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Purpose: Metformin, widely used for the treatment of diabetes mellitus (DM), has shown potential for inhibiting abdominal aortic aneurysm (AAA) growth by reducing extracellular matrix remodeling and inflammation. However, its influence on clinical outcomes and aneurysm sac dynamics after endovascular aneurysm repair (EVAR) remains uncertain. This retrospective study aims to explore the effects of metformin on long-term outcomes following EVAR.Materials and Methods: Patients who underwent elective standard EVAR for infrarenal AAA at a single academic Dutch hospital from 2000 to 2022 were included. We collected baseline patient demographics, comorbid conditions, anatomical and operative characteristics, and 30-day postoperative events. Metformin use was defined as using it preceding EVAR. The primary outcome, the postoperative aneurysm sac volume over time, was investigated using linear mixed-effects modeling. The secondary outcomes, 8-year all-cause mortality and freedom from graft-related events, were evaluated using Kaplan-Meier methods.Results: We analyzed 685 patients, including 634 (93%) non-metformin users and 51 (7%) metformin users. The median follow-up period was similar (4.0 years [IQR=1.5, 6.5] vs 5.0 years [IQR=2.0, 8.0]; p=0.091). Patients on metformin had a preoperative aneurysm sac volume of 153 cc (IQR=114, 195) compared with 178 cc (IQR=133, 240) for non-metformin patients (p=0.054). At 30 days post-EVAR, metformin patients had a comparable mean aneurysm sac volume compared with non-metformin patients (metformin: -19.4 cc [95% confidence interval [CI]: -47.4, 8.5]; p=0.173). The effect of metformin on aneurysm growth over time was not significant (-3.9 cc/year; [95% CI: -22.7, 14.9]; p=0.685). Following risk-adjusted analysis, metformin use was associated with similar rates of all-cause mortality (metformin vs no metformin: 50% vs 44%; hazard ratio [HR]=1.11, 95% CI: 0.66, 1.88; p=0.688) and freedom from graft-related events (metformin vs no metformi

Since 2020, our lab has received blood samples from traffic cases involving suspicion of driving under the influence of nitrous oxide (N2O). While N2O analysis by gas chromatography (GC) has been around for decades, quantitative results in blood from drivers have been only scarcely reported. We present a three-year (2020–2022) retrospective study of N2O from traffic cases in Eastern Denmark with suspected involvement of N2O intake. Whole blood samples from traffic cases were analysed for N2O using headspace-GC-MS. Freshly made calibration curves and additions of xenon gas as an internal standard were used for calculation of N2O concentrations. Positive samples have been defined as having concentrations greater than 0.1 mL N2O/L blood. Over a three-year period, we have tested 62 traffic case blood samples for the presence of N2O. Despite the technical challenges associated with the analysis of N2O, we have found N2O in 52 of the samples. Calculated concentrations were in the range 0.1–48 mL N2O/L blood, which are similar to the few cases previously found in the literature.

BACKGROUND: New onset refractory status epilepticus (NORSE) is a neurologic emergency without an immediately identifiable cause. The complicated and long ICU stay of the patients can lead to perceiving a prolongation of therapies as futile. However, a recovery is possible even in severe cases. This retrospective study investigates ICU treatments, short- and long-term outcome and ethical decisions of a case series of patients with NORSE. METHODS: Overall, 283 adults were admitted with status epilepticus (SE) to the Neurocritical Care Unit of the University Hospital Zurich, Switzerland, between 01.2010 and 12.2022. Of them, 25 had a NORSE. We collected demographic, clinical, therapeutic and outcome data. Descriptive statistics was performed. RESULTS: Most patients were female (68%), previously healthy (Charlson comorbidity index 1 [0-4]) and relatively young (54 ± 17 years). 96% presented with super-refractory SE. Despite extensive workup, the majority (68%) of cases remained cryptogenic. Most patients had a long and complicated ICU stay. The in-hospital mortality was 36% (n = 9). The mortality at last available follow-up was 56% (n = 14) on average 30 months after ICU admission. The cause of in-hospital death for 89% (n = 8) of the patients was the withholding/withdrawing of therapies. Medical staff except for one patient triggered the decision. The end of life (EOL) decision was taken 29 [12-51] days after the ICU admission. Death occurred on day 6 [1-8.5] after the decision was taken. The functional outcome improved over time for 13/16 (81%) hospital survivors (median mRS at hospital discharge 4 [3.75-5] vs. median mRS at last available follow-up 2 [1.75-3], p < 0.001). CONCLUSIONS: Our data suggest that the long-term outcome can still be favorable in NORSE survivors, despite a prolonged and complicated ICU stay. Clinicians should be careful in taking EOL decisions to avoid the risk of a self-fulfilling prophecy. Our results encourage clinicians to continue treatme

Highlights: What are the main findings? This multicenter retrospective study, encompassing two hospital sites for training and leveraging data from forty-seven different hospitals for testing, aimed to develop machine learning models utilising both clinical and radiomics features (individually and in combination) extracted from pre-treatment CT scans. The objective was to predict PFS and OS in patients with PDAC. Among the various models developed, the model based on the combination of clinical and CT-derived tumour radiomics features demonstrated superior performance for OS with a C-index of 0.72 in the testing dataset. Conversely, the model based solely on clinical features excelled in predicting PFS, achieving a C-index of 0.70 in the testing dataset. What is the implication of the main finding? The analysis further highlighted the high relevance of clinical features both for OS and PFS outcomes in patients with PDAC. Purpose. This multicenter retrospective study aims to identify reliable clinical and radiomic features to build machine learning models that predict progression-free survival (PFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC) patients. Methods. Between 2010 and 2020 pre-treatment contrast-enhanced CT scans of 287 pathology-confirmed PDAC patients from two sites of the Hopital Universitaire de Bruxelles (HUB) and from 47 hospitals within the HUB network were retrospectively analysed. Demographic, clinical, and survival data were also collected. Gross tumour volume (GTV) and non-tumoral pancreas (RPV) were semi-manually segmented and radiomics features were extracted. Patients from two HUB sites comprised the training dataset, while those from the remaining 47 hospitals of the HUB network constituted the testing dataset. A three-step method was used for feature selection. Based on the GradientBoostingSurvivalAnalysis classifier, different machine learning models were trained and tested to predict OS and PFS. Model performances, SCOPUS: ar.j, info:eu-repo/semantics/published

Purpose: Tildrakizumab is a selective inhibitor of IL-23 approved for the treatment of moderate-to-severe plaque psoriasis in two dosages. We conducted a 16-week multicenter retrospective study to compare the effectiveness and safety of tildrakizumab 200 mg versus tildrakizumab 100 mg in patients with a high disease burden or high body weight. Materials and methods: Our retrospective study included 134 patients treated with tildrakizumab 200 mg and 364 patients treated with tildrakizumab 100 mg from 28 Italian Dermatology Units affected by moderate-to-severe plaque psoriasis. The patients had a body weight above 90 kg or a high disease burden (Psoriasis Area and Severity Index [PASI] ≥ 16 or the involvement of difficult-to-treat areas). We evaluated the effectiveness of tildrakizumab at the week-16 visit in terms of PASI90, PASI100 and absolute PASI ≤ 2. Results: After 16 weeks of treatment with tildrakizumab 200 mg, PASI90 was reached by 57.5% of patients and PASI100 by 39.6% of patients. At the same time point, 34.3% and 24.2% of patients treated with tildrakizumab 100 mg achieved PASI90 and PASI100, respectively. Conclusions: Our data suggest that tildrakizumab 200 mg has better effectiveness than tildrakizumab 100 mg in patients with a body weight ≥ 90 kg and a high disease burden.

Lingual nerve injury (LNI) is a rare, serious complication and previous studies include limited numbers of cases. The aim of this retrospective study was to report the neurosensory outcomes for a large patient cohort with permanent LNI and correlate the mechanism of injury (surgical vs non-surgical) to neurosensory characteristics. Demographics, procedural parameters, mandibular third molar (M3) position, surgeon type, neurosensory test results, and symptoms were recorded for 228 patients and analysed. The majority were female (67.1%). Overall, 59.6% of LNIs were caused by M3 removal and 36.4% by local anaesthesia. Complete loss occurred more frequently in surgical LNIs (P = 0.013). The presence of pain did not differ significantly, however the burning type of pain was significantly more frequent in non-surgical LNIs (P = 0.008) along with altered gustation (P = 0.025). The most common M3 position related to LNI was distoangular (40.4%), class III (63.2%), level A (58.1%) (Winter/Pell and Gregory classifications). The majority of patients undergoing M3 removal were >24 years. A total of 71.7% showed no sign of recovery and 5.5% reported further impairment in their condition. Overall, nine patients underwent microsurgical repair. This study presents neurosensory characteristics potentially decisive for timely referral of operable LNIs.

Background: Robot-assisted esophagectomy (RAE), video-assisted minimally invasive esophagectomy (VAMIE), and open esophagectomy (OE) all have significant roles in the management of esophageal cancer (EC). Few studies have compared efficacy and safety between RAE, VAMIE, and OE for resectable EC after neoadjuvant treatment. Therefore, this study aimed to explore the short-term outcomes between RAE, VAMIE, and OE for resectable EC after neoadjuvant treatment. Methods: Ninety-eight patients were consecutively enrolled who underwent esophagectomy. A retrospective study was performed including 98 consecutive patients treated from January 2021 to August 2022 who received neoadjuvant treatment (including immunochemotherapy and chemoradiotherapy) followed by RAE, VAMIE or OE. Evaluated endpoints in the present study consisted of pathological outcomes, intraoperative and postoperative outcomes, as well as postoperative complications. Results: No significant differences were seen in the operating time, blood loss, length of intensive care unit (ICU) stay, R0 resection, and number of dissected lymph nodes between the three RAE, VAMIE, or OE groups. The achievement rate of right recurrent laryngeal nerve (RLN) lymph node removal (P=0.01) and the total cost (P<0.001) were higher in RAE. The postoperative hospital stay of OE was longer than the other two groups (P<0.05). There were no significant differences in postoperative complications. Conclusions: Compared to VAMIE, no clear benefit exists for RAE in the treatment of resectable EC after neoadjuvant therapy. OE resulted in a longer hospital stay. Although the rate of successful right RLN node removal was higher with RAE, the clinical relevance for this is yet unclear.

