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OBJECTIVE:  Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization. STUDY DESIGN:  We analyzed California birth cohort data on all live and stillbirths ≥ 20 weeks gestation from 1997 to 2017 (n = 10,580,096) using the Centers for Disease Control and Preventions SMM index. Cases were categorized into seven nonmutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression. RESULTS:  SMM occurred in 1.16% of births and nontransfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over 3-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717 and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, U.S.-born Hispanic, and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial. CONCLUSION:  Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities, and potential needs for intervention. KEY POINTS: · By SMM subgroup, trends and racial and ethnic disparities varied yet Black individuals consistently had highest rates.. · Hemorrhage, renal, respiratory, and sepsis SMM significantly increased over time.. · Disparities increased for respiratory SMM among Black, U.S.-born Hispanic and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals..

ImportanceCurrent measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact.ObjectiveTo explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI).Evidence reviewA total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds. The first 2 sessions took place via a text-based web application following the Delphi study design. The final round took place virtually among participants via video conferencing software on April 30, 2022.FindingsOf all invited experts, 64 completed the first survey round (global representation: Africa [4.7%], Asia [9.4%], Australia [14.1%], Europe [43.8%], North America [23.4%], and South America [4.7%]; health care setting: public [20.3%], private [28.1%], and both [51.6%]). A total of 58 specialists completed the second round, and 42 participated in the final video conference meeting. Overall, consensus was achieved in 96 of 107 questions. Several factors, independent of the Severity of Alopecia Tool score, were identified as potentially worsening AA severity outcomes. These factors included a disease duration of 12 months or more, 3 or more relapses, inadequate response to topical or systemic treatments, rapid disease progression, difficulty in cosmetically concealing hair loss, facial hair involvement (eyebrows, eyelashes, and/or beard), nail involvement, impaired quality of life, and a history of anxiety, depression, or suicidal ideation due to or exacerbated by AA. Consensus was reached that the Alopecia Areata Investigator Global Assessment scale adequately classified the severity of scalp hair loss.Conclusions and relevanceThis eDelphi survey study, with consensus among global experts, identified various determinants of AA severity, encompassing not only scalp hair loss but also other outcomes. These findings are expected to facilitate the development of a multicomponent severity tool that endeavors to competently measure disease impact. The findings are also anticipated to aid in identifying candidates for current and emerging systemic treatments. Future research must incorporate the perspectives of patients and the public to assign weight to the domains recognized in this project as associated with AA severity.

OBJECTIVE: To describe changes over time in resuscitation, survival, and morbidity of extremely preterm infants in California. STUDY DESIGN: This population-based, retrospective cohort study includes infants born ≤28 weeks. Linked birth certificates and hospital discharge records were used to evaluate active resuscitation, survival, and morbidity across two epochs (2011-2014, 2015-2019). RESULTS: Of liveborn infants, 0.6% were born ≤28 weeks. Active resuscitation increased from 16.9% of 22-week infants to 98.1% of 25-week infants and increased over time in 22-, 23-, and 25-week infants (p-value ≤ 0.01). Among resuscitated infants, survival to discharge increased from 33.2% at 22 weeks to 96.1% at 28 weeks. Survival without major morbidity improved over time for 28-week infants (p-value

Physical inactivity is a leading contributor to increased cardiovascular morbidity and mortality. Almost 500 million new cases of preventable noncommunicable diseases (NCDs) will occur globally between 2020 and 2030 due to physical inactivity, costing just over US$300 billion, or around US$ 27 billion annually (WHO 2022). Active adults can achieve a reduction of up to 35% in risk of death from cardiovascular disease. Physical activity also helps in moderating cardiovascular disease risk factors such as high blood pressure, unhealthy weight and type 2 diabetes. For people with cardiovascular disease, hypertension, type 2 diabetes and many cancers, physical activity is an established and evidence-based part of treatment and management. For children and young people, physical activity affords important health benefits. Physical activity can also achieve important cross-sector goals. Increased walking and cycling can reduce journeys by vehicles, air pollution, and traffic congestion and contribute to increased safety and liveability in cities.

OBJECTIVE: We sought to examine trends in diagnosed behavioral health (BH) conditions [mental health (MH) disorders or substance use disorders (SUD)] among pregnant and postpartum individuals between 2008-2020. We then explored the relationship between BH conditions and race/ethnicity, acknowledging race/ethnicity as a social construct that influences health disparities. METHODS: This study included delivering individuals, aged 15-44 years, and continuously enrolled in a single commercial health insurance plan for 1 year before and 1 year following delivery between 2008-2020. We used BH conditions as our outcome based on relevant ICD 9/10 codes documented during pregnancy or the postpartum year. RESULTS: In adjusted analyses, white individuals experienced the highest rates of BH conditions, followed by Black, Hispanic, and Asian individuals, respectively. Asian individuals had the largest increase in BH rates, increasing 292%. White individuals had the smallest increase of 192%. The trend remained unchanged even after adjusting for age and Bateman comorbidity score, the trend remained unchanged. CONCLUSIONS: The prevalence of diagnosed BH conditions among individuals in the perinatal and postpartum periods increased over time. As national efforts continue to work toward improving perinatal BH, solutions must incorporate the needs of diverse populations to avert preventable morbidity and mortality.

Epidemiologic research and quantitative risk assessment play a crucial role in transferring fundamental scientific knowledge to policymakers so they can take action to reduce the burden of ambient air pollution. This commentary addresses several challenges in quantitative risk assessment of air pollution that require close attention. The background to this discussion provides a summary of and conclusions from the epidemiological evidence on ambient air pollution and health outcomes accumulated since the 1990s. We focus on identifying relevant exposure-health outcome pairs, the associated concentration-response functions to be applied in a risk assessment, and several caveats in their application. We propose a structured and comprehensive framework for assessing the evidence levels associated with each exposure-health outcome pair within a health impact assessment context. Specific issues regarding the use of global or regional concentration-response functions, their shape, and the range of applicability are discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT While globally hepatitis A (hepA) infections occur in 150 million people annually, European high‐income countries now have a low endemicity. However, this results in a more susceptible adult population which is prone to severe illness. To determine current epidemiological characteristics, we performed a systematic literature review to assess the severity of hepA disease in the past two decades in 11 European countries (i.e., Denmark, France, Germany, Greece, Hungary, Italy, the Netherlands, Spain, Sweden, Switzerland and the United Kingdom). Literature search was performed using PubMed and Embase between 1 January 2001 and 14 April 2021. Search terms included the disease (hepA), the 11 selected countries, the term ‘outbreaks’ and its synonyms, outcomes and terms for hepA virus circulation. In total, 43 records reported data on hepA disease outcomes. Hospitalisation rates varied between the countries, with annual rates exceeding 50% at least once in seven countries. The lowest hospitalisation rates were reported for the Netherlands (≤ 32%) and the highest for Greece (≥ 81%). Liver failure, haemorrhagic and other complications were rarely reported, and case fatality rates were low (0.03%–0.26%). Our findings are consistent with the trends observed globally. This systematic literature review highlights the need to increase awareness of hepA risks and to strengthen prevention strategies. Continuous monitoring of epidemiological data is crucial to assess which populations would most benefit from prevention, mainly with respect to future vaccination recommendations. [ABSTRACT FROM AUTHOR]

Objective: The superiority of laparoscopic liver resection (LLR) and open liver resection (OLR) in obese patients remains controversial. The study aims to assess the available literature and compare the perioperative outcomes of LLR and OLR for liver tumors in obese patients. Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science databases for studies comparing LLR and OLR. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Nine studies were included, with a total of 1116 patients (LLR group: 482 patients; OLR group: 634 patients). Compared with OLR, LLR has lower overall morbidity (OR 0.47, 95% CI 0.34, 0.64), major complications (OR 0.45, 95% CI 0.25, 0.82), surgical site infection (OR 0.18, 95% CI 0.07, 0.48), bile leak (OR 0.45, 95% CI 0.22, 0.95), less blood loss (MD, -329.12 mL; 95% CI, -623.35, -34.88), and shorter length of stay (MD, -5.20 days; 95% CI, -7.43, -2.97). There were no significant differences in mortality, operation time, liver failure, and blood transfusion between the two groups. Conclusions: LLR for obese patients is safe and feasible. Compared to OLR, it offers better short-term outcomes. Further randomized controlled trials to verify the potential advantages of LLR over OLR are warranted. [ABSTRACT FROM AUTHOR]

