Search Results (1,332)

Background/Objectives: C-reactive protein (CRP) is widely used as a marker of perioperative inflammation, but its predictive value for cardiac surgical outcomes remains uncertain. Obstructive sleep apnea (OSA), a prevalent and underrecognized comorbidity, may independently contribute to postoperative complications through non-inflammatory mechanisms. This study aimed to reevaluate the prognostic role of CRP and determine the clinical impact of OSA severity on postoperative recovery, focusing on new-onset atrial fibrillation (AF), prolonged intubation time, and postoperative CPAP/AIRVO use as indicators of respiratory burden. Methods: In this prospective cohort of 142 elective cardiac surgery patients, preoperative polysomnography and serial CRP measurements were obtained. Multivariable regression, mediation analysis, and propensity score matching (PSM) were performed to evaluate associations between OSA severity, CRP, and perioperative outcomes (AF, intubation time, CPAP/AIRVO use). Results: OSA severity independently predicted prolonged intubation (β = 1.74, p = 0.0019) and new-onset AF (β = 0.85, p = 0.004), even after excluding patients with preexisting arrhythmia. CRP showed poor discriminatory power as a standalone biomarker (AUC for IOT > 14 h = 0.445) and did not mediate OSA–outcome associations. However, CRP > 2.1 mg/dL doubled the odds of moderate-to-severe OSA (OR = 2.05, p = 0.041). A composite score integrating AHI, BMI, and postoperative CRP strongly correlated with postoperative respiratory support (p < 0.0001). Conclusions: OSA exerts a stronger and more consistent influence on perioperative outcomes than CRP, challenging reliance on CRP for risk stratification. Incorporating objective OSA screening and spirometry into preoperative assessment may enhance perioperative risk prediction and guide personalized management strategies. Full article

Objective: To evaluate the association of preoperative conization prior to radical hysterectomy (RH) with overall survival (OS) and progression-free survival (PFS) in patients with early-stage cervical cancer. Methods: We conducted a retrospective cohort study involving patients with stage IB1 cervical cancer treated by RH at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Thailand, between January 2003 and December 2019. Propensity-score matching (1:1 ratio, caliper of 0.2 standard deviations) was used to balance covariates between patients who underwent conization (n = 314) and those who did not (n = 528). Survival outcomes were analyzed using Kaplan–Meier curves and the log-rank test. Subgroup analysis was also conducted on patients without high-risk histopathological factors, including pelvic node metastasis, parametrial invasion, and positive vaginal margins. Results: A total of 274 matched pairs were analyzed. Conization was significantly associated with improved OS (log-rank p = 0.03). For PFS, the benefit associated with conization was not demonstrated (log-rank p = 0.18). Similarly, subgroup analysis excluding patients with high-risk histopathological factors showed a significant association between conization and improved OS (log-rank p = 0.04) but not with PFS (log-rank p = 0.29). Conclusions: Conization prior to RH is significantly associated with improved OS in patients with early-stage cervical cancer, though its association with PFS remains inconclusive. These findings support the integration of conization into personalized surgical treatment strategies, with further prospective validation recommended. Full article

Background: Robot-assisted surgery (RAS) is a major innovation in the treatment of lung cancer, offering advantages in surgical precision and reducing postoperative complications. However, its impact on 90-day mortality remains controversial due to methodological biases in comparative studies. This study uses machine learning methods to improve propensity score estimation and reduce selection bias. Methods: We used the French national hospital database (PMSI) to identify patients who underwent lung resection for cancer between 2019 and 2023. Four models were applied for propensity score estimation: logistic regression, Random Forest, Gradient Boosting Machine (GBM), and XGBoost. Group balancing was achieved through propensity score weighting and matching, followed by logistic regression analysis to estimate the effect of RAS on 90-day mortality. Results: Among the 30,988 patients included, 5717 (18.5%) underwent robot-assisted surgery, while 25,271 (81.5%) underwent thoracotomy. RAS patients had a lower prevalence of comorbidities and earlier-stage tumors. XGBoost was the most effective model for propensity score estimation, with an AUC ROC of 0.9984 and a Brier Score of 0.0119. The adjusted analysis showed a significant reduction in 90-day mortality in the RAS group (OR = 0.39, 95% CI: 0.34–0.45) with weighting and (OR = 0.58, 95% CI: 0.48–0.70) with matching. Conclusions: The application of machine learning to adjust for selection bias allowed for better control of confounding factors in the analysis of the effect of RAS on 90-day mortality. Our results suggest a potential benefit of robotic surgery compared to thoracotomy, although further studies are needed to confirm these findings. Full article

