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Purpose: The primary objective of this study was to explore the potential disparity in postoperative fistula occurrence rates between patients who undergo (partial) lateral parotidectomy and those who undergo the extracapsular dissection technique for the management of benign parotid gland tumours. Methods: A consecutive series of 363 patients treated with (partial) lateral parotidectomy and extracapsular dissection technique for benign parotid gland tumours at one tertiary centre between 2018 and 2022 were included. To evaluate the impact of the surgical technique and possible other risk factors (tumour location, tumour size, Body Mass Index, age, smoking, diabetes mellitus, arterial hypertension) for the development of fistulas, multivariate logistic regression analyses using backward lection were applied to estimate odds ratios (ORs) and 95%‐confidence intervals (CIs). Results: In 363 patients, 21 patients (5.8%) developed a fistula. Patients who underwent (partial) lateral parotidectomy had three times higher chance of developing a fistula compared to patients who were operated using the extracapsular dissection technique (ORadjusted = 2.6, 4.1% vs. 12.5%, p = 0.044). In the multivariate analyses, no other risk factors for the development of fistulas were statistically significant in this cohort. The incidence of facial nerve paralysis was not significantly different between the extracapsular dissection and lateral parotidectomy group (5/73 = 6.8% vs. 11/290 = 3.8%, p = 0.333). Conclusion: Fistulas occur more often in patients treated by means of a (partial) lateral parotidectomy approach compared to patients treated using the extracapsular dissection technique. Therefore, surgeons should be vigilant about postoperative fistula risks in lateral parotidectomy and consider preventive measures. [ABSTRACT FROM AUTHOR]

Background: Ear and temporal bone squamous cell carcinoma (ETBSCC) is a rare and aggressive malignant tumor with minimal clinicopathological studies. The object of this study was to retrospectively evaluate the predictive effect of clinicopathological variables on the 5‐year overall survival (OS) rate of ETBSCC patients in a single tertiary medical center in Tianjin, China. Methods: A cohort of 44 patients with diagnosed ETBSCC from December 2012 to August 2022 were retrospectively studied. Univariate and multivariate analysis were, respectively, performed for the assessment of clinicopathological predictors, including sex, age, history of chronic suppurative otitis media (CSOM), lesion side, diameter, the choice of surgical approach, parotidectomy, neck dissection, adjuvant therapies, T stage, lymph node metastasis, tumor grade, margin, perineural invasion (PNI), and Ki‐67 index. Results: Seventeen females and 27 males were included, with the mean age of 65 years old, ranging from 36 to 89 years. The 5‐year OS rate was 43% (mean 51 months, 95% confidence interval [CI] = 39–64). Significant prediction of a worse prognosis for 5‐year OS rate was observed under univariate analysis for advanced T stage, positive margin, identified PNI, and higher Ki‐67 index, respectively. Advanced T stage was confirmed to be an independent prognostic factor strongly affecting 5‐year OS rate among this cohort of patients using a multivariate cox proportional hazard model. Conclusion: We found that clinicopathological parameters, especially postoperative pathological parameters, play a critical role in predicting the prognosis of ETBSCC patients. [ABSTRACT FROM AUTHOR]

Aim: Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD‐associated peritonitis in the past decades. Methods: This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups. Results: A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000–2008 period, the 2‐year peritonitis‐free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009–2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000–2008 period. However, this was not evident in the 2009–2017 period. Conclusions: The incidence of PD‐associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD‐associated peritonitis. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient‐related and implant‐related factors associated with PLCBL. Methods: This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm. Results: A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11–3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73–6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57–6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16–3.73), with bone‐level platform‐abutment connection (OR = 4.73, 95% CI = 1.94–11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84–7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28–0.84). Conclusion: The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone‐level platform‐abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusion This study aimed to report the clinical and radiographic results of 2.8 mm two‐piece narrow diameter implant (NDI) supporting fixed restorations.Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow‐up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated.An implant failed during the follow‐up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33–9.00) and 7.42 ± 1.03 (range: 3.67–9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25–4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri‐implantitis.Within the limitation of the study, the results indicate that the use of two‐piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal–lingual width is viable. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Immune checkpoint inhibitors, such as nivolumab, combined with small molecule antiangiogenic receptor tyrosine kinase inhibitors (TKIs), present a promising strategy for future immunotherapy. However, combination therapy can lead to specific adverse drug reactions (ADRs) in various clinical settings. Current research on the ADRs associated with combination therapy is limited. Our study aims to assess the safety of combination therapy.We extracted ADR reports on combination therapy from the Food and Drug Administration (FDA) Adverse Event Reporting System database, covering the period from the first quarter of 2012 to the third quarter of 2023, and conducted a large‐scale retrospective study. We evaluated ADR risk signals using the reporting odds ratio (ROR) and calculated the Ro/e ratio to compare the differences in the risk of fatal ADRs among various tumour types.We comprehensively reported the occurrence of ADRs in pan‐cancer patients undergoing combination therapy. The combination therapy significantly increased the risk of sensitive skin (ROR: 231.43, 95% CI: 55.01–973.72, P < .05), metastatic renal cell carcinoma (ROR: 220.71, 95% CI: 28.99–1695.41, P < .05) and renal cell carcinoma (ROR: 188.22, 95% CI: 44.24–800.85, P < .05). We also compared the differences in ADRs resulting from different small molecule drug combinations, as well as the differences in ADRs among patients with different types of tumours under combination therapy. Furthermore, we analysed the characteristics of patients prone to experiencing fatal ADRs.These results can help enhance understanding of the ADRs commonly associated with combination therapy and assist oncologists in formulating screening protocols. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Artery and vein (AV) clamps can control venous bleeding in the surgical field and prevent carbon dioxide embolism, especially when large veins are expected to open. However, whether AV clamps cause more renal damage than artery‐only (AO) clamps remains unclear. This study aimed to compare renal function and blood loss in surgeries using AO and AV clamps based on high RENAL nephrometry scores (RNS) in robot‐assisted partial nephrectomy (RAPN).We retrospectively analyzed the medical records of 500 patients who underwent RAPN between March 2016 and December 2021. We performed 1:1 propensity matching for these patients.A total of 340 patients with pathological malignancies who were followed up for at least 12 months were included in this analysis. A total of 291 patients with AO clamping and 49 patients with AV clamping were included. Overall, the AV clamp group had higher total RNSs and larger diameters than the AO clamp group. Propensity score‐matched analysis included 37 patients in each clamp group. The median warm ischemia times of the AV and AO clamps were 25 and 22 min, respectively, with no significant difference. There were no statistically significant differences between the groups in the amount of blood loss, rate of acute kidney injury (AKI), or renal function at 1, 3, or 12 months post‐RAPN.Compared with the AO clamp, the AV clamp did not have a detrimental impact on blood loss or renal dysfunction. Consequently, AV clamps may be considered for patients presenting with moderate‐to‐high‐complexity RNSs. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Endoscopic full‐thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.We retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure‐related parameters, adverse events (AEs), and follow‐up outcomes were assessed in all patients.The en‐bloc resection and en‐bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty‐one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, P = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow‐up period of 3.7 ± 2.3 years.EFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted. [ABSTRACT FROM AUTHOR]

Background: Plasma cell leukemia (PCL) is a rare monoclonal gammopathy, associated with short survival. Because of its very low incidence, only a few cohorts have been reported and thus, information on this disease is scarce. The goal of this study was to better understand the clinical features, prognostic factors, and efficacy of modern treatments in both primary PCL (pPCL) and secondary PCL (sPCL). Methods: We performed a retrospective, multicenter study of patients diagnosed with PCL, defined as circulating plasma cells ≥20% of total leukocytes and/or ≥2 × 109/L. Results: We identified 99 eligible PCL patients, of whom 33 were pPCL and 66 were sPCL. The median progression‐free survival (PFS) to frontline treatment and overall survival (OS) were, respectively, 4.8 (95% CI, 0.4–9.2) and 18.3 months (95% CI, 0.0–39.0) for pPCL and 0.8 (95% CI, 0.5–1.1) and 1.2 months (95% CI, 0.9–1.5) for sPCL (both p < 0.001). We observed no improvement in OS over time (2005–2012 vs. 2013–2020, p = 0.629 for pPCL and p = 0.329 for sPCL). Finally, our data suggested that sPCL originates from a high‐risk multiple myeloma (MM) population with a short OS (median 30.2 months), early relapse after stem cell transplant (median 11.9 months) and a high proportion of patients with multiple cytogenetic abnormalities (36% with ≥2 abnormalities). Conclusions: This study is one of the largest PCL cohorts reported. We are also the first to investigate characteristics of MM before its transformation into sPCL and demonstrate that high‐risk biologic features already present at the time of MM diagnosis. Moreover, our data highlights the lack of improvement in PCL survival in recent years and the urgent need for better treatment options. [ABSTRACT FROM AUTHOR]

