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Incontinence and sexual dysfunction remain common side effects from robotic-assisted radical prostatectomy (RARP) despite nerve sparing (NS) and bladder neck reconstruction techniques. Placing growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA-approved for surgery. The objective is to determine if vCUT use in NS-RARP accelerates return of continence and sexual function. A retrospective cohort of 176 patients undergoing NS-RARPs with and without vCUT from 2015 to 2020 was identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence at 3, 6, and 12 months, postoperatively was evaluated using MUSIC patient-reported outcomes (PRO), a validated questionnaire assessing urinary and sexual quality of life at baseline and post-treatment. A distinct cohort of 65 patients undergoing NS-RARP with and without vCUT was assessed for erections firm enough for intercourse at 12 and 24 months post-operatively using MUSIC-PRO. The association between vCUT use and social continence at 3 months was assessed via multivariable logistic regression. A descriptive analysis among patients with quality erections prior to surgery assessed the association between vCUT use and erection quality. Continence was achieved by 3 months post-op in 86% (99/115) of vCUT patients versus 74% (45/61) in non-vCUT patients (p = 0.044). In a multivariable analysis, although not reaching conventional statistical significance, vCUT patients were more likely to achieve continence than non-vCUT patients (OR = 2.21, p = 0.073). At 24 months post-op, 32% of vCUT patients reported good sexual function versus 33% in non-vCUT patients (p = 0.9). vCUT use during NS-RARP is associated with quicker return to social urinary continence. However, no differences were seen in return of potency. Further studies with longer follow-up and larger sample sizes may further evaluate effectiveness of vCUT in accelerating return of postoperative continence and potency., Competing Interests: Declarations. Conflicts of interest: The authors declare that there are no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

BPH is a common urological pathology that affects 2480 per 100,000 men worldwide. With a rising population and increased age expectancy, the prevalence of benign prostatic hyperplasia (BPH) is increasing (Awedew et al. in Lancet Healthy Longev 3(11), 2022). There are many surgical management options for BPH with LUTS, including open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), transurethral resection of prostate (TURP), and transurethral electro vaporization of the prostate (TUVP) (Cho et al. in Int Neurourol J 24(1), 2020). However, these options often have a steep learning curve and increasing complexity with larger prostates. Robot-assisted simple prostatectomy (RASP) offers an alternative approach for large and very large glands for those already trained in robotic-assisted radical prostatectomy (RARP), particularly as robotic surgery continues to increase in popularity and is steadily becoming the standard of care in the management of prostate disease (Madersbacher et al. in Gerontology 65(5), 2019). The aim of this study was to demonstrate the surgical outcomes for men undergoing RASP for bothersome LUTs and/or acute urinary retention (AUR) secondary to BPH. A retrospective study was performed which included 105 patients who underwent RASP for the treatment of BPH causing lower urinary tract symptoms or acute urinary retention. This study reviews the pre-operative, (age, PSA, weight, prostate size) operative (duration, histology, estimated blood loss and hospital length of stay) and post-operative (duration of indwelling catheter, trial of void outcome, complications and post-operative PSA) outcomes, to evaluate the effectiveness of RASP for the management of BPH with LUTS. Data were analyzed using standard descriptive measures and multivariate logistic regression for comparison of continuous variables, significance was set to a CI of 95%. The median age of patients was 75 years (IQR 70-78) with a median prostate size of 135.5 cc (IQR 112.25-162.25). Patient demographic and pre-operative LUTS assessments are summarized in Table 1. Median operative time was 60 min (IQR 50-80), estimated blood loss was 350 ml (IQR 200-563), specimen weight was 98.5 g (IQR 69.5-120). Prostate size on imaging directly impacted operative duration (CI 0.07-0.2, p =  < 0.001). Eleven (10.5%) of the patients involved in the review had a post-operative complication, two (1.9%) considered major complications Clavien-Dindo grade ≥ 3. There was a statistically increased risk of complications associated with advanced age and prostate size (p = 0.043 and p = 0.001). This study, although limited by its retrospective nature, demonstrates the safety and utility of robotic simple prostatectomy in the context of large and very large prostate volumes. In particular, it offers a safe alternative for men with large prostates who otherwise may not be suitable for endoscopic management. Further prospective and randomized control trials are needed to reinforce the efficacy of RASP to assess its functional and cost effectiveness long term., Competing Interests: Declarations. Conflict of interest: In addition, the authors have no relevant financial or non-financial interests to disclose. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was given by SA Health Central Adelaide Local Health Network HREC, approval number 18842., (© 2024. Crown.)

Objective: Postoperative delirium (POD) may cause cognitive morbidities and prolonged hospital stay. This study aimed to evaluate the risk factors associated with postoperative delirium in patients undergoing deep brain stimulation (DBS) for Parkinson's disease (PD)., Method: We retrospectively reviewed 83 patients with idiopathic PD who underwent bilateral DBS between 2016 and 2023. The target of DBS was the globus pallidus interna (Gpi) or the subthalamic nucleus (STN) in 84.3% and 15.7% of patients, respectively. Patients were evaluated using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and categorized into two groups: those with delirium and those without. Demographic features, disease duration, preoperative cognitive status (Mini-Mental State Examination) and silent ischemia, brain atrophy rates, DBS target location, surgical type and duration, Unified PD Rating Scale-3 scores, Hoehn and Yahr scores, postoperative perilead edema, and electrolyte imbalance were compared between patients with and without post-DBS delirium. Apart from univariate analysis, receiver operating characteristic (ROC) curve analysis for disease duration and multivariate logistic regression analyses were used to determine independent risk factors for post-DBS delirium., Results: Five out of the 83 patients (6%) developed post-DBS delirium. Age (> 68 years), disease duration, preoperative cerebral atrophy rates, and postoperative perilead edema were significantly higher in patients who developed delirium (p < 0.05 each). The ROC curve analysis revealed disease duration of ≥ 11 years as a risk factor for delirium (p = 0.001; odds ratio, OR: 58.4, 95% confidence interval, CI: 5.45-625.49). Age and disease duration were independent risk factors for post-DBS delirium (OR: 1.243, 95% CI: 1.070-1.592 and OR: 22.52, 95% CI: 1.21-383.96, respectively)., Conclusions: Older age and longer disease duration are independent risk factors for postoperative delirium in patients with PD. This study highlights the need to identify high-risk patients when undertaking DBS to facilitate early diagnosis and timely management., Competing Interests: Declarations. Ethical approval: This study was approved by our hospital’s ethics committee and conformed with the principles outlined in the Declaration of Helsinki. Competing interests: The authors declare no competing interests. Usage of AI in manuscript preparation: None., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Recently, a minimally invasive procedure based on a laser technique (SiLaT) has been developed for the treatment of pilonidal cysts. Although less invasive and less painful than surgery, this solution is nevertheless limited by its high cost. Other more affordable laser devices, such as the holmium laser, are also used in minimally invasive surgery. The objective of this study was to evaluate the possibility of using the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts. Retrospective cohort study with the primary endpoint being the cure rate one month after treatment. Median duration of local care was 21 days (mean = 22 ± 7.5) and healing rate at 1 month was 90.7%. During follow-up, 102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting and significantly more common in people with a small frame, overwhelmingly female. A surgical site infection was reported in 36 patients (15.9%). Recurrence, occurred in 39 patients (17.2%), was related to cyst type (type 1 do not recur, type 3 recur twice three time than type 2). Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment. However, it is characterised by a moderately higher incidence of complications, foremost of which is the occurrence of pain that can persist for up to a year after the procedure and which could be related to an increase in heat inherent to the use of holmium. As a result, this procedure does not seem to represent an alternative to SiLaT., Competing Interests: Declarations. Conflict of Interest: This study was funded by the Groupement de coopération sanitaire Ramsay Santé pour l’Enseignement et la Recherche. The authors have no competing interests to declare that are relevant to the content of this article. Ethical Statement: The protocol for this study was approved by the IRB (Institutional Review Board) of the Groupement de coopération sanitaire Ramsay Santé pour l’Éducation et la recherche. Given the retrospective nature of the study, all the procedures performed were part of the routine care. Informed Consent: Informed consent was not required for this retrospective study according to the principles of ethics in medical research. However an information letter was sent to all patients. None of them objected to the use of their anonymized data for this study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Purpose: To assess OSA prevalence, comorbidities, and the influence of sleep stages and body positions on respiratory events distribution in toddlers aged 12-24 months., Methods: A single center retrospective study that included toddlers aged 12-24 months old who underwent overnight PSG. OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1-4.9 events/h), moderate (5-9.9 events/h), and severe (≥ 10 events/h)., Results: 283 PSG data were included with a median age of 18 months (IQR 16-20.25) for the OSA group (168/283) and 19 months (IQR 16-22) for the non-OSA group (115/283) (p = 0.047). OSA prevalence was 68.5% (42.3% mild, 18.5% moderate, and 39% severe). 