Retrospective Studies

Myosteatosis and the survival of patients with hepatocellular carcinoma: a meta-analysis

Myosteatosis, characterized by fat infiltration into skeletal muscle, is increasingly recognized as a prognostic factor in hepatocellular carcinoma (HCC), although the results were not consistent. This meta-analysis aimed to summarize impact on overall survival (OS) and progression-free survival (PFS) in patients with HCC.A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting survival outcomes in HCC patients with and without myosteatosis. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 24 retrospective cohort studies involving 7436 HCC patients were included. Myosteatosis was significantly associated with poorer OS (HR: 1.60, 95% CI: 1.40-1.83, p < 0.001, I2 = 65%) and PFS (HR: 1.53, 95% CI: 1.33-1.76, p < 0.001, I2 = 36%). Subgroup analysis revealed a stronger association in Asian studies (HR: 1.74 for OS; 1.57 for PFS) compared to European studies (HR: 1.08 for OS; 1.05 for PFS). The prognostic impact remained significant regardless of anticancer treatment type, myosteatosis assessment method, sex-specific or universal cutoff values, and follow-up duration (p for subgroup differences all > 0.05). The results remained significant in studies adjusting for sarcopenia (HR: 1.89 for OS; 1.50 for PFS). Meta-regression analyses did not suggest any of the following variables may affect the results, including sample size, mean ages of the patients, proportions of men, follow-up durations, and study quality scores (p all > 0.05).Myosteatosis is independently associated with worse survival in HCC patients, particularly in Asian populations. These findings highlight the significance of assessing muscle quality as a prognostic factor in HCC.

Assessing Aquatic Readiness as a Health-Enhancing Measure in Young Swimmers with Physical Disabilities: The Revised Aquatic Independence Measure (AIM-2)

Based on the well-established health outcomes associated with the aquatic environment, this study aimed to evaluate the validity of the Aquatic Independence Measure-Revised (AIM-2). The original scale comprised twenty-three skills, graded on a five-point proficiency scale. A sample of one hundred eight young swimmers with disabilities, who had completed at least two years of training, was assessed by their coaches, generating a dataset of four thousand nine hundred sixty-eight scores. Exploratory factor analysis (EFA) and internal consistency measures were applied to validate the scale's structure, resulting in the extraction of three factors accounting for sixty-four percent of the variance, based on thirteen original items. Two independent experts established interrater reliability in twenty-two participants. Additionally, divergent validity was examined across participants' years of swim-training experience across three disability severity categories, gender, and two age groups. Significant differences were found in skill acquisition based on years of experience and disability severity. The results indicate that the AIM-2 effectively assesses swimming readiness in young swimmers with disabilities. Coaches can use it to monitor progress, optimize training, and support the health benefits of aquatic activities for children and adolescents with disabilities.

Risk prediction models for stress urinary incontinence after pelvic organ prolapse (POP) surgery: a systematic review and meta-analysis

OBJECTIVE

To systematically evaluate existing developed and validated predictive models for stress urinary incontinence after pelvic floor reconstruction.

METHODS

Relevant literature in PubMed, Embase, Web of Science, Cochrane Library, OVID, China National Knowledge Infrastructure(CNKI), Wan Fang Database, VIP database and Chinese Biomedical Literature Service System (SinoMed) were search from inception to 1 March 2024. Literature screening and data extraction were performed independently by two researchers. The chosen study's statistics included study design, data sources, outcome definitions, sample size, predictors, model development, and performance. The Predictive Modelling Risk of Bias Assessment Tool (PROBAST) checklist was used to assess risk of bias and applicability.

RESULTS

A total of 7 studies containing 9 predictive models were included. All studies had a high risk of bias, primarily due to retrospective design, small sample sizes, single-center trials, lack of blinding, and missing data reporting. The meta-analysis revealed moderate heterogeneity (I² = 68.8%). The pooled AUC value of the validated models was 0.72 (95% CI: 0.65, 0.79), indicating moderate predictive ability.