Background/Objectives: The geriatric nutrition risk index (GnRI) has been regarded as a useful predictor of morbidity and mortality in elderly patients. This study aimed to determine the use of the GnRI as a prognostic predictor in extremely elderly patients undergoing proximal femur fracture surgery and the usefulness of evaluation tools related to a patient's underlying disease and functional capacity in predicting the prognosis of extremely elderly patients. Methods: We analyzed 548 patients who had undergone surgery for proximal femur fracture caused by trauma, with an age of ≥80 years, without other accompanying trauma. Results: Body mass index (BMI) (OR, 1.077; 95% CI, 1.010–1.149; p = 0.023), serum albumin levels (0.389; 0.223–0.678; p = 0.001), and Charlson comorbidity index (CCI) (1.170; 1.014–1.349; p = 0.031) were determined to be predictors of morbidity in a multivariable regression analysis. The area under the curve (AUC) in the receiver operating characteristic curve of BMI was 0.565 (95% CI, 0.493–0.637; p = 0.065), and the optimal cut-off value could not be determined. The AUC of serum albumin was 0.647 (0.576–0.717; p < 0.001), and the optimal cut-off value was 3.65 g/dL (sensitivity, 72.2%; specificity, 52.7%). The AUC of the CCI was 0.648 (0.580–0.715; p < 0.001), and the optimal cut-off value was 6.5 (sensitivity, 63.3%; specificity, 61.4%). Conclusions: The GnRI was not a predictive factor for patient prognosis after proximal femur fractures in extreme elderly patients. Rather, serum albumin level and CCI, which reflect the patient's underlying comorbid conditions, were more useful in predicting in-hospital morbidity after proximal femur surgery in extremely elderly patients. [ABSTRACT FROM AUTHOR]

The objective of this randomized controlled trial was to determine whether providing a rest period to surplus calves transported for 16 h reduced the effect of long-distance transportation on health, growth, and activity after arrival to a calf-raising facility. Between September 2022 to January 2023, 6- to 24-d-old surplus calves were randomly assigned to one of 2 treatment groups: (1) continuous transportation by road for 16 h (n = 86) or (2) 8 h of transport, an 8 h rest period, then a further 8 h of transport to a single commercial calf-raising facility in Ontario, Canada (n = 84). Calves that received the rest period were fed 2 L of milk replacer at the time of unloading for the rest period and again before reloading for the second leg of transportation. Calves were weighed before and after transportation and once weekly until they left the calf-raising facility at 11 wk after arrival. Additionally, fecal consistency and respiratory health were assessed immediately before and after transportation, as well as twice daily following arrival. The odds of abnormal fecal and respiratory scores were assessed with mixed effects logistic regression models, whereas Cox proportional hazards models were used to evaluate the hazard of treatment for diarrhea and respiratory disease. To evaluate weight loss during transportation, ADG, lying bouts, and steps, mixed linear regression models were used. Furthermore, mixed logistic regression models with repeated measures were built to assess associations with the odds of having a sunken flank and prolonged skin tent. There were no statistical differences in the odds of abnormal fecal or respiratory scores or the treatment for diarrhea between treatment groups; however, there was evidence that calves that received a rest period had a higher hazard of treatment for respiratory disease. Calves >10 d old had reduced odds of having an abnormal respiratory score and calves 13 to 24 d old had lower odds of arriving with a prolonged skin tent, lower odds of abnormal fecal score, and reduced hazard of treatment for diarrhea compared with calves that were 6 to 8 d old at transportation. During transportation, calves that received a rest period lost less weight than continuously transported calves. With respect to ADG over the 77-d study, an interaction between age at transport and treatment group was identified where calves aged 9 to 10 d old and receiving a rest period had higher ADG compared with calves that were 9 to 10 d old and not receiving a rest period. As for calf activity, calves receiving an rest period spent more time lying on the day after transportation compared with calves that were continuously transported. The results of this trial show few differences in the health and growth of calves having a rest period compared with those that underwent continuous transport. Furthermore, calves receiving a rest period may arrive more fatigued than calves that arrive at their destination in a shorter period of time overall. Transporting calves at older ages presents an opportunity to reduce the effect of long-distance transportation on subsequent health, growth, and activity. The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. [ABSTRACT FROM AUTHOR]

Introduction Warfighters are issued hard body armor designed to defeat ballistic projectiles. The resulting backface deformation can injure different thoracoabdominal organs. Developed over decades ago, the behind armor blunt impact criterion of maximum 44 mm depth in clay continues to be used independent of armor type or impact location on the thoracoabdominal region covered by the armor. Because thoracoabdominal components have different energy absorption capabilities, their mode of failures and mechanical properties are different. These considerations underscore the lack of effectiveness of using the single standard to cover all thoracoabdominal components to represent the same level of injury risk. The objective of this pilot study is to conduct cardiac impact tests with a live animal model and analyze biomechanical injury candidate metrics for behind armor blunt trauma applications. Materials and Methods Live swine tests were conducted after obtaining approvals from the U.S. DoD. Trachea tubes. An intravenous line were introduced into the swine before administering anesthesia. Pressure transducers were inserted into lungs and aorta. An indenter simulating backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers delivered impact to the heart region. The approved test protocol included 6-hour monitoring and necropsies. Indenter accelerometer signals were processed to compute the velocity and deflection, and their peak magnitudes were obtained. The deflection-time signal was normalized with respect to chest depth along the impact axis. The peak magnitude of the viscous criterion, kinetic energy, force, momentum and stiffness were obtained. Results Out of the 8 specimens, 2 were sham controls. The mean total body mass and soft tissue thickness at the impact site were 81.1 ± 4.1 kg and 3.8 ± 1.1 cm. The peak velocities ranged from 30 to 59 m/s, normalized deflections ranged from 15 to 21%, and energies ranged from 105 to 407 J. The range in momentum and stiffness were 7.0 to 13.9 kg-m/s and 22.3 to 79.9 N/m. The maximum forces and impulse data ranged from 2.9 to 11.7 kN and 1.9 to 5.8 N-s. The peak viscous criterion ranged from 2.0 to 5.3 m/s. One animal did not sustain any injuries, 2 had cardiac injuries, and others had lung and skeletal injuries. Conclusions The present study applied blunt impact loads to the live swine cardiac region and determined potential candidate injury metrics for characterization. The sample size of 6 swine produced injuries ranging from none to pure skeletal to pure organ trauma. The viscous criterion metric associated with the response of the animal demonstrated a differing pattern than other variables with increasing velocity. These findings demonstrate that our live animal experimental design can be effectively used with testing additional samples to develop behind armor blunt injury criteria for cardiac trauma in the form of risk curves. Injury criteria obtained for cardiac trauma can be used to enhance the effectiveness of the body armor, reduce morbidity and mortality, and improve warfighter readiness in combat operations. [ABSTRACT FROM AUTHOR]

Background: Intraventricular hemorrhage (IVH) often affects newborns of low gestational age and low birth weight, requires critical care for neonates, and is linked to long-term neurodevelopmental outcomes. Assessing regional differences in the U.S. in care for neonatal IVH and subsequent outcomes can shed light on ways to mitigate socioeconomic disparities. Methods: Using the 2016–2019 National Inpatient Sample (NIS), patients with a primary diagnosis of IVH were identified using ICD-10-CM codes. A retrospective cohort study was conducted with patients stratified by hospital region. Demographics, comorbidities, presentation, intraoperative variables, and inpatient outcomes were assessed. Multivariate logistic regression analyses were used to identify the impact of insurance status on extended LOS (defined as > 75th percentile of LOS), exorbitant cost (defined as > 75th percentile of cost), and mortality. Results: Included in this study were 1630 newborns with IVH. A larger portion of patients in the South and Midwest were Black, compared to the Northeast and West (Northeast: 12.2% vs Midwest: 30.2% vs South: 22.8% vs West: 5.8%, p < 0.001), while a greater percentage of patients in the West and South were Hispanic (Northeast: 7.3% vs Midwest: 9.5% vs South: 22.8% vs West: 36.2%, p < 0.001). LOS was similar among all regions. Factors associated with prolonged LOS included hydrocephalus and CSF diversions. Median total cost of admission was highest in the West, while the South was associated with decreased odds of exorbitant cost. LOS was associated with exorbitant cost, and large bed-volume hospital, VLBW, and permanent CSF shunt were associated with mortality. Conclusions: Demographic variables, but not presenting or intraoperative variables, differed among regions, pointing to possible geographic health disparities. The West had the highest total cost of admission, while the South was associated with reduced odds of exorbitant admission costs. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to assess: (i) trends in alcohol‐specific — that is, fully attributable — morbidity and mortality in the German adult population aged 15–69 between 2000 and 2021; and (ii) changes in alcohol‐attributable disease burden — that is, fully and partially alcohol‐attributable categories — for 2006, 2012, 2018 and 2021. Methods: Morbidity data was pulled from hospitalisation and rehabilitation statistics and mortality data was pulled from the causes of death registry. Alcohol use, adjusted for unrecorded consumption, was estimated using the Epidemiological Survey of Substance Abuse and triangulated with per capita consumption from annual sales data. For major disease categories, alcohol‐attributable fractions were estimated for males and females by age groups (15–29, 30–49, 50–69 years) using the comparative risk assessment methodology. Results: For males and females, the age‐standardised rate of alcohol‐specific morbidity peaked in 2012 and decreased thereafter showing a steep decline from 2019 to 2021. The rates of alcohol‐specific mortality decreased constantly from 2000 to 2019 but increased from 2019 to 2021. Compared to 2006 the age‐standardised alcohol‐attributable morbidity and mortality rates in males and females were lower in 2021. For both sexes, the age‐standardised alcohol‐attributable morbidity and mortality rates and the proportions of morbidity/mortality rates relative to all‐cause morbidity/mortality decreased between 2006 and 2021. Discussion: The declines in alcohol‐attributable morbidity and mortality are in line with decreases in consumption and signal that the importance of alcohol in health service utilisation and mortality has weakened. Sex ratios in morbidity and mortality do not indicate a strong converging trend. [ABSTRACT FROM AUTHOR]

