BACKGROUND: The prognostic importance of residual congestion after acute heart failure (AHF) hospitalization is still debated. OBJECTIVES: The authors aimed to assess the impact of residual congestion in a large cohort of patients with AHF enrolled in the RELAX-AHF-2 (Relaxin in Acute Heart Failure 2) trial. METHODS: Residual congestion was assessed at day 5 after admission among hospitalized patients using an established composite congestion score (CCS) based on the presence of orthopnea, peripheral edema, and increased jugular venous pressure, ranging from 0 to 8 points. The primary endpoint was a composite of cardiovascular death or rehospitalization for heart failure or renal failure at 180 days. RESULTS: Among the 5,900 AHF patients included in this analysis, 3,380 (57.3%) had at least 1 sign of congestion (ie, CCS ≥1) and 1,066 (18.1%) had a CCS ≥3 at day 5 after admission. Patients with residual congestion at day 5 were more symptomatic, had more comorbidities, received higher doses of loop diuretic agents in-hospital, albeit with lower diuretic response, were less likely to have hemoconcentration, and were more likely to have worsening renal function at day 5. After multivariable adjustment for clinically meaningful variables, any sign of residual congestion and CCS ≥3 at day 5 were both independently associated with a higher risk of the primary endpoint (adjusted HR: 1.32 [95% CI: 1.15-1.51]; P < 0.001 and adjusted HR: 1.62 [95% CI: 1.39-1.88]; both P < 0.001). CONCLUSIONS: Among patients with AHF who were still hospitalized at day 5, residual congestion was common and independently associated with worse outcome. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778).

BACKGROUND: Due to increased exposure to health hazards, patients with cancer are at a higher risk of developing infective endocarditis (IE), which in turn maximizes their risk of poor outcomes. This study aimed to analyze IE events in patients with cancer and matched controls. METHODS: We conducted a retrospective case-control study in four third-level centers in Mexico City between 2006 and 2022. Patients with IE were identified; cases (patients with cancer) were matched in a 1:2 ratio with controls (patients without cancer). Baseline characteristics, factors associated with IE, and outcomes were assessed in both groups. RESULTS: A total of 108 patients were included (36 cases and 72 controls). After logistic regression analysis, the risk factors independently associated with IE in cases were obesity (adjusted odds ratio [aOR] 9.03, 95 % CI 1.5-51.8), surgery within six months before IE (aOR 6.23, 95 % CI 1.8-21.5), and invasive procedures within six months prior to IE (aOR 3.89, 95 % CI 1.15-13.1). Healthcare-associated IE was more common in these cases, as were systemic embolic episodes. Subjects with S. aureus IE were more prone to experience systemic embolization. There were no differences in mortality between the groups. CONCLUSION: In this study, risk factors associated with the healthcare environment were more frequent in patients with IE and cancer. S. aureus was a common culprit and was associated with systemic embolization.

This study aimed to develop and validate a machine learning (ML)-based model for predicting liposuction volumes in patients with obesity. This study used longitudinal cohort data from 2018 to 2023 from five nationwide centers affiliated with 365MC Liposuction Hospital, the largest liposuction hospitals in Korea. Fifteen variables related to patient profiles were integrated and applied to various ML algorithms, including random forest, support vector, XGBoost, decision tree, and AdaBoost regressors. Performance evaluation employed mean absolute error (MAE), root mean square error (RMSE), and R-squared (R2) score. Feature importance and RMSE importance analyses were performed to compare the influence of each feature on prediction performance. A total of 9,856 were included in the final analysis. The random forest regressor model best predicted the liposuction volume (MAE, 0.197, RMSE, 0.249, R2, 0.792). Body fat mass and waist circumference were the most important features of the random forest regressor model (feature importance 71.55 and 13.21, RMSE importance 0.201 and 0.221, respectively). Leveraging this model, a web-based application was developed to suggest ideal liposuction volumes. These findings could be used in clinical practice to enhance decision-making and tailor surgical interventions to individual patient needs, thereby improving overall surgical efficacy and patient satisfaction.

BACKGROUND: Total knee arthroplasty (TKA) offers substantially improved function for patients with severe osteoarthritis, but long-term success can be overshadowed by aseptic loosening, a complication with a multifactorial etiology. This study aims to investigate the association between BMI and the rate of aseptic loosening and other complications in patients undergoing primary TKA. METHODS: This retrospective cohort study examined 354 TKA patients, evenly categorized by BMI (≤ 30 kg/m² and > 30 kg/m²). Demographics, imaging findings, surgical details, and postoperative complications were assessed. Survival for postoperative complications was compared between the two BMI cohorts using Kaplan-Meier analysis. RESULTS: The mean age of patients in the BMI ≤ 30 group was 62.44 years, while it was 62.84 years in the BMI > 30 group. The number of patients with short-stemmed tibial components was comparable in the two groups. Out of the total patients, 350 cases showed no loosening, while four experienced aseptic loosening. There was no statistically significant difference in the rate of aseptic loosening or other complications between the two groups. CONCLUSION: While a high BMI may contribute to aseptic loosening, it does not appear to be the sole determinant. A multifactorial approach to prevention and management is essential, considering patient-specific factors and prosthetic considerations. Future research with larger cohorts and extended follow-up periods is needed to better elucidate the interplay between BMI and aseptic loosening in patients undergoing TKA.

