Diabetic patients are highly susceptible to cardiovascular and renal diseases. As a newly updated comprehensive index for assessing cardiovascular health (CVH), Life's essential 8 (LE8) has the potential to serve as a practical tool for evaluating the risk of diabetic kidney disease (DKD). We are committed to exploring the relationship between LE8 and its subscales with DKD in diabetic patients, aiming to provide preliminary evidence for the formulation of clinical strategies.

A total of 3,715 NHANES participants were included in this study, representing 18.9 million non-institutionalized residents of the United States. The mean age of all subjects was 59.72 years, and the weighted prevalence of DKD among diabetic patients was 36.39%. After adjusting for potential confounding factors, it was found that compared to the low LE8 group, the risk of developing DKD was significantly lower in the moderate LE8 group (OR: 0.54, 95% CI: 0.43-0.66) and the high LE8 group (OR: 0.18, 95% CI: 0.08-0.42). A similar trend was observed across the subscales of the LE8 score. The results of the fully adjusted restricted cubic spline regression analysis revealed a linear relationship between LE8 and its subscales with DKD. The findings remained consistent in subgroup and sensitivity analyses, with no significant interactions observed between subgroups.

Higher scores on the LE8 and its subscales were associated with a lower risk of developing DKD. However, the long-term causal relationship between LE8 and DKD risk necessitates further validation and exploration through large-scale, rigorously designed prospective studies.

The Acute Disease Quality Initiative (ADQI) working group recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), but the prognosis and risk factors for early and late SA-AKI have not been studied.

This was a retrospective cohort study based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (v2.2). First, SA-AKI patients that met the new definition from the ADQI were screened, and then, the relationships between SA-AKI occurrence time and relevant clinical parameters were analyzed.

After propensity score matching, 1,090 early SA-AKI (AKI occurring within 48 h of sepsis diagnosis) cases and late SA-AKI (AKI occurring between 48 h and 7 days after sepsis diagnosis) cases were identified. Compared with late SA-AKI patients, early SA-AKI patients had no significant differences in all-cause mortality at 28 days, 60 days or 180 days, renal replacement therapy (RRT) rates; or major adverse kidney events at 30 days (MAKE-30). However, the renal recovery of early SA-AKI patients was significantly better than that of late SA-AKI patients, their lengths of hospital stay and intensive care unit stay were significantly shorter, and the number of patients with positive fluid balance was lower, but the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and nephrotoxic antibiotics and the incidence of septic shock were higher. In addition, there was a difference in the number of patients with early and late SA-AKI at highest AKI stages 1 and 3. Data analysis also revealed that liver disease, cancer, highest AKI stage 3 and septic shock were associated with renal nonrecovery.

Although there was no significant difference in mortality between early and late SA-AKI patients, there were significant differences in renal recovery, positive fluid balance, nephrotoxic antibiotic use, septic shock and AKI stage. Therefore, the classification of early and late SA-AKI has certain scientific and rational validity, but whether the two have different clinical outcomes and pathogeneses requires further study.

Insulin-like growth factor-binding proteins (IGFBPs) contribute to central nervous system development and may influence recovery after stroke. This study aimed to determine whether serum IGFBPs levels in acute ischemic stroke (AIS) patients are associated with 3-month outcomes.

We retrospectively reviewed data from AIS patients admitted within 24 h after stroke onset, and who had been prospectively enrolled in the Chengdu Stroke Registry. Serum IGFBPs 4, 6 and 7 levels at admission were compared between patients experienced good outcome (modified Rankin Scale scores of 0-2) or poor outcome (scores of 3-6) at 3 months after stroke onset. Factors associated with good outcome were identified using logistic regression.

Among 194 patients, 115 (59.3%) experienced good outcome at 3 months. Patients with good outcome showed significantly higher levels of all three IGFBPs at admission. Good outcome was independently associated with higher serum levels of IGFBP 4 (OR 1.013, 95% CI 1.005-1.020) and IGFBP 7 (OR 1.012, 95% CI 1.003-1.021) after adjustment for potential confounders. Adding either or both IGFBPs to a model based on conventional clinical factors significantly improved good outcome prediction, with net reclassification improvement of 41.9-54.5% and integrated discrimination improvement of 3.8-5.8%. The model containing both IGFBPs predicted good outcome with an area of 0.878 (95% CI 0.827-0.929) under the receiver operating characteristic curve.

Higher serum IGFBPs 4 and 7 levels may be associated with greater probability of good outcome at 3 months after AIS.

Obesity is a significant public health challenge in the Kingdom of Saudi Arabia (KSA), with profound impacts on individual well-being and the healthcare system. Recent epidemiological studies have reported variable trends in obesity prevalence within the country. This population-based study aimed to estimate the prevalence, identify behavioral risk factors, and assess comorbidities associated with overweight and obesity using a nationally representative sample in KSA. Findings will inform targeted public health policies, optimize healthcare resource allocation, and support Saudi Vision 2030 goals by promoting healthier lifestyles and reducing chronic diseases.

This study analyzed data from the 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS), implemented by the Ministry of Health using a nationally representative sample. A stratified, three-stage sampling design based on the 2010 Census was used to select 10,000 households from 13 administrative regions. Data collection included socio-demographic, anthropometric measurements and medical information from consenting individuals. Continuous variables were summarized as mean ± SD, and univariate analysis was performed using one-way ANOVA and Chi-square tests. Logistic regression identified predictors of obesity and overweight, reporting odds ratios (OR) with 95% confidence intervals (CI). Analyses were conducted in SPSS (v29).

A total of 7930 adults across different regions in KSA were included in this study. The overall prevalence of obesity and overweight was 20.3% and 38.7%, respectively. Overweight was significantly more prevalent in males (44.4%) than females (35.6%), whereas obesity was more common in females (22.1%) compared to males (18.6%) (p < 0.001). Regional differences were observed with the West region reporting the lowest prevalence of obesity (16.5%) and overweight (37.3%) (p < 0.001). Married individuals exhibited a significantly higher prevalence of both obesity and overweight (p < 0.001).