38.1% of children had no comorbidities, 24.4% had a history of prematurity and 11.3% had Down syndrome. Multivariate binominal regression analysis showed that children with history of prematurity (p = 0.017) and Down syndrome (p = 0.043) had higher odds of having OSA. The mean SaO 2 in REM sleep was lower, and the mean time spent with oxygen saturation below 90% was higher in children with neuromuscular disease compared to those with other comorbidities. In toddlers without comorbidities, the median REM OAHI was 29.8 events/h (IQR: 58.48), whereas the median non-REM OAHI was 4.1 events/h (IQR: 10.4 p < 0.001). Supine OAHI was 7.9 (IQR: 24.9), and off supine OAHI was 10.5 (IQR: 18.1, p = 0.407)., Conclusion: In toddlers aged 12-24 months, history of prematurity and Down syndrome were significantly associated with OSA. Obstructive respiratory events occurred predominantly in REM sleep, and no significant positional relations were noted., Competing Interests: Declarations. Ethical approval: This retrospective chart review study involving human participant were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the University of Louisville and Norton Healthcare approved this study. Informed consent: For this type of study formal consent is not required. Conflict of interest: Dr. El-Kersh is a consultant for United Therapeutics, J&J, and Merck. The other authors do not have any financial or non-financial conflict of interest disclosure., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure., Methods: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group., Results: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years., Conclusion: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications., Competing Interests: Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the University Hospital Pilsen and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: The pathogenesis of life-threatening coronavirus disease 2019 (COVID-19) pneumonia in ICU patients can involve pre-existing auto-antibodies (auto-Abs) neutralizing type I interferons (IFNs). The impact of these auto-Abs on SARS-CoV-2 clearance in the lower respiratory tract (LRT) is unclear., Methods: We performed a retrospective study in 99 ICU patients with COVID-19 pneumonia between March and May 2020. LRT SARS-CoV-2 load (intensity and duration) was analyzed according to the presence or not of circulating auto-Abs neutralizing type I IFNs., Results: Among the 99 included patients, 38 (38%) were positive for auto-Abs neutralizing type I IFNs, with 5 (5%) harboring auto-Abs neutralizing IFN-α2 at any concentration, while 33 (33%) had auto-Abs neutralizing only IFN-ω at the lower concentration. SARS-CoV-2 load in the LRT and duration of viral shedding, were similar in patients with or without auto-Abs neutralizing type I IFNs. Patients with auto-Abs had the same mortality than those without auto-Abs, despite greater occurrence of renal failure and ECMO support, and longer duration of mechanical ventilation and ICU stay., Conclusion: In summary, 5% of patients with critical COVID-19 pneumonia carried auto-Abs neutralizing IFN-α2, while about 1/3 harbored auto-Abs neutralizing low concentrations of IFN-ω. The detection of either type of auto-Abs did not impact LRT viral clearance and mortality, although it was associated with greater morbidity and a longer hospitalization. These findings suggest that similar albeit hitherto unknown mechanisms of disease drive critical COVID-19 pneumonia in patients without auto-Abs against type I IFNs., Competing Interests: Declarations. Ethics Approval and Consent to Participate: In accordance with current French law, informed written consent for demographic, physiologic and hospital-outcome data analyses was not obtained because this observational study did not modify existing diagnostic or therapeutic strategies. Nonetheless, patients and/or relatives were informed about the anonymous data collection and told that they could decline inclusion. The protocol was approved by the ethics committee of the Société de Réanimation de Langue Française (registration no. CE-SRLF-2093) and the database is registered with the Commission Nationale de l’Informatique et des Libertés (CNIL, registration no. 1950673). Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Hereditary cancer predisposition disorders account for up to 10% of all pediatric cancers. Genetic counseling for families of the proband includes risk assessment and recommendations for cascade genetic testing for parents and siblings, but there is no standardized method for cascade testing in place resulting in variability in how clinics approach cascade genetic testing. We explored the uptake and outcomes associated with a family-based approach to cascade testing, for non-syndromic cancer predisposition disorders, at a pediatric cancer genetics clinic serving an ethnically diverse patient population. A retrospective chart review was conducted to evaluate test uptake in the parents and siblings of 106 pediatric probands. The study included 99 mothers, 97 fathers, 116 full siblings, and 53 half siblings who were recommended testing due to genetic risk. Of these relatives, 156 (43%) had documentation of completed cascade testing within twenty-four months after the proband's result disclosure. Completion of cascade testing varied by the type of family member and degree of relatedness. 41% of mothers (41/99) were tested in comparison to 26% of fathers (26/97) and 70.6% of full siblings (82/116) were tested compared to 13.2% of half siblings (7/53). Statistical analysis using chi-squared tests revealed that siblings were more likely to have completed testing than parents (p < 0.001). Furthermore, amongst parents, mothers were more likely to complete testing than fathers (p = 0.03) and amongst siblings, full siblings were more likely to complete testing than half siblings (< 0.001). The proband's age (p = 0.008), parents' preferred language (p = 0.002), and interpreter use during visit (p = 0.004) were the factors associated with differences in test uptake amongst siblings, whereas the proband's race/ethnicity (p = 0.019) was the only factor associated with differences in test uptake amongst parents. The most common barriers noted in charts for lack of test completion included country of residence, lack of insurance, and loss to follow-up. In conclusion, we found that test uptake differed significantly among relatives of a proband with siblings being more likely to test than parents. We also found differences in the demographic and clinical factors associated with test uptake in parents and siblings. Future studies need to validate these differences and further explore the underlying cause of variation in test uptake among relatives., Competing Interests: Declarations. Competing interests: SEP is a member of the scientific advisory panel of Baylor Genetics. The authors have no other competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Although most pilocytic astrocytomas grow slowly, their progression in critical sites such as the brainstem or hypothalamus may prove fatal much more rapidly. Cystic progression may be more problematic than solid tumor. Patients with progressive cystic PAs located in eloquent deep areas of the brain are the best candidates for stereotactic radiosurgery., Objective: This retrospective case series aims to present the effective outcomes obtained from GKRS, targeting the mural nodules of symptomatic eloquently deep-seated cystic PAs in 9 consecutive patients treated at the IMC Gamma Knife Centre in Cairo, Egypt, between 2003 and 2021., Patient and Methods: The median follow-up period was 84 months (range 24-240 months). The median treated mural nodule volume was 1.25 cm 3 (range 0.32-1.97 cm 3 ), treated with a median peripheral prescription dose of 12 Gy and a median maximum dose of 24 Gy. The median cyst volume in treated patients was 7.64cm 3 (range 1.66-40.6cm 3 )., Results: At the last follow-up, 7 out of 9 patients (78%) achieved tumor control (marked reduction > 50% of the entire tumor volume in 6 patients and moderate tumor reduction < 50% in one patient) in addition to clinical improvement. The median time of confirmed tumor reduction was 18 months (range 12-32 months). Two patients reported progression of the treated tumor. The overall tumor control rates at 2, 5, and 7 years of follow-up were 88.9%, 78%, and 78%, respectively., Conclusion: The encouraging results of this series indicate that limiting the GKRS to the mural nodule of eloquently deep-seated cystic PAs may be a practical and effective pattern in the salvage of its treatment. Our data do not support radiation for extensive, large symptomatic cysts in deep-seated cystic PA or patients where microsurgical removal is feasible., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Retrospective study: "For this type of retrospective study, formal consent or committee approval is not required, it does not contain any studies with human participants", (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Background: Both long and short sleep durations may lead to cognitive decline in the elderly individuals, though the underlying mechanisms remain unclear., Aims: To explore the mediating mechanism of activities of daily living and depression on different sleep durations and cognitive function in older Chinese older adults., Methods: This retrospective study used data from 5,899 older adults who completed the 2018 China Health and Retirement Longitudinal Surveys. We used the PROCESS macro in SPSS to determine the chain mediating effect of ADL and depression on the relationship between different sleep durations and cognitive functions., Results: (1) There were significant correlations among sleep duration, ability to perform ADL, depression, and cognitive function. (2) For sleep durations ≤ 7 h/night or > 7 h/night, ADL and depression play a chain mediating role in the relationship between sleep duration and cognitive function., Conclusions: Shorter or longer sleep durations were associated with cognitive decline by weakening ADL and worsening depression, which suggests that medical personnel should take action to correct abnormal sleep duration in older adults. Timely treatment of ADL impairment and depression may help prevent cognitive decline., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval for the collection of data from the CHARLS was obtained from the Institutional Review Board of Peking University (IRB00001052-11015). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Acquired hypophosphatemic osteomalacia (AHO) is a rare metabolic bone disorder characterized by hypophosphatemia and impaired bone mineralization. Tumor-induced osteomalacia (TIO) is the most common cause of AHO, caused by phosphaturic tumors that overproduce fibroblast growth factor 23 (FGF-23)., Objective: To present the clinical characteristics, diagnostic challenges, and outcomes of seven cases of AHO in Peruvian patients between 1999 and 2023., Methods: A retrospective review of seven patients diagnosed with AHO was conducted. Clinical data, including diagnostic procedures, treatments, and outcomes, were collected., Results: Seven cases of AHO were reviewed. In case one, osteomalacia did not improve despite supraphysiological doses of vitamin D (ergocalciferol/cholecalciferol), and no tumor was detected with available tests, resulting in the patient's death. Cases two and three involved tumors located in the right leg and right hemithorax, respectively, with symptom resolution following total resection. In cases four, five, and seven, exhaustive exams failed to locate tumors. Cases four, six, and seven showed elevated FGF-23 levels, while case five had inappropriately normal FGF-23 levels. Case seven was the first patient in Peru to receive burosumab treatment. In case six, a tumor in the head of the femur was identified, but the patient opted for nonsurgical management., Conclusion: The diagnosis of AHO is challenging, requiring a high index of clinical suspicion and biochemical confirmation. TIO is the most common cause of AHO, emphasizing the importance of locating the phosphaturic tumor. However, in some cases, the tumor remains elusive despite exhaustive diagnostic workups. This is particularly challenging in developing countries like Peru, where resources are limited., Competing Interests: Declarations Conflicts of interest None., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: The survival benefit from later-line treatment for patients with metastatic colorectal cancer (mCRC) remains disappointing. Here, in a real-world study, we were aimed to evaluate which choice will affect the survival of mCRC patients after standard treatment in Chinese patients., Methods: A total of 129 patients with refractory mCRC were involved in the study. They received targeted monotherapy or combined with chemo-agents or PD-1 inhibitor before death. Overall survival (OS) and progression-free survival (PFS) were reviewed and evaluated from clinical features and treatment options., Results: Among the 129 patients, the median age was 56 years (25-81). The mOS from third-line was 12.5 months. OS of patients who treated with chemo plus targeted therapy group in third-line was shown to be superior to pd-1 inhibitor in combination with antiangiogenic agents or antiangiogenic monotherapy group (15.6 m vs. 10.5 m vs. 8.4 m, p < 0.05). Patients had received triplet-drugs (bevacizumab plus low-dose irinotecan and oxaliplatin) and had prolonged survival compared to those had not (21.3 m vs 10.3 m, p = 0.004). OS between patients who had immunotherapy history or not was not significantly different (p > 0.05). The mPFS was 3.5 months in patients who had administered with antiangiogenic targeted agents plus anti-pd-1 and 4.7 months in chemo plus targeted therapy group and 2.2 months in the other group. In the triplet drugs group, preliminary results showed that ORR was 13.3% and DCR was 80%. The median PFS was 5.1 m, and the median OS was 10.6 m., Conclusions: Triplet drugs resulted in significantly longer overall survival, and immunotherapy may have limited benefit in MSS type CRC patients., Competing Interests: Declarations Consent for Publication All the authors had consent for publication. Ethics Approval and Consent to Participate This retrospective study was approved by the independent