Citations

Study Design Retrospective Cohort Study. Objectives To determine if 3D printed porous titanium (Ti) cages compared to non-porous polyetheretherketone (PEEK) cages predicted improved fusion rate or clinical outcomes after transforaminal lumbar interbody fusion (TLIF). Methods All adult patients who underwent one- and two-level TLIF for degenerative conditions by a single surgeon at an academic center between 2017-2021 were retrospectively identified. Patients were dichotomized into porous Ti and non-porous PEEK interbody cage groups. Fusion status was assessed by at 6-months and 1-year postoperatively by CT Bridwell scale and flexion/extension X-Rays. Postoperative complications (CT-based subsidence, adjacent segment disease, reoperation rates) and interval changes in lumbar radiographic alignment at short- and long-term follow-up were determined. Univariate and multivariate analysis compared patient and surgical factors, fusion rates, alignment, and complications across interbody groups. Results A total of 136 patients with 169 unique fusion levels (125 Ti cages, 44 PEEK cages) met the inclusion/exclusion criteria. Ti relative to PEEK interbodies had significantly decreased surface area and increased height and lordosis. Ti cage use was associated with greater subsidence ( P < 0.001) but did not independently predict maximum subsidence on regression ( P = 0.109). In the overall cohort, there were no significant differences in fusion rates or lumbopelvic alignment between interbody groups. Reoperation (Ti: 10.9% vs PEEK: 28.6%, P = 0.026) and reoperation for pseudoarthrosis (Ti: 2.0% vs PEEK: 11.4%, P = 0.038) was significantly more likely in the PEEK relative to the Ti group. Conclusions Use of 3D printed porous Ti cages relative to non-porous PEEK cages may mitigate pseudoarthrosis related reoperation after TLIF.

BACKGROUND AND OBJECTIVES: There has been limited assessment between anterior cervical diskectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) on patient-reported outcome measures (PROMs) in the treatment of cervical spondylotic myelopathy. We sought to compare PROMs from two-level ACDF with single-level ACCF procedures. We evaluate these results in the context of minimum clinically important difference (MCID) thresholds, which have not been performed previously. METHODS: This retrospective analysis of prospectively collected data from the Quality Outcomes Database Spine Collaborative Research Study Group compared two-level ACDF and single-level ACCF at 3-, 12-, and 24 months postoperatively. PROMs included arm pain Numeric Rating Scale, neck pain Numeric Rating Scale, Neck Disability Index, and North American Spine Society Patient Satisfaction Index. Multivariate logistic regression was used to determine differences in perioperative outcomes, as well as the impact of two-level ACDF vs one-level ACCF on PROMs. MCID thresholds were based off previously established limits. RESULTS: Three hundred and thirty patients were included (236 ACDF, 94 ACCF), and the follow-up rate was 82% at 2 years. There was a significantly higher baseline age, American Society of Anesthesiologists grade, proportion of diabetes, osteoarthritis, ambulation dependence, and myelopathy severity in the ACCF cohort. On multivariable analysis, the ACCF group had greater average length of stay and estimated blood loss. There were no significant differences between reoperation rates or nonroutine discharge. There were similar rates of MCID achievement for PROMs at all time points. CONCLUSION: This study suggests that both ACDF and ACCF procedures for cervical spondylotic myelopathy are able to achieve similar, clinically meaningful improvements in PROMs by 2 years. Patients undergoing single-level ACCF have more estimated blood loss and longer length of stay, as well as worse baseline myelopathy. Both procedures have efficacious, durable outcomes. It is reasonable that other factors, such as radiographic characteristics and patient symptoms, may influence patient selection for ACDF vs ACCF.

