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Background: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is typically resistant to pharmacological interventions; however, achieving seizure freedom is possible through surgery. Our objective was to focus on the pregnancy and seizure outcomes during pregnancy of women with TLE-HS, and aim to identify predictors of seizure control. Methods: The West China Registry of Pregnancy of Women with Epilepsy (WCPR_EPi) was a monocentric prospective cohort study of women with epilepsy (WWE). We screened women with TLE-HS in this database. Their clinical profile, anti-seizure medication (ASM) use, and pregnancy outcomes were extracted from the records of the registry (2010–2023). Results: Out of 2320 WWE followed up, 47 pregnancies in women with TLE-HS were identified and analyzed. Seizure exacerbation occurred in 40.4% of pregnancies, and seizure freedom was present in 34.0% of these during pregnancy. Factors associated with seizure exacerbation during pregnancy was ASM non-adherence (odds ratio [OR] =7.00, 95% confidence interval [CI] 1.43–34.07, P=0.016). The surgery group showed a significantly higher seizure freedom rate (OR = 6.87, 95% CI 1.02–46.23, P=0.016) and lower rate of induced labor (0.0% vs 26.5%, P=0.047) compared to the medically-treated group alone. Caesarean section was chosen in 77.1% of cases due to seizure concerns, with comparable in epilepsy-related (n=20) and obstetric causes (n=24). No major congenital malformations were reported. Conclusions: Surgical treatment before pregnancy appears to offer a higher chance of seizure freedom compared to medication alone. Most of women with TLE-HS can deliver healthy offspring regardless of suboptimal seizure control and unwarranted concerns. [ABSTRACT FROM AUTHOR]

Background: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates. Methods: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors. Results: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73). Conclusions: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to characterize the differences between respiration and swallowing in patients with dysphagia after cervical spinal cord injury (CSCI) and to explore the underlying physiological changes. Method: A total of 95 participants were recruited for bedside swallowing evaluation followed by a flexible endoscopic evaluation of swallowing and surface electromyography with a thermocouple nasal airflow sensor examination: 32 with dysphagia, 33 without dysphagia, and 30 healthy controls. The differences in respiratory patterns, swallowing apnea duration (SAD), inspiratory-expiratory ratio, and swallowing efficiency were observed among healthy adults, CSCI patients with and without dysphagia after CSCI. Results: Compared with those of healthy controls and patients without dysphagia after CSCI, the postswallow respiratory pattern of patients with dysphagia after CSCI was an inspiratory pattern, and the SAD was significantly shorter in patients with dysphagia after CSCI (p < .001). Additionally, the expiratory time in patients with dysphagia was significantly shorter than the inspiratory time, and the swallowing efficiency was reduced, requiring multiple swallows. Moreover, the index of SAD was statistically significant for predicting the development of dysphagia in patients with CSCI (p < .001). Conclusion: Patients with CSCI have an inspiratory pattern after swallowing, and the SAD is significantly reduced; SAD can be used as the predictor of dysphagia in patients after CSCI; the pattern of coordination between respiration and swallowing in patients with dysphagia after CSCI is different from that of healthy controls and patients without dysphagia after CSCI. [ABSTRACT FROM AUTHOR]

Introduction: Anticancer drug-induced stomatitis can affect a patient's quality of life and the continuation of drug treatment. Although there have been reports of the occurrence of stomatitis associated with anticancer agents in clinical trials, few Japanese participants have been enrolled in clinical trials and have not been sufficiently investigated. In addition, there has been little attention on research on anticancer drugs associated with stomatitis by patient stratification with different carcinogenic sites. Therefore, the aim of this study was to determine the disproportionality associated with stomatitis for various types of anticancer drugs in different types of cancer patients using the Japanese Adverse Drug Event Report (JADER) database. Methods: The aim of this study was to identify the disproportionality of stomatitis by analyzing the type of anticancer drug and cancer patients using the Japanese Pharmacovigilance Database. Data obtained from spontaneous reports of adverse events with more than 10 stomatitis outbreaks reported in the JADER database between April 2004 and March 2023 were analyzed. The safety signal for an adverse event was defined as the lower limit of the 95% confidence interval of the reported odds ratio of >1. Results: There were 6,178 reports of drugs associated with stomatitis. Among these, 41 drugs were suggested to be associated with stomatitis, and 41 drugs were detected as signals. These drugs were classified based on their efficacy: antipyrimidines (six drugs), folate metabolism antagonists (three drugs), alkylating agents (four drugs), platinum (three drugs), topoisomerase inhibitors (three drugs), microtubule inhibitors (three drugs), mammalian target of rapamycin (mTOR) inhibitors (two drugs), kinase inhibitors (seven drugs), anti-growth factor antibodies (five drugs) immune checkpoint inhibitors (one drug), and others (four drugs). Conclusion: The drugs that may be associated with stomatitis were cell cycle-dependent drugs, epidermal growth factor receptor-tyrosine kinase inhibitors, and mTOR inhibitors. Moreover, this study suggested that anti-growth factor antibodies and immune checkpoint inhibitors may be associated with stomatitis development. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. METHODS: Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. RESULTS: 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2--at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. CONCLUSIONS: Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center. [ABSTRACT FROM AUTHOR]

The article focuses on assessing whether sites of primary lesions in pemphigus vulgaris (PV) are more susceptible to relapse. It identifies the anatomical locations where initial lesions occur and determines if these same sites are more likely to experience relapses. It suggests that tissue-resident memory T cells may play a significant role in this phenomenon, potentially explaining why certain sites are recurrently affected.

The purpose of this study was to assess the awareness and knowledge of professional team sport athletes about ACL injuries, injury prevention programs, and the return to sports after ACL injuries. A total of 419 athletes representing soccer, basketball, volleyball and handball sports were included in the study. We utilized a 15-item self-report survey to assess the awareness of athletes about ACL injury, ACL injury prevention program, and return to sport after ACL injuries. Male and soccer players participated in prevention programs more than female athletes (p = 0.001). Participation in prevention programs was significantly higher in the ≥ 18 years old group than in the < 18 years old group (p = 0.040). Participants who were informed about ACL injuries were 8.4 times more likely to participate in the ACL injuries prevention program than others (OR: 8.38, 95% CI: 3.823–18.376, p < 0.001). The majority of participants believed that return to sport after ACL injury takes 6 months and 81.4% of them thought that it is not possible to do sport without an ACL. This study revealed that the awareness and performance of ACL prevention training programs among professional team sport athletes were insufficient. The athletes' knowledge regarding return to sports after ACL injuries was also inadequate. Improving athletes' knowledge of ACL injuries may lead to increased participation in ACL injury prevention programs. Thus, the provision of tailored educational interventions to athletes could potentially enhance their awareness and understanding of ACL injuries, consequently contributing towards the prevention of such injuries. [ABSTRACT FROM AUTHOR]

Purpose. This study examined predictors of sexual victimization among autistic and non-autistic college students. Specifically, we aimed to determine whether autistic students are more likely than non-autistic students to experience unwanted sexual contact and sexual assault, controlling for co-occurring diagnoses. We also aimed to determine whether students with other disabilities, specifically ADHD, learning disability (LD), and psychological disorders, are more likely than students without these disabilities to experience unwanted sexual contact and sexual assault. Methods. Autistic students (n=270) and non-autistic students (n=270) who had participated in a nationwide survey were matched on demographic characteristics and co-occurring diagnoses. Logistic regression analyses were conducted to address the research questions and evaluate predictors of unwanted sexual contact and sexual assault. Results. Autistic students were as likely as non-autistic students to have experienced unwanted sexual contact and sexual assault, controlling for co-occurring diagnoses. Regardless of autism diagnostic status, students with ADHD were more likely than students without ADHD to have experienced unwanted sexual contact and sexual assault. Conclusions. Although autism diagnostic status was not a significant predictor of unwanted sexual contact or sexual assault, other factors associated with increased risk of sexual victimization, such as co-occurring ADHD, are likely to be found in autistic populations. This study highlights the importance of educational, social, and institutional supports to decrease sexual victimization among college students with neurodevelopmental disabilities. [ABSTRACT FROM AUTHOR]

