A 2019 nationwide study in Japan revealed the predominant methicillin-resistant Staphylococcus aureus (MRSA) types in bloodstream infections (BSIs) to be sequence type (ST)8-carrying SCCmec type IV (ST8-MRSA-IV) and clonal complex 1-carrying SCCmec type IV (CC1-MRSA-IV). However, detailed patient characteristics and how these MRSA types evolve over time remain largely unknown. In this long-term single-center study, MRSA strains isolated from blood cultures at Nagasaki University Hospital from 2012 to 2019 were sequenced and analyzed. Additionally, we compared the SCCmec types and patient characteristics identified in this study with previous data from our hospital spanning 2003-2007 and 2008-2011. Over this 16-year period, SCCmec type II decreased significantly from 79.2% to 15.5%, while type IV increased from 18.2% to 65.5%. This shift in SCCmec types was associated with notable changes in severity and outcomes; the sequential organ failure assessment (SOFA) score decreased from 5.8 to 3.1; in-hospital mortality declined from 39.8% to 15.5%. In contrast, no significant changes in patient demographics, such as age, sex, or underlying diseases, were observed. Between 2012 and 2019, the major combinations of SCCmec type and sequence type were ST8-MRSA-IV, ST8-MRSA-I, CC1-MRSA-IV, and ST5-MRSA-II. Additionally, ST8-MRSA-IV was divided into CA-MRSA/J, t5071-ST8-MRSA-IV, and USA300-like clone based on the results of molecular analysis. These major combinations showed similar drug resistance patterns, molecular characteristics, and phylogenetic features to those identified in nationwide surveillance. This study highlights the evolving nature of MRSA types in bloodstream infections, correlating with improved patient outcomes over time.

With the aging population, there is a growing need for treating multiple myeloma (MM) in elderly patients; however, real-world studies of them are quite limited.

We retrospectively analyzed 519 patients diagnosed between 1997 and 2020 in the Kansai Myeloma Forum database to evaluate the efficacy and safety of novel agents available for 80 years and older patients with MM. Patients were divided into groups according to the treatment year: up to 2010 (Group 1), 2011-2015 (Group 2), and 2016-2020 (Group 3).

The median age and number of treatment lines were 83 years (range, 80-96) and 2, respectively. The median time to next treatment (TTNT) was 7.8 months. The TTNT for Group 3 was significantly shorter (3.8 months) than in other groups (p < 0.001). Median progression free survival and overall survival (OS) were 24.4 and 43.7 months, respectively, and did not differ significantly between 3 groups based on pairwise comparisons. In Group 3, the 1-year cumulative incidence of adverse events (AEs), progression or death, and planned treatment leading to treatment discontinuation was 37.7%, 29.4%, and 15.6%, respectively. In addition, the median time until discontinuation due to AEs has been shortened in recent years.

Our findings suggest that AEs threaten the continued treatment of very elderly patients receiving novel agents, with careful management needed to extend the TTNT.

Multimorbidity is increasing globally, emphasizing the need for effective self-management strategies. The Cumulative Complexity Model (CuCoM) offers a unique perspective on understanding self-management based on workload and capacity. This study aims to validate the CuCoM in multimorbid patients and identify tailored predictors of self-management.

This multicenter cross-sectional survey recruited 1920 multimorbid patients in five primary health centres and four hospitals in China. The questionnaire assessed workload (drug intake, doctor visits and follow-up, disruption in life, and health problems), capacity (social, environmental, financial, physical, and psychological), and self-management. Data were analyzed using latent profile analysis, chi-square, multivariate linear regression, and network analysis.

d Patients were classified into four profiles: low workload-low capacity (10.2%), high workload-low capacity (7.5%), low workload-high capacity (64.6%), and high workload-high capacity (17.7%). Patients with low workload and high capacity exhibited better self-management (β = 0.271, p < 0.001), while those with high workload and low capacity exhibited poorer self-management (β=-0.187, p < 0.001). Social capacity was the strongest predictor for all profiles. Environmental capacity ranked second for 'high workload-high capacity' (R² = 3.26) and 'low workload-low capacity' (R² = 5.32) profiles. Financial capacity followed for the 'low workload-high capacity' profile (R² = 5.40), while psychological capacity was key in the 'high workload-low capacity' profile (R² = 6.40). In the network analysis, socioeconomic factors exhibited the central nodes (p < 0.05).

Personalized interventions designed to increase capacity and reduce workload are essential for improving self-management in multimorbid patients. Upstream policies promoting health equity are also crucial for better self-management outcomes.

Physio-cognitive decline syndrome (PCDS) is a reversible condition affecting physical and cognitive health in older adults. Early detection is essential to facilitate timely interventions. This study aimed to evaluate wrist rotation metrics as potential biomarkers for PCDS and explore their applicability in digital health tools.

This pilot study recruited 50 community-dwelling individuals aged 50 years or older from Yi-Lan County, Taiwan, including 19 with PCDS and 31 robust participants. Wrist rotation movements were assessed using a custom device, and statistical analyses, including logistic regression and receiver operating characteristic (ROC) curve analysis, were performed to evaluate the diagnostic accuracy of the metrics.

Two rotation metrics, Rotate (60°-30°) and the ratio Rotate (30°-90°)/Rotate (60°-90°), were significantly associated with PCDS. The ratio metric demonstrated high sensitivity, making it suitable for initial screening, while Rotate (60°-30°) exhibited high specificity, supporting its use as a confirmatory test. These complementary roles highlight the potential of these metrics in tiered diagnostic frameworks.

Wrist rotation metrics show promise as scalable and non-invasive tools for detecting PCDS. These findings support their integration into digital platforms, such as smartphone applications, for early screening and intervention. Further studies are needed to validate these findings in larger, diverse populations and to assess their utility in monitoring disease progression and guiding interventions to improve physical and cognitive health.

