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Current functional assessments after brachial plexus (BP) reconstruction, including surgeon-graded active range of motion and strength scores, and patient-reported outcomes (PROs), have limitations. This study evaluated the feasibility of wearable sensors to quantify recovery and functional outcomes following BP reconstruction. We hypothesized that sensor-derived measures of daily upper-extremity use would correlate with PROs and that real-world upper-extremity use would improve. Traumatic BP injury patients wore bilateral wrist accelerometers for 7-day periods at 3- to 6-month intervals. Data were grouped relative to timing of reconstruction. Duration and magnitude of upper-extremity activity were expressed as ratios of injured to uninjured limb (use and magnitude ratios). Disabilities of the Arm, Shoulder, and Hand; Impact of BP Injury; 36-Item Short Form Health Survey; and Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were collected. Correlations assessed relationships between accelerometry data and PROs. Linear mixed models characterized changes in these relationships over time and the effect of time from surgery on accelerometry data. Twenty-seven participants were enrolled (82% male, 78% White). Mean age at injury and surgery were 41.7 ± 14.0 years and 42.5 ± 14.3 years, respectively. The use ratio correlated significantly with Disabilities of the Arm, Shoulder, and Hand (r = -0.45, P < .05), Impact Disability (r = -0.56, P < .05), 36-Item Short Form Health Survey Physical Function (r = 0.26, P < .05), and Patient-Reported Outcomes Measurement Information System-Upper Extremity (r = 0.38, P < .05) scores. The magnitude ratio significantly correlated with Disabilities of the Arm, Shoulder, and Hand (r = -0.44, P < .05), Impact Disability (r = -0.50, P < .05), and Patient-Reported Outcomes Measurement Information System-Upper Extremity (r = 0.47, P < .05) scores. Linear mixed models supported these associations but showed no effect of time from surgery on use or magnitude ratios. Wearable sensor-derived use and magnitude ratios demonstrate convergent validity with PROs following BP reconstruction. Wearable sensors may offer a more direct, objective assessment of functional recovery to support postoperative assessment, prognostication, treatment planning, and counseling beyond traditional clinical measures.
What have been the activities, characteristics, and outcomes of uterus transplantation (UTx) performed worldwide from 2000 through 2024? In 91 UTx cases, 67 involved live donors and 80 of the recipients had Mayer-Rokitansky-Küster-Hauser syndrome, with 12-month graft survival of 74%, enabling pregnancy attempts that yielded 44 healthy singleton deliveries with a live birth rate per embryo transfer of 30.3%. UTx is the only treatment for women with absolute uterine factor infertility who wish to carry a pregnancy. According to a comprehensive report including data up to 2020 on 45 UTx cases, 19 live births occurred (35.8% per embryo transfer) at a mean of 35.3 weeks gestation. Data were extracted from the web-based registry of the International Society of Uterus Transplantation (ISUTx). This registry captures information on donor and recipient characteristics, transplantation procedures, postoperative complications, immunosuppression, complications including rejections, and reproductive outcome. Analyses were undertaken of the 91 transplants performed between 6 April 2000 and 31 December 2024, that were recorded in the registry. Twenty-four medical centers in five continents registered their uterus transplants by entering data from the day of transplantation until 3 months after graft removal. The following variables were assessed: the demographic and laboratory characteristics of donors and recipients, the source of graft (live versus deceased donor), surgical specifics including technique, duration, ischemic times, and post-op complications, immunosuppression, rejection data, pregnancy with live birth(s), and hysterectomy. In 91 uterus transplantations (67 from live donors, 24 from deceased donors), the overall surgical success rate, defined as graft viability by 12 months, was 75%. Most recipients (88%) had Mayer-Rokitansky-Küster-Hauser syndrome, with mothers being the most frequent (64%) live donors. Live donor hysterectomies were performed by laparotomy (54%), robotics (28%), or laparoscopy (18%). Total ischemic time was shorter in live- versus deceased-donor UTx procedures. Rejection episodes that were treated with escalations of immunosuppression were more frequent during months 1-5 (44%) than during months 6-10 (28%) post-UTx. Graft survival during the first 12 months was superior when grafts from premenopausal donors were used as compared to from postmenopausal donors. Forty-four singleton live births (mean gestational length of 34.5 weeks), including eight second births, were reported, with a live birth rate per embryo transfer of 30%. Preeclampsia was the most common pregnancy complication, occurring in 23% of live-birth pregnancies. Major postnatal complications occurred in 11 infants, 9 with respiratory distress syndrome; no major malformations were observed. Data in the registry are self-reported and not subjected to validation. Although the ISUTx registry represents the most comprehensive quality registry of UTx activity in the world, cases from at least four centers are excluded as they were not entered into the registry. Birth outcomes from some registry cases are as yet unknown as these ongoing cases have not yet reached the endpoint of hysterectomy. This study presents the most comprehensive analysis to date of UTx, the only fertility treatment for absolute uterine factor infertility. The registry serves as the prime source for quality assessment and process improvement in UTx. The establishment and operation of the registry were funded by the Swedish Research Council (2024-03487 to M.B.) and Jane and Dan Olsson Foundation (2024-11 to M.B.). There was no competing interest. Not applicable.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Rheumatoid arthritis (RA) is a chronic autoimmune disease influenced by not only biological but also social and environmental factors. However, the cumulative associations of multiple social determinants of health (SDoHs) with prevalent RA remain underexplored. This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018, including 32,758 adults aged ≥ 20 years after exclusions. Rheumatoid arthritis (RA) cases (n = 1,832) were identified based on participants' self-reported physician diagnosis using the NHANES arthritis questionnaire. Survey-weighted logistic regression models were applied to examine associations between cumulative social determinants of health (SDoHs) and prevalent RA. Eight SDoH indicators were evaluated: employment status, family income-to-poverty ratio, food security, educational attainment, health insurance coverage, type of health insurance, home ownership, and marital status. Each variable was dichotomized as favorable or unfavorable. A cumulative SDoH score was calculated by summing the number of unfavorable conditions. Survey-weighted logistic regression models were used to assess associations between SDoHs and RA, with stratified analyses by sex and race or ethnicity. Five SDoHs including unemployment, low income-to-poverty ratio, food insecurity, low educational attainment, and non-private health insurance were independently associated with higher odds of prevalent self-reported RA. A significant graded association was observed between the number of unfavorable SDoHs and the odds of prevalent rheumatoid arthritis. Participants with five unfavorable conditions had 4.69 times higher odds of prevalent RA compared with those with none (95 percent confidence interval 3.42 to 6.44, P for trend < 0.0001). The association was stronger among women and in the White subgroup. Cumulative exposure to adverse social determinants was cross-sectionally associated with higher odds of self-reported RA. These findings may help inform equity-oriented care and future research; longitudinal studies are needed to clarify temporality and causality. Key Points • Cumulative Association of Social Determinants: The study demonstrates that cumulative exposure to multiple adverse social determinants of health, including unemployment, low income, food insecurity, low education, and non-private health insurance, is significantly associated with higher odds of prevalent self-reported rheumatoid arthritis. • Graded Association: A graded association was observed between the number of unfavorable social determinants and the odds of prevalent rheumatoid arthritis, with a higher number of unfavorable conditions correlating with higher odds of disease. • Sex and Racial/Ethnic Variations: The study found that the associations between social determinants and the odds of prevalent rheumatoid arthritis varied across sex and racial/ethnic groups, with stronger associations observed in women and White individuals. • Public Health Implications: Inequalities in social factors such as employment, income, education, food security, and healthcare access may help contextualize disparities in rheumatoid arthritis burden and support equity-oriented interpretation.
