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Background and purpose: Elevated serum lipoprotein(a) (Lp[a]) levels have been linked to an increased incidence of stroke. This systematic review and meta‐analysis aimed to evaluate the impact of serum Lp(a) on the functional outcomes of patients with ischemic stroke (IS). Methods: We conducted a comprehensive search of the MEDLINE, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure databases to identify relevant cohort studies. A random effects model was utilized to synthesize the data, accounting for study heterogeneity. Results: The analysis included 11 cohort studies comprising 11,958 patients with IS. Pooled results indicated that high baseline Lp(a) levels were associated with an increased risk of poor functional outcomes during follow‐up (odds ratio [OR] = 2.13, 95% confidence interval = 1.67–2.71, p < 0.001, I2 = 62%). Subgroup analyses revealed that the relationship between high Lp(a) levels and the risk of poor functional outcomes was more pronounced at discharge (OR = 3.25), 3 months (OR = 2.02), and 6 months (OR = 2.11) poststroke, compared to 12 months (OR = 1.25, p for subgroup difference < 0.001). Furthermore, the association was attenuated yet remained significant in studies adjusting for low‐density lipoprotein cholesterol (LDL‐C) compared to those that did not adjust for LDL‐C (OR = 1.69 vs. 2.63, p for subgroup difference = 0.03). Conclusions: High serum Lp(a) levels at baseline are significantly associated with poor functional outcomes in patients with IS. [ABSTRACT FROM AUTHOR]

Purpose: To identify the effect of releasing a tourniquet before versus after wound closure in total knee arthroplasty (TKA) on blood loss, functional outcome and postoperative complications. Methodology: A prospective cohort study was conducted including 53 patients from May 2023 to September 2023. All patients underwent unilateral TKA and were divided into two groups based on surgeon preference of deflating tourniquet, Group A consisted of patients in whom the tourniquet was deflated before wound closure for haemostasis and Group B consisted of patients in which tourniquet was deflated after wound closure and compressive dressing. Blood loss was evaluated via intraoperative blood loss (the number of soaked sponges/gauzes, blood in a suction bottle, total output in a suction bottle—irrigation used) and on‐field blood loss and calculated blood loss (Using Gross and Meunier's formula). The Functional outcome was evaluated using Knee injury and osteoarthritis score‐42 questions. Early postoperative complications and differences in the requirement of blood transfusions were also assessed. Results: There was a significant difference in intraoperative blood loss between the two groups. The median intraoperative blood loss was 135 mL (interquartile range [IQR]: 90–149) in Group A and 56.2 mL (IQR: 45–68) in Group B (p value: 0.001). However, no difference was found between the groups in calculated blood loss using Gross and Meunier's formula. The median calculated blood loss was 439 mL (IQR: 450–813) in Group A and 508 mL (IQR: 226–671) in group B (p value: 0.981). There was no significant difference between the groups in blood transfusion requirements or functional outcomes. Conclusion: Based on our results, we conclude that the intraoperative blood loss in TKA is significantly different between the groups but only represents a fraction of true blood loss (23%). The timing of releasing the tourniquet does not affect functional outcomes, blood transfusion and postoperative morbidity; hence, any time can be opted as per surgeon preference. Level of Evidence: Level II, prospective comparative study. [ABSTRACT FROM AUTHOR]

Somatic mutations related to clonal hematopoiesis of indeterminate potential (CHIP) are risk factors for stroke. The impact of DNMT3A, the most mutated gene in CHIP, on clinical functional outcomes of acute ischemic stroke (AIS) remains unclear. In a well‐characterized cohort of 8524 ischemic stroke patients, we demonstrated that DNMT3A‐driven CHIP was significantly associated with neurological disability in these patients. With a stroke mouse model of transient middle cerebral artery occlusion (tMCAO), we demonstrated that DNMT3A protein levels in the brain penumbra increased. The DNMT3A inhibitor RG108 administration amplified neutrophil proliferation in the blood, promoted neutrophil infiltration into the brain penumbra, and exaggerated proinflammatory activation in tMCAO male mice. DNMT3A inhibition also significantly increased infarct volume and worsened neurobehavioral function in tMCAO male mice. In conclusion, DNMT3A somatic mutations are associated with worsened neurological disability in some patients with AIS, potentially through increased neutrophil proliferation and infiltration in the ischemic brain region. These findings suggest a possible mechanism for proinflammatory activation and tissue damage in the affected brain tissue, highlighting the need for further research in this area. [ABSTRACT FROM AUTHOR]

Aim: Sacral neuromodulation (SNM) is approved for the treatment of faecal incontinence (FI) in a two‐stage technique. With standardized implantation, approximately 90% of patients undergo successful Stage I operation and proceed to a permanent implant (Stage II). The aim of this work was to explore the feasibility of SNM as a one‐stage procedure and report the 24‐week efficacy. Method: This study included patients diagnosed with idiopathic FI or FI due to an external anal sphincter defect ≤160° and one or more episodes of FI per week despite maximal conservative therapy. Patients were offered a one‐stage procedure if a motor response of the external anal sphincter was achieved in three or more poles with at least one at ≤1.5 mA at lead placement. Patients were followed for 24 weeks. Their evaluation included the Wexner/St Mark's Incontinence Score, Faecal Incontinence Quality of Life score (FIQoL), a visual analogue scale (VAS) for assessing patient satisfaction and a bowel habit diary. Results: Seventy‐three patients with a median age of 60 years (interquartile range 50–69 years) completed this prospective study. Episodes of FI were significantly reduced at the 24‐week follow‐up, from 13 (8–23) at baseline to 2 (0–5) (p‐value = 0002). A ≥50% reduction in the number of FI episodes was achieved in 92% of participants. The Wexner score improved significantly from 16 (14–17) at baseline to 9 (5–13) (p‐value < 0.001), and the St Mark's score improved significantly from 18 (16–20) to 11 (7–16) (p‐value < 0.001). All domains in the FIQoL score and VAS for patient satisfaction improved significantly following the one‐stage procedure. Conclusion: A one‐stage implantation procedure is feasible in selected patients with FI, significantly improving continence, quality of life and patient satisfaction after 24 weeks of follow‐up. [ABSTRACT FROM AUTHOR]

Purpose: The tibial anatomical anteroposterior (AP) axis "Akagi's line" was originally defined on computed tomography (CT) in total knee arthroplasty (TKA); however, its intraoperative reproducibility remains unknown. This study aimed to evaluate the intraoperative reproducibility of the Akagi's line and its effect on postoperative clinical outcomes. Methods: This prospective study included 171 TKAs. The rotational angle of the intraoperative Akagi's line relative to the original Akagi's line (RAA) defined on CT was measured. The RAA was calculated based on the tibial component rotational angles relative to the intraoperative Akagi's line measured using the navigation system and CT. The effects of RAA on postoperative clinical outcomes and rotational alignments of components were also evaluated. Results: The mean absolute RAA (standard deviation) value was 5.5° (3.9°). The range of RAA was 22° internal rotation to 16° external rotation. Intraoperative Akagi's line outliers (RAA > 10°) were observed in 14% of the knees (24 knees). In outlier analysis, the tibial component rotation angle was externally rotated 6.5° (5.6°) in the outlier group and externally rotated 3.7° (4.2°) in the nonoutlier group (≤10°), with a significant difference between the two groups. Additionally, the outlier group (RAA > 10°) showed lower postoperative clinical outcomes. Conclusion: The original Akagi's line defined on CT showed insufficient reproducibility intraoperatively. The poor intraoperative detection of Akagi's line could be the reason for the tibial component rotational error and worse postoperative clinical outcomes. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Background and purpose: In ischemic stroke, the impact of short‐ versus long‐term blood glucose level (BGL) on early lesion pathophysiology and functional outcome has not been assessed. The purpose of this study was to directly compare the effect of long‐term blood glucose (glycated hemoglobin [HbA1c]) versus serum BGL on early edema formation and functional outcome. Methods: Anterior circulation ischemic stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) on admission were analyzed. Endpoints were early ischemic cerebral edema, measured by quantitative net water uptake (NWU) on initial CT and functional independence at Day 90. Results: A total of 345 patients were included. Patients with functional independence had significantly lower baseline NWU (3.1% vs. 8.3%; p < 0.001) and lower BGL (113 vs. 123 mg/dL; p < 0.001) than those without functional independence, while HbA1c levels did not differ significantly (5.7% vs. 5.8%; p = 0.15). A significant association was found for NWU and BGL (ß = 0.02, 95% confidence interval [CI] 0.006–0.03; p = 0.002), but not for HbA1c and NWU (ß = −0.16, 95% CI −0.53–0.21; p = 0.39). Mediation analysis showed that 67% of the effect of BGL on functional outcome was mediated by early edema formation. Conclusion: Aggravated early edema and worse functional outcome was associated with elevated short‐term serum BGL, but not with HbA1c levels. Hence, the link between short‐term BGL and early edema development might be used as a target for adjuvant therapy in patients with ischemic stroke. [ABSTRACT FROM AUTHOR]