Objective Materials and Methods Results Conclusions This study aimed to assess clinical efficacy of 4‐mm‐short implants in patients with posterior severe vertical bone atrophy in the medium‐ and long‐term follow‐up.Patients rehabilitated with 4‐mm‐short implants in the posterior atrophic jaws, with a minimum follow‐up of 3 years post‐loading, were included in the study. Data were collected for eligible patients, and marginal bone loss (MBL) for each implant was evaluated. The research outcomes were implant failure, MBL and complications.A total of 212 patients with 496 implants were included, resulting in a mean follow‐up of 8.02 ± 2.17 years. The implant survival rate was 95.36% (95% CI: 93.12%–97.04%). More implant failures were observed in the maxilla (p = .02) and fewer failures were observed in patients undergoing more number of hygienic sessions per year (p < .001). The average MBL after 1‐year‐loading was 0.47 mm, increasing to 0.59 mm after 10 years; after 3 years no statistically significant increase in MBL was observed. Maxillary implants showed greater bone loss than mandibular ones (p < .001). More frequent professional oral hygiene sessions per year resulted being related with reduced MBL (p < .001).Four‐mm‐short implants showed high survival rates with an up to 10‐year follow‐up. Their use can offer a fixed prosthetic solution for patients with posterior vertical bone atrophy, minimizing surgical invasiveness, rehabilitative times and costs. [ABSTRACT FROM AUTHOR]

Objective: Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium‐ to long‐term follow‐up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment. Methods: This was a retrospective study that included 273 patients with single‐level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1‐day, 1‐week, 1‐year, and 5‐year follow‐ups. Complications, recurrences, and 5‐year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t‐tests, repeated measures analysis of variance (ANOVA), and χ2 tests. Results: Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow‐ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895). Conclusion: This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusions The objective of this long‐term retrospective study was to evaluate the fracture rate and the risk factors associated with the fracture of 3.3 mm narrow diameter implants (NDIs).A total of 524 records of patients rehabilitated with 3.3 mm NDIs between 1997 and 2015 were assessed. Data on patients, implants, and prostheses were collected, and descriptive analysis of the variables was performed. NDIs were separated into 2 groups: “fractured” and “non‐fractured”, and a multilevel logistic regression model was applied to identify the risk factors associated with NDI fracture.Eighty‐four patients were removed from the analysis for interrupting follow‐up or presenting failures other than fractures. Of the 440 patients included (64.66 ± 13.4 years), 272 were females (61.8%), and 168 males (38.2%), and mean follow‐up time was 129 ± 47.1 months. Of the 1428 NDIs, 15 (1.05%) in 9 patients (2.04%) fractured during the studied period. Ten fractures (66.66%) happened in 6 patients (66.66%) showing signs of parafunction. NDI with modified sandblasted, large grit, acid‐etched surface was the only implant variable to show a protective statistical significance (p = .0439).NDI fracture was a rare event in the studied sample. NDIs manufactured with modified sandblasted, large grit, acid‐etched surface may provide extra protection against NDI fracture. Patient‐specific factors and implant characteristics should be carefully considered to limit the risk of fracture of 3.3 mm NDIs. [ABSTRACT FROM AUTHOR]

Aim: For women, being underweight increases their susceptibility to osteoporosis, anemia, and other conditions and affects the weight of their infants and the well‐being of future generations. This study examined the association between low pre‐pregnancy body mass index (BMI) and low birthweight using health insurance claims data and health checkup data, including weight measurements. Methods: We used health insurance claims data and health checkup data (JMDC, Tokyo, Japan) of women and their newborns in Japan between 2006 and 2020. We used checkup data, which included more accurate weight measurements and blood test‐based diagnoses of anemia and hyperlipidemia compared to self‐reported data. Maternal pre‐pregnancy BMI was compared across three groups: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), and overweight (BMI ≥25.0 kg/m2). The primary outcome was low birthweight (<2500 g), and secondary outcome was preterm childbirth. Logistic regression analyses were conducted to compare outcomes in the three groups by BMI. The underweight BMI group was considered as the reference group. A subgroup analysis was performed by maternal age. Results: In total, 16 363 mothers (underweight, 3418 [21%], normal weight, 11 493 [70%], and overweight, 1452 [8.9%]) were included. The risk of primary outcome (low birthweight) was significantly lower in the normal weight group than in the underweight group (4.6% vs. 5.7%; adjusted odds ratio 0.78 [95% confidence interval: 0.65–0.96]). In the subgroup analyses, no significant differences were noted in the incidences of low birthweight and preterm childbirth between maternal age groups. Conclusions: Pre‐pregnancy BMI was associated with an increased risk of delivering low‐birthweight infant. Awareness about the importance of women's pre‐pregnancy health and appropriate BMI may reduce the incidence of low birthweight. [ABSTRACT FROM AUTHOR]

Background: The clinical strategy of oral supplementation of Vitamin D (VD) as a preventive and therapeutic measure for warts needs further exploration. Methods: The clinical data of patients with skin diseases who visited the Children's Hospital affiliated with Chongqing Medical University from February 2018 to June 2024 were collected. The serum VD levels in patients with warts (common warts, flat warts, and plantar warts) and patients with other common skin diseases (atopic dermatitis, psoriasis, alopecia areata, vitiligo, and chronic urticaria) were compared. Two‐sample bidirectional Mendelian randomization (MR) analysis was performed to investigate potential causal associations between VD and warts. Results: The average serum VD level of children with warts was 23.27 ± 7.07 ng/mL, which showed no statistically significant difference compared to children with other common skin diseases. The inverse variance weighted (IVW) method analysis indicated a positive causal relationship between VD and warts (Odds Ratio [OR] = 1.86, [95% CI: 1.19−2.92], p = 0.007). Sensitivity analysis did not show any indication of horizontal pleiotropy or heterogeneity. The MR‐PRESSO method did not identify any outliers. Conclusion: The levels of serum VD in children with warts do not significantly decrease compared to children with other common skin conditions. The evidence from the MR analysis indicates a positive causal relationship between VD and warts, suggesting caution in supplementing VD for children with warts who have normal or elevated serum VD levels. Further clinical studies are needed for validation in the future. [ABSTRACT FROM AUTHOR]

Objectives: The relationship between adherence to professional oral maintenance visits and tooth loss is generally accepted in periodontal treatment; however, this relationship has not been clarified in general dental practices. We evaluated the effectiveness of adherence to professional maintenance by a retrospective survey in a private practice. Methods: We retrospectively extracted data of 395 patients in a general dental practice who had been followed for more than 20 years. For comparisons, two patient groups were created based on oral maintenance rates: a high‐ (≥75%) and a low‐ (<75%) adherence groups. Additionally, multiple logistic regression analysis for tooth loss was conducted with the same two adherence groups and three adherence groups (<50%, ≥50% and <75% and ≥75%), adjusting with risk factors including sex, age, decayed, missing, and filled teeth (DMFT), periodontal status, smoking status, and diabetes at the beginning of maintenance. Results: The number of teeth lost and increased DMFT over time were significantly lower in the high‐adherence group than in the low‐adherence group. Multiple logistic regression analysis for tooth loss in the two adherence groups yielded an odds ratio (95% confidence interval) of 6.50 (3.73–11.32) in the low‐adherence group relative to the high‐adherence group. Further analysis with the three adherence groups showed highest risk in the low‐adherence group and a higher risk in the moderate‐adherence group than the high‐adherence group. Conclusions: Patients with high adherence to maintenance schedules for more than 20 years demonstrated significantly less tooth loss. Dental practitioners should promote high adherence to professional maintenance in general dental practices. [ABSTRACT FROM AUTHOR]