Background: The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated. Aim: Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR. Material and methods: A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL). Results: After matching, the study group (n = 109) and control group (n = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, P = 0.026) and after matching (3.7% vs. 10.5%, P = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035–0.937, P 0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765–0.921, P 0.002), and regression analysis (OR 0.298, 95% CI 0.112–0.790, P = 0.015), showed that FAEA was an independent protector factor for AL. This technique can significantly shorten postoperative hospital stay [9 (6–13) vs. 10 (8–13), P = 0.024] and reduce the risk of SSAL (1.4% vs. 6.0%, P = 0.029). Conclusions: Perfusion assessment by FAEA can achieve better visualization in LsISR and reduce the incidence of AL, subsequently avoiding SSAL after LsISR. [ABSTRACT FROM AUTHOR]

Background: The safety and efficacy of robotic liver resection (RLR) for patients with hepatocellular carcinoma (HCC) have been reported worldwide. However, the exact role of RLR in HCC patients with liver cirrhosis is not sufficiently determined. Methods: We conducted a retrospective study on consecutive patients with cirrhosis or non-cirrhosis who received RLR for HCC from 2018 to 2023. Data on patients' demographics and perioperative outcomes were collected and analyzed. Propensity score matching (PSM) analysis was performed. Multivariate logistic regression analysis was performed to determine the risk factors of prolonged postoperative length of stay (LOS) and morbidity. Results: Of the 571 patients included, 364 (64%) had cirrhosis. Among the cirrhotic patients, 48 (13%) were classified as Child–Pugh B. After PSM, the cirrhosis and non-cirrhosis group (n = 183) had similar operative time, estimated blood loss, postoperative blood transfusion, LOS, overall morbidity (p > 0.05). In addition, the intraoperative and postoperative outcomes were similar between the two groups in the subgroup analyses of patients with tumor size ≥ 5 cm, major hepatectomy, and high/expert IWATE difficulty grade. However, patients with Child–Pugh B cirrhosis had longer LOS and more overall morbidity than that of Child–Pugh A. Child–Pugh B cirrhosis, ASA score > 2, longer operative time, and multiple tumors were risk factors of prolonged LOS or morbidity in patients with cirrhosis. Conclusion: The presence of Child–Pugh A cirrhosis didn't significantly influence the difficulty and perioperative outcomes of RLR for selected patients with HCC. However, even in high-volume center, Child–Pugh B cirrhosis was a risk factor for poor postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: Although robotic pancreatectomy may facilitate an earlier functional recovery, the impact of a robotic pancreatectomy program during its early experience on the timing of return to intended oncologic therapy (RIOT) after surgery is unknown. Methods: In this retrospective cohort study, we used propensity score matching with a 1:2 ratio to compare patients who underwent robotic or open surgery (distal pancreatectomy or pancreatoduodenectomy) for pancreatic ductal adenocarcinoma (PDAC) during the first 3 years of our robotic pancreatectomy experience (January 2018–December 2021). Generalized estimating equations modeling was used to evaluate the effect of surgical approach on early RIOT, defined as adjuvant chemotherapy initiation within 8 weeks after surgery, and late RIOT, defined as initiation within 12 weeks after surgery. Results: The matched cohort included 26 patients who underwent robotic pancreatectomy and 52 patients who underwent open pancreatectomy. Rates of receipt of adjuvant chemotherapy were 96.2% and 78.9%, respectively. Rate of early RIOT in the robotic group (73.1% was higher than that in the open group (44.2%; P = 0.018). In multivariable analysis, a robotic approach was associated with early RIOT (odds ratio, 3.54; 95% confidence interval 1.08–11.62; P = 0.038). Surgical approach did not impact late RIOT (odds ratio, 3.21; 95% confidence interval 0.71–14.38; P = 0.128). Conclusions: Compared with open pancreatectomy, robotic pancreatectomy did not delay RIOT. In fact, odds of early RIOT were increased, which supports the oncological safety of our robotic pancreatectomy program during its implementation. [ABSTRACT FROM AUTHOR]

Background: Excessive tension at the anastomosis contributes to anastomotic leakage (AL) in low anterior resection (LAR). However, the specific tension has not been measured. We assessed whether "Bridging," characterized by the proximal colon resembling a suspension bridge above the pelvic floor, is a significant risk factor for AL following LAR for rectal cancer. Methods: This retrospective study reviewed the medical records and laparoscopic videos of 102 patients who underwent laparoscopic LAR using the double stapling technique at Yachiyo Hospital between January 2014 and December 2023. Patients were classified based on whether they had Bridging (tight or sagging) or were in a Resting state of the proximal colon, and the association between Bridging and AL was examined. Results: AL occurred in 31.3% of the Tight Bridging group, 20% of the Sagging Bridging group, and 2.2% of the Resting group (P = 0.002). The incidence of AL was significantly higher in patients with Bridging than in those without (23.2% vs. 2.2%, P = 0.003). Multivariate analysis revealed that Bridging is an independent risk factor for AL (odds ratio = 6.97; 95% confidence interval: 1.45–33.6; P = 0.016). Conclusions: The presence of Bridging is a significant risk factor for AL following LAR for rectal cancer, suggesting the need for implementing preventive measures in patients with this condition. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon's experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees. Methods: A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees' overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A "Challenging" procedure was defined as a combination of either/or "perforation" and "difficult". Trainees who had performed > 30 appendectomies were defined as "experienced". The trainees were asked if they had used simulation or web-based tools the week prior to surgery. Results: 142 procedure evaluation forms were included of which 19 (13%) were "perforated", 14 (10%) "difficult" and 24 (17%) "Challenging". Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0–75.6). Experienced trainees performed "proficient" more often than non-experienced (OR 34.5, 95% CI 6.8–176.5). "Difficult" procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0–0.9). In "Challenging" procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1–0.9). The procedures assessed as "difficult" had significantly longer operating time with a median (IQR) of 90 (75–100) min compared to 59 (25–120) min for the non-difficult (p < 0.001). Conclusion: Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a "difficult" procedure had most overall impact on proficiency evaluation. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic simultaneous resection (LSR) of primary colorectal tumors and synchronous colorectal liver metastases (sCRLM) has been recently performed. This study aimed to evaluate the postoperative outcomes after LSR and determine the risk factors for resection surface-related complications (RSRC), such as postoperative biliary fistula and liver-transection surface abscess. Methods: Between 2009 and 2022, consecutive patients with sCRLM who underwent LSR were included. We retrospectively analyzed clinicopathological data, including intraoperative factors and postoperative outcomes. The difficulty level of all liver resections was classified according to the IWATE difficulty scoring system (DSS). We then performed univariate and multivariate analyses to identify the risk factors for RSRC. Results: Of the 112 patients, 94 (83.9%) underwent partial hepatectomy and colorectal surgery. The median DSS score was 5 points (1–11), with 12 (10.7%) patients scoring ≥ 7 points. Postoperative complications were observed in 41 (36.6%) patients, of whom 16 (14.3%) experienced severe complications classified as Clavien–Dindo grade IIIa or higher. There was no postoperative mortality. The most common complication was RSRC (19 patients, 17.0%). Multivariate analysis identified American Society of Anesthesiologists (ASA) classification ≥ 3 [odds ratio (OR) 10.3, 95% confidence interval (CI) 1.37–77.8; P = 0.023], DSS score ≥ 7 points (OR 5.08, 95% CI 1.17–20.0; P = 0.030), and right-sided colectomy (OR 4.67, 95% CI 1.46–15.0; P = 0.009) as independent risk factors for RSRC. Postoperative hospital stays were significantly longer for patients with RSRC than for those without RSRC (22 days vs. 11 days; P < 0.001). Conclusion: Short-term outcomes of LSR for patients with sCRLM were acceptable in an experienced center. RSRC was the most common complication, and high-difficulty hepatectomy, right-sided colectomy, and ASA classification ≥ 3 were independent risk factors for RSRC. [ABSTRACT FROM AUTHOR]