ABSTRACT Aim To describe interventions to mitigate weight bias among practicing healthcare providers and examine their effectiveness. Design An integrative review. Methods The framework of Whittemore and Knafl (2005) was utilised to identify and synthesise studies of weight bias interventions. Covidence reference management software facilitated screening using predetermined eligibility criteria that is, published in peer‐reviewed journals, reported in English, and described outcomes for weight bias mitigation interventions among healthcare providers with a professional practice licence. We evaluated study quality using Joanna Briggs Institute's Critical Appraisal Tools for qualitative and quantitative studies. Data Sources Five databases were searched (CINAHL, Embase, EBSCOhost, APA PsycINFO, and Scopus) in July 2024. Results Sixteen articles met the inclusion criteria. Four themes emerged: (1) active learning lessens weight bias more than passive learning, (2) multicomponent approaches yield better outcomes, (3) healthcare providers are willing to change their practices, and (4) explicit attitudes and beliefs are more amenable to change than implicit ones. Four sub‐themes within theme one included the use of in‐person workgroups; films, computer‐based, and podcast delivery; written modules; and physical characteristic modifications, such as the use of an adiposity empathy suit. Intervention designs using a theory‐based, active learning approach with repeated sessions were most successful at decreasing negative weight‐biased attitudes and beliefs. Conclusions Interventions that effectively reduce weight bias among practicing healthcare providers vary, yet evidence suggests that weight bias mitigation is achievable. These interventions offer strategies to improve patient‐centred care among patients living with obesity. Impact Healthcare providers often display weight bias. This review synthesises information on effective interventions for reducing bias, which may limit the subsequent negative patient outcomes associated with it. Reporting Method The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses was the structure used for this paper. Patient or Public Contribution There were no patient or public contributions.

ABSTRACTHepatopulmonary syndrome (HPS) poses a significant challenge in liver transplant recipients, mostly resulting in persistent hypoxaemia postoperatively. We present the case of a 59‐year‐old male with decompensated metabolic dysfunction associated with steatohepatitis (MASH) cirrhosis, who had liver transplantation due to end‐stage liver disease complicated by HPS‐related hypoxaemia. Despite successful transplantation, the patient continued to experience severe hypoxaemia, requiring high supplemental oxygen despite maximal conservative treatment per guidelines. Potential causes for hypoxaemia post‐liver transplant have been excluded; HPS as the sole cause of hypoxaemia was proved with a repeat shunt study, which estimated the shunt at 59%. Treatment with inhaled Treprostinil led to a remarkable improvement in oxygenation, facilitating the successful weaning of oxygen supplementation. The patient's hypoxaemia improved to full recovery upon discharge. This case highlights the persistence of hypoxaemia post‐liver transplantation in HPS patients and underscores the potential role of inhaled Treprostinil as a novel therapeutic approach to address this complication.

Abstract Introduction Emerging evidence suggests that positive airway pressure (PAP) treatment for moderate-to-severe obstructive sleep apnea (OSA) in elderly patients does not improve daytime sleepiness, or quality of life outcomes, despite improving apnea-hypopnea index (AHI). While oral appliance therapy (OAT) is known to be an effective treatment for mild-to-moderate OSA, its efficacy in treatment of elderly patients with severe OSA is unknown. Methods Retrospective chart review of patients ≥ 65 years old with diagnosis of OSA, treated with OAT, who underwent subsequent follow-up sleep testing and clinical assessments, including Epworth Sleepiness Scale (ESS), a measure of daytime sleepiness. Results We studied 66 elderly patients with OSA (31 women, 35 men), including 58 with mild-to-moderate OSA (AHI &lt; 30) and 8 with severe OSA (AHI ≥ 30) treated with OAT. At baseline, patients with mild-to-moderate OSA had a median AHI of 11.6 compared to 41.3 in patients with severe OSA (p &lt; 0.0001). There was no difference in ESS score between patients with mild-to-moderate OSA (median ESS = 8; IQR = 4-12) and severe OSA (median ESS = 6; IQR = 3-9). Following their OSA diagnosis, OAT was offered due to PAP intolerance (n = 32), patient preference (n = 28), or as an alternative treatment option (n = 4). After initiation of OAT, 42 patients with mild-to-moderate and 7 with severe OSA underwent follow-up assessment with home sleep testing (n = 32), oximetry (n = 15), or polysomnography (n = 2). At follow-up assessment, ESS was decreased in patients with mild-to-moderate OSA (median ESS = 5; IQR = 3-8) and severe OSA (median ESS = 5; IQR = 3-7), indicating reduction in daytime sleepiness in response to OAT in both groups. Moreover, 50% of patients with mild-to-moderate OSA and 50% of severe OSA patients saw ≥ 50% reduction in AHI. Conclusion Our study findings suggest that treatment with OAT in mild-to-moderate and severe OSA is tolerable and effective in elderly patients who do not have contraindication for this treatment. OAT should be considered as an alternative treatment specifically for elderly adults with severe OSA not tolerating or improving with PAP therapy. Support (if any)

