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Study of brain health in women of childbearing age

Year 2025
Registry of Trials ISRCTN registry
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Effectiveness of surgical procedures for acute cranial expansion in traumatic brain injury

Year 2025
Registry of Trials ISRCTN registry
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Working Toward Defining Frailty in Breast Surgery: A Multi-institution Cohort Study Identifying Risk Factors of Free Flap Failure Following Autologous Breast Reconstruction.

Year 2025
Giornale Annals of plastic surgery
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BACKGROUND:

The integration of frailty assessments into preoperative evaluation protocols is essential for enhancing surgical procedure safety. As autologous breast reconstruction (ABR) increases in popularity, it is critical to stratify risk in patients with significant comorbidities with an ABR-specific frailty model. The aim of this study was to identify comorbidities associated with patients for unilateral or bilateral ABR flap failure, to develop a frailty index with a multi-institutional database.

METHODS:

The TriNetX database was queried for patients who underwent free flap breast reconstruction (CPT code 19364) between 2016 and 2024 across 89 healthcare institutions. Patients who experienced unilateral or bilateral flap failure (ICD-10 T86.821) were identified; preoperative comorbidities that occurred at a significantly different frequency were detected. Subsequently, univariate and multivariable logistic regression analyses were used to identify independent risk factors of free flap failure. Odds ratios were converted into relative risk ratios and probabilities using the baseline frequency of flap failure without any comorbidity.

RESULTS:

A total of 10,291 patients who underwent either unilateral or bilateral primary free flap ABR were identified. A total of 120 (1.17%) patients experienced partial or total flap failure. Comorbidities of interest were seen among infectious, oncologic, hematologic, cardiovascular, gastrointestinal, and dermatologic systems. Significant risk factors on multivariable logistic regression included history of anemia (OR, 2.87), breast abscess (OR, 2.98), chronic obstructive pulmonary disease (OR, 3.08), hypertension (OR, 1.69), and body mass index ≥30 (OR, 2.37) (P < 0.05 for all). The baseline frequency of flap failure without any comorbidity was 0.73%. The presence of one or more risk factors increased the probability of 1-week flap failure anywhere from 1.23% (hypertension alone) to 43.69% (all five comorbidities).

CONCLUSIONS:

Select preoperative comorbidities were identified as patient-specific risk factors for postoperative flap failure. A future direction may also include identifying complications specific to certain flap techniques and within partial and total flap failures, as well as prospectively tracking data per flap, rather than per patient through the TriNetX database.

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Evaluating cystatin-C and monocyte-to-high-density lipoprotein cholesterol ratio as indicators of obstructive sleep apnea severity in male patients.

Year 2025
Autori Meng RT , Chen QW , Ko CY
Giornale Frontiers in cardiovascular medicine
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OBJECTIVES:

This study investigates the association between blood cystatin-C (Cys-C) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR), both established inflammatory markers, with the severity of obstructive sleep apnea (OSA) in male patients.

METHODS:

A total of 117 male participants who underwent overnight polysomnography (PSG) between February 2019 and December 2022 were included. Based on the apnea-hypopnea index (AHI), participants were categorized into three groups: G1 (AHI < 5 events/hour, n = 9; control group), G2 (5 ≤ AHI < 30 events/hour, n = 32), and G3 (AHI ≥ 30 events/hour, n = 76). Serum Cys-C and MHR levels were measured and analyzed for their correlation with OSA severity. Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed their diagnostic value, while restricted cubic spline (RCS) analysis examined potential nonlinear relationships.

RESULTS:

Cys-C and MHR levels increased with OSA severity and showed significant positive correlations with AHI (Cys-C: r = 0.084, P < 0.05;

MHR:

r = 0.1286, P < 0.05). In multivariate regression, MHR remained an independent correlate of OSA severity (adjusted OR = 47.130, 95% CI.: 1.014-6.692, P = 0.008), whereas Cys-C lost statistical significance after adjusting for confounders. RCS analysis found no significant nonlinear relationship (P > 0.05). ROC analysis showed that combining Cys-C and MHR modestly improved diagnostic accuracy (AUC = 0.6622, 95% CI.: 0.554-0.77). Subgroup analysis indicated that severe OSA patients with hypertension had higher Cys-C and MHR levels compared to those without hypertension, though the differences were not statistically significant (P > 0.05).

CONCLUSIONS:

Cys-C and MHR are positively associated with OSA severity, with MHR emerging as a stronger independent biomarker. Incorporating these markers into OSA risk stratification may enhance clinical assessment and targeted interventions. Future large-scale prospective studies are needed to validate their prognostic value and clinical utility.

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Assessing Perioperative Complications and Cost of Nipple-Areolar Complex Neurotization in Immediate Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Matched-Paired Comparison.

Year 2025
Autori Boyd CJ , Hemal K , Sorenson TJ , Amro C , Lu S , Miller B - More
Giornale Annals of plastic surgery
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BACKGROUND:

Reports suggest neurotization can help restore sensation in patients undergoing implant-based breast reconstruction (IBBR) following nipple-sparing mastectomy (NSM). There is a dearth of information regarding the outcomes and cost associated with neurotization of the nipple-areola complex (NAC). The objective of this study is to determine perioperative complications of performing NAC neurotization in IBBR and analyze the added cost of performing this procedure.

METHODS:

A retrospective chart review was performed of patients who underwent NSM with IBBR. Breasts undergoing neurotization of the NAC were compared to breasts that did not undergo neurotization using 2:1 propensity score matching on age, reconstruction type, and BMI. Primary endpoints included 30-day complications and cost. Statistical analysis included descriptive statistics, t tests, and chi-square tests where applicable with a predetermined level of significance of P < 0.05.

RESULTS:

A total of 15 patients (26 breasts) were in the neurotized cohort and matched to 30 patients (52 breasts) in the nonneurotized cohort. Mean follow-up period was 10 months and significantly lower in neurotized group (P < 0.001). Rates of major and minor complications did not vary by neurotization (P > 0.05). Cases of neurotization added a mean cost of $7839 per breast.

CONCLUSIONS:

As NAC neurotization introduces increased complexity from coordination with the oncologic surgeons, use of microsurgical instruments, and additional implantable devices, it is important to compare perioperative outcomes to standard breast reconstruction. As our institution begins to offer this new technique, we have identified no increased risk of perioperative complications with NAC neurotization.

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Intradialytic Parenteral Nutrition During In-Center Hemodialysis of Patients Leads to Increase in Albumin Without Compromising Safety: Retrospective Analysis.

Year 2025
Giornale Kidney360
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BACKGROUND:

Albumin is an established survival surrogate in dialysis. We evaluated the effect of intradialytic parenteral nutrition (IDPN) on albumin levels in patients with end-stage renal disease (ESRD) undergoing in-center hemodialysis (ICHD) and determined characteristics associated with response to IDPN treatment.

METHODS:

We conducted a 5-year (05/2018 - 04/2023) retrospective chart review of 2,270 ICHD patients from 1039 Dialysis Centers, in 43 states and D.C., who received concurrent IDPN treatment 3 times per week. Patients were ≥18y (mean 69.1y) with albumin levels <4.0 g/dl (mean 3.11g/dl) and were on HD for more than 6 mos (mean 3.7 years). Other criteria included unintentional weight loss (≥5%/3mo) and/or BMI below 20kg/m2. The co-primary endpoints included mean change in albumin levels from baseline to month 6 of IDPN therapy and percentage of patients with a clinically significant change in albumin levels, defined as ≥0.2 g/d with a p<0.05. Each patient studied was their own control. We used Kaplan-Meier curves to evaluate the time to positive IDPN response. Two-sample t-tests for continuous variables and Chi-square tests for categorical variables were used to determine if certain defined patient characteristics were associated with a positive response to IDPN therapy.

RESULTS:

1,946 eligible patients consented to being evaluated. Baseline demographics (Table 1) include: 50.9% female and 49.1% male with a mean albumin of 3.11g/dL. Evaluable data at six months were available for 73% of patients. Mean change in albumin levels from baseline to 6 months after initiation of IDPN therapy was 0.330 g/dL; 82.0% of patients achieved ≥0.2-g/dL increase in albumin level within those six months. Younger age and lower baseline albumin levels were significantly and independently associated with a higher and more rapid significant rise, p <0.05, in albumin levels. While receiving IDPN, fewer than 8% of patients reported minimal and treatable side effects.

CONCLUSION:

IDPN is a safe and effective therapy resulting in clinically significant improvement in serum albumin levels. Further research on associated outcomes and QoL data is needed.

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Polylactic Acid Membrane for the Treatment of Pediatric Burn Injuries: An Adoptable Practice to Improve Burn Management.

Year 2025
Giornale Annals of plastic surgery
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BACKGROUND:

Polylactic acid membrane (PLAM) is a one-time application alloplastic skin substitute that has been utilized as an adjunct for pediatric burns for a multitude of indications. Literature has established its utility in mixed superficial and deep dermal burns, with advantages related to decreased need for procedures requiring general anesthesia and decreased overall healthcare cost (Eur Burn J 2021;3(1):1-9). Additionally, its application has been comparable in wound healing outcomes to established standard of care practices (Burns 2023;49(7):1585-1591, Wound Repair Regen 2006;14(3):321-4). Our study analyzes the impact of integrating PLAM into pediatric burn management at a single burn center. We hypothesize that the integration of PLAM into our practice would result in improved outcomes related to wound care needs, surgical efficiency, hospital length of stay, and overall wound healing.

METHODS:

We conducted a retrospective study of all pediatric (<18 years of age) patients with second- and third-degree burns treated at a single American Burn Association (ABA)-verified pediatric burn center from December 2019 to April 2024. All burn etiologies were included, and isolated first-degree burns were excluded. Our retrospective cohort was separated into two distinct treatment periods (pretherapy Era 1 and posttherapy Era 2) based on time before and after the introduction of PLAM at our institution (March 1, 2022). Data on patient demographics, burn characteristics, hospitalization treatments, operative details, surgical outcomes, and time to wound healing were analyzed.

RESULTS:

A total of 331 pediatric patients met the inclusion criteria. A total of 155 patients were included in our pretherapy Era 1 and 176 patients in our posttherapy Era 2. The average age was 5.6 years old, and the majority of patients were male (62.2%) and White (55.0%). Baseline characteristics between our two cohorts were comparable across age, gender, race, ethnicity, BMI, mechanism of burn, and total body surface area (TBSA) burned. The need for sedated burn care significantly decreased after the introduction of PLAM (72.9% vs 59.4%, P = 0.010), and the average number of days of sedation decreased as well (3.7 vs 2.1 days, P < 0.001). Forty-one percent of all patients underwent surgical intervention for their burns with a significant increase in the number of patients receiving surgery in the posttherapy era (32.9% vs 48.3%, P < 0.001). Additionally, time from burn to surgery shortened in Era 2 (9.1 vs 7.2 days, P < 0.001). There was a statistically significant reduction in median procedure time in Era 2 (26 vs 13 minutes, P < 0.001). Finally, we observed significant reductions in median length of hospital stay (5 vs 4 days, P = 0.004), postoperative length of stay (1 vs 0 days, P = 0.017), the need for sedated postoperative dressing changes (54.9% vs 18.8%, P < 0.001), and need for home nursing visits (51.0% vs 17.1%, P < 0.001) in Era 2.

CONCLUSIONS:

The integration of PLAMs into pediatric burn management provides significant benefits. Our study highlights the decreased need for sedated burn care, improved operative efficiency, decreased time to surgical intervention, shortened hospital stays, the decreasing demand for home nursing visits, and minimized need for additional surgeries, with healing outcomes comparable to current standard of care practices. These findings suggest potential cost savings for healthcare systems, improved healthcare efficiency, and increased patient satisfaction.

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Does teaching correct sitting and sleeping postures help people with low back pain?

Year 2025
Autori Awwad, Mohammad Akram
Registry of Trials ISRCTN registry
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Cross-sectional analysis of eating disorder risk and risk correlates in candidates for bariatric surgery from the BariPredict cohort.

Year 2025
Giornale Scientific reports
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Bariatric surgery is an effective intervention for managing obesity. Persons with obesity are a high-risk population for eating disorders (ED), and these can negatively impact perioperative and long-term outcomes of surgery. We aim to understand prevalence and correlates of ED in preintervention patients, identifying those needing psychological support. Baseline cross-sectional analysis of 275 patients of the BariPredict cohort (NCT06480058), a study to assess predictors of long-term surgery outcomes. Psychological assessments were conducted using SCOFF, KUAS, and BDI tools. Data were analyzed for prevalence of high ED risk and for associations of clinical, biological and demographic factors. Mean age was 38.5 years, mean BMI was 42.3 kg/m², with 62.5% being female. 65.8% of patients had a SCOFF score ≥ 2 indicating high ED risk. Class II obesity (p < 0.05), younger age (p < 0.01), and higher depression (p < 0.01) were associated with ED risk in a logistic regression adjusted for age, obesity class, diabetes, HbA1c, depression and anxiety scores. We report high preintervention prevalence of ED, with a risk profile corresponding to BMI of 35-39.9 Kg/m2 in younger adults with concurrent depression. This patient profile should be prioritized for psychological assessment and support to potentially improve outcomes of bariatric surgery.

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Giant Hyperkeratotic Lymphangioma Circumscriptum on the Thigh of a 79-Year-Old Woman: A Report of a Rare Case.

Year 2025
Giornale Cureus
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Lymphangioma circumscriptum (LC) is a rare benign lymphatic anomaly that often manifests during childhood. We report an atypical instance of enormous hyperkeratotic LC in an older patient, augmenting the little literature on severe manifestations of this illness. This is a case of a 79-year-old woman with a medical history notable for deep vein thrombosis (DVT) and morbid obesity who presented with a developing skin lesion on her left thigh. During the clinical examination, a well-defined, verrucous lesion measuring approximately 15 cm × 2 cm and resembling a cauliflower was identified. The excisional samples obtained for histological analysis to verify the diagnosis revealed an edematous fibro-adipose stroma with dilated lymphatic channels, hyperkeratosis, and moderate papillomatosis, confirming the diagnosis of hyperkeratotic LC. To our knowledge, this is the first reported case involving LC late in life, occurring in an unusual site with gigantic proportions and being hyperkeratotic, which are all regarded as atypical features for LC. The patient, having a history of DVT and being obese, would most likely have lymphatic dysfunction, predisposing her to the development of LC. The form of hyperkeratotic LC seen in this case is even less common than the more familiar presentation of LC, which typically forms large, translucent bullae. This case highlights the different clinical presentations of LC and emphasizes that it should be regarded as a differential diagnosis for verrucous lesions, especially in older people. It also emphasizes the significance of a biopsy in validating instances with unusual manifestations, such as in older age groups, bigger lesion sizes, and atypical sites. Further research is necessary to elucidate the etiopathogenetic causes of acquired LC in adults and develop therapeutic procedures for large lesions.

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