Background: Neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia (HIE + TH) are at risk for acute kidney injury (AKI). The standardized Kidney Disease Improving Global Outcomes (KDIGO) criteria identifies AKI based on a rise in serum creatinine (SCr) or reduced urine output. This definition is challenging to apply in neonates given the physiologic decline in SCr during the first week of life. Gupta et al. proposed alternative neonatal criteria centered on rate of SCr decline. This study aimed to compare the rate of AKI based on KDIGO and Gupta in neonates with HIE and to examine associations with mortality and morbidity. Methods: A retrospective review was performed of neonates with moderate to severe HIE + TH from 2008 to 2020 at a single center. AKI was assessed in the first 7 days after birth by KDIGO and Gupta criteria. Mortality, brain MRI severity of injury, length of stay, and duration of respiratory support were compared between AKI groups. Results: Among 225 neonates, 64 (28%) met KDIGO, 69 (31%) neonates met Gupta but not KDIGO, and 92 (41%) did not meet either definition. Both KDIGO-AKI and GuptaOnly-AKI groups had an increased risk of the composite mortality and/or moderate/severe brain MRI injury along with longer length of stay and prolonged duration of respiratory support compared to those without AKI. Conclusions: AKI in neonates with HIE + TH was common and varied by definition. The Gupta definition based on rate of SCr decline identified additional neonates not captured by KDIGO criteria who are at increased risk for adverse outcomes. Incorporating the rate of SCr decline into the neonatal AKI definition may increase identification of clinically relevant kidney injury in neonates with HIE + TH. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To understand and describe attitudes toward general health checkups, breast health knowledge, cultural beliefs, and health-promoting behaviors among Myanmar American immigrant women in the United States. SAMPLE & SETTING: 267 women participated in the study. 10 women were excluded because of missing data, so the total sample size was 257 participants. METHODS & VARIABLES: A descriptive, crosssectional survey design was used to describe and investigate breast health perceptions and behaviors. RESULTS: Nearly 75% of the study sample reported having negative attitudes toward general health checkups and were found to have less accurate breast health knowledge and more fatalistic views about breast cancer. Only 29% of older women adhered to mammogram recommendations. Younger women reported more barriers to mammograms, and older women reported fewer barriers to mammograms. IMPLICATIONS FOR NURSING: This study demonstrated the need for additional research focusing on unique perspectives when investigating breast health practices among Myanmar American immigrant women. The findings highlight the essential need to build a strong partnership with stakeholders to combat breast health disparities and address the complex nature of acculturation. [ABSTRACT FROM AUTHOR]

Objective: Tropical diabetic hand syndrome (TDHS) is rarely described and recognized in the literature as a complication in people with diabetes, and Mexico has high incidence rates of diabetes mellitus II (DMII). The minor or major amputation of the arm represents a physically and economically significant morbidity problem in patients. To optimize the diagnosis and treatment, in this work, we identify prognostic factors and their association with the severity of TDHS and the need for amputation in patients with diabetes mellitus and hand tissue infection. Methods: A total of 55 patients with a confirmed diagnosis of DMII with soft tissue infection in the hand referred to the plastic and reconstructive surgery department were studied for their evaluation and treatment. We analyze sociodemographic and clinical factors and follow-up of remission and recovery in limb functions. Results: In our study, we identified factors associated with amputation such as schooling under 6 years (OR: 21.98, confidence interval (CI): 1.21–3.98, p = 0.003), body mass index ≥ 20 (OR: 0.07, CI = 0.003–1.41, p = 0.031), and history of amputation (no upper limb) (OR: 5.9, CI = 1.11–32.1, p = 0.032). Furthermore, people with TDHS requiring amputation had slightly higher glycated hemoglobin (Hb1Ac) ≥ 10% (OR: 2.36, CI = 0.62–8.98, p = 0.338), and the risk of death was also increased (OR: 3.4, CI = 0.355–32.6, p = 0.288), although these outcomes did not reach statistical significance. Conclusions: Risk factors for amputation as a treatment of THDS are directly linked to lower schooling status, poor nutrition/low weight, as well as previous amputation procedures in patients. These data will help to establish a timelier evaluation and management in patients with suspected THDS. [ABSTRACT FROM AUTHOR]

Objective: To analyse the influence of the COVID‐19 pandemic and the perception of self‐efficacy on the health professionals of the Spanish out‐of‐hospital emergency services. Design: Observational, cross‐sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February–30 April, 2021). Methods: The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self‐efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self‐efficacy on mental health. Results: The means of the sample for stress, anxiety, depression and self‐efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self‐efficacy. Self‐efficacy had a direct effect on the mental health for working in patient care. Conclusions: Healthcare workers showed moderate stress, severe anxiety, mild depression and good self‐efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self‐efficacy is a determining factor of mental health in the direct care modality. Implications: The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out‐of‐hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self‐efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. Reporting Method: We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros ‐ ASISA Foundation (Spain). Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether qualitative and quantitative imaging phenotypes can predict the grade of oligodendroglioma. Methods: Retrospective chart and imaging reviews were conducted on 180 adults with oligodendroglioma (IDH-mutant and 1p/19q codeleted) between 2005 and 2021. Qualitative imaging characteristics including tumor location, calcification, gliomatosis cerebri, cystic change, necrosis, and infiltrative pattern were analyzed. Quantitative imaging assessment was performed from the tumor mask via automatic segmentation to calculate total, contrast-enhancing (CE), non-enhancing (NE), and necrotic tumor volumes. Logistic analyses were conducted to determine predictors of oligodendroglioma grade. Results: This study included 180 patients (84 [46.7%] with grade 2 and 96 [53.3%] with grade 3 oligodendrogliomas), with a median age of 42 years (range 23–76 years), comprising 91 females and 89 males. On univariable analysis, calcification (odds ratio [OR] = 6.00, P < 0.001), necrosis (OR = 21.84, P = 0.003), presence of CE tumor (OR = 7.86, P < 0.001), larger total (OR = 1.01, P < 0.001), larger CE (OR = 2.22, P = 0.010), and larger NE (OR = 1.01, P < 0.001) tumor volumes were predictors of grade 3 oligodendroglioma. On multivariable analysis, calcification (OR = 3.79, P < 0.001) and larger CE tumor volume (OR = 2.70, P = 0.043) remained as independent predictors of grade 3 oligodendroglioma. The multivariable model exhibited an AUC, accuracy, sensitivity, specificity of 0.78 (95% confidence interval 0.72–0.84), 72.8%, 79.2%, 69.1%, respectively. Conclusion: Presence of calcification and larger CE tumor volume may serve as useful imaging biomarkers for prediction of oligodendroglioma grade. Clinical Relevance Statement: Assessment of intratumoral calcification and CE tumor volume may facilitate accurate preoperative estimation of oligodendroglioma grade. Summary statement: Presence of intratumoral calcification and larger contrast-enhancing tumor volume were the significant predictors of higher grade oligodendroglioma based on the 2021 WHO classification. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. Methods: Population‐based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi‐square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. Results: Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower‐risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13–1.32)), 39 (aOR 1.31(1.23–1.40)), 40 (aOR 1.42(1.35–1.50)), and 41 weeks of gestation (aOR 1.43(1.35–1.51)). Perinatal mortality was rare in both groups and non‐significantly lower in the induced group at most gestations. Discussion: For lower‐risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only. [ABSTRACT FROM AUTHOR]