Objectives. The medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts. Methods. This retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal crosssectional area (CSmin) were also considered. Results. All PAs’ volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p<0.05). Inter-group comparisons showed significant differences (p<0.05) for nasopharynx and CSmin parameters (p<0.05), while no significant changes were recorded for the other UA’s subregions and PW (p>0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. Conclusions. Twelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. Clinical Significance. From the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.

Background. Transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) has an analgesic effect superior to a placebo in chronic pain. Some years ago, tDCS was implemented at the Hospital Nacional of Paraplegics (Toledo, Spain) to treat patients with pharmacological resistance to chronic pain. Objective. The main objectives of this study with tDCS were (1) to confirm the safety of one-year treatment; (2) to estimate the number of patients after one year in treatment; (3) to describe the effects of tDCS on the pain intensity during one-year treatment; and (4) to identify factors related to treatment success. Methods. This was a retrospective study conducted at the National Hospital for Paraplegics with 155 patients with pharmacologically resistant chronic pain. Anodal tDCS was applied over the M1 for 20 min at 1.5 mA for 10 treatment sessions from Monday to Friday (Induction phase), followed by 2-3 sessions per month (Maintenance phase). Pain intensity was assessed using a Visual Analogue Scale (VAS). Results. Anodal tDCS on M1 confirmed the reduction in the pain intensity. Moreover, 58% of outpatients completed one year of treatment. Only the VAS values obtained during the baseline influenced the response to treatment. Patients with a very high VAS at the baseline were more likely to not respond adequately to tDCS treatment. Conclusions. Anodal tDCS over M1 is an adequate therapy (safe and efficient) to treat drug-resistant chronic pain. Moreover, pain intensity at the start of treatment could be a predictor of patients' continuity with tDCS for at least one year.

Jiraporn Sri-on,1 Jesda Phumsrisawat,2 Rapeeporn Rojsaengroeng2 1Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; 2The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, ThailandCorrespondence: Jiraporn Sri-on, Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen road, Bangkok, Dusit, 10130, Thailand, Tel +66 896840010, Email Jiraporn.rew@gmail.comPurpose: This study aimed to determine the percentage of missed opportunities (MOs) to identify and treat older adults presenting with palliative care (PC) needs at one emergency department (ED). The secondary objective was to determine the rate of treatment interventions regardless of whether the patients received a PC plan as well as the direct cost of treatment.Patients and Methods: In this retrospective study, PC need was determined using broad and narrow criteria. The subjects comprised patients aged 65 or older who had out-of-hospital cardiac arrest and/or died in the ED (Group 1) or within 72 hours after ED disposition (Group 2) over a 3-year period (2016– 2018). Overall, 17,414 older adults visited the ED, 60 died in the ED, and 400 died within 72 hours after ED disposition and admitted to in-hospital ward. In total, 200 patients were randomly selected; of these, 15 were excluded.Results: Of the remaining 185 patients enrolled, 161/185 (87%) met the PC criteria and 60/161 (37.3%) were missed opportunities for PC planning. Group 1, had thirty patients, and 8 of those 30 (27%) were missed opportunities for PC planning. Group 2, 131/161 (81.4%), died within 72 hours, and there were 52 missed opportunities (39.7%) of ED PC planning. By comorbidity (Group 2), providers considered PC planning most often for cancer patients (PC: 41.8%; missed opportunities: 15.4%; p = 0.001) and there were more missed opportunities for

Coronavirus disease 2019 (COVID-19) is characterized by an acute respiratory infection with multisystem involvement and the association of its severity to liver function abnormalities is not well characterized. The aim of this study was to assess the association between the severity of COVID-19 patients and liver function abnormalities. This retrospective study included adult patients with confirmed COVID-19, which were classified as non-severe or severe according to World Health Organization guidelines. Liver function test results were compared between the severity groups. A total of 339 patients were included of which 150 (44.25%) were severe cases. The male-to-female ratio was 0.9:1 and 3:2 in the non-severe and severe groups, respectively (p=0.031). Aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin levels and acute liver injury (ALI) incidence were significantly higher in the severe group compared to non-severe group (p<0.001, p<0.001, p=0.025, p=0.014, respectively). In contrast, albumin levels were significantly lower (p=0.001). Multivariate analysis showed that ALI was significantly associated with human immunodeficiency virus (HIV) infection (odds ratio (OR): 5.275; 95% confidence interval (CI): 1.165–23.890, p=0.031), hemoglobin level (OR: 1.214; 95%CI: 1.083–1.361, p=0.001), and hypoalbuminemia (OR: 2.627; 95%CI: 1.283–5.379, p=0.008). Pre-existing liver diseases were present in 6.5% of patients. No significant differences were observed between the groups based on COVID-19 severity and ALI presence. Liver function test abnormalities, including ALI, are more prevalent in patients with severe COVID-19 infection. HIV infection, high hemoglobin levels, and hypoalbuminemia may be potential risk factors for ALI.

Purpose: Data on the prognostic impact of the micropapillary component in breast cancer are limited. The purpose of this study was to investigate the clinicopathological characteristics and long-term outcomes of pure and mixed invasive micropapillary breast cancer (IMPC) patients compared to invasive ductal cancer (IDC) patients. Methods: This retrospective study analysed all IMPC and IDC patients treated at the European Institute of Oncology (IEO) between 1997 and 2019. The overall cohort of IMPC patients was divided in two groups, pure and mixed IMPC. Each patient with mixed or pure IMPC was matched with one patient with IDC, based on year of surgery, age, pT, pN, and molecular subtype. Results: A total of 30,115 IDC, 120 pure IMPC and 150 mixed IMPC patients were considered eligible. Compared to IDC, pure and mixed IMPC patients presented a higher rate of locally advanced disease (pT2-T3, pN2-N3), vascular invasion, and Luminal B subtype. After matching, pure and mixed IMPC showed a significant higher rate of vascular invasion compared to IDC patients (p < 0.001). Invasive disease-free survival was better in IDC compared to pure IMPC patients (p = 0.11). Long-term overall survival was significantly worse in pure IMPC group compared to IDC group (p = 0.004), being instead similar between mixed IMPC vs matched IDC (p = 0.07). Conclusion: These real-world data reported the worse prognosis of pure IMPC compared to IDC, highlighting the peculiar prognostic value of the micropapillary subtype itself in the decision-making process of IMPC management. An accurate pre-surgical diagnostic evaluation and a multidisciplinary approach are pivotal to best personalize its treatment.

Kun Li,1 Ahmad Alhaskawi,2 Haiyin Zhou,2 Yanzhao Dong,2 QingFang Zhao,3 Chenxi Wang,4 Hui Lu2 1Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 4Medical Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Kun Li, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Email Likicu@zju.edu.cn Hui Lu, Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang Province, People’s Republic of China, Email HuiLu@zju.edu.cnObjective: This retrospective study examines risk factors and electromyographic (EMG) characteristics associated with acquired weakness in critically ill patients and assesses their impact on patient prognosis.Methods: Ninety-seven critically ill patients, ventilated for over 48 hours, were included. Patient data, encompassing general condition, medical history, Medical Research Council (MRC) scores, serum markers (c-reactive protein, calcitonin gene, albumin, brain natriuretic peptide, urea nitrogen, creatinine), EMG characteristics, respiratory treatment modalities, and parameters, were recorded. Mechanical ventilation duration, ICU stay duration, hospitalization duration, and patient prognosis were documented. Based on MRC scores, patients were categorized into the ICU-ac

Objective: The aim of this study was to analyze the type, frequency, treatment options and prevention methods of complications arising after surgical treatment of maxillofacial deformities. Methods: This retrospective study was conducted using 72 medical records of Caucasian subjects who underwent surgery in 2018 and 2019 at the Clinic of Maxillofacial and Oral Surgery at Rijeka University Hospital Center. Intraoperative and postoperative complications were recorded. Results: Most of the patients experienced some kind of complication and in most cases they were transitory. The consequences of damage to the sensory branches of the trigeminal nerve (occasional tingling, tightness, pain, loss of sensation) remain permanently present in most of the patients. The highest percentage of patients underwent surgical treatment due to speech and mastication problems. The majority of them are satisfied with the outcome. Conclusion: Most of the complications can be successfully treated.