Background: Immunotherapy has emerged as a breakthrough for the treatment of advanced non-small-cell lung cancer (NSCLC), significantly improving patients’ progression-free survival (PFS) and overall survival (OS). However, the medical burden of response assessment has worsened for long-term maintenance therapy. It remains unclear whether a specific response assessment interval could provide both survival benefits and cost savings. Methods: We retrospectively included patients with advanced NSCLC who underwent immunotherapy and achieved PFS > 12 months. We utilized propensity score matching (PSM) to reduce the selection bias. The survival outcomes were evaluated using the log-rank test and Cox proportional hazard models, while the economic impact was assessed through the performance of a cost minimization analysis (CMA). A medical expenditure extrapolation model was developed based on epidemiological statistics and data from clinical trials. Results: After PSM, a total of 376 patients were included. The survival difference was not significant [hazard ratio (HR) = 0.78, 95% confidence intervals (CIs) = 0.53–1.14; p = 0.200] between the 2-month response assessment group (n = 188) and the 3-month response assessment group (n = 188). Patients receiving immunotherapy alone and those with a positive PD-L1 expression experienced a significant survival benefit. Our extrapolation model projects that, annually, there will be approximately 7026 new long-term responders to immunotherapy in the United States. Adopting a 3-month assessment strategy could reduce annual healthcare expenditure by nearly USD 6 million. Conclusions: This study presented the first statistical evidence supporting a refined response assessment strategy for long-term responders to immunotherapy with advanced NSCLC. These findings support the adoption of a less frequent, yet equally effective, monitoring approach to make tumor surveillance more precise and cost-effective. Full article

Background/Objectives: Patients with single metastases from colorectal cancer constitute a subgroup with an excellent 5-year OS of 55–70% and with a real chance for cure. In this situation, local margin recurrence in the lung may impair the prognosis and thus is the main outcome target of surgery. Methods: A retrospective multicenter analysis of patients with single metastases from colorectal cancers was performed. Four German Thoracic Surgery units contributed data from their prospective metastasectomy databases. Statistical analysis was focused on tumor recurrence and risk factors for local margin recurrence. Results: 166 patients from four centers could be further analyzed. For later comparison, 93 (56%) anatomic resections and 73 (44%) non-anatomic resections were pooled. Tumor recurrence was detected: at any site 87/161 (54%), within the lung 62/161 (38.5%) at intrapulmonary margins 25/145 (17.2%) and in intrathoracic lymph nodes 14/138 (10.1%). Intrapulmonary local margin recurrence was more often found in non-anatomic (25.4%) versus anatomic (11.6%) resections (p = 0.052). After propensity score matching (PSM), local margin recurrence was significantly more frequent after non-anatomic resection of intermediate and peripherally located metastases (p = 0.042). Furthermore, local margin recurrence was associated with small safety margins (p < 0.001), small number of lymph nodes removed (p < 0.001) and with intrathoracic lymph node recurrence (p = 0.001). The 5- and 10-year OS of the whole group was 70% and 47% with a median survival of 9.0 years. The 5- and 10-year RFS of the whole group was 59% and 43% with a median of 7.3 years. Conclusions: This study demonstrates that anatomical resection of single CRC lung metastases is superior to non-anatomic resection with respect to local radicality and local intrapulmonary margin recurrence, but there was no difference in OS and RFS. Full article

