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Background Aims Methods Results Conclusions Comprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings.The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study.This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study.The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2–16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource‐limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e‐CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing).The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e‐CRF technical difficulties, and ensuring consistent institutional support. [ABSTRACT FROM AUTHOR]

This study aimed to analyze early and midterm results of custom-made proximal scallop and fenestrated stent grafts for thoracic endovascular aortic repair (TEVAR) with a proximal landing zone (PLZ) in the aortic arch. All consecutive patients treated with the custom made proximal scalloped and fenestrated Relay stent grafts (Terumo Aortic Bolton Medical Inc.) in 10 Italian centers between January 2014 and December 2022 were included. The primary end points were technical success, incidence of intraoperative major adverse events, deployment accuracy, and rate of early neurological complications, endoleaks (ELs) and retrograde aortic dissection. During the study period, 49 patients received TEVAR with Relay custom-made endograft in Italy were enrolled. The median patient age was 70.1 years (interquartile range, 23-86 years) and 65.3% were male. The indication for treatment was atherosclerotic aneurysms in 59.2% of cases and penetrating aortic ulcer in 22.4%. The endograft configuration was proximal fenestration in 55.1% and scallop in 44.9%. The proximal landing zone was zone 0 in 25 cases (51%), zone 1 in 14 cases (28.6%), and zone 2 in 10 cases (20.4%). The supra-aortic debranching procedures were 38 (77.5%). Technical success was 97.9% (48/49) owing to one case (2.0%) of inaccurate deployment. Intraoperatively, one (2.0%) type Ia and one (2.0%) type III EL were detected. There were no cases of in-hospital mortality, major adverse events, or retrograde dissection. Three minor strokes (6.1%) (National Institutes of Health Stroke Scale score of ≤4) were observed. At a mean follow-up time of 36.3 ± 21.3 months the rate of types I to III ELs and reintervention was 4.1%, respectively. Four patients (8.2%) died during the follow-up period, one (2.1%) from abdominal aortic rupture and three (6.1%) from nonaortic causes. Our early and midterm outcomes suggest that scalloped and fenestrated TEVAR may provide an acceptable alternative treatment option for aortic arch pathologies. Large-scale studies are needed to assess the long-term durability of this technique. [ABSTRACT FROM AUTHOR]

Background: Resilience is a crucial factor in students' mental health, playing an important role in their successful adaptation to the academic environment. However, there is a lack of understanding about resilience and its associated factors in students from different undergraduate courses. This study aimed to describe the resilience profile of undergraduate students from various courses in Brazil and identify sociodemographic, economic, and academic factors associated with resilience. Methods: This study has data from a cross-sectional multicenter study involving undergraduate students from eight Federal Institutions of Higher Education in Minas Gerais, Brazil. The dependent variable was resilience, measured using the Connor-Davidson Resilience Scale (CD-RISC) 10-item version, with sociodemographic, economic, and academic factors considered independent variables. Data was collected virtually via a self-administered questionnaire between October 2021 and February 2022 (during the covid-19 pandemic). Independent samples t-tests and ANOVAs were conducted to compare resilience scores between independent variables, and Tukey's post-hoc test was performed when necessary. Multiple linear regression was performed to create three models. Results: 8,650 undergraduate students were included in this study. The average score on the resilience scale was 19.86 ± 8.15, with a normal distribution. The respondents ranged from 18 to 71 years old, averaging 23.9 ± 6.33. Being female, not having a religious belief, having low per capita family income, having had a decrease in the family income, not being heterosexual, or having the head of the family with a low education level were the main factors associated, individually, with low resilience scores in the sociodemographic and economic multiple linear regression model constructed. Being from linguistics, letters and arts courses, being enrolled in fewer subjects, or being from UFMG were the main factors associated, individually, with low resilience scores in the academic multiple linear regression model constructed. Conclusions: The study's findings revealed that sociodemographic, economic, and academic variables were significantly associated with resilience scores in undergraduates from Minas Gerais during the covid-19 pandemic. These findings can help universities develop target strategies to promote students' resilience and reduce the risk of poor mental health among this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physician modified endografts (PMEGs) have been widely used in the treatment of complex abdominal aortic aneurysm and thoracoabdominal aortic aneurysm, however, previous data are limited to small single center studies and robust data on safety and effectiveness of PMEGs are lacking. We aimed to perform an international multicenter study analyzing the outcomes of PMEGs in complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. METHODS: An international multicenter single-arm cohort study was performed analyzing the outcomes of PMEGs in the treatment of elective, symptomatic, and ruptured complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Variables and outcomes were defined according to the Society for Vascular Surgery reporting standards. Device modification and procedure details were collected and analyzed. Efficacy outcomes included technical success and safety outcomes included major adverse events and 30-day mortality. Follow-up outcomes included reinterventions, endoleaks, target vessel patency rates and overall and aortic-related mortality. Multivariable analysis was performed aiming at identifying predictors of technical success, 30-day mortality, and major adverse events. RESULTS: Overall, 1274 patients were included in the study from 19 centers. Median age was 74 (IQR, 68–79), and 75.7% were men; 45.7% were complex abdominal aortic aneurysms, and 54.3% were thoracoabdominal aortic aneurysms; 65.5% patients presented electively, 24.6% were symptomatic, and 9.9% were ruptured. Most patients (83.1%) were submitted to a fenestrated repair, 3.6% to branched repair, and 13.4% to a combined fenestrated and branched repair. Most patients (85.8%) had ≥3 target vessels included. The overall technical success was 94% (94% in elective, 93.4% in symptomatic, and 95.1% in ruptured cases). Thirty-day mortality was 5.8% (4.1% in elective, 7.6% in symptomatic, and 12.7% in ruptured aneurysms). Major adverse events occurred in 25.2% of cases (23.1% in elective, 27.8% in symptomatic, and 30.3% in ruptured aneurysms). Median follow-up was 21 months (5.6–50.6). Freedom from reintervention was 73.8%, 61.8%, and 51.4% at 1, 3, and 5 years; primary target vessel patency was 96.9%, 93.6%, and 90.3%. Overall survival and freedom from aortic-related mortality was 82.4%/92.9%, 69.9%/91.6%, and 55.0%/89.1% at 1, 3, and 5 years. CONCLUSIONS: PMEGs were a safe and effective treatment option for elective, symptomatic, and ruptured complex aortic aneurysms. Long-term data and future prospective studies are needed for more robust and detailed analysis. [ABSTRACT FROM AUTHOR]

Magnetoencephalography (MEG) provides crucial information in diagnosing focal epilepsy. However, dipole estimation, a commonly used analysis method for MEG, can be time-consuming since it necessitates neurophysiologists to manually identify epileptic spikes. To reduce this burden, we developed the automatic detection of spikes using deep learning in single center. In this study, we performed a multi-center study using six MEG centers to improve the performance of the automated detection of neuromagnetically recorded epileptic spikes, which we previously developed using deep learning. Data from four centers were used for training and evaluation (internal data), and the remaining two centers were used for evaluation only (external data). We used a five-fold subject-wise cross-validation technique to train and evaluate the models. A comparison showed that the multi-center model outperformed the single-center model in terms of performance. The multi-center model achieved an average ROC-AUC of 0.9929 and 0.9426 for the internal and external data, respectively. The median distance between the neurophysiologist-analyzed and automatically analyzed dipoles was 4.36 and 7.23 mm for the multi-center model for internal and external data, respectively, indicating accurate detection of epileptic spikes. By training data from multiple centers, automated analysis can improve spike detection and reduce the analysis workload for neurophysiologists. This study suggests that the multi-center model has the potential to detect spikes within 1 cm of a neurophysiologist's analysis. This multi-center model can significantly reduce the number of hours required by neurophysiologists to detect spikes. [ABSTRACT FROM AUTHOR]

We aimed to determine the intra-site repeatability and cross-site reproducibility of T1 and T2* relaxation times and quantitative susceptibility (χ) values obtained through quantitative parameter mapping (QPM) at 3 T. This prospective study included three 3-T scanners with the same hardware and software platform at three sites. The brains of twelve healthy volunteers were scanned three times using QPM at three sites. Intra-site repeatability and cross-site reproducibility were evaluated based on voxel-wise and region-of-interest analyses. The within-subject coefficient of variation (wCV), within-subject standard deviation (wSD), linear regression, Bland–Altman plot, and intraclass correlation coefficient (ICC) were used for evaluation. The intra-site repeatability wCV was 11.9 ± 6.86% for T1 and 3.15 ± 0.03% for T2*, and wSD of χ at 3.35 ± 0.10 parts per billion (ppb). Intra-site ICC(1, k) values for T1, T2*, and χ were 0.878–0.904, 0.972–0.976, and 0.966–0.972, respectively, indicating high consistency within the same scanner. Linear regression analysis revealed a strong agreement between measurements from each site and the site-average measurement, with R-squared values ranging from 0.79 to 0.83 for T1, 0.94–0.95 for T2*, and 0.95–0.96 for χ. The cross-site wCV was 13.4 ± 5.47% for T1 and 3.69 ± 2.25% for T2*, and cross-site wSD of χ at 4.08 ± 3.22 ppb. The cross-site ICC(2,1) was 0.707, 0.913, and 0.902 for T1, T2*, and χ, respectively. QPM provides T1, T2*, and χ values with an intra-site repeatability of <12% and cross-site reproducibility of <14%. These findings may contribute to the development of multisite studies. [ABSTRACT FROM AUTHOR]