Introduction: Craniopharyngiomas (CPs) are benign brain tumors accounting for 5 - 11% of intracranial tumors in children. These tumors often recur and can cause severe morbidity. Postoperative radiotherapy efficiently controls and prevents progression and recurrence. Despite advancements in neurosurgery, endocrinological, visual, and neuropsychological complications are common and significantly lower the quality of life of patients. Methods: We performed a retrospective study, including all patients younger than sixteen diagnosed with CP between July 1989 and August 2022 and followed up in Hôpital Universitaire de Bruxelles. Results: Nineteen children with CP were included, with median age of 7 years at first symptoms and 7.5 at diagnosis. Common symptoms at diagnosis were increased intracranial pressure (63%), visual impairment (47%), growth failure (26%), polyuria/polydipsia (16%), and weight gain (10.5%). As clinical signs at diagnosis, growth failure was observed in 11/18 patients, starting with a median lag of 1 year and 4 months before diagnosis. On ophthalmological examination, 27% of patients had papillary edema and 79% had visual impairment. When visual disturbances were found, the average preoperative volume was higher (p=0.039). Only 6/19 patients had gross total surgical resection. After the first neurosurgery, 83% experienced tumor recurrence or progression at a median time of 22 months. Eleven patients (73%) underwent postsurgical radiotherapy. At diagnosis, growth hormone deficiency (GHD) was the most frequent endocrine deficit (8/17) and one year post surgery, AVP deficiency was the most frequent deficit (14/17). Obesity was present in 13% of patients at diagnosis, and in 40% six months after surgery. There was no significant change in body mass index over time (p=0.273) after the first six months post-surgery. Conclusion: CP is a challenging brain tumor that requires multimodal therapy and lifelong multidisciplinary follow-up including hormonal subs, SCOPUS: ar.j, info:eu-repo/semantics/published

Syfte: Syftet med denna retrospektiva studie var att undersöka samt öka förståelsen för eventuella histologiska skillnader mellan snuslesioner från olika tidsintervall. Detta då få studier kartlagt histologiska skillnader vid användning av vitt snus. Material och Metod: Biopsier på snuslesioner tagna under årsintervallen 2000–2005och 2017–2021 studerades med avseende på histopatologiska skillnader mellan grupperna. Antal sampel har varit 37 st. i urvalsgrupp 1 och 53 st. i urvalsgrupp 2. Preparaten som analyserades var kodade som “snuslesion”. Årsintervallen valdes utifrån hypotesen att fler olika typer av snus samt smakämnen var tillgängliga på marknaden under den senare tidsperioden. Framför allt det vita snuset som är tobaksfritt men innehåller nikotin. Parametrar som studerades var epiteltjocklek, vakuolisering, ödem, inflammationsgrad, PMN-celler, eosinofila granulocyter, lymfocyter samt fibrinogen. Två observatörer samlade data individuellt som sedan kalibrerades gemensamt för att senare föras in i SPSS för granskning och analys. Resultat: Studiens resultat visar på en icke signifikant skillnad i fibrinogenutfällning mellan grupperna. I grupp 2 (2017–2021) påvisades en större fibrinogenutfällning än för grupp 1 (2000–2005). Studien påvisar även en signifikant svag positiv korrelation mellan eosinofila granulocyter och fibrinogen. Ingen signifikant skillnad mellan de två grupperna avseende inflammationsgrad, epiteltjocklek, vakuolisering, ödem, polymorfonukleära celler, lymfocyter och fibrinogen detekteras. Slutsats: Den högre fibrinogenutfällningen i grupp 2 skulle kunna bero på ämnen i snuset, som exempelvis smakämnen eller konserveringsmedel. Det icke-signifikanta resultaten kan också antyda att det inte finns så stora skillnader mellan vitt och tobaksinnehållande snus. På grund av bristande information i remisserna krävs prospektiv forskning där olika variabler såsom snussort, duration och nikotinmängd kan kontrolleras för att resultat med säkerhet ska kunn, Aim: This retrospective study aims to document, analyze, and increase the comprehension of histological differences of snuff lesions between a selection of snuff biopsies with the code “snuff lesion” from Swedish snuff. Given the limited availability of studies focusing on the histological variances in white snuff, there remains much to be explored in this area. Materials and Method: The groups were divided between the years of 2000-2005 (37, St.) and 2017-2021 (35, St.). The two groups were selected with the intention that more recent snuff flavors and brands were available for the later years. Especially the white snuff, containing no tobacco. Giving the study a hypothetical lead. The analyzedparameters include epithelial thickness, fibrinogen, vacuolization, polymorphonuclear cells, eosinophil granulocytes, lymphocytes, and degree of inflammation. Two observers studied and performed individual protocols of collected data. These were later analyzed in SPSS for the result. Results: From the analyzed data the histologic feature that was detected was the presence and variation of fibrinogen between the two groups. The fibrinogen showed an increased amount in group 2. A weak positive correlation between fibrinogen and eosinophil granulocytes were found. This study did not conclude statistically significant difference between the two groups regarding any of the measured parameters. Conclusion: Due to the increased fibrinogen that was discovered in group 2 could depend upon the ingredients such as flavors, additives, preservatives, or the amount of nicotine. This might suggest that the perceived differences between snuff lesions might not be significant when experienced in the mouth. Due to the lack of information from the remittance we could not know the specific snuff the person was using. Studies that correlate the histopathological appearance linked to the usage of specific snuff would be interesting to acknowledge in further studies.

Purpose The present retrospective study aimed to investigate the risk factors possibly associated withfailure and technical complications of implant-supported single crowns and their supportingimplants.Materials and methodsPatients treated at the Faculty of Odontology, Malmö University, Malmö, Sweden(2009–2019) were considered for inclusion. Implant and prosthesis failure, as well asmechanical/technical complications (ceramic fracture/chipping; crown loss ofretention/mobility; crown failure/fracture; loosening/loss/fracture of prosthetic screw; implantfailure/fracture) were the outcomes analyzed. Any condition/situation that led to theremoval/replacement of crowns (implant failure not included) was considered prosthesisfailure. Univariate/multivariate Cox regression models were used to evaluate the associationsbetween clinical covariates and failure.Results278 patients (358 crowns) were included. Mean±SD follow-up was 56.5±29.7 months. Sevenimplants (76.5±43.7 months) and twenty crowns (21.3±23.5 months) failed. Cumulativesurvival rate for crowns: 93.5% (5 years), 92.2% (6-11 years). Most common reasons forcrown failure: porcelain large fracture (n=6), crown repeatedly loose (n=6), porcelainchipping (n=5). Men and probable bruxism were identified in the Cox regression model asbeing associated with crown failure. The most common observed technical complicationswere mobility of the crown and chipping of the ceramic material, with the latter beingobserved even in crowns manufactured of monolithic zirconia. Cases with at least onetechnical complication (not considering loss of screw hole sealing) were more commonamong probable bruxers than in non-bruxers (p=0.002). Cases of ceramic chipping were morecommon among bruxers than in non-bruxers (p=0.014).ConclusionProbable bruxism and patient’s sex (men) were factors associated with a higher risk of failureof implant-supported single crowns.Keywords: Dental implant; fixed prosthesis; implant-supported single crown; technical, Syfte Denna retrospektiva studie syftade till att undersöka riskfaktorer som möjligen är förknippade med misslyckande och tekniska komplikationer av implantatstödda singelkronor och deras stödjande implantat. Material och metod Patienter som behandlats vid Odontologiska fakulteten, Malmö Universitet mellan 2009 och 2019 övervägdes för inkludering. Implantat- och protes misslyckande och mekaniska/tekniska komplikationer (keramisk fraktur/chip-off; kronförlust av retention/rörlighet; krona misslyckande/fraktur; lossning/förlust/fraktur av protesskruv; implantat misslyckande/fraktur) var resultaten som analyserades. Varje tillstånd/situation som ledde till avlägsnande/byte av kronor (implantat misslyckande ingår ej) ansågs vara protes misslyckande. Univariat/multivariat Cox-regressionsmodeller användes för att utvärdera sambanden mellan kliniska kovariater och misslyckande. Resultat 278 patienter (358 kronor) inkluderades. Medelvärde±SD uppföljningstud var 56,5±29,7 månader. Sju implantat (76,5±43,7 månader) och tjugo kronor (21,3±23,5 månader) misslyckades. Kumulativ överlevnadsgrad för kronor: 93,5% (5 år), 92,2% (6–11 år). Vanligaste orsakerna till misslyckande av singelkronor: porslinsstor fraktur (n=6), kronan lös upprepade gånger (n=6), porslin chip-off (n=5). Män och bruxism identifierades i Coxregressionsmodellen som associerade med singel kronans misslyckande. De vanligaste observerade tekniska komplikationerna var rörligheten hos kronan och chip-off av det keramiska materialet, där det senare observerades även i kronor tillverkade av monolitisk zirkoniumoxid. Fall med minst en teknisk komplikation (utan hänsyn till förlust av skruvhålstätning) var vanligare bland troliga bruxare än hos icke- bruxare (p = 0,002). Keramisk chip-off var vanligare bland bruxare än hos icke-bruxare (p = 0,014). Slutsats Bruxism och patientens kön (män) var faktorer associerade med en högre risk för misslyckande av implantatstödda singelkronor.

Mammary gland tumours (MGT) are the most common neoplasia in female dogs, and up to 50% of them are malignant. Treating MGTs is typically conducted through surgery, but there is no consensus on which type of operation yields the best results while also being minimally invasive. Thus, surgical technique, as well as factors such as age at diagnosis, tumour size, lymph node involvement, etc., are important to consider in prognostication and clinical decision-making. This retrospective study aims to investigate the association between different host and tumour factors in dogs diagnosed with MGTs at the SLU University Small Animal Hospital and time to recurrence and overall survival during the years 2017-2019. A total of 264 medical records were reviewed, and dogs that underwent surgery were recruited (n=183) for data collection. Factors that were reviewed include age at diagnosis, breed, dog size, spaying status, size of the largest nodule, number of nodules, number of mammary glands involved, signs of lymph node involvement, signs of radiological metastasis, ulceration, invasion of adjacent tissue, blood sample alterations, surgical technique, tumour character, and subtype. Statistical analyses were performed to assess the factors' correlation to the recurrence of MGTs and death. Mean survival time was estimated for several variables, and dog size (P=0.036), spaying status (P=0.006), lymph node involvement (P=0.004), size of the largest nodule (P=0.013) and tumour subtype (P=0.044) were identified as independent predictors affecting overall survival. In conclusion, the results aligned with previous published reports regarding prognostic markers for MGTs, such as tumour size, lymph node involvement and subtype. It also found spayed dogs to have a 3.7 higher risk of dying then intact dogs. Thus, the study successfully identified some prognostic factors and can act as a model for the Swedish dog population and give some indications for clinical decision making and prognos

Background: In conjunction with post placement in root-filled teeth with periapical healthy conditions, root canal retreatment may be performed to improve the seal of the root canal. Whether root canal retreatment for technical reasons (retreatments in teeth without apical periodontitis (AP)) results in lower frequency of AP is unknown. Objective: To examine whether there is a difference in frequency of AP between roots with root canals retreated for technical reasons, and roots with root canals not retreated before post placement, with a minimum follow-up of 5 years. Also, to examine changes in root filling quality following root canal retreatment for technical reasons. Methods: This retrospective study included radiographs of 441 root-filled roots without periapical radiolucencies at baseline, scheduled for post and core treatment. Follow-up data for a minimum of 5 years were available for 305 roots (loss to follow-up 30.8%), 46 of which were retreated for technical reasons. Two calibrated observers assessed root filling sealing quality and length, respectively, and periapical status according to the Periapical Index. The main outcome of the study, AP, was used as the dependent variable and all analyses were performed at root level. Results: The overall frequency of AP at follow-up was 13.8%. The difference in frequency of AP between retreated (4.3%) and nonretreated (15.4%) root canals was not statistically significant, p = .061. Analyses including only roots with preoperatively inadequate root filling quality showed a statistically significant difference (p = .017) between the two treatment groups (2.4% vs. 22.9%). Conclusions: Root canal retreatment for technical reasons before post and core placement significantly reduces the frequency of AP in roots with inadequate root filling quality.