Aims: A post hoc analysis of RICAMIS trial to evaluate functional outcomes in relation to patient age. Methods: Patients in RICAMIS were divided into six age groups. The primary outcome was excellent functional outcome at 90 days, defined as modified Rankin Scale (mRS) score of 0–1. Compared with patients receiving usual care alone, we investigated the association of remote ischemic conditioning (RIC) effect with functional outcomes in each group and the interaction between RIC effect and age. Results: Of 1776 patients, 498 were assigned to <60 years, 326 to 60 to <65 years, 325 to 65 to <70 years, 278 to 70 to <75 years, 206 to 75 to <80 years, and 143 to ≥80 years. Higher proportions of primary outcome were found associated with RIC in <60 years group (72.6% vs. 64.8%; adjusted risk difference [RD], 6.8%; 95% CI, −1.6% to 15.1%; p = 0.11), 60 to <65 years group (70.7% vs. 67.1%; adjusted RD, 3.1%; 95% CI, −7.2% to 13.3%; p = 0.56), 65 to <70 years group (70.5% vs. 63.6%; adjusted RD, 3.5%; 95% CI, −6.8% to 13.8%; p = 0.51), 70 to <75 years group (59.7% vs. 54.9%; adjusted RD, 4.7%; 95% CI, −7.1% to 16.4%; p = 0.61), 75 to <80 years group (61.5% vs. 55.9%; adjusted RD, 5.7%; 95% CI, −7.8% to 19.1%; p = 0.41), and ≥ 80 years group (59.2% vs. 59.7%; adjusted RD, −2.6%; 95% CI, −18.8% to 13.5%; p = 0.75). No significant interaction between RIC effect and age was found among groups. Conclusions: This is the first report that RIC effect may be attenuated with increasing age in patients with acute moderate ischemic stroke with respect to functional outcome. [ABSTRACT FROM AUTHOR]

In the SARS‐CoV‐2 Omicron period, the pattern of pneumonia changed from primarily viral pneumonia to pneumonia mixed with bacteria in the elderly. We investigated functional outcomes at 1 year after hospital discharge in patients with primary Omicron pneumonia and pneumonia mixed with bacteria, mainly aspiration pneumonia. Functional decline rates calculated using the Barthel Index at 1 year after hospital discharge were significantly higher in the pneumonia mixed with bacteria group than the primary viral pneumonia group (42.6% vs. 20.5%, p < 0.0001). It is necessary to consider early rehabilitation and treatment in elderly patients even when the predominant strain is the Omicron variant. [ABSTRACT FROM AUTHOR]

Background: We aimed to develop a simple scoring table for predicting probability of death within 1‐year after admission to an intensive care unit. We analysed data on emergency admissions from the nationwide Finnish intensive care quality registry. Methods: We included first admissions of adult patients with data available on 1‐year vital status (dead or alive) and all five variables included in a premorbid functional status score, which is the number of activities the person can manage independently of the following five: get out of bed, move indoors, dress, climb stairs and walk 400 m. We analysed data on patient characteristics and admission‐associated factors from 2012 to 2014 to find predictors of 1‐year mortality and to develop a score for predicting probability of death. We tested the performance of this score in data from 2015. We assessed the 1‐year functional status score of survivors with data available. Results: Out of 25,261 patients, 20,628 (81.7%) patients were able to perform all five functional activities independently prior to the intensive care unit admission. At 1‐year post admission, 19,625 (77.7%) patients were alive. 1‐year functional status score was known for 11,011 patients and 8970 (81.5%) patients achieved functional status score 5, managing all five activities independently. The score based on age, sex, preceding functional status, type of intensive care unit admission, severity of acute illness and the most significant diagnoses predicted 1‐year mortality with an area under the receiver operating characteristic curve 0.78 (95% CI, 0.76–0.79). The calibration of our prediction model was good, with calibration intercept −0.01 (−0.07 to 0.05) and calibration slope 0.96 (0.90 to 1.02). Conclusion: Our score based on data available at intensive care unit admission predicted 1‐year mortality with fairly good discrimination. Most survivors achieved good functional recovery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to introduce a novel radially pedicled in‐situ split‐thickness skin graft (STSG). The morbidity, esthetic, and functional outcomes of the radially pedicled in‐situ STSG were in comparison with those of the distal STSG. Study Design: Retrospective analysis. Setting: A single‐institution review. Methods: Seventy patients with oral cancer who underwent radical surgical resection and simultaneous radial forearm free flap (RFFF) reconstruction from July 2021 to March 2022 were included. De‐epithelialized RFFFs and traditional RFFFs were used to repair oral defects of 35 patients in Group A and Group B, respectively, while radially pedicled in‐situ STSGs and distal STSGs taken from abdomens were used to repair donor site defects in the above groups, respectively. Patient demographics, wound healing complications, and esthetic and functional outcomes of the forearms were compared between the 2 groups. Results: No significant difference between Group A and Group B was observed in terms of donor site and recipient site complications. The esthetic outcome was superior in Group A compared to Group B (P =.011). The extension range, sensation, and pinch strength of operated forearms were significantly reduced in both groups after surgery (P <.05), however, intergroup differences were not observed. Conclusion: Taken together, our results suggest that radially pedicled in‐situ STSG is an applicable technique for direct closure and better esthetic outcomes in the forearm donor site. [ABSTRACT FROM AUTHOR]

Objectives: To compare functional and oncological outcomes of robot‐assisted laparoscopic prostatectomy (RALP) to three‐dimensional laparoscopic radical prostatectomy (3D‐LRP) at 12 months after surgery. Patients and methods: Prospective randomised single‐centre study of 145 consecutive men referred to radical prostatectomy in a tertiary referral centre in Finland. Patients were randomised 1:1 to the RALP (N = 75) and 3D‐LRP (N = 70) groups. The primary outcome was urinary continence evaluated with the Expanded Prostate Cancer Index Composite 26‐item version (EPIC‐26) incontinence domain score at 12 months after surgery. Secondary outcomes included the use of protective pads at 12 months after surgery, EPIC‐26 domain scores of irritative/obstructive, bowel, sexual and hormonal symptoms, positive surgical margin (PSM) rate, and biochemical recurrence (BCR). Complication frequency within the 3‐month period after surgery was evaluated according to Clavien–Dindo classification. Statistical significance between groups was analysed using Mann–Whitney, chi‐square and Fisher's exact tests. The trial was terminated after interim analysis based on no statistically significant difference in EPIC‐26 urinary incontinence domain scores. Altogether 145 patients of the target accrual of 280 patients were recruited. Results: Postoperative continence at 12 months after surgery according to the EPIC‐26 incontinence domain was 79.25 in both groups (P = 0.4). Between group difference was −5.8 (95% confidence interval –15.2 to 3.6). There was no statistically significant difference in the rates of PSM or BCR between the two surgical modality groups. Conclusion: We were unable to demonstrate a difference between the RALP and 3D‐LRP groups for functional and oncological outcomes at 12 months after surgery. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present research was to examine the correlation between the neutrophil‐to‐lymphocyte ratio (NLR) and stroke progression (SP) as well as the functional outcome following an ischemic stroke (IS). Methods: The current study was conducted as prospective observational research. A cohort of 341 participants diagnosed with IS was included in the study from March 2019 to August 2021. This study's primary measure of interest was the occurrence of SP within the initial week following hospital admission. The secondary outcome was functional status 3 months after IS as measured by a modified Rankin scale score. The association between NLR with SP, and poor functional outcomes was examined using multivariate logistic regression. The predictive value of NLR for SP and poor functional outcomes was evaluated using the receiver operating characteristic (ROC) curve. Results: Among the 341 enrolled patients, 56 (16.4%) had SP, and 285 (83.6%) had no SP. The results of the multivariate logistic regression analysis demonstrated that the existence of diabetes mellitus and the NLR were independently associated with SP and poor functional outcomes. The area under the ROC curve of NLR in predicting poor functional outcome was 0.6117 (95% confidence interval,.5341–.6893, p =.0032), and the optimal cut‐off point was 4.2139. The sensitivity and specificity of NLR in predicting poor functional outcomes were 52.7% and 72.0%, respectively. Conclusion: Patients with acute IS exhibited a very high incidence of SP. NLR may be a valuable prognostic indicator in clinical practice because it was independently associated with SP and a poor functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: Focal chondral lesions of the femur are currently treated with biological repair or arthroplasty. However, some patients are not suitable for either one due to lesion size, age, or prior biological treatment attempts. While singular patient-specific focal mini metal implants already showed good results, the outcomes of bicompartmental implantation of these implants have not been discussed in the literature yet. This study aims to evaluate clinical outcomes of patients who underwent bicompartmental implantation of two patient-specific implants. Methods: This prospective, non-randomized, non-comparative pilot study evaluates results up to two years after bicompartmental implantation of two implants (Episealer Implant, Episurf, Stockholm, Sweden). A damage report is compiled using a special MRI program and patient specific implants are manufactured, including 3D-printed surgical instruments to provide exact placement of the implant. The patients were assessed repeatedly using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) for pain during the follow-up. Results: The scores were evaluated three, 12, and 24 months after surgery and showed good results. The median in both scores improved from 37.7 for the KOOS5 preoperatively to 69.1 after 24 months and from 69 for the VAS for pain preoperatively to 9 after 24 months. Conclusion: Overall, for the small study group presented, the early results are promising. With noticeable improvement in KOOS and VAS for pain after two years, patient specific implants appear to become relevant in future standardized treatment of femoral chondral lesions. Especially with bicompartmental implantation, full arthroplasty can be delayed even further. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

