Journal of Clinical Medicine

Background: Childhood and adolescent hearing loss affects not only communication and cognitive development but also motor skills and school participation. Consequently, it generates inequalities in learning and educational inclusion. Nevertheless, no systematic review has yet analyzed these differences from an inclusive education perspective. Methods: A systematic review with meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO. Observational studies comparing physical fitness between children and adolescents with hearing loss and their hearing peers were included. Methodological quality was assessed using the Newcastle--Ottawa Scale, and standardized effect sizes were calculated with a random-effects model. Results: Five studies (n=404) were analyzed. Findings revealed significant differences in strength, agility, speed, and balance. Moreover, the meta-analysis showed a large standardized effect favoring hearing children (ES=-2.35; 95% CI: -3.34 to -1.37). Conclusions: Children and adolescents with hearing loss present significantly lower physical fitness, which may affect the planning of physical education activities if their capacities are misinterpreted. Implementing inclusive and adapted strategies within the school curriculum is essential to ensure equal opportunities, improve physical fitness, and promote educational equity.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory airway disease associated with impaired mucociliary clearance and persistent inflammation. While prior work has focused on inflammatory and molecular pathways, the physicochemical properties of mucus itself remain poorly characterized. This study aimed to define compositional and biophysical features of CRS mucus that may contribute to dysfunction. Methods: A prospective cross-sectional study was conducted in 15 adults undergoing endoscopic sinus surgery (11 CRS, 4 controls). Mucus was collected from the middle meatus. Hydration was measured by lyophilization. Ionic composition was quantified using mass spectrometry. Viscoelasticity was assessed via oscillatory shear rheology. Total protein, total carbohydrate, sialic acid (Sia) and fucose (Fuc) content were quantified using enzymatic and chemical assays. Statistical comparisons were performed using nonparametric tests. Results: CRS mucus exhibited significantly higher Ca2+; and Mg2+; concentrations (approximately two-fold; p<0.05) and increased variability in hydration and ion content compared to controls. Rheology showed greater heterogeneity and a non-significant trend toward increased viscoelasticity in CRS. Total protein and carbohydrate content were not significantly different; however, the carbohydrate-to-protein ratio was significantly reduced in CRS (p=0.04). Sia content and Sia-to-carbohydrate ratio were significantly elevated in CRS (p=0.04 and p=0.002), particularly in CRS with nasal polyps. Fuc content did not differ between groups. Conclusions: CRS mucus demonstrates coordinated alterations in ionic composition and glycosylation, characterized by increased cation content, hypersialylation, and reduced carbohydrate-to-protein ratios. These changes may contribute to altered mucus properties and impaired mucociliary clearance, highlighting mucus composition as a potential therapeutic target in CRS.

Background: Improved survival of adolescents with congenital heart disease has shifted the focus to examine health-related quality of life and address challenges in transition to adult care. We aim to describe how congenital heart disease complexity, gender, number of interventions, and Fontan circulation may affect the health-related quality of life and transition readiness of adolescents with congenital heart disease. Methods: We conducted a single-center cross-sectional study involving 536 patients aged 14 to 18 years old who attended a nurse-led, pediatric to adult care cardiac transition clinic, from 2020 to 2024. health-related quality of life was evaluated using the PedsQLTM 4.0 Generic Core Scales and the PedsQLTM 3.0 Cardiac Module. Patients were screened for anxiety and depression using the PHQ-9 and GAD-7. Transition readiness was assessed using the Transition-Q score. Results: The median age of patients was 16 years old and 44% self-identified as female. PedsQLTM 4.0 Generic had a median overall score of 77 (IQR 67?87), with no significant difference according to congenital heart disease severity. Female patients had significantly lower overall PedsQLTM 4.0 score (p=0.028) and lower physical and emotional functioning scores (p=0.005, p<0.001, respectively) when compared to males. Physical functioning scores were lower amongst patients with Fontan circulation compared to non-Fontan patients (p=0.003), although overall PedsQLTM 4.0 score and transition readiness scores were similar to those with complex biventricular congenital heart disease. Number of previous interventions were inversely associated with overall PedsQLTM 4.0 score (p=0.036). Moderate to severe symptoms of depression or anxiety were reported in 30% of screened patients and were associated with 2 significantly lower PedsQLTM 4.0 scores (p<0.001). Transition readiness was significantly lower in patients with moderate and complex compared to those with simple congenital heart disease (p<0.001). Transition readiness improved with repeat transition clinic visits (p=0.004) whereas PedsQLTM 4.0 score did not change significantly. Conclusion: In this large cohort of adolescents with congenital heart disease, health-related quality of life was lower than population norms. Female gender, higher interventional burden, and anxiety or depressive symptoms are associated with lower health-related quality of life scores rather than anatomical severity or Fontan physiology. Transition readiness was lower in complex disease; it has improved with a structured, nurse-led transition clinic, demonstrating modifiability. Consequently, adolescent congenital heart disease care requires a multidisciplinary approach including psychosocial screening, especially for high-risk groups, and structured transition planning to improve long-term outcomes.