Purpose: To compare the complication rates of two different types of posterior instrumentation in patients with MMC, namely, definitive fusion and fusionless surgery (growing rods). Methods: Single-center retrospective study of 30 MMC patients that underwent posterior instrumentation for deformity (scoliosis and/or kyphosis) treatment from 2008 until 2020. The patients were grouped based on whether they received definitive fusion or a growth-accommodating system, whether they had a complication that led to early surgery, osteotomy or non-osteotomy. Number of major operations, Cobb angle correction and perioperative blood loss were the outcomes. Results: 18 patients received a growing system and 12 were fused at index surgery. The growing system group underwent a mean of 2.38 (± 1.03) surgeries versus 1.91 (± 2.27) in the fusion group, p = 0.01. If an early revision was necessitated due to a complication, then the number of major surgeries per patient was 3.37 (± 2.44) versus 1.77 (± 0.97) in the group that did not undergo an early revision, p = 0.01. Four patients developed a superficial and six a deep wound infection, while loosening/breakage occurred in 10 patients. The Cobb angle was improved from a mean of 69 to 22 degrees postoperatively. Osteotomy did not lead to an increase in perioperative blood loss or number of major operations. Conclusion: Growing systems had more major operations in comparison with fusion surgery and early revision surgery led to higher numbers of major operations per patient; these differences were statistically significant. Definitive fusion at index surgery might be the better option in some MMC patients with a high-risk profile.

Hospital-acquired pneumonia (HAP) and ventilation-associated pneumonia (VAP) are challenging clinical conditions due to the challenging tissue penetrability of the lung. This study aims to evaluate the potential role of fosfomycin (FOS) associated with ceftazidime/avibactam (CZA) in improving the outcome in this setting. We performed a retrospective study including people with HAP or VAP treated with CZA or CZA+FOS for at least 72 h. Clinical data were collected from the SUSANA study, a multicentric cohort to monitor the efficacy and safety of the newer antimicrobial agents. A total of 75 nosocomial pneumonia episodes were included in the analysis. Of these, 34 received CZA alone and 41 in combination with FOS (CZA+FOS). People treated with CZA alone were older, more frequently male, received a prolonged infusion more frequently, and were less frequently affected by carbapenem-resistant infections (p = 0.01, p = 0.06, p < 0.001, p = 0.03, respectively). No difference was found in terms of survival at 28 days from treatment start between CZA and CZA+FOS at the multivariate analysis (HR = 0.32; 95% CI = 0.07–1.39; p = 0.128), while prolonged infusion showed a lower mortality rate at 28 days (HR = 0.34; 95% CI = 0.14–0.96; p = 0.04). Regarding safety, three adverse events (one acute kidney failure, one multiorgan failure, and one urticaria) were reported. Our study found no significant association between combination therapy and mortality. Further investigations, with larger and more homogeneous samples, are needed to evaluate the role of combination therapy in this setting.

This retrospective study evaluated 35 children (median age 5.2 years; range 0.4–18) with myelofibrosis (MF), including 33 with primary myelofibrosis and 2 with secondary myelofibrosis transplanted from matched sibling donor (MSD) (n = 17) or non-MSD (n = 18) between 2000 and 2022. Conditioning was usually chemotherapy-based (n = 33) and myeloablative (n = 32). Fifteen patients received bone marrow (BM), 14 haematopoietic cells (HC) from peripheral blood (PB), and 6 from cord blood (CB). Day +100 acute GvHD II–IV incidence was significantly lower after MSD-haematopoietic cell transplantation (MSD-HCT) than after non-MSD-HCT [18.8% (4.3–41.1) vs 58.8% (31–78.6); p = 0.01]. Six-year non-relapse mortality (NRM) was 18% (7.1–32.8), relapse incidence was 15.9% (5.6–30.9), progression-free survival (PFS) was 66.1% (47–79.7), GvHD-free relapse-free survival was 50% (30.6–66.7), and overall survival (OS) was 71.1% (51.4–84). Six-year PFS and OS were significantly higher after BM transplantation compared to HCT from other sources [85.1% (52.3–96.1) vs 50.8% (26.3–71), p = 0.03, and 90.9% (50.8–98.7) vs 54% (28.1–74.2), p = 0.01, respectively], whereas NRM was significantly lower [0% vs 32% (12.3–53.9); p = 0.02]. This first multicentre study on outcomes of allogeneic HCT in children with myelofibrosis proves feasibility and curative effect of transplantation in these children, suggests that bone marrow transplantation is associated with better outcomes, and indicates the need for further studies.

Biological drugs have dramatically changed the approach to treating moderate-to-severe plaque psoriasis, achieving excellent skin clearance and safety outcomes. However, the management of difficult-to-treat areas (e.g., scalp, palms/soles, nails, and genitalia) still represents a challenge in psoriasis treatment. Data in the literature on difficult-to-treat sites are limited and, frequently, no specific analysis is performed during clinical trials. We conducted a 52-week, retrospective study to evaluate the effectiveness of ixekizumab in 120 patients with moderate-to-severe plaque psoriasis of at least one difficult-to-treat area (scalp, palmoplantar surfaces, nails, and genitalia). Ninety-nine patients had scalp psoriasis, 35 had involvement of the palms or soles, 27 were affected by genital psoriasis, and 22 patients reported involvement of the nails. After 1 year of treatment, 96% of patients with scalp involvement, 95.6% of patients with palmoplantar psoriasis, 95.2% of patients with genital psoriasis, and 85% of patients with nail involvement achieved a site-specific Physician's Global Assessment of 0 or 1 (clear or almost clear). No serious adverse events were observed during the study. Our study supports the effectiveness of ixekizumab in plaque psoriasis involving difficult-to-treat sites.

[eng] Introduction and aim: In the past twenty years, bariatric surgery has witnessed a huge demand by patients with obesity, especially those who suffer from related diseases. The current study aimed to compare the outcomes of a single anastomosis sleeve ileal bypass (SASI) and laparoscopic sleeve gastrectomy (LSG). Methods: In this cohort retrospective study, 80 obese adult patients who underwent bariatric surgery participated, 40 of them for SASI versus 40 others for LGS surgery in a private hospital in Kirkuk governorate, northern Iraq. All participants were followed up after the sixth and twelfth months after the operation. The outcomes were evaluated through of weighing loss, betterment of comorbidities, and complications that were observed after surgery. Results: The results showed that the percentage of excess weight loss at six months after surgery was analogous between both surgeries while bypassing SASI showed a clear elevation of EWL% at twelve months postoperatively when compared with LGS. As for comorbidities, the improvement in type 2 diabetes mellitus and GERD by bypassing SASI was significantly better than that of LGS. As for postoperative complications, it has been proven that there are fewer complications after SASI surgery compared to LGS, but not significant. Conclusions: It was concluded that bypassing the SASI gave better results, especially after twelve months of the operation, and further articles are needful to compare the outcomes of SASI bypass over a longer term., [spa] Introducción y objetivo: En los últimos veinte años, la cirugía bariátrica ha sido testigo de una enorme demanda por parte de los pacientes con obesidad, especialmente los que padecen enfermedades relacionadas. El objetivo del presente estudio era comparar los resultados de la derivación ileal en manga con anastomosis única (SASI) y la gastrectomía en manga laparoscópica (LSG). Metodología: En este estudio retrospectivo de cohortes participaron 80 pacientes adultos obesos que se sometieron a cirugía bariátrica, 40 de ellos para SASI frente a otros 40 para cirugía LSG en un hospital privado de la gobernación de Kirkuk, en el norte de Irak. Se realizó un seguimiento de todos los participantes al sexto y al duodécimo mes de la operación. Resultados: Los resultados se evaluaron mediante la pérdida de peso, la mejora de las comorbilidades y las complicaciones observadas tras la intervención. Los resultados mostraron que el porcentaje de pérdida de exceso de peso a los seis meses de la intervención era análogo entre ambas cirugías, mientras que la derivación SASI mostraba una clara elevación del LPE% a los doce meses del postoperatorio en comparación con la LGS. En cuanto a las comorbilidades, la mejora de la diabetes mellitus tipo 2 y la ERGE mediante la derivación de la SASI fue significativamente mejor que la de la LGS. En cuanto a las complicaciones postoperatorias, se ha demostrado que hay menos complicaciones tras la cirugía del SASI en comparación con el LGS, pero no significativas. Conclusiones: Se llegó a la conclusión de que la derivación del SASI daba mejores resultados, sobre todo a los doce meses de la operación, y son necesarios más artículos para comparar los resultados de la derivación del SASI a más largo plazo.