Background and Objectives: Minimally invasive surgery is considered the standard of care for early-stage endometrial cancer. However, the oncological safety of intrauterine manipulator (IUM) use during laparoscopic hysterectomy remains controversial. The aim of this study was to evaluate the impact of intrauterine manipulator use during laparoscopic hysterectomy on oncological outcomes in patients with clinically early-stage endometrial cancer. Materials and Methods: In this retrospective cohort study, 612 patients with FIGO 2009 stage I–III endometrial cancer who underwent staging surgery at a tertiary center between January 2010 and May 2025 were included. Clinical and pathological characteristics were compared between laparoscopy (n = 168) and laparotomy (n = 444). To reduce selection bias, propensity score matching (PSM) was performed based on age, histological subtype, and FIGO stage. Kaplan–Meier survival analysis and Cox regression modeling were utilized to evaluate disease-free survival (DFS) and overall survival (OS). Results: After matching, groups were balanced except for higher rates of para-aortic lymphadenectomy and adjuvant therapy in the laparotomy group. IUM use was not associated with increased LVSI or positive peritoneal cytology. Recurrence was more frequent after laparoscopy (10.1% vs. 6.0%, p = 0.028), with inferior 5-year DFS (87.6% vs. 97.4%, HR 5.60, p = 0.0006), while OS was similar (82.0% vs. 87.6%, p = 0.842). In multivariate Cox analysis, independent predictors of worse DFS were non-endometrioid histology (HR 3.57), FIGO stage III (HR 3.06), grade 3 tumors (HR 2.63), and laparoscopic surgery (HR 0.51). For OS, non-endometrioid histology (HR 5.12), stage III disease (HR 2.98), and grade 3 tumors (HR 4.51) were independent adverse factors, whereas surgical approach was not. Conclusions: The use of an intrauterine manipulator in laparoscopic hysterectomy for early-stage endometrial cancer was linked to worse DFS but not OS. These findings suggest caution regarding the routine use of IUMs and highlight the need for prospective randomized trials to clarify their oncological safety. Full article

Objectives: This study aimed to assess the impact of traditional Korean medicine services (TKMS) on subsequent knee surgery and opioid use in patients diagnosed with knee osteoarthritis (KOA). Methods: This retrospective cohort study used National Health Insurance Review and Assessment Service claims data from 2015 to 2017 to identify patients treated for KOA (M17) in 2016. Patients with at least two Korean medicine (KM) clinic visits within 6 weeks of the initial diagnosis formed the TKMS group, while those without visits to KM clinics formed the n group. Propensity score matching (PSM) (1:1) was applied and the incidence of knee surgery and opioid use was followed up for one year. Kaplan–Meier survival curves and Cox proportional hazards models estimated time-to-event outcomes and hazard ratios (HRs). Sensitivity analyses were performed to verify the results across varied treatment windows of 4, 8, and 10 weeks. Results: After PSM, 247,168 patients were included in the analysis for each group. The TKMS group exhibited significantly lower HRs for knee surgery (HR = 0.69, 95% CI: 0.66–0.72), opioid use (HR = 0.66, 95% CI: 0.65–0.66), and their compound events (HR = 0.66, 95% CI: 0.65–0.67) compared with the Non-TKMS group. The results remained consistent across sensitivity analyses. Conclusions: Among patients with KOA, the utilization of TKMS may significantly reduce the incidence of knee surgery and opioid use. Thus, the utilization of TKMS may be associated with a reduced need for unnecessary surgical interventions and with lower reliance on high-risk medications. Full article