Background: Complicated acute appendicitis carries a higher risk of postoperative morbidity relative to uncomplicated cases. It remains unclear whether surgical timing (night vs. day; weekend vs. weekday) or surgeon seniority influence short-term outcomes in this high-risk population. Methods: This was a retrospective analysis of the RIFT Turkey dataset restricted to histologically confirmed cases of complicated appendicitis who had undergone laparoscopic appendectomy. Primary exposures were surgical timing (day [n=92] vs. night [n=123]; weekday [n=172] vs. weekend [n=43]) and surgeon seniority (trainee [n=89] vs. consultant [n=126]). The primary outcome was unplanned readmission and/or reintervention within 60 days. Secondary outcomes were conversion to open surgery and length of stay (LOS) >3 days. Propensity score matching (PSM) using RIPASA score (caliper 0.05, SMD <0.1) was performed as a pre-specified sensitivity analysis for each comparison. Results: Night-time surgery was associated with higher frequencies of unplanned readmission / reintervention (12.2% vs. 6.5%; OR 1.99 [95% CI 0.74-5.35], p=0.166) and surgical conversion (9.8% vs. 3.3%; OR 3.21 [0.88-11.72], p=0.064) compared with daytime surgery, neither reaching significance. Trainee surgeons had significantly higher readmission/reintervention rates than consultants (15.7% vs. 5.6%; OR 0.32 [0.12-0.82], p=0.013). PSM-adjusted results also showed similar relationships: night vs. day (readmission OR 2.45 [0.85-7.03], p=0.09; conversion OR 2.84 [0.73-11.1], p=0.13), weekend vs. weekday (readmission OR 1.53 [0.24-9.72], p=0.65), and trainee vs. consultant (readmission OR 0.25 [0.08-0.79], p=0.013). Conclusion: Surgical timing was not significantly associated with short-term outcomes in complicated appendicitis, though night-time surgery showed a consistent trend towards higher complication rates. Surgeon seniority was the only factor independently and significantly associated with unplanned readmission and reintervention in both primary and PSM analyses, indicating the need for senior supervision during out-of-hours procedures. Keywords: complicated appendicitis; surgical timing; night surgery; weekend effect; surgeon seniority; propensity score matching; RIFT Turkey

Background: Olfactory dysfunction (OD) in children remains underdiagnosed and poorly characterised. Despite its known impacts on nutrition, quality of life, safety awareness, and psychosocial development, no standardised diagnostic or management pathway currently exists for paediatric OD. This study aimed to characterise global practice patterns and identify diagnostic and therapeutic challenges unique to paediatric care. Methodology/Principal: A 44-item cross-sectional online survey was distributed to a verified international network of paediatric otolaryngologists across 36 countries via a closed professional platform. The survey assessed five domains: diagnostic practices, management protocols, technology and innovation, education and training, and barriers to effective care. Regional grouping was used to facilitate meaningful statistical comparisons. Categorical variables were evaluated using chi-square tests, with odds ratios and 95% confidence intervals reported for significant findings. Results: Of 351 potential participants, 167 responded (47.6% response rate). Most respondents (83%) reported seeing children with OD, yet 95% saw fewer than ten such patients annually. Psychophysical testing was never performed by 54.8% of respondents, while 88.4% routinely ordered cross-sectional imaging. Testing frequency increased significantly with patient age (Cochran's Q p<0.001). The most common barriers to objective testing were insufficient training (44.3%), time constraints (29.9%), and funding limitations (28.1%). Multidisciplinary collaboration was negligible. Significant regional variation was observed across most practice domains. Conclusions: Paediatric OD care is characterised by functional underinvestigation, fragmented multidisciplinary collaboration, and systemic educational gaps. These findings support urgent development of standardised clinical guidelines, age-appropriate validated assessment tools, and formal interdisciplinary care pathways.

