Journal of Clinical Medicine

Hypospadias, a common congenital anomaly requiring surgical correction, has seen growing research in surgical techniques and outcomes. However, no comprehensive bibliometric or disruption-based analysis exists to map the fields evolution. This study uses bibliometrics and the Disruption Index (DI) to identify key transformational research in hypospadias. A systematic search of five databases (PubMed, Web of Science, ScienceDirect, Scopus, and Dimensions) from January 1990 to December 2023 was conducted, yielding 7,732 articles. After applying inclusion criteria, 200 studies were analyzed. Citation data and DI scores were calculated using OpenCitations. Spearmans rank test assessed correlations between DI and citation metrics. A subgroup analysis identified trends based on the latest hypospadias research priorities. The mean citation count was 72.3 (SD = 43.1) with a mean DI of 0.011 (SD = 0.17). Five studies, focusing on complications, analgesia, and surgical techniques, had the highest DI (1.0). A moderate positive correlation was found between DI and citation rate ({rho} = 0.405, p < 0.001). Subgroup analysis showed most research focused on surgical techniques (30.5%) and etiology (25.8%), while areas like surgical training (2.6%) and innovation (0%) were underrepresented. This study identifies critical gaps in hypospadias research. The DI reveals influential studies that redirect research trajectories. Future work should focus on innovation and translational research to accelerate advancements in hypospadias care.

Objectives: Accurate assessment of orthognathic surgical accuracy is essential in the evaluation of operative techniques. Surgical accuracy is often reported as rotational and translational deviations from planned positions. This results in 6 separate values, translation in three planes, anterior-posterior (AP), superior-inferior (SI) and medial-lateral (ML) and rotations about three axes, pitch, roll and yaw. However, rotations will influence 3-dimensional positions and translational discrepancies. Methods: We have derived a mathematical formula using Euclidean geometry and quadratic functions that quantifies the impact of rotations on translational discrepancies. This allows for the calculation of a total discrepancy value that incorporates the three translations and rotations. Furthermore, we developed an interactive web-based application using the open-source shiny R package. Results: We have successfully reduced equations from Euclidean geometry into a quadratic form. The equation is as follows, [4(sin{theta}/2)2-2]x2 + [8d(sin{theta}/2)2-2d]x + 4d2(sin{theta}/2)2 = 0, where {theta} represents the rotational discrepancy in radians and d represents the translation discrepancy. This allows us to solve for the correction needed to be made to translational discrepancies to account for the influence of rotational discrepancies. We successfully developed a web application with a user-friendly graphical user interface. Clinicians upload their own data in the excel (.xlsx) file format and the application automatically performs the necessary calculations over many patients, returning a downloadable table of results. Conclusion: We present a mathematical formula incorporated into a web-application to combine translational and rotational discrepancies for deeper insight when evaluating orthognathic surgical accuracy. Clinical Relevance: This allows surgeons to account for rotational influence on 3-dimensional translational discrepancies.

The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI Clinical Practice Guidelines (CPGs) can assist clinicians in making a proper diagnosis, and guide them to the most appropriate therapy for every case. The aim of this study was to identify and evaluate the quality of CPGs for the diagnosis, emergency management and follow-up of TDIs. A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. T-student or ANOVA tests were used to determine the attributes of CPGs associated with the total score in AGREE II. Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n=6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91-0.97). The mean scores for each domain were as follows: Scope and purpose 78.0 {+/-} 18.9%; Stakeholder involvement 46.9 {+/-} 29.6%; Rigour of development 41.8 {+/-} 26.7%; Clarity of presentation 75.8 {+/-} 17.6%; Applicability 15.3 {+/-} 18.8% and Editorial independence 41.7 {+/-} 41.7%. The overall mean rate was 4 {+/-} 1.3 out of a maximum score of 7. Only two guidelines were recommended by the reviewers and rated as high quality. The CPGs developed by governments showed a significantly higher overall score. The overall quality of CPGs on TDI was suboptimal. Therefore, the CPGs developers need to use a methodology that allows them to formulate recommendations in a structured, transparent, and explicit way.