A precise radiotherapy plan is crucial to ensure accurate segmentation of glioblastomas (GBMs) for radiation therapy. However, the traditional manual segmentation process is labor‐intensive and heavily reliant on the experience of radiation oncologists. In this retrospective study, a novel auto‐segmentation method is proposed to address these problems. To assess the method's applicability across diverse scenarios, we conducted its development and evaluation using a cohort of 148 eligible patients drawn from four multicenter datasets and retrospective data collection including noncontrast CT, multisequence MRI scans, and corresponding medical records. All patients were diagnosed with histologically confirmed high‐grade glioma (HGG). A deep learning‐based method (PKMI‐Net) for automatically segmenting gross tumor volume (GTV) and clinical target volumes (CTV1 and CTV2) of GBMs was proposed by leveraging prior knowledge from multimodal imaging. The proposed PKMI‐Net demonstrated high accuracy in segmenting, respectively, GTV, CTV1, and CTV2 in an 11‐patient test set, achieving Dice similarity coefficients (DSC) of 0.94, 0.95, and 0.92; 95% Hausdorff distances (HD95) of 2.07, 1.18, and 3.95 mm; average surface distances (ASD) of 0.69, 0.39, and 1.17 mm; and relative volume differences (RVD) of 5.50%, 9.68%, and 3.97%. Moreover, the vast majority of GTV, CTV1, and CTV2 produced by PKMI‐Net are clinically acceptable and require no revision for clinical practice. In our multicenter evaluation, the PKMI‐Net exhibited consistent and robust generalizability across the various datasets, demonstrating its effectiveness in automatically segmenting GBMs. The proposed method using prior knowledge in multimodal imaging can improve the contouring accuracy of GBMs, which holds the potential to improve the quality and efficiency of GBMs' radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Repeat endoscopic submucosal dissection for metachronous recurrence of esophageal squamous cell carcinoma close to previous endoscopic submucosal dissection scars is challenging. Therefore, this study evaluated the efficacy and safety of repeat endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma. Methods: The study included 1680 patients. After propensity score matching, esophageal endoscopic submucosal dissection-related outcomes were compared between the post-endoscopic submucosal dissection scar group (n = 91) and first endoscopic submucosal dissection group (n = 910). The Kaplan–Meier method and log-rank tests were used to compare both groups' survival and local recurrence curves. Results: After propensity score matching, the two groups showed no significant difference in en bloc resection rate (97.80% vs. 99.56%, p = 0.096), treatment time (64.75 min vs 61.33 min, p = 0.448), recurrence rate (3.30% vs. 2.20%, p = 0.458), and stricture rate (7.69% vs. 4.07%, p = 0.110). However, the perforation rate was higher in the post-endoscopic submucosal dissection scar group than in the first endoscopic submucosal dissection group (4.40% vs. 1.10%, p = 0.031). The 5-year overall survival rates in the post-endoscopic submucosal dissection scar and first endoscopic submucosal dissection groups were 88.6% and 89.0%, respectively. Conclusions: Repeated esophageal endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma yielded satisfactory clinical outcomes and survival rates. Therefore, repeat endoscopic submucosal dissection may effectively treat esophageal squamous cell carcinoma recurrence close to the initial endoscopic submucosal dissection scars. [ABSTRACT FROM AUTHOR]

This study addresses the relationship between platelet count and 30-day in-hospital mortality in End-Stage Kidney Disease (ESRD) patients in the intensive care unit (ICU), a topic with limited existing evidence. Utilizing data from the US eICU-CRD v2.0 database (2014–2015), a retrospective cohort study was conducted involving 3700 ICU ESRD patients. We employed binary logistic regression, smooth curve fitting, and subgroup analyses to explore the association between platelet count and 30-day in-hospital mortality. The 30-day in-hospital mortality rate was 13.27% (491/3700), with a median platelet count of 188 × 109/L. After adjusting for covariates, we observed a relationship between platelet count and 30-day in-hospital mortality (OR = 0.98, 95% CI 0.97, 0.99). Subgroup analyses supported these findings. More importantly, a nonlinear association was detected, with an inflection point at 222 × 109/L. The effect sizes (OR) on the left and right sides of the inflection point were 0.94 (0.92, 0.96) and 1.03 (1.00, 1.05), respectively. The most significant finding of this study is the revelation of a nonlinear relationship between baseline platelet count and 30-day in-hospital mortality in ICU patients with ESRD. This discovery explicitly suggests that when ESRD patients are admitted to the ICU, a platelet level closer to 222 × 10⁹/L may predict a lower 30-day in-hospital mortality risk. [ABSTRACT FROM AUTHOR]

Background: The German multicenter research consortium BipoLife aims to investigate the mechanisms underlying bipolar disorders. It focuses in particular on people at high risk of developing the disorder and young patients in the early stages of the disease. Functional and structural magnetic resonance imaging (MRI) data was collected in all participating centers. The collection of neuroimaging data in a longitudinal, multicenter study requires the implementation of a comprehensive quality assurance (QA) protocol. Here, we outline this protocol and illustrate its application within the BipoLife consortium. Methods: The QA protocol consisted of (1) a training of participating research staff, (2) regular phantom measurements to evaluate the MR scanner performance and its temporal stability across the course of the study, and (3) the assessment of the quality of human MRI data by evaluating a variety of image metrics (e.g., signal-to-noise ratio, ghosting level). In this article, we will provide an overview on these QA procedures and show exemplarily the influence of its application on the results of standard neuroimaging analysis pipelines. Discussion: The QA protocol helped to characterize the various MR scanners, to record their performance over the course of the study and to detect possible malfunctions at an early stage. It also assessed the quality of the human MRI data systematically to characterize its influence on various analyses. Furthermore, by setting up and publishing this protocol, we define standards that must be considered when analyzing data from the BipoLife consortium. It further promotes a systematic evaluation of data quality and a definition of subject inclusion criteria. In the long term, it will help to increase the chance of achieving clinically relevant results. [ABSTRACT FROM AUTHOR]

Background: The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients. Methods: We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included. Results: In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3–50.3 months). Median duration between consultation and death was seven days (IQR 3–28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p < 0.001; DNR before: n = 20, after: n = 28, p < 0.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3–6); first contact: median 9 (IQR 6–10); p < 0.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit. Conclusions: This largest European multicenter investigation of LVAD-patients receiving specialist palliative care shows a late integration and high physical and psychosocial symptom burden. This study highlights the urgent need for earlier integration to identify and address poorly controlled symptoms. Further studies and educational efforts are needed to close the gap between guideline-recommendations and the current status quo. [ABSTRACT FROM AUTHOR]

Background: Approximately half of the patients with advanced pancreatic ductal adenocarcinoma (PDAC) receive subsequent lines of chemotherapy. Recently, the liposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) regimen is recommended as subsequent lines of chemotherapy. However, little is known about the predictive factors for the nal-IRI + 5-FU/LV regimen, especially in patients with previous irinotecan (IRI) exposure. Objectives: We investigated the predictive factors associated with nal-IRI + 5-FU/LV treatment in patients with PDAC. Design: Multicenter, retrospective cohort study. Methods: This study included patients with advanced PDAC who received the nal-IRI + 5-FU/LV regimen for palliative purposes. Results: Overall, 268 patients were treated with nal-IRI + 5-FU/LV. The median overall survival (OS) was 7.9 months (95% confidence interval (CI): 7.0–8.8), while the median progression-free survival (PFS) was 2.6 months (95% CI: 1.9–3.2). An albumin level of<4.0 g/dL, neutrophil-to-lymphocyte ratio (NLR) of ⩾3.5, liver or peritoneal metastasis, and a history of >3 lines of palliative chemotherapy were associated with worse OS. An NLR of ⩾3.5 and liver metastasis were significant predictive factors for worse PFS. Previous exposure to IRI was not a significant predictor. Patients without prior IRI (no-IRI) treatment showed relatively longer OS and PFS compared to IRI responders and nonresponders, but these differences were not significant when compared specifically to the responders (OS: 8.8 vs 8.1 months, p = 0.388; PFS: 3.6 vs 2.6 months, p = 0.126). Conclusion: An NLR of ⩾3.5 and liver metastasis were associated with worse PFS. Prior IRI exposure was not a significant predictive factor for OS and PFS, especially in IRI responders. [ABSTRACT FROM AUTHOR]

