[Purpose] This study examined the impact of shoe-foot length mismatch on gait speed and sagittal-plane lower-limb joint motion in healthy adults during comfortable and maximal-effort walking. [Participants and Methods] Thirty healthy adults participated in the study. Four shoe-length conditions were tested: an appropriately fitted condition and oversized conditions in which shoes were 1-, 2-, and 3 cm longer than the appropriate length. Shoe width was standardized to the appropriate-size for each participant. Gait speed was assessed via 10 m gait time under comfortable and maximal-effort conditions. Sagittal-plane motion of the hip, knee, and ankle joints was recorded. [Results] 10 m gait time increased with shoe length. During comfortable walking, 10 m gait time was significantly longer in the 2- and 3 cm longer conditions, whereas no significant difference was observed in the 1 cm longer condition. During maximal-effort walking, 10 m gait time was significantly longer in all oversized conditions. Sagittal-plane joint motion also increased with shoe length, particularly at the hip and knee, with significant increases primarily observed in these joints. [Conclusion] Shoe-foot length mismatch prolonged 10 m gait time and increased sagittal-plane lower-limb joint motion. Clinicians should recognize that even minor shoe-foot length mismatch may reduce gait efficiency.
The pros and cons of incorporating radiotherapy (RT) into chemotherapy (CT) for locally advanced unresectable pancreatic cancer (LAPC) have been debated for decades. Recently, particle (proton and carbon-ion) therapy has emerged as a new radiotherapy modality. Given the unclear benefits of this approach, we summarized clinical outcomes of LAPC treated with concurrent chemoradiotherapy (CRT) using particle therapy to compare outcomes with current treatments. To evaluate the efficacy and safety of particle therapy-based CRT in patients with LAPC and compare survival outcomes with photon CRT, combination CT, and single-agent CT. Systematic review and single-arm meta-analysis. Studies evaluating LAPC treated with first-line particle CRT, photon CRT, combination CT, and single-agent CT were included. A single-arm meta-analysis was performed to calculate a pooled effect size using the DerSimonian and Laird random-effects model. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), response rate, and adverse events. Across 42 studies and 3161 patients with LAPC, particle CRT achieved a pooled 1-year OS of 75.8% (95% confidence interval (CI) 71.3-79.7), 2-year OS of 41.3% (95% CI 35.6-47.3), and 1-year PFS of 51.7% (95% CI 43.2-60.0). Photon CRT achieved a 1-year OS of 59.4% and 2-year OS of 21.0%; combination chemotherapy 64.4% and 30.8%; and single-agent chemotherapy 37.2% and 13.1%. Pooled response rate after particle CRT was 48.8%. Grade ⩾3 upper gastrointestinal events (ulcer/bleeding) were more frequent after particle CRT (4.3%) than after photon CRT (2.1%). Particle therapy CRT might have comparable survival outcomes in treating LAPC with combination CT, photon CRT, and single-agent CT. These findings support considering particle CRT as a valuable first-line treatment option for LAPC, which should be validated in randomized clinical trials. The final search was conducted on December 31, 2024. The review protocol was registered in PROSPERO with the registration number CRD42023493665. Can Particle Therapy Plus Chemotherapy Help Patients Live Longer with Inoperable Pancreatic Cancer? Pancreatic cancer that cannot be removed by surgery is very difficult to treat. Doctors have long debated whether adding radiotherapy to chemotherapy helps patients live longer. Newer forms of radiotherapy, called particle therapy (which includes proton and carbon-ion therapy), may target tumors more precisely, but it is still unclear how helpful they are. To better understand this, we reviewed results from many previous studies that looked at people with locally advanced unresectable pancreatic cancer. We compared different first treatments, including particle therapy combined with chemotherapy, standard radiotherapy with chemotherapy, combination chemotherapy alone, and single-drug chemotherapy. We analyzed 40 studies and focused mainly on how long patients lived after treatment. We also looked at how long the cancer stayed under control, how well tumors responded to treatment, and what side effects occurred. We found that patients treated with particle therapy plus chemotherapy tended to live longer at one and two years after treatment compared with the other approaches. Their cancer also stayed under control for longer during the first year. However, this treatment was linked to a higher chance of stomach or intestinal side effects, such as ulcers or bleeding. Overall, particle therapy combined with chemotherapy may offer survival results that are similar to, or better than, current standard treatments for this type of pancreatic cancer. These findings suggest that particle therapy could be a useful first treatment option, but more high-quality clinical trials are needed to confirm its benefits and risks.