ethics committee of the Chinese PLA General Hospital and performed in accordance with the Declaration of Helsinki, and all the authors obtained written informed consent from the participants, to participate in the study. Competing Interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Aseptic bone flap necrosis (ABFN) is a common complication of autologous cranioplasty that often requires reoperation. This study aimed to create a risk score for ABFN using relevant demographic, clinical, and laboratory markers., Methods: We included all patients who underwent autologous cranioplasty after decompressive surgery between 2007 and 2019. We collected laboratory data, initial clinical diagnoses, and demographic parameters before autologous bone flap reimplantation. The significant predictors of ABFN identified in the final multivariate analysis were used to develop a risk score., Results: Of the 412 patients who underwent craniectomy, 58 (14%, 32 females: 55.2%) developed ABFN. The following independent predictors of ABFN were included in the risk score (0-7 points): craniectomy due to trauma or hemorrhagic stroke (2 points), younger age (< 40 years, 2 points), cranioplasty timing (> 95 days post-craniectomy, 1 point), glutamate-pyruvate transferase < 18 U/L (1 point), and serum creatinine level < 0.815 mg/dL (1 point). The ABFN rates in patients with scores of 0-2, 3-4, and 5-7 points were 4.2%, 16.1%, and 34.6%, respectively. The risk score demonstrated moderate diagnostic accuracy for predicting ABFN, with an area under the curve of 0.739., Conclusion: The proposed risk score may help in early identification of individuals prone to ABFN. These data suggest that future studies should investigate the significance of metabolic syndromes related to ABFN occurrence. Understanding the potential impact of metabolic factors on ABFN can enhance risk assessment and targeted preventive measures for patients undergoing cranioplasty procedures., Competing Interests: Declarations Ethics approval The local Research Ethics Committee approved the study (24-11849-BO). Consent to participate Informed consent was not required for all patients due to the retrospective design in accordance with local ethics committee protocols. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS)., Methods: All pediatric patients (< 18 years) receiving a posterior fossa decompression for Chiari 1 between the years of 2005 and 2020 at the study center were eligible for inclusion. Patients with congenital anomalies were excluded., Results: Seventy-one pediatric patients with a median age of 9 years were included. Most patients (58%) were females. Chiari 1 was associated with syringomyelia (51%), scoliosis (37%), and hydrocephalus (7%). Perioperative complications occurred in 13 patients (18%) of which two required additional procedures under general anesthesia. On multivariable proportional odds logistic regression, motor deficits (OR: 0.09; CI95%: [0.01-0.62]; p = 0.015), and surgical complications (OR: 0.16; CI95%: [0.41-0.66]; p = 0.011) were significant predictors of worse outcomes. The presence of syringomyelia was identified as a predictor of better outcomes (OR: 4.42 CI95% [1.02-19.35]; p = 0.048). A persistent hydrocephalus during the early postoperative period after posterior fossa decompression was a strong predictor of worse long-term CCOS (OR: 0.026; CI95%: [0.002-0.328]; p = 0.005)., Conclusion: Results from this study indicate that the existence of motor deficits and syringomyelia prior to surgery, and surgical complications and persistent hydrocephalus despite posterior fossa decompression, were useful predictors of long-term outcome., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: When faced with contaminated ventral hernia repairs, surgeons must decide to repair the defect in a single-stage or delay the definitive repair until a clean scenario has been achieved. We sought to compare wound complications, long-term hernia recurrence and quality of life for patients who underwent delayed versus single-staged abdominal wall reconstruction (AWR) in the setting of clean-contaminated and contaminated wounds., Methods: The Abdominal Core Health Quality Collaborative was used to identify adult patients at our institution who underwent open AWR with retromuscular synthetic mesh placement between January 2014 and August 2023. The delayed group included patients who underwent clean-contaminated or contaminated abdominal operation in the setting of a ventral hernia without placement of permanent synthetic mesh, then underwent AWR with permanent synthetic mesh placement in a separate operation. The single-staged group had clean-contaminated or contaminated wounds concomitant with AWR. Outcomes of the AWR were compared., Results: 63 patients underwent a delayed AWR and 375 patients underwent a single-staged AWR with a median(IQR) follow-up of 3(2,5)years. Most common concomitant procedures involved small intestine(30%) or hepatobiliary(30%). Most common index operations in delayed AWR were ileostomy(52.4%) and colostomy(14.2%) reversals. Median(IQR) time between initial operation and definitive AWR was 1.0 (0.7, 1.9)years. Median(IQR) hernia width was 11.35(8.4, 15.0)cm at initial operation and 16.0(15.0,20.0)cm at AWR for the delayed group(p < 0.001). Three patients (19%) in the delayed group and 14(12%) in the single-staged underwent wound debridement within 30-days(p = 0.46); a single patient in each required partial mesh excision within 30-days(p = 0.098). Wound morbidity, reoperation and hernia recurrence were similar (p > 0.05)., Conclusion: In patients with a ventral hernia and separate indication for abdominal operation with a clean-contaminated or contaminated wound, either delayed or single-stage approaches to AWR may be viable., Competing Interests: Declarations Competing interests Dr. Prabhu is on the advisory board for Surgimatix and CMR Surgical. Dr. Petro serves as an Advanced Medical Solutions, Bard-Davol, and Surgimatix Consultant, and has received research grants from the American Hernia Society, the Central Surgical Association, and the Society of American Gastrointestinal and Endoscopic Surgeons. Dr. Rosen serves as the medical director of the ACHQC and receives salary for this position, received a grant to his institution for research from Telabio and has stock options with Ariste. Dr. Miller received a research grant from the American Hernia Society and research funding for his institution from Integra. Dr. Maskal accepted a Resident Research Grant from the Abdominal Core Health Quality Collaborative and honoraria from Momentis Surgical. Dr. Ellis and Dr. Woo accepted honoraria from Momentis Surgical. Mr. Mali, Dr. Beffa, Dr. Al Marzooqi, Dr. Huang and Dr. Remulla have no disclosures., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Mental health (MH) conditions are common in patients with colorectal cancer (CRC) due to the unique challenges these patients encounter. The primary aim was to investigate predictors of new onset MH conditions after a diagnosis of CRC and determine the association of new MH conditions on survival., Methods: A single institution, retrospective study was conducted. A multivariable Fine-Gray competing risks model was used to describe the primary study outcome of new MH diagnosis in patients at least 18 years of age with CRC. Survival was modeled using Cox proportional hazards regression with a time-varying covariate for new MH diagnosis., Results: 456 patients were identified for inclusion, with 16% developing a new MH condition and 29% dying during follow-up. A new MH condition was more likely among non-Hispanic white patients compared to non-Hispanic black and were less likely among those who are male or had a pre-cancer MH condition. The onset of a new MH condition was associated with a threefold decrease in survival. In addition, having a pre-cancer MH condition decreased survival nearly twofold., Conclusions: Our findings emphasize the importance of new-onset MH in patients after CRC diagnosis. Standardized screenings may alleviate some of the MH burden that patients with CRC experience in addition to potentially improving the overall health of patients., Implications for Cancer Survivors: MH conditions may impact not only CRC outcomes but may direct future studies analyzing the risks of new onset MH conditions in other types of cancers, further expanding the importance of psychiatric support in patients with cancer., Competing Interests: Declarations The authors declare that no funds, grants, or other support were received during preparation of this manuscript. DT discloses salary support from Kate B. Reynolds Charitable Trust Foundation and Lilly Grant Office for research and quality improvement projects unrelated to the present work. Competing Interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Pre-optimization of obese patients prior to abdominal wall reconstruction (AWR) is essential in mitigating their increased preoperative risks. Traditionally diet, exercising, bariatric surgery are the tools typically prescribed for weight loss. The advent of glucagon-like peptide-1 agonists (GLP-1A) which stimulate insulin secretion and inhibit gastric emptying have improved the weight loss armamentarium. However, there is a limited amount of literature on GLP-1A effectiveness and postoperative outcomes in AWR patients. This study compares the efficacy of GLP-1A to Bariatric Surgery (BAS) in perioperative AWR patient., Methods: A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2021 and March 2024. We included patients who required GLP-1A or BAS for weight optimization prior to AWR. We excluded patients on GLP1-A or history BAS not performed for AWR preoptimization. Basic demographics such as age, sex, race, weight and BMI at initial clinic visit and at surgery were compared. Primary endpoints included time to surgery, time to bowel recovery and length of stay (LOS). Time to surgery was defined as the number of months between the initial clinic visit and AWR. Time to bowel recovery was defined as the number of days it took for the first postoperative bowel function. Secondary endpoints included standard 30-days postoperative variables. Nominal variables were analyzed using a Fisher exact test and continuous variables were analyzed with Student's T test., Results: 35 patients were included in this study (GLP-1A: 17, BAS: 18). The GLP-1A cohort had a lesser BMI at the initial clinic visit (40.8 vs 43.4, p = 0.188). GLP-1A cohort made it to the operating room faster (9.1 months vs 13.5 months, p = 0.06) from the first clinic visit; and (7.9 months vs 9.7 months, p = 0.4) from initiation of weight loss intervention. Albeit losing less weight (14.9 kg vs 27.1 kg, p = 0.008) with a lesser reduction in the BMI (4.69 vs 9.23, p = 0.004). The GLP-1A cohort showed a non-significant elevated LOS (5.2 days vs 3.6 days, p = 0.25) and an increased ileus rate (17.6% vs 0%, p = 0.1). However, there were no differences noted in time to bowel recovery (2.9 days vs 3.1 days, p = 0.76)., Conclusion: GLP-1A is effective in optimizing patients needing weight loss before AWR. They shorten the timeline to AWR intervention and have comparable peri-operative outcomes to BAS patients., Competing Interests: Declarations Competing interests None., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

