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Purpose: Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. Methods: We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. Results: Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). Conclusion: The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the clinical and radiographic outcomes and arthroscopic findings after high tibial osteotomy (HTO) between neutral and classic targeted coronal alignments in patients with medial meniscus posterior root tears (MMPRTs). Methods: Ninety-eight patients with MMPRT were prospectively enrolled in the final cohort and randomized into two groups. Fifty-two patients with the targeted alignment through the Fujisawa point (60–62.5% of the entire tibial plateau width measured from the medial side) during HTO were included in group A, whereas 46 patients with the targeted alignment through the point at 50–55% of the tibial plateau width were included in group B. The clinical and radiographic outcomes and second-look arthroscopic findings were statistically compared for comprehensive assessments. Results: After a mean follow-up of 37.1 months, we found no significant differences between the two groups regarding the final Lysholm (p = 0.205) and Hospital for Special Surgery scores (p = 0.084). However, we only observed significant differences between the two groups in terms of the final hip–knee–ankle angle, weight-bearing line ratio, and medial proximal tibial angle (p < 0.001). Second-look arthroscopy did not reveal a significant difference in meniscal healing rate (p = 0.786). Conclusions: Performing HTO with the aim to achieve neutral alignment leads to similar clinical outcomes in patients with MMPRT compared to classic alignment. Although subsequent research is required, the current study provides clinical evidence for the safety and efficacy of the new targeted alignment during HTO, which may avoid long-term complications associated with overcorrection when using the traditional technique. [ABSTRACT FROM AUTHOR]

This systematic review compares the clinical outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD) and kidney disorders. The review found that CABG had better long-term survival rates compared to PCI in terms of myocardial infarction and revascularization. However, there was no significant difference in mortality rates from different causes between the two procedures. The study suggests that PCI may be less successful in patients with impaired renal function and that CABG should be preferred for treating CAD in these patients. The given text includes references to two articles: "The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease" and "Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease." The copyright holder is Dhiya Putri Aqilah Sandha, Yanto Sandy Tjang, Tri Faranita, and Karina, and the first publication right is held by Jurnal Health Sains. [Extracted from the article]

Introduction: The sustentaculum tali is displaced in almost half of calcaneal fractures and during surgical fixation represents one of the main reference points upon which the other bone has to be reduced. The purpose of this study was to investigate which subtalar joint fracture pattern is more frequently associated with sustentaculum tali involvement. Furthermore, correlation between postoperative clinical outcome and sustentaculum tali integrity was performed. Material and methods: Patients with isolated calcaneal fractures were analyzed. Sanders-type fracture and involvement of both sustentaculum tali and calcaneocuboid joint were detected on computed tomography imaging; postoperative AOFAS scores were analyzed according to sustentacular involvement. Results: Fifty calcaneus fractures in 47 patients were included in the final analysis. The sustentaculum tali was fractured in 18 cases (36.0%), thus contradicting its supposed constant position. Sanders type 3 and 4 fractures were more frequently associated with fractured sustentaculum than type 2 (p = 0.012). Sanders type 4 fractures were associated with displaced sustentacular fragment significantly more than type 2 and 3 (p = 0.043). Patients with intact sustentaculum tali reported significantly higher (p < 0.001) mean AOFAS scores than the uninjured group (84.4 ± 9.1 and 74.3 ± 9.5, respectively). Conclusion: Sanders type 3 and 4 fractures were more frequently associated with sustentaculum tali and/or calcaneocuboid joint involvement than simpler fractures. Injury of sustentaculum tali was related to significant worse postoperative clinical outcomes, underlying the relevance of this fragment on clinical course. [ABSTRACT FROM AUTHOR]

Cervical total disc replacement (TDR) aims to maintain normal cervical kinematics after surgery. This study investigates the relation between shifted location of centre of rotation (COR) and subsequent surgical outcomes after multilevel cervical TDR (MCTDR) and identifies radiological parameter that corresponded to this change of COR after MCTDR. The study included a consecutive 24 patients treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric Rating Scale (NRS), range of motion (ROM) at both C2-7 segment and TDR implanted levels, and location of COR at TDR level were evaluated at pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief. The inherent CORs relatively at ventro-cranial coordinates have demonstrated significant migrations to dorso-caudal location, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 as well as MCTDR level in comparison with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the X axis. The determinant for clinical success after MCTDR, other than mere preservation of the ROM both at C2-7 and TDR levels, was restoration of COR from ventro-cranial location close to normal coordinates by posterior and inferior shifts. The position of COR along the X axis after MCTDR was important factor to determine maintenance of C2-7 ROM. [ABSTRACT FROM AUTHOR]

Patients with rheumatoid arthritis (RA) are reported to be more vulnerable to coronavirus disease 2019 (COVID‐19), so clinical severity is a particular concern for them. This meta‐analysis was performed to evaluate the clinical outcomes in RA patients with COVID‐19. A systematic literature search was performed in electronic databases for relevant articles published from January 2020 to October 2022. We extracted necessary relevant data and Egger's test was used to evaluate the risk of publication bias. This meta‐analysis included 9 studies with a total of 12 339 RA patients with COVID‐19 and 685 982 non‐RA patients with COVID‐19. We found serious adverse outcomes in RA patients with COVID‐19, including the rates of severity (OR: 1.59, 95% CI: 1.23–2.05, p =.0004), hospitalization (OR: 1.73, 95% CI: 1.55–1.92, p <.00001), mortality (OR: 1.92, 95% CI: 1.67–2.20, p <.00001), mechanical ventilation (OR: 1.64, 95% CI: 1.47–1.84, p <.00001), despite no significant difference observed in ICU admission (OR: 1.37, 95% CI: 0.95–1.98, p =.09). Our data suggests that RA patients had an increased risk of adverse clinical outcomes with COVID‐19 infection. [ABSTRACT FROM AUTHOR]

All work done by humans from mild to severe can cause the risk of the supporting tissue wall weakening and if heavy lifting work is carried out for a long time with continuous frequency can cause the risk of weakness of the abdominal wall The purpose of this study is to determine the relationship between risk factors for inguinal hernia, namely physical workload, age, and obesity with the incidence of inguinal hernia at RSUD dr. Soeselo Tegal Regency. This study is an observational study with a retrospective approach. The samples used in this study were 80 inguinal hernia patients. The independent variables in this study were physical workload, age, and obesity. While the dependent variable of this study is inguinal hernia. The study was conducted online and at RSUD dr. Soeselo, Tegal Regency which was carried out in August 2020 - September 2021The results of the study found 13 patients with bilateral inguinal hernia and 67 patients with unilateral inguinal hernia. The results of statistical tests found that there was a relationship between physical workload and the incidence of inguinal hernia with a value of p = 0.026. There is a relationship between age and the incidence of inguinal hernia with the incidence of inguinal hernia with a value of p = 0.002. There is an association between obesity and the incidence of inguinal hernia with a value of p = 0.026. The conclusion of this study shows that there is a relationship between the risk factors for inguinal hernia, namely physical workload, age, and obesity with the incidence of inguinal hernia at RSUD dr. Soeselo, Tegal Regency [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is usually treated with surgery followed by adjuvant partial radiotherapy combined with temozolomide (TMZ) chemotherapy. Recent studies demonstrated a better survival and good response to TMZ in methylguanine-DNA methyltransferase (MGMT)-methylated GBM cases. However, approximately 20% of patients with MGMT-unmethylated GBM display an unexpectedly favorable outcome. Therefore, additional mechanisms related to the TMZ response need to be investigated. As such, we decided to investigate the clinical relevance of six miRNAs involved in brain tumorigenesis (miR-181c, miR-181d, miR-21, miR-195, miR-196b, miR-648) as additional markers of response and survival in patients receiving TMZ for GBM. We evaluated miRNA expression and the interplay between miRNAs in 112 IDH wt GBMs by applying commercial assays. Then, we correlated the miRNA expression with patients' clinical outcomes. Upon bivariate analyses, we found a significant association between the expression levels of the miRNAs analyzed, but, more interestingly, the OS curves show that the combination of low miR-648 and miR-181c or miR-181d expressions is associated with a worse prognosis than cases with other low-expression miRNA pairs. To conclude, we found how specific miRNA pairs can influence survival in GBM cases treated with TMZ. [ABSTRACT FROM AUTHOR]