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability. [ABSTRACT FROM AUTHOR]

Background: Technological disasters in Asia have significant public health and environmental implications, but there is limited epidemiological analysis of these events. This study aims to characterize the epidemiological profile of technological disasters in Asia from 2000 to 2021, focusing on morbidity and mortality trends. Methods: A retrospective descriptive observational analysis was conducted using data from emergency events database (EM‐DAT), DesInventar, NatCAt, and Sigma. The study categorized disasters into transport, industrial, and miscellaneous accidents. Statistical analyses were used to examine frequencies, trends, and correlations among the different disaster types. Results: From 2000 to 2021, Asia experienced 2333 technological disasters, with transport accidents being the most frequent (55.77%), followed by industrial (26.10%) and miscellaneous accidents (18.13%). The overall trend showed a statistically significant decrease in the frequency of these disasters and in average mortality and injury rates. The study highlighted the varying impact of different disaster types, with industrial accidents causing the highest fatality and affected rates despite being less frequent than transport accidents. Conclusions: The study indicates a declining trend in the frequency and severity of technological disasters in Asia, reflecting improved safety measures and disaster management. However, the high impact of industrial accidents underscores the need for targeted prevention strategies. [ABSTRACT FROM AUTHOR]

The main aim of this study was to determine expanded sequence types (eSTs) of Ureaplasma species (U. spp.). DNA isolated from the amniotic fluid of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) using an expanded multilocus sequence typing scheme. Additionally, the study sought to examine whether phylogenetic subgroups of U. spp. DNA differ with respect to maternal demographic and clinical parameters and selected aspects of short-term neonatal morbidity. This retrospective cohort study was focused on singleton pregnancies complicated by PPROM occurring between the gestational ages of 24+0 and 36+6 weeks, where amniocentesis was conducted to assess the intra-amniotic environment and the presence of U. spp. DNA in the amniotic fluid samples was confirmed. The stored aliquots of U. spp. DNA were used to assess differences in nucleotide sequences in six U. spp. genes (ftsH, rpL22, valS, thrS,ureG, and mba-np1) using the eMLST scheme. The expanded multilocus sequence typing scheme was performed in 73 samples of U. spp. DNA isolated from pregnancies complicated by PPROM. In total, 33 different U. spp. DNA eSTs were revealed, 21 (#20, 233–244, 248–251, 253, 255, 259, and 262) of which were novel. The most frequently identified eST was #41, identified in 18% (13/73) of the aliquots. Based on their genetic relationships, the U. spp. DNA was divided into two clusters and four subgroups [cluster I (U. parvum): A, 43% (n = 31); B, 15% (n = 11); and C, 26% (n = 19); cluster II (U. urealyticum): 1; 16% (n = 12)]. Cluster II had a higher rate of polymicrobial findings than cluster I (58% vs 16%; p = 0.005), while subgroup A had the highest rate of concomitant Mycoplasma hominis in the amniotic fluid samples (66%; p = 0.04). In conclusion, Ureaplasma spp. DNA obtained from PPROM consisted of 33 different eSTs of U. spp. DNA. No differences in maternal and neonatal characteristics were found among the phylogenetical subgroups of U. spp. DNA, except for a higher rate of polymicrobial amniotic fluid findings in those with U. urealyticumand the concomitant presence of M. hominis in the amniotic fluid in those with the presence of U. parvum. [ABSTRACT FROM AUTHOR]

Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed. Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons' Intermacs registry were studied. Cox proportional hazard multivariable analyses incorporating AEs as time-varying covariates for mortality out to 180 days was used to generate the INtermacs Short term composITE quality score (INSITE score derivation), reflecting the adjusted hazard ratio (HR) for mortality contributed by each AE, applying the global ranking methodology. In those alive and on support at 6 months, multivariable logistic regression (odds ratio) was used to examine the impact of AEs on health-related quality of life (QOL) at 180 days, captured through the INSITE-QOL score. Failure to achieve ≥1 point increase in visual analog scale from baseline was the event. Of 13,148 patients, 4,389 (33.4%) suffered at least 1 AE or death through 180 days. Stroke (survival: HR 13.1; QOL: HR 1.7), dialysis (survival: HR 31.4; QOL: HR 4.2), prolonged respiratory failure (survival: HR 5.7; QOL: HR 2.3), reoperation (survival: HR 3.4; QOL: HR 1.6), and right heart failure (survival: 5.0; QOL: HR 1.4), contributed to both mortality and failure to improve QOL at 180 days (all p < 0.05). The median INSITE and INSITE-QOL scores were 0.0 [0.0, 1.6] and 0.0 [0.0, 0.0], respectively. At 9.4% (n = 17) of centers, a high INSITE score (≥13) was present in 15% of patients, while the top 25% of centers had perfect INSITE-QOL scores in at least 75% of patients. AEs after LVAD confer differential impact on mortality and QOL, enabling the development of global rank outcome scores. Given the high mortality hazard conferred by 180-day AEs, center-specific quality interventions aimed at reducing early complications provide the greatest opportunity to improve long-term survival and QOL. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: The American College of Surgeons (ACS) recommends that special considerations be made during triage of trauma patients aged ≥55 due to an observed increase in morbidity and mortality in this population. The geriatric population aged ≥65 represents 30% of all trauma patients. Our objective was to assess which pre-existing conditions (PECs) are associated with worse outcomes in trauma patients aged ≥55. Methods: Study population was selected from the local trauma registry (2020-22). Bi-variate analysis compared PEC status with outcomes controlling for each Injury Severity Score (ISS) category. Injury Severity Score was defined as mild (1-8), moderate (9-15), severe (16-24), and critical (≥25). Results: A total of 5,168 patients were identified (54.9% female, 56.7% age ≥75, 49.1% mild injury). Patients who had chronic renal failure (CRF) were at increased odds of mortality after adjusting for mild (adjusted odds ratio [aOR]: 2.63), moderate (aOR: 2.97), severe (aOR: 2.84), and critical (aOR: 2.62) injuries. Patients who had cirrhosis or congestive heart failure (CHF) were at increased odds of mortality after adjusting for mild (aOR: 3.03, 1.61), moderate (aOR: 3.63, 2.14), and severe (aOR: 3.46, 1.93) injuries, respectively. In addition, there was a relationship between having chronic obstructive pulmonary disease (COPD), dementia, anticoagulant therapy, or diabetes with unplanned intensive care unit (ICU) admission and development of acute kidney injury (AKI). Discussion: There is an association between certain pre-exiting conditions and worse outcomes. Early identification of these factors could provide a foundation for better interdisciplinary management, prevention of complications and associated mortality. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess short-term biliary outcomes in adult living donor liver transplants using right grafts, comparing robotic surgery with real-time indocyanine green fluorescence cholangiography for optimal hilar plate transection, against the conventional open approach. Background: Determining the optimal transection plane through the hilar plate is crucial in donor hepatectomies, impacting outcomes significantly. Methods: From 2011 to 2023, a total of 839 right graft living donor hepatectomies were performed, with 414 (49%) performed via the open approach and 425 (51%) utilizing the robotic platform. Results: The magnetic resonant cholangiopancreatography predictions correlated moderately with the actual count of graft ducts (r = 0.57, P < 0.001). Out of all 839 right donor hepatectomies, 321 (44%) were single duct grafts, of which 193/425 (49%) were retrieved with the robotic while 128/414 (38%) were with the open approach (OR: 1.58, 95% CI: 1.16--2.14), P = 0.003). Overall, 50 (6%) of the donors developed a biliary complication during their hospital stay, of whom 38 (9%) were grafts retrieved with the open, while 13 (3%) with the robotic approach (OR: 0.31, 95% CI: 0.15--0.61, P < 0.001). Similarly, 63 (15%) of the adult recipients developed a biliary complication of any severity when grafts were retrieved with the open approach compared to 35 (8%) with the robotic approach (OR: 0.50, 95% CI: 0.31--0.79), P = 0.002). Conclusions: The robotic platform with integrated real-time indocyanine green fluorescence cholangiography during right donor hepatectomy offers improved safety for the donor by accurately addressing the right hilar corridor, resulting in fewer graft ducts and fewer complications for the donor and recipient when compared to the standard open approach. [ABSTRACT FROM AUTHOR]