BACKGROUND: A protocolized extubation readiness test (ERT), including a spontaneous breathing trial (SBT), is recommended for patients who are intubated. This quality-improvement project aimed to improve peri-extubation outcomes by using a high-risk ERT protocol in intubated cardiac patients in addition to a standard-risk protocol. METHODS: After baseline data collection, we implemented a standard-risk ERT protocol (pressure support plus PEEP), followed by a high-risk ERT protocol (PEEP alone) in cardiac subjects who were intubated. The primary outcome, a composite of extubation failure and rescue noninvasive respiratory support, was compared between phases. Ventilator duration and use of postextubation respiratory support were balancing measures. RESULTS: A total of 213 cardiac subjects who were intubated were studied, with extubation failure and rescue noninvasive respiratory support occurring in 10 of 213 (4.7%) and 8 of 213 (3.8%), respectively. We observed a reduction in the composite outcome among the 3 consecutive phases (5/29 [17.2%], 10/110 [9.1%] vs 3/74 [4.1%]; P = .10), but this did not reach statistical significance. In the logistic regression model when adjusting for admission type, the high-risk ERT protocol was associated with a significant reduction of the composite outcome (adjusted odds ratio 0.20, 95% CI 0.04-0.091; P = .037), whereas the standard-risk ERT protocol was not (adjusted odds ratio 0.48, 95% CI 0.15-1.53; P = .21). This was not accompanied by a longer ventilator duration (2.0 [1.0, 3.0], 2.0 [1.0-4.0], vs adjusted odds ratio 2.0 [95% [1.0-6.0]; P = .99) or an increased use of planned noninvasive respiratory support (10/29 [35.5%], 35/110 [31.8%], vs 25/74 [33.8%]; P > .99). CONCLUSIONS: In this quality-improvement project, a high-risk ERT protocol was implemented with improvement in peri-extubation outcomes among cardiac subjects. [ABSTRACT FROM AUTHOR]

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Spinal cord injury (SCI) is a life-changing event that often results in chronic physical damage and challenges in maintaining a good quality of life as it affects every aspect of life. These situations require adjustment, increasing vulnerability to psychological disorders. The objective of this study was to evaluate the impact of SCI on psychological morbidity in individuals with subacute and chronic SCI. The present investigation was designed to determine the presence and extent of psychological complications following SCI. We used two reliable questionnaires and validated psychological assessments to study depression (BDI) and anxiety (STAI), a broad range of factors derived from SCI that may be predictors of certain psychological problems. The psychological assessment revealed alterations in depression and anxiety, although the data do not exceed those of previous investigations. No clear predisposing factors leading to certain psychological pathologies were found. In addition, individuals in the subacute and chronic stages differed in their scores. In individuals with SCI, identifying predictors of psychological problems is difficult, but premature assessment of mental state is essential. This early diagnosis of possible problems or changes at the mental level is fundamental and necessary to avoid possible alterations at the cognitive level and, of course, more serious mental complications. [ABSTRACT FROM AUTHOR]

Men who have sex with men are at an increased risk of acquiring sexually transmitted infections, and although behavioral and contextual interventions have improved, infections continue to spread. Therefore, a new focus on recent trends in sexual health in this population is needed. The aim of this study was to describe the relationship between sociodemographic and behavioral characteristics according to Grindr usage patterns, the prevalence of sexually transmitted infections (STIs), and attitudes toward HIV testing. In January 2020, a cross-sectional study was conducted using a sample of 881 men who have sex with men (MSM) who completed an online questionnaire. We evaluated their Grindr use patterns (moderate or intensive) and explored the associations of these with sociodemographic behavioral characteristics, STIs, and attitudes toward HIV testing. Of 881 participants in total, 587 (66.6%) were intensive Grindr users. Compared to moderate users, these participants reported significantly higher numbers of casual sexual partners (76.2% vs. 23.8%; p < 0.001), were more likely to participate in Chemsex (77.3% vs. 22.7%: p = 0.031), and had a higher self-reported number of STIs (69.9% vs. 30.1; p = 0.046). They also demonstrated better attitudes toward HIV testing (69.7% vs. 30.3%; p = 0.045) and perceived themselves to be at moderate risk of HIV (71.2% vs. 28.8%: p = 0.048). Moreover, intensive Grindr users were 1.36 times more likely than moderate users to test positive for STIs (95%CI = 1.15–1.91; p = 0.048). With some limitations, age, sexual partners, intensive Grindr users, and PrEP uses were associated with the risk of STIs in the sample of Spanish Grindr users studied. As Grindr users are vulnerable to sociodemographic and behavioral factors that determine STIs and HIV infection, mainly among intensive users, it is necessary to highlight the importance of new trends such as online dating apps, PrEP use, substance use in sex, and Chemsex, and these need to be incorporated into online public health strategies. [ABSTRACT FROM AUTHOR]

(1) Background: During and after the pandemic, individuals with type 1 and type 2 diabetes struggled to maintain a healthy lifestyle due to psychological distress and the struggle to accommodate contextual challenges and changes in their family and work obligations and expectations. This study aims to explore the long-term impacts of the pandemic on proactive self-management behaviors and outcomes that consider contextual and environmental factors, such as family and work dynamics. (2) Methods: In this mixed-method study, data were collected from 418 participants using the Hospital Anxiety and Depression Scale (HADS) and the Insomnia Severity Index (ISI), followed by 16 individual interviews. (3) Results: The prevalence of depression was 37.1%, that of anxiety was 59.1%, and that of insomnia was 66.3%. Significant differences were observed in anxiety by age (p = 0.02), while individuals with other comorbidities were more likely to report insomnia (p = 0.3). Overall, various challenges during the pandemic have exacerbated emotional distress and complicated self-care routines and adherence to healthy lifestyles. (5) Conclusions: The COVID-19 pandemic has prompted individuals with type 1 and 2 diabetes to adopt alternative health-management methods, such as self-care, proactive initiatives, and daily challenges. Enhancing proactiveness, awareness, and an understanding of individuals' needs is crucial for alleviating stress, controlling disease, and preparing for potential future health crises in the wake of the pandemic's long-term effects. [ABSTRACT FROM AUTHOR]

Background: The direct anterior approach is increasingly used for primary total hip arthroplasty (THA) due to its minimally invasive nature and rapid recovery time. Difficulties in identifying the correct intermuscular interval can arise during the procedure, sometimes resulting in excessive medial exposure. This study aimed to evaluate demographics and risk factors, outcomes, and potential complications in those THA patients in which a medialized approach was performed. Methods: We retrospectively reviewed cases of anterior THA to identify cases where the surgical approach to the hip was more medial than the standard interval. Demographic data, operative time, blood loss, intraoperative and postoperative complications, radiographic findings were collected and compared with a control group of 50 THA performed using the standard anterior intermuscular interval. Results: In a series of 1,450 anterior total hip arthroplasty (THA) procedures performed between January 2018 and December 2021, with an average follow-up of 33 ± 22.3 months, six patients (0.4%) had a medialized surgical interval. In one case the superficial layer was medial to the sartorious muscle while in the other five cases, the interval was lateral to the sartorius superficially, and medial to the rectus femoris deeply. Four out of 6 patients (66.6%) showed neuropraxia affecting the femoral nerve, and 3 out of 6 (50%) had involvement of the lateral femoral cutaneous nerve. In 6 out of 6 patients (100%), surgery was performed during the learning curve of DAA. No patients in the control group developed femoral nerve neuropraxia, and 2 out of 50 patients (4%) showed involvement of the lateral femoral cutaneous nerve. Discussion and conclusion: The anterior approach can rarely result in excessive medial exposure to the hip joint, especially during the learning curve. In our study cohort, an increased rate of neurological complications and reduced outcomes were observed, thereby rendering this event of particular clinical significance. To avoid unconventional intermuscular intervals, patient positioning and correct identification of the muscle bellies by recognizing the orientation of the muscle fibers are useful, together with the identification and ligation of the circumflex vessels, to ensure the identification of the correct intermuscular interval. [ABSTRACT FROM AUTHOR]

