The Hillel Yaffe Medical Center (Hebrew: מרכז רפואי הלל יפה) is a major hospital on the western edge of Hadera, Israel. It serves a population of about 450,000 