Objective: To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others. Background: Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and within centers. However, data on interobserver variability for pancreatoduodenectomy-specific complications are lacking. Methods: International cross-sectional multicenter study including 52 raters from 13 high-volume pancreatic centers in 8 countries on 3 continents. Per center, 4 experienced raters scored 30 randomly selected patients after pancreatoduodenectomy. In addition, all raters scored 6 standardized case vignettes. This variability and the "within centers" variability were calculated for 2-fold scoring (no complication/grade A vs grade B/C) and 3-fold scoring (no complication/ grade A vs grade B vs grade C) of postoperative pancreatic fistula, postpancreatoduodenectomy hemorrhage, chyle leak, bile leak, and delayed gastric emptying. Interobserver variability is presented with Gwet AC-1 measure for agreement. Results: Overall, 390 patients after pancreatoduodenectomy were included. The overall agreement rate for the standardized cases vignettes for 2-fold scoring was 68% (95% CI: 55%--81%, AC1 score: moderate agreement), and for 3-fold scoring 55% (49%--62%, AC1 score: fair agreement). The mean "within centers" agreement for 2-fold scoring was 84% (80%--87%, AC1 score; substantial agreement). Conclusions: The interobserver variability for the ISGPS-defined complications of pancreatoduodenectomy was too high even though the "within centers" agreement was acceptable. Since these findings will decrease the quality and validity of clinical studies, ISGPS has started efforts aimed at reducing the interobserver variability. [ABSTRACT FROM AUTHOR]

Non-cancer-related risk factors for secondary lymphedema were defined across four categories: co-morbidity, social determinants of health, behavioral factors, and environmental effectors. Based on rapid reviews of the literature and presentations at the ACS/LANA Lymphedema Summit, this working group categorized these risk factors according to the strength of evidence. Consensus agreement on level of evidence was achieved through one face-to-face working session and three follow-up virtual meetings. Findings elucidate strong evidence for co-morbidities, such as cardio/metabolic and vascular factors contributing to the risk for lymphedema. Evidence is low-to-moderate for social and behavioral factors and is lacking for environmental factors. Panel recommendations suggest a tailored approach to prospective surveillance when monitoring for secondary lymphedema that includes social determinants of health considering the growing awareness and evidence of these factors' influence on cancer and cancer-related morbidity. [ABSTRACT FROM AUTHOR]

In the era of minimally invasive surgery, esophagectomy remains a highly invasive procedure with a high rate of postoperative complications. Preoperative risk assessment is essential for planning esophagectomy in patients with esophageal cancer, and it is crucial to implement evidence‐based perioperative management to mitigate these risks. Perioperative support from multidisciplinary teams has recently been reported to improve the perioperative nutritional status and long‐term survival of patients undergoing esophagectomy. Intraoperative management of anesthesia and fluid therapy also significantly affects short‐term outcomes after esophagectomy. In this narrative review, we outline the recent updates in the perioperative management of esophagectomy, focusing on preoperative risk assessment, intraoperative management, and perioperative support by multidisciplinary teams to improve operative outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this systematic review is to provide an overview of published follow-up care programs of primary and secondary health conditions (SHCs) in spinal cord injury/disorder (SCI/D) and spina bifida and describe recommendations on content, frequency, setting of follow-up care programs for persons with SCI/D and spina bifida. Methods: According to the sequence of procedures of the AWMF (Association of the Scientific Medical Societies in Germany) a systematic literature search was performed (in PubMed, Cochrane Library and nine additional databases for guidelines) between 5 September 2019 and 22 September 2019. Publications (Jan. 2008-Dec. 2018) and guidelines (up to 2018) published in English or German and describing an evidence-based follow-up care program for persons with SCI/D or spina bifida were included. Results: The systematic literature search found 1973 publications in PubMed and Cochrane Library, resulting in 19 papers for SCI/D and 6 for Spina bifida. Additionally, we included 34 guidelines developed by reputable committees or medical associations. All eligible guidelines, and publications, were rated and classified according to the guidance of AWMF. Of the retrieved publications, and guidelines, level of evidence of follow-up care programs was mostly based on informal procedures and expert opinion or formally consent based expert opinion. None of the guidelines, or publications described an evidence based comprehensive clinical practice guideline (CPG) for follow-up care for people with SCI/D or spina bifida. Conclusion: Based on the comprehensive and extensive literature research conducted, regular (annual) follow-up care appointments at specialized SCI clinics are recommended. There is a notable absence of a comprehensive CPG covering all relevant health conditions for long-term follow-up in SCI/D or spina bifida. In order to provide persons with SCI/D with up-to-date and best possible medical and rehabilitative care, a CPG for follow-up care is urgently needed. In response to this gap, the German-speaking Medical Society of Paraplegia (DMGP) has commissioned its members to establish a guideline for follow-up care for individuals with SCI/D. The current review serves as an evidence-based framework for the development of this guideline. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions The prevalence of cardiovascular disease during pregnancy (cardiovascular disease diagnosed before, during or up to 6 months after childbirth) and the risk of adverse outcomes associated with it have not been previously described in Sweden. This study examined trends in prevalence of cardiovascular disease and its association with maternal and perinatal outcomes, overall and by timing of diagnosis in relation to pregnancy.This population‐based observational retrospective cohort study consisted of women aged 15–49 years who were registered in the Swedish Medical Birth Register 2000–2019. Prevalence was defined as annual diagnosis of cardiovascular disease per pregnant woman as numerator and all pregnant women per year as denominator. Adverse maternal and perinatal outcomes were analyzed using time‐dependent Cox regression and Poisson regression models. Outcomes were obtained during and after childbirth up to 1 year postpartum, depending on the outcome.There were 2 069 107 births to 1 186 137 women (911 101 primiparous). The prevalence of cardiovascular disease among pregnant women in Sweden during 2000–2019 increased from 0.31% to 1.34%, for non‐congenital cardiovascular disease, this was primarily driven by arrythmia (0.11%–0.58%). Primiparous women with cardiovascular disease had a higher risk of eclampsia over‐all (aHR 4.50, 95% CI 2.01–10.05) and when diagnosed during pregnancy (aHR 3.22, 95% CI 1.21–8.61); admission to psychiatric ward overall (aHR 2.51, 95% CI 1.30–4.83), and when diagnosed during pregnancy (aHR 2.54, 95% CI 1.21–5.34); and one‐year mortality when diagnosed before pregnancy (aHR 1.67, 95% CI 1.16–2.42) and when diagnosed postpartum (aHR 6.59, 95% CI 3.38–12.84), compared to those without cardiovascular disease. Children born to women with cardiovascular disease diagnosed both overall and in relation to timing of diagnosis had an increased risk of being born preterm and small for gestational age.Cardiovascular disease prevalence among pregnant women in Sweden increased during 2000–2019, primarily driven by arrhythmias. In primiparous women, the timing of diagnosis of cardiovascular disease is important for maternal and perinatal outcomes, including when diagnosed postpartum. This calls for awareness among all staff when planning pregnancy and monitoring women with cardiovascular disease throughout pregnancy and in the postpartum period. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the relationship between heat and emergency hospital admissions (EHAs) in Switzerland using clinically relevant metrics. Methods: Applying distributed lag non-linear models, we investigated temperatureadmission associations between May and September 1998--2019 for various disease groups, by age class and gender. We estimated the relative risk (RR) for moderate (29°C) and extreme (34°C) daily maximum temperatures relative to disease-specific optimum temperature, and calculated attributable fractions (AFs) for hot days and the following week. We also calculated the total number of heat-related EHAs. Results: We attributed 31,387 (95% confidence interval: 21,567--40,408) EHAs to aboveoptimal temperatures, 1.1% (0.7%--1.4%) of the total. Extreme temperatures increased the EHA risk for mental, infectious and neurological diseases. We observed particularly high AFs due to extreme heat for dehydration (85.9%, 95% CI: 82.4%--88.8%) and acute kidney injury (AKI, 56.1%, 95% CI: 45.3%--64.7%). While EHA risk generally increased with age, we also found high RRs for infectious diseases in children (0--15 years) and AKI in young adults (15--64 years). Conclusion: Hot weather increases the EHA risk in Switzerland. Therefore a comprehensive clinical and public health response is needed. [ABSTRACT FROM AUTHOR]

