COVID and microsurgery: Did the microsurgical anastomosis failure rate in three hand surgery and orthoplastic units increase? A retrospective multicenter study

Disclosure: V. Balderrama-Brondani: None. R. Al-ward: None. K. Kiseljak-Vassiliades: None. L.M. Fishbein: None. D.A. Kirelik: None. O. Hamidi: None. R. Pishdad: None. H.K. Ghayee: None. M. Sukkari: None. S.S. Bedrose: None. A.H. Hamrahian: None. M.A. Habra: None. Background: Lipid-poor adrenal masses (LPAMs) with pre-contrast radiodensity >10 Hounsfield Units (HU) on computed tomography (CT) represent ∼25% of adrenal tumors. There is limited data about the natural history of LPAMs; therefore, we evaluated a large series of patients with LPAMs to describe the radiological and clinical features and outcomes of these cases. Methods: We conducted a multi-center retrospective cohort study of patients with LPAMs with a baseline diameter of 10-39 mm and derived from 6 institution members of the American-Australian-Asian Adrenal Alliance (A5). We excluded suspected or proven adrenal metastasis, pheochromocytoma, sarcoma, lymphoma, myelolipoma, infiltrative lesions, and adrenal hemorrhage, as well as patients with personal/familial history of genetic predisposition to adrenal neoplasms. The data is presented in percentage and median (range). Results: A total of 242 adrenal masses from 218 patients were evaluated, but only 225 (93%) masses met the inclusion criteria and were analyzed. The age was 58 (23-92), and 61% were women. LPAMs were incidentally discovered in 155 (71.1%) cases, 32 (14.7%) cases were diagnosed due to hormonal overproduction, and 17 (7.8%) due to pain/mass effect. Forty-six (21.1%) patients were on surveillance for a history of extra adrenal malignancy. Masses were unilateral in 89.9% (left side, 57.1%), with size 21 (10-38) mm, with a pre-contrast density of 24 (11-136) HU. Absolute washout was reported in 107 LPAMs and was >60% in 73 (68.2%) cases. The follow-up time was 44.4 (0.9-241) months. Hormonal overproduction developed during the follow-up in 23 (10.5%) cases as follows: cortisol in 15 (6.9%), aldosterone in 4 (1.8%), and sex hormones in 3 (1.4%) cases. LPAM growth rate was 0.03 (-2.18-11.59) cm/year. Seventy-one masses (31.5%) underwent diagnostic procedures (surgery/biopsy) with adrenocortical adenoma (n=37; 52.1%) and adrenocortical carcinoma (ACC) (n=25; 35.2%) being the two most common diagnoses. The tumor growth rate of pathologically confirmed adenomas was 0.03 (-0.30-10.50) cm/year, and of ACC was 1.31 (0.03-11.59) cm/year. A total of 154 (68.4%) LPAMs remained under surveillance at the end of the study, with a follow-up time of 51.8 (6-241) months and a tumor growth rate of 0.02 (-2.18-1.36) cm/year. Forty-five (20.6%) LPAMs decreased by 2 mm (1-13) during the study period. Cases that proved to be ACC had the most significant tumor growth rate over the study (p<0.001). The median time between the initial discovery of LPAM and the surgical resection of ACC cases was 34 (6-128) months. Conclusion: Our study showed that LPAMs carry significant malignant potential, and close long-term follow-up is warranted when surgical resection is not pursued. Prospective studies are critically needed to validate our findings and to establish high-risk molecular, imaging, and biochemical features associated with malignancy. Presentation: 6/2/2024