Objectivethe biomarkers performance for diagnosis and severity stratification of sepsis has not been properly evaluated anew using the SEPSIS-3 criteria introduced in 2016. We evaluated the accuracy of 21 biomarkers classically tested in sepsis research to identify infection, sepsis, and septic shock in surgical patients classified using SEPSIS-3. Methodsfour groups of adult surgical patients were compared: post-surgical patients with no infection, patients with infection but no sepsis, patients with sepsis, and patients with septic shock were recruited prospectively from the surgery departments and surgical ICUs from four Spanish hospital. The area under the curve (AUC) to differentiate between groups was calculated for each biomarker. ResultsA total of 187 patients were recruited (50 uninfected post-surgery controls, 50 patients with infection, 47 with sepsis and 40 with septic shock). The AUCs indicated that none of the biomarkers tested was accurate enough to differentiate those patients with infection from the uninfected controls. In contrast, procalcitonin, lipocalin 2, pentraxin 3, IL-15, TNF-, IL-6, angiopoietin 2, TREM-1, D-dimer and C-reactive protein yielded AUCs > 0.80 to discriminate the patients with sepsis or septic shock from those with no infection. C-reactive protein and IL-6 were the most accurate markers to differentiate plain infection from sepsis (AUC = 0.82). Finally, our results revealed that sepsis and septic shock shared similar profiles of biomarkers. ConclusionRevaluation in the "SEPSIS-3 era" identified the scenarios where biomarkers do and do not provide useful information to improve the management of surgical patients with infection or sepsis.

Over the last few decades, there has been a significant increase in the number of patients seeking orthodontic treatment due to the esthetics of clear aligners. However, clear aligners rely on accurate tracking and if not achieved, can lead to frustrations. Data from 60 comprehensive clear aligner patients were analyzed. The OrthoFX Rescue Aligner intervened in the cases that were not tracking to get the patient back on track. The Rescue Aligner is designed to quickly and cost-effectively correct treatment lag up to a four to eight weeks deviation. The hyper elastic rescue aligners could produce movement ranges up to at least 0.5mm per tray. This retrospective study indicates the potential for further prospective clinical and laboratory studies with improved methods such as 3D superimposition, remote monitoring as well as calibrated inter and intra observer visual inspection methods for better assessment on tracking of each tooth per aligner.

ObjectivesThe vestibular implant is a neuroprosthesis that may offer a promising treatment for patients with severe bilateral vestibulopathy (BVP). This study explored the impact of different vestibular stimulation modes on gait and balance outcomes. It was expected that stimulation modes incorporating head motion-modulated input (modes A and B) would result in more favourable gait and balance outcomes compared to non-modulated baseline stimulation or no stimulation. MethodsThe VertiGo! trial is a randomized controlled crossover study. The trial includes nine participants with severe BVP who received a vestibular implant. In this triple-blinded sub-study, balance and gait variability were assessed during four testing weeks, the first providing a reference (no stimulation) followed by three weeks each with four days of stimulation: (A) baseline stimulation with head motion-modulation; (B) reduced baseline stimulation with head motion-modulation, and (C) baseline stimulation without modulation. Participants walked at different walking speeds (0.6, 0.8, and 1.0m/s) on an instrumented treadmill integrated in a 6-degree of freedom motion platform. Different walking conditions were evaluated (unperturbed, three levels of mediolateral platform sway and darkness). Coefficients of variation of spatiotemporal step parameters were analysed using 3D motion capture. Participants also completed the Mini-Balance Evaluation Systems Test (Mini-BESTest) once during the reference week and twice (day 1 and day 4) of each stimulation period. ResultsThere were no clear indications across the participants that stimulation modes A and B (compared to either mode C or no stimulation) were uniformly beneficial for either step time CoV after three days of stimulation or Mini-BESTest scores after four days of stimulation (though some individuals did demonstrate this pattern). Mini-BESTest scores significantly improved between day one and day four of stimulation. ConclusionsFour days of VCI stimulation appears to affect gait variability and balance (as measured by the Mini-BESTest) but effects vary between individuals and no consistent effect of stimulation mode across participants and walking conditions was found. Balance improved from day one to day four of stimulation (without a significant learning effect over all seven clinical balance assessments), indicating the importance of habituation to vestibular implant stimulation before beneficial functional outcomes can be expected.