Background: While early risk stratification in STEMI is essential, the threat of cardiogenic shock (CS) persists after revascularization due to reperfusion injury and evolving instability. However, risk prediction in later phases—after revascularization—is less explored, despite its importance in guiding intensive care decisions. This study evaluates machine learning (ML) models for dynamic risk assessment in interventional cardiology and cardiac intensive care unit (CICU) phases, where timely detection of deterioration can guide treatment escalation. Methods: We retrospectively analyzed clinical and procedural data from 158 patients diagnosed with STEMI complicated by cardiogenic shock, treated between 2019 and 2022 at the Cardiology Department of the University Emergency Hospital of Bucharest, Romania. Machine learning models—Random Forest (RF), and Quadratic Discriminant Analysis (QDA)—were developed and tested specifically for the interventional cardiology and CICU phases. Model performance was evaluated using area under the receiver operating characteristic curve (ROC-AUC), accuracy (ACC), sensitivity, specificity, and F1-score. Results: In the interventional phase, RF and QDA achieved the highest accuracy, both reaching 87.50%. In the CICU, RF and QDA demonstrate the best performance, reaching ACCs of 0.843. QDA maintained consistent performance across phases. Relevant predictors included reperfusion strategy, TIMI flow before percutaneous coronary intervention (PCI), Killip class, creatinine, and Creatine Kinase Index (CKI)—all parameters routinely assessed in STEMI patients. These models effectively identified patients at risk for post-reperfusion complications and hemodynamic decline, supporting decisions regarding extended monitoring and ICU-level care. Conclusions: Predictive models implemented in advanced STEMI phases can contribute to dynamic, phase-specific risk reassessment and optimize CICU resource allocation. These findings support the integration of ML-based tools into post-PCI workflows, enabling earlier detection of clinical decline and more efficient deployment of intensive care resources. When combined with earlier-stage models, the inclusion of interventional and CICU phases forms a dynamic, end-to-end risk assessment framework. With further refinement, this system could be implemented as a mobile application to support clinical decisions throughout the STEMI care continuum.

Objective Raynaud phenomenon (RP) is often the initial clinical manifestation of systemic sclerosis (SSc), but some patients develop other manifestations first. To help elucidate the diversity of SSc presentation in its early stages, we describe the initial clinical manifestations and antinuclear antibody (ANA) profiles of patients in two early SSc cohorts. Methods All patient data in the Genetics vs Environment in Scleroderma Outcomes Study (GENISOS) and Collaborative National Quality and Efficacy Registry (CONQUER) cohorts were reviewed. Both studies enrolled patients within five years of the first non‐RP symptom. Results In GENISOS and CONQUER, respectively, 194 (44.2%) of 439 and 292 (31.1%) of 938 patients had a non‐RP initial symptom, most commonly puffy fingers/hands. Black patients had a non‐RP symptom before RP more commonly than patients in other race and ethnicity categories. Non‐RP first patients were more likely than RP first patients to have diffuse cutaneous involvement and joint contractures at enrollment and had a higher prevalence of RNA polymerase III antibody positivity. Conclusion In two large US cohorts, >30% of patients began to manifest SSc with puffy fingers/hands or other symptoms, without the “warning sign” of RP as their initial symptom. These patients presented with more severe skin and musculoskeletal disease on average, highlighting the importance of early recognition. The most common autoantibody associated with this presentation was RNA polymerase III. These results should be considered in efforts to recognize SSc in its earliest stages. Puffy fingers/hands, even in the absence of RP, should prompt consideration of early SSc and testing for ANA and SSc‐associated autoantibodies, including RNA polymerase III.

Chronic proximal interphalangeal (PIP) joint instability is a rare and difficult problem to treat, with the main options including collateral ligament reconstruction and joint arthrodesis. To date, there are minimal described techniques for collateral ligament reconstruction. We describe a novel technique utilizing a slip of the flexor digitorum superficialis (FDS), harvested through a single minimal incision. This technique can be used for collateral ligament reconstruction with multiple applications, including chronic recurrent PIP joint dislocations and instability during PIP joint arthroplasty.