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Background: Data on the desire for pregnancy and the status of fertility preservation (FP) in patients with breast cancer remain unclear. This study aimed to determine the status of patients with breast cancer who desired pregnancy and FP implementation before systemic therapy. Methods: This retrospective study surveyed the institutional clinical databases and electronic medical records of patients aged < 43 years with stages 0–III primary breast cancer during surgery and treated between April 2020 and March 2021. All patients were enquired about their desire for pregnancy in a questionnaire by "present," "absent," and "unsure" at their first visit. The correlation between the desire for pregnancy, implementation of FP, and clinicopathological factors was investigated. Results: Among 1005 patients who underwent surgery for primary breast cancer, 146 were included in the analysis. Of them, 34 (23.3%) patients had a desire for pregnancy, and 45 (30.8%) chose "unsure." Factors associated with the desire for pregnancy were younger age during surgery (p < 0.0022), unmarried status (p < 0.001), nulliparity (p < 0.001), early-stage disease (p = 0.0016), and estrogen receptor positivity (p = 0.008). Among 115 patients who underwent systemic therapy, 13 (11.3%) underwent FP before systemic therapy. Patients who were nulliparous frequently pursued FP (p = 0.0195). The proportion of FP implementation was low in patients who received neoadjuvant chemotherapy (p = 0.0863). Conclusions: Our study suggests that unmarried, nulliparous, and younger patients were more interested in pregnancy, and nulliparous patients frequently pursued FP. [ABSTRACT FROM AUTHOR]

The question of optimal timing for catheter ablation of atrial fibrillation (AF) to achieve best outcomes remains a crucial clinical issue. As AF occurs less frequently in younger patients, data regarding Diagnosis-to-Ablation Time (DAT) is especially limited in patients under the age of 55 years with persistent AF. We therefore analyzed the temporal relationship between initial AF presentation and timing of catheter ablation in this cohort. We conducted a retrospective single-centre study of patients ≤ 55 years with persistent AF who underwent first-time catheter ablation at our center. The cohort was divided into patients that underwent catheter ablation after diagnosis of persistent AF within a DAT of ≤ 12 months and patients with a DAT of > 12 months. A total of 101 patients (median age 51 years; female n = 19 (18.8%)) with persistent AF were included. Ablation was performed within 12 months ("early DAT") in 51 patients and > 12 months ("late DAT") in 50 patients. Pulmonary vein isolation was performed using high-power short-duration (HPSD) radiofrequency ablation. Median DAT was 5 months (1–12 months) in the early ablation group and 36 months (13–240 months) in the late ablation group. The median follow-up was 11.3 months (0.03–37.1 months). The rate of any atrial arrhythmia recurrence after a 30-day blanking period was significantly lower in the early DAT group (13/51 patients; 25.5%) as compared to the late DAT group (26/50 patients; 52.0%) (log rank test; p = 0.003). Catheter ablation performed > 12 months after the initial AF diagnosis was an independent predictor for the occurrence of any atrial arrythmia (OR: 2.58; (95%-CI: 1.32–5.07). Early first-time catheter ablation (DAT ≤ 12 months) in patients ≤ 55 years with persistent AF is associated with a significantly lower rate of arrhythmia recurrence. [ABSTRACT FROM AUTHOR]

Background: Prediction of short-term outcomes in young patients with acute ischemic stroke (AIS) may assist in making therapy decisions. Machine learning (ML) is increasingly used in healthcare due to its high accuracy. This study aims to use a ML-based predictive model for poor 3-month functional outcomes in young AIS patients and to compare the predictive performance of ML models with the logistic regression model. Methods: We enrolled AIS patients aged between 18 and 50 years from the Third Chinese National Stroke Registry (CNSR-III), collected between 2015 and 2018. A modified Rankin Scale (mRS) ≥ 3 was a poor functional outcome at 3 months. Four ML tree models were developed: The extreme Gradient Boosting (XGBoost), Light Gradient Boosted Machine (lightGBM), Random Forest (RF), and The Gradient Boosting Decision Trees (GBDT), compared with logistic regression. We assess the model performance based on both discrimination and calibration. Results: A total of 2268 young patients with a mean age of 44.3 ± 5.5 years were included. Among them, (9%) had poor functional outcomes. The mRS at admission, living alone conditions, and high National Institutes of Health Stroke Scale (NIHSS) at discharge remained independent predictors of poor 3-month outcomes. The best AUC in the test group was XGBoost (AUC = 0.801), followed by GBDT, RF, and lightGBM (AUCs of 0.795, 0, 794, and 0.792, respectively). The XGBoost, RF, and lightGBM models were significantly better than logistic regression (P < 0.05). Conclusions: ML outperformed logistic regression, where XGBoost the boost was the best model for predicting poor functional outcomes in young AIS patients. It is important to consider living alone conditions with high severity scores to improve stroke prognosis. [ABSTRACT FROM AUTHOR]

Influenza can lead to or coexist with severe bacterial pneumonia, with the potential to permanently damage lung tissue, refractory to conservative treatment in the post-COVID-19 period. It can lead to serious complications; therefore, annual vaccinations are recommended. This case series with a literature review pertains to two young female patients with an insignificant past medical history, who required emergency lobectomy due to bacterial complications after influenza infection. Urgent lobectomy proves to be a feasible therapeutic option for selected patients with pleural complications. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) may cause fatigue and participation restrictions in young patients. However, knowledge regarding the course of these problems over time is lacking. This study aims to describe the course of fatigue and participation and their relationship over time in an observational two-year follow-up study among patients(5–24 years) with ABI referred for outpatient rehabilitation and their parents. Patients/parents completed the PedsQL™Multidimensional-Fatigue-Scale(PedsQL™MFS, totalscore/3-domains) and the Child/Adolescent-Scale of Participation(CASP, totalscore/4-domains). Scores ranged from 0-100: lower scores = more fatigue/participation problems. Linear mixed models and repeated measures correlations were used to determine the course over time (change-scores/95%CI) and correlations between fatigue/participation. At baseline, 223 patients/246 parents participated with 94/104 at either T1, T2 or both. Median age was 15 years (IQR:12-17), 74% had a traumatic brain injury. Mean(SD) patient/parent-reported PedsQL™MFS totalscores(baseline) were: 50.3(17.3) and 53.8(19.1), respectively. CASP totalscores were 78.0(16.4) and 87.1(13.6). Over time, patient-reported scores improved significantly (fatigue: + 8.8 (2.9;14.7), p < 0.05)/participation: + 10.5 (6.3;14.7), p < 0.05)). Similar results were found regarding parent-reported fatigue: + 8.7 (3.4;13.9), p < 0.05 but not regarding participation. Two years later, fatigue was still considerable(patients:59.1/parents:62.5). Moderate/fair correlations between fatigue/participation over time were found. Fatigue and participation in young patients with ABI improved two years after referral to rehabilitation. However, fatigue remained a considerable problem. [ABSTRACT FROM AUTHOR]

Hormone receptor expression is a known positive prognostic and predictive factor in breast cancer; however, limited evidence exists on its prognostic impact on prognosis of young patients harboring a pathogenic variant (PV) in the BRCA1 and/or BRCA2 genes. This international, multicenter, retrospective cohort study included young patients (aged ≤40 years) diagnosed with invasive breast cancer and harboring germline PVs in BRCA genes. We investigated the impact of hormone receptor status on clinical behavior and outcomes of breast cancer. Outcomes of interest [disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS)] were first investigated according to hormone receptor expression (positive versus negative), and then according to breast cancer subtype [luminal A-like versus luminal B-like versus triple-negative versus human epidermal growth factor receptor 2 (HER2)-positive breast cancer]. From 78 centers worldwide, 4709 BRCA carriers were included, of whom 2143 (45.5%) had hormone receptor-positive and 2566 (54.5%) hormone receptor-negative breast cancer. Median follow-up was 7.9 years. The rate of distant recurrences was higher in patients with hormone receptor-positive disease (13.1% versus 9.6%, P < 0.001), while the rate of second primary breast cancer was lower (9.1% versus 14.7%, P < 0.001) compared to patients with hormone receptor-negative disease. The 8-year DFS was 65.8% and 63.4% in patients with hormone receptor-positive and negative disease, respectively. The hazard ratio of hormone receptor-positive versus negative disease changed over time for DFS, BCSS, and OS (P < 0.05 for interaction of hormone receptor status and survival time). Patients with luminal A-like breast cancer had the worst long-term prognosis in terms of DFS compared to all the other subgroups (8-year DFS: 60.8% in luminal A-like versus 63.5% in triple-negative versus 65.5% in HER2-positive and 69.7% in luminal B-like subtype). In young BRCA carriers, differences in recurrence pattern and second primary breast cancer among hormone receptor-positive versus negative disease warrant consideration in counseling patients on treatment, follow-up, and risk-reducing surgery. • In young BRCA carriers, hormone receptor status did not appear to be a strong positive prognostic factor. • Patients with luminal A-like disease seem to have the worst DFS compared to all the other subtypes. • Treatment, surveillance, and prevention strategies based on disease biology are recommended in young BRCA carriers. [ABSTRACT FROM AUTHOR]