Hemodynamic instability may develop in patients with acute pulmonary embolism (PE) days after the emboli event. Simplified methods to predict clinical deterioration are currently lacking. This retrospective cohort study included patients diagnosed with acute. The aim is to develop a simplified imaging model with good clinical accessibility to predict the clinical deterioration of patients with acute PE. This study included patients with acute PE under the International Classification of Disease, ninth or tenth revision. Seven models based on computed tomography pulmonary angiography (CTPA) were developed based on the location (central versus peripheral) and the degree (nearly total versus partial) of obstruction. The outcome includes clinical deterioration, which is defined as death from PE, cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, thrombolysis, catheter-directed therapy, and surgical embolectomy. Logistic regression analysis was used to test the association between different models and clinical deterioration. The area under the receiver operating characteristic curve (AUC) was used to test the predictive ability. The category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to quantify the improvement of the proposed models plus the simplified Pulmonary Severity Index (sPESI) compared with the sPESI alone. Calculating the nearly totally obstructed 20 peripheral arteries provides good predictive ability in the seven models (AUC: 0.77). Calculating nearly totally obstructed 20 peripheral segments can predict clinical deterioration. Obstruction on CTPA combined with the sPESI increased the ability to predict clinical deterioration compared to the sPESI alone and may be used as guidance in clinical decision-making. Clinical perspectiveA simple model based on computed tomography pulmonary angiography (CTPA) to predict clinical deterioration in patients with acute pulmonary embolism (PE) is currently lacking. This retrospective study included 210 patients and used the model for calculating the nearly totally obstructed segmental pulmonary arteries as an efficient and simple method to predict clinical deterioration. This model added to the simplified PE severity index (sPESI) has an increased predictive ability compared to the sPESI alone. CTPA images can predict the clinical deterioration of patients with acute PE and may assist in clinical decision-making.

IntroductionMedicare Part B reimbursement data has been thoroughly evaluated in several surgical subspecialties to date, with significant ramifications for continued policy research and payment reform discussions. However, trends in maxillofacial surgery payment remain unstudied. MethodsIn this cross-sectional study of Part B reimbursement data, we analyzed regional trends in reimbursement for common maxillofacial repair and reconstruction procedures (N=17). All payment data converted to January 2019 United States dollars. ResultsFrom 2010 to 2019, fees for maxillofacial surgery evidenced strong region- and procedures-specific changes. After adjusting for inflation, the Southern United States reported an unweighted mean change in Medicare reimbursement of negative 12.59% (SD = 2.63%), while the Western United States reported an unweighted mean change in Medicare reimbursement of +0.08% (SD = 2.82%). In the Midwest, only Part B billing for reconstruction of the mandibular rami and/or body without internal rigid fixation (CPT code 21195) kept up with inflation. In the West, 8 CPT codes (47%) kept up with inflation: 21422, 21246, 21196, 21195, 21194, 21193, 21048, and 21046. In the Northeast and the South, all analyzed procedures reported decreased reimbursement rates after adjusting for inflation. ConclusionReimbursement for maxillofacial surgery has lagged behind inflation with pronounced regional bias.

The Contact Surface Area (CSA) is a predictor for peri-operative parameters and represent the contact area between the tumor and the respective organ. Nowadays, a precise method for calculating CSA is yet to be found in the literature. We tested a new CSA calculation method as a predictor of intra-operative parameters in robot assisted partial nephrectomy (RAPN). The study population consisted of all consecutive patients treated with RAPN at a single high-volume European institution (between 2020 to 2023; 82 patients). We proposed a new method to measure the real value of CSA using an algorithm that leverages the geometry of kidneys and tumors obtained from 3D reconstruction. These reconstructions were obtained using the certified medical software Materialized Mimics InPrint. Peri-operative parameters of patients were recorded in an anonymous database. We explored the correlation between RCSA, CSA of Hsieh (HCSA), PADUA and R.E.N.A.L. scores with peri-operative parameters using Spearmans correlation. Furthermore, we examined which of RCSA, PADUA and R.E.N.A.L. score better describes the intra-operative parameters, Warm Ischemia Time (WIT), Operating Time (OT), and Estimated Blood Loss (EBL) using Receiver Operating Characteristic (ROC) curve analysis. Multivariable linear regression analyses were performed. We observed a significant correlation between RCSA and WIT, OT and EBL. Moreover, RCSA outperformed both the PADUA and R.E.N.A.L. score as demonstrated in the ROC curve analysis. In ROC analysis was chosen a threshold for each of the parameters: for WIT 20 minutes, for OT 180 minutes and for EBL 200 mL. At multivariable regression analysis, RCSA emerged as the only independent predictor for WIT, OT and EBL (B=0.39 & p=0.03, B=0.35 & p=0.01, B=0.48 & p<0.001, respectively). Our original and effective 3D RCSA calculation method was favorably associated to intra-operative surgical outcomes. As compared to PADUA and RENAL score, our calculated RCSA represented a better predictor of intra-operative parameters.