Background The health and environmental benefits of legume consumption are reflected in dietary guidelines worldwide. However, legume intake fails to meet recommendations. Dietitians' legume counseling practices can impact consumption patterns. This cross-sectional study assessed Israeli dietitians' knowledge, attitudes, perceptions and practices regarding legume counseling and identified pertinent barriers and facilitators. Methods An electronic survey among Israeli dietitians (n  = 309) was performed. Multivariable logistic regression assessed associations between recommending legumes with participants' socio-demographic and professional characteristics, knowledge, perceptions, attitudes toward legume counseling and personal legume intake. Results Almost half (47.4%) of the participants recommended that 76% or more of their patients increase legume intake. Factors that were associated with recommending legumes were perceptions of fewer barriers to consumption [adjusted OR (aOR) 1.92 (95% CI 1.24–2.96)] and positive attitudes toward legume counseling pertaining to its importance [aOR 1.95 (95% CI 1.12–3.4)]. Negatively associated factors were a low level of personal legume consumption [aOR 0.38 (95% CI 0.15–0.94)] and working in hospitals [aOR 0.43 (95% CI 0.19–0.98)]. Conclusions Israeli dietitians' recommendations for legume consumption were well below current guidelines. These findings indicate the need for a tailored intervention for nutrition professionals to increase the frequency of legume counseling and overall consumption. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the unique electroencephalography (EEG) patterns in neuronopathic Gaucher disease (GD) patients and explore the correlations between EEG findings and neurological phenotypes so as to optimize clinical outcomes. Methods: A retrospective analysis was conducted on 74 EEG recordings from 50 GD patients between January 2012 and July 2022. Results: Twenty-three patients exhibited abnormal EEG recordings, including 11 of the GD1 type (the transitional type) and 12 with neuronopathic GD. Of the 12 neuronopathic GD patients, 9 patients with epilepsy were analysed specifically in terms of the clinical course. The primary waveform observed in the neuronopathic EEG recordings was the spike-and-wave complex (SWC) during both awake and sleep states. This was significantly different from sharp waves observed only during sleep in the patients of the transitional type (P = 0.0230). The abnormal discharges in the neuronopathic patients were most commonly located in the bilateral Rolandic areas, while the transitional type commonly involved the bilateral frontal regions. Three patients with an epileptic EEG pattern reported their initial seizures years later. Seizures in the neuronopathic patients were effectively controlled with anti-seizure medications (ASMs), despite the ongoing presence of abnormal EEG patterns. The EEG patterns during ocular symptoms were characterized by sporadic or continuous unilateral SWC during sleep. Conclusions: Patients with neuronopathic GD exhibit distinct EEG patterns that can help differentiate them from GD1 patients. Early treatment with ASMs can effectively control seizures. EEG plays a crucial role in monitoring seizures and can facilitate prompt intervention for GD patients. [ABSTRACT FROM AUTHOR]

Background: Dental caries is the most common chronic childhood disease. The recommended age for the first dental visit (FDV) is 1 year, yet a minority of children visit before the age of 3 years. Aim: The aim of the study was to estimate the patterns of and predictors for dental visits among a sample of children. Design: Parents of children between the ages of 6 months and 18 years, who attended the paediatric dentistry clinics and the well‐baby clinics, were recruited. A validated questionnaire was used to collect data. Logistic regression was utilized to assess the predictors of ever visiting a dentist. Results: The mean age at FDV was 5.8 ± 2.1 years. Parents' belief of not needing to see a dentist was the most common barrier to visiting a dentist (33%). Among the reasons for FDV, caries and pain were the most common (45% and 20%, respectively). Predictors of ever visiting a dentist were children who are not an only child and children of parents who visited a dentist themselves. Conclusion: Children visited the dentist at an age older than that recommended, and the reasons for FDV were mainly caries and its consequences. [ABSTRACT FROM AUTHOR]

Background: Post-intensive care syndrome could be responsible for inability to receive proper cancer treatment after ICU stay in patients with solid tumors (ST). Our purpose was to determine the factors associated with cancer treatment resumption and the impact of cancer treatment on the outcome of patients with ST after ICU stay. Methods: We conducted a retrospective study including all patients with ST admitted to the ICU between 2014 and 2019 in a French University-affiliated Hospital. Results: A total of 219 patients were included. Median SAPS II at ICU admission was 44.0 [IQR 32.8, 66.3]. Among the 136 patients who survived the ICU stay, 81 (59.6%) received cancer treatment after ICU discharge. There was an important increase in patients with poor performance status (PS) of 3 or 4 after ICU stay (16.2% at admission vs. 44.5% of patients who survived), with significant PS decline following the ICU stay (median difference − 1.5, 95% confidence interval [-1.5-1.0], p < 0.001). The difference between the PS after and before ICU stay (delta PS) was independently associated with inability to receive cancer treatment (Odds ratio OR 0.34, 95%CI 0.18–0.56, p value < 0.001) and with 1-year mortality in patients who survived at ICU discharge (Hazard ratio HR 1.76, 95%CI 1.34–2.31, p value < 0.001). PS before ICU stay (OR 3.73, 95%IC 2.01–7.82, p value < 0.001) and length of stay (OR 1.23, 95%CI 1.06–1.49, p value 0.018) were independently associated with poor PS after ICU stay. Survival rates at ICU discharge, at 1 and 3 years were 62.3% (n = 136), 27.3% (n = 59) and 17.1% (n = 37), respectively. The median survival for patients who resumed cancer treatment after ICU stay was 771 days (95%CI 376–1058), compared to 29 days (95%CI 15–49) for those who did not resume treatment (p < 0.001). Conclusion: Delta PS, before and after ICU stay, stands out as a critical determinant of cancer treatment resumption and survival after ICU stay. Multidisciplinary intervention to improve the general condition of these patients, in ICU and after ICU stay, may improve access to cancer treatment and long-term survival. [ABSTRACT FROM AUTHOR]

Diabetes is increasing significantly in the world especially among low- and middle-income countries including Algeria where it is ranked second in term of morbidity. This study was conducted aiming to evaluate the level of knowledge and lifestyle practice among Algerian university students. A national online cross-sectional survey was conducted between 14 November 2022 and 11 February 2023. 417 students answered the questionnaire. Demographically, females (82%), singles (86.1%), students aged between 20 and 30 years old (62.2%) and those living in urban areas (86.8%) were the most represented. More than half were students of bachelor level (52.3%) and were mainly studying in Natural and Life Sciences (37.2%) and Humanities (29.5%) faculties, and 10.6% of them declared living with diabetes. Overall, an average percentage of 75.1% correct responses was obtained and 54.6% of the respondents have shown a high level of knowledge. If age, the field of study and paternal education were associated with a high level of knowledge, being a Health Sciences student (OR: 10.175, CI 95%: 2.985–34.677) and being diabetic (OR: 10.486, CI95%: 3.424–32.12) were highly significant factors (p < 0.01). Regarding lifestyle practice, a moderate level of good practice of 54.2% was obtained and the level of knowledge was the only associated factor. These results described that some gaps of knowledge were observed especially among certain categories including students without formal education in Health, and Natural and Life Sciences. Results of this study could be helpful to the health program deciders in their campaigns of prevention against this silent disease. [ABSTRACT FROM AUTHOR]

Background: Obesity and sarcopenia are both viewed as pathological body composition issues and indicators of compromised nutritional status. The aim of this study was to evaluate the effects of sarcopenic obesity on short- and long-term clinical outcomes. Methods: The clinical data of patients who underwent radical gastrectomy between 2013 and 2019 were prospectively collected. Sarcopenia is defined by European Working Group on Sarcopenia in Older People (EWGSOP2) and obesity is defined by the body mass index (BMI). To identify the independent predictors of postoperative complications and overall survival, we performed univariate and multivariate logistic and Cox regression analyses. Results: In a total of 508 cases, 372 (73.2%) cases were diagnosed with non-sarcopenia, 112 (22.0%) with non-obese sarcopenia, and 24 (4.7%) with sarcopenic obesity. In the multivariate logistic regression, both of non-obese sarcopenia (OR = 2.305, 95% CI = 1.444–3.679, P < 0.001) and sarcopenic obesity (OR = 2.589, 95% CI = 1.088–6.156, P = 0.031) were independent risk factors for postoperative complications. In the multivariate Cox analysis, only non-obese sarcopenia (HR = 2.614, 95% CI = 1.882–3.631, P < 0.001) was independent risk factor for overall survival. Conclusions: Sarcopenic obesity serves as an independent risk factor for postoperative complications, but not for overall survival. [ABSTRACT FROM AUTHOR]