The burden of obesity and overweight in KSA is still alarming due to the associated risk of metabolic, cardiovascular, and psychological disorders, affecting both patients and the healthcare system. Urgent interventions, including targeted public health campaigns, lifestyle modifications, and policy-driven strategies, are essential to curb obesity trends and promote long-term health improvements.

The Foot Health Status Questionnaire (FHSQ) is a foot health psychometric tool for measuring foot health status that consists of eight dimensions. Currently, the FHSQ has been adapted to several languages. It was considered necessary to translate and adapt the FHSQ to the Persian language. Thus, the aim of this study was to assess the repeatability and reliability of the Foot Health Status Questionnaire (FHSQ) translated into Persian.

The translation into Persian and test-retest reliability methods came from the English version of the questionnaire. The questionnaire was distributed to 88 individuals diagnosed with plantar heel pain, who were recruited from a podiatry clinic in Iran. To assess test-retest reliability, the instrument was administered on two separate occasions, with a five-day interval between the initial and follow-up assessments.

As regards the total mark for each dimension, internal consistency and reliability were determined with the Cronbach α and intraclass correlation coefficient (ICC) with a confidence interval (CI) of 95%. High internal consistency was shown for the eight dimensions: (a) foot pain, with a Cronbach α of 0.773; (b) foot function and (c) general foot health with 0.788 and 0.776 respectively; (d) shoe with 0.793; (e) general health with 0.784; (f) physical function with 0.795; (g) social function with 0.801 and (h) vigour with 0.748. Excellent test-retest reliability (ICC = 0.911 [95% CI =0.844-0.949]) was shown for the total score.

The Persian version of the FHSQ was shown to be a valid and reliable tool for acceptable use in the Iran population.

This study aimed to explore the association between weekend catch-up sleep (WCS) and chronic kidney disease (CKD) in American adults.

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2017 to 2020, this study encompassed 4,934 individuals aged 20 years and above. We assessed the risk of CKD in relation to WCS. To evaluate CKD risk across various WCS durations, participants were categorized into four groups based on WCS length: < 1 h (reference group), ≥ 1 h and < 2 h, ≥ 2 h and < 3 h, and ≥ 3 h.

In the fully adjusted multivariate logistic regression model, the odds ratio (OR) of CKD to WCS response was 0.86 (95% CI = 0.61-1.22; p = 0.31). In addition, only CKD was significantly associated with WCS duration between 2-3 h (OR = 0.44, 95% CI = 0.21-0.88, p = 0.03). Subgroup analyses showed stronger negative associations (p < 0.05) for men and women with a WCS of 2-3 h, adults under 60 years of age with a WCS of 2-3 h, those with less than 1 h of catch-up sleep on weekends and a body mass index (BMI) of 25-29.9, those with a BMI of less than 25 or greater than or equal to 30 with a WCS of 2-3 h, and those with less than 7 h of sleep on weekdays and 2-3 h of catch-up sleep on weekends.

Our findings suggest that when weekday sleep duration is < 7 h, WCS in 2-3 h is strongly associated with a lower prevalence of CKD.

Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.

The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).

Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (P = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (P = .002).

Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.

Heart transplantation remains the gold standard treatment of end stage heart failure. The prognosis of heart transplantation has continuously improved, with a 10-yr survival of 53%. Dexmedetomidine is commonly used as a sedative in cardiac patients. Recently its clinical use has been limited because it was associated with increased mortality in the SPICE 3 trial. The impact of perioperative dexmedetomidine treatment on patients undergoing heart transplantation has not been examined yet. Therefore, this study investigated the influence of dexmedetomidine treatment on 1-yr mortality in patients undergoing heart transplantation.

This retrospective cohort study included patients who underwent heart transplantation at the University Hospital Duesseldorf between 2011 and 2021. The main exposure was perioperative dexmedetomidine treatment. The primary endpoint was 1-yr mortality after surgery. Kaplan-Meier analysis and multivariate cox regression with adjustment for risk index for mortality prediction after cardiac transplantation (IMPACT) and packed red blood cells were performed.

A total of 267 patients were screened. To avoid a potential selection bias, patients who needed postoperative treatment with extracorporeal life support system were excluded, leaving 169 patients included in the analysis. Out of 169 patients, 85 received perioperative dexmedetomidine treatment and 84 were not treated with dexmedetomidine. Overall, 1-yr mortality was 10.3% (dexmedetomidine 4.9% vs no dexmedetomidine 15.5%, P=0.025). After adjustment for IMPACT score and packed red blood cells, dexmedetomidine treatment was independently associated with lower 1-yr mortality after heart transplantation (hazard ratio: 0.25, 95% confidence interval 0.07-0.93, P=0.03).

Perioperative dexmedetomidine treatment appears to be safe regarding 1-yr mortality in patients undergoing orthotopic heart transplantation.

In this study, we examined 1) the prevalence of maltreatment in British junior elite track and field athletes, 2) relationships between maltreatment, psychological safety, and subjective vitality, and 3) whether maltreatment is indirectly related to subjective vitality via psychological safety. Using a cross-sectional design, British junior elite track and field athletes (N = 254) completed measures of maltreatment (physical, psychological, non-contact sexual and neglect), psychological safety and subjective vitality. Results showed that nearly three-quarters experienced maltreatment in sport (74.4%). Psychological maltreatment was most frequently reported (70.5%), followed by neglect (50.8%), physical (31.5%) and non-contact sexual (24.0%). Psychological and physical maltreatment, and neglect were indirectly related to subjective vitality via psychological safety (effect size range = -0.27 to -0.11), whereas no relationship was shown between non-contact sexual maltreatment and psychological safety. In conclusion, maltreatment is prevalent in British junior elite track and field athletes and that those who experience physical and psychological maltreatment, as well as neglect, are more likely to report lower psychological safety, and in turn, lower subjective vitality. International and national organisations aiming to protect athlete well-being should target psychological safety in their safeguarding interventions by supporting and encouraging athletes to speak out about their concerns.

Bariatric surgery has been shown to cause a negative impact on oral health, as reflected by postsurgical increase of caries-related dental interventions.

The aim of this study was to compare dental intervention rates after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Nationwide and register-based (Sweden).

