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Objective: To evaluate complication rate and functional outcomes of nerve‐sparing parametrectomy for deep endometriosis in relation to the extension of the surgical procedure, based on recognizable anatomical landmarks. Methods: This was a prospective single‐center study including all patients undergoing parametrectomy for deep endometriosis from September 2020 to June 2023 at our tertiary center. Dorsolateral parametrectomies were divided into parametrectomies medial to the presacral fascia and cranial to the medial rectal artery (superficial parametrectomy), and parametrectomies in which one of the two landmarks was overcome during the surgical procedure, leading to the excision of tissue lateral to the presacral fascia (deep parametrectomy type 1, or DP1) or caudal to the medial rectal artery (DP2). Finally, we used the hypogastric fascia as landmark to define type 3 deep parametrectomy (DP3), when the procedure was deeply lateral to the fascia. Results: Bladder voiding deficit occurred in 9.7% of cases, with higher rates in DP2 (20.8%) and DP3 (30%) groups. Regarding postoperative gastrointestinal function, our data showed a significant improvement over time in all groups, with the exception of DP2; instead an improvement in postoperative bladder function was only shown in DP3. Parametrectomy was not associated with a simultaneous improvement in sexual function expressed with the female sexual function index, in any of the four groups. Conclusion: Our classification constitutes a concrete approach for comparing, in a standardized way, the complications and functional outcomes of parametrectomy, which, even if carried out by expert surgeons, demonstrates a non‐negligible rate of bladder voiding deficit. Synopsis: Parametrectomy demonstrates a non‐negligible rate of post‐voiding bladder retention, and despite a generic improvement in dyspareunia, is not associated with a simultaneous improvement in sexual function [ABSTRACT FROM AUTHOR]

Backgrounds Methods Results Conclusion This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)‐assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation.Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot‐assisted (n = 51) and laparoscopy‐assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post‐surgery.Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group.No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: Childhood stroke has an estimated incidence of 2–13 per 100 000 children. Limited consensus exists regarding best practice recommendations for childhood stroke rehabilitation. A retrospective study completed at a tertiary institution identified potential associations between factors including type of stroke, functional presentation, muscle strength and length of stay (LOS). Methods: A retrospective study of children post‐stroke admitted 2014–2019 evaluated factors influencing outcome within inpatient rehabilitation. Exploratory analyses were completed to investigate relationships between variables including LOS, functional change, premorbid comorbidities and muscle strength. Results: Data on 42 episodes of care (42 children: 18 males) following stroke were sourced from 2014 to 2019. Descriptive statistics were calculated for patient demographics, stroke characteristics, surgical treatment, premorbid comorbidities and muscle strength. Differences in WeeFIM scores between admission and discharge from the inpatient rehabilitation unit were tested using paired t tests. A higher number of children sustained ischaemic stroke (AIS, n = 24) when compared with haemorrhagic stroke (HS, n = 16). The average proportion of rehabilitation LOS to total hospital stay across all stroke types was 54.5%. Assessment of function demonstrated significant improvement between admission and discharge scores across all WeeFIM domains. Presence of comorbidities across stroke survivors was correlated with lower functional levels at discharge despite similar rehabilitation LOS. Conclusion: Limited consensus exists guiding paediatric rehabilitation post‐childhood stroke. This paper provides preliminary data on a cohort post‐childhood stroke at a tertiary‐level inpatient service. Paediatric stroke survivors showed significant functional improvements after inpatient rehabilitation, with the self‐care domain showing greater improvements than mobility and cognition domains, respectively. [ABSTRACT FROM AUTHOR]

Background: Primary fit tracheoesophageal puncture (TEP) is widely preferred for individuals who have not undergone prior radiation. However, there is no consensus on the relative utility of primary‐fit TEP in the setting of salvage laryngectomy. Methods: A retrospective, single‐center review was conducted of individuals undergoing laryngectomy with primary fit TEP between 2012 and 2018. Multivariable analysis was conducted to compare short‐term and long‐term complications, as well as speech and swallowing outcomes, of those who underwent primary versus salvage laryngectomy. Results: In this study, 134 patients underwent total laryngectomy with primary fit TEP. Aside from a higher rate of peristomal dehiscence (13.1% vs. 1.4%) found in the salvage group, there was no difference in incidence of all other complications, including pharyngocutaneous fistula formation. The groups had comparable speech and swallow outcomes. Conclusion: Primary fit TEP is a safe and effective surgical choice for individuals undergoing salvage laryngectomy who desire a voice prosthesis. [ABSTRACT FROM AUTHOR]

Aim: Diverting stomas are routinely used in restorative surgery following total mesorectal exicision (TME) for rectal cancer to mitigate the clinical risks of anastomotic leakage (AL). However, routine diverting stomas are associated with their own complication profile and may not be required in all patients. A tailored approach based on personalized risk of AL and selective use of diverting stoma may be more appropriate. The aim of the TAilored SToma policY (TASTY) project was to design and pilot a standardized, tailored approach to diverting stoma in low rectal cancer. Method: A mixed‐methods approach was employed. Phase I externally validated the anastomotic failure observed risk score (AFORS). We compared the observed rate of AL in our cohort to the theoretical, predicted risk of the AFORS score. To identify the subset of patients who would benefit from early closure of the diverting stoma using C‐reactive protein (CRP) we calculated the Youden index. Phase II designed the TASTY approach based on the results of Phase I. This was evaluated within a second prospective cohort study in patients undergoing TME for rectal cancer between April 2018 and April 2020. Results: A total of 80 patients undergoing TME surgery for rectal cancer between 2016 and 2018 participated in the external validation of the AFORS score. The overall observed AL rate in this cohort of patients was 17.5% (n = 14). There was a positive correlation between the predicted and observed rates of AL using the AFORS score. Using ROC curves, we calculated a CRP cutoff value of 115 mg/L on postoperative day 2 for AL with a sensitivity of 86% and a negative predictive value of 96%. The TASTY approach was designed to allocate patients with a low risk AFORS score to primary anastomosis with no diverting stoma and high risk AFORS score patients to a diverting stoma, with early closure at 8–14 days, if CRP values and postoperative CT were satisfactory. The TASTY approach was piloted in 122 patients, 48 (39%) were identified as low risk (AFORS score 0–1) and 74 (61%) were considered as high risk (AFORS score 2–6). The AL rate was 10% in the low‐risk cohort of patient compared to 23% in the high‐risk cohort of patients, p = 0.078 The grade of Clavien‐Dindo morbidity was equivalent. The incidence of major LARS was lowest in the no stoma cohort at 3 months (p = 0.014). Conclusion: This study demonstrates the feasibility and safety of employing a selective approach to diverting stoma in patients with a low anastomosis following TME surgery for rectal cancer. [ABSTRACT FROM AUTHOR]

Purpose: The impact of a permanent stoma, such as post‐abdominoperineal resection (APR), on quality of life (QoL) is well‐documented. While stoma‐related QoL tools exist, their relationship with stoma satisfaction is unclear. This study aimed to identify which aspects of QoL were most associated with stoma satisfaction. Methodology: A cross‐sectional study of consecutive patients who had an APR for rectal cancer at an Australian tertiary hospital (2012–2021), identified from a prospectively maintained database, was conducted. The Stoma‐QoL questionnaire was used. Overall patient satisfaction with stoma function, and whether healthcare advice was sought for stoma dysfunction, were explored. Linear regression assessed the association between individual issues examined in the Stoma‐QoL questionnaire and overall patient satisfaction with stoma function. Results: Overall, 64 patients (62.5% male, mean 68.1 years) participated. Stoma‐QoL score was associated with stoma satisfaction (P < 0.05). QoL items impacting satisfaction were: needing to know nearest toilet location (P = 0.04), pouch smell concerns (P = 0.008), needing daytime rest (P = 0.02), clothing limitations (P = 0.02), sexual attractiveness concerns (P < 0.05), embarrassment (P < 0.05), difficulty hiding the pouch (P = 0.02), concerns about being burdensome (P = 0.04) and difficulty with interpersonal interaction (P = 0.03). Only 11 (17.2%) patients sought healthcare advice for stoma dysfunction. Conclusion: While stoma‐specific QoL is associated with stoma satisfaction, individual QoL aspects impact differently on satisfaction in permanent colostomy patients. These findings may help identify focus areas for peri‐operative counselling for clinicians and stomal therapists, highlight the importance of tailored multidisciplinary care in ostomates and suggests that a stoma type‐specific Stoma‐QoL questionnaire is required. [ABSTRACT FROM AUTHOR]