Background: Histological examination of mucosal tissue in inflammatory bowel diseases (IBD) is a sensitive tool to measure disease activity, and histological remission is emerging as a potentially important treatment target. There are several existing histopathological indices, but they often encompass caveats such as not primarily having been designed to measure the degree of inflammation, encompassing subjective components with poor intra- and interindividual reproducibility, and requiring expert pathologists who are scarce, thus resulting in extended response times. Aim: To construct a new computerized, automated index to objectively measure histological disease activity in the ileal and colonic mucosa, applicable to both Crohn's disease (CD) and ulcerative colitis (UC). Materials and methods: Ileocolonic biopsies were collected from control subjects and patients with CD or UC. A group of CD patients was sampled before and after 12 weeks of anti-TNF therapy. Another group of CD and UC patients functioned as a small validation cohort. Epithelial cells, neutrophils, macrophages, and T cells were immunohistochemically stained, followed by digitalization of the color signal and computerized delineation of the epithelial and lamina propria compartments. The various immune cell types within the epithelium and the lamina propria, respectively, were enumerated, and the numbers were compared between control subjects and patients with CD or UC. Results: The numbers of neutrophils and macrophages in the epithelium, and neutrophils in the lamina propria, showed the highest sensitivity and specificity for distinguishing control-subject tissues from CD and UC tissues. These three parameters were thus chosen to construct a new index, named QiC3 1.0, that could separate tissues from control subjects and patients with CD or UC with high precision. It performed equally well in a small validation cohort of patients. The QiC3 index correlated well with previously described histopathological indices, fecal calprotectin, and endoscopic scores in UC, but showed worse correlation with endoscopic scores in CD and symptomatic scores. When applying the new index to tissues from CD patients before and after therapy, it showed good responsiveness, demonstrating a distinct amelioration in the microscopic inflammatory status that corresponded well to improvements in histopathological scores. Conclusion: We describe a new quantitative, computerized, automated, non-subjective, and response-sensitive immunohistological index (QiC3) for measuring disease activity in ileal and colonic mucosal biopsies, suitable for both CD and UC.

Background Totally endoscopic aortic root (AR) surgery via right anterior minithoracotomy (RAMT) may reduce surgical trauma and accelerate recovery compared with full sternotomy (FS). However, the approach is technically demanding due to limited access and anatomical complexity. This study compares early clinical outcomes and quality of life (QoL) after RAMT versus FS to evaluate the feasibility and safety of the totally endoscopic approach. Methods This single-center, retrospective study included 149 patients underwent AR surgery via RAMT (n=74) or FS (n=75) between January 2021 and March 2026. Patients with aortic dissection, infective endocarditis, redo surgery, concomitant procedures, or arch replacement were excluded. Operative outcomes, postoperative recovery, 30-day and 1-year mortality were analyzed. QoL was assessed using the Short Form-8 (SF-8) questionnaire. Results The median age was 60.0 years, and 79.9% of patients were male. Bentall procedure was performed in 84.6% of patients, 15.4% underwent a David procedure. Compared with FS-AR, RAMT-AR was associated with shorter median operative time (147.0 vs. 178.0 min; p<0.001), lower median chest drainage volume (650.0 vs. 850.0 mL; p<0.001), and shorter median ICU stay (24.0 vs. 25.0 h; p=0.008) and hospital stay (6.0 vs. 8.0 days; p=0.028). Overall, 30-day and 1-year mortality was 0.7%. SF-8 analysis demonstrated significantly higher physical and mental component scores in RAMT-AR patients. Conclusion In specialized centers, totally endoscopic AR surgery via RAMT is a safe and feasible minimally invasive approach associated with favorable early outcomes and a potential benefit in postoperative physical and mental QoL by reducing surgical trauma.