Anticancer treatments have significantly contributed to increasing cure rates of breast cancer in the last years; however, they can also lead to short- and long-term side effects, including gonadotoxicity, and compromised fertility in young women. Oncofertility is a crucial issue for young patients who have not yet completed their family planning at the time of cancer diagnosis. This review aims to cover all the latest available evidence in the field of oncofertility, including the gonadotoxicity of currently adopted anticancer therapies in the curative breast cancer setting, the available strategies for fertility preservation and the feasibility of achieving a pregnancy following anticancer treatment completion. Over the past years, a significant progress has been made in oncofertility care for young women with breast cancer. In the context of the currently available evidence, every young woman with newly diagnosed breast cancer should receive a proper and complete oncofertility counseling before starting any anticancer treatment to increase her chances of future pregnancies. [ABSTRACT FROM AUTHOR]

As total shoulder arthroplasty (TSA) expands to younger patients, it is crucial to weigh the benefits of early intervention against potential complications and implant longevity in patients under 60 years of age. This study examines mid-term outcomes in this patient subset. Between 2009 and 2019, a retrospective analysis was conducted on 50 patients (25 male, 25 female) who underwent anatomic TSA (TSA) under the age of 60 with minimum 5 years follow-up. Demographic and baseline variables were extracted from medical records. Pre-operative and post-operative outcomes of range of motion (ROM) and strength were recorded. Patient-reported outcomes (PROs) were obtained. Fifty patients were followed for an average of 8.7 ± 2.4 years, having a mean age of 54.1 ± 8.4 years. Comparison of pre-operative and post-operative measurements revealed significant improvements in active ROM, including external rotation (ER) (p < 0.0001), forward elevation (FE) (p < 0.0001), and internal rotation (IR) (p = 0.0001). There were significant improvements in functional strength scores, including ER (p = 0.0005) and FE (p = 0.0002). PROs included visual analog scale (VAS) (2.2 ± 2.6), Single Assessment Numeric Evaluation (SANE) (80.3 ± 17.6), American Shoulder and Elbow Surgeons (ASES) score (76.4 ± 22.8), and Simple Shoulder Test (SST) (8.9 ± 3.2). The 5-year and 10-year implant survival rates were found to be 98.0 % and 83.3 %, respectively. There were 7 postoperative complications in 5 patients (14.0 %), including glenoid loosening (n = 2), infection (n = 1), atraumatic instability (n = 1), lesser tuberosity avulsion (n = 1), painful arthroplasty (n = 1) and traumatic rotator cuff insufficiency (n = 1). Subsequently, all 5 patients underwent revision shoulder arthroplasty at an average of 6.5 years after the initial procedure. Positive mid to long-term outcomes, including significant improvements in ROM and strength, along with high 5-year and 10-year implant survival rates support TSA as an effective treatment option for patients under the age of 60. [ABSTRACT FROM AUTHOR]

Abstract The question of optimal timing for catheter ablation of atrial fibrillation (AF) to achieve best outcomes remains a crucial clinical issue. As AF occurs less frequently in younger patients, data regarding Diagnosis-to-Ablation Time (DAT) is especially limited in patients under the age of 55 years with persistent AF. We therefore analyzed the temporal relationship between initial AF presentation and timing of catheter ablation in this cohort. We conducted a retrospective single-centre study of patients ≤ 55 years with persistent AF who underwent first-time catheter ablation at our center. The cohort was divided into patients that underwent catheter ablation after diagnosis of persistent AF within a DAT of ≤ 12 months and patients with a DAT of > 12 months. A total of 101 patients (median age 51 years; female n = 19 (18.8%)) with persistent AF were included. Ablation was performed within 12 months (“early DAT”) in 51 patients and > 12 months (“late DAT”) in 50 patients. Pulmonary vein isolation was performed using high-power short-duration (HPSD) radiofrequency ablation. Median DAT was 5 months (1–12 months) in the early ablation group and 36 months (13–240 months) in the late ablation group. The median follow-up was 11.3 months (0.03–37.1 months). The rate of any atrial arrhythmia recurrence after a 30-day blanking period was significantly lower in the early DAT group (13/51 patients; 25.5%) as compared to the late DAT group (26/50 patients; 52.0%) (log rank test; p = 0.003). Catheter ablation performed > 12 months after the initial AF diagnosis was an independent predictor for the occurrence of any atrial arrythmia (OR: 2.58; (95%-CI: 1.32–5.07). Early first-time catheter ablation (DAT ≤ 12 months) in patients ≤ 55 years with persistent AF is associated with a significantly lower rate of arrhythmia recurrence.

Abstract Background Prediction of short-term outcomes in young patients with acute ischemic stroke (AIS) may assist in making therapy decisions. Machine learning (ML) is increasingly used in healthcare due to its high accuracy. This study aims to use a ML-based predictive model for poor 3-month functional outcomes in young AIS patients and to compare the predictive performance of ML models with the logistic regression model. Methods We enrolled AIS patients aged between 18 and 50 years from the Third Chinese National Stroke Registry (CNSR-III), collected between 2015 and 2018. A modified Rankin Scale (mRS) ≥ 3 was a poor functional outcome at 3 months. Four ML tree models were developed: The extreme Gradient Boosting (XGBoost), Light Gradient Boosted Machine (lightGBM), Random Forest (RF), and The Gradient Boosting Decision Trees (GBDT), compared with logistic regression. We assess the model performance based on both discrimination and calibration. Results A total of 2268 young patients with a mean age of 44.3 ± 5.5 years were included. Among them, (9%) had poor functional outcomes. The mRS at admission, living alone conditions, and high National Institutes of Health Stroke Scale (NIHSS) at discharge remained independent predictors of poor 3-month outcomes. The best AUC in the test group was XGBoost (AUC = 0.801), followed by GBDT, RF, and lightGBM (AUCs of 0.795, 0, 794, and 0.792, respectively). The XGBoost, RF, and lightGBM models were significantly better than logistic regression (P

We present a clinical case of a 20-year-old woman with acute myocardial infarction with persistent ST-segment elevation (STEMI). The coronary angiography performed on the patient showed coronary vasospasm with no evidence of atherosclerotic plaque. The aim of this case report is to draw attention to the different types of myocardial infarction, other possible differential diagnoses (DD), and to the investigations necessary for determining a definitive diagnosis.

Background: To report clinical and activity-specific outcomes after arthroscopic rotator cuff repair (ARCR) for full-thickness supraspinatus tears in active individuals aged less than or equal to 45 years. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities. Methods: Patients were included in this study if they were (1) active individuals aged between 18 and 45 years at the time of surgery, (2) had a full-thickness rotator cuff tear of the supraspinatus tendon with or without anterior or posterior extension, and (3) underwent ARCR. Preoperative and postoperative patient-reported outcomes scores including the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of Arm, Shoulder and Hand; Single Assessment Numeric Evaluation; and Short Form-12 Physical Component Summary were prospectively collected and postoperative patient satisfaction (scale of 1-10) was recorded at a minimum of 2 years postoperatively. Attainment of the minimal clinically important difference and patient acceptable symptom state for the ASES was calculated. Athletic activity–specific outcomes and return to activity were investigated prospectively via a custom-made comprehensive questionnaire. Results: Between November 2005 and June 2020, of 1149 RCRs performed by the senior author, 54 patients (mean age 40.9 years, 13 female; follow-up 69.7 ± 35.2 months in a range of 24.6-179.6 months) were included into the outcomes analysis. Of those, 4 patients (7.4%) had progressed to revision RCR. At a follow-up of 5.8 years, outcome scores had significantly improved compared to preoperative baselines (ASES 55.6 ± 13.8 to 90.1 + 15.8; P