Achondroplasia (ACH) is a rare, autosomal dominant skeletal dysplasia characterized by short stature, characteristic facial configuration, and trident hands. Before vosoritide approval in Japan, patients with ACH could start growth hormone (GH) treatment at age 3 years. However, ACH and its treatment in young Japanese children have not been studied. This retrospective, longitudinal, medical records‐based cohort study (before vosoritide approval) summarized symptoms, complications, monitoring, surgery/interventions, and height with/without GH in Japanese patients with ACH <5 years. Complications were observed in 89.2% of all 37 patients; 75.7% required surgery or intervention. All patients were monitored by magnetic resonance imaging; 73.0% had foramen magnum stenosis, while 54.1% had Achondroplasia Foramen Magnum Score 3 or 4. Of 28 GH‐treated patients, 22 initiating at age 3 years were generally taller after 12 months versus 9 non‐GH‐treated patients. Mean annual growth velocity significantly increased from age 2 to 3 versus 3 to 4 years in GH‐treated patients (4.37 vs. 7.23 cm/year; p = 0.0014), but not in non‐GH‐treated patients (4.94 vs. 4.20 cm/year). The mean height at age 4 years with/without GH was 83.6/79.8 cm. These results improve our understanding of young patients with ACH in Japan and confirm that early diagnosis of ACH and monitoring of complications help facilitate appropriate interventions. [ABSTRACT FROM AUTHOR]

This study assessed the influence of diverse variables on the outcome of nonsurgical root canal treatment/retreatment. In general, 304 teeth from 218 patients were treated/retreated and the outcome evaluated by the periapical index (PAI). Teeth with apical periodontitis lesions that have not completely healed were classified as success or failure based on lenient and rigid criteria, respectively. Findings were evaluated using a logistic regression analysis. The overall success rates were 74% and 82% using the PAI‐rigid and lenient success criteria, respectively. Specifically for treatment, the success rates were 73% (rigid) and 82% (lenient), while for retreatment they were 78% (rigid) and 83% (lenient). The treatment outcome was negatively affected by overextension, presence of preoperative lesion, lesion size >10 mm, and higher number of treatment visits (with no intracanal medication). Regarding retreatment, the chance of success was greater for teeth with adequate coronal restorations. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the correlation between C‐peptide index (CPI) at 2 h post‐meal and endogenous insulin secretory capacity and to develop clinical models to predict the possibility of withdrawal from insulin therapy in patients with type 2 diabetes. Method: This was a single‐centre retrospective study of patients with type 2 diabetes admitted to our hospital. Patients were divided into a withdrawal group (n = 72) and a non‐withdrawal group (n = 75) based on whether they were able to withdraw from insulin therapy at discharge, and the correlation between CPI at 2 h after meal and diabetes‐related parameters was evaluated. In addition, we created two clinical models to predict the possibility of withdrawal from insulin therapy using machine learning. Results: The glycated haemoglobin values of the study participants were 87.8 ± 22.6 mmol/mo. The CPI at 2 h post‐meal was 1.93 ± 1.28 in the non‐withdrawal group and 2.97 ± 2.07 in the withdrawal group (p < 0.001). CPI at 2 h post‐meal was an independent predictor of withdrawal from insulin therapy. In addition, CPI at 2 h post‐meal was a better predictor than fasting CPI. Six factors associated with insulin therapy withdrawal (age, duration of diabetes, creatinine, alanine aminotransferase, insulin therapy until hospitalization, and CPI at 2 h post‐meal) were used to generate two clinical models by machine learning. The accuracy of the generated clinical models ranged from 78.3% to 82.6%. Conclusion: The CPI at 2 h post‐meal is a clinically useful measure of endogenous insulin secretory capacity under non‐fasting conditions. [ABSTRACT FROM AUTHOR]

Aim: In this study, we aimed to investigate patient characteristics, efficacy, prognostic factors, and safety of olaparib maintenance therapy for platinum‐sensitive recurrent ovarian cancer at our institution. Methods: Patients responding to platinum‐based therapy and starting olaparib maintenance therapy for recurrent epithelial ovarian, fallopian tube, or peritoneal cancer at Kurume University Hospital between January 2018 and November 2021 were enrolled in the study. Their data were extracted retrospectively from medical records. Results: In all, 50 patients were included. The median (range) age of the patients, follow‐up time, and duration of olaparib maintenance therapy were 62 (39–87) years, 21.6 (2.2–45.9) months, and 7.2 (2–45.9) months, respectively. Among the 29 patients tested for homologous recombination (HR) status, 22 (75.9%) were positive for HR deficiency (HRD), 12 (54.5%) of whom had BRCA‐positive tumors. The median progression‐free survival was 8.9 months (95% confidence interval: 6.2–12.6), and the median overall survival was 27.1 months (95% confidence interval: 22.5–40.3). Multivariate analysis of prognostic factors revealed that HRD was an independent prognostic factor for both progression‐free survival and overall survival. The most common adverse event was nausea (any grade, n = 30, 60%), resulting in drug interruption (n = 23, 46%), dose reduction (n = 17, 34%), and discontinuation of treatment (n = 1, 2%). Conclusion: Olaparib maintenance therapy for recurrent platinum‐sensitive ovarian cancer at our institution was effective, with acceptable adverse events. HRD was the most significant prognostic factor for patients with recurrent platinum‐sensitive ovarian cancer. [ABSTRACT FROM AUTHOR]

Objective: Despite the established success of total knee arthroplasty (TKA) with end‐stage osteoarthritis, there is a notable scarcity of research on its long‐term outcomes in individuals suffering from end‐stage Kashin–Beck disease (KBD). This retrospective study aimed to assess the long‐term outcomes and effectiveness of clinical function, quality of life, and complications of TKA and end‐stage KBD patients in Tibetan highland areas. Methods: The retrospective cohort included 43 KBD patients, comprising a total of 59 knees, who had undergone TKA at West China Hospital, Sichuan University between 2008 and 2021. Patients were subsequently followed up for a minimum of 3 years, and received rigorous radiological and clinical assessments at 3, 6, and 12 months post surgery, followed by annual examinations thereafter. The evaluation included various efficacy indices, including visual analogue scale (VAS) scores, hospital for special surgery (HSS) scores, functional score for adult Tibetans with Kashin–Beck disease (FSAT‐KBD), and radiographic findings. Comparison of indicators within the same group was conducted using one‐way repeated‐measures analysis of variance or paired sample t‐tests, whereas between‐group differences were compared using an independent t‐test. Results: Throughout the average follow‐up duration of 10.8 years, patients experienced a substantial reduction in knee pain and noteworthy functional improvement. The VAS scores decreased significantly from 77.47 ± 4.12 mm before surgery to 10.91 ± 1.97 mm after surgery, indicating considerable alleviation of knee pain. The HSS scores improved markedly, increasing from 44.26 ± 4.95 preoperatively to 91.26 ± 4.37, indicating enhanced joint function. Similarly, the FSAT‐KBD exhibited positive progression, increasing from 25.90 ± 3.12 to 36.95 ± 3.54. Importantly, at the last follow‐up, none of the patients presented with periprosthetic infection, prosthesis loosening, or periprosthetic fracture. Conclusion: At long‐term follow‐up, compared with patients in the preoperative period, patients in Tibetan highland areas with KBD of the knee who underwent TKA benefited from a significant reduction in pain, improvement in joint function, and satisfactory improvement in quality of life. [ABSTRACT FROM AUTHOR]

Objective: Primary joint arthroplasty (JA) is one of the most common operating room (OR) procedures, with knee and hip arthroplasties being listed in the top five most frequent OR procedures and while not as common, shoulder arthroplasties are increasing at greater rates than knee and hip arthroplasties. Periprosthetic joint/shoulder infections (PJI/PSI) are a devastating complication of primary JAs with infection prevention deemed as the single most important strategy in combating them. The objective of this study was to retrospectively evaluate the efficacy of XPERIENCE® Advanced Surgical Irrigation (XP) in preventing PJI following primary joint arthroplasty. Methods: This is a retrospective study of primary knee, hip and shoulder arthroplasties that were performed by multiple orthopedic surgeons at a single hospital setting. XPERIENCE was used as an intraoperative surgical irrigant either solely, or with other intraoperative practices for prevention of infection. Incidence of acute PJI occurring within 90 days of index surgery were retrospectively collated. Results: Four hundred and twenty‐three (423) primary joint replacement surgeries treated intraoperatively with XP, were evaluated for acute PJI incidence. Retrospective evaluations determined that 95% of the subjects had at least one risk factor predisposing them to PJI. There were zero PJIs diagnosed in the knee and hip arthroplasty cohorts and zero PSIs diagnosed in the shoulder arthroplasty cohorts. Conclusion: The absence of PJI/PSI diagnoses in the JA cohorts treated intraoperatively with XP indicates that it could be an efficacious antimicrobial irrigant in preventing PJI, and warrants being evaluated in prospective, randomized controlled clinical trials as the sole intraoperative irrigant, as well as in combination with the other intraoperative infection prevention regimens evaluated in this retrospective study. [ABSTRACT FROM AUTHOR]