Abstract Background: Management of high sagittal split fractures of the mandibular condyle remains a formidable surgical chal-lenge due to limited visualization, technical difficulties in direct in-situ fixation, and the high risk of secondary avascular necrosis or temporomandibular joint (TMJ) ankylosis. Objectives: To evaluate the clinical outcomes and technical efficacy of the "Motamed Technique, "a standardized protocol involving extracorporeal rigid internal fixation followed by anatomical re-implantation for complex high condylar split fractures. Methods: A retrospective evaluation was conducted on a clinical series of 11 consecutive patients (9 males, 2 females) presenting with severe, displaced high sagittal split condylar fractures secondary to high velocity trauma. In all cases, the fragmented condylar segments were completely retrieved, stabilized ex vivo on a back table using a titanium X-shaped 3D mini-plate system (1.5 mm), and meticulously reimplanted into the glenoid fossa. Total cold ischemia time was strictly maintained between 10 to 20 minutes. The postoperative longitudinal follow-up period ranged from 6 to 11 months (mean duration: 8.6 months). Comprehensive post-operative tracking included clinical parameter checking, 3D Computed Tomography (3D-CT), and high-resolution dynamic Magnetic Resonance Imaging (MRI) to analyze ony union, vertical ramus height restoration, and articular disc kinetics. Results: All 11 patients achieved predictable and stable functional outcomes. At the definitive milestones, the mean maximum mouth opening (MMO) was 37.3 mm (range, 33-45 mm), demonstrating excellent vertical clearance and stable lateral/protrusive excursions. Pre-traumatic stable centric occlusion was perfectly restored and maintained in 100% of cases (n=11), with zero incidence of postoperative open bite or crossbite. Facial nerve motor function was entirely pre-served across the cohort (100% House-Brackmann Grade I at final follow-up). Longitudinal 3D-CT scans confirmed complete osseous union and anatomical alignment in all cases by the 4th postoperative month, with no radiographic evidence of condylar head resorption or hardware failure. Follow-up MRI findings demonstrated the preservation of TMJ dynamics, functional articular disc movement (with stable reduction in 3 cases), and a total absence of avascular necrosis or intra-articular effusion. No cases of TMJ ankylosis were reported. Conclusion: The Motamed Technique provides a reliable, reproducible, and biologically sound approach for managing intricate high condylar split fractures. By utilizing systematic extracorporeal mini-fixation, this protocol effectively overcomes intraoperative spatial limitations while ensuring excellent long-term anatomical stability, stable occlusion, and functional joint mobility without compromising facial nerve integrity.

BACKGROUND & AIMS Conventional reusable endoscopes incur significant expenses in the form of purchase, maintenance, reprocessing, and disinfection. Reprocessing is frequently ineffective even following the use of high-level disinfectants (HLDs). Disposable gastroscopy might be a strategy to decrease infectious outbreaks associated with reusable endoscope. The aim of this study was to analyze and evaluate the performance, efficiency and safety in gastroscopy observation and subsequent potential EMR procedure via the disposable gastroscope in a clinical setting. METHODS Patients who required gastroscopies and met the criteria were recruited to this prospective, open-label, non-inferiority study. After obtaining the written informed content, the enrolled subjects selected themselves independently to the disposable group or reusable group. The primary measure was to evaluate the acceptable image quality and whether the disposable endoscope devices could meet the basic clinical demands with a noninferiority margin of -8%. The second measures were to analyze and evaluate the image conditions, accepted endoscopic maneuverability, efficiency and safety of observation and advanced potential EMR procedure. Appropriate statistical methods were conducted via PASS software and SAS 9.4. A two-tailed P value < 0.05 was considered statistically significant. RESULTS A total of 90 individuals (the number of those in disposable group and reusable group was both 45) were recruited to this study. The success rate of acceptable image quality via photographing iconic anatomical sites between two groups was 100.0% (45/45, 95% confidence interval (CI): 0.9213,1.0000) and the lower limit of the 95%CI (-7.8654%, 7.8654%) was larger than the noninferiority margin of -8% (Newcombe-Wilson score method). Significant differences were showed in the measures of image conditions (image acquisition, image quality, brightness, contrast and sharpness) and accepted endoscopic maneuverability (endoscopy body rigidity). No significant differences were observed in the field of knob operation, sharp angle adaptability, and the auxiliary features including air supply, water supply and suction. In terms of efficiency, the total operating time, insertion time and withdrawal time were longer in the disposable group. The En-bloc resection rate of those observed polyps and required to EMR procedure due to relatively larger diameter (5mm-15mm) was the same 100% in both groups (26/26 vs 23/23, 95%CI: 0.8713,1.0000). Nevertheless, the procedure time of EMR for each polyp was significantly longer in the disposable group. This study showed no intraoperative bleeding, delayed bleeding, perforation or other study-related adverse events among 90 patients. No dramatic fluctuations in vital signs were showed in perioperative period. CONCLUSIONS In consideration of the efficiency, efficacy and safety evaluation, the disposable gastroscopes might represent an alternative to conventional reusable gastroscopes in routine examination and endoscopic mucosal resection.

