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Primary mediastinal apocrine adenocarcinoma is extremely rare, with only one case reported to date. Here, we report a surgical case of primary mediastinal apocrine adenocarcinoma. An anterior mediastinal cystic tumor with calcification was identified on chest computed tomography scan in a 51‐year‐old female patient undergoing maintenance hemodialysis. The tumor was 19 mm in size, did not invade the adjacent organs or show distant metastases, and was surgically removed. Microscopic examination revealed that the tumor cells exhibited cribriform or solid proliferation patterns with thick fibrous capsules. The tumor cells had an abundant eosinophilic cytoplasm, and decapitation secretion was noted. Immunohistochemistry revealed positivity for GCDFP‐15 and androgen receptors, with Ki‐67 positivity at 10%. The cyst wall exhibited extensive fibrosis and keratinized material, with bone and bronchial glands identified at the cyst periphery; the tumor cells were contiguous with those structures. The patient was diagnosed with apocrine adenocarcinoma arising from a mature cystic teratoma. The patient has maintained a recurrence‐free status without adjuvant therapy for 6 years after surgery. This case presents a small primary mediastinal apocrine adenocarcinoma that achieved remarkable long‐term survival. [ABSTRACT FROM AUTHOR]

Background: Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with "before medically advised" hospital discharge (BMA discharge; commonly known as discharge "against medical advice"). Objective: To evaluate whether patient-physician sex discordance is associated with BMA discharge. Design: Retrospective cohort study using 15 years (2002–2017) of linked population-based administrative health data for all non-elective, non-obstetrical acute care hospitalizations from British Columbia, Canada. Participants: All individuals with eligible hospitalizations during study interval. Main Measures: Exposure: patient-physician sex discordance. Outcomes: BMA discharge (primary), 30-day hospital readmission or death (secondary). Results: We identified 1,926,118 eligible index hospitalizations, 2.6% of which ended in BMA discharge. Among male patients, sex discordance was associated with BMA discharge (crude rate, 4.0% vs 2.9%; adjusted odds ratio [aOR] 1.08; 95%CI 1.03–1.14; p = 0.003). Among female patients, sex discordance was not associated with BMA discharge (crude rate, 2.0% vs 2.3%; aOR 1.02; 95%CI 0.96–1.08; p = 0.557). Compared to patient-physician sex discordance, younger patient age, prior substance use, and prior BMA discharge all had stronger associations with BMA discharge. Conclusions: Patient-physician sex discordance was associated with a small increase in BMA discharge among male patients. This finding may reflect communication gaps, differences in the care provided by male and female physicians, discriminatory attitudes among male patients, or residual confounding. Improved communication and better treatment of pain and opioid withdrawal may reduce BMA discharge. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions This study investigated healthcare utilisation in general practice and hospitals in the 2 years preceding a diagnosis of haematological cancer and the association with patient pathways.The nationwide register‐based cohort study included 12 994 patients diagnosed with leukaemia, multiple myeloma and lymphoma in 2014–2018 and 10 matched references. Patient pathways were analysed in unplanned routes (acute admission up to 1 month's prior diagnosis) and elective routes (other routes, e.g., cancer patient pathways).Female patients in unplanned diagnostic pathways had more contacts to general practice from 19 months before the diagnosis compared to their matched references; with IRR increasing from 1.14 (95% confidence interval (CI) 1.05–1.24) to 2.27 (95% CI 2.13–2.41) at 30–60 days before the diagnosis. Female patients had more point‐of‐care tests, hospital contacts and radiological investigations at 17, 24 and 17 months, respectively, before diagnosis compared to their references. Similar patterns were seen for male patients, although with a later onset of increase. No healthcare use variations were seen between patients diagnosed in unplanned versus elective pathways.Increased healthcare utilisation was seen in general practice and hospitals up to 24 months preceding a diagnosis, which may indicate a diagnostic window for detecting haematological cancer earlier. [ABSTRACT FROM AUTHOR]

Background: The stress hyperglycemia ratio (SHR) is associated with poor outcomes in critically ill patients. However, the relationship between SHR and mortality in patients with sepsis-associated acute kidney injury (SA-AKI) remains unclear. Methods: The data of patients with SA-AKI, identified based on the KDIGO criteria, were retrospectively collected from the Beth Israel Deaconess Medical Center between 2008 and 2019. SHR was calculated as follows: (glycemia [mmol/L]) / (1.59 × HbA1c [%] – 2.59). Primary outcomes were 30-day and 1-year mortality. The cumulative incidence of all-cause mortality was assessed using Kaplan–Meier survival analysis. Multivariable-adjusted logistic and Cox models and restricted cubic spline curves were used to analyze the correlation between SHR and all-cause mortality. Post-hoc subgroup analysis was performed to compare the effects of SHR across different subgroups. Results: 1161 patients with SA-AKI were identified and categorized into four SHR quartiles as follows: Q1 (0.26, 0.90), Q2 (0.91, 1.08), Q3 (1.09, 1.30), and Q4 (1.31, 5.42). The median age of patients was 69 years, with 42.7% of the patients being women and 20.2% of the patients having chronic kidney disease. The 30-day and 1-year mortality were 22.1% and 35.0% respectively. Kaplan–Meier survival analysis indicated a gradual decrease in survival probability with increasing SHR quartiles. An increased SHR exhibited a strong correlation with 30-day mortality (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.18–1.90; P < 0.001) and 1-year mortality (HR, 1.32; 95% CI, 1.06–1.65; P = 0.014). SHR has a nonlinear relationship with 1-year mortality but not with 30-day mortality (P-nonlinear = 0.048 and 0.114, respectively). The results of subgroup analysis were mostly consistent with these findings. Conclusion: An increased SHR is independently associated with 30-day and 1-year mortality in patients with SA-AKI. Therefore, SHR may serve as an effective tool for risk stratification in patients with SA-AKI. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of gluten-related disorders, mainly celiac disease (CD) and non-celiac gluten sensitivity (NCGS), varies between 0.6% and 13% in the general population. There is controversial evidence regarding the association of both CD and NCGS with extra-digestive manifestations, including recurrent reproductive failure (RRF), which may have clinical implications. Objective: To study the prevalence of HLA susceptibility alleles for CD/NCGS in a cohort of female patients with RRF from a single reference center and to evaluate the effect of a gluten-free diet on reproductive success. Material and methods: A retrospective study was conducted on 173 patients with RRF, consecutively attended at the Reproductive Immunology Unit of San Carlos University Clinical Hospital in Madrid. We collected and analyzed the clinical, analytical, and immunological profiles of RRF patients who presented HLA alleles associated with CD and NCGS (HLA DQ2.2, DQ2.5, DQ8, and DQ7.5). Results: We observed a significantly higher prevalence of HLA alleles associated with CD and NCGS in our RRF cohort compared to the prevalence in the general population (69% vs. 35%–40%, p<0.0001). Only 2.3% of patients met the criteria for a CD diagnosis. In our RRF cohort, HLA-genetic susceptibility for CD/NCGS (HLA-risk group) was associated with a significantly higher rate of hypothyroidism compared to patients without these alleles (HLA-negative group) (48.7% vs. 26.92%, p=0.03). Patients with HLA-genetic susceptibility for CD/NCGS and thyroid disease had a significantly higher success rate in the subsequent pregnancy after management (55% vs. 30%, p=0.002). Two factors were found to be significant in this group: a gluten-free diet (p=0.019) and the use of levothyroxine (p=0.042). Conclusions: In our cohort of RRF patients, we observed a significantly higher prevalence of HLA susceptibility genes for CD/NCGS compared to the general population, also associated with a higher incidence of thyroid alterations. A gluten-free diet and the use of levothyroxine in cases of thyroid pathology had significant beneficial effects on pregnancy outcomes. We suggest that HLA typing for CD/NCGS and a gluten-free diet, in the presence of risk alleles, can improve pregnancy outcomes in RRF patients. [ABSTRACT FROM AUTHOR]

This study aims to discover the association between serum osteocalcin, the Chinese visceral adiposity index (CVAI), and atherosclerotic cardiovascular disease (ASCVD) risk, and their impact on arterial stiffness in T2DM patients. We included 639 T2DM patients aged 30 and older who received the assessment of ASCVD risk using the China-PAR equation, Osteocalcin and arterial stiffness in this cross-sectional study. We found that osteocalcin and CVAI as independent risk factors for both medium–high-risk ASCVD (osteocalcin: men, OR,0.96, 95% CI 0.92, 1.00; women, OR, 0.93, 95% CI 0.8, 1.08, respectively)(CVAI: men, OR,1.01,95% CI 1.00,1.02; women: OR, 1.08, 95% CI 1.02,1.14, respectively) and arterial stiffness (osteocalcin: men, OR, 0.98, 95% CI 0.94,1.01; women, OR, 0.98, 95% CI 0.90,1.06, respectively)(CVAI: men, OR,1.0, 95% CI 0.99,1.01; women, OR, 1.02, 95% CI 1.00,1.04, respectively) in both men and women patients with T2DM. Combining osteocalcin levels and CVAI improved the prediction accuracy of arterial stiffness in men patients with T2DM (difference of AUC(Model 4 vs. Model 1):1.5%, NRI: 0.06 [0.0,0.4]). All P-values were < 0.05. The results suggested that osteocalcin levels and CVAI are independent risk factors for ASCVD risk and arterial stiffness in T2DM. Combining osteocalcin and CVAI can enhance the early detection of atherosclerosis through male patients with T2DM. [ABSTRACT FROM AUTHOR]

This paper will describe a seven-year therapeutic process, including an interval of four years, of a female patient continuing in therapy. Her history and therapeutic process will portray the patient’s forward-edge striving. How the transference needs of the patient helped her go forward, even without mourning, despite a traumatic and neglectful environment during her childhood and despite all the disadvantages of the current political atmosphere, will also be explored. As an outcome of the therapeutic process, how a securely based intersubjective realm helped this patient to integrate sorrow associated with trauma into her “self” will be depicted. [ABSTRACT FROM AUTHOR]

Conventional ameloblastoma presents infiltrative behavior and its treatment ranges from enucleation combined with adjuvant therapies to marginal/segmental resection. The purpose of this study is to present a cohort of twenty-four patients with ameloblastoma treated in the same institution after marginal/segmental resection for the past 21 years. All cases had diagnosis confirmation by incisional biopsy. Patients with an unconfirmed diagnosis and missing follow-up information were excluded. Data were categorized into clinicopathological, surgical and recurrence aspects. Thirteen patients were females (54%). The mean age was 40.2 years. Mandible was the most affected site (91%). The mean length of the lesions was 4.10 cm (± 2.06) and the multilocular aspect was predominant (83%). Root resorption (37.5%), tooth displacement (45.8%) and cortical perforation (45.8%) were noticed. Histologically, most of the cases were follicular (n = 19,79%). Microscopic analysis showed positive margins in four cases. Patients were treated by marginal (n = 19) and segmental (n = 5) resections. Recurrence occurred in two cases (8.33%). Both primary and recurrent ameloblastomas were treated through marginal resections and no recurrence was observed during the past 9 and 5 years after the last intervention, respectively. The overall mean follow-up was 79.25 months and patients are still monitored over these years. Marginal/segmental resection of conventional ameloblastoma is associated with a low recurrence rate. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dermal microcoring extracts cores of skin that are small enough to allow healing in a scarless fashion. Its use has been reported in the treatment of skin laxity, rhytides, and textural abnormalities. OBJECTIVE: To report the authors' clinical experience using dermal microcoring in a variety of cases. MATERIALS AND METHODS: A retrospective chart review was performed looking at dermal microcoring cases for any indication between August 2022 and March 2024. RESULTS: Thirty-eight patients were treated. Overall, 32 (84.2%) patients were women, with median age of 67 years (R: 20-80 years). Fitzpatrick skin types I to V were represented. Among patients with adequate photographs for review, improvements of grade 3 and 4 (good and excellent) were seen in 85.7% (n 5 18/21) treated for skin laxity and rhytides, 50.0% (n53/6) treated for acne scars, 66.7% (n52/3) treated for traumatic or surgical scars, and 100.0% (n53/3) treated for foreign material. Six (15.4%) patients experienced erythema or hyperpigmentation lasting more than 4 weeks, and 2 (5.1%) patients experienced temporary focal scarring, which improved with intralesional therapy and laser treatment. No patients experienced permanent dyspigmentation, prolonged edema, or infection. CONCLUSION: Dermal microcoring has been demonstrated to safely and effectively treat skin laxity, rhytides, scars, and foreign material. [ABSTRACT FROM AUTHOR]

Background: The insertion of chest drains (CD) in trauma patients is a lifesaving, albeit high-risk intervention. Safe insertion of CD in settings where aids like ultrasound are not available relies on a landmark technique defining the so-called triangle of safety. The inferior margin of this triangle is identified by nipple height, which is thought to correspond to the fifth intercostal space (ICS). Training manikins are modeled after a lean male body and oftentimes insinuating jokes fuel uncertainty about the height of the nipple as a reliable landmark in female trauma patients. This study aims to prove that the nipple can be considered a safe landmark for CD insertion in women: even if larger breasts follow the force of gravity, it should not act towards the direction of the feet, but to the sides of the thorax in a flat-lying trauma patient. Methods: An online questionnaire was designed and distributed amongst female surgeons. Epidemiological data (age, nr of pregnancies, history of breastfeeding) was collected. Height, weight, and body mass index (BMI) were reported. Chest circumference and underbust girth were self-measured. The nipple position in relation to the ICS was measured by the women while lying in a supine position. Results: 237 female surgeons completed the questionnaire. Nine questionnaires were excluded due to incomplete data sets. 20 women were excluded due to previous breast surgery. Thus, 208 participants (or 416 nipples) were included in analysis. In supine position, both nipples were located in the 5th (±0.8) intercostal space. Age, BMI, height, weight, and status post-pregnancy had no significant impact on nipple position. Interestingly, a history of breastfeeding correlated with lower nipple position. Conclusions: The nipple is a safe landmark for identifying the correct insertion position of chest drains in supine-lying female trauma patients. [ABSTRACT FROM AUTHOR]

Vincristine-induced peripheral neuropathy (VIPN) is an adverse effect of regimens used for the treatment of aggressive B-cell non-Hodgkin lymphoma (B-NHL). A single-nucleotide polymorphism (SNP) in the promotor region of the CEP72 gene has been identified as risk factor for the development of VIPN in children. To validate these results in adults we aimed to determine the association of the high-risk CEP72 (rs924607 TT genotype) with the occurrence and severity of VIPN. Analysis of SNP rs924607 (TT, CC or CT) was performed in all enrolled patients with available blood samples with a TaqMan genotyping assay. Rates and grades of VIPN were assessed prospectively as part of the RICOVER-60 trial. CEP72 genotype could be assessed in 519 patients. VIPN data was available for 499/519 patients who were included in the final analysis. 286 (57%) patients developed VIPN of any grade during treatment. Grade 2–4 VIPN occurred in 33% (166/499) of patients. The high-risk CEP72 TT genotype at rs924607 was identified in 97/499 (19%) patients. The TT genotype was not correlated with VIPN in the overall study population compared to patients with either CC or CT genotypes (p = 0.748). However, in the subgroup of female patients, the TT genotype was associated with increased occurrence of any-grade VIPN as well as grade 2–4 VIPN as compared to patients with either CC or CT genotypes (p = 0.016 and p = 0.020, respectively). Thus, the SNP rs924607 in the CEP72 gene is associated with increased VIPN incidence in female patients with aggressive B-NHL treated with CHOP chemotherapy. Trial registration ClinicalTrials.gov identifier: NCT00052936, submission date: 2005-06-23, EudraCT Number: 2010-019587-36. [ABSTRACT FROM AUTHOR]

Historically, studies show that female patients with cystic fibrosis (CF) have worse pulmonary outcomes than male patients, including decreased life expectancy. It is unknown whether this disparity persists in the new era of highly effective modulator therapies. Ivacaftor has been available in the United States for > 10 years, allowing for the opportunity to understand the impact this therapy may have on sex disparities in CF. We hypothesized that female patients will continue to show worse outcomes because we suspect that the disparity is not driven solely by ion channel dysfunction. Does a difference in outcomes between male and female patients persist after the initiation of ivacaftor in people with CF? We conducted a retrospective cohort study using the CF Foundation Patient Registry comparing changes in pulmonary exacerbation rate, lung function (FEV 1 % predicted), and presence of Pseudomonas aeruginosa among male patients vs female patients before and after initiation of treatment with the highly effective modulator ivacaftor. The cohort comprised 1,900 people with CF who were treated with ivacaftor between 2010 and 2017; 928 patients (48.84%) were male and 972 patients (51.16%) were female with a mean age of 33.09 years. Male patients showed a significant decrease in pulmonary exacerbations after ivacaftor treatment (from 0.38 to 0.34; adjusted rate ratio, 0.89; P =.028), whereas female patients did not (from 0.48 to 0.45; adjusted rate ratio, 0.95; P =.174). FEV 1 % predicted similarly decreased in both male and female patients before vs after ivacaftor treatment. P aeruginosa prevalence decreased to a similar extent in both male and female patients after ivacaftor treatment. Our findings demonstrate that sex disparities in CF persist in those treated with ivacaftor because of differences in pulmonary exacerbations. More research is needed to determine the specific pathophysiologic drivers of this disparity. [ABSTRACT FROM AUTHOR]

Gastroparesis (Gp) patients often have gastroesophageal reflux disease (GERD). Management of GERD in Gp patients is a challenge. Many studies have shown that gastric peroral endoscopic pyloromyotomy (G-POEM or POP) is moderately effective in reducing nausea and vomiting in patients with Gp. This study aims to determine whether G-POEM can improve GERD in Gp Patients. Patients who underwent G-POEM from July 2021 to October 2022 were enrolled in the study. GERD Health-Related Quality of Life (GERD HRQL) and Reflux Symptom Index (RSI) were used to assess patients' GERD before and after G-POEM. The use of proton pump inhibitors (PPIs) before and after G-POEM were also documented. The Gastroparesis Cardinal Symptom Index (GCSI) was used to assess the severity of Gp before and after G-POEM. A 'Welch two-sample t -test' was used to find differences in GERD HRQL (health-related quality of life) and RSI scores before and after the procedure. Pearson's chi-square test was used to find differences for use of PPI before and after G-POEM. Twenty-three consecutive refractory Gp patients with 30% male (average age 63.2) and 70% female patients (average age 53.9) were enrolled. Of these, 14 had diabetes, 3 had a history of surgery, and 6 had idiopathic Gp. The mean follow-up was 41 days (range 7–61 days). There was a significant decrease in the mean GERD HRQL score from 16.5 to 6.5 after G POEM with a P -value <0.0001 (95% level of significance) and a significant decrease in mean RSI score from 15.3 to 5.2 after G-POEM with P -value <0.0001 (95% level of significance). The proportion of use of PPI before GPOEM was 0.91, and the proportion of PPI use after GPOEM was 0.43 (P  = 0.0008). The mean GCSI pre- and post-GPOEM were 3.53 and 1.59, respectively. Eighteen had clinical success in Gp as defined by decreased mean GCSI score greater than 1. In this short-term outcome study, 87% of patients' GERD HRQL scores and RSI scores decreased after G-POEM. These findings indicate that GPOEM not only effectively reduces Gp symptoms but also improves GERD symptoms leading to decreased or more effective use of PPI in these patients. To our knowledge, this is the first study to comprehensively show G-POEM significantly improves GERD. Further studies with a larger patient population and long-term outcomes are needed. [ABSTRACT FROM AUTHOR]

This case report presents an 18-year-old female patient diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a rare congenital anomaly causing primary amenorrhea. MRI revealed vaginal agenesis and a left hemiuterus associated with hematosalpinx and cervical agenesis, while both ovaries were normal. The patient underwent successful neovagina creation using the McIndoe technique, involving a split-thickness skin graft from below the umbilicus. Postoperative follow-up showed excellent graft adherence and significant improvement in sexual function and quality of life. This case highlights the efficacy of the McIndoe technique for neovagina creation in MRKH syndrome and underscores the importance of a multidisciplinary approach in diagnosis and treatment, including psychological support. [ABSTRACT FROM AUTHOR]

Hip fractures are a serious health concern and a major contributor to healthcare resource utilisation. We aimed to investigate nationwide trends in the USA in patient characteristics and outcomes in patients after hip fracture repair surgery. From the Premier Healthcare dataset, we extracted patient encounters for surgical hip fracture repair from 2016 to 2021. Patient characteristics, comorbidities, complications, and anaesthetic and surgical details were analysed. Cochran–Armitage trend tests and simple linear regression were used to determine trends. We included 347 086 hip fracture repair encounters. Notable trends included the following: median patient age declined from 82 yr [interquartile range: 73–88 yr] to 81 yr [interquartile range: 73–88 yr], (P -value=0.002), the proportion of female patients decreased from 68% to 66.2% (P -value=0.019); internal fixation was the most common intervention initially, but with a declining percentage from 49.9% to 43.8% (P -value <0.001); in general, patients carried a greater comorbidity burden, with the proportion with three or more Elixhauser comorbidities increasing from 56.4% to 58.6% (P -value=0.006); general anaesthesia remained the most common anaesthetic technique, from 68.90% to 56.80% without a significant trend; per 1000 inpatient days, the most common complication remained acute renal failure; despite a higher comorbidity burden, no complication showed a statistically significant upward trend, and many showed downward trends. Over the 6-yr period from 2016 to 2021, a majority of hip fracture repairs continued to be performed under general anaesthesia but with that percentage declining over time. Notable trends included a lower percentage of female patients, an increase in femoral neck fractures, a higher comorbidity burden among patients, and a decrease in complications. [ABSTRACT FROM AUTHOR]

The esthetic problems inherent to peripheral (PFP) are frequent causes of complaint. Make-up is advocated as a form of therapy and can alleviate symptoms of depression. The aim of the present study was to collect data on make-up habits in female PFP patients and assess links with esthetic and/or functional complaints. Two questionnaires were drawn up to compare make-up habits in female PFP patients and women in the general population. The first was sent out between September and December 2019, to 39 House-Brackmann grade III PFP patients (group A), and the second on-line questionnaire was sent to a control population of 1385 women (group B). PFP patients used make-up more often than controls at weekends (χ2 = 16.38; P = 0.0009) and while at home (χ2 = 8.21; P = 0.042), and more often with foundation (χ2 = 17.21; P = 0.0006) and lip make-up (χ2 = 59.31; P < 0.0001). The greater their functional complaint, the less they made up their eyes. The greater their self-confidence and the more they felt attractive, the less they made up their lips. The differences in make-up use found in the present study aimed to mask facial palsy and were related to the esthetic complaint, impacting social life. [ABSTRACT FROM AUTHOR]

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Introduction: Literature shows differences in pain experiences between sexes. The exact influence of thermal liver ablation on experienced pain is still not well-known. This study aims to investigate the maximum pain intensity at the recovery between men and women after percutaneous thermal liver ablation. Methods: Patients treated with percutaneous thermal liver ablation (radiofrequency or microwave ablation) in Maastricht University Medical Center + between 2018 and 2022 for primary or secondary liver tumors were included retrospectively. Outcomes included maximum numerical rating scale (NRS, scale:0–10) score at the recovery room, prevalence of post-procedural pain (defined as NRS score ≥ 4), duration of anesthesia, length of stay at recovery, and complications. Regression analyses were adjusted for age, ASA-score, BMI, tumor type, maximum diameter of lesion, chronic pain in patients' history, and history of psychological disorder. Results: 183 patients were included of which 123 men (67%). Results showed higher average maximum NRS scores in women patients compared to men (mean:3.88 versus 2.73), but not after adjustments (aß:0.75, 95%CI:−0.13–1.64). Women suffered more from acute post-procedural pain (59% versus 35%; aOR:2.50, 95%CI:1.16–5.39), and needed analgesics more often at the recovery room (aOR:2.43, 95%CI:1.07–5.48) compared to men. NRS score at recovery arrival did not significantly differ (aß:0.37, 95%CI:-0.48–1.22). No differences were seen in the length of stay at the recovery, duration of anesthesia, procedure time, and complication rate. Location of the tumor (subcapsular or deep), total tumors per patient, and distinction between primary and secondary tumors had no influence on the NRS. Conclusion: This retrospective single-center study shows higher post-procedural pain rates after thermal liver ablation in women, resulting in higher analgesics use at the recovery room. The results suggest considering higher dosage of analgesics during thermal liver ablation in women to reduce post-procedural pain. Level of Evidence 3: Non-controlled retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: The objective of this study lies in identifying the dominant genotype of C. trachomatis isolated in Republic of Korea (ROK) between 2017 and 2018. Methods: A total of 504 clinical cervicovaginal swabs from patients were collected and inoculated on McCoy cell monolayers to isolate Chlamydial agents. C. trachomatis isolates were analyzed by sequencing of its ompA gene. Results: A total of 54 C. trachomatis isolates were obtained. The constructed phylogenetic tree revealed the genotypes of isolates are D/Ep6 (48, 88.89%), D/Ep6-like (5, 9.26%), and Ja (1, 1.85%). The C. trachomatis D/Ep6-like have one single nucleotide polymorphism (SNP) compared to C. trachomatis D/Ep6, leading to E870K amino acid change. Conclusions: Phylogenetic analysis demonstrated globally rare C. trachomatis D/Ep6 was dominant in the ROK from 2017 to 2018. Findings in this study act as a keystone, bridging past and present molecular epidemiology of C. trachomatis in context of ROK. [ABSTRACT FROM AUTHOR]

Objectives: Differences in clinicopathological characteristics of extensive-stage small cell lung cancer (ES-SCLC) patients may influence the immune response. This study aims to evaluate the heterogeneity of response to first-line chemoimmunotherapy between subgroups in ES-SCLC to screen out suitable populations. Materials and methods: We searched the PubMed, EMBASE, and Cochrane Library databases from inception to December 3, 2022 for randomized controlled trials (RCTs) of ES-SCLC chemoimmunotherapy. We also reviewed main conferences from January 1, 2021 to October 1, 2023. A trial-specific hazard ratio (HR) ratio for each subgroup was calculated, and these ratios were then pooled using the deft approach. Results: A total of 9 RCTs with 4099 patients were finally included. The pooled ratios were 0.92 (95% CI = 0.77 to 1.09) for OS-HRs and 0.79 (95% CI = 0.55 to 1.13) for PFS-HRs in women versus men. The pooled ratios of OS-HRs and PFSHRs in patients with positive versus negative PD-L1 expression were 1.26 (95% CI = 0.91 to 1.73) and 1.08 (95% CI = 0.77 to 1.52), respectively. The pooled ratios of OS-HRs and PFS-HRs in patients without versus with brain metastasis were 0.77 (95% CI = 0.59 to 1.01) and 0.71 (95% CI = 0.44 to 1.12). No statistically significant differences were also found in terms of subgroups for age, liver metastasis, smoking status, ECOG PS, LDH level, type of platinum salt and race. Conclusion: Women or patients with negative PD-L1 expression or with LDH ≤ ULN or without brain metastasis tend to benefit more from first-line chemoimmunotherapy in ES-SCLC. More trials are needed to prospectively validate the therapeutic heterogeneity among clinicopathological characteristics. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between overactive bladder syndrome (OAB) and the metabolic syndrome (MetS). Patients and Methods: A population‐based study was conducted to compare OAB patients with age‐, sex‐ and ethnicity‐matched control subjects regarding the prevalence of the parameters of the MetS, with respect to obesity, hyperlipidemia, hypertension and diabetes mellitus. The characteristics of the OAB population were assessed. Adjusted odds ratios (OR) were calculated by logistic regression. Results: 110 024 OAB patients and 220 455 controls. were identified. OAB was associated with a higher prevalence of MetS (35.4% vs. 27.5%, p < 0.001). The fully adjusted OR for MetS in patients with OAB compared to controls was 1.44; 95% confidence interval (CI) 1.42−1.46; p < 0.001. Among metabolic parameters, obesity was found to be the strongest factor associated with OAB (OR 1.55, 95% CI 1.53−1.58, p < 0.001), and higher high‐density lipoprotein cholesterole levels (>50) had a protective effect on the risk of OAB (OR 0.75, 95% CI 0.73−0.76, p < 0.001). Conclusions: Data from this cohort suggest that OAB is positively associated with MetS. Clinicians approaching patients with OAB should be aware of this association. A multimodal treatment focusing on the MetS may be considered in these patients. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal. The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. Methods: The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. Results: The WG outlined standardization in four major areas: (1) study design, (2) pretreatment demographics and characterization of the study population, (3) intraoperative events, and (4) posttreatment evaluation, and complications. Forty‐two items were evaluated and graded as: STANDARD—must be included; ADDITIONAL—may be included for a specific study and is inclusive of the Standard items; OPTIMAL—may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY—not relevant. Conclusions: A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long‐term outcomes for female patients undergoing surgery to correct SUI. [ABSTRACT FROM AUTHOR]

Desmoid tumors develop from musculoaponeurotic tissues. They are locally aggressive, but they cannot metastasize. In this case report, we evaluated a patient with a desmoid tumor and the approach to the tumor. A 28-year-old female patient presented with an abdominal mass. She underwent a partial nephrectomy operation on the same side as the mass. Computed tomography revealed a 65x70 mm solid mass on the left abdominal wall. The desmoid tumor was diagnosed by a tru-cut biopsy, the patient was operated on, and the mass was removed. No complications were observed. Desmoid tumors can be classified as extra-abdominal, abdominal, and intra-abdominal according to their location and may cause different symptoms according to their localization. Treatment options should be determined according to the increase in the size of the mass and the symptoms in the patient. [ABSTRACT FROM AUTHOR]

This study investigates predictors of unsatisfactory outcomes in female overactive bladder (OAB) patients treated with oral monotherapy by analyzing skin sympathetic nerve activity (SKNA) using a novel "neuECG" method. The study included 55 newly diagnosed female patients with idiopathic OAB, autonomic function was evaluated using neuECG before treatment initiation, and validated OAB questionnaires and urodynamic studies were administered. Initial monotherapy was administered for the first 4 weeks, with non‐responders defined as patients not achieving satisfactory symptom relief and requiring further treatment. Responders (n = 32) and non‐responders (n = 23) had no significant differences in baseline characteristics or urodynamic parameters; however, non‐responders exhibited significantly higher baseline average SKNA (aSKNA) (1.36 ± 0.49 vs. 0.97 ± 0.29 μV, p = 0.001), higher recovery aSKNA (1.28 ± 0.46 vs. 0.97 ± 0.35 μV, p = 0.007), and a lower stress/baseline ratio of aSKNA (1.05 ± 0.42 vs. 1.26 ± 0.26, p = 0.029). Baseline aSKNA had the highest predictive value for monotherapy refractoriness in OAB (AUROC = 0.759, p = 0.001), with an optimal cut‐off point of >1.032 μV. These findings suggest that elevated pre‐treatment aSKNA can predict resistance to oral monotherapy in OAB, warranting close monitoring and proactive treatment strategies for patients with high aSKNA. [ABSTRACT FROM AUTHOR]

Background: Fibrous dysplasia (FD) is a rare hereditary bone disorder, typically accompanied by a seemingly-high percentage of cystic changes in central nerve system tumors. This study aimed to investigate the associations between concurrent FD lesions and the cystic formation of vestibular schwannoma (VS). Methods: Patients with VSs in our institution from January 2020 to September 2022 were retrospectively included. Based on the contrasted MRI, VSs were grouped as the cystic and solid type. Concurrent FD was diagnosed based on the radiological findings. A logistic analysis was applied to investigate the relationship between concurrent FD and cystic VSs. The effect of the interaction between gender and concurrent FD on the cystic formation of VSs was further analyzed. Results: The current study included 1255 patients with VSs (681 females with a median age of 47 years). Of them, 142 (11.3%) were with cystic VSs. A higher percentage of cystic VSs was observed in female patients (P = 0.021), patients with concurrent FDs (P < 0.001) and those with a larger VS volume (P < 0.001). An increasing trend in percentage of cystic VSs was found among patients with from 0 to ≥ 3 FD lesions (P for trend as < 0.001). A multivariate logistic analysis identified concurrent FD (odds ratio, 6.58; 95%CI, 1.66–26.09; P = 0.007) and VS volume (odds ratio, 1.55; 95%CI, 1.66–1.70; P < 0.001) as independent risk factors related to the cystic formation. Conclusion: Concurrent FD is associated with a high incidence of cystic formation in VSs, which provides a new breakthrough point to investigate the underlying mechanism of cystic formation of VSs. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation Subcutaneous ocrelizumab is being developed to provide treatment flexibility and additional choice to patients with multiple sclerosis. OCARINA I (NCT03972306) is an open‐label, multicenter, Phase 1b, dose‐finding study to investigate the pharmacokinetics, safety, tolerability, and immunogenicity of subcutaneous ocrelizumab and to select a dose for the Phase 3 OCARINA II study (NCT05232825).Patients with relapsing or primary progressive multiple sclerosis (aged 18–65 years; Expanded Disability Status Scale score 0.0–6.5) were enrolled into two groups: previously treated with intravenous ocrelizumab (Group A) or naïve to ocrelizumab (Group B). Patients received single ascending doses of subcutaneous ocrelizumab up to 1200 mg. Following dose escalation, new patients in Group A were randomized (1:1) to receive a single 600 mg intravenous ocrelizumab dose or the candidate subcutaneous dose, which was predicted to result in similar exposure as the 600 mg intravenous dose while being safe and well tolerated. The area under the concentration–time curve for both formulations was used to select the subcutaneous ocrelizumab dose. Patients in all cohorts could enter a dose‐continuation phase.Eighty‐eight and 47 patients were enrolled into Group A and B, respectively; most patients were female (72.7%/63.0%), and mean age at baseline was 45.7 and 39.7 years, respectively. Subcutaneous ocrelizumab was well tolerated across all doses tested. The 920 mg subcutaneous ocrelizumab dose was selected for the OCARINA II study based on pharmacokinetic and safety data.Subcutaneous ocrelizumab may provide patients with multiple sclerosis with an additional treatment option. [ABSTRACT FROM AUTHOR]

Background: Anorectal malignant melanoma (ARMM) has an extremely poor prognosis, and there is no report of resection of liver metastases so far. We report herein a rare case of postoperative laparoscopic partial hepatic S7 resection for rectal malignant melanoma. Case presentation: A 51-year-old female patient with a diagnosis of an ARMM underwent a laparoscopic rectal amputation. Eleven months later, computed tomography (CT) revealed a 14-mm nodule in liver segment 7 (S7), which was diagnosed as a hepatic recurrence of the ARMM. Because no other recurrences were found, a laparoscopic partial resection of S7 was performed. Pathological analysis found intracellular melanin deposition, and immunostaining was S-100 (+), HMB-45 (+), and SOX-10 (+). Based on these findings, a liver metastasis of malignant melanoma was diagnosed. The patient is alive 7 months after the second surgery and has so far experienced no recurrences. Conclusion: We reported an extremely rare case of a laparoscopic resection of a liver metastasis following surgery for ARMM. [ABSTRACT FROM AUTHOR]

Background: The early detection of transthyretin cardiac amyloidosis (ATTR-CM) is essential, with Tc-99m pyrophosphate scintigraphy (PYP scan) being a key diagnostic tool. Although a previously validated score has shown promise in predicting PYP scan positivity among patients with HFpEF, further evaluation in diverse cohorts is necessary. Objectives: To assess the effectiveness of the ATTR-CM score in predicting PYP scan positivity within our patient population. Methods: We analyzed patients referred for PYP with SPECT at the Cleveland Clinic from January 2012 to January 2020, all of whom had undergone echocardiography within the previous year. The ATTR-CM score was determined using the following criteria: Age (60–69, +2; 70–79, +3; ≥80, +4), sex (male, +2), hypertension (present, −1), left ventricular ejection fraction (LVEF <60%, +1), posterior wall thickness (≥12 mm, +1), and relative wall thickness (>0.57, +2). A score of ≥6 indicated high risk. Results: Among the 540 patients (32% female, 33% black), 27% had an LVEF <40%. The score demonstrated good discrimination by AUC, with consistent performance across different racial groups, sexes, and LVEF categories. For scores ≥6, sensitivity was lower in women and black patients; however, lowering the cutoff to 5 markedly improved sensitivity. Conclusions: The ATTR-CM score displayed consistently good performance by AUC across our cohort, including patients with HFrEF. Nevertheless, its sensitivity was reduced in black patients and women. Efforts to scale ATTR-CM diagnosis tools should be mindful of demographic differences in risk prediction models. [ABSTRACT FROM AUTHOR]

Background: Anti‐NMDA receptor (A‐NMDAR) encephalitis is an autoimmune condition often associated with ovarian teratoma. Surgical removal of the teratoma is generally curative, and recurrence is uncommon. Case: A 14‐year‐old female presented with psychiatric symptoms and was ultimately diagnosed with A‐NMDAR encephalitis during a prolonged hospitalization. She was found to have bilateral ovarian teratomas, underwent laparoscopic bilateral ovarian cystectomy, and returned to neurologic baseline within 2 months. One year later, the patient was re‐presented with similar symptoms and was diagnosed with recurrent A‐NMDAR encephalitis. Initial imaging was negative for ovarian teratomas. After another prolonged hospitalization, repeat imaging ultimately demonstrated a suspected left ovarian teratoma. A left salpingo‐oophorectomy was performed, and the patient's condition again fully recovered. Conclusion: This case of A‐NMDAR encephalitis presented with many atypical features including neuropsychiatric presenting symptoms, bilateral teratomas, and severe recurrence of disease. While imaging is the recommended modality for investigation of etiology, no teratoma was identified on the second presentation, leading to an ethical and clinical conundrum in this adolescent patient. More research is needed to investigate other diagnostic methods for A‐NMDAR encephalitis without distinct teratoma on imaging in female patients. [ABSTRACT FROM AUTHOR]

Background: This case series presents five cases of adult atlantoaxial rotatory subluxation (AARS) following traumatic events, focusing on treatment strategies and long-term outcomes. Case presentation: This paper includes four Iranian male patients and one Iranian female patient with ages ranging from 25 to 46 years old. Each case involved unique presentations and management approaches. Initial conservative treatments, including skull traction and orthoses, were attempted, but surgical intervention became necessary due to inadequate response. Surgical fixation significantly improved functional status and alleviated symptoms in all patients, leading to long-term relief. Radiological assessments demonstrated successful outcomes post-surgery. Conclusions: This study underscores the importance of considering both conservative and surgical options in managing adult atlantoaxial rotatory subluxation to achieve optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to report the early outcomes of valvular heart surgeries performed via the right thoracotomy approach. While thoracotomy with femoro-femoral bypass is an established method for minimally invasive open-heart surgeries, thoracotomy with conventional cannulation is still being explored. In our center, we conducted 958 valvular heart surgery cases using the right anterolateral thoracotomy approach with central cannulation and data were analyzed. Methods: This is a retrospective observational study based on prospectively collected data from patients who underwent valvular heart surgery at our center spanning from April 2013 to April 2023. The data encompass demographics, procedures, operative techniques, post-operative morbidity, mortality, and a 1-month follow-up. Results: Our study revealed no procedure-related mortality. No patient required conversion to median sternotomy. Smooth cannulation and satisfactory exposure were achieved in all patients. The study encompassed a wide age range, from 14 to 68 years, with 618 female patients (64.5%) and 340 male patients (35.5%). The average cross-clamp time ranged from 38 to 90 min, the duration of cardio-pulmonary bypass ranged from 45 to 105 min, post-operative extubation ranged from 3 to 8 h, the average drain volume ranged from 100 to 350 ml, and the incision size ranged from 5 to 7 cm. Conclusions: Our data demonstrate that conventional cannulation via the right antero-lateral thoracotomy approach for valvular heart disease is a viable alternative to reduce the side effects associated with sternotomy and femoral cannulation. This procedure is safe, reproducible, and provides the same level of treatment quality. [ABSTRACT FROM AUTHOR]

Background: Intertrochanteric fractures are the most frequent fractures of the hip joint. This is attributed to the increase in the elderly population in our country, along with osteoporosis being prevalent in these populations. Aims and Objectives: The aim of the study is to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with "proximal femoral nail" (PFN). Materials and Methods: The prospective study was conducted on 48 cases of unstable intertrochanteric in Maharani Laxmi Bai Medical College, Jhansi, between June 2022 and December 2023. Results: In our study, the mean age of the patient is 36.16 and the most common age group is 41-60 years, 33.33%, and >60 years, 41.67%. In forty-eight cases, 37 (77.08%) were male patients, and 11 (22.92%) were female patients. The Harris hip score patients follow-up after 3 months 8 (16.67%) patients of excellent outcomes, 18 (37.50%) patients of good outcomes, 12 (25.00%) of fair outcomes, and 10 (20.83%) patients of poor outcomes. The Harris hip score patients follow-up after 6 months 24 (50%) patients of excellent outcomes, 20 (41.67%) patients of good outcomes, 2 (4.17%) of fair outcomes, and 2 (4.17%) patients of poor outcomes. Conclusion: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation, and early return to work. [ABSTRACT FROM AUTHOR]

Context Patients with primary aldosteronism (PA) have higher cardiac comorbidities including more pronounced left ventricular hypertrophy than patients with essential hypertension. Objective Autonomous cortisol cosecretion (ACS) is a common subtype in PA associated with a worse metabolic profile. Hypothesis Autonomous cortisol cosecretion may affect myocardial parameters and result in a worse cardiac outcome compared to patients with PA and without ACS. Methods Three hundred and sixty-seven patients with PA undergoing 1 mg dexamethasone suppression test (DST) and echocardiography at baseline from 2 centers of the German Conn's Registry were included. Follow-up for up to 3.8 years was available in 192 patients. Results Patients with PA and ACS had higher NT-proBNP levels at baseline compared to patients with PA without ACS (114 vs 75.6 pg/mL, P =.02), but showed no difference in echocardiography values. NT-proBNP levels showed a significant positive correlation (r = 0.141, P =.011) with cortisol levels after DST at baseline. In response to therapy of PA, NT-proBNP levels decreased, but remained significantly higher in patients with ACS compared to patients without ACS. At follow-up, left ventricle end-diastolic dimension (LVEDD) decreased significantly only in patients without ACS. Left atrial diameter (LAD) decreased significantly in patients without ACS and in female patients with ACS but not in male patients. Left ventricular mass index (LVMI) significantly improved in female patients without ACS but remained unchanged in female patients with ACS as well as in male patients at follow-up. Conclusions In patients with PA, concomitant ACS is associated with a worse cardiac profile and only partial recovery even years after initiation of targeted PA therapy. [ABSTRACT FROM AUTHOR]

To investigate the efficacy and safety of propofol combined with different doses of esketamine (ESK) for anesthesia during loop electrosurgical excision procedure (LEEP). Ninety female patients undergoing LEEP were randomly allocated to three groups: group P (2 mg/kg propofol + saline), group propofol + esketamine (PK)1 (1.5 mg/kg propofol + 0.5 mg/kg ESK), and group PK2 (1.5 mg/kg propofol + 0.25 mg/kg ESK). Parameters including mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SPO2), and venous carbon dioxide (PvCO2) were recorded. Additionally, the need for supplemental propofol, jaw thrust maneuver or ventilation, postoperative awakening time, and adverse reactions were assessed. After induction, there was a significant decrease in MAP and HR observed in group P, while an increase was noted in group PK1 (both p < 0.05), with no notable change in group PK2 (p > 0.05). By the 5-minute mark post-induction, group PK1 exhibited RR and PvCO2 levels similar to pre-induction levels (p > 0.05), whereas group PK2 demonstrated an increase in RR and a decrease in PvCO2 (p < 0.05). The occurrence of jaw thrust maneuvers in group PK1 and group P was higher than in group PK2 (p < 0.05). Moreover, fewer patients necessitated additional intraoperative propofol in groups PK1 and PK2 compared to group P (p < 0.05). The time to awakening was shorter in group PK2 than in groups PK1 and P (p < 0.05). Additionally, the frequency of postoperative vertigo was higher in group PK1 compared to groups P and PK2 (p < 0.05), the incidence of nausea did not significantly differ among the three groups (p > 0.05). Notably, neither irritation nor delirium was reported in any of the three groups. This study suggested that propofol combined with low-dose esketamine characterized minimal disruption to circulatory and respiratory parameters, reduced occurrences of adverse reactions, and faster postoperative awakening. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objective of this study was to investigate whether there are differences between brain natriuretic peptide (BNP) levels and computed tomography pulmonary angiography (CTPA) parameters, in patients with acute PE, with respect of sex. BACKGROUND: Acute pulmonary embolism (PE) may provoke sudden right ventricle overload and stretching of their thin walls, causing significant raise of BNP blood levels, which correlates to acute PE severity. The properties of RV are different between sexes. METHODS: This retrospective analysis was gained from the data of 1612 PE patients from the regional PE register. The patients have had CTPA verification of PE, with described localization of thrombus masses, as well as the ratio between RV and left ventricle (RV/LV), and BNP as biomarker, measured during the first 24 hours upon admission. RESULTS: Out of 96 male patients with detected central thrombus, 75.0% patients had an increase in BNP level compared to 25.0% patients with normal BNP value (p<0.001). Of the 94 female patients with central thrombus, 85.1% patients had an elevated BNP level, compared to 14.9% patients, with BNP normal values (p<0.001). Of the 135 male patients with RV/LV>1, 79.3% of them, had elevated BNP, compared to 20.7% patients whose BNP level was normal (p<0.001). Out of 123 female patients with RV/LV>1, 91.1% patients had elevated BNP compared to 8.9%, whose BNP was normal (p<0.001). CONCLUSION: Elevated BNP blood level correlates with CTPA parameters, such as the presence of central thrombus and the ratio between right and left ventricles greater than 1, in patients with acute PE, regardless of sex [ABSTRACT FROM AUTHOR]

Background: In the literature, female anorgasmia (AO) is closely related to obsessive–compulsive disorder (OCD), but no publication has explored the role of individual obsessive traits that may also be typical of other disorders, assuming that repetitive thoughts and compulsions must necessarily correspond to an obsessive-type neurotic profile. It is worth investigating and assessing the specific weight of other morbid conditions involved, beyond OCD. Materials and Methods: This study was conducted during 2022–2023 by selecting 208 Italian clinical patients from private databases. They submitted to individual clinical interviews and two psychometric questionnaires (Perrotta Integrative Clinical Interviews 3, PICI-3-TA, and Perrotta Individual Sexual Matrix Questionnaire, PSM-Q). Results: Among the 208 patients (M: 39.05 years), divided into subgroups by age and obsessive symptomatology, no significant differences were found between the subgroups in the comparisons of the data obtained from the administration of the PSM-Q. Conclusions: This study confirms that it is not OCD that correlates with OA but obsessive traits, which are also common to other psychopathological disorders, such as bipolar disorder, borderline disorder, manic, and psychotic disorders and, therefore, in psychotherapy, it is necessary to intervene with a clinical approach that has in mind the patient's psychopathological personality picture and the causes that originated or reinforced OA. [ABSTRACT FROM AUTHOR]

Objective: Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features. Methods: Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre‐ and post‐treatment VHI‐10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality. Results: One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty‐five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty‐five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI‐10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post‐treatment, (p <.001). 57/111 patients reported high voice demand professions or recreational activities. The average self‐reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in‐office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%). Conclusions: In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs. Level of evidence: Level 3: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence (AI) into academic publishing has raised concerns about AI-generated anomalies in scholarly articles, highlighting the need for enhanced editorial scrutiny to maintain research integrity. Current methodologies for detecting AI-generated content are insufficient, necessitating the development of more robust detection technologies. Academic journals are urged to implement rigorous editorial standards, provide comprehensive training for reviewers and editors, and adopt advanced AI detection tools to uphold the quality of scholarly publications. The challenges posed by AI in scholarly publishing require comprehensive training, specialized software tools for AI detection, regular policy review, ethics and transparency in AI usage, scholarly dialogue, and collaboration between academia and the tech industry to ensure the integrity and reliability of academic outputs. [Extracted from the article]

Background: Female pattern hair loss (FPHL) is women's most common form of alopecia. The study aimed to evaluate the efficacy of extracorporeal shock waves for hair growth and regeneration in women with FPHL. Methods: A prospective single‐center noncontrolled study was conducted in patients with FPHL who underwent eight treatment sessions with C‐Actor, a shock wave applicator. Outcome measures included total hair count, number of follicular units (FUs)—single FUs, double FUs, triple and bigger FUs—the average thickness, cumulative hair thickness, and changes in the Derived Sinclair scale, assessed with Tricholab (Fotofinder System). Patients completed a survey to assess their subjective perceptions of hair improvement regarding softness, hair loss, quality, and volume. Results: Twenty women were included with a mean age of 43 (SD = 5.65). The mean increase in total hair count was 8.9% (p < 0.00001), in number of FUs 4.6% (p = 0.00031), in number of triple and bigger FUs 18.4% (p = 0.0004), in cumulative hair thickness 8.0% (p < 0.00001), with a decrease of 5.7% in mean Derived Sinclair scale value by 2.2–2.1 (p < 0.0001). After 3 months, 85% of patients perceived improvement in hair volume. Conclusion: Extracorporeal shock waves for hair growth and capillary regeneration in women with FPHL showed statistically significant outcomes, and all patients reported an improvement in hair characteristics. [ABSTRACT FROM AUTHOR]

Introduction: spinal anaesthesia has emerged as a most popular technique for abdominal and lower abdominal surgeries for its safety, simplicity and effectivity. Adding adjuvants drugs to intrathecal local anaesthetics improves quality and duration of spinal blockade, and prolongs postoperative analgesia. Intrathecal dexmedetomidine with low-dose bupivacaine provides faster onset, prolonged sensory and motor block and reduced rescue analgesic requirement in patient undergoing TURP. Aims and objectives: To assess the Onset of sensory analgesia, onset of motor block, fixation time of sensory block, highest level of sensory block, quality of analgesia. Material and methods: This Prospective - Randomized study was conducted in the Anaesthesia Anaesthesia Department in Government Medical College, Nagpur from December 2018 to November 2020. 60 adult female patients between the age of 18 and 60 years participated in the study. The samples were equally divided into 2 groups, Group D-Case group-30 patients and Group B-Control group-30 patients. Intravenous cannula of 18/20 G was secured and patient was preloaded with 10ml/kg of Ringer lactate solution over 10-30 minutes. Baseline vital signs such blood pressure, pulse rate were recorded. Result: Maximum number of patients in group D and group B i. e 100% and 60% respectively had an excellent quality of analgesia during the procedure. Quality of analgesia was reported as satisfactory in 30% of patients and poor in 10% patients in group B. Quality of analgesia was found to be comparable in the two groups (p= 0.001). Thus, addition of dexmedetomidine only marginally improved quality of surgical analgesia in our study. Conclusion: Intrathecal inj. Dexmedetomidine 5mcg acts synergistically to potentiate intrathecal local anaesthetic bupivacaine with the result that there is relatively faster onset of sensory block and prolongation of both sensory and motor block. [ABSTRACT FROM AUTHOR]

Background Prior studies showed that female patients with chronic rhinosinusitis (CRS) suffer a worse disease-specific quality of life (QoL). Goal The aim of this study is to investigate gender differences in sinonasal QoL outcomes in patients requiring endoscopic endonasal skull base surgeries (EESBS). Methods Cross-sectional analysis of patients presenting to our clinic from August 2020 to December 2022 with skull base tumors, spontaneous cerebrospinal fluid (CSF) rhinorrhea, or Grave's orbitopathy (for orbital decompression) was performed. Baseline and postsurgical QoL were measured using the 22-item Sinonasal Outcome Test (SNOT-22). Patients' demographics and comorbidities were reviewed. Patients with concomitant CRS were excluded. Results Eighty-six patients were included (54 with skull base tumors, 17 Grave's orbitopathy, and 15 spontaneous CSF rhinorrhea). The mean age of the patients was 52 years (range: 12.4–81.5 years), and 51.6% of the patients were females. There was no age difference between female and male patients. Smoking history, asthma, and allergic rhinitis were also similar between the two groups. Female patients had a significantly higher incidence of depression (58.3 vs. 32.4%, p = 0.018) and migraine (50.0 vs. 21.6%, p = 0.007). Female patients had a significantly worse overall SNOT-22 scores at baseline (33.6 vs. 18.2, p = 0.001), at the 3-month follow-up (29.7 vs. 15.5, p = 0.002), and at the 6-month follow-up (33.5 vs. 14.9, p = 0.005). This worse QoL was seen mainly in the ear/facial, sleep, and psychological domains. Linear regression of the SNOT-22 scores and its subdomains adjusting for comorbidities showed that migraine was found to be the most significant determinant of gender differences in the QoL. Conclusion Female patients who undergo EESBS show higher overall SNOT-22 scores secondary to higher incidence of migraine. [ABSTRACT FROM AUTHOR]

The success of spine surgery is variable among patients. Finding reliable predictors of successful outcomes will not only maximize patient benefit, but also increase the cost effectiveness of surgery. Recent research has demonstrated the importance of patient specific factors in predicting patient outcomes, including gender. While many studies show that female patients present with worse pain and function preoperatively, there is conflicting data on whether male and female patients reap the same benefits from lumbar spine surgery. In this manuscript we review the current research on gender and sex differences in preoperative characteristics and post-operative outcomes and comment on the need for more studies to better elucidate the mechanism driving the conflicting evidence. [ABSTRACT FROM AUTHOR]

Background: One of these methods in the thread lifting approach is polydiaxonone(PDO)threads. They are thin, non-barbed polymerized threads with a diameter of 0.07 to 0.15 mm. They can be unidirectional or bidirectional and they possess higher strength and flexibility compared to other thread types. This study aimed to evaluate the efficacy and safety of polydioxonone thread lifting in lower face (marionette line) rejuvenation. Methods: This study is single non-blinded study, included thirty female patients their ages ranged from 32 to 60 years seeking for lower face rejuvenation attending to the outpatient clinic of Plastic surgery Department, Zagazig University Hospitals in the period between September 2023 till March 2024. Patients were treated with three PDO threads on each side of their lower face while all patients were followed up in the first week, one, three and six months after the procedure. Results: Average scale before the procedure according to the validated grading scale was from 2 to 5 with a mean of 3.37±0.76 and a median 3.50(2.75-4.0). The validated scale range changed to 1 to 3 with a mean of 1.70±0.82 and a median of 1.50(3.0-4.0) immediately following therapy. The global aesthetic improvement scale in group patient, ranged from 20-90% with a mean of 46.33±18.92 and a median 40(20.0-75). There was 10% improvement in three patients, 50% improvement in fifteen patients, 30% improvement in nine patients, and an excellent 10% improvement in three patients. Conclusions: Polydiaxonone threads are simple, quick, and successful office technique operation. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study was to examine sex-related differences in the outcomes of polytraumatized patients admitted to a level I trauma center. Methods: This was a retrospective data analysis of 980 consecutive polytraumatized patients admitted to a single level I trauma center between January 1995 and December 2020. Results: Among all patients, about 30% were female, with a significantly higher age and significantly higher rates of suicidal attempts. No sex-related differences regarding injury severity or trauma mechanisms could be seen, but female patients had significantly higher overall in-hospital mortality rates compared to male patients. Even in the elderly group of patients, elderly female patients were significantly older compared to elderly male patients, with significantly increased lengths of hospital stay. In the elderly group of patients, no sex-related differences regarding injury severity, trauma mechanisms or mortality could be detected. Multivariate analysis revealed suicidal attempt, severe head injury and age > 54 years as independent prognostic factors in the survival of polytraumatized patients. Conclusions: Distinctive sex-related differences can be found, with female polytraumatized patients being significantly older and having higher overall mortality rates with significantly increased LOS. Our study suggests a strong sex-independent influence of age, suicidal attempt and severe head injury on the outcomes of polytraumatized patients. [ABSTRACT FROM AUTHOR]

Background: The increasing popularity of non-surgical cosmetic enhancements for the lower face and perioral area, particularly through hyaluronic acid (HA) fillers, reflects the growing desire for improved lip volume and definition. This study showcases the effects of a specific HA filler on lip fullness, shape, and overall perioral rejuvenation. Methods: We conducted a retrospective single-site observational analysis of adult female patients treated with Genefill Soft Fill HA injections in the lips and perioral areas. Both patient and physician satisfaction were evaluated using the Likert scale and Global Aesthetic Improvement Scale (GAIS), respectively. The outcomes for natural appearance, volume, and durability were assessed using a five-point scale. The patients were followed up with for up to six months to monitor any adverse events. Results: The cohort included thirteen female patients with an average age of 55.3 ± 8.3 years. Approximately 1.2 ± 0.4 mL of filler was used per patient. The results indicate high satisfaction, with scores above 4 for naturalness, volume, and durability. Over 92% of patients reported a significant improvement in appearance. No moderate or severe adverse events were reported. Conclusions: Genefill Soft Fill HA filler is both effective and safe for enhancing lip esthetics, with high satisfaction rates among recipients and no significant adverse events observed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the correlation between background parenchymal enhancement (BPE) and various patient-related and technical factors in recombined contrast-enhanced spectral mammography (CESM) images. Material and Methods: We assessed CESM images from 62 female patients who underwent CESM between May 2017 and October 2019, focusing on factors influencing BPE. A total of 235 images, all acquired using the same mammography machine, were analyzed. A region of interest (ROI) with a standard size of 0.75 to 1 cm2 was used to evaluate the minimal, maximal, and average pixel intensity enhancement. Additionally, the images were qualitatively assessed on a scale from 1 (minimal BPE) to 4 (marked BPE). We examined correlations with body mass index (BMI), age, hematocrit, hemoglobin levels, cardiovascular conditions, and the amount of pressure applied during the examination. Results: Our study identified a significant correlation between the amount of pressure applied during the examination and the BPE (Spearman's ρ = 0.546). Additionally, a significant but weak correlation was observed between BPE and BMI (Spearman's ρ = 0.421). No significant associations were found between BPE and menopausal status, cardiovascular preconditions, hematocrit, hemoglobin levels, breast density, or age. Conclusions: Patient-related and procedural factors significantly influence BPE in CESM images. Specifically, increased applied pressure and BMI are associated with higher BPE. [ABSTRACT FROM AUTHOR]

Histoplasma capsulatum (H. capsulatum) is considered to be one of the most extensively spread dysmorphic fungi worldwide. Histoplasmosis primarily impacts patients with weakened immune systems and can result in a diverse range of clinical manifestations. In immunocompetent patients, the disease may manifest as a self-limiting or asymptomatic infection; however, in immunocompromised individuals, it can occur as a debilitating, disseminated disease. Diagnosing histoplasmosis may be challenging. A medical professional that specializes in treating endemic fungal illnesses is better able to assist with an accurate and timely diagnosis since they have a deeper grasp of these illnesses. Consequently, the process of diagnosing histoplasmosis might be difficult for less experienced physicians. The case presented is an example of the myriad faces that histoplasmosis can take on, mimicking other common infectious or malignant conditions, leading to extensive work-up and invasive procedures in establishing the diagnosis of this otherwise benign condition. We hereby report the case of disseminated histoplasmosis in a young immunocompetent female patient. [ABSTRACT FROM AUTHOR]

Purpose: We investigated personality traits and symptoms of anxiety and depression in patients with primary vitreous floaters. Methods: A U.K. sample of adult patients (> 18 years old) with vitreous floaters of a minimum of three months severe enough to seek a consultation was assessed for personality traits (The Big Five Inventory (BFI)), symptoms of depression (Patient Health Questionnaire-9), and symptoms of anxiety (Generalized Anxiety Disorder Questionnaire-7). Results: 149 patients participated in the study. Compared to the general population, our sample had a significantly increased score in the domain of BFI-neuroticism (3.27 vs 2.97, ρ < 0.0001, d = 0.38) and reduced score in the domain of extraversion (2.97 vs 3.24, ρ < 0.0001, d = 0.33). Female patients scored significantly higher than male patients on BFI-neuroticism (ρ = 0.01), and on BFI-agreeableness (ρ = 0.01). Age was positively correlated with BFI-Conscientiousness (r = 0.19, ρ = 0.02) and with BFI-Agreeableness (r = 0.20, ρ = 0.01). 36% of our sample had moderate to severe symptoms of depression, and 43% had moderate to severe symptoms of anxiety. Conclusions: Our study highlights the underlying psychological traits of patients with severe vitreous floaters and particular mental health needs that deserve further consideration by ophthalmological and vision science clinicians. [ABSTRACT FROM AUTHOR]

Background: In recent years, clinicians often encounter patients with multiple pulmonary nodules in their clinical practices. As most of these ground glass nodules (GGNs) are small in volume and show no spicule sign, it is difficult to use Mayo Clinic Model to make early diagnosis of lung cancer accurately, especially in large numbers of nonsmoking women who have no tumor history. Other clinical models are disadvantaged by a relatively high false-positive or false-negative rate. Therefore, there is an urgent need to establish a new model of predicting malignancy or benignity of pulmonary GGNs for the sake of making accurate and early diagnosis of lung cancer. Methods: Included in this study were GGNs surgically resected from patients who were admitted to Yiwu Central Hospital from January 2018 to March 2024, including both male and female patients, there is no gender specific issue. The nature of all these GGN tissues was confirmed pathologically. The case data were statistically analyzed to establish a mathematical prediction model, the prediction performance of which was verified by the pathological results. Results: Altogether 261 GGN patients met the inclusion criteria. Using the results of logistic regression analysis, a mathematical prediction equation was established as follows: Malignant probability (mP) = ex/ (1 + ex); when mP was > 0.5, the GGN was considered as malignant, and when mP was ≤ 0.5, it was considered as benign. x= -2.46 + 1.032*gender + 1.85*mGGN + 1.40*VCS-0.0027*mean CT value of the nodule + 0.078*maximum diameter of the nodule, where e represents the natural logarithm; if the patient was a female, gender = 1 (otherwise = 0); if the pulmonary nodule was a mixed GGN, mGGN = 1 (otherwise = 0); if the pulmonary nodule had vascular convergence sign, VCS = 1 (otherwise = 0). The prediction performance of the mathematical prediction model was verified as follows: the negative prediction value was 0.97156 and the positive prediction value was 0.3800 in the model group versus 1 and 0.25 in the verification group. Conclusion: In this study, we identified female gender, mGGN, VCS, mean CT value and maximum nodule diameter as five key factors for predicting malignancy or benignity of pulmonary nodules, based on which we established a mathematical prediction model. This novel innovation may provide a useful auxiliary tool for predicting malignancy and benignity of pulmonary nodules, especially in women patients. [ABSTRACT FROM AUTHOR]

It is exceptionally unusual to see oral malignant melanoma, which is highly aggressive with dismal prognosis. A 61-year-old female patient presented with hyperpigmented and hemorrhagic areas in the anterior mandible. Microscopically, positive Immunohistochemistry staining with monoclonal antibody Human Melanoma Black (HMB45) and S100 protein, confirmed the diagnosis as malignant melanoma. [ABSTRACT FROM AUTHOR]