Tibial eminence fractures can occur in adults and are equivalent to an acute ACL rupture. The purpose of this retrospective study was to compare the therapeutic outcomes of ARIF versus ORIF in tibial eminence fractures. Our hypothesis was that ARIF does not offer better results. A retrospective national multicentric study was conducted in five university hospitals between 2010 and 2015. A total of 65 consecutive patients were included. 33 patients were treated with ARIF and 32 with ORIF. Clinical functional outcomes were assessed using the Lysholm score and IKDC score. Radiographic findings were recorded, and a statistical analysis carried out. IKDC score at the mean last follow-up of 68.8 ± 11.8months was significantly higher in the ORIF group with a mean difference of 20.2 points ± 8.9 (p = 0.028). There were early osteoarthritis findings in 12 patients (18.4%). At last follow-up, 7 patients (10.7%) presented complications. In this retrospective multicentric study, better functional outcomes were observed in the ORIF group. This difference needs to be carefully interpreted as many confounding factors exist. In terms of complications, the results for both ORIF and ARIF are similar at midterm follow-up. ORIF should remain gold standard for tibial eminence fracture treatment. III.

There are uncertainties when to start patients on oral loop diuretics after managing acute decompensated heart failure (ADHF) before discharge. This study aims to investigate the impact of prolonging observation duration on hospital readmissions following the switch to oral loop diuretics before discharge in patients with ADHF. A multicenter retrospective study that included adult patients (>18 years) diagnosed with ADHF and discharged on oral loop diuretics in Saudi Arabia. Patients who received oral loop diuretics were divided into 2 groups based on the observation duration before discharge. The primary outcome was a 30-day readmission rate for all causes; the secondary outcomes were 60- and 90-day readmission rates for all causes; and 30-, 60-, and 90-day readmission rates for heart failure. A total of 400 ADHF patients were included in the final analysis. Patients in group 1 (n = 142; < 24 hours) and group 2 (n = 258; ≥ 24 hours) had similar baseline characteristics (P > .05), except for the length of hospital stay (P = .03) and total observation time (P = <.01). ADHF patients with <24 hours observation durations were significantly associated with higher all-cause 30-day readmissions compared to those with ≥24 hours observations (odds ratio = 1.83, 95% confidence interval = 1.11–3.02, P = .017). Our study showed a significant decrease in all-cause 30-day readmissions for ADHF patients who received oral loop diuretics at discharge with a longer duration of observation. This study emphasizes the significance of standardizing the observational period when initiating oral loop diuretics before discharge following admission to ADHF.

IntroductionFirearm related injuries and fatalities have been steadily increasing over the last two decades. 30,000 firearm-related traumatic brain injuries (TBI) occur in the United States yearly. Mortality remains greater than...

Acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD) carries a high risk of recurrence despite aggressive medical management. The aim of our study is to present our initial experience with the Onyx Frontier™ balloon-mounted drug-eluting stent (Medtronic, Santa Rosa, CA) for AIS due to ICAD. We conducted a multicenter retrospective cohort study describing the technical feasibility, safety, and performance of using the Onyx Frontier™ balloon-mounted drug-eluting stent in patients with acute intracranial vessel occlusion due to ICAD across three comprehensive stroke centers in the United States. We included 23 patients in our study (mean age 67.3 [10.7]; females: n = 13/23, 56.5%). Most patients were Black (n = 14/23, 60.9%). The most common site of vessel occlusion was the M1 branch of the middle cerebral artery (MCA) (n = 14/23, 60.9%), followed by the vertebrobasilar system (n = 5/23, 21.7%), and the internal carotid artery (n = 3/23, 13.0%). Treatment with the Onyx Frontier™ stent was associated with a final mTICI score ≥2b for 100% of patients, with no vessel perforations or distal embolization. None of the patients had any restenosis or re-treatment over a median follow-up of 3.5 months (interquartile range [IQR] 7.8). All cases required a single stent except for one, where two were deployed. Transfemoral access was used in most cases (n = 18/23, 78.3%), with one in-hospital death due to access site complication (n = 1/23, 4.3%). This is the largest multicenter cohort study demonstrating the feasibility and safety of using the Onyx Frontier™ balloon-mounted zotarolimus-eluting stent to treat symptomatic AIS due to ICAD.