Patients with the 22q11.2 deletion syndrome (DS) show an increased risk of developing a psychotic illness lifetime. 22q11.2DS may represent a reliable model for studying the neurobiological underpinnings of schizophrenia. The study of social inference abilities in a genetic condition at high risk for psychosis, like 22q11.2DS, may shed light on the relationships between neurocognitive processes and patients' daily general functioning. The study sample consisted of 1736 participants, divided into four groups: 22q11.2DS patients with diagnosis of psychotic disorder (DEL SCZ, N = 20); 22q11.2DS subjects with no diagnosis of psychosis (DEL, N = 43); patients diagnosed with schizophrenia without 22q11.2DS (SCZ, N = 893); and healthy controls (HC, N = 780). Social cognition was assessed through The Awareness of Social Inference Test (TASIT) and general functioning through the Specific Levels of Functioning (SLoF) scale. We analysed data through regression analysis. The SCZ and DEL groups had similar levels of global functioning; they both had significantly lower SLoF Total scores than HC (p <.001); the DEL SCZ group showed significantly lower scores compared to the other groups (SCZ, p =.004; DEL, p =.003; HC, p <.001). A significant deficit in social cognition was observed in the three clinical groups. In the DEL SCZ and SCZ groups, TASIT scores significantly predicted global functioning (p <.05). Our findings of social cognition deficit in psychosis‐prone patients point to the possible future adoption of rehabilitation programmes, like Social Skills Training and Cognitive Remediation, during premorbid stages of psychosis. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim was to identify baseline clinical and radiological/procedural predictors and 24‐h radiological predictors for clinical and functional outcomes in stroke patients obtaining complete recanalization in one pass of mechanical thrombectomy (MT) in an optimal baseline and procedural setting. Methods: A retrospective analysis was conducted of prospectively collected data from 924 stroke patients with anterior large vessel occlusion, Alberta Stroke Program Early Computed Tomography (ASPECT) score ≥6 and pre‐stroke modified Rankin Scale score 0, who started MT ≤6 h from symptom onset and obtained first‐pass complete recanalization. A first logistic regression model was performed to identify baseline clinical predictors and a second model to identify baseline radiological/procedural predictors. A third model including baseline clinical and radiological/procedural predictors was performed, and a fourth model including independent baseline predictors from the third model plus 24‐h radiological variables (hemorrhagic transformation [HT] and cerebral edema [CED]). Results: In the fourth model, higher National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.089) and higher ASPECT score (OR 1.292) were predictors of early neurological improvement (ENI) (NIHSS score ≤4 points from baseline or NIHSS score of 0 at 24 h), whereas older age (OR 0.973), longer procedure time (OR 0.990), HT (OR 0.272) and CED (OR 0.569) were inversely associated with ENI. Older age (OR 0.970), diabetes mellitus (OR 0.456), higher NIHSS score (OR 0.886), general anesthesia (OR 0.454), longer onset‐to‐groin time (OR 0.996), HT (OR 0.340) and CED (OR 0.361) were inversely associated with 3‐month excellent functional outcome (mRS score 0–1), whereas higher ASPECT score (OR 1.294) was a predictor of excellent outcome. Conclusions: Higher NIHSS score was a predictor of ENI but inversely associated with 3‐month excellent outcome. Older age, HT and CED were inversely associated with both good outcomes. [ABSTRACT FROM AUTHOR]

Aim: To examine secular change in functional outcomes and associated factors of stroke in a rapidly aging region. Methods: We retrospectively analyzed cerebral infarction and intracerebral hemorrhage incidence registered cases in the Akita Stroke Registry from 1985 to 2014, divided into three of 10 years each. Functional outcome was defined as good with a modified Rankin scale score of 0–1 and poor with a score of 3–6 at discharge. Mixed effects logistic regression analysis with the location of medical facility as a random effects variable by disease type was used to examine the results. Results: There were 81 254 eligible patients (cerebral infarction: 58 217, intracerebral hemorrhage: 23 037). Age at onset increased over time in both diseases (cerebral infarction: median [interquartile range] age, 70 [63–77] years in 1985–1994 to 77 [69–83] years in 2005–2014; intracerebral hemorrhage: 64 [56–72] years in 1985–1994 to 72 [61–80] years in 2005–2014). Multivariate analysis showed that the odds ratio associated with good outcomes increased over time for cerebral infarction, and cerebral hemorrhage increased in periods 2 and 3 compared with period 1, but decreased from period 2 to period 3. For cerebral infarction, the odds ratios of prior diabetes associated with poor outcomes decreased over time. Conclusion: The age at onset increased over time. In cerebral infarction, functional outcomes improved over time, and the association between diabetes and poor outcome declined over time. It was speculated that these results were related to advances in the healthcare system and improved management of vascular risk factors during the study period. Intracerebral hemorrhage improved during the first 20 years, with no apparent improvement thereafter. Geriatr Gerontol Int 2023; 23: 486–492. [ABSTRACT FROM AUTHOR]

Aims: The monocyte to high‐density lipoprotein cholesterol ratio (MHR) has emerged as a novel inflammatory biomarker of atherosclerotic cardiovascular disease. However, it has not yet been identified whether MHR can predict the long‐term prognosis of ischemic stroke. We aimed to investigate the associations of MHR levels with clinical outcomes in patients with ischemic stroke or transient ischemic attack (TIA) at 3 months and 1 year. Methods: We derived data from the Third China National Stroke Registry (CNSR‐III). Enrolled patients were divided into four groups by quartiles of MHR. Multivariable Cox regression for all‐cause death and stroke recurrence and logistic regression for the poor functional outcome (modified Rankin Scale score 3–6) were used. Results: Among 13,865 enrolled patients, the median MHR was 0.39 (interquartile range, 0.27–0.53). After adjustment for conventional confounding factors, the MHR level in quartile 4 was associated with an increased risk of all‐cause death (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.10–1.90), and poor functional outcome (odd ratio [OR], 1.47; 95% CI, 1.22–1.76), but not with stroke recurrence (HR, 1.02; 95% CI, 0.85–1.21) at 1 year follow‐up, compared with MHR level in quartile 1. Similar results were observed for outcomes at 3 months. The addition of MHR to a basic model including conventional factors improved predictive ability for all‐cause death and poor functional outcome validated by the C‐statistic and net reclassification index (all p < 0.05). Conclusions: Elevated MHR can independently predict all‐cause death and poor functional outcome in patients with ischemic stroke or TIA. [ABSTRACT FROM AUTHOR]

In patients with acute ischemic stroke (AIS), the effect of salvianolic acids for injection (SAFI) as the secondary treatment after intravenous thrombolysis (IVT) is unclear. We aimed to evaluate the efficacy of SAFI for patients with AIS undergoing IVT. We searched seven electronic databases and two registries from inception to July 24, 2022, for randomized controlled trials (RCTs) assessing the effect of SAFI plus recombinant tissue plasminogen activator (rt‐PA) on the functional recovery compared to rt‐PA alone in patients with AIS. Two independent authors selected RCTs, extracted data, and assessed the risk of bias. A meta‐analysis was conducted. Eight RCTs involving 682 patients with AIS were included. Compared to patients receiving intravenous rt‐PA alone, those receiving intravenous rt‐PA combined with SAFI had a higher likelihood of achieving favorable functional outcomes at 3 months. In addition, the use of SAFI for 2 weeks was associated with better neurological recovery. The evidence of benefit was confirmed by trial sequential analysis (TSA). The incidence of intracranial hemorrhage did not differ between the two groups. In patients with AIS, intravenous rt‐PA combined with SAFI might achieve better functional outcomes. However, further high‐quality studies are needed to firmly establish the clinical efficacy of SAFI. [ABSTRACT FROM AUTHOR]