IntroductionVestibular schwannomas (VSs) are benign tumors of the vestibulocochlear nerve that often cause significant neurological and functional impairment, affecting patients overall quality of life (QoL). While clinical assessments have traditionally focused on hearing preservation and tumor control, patients often emphasize other critical symptoms such as dizziness, pain, cognitive difficulties and satisfaction with care. Therefore, patient-centered care that addresses the full range of patient experiences is essential. Despite its importance, patientcentered care in VS remains underexplored. This study will address this gap by psychometrically validating the German version of the Vestibular Schwannoma Quality of Life (VSQOL) Index, a newly developed QoL tool that includes key patient-centered domains. The primary objective is to validate the reliability and validity of the German VSQOL Index. The secondary aim is to assess VS patients experience of patient-centered care and its impact on their well-being. Methods and analysisThis multicenter, cross-sectional study will involve German-speaking VS patients from several clinical centers in Germany and Switzerland as well as an online cohort. Psychometric testing of the German VSQOL will include reliability assessments (e.g. Cronbachs alpha, test-retest reliability), confirmatory factor analysis and convergent validity. In parallel, the study will assess patient-centered experiences of care using the EPAT questionnaire. DiscussionEthical approval has been obtained and all participants will be asked to provide written informed consent. The results will be shared through scientific publications and conferences, as well as with patient groups, in order to support improvements in clinical care. By validating the German version of the VSQOL Index, this study will provide clinicians with a reliable tool for capturing patient-reported outcomes in VS, including symptoms that are often overlooked in standard assessments. Using the EPAT questionnaire alongside the VSQOL Index will provide insight into the relationship between patient experiences of care and quality of life. Together, these findings will support the delivery of more patient-centred and needs-oriented care in clinical practice and future research.

Study design A retrospective case control study Objective To predict proximal junctional kyphosis (PJK) risk by normalizing individual vertebral bone strength using the ratio of vertebral Hounsfield unit (HU) values around the upper instrumented vertebrae (UIV). Summary of background data PJK poses a significant challenge in treating patients after adult spinal deformity (ASD) surgery. While the vertebral body HU value is associated with PJK risk, the optimal threshold remains unclear, and a relative assessment of HU values within individuals has not been conducted. Methods Data on patients who underwent corrective fusion of the middle to lower thoracic region of the pelvis for ASD were assessed. The 126 patients were categorized into PJK and non-PJK groups. We compared the patients' backgrounds, vertebral body HU, and junctional HU ratio, defined as the HU value of UIV+1 divided by the HU value of UIV (HUUIV+1/HUUIV). The UIV+2/UIV+1 HU ratio was calculated similarly. Results The PJK and non-PJK groups included 30 and 96 patients, respectively. After propensity score matching, 28 patients from each group were analyzed. HU values at UIV+2 and UIV+1 (117.0 {+/-} 46.6 vs 145.1 {+/-} 45.9, p=0.018, and 105.5 {+/-} 36.2 vs 147.3 {+/-} 44.9, p<0.001, respectively) were lower in the PJK group. Junctional HU ratio was significantly lower in the PJK group (0.88 {+/-} 0.18 vs 1.13 {+/-} 0.25, p<0.001), and receiver operating characteristic analysis showed that the junctional HU ratio had the highest discriminative ability (area under the curve 0.812). At the optimal cutoff value (HU ratio of 0.905), the sensitivity and specificity for PJK were 64.3% and 89.3%, respectively. Conclusions A low junctional HU ratio was strongly associated with PJK after ASD surgery. This parameter reflects the bone strength mismatch at the proximal junction and may help improve preoperative risk assessment and UIV selection.