This 2-staged matched cohort study included all adults who underwent RYGB (n = 26,594) or SG (n = 3416) between 2011 and 2015, registered in the Scandinavian Obesity Surgery Register. Propensity score matching was used to match SG patients to RYGB patients, based on several covariates. The follow-up time was 3 years after surgery. The dental variables were collected from the Dental Health Register, including tooth extractions, restorative interventions (dental fillings), and endodontic interventions (root canal treatment).

In total, 3317 RYGB and 3317 SG patients were included. Both groups showed increased dental event rates postoperatively. RYGB patients had significantly higher event rates compared with SG postoperatively regarding all interventions, restorative and endodontic interventions.

The negative effect on dental outcomes in terms of dental fillings and tooth extractions were higher after RYGB than after SG. The reasons are not clear. More research is needed to replicate these findings, to understand the mechanisms, and further delineate the significance of the surgical method.

Cardiometabolic risk factors have been associated with the risk of late-onset dementia. However, evidence regarding early-onset dementia was inconsistent, and the impact of clustered cardiometabolic risk factors was unclear. We aimed to investigate the associations of cardiometabolic profiles with incident early-onset and late-onset dementia.

Among 289 494 UK Biobank participants, cluster analysis was built on 12 common cardiometabolic markers. Analyses were performed on those aged <65 years at baseline (n = 249 870) for early-onset dementia and those ≥65 at the end of follow-up (n = 191 213) for late-onset dementia.

During a median follow-up of 14.1 years, 279 early-onset dementia cases and 3167 late-onset dementia cases were documented. Among the five clusters of cardiometabolic profiles identified (cluster 1 [obesity-dyslipidemia pattern], cluster 2 [high blood pressure pattern], cluster 3 [high liver enzymes pattern], cluster 4 [inflammation pattern] and cluster 5 [relatively healthy pattern]), cluster 3 was significantly associated with higher risks of both early-onset and late-onset dementia; however, the risk estimate for early-onset dementia (hazard ratio 2.58, 95% CI 1.61-4.14) was larger than that for late-onset dementia (1.36, 1.09-1.71). Cluster 4 was associated with a higher risk of late-onset dementia (hazard ratio 1.39, 95% CI 1.13-1.72). No significant interactions were observed between cardiometabolic clusters and apolipoprotein E ε4 genotype.

Cardiometabolic patterns characterised by relatively high liver enzyme levels or systemic inflammation were associated with increased risks of early-onset and late-onset dementia. Identification of high-risk subgroups according to distinct cardiometabolic patterns might help develop more precise strategies for dementia prevention regardless of apolipoprotein E (APOE) ε4 status.

This study aimed to evaluate the muscle activation ratio of hip and knee during hip-focused exercises. Eleven active university students performed 13 hip-focused exercises frequently used in the treatment of knee disorders. The average sEMG amplitude of tensor fasciae latae (TFL), gluteus medius (GMed), gluteus maximus (GMax), adductor longus (AL), vastus medialis (VM), vastus lateralis (VL), and GMed/AL, GMax/AL, and VL/VM ratios were determined. Repeated-measures analyses of variance were performed to determine if there were differences in muscle activation while performing each of the 13 exercises. Sidelying clam-shell had the highest GMax/AL ratio of all the exercises examined. The hip hike exercise (5.36) had the highest GMed/AL ratio. The VL/VM ratio ranged from 0.77 to 1.16. Based on these results, sidelying clam-shell had the highest GMax/AL ratio. The hip hike exercise had a higher GMed/AL ratio compared to other hip-focused exercises. Additionally, forward lunge, squat, and single-leg squat with resistance band around the knee had the highest activity VL/VM ratio among exercises.

Spinal cerebrospinal fluid (CSF) leaks may cause a myriad of clinical symptoms, the most common being orthostatic headache. Lateral leaks (Type II) and direct CSF-venous fistulas (Type III) are a subgroup of spinal CSF leaks, representing about 1/3 of spinal CSF leaks. This study aimed to analyze the risk and efficacy of nerve root clipping in patients with Type II and Type III CSF leaks.

All consecutive patients with Type II and Type III CSF fistulas treated with nerve root clipping at our institution from May 2018 to December 2022 were included. Patients were evaluated for postoperative sensory motor deficits and neuropathic pain using the "Douleur Neuropathique 4" questionnaire, and the outcome was evaluated using the "Patient Global Impression of Change" and the return-to-work rate.

A total of 40 patients were included, and the mean follow-up time was 22 months. According to the Patient Global Impression of Change, significant symptoms improvement was reported in 85% of patients. Over 87% of patients returned to work fully or partially. One patient experienced a low-grade motor deficit after T1-nerve root clipping. 2.5% of patients developed postoperative neuropathic pain requiring medical treatment under which they fully improved. Over 80% of patients developed dermatomal hypoesthesia, with no reported effect on quality of life.

The surgical strategy of noneloquent nerve root clipping shows favorable outcomes and return-to-work rates. There are instances of neuropathic pain and dermatomal hypoesthesia with no significant morbidity. Despite the favorable outcome and low recurrence rate, nerve root-sparing surgical techniques should be further explored.

Breastfeeding provides numerous benefits for mothers and infants, but there are disparities in breastfeeding rates by race and ethnicity in the United States.

Our study aimed to identify the extent to which Baby Friendly Hospital Initiative (BFHI) key clinical practices during the birth hospitalization influenced breastfeeding success by race and ethnicity.

This study was a secondary analysis of the 2016 to 2019 National Pregnancy Risk Assessment Measurement System (PRAMS), a cross-sectional survey. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We examined the odds of breastfeeding to ≥ 10 weeks by percent of key clinical practices received and racial and ethnic group. Absolute racial differences were calculated to reflect the difference in breastfeeding rates by race and ethnicity overall, and stratified by percent of BFHI key clinical practices received.

BFHI key clinical practices were a significant predictor of breastfeeding at ≥ 10 weeks; receipt of progressively more key clinical practices resulted in higher odds of breastfeeding. Over 75% of mothers who received 100% of key clinical practices breastfed for at least 10 weeks across all racial and ethnic groups. Among mothers who received ideal breastfeeding care, disparities were eliminated; there were no statistically significant differences in rates of breastfeeding ≥ 10 weeks for Black non-Hispanic (adjusted absolute racial difference [aARD] -4.5, 95% CI [-9.5, 0.4]), Hispanic English-speaking (aARD -2.6, 95% CI [-6.6, 1.4]), or Hispanic Spanish-speaking (aARD 1.7, 95% CI [-5.2, 8.6]) mothers compared to White non-Hispanic mothers.