Objective: To observe the treatment effect of unilateral biportal endoscopy and annulus fibrosus stapler in the treatment of lumbar spinal stenosis in young people. Methods: A retrospective analysis of 96 cases of lumbar spinal stenosis in young people using unilateral biportal endoscopy and annulus fibrosus stapler (52, UBE) and percutaneous endoscopic lumbar discectomy, 44, PELD）. The perioperative period, follow-up and imaging data were evaluated. Results: All patients in both groups had operations performed successfully without serious complications. There is a significantly improvement after operation in VAS and ODI in all groups (P<0.05), while there is a significantly superior in long-term in UBE group. In addition, the UBE group proved significantly superior to the PELD group in terms of the X-ray times and recurrence(P<0.05). Radiographically, the UBE group also proved significantly superior to the PELD group in terms of the spinal canal area and the the postoperative residual(P<0.05). Conclusion: The unilateral biportal endoscopy could be a kind of ideal and safe treatment in clinic in the treatment of lumbar spinal stenosis in young people. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on population health. The genetic determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in southern Bangladesh are not well understood. Methods: This study aimed to determine the genomic variation in SARS-CoV-2 genomes that have evolved over 2 years of the pandemic in southern Bangladesh and their association with disease outcomes and virulence of this virus. We investigated demographic variables, disease outcomes of COVID-19 patients and genomic features of SARS-CoV-2. Results: We observed that the disease severity was significantly higher in adults (85.3%) than in children (14.7%), because the expression of angiotensinconverting enzyme-2 (ACE-2) diminishes with ageing that causes differences in innate and adaptive immunity. The clade GK (n = 66) was remarkable between June 2021 and January 2022. Because of the mutation burden, another clade, GRA started a newly separated clustering in December 2021. The burden was significantly higher in GRA (1.5-fold) highlighted in mild symptoms of COVID-19 patients than in other clades (GH, GK, and GR). Mutations were accumulated mainly in S (22.15 mutations per segment) and ORF1ab segments. Missense (67.5%) and synonymous (18.31%) mutations were highly noticed in adult patients with mild cases rather than severe cases, especially in ORF1ab segments. Moreover, we observed many unique mutations in S protein in mild cases compared to severe, and homology modeling revealed that those might cause more folding in the protein's alpha helix and beta sheets. Conclusion: Our study identifies some risk factors such as age comorbidities (diabetes, hypertension, and renal disease) that are associated with severe COVID-19, providing valuable insight regarding prioritizing vaccination for high-risk individuals and allocating health care and resources. The findings of this work outlined the knowledge and mutational basis of SARS-CoV-2 for the next treatment steps. Further studies are needed to confirm the effects of structural and functional proteins of SARS-CoV-2 in detail for monitoring the emergence of new variants in future. [ABSTRACT FROM AUTHOR]

Background: Most critically ill patients with COVID‐19 experience malnutrition and weight loss associated with negative clinical outcomes. Our primary aim was to assess body composition during acute and late phase of illness in these patients in relation to clinical outcome and secondary to tailored nutrition support. Methods: This prospective cohort study included adult critically ill patients with COVID‐19. Body composition (fat‐free mass [FFM] [exposure of interest], fat mass [FM], skeletal muscle mass [SMM], and phase angle [PA]) was determined with multifrequency bioelectrical impedance analyses in the acute and late phase. Nutrition support data were collected simultaneously. Clinical outcome was defined as intensive care unit (ICU) survival (primary outcome) and 30–90 days thereafter, duration of mechanical ventilation, and length of ICU stay and length of hospital stay (LOS). Nonparametric tests and regression analyses were performed. Results: We included 70 patients (73% male, median age 60 years). Upon admission, median BMI was 30 kg/m2, 54% had obesity (BMI > 30 kg/m2). Median weight change during ICU stay was −3 kg: +3 kg FM and −6 kg FFM (−4 kg SMM). Body composition changed significantly (P < 0.001). Regarding clinical outcome, only low PA was associated with prolonged LOS (odds ratio = 0.83, 95% CI = 0.72–0.96; P = 0.015). Patients with optimal protein intake (>80%) during acute phase maintained significantly more FFM (2.7 kg, P = 0.047) in the late phase compared with patients who received <80%. Conclusion: FFM decreased significantly during acute and late phase of illness, but we observed no association with ICU survival. Only low PA was associated with prolonged LOS. FFM wasting likely occurred because of disease severity and immobility. [ABSTRACT FROM AUTHOR]

Introduction: Reported outcomes for parenteral nutrition (PN)–related complications in older adult patients with acute intestinal failure who are receiving PN in the acute hospital setting are limited. Our study aims to compare PN‐related complications between older and younger adult patients. Methods: A retrospective descriptive study of inpatients who were administered PN from January 1, 2019, to December 31, 2019, was performed. Patients were categorized into older (≥65 years old) and younger (<65 years old) adult groups. Results: Two hundred thirty‐five patients were included. There were 103 patients in the older adult group (mean age: 73.9 [SD: 6.9] years) and 132 patients in the younger adult group (mean age: 52.4 [SD: 12.5] years). There was a significantly higher Charlson Comorbidity Index score and lower Karnofsky score in the older adult group. The older adult group received significantly lower total energy (20.8 [SD: 7.8] vs 22.8 [SD: 6.3] kcal/kg/day), dextrose (3.1 [SD: 1.4] vs 3.6 [SD: 1.4] g/kg/day), and protein (1.1 [SD: 0.4] vs 1.2 [SD: 0.3] g/kg/day) than the younger group received. The mean length of stay was significantly shorter in the older adult group (35.9 [SD: 21.3] vs 59.8 [SD: 55.3]; P < 0.05). There was no significant difference in PN‐related complications and clinical outcomes (catheter‐related bloodstream infections, hypoglycemia or hyperglycemia, fluid overload, or inpatient mortality) between the two groups. Conclusion: Despite more comorbidities in the older adult, the usage of PN in older adult patients with acute intestinal failure was associated with neither an increased rate of PN‐related complications nor worse clinical outcomes when compared with that of younger patients. [ABSTRACT FROM AUTHOR]

Our study describes the frequency and severity of COVID-19 in HCWs and estimates the dynamic risk of COVID-19-related events. We actively surveyed all HCWs from a tertiary infectious disease hospital from 26 February 2020 to 31 May 2023. Of 1220 HCWs, 62.9% (767) had at least one COVID-19 episode. The under 29 years (p = 0.0001) and 40–49 years (p = 0.01) age groups, nurses (p = 0.0001), and high-risk departments (p = 0.037) were characteristics significantly more frequent in HCWs with COVID-19 history. A higher percentage of boosters (53.2%; p < 0.0001) were registered in the uninfected group. The second episode of COVID-19 was significantly milder than the first. Data regarding clinical outcomes from 31 January 2021 to 31 May 2023 were analyzed in a follow-up study to determine the risk of COVID-19-related events. The Cox regression analysis revealed that HCWs with booster shots had a lower risk of COVID-19 across all events, symptomatic events, and moderate to severe events as adjusted hazard ratio (aHR) were: 0.71 (95%CI: 0.54–0.96), 0.23 (95%CI: 0.12–0.46), and 0.17 (95%CI: 0.07–0.43), respectively. Within the vaccinated subgroup, the HCWs with hybrid immunity and booster had aHR for all followed-up events of 0.42 (95%CI: 0.30–0.58), for symptomatic events of 0.52 (95%CI: 0.36–0.74), and 0.15 (95%CI: 0.03–0.66) for moderate to severe events. The risk of COVID-19 clinical events was lower for HCWs with at least one booster than those completely vaccinated. [ABSTRACT FROM AUTHOR]

Purpose: Endovascular treatment (EVT) of tandem lesion (TL) in anterior circulation (AC) acute ischemic stroke (AIS) represents still a clinical challenge. We aimed to evaluate selected factors related to EVT and assess other possible predictors of good clinical outcome besides the generally known ones. Methods: AIS patients with TL in AC treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0–2 points in modified Rankin Scale (mRS) and achieved recanalization using the TICI scale. Symptomatic intracerebral hemorrhage (SICH) was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of mRS 0–2 with adjustment for potential confounders. Results: In total, 300 (68.7% males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7%) patients and 176 (58.7%) had mRS 0–2. Besides the age, admission NIHSS and SICH, admission glycemia (p = 0.005, OR: 0.884) the stent patency within the first 30 days after EVT (p = 0.0003, OR: 0.219), dual antiplatelet therapy (DAPT) started within 12 h after EVT (p < 0.0001, OR: 5.006) and statin therapy started within 24 h after stenting (p < 0.0001, OR: 5.558) were found as other predictors. Conclusion: Admission glycemia, start of DAPT within 12 h and statin therapy within 24 h after EVT, and stent patency within the first 30 days after EVT were found as other predictors of good three-month clinical outcome in AIS patients treated with EVT for TL. [ABSTRACT FROM AUTHOR]

The safety and efficacy of intravenous thrombolysis (IVT) are well established in anterior circulation stroke (ACS) but are much less clear for posterior circulation stroke (PCS). The aim of this study was to evaluate the occurrence of parenchymal hematoma (PH) and 3-month clinical outcomes after IVT in PCS and ACS. In an observational, cohort multicenter study, we analyzed data from ischemic stroke patients treated with IVT prospectively collected in the SITS (Safe Implementation of Treatments in Stroke) registry in the Czech Republic between 2004 and 2018. Out of 10,211 patients, 1166 (11.4%) had PCS, and 9045 (88.6%) ACS. PH was less frequent in PCS versus ACS patients: 3.6 vs. 5.9%, odds ratio (OR) = 0.594 in the whole set, 4.4 vs. 7.8%, OR = 0.543 in those with large vessel occlusion (LVO), and 2.2 vs. 4.7%, OR = 0.463 in those without LVO. At 3 months, PCS patients compared with ACS patients achieved more frequently excellent clinical outcomes (modified Rankin scale [mRS] 0–1: 55.5 vs. 47.6%, OR = 1.371 in the whole set and 49.2 vs. 37.6%, OR = 1.307 in those with LVO), good clinical outcomes (mRS 0–2: 69.9 vs. 62.8%, OR = 1.377 in the whole set and 64.5 vs. 50.5%, OR = 1.279 in those with LVO), and had lower mortality (12.4 vs. 16.6%, OR = 0.716 in the whole set and 18.4 vs. 25.5%, OR = 0.723 in those with LVO) (p < 0.05 in all cases). In PCS versus ACS patients, an extensive analysis showed a lower risk of PH both in patients with and without LVO, more frequent excellent and good clinical outcomes, and lower mortality 3 months after IVT in patients with LVO. [ABSTRACT FROM AUTHOR]