BACKGROUND: We conducted a retrospective cohort study of women with suspected tubal factor infertility who underwent vaginal natural orifice endoluminal surgery (vNOTES) chromopertubation and adnexal anatomy assessment at a large referral hospital. METHODS: Twelve women aged between 29 and 38 years with suspected tubal factor infertility who underwent vNOTES chromopertubation were retrospectively examined. Demographic data, as well as clinical and surgical characteristics, were reviewed and the surgical technique was defined. RESULTS: The mean BMI was 34.2 ± 7.12 kg/m2 (range 24.7-42.6). No conversion to laparotomy or laparoscopy was required. The median operative time was 39 (26.5-42) minutes. The median VAS scores at six and 12 h postoperatively were 3.5 (3-4) and 2 (1-2), respectively. There were no complications and all patients were discharged at the 12th postoperative hour. CONCLUSIONS: Considering the increased risk of surgical morbidity and mortality associated with increasing BMI and the difficulty in gaining access to the abdominal cavity not only in obese women but also in cases with previous extensive midline incisions, where dense intra-abdominal adhesions are likely, or in cases where esthetic considerations are important, vNOTES appears to be a useful alternative to assess tubal patency and adnexal anatomy and even to perform concomitant adnexal surgery.

Disparities in healthcare adversely affects socioeconomically disadvantaged patients. Social determinants of health, including black race, Hispanic ethnicity, public health insurance, and lower socioeconomic status contribute to a delay in access to care for ACL-injured patients, which may result in increased severity of concomitant knee meniscus and cartilage injuries and inferior outcomes. Surgeons should evaluate their practice setting and pattern, and seek to mitigate this risk. The use of standardized practice protocols and individual patient education can minimize disparities in outcomes due to socioeconomic variables. Implementing health literacy, fostering close therapeutic relations, and ensuring accessibility, particularly for underinsured patients, can reduce complications and readmissions. The issue is understudied. Reporting of gender, age, and BMI is common, but race and ethnicity is less frequently reported; and insurance status, employment status, education level, and socioeconomic status are only minimally reported. Finally, the area deprivation index (ADI) is a free, validated, online tool (with high internal and external validity) to determine patients' levels of socioeconomic disadvantage.

BACKGROUND: Hypoalbuminemia, a biomarker of malnutrition, has been associated with adverse surgical outcomes;, however, its impact on breast reduction surgery is not yet well-documented. METHODS: We queried the American college of surgeons national surgical quality improvement program database to identify patients who underwent breast reduction surgery between 2008 and 2022. Patients were grouped by preoperative normal albumin levels (≥3.5 g/dL) and hypoalbuminemia (<3.5 g/dL). Preoperative, intraoperative, and 30-day postoperative outcomes, including complications and readmissions, were compared using the univariate tests and multivariable logistic regression. RESULTS: We included a total of 7277 cases, among whom 96% (n = 6964) had normal albumin values and 4% (n = 298) had hypoalbuminemia (n = 298). Patients with hypoalbuminemia showed a significantly higher body mass index (37.1 ± 8.1 vs. 33.3 ± 6.3 kg/m², p < 0.001) and were more likely to be Black or African American (49.0 vs. 27.8%, p < 0.001). Comorbidities such as diabetes (14.7 vs. 7.4%, p < 0.001), chronic obstructive pulmonary disease (4.0 vs. 1.0%, p < 0.001), and hypertension (35.2 vs. 26.3%, p = 0.002) were significantly more prevalent in the hypoalbuminemia group. Hypoalbuminemia was associated with a significantly increased risk of complications (13.8 vs. 6.1%, p < 0.001), with higher rates of superficial incisional infections (7.0 vs. 2.6%, p = 0.001) and unplanned readmissions (3.4 vs. 1.4%, p = 0.05). Multivariable analysis confirmed hypoalbuminemia as an independent predictor of postoperative complications (OR 1.96, p = 0.001), medical complications (OR 2.62, p = 0.02), and surgical complications (OR 1.91, p = 0.02). CONCLUSION: Hypoalbuminemia significantly raises the risk of 30-day postoperative complications in breast reduction surgery. Preoperative nutritional assessment and optimization are crucial in improving surgical outcomes, particularly in patients with high body mass index and comorbidities.