Background: Intra-abdominal infections (IAIs) caused by Stenotrophomonas maltophilia have rarely been reported. This study aimed to describe the clinical characteristics and risk factors for mortality among patients with S. maltophilia IAIs. Methods: A retrospective study was conducted on inpatients with IAIs caused by S. maltophilia at Tri Service General Hospital from 2004 to 2017. Clinical and microbiologic data of the included cases were reviewed via medical charts and microbiology databases. Multivariable logistic regression analyses were performed to identify risk factors for in-hospital death. Results: In total, 110 patients were diagnosed with S. maltophilia IAIs. Malignancy (56.3%) and liver cirrhosis (35.3%) were the most commonly identified underlying diseases. The major causes of S. maltophilia IAIs were biliary tract infection (42.7%), recent abdominal surgery (35.4%), and spontaneous bacterial peritonitis (20.0%). Polymicrobial infections were observed in 84 (76.4%) patients. In addition to S. maltophilia, co-cultured bacteria (n = 140) included Enterobacterales, representing 19.3% (27/140) of the total isolates, and non-fermentative aerobes, comprising 29.3% (41/140). In addition, anaerobic bacteria and fungi accounted for 9.2% (13/140) and 10% (14/140), respectively. The overall mortality rate was 40.9%. Multivariable logistic regression analysis revealed that high Sequential Organ Failure Assessment scores and malignancies were independent risk factors for mortality, while the immediate administration of appropriate antibiotics targeting S. maltophilia was a protective factor (p < 0.05). Conclusions: Patients with an underlying malignancy or liver cirrhosis were at risk for IAIs caused by S. maltophilia. The prompt initiation of effective antibiotics against S. maltophilia is critical for achieving favorable outcomes.

Residential mobility can affect health through changes in available resources, social support, or continuity of healthcare. This study sought to understand whether residential mobility and/or change in neighborhood environment among patients with diabetes were associated with diabetes-related complications. This retrospective study used electronic health record data from 19,853 adults aged 18-64 with a diabetes diagnosis seen in 110 safety-net clinics across the United States. Generalized estimating equations logistic regression models estimated whether moving (pre/post) and change in neighborhood environment (improving, worsening, similar) were associated with diagnoses of chronic diabetes-related complications. Post-move versus pre-move was associated with significantly higher probability of diabetes-related chronic complications (predicted probability: 13.16 vs 6.00, respectively), but no association was found by change in neighborhood environment. Those who moved had lower probability of chronic complications than those who did not move which could have been driven by pre-move circumstances among patients who moved. Residential mobility plays an important role in understanding diabetes-related complications while changes in neighborhood environment may be less important among low-income patients served by safety-net clinics. Moving may not be directly responsible for the development of diabetes-related chronic complications, but it may be an indicator for other factors of instability.

The increasing longevity of the population emphasizes the need for a deeper understanding of geriatric syndromes and their implications for healthcare usage and mortality among older adults. This study aimed to identify risk factors associated with healthcare service utilization and mortality of community-dwelling adults aged 80 and older in YASAM project.

This prospective cohort study was part of the HEAT-YASAM trial, which focused on the community-based integrated healthy aging program for individuals aged 80 years and older in Balıkesir, Türkiye. The burden of geriatric syndromes was assessed based on a comprehensive evaluation at least two domains of the nutrition, cognitive, physcological and locomotor capacities. The study outcome was healthcare services utilization (inpatient, outpatient, emergency admission) and all-cause mortality data obtained during follow-up period (9 months).

The cohort consisted of 5018 participants with a mean age of 85.8 years, predominantly female (53.1%). On the multivariable analysis, geriatric syndrome burden and Deyo Charlson Comorbidity index (D-CCI) score significant on independent predictors of 9-month mortality (p = 0.01). Higher geriatric syndrome burden was linked to an approximately 10% lower risk for outpatient admissions (p = 0.01) and every point increase in the D-CCI score was associated with a 1.3-fold increased risk of utilizing outpatient services (p = 0.01). For multimorbidity, every point increase corresponded to a 2.6-fold higher risk of inpatient admissions (p = 0.01) and a 1.2-fold higher risk of emergency admissions (p = 0.01).

This study demonstrate that a geriatric syndrome burden and multimorbidity has a significant impact on healthcare utilization and mortality in adults aged 80 years and older. Integrated comprehensive, coordinated, and patient-centered care models for this population facing multiple geriatric syndromes could positively impact the healthcare system.

The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.

Melanomas in special populations constitute a unique challenge. Pediatric melanomas present with atypical histopathological features, and the most common subtypes include congenital nevi-associated, Spitzoid, and conventional melanomas. Although they present in more advanced stages than in adults, pediatric melanomas show better prognosis. In the elderly, melanomas are common and often more aggressive than in younger adults, contributing to poorer outcomes and lower survival rates. Pregnancy-associated melanomas (PAMs) do not present with a worse prognosis than all other melanomas. PAM management involves balancing maternal and fetal safety and tailoring surgical treatment according to pregnancy timeline and tumor stage.

Whether the application of machine learning algorithms offers an advantage over logistic regression in forecasting discharge against medical advice occurrences needs to be evaluated.

This retrospective study included all inpatient records from January 1, 2018, to December 31, 2023. The foundational data set (2018-2021) was divided into a training set (80%) and a test set (20%) for model construction and internal validation. The temporal validation data set (2022-2023) was used to assess the model's prospective performance. Feature selection was performed using the BorutaShap method. Techniques including random oversampling, random undersampling, synthetic minority oversampling technique, and edited nearest neighbors were applied to address data imbalance. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve, accuracy, specificity, sensitivity, F1 score, and geometric mean. The Shapley Additive Explanations analysis provided interpretation for the best machine learning model.

A total of 48,394 inpatient records for injured patients met the study criteria, of which 44,119 were discharged following medical advice and 4,275 chose discharge against medical advice, resulting in a ratio of 10.32:1. Among injury inpatients, 8.8% opted for discharge against medical advice. Based on the results of feature selection and multicollinearity analysis, 16 variables were ultimately selected for the construction and evaluation of the discharge against medical advice model. The light gradient boosting machine + edited nearest neighbors model showed the best generalization, with areas under the curves of 0.820 for internal validation and 0.837 for temporal validation. The Shapley Additive Explanations method was used to interpret the model, indicating that the grade of surgery is the most important variable.

The study is the first to use machine learning models to predict discharge against medical advice in injured inpatients, demonstrating its feasibility. In the future, health care institutions can learn from these models to optimize patient management and reduce discharge against medical advice incidents.