Background: Hot flashes are a common side effect of endocrine therapy (ET) that contribute to poor quality of life and decreased treatment adherence. Methods: Patients with breast cancer wo were receiving ET and experiencing hot flashes were enrolled through three parallel, randomized trials conducted in the United States, China, and South Korea. Participants were randomized to either immediate acupuncture (IA) or delayed acupuncture control (DAC). IA participants received 20 acupuncture sessions over 10 weeks, whereas DAC participants received usual care, then crossed over to acupuncture with a reduced intensity. The primary end point was a change in score on the endocrine symptom subscale of the Functional Assessment of Cancer Therapy (FACT)‐Endocrine Symptoms between baseline and week 10. Secondary end points included the hot flash score and the FACT‐Breast score. A planned pooled analysis of individual patient data was performed using longitudinal mixed models. Results: In total, 158 women with stage 0–III breast cancer were randomized (United States, n = 78; China, n = 40; South Korea, n = 40). At week 10, IA participants reported statistically significant improvements in the endocrine symptom subscale score (mean change ± standard error: 5.1 ± 0.9 vs. 0.2 ± 1.0; p =.0003), the hot flash score (−5.3 ± 0.9 vs. −1.4 ± 0.9; p <.003), and the FACT‐Breast total score (8.0 ± 1.6 vs. −0.01 ± 1.6; p =.0005) compared with DAC participants. The effect of the acupuncture intervention differed by site (p =.005). Conclusions: Acupuncture led to statistically and clinically meaningful improvements in hot flashes, endocrine symptoms, and breast cancer‐specific quality of life in women undergoing ET for breast cancer in the United States, China, and South Korea. In a pooled analysis of three parallel trials, acupuncture significantly reduced hot flashes and other endocrine symptoms in women with stage 0–III breast cancer undergoing endocrine therapy in the United States, China, and South Korea. In the women studied, acupuncture led to statistically and clinically meaningful improvements in hot flashes, endocrine symptoms, and breast cancer‐specific quality of life. [ABSTRACT FROM AUTHOR]

Background: F-627 (efbemalenograstim alfa) is a novel long acting granulocyte colony-stimulating factor (G-CSF) that contains two human G-CSF fused to a human immunoglobulin G2 (hIgG2) -Fc fragment with a peptide linker. This studyevaluated the efficacy and safety of F-627, also known as efbemalenograstim alfa (Ryzneuta®) in reducing neutropenia compared with filgrastim (GRAN®). Methods: This was a multicenter, randomized, open-label, active-controlled non-inferiority study. Two hundred thirty nine (239) patients were enrolled in thirteen centers and received the chemotherapy with epirubicin (100 mg/m2) and cyclophosphamide (600 mg/m2) on day 1 of each cycle for a maximum of four cycles. Patients were randomized to receive either a single 20 mg subcutaneous (s.c.) injection of F-627 on day 3 of each cycle or daily s.c. injection of filgrastim 5 µg/kg/d starting from day 3 of each cycle. The primary endpoint was the duration of grade 3 or 4 neutropenia in cycle 1. The safety profile was also evaluated. Results: The mean (SD) duration of grade 3 or 4 neutropenia in cycle 1 was 0.68 (1.10) and 0.71 (0.95) days for the F-627 and the filgrastim groups, respectively. The Hodges-Lehmann estimate of the between-group median difference (F-627 vs filgrastim) in the duration of grade 3 or 4 neutropenia in cycle 1 was 0 day and the upper limit of the one-sided 97.5% CI was 0 day, which was within the prespecified non-inferiority margin of 1-day. Results for all efficacy endpoints in cycles 2 − 4 were consistent with the results in cycle 1, however a trend towards a lower incidence and a shorter duration of grade 3 or 4 neutropenia and grade 4 neutropenia was observed in the F-627 group compared with the filgrastim group. The ANC nadir in the F-627 group was significantly higher than that in the filgrastim group in each cycle. A single fixed dose of F-627 was well tolerated and as safe as standard daily filgrastim. Conclusions: A single fixed dose of 20 mg of F-627 in each cycle was as safe and effective as a daily dose of filgrastim 5 µg/kg/d in reducing neutropenia and its complications in patients who received four cycles of EC. Trial registration: ClinicalTrials.gov: NCT04174599, on 22/11/2019. [ABSTRACT FROM AUTHOR]

This multicenter study aims to investigate the incidence of chronic postsurgical pain (CPSP) after cardiac surgery, exploring the influence of various factors and their implications on patients' quality of life. The CPSP-Cardiac is a large, multicenter, observational study. The target population of 1176 cardiac surgery patients will be recruited from participating hospital sites. Patients undergoing cardiac surgery with median sternotomy for coronary surgery and all open-heart procedures will be eligible for the study. Patients between the ages of 18–80 years who have an American Society of Anesthesiologists Physical Status score of II–III will be included. The primary outcome of our study is to determine the incidence of chronic postsurgical pain in the third month following cardiac surgery, along with identifying the factors that influence it. Our secondary outcomes include assessing opioid consumption in the first 24 hours postoperatively, NRS scores, incidences of postoperative nausea and vomiting, side effects and complications, extubation time, length of stay in the intensive care unit and hospital, chronic pain status at 3 and 6 months, psychological assessments, quality of life, and postoperative complications at 3 and 6 months. [ABSTRACT FROM AUTHOR]

Purpose: Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. We investigated the long-term follow-up results of FNS with good facial nerve function. Methods: At nine medical centers in the Korean Facial Nerve Study Group, 43 patients undergoing observation periods longer than 12 months for FNS with good facial nerve function (House-Brackmann grade ≤ II) were enrolled, and clinical and radiographic data were obtained for these cases. Results: The mean follow-up period was 63 months. In the majority of cases, tumors involved multiple segments (81.4%) and only eight cases were confined to a single site. There were no cases where the tumor was confined to the extratemporal region. Tumor size increased slightly, with an average estimated change of 0.48 mm/year. Twenty (46.5%) of 43 patients showed no change in tumor size. Seven patients (16.3%) showed worsening House-Brackmann (H–B) grade, of which two patients deteriorated from H–B grade I to II, four worsened to grade III, and one deteriorated to grade IV. The remaining 36 patients (83.7%) showed no change in facial nerve function. There was no difference in H–B grade according to tumor size at the time of diagnosis or change in tumor size. Conclusion: We conducted a large-scale observational study of FNS with good facial nerve function. Our study showed that many patients maintained facial nerve function during long-term follow-up. Conservative management with regular examination and imaging can be an appropriate option for managing FNS with good facial nerve function. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI)–enabled sinus rhythm (SR) electrocardiogram (ECG) interpretation can aid in identifying undiagnosed paroxysmal atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). The purpose of this study was to assess the efficacy of an AI model in identifying AF based on SR ECGs in patients with ESUS. A transformer-based vision AI model was developed using 737,815 SR ECGs from patients with and without AF to detect current paroxysmal AF or predict the future development of AF within a 2-year period. Probability of AF was calculated from baseline SR ECGs using this algorithm. Its diagnostic performance was further tested in a cohort of 352 ESUS patients from 4 tertiary hospitals, all of whom were monitored using an insertable cardiac monitor (ICM) for AF surveillance. Over 25.1-month follow-up, AF episodes lasting ≥1 hour were identified in 58 patients (14.4%) using ICMs. In the receiver operating curve (ROC) analysis, the area under the curve for the AI algorithm to identify AF ≥1 hour was 0.806, which improved to 0.880 after integrating the clinical parameters into the model. The AI algorithm exhibited greater accuracy in identifying longer AF episodes (ROC for AF ≥12 hours: 0.837, for AF ≥24 hours: 0.879) and a temporal trend indicating that the AI-based AF risk score increased as the ECG recording approached the AF onset (P for trend <.0001). Our AI model demonstrated excellent diagnostic performance in predicting AF in patients with ESUS, potentially enhancing patient prognosis through timely intervention and secondary prevention of ischemic stroke in ESUS cohorts. [Display omitted] [ABSTRACT FROM AUTHOR]