Introduction: Non-attendance with scheduled postoperative follow-up visits remains a common issue in orthopaedic clinical research. The objective of this study was to identify the risk factors associated with loss to follow-up among elderly patients with hip-fracture postoperatively. Methods: A retrospective analysis of 1-year post-surgery was performed on patients aged over 60 years who underwent hip-fracture surgery from January 2017 to March 2019. Based on their completion of the appointed follow-up schedule, the patients were classified into 2 groups: the Loss to Follow-up (LTFU) Group and the Follow-up (FU) Group. Clinical outcomes were evaluated by Functional Recovery Score (FRS) questionnaires. Telephone interviews were conducted with patients lost to follow-up to determine the reasons for non-attendance. A comparative analysis of baseline characteristics between the 2 groups was implemented, with further exploration of statistical differences through logistic regression. Results: A total of 992 patients met the inclusion criteria were included in this study, of which 189 patients, accounting for 19.1%, were lost to follow-up 1 year postoperatively. The mean age of the patients in the LTFU Group was 82.0 years, significantly higher than the 76.0 years observed in the FU Group (P < 0.001). The FRS for the LTFU Group was marginally higher than that of the FU group (84.0 vs 81.0), with no significant difference (P = 0.060). Logistic regression analysis identified several significant predictors of noncompliance, including advanced age at surgery, femoral neck fracture, hip arthroplasty, long distance from residence to hospital, and the reliance on urban-rural public transportation for reaching the hospital. Conclusion: Postoperative follow-up loss was prevalent among elderly patients with hip fractures. Our study indicated a constellation of risk factors contributing to noncompliance, including advanced age, transportation difficulties, long travel distance, femoral neck fracture and hip arthroplasty surgery. [ABSTRACT FROM AUTHOR]

Background: The Great East Japan Earthquake and the subsequent Fukushima nuclear power plant accident in 2011 posed significant challenges to the educational sector, particularly affecting nursing students in the disaster area. However, to the best of our knowledge, there are no reports on the effects of the natural disaster coupled with the nuclear accident on the nursing students. Therefore, this study aimed to determine the impact of the Fukushima disasters on rate of academic failure events in nursing education. Methods: A retrospective cohort approach was conducted, focusing on 677 students from Soma Nursing School admitted between 2001 and 2017. Four failure events—failure to pass the national examination, student retention, suspension, and withdrawal from school—were compared between three time periods: pre-disaster, early peri-disaster, and later peri-disaster. This analysis was followed by a questionnaire survey among the students and an interview with faculty members to gain further insights. Results: Of the student cohort, 17% had at least one failure event. Students in the later peri-disaster phase faced an elevated failure rate at 29%. Variables such as being male, admission during later peri-disaster period, and local pre-admission residence played a significant role in these failure events in multivariate logistic regression analysis (adjusted odds ratio [95% confidence interval, p value]; 2.63 [1.49–4.64, < 0.001], 3.207 [2.00–5.15, < 0.001], and 1.84 [1.12–3.02, 0.02], respectively). Conclusions: This study highlights the impact of the Great East Japan Earthquake and the following nuclear accident on nursing education. The elevated failure rates in the later peri-disaster period emphasize the challenges posed by continuing disaster phases. Thus, there is a need for intensified and tailored strategies in nursing education in disaster-affected regions. [ABSTRACT FROM AUTHOR]

Background: Patients on maintenance hemodialysis (MHD) have been disproportionately affected by COVID-19. Identifying factors associated with disease severity and viral clearance times can inform better clinical management for this high-risk group. Methods: We retrospectively analyzed clinical and hematological data from 85 COVID-19 positive MHD patients. Disease severity was classified as non-severe (mild/moderate) or severe (severe/critical). Logistic regression was used to evaluate factors associated with disease severity. The time to viral clearance was assessed and correlated with clinical variables. Results: Cardiovascular disease (OR=11.19, 95% CI 2.35–53.38), neutrophilia (OR=1.24, 95% CI 1.01–1.53), and elevated inflammatory markers (procalcitonin and white blood cell count) were independent predictors of severe COVID-19. A prognostic model incorporating these factors showed good discrimination for severity risk (AUC=0.835). The median time to viral clearance was 19 days. Delayed clearance was associated with higher levels of C-reactive protein, troponin, and N-terminal pro-B-type natriuretic peptide. Conclusions: We identified key prognostic factors for COVID-19 severity and characterized the time to viral clearance in MHD patients. These findings can aid in risk stratification and optimize management for this vulnerable population. Further research through multicenter collaborative studies is warranted to validate these results. [ABSTRACT FROM AUTHOR]

Background. Despite global efforts to promote contraceptive use and ensure reproductive health, Somalia continues to face significant challenges in this regard. This study aims to explore the prevalence of contraceptive use in Somalia and identify the determinants influencing its use. Methods. A total of 8,162 reproductive‐aged women's data were analyzed extracted from 2020 Somali Health and Demographic Survey. The outcome variable was contraception use, classified as any contraception use (yes vs. no), any modern contraception use (yes vs. no), and any traditional contraception use (yes vs. no). The explanatory variables were factors at the individual, household, and community level. The multivariate binary logistic regression model was used to explore associations of outcome variables with explanatory variables. Results. The findings revealed low prevalence of contraceptive use among Somalia women, with only 7% reporting its use. Among them, less than 1% utilized modern contraceptive methods. Several determinants of contraception use were identified, including younger age, higher educational attainment (primary and secondary education), higher parity, exposure to family planning messages through mass media, urban place of residence, and residing in the northwest and northeast regions of Somalia. Conclusion. The results underscore the urgent need for substantial efforts to improve contraceptive use in Somalia. Strengthening healthcare facilities to provide comprehensive sexual and reproductive health services, with a particular focus on promoting contraception uptake, is crucial. Public awareness campaigns and educational programs should also be prioritized to enhance knowledge and understanding of contraception among Somali women. [ABSTRACT FROM AUTHOR]

Objective: The cingulate sulcus sign (CSS) has been observed in patients with idiopathic normal pressure hydrocephalus (iNPH), suggesting potential disruptions in cerebrospinal fluid circulation and compromised glymphatic system. Although there are similarities in the underlying mechanisms between cerebral small vessel disease (CSVD) and iNPH, the relationship between CSS and CSVD remains unclear. This study aimed to investigate the prevalence and potential mechanisms of CSS in patients with CSVD. Methods: Data from patients diagnosed with CSVD at Shengjing Hospital of China Medical University between January 2020 and October 2022 were retrospectively collected, including general information, global cognitive function [assessed by measuring Mini-Mental State Examination (MMSE)], and four CSVD magnetic resonance imaging (MRI) markers [(white matter hyperintensity (WMH), cerebral microbleeds (CMBs), lacunes, and enlarged perivascular spaces (EPVS)], CSS and the Evan's index (EI). Results: A total of 308 patients were included, and CSS was detected in 80 patients (26%). Univariate analysis revealed that MMSE scores in the CSS group were significantly lower compared to the non-CSS group (p < 0.001). Multivariable analysis showed an independent correlation between CSS and the presence of lacunes (odds ratio [OR] 0.358, 95% confidence interval [CI] 0.193-0.663, p = 0.001), presence of lobar dominant CMBs (OR 2.683, 95%CI 1.385-5.195, p = 0.003), periventricular WMH Fazekas score (OR 1.693, 95% CI 1.133-2.529, p = 0.01), and EI (OR 1.276, 95% CI 1.146-1.420, p < 0.001). Conclusion: This preliminary study showed that CSS can be observed in some patients with CSVD. The presence of CSS may represent different mechanisms of CSVD pathogenesis and reflect differences in the degree of cerebrospinal fluid (CSF)/interstitial fluid (ISF) stasis. [ABSTRACT FROM AUTHOR]