Background: The total glucoside of paeony (TGP) is recognized for its immunomodulatory properties and anti‐inflammatory effects. This study evaluates the efficacy of TGP combined with oral mini‐pulse therapy (OMP) and narrow‐band ultraviolet B (NB‐UVB) in treating active nonsegmental vitiligo (NSV). Materials and methods: The combination therapy was contrasted against those from a group treated solely with OMP and NB‐UVB. Data from 62 patients undergoing TGP combination treatment and 55 without were analyzed over a 3‐month period. After 6 months, the differences in recurrence rate were investigated by follow‐up. Results: The findings indicate that integrating TGP may yield superior outcomes compared to OMP + NB‐UVB alone. Moreover, the patient's oxidative stress makers were significantly reduced after the treatment. The majority of patients in the TGP cohort exhibited enhanced skin pigmentation over the duration. Notably, no increase in side effects or recurrence was observed in this group. Especially, patients with vitiligo on their head and neck experienced pronounced improvements. Conclusion: The efficacy of the combination treatment group was better than that of the control group at 2 and 3 months, and there was no difference in recurrence rate and side effects, suggesting that TGP may continue to show efficacy in NSV for a longer period of time by reducing the level of oxidative stress, and is especially suitable for patients with head and neck lesions. [ABSTRACT FROM AUTHOR]

Objective: We aimed to examine the factors associated with treatment outcomes in patients with Alzheimer's disease (AD) after 1 year of acetylcholinesterase inhibitors (AChEI) treatment. Method: We obtained electronic medical records from a medical center in Southern Taiwan between January 2015 and September 2021. Participants aged ≥60 who were newly diagnosed with AD and had been prescribed AChEIs were included. Cognitive assessments were performed before the AChEIs were prescribed and at the 1 year follow‐up. Cognition progressors were defined as a Mini‐Mental State Examination decline of >3 or a Clinical Dementia Rating decline of ≥1 after 1 year of AChEI treatment. The relationship between the baseline characteristics and cognitive status after follow‐up was investigated using logistic regression analysis after adjusting for potential confounders. Results: A total of 1370 patients were included in our study (mean age, 79.86 ± 8.14 years). After adjustment, the body mass index (BMI) was found to be significantly lower in the progressor group [adjusted odds ratio (AOR): 0.970, 95% confidence intervals (95% CIs): 0.943 to 0.997, P = 0.033]. The usage of antipsychotics was significantly higher in the progressor group (AOR: 1.599, 95% CIs: 1.202 to 2.202, P = 0.001). The usage of benzodiazepine receptor agonists also tended to be significantly higher in the progressor group (AOR: 1.290, 95% CIs: 0.996 to 1.697, p = 0.054). Conclusion: These results suggest that patients with AD who receive 1 year of AChEI treatment and have a lower BMI or concurrent treatment with antipsychotics and benzodiazepine receptor agonists are more likely to suffer from cognitive decline. [ABSTRACT FROM AUTHOR]

Calciphylaxis is a serious condition that can be difficult to diagnose and has a poor prognosis. Biopsy is the gold standard for diagnosis, but it can have sampling errors. A retrospective case series found that bone scan, a non-invasive imaging tool, may be a useful alternative for evaluation when the initial biopsy is negative. The bone scan was positive in 60% of patients who were clinically managed for calciphylaxis despite negative biopsies. The study suggests that bone scan can provide a more comprehensive assessment of the extent of the disease compared to biopsy. However, further research is needed to validate the use of bone scan in diagnosing calciphylaxis. [Extracted from the article]

Background: Sentinel lymph node biopsy (SLNB) is a common choice for axillary surgery in patients with early‐stage breast cancer (BC) who have clinically negative lymph nodes. Most research indicates that obesity is a prognostic factor for BC patients, but studies assessing its association with the rate of positive sentinel lymph nodes (SLN) and the prognosis of patients with early BC undergoing SLNB are limited. Methods: Between 2013 and 2016, 7062 early‐stage BC patients from the Shanghai Cancer Center of Fudan University were included. Based on the Chinese Body Mass Index (BMI) classification standards, the patients were divided into three groups as follows: normal weight, overweight, and obese. Propensity score matching analysis was used to balance the baseline characteristics of the participants. Logistic regression analysis was used to determine the association between obesity and positive SLN rate. Cox regression analysis was used to investigate whether obesity was an independent prognostic factor for early‐stage BC patients who had undergone SLNB. Results: No significant association was observed between obesity and positive SLN rate in early‐stage BC patients who had undergone SLNB. However, multivariate analysis revealed that compared to patients with normal BMI, the overall survival (hazard ratio (HR) 2.240, 95% confidence interval (CI) 1.27–3.95, p = 0.005) and disease‐free survival (HR 1.750, 95% CI 1.16–2.62, p = 0.007) were poorer in patients with high BMI. Conclusion: Obesity is an independent prognostic factor for early‐stage BC patients who undergo SLNB; however, it does not affect the positive SLN rate. [ABSTRACT FROM AUTHOR]

Background: Malaria is one of the biggest public health challenges in Ethiopia that has hampered the country's economic growth and development, and the government is on track to reduce malaria prevalence by 80% by 2025. Objective: As a result, the purpose of this study was to examine the trends in malaria prevalence in Wayu Tuqa District, Gute Health Center, over the last 10 years (2013–2022). Material and Methods: A retrospective analysis was undertaken to identify the patterns of malaria cases in Wayu Tuqa District, Gute Health Center, from 2013 to 2022 by evaluating the malaria registration laboratory logbook. All socio‐demographic data, as well as the year, month, and malaria prevalence, were obtained using a predesigned data collection form from previous years. Results: In this study, 3402 (22.50%) of the total 15,040 probable patients had malaria. P. falciparum was the most common species, accounting for 82.84% (2818) of the total, followed by P. vivax (16.00%) (547). Males and people over the age of 15 were the most affected demographics. Conclusion: In this study, the highest number of malaria cases were observed in 2021 and 2022, respectively. Furthermore, the autumn season had the highest incidence of malaria cases, 40% (1339), while the spring season had the lowest prevalence, 16% (546). The general trend of plasmodium species at Gute Health Center over the previous 10 years (2013–2022) has not shown inconsistent trends. As a result, proper malaria prevention and control planning, implementation, and monitoring should be strengthened at all levels. [ABSTRACT FROM AUTHOR]

Craniotomies are intricate neurosurgical procedures susceptible to post‐operative complications, among which surgical site infections (SSIs) are particularly concerning. This study sought to elucidate the potential risk factors and pathogenetic characteristics associated with SSIs following craniotomy procedures in a clinical setting. A retrospective study was conducted from May 2020 to May 2023, examining patients subjected to elective or emergency craniotomies. The cohort underwent post‐operative surveillance for SSIs, facilitating patient classification into SSI and Non‐SSI groups based on infection occurrence. Data collection encapsulated demographic and clinical parameters, including American Society of Anesthesiologists (ASA) classifications, and operative factors. SSIs were diagnosed via an integrated approach combining clinical symptoms, microbiological culture findings and pertinent laboratory tests. A rigorous statistical methodology employing IBM's SPSS version 27.0 was utilised for data analysis. In a univariate analysis, significant risk factors for post‐craniotomy SSIs were identified, with patients aged over 60 displaying a pronounced susceptibility. Moreover, surgeries exceeding a duration of 4 h heightened infection risks. Elevated ASA grades denoted an increased prevalence of SSIs, as did emergency procedures and higher National Nosocomial Infections Surveillance scores. Multivariate analysis pinpointed epidural/subdural drainage as a protective measure against SSIs, whereas emergency surgeries, operative times beyond 4 h and subsequent surgeries within the hospital stay amplified infection risks. Notably, coagulase‐negative Staphylococcus dominated the identified pathogens at 28.09%, followed by Escherichia coli (17.98%), Klebsiella pneumoniae (10.11%) and Staphylococcus aureus (11.24%), underscoring the need for diverse prophylactic measures. SSIs following craniotomies present a multifaceted challenge influenced by a confluence of patient‐related, operative and post‐operative determinants. Understanding these risk factors is paramount in refining surgical protocols and post‐operative care strategies to mitigate SSI incidence. [ABSTRACT FROM AUTHOR]