BackgroundEndoscopic sinus surgery (ESS) continues to be widely used as a treatment for refractory chronic rhinosinusitis (CRS). With advancements in technology and surgical technique, we might expect fewer surgical complications to occur in the modern era as compared to established rates that are often quoted in the literature and patient counseling. MethodsWe queried the TriNetX Research Network (2010-2023) for ESS complications (cerebrospinal fluid (CSF) leak, orbital injury, epistaxis event, ER visit, stroke, MI, thromboembolic event, 30-day mortality) by ICD and CPT codes in timeframes consistent with prior literature. Complication rates and IGS trends were evaluated over time (2010-2016 vs 2017-2023) and age groups (pediatric <12, adolescent (12-17), and adult >18-<65). ResultsOverall rate of major complications of CSF leak and orbital injury was similar or slightly better than prior reports, but epistaxis and other perioperative complications were higher than anticipated (>1%) and might deserve additional attention in preoperative counseling and perioperative care. IGS use increased over time and was associated with lower CSF leak rates (0.8 vs. 0.95%, p = 0.003), increased epistaxis rates (2.5 vs. 2.1%, p < 0.0001), and no significant difference in orbital injury. CSF leak was higher in patients under 18 (p <0.001), while adults had higher rates of epistaxis (p = 0.007). ConclusionComplications from ESS remain low. But, increasing epistaxis and other perioperative complications are notable and may result from worsened overall population health. IGS use has increased with time and is associated with a decreased risk of CSF leak.

Bladder cancer is one of the most frequent cancers of the urinary tract, associated with high recurrence rates and metastasis. Cancer stem cells (CSCs) are a subpopulation of cancer cells characterized by high self-renewal and differentiation capacities, resulting in increased cancer recurrence, larger tumor size, higher rates of metastasis, higher resistance to treatment, and overall poorer prognosis. This study aimed to evaluate the role of CSCs as a prognostic tool to predict the risks of metastasis and recurrence in bladder cancer. A literature search was conducted across seven databases from January 2000 to February 2022 for clinical studies investigating the use of CSCs to determine the prognosis of bladder cancer. The following keywords were used: ("Bladder Cancer" OR "Transitional Cell Carcinoma" OR "Urothelial Carcinoma") AND ("Stem Cell" OR "Stem Gene") AND ("Metastasis" OR "Recurrence"). A total of 12 studies were deemed eligible for inclusion. SOX2, IGF1R, SOX4, ALDH1, CD44, Cripto-1, OCT4, ARRB1, ARRB2, p-TFCP2L1, CDK1, DCLK1, and NANOG, which were all identified as CSC markers, have been implicated in the recurrence and metastasis of tumor in bladder cancer, which played a role as prognostic factor of bladder cancer. Given the pluripotent and highly proliferative properties of CSCs. CSCs may play a role in the complex biological behavior of bladder cancer, including, but not limited to, its high rates of recurrence, metastasis, and resistance to treatment. The detection of cancer stem cell markers offers a promising approach in determining the prognosis of bladder cancer. Further studies in this area are thus warranted and may contribute significantly to the overall management of bladder cancer.