Treatment decisions for hepatocellular carcinoma (HCC) involve considering tumour stage, liver function and performance status, including comorbidities, although rarely analysed specifically. This study examines the patterns and prognostic impact of comorbidities in HCC patients.

We included patients diagnosed with HCC before undergoing transplantation, resection or ablation, registered in the Swedish Registry for Cancers in the Liver and Bile ducts (SweLiv) 2008-2016. Data were cross-linked with the Swedish National Patient Registry (NPR) to capture International Classification of Diseases (ICD) codes reflecting comorbidities within 10 years before the HCC treatment decision. The Charlson Comorbidity Index (CCI), excluding the liver disease category (CCI-P), was used to estimate accumulated comorbidity.

We identified 980 HCC patients with transplantation (225), resection (425) or ablation (330). The comorbidity burden, assessed using the CCI-P, was highest in ablation patients and lowest in the transplanted group (p < 0.001). The CCI-P category distribution varied across treatment groups. After adjusting for age and tumour burden, several CCI-P categories were associated with 5-year mortality, including heart failure, cerebrovascular disease, pulmonary disease, ulcers, and renal disease. ICD diagnoses not included in the CCI, such as trauma, infection, psychiatric disease, anaemia, and obesity, were also linked to 5-year mortality.

Comorbidity burden and patterns differed between HCC treatment groups, with CCI-P significantly associated with mortality. Preoperative attention to cardiovascular disease is important, but other comorbid conditions may require vigilance. Given the higher prevalence of comorbidities in ablation and resection patients, efforts to optimize comorbidity in these groups may be warranted.

Sacroiliac joint (SIJ) changes due to ankylosis may influence the fracture pattern of the posterior ilium, an essential component of the posterior ring. This study aimed to assess the association between SIJ ankylosis and posterior ilium fractures (PL) in pelvic ring injuries.

A retrospective analysis was conducted on 272 patients diagnosed with pelvic ring injuries between January 2004 and October 2023. Patients were categorized into non-ankylosed (n=185) and ankylosed (n=87) SIJ cohorts. The prevalence of SIJ ankylosis in our study sample was 32.0% (87/272). Patient demographics, SIJ ankylosis, PL, and fracture classification using computed tomography were compared between the two groups. PL was defined as any type of posterior ring injury with fracture lines extending to the region posterior to the iliac pillar, with or without SIJ subluxation or dislocation. To determine the association between SIJ ankylosis and PL, a logistic regression analysis adjusted for age, body mass index, sex, and energy of injury mechanism was performed.

Our results found that the ankylosed group had a higher PL ratio (47.1% vs. 31.4%, P=0.012), was older (64.9 years vs. 53.5 years, P<0.001), and included more males (58.6% vs. 37.8%, P=0.001) than the non-ankylosed group. Multivariate analysis revealed a significant association between SIJ ankylosis and PL (odds ratio 2.15, P=0.022).

This study determined that SIJ ankylosis is significantly associated with PL in pelvic ring injuries; transformed SIJ may contribute to changes in posterior ring fracture patterns.

COVID-19 is no longer a global health emergency, but it remains challenging to predict its prognosis.

To develop and validate an instrument to predict COVID-19 progression for critically ill hospitalized patients in a Brazilian population.

Observational study with retrospective follow-up. Participants were consecutively enrolled for treatment in non-critical units between January 1, 2021, to February 28, 2022. They were included if they were adults, with a positive RT-PCR result, history of exposure, or clinical or radiological image findings compatible with COVID-19. The outcome was characterized as either transfer to critical care or death. Predictors such as demographic, clinical, comorbidities, laboratory, and imaging data were collected at hospitalization. A logistic model with lasso or elastic net regularization, a random forest classification model, and a random forest regression model were developed and validated to estimate the risk of disease progression.

Out of 301 individuals, the outcome was 41.8 %. The majority of the patients in the study lacked a COVID-19 vaccination. Diabetes mellitus and systemic arterial hypertension were the most common comorbidities. After model development and cross-validation, the Random Forest regression was considered the best approach, and the following eight predictors were retained: D-dimer, Urea, Charlson comorbidity index, pulse oximetry, respiratory frequency, Lactic Dehydrogenase, RDW, and Radiologic RALE score. The model's bias-corrected intercept and slope were - 0.0004 and 1.079 respectively, the average prediction error was 0.028. The ROC AUC curve was 0.795, and the variance explained was 0.289.

The prognostic model was considered good enough to be recommended for clinical use in patients during hospitalization (https://pedrobrasil.shinyapps.io/INDWELL/). The clinical benefit and the performance in different scenarios are yet to be known.

Assessment of surgical complications is an important part of quality control on departments of otorhinolaryngology and head and neck surgery. Nevertheless, standardized assessment of surgical complications with easy-to-use instruments is not yet clinical routine.

Data from all 1,465 otorhinolaryngology and head and neck surgeries (male 60.3%; median age: 52 years) performed in 2020 at a department of otorhinolaryngology of a tertiary university hospital were analyzed. The postoperative complications were graded with the Clavien-Dindo classification (CDC).

The most frequent types of surgery were: diagnostic endoscopy (19.4%), ear surgery (14.8%) and oral/pharyngeal surgery (12.1%). Two-hundred seven patients (14.1%) had CDC complications, mostly CDC grade II (6.9%) and CDC grade III (5.1%). Due to multivariate analysis, smoking was an important predictor of postoperative CDC complication (Odds ratio [OR] = 1.526; confidence interval [CI] = 1.037 to 2.244). The risk of re-admission was higher for patients with postoperative complications (OR = 2.859; CI = 2.119 to 3.8591). Compared to a diagnostic endoscopy, the incidence of postoperative complications was highest for esophageal surgery (highest risk: OR = 23.580; CI = 7.619 to 72.978), thyroid surgery (second highest risk: OR = 21.060; CI = 4.838 to 91.665), and salivary gland surgery (OR = 15.330; CI = 5.215 to 45.070).

The CDC grading is a useful tool for grading all kind of otorhinolaryngology and head and neck surgery complications. CDC is well suited for comparing different types of otorhinolaryngology and head and neck surgeries with each other and also patients of different hospitals.