Objective: We aimed to develop a modified tinnitus‐relieving sound system and establish a model for predicting its treatment effects. Study Design: Retrospective study. Setting: Tinnitus Specialist Clinic of Eye & ENT Hospital, Fudan University. Methods: We recruited 107 patients undergoing modified tinnitus‐relieving sounds between August 2020 and May 2021. Patients were divided into training (n = 75) and validation (n = 32) cohorts in a 7:3 ratio. The treatment outcome was Tinnitus Handicapped Inventory scores. Features were established using a least absolute shrinkage and selection operator‐derived logistic regression model, where the selected clinical risk factors were included in the multivariate logistic regression, and a nomogram was established based on the model. The discrimination and calibration abilities of the nomogram were evaluated using the Hosmer‐Lemeshow test and calibration curves. Decision curve analysis (DCA) was used to evaluate the net benefit of predictive efficacy. Results: Multivariate logistic analysis indicated that the initial Tinnitus Handicapped Inventory score (odds ratio [OR]: 1.13 [1.07‐1.19], P <.001) and treatment duration (OR: 3.4 [1.34‐8.62], P <.001) were positive factors for improved tinnitus. The nomogram model that included baseline Tinnitus Handicapped Inventory score and treatment duration achieved a better concordance index of 0.880. DCA revealed that the nomogram model could lead to net benefits and exhibited a wider range of threshold probabilities for the prediction of therapeutic effects. Conclusion: Our study suggests that the nomogram model, including baseline Tinnitus Handicapped Inventory score and treatment duration, could achieve optimal performance in the preoperative prediction of the therapeutic effect of modified tinnitus‐relieving sound. [ABSTRACT FROM AUTHOR]

Objectives: In the phase 3 JAVELIN Renal 101 trial in patients with advanced renal cell carcinoma (aRCC), objective response rate (ORR) and progression‐free survival (PFS) were significantly improved in patients treated with first‐line avelumab plus axitinib vs sunitinib. Here we evaluate real‐world outcomes with first‐line avelumab plus axitinib in Japanese patients with aRCC. Methods: In this multicenter, noninterventional, retrospective study, clinical data from patients with aRCC treated with first‐line avelumab plus axitinib between December 2019 and December 2020 in Japan were reviewed. Endpoints included ORR and PFS per investigator assessment, and time to treatment discontinuation (TTD). Results: Data from 48 patients (median age, 69 years) from 12 sites were analyzed. Median follow‐up was 10.4 months (range, 2.6–16.5), and median duration of treatment was 7.4 months (range, 0.5–16.5). International Metastatic RCC Database Consortium risk category was favorable, intermediate, or poor in 16.7%, 54.2%, and 29.2% of patients, respectively. The ORR was 48.8% (95% CI, 33.3%–64.5%), including complete response in 3/43 patients (7.0%). Thirteen patients (27.1%) had disease progression or died, and median PFS was 15.3 months (95% CI, 9.7 months – not estimable). At data cutoff, 24 patients (50.0%) were still receiving avelumab plus axitinib, and median TTD was 15.2 months (95% CI, 7.4 months – not estimable). Three patients (6.3%) received high‐dose corticosteroid treatment for immune‐related adverse events, and 8 (16.7%) received treatment for infusion‐related reactions. Conclusions: We report the first real‐world evidence of the effectiveness and tolerability of first‐line avelumab plus axitinib in Japanese patients with aRCC. Results were comparable with the JAVELIN Renal 101 trial. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect and dose‐response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder. Participants and methods: This retrospective study comprises a cohort of military recruits aged 18–25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period. Results: Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p <.0001). On multivariate analysis, the dose‐response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) Conclusions: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH). [ABSTRACT FROM AUTHOR]

Background: Studies indicate that 6% to 20% of feline patients have at least one dermatopathy. Hypothesis/Objective: This retrospective study aimed to provide comprehensive information about the types of skin diseases, diagnosis methods, treatments and follow‐up data in a hospital population of domestic cats in Iran. Animals/Materials and Methods: The present survey of clinical observations was conducted on the medical records of 1825 individual cats brought to the Faculty of Veterinary Medicine, Ferdowsi University of Mashhad (Iran) over a 12‐year period (2009–2020). Results: Feline dermatoses accounted for 154 (8.43%) of the 1,825 cats examined during the study period. The most prevalent dermatological manifestations in the studied population of 154 were erythema, macules, papules and/or pustules (36; 23.37%), alopecia (18; 11.68%) and erosive/ulcerative lesions (17; 11.03%). Specific dermatological diagnoses made were the following (in descending order, of 154): dermatophytosis (34; 22.07%), subcutaneous abscesses (16; 10.38%), atopic skin syndrome/environmental allergies (20; 10.38%), external parasites (15; 9.74%), otitis (10; 6.49%), flea infestation (6; 3.89%), food allergy (4; 2.59%) and primary pyoderma (2; 1.29%). Most lesions were observed in the head/face of cats (41 of 154; 26.62%) and their ears (39; 25.32%). Following treatment, 86 of 154 cats (69.35%) had complete remissions, 17 cats faced recurrent dermatoses and the owners of 21 cats were not satisfied. Conclusions and Clinical Relevance: The prevalence of dermatoses among this cohort of Iranian cats is similar to that in other parts of the world. However, a noticeable difference was detected in the most prevalent dermatoses. To the best of our knowledge, this is the first study to assess the characteristics and outcomes of feline dermatological conditions in Iran. Background – Studies indicate that 6%–20% of feline patients have at least one dermatopathy. Objective – This retrospective study aimed to provide comprehensive information about the types of skin diseases, diagnosis methods, treatments and follow‐up data in a hospital population of domestic cats in Iran. Conclusions and Clinical Relevance – The prevalence of dermatoses among this cohort of Iranian cats is similar to that in other parts of the world. However, a noticeable difference was detected in the most prevalent dermatoses. To the best of our knowledge, this is the first study to assess the characteristics and outcomes of feline dermatological conditions in Iran. [ABSTRACT FROM AUTHOR]

Objective: To reflect on the complications of transvaginal natural orifice transluminal endoscopic surgery (vNOTES), identify the corresponding risk factors, and provide caution to surgeons when performing this novel surgery. Methods: A retrospective study was carried out among 2000 patients in our hospital who underwent vNOTES between May 2019 and May 2022. Perioperative complications were stratified in chronological order and divided into those developed while establishing the vNOTES approach, during surgery, postoperatively, and 1 month after discharge. The complications were classified based on the Modified Clavien‐Dindo classifications. The causes of each type III/IV complication were analyzed. Results: Of the 2000 patients, 88 (4.4%) experienced complications, which is not higher than that reported in laparoendoscopic surgery in previous studies. Grade I, II, III, IV, and V complications developed in 19 (0.95%), 57 (2.85%), 11 (0.55%), 1 (0.05%), and 0 (0%) patients, respectively. Complications were developed while establishing the approach platform, during the surgery, postoperatively, and within 1 month after discharge in 5 (0.25%), 30 (1.50%), 50 (2.50%), and 3 (0.15%) patients, respectively. Eight patients (0.4%) underwent conversion, including five cases of rectal injury repair. Conclusion: The summarized suggestions were divided into three levels. Considering the security and effectiveness of vNOTES, it can be routinely used in various gynecologic operations. However, surgeons should focus on preoperative evaluation, strictly conduct preoperative disinfection, conform to prompt conversion during surgery, call for the presence of experienced doctors, and have routine use of antibiotics to prevent postoperative infections. Trial Registration: ChiCTR2100053483. SYNOPSIS: vNOTES can be routinely used in gynecologic operations, but preoperative evaluation and disinfection, prompt conversion during surgery, and routine antibiotic use are essential. [ABSTRACT FROM AUTHOR]