Background/Objectives: Comparative studies examining postoperative pain and cosmetic outcomes following single-port laparoscopic appendectomy (SLA) and three-port laparoscopic appendectomy (TLA) in pediatric patients with appendicitis have produced inconsistent results. We aimed to determine whether SLA offers practical benefits over TLA in terms of recovery-phase pain relief and long-term cosmetic satisfaction in pediatric patients. Methods: This prospective comparative study included children aged 15 years or younger who underwent laparoscopic appendectomy for uncomplicated acute appendicitis. The degree of pain reduction was compared between the SLA and TLA groups on postoperative days (PODs) 1, 2, and 7, both at rest and during coughing and ambulation, using the Visual Analog Scale for Pain (VASP). Global cosmetic satisfaction was assessed at 1 month and 3 years postoperatively using the Visual Analog Scale for Cosmesis (VASC). Scar perception was evaluated with the Patient and Parental Scar Assessment Scale (PSAS). The primary outcome was the degree of pain reduction during ambulation on POD7. The secondary outcome was global cosmetic satisfaction at 3 years. Propensity score matching (PSM) was used as a sensitivity analysis to control for baseline differences. Continuous variables were assessed for normality using the Shapiro–Wilk test. Results: Baseline characteristics were similar among 238 patients (127 SLA and 111 TLA). SLA resulted in significantly greater pain reduction during ambulation on POD7 (deltaVASP7_walk: −6.22 ± 2.60 vs. −5.06 ± 3.23, p < 0.01, mean difference = −1.16, Cohen’s d = 0.39). However, this difference did not reach the minimal clinically important difference (MCID) threshold of 1.3. PSM analysis with 82 matched pairs confirmed the results, with even larger effect sizes. At 3 years, the SLA group reported significantly higher cosmetic satisfaction (VASC: median 10 [9–10] vs. 8 [6–9], p < 0.001, r = 0.44), surpassing the MCID of 1.5. The TLA group scored worse in scar perception regarding color, stiffness, thickness, and irregularity. Mediation analysis indicated that 66% of the overall effect on cosmetic satisfaction was mediated by scar perception. Conclusions: Although SLA offers statistically significant yet clinically marginal benefits in early postoperative pain reduction, it provides substantial benefits in long-term cosmetic satisfaction compared with TLA in pediatric patients. Full article

Using a panel of 3515 Chinese listed firms from 2011 to 2023, this study shows that the education level of the top management team (TMT) positively influences firm stock liquidity. The beneficial effect of TMT education on stock liquidity is stronger in settings with lower industry competition, higher information disclosure quality, and bull market periods. Mediation analysis indicates that analyst coverage provides a weak channel through which TMT education affects stock liquidity. Endogeneity concerns are alleviated by reverse causality tests, two-stage least squares regressions, propensity score matching, and generalized method of moments. The results are also robust to alternative liquidity measures and alternative definitions of TMT education. This study offers practical implications for investors, corporate executives, and policymakers seeking to promote market efficiency and liquidity. Full article

Background: The miniaturization of ureterorenoscopes increasingly enables atraumatic primary ureteroscopy, without ureteral dilation or presenting. This study aims to evaluate the feasibility and safety of primary ureteroscopy using the HU30M (6.3 Fr, HugeMed, Shenzhen HugeMed Medical Technical Development Co., Ltd., Shenzhen, China), the smallest currently available ureteroscope. Methods: We analyzed consecutive patients in whom primary ureteroscopy using the HU30M was performed or attempted, using prospectively collected in-hospital and 30-day follow-up data for retrospective evaluation. The primary outcome was the success rate of primary ostial intubation. Secondary outcomes included the stone-free rate (SFR) in patients with urolithiasis, incidence of in-hospital complications (Clavien–Dindo classification) and 30-day emergency readmission. Additionally, we conducted a propensity score-matched comparative analysis of the HU30M versus a contemporary 7.5 Fr digital single-use ureteroscope (PUSEN PU3033AH, Zhuhai Pusen Medical Technology Co., Ltd., Jinhua, China). Results: Between January and April 2025, primary ureteroscopy using the HU30M was performed or attempted in 34 patients, including four bilateral procedures. Primary ureteroscopy was defined as ureteroscopic access without prior stenting or dilation. Indications were diagnostic evaluation in 15 patients (44%), uretreroscopic stone treatment in 10 patients (29%) and endoscopic combined intrarenal surgery (ECIRS) in 9 patients (27%). Successful primary ostial intubation was achieved in 36 of 38 renal units (95%). Among urolithiasis cases, SFR was 17/19 (90%) in-hospital complications were limited to postoperative fever in two patients (6%) and no procedure-related 30-day emergency readmission occurred. In matched analyses, HU30M demonstrated significantly shorter operative times compared with the 7.5 Fr ureteroscope, while postoperative hemoglobin drop, inflammatory parameters and renal function were comparable. Conclusions: Primary ureteroscopy with HU30M is feasible and safe across diverse indications, achieving high success of atraumatic ostial access. Comparative analyses suggest procedural efficiency advantages and overall safety comparable to the current digital single-use ureteroscope standard. Full article

Background: The impact of transfusion timing relative to endoscopy in upper gastrointestinal bleeding (UGIB) remains unclear. Aim: To assess whether transfusion performed before versus after endoscopy affects 30-day mortality in UGIB. Methods: We conducted a post hoc analysis of a multicenter cohort study including 3324 UGIB patients consecutively admitted in hospital. Propensity score matching adjusted for clinical and procedural variables. Results: Among 2017 transfused patients, 34.7% received Red Blood Cells (RBC) before endoscopy. Patients who received transfusions before endoscopy were older, had more severe comorbidities, and presented with a worse physical and hemodynamic status. This study also explored whether transfusion timing relative to endoscopy affects clinical outcomes in patients stratified by baseline hemoglobin levels. While pre-endoscopy transfusion was not significantly associated with reduced 30-day mortality in the overall population, we observed an advantage in patients transfused before the endoscopy when the Hb value was <7 g/dL. Pre-endoscopy transfusion was associated with a 6% absolute reduction in 30-day mortality (p < 0.06), with a greater benefit observed in patients with Hb < 7 g/dL (−27%) and <8 g/dL (−21%). Moreover, for this group of patients more favorable outcome was observed when the endoscopy was performed between 6 and 12 h from admission. These findings suggest that transfusion timing should be integrated into individualized UGIB management and may impact future clinical guidelines. Conclusions: In patients with severe anemia and UGIB, transfusion before endoscopy may reduce mortality. Timing to transfusion should be considered alongside hemodynamic and procedural factors in future guidelines. Full article

Background/Objectives: Complex endovascular solutions have expanded treatment options for complex abdominal aortic aneurysms (cAAA), particularly in elderly high-risk patients. However, these techniques are limited by anatomical constraints and costs, while the superiority over open repair (OSR) remains debatable. This study aimed to compare short- and mid-term outcomes of OSR for cAAA in patients aged ≥80 versus <80 years. Methods: Retrospective analysis was performed for patients who underwent OSR for cAAA between 2017 and 2022 at two tertiary vascular centers. A total of 226 patients (median age 71 years [IQR 66–80]; 89% male) were included, of whom 74 were aged ≥80 years. Primary endpoints were 30-day mortality, major adverse cardiovascular events (MACE), and early reintervention. Secondary endpoints included length of stay (LOS), acute kidney injury, new renal dysfunction, mid-term survival (≤5 years), and procedure-related reintervention. Propensity score matching (PSM) was performed to adjust for baseline differences. Results: Out of 1087 screened patients, 226 met the inclusion criteria: 74 octogenarians and 152 younger patients. Thirty-day mortality was significantly higher in octogenarians (9.5% vs. 0.7%; p < 0.001), as was the incidence of MACE (8.2% vs. 1.9%; p = 0.026). Rates of kidney impairment LOS and other major complications were comparable. During a median follow-up of 42.7 months, mid-term survival and freedom from reintervention did not differ significantly between groups. PSM analysis confirmed higher early mortality and cardiovascular events in octogenarians but similar mid-term outcomes. Conclusions: Although octogenarians undergoing OSR for cAAA face increased early mortality and cardiovascular complications, their mid-term survival and freedom from reintervention are comparable to younger patients. These results suggest that age alone should not represent a contraindication to open repair in appropriately selected individuals. Full article

Background: Polycarbonate–urethane (PCU) is a recently developed bearing surface used in prosthetic hip surgery. It offers several theoretical advantages, including an elasticity modulus similar to that of natural cartilage, good lubrication properties, low wear, and the possibility of using large heads. However, comparative clinical experience is limited. The purpose of this study was to analyze the results of the PCU bearing surface and compare them with those of ceramic-on-ceramic (CoC) bearings using the same femoral stem model. (2) Methods: Following a propensity score matching analysis of a prospectively collected database, patients with a primary total hip arthroplasty aged between 18 and 60 years were included. Subjects were divided into two groups (PCU and CoC). Demographic, patient satisfaction, and implant survival data were recorded. Clinical results were evaluated using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). (3) Results: A total of 105 patients were included in each group. All patients exhibited a positive evolution on both the HHS and the WOMAC subscales between pre-op and one year post-op, no statistically significant differences being found between the groups with respect to improvement on the HHS (p = 0.172) or the pain (p = 0.523), stiffness (p = 0.448), and physical function (p = 0.255) subscales of the WOMAC. Head sizes in the PCU group were found to be larger, but this was not seen to have any effect on the patients’ clinical status or the prostheses’ dislocation rate. Although the complication rate was similar across the groups (p = 0.828), the incidence of squeaking was higher in the PCU group (p = 0.010). No differences were observed when comparing the implant survival rate (p = 0.427). nor in mean patient satisfaction (p = 0.138). (4) Conclusions: No differences were found in terms of clinical results, complications, implant survival, or patient satisfaction between the bearing surfaces under analysis, indicating that all of them are valid alternatives in total hip replacement, although the higher proportion of squeaking observed makes it advisable to exercise some caution. Full article

Smallholder farmers in developing countries often face barriers to market participation due to information asymmetry and limited access to marketing channels. This study investigates the impact of internet technology on farmers’ agricultural sales and its heterogeneity, using data from the China Family Panel Studies (CFPS) covering 14,577 agricultural households. Propensity score matching and unconditional quantile regression are employed for empirical analysis. The results show that (1) internet adoption significantly improves agricultural sales performance, increasing average sales output by 4680 CNY (Chinese Yuan, the official currency of China); (2) the effects of internet adoption are heterogeneous across industry types, education level, income level, social ties, and internet access devices; (3) the marginal impact of internet use grows with higher sales levels, with the strongest effect observed at the 95% quantile. This study highlights the impact of rural internet technology on increasing market transaction efficiency. Full article

Background/Objectives: Aortic stenosis (AS) is an increasingly recognized end-stage renal disease (ESRD) complication. This study aimed to identify AS incidence and prevalence in Korean patients with ESRD, assess the effect of AS on all-cause mortality, and determine associated risk factors unique to this population. Methods: This retrospective study used Korean National Health Insurance Service data from 2009 to 2021 and included adult patients with ESRD undergoing maintenance dialysis. AS was identified based on diagnostic codes, and 4:1 propensity score matching was conducted. Temporal trends in AS incidence and prevalence were analyzed in terms of sex and age. Kaplan–Meier survival analysis and Cox proportional hazards models were employed for all-cause mortality assessment. Results: Among 91,466 eligible patients, 708 (0.77%) had AS. AS incidence and prevalence increased from 8.05 to 35.29 and from 8.05 to 77.43 per 10,000, respectively, from 2009 to 2021, and were higher in women than in men. Age-stratified analysis revealed the greatest burden in patients aged ≥80. AS in the matched cohort (n = 2875) was associated with <10-year survival (13% vs. 24%, p < 0.001), with differences evident from age 60 onward. Multivariable analysis revealed AS as an independent mortality predictor (hazard ratio: 1.23, 95% confidence interval: 1.08–1.40, p = 0.002). Older age, atrial fibrillation, stroke, and a higher Charlson Comorbidity Index were significant mortality predictors among patients with AS. Conclusions: AS burden in dialysis-dependent patients with ESRD is markedly increasing, particularly among women and older adults, and is independently associated with elevated mortality. Full article