Background and purpose: Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. Patients and methods: INTERSTROKE is an international case–control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1‐month follow‐up, and logistic regression was used to identify risk factors for blood pressure variability. Results: Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03–1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04–1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. Conclusion: Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinary sodium excretion. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to evaluate the effectiveness of batroxobin in improving functional outcomes and reducing stroke recurrence among patients with acute ischemic stroke beyond the therapeutic time window for thrombolytic therapy. Methods: This multicenter, retrospective study enrolled 492 patients with acute moderate‐to‐severe ischemic stroke within 24 h. 238 patients were given standard (basic) therapy. On the basis of standard treatment, 254 patients received an initial intravenous infusion of batroxobin 10 U on day 1, followed by subsequent infusions of batroxobin 5 U on the 3rd and 5th days, respectively. Results: In the batroxobin group, 8.3% of patients experienced recurrence stroke, compared to 17.2% in the control group (HR, 0.433; 95% CI, 0.248 to 0.757; p = 0.003). Furthermore, intravenous batroxobin significantly improved the distribution of 90–120 day disability. Moderate‐to‐severe bleeding events were reported in three patients (1.2%) in the batroxobin group and one patient (0.4%) in the control group (p = 0.369). Conclusions: Among patients with acute moderate‐to‐severe ischemic stroke beyond the time window for thrombolytic therapy, treatment with intravenous batroxobin had a lower risk of stroke recurrence and a better recovery of function outcome without increasing bleeding events. Prospective studies are needed to further confirm. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the effect of curative‐intent surgery on loss of independence (LOI) in patients with oral cavity squamous cell carcinoma (OCSCC). Study Design: Retrospective observational study of patients diagnosed from 2014 to 2021. Setting: Single tertiary care academic center. Patients having undergone curative‐intent surgical treatment for OCSCC from 2014 to 2021 in the cancer registry. Methods: LOI as the primary outcome was measured based on a combination of decrease in activities of daily living (ADLs) and/or decline in mobility during treatment. Descriptive statistics were used to compare baseline demographics and multivariable logistic regression was used to assess the association between LOI and perioperative variables of interest. Results: Of the 180 patients included in this study, 139 (79%) were fully independent in ADLs/instrumental ADLs prior to surgery. The average age of the cohort was 74 with 49% males. Thirty‐seven (21%) experienced a decline in mobility or increased care needs following surgery, and 18 (10%) experienced an independent decline in functional status. Increasing age, osseous flap reconstruction, high Charlson Comorbidity Index, and major postoperative adverse events were associated with LOI. Fifty‐five percent of patients with LOI had recovered to baseline within 7 months from surgery. LOI was associated with poor treatment tolerance (odds ratio: 4.77, 95% confidence interval: 1.87‐12.2) while adjusting for multiple confounders. Conclusion: LOI is common in older adults undergoing curative‐intent surgery for OCSCC and associated with poor treatment tolerance. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the learning curve (LC) on perioperative and long‐term functional outcomes of a consecutive single‐centre series of robot‐assisted radical cystectomy with Padua intracorporeal orthotopic neobladder. Patients and Methods: Patients treated between 2013 and 2022 were included, with ≥1 year of follow‐up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1‐year day‐ and night‐time continence. Uni‐ and multivariable Cox regression analyses identified predictors of day‐ and night‐time continence recovery. Day‐time continence was defined as 'totally dry' (no pads), night‐time continence as pad wetness ≤50 mL (one safety pad). Results: Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30‐day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1‐year day‐ and night‐time continence probabilities displayed a significant improving trend (day‐time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night‐time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day‐ (hazard ratio [HR] 1.008; P < 0.001) and night‐time continence (HR 1.004; P = 0.03) over time. Conclusion: Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10‐year analyses, we observed a significant improving trend for both the 1‐year day‐ and night‐time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day‐ and night‐time continence rates. [ABSTRACT FROM AUTHOR]

Background: Transoral robotic surgery (TORS) for oropharyngeal malignancy optimizes oncologic outcomes while preserving functionality. This study identifies patterns of functional recovery after TORS with free flap reconstruction (FFR). Methods: Retrospective cohort study at a tertiary care center of patients with primary oropharyngeal tumors treated with TORS with FFR between 2010 and 2022. Patients were categorized into: adjuvant chemoradiation or radiation, or no adjuvant therapy (NAT). Functional outcomes were measured by functional oral intake scale (FOIS). Results: 241 patients were included. FOIS declined at first postoperative appointment (median = 7.0 to 2.0, IQR = [7.0, 7.0], [2.0, 4.0]), and progressively improved to 6.0 (5.0, 6.0) after 1 year, with NAT having the highest FOIS (7.0, p < 0.05). Predictors of poor long‐term FOIS included RT and hypoglossal nerve (CN XII) involvement (p < 0.05). Conclusions: TORS with FFR leads to good long‐term function with minimal intake restrictions. Radiation therapy and CN XII involvement increase risk of worse functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: Attention is increasingly being turned to functional outcomes as being central to colorectal cancer (CRC) survivorship. The current literature may underestimate the impact of evacuatory dysfunction on patient satisfaction with bowel function after anterior resection (AR) for CRC. The aim of this study was to investigate the impact of post‐AR symptoms of storage and evacuatory dysfunction on patient satisfaction and health‐related quality of life (HRQoL). Method: A cross‐sectional study was performed at an Australian hospital of patients post‐AR for CRC (2012–2021). The postoperative bowel function scores used were: low anterior resection syndrome (LARS), St Mark's incontinence, Cleveland Clinic constipation and Altomare obstructive defaecation syndrome scores. Eight 'storage' and 'evacuatory' dysfunction symptoms were derived. A seven‐point Likert scale measured patient satisfaction. The SF36v2® measured HRQoL. Linear regression assessed the association between symptoms, patient satisfaction and HRQoL. Results: Overall, 248 patients participated (mean age 70.8 years, 57.3% male), comprising 103 with rectal cancer and 145 with sigmoid cancer. Of the symptoms that had a negative impact on patient satisfaction, six reflected evacuatory dysfunction, namely excessive straining (p < 0.001), one or more unsuccessful bowel movement attempt(s)/24 h (p < 0.001), anal/vaginal digitation (p = 0.005), regular enema use (p = 0.004), toilet revisiting (p = 0.004) and >10 min toileting (p = 0.004), and four reflected storage dysfunction, namely leaking flatus (p = 0.002), faecal urgency (p = 0.005), use of antidiarrhoeal medication (p = 0.001) and incontinence‐related lifestyle alterations (p < 0.001). A total of 130 patients (53.5%) had 'no LARS', 56 (23.1%) had 'minor LARS' and 57 (23.4%) had 'major LARS'. Fifty‐seven (44.5%) patients classified as having 'no LARS' had evacuatory dysfunction. Conclusion: Postoperative storage and evacuatory dysfunction symptoms have an adverse impact on patient satisfaction and HRQoL post‐AR. The importance of comprehensively documenting symptoms of evacuatory dysfunction is highlighted. Further research is required to develop a patient satisfaction‐weighted LARS‐specific HRQoL instrument. [ABSTRACT FROM AUTHOR]

Aims: We endeavored to introduce a novel scoring system (Lumbar Functional Index, LFI) capable of evaluating lumbar function in pelvic bone sarcoma patients who underwent surgical resection and spinal pelvic fixation, while simultaneously identifying the incidence, outcomes, and risk factors of lumbar function impairment among these populations. Patients and Methods: A cohort of 304 primary bone sarcoma patients were recruited. The LFI was created based on the Oswestry Dysfunction Index (ODI) and Japanese Orthopaedic Association (JOA) scores. Lumbar function impairment was defined as LFI score ≥ 18 points, which was identified as high LFI. Demographic data, clinical characteristics, and oncological outcomes were analyzed. Results: The cohort included chondrosarcoma (39.8%), osteosarcoma (29.9%), Ewing sarcoma (8.6%), bone‐derived undifferentiated pleomorphic sarcoma (7.2%), giant cell tumor of bone (7.2%), chordoma (2.3%), and other bone sarcomas (5.0%). The LFI score exhibited significant negative correlation with common scoring systems of bone sarcoma. The incidence of high LFI was 23.0%. Patients with high LFI demonstrated a higher prevalence of type I + II + III + IV pelvic tumor, more sacrificed nerve roots and bilateral lumbar spine fixation during surgery, while lower percentage of R0 resection and local control of pelvic tumor. Decreased median overall survival (30 vs. 52 months, p < 0.001) and recurrence‐free survival (14 vs. 24 months, p < 0.001) time were observed in these patients. Type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2 were identified as risk factors for high LFI, while R0 resection and local control were identified as protective factors. Conclusion: The LFI scoring system exhibited a significant negative correlation to current scoring systems. High LFI patients had worse prognosis and distinct characteristics. The risk factors of high LFI included type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2, and the protective factors included R0 resection and local control. [ABSTRACT FROM AUTHOR]