Background: Placenta accreta spectrum (PAS) is an important cause of severe maternal morbidity. Although prior cesarean delivery is a well-established risk factor, PAS also occurs in women without prior cesarean section (CS), in whom risk may be underestimated. This study evaluated routinely available clinical factors associated with PAS in this population and developed a clinical-history-based prediction model. Methods: We conducted a retrospective cohort study of women without prior CS who delivered at Peking University Third Hospital, China, from January 1, 2022, to December 31, 2023. PAS was diagnosed according to the 2019 International Federation of Gynecology and Obstetrics clinical and/or histopathological criteria. Multivariable logistic regression was used to identify independent risk factors. Model performance was assessed using receiver operating characteristic curves, calibration, decision curve analysis, and stratified 5-fold cross-validation. Analyses were repeated after stratification by placenta previa status. Results: Among 11,148 women without prior CS, 236 had PAS. Independent risk factors in the overall cohort were placenta previa, operative hysteroscopy, uterine curettage, in vitro fertilization, and multifetal pregnancy. The overall clinical prediction model showed an area under the curve of 0.838 (95% confidence interval, 0.81-0.87), with stable performance in internal validation. In stratified analyses, model discrimination was lower among women without placenta previa (area under the curve, 0.734) and those with placenta previa (area under the curve, 0.647). Conclusions: In this single-center cohort, routinely available clinical history was associated with PAS risk among women without prior CS. The proposed model may help identify patients who warrant targeted PAS imaging or specialist assessment, but external validation and integration with imaging features are needed before broad clinical implementation.

Background The use of Assisted Reproductive Technology (ART) is increasing worldwide. These treatments involve ovarian stimulation to enable multiple follicle recruitment, hence inducing supraphysiological estrogen levels. While most long-term follow-up of women undergoing ART has concerned cancer incidence, the long-term safety regarding cardiovascular and metabolic diseases remains under-explored. This study was performed to assess the risk of acute myocardial infarction, cerebral ischemic conditions, intracranial hemorrhage, type 2 diabetes mellitus, heart failure, aortic aneurysm or dissection, and chronic kidney disease in women that conceived with ART, and to investigate the role of the underlying infertility and its risk factors. Methods and Findings Swedish national registers allowed us to follow a nationwide cohort of 380,756 women from their first birth between 1992 and 2002 until the end of 2023. The safety of ART was evaluated by comparing women with infertility who conceived with and without ART, while adjusting for baseline differences in age, body mass index, country of origin, socioeconomic factors, pre-existing comorbidity, smoking and year. The role of infertility was additionally explored by comparing all women with and without infertility adjusting for age, as well as the aforementioned baseline characteristics. Cumulative risks were plotted using inverse-probability weighted Kaplan-Meier curves. To facilitate the comparison of groups we also estimated risk differences and ratios at 10-, 20-, and 30-years of follow-up. Use of ART was not associated with cardiovascular disease except for an excess risk of cerebral ischemic conditions, with a 30 year risk ratio of 1.43 (1.09; 1.89). With the exception of cerebral ischemic conditions, intracranial hemorrhage, aortic dissection, and chronic kidney disease, women with a history of infertility exhibited consistently higher risk of all outcomes, adjustment for differences in baseline characteristics explained some but not all of these elevated risks. Conclusions With the exception of ischemic cerebral conditions, the findings provide reassurance regarding the long-term cardiometabolic safety of ART use, while adding to the growing literature suggesting that infertility can act as a marker of womens cardiovascular and metabolic disease.

Tricuspid regurgitation and pulmonary artery systolic pressure may contribute to post-operative morbidity and mortality in liver transplantation. Previous studies suggest that a high Model for End-Stage Liver Disease score may influence the relationship between tricuspid regurgitation and post-operative mortality. Adult patients undergoing liver transplantation workup between 2010 and 2023 were included in this retrospective observational cohort study. Patients with significant portopulmonary hypertension were excluded. Transthoracic echocardiograms were completed pre-transplant and patients were followed up for one year post-operatively. 1031 patients (median MELD score 17, IQR 12-23) underwent transthoracic echocardiography for liver transplantation workup, of whom 708 underwent successful transplantation. Mild or greater tricuspid regurgitation did not predict 1-year mortality in the overall population (HR 1.79 (95% CI 0.78-4.11), p=0.19). Among patients with MELD scores [&ge;]20, mild or greater tricuspid regurgitation was a significant predictor of 1-year mortality (7 (12.7%) vs 9 (3.8%), p=0.01) (HR 3.46 (1.30-10.32), p=0.02). Tricuspid regurgitation in patients with high MELD scores was associated with a trend towards an increased risk of 30-day major adverse cardiovascular events (9 (16.4)% vs 46 (8.1%), p=0.06), driven predominantly by rates of post-operative heart failure (12.7% vs 3.8%, HR 3.66 (95%CI 1.30-10.32), p=0.01). Elevated pulmonary artery systolic pressure was associated with prolonged hospital stay (30 days (14-46) vs 15 days (11-29), p=0.01). Our study confirms that mild or greater tricuspid regurgitation is a significant predictor of 1-year mortality in patients with high MELD scores undergoing liver transplantation. Tricuspid regurgitation severity should be considered during pre-liver transplantation risk stratification.