Simple Summary: Renal Cell Carcinoma is a common cancer in Western countries. To date, the gold standard treatment for localized non-metastatic disease is partial or radical nephrectomy. When surgical treatment is feasible, the prediction of postoperative renal function might influence the treatment algorithm. On the other hand, there is growing evidence indicating that immune response and nutritional status are crucial factors in human cancer development and progression. In this scenario, the Controlling Nutritional Status (CONUT) score was initially developed as a malnutrition screening tool. Its formula includes serum albumin levels, total lymphocyte count, and total serum cholesterol. Serum albumin is used as an indicator of protein reserves. Cholesterol is used as a caloric depletion parameter. Total lymphocyte count represents an indicator of immune defense impairment due to malnutrition. In this study, we evaluated the impact of the CONUT score on clinically significant decline in estimated glomerular filtration rate in patients with non-metastatic Clear Cell Renal Cell Carcinoma undergoing radical nephrectomy. Our findings confirmed that a preoperative high CONUT score is an independent predictor of a significant renal function decline after surgery. Being easy to use, cost effective, and ideally a completely automated tool, its preoperative assessment could be part of a personalized risk-stratification tailored to the clinical conditions and comorbidities of each patient. Background and Objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher's exact test for categorical variables and a Mann–Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs). Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59–0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (>2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17–3.09; p = 0.05), stage II–III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79–28.3; p = 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58–10.4; p = 0.004). Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN. [ABSTRACT FROM AUTHOR]

Hemobiologic reactions associated with the hemoincompatibility of extracorporeal circuit material are an undesirable and inevitable consequence of all blood-contacting medical devices, typically considered only from a clinical perspective. In hemodialysis (HD), the blood of patients undergoes repetitive (at least thrice weekly for 4 h and lifelong) exposure to different polymeric materials that activate plasmatic pathways and blood cells. There is a general agreement that hemoincompatibility reactions, although unavoidable during extracorporeal therapies, are unphysiological contributors to non-hemodynamic dialysis-induced systemic stress and need to be curtailed. Strategies to lessen the periodic and direct effects of blood interacting with artificial surfaces to stimulate numerous biological pathways have focused mainly on the development of 'more passive' materials to decrease intradialytic morbidity. The indirect implications of this phenomenon, such as its impact on the overall delivery of care, have not been considered in detail. In this article, we explore, for the first time, the potential clinical and economic consequences of hemoincompatibility from a value-based healthcare (VBHC) perspective. As the fundamental tenet of VBHC is achieving the best clinical outcomes at the lowest cost, we examine the equation from the individual perspectives of the three key stakeholders of the dialysis care delivery processes: the patient, the provider, and the payer. For the patient, sub-optimal therapy caused by hemoincompatibility results in poor quality of life and various dialysis-associated conditions involving cost-impacting adjustments to lifestyles. For the provider, the decrease in income is attributed to factors such as an increase in workload and use of resources, dissatisfaction of the patient from the services provided, loss of reimbursement and direct revenue, or an increase in doctor–nurse turnover due to the complexity of managing care (nephrology encounters a chronic workforce shortage). The payer and healthcare system incur additional costs, e.g., increased hospitalization rates, including intensive care unit admissions, and increased medications and diagnostics to counteract adverse events and complications. Thus, hemoincompatibility reactions may be relevant from a socioeconomic perspective and may need to be addressed beyond just its clinical relevance to streamline the delivery of HD in terms of payability, future sustainability, and societal repercussions. Strategies to mitigate the economic impact and address the cost-effectiveness of the hemoincompatibility of extracorporeal kidney replacement therapy are proposed to conclude this comprehensive approach. [ABSTRACT FROM AUTHOR]

Background: Comprehensive summaries on real-world outcomes in pulmonary arterial hypertension (PAH)—a rare, incurable condition, are lacking. We conducted a systematic literature review to describe current survival, morbidity, and quality of life (QoL) outcomes in adult and pediatric PAH patients. We searched Medline and Embase electronic databases, clinicaltrials.gov, and encepp.eu entries, and grey literature to identify outcome estimates for right-heart catheterization-confirmed PAH patients from population-based observational studies (search date: 25 Nov 2021). Data were synthesized using a narrative approach and post-hoc subgroup meta-analyses were conducted to explore adult survival by region, disease severity, representativeness, and study period. The search yielded 7473 records. Following screening and full text review, 22 unique studies with 31 individual reports of outcomes were included. Studies were mostly national registries (n = 21), European (n = 13) and covering adults (n = 17); only six had systematic countrywide coverage of centers. Survival was the most frequently reported outcome (n = 22). Global adult 1-, 3-, and 5-year survival ranged from 85 to 99% (n = 15), 65 to 95% (n = 14), and 50 to 86% (n = 9), respectively. Subgroup meta-analysis showed that 1-, 3-, and 5-year survival in Europe was 90% (95% CI 86–94%; n = 8), 78% (95% CI 68–86%; n = 8), and 61% (95% CI 49–72%; n = 6), respectively; 1-year survival in North America was 88% (95% CI 83–93%; n = 3) and 3-year survival in Asia was 85% (95% CI 82–88%; n = 3). No difference in survival between regions was observed. Subgroup analysis suggested higher survival in patients with better baseline functional class; however, interpretation should be cautioned due to large subgroup heterogeneity and potential missingness of data. Short conclusion: This review describes current disease outcomes based on well-defined and representative PAH populations. There is an overall lack of follow-up data for morbidity and QoL outcomes; survival estimates for pediatric patients are scarce and may not be generalizable to the current treatment era, although publications from large pediatric registries became available after our search date. This study demonstrated a remaining unmet need world-wide to improve long-term prognosis in PAH in the current era. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing dialysis treatment have long been recognized as having an elevated risk of developing coronary artery disease necessitating coronary artery bypass grafting (CABG). However, the prognostic implications of CABG in dialysis-dependent patients remain underexplored. This study aimed to comprehensively assess both short- and long-term outcomes in dialysis-dependent patients undergoing CABG. Methods: In this retrospective analysis, we meticulously matched 55 dialysis-dependent patients with 55 non-dialysis patients, controlling for baseline characteristics including age, sex, etiology, and date of surgery. All patients underwent CABG treatment at our institution between January 2014 and June 2022. We conducted a comparative analysis of postoperative complications and survival rates between the two groups. Results: Our findings revealed that the dialysis-dependent group exhibited a significantly higher incidence of postoperative complications compared to the non-dialysis group (92.7% vs. 61.8%; p < 0.001). Furthermore, the 5-year survival rates were notably diminished among dialysis patients relative to their non-dialysis counterparts (46.2 ± 7.9% vs. 58.2 ± 12.1%, p = 0.045). Consistently, dialysis patients exhibited decreased 5-year cardiac-event-free rates in contrast to non-dialysis patients (31.6 ± 7.6% vs. 58.8 ± 11.3%, p = 0.041). Predictably, several baseline parameters were identified as significant risk factors contributing to adverse outcomes among dialysis patients, including a history of smoking, diabetes mellitus, congestive heart failure upon admission, and the requirement for intraoperative concomitant surgery (p = 0.006, p = 0.043, p = 0.017, p = 0.003, respectively). Conclusions: This study underscores the poorer prognosis associated with CABG treatment in dialysis-dependent patients. Notably, baseline factors such as a smoking history, diabetes mellitus, congestive heart failure upon admission, and the need for intraoperative concomitant surgery were all independently linked to increased mortality in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Sinonasal malignancies are rare and histologically heterogeneous cancers of the nasal cavity and sinuses. The treatment of choice is usually surgery and, if necessary, adjuvant radiotherapy. In this study, we aimed to investigate treatment modalities and associated morbidity. Methods: A consecutive case series of solid sinonasal cancer treated at our tertiary referral center was analyzed. We performed a retrospective chart review and statistical analysis. Results: A total of 156 patients with sinonasal cancer were enrolled in the present study. Male patients were more frequently affected (62%) and the median age was 64 years. Squamous cell carcinoma, adenocarcinoma and malignant melanoma (MM) were the most common histopathological entities. Surgery was the primary treatment modality for 73% of curatively treated patients. Primary radiotherapy alone or in combination with systemic treatment was less frequent. Median overall (OS) and recurrence-free survival (RFS) was 164 months and 71.3 months, respectively. Multivariate analysis revealed negative associations of histology (MM) and skull base involvement on RFS and age, skull base involvement and the type of primary therapy (radiochemotherapy) on OS. Postoperative 30-day morbidity was low, with most patients (84%) experiencing no reported events. Radiotherapy was generally well-tolerated, despite most of patients experienced acute toxicity such as dermatitis (80.6%) or mucositis (72.1%). However, only one event of acute toxicity > grade 3 was reported. Long term morbidity was most frequently reported as pain (23%), dry mucosa (19%) and anosmia (14%). Conclusion: We observed negative associations of histology (MM) and skull base involvement on RFS and age, skull base involvement and the type of primary therapy (radiochemotherapy) on OS. Acute treatment-related morbidity was generally low for surgical patients and considerable for irradiated patients. Moreover, a consistent part of the cohort displayed long term morbidity. [ABSTRACT FROM AUTHOR]