Background and purpose: We aimed to assess the course and predictors of functional outcome after single and multiple intracerebral hemorrhage (ICH) in pediatric patients with cerebral cavernous malformations (CCMs) and to conduct a risk assessment of a third bleed during the first follow‐up year after second ICH. Methods: We included patients aged ≤18 years with complete baseline characteristics, a magnetic resonance imaging dataset, ≥1 CCM‐related ICH and ≥1 follow‐up examination, who were treated between 2003 and 2021. Neurological functional status was obtained using modified Rankin Scale scores at diagnosis, before and after each ICH, and at last follow‐up. Kaplan–Meier analysis was performed to determine the cumulative 1‐year risk of third ICH. Results: A total of 55 pediatric patients (median [interquartile range] age 12 [11] years) were analyzed. Univariate analysis identified brainstem cavernous malformation (BSCM; p = 0.019) as a statistically significant predictor for unfavorable outcome after second ICH. Outcome after second ICH was significantly worse in 12 patients (42.9%; p = 0.030) than after first ICH and in five patients (55.6%; p = 0.038) after a third ICH compared to a second ICH. Cumulative 12‐month risk of rebleeding during the first year after a second ICH was 10.7% (95% confidence interval 2.8%–29.37%). Conclusions: Pediatric patients with a BSCM have a higher risk of worse outcome after second ICH. Functional outcome improves over time after an ICH but worsens following each ICH compared to baseline or previous ICH. Second bleed was associated with neurological deterioration compared to initial ICH, and this deteriorated further after a third ICH. [ABSTRACT FROM AUTHOR]

Background and purpose: Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice. Methods: Patients enrolled between June 2015 and December 2019 in the German Stroke Registry‐Endovascular Treatment (GSR‐ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b‐3), substantial neurological improvement (≥8‐point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge ≤1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0–2). Results: Out of 6635 GSR‐ET patients, 640 (9.6%) patients (age 72.2 ± 13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3‐month follow‐up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76–5.23) and successful reperfusion (OR 4.92, 95% CI 1.15–21.11), while the effect of time between symptom onset and reperfusion seemed to be small. Conclusions: Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact. [ABSTRACT FROM AUTHOR]

Introduction: Lipocalin‐2 (LCN2) is an acute‐phase protein that could mediate neuroinflammation after brain injury. We aimed to evaluate if LCN2 level was associated with early neurological deterioration (END) in acute ischemic stroke patients, thus hindering clinical recovery. Methods: We conducted a prospective study of acute ischemic stroke patients between June 2021 and February 2022. Serum LCN2 concentration was measured after admission using an enzyme‐linked immunosorbent assay. Outcomes included END and 90‐day poor functional outcome (modified Rankin Scale 3‐6). The National Institutes of Health Stroke Scale increment ≥4 points within 72 h after admission was defined as END. Results: A total of 253 acute ischemic stroke patients (mean age, 65.2 ± 13.4 years; 64.0% male) were recruited. In the multivariate adjustment, increased serum LCN2 levels (per 1‐SD increase of LCN2) were associated with a higher risk of END (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.20–2.25; p =.002) and 90‐day poor outcome (OR, 1.73; 95% CI, 1.22–2.45; p =.002). Restricted cubic splines found a linear relationship between LCN2 level and 90‐day unfavorable outcome (END, p =.001 for linearity; 90‐day poor outcome, p =.013 for linearity). Subgroup analysis further confirmed the significant association of LCN2 with clinical outcomes. Conclusions: This study demonstrated that higher circulating LCN2 level was associated with an increased risk of early clinical worsening and 90‐day unfavorable outcomes in ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Objective: The efficacy of decompressive surgery (DS) in cerebral venous thrombosis (CVT) patients has been reported in several case reports and case series. We aimed at determining the association of DS compared with medical management and timing of surgery with functional outcome and mortality. We also aimed at determining the prevalence of DS in CVT patients. Methods: The literature search was conducted till 7 November 2022 in PubMed, Google Scholar, EMBASE and Cochrane Library databases. Risk of bias was examined using Joanna Briggs Institute scale for case series and case reports. Association of DS compared with medical management and timing of surgery with functional outcome and mortality was determined using odds ratio (OR) and 95% confidence interval (CI). Pooled prevalence of DS in CVT patients with 95%CI was calculated. Heterogeneity was explored using outlier, meta‐regression, sensitivity and subgroup analyses. Results: Fifty‐one studies consisting of 483 CVT cases with DS were included. The OR of poor outcome with surgery was 0.03; (95%CI: 0.00–0.22) and of mortality with surgery was 0.25; (95%CI: 0.02–2.60) versus that with medical management. Surgery done ≤48 h of admission was significantly associated with less mortality (OR: 0.26; 95%CI: 0.10–0.69). Pooled prevalence of DS in CVT was 12% (95%CI: 8%–17%; I2 = 91%). Revised pooled prevalence after removing outliers was 10% (95%CI: 7%–13%; I2 = 73%). Conclusions: Surgery ≤48 h of admission might decrease mortality in CVT patients and may result in improved functional outcome. Further prospective studies with appropriate control arms are required to confirm its efficacy over medical management. [ABSTRACT FROM AUTHOR]

Introduction: It remains unknown whether the global small vessel disease (SVD) burden predicts post‐stroke outcomes. Methods: In a prospective multicenter study of 666 ischemic and hemorrhagic stroke patients, we quantified magnetic resonance imaging (MRI)–based SVD markers (lacunes, white matter hyperintensities, microbleeds, perivascular spaces) and explored associations with 6‐ and 12‐month cognitive (battery of 15 neuropsychological tests) and functional (modified Rankin scale) outcomes. Results: A global SVD score (range 0–4) was associated with cognitive impairment; worse performance in executive function, attention, language, and visuospatial ability; and worse functional outcome across a 12‐month follow‐up. Although the global SVD score did not improve prediction, individual SVD markers, assessed across their severity range, improved the calibration, discrimination, and reclassification of predictive models including demographic, clinical, and other imaging factors. Discussion: SVD presence and severity are associated with worse cognitive and functional outcomes 12 months after stroke. Assessing SVD severity may aid prognostication for stroke patients. Highlights: In a multi‐center cohort, we explored associations of small vessel disease (SVD) burden with stroke outcomes.SVD burden associates with post‐stroke cognitive and functional outcomes.A currently used score of SVD burden does not improve the prediction of poor outcomes.Assessing the severity of SVD lesions adds predictive value beyond known predictors.To add predictive value in assessing SVD in stroke patients, SVD burden scores should integrate lesion severity. [ABSTRACT FROM AUTHOR]

Objectives: The six‐minute walk test (6MWT) is a commonly used measure of functional capacity. This study is the first to investigate the test‐retest reliability, minimal detectable difference (MDD) and the minimal clinically important difference (MCID) for people attending a persistent pain service. Relationships between change in 6MWT performance and change in self‐reported physical, functional and psychological outcome measures were also explored. Methods: A cross‐sectional repeated measures design was used with people having >9 months of pain attending an 8‐week outpatient persistent pain programme. For reliability and MDD, 27 people were recruited, for MCID calculations, 32 people were recruited. The MCID was examined by dichotomising people into "improvers", or "non‐improvers" based upon the Global Rating of Change (GRC) in physical abilities score. Results: The mean (SD) 6MWT distance was 389.4 (93.6) m at programme start, and 427.8 (83.0) m at week eight completion. The test‐retest reliability was good (intraclass correlation coefficient = 0.89) and the MDD = 86.1 m. As there was no relationship between change in 6MWT distance and GRC physical abilities at week eight (r = 0.132, p = 0.472) the MCID could not be calculated. Furthermore, no relationships were found between change in 6MWT distance and other self‐reported measures. Changes in GRC physical abilities and 6MWT were frequently discordant, with increased 6MWT for 7/11 "GRC non‐improvers" and decreased 6MWT for 7/21 "GRC improvers". Conclusions: Amongst this cohort, change in physical ability may or may not be reflected by self‐reported change. Objective tests of physical ability are recommended for people attending pain services, and validated tests should align with intervention aims. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the influence of stroke lesions in predefined highly interconnected (rich‐club) brain regions on functional outcome post‐stroke, determine their spatial specificity and explore the effects of biological sex on their relevance. We analyzed MRI data recorded at index stroke and ~3‐months modified Rankin Scale (mRS) data from patients with acute ischemic stroke enrolled in the multisite MRI‐GENIE study. Spatially normalized structural stroke lesions were parcellated into 108 atlas‐defined bilateral (sub)cortical brain regions. Unfavorable outcome (mRS > 2) was modeled in a Bayesian logistic regression framework. Effects of individual brain regions were captured as two compound effects for (i) six bilateral rich club and (ii) all further non‐rich club regions. In spatial specificity analyses, we randomized the split into "rich club" and "non‐rich club" regions and compared the effect of the actual rich club regions to the distribution of effects from 1000 combinations of six random regions. In sex‐specific analyses, we introduced an additional hierarchical level in our model structure to compare male and female‐specific rich club effects. A total of 822 patients (age: 64.7[15.0], 39% women) were analyzed. Rich club regions had substantial relevance in explaining unfavorable functional outcome (mean of posterior distribution: 0.08, area under the curve: 0.8). In particular, the rich club‐combination had a higher relevance than 98.4% of random constellations. Rich club regions were substantially more important in explaining long‐term outcome in women than in men. All in all, lesions in rich club regions were associated with increased odds of unfavorable outcome. These effects were spatially specific and more pronounced in women. [ABSTRACT FROM AUTHOR]