There is a need to renew the push for universal adoption of BFHI by U.S. hospitals to address racial and ethnic disparities in breastfeeding outcomes.

Posthepatectomy liver failure (PHLF) is the most fatal complication after liver resection, particularly in patients with comorbidities. This study aimed to assess the effect of long-term medication on PHLF incidence after open liver resections.

A retrospective analysis of 682 patients who underwent elective open hepatectomies between 2008 and 2015 at 2 academic centers was performed. Preoperative, intraoperative, and postoperative data were collected, including long-term medication. The risk factors for the development of PHLF and other postoperative complications were evaluated using univariate and multivariate logistic regression analyses.

PHLF occurred in 81 patients (11.9%), with a higher incidence in patients taking diuretics as long-term medication than in those not taking diuretics (17.7% vs 5.3%, respectively; P <.001). Diuretic use was identified as a strong independent risk factor for PHLF (odds ratio [OR], 3.8 [95% CI, 2.1-7.0]; P <.001), alongside liver cirrhosis (OR, 3.8 [95% CI, 1.9-7.6]; P <.001), primary liver malignancies (OR, 3.8 [95% CI, 1.6-9.3]; P <.001), major hepatectomies (OR, 3.1 [95% CI, 1.7-5.7]; P <.001), and long operating time (OR, 4.2 [95% CI, 2.4-7.2]; P <.001). Patients with long-term diuretic intake were older, had higher body mass indices, and had more comorbidities, including liver cirrhosis.

Long-term diuretic use is associated with a significantly increased risk of PHLF after open hepatectomy.

Type 2 diabetes is associated with excess hospital admissions and increased mortality. Structured diabetes self-management education (DSME) is recommended internationally and is associated with improved self-management skills, well-being and minor improvements in glycated haemoglobin (HBA1c), but does it reduce hospital admissions or prevent premature mortality? Our aim is to examine the relationship between DSME attendance, hospitalisations, mortality and 3-point major adverse cardiovascular events (MACE) in people with type 2 diabetes to inform future healthcare policy and diabetes care.

This protocol details a 10-year retrospective open cohort study of patients aged over 18 years old who have a clinical diagnosis of type 2 diabetes and were registered to an English GP practice from 29 March 2011 to 29 March 2021 and have attended DSME. Patients in the 'ever' cohort will be matched at baseline for age, sex, age at diagnosis and diabetes duration, to those who have 'never' attended DSME. Data will be identified via the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics Admitted Patient Care data, Office for National Statistics death registrations and patient Index of Multiple Deprivation deciles. Patients will be followed-up through serial cross-sections. Multiple imputation will be considered to manage covariates where data are >12-months from baseline or are not expected to be missing at random. Cox proportional hazard regression and time to event modelling adjusted a priori for cofounding during multivariate analysis will be used.

This study was approved by CPRD (24_003744). Study findings will be disseminated through peer-reviewed publications and international conferences.

High-dose long-term opioid treatment for chronic non-cancer pain (CNCP) has become an increasing burden in industrialised countries. Opioid tapering and withdrawal in patients with CNCP remain challenging. This study evaluated a two-phase inpatient opioid withdrawal (OW) programme aimed at safely discontinuing opioid use in CNCP patients.

This prospective observational study was conducted from 2018 to 2023 at a Swiss tertiary care centre, involving CNCP patients on long-term opioid therapy (≥ 6 months, ≥ 100 mg morphine equivalent daily dose) who had failed outpatient withdrawal attempts. The programme consisted of a withdrawal phase (Phase 1) followed by multimodal pain rehabilitation (Phase 2). Outcomes included the proportion of patients opioid-free after Phase 2 (primary) and at 3 months, pain intensity changes, and adverse events (secondary).

Among the 38 enrolled patients (58% female, median age 54 years [IQR 49, 62]), 34 (89%) completed both phases, and 32 (84%) were opioid-free at the end of Phase 2. At 3 months, 23 patients (61%) remained opioid-free, while 4 (11%) resumed opioids, and 11 (29%) were lost to follow-up. Median pain intensity remained stable after discharge. One patient died by suicide 10 days post-withdrawal.

This two-phase inpatient withdrawal and rehabilitation programme enabled most CNCP patients to discontinue opioids without increased pain intensity, with a majority remaining opioid-free at 3 months. These findings highlight the importance of ongoing psychological support and careful patient selection in OW management.

This study introduces a structured inpatient opioid withdrawal model tailored for chronic non-cancer pain patients on high-dose opioid therapy, demonstrating that high cessation rates can be achieved without worsening pain intensity. By addressing the gap in care for patients who fail outpatient tapering, this research provides clinical insights into optimising withdrawal protocols and highlights the need for targeted resource allocation for intensive, multidisciplinary pain management. These findings support evidence-based decision-making in designing more effective opioid tapering strategies.

The aim of this study was to investigate the applications of cone beam computed tomography (CBCT) amongst endodontic specialists in the United Kingdom (UK) via an online survey.

An online invitation to take part in the survey was sent out to 306 specialist endodontists registered on the UK specialist register. The survey consisted of a series of questions associated with demographics, access and use of CBCT, utilization of dose optimization parameters, and frequency of use in different clinical scenarios.