Failing to obtain adequate sleep has been associated previously with greater postconcussion symptom burdens and protracted neurocognitive recovery. Sleep-related symptoms may delay concussion recovery. Active military populations frequently obtain less sleep than is recommended. Cadets and midshipmen who reported less sleep experienced prolonged recovery trajectories postconcussion. Retrospective observational cohort. Level 4. Study participants were military service academy members from 4 United States (US) Service Academies. The primary outcome of interest was the association between sleep duration recorded during the initial concussion injury assessment and time to unrestricted return to activity (URTA). Participants were divided into groups based on sleep duration (<6, ≥6 to <7, ≥7 to ≤8, >8 hours). Kaplan-Meier survival estimates were calculated for different recovery milestones, including time (days) from initial injury to clearance for URTA, and from initiation of a graduated return to activity (GRTA) protocol and URTA clearance. Univariate and multivariable Cox proportional-hazards regression models were used to estimate hazard ratios and 95% CI for recovery by sleep group. During the study period, 1339 participants (39% female; age, 19.4 ± 1.5 years; height, 175.1 ± 14.8 cm; weight, 74.1 ± 15.2 kg) sustained a concussion. Participants reporting <6 hours of sleep at their initial injury evaluation took 19% longer to reach URTA when compared with participants reporting ≥7 hours to ≤8 hours of sleep. These participants also displayed GRTA protocol durations that were 18% longer than those reporting ≥7 hours to ≤8 hours of sleep. Sleep duration influenced postconcussion recovery trajectories. Participants who reported <6 hours of sleep took significantly longer to reach URTA. The amount of sleep obtained before a concussion and during a postconcussion recovery trajectory may impact the total recovery duration.
Robot-assisted cholecystectomy (RAC) is widely implemented, but the quality of related public-facing information on short-video platforms remains largely unexamined. To systematically evaluate and compare the quality and reliability of RAC-related videos on Douyin and Bilibili, and to assess the influence of uploader background and audience engagement. We collected the top 100 videos from each platform Douyin using the keyword "Robot-assisted cholecystectomy". After applying exclusion criteria, 66 videos (49 from Douyin, 17 from Bilibili) were assessed using the Global Quality Score (GQS) and the modified DISCERN (mDISCERN) instrument. Videos were independently categorized by uploader source and content type. Bilibili hosted significantly longer videos than Douyin(median 452.0 vs. 76.3 s) and demonstrated a significantly higher mean GQS (3.41 vs. 2.61, P = 0.022). Professional individuals and instructional content consistently provided the highest GQS and mDISCERN scores, whereas non-professional institutions and promotional content performed the poorest. Notably, video duration and active engagement metrics, specifically comments and saves, were significantly and positively correlated with both GQS and mDISCERN scores (all P < 0.05). The quality of RAC information on short-video platforms is highly variable. While Douyin was associated with higher baseline audience engagement, Bilibili was associated with superior quality ratings and longer-form medical education. Increased engagement from authoritative medical professionals utilizing longer video formats is necessary to optimize the accurate dissemination of complex surgical data and combat low-quality promotional content.