The Hugo ™ robotic assisted surgery system is a relatively new robotic platform developed by Medtronic. The study objective was to describe the experience of using Hugo ™ robotic assisted surgery in gynecological surgeries and compare robotic assisted surgery-related outcomes between complex and non-complex gynecological patients at the Pacifica Salud Hospital. We performed secondary data retrospective analysis of 144 consecutive patients who underwent gynecological surgery with Hugo ™ robotic assisted surgery system (Medtronic) at the Pacifica Salud hospital in Panama City from July 19, 2021, to August 3, 2023. Complex patients were defined as those with one or more risk factors for surgery complications. Descriptive analysis of participants' sociodemographic and robotic assisted surgery-related characteristics. Due to the non-normal distribution of the RAS-related numeric variables, we compared these variables between complex and non-complex cases of gynecological patients using Kruskal-Wallis's test. The study found that Hugo ™ robotic assisted surgery system was safe for gynecological surgery in patients with and without risk factors for developing major surgery complications. None of the patients experienced any complications, and they had short hospital stays with low blood loss without requiring a blood transfusion. The Hugo ™ robotic assisted surgery system was technically sound and did not present technical failures. The results could be a reference for adopting this technology and developing best practices in the Latin American region., Competing Interests: Declarations Conflict of interests Dr Miguel Cáceres is proctor of HUGO RAS in Medtronic PLC and he is also this study grant-recipient. Dr. Ricardo Perez Cuevas received consultant honoraria from Medtronic PLC. The rest of the authors have no relevant financial or non-financial interests to disclose. All authors declare their complete independence from Medtronic PLC during the entire research process and are solely responsible for the methods, results, concepts, and conclusions in this manuscript. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. The study protocol obtained Institutional Review Board approval of the Pacifica Salud Hospital (N#2586). Consent to participate The manuscript presents the results of the secondary data retrospective analysis of patients who underwent gynecological surgery with HugoTM RAS System (Medtronic), according to the institutional review bord the inclusion in the analysis of the deidentified patients’ data did not require their consent. However, all patients who underwent surgery with HugoTM RAS System gave written informed consent for robotic surgery and were personally informed by the operating surgeon about the surgical procedure and its possible complications. Consent to publish According to the institutional review bord the inclusion in the analysis of the deidentified patients’ data did not require their consent to publish., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Objectives: Evaluation of the validity of the Quadruple-D score in the prediction of success in pediatric stone disease., Materials and Methods: Of the 292 children treated with SWL between 2007 and 2023, a total of 158 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), stone density (SD) and stone location (SL) variables. Receiver operator characteristic analysis was used to set cut-off values. Quadruple-D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL., Results: The median age of the study group was 8 (range 1 to 16). One hundred and one of the 158 (64%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 150 mm 3 , 6.7 cm, and 540 HU, respectively. Stone-free rates were detected as 19.6%, 24.7%, 37.2%, 76.2%, and 90.2% with the Quadruple-D scores of 0, 1, 2, 3 and 4 points., Conclusions: Quadruple-D scoring system can further improve Triple-D scoring system by adding stone position parameter to clarify SFR with a simple and easy calculation. We believe that the Quadruple-D score will have better clinical significance than the Triple-D scoring system in predicting the success of SWL in children., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

To determine risk factors for urinary retention (UR) after robot-assisted radical cystectomy (RALC) with orthotopic neobladder diversion. A total of 269 patients who underwent RALC with orthotopic neobladder diversion from 2008 to 2019 at seven tertiary hospitals were retrospectively analyzed. There were 68 patients who had UR (UR arm) and 201 patients who did not have UR (no-UR arm). UR was defined as voiding dysfunction without catheterization or more than 100 mL of residual urine after voiding. Preoperative demographics, perioperative factors, pathology outcomes, and postoperative complications of UR and no-UR arms were compared and predictors of UR were identified. Among demographic factors, only gender proportion showed a difference, with male proportion being significantly lower in the UR arm than in the no-UR arm (81% vs 92%, p = 0.010). For perioperative outcomes, anastomosis site stricture (27% vs 11%, p = 0.003) and length of hospital stays (23 days vs. 19 days, p = 0.001) were significantly higher in the UR arm than in the no-UR arm. In multiple logistic regression analysis, female (OR 3.32, 95% CI: 1.43-7.72) and body mass index (BMI) (OR 1.10, 95% CI 1.00-1.20) were UR predictors. UR after RALC with orthotopic neobladder diversion is significantly increased in females. Multiple logistic regression analysis identified female and BMI elevation as UR predictors., Competing Interests: Declarations Conflict of interest The authors declare no competing interests. Ethical approval We performed this retrospective, multi-institutional study after Institutional Review Board (IRB) approval of Seoul National University Bundang Hospital (Approval number: B-2309–853-303) and in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments., (© 2024. The Author(s).)

Purpose: The study aim was to assess the impact of clinically significant weight loss (CSWL; ≥5% weight reduction) on postoperative complications following abdominal wall reconstruction with the component separation technique (CST)., Methods: A retrospective review of patients who underwent open ventral hernia repair (VHR) with CST from November 2008 to January 2022 was performed. Cohorts were stratified by presence of CSWL from baseline weight at preoperative consultation., Results: Of 180 total patients, 40 (22.2%) achieved CSWL prior to VHR. Mean age was 59.6 ± 11.2 years. Patients in the CSWL cohort represented a higher average body mass index (BMI) (33.6 vs. 31.7 kg/m 2 , p = 0.076), and were obese more frequently (80.0% vs. 56.4%, p = 0.007). The CSWL cohort had a higher proportion of patients in Ventral Hernia Working Group (VHWG) classification II (82.5% vs. 63.6%) while the non-CSWL cohort had more VHWG classification III/IV (20.0% vs. 10.0%, p = 0.078). Mean follow-up duration was 6.1 ± 13.4 months. Complications, including 30- and 90-day surgical site occurrence (SSO), return to operating room, readmission, and hernia recurrence (CSWL: 5.0% vs. non-CWL 1.4%, p = 0.179), were comparable between cohorts. BMI was an independent predictor of any complication (OR 1.07, p = 0.044) and 90-day SSO (OR 1.10, p = 0.043)., Conclusion: Achievement of CSWL prior to open VHR utilizing CST results in similar post-reconstruction outcomes to patients who maintained a comparable BMI at baseline. Higher day-of-surgery BMI was more consequential to postoperative complications than percent weight loss., Competing Interests: Declarations Competing interests Authors have no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objective: The aim of this study is to investigate the effect of modified holmium laser enucleation of the prostrate (HoLEP) on the function of urine control., Methods: An analysis was conducted on a cohort of 305 elderly patients in a retrospective study spanning from February 2019 to February 2023. The cohort consisted of 150 patients who underwent modified HoLEP and 155 patients who underwent traditional HoLEP. Factors such as age, length of membranous urethra, prostate volume, BMI, IPSS, Qmax, enucleated weight, enucleation time, post-operative bladder irrigation time, catheterization and hospitalization were compared between both the groups. Multivariable logistic regression was used to identify independent predictors of urinary incontinence, and receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of urethral membrane length in the diagnosis of urinary incontinence. Postoperative Qmax,IPSS, V 2 were compared between 2 groups in the 6th month., Results: Groups were compared in terms of age, volume, BMI, IPSS, Qmax and membranous urethral length (MUL). The time of enucleation, bladder irrigation, post-operative catheterization and hospitalization was lower in the modified HoLEP group (p < 0.05). The incidence of urinary incontinence (UI) in the modified group had a statistically significant decrease at 3 months (3.3% vs 9.7%, p = 0.025) and 6 months (0.6% vs 5.2%, p = 0.048). The median MUL had a significant difference in the 1st month (15.07 vs 12.5 mm, p < 0.001). In multivariate regression analysis, older age (OR per SD = 1.102, 95%CI: 1.077-1.136), shortened MUL (OR per SD = 0.776, 95%CI: 0.629-0.957) and increased enucleated prostate weight (OR per SD = 1.29,95%CI: 1.005-1.084) were significantly associated with UI. The ROC curve revealed the threshold value of MUL was 13.5 mm, the sensitivity was 76.7%, and the specificity was 98.1%., Conclusion: The modified HoLEP technique is safe and effective on the function of urine control, and is superior to less residual prostate volume and higher maximum urine flow rate after surgery., Competing Interests: Declarations Ethics approval and consent to participate This study was conducted in accordance with the declaration of Helsinki.This study was conducted with approval from the Ethics Committee of The Second Affiliated Hospital of Nantong University(2023KT258). A written informed consent was obtained from all participants. Consent for publication Consent for publication was obtained from every individual whose data are included in this manuscript. Competing interests None of the authors have any financial disclosure or conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Single-port (SP) robotic surgery is a novel technology, and although there is emerging data, it remains limited in assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. To compare perioperative and postoperative outcomes between SP and MP robotic technologies for radical nephrectomy (RN). This is a retrospective cohort study of patients who have undergone robot-assisted radical nephrectomy using either the SP or MP technology. Baseline demographics, clinical, tumor-specific characteristics, and perioperative and postoperative outcomes were compared using χ 2 , t-test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust, Poisson, and logistic regressions. A total of 341 patients underwent robotic RN with 47 patients (14%) in the SP group. The two groups exhibited similar baseline characteristics, with no significant differences in age, sex, body mass index, Charlson comorbidities index, and tumor laterality. However, SP group had a smaller average tumor size (5.1 cm vs 6.4 cm, p = 0.009). The SP had longer operative time (178 ± 84 min vs 142 ± 75 min; p = 0.011) but showed no significant difference in the estimated blood loss, blood transfusion rate, length of stay, overall 30-day and major complication rates. Controlling for other variables, SP was significantly associated with a longer operative time and shorter length of stay. SP is associated with longer operative time but offers advantages such as smaller incisions and shorter hospital stays with a comparative safety profile to MP for radical nephrectomy., Competing Interests: Declarations Conflict of interest Kennedy E Okhawere certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Dr. Ronney Abaza is a lecturer for Intuitive Surgical Inc. and VTI Inc. Dr. Michael Stifelman is on the scientific advisory board of Intuitive Surgery and has an educational agreement with Ethicon. Dr. Mutahar Ahmed is a consultant for CONMED and Intuitive Surgical. Dr. Jihad Kaouk is a consultant for Intuitive Surgical. The remaining authors declare that they have no relevant financial interest. Ethical approval Before involving any centers or recruiting participants, the study secured the necessary approvals from the relevant institutional ethics review boards and established data sharing agreements. Consent to participate Informed consent was obtained from all individual participants included in this study. Consent to publish Not applicable., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm 3 , p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32 min, p = 0.02 and 50 vs. 45 min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment ≤ 2 mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS., Competing Interests: Declarations Ethics approval All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Asian Institute of Nephrology and Urology, Hyderabad (#AINU 12/2022). Consent to participate Informed consent was obtained from all individual participants included in the study. Financial disclosures The authors have no relevant financial or non-financial interests to disclose. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Pituitary adenomas are amongst the most common benign central nervous system tumors, and often require resection via an endoscopic endonasal approach (EEA). Two of the most common associated complications are central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both are thought to be caused by manipulation of the posterior pituitary gland (PPG), making intraoperative visualization and preservation of this structure critical. Intraoperative endoscopic endonasal ultrasound (IEUS) may present an optimal tool for this purpose. This study aims to describe the appearance and morphology of the PPG on IEUS., Methods: This study included all pituitary adenoma surgeries during which IEUS was utilized and the PPG was visualized between 1/1/2022, and 12/31/2023. Demographic, clinical, pathological, and radiological data were retrospectively collected. The PPG was described as either hypoechoic, isoechoic, or hyperechoic as compared to the anterior pituitary gland and adenoma, and the morphology of the PPG was further classified as ellipse or crescent shaped., Results: The PPG was hypoechoic in all 43 cases included in our final cohort (100.0%). Morphologically, the PPG appeared elliptical in 27 cases (62.8%), and crescent shaped in 16 cases (37.2%)., Conclusion: The PPG can typically be visualized by IEUS as a hypoechoic structure immediately anterior to the posterior wall of the sella turcica, with elliptical morphology being the most common appearance. These characteristics can be used by the skull base surgeon to more confidently identify the position and morphology of the PPG intraoperatively for its' preservation., Competing Interests: Declarations Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board/ethics committee of The Ohio State University (study #2020H0221). Competing interests Dr. Daniel Prevedello is a consultant for Stryker Corp., Medtronic Corp., BK Medical and Integra; he has received an honorarium from Mizuho and royalties from KLS- Martin and ACE Medical. All other authors report no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Background: Spontaneous intracerebral abscess formation is a rare condition presenting with a disabling sequela. The origin of infection can either be primary or secondary to an infection at another location. The site of primary infection - due to the proximity, often the oral cavity, the sinuses, and the orbit - determines the causative pathogens. Treatment often combines surgical and antimicrobial therapies. To determine the microbiology and respective changes and treatment outcome, we performed this retrospective monocentric cohort study of patients requiring surgical treatment of brain abscesses., Methods: Patients undergoing surgical treatment of a primary intracranial abscess between January 2000 and January 2021 in the Department of Neurosurgery, Freiburg University Hospital were included. Demographic, clinical and imaging data were extracted from patients' medical records and databases. Treatment approaches were also analyzed, and surgical therapy and antibiotic therapy were reported. Outcome was assessed by the modified Rankin score (mRS) and was dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcome., Results: We included 65 patients with spontaneous intracerebral abscess that were treated with neurosurgical intervention at our institution. Analysis of the causative pathogens showed an increasing dominance of rare pathogens such as fungi, parasites, mycobacteria and anaerobes. Outcome measured by the mRS was similar from 2005 to 2021., Conclusions: The pathogen spectrum of spontaneous intracerebral abscess at our institution is shifting with rarer pathogens being increasingly detected. This retrospective analysis highlights the need for microbiological diagnosis and of combined surgical and antibiological treatment., Competing Interests: Declarations Disclosures None. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: The relationship between dysmagnesemia and all-cause mortality probability in individuals with acute kidney injury (AKI) have not been investigated. In this study, we evaluated the correlation of varying magnesium levels with mortality in older adults undergoing AKI., Patients and Methods: Older adults receiving treatment at the Chinese PLA General Hospital between 2007 and 2018 were retrospectively recruited. All-cause mortality was evaluated at four preset magnesium concentrations: <0.8, 0.8-0.9, 0.9-1.0, and ≥ 1.0 mmol/L. Using multivariable-adjusted Cox assessment, the all-cause mortality risk was approximated by setting the reference magnesium concentration at 0.8-0.9 mmol/L., Results: Totally 744 participants were enrolled, whose median age was 88 years, with most of them being male (94.2%). Among them, 184 patients were assigned into the < 0.8 mmol/L group, 156 into the 0.8-0.9 mmol/L group, 206 into the 0.9-1.0 mmol/L group, and 198 into the ≥ 1.0 mmol/L group. After 28 days, the mortality rates in the four strata were 26.6, 17.9, 17.5, and 37.4%, respectively. The corresponding mortalities after 90 days were 42.4, 23.7, 26.7, and 45.5%, respectively. Compared with patients who had magnesium levels of 0.8-0.9 mmol/L, those with magnesium levels < 0.8 mmol/L (P = 0.048), and ≥ 1.0 mmol/L (P < 0.001) exhibited higher 28-day mortalities. Significant correlations also showed that patients with magnesium levels < 0.8 mmol/L (P = 0.017) and ≥ 1.0 mmol/L (P < 0.001) were significantly related to the increased 90-day mortality., Conclusion: Magnesium levels outside the interval of 0.8-1.0 mmol/L were related to the higher risks of 28- and 90-day mortalities among older adults with AKI., Competing Interests: Declarations Ethical approval This study has been approved by the Ethics Committee of the Chinese PLA General Hospital (No.: S2023–725–01). Consent for publication The manuscript has been read and its submission approved by all coauthors. Informed consent The requirement for written informed consent was waived by the ethics committee of the designated hospital because this was an observational retrospective study. Human and animal rights All the procedures in the study were in accordance with the ethical standards of the Chinese PLA General Hospital Ethical Committee and with the 1964 Helsinki Declaration (with amendments). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRSH) or liver resection have led to increased survival in patients with peritoneal or liver metastases of colorectal cancer. Selected patients undergo concomitant CRSH and liver resection. Differences in survival and morbidity between patients who underwent concomitant surgery, CRSH or liver resection for peritoneal and/or liver metastases were compared., Methods: Patients who underwent liver resection and/or CRSH for colorectal liver and/or peritoneal metastases, 2006-2016, were included. Regression analysis was used to evaluate the associations between baseline characteristics and survival., Results: Overall, 634 patients were studied. Twenty-eight patients had peritoneal and liver metastases, 121 patients had peritoneal metastases only, and 485 patients had isolated liver metastases. Median survival after concomitant treatment was 23.8 months (95% CI 12.8-43.8), after CRSH 34.5 months (95% CI 27.1-41.9), and after liver resection 54.2 months (95% CI 47.4-61.0) (p < 0.001). Increased hepatic tumor burden (HR 3.2, 95% CI 1.8-5.8) and high-volume peritoneal disease (HR 6.0, 95% CI 3.7-9.8) were associated with decreased survival in multivariate analysis. Postoperative complications according to a Clavien-Dindo score > 3a were observed in 11% in the liver resection group, 15% in the CRSH group, and 11% in the concomitant treatment group (p = 0.945)., Conclusions: Patients treated with concomitant surgery for liver and peritoneal metastases experienced a shorter median overall survival than patients treated for metastases at an isolated site but had a similar rate of severe postoperative complications. The extent of peritoneal spread seemed to impact survival more than the tumor burden in the liver., Competing Interests: Declarations Ethics Approval The study was approved by the Swedish Ethical Review Authority in Uppsala (Dnr. 2013/203 and 2018/086). Consent to Participate Not applicable. All patient data is presented at group level and is unidentifiable. Consent for publication Not applicable. Competing Interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: X-linked agammaglobulinaemia (XLA), caused by mutations in BTK, is characterised by low or absent peripheral CD19 + B lymphocytes and agammaglobulinaemia. The mainstay of treatment consists of immunoglobulin replacement therapy (IgRT). As this cannot fully compensate for the immune defects in XLA, patients may therefore continue to be at risk of complications., Objectives: To describe the clinical outcomes of XLA patients in the United Kingdom and Hong Kong and evaluate current treatment strategies., Methods: Patients with a definitive diagnosis of XLA were included in this cross-sectional and retrospective analysis of clinical health outcomes. Data pertaining to diagnosis, infection incidence, IgG trough levels and lung function were collected and analysed., Results: 99 patients with a median age of 29.02 years (IQR 12.83-37.41) and a total follow up of 1922 patient years, were included this study. The median age at diagnosis was 3.30 years (IQR 1.04-8.38) which decreased over time (p = 0.004). 40% of the cohort had radiological evidence of bronchiectasis. Risk of bronchiectasis was not significantly associated with clinical infection incidence (p = 0.880) or IgG trough levels (p = 0.407). Two patients demonstrated novel complications, namely persistent norovirus infection, leading to haemopoietic stem cell transplantation (HSCT)., Conclusions: Despite modern therapy, most XLA patients continue to experience complications, most notably bronchiectasis, likely due to absence of IgA/M in current therapies, but lack of B lymphocytes may also lead to additional sequalae. These data strongly support the need for further research, particularly that of curative modalities including HSCT and gene therapy., Competing Interests: Declarations Competing Interests Ben Shillitoe has received travel grants from Pharming and speaker fees from TakedaTomaz Garcez has Consulting, advisory work and educational support from BioCryst, CSL Behring, KalVista, Novartis, Octapharma, Pharming and Takeda.Jaime S Rosa Duque received a conference sponsorship from Merck Sharp & Dohme in 2023Yu Lung Lau chairs the Scientific Committee on Vaccine Preventable Diseases of the Hong Kong Government. The remaining authors have no COIs to delcare., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: We examined whether admission risk increases at a certain threshold of number of systems medicated or whether any increase confers greater admission risk in either sex in a community-dwelling cohort of older persons in Hertfordshire. This study uses a longitudinal retrospective study design., Methods: Data from 2997 men and women (aged 59-73 at baseline) were analyzed. Participants were followed up from baseline (1998-2004) until December 2018 using Hospital Episode Statistics and mortality data, reporting clinical outcomes using ICD-10 coding. Number of systems medicated in relation to mortality (all-cause, cancer-related, cardiovascular-related) and admission (any, neurological, cardiovascular, and respiratory) were examined using Cox regression., Results: Apart from cancer-related mortality among women, more systems medicated predicted increased risk of all events among both sexes (p ≤ 0.001). For 'any', cardiovascular and respiratory admissions, there were increases in risk for each category of number of systems medicated. For example, compared to men with no systems medicated, those with 1, 2 and > 2 systems medicated had hazard ratios (95% CI) for cardiovascular admissions of 1.82 (1.57,2.12), 2.39 (2.00,2.84) and 3.45 (2.84,4.20) respectively; estimates among women were 1.74 (1.44,2.11), 2.35 (1.92,2.88) and 3.40 (2.79,4.13)., Conclusions: Increases in numbers of systems medicated conferred greater risk of admission in both sexes. Interventions aimed at reducing the burden of chronic disease in mid-late adulthood are required., Competing Interests: Declarations Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and /or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for the baseline Hertfordshire Cohort Study was obtained from the Hertfordshire and Bedfordshire Local Research Ethics Committee. Permission to obtain a HES extract for HCS participants from 01/04/1998 to 31/12/2018 was granted by the Ethics and Confidentiality Committee of the National Information Governance Board and NHS Digital. Consent to participate All study participants provided written informed consent for the investigations they underwent and for researchers to access their medical records in the future. Competing interests EMD declares consultancy and speaker fees from Pfizer, UCB and Lilly. The remaining authors declare that they have no conflicts of interest., (© 2024. The Author(s).)