In total, 202 respondents completed the survey (a response rate of 66.3%), 128 were male (63.4%), and 74 were female (36.6%). Of the 202 respondents, 174 (85.7%) used CBCT for diagnosis and/or management of endodontic problems. A CBCT scanner was on-site in 71.3% (n = 124) and 28.7% (n = 50) being off-site. A small field of view (FOV) was the prescribed scan in most cases (88.5%, n = 154/174). The cost of the CBCT scan was included in the assessment/treatment fee in 21.8% (38/174) of cases, with 78.2% (136/174) charged a separate fee for the scan. In total, 89.1% (155/174) respondents used CBCT 'often or always' for management of complex root canal anatomy, 87.4% (152/174) for root resorption, 84.5% (147/174) for periapical microsurgery, only 20.7% (36/174) of respondents would use CBCT to assess the outcome of treatment. Only 35.1% (61/174) of respondents would prescribe a CBCT scan for a pregnant patient and 78.2% (136/174) would take a CBCT scan for a paediatric patient. In total, 22.4% (39/174) of respondents did not report or request reports of their CBCT scans. Respondents chose to alter the exposure parameters depending on the patient's age or if the dentition was deemed extensively restored. Of the clinicians who incorporate CBCT into their practice, 93.7% (164/174) believe it improves the quality of the care they provide, and 93.6% (163/174) felt that the use of CBCT improves confidence in their diagnosis.

The use of CBCT amongst specialist endodontists in the UK is commonplace. However, usage does not appear to completely follow best practice guidance for certain clinical scenarios and highlights the need for further training in CBCT.

To study the impact of laparoscopic niche repair on subendometrial peristalsis in women with a large niche.

A explorative prospective cohort study that included women with a large niche (residual myometrium ≤ 3 mm), actual wish to conceive who were scheduled for laparoscopic niche repair. To analyse the effect of a laparoscopic niche repair on the uterine anatomy and subendometrial peristalsis, all participants underwent a 4-5 min transvaginal ultrasound before surgery and three months post-surgery during the mid-luteal phase of the menstrual cycle. Subendometrial peristalsis was evaluated by strain analysis using a dedicated two-dimensional optical flow speckle tracking method. The following features were extracted from the strain signals: frequency, amplitude, velocity, coordination and direction of coordination.

Post-surgery, the mean niche volume significantly decreased, with a mean reduction of 963.9 mm3 (95 % CI 382.0-1545.7). Additionally, the residual myometrium thickness increased significantly, with a mean difference of 5.8 mm (95 % CI 6.8 to 4.7). Of the subendometrial peristalsis, a significant improvement of the frequency was observed. Although amplitude, velocity, and direction of the contractions shifted towards normal values, these changes did not reach statistical significance in this pilot study. The improvements in individual peristaltic characteristics were closely associated with reductions in niche volume and enlargement of residual myometrium.

Subendometrial peristalsis is disturbed in women with a large niche. Individual contraction parameters such as velocity, amplitude and frequency decreased following laparoscopic niche repair which might be favourable for fertility purposes. These changes were associated with a reduction in niche volume and enlargement of the residual myometrium and warrant further validation in a larger cohort study.

What do we already know about this topic?Significant obstacles to providing effective pain relief still exist despite major improvements in pain management strategies.How does this research contribute to the field?It highlights the necessity for a thorough comprehension of the complex nature of pain management, where nurses play a crucial role, in the context of patient care.What are the implications of this research for theory, practice, or policy?It highlights the need for healthcare organizations and educational institutions to give nurses priority in their ongoing training and education, with an emphasis on cultivating a holistic and compassionate approach to pain management.

Minimally invasive right hemicolectomy for cancer with complete mesocolic excision is a difficult procedure to perform. The aim of this single-center prospective study was to evaluate whether preoperative angio-CT colonography (A-CTC) improved the quality of lymph node dissection during this surgery.

All patients undergoing elective minimally invasive right hemicolectomy for colon adenocarcinoma with complete mesocolic excision between 01/2020 and 12/2023 have been prospectively included. The primary endpoint was the number of lymph nodes examined in the surgical specimen, including the total number of lymph nodes and the percentage of patients with at least 12 lymph nodes examined. Secondary endpoints included operating time, intraoperative complications, overall postoperative morbidity, and length of hospital stay. A propensity score was constructed with groups matched 3:1 using nearest neighbor matching based on the propensity score.

Of the 161 patients included, 44 had A-CTC (27%) and 117 had conventional CT scans. After propensity score matching, patients in the A-CTC group had significantly more lymph nodes on the surgical specimen (24 vs. 20, p = 0.006) and a better quality of lymph node dissection (≥ 12 examined lymph nodes: 100% vs. 87%, p < 0.001). Median operative times were similar between the two groups (184 vs. 180 min, p = 0.07), but two patients (2%) in the conventional CT group experienced an intraoperative bleeding complication. Postoperative morbidity and length of hospital stay were comparable.

Preoperative 3D reconstruction of vascular anatomy with A-CTC is useful and improves the quality of lymph node dissection during minimally invasive right hemicolectomy for cancer.

Nursing managers increasingly focus on improving the quality of patient-centred nursing services.The combination of SERVQUAL model and Kano model can be used for the study on the improvement of nursing quality. Through a literature review and expert discussion, an evaluation questionnaire and a Kano model questionnaire were developed to assess the nursing service quality for orthopaedic trauma inpatients. The SERVQUAL model was used to identify low-level nursing service elements, and the Kano model, factor selection line and sensitivity analysis were used to determine the rectification order. Three hundred people completed two rounds of the survey. The total score for nursing service quality was -0.55. The 26 items assessing nursing service quality included 21 low-level items. There were 10 items that needed improvement. The main reason for low nursing service quality is inadequate attention to patient safety and comfort requirements. Constructing a training system for orthopaedic nurses and optimising the nursing service process are the primary strategies for optimizing the nursing service quality for orthopaedic trauma inpatients. It lays a good foundation for improving patients' experience and health outcomes.

The integration of artificial intelligence (AI) in healthcare has rapidly expanded, particularly in clinical decision-making. Large language models (LLMs) such as GPT-4 and GPT-3.5 have shown potential in various medical applications, including diagnostics and treatment planning. However, their efficacy in specialized fields like sports surgery and physiotherapy remains underexplored. This study aims to compare the performance of GPT-4 and GPT-3.5 in clinical decision-making within these domains using a structured assessment approach.

This cross-sectional study included 56 professionals specializing in sports surgery and physiotherapy. Participants evaluated 10 standardized clinical scenarios generated by GPT-4 and GPT-3.5 using a 5-point Likert scale. The scenarios encompassed common musculoskeletal conditions, and assessments focused on diagnostic accuracy, treatment appropriateness, surgical technique detailing, and rehabilitation plan suitability. Data were collected anonymously via Google Forms. Statistical analysis included paired t-tests for direct model comparisons, one-way ANOVA to assess performance across multiple criteria, and Cronbach's alpha to evaluate inter-rater reliability.