Background: An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long‐term mortality and other important functional outcomes for older EL patients have not been fully explored. Methods: A prospective multicenter study of older EL patients was conducted across four hospital sites in New Zealand from August 2017 to September 2022. The Clinical Frailty Scale (CFS) was used to measure frailty—defined as a CFS of ≥5. Primary outcomes were 30‐day and one‐year mortality. Secondary outcomes were postoperative morbidity, admission for rehabilitation, and increased care level on discharge. A multivariate logistic regression analysis was conducted, adjusting for age, sex, and ethnicity. Results: A total of 629 participants were included. Frailty prevalence was 14.6%. Frail participants demonstrated higher 30‐day and 1‐year mortality—20.7% and 39.1%. Following adjustment, frailty was directly associated with a significantly increased risk of short‐ and long‐term mortality (30‐day aRR 2.6, 95% CI 1.5, 4.3, p = <0.001, 1‐year aRR 2.0, 95% CI 1.5, 2.8, p < 0.001). Frailty was correlated with a 2‐fold increased risk of admission for rehabilitation and propensity of being discharged to an increased level of care, complications, and readmission within 30 days. Conclusion: Frailty was associated with increased risk of postoperative mortality up to 1‐year and other functional outcomes for older patients undergoing EL. Identification of frailty in older EL patients aids in patient‐centered decision‐making, which may lead to improvement in outcomes. [ABSTRACT FROM AUTHOR]

Background: Kinematic driving data studies are a novel methodology relevant to health care, but prior studies have considerable variance in their methods, populations, and findings suggesting a need for critical analysis and appraisal for feasibility and methodological guidelines. Methods: We assessed kinematic driving studies of adults with chronic conditions for study feasibility, characteristics, and key findings, to generate recommendations for future study designs, and to identify promising directions for applications of kinematic driving data. PRISMA was used to guide the review and searches included PubMed, CINAHL, and Compendex. Of 379 abstract/titles screened, 49 full‐text articles were reviewed, and 29 articles met inclusion criteria of analyzing trip‐level kinematic driving data from adult drivers with chronic conditions. Results: The predominant chronic conditions studied were Alzheimer's disease and related Dementias, obstructive sleep apnea, and diabetes mellitus. Study objectives included feasibility testing of kinematic driving data collection in the context of chronic conditions, comparisons of simulation with real‐world kinematic driving behavior, assessments of driving behavior effects associated with chronic conditions, and prognostication or disease classification drawn from kinematic driving data. Across the studies, there was no consensus on devices, measures, or sampling parameters; however, studies showed evidence that driving behavior could reliably differentiate between adults with chronic conditions and healthy controls. Conclusions: Vehicle sensors can provide driver‐specific measures relevant to clinical assessment and interventions. Using kinematic driving data to assess and address driving measures of individuals with multiple chronic conditions is positioned to amplify a functional outcome measure that matters to patients. [ABSTRACT FROM AUTHOR]

This article discusses the long-term functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal ileal orthotopic neobladder (iNeoB) for the treatment of bladder cancer. The study included 81 men who underwent RARC with iNeoB and were followed up for a median of 41 months. The results showed that 78% of patients regained urinary continence (UC) and 47% regained erectile function (EF) at 2 years of follow-up. The study also evaluated the use of clean intermittent catheterization (CIC) and bowel function (BF) recovery, finding that the 2-year rate of CIC was 13% and 87% of patients reached regular BF after 2 years. The authors suggest that these findings can be used to provide realistic expectations to patients undergoing RARC with iNeoB and emphasize the importance of long-term follow-up for assessing EF recovery. [Extracted from the article]

Background: Restorative proctocolectomy (RP) with ileal pouch‐anal anastomosis (IPAA) remains the gold standard for the surgical management of patients with medically refractive mucosal ulcerative colitis. We aimed to identify functional and quality of life (QOL) outcomes in RP and IPAA surgery patients at our institution. Methods: A retrospective observational study was performed including all patients who had undergone RP and IPAA between August 1984 and November 2017 at Royal Prince Alfred Hospital (RPAH). Results: 316 consecutive patients were identified, median age 39 (range 5 to 81) years. The median duration of disease was 60 (range 1 to 528) months. Ulcerative colitis was the main preoperative diagnosis with the main RP indication being failure of medical treatment. The median postoperative stay post‐IPAA was 11 (range of 5 to 67) days. Pouchitis was the most common late complication (22.1%), bleeding pouch (3.5%) the earliest, with a 6.8% rate of symptomatic anastomotic leak. Visual analogue scale QOL measure (P‐value <0.001), St Marks incontinence score (P‐value = 0.001) and Cleveland clinic score (P‐value = 0.002) all revealed significant improvement in functional outcomes and QOL. Conclusion: QOL and functional outcomes following RP with IPAA in patients at our institution are excellent and comparable to institutions with larger patient numbers. [ABSTRACT FROM AUTHOR]

Objectives: Previous observational studies have indicated correlations between various inflammatory cytokines and functional outcomes following ischemic stroke (IS); however, the causality remains unclear. We aimed to further evaluate the causal association between 41 circulating inflammatory cytokines and functional outcomes following IS. Methods: Two‐sample bidirectional Mendelian randomization (MR) analysis was used in this study. The genetic variation of 41 circulating inflammatory cytokines were derived from genome‐wide association study (GWAS) data of European ancestry (n = 8293). The corresponding genetic association of functional outcomes following IS were derived from European ancestry GWAS data (n = 6021). Results: Inverse variance weighted (IVW) analysis showed that genetically predicted increased levels of regulation and activation in normal T‐cell expression and secretion factor (RANTES/CCL5) and eosinophilic chemotactic factor (EOTAXIN/CCL11) were positively correlated with the increased adverse functional outcomes (modified Rankin Scale [mRS≥3] following IS (OR: 1.40, 95% CI: 1.002–1.96, p = 0.049; OR: 1.33, 95% CI: 1.15–1.54, p = 0.0001). Interleukin 18 (IL‐18) level might be the downstream consequence of adverse functional outcomes following IS (β: −0.09, p = 0.039). Other inflammatory cytokines and functional outcomes following IS did not appear to be causally related. Conclusions: This study suggests a causality between inflammation and adverse functional outcomes following IS. RANTES (CCL5) and EOTAXIN (CCL11) may be the upstream factors of adverse functional outcomes following IS, while IL‐18 may be the downstream effect of adverse functional outcomes following IS. Whether these cytokines can be used to predict or improve adverse functional outcomes after IS requires further researches. [ABSTRACT FROM AUTHOR]

Introduction: Individuals recovering from acute COVID‐19 episodes may continue to suffer from various ongoing symptoms, collectively referred to as Long‐COVID. Long‐term pain symptoms are amongst the most common and clinically significant symptoms to be reported for this post‐COVID‐19 syndrome. Objectives: This systematic review and meta‐analysis aimed to evaluate the proportions of persisting pain symptoms experienced by individuals past the acute phase of COVID‐19 and to identify their associated functional consequences and inflammatory correlates. Methods: Two online databases were systematically searched from their inception until 31 March 2022. We searched primary research articles in English, which evaluated individuals after laboratory‐confirmed COVID‐19 acute phase resolution and specifically reported on pain symptoms and their inflammatory and/or functional outcomes. Results: Of the 611 identified articles, 26 were included, used for data extraction, and assessed for their methodological quality and risk of bias by two independent reviewers. Pain symptoms were grouped under one of six major pain domains, serving as our primary co‐outcomes. Proportional meta‐analyses of pooled logit‐transformed values of single proportions were performed using the random‐effects‐restricted maximum‐likelihood model. An estimated 8%, 6%, 18%, 18%, 17%, and 12% of individuals continued to report the persistence of chest, gastrointestinal, musculoskeletal joint, musculoskeletal muscle, general body, and nervous system‐related pain symptoms, respectively, for up to one year after acute phase resolution of COVID‐19. Considerable levels of heterogeneity were demonstrated across all results. Functional and quality‐of‐life impairments and some inflammatory biomarker elevations were associated with the persistence of long‐COVID pain symptoms. Conclusion: This study's findings suggest that although not well characterized, long‐COVID pain symptoms are being experienced by non‐negligible proportions of those recovering from acute COVID‐19 episodes, thus highlighting the importance of future research efforts to focus on this aspect. [ABSTRACT FROM AUTHOR]