Mohamed Sheikh Hassan,1,2 Ahmet Bakir,1 Nor Osman Sidow,1 Umut Erkok,3 Said Abdirahman Ahmed,4 Maryan Dahir Abshir,5 Ayhan Ayhan Köksal6 1Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 2Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia; 3Department of Gynecology and Obstetrics, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 4Department of Cardiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 5Department of Medical Laboratory, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 6University of Health Sciences, Istanbul Ba&scedil;ak&scedil;ehir Cam and Sakura City Hospital, Istanbul, TurkiyeCorrespondence: Mohamed Sheikh Hassan, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Email dr.m.qalaf@gmail.comIntroduction: Spontaneous Intracerebral hemorrhage (ICH) in young patients is less common and not well studied compared to ICH in older patients. The etiology, risk factors and outcome of ICH in young patients may have regional and ethnic differences. The study aims to investigate the clinical characteristics, risk factors, etiology and outcome of spontaneous intracerebral hemorrhage in young adults in Somalia.Methods: The study enrolled 168 young patients with ICH (16– 50 years) admitted to the neurology department of a tertiary hospital from 2019 to 2022. The information about the demographic details, documented ICH risk factors, etiology and patients’ clinical status were retrieved. The etiology of ICH was determined based on clinical, laboratory and radiological findings. Intra-hospital survival status and associated factors were assessed.Results: The mean age of the patients was 35± 8.6 years. 99 (59%) of patients were male while 69 (41%) were females. Hypertension 48 (29%) was the most common risk factor, followed by substance abuse. Hypertensive hemorrhage was the most common etiology of ICH 60 (35.7%), followed by cerebral venous thrombosis (CVT) 5(15%), substance abuse 23 (13.7%) and arteriovenous malformation (AVM) in 10 (6%). AVM, CVT, cavernoma, eclampsia, substance abuse and cryptogenic etiology were more common in the 2nd and 3rd decades whereas hypertension was more common in the 4th and 5th decade. Intrahospital mortality was 28% in this study. Factors predicting intrahospital mortality were hematoma volume of greater than 30mL, thrombolytic etiology, brainstem ICH location, substance abuse related etiology, presence of associated mass effect, low GCS score on admission, high systolic blood pressure on admission, and the presence of chronic renal failure.Conclusion: In this study, hypertension, substance abuse, CVT and vascular malformation are the leading causes of ICH in young adults. Intracerebral hemorrhage in the young has different spectrum of etiologies and factors associated with short-term mortality compared to older patients.Keywords: intracerebral hemorrhages, young patients, etiology, outcome

Background: Ruptured and unruptured aneurysms are less common in younger individuals compared to older patients. Endovascular treatment has gained popularity over surgical options in the general population, but surgery remains the primary treatment for younger patients due to concerns about higher recurrence rates with endovascular procedures. Methods: This study compared the immediate and long-term outcomes of endovascular treatment in patients under 40 years with those aged 41–60. The study included 239 patients who underwent endovascular treatment for intracranial aneurysms, divided into two age groups: under 40 and 41–60 years. The rates of immediate radiologic outcomes, complications, and recurrence were assessed. Results: The results showed successful aneurysm obliteration rates of 70.1% in the younger group and 64.0% in the older group. The complication rates were 1.5% in the younger group and 3.5% in the older group, with the older group experiencing more procedure-related complications, though this difference was not statistically significant. Long-term follow-up revealed recurrence rates of 23.2% in the younger group and 18.2% in the older group, with no significant difference. Conclusions: The study suggests that endovascular treatment is as effective and safe for patients under 40 years. Therefore, it may be considered an acceptable first-line treatment for younger patients, aligning its use with that in older populations. [ABSTRACT FROM AUTHOR]

Featured Application: Nail biting is a very common oral disorder whose dental and clinical implication are not well-known. Therefore, this study is a novelty in the field of oral disease since it considers changes on tooth shape caused by nail biting. Nail biting (NB) is a repetitive and uncontrolled parafunctional activity that can affect oral health by altering tooth shape and intraoral position. Nowadays, there is not enough scientific evidence about the impact of NB on teeth; therefore, this study aimed to evaluate the effects of NB on the length, width and inclination of upper central incisors. This retrospective study involved 76 patients, 40 males and 36 females, with a mean age of 10.6 ± 0.3 years. Digital scans of the maxillary arch of each patient were recorded. Next, the length, width and inclination of upper central incisors used and not used for NB were measured. Finally, data were analysed with a paired t-test. Statistical analysis showed statistically significant differences in the length and inclination of upper central incisors used for NB compared with those of upper central incisors not used for NB, while the width did not show a significant difference. There were relevant changes in upper central incisors subjected to NB, demonstrating that NB impairs the shape, morphology and inclination of teeth. Therefore, because of the potentially negative consequences of NB, it is recommended that NB not be underestimated. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In younger patients, including those with extensive infarction involving the anterior and middle cerebral artery regions of the right hemisphere, appropriate treatment for rare causes and goal‐oriented long‐term rehabilitation could improve severe hemiplegia and higher brain dysfunction, and allow for further education and employment. Although the number of young stroke patients is small, many have serious sequelae and rare causes. In addition to independence in activities of daily living, education and employment are desired. We present two cases of extensive infarction in the right cerebrum in patients who underwent rehabilitation with good outcomes. [ABSTRACT FROM AUTHOR]

Mitral valve repair is the ideal intervention for mitral valve disease with excellent long-term survival comparable to the age-matched general population. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. Patients presenting for mitral valve surgery after failed transcatheter mitral valve-in-valve have high rates of postoperative mortality and morbidity, exceeding those seen with reoperative mitral valve surgery, which poses issues in young patients who have a higher cumulative incidence of reintervention. Plain Language Summary Patients presenting with mitral valve disease, the most common type of heart valve disease, have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. When the mitral valve is not repairable, mechanical prostheses (prosthetic implants) may be associated with improved survival as compared with biological prostheses, and this difference is mostly observed until the age of 70 years. Newer techniques of treating mitral valve disease without requiring open heart surgery have not yet been shown to be superior or even equivalent to traditional open heart surgery in the general population. Patients presenting for mitral valve surgery after failure of these newer techniques have high rates of death, exceeding those seen with mitral valve reoperation, which has important implications for young patients with mitral valve disease. Article highlights Patients presenting with mitral valve disease have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. Most young patients with degenerative mitral disease can be successfully repaired but those with nondegenerative etiology pose a greater challenge, including patients with infective endocarditis and advanced rheumatic disease. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses, and this difference in survival is mostly observed until the age of 70 years. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. As compared with primary mitral valve surgery, reoperation is associated with significantly higher mortality and morbidity. Patients presenting for redo mitral surgery might benefit from a right mini-thoracotomy approach as opposed to a median resternotomy. While transcatheter mitral valve-in-valve is a less invasive and appealing option, there are multiple concerns about exponentially increasing transvalvular gradients with each subsequent valve-in-valve, which may limit its durability and success in young patients. [ABSTRACT FROM AUTHOR]

Background: Patients with Cushing's disease (CD) often experience slow recovery of bone mineral density (BMD), and the effectiveness of anti-osteoporosis drugs in young CD patients who have achieved biochemical remission after surgery is not well understood. Therefore, we aimed to explore whether bisphosphonates could help accelerate the recovery of osteoporosis in young CD patients with remission. Methods: We retrospectively enrolled 34 young patients with CD who achieved postoperative biochemical remission. All patients suffered from osteoporosis before surgery and were divided into postoperative bisphosphonate treatment group (16 cases) and without bisphosphonate treatment group (18 cases). Clinical data, BMD (Z Value), and bone turnover markers were collected at the time of diagnosis and one year after successful tumor resection. Results: The Z values in the lumbar spine showed slight improvement in both groups at follow-up compared to baseline, but this improvement was not statistically significant. There was no significant difference observed between the two groups at follow-up. One year after operation, bone formation markers (OC and P1NP) were significantly higher than those at baseline in both groups. However, OC and P1NP in the bisphosphonate treatment group were lower than those in control group at one year follow-up. In without bisphosphonate treatment group, β-CTX from follow-up visit was higher than that at baseline, while no significant difference was observed in the bisphosphonate treatment group before and after surgery. Conclusion: Young patients with Cushing's disease combined with osteoporosis might not benefit from bisphosphonate therapy for osteoporosis recovery in the first year after achieving biochemical remission. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between medication non-compliance and attempted suicide among young patients with severe mental disorders, while identifying and controlling for unmeasured confounding factors to accurately assess the strength of this association. Methods A large prospective cohort study was conducted, utilizing a multi-level Cox proportional hazard regression model to estimate the impact of medication compliance on attempted suicide. Additionally, a Negative Control Outcome (NCO) design was employed to evaluate the effect of unmeasured confounders on the association between medication compliance and attempted suicide. Results The study included 52 917 patients aged 14 to 35 years with severe mental disorders. The overall rate of medication non-compliance was 32.95%, and the incidence of attempted suicide was 0.86%. Results from the multi-level Cox proportional hazard regression and the NCO-based design, adjusted for unmeasured confounding, indicated that medication non-compliance significantly increased the risk of attempted suicide (HRCox=1.623, 95%CI: 1.318-1.999; HRNCO=1.282, 95%CI: 1.176-1.397). Conclusion Medication non-compliance increases the risk of attempted suicide in young patients with severe mental disorders. These findings provide empirical evidence for mitigating the societal risks associated with violence against young individuals with severe mental disorders. [ABSTRACT FROM AUTHOR]