Introduction: Rapid exome sequencing (rES) has become the first-choice genetic test for critically ill patients, mostly neonates, young infants, or fetuses in prenatal care, in time-sensitive situations and when it is expected that the genetic test result may guide clinical decision making. The implementation of rES has revolutionized medicine by enabling timely identification of genetic causes for various rare diseases. The utilization of rES has increasingly been recognized as an essential diagnostic tool for the identification of complex and undiagnosed genetic disorders. Methods: We conducted a retrospective evaluation of our experiences with rES performed on 575 critically ill patients from various age groups (prenatal to adulthood), over a four-year period (2016-2019). These patients presented with a wide spectrum of rare diseases, including but not limited to neurological disorders, severe combined immune deficiency, and cancer. Results: During the study period, there was a significant increase in rES referrals, with a rise from a total of two referrals in Q1-2016 to 10 referrals per week in Q4-2019. The median turnaround time (TAT) decreased from 17 to 11 days in the period 2016-2019, with an overall median TAT of 11 days (IQR 8-15 days). The overall diagnostic yield for this cohort was 30.4%, and did not significantly differ between the different age groups (e.g. adults 22.2% vs children 31.0%; p-value 0.35). However, variability in yield was observed between clinical entities: craniofacial anomalies yielded 58.3%, while for three clinical entities (severe combined immune deficiency, aneurysm, and hypogonadotropic hypogonadism) no diagnoses were obtained. Discussion: Importantly, whereas clinical significance is often only attributed to a conclusive diagnosis, we also observed impact on clinical decision-making for individuals in whom no genetic diagnosis was established. Hence, our experience shows that rES has an important role for patients of all ages and across the broad spectrum of rare diseases to impact clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the safety and efficacy of docetaxel plus S-1-based therapy in gastric cancer treatment. Methods: PubMed, Embase, The Cochrane Library, and Web of Science electronic databases were searched for randomized controlled trials on docetaxel plus S-1-based therapy in the treatment of gastric cancer from the establishment of the database to 1 September 2022. Relevant studies were included per pre-defined eligibility criteria, and two researchers independently screened and assessed the included literature using Review Manager v5. Outcome measures and statistics related with efficacy and safety profiles were extracted from the included studies, and Stata v15.1 was used for pooled analysis. Results: Objective response rate (odds ratio = 2.34, 95% CI = [1.32, 4.13], p = 0.003), relapse-free survival (HR = 0.68, 95% CI = [0.58, 0.79], p < 0.001), progression-free survival (HR = 0.81, 95% CI = [0.68, 0.96], p = 0.016), and overall survival (HR = 0.86, 95% CI = [0.79, 0.95], p = 0.002) of docetaxel plus S-1-based therapy (DS-based therapy) in gastric cancer treatment were better than those of the non-DS-based therapy. However, DS-based therapy was associated with increased risk of certain adverse drug effects, such as alopecia, leukopenia, and oral mucositis. Further studies are warranted to validate the efficacy superiority of DS-based versus non-DS-based regimens as per our trial sequential analysis findings. Conclusion: DS-based therapy significantly improves patients' clinical outcomes in gastric cancer, albeit at the cost of increased toxicity. Further RCTs are needed to confirm the efficacy superiority of DS-based regimens. [ABSTRACT FROM AUTHOR]

Background: The lack of randomized evidence makes it difficult to establish reliable treatment recommendations for endovascular treatment (EVT) in elderly patients. This meta-analysis aims to evaluate the therapeutic effects of endovascular treatment for acute ischemic stroke in the elderly compared with younger patients. Methods: Comprehensive literature retrieval was conducted to identify studies that directly compared the outcomes of EVT in elderly patients and those aged <80 years. The primary outcome was functional independence, defined as mRS 0-2 at 90 days after EVT. The secondary outcomes were the rate of successful recanalization, symptomatic intracranial hemorrhage (sICH) and mortality. Odds ratios (ORs) were estimated using a random effects model. Results: In total, twenty-six studies with 9,492 enrolled participants were identified. Our results showed that, compared with patients aged <80 years undergoing EVT, EVT was associated with a lower rate of functional independence at 90 days (OR = 0.38; 95% CI, 0.33-0.45; p < 0.00001) and a higher mortality rate (OR = 2.51; 95% CI, 1.98-3.18; p < 0.00001) in the elderly. Furthermore, even without a significantly observed increase in sICH (OR = 1.19; 95% CI, 0.96-1.47; p = 0.11), EVT appeared to be associated with a lower rate of successful recanalization (OR = 0.81; 95% CI, 0.68-0.96; p = 0.02). Conclusion: Evidence from observational studies revealed that EVT has less functional outcomes in elderly patients with acute ischemic stroke. Further studies are needed to better identify patients aged =80 years who could potentially benefit from EVT. [ABSTRACT FROM AUTHOR]

Background: To compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD). Methods: A total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab's criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded. Results: The average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). The intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were significantly less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before the operation in the two groups (P < 0.01). Three days after the operation and 1 week after the operation, the VAS scores for low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). Three days after the operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). All patients showed intervertebral fusion at 6 months after the operation. Two patients (5.4%) in the PE-PLIF group experienced complications. Conclusion: Both PE-PLIF and MPLIF surgery were clinically effective and safe for patients with single-segment LDD. PE-PLIF surgery is a promising technique that can be used as an alternative treatment for single-segment LDD. [ABSTRACT FROM AUTHOR]

Introduction: Poison is a substance that can hurt or cause dysfunction in the body due to its chemical action. Poisoning related to pesticides used in agriculture is a major public health issue in developing countries. However, there is a limited epidemiological data on poisoning in Ethiopia. Objective: The aim of this study was to determine poisoning patterns, clinical outcome, and factors associated with poisoned patients in Northwest Ethiopia. Methods: A cross-sectional study was conducted in July 2021 to include data of 1 year period. Data of all poisoned patients were collected using a standardized checklist from the registration book and patient medical records. The association between variables and outcomes was analyzed using a multivariable logistic regression model. A p -value of < 0.05 was considered to declare a statistically significant association. Result: Over one-third of the poisoning cases (35.9%) were seen in the spring, according to a survey of 315 patient medical data. The majority of patients were in the age group of 21–30 years (44.1%). The most common form of poison consumed was organophosphate (OP), which accounts for 61.3% of all visits, and the least common was food poisoning, which accounts for 1.9%. About 82.5% of poisoning cases survived, while the remaining 17.5% were died. Time of arrival to the hospital ≥1 h (adjusted odds ratio (AOR) = 7.02; 95% confidence interval (CI): 1.16, 11.40), lack of oxygen support (AOR = 6.64; 95% CI: 3.56–6.78), and lack of adrenaline/dopamine medication (AOR = 3.57; 95% CI: 1.17–5.78) were all substantially linked with death of poisoned cases. Conclusions: Three-fourth of poisoning cases survived, while the remaining one-fourth died. Ingestion of OPs is the most prevalent type of poisoning, and most cases are intentional. Delayed arrival ≥1 h, lack of oxygen support, and adrenaline/dopamine treatment were all linked to death. On-time arrival, oxygen assistance, and adrenaline/dopamine treatment in a healthcare setting are all recommended. [ABSTRACT FROM AUTHOR]