Objective: Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve‐ and vascular‐sparing approach. Methods: A single‐center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles‐Eccersley‐Scott‐Symptom [KESS] questionnaire and Gastro‐Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery. Results: Sixty‐one patients were enrolled. No patients had Clavien‐Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self‐catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity. Conclusion: Our vascular‐ and nerve‐sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery. Synopsis: Our vascular‐ and nerve‐sparing technique for bowel resection for endometriosis is associated with an improvement of gastrointestinal function and a low rate of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Following total laryngectomy (TL) or laryngopharyngectomy (TLP), patients may develop strictures that require multiple dilations to treat. However, the risk factors associated with dysphagia refractory to a single dilation are unknown. Methods: Single‐institution retrospective review of patients who underwent at least one stricture dilation after TL/TLP between March 2013 and March 2022. Results: A total of 49 patients underwent stricture dilation after TL/TLP. Thirty‐five (71%) underwent multiple dilations. Pharyngocutaneous fistula, primary chemoradiation therapy, and a shorter time interval from TL/TLP to first dilation were independently associated with dysphagia requiring multiple dilations. Patients in the multiple dilations group had a higher rate of limited diet and G‐tube dependence compared to patients in the single dilation group. Conclusions: Shorter time interval to stricture formation is a prognostic indicator of the need for multiple dilations following TL/TLP. Patients requiring multiple dilations are at increased risk of persistent dysphagia long‐term. [ABSTRACT FROM AUTHOR]

The ability to maintain functional independence throughout the lifespan may be diminished among medically compromised and chronically stressed populations. People living with HIV are more likely to demonstrate functional impairment and report greater exposure to lifetime and chronic stressors than their seronegative counterparts. It is well‐known that exposure to stressors and adversity is associated with functional impairment outcomes. However, to our knowledge, no studies have examined how protective factors such as psychological grit mitigate the negative effects of lifetime and chronic stressor exposure on functional impairment, and how this association differs by HIV‐status. To address this issue, we studied associations between lifetime and chronic stressor exposure, grit, and functional impairment in 176 African American and non‐Hispanic White HIV‐seropositive (n = 100) and HIV‐seronegative (n = 76) adults, aged 24–85 (M = 57.28, SD = 9.02). As hypothesised, HIV‐seropositive status and lower grit, but not lifetime stressor exposure, were independently associated with more functional impairment. Moreover, there was a significant three‐way interaction between HIV‐status, grit, and lifetime stressor exposure, b = 0.07, p = 0.025, 95% CI [0.009, 0.135]. Specifically, lifetime stressor exposure was related to more functional impairment for HIV‐seronegative—but not HIV‐seropositive—adults who reported low levels of grit. These findings suggest that the protective effects of grit may differ across populations at risk for functional impairment. [ABSTRACT FROM AUTHOR]

Aim: Sphincter‐sparing surgery can be achieved in most cases of low rectal cancer with the development of intersphincteric resection. However, abdominoperineal resection is still inevitable for patients with tumours located below the dentate line. To address this, we have developed a procedure called conformal sphincteric resection (CSR) in which the corresponding part of the subcutaneous portion of the external anal sphincter and the perianal skin on the tumour side is removed to achieve a safe distal resection margin and lateral resection margin while the dentate line and the internal anal sphincter on the tumour‐free side are preserved as much as possible, to achieve sphincter preservation without compromising oncological safety and functional acceptability, and to render tumour location no longer a contraindication for sphincter‐sparing surgery. This is the first study to describe the concept, indication and surgical procedure of CSR and to report its preliminary surgical, oncological and functional results. Methods: This is a retrospective, single‐centre, single‐arm pilot study conducted at Huashan Hospital, Fudan University. Demographic, clinicopathological, oncological and functional follow‐up data were collected from 20 consecutive patients with rectal tumours located below the dentate line who underwent laparoscopic CSR by the same surgical team from June 2018 to March 2022. Results: The mean distance of the tumour's lower edge from the anal verge was 13.1 ± 6.0 mm. The mean distal resection margin was 10.6 ± 4.3 mm. All circumferential resection margins were negative. There were no instances of perioperative mortality. The complication rate was 25% but all were Clavien−Dindo Grade I. Among the 20 cases, 17 were diagnosed with adenocarcinoma, one with squamous cell carcinoma and two with adenoma featuring high‐grade intraepithelial neoplasia. Pathological TNM staging revealed two, seven, five, five and one case(s) in Stages 0, I, II, III and IV, respectively. The median follow‐up period was 20 months (interquartile range 22 months), with no withdrawals. The overall and disease‐free survival rates were both 95%. The mean Wexner incontinence score and low anterior resection syndrome score recorded 18 months following diverting ileostomy closure were 6.3 ± 3.8 and 27.3 ± 3.6, respectively. Conclusions: This study has proposed the CSR procedure for the first time, which is a technically feasible, oncologically safe and functionally acceptable procedure for carefully selected patients with rectal tumours located below the dentate line. [ABSTRACT FROM AUTHOR]

Aims: The prediction of outcomes in convulsive status epilepticus (CSE) remains a constant challenge. The Encephalitis‐Nonconvulsive Status Epilepticus‐Diazepam Resistance‐Image Abnormalities‐Tracheal Intubation (END‐IT) score was a useful tool for predicting the functional outcomes of CSE patients, excluding cerebral hypoxia patients. With further understanding of CSE, and in view of the deficiencies of END‐IT itself, we consider it necessary to modify the prediction tool. Methods: The prediction model was designed from a cohort of CSE patients from Xijing Hospital (China), between 2008 and 2020. The enrolled subjects were randomly divided into training cohort and validation cohort as a ratio of 2:1. The logistic regression analysis was performed to identify the predictors and construct the nomogram. The performance of the nomogram was assessed by calculating the concordance index, and creating calibration plots to check the consistency between the predicted probabilities of poor prognosis and the actual outcomes of CSE. Results: The training cohort included 131 patients and validation cohort included 66 patients. Variables included in the nomogram were age, etiology of CSE, non‐convulsive SE, mechanical ventilation, abnormal albumin level at CSE onset. The concordance index of the nomogram in the training and validation cohorts was 0.853 (95% CI, 0.787–0.920) and 0.806 (95% CI, 0.683–0.923), respectively. The calibration plots showed an adequate consistency between the reported and predicted unfavorable outcomes of patients with CSE at 3 months after discharge. Conclusions: A nomogram for predicting the individualized risks of poor functional outcomes in CSE was constructed and validated, which has been an important modification of END‐IT score. [ABSTRACT FROM AUTHOR]

We present a case of a 41-year-old male amateur soccer player with no comorbidities, who experienced a rerupture of the Achilles tendon 5 years after his initial end-to-end plasty. To address this, we opted for a full-thickness reconstruction using a graft under the Clearant Process of the Achilles tendon. As an innovative approach, we proposed an alternative fixation technique, employing a Bio Composite Arthrex 9 mm x 35 mm interference screw, placed at the apex of the calcaneus body. For a period of 5 years, the patient underwent regular imaging follow-ups with Magnetic Resonance Imaging (MRI) and clinical assessments using the Foot and Ankle Ability Measure Activity Subscale Score and Foot and Ankle Ability Measure Sports Subscale Score. This case highlights the importance of exploring novel fixation methods for Achilles tendon reconstruction, particularly in cases of rerupture. The use of the Bio Composite Arthrex screw, in conjunction with the Clearant Process graft, demonstrated promising results both in imaging and functional outcomes, but more case studies with positive results are needed to evaluate the effectiveness of this reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: The potential benefits of electroconvulsive therapy (ECT) in chronic pain and several theories for its mechanism have been reported in the past, but mixed findings have also been reported. In the current systematic review and case series, our primary aim was to assess whether pain and functional outcomes are improved after ECT in patients with chronic pain. Secondary objectives included examining whether psychiatric improvement, specific pain diagnoses, and demographic or medical characteristics were associated with differences in pain treatment response. Methods: We performed a retrospective chart review to identify patients with chronic pain diagnoses for more than 3 months prior to the initiation of ECT and a systematic literature search on electronic databases for studies on chronic pain outcomes after ECT. Results: Eleven patients with various chronic pain diagnoses and comorbid psychiatric conditions were identified in the case series. Six patients reported improvement in pain while 10 patients reported improvement in mood following ECT. Systematic review identified 22 articles reporting a total of 109 cases. Eighty‐five (78%) of cases reported reduction in pain while 96.3% of the patients with a comorbid psychiatric diagnosis reported improvement in mood symptoms post‐ECT. While there was an association between improvement in mood and pain in studies with numeric ratings in both outcomes (r = 0.61; p < 0.001), some patients reported pain improvement without improvement in mood in both the case series and the pooled analysis of cases in the review. Certain pain diagnoses such as CRPS, phantom limb pain, neuropathic pain, and low back pain have consistently reported benefits and should be further studied in future studies with matched case controls. Conclusion: ECT may be offered to patients with certain pain conditions who have not responded sufficiently to conventional therapies, particularly when comorbid mood symptoms are present. Improved documentation practices on the outcomes in chronic pain patients receiving ECT will help generate more studies that are needed on this topic. [ABSTRACT FROM AUTHOR]