Context Presently, there is a paucity of prospective clinical trials investigating neoadjuvant therapy for locally advanced thyroid cancer. Objective This study was a multicenter, open-label, single-arm, phase II trial evaluating the efficacy and safety of apatinib as neoadjuvant therapy in patients with local advanced differentiated thyroid cancer (DTC). Methods Patients were treated with preoperative apatinib over a course of 2 to 4 cycles, culminating in surgical resection. The primary endpoints were objective response rate (ORR) and disease control rate (DCR); the secondary endpoints were the rate of R0 surgery, alterations in serum thyroglobulin levels, disease-free survival, and adverse events (AEs). Results A total of 14 patients who met the inclusion criteria were administered neoadjuvant apatinib. Among these, 13 patients underwent surgical procedures following apatinib treatment and were enrolled in the ITT population. The ORR was 53.8% and the DCR was 100%. Of the patients, 84.6% received R0 surgery, while the remaining 15.4% underwent R1 resection. Predominant among the observed AEs were hypertension, hand–foot syndrome, hepatic dysfunction, proteinuria, and hypothyroidism, with no instances of grade 4 or 5 AEs reported. Subsequent to surgery, patients were followed up for a median period of 34 months, during which disease progression occurred in 5 individuals (35.7%), encompassing 3 cases of locoregional recurrences and 2 cases of distant metastases. Conclusion Apatinib may be an effective agent in the use of neoadjuvant therapy for locally advanced DTC. Patients may therefore benefit from surgical outcomes and their long-term prognosis. [ABSTRACT FROM AUTHOR]

Abstract Background Resilience is a crucial factor in students’ mental health, playing an important role in their successful adaptation to the academic environment. However, there is a lack of understanding about resilience and its associated factors in students from different undergraduate courses. This study aimed to describe the resilience profile of undergraduate students from various courses in Brazil and identify sociodemographic, economic, and academic factors associated with resilience. Methods This study has data from a cross-sectional multicenter study involving undergraduate students from eight Federal Institutions of Higher Education in Minas Gerais, Brazil. The dependent variable was resilience, measured using the Connor-Davidson Resilience Scale (CD-RISC) 10-item version, with sociodemographic, economic, and academic factors considered independent variables. Data was collected virtually via a self-administered questionnaire between October 2021 and February 2022 (during the covid-19 pandemic). Independent samples t-tests and ANOVAs were conducted to compare resilience scores between independent variables, and Tukey’s post-hoc test was performed when necessary. Multiple linear regression was performed to create three models. Results 8,650 undergraduate students were included in this study. The average score on the resilience scale was 19.86 ± 8.15, with a normal distribution. The respondents ranged from 18 to 71 years old, averaging 23.9 ± 6.33. Being female, not having a religious belief, having low per capita family income, having had a decrease in the family income, not being heterosexual, or having the head of the family with a low education level were the main factors associated, individually, with low resilience scores in the sociodemographic and economic multiple linear regression model constructed. Being from linguistics, letters and arts courses, being enrolled in fewer subjects, or being from UFMG were the main factors associated, individually, with low resilience scores in the academic multiple linear regression model constructed. Conclusions The study’s findings revealed that sociodemographic, economic, and academic variables were significantly associated with resilience scores in undergraduates from Minas Gerais during the covid-19 pandemic. These findings can help universities develop target strategies to promote students’ resilience and reduce the risk of poor mental health among this population.

In ophthalmology, the quality of fundus images is critical for accurate diagnosis, both in clinical practice and in artificial intelligence (AI)-assisted diagnostics. Despite the broad view provided by ultrawide-field (UWF) imaging, pseudocolor images may conceal critical lesions necessary for precise diagnosis. To address this, we introduce UWF-Net, a sophisticated image enhancement algorithm that takes disease characteristics into consideration. Using the Fudan University ultra-wide-field image (FDUWI) dataset, which includes 11 294 Optos pseudocolor and 2415 Zeiss true-color UWF images, each of which is rigorously annotated, UWF-Net combines global style modeling with feature-level lesion enhancement. Pathological consistency loss is also applied to maintain fundus feature integrity, significantly improving image quality. Quantitative and qualitative evaluations demonstrated that UWF-Net outperforms existing methods such as contrast limited adaptive histogram equalization (CLAHE) and structure and illumination constrained generative adversarial network (StillGAN), delivering superior retinal image quality, higher quality scores, and preserved feature details after enhancement. In disease classification tasks, images enhanced by UWF-Net showed notable improvements when processed with existing classification systems over those enhanced by StillGAN, demonstrating a 4.62% increase in sensitivity (SEN) and a 3.97% increase in accuracy (ACC). In a multicenter clinical setting, UWF-Net-enhanced images were preferred by ophthalmologic technicians and doctors, and yielded a significant reduction in diagnostic time ((13.17 ± 8.40) s for UWF-Net enhanced images vs (19.54 ± 12.40) s for original images) and an increase in diagnostic accuracy (87.71% for UWF-Net enhanced images vs 80.40% for original images). Our research verifies that UWF-Net markedly improves the quality of UWF imaging, facilitating better clinical outcomes and more reliable AI-assisted disease classification. The clinical integration of UWF-Net holds great promise for enhancing diagnostic processes and patient care in ophthalmology.

Abstract Magnetoencephalography (MEG) provides crucial information in diagnosing focal epilepsy. However, dipole estimation, a commonly used analysis method for MEG, can be time-consuming since it necessitates neurophysiologists to manually identify epileptic spikes. To reduce this burden, we developed the automatic detection of spikes using deep learning in single center. In this study, we performed a multi-center study using six MEG centers to improve the performance of the automated detection of neuromagnetically recorded epileptic spikes, which we previously developed using deep learning. Data from four centers were used for training and evaluation (internal data), and the remaining two centers were used for evaluation only (external data). We used a five-fold subject-wise cross-validation technique to train and evaluate the models. A comparison showed that the multi-center model outperformed the single-center model in terms of performance. The multi-center model achieved an average ROC-AUC of 0.9929 and 0.9426 for the internal and external data, respectively. The median distance between the neurophysiologist-analyzed and automatically analyzed dipoles was 4.36 and 7.23 mm for the multi-center model for internal and external data, respectively, indicating accurate detection of epileptic spikes. By training data from multiple centers, automated analysis can improve spike detection and reduce the analysis workload for neurophysiologists. This study suggests that the multi-center model has the potential to detect spikes within 1 cm of a neurophysiologist’s analysis. This multi-center model can significantly reduce the number of hours required by neurophysiologists to detect spikes.

Abstract Background The German multicenter research consortium BipoLife aims to investigate the mechanisms underlying bipolar disorders. It focuses in particular on people at high risk of developing the disorder and young patients in the early stages of the disease. Functional and structural magnetic resonance imaging (MRI) data was collected in all participating centers. The collection of neuroimaging data in a longitudinal, multicenter study requires the implementation of a comprehensive quality assurance (QA) protocol. Here, we outline this protocol and illustrate its application within the BipoLife consortium. Methods The QA protocol consisted of (1) a training of participating research staff, (2) regular phantom measurements to evaluate the MR scanner performance and its temporal stability across the course of the study, and (3) the assessment of the quality of human MRI data by evaluating a variety of image metrics (e.g., signal-to-noise ratio, ghosting level). In this article, we will provide an overview on these QA procedures and show exemplarily the influence of its application on the results of standard neuroimaging analysis pipelines. Discussion The QA protocol helped to characterize the various MR scanners, to record their performance over the course of the study and to detect possible malfunctions at an early stage. It also assessed the quality of the human MRI data systematically to characterize its influence on various analyses. Furthermore, by setting up and publishing this protocol, we define standards that must be considered when analyzing data from the BipoLife consortium. It further promotes a systematic evaluation of data quality and a definition of subject inclusion criteria. In the long term, it will help to increase the chance of achieving clinically relevant results.

Abstract This study addresses the relationship between platelet count and 30-day in-hospital mortality in End-Stage Kidney Disease (ESRD) patients in the intensive care unit (ICU), a topic with limited existing evidence. Utilizing data from the US eICU-CRD v2.0 database (2014–2015), a retrospective cohort study was conducted involving 3700 ICU ESRD patients. We employed binary logistic regression, smooth curve fitting, and subgroup analyses to explore the association between platelet count and 30-day in-hospital mortality. The 30-day in-hospital mortality rate was 13.27% (491/3700), with a median platelet count of 188 × 109/L. After adjusting for covariates, we observed a relationship between platelet count and 30-day in-hospital mortality (OR = 0.98, 95% CI 0.97, 0.99). Subgroup analyses supported these findings. More importantly, a nonlinear association was detected, with an inflection point at 222 × 109/L. The effect sizes (OR) on the left and right sides of the inflection point were 0.94 (0.92, 0.96) and 1.03 (1.00, 1.05), respectively. The most significant finding of this study is the revelation of a nonlinear relationship between baseline platelet count and 30-day in-hospital mortality in ICU patients with ESRD. This discovery explicitly suggests that when ESRD patients are admitted to the ICU, a platelet level closer to 222 × 10⁹/L may predict a lower 30-day in-hospital mortality risk.