Venous thromboembolism (VTE), major adverse cardiovascular events (MACE), neoplasia, and serious infections are significant complications associated with Immune-mediated inflammatory diseases. Actually, the occurrence of such complications in these patients has been observed to be higher than that anticipated from classical risk factors alone. Additionally, the administration of anti-inflammatory treatments, such as corticosteroids, associated to inflammatory diseases is recognized to further elevate this risk. In Spain, data on the prevalence of risk of cardiovascular events, neoplasia or serious infections, particularly among individuals with ulcerative colitis are scarce. This study leverages real-world data from the Andalusian Health Population Database (BPS) to analyze the incidence and risk factors of these complications among ulcerative colitis patients. A cohort of 23,518 patients, aged 18 years or older, with an ulcerative colitis diagnosis between 2010 and 2019, was used in the study. The objective was to assess the incidence of VTE, MACE, neoplasms, and serious infections and to evaluate the impact of age and other factors related to ulcerative colitis on these outcomes. The study revealed a notably higher incidence of VTE and MACE in ulcerative colitis patients compared to the incidence described for the general population, particularly among those over 60 years of age. Specifically, the incidence of VTE was significantly elevated post-diagnosis, with deep vein thrombosis (DVT) and pulmonary embolism, being the most common manifestations. MACE, including myocardial infarction and stroke, also presented a higher risk, especially in older patients. Also, a significant portion of patients developed various malignancies. Also remarkable is the significant higher incidence of VTE, malignancies and serious infections as the severity of ulcerative colitis increases. The use of immunosuppressive therapies was associated with an increased risk of infections, and likely with VTE and malignancies, further complicating the management of these patients. The findings of this study underscore the need for heightened vigilance in the management of ulcerative colitis patients, particularly those at advanced ages. Preventive strategies, such as thromboprophylaxis during hospitalization and regular monitoring for cardiovascular and neoplastic complications, are essential. The study contributes valuable insights into the burden of comorbidities in ulcerative colitis and highlights the importance of tailored treatment and monitoring strategies to improve patient outcomes.

Study objectiveSleeve gastrectomy is effective in morbid obesity, and it improves glucose homeostasis. In gastric cancer patients with type 2 diabetes mellitus, gastrectomy, including total gastrectomy (TG), is beneficial for glycaemic control. However, the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative diabetes in gastric cancer patients are unclear. This study investigated the development of new-onset diabetes in these patients, focusing on different reconstruction methods. DesignA comparative study SettingElectrical medical records PatientsThis study included 715 patients without diabetes who underwent TG at Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019. InterventionsPatients underwent reconstruction by Roux-en-Y (RY) or other surgical techniques (OT), with diabetes onset determined by HbA1c levels or medical records. MeasurementsAnalyses included two-sample t-tests, chi-squared tests, and the Kaplan-Meier method with log-rank tests to compare the onset curves between the two groups. Main ResultsStratified data analysis compared the RY and OT reconstruction methods. Log-rank test results (P=0.0217) indicated a statistically significant difference in the incidence of new-onset diabetes between RY and OT groups in gastric cancer patients. ConclusionThis first-of-its-kind study provides insight into how different methods of gastric reconstruction affect postoperative diabetes. The results suggest significant differences in new-onset diabetes mellitus after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative diabetes, particularly in patients with a family history of diabetes mellitus. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative diabetes.