Background: Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health‐related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer. Methods: PRISMA guidelines were followed. Thirteen studies met inclusion criteria. Results: Results favoring sentinel lymph node biopsy were found in complications, scar length and appearance, length of hospital stay, time to drain removal, and objective shoulder measures at timepoints up to 12 months. Where differences in health‐related quality of life were found, methodological issues make their clinical significance questionable. Conclusions: Sentinel lymph node biopsy was associated with fewer complications and statistically better outcomes in a number of physical measures. There is as yet no strong evidence to suggest it is associated with better health‐related quality of life outcomes. While a number of health‐related quality of life outcome measures show promise, their interpretation is hampered by methodological concerns. Further rigorous research is required to address this. [ABSTRACT FROM AUTHOR]

Objectives: To describe swallowing and feeding‐tube outcomes in patients with high‐risk oropharyngeal cancer treated with trimodality therapy (TMT), including transoral robotic surgery (TORS) and adjuvant chemoradiotherapy. Methods: A chart review was conducted on patients with HPV+ OPSCC receiving TMT with TORS at an academic medical center from March 2010 to March 2021. Data collected included demographics, treatment, feeding tube placement, functional oral intake scale (FOIS) scores, and swallowing‐language pathology (SLP) evaluations. Results: A total of 255 patients met selection criteria (mean age 61 years, 88% male). Following intraoperative nasogastric tube (NG) placement, 31% remained NG tube dependent after 3 weeks. A gastrostomy tube was placed in 19% of patients, and at 1 year after end‐of‐treatment (EOT), 3.5% overall remained tube‐dependent. Mean FOIS scores were 6.9 (SD = 0.3) at pre‐operative visit, 2.6 (1.8) at first post‐operative visit, and 5.5 (1.5) after EOT. In the subset of patients with follow‐up longer than 2 years (n = 118), the mean FOIS was 6.1 (SD = 1.3) at most recent visit. Clinical signs of aspiration/penetration were suspected on SLP evaluation in 18% of patients. These patients were subsequently evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) and/or barium swallow study, which confirmed signs of aspiration in 2.7% of patients overall. Delayed NG tube removal after 3 weeks was predictive of (1) gastrostomy tube requirement and (2) clinical signs of aspiration on an SLP visit after EOT. Conclusions: Favorable functional and feeding‐tube outcomes are demonstrated in patients with HPV‐associated OPSCC undergoing TMT. In this single‐institution study, we found low rates of long‐term feeding tube dependence and high median FOIS following treatment. Review of routine SLP visits provides a detailed and easily accessible means for assessing swallowing function in this cohort. Level of Evidence: 4 Laryngoscope, 133:3013–3020, 2023 [ABSTRACT FROM AUTHOR]

Objective: Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free‐flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence. Primary objective: describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation. Secondary objective: evaluate patient, tumor, and treatment factors associated with tube dependence. Study Design: Retrospective, multi‐institutional cohort study. Patients treated from 2003 to 2020. Average follow‐up 21.4 months. Setting: Five tertiary care centers. Methods: Consecutive cohort of patients undergoing resection and simultaneous free‐flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation. Primary outcomes: gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence. Results: 89 patients underwent oropharyngectomy and free‐flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially‐dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83–389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71–105, p = 0.018) were associated with long‐term gastrostomy tube. No factors were associated with long‐term tracheostomy on multivariable analysis. Conclusion: Even among long‐term survivors after salvage resection and free‐flap reconstruction, rates of tube dependence are significant. This multi‐institutional review is the largest such study to the date and may help inform shared decision‐making. Level of Evidence: 4 Laryngoscope, 133:2141–2147, 2023 [ABSTRACT FROM AUTHOR]

Introduction: Anorectal manometry (ARM) is sometimes performed before ostomy reversal in patients with an intersphincteric resection (ISR) to predict bowel function. However, no clinical predictive data exist regarding its utility. Methods: The single‐centre, retrospective data of ISR patients who had an ARM prior to ostomy reversal, and bowel functional assessment with the low anterior resection syndrome (LARS) and Wexner incontinence scores at least 6 months after reversal, were considered. Correlation statistics were performed with each of the manometric parameters and functional outcome categories. Results: Eighty‐nine patients were included. The median basal and squeeze pressures were 41 and 100 mmHg, respectively. Any LARS (score ≥20) and major incontinence (score ≥11) was observed in 51.7% and 16.9%, respectively. None of the manometric parameters (median basal or maximum squeeze pressure, anal canal length, volume at urge and the ability to expel) correlated with LARS or incontinence. Conclusions: Anorectal manometry (ARM) before ostomy reversal to predict bowel function at 6 months or beyond was not helpful in patients with an ISR and diverting stoma. No manometric parameter correlated with the LARS or Wexner incontinence scores. [ABSTRACT FROM AUTHOR]

Objective: To externally validate Yonsei nomogram. Methods: From 2000 through 2018, 3526 consecutive patients underwent on‐clamp PN for cT1 renal masses at 23 centers were included. All patients had two kidneys, preoperative eGFR ≥60 ml/min/1.73 m2, and a minimum follow‐up of 12 months. New‐onset CKD was defined as upgrading from CKD stage I or II into CKD stage ≥III. We obtained the CKD‐free progression probabilities at 1, 3, 5, and 10 years for all patients by applying the nomogram found at https://eservices.ksmc.med.sa/ckd/. Thereafter, external validation of Yonsei nomogram for estimating new‐onset CKD stage ≥III was assessed by calibration and discrimination analysis. Results and limitation: Median values of patients' age, tumor size, eGFR and follow‐up period were 47 years (IQR: 47–62), 3.3 cm (IQR: 2.5–4.2), 90.5 ml/min/1.73 m2 (IQR: 82.8–98), and 47 months (IQR: 27–65), respectively. A total of 683 patients (19.4%) developed new‐onset CKD. The 5‐year CKD‐free progression rate was 77.9%. Yonsei nomogram demonstrated an AUC of 0.69, 0.72, 0.77, and 0.78 for the prediction of CKD stage ≥III at 1, 3, 5, and 10 years, respectively. The calibration plots at 1, 3, 5, and 10 years showed that the model was well calibrated with calibration slope values of 0.77, 0.83, 0.76, and 0.75, respectively. Retrospective database collection is a limitation of our study. Conclusions: The largest external validation of Yonsei nomogram showed good calibration properties. The nomogram can provide an accurate estimate of the individual risk of CKD‐free progression on long‐term follow‐up. [ABSTRACT FROM AUTHOR]