Background: Traditional models to predict intensive care outcomes do not perform well in COVID‐19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID‐19. Methods: In this prospective multicentre cohort study, we enrolled laboratory‐confirmed, critically ill COVID‐19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU‐treated COVID‐19 patients in the region on admission. Surviving patients had a follow‐up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale‐Extended (GOSE), an ordinal scale (1–8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90‐day mortality; the secondary outcome was functional outcome at 90 days. Results: Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m2. Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in‐hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two‐fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, PaCO2 >7 kPa, and inflammatory markers on admission were independent factors of 90‐day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU. Conclusion: In critically ill COVID‐19 patients, the 90‐day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days. [ABSTRACT FROM AUTHOR]

Aims: To propose a novel S.I.S technique during the robotic‐assisted radical prostatectomy (RARP), encompassing pubourethral suspension, posterior wall intensification, and bladder neck stripping, and to present functional and oncological outcomes with a special focus on long‐term continence. Methods: From January 1, 2018, to December 31, 2019, consecutive patients who underwent RARP were retrospectively investigated and separated into the S.I.S group and the conventional group. Preoperative patient characteristics, tumor status, and perioperative parameters were collected, followed by the assessment of self‐reported status on continence, using an International Consultation on Incontinence Modular Questionnaire—urinary incontinence short form (ICIQ‐UI‐SF). Statistical comparisons were performed on variables between the two surgery groups, and multivariate logistic regression analysis was used to determine predictive factors for postoperative incontinence severity. Results: A total of 602 subjects were analyzed with a median follow‐up of 24 months. There was no significant difference regarding baseline characteristics and perioperative parameters, except for a more advanced tumor stage in the S.I.S group. The application of the S.I.S technique did not jeopardize the positive surgical margin rate at the bladder neck or long‐term tumor control. Notably, the patient‐reported degree of incontinence was significantly reduced with the assistance of S.I.S technique, as evidenced by the diminished severe‐to‐very severe cases. On multivariate analysis, both preoperative body mass index and use of S.I.S modification were independent predictive factors for the long‐term incontinence severity. Conclusions: The application of S.I.S technique during RARP is feasible and superior compare with the conventional approach, with a significantly alleviated long‐term incontinence severity, without compromising cancer control. [ABSTRACT FROM AUTHOR]

Objective: To evaluate potential interactions and compensatory mechanisms of subjectively impaired taste function with ortho‐ and retronasal olfaction after glossectomy. Study Design: In this cross‐sectional pilot study, chemosensory functions were assessed in 25 patients with tongue carcinomas after glossectomy. The orthonasal‐, retronasal‐, and gustatory functions were tested with a mean time of 25 months after surgery with the Sniffin' Sticks odor identification test kit (ISST), the Candy Smell‐27 test (CST‐27) and the Taste strip test (TST). Visual analog scales (VAS) were additionally used for self‐assessment of taste, flavor perception, and odor ranging from 0 (no perception) to 10 (excellent perception) and further correlated with our psychophysical evaluated outcome measures. Results: The TST, ISST, and CST‐27 tests revealed that only eight (32%) and 13 (52%) glossectomy patients had normal taste and orthonasal function, e 21 (84%) patients showed normal retronasal function. Importantly, neither extent of resection and reconstruction nor prior radiotherapy affected chemosensory functions. Contrary, 20 (80%) patients rated their taste and flavor perception as acceptable (VAS >5). Results of the TST, ISST, and CST‐27 tests did not correlate with the equivalent self‐assessments of taste (p = 0.260, r = 0.234), odor (p = 0.588, r = −0.114), and flavor (p = 0.728, r = 0.073) perception. Conclusion: There was a significant discrepancy between self‐perception of taste and flavor and assessed gustatory function after glossectomy. A contribution of the intact retronasal olfactory system could be a possible explanation of our results. Level of Evidence: 4 Laryngoscope, 133:375–382, 2023 [ABSTRACT FROM AUTHOR]

BACKGROUND: Soft tissue sarcoma (STS) occurs most commonly in the anterior compartment of the thigh. Limb salvage surgery is the mainstay of treatment, however, resections frequently involve muscle sacrifice. This study determines the impact of a single quadriceps muscle sacrifice on daily living functions. This is to assist clinical decisionmaking relating to when a functional reconstruction should be offered over simple soft tissue coverage for these defects. METHODS: Patients who underwent single quadriceps resection as part of the management of STS between 2010 and 2020 were selected. Three functional tests were performed: Time Up and Go (TUG), Timed Up and Down Stairs (TUDS) and Toronto Extremity Salvage Score (TESS). The results were compared with age/sex matched healthy reference values and literature cohorts of lower limb STS patients. Correlations between the tests and age and follow-up duration were determined by the Spearman’s test. RESULTS: The mean TESS, TUG and TUDS results of the 13 patients were 89.6%, 9.8 and 1.01 s/step, respectively. These scores were either similar or significantly better than the comparator values. The TESS score showed no statistical significance compared with patients with no muscle resection. TUG and TUDS scores showed significant positive correlation with each other (ρ = 0.885, P = <0.01) and with age (ρ = 0.646, P = 0.017 and ρ = 0.567, P = 0.043, respectively). CONCLUSION: This is the largest documented case series of single quadriceps resection for STS. The study suggests that this group of patients does not show a functional deficit and therefore does not require functional reconstruction. [ABSTRACT FROM AUTHOR]

We explored the association between the serum level of cystatin C (CysC) at admission and short‐term functional outcome in patients with hypertensive intracerebral hemorrhage (HICH) without chronic kidney disease (CKD). A total of 555 patients with HICH were consecutively recruited after admission and were followed‐up for 3 months after admission. The primary outcome was poor functional outcome (modified Rankin Scale [mRS] score ≥ 3). The median serum CysC level in our cohort was 1.03 mg/L (interquartile range,.89–1.20). Patients were categorized into four groups according to the serum CysC quartiles. Multivariate logistic regression analysis revealed a negative association between serum CysC and poor functional outcome at 3‐month follow‐up (quartile [Q]1 vs. Q4: adjusted odds ratio [OR] =.260, 95% confidence interval [CI] =.098,.691, p <.001). The negative association between serum CysC and poor functional outcome at 3 months was more pronounced in subgroups with smaller hematoma volume (≤ 30 mL), and absence of secondary intraventricular hemorrhage (IVH). Addition of serum CysC to a model containing conventional risk factors improved the model performance with net reclassification index (NRI) of.426% (p <.001) and integrated discrimination improvement (IDI) of.043% (p <.001) for poor functional outcome. Serum CysC was found to be a negative predictor of poor short‐term functional outcome in HICH patients independent of renal function. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim was to investigate whether cerebral small vessel disease (CSVD) markers and the total CSVD burden are associated with functional outcome, mortality, stroke recurrence and haematoma expansion in patients with spontaneous intracerebral haemorrhage (ICH). Methods: Following a previously registered protocol (PROSPERO protocol: CRD42021287743), PubMed, Web of Science and Embase were systematically searched to identify relevant literature up to November 2021. Cohort studies that examined the association between CSVD markers (white matter hyperintensity [WMH], lacune, enlarged perivascular space [EPVS], cerebral microbleed [CMB] and brain atrophy) or CSVD burden and prognosis in patients with ICH were included. The pooled estimates were calculated using random effects models. Results: Forty‐one studies with 19,752 ICH patients were pooled in the meta‐analysis. WMH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.32–1.70), lacune (OR = 1.32, 95% CI 1.18–1.49), CMB (OR = 2.60, 95% CI 1.13–5.97) and brain atrophy (OR = 2.22, 95% CI 1.48–3.31) were associated with worse functional outcome. CSVD markers concerning increased risk of mortality were WMH (OR = 1.57, 95% CI 1.38–1.79) and brain atrophy (OR = 1.84, 95% CI 1.11–3.04), and markers concerning increased risk of stroke recurrence were WMH (OR = 1.62, 95% CI 1.28–2.04) and lacune (OR = 3.00, 95% CI 1.68–5.37). Enlarged perivascular space was not related to prognosis. There was a lack of association between CSVD markers and haematoma expansion. CSVD burden increased the risk of worse functional outcome, mortality and stroke recurrence by 57%, 150% and 44%, respectively. Conclusions: In patients with spontaneous ICH, WMH, lacune, CMB, brain atrophy and the total CSVD burden are associated with substantially increased risk of worse functional outcome, mortality or stroke recurrence. [ABSTRACT FROM AUTHOR]