Background and Objectives: Hospital length of stay (LOS) after breast cancer surgery is a key indicator of postoperative recovery, healthcare quality, and hospital resource utilization. Traditional statistical approaches have identified general correlates of LOS but remain limited in predictive accuracy, particularly in heterogeneous real-world surgical populations. Machine learning (ML) models may offer improved performance by capturing nonlinear interactions among clinical, pathological, and operative factors. This study aimed to evaluate ML algorithms for LOS prediction and to identify determinants of prolonged hospitalization in a contemporary breast cancer cohort. Materials and Methods: We conducted a retrospective cross-sectional study of 198 consecutive breast cancer patients who underwent surgery between January 2022 and December 2023 at a single tertiary care center. Clinical, pathological, and surgical data were extracted from electronic medical records. Three regression models-multiple linear regression, Random Forest, and Gradient Boosting-were trained to predict continuous LOS, and three classification models were applied to prolonged LOS (≥10 days). Model performance was assessed using mean absolute error (MAE), root mean square error (RMSE), coefficient of determination (R2), and area under the curve (AUC). Feature importance was analyzed for the best-performing model. Results: The median LOS was 7 days (IQR 5-10), ranging from 1 to 26 days. Breast-conserving surgery showed the shortest LOS (median 3 days), while mastectomy with immediate reconstruction resulted in the longest stays (median 8 days). Random Forest regression achieved the lowest prediction error (MAE 2.31 days; RMSE 2.82; R2 = 0.37), outperforming Gradient Boosting and substantially surpassing linear regression (MAE 8.63 days; R2 = -8.17). Key predictors included age, surgical complexity, reconstruction modality, BMI, implant capacity, and tumor burden. Classification models yielded modest AUCs (0.545-0.589) with low sensitivity, indicating limited discriminative performance for dichotomized LOS outcomes. Conclusions: Machine-learning models, particularly Random Forest, substantially improve LOS prediction compared with classical regression and provide clinically meaningful insights into the drivers of hospitalization after breast cancer surgery. Continuous LOS modeling is more informative than binary thresholds. These findings support integrating ML-based tools into perioperative planning, resource allocation, and patient counseling in breast surgical care.
In current practice, the traditional strategy of excising all IDPs has been replaced by more selective management. However, criteria for selecting patients for surveillance remain unclear, and no widely accepted predictive model exists. We retrospectively analyzed real-world data from 325 cases of IDPs diagnosed via core needle biopsy (CNB) at a tertiary teaching hospital between 2010 and 2023. We assessed upgrade rates to malignancy and evaluated potential predictive factors. Two previously published models were applied to our cohort, and a new model was developed based on our data. Overall, 17% (55/325) of IDPs were upgraded to malignancy. Among lesions without atypia on CNB (n = 215), the upgrade rate was 8.8% (19/215), compared to 40% (23/58) in those with atypia (p < 0.001). Previously suggested models yielded modest results when applied to our study population. First model would have spared 11% (24/215) of patients from surgery, while the second model would have spared 17% (36/215), with one missed upgrade. Our model identified all upgraded cases and would have spared 33% (72/215) of non-atypical IDPs from surgery. Atypia on CNB is a strong predictor of upgrade to malignancy. Existing models showed limited utility in reducing unnecessary surgeries. Our proposed model demonstrated improved performance and may support more individualized management of IDPs.
Female genital mutilation (FGM) is recognized as a violation of human rights, with global prevalence affecting million girls and women. FGM varies in type and severity, and poses physical, emotional, and social risks, with a significant impact on female sexual function leading to mental health issues and reduced quality of life. Surgical techniques, such as clitoral reconstructive surgery, are practiced to restore clitoral function. To assess the effectiveness of clitoral reconstructive surgery in mitigating sexual dysfunction, vulvodynia, clitoral pain, low self-esteem, and negative body image among women living with any type of FGM. The following major databases were searched for published and gray literature, without language restrictions, from inception to May 2023: CINAHL Plus, IRIS, MEDLINE (Ovid), PsycINFO (EBSCOhost), SCOPUS, and Web of Science. Controlled studies, cohort studies, and quasi-experimental studies with assessment before and after the intervention were included if they involved women seeking clitoral reconstruction to address the selected outcomes measured (sexual dysfunction, vulvodynia, clitoral pain, low self-esteem, and negative body image). Studies were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses and the evidence assessed using the GRADE (Grade of Recommendation, Assessment, Development and Evaluation) approach. We identified 13 studies. All but one used the same "Foldès technique". The other study used a vaginal mucosal graft. Meta-analysis of vulval pain, clitoral pain, or pain during intercourse before and after clitoral reconstruction showed a significant reduction in pain (odds ratio 79.67, 95% confidence interval 41.67-152.33). The studies also reported an improvement in body image and self-esteem, as well as in clitoral sexual function. Adverse events included hematoma, infection, suture failure, edema, prolonged postoperative pain, mild inflammation, and necrosis. The certainty of evidence was very low on all outcomes. Although clitoral reconstructive surgery for FGM seems safe and effective, preoperative sexual health counseling should be offered. Women should be clearly informed about the risks and the limited evidence of possible benefits of clitoral reconstructive surgery, and their assessment and treatment should follow current scientific evidence and best clinical practice.
