Citations

ABSTRACT Background and Objectives The relevance of Cochrane systematic reviews depends on timely completion and updates. This study aimed to empirically assess the lifecycles of Cochrane reviews published from 2003 to 2024, including transitions from protocol to review, update patterns, and withdrawals. Methods We extracted data from Cochrane Library publications between 2003 and 2024. Each review topic was identified using a unique six‐digit DOI‐based ID. We recorded protocol publication, review publication, updates, and withdrawals (i.e., removed from the Cochrane Library for editorial or procedural reasons), calculating time intervals between stages and conducting subgroup analyses by review type. Results Of 8137 protocols, 71.9% progressed to reviews (median 25.7 months), 2.4% were updated during the protocol stage, and 10.0% were withdrawn. Among 8477 reviews, 64.3% were never updated by the time of our analysis; for those updated at least once, the median interval between updates was 57.2 months. Withdrawal occurred in 2.5% of reviews (median 67.6 months post‐publication). Subgroup analyses showed variation across review types; diagnostic and qualitative reviews tended to have longer protocol‐to‐review times than other types of reviews. Conclusions Cochrane reviews show long development and update intervals, with variation by review type. Greater use of automation and targeted support may improve review efficiency and timeliness.

Abstract The combination of enfortumab vedotin and pembrolizumab (EVP) has recently revolutionized care for patients with previously untreated locally advanced and metastatic urothelial carcinoma. However, predictive biomarkers of response, the optimal duration of EVP for patients who respond well to therapy, and the role of circulating tumor DNA to monitor treatment response have not yet been fully elucidated. In this molecular tumor board, we summarize 6 patients from 4 different academic institutions with unresectable or oligometastatic urothelial carcinoma who achieved long-term remission on surveillance after a short duration of EVP treatment that resulted in complete response on follow-up imaging followed by consolidative radical cystectomy. We discuss potential predictive biomarkers for patients with exceptional response to EVP. These findings highlight the need to determine an optimal duration of EVP to maximize efficacy while minimizing adverse events. We aim to further define and explore the value of local therapy with consolidative cystectomy in the setting of unresectable, locally advanced, oligometastatic disease, or those with metastatic disease who achieve complete response of disease outside of the bladder. Identifying this subset of patients who may be candidates for this type of multidisciplinary management may result in durable treatment-free remission.

Seronegative neuromyelitis optica spectrum disorder (NMOSD) is a diagnostic challenge. This study aimed to characterize misapplication of the 2015 international criteria for seronegative NMOSD. We reviewed 35 consecutive seronegative NMOSD referrals to a tertiary center. Two (6%) met formal criteria, and 2 (6%) were clinically suspected of NMOSD without fulfilling radiologic supportive criteria. Alternative diagnoses were common including multiple sclerosis (37%), optic neuritis (14%), functional neurologic disorder (11%), and other (38%). Immunosuppression with rituximab was used in 3 of 4 patients with functional neurologic disorder. Misapplication of the 2015 criteria is common, and alternative explanations in seronegative NMOSD patients should be strongly considered.

AbstractIntroductionThis study evaluates the feasibility of utilizing a commercial‐grade 3D LiDAR/RGB camera, combined with 3D reconstruction software, to create an accurate and hyper‐realistic digital model of a proton therapy treatment room. This reconstructed model aims to enhance collision avoidance strategies and improve 3D machine model accessibility. Utilization of a 3D LiDAR/RGB camera as a radiotherapy environment modeling has not been reported prior.MethodsTo create a comprehensive 3D model of a half‐gantry proton therapy system, colored point cloud data was captured using the Matterport Pro 3 camera, a hybrid LiDAR and RGB imaging system with high‐resolution capabilities (134.2 MP), a 360° horizontal field of view, and 20 mm accuracy at 10 m. A total of 117 acquisition points, distributed across the treatment room with three camera heights, ensured complete coverage and minimal occlusions. Scanning, completed in under 3 hours, was monitored in real time using the Matterport App. Post‐scan processing involved denoising and converting the point cloud into 3D mesh structures using MeshLab, followed by refined pair‐wise iterative closest point (ICP) alignments. Textures and materials were assigned to reflect real‐world objects, and a ray‐tracing engine simulated realistic lighting in Blender. Animations illustrating the kinematics of the treatment couch and gantry were simulated in Blender for enhanced visualization.ResultsThe scanning process achieved complete data capture without missing information, attributed to strategic oversampling during data acquisition. The mean root mean square error (RMSE) of the ICP registration was 0.008 m. The validation process confirmed that the dimensions of the treatment couch within the digital model closely matched the actual measurements with less than 2 cm deviation, indicating high accuracy. The resulting digital twin provided a photorealistic and immersive representation of the proton therapy treatment room, serving as a valuable digital asset for various applications.ConclusionIt is possible to generate vendor‐independent and highly accurate 3D models of the proton treatment room environment with a commercial grade LiDAR/RGB camera to expand future research opportunities and education endeavors.

Background: Treatment decisions in patients with anterior cruciate ligament (ACL) injuries are influenced by multiple factors, such as the desire to return to sports or symptomatic instability. Identifying the differential treatment effect of ACL reconstruction (ACLR) compared with nonoperative management on a patient-specific level can inform surgical decision-making. Hypothesis: Unsupervised machine learning can identify distinct patient subgroups based on outcome achievement after ACL injury, and ACLR will exert a protective effect on the development of posttraumatic osteoarthritis (PTOA) over nonoperative management. Study Design: Cohort study; Level of evidence, 3. Methods: A longitudinal populational registry identified patients with ACL injuries from 1990 to 2016 with a minimum 7.5-year follow-up. An unsupervised random forest algorithm was utilized to develop and validate patient subgroups. Treatment effects of ACLR on outcomes were analyzed using a machine learning causal inference estimator. Patient subgroup membership was incorporated into a multivariable logistic regression to identify factors predictive of optimal outcomes. Results: A total of 923 patients (785 primary ACLR, 138 nonoperative) were included. The random forest algorithm arrived at an optimal partition of 2 subgroups, with 653 patients in the optimal outcome subgroup (368 male [56.4%]; mean age, 26.0 ± 10.2 years; mean body mass index [BMI], 26.5 ± 4.30) and 270 patients in the suboptimal outcome subgroup (152 male [56.3%]; mean age, 35.0 ± 10.1 years; mean BMI, 30.5 ± 5.54). The latter group demonstrated significantly increased rates of secondary meniscal injury, development of symptomatic PTOA, and progression to total knee arthroplasty (TKA) at the final follow-up (all P < .01). In the optimal outcome subgroup, ACLR had significantly protective treatment effects on the risk of secondary meniscal injury (average treatment effect [ATE], 61%), contralateral ACL injury (ATE, 8%), symptomatic PTOA (ATE, 16%), and progression to TKA (ATE, 6%) (all P < .01). Conversely, in the suboptimal outcome subgroup, ACLR only protected against symptomatic PTOA (ATE, 11%) and progression to TKA (ATE, 8%) (both P < .01). Conclusion: Two clinically meaningful subgroups were identified from retrospectively collected data and found to experience differential treatment responses after ACL injuries. ACLR decreased the rate of development of PTOA and TKA in both subgroups but was not as effective in preventing secondary meniscal injuries or contralateral ACL injuries in patients who were older, heavier, or had concomitant medial meniscus injuries.

Abstract Changes in the clinical symptoms of acute graft-versus-host disease (GVHD) are currently used to assess treatment responses. The Mount Sinai Acute GVHD International Consortium (MAGIC) consortium has recently revealed that the integration of serum biomarkers with clinical symptoms at the onset of treatment in a MAGIC composite score (MCS) more accurately predicts treatment response and 6-month nonrelapse mortality (NRM) than clinical symptoms alone. In this study, we evaluated whether the integration of serum biomarkers and clinical symptoms on day 28 (D28) would also better predict NRM than clinical response only (CRO). We analyzed data from 1135 patients receiving systemic treatment for acute GVHD and created a fourth MCS category for patients with complete resolution of symptoms and low-risk clinical biomarkers on D28. Using a classification and regression tree model with 6-month NRM as the end point, we identified status of MCS 0 or MCS 1 at D28 as responses, which we termed the MAGIC composite response (MCR). In the validation cohort (n = 309), MCR more accurately predicted 6-month NRM than CRO (area under the curve: 0.77 vs 0.69; P = .014) and demonstrated higher negative and positive predictive values. MCR correctly reclassified both clinical nonresponders and responders: 28 of 213 clinical responders (13%) became nonresponders with fivefold higher NRM (34.3% vs 6.8%, P &lt; .001) and a larger group (29/96, 30%) of clinical nonresponders became responders with sixfold lower NRM (7.6% vs 50.7%, P &lt; .001). These findings support the use of MCR as a superior surrogate end point for long-term GVHD control and survival in future clinical trials.

» Affordable Care Act Medicaid expansion increased orthopaedic surgery access and utilization among Medicaid patients, including for racial and ethnic minorities. » Despite improved coverage, Medicaid patients continue to face significant real-world barriers to orthopaedic care, including lower appointment success and longer wait times compared with privately insured patients. » Evidence on cost and quality impacts remains limited, with early signals of increased reimbursements, higher charges, and some quality improvements postexpansion.