Background: Purpura fulminans (PF) is a rare but severe thrombotic disorder affecting small cutaneous blood vessels. It may present as bruising and discoloration but can rapidly progress necrosis and life-threatening complications if not promptly diagnosed and treated. This paper presents a rare case of neonatal PF associated with protein C and S deficiency, highlighting the importance of prompt recognition and diagnosis. Case presentation: A 10-day-old male infant presented with extensive purpura fulminans, microcephaly, and craniofacial abnormalities. Laboratory investigations revealed severe deficiencies in protein C, protein S, and antithrombin III. Treatment involved a multidisciplinary approach including antibiotic therapy, blood transfusions, and anticoagulation. Discussion: Neonatal PF poses significant challenges due to its high mortality rate and potential neurological complications. Prompt diagnosis and management are crucial, although outcomes can vary. Long-term care and genetic counseling are essential for families affected by this rare disorder. Conclusion: This case underscores the importance of early recognition and intervention in neonatal PF, especially in resource-limited settings. Improved strategies for diagnosis, management, and patient education are necessary to enhance outcomes and support affected families. [ABSTRACT FROM AUTHOR]

Background: Influenza is the most common vaccine-preventable infection among travelers, affecting approximately one percent of those travelling to subtropical and tropical destinations. Methods: We analysed demographic, travel-related and clinical information from travelers diagnosed with influenza at our travel clinic between January 2015 and March 2020 and influenza-negative controls. Results: We included 68 travelers diagnosed with influenza and 207 controls. In total, 22.1% of influenza patients (n = 15) were older than 60 years and/or had comorbidities for which annual influenza vaccination is recommended, but only one had received an influenza vaccine. Patients with respiratory and musculoskeletal symptoms who presented during the German influenza season had the highest risk proportion of positive tests (54%, n = 25/46). Overall, three (4.4%) influenza patients were hospitalised, two (2.9%) received antiviral treatment, and eight (11.8%) received antibiotic therapy. Conclusions: Influenza occurs throughout the year in international travelers and can cause significant morbidity. Travelers with febrile illness should be tested for influenza, especially if they have respiratory or musculoskeletal symptoms, present during the local influenza season, or have travelled to South-East Asia. Influenza vaccination coverage among international travelers needs to be improved among high-risk individuals. [ABSTRACT FROM AUTHOR]

Introduction: Nonoperating room anesthesia is a growing field of medicine that can have an increased risk of complications, particularly in low‐ and middle‐income countries. Aims: The aim of this study was to describe the incidence of complications after pediatric nonoperating room anesthesia and investigate its risk factors. Methods: In this prospective observational study, we included all children aged less than 5 years who were sedated or anesthetized in the radiology setting of a university hospital in a low‐ and middle‐income country. Patients were divided into two groups: complications or no‐complications groups. Then, we compared both groups, and univariable and multivariable logistic regression models were used to investigate the main risk factors for complications. Results: We included 256 children, and the incidence of complications was 8.6%. The main predictors of nonoperating room anesthesia‐related morbidity were: critically‐ill children (aOR = 2.490; 95% CI: 1.55–11.21), predicted difficult airway (aOR = 5.704; 95% CI: 1.017–31.98), and organization insufficiencies (aOR = 52.6; 95% CI:4.55–613). The preanesthetic consultation few days before NORA protected against complications (aOR = 0.263; 95%CI: 0.080–0.867). Conclusions: The incidence of complications during NORA among children in our radiology setting remains high. Investigating predictors for morbidity allowed high‐risk patient selection, which allowed taking precautions. Several improvement measures were taken to address the organization's insufficiencies. [ABSTRACT FROM AUTHOR]

The Chevrel technique is a well-established procedure for open repair of midline incisional hernia. This retrospective single-center case series aims to present the outcome of patients with midline incisional hernia treated with a modified Chevrel technique. The modification itself comprehended the use of a single-layer continuous suture for the inverted anterior rectus abdominis muscle sheet for the creation of the "new linea alba" without overlapping. Between January 2017 and December 2023, 40 patients were operated. The overall postoperative morbidity rate was 65%. Hernia recurrence occurred in three patients (7.5%). When the basic principles of the Chevrel technique are respected and conducted, this leads to satisfactory results. The postoperative outcome of this case series showed rates of complications and recurrences in concordance with the already published literature. Therefore, this technique should always be considered for the open approach for midline incisional hernia repair. [ABSTRACT FROM AUTHOR]

Aims While elevated levels of anxiety are associated with worse prognosis of cardiovascular disease (CVD), this association may vary between different aspects of anxiety. The aim of this study was to analyse self-reported behavioural, physiological, affective, and cognitive aspects of anxiety and their relation to the risk of recurrent CV events. Methods and results This prospective cohort study utilized data from the U-CARE Heart trial. Participants (N = 935, post myocardial infarction) answered the Hospital Anxiety and Depression Scale (HADS: Anxiety subscale) and the Cardiac Anxiety Questionnaire (CAQ: Fear, Avoidance & Attention subscales). HADS Anxiety reflected physiological aspects, CAQ Fear reflected cognitive and affective aspects, CAQ Avoidance reflected behavioural aspects, and CAQ Attention reflected cognitive aspects of anxiety. Cox regression was used to estimate the risk between anxiety and recurrent major adverse cardiac event (MACE). During the follow-up period (mean 2.9 years), 124 individuals (13%) experienced a specified MACE endpoint. HADS Anxiety and CAQ Total were both associated with increased risk of MACE [hazard ratio (HR) = 1.52, 95% confidence interval (CI): 1.15–2.02 and HR = 1.30, 95% CI: 1.04–1.64, respectively]. Among the CAQ subscales, there was support for an association between Avoidance and risk of MACE (HR = 1.37, 95% CI 1.15–1.64), but not for Attention and Fear. Conclusion The results support that anxiety is associated with an increased risk of recurrent MACE in post-myocardial infarction patients. The association between anxiety and risk was strong for the aspects of anxiety relating to behaviour and physiology, while the support for an association with cognitive and affective aspects was lacking. [ABSTRACT FROM AUTHOR]

Introduction: Pancreaticoduodenectomy (PD) has been the primary curative-intent surgical option for resectable periampullary tumours. Despite advancements in relevant surgical techniques, PD-related morbidity and mortality rates continue to remain high. Therefore, the preoperative identification of high-risk patients is vital for tailoring PD approaches to the individual patient. Aim: To assess early postoperative morbidity and mortality following PD in a tertiary centre in Turkey and identify the associated risk factors. Materials and Methods: This cross-sectional, single-centre study conducted in the General Surgery Clinics of Ankara Numune Training and Education Hospital in Ankara, Turkey included a population of 64 patients undergoing PD for malignant periampullary tumours between May 2010 and May 2014. Patients' demographic, clinical and intraoperative data were collected. The primary outcome of the study was the 30-day postoperative mortality rate. Pearson's Chi-square, Fisher'sexact and Fisher-Freeman-Halton tests were used to compare differences in categorical variables between the groups. Results: The study sample consisted of 64 patients with a mean age of 60.1±12.4 years. The 30-day postoperative mortality rate in the sample was 18.75%. Non survivors were significantly older (age >70 years) (p=0.006), had significantly higher American Society of Anaesthesiologists (ASA) physical status classes (>III) (p=0.008), had significantly lower Neutrophil-to-lymphocyte Ratios (NLR) (<2.5) (p<0.001) and had significantly lower serum albumin levels (<3.5 g/dL) (p=0.038) compared to survivors. The rate of patients experiencing intraoperative blood loss exceeding 1000 mL and consequently the median number of blood units transfused, was significantly higher in non survivors than in survivors (p<0.009 and p<0.001, respectively). Similarly, overall and major complications were significantly more common in non survivors than in survivors (p=0.002 and p=0.012, respectively). Conclusion: The findings of the study indicated that a higher ASA class, older age, lower NLR, hypoalbuminemia, higher intraoperative blood loss, the need for blood transfusion and postoperative complications were associated with increased 30-day mortality after PD. [ABSTRACT FROM AUTHOR]