BACKGROUND: Localisation of non-palpable soft tissue lesions remains challenging, particularly in previously treated or anatomically complex regions. Magnetic seed (Magseed®) localisation, widely used in breast surgery, offers a radiation-free alternative to wire or radioactive methods; however, its use in non-palpable soft tissue lesions has not yet been described in the literature. This paper presents the experience of a tertiary cancer centre with the use of magnetic seed in the intraoperative localisation of non-palpable soft tissue lesions, outlining its feasibility, accuracy, and safety. METHODS: All patients who underwent excision of non-palpable soft tissue lesions localised with Magseed® between February 2021 and December 2024 at a tertiary cancer centre were retrospectively reviewed. The primary endpoints were successful placement and retrieval of the seed. Secondary outcomes included dislocation, margin status, operative time, and perioperative complications. RESULTS: Thirty-one seeds were placed in 27 patients (median age 67 years). The median lesion size was 15 mm, and the median depth was 21 mm. All seeds were correctly positioned under ultrasound guidance without complications. The detection rate was 100%, and negative margins were achieved in 97% of cases. Minor perioperative complications occurred in 6% of cases. Operative time was not correlated with lesion depth or BMI but was shorter in lymph node localisations (p = 0.079). CONCLUSIONS: Magnetic seed localisation is a safe, effective, and radiation-free method for non-palpable soft tissue lesions. This pilot series provides the first clinical evidence supporting its feasibility beyond breast surgery and highlights its potential to enhance precision in oncological procedures.
Child growth failure (CGF), which includes underweight, wasting, and stunting, is among the factors most strongly associated with mortality and morbidity in children younger than 5 years worldwide. Poor height and bodyweight gain arise from a variety of biological and sociodemographic factors and are associated with increased vulnerability to infectious diseases. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to estimate CGF prevalence, the risk of infectious diseases associated with CGF, and the disease mortality, morbidity, and overall burden associated with CGF. In this analysis we estimated the all-cause and cause-specific (diarrhoea, lower respiratory tract infections, malaria, and measles) disability-adjusted life-years (DALYs) lost and mortality associated with stunting, wasting, underweight, and CGF in aggregate. We combined the burden associated with mild, moderate, and severe forms of CGF: stunting was defined as height-for-age Z scores (HAZ) less than -1, underweight was defined as weight-for-age Z scores (WAZ) less than -1, and wasting was defined as weight-for-height Z scores (WHZ) less than -1, according to WHO Child Growth Standards. Population-level continuous distributions of HAZ, WAZ, and WHZ were estimated for 2000 to 2023 using data from surveys, literature, and individual-level study data. The risk of incidence of, and mortality due to, diarrhoea, lower respiratory infections, malaria, and measles was separately estimated in a meta-regression framework from longitudinal cohort data for Z scores less than -1. Finally, fatal outcomes associated with these diseases were estimated with vital registration, verbal autopsy, and case-fatality data, while non-fatal outcomes were estimated with surveys as well as health-care utilisation and case reporting data. The exposure prevalence and relative risk estimates were from continuous distributions, allowing for direct assessment of the attributable fractions for mild, moderate, and severe stunting, underweight, wasting, and the combined impact of child growth failure within populations. All estimates were age-specific, sex-specific, geography-specific, and year-specific. We estimated that, in children younger than 5 years in 2023, CGF was associated with 79·4 million (95% uncertainty interval [UI] 47·0-106) DALYs lost and 880 000 (517 000-1 170 000) deaths. This represented 17·9% (10·6-23·8) of 444 million (434-457) total under-5 DALYs and 18·8% (11·1-25·0) of all 4·67 million (4·59-4·75) under-5 deaths. Compared to stunting (33·0 million [24·1-42·2] DALYs, 373 000 [272 000-477 000] deaths) and wasting (39·2 million [23·8-53·0] DALYs, 428 000 [256 000-583 000] deaths), childhood underweight was associated with the largest share of CGF-related disease burden: 52·2 million (21·9-75·1) DALYs and 573 000 (236 000-824 000) deaths in children younger than 5 years in 2023. CGF remains a leading factor associated with death and disability in children younger than 5 years, despite global attention and focused interventions to reduce the prevalence of associated CGF indicators. Our findings underscore the need for policies, strategies, and interventions that focus on all indicators of CGF to reduce its associated health burden. Gates Foundation.