This study compares age at death in patients with myasthenia gravis (MG) and multiple sclerosis (MS) with the general U.S. population and examines age at death patterns during a period preceding modern high-efficacy therapies. To compare age at death among individuals with MG and MS with the general population and assess differences in age at death between MG and MS. Retrospective population-based study using death certificate data from four U.S. states (Florida, Wisconsin, Texas, and New York) for 2000, 2005, 2010, and 2015. Individuals with MG or MS listed on death certificates were identified. Age at death was compared between MG and MS among four states and contemporaneously with U.S. population via Social Security life tables, adjusting for sex and geography. Because data were provided in different formats across states (individual-level, aggregated, and categorical), analyses were tailored to each dataset while addressing the same underlying question. During the study period, high-efficacy targeted therapies for both conditions were not yet available, allowing comparison of mortality patterns under standard-of-care treatment. Age at death of MS patients was significantly lower than the general population (-12.4 years, p < 0.001). In contrast, MG patients showed a higher mean age at time of death compared with the general population (+4.8 years, p < 0.0001) and died significantly later than MS patients (+15.5 years, p < 0.001, adjusted for sex and year). These patterns were consistent across datasets. Despite a higher reported burden of age-related comorbidities in MG populations, MG patients demonstrated higher mean age at death than both MS patients and the general population. MG was associated with significantly older age at death compared with both MS and the general population under historical standard-of-care conditions. These findings suggest that survival patterns in MG differ from those in MS and raise questions about the factors driving this difference. Further studies are needed to clarify the roles of disease biology, comorbidity, age at diagnosis, and healthcare utilization in shaping long-term outcomes. People with myasthenia gravis appear to live longer than people with multiple sclerosis in the United States What are mortality rates? Mortality rates describe how long people live and the age at which they die within a specific group. Looking at death certificate age at death helps researchers understand whether a disease is associated with a shorter or longer life compared with the general population. These comparisons do not explain why differences exist, but they can highlight important patterns. What did we look at? We examined death records from four US states in the years 2000, 2005, 2010, and 2015. We compared the age at death for people with myasthenia gravis (MG) and multiple sclerosis (MS) to life expectancy in the general US population. During this period, many of today’s newer high-efficacy treatments were not yet available, which allowed us to examine mortality patterns before the introduction of more recent therapies. Why is this important? MS is widely known to shorten life expectancy, but less is understood about long-term survival in MG. In clinical practice, we observed that many patients with MG were living into their 80s and 90s, while this was uncommon in MS. Understanding whether these observations reflect broader patterns can help clinicians, patients, and researchers better understand the long-term impact of these conditions. What is the takeaway? In this analysis, people with MS died, on average, more than a decade earlier than the general population. In contrast, people with MG had a higher average age at death than the general population. These findings suggest that the long-term outlook for MG may be more favorable than often assumed and raise important questions about why age at death differs between these two autoimmune conditions. Further research is needed to better understand the reasons for these differences.
To assess the determinants and clinical impact of missed incidental lung cancers on neck CT and explore the potential role of artificial intelligence-based computer-aided detection (AI-CAD). This study retrospectively screened adults who underwent neck CT at a tertiary care hospital between 2008 and 2024. Patients with prior lung cancer, prior or concurrent chest CT, absence of visible lung lesions on neck CT, lack of histological confirmation, or indeterminate staging or stage shift were excluded. Determinants of missed detection and their impact on diagnostic intervals and stage shift (progression in any T, N, or M category) were evaluated. AI-CAD was retrospectively applied to the missed cases. Of 81,794 patients screened, 123 with lung cancer visible on neck CT were identified (mean age, 65.1 ± 10.5 years; 63 male), of whom 80 (65.0%) were not described in the original reports. Missed detection was more common with CT examinations including CT angiography (odds ratio [OR], 3.40 [95% confidence interval {CI}: 1.13, 11.69]; P = 0.037) and squamous cell carcinoma (OR, 6.84 [95% CI: 1.32, 55.16]; P = 0.037) and was less common with double reading (OR, 0.16 [95% CI: 0.03, 0.81]; P = 0.031), lymphadenopathy (OR, 0.11 [95% CI: 0.04, 0.32]; P < 0.001), and lobulated margins (OR, 0.29 [95% CI: 0.11, 0.79]; P = 0.016). Missed detection was associated with a longer diagnostic interval to pathologic confirmation (median, 27.5 vs. 0 months; P < 0.001) and more frequent stage shift (47.5% vs. 11.6%, P < 0.001), including numerically more frequent progression from stage I-II to III-IV (11.3% vs. 2.3%, P = 0.146). AI-CAD detected 41 of 80 missed lesions (51.3%), without significant variations across imaging or lesion characteristics. Incidental lung cancers on neck CT are rare but are frequently overlooked. Missed detection is associated with substantially longer diagnostic intervals and more frequent stage shifts. AI-CAD has the potential to reduce diagnostic oversight, warranting further validation.