GPT-4 significantly outperformed GPT-3.5 across all evaluated criteria. Paired t-test results (t(55) = 10.45, p < 0.001) demonstrated that GPT-4 provided more accurate diagnoses, superior treatment plans, and more detailed surgical recommendations. ANOVA results confirmed the higher suitability of GPT-4 in treatment planning (F(1, 55) = 35.22, p < 0.001) and rehabilitation protocols (F(1, 55) = 32.10, p < 0.001). Cronbach's alpha values indicated higher internal consistency for GPT-4 (α = 0.478) compared to GPT-3.5 (α = 0.234), reflecting more reliable performance.

GPT-4 demonstrates superior performance compared to GPT-3.5 in clinical decision-making for sports surgery and physiotherapy. These findings suggest that advanced AI models can aid in diagnostic accuracy, treatment planning, and rehabilitation strategies. However, AI should function as a decision-support tool rather than a substitute for expert clinical judgment. Future studies should explore the integration of AI into real-world clinical workflows, validate findings using larger datasets, and compare additional AI models beyond the GPT series.

The ongoing regional nursing shortages in the United States, exacerbated by the COVID-19 pandemic, compromise patient safety and quality. Additionally, an aging workforce coupled with an aging population requiring more nursing care services limits organizations' ability to adequately staff their facilities. Nurses' turnover from the profession has been studied less than organizational turnover, thus, the purpose of this integrative review is to identify factors associated with intention to leave the nursing profession in the United States. Using Whittemore and Knafl's (2005) guidelines for integrative review methods, we conducted systematic searches in CINAHL, PubMed, and Web of Science in July 2024. There were 39 peer-reviewed studies that met inclusion criteria. Synthesis of findings resulted in four individual and four work-level themes associated with intent to leave the nursing profession. Individual themes included individual beliefs, health and wellbeing, individual work experiences, and career stability. Work-level themes included job characteristics, job demands/workload, resources and support, and work environment. Notably, job-level factors (i.e., workload, work environment, and support) were associated with professional turnover intention, which suggests that nurses do not believe their experiences will improve at another nursing job. Gaps in the literature include studies with nationally representative samples, studies using validated measures of health, and qualitative studies conducted with the aim of understanding why nurses want to leave the profession. To promote retention of nurses at the professional and organizational level, organizations should measure and modify relevant job-level factors, and the protection of nurses' wellness should be a top organizational priority.

To realise the full potential of artificial intelligence (AI) systems in medical imaging, it is crucial to address challenges, such as cyberterrorism to foster trust and acceptance. This study aimed to determine the principles that enhance trust in AI systems from the perspective of medical imaging professionals in Ghana.

An anonymous, online, nationwide cross-sectional survey was conducted. The survey contained questions related to socio-demographic characteristics and AI trustworthy principles, including "human agency and oversight", "technical robustness and safety", "data privacy, security and governance" and "transparency, fairness and accountability".

A total of 370 respondents completed the survey. Among the respondents, 66.5 % (n = 246) were diagnostic radiographers. Considerable number of respondents (n = 121, 32.7 %) reported having little or no understanding of how medical imaging AI systems work. Overall, 54.9 % (n = 203) of the respondents agreed or strongly agreed that each of the four principles was important to enhance trust in medical imaging AI systems, with a composite mean score of 3.88 ± 0.45. Transparency, fairness and accountability had the highest rating (4.27 ± 0.58), whereas the mean score for human agency and oversight was 3.89 ± 0.53. Technical robustness and safety as well as data privacy, security and governance obtained mean scores of 3.79 ± 0.61 and 3.58 ± 0.65, respectively.

Medical imaging professionals in Ghana agreed that human agency, technical robustness, data privacy and transparency are important principles to enhance trust in AI systems; however, future plans including medical imaging AI educational interventions are required to improve AI literacy among medical imaging professionals in Ghana.

The evidence presented should encourage organisations to design and deploy trustworthy medical imaging AI systems.

This retrospective case-control study compares arthroscopic surgery (AS) with open reduction and internal fixation (ORIF) in early and late follow-up outcomes for perilunate injuries. Of 74 patients treated between 2012 and 2023, 28 were matched into two groups: 14 AS and 14 ORIF. Baseline characteristics were similar. Arthroscopic surgery had a significantly shorter operative time (mean difference (MD) 71 min, 95% confidence interval (CI) 10 to 132 min, p = 0.021). At early follow-up (mean 4.1, SD 1.3 months), AS patients had significantly higher Mayo Wrist Scores (MWS) with better pain relief, return to work and grip strength (MWS MD 24 points, 95% CI 12.4, 35.6 points, p < 0.001). The subscales levelled off at late follow-up (mean 14.7, SD 4.8 months). There were no significant differences in complications, revision incidence or intercarpal angles at final follow-up. When feasible, AS is a promising, time-efficient alternative to dorsopalmar double approach ORIF for the treatment of perilunate injuries, particularly in terms of early postoperative clinical outcomes.Level of evidence: III.

The Trauma and Injury Severity Score (TRISS) uses anatomic and/or physiologic variables to predict mortality; however, Injury Severity Score is less reliable for penetrating trauma. National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) and American Society of Anesthesiologists Physical Status (ASA-PS) include functional status and comorbidities. This study evaluates the accuracy of these tools in predicting mortality, length of stay (LOS), and complications for operative penetrating trauma.

Adult penetrating trauma patients (≥18 y) who underwent surgery within 24 h of admission were included in this subgroup analysis of a prospective observational study at four trauma centers. The following three scoring models were compared: NSQIP-SRC, TRISS, and ASA-PS. Brier scores and area under the receiver-operating characteristic curve were used to compare mortality prediction. LOS prediction was assessed with linear regression and complications were evaluated with negative binomial regression. Likelihood ratio (LR) test was used to assess model fit.