The burden of diabetes foot ulcer is immense, resulting to prolonged hospital stay and high cost of care. The aim of this study is to identify the predictors of ulcer recurrence which will help mitigate this disabling, pocket-draining, but highly preventable complication of diabetes mellitus (DM). Methodology: This was a 3-year retrospective study of patients hospitalised for diabetic foot ulcer (DFU) in Enugu State University Teaching Hospital from March 2020 to February 2023. Information on demographics, relevant diabetes history and complications, characteristics of DFU, outcome, DFU recurrence were obtained. Results: Most of the patients (82.5%) were between 41 and 70 years of age with a mean age is 57.86 ± 12.45. There were marginally more females (52.6%) than male (47.4%). The subjects were predominantly businessmen/traders (43.9%), and 73.7% had DM duration of 1-5 years. Duration of admission was 8 weeks for 31.6% of the patients, 4 weeks for 26.3%, 3 weeks for 21.1% and 12 weeks for 12.3% of the patients. More of the patients were in Wagner grades 3 (43.9%) and 4 (31.6%). The Prevalence of (diabetic peripheral neuropathy) DPN, peripheral artery disease (PAD) and Retinopathy among the patients were 82.5%, 45.6% and 59.6% respectively. Recurrence of DFU occurred in 35% of the subjects. Occupation and wound site positively correlated with reocurrence in this study. The outcome shows that 59.6% of the patients had good healing, 21.1% had ray amputation while 14% had below knee amputation. Keywords: Diabetic foot ulcer, recurrence, peripheral neuropathy, peripheral artery disease.

Abdulfattah Altam,1 Yasser Obadiel,2 Rami Salim Alazaiza,1 Mohamed Ali Alshujaa,3 Faris Alhajami,1 Faisal Ahmed,4 Abdullah Mohammed Al-Naggar,5 Ahmed Mohamed Albushtra,6 Mohamed Badheeb7 1Department of General Surgery, School of Medicine, 21 September University, Sana’a, Yemen; 2Department of General Surgery, School of Medicine, Sana’a University, Sana’a, Yemen; 3Department of General Surgery, School of Medicine, Thamar University, Dhamar, Yemen; 4Department of Urology, School of Medicine, Ibb University, Ibb, Yemen; 5Department of Anesthesiology, Faculty of Medicine, Sana’a University, Sana’a, Yemen; 6Department of Orthopedics, School of Medicine, Ibb University, Ibb, Yemen; 7Department of Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USACorrespondence: Faisal Ahmed, Department of Urology, School of Medicine, Ibb University, Ibb, Yemen, Tel/Fax +967 4428950, Email fmaaa2006@yahoo.comBackground: This article aims to share our experiences with microsurgical finger replantation in a resource-limited setting.Methods: This multi-institutional, retrospective study included 21 cases of finger amputation that underwent microsurgical replantation, within 7 years period. Patient demographics, preoperative assessments, surgical approaches, and outcomes were documented and analyzed. A univariate analysis was performed to obtain factors associated with digit reimplantation failure.Results: Out of 21 cases included, 8 (38.1%) had complete amputations and 13 (61.9%) had incomplete amputations. Crush injuries accounted for the majority (71.4%). On average, 2.2 ± 1.1 digits were affected, with the ring finger being the most commonly injured (71.4%). The mean operative time was 121.5 ± 26.8 minutes. The success rate of digit replantation was 76.2%. During a mean follow-up of 14.3 ± 3.7 months, 85.7% of successfully replanted digits considered their replantation results satisfactory. The majority of replanted digits demonstrated active and

Aysha A AlShareef,1,2,&ast; Moafaq S Alrawaili,1,2,&ast; Salwa Awwadh Almutairi,3 Mustafa Mohammad Ayyad,3 Weam Alshora4 1Department of Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Neuromuscular Medicine Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Neurology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Family Medicine, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Moafaq S Alrawaili, Department of Neurology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia, Tel +966547900080, Fax +966126128188, Email alruily@kau.edu.saBackground: Diabetic neuropathy (DN) is a common complication of type 2 diabetes (T2DM) and is characterized by persistent inflammation. Hematological parameters have emerged as a novel marker for detecting chronic inflammatory conditions, including diabetes.Aim: We aim to examine the association between HbA1c levels, which can indicate the presence of diabetic neuropathy, and hematological parameters to explore the possibility of using hematological parameters as a new indicator for DN in T2DM patients.Methods: This was a retrospective study of 768 (483 males and 284 females) medical records of adult T2DM patients with or without neuropathy who attending the outpatient neuromuscular clinic at King Abdul-Aziz University Hospital from January 2016 to December 2021.Results: The results showed significant increases in HbA1c levels (p=0.000), lymphocyte levels (p=0.028), and the neutrophil-lymphocyte ratio (NLR) (p=0.011). In the T2DM group, HBA1C levels were found to be positively correlated with age (r=0.306, p=0.000), neutrophil (NEUT) (r=0. 287, p=0.000), platelet (PLT) (r=0. 148, p=0.039), and neutrophil-lymphocyte ratio (NLR) (r=0

INTRODUCTION: Peripheral nerve sheath tumors are the most common tumor of the peripheral nerves. In general, surgery has a favorable outcome and is the treatment of choice. However, postoperative neurologic deficits are not uncommon, and predictors of outcome are poorly defined. OBJECTIVE: To evaluate clinical outcomes after surgical treatment of benign peripheral nerve sheath tumors and identify outcome predictors that may affect preoperative decision making and improve surgical outcomes. METHOD: In this single center retrospective study, all patients surgically treated for a benign peripheral nerve sheath tumor between 2005 and 2020 were eligible for inclusion. Medical records and imaging data were reviewed. Studied outcomes were changes in neurological symptoms, pain, and tumor recurrence. Logistic regression was performed to identify possible outcome predictors. RESULTS: In total, 81 patients undergoing 85 separate surgeries for benign peripheral nerve sheath tumors were included. The most common preoperative symptoms were local pain (90%) followed by a noticeable mass (78%), radiating pain (72%), sensory deficit (18%) and motor deficit (16%). A postoperative improvement of symptoms was seen in 94% of those with pain, 48% of those with sensory deficits and 78% of those with motor deficits. However, 35% and 9% developed new postoperative sensory and motor deficits, respectively. Multivariable analysis showed complete tumor removal as a predictor of reduced pain (p = 0.033), and younger age and larger tumors were risk factors for persistent or increased sensory deficits (p = 0.002 and p = 0.005, respectively). There were no significant predictors of motor deficits. Neurocutaneous syndromes were associated with increased odds of tumor recurrence on univariable analysis (p = 0.008). CONCLUSION: Surgery of benign peripheral nerve sheath tumors is a safe procedure with a favorable outcome in most cases. Younger age and larger tumors were risk factors for persistent or

Yong Liu,1 Hui Liu,2 Queqiao Bian,1 Shuhuan Zhang,1 Yanmin Guan3 1Department of Dermatology & STD, the Third Central Hospital of Tianjin; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases; Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, People’s Republic of China; 2Tianjin Institute of Hepatobiliary Disease, Tianjin, People’s Republic of China; 3Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin, People’s Republic of ChinaCorrespondence: Yong Liu, Department of Dermatology & STD, the Third Central Hospital of Tianjin, No. 83, Jintang Road, Hedong District, Tianjin, 300170, People’s Republic of China, Tel +8602284112488, Email liuyongtj@163.comBackground: Herpes zoster (HZ) typically manifests in the acute phase with distinct blisters and severe neuropathic pain. Remarkably, a subset of patients initially presents with only a mild skin rash and moderate pain that gradually intensifies, following a parabolic pattern. Despite being frequently observed in clinical settings, the underlying causes of this trajectory and its potential connection with post-herpetic neuralgia (PHN) remain unclear.Methods: To investigate this phenomenon in-depth, we conducted a meticulous retrospective study involving 529 eligible HZ patients. All these patients sought medical care at the Third Central Hospital of Tianjin, China, between January 2020 and December 2023.Results: The research identified that 14.6% of the sample (77 patients) experienced pain scores aligning with a parabolic curve. This trend was significantly more prevalent in patients aged 60 and above, accounting for 90.9% of this group, and demonstrated a positive correlation with age. Moreover, 87.0% of these patients had pre-existing medical conditions, highlighting the potential role of comorbidities in influencing the pain trajectory. A concerning 45.5% of patients sought medical attention more than seven days a

The epidemiology, diagnostic methods and management of infectious complications after solid-organ transplantation (SOT) are evolving. The aim of our study is to describe current infectious complications in the year following SOT and risk factors for their development and outcome. We conducted a retrospective study in adult SOT recipients in a Belgian university hospital between 2018 and 2019. We gathered demographic characteristics, comorbidities leading to transplantation, clinical, microbiological, surgery-specific and therapeutic data concerning infectious episodes, and survival status up to one year post-transplantation. Two-hundred-and-thirty-one SOT recipients were included (90 kidneys, 79 livers, 35 lungs, 19 hearts and 8 multiple organs). We observed 381 infections in 143 (62%) patients, due to bacteria (235 (62%)), viruses (67 (18%)), and fungi (32 (8%)). Patients presented a median of two (1-5) infections, and the first infection occurred during the first six months. Nineteen (8%) patients died, eleven (58%) due to infectious causes. Protective factors identified against developing infection were obesity [OR [IC]: 0.41 [0.19-0.89]; p = 0.025] and liver transplantation [OR [IC]: 0.21 [0.07-0.66]; p = 0.007]. Risk factors identified for developing an infection were lung transplantation [OR [IC]: 6.80 [1.17-39.36]; p = 0.032], CMV mismatch [OR [IC]: 3.53 [1.45-8.64]; p = 0.006] and neutropenia [OR [IC]: 2.87 [1.27-6.47]; p = 0.011]. Risk factors identified for death were inadequate cytomegalovirus prophylaxis, infection severity and absence of pneumococcal vaccination. Post-transplant infections were common. Addressing modifiable risk factors is crucial, such as pneumococcal vaccination., info:eu-repo/semantics/published

