The Central Maine Medical Center is a hospital located at 300 Main Street in the city of Lewiston, Maine. It serves most of Androscoggin County, including Lewiston and Auburn, Maine and various small and medium-sized communities. It is designated as a trauma center. The hospital was established in the 1860s and officially incorporated in 1888 by Dr. Edward H. Hill, an alumnus of nearby Bates College and also Harvard Medical School. The hospital is currently a teaching affiliate of Boston University School of Medicine and University of New England College of Osteopathic Medicine.
This narrative review provides a historical perspective on how observational research on type 2 diabetes has been developed and consolidated over the last 50 years and how well-designed cohort studies will provide us with knowledge for research and practice in the future and aid guideline development. We have included data from a large number of cohorts from every continent that have been used to study the development and/or progression of type 2 diabetes, including cohorts that are general population-based, disease-based, intervention-based and registry-based. We have structured the results from the past 50 years based on the following themes: diagnosis and screening, complications, risk factors and pathophysiology. We also discuss the strengths and weaknesses of observational research when compared with other research designs. Finally, we discuss the emerging and future directions for type 2 diabetes research using cohorts, which include novel developments, such as artificial intelligence, precision health and the exposome. We conclude that cohort research has significantly advanced our understanding of type 2 diabetes and aided guideline development, and complements experimental work, such as human randomised controlled trials and animal studies. Both approaches are essential and complementary in our pursuit to provide a more comprehensive understanding of the development and progression of type 2 diabetes, and to change dogma, practice and policies for better outcomes.
Background: Pancreatic cysts, frequently identified incidentally on imaging, present diagnostic challenges due to their variable malignant potential. Serous cystic neoplasms (SCNs) are benign and account for 1-2% of pancreatic lesions. However, imaging techniques alone often lack the accuracy to definitively diagnose these lesions, leading to unnecessary surveillance and interventions. Aims: This study evaluates the safety and diagnostic efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for identifying microcystic SCNs. Methods: We conducted a retrospective analysis of 39 patients who underwent EUS-FNB for solitary pancreatic lesions with microcystic features, identified through cross-sectional imaging at our medical center between 2018 and 2024. Patients with a stellate scar or definitive imaging features of microcystic SCNs were excluded. Outcomes assessed included histologic results and complications. Results: Histological confirmation of microcystic SCN was achieved in 79.5% of cases, eliminating the need for further imaging and surveillance. A single complication—mild intra-lesional bleeding—occurred in one patient, which resolved without further intervention. Conclusions: EUS-FNB is a safe and effective method for diagnosing microcystic SCNs, offering a definitive diagnosis and reducing unnecessary surveillance and interventions. This approach provides a favorable risk-benefit profile for managing SCNs. However, future multicenter studies with larger cohorts are needed to further validate these findings and refine diagnostic protocols for pancreatic cystic neoplasms.
Background Different fixation methods in anterior cruciate ligament reconstruction (ACLR) have been associated with different revision rates, specifically in the early postoperative period. However, most previous research has either grouped together different fixation types or evaluated femoral-sided fixation or tibial-sided fixation separately. Therefore, the purpose of this study was to determine ACL revision rates for specific combinations of femoral and tibial fixation methods within 2 years of primary hamstring tendon autograft ACLR based on data from the Swedish National Knee Ligament Registry (SNKLR). Methods Patients that underwent primary hamstring tendon autograft ACLR between 2005 and 2018 in the SNKLR were included. The collected data included patient characteristics (age, sex, body mass index [BMI]), activity at time of injury, surgical information (concomitant injuries, time from injury to surgery, fixation types at the femur and tibia), and subsequent revision ACLR. Revision rate within 2 years of the index procedure was chosen, as ACLR fixation is most likely to contribute to ACLR revision within the first 2 years, during graft maturation. Results Of the 23,238 included patients undergoing primary hamstring ACLR, 581 (2.5%) underwent revision ACLR within 2 years of the index procedure. Among the combinations used for > 300 patients, the femoral metal interference screw/tibial metal interference screw fixation combination had the highest revision rate followed by metal interference screw/resorbable screw and Endobutton/AO screw fixation combinations, with respective revision rates of 4.0, 3.0, and 3.0%. The lowest revision rate within 2 years of ACLR was found in the Endobutton/metal interference screw with backup Osteosuture fixation combination, used in 433 cases, with a failure rate of 0.9%. Conclusion Different early ACL revision rates were found across different combinations of femoral and tibial fixation devices within 2 years of primary hamstring tendon autograft ACLR. Metal interference screw fixation, particularly when performed on both the femoral and tibial sides, most frequently resulted in revision ACLR. These findings may be helpful for surgeons in selecting appropriate fixation devices for hamstring ACLR. Level of evidence IV