PURPOSE: As the armamentarium of BPH therapies continues to expand, it remains imperative to maximize patient satisfaction and minimize decisional regret. We sought to determine the impact of time from BPH diagnosis to index treatment on symptom improvement and subsequent procedural events. MATERIALS AND METHODS: We queried the American Urological Association Quality Registry for men [&ge;] 40 years old with BPH, available IPSS data, and no receipt of prior BPH treatment. Index treatment included medication, surgery, or minimally invasive surgical therapy (MIST). Outcomes included IPSS over 3 years of follow-up, change in percentage of mild lower urinary tract symptoms (LUTS) by 3 months, and time to procedural event. Patients were stratified by time from index diagnosis to treatment by <12 months, 1-3 years, and >3 years. Outcomes were compared across time-to-treatment cohorts with appropriate statistical tests with p < 0.05 as significant. RESULTS: 43,919 patients met criteria with 19,642 pursuing treatments. Patients pursued treatment at comparably lower baseline IPSS compared to prior prospective series. Patients undergoing surgery and MIST had significantly higher baseline IPSS, while medical comorbidities were significantly more common among men initiating pharmacotherapy. Early surgery and MIST were associated with significant improvement in IPSS within 6-12 months and an increase in mild LUTS by 3 months. All forms of early treatment were associated with delayed time to procedural events, including catheterization and fulguration. CONCLUSIONS: Early procedural intervention for BPH is associated with early symptom improvement and delayed time to procedural events among real-world, contemporary practice.

Background and Purpose: Hemorrhagic transformation (HT) is a serious complication of endovascular thrombectomy (EVT), yet dedicated prediction models for young adults are lacking. We aimed to develop and externally validate a simplified risk score for HT in young adults with acute ischemic stroke undergoing EVT. Methods: This multicenter retrospective study included patients aged 18 to 49 years with acute anterior circulation large vessel occlusion who underwent EVT. The primary outcome was any HT within 24 hours after EVT. Multivariable logistic regression was used to identify independent predictors of HT, from which the NO?PAIN Score was derived. External validation was performed in an independent cohort of 138 patients. Results: Among 598 patients in the derivation cohort, HT occurred in 176 (29.4%). Five independent predictors were identified: admission NIHSS, number of thrombectomy passes, atrial fibrillation, alcohol consumption, and mTICI grade. The mTICI grade demonstrated a non-linear, inverted U-shaped relationship with HT risk, peaking at partial recanalization. The NO-PAIN Score showed acceptable discrimination in both the derivation (C-index, 0.737; optimism-corrected C-index, 0.748) and external validation cohorts (C-index, 0.726), with satisfactory calibration. Conclusions: The NO-PAIN Score is a simple risk prediction tool for HT after EVT in young adults with acute anterior circulation large vessel occlusion. It may assist in individualized risk stratification in this population.