To compare the maternal and neonatal outcomes following induction of labor (IOL) using oral misoprostol vs mechanical cervical ripening using a cervical ripening balloon (CRB) in singleton pregnancies complicated by small-for-gestational age (SGA), including those with late-onset fetal growth restriction (FGR). This was a retrospective multicenter cohort study of women with a singleton pregnancy with estimated fetal weight < 10th percentile and a Bishop score of < 7, who underwent IOL ≥ 37 weeks' gestation for suspected SGA or late-onset FGR in one of three European tertiary centers. Participants were assigned to one of two groups depending on whether they underwent cervical ripening using a CRB without pharmacologic agents (CRB-only group) or received oral misoprostol with or without a CRB (misoprostol group). Women who had had a prior Cesarean delivery (CD), those who received vaginal misoprostol and those with early-onset FGR, fetal structural anomalies or contraindications to vaginal delivery were excluded. The primary outcome was CD. Secondary outcomes included spontaneous vaginal delivery (SVD) within 24 h after starting IOL, operative vaginal delivery (OVD), oxytocin augmentation, uterine tachysystole and neonatal outcomes. Inverse probability of treatment weighting was used to account for baseline differences and doubly robust estimation was used to adjust for confounders. A total of 848 women was included in the analysis, of whom 431 (50.8%) received a CRB only and 417 (49.2%) received oral misoprostol with or without a CRB. Baseline characteristics differed between the two groups, with women in the misoprostol group being older, more often nulliparous and undergoing IOL later in gestation. After adjustment, there was no significant difference in the rate of CD between the two groups (adjusted odds ratio (aOR), 1.29 (95% CI, 0.82-2.04)). Women receiving misoprostol were significantly less likely to undergo OVD (aOR, 0.33 (95% CI, 0.18-0.64)) or require oxytocin augmentation (aOR, 0.04 (95% CI, 0.03-0.07)) compared with the CRB-only group. SVD within 24 h after starting IOL was also less likely in the misoprostol group (aOR, 0.49 (95% CI, 0.33-0.74)). Uterine tachysystole occurred more frequently in the misoprostol ± CRB group, but this was not associated with higher rates of CD for fetal distress or adverse neonatal outcomes. The rate of admission to the neonatal intensive care unit was similar between the two groups. Subgroup analysis in pregnancies with confirmed late-onset FGR yielded comparable findings. In pregnancies complicated by late-onset FGR or SGA, oral misoprostol did not increase the risk of CD compared with mechanical cervical ripening only, and was associated with a reduced need for operative interventions and labor augmentation. These findings support the use of oral misoprostol as a safe and effective option for IOL in this high-risk population. Randomized controlled trials are needed to confirm these results. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

BackgroundAdolescent girls and young women are more exposed to sexual violence. A significant proportion of victims of sexual abuse are victims of sexual re-victimization. However, information on the burden of sexual re-victimization among AGYW in contexts other than conflict-affected areas in the Democratic Republic of the Congo (DRC) is limited. The aim of this study was to assess the magnitude of sexual re-victimization among AGYW and to identify associated risk factors in the capital, Kinshasa.MethodsWe conducted a retrospective multicenter cohort study in which sexual violence records between 2015 and 2020 were used to extract and analyze victims’ sociodemographic and behavioral characteristics and profiles of sexual violence perpetrated. Multivariate logistic regression models were employed to identify factors associated with sexual re-victimization using the adjusted odds ratio (AOR) with its 95% confidence interval (95% CI) and p value < 0.05.ResultsWe found that 74 (31%) of the 241 AGYW included in this study had experienced sexual re-victimization. Sexual re-victimization was associated with being older (> 19 years), sexually active, and living in a single-parent family, and with perpetrator types, particularly intimate partners and family members.ConclusionsOur findings provide tools for developing and implementing targeted prevention and intervention programs to reduce sexual violence in general and sexual re-victimization in particular.