Objectives The optimal use of opioids after knee replacement (KR) remains to be determined, given the growing evidence that opioids are no more effective than other analgesics and that their adverse effects can impair quality of life. Therefore, the objective is to examine opioid prescriptions after KR. Design In this retrospective study, we used descriptive statistics and estimated the association of prognostic factors using generalised negative binomial models.  Setting The study is based on anonymised claims data of patients with mandatory health insurance at Helsana, a leading Swiss health insurance. Participants Overall, 9122 patients undergoing KR between 2015 and 2018 were identified. Primary and secondary outcome measures Based on reimbursed bills, we calculated the dosage (morphine equivalent dose, MED) and the episode length (acute: <90 days; subacute: ≥90 to <120 days or <10 claims; chronic: ≥90 days and ≥10 claims or ≥120 days). The incidence rate ratios (IRRs) for postoperative opioids were calculated.  Results Of all patients, 3445 (37.8%) received opioids in the postoperative year. A large majority had acute episodes (3067, 89.0%), 2211 (65.0%) had peak MED levels above 100mg/day and most patients received opioids in the first 10 postoperative weeks (2881, 31.6%). Increasing age (66–75 and >75 vs 18–65) was associated with decreased IRR (0.776 (95% CI 0.7 to 0.859); 0.723 (95% CI 0.649 to 0.805)), whereas preoperative non-opioid analgesics and opioids were associated with higher IRR (1.271 (95% CI 1.155 to 1.399); 3.977 (95% CI 4.409 to 3.591)). Conclusion The high opioid demand is unexpected given that current recommendations advise

Luyang Zhang,1,&ast; Li Wang,2,&ast; Jiewen Long,1 Yan Yin,1 Sandip Patil1 1Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China; 2Department of Clinical Nutrition, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Sandip Patil; Yan Yin, Department of Haematology and Oncology, Shenzhen Children’s Hospital, 7019 Yitian Road, Shenzhen, Guangdong Province, 518000, People’s Republic of China, Tel +86-755-83008283, Email sandippatil1309@yahoo.com; yinyan0915@sina.comObjective: This retrospective study evaluated nutritional status and body composition changes in paediatric β-thalassemia (β-TM) patients before and after hematopoietic stem cell transplantation (HSCT), using bioelectrical impedance analysis (BIA), and explored their relationship with HSCT outcomes.Methods: A cohort of 40 paediatric β-TM patients undergoing allogeneic HSCT was assessed for their nutritional status, anthropometric parameters, including body mass index (BMI), weight, and height, and body composition parameters pre-and post-HSCT, focusing on BIA measurements, including intracellular water (ICW), extracellular water (ECW), fat mass (FAT), fat-free mass (FFM), Skeletal Muscle Mass (SMM), soft Lean Mass (SLM), percent body fat (PBF), Body Cell Mass (BCM), Phase angle (PA) and muscle balance pre- and post-HSCT. Post-HSCT clinical outcomes, including acute graft-vs-host disease (aGVHD), engraftment time, oral mucositis (OM), sinusoidal obstruction syndrome (SOS), and diarrhoea in relation to nutrition status after HSCT were analysed.Results: After HSCT, 28.21% experienced diminished nutritional status, with 71.43% of those who were wasting before HSCT showing diminished nutritional status, significantly higher than the normal group (18.75%, P = 0.012). Anthropometric changes included

Changbao Yan,1 Sheng Wang,2 Yaoguo Yang,2 Liang Zhao,1 Jie Zhang,1 Yanyang Wang,1 Dafang Liu,1 Yihe Geng,1 Zhong Chen2 1Department of Vascular Surgery, Capital Medical University Affiliated Luhe Hospital, Beijing, People’s Republic of China; 2Department of Vascular Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing, People’s Republic of ChinaCorrespondence: Zhong Chen, Tel /Fax +86-010-64456383, Email chenzhong8658@vip.sina.comAim: To evaluate the advantages and problems in the diagnosis and treatment of diabetic foot (DF) patients by analyzing the results of a 5-year follow-up of the organ system based (TOSF) treatment model.Methods: A retrospective study was conducted in 229 patients with diabetic foot. Chi-square test and rank-sum test were used to analyze the effects of patients’ general condition, behavioral and nutritional status, degree of infection (inflammatory markers), comorbidity, diabetic foot grade/classification, and revascularization on readmission rate, amputation rate, all-cause mortality, incidence of other complications, and wound healing time. Logistic regression was used to analyze the risk factors affecting the prognosis of diabetic foot. Kaplan-Meier survival curve was used to analyze the differences in amputation rate and mortality rate at each time point.Results: This study showed that nutritional status, degree of infection, and revascularization influenced readmission rates. General condition, behavior and nutritional status, degree of infection, Wagner grade and revascularization affect the amputation rate. General conditions, behavioral and nutritional status, degree of infection, comorbidities, classification and revascularization affect the mortality of patients. Age and white blood cell(WBC) count affected the incidence of other complications. Influence of infection degree and Wagner grade and revascularization in patients with wound healing time. Revascularization was an independent protective factor for r

Wenying Yi,1,2 Haibo Wu,1,2 Weibin Fu,1,2 Huimei Feng,1,2 Jie Huang,1,2 Haijing Li,1,2 Zhen Song,1,2 Yuwei Chen,1,2 Yingjun Zheng,1,2 Shenglin She1,2 1Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China Guangzhou Medical University, Guangzhou, People’s Republic of ChinaCorrespondence: Shenglin She, Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou MedicalUniversity, No. 36 Mingxin Road, Liwan District, Guangzhou, People’s Republic of China, Tel +86-13825154669, Fax +86-20-82068107, Email shenglinshe@gzhmu.edu.cnBackground: To assess the prevalence and risk factors of NAFLD in non-obese patients with schizophrenia in a public psychiatric hospital in China.Methods: A total of 1,305 adult inpatients with schizophrenia in 2019 were included in this retrospective study. Body mass index (BMI) ≥ 25 kg/m2 was considered obese, and BMI < 25 kg/m2 was considered non-obese. We obtained the data from electronic records of the Affiliated Brain Hospital of Guangzhou Medical University.Results: A total of 1,045 non-obese patients and 260 obese patients were included in this study. The prevalence of NAFLD in non-obese patients was 25.0%, and it was much lower that in the obese patients (25.0% vs 64.6%, p < 0.001). Among the non-obese patients, there were significant differences in age, BMI, alanine aminotransferase (ALT), metabolic indices, and the prevalence of diabetes and hypertension between patients with NAFLD and patients without NAFLD. According to the results of binary logistic regression analysis, age, BMI, ALT, triglyceride (TG) and diabetes were significantly related to NAFLD among non-obese patients with schizophrenia. In contrast, HDL-C was was negatively associated with NAFLD among non-obese patients.Conclusion: This study suggested that NAFLD was c

Xueyan Shan,1,2 Yongpeng Ge3 1Department of Rheumatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 2Postgraduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, People’s Republic of ChinaCorrespondence: Yongpeng Ge, Department of Rheumatology, The Key Laboratory of Myositis, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, People’s Republic of China, Email gyp2016@163.comObjective: To investigate the clinical features, severity and prognosis of interstitial lung disease (ILD) in patients with mixed connective tissue disease (MCTD).Methods: We performed a retrospective study on clinical data of MCTD patients admitted to China-Japan Friendship Hospital between October 2012 and October 2022. Data including long-term follow-up were retrieved from medical records. We compared MCTD patients with and without ILD in terms of clinical features, laboratory and imaging findings, severity and treatment response.Results: A total of 59 patients were included, with a mean age of 46 years, among which 91.5% (n = 54) were females. Symptoms of pulmonary involvement were present in 44 patients (74.6%, 95% CI: 62.3– 84.9%). Based on lung high-resolution computed tomography (HRCT), ILD was diagnosed in 39 (66.1%) patients, among which 31 (79.5%) showed nonspecific interstitial pneumonia (NSIP) as the radiological pattern, 21 (53.9%) showed a reticulation pattern, while 24 (61.5%) showed ground glass opacity (GGO). Eight (13.6%) patients had pulmonary arterial hypertension (PAH), and 7 (11.9%) had pleural effusions. Based on pulmonary function tests (PFTs), 27 patients were divided into the mild 13 (48.1%) and moderate 14 (51.9%) groups. Multivariate analysis showed that gastroesophageal reflux (GER; OR=5.28, p=0.010) and cough (OR=4.61, p=

Rui-Gui Zhang,1– 3 Yu-Mei Liu,2– 4 Zhi-Ye Yao,2,3 Jing-Xuan Fang,4 Yuan Li,2– 4 Man-Li Zheng,2,3 Xin Sun,2,3 Shu-Sheng Wen,4,5 Xi-Meng Wang,4,6 Jian Zhuang,4 Dan-Dong Luo,4 Shao-Ru He1– 3 1The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510260, People’s Republic of China; 2Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China; 3Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China; 4Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China; 5Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China; 6Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of ChinaCorrespondence: Shao-Ru He, Department of NICU, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences, No. 106 of Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People’s Republic of China, Tel +8620-83827812, Email Hshru_rsh@163.comBackground: Studies of chylothorax after congenital heart disease in infants are rare. Chylothorax has a higher incidence in infancy, but its risk factors are not well understood.Objective: The purpose of this study is to investigate the risk factors of chylothorax after congenital heart surgery in infants.Methods: This retrospective study included 176 infants who underwent congenital heart disease surgery at the Guangdong Cardiovascular Institute, China, between 2016 and 2020. According to the o

Abdulrahman Hassan Imam Abdulbaky, Vincent Wong TriVin Aesthetics, London, UKCorrespondence: Vincent Wong, TriVin Aesthetics, 10 Harley Street, London, W1G 9PF, UK, Tel +44 207 299 0380, Fax +44 207 467 8312, Email info@drvincentwong.comPurpose: The physicochemical characteristics of hyaluronic acid (HA) fillers can affect the outcome of minimally invasive aesthetic treatments. The effect of a novel HA-based filler manufactured with a novel 3D structure (XTRTM technology) was assessed in the nasolabial fold.Patients and Methods: We performed a retrospective study of patients who underwent treatment of the nasolabial fold with a novel HA filler in our clinic. Treatment outcome was assessed at 3 and 6 months with wrinkle score, GAIS, and VAS.Results: Eighteen patients were injected with the novel HA filler in the nasolabial fold. At six months, mean wrinkle scores were improved on both sides compared to baseline. GAIS and VAS were high at three and six months.Conclusion: The HA-based filler manufactured with XTRTM technology is safe and effective in treating the nasolabial fold. Good aesthetic results were seen for up to 6 months. Patient satisfaction was high during the entire follow-up.Keywords: filler injection, face rejuvenation, monophasic, crosslinking technology