Objective: To identify Dickkopf-1 (DKK1) as a prognostically relevant candidate in head and neck squamous cell carcinoma and to evaluate whether DKK1 and cytoskeleton-associated protein 4 (CKAP4) expression is associated with cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). Methods: DKK1 was screened using the Human Protein Atlas Pathology Atlas. Immunohistochemical expression of DKK1 and CKAP4 was examined in 54 patients with primary TSCC (cT1-4N0) treated surgically between 2015 and 2020. Nine cases were excluded because of insufficient tissue blocks or inadequate staining quality, leaving 45 evaluable cases. Associations with delayed cervical lymph node metastasis were assessed together with conventional clinicopathological factors, including infiltrative growth pattern (INF) and pathological depth of invasion (pDOI). Results: In public database analysis, high DKK1 expression was associated with poorer overall survival in head and neck squamous cell carcinoma. In the TSCC cohort, pDOI [&ge;]5 mm and INF pattern c were significantly associated with cervical lymph node metastasis. Positive DKK1 and CKAP4 expression were also significantly associated with cervical lymph node metastasis. Furthermore, combined DKK1/CKAP4 positivity, when incorporated with INF and pDOI, provided additional risk stratification, and cases with all 3 factors showed a markedly increased likelihood of cervical lymph node metastasis. Conclusions: Expression of DKK1 and CKAP4 was associated with cervical lymph node metastasis in TSCC. Combined assessment of DKK1/CKAP4 expression with INF and pDOI may improve pathological risk stratification and may help identify patients who require closer neck evaluation and postoperative management.

Congenital heart disease contributes substantially to chronic morbidity, growth impairment, and repeated healthcare utilization among children. Evidence regarding nutritional burden and outpatient healthcare patterns among pediatric patients with congenital heart disease in Indonesia remains limited. This study aimed to evaluate clinical characteristics, nutritional status, healthcare utilization, and factors associated with malnutrition among pediatric outpatients with congenital heart disease at Adam Malik General Hospital, Indonesia. A retrospective observational study was conducted using medical records of pediatric outpatients treated between January and December 2024. Demographic characteristics, cardiac diagnoses, nutritional status, complications, and outpatient visit history were analyzed. Logistic regression analysis was performed to identify factors associated with malnutrition. A total of 606 pediatric outpatients were included. Non cyanotic congenital heart disease predominated the cohort, with ventricular septal defect representing the most common diagnosis followed by patent ductus arteriosus and atrial septal defect. Nearly half of all patients demonstrated underweight or severe underweight nutritional status, while pulmonary hypertension emerged as the most frequent complication. Younger pediatric age groups and higher cumulative clinical burden independently increased the odds of malnutrition. Children with congenital heart disease at this tertiary referral center carried a substantial nutritional and clinical burden. Early nutritional surveillance and integrated long term outpatient management may improve growth outcomes and reduce chronic disease burden in resource limited settings.

BackgroundRecent studies have established an association between traumatic brain injury (TBI) and cardiometabolic diseases (CMDs). However, the influence of TBI on the sequential progression from a healthy state to CMD, subsequent to cardiometabolic multimorbidity (CMM), and ultimately to mortality remains unclear. MethodsA total of 366,616 participants free of CMD at baseline were derived from the UK Biobank (UKB). CMM was defined as the co-occurrence of [&ge;]2 CMD, including diabetes mellitus (DM), ischemic heart disease (IHD), and stroke. Cox proportional hazards models and multi-state models were utilized to evaluate the association of TBI with disease transitions from a healthy state to CMM and subsequent mortality. ResultsDuring a median follow-up of 16.91 years, 54,224 participants developed at least one CMD, among whom 7,562 progressed to CMM. Furthermore, 32,785 cases of mortality were documented. In multi-state models, the hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for transitions from a healthy state to IHD, DM, stroke, and mortality were 1.91(95% CI: 1.77-2.05), 1.89 (95% CI: 1.71-2.09), and 4.73 (95% CI: 4.39-5.09), respectively. For sequential transitions from IHD, DM, and stroke to CMM, the HRs (95% CIs) were 2.67 (95% CI: 2.34-3.04), 3.29 (95% CI: 2.78-3.89), and 1.41 (95% CI: 1.15-1.72), respectively. Additionally, in Cox proportional hazards models, the HRs (95% CIs) for incident CMM and mortality among individuals with TBI were 3.98 (95% CI: 3.63-4.36) and 2.57 (95% CI: 2.44-2.71), respectively. ConclusionThis study found that TBI was associated with increased risk of progression from a healthy state to CMD, and subsequently to CMM and mortality, highlighting the importance of comprehensive management of TBI in cardiometabolic health. What is Known; What the Study AddsO_ST_ABSWhat is KnownC_ST_ABSTraumatic brain injury (TBI) is associated with an elevated risk of developing multiple cardiometabolic diseases (CMDs). What the Study AddsThis study performed a systematic analysis of the relationships between TBI and multiple CMDs, providing valuable clinical references for the prevention and management of the onset and progression of cardiometabolic diseases and cardiometabolic multimorbidity (CMM) among patients with TBI.

