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Ha Thi Thu Tran,1,* Yen Hoang Nguyen,1,* Thuy Dinh Vuong,2 Loi Van Bui,3 Hue Thi Doan,1 Ha Thi Thu Le,1 Thien Cong Le,1 Thai Quoc Nguyen,4 Son Ngoc Do,5 Phuong Doan Nguyen,6 Chinh Quoc Luong,5 Tung Son Vu,7 Son Nam Tran,8 Ngoc Bao Doan,9 Long Bao Hoang,10 Tuan Van Nguyen1,11 1Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam; 2Department of Schizophrenia, Vietnam National Institute of Mental Health, Hanoi, Vietnam; 3Department of Stress-Related Disorders, Vietnam National Institute of Mental Health, Hanoi, Vietnam; 4Center of Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam; 5Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam; 6Outpatient Department, Construction Hospital, Hanoi, Vietnam; 7Department of Mood Disorders, Vietnam National Institute of Mental Health, Hanoi, Vietnam; 8Department of Oncology, Vietnam National Hospital of Traditional Medicine, Hanoi, Vietnam; 9School of Preventive medicine and Public health, Hanoi Medical University, Hanoi, Vietnam; 10Research and Training Management Department, Institute of Gastroenterology and Hepatology, Hanoi, Vietnam; 11Vietnam National Institute of Mental Health, Hanoi, Vietnam*These authors contributed equally to this workCorrespondence: Ha Thi Thu Tran, Email tran_thuha@hmu.edu.vnObjective: To evaluate the prevalence of post-traumatic stress disorder (PTSD) and other psychological disturbances in the Vietnamese healthcare workers (HCWs) at COVID-19 field hospitals.Methods: A cross-sectional study was conducted using the Impact of Event Scale–Revised (IES-R) to measure PTSD and the Depression Anxiety Stress scale (DASS) to measure other psychological disturbances. The anxiety about COVID-19 was evaluated by the fear of COVID-19 (FOC) scale. A self-developed questionnaire was used to assess work conditions and HCW’s major concerns and preparedness. Ordinal logistic regression was used to identify factors associated with the severity of PTSD. A structural modeling equation (SEM) model was fitted to examine the correlation between PTSD and other psychological disturbances.Results: A total of 542 HCWs participated in this study. The prevalence of PTSD was 21.2%, most cases were mild. In the ordinal logistic regression analysis, a history of mental illness, poor preparedness, working in a condition with poor resources, a greater number of concerns, and greater fear of COVID-19 were independently associated with higher severity of PTSD. The prevalence of depression, anxiety, and stress was 46.8%, 38.3%, and 60.2, respectively. In the SEM model, PTSD and psychological disturbances had a strong correlation (standardized covariance 0.86).Conclusion: The prevalence of PTSD and other psychological disturbances was alarmingly high among HCWs who worked at COVID-19 field hospitals. The reported associated factors can be useful for policymakers and health authorities in the preparation for future pandemics.Keywords: PTSD, COVID-19, healthcare workers, DASS, fear of COVID, psychological disturbances

Atmospheric rivers (ARs) are now widely known for their association with high-impact weather events and long-term water supply in many regions. Researchers within the scientific community have developed numerous methods to identify and track of ARs—a necessary step for analyses on gridded data sets, and objective attribution of impacts to ARs. These different methods have been developed to answer specific research questions and hence use different criteria (e.g., geometry, threshold values of key variables, and time dependence). Furthermore, these methods are often employed using different reanalysis data sets, time periods, and regions of interest. The goal of the Atmospheric River Tracking Method Intercomparison Project (ARTMIP) is to understand and quantify uncertainties in AR science that arise due to differences in these methods. This paper presents results for key AR-related metrics based on 20+ different AR identification and tracking methods applied to Modern-Era Retrospective Analysis for Research and Applications Version 2 reanalysis data from January 1980 through June 2017. We show that AR frequency, duration, and seasonality exhibit a wide range of results, while the meridional distribution of these metrics along selected coastal (but not interior) transects are quite similar across methods. Furthermore, methods are grouped into criteria-based clusters, within which the range of results is reduced. AR case studies and an evaluation of individual method deviation from an all-method mean highlight advantages/disadvantages of certain approaches. For example, methods with less (more) restrictive criteria identify more (less) ARs and AR-related impacts. Finally, this paper concludes with a discussion and recommendations for those conducting AR-related research to consider.

Hand surgery in Vietnam has evolved significantly, especially in cities like Ho Chi Minh City, Hanoi and Hue. Despite advancements, there remain challenges, including the lack of a unified national hand surgery society. This article highlights the contributions of key figures, advances and the future of the discipline in the country., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: As Medicaid continues to expand, it remains unclear if reimbursement rates for cleft care are keeping up with the national economy. The purpose of this study is to determine how financial trends in cleft lip and palate repair reimbursements compare to annual changes in the U.S. economy., Design: Current Procedural Terminology (CPT) codes for cleft lip and palate repair were retrospectively reviewed between 2018 and 2023. Reimbursements were adjusted for inflation to 2023 U.S. dollars using Medicaid physician fee schedules. Annual percentage changes in inflation-adjusted reimbursements, and reimbursement Compounded Annual Growth Rate (CAGR) were compared to the annual change in the U.S. Consumer Price Index (CPI)., Setting: Multi-state, Medicaid., Participants: Medicaid reimbursements of 6 U.S. states, 5 with highest birthrates: California, Texas, Florida, New York, and Pennsylvania. Colorado, the study institution, was evaluated., Main Outcome(s): Primary outcomes included annual changes in overall and inflation-adjusted reimbursement rates for cleft lip and palate surgical procedures as compared to annual changes in CPI., Results: The U.S. CPI increased by 20.9% from 2018 to 2023, while the overall total percentage change in reimbursement rates for all cleft lip and palate procedures increased by 7.23%. The inflation-adjusted overall percent change in reimbursements for all procedures decreased by -12.81%. For all procedures, the average CAGR was -2.66%., Conclusions: Inflation-adjusted reimbursement rates for cleft lip and palate repair have significantly decreased in contrast to the annual growth in U.S. CPI. These findings show a potential lack of financial sustainability for surgical cleft care, indicating the need for healthcare policy reform., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Timely medical care is crucial for optimal outcomes in children with cleft lip and palate. Undocumented migrant children face significant healthcare barriers. This study assesses the demographic characteristics and unmet surgical needs of undocumented children at our institution and analyzes state-level policies affecting their care., A retrospective review was conducted at a single institution between 2023 and 2024. Medicaid and Children's Health Insurance Program policies were reviewed as of August 2024, categorizing states by immigrant child healthcare coverage., Multidisciplinary cleft clinic in a pediatric referral center., Ten undocumented children were included, with clinical data and immigration status collected from social work and insurance records., Timing of initial cleft surgery, additional surgical needs, and surgical completion were assessed., Ten undocumented children were identified, with a mean age of 7 (range 1-10) years. Eight received primary cleft surgery in their home countries, but many had unmet surgical needs, including alveolar bone grafting (n = 4), oronasal fistula closure (n = 5), and dental care (n = 3). Twelve states provide comprehensive coverage regardless of immigration status, with 2 more expected by 2025. Twenty-three states cover only certain noncitizens without a waiting period, while 14 impose a 5-year delay. Broad coverage was concentrated in the Northeast and West ( P  = .002), with only one US-Mexico border state included., This study highlights barriers undocumented migrant children face in accessing cleft care, with disparities in state-funded policies potentially delaying critical interventions. Addressing these disparities is essential for equitable healthcare access., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Fronto-orbital advancement (FOA) is the standard surgical intervention for patients with craniosynostosis and associated fronto-orbital dysmorphology. Although previous studies have provided insights into center-specific complications, comprehensive, large-scale analyses remain limited. This study utilizes a national database to address these gaps, offering a large-scale perspective on FOA outcomes., Methods: Patients aged 0 to 16 years who underwent FOA from 2007 to 2015 were identified using the PearlDiver database. Patients were divided into early (0-5 y) and late (6-16 y) groups. Complications were identified using a combination of ICD and CPT codes. Intraoperative complications, including hematoma/hemorrhage, cerebrovascular infarction, and cardiac arrest, were defined as those occurring within 48 hours of the procedure. Postoperative complications analyzed at intervals of 0, 30, 90, 180, and 365 days post-operation included cerebrospinal fluid leak, hardware-related complications, hemorrhage, seizure, surgical site infection, wound dehiscence, and death. Summary statistics were conducted utilizing Bellwether software in PearlDiver., Results: A total of 2026 patients underwent FOA, with a mean of 1.5 years in the younger cohort (n=1905) and 9.0 years in the older cohort (n=121). Although rare, hemorrhage was the most common intraoperative complication. One-year postoperative complications were predominantly related to wound dehiscence and surgical site infection in the younger (5.10%) and older (14.1%) cohorts. The 1-year reoperation rate was 7.2% for the younger cohort and 19.0% for the older cohort., Conclusions: FOA is a safe operation with an overall low complication rate. However, older patients demonstrate a higher rate of reoperations, emphasizing the need to identify the optimal timing for FOA in patients with craniosynostosis., Competing Interests: The authors report no conflicts of interest., (Copyright © 2025 by Mutaz B. Habal, MD.)

Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes., Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality., Results: A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all P > .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, P = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, P = .040) and bile-leak/biloma (34.8% vs 12.5%, P = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, P = .001) and readmission within 30 days (30.4% vs 9.4%, P = .046). No significant differences were observed in hospital length of stay and mortality (all P > .05)., Conclusions: Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity., Competing Interests: Conflict of Interest/Disclosure The authors have no relevant financial disclosures., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Single-stage bilateral cleft lip repair may require preoperative naso-alveolar molding (NAM) to decrease cleft widths and reposition the premaxilla. Staged operations may be performed in centers or regions without easy access to NAM. This retrospective study aims to examine the national prevalence of single-stage and staged bilateral cleft lip repairs over the past 23 years., Methods: This retrospective study used TriNetX, a national deidentified aggregate database. The study used CPT codes to identify patients younger than 12 months who underwent single-stage (CPT-40701) or staged (CPT-40702) operation for bilateral cleft lip repair between 1/1/2000 to 9/16/2023. Patients were categorized by the year of their cleft lip repair. Patient demographics were analyzed through TriNetX. Linear regression analysis was conducted using PRISM software., Results: Of the 1303 patients who underwent bilateral cleft lip repair, 57 patients were billed for both operations and were excluded from the analysis. In the remaining cohort, 1136 (91%) patients had a single-stage, and 110 (9%) had a staged bilateral cleft lip repair. No significant demographic differences were found between the 2 groups.The incidence of staged operations increased from 0 patients in 2000 to 14 patients in 2022. The incidence of single-stage operations increased from 6 patients in 2000 to 81 patients in 2022. Staged operations were rare in the first decade, accounting for 2% (n=5) of all bilateral cleft lip repairs between 2000 and 2011. The prevalence of staged operations showed a positive linear correlation (R2=0.75, P<0.0001) over the 23-year period, rising from 0% (n=0) in 2000 to 17% (n=12) in 2023., Conclusion: Most bilateral cleft lip repairs have remained single-stage operations; however, staged approaches have also increased in popularity. This could indicate that NAM is less effective in patients with wide, severe bilateral cleft lip and palate, and surgeons may need to rely on a 2-stage approach for these patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2025 by Mutaz B. Habal, MD.)

Introduction: Pediatric craniofacial trauma, particularly from non-accidental trauma (NAT), is a significant cause of injury with enduring physical and psychological impacts. This study analyzes demographic patterns, injury characteristics, and trends in NAT-related craniofacial injuries to inform early identification, intervention, and prevention efforts., Methods: Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for the years 2009 to 2019. Patients aged 0 to 17 with craniofacial injuries and a diagnosis of non-accidental trauma were identified based on current procedural codes; demographic and temporal trends were analyzed., Results: Overall, 306,115 patients with craniofacial injuries and 20,540 patients with non-accidental trauma (NAT) were identified. Patients with NAT represented 2.6% of all craniofacial injuries, with a greater proportion of males affected. On average, 39% of all NAT cases involved a craniofacial injury. The most common injury patterns were intracranial (50.1%), superficial head injuries (37.7%), and craniofacial fractures (31.9%. Isolated facial fractures were rare, comprising <1% of all cases. Although the average in-hospital mortality was 6.78%, temporal analysis demonstrated significant reductions in in-hospital mortality and length of hospitalization (P<0.001)., Conclusions: Pediatric craniofacial injuries from NAT remain a significant public health concern. However, the observed decrease in both hospitalization length and in-hospital deaths suggests improvements in early intervention and treatment outcomes. Continued efforts to refine diagnostic strategies, enhance provider awareness, and strengthen prevention initiatives are essential to mitigate the devastating impacts of NAT in the pediatric population., Competing Interests: The authors report no conflicts of interest., (Copyright © 2025 by Mutaz B. Habal, MD.)

Introduction: Cleft lip and palate (CLP) is one of the most common congenital anomalies worldwide, affecting approximately 2,000 children annually in Vietnam. Parental caregivers, particularly mothers, face considerable challenges in managing complex treatment pathways and addressing their children's multifaceted needs. This often leads to increased stress and decline in the quality of life (QoL). This study aimed to explore the relationship between disease-related knowledge, stress, and QoL among caregivers of children with CLP in Ho Chi Minh City., Materials and Methods: A descriptive-correlational design was used with a purposive sample of 235 parental caregivers from an Odonto-Stomatology Hospital in Ho Chi Minh City, Vietnam. Data were collected using three validated instruments: the Disease-Related Knowledge Scale, Stress Scale for Parents of Children with CLP, and WHOQOL-BREF. Descriptive statistics were used to summarize the data; Pearson's correlation coefficient and multiple linear regression were used to examine the relationships between knowledge, stress, and QoL., Results: Caregivers had moderately good disease-related knowledge (M=3.66, SD=0.39), with the highest scores in information provision (M=3.90, SD=0.43). Stress levels were moderately low (M=3.46, SD=0.44), with resource deficiencies being the most significant stressor. Although the caregivers reported good overall QoL (M=3.97, SD=0.47), psychological health scored lower (M=3.45, SD=0.84). A significant positive correlation was found between knowledge and stress (r=0.421, p<0.001), but no significant correlation was observed between knowledge and QoL (r=-0.033, p=0.619)., Conclusion: Greater disease-related knowledge correlated with increased stress, yet it did not directly improve QoL. These findings emphasize the need for comprehensive support, including education and psychosocial interventions, to reduce stress and enhance the well-being of parental caregivers., Competing Interests: None., (© 2025 The Authors.)

Purpose: This study aims to evaluate the effectiveness and safety of lateral closing wedge osteotomy with tension-band wire fixation for correcting cubitus varus deformity in pediatric patients. The primary objective was to assess the bone union rate, functional outcomes, and potential complications associated with this surgical approach., Methods: We conducted a retrospective review of 104 pediatric cases (ages 7-15) with post-traumatic cubitus varus deformity treated between January 2018 and December 2019 at the Pediatric Orthopedic Department. The surgical technique involved a lateral closing wedge osteotomy with fixation achieved using an 8-figure tension-band wire on the lateral column of the distal humerus. Follow-up assessments were conducted for bone union, correction stability, range of motion, and any post-surgical complications., Results: Out of 104 cases, 63 involved left elbows and 41 right elbows, with an average patient age of 8.12 years. The deformity was severe (>30° varus) in 33.65 % of cases. Successful correction and bone union were achieved in 100 % of cases, with an average follow-up duration of 8 months (range: 3-20 months). Complications included minor recurrence in two cases due to early post-operative trauma, limited range of motion in three cases, K-wire protrusion in three cases, and infection in two cases. Functional outcomes rated as excellent in 94.2 % of cases and good in 5.8 %., Conclusion: Lateral closing wedge osteotomy with tension-band wire fixation is a reliable technique for correcting pediatric cubitus varus deformity, offering stable fixation, high success rates in bone healing, and favorable functional outcomes with minimal complications., Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© 2025 Society for Indian Hand Surgery and Micro Surgeons. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

In contrast to adult mammalian hearts, the adult zebrafish heart efficiently replaces cardiomyocytes lost after injury. Here we reveal shared and species-specific injury response pathways and a correlation between Hmga1, an architectural non-histone protein, and regenerative capacity, as Hmga1 is required and sufficient to induce cardiomyocyte proliferation and required for heart regeneration. In addition, Hmga1 was shown to reactivate developmentally silenced genes, likely through modulation of H3K27me3 levels, poising them for a pro-regenerative gene program. Furthermore, AAV-mediated Hmga1 expression in injured adult mouse hearts led to controlled cardiomyocyte proliferation in the border zone and enhanced heart function, without cardiomegaly and adverse remodeling. Histone modification mapping in mouse border zone cardiomyocytes revealed a similar modulation of H3K27me3 marks, consistent with findings in zebrafish. Our study demonstrates that Hmga1 mediates chromatin remodeling and drives a regenerative program, positioning it as a promising therapeutic target to enhance cardiac regeneration after injury., Competing Interests: Competing interests: D.E.M.d.B. and J.B. are co-inventors on a patent application associated with this study: patent no. PCT/NL2022/050553, ‘Mammalian heart regeneration’. J.B. is co-founder of Myogene Therapeutics. The other authors declare no competing interests., (© 2025. The Author(s).)

Objective: To evaluate the effect of healthcare employees' emotional competence (EC) on patient loyalty in public and private hospitals in Ho Chi Minh City, with a focus on the mediating roles of respect, trust, and rapport., Method: A survey of 244 patients measured respect, trust, rapport, EC, and patient loyalty using a 5-point Likert scale. Structural equation modeling (SEM) was applied to assess the relationships between EC and patient loyalty, comparing results between public and private hospitals., Results: EC significantly enhanced patient loyalty, with respect and rapport serving as key mediators. Private hospitals showed higher EC levels among staff, leading to greater patient loyalty, while public hospitals, impacted by staff fatigue and high patient loads, demonstrated lower EC and reduced loyalty. EC accounted for 58% of service quality variance and 65% of loyalty variance., Conclusions: Emotional competence is essential for improving patient loyalty in healthcare settings. Training programs targeting EC, especially in public hospitals, could enhance patient satisfaction and long-term loyalty., Competing Interests: None

3D photogrammetry is a cost-effective, non-invasive imaging modality that does not require the use of ionizing radiation or sedation. Therefore, it is specifically valuable in pediatrics and is used to support the diagnosis and longitudinal study of craniofacial developmental pathologies such as craniosynostosis - the premature fusion of one or more cranial sutures resulting in local cranial growth restrictions and cranial malformations. Analysis of 3D photogrammetry requires the identification of craniofacial landmarks to segment the head surface and compute metrics to quantify anomalies. Unfortunately, commercial 3D photogrammetry software requires intensive manual landmark placements, which is time-consuming and prone to errors. We designed and implemented SHAPE, a System for Head-shape Analysis and Pediatric Evaluation. It integrates our previously developed automated landmarking method in a visual computing pipeline to evaluate a patient's 3D photogram while allowing for manual confirmation and correction. It also automatically computes advanced metrics to quantify craniofacial anomalies and automatically creates a report that can be uploaded to the patient's electronic health record. We conducted a user study with a professional clinical photographer to compare SHAPE to the existing clinical workflow. We found that SHAPE allows for the evaluation of a craniofacial 3D photogram more than three times faster than the current clinical workflow (3.85 ± 0.99 vs. 13.07 ± 5.29 minutes, p < 0.001). Our qualitative study findings indicate that the SHAPE workflow is well aligned with the existing clinical workflow and that SHAPE has useful features and is easy to learn.

Domestic and global access to surgical care for paediatric hand and upper limb conditions is challenged by limited resources, increasing direct and indirect costs of care and a growing number of patients who require specialty care. There are numerous barriers for patients from developing countries to receiving medical care in Japan due to the substantial costs, which include travel, uninsured medical expenses and fees imposed by intermediaries. To address this issue, I realised that I needed to take a more direct approach - by travelling to these countries, not only to provide treatment, but also to teach and train local doctors. By emphasising on the education of local clinicians through the sharing of knowledge and skills, it is possible to expand the timely access to paediatric hand surgery and improve outcomes for children in need. Our mission is rooted in the belief that every nation holds its own unique treasures - its culture, food, beauty and joy - that are worth celebrating and preserving. By fostering sustainable relationships built on mutual respect and understanding, we can make a greater impact; engagement with local surgeons will ultimately elevate the level of care that they can provide in their own communities, through improving core competencies of medical knowledge, technical/surgical skills and resource allocation for simple and complex conditions. This work not only reflects my personal commitment, but also my focus on expanding our team of fellows and strengthening organisational support. We aim to actively pursue these efforts throughout Asia, fostering cross-cultural collaboration and, ultimately, helping to heal the hands and futures of children worldwide. The aim of this review article is to share with readers how we started our mission trips to Vietnam and highlight 10 steps that I feel are critical to a successful mission trip.

Background: Supracondylar humerus fractures (SCHF) in children are common and can lead to serious complications, including neurovascular injury. The optimal management of children with a 'pink pulseless' hand following such a fracture is unclear. This study aimed to ascertain an appropriate therapeutic approach for children with SCHF and a pink pulseless hand. Methods: A retrospective analysis of medical records from paediatric patients under 16 years old with SCHF and clinically perfused but pulseless hands between 1 January 2016 and 30 June 2021 was conducted. Clinical characteristics, imaging, treatment processes and follow-up results were analysed to predict arterial injuries requiring vascular repair and determine the optimal timing for exploratory surgery. Results: The study included 88 patients, predominantly male (58%) with an average age of 6 years. Most fractures resulted from falls onto outstretched arms. Satisfactory outcomes, indicated by the return of the pulse following closed reduction and percutaneous pinning (CRPP) alone, were seen in 66% of patients, negating the necessity for vascular exploration. Amongst patients with a persistently absent radial pulse 72 hours after CRPP, 83% were diagnosed with brachial artery injuries, with all such patients experiencing recurrent pulse loss after surgery. Conclusions: Urgent reduction and CRPP are effective initial treatments for children with SCHF and a pink pulseless hand. Immediate vascular exploration is generally not necessary in these patients. Further research is needed to determine the optimal management for persistent pulselessness and recurrent pulse loss. Level of Evidence: Level IV (Therapeutic).

Purpose: Unhealthy dietary patterns contribute to an increased risk of colorectal cancer (CRC). Limited prior research has used reduced rank regression (RRR) to assess dietary patterns relative to CRC risk. This study aimed to identify dietary patterns derived by RRR and assess their associations with CRC risk and mortality., Methods: We used data from the multicentre Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) trial. Dietary intake was assessed using a Dietary History Questionnaire. In the RRR intake of fibre, folate, and the percentage of energy from carbohydrates, saturated and unsaturated fatty acids were used as response variables. Cox models and competing risk survival regression, with age as the time scale, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC risk and mortality, respectively., Results: The median follow-up time for CRC risk (n = 1044) and mortality (n = 499) was 9.4 years (Interquartile Range: 8. 0, 10.1) and 16.9 years (11.9, 18.6), respectively. Two dietary patterns were identified: the first was characterised by high carbohydrate, folate and low fatty acid intake, and the second by high fibre and unsaturated fatty acid. Compared to participants in the first tertile of the high fibre and unsaturated fatty acid pattern, those in the third tertile had a lower risk of CRC (HR = 0.88; 95% CI: 0.76, 1.03), and colon cancer (HR = 0.85; 95% CI: 0.72, 1.01). Conversely, the high carbohydrate, high folate and low fatty acid pattern had no association with CRC outcomes. None of the dietary patterns showed associations with rectal cancer or CRC mortality., Conclusion: A diet enriched with high fibre and unsaturated fatty acids may reduce the risk of CRC. These results highlight the potential protective effect of adequate fibre intake in conjunction with high consumption of unsaturated fatty acids against CRC., Competing Interests: Declarations. Ethical approval: The usage of the CRC data in the PLCO study was authorised by the National Cancer Institute (PLCO-1166) and the Human Research Ethics Committee of Flinders University (project number 6435). Competing interests: All authors declare that they have no competing interests., (© 2024. Crown.)

This letter addresses the recent study by Zhu et al on the predictive factors for coronal and sagittal graft extrusion length following medial meniscus reconstruction using tendon autografts. The study provides valuable insights into the importance of preoperative joint space width and tunnel positioning as predictors of graft extrusion. Specifically, it found strong correlations between preoperative joint space width and medial, posterior, and mean graft extrusion at both 1 week and 8 months post-operation. Additionally, tunnel edge distance at 1 week post-operation correlated with anterior and posterior graft extrusion. These findings offer critical guidance for improving surgical outcomes. However, the letter highlights the need for further research with larger sample sizes and comparative studies involving different graft types to strengthen these findings and broaden their applicability in clinical settings. The study's contributions to understanding meniscus reconstruction using tendon autografts are acknowledged, along with suggestions for future research directions., Competing Interests: Conflict-of-interest statement: Nguyen PD and Lam TK declare that they have no conflicts of interest related to this manuscript. The authors have not received any fees for serving as speakers, consultants, or advisory board members. They have not received any research funding from organizations related to this work. Neither author is an employee of any organization that may have an interest in this research. The authors do not own stocks, shares, or patents related to the subject matter of this manuscript., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Upper gastrointestinal (GI) bleeding in older children is generally caused by conditions like esophagitis, esophageal variceal rupture, and peptic ulcer disease. However, it is rare for bleeding to result from a ruptured vascular aneurysm of the gastroduodenal artery, particularly when associated with peptic ulcer disease. This report describes a case involving a 13-year-old male who presented with severe upper GI bleeding and hemodynamic instability, requiring blood transfusion. During an emergency upper GI endoscopy, a bleeding gastric ulcer classified as Forrest IIB was identified. The bleeding was managed initially with endoscopic hemostasis and surgical suturing. Despite these interventions, the patient experienced recurrent bleeding. Further investigation with contrast-enhanced computed tomography (CT) imaging revealed a vascular aneurysm in the gastroduodenal artery. The patient subsequently underwent successful endovascular embolization, as confirmed by digital subtraction angiography (DSA). Following this procedure, there were no further episodes of GI bleeding. This case highlights the critical need for thorough diagnostic evaluation using contrast-enhanced CT and endoscopy in managing complex GI bleeding cases. Early detection and appropriate intervention are essential, especially in pediatric patients where the cause of bleeding may be rare and severe., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Prior studies evaluating observation versus angioembolization (AE) for blunt liver injuries (BLT) with contrast extravasation (CE) on computed tomography imaging have yielded inconsistent conclusions, primarily due to limitations in single-center and/or retrospective study design. Therefore, this multicenter study aims to compare an observation versus AE-first approach for BLT, hypothesizing decreased liver-related complications (LRCs) with observation., Methods: We conducted a post hoc analysis of a multicenter, prospective observational study (2019-2021) across 23 centers. Adult patients with BLT + CE undergoing observation or AE within 8 hours of arrival were included. The primary outcome was LRCs, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. A multivariable logistic regression analysis was used to evaluate risk factors associated with LRCs., Results: From 128 patients presenting with BLT + CE on imaging, 71 (55.5%) underwent observation-first and 57 (45.5%) AE-first management. Both groups were comparable in age, vitals, mechanism of injury, and shock index (all p > 0.05), however the AE group had increased frequency of American Association for the Surgery of Trauma Grade IV injuries (51.0% vs. 22.0%, p = 0.002). The AE cohort demonstrated increased rates of in-hospital LRCs (36.8% vs. 12.7%, p = 0.038), emergency department representation (25.0% vs. 10.0%, p = 0.025), and hospital readmission for LRCs (12.3% vs. 1.4%, p = 0.012). However, the two cohorts had similar mortality rates (5.7% vs. 5.3%, p = 0.912). After adjusting for age, ISS, and grade of liver injury, an AE-first approach had a similar associated risk of LRCs compared with observation-first management (odds ratio, 1.949; 95% confidence interval, 0.673-5.643; p = 0.219)., Conclusion: Patients with blunt liver injury and CE undergoing an observation-first approach were associated with a similar adjusted risk of LRCs and rate of mortality compared with AE-first approach. Overall, this calls for reevaluation of the role of routine AE in blunt liver trauma patients with CE. Future prospective randomized trials are needed to confirm these findings., Level of Evidence: Therapeutic/Care Management, Level IV., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: For patients with cleft lip/palate, adolescence is a time of maxillofacial growth and complex psychosocial stressors. The personal significance of facial differences may change, making patient-reported outcomes measures invaluable. In this study, we use several scales from the CLEFT-Q and FACE-Q to explore how aesthetic outcomes differ by age and by gender among patients with unilateral cleft lip/palate., Methods: This was a multicenter, cross-sectional study that prospectively collected CLEFT-Q and FACE-Q data across 6 cleft treatment centers during clinical appointments from 2019 to 2022. Subjects were aged 8 to 22 years, with unilateral cleft lip, alveolus, and palate, who had not undergone tertiary operative care (maxillary advancement or septorhinoplasty) at the time of survey response. Data cross-sections were prepared by age (8 to 10, 11 to 13, and 14 years or older), by gender, and by age and gender together., Results: Older age groups reported poorer aesthetic outcomes and worse appearance-related distress compared with younger groups. Although male and female subjects reported similar aesthetic outcomes, female subjects reported more appearance-related distress. When considered simultaneously, age and gender appear to have an intersectional impact on perceived aesthetic outcome and appearance-related distress during adolescence., Conclusions: This exploratory project suggests that patients with cleft lip/palate may perceive worsening of facial aesthetics throughout the course of adolescence, the exact pattern of which may be dependent on gender. Future work will evaluate this hypothesis using longitudinal cohorts. It will be important to investigate psychosocial factors that may impact these outcomes, and also to quantify the impact of tertiary operative care on these outcomes., Clinical Question/level of Evidence: Risk, II., (Copyright © 2023 by the American Society of Plastic Surgeons.)