Objectives: Injury to the recurrent laryngeal nerve (RLNI) is a known possible morbidity after thyroid surgery. The clinical presentation varied in severity, from changes in voice quality and swallowing in unilateral cases to airway compromise in bilateral cases. In minor cases, vocal fold paralysis (VFP) may occur unnoticed. Although many intraoperative measures have been implemented to minimize nerve injury, the risk remains, either transient or permanent. This study evaluated the incidence and potential risk factors of recurrent laryngeal nerve injury after thyroidectomy. Methods: Retrospective data analysis was conducted on 1368 patients who underwent thyroidectomy at the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, between January 2008 and December 2021. Evaluations were conducted on the pathological features, surgical procedure type, and state of the recurrent laryngeal nerve during surgery as contributing to recurrent laryngeal nerve injury. All patients underwent preoperative and postoperative indirect laryngoscopy examinations with or without videostroboscopy. Physiological testing of the RLN using neurostimulation and laryngeal palpation (NSLP) or intraoperative neuromonitoring (IONM) was performed in all cases. VFP was considered present when vocal fold mobility was absent or significantly reduced. Results: A total of 1368 patients (2177 nerves at risk) who underwent thyroidectomy and fulfilled the inclusive criteria (809 bilateral, 559 unilateral) were evaluated. A total of 62% of patients were more than 45 years old, and the mean age was 48.36 ± 13.03 with a male-to-female ratio of 1:3.6. Eight-hundred one (58.6%) patients underwent total or subtotal thyroidectomies (1602 nerves at risk). Two-hundred seventy-six patients underwent hemithyroidectomy (276 nerves at risk), and 291 patients underwent completion or redo surgeries (299 nerves at risk). Of these 1368 patients, post-surgery laryngoscopy showed reduced or absent vocal fold mobility in 47 (3.4%) patients. Forty-three out of 47 patients had unilateral vocal fold paralysis, and 4 had bilateral VFP. When we analyzed the three risk factors statistically significant for postoperative RLN palsy, age (OR, 1.01; 95% CI, 0.98–1.05; p = 0.365) became non-significant. The other risk factors (extent of surgery and histopathological diagnosis) remained statistically significant (p = 0.004 and 0.031). After adjustment, the extent of surgery, including total thyroidectomy and revision surgery, was strongly associated with a higher risk of odds of postoperative RLN palsy. Physiological RLN stimulation was performed in all cases with NSLP or INOM, and no significant association was observed in the incidence of VFP (p = 0.365). In most cases, symptoms were spontaneously resolved with recovery of vocal fold movement within a few months. Conclusion: In this study, 3.4% of the recurrent laryngeal nerve showed postoperative dysfunction either transient or permanent VFP. Intraoperative identification of the nerve remains the gold standard of care during thyroidectomy. Neuromonitoring aids in detecting the nerve, particularly in severe cases, but does not reduce the nerve injury compared to NSLP. [ABSTRACT FROM AUTHOR]

Background: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. Methods: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. Results: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (β =.24; 95% CI = 0.14-0.35) and anxiety (β =.31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. Conclusions: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being. [ABSTRACT FROM AUTHOR]

Group-based trajectory modeling (GBTM) allows the trajectory analyses of repeated N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements during follow-up visits of pulmonary artery hypertension associated with connective tissue disease (CTD-PAH) patients. This study aimed to (1) identify trajectories of NT-proBNP changing over time, (2) explore the association between NT-proBNP trajectories and prognosis, and (3) explore the effects of baseline clinical characteristics on NT-proBNP trajectories. A retrospective, single-centred, observational study was performed on 52 CTD-PAH patients who had undergone at least three follow-up visits within 1 year from baseline. Four NT-proBNP trajectories were identified using GBTM: low stability (n = 15, 28.85%), early remission (remission within 3 months) (n = 20, 38.46%), delayed remission (remission after 6 or 9 months) (n = 11, 21.15%), and high stability (n = 6, 11.54%). The low-stability and early-remission trajectories were related to a similar positive prognosis, while the delayed-remission and high-stability trajectories were associated with a gradually worsening prognosis (p = 0.000). Intensive CTD immunotherapy (corticosteroids plus immunosuppressants) was the only factor that remained significant after least absolute shrinkage and selection operator regression and multivariate logistic regression, and was independently associated with a lower risk NT-proBNP trajectory (p = 0.048, odds ratio = 0.027, 95% confidence interval: 0.001–0.963), which preliminarily indicated a benefit of CTD-PAH patients undergoing intensive CTD immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients. Methods: Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD. Results: One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804). Conclusion: Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery. [ABSTRACT FROM AUTHOR]

Background: The use of herbal medicine has a long history in Sudan and is widely practiced among the general population. However, there is a lack of studies examining the prevalence, patterns, and predictors of herbal medicine usage in Sudan. Thus, this study was conducted to bridge this gap. Methods: This descriptive cross-sectional study was conducted between January and February 2021. It included Sudanese adults residing in Omdurman, Sudan, using systematic and simple random sampling methods. Data were collected using a structured, adapted questionnaire comprising: the socio-demographic characteristics and the knowledge of herbal medicine and its usage. Moreover, it investigated the commonly used herbal remedies and the participants' sources of information and procurement of such products. Additionally, we examined the correlation between socio-demographic factors, cultural beliefs, and the use of herbal medicine. Data were analyzed using SPSS, and categorical data were presented as frequencies and percentages. Associations were assessed using chi-square, Fisher's exact tests, and binary logistic regression (p < 0.05). Results: This study included 381 participants, of which 48.1% were females and 31.4% were aged 20-30. The majority of participants were aware of the practice of herbal medicine and the prevalence of its usage was 85.9%. Peppermint, acacia, hibiscus, ginger, and fenugreek were the most commonly used remedies. Chi-square and Fisher's exact testing revealed that the participants' gender and beliefs in the safety and effectiveness of herbal medicines were significantly associated with herbal medicine usage (p < 0.05). Binary logistic regression analysis showed that only the perception of herbal medicine's safety was an independent predictor of its usage (p-value 0.038). Conclusion: This study reported a very high prevalence of herbal medicine usage, highlighting the acceptability of Sudanese adults towards herbal medicine usage. This prompts further studies to explore their safety, efficacy, and the possibility of their integration into mainstream healthcare practices and policies. [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP. Methods: BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions. Results: Results in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06–2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk. Conclusions: The interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP. Trial registration: Prospectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study was conducted to identify factors associated with repeated suicide attempts by analyzing the electronic medical records of suicide attempters who visited emergency medical centers due to drug intoxication. Methods: Data from January 1, 2020 to December 31, 2021 were collected for this study and analyzed using SPSS/WIN 25.0. Results: In this study, the factors affecting repeated suicide attempts among individuals who visited the emergency medical center due to acute drug intoxication were the presence or absence of psychiatric diseases, the season of drug intoxication, and age. In order to identify the factors affecting repeated suicide attempts in those who presented with acute drug intoxication, logistic regression analysis was performed by inputting psychiatric diseases, season of drug intoxication, and age, all of which exhibited significant differences between those who did and did not attempt suicide again. The presence of psychiatric diseases (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.04~3.80), intoxication occurring in the fall (vs. spring; OR = 3.35, 95% CI = 1.28~8.75), and age ≥ 65 (vs. those under the age of 18; OR = 12.96, 95% CI = 2.02~83.17). The regression model was found to be statistically significant (F = 30.01, p < .001), and the coefficient of determination of Cox and Snell, which represents the explanatory power of the model, was 12.0%. Conclusion: This study suggests that to prevent repeated suicide attempts, it is necessary to develop a tool to evaluate the risk of suicide, use it to evaluate the risk of suicide, and then manage individuals accordingly. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and severity of depression in patients with retinitis pigmentosa (RP). Materials and Methods: The Beck Depression Inventory (BDI) was administered to 74 patients with RP and 60 healthy controls. Biomicroscopic anterior segment and fundus examination, visual field, optical coherence tomography, and full-field electroretinography tests were performed in all cases. Variables were evaluated with bivariate, multiple linear, and ordinal logistic regression analyses. Results: The RP group included 40 (54%) male and 34 (46%) female patients, while the control group included 23 (38%) male and 37 (62%) female subjects. The patient group had a mean age of 39.20±12.4 years, median best corrected visual acuity (BCVA) of 0.10 decimal (1.0 logarithm of the minimum angle of resolution [logMAR]; range, 1.3-0.7 logMAR), and median visual field mean deviation (MD) score of -28.00 decibels (dB) (range, -1.00 to -34.00 dB). The median BDI score was statistically significantly higher in the patient group (19 points) than in the control group (12 points) (p<0.001). Moderate to severe depression (BDI ≥20) was detected in 61% of patients, while this rate was 25% in healthy controls. BCVA and visual field MD values were identified as predictors of depression score and severity level. The patients' age and gender did not affect total depression score or severity. Conclusion: The prevalence and severity of depression were found to be higher in RP patients than in healthy controls. There was a significant relationship between the patient's functional vision tests and the frequency and severity of depression. Depression reduces the reliability of visual function tests and impairs patients' quality of life. Therefore, assessing mental health as well as functional tests is important in patients with RP. [ABSTRACT FROM AUTHOR]