Background: Genetic mosaicism is commonly observed in human blastocysts. Embryos’ morphokinetic feature observed from time-lapse monitoring (TLM) is helpful to predict the embryos’ ploidy status in a non-invasive way. However, morphokinetic research on mosaic embryos is extremely limited. Moreover, transfer of mosaic embryos is a new attempt in reproductive medicine, while studies regarding the clinical and neonatal outcomes following transfer of embryos with different levels and types of mosaicism are needed. This study aimed to investigate the morphokinetic characteristics of mosaic blastocysts, uncover clinical outcomes of mosaic embryos, and evaluate the effect of level and type of mosaicism on transfer outcomes. Results: A total of 923 blastocysts from 229 preimplantation genetic testing cycles were cultured in TLM incubators in a single fertilization center between July 2016 and July 2021. Multivariate logistic regression models showed mosaic embryos had significantly shorter time to reach morula when compared with euploid (P = 0.002), mosaic with aneuploid (P = 0.005), and aneuploid (P = 0.005) embryos after adjusting the potential confounders. KIDScore is an artificial intelligence scoring program from time lapse incubation system to predict embryo implantation potential. Mosaic with aneuploid embryos had significantly lower KIDScore than euploid (P = 6.47e−4), mosaic (P = 0.005), and aneuploid (P = 0.004) embryos after adjustment. Meanwhile, we compared the clinical outcomes following transfer of low-level (< 50%) mosaic embryos (N = 60) with euploid embryos (N = 1301) matched using propensity scoring collected from September 2020 to January 2023. Mosaic embryos had significantly lower clinical pregnancy rate (41.67% vs. 57.65%, P = 0.015) and live birth rate (38.33% vs. 51.35%, P = 0.048) than the euploid embryos. Subgroup analyses showed the whole, segmental, and complex chromosome mosaic embryos had the similar clinical outcomes. Conclusions: The shortened time to reach morula in mosaic embryos and the low KIDScore in mosaic with aneuploid embryos revealed innovative clues to embryo selection with the non-invasive TLM and provided new insights into biological mechanism of chromosomal abnormality. The analyses of overall and subgroups of mosaic embryo transfer outcomes helped to optimize embryo transfer scheme for in-vitro fertilization procedures. Multi-center prospective studies with large sample sizes are warranted to validate our results in the future. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to conduct a systematic review and meta-analysis examining the relationship between the vasoactive-inotropic score (VIS) and patient outcomes in surgical settings. Methods: Two independent reviewers searched PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, Google Scholar, and CNKI databases from November 2010, when the VIS was first published, to December 2022. Additional studies were identified through hand-searching the reference lists of included studies. Eligible studies were those published in English that evaluated the association between the VIS and short- or long-term patient outcomes in both pediatric and adult surgical patients. Meta-analysis was performed using RevMan Manager version 5.3, and quality assessment followed the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: A total of 58 studies comprising 29,920 patients were included in the systematic review, 34 of which were eligible for meta-analysis. Early postoperative VIS was found to be associated with prolonged mechanical ventilation (OR 5.20, 95% CI 3.78–7.16), mortality (OR 1.08, 95% CI 1.05–1.12), acute kidney injury (AKI) (OR 1.26, 95% CI 1.13–1.41), poor outcomes (OR 1.02, 95% CI 1.01–1.04), and length of stay (LOS) in the ICU (OR 3.50, 95% CI 2.25–5.44). The optimal cutoff value for the VIS as an outcome predictor varied between studies, ranging from 10 to 30. Conclusion: Elevated early postoperative VIS is associated with various adverse outcomes, including acute kidney injury (AKI), mechanical ventilation duration, mortality, poor outcomes, and length of stay (LOS) in the ICU. Monitoring the VIS upon return to the Intensive Care Unit (ICU) could assist medical teams in risk stratification, targeted interventions, and parent counseling. Systematic review registration: PROSPERO CRD42022359100. [ABSTRACT FROM AUTHOR]

Background: While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma. Methods: A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size. Results: The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group. Conclusions: Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes. [ABSTRACT FROM AUTHOR]

Renew interest and enthusiasm for anaerobes stem from both technological improvements (culture media, production of an adequate anaerobic atmosphere, identification methods) and greater awareness on the part of clinicians. Anaerobic infections were historically treated empirically, targeting the species known to be involved in each type of infection. Prevotella, fusobacteria, and Gram-positive cocci (GPAC) were considered responsible for infections above the diaphragm whereas for intra-abdominal infections, Bacteroides of the fragilis group (BFG), GPAC and clostridia were predominantly implicated. The antibiotic susceptibility of anaerobes was only taken into consideration by the clinician in the event of treatment failure or when faced with infections by multidrug-resistant bacteria (MDR). The evolution of antibiotic resistance together with clinical failures due to the absence of detection of hetero-resistant clones has resulted in a greater need for accessible antibiotic susceptibility testing (AST) and disc diffusion method. Improved isolation and identification of anaerobes, along with the availability of accessible and robust methods for performing AST, will ensure that treatment, whether empirical or guided by an antibiogram, will lead to better outcomes for anaerobic infections. [ABSTRACT FROM AUTHOR]