Of 329 penetrating trauma patients, 13 (3.9%) died. The median LOS was 4 d (interquartile range 2-9), and median number of complications was zero (interquartile range 0-1). TRISS better predicted mortality than NSQIP-SRC or ASA-PS on Brier score (0.02 versus 0.03 versus 0.03) but all had similar area under the receiver-operating characteristic curve (0.93 versus 0.93 versus 0.91, P = 0.26). NSQIP-SRC and ASA-PS better predicted LOS on adjusted R2 (14.4% versus 14.1% versus 1.6%) and LR showed no difference between these two tools (P = 0.16). NSQIP-SRC best predicted complications compared to TRISS and ASA-PS (Pseudo R2: 10.3% versus 3.8% versus 5.5%; LR: P = 0.003).

For penetrating trauma, all three models were similarly excellent at predicting mortality. NSQIP-SRC and ASA-PS better predicted LOS and NSQIP-SRC best predicted complications, suggesting these are better tools for prognostication of outcomes for penetrating trauma.

The Victorian Virtual Emergency Department (VVED) provides emergency care for patients across Victoria, Australia with non-life-threatening concerns. This study aims to explore subsequent self-referral patterns of patients after initial presentation to the VVED.

A retrospective cohort study was conducted in 42,921 VVED patients between October 2020 and June 2024. Subsequent self-referral rates among VVED patients who were initially referred through a health care provider (HCP) referral pathway were compared to those who self-referred upon their first presentation. Descriptive statistics and multivariable logistic regression modelling were used.

Patients were more likely to self-refer on their second presentation if they self-referred on their first presentation (88 % vs 40 %; p < 0.001). Multivariable logistic regression analyses showed significantly lower odds of subsequent self-referral in all HCP referral pathways compared to the self-referral group. Patients referred through pathways without an HCP present had higher odds of subsequent self-referral than those referred via pathways with a HCP present (OR=1.19, 95 % CI: 1.10-1.28).

Patients who self-refer to the VVED initially are more likely to continue self-referring to the service. Further research is needed to explore factors that may enhance the likelihood of self-referral to virtual emergency care services.

The role of hysterectomy for borderline ovarian tumor (BOT) among postmenopausal women is still unclear.

To assess the impact of hysterectomy on survival outcomes in postmenopausal women with BOT.

This study was a national, multicenter, observational, retrospective, cohort study including all consecutive eligible postmenopausal patients who underwent primary surgery for BOT in 20 Italian centers from January 2005 to December 2017. Patients were divided into two groups: hysterectomy group vs no-hysterectomy group. Primary outcome was disease-free survival (DFS) at 5 years of follow-up; secondary outcomes were overall survival (OS) and disease-specific survival (DSS) at 5 years of follow-up, hazard ratio (HR) for recurrence, death of any cause and death due to BOT, peri-operative complications rates.

483 patients were included, 144 (29.8 %) women in the no-hysterectomy group and 339 (70.2 %) in the hysterectomy group. Recurrences were significantly more common in the no-hysterectomy group compared to hysterectomy one (8.3 % vs 2.7 %; p = 0.012). The 5-year DFS rate was lower in the no-hysterectomy group than that in the hysterectomy one [92.4 % vs 98.5 %; p = 0.007]. At univariate analyses, women who underwent hysterectomy showed HR of 0.312 (95 %CI:0.131-0.740; p = 0.008) for recurrence. At multivariate analysis, hysterectomy was found to be an independent protective factor for recurrence (HR: 0.253, 95 %CI:0.103-0.618, p < 0.003).

In postmenopausal women with BOT, hysterectomy is associated with a decreased risk of recurrence, while it does not affect the risk of death from any cause or death due to the disease. Based on these findings, hysterectomy should be routinely integrated into the surgical staging of BOT in postmenopausal women.

This study aimed to investigate the barriers and lack of knowledge perceived by pediatric nurses in managing pain in children with sickle cell disease (SCD).

A descriptive, cross-sectional design was employed.

In this study, 298 nurses aged between 21 and 53 years from 10 hospitals in the northern and middle regions of Jordan completed a structured, self-reporting questionnaire. Descriptive and inferential statistics were used for data analysis.

Nurses identified 12 perceived barriers to optimal pain management in children with SCD. The top three barriers included workload (mean rating of 7.29/10), absence of psychological support for children (mean rating of 7.13/10), and insufficient time (mean rating of 6.83/10). A lack of knowledge and training about SCD pain was also recognized as a significant barrier. Regarding nurses' perceptions of their understanding of SCD in children, less than half (41%-46%) believed they had adequate knowledge. Only 23% of nurses had received education on pain management, and only 6% had received structured education on caring for patients with SCD.

System-related challenges, such as heavy workloads and limited time, were significant obstacles that prevented healthcare providers from prioritizing pain management for children with SCD.

To reduce delays in SCD-related pain care and improve health outcomes, nursing policymakers, administrators, and educators must implement multilevel strategies to address the identified barriers to optimize pain management in children with SCD.

The objective of this study was to determine associations between atrial fibrillation diagnosed after stroke (AFDAS) and known atrial fibrillation with 2-year mortality among men and women.

This longitudinal, register-based study included patients with ischemic stroke admitted to 3 hospitals in Gothenburg, Sweden, between November 1, 2014 and June 30, 2019. The exposures were known atrial fibrillation and AFDAS detected at the stroke units. The outcome was all-cause mortality 2 years after stroke. Cox-regression analyses were conducted to assess sex differences in relation to the adjusted mortality risk. Of 5468 patients with ischemic stroke, 2583 (47%) were women, and the mean age was 74 years (SD 14). Overall, 19% had known atrial fibrillation, and 10% had AFDAS. Women were older and had more severe strokes compared with men. Within the first month, women with AFDAS did not have an increased risk of mortality compared with women with no atrial fibrillation (hazard ratio, 0.93 [95% CI, 0.46-1.88]), in contrast to men with AFDAS who had an increased risk (hazard ratio, 2.14 [95% CI, 1.07-4.26]). Men and women with AFDAS had an increased risk of long-term mortality (31 days to 2 years) compared with those with no atrial fibrillation. Known atrial fibrillation was associated with the highest poststroke mortality irrespective of sex and time interval.

Our findings suggest that underlying sex differences exist in the association between the occurrence of AFDAS and poststroke mortality. Sex differences related to the timing of atrial fibrillation diagnosis should be considered when developing preventive measures and medical care after stroke.