ObjectiveRecurrent urinary tract infections (rUTIs) significantly decrease quality of life and antibiotics are becoming increasingly less effective due to antimicrobial resistance. Alternative effective treatment strategies are urgently needed for rUTIs. Prior studies have indicated that women can experience resolved or improved rUTI following electrofulguration (EF). To further investigate these findings, we report on the design and methodology behind a randomized trial examining two treatment arms: standard prolonged antibiotic treatment with nitrofurantoin (NF) alone or in combination with EF. Patients and MethodsThe aim of this randomized trial is to determine, at two institutions, the efficacy of two interventions for rUTI associated with early stages of chronic cystitis (stages 1 and 2): conventional 6 months low-dose (100mg) NF daily antibiotic suppression alone (NF) or conventional NF with EF (EF + NF). The study is also designed to analyze changes in the urinary microbiomes in the two different treatment arms and to determine the durability of clinical outcomes in both treatment arms at 2 years after the end of each intervention. The primary outcomes will be obtained from 6 to 18 months, as well as 18 - 30 months following completion of the original 6-month intervention. Failure is defined based on UTI symptoms documented by a validated questionnaire with a documented urine culture confirming a bacterial strain at each UTI episode following the end of the 6-month intervention. ConclusionsThis randomized trial is designed to examine the efficacy and durability of treating women with rUTIs using the standard of care of NF alone, or an EF procedure with NF.

Intro: Characteristics of the pulse wave transmitted through the carotid arteries are predictive of cognitive decline and cerebrovascular health in humans. This study aimed to identify risk factor trajectories in childhood, adolescence and early adulthood that are associated with forward compression wave intensity (FCWI) in the common carotid artery in adults aged 28 years. Methods: Systolic blood pressure (SBP), body mass index (BMI) and fasting blood glucose (FBG) measured at multiple time-points when participants were aged between 8-20 years were included in a trajectory analysis. At age 28 years, FCWI was measured in 402 (M=206, F=196) participants who underwent a Duplex ultrasound assessment of the common carotid artery. Statistical analysis assessed differences in FCWI between each trajectory group for males and females separately. Results: In males, four trajectory groups were identified for BMI, three for SBP, and two for FBG. In females, three trajectory groups were identified for BMI, SBP, and FG. In males, having higher BMI (P=0.006), SBP (P=0.021) and FBG (P=0.002) from ages 8-20 years was associated with greater FCWI at age 28 years. In females, no associations were found between FCWI at age 28-years and trajectory groups for BMI (P=0.185), SBP (P=0.289) or FBG (P=0.070). Conclusion: Having high BMI, SBP and FBG throughout childhood, adolescence and early adulthood was associated with higher FCWI in the carotid artery at age 28 years in males, but not females. This may have a direct impact on the etiology of cognitive decline and cerebrovascular disease in later life.

Background: Heterotopic caval valve implantation using the TricValve(R) (OrbusNeich P&F) is a unique interventional approach for treatment of severe Tricuspid Regurgitation in patients who are deemed ineligible for surgery. Given the complexity and novelty of TricValve(R) implantation, there is a pressing need for robust clinical data to evaluate its safety, efficacy, and long-term outcomes. Our study assesses the clinical results of patients followed up for 1 year from our center. Methods: Retrospective, single center registry involving patients who have undergone TricValve(R) Transcatheter Bicaval Valves System (OrbusNeich P&F) implantation for the treatment of severe tricuspid regurgitation. Results: Fourteen patients were included. The mean age was 67.5 {+/-} 8.7 years, with high surgical risk (mean EuroSCORE II 6.1 {+/-} 3.7). Procedural success was achieved in thirteen patients, with no reported in-hospital mortality or stroke among all fourteen patients. At 1-year, significant improvements were observed in New York Heart Association (NYHA) functional class (86% Class III at baseline to 0% Class III at 1 year, P=0.002) and Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores (mean 32.0 {+/-} 7.4 to 42.4 {+/-} 12.0, P=0.015). TR Regurgitant Volume significantly decreased (65.5 {+/-} 16.9 ml to 38.2 {+/-} 13.6 ml, P=0.005). No deaths or strokes occurred during follow-up. Rehospitalization due to heart failure occurred in 14% (2 out of 14) of patients. Conclusion: In this single-center registry of high-risk patients, TricValve(R) implantation was associated with a favorable safety profile, significant reduction in tricuspid regurgitant volume, and meaningful improvements in functional status and quality of life at 1 year follow-up.