Ischemic stroke is a cerebrovascular disease due to atherosclerosis of the blood vessels of the brain. Ischemic stroke can end in worsening clinical outcomes in the form of disability and death due to the influence of several risk factors, such as age, sex, history of disease, initial level of consciousness, blood pressure, and total cholesterol levels. This study aims to determine the correlation between risk factors and clinical outcomes of ischemic stroke patients at Dr. H. Chasan Boesoirie Ternate Hospital. This study is an observational analytical study using a crosssectional design with secondary data taken by total sampling technique. The results of the study were obtained from 34 patients, 24 (70.6%) patients had hyperglycemia with worsening outcomes in 21 (61.7%) patients. Patients aged ≥45 years with worsening outcomes amounted to 19 (55.9%) patients. Patients with female sex 29 (85.3%) patients with deteriorating outcomes 23 (67.6%) patients. Patients with a history of diabetes mellitus 29 (85.3%) patients with worsening outcomes 23 (67.6%) patients. Patients with GCS ≤8 awareness level were 29 (85.3%) patients with worsening outcomes 23 (67.6%) patients. Patients with hypertensive blood pressure conditions 24 (70.6%) patients with worsening outcomes 21 (61.7%) patients. Patients with hypercholesterolemia with worsening outcomes 19 (55.9%) patients. This study concluded that all variables had a p-value of < 0.05, which means that there is a significant relationship between risk factors and clinical outcomes of ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Background: Acute urticaria (AU) may be associated with atopy, but the relationship between atopic status and the clinical features of the disease has not been fully described. Objectives: The aim of the study was to determine the proportion of atopy in AU patients and to see whether atopy is related to the clinical characteristics of AU and whether it has an impact on the outcome of the disease. Materials and Method: A retrospective analysis of patients with AU was performed. Demographic data, clinical features, and laboratory results were compared and analyzed between the atopic and non-atopic AU (napAU). Results: In total, 139 participants were included. 54 (38.8%) patients were atopic AU (apAU) and 85 (61.2%) were napAU. Compared with napAU patients, apAU patients were more likely to have anaphylaxis, higher levels of C4, and lower levels of antistreptolysin. There were no significant differences between the two groups in terms of other clinical features, laboratory tests, the natural course of the disease, or disease outcomes. Conclusion: Atopy does exist in some patients with AU, and AU patients with an atopic background are at higher risk for anaphylaxis. Atopy does not influence the clinical outcome of AU and is not correlated with other clinical features and laboratory results of AU. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical outcomes of patients with acute kidney injury in patients with upper gastrointestinal bleeding (UGIB), as it is a very frequently encountered condition with high morbidity and treatment costs. We aimed to study the differences in clinical outcomes in patients with UGIB who developed acute kidney injury (AKI) and those who did not. Methods: This cross-sectional study was conducted between Jan 1 and Jun 30, 2023, at a private hospital in Karachi. 200 cases with upper gastrointestinal bleeding were recruited by non-probability sampling after participant assent. 100 patients comprised the acute kidney injury (AKI group) and 100 patients were without AKI. Participants documented age, gender, and co-morbidities in a self-structured questionnaire. Clinical outcomes i.e. hypoalbuminemia, hospital stay and mortality were evaluated and compared. Results: Mean age was 45.03+9.17 years in AKI group and 45.57+9.31 years in without AKI, p-value=0.680, albumin levels in AKI was 2.74+0.43 and without AKI 3.18+0.31, p-value=0.00, Hb level in AKI group was 9.07+0.83 and without AKI 9.54+1.04, p-value=0.001, mean hospital stay in AKI group was 5.21+1.00 and without AKI group 4.20+0.96 days, pvalue= 0.000. A comparison of the two groups regarding gender and clinical outcome shows that 58 (58%) in AKI and 56%(56) without AKI were male whereas 42 (42%) in AKI and 44 (44%) without AKI were females, mortality in AKI group was 27(27%) and in without AKI group 8(8%) cases, p-value=0.000. Conclusion: We concluded that the rate of clinical outcome in terms of hospital stay, hypoalbuminemia and mortality was adverse in upper gastrointestinal bleeding with AKI than those without AKI. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effect and radiographic features of posterior reduction and internal fixation with bone graft fusion for children with high dysplastic developmental spondylolisthesis(HDDS). Methods A total of 29 HDDS children undergoing lumbar spondylolisthesis surgery were recruited from January 2014 to December 2019. There were 2 boys and 27 girls with a mean age of(9.9±2.6)years. According to the Meyerding classification scheme, clinical grades were Ⅲ(n=16), Ⅳ(n=9)and Ⅴ(n=4). Spinal parameters were recorded pre-operation and at Month 3/24 post-operation, including lumbar spondylolisthesis rate, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS)and slip angle(SA). Clinical outcomes were evaluated by visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score. Results All procedures were completed successfully. All of them were followed up for over 2 years with a mean period of(31.8±10.9)months. The relevant measurements were SVA[pre-operation vs Month 3 post-operation(37.8±21.5)° vs. (21.1±8.2)°], LL[pre-operation vs Month 3 post-operation(52.2±19.3)° vs. (34.5±11.7)°], PT[pre-operation vs Month 3 post-operation(39.4±14.0)° vs. (26.4±8.2)°], SS[pre-operation vs Month 3 post-operation(27.8±10.7)° vs. (35.2±7.9)°]and SA[pre-operation vs Month 3 post-operation(26.4±14.4)° vs. (10.7±5.2)°], There were significant improvements as compared with pre-operation(P < 0.05), No significant changes occurred in TK(pre-operation vs Month 3 post-operation 14.4±9.3° vs. 15.5±5.4°)or PI(67.3±12.5° vs. 61.6±10.9°)(P>0.05). SVA[Month 3 vs. Year 2 post-operation were(21.1±8.2)° vs. (19.9±8.2)°], TK[Month 3 vs. Year 2 post-operation(15.5±5.4)° vs. (20.1±7.5)°], PT[Month 3 vs. Year 2 post-operation(26.4±8.2)° vs. (30.7±11.4)°], SS[Month 3 vs. Year 2 post-operation(35.2±7.9)° vs. (41.0±11.0)°]and SA[Month 3 vs. Year 2 post-operation(10.7±5.2)° vs. (10.6±6.0)°]showed no marked changes(P>0.05). LL[Month 3 vs. Year 2 post-operation(34.5±11.7)° vs. (46.3±11.8)°]and PI[Month 3 vs. Year 2 post-operation(61.6±10.9)° vs. (71.7±13.8)° changed markedly(P < 0.05). At Year 2 post-operation, VAS score dropped from pre-operation(5.6±1.1)to(0.4±0.2)(t=17.030, P < 0.05)and JOA score spiked from pre-operation(11.9±2.9)to(20.4±2.8)(t=-17.972, P < 0.05). Improvement rate of JOA score was 96.6%. In this cohort, the complications were nerve root stimulation symptoms(n=2)and wound effusion(n=1). All of them recovered after conservative measures. No internal fixation failure occurred. The mean lumbar spondylolisthesis rate and fusion rate was(82.6±6.7)% and 100% at the final follow-up. Conclusions Posterior reduction and internal fixation with bone graft fusion is both effective and safe for HDDS children. A wider clinical popularization is warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE The goal of this study was to determine the prevalence of gastrointestinal manifestations in coronavirus disease 2019 (COVID-19) and to show the identification of potential connections between gastrointestinal manifestations and outcomes. METHOD This was a retrospective single-centre cohort study, enrolling 205 COVID-19 patients at Saiful Anwar Genera Hospital in Malang, Indonesia, from October 2020 to February 2021. All patients were confirmed by real-time polymerase chain reaction (real-time PCR). Demographics and clinical characteristics, laboratory data, and clinical outcomes were analyzed. RESULTS Among 205 patients, 163 patients (79.5%) had gastrointestinal manifestations, including 145 (89.0%) nausea and vomiting, 132 (81.0%) hyporexia/anorexia, 48 (29.4%) abdominal pain, 38 (23.3%) diarrhea, 13 (8.0%) dysphagia, 12 (7.4%) hematemesis/melena, and 4 (2.5%) constipation. In our findings, we revealed that patients with gastrointestinal manifestations were significantly associated with higher body mass index, a longer length of stay, decreased albumin level and increased several parameters, including fibrinogens, D-Dimer, alanine aminotransferase, total bilirubin, random blood glucose, lactate dehydrogenase, ferritin, C-reactive protein, and lactate acid compared to those without gastrointestinal manifestations. Gastrointestinal manifestation in COVID-19 patients was associated with severe/critical degree (odds ratio [OR]: 4.09; 95% confidence interval [CI]: 1.52-10.97; p=0.00) of COVID-19, intensive care unit (ICU) admission (OR: 4.23; 95% CI: 1.24-14.43), and in-hospital mortality (OR: 4.51; 95% CI: 1.41-16.35; p=0.01). CONCLUSIONS Gastrointestinal manifestations are frequent in COVID-19 patients and associated with an increased hypercoagulable and inflammatory marker, longer length of stay, severe and critical degree of COVID-19, ICU admission, and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: "Within the first ninety minutes, sometimes called the door-to-balloon time (DTBT1), medical professionals strongly recommend that patients with ST-elevation myocardial infarction (STEMI) get mechanical reperfusion. Aim: This study set out to examine, within a group of patients aged 75 and above, the intricate connection between the time elapsed between the door and the balloon and the clinical outcomes. After that, we subdivided this cohort further into those aged 75-84 and those aged 85 and higher. Materials and methods: Following the acceptance of consent from the Institutional Ethics Committee, this study's first point of departure was determined. The investigation was conducted at the Care Hospital in Bhubaneswar, which was the healthcare facility's site. Results: Patients as young as 75 and younger were included in the younger group. People deemed elderly were those between the ages of 75 and 84. On the other hand, those who were 85 were considered among the demographic of elderly citizens considered exceedingly old. This study aimed to reduce the number of major adverse cardiovascular events (MACE) and death rates after one year. One hundred eighteen of the patients were eighty-five years old, and thirty-four were in the age range of seventy-five to eighty-four years old. Participants in this study had an average age of 60.1 years, making it a relatively young group. We discovered a tendency in the senior population (p-for-trend = 0.10) and a substantial drop in DTBT with time in both younger and older persons (p-for-trend = 0.02, 0.05). Similarly, a pattern appeared among the somewhat younger patients. A greater mortality rate (4.1% compared to 11.2% vs 31%; p < 0.05) was seen among those who were highly elderly all during the 12 months investigated. Additionally, it was shown that they had a higher probability of developing major adverse cardiovascular events (MACE) (11.7% vs 21.8% versus 34.6%; p < 0.05). A more favourable outcome was linked to DTBT for 90 minutes. While it did reduce mortality at 12 months (OR0.89, 95% CI0.61-1.45), it was not a reliable predictor of severe adverse cardiovascular events (OR0.91, 95% CI0.71-1.21). We arrived at this result using a univariate analysis. Conclusion: A 90-minute DTBT was not proven to be an independent predictor of outcomes at one year, even though DTBT improved in patients aged 75 and 75-84 over ten years compared to the duration of the experiment. Therefore, it is not always the case that less favourable clinical outcomes are more favourable when deciding whether patients above 85 are suitable candidates for invasive therapy. [ABSTRACT FROM AUTHOR]

Background: The optimal systemic treatment for pulmonary large-cell neuroendocrine carcinoma (LCNEC) remains controversial, and recent advances in LCNEC molecular subtype classification have provided potential strategies for assisting in treatment decisions. Our study aimed to investigate the impact of treatment regimens, molecular subtypes and their concordance on clinical outcomes of patients diagnosed with LCNEC. Patients and Methods: All patients diagnosed with advanced pulmonary LCNEC in Peking Union Medical College Hospital (PUMCH) between January 2000 and October 2021 were enrolled in this retrospective study. The tumor samples were collected and sequenced using a tumor-specific gene panel, while clinical information was retrieved from the medical records system. The survival and therapeutic response were analyzed and compared between different subgroups classified by treatment regimen (SCLC or NSCLC-based), molecular subtype (type I or II) or the combination. Results: In univariate subgroup analysis categorized only by treatment regimen or molecular subtype, there were no differences identified in DCR, ORR, PFS, or OS. Nevertheless, the group with consistent treatment regimen and molecular subtype exhibited significantly longer OS than that of the inconsistent group (median OS 37.7 vs. 8.3months; p=0.046). Particularly, the OS of patients with type II LCNEC treated with SCLC-based regimen was significantly prolonged than that of others (median 37.7 vs. 10.5months; p=0.039). Conclusions: Collectively, our study revealed the clinical outcomes of different treatment regimens for LCNEC patients highly depend on their molecular subtypes, highlighting the need for sequencing-guided therapy. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease often advances rapidly in people with diabetes mellitus, resulting in unfavorable clinical outcomes and complications after revascularization procedures. The purpose of our study was to determine how baseline parameters and Diabetes Mellitus (DM) affected clinical outcomes in the immediate aftermath of revascularization. Materials and Methods: For this investigation, 189 patients who underwent CABG (Coronary Artery Bypass Graft) and PCI (Percutaneous Coronary Intervention) operations for revascularization during a five-month period in a South Indian tertiary care hospital were the subject of a hospital-based prospective observational analysis. During the first 30 days following revascularization, patients were assessed for clinical outcomes and baseline characteristics in the diabetic and non-diabetic groups. To ascertain the relevance of the findings, statistical analyses were carried out. Results: The study reveals that there is no statistically significant difference in the type of surgery, number of grafts or stents, urgency of the surgery, angiographic finding, length of ventilation, volume of the chest drain, stay in the cardiothoracic unit, and length of hospitalization between the diabetes and non-diabetic cohorts. Arrhythmia, stroke after revascularization, re-exploration within discharge mortality, pulmonary embolism, hemorrhage, perioperative mortality, and postoperative mortality within 30 days were evaluated as follow-up events in both the groups and determined to be insignificant. Conclusion: Even though prevalence of Cardiovascular Disease (CVD) is higher in diabetics, when comparing the diabetic and non-diabetic cohorts, it is not regarded as a risk factor for any negative outcomes following revascularization immediately within a period of thirty days following the angioplasty. [ABSTRACT FROM AUTHOR]