Artificial intelligence (AI) models are promising tools for predicting antimicrobial susceptibility in gram-negative bloodstream infections (GN-BSI). Single-center study on hospitalized patients with GN-BSI, over 7-year period, aimed to predict resistance to fluoroquinolones (FQ-R), third generation cephalosporins (3GC-R), beta-lactam/beta-lactamase inhibitors (BL/BLI-R) and carbapenems (C-R) was performed. Analyses were carried out within a machine learning framework, developed using the scikit-learn Python package. Overall, 2552 patients were included. Enterobacterales accounted for 85.5% of isolates, with E. coli, Klebsiella spp, and Proteus spp being most common. Distribution of resistance was FQ-R 48.6%, 3GC-R 40.1%, BL/BLI-R 29.9%, and C-R 16.9%. Models' validation showed good performance predicting antibiotic resistance for all four resistance classes, with the best performance for C-R (AUC-ROC 0.921 ± 0.013). The developed pipeline has been made available ( https://github.com/EttoreRocchi/ResPredAI ), along with documentation for running the same workflow on a different dataset, to account for local epidemiology and clinical features.

Background: Epilepsy is a chronic neurological disorder frequently influenced by systemic inflammation, nutritional status, and comorbid conditions, which may worsen seizure outcomes. Given the increasing recognition of these factors in disease progression, this study aimed to investigate the relationship between the Modified Charlson Comorbidity Index (mCCI), inflammatory hematological parameters, and the prognostic nutritional index (PNI) with seizure frequency and clinical prognosis in patients with epilepsy. Methods: A total of 159 participants were enrolled between January 2021 and January 2023, including 53 healthy controls (mean age: 44 ± 14.2 years; female: 21, male: 32), 53 epilepsy patients without comorbidity (mean age: 33 ± 12.5 years; female: 28, male: 25), and 53 epilepsy patients with comorbidities (mean age: 56.2 ± 13.8 years; female: 22, male: 31). The participants were divided into three groups: 53 patients with isolated epilepsy, 53 patients with epilepsy and comorbid conditions, and 53 healthy individuals with no known diseases, matched for age and sex with the patient groups, who presented for routine check-ups. The mCCI was calculated for patients with comorbid epilepsy. Inflammatory hematological parameters and the PNI were assessed in all participants using previously obtained complete blood count data. Results: Inflammatory markers such as white blood cell count, neutrophil count, C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and mean platelet distribution width (PDW) were significantly higher in epilepsy patients with comorbidities compared to other groups. Epilepsy patients with comorbidities had a higher seizure frequency compared to those without comorbidities (75.5% vs. 54.7%, p < 0.001). The PNI was lowest in epilepsy patients with comorbidities, showing a significant difference between all groups (p < 0.001). High comorbidity burden increased seizure risk by 4.56 times (95% CI: 1.30-16.01), each unit increase in the SII raised the risk by 1.13 times (95% CI: 1.08-1.19), and each unit decrease in the PNI increased the risk by 1.14 times (OR = 0.88, p < 0.001). Cerebrovascular disease and hemiplegia were also significant risk factors, increasing seizure risk by 4.15 and 4.48 times, respectively. Conclusions: Our study demonstrates that inflammatory hematological parameters, particularly SII and MCCI scores, are elevated in epilepsy patients and further increase with comorbidities. These markers are strongly associated with seizure occurrence, highlighting the prognostic significance of systemic inflammation and comorbidity burden in epilepsy. Given the frequent observation of low PNI values in patients with comorbid conditions, which may reflect compromised nutritional status, and given associations suggest a role in poor clinical outcomes, comprehensive management is essential. Monitoring the PNI and SII may help stratify high-risk patients for targeted nutritional and anti-inflammatory interventions.

As the trajectory of very old critically-ill patients becomes an increasingly significant global challenge, these patients are often referred to intermediate care units. Intermediate care units provide a level of care that is less intensive than the intensive care unit (ICU) but more advanced than standard hospital wards. We aimed to assess the nationwide utilization of intermediate care units for critically ill patients aged 80 years or older (≥ 80 y.o.) and to examine their characteristics and long-term mortality outcomes.

From the overall adult population (aged 18 years and older) hospitalized in France (French Hospital Discharge Database) from January 1, 2014, to December 31, 2022, patients ≥ 80 y.o. were included. We examined trends in the utilization of medical intermediate care units for critically ill patients ≥ 80 y.o and reported patient characteristics, including the Charlson comorbidity index and Hospital Frailty Risk Score. Readmission rates (hospital or rehabilitation unit) and mortality rates were calculated during a one-year follow-up period after the end of hospital stay.

The proportion of patients ≥ 80 y.o. in intermediate care units was 31% whereas it was 17% in ICU. Patients with greater comorbidities and severity were more frequently hospitalized in polyvalent intermediate care units (10% of them receiving acute organ support) compared to specialized intermediate care units. Admission to intermediate care units was associated with a 14% mortality rate during the stay, 28% at one year. Additionally, 58% of intermediate care units patients were rehospitalized within the year following discharge (6% in critical care units).

One-third of the patients hospitalized in the intermediate care units in France are aged 80 years or older.

This study investigated the effects of the COVID-19 pandemic on cardiovascular disease (CVD) incidence among hypertensive patients without SARS-CoV-2 infection by changes in CVD incidence, all-cause mortality, blood pressure (BP) control, and healthcare utilization rates among this population from Hong Kong. Individuals diagnosed with hypertension from January 2010 to January 2020 were followed up until death, SARS-CoV infection, or April 2022. Interrupted time series analyses on 1,318,907 patients with hypertension, comparing outcomes across four periods: pre-pandemic (January 2012-January 2020), early pandemic (February 2020-February 2021), interwave (March-December 2021), and Omicron outbreak (January-April 2022). A significant increase in out-of-hospital mortality was found when the early pandemic started. Overall all-cause mortality increased progressively during the interwave period. CVD incidence decreased immediately in the early pandemic period, followed by a progressive increase, and surpassed the pre-pandemic level at the beginning of the interwave period. The proportion of patients with office-measured BP ≤ 140/90 mmHg remained below pre-pandemic levels across the pandemic periods. Healthcare utilization declined immediately in February 2020, while most utilization rebounded to the pre-pandemic level after March 2021 and declined again during the Omicron outbreak. Healthcare disruptions during the early pandemic likely delayed CVD diagnosis and treatment, driving an immediate rise in out-of-hospital mortality. When healthcare services gradually recovered in the interwave period, CVD incidence rebounded and both in and out-of-hospital all-cause mortality increased with a lag, possibly related to delayed treatment.

