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Active video games (AVG) have been used as training tools and are known to ameliorate balance performance in children with Developmental Coordination Disorder (DCD). Our aim was to evaluate balance using clinical tests and by measuring body sway using a force plate with a mixed design of vision (eyes open/eyes closed), surface (rigid/soft). and support (stance/semitandem) before, and after, training and 4 months later (follow-up). Thirty-six DCD children and 40 typically developing children participated in the study, of which 50 children (26 DCD; 24 typically developing) were retested after 4 months. Balance improved on the clinical measures after the training, which was independent of type of AVG (Wii-Fit and Xbox Kinect) used, and this effect was still present after 4 months. The AVG training did not influence general sway behavior, but only sway in the eyes-open condition. corresponding with task demands of the training and indicating a training-specific effect. Overall, DCD children and typically developing children responded comparably to the AVG training, thereby maintaining the gap in performance between the two groups. The changes iii postural sway are interpreted as a sign of more confidence and less freezing of the joints, enabling greater flexibility of movements and balance strategies as supported by the improved performance on balance tests in the DCD children. This is the first study that showed long-term effects of AVG training on balance performance. However. these follow-up results should be interpreted with caution given that 35% of the children were lost in follow-up. [ABSTRACT FROM AUTHOR]

Background: Patients with gastric cancer (GC) who underwent radical surgery require long-term follow-up (usually 5 years). The purpose of this study was to explore individualized follow-up strategies for patients with GC. Methods: This is a retrospective cohort study that established a clinicopathologic database of patients who underwent gastrectomy from January 2010 to December 2020 at Ningbo No. 2 Hospital. Follow-up was performed until March 2023. The rate of new-onset recurrence of patients with GC was explored annually according to different pTNM stages, defining a recurrence rate of less than 1% as adequate follow-up time. Results: Of the 1606 patients who were eligible, the total number of patients who completed the 5- and 10-year follow-up was 1107 and 586, respectively. A total of 444 cases were diagnosed with recurrence. The recurrence rate for stage IA patients was consistently less than 1% during the follow-up time. The adequate follow-up time (the rate of new-onset recurrence less than 1%) was 5 years for stage IB and IIA patients, and 8 years for stage IIB and IIIA patients, respectively. In contrast, stage IIIB patients were always at risk of recurrence during the follow-up time (>1%). Time to a new recurrence rate for stage IIIC patients was 6 years. Conclusion: Among patients who underwent radical gastrectomy, the rate of new-onset recurrence varied among patients with different pTNM stages. This study suggests that the follow-up of GC can be individualized and refer to pTNM stage. [ABSTRACT FROM AUTHOR]

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Despite the severe impact of COVID-19 on cancer patients, data on COVID-19 outcomes in cancer patients from low- and middle-income countries is limited. We conducted a large study about the mortality rate of COVID-19 in cancer patients in Iran. Methods: We analyzed data from 1,079 cancer (average age: 58.2 years) and 5,514 non-cancer patients (average age: 57.2 years) who were admitted for COVID-19 in two referral hospitals between March 2019 and August 2021. Patients were followed up until death or 31st August 2021. Multiple logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) of factors associated with ICU admission and intubation. The Cox regression model estimated hazard ratios (HRs) and 95% CI of factors associated with hospital and post-discharge 60-day mortalities. Results: The cancer patients had higher ICU admission (OR = 1.65, 95% CI: 1.42–1.91; P-value 0.03) and intubation (OR = 3.13, 95% CI = 2.63–3.73, P-value < 0.001) than non-cancer patients. Moreover, hospital mortality was significantly higher in cancer patients than in non-cancer patients (HR = 2.12, 95% CI: 1.89–2.41, P-value < 0.001). HR for the post-discharge mortality was higher in these patients (HR = 2.79, 95% CI: 2.49–3.11, < 0.001). The hospital, comorbidities, low oxygen saturation, being on active treatment, and non-solid tumor were significantly associated with ICU admission (P-value < 0.05) in cancer patients, while only low oxygen saturation was associated with intubation. In addition, we found that old age, females, low oxygen saturation level, active treatment, and having a metastatic tumor were associated with death due to COVID-19 (P-value < 0.05). Only lung cancer patients had a significantly higher risk of death compared to other cancer types (HR = 1.50, 95% CI: 1.06–2.10, P-value = 0.02). Conclusion: Cancer patients are at a higher risk of ICU admission, intubation, and death due to COVID-19 than non-cancer patients. Therefore, cancer patients who are infected with COVID-19 require intensive care in the hospital and active monitoring after their discharge from the hospital. [ABSTRACT FROM AUTHOR]

Introduction The War-Related Illness and Injury Study Center at the VA New Jersey Health Care System (WRIISC-VANJ) serves as one of the three tertiary referral centers for combat deployed Veterans of all eras with medically unexplained or difficult-to-diagnose conditions that may be related to deployment-related exposures. Many of the Veterans seen at the WRIISC experience chronic multisymptom illness (CMI), also known as Gulf War Illness (GWI). Given the complexity and interconnectedness of symptoms, Veterans with GWI are often unlikely to produce meaningful results when addressing single symptoms. Further, Veterans with GWI often have co-morbid cognitive and behavioral health conditions (e.g. TBI, PTSD, Depression), which further compromise their self-efficacy in following treatment recommendations. Thus, the WRIISC-NJ, in collaboration with Wellness Solutions Group, developed a virtual Functional Medicine-based Interdisciplinary and Integrative Intervention to improve the health of Veterans by assisting them in implementing lifestyle changes. Methods The 6-month telehealth program included functional medicine assessments, nutrition and adaptive exercise coaching, mindfulness meditation and yoga, guest health lectures, character strength coaching, and targeted nutritional supplements. Aspects of the program were tailored to the unique clinical needs of each Veteran. Participants completed baseline and 6 month follow-up assessments of physical and emotional symptoms and overall functioning. Follow-up scores were compared with baseline data. Results The program was well received by Veterans with attendance across all offered sessions ranging from 70 to 100%. Further, at the end of the clinical pilot program, improvements were demonstrated in physical and mental health symptoms, intentional weight loss/gain, functional movement, and sleep quality. Conclusions These preliminary results demonstrate the possibility of creating positive health outcomes across multiple health indicators in medically complex combat-deployed Veterans. Our early success and participant enthusiasm for this clinical pilot program also illustrate an opportunity to provide individualized, innovative solutions for the evaluation and treatment of Veterans with GWI. [ABSTRACT FROM AUTHOR]

Background α1-Adrenergic receptor antagonists are commonly used to treat benign prostatic hyperplasia. Preclinical studies suggest that they induce cell death and inhibit tumor growth. This study evaluated the risk of prostate cancer death in men using α1-adrenergic receptor antagonists. Methods A population-based cohort study in Stockholm, Sweden (January 1, 2007, to December 31, 2019) included 451 779 men with a prostate-specific antigen test result. Study entry was 1 year after the first prostate-specific antigen test. Men were considered exposed at their second filled prescription. The primary outcome was prostate cancer mortality. Secondary outcomes were all-cause mortality and prostate cancer incidence. Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all outcomes. Inverse-probability weighting with marginal structural models accounted for time-dependent confounders. Results Of 351 297 men in the final cohort, 39 856 (11.3%) were exposed to α1-adrenergic receptor antagonists. Median (interquartile range) follow-up for prostate cancer mortality was 8.9 (5.1-10.9) years; median (interquartile range) exposure time to α1-adrenergic receptor antagonists was 4.4 (2.0-7.6) years. There was no evidence of an association between α1-adrenergic receptor antagonist use and prostate cancer mortality, all-cause mortality, or high-grade prostate cancer. α1-Adrenergic receptor antagonist use was associated with an increased risk of prostate cancer (HR = 1.11, 95% CI = 1.06 to 1.17) and low-grade prostate cancer (HR = 1.22, 95% CI = 1.11 to 1.33). Men whose prostate cancer was treated with α1-adrenergic receptor antagonists underwent more frequent prostate-specific antigen testing. Conclusions Our findings show no significant association between α1-adrenergic receptor adrenoceptor antagonist exposure and prostate cancer mortality or high-grade prostate cancer. Although the preclinical evidence indicates a potential chemopreventive effect, this study's findings do not support it. [ABSTRACT FROM AUTHOR]