Objective: Chemoradiation for patients with laryngeal squamous cell carcinoma (SCC) may achieve organ preservation, but appropriate patient selection remains unknown. This study investigates pre‐treatment risk factors associated with functional and survival outcomes after radiation‐based therapy in patients with advanced laryngeal SCC. Methods: A retrospective cohort study was performed on 75 adult patients with stage III or IV laryngeal SCC receiving definitive radiation‐based therapy from 1997 to 2016 at a tertiary care center. Tracheostomy and gastrostomy dependence were the primary functional outcomes. Multivariable logistic regressions were performed to evaluate relationships between pre‐treatment factors and tracheostomy and gastrostomy dependence. Time‐to‐event analyses were performed to determine risk factors associated with overall survival. Results: Among 75 patients included in the analysis, 30 (40%) patients were tracheostomy dependent and 31 (41%) were gastrostomy tube dependent. The median length of follow‐up was 31 months (range = 1 to 142 months). Pre‐treatment tracheostomy was a significant predictor of post‐treatment tracheostomy (aOR = 13.9, 95% CI = 3.35 to 57.5) and moderate–severe comorbidity was a significant predictor of post‐treatment gastrostomy dependence (aOR = 2.96, 95% CI = 1.04 to 8.43). The five‐year overall survival was 51% (95% CI = 38 to 64%). Pre‐treatment gastrostomy tube dependence was associated with an increased risk of death (aHR = 2.45, 95% CI = 1.09 to 5.53). Conclusions: Baseline laryngeal functional status and overall health in advanced laryngeal SCC are associated with poor functional outcomes after radiation‐based therapy, highlighting the importance of patient selection when deciding between surgical and non‐surgical treatment plans. Laryngoscope, 133:594–600, 2023 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the 10‐year outcomes of high uterosacral ligaments suspension as a primary repair for apical prolapse and to evaluate the long‐term impact of prognostic factors. Methods: A retrospective study analyzed 10‐year follow up after repair of primary apical prolapse through high uterosacral ligament suspension. Bulging symptoms and postoperative prolapse stage II or above were considered subjective and objective recurrences, respectively. Patient Global Impression of Improvement score was used to evaluate subjective satisfaction after surgery. Results: A total of 287 women were analyzed. Ten‐year recurrence rates were 19.1% for objective recurrence and 6.3% for subjective recurrence; surgical retreatment rate was 2.1%. Premenopausal status was related to 15‐fold increased risk of developing either objective or subjective recurrence. Conversely, anterior and posterior repair were protective factors against reoperation. Conclusion: High uterosacral ligaments suspension is a safe and long‐lasting effective procedure for the treatment of uterovaginal prolapse even 10 years after index surgery. Premenopausal status and lack of anterior and posterior repair represented long‐term risk factors for surgical failure. The contents of this page will be used as part of issue TOC only. It will not be published as part of main article. Uterosacral ligaments suspension showed great efficacy and safety profile at long‐term follow up, without deterioration of outcomes over time. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the functional outcomes of nerve‐sparing surgery for deep infiltrating endometriosis (DIE) with or without posterolateral parametrectomy. Methods: A multicenter, observational, retrospective, cohort study was performed including all symptomatic women who underwent nerve‐sparing laparoscopic excision of DIE and preoperative and postoperative assessment of functional outcomes through validated questionnaires between April 2019 and March 2020. Women with posterolateral parametrial DIE (P‐group) and women with no parametrial involvement (NP‐group) were compared in terms of preoperative and postoperative functional outcomes related to pelvic organs assessed through validated questionnaires (KESS and GIQLI for bowel function, BFLUTS for urinary function, and FSFI for sexual function); pain symptoms at 3‐month follow up assessed through an 11‐point visual analogue scale (VAS) for dyschezia, dysmenorrhea, dyspareunia and chronic pelvic pain; surgical outcomes; and rate of urinary voiding dysfunction at 3‐month follow up. Results: One‐hundred patients were included: 69 in the P‐group and 31 in the NP‐group. Preoperative and postoperative values of questionnaires, pain symptoms, and postoperative complication rates were comparable between the two groups, except for postoperative dyspareunia and sexual dysfunction, which were statistically higher in the P‐group. Only patients in the P‐group experienced urinary voiding dysfunction, but no statistical significance was reached (P = 0.173). Conclusion: Posterolateral parametrectomy for DIE appears to be associated with a higher risk of postoperative dyspareunia and sexual dysfunction. Despite a nerve‐sparing approach, posterolateral parametrectomy for deep infiltrating endometriosis is associated during postoperative course with a higher incidence of dyspareunia and sexual dysfunction. [ABSTRACT FROM AUTHOR]

Background: Connecting patients to treatment for a substance use disorder (SUD) that satisfies their needs is often complicated by confounding factors. A reliable measurement of patients' underlying stress level may be helpful because it often reflects many of the same confounders as their SUD. Whereas cortisol levels reflect physiological responses to stress, patients' cortisol levels during recovery from an SUD may serve as biomarkers for stressors that result in poor treatment outcomes, including early discontinuation of treatment. However, further exploration of the relationship between patients' cortisol levels and their treatment outcomes is needed for this approach to be clinically useful. Methods: We enrolled participants from an abstinence‐based, male‐only, residential alcohol and drug recovery program to examine the relationship between salivary cortisol, stress exposure, ACEs, and treatment retention. Results: Participants who remained in the program <90 days had significantly higher initial cortisol levels than those who remained ≥90 days (0.62 ± 0.074 μg/dl vs. 0.36 ± 0.037 μg/dl). Kaplan–Meier curves differed significantly when we grouped participants according to whether their cortisol level was below or above the overall average of 0.49 ± 0.044 μg/dl, with the median numbers of days before discontinuing being 110 and 60, respectively. A Cox proportional hazards model indicated that elevated salivary cortisol (with increases in μg/dl), marital/relationship status, and adverse childhood experiences (ACEs) score correlated significantly with hazards of discontinuing the program (hazard ratios for the three factors were 3.49, 2.39, and 1.50, respectively). Discussion: Cortisol level may predict, at least partially, SUD treatment program retention regardless of individuals' numerous confounding factors or the substance used. If this approach is validated, it could enable providers to consider patients' cortisol levels at the time of admission to treatment to facilitate their retention in treatment and thereby enhance their recovery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision‐making. Patients and Methods: Men aged 50–69 years diagnosed with localised prostate cancer by prostate‐specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external‐beam radiotherapy (EBRT) with concurrent androgen‐deprivation therapy (ADT) and 77 low‐dose‐rate brachytherapy (BT, not a randomised treatment). Patient‐reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results: Treatment‐received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion: Treatment decision‐making for localised prostate cancer can be informed by these 6‐year functional and QoL outcomes. [ABSTRACT FROM AUTHOR]