Thicker (folded) facia lata autografts have been shown to be superior to thinner grafts and single-layered acellular human dermal (HD) allografts for superior capsular reconstruction (SCR) in biomechanical studies. The aim of this study was to evaluate the midterm clinical outcomes following SCR for irreparable supraspinatus tears using doubled (folded) HD allograft. Thirty-two patients who had undergone SCR using doubled HD allograft between February 2012 and January 2020 were recruited in a continuous manner in this retrospective study. The inclusion criteria were SCR performed for irreparable supraspinatus tear and a minimum of 2 years' follow-up. The primary outcome measure was the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score. The secondary outcome measures were complications and revision surgery. A subgroup analysis was performed between patients who received a "standard" graft of mean 3-mm thickness or a "thick" graft of mean 4.4-mm thickness. One patient was lost to follow-up. A total of 31 patients (31 shoulder joints) were analyzed with a mean follow-up duration of 48 months (range, 25-96 months). Following surgery, there was significant improvement in the ASES score from 18.1 ± 14.3 (preoperative) to 76.3 ± 25.1 (postoperative) (P <.001), with a satisfactory clinical outcome obtained in 83.8% of the patients. In a subset of 8 patients completing 5 years' follow-up, the clinical improvements were sustained. The percentage of patients with a clinically successful outcome was higher among those with thick grafts compared to those with standard grafts, although this failed to reach statistical significance (94.4% vs. 69.2%, risk ratio 1.36, 95% confidence interval 0.93-1.99, P =.13). One patient within the standard group underwent revision surgery. SCR for irreparable rotator cuff tears with doubled HD allograft results in improved clinical outcomes and low reoperation at midterm follow-up duration. [ABSTRACT FROM AUTHOR]

Coronary artery epicardial spasm is involved in the pathogenesis of many cardiac disorders. Vasoreactivity testing, such as intracoronary injection of acetylcholine (ACH) or ergonovine (ER), is the gold standard method for the diagnosis of vasospastic angina. Provoked epicardial spasm phenotypes are classified as focal spasm and diffuse spasm. Multiple factors, including sex, ethnicity, and use of coronary vasoactive stimulators, are related to the provoked phenotypes of epicardial spasm. Diffuse-provoked spasm is often observed in females, where focal-provoked spasm is markedly more common in males. ACH provokes more diffuse and distal spasms, whereas ER induces more focal and proximal spasms. Yellow plaque and coronary thrombi are often observed in lesions with focal spasms, and intimal thickness with a sonolucent zone is significantly more common in lesions with focal spasm. Furthermore, clinical outcomes in patients with focal spasm are unsatisfactory compared with those in patients with diffuse spasm. However, the reproducibility and eternality of provoked spasm phenotypes by vasoreactivity testing is uncertain. Coronary atherosclerosis or endothelial damage may affect coronary vasomotor tone. Although coronary artery spasm may persist in the same coronary artery, provoked coronary spasm phenotypes may exhibit a momentary coronary reaction by intracoronary ACH or ER testing. [Display omitted] • What is the meaning of provoked spasm phenotypes by vasoreactivity testing? • Reproducibility and eternality of provoked spasm phenotypes is uncertain. • Provoked coronary spasm phenotypes may exhibit a momentary coronary reaction. [ABSTRACT FROM AUTHOR]

Background: Comorbidities are risk factors for poor clinical outcomes in patients with heart failure. However, no consensus has been reached on how to assess comorbidities related to clinical outcomes in patients with heart failure. Objective: The aims of this study were to review (1) how comorbidities have been assessed, (2) what chronic conditions have been identified as comorbidities and (3) the rationale for choosing the comorbidity instruments and/or specific comorbidities when exploring clinical outcomes in patients with heart failure. Methods: The clinical outcomes of interest were mortality, hospitalization, quality of life, and self-care. Three electronic databases and reference list searches were used in the search. Results: In this review, we included 39 articles using 3 different ways to assess comorbidities in the relationship with clinical outcomes: using an instrument (ie, Charlson Comorbidity Index), disease count, and including individual comorbidities. A total of 90 comorbidities were investigated in the 39 articles; however, definitions and labels for the diseases were inconsistent across the studies. More than half of the studies (n = 22) did not provide a rationale for selecting the comorbidity instruments and/or all of the specific comorbidities. Some of the rationale for choosing the instruments and/or specific comorbidities was inappropriate. Conclusions: We found several issues related to measuring comorbidities when examining clinical outcomes in patients with heart failure. Researchers need to consider these methodological issues when measuring comorbidities in patients with heart failure. Further efforts are needed to develop guidelines on how to choose proper measures for comorbidities. [ABSTRACT FROM AUTHOR]

As the search for effective treatments for COVID-19 continues, the high mortality rate among critically ill patients in Intensive Care Units (ICU) presents a profound challenge. This study explores the potential benefits of traditional Chinese medicine (TCM) as a supplementary treatment for severe COVID-19. A total of 110 critically ill COVID-19 patients at the Intensive Care Unit (ICU) of Vulcan Hill Hospital between Feb., 2020, and April, 2020 (Wuhan, China) participated in this observational study. All patients received standard supportive care protocols, with a subset of 81 also receiving TCM as an adjunct treatment. Clinical characteristics during the treatment period and the clinical outcome of each patient were closely monitored and analysed. Our findings indicated that the TCM group exhibited a significantly lower mortality rate compared with the non-TCM group (16 of 81 vs 24 of 29; 0.3 vs 2.3 person/month). In the adjusted Cox proportional hazards models, TCM treatment was associated with improved survival odds (P < 0.001). Furthermore, the analysis also revealed that TCM treatment could partially mitigate inflammatory responses, as evidenced by the reduced levels of proinflammatory cytokines, and contribute to the recovery of multiple organic functions, thereby potentially increasing the survival rate of critically ill COVID-19 patients. [ABSTRACT FROM AUTHOR]

The complex interplay between nutrition and inflammation has become a major focus of research in recent years across different clinical settings and patient populations. Inflammation has been identified as a key driver for disease‐related malnutrition promoting anorexia, reduced food intake, muscle loss, and on a cellular level, insulin resistance, which together stimulate catabolism. However, these effects may well be bidirectional, and there is strong evidence showing that nutrition influences inflammation. Several single nutrients and dietary patterns with either proinflammatory or anti‐inflammatory properties have been studied, such as the long‐chain ω‐3 fatty acids eicosapentaenoic acid or docosahexaenoic acid. The Mediterranean diet combines several such nutrients and has been shown to improve medical outcomes in the outpatient setting. In addition, there is increasing evidence suggesting that inflammation affects the metabolism and modulates the response to nutrition support interventions. In fact, recent studies from the medical inpatient setting suggest that inflammation, mirrored by high levels of C‐reactive protein, diminishes the positive effects of nutrition support. This may explain the lack of positive effects of some nutrition trials in severely ill patients, whereas similar approaches to nutritional support have shown positive results in less severely ill patients. The use of biomarkers, such as C‐reactive protein, may help to identify patients with a lower response to nutrition, in whom other treatment options need to be used. There is need for additional research to understand how to best address the malnourished patient with inflammation by specifically lowering inflammation through anti‐inflammatory medical treatments and/or nutrition interventions. [ABSTRACT FROM AUTHOR]

The risk of peritonitis complications in continuous ambulatory peritoneal dialysis (CAPD) can be prevented or reduced by providing proper education and continuous monitoring. Telemedicine and telemonitoring are methods that enable remote monitoring and patient care. This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care. This study is a scoping review (ScR) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method. Article searches were carried out on ProQuest, PubMed, and ScienceDirect with a time range of 2018-2023. Data extraction was performed regarding knowledge level, quality of life, clinical outcomes (peritonitis), and risk of hospitalization. Of the 12 articles and studies included, 6 articles were related to the effect of telemonitoring on CAPD patient outcomes, and 6 articles were associated with the effect of education on CAPD patient outcomes. Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders, reduce the potential for peritonitis and dialysis complications, and improve the quality of life of patients with CAPD. CAPD patients who received telemonitoring had a better quality of life, good clinical outcomes, and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits. In summary, the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks. [ABSTRACT FROM AUTHOR]