Background: The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons. Aims: To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re‐operation. Patients/Methods: This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5‐point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re‐operation. Results: The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm2 to 40 × 70 mm2, and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re‐operation (p = 0.004), but no risk factor was associated with complications. Conclusions: The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners. [ABSTRACT FROM AUTHOR]

Management of pressure sores can have various environmental effects; moreover, the COVID‐19 pandemic notably affected efforts towards effective management of pressure sores. Some cases of COVID‐19 infections require long‐term hospitalization in the intensive care unit. Moreover, special protective equipment worn by physicians owing to the pandemic complicate wound management. In this study, we compared the pressure ulcer characteristics between isolated patients with and those without COVID‐19 and evaluated the effects of isolation on pressure sores. From November 2022 to February 2023, patients who had pressure sores were included and their medical records were reviewed retrospectively. The experimental group included patients with confirmed COVID‐19 infections, who received clinical treatment in an isolated unit. Wound characteristics in each group and associated risk factors were analysed. Fifty‐four isolated patients with COVID‐19 and 58 control patients were included. The Braden Scale score and Korea patient classification system‐1 did not vary significantly between the two groups. However, the number of Grade I pressure sores in the COVID‐19 isolation group was significantly lower than those in the control group (p < 0.001), while the number of lesions was significantly higher (p = 0.034). The mortality rate in the COVID‐19 isolation group was higher than that in the control group (p = 0.008), and more patients were discharged with unhealed wounds (p = 0.004). A higher treatment effect on pressure sores may be expected if the disease is more actively managed. Moreover, the wound care systems for isolated patients with COVID‐19 require further attention. [ABSTRACT FROM AUTHOR]

Rhinoplasty is a frequently performed aesthetic surgery with a high procedural volume. Despite the operational ease and safety profile of biocompatible materials such as silicone and inflatable prosthetics, postoperative complications like surgical site infections can lead to significant clinical challenges. These complications necessitate effective therapeutic and reconstructive interventions. This study aims to evaluate the efficacy of different flap transplantation techniques for early treatment of post‐rhinoplasty nasal tissue deficiencies. A retrospective study was conducted from May 2018 to May 2023, involving 38 patients divided into a control group receiving standard anti‐infective treatment and an observation group undergoing early flap grafting procedures. Efficacy was evaluated using objective metrics—namely, nasal appearance, function and flap condition—each assessed through a 10‐point scoring system, and subjective metrics such as patient satisfaction gauged through self‐administered questionnaires. Statistical analyses were performed using SPSS version 27.0. Both groups were statistically comparable in terms of demographics such as age, marital status and educational background. The observation group displayed significantly improved outcomes in terms of nasal aesthetics (mean score 7.92 ± 1.00), nasal function (mean score 8.47 ± 0.51) and flap condition (mean score 7.89 ± 1.12) compared to the control group. Flap transplantation techniques demonstrated superior therapeutic and reconstructive efficacy in the management of nasal tissue deficiencies arising from post‐rhinoplasty surgical infections. These findings contribute to evidence‐based recommendations for optimal clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Ankle joint fractures are often accompanied by medial deltoid ligament rupture. There is controversy over whether or how to treat deltoid ligament rupture. This study was aimed to explore the feasibility of repairing the medial deltoid ligament using Kirschner wire internal fixation of the medial tibiotalar joint combined with external fixation. Methods: Forty‐six patients with ankle fractures involving deltoid ligament rupture, treated between October 2012 and February 2021, were retrospectively evaluated. Twenty‐five patients were treated with a Kirschner wire to fix the tibiotalar joint and indirectly repair the deltoid ligament as the repaired group. Twenty‐one patients underwent reduction and fixation of internal and external malleolus fractures, and the deltoid ligament was not repaired in the unrepaired group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle‐hindfoot score, visual analog scale (VAS), Medical Outcomes Short Form 36‐item questionnaire score (SF‐36), and Medial clear space perpendicular (preoperative, postoperative, final follow‐up) were used for functional evaluations and reduction assessments. Mann–Whitney test were used to compare the differences between the groups. Results: The follow‐up time was 13–112 months with a mean of 59.32 months for the repaired group and 11–94 months with a mean of 53.43 months for the unrepaired group. There was no significant difference in the operative time or intraoperative blood loss between the two groups (p > 0.05). At the last follow‐up, the AOFAS ankle‐hindfoot and SF‐36 scores of the repaired group were significantly higher than those of the non‐repaired group (p < 0.05). Moreover, the VAS pain score was significantly lower and the Medial clear space perpendicular was significantly narrower in the repaired group than that in the unrepaired group. Conclusion: Tibiotalar joint fixation using Kirschner wires is a simple and effective technique that can indirectly reduce and repair the deltoid ligament and stabilize the ankle. [ABSTRACT FROM AUTHOR]

This study aimed to describe hospital admissions in patients experiencing polypharmacy and evaluate the effects of demographic factors on length of stay (LOS) and polypharmacy. We found that increasing age is associated with increasing polypharmacy rates but decreasing LOS. Females were more likely to experience higher rates of polypharmacy, but males were more likely to have longer LOS. First Nations peoples had higher rates of polypharmacy and longer LOS. Future projects investigating deprescribing methods are critical. [ABSTRACT FROM AUTHOR]

Background: There are limited to no data regarding the use of immune checkpoint inhibitors (ICIs) in patients who have preexisting organ dysfunction because these patients are frequently excluded from clinical trials. The authors' objective was to evaluate the effects of ICIs in patients with chronic kidney disease (CKD), cirrhosis, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). Methods: Data were obtained retrospectively for patients older than 18 years with solid organ malignancies who received at least one dose of an ICI between January 1, 2015, and January 1, 2021, and had either CKD (n = 90), cirrhosis (n = 20), COPD (n = 142), or CHF (n = 82) before ICI initiation at the authors' institution. Descriptive statistics were used to summarize patient characteristics, treatment characteristics, immune‐related adverse events (IrAEs), and outcomes. An independent samples t‐test or the Wilcoxon rank‐sum test was used to assess differences in continuous variables; the χ2 test or the Fisher exact test was used to assess differences in categorical variables between patients with and without IrAEs. Progression‐free survival (PFS) was assessed using Kaplan–Meier curves, and the log‐rank test was used to assess differences in PFS. Results: In all four cohorts, there were no statistically significant differences in patient characteristics, treatment characteristics, or outcomes, such as the number of hospitalizations and PFS, among those who experienced IrAEs compared with those who did not. In the CKD cohort, patients with IrAEs were significantly less likely to die than those without IrAEs (52% vs. 81% [p =.009] for all patients; 53% vs. 83% [p =.008] for patients with stage II/III disease who received no definitive local treatment and patients with stage IV disease); this difference was not observed in the cirrhosis, COPD, or CHF cohorts. There was no statistically significant difference in the number of heart failure and COPD exacerbations during the receipt of ICIs in the CHF and COPD cohorts, respectively. The incidence and time to onset of IrAEs in this study appeared to be similar to those reported previously in clinical trials that excluded patients with significant comorbidities. Conclusions: The current results demonstrate that ICIs are well tolerated by patients who have preexisting organ dysfunction. The authors assessed for differences between patients with preexisting organ dysfunction (chronic kidney disease, cirrhosis, chronic obstructive pulmonary disease, and congestive heart failure; patients had these organ dysfunctions prior to starting immune checkpoint inhibitors) who were receiving immune checkpoint inhibitors and experienced immune‐related adverse events (IrAEs) versus those who did not. No statistically significant differences were observed in patient characteristics, treatment characteristics, or outcomes between those with and without IrAEs, except in the chronic kidney disease cohort, in which patients who had IrAEs were significantly less likely to die than those without IrAEs. [ABSTRACT FROM AUTHOR]

