Alma

Instability is a rising cause of revision total knee arthroplasty (rTKA), creating significant challenges for patients, surgeons and the healthcare system. This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management, isolated polyethylene exchange (PE), and rTKA as treatments for post-TKA instability. The primary outcome was patient-reported outcome measures (PROMs), with secondary outcomes including reoperation rates, revision rates, and implant survival (Aim 1). Additionally, the study examined the effect of instability type on PROMs (Aim 2) and the impact of prosthesis constraint on PROMs (Aim 3). A systematic search of studies published from 2000 to July 2024 was conducted. (1) Studies analysing the outcome of conservative treatment, isolated PE exchange or revision surgery for instability were included, reporting on PROMs, reoperations, revisions, and/or survival free from revision. PROMs included the Knee Society Score, both clinical (KSCS) and functional (KSFS). Revision was defined as the removal and replacing of the femoral and/or tibial component. A meta-analysis was only performed for revision surgery as treatment. (2) Instability was classified into flexion and extension instability. (3) Prosthetic constraints analysed included posterior stabilised (PS), condylar constrained knee (CCK), and rotating hinged knee (RHK). A total of 27 articles, involving 4269 knees, were included in the analysis: two studies on conservative management, 12 on isolated PE exchange, and 19 on revision surgeries. (1) Conservative treatment, primary physiotherapy, yielded inconsistent results. Isolated PE exchange showed poor outcomes, with recurrent instability and subsequent revision occurring in 6.5%-18.5% of cases. However, in carefully selected patients, outcomes comparable to rTKA were observed. Revision surgery showed a mean improvement of 32 points (95% confidence interval [CI], 20.5-43.5; p < 0.001) for KSKS and 24.3 points (95% CI, 17.2-31.4; p < 0.001) for KSFS. During follow-up, 5.3% (46/864) of the patients underwent a rerevision, with 41.3% attributed to instability. (2) Extension instability showed a trend toward better KSKS (p = 0.04) and KSFS scores (p = 0.03) than flexion instability, and (3) no evidence of superiority was found between different types of constraint in this study. When guided by appropriate clinical indications, conservative management, isolated PE exchange, and revision surgery can yield favourable outcomes in the treatment of post-TKA instability. Instability remains the leading cause of rerevision, highlighting the need for higher prosthetic constraints when flexion-extension gap balancing cannot be achieved. Level IV, systematic review.

Early prediction of disability progression in multiple sclerosis (MS) remains challenging despite its critical importance for therapeutic decision-making. We present the first systematic evaluation of personalized federated learning (PFL) for 2-year MS disability progression prediction, leveraging multi-center real-world data from over 26,000 patients. While conventional federated learning (FL) enables privacy-aware collaborative modeling, it remains vulnerable to institutional data heterogeneity. PFL overcomes this challenge by adapting shared models to local data distributions without compromising privacy. We evaluated two personalization strategies: a novel AdaptiveDualBranchNet architecture with selective parameter sharing, and personalized fine-tuning of global models, benchmarked against centralized and client-specific approaches. Baseline FL underperformed relative to personalized methods, whereas personalization significantly improved performance, with personalized FedProx and FedAVG achieving ROC-AUC scores of 0.8398 ± 0.0019 and 0.8384 ± 0.0014, respectively. These findings establish personalization as critical for scalable, privacy-aware clinical prediction models and highlight its potential to inform earlier intervention strategies in MS and beyond.

BackgroundNeoadjuvant chemotherapy is used in borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) to increase resection rate and improve cancer outcome. However, there is a need for better prediction of resectability. The aim of this prospective, single arm study is to improve prediction of surgical resection by using radiomics and liquid biopsy.MethodsIn this multicentric trial, 45 patients with BR or LA PADC will undergo neoadjuvant chemotherapy with FOLFIRINOX. An intention to treat analysis will be performed. The primary endpoint is the accuracy of the prediction of surgical resection. Secondary endpoints are overall survival and disease-free survival from the date of diagnosis, R0 and R1 resection rates, histopathological response, postoperative complications, patient reported outcomes with quality of life and health economic analysis. Translational research with multi-omics and radiomics based on computed tomography and magnetic resonance imaging aims to identify factors predictive of surgical resectability and survival. The primary hypothesis is that these strategies can increase the accuracy of predicting surgical resection.DiscussionImproved prediction of resectability is necessary in BR and LA PDAC. We aim to investigate whether a combination of clinical, radiological, and multi-omics profiling in liquid biopsies can successfully predict resectability and thus optimize the therapeutic decision tree.Trial registrationClinicalTrials.gov Identifier: NCT05298722. Date of registration: March 28, 2022.

Working from home (WFH) has become increasingly common, and its impact on job performance is particularly interesting to researchers. Prior research has established a positive correlation between remote work and job performance, but the underlying mechanisms still need to be fully understood. This diary study addresses this issue by applying the Job Demands-Resources (JD-R) theory and developing a mediation model that identifies two processes responsible for the positive and negative relationships of WFH (compared to working at the office or WATO) with job performance. The study was conducted in a public organization, and 203 employees engaged in hybrid work arrangements answered an online survey for eight consecutive workdays. Results showed that working from home (WFH) had an indirect positive relationship with job performance through daily concentration and work engagement. Instead, no significant indirect relationship of WFH with daily job performance through daily social isolation and tension was observed. However, a disengagement “effect” was found, as the indirect relationship of WFH with daily job performance via daily social isolation and work engagement was negative and statistically significant. Theoretically, this study supports a motivational mechanism linking WFH to job performance, does not support the health-impairment process triggered by WFH, and emphasizes the importance of considering the complex interplay between job demands and motivational states. From a practical standpoint, the study suggests that organizations implementing hybrid work should enhance employee motivation, for instance, by providing tools to improve employee concentration and addressing potential feelings of social isolation when working from home.

ABSTRACT Background A palliative care approach (PCA), including advanced care planning (ACP), should be considered for patients with limited life expectancy. The Belgian Palliative Care Indicators Tool (Be-PICT) has been released to help identify patients who may benefit from such approach. This study aimed at measuring 1-year mortality and describe the quality of life in older inpatients, according to baseline Be-PICT results. Methods Prospective multicentre cohort study in older patients (≥ 75 years) admitted at geriatrics and cardiology wards of four Belgian hospitals. The palliative profile was defined as a positive Be-PICT.1, defined by the presence of its three criteria, i.e. a negative physician’s answer to the surprise question ‘would you be surprised if this patient dies in the 6–12 next months?’, ≥ 1 poor health indicator and ≥ 1 life-limiting condition. Results Of the 379 patients (50% aged ≥85 years; 51% female), 52 (14%) presented a palliative profile and 83 (23%) died within 1 year. Be-PICT.1 showed the following characteristics to predict 1-year mortality: sensitivity 0.54, specificity 0.83, positive and negative predictive values 0.48 and 0.86, positive and negative likelihood ratios 3.22 and 0.55. The patients with a palliative profile were at higher mortality risk (hazard ratio 4.79 p < 0.001) and 1-year mortality rate (45%). Not using the SQ allowed to improve sensitivity to include a larger number of patients who may benefit from ACP and PCA. Conclusions Be-PICT.1 is a simple case-finding tool to identify older inpatients being at high mortality risk and candidates for ACP and PCA.

Background In the context of the current COVID-19 pandemic, there has been renewed interest in the drug hydroxychloroquine. However, clinicians should be aware of the dangers of hydroxychloroquine intoxication, an insufficiently studied condition. Case Report. We present a case of autointoxication with 20 g hydroxychloroquine in a 35-year-old woman. Cardiac monitoring showed ventricular arrhythmias for which high-dose midazolam and propofol were initiated, resulting in a brief normalization of the cardiac rhythm. Because of the reoccurrence of these arrhythmias, intravenous lipid emulsion was administered with fast cardiac stabilization. Treatment with continuous norepinephrine, potassium chloride/phosphate, and sodium bicarbonate was initiated. On day 6, she was extubated and after 11 days, she was discharged from the hospital without complications. Conclusion Since high-quality scientific evidence is lacking, treatment options are based on experience in chloroquine toxicity. Activated charcoal is advised if the patient presents early. Sedation with diazepam, early ventilation, and continuous epinephrine infusion are considered effective in treating severe intoxication. Caution is advised when substituting potassium. Despite the lack of formal evidence, sodium bicarbonate appears to be useful and safe in case of QRS widening. Intravenous lipid emulsion, with or without hemodialysis, remains controversial but appears to be safe. As a last resort, extracorporeal life support might be considered in case of persisting hemodynamic instability.

Abstract Background. The patients who attend a hospital without a hemodynamic laboratory may have differences in health outcomes, treatment, reperfusion times, the rate of cardiovascular complications, hospital stay, mortality or costs may be affected. The study aimed to analyze the prognostic of patients with STEMI treated in the Emergency Department (ED) and the impact prognostic of the delayed reperfusion time in a Hospital General without hemodynamic laboratory. Methods. After ethics review board approval, this retrospective observational cohort study of patients included acute coronary syndrome with ST elevation of ≤ 24 h in the Illes Balears infarction code registry (CI-IB) between May 2008 and December 2018. The information recorded were age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty (PA). Cardiovascular Event (CE) was defined the combined variable: Killip class progression, malignant arrhythmias, Re-infarction, cerebrovascular disease and mortality. Results.605 patients were analyzed. The reperfusion treatment was 83,1% (80,8% with PA). 19% presented some CE. Hospital and monthly mortality was 6.8% and 7.8% respectively. The main differences between patients with and without CE were: age (66 vs 59 years); Chronic obstructive pulmonary disease (COPD); previous infarction; anterior location; Door-To-Needle Time and FPC-PA time. The risk factors of CE were: age, COPD, anterior location, fibrinolysis and patients without reperfusion treatment. In the group with PA, the risk of mortality was higher in COPD (p=0.012), Symptom start –FPC time with (p = 0,084) and FPC-PA time &gt; 90 minutes (p= 0.107). FCM-AP&gt; 90 minutes had a higher mortality (10 vs 4.4%;HR 1,79; IC 95% 1,15-2,78; log-rank:p=0,013)Conclussions. In our cohort, most patients received reperfusion treatment and were performed within the recommended time. In ED, the pacients with a FCM-PA time longer than recommended in the guidelines and COPD had higher CE y mortality.

Hypoparathyroidism is a rare disease characterized by low serum calcium levels and absent or deficient parathyroid hormone level. Regarding the epidemiology of chronic hypoparathyroidism, there are limited data in Italy and worldwide. Therefore, the purpose of this study was to build a unique database of patients with chronic hypoparathyroidism, derived from the databases of 16 referral centers for endocrinological diseases, affiliated with the Italian Society of Endocrinology, and four centers for endocrine surgery with expertise in hypoparathyroidism, to conduct an epidemiological analysis of chronic hypoparathyroidism in Italy. The study was approved by the Institutional Review Board. A total of 537 patients with chronic hypoparathyroidism were identified. The leading etiology was represented by postsurgical hypoparathyroidism (67.6%), followed by idiopathic hypoparathyroidism (14.6%), syndromic forms of genetic hypoparathyroidism (11%), forms of defective PTH action (5.2%), non-syndromic forms of genetic hypoparathyroidism (0.9%), and, finally, other forms of acquired hypoparathyroidism, due to infiltrative diseases, copper or iron overload, or ionizing radiation exposure (0.7%). This study represents one of the first large-scale epidemiological assessments of chronic hypoparathyroidism based on data collected at medical and/or surgical centers with expertise in hypoparathyroidism in Italy. Although the study presents some limitations, it introduces the possibility of a large-scale national survey, with the final aim of defining not only the prevalence of chronic hypoparathyroidism in Italy, but also standards for clinical and therapeutic approaches.