Purpose: To assess, clinically, patient satisfaction of additively manufactured complete dentures with intraoral scanning and hybrid cast digitization in comparison with conventional complete dentures. Materials and Methods: Participants who were edentulous in both arches were recruited and received three types of complete dentures (CDs): conventionally manufactured with conventional impression (CC), additively manufactured with intraoral scanning (AMI), and additively manufactured with cast digitization (AMH). Definitive impressions of the edentulous arches were made with medium viscosity polyvinyl siloxane (Hydrorise Monophase; Zhermack, Italy) for the CC group, intraoral scanning (TRIOS 4; 3Shape, Copenhagen, Denmark) for the AMI group, and laboratory scanning of the definitive casts (Ceramill Map400 AMANNGIRRBACH, Pforzheim, Deutschland) for the AMH group. The trial dentures of the CC group were scanned for occlusion registrations of the AMI and AMH groups and were used to guide the designing process (Exocad 3.0 Galway; Exocad GmbH). The AMI and AMH dentures were additively manufactured with a vat‐polymerization 3D printer (Sonic XL 4K; phrozen, Taiwan). Patient satisfaction and clinical outcome were assessed with OHIP EDENT, and 14‐factor criteria, respectively. Statistical analyses were performed with paired sample t‐test and one‐way repeated measure ANOVA for satisfaction, Wilcoxon signed rank test for clinical outcome, and Pearson's r (r) for effect size, with α = 0.05. Results: A total of 20 participants were included. Satisfaction had no statistically significant difference within or among the groups (p < 0.105). Within‐group comparison between the two arches showed no statistical significance for the clinical outcome except for a significantly higher maxillary AMI score (p = 0.01, r = −0.40 with medium effect size). For among group's comparison; AMI had a significantly lower score than CC for the maxillary and mandibular arches (p = 0.01, r = −0.40, medium effect size, and p = 0.003, r = −0.47, medium effect size), and significantly lower score than the mandibular AMH (p = 0.03, r = −0.47, medium effect size), with significantly lower quality in teeth arrangement and retention domains for the AMI, and teeth arrangement for the AMH, in comparison with CC. Conclusions: Patient satisfaction with both types of additively manufactured dentures is comparable to conventional dentures. The comparable overall clinical outcomes between hybrid and conventional dentures indicate that additive manufacturing is an acceptable clinical substitute for the conventional methods. However, additively manufactured dentures made with intraoral scanning have lower clinical quality and retention than hybrid and conventional dentures, particularly for the mandibular arch. Teeth arrangement of both additively manufactured dentures is clinically inferior to the conventional denture. [ABSTRACT FROM AUTHOR]

Background: Rhinoplasty presents a unique challenge to facial cosmetic surgeons due to the intricate nasal anatomy, lack of standardization in surgical approaches, and the diverse expectations of patients. This study aims to address the growing trend of rhinoplasty among young individuals, focusing on the need for comprehensive data collection and outcome analysis. Patient-reported outcomes, particularly quality of life (QOL) assessments, are gaining significance in evaluating the success of facial cosmetic procedures. Methodology: A prospective longitudinal study was conducted on 30 patients with various forms of nasal deformities at SLN Medical College and Hospital, Koraput, Odisha. Surgeries were performed by senior consultants, and the outcomes were analyzed using the Glasgow Benefit Inventory (GBI). Patients were assessed using GBI questionnaires in English and Hindi at 3 and 6 months postsurgery. Inclusion criteria involved patients aged 18 to 60 with parental support and consent for rhinoplasty, while exclusion criteria included psychologically unstable patients and those medically unfit. Detailed preoperative evaluations, standardized surgeries, and postoperative assessments were conducted. Results: Among 31 patients undergoing rhinoplasty, the most common deformity was a crooked nose (38.7%). The mean total GBI score was 63.21, with significant differences observed in total scores, general benefit, and social support scores over 3 and 6 months. Descriptive analysis revealed no significant differences between male and female patients or among different forms of nasal deformities. The study indicated an overall improvement in health status, with a notable impact on general benefit and social support. Discussion: Surgeons undertaking rhinoplasty must navigate the complex interplay of nasal anatomy and psychosocial expectations. Patient satisfaction, a key metric, necessitates scrutiny of surgical outcomes. This study employs GBI, a validated post-intervention questionnaire, to comprehensively assess clinical, QOL, and psychological improvements. The positive results underscore the significance of aesthetic and functional rhinoplasty in enhancing the QOL of the study population. Conclusion: This study concludes that rhinoplasty positively impacts patients' psyches by improving their selfperception and overall well-being. Through meticulous preoperative assessment, proper patient selection, and standardized surgical procedures, rhinoplasty can achieve excellent clinical and psychological outcomes. The Glasgow Benefit Inventory emerges as a vital tool for postintervention assessment in rhinoplasty studies. [ABSTRACT FROM AUTHOR]

Background: This study was aimed to investigate the correlation between low body temperature and outcomes in critically ill patients with coronary heart disease (CHD). Methods: Participants from the Medical Information Mart for Intensive Care (MIMIC)-IV were divided into three groups (≤ 36.5 ℃, 36.6–37.4 ℃, ≥ 37.5 ℃) in accordance with body temperature measured orally in ICU. In-hospital, 28-day and 90-day mortality were the major outcomes. Multivariable Cox regression, decision curve analysis (DCA), restricted cubic splines (RCS), Kaplan–Meier curves (with or without propensity score matching), and subgroup analyses were used to investigate the association between body temperature and outcomes. Results: A total of 8577 patients (65% men) were included. The in-hospital, 28-day, 90-day, and 1-year overall mortality rate were 10.9%, 16.7%, 21.5%, and 30.4%, respectively. Multivariable Cox proportional hazards regression analyses indicated that patients with hypothermia compared to the patients with normothermia were at higher risk of in-hospital [adjusted hazard ratios (HR) 1.23, 95% confidence interval (CI) 1.01–1.49], 28-day (1.38, 1.19–1.61), and 90-day (1.36, 1.19–1.56) overall mortality. For every 1 ℃ decrease in body temperature, adjusted survival rates were likely to eliminate 14.6% during the 1-year follow-up. The DCA suggested the applicability of the model 3 in clinical practice and the RCS revealed a consistent higher mortality in hypothermia group. Conclusions: Low body temperature was associated with increased mortality in critically ill patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Background: Traditional screw or cemented connections in dental implants present limitations, prompting the exploration of alternative methods. This study assesses the clinical outcomes of single crowns and fixed partial prostheses supported by conometric connections after one year of follow-up. Methods: Twenty-two patients received 70 implants, supporting 33 rehabilitations. Biological responses and prosthodontic complications were evaluated at baseline, 6 months, and 12 months. Results: All implants exhibited successful osseointegration, with no losses or peri-implant inflammation. Marginal bone levels showed minimal changes, well below pathological thresholds. The difference in marginal bone loss (MBL) was −0.27 ± 0.79 mm between T0 and T1, and −0.51 ± 0.93 mm between T0 and T2. No abutment screw loosening or crown chipping occurred. However, coupling stability loss was observed in nine cases. Conclusions: The conometric connection demonstrated successful integration and minimal complications after one year. This alternative shows promise, particularly in simplifying handling and improving marginal adaptation. Further research with larger sample sizes and longer follow-up is warranted for comprehensive validation. [ABSTRACT FROM AUTHOR]

Background and purpose: Stress hyperglycemia is a neuroendocrine physiological response to medical stress, hyperglycemic stress increases the risk of mortality and morbidity in ill patients. This study aimed to investigate the frequency of hyperglycemic stress and its related factors, as well as the relationship between hyperglycemia and the severity and clinical outcomes of hospitalized patients with COVID-19. Materials and methods: This cross-sectional study was conducted in Imam Khomeini Hospital in Sari in 2019. The patients were diagnosed based on clinical symptoms, CBC, CRP, ESR tests, RT-PCR test, and CT scan of the lungs and were hospitalized in the Covid ward. Data analysis was performed using SPSS Software. Results: 312 COVID-19 patients were investigated, and 22 (7.1%) suffered from hyperglycemic stress. Hyperglycemic stress patients had more mortality, hospitalization in ICU, respiratory ventilation, and length of hospital stay compared to the normoglycemic subjects, but only in terms of mortality, there was a statistically significant difference between the two groups (P=0.46) Conclusion: Considering the effect of hyperglycemia on the outcome of the disease and the death rate in ill and hospitalized patients compared to patients with normal blood sugar, it shows the importance of timely diagnosis and proper control of blood sugar in these patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Medial coronoid disease of the elbow is a common lesion of the elbow in young and middle-aged dogs, which can cause pain and lameness. Various treatment options are available for this disease, all aimed at providing a pain-free life for the patient and minimizing potential consequential damage, such as osteoarthritis and cartilage damage. This study investigates the use of both conservative and surgical (arthroscopic) therapies for single dogs, with a focus on clinical outcomes (owner-based dog lifestyle and mobility evaluation), radiological changes, and gait patterns. The study has shown that arthroscopic treatment can improve gait patterns and enhance the overall quality of life for affected dogs, despite worsening radiological findings. Notably, diagnostic imaging often does not correlate with clinical outcomes. Computed tomographic findings, such as fragment size and the presence of dislocation, may influence the treatment outcomes. This was indicated in the group of conservatively treated limbs. However, further studies are needed to establish this relationship more precisely. In summary, a patient-specific evaluation, considering all available diagnostic options, should guide the appropriate treatment. The purpose of this study was to assess the outcome of dogs with bilateral medial coronoid disease (MCD) treated with arthroscopic intervention for the clinically more severely affected side and conservative management for the contralateral side. The medical records of dogs with bilateral medial coronoid disease diagnosed using computed tomography (CT) and treated using arthroscopic intervention on one elbow and conservative management on the other elbow were retrospectively reviewed. The outcome evaluation included clinical re-examination; follow-up radiographic-visible osteophytic lesions; as well as sclerotic changes and Liverpool osteoarthritis in a dogs questionnaire. Data from 48 clinically affected elbow joints (24 dogs) with bilateral MCD diagnosed using CT were included. Every dog underwent arthroscopic intervention on the elbow joint, which was clinically more severely affected, and the other side was treated with conservative management. A fragment of the medial coronoid was diagnosed using CT in all elbows, whereas 19 elbows (39.4%) showed a dislocation of the fragment and the other 29 elbows (60.4%) did not. There are no findings regarding the radioulnar Incongruence. Initially, 86% of all radiographs had the same degree of osteophytes. At the time of follow-up, the arthroscopic-treated limbs had more severe radiological changes in comparison to the conservatively treated limbs. Lameness improved after arthroscopic therapy in walking. The conservative group showed a largely unchanged gait pattern. Radiological changes do not necessarily reflect the severity of clinical signs. Arthroscopic intervention showed an improvement of the clinical gait pattern, even though the radiographic changes worsened. [ABSTRACT FROM AUTHOR]