Objective: Acute trauma care has significantly reduced mortality over the last two decades. The last study to examine the epidemiology of traumatic amputees predates these gains. The majority of those who sustain traumatic amputation are male; therefore, limited data exist on female amputees. This study aimed to (1) provide a current epidemiological analysis of traumatic amputees and (2) compare male and female amputees. Design: All patients sustaining a major limb amputation in the National Trauma Data Bank from 2013 to 2017 were identified. First, descriptive analyses of patient demographics and injury characteristics were performed and compared with a previous 2000-2004 National Trauma Data Bank study. Second, female and male traumatic amputees were compared in this study. Results: From2013 to 2017, we identified 7016 patientswho underwent major limb amputation. Compared with previous years, the current amputees were older and more severely injured. Mortality was 6.3% in the current years compared with 13.4% in the previous years (odds ratio, 0.44, 95% CI = 0.37-0.51, P < 0.001). After multivariable analysis, mortality remained significantly decreased, with no difference in hospital length of stay. Conclusions: Contemporary National Trauma Data Bank analysis demonstrated that patients with traumatic amputations, regardless of sex, often survive until hospital discharge, despite more severe injuries. [ABSTRACT FROM AUTHOR]

Background: The advancement of laparoscopic technology has broadened the application of laparoscopic pancreaticoduodenectomy (LPD) for treating pancreatic head and ampullary tumors. Despite its benefits, postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH) remain significant complications. Ligamentum teres hepatis wrapping around the gastroduodenal artery (GDA) stump show limitations in reducing POPF and PPH. Methods: This study retrospectively analyzed patients undergoing LPD from January 2016 to October 2023, We compared the effectiveness of the two-parts wrapping (the ligamentum teres hepatis wrapping of the gastroduodenal artery stump and the omentum flap wrapping of the pancreatojejunal anastomosis) and ligamentum teres hepatis wrapping around the gastroduodenal artery (GDA) in reducing postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH), using propensity score matching for the analysis. Results: A total of 172 patients were analyzed, showing that the two-parts wrapping group significantly reduced the rates of overall and severe complications, POPF, and PPH compared to ligamentum teres hepatis wrapping around the GDA group. Specifically, the study found lower rates of grade B/C POPF and no instances of PPH in the two-parts wrapping group, alongside shorter postoperative hospital stays and drainage removal times. These benefits were particularly notable in patients with soft pancreatic textures and pancreatic duct diameters of < 3 mm. Conclusion: The two-parts wrapping technique significantly reduce the risks of POPF and PPH in LPD, offering a promising approach for patients with soft pancreas and pancreatic duct diameter of < 3 mm. [ABSTRACT FROM AUTHOR]

Background: The optimal approach for the safe implementation and education of robotic pancreaticoduodenectomy (RPD) remains unclear. Prolonged operation time may cause surgeon fatigue and result in perioperative complications. To solve this issue, our department adopted task division by the console surgeon turnover between resection and reconstruction in 2022. Methods: This study retrospectively investigated consecutive patients who underwent RPD from November 2009 (initial introduction of RPD) to December 2023. The analysis excluded patients who underwent concomitant resection of other organs. The cases performed by a single console surgeon (single approach) were compared with those performed by two or more console surgeons (multiple approach). Results: This study analyzed 85 consecutive RPD cases, including 51 with the single approach and 34 with the multiple approach. The operation time was significantly shorter (832 vs. 618 min, p < 0.001), and the postoperative major complication was less frequent (45% vs. 12%, p = 0.003) in the multiple approach group, although less experienced surgeons performed the multiple approach (number of RPD experiences: 19 cases vs. 5 cases, p < 0.001). The console surgeon turnover between the resection and reconstruction resulted in a safe pancreatojejunostomy performed by the less experienced surgeon (number of pancreatic reconstruction experiences: 6.5 vs. 14 cases, p = 0.010). Surgeons who started RPD with a multiple approach observed a reduction in surgical time and a lower incidence of complications earlier than those who started with a single approach. Conclusion: Task division during the early introduction phase of RPD using the multiple approach demonstrated potential contributions to improved surgical outcomes and enhanced educational benefits. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure. Methods: Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis. Results: Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4–23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24 h (median [IQR] time: 14.5 [7.00–30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87 mm ± 5.97 mm and 8.55 mm ± 6.17 mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00–12.25] days) and non-surgical group (9.00[7.00–13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00–16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00–10.00]) than in the non-surgical group (9.00[7.00–11.00]) and surgical group (11.00[9.00–13.00]) (p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00–5.25]) than in the non-surgical group (7.00[6.13–9.00]) and surgical group (8.00[6.53–10.00]), respectively (p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687–0.993), 1.077 (1.005–1.154), and 1.025 (1.006–1.043), respectively (all p < 0.05). Conclusion: OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction. [ABSTRACT FROM AUTHOR]

Objectives To investigate, in anti-CCP antibody–positive individuals with musculoskeletal symptoms but no clinical synovitis (CCP+ at-risk), the additional value of US for the prediction of inflammatory arthritis. Furthermore, to define a concise US protocol for feasible risk prediction. Methods Demographic and clinical data were collected in 417 CCP+ at-risk (Leeds CCP cohort) with a baseline US scan assessing synovitis and bone erosions in 36 joints, and a follow-up duration ≥24 months. Multivariable binary regression models for inflammatory arthritis development at 24 months evaluated routine clinical variables associated with inflammatory arthritis alone ('clinical' model) and combined with a 36-joint US scanning protocol ('clinical-US extended' model). A 'clinical-US short' model was also developed. Results At 24 months, 92/417 (22.1%) CCP+ at-risk developed inflammatory arthritis (median time 7 months, interquartile range 3–12). The 'clinical-US extended' model performed better than the 'clinical' model [area under the curve (AUC) 0.788 vs AUC 0.731, respectively, P  < 0.001] with an odds ratio for inflammatory arthritis development of 3.18 (95% CI 1.80–5.63) for US synovitis and 2.54 (95% CI 1.21–5.37) for bone erosions. The 'clinical-US short' model, which retained the wrists, knees and MTP5 joints, performed better (AUC 0.782) than the 'clinical' model (P  < 0.001) and similarly (difference in Akaike information criteria <2) to the 'clinical-US extended' model. Conclusions US provides valuable information for predicting progression to inflammatory arthritis in CCP+ individuals both alone and in addition to clinical variables. US synovitis was associated with a 3-fold increase risk of inflammatory arthritis development. A concise US protocol of six joints provides clinically feasible risk prediction in CCP+ at-risk. [ABSTRACT FROM AUTHOR]