BackgroundAcute kidney injury (AKI) is a significant complication in pediatric patients undergoing cardiac surgery. Iron metabolism-related indicators such as ferritin may predict AKI after adult cardiac surgery. However, it remains unclear whether ferritin can be used as a predictor of AKI after pediatric cardiac surgery. This study aims to investigate the association between preoperative serum ferritin levels and the risk of AKI in pediatric population. MethodsA prospective observational cohort study included 6088 pediatric patients (aged <16 years) who underwent cardiac surgery between 2022 and 2023 in Fuwai hospital. Preoperative serum ferritin levels were measured. The primary outcome was the occurrence of AKI within 7 days postoperatively, diagnosed per KDIGO criteria. Secondary outcomes included severe AKI (KDIGO stages 2 and 3), postoperative dialysis, and in-hospital mortality. ResultsThe preoperative serum ferritin demonstrated a J-shaped association with the occurrence of AKI. Categorically, higher serum ferritin levels (>300 g/L, 150-300 g/L and 80.6-150 g/L) significantly increased the risk of AKI compared to lower level (40-80.6 g/L) (adjusted OR, 3.468; 95% CI, 1.911-6.291; adjusted OR, 3.142; 95% CI, 2.037-4.8451; and adjusted OR, 1.880; 95% CI, 1.299-2.495; respectively). The risk of stage 2 and stage 3 AKI significantly increased with higher serum ferritin categories compared to lower level (adjusted OR, 4.428; 95% CI, 1.631-12.026; adjusted OR, 3.707; 95% CI, 1.710-8.035; and adjusted OR, 2.345; 95% CI, 1.220-4.505; respectively). As a continuous variable, consistent with categorical variables, elevated serum ferritin levels (>80.6g/L) independently predicted AKI (adjusted OR, 1.001; 95% CI, 1.000-1.002). ConclusionsThis study highlights the importance of preoperative serum ferritin levels in predicting AKI risk in pediatric patients undergoing cardiac surgery. Further research is warranted to elucidate the underlying mechanisms and explore the therapeutic implications of ferritin monitoring in clinical practice. RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT05489263. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSAn important role for iron metabolism in the pathogenesis of AKI has long been appreciated. Inflammatory factors and hemodynamic and the release of labile iron, contributing to oxidation from reactive oxygen species are among the major determinants of CSA-AKI. This study highlights the importance of preoperative serum ferritin levels in predicting AKI risk in pediatric patients undergoing cardiac surgery. In this prospective observational cohort study included 3703 pediatric patients, who developed AKI had significantly higher concentrations of preoperative serum ferritin. The elevated serum ferritin levels exceeding 80.6g/L were significantly correlated with AKI and severe AKI. This study highlights elevated preoperative serum ferritin level is an early warning indicator of CSA-AKI. What Are the Clinical Implications?Among pediatric patients undergoing cardiac surgery, serum creatine delayed diagnose of AKI. This study is the first to establish a relationship between elevated serum ferritin levels and CSA-AKI in a substantial pediatric population, thereby offering novel insights into AKI mechanisms within this demographic. Early elevation of serum ferritin may serve as an early warning sign for AKI development in pediatric patients, with implications for utilizing ferritin as a biomarker to stratify AKI risk and exploring iron chelation therapy as a preventive measure. Abbreviated legend for Central Picture O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=173 SRC="FIGDIR/small/24319197v1_ufig1.gif" ALT="Figure 1"> O_LINKSMALLFIG WIDTH=200 HEIGHT=10 SRC="FIGDIR/small/24319197v1_ufig1a.gif" ALT="Figure 1"> View larger version (18K): org.highwire.dtl.DTLVardef@6a2ff0org.highwire.dtl.DTLVardef@1716910org.highwire.dtl.DTLVardef@a8d6b3org.highwire.dtl.DTLVardef@a79dce_HPS_FORMAT_FIGEXP M_FIG C_FIG

AimsThe European Society of Cardiology (ESC) has proposed four pre-test probability (PTP) models for obstructive coronary artery disease (CAD). However, no studies have evaluated the diagnostic performance of any predictive model in the Latin American population. The aim of this study is to compare the PTP2013 and PTP2019 predictive models in order to determine which demonstrates a superior diagnostic performance for CAD in a cohort of Colombian patients. MethodsA total of 408 patients who presented with chest pain and underwent coronary angiography (CA) and/or coronary computed tomography angiography (CCTA) at Fundacion Santa Fe de Bogota, between January 2019 and December 2023 were enrolled. Medical records were retrieved from the Hemodynamics and Radiology units. Pre-test probabilities were calculated for each patient using both the PTP2013 and PTP2019 models. CAD was defined as >50% stenosis on CA or CCTA. Each predictive model was assessed against CA and/or CCTA findings. The comparative performance of both models was evaluated. ResultsPrevalence of obstructive CAD of 24.9%. The PR2019 model underestimated the probability of CAD by 59%, whereas the PTP2013 model overestimated it by 35.6%. PTP2019 model yielded a C-statistic of 0.610 [95% CI: 0.544 - 0.676], while the PTP2013 model reported a C-statistic of 0.633 [95% CI: 0.570 - 0.696] (comparative p-value: 0.060). The net reclassification improvement was 14.7%). At a 15% threshold, the PTP2013 model demonstrated a sensitivity of 90% (82.38 - 95.10%), compared to 48% (37.9 - 58.22%) for the PTP2019 model. ConclusionThe PTP2013 model is favored, as it showed higher sensitivity and a tendency to overestimate risk, in contrast to the PTP2019 model, which exhibited a concerning underdiagnosis of CAD. Consequently, the methodological challenge of identifying the predictive model with the highest diagnostic performance remains, highlighting the need to develop a tailored prediction model for the local population.