Objective: Robot‐assisted surgery has been promoted worldwide in recent years. The development of a domestic orthopaedic robot and its clinical application are therefore of great significance. This study aimed to compare the early clinical and radiographic outcomes of domestic robot‐assisted total knee arthroplasty (RA‐TKA) with conventional manual total knee arthroplasty (CM‐TKA). Methods: A total of 77 patients who underwent primary single‐sided TKA from June to December 2020 were prospectively enrolled; resulting in the inclusion of 72 patients. The patients were randomly divided into the RA‐TKA group (37 cases, with TKA being assisted by the Yuanhua Orthopaedic Robotic System) and the CM‐TKA group (35 cases, with TKA being performed using conventional tools). Knee function was evaluated by the knee range of motion (ROM), the American Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Postoperative radiographic results were evaluated by full‐length weight‐bearing X‐rays of the lower limb and anteroposterior and lateral X‐rays of the knee were obtained preoperatively and at 90 days postoperative. The operative duration, blood loss, postoperative knee function, radiographic outcomes, and incidence of complications were compared by Student's t‐test, Mann–Whitney U test, or chi‐square test. Serum levels of inflammatory markers before the operation and 1, 3, and 30 days after the operation were recorded and compared between the two groups. Results: The operation was significantly longer in the RA‐TKA group than in the CM‐TKA group (154.3 vs 115.2 min, p < 0.001). There was no significant difference in blood loss (933 vs 863 ml, p = 0.519) between the two groups. The knee ROM, KSS, and WOMAC were significantly improved in both groups 90 days after the operation compared with before the operation (p < 0.05), but there were no significant differences between the two groups (p > 0.05). The incidence of postoperative deep vein thrombosis was not statistically different between the two groups. In the radiographic findings at 90 days postoperatively we found the frequency of lateral tibial component (LTC) angle outliers was significantly lower in the RA‐TKA group (3.0% vs 29.4%, p = 0.003). The neutrophil‐to‐lymphocyte ratio (NLR) was significantly lower in the RA‐TKA group than in the CM‐TKA group on day 1 after surgery (9.9 vs 12.7, p = 0.024). Conclusions: RA‐TKA requires more time than CM‐TKA, which may be related to the learning curve and intraoperative registration. The short‐term postoperative knee functional outcomes had no differences between the two groups, and RA‐TKA improved the accuracy of tibial component alignment. Further follow‐up studies are required to investigate the long‐term outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To establish a model in order to predict the functional outcomes of patients with anti‐leucine‐rich glioma‐inactivated 1 (LGI1) encephalitis and identify significant predictive factors using a random forest algorithm. Methods: Seventy‐nine patients with confirmed LGI1 antibodies were retrospectively reviewed between January 2015 and July 2020. Clinical information was obtained from medical records and functional outcomes were followed up in interviews with patients or their relatives. Neurological functional outcome was assessed using a modified Rankin Scale (mRS), the cutoff of which was 2. The prognostic model was established using the random forest algorithm, which was subsequently compared with logistic regression analysis, Naive Bayes and Support vector machine (SVM) metrics based on the area under the curve (AUC) and the accuracy. Results: A total of 79 patients were included in the final analysis. After a median follow‐up of 24 months (range, 8–60 months), 20 patients (25%) experienced poor functional outcomes. A random forest model consisting of 16 variables used to predict the poor functional outcomes of anti‐LGI1 encephalitis was successfully constructed with an accuracy of 83% and an F1 score of 60%. In addition, the random forest algorithm demonstrated a more precise predictive performance for poor functional outcomes in patients with anti‐LGI1 encephalitis compared with three other models (AUC, 0.90 vs 0.80 vs 0.70 vs 0.64). Conclusions: The random forest model can predict poor functional outcomes of patients with anti‐LGI1 encephalitis. This model was more accurate and reliable than the logistic regression, Naive Bayes, and SVM algorithm. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the postoperative and 1-year functional outcomes after free flap surgery among patients ≥80 years old. Study Design: Retrospective chart review. Setting: Single tertiary care center. Methods: We conducted a retrospective review of 596 patients who underwent head and neck ablation and reconstruction with free tissue over a 7-year period. Patients ≥80 years of age were included. Results: Fifty patients were ≥80 years old, with an average age of 83.7 years. Ninety-day mortality was 12.0%, and those who died were of older age (87.5 vs 83.1 years, P =.036). Prior radiation therapy (odds ratio, 6.8 [95% CI, 1.1-42.7]) and a Charlson Comorbidity Index ≥3 (odds ratio, 10.0 [95% CI, 1.5-67.0]) were associated with an increased risk of 90-day mortality. Overall 21 (42.0%) patients experienced a 30-day complication; 7 (14.0%) were readmitted within 30 days; and 5 (10.0%) underwent additional flap-related operations. Flap failure occurred in 2 (4.0%) patients. Before surgery, 45 (90%) patients were living independently or within assisted living; among these, 19.5% declined to dependent functional status at 90-day follow-up. At 90 days, 2 (8.3%) of 24 patients remained tracheostomy dependent, and 20 (66.7%) of 30 patients required feeding tube supplementation. Among 42 patients, 36 (85.7%) had unrestricted or modified oral diets at 90 days. Charlson Comorbidity Index ≥2 was associated with an increased risk of 1-year mortality (odds ratio, 5.1 [95% CI, 1.4-18.6]). Conclusion: The potential for functional decline and risk of 90-day mortality should be discussed with patients aged ≥80 years. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leak (AL) is the anathema of colorectal surgery, with well‐documented adverse impacts on patient morbidity and mortality. The long‐term consequences of AL on bowel function and quality of life (QoL) is less well‐defined after minimally invasive surgery. By omitting a temporary diverting ileostomy (TDI), it is postulated that the minimally invasive approach will lead to early diagnosis and expedient management of AL. Methods: This retrospective and cross‐sectional study included patients who underwent minimally invasive restorative rectal surgery with a low pelvic colorectal anastomosis and without a TDI at two tertiary hospitals in Brisbane, Australia between 2004 and 2018. Surgical management of AL is described and long‐term functional outcomes were evaluated through validated questionnaires. Results: Two hundred and twenty‐four patients met inclusion criteria. AL was associated with lesion proximity to the anal verge (P = 0.011), total mesorectal excision (TME) (P <0.001) and advanced malignant disease (P = 0.019). Twenty‐four patients experienced an AL (11%) diagnosed at a median of 5.5 days post‐operative. Survey responders (n = 99, 62%) included 10 (10%) AL and 89 (90%) non‐AL patients, with a median follow‐up of 4 and 6.4 years. SF‐36 and FISI scores were comparable between groups, however AL patients had worse LARS scores (P = 0.028). Patients undergoing TME, irrespective of AL, had poorer low anterior resection syndrome (LARS) (P <0.001) and FISI scores (P = 0.001). Conclusion: AL in patients undergoing minimally invasive low pelvic colorectal anastomosis without a TDI does not impact long term QoL. The occurrence of LARS is dependent on the extent of resection, rather than the occurrence of AL. [ABSTRACT FROM AUTHOR]

Aim: The current study examined whether changes in core beliefs over time predict positive symptoms, negative symptoms, social functioning, and role functioning within individuals at clinical high risk for psychosis (CHR). Methods: CHR participants (N = 73) completed the Brief Core Schemas Scale (BCSS) at baseline, with a subset of participants (n = 54) completing study procedures at a 12‐month follow‐up. Attenuated psychotic symptoms, social, and role functioning were assessed at both timepoints. Results: Hierarchical regression analyses showed that changes in self‐beliefs between baseline and follow‐up predicted worsening social and role functioning at 12‐month follow‐up, with trends suggesting they also predicted negative and positive symptoms at 12‐month follow‐up. The independent effect of an increase in negative self‐beliefs marginally or significantly predicted all outcomes of interest. Conclusions: The current study shows incremental validity of self‐beliefs from a novel perspective. It suggests that worsening self‐beliefs have a clinically meaningful impact within CHR populations. [ABSTRACT FROM AUTHOR]

Background: The da Vinci Xi system is not Food and Drug Administration approved for transoral robotic surgery (TORS), resulting in limited data. Methods: This prospective study evaluates the feasibility, safety, and outcomes of Xi‐TORS in an oncological setting. Results: Sixty‐one patients with head and neck cancer were consecutively included for Xi‐TORS. Adequate exposure and macroscopically complete resection were achieved in 59 patients (success rate = 96.7%). Intraoperative difficulties and complications were encountered in 47.5% and 20.3% of patients, respectively. Postoperative hemorrhage occurred in 11.9%; no treatment‐related deaths were encountered. Two‐year overall survival and disease‐specific survival were 90.5% and 95.6%, respectively. No long‐term (>1 month) tracheotomies were necessary, and only two patients remained tube‐feeding dependent. The functional baseline level was regained at 12 months for the MD Anderson Dysphagia Inventory and at 24 months for the Swallowing quality‐of‐life questionnaire. QLQ‐H&N35‐assessed QOL returned to baseline 6 months postoperatively. Conclusions: Xi‐TORS is safe, feasible, and with high oncological and functional effectiveness. [ABSTRACT FROM AUTHOR]

This article discusses the controversies surrounding mucosa and spongiosum preservation in non-transecting augmented anastomotic repair for urethroplasty. The authors appreciate the ongoing discussion on this topic and highlight recent advances in reconstructive urology. They mention the Scandinavian Urethroplasty Study, which found that transecting the corpus spongiosum leads to a higher incidence of penile complications. The authors describe their MANTA technique, which involves dorsal reconstruction of the urethral plate combined with a ventral onlay augmentation. They believe that selectively removing a short section of cicatrised dorsal mucosa and adapting healthy, well-vascularized mucosal tissue is unlikely to adversely impact wound healing. The authors emphasize the need for standardization in imaging, intraoperative parameters, and outcome measures to improve long-term functional outcomes. [Extracted from the article]

Aim: Patient‐reported outcome measures (PROMs) are increasingly being used in routine cancer care to evaluate treatment and monitor symptoms, function and other aspects of quality of life (QoL). There is no suitable PROM for rectal cancer patients following a watch‐and‐wait (W&W) programme. Insight into patient experiences with this programme is an essential step in the development of a PROM. The aim of this qualitative study was to provide insights into the most important functional outcomes and QoL features experienced by patients during our W&W programme. Method: Patients with locally advanced rectal cancer who are enrolled in the W&W programme in the Netherlands were interviewed by telephone using a semistructured interview guide. All interviews were digitally audio‐recorded, transcribed verbatim and coded. A thematic approach was used to analyse the data and identify themes and subthemes of importance to patients. Results: Eighteen patients were interviewed (78% male, mean age 68 years, range 52–83 years). Physical complaints after treatment were present, most notably gastrointestinal problems, neuropathy and fatigue. Furthermore, patients were anxious about a possible recurrence, had a fear of surgery or a stoma, or were experiencing a general feeling of apprehension in daily life. Many patients had different coping mechanisms, such as acceptance, and there were few limitations in daily life. Conclusion: We identified important functional outcomes, such as gastrointestinal complaints, fatigue and neuropathy, in patients who were enrolled in this W&W programme. Furthermore, an emotional burden and unmet needs were reported by these patients. These findings can be used to improve clinical practice and inform the development of a PROM. [ABSTRACT FROM AUTHOR]