Abstract Background The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients. Methods We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included. Results In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3–50.3 months). Median duration between consultation and death was seven days (IQR 3–28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p

Abstract Background F-627 (efbemalenograstim alfa) is a novel long acting granulocyte colony-stimulating factor (G-CSF) that contains two human G-CSF fused to a human immunoglobulin G2 (hIgG2) -Fc fragment with a peptide linker. This studyevaluated the efficacy and safety of F-627, also known as efbemalenograstim alfa (Ryzneuta®) in reducing neutropenia compared with filgrastim (GRAN®). Methods This was a multicenter, randomized, open-label, active-controlled non-inferiority study. Two hundred thirty nine (239) patients were enrolled in thirteen centers and received the chemotherapy with epirubicin (100 mg/m2) and cyclophosphamide (600 mg/m2) on day 1 of each cycle for a maximum of four cycles. Patients were randomized to receive either a single 20 mg subcutaneous (s.c.) injection of F-627 on day 3 of each cycle or daily s.c. injection of filgrastim 5 µg/kg/d starting from day 3 of each cycle. The primary endpoint was the duration of grade 3 or 4 neutropenia in cycle 1. The safety profile was also evaluated. Results The mean (SD) duration of grade 3 or 4 neutropenia in cycle 1 was 0.68 (1.10) and 0.71 (0.95) days for the F-627 and the filgrastim groups, respectively. The Hodges-Lehmann estimate of the between-group median difference (F-627 vs filgrastim) in the duration of grade 3 or 4 neutropenia in cycle 1 was 0 day and the upper limit of the one-sided 97.5% CI was 0 day, which was within the prespecified non-inferiority margin of 1-day. Results for all efficacy endpoints in cycles 2 − 4 were consistent with the results in cycle 1, however a trend towards a lower incidence and a shorter duration of grade 3 or 4 neutropenia and grade 4 neutropenia was observed in the F-627 group compared with the filgrastim group. The ANC nadir in the F-627 group was significantly higher than that in the filgrastim group in each cycle. A single fixed dose of F-627 was well tolerated and as safe as standard daily filgrastim. Conclusions A single fixed dose of 20 mg of F-627 in each cycle was as safe and effective as a daily dose of filgrastim 5 µg/kg/d in reducing neutropenia and its complications in patients who received four cycles of EC. Trial registration ClinicalTrials.gov: NCT04174599, on 22/11/2019.

Objective: To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment. Methods: A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements. Results: Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X2 = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint. Conclusions for practice: Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments. Significance: What is already known on this subject?: Mothers of overweight or obese children often underestimate their children's weight status. Research shows when mothers are unaware of their children's weight issues, they are less likely to take preventive actions, or seek health services. The most frequent maternal child feeding style in Hispanic mothers is the authoritarian, What this study adds?: Healthy Change intervention was first of its kind designed to increase mothers' awareness about their preschooler's overweight and obese status. Healthy Change promote authoritative feeding style, and favorable changes in family nutrition and physical activity. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the efficacy and safety of linaclotide in patients with chronic constipation (CC) or irritable bowel syndrome with constipation (IBS‐C) who did not respond to treatment with magnesium oxide (MgO). Method s : This study was designed as a multicenter, open‐label, single‐arm, exploratory study. Patients with CC or IBS‐C who took MgO and those meeting the medication initiation criteria were administered linaclotide at a daily dosage of 500 μg for 12 weeks. The primary endpoint was a change in the Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC‐QOL) score from baseline, which was evaluated by using a paired t‐test. Key Results: The patients' mean age (± standard deviation) was 67.6 ± 13.82 years. The full analysis set included 61 patients. The JPAC‐QOL total score was 1.60 at baseline and 0.70 at 12 weeks, with a significant mean change of −0.89 ± 0.721 (p < 0.001). Several secondary endpoints also showed improvement. The frequency of spontaneous bowel movement (SBM) and complete SBM increased by 2.70 ± 7.254 (p < 0.01) and 2.81 ± 5.254 times, respectively (p < 0.001). The Bristol Stool Form Scale, abdominal bloating severity, and straining severity scores improved by 1.33 ± 1.274 (p < 0.001), −0.16 ± 0.563 (p < 0.05), and −0.46 ± 0.795 (p < 0.001) points, respectively. The safety analysis set included 65 patients, 7 of whom had diarrhea, which improved with dose reduction and drug withdrawal. Conclusion & Inferences: The study was conducted in an older adult population, similar to real clinical practice. Linaclotide may be an option for treating CC that shows an inadequate response to conventional therapy. [ABSTRACT FROM AUTHOR]

Abstract Background A stent with characteristics of a hybrid design may have advantages in improving the patency of symptomatic iliofemoral vein obstruction. This study assessed the safety and effectiveness of the V-Mixtent Venous Stent in treating symptomatic iliofemoral outflow obstruction. Methods Eligible patients had a Clinical-Etiologic-Anatomic-Physiologic (CEAP) C classification of ≥ 3 or a Venous Clinical Severity Score (VCSS) pain score of ≥ 2. The primary safety endpoint was the rate of major adverse events within 30 days. The primary effectiveness endpoint was the 12-month primary patency rate. Secondary endpoints included changes in VCSS from baseline to 6 and 12 months, alterations in CEAP C classification, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) scores at 12 months, and stent durability measures. Results Between December 2020 and November 2021, 171 patients were enrolled across 15 institutions. A total of 185 endovenous stents were placed, with 91.81% of subjects receiving one stent and 8.19% receiving 2 stents. Within 30 days, only two major adverse events occurred (1.17%; 95% confidence interval [CI], 0.14–4.16%), below the literature-defined performance goal of 11% (P

Background Post-stroke cognitive impairment (PSCI) can significantly limit the recovery of stroke patients at all stages and lead to a decline in activity participation and quality of life. Objective Based on the concept of full-cycle rehabilitation in stroke, by investigating the incidence of PSCI, to analyzed the differences of PSCI in different age and disease period and its potential influencing factors. Methods Stroke patients were hospitalized in the rehabilitation departments of 27 hospitals in different regions of China from October 2022 to July 2023 using simple random sampling method for cross-sectional analysis. A total of 402 patients were finally included according to the study criteria, and categorized into the young and middle-aged group (18-64 years old, n=234) and the elderly group (≥65 years old, n=168) according to the criteria of the National Bureau of Statistics of China, and the patients were also categorized into the acute-phase group (1-7 d, n=25), subacute-phase group (8-180 d, n=338), and the chronic-phase group (>180 d, n=39) according to the International Stroke Rehabilitation Alliance. Baseline information on patients was collected through interviews, assessments, and an electronic case system. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and subscores and total scores were calculated for each cognitive domain. Using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Hospital Anxiety Scale (HADS-A), and the Hospital Depression Scale (HADS-D) were used to assess the disease conditions and physical functioning of the patients. Spearman's rank correlation analysis was used to investigate the correlation between cognitive function levels and other clinical indicators at different ages and different stages of disease. Results The prevalence of PSCI in stroke patients was 76.4% (307/402), including 81.0% (136/168) in elderly patients and 73.1% (171/234) in young and middle-aged patients; the prevalence of PSCI in stroke patients was 56.0% (14/25) in the acute phase, 78.4% (265/338) in the subacute phase, and 71.8% (28/39) in the chronic phase. The results of grouping by age and disease period showed that the elderly group had lower visuospatial and executive function, attention, numeracy, delayed recall scores and total MoCA scores than those in the young and middle-aged group (P

Background Somatosensory and motor dysfunctions are common after stroke, both lead to limitations in activities of daily living and social participation, there is still a lack of research evidence to analyze the relationship between the two from multiple perspectives. Objective To investigate the relationship between somatosensory and motor function among overall, upper and lower extremities in different-age-group patients within one year after stroke. Methods This prospective study enrolled the poststroke patients within one year from several hospitals in Fujian Province from October 2022 to April 2023. The sensory subscale of the Fugl-Meyer assessment (FMA-S) and the sensory subitem of National Institute of Health Stroke Scale (NIHSS) were used to evaluate the patient's somatosensory function. The motor subscale of the Fugl-Meyer assessment (FMA-M), Brunnstrom assessment, Berg Balance Scale (BBS) and the motor subitem of NIHSS were used to evaluate the patient's motor function. Modified Barthel Index (MBI) was used to evaluate the patient's activities of daily living (ADL). Hospital Anxiety and Depression Scale (HADS) was used to evaluate the patient's psychosomatic function. They were divided into two groups (the elderly group/the young and middle-aged group) according to their age, we compared the differences in general information and rehabilitation assessments between the two groups. And we analyzed the correlation between somatosensory function and motor function/ADL/psycho-psychological function. Results A total of 254 patients were included, with an average age of (61.0±12.3) years and an average disease course of 30.0 (17.0, 65.5) days. There were 112 cases (44.1%) in the elderly group and 142 cases (55.9%) in the young and middle-aged group. FMA-S and FMA-M scores were positively correlated in both groups (rs values were 0.313 and 0.171, both P