Rising health care costs are influenced by health care utilization, which encompasses hospital, ambulatory and non-face-to-face episodes of care. In this study, we created a novel a health care utilization-scoring tool that was used to examine whether one psychosocial factor, intimate partner violence (IPV), leads to higher utilization of health care services when controlling for relevant confounders. We sought to fill gaps about how social and behavioral issues impact utilization--particularly non-face-to-face episodes of care. We conducted a retrospective cross-sectional study in 2017 examining patients seen at 11 University-affiliated primary care clinics from January 2015 to December 2016 who were screened for IPV. A total of 31,305 patients were screened, of which 280 screened positive. We controlled for medical complexity by deriving the revised Charlson Comorbidity Index for each patient. We calculated a novel utilization score, which was a weighted sum of hospital, ambulatory and non-face-to-face encounters. Missed appointments were also measured. IPV-positive and IPV-negative patients were similar with respect medical complexity. IPV-positive patients had significantly higher mean utilization scores (54 vs. 40, p<0.001) and more missed appointments (3 vs. 1.3, p<0.001). IPV was associated with increased total utilization (p=0.015), as well as non-face-to-face and ambulatory visits (p=0.025 and p=0.015, respectively) for female patients and was associated with more missed appointments for both males and females (p< .001). These data support more inclusive population-specific interventions focusing on social determinants of health to reduce both face-to-face and non-face-to-face utilization, which may improve health care expenditures, outcomes and provider satisfaction.

A potential beneficial effect of hyperbaric oxygen therapy (HBOT) on complaints of long COVID was found, leading to increased demand for this treatment despite many remaining clinical questions and lack of formal guideline recommendations and reimbursement. A registry was set up in order to gain more insight into patient characteristics and (long-term) outcomes of long COVID patients undergoing HBOT. Patient-reported outcome measures were collected at baseline, after treatment and at 3-month follow up. The primary outcome measures were the mental and physical component score (MCS/PCS) of the SF-36 questionnaire 3 months after HBOT. A clinically relevant positive or negative response was defined as an increase or decrease of [&ge;]10% in MCS and/or PCS after 3 months. Secondary outcomes included the EQ-5D, severity of complaints and ability to work. In this prospective registry of 232 long COVID patients, 65% of long term-ill patients had a clinically relevant increase in quality of life. However, 15% of the patients experienced deterioration in quality of life. Symptoms that showed most improvement were predominantly in the cognitive domain. This indicates that HBOT may have a positive effect on complaints of long COVID, but alertness for worsening of the condition should be exercised.

BackgroundAppendicular lean mass index (ALMI), a term used to describe appendicular lean soft tissue measured by dual-energy X-ray absorptiometry (DXA), is a major determinant of cardiorespiratory fitness in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Moreover, ALMI can be used to diagnose sarcopenia and sarcopenic obesity in this population. DXA is a reference standard for assessing body composition, however, segmental single-frequency bioelectrical impedance analysis (SF-BIA) could offer a more accessible, portable, cost-effective, and radiation-free alternative. To validate segmental SF-BIA for body composition analysis in patients with HFpEF and obesity, with a focus on ALMI. MethodsWe analyzed 62 consecutive euvolemic patients with persistent obesity-related HFpEF (83.8% female, 60.8{+/-} 2.8 years of age). We used both DXA and segmental SF-BIA to measure ALMI and appendicular fat mass index (AFMI), fat mass (FM), fat-free mass (FFM) in kg and as % of body weight, FM index, and FFM index. Correlations were assessed using Pearsons coefficients and Bland-Altman plots, while linear regression was performed to evaluate proportional bias. ResultsStrong, statistically significant correlations were found between BIA and DXA for ALMI (r=0.897), AFMI (r=0.864), FM (r=0.968), FM% (r=0.867), FFM (r=0.954), and FFM% (r=0.852), FM index (r=0.97), and FFM index (r=0.88) (all p<0.001). The Bland-Altman analysis demonstrated agreement between methods and linear regression indicated no significant proportional bias for all parameters, except for AFMI. ConclusionsSegmental SF-BIA-measured body composition shows strong correlations, appropriate agreements, and no proportional bias compared to DXA. Considering the central role of body composition and particularly of ALMI in patients with obesity-related HFpEF, when DXA is not readily available or contraindicated, segmental SF-BIA should be considered in this population.