Aim: Postoperative functional outcomes following pelvic exenteration surgery for treatment of advanced or recurrent pelvic malignancies are poorly understood. The aim of this study was to determine the short‐term functional outcomes following pelvic exenteration surgery using objective measures of physical function. Method: Patients undergoing pelvic exenteration surgery between January 2017 and May 2020 were recruited at a single quaternary referral hospital in Sydney, Australia. The primary measures were the 6‐min walk test (6MWT) and the five times sit to stand (5STS) test. Data were collected at baseline (preoperatively), 10 days postoperatively and at discharge from hospital, and were analysed according to tumour type, extent of exenteration, sacrectomy, length of hospital stay, major nerve resection and postoperative complications. Results: The cohort of patients that participated in functional assessments consisted of 135 patients, with a median age of 61 years. Pelvic exenteration patients had a reduced 6MWT distance preoperatively compared to the general population (P < 0.001). Following surgery, we observed a further decrease in 6MWT distance (P < 0.001) and an increase in time to complete 5STS (P < 0.001) at postoperative day 10 compared to baseline, with a slight improvement at discharge. There were no differences in 6MWT and 5STS outcomes between patients based on comparisons of surgical and oncological factors. Conclusion: Pelvic exenteration patients are functionally impaired in the preoperative period compared to the general population. Surgery causes a further reduction in physical function in the short term; however, functional outcomes are not impacted by tumour type, extent of exenteration, sacrectomy or nerve resection. [ABSTRACT FROM AUTHOR]

Aim: Low anterior resection syndrome (LARS) following sphincter‐preserving surgery for rectal cancer has a high prevalence, with an impact on long‐term bowel dysfunction and quality of life. We designed the bowel rehabilitation programme (BOREAL) as a proactive strategy to assess and treat patients with LARS. The BOREAL programme consists of a stepwise approach of escalating treatments: medical management (steps 0–1), pelvic floor physiotherapy, biofeedback and transanal irrigation (step 2), sacral nerve neuromodulation (step 3), percutaneous endoscopic caecostomy and anterograde enema (step 4) and definitive colostomy (step 5). Methods: A pilot study was undertaken to assess the feasibility of collecting LARS data routinely with the parallel implementation of the BOREAL programme. All patients who underwent total mesorectal excision for rectal cancer between February 2017 and March 2019 were included. LARS was assessed using the LARS score and the Wexner Faecal Incontinence score at 30 days and 3, 6, 9 and 12 months postoperatively. A good functional result was considered to be a combined LARS score <20 and/or a Wexner score <4. Results: In all, 137 patients were included. Overall compliance with the BOREAL programme was 72.9%. Major LARS decreased from 48% at 30 days postoperatively to 12% at 12 months, with a concomitant improvement in overall good function from 33% to 77%, P < 0.001. The majority of patients (n = 106, 77%) required medical management of their LARS. Conclusion: The BOREAL programme demonstrates the acceptability, feasibility and effectiveness of implementing a responsive, stepwise programme for detecting and treating LARS. [ABSTRACT FROM AUTHOR]

Aim: Despite good overall outcomes in most patients undergoing ileal pouch–anal anastomosis (IPAA), there is still hesitation about performing an IPAA in older patients due to the comorbidity burden and concern about incontinence. The aim of this work was to identify short‐ and long‐term outcomes in older patinets undergoing IPAA to determine the perioperative safety and long‐term functional success of IPAA in older patients. Method: A literature search was performed for all publications on IPAA in adults aged ≥50 years that reported short‐ and long‐term outcomes. Data extraction included demographics, 30‐day outcomes, long‐term functional outcomes and pouch failure. Data were further separated by age group (50–65 and ≥65 years). Outcomes were compared between age groups. Study quality and risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Of 1053 publications reviewed, 13 full papers were included in the analysis. The overall 30‐day morbidity and mortality rates were 47.3% and 1.3%, respectively. Thirty‐day postoperative rates of small bowel obstruction and pelvic sepsis were 7.6% and 9.9%, respectively. After a median follow‐up time of 62 months, rates of pouchitis, incontinence and pouch failure were 13.9%, 17.5% and 7.5%, respectively. There was no statically significant difference in rates of short‐ or long‐term functional outcomes based on age 50–65 versus ≥65 years. Conclusion: Increasing age did not increase the rate of short‐ or long‐term outcomes, including pouch failure. These data suggest that the decision for IPAA construction should not be based on age alone. [ABSTRACT FROM AUTHOR]

Endovascular thrombectomy (EVT) is the standard of care for anterior circulation acute ischemic stroke (AIS) with large vessel occlusion (LVO). Young patients with AIS‐LVO have distinctly different underlying stroke mechanisms and etiologies. Much is unknown about the safety and efficacy of EVT in this population of young AIS‐LVO patients. All consecutive AIS‐LVO patients aged 50 years and below were included in this multicenter cohort study. The primary outcome measured was functional recovery at 90 days, with modified Rankin Scale of 0–2 deemed as good functional outcome. A total of 275 AIS‐LVO patients that underwent EVT from 10 tertiary centers in Germany, Sweden, Singapore, and Taiwan were included. Successful reperfusion was achieved in 85.1% (234/275). Good functional outcomes were achieved in 66.0% (182/275). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%). National Institutes of Health Stroke Scale (NIHSS) score at presentation was inversely related to good functional outcomes (aOR: 0.92, 95% CI: 0.88–0.96 per point increase, p < 0.001). Successful reperfusion (aOR: 3.22, 95% CI: 1.44–7.21, p = 0.005), higher ASPECTS (aOR: 1.21, 95% CI: 1.01–1.44, p = 0.036), and bridging intravenous thrombolysis (aOR: 2.37, 95% CI: 1.29–4.34, p = 0.005) independently predicted good functional outcomes. Successful reperfusion was inversely associated with in‐hospital mortality (aOR: 0.14, 95% CI: 0.03–0.57, p = 0.006). History of hypertension strongly predicted in‐hospital mortality (aOR: 4.59, 95% CI: 1.10–19.13, p = 0.036). While differences in functional outcomes exist across varying stroke aetiologies, high rates of successful reperfusion and good outcomes are generally achieved in young AIS‐LVO patients undergoing EVT. [ABSTRACT FROM AUTHOR]

Duchenne muscular dystrophy (DMD) is a lethal genetic muscle disorder caused by recessive mutations in dystrophin gene, affecting 1/3000 males. Gene therapy has been proven to ameliorate dystrophic pathology. To investigate therapeutic benefits from long-term effect of human mini-dystrophin and functional outcomes, transgenic mdx mice (Tg-mdx) containing a single copy of human mini-dystrophin (∆hDys3849) gene, five rods (Rods1-2, Rods22-24), and two hinges (H1 and H4) driven by a truncated creatine-kinase promoter (dMCK) in a recombinant adenoassociated viral vector (rAAV) backbone, were generated and used to determine gene expression and improvement of muscle function. Human mini-dystrophin gene expression was found in a majority of the skeletal muscles, but no expression in cardiac muscle. Dystrophin-associated glycoproteins (DAGs) such as sarcoglycans and nNOS were restored at the sarcolemma and coincided with human mini-dystrophin gene expression at the ages of 6, 10, and 20 months; Morphology of dystrophic muscle expressing the human mini-dystrophin gene was improved and central nuclei were reduced. Myofiber membrane integrity was improved by Evans blue dye test. Improvement in treadmill running and grip force was observed in transgenic mice at 6 months. Tetanic force and specific force of tibialis anterior (TA) muscle were significantly increased at the ages of 6, 10, and 20 months. Pseudohypertrophy was not found in TA muscle at 10 and 20 months when compared with wild-type C57 (WT) group. This study demonstrated that the long-term effects of human mini-dystrophin effectively ameliorated pathology and improved the functions of the dystrophic muscles in the transgenic DMD mouse model. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare clinical characteristics and treatment outcomes between children with Childhood‐onset schizophrenia spectrum disorders (COSS) and children with other severe non‐psychotic psychiatric conditions (non‐COSS), all admitted to a national mental health inpatient children's unit. Methods: We conducted a retrospective study of all children discharged from a national children's inpatient unit in the United Kingdom, between 2009 and 2018. We compared functional and treatment outcomes and satisfaction with treatment in COSS with non‐COSS in the whole sample and separately for male and female patients. Results: A total of 211 children (55% boys) were included in the sample. The mean age on admission was 129.7 months (10.8 years; age range, 6‐12).Twenty cases were diagnosed with COSS (9.5%). In the whole sample, COSS patients had significantly lower Children's Global Assessment Scale (CGAS) scores on admission compared to non‐COSS (P =.006). There was a trend towards children with COSS as a group having a longer admission (M = 194.6 days, SD = 125.4) compared to non‐COSS (M = 135.8 days, SD = 86.2), (P =.053). Females with COSS seemed to have more significant differences compared to females with non‐COSS, in particular, longer admissions (P =.016) and worse CGAS scores at discharge (P =.04), whilst in males, these differences seemed to be attenuated. Conclusions: Children with COSS have lower functioning at the point of inpatient admission and possibly longer admissions, but similar satisfaction with treatment at discharge from hospital compared with non‐COSS. Females with COSS may have worse functional outcomes compared to non‐COSS at discharge. [ABSTRACT FROM AUTHOR]