Background Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies. Objective To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors. Methods Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression. Results A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P

Abstract Background Many people struggle with the choice in a series of processes, from prostate cancer (PCa) diagnosis to treatment. We investigated the degree of regret after the prostate biopsy (PBx) and relevant factors in patients recommended for biopsy for suspected PCa. Methods From 06/2020 to 05/2022, 198 people who performed PBx at three institutions were enrolled and analyzed through a questionnaire before and after biopsy. Before the biopsy, a questionnaire was conducted to evaluate the sociodemographic information, anxiety scale, and health literacy, and after PBx, another questionnaire was conducted to evaluate the decision regret scale. For patients diagnosed as PCa after biopsy, a questionnaire was conducted when additional tests were performed at PCa staging work-up. Results 190 patients answered the questionnaire before and after PBx. The mean age was 66.2 ± 7.8 years. Overall, 5.5% of men regretted biopsy, but there was no significant difference between groups according to the PCa presence. Multivariate analysis, to identify predictors for regret, revealed that the case when physicians did not properly explain what the prostate-specific antigen (PSA) test was like and what PSA elevation means (OR 20.57, [95% CI 2.45–172.70], p = 0.005), low media literacy (OR 10.01, [95% CI 1.09–92.29], p = 0.042), and when nobody to rely on (OR 8.49, [95% CI 1.66–43.34], p = 0.010) were significantly related. Conclusions Overall regret related to PBx was low. Decision regret was more significantly related to media literacy rather than to educational level. For patients with relatively low media literacy and fewer people to rely on in case of serious diseases, more careful attention and counseling on PBx, including a well-informed explanation on PSA test, is helpful.

Abstract Background Limited evidence exists regarding the link between platelet count and 30-day in-hospital mortality in acute respiratory failure (ARF) patients. Thus, this study aims to investigate this association among ICU patients experiencing acute respiratory failure. Methods We conducted a retrospective cohort study across multiple centers, utilizing data from the US eICU-CRD v2.0 database covering 22,262 patients with ARF in the ICU from 2014 to 2015. Our aim was to investigate the correlation between platelet count and 30-day in-hospital mortality using binary logistic regression, subgroup analyses, and smooth curve fitting. Results The 30-day in-hospital mortality rate was 19.73% (4393 out of 22,262), with a median platelet count of 213 × 109/L. After adjusting for covariates, our analysis revealed an inverse association between platelet count and 30-day in-hospital mortality (OR = 0.99, 95% CI 0.99, 0.99). Subgroup analyses supported the robustness of these findings. Furthermore, a nonlinear relationship was identified between platelet count and 30-day in-hospital mortality, with the inflection point at 120 × 109/L. Below the inflection point, the effect size (OR) was 0.89 (0.87, 0.91), indicating a significant association. However, beyond this point, the relationship was not statistically significant. Conclusion This study establishes a clear negative association between platelet count and 30-day in-hospital mortality among ICU patients with ARF. Furthermore, we have identified a nonlinear relationship with saturation effects, indicating that among ICU patients with acute respiratory failure, the lowest 30-day in-hospital mortality rate occurs when the baseline platelet count is approximately 120 × 109/L.

Introduction: Health literacy (HL) is correlated with the risk of mortality and readmission during cardiac rehabilitation. However, the correlation between HL and utility-based health-related quality of life (HRQOL) scores has been poorly documented. Therefore, we examined the correlation between HL and utility-based HRQOL scores in participants undergoing cardiac rehabilitation. Methods: The data of 448 participants undergoing cardiac rehabilitation from the Kobe-Cardiac Rehabilitation Project for People Around the World (K-CREW) clinical trial were analyzed. Participants were divided into low and high HL cohorts. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire to assess HRQOL at discharge. The utility scores of the EQ-5D-5L questionnaire were calculated. The median age was 71.0 [61.0–78.0] years, 75.7% of participants were male, and 60% had a low HL. Results: Median utility score was 0.88 [0.75–1.00]. Regarding the dimensions of the EQ-5D-5L questionnaire, more than 60% of participants responded positively to the severity level of "no problem." In the comparative analysis, the low HL cohort had a statistically significantly lower utility score than that of the high HL cohort (p-value = 0.03). The multivariate analysis revealed that the HLS-14 scores were not statistically significantly correlated with the utility scores. Conclusion: Participants with low HL had lower HRQOL in the comparative analysis. However, multivariate analysis revealed that HL was not statistically significantly correlated with utility-based HRQOL scores. Future studies should explore the influence of confounding or intermediate variables on the correlation between HL and HRQOL. [ABSTRACT FROM AUTHOR]

Background: A stent with characteristics of a hybrid design may have advantages in improving the patency of symptomatic iliofemoral vein obstruction. This study assessed the safety and effectiveness of the V-Mixtent Venous Stent in treating symptomatic iliofemoral outflow obstruction. Methods: Eligible patients had a Clinical-Etiologic-Anatomic-Physiologic (CEAP) C classification of ≥ 3 or a Venous Clinical Severity Score (VCSS) pain score of ≥ 2. The primary safety endpoint was the rate of major adverse events within 30 days. The primary effectiveness endpoint was the 12-month primary patency rate. Secondary endpoints included changes in VCSS from baseline to 6 and 12 months, alterations in CEAP C classification, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) scores at 12 months, and stent durability measures. Results: Between December 2020 and November 2021, 171 patients were enrolled across 15 institutions. A total of 185 endovenous stents were placed, with 91.81% of subjects receiving one stent and 8.19% receiving 2 stents. Within 30 days, only two major adverse events occurred (1.17%; 95% confidence interval [CI], 0.14–4.16%), below the literature-defined performance goal of 11% (P <.001). The 12-month primary patency rate (91.36%; 95% CI, 85.93–95.19%; P <.001) exceeded the literature-defined performance goal. VCSS changes from baseline demonstrated clinical improvement at 6 months (− 4.30 ± 3.66) and 12 months (− 4.98 ± 3.67) (P <.001). Significant reduction in symptoms, as measured by CEAP C classification and CIVIQ-14, was observed from pre-procedure to 12 months (P <.001). Conclusions: The 12-month outcomes confirm the safety and effectiveness of the V-Mixtent Venous Stent in managing symptomatic iliofemoral venous outflow obstruction, including clinical symptom improvement compared to before treatment. [ABSTRACT FROM AUTHOR]

Purpose: Since the introduction of the Exeter stem for clinical use in Japan in 1996, the number of stems used has continued to rise owing to its favorable results. We investigated the outcomes of patients who had previously undergone total hip arthroplasty with the Exeter stem in Japan with a 10-year + follow-up period. Methods: This retrospective cohort study used clinical and radiographic data of 682 cases of primary total hip arthroplasty performed using the Exeter stem. Results: The mean postoperative follow-up period was 13.3 years. Femoral-side revision was required in 14 hips, with no cases of aseptic stem loosening-associated revision observed. Kaplan–Meier survival analysis predicted 97.3% 15-year survival when revision for any reason was used as the endpoint. Conclusion: The obtained findings suggested the excellent long-term stability of the Exeter stem for primary total hip arthroplasty in Japan. [ABSTRACT FROM AUTHOR]

Background: Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition. Objective: This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer. Design: Multicenter retrospective cohort trial. Setting: Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers. Patients: The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique. Results: After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140 min (125–170 min) vs. 140 min (120–160 min), P = 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48 h (41–56 h) vs. 48 h (44–62 h), P = 0.049 and 77 h (72–94 h) vs. 82 h (72–96 h), P = 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7–9 day) vs. 8 day (7–9 day), P = 0.005]. The overall postoperative complication rates were similar between the groups (10.7% in the R-NOSES group vs. 11.9% in the R-TSES group, P = 0.617). However, the R-NOSES group had a lower incidence of wound complications compared to the R-TSES group (0.0% vs. 2.2%, P = 0.015). Regarding surgical stress response, the R-NOSES group showed superior outcomes. Additionally, patients in the R-NOSES group required fewer additional analgesics on postoperative days 1, 3, and 5 and reported lower pain scores compared to the R-TSES group. The body image scale (BIS) and cosmetic scale (CS) scores were also significantly higher in the R-NOSES group. Furthermore, the R-NOSES group demonstrated significantly better outcomes in functional dimensions such as physical, role, emotional, social, and cognitive functioning, and in symptoms like fatigue and pain, when compared to the R-TSES group. Limitations: It is imperative to ensure the safe and standardized implementation of R-NOSES through the establishment of a uniform training protocol. Conclusions: These results affirm that R-NOSES is a safe and effective treatment for early-stage rectal cancer when meticulously executed by skilled surgeons. [ABSTRACT FROM AUTHOR]

