Predilection for Perplexion: Preoperative microstructural damage is linked to postoperative delirium.

Postoperative delirium is the most common postsurgical complication in older adults and is associated with an increased risk of long-term cognitive decline and Alzheimer's disease (AD) and related dementias (ADRD). However, the neurological basis of this increased risk-whether postoperative delirium unmasks latent preoperative pathology or leads to AD-relevant pathology after perioperative brain injury-remains unclear. Recent advancements in neuroimaging techniques now enable the detection of subtle brain features or damage that may underlie clinical symptoms.

Associations Between Delayed Sleep Phase Syndrome and Daytime Napping with the Metabolic Syndrome Among Adults: Results from the Ravansar Non-Communicable Disease (RaNCD) Cohort Study.

Objective: Adverse sleep and wake patterns are associated with physical health complaints, including metabolic disorders. The aim of this study was to evaluate the relationship between delayed sleep phase syndrome (DSPS) and napping during the day with metabolic syndrome (MetS).

Methods: This study was conducted on 10 065 participants aged 35-65 years using baseline data from the Ravansar Non-Communicable Disease (RaNCD) cohort study.

EPISeg: Automated segmentation of the spinal cord on echo planar images using open-access multi-center data.

Functional magnetic resonance imaging (fMRI) of the spinal cord is relevant for studying sensation, movement, and autonomic function. Preprocessing of spinal cord fMRI data involves segmentation of the spinal cord on gradient-echo echo planar imaging (EPI) images. Current automated segmentation methods do not work well on these data, due to the low spatial resolution, susceptibility artifacts causing distortions and signal drop-out, ghosting, and motion-related artifacts.

Prenatal Care of Parents Who Continued Pregnancies With Down Syndrome, 2003-2022.

Parents of children with Down syndrome have historically reported poor experiences receiving a prenatal diagnosis. In a 2003 survey, mothers reported that their physicians pitied them, emphasized negative aspects of Down syndrome, and encouraged them to terminate the pregnancy. This study assesses whether parents' perceptions have since improved.

Clinical entity augmented retrieval for clinical information extraction.

Large language models (LLMs) with retrieval-augmented generation (RAG) have improved information extraction over previous methods, yet their reliance on embeddings often leads to inefficient retrieval. We introduce CLinical Entity Augmented Retrieval (CLEAR), a RAG pipeline that retrieves information using entities. We compared CLEAR to embedding RAG and full-note approaches for extracting 18 variables using six LLMs across 20,000 clinical notes.

Virtual Human Retina: Simulating Neural Signalling, Degeneration, and Responses to Electrical Stimulation.

Introduction: Current brain-based visual prostheses pose significant challenges impeding adoption such as the necessarily complex surgeries and occurrence of more substantial side effects due to the sensitivity of the brain. This has led to much effort toward vision restoration being focused on the more approachable part of the brain - the retina. Here we introduce a novel, parameterized simulation platform that enables study of human retinal degeneration and optimization of stimulation strategies.

The ACTION VAD registry: A collective five-year experience.

Background: The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) began in 2018 as a collaborative learning health system committed to improving outcomes in pediatric heart failure, including children and adults with congenital heart disease, supported with ventricular assist devices (VADs). This report describes patient and device characteristics, and outcomes through 1-year post-implant.

Methods: The ACTION VAD registry report was created from data submitted to the ACTION learning network from April 2018 to June 2023.

Comparison of Postoperative Antibiotic Protocols for Pediatric Complicated Appendicitis: A Western Pediatric Surgery Research Consortium Study.

Background: There is no consensus on the appropriate duration of postoperative antibiotics for complicated appendicitis in children. Commonly used antibiotic endpoints include normalization of white blood cell count (WBC) or completion of a minimum number of prespecified treatment days. We compared clinical outcomes resulting from varying postoperative antibiotic protocols for complicated appendicitis in children.

Evolving Paradigms in the Treatment of Oligometastatic Pancreatic Ductal Adenocarcinoma.

Multiple randomized trials have suggested that the addition of comprehensive metastasis-directed therapy to best systemic therapy improves disease control and survival among patients with oligometastatic disease, even for histologies with a high propensity for rapid spread. Here, we review the growing literature supporting the oligometastatic paradigm in pancreatic ductal adenocarcinoma. We summarize key details from nascent institutional series and reflect on the recently reported phase II randomized EXTEND trial.

Age and Weight Stratified Outcomes of Single Stage Endorectal Pull-through Procedures for Hirschsprung's Disease in Children: Analysis of NSQIP-P Data.

Background: We aimed to analyze the effect of age and weight on 30-day outcomes of single-stage endorectal pull tthrough (ERPT) procedures for Hirschsprung's Disease (HD) using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify an optimal time for surgery.

Methods: We queried NSQIP-P for children <2 years with HD who underwent ERPT between 2016-2021 and did not have a preoperative stoma. Patients were stratified by age (<3 months, 3-6 months and >6 months) and weight (<4 kg, 4-8 kg, and >8 kg) at the time of surgery.

Association of Care Fragmentation and Hospital Cancer Designation with Survival in Gastroesophageal Junction Cancer: A State-Wide Study.

Background: Fragmentation of care (FC) is healthcare provided by different providers and/or facilities. FC has been associated with inferior outcomes, yet it improves access to specialized cancer care. We aim to identify the association of fragmented gastroesophageal junction cancer (GEJ) care with survival.

Burden and risk factors of stroke in Vietnam from 1990 to 2021 - a systematic analysis from global burden disease 2021.

Background: Stroke is a leading cause of death in Vietnam. However, a comprehensive analysis of stroke burden remains limited. This study aims to investigate the burden of stroke and various risk factors in Vietnam from 1990 to 2021.

Up-front resection for hepatocellular carcinoma: Assessing futility in the preoperative setting.

Objective: We sought to develop a predictive model to preoperatively identify patients with hepatocellular carcinoma (HCC) at risk of undergoing futile upfront liver resection (LR).

Methods: Patients undergoing curative-intent LR for HCC were identified from a large multi-institutional database. Futile LR was defined by death or disease recurrence within six months postoperatively.

Development of a patient decision aid for people with chronic low back pain and degenerative disc disease considering lumbar fusion: A mixed-methods study.

Objectives: To develop and user-test a patient decision aid providing evidence-based information for people with chronic low back pain (LBP) and degenerative disc disease considering lumbar fusion.

Design: Convergent parallel mixed methods study.

Setting: A prototype patient decision aid was developed, guided by the International Patient Decision Aid Standards (IPDAS) criteria, a multidisciplinary steering committee, and insights from previous studies.

Proceedings of the 2024 Santa Fe Bone Symposium: Update on the Management of Osteoporosis and Rare Bone Diseases.

The 24 Annual Santa Fe Bone Symposium (SFBS) was held in Santa Fe, New Mexico, USA, on August 2-3, 2024. This was a "hybrid" meeting, with in-person and real-time remote participants representing a broad range of geographical locations and medical disciplines. The focus was on new developments in the care of patients with osteoporosis, other metabolic bone diseases, and inherited skeletal disorders.

Cerebral blood volume index in the era of thrombectomy-treated large and medium vessel ischemic strokes.

The cerebral blood volume index (CBV index) is a perfusion-based marker of collateral status. Several real-world data analyses from observational stroke cohorts have established relationships between this parameter and a range of favorable and unfavorable stroke outcomes. In this review, an overview is provided of the CBV index, within the context of thrombectomy-treated large vessel and medium vessel occlusion ischemic strokes.

Assessing Surgical Competency Among Fellows in Vitreoretinal Surgery: A Survey of Fellowship Program Directors and Fellows.

Purpose: We surveyed vitreoretinal (VR) fellowship program directors (PDs) to elucidate how they assess surgical competency among VR fellows. In addition, we also surveyed fellowship program graduates for the years 2022 and 2023 regarding assessment metrics and tools used during VR fellowship training.

Design: Web-based, cross-sectional descriptive study.

Development and Evaluation of a Presenter Coaching Program at an Academic Surgical Conference.

Objective: Presenting at academic conferences is an important means of disseminating research, networking, and building a professional reputation, but the quality of presentations at conferences is often suboptimal. This project describes the design, implementation, and evaluation of a presentation coaching program offered by an academic surgical society to presenters at its annual meeting.

Design: Oral presenters were paired with a coach and encouraged to meet independently, yet coaching was unstructured.

The power of personas: Exploring an innovative model for understanding stakeholder perspectives in an oncology learning health network.

Introduction: Learning health networks (LHNs) improve clinical outcomes by applying core tenets of continuous quality improvements (QI) to reach community-defined outcomes, data-sharing, and empowered interdisciplinary teams including patients and caregivers. LHNs provide an ideal environment for the rapid adoption of evidence-based guidelines and translation of research and best practices at scale. When an LHN is established, it is critical to understand the needs of all stakeholders.

Advances in moyamoya disease: pathogenesis, diagnosis, and therapeutic interventions.

Moyamoya disease (MMD) is a type of cerebrovascular disease characterized by occlusion of the distal end of the internal carotid artery and the formation of collateral blood vessels. Over the past 20 years, the landscape of research on MMD has significantly transformed. In this review, we provide insights into the pathogenesis, diagnosis, and therapeutic interventions in MMD.

Nonresponse Bias on Inpatient Rehabilitation Hospitals' Experience of Care Quality Measure Scores.

Objective: To describe the magnitude of nonresponse bias on inpatient rehabilitation facility (IRF) experience of care survey data in patients with neurologic disorders.

Design: Cohort study of patients at 2 IRFs. Patients reported experience of care via an IRF-administered survey as part of routine operations approximately 2 weeks after discharge.