Introduction: Historically, total hip arthroplasty (THA) in very young patients has been associated with lower survivorship. However, the long-term outcomes of THA using short stems for osteonecrosis of the femoral head (ONFH) in very young patients remain unclear. Therefore, this study aimed to investigate the long-term outcomes of the Mayo conservative hip system, a short metaphyseal stabilised stem, in patients with ONFH aged ≦30 years. Materials and Methods: We retrospectively reviewed 104 joints in 76 patients with ONFH who underwent THA using the Mayo conservative hip system with a minimum follow-up of 8 years. The mean follow-up period was 12.5 (range, 8–19) years. Patients were categorised into two age groups (≦30 years, n = 21 and > 30 years, n = 83). Radiographic evaluation was used to assess stem sinking, stress shielding, and spot welds. The clinical evaluations were performed using the Japanese Orthopedic Association (JOA) hip score. Postoperative major complication and revision surgery rates were also assessed. Results: The patient characteristics were similar between the two groups, except for the age. Revision surgeries were performed in five cases, with similar implant survival rates between the groups. Dislocations occurred in the older age group alone (four joints). One case of intra-operative periprosthetic femoral fracture was found in the younger age group. Stem sinking of > 3 mm occurred in one and seven joints in the younger and older age groups, respectively. Spot welds were observed in most joints (93.2%) in modified Gruen zones 2 and 6 without significant differences between the groups. Stress shielding showed no significant differences in the frequency of occurrence or location between the two groups. Furthermore,the JOA score showed no significant difference between the two groups. Conclusion: The use of short stems in patients aged ≤ 30 years with ONFH showed favourable long-term outcomes. [ABSTRACT FROM AUTHOR]

Background and objectives: The aim of this study was to evaluate the clinical–pathological profile in young patients with thyroid cancer. Materials and methods: We realized a retrospective study on patients with thyroid neoplasms who underwent surgery at the "Pius Brinzeu" County Clinical Emergency Hospital in Timisoara, Romania. A comparative analysis of some parameters between two groups, young patients (<45 years) versus patients ≥45 years, was performed. Results: A total of 211 patients met the study inclusion criteria, mostly females (86.26%) with a female/male ratio of 6.81:1. In patients <45 years old (25.64%), papillary thyroid carcinoma was identified in 51.85% of cases; in 53.85% of cases, the tumor was >1 cm; 13.46% had extrathyroidal extension (p = 0.0430); 21.15% capsule invasion (p = 0.1756); 23.08% lympho-vascular invasion (p = 0.0048); and 13.46% of cases locoregional nodal invasion (p = 0.0092). Conclusions: Thyroid cancer in young people was associated with chronic lymphocytic thyroiditis and tumor progression parameters, identifying more cases of extrathyroidal extension, locoregional nodal invasion, lympho-vascular invasion and perineural invasion in young patients compared to older ones. For a better understanding of this pathology and to improve diagnosis and therapeutic management, more studies are needed for these patients. [ABSTRACT FROM AUTHOR]

Brain injuries (traumatic-/nontraumatic, TBI/nTBI) in young patients may lead to problems e.g., decreased health-related quality of life (HRQoL), and causes family impact. Knowledge regarding the family impact and the relationship with patients' HRQoL over time is scarce. This follow-up study describes family impact/HRQoL and their mutual relationship in young patients (5–24 years) after TBI/nTBI. Parents of patients that were referred to outpatient rehabilitation completed the PedsQL™Family-Impact-Module questionnaire to assess the family impact and the parent-reported PedsQL™Generic-core-set-4.0 to assess patients' HRQoL (lower scores: more family impact/worse HRQoL). Questionnaires were completed at the time of referral to rehabilitation (baseline) and one/two years later (T1/T2). Linear-mixed models were used to examine family impact/HRQoL change scores, and repeated-measure correlations (r) to determine longitudinal relationships. Two-hundred-forty-six parents participated at baseline, 72 (at T2), median patient's age at baseline was 14 years (IQR:11–16), and 181 (74%) had TBI. Mean (SD) PedsQL™Family-Impact-Module score at baseline was 71.7 (SD:16.4) and PedsQL™Generic-core-set-4.0: 61.4 (SD:17.0). Over time, PedsQL™Family-Impact-Module scores remained stable, while PedsQL™Generic-core-set-4.0 scores improved significantly(p < 0.05). A moderately strong longitudinal correlation was found between family impact&HRQoL (r = 0.51). Family impact does not tend to decrease over time but remained a considerable problem, although patients' HRQoL improved. Next to focusing on patients' HRQoL, it remains important to consider family impact and offer family support throughout rehabilitation. This longitudinal study found that in young patients with traumatic brain injury (TBI) or non-traumatic brain injury (nTBI) referred for rehabilitation there is a considerable impact on the family until two years after referral, whereas the patients' health-related quality of life (HRQoL) improved significantly. Improvements in patients' quality of life status may not automatically lead to a decrease of family impact. Rehabilitation clinicians should monitor the impact on the family over time and provide long-term family support with special attention to parental worrying when needed. Clinicians should be aware that, despite significant differences between the clinical characteristics of patients with TBI and nTBI, the courses of family impact are very similar. [ABSTRACT FROM AUTHOR]

To explore the optimal treatment for young patients with untreated mantle cell lymphoma (MCL), we compared the efficacy and safety of R-CHOP/R-DHAP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone/rituximab, dexamethasone, cytarabine and cisplatin) and R-BAP (rituximab, bendamustine, cytarabine, and prednisone) plus BTK (Bruton's tyrosine kinase) inhibitors in newly diagnosed patients. Eighty-three young patients (≤ 65 years old) with newly diagnosed MCL admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2014, to June 1, 2023, using R-CHOP/R-DHAP or R-BAP plus BTK inhibitor were assessed in this study. The median age at presentation was 60 (42–65) years in 83 patients, including 64 males and 19 females; 59 were treated with R-CHOP/R-DHAP regimen chemotherapy, and 24 were treated with R-BAP in combination with the BTK inhibitor regimen. The median follow-up was 17 months (2–86 months) in 83 patients, and the median PFS (progression-free survival) time was not reached. The CRR (complete response rate) of the R-BAP group was higher than that of the R-CHOP/R-DHAP group (87.5% vs. 54.2%, P = 0.005). The ORR (overall response rate) was not significantly different between the two groups (ORR: 91.7% vs. 84.7%, P = 0.497). The PFS (progression-free survival) of the R-BAP group was longer than that of the R-CHOP/R-DHAP group (P = 0.013), whereas OS was not significantly different between the two groups (P = 0.499). The most common adverse effect in both groups was hematotoxicity, with a higher incidence of grade 3–4 lymphopenia and grade 3–4 thrombocytopenia in the R-BAP group than in the R-CHOP/R-DHAP group (P = 0.015 and P = 0.039). Male sex (HR = 4.257, P = 0.013), LDH (lactate dehydrogenase) ≥ 245 U/L (HR = 3.221, P = 0.012), pleomorphic-blastoid (HR = 2.802, P = 0.043) and R-CHOP/R-DHAP regimen (HR = 7.704, P = 0.047) were independent risk factors for PFS. Ki67 ≥ 30% (HR = 8.539, P = 0.005) was an independent risk factor for OS. First-line treatment with R-BAP in combination with BTK inhibitor improved CRR and prolonged PFS in young patients with mantle cell lymphoma and adverse events were tolerable. [ABSTRACT FROM AUTHOR]

Background: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. Methods: A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. Results: MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. Conclusions: To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients.

The TERT (Telomerase Reverse Transcriptase) gene promoter mutation is one of the most prevalent mutations in urothelial bladder tumors and this mutation is related to bladder tumor progression. Our purpose was to evaluate the presence of this mutation in a population of patients who were first diagnosed at age ≤ 40 years and to examine its relationship with tumor characteristics and progression. A molecular study was performed to detect the two most prevalent mutations in the TERT promoter (C228T and C250T). The study included 29 patients, with a mean follow-up of 152 months. There were no statistically significant differences in the clinical or tumor characteristics according to the presence or absence of the mutation. Although the mutation group showed poorer recurrence-free survival (RFS), there was no statistically significant difference and there was no difference in progression-free survival by group (p > 0.05). The pTERT mutations in bladder tumor cells occurred less frequently in younger patients than in older patients, a finding that could indicate different mechanisms of carcinogenesis. The trend towards lower RFS in patients with mutated pTERT needs to be confirmed by further studies, given the small number of patients included in these studies due to the low incidence of bladder tumors in this age group.