Jian Zhao,1 Surong Liang,2 Boyang Zhou,1 Min Li,3 Linfeng Li1 1Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Clinical Epidemiology and Evidence Based Medicine Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Linfeng Li, Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Beijing, 100050, People’s Republic of China, Tel +86-10-63139108, Email zoonli@sina.comObjective: To assess the correlations between Immunoglobulin E (IgE) levels, pruritus, and lesion severity in patients with eczema, atopic dermatitis, or urticaria.Methods: A retrospective study was conducted and data of 814 patients who visited the dermatology or allergy clinics of multiple hospitals, from December 2019 to December 2021, were collected. Patients were divided into children group (< 18 years, 325 cases), adult group (18– 60 years, 435 cases), and older population group (> 60 years, 54 cases) based on the age. Baseline information, pruritus severity, severity of skin lesions, total IgE level, and specific IgE level were recorded to analyze the complex relationship between them.Results: The prevalence of allergic conjunctivitis and allergic rhinitis in the children group was significantly higher than that in the adult and older population group (P < 0.01 or P < 0.05). The positive rate of specific IgE in children group was significantly higher than that in the adult and older population group (P < 0.01). The IgE levels in children with moderate pruritus were significantly lower than those of severe pruritus (63.39vs 114.42 IU/mL, P < 0.05). The IgE levels in children with mild and moderate skin lesions were significantly lower than those in children with severe skin lesions (58.95 vs 72.88 vs

Background & aims: Severe COVID-19 infection is characterized by an inflammatory response and lung injury that can evolve into an acute respiratory distress syndrome that needs support treatment in intensive care unit. Nutritional treatment is an important component of the management of critically ill patients and should be started in the first 48 h of ICU admission to avoid malnutrition. This study describes the characteristics of the patients treated in a tertiary hospital in Madrid during the months of March-May 2020 (first wave), the medical nutrition treatment employed and its influence in the clinical outcome of these patients. Methods: This is a retrospective study including COVID-19 patients admitted in ICU that needed medical nutrition treatment (MNT). Collected variables included sex, age, BMI, underlying diseases, time from hospitalisation to ICU admission, type of respiratory support (invasive mechanical ventilation (IMV) or high flow nasal cannula (HFNC) or non-invasive ventilation (non-IMV)), caloric and protein requirements (25 kcal/kg adjusted body weight (ABW), 1.3 g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral nutrition (PN), mixed EN + PN), total calories (including propofol) and proteins administered, percentage of caloric and protein goal in ICU day 4th and 7th, metabolic complications, acute kidney failure (AKF), length of stay (LOS) and mortality. Data are expressed as mean ± SD, median (IQR) or frequencies. Statistical analysis was performed with the IBM SPSS Statistics for Windows, Version 25.0. p < 0.05 were considered statistically significant. Results: A total of 176 patients were included (72.7% male), 60.1 ± 13.5 years, BMI 29.9 ± 5.4 kg/m2. Underlying diseases included 47.4% overweight, 39.8% obesity, 49.1% hypertension, 41.4% dyslipidaemia. 88.6% of patients needed IMV, 89.1% prone position, 2.9% ECMO. Time to ICU admission: 2 (4.75) days. Estimated caloric and protein requirements were 1775 ± 202 kcal and 92.4 ± 10.3 g., Depto. de Medicina, Fac. de Medicina, Universidad Complutense de Madrid, TRUE, pub

Ruxolitinib has become the new standard of care for steroid-refractory and steroid-dependent chronic GVHD (SR-cGVHD). Our aim was to collect comparative data between ruxolitinib and extracorporeal photophoresis (ECP). We asked EBMT centers if they were willing to provide detailed information on GVHD grading, -therapy, -dosing, -response and complications for each included patient. 31 centers responded positively and we included all patients between 1/2017-7/2019 treated with ECP or ruxolitinib for moderate or severe SR-cGVHD. We identified 84 and 57 patients with ECP and ruxolitinib, respectively. We performed multivariate analyses adjusted on grading and type of SR-cGVHD (steroid dependent vs. refractory vs. intolerant to steroids). At day+180 after initiation of treatment for SR-cGVHD the odds ratio in the ruxolitinib group to achieve overall response vs. the ECP group was 1.35 (95% CI = [0.64; 2.91], p = 0.43). In line, we detected no statistically significant differences in overall survival, progression-free survival, non-relapse mortality and relapse incidence. The clinical significance is limited by the retrospective study design and the current data can’t replace prospective studies on ECP in SR-cGVHD. However, the present results contribute to the accumulating evidence on ECP as an effective treatment option in SR-cGVHD.

Objective: Chronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment. Methods: Data were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment. Results: In this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n = 5, 6%), 1 (n = 43, 52%), and 2 (n = 35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10 mL; 95% confidence interval [CI] 0.64–0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61–6.69). Conclusions: Three quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices.

Background/AimsData regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site infection (SSI) rate in lacrimal surgery without PSA.MethodsWe retrospectively analysed files of patients who underwent external (extDCR) or endoscopic endonasal dacryocystorhinostomy (endoDCR). We excluded patients with incomplete data (n = 68), acute a priori infection with the need for antibiotics (n = 15) and PSA post-operatively for other reasons (n = 28). Indications for surgery were canalicular stenosis (n = 51, 18.6% endoDCR vs n = 131, 19.5% extDCR), nasolacrimal duct obstruction (n = 118, 43.2% endoDCR vs n = 480, 64.3% extDCR) and mucocele/chronic dacryocystitis (n = 52, 19.0% endoDCR vs n = 187, 25.0% extDCR).ResultsIn this study, 1020 DCR surgeries were performed in 899 patients. Postoperative SSI was diagnosed in eight patients (0.8%); exclusively after extDCR (1.1% of all extDCR). No SSIs were found in endoDCR cases. The prevalence between SSI in extDCR versus endoDCR did not prove significant (n = 8/747 0.8% vs n = 0/273 0%, p = 0.13). All patients diagnosed with SSI were successfully treated with systemic oral antibiotics.ConclusionThe prevalence of SSI after DCR is low and was effectively treated with oral antibiotics. In our study, SSI occurred rarely after extDCR and was not observed after endoDCR. We conclude that lacrimal surgery is safe without the routine administration of PSA.

Introduction Pilomatrixoma is a benign skin neoplasm that is common in children and is often misdiagnosed. This study aimed to summarize the clinical and pathological features of pilomatrixoma in children. Methods Data on demographic information, clinical and pathological features, diagnosis, and treatment of 171 patients with pilomatrixoma from Shenzhen Baoan Women's and Children's Hospital were collected and analyzed retrospectively. Results The mean age of the patients was 5.7 (standard deviation (SD) = 3.9) year-old, and there were two age peaks (<= 1 year-old, 5-11 years old) and two age valleys (2-4 years old, >= 12 years old). The mean disease course was 9.3 (SD = 14.1) months, 69.0%, 86.5%, and 95.3% of the patients' disease course in 6 months, 12 months, and 24 months, respectively. The mean tumor volume is 0.6 (SD = 1.0) cm(3), 81.3% of the patients' tumor volume <= 1.0 cm(3). Tumors were distributed sequentially in the head and neck (77.2%), upper limbs (12.9%), trunk (7.6%), and lower limbs (2.3%). The correct rates of clinical and ultrasonic diagnosis were 50.9% and 38.6%, respectively. The two most common pathological features of pilomatrixoma were shadow cells (99.4%) and basaloid cells (94.7%). There were no significant differences in age, disease course, or tumor volume between the male and female patients (P > 0.05). The age and tumor volume of the patients in different body parts were significantly different (P-1 = 3.10E-05 and P-2 = 5.60E-05, respectively). The correlation between the disease course and tumor volume was positively significant (P <= 0.05). There was a significantly correlation between the disease course and tumor volume in patients with tumors at upper limbs (P = 0.03). Conclusion The age of children with pilomatrixoma presented two peaks and two valleys. Most patients had disease courses in 24 months and with tumor volumes <= 1.0 cm(3). The correct rates of clinical and ultrasonic diagnosis were relatively low. The head and neck

Objective: The objective was to evaluate treatment with the Herbst appliance at the specialist clinic of the Faculty of Odontology regarding treatment time, success rate and complications. Specifically comparing the Herbst appliance with cast-splints and bands, whether there were differences regarding treatment time or complications. Furthermore, treatments were evaluated between genders. Material and methods: Data was collected from 63 patient records from treatments with Herbst between 2013-2023. The data was then analysed through IBM SPSS. Individual casts were examined to complete the data. Chi-square tests and t-tests were used to identify statistical differences. Results: 95,2% of patients treated with the Herbst appliance achieved an Angle Class I and 90,5% of patients achieved all treatment goals, with a total treatment time at an average of 22,7 months, with the Herbst being in use for about 6,3 months. The most common complication was either that the cast-splints or bands loosened or broke. Only 8 of the 63 patients did not experience loss of attachment while a majority experienced between 1-3 complications with loss of attachment. There were no statistically significant differences with treatment between the genders, or either types of Herbst regarding treatment time, success rate or complications. Conclusions: The Herbst appliance seems to be an effective functional appliance, with high success rate, in treatments of Class II malocclusions, regardless of gender. The choice between cast-splints or bands seems to have no substantial impact regarding the effectiveness of the treatment, however further studies regarding the total costs between the two are needed., Syfte: Det huvudsakliga syftet med denna studie var att utvärdera behandlingar med Herbst apparatur på Malmö universitets specialistklinik, avseende behandlingstid, lyckandefrekvens, vilken typ av komplikationer som uppstår samt varför de uppstår. Studien ämnade även att utvärdera eventuella skillnader mellan Herbst med band respektive gjutna splintar samt även mellan könen avseende behandlingstid och komplikationer. Material och metod: Data samlades från 63 journaler från patienter behandlade med Herbst apparatur under perioden 2013-2023. Två observatörer granskade och registrerade datan som sedan analyserades med hjälp av IBM SPSS. Datainsamlingen kompletterades genom granskning av gipsmodeller. Chi2-test och t-test användes för att beräkna statistiska skillnader. Resultat: 95,2% av patienter behandlade med Herbst apparatur uppnådde Angle Class I, och 90,5% av patienterna nådde samtliga behandlingsmål. Den totala behandlingstiden var ca 22,7 månader och den ungefärliga behandlingstiden med enbart Herbst var ca 6,3 månader. Den främsta komplikationen visade sig vara att apparaturen lossnade eller gick sönder. Enbart 8 av de 63 patienterna genomgick behandling utan att delar av Herbst apparaturen lossnade, och majoriteten av patienterna hade 1-3 registreringar om lossnad apparatur. Där fanns ingen statistisk signifikant skillnad mellan varken kön eller typ av Herbst, vad gäller behandlingstid, lyckandefrekvens eller komplikationer. Slutsats: Herbst apparatur verkar vara en effektiv apparatur, med hög lyckandefrekvens, vid behandling av Class II bettavvikelser, oavsett kön. Valet mellan gjutna splintar och band spelar ingen större roll för behandlingens effektivitet men vidare studier bör utföras vad gäller skillnaden i de totala kostnaderna mellan de två typerna.