Background Camonsertib is a selective oral inhibitor of ataxia telangiectasia and Rad3-related (ATR) kinase with demonstrated efficacy in tumors with DNA damage response gene deficiencies. On-target anemia is the main drug-related toxicity typically manifesting after the period of dose-limiting toxicity evaluation. Thus, dose and schedule optimization requires extended follow-up to assess prolonged treatment effects. Methods Long-term safety, tolerability, and antitumor efficacy of 3 camonsertib monotherapy dosing regimens were assessed in the TRESR study dose-optimization phase: 160 mg once daily (QD) 3 days on, 4 days off (160 3/4; the preliminary recommended Phase II dose [RP2D]) and two step-down groups of 120 mg QD 3/4 (120 3/4) and 160 mg QD 3/4, 2 weeks on, 1 week off (160 3/4, 2/1w). Safety endpoints included incidence of treatment-related adverse events (TRAEs), dose modifications, and transfusions. Efficacy endpoints included overall response rate, clinical benefit rate, progression-free survival, and circulating tumor DNA (ctDNA)-based molecular response rate. Results The analysis included 119 patients: 160 3/4 (n = 67), 120 3/4 (n = 25), and 160 3/4, 2/1w (n = 27) treated up to 117.1 weeks as of the data cutoff. The risk of developing grade 3 anemia was significantly lower in the 160 3/4, 2/1w group compared with the preliminary RP2D group (hazard ratio = 0.23, 2-sided P  = .02), translating to reduced transfusion and dose reduction requirements. The intermittent weekly schedule did not compromise antitumor activity. Conclusion The 160 3/4, 2/1w dose was established as an optimized regimen for future camonsertib monotherapy studies offering a substantial reduction in the incidence of anemia without any compromise to efficacy. Clinical Trial ID NCT04497116. [ABSTRACT FROM AUTHOR]

To evaluate the long-term success rate of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus due to aqueductal stenosis in the pediatric population. Between January 2007 and June 2023, a total of 82 children underwent ETV surgery for hydrocephalus and met the inclusion criteria for our study. The children's medical records were reviewed, and cases requiring additional surgery in the months and years following surgery for ventriculostomy failure were reviewed. The mean age was 5.35 years. Successful ETV was observed in 74 children with a successful ETV rate of 90%. The median follow-up was 6.75 years (2 months to 15.5 years). Eight children (10%) underwent additional surgery. In 7 cases, additional surgery was performed within 3 months, while in the remaining case; a delayed failure was noted (more than 3 years later). At 6 months and 3 years, the cumulative proportion of children with revision-free survival was 91%, declining slightly to 89% at 5 years. ETV is highly effective in treating hydrocephalus in pediatric patients with aqueductal stenosis, with a 91% success rate at 6 months and 3 years. Although the success rate drops slightly to 89% at 5 years, it still demonstrates durability. Late failures are usually characterized by symptoms of increased intracranial pressure. While patients with a confirmed successful ETV at 6 months may be considered for reduced follow-up frequency, it is critical to educate them about the symptoms of intracranial hypertension and the importance of seeking medical attention promptly if such symptoms occur. [ABSTRACT FROM AUTHOR]

Background Population screening for colorectal cancer (CRC) remains low, requiring alternative approaches for increasing participation. Opportunistic screening of hospitalized patients may aid in increasing uptake rates. Objective To assess whether inpatients can be recruited for opportunistic CRC screening using fecal immunochemical testing (FIT). Methods Inpatient charts were prospectively reviewed for study eligibility on admission of patients to the medical wards of 3 hospitals in Winnipeg, Canada. Eligible patients were approached for participation and consent. Inoculated FIT specimen collection tubes were sent to the hospital laboratory for testing. Patients with positive FIT results received a follow-up colonoscopy. Results In total, 1542 inpatient charts were screened for eligibility; 53 patients were identified for enrollment (51.9% were male; median age, 59 years), of whom 13 patients consented to participate but only 7 provided a stool specimen. One of those 7 patients had a positive FIT result. The overall screening rate was low, at 0.45%. The primary reason for exclusion of patients was age (outside of the range of 50-75 years), followed by patients having recent gastrointestinal bleeding and/or known intestinal diseases. Conclusions Our data suggest that it is infeasible to recruit inpatients for opportunistic CRC screening in routine clinical practice. [ABSTRACT FROM AUTHOR]

Evidence on the optimal follow-up schedule after endometrial cancer is lacking. The study aim was to compare satisfaction with care between women who received reduced follow-up care and women who received usual guideline-directed follow-up care for three years after surgery. The ENSURE (ENdometrial cancer SURvivors' follow-up carE) trial was a non-inferiority randomized controlled multicenter trial in 42 hospitals in the Netherlands. The intervention arm received reduced follow-up care (4 visits/3 years), while the control group received usual follow-up care (8–11 visits/3 years). Primary outcome was overall satisfaction with care, PSQIII score, over three years follow-up, with a non-inferiority margin of 6. Mixed linear regression, intention-to-treat and per-protocol analyses (presented below) were used. Among 316 women included, overall satisfaction with care was not lower in the reduced follow-up (mean 82; SD = 15) compared with the usual follow-up group (mean 80; SD = 15) group (B = 1.80(−2.09;5.68)). At 6, 12 and 36 months, more women (93/94/90%) in the reduced follow-up group were satisfied with their follow-up schedule than in the usual follow-up group (79/79/82%; p < 0.001; p < 0.001; p = 0.050). Women with low-risk, early-stage endometrial cancer who received reduced follow-up care were no less satisfied with their care than women receiving usual follow-up care. Compared with usual follow-up, women in the reduced follow-up group had fewer clinical visits and, at the same time, more often reported being satisfied with their follow-up schedule. Findings suggest that reduced follow-up care may be the new standard, but should be tailored to meet additional needs where indicated. • Reduced follow-up does not compromise satisfaction with care or worry. • Patients prefer the schedule of reduced follow-up. • Reduced follow-up care may be the new standard for endometrial cancer. • Follow-up should be tailored to meet individual patient needs in case of worry. • Findings may be relevant for other low-risk cancers. [ABSTRACT FROM AUTHOR]

Because Systemic Lupus Erythematosus (SLE) is a rare disease, and due to the significant prognostic impact of early management, a diagnosis confirmed by a physician with experience in SLE is recommended, for example from an expert center. Once the diagnosis is confirmed, existing manifestations should be identified in particular, renal involvement by an assessment of proteinuria, disease activity and severity should be determined, potential complications anticipated, associated diseases searched for, and the patient's socioprofessional and family context noted. Therapeutic management of SLE includes patient education on recognizing symptoms, understanding disease progression as well as when they should seek medical advice. Patients are informed about routine checkups, treatment side effects, and the need for regular vaccinations, especially if they are receiving immunosuppressive treatment. They are also advised on lifestyle factors such as the risks of smoking, sun exposure, and dietary adjustments, especially when they are receiving corticosteroids. The importance of contraception, particularly when teratogenic medications are being used, and regular cancer screening are emphasized. Support networks can help relieve a patient's isolation. The first-line medical treatment of SLE is hydroxychloroquine (HCQ), possibly combined with an immunosuppressant and/or low-dose corticosteroid therapy. The treatment of flares depends on their severity, and typically involves HCQ and NSAIDs, but may be escalated to corticosteroid therapy with immunosuppressants or biologic therapies in moderate to severe cases. Because there is no curative treatment, the goals of therapy are patient comfort, preventing progression and flares, and preserving overall long-term health and fertility. The frequency of follow-up visits depends on disease severity and any new symptoms. Regular specialized assessments are necessary, especially when treatment changes, but a frequency of every 3 to 6 months is recommended during periods of remission and monthly during active or severe disease, especially in children. These assessments include both clinical and laboratory tests to monitor complications and disease activity, with specific attention to proteinuria. [ABSTRACT FROM AUTHOR]