Background The incidence of colonic adenomas and colorectal cancer has been on the rise among young patients. In this study, we aimed to describe the characteristics of young patients (<50 years) with adenomatous polyps and to characterize those polyps. We also aimed to determine appropriate surveillance intervals for young patients. Methods We performed a retrospective chart review of patients <50 years of age who had polypectomy of 1 or more adenomatous polyps on colonoscopy between 2008 and 2021. Patient demographics, colonoscopy indication and polyp characteristics were obtained from the chart. Timing and findings on surveillance colonoscopies were recorded. Results A total of 610 patients were included: mean age 42.9±5.9 years, 61% males, body mass index 27.5±4.7 kg/m², and over 50% smokers. The most common indications were abdominal pain (23.3%), rectal bleeding (22.3%), and change in bowel habits (17.6%). Almost half of the patients who had adenomas (299) were younger than 45 years. Tubular adenoma was the most frequently encountered type of polyp (571; 93.6%). Mean polyp size was 1.1±0.9 cm. The most common location of adenomas was the sigmoid colon (41%). Of patients with adenomas, 156 (26%) had surveillance colonoscopy within 2.9±2.3 years; 74 patients (47.4%) were found to have new adenomas. Conclusions Patients aged <50 years with colonic adenomas were mostly males, overweight, and smokers. Further adenomas were found in 47% of surveillance colonoscopies, and most were encountered within 5 years. High rates of recurrent adenomas in people ˂50 years of age may warrant frequent surveillance. [ABSTRACT FROM AUTHOR]

Background: Regional metastases are considered the most important prognostic factor in OSCC patients. We aimed to investigate the impact of regional disease among different age groups with OSCC. Methods: A retrospective comparison between patients 40 years old or younger, 41–69 years old, and 70 years or older treated for OSCC between 2000 and 2020 in a tertiary‐care center. Results: 279 patients were included. The mean age was 65 ± 17.7 and 133 were male (47.7%). Thirty‐six (12.9%) were 40 years old or younger, 101 (36.2%) were 41–69 years and 142 (50.9%) were 70 years or older. Five‐year overall survival and disease‐specific survival (DSS) were significantly better among patients younger than 40 compared to the mid‐age group and patients 70 years or older (76.7% vs. 69.4% vs.48.2%, Log‐rank p < 0.001, and 76.7% vs. 75.3% vs. 46.5%, Log‐rank p < 0.001, respectively). While an association between regional spread and overall survival and DSS was demonstrated among all age groups, the odds ratio (OR) for death of any cause and death of disease regarding cervical metastasis was much higher among patients younger than 40 compared with the 41–69 and 70+ age groups (death of any cause‐OR = 23, p‐value = 0.008, OR = 2.6, p‐value = 0.026, OR = 2.4, p‐value = 0.13, respectively. Death of disease‐OR = 23, p‐value = 0.008, OR = 2.3, p‐value = 0.082, OR = 4.1, p‐value = 0.001, respectively). In univariate analysis, regional metastasis was associated with disease‐free survival only among patients younger than 40 (p‐value = 0.04). Conclusions: Regional metastases correspond with worse prognosis in young patients compared to older patients. These patients may benefit from a comprehensive treatment approach with close post‐treatment follow‐up. Level of Evidence: 3 Laryngoscope, 134:2212–2220, 2024 [ABSTRACT FROM AUTHOR]

Background: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. Methods: A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. Results: MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. Conclusions: To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to report outcomes of eyelid full-thickness skin grafting augmentation in facial nerve palsy (FNP) patients younger than 50 years of age. Methods: In a retrospective, consecutive case series, nine eyelid skin grafts performed on eight FNP patients with skin contraction (five females; median age 42 years [range, 17–47]) are presented. In most cases, upper eyelid skin grafting was combined with levator recession and anterior lamellar repositioning. Lower eyelid skin grafting was combined with lower retractors recession in all cases. Functional and cosmetic outcomes were measured preoperatively and at early (1–3 months), intermediate (3–6 months), and late (≥12 months) follow-up. Results: The corneal score improved at early follow-up (p = 0.03) and remained improved at late follow-up (p = 0.042). The gentle closure lagophthalmos was improved at late follow-up (p = 0.042). (p = 0.048). The grades of graft color, edge/skin interface, and size improved at 3–6 months post-grafting and remained improved at late follow-up (p < 0.05). Over the follow-up, four patients (50%) were recommended to have further surgical procedures. Conclusions: The preliminary results from this small cohort suggest that eyelid skin grafting is a viable option for young patients prioritizing cosmesis. This technique warrants consideration for its functional benefits. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients. Methods: Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher's exact tests were employed for bivariate analysis. Results: Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5–54). Median prostate size was 35 mL (24.5–56), with median prostate-specific antigen of 1.4 ng/mL (0.65–3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from a median of 6.85 mL/s to 17.9 mL/s (P<0.001), and from 120 mL to 10 mL (P=0.0142), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder. Conclusions: In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered. [ABSTRACT FROM AUTHOR]

Objectives: The effect of gender on the outcomes of revascularization procedures in young patients with premature atherosclerotic peripheral arterial disease (PAD) is not known. The objective of this study was to compare short-term and long-term outcomes between young males and females undergoing infra-inguinal revascularization procedures. Methods: We examined postoperative outcomes of male and female PAD patients under the age of 55 who underwent infra-inguinal revascularization procedures at a single tertiary institution from 2011 to 2019. Primary outcomes included 30-day morbidity, patency of the revascularization procedures, and major adverse limb events (MALE). Secondary outcomes included survival, amputation rate, reintervention rate, improvement of ankle-brachial index (ABI), and number of reinterventions. Results: Eighty-one infra-inguinal revascularization procedures (46 endovascular and 35 open procedures) were reviewed including 45 procedures in 37 males and 36 procedures in 31 females. Fifty-three (65.4%) of the procedures were performed in patients with chronic limb-threatening ischemia symptoms. The rest were treated for life-disabling claudication. The female patients were younger, had higher body mass index, and were more likely to have diabetes, hyperlipidemia, or chronic obstructive pulmonary disease in comparison to males. Thirty-day major adverse cardiovascular event was 0.0% and MALE was 16.0%. Mean follow-up was 806.2 days. At 1 year, primary patency was 34.4 ± 6.2%, primary assisted patency was 52.7 ± 6.5%, secondary patency was 61.8 ± 6.3%, and MALE-free rate was 47.0 ± 6.4%. For secondary outcomes at 1 year, amputation-free rate was 92.5 ± 3.2%, reintervention-free rate was 50.2 ± 6.4%, and survival was 96.2 ± 2.6%. By the end of the study, overall mortality rate was 14.8% and major amputation rate was 13.6%. No major differences were observed between males and females among these outcomes. A smaller improvement in ABI after revascularization was noted in females compared to males (female 0.2 ± 0.2 vs male 0.4 ± 0.2, p =.04). Among patients who required reintervention, females required a higher number of reinterventions than males (female 1.7 ± 2.5 vs male 0.8 ± 1.1, p =.03). Conclusions: There were no significant differences in short-term and long-term outcomes between males and females under the age of 55 after infra-inguinal revascularization. Poor patency, high MALE rate, and high mid-term mortality, and amputation rates after revascularization in young PAD patients highlight the need for improved strategies to treat premature PAD. [ABSTRACT FROM AUTHOR]

Opinion statement: Around 90% of breast tumours are diagnosed in the early stage, with approximately 70% being hormone receptor-positive. The cornerstone of adjuvant therapy for early-stage hormone receptor-positive breast cancer is endocrine therapy, tailored according to disease stage, biological characteristics of the tumour, patient's comorbidities, preferences and age. In premenopausal patients with hormone receptor-positive breast cancer, ovarian function suppression is a key component of the adjuvant endocrine treatment in combination with an aromatase inhibitor or tamoxifen. Moreover, it can be used during chemotherapy as a standard strategy for ovarian function preservation in all breast cancer subtypes. In the metastatic setting, ovarian function suppression should be used in all premenopausal patients with hormone receptor-positive breast cancer to achieve a post-menopausal status. Despite its efficacy, ovarian function suppression may lead to several side effects that can have a major negative impact on patients' quality of life if not properly managed (e.g. hot flashes, depression, cognitive impairment, osteoporosis, sexual dysfunction, weight gain). A deep knowledge of the side effects of ovarian function suppression is necessary for clinicians. A correct counselling in this regard and proactive management should be considered a fundamental part of survivorship care to improve treatment adherence and patients' quality of life. [ABSTRACT FROM AUTHOR]