Introduction: Seroma formation following inguinal hernia surgery is a significant concern, causing considerable morbidity for patients. It can lead to prolonged hospital stays and, most devastatingly, mesh infection. Every effort should be made to reduce seroma formation, and newer techniques are being advocated to address this issue. Aim: To assess the role of pseudosac fixation during Totally Extraperitoneal (TEP) repair for direct inguinal hernia in relation to postoperative seroma formation. Materials and Methods: The present single-blinded randomised controlled study was conducted in the Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from June 2019 to May 2021. A total of 60 patients (group A: 30 patients with pseudosac fixation; group B: 30 patients without pseudosac fixation) aged 18 years and above, presenting with direct inguinal hernia, were included. All patients underwent TEP repair. Seroma formation, postoperative pain and early recurrence were assessed in the postoperative period. Statistical analysis were performed using the Statistical Package for Social Sciences (SPSS) version 22.0. Fisher's exact test and t-tests were employed, with a p-value of <0.05 considered significant. Results: The mean±Standard Deviation (SD) age in group 1 and group 2 was 60.7±7.26 years and 57.5±8.9 years, respectively. Postoperative seroma was observed in 3 (10%) patients each from both groups three months after surgery (p-value=1). Nine (30%) patients in group A and 12 (40%) patients in group B experienced mild postoperative pain (p-value=1). None of the patients in either group experienced recurrence at three months postsurgery. Conclusion: Based on the results observed and analysed, fixation of the pseudosac in direct inguinal hernias does not appear to have an impact on postoperative seroma formation, postoperative pain, or early recurrence. [ABSTRACT FROM AUTHOR]

OBJECTIVES Prolonged pleural effusion/chylothorax (PPE/C) is a less investigated complication following paediatric cardiac surgery, and its true incidence, risk factors and impact on postoperative outcomes are not well described. We aim to address these gaps in knowledge using data from a prospective, multicentre study. METHODS Data on 9 post-operative morbidities (unplanned reinterventions, extracorporeal life support, necrotising enterocolitis, PPE/C, renal replacement therapy, major adverse events, acute neurological events, feeding issues and postsurgical infection) were prospectively collected at 5 UK centres between 2015 and 2017, following paediatric cardiac surgery. Incidence of PPE/C, associations with procedure types, and risk factors were described. Mortality (30-day and 6-month) and hospital length of stay (HLoS) were compared between those with isolated PPE/C, single non-PPE/C morbidity, no morbidity, multimorbidity PPE/C and non-PPE/C multimorbidity. RESULTS A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 202 PPE/C (incidence of 6.5%), occurring at a median of 6 days postoperatively (interquartile range: 3–10). PPE/C was associated with excess early mortality only when complicating scenarios where at least 2 other post-operative morbidities occurred. On average PPE/C is associated with 8 more HLoS days, but the relative impact is greatest when comparing isolated PPE/C with no morbidity (P  < 0.001), whereas in multimorbidity scenarios, PPE/C does not significantly contribute to an increase of HLoS. CONCLUSIONS Addition of PPE/C increases mortality but not HLoS in multimorbidity and HLoS only in single morbidity scenarios. This reinforces the important role of prevention, early detection and management of PPE/C in complex situations. [ABSTRACT FROM AUTHOR]

Emergency repair of type II thoracoabdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoracoabdominal aortic aneurysm that was treated using a hybrid technique. The repair was carried out in 2 stages. In the first stage, we deployed 2 imbricated stent grafts in the descending thoracic aorta. A left carotid-to-left subclavian artery bypass was pre-emptively performed to obtain a proper proximal landing zone and as part of the manoeuvres to protect the spinal cord. The endovascular first stage was effective in obtaining proximal sealing but, as expected, it did not prevent distal reperfusion of the aneurysmatic false lumen. A few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by means of a multibranched synthetic graft. The repair was carried out through a left thoracophreno-laparotomy in the seventh intercostal space. A left passive arterial bypass and selective cold renal and warm visceral perfusion were adopted to provide organ protection. Technical success was achieved and confirmed radiologically. The patient experienced mild postoperative paraplegia, which almost completely regressed after a neuromotor rehabilitation program. [ABSTRACT FROM AUTHOR]

AIM: To study the efficacy of Mannheim's peritonitis index in predicting the outcome in a patient of peritonitis. OBJECTIVES: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the morbidity and mortality in patients with peritonitis due to hollow viscus perforation. MATERIALS AND METHODS: Prospective study of 53 patients operated for perforation peritonitis in Oxford Medical College, Bengaluru from October 2020 to August 2022. Mannheim Peritonitis Index score was calculated for each patient. RESULTS: Mean age group was 35.19 ± 12.77. Male predominant with 38 (71.7%) and female were 15 (28.3%) Duration of peritonitis was <24 hours in 25 (47.2%) cases and >24 hours in 28 (52.8%) cases. Peritonitis was localized in 8(15.1%) cases and diffuse in 45(84.9%) cases. Exudate was clear in 7 (13.2%) cases, cloudy and purulent in 43 (81.1%) cases and fecal in 03 (5.7%) cases. MPI score was <21 in 36 (67.92%) cases, 21-29 in 06 (11.32%) cases and >29 in 11 (20.75%) cases. Perforated appendix was 21 (39.62%), peptic ulcer perforation 17 (32.07%) and duodenal perforation was 09 (16.98%) were common causes of perforation peritonitis. Organ failure was present in 12 (22.6%) cases. Malignancy was present in 8 (15.1%) cases. Colonic origin of sepsis was in 16 (30.2%) cases. Mortality was in 5 (9.43%) cases out of which 3 (5.66%) were male and 2 (3.77%) were females. Mannheim Peritonitis Index scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 0%, 0%, and 9.43% respectively. Presence of generalized peritonitis, organ failure at time of admission, type of intra peritoneal exudates carried more significance in predicting the mortality and morbidity in the post op period than other variables. CONCLUSION: Mannheim Peritonitis Index is a simple and specific scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management. [ABSTRACT FROM AUTHOR]

This article provides an overview of a model of psychological well-being put forth over 30 years ago. The intent was to advance new dimensions of positive functioning based on integration of clinical, developmental, existential, and humanistic thinking along with Aristotle's writings about eudaimonia. The operationalization and validation of the model are briefly described, followed by an overview of scientific findings organized around (a) demographic and experiential predictors of well-being, (b) well-being as predictors of health and biomedical outcomes, (c) pathway studies that examine intervening processes (moderators, mediators), and (d) underlying mechanistic processes (neuroscience, genomics). Much prior work underscores the benefits of well-being, including for longevity. Widening socioeconomic inequality is, however, increasingly compromising the well-being of disadvantaged segments of the population. These problems have been exacerbated by recent historical stressors (Great Recession, COVID-19 pandemic). Cumulative hardships from these events and their implications for health are critical targets for future science and practice. [ABSTRACT FROM AUTHOR]