Introduction: Insulin lispro 100 units/mL Jr KwikPen is the first prefilled, disposable, half‐unit insulin pen that delivers 0.5–30 units in increments of 0.5 units for the treatment of patients with diabetes. This study describes the profile of patients in Spain who initiated insulin therapy with Jr KwikPen in a real‐world setting. Methods: This retrospective, observational study based on IQVIA's electronic medical records database included patients with Type 1 (T1D) or Type 2 (T2D) diabetes who initiated therapy with Jr KwikPen between May 2018 and December 2020. Sociodemographic, clinical, and treatment characteristics at treatment initiation were analysed descriptively. Results: A total of 416 patients were included. The main characteristics of the T1D/T2D groups (N = 326/90), respectively were as follows: female sex, 61.7%/65.6%; mean age (standard deviation [SD]), 32.5 (20.7)/55.5 (16.6) years; body mass index, 20.9 (4.2)/25.2 (4.6) kg/m2 (N = 239/77); HbA1c, 7.8 (1.7)%/8.0 (1.5)% (N = 141/64); and presence of diabetes‐associated comorbidities, 27.9%/64.4%. Only 32.8% of patients with T1D were < 18 years old. Among Jr KwikPen users, 12.3% (T1D/T2D, 7.7%/28.9%) were ≥ 65 years old, 17.1% patients were newly diagnosed, and 3.8% were pregnant women. The mean (SD) total insulin dose pre‐index for T1D/T2D was 43.1 (23.6) and 40.7 (21.6) UI/day, respectively. The mean (SD) insulin dose at the start of Jr KwikPen use was 26.63 (16.56) and 22.58 (13.59) UI/day for T1D/T2D, respectively. Jr KwikPen was first prescribed mainly by endocrinologists (58.7%) or paediatricians (22.6%). Conclusions: The profile of patients who initiated therapy with Jr KwikPen in routine practice was broad with many patients being adults. Most of these patients had T1D, inadequate glycemic control, and multiple associated comorbidities. These results suggest that Jr KwikPen is prescribed in patients who may benefit from finer insulin dose adjustments, namely children, adolescents, adults, older individuals, or pregnant women with T1D or T2D. [ABSTRACT FROM AUTHOR]

Inherited neuromuscular disorders (NMDs) are a large group of genetic conditions characterized by impaired peripheral nerve, motor neuron, neuromuscular junction, or skeletal muscle function. These conditions are also known to have clinical and genetic heterogeneity and variable ages of onset. Clinical evaluation for NMDs has increasingly incorporated molecular genetics. However, genetic testing is complicated by the variety of testing options and the ambiguity of NMD phenotypes. Examining test selection and yield may elucidate testing recommendations and improve the diagnostic journey for these patients. This retrospective chart review evaluated the clinical presentations, genetic testing approaches, and diagnostic outcomes of 155 patients with suspected NMDs at Cincinnati Children's Hospital Medical Center. A total of 262 individual tests were ordered, averaging 1.7 tests per patient. The clinic utilized 26 separate genetic tests, with test yields ranging from 0% to 66%. Overall, 21% of patients received a genetic diagnosis. Of all the clinical findings evaluated, elevated CPK levels with or without muscle weakness were the most informative symptoms correlated with a diagnostic result. This study highlights several genetic testing considerations for NMDs, including the variability of diagnostic outcomes. This knowledge is relevant to clinicians and patients, especially during the pretest counseling and consenting process. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the dimensional changes after horizontal and vertical guided bone regeneration (GBR) without membrane fixation using the retentive flap technique. Methods: This study retrospectively examined two cohorts that received vertical or horizontal ridge augmentations (VA or HA groups). GBR was performed using particulate bone substitutes and resorbable collagen membranes. The augmented sites were stabilized using the retentive flap technique without any additional membrane fixation. The augmented tissue dimensions were assessed using cone‐beam computed tomography at preoperative, immediately postoperative (IP), 4 months (4M), and 1 year (1Y). Results: Postoperative vertical bone gain in 11 participants of VA group amounted to 5.96 ± 1.88 mm at IP, which decreased to 5.53 ± 1.62 at 4M and to 5.26 ± 1.52 mm at 1Y (intragroup p < 0.05). The horizontal bone gain at IP in 12 participants amounted to 3.98 ± 2.06 mm, which decreased to 3.02 ± 2.06 at 4M and to 2.48 ± 2.09 mm at 1Y (intragroup p < 0.05). The mean implant dehiscence defect height after 1Y was 0.19 ± 0.50 mm in the VA group, and 0.57 ± 0.93 mm in the HA group. Conclusion: GBR without membrane fixation using the retentive flap technique seems to preserve the radiographic bone dimensions of vertically augmented sites. This technique may be less effective at preserving the width of the augmented tissue. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusion Tooth loss studies show that periodontal treatment is effective. However, it is not known whether these results can be projected into a lifetime of treatment. The aim of the study was to study all patients with stages III/IV of periodontitis over 30 years in a private practice.All patients referred between 1986 and 1990 were monitored for 30 years for tooth loss and prognostic factors. All dropouts were accounted for.In all, 386 patients were followed, of whom 283 patients dropped out, leaving 103 patients (67 females and 36 males, average age 40.1 years) monitored over 30 years. Tooth loss was stable until 16 years, when the population was divided into groups of low (n = 65), moderate (n = 18) and high (n = 20) tooth loss, losing 1.05 (SD 1.27), 4.83 (SD 0.96) and 11.90 (SD 4.25) teeth, respectively. The strongest prognostic factors were first‐degree relatives with periodontitis, periodontal treatment before the age of 35 years, diabetes and patients with teeth with initial hopeless prognosis.The majority of patients with stages III and IV periodontitis could be successfully treated with conventional periodontal treatment over a period of 30 years. The findings suggest that retrospective studies with shorter observation times cannot automatically be projected onto the outcome of a lifetime of periodontal treatment. [ABSTRACT FROM AUTHOR]

Background: This retrospective multicenter study evaluated the efficacy and safety of bariatric surgery in Chinese patients with obesity. Methods: Patients with obesity who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux‐en‐Y gastric bypass and completed a 12‐month follow‐up between February 2011 and November 2019 were enrolled. Weight loss, glycemic and metabolic control, insulin resistance, cardiovascular risk, and surgery‐related complications at 12 months were analyzed. Results: We enrolled 356 patients aged 34.3 ± 0.6 years with a mean body mass index of 39.4 ± 0.4 kg/m2. Successful weight loss occurred in 54.6%, 86.8%, and 92.7% of patients at 3, 6, and 12 months, respectively, with no difference in percent excess weight loss between the laparoscopic sleeve gastrectomy and laparoscopic Roux‐en‐Y gastric bypass surgery groups. The average percentage of total weight loss was 29.5% ± 0.6% at 12 months; 99.4%, 86.8%, and 43.5% of patients achieved at least 10%, 20%, and 30% weight loss, respectively, at 12 months. Significant improvements in metabolic indices, insulin resistance, and inflammation biomarkers were observed at 12 months. Conclusions: Bariatric surgery resulted in successful weight loss and improved metabolic control, insulin resistance, and cardiovascular risk in Chinese patients with obesity. Both laparoscopic sleeve gastrectomy and laparoscopic Roux‐en‐Y gastric bypass are suitable approaches for such patients. [ABSTRACT FROM AUTHOR]

Introduction: Providing undergraduate dental students with a range of clinical experiences in fixed prosthodontics procedures is an important component of dental education. The aim of this retrospective study was to analyse the types of laboratory‐fabricated fixed prosthodontics clinical units completed by undergraduate students over 10 consecutive years and determine any significant trends. Materials and Methods: The fixed prosthodontics treatment registers from 2012 to 2021 were reviewed and the different types of completed fixed prosthodontics units and total number of fixed prosthodontics units were recorded for each year. Completed units were categorised according to the type of restoration and expressed in whole numbers and as a percentage of the total number of units completed in each year. The data were presented in table and graph form. Mann‐Kendall tests were performed to statistically analyse for trends in the different restoration types. Results: Throughout all study years, porcelain bonded to metal (PBM) crowns (48.25%, range 35.70%–59.91%) were the most frequently completed fixed prosthodontics unit followed by full gold crowns (FGC) (20.84%, range 14.89%–27.30%) and all‐ceramic crowns (ACC) (12.70%, range 3.67%–24.41%). Collectively, PBM, FGC and ACC comprised 81.80% of all completed fixed prosthodontics units. There were observed trends of increased use of all types of all‐ceramic containing restorations, all types of all‐gold containing restorations, all types of partial coverage restorations and specifically ceramic onlays and gold onlays. There were observed trends of reduced use of cast gold post‐cores and all types of bridges. Conclusion: PBM crowns were the mainstay laboratory‐fabricated fixed prosthodontic unit completed over 10 years of undergraduate student fixed prosthodontics clinical practice. [ABSTRACT FROM AUTHOR]