Background: This study aims to evaluate the relationship between volumetric measurements of residual tumor via magnetic resonance imaging (MRI) and pathologic complete response (pCR) in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT)., Methods: Patients with locally advanced rectal cancer who had pelvic MRI for clinical staging and completed nCRT followed by radical resection were included. Two experienced radiologists measured tumor volume on MRI obtained before and after nCRT. We compared the pre- and post-CRT tumor volume and measured tumor volume reduction rates., Results: The median value of tumor volume reduction rate in all patients was 64.7% (min-max - 81.1-98.1%). When the relationship between tumor volume and tumor regression grade (TRG) after nCRT was assessed, it was found that 18 of 21 (86%) patients with a good response (TRG 1) had a post-CRT tumor volume of ≤ 8 cm3 (p = 0.001). While 9 of 10 patients with pCR after nCRT had a tumor volume of ≤ 8 cm3, one patient had pCR despite having a tumor volume greater than 8 cm3 (p = 0.015)., Conclusion: The correlation between post-nCRT residual tumor volume and pCR underscores the potential of volumetric MRI as a predictive tool in tailoring rectal cancer treatment. For patients with residual tumor volumes greater than 8 cm 3 , extending neoadjuvant chemotherapy as part of TNT may enhance the likelihood of achieving pCR. This approach advocates for a more personalized treatment strategy, potentially optimizing outcomes for rectal cancer patients., Competing Interests: Declarations Ethical Approval Ethical approval was received from the Gazi University Ethics Commission on 3.3.2023. Informed Consent Patient consent was waived as this study included only review of existing data without contact with or direct involvement of patients in the study. Institutional Review Board Statement The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of Gazi University Medical Faculty. Conflict of Interest The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Parsonage-Turner Syndrome (PTS) is a rare idiopathic brachial neuritis that classically presents with sudden onset upper extremity pain followed by upper limb weakness, sensory disruption, and muscle atrophy. We hypothesized that the type of antecedent event before symptom onset would determine the degree of spontaneous recovery after PTS., Methods: We retrospectively reviewed all patients who presented with PTS to a single tertiary referral center from January 2002 to December 2021. Each medical record was reviewed to exclude patients with any other identifiable neurologic etiology. The primary outcome was improved muscle strength measured by a modified British Medical Research Council (mBMRC) grading system. The spontaneous recovery cohort included patients with appreciable or full recovery (mBMRC 4 and 5). In contrast, patients with little to no recovery (mBMRC 0 to 3) were included in the incomplete recovery group. Antecedent events, demographic variables, affected upper extremity region, time between symptom onset and final visit, and presence of nerve surgery were analyzed. Two-tailed T-test and Fisher exact tests were used to compare continuous and categorical variables. Multivariable logistic regression was modeled to identify variables associated with spontaneous recovery., Results: 100 patients with 144 extremities met the inclusion criteria. The average time from symptom onset to the final clinic visit was 3.5 years. 65 extremities (57.0%) spontaneously recovered without surgical intervention, whereas 49 extremities (43.0%) incompletely recovered. The spontaneous recovery cohort was younger (mean [SD] age, 47.4 [18.1] vs. 56.5 [18.7]; p = 0.02) and had fewer bilateral cases (count[%], 4 [6.5%] vs. 10 [26.3%]; p = 0.008). Multivariable logistic regression revealed that each year of increased age was associated with a 3% decreased chance of spontaneous recovery (OR[95%CI] 0.97[0.95, 0.99], p = 0.046). Bilateral involvement was associated with 93% decreased chance of recovery (OR[95%CI] 0.07[0.01, 0.39], p = 0.002), each additional muscle affected was associated with 10% decreased chance of recovery (OR[95%CI] 0.90[0.83, 0.97], p = 0.01), and traumatic antecedent events were associated with increased chance of recovery (OR[95%CI] 27.3[2.59, 287.5], p = 0.006)., Conclusions: Younger patients with unilateral symptoms and fewer muscle involvement have a greater chance of spontaneous recovery after PTS. PTS precipitated by trauma may have better spontaneous recovery than those precipitated by other causes., Competing Interests: Declarations Ethical approval This study was deemed exempt by the Mayo Clinic Institutional Review Board (IRB# 22-011399). Competing interests AYS: Royalties from Mayo Medical Venture/TriMed Orthopedics Editor, Techniques in hand and upper extremity National Institutes of Health, RO1 funding., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Aim: To compare three-dimensional changes of aporcine derived collagen matrix (CM) and free gingival grafts (FGG) for increasing keratinized tissue (KT) at dental implants over a 24-month follow-up period., Materials and Methods: This retrospective study enrolled 25 patients exhibiting 41 implants with deficient KT width (i.e., < 2 mm) who underwent soft tissue augmentation using either CM (11 patients/15 implants) or FGG (14 patients/26 implants). The primary outcome was tissue thickness change (mm) at treated implant sites between 1- (S0), 12- (S1), and 24-months (S2). Secondary outcome was the changes of KT width over a 24-month follow-up period., Results: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of -0.05 ± 0.35 mm and - 0.31 ± 0.41 mm in the CM group, and - 0.23 ± 0.38 mm and - 0.22 ± 0.81 mm in the FGG group, with no significant differences found between the groups (S0-S1: p = 0.14, S0-S2: p = 0.58). Within S1 and S2, the CM and FGG groups displayed comparable tissue thickness reduction (CM: -0.32 ± 0.53 mm, FGG: -0.02 ± 0.21 mm; p = 0.07). The FGG group exhibited a significantly greater KT gain 24-months compared to the CM group (CM: 1.50 ± 1.14 mm, FGG: 4.04 ± 1.65 mm; p < 0.001)., Conclusions: CM and FGG were associated with comparable three-dimensional thickness changes over a period of 24 months. A significantly wider KT band could be established in the FGG group., Competing Interests: Declarations Ethics approval The original study protocol was approved by the Ethics Committee of the Goethe University (No. 20–541). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

BACKGROUND  : The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor., Methods: This was a retrospective cohort study. ASD patients were stratified by use of intra-operative BMP (BMP +) or not (BMA + I) and surveyed for the development of complications and mechanical failure. Quality of life gained following the procedure was evaluated using quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions. Multivariable analyses (ANCOVA) and logistic regression were used to adjust for confounding., Results: 512 patients were included (60% BMP +). At baseline, BMP + patients were older (62.5 vs 60.8 years, p < 0.010). Radiographic and quality-of-life metrics did not differ at follow up timepoints (all p > 0.05). BMP use was associated with higher supplemental rod use (OR: 7.0, 1.9 - 26.2, p = 0.004), greater number of levels fused (OR: 1.1, 1.03 - 1.17, p = 0.003) and greater neurological complications (OR: 5.0, 1.3 - 18.7, p = 0.017). Controlling for rod use and levels fused, BMP use was not associated with a lower risk of mechanical complications (OR 0.3, 95% CI: 0.2 - 3.0, p = 0.353), rod breakage (OR: 3.3, 0.6 - 18.7, p = 0.182) or implant failure (OR: 0.3, 0.04 - 1.51). At 2 years, the BMP + cohort exhibited higher overall costs ($108,062 vs $95,144, p = 0.002), comparable QALYs (0.163 vs 0.171, p = 0.65) and higher cost per QALY (p = 0.001) at two years., Conclusions: In this analysis, BMP-2 application was not associated with superior outcomes when compared to a less costly biologic alternative (bone marrow aspirate + cancellous bone chips + i-Factor) following ASD surgery. The use of BMP-2 in ASD surgery appears to have reduced cost-efficacy at two years postoperatively., Competing Interests: Declarations Ethical approval This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of NYU School of Medicine. Informed consent Informed consent was obtained from each patient prior to enrollment. Competing interests Peter G. Passias Cerapedics: Other financial or material support Cervical Scoliosis Research Society: Research support Globus Medical: Paid presenter or speaker Medtronic: Paid consultant Royal Biologics: Paid consultant Spine: Editorial or governing board Spinevision: Other financial or material support SpineWave: Paid consultant JNS Spine: Editorial Board JCM: Editorial Board., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objectives: While some metals have been reported as carcinogens or potential carcinogens, only few modern-standard datasets including a large number of elements are available. The present analysis established a first trace elements spectrum by relating the concentration of metals and trace elements in the serum of sarcoma patients with survival data., Methods: Patients with sarcoma and controls were retrospectively selected from the International Sarcoma Kindred Study database (ISKS). As part of the ISKS study, blood samples were prospectively collected at the Leon Bérard Cancer Center from February 2012 to July 2019. Stable specimens and copper isotopes ( 65 Cu/ 63 Cu) were analyzed using Triple Quadrupole Inductively Coupled Plasma Mass Spectrometer (ICP-MS) and the Multicollector MC-ICP-MS Nu Plasma HR 500. Wilcoxon rank sum test, log-rank test, and multivariate Cox regression models were used for statistics., Results: In total, 151 patients and 59 healthy controls were included. At the time of blood sample collection, 62% of patients had locally advanced or metastatic disease. Copper (Cu), copper/zinc (Cu/Zn) and potassium/rubidium (K/Rb) ratio were significantly higher in patients compared to controls and were also significantly higher in patients with advanced compared to early-stage sarcoma. Whereas S and Se were significantly correlated in patients, no correlation was observed in controls. Importantly, levels of K, Rb, Se, Fe, P, Si, S, δ 65 Cu, Cu, S/Se and Cu/Zn ratio were independently associated with overall survival., Conclusions: These results depict the metallomic spectrum in sarcoma and highlight substantial variation associated with survival, enhancing our understanding of sarcoma's biology., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: ProGAV and ProGAV2.0 adjustable valves are extensively used for treating hydrocephalus in pediatric patients. This study aims to conduct a comprehensive comparison between these two valves concerning their survival and complication rates., Methods: This retrospective study included all pediatric patients who underwent ProGAV or ProGAV2.0 valve implantation at our neurosurgical clinic from August 2008 to August 2020. A comparative analysis was performed considering age, gender, follow-up duration, complication and survival rates, adjustments, spontaneous adjustments, and adjustment difficulty rates. All valves were followed up for a maximum of 3 years., Results: Inclusion involved 333 cases (mean age of 5.4 ± 5.1 years; 54.1% males), comprising 173 cases (52.0%) with ProGAV valve implantation and 160 cases (48.0%) with ProGAV 2.0. Early complications within the first month post-implantation were observed in 51 cases (15.3%). No significant differences were noted in valve implantation indications, age distribution, or survival duration (27.1 vs. 27.8 months, p = 0.629) between the two groups. Predominant indications for implantation were post-hemorrhagic hydrocephalus and aqueduct stenosis for both valve types. Notably, both valves showed non-significantly different explantation rates during the first three years after implantation (34.7% vs. 29.7%, p < 0.289). However, there was a significantly higher early post-implantation complication rate (22% vs. 9.4%, p = 0.002), and a significantly increased association with difficulties in valve adjustments and spontaneous adjustments (p = 0.041 and 0.011, respectively). ProGAV2.0 cases displayed notably enhanced clinical and radiological improvement within the initial 6 months after implantation (p = 0.001 and p = 0.038). Younger children (< 2 years of age) also experienced significantly more valve adjustment difficulties (p = 0.049) and had higher rates of valve explantation (p < 0.001)., Conclusion: The findings of this study highlight the superior performance of the ProGAV2.0 valve in terms of complication rate and maladjustment rate when employed in the treatment of pediatric hydrocephalus. Both valves demonstrated an acceptable survival rate with 65.3% for ProGAV and 71.3% for ProGAV2.0 within three years of implantation., (© 2024. The Author(s).)