Simple Summary: Since no randomized clinical trial has compared surgery to chemoradiotherapy (CTRT) in FIGO stage IB3 cervical cancer patients, the optimal management remains controversial. In our study, nerve-sparing laparoscopic radical hysterectomy (nsLRH) proved to be safe and effective. The encouraging results on toxicity and survival, when compared to CTRT, warrant further investigation and reinforce the idea that surgery is a valid option for these patients. (1) Background: In 2018 FIGO reclassified tumors confined to the cervix larger than 4 cm as stage IB3. Although concurrent CTRT has been the standard of care and surgery the alternative, optimal management remains controversial due to the lack of direct comparison between surgery and CTRT. (2) Methods: This prospective observational study investigated the efficacy, safety and oncologic outcomes of nerve-sparing laparoscopic radical hysterectomy (nsLRH) for FIGO stage IB3 cervical cancer patients (IB3). From 2009 to 2023, IB3 patients underwent laparoscopic pelvic lymphadenectomies with frozen section analysis, followed by a nsLRH if the lymph nodes were tumor-free. No uterine manipulator was used and the vaginal cuff was sealed before retrieving the specimen. Intermediate-risk patients were under close observation without adjuvant therapy. Outcomes were monitored until 2023. (3) Results: During the study period, 74 IB3 patients were treated. Sixty-eight (91.9%) underwent a nsLRH. A complete resection with negative margins was achieved in all cases. At a median of 68 months of follow-up, the disease-free survival (DFS) rate was 89.7% and the overall survival (OS) rate was 93.1%. The overall complication rate was 23.5% and there were no grade 4–5 complications. (4) Conclusions: In patients with IB3 cervical cancer, a nsLRH is safe and effective. While awaiting the results from ongoing randomized trials, these findings support nsLRH as a viable treatment. [ABSTRACT FROM AUTHOR]

Background: Lower extremity (LE) injuries following pedestrian versus motor vehicle collision (PMVC) are a common cause of morbidity and mortality in orthopedic trauma. There is currently no evidence illustrating the presentation of orthopedic bilateral LE injuries (BLEI). This study aimed to evaluate the patterns of BLEI on postoperative outcomes and hospital utilization following PMVC. Methods: This retrospective cohort analysis included 532 consecutive patients presenting to a single level I trauma center with LE injuries following PMVC from January 1, 2017 to May 31, 2021. Injury location was categorized by extremity region (hip/femur, knee, leg, ankle, midfoot). Outcome measures included 30-day postoperative complications (infection, compartment syndrome, myocardial infarction, pneumonia, pulmonary embolism, sepsis, stroke) and hospital utilization (length of stay, ICU admission, prolonged ventilation [≥48 h], readmission). Mann–Whitney U, chi-square, and logistic regressions were performed calculating odds ratio (OR) with 95% confidence intervals. Results: A total of 142 (26.7%) patients sustained BLEI. The most common BLEI complexes (212 total) were bilateral leg (25.0%), hip/femur and leg (17.0%), leg and knee (12.3%), and hip/femur and knee (8.0%). Bilateral and unilateral injuries showed no difference for postoperative complications (11.3% vs. 6.2%; p = 0.062). However, BLEI had higher odds of ICU admission (OR:2.97, CI:1.68–5.26), prolonged ventilation (OR:2.38, CI:1.24–4.59), and patients remained hospitalized 10.87 days longer (p < 0.001). Conclusion: Our findings indicate that more than a quarter of PMVCs with LE injuries present with BLEI and require significantly more hospital resources. This is the first study to characterize BLEI in PMVCs, highlighting associated patterns to encourage heightened awareness in trauma evaluation. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Valproate is the most effective treatment for idiopathic generalized epilepsy. Current guidance precludes its use in females of childbearing potential, unless other treatments are ineffective or not tolerated, because of high teratogenicity. This risk was recently extended to males. New guidance will limit use both in males and females aged <55 years, resulting in withdrawal of valproate from males already taking it, as occurs for females. Whether there are risks of personal harm (including injury or death) associated with valproate withdrawal has not yet been quantified for males or females ON valproate, meaning clinicians cannot reliably counsel either sex when discussing valproate withdrawal with them, despite that this concern may be at the forefront of patients' and clinicians' minds. We assessed whether there are any morbidity or mortality risks associated with valproate withdrawal in young males and females. We performed a retrospective cohort study of internationally derived electronic health data within the TriNetX Global Collaborative Network. Included were males and females aged 16–54 years with ≥1 epilepsy disease or symptom code between 1 December 2017 and 1 December 2018, and ≥2 valproate prescriptions over the preceding 2 years (1 January 2015–30 November 2017). Five-year propensity-matched risks of mortality and a range of morbidity outcomes were compared between those remaining ON versus withdrawn from valproate during the 1 December 2017–1 December 2018 recruitment period, regardless of whether switched to another antiseizure medication. Survival analysis was undertaken using Cox-proportional hazard models, generating hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 8991 males and 5243 females taking valproate were recruited. Twenty-eight per cent of males and 36% of females were subsequently withdrawn from valproate. Valproate withdrawal was associated with significantly increased risks of emergency department attendance [HRs overall: 1.236 (CI 1.159–1.319), males: 1.181 (CI 1.083–1.288), females: 1.242 (CI 1.125–1.371)], hospital admission [HRs overall: 1.160 (CI 1.081–1.246), males: 1.132 (CI 1.027–1.249), females: 1.147 (CI 1.033–1.274)], falls [HRs overall: 1.179 (CI 1.041–1.336), males: 1.298 (CI 1.090–1.546)], injuries [HRs overall: 1.095 (CI 1.021–1.174), males: 1.129 (CI 1.029–1.239)], burns [HRs overall: 1.592 (CI 1.084–2.337)] and new-onset depression [HRs overall 1.323 (CI 1.119–1.565), females: 1.359 (CI 1.074–1.720)]. The risk of these outcomes occurring was 1%–7% higher in those withdrawn from valproate than in those remaining ON valproate. Overall, valproate withdrawal was not associated with increased mortality. These results may help patients and clinicians have a more informed discussion about personal safety when considering valproate withdrawal. [ABSTRACT FROM AUTHOR]

This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. [ABSTRACT FROM AUTHOR]

Purpose: The emergency midline laparotomy is a commonly performed procedure with a burst abdomen being a critical surgical complication requiring further emergency surgery. This study aimed to investigate the clinical outcomes of patients with burst abdomen after emergency midline laparotomy. Methods: A single-center, prospective, observational cohort study of patients undergoing emergency midline laparotomy during a two-year period was done. Abdominal wall closure followed a standardized technique using monofilament, slowly absorbable suture in a continuous suturing technique with a suture-to-wound ratio of at least 4:1. Treatment of burst abdomen was surgical. Data, including intra-hospital postoperative complications, were collected and registered chronologically based on journal entries. The primary outcome was to describe postoperative complications, length of stay, and the overall morbidity based on the Comprehensive Complication Index (CCI), stratified between patients who did and did not suffer from a burst abdomen during admission. Results: A total of 543 patients were included in the final cohort, including 24 patients with burst abdomen during admission. The incidence of burst abdomen after emergency midline laparotomy was 4.4%. Patients with a burst abdomen had a higher total amount of complications per patient (median of 3, IQR 1.3–5.8 vs. median of 1, IQR 0.0–3.0; p = 0.001) and a significantly higher CCI (median of 53.0, IQR 40.3–94.8 vs. median of 21.0, IQR 0.0–42.0; p = < 0.001). Conclusion: Patients with burst abdomen had an increased risk of postoperative complications during admission as well as a longer and more complicated admission with multiple non-surgical complications. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of spinal chordomas presents a significant challenge due to their resistance to both radiotherapy and chemotherapy as well as the complexity of the surgical procedures required. This study presents a series of cases of primary spinal chordomas, focusing on the development of a personalized therapeutic strategy that is tailored to each patient's unique clinical status. This approach aims to ensure that treatments are optimally aligned with the patient's overall prognosis and surgical eligibility. Methods: This retrospective study analyzed 14 patients with primary spinal chordomas treated at our institution. We evaluated surgical strategies, clinical outcomes, and survival rates, The therapeutic strategy was formulated after interdisciplinary conferences with sarcoma management specialists. Data were collected on patient demographics, surgical details, postoperative outcomes, and follow-up status. Results: All patients presented with neurological deficits preoperatively, which generally improved post-surgery. The study included a detailed analysis of two distinct surgical approaches: five patients underwent en bloc resection with dorsal stabilization and nine received decompression only. Patients undergoing en bloc resection showed a reduced need for additional surgery due to the comprehensive removal of the tumor. As anticipated, 40% of the patients who underwent decompression experienced tumor progression within the first three months. However, given the poor overall prognosis, the objective of maintaining neurological function was achieved. Conclusions: Surgical en bloc resection offers a viable and effective intervention for spinal chordomas, enhancing neurological function. It is imperative to tailor treatment strategies to individual prognoses, integrating insights from multidisciplinary discussions that meticulously evaluate surgical risks. This collaborative approach aids in selecting the most appropriate surgical technique tailored to each patient's specific condition. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures. Methods: Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI. Results: Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2–1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0–1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2–2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1–15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4–0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4–2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI. Conclusions: While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI. [ABSTRACT FROM AUTHOR]