Fragility fracture of the pelvis (FFP) with a low-energy mechanism of injury is relatively common among the growing geriatric population. The incidence of postoperative complications after surgically treated FFP is not well documented. The aim of this study was to report complications after operatively treated FFP and to determine whether these complications would have a detrimental effect on outcomes. Retrospective study of 200 consecutive patients who underwent operative treatment at Oulu University Hospital, Oulu, Finland, between 1.1.2010 and 15.4.2021 for FFP with a low-energy injury mechanism. Postoperative complications were recorded, and associations with outcomes were depicted. Postoperative complications were recorded in 31 (15.5%) patients. Patients with complications had higher intraoperative bleeding (OR 2.8 (1.0-7.9), p = 0.048) and higher ASA classification 3.4 (1.3-8.4), P = 0.009). Patients with complications had longer hospital stays, but no clear association between complications and mortality or discharge location was observed. The incidence of postoperative complications was comparable with that reported in previous literature. Patients who experienced complications had longer hospital stays; however, no definitive association between complications and outcomes was identified.
Holmium laser enucleation of prostate (HoLEP) is a size-independent procedure for benign prostatic obstruction. However, the predictors of various complications are poorly defined in the literature. We propose a standardized framework for reporting postenucleation complications using a modified Clavien-Dindo (CD) classification. We aim to identify predictors of postoperative complications following HoLEP within this unified framework, integrating both patient- and procedure-related variables. We retrospectively analyzed a prospectively collected database of patients undergoing HoLEP. Complications were stratified according to a modified CD classification framework developed for HoLEP. Predictors were analyzed using multinomial regression, and a heatmap was generated to identify correlations among predictors. A total of 855 patients were included in the study. The median prostate volume was 102 cc. Minor complications were seen in 513 patients (60%), most frequently transient incontinence (37.4%). Major complications occurred in 46 patients (5.4%), primarily bladder neck stenosis (2%) and urethral stricture (2%). Multivariate analysis showed that advancing age (odds ratio [OR] 1.03; p = 0.008), recurrent urinary retention (OR 1.60; p = 0.003), elevated body mass index (BMI) (OR 1.04; p = 0.017), Anticoagulation use (OR 1.44; p = 0.029) and longer operative duration (OR 1.004; p = 0.002) were independent predictors of minor complications. Major complications were associated with smaller prostates (OR 0.93, p = 0.016). Spearman's correlation showed that postoperative incontinence was correlated with advanced age (r = 0.090, p < 0.01), high BMI (r = 0.082, p < 0.05), and longer surgical duration (r = 0.119, p < 0.01). Prostate volume was negatively correlated with postoperative inability to void (r = -0.107, p < 0.01), bladder neck stenosis (r = -0.107, p < 0.01), and urethral stricture (r = -0.102, p < 0.01). Gross hematuria was correlated with anticoagulation use (r = 0.101, p < 0.01) and BMI (r = 0.114, p < 0.01), although neither factor predicted major complications. We proposed a standardized framework for reporting complications following endoscopic enucleation of the prostate. Our study also identified predictors of post-HoLEP major and minor complications.
The objective of this study was to evaluate whether diagnostic interval is associated with tumor stage in dogs with malignant nasal tumors and whether intranasal bacterial infection contributes to delayed diagnosis. Medical records of 96 dogs with histopathologically confirmed malignant nasal tumors were retrospectively reviewed. Data included diagnostic interval, clinical stage, results of intranasal bacterial culture, and prior antimicrobial administration. Associations were analyzed using non-parametric tests. The median diagnostic interval was 83 d (range: 8 to 995 d). Dogs with Stage I tumors had a significantly shorter diagnostic interval than those with Stages II to IV disease (50.0 versus 89.5 d; P = 0.022). When stratified by the overall median interval (≤ 83 versus > 83 d), advanced-stage tumors (Stages III to IV) were more common in dogs with longer intervals (P = 0.014). Bacterial culture was positive in 33 of 57 tested dogs and was not associated with diagnostic interval or tumor stage. Prior antimicrobial therapy (62.5%) was not associated with stage or culture status. A longer diagnostic interval was associated with more advanced tumor stage. Intranasal bacterial infection did not explain delayed diagnosis. Persistent nasal signs should prompt further diagnostic evaluation to determine the underlying cause, including neoplasia. Délai diagnostique prolongé et stade tumoral dans les tumeurs nasales malignes canines. Cette étude visait à évaluer si le délai diagnostique est associé au stade tumoral chez les chiens atteints de tumeurs nasales malignes et si une infection bactérienne intranasale contribue à un diagnostic tardif. Les dossiers médicaux de 96 chiens présentant des tumeurs nasales malignes confirmées par histopathologie ont été analysés rétrospectivement. Les données recueillies incluaient le délai diagnostique, le stade clinique, les résultats des cultures bactériennes intranasales et les traitements antimicrobiens antérieurs. Les associations ont été analysées à l’aide de tests non paramétriques. Le délai diagnostique médian était de 83 j (intervalle : 8 à 995 j). Les chiens avec des tumeurs de stade I présentaient un délai diagnostique significativement plus court que ceux avec des tumeurs de stade II à IV (50,0 versus 89,5 j; P = 0,022). Après stratification selon l’intervalle médian global (≤ 83 versus > 83 j), les tumeurs de stade avancé (stades III à IV) étaient plus fréquentes chez les chiens présentant des intervalles plus longs (P = 0,014). La culture bactérienne était positive chez 33 des 57 chiens testés et n’était pas associée à l’intervalle diagnostique ni au stade tumoral. Un traitement antimicrobien antérieur (62,5 %) n’était associé ni au stade ni au résultat de la culture. Un intervalle diagnostique plus long était associé à un stade tumoral plus avancé. L’infection bactérienne intranasale n’expliquait pas le retard diagnostique. La persistance de signes nasaux doit inciter à des investigations diagnostiques complémentaires afin de déterminer la cause sous-jacente, incluant une néoplasie.(Traduit par Dr Serge Messier).
Puberty is a critical window for bone mass acquisition, determining lifelong fracture risk. Gonadotropin-releasing hormone agonist (GnRHa)-based pubertal suppression followed by gender-affirming hormone therapy (GAHT) is increasingly used in transgender and gender-diverse (TGD) adolescents, raising concerns about peak bone mass. To quantify changes in bone mineral density (BMD), bone mineral apparent density (BMAD), and z scores in TGD adolescents undergoing GnRHa with or without GAHT, and to identify predictors of skeletal outcomes. PubMed, Scopus, Web of Science, and Cochrane Library, from inception through September 2025. Longitudinal cohorts assessing BMD, BMAD, or z scores at the lumbar spine, total hip, or femoral neck in TGD adolescents treated with GnRHa with or without GAHT. Ten studies met the inclusion criteria. Data were extracted in duplicate; study quality was assessed using the Newcastle-Ottawa Scale. Random-effects models pooled mean changes across baseline (time 0 [T0]), after GnRHa (T1), and after GAHT (T2), stratified by skeletal site and sex assigned at birth. Metaregressions examined body mass index, age, Tanner stage, and treatment duration. Dual-energy x-ray absorptiometry-derived BMD, BMAD, and z scores. Ten cohorts comprising 751 adolescents (427 assigned female at birth [AFAB]; 324 assigned male at birth [AMAB]) were included. Lumbar spine z scores declined during GnRHa (AFAB: z-score change, -0.97 [95% CI, -1.09 to -0.85]; AMAB: z-score change, -0.73 [95% CI, -0.93 to -0.53]) despite stable BMD. z Scores used sex-assigned-at-birth normative references. After GAHT, BMD increased (AFAB: BMD mean difference, 0.09 g/cm2 [95% CI, 0.07-0.10 g/cm2]; AMAB: BMD mean difference, 0.13 g/cm2 [95% CI, 0.10-0.16 g/cm2]), with partial z-score recovery; values remained below baseline at T2 (AFAB: z-score change, -0.51 [95% CI, -0.69 to -0.34]; AMAB: z-score change, -0.52 [95% CI, -0.82 to -0.21]) but were not consistently statistically different across skeletal sites. Recovery at the total hip and femoral neck was smaller and more heterogeneous. Higher body mass index, shorter GnRHa duration, and longer GAHT exposure were associated with more favorable outcomes. This systematic review and meta-analysis found that pubertal suppression followed by GAHT was associated with transient z-score reductions and subsequent BMD increases. At T2, z scores remained numerically below baseline but were not consistently statistically different, suggesting an uncertain rather than demonstrated persistent deficit. Timely GAHT initiation is recommended.