Background: In the last years, there has been increasing use of shoulder arthroplasty. As a result, an increasing incidence of periprosthetic humerus fractures (PPHF) is expected. Therefore, this retrospective, multicenter analysis aimed to collect demographic data from patients with PPHF, their treatment strategies, and associated complications. Methods: Demographics of patients with PPHF were collected retrospectively from the database of six trauma hospitals between January 2000 and December 2020. All fractures were categorized according to the Wright and Cofield, and Worland classifications. In addition, the type of treatment for PPHF, as well as subsequent complications, were evaluated. Results: A total of 72 patients with a PPHF were identified. The mean age of the 55 female and 17 male patients was 77 years. PPHF occurred a mean of 50 months after primary arthroplasty implantation, almost exclusively as a result of a fall from standing height (n = 67). In-situ implant was a RTSA in 40 patients and a hemiarthroplasty in 32 patients. More than half of the fractures (n = 38) were type B fractures, according to Wright and Cofield. According to Worland, the majority of patients also had a type B fracture (type B1 (n = 22), type B2 (n = 28), type B3 (n = 10)). Associated comorbidities were found in 21 patients. A total of 31 patients were treated non-operatively, 27 with Open Reduction Internal Fixation (ORIF), and 14 with a revision arthroplasty. Nine primary radial nerve palsies were found (pre-operatively), and seven secondarily (post-operatively). Nine patients suffered from non-union (ORIF 4, non operative 4, stem replacement 1). Conclusion: The treatment strategy for PPHF is primarily tailored to the individual patient. Decisive factors such as patient's age, fracture type, and primary palsies have to be considered for optimal treatment. In type B1 fractures, there is a recommendation for ORIF because of high non-union rates under non-operative treatment. In contrast, in type B2 fractures, a non-operative approach should be preferred, provided there are no radial nerve lesions. Level of evidence: Level IV, epidemiologic study. [ABSTRACT FROM AUTHOR]

Background: The incidence of hip fractures is increasing. Femoral intertrochanteric fractures make up 50% of hip fractures and are treated by intramedullary nails. Implant breakage is a recognized complication that can have rare and serious implications. This study aimed to investigate implant breakage rates after surgical treatment for femoral intertrochanteric fractures. Methods: This was a retrospective multicenter analysis. All 1854 patients who underwent surgical treatment for femoral intertrochanteric fractures were selected from 12 hospitals (TRON group) between 2016 and 2020. Exclusion criteria included implants other than those specified and follow-up periods less than three months. Demographic data, surgical details, and radiographic assessments were collected from medical records and X-ray evaluations. Results: Among the 983 study patients, consisting of 245 males (24.9%) and 738 females (75.1%), the implant breakage rate was 0.31%, with three confirmed cases. The average age was 83.9 years. The mean follow-up period was 640.9 days. Two cases were linked to ASULOCK implants, and one to an OLSII implant. Statistical analysis showed a significantly higher incidence of ASULOCK implant breakage (p < 0.001). In the two cases of ASULOCK implant breakage and one case of OLSII implant breakage, breakage in all three implants occurred at the anti-rotation screws. Conclusions: There were no implant breakages of the main body of the implants; all breakages occurred in the additional anti-rotation screw. The necessity of the anti-rotation screw will require further discussion. These results can potentially inform clinical decisions and guide further research in preventing implant breakage. [ABSTRACT FROM AUTHOR]

Background: Parameters from diffusion-weighted imaging (DWI) have been increasingly used as imaging biomarkers for the diagnosis and monitoring of treatment responses in cancer. The consistency of DWI measurements across different centers remains uncertain, which limits the widespread use of quantitative DWI in clinical settings. Purpose: To investigate the consistency of quantitative metrics derived from DWI between different scanners in a multicenter clinical setting. Material and Methods: A total of 193 patients with cervical cancer from four scanners (MRI1, MRI2, MRI3, and MRI4) at three centers were included in this retrospective study. DWI data were processed using the mono-exponential and intravoxel incoherent motion (IVIM) model, yielding the following parameters: apparent diffusion coefficient (ADC); true diffusion coefficient (D); pseudo-diffusion coefficient (D*); perfusion fraction (f); and the product of f and D* (fD*). Various parameters of cervical cancer obtained from different scanners were compared. Results: The parameters D and ADC derived from MRI1 and MRI2 were significantly different from those derived from MRI3 or MRI4 (P <0.01 for all comparisons). However, there was no significant difference in cervical cancer perfusion parameters (D* and fD*) between the different scanners (P >0.05). The P values of comparisons of all DWI parameters (D, D*, fD*, and ADC) between MRI3 and MRI4 (same vendor in different centers) for cervical cancer were all >0.05, except for f (P = 0.05). Conclusion: Scanners of the same model by the same vendor can yield close measurements of the ADC and IVIM parameters. The perfusion parameters showed higher consistency among the different scanners. [ABSTRACT FROM AUTHOR]

Objective Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. Methods This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. Results At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97–6.06), obesity (odds ratio = 1.79; 95% CI = 1.26–2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20–8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17–2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48–0.90), and student status (odds ratio = 0.58; 95% CI = 0.37–0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46–0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01–2.13). Conclusions This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. Impact In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity. [ABSTRACT FROM AUTHOR]

The Omoto technique is a well-known method that is commonly used for noninvasive manual repair of calcaneal fractures. However, there have been no detailed studies on its clinical outcomes in preoperative closed reduction for surgical cases. This multicenter retrospective study aimed to compare the clinical and radiographic outcomes of calcaneal fractures treated with and without the preoperative Omoto technique, assessing its effectiveness. We extracted 335 patients with calcaneal fracture who underwent surgery between 2015 and 2020 from our multicenter database, named TRON. We evaluated the clinical outcomes using the American Orthopedic Foot and Ankle Society (AOFAS) score, the Böhler angle (BA) for radiographic analysis, and noted any complications. We divided the patients into those managed with the Omoto technique (group O) and those managed without the Omoto technique (group N). Patients were matched by age, sex, and fracture type, resulting in 43 patients per group. The use of the Omoto technique at the time of injury significantly improved the Böhler angle (BA). Furthermore, there were no significant differences in AOFAS, postoperative complications, or BA values at the final follow-up. In conclusion, our study demonstrates that the Omoto technique, when used preoperatively for calcaneal fractures, does not negatively impact the outcomes of subsequent surgical treatments. For patients who prefer to avoid surgery, the Omoto technique can be an effective initial intervention. Additionally, our findings suggest that the Omoto technique may facilitate less invasive surgical options in certain cases. [ABSTRACT FROM AUTHOR]

Background: Many people struggle with the choice in a series of processes, from prostate cancer (PCa) diagnosis to treatment. We investigated the degree of regret after the prostate biopsy (PBx) and relevant factors in patients recommended for biopsy for suspected PCa. Methods: From 06/2020 to 05/2022, 198 people who performed PBx at three institutions were enrolled and analyzed through a questionnaire before and after biopsy. Before the biopsy, a questionnaire was conducted to evaluate the sociodemographic information, anxiety scale, and health literacy, and after PBx, another questionnaire was conducted to evaluate the decision regret scale. For patients diagnosed as PCa after biopsy, a questionnaire was conducted when additional tests were performed at PCa staging work-up. Results: 190 patients answered the questionnaire before and after PBx. The mean age was 66.2 ± 7.8 years. Overall, 5.5% of men regretted biopsy, but there was no significant difference between groups according to the PCa presence. Multivariate analysis, to identify predictors for regret, revealed that the case when physicians did not properly explain what the prostate-specific antigen (PSA) test was like and what PSA elevation means (OR 20.57, [95% CI 2.45–172.70], p = 0.005), low media literacy (OR 10.01, [95% CI 1.09–92.29], p = 0.042), and when nobody to rely on (OR 8.49, [95% CI 1.66–43.34], p = 0.010) were significantly related. Conclusions: Overall regret related to PBx was low. Decision regret was more significantly related to media literacy rather than to educational level. For patients with relatively low media literacy and fewer people to rely on in case of serious diseases, more careful attention and counseling on PBx, including a well-informed explanation on PSA test, is helpful. [ABSTRACT FROM AUTHOR]

Within influenza vaccine effectiveness (VE) studies at primary care level with a laboratory-confirmed outcome, clinical case definitions for recruitment of patients can vary. We used the 2022–23 VEBIS primary care European multicentre study end-of-season data to evaluate whether the clinical case definition affected IVE estimates. We estimated VE using a multicentre test-negative case-control design. We measured VE against any influenza and influenza (sub)types, by age group (0–14, 15–64, ≥65 years) and by influenza vaccine target group, using logistic regression. We estimated IVE among patients meeting the European Union (EU) acute respiratory infection (ARI) case definition and among those meeting the EU influenza-like illness (ILI) case definition, including only sites providing information on specific symptoms and recruiting patients using an ARI case definition (as the EU ILI case definition is a subset of the EU ARI one). We included 24 319 patients meeting the EU ARI case definition, of whom 21 804 patients (90 %) meet the EU ILI case definition, for the overall pooled VE analysis against any influenza. The overall and influenza (sub)type-specific VE varied by ≤2 % between EU ILI and EU ARI populations. Among all analyses, we found similar VE estimates between the EU ILI and EU ARI populations, with few (10%) additional non-ILI ARI patients recruited. These results indicate that VE in the 2022–23 influenza season was not affected by use of a different clinical case definition for recruitment, although we recommend investigating whether this holds true for next seasons. [ABSTRACT FROM AUTHOR]