The aim of this article was to perform a bibliometric analysis of Iranian researchers in orthognathic surgery. A bibliographical search for orthognathic surgery literature on Iran was conducted on Wef of Science. Mendeley and Microsoft Excel were used for tabulation and data visualization. Some statistical tests were performed with a 95% confidence interval, considered significant. From 7,535 articles, 86 included at least one Iranian author, making Iran the second highest contributor in the Middle East after Turkey. Notable topics beyond orthodontic treatment included cosmetic surgery, obstructive sleep apnea, blood clotting, and anesthesiology, with complications being the most studied. Emerging themes were Virtual Surgical Planning and technology. Statistical analysis showed a very high Pearson correlation between the number of ranked institutions and both the number of published articles (ρ=0.85) and the quantity of citations (ρ=0.80), and a moderate correlation with the H-index (ρ=0.46). No correlation was found between citations per document and the number of ranked institutions (ρ= -0.27). Iran is a leading country in the field of orthognathic surgery, both regionally and globally. This article provides valuable insights for Iranian researchers and academics, highlighting the potential of international collaboration and free open-source technology to advance knowledge in areas like Virtual Surgical Planning. Promoting global partnerships and utilizing innovative technologies can enhance patient outcomes and benefit practitioners in resource-limited regions worldwide.
To assess the clinical effectiveness and cost benefits of negative pressure wound therapy with instillation and dwell (NPWTi-d) compared to standard NPWT and other therapies in managing hard-to-heal wounds. An observational, retrospective, multicentre study was conducted using data from three hospitals in Italy. Eligible patients included all adults discharged in 2021 with specific diagnoses related to hard-to-heal wounds. Data on healthcare resource use, including length of hospital stay (LoS), number of dressings used and procedures performed, were analysed. The economic evaluation estimated hospitalisation costs based on the average daily rate. The analysis findings were further examined in an expert meeting focused on assessing the impact of continuity of care pathways on treatment outcomes. A total of 64 patients were enrolled: 38 received NPWT; 16 received NPWTi-d; and 10 received other treatments, including traditional and advanced wound care approaches. The NPWTi-d group demonstrated a significantly shorter average LoS (13.4 days) compared to the NPWT (23.6 days) and other treatments (21.5 days) groups. Patients receiving NPWTi-d also had fewer dressing changes (2.6) than those treated with NPWT (3.5) and other therapies (6.6). This reduction in resource consumption translates to cost savings of >€6000 (-35.1%) per hospitalisation compared to the overall average hospitalisation cost across the study sample and €7645 (-40.7%) compared to other treatments. The findings were confirmed during the expert meeting. As shown by the findings of this study, by improving patient outcomes and reducing the burden on healthcare systems, NPWTi-d should be considered a key component in modern wound care pathways. Its implementation aligns with current healthcare initiatives focused on optimising resource use and improving patient quality of life.
Understanding the anatomical relationship between the pneumatized middle turbinate (PMT) and ethmoid roof structures is crucial for minimizing complications in endoscopic sinus surgery. We aimed to evaluate the association between PMT and the dimensions of the anterior ethmoid roof using cone-beam computed tomography (CBCT) imaging. A retrospective, cross-sectional study was conducted on 249 CBCT scans obtained at a maxillofacial radiology center. All images were acquired using a NewTom VGi scanner (QRsrl, Verona, Italy) with a 15 × 15 cm field of view and 1-mm slice thickness. Measurements were taken from coronal sections displaying the infraorbital nerve canal. Key anatomical points, including the medial and lateral ethmoid roof points (MERP and LERP) and the cribriform plate (CP), were identified. The width and height of these structures were measured. PMT was classified as lamellar, bulbous, or extensive. Statistical analyses included chi-square, t-test, and Pearson correlation tests. A significant relationship was found between the axial dimensions of PMT and the anterior ethmoid roof width (AER) in both genders (P<0.05). Differences in ethmoid roof dimensions were statistically significant between PMT types. In males, vertical PMT dimensions were correlated with CP and AER height. AER width was greater in males than females, particularly in cases with PMT. A close anatomical relationship exists between PMT and ethmoid roof dimensions, especially AER width. Recognition of these variations is essential for surgical planning and avoiding complications in sinus and skull base surgery.