BACKGROUND AND OBJECTIVES: Compliance rates for follow-up appointments are an issue for postoperative sleeve gastrectomy (SG) patients. Without consistent reinforcement and monitoring of patient progress, patients tend to gain the weight back, all of the medical improvements made are lost, and the ability to access patients for potential complications is denied. Patients need much reinforcement during their forever bariatric lifestyle, and the lack of consistent reminders may contribute to follow-up noncompliance and recidivism in SG patients. As time progresses, the follow-up appointment compliance rate decreases. Decreased follow-up can lead to a higher risk for complications such as asymptomatic esophagitis, and current recommendations suggest that esophagogastroduodenoscopy screening should occur 3 years postoperatively. After 1 year, the follow-up compliance decreases dramatically so that by the 3-year postoperative period, very few patients are being seen and scheduled for interventions such as an esophagogastroduodenoscopy. The objective of this quality improvement project was to evaluate the effectiveness of a patient educational handout on SG bariatric patient follow-up visit compliance. METHODS: A quasi-experimental design and retrospective chart review was chosen. An educational handout was developed. Preintervention retrospective chart review consisted of 441 SG patients expecting a follow-up in 12 to 48 months. Postintervention included 3 months of the handout intervention with data collection totaling 198 patients. RESULTS: Follow-up compliance for 4 year visits noted 0% preintervention/12.2% postintervention (P = .008), for 3 year visits 13.4% preintervention/12% postintervention (P = .846), for 2 year visits 26.3% preintervention/28.6% postintervention (P = .755), for 18 months visits 26.3% preintervention/32.6% postintervention (P = .365), and for 12 months visits 54.2% preintervention/34.1% postintervention (P = .011). CONCLUSION: In this quality improvement project, educational handouts did not have a statistical impact on follow-up compliance.

With the increasing demand for high-performance printed circuit boards (PCBs) in the 6G communication era, dielectric substrate materials must exhibit a low dielectric constant (Dk), low dielectric loss (Df), and high dimensional stability. In this study, a series of bismaleimide-incorporated poly(phenylene ether) resins (PPE-BMI) with varying bismaleimide (BMI) crosslinker contents is developed, exhibiting significantly enhanced dielectric properties and dimensional stability, owing to the restricted polymer chain mobility and increased crosslinking density. Dielectric property measurements reveal that the PPE-BMI resins exhibit low Dk and Df values at frequencies above 100 GHz, while maintaining an excellent dielectric performance even after an 85 °C/85% relative humidity reliability test. A significant reduction in the coefficient of thermal expansion is observed with an increase in the BMI content. Molecular dynamics simulations are employed to clarify the role of BMI crosslinkers in reducing the free volume, enhancing the crosslinking in the PPE (poly(phenylene ether)) matrix, and influencing the thermophysical properties of PPE-BMI. The infiltration of PPE-BMI into glass fabrics and liquid crystal fabrics highlights their potential for practical use in advanced PCB applications operating at high frequencies.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common adverse effect after metabolic and bariatric surgery (MBS). Identifying patients with preexisting GERD is critical for preoperative planning. The American Foregut Society (AFS) recently proposed a new endoscopic classification system for objective assessment of the esophagogastric junction (EGJ) integrity, building upon the Hill classification. Grade 1 represents an intact EGJ, while grades 2, 3, and 4 represent partial, moderate, and complete disruption of the ARB. Unlike Hill classification, the AFS classification includes objective measurement of hiatal axial length and aperture diameter. The study aimed to evaluate the ability of the AFS hiatus classification to predict GERD severity using symptom questionnaires. METHODS: We performed a prospective study of obese patients who underwent endoscopy as work-up for MBS. The endoscopy was evaluated for esophagitis, Barrett's esophagus, and AFS grade. All patients were also surveyed preoperatively with the GERD-HRQL, GerdQ, and RSI. The correlation between AFS grades and questionnaire scores was analyzed using Spearman's test. RESULTS: A total of 393 patients were included in the study. There were 81% female, with a mean age of 36 ± 10.7 years and a mean BMI of 41.7 ± 7.2 kg/m2. The AFS grades were distributed as follows: 11 (2.8%) patients had grade 1; 137 (34.9%) had grade 2; 162 (41.2%) had grade 3; and 83 (21.1%) had grade 4. There was a positive but weak correlation between AFS grades and all scoring systems, including GERD-HRQL (r = 0.201), heartburn (r = 0.203), regurgitation (r = 0.212), RSI (r = 0.110), and GerdQ scores (r = 0.202). However, the proportion of patients with esophagitis increased progressively with increasing grades (0% in grade 1, 2.2% in grade 2, 9.9% in grade 3, and 32.5% in grade 4, p = 0.01). CONCLUSION: The AFS hiatus classification can stratify the population with obesity based on rate of esophagitis and symptom scores. This study supports the practical utility of the AFS classification as an adjunct in the detection of patients who are at risk for GERD after MBS. Further validation studies with pH testing are needed.