The purpose of this study was to review two surgeons' medium-term results with the Ascension Pyrotitan surface replacement and the Pyrocarbon hemiarthroplasty. We hypothesized they would provide good medium-term outcomes with no significant difference between the two implants. The first 21 implants were surface replacements and the subsequent 58 hemiarthroplasties making a total of 79. Overall, the minimum follow-up was two years and maximum nine years and nine months (average = five years and six months). The average follow-up for the Ascension Pyrotitan was eight years and two months and Pyrocarbon hemiarthroplasty was five years and two months. Survivorship, Oxford, and Subjective Shoulder Value (SSV) scores, and incidence of squeaking were recorded. The average age at implantation was 57.7 years (range 20-80). Thirty-five were female and 44 male. The indication for surgery was osteoarthritis in 56 patients, post instability in 10 patients, post fracture in 7 patients, avascular necrosis in 4 patients, synovial osteochondromatosis in one, and rheumatoid arthritis in one. Of the 79 patients in the cohort, five were deceased, two were revised to reverse for cuff failure, one was revised for Cutibacterium acnes infection, and one was revised to Pyrocarbon hemiarthroplasty for fracture of a Pyrotitan surface replacement. This left 70 patients, all of whom were included in this review. Survivorship at final follow-up for the Pyrotitan surface replacement was 88.9% and Pyrocarbon hemiarthroplasty was 96.4%. The average SSV for all patients reviewed was 86%, the Ascension Pyrotitan patients scoring 87% and the Pyrocarbon hemiarthroplasty scoring 86%. The average Oxford score for the whole cohort was 42 out of a maximum of 48, with Ascension Pyrotitan scoring 42.3 and Pyrocarbon hemiarthroplasty 41.9. Recent Oxford score for the postinstability group was 44, osteoarthritis 42.6, postfracture 39.5, and 35 for avascular necrosis (not statistically significant). Fourteen of 70 patients reported squeaking (20%), 4 daily, 5 weekly, and 5 monthly. Average Oxford score in those who experienced squeaking was 39 compared with nonsqueakers at 43 (P =.02). Correlation between Oxford score and SSV was high with a correlation coefficient of 0.79. The Oxford score for the Pyrotitan at 42.3 was significantly better than the New Zealand Joint Registry score for the Global Cap at 34.5 (P =.001) and the Pyrocarbon hemiarthroplasty at 41.9 significantly better than the Aequalis CoCr hemiarthroplasty at 36.8 (P =.005) Pyrocarbon looks to be a durable bearing surface and a good option for the younger osteoarthritic patient where risk of glenoid component failure is high. [ABSTRACT FROM AUTHOR]

Key Clinical Message In younger patients, including those with extensive infarction involving the anterior and middle cerebral artery regions of the right hemisphere, appropriate treatment for rare causes and goal‐oriented long‐term rehabilitation could improve severe hemiplegia and higher brain dysfunction, and allow for further education and employment. Abstract Although the number of young stroke patients is small, many have serious sequelae and rare causes. In addition to independence in activities of daily living, education and employment are desired. We present two cases of extensive infarction in the right cerebrum in patients who underwent rehabilitation with good outcomes.

Abstract Oral squamous cell carcinoma (OSCC) has a poor prognosis and the treatment employed generates significant physical deformity in patients. In recent years, an increase in the incidence of cases of OSCC has been observed in adult patients up to 45 years old in several genetic underrepresented and underserved countries. The increase in OSCC cases in young people is very relevant because it shows that OSCC does not make exceptions and hereditarily must play an important role. This fact has not been associated with an evident biological basis, and a large majority of these patients do not present the classic principal risk factors association. OSCC is the result of accumulation of genetic and epigenetic alterations and this information is still fragmented in the literature, mainly in the young group. Conducting studies with a comprehensive analysis of genetic and epigenetic data is crucial, to provide greater understanding of the underlying biology of OSCC, because this information can be decisive to determine targets for therapeutic treatment. We review the main germline and somatic aspects of genetic and genomic variation in OSCC considering the absence of genomic data from developing countries such as Chile and the rest of Hispano-America.

An aim of the research is to improve validity of the Moshkov test in relation to the body dimensions of young patients. This short report presents a new research that adds to previous studies about validity of the Moshkov test regarding a spine asymmetry in young patients. Because children body's dimensions are smaller than adults' ones, results indices of the Moshkov test are less as well. These results have been corrected proportionally to a half sum of rhombus sides' lengths. Mechanical and mathematical modeling using Wolfram Mathematica computer package has been done during Moshkov rhombus modification. The modified rhombus model made it possible to improve validity of the test regarding smaller dimension of young patients' bodies. The results are presented in a graph nomogram that is comprehensive for practical specialists which are not familiar with using of mathematical methods. [ABSTRACT FROM AUTHOR]

Introduction. Cardiovascular disease is a leading cause of death worldwide. Three-quarters of these deaths occur in lowand middle-income countries among individuals in their productive years. ST-segment elevation myocardial infarction (STEMI) is a dangerous manifestation of coronary artery disease (CAD) and can lead to sudden death. Smoking and a family history of early CAD are major risk factors for STEMI cases. However, their role in any risk stratification system for patients has not been clearly established. The most widely used score in assessing the prognosis of STEMI patients is the TIMI score, but its accuracy in the young patient population is still unknown. The objectives of this study were to determine the proportion of mortality in young STEMI patients at RSCM, validate the TIMI score in young patients, and develop a risk stratification system for young STEMI patients. Methods. This research is a retrospective cohort study using medical record data from the Dr. Cipto Mangunkusumo National General Hospital (RSCM) on patients aged ≤50 years who were treated for ST-elevation myocardial infarction (STEMI) from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the 30-day mortality proportion of young STEMI patients. Bivariate Cox regression analysis was performed to examine the relationship between smoking and a family history of early coronary artery disease (CAD) with 30-day mortality. The TIMI score was validated in the study subjects of young patients. Multivariate analysis was conducted to obtain a new prediction model, and the model’s discriminatory performance was assessed using the area under the ROC curve (AUC), and model calibration was modified using the Hosmer-Lemeshow test. Results. A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young patients was 7.9% (13 individuals). Statistical analysis showed that there was no correlation between 30-day mortality in young STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312)) or a family history of early CAD (HR 0.567 (95% CI 0.126- 2.559)). The TIMI score showed good predictive ability for 30-day mortality in young STEMI patients, with an AUC value of 0.836 (95% CI 0.717- 0.956). The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young STEMI patients, with an AUC value of 0.875. However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value=0.215). Conclusions. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young STEMI patients compared to the pure TIMI score but does not significantly enhance the accuracy.

Objective: To explore the efficacy and prognostic factors of Xuanfei Jiaoji Qingre decoction in the treatment of young patients with hot wheezing. Methods: Sixty young patients with febrile croup admitted to our hospital from October 2019 to September 2021 were selected as the subjects of this study, and they were divided into 2 groups according to different treatment methods, observation group, n=30, and control group, n=30. The control group was treated with budesonide formoterol powder inhalation based on their severity on the basis of conventional treatment such as oxygenation and sputum dissolution. In the observation group, based on the control group, the adjuvant treatment of Xuanfei antispasmodic and clearing heat formula was added. The relevant factors, adult asthma survival quality rating scale (AQLQ) and treatment effect were compared before and after treatment between the groups, and the patients were divided into good prognosis group (n=40) and poor prognosis group (n=20) according to their prognosis effect, and the prognosis of patients with febrile croup was analyzed unilaterally and logistic regression analysis was conducted to determine the independent factors affecting prognosis. Results: Before treatment, there was no difference in the comparison of interleukin-4 (IL-4), interferon-γ (IFN-γ), FEV1 st second expiratory volume/exertional spirometry (FEV1/FVC) levels and AQLQ scores between the observation and control groups(P>0.05), after treatment, compared with before treatment, IL-4 levels were lower in the observation group, and IFN-γ levels, FEV1/FVC levels and AQLQ scores were higher in the observation group, and the levels were higher in the observation group (P<0.05);Treatment group effective rate in the observation group was higher than control group(P<0.05); In the analysis of influencing factors for the prognosis of hot wheezing in adolescents, the results showed that the course of disease, BMI, allergic rhinitis, genetic factors, age of onset, number of respiratory tract infections, smoking history, and frequency of attacks were all single factors affecting the prognosis of hot wheezing(P<0.05). Compliance, skin eczema and route of administration did not have a great influence on the prognosis of hot wheeze (P>0.05). The single factors affecting the prognosis of heat asthma were assigned values and included in the Logistic regression analysis. The course of disease, BMI, allergic rhinitis, genetic factors, age of onset, frequency of respiratory tract infection, smoking history and frequency of attack were used as independent variables. Course, BMI, allergic rhinitis, genetic factors, smoking history, seizure frequency is the independent factors influencing the prognosis of hot xiao (P<0.05). Conclusion: Xuanfei spasmolysis heat can effectively regulate young fever patients body inflammation factor and lung function, improve the quality of life and treatment effect, according to the prognosis of effect in patients with fever, course, BMI, allergic rhinitis, genetic factors, smoking history, attack frequency is an independent factor affecting the prognosis of fever, can be targeted intervention, to improve the prognosis effect in patients. [ABSTRACT FROM AUTHOR]