Background: The concept of amnestic mild cognitive impairment (aMCI) was developed to identify patients at an initial stage of Alzheimer's disease (AD). However, some patients with aMCI do not present biomarkers of amyloid pathology or neuronal injury. Objective: To know the natural history of amyloid-negative and neurodegeneration-negative patients with aMCI, namely to ascertain: 1) whether these patients remain cognitively stable or they present a slow decline in neuropsychological tests; 2) whether the memory complaints subside with the apparently benign clinical course of the disorder or if they persist along the time. Methods: Patients who fulfilled criteria for aMCI with no biomarkers of amyloid pathology or neuronal injury were selected from a large cohort of non-demented patients with cognitive complaints, and were followed with clinical and neuropsychological assessments. Results: Twenty-one amyloid-negative and neurodegeneration-negative aMCI patients were followed for 7.1±3.7 years. At the baseline they had more pronounced deficits in verbal learning (California Verbal Learning Test) and were also impaired in Word Recall and Logical Memory. However, they did not decline in any cognitive test during follow-up. The patients maintained a high level of subjective memory complaints from baseline (9.7±4.1) to the follow-up visit (9.2±4.1, a non-significant difference), in spite of a statistically significant decrease in the depressive symptoms, with Geriatric Depression Scale (15 items) score 4.9±2.8 at baseline and 3.2±1.8 at the follow-up visit. Conclusions: Amyloid-negative, neurodegeneration-negative aMCI is a chronic clinical condition characterized by the long-term persistence of cognitive deficits and distressing memory complaints. Adequate strategies to treat this condition are needed. [ABSTRACT FROM AUTHOR]

Introduction The COVID-19 pandemic profoundly affected the health and well-being of people globally. Some studies suggest individuals with overweight or obesity may have been more adversely impacted by pandemic restrictions. Additionally, military personnel may have been more vulnerable to stress during the pandemic because of job demands (e.g. work in close quarters). Our research group was conducting a randomized clinical trial of a weight management intervention in active duty military personnel with overweight or obesity when the COVID-19 pandemic struck. Thus, we collected additional pandemic-related data from participants enrolled during the COVID-19 pandemic and conducted exploratory analyses to understand how the pandemic affected their stress levels and perceived abilities to engage in health behaviors like exercise and healthy eating. The aims of this exploratory study were to: (1) assess associations between pandemic-related stress and health behaviors with body fat percentage (BF%) and psychological and physical health, and (2) explore how pandemic-related stress and health behaviors affected BF% during and after the intervention. Materials and Methods A total of 29 active duty Navy personnel (55% female, 69% White) were enrolled after the onset of pandemic restrictions and completed measures assessing pandemic-related stress and health behaviors as well as measures of general psychological and physical health before the intervention. BF% was collected at 5 timepoints, including baseline, during, and following the intervention. Bivariate correlations assessed associations at baseline. Linearmixed-effects longitudinal models explored how pandemic-related stress and health behaviors affected BF%. Post-hoc analyses evaluated the effects of pandemic factors on BF% at each timepoint. Results Most participants perceived of the pandemic as increasing stress and detracting from their abilities to engage in health behaviors (i.e. exercise and healthy eating). Higher pandemic stress was significantly associated with reporting exercise and healthy eating as more difficult, worse overall health, and more anxiety and general stress. Reporting exercise as harder during the pandemic also was associated with more psychological distress at baseline. A linearmixed- effects model controlling for age, sex, and number of intervention sessions attended revealed endorsing "exercise as harder" was associated with higher BF%. Post-hoc regression analyses revealed rating "exercise as harder" significantly predicted higher BF% 3 months post-intervention (B = 0.65, P  = .01), whereas pandemic stress was not significantly associated with higher BF% at 3 month (B =0.14, P  = .08) or 6 month (B = 0.21, P  = .09) follow-up. Conclusions As expected, most participants perceived of the pandemic as heightening stress and interfering with engagement in health behaviors. It is possible that pandemic-related stress may have exacerbated weight gain-promoting behaviors and/or interfered with achievement of desired weight management outcomes. Outside the context of the pandemic, it may be beneficial for healthcare providers to screen individuals for stress and perceptions of ease of engagement in health behaviors before enrollment in a weight management intervention. Further, tailoring interventions to mitigate stress and promote perceptions of ease in engaging in health behaviors may promote better weight management outcomes. [ABSTRACT FROM AUTHOR]

Introduction Mobile applications (apps) may be beneficial to promote self-management strategies to mitigate the risk of developing post-traumatic osteoarthritis in military members following a traumatic knee injury. This study investigated the efficacy of a mobile app in facilitating behavior modification to improve function and symptomology among military members. Materials and Methods This is a preliminary pre and post hoc analysis of a randomized control trial. The MARX scale, Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Knee Injury and Osteoarthritic Outcome Score Readiness to Manage Osteoarthritis Questionnaire were completed at baseline, 6-week, 6-month, and 12-month follow-up. Participants in the treatment arm completed the System Usability Scale. Data were analyzed using descriptive statistics, the Wilcoxon sum of ranks test, the Wilcoxon signed-rank test, and Cohen's d effect size. Results A total of 28 participants were included. Between-group differences for baseline and 6-week follow-up were significantly improved in the injured knee ICOAP constant pain score for the treatment group (treatment: −4.2 ± 12, 95% CI: −11.5, 3.1; control: 5.5 ± 9.9, 95% CI: 0.9, 10.1; P  = .035, effect size = 0.905). Within-group differences for baseline and 6-week follow-up demonstrated a significant decline in the injured knee ICOAP constant pain score among the control group (signed-rank: 16.0, P  = .031, Cohen's d  = 0.339). No other significant differences were observed. A good System Usability Scale score for usability was found (76.6 ± 8.8). Conclusions These results indicate that the mobile app is easy to use and may contribute to improved constant pain symptomology for patients at risk for post-traumatic osteoarthritis. [ABSTRACT FROM AUTHOR]

Introduction Finnish military divers perform a great variety of tasks all year round, all of which require good physical health and fitness. Poor physical fitness can hinder the ability to cope with different situations. A high body fat percentage has been suggested to increase the risk of decompression sickness, whereas low muscle mass has been associated with an increased risk of musculoskeletal disorders and trauma. However, a low-fat composition may render divers vulnerable to cold and hypothermia during a dive in cold Arctic conditions. The aim of this study was to evaluate possible changes in body composition of Finnish military divers during a 15-year follow-up period (2007-2021). Materials and Methods We used body composition measures from military divers' fit-to-dive evaluations from the Finnish Defence Forces' Diving Medical Centre. Measurements were taken with two bioimpedance devices that function based on the electrical conductivity properties of the human body. The data from both devices were compared with Bland–Altman plots to show that the devices produced congruent data and the results from both devices could be included in the study. Possible changes in body composition were evaluated with a linear mixed model with random intercepts and slopes for each variable. Results Results from the two bioimpedance devices showed no significant differences. This allowed us to combine the results in the same data analysis. There were no apparent differences in the age of the divers between the years during the follow-up. The majority of the divers were between 25 and 30 years of age. Age correlated significantly with most measures, the clinically most significant being a higher fat percentage in older divers. However, all measures were within target values defined by the Diving Medical Centre. The divers were able to retain sufficient muscle mass in all age groups. Discussion and Conclusions According to this study, Finnish military divers have managed to maintain a surprisingly good muscle mass in all age groups despite body composition changes due to aging in older subjects. A slight increase in fat mass can be observed with increasing age; nevertheless, the values have remained within fit-to-dive target levels. The current training routines of Finnish military divers are adequate for maintaining solid physical fitness and body composition over the course of the diving career. [ABSTRACT FROM AUTHOR]

Negative symptoms in CHR-P people are generally not responsive to treatments and commonly related to poorer functional outcome. However, less research attention has been dedicated to Persistent Negative Symptoms (PNS), defined as clinically stable negative symptoms of moderate severity evident for at least 6 months. This study aims to (a) determine the prevalence of PNS in a sample of young people at CHR-P; (b) investigate any association of PNS with functioning and clinical features; (c) examine longitudinal course of PNS across 2 years of follow-up and changes in PNS severity levels with specialized treatments. One Hundred Eighty CHR-P participants were recruited and were divided into CHR-P/PNS + and CHR-P/PNS− subgroups. The clinical assessments were based on the PANSS and the GAF and were conducted at baseline and every 12 months during the follow-up. Twenty four participants showed PNS at entry. Of them, 21 concluded the 2-year follow-up period. At baseline, the CHR-P/PNS + participants showed more educational and employment deficits, and more social and functioning impairment. During the follow-up, the CHR-P/PNS + subgroup had a significant longitudinal decrease in negative symptoms, which was specifically related to antidepressant treatment. CHR-P/PNS + subjects also showed a higher incidence of new hospitalization and a lower functional recovery over time. Our findings support that the persistence of negative symptoms in CHR-P people is longitudinally related to worse daily functioning and more severe clinical conditions that are at higher risk of hospitalization and are less responsive to specialized treatments. [ABSTRACT FROM AUTHOR]

Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10–14 mm 'extremely low risk' or '7–14 mm' low risk polyps that decrease in size by ≥ 4 mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone. [ABSTRACT FROM AUTHOR]

Introduction Poor retention in clinical trials can impact on statistical power, reliability, validity, and generalizability of findings and is a particular challenge in smoking cessation studies. In online trials with automated follow-up mechanisms, poor response also increases the resource need for manual follow-up. This study compared two financial incentives on response rates at 6 months follow up, in an online, automated smoking cessation feasibility trial of a cessation smartphone app (Quit Sense). Aims and Methods A study within a trial (SWAT), embedded within a host randomized controlled trial. Host trial participants were randomized 1:1 to receive either a £10 or £20 voucher incentive, for completing the 6-month questionnaire. Stratification for randomization to the SWAT was by minimization to ensure an even split of host trial arm participants and by 6-week response rate. Outcome measures were: Questionnaire completion rate, time to completion, number of completers requiring manual follow-up, and completeness of responses. Results Two hundred and four participants were randomized to the SWAT. The £20 and £10 incentives did not differ in completion rate at 6 months (79% vs. 74%; p  = .362) but did reduce the proportion of participants requiring manual follow-up (46% vs. 62%; p  = .018) and the median completion time (7 days vs. 15 days; p  = .008). Measure response completeness rates were higher among £20 incentive participants, though differences were small for the host trial's primary smoking outcome. Conclusions Benefits to using relatively modest increases in incentive for online smoking cessation trials include more rapid completion of follow-up questionnaires and reduced manual follow-up. Implications A modest increase in incentive (from £10 to £20) to promote the completion of follow-up questionnaires in online smoking cessation trials may not increase overall response rates but could lead to more rapid data collection, a reduced need for manual follow-up and reduced missing data among those who initiate completing a questionnaire. Such an improvement may help to reduce bias, increase validity and generalizability, and improve statistical power in smoking cessation trials. Trial Registration Host trial ISRCTN12326962, SWAT repository store ID 164. [ABSTRACT FROM AUTHOR]

Introduction: University psychological counselling services represent a frontline defence to detect, treat or refer students with a wide range of (clinical and non‐clinical) difficulties. Nevertheless, only few studies describe their impact on academic self‐efficacy and report follow‐up data. Evidence on students' actual access to further psychological support in times of hardship is also scant and most needed. This study aimed to fill these gaps, exploring the stability of improvement in clinical conditions in a wide sample of university students and reporting post‐intervention referrals to mental health services. Methods: In a longitudinal study, 218 students who accessed a psychological counselling service at the University of Milano‐Bicocca between 2015 and 2019 completed an assessment at the beginning (T0), conclusion (T1) and 6 months after (T2) a brief cognitive behavioural intervention. The assessment included psychological symptoms, general distress, emotion dysregulation and academic self‐efficacy. Information about students' choices to continue a psychological intervention in other services was also collected and contrasted with the counsellor's indication. Results: At follow‐up, the improvement in academic self‐efficacy remained stable, with more than 60% of the students maintaining a reliable clinical change, and nearly half of them reporting having accessed (or being willing to contact) a mental health service outside the university services. Conclusion: These findings highlight the key role of counselling services in addressing students' distress and academic performances in the long term and in building bridges with mental health services outside the university system for students who need longer and specialised treatment. [ABSTRACT FROM AUTHOR]

The purpose of this report is to provide a comprehensive description of a post-transplant febrile patient's clinical course, complications, surgical procedure, and long-term management including evaluation by 18 F-fluorodeoxyglucose [(18 F)FDG] positron-emission tomography combined with computed tomography (PET/CT). A 35-year-old male, a postrenal transplant patient, developed chronic allograft dysfunction and presented with fever with chills, with suspicion of acute-on-chronic graft dysfunction, but no infective focus localization on chest X-ray, ultrasonography (USG) whole abdomen, or blood culture. Urine microscopy showed 8 to 10 pus cells/high-power field (hpf) and culture showed Klebsiella pneumoniae and Pseudomonas aeruginosa with low colony count. Culture-sensitive antibiotics were prescribed for 2 weeks, and after 3 weeks febrile episodes relapsed, symptoms progressed, and required emergency hospitalization due to acute painful urinary retention. Proteinuria and no growth were noted in urine analysis, serum creatinine was 5.36 mg/dL, and C-reactive protein was 15.7mg/dL, and remaining parameters were unremarkable. [ 18 F]FDG-PET/CT was considered in order to resolve diagnosis, which revealed abnormal heterogeneous tracer uptake in the enlarged prostate with hypodense areas within, suggesting prostatitis with abscess formation and pyelonephritis in the upper pole of the transplant kidney. USG kidney urinary bladder (KUB) correlation confirmed prostatic abscess and transurethral drainage done, and pus culture revealed Burkholderia pseudomallei. Culture-sensitive intravenous meropenem treatment was given for 3 weeks. At 5 weeks, follow-up [ 18 F]FDG-PET/CT showed low metabolic residual prostate uptake, suggesting a good response with residual infection. Thus, intravenous antibiotics was changed to oral antibiotics for another 6 weeks. His symptoms completely resolved at the end of treatment; however, his graft function worsened, with serum creatinine reaching 6 to 7 mg/dL, and eventually, after 8 months he became dialysis dependent. [ABSTRACT FROM AUTHOR]

Data regarding the risk of atrial fibrillation (AF) during the post-acute phase of COVID-19 are lacking. We assessed the risk of incident AF in COVID-19 recovered patients by performing a systematic review and meta-analysis of the available data. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Medline and Scopus to locate all articles published up to December 1, 2023, reporting the risk of AF in patients recovered from COVID-19 infection compared with noninfected patients in whom the arrhythmia developed during the same follow-up period. AF risk was evaluated by the Mantel-Haenszel random effects model with hazard ratio as the effect measure with 95% confidence interval (CI); heterogeneity was assessed by Higgins I 2 statistic. Overall, 19,478,173 patients (mean age, 56.5 years; 63.0% male) enrolled in 5 observational studies were included in the analysis. Of these, 5,692,510 recovered from severe acute respiratory syndrome coronavirus 2 infection. During a mean follow-up of 14.5 ± 3.2 months, a random effects model revealed a pooled incidence of new-onset AF in 2.6% of cases (95% CI, 1.8%–6.18%). Recovered COVID-19 patients presented with a higher risk of incident AF (hazard ratio, 1.57; 95% CI, 1.24–1.99; P <.0001; I 2 = 77.9%) compared with noninfected patients during the same follow-up period. Sensitivity analyses confirmed the yielded results. A multivariable metaregression including age, male sex, history of hypertension, coronary artery disease, and length of follow-up was able to explain a significant part of the heterogeneity (R 2 = 54.3%; P =.01). Recovered COVID-19 patients have a higher risk of AF events compared with individuals from the general population. [Display omitted] [ABSTRACT FROM AUTHOR]

Management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts' responses, only those statements reaching a grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final document. One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues. [ABSTRACT FROM AUTHOR]