To develop and validate a novel Comorbidity score for Robotic Surgery (CRS) in predicting severe complications after robot-assisted radical prostatectomy (RARP). Furthermore, we investigated the impact of the surgical platform (Multi-Port - MP vs Single-Port - SP) according to this score. We included 2085 ("development cohort") and 595 ("validation cohort") patients undergoing RARP at two tertiary referral centers between 2014 and March 2024 in a retrospective study. Statistical analyses included validation of the Charlson Comorbidity Index (CCI) to predict 30-day severe complications (Clavien-Dindo ≥ 3a), development and external validation of CRS using calibration plots and decision curve analysis. Lastly, locally weighted scatterplot smoothing (LOWESS) analysis was used to graphically explore the impact of the robotic platform according to novel CRS. CCI exhibited limited predictive ability for severe complications (60% in the validation cohort). In multivariable logistic regression analyses testing the correlation between each condition included in CCI and severe complications, diabetes and myocardial infarction resulted as independent predictors (OR 1.75 [95%CI 1.05-2.82]; OR 1.92 [95%CI 1.26-2.88]) and were subsequently fitted into a multivariable logistic model including age, previous abdominal surgery and obesity (BMI > 30). The resulting predictive model demonstrated superior discrimination and clinical net benefit in predicting severe complications compared to CCI (AUC 64 vs 60%). At LOWESS analysis, SP platform was associated with lower risk of severe complications as CRS increased compared to MP system. The validated CRS showed better accuracy compared to CCI in predicting severe complications after RARP. Additionally, the use of SP robotic platform may reduce the risk of severe complications in highly comorbid patients according to CRS., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Transoral robotic surgery (TORS) has become a common surgical approach for the treatment of both benign and malignant conditions of the oropharynx. While the newer da Vinci Xi platform has largely replaced the previous Si model in many institutions, the reported outcomes with this system in head and neck surgery are limited. We report the feasibility of using the da Vinci Xi platform for managing oropharyngeal cancer and obstructive sleep apnea in a low-volume center. This retrospective review from a consecutive case series includes demographic, procedural, and outcome data from all patients who underwent TORS using the da Vinci Xi platform at a single institution over a 5-year period from 2019 to 2023. Thirty-five patients (19 males and 16 females) underwent TORS for a variety of indications. No patients were excluded from the study. There were no mortalities, readmissions, or severe complications directly related to the primary surgery. Our case series demonstrates that TORS is feasible with the da Vinci Xi system even in low-volume centers and supports the existing data suggesting that the Xi platform has an acceptable safety profile., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Nissen fundoplication (NF) is a common surgical procedure to treat gastroesophageal reflux disease; however, a subset of patients may continue to experience symptoms or develop symptom recurrence despite a successful procedure. This study aims to compare laparoscopic and robotic approaches for treating failed NF and evaluate the outcomes after converting to Toupet fundoplication (TF). We conducted a retrospective analysis of patients who underwent robotic or laparoscopic revision to TF for failed NF between 2016 and 2023. The data collected included demographics, pre-operative workup, and peri- and post-operative outcomes. Symptom analysis and anti-reflux medication usage were collected using a patient questionnaire. Failed fundoplication was defined as the need for an additional operation due to unresolved GERD symptoms or the emergence of a new issue. Eighty-eight patients (56 laparoscopic, 32 robotic) were included. Mean operative time was 148.71 ± 53.64 min for the total cohort and was significantly longer in the robotic group (RG) 167.43 min vs 138.01 min in the Laparoscopic group (LG) (p value = 0.012). The LG had a length of hospital stay of 2.16 ± 1.69 days vs RG 2.21 ± 1.28 days (p value = 0.867). The LG had a higher number of early readmissions (5.4%, p value = 0.629) and both the LG and the RG had 1 patient that required an early reintervention. Symptoms of dysphagia and reflux decreased in both groups at last follow-up, but the reduction in PPI use was not significant. Surgical revision to TF for failed NF provides significant symptom improvement with low rates of complications and recurrences. Our study shows that both approaches are safe and feasible and have comparable surgical and symptom outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

The concentration of PM 2.5 (particulate matter with a diameter < 2.5 µm) on Sumatra Island has increased, mainly because of forest and peatland fires, transportation, and industry. Biomass burning releases partially burned carbon into the atmosphere, resulting in a smoky haze containing PM 2.5 . Air quality has deteriorated quickly, and PM 2.5 has become a major health hazard in Indonesia. Studies on long-term exposure to PM 2.5 have indicated its associations with both morbidity and mortality. Here, we measured long-term (2000-2014) exposure to PM 2.5 on the basis of satellite-derived aerosol optical depth measurements (1 × 1 km 2 ) used to predict ground-level PM 2.5 concentrations. Additionally, population data on Sumatra Island residents from the fourth wave of the Indonesian Family Life Survey (IFLS) were obtained. We investigated the association between long-term PM 2.5 exposure and mortality with a retrospective cohort study design. A total of 2409 subjects aged ≥ 40 years participated in the IFLS-3 beginning in November 2000, and we examined mortality outcomes until the IFLS-5 in September 2014. We used Cox regression models to calculate hazard ratios (HRs) of mortality associated with PM 2.5 exposure. According to the adjusted model, the mortality HRs per 10 µg/m 3 increase in PM 2.5 concentration were 1.10 (95% CI 1.03, 1.17) for all natural causes, 1.17 (95% CI 1.05, 1.25) for cardiovascular causes, and 1.19 (95% CI 1.04, 1.36) for respiratory causes. Long-term exposure to PM 2.5 was associated with all-natural, cardiovascular, and respiratory mortality on Sumatra Island, where PM 2.5 levels exceed the WHO and US-EPA air quality standards., (© 2024. The Author(s).)