Venous thromboembolism (VTE) is one of the known medical complications in autologous breast reconstruction (ABR) which is associated with a short and long-term morbidity as well as mortality. Identifying VTE risk factors is crucial for appropriate VTE prophylaxis measurements to lower this complication following ABR. Using American College of Surgeons National Surgery Quality Improvement Project database, we examined the clinical data of patients who underwent ABR from 2016-2020 in the US. The frequency of VTE, day of occurrences and risk factors associated with VTE were evaluated. Overall, 11,847 patients underwent ABR in the study period. The overall VTE rate was 1.0%. Totally 117 patients experienced VTE with a total occurrence of 127. Postoperative day 1 and 2 were reported with the highest frequency of VTE (21/127). Using multivariate regression analysis, independent risk factors associated with a higher VTE rate were length of hospital stay>=5 d [adjusted odd's ratio (AOR), 3.29], operative time longer than 10 h (AOR,2.17), and immediate reconstruction (AOR,1.51). Although free flap breast reconstruction was associate with a higher VTE rate compared with pedicled flap reconstruction (1.2% vs. 0.8%); however, multivariate regressing analysis did not show this factor as an independent VTE risk factor. Being proactive to make the patients ready to discharge by POD-4 and having strategy to shorten the length of operation could help to lower the rate of VTE in ABR. Plastic surgeons should consider these factors and use appropriate prophylactic measures to minimize the risk of VTE development.
BACKGROUND: The mandible-preserving pull-through oropharyngectomy (MPPO) offers a less morbid alternative for traditional mandibular swing approach, particularly for tonsillar carcinoma. The lateral arm free flap (LAFF) is a versatile and reliable option for soft tissue reconstruction, particularly suitable for small-to-medium-sized defects of the oropharyngeal region. METHODS: This study is a retrospective study including data from 23 patients with tonsil carcinoma, diagnosed and treated at a tertiary referral center. The QLQ-C30, QLQ-H&N35 inventories, were administered at three different timepoints: At 1-month, 3-month and 6-month postoperatively. The flap-related data and the quality-of-life data were collected and presented in a descriptive manner. RESULTS: Most flaps survived (95.65%), one case of necrosis occurred, while 8.70% patients experienced recipient-site bleeding, 4.35% and 21.74% of patients experienced systemic complications such as pulmonary embolism and hypoalbuminemia respectively. Following surgery, all patients successfully underwent decannulation (average 28.22 days) and NGT extraction (average 12.09 days). Among ten patients with complete QoL data, global QoL and most functional domains improved over six months, with resolution of fatigue, insomnia, speech, social, and cough issues but a worsening of xerostomia. CONCLUSION: The LAFF reconstruction in tonsil carcinoma patients with MPPO surgery demonstrates favorable postoperative outcomes and QoL results in our institution. TRIAL REGISTRATION: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of West China Hospital, Sichuan University (Approval No. 2025‑1235; Date: 1 February 2025). Written informed consent was obtained from all participants. As a retrospective analysis of a standard reconstructive technique, this study did not require prospective trial registration.