CONCLUSION

The prediction models evaluated demonstrated moderate discrimination, but significant bias and methodological flaws. The meta-analysis revealed moderate heterogeneity (I² = 68.8%) among the included studies, reflecting differences in study populations, predictors, and methods, which limits the generalizability of the findings. Despite these challenges, these models highlight the potential to identify high-risk patients for targeted interventions to improve surgical outcomes and reduce postoperative complications. The findings suggest that by integrating these models into clinical decision-making, clinicians can better tailor surgical plans and preoperative counseling, thereby improving patient satisfaction and reducing the incidence of postoperative stress urinary incontinence. Future research should follow TRIPOD and PROBAST principles, focus on addressing sources of heterogeneity, improve model development through robust designs, large sample sizes, comprehensive predictors, and novel modelling approaches, and validate tools that can be effectively integrated into clinical decision-making to manage stress urinary incontinence after pelvic floor reconstruction.

An Observational Review of Tonsillectomy and Appendectomy Procedures Conducted at a Tertiary Care Hospital

BACKGROUND

Tonsillectomy and appendectomy are the most frequently performed surgical procedures in pediatric and adult populations. However, comprehensive data examining their occurrence within the same hospital setting remain sparse. This study aimed to characterize the demographic and clinical profiles of patients undergoing tonsillectomy and assess the frequency and outcomes of those who additionally underwent appendectomy.

METHODS

A retrospective review was performed on 337 patients who underwent tonsillectomy at a tertiary care hospital from 2015 to 2017. Data collected included age, nationality, sex, year of tonsillectomy, and details of any concurrent or subsequent appendectomy, such as complicating factors (e.g., perforation and abscess), imaging findings (appendicolith), and pathology results. Statistical analyses were performed using Minitab 18 (Minitab, Inc., State College, PA).

RESULTS

Among 337 patients, five (1.5%) underwent appendectomy in addition to tonsillectomy. Overall, 78.3% (264/337) of the tonsillectomy group were pediatric vs. 21.7% (73/337) adult, while 60% (3/5) of the appendectomy group were pediatric and 40% (2/5) adult (p = 0.33). The mean (standard deviation) age across the entire cohort was 16.17 (10.48) years, and 55.2% (186/337) were men. No cases of complicated appendicitis were identified among the appendectomy patients, although three (representing 0.9% of the total cohort and 60% of the appendectomy subgroup) exhibited an appendicolith on imaging. Pathology findings confirmed acute appendicitis in four (1.2%) of these cases and a normal appendix in one (0.3%). Statistical comparisons revealed no significant difference in median age between patients undergoing tonsillectomy alone and those who also had an appendectomy (p = 0.86), nor in distribution by gender across procedures (p = 0.78).

CONCLUSION

This review highlights the young demographic profile of patients undergoing tonsillectomy in a tertiary care hospital and underscores the relatively low incidence of appendectomy in this cohort. Despite the small subset of appendectomy cases, timely intervention may have contributed to the absence of complicated appendicitis. Notably, institutionwide data suggest that negative appendectomies remain rare overall, indicating a need for further research into this phenomenon. These findings underscore the need for continued surveillance and future multicenter studies to better elucidate potential shared risk factors and outcomes associated with these commonly performed surgical procedures.

Global Longitudinal Strain for the Early Detection of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis

AIMS

Left ventricular ejection fraction is used to monitor patients undergoing cardiotoxic chemotherapy. A decrease in left ventricular ejection fraction represents a relatively late stage of systolic involvement. Global longitudinal strain has been studied to detect early changes in left ventricular myocardial contractile function. The aim of the present study was to evaluate the global longitudinal strain measurement in the early detection of cardiotoxicity induced by cardiotoxic chemotherapeutic agents.

MATERIALS AND METHODS

A study search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was carried out to report systematic reviews. A search on PubMed, EMBASE, Web of Science and SCOPUS was carried out using the following keywords: 'echocardiography' and 'cardiotoxicity' and their variations, without language or date restrictions (until March 2021).