Aim: Avolition, or the lack of motivation, has consistently been shown to be a significant predictor of poor psychosocial outcome, with decreased overall motivation as the single strongest predictor of poor work or school outcome in first episode psychosis. This study aimed to better understand the ways in which motivation impacts work and school functioning. This study first examined the factors related to motivation in people recovering from a recent onset of psychosis, then explored the unique interrelationships between positive symptoms, stigma, and motivation and how they influence role functioning. Methods: A total of 40 participants with early psychosis were recruited for this cross‐sectional design study; with a mean of 14.5 months of treatment prior to study assessment. Results: Neither experienced nor internalized stigma were related to motivation in this sample, but internalized stigma was related to work and school functioning. Positive symptoms were significantly inversely related to both work and school functioning and motivation, with mediation analyses showing that motivation significantly mediates the relationship between positive symptoms and role functioning. Conclusion: This relationship may shed light on the link between motivational deficits and work and school outcomes early in the course of psychosis, an area of critical importance for early intervention. [ABSTRACT FROM AUTHOR]

Background: Despite having an overall benign course, non‐traumatic non‐aneurysmal subarachnoid hemorrhage (naSAH) is still accompanied by a risk of clinical complications and poor outcomes. Risk factors and mechanisms of complications and poor outcomes after naSAH remain unknown. Our aim was to explore the effect of stress‐induced hyperglycemia (SIH) on complication rates and functional outcomes in naSAH patients. Methods: We retrospectively reviewed patients with naSAH admitted to our institution between 2013 and 2018. SIH was identified according to previous criterion. Symptomatic vasospasm, delayed cerebral infarction, and hydrocephalus were identified as main complications. Outcomes were reviewed using a modified Rankin Scale (mRS) at discharge, 3 months, and 12 months. A statistical analysis was conducted to reveal the associations of SIH with complications and outcomes. Results: A total of 244 naSAH patients were included in the cohort with 74 (30.3%) SIH. After adjusting for age, gender, hypertension, Hunt and Hess (HH) grade, modified Fisher Scale (mFS), intraventricular hemorrhage (IVH), and subarachnoid blood distribution, SIH was significantly associated with symptomatic vasospasm (p < 0.001, 12.176 [4.904–30.231]), delayed cerebral infarction (p < 0.001, 12.434 [3.850–40.161]), hydrocephalus (p = 0.008, 5.771 [1.570–21.222]), and poor outcome at 12 months (p = 0.006, 5.506 [1.632–18.581]), whereas the correlation between SIH and poor outcome at discharge (p = 0.064, 2.409 [0.951–6.100]) or 3 months (p = 0.110, 2.029 [0.852–4.833]) was not significant. Incorporation of SIH increased the area under curve (AUC) of ROC in the combined model for predicting symptomatic vasospasm (p = 0.002), delayed cerebral infarction (p = 0.024), hydrocephalus (p = 0.037), and 12‐month poor outcome (p = 0.087). Conclusions: SIH is a significant and independent risk factor for symptomatic vasospasm, delayed cerebral infarction, hydrocephalus, and long‐term poor outcome in naSAH patients. Identifying SIH early after naSAH is important for decision‐making and treatment planning. [ABSTRACT FROM AUTHOR]

Objective: To specify indications and contraindications of the modified percutaneous inferior extensor retinaculum augmentation (PIERA) technique for chronic ankle instability cases, and to introduce technique details and report surgical outcomes and complications. Methods: The PIERA technique was performed on seven patients with chronic ankle instability (four females and three males, 36.4 ± 15.1 years of age, and course of symptoms of 33.7 ± 8.8 months) from June to October 2018 in this retrospective study of case series. All patients demonstrated attenuated ligamentous tissue quality, which was confirmed using preoperative ankle MRI. IER were drew up to the distal fibula using suture anchors with the ankle in neutral position for all cases, to engage the entire IER in reconstructing the stability of the ankle. Patients were assessed using American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot (AOFAS) score and Cumberland Ankle Instability Tool (CAIT) scores pre‐ and postoperatively at the last follow‐up examination. Preoperative and postoperative outcome scores of patients were compared using paired t‐test. A p value of less than 0.05 was regarded statistically significant. Results: Mean follow‐up duration was 16.7 ± 1.6 months. The mean AOFAS score significantly improved from 66.9 ± 11.2 preoperatively to 93.7 ± 8.5 postoperatively (P = 0.001). Mean CAIT score significantly improved from 13.1 ± 4.7 preoperatively to 26.3 ± 1.8 postoperatively (P = 0.001). Patients did not report any wound healing problem, numbness, swelling, or instability at the last follow‐up examination, except for one patient who reported pain and minimal stiffness, and presented an AOFAS score of less than 80 and a CAIT score below 24. All patients returned to at least recreational sport activity level. Conclusion: The PIERA technique can improve the functional outcomes of patients with chronic ankle instability with few complications. [ABSTRACT FROM AUTHOR]

Background: Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2]). Methods: Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8‐11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS‐HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades. Results: With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS‐HN (P <.0001); correlations maintained a similar magnitude between versions 1 and 2. Forty‐six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2). Conclusions: Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios. Lay Summary: Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study.This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree. Version 2 of Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2) incorporates 2 modifications to the decision tree used by clinicians to grade mild (grade 1) safety impairments based on patterns of laryngeal penetration/aspiration on a radiographic modified barium swallow study. Key findings of this work include 1) the criterion validity of DIGESTv2 with respect to reference measures of clinician‐graded pharyngeal swallowing impairment and patient‐reported dysphagia and 2) the ordinality of DIGESTv2. [ABSTRACT FROM AUTHOR]

The heart rate (HR) trajectory is a dynamic metric that shows how HR changes over time. Previous studies have demonstrated that elevated HR is associated with stroke events. However, little research has been done on the influence of shifting HR throughout the acute period on clinical outcomes. This study aims to investigate the effect of HR trajectories on functional outcomes in patients with acute ischemic stroke (AIS). A total of 981 AIS patients were included in the study. A latent mixture model was used to assess HR trends over the first 7 days following disease onset. The patients were divided into four groups based on different HR trajectories: markedly decreasing in 48 h (T1), mildly decreasing in 48 h (T2), sustained moderate in 7 days (T3), and sustained high in 7 days (T4). Poor outcome was defined as a modified Rankin Scale (mRS) score of ≥3 in 3 months. Logistic regression was used to analyze the correlation between different HR trajectories and outcomes. The incidence of poor outcomes was 9.02%, 10.80%, 11.79%, 16.36% in T1 (n = 133), T2 (n = 352), T3 (n = 441), and T4 (n = 55) groups, respectively. Compared with T1 group, T4 group was significantly associated with a higher risk of poor outcome at 3 months (odds ratio = 3.00, 95% confidence interval = 1.06–8.54, p value =.0392). This suggests that in AIS patients, a sustained high HR trajectory is linked to a greater likelihood of poor functional outcome than a markedly decreasing HR trajectory. HR trajectories demonstrate the utility of repeated HR measurements for outcome assessment. [ABSTRACT FROM AUTHOR]

Purpose: Patella baja after total knee arthroplasty (TKA) is a common problem that is usually treated via proximal transfer of the tibial tubercle. As the long-term outcomes of this procedure are unclarified, this study aimed to investigate the changes in clinical function and radiographic patellar height during five years of follow-up. Methods: Sixty patients with patella baja after TKA who underwent proximalisation of the tibial tubercle were followed up for a mean of 71 months (range 21–153 months). The pre- and postoperative range of motion (ROM) and clinical scores (Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) were compared. The radiographic patellar height was measured with the Caton-Deschamps index (CDI), Blackburne-Peel ratio (BP), and modified Insall-Salvati index (MIS). Results: Proximalisation of the tibial tubercle resulted in a significant improvement in the ROM from 80° to 88°. The KSS and WOMAC did not improve or even worsened after the intervention. The radiographic patellar height immediately after tibial tubercle transfer was not better than prior to the intervention (CDI 0.72 vs. 0.63, p = 0.72; BP 0.66 vs. 0.61, p = 0.72; MIS 1.59 vs. 1.55, p = 1.00) and further decreased significantly so that the mean final values were worse than the values in the native joint (CDI 0.59 vs. 0.78, p = 0.001; BP 0.58 vs. 0.74, p = 0.001; MIS 1.39 vs. 1.81, p < 0.001). Conclusion: Proximalisation of the tibial tubercle in patients with patella baja after TKA does neither lead to significant improvements in the clinical outcome nor in the radiographic patellar height during long-term follow-up. Level of evidence: III [ABSTRACT FROM AUTHOR]

