Explore the vast range of titles available.

Background Several contemporary risk stratification tools are now being used since the development of the Charlson Comorbidity Index (CCI) in 1987. The purpose of this systematic review and meta-analysis was to compare the utility of commonly used co-morbidity indices in predicting surgical outcomes. Methods A comprehensive review was performed to identify studies reporting an association between a pre-operative co-morbidity measurement and an outcome (30-day/in-hospital morbidity/mortality, 90-day morbidity/mortality, and severe complications). Meta-analysis was performed on the pooled data. Results A total of 111 included studies were included with a total cohort size 25,011,834 patients. The studies reporting the 5-item Modified Frailty Index (mFI-5) demonstrated a statistical association with an increase in the odds of in-hospital/30-day mortality (OR:1.97,95%CI: 1.55–2.49, p  < 0.01). The pooled CCI results demonstrated an increase in the odds for in-hospital/30-day mortality (OR:1.44,95%CI: 1.27–1.64, p  < 0.01). Pooled results for co-morbidity indices utilizing a scale-based continuous predictor were significantly associated with an increase in the odds of in-hospital/30-day morbidity (OR:1.32, 95% CI: 1.20–1.46, p  < 0.01). On pooled analysis, the categorical results showed a higher odd for in-hospital/30-day morbidity (OR:1.74,95% CI: 1.50–2.02, p  < 0.01). The mFI-5 was significantly associated with severe complications (Clavien-Dindo ≥ III) (OR:3.31,95% CI:1.13–9.67, p  < 0.04). Pooled results for CCI showed a positive trend toward severe complications but were not significant. Conclusion The contemporary frailty-based index, mFI-5, outperformed the CCI in predicting short-term mortality and severe complications post-surgically. Risk stratification instruments that include a measure of frailty may be more predictive of surgical outcomes compared to traditional indices like the CCI.

BackgroundPost-operative pancreatic fistula (POPF) is a major complication following pancreatectomy and is currently difficult to predict pre-operatively. This study aims to validate pre-operative risk factors and develop a novel combined score for the prediction of POPF in the pre-operative setting.MethodsData were collected from 2016 to 2021 for radiologic main pancreatic duct diameter (MPD), body mass index (BMI), physical status classified by American Society of Anesthesiologists (ASA), polypharmacy, mean platelet ratio (MPR), comorbidity-polypharmacy score (CPS), and a novel Combined Pancreatic Leak Prediction Score (CPLPS) (derived from MPD diameter, BMI, and CPS) were obtained from pre-operative data and analyzed for their independent association with POPF occurrence.ResultsIn total, 166 patients who underwent pancreatectomy with pancreatic leak (Grade A, B, and C) occurring in 51(30.7%) of patients. Pre-operative radiologic MPD diameter < 4 mm (p < 0.001), < 5 mm (p < 0.001), < 6 mm (p = 0.001), BMI ≥ 25 (p = 0.009), and ≥ 30 (p = 0.017) were independently associated with the occurrence of pancreatic leak. CPLPS was also predictive of pancreatic leak following pancreatectomy on univariate (p = 0.005) and multivariate analysis (p = 0.036).ConclusionMPD and BMI were independent risk factors predictive for the development of pancreatic leak. CPLPS, was an independent predictor of pancreatic leak following pancreatectomy and could be used to help guide surgical decision making and patient counseling.

Background Informal carers of terminally ill patients play a vital role in providing palliative care at home, which impacts on their pre- and post-death bereavement experience and presents an up to 50% greater risk for mental-health problems. However, developing and implementing effective bereavement support remains challenging. There is a need to build the evidence base for music therapy as a potentially promising bereavement support for this vulnerable population. This study aimed to co-design an international best practice agenda for research into music therapy for informal carers of patients pre- and post-death bereavement. Methods Online half day workshop using a World Café approach; an innovative method for harnessing group intelligence within a group of international expert stakeholders (music therapy clinicians and academics with experience of music therapy with informal carers at end-of-life). Demographics, experience, key priorities and methodological challenges were gathered during a pre-workshop survey to inform workshop discussions. The online workshop involved four rounds of rotating, 25-minute, small group parallel discussions using Padlet. One final large group discussion involved a consensus building activity. All data were analysed thematically to identify patterns to inform priorities and recommendations. Results Twenty-two consented and completed the pre-event survey (response rate 44%), from countries representing 10 different time zones. Sixteen participated in the workshop and developed the following best practice agenda. The effectiveness of music therapy in supporting informal carers across the bereavement continuum should be prioritised. This should be done using a mixed methods design to draw on the strengths of different methodological approaches to building the evidence base. It should involve service users throughout and should use a core outcome set to guide the choice of clinically important bereavement outcome measures in efficacy/effectiveness research. Conclusions Findings should inform future pre- and post-death bereavement support research for informal caregivers of terminally ill patients. This is an important step in building the evidence base for commissioners and service providers on how to incorporate more innovative approaches in palliative care bereavement services.

PurposeTo compare the oncological and renal function outcomes for patients receiving microwave ablation (MWA) in tumors < 3 and 3–4 cm.MethodsRetrospective analysis of a prospectively maintained database identified patients with < 3 or 3–4 cm renal cancers undergoing MWA. Radiographic follow-up occurred at approximately 6 months post-procedure and annually thereafter. Serum creatinine and estimated glomerular filtration rate (eGFR) were calculated before and 6-months post-MWA. Local recurrence-free survival (LRFS) was estimated using the Kaplan–Meier method. Tumor size was evaluated as a prognostic factor using Cox proportional-hazards regression. Predictors for change in eGFR and chronic kidney disease (CKD) stage were modeled using linear and ordinal logistic regression.ResultsA total of 126 patients fit the inclusion criteria. Overall recurrences were 2/62 (3.2%) and 6/64 (9.4%) for < 3 versus 3–4 cm. Both recurrences in the < 3 cm group were local, 4/6 in the 3–4 cm group were local and 2/6 were metastatic without local progression. For < 3 versus 3–4 cm, cumulative LRFS at 36 months was 94.6% versus 91.4%. Tumor size was not a significant prognostic factor for LRFS. Renal function did not change significantly after MWA. Patient comorbidities and RENAL nephrometry score significantly affected change in CKD.ConclusionWith comparable oncological outcomes, complication rates, and renal function preservation, MWA is a promising management strategy for renal masses of 3–4 cm in select patients. Our findings suggest that current AUA guidelines, which recommend thermal ablation for tumors < 3 cm, may need review to include T1a tumors for MWA, regardless of size.

Background/Objectives: There is increasing evidence that a subset of patients with stage IV pancreatic ductal adenocarcinoma (PDAC) and liver-only metastasis may benefit from surgical resection of both the primary tumor and metastatic lesions. Methods: A meta-analysis and systematic review were conducted in patients with stage IV PDAC and hepatic-only metastasis. A comprehensive literature search (January 2015–June 2023) was performed using PubMed with keywords including “pancreatic cancer”, “oligometastatic”, and “surgery”. Results: Sixteen articles were included in the final review and characterized based on patient selection factors and prognostic indicators. Seven studies reported hazard ratios (HRs) or Kaplan–Meier curves for survival in synchronous resected cohorts versus chemotherapy/palliation alone, which indicated a statistically significant survival benefit in the resection cohorts (pooled HR: 0.41, 95% CI: 0.31–0.53, p < 0.01). Prognostic indicators for synchronous and metachronous resection included lower pre-operative CA19-9, negative margin status of the primary tumor, moderate-to-well-differentiated tumors (grades I–II), and receiving pre-operative chemotherapy. Conclusions: Surgical/ablation selection factors are evolving, with priorities on (1) response to induction chemotherapy, (2) ability to achieve R0 resection, and (3) minimally invasive approaches remaining critical to optimal patient selection. Standardized radiologic and tumor marker evaluation and response to neoadjuvant therapy and optimizing performance status are critical to improved outcomes.

Aerosol measurements were collected at fifteen homes over the course of one year in Colorado (USA) to understand the temporal variability of indoor air particulate matter and bacterial concentrations and their relationship with home characteristics, inhabitant activities, and outdoor air particulate matter (PM). Indoor and outdoor PM2.5 concentrations averaged (±st. dev.) 8.1 ± 8.1 μg/m3 and 6.8 ± 4.5 μg/m3, respectively. Indoor PM2.5 was statistically significantly higher during summer compared to spring and winter; outdoor PM2.5 was significantly higher for summer compared to spring and fall. The PM2.5 I/O ratio was 1.6 ± 2.4 averaged across all homes and seasons and was not statistically significantly different across the seasons. Average indoor PM10 was 15.4 ± 18.3 μg/m3 and was significantly higher during summer compared to all other seasons. Total suspended particulate bacterial biomass, as determined by qPCR, revealed very little seasonal differences across and within the homes. The qPCR I/O ratio was statistically different across seasons, with the highest I/O ratio in the spring and lowest in the summer. Using one-minute indoor PM10 data and activity logs, it was observed that elevated particulate concentrations commonly occurred when inhabitants were cooking and during periods with elevated outdoor concentrations.

The largest Herschel extragalactic surveys, H-ATLAS and HerMES, have selected a sample of \"ultrared\" dusty, star-forming galaxies (DSFGs) with rising SPIRE flux densities (\\(S_{500} > S_{350} > S_{250}\\); so-called \"500 \\(\\mu\\)m-risers\") as an efficient way for identifying DSFGs at higher redshift (\\(z > 4\\)). In this paper, we present a large Spitzer follow-up program of 300 Herschel ultrared DSFGs. We have obtained high-resolution ALMA, NOEMA, and SMA data for 63 of them, which allow us to securely identify the Spitzer/IRAC counterparts and classify them as gravitationally lensed or unlensed. Within the 63 ultrared sources with high-resolution data, \\(\\sim\\)65% appear to be unlensed, and \\(\\sim\\)27% are resolved into multiple components. We focus on analyzing the unlensed sample by directly performing multi-wavelength spectral energy distribution (SED) modeling to derive their physical properties and compare with the more numerous \\(z \\sim 2\\) DSFG population. The ultrared sample has a median redshift of 3.3, stellar mass of 3.7 \\(\\times\\) 10\\(^{11}\\) \\(M_{\\odot}\\), star formation rate (SFR) of 730 \\(M_{\\odot}\\)yr\\(^{-1}\\), total dust luminosity of 9.0 \\(\\times\\) 10\\(^{12}\\) \\(L_{\\odot}\\), dust mass of 2.8 \\(\\times\\) 10\\(^9\\) \\(M_{\\odot}\\), and V-band extinction of 4.0, which are all higher than those of the ALESS DSFGs. Based on the space density, SFR density, and stellar mass density estimates, we conclude that our ultrared sample cannot account for the majority of the star-forming progenitors of the massive, quiescent galaxies found in infrared surveys. Our sample contains the rarer, intrinsically most dusty, luminous and massive galaxies in the early universe that will help us understand the physical drivers of extreme star formation.