Background: Limited evidence exists regarding the link between platelet count and 30-day in-hospital mortality in acute respiratory failure (ARF) patients. Thus, this study aims to investigate this association among ICU patients experiencing acute respiratory failure. Methods: We conducted a retrospective cohort study across multiple centers, utilizing data from the US eICU-CRD v2.0 database covering 22,262 patients with ARF in the ICU from 2014 to 2015. Our aim was to investigate the correlation between platelet count and 30-day in-hospital mortality using binary logistic regression, subgroup analyses, and smooth curve fitting. Results: The 30-day in-hospital mortality rate was 19.73% (4393 out of 22,262), with a median platelet count of 213 × 109/L. After adjusting for covariates, our analysis revealed an inverse association between platelet count and 30-day in-hospital mortality (OR = 0.99, 95% CI 0.99, 0.99). Subgroup analyses supported the robustness of these findings. Furthermore, a nonlinear relationship was identified between platelet count and 30-day in-hospital mortality, with the inflection point at 120 × 109/L. Below the inflection point, the effect size (OR) was 0.89 (0.87, 0.91), indicating a significant association. However, beyond this point, the relationship was not statistically significant. Conclusion: This study establishes a clear negative association between platelet count and 30-day in-hospital mortality among ICU patients with ARF. Furthermore, we have identified a nonlinear relationship with saturation effects, indicating that among ICU patients with acute respiratory failure, the lowest 30-day in-hospital mortality rate occurs when the baseline platelet count is approximately 120 × 109/L. [ABSTRACT FROM AUTHOR]

Endometriosis, affecting approximately 10% of reproductive-aged women globally, poses significant challenges, including chronic pelvic pain, dysmenorrhea, and infertility. In low- and middle-income countries like India, accessibility to affordable infertility care remains a concern. This multicenter prospective cohort study, conducted across six tertiary care hospitals in India from 2017 to 2022, aims to explore the natural progression of conception and pregnancy outcomes in women with endometriosis. Of the 257 participants, 19.1% conceived during the study, revealing significant geographic and income-based variations (p < 0.001, p = 0.01). Dysmenorrhea (p < 0.001) and dyspareunia (p=0.027) were correlated with conception, while no such associations were found with chronic pelvic pain or menstrual factors. Lesion type, number, and severity showed no conclusive link with conception. Natural conception occurred in 70% of cases, with an average post-surgery conception time of 282.1 days. Live birth rate was 85.7%, while complications included placenta previa (16.4%), preeclampsia (4.1%), and preterm births (4.1%). This study, one of the first in India on endometriosis-related fertility progression, emphasizes the need for comprehensive understanding and management of conception and pregnancy outcomes. Considering India's substantial endometriosis burden, the study recommends prioritizing larger multicenter investigations for a better understanding and effective strategies for infertility management. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors for bronchopulmonary dysplasia (BPD) in twin preterm infants with a gestational age of <34 weeks, and to provide a basis for early identification of BPD in twin preterm infants in clinical practice. Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of <34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020. According to their conditions, they were divided into group A (both twins had BPD), group B (only one twin had BPD), and group C (neither twin had BPD). The risk factors for BPD in twin preterm infants were analyzed. Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins. Results A total of 904 pairs of twins with a gestational age of <34 weeks were included in this study. The multivariate logistic regression analysis showed that compared with group C, birth weight discordance of >25% between the twins was an independent risk factor for BPD in one of the twins (OR=3.370, 95%CI: 1.500-7.568, P<0.05), and high gestational age at birth was a protective factor against BPD (P<0.05). The conditional logistic regression analysis of group B showed that small-for-gestational-age (SGA) birth was an independent risk factor for BPD in individual twins (OR=5.017, 95%CI: 1.040-24.190, P<0.05). Conclusions The development of BPD in twin preterm infants is associated with gestational age, birth weight discordance between the twins, and SGA birth. [ABSTRACT FROM AUTHOR]

Objective: To assess the short‐ and long‐term dentoskeletal effects of early Class III treatment with rapid maxillary expansion and facemask (RME/FM) followed by fixed appliances. Materials and Methods: A total of 44 patients (27 females, 17 males) treated consecutively with RME/FM were included from the archives of 3 centres. Three lateral cephalograms were available: T0 (before the start of RME/FM therapy, mean age 8.1 ± 1.8 years), T1 (immediately after RME/FM, mean age 9.8 ± 1.6 years), and T2 (long‐term observation, mean age 19.5 ± 1.6 years). A control group of 17 untreated Class III subjects (12 females and 5 males) also was selected. Between‐group statistical comparisons were performed with ANCOVA. Results: No statistically significant differences for any of the cephalometric variables were found at T0. In the short term, the treated group showed significant improvements in ANB (+2.9°), Wits appraisal (+2.7 mm), SNA (+1.8°) and SNB (−1.1°). A significant closure of CoGoMe angle (−1.3°) associated with smaller increments along Co‐Gn (−2.4 mm) also was found together with a significant increase in intermaxillary divergence (+1.3°). In the long‐term, significant improvements in ANB (+2.6°), Wits appraisal (+2.7 mm) and SNB (−1.7°) were recorded together with a significant closure of the CoGoMe angle (−2.9°). No significant long‐term changes in vertical skeletal relationships were found. Conclusions: RME/FM therapy was effective in improving Class III dentoskeletal relationships in the short term. These changes remained stable in the long‐term due mainly to favourable mandibular changes. [ABSTRACT FROM AUTHOR]

BackgroundAlthough unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial.MethodsPWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described.ConclusionsThe FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH.Clinicaltrialsgov identifier: NCT03089320.

Summary: Background: The survival rate of patients with distant metastasis (DM) of papillary thyroid carcinoma (PTC) is significantly reduced. It is of great significance to find an effective method for early prediction of the risk of DM for formulating individualized diagnosis and treatment plans and improving prognosis. Previous studies have significant limitations, and it is still necessary to develop new models for predicting the risk of DM of PTC. We aimed to develop and validate interpretable machine learning (ML) models for early prediction of DM in patients with PTC using a multicenter cohort. Methods: We collected data on patients with PTC who were admitted between June 2013 and May 2023. Data from 1430 patients at Yunnan Cancer Hospital (YCH) served as the training and internal validation set, while data from 434 patients at the First Affiliated Hospital of Kunming Medical University (KMU 1st AH) was used as the external test set. Nine ML methods such as random forest (RF) were used to construct the model. Model prediction performance was compared using evaluation indicators such as the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanation (SHAP) method was used to rank the feature importance and explain the final model. Findings: Among the nine ML models, the RF model performed the best. The RF model accurately predicted the risk of DM in patients with PTC in both the internal validation of the training set [AUC: 0.913, 95% confidence interval (CI) (0.9075–0.9185)] and the external test set [AUC: 0.8996, 95% CI (0.8483–0.9509)]. The calibration curve showed high agreement between the predicted and observed risks. In the sensitivity analysis focusing on DM sites of PTC, the RF model exhibited outstanding performance in predicting “lung-only metastasis” showing high AUC, specificity, sensitivity, F1 score, and a low Brier score. SHAP analysis identified variables that contributed to the model predictions. An online calculator based on the RF model was developed and made available for clinicians at https://predictingdistantmetastasis.shinyapps.io/shiny1/. 11 variables were included in the final RF model: age of the patient with PTC, whether the tumor size is > 2 cm, whether the tumor size is ≤ 1 cm, lymphocyte (LYM) count, monocyte (MONO) count, monocyte/lymphocyte ratio (MLR), thyroglobulin (TG) level, thyroid peroxidase antibody (TPOAb) level, whether the T stage is T1/2, whether the T stage is T3/4, and whether the N stage is N0. Interpretation: On the basis of large-sample and multicenter data, we developed and validated an explainable ML model for predicting the risk of DM in patients with PTC. The model helps clinicians to identify high-risk patients early and provides a basis for individualized patient treatment plans. Funding: This work was supported by the National Natural Science Foundation of China (No. 81960426, 82360345 and 82001986), the Outstanding Youth Science Foundation of Yunnan Basic Research Project (No. 202401AY070001-316), Yunnan Province Applied and Basic Research Foundation (No. 202401AT070008), and Ten Thousand Talent Plans for Young Top-notch Talents of Yunnan Province.