RESULTS

In total, 4873 articles were identified for title and abstract analysis. The systematic review included 10 studies comprising 661 patients with cancer, including mainly breast cancer and haematological malignancies, mainly treated with anthracyclines. The meta-analysis included four studies: patients with cardiotoxicity showed a reduction in strain, compared with baseline, 14.13% greater than patients without cardiotoxicity (95% confidence interval 5.07-23.19; P < 0.01). No heterogeneity was observed between studies (I2 = 0).

CONCLUSION

The meta-analysis showed that strain is a tool with proper predictive capacity for the detection of cardiotoxicity.

The Impact of COVID-19 on Physical Performance and Mental Health-A Retrospective Case Series of Belgian Male Professional Football Players

Rationale: As every season, physical performance of players of Royal Antwerp FC's first team was regularly tested and mental well-being and mood were assessed during football season 2020-2021. Just like in the general population, several professional athletes were infected by SARS-CoV-2 during that season. COVID-19 is a complex disorder affecting multiple body systems, potentially damaging lungs, affecting the cardiovascular system or causing muscle weakness. Therefore, the impact of COVID-19 on performance was a major concern for the affected football players and their entourage. Objectives: To retrospectively examine the influence of COVID-19 on physical performance and mental health in professional football athletes during the season 2020-2021. Methods: Thirty-three professional athletes (age: 25.37 ± 4.11 years; height: 182.75 ± 7.62 cm; weight: 78.90 ± 8.97 kg) of a Belgian first division football club were assessed weekly during the 2020-2021 season. Weekly assessments comprised strength values of the hamstrings, hip abductors and hip adductors, jump performance, a modified Hooper questionnaire to assess mental status and nose swab PCR tests for COVID-19. Data analysis was performed from 2 weeks prior to COVID-19 contamination up to 8 weeks after the first positive test. Post-hoc Bonferroni correction was applied when performing statistical analysis. Results: Eleven players tested positive for COVID-19. Duration of contamination was 13 ± 7 days. There was no statistically significant difference before and after COVID-19 infection for jump performance, and adductor and abductor muscle strength (p > 0.05). Functional hamstring strength improved significantly 2 weeks (MD: 41.48; 95%CI: -3.79 to 86.75; p = 0.009) and 4 weeks (MD: 34.76; 95%CI: -8.91 to 78.42; p = 0.019) after COVID-19, whereas mood (MD: -0.60; 95%CI: -1.46 to 0.26; p = 0.041), stress levels (MD: -0.83; 95%CI: -1.85 to 0.20; p = 0.020) and total wellness (MD: -2.41; 95%CI: -5.25 to 0.43; p = 0.015) showed a significant reduction 8 weeks after confirmed COVID-19. Conclusion: Physical performance varied considerably across outcomes before and 8 weeks after COVID-19 contamination in a sample of first division football players. However, affected football players' overall well-being, stress levels and mood diminished after a positive COVID-19 test.

Using the Braden subscales to assess risk of pressure injuries in adult patients: A retrospective case-control study

The aim of this study was to compare the pressure injury risk predictability between the individual Braden subscales and the total Braden scale in adult inpatients in Singapore. A retrospective 1:1 case-control design was used from a sample of 199 patient medical records. Clinical data were collected from a local university hospital's medical records database. The results showed that, among the six subscales, the activity subscale was the most sensitive and specific in predicting pressure injury (PI). However, the overall results showed that the Braden scale remained the most predictive of PI development in comparison with the individual subscales. The study also found that, among the Singaporean patients, the Braden cut-off score for PI risk was 17 compared with the current cut-off score of 18. Therefore, it may be relevant for local tertiary hospitals to review their respective Braden cut-off scores as the study results indicate an over-prediction of PI risk, which leads to unnecessary utilisation of resources. The hospital may also consider developing a PI prevention bundle comprising commonly used preventive interventions when at least one Braden subscale reflects a suboptimal score.