Rectus diastasis of parity is the separation of the abdominal muscles that can occur after childbearing. We hypothesized that a subpopulation of women with rectus diastasis also present with back pain and/or urinary incontinence, a condition referred to as symptomatic established rectus diastasis, and this results in impaired health-related quality of life. This study identified the prevalence of symptomatic established rectus diastasis in primiparous women and measured their health-related quality of life. Gravid nulliparous women over 18 years old were consecutively recruited from December 2021 to August 2022 and followed prospectively. Inter-rectus distances were measured with ultrasound in early pregnancy, and 6-week, 6-month, and 12-month postpartum. Patient reported outcome measures included the Oswestry Disability Index (ODI) for back pain, International Consultation on Incontinence Questionnaires Urinary Incontinence Short Form (ICIQ-UI SF) for urinary incontinence, and the 36-item short form (SF-36) for health-related quality of life. Two-hundred and thirteen women were recruited, of which 192 underwent ultrasound measurement in early pregnancy, 130 at 6-week postpartum, 120 at 6-month, and 109 at 12-month. There was a significant increase in mean inter-rectus distance over the study period (p < 0.001). The proportion of women with rectus diastasis at 12-month postpartum (> 30 mm) was 30.3% and compared to those without they had worse back pain (p = 0.014) but no difference in urinary incontinence (p > 0.05). Women with symptomatic established rectus diastasis at 12-month postpartum (rectus diastasis and back pain (ODI > 0)), made up 25% of the cohort and had significantly worse health-related quality of life than those without (p < 0.05). Predictive factors for symptomatic established rectus diastasis included increased total fetal birthweight (OR 3), lower maternal BMI (OR 1.2), and gestational diabetes (OR 6.7). This study of gravid nulliparous women from early pregnancy until 12-month postpartum identified rectus diastasis in 30.3% and symptomatic established rectus diastasis in 25%. Women with symptomatic established rectus diastasis had significantly worse health-related quality of life.
Obesity is becoming increasingly common around the world and is often co-occurring with chronic diseases that could complicate surgical treatment. Partial Nephrectomy is a complex surgical procedure and obesity may influence surgical complexity, postoperative recovery and resource use. Previous studies have produced mixed results, and many are limited by small sample sizes or single-center data. This study assesses how obesity affects in-hospital perioperative outcomes by analyzing data from a large national dataset. We performed a retrospective analysis of the National Inpatient Sample from 2018 to 2020, including adult patients with non-metastatic RCC who underwent open, laparoscopic, or robot assisted partial nephrectomy. Outcomes included in-hospital mortality, complications, discharge disposition, length of stay, and total hospital charges. Survey-weighted methods and multivariable regression models were employed to adjust for measured demographic, clinical, and hospital-level factors. Among 40,300 weighted hospitalizations, 10,270 patients were obese, younger and had higher comorbidity burdens. Surgical approaches were similar across groups, with robotic partial nephrectomy most frequent. Unadjusted analyses showed higher postoperative complication rates in obese patients. However, after adjusted analysis, obesity was not independently linked to in-hospital mortality, major complications, non-home discharge, length of stay, or hospital costs. Robotic surgery was associated with lowest adjusted odds of complications, mortality, and shorter hospitalization. The comorbidity index proved a reliable predictor for mortality, complications, length of stay, and total charges. Obesity alone was not an independent predictor of adverse in-hospital perioperative outcomes following partial nephrectomy. It is of utmost importance to manage the underlying conditions, as the comorbidity index remains the strongest determinant of worse outcomes and higher hospital costs. The robotic partial nephrectomy was associated with lowest adjusted odds of complications and shorter hospitalization within contemporary practice patterns.
Artificial intelligence (AI) is increasingly integrated into patient education and postoperative care. Almousa et al. recently evaluated ChatGPT-4 and Gemini for postoperative facelift counseling, reporting high accuracy and clarity. While their study represents an important step toward AI-assisted communication in aesthetic surgery, several methodological issues may limit the validity and clinical applicability of their findings. We critically appraised Almousa et al.'s study design, data collection, and analytic methods. Specific attention was given to question selection, evaluation metrics, reproducibility, and statistical robustness, comparing them with established standards for AI evaluation and inter-rater reliability. The study used ChatGPT-4 itself to generate the five "most common" postoperative questions, introducing circularity and potential selection bias. Responses were assessed on a dichotomous (Yes/No) scale by five surgeons, without reporting inter-rater reliability or use of scaled metrics. It was unclear whether prompts were entered sequentially or independently, raising reproducibility concerns. The limited sample size (five questions per model) provided only 25 binary data points per system, precluding meaningful statistical inference. Furthermore, AI responses lacked individualized safety guidance and escalation advice, limiting clinical safety in real-world postoperative settings. Although the study highlights the promise of LLMs in aesthetic surgery, future studies should employ patient-derived question sets, graded and reproducible evaluation scales, transparent prompt protocols, and inclusion of complication-related queries to accurately determine the safety and educational value of AI-generated postoperative information. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