Herein, we present two cases of older adult patients with highly destructive changes in ankle joints (Larsen grade IV) who underwent retrograde intramedullary ankle nail fixation with fins. In both patients, bony union was achieved, and full weight‐bearing was attained at 3 months after surgery. Intramedullary retrograde ankle nails with fins improved postoperative functional outcome and disease activity score 28 in 2 cases with rheumatoid arthritis (RA) who had destructive ankle joints. These cases indicated that this implant is one of good options for elderly RA patients who affected destructive ankle joints. [ABSTRACT FROM AUTHOR]

Background: Comparative bowel functional outcomes between ultralow anterior resections (ULAR) and inter‐sphincteric resection (ISR) for similar tumour and patient characteristics is not known. Methods Single centre study of low rectal caners (<5cm from anal verge) with 1:1 propensity matching of age, sex, body mass index, prior radiation, and surgical approach (open vs. minimally invasive) was performed for the ULAR and ISR groups. Primary outcome measure was Wexner Incontinence scores and Low Anterior Resection Syndrome (LARS) score at a single time point after stoma reversal. Results: Seventy‐two matched patients were included. Median Wexner scores were five and eight for the ULAR and ISR cohorts (p = 0.006). Major incontinence (Wexner >11) was found in 5.6% versus 33% after ULAR and ISR, respectively. Major LARS (score > 29) was demonstrated in 11% versus 25% in ULAR versus ISR (p = 0.293). Majority in both groups has no LARS (score < 20), that is, 72.2% versus 63.9% in ULAR against ISR. Besides these, stool fragmentation (p < 0.001), nocturnal defecation (p < 0.001) and use of anti‐diarrhoeal medications (p = 0.023) were significantly more after ISR. Conclusions: Bowel continence was relatively inferior after ISR as compared to an ULAR for low rectal cancers in matched cohorts. Major LARS in ISR was twice as prevalent without statistical differences. [ABSTRACT FROM AUTHOR]

Background: Stroke is a leading cause of death worldwide, with a lack of effective treatments for improving the prognosis. The aim of the present study was to identify novel therapeutic targets for functional outcome after ischemic stroke ., Methods and Results: Cis-expression quantitative trait loci data for druggable genes were used as instrumental variables. The primary outcome was the modified Rankin Scale score at 3 months after ischemic stroke, evaluated as a dichotomous variable (3-6 versus 0-2) and also as an ordinal variable. Drug target Mendelian randomization, Steiger filtering analysis, and colocalization analysis were performed. Additionally, phenome-wide Mendelian randomization analysis was performed to identify the safety of the drug target genes at the genetic level. Among >2600 druggable genes, genetically predicted expression of 16 genes ( ABCC2 , ATRAID , BLK , CD93 , CHST13 , NR1H3 , NRBP1 , PI3 , RIPK4 , SEMG1 , SLC22A4 , SLC22A5 , SLCO3A1 , TEK , TLR4 , and WNT10B ) demonstrated the causal associations with ordinal modified Rankin Scale ( P <1.892×10 -5 ) or poor functional outcome (modified Rankin Scale 3-6 versus 0-2, P <1.893×10 -5 ). Steiger filtering analysis suggested potential directional stability ( P <0.05). Colocalization analysis provided further support for the associations between genetically predicted expression of ABCC2 , NRBP1 , PI3 , and SEMG1 with functional outcome after ischemic stroke. Furthermore, phenome-wide Mendelian randomization revealed additional beneficial indications and few potential safety concerns of therapeutics targeting ABCC2 , NRBP1 , PI3 , and SEMG1 , but the robustness of these results was limited by low power., Conclusions: The present study revealed 4 candidate therapeutic targets for improving functional outcome after ischemic stroke, while the underlying mechanisms need further investigation.

Background: The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS., Methods and Results: This is a prespecified propensity score-matched analysis from a prospective multicentric real-world study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]). We included patients with MIS (National Institutes of Health Stroke Scale score at admission ≤5), without prestroke disability (modified Rankin scale [mRS] score ≤2). The primary outcomes were 90-day mRS score of 0 to 2 and ordinal mRS distribution. The secondary outcomes included 90-day risk of stroke and other vascular events and 24-hour early neurological improvement or deterioration (≥2-point National Institutes of Health Stroke Scale score decrease or increase from the baseline, respectively). From 1373 patients with MIS, 240 patients treated with IVT plus DAPT were matched with 427 patients treated with DAPT alone. At 90 days, IVT plus DAPT versus DAPT alone showed similar frequency of mRS 0 to 2 (risk difference, 2.3% [95% CI -2.0% to 6.7%]; P =0.295; risk ratio, 1.03 [95% CI 0.98-1.08]; P =0.312) but more favorable ordinal mRS scores distribution (odds ratio, 0.57 [95% CI 0.41-0.79]; P <0.001). Compared with patients treated with DAPT alone, those combining IVT and DAPT had higher 24-hour early neurological improvement (risk difference, 20.9% [95% CI 13.1%-28.6%]; risk ratio, 1.59 [95% CI 1.34-1.89]; both P <0.001) and lower 90-day risk of stroke and other vascular events (hazard ratio, 0.27 [95% CI 0.08-0.90]; P =0.034). There were no differences in safety outcomes., Conclusions: According to findings from this observational study, patients with MIS may benefit in terms of better functional outcome and lower risk of recurrent events from combining IVT and DAPT versus DAPT alone without safety concerns., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05476081.

Background: We aim to identify the distinct lesion patterns and regions associated with functional outcome and inflammation in patients with acute ischemic stroke, and investigate whether the association between lesion patterns and functional outcome was mediated by inflammation., Methods and Results: We performed nonnegative matrix factorization to derived low-dimensional lesion patterns (atoms), and Bayesian linear regression models were applied to explore the associations of lesion patterns with inflammatory factors including high-sensitivity C-reactive protein and interleukin-6, as well as functional outcome (defined as modified Rankin Scale score at 3 months). The difference distribution mean and 95% highest probability density interval (HPDI) were calculated. Mediation analysis was used to examine the mediating effects of inflammation on the relationships between lesion patterns and functional outcome. Seven lesion patterns were derived from 5914 patients with acute ischemic stroke. Lesion patterns distributed in the cortical regions were associated with inflammatory response, including atom 1 (interleukin-6: mean, 0.113 [95% HPDI, 0.073-0.162]; high-sensitivity C-reactive protein: mean, 0.082 [95% HPDI, 0.038-0.123]) and atom 4 (interleukin-6: mean, 0.113 [95% HPDI, 0.071-0.167]; high-sensitivity C-reactive protein: mean, 0.108 [95% HPDI, 0.058-0.165]). These lesion patterns were also significantly associated with functional outcome (atom 1: mean, 1.958 [95% HPDI, 1.538-2.383]; atom 4: mean, 2.245 [95% HPDI, 1.773-2.741]). Mediation analysis suggested that interleukin-6 explained 15.34% and 7.47% in the association of atom 1 and atom 4 with functional outcome, respectively., Conclusions: Certain lesion patterns that are associated with both inflammation and functional outcome of acute ischemic stroke, especially cortical infarction, may play a role in functional outcome through modulating inflammatory reactions.

Background: Early seizures have been recognized as serious complications of ischemic strokes where the data are limited among Lebanese patients. This study aimed to assess the incidence and risk factors of early seizures postischemic stroke and to determine the effect of early seizures on functional outcome among Lebanese stroke patients. Methods: This was a retrospective observational study conducted between January 2017 and March 2020 on patients with acute ischemic strokes at two tertiary hospitals in Lebanon. Data were collected from patients' medical records at each site through a well‐designed data collection sheet. Early seizures were defined as seizures occurring within 7 days after acute stroke. Functional outcome was assessed at discharge, according to modified Rankin scale (mRS). Results: Of 140 enrolled patients, early seizure developed in 12 patients (8.6%) with mean age of 68.42 ± 9.89 years and 8 (67%) were females. Independent risk factors for early seizure development were female gender and cortical involvement. Moreover, early seizure development was not associated with higher disability and mortality at hospital discharge. Conclusion: The findings of the study highlight that early seizures occurred more commonly in patients with cortical involvement and female gender. In addition, early seizures did not impair functional outcome in our study, however; further studies are needed to predict patients at risk of early seizure so that appropriate prevention and treatment strategies can be implemented promptly. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of frailty, alone and in combination with post-operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF).Methods: This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5-edition criteria. A 22-items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log-binomial regression model was used to assess the effect of frailty and POD on CAS.Results: A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6-89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non-frail patients (68.3% vs. 53.8%, p < 0.001) In a regression adjusted for confounders, frailty alone (Relative Risk, RR = 1.33, 95% Confidence Intervals, CI = 1.14-1.55) and POD alone (RR 1.38, 95% CI = 1.2-1.59) were associated with poor functional status at discharge; when combined, frailty and POD had an interaction, yielding a mild increase in the risk of poor outcome (RR 1.47, 95% CI = 1.28-1.69).Conclusions: In older patients undergoing HF surgery, frailty, POD and their combination, are associated with poor functional status at discharge. [ABSTRACT FROM AUTHOR]