Purpose: Although the effects of lateral hinge fractures (LHF) on bone union and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO) have been established, the effects of LHF after opening-wedge distal tibial tubercle osteotomy (OWDTO) are unclear. We hypothesised that LHF after OWDTO would be associated with delayed bone union and result in poorer clinical outcomes than expected for LHF after OWHTO. Methods: This study enrolled 100 patients, with 50 OWDTO patients (18 men; mean age, 63.2 years) and 50 OWHTO patients compared based on the propensity score matched analysis. The effect of LHF on bone union was compared between the groups. Clinical outcomes were assessed using the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the mean follow-up of 28 months. Results: There was no between-group difference in the incidence rate of LHF. However, the rate of bone union at the anterior flange in the presence of an LHF was significantly lower in the OWDTO (26%) than in the OWHTO (80%) 3 months postoperatively (p < 0.05), but no difference was observed 12 months postoperatively. The Lysholm score was significantly lower for patients with LHF following OWDTO than for OWDTO patients without LHF or OWHTO patients with/without LHF 3 and 12 months postoperatively (p < 0.001); Lysholm score and KOOS were not different at the final follow-up. Conclusions: LHF after OWDTO was associated with delayed bone union and poor clinical outcomes until 12 months. This information can guide decisions regarding the indications and the management of patients after OWDTO. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Few co-occurrence cases of mosaic aneuploidy and uniparental disomy (UPD) chromosomes have been reported in prenatal periods. It is a big challenge for us to predict fetal clinical outcomes with these chromosome abnormalities because of their highly heterogeneous clinical manifestations and limited phenotype attainable by ultrasound. Methods: Amniotic fluid samples were collected from four cases. Karyotype, chromosome microarray analysis, short tandem repeats, and whole exome sequencing were adopted to analyze fetal chromosomal aneuploidy, UPD, and gene variation. Meanwhile, CNVseq analysis proceeded for cultured and uncultured amniocytes in case 2 and case 4 and MS-MLPA for chr11 and chr15 in case 3. Results: All four fetuses showed mosaic chromosomal aneuploidy and UPD simultaneously. The results were: Case 1: T2(7%) and UPD(2)mat(12%). Case 2: T15(60%) and UPD(15)mat(40%). Case 3: 45,X(13%) and genome-wide paternal UPD(20%). Case 4: <10% of T20 and > 90% UPD(20)mat in uncultured amniocyte. By analyzing their formation mechanism of mosaic chromosomal aneuploidy and UPD, at least two adverse genetic events happened during their meiosis and mitosis. The fetus of case 1 presented a benign with a normal intrauterine phenotype, consistent with a low proportion of trisomy cells. However, the other three fetuses had adverse pregnancy outcomes, resulting from the UPD chromosomes with imprinted regions involved or a higher level of mosaic aneuploidy. Conclusion: UPD is often present with mosaic aneuploidy. It is necessary to analyze them simultaneously using a whole battery of analyses for these cases when their chromosomes with imprinted regions are involved or known carriers of a recessive allele. Fetal clinical outcomes were related to the affected chromosomes aneuploidy and UPD, mosaic levels and tissues, methylation status, and homozygous variation of recessive genes on the UPD chromosome. Genetic counseling for pregnant women with such fetuses is crucial to make informed choices. [ABSTRACT FROM AUTHOR]

Background: Stroke represents a prominent global health issue, exhibiting the third highest incidence of disability and a significant burden on both healthcare and the economy. Stress hyperglycemia, an acute reaction of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, leading to adverse outcomes and mortality. Several previous studies have indicated that stress hyperglycemia, as evaluated by the stress hyperglycemia ratio (SHR), significantly increases the risk of adverse outcomes and mortality in stroke patients. However, there is a lack of further investigation into the influence of dynamic changes in stress hyperglycemia on the clinical outcomes of acute ischemic stroke (AIS) patients. Consequently, we performed a meticulous analysis, considering dose-response relationships from existing studies, to ascertain the correlation between dynamic changes in stress hyperglycemia and the susceptibility to adverse outcomes in patients with AIS. Methods: This investigation was prospectively registered in PROSPERO and adhered to the PRISMA guidelines. A comprehensive search was performed across English and Chinese databases. A two-sided random-effects-model was employed to consolidate the odds ratios (ORs) of the highest vs. lowest categories of SHR. Restricted cubic spline (RCS) models were employed to estimate potential non-linear trends between SHR and the risk of adverse outcomes in AIS patients. Egger's test was utilized to assess publication bias. Heterogeneity was evaluated using Cochran's Q-test. The Newcastle-Ottawa Scale (NOS) tool was employed to evaluate the risk of bias of the included studies. Results: The final analysis incorporated a total of thirteen studies, which were published between 2019 and 2023, encompassing a participant cohort of 184,179 individuals. The SHR exhibited a significant association with the risk of various adverse outcomes. Specifically, a higher SHR was correlated with a 2.64-fold increased risk of 3-month poor functional outcomes (OR: 2.64, 95% CI 2.05-3.41, I² = 52.3%, P < 0.001), a 3.11-fold increased risk of 3-month mortality (OR: 3.11, 95% CI 2.10-4.59, I² = 38.6%, P < 0.001), a 2.80-fold increased risk of 1-year mortality (OR: 2.80, 95% CI 1.81-4.31, I² = 88%, P < 0.001), a 3.90-fold increased risk of intracerebral hemorrhage (ICH) and 4.57-fold increased risk of symptomatic ICH (sICH) (ICH-OR: 3.90, 95% CI 1.52-10.02, I² = 84.3%, P = 0.005; sICH-OR: 4.57, 95% CI 2.05-10.10, I² = 47.3%, P < 0.001), a 1.73-fold increased risk of neurological deficits (OR: 1.73, 95 CI 1.44-2.08, I² = 0%, P < 0.001), and a 2.84-fold increased risk of stroke recurrence (OR: 2.84, 95 CI 1.48-5.45, I² = 50.3%, P = 0.002). It is noteworthy that, except for hemorrhagic transformation (HT) and stroke recurrence, the remaining adverse outcomes exhibited a "J-shaped" non-linear dose-response relationship. Conclusion: In summary, our findings collectively suggest that increased exposure to elevated SHR is robustly linked to a heightened risk of adverse outcomes and mortality in individuals with AIS, exhibiting a non-linear dose-response relationship. These results underscore the significance of SHR as a predictive factor for stroke prognosis. Therefore, further investigations are warranted to explore the role of SHR in relation to adverse outcomes in stroke patients from diverse ethnic populations. Furthermore, there is a need to explore the potential benefits of stress hyperglycemia control in alleviating the physical health burdens associated with AIS. Maintaining a lower SHR level may potentially reduce the risk of adverse stroke outcomes. [ABSTRACT FROM AUTHOR]

Background Little is known about the relationship between signal intensity patterns on T2-weighted magnetic resonance imaging (MRI) in non-functioning pituitary adenomas (NFPAs). Objective In this study, the clinical, hormonal, histological features, and therapeutic responses were evaluated according to the T2 signal intensity in NFPAs. Methods This retrospective and multicenter study included a group of 166 NFPA patients (93 men, 56%, mean age 58.5 ±14.8 yr). Results: Approximately half of the tumors (n=84, 50.6%) were hyperintense, while 34.3% (n=57) and 15.1% (n=25) were iso- and hypointense, respectively. The median maximum tumor diameter of the isointense group [16 (13–25) mm] was significantly lower than that of the hyperintense [23 (16.6–29.7) mm] group (p=0.003). Similarly, the tumor volume of the isointense group [1,523 (618–5,226) mm3 ] was significantly lower than that of the hyperintense [4,012 (2,506–8,320) mm3 ] group (p=0.002). Chiasmatic compression occurred less frequently in tumors with isointense signal characteristics (38.6%) compared to tumors with hypointense (68%) and hyperintense (65.5%) signal characteristics (p=0.003). Invasive adenomas (p=0.001) and the degree of cavernous sinus invasion (p<0.001) were more frequent in the hyperintense adenoma group compared to the remaining groups. Plurihormonal tumors and silent lactotroph adenomas were more frequent in the isointense tumor group. Conclusion In conclusion, hyperintensity on T2-weighted MRI in NFPAs is associated with larger and more invasive tumors compared to isointense NFPAs. [ABSTRACT FROM AUTHOR]