Aim: We aimed to verify the therapeutic efficacy and safety of stereotactic body radiotherapy (SBRT) for previously untreated initial small hepatocellular carcinoma (HCC) in a multicenter, retrospective study. Methods: Patients who underwent SBRT for HCC at the Japanese Society of Clinical Oncology (JCOG) member hospitals in Japan between July 2013 and December 2017 and met the following eligibility criteria were included: (1) initial HCC; (2) ≤3 nodules, ≤5 cm in diameter; (3) Child–Pugh score of A or B; and (4) unsuitability for or refusal of standard treatment. We analyzed the overall survival, recurrence‐free survival, and cumulative incidence of local recurrence rate, and adverse events directly related to SBRT. Results: Seventy‐three patients with 79 lesions from 14 hospitals were analyzed. The median age was 77 years (range: 50–89 years), and the median tumor size was 23 mm (range: 6–50 mm). The median radiation dose was 40 Gy (range: 35–60 Gy) in five fractions (range: 4–8). The median follow‐up period was 45 months (range: 0–103 months). The 3‐year overall survival, recurrence‐free survival, and cumulative incidence of local recurrence rates were 69.9% (95% CI: 58.7%–81%), 57.9% (95% CI: 45.2%–70.5%), and 20.0% (95% CI: 11.2%–30.5%), respectively. Four cases (5.5%) of adverse events of grade 3 or higher were reported: three cases of grade 3 and one case of grade 4 (duodenal ulcer). No grade 5 toxicities were observed. Conclusion: SBRT is a promising treatment modality, particularly for small HCCs, as they are not suitable for standard treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post‐stroke dysphagia (PSD). Methods: Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration‐aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function. Results: A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p <.001), PAS scores (p <.05), MSS scores (p <.05), and vocal fold mobility (p <.001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p <.05). Kaplan–Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5 versus PAS > 5, PR ≥ 3 versus PR < 3, and normal vocal fold mobility versus vocal fold motion impairment group (p <.05). Conclusions: The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS > 5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is one of the most prevalent chronic inflammatory skin conditions. We aimed to describe the clinical features of adult‐onset and childhood‐onset AD in a multi‐ethnic Asian population. Methods: A retrospective study was performed of 188 patients with AD managed at a tertiary skin institution in Singapore. Patient demographics, clinical features and disease scores were analysed. Results: Clinical features related to pigmentary changes, such as orbital darkening and Dennie–Morgan folds were more prevalent among childhood‐onset AD patients than in adult‐onset AD patients. Similarly, features related to prolonged scratching or friction, such as anterior neck folds, perifollicular accentuation and infra‐auricular/infranasal fissuring were also more prevalent in childhood‐onset AD patients. Disease scores such as SCORAD and EASI were not different between patients with childhood versus adult‐onset disease. Conclusion: There were significant differences in clinical features between childhood‐onset and adult‐onset AD. Certain features are related to pigmentary changes and might be more accentuated in patients with skin of colour. Further studies are needed to understand how the different features might be clinically significant and related to the various AD endotypes and disease trajectories. [ABSTRACT FROM AUTHOR]

Background: Whether ultrasound‐guided stellate ganglion block (SGB) is a valuable therapeutic option for the treatment of patients with chronic migraine (CM) is worth exploring. If SGB is proven to be effective for CM, the identification of potential predictors for the effectiveness of SGB warrants further investigation. This study aimed to investigate the effectiveness and safety of SGB in patients with CM and to explore the predictive factors for its treatment effectiveness. Methods: This is a retrospective observational study. We retrospectively analyzed the effects of SGB for the treatment of patients with CM under ultrasound guidance, between January 2018 and June 2022. The follow‐up time was approximately 1 month, 2 months, and 3 months after the last SGBs. The response criterion was defined as a reduction in pain intensity of > 50% measured using the most severe numerical rating scale (NRS) score compared to pretreatment baseline, without an increase in the dose or the type of analgesic or anxiolytic/antidepressant medication, otherwise unresponsive to SGB. Univariable and multivariable analyses were performed to identify the predictive factors for SGB response. Results: Ninety‐seven patients were included in this study. SGB was effective in most of the CM patients, with an effective rate of 90.7%, 82.5%, and 71.1% after 1, 2, and 3 months of the last SGBs, respectively. At 3‐month follow‐up, 95.7% responsive patients benefited from repeated SGBs. In patients receiving repeated SGB treatments, the number of SGBs in responsive patients was significantly greater than those in patients with no response at 3‐month follow‐up (3.41 ± 1.31 vs. 2.68 ± 0.67, p = 0.02). Comorbid anxiety or depression was a negative predictor of SGB effectiveness at 3‐month follow‐up (B = −0.25, 95% CI −0.45 to −0.05, p = 0.01). The overall adverse events rate associated with ultrasound‐guided SGB was 9.3%. There were no serious complications; all adverse events were transient, with hoarseness being the most common adverse event. Conclusions: Ultrasound‐guided SGB was an effective and safe treatment for CM patients. The majority of responsive patients with CM benefited from repeated SGBs. CM patients who needed repeated SGBs may obtain good and sustained analgesic effect after receiving a greater number of SGBs. Patients without comorbidities such as anxiety or depression were more likely to benefit from SGB treatments. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Myasthenia gravis (MG) with muscle‐specific tyrosine kinase (MuSK) antibodies (MMG) is predominantly seen in women of childbearing age. Our objective in this study was to describe the course of MMG during pregnancy and within 6 months postpartum, and to document any effect on fetal health. Methods: A retrospective review was performed of medical records of patients with MMG seen in the Duke Myasthenia Gravis Clinic from 2003 to 2022. MMG patients with onset of MMG symptoms before or during pregnancy as well as within 6 months postpartum were reviewed. Results: A total of 14 pregnancies in 10 patients were included in our study cohort. Initial MG symptoms developed during pregnancy or within 6 months postpartum in six patients. Four patients had two pregnancies, three of whom developed MG during their first pregnancy. In the patients diagnosed before pregnancy, MG symptoms increased in five of eight patients during pregnancy or postpartum. Four patients required rescue therapy with plasma exchange or intravenous immunoglobulin during pregnancy or postpartum. One patient had a cesarean section after prolonged labor due to failure of progression. There were no other complications of pregnancy or delivery, and all infants were healthy at delivery. Discussion: As in non‐MuSK MG, women with MMG may also have worsening or may develop initial MG symptoms during pregnancy or within 6 months postpartum. More aggressive medical therapy may be required for pregnant patients with MMG. Further study is needed to identify the mechanism and risk of worsening of MMG during pregnancy or postpartum. [ABSTRACT FROM AUTHOR]

Background: Few studies have focused on high‐flow nasal cannula (HFNC) usage in the last few weeks of life. The aim of this study was to identify the status of HFNC use in patients with cancer at the end of life and the relevant clinical factors. Methods: We performed a retrospective cohort study in a tertiary hospital in the Republic of Korea. Among patients with cancer who died between 2018 and 2020, those who initiated HFNC within 14 days before death were included. Patients were categorized based on the time from HFNC initiation to death as imminent (<4 days) and non‐imminent (≥4 days). Results: Among the 2191 deceased patients with terminal cancer, 329 (15.0%) were analyzed. The median age of the patients was 66 years, and 62.9% were male. The leading cause of respiratory failure was pneumonia (70.2%), followed by pleural effusion (30.7%) and aggravation of lung neoplasms (18.8%). Most patients were conscious (79.3%) and had resting dyspnea (76.3%) at HFNC initiation. Patients received HFNC therapy for a mean of 3.4 days in the last 2 weeks of life, and 62.6% initiated it within 4 days before death. Furthermore, female sex, no palliative care consultation, no advance statements in person on life‐sustaining treatment, and no resting dyspnea were independently associated with the imminent use of HFNC. Conclusions: Many patients with cancer started HFNC therapy at the point of imminent death. However, efforts toward goal‐directed use of HFNC at the end‐of‐life stage are required. This study illustrates the status of high‐flow nasal cannula use in patients with terminal cancer at the end of life. Efforts to communicate patients' stated goals of care may help enhance goal‐concordant use of high‐flow nasal cannula at the end of life and reduce initiating in an imminently dying state. [ABSTRACT FROM AUTHOR]