Background and purpose: Previous studies have established that vitamin D was associated with stroke. The purpose of this study was to investigate the relationship between vitamin D and 5‐year outcome of patients with stroke including acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) stroke. Methods: Serum 25‐hydroxyvitamin D levels were prospectively analyzed in patients admitted to the First Affiliated Hospital of Wenzhou Medical University from 2013 to 2015. Modified Rankin scale (mRS) was used to evaluate their 5‐year functional outcome, and univariate and multivariate logistic regressions were applied to evaluate the effects of vitamin D on stroke outcome. Results: In total, 668 patients diagnosed with stroke were recruited, and 420 completed the 5‐year follow‐up. Ninety‐five patients experienced poor outcome in the 5 years since stroke onset. Vitamin D levels in patients with poor outcome showed significant differences compared to good outcome patients (p <.001). In multivariable logistic regression analysis, after adjusting the potential confounders, the 5‐year functional outcome was significantly associated with vitamin D levels. Stroke patients with vitamin D levels less than 38.4 nmol/L had a higher risk for poor outcome compared with those with vitamin D level over 71.4 nmol/L at 5‐year (odds ratio [OR] = 3.66, 95% confidence interval [CI] = 1.42–9.45, p =.007), which was consistent with AIS patients (OR = 6.36, 95% CI = 1.89–21.44, p =.003). Conclusion: Vitamin D level less than 38.4 nmol/L at admission is a potential risk biomarker for poor functional outcome at 5‐year prognosis in AIS patients, which might provide new ideas for the prognostic assessment of stroke. [ABSTRACT FROM AUTHOR]

Aim: The aim was to study anorectal function in long‐term survivors after combined, curatively intended, chemoradiotherapy and endorectal brachytherapy for low rectal cancer. Methods: This was a case–control design. We compared anorectal function by anal manometry, anal functional lumen imaging probe (EndoFLIP) and rectal bag distension in rectal cancer patients (RCPs) and healthy, normal subjects (NSs). Symptoms were assessed by the low anterior resection syndrome (LARS) and Wexner faecal incontinence scores. Results: Thirteen RCPs (12 men, median age 68 years, range 52–92) after 60 Gy radiotherapy, 5 Gy endorectal brachytherapy and oral tegafur‐uracil with complete clinical response (median time since treatment 2.8 years, range 2.2–5.6) were compared to 15 NSs (14 men, median age 64 years, range 47–75). RCPs had lower than normal anal resting pressure, 38.6 mmHg (range 8.8–67.7) versus 58.8 mmHg (25.7–105.2) (P < 0.003), and squeeze pressure, 117 mmHg (55.2–203) versus 188 mmHg (103–248) (P < 0.01). Squeeze‐induced pressure increase recorded by EndoFLIP was also lower in RCPs (q > 7.56, P < 0.001) as was the anal canal resistance to increasing distension (q = 3.13, P < 0.05). No differences in median rectal volume at first sensation (72 [22–158] vs. 82 [36–190] ml, P = 0.4) or at urge to defaecate (107 [42–227] vs. 132 [59–334] ml, P = 0.2) were found. However, maximum tolerable rectal volume was lower in RCPs (145 [59–319] vs. 222 [106–447] ml, P < 0.02). The median (range) low anterior resection syndrome score was 27 (0–39) for RCPs and 7 (0–23) for NSs (P < 0.001), while the Wexner score was 0 (0–5) versus 0 (0–4) (P = 0.56). Conclusion: Radiotherapy combined with endorectal brachytherapy for rectal cancer causes long‐term anorectal symptoms, impaired anal sphincter function and reduced rectal capacity. [ABSTRACT FROM AUTHOR]

Aim: Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high‐risk (CHR) for psychosis. Methods: Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. Results: Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's <.01). In SZ, higher DPBs were associated with greater negative symptoms (r's =.31‐.37, p's <.01), poorer social functioning and impaired social cognition (r = −.40, P <.001). In CHR, greater DPBs were associated with poorer social functioning (r = −.52, P <.05) and impairments in the neurocognitive domains of reasoning (r = −.48, P <.05) and processing speed (r = −.41, P <.05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. Conclusions: Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness. [ABSTRACT FROM AUTHOR]

Background and Purpose: A prior study found a link between post-stroke blood-brain barrier disruption and functional outcomes. The current study aimed to replicate this finding in a cohort of patients recruited in the context of a randomized clinical trial.Methods: The ACTION trial was a study of natalizumab in acute stroke patients. Patients with MRI-perfusion weighted imaging (PWI) were included in this post-hoc analysis. Blood-brain permeability images (BBPI) were calculated from the PWI source images. Mean BBPI values from the 24 h time point were compared with modified Rankin scores (mRS) at 5, 30, and 90-day assessments using linear regression. Good functional outcome (mRS< = 1) was compared with mean BBPI using logistic regression.Results: One hundred and nineteen patients were included in the analysis (median age = 74, 43% female). Higher mean BBPI was associated with worse mRS at 5 days (p = 0.002; r2 = 0.078) and 30 days (p = 0.036; r2 = 0.039) but did not reach statistical significance at 90 days (p = 0.30; r2 = 0.010). When removing high-value outliers, all outcome measures showed a stronger relationship with mean BBPI. Logistic regression found that with every 1% increase in mean BBPI measured 24 h after the stroke, the likelihood of achieving a good functional outcome at 90 days is decreased by half (OR = 0.53; CI = 0.30:0.95; p = 0.032).Conclusions: With sufficient image quality, elevated BBPI measured in the days after an ischemic event is predictive of worse functional outcome and may serve as a biomarker for post-stroke inflammation. [ABSTRACT FROM AUTHOR]

Purpose: The optimal rehabilitation strategy after a unicompartmental knee arthroplasty (UKA) is unclear. This study aims to compare the effect of transitioning from a supervised to a self-management rehabilitation regime by pilot study of patient outcomes subsequent to UKA surgery. Methods: Fifty consecutive patients scheduled to undergo unilateral UKA surgery at our institution between 22nd February 2016 and 18thof January 2017 were prospectively identified via local medical database and included. Performed UKAs were grouped into two cohorts, Supervised Cohort and Self-management Cohort, temporally separated by introduction of new rehabilitation. Self-management Cohort(n = 25) received an extensive inpatient rehabilitation regime along with outpatient referral to rehabilitation center. The Self-management Cohort(n = 25) were only instructed in use of crutches and free ambulation at own accord. Follow-up (F/U) was 1 year from receiving UKA. A range of outcomes were recorded, and between-cohort differences compared: knee joint range of motion, pain and functional limitations, length of stay (LOS), readmission rate, pain during activity and rest, and knee circumference. Results: Complete data was obtained for n = 45 patients. The mean between-cohort difference in ROM (range of motion) from preoperatively to discharge was 15.4 degrees (CI:5.2,25.8, p = 0.004), favoring the supervised regime, with no difference detected in any outcome at 3- or 12 months F/U. Median LOS was 1 day in both cohorts. Conclusion: Transition to a simple rehabilitation regime following UKA surgery was associated with decreased ROM at discharge, which was not present at 3-month F/U. We found no other between-cohort differences for any other outcomes at 3- and 12-month F/U including functional limitations, although the study was likely underpowered for these outcomes. We encourage large-scale replication of these findings using randomized designs. Level of evidence: Therapeutic level II [ABSTRACT FROM AUTHOR]

Introduction: Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke mechanism, neurological poststroke complications and remaining vascular risk factors and the presence of comorbid PSD and PSA, termed poststroke emotional distress (PSED). Methods: This was a retrospective analysis of a prospectively compiled medical records database of consecutive patients evaluated during a follow‐up visit 3‐ to 4‐month poststroke. HAD scale was used to define PSED category (PSD+PSA vs. NoPSD+NoPSA). Stroke mechanism and poststroke complications were identified clinically or using appropriate scales. Their association with PSED was tested using a multivariate logistic regression model. Results: The sample included 2,300 patients (male: 64.8%); 19% had a PSED and 56.39% were free of any depression or anxiety. The most frequent poststroke complications were fatigue/fatigability (58.4%), sleep problems (26.7%), and pain (20.4%). While no association was observed between PSED and stroke mechanism, higher functional disability (OR:1.572), lower cognitive abilities (OR:0.953), sleep problems (OR:2.334), pain (OR:1.478), fatigue/fatigability (OR:2.331), and abnormal movements (OR:2.380) were all independent risk factors. Persisting tobacco consumption (OR:1.360) was the only vascular significant risk factor. Conclusions: The frequency of comorbid PSED remains high (1/5 patient) despite improved awareness of these conditions. The association between poststroke complications and the presence of PSED emphasizes the need for standardized neurological and psychological evaluations at follow‐up. These results foster the need to improve the management of addictive behaviors to reduce the burden of PSED. [ABSTRACT FROM AUTHOR]