To evaluate the diagnostic performance of a novel CT upper gastrointestinal (UGI) protocol for detecting gastroduodenal leaks in patients who would typically undergo fluoroscopic UGI (fUGI). In this retrospective cohort study, adult patients undergoing CT UGI between June 2022 and September 2025 were included. The protocol involved biphasic positive oral contrast administration 30 min and immediately prior to CT scanning in supine and right lateral decubitus positions. Study indication and CT findings were documented retrospectively; surgical findings and clinical follow-up served as reference standards. Sensitivity, specificity, PPV, and NPV were calculated. Mann-Whitney U tests compared length of stay (LOS) and imaging utilization by leak status. One hundred fifty-seven patients (184 exams; mean age 62.8 ± 13.8 years; 86 females) were included; 93% of exams were performed for suspected leak. Sensitivity, specificity, PPV, and NPV were 87%, 98%, 92%, and 97%, respectively. Among positive exams (36/184, 20%), extraluminal contrast, gas, and fluid collection were present in 75%, 78%, and 72% of cases versus 0%, 44%, and 24% in negative exams. Patients with confirmed leaks had significantly longer median LOS (26 vs. 8 days, p < 0.001) and greater imaging utilization (median 12 vs. 4 exams, p < 0.001). This CT UGI protocol demonstrates high specificity and NPV for gastroduodenal leak detection, supporting its utility for both suspected and routine postoperative leak evaluation.
Microwave (MW) drying offers rapid processing but poses challenges in controlling thermal exposure, which can degrade heat-sensitive bioactive compounds such as ascorbic acid (AA) and anthocyanins. Although conventional and hybrid MW configurations have been explored, real-time temperature-based power modulation remains underexplored as a strategy to balance drying efficiency and bioactive retention. This study evaluated a temperature-controlled MW drying mode (Tcon), in which magnetron power was dynamically regulated via infrared thermography surface feedback, and compared it against conventional MW, fluidized-bed (FB), and hybrid FB-MW configurations for drying acerola (Malpighia emarginata). Drying kinetics, drying rate, and thermal histories were assessed alongside the retention of total polyphenol content (TPC), antioxidant capacity (2,2-diphenyl-1-picrylhydrazyl), anthocyanins, and AA. The Tcon mode achieved the shortest drying time among the treatments evaluated while maintaining moderate surface temperatures, and showed higher retention of TPC, antioxidant capacity, and AA compared to fixed-power MW and hybrid processes. Hybrid configurations accelerated drying relative to FB alone; however, longer residence times led to greater cumulative thermal exposure and reduced bioactive retention. These findings suggest that real-time infrared-based power modulation is a promising strategy for improving bioactive preservation during MW drying of thermally sensitive fruit products.
Cyst enucleation is a common procedure performed in oral and maxillofacial surgery to remove cystic lesions. Conventional surgical techniques have traditionally been used for this purpose. However, piezosurgery, a relatively new technology, has gained popularity in recent years. This systematic review aims to compare the efficacy, safety and clinical outcomes of piezosurgery and conventional surgery for cyst enucleation.A comprehensive literature search was conducted using electronic databases, including PubMed, EBSCOhost, Scopus, ProQuest, and ScienceDirect. Studies published from inception up to May 2023 were included. Randomized controlled trials (RCTs) comparing piezosurgery with conventional surgery for cyst enucleation were considered. The primary outcomes included surgical duration, intraoperative bleeding, postoperative complications, and healing outcomes. Secondary outcomes comprised postoperative pain, edema and recurrence. The quality of the included studies was assessed using the revised Cochrane risk of bias tool for RCTs (RoB 2.0).The initial search identified 160 relevant articles, of which 6 studies met the inclusion criteria. Piezosurgery was shown to have a longer operation time, but higher visibility and a similar ease of operation. Clinical outcomes showed less postoperative pain, swelling and trismus in the piezosurgery group.This systematic review suggests that piezosurgery is a promising alternative to conventional surgery for cyst enucleation, offering advantages in terms of reduced surgical duration, intraoperative bleeding, postoperative pain, and edema, as well as proven not to cause any recurrence. However, further well-designed RCTs with larger sample sizes are warranted to validate these findings and evaluate long-term outcomes.