Thermal Ablation (TA) represents a valid option for management of renal cortical neoplasms. Recognizing paucity of tools to predict overall survival (OS) for patients undergoing TA, we developed a nomogram to offer personalized OS predictions utilizing the National Cancer Database.

We included patients diagnosed with primary renal tumors who underwent TA between 2004 and 2020. Cox proportional hazards (CPH) model included age, Charlson-Deyo Comorbidity Index (CCI), tumor size, insurance status, ethnicity, histology, and tumor grade. A nomogram was developed to predict OS at 1, 5, and 10 years using a multivariable CPH model. Model robustness was confirmed through bootstrap validation with 1,000 iterations. Model performance was evaluated using Harrell's C-index, calibration plots at 1, 5, and 10 years, and time-dependent area under the curve (AUC) from ROC curves for 1-, 5-, and 10-year OS predictions RESULTS: We identified 10,121 patients (median age: 69 years; median follow-up: 55 months). Significant predictors of worse OS included advanced age (Hazard Ratio [HR] = 1.04, P < 0.001), higher CCI (HR = 2.20, P < 0.001), larger tumor size (HR = 1.03, P < 0.001), non-private insurance (HR = 2.16, P < 0.001), high-grade (HR = 1.31, P < 0.001), and clear cell (HR = 1.14, P = 0.015). Bootstrap validation confirmed the stability of the model, which achieved a C-index of 0.68. Calibration plots showed agreement between predicted and observed survival probabilities at 1, 5, and 10 years, with AUC values of 0.70, 0.71, and 0.74, respectively.

We constructed a nomogram incorporating clinical, pathological, and socioeconomic factors to offer personalized OS prediction for TA. Future research should focus on external validation and clinical implementation.

The use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear.

To compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery.

This was a retrospective cohort study using patient data from a commercial claims and encounter database from 2016 to 2021. Included in the study were adult patients undergoing robotic-assisted cholecystectomy or laparoscopic cholecystectomy in acute care surgery. Data were analyzed from January to October 2024.

Robotic-assisted or laparoscopic cholecystectomy in acute care surgery.

The primary outcome was bile duct injury.

A total of 844 428 patients (mean [SD] age, 45.6 [12.5] years; 547 665 female [64.9%]) were included in this analysis. After propensity score matching, robotic-assisted cholecystectomy (n = 35 037) and laparoscopic cholecystectomy (n = 35 037) had similar bile duct injury rates (0.37% [128 of 35 037] vs 0.39% [138 of 35 037]; odds ratio [OR], 0.93; 95% CI, 0.73-1.18; P = .54). Robotic-assisted cholecystectomy had higher major postoperative complications (8.37% [2934 of 35 037] vs 5.50% [1926 of 35 037]; OR, 1.57; 95% CI, 1.48-1.67; P < .001), more postoperative drain use (0.63% [219 of 35 037] vs 0.48% [132 of 35 037]; OR, 1.66; 95% CI, 1.34-2.07; P < .001), and longer median (IQR) hospital length of stay (3 [2-4] days vs 2 [1-4] days; P < .001).

In this large, propensity-matched cohort analysis of acute care surgery cholecystectomy, robotic-assisted and laparoscopic cholecystectomy had similar bile duct injury rates, but robotic-assisted cholecystectomy was associated with higher postoperative complications, longer hospital stays, and increased drain use. Further research is needed to optimize the use of robotic-assisted cholecystectomy for acute gallbladder disease. These findings suggest that, under current practice conditions, robotic-assisted cholecystectomy may not offer clear benefits compared with the standard, established laparoscopic cholecystectomy approach.

This study aimed to examine the association between health literacy and illness perception among Chinese patients with chronic disease in the community through a national cross-sectional study.

This cross-sectional study was conducted in China from June 20, 2022, to August 31, 2022, and used a multistage sampling approach to select patients with chronic diseases. The study included 5,525 participants from 15 provinces, drawn from the Psychology and Behavior Investigation of Chinese Residents in 2022. We constructed univariate analysis, smooth curve fitting, threshold saturation effect analysis, and forest plot of subgroup analysis to evaluate the association between health literacy and illness perception.

The analysis revealed an inverted J-shaped association between health literacy and illness perception (P < 0.001). Moreover, the identified inflection point was 22.22. When the health literacy score was below 22.22, illness perception exhibited a positive association with health literacy (β = 0.12, 95%CI = 0.03, 0.21, P = 0.009). When the health literacy score was higher than 22.22, illness perception decreased with the increasing health literacy (β=-0.23, 95%CI=-0.27, -0.19, P < 0.001). The significant association between health literacy and illness perception did not differ significantly across subgroups, except for the Hukou subgroup.

This study determined a threshold of health literacy that was associated with the illness perception of Chinese chronic disease patients. Additionally, an inverted J-shaped association between health literacy and illness perception was observed, suggesting that targeted health literacy intervention measures should be tailored to specific chronic disease groups rather than a uniform approach.

Not applicable.

The rationale for intraperitoneal chemotherapy after complete macroscopic cytoreduction (CC-0) is well-established for peritoneal surface malignancies. This study aimed to analyze prognostic factors for disease-free survival (DFS) of patients with high-grade serous ovarian cancer (HGSOC) undergoing interval CC-0 cytoreductive surgery (iCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

This retrospective multicenter study included 293 HGSOC patients treated between January 2010 and May 2023. All the patients received neoadjuvant platinum-based chemotherapy followed by CC-0 iCRS and HIPEC with cisplatin or paclitaxel. Prognostic factors for DFS were analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression.