Background: There is skepticism about the benefit of surgery in elderly patients affected by traumatic brain injury (TBI) due to the negative effect of age on the outcome and surgical complications. However, there are few studies that have investigated differences in patient's outcome between surgically and conservatively managed patients after adjusting for the imbalance in preinjury characteristics and clinical and radiological features. The primary aim of this study was to evaluate the effect of early surgery on mortality and functional recovery in a cohort of older adults with acute traumatic intracranial lesions after adjustment by Propensity Score (PS) matching.     MATERIALS AND METHODS: We conducted a retrospective cohort study on older adult patients (≥ 65 years) admitted for TBI between 2013 and 2023 to a single level 1 trauma center. Patients were categorized based on whether they underwent early surgery (< 48 h after TBI) for a space-occupying lesion evacuation. PS model was constructed based on age, frailty, comorbidities (Charlson comorbity index and American Society of Anaesthesiologists score), anticoagulants, hypoxia, shock, pupillary abnormalities and GCS motor response upon admission, midline shift, basal cistern effacement, volume of subdural and intracerebral hematomas, and limitation of life-sustaining treatment decisions.The effect of early surgery on 30-day mortality and unfavorable functional outcomes (GOSE 1-3) at 6 and 12 months were investigated after matching by paired test., Results: We identified and reviewed 301 patients who met all inclusion criteria and contained no exclusions. After matching, 62 patients (31 pairs of conservative and surgical patients) remained as the matched datasets. Our key finding was that older adult TBI patients who underwent early surgery had a statistically significant reduction in the risk of 30-day mortality (OR 0.313, 95% CI 0.114-0.853, p = 0.023) and unfaourable outcome at 12 months after TBI (OR 0.286, 95% CI 0.094-0.868, p = 0.027)., Conclusions: Early surgery was associated with decreased 30-day mortality and better functional outcome at 12 months after TBI in older adults with few comorbidities and good functionality when clinically affected by acute traumatic intracranial lesions with mass effect., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objectives: To develop a deep learning (DL) model based on computed tomography (CT) images to predict the success of extracorporeal shock wave lithotripsy (SWL) treatment for patients with ureteral stones larger than 1 cm., Materials and Methods: We enrolled 333 patients who underwent SWL treatment for ureteral stones and randomly divided them into training and test sets. A DL model was built based on CT images of ureteral stones to predict SWL outcomes. The predictive efficacy of the DL model was assessed by comparing it with traditional and radiomics models., Results: The DL model demonstrated significantly better predictive performance in both training and test sets compared to radiomics (training set, AUC: 0.993 vs. 0.923, P < 0.001; test set AUC: 0.982 vs. 0.846, P < 0.001) and traditional models (training set AUC: 0.993 vs. 0.75, P = 0.005; test set AUC: 0.982 vs. 0.677, P < 0.001). Decision curve analysis (DCA) also proved that the DL model brought more benefit in predicting the success of SWL treatment than other methods., Conclusion: The DL model based on CT images showed excellent ability to predict the probability of success of SWL treatment for patients with ureteral stones larger than 1 cm, providing a new auxiliary tool for clinical treatment decision-making., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Trigeminal schwannoma (TS), though a rare and benign tumor, becomes a significant surgical challenge due to its intricate location. This study aims to detail the long-term functional outcomes and tumor control post-surgical resection., Method: We analyzed a multicentric retrospective cohort of 39 patients operated on for a TS in five tertiary centers between January 1993 and July 2022., Results: Six TS (15%) were in the middle fossa (type M), two (5%) in the posterior fossa (type P), and two (5%) were extracranial (type E). Twenty-nine (75%) were Dumbbell shape: Eighteen (47%) were MP type, seven (18%) were MPE type, and four (10%) were ME type. Fifth nerve symptoms were the foremost preoperative complaint: hypesthesia (51%), trigeminal neuralgia (36%), and paresthesia (30%). We report a favorable evolution course for 61% of preexisting deficits (half of patients with preoperative paresthesia and neuralgia improved while only 5% of preoperative hypesthesia improved). Postoperative hypesthesia was the most frequent de novo deficit 14 (74%) and resolved in solely half the cases. Various approaches were used according to tumor type. Gross total resection (GTR), Subtotal resection (STR), and partial resection (PR) were achieved in respectively 33% (N = 13), 10% (N = 4), and 56% (N = 22) of patients. The mean clinical and radiological FU was 63 months (12 - 283 months). GTR led to no sign of recurrence (mean FU: 60 months - range: 12-283 months). For STR or PR (67%): 23 (88%) were assigned to a Wait-&-rescan policy (WS group) which offered stability in 70% (N = 16). Three cases (8%) underwent a complementary GKS (GammaKnife) on the residual lesion (GK group) without tumor change., Conclusion: For large TS, the completeness of resection must consider the potential functional burden of surgery. With giant infiltrating lesions, a strategy of planned subtotal resection, complemented by radiosurgery, either complementary or uppon regrowth, may provide similar oncological outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

The sinus lift procedure has become the most common method for maxillary bone augmentation. The most frequently observed intraoperative complication is the perforation of the Schneiderian membrane. Various treatment options have been proposed for managing these perforations, including the use of resorbable membranes, centrifugated blood products as PRF, or PRGF, suturing, and fibrin glue application. While long-term studies exist for the use of resorbable membranes to close perforations, there is limited data on the long-term outcomes of suturing or gluing the perforated sinus membrane. The aim of this retrospective study is to evaluate the long-term outcomes of suturing and/or applying fibrin glue to repair perforated sinus mucosa during sinus floor elevation procedures. Between 2005 and 2009, a total of 692 patients underwent 923 sinus lift surgeries, and Schneiderian membrane perforation occurred in 202 sinus floor elevations (21.98%) across 168 patients. The main documented causes of perforations, which ranged from 2 to 10 mm in diameter, were the presence of septa, followed by thin and adherent membranes. Of the perforations, 100 (49.5%) were treated with microsurgical suturing combined with fibrin glue, 78 (38.6%) were treated with fibrin glue alone, and 24 (11.9%) were treated exclusively with suturing. Sinus grafting was performed using autogenous bone in combination with a biomaterial, following the layering technique. All surgeries resulted in primary healing without complications, enabling all patients to undergo restoration as planned. The long term clinical and radiological evaluations of 44 randomly selected patients who followed the recall program up to 10 years post operative confirmed the effectiveness of this treatment approach., (© 2024. The Author(s).)

Purpose: This study investigated the interfractional volume changes of large (≥ 10 cm 3 ) brain metastases (BMs) during fractionated gamma knife radiosurgery (FGKRS) to assess its predictive value for tumor control outcomes., Methods: The patients who underwent FGKRS for large BMs between January 2017 and December 2022 in our center were reviewed. The interfractional volume change was defined as the disparity in tumor volume (TV) measured between the magnetic resonance images acquired on the first treatment day and those obtained after 2 or 3 fractions during the course of FGKRS., Results: A total of 73 lesions in 70 patients with various primary pathologies were included. Over a median follow-up period of 11 months (range 1-77), the tumor control rate was 63%. Initial TV (cm 3 ) was associated with progression free survival (PFS) and overall survival (OS) in both univariate and multivariate analyses (p = 0.01). Interfractional TV changes revealed an increase in 13 (17.8%) lesions, no change in 14 (19.2%) lesions, and a decrease in 46 (63.0%) lesions, with a mean volume reduction of 5% ± 0.12. Three cut-offs (5%, 10% and 15% volume decrement) were established and patients were divided into two groups based on each reference point. However, there were no significant differences in PFS and OS between the two groups, irrespective of the chosen cut-off value used., Conclusion: Interfractional volume changes of large BMs were not found to be associated with tumor control outcomes. Neither significant interfractional volume reduction nor significant volume increase necessarily predicts the tumor control, making early close monitoring essential after FGKRS., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Prostate cancer (PC) is common among men and has become a significant societal issue. Localized PC has a good prognosis with appropriate treatment. Prostatectomy, particularly robot-assisted radical prostatectomy (RARP), has become a common treatment since the da Vinci prostatectomy was approved by the FDA in 2001. The current study aimed to assess the learning curve for RARP, focusing on anastomosis time, using the cumulative sum (CUSUM) method. Data were collected from Nagoya City University Hospital between May 2011 and December 2018 and included 469 surgeries performed by experienced surgeons. Our findings indicated that, on average, 11 patients were required to complete the initial phase and 24 patients were required to complete the consolidation phase of anastomosis. Additionally, for complete resection of pT2c cases, 16 cases were required for the initial phase and 27 cases were required for the consolidation phase. The CUSUM method proved useful for visualizing trends in surgical proficiency, although the study noted potential confounding biases and limitations in evaluating surgical proficiency based solely on surgical time or positive surgical margins., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: Chronic subdural hematoma (CSDH) is commonly treated by burr-hole drainage with subgaleal or subdural drain insertion, mostly based on surgeon's preference. We analyzed the recurrence rate and clinical outcomes after burr-hole drainage for CSDH and subdural or subgaleal drain insertion in a single center, retrospective cohort study., Methods: 700 cases of burr-hole drainage for CSDH between 2017 and 2022 were included. Subdural drain insertion was compared to subgaleal drain insertion. The primary outcome were the rates of recurrence and reoperation. The secondary outcomes consisted of morbidity, postoperative complications, and mortality., Results: Baseline characteristics were comparable. The recurrence and reoperation rate after subdural drainage were respectively 15.3% (38/249) and 9.6% (24/249). The recurrence and reoperation rate after subgaleal drainage were respectively 13.4% (55/409) and 10.8% (44/409). There were no significant associations found in recurrence and reoperation rate between both drain insertions. No differences in morbidity, complication rate and mortality between drain insertion locations was found., Conclusion: We found relative equipoise between subdural or subgaleal drain insertion concerning recurrence, reoperation rate or clinical outcome. A large multicenter randomized controlled trial could be designed to further assess the outcomes of subdural and subgaleal drain placement after burr-hole drainage for CSDH., (© 2024. The Author(s).)

Background: For emergency department (ED) patients with cardiac chest pain, introduction of high-sensitivity troponin (hsTnT) pathways has been associated with reductions in length of stay of less than 1 h., Methods: At two urban Canadian sites, we introduced hsTnT on January 26, 2016. While the prior diagnostic algorithm required troponin testing at 0 and 6 h, serial hsTnT serial testing was conducted at 0 and 3 h. We identified consecutive patients who presented with cardiac chest pain from January 1, 2015, to March 31, 2017, along with 30-day outcomes. The primary outcome was a missed 30-day major adverse cardiac event, (MACE) defined as death, revascularization, or readmission for myocardial infarction occurring in a patient-discharged home with a minimizing diagnosis and without cardiac-specific follow-up. Secondary outcomes included admission rate, ED length of stay, and MACE. We compared pre- and post- implementation periods using descriptive methods and repeated this analysis in patients with noncardiac chest pain., Results: We collected 5585 patients with cardiac chest pain, (2678 pre- and 2907 post-introduction) and 434 had (7.8%, 95% CI 7.1 to 8.5%) MACE, with 1 missed MACE. (0.2%, 95% CI 0.04 to 1.3%). Admission rate was stable at 24.1% pre- and 23.7% while median length of stay decreased from 464 to 285 min, a difference of 179 min. (95% CI 61 to 228 min). For 11,611 patients with noncardiac chest pain, admission rate (9%) and length of stay (191 versus 193 min) remained constant., Conclusions: Implementation of hsTnT for evaluation of ED chest pain patients was safe and associated with a 3-h decrease in length of stay., Competing Interests: Declarations Conflict of interest On behalf of all authors, the corresponding author states there is no conflict of interest., (© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

Background: Previous studies have demonstrated that access to robotic surgery is influenced by socioeconomic factors, including insurance status. The 2010 Affordable Care Act established an avenue for states to expand Medicaid coverage, which has increased access to surgical care for many conditions. We hypothesized that socioeconomic disparities in access to robotic repair of non-elective emergency general surgery (EGS) hernias are less prevalent in California, a Medicaid expansion state, compared to Florida, which has not adopted Medicaid expansion., Methods: The 2021 California and Florida State Inpatient Databases were used to identify all EGS admissions with an ICD-10 procedure code for ventral or inguinal hernia repair. Elective procedures and those with concurrent unrelated abdominal procedures were excluded. Patient demographics, comorbidity burden, payor status, and income quartile were abstracted. Aggregation of hospital data identified high-volume trauma, robotic, and EGS centers., Results: There were 15,683 EGS hernia procedures of which 11% underwent robotic repair: 14% in Florida and 8% in California. On multivariable logistic regression, older age, male sex, lower income, and Medicare insurance were associated with reduced odds of robotic hernia repair in California, but not in Florida, despite an uninsured rate of 10%. The greatest predictor of robotic surgery in both states was treatment at a robotic surgery center. Overall, accounting for patient- and hospital-level factors, hernia surgeries in Florida were more likely to involve robotics (OR 1.61, CI 1.42-1.81, p < 0.001) compared to California., Conclusion: There were fewer disparities in access to EGS robotic hernia repairs in Florida than in California. This suggests that robotic surgery access for EGS hernia repairs is primarily determined by institutional adoption of robotic surgery, not income or payor status. Compared to California, Florida appears to have greater market penetration of robotic surgery, which has increased access to robotic EGS for all patients., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)