Hepatic artery infusion pump (HAIP) therapy has re-emerged as an important liver-directed treatment for colorectal liver metastases (CRLM), yet its integration into contemporary surgical workflows, including minimally invasive and combined procedures, remains incompletely characterized. We performed a retrospective analysis of patients undergoing HAIP placement between 2022 and 2024 at a multi-hospital academic health system. Nine patients were identified, including four who underwent synchronous colectomy. Operative time and length of stay were longer in synchronous cases (10h51min vs 8h56min; 7.0 vs 3.5 days), while a minimally invasive approach was utilized in 78% of cases and hepatectomy in two-thirds. No 30-day mortality or infectious complications were observed, and one Clavien-Dindo grade III complication occurred.This early implementation-focused experience demonstrates how HAIP therapy can be operationalized within a contemporary multi-hospital system through multidisciplinary patient selection, integration with minimally invasive surgery, and coordination of combined colorectal and liver procedures. These findings provide practical insights for centers seeking to develop similar HAIP programs.
Scaphoid fractures still have high rate of nonunion, mainly due to the tenuous blood supply and only primary bone healing. Rigid fixation facilitates this kind of bone healing and is considered as vital as protection of the blood supply. The optimal implant (screw) location should meet the requirements for researcher's biomechanical findings on fracture stability. Raw CT-scanned data of eight volunteers' wrists were imported into Mimics. The 3D scaphoid was segmented out and calculated, then opened in Geomagic Studio. Four fracture planes (proximal, oblique waist, horizontal waist and distal) simulating common broken scaphoid were created. Mimicking scaphoid implants (screws), the longest, the sub-longest, and central and eccentric cylinders perpendicular to each fracture plane were created. Whole and inside-fragmental length, and the relative location of each cylinder were measured and analyzed. The longest (28.5 ± 1.6 mm) cylinder was significantly longer than the sub-longest (25.4 ± 1.4 mm). Several eccentric perpendicular cylinders (so short or cutting out of the scaphoid) couldn't be created. Some proximal inside-fragmental lengths ranged from 3.0 to 5.1 mm. Several central perpendicular cylinders intersected with the longest one. Several central and eccentric perpendicular cylinders were outside of the proximal scaphoid non-contact region. The results of this study showed that scaphoid fracture images from CT scan can be calculated and yield the optimal implant location.
Return migration, whether voluntary or forced, can disrupt individuals' lives as they navigate life in a country that may feel unfamiliar. This disruption often extends to healthcare, including reproductive care. The migration experience, combined with differences between healthcare systems-in terms of availability, accessibility, and affordability-may create barriers to contraceptive access. This study utilizes data from the 2014, 2018, and 2023 National Survey of Demographic Dynamics (ENADID) surveys to analyze contraceptive use and access among female Mexican returnees. Findings indicate that returnees are more likely to use contraception than nonmigrants, particularly short-acting hormonal methods (SACs), while being less likely to rely on permanent methods. These patterns suggest that both migrant selectivity and adaptation shape contraceptive behavior. However, important differences emerge by time since return. Women who recently returned are less likely to use SACs and long-acting contraceptives and are more likely to obtain contraception from private clinics and pharmacies, compared to those with longer residence in Mexico. At the same time, there is little evidence that these patterns reflect shifts in fertility preferences. Instead, findings point more strongly to disruption and barriers to public healthcare following return. Overall, results highlight the need for reproductive healthcare interventions that better support return migrants during reintegration.
Migrants account for a substantial proportion of people living with HIV in Europe, yet inequalities across the HIV care continuum remain insufficiently characterized. We examined migration-related differences in HIV diagnosis, treatment initiation and retention in care in Greece. We analyzed data from the Athens Multicenter AIDS Cohort Study (AMACS), including individuals diagnosed with HIV between 1996 and 2024. Participants were classified by region of origin. Markers of HIV diagnosis (CD4 cell count, late presentation, advanced disease and time from seroconversion to diagnosis) and post-diagnosis outcomes (time to antiretroviral therapy [ART] initiation and loss to follow-up [LTFU]) were evaluated using appropriate regression and flexible parametric survival models. Among 11 467 individuals, 19.3% were migrants. Migrants presented with more advanced disease, including higher rates of late presentation (71.0% among those from Africa vs. 48.9% among Greek-born) and longer diagnostic delays (median 4.8 vs. 3.1 years, respectively). Over time, differences in late presentation narrowed, although advanced disease and diagnostic delay remained higher among some groups. Time to ART initiation decreased substantially with attenuated differences between groups after adjustment for CD4 levels at diagnosis. In contrast, recorded LTFU in AMACS increased over time and remained higher among migrants, reaching 49% within 3 years among individuals from Africa compared with 12% among Greek-born. Inequalities in HIV care outcomes across region-of-origin groups in Greece persist but have shifted along the care continuum. While timely ART initiation has largely equalized, disparities remain in delayed diagnosis and recorded follow-up. Targeted strategies to mitigate observed inequalities are essential.