The median DFS was 23 months, with 3- and 5-year survival rates of 39 % and 29 %, respectively. The patients with a peritoneal carcinomatosis index (PCI) of 15 or lower had significantly better DFS than those with a PCI greater than 15 (24 vs 15 months; p < 0.05). Paclitaxel-based HIPEC was associated with superior DFS compared with cisplatin (25 vs 16 months; p < 0.05). Multivariate analysis showed a PCI greater than 15 related to a lower DFS (hazard ratio [HR], 1.539; p = 0.048) and paclitaxel-based HIPEC as a factor associated with better DFS (HR, 0.663; p = 0.016). The patients treated with HIPEC-paclitaxel and with a PCI of 15 or lower demonstrated the best outcomes (median DFS, 33 months).

In HGSOC, the PCI is the most significant determinant of DFS after CC-0 iCRS and HIPEC. Paclitaxel-based HIPEC showed better outcomes than cisplatin, particularly for patients with a PCI of 15 or lower. Further prospective studies are needed to confirm the role of paclitaxel and to evaluate BRCA mutation and homologous recombination deficiency status in treatment efficacy.

Patients operated for endometrial cancer (EMCA) are typically elderly with multiple comorbidities, potentially impacting surgical outcomes and survival. This study evaluated the prognostic value of frailty and frailty-related scores in predicting perioperative morbidity and survival in EMCA patients undergoing minimally invasive surgery.

This retrospective cohort study included 289 patients from the Sentinel Database treated for EMCA at Bern University Hospital (2012-2020). Patients underwent minimally invasive hysterectomy with sentinel lymph node dissection (39%) or additional radical lymphadenectomy (61%). Frailty was assessed using the Age-Adjusted Charlson Comorbidity Index (ACCI), modified Frailty Index (mFI), 5-item mFI (mFI-5), American Society of Anesthesiologists (ASA) scores, and independent parameters. Primary outcomes included perioperative complications, hospital stay, recurrence-free survival (RFS), and overall survival (OS).

Median age was 65 years (range 26-94) and median follow-up was 41 months (0-105). ACCI > 4 (23.2%) was the strongest predictor of postoperative complications (p = 0.025), prolonged hospitalization (p = 0.03), and reduced OS (hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.18-5.60; p = 0.018). Multivariable analysis confirmed ACCI > 4 (HR 2.24, 95% CI 1.02-4.90; p = 0.044), European Society for Medical Oncology (ESMO) risk group (HR 1.61, 95% CI 1.24-2.07; p < 0.001), hemoglobin (HR 1.03, 95% CI 1.00-1.05; p = 0.033), and congestive heart failure (HR 6.29, 95% CI 1.35-29.27; p =0.019) were significant predictors of OS. Radical lymphadenectomy (p < 0.001), ACCI > 4 (p = 0.025), and age > 70 years (p = 0.034) increased complication risks.

ACCI > 4 is a practical tool for preoperative risk assessment and predicting surgical tolerance and survival, and is therefore applicable for guiding surgical decisions and personalized care in patients with EMCA.

In recent years, the efficacy of various physical exercise programs in enhancing functional fitness among frail older adults has gained recognition. However, limited research has concurrently explored the long-term effects of exercise on brain health, stress biomarkers, and mental well-being. This study aimed to investigate the impact of two distinct chair-based exercise programs on salivary stress hormones and psychological well-being in frail older women over a 28-week period.

A total of 140 individuals participated in the enrollment phase, with 84 eligible participants randomly assigned to three groups. Following the intervention, data from 60 participants were analyzed across the multicomponent exercise (MCE, n = 23), elastic band muscle-strength exercise (ESE, n=19), and non-exercise control (CG n=18) groups. Salivary biomarkers of alpha-amylase (α-AMY) Cortisol (COR), alpha-amylase/cortisol ratio, psychological indicators and physical frailty (PF) and functional fitness were assessed pre- and post-intervention.

Salivary COR levels exhibited a significant time × group interaction, with a moderate increase in MCE, a small decrease in ESE, and a substantial increase in CGne. Salivary α-AMY levels varied significantly over time and by group, with a small decrease in both exercise groups and a moderate increase in CGne. The α-AMY /COR ratio also displayed a significant interaction effect. Additionally, significant improvements were observed in PF compound scores, general self-efficacy, attitudes toward aging, and reductions in perceived stress and depressive symptoms (p < 0.05).

Notably, the MCE program demonstrated greater benefits than ESE. The observed associations between changes in α-AMY levels, mental well-being, and functional fitness indicators contribute novel evidence on the psychophysiological adaptations to long-term exercise. Importantly, reductions in PF scores correlated with improvements in self-efficacy, attitudes toward aging, and handgrip strength, reinforcing the link between functional fitness, stress regulation, and psychological well-being. These findings emphasize the need for tailored exercise interventions to enhance both physiological resilience and mental health in frail older populations.

Elderly hospitalized patients with inflammatory bowel disease (IBD) flare and concurrent Clostridioides difficile infection (CDI) are considered at high risk of IBD-related complications. We aimed to evaluate the short-,intermediate-, and long-term post-discharge complications among these patients.

A retrospective multicenter cohort study assessing outcomes of elderly individuals (≥60 years) hospitalized for an IBD flare who were tested for CDI (either positive or negative) and discharged. The primary outcome was the 3-month post-discharge IBD-related complication rates defined as steroid dependency, re-admissions (emergency department or hospitalization), IBD-related surgery, or mortality. We assessed post-discharge IBD-related complications within 6 month and mortality at 12 month among secondary outcomes. Risk factors for complication were assessed by multivariable logistic regression.

In a cohort of 654 patients hospitalized for IBD {age 68.9 (interquartile range [IQR]): 63.9-75.2 years, 60.9% ulcerative colitis (UC)}, 23.4% were CDI-positive. Post-discharge complication rates at 3 and 6 months, and 12 months mortality, did not differ significantly between CDI-positive and CDI-negative patients (32% vs 33.1%, p = 0.8; 40.5% vs 42.5%, p = 0.66; and 4.6% vs 8%, p = 0.153, respectively). The Charlson comorbidity index was the only significant risk factor for complications within 3 months (aOR 1.1), whereas mesalamine (5-aminosalicylic acid [5-ASA]) use was protective (aOR 0.6). An UC diagnosis was the sole risk factor for complication at 6 months (aOR 1.5). Clostridioides difficile infection did not significantly impact outcomes or interact with IBD type.

In elderly IBD patients hospitalized for IBD flare and subsequently discharged, a concurrent CDI infection was not associated with post-discharge IBD-related complications or mortality up to 1 year.

This study retrospectively analysed the effect of the number of resected pulmonary segments on surgical outcomes of patients with non-small-cell lung cancer undergoing anatomical pulmonary resection.

We examined patients who underwent lobectomy or segmentectomy for non-small-cell lung cancer between January 2016 and June 2021. We compared the surgical outcomes between the ≤3 segment group (group A) and the ≥4 segment group (group B). Lung functions were evaluated by comparing the preoperative and 6-month postoperative periods. Comprehensive preoperative status, including osteoporosis, sarcopenia and lung function, was incorporated into the propensity score matching analysis.

Propensity score matching for 420 patients yielded 310 for evaluation (1:1 matching), with a median follow-up of 57.6 months. Fifty-four patients (17.5%) died (17 from lung cancer and 37 from other diseases), and 50 patients (16.1%) experienced cancer recurrence. The 2 groups had no significant differences in surgical outcomes, including operation time, blood loss and postoperative complications. However, group B showed the worst reduction in vital capacity and forced expiratory volume in 1 s (all P < 0.05). Additionally, there were no significant differences in cancer recurrence or lung cancer mortality between the groups, although group B was significantly associated with increased deaths from other causes (P = 0.007, Gray's test; adjusted subdistribution hazard ratio 2.392; 95% confidence interval 1.170-5.167). Subgroup analyses revealed adverse effect modification in male patients regarding non-cancer-related deaths (P-value for interaction = 0.044).

The ≥4 segment group exhibited poorer postoperative pulmonary function and more deaths from other causes, indicating the need for careful postoperative management.

The Life's Essential 8 (LE8) is a composite metric including 4 health behaviors (diet, physical activity, nicotine exposure, and sleep) and 4 health factors (body mass index, nonhigh-density lipoprotein cholesterol, blood glucose, and blood pressure). This study aimed to describe the cardiovascular health (CVH) metrics promoted by LE8 in nonagenarians and to investigate their relationship with mortality at 5 and 10 years.

This study was conducted within the framework of the Mugello Study, a longitudinal survey on nonagenarians living in the Mugello area (Tuscany, Italy). One-hundred and fifty-seven subjects (42 males and 115 females, median age 92 years) were administered a series of validated questionnaires and underwent instrumental examinations and blood withdrawal. CVH metrics were calculated according to LE8 guidelines. Physical activity and sleep duration were quantitatively estimated using a monitor device.

In the male group, after 5 and 10 years of follow-up, a higher Health Behavior score was associated with a lower risk of all-cause mortality (HR: 0.963, p = .005 and HR: 0.972, p = .020; after 5 and 10 years). Differently, in the female group, no significant association was observed between the LE8 total score and subscores and different risk of mortality after 5 and 10 years from the interview.

These findings highlight the importance of potentially modifiable behaviors in improving survival. They support resource investments to address the needs of individuals in this stage of life and encourage them to be empowered and actively engage in health-promoting behaviors.

Postthyroidectomy hypoparathyroidism is common and usually managed as an outpatient. A better understanding of patients at risk for an emergency department (ED) visit can improve health-care utilization and patient care.

The California Cancer Registry and Health Care Access and Information Databases were linked to identify patients who underwent a thyroidectomy for thyroid cancer 2005-2018 and had an ED visit for hypoparathyroidism within 2 y of surgery. Cumulative incidence and multivariable Cox proportional hazards models were used to identify factors associated with an ED visit.

Among 41,502 thyroidectomy patients, 588 (1.42%) presented to the ED for hypoparathyroidism, with a median time between thyroidectomy and first ED visit of 4 ds. Two-year cumulative incidence was highest for women (1.56%), Hispanic patients (2.04%), younger adults aged 18-40 y (1.97%), higher Charlson comorbidity index score (2.43%), lowest neighborhood socioeconomic status quintile (1.97%), patients with >4 lymph nodes removed (2.04%), and patients not seen at an American College of Surgeons Committee on Cancer site (1.60%). Multivariable analysis revealed several factors associated with an increased risk of hypoparathyroidism, including female gender (hazard ratio [HR] 1.67, 95% confidence interval [CI] = 1.32-2.10), Hispanic ethnicity (HR 1.41, 95% CI = 1.16-1.71), a higher Charlson comorbidity index score (≥2 = HR 1.91 [95% CI = 1.46-2.51]), and patients with >4 lymph nodesremoved (HR 1.70 [95% CI = 1.43-2.01]).

ED visits for postthyroidectomy hypoparathyroidism are uncommon, but usually occurs shortly after surgery. Most risk factors identified are not modifiable, but they help identify high-risk patients who could benefit from targeted postoperative care (programs) to reduce unplanned ED visits.

Epidemiological studies of traumatic brain injury (TBI) in Switzerland have, to date, poorly investigated sex-related differences in causality and predisposing factors. This study examines differences in sex and age related TBI epidemiology in a high-volume trauma centre intensive care unit (ICU) cohort, aiming to identify potential targets for prevention.

This retrospective, single centre study includes all consecutive TBI patients admitted to the ICU in a 4-year study period. Patient demographics, comorbidities, co-medication, trauma setting and associated risk behaviour were compared between sexes and age groups (over/under 65 years).

592 patients (73.3% male, 26.7% female) were included. The leading cause of TBI was falls (52.4%), followed by road traffic accidents (RTA) (35.8%). Overall, men were more likely to suffer from a road traffic accident, while women were more likely to suffer a low energy fall. No differences in injury severity and comorbidities between sexes were observed. Young patients most likely suffered from a RTA while older patients from a low energy fall irrespective of sex. Both sexes portrayed risk associated behaviors with higher rates of alcohol intoxication in males, while females were less likely to wear a helmet in two-wheeled RTAs.

We conclude that sex- and age-related epidemiologic differences in TBI exist. Our results suggest that sex and age-specific prevention measures might be advisable for optimal mitigation of TBI and its sequelae.

Studies have shown that sarcopenia prevalence in the Chinese population aged over 60 years was 14%. The quality of life of older adults with sarcopenia has drawn increasing attention. Sarcopenia-related quality of life has not been well studied. We explored the quality of life of patients with sarcopenia and the related influencing factors in Xinjiang.

This study was conducted from July-September 2023 in the northern and southern regions of Xinjiang, China. Possible sarcopenia and sarcopenia were diagnosed according to the AWGS 2019. The Sarqol® questionnaire was used to evaluate quality of life. A linear regression model with a stepwise method was used to identify quality-of-life-associated factors for possible sarcopenia and sarcopenia.

A total of 987 older adults were enrolled,18.5% had possible sarcopenia, and 15.1% had sarcopenia. Quality of life scores: possible sarcopenia 26.46-92.55 (56.31 ± 14.69), sarcopenia 30.74-90.93 (56.91 ± 13.45).The indicators for which the difference analysis were meaningful, in the group with possible sarcopenia are gender, inhabiting information, ACCI score, hearing loss, social support level and self-rated risk of falling. In the sarcopenia group are gender, ACCI score, hearing loss, vision loss, self-rated health status, number of remaining teeth, self-rated risk for falling, and dysphagia status. The risk factors for quality of life in patients with possible sarcopenia were gender and hearing loss, whereas self-rated of general health, self-rated of poor health, self-rated of very poor health and falls were risk factors in the sarcopenia group.

This study focused on quality of life and factors in older adults with possible sarcopenia or sarcopenia. The research results showed that in order to prevent the decline in the quality of life of older adults with sarcopenia, it is very important to regularly examine the oral health status of the older adults, prevent the occurrence of chronic diseases.Multimodal interventions address common sensory impairments.Carry out aging-friendly renovation of the home environment and conduct balance training to prevent the occurrence of falls among the older adults.

The purpose of this study was to identify preoperative factors associated with worse postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores 2 years after hand and wrist surgery. We hypothesized that older age, more comorbidities, increased substance use, and lower socioeconomic status would correlate with worse 2-year PROMIS PI scores.

This study was a retrospective review of prospectively acquired data on 253 patients. Surveys were administered within 1 week of surgery and 2 years postoperatively. Bivariate and multivariable analyses were conducted to identify significant predictors of worse 2-year PROMIS PI scores and change in PROMIS PI scores.

Older age, higher body mass index, more comorbidities, lower preoperative expectations, more prior surgeries, unemployment, smoking, higher American Society of Anesthesiologists (ASA) score, and multiple other socio-demographic factors were correlated with worse 2-year PROMIS PI scores (P ≤ .018). Similar factors were also correlated with less improvement in 2-year PROMIS PI scores (P ≤ .048). Worse scores on all preoperative patient-reported outcome measures correlated with worse 2-year PROMIS PI scores (P ≤ .007). Multivariable analysis identified smoking history, less frequent alcohol consumption, worse preoperative PROMIS social satisfaction and Numeric Pain Scale whole body scores, and higher ASA scores as independent predictors of worse 2-year PROMIS PI. The same factors in addition to better baseline PROMIS PI were predictive of less improvement in 2-year PROMIS PI.

Numerous preoperative factors were predictive of worse postoperative 2-year PROMIS PI and less improvement in 2-year PROMIS PI for patients undergoing hand and wrist surgery.

Centrally located early-stage non-small cell lung cancer (ES NSCLC) with tumors close to the bronchi is potentially curable with stereotactic body radiation therapy (SBRT). To evaluate the clinical benefit of the treatment, both the risk of high-grade toxicity as well as the treatment efficacy need to be assessed.

From the expanded HILUS cohorts, 72 patients with T1-T3N0M0 NSCLC were included in the current analysis. All patients had been treated with SBRT in 8 fractions to 56 Gy for a tumor located within 2 cm from the tracheobronchial tree. Primary endpoint was progression free survival (PFS) and secondary endpoints included pattern of failure, local control (LC), lung cancer-specific survival (LCSS), overall survival (OS) and toxicity. The Kaplan-Meier method and Cox regression analysis were used.

The median age of the cohort was 73 years and all patients suffered from comorbidities prior to SBRT. T2-T3 tumors were seen in 65 % of the patients. Seventeen patients relapsed after SBRT and distant recurrence was the most common form of relapse. Three-year PFS was 31 % (95 % CI 22-44) and largely explained by the short overall survival (38 % (95 % CI 22-44) at 3 years). Three-year rates of LC and LCSS were 97 % (95 % CI 92-100) and 76 % (95 % CI 65-89), respectively. Twelve patients (17 %) suffered from grade 5 toxicity, of which 9 were bronchopulmonary bleedings.

The severe toxic profile limits the clinical benefit using SBRT with the investigated approach for patients with centrally located ES NSCLC.

Few population-based studies with large sample sizes have examined the long-term effects of integrated diabetes care in patients with schizophrenia. This study aimed to examine the association between participation in the nationwide diabetes Pay-for-Performance (DM-P4P) program and both health outcomes and healthcare utilization in individuals with schizophrenia comorbid with type 2 diabetes in Taiwan.

This was a longitudinal, real-world, nested case-control follow-up study from 2015 to 2021 in Taiwan.

Multiple national population-based databases were used, including Taiwanese population-based longitudinal National Health Insurance (NHI) claims database, registry for NHI enrollment, catastrophic illness registry, board-certificated specialist registry, and registry for health care facilities. A total of 6172 schizophrenia patients with type 2 diabetes and matched controls were compared on a set of process outcome, health utilization, and direct medical cost measures between DM-P4P and non-P4P patients, with a follow-up period of at least three years. Generalized linear regression models were used to investigate the factors influencing participation in the DM-P4P program and to compare health outcomes.

Schizophrenia patients with more severe diabetes complications and chronic comorbid conditions, or those who had previously participated in a schizophrenia P4P program, were more likely to participate in the program. Those who participated in the DM-P4P program were more likely to receive regular diabetes check-ups, and to have had more DM-related outpatient visits but fewer emergency room visits, hospitalizations, and related expenditures, as well as lower all-cause mortality, than non-DM-P4P patients.

The nationwide DM-P4P program positively affected health outcomes and healthcare utilization among people with schizophrenia comorbid with type 2 diabetes. Policymakers should consider establishing incentive mechanisms to encourage integrated care for schizophrenia patients with diabetes.