Conventional Garden classification of femoral-neck fractures relies on radiography or CT, but image quality variations, indistinct fracture lines, and inter-observer differences often cause misclassification—especially for Garden I/II fractures—while fully automated classification remains unexplored. This retrospective multicenter study (2018–2024) included 10,010 hip images from 806 patients across four Chinese hospitals: 7,818 images (529 patients) for model training/internal validation (five-fold cross-validation) and 2,192 images (277 patients) for external robustness testing, with comparisons against 12 physicians of varying experience. Performance was assessed via sensitivity, specificity, accuracy, AUC, and other metrics, alongside heat-map interpretability. Five-fold cross-validation yielded 93.34% mean accuracy and 95.29% specificity, with 95.78% mean AUC on the independent test set; the model markedly improved resident physicians' diagnostic accuracy, narrowing gaps with senior clinicians. This deep-learning model enables accurate automatic femoral-neck fracture localization and Garden classification, showing promise for clinical decision support, while prospective randomized studies are needed to confirm its utility.

Background Long-term HER2-targeted therapies improve survival in metastatic HER2-positive breast cancer (BC) (1) but are associated with cancer therapy related cardiac dysfunction (CTRCD) (2); indefinite cardiac surveillance is therefore mandated (3). EMA guidance recommends 3 monthly imaging, although recent guidelines suggest clinicians consider increased surveillance intervals (3). Rationalising cardiac surveillance could improve patients’ quality of life and reduce costs, but doing so requires better understanding of CTRCD in this population. Purpose To investigate the incidence, severity and timing of CTRCD in metastatic HER2-positive BC patients receiving long-term HER2 targeted therapy. Methods A retrospective multicentre cohort study of metastatic HER2-positive BC patients receiving HER2 targeted therapy between 2012-2024. Patients were identified from cancer therapy prescriptions at two large oncology centres. CTRCD was defined as per the European Society of Cardiology (ESC) Cardio-Oncology guidelines (3). Patients were stratified by Heart Failure Association and International Cardio-Oncology Society (HFA-ICOS) cardiotoxicity risk (4). Results 191 patients (median age 53 [interquartile range [IQR] 45-62], 99% female, 45% non-Caucasian) were identified. Median HER2 treatment duration was 38 months [IQR 19-57]), each with a median of 12 [IQR 8-18] echocardiograms (total n=2091) for CTRCD surveillance (Table 1). CTRCD occurred in 43% (n=82) at a median of 62 weeks (IQR 25 - 122) from treatment initiation; most commonly mild asymptomatic (50%, n=41) followed by moderate asymptomatic (41%, n=34), symptomatic (5%, n=4) and severe asymptomatic (4%, n=3). Symptomatic and moderate or severe asymptomatic CTRCD occurred significantly earlier than mild asymptomatic (median 41, 18 and 6 vs 87 weeks respectively, p&amp;lt;0.05). HER2 targeted therapy was interrupted in 33% of patients with CTRCD (n=27) for a median of 12 [4-16] weeks; 96% were re-challenged successfully with cardio-protective therapies. Moderate, high or very high-risk patients, by baseline HFA-ICOS risk, were significantly more likely to develop CTRCD than low risk (hazard ratio 3.1, 95% confidence interval 1.7-5.9; p = 0.028). Conclusion In the largest-to-date multicentre analysis of cardiotoxicity surveillance in metastatic HER2-positive BC patients receiving long-term HER2-targeted therapies, CTRCD was common but generally mild, asymptomatic. With cardio-oncology support, most patients were able to continue HER2 targeted therapies. The HFA-ICOS cardiotoxicity risk score can identify those most at risk of CTRCD. Only half of all cases of CTRCD were symptomatic or moderate or greater asymptomatic, and 63% presented within 12 months. For patients receiving long-term HER2 targeted therapies in the metastatic setting, reducing the frequency of cardiac surveillance after the first 12 months is unlikely to significantly impact the sensitivity of detection of clinically significant CTRCD.Table 1.Patient demographics (n=191). Figure 1.A) Incidence B) HFA-ICOS Risk