Persistent symptoms after a respiratory infection can impair daily life, as has been shown, for example, for "long COVID." In this study, we determined the frequency and impact of symptoms that persisted for 12 weeks or more after a respiratory infection. A further endpoint was health care utilization for such symptoms in the general population. A cross-sectional study was conducted within the population-based digital cohort DigiHero in Germany (DRKS00025600). 39.3% of invited participants responded by completing an online questionnaire. 46 915 adults were included in the analysis. Participants were asked about symptoms that persisted 12 weeks or longer after a respiratory infection between September 2024 and August 2025. 48.3% of participants (95% confidence interval: [47.9; 48.8]) reported having had at least one respiratory infection during the study period. Among them, 18.8% [18.3; 19.3] stated that they still had symptoms 12 weeks or more afterward. The frequency of persistent symptoms was higher in older persons (13.1% for ages 20 to 29, 21.4% for ages 60 to 69). Most (86.8%) of those affected reported at least moderate functional impairment, and 57.9% consulted a physician. The pathogen causing the original infection was known for 24.3% of those reporting persistent symptoms: there were 483 cases of SARS-CoV-2 infection, 102 of influenza, and 36 of RSV. The symptom duration, functional impairment, and symptom pattern were similar after infection with SARS-CoV-2 and influenza. The most common symptoms in all pathogen groups were impaired physical performance, shortness of breath, rapid exhaustion, and fatigue. Persistent symptoms after respiratory infections are common and similar across pathogens in frequency and severity.
An 80-year-old man was diagnosed with acute myeloid leukemia (AML), and molecular analysis identified FLT3-ITD, TKD mutations. Induction chemotherapy with daunorubicin plus cytarabine achieved hematological complete remission; however, extramedullary infiltration was detected in the skin and central nervous system. Due to this extramedullary disease, treatment with mitoxantrone plus high-dose cytarabine was administered, leading to systemic complete remission. Two cycles of the same regimen were then added. The patient relapsed 5 months later, at which time FLT3 mutations were no longer detectable by a companion diagnostic test. However, targeted sequencing analysis identified a novel FLT3-ITD positive minor clone. Treatment with venetoclax plus azacitidine was then started. The patient achieved complete remission and has remained relapse-free for more than 2 years. In this case, the FLT3 mutation companion diagnostic test result became spontaneously negative without FLT3-directed treatment, and the response to venetoclax plus azacitidine was favorable. This case highlights the importance of molecular testing not only at diagnosis but also at relapse for appropriate treatment selection.
Lung transplantation (LT) is the only definitive treatment for end-stage lung diseases; however, patients often experience psychiatric problems that can affect post-transplant recovery. Although postoperative delirium frequently occurs, its risk factors and influence on mortality are not well established. This study aimed to evaluate the incidence of LT-associated psychiatric issues and analyse the association of delirium with mortality. Retrospective cohort study. Patients who underwent LT between January 2013 and March 2023. We reviewed the incidence of psychiatric conditions before and after LT. Logistic regression analysis identified risk factors for postoperative delirium, and survival analysis was conducted. Pre-transplant psychiatric assessments revealed mild anxiety and depression among 398 patients. Notably, 45% of patients experienced delirium after LT. Patients with a higher body mass index (BMI), longer operation duration and high Beck Anxiety Inventory scores exhibited an increased risk of postoperative delirium. Furthermore, patients who developed postoperative delirium had a higher 2- and 5-year mortality rate. The findings revealed that pre-transplant anxiety, high BMI and prolonged operative duration increase the risk of postoperative delirium risk, which in turn affects long-term mortality. Comprehensive psychiatric evaluation and targeted management are essential for improving post-transplant outcomes.