Objectives: Diagnostic errors contribute substantially to preventable medical errors. Especially, the emergency department (ED) is a high-risk environment. Previous research showed that in 15%-30% of the ED patients, there is a difference between the primary diagnosis assigned by the emergency physician and the discharge diagnosis. This study aimed to determine the number and types of diagnostic discrepancies and to explore factors predicting discrepancies. Methods: A retrospective record review was conducted in an academic medical center. The primary diagnosis assigned in the ED was compared with the discharge diagnosis after hospital admission. For each patient, we gathered additional information about the diagnostic process to identify possible predictors of diagnostic discrepancies. Results: The electronic health records of 200 patients were reviewed. The primary diagnosis assigned in the ED was substantially different from the discharge diagnosis in 16.0%. These diagnostic discrepancies were associated with a higher number of additional diagnostics applied for (2.4 versus 2.0 diagnostics; P = 0.002) and longer stay in the ED (5.9 versus 4.7 hours; P = 0.008). Conclusions: A difference between the diagnosis assigned by the emergency physician and the discharge diagnosis was found in almost 1 in 6 patients. The increased number of additional diagnostics and the longer stay at the ED in the group of patients with a diagnostic discrepancy suggests that these cases reflect the more difficult cases. More research should be done on predictive factors of diagnostic discrepancies.

Introduction: Defining major trauma (MT) with an Injury Severity Score (ISS) > 15 has limitations. This threshold is used for concentrating MT care in networks with multiple levels of trauma care. Objective: This study aims to identify subgroups of severely injured patients benefiting on in-hospital mortality and non-fatal clinical outcome measures in an optimal level of trauma care. Methods: A multicentre retrospective cohort study on data of the Dutch National Trauma Registry, region South West, from January 1, 2015 until December 31, 2019 was conducted. Patients ≥ 16 years admitted within 48 h after trauma transported with (H)EMS to a level I trauma centre (TC) or a non-level I trauma facility with a Maximum Abbreviated Injury Scale (MAIS) ≥ 3 were included. Patients with burns or patients of ≥ 65 years with an isolated hip fracture were excluded. Logistic regression models were used for comparing level I with non-level I. Subgroup analysis were done for MT patients (ISS > 15) and non-MT patients (ISS 9–14). Results: A total of 7,493 records were included. In-hospital mortality of patients admitted to a non-level I trauma facility did not differ significantly from patients admitted to the level I TC (adjusted Odds Ratio (OR): 0.94; 95% confidence interval (CI) 0.68–1.30). This was also applicable for MT patients (OR: 1.06; 95% CI 0.73–1.53) and non-MT patients (OR: 1.30; 95% CI (0.56–3.03). Hospital and ICU LOS were significantly shorter for patients admitted to a non-level I trauma facilities, and patients admitted to a non-level I trauma facility were more likely to be discharged home. Findings were confirmed for MT and non-MT patients, per injured body region. Conclusion: All levels of trauma care performed equally on in-hospital mortality among severely injured patients (MAIS ≥ 3), although patients admitted to the level I TC were more severely injured. Subgroups of patients

Craniosynostosis, characterized by premature fusion of one or more cranial sutures, results in a distorted skull shape. Only three studies have assessed facial asymmetry manually in unicoronal synostosis patients. It is therefore important to understand how uni- and bicoronal synostosis affect facial asymmetry with a minimum risk of human bias. An automated algorithm was developed to quantify facial asymmetry from three-dimensional images, generating a mean facial asymmetry (MFA) value in millimeters to reflect the degree of asymmetry. The framework was applied to analyze postoperative 3D images of syndromic patients (N = 35) diagnosed with Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis with respect to MFA values from a healthy control group (N = 89). Patients demonstrated substantially higher MFA values than controls: Muenke syndrome (unicoronal 1.74 ± 0.40 mm, bicoronal 0.77 ± 0.21 mm), Saethre-Chotzen syndrome (unicoronal 1.15 ± 0.20 mm, bicoronal 0.69 ± 0.16 mm), and TCF12-related craniosynostosis (unicoronal 1.40 ± 0.51 mm, bicoronal 0.66 ± 0.05 mm), compared with controls (0.49 ± 0.12 mm). Longitudinal analysis identified an increasing MFA trend in unicoronal synostosis patients. Our study revealed higher MFA in syndromic patients with uni- and bicoronal synostosis compared with controls, with the most pronounced MFA in Muenke syndrome patients with unilateral synostosis. Bicoronal synostosis patients demonstrated higher facial asymmetry than expected given the condition's symmetrical presentation.

Background: In the general intensive care unit (ICU) women receive invasive mechanical ventilation (IMV) less frequently than men. We investigated whether sex differences in the use of IMV also exist in the neurocritical care unit (NCCU), where patients are intubated not only due to respiratory failure but also due to neurological impairment. Methods: This retrospective single-centre study included adults admitted to the NCCU of the University Hospital Zurich between January 2018 and August 2021 with neurological or neurosurgical main diagnosis. We collected data on demographics, intubation, re-intubation, tracheotomy, and duration of IMV or other forms of respiratory support from the Swiss ICU registry or the medical records. A descriptive statistics was performed. Baseline and outcome characteristics were compared by sex in the whole population and in subgroup analysis. Results: Overall, 963 patients were included. No differences between sexes in the use and duration of IMV, frequency of emergency or planned intubations, tracheostomy were found. The duration of oxygen support was longer in women (men 2 [2, 4] vs. women 3 [1, 6] days, p = 0.018), who were more often admitted due to subarachnoid hemorrhage (SAH). No difference could be found after correction for age, diagnosis of admission and severity of disease. Conclusion: In this NCCU population and differently from the general ICU population, we found no difference by sex in the frequency and duration of IMV, intubation, reintubation, tracheotomy and non-invasive ventilation support. These results suggest that the differences in provision of care by sex reported in the general ICU population may be diagnosis-dependent. The difference in duration of oxygen supplementation observed in our population can be explained by the higher prevalence of SAH in women, where we aim for higher oxygenation targets due to the specific risk of vasospasm.

Background Implant rotation is a known complication to breast reconstruction using anatomical implants. However, there is a lack of large studies investigating the risk of implant rotation and potential predisposing risk factors. Method We reviewed the medical records of all patients who underwent breast reconstruction with Mentor anatomical implants from 2010 to 2021 at two Danish hospitals. We compared the risk of implant rotation between one- and two-stage breast reconstruction using univariate logistic regression. We analyzed the effect of biological mesh, immediate versus delayed reconstruction, and use of a higher final expander volume than the permanent implant volume on the risk of implant rotation. Finally, we analyzed the success rate of revision surgery for implant rotation. Results In total, 1134 patients were enrolled. Patients who underwent two-stage breast reconstruction (n = 720) had a significantly higher risk of implant rotation than those who underwent one-stage breast reconstruction (n = 426; 11% vs. 5%, p < 0.01). There was no significant association between implant rotation and the use of biological mesh, immediate breast reconstruction, or use of a higher final expander volume than the permanent implant volume. The success rate of revision surgery after implant rotation was 73% (62/85 rotations). Conclusions Two-stage breast reconstruction significantly increased the risk of implant rotation compared to one-stage breast reconstruction. The overall risk of implant rotation was low and success rate of revision surgery was high. These findings suggest that anatomical implants are safe to use for breast reconstruction. However, surgeons and patients should be aware of the increased risk of implant rotation after two-stage reconstruction., Background: Implant rotation is a known complication to breast reconstruction using anatomical implants. However, there is a lack of large studies investigating the risk of implant rotation and potential predisposing risk factors. Method: We reviewed the medical records of all patients who underwent breast reconstruction with Mentor anatomical implants from 2010 to 2021 at two Danish hospitals. We compared the risk of implant rotation between one- and two-stage breast reconstruction using univariate logistic regression. We analyzed the effect of biological mesh, immediate versus delayed reconstruction, and use of a higher final expander volume than the permanent implant volume on the risk of implant rotation. Finally, we analyzed the success rate of revision surgery for implant rotation. Results: In total, 1134 patients were enrolled. Patients who underwent two-stage breast reconstruction (n = 720) had a significantly higher risk of implant rotation than those who underwent one-stage breast reconstruction (n = 426; 11% vs. 5%, p < 0.01). There was no significant association between implant rotation and the use of biological mesh, immediate breast reconstruction, or use of a higher final expander volume than the permanent implant volume. The success rate of revision surgery after implant rotation was 73% (62/85 rotations). Conclusions: Two-stage breast reconstruction significantly increased the risk of implant rotation compared to one-stage breast reconstruction. The overall risk of implant rotation was low and success rate of revision surgery was high. These findings suggest that anatomical implants are safe to use for breast reconstruction. However, surgeons and patients should be aware of the increased risk of implant rotation after two-stage reconstruction.