During the Covid-19 pandemic, reproductive health of women was disproportionately affected due to difficult access to safe abortion and contraceptive services. This study aims to assess the impact of the Covid-19 pandemic on the prevalence of MTP cases and to find out the clinicodemographic profiles of women undergoing MTP during three Covid-waves in different hospitals-Government and private sectors in India. This retrospective multicentric cohort study was conducted during three Covid-19 pandemic waves. The records were retrieved from the centers' medical record section and the MTP register from the Department of Obstetrics and Gynaecology. On an average, 1.1 women/day underwent MTP during covid waves compared to 1.9 women/day during the pre-covid 2019. The first Covid wave's average MTP/day was very low (0.71) compared to the third (2.88) and second wave (1.12), respectively. These differences were statistically significant (p<0.0001). The most common indication for MTP was contraceptive failure 245(50.9%), followed by eugenic/congenital anomalies 88(18.9%). A total of 244 cases (50.6%) reported for MTP ≤ seven weeks and 114(23.6%) presented between 7 and 12 weeks. More than half (54%) of the women underwent surgical methods for abortion as the unavailability of medical abortion (MA) drugs. IUCD and sterilization were severely affected during the first and second Covid waves. Safe abortions are essential services for reproductive-age women. With the uncertainty of future Covid-like an emergency, we should strengthen our telemedicine network so that women can reach out early and MMA can be initiated to reduce the number of surgical abortions and unwanted pregnancies.

Risk of infective endocarditis in oncohaematological patients undergoing active treatment with Enterococcus faecalis bloodstream infection: A retrospective multicentre study.

To explore the potential role of serum calcium levels at admission in the expansion of acute traumatic intracerebral hematoma (tICH) and to construct a novel nomogram to predict tICH expansion. In this multicenter retrospective study, 640 and 237 patients were included in the training and validation datasets, respectively. Risk factors for acute tICH expansion were selected by logistic regression analysis. Causal mediation and interaction analysis were used to explore the relationship between serum calcium promotion of tICH expansion and inflammatory response. Receiver operating characteristic, calibration and clinical decision curves were applied to estimate the performance of multivariate models. Low serum calcium level was strongly associated with acute tICH expansion in patients with brain contusion. There was no significant interaction of hypocalcemia across multiple subgroups including sex, age, and coagulation dysfunction. 24.5% of the mechanisms by which hypocalcemia promotes acute tICH expansion can be explained by an inflammatory response. The addition of serum calcium made the modified model (serum calcium plus basic model) more accurate than basic model with subdural hematoma, multihematoma fuzzy sign, time to baseline CT, level on Glasgow Coma Scale score, platelet count, baseline tICH volume ≥ 5 mL, and monocyte-to-lymphocyte ratio. Low serum calcium level is a novel risk factor for acute tICH expansion, the mechanism of which may be mediated in part through the response of immune cell. The online dynamic nomogram provides a user-friendly tool for the prediction of acute tICH expansion.

BACKGROUNDGastric cancer (GC) is a major global health challenge, and the treatment of proximal GC in particular presents unique clinical and surgical complexities. Currently, there is no consensus on whether proximal gastrectomy (PG) or total gastrectomy (TG) should be used for advanced proximal GC, and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIMTo compare the short-term efficacy, long-term survival, and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y reconstruction in patients with proximal GC following neoadjuvant chemotherapy (NACT) in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODSA multicenter retrospective cohort study was conducted at two Chinese medical centers between December, 2012 and December, 2022. Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included. Propensity score matching (PSM) was performed to balance baseline characteristics, and the primary endpoint was 5-year overall survival (OS). Secondary endpoints included recurrence-free survival (RFS), postoperative complications, and reflux severity.RESULTSAfter PSM, 244 patients (122 PG, 122 TG) were finally included and all baseline characteristics were comparable between groups. The PG group had a significantly shorter operation time compared to the TG group (189.50 vs 215.00 minutes, P < 0.001), with no differences in intraoperative blood loss or postoperative complications (19.68% vs 14.75%, P = 0.792). The 5-year OS rates were 52.7% vs 45.5% (P = 0.330), and 5-year RFS rates were 54.3% vs 47.6% (P = 0.356) for the PG and TG groups, respectively. Reflux symptoms (18.0% vs 31.1%, P = 0.017) and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores ≥ 8 (7.4% vs 21.3%, P < 0.001) were significantly less frequent in the PG group. Multivariate analysis identified histological differentiation (HR = 2.98, 95%CI: 2.03-4.36, P < 0.001) and tumor size (HR = 0.26, 95%CI: 0.17-0.41 for tumors ≤ 4 cm, P < 0.001) as independent prognostic factors.CONCLUSIONPG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT. Additionally, PG has the advantages of shorter operation time and lower rates of postoperative reflux, suggesting potential benefits for patient quality of life. Notably, the analysis of postoperative prognostic factors, including histological differentiation and tumor size, further informs clinical decision-making and highlights the importance of individualized treatment strategies.

Background:No studies to date have focused on the timing of pulmonary resection in patients with previous severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. In the present study, the authors analyzed the surgical outcomes and evaluated the optimal time point of pulmonary resection surgery following SARS-CoV-2 infection.Materials and methods:In this multicenter retrospective cohort study, patients were divided into different groups according to the time interval between SARS-CoV-2 diagnosis and pulmonary resection. The primary outcome measure was postoperative complications within 30 days after surgery, which was investigated to determine the optimal time point of pulmonary resection. Logistic regression models were used to calculate the risk factors for postoperative complications.Results:In total, 400 patients were enrolled, and the postoperative pathologic examination of 322 (80.5%) patients showed lung cancer. As the interval between SARS-CoV-2 infection and pulmonary resection increased, the incidence of complications gradually decreased in each group. The incidence of grade ≥II complications was higher in the ≤2-week and 2-week to 4-week groups than in the 4-week to 6-week, 6-week to 8-week and >8-week groups [3 (21.4%), 17 (20.2%), 10 (10.6%), 13 (7.9%), and 3 (6.5%), respectively] (P<0.05). Multiclassification regression analysis showed that the risk of grade ≥II complications in the ≤2-week and 2-week to 4-week groups was significantly higher than that in the >8-week group [odds ratio (95% CI), 3.937 (1.072–14.459), P=0.039 and 3.069 (1.232–6.863), P=0.015]. The logistic regression analysis suggested that underlying disease, persistent SARS-CoV-2 symptoms, and surgical timing (≤4 weeks) were independent risk factors for complications of pulmonary resection after SARS-CoV-2 infection.Conclusion:Pulmonary resection should be delayed for at least 4 weeks following SARS-CoV-2 infection to reduce the risk of postoperative complications.

AimIn order to gain insight into the current prevailing practices regarding the limitation of life-sustaining treatment in intensive care units (ICUs) in Croatia, we assessed the frequency of limitation and provision of certain treatment modalities, as well as the associated patient and ICU-related factors.MethodsA multicenter retrospective cross-sectional study was conducted in 17 ICUs in Croatia. We reviewed the medical records of patients deceased in 2017 and extracted data on demographic, clinical, and health care variables. A logistic regression analysis was conducted to determine the associations between these variables and treatment modalities.ResultsThe study enrolled 1095 patients (55% male; mean age 69.9 ± 13.7). Analgesia and sedation were discontinued before the patient’s death in 23% and 34% of the cases, respectively. Patients older than 71 years were less often mechanically ventilated (P < 0.001), and less frequently received inotropes and vasoactive therapy (P = 0.002) than younger patients. Patients hospitalized in the ICU for less than 7 days less frequently had discontinuation of mechanical ventilation and inotropes and vasoactive therapy than patients hospitalized for 8 days and longer (P < 0.001). Logistic regression analysis showed that ICU type was a crucial determinant, with multidisciplinary and surgical ICUs being associated with higher odds of intubation, mechanical ventilation, vasoactive and inotropic therapy, analgesia, and sedation.ConclusionOlder patients and those diagnosed with stroke and intracranial hemorrhage received fewer therapeutic modalities. All the observed treatment modalities were more frequently discontinued in patients who were hospitalized in the ICU for a prolonged time.