To quantify national trends in the incidence, treatment patterns, and direct medical costs of malignant melanoma (MM) and non-melanoma skin cancer (NMSC) in South Korea between 2011 and 2019. We analyzed data from the National Health Insurance Service and Korea Central Cancer Registry and also identified incident cases of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and MM. Age-standardized incidence rates (ASIRs; Segi World Standards) were calculated. Surgical procedures (wide excision, flap, skin graft, Mohs micrographic surgery), recurrence (repeat surgery ≥6 mo), and medical costs were evaluated. Overall, 43,521 incident skin cancer cases were recorded (BCC 58.9%; SCC 29.7%, MM 11.3%). ASIR doubled from 6.9/100,000 person years between 2011 and 12.0/100,000 in 2019 (average annual percentage change +7.9%). Rural regions had higher incidence rates than metropolitan areas (14.9 vs. 9.8/100,000). Complex reconstructions escalated; flap procedures increased threefold (1341-4038) and Mohs surgery (387-1236). Annual direct medical costs increased from US $66 million to US $177 million (+168%). Recurrence rates were 1.15% for BCC, 1.88% for SCC, and 2.13% for MM. The absolute skin cancer burden in Korea remains modest; however, its incidence, operative complexity, and costs are increasing than what demographic aging alone would predict. Targeted ultraviolet (UV) protection policies, early detection strategies, and resource planning for the reconstruction capacity are required.
Syndrome-specific International Classification of Diseases, 10th Revision (ICD-10) codes have the potential to improve identification of patients for precision therapies, clinical trials, and research, yet their real-world uptake is not well characterized. We evaluated the utilization of syndrome-specific ICD-10 codes at a large academic medical center among patients with pathogenic or likely pathogenic variants in 10 monogenic epilepsy genes with established codes (CDKL5, EHMT1, KCNQ2, MECP2, MED13L, SCN1A, SHANK3, SLC13A5, SLC2A1, SYNGAP1). Patients were identified from an institutional genetic testing database and were included if they had at least one clinical encounter after code implementation or genetic diagnosis. Variants of uncertain significance were manually curated, and Rett and Dravet phenotypes were reviewed for accuracy. Of 83 patients with qualifying variants, 39 met inclusion criteria. Only 56.4% (22/39) were ever assigned a syndrome-specific ICD-10 code, which appeared in 31.1% of encounters and accounted for 14.5% of all documented codes. Uptake varied by syndrome, provider specialty, and encounter type and increased over time. In the Dravet syndrome subgroup (n = 23), generic epilepsy codes were documented more than twice as often as the Dravet-specific code (G40.83). When G40.83 was documented, other epilepsy codes were used less frequently, suggesting it may be treated as a substitute for broader epilepsy codes. These findings demonstrate inconsistent and limited adoption of syndrome-specific ICD-10 codes, highlighting the need for improved coding support and integration of structured genetic data within the electronic health record.
The Burn-Specific Health Scale Brief (BSHS-B) is the only specific, standardized, multidimensional tool designed precisely to measure health-related quality of life (HRQoL) after burns. It is translated into many different languages and is used worldwide. To date, an Arabic version has not been available. The current study aimed to translate, culturally adapt, and validate the BSHS-B into Arabic (BSHS-B-AR). A total of 188 patients with burn injuries completed the final Arabic version of BSHS-B to assess the psychometric properties of BSHS-B-AR. Reliability was tested by internal consistency (Cronbach's alpha) and test-retest reliability (interclass correlation coefficients [ICCs]). Validity was investigated through floor and ceiling effect and confirmatory factor analysis (CFA). Also, convergent validity was assessed using the World Health Organization Quality of Life Scale abbreviated version (WHOQOL-BREF) questionnaire and construct validity was verified through the known-groups technique. The scale showed excellent reliability. Cronbach's alpha was > 0.90 (total scale and for each subdomain) and ICC was > 0.80 for the total scale and for the 9 domains. Validity of the scale was satisfactory through CFA (82.7% of the total variance) and it showed a good fit with the original scale (comparative fit index = 0.933). Also, a significant positive correlation was found between the BSHS-B-AR and the WHOQOL-BREF (P < .001). The scale was able to discriminate between patient groups according to site of burns and length of hospitalization (P < .05). The BSHS-B-AR is a reliable and valid scale that can be used both in Arabic and international communities.