Recently, arthroscopic superior capsular reconstruction (SCR) has been performed for irreparable large to massive rotator cuff tears and excellent clinical results have been reported. Although the muscle strength is reported to recover, it has not yet been clarified when and how much it recovers. The purpose of this study was to determine the recovery pattern of muscle strength after SCR. We retrospectively reviewed 35 patients (mean age, 65 years) who met the following inclusion criteria: (1) patients with large to massive irreparable tears of the rotator cuff including the supraspinatus and infraspinatus tendons; (2) those with severe muscle atrophy and fatty change; (3) those who underwent assessment of muscle quality and strength by magnetic resonance imaging and dynamometry at 6 months, 1 year, and 2 years; (4) those with a minimum follow-up period of 2 years; and (5) those without severe osteoarthritis. The isometric muscle strength of scaption (ie, scapular-plane elevation), internal rotation, and external rotation in adduction was measured twice for each motion by a dynamometer. Relative to the muscle strength on the uninvolved side, the involved side showed 61% ± 21% in scaption, 63% ± 20% in external rotation, and 103% ± 29% in internal rotation at 2 years after surgery. Whereas no significant differences were observed between the 1-year and 2-year follow-up assessments, a significant difference in muscle strength of scaption was found between 6 months and 1 year (P =.0174). Graft retear was seen in 5 cases (14%). There was a trend that the muscle strength of scaption and external rotation in the no-retear group was greater than that in the retear group despite no significant difference (P =.0717 and P =.0824, respectively). The recovery of the muscle strength after SCR was observed until 1 year after surgery, and the muscle strength of scaption and external rotation returned to 60% of that on the uninvolved side at 2 years. [ABSTRACT FROM AUTHOR]

Objective To apply Social Network Analysis (SNA) to analyze the characteristics of the social support network from 18 to 50 years old HIV/AIDS patients receiving community follow 一 up management in Luzhou City, and to provide a basis for the development of social support and health intervention work. Methods A quota sampling method was used, with young and middle - aged HIV/AIDS patients receiving community follow - up management in Luzhou City as the survey subjects, A social support network matrix questionnaire was designed, and a relationship matrix was constructed using Excel 2016. The social support network characteristics were analyzed using UCINET 6. 0 software, and a 2 - mode social network graph was drawn using Net 一 Draw. Results The social support scores of 165 young and middle 一 aged HIV/AIDS patients who received community follow 一 up management in Luzhou City were 24. 15 ±8. 10, as follows: hospital(2, 45), community (2. 36), family (2. 16), new media (1. 65), traditional media (1. 59), friends (1. 47), relatives (1. 30), social organizations (1. 18), colleagues (0. 95), and neighbors (0. 83); The overall density matrix of the social support network is 1. 59, with a core edge final goodness of fit of 0. 61, indicating a good fit. Among them, hospitals and communities had the highest centrality and were located in the main core position, while family and new media were in the secondary core position. The rest were situated in the periphery. Conclusion The social support level of young and middle - aged HIV/AIDS patients receiving community follow 一 up management in Luzhou City is relatively low, mainly relying on support from hospitals, community health service centers, family, new media, and social organizations as supplementary sources. In the future, it is recommended to establish a social support network with hospitals and communities as the core, utilizing family members as bridges. Furthermore, expanding the social support network through social organizations and implementing internet 一 based health interventions can increase the variety and intensity of support, improve the patients' quality of life, and also serve as a reference for other regions. [ABSTRACT FROM AUTHOR]

Background: Long COVID is of particular concern among older people, who are at greater risk than younger people for persisting symptoms associated with COVID-19. In addition, COVID-19 might trigger or exacerbate chronic conditions that occur commonly in older people, such as cardiovascular diseases, respiratory diseases, and others. Aim of the study: This study aimed to investigate the differences in treatment types and post-COVID symptoms in elderly versus young patients. Material and methods: Alternative, non-parametric, and correlation analyses were used. Logical units of observation: two hundred patients suffered from COVID-19 in the period from 01.09.2021 until 01.09.2022. results: The majority of those examined were women -- 58.5%. Age turned out to be a key factor in the disease. As age increases, cardiac complaints also increase p=0.001 (Χ²=79.51). The correlation relationship was straight and significant, p=0.001 (r=0.619). In the studied group, "shortness of breath" was more often experienced by the elderly group compared to young patients p=0.001 (Χ²=17.90), p=0.001(r=0.278). regarding the symptoms of "hair loss" and fatigue, gender was found to have a key role in women (p=0.001, Χ²=5.04; p=0.001, Χ²=9.60, respectively). The analysis of our study shows that the majority were treated on an outpatient basis, and the rest -- 29.5% -- received their treatment in a hospital. Conclusion: In conclusion, this study underscores the multifaceted nature of post-COVID recovery, influenced by demographic factors, vaccination status, and the presence of comorbidities. [ABSTRACT FROM AUTHOR]

Background: Gastroesophageal adenocarcinoma in young adults (GCYA) counts for 10–15% of diagnoses. Previous studies have mainly focused on surgical outcomes in patients with resectable tumors; however, systemic therapy for advanced GCYA remains under-evaluated. This study aims to assess the efficacy-related outcomes and safety of first-line chemotherapy (CT) in younger versus older patients with advanced gastroesophageal adenocarcinoma. Methods: Patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry treated with first-line polychemotherapy between January 2008 and October 2022 were included. We compared clinicopathological features, therapies received, efficacy-related outcomes, and toxicity between individuals aged < and ≥ 45 years. Results: Out of 3386 patients, 263 (7.8%) were < 45 years. Young patients exhibited a higher proportion of females affected, lower ECOG-PS ≥ 2, fewer comorbidities, and more aggressive disease-related features, such as higher proportion of diffuse subtype, signet-ring cells, plastic linitis, grade 3, peritoneal metastases and metastatic disease at diagnosis. They received more triple-agent combinations and underwent more surgeries in metastatic setting. No significant differences were observed between groups in overall response rate (53.1% vs. 52.3% in < and ≥ 45 years, respectively, p = 0.579), progression-free survival (6.1 vs. 6.83 months, p = 0.158) and overall survival (11.07 vs. 10.81 months, p = 0.82), even after adjusting for potential confounding factors. Grade 3–4 adverse events were comparable in both groups, although toxicity leading to treatment discontinuation was more frequent in older patients. Conclusions: In the AGAMENON-SEOM registry, younger patients with GCYA exhibited more aggressive clinicopathological features, and despite receiving more aggressive treatments, similar efficacy outcomes and toxicity profiles were achieved compared to their older counterparts. In the AGAMENON-SEOM registry, GEAC in < 45 years showed more aggressive clinicopathological features and, although treated with more intense first-line CT regimens, similar efficacy outcomes and toxicity were achieved compared to older patients. [ABSTRACT FROM AUTHOR]

Background: Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up. Methods: We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (p = 0.11). The mean age of the series was 46 years (17–55) (p = 0.16). The mean follow-up of groups A and B were 9.9 (7–12) years and 9.7 (7–12) years, respectively (p = 0.21). Results: Mean Harris Hip Score improved from 55 to 92 in group A (p < 0.001) and from 54 to 95 in group B (p < 0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0–28) mm and 26 (11–38) mm, respectively (p = 0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (p = 0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p = 0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p = 0.06). Conclusions: Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients. [ABSTRACT FROM AUTHOR]

(1) Background: The mechanism responsible for stroke in patients younger than 50 often remains unknown. This study was designed to assess whether high-resolution intracranial vessel wall MR imaging (icVWI) may be instrumental in determining stroke cause. (2) Methods: Young stroke patients with and without an identified cause of stroke despite an exhaustive investigation were prospectively included. Patients who underwent icVWI were compared to those who did not. We next compared patients with and without intracranial vulnerable plaques on icVWI. (3) Results: Overall, 47 young stroke patients were identified over the span of 2 years and included in this study. Of those, 20 (42%) underwent intracranial icVWI. Cancer prevalence was higher among patients who did not have an icVWI study (19% vs. 0% p = 0.042) but there were no other significant differences between patients who had an icVWI study and those who did not have an icVWI. Among patients who had an icVWI, 11 (55%) had vulnerable plaques and the remaining nine studies were negative. Patients with positive icVWI scans had significantly higher stroke severity at admission (mean ± SD NIHSS score 5.5 ± 3.5 vs. 1.7 ± 2.3, p = 0.012). Patients with positive icVWI scans were more often treated with antiplatelets upon discharge (100% vs. 67%, p = 0.038). (4) Conclusions: icVWI can add significant information relevant to stroke pathogenesis and secondary prevention among young stroke patients with a negative exhaustive diagnostic workup. [ABSTRACT FROM AUTHOR]

Background and Objectives: Type 1 diabetes mellitus (T1DM) is a chronic and serious condition that is characterized by inadequate pancreatic-β-cells' insulin production. The connection between T1DM and Helicobacter pylori infection remains uncertain. This study aimed to conduct a systematic meta-analysis to examine the association between H. pylori infection, hemoglobin A1c levels, and the development of T1DM. Materials and Methods: The initial search identified 451 articles on the association between H. pylori infection and T1DM. Among them, 12 articles had 2797 participants who met the inclusion criteria for an advanced meta-analysis. Results: A significant association was observed between H. pylori infection and T1DM (OR 1.77, 95% CI 1.47–2.12, p < 0.0001), with heterogeneity: Tau2 = 0.47; Chi2 = 57.07, df = 11 (p < 0.0001); I2 = 81%. Subgroup analysis showed that H. pylori infection was significantly associated with a longer duration of T1DM and higher hemoglobin A1c levels (p < 0.001 for both) but not with age at T1DM diagnosis (p = 0.306). Conclusions: These findings contribute to the understanding of the association between H. pylori infection and T1DM and highlight the potential role of H. pylori in influencing the duration and glycemic control of diabetes. Therefore, pediatric patients who have longstanding T1DM and poor glycemic control should be screened for H. pylori infection. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo explore the efficacy of interventional closure therapy in young patients with cryptogenic stroke and coexisting patent foramen ovale and analyze its impact on serum fibrinogen and D-dimer levels.All subjects in this study were young stroke patients with PFO. After excluding patients who did not meet the inclusion criteria, they were registered and divided into two groups based on the treatment method: the closure group and the medical group.There were no significant differences in basic clinical data between the two groups, indicating comparability (p > 0.05). The closure group showed better heart function after treatment compared to the medical group, with significant differences (p < 0.05). Headache symptoms in the closure group were less severe than those in the medical group after treatment, with significant differences (p < 0.05). Laboratory indicators in the closure group were better than those in the medical group after treatment, with significant differences (p < 0.05). Serum fibrinogen and D-dimer levels in the closure group were lower than those in the medical group after treatment, with significant differences (p < 0.05).Interventional closure therapy demonstrated positive effects on young patients with cryptogenic stroke and coexisting PFO, showing improvements in heart function, headache symptoms, and blood coagulation parameters. While the study suggests potential benefits, cautious interpretation is warranted, given the observational study design. Further research with a larger sample size and long-term follow-up is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The aim of this study was to investigate the early and long-term outcomes after total arch replacement (TAR) and frozen elephant trunk (FET) implantation in adult patients ≤30 years with acute type A aortic dissection (ATAAD). METHODS All young adult patients (≤30 years) with ATAAD who underwent TAR and FET between 2009 and 2017 were enrolled. The end points were major organ morbidity and mortality, aortic-related events and reoperation. RESULTS The mean age of all 83 patients was 25.9 (standard deviation, 3.3) years. The in-hospital mortality was 9.64% (8/83), and 9 (10.8%) patients required re-exploration for bleeding. The aortic-related events risk was 42.7% (32/75) and the aortic reoperation risk was 17.3% (13/75). Overall survival was 85.5% [95% confidence interval (CI), 75.9–91.5%] at 5 years and 75.9% (95% CI, 63.3–84.7%) at 10 years. The cumulative incidence of aortic-related events was 35% (95% CI, 24–47%) at 5 years and 58% (95% CI, 36–75%) at 10 years; the cumulative reoperation rate was 15% (95% CI, 7.9–24%) at 5 years and 17% (95% CI, 9.2–27%) at 10 years. Marfan syndrome significantly increased the aortic-related events (P  =   0.036) and reoperation (P  =   0.041) risks. CONCLUSIONS Despite extensive repair in young ATAAD patients, the late aortic dilatation and reoperation risk remain high. The TAR and FET procedures achieved satisfactory early outcomes and reduced late aortic dilatation and reoperation in young patients compared with other records. Close follow-up and aggressive early reintervention are essential for patients with aortic-related risk factors early in life. [ABSTRACT FROM AUTHOR]

It is unclear whether nonsmall cell lung cancer (NSCLC) is associated with more aggressive disease and worse overall survival (OS) among younger patients. The aim of this study is to evaluate outcomes in young patients. We hypothesize that young age is associated with more advanced disease upon presentation, but better OS. We identified patients with NSCLC from 2004 to 2018 in the National Cancer Database. Patients were categorized in 3 groups: age≤50, 51-84, and ≥85 y. The outcomes were OS, stage IV NSCLC and clinical nodal metastasis. OS was analyzed using multivariate cox and Kaplan–Meier analysis accounting for stage, comorbidities, and other factors. The association of age, presentation with stage IV NSCLC and node positivity was analyzed using multivariate logistic regression. In total 1,651,744 patients were identified: 92,506 (5.57%) age ≤50, 1,477,723 (88.90%) age 51-84, and 91,964 (5.53%) age ≥85. Multivariate model showed stage IV NSCLC was associated with age ≤50 (OR 1.17 (1.15-1.20) P < 0.001) and ≥85 (odds ratio (OR) 1.03 (1.02-1.04) P < 0.001). Clinical lymph node positivity was associated with age ≤50 (OR 1.27 (1.23-1.30) P < 0.001). Relative to patients 51-84, the ≤50 group was associated with better survival in Stage I (hazard ratio (HR) 0.61 versus 1.00), stage II (HR 1.12 versus 1.50), stage III (HR 2.12 versus 2.53), and stage IV (HR 6.65 versus 7.53). Patients ≤50-y-old present with more advanced NSCLC, but better OS compared to patients 51-84. These findings suggest the need for increased awareness regarding NSCLC among age groups seen as low risk. [ABSTRACT FROM AUTHOR]

Young adults with acute myeloid leukemia (AML) often fail to achieve permanent complete remission (CR) and frequently relapse, indicating an urgent need to explore effective salvage therapies. Recent advances in AML treatment have been attributed to the combination of the B-cell lymphoma 2 (Bcl-2) inhibitor venetoclax (VEN) with hypomethylating agents (HMAs); however, the use of this combination in young adults with relapsed or refractory (R/R) AML has not been reported. We retrospectively examined 31 young patients with R/R AML treated with VEN plus an HMA. We evaluated the demographic data, cytogenetic characteristics, AML types, response rates, and transplantation-related data for the patients in our cohort. The combination of VEN + HMA yielded a CR rate of 48.4%. The most prominent hematologic adverse event was neutropenia, which occurred in all patients, with 90.3% of cases being grade ≥3. Non-hematologic toxicities were relatively mild and infrequent, with an incidence of 45.2%. More than half of the patients with sustained CR had received an allogeneic hematopoietic stem cell transplantation (allo-HSCT), of whom two died of transplant-related complications. Our results showed that the combination of VEN + HMA appeared to be a highly effective and well-tolerated salvage therapy option for young patients with R/R AML, enabling more young patients to proceed to potentially curative allo-HSCT. However, additional, well-designed studies with larger numbers of patients are required to confirm the advantages of VEN + HMA in this population. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients. Methods: Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher’s exact tests were employed for bivariate analysis. Results: Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5–54). Median prostate size was 35 mL (24.5–56), with median prostate-specific antigen of 1.4 ng/mL (0.65–3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from 9 mL/s to 21 mL/s (P=0.01), and from 171 mL to 61 mL (P=0.006), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder. Conclusions: In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered.