Citations

ABSTRACT Background Feeding is an important health consideration for children with Down syndrome due to their increased risks for feeding challenges and overweight/obesity. Healthcare providers play an important role in providing feeding guidance to families; however, there is limited research on feeding children with Down syndrome and the role of healthcare providers. The purpose of this study is to explore how interactions with healthcare providers contribute to mothers' experiences feeding their children with Down syndrome. Methods In this qualitative study, 29 mothers of children with Down syndrome aged 3–10 years completed semi‐structured interviews. Results Three themes were identified: (1) Access, provider expertise and maternal concerns, (2) Infant feeding experiences matter and (3) Mothers are experts on and advocates for their children. Conclusion Gaps in care were identified for children with Down syndrome and their families. Findings have implications for clinical practice and research related to feeding children with Down syndrome.

ABSTRACT Importance Despite the current enthusiasm for anti‐obesity medications, there is a critical need for effective lifestyle interventions that can be broadly implemented. Objective To assess the effectiveness of REWIND, an obesity and diabetes treatment program. Design Prospective cohort study. Setting Virtual, community‐based weight management program. Participants Two‐hundred and nineteen participants, BMI ≥ 30 kg/m 2 , with and without type 2 diabetes (T2D). Intervention Three phases: “induction” with meal replacement diet to promote ≥ 15% weight loss; “transition” to everyday foods; and “maintenance” to prevent weight regain. REWIND leveraged teams including community leaders, media personalities, nationally recognized athletes and participants, to disseminate information, and foster belonging, commitment, and resilience. Main Outcomes The co‐primary outcomes were the change in weight at 6‐, 12‐, and 18 months. Secondary outcomes were the proportion of patients achieving ≥ 5%, 10%, 15%, and 20% weight loss at 6, 12, and 18 months, and remission rates in T2D at 6‐, 12‐, and 18‐month, respectively. Results Two hundred and nineteen participants (mean age 49.1 [SD 10.5] years), 37% men, 12% Black, 26% with T2D. Weight decreased from: 114.4 (20.8) kg to 96.1 (18.4) kg at 6 months, to 98.5 (18.1) kg at 12 months, and to 101.1 (20.5) kg at 18 months. Weight loss percentages at 6, 12, and 18 months were ≥ 5%: 95%, 91%, 84%; ≥ 10%: 79%, 72%, 67%; ≥ 15%: 58%, 46%, 47%; and ≥ 20%: 24%, 25%, 22%. Diabetes remission was achieved by 52% and 43% of participants with T2D at 12‐ and 18‐month, respectively. Limitations Single geographic region. Weight was self‐reported. Conclusion A virtual community‐based program for individuals with obesity and T2D facilitated substantial weight loss and T2D remission. This model has the potential for wide‐scale implementation in diverse settings.

ABSTRACT Introduction The American Association of Endocrine Surgeons (AAES) drafted Entrustable Professional Activities (EPAs) for Endocrine Surgery (ES) to assess general surgery residents and ES fellows in core topics. Here, we examine learner and teacher concordance of entrustability ratings. Methods Fourteen EPAs were defined (10 “core”–6 with pre‐, intra‐, and post‐operative phases, four single‐phase–and four elective EPAs). Ten institutions collected three‐item micro‐assessments (MAs) of learner EPA performance using a web‐based platform, where entrustment was assessed on observable behaviors using a five‐point scale. Learner provided self‐assessment ratings, while teachers separately assigned ratings for the same activities. Spearman rank correlation tests were applied to compare learner‐teacher ratings for EPAs. Results MAs ( n = 698) were submitted between 7/2022‐9/2023. Programs submitted between 3 and 468 MAs. Among 3‐phase core EPAs, the intraoperative phase was most assessed ( n = 496), followed by pre‐ and post‐operative phases ( n = 108 and 55, respectively). Thirty‐nine single‐phase EPAs were submitted. Learner self‐assessment and teacher ratings were equivalent for 32% of pre‐operative EPAs, 53% of intra‐operative EPAs, 29% of post‐operative EPAs, and 64% of single phase of care EPAs. Spearman rank correlation between teacher and learner ratings for all phases of care combined was 0.66. Correlation was highest for the intra‐operative phase (0.73), followed by single‐phase (0.65), pre‐operative phase (0.27), and post‐operative phase (0.20). Rating concordance did not differ when high and low scores were examined independently. Learners were more prone to underestimate performance than to overestimate it when ratings were discordant. Conclusions Learners' self‐assessment and teacher ratings of endocrine surgery EPAs are strongly concordant with operative technical skills. However, learners often underestimate their performance of pre‐ and post‐operative care compared to faculty ratings when using EPAs.

AimsPeriacetabular osteotomy (PAO) is a complex procedure for treating hip dysplasia by reorienting the acetabulum to slow osteoarthritis progression. This study aimed to assess the types and rates of complications after PAO and provide recommendations for prevention.MethodsA total of 715 consecutive patients underwent unilateral PAO by a single surgeon between December 2006 and January 2024, with at least one year of follow-up. Indications included hip dysplasia, acetabular retroversion, and protrusio. Hip arthroscopy was performed concurrently in 325 cases. Demographic factors, perioperative data, and complications – graded using the modified Clavien-Dindo system – were analyzed. Risk factors and learning curves were also assessed.ResultsOf the 715 patients, 121 (16.6%) experienced 144 complications. There were 68 grade I, 52 grade II, 23 grade III, one grade IV, and 0 grade V complications. The 23 grade III complications requiring reoperations included four revision PAOs for overcorrection, three fixations for posterior column fracture, four neurolysis procedures for symptomatic lateral femoral cutaneous nerve (LFCN) dysesthesias, four heterotopic bone excisions, and eight wound debridements. All type I and II complications were treated without sequelae. The addition of hip arthroscopy did not increase complication rates. Age < 20 years was associated with a lower risk of complications (odds ratio (OR) = 0.53, 95% CI 0.33 to 0.84, p = 0.008), whereas smoking history (OR = 1.72, 95% CI 1.01 to 2.87, p = 0.040) and correction of both acetabular dysplasia and retroversion (OR = 2.46, 95% CI 1.08 to 5.24, p = 0.024) were linked to an increased risk of complications. The operating time and incidence of complications decreased with increasing experience.ConclusionPAO is an effective procedure with an acceptable complication rate. Risk factors should be discussed during preoperative counselling. While patient optimization may help to reduce complications, precise intraoperative technique remains critical for minimizing risk.Cite this article: Bone Jt Open 2025;6(10):2022–2031.

AbstractPostoperative (or postprocedural) pneumocephalus is unique from those associated with head injury, spontaneous cerebrospinal fluid leaks, and intracranial infection. Postoperative cranial imaging usually demonstrates a small volume of air that remains in the surgical bed, which is essentially self-limited and resolves over several weeks or less. However, occasionally, surgical defects lead to symptomatic postoperative air entrapment, and severe cases are generally due to one-way valves created by tissue, a mechanism shared with severe traumatic pneumocephalus. In the case where this causes progressive pressurization, this is termed tension pneumocephalus, analogous to its pulmonary counterpart. In the closed adult cranium, the Monroe-Kellie doctrine can be extended to include pneumocephalus if the compressible nature of gas is accounted for. Three illustrative cases are used to highlight common etiologies of postoperative tension pneumocephalus, management strategies, and imaging findings of these collections.

ABSTRACT Background Magnetic resonance elastography (MRE) has demonstrated potential in characterizing intracranial tumors, including glioblastoma. The influence of pathology on measurement consistency and interobserver agreement needs evaluation to promote MRE implementation as a quantitative biomarker. Purpose To assess repeatability and interobserver agreement of absolute and normalized magnitude of the complex shear modulus (| G *|), storage modulus ( G ′), and loss modulus ( G ″) in glioblastoma. Study Type Prospective. Population Thirteen adults (5 male, 8 female, mean age 66.23 years) with histopathologically confirmed glioblastoma. Field Strength/Sequence 3 T MRI, modified single‐shot spin‐echo echo‐planar imaging. Assessment Two same‐session MRE acquisitions were performed with patient repositioning. The solid tumor component was independently segmented by 2 observers on contrast‐enhanced T1‐weighted images co‐registered to MRE maps. Statistical Tests Repeatability was assessed using the repeatability coefficient, coefficient of variation, and Bland–Altman plots, and interobserver agreement by the intraclass correlation coefficient. The Wilcoxon signed‐rank test compared parameters and coefficients of variation between tumor‐normal‐appearing white matter and absolute and normalized measurements. Significance was set at 0.05. Results Tumor | G *| and G ′ showed repeatability coefficients of 0.07–0.08 kPa and 0.05 kPa, compared with 0.13 kPa (| G *|) and 0.15–0.16 kPa ( G ′) for normalized measurements. Coefficients of variation in tumor regions were 1.42% ± 1.12%–1.60% ± 1.41% for | G *| and 1.19% ± 0.96%–2.08% ± 2.22% for G ′, significantly lower than normalized values (4.82% ± 4.49%–4.21% ± 4.27% for | G *|; 5.12% ± 5.04%–5.45% ± 4.53% for G ′). Tumor | G *| and G ′ showed excellent interobserver agreement (intraclass correlation coefficients 0.97 and 0.95). Tumor G ″ demonstrated higher variability than | G *| and G ′ (coefficients of variation 8.58% ± 7.69%–7.51% ± 6.73%), with no significant difference between absolute and normalized measurements ( p = 0.14). Data Conclusion Tumor | G *| and G ′ are the most repeatable metrics in glioblastoma. Normalization reduces measurement repeatability due to normal‐appearing white matter variability. The small sample size ( n = 13) limits generalizability. Evidence Level 2. Technical Efficacy Stage 2.

Multiple myeloma (MM) is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). While these precursor conditions are asymptomatic, they are not entirely benign and carry a lifelong risk of progression to MM. Unlike other cancers defined by pathology, malignant transformation from MGUS or SMM to MM has so far relied on demonstration of clinical end-organ damage as morphology and cytogenetics cannot reliably distinguish them. In this study, using genomic data from 374 patients with MGUS or SMM (277 training, 97 validation), to our knowledge, we demonstrate for the first time the ability to identify malignant transformation in MGUS and SMM. We introduce the concept of genomic MM and genomic MGUS to differentiate the subsets of MGUS and SMM that are biologically malignant with genomic features indistinguishable from MM from the subset that is premalignant and unlikely to progress to malignancy. Importantly, we find that most SMM has biological features of malignant transformation indistinguishable from MM. As expected, this subset that we consider having genomic MM is associated with a high risk of progression to MM although some patients remained progression-free beyond 5 years. Conversely, 60% of MGUS and 10% of SMM have no evidence of malignant transformation (genomic MGUS), with no progression during follow-up. Integration of genomic features with the 2/20/20 International Myeloma Working Group model significantly improved the prediction of progression among genomic MM. These findings support the use of genomic criteria to refine the classification and the risk stratification in myeloma precursor conditions.

Introduction: An 83-year-old female was discovered to have an incidental circumferential duodenal adenoma by upper endoscopy after being evaluated for irritable bowel syndrome. Imaging revealed a dilated common bile duct and main pancreatic duct but no evidence of malignancy. Therefore, she was considered a candidate for surgical removal. Methods and Materials: Using robotic-assisted surgery, a 4 trocar approach was employed involving three 8-mm and one 12-mm robotic trocar apart. 1 A standard cholecystectomy followed by careful dissection of the duodenum from the pancreas head was performed. The ampulla was identified, and the duodenum was laterally retracted with transection of the identified ampulla with exposure of the pancreaticobiliary orifice. A two-layered duct to mucosa pancreaticobiliary anastomosis was established between the common bile, pancreatic duct, and the jejunum. A side-to-side stapled gastrojejunostomy was constructed and the operation concluded. 2 , 3 Results: Pathological analysis revealed a noninvasive polypoid lesion within the duodenum measuring 7.5 × 5.0 × 0.6 cm. The surgery was completed in 350 minutes with blood loss of 100 mL. There were no postop complications, and the patient was discharged on the fifth day. The patient had some gastric symptoms post discharge which subsided with time. Conclusions: This case highlights the feasibility and safety of robotic resection for an obstructing duodenal polyp in complex anatomical regions, demonstrating its clinical utility and relevance for the management of benign ampullary duodenal lesions. Patient Consent Statement: The patient who was operated upon issued consent for operative data to be used for publication, under Mayo Clinic, Jacksonville, signed consent forms. The author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Conflict of Interests: This article is not under consideration by any other journal, and all authors have approved the article. None of the authors have any competing financial interests. Runtime of video: 9 minutes and 33 seconds.