Periodontitis and pulmonary disease both are common diseases of humans worldwide and are interconnected to each other. Pulmonary disease is one of the leading causes of morbidity and mortality globally. Poor periodontal health has been attributed to enhance multiple systemic diseases including respiratory disease. Therefore, the study was carried out to determine the periodontal status of patients presenting with pulmonary disease and also to assess the association of periodontitis with pulmonary disease along with their oral health behavior.

A cross-sectional study was conducted among 103 patients (> 18 years) diagnosed primarily with pulmonary disease in pulmonology/internal medicine ward of a tertiary health care facility in eastern Nepal. A pretested structured questionnaire (WHO-2013 oral health questionnaire for adults/ Global adult tobacco survey questionnaire) was used to assess oral health behavior of participants. Plaque index, gingival index, pocket depth and attachment loss were recorded to assess periodontal condition. Chi square test, t-test and ANOVA were used based on nature of variables. The level of significance was set at p < 0.05.

The mean age of participants was 63.57 (± 16.42) ranging from 19 - 89 years. Male participants were higher (60.2%) compared to female (39.8%). Most of the participants were former smokers (79.6%) and former smokeless tobacco users (62.1%). Majority of the participants had fair plaque control (75.6%) and moderate form of gingivitis (92.2%). Of the total (n = 103) participants, 36.9% (n = 38) were diagnosed with COPD, 23.3% (n = 24) with pneumonia, 18.4% (n = 19) with pulmonary tuberculosis and 21.4% (n = 22) with lung malignancy. Overall, 85.5% of participants had periodontitis. More than two-thirds (73.3%) had moderate periodontitis, followed by severe periodontitis (11.1%). Out of all forms of pulmonary disease periodontitis was found to be higher in COPD group (33.8%). No association was observed between periodontitis and pulmonary disease (p = 0.05) whereas former smokers, former smokeless tobacco users and gingival index score was found to be associated (p < 0.05).

More than two-third of the participants diagnosed primarily with pulmonary disease had periodontitis. No association was observed between periodontitis and pulmonary disease. However, gingival index score, habit of smoking and smokeless tobacco was associated with periodontitis.

This study investigates the frequency and characteristics of obsessive-compulsive (OC) symptoms and Obsessive-Compulsive Personality Disorder (OCPD) in patients with Burning Mouth Syndrome (BMS).

Obsessive-Compulsive Disorder (OCD) is a chronic condition involving intrusive thoughts (obsessions) and repetitive behaviors (compulsions), while Obsessive-Compulsive Personality Disorder (OCPD) is a personality disorder characterized by specific traits such as perfectionism, rigidity and need for control. Both conditions frequently overlap, but their prevalence in patients with BMS has never been explored.

A total of 151 BMS patients were assessed using the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Visual Analog Scale (VAS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hamilton Anxiety and Depression scales (HAM-A, HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Patients were grouped based on OCI and CPAS scores.

n = 123 (81.6%) of our sample were females, with a mean age of 63.19 ± 12.2 years. Clinically significant OC symptoms (OCI-R > 21) were observed in 41.7% of the sample, while 37% met OCPD criteria; both OC symptoms and OCPD were present in 24.5% of patients.

BMS patients show a high prevalence of OC symptoms and OCPD traits, which should be taken into account by clinicians and considered in the therapeutic approach, given that they could complicate symptom management.

By identifying these symptoms and traits through OCI-R and CPAS, clinicians may improve treatment strategies, in the perspective of a multidisciplinary tailored and personalized approach.

Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48-96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03-4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication.

Controlling HbA1c can help reduce the symptoms and complications of diabetes. However, only about 25% of adults with diabetes achieve this diabetes care goal. It can be seen that diabetes requires more research investment and breakthroughs, as well as a more complete discussion of related factors that affect diabetes control, in order to better control the disease. This study explored the effects of diabetes self-care behavior, healthy lifestyle, diabetes symptoms, social support, demographic variables, and physical examination values on HbA1c levels in individuals with type 2 diabetes.

This study used a cross-sectional design and recruited 305 subjects with type 2 diabetes at a medical center. Personal data were collected using a structured questionnaire and same-day outpatient medical records.

Multiple linear regression analysis identified significant predictors of HbA1c levels. These include insulin treatment (P < .001), age (P < .001), gender (P < .001), diabetes duration (P = .003), proteinuria (P < .001), diabetes self-care behaviors (P = .021), physical activity (running; P = .018), and spousal involvement in care (P = .031). Female gender, insulin treatment, longer diabetes duration, spousal involvement in care, and the presence of proteinuria were positively associated with higher HbA1c levels. In contrast, higher age, better diabetes self-care behaviors, and regular physical activity (running) were associated with lower HbA1c levels. These findings underscore the importance of considering both demographic factors and lifestyle behaviors in the management of HbA1c levels.

For reasons that hinder subjects from controlling HbA1c levels, individual self-management intervention programs should be provided to improve the effectiveness of subjects in controlling HbA1c levels. The care giver should be included in the educational program of diabetes management. Running exercise contributes to the control of HbA1c levels.

Background: Pancreatoduodenectomy with venous resection (PDVR) may be performed to achieve tumour clearance in patients with a pancreatic ductal adenocarcinoma (PDAC) with venous involvement. This study aimed to evaluate the impact of PDVR on PDAC outcomes. Methods: In total, 435 PDAC patients with either R0 status (n = 322) or R1 status within the superior mesenteric vein groove (n = 113) were extracted from the Recurrence After Whipple's (RAW) study dataset. PDVR patients were matched in a 1:2 ratio with standard PD patients. Comparisons were then made between the two groups (surgical radicality and survival). Results: A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%, p = 0.032) and R1 resection rates (17.9% vs. 42%, p < 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection (p < 0.001 for sleeve and p = 0.034 for segmental resection), pT3 (p = 0.007), and pN1 stage (p = 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m), p = 0.023) and disease-free survival (DFS, 17 m vs. 24 m, p = 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m, p = 0.928) or DFS (R0: 18 m, R1: 17 m, p = 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group (p = 0.034). Conclusions: Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates.