook-wire puncture localization. However, the problem of pain occurrence following this localization procedure has not been sufficiently examined. In this prospective study, we aimed to investigate the incidence and risk factors associated with acute pain after preoperative CT-guided hook-wire puncture localization of pulmonary nodules. Methods: Clinical data were collected prospectively from patients with small pulmonary nodules who underwent preoperative CT-guided hook-wire puncture localization between May 2022 and May 2023 at the Affiliated Hospital of Xuzhou Medical University. Patients were divided into two groups on the basis of the presence or absence of moderate-to-severe pain following the localization process. Univariate logistic analysis was conducted to analyse the clinical data of the two groups. Subsequently, the significant variables (P < 0.1) from the univariate analysis were subjected to multivariate logistic analysis, followed by the establishment of regression equations to determine the significant risk factors related to moderate-to-severe pain after hook-wire puncture localization. Results: A total of 281 patients with small pulmonary nodules undergoing preoperative CT-guided hook-wire puncture localization were finally included, with a mean age of 54.86 years (SD = 12.1 years) and female predominance (67.6%). In the resting state, 53% of the patients reported moderate-to-severe pain. Univariate analysis revealed that age (P = 0.085), the depth of localization needle insertion into the lung (P = 0.024) and the location of the chest wall puncture (P = 0.07) were associated with moderate-to-severe pain occurrence after hook-wire puncture localization (P < 0.1). Furthermore, multivariate logistic regression analysis demonstrated that the depth of localization needle insertion into the lung (OR = 0.953, 95% CI: 0.914–0.992, P = 0.02) and the location of the chest wall puncture (lateral chest wall vs. anterior chest wall: OR = 2.101, 95% CI: 1.166–3.784, P = 0.013; posterior chest wall vs. anterior chest wall: OR = 1.163, 95% CI: 0.895–2.971, P = 0.11) were independent predictors of moderate-to-severe pain incidence following CT-guided hook-wire puncture localization (P < 0.05). Conclusion: Moderate-to-severe pain is prevalent in patients with pulmonary nodules who undergo preoperative CT-guided hook-wire puncture localization. The depth of needle insertion into the lung and the location of the chest wall puncture are significant predictors of moderate-to-severe pain onset. [ABSTRACT FROM AUTHOR]

Objective: Chronic inflammation's role in the pathogenesis, development, and rupture of vascular malformations is undebated. Advanced magnetic resonance imaging techniques with vessel wall studies, specifically Black Blood (bbMRI), may offer insights into vascular wall instability and predict rupture. This case series aims to assess bbMRI as a predictive diagnostic tool for brain arteriovenous malformations (bAVMs) rupture, suggesting early treatment. Material and methods: A prospective study included demographic, clinical, and neuroimaging data from a consecutive series of patients with ruptured or unruptured bAVMs, regardless of age or gender, between October 2018 and March 2024. All patients underwent MRI brain resonance with Black Blood study. Those with impaired renal function were excluded. Statistical analyses tested sample homogeneity. Univariate and multivariate logistical regressions assessed bbMRI as a rupture predictor for bAVMs, with a p-value set at < 0.05. Results: Ninety patients were retrieved: 64 with unruptured and 26 with ruptured bAVMs. The mean age was 31.9 years, and 55 were female. Admission symptoms were headache, neurological deficits, and seizure in 49, 21, and 19 cases, respectively. bbMRI showed wall enhancement in 56 cases, with 19 in the ruptured and 37 unruptured groups. Univariate and multivariate analyses revealed a significant correlation between bbMRI wall enhancement and bAVM rupture (p:0.033; p:0.047). Conclusion: bbMRI may be a useful and feasible diagnostic implement to determine vessel inflammation and the bAVMs prone to rupture. Additional studies are needed to confirm the positive bbMRI as a predictive factor for bAVMs rupture. [ABSTRACT FROM AUTHOR]