Postmenopausal Shrinkage of Uterine Myomas: A Retrospective Study of 97 Cases Monitored Annually for 10 Years.

Introduction and aim Both patients and gynecologists are concerned about how much and how quickly myomas shrink after menopause. This study aimed to elucidate clinical findings that may be associated with postmenopausal shrinkage of uterine myomas. Materials and methods This study included 97 patients who underwent menopause by August 2012, had myoma nodules with the longest diameter between 50 mm and 160 mm, and visited our specialized myoma clinic annually for at least 10 years after menopause. They underwent transabdominal ultrasonography at least once per year. An experienced gynecologist measured the longest diameter of myoma nodules with a maximum diameter between 50 mm and 160 mm. The shrinkage rate of myoma diameters after menopause compared to premenopausal diameters was calculated each year for 10 years. The shrinkage rate of the longest diameter of the largest nodule 10 years after menopause (10-year shrinkage rate) and its relationship with clinical findings (the age at menopause, parity, body mass index {BMI}, number of nodules, MRI findings on T2-weighted image, location of the nodule, and longest diameter of the largest nodule before menopause) were analyzed. Additionally, we examined annual changes in shrinkage rate of myomas over a 10-year period after menopause (annual trend), and the relationship between annual trends and factors such as BMI and the number of nodules. Results In this examination of 10-year shrinkage rate, the group with a BMI of less than 25 showed a significantly greater shrinkage rate compared to the group with a BMI of 25 or more (25.0% vs 15.7%, p=0.023). Additionally, the group with a single nodule showed a significantly greater 10-year shrinkage rate compared to the group with four or more nodules (26.3% vs 15.2%, p=0.036). For annual trends, the rate of change in the first two years after menopause was significantly faster compared to the trend from the third to the 10th year (difference in slope: 3.888 points per year, p<0.001). When divided into two groups based on the number of nodules (one or two nodules group and three or more nodules group), the group with one or two nodules showed a significant difference in the shrinkage rate between up to two years after menopause and from the period from the third to the 10th year (difference in slope: 4.590 points per year, p<0.001). However, for the group with three or more nodules, there was no significant difference in the annual trend between the first two years after menopause and the rate from the third to the 10th year (difference in slope: 1.626 points per year, p=0.107). Conclusion BMI and the number of myoma nodules were significantly related to the 10-year shrinkage rate. Although myomas shrank significantly faster within the first two years after menopause compared to the later period, the early annual trend did not differ significantly from the trend in the later period when there were multiple nodules with a maximum diameter of 50 mm or more.

Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum Follow-Up of a Randomized Controlled Trial.

PURPOSE: There is no consensus on the optimal postoperative rehabilitation program following flexor tendon repair. Some studies suggest a faster recovery after active mobilization, whereas other studies have failed to find any differences between active and passive mobilization at 12 months. To our knowledge, no prior randomized controlled trial has compared the long-term effects of these two approaches. This randomized controlled trial compared the long-term outcomes of active mobilization with those of passive mobilization in combination with place-and-hold. METHODS: Sixty-four patients with a flexor tendon injury in zones I or II were included in the study. After surgery, patients were randomized to either active mobilization or passive mobilization with place-and-hold. Forty-seven patients were available for the 5-year minimum follow-up. Assessments included range of motion, grip strength, key pinch, as well as the Disabilities of the Arm, Shoulder, and Hand (DASH) and ABILHAND questionnaires. RESULTS: At the 5-year minimum follow-up, range of motion was significantly better in the group treated with passive mobilization with place-and-hold compared with the active mobilization group. Furthermore, there was a significant deterioration in the range of motion and an increased flexion contracture in the active mobilization group compared with 1 year after surgery. Grip strength deteriorated significantly in both groups from the 1-year to the 5-year minimum follow-up, but key pinch did not change. In both groups, DASH and ABILHAND scores improved from the 1-year to the 5-year minimum follow-up. CONCLUSIONS: Passive mobilization with place-and-hold following flexor tendon repair results in superior long-term outcomes compared with active mobilization. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Long-term outcomes following closed reduction and internal fixation of femoral neck fractures with cannulated screws in patients under 65 years.

Background: The long-term studies for femoral neck fractures (FNFs) in young patients treated with closed reduction and internal fixation (CRIF) are limited. This study aimed to evaluate the long-term outcomes of a group of young patients (<65 years) with FNFs treated with CRIF at our department during the last decade. We estimated treatment failure rates and identified risk factors for poor outcomes. Methods: This retrospective cohort study included patients under 65 with a unilateral FNF treated with CRIF using partially threaded cannulated screws (CSs) between 2011 and 2021. During the latest follow-up visit, we recorded the patients' complications, re-admissions, reoperations, functional outcomes, and quality of life scores. Results: We included 52 patients with a mean age of 53.04 years and a mean follow-up of 5.3 (range: 1.3-11) years. No non-union was recorded. Nine patients (17.3 %) underwent total hip arthroplasty (THA) due to femoral head avascular necrosis (AVN) at an average of 1.68 years following the index operation (THA group). The mean age (p =0.96), trauma type (p =0.290), sex prevalence (p =0.989), Garden classification (p =0.187), CSs number (p =0.751), and comorbidities (p =0.516) were comparable between THA and non-THA groups. Time from trauma to index surgery was significantly shorter for the THA than the non-THA group (p =0.03). Conclusions: During a mid-to-long follow-up, 17.3 % of patients under 65 years who were treated with CRIF and CSs for FNFs developed AVN. Age, trauma type, comorbidities, time from trauma to treatment, and the number of screws did not affect the outcomes. HIPPOKRATIA 2024, 28 (1):29-34.

Different prognosis according to treatment in patients with acute promyelocytic leukemia: How the outcome changed over time.

A comprehensive analysis of 220 patients diagnosed with APL between 1993 and 2022 is here reported. Overall, 214 patients (97.2%) received induction therapy. Complete response (CR) was achieved in 97.4%, 100%, 100%, and 27% of patients treated with AIDA protocol, AIDA + Ara-C, ATRA + ATO, and ATRA monotherapy, respectively. Molecular complete response (CRMRD-) was achieved in 96.8% cases, and 142 patients proceeded to maintenance therapy. Overall, the 3-year and 5-year overall survival (OS) rates were 80.8% (95% CI, 78.1-83.5) and 79.1% (95% CI, 76.4-81.8), respectively. Considering only patients who completed induction and maintenance therapy, the 5-year OS rates were 82.1% (95% CI, 77.5-86.7) for the AIDA0493 cohort, 87.5% (95% CI, 84.4-91.1) for the AIDA2000 cohort, and 100% for the APL0406 cohort (p = 0.044). Additionally, the disease-free survival (DFS) rates were 65.7% (95% CI, 60.4-70.9), 70% (95% CI, 65.8-75.2), and 95.1% (95% CI, 91.7-98.5) (p = 0.016), respectively. Among low and intermediate-risk patients, age > 70 years (p = 0.027) and relapse (p < 0.001) were significantly associated with reduced outcomes. This study contributes to the advancement of our understanding of APL treatment, underscoring the ongoing need for research to enhance outcomes and explore new therapeutic approaches and prognostic factors.

Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion.

PURPOSE: To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas. MATERIALS AND METHODS: Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36 months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3 years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images. RESULTS: A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40-300) to 73 mm (range: 15-240), and the mean volume reduced from 984.4 (range: 30-7312) to 286.6 cm3 (range: 1-3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15 years. CONCLUSION: TACE with bleomycin-Lipiodol is safe, reducing the size and volume of giant liver hemangiomas with stable results in the long-term follow-up.

Doses of Botulinum Toxin in Cervical Dystonia: Does Ultrasound Guidance Change Injection Practices?

BACKGROUND: Cervical dystonia is widely understood to benefit from botulinum toxin injections. The injection practices may be influenced by specific factors, including the method of injection. Three main guidance methods can be used: palpation of anatomical landmarks, ultrasound, and electromyography. We investigated how target muscles and doses of botulinum toxin were modified after the transition from surface anatomy (non-guided) to ultrasound (US-guided), in patients with cervical dystonia. We also determined the long-term dose trend. METHODS: We studied a group of 82 patients, who received non-guided injections (median: 16.5 cycles/5.1 years) followed by US-guided injections (median: 12.0 cycles/3.8 years). RESULTS: More muscles, and especially deep muscles, were injected during the US-guided period. The total dose and number of injected muscles were higher when US guidance was used, but the mean dose per muscle was lower. Over the long term, the total dose stabilized, and the mean dose per muscle decreased during the US-guided period. CONCLUSIONS: According to our results, the guidance method has a strong impact on the botulinum toxin injection strategy in cervical dystonia (target muscles and dose). Also, the treatment appeared more stable when using US guidance; this could be explained by the good precision of such injections.

The Long-Term Clinical and Radiographic Outcomes of Cerclage Cable Fixation for Displaced Acetabular Fractures Using a Posterior Approach: A Retrospective Cohort Study.

Background and Objectives: Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods: We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results: We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8-18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28-74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9-22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74-100); seven patients scored >90 at the last follow-up. Conclusions: Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods.

Free fatty acids: independent predictors of long-term adverse cardiovascular outcomes in heart failure patients.

BACKGROUND: The association between plasma free fatty acid (FFA) and the outcomes in the heart failure (HF) patients remains unclear. METHODS: A cohort study among HF patients was performed. Plasma FFA was analyzed as both a continuous and a categorical variable (grouped by tertiles) to assess its association with composite cardiovascular (CV) death and HF hospitalization (CV death & HHP), CV death alone, and all-cause mortality (ACM) using Cox regression models. Subgroup analyses of HF patients with preserved ejection fraction (HFpEF) and mildly reduced/reduced ejection fraction (HFmrEF/HFrEF) were performed. This work also assessed the effectiveness of combining FFA and NT-pro BNP biomarkers for risk stratification by calculating the concordance index (C-index). RESULTS: Among the 4,109 HF patients, FFA levels exceeding 0.4-0.42 mmol/L were associated with increased risks of the three outcomes. Patients in the highest FFA tertile faced greater risks than those in the lowest tertile. Adjusted hazard ratios were 1.32 (95% CI: 1.11-1.58) for CV death & HHP, 1.45 (95% CI: 1.16-1.82) for CV death, and 1.39 (95% CI: 1.15-1.68) for ACM, with a maximum follow-up of 8 years (median: 25 months). Subgroup analyses revealed that elevated FFA levels consistently predicted worse outcomes in both HFmrEF/HFrEF and HFpEF patients. The C-index for predicting outcomes was significantly greater when NT-pro BNP and FFA were combined than when NT-pro BNP was used alone (P < 0.01). CONCLUSION: Increased plasma FFA concentrations were independently associated with greater risks of CV death & HHP, CV death, and ACM among HF patients, irrespective of the ejection fraction. The combination of FFA and NT-pro BNP biomarkers significantly improved risk stratification in HF patients.

Clinical Analysis of 32 Cases of Subglottic Benign Airway Stenosis Treated With Montgomery T Silicone Stent.

Objective: To explore the complications of long-term placement of Montgomery T silicone stent (T-tube) in the treatment of subglottic benign airway stenosis (SBAS) and the timing of successful T-tube removal. Methods: We retrospectively collected the clinical data of 32 patients with SBAS who underwent the treatment of T-tube and analyzed their placement and successful removal of the T-tube. Results: There were 22 males and 10 females, aged from 21 to 79 years (60.9 ± 13.7 years). The T-tubes were successfully placed in all 32 patients, and 6 patients (18.8%) with mild stenosis were placed by the intravenous conscious sedation. The longest follow-up period was 60.4 months, and 17 patients (53.1%) had the T-tubes for more than 12 months; 5 patients (15.6%) were changed to the tracheostomy cannula after unplanned removal of the T-tubes for various reasons; the T-tubes were successfully removed in 9 patients (28.1%), and the duration of T-tubes placement was 5.2-22.7 months (12.1 ± 6.3 months), among them anatomical stenosis in 9 patients (100%). Secretion retention was observed in 32 patients (100%), granulation tissue hyperplasia was observed in 9 patients (28.1%), and the normal ventilation was not affected in most patients by bronchoscopic treatment and follow-up; the T-tubes were removed in 3 patients due to severe complications. There was no significant difference in the incidences of secretion retention and granulation tissue hyperplasia between the time point at 1 week, 1 month, 3 months, and 12 months, p > 0.05. In patients with T-tube more than 12 months, the severity of secretion retention at 1 week, 1 month, 3 months, and 12 months was significantly different, p < 0.05, however, there was no significant difference in the severity of granulation tissue hyperplasia, p > 0.05. Conclusions: T-tube is safe and effective in the treatment of SBAS. The severity of secretion retention increased in patients with long-term placement of the T-tube. For patients with mild stenosis and anatomical stenosis, the T-tube removal can be attempted at about 1 year of follow-up.

The 13-year long-term follow-up on the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in Chinese females vaccinated at 20-45 years of age.

TRIAL REGISTRATION: The LTFU study was registered at the Chinese Clinical Trial Registry, ChiCTR2100052313.

Long-Term Outcomes of Tension-Free Vaginal Tape Obturator: Efficacy and Safety at Long-Term Follow-Up.

Background/Objectives: The use of tension-free vaginal tape obturator (TVT-O) for the treatment of stress urinary incontinence (SUI) has been widely debated over the last decade due to the lack of evidence on its long-term outcomes. The aim of this prospective study is to assess, for the first time in the available literature, the efficacy and safety of TVT-O implantation in women with pure SUI over a 17-year follow-up period. Methods: We included all women who complained of pure SUI symptoms (confirmed urodynamically) and underwent the TVT-O procedure. An objective cure was defined as the absence of urine leakage during the stress test, while subjective outcomes were assessed by means of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS). Results: A total of 70 patients who met the inclusion criteria underwent the TVT-O procedure. During the study period, no patients were lost to follow-up, and all women completed the last evaluation at the 17-year mark. At the 17-year mark of follow-up, 62 out of 70 patients (81.4%) were subjectively cured, and 56 out of 70 (80%) patients were objectively cured. These data do not reveal any significant variation in the surgical outcomes over the follow-up period. We recorded seven (10%) tape exposure (three occurred after 10 years and four after 17 years). Among these, one woman was symptomatic for dyspareunia and "hispareunia". All patients with mesh exposure were treated with partial removal and re-suture of the vagina, but only one developed the recurrence of SUI that required a second treatment with a urethral bulking agent (UBA). In all other cases, women reported a complete resolution of symptoms without any worsening of the urinary continence. No significant bladder or urethral erosion was recorded. Conclusions: The 17-year evaluation of the TVT-O procedure has shown that it is a highly effective and safe option for the treatment of female SUI. Although there was an increased risk of tape exposure 17 years after implantation, no serious complications were reported, and no patient required the total removal of the sling.

Characterization of Patients with Poor Clinical Outcome after Adult Spinal Deformity Surgery: A Multivariate Analysis of Mean 8-Year Follow-Up Data.

Background/Objective: Limited data exist regarding the long-term clinical outcomes and related factors after adult spinal deformity (ASD) surgery. This study aims to characterize patients who experienced poor clinical outcomes during long-term follow-up after ASD surgery. Methods: Patients who underwent ASD surgery with ≥5-vertebra fusion including the sacrum and ≥5-year follow-up were included. They were divided into two groups according to the Oswestry Disability Index (ODI) at the last follow-up: group P (poor outcome, ODI > 40) and group NP (non-poor outcome, ODI ≤ 40). Clinical variables, including patient factors, surgical factors, radiographic parameters, and mechanical complications (proximal junctional kyphosis [PJK] and rod fracture), were compared between the groups. Results: A total of 105 patients were evaluated, with a mean follow-up of 100.6 months. The mean age was 66.3 years, and 94 patients (89.5%) were women. There were 52 patients in group P and 53 patients in group NP. Univariate analysis showed that low T-score, postoperative correction relative to age-adjusted pelvic incidence-lumbar lordosis, T1 pelvic angle (TPA) at last follow-up, and PJK development were significant factors for poor clinical outcomes. Multivariate analysis identified PJK as the single independent risk factor (odds ratio [OR] = 3.957 for PJK development relative to no PJK, OR = 21.141 for revision surgery for PJK relative to no PJK). Conclusions: PJK development was the single independent factor affecting poor clinical outcomes in long-term follow-up. Therefore, PJK prevention appears crucial for achieving long-term success after ASD surgery.

Fast-Track Aspirin Odyssey: ICU Chronicles.

Aspirin is used in patients with coronary artery disease essential in both acute and chronic phases of treatment, especially post-catheterization and post-coronary artery stent placement. Some patients have sensitivity to aspirin. Hypersensitivity reaction symptoms include itchy and watery eyes, itchy rash, worsening asthma, wheezing to fatal angioedema, and anaphylaxis. In such cases, clopidogrel can be used instead of aspirin if it is necessary to avoid the use of aspirin. Alternatively, we can try desensitization to aspirin. In aspirin desensitization, incremental doses of aspirin are provided at fixed time intervals. It usually lasts between one and three days. These protocols are often impractical in emergent conditions, especially in conditions where percutaneous coronary intervention (PCI) reveals coronary artery stenosis requiring stent placement. Post-stent placement long-term treatment with aspirin is needed. This has led to limited application in clinical practice despite the potential benefits. We present a case of a patient who presented to us with complaints of shortness of breath and intermittent chest pain. A thorough evaluation was conducted, including cardiac catheterization, which revealed a 70% blockage in the right coronary artery (RCA) and a 65% blockage in the left anterior descending (LAD) artery, necessitating stent placement. The patient reported a severe allergy to aspirin, requiring aspirin desensitization. Rapid aspirin desensitization was successfully performed in the ICU, taking two hours and 15 minutes. The patient underwent PCI and stent placement in the RCA the following day. She is currently on dual antiplatelet therapy with aspirin and clopidogrel and has scheduled follow-ups with both a cardiologist and an allergist.

Long-term effectiveness of the nine-valent human papillomavirus vaccine: Interim results after 12 years of follow-up in Scandinavian women.

A pivotal study in women aged 16-26 years demonstrated that the nine-valent human papillomavirus (9vHPV) vaccine was efficacious against high-grade cervical dysplasia related to the HPV types covered by the vaccine. To evaluate whether effectiveness remains above 90% for up to 14 years post-vaccination, a long-term follow-up (LTFU) extension of the study was conducted in Denmark, Norway, and Sweden (N = 2,029). Interim findings at 12 years post-vaccination are reported. Effectiveness of the vaccine was measured by comparing the percentage reduction in incidence of HPV16/18/31/33/45/52/58-related high-grade cervical dysplasia in the LTFU cohort with the expected incidence in an unvaccinated cohort. Cervical pre-cancer/cancer diagnoses were identified using national health registries. Tissue samples were obtained from national and regional biobanks for polymerase chain reaction HPV testing, and pathology diagnosis adjudication. Potential waning of vaccine effectiveness and statistical significance were assessed using a control chart method. During LTFU, there were no cases of HPV16/18/31/33/45/52/58-related high-grade cervical dysplasia over 10,396.2 person-years' follow-up in the per-protocol effectiveness population (n = 1,628). No signals indicated vaccine effectiveness decreasing below 90%. Statistically significant protection was provided by the 9vHPV vaccine through at least 10 years, with complete, although not statistically significant, effectiveness through 12 years.

Immune Checkpoint Blockade Therapies Efficacy and Toxicity in Patients With Impaired Renal Function in Metastatic Bladder Cancer.

BACKGROUND: In this study, we reported the real-life results of data from impaired renal patients with urothelial carcinoma who were treated with ICTs. METHODS: The patients were categorized into 3 different groups GFR ≥60mL/min (normal), 60mL/min-30mL/min (low), and less than 30 mL/min (very low) based on GFR. The primary endpoints were the overall response rate (ORR), overall survival (OS), duration of response with ICT, and safety. Median follow-up and OS were estimated by using the Kaplan-Meier method. RESULTS: One hundred-five (60.3%) of patients were GFR normal, 26.4% were GFR low with 30mL/min-60mL/min, and 13.2% were very low group. ORR for GFR normal, low and very low groups were 36% (n = 38), 26% (n = 12) and %31 (7); P = .2, respectively. The median duration of response for GFR normal, low and very low groups were 47.2 months (95% CI, 24.5-51.4), 33.1 months (95% CI, 26.9-47), and 23.5 months (95% CI, 12.2-43.7); P = .01, respectively. The Median OS rate for GFR normal, low and very low groups were 11.9 (7.2-16.5) months, 4.7 (1.8-7.7) and 6.8 (1.1-13.6) months, P = .015, respectively. In addition, GFR <60 ml/min HR = 1.6; 95% CI 1.12-1.80; P = .02, maintained a significant association with OS in multivariate analysis. CONCLUSIONS: Long-term follow-up of real-world data confirms that the overall survival rate and durable response rate with ICT were higher in patients with GFR >60mL/min. On the other hand, we demonstrated that ICT was effective and a durable response seen in a group of patients with renal inpairement who did not have an effective systemic treatment option.

Recurrent Intrathoracic Liposarcoma: A Case Report and a Comprehensive Literature Review of a Rare Clinical Entity.

Liposarcomas (LPSs) are rare malignant tumors of adipocytic origin, primarily occurring in the extremities and retroperitoneum, with thoracic involvement being exceptionally rare. This case report details the surgical management and outcomes of a recurrent intrathoracic LPS in a 65-year-old male with a history of previous mediastinal tumor resection. CT imaging revealed a recurrent tumor extending into the left pleura. The patient underwent a posterolateral thoracotomy for complete tumor excision and limited replacement of the descending aorta. Postoperative recovery was smooth, and histology confirmed dedifferentiated LPS (G2) with areas of highly differentiated LPS. LPSs encompass a heterogeneous group of tumors with various subtypes, including atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS), dedifferentiated liposarcoma (DDLPS), myxoid liposarcoma (MLPS), and pleomorphic liposarcoma (PLPS). Treatment primarily involves complete surgical resection, while the roles of radiotherapy and chemotherapy remain debated. Immunotherapy shows potential benefits, particularly for DDLPS patients expressing PD-L1. Prognosis varies significantly by subtype, with DDLPS and PLPS associated with poorer outcomes compared to MLPS and ALT/WDLPS. Long-term follow-up is crucial for managing LPSs due to their high recurrence rate. This case highlights the effectiveness of surgical intervention in recurrent intrathoracic LPSs and underlines the need for continued research into adjuvant therapies to improve patient outcomes.

A Case of Myelin Oligodendrocyte Glycoprotein Antibody Disease in a Pediatric Patient: Clinical Presentation, Treatment Response, and Follow-Up Considerations.

Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a rare autoimmune demyelinating disorder that targets the central nervous system and is characterized by antibodies that act against myelin oligodendrocyte glycoprotein (MOG). This disorder typically manifests with symptoms such as optic neuritis, transverse myelitis, or encephalitis, leading to symptoms such as vision loss, muscle weakness, sensory disturbances, and cognitive impairment. We present the case of a 10-year-old male who was eventually diagnosed with MOGAD after consideration of several other neurological and musculoskeletal disorders, who was admitted to the hospital due to an initial presentation of urinary retention and pelvic pain. The patient's clinical course included an MRI scan showing extensive demyelinating lesions in the spinal cord, along with positive MOG antibody serology. Management involved a multidisciplinary approach, including consultations from neurology, physical therapy, and the general pediatrics team, as well as administration of high-dose corticosteroids. This case underscores the importance of early recognition and aggressive treatment of MOGAD, a disorder that can present similarly to other demyelinating diseases such as multiple sclerosis and neuromyelitis optica spectrum disorder, with the distinguishing feature of MOGAD being the presence of antibodies against MOG.

Do treatment responders maintain their gains following a randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder?

To examine the maintenance effects of acceptance-based behavior therapy (ABBT) and applied relaxation (AR) for generalized anxiety disorder (GAD) 46 adults (69.6% female, 82.6% White) with high end-state functioning following an RCT comparing ABBT to AR were re-assessed at 12- and 24-month follow-up. End-state functioning was based on post-treatment scores within one standard deviation of the mean on three of five outcome measures [Clinician Severity Rating (CSR), Hamilton Anxiety, Penn State Worry Questionnaire (PSWQ), Depression Anxiety Stress Scale stress subscale (DASS-Stress), and State-Trait Anxiety Inventory (STAI)]. At 12 months, 93.8% of high endstate responders in ABBT and 95.5% in AR had maintained gains. At 24 months, 71.4% of responders from ABBT and 83.3% from AR maintained gains. Mixed-effects regression models revealed a significant effect for Time and Condition for DASS-Stress but not for Condition X Time. There was also a significant time effect for PSWQ, indicating PSWQ and DASS-Stress scores increased across follow-up. The rate of increase did not differ across conditions. Non-significant, small effects were found for all other outcomes indicating that symptoms did not significantly change across follow-up regardless of condition. While the results are limited by dropout rates, clients receiving ABBT or AR appear to maintain gains over long-term follow-up.

Long-term follow-up of methotrexate and cytarabine in adult patients with Langerhans cell histiocytosis.

The optimal treatment strategy for adult Langerhans cell histiocytosis (LCH) remains unclear. Our previous study demonstrated the remarkable efficacy of combined methotrexate and cytarabine (Ara-C) [MA] therapy in patients newly diagnosed with LCH, with a median follow-up of 2 years. The present article reports long-term follow-up data spanning a median of 78 months (6.5 years) from a single-arm, single-centre, prospective phase 2 clinical trial (NCT02389400) conducted between January 2014 and December 2020. Ninety-five adults with newly diagnosed LCH exhibiting multisystem disease or multifocal single-system involvement underwent MA therapy every 35 days for six cycles. Methotrexate (1 g/m2) was administered by 24 h infusion on day 1 and AraC (0.1 g/m2) by 24 h infusion for 5 days. The primary end-point was event-free survival (EFS). The median patient age was 32 years (range 18-65 years). The overall response rate was 89.5%. Seven patients in this cohort died, and 38 experienced disease reactivation. No degenerative central nervous system diseases were observed. The estimated 6-year overall survival (OS) and EFS rates were 93.2% and 55.2% respectively. Multivariate analysis revealed that risk organ (RO) involvement at baseline (hazard ratio [HR] 6.135 [95% confidence interval (CI) 1.185-32.259]; p = 0.031) and age >40 years at diagnosis (HR 7.299 [95% CI 1.056-21.277]; p = 0.042) were associated with inferior OS. RO (HR 2.604 [95% CI 1.418-4.762]; p = 0.002) and skin (HR 2.232 [95% CI 1.171-4.255]; p = 0.015) involvement at baseline were poor prognostic factors for EFS. Regarding adverse events, four patients developed a second primary malignancy. In conclusion, the MA regimen was a valid and safe therapeutic approach for adult patients newly diagnosed with LCH.

Longitudinal study of root resorption on incisors caused by impacted maxillary canines-a clinical and cone beam CT assessment.

OBJECTIVE: To evaluate the long-term status of incisors with canine-induced root resorption (CIRR). MATERIALS AND METHODS: Subjects with impacted maxillary canines (IMC) and persisting incisors with CIRR examined with cone beam computed tomography (CBCT), diagnosed ≥ 5 years earlier, were recalled. The resorption grade in the horizontal and vertical plane was assessed on CBCT images at baseline (T0) and follow-up (T1). Clinical examination was done at T1 which included probing depth, gingival retraction, mobility, ankylosis, discoloration and vitality test. In addition, patients completed a questionnaire regarding symptoms from the incisors. RESULTS: Forty subjects (mean age 13.7 ±â€…2.1 years) with 43 IMC and 47 incisors with CIRR were recruited. The IMC either spontaneously erupted, were surgically exposed or surgically removed. Thirty-four of the patients were treated with a fixed appliance and six had no orthodontic treatment. The follow-up range was 5.5-14.6 years. None of the incisors were lost or endodontically treated at T1. The horizontal resorption grade was unchanged in 38, improved in 7, and worsened in 2 teeth. The corresponding results for the vertical resorption grade were unchanged in 20 and worsened in 27 teeth. Three incisors with severe horizontal resorption at T0 were significantly more obliterated at T1 (P = .01). No significant differences were found in clinical parameters or patient-reported outcomes between incisors with CIRR and non-resorbed contralateral incisors at T1. LIMITATIONS: The extent of root resorption during active orthodontic treatment was not possible to assess as only CBCT images from T0 and T1 were available. CONCLUSION: Incisors with CIRR caused by IMC have a high survival rate in a long-term perspective and do not cause more symptoms or exhibit more signs of pathology than non-resorbed contralateral incisors. Extraction of asymptomatic incisors based solely on root resorption should not be performed routinely.