Multi-modal therapies for gynecological cancers management may determine a wide range of side effects which depend on therapy-related factors and patient characteristics and comorbidities. Curative or adjuvant pelvic radiotherapy is linked with acute and late toxicity due to irradiation of organs at risk, as small and large bowel, rectum, bladder, pelvic bone, vagina and bone marrow. Successful toxicity management varies with its severity, Radiation Centre practice and experience and skills of radiation oncologists. This position paper was designed by the Italian Association of Radiation and Clinical Oncology Gynecology Study Group to provide radiation oncologists with evidence-based strategies to prevent and manage acute and late toxicities and follow-up recommendations for gynecological cancer patients submitted radiotherapy. Six workgroups of radiation oncologists with over 5 years of experience in gynecologic cancers were setup to investigate radiotherapy-related toxicities. For each topic, PubMed database was searched for relevant English language papers from January 2005 to December 2022. Titles and abstracts of results were checked to verify suitability for the document. Reference lists of selected studies and review papers were added if pertinent. Data on incidence, etiopathogenesis, prevention, treatment and follow-up of acute and late side effects for each organ at risk are presented and discussed. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the proficiency of a HIPAA-compliant version of GPT-4 in identifying actionable, incidental findings from unstructured radiology reports of Emergency Department patients. To assess appropriateness of artificial intelligence (AI)-generated, patient-facing summaries of these findings. Materials and Methods Radiology reports extracted from the electronic health record of a large academic medical center were manually reviewed to identify non-emergent, incidental findings with high likelihood of requiring follow-up, further sub-stratified as "definitely actionable" (DA) or "possibly actionable—clinical correlation" (PA-CC). Instruction prompts to GPT-4 were developed and iteratively optimized using a validation set of 50 reports. The optimized prompt was then applied to a test set of 430 unseen reports. GPT-4 performance was primarily graded on accuracy identifying either DA or PA-CC findings, then secondarily for DA findings alone. Outputs were reviewed for hallucinations. AI-generated patient-facing summaries were assessed for appropriateness via Likert scale. Results For the primary outcome (DA or PA-CC), GPT-4 achieved 99.3% recall, 73.6% precision, and 84.5% F-1. For the secondary outcome (DA only), GPT-4 demonstrated 95.2% recall, 77.3% precision, and 85.3% F-1. No findings were "hallucinated" outright. However, 2.8% of cases included generated text about recommendations that were inferred without specific reference. The majority of True Positive AI-generated summaries required no or minor revision. Conclusion GPT-4 demonstrates proficiency in detecting actionable, incidental findings after refined instruction prompting. AI-generated patient instructions were most often appropriate, but rarely included inferred recommendations. While this technology shows promise to augment diagnostics, active clinician oversight via "human-in-the-loop" workflows remains critical for clinical implementation. [ABSTRACT FROM AUTHOR]

Background Nanotextured implants, an innovation in implant technology, are designed to enhance tissue interaction, reduce inflammation, and mitigate complications of traditional implants. Objectives The aim of the study was to evaluate the aesthetic potential and safety profile of nanotextured breast implants in breast augmentation from a single-surgeon experience. Methods This prospective cohort study included 1000 patients who underwent breast augmentation with nanotextured implants. Aesthetic outcomes were assessed with direct measurements and BCCT.core software, focusing on breast projection, symmetry, and upper pole fullness. Patient satisfaction was measured with BREAST-Q and overall satisfaction surveys. Safety profiles were evaluated based on the incidence of complications such as infection, hematoma, capsular contracture, and implant rupture. Statistical analyses were conducted to assess the outcomes. Results The study found significant improvements in aesthetic outcomes, with 92.8% of cases achieving substantial aesthetic enhancements. Patient satisfaction was high, with 96.4% of patients reporting enhanced self-esteem and contentment. The safety profile was favorable, with a low incidence of complications (0.7% requiring revisional surgery) and no major complications reported. Long-term follow-up data indicated sustained aesthetic outcomes and a stable safety profile. Conclusions The synergistic quality of nanotextured implants in relation to the natural breast gland tissue is defined by a significantly wider range of aesthetic options. The findings of this study underscore the positive impact of nanotextured breast implants on enhancing the aesthetic potential of breast augmentation and their contribution to a low incidence of complications. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background Abdominoplasty procedures continue to evolve because combining techniques such as suction-assisted lipectomy or direct subscarpal lipectomy have proven to be powerful adjuncts to achieve optimal aesthetic results. However, concern has been expressed about combining techniques simultaneously given the potential to damage the vascularity of the abdominoplasty flap. Objectives The aim of this study was to assess the safety and efficacy of simultaneous direct subscarpal lipectomy combined with liposuction in abdominoplasty patients. Methods A 4-year retrospective review of consecutive abdominoplasties (n = 200) performed by a single surgeon was conducted. Liposuction of the abdominal flap and flanks was performed in all patients. After raising the abdominoplasty flap, undermining was performed to just beyond the xyphoid, the lower rib margins superiorly, and the anterior axillary line laterally. Fat deep to Scarpa's fascia was then removed by direct tangential excision in all zones of the abdominal flap. Results The patients had a mean age of 42.19 years and BMI of 28.10 kg/m2; the mean follow-up time was 7 months. Seroma occurred in 13 patients (6.5%), superficial wound dehiscence treated with local wound care in 16 patients (8%), hypertrophic scarring in 16 patients (8%), partial umbilical necrosis in 1 patient (0.5%), and partial umbilical epidermolysis in 6 patients (3%). No patients experienced major or minor full-thickness tissue loss. No patients needed reoperation. Conclusions Simultaneous direct excision of subscarpal fat with liposuction of the abdomen and flanks does not appear to subject any zone of the abdominoplasty flap to increased risks of vascular compromise. No flap necroses were observed. The technique described is safe and may provide superior abdominoplasty results. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. Method: Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson’s correlation. The study considered a significance level of 0.05. Results: There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. [ABSTRACT FROM AUTHOR]

Purpose: While follow-up assessment of clipped aneurysms (CAs) using magnetic resonance angiography (MRA) can be challenging due to susceptibility artifacts, a novel MRA sequence pointwise encoding time reduction with radial acquisition (PETRA) subtraction-based MRA, has been developed to reduce these artifacts. The aim of the study was to validate the diagnostic performance of PETRA-MRA by comparing it with digital subtraction angiography (DSA) as a reference for follow-up of CAs using a 3T MR scanner. Methods: Patients with clipping who underwent both PETRA-MRA and DSA between September 2019 and December 2021 were retrospectively included. Two neuroradiologists independently reviewed with the reconstructed images of PETRA-MRA to assess the visibility of the arteries around the clips and aneurysm recurrence or remnants of CA using a 3-point scale. The diagnostic accuracy of PETRA-MRA was evaluated in comparison to DSA. Results: The study included 34 patients (28 females, mean age 59 ± 9.6 years) with 48 CAs. The PETRA-MRA allowed visualization of the parent vessels around the clips in 98% of cases, compared to 39% with time-of-flight (TOF) MRA (p < 0.0001). The DSA confirmed 14 (29.2%) residual or recurrent aneurysms. The PETRA-MRA demonstrated a high accuracy, specificity, positive predictive value, and negative predictive value of 99.2%, 100%, 100%, and 97.8%, respectively, while the sensitivity was 66.7%. Conclusion: This retrospective study demonstrates that PETRA-MRA provides excellent visibility of adjacent vessels near clips and has a high diagnostic accuracy in detecting aneurysm remnants or recurrences in CAs. Further prospective studies are warranted to establish its utility as a reliable alternative for follow-up after clipping. [ABSTRACT FROM AUTHOR]

We investigated the longitudinal associations between sports participation patterns in youth and physical activity (PA) in adulthood. PA was self-reported triannually between ages 9–18 (n = 2550, 52% females) and measured by accelerometers in mid-adulthood (n = 1002, 61% females, aged 48 ± 4 years). Three latent classes of youth sports participation emerged for both genders: 1) “organized sports” (persistent high PA with regular sports club activities), 2) “unorganized sports” (persistent high PA without sports club activities and 3) “low activity” (low PA with decreasing sports involvement). These groups comprised 29%, 34% and 37% of males, and 23%, 27% and 50% of females, respectively. Youth “organized sports” was associated with higher adult PA in both males (+1166 steps/day, p = 0.012) and females (+15 min/day moderate-to-vigorous PA [MVPA], +1064 steps/day, +1066 leisure-time steps/day; p ≤ 0.005) compared to “low activity”. In males, youth “organized sports” was associated with higher adult PA (+1103 steps/day, −26 min/day sedentary time and +133 counts/minute higher total PA, p ≤ 0.039) compared to “unorganized sports”. In females, “unorganized sports” in youth was related to higher adult PA (+10 min/day MVPA, p = 0.034) when compared to “low activity”. Sustained participation in youth organized sports, and for females, also in unorganized sports, is positively linked with adult PA. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionTo explore the rates and timing of a first follow-up visit for children and adolescents with a concussive injury and to identify factors associated with follow-up timing.A descriptive, correlational design drawing on linked, population-based administrative data of concussed children and adolescents (ages 5–18 years) from the province of British Columbia (BC), Canada. Data were accessed through Population Data BC. Descriptive statistics and binary logistic regression were used to analyze the data.From January 1, 2016 to December 31, 2017, we retrieved 22,601 cases of concussion, of which 19% had an early follow-up visit (N = 4,294), 4.9% had later follow-up (N = 1,107), and 76.1% had no follow-up (N = 17,200). The factors of older age, living in a rural area, higher socioeconomic status, and seeing a specialist physician at an initial concussion diagnosis were more likely to have an early follow-up visit.Early follow-up is important for recovery, but most children and adolescents with a concussion do not receive follow-up in BC. [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: Surgery is the main treatment option for destroyed-lung (DL) patients with life-threatening massive hemoptysis. However, short-term and long-term surgical safety and efficacy are unclear, prompting this study. Methods: Data from 124 DL patients undergoing surgery between November 2001 and January 2022 at Beijing Chest Hospital were retrospectively analyzed. Data of the DL group (82 cases) and DL + massive hemoptysis group (42 cases) were compared with regard to clinical characteristics, long-term postoperative residual lung reinfection. Results: As compared with DL group rates, The DL + massive hemoptysis group had greater incidence rates of postoperative complications, invasive postoperative respiratory support, long-term postoperative residual lung reinfection, and postoperative tuberculosis recurrence. Revealed risk factors for postoperative complications (Extent of lung lesion resection), postoperative invasive respiratory therapy (preoperative Hb < 9 g/L, severe intraoperative hemoptysis), and postoperative long-term residual lung reinfection (DL with massive hemoptysis). Conclusions: DL patients with massive hemoptysis had greater rate of invasive respiratory support therapy and postoperative complications. Extensive lesion removal, preoperative anaemia, severe intraoperative bleeding associated with recent postoperative complications for the patient. [ABSTRACT FROM AUTHOR]

Background: The Point-of-Care Diabetic Retinopathy Examination Program (POCDREP) was initiated in 2015 at the University of Pittsburgh/UPMC in response to low diabetic retinopathy (DR) examination rates, a condition affecting a quarter of people with diabetes mellitus (PwDM) and leading to blindness. Early detection and treatment are critical with DR prevalence projected to triple by 2050. Approximately, half of PwDM in the U.S. undergo yearly examinations, and there are reported varying follow-up rates with eye care professionals, with limited data on the factors influencing these trends. POCDREP aimed to address screening and follow-up gap, partnering with diverse healthcare entities, including primary care sites, free clinics, and federally qualified health centers. Methods: A non-concurrent retrospective cohort study spanning 2015–2018 examined data using electronic health records of patients who underwent retinal imaging. Imaging was performed using 31 cameras across various settings, with results interpreted by ophthalmologists. Follow-up recommendations were made for cases with vision-threatening DR (VTDR), incidental findings, or indeterminate results. Factors influencing follow-up were analyzed, including demographic, clinical, and imaging-related variables. We assessed the findings at follow-up of patients with indeterminate results. Results: Out of 7,733 examinations (6,242 patients), 32.25% were recommended for follow-up. Among these, 5.57% were classified as having VTDR, 14.34% had other ocular findings such as suspected glaucoma and age-related macular degeneration (AMD), and 12.13% were indeterminate. Of those recommended for follow-up, only 30.87% were assessed by eye care within six months. Older age, marriage, and severe DR were associated with higher odds of following up. Almost two thirds (64.35%) of the patients with indeterminate exams were found with a vision-threatening disease at follow-up. Conclusion: The six-month follow-up rate was found to be suboptimal. Influential factors for follow-up included age, marital status, and the severity of diabetic retinopathy (DR). While the program successfully identified a range of ocular conditions, screening initiatives must extend beyond mere disease detection. Ensuring patient follow-up is crucial to DR preventing programs mission. Recommended strategies to improve follow-up adherence include education, incentives, and personalized interventions. Additional research is necessary to pinpoint modifiable factors that impact adherence and to develop targeted interventions. [ABSTRACT FROM AUTHOR]

Background/Objectives: The most important prognostic factors in curatively treated prostate cancer are T and N stage, histology, grade group and initial PSA. A recent study found that men with blood calcium levels at the high end of the normal range are over two-and-a-half times more likely to develop fatal prostate cancer than those with lower calcium levels. However, there is limited evidence regarding the prognostic value of calcium levels at the time of prostate cancer diagnosis. We aimed to determine whether a calcium level in the upper range of normal values has any prognostic value in curatively treated prostate cancer. Methods: We conducted a retrospective analysis of 84 consecutive patients with prostate cancer who underwent curative-intent radiotherapy—either as primary treatment or adjuvant therapy—using external beam radiotherapy with or without brachytherapy. We analyzed all pertinent prognostic factors that could potentially impact disease-free survival. Results: The study revealed that calcium levels at diagnosis significantly predict disease-free survival, whereas the initial PSA level did not hold prognostic significance—likely due to interference from benign prostatic hyperplasia. Conclusions: If our findings are validated, calcium levels at the time of prostate cancer diagnosis could be incorporated into future predictive and prognostic models. [ABSTRACT FROM AUTHOR]

Background: Cauliflower ear deformity, a common sequela of auricular trauma, presents an esthetic and reconstructive challenge. Existing surgical techniques have limitations, including complexity, donor site morbidity, and variable long-term outcomes. Materials and Methods: In this case series, we present a novel and minimally invasive surgical approach for the correction of cauliflower ear deformity that adapts the Valente otoplasty technique; it combines cartilage debulking with helical rim release and Mustardé mattress stitches to restore ear contour and reduce the risk of recurrence. The procedural steps include bielliptic post-auricular skin and soft tissue incision, release of the cartilaginous spring, removal of excess fibrocartilaginous tissue, cartilage reshaping with suture to restore contour, and tissue redistribution to promote adherence of skin to the cartilage framework. Results: Outcomes were evaluated in 7 patients (9 ears) with cauliflower ear deformity, assessing surgical duration, complications, patient satisfaction, and esthetic outcomes at two years after surgery. The mean surgical duration per patient was 52 ± 17 minutes, including 2 bilateral procedures. Follow-up at 24 months showed favorable esthetic outcome in all patients with sustained improvements in auricular contour and symmetry with neither loss of the shape nor recurrence of deformity. Patients reported high satisfaction and improved quality of life, with mean Glasgow Children Benefit Questionnaire scores of 99.3 ± 6.3. Conclusions: This technique thus demonstrated lasting correction of cauliflower ear with favorable cosmetic outcomes, low risk of complications, and high patient satisfaction. Further investigations and longer-term follow-up are warranted to validate the technique's durability and expand its application to older and more diverse patient populations. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

After bariatric surgery lifelong follow-up is recommended. Evidence of the consequences and reasons for being lost to follow-up (LTFU) is sparse. In this prospective study follow-up data of all patients who underwent bariatric surgery between 2008 and 2017 at a certified obesity centre were investigated. LTFU patients were evaluated through a structured telephone interview. Overall, 573 patients (female/male 70.9%/29.1%), aged 44.1 ± 11.2 years, preoperative BMI 52.1 ± 8.4 kg/m2 underwent bariatric surgery. Out of these, 33.2% had type 2 diabetes mellitus and 74.4% had arterial hypertension. A total of 290 patients were LTFU, of those 82.1% could be reached. Baseline characteristics of patients in follow-up (IFU) and LTFU were comparable, but men were more often LTFU (p = 0.01). Reported postoperative total weight loss (%TWL) and improvements of comorbidities were comparable, but %TWL was higher in patients remaining in follow-up for at least 2 years (p = 0.013). Travel issues were mentioned as the main reason for being LTFU. A percentage of 77.6% of patients reported to regularly supplement micronutrients, while 71.0% stated regular monitoring of their micronutrient status, mostly by primary care physicians. Despite comparable reported outcomes of LTFU to IFU patients, the duration of the in-centre follow-up period affected %TWL. There is a lack of sufficient supplementation and monitoring of micronutrients in a considerable number of LTFU patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate whether persistent human papillomavirus integration at the same loci (PHISL) before and after treatment can predict recurrent/residual disease in women with CIN2-3. Methods: A total of 151 CIN2-3 women treated with conization between August 2020 and September 2021 were included. To investigate the precision of HPV integration, we further analyzed HPV integration-positive patients. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and the Youden index for predicting recurrence/residual disease were calculated. Results: Among the 151 enrolled CIN2-3 women, 56 were HPV integration-positive and 95 had HPV integration-negative results. Six (10.7%) experienced recurrence among 56 HPV integration-positive patients, which was more than those in HPV integration-negative patients (one patient, 1.1%). In the 56 HPV integration-positive patients, 12 had positive HPV results after treatment, seven had PHISL, and two had positive cone margin. Among the seven patients who tested with PHISL, six (85.7%) had residual/recurrent disease. PHISL was a prominent predictor of persistent/recurrent disease. The HPV test, the HPV integration test, and PHISL all had a sensitivity of 100% and a NPV of 100% for residual/recurrent disease. PHISL showed better specificity (98.0% vs. 82.0%, p = 0.005) and PPV (85.7% vs. 40.0%, p = 0.001) than the HPV test for predicting recurrence. Conclusions: The HPV-integration-positive CIN2-3 women had much higher relapse rates than HPV-integration-negative CIN2-3 women. The findings indicate that PHISL derived from preoperative and postoperative HPV integration tests may be a precise biomarker for the identification of residual/recurrent CIN 2/3. [ABSTRACT FROM AUTHOR]

Background: Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such presentations. Concurrently, not having a general practitioner (GP) increases the likelihood of low-acuity ED utilization. This pilot study thus investigated feasibility, acceptance, and potential effects of an ED-delivered intervention for low-acuity patients with no regular primary care provider, consisting of an educational leaflet on acute care options and an optional GP appointment scheduling service. Methods: Low-acuity ED consulters not attached to a GP were given an information leaflet about alternative care offers for acute health problems and offered optional personal appointment scheduling at a local GP practice. Patients were surveyed on demographics, medical characteristics, health care utilization, valuation of the intervention, and reasons for not being attached to a GP and visiting the ED. A follow-up survey was conducted after twelve months. Trends in health and health care utilization were evaluated. Results: Between December 2020 and April 2022, n = 160 patients were enrolled, n = 114 were followed up. The study population was characterized by young age (mean 30.6 years) and predominantly good general health. Besides good health, personal mobility was a central reason for not being attached to a GP, but general preference for specialists and bad experiences with primary care were also mentioned. Most frequently stated motives for the ED consultation were subjective distress and anxiety, a belief in the superiority of the hospital, and access problems in primary care. The interventional offers were favorably valued, 52.5% (n = 84) accepted the GP appointment scheduling service offer. At follow-up, GP utilization had significantly increased, while there were no significant changes regarding utilization of other providers, including ED. An additional practice survey showed a 63.0% take-up rate for the appointment service. Conclusions: With this pilot study, we were able to show that a personalized appointment scheduling service seems to be a promising approach to promote GP attachment and increase primary care utilization in patients without a regular GP in a highly urbanized setting. Further larger-scale studies are needed to investigate potential quantitative effects on ED visits. Trial Registration: German Clinical Trials Register (DRKS00023480); date 2020/11/27. [ABSTRACT FROM AUTHOR]

Background: The current Italian scenario of pediatric palliative care (PPC) services is characterized by inadequate coverage of the territory. Therefore, it is important to improve the referral of patients to the most appropriate setting (community care, general PPC, or specialized PPC) and to improve the delivery of PPC care. Methods: Aiming at obtaining information about the referrals to the Padua Pediatric Hospice that could help estimate the investments needed to improve the provision of care, a retrospective analysis has been carried out. The rate of proper referral and discharge, the number of patients followed at the hospice, the mortality rate, and the length of follow-up were analyzed, and, when possible, data were stratified by oncological and non-oncological diseases. Results: The analysis showed that of the 870 patients referred to the Padua Pediatric Hospice between 2008 and 2022, 76% were affected by non-oncological conditions. 82% of patients referred were taken in charge and most of the remaining patients have been inappropriately referred. The analysis showed a growing number of total referrals, which increased by 195% from 2008 to 2022. An increase in proper referrals and referrals of non-oncological patients was observed alongside a decrease in oncological patient referrals and a trend toward a decrease in discharge rates. A decreased mortality was observed in patients with non-oncological conditions, with only 6% of deceased patients in 2022. Moreover, a longer survival with a median follow-up length of 43 months was observed among patients with non-oncological conditions who were followed up at the Padua Pediatric Hospice for more than 12 months. Conversely, the short survival rate observed for oncological patients suggests that those patients should have been referred to PPC earlier to benefit from palliative care for longer periods. Conclusions: Considering these data, it is expected that the number of patients needing PPC services will steadily increase in the next years. Hence, there is a need to invest resources to provide the best care delivery model encompassing specific pathways for the transition into adulthood, the establishment of networks within all the Italian regions, and an efficient referral to the more suitable setting of care. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The introduction of universal test and treat (UTT) strategy has demonstrated a reduction in attrition in some low‐resource settings. UTT was introduced in Ethiopia in 2016. However, there is a paucity of information regarding the magnitude and predictors of attrition from HIV treatment in Ethiopia. This study aims to assess the incidence and predictors of attrition from HIV treatment among adults living with HIV (PLHIV) in high‐caseload facilities following the implementation of universal test and treat strategy in Ethiopia from March 2019 to June 2020.A prospective cohort of individuals in HIV care from 39 high‐caseload facilities in Oromia, Amhara, Tigray, Addis Ababa and Dire Dawa regions of Ethiopia was conducted for 12 months. Participants were adults aged 15 year and older who were first testers recruited for 3 months from March to June 2019. Subsequent follow‐up was for 12 months, with data collected on sociodemographic and clinical conditions at baseline, 6 and 12 months and attrition at 6 and 12 months. We defined attrition as discontinuation from follow‐up care due to loss to follow‐up, dropout or death. Data were collected using Open Data Kit at field level and aggregated centrally. Kaplan–Meier survival analysis was employed to assess survival probability to the time of attrition from treatment. The Cox proportional hazards regression model was used to measure association of baseline predictor variables with the proportion of antiretroviral therapy (ART) patients retained in ART during the follow up period.The overall incidence rate for attrition from HIV treatment among the study participants during 12 months of follow‐up was 5.02 cases per 1000 person‐weeks [95% confidence interval (CI): 4.44–5.68 per 1000 person‐weeks]. Study participants from health facilities in Oromia and Addis Ababa/Dire Dawa had 68% and 51% higher risk of attrition from HIV treatment compared with participants from the Amhara region, respectively [adjusted hazard ratio (AHR) = 1.68, 95% CI: 1.22–2.32 and AHR = 1.51, 95% CI: 1.05–2.17, respectively]. Participants who did not have a child had a 44% higher risk of attrition compared with those who had a child (AHR = 1.44, 95% CI: 1.12–1.85). Individuals who did not own mobile phone had a 37% higher risk of attrition than those who owned a mobile phone (AHR = 1.37, 95% CI: 1.02–1.83). Ambulatory/bedridden functional status at the time of diagnosis had a 44% higher risk of attrition compared with participants with a working functional status (AHR = 1.44, 95% CI: 1.08–1.92) at any time during the follow‐up period.The overall incidence of attrition among people living with HIV enrolled into HIV treatment was not as high as what was reported by other studies. Independent predictors of attrition were administrative regions in Ethiopia where health facilities are located, not having a child, not owning a mobile phone and being ambulatory/bedridden functional status at the time of diagnosis. Concerted efforts should be taken to reduce the magnitude of attrition from HIV treatment and address its drivers. [ABSTRACT FROM AUTHOR]

Background: Lung nodules are commonly detected in high-risk populations, necessitating reliable screening methods. Low-dose computed tomography (CT) is considered effective for early detection and follow-up. Objective: To evaluate the utility of low-dose CT in screening and follow-up of lung nodules over one year. Methods: A longitudinal study was conducted with 100 participants aged 50-75 years, including 60 males and 40 females. Participants were categorized based on smoking status: 40% current smokers, 50% former smokers, and 10% never smokers. Baseline and follow-up CT scans were performed at 3, 6, 9, and 12 months to detect and monitor lung nodules. Results: At baseline, 35 participants (35%) had detected nodules. Follow-up scans showed 40 nodules (88.9%) remained stable, 4 (8.9%) increased in size, and 1 (2.2%) decreased. New nodules were detected in 10 participants (10%). Statistical analysis revealed a sensitivity of 95%, specificity of 90%, positive predictive value of 85%, and negative predictive value of 97%. Clinical outcomes indicated 4 malignant nodules, with 2 classified as Stage I, 1 as Stage II, and 1 as Stage III. Treatments included surgical resection, chemotherapy, and radiation therapy. The cost-effectiveness analysis showed an average cost per low-dose CT scan of ₹3,250, with a total annual screening cost of ₹1,300,000 and a cost per detected malignant nodule of ₹3,25,000. Patient satisfaction was high at 90%, and overall survival rate was 100% at one year. Conclusion: Low-dose CT is an effective, sensitive, and cost-efficient method for screening and monitoring lung nodules, with significant potential for early detection and improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Based on the management data of patients with type 2 diabetes in Tianchang City in 2023, this study selected 519 patients aged 35 and above who were newly included in the management of patients with type 2 diabetes in Tianchang City in the first quarter of 2023 as research subjects, and used propensity score matching to study the effect of free medication on the follow - up effect of patients with type 2 diabetes. The results showed that the average treatment effect of free medication on glycemic control, medication compliance, psychological adjustment, and medical compliance in patients with type 2 diabetes mellitus in Tianchang City were 0.064, - 0.338, - 0.293 and - 0.358, respectively, with positive effects and significant effects. Overall, actively encouraging free medication can help promote the health management of patients with type 2 diabetes in Tianchang City. In a certain extent, free medication can play a positive role in improving the medication compliance of these patients with type 2 diabetes in Tianchang City, as well as in improving their psychological adjustment and medical compliance behavior. [ABSTRACT FROM AUTHOR]

Plexiform neurofibroma (PF) is a rare benign variant belonging to a subtype of neurofibromatosis type 1 that forms bulging or deforming masses arising from the peripheral nerve sheath. These masses involve surrounding connective tissue or dermal layers, leading to multiple cutaneous changes and certain characteristic appearances. It is these appearances that aid in the diagnosis of PF. We have encountered two distinct patients diagnosed with this disorder. While one patient was clinically and pathologically confirmed for PF, the other had no characteristic cutaneous changes. The diagnosis was made with postoperative histopathology and confirmed with an immunohistochemical examination. There are various modalities in the management of PFs, with surgery being a mainstay in the treatment of disfiguring large PFs, especially in resource-restrained settings. In view of high recurrence rates, postoperative clinical follow-up is a must. This paper describes these patients' typical and atypical clinical presentation and subsequent management. [ABSTRACT FROM AUTHOR]

OBJECTIVES Mechanical composite valve grafts (MCVGs) are the first-line therapy for aortic root replacement in young adults. Decellularized aortic homografts (DAH) present a promising novel alternative due to their lower thrombogenicity. We aimed to compare both treatment options regarding survival and valve-related adverse events. METHODS This study was designed as a single-centre retrospective cohort study including patients who underwent root replacement with MCVG or DAH between 2000 and 2022. Urgent or emergent procedures were excluded. RESULTS The study cohort included 289 patients (MCVG n  = 216, DAH n  = 73) with a mean age of 48.5 ± 12 years (MCVG 49 ± 12 years vs DAH 47 ± 11 years; P  = 0.23) and a median EuroScore II of 1.7% (1.2, 2.6). The 30-day mortality was 1% (n  = 3). Cumulative survival at 3 years was 99% for DAH and 94% for MCVG, respectively (P  = 0.15). Mean follow-up was 98.9 ± 72.7 months. Bleeding events (n  = 14, 6.5%) and thromboembolism (n  = 14, 6.5%) were only observed in the MCVG group (P  = 0.19 and 0.09, respectively). Four cases (5%) of moderate structural valve deterioration occurred, all in the DAH group (P  ≤ 0.001). The cumulative incidence of a composite end point of valve-related adverse events was significantly higher in the MCVG group (P  = 0.0295). CONCLUSIONS Aortic root replacement with MCVGs and decellularized aortic homografts showed low mortality in an elective setting. Patients in the homograft cohort demonstrated significantly higher freedom from valve-related adverse events. DAH present a promising treatment option for young patients requiring root replacement; however, data on long-term durability are needed. [ABSTRACT FROM AUTHOR]

OBJECTIVES The objective of this study was to enhance the efficiency of aortic arch replacement through the development of a novel frozen elephant trunk (FET) prosthesis with an endovascular side branch for left subclavian artery (LSA) connection. After successful pre-clinical testing, the feasibility and safety of implementing this innovative prosthesis in human subjects were investigated. METHODS Between September 2020 and September 2021, 4 patients (mean age 67) with conditions such as penetrating ulcer, non A–non B aortic dissection and chronic arch aneurysm underwent surgery utilizing the customized device. Surgeries were performed under high moderate hypothermia (27°C), employing bilateral selective antegrade cerebral perfusion (SACP) and distal aortic perfusion. Anastomosis of the FET prosthesis with the aortic arch occurred in zone 1, followed by separate reimplantation of the left common carotid artery and the brachiocephalic artery. RESULTS All patients were discharged in good clinical condition. The mean aortic cross-clamp, antegrade selective cerebral perfusion and distal aortic perfusion times were 111, 71 and 31 min, respectively. Endovascular extension of the side branch for the LSA was required in all cases to prevent endoleak formation. One patient received a stent graft extension at the end of the operation, while 2 others underwent the procedure during their hospital stay. One patient was diagnosed with an endoleak at the first follow-up after 3 months, and endoleak sealing was achieved via the brachial artery with an extension stent graft. CONCLUSIONS Preliminary clinical outcomes suggest that the newly designed FET prosthesis shows promise in simplifying total arch replacement. These initial findings provide a foundation for planned clinical studies to further assess the effectiveness of this modified surgical hybrid graft, with particular attention to the length and diameter of the LSA sidearm. [ABSTRACT FROM AUTHOR]

OBJECTIVES There remains debate over the optimal mitral valve replacement (MVR) option for patients aged 50–70 years. The objective of this study was to retrospectively compare the long-term outcomes of mechanical and bioprosthetic MVR in this patient population. METHODS Data from patients undergoing MVR between 2004 and 2018 were retrospectively reviewed. The primary outcome was all-cause mortality. Secondary outcomes included perioperative and late morbidity. RESULTS Two hundred and eight-six propensity-matched patients (n  = 143 mechanical; n  = 143 bioprosthetic) aged 50–70 years were included in the final analysis. Maximum follow-up was 15.8 years. There was no significant difference in all-cause mortality between the groups at 30 days, 1 year, 5 years, 10 years, and at the longest follow-up. Patients who underwent mechanical MVR experienced significantly lower rates of postoperative atrial fibrillation (P  = 0.001). There were no significant differences in rates of sepsis, acute kidney injury, superficial and deep sternal wound infection, mediastinal bleeding, and permanent pacemaker implantation. At the longest follow-up, there were no differences in myocardial infarction, stroke, heart failure or overall rehospitalization. At the same time point, there was an increased rate of MVR in patients receiving a bioprosthetic valve (P  = 0.015). CONCLUSIONS Survival following mechanical and bioprosthetic MVR in patients 50–70 years of age is similar to up to 15 years of follow-up. Bioprosthetic MVR is associated with an increased risk of repeat MVR. Mechanical MVR is not associated with an increased risk of stroke. Valve selection in this patient population requires diligent consideration of structural valve deterioration and subsequent reoperation risk as well as bleeding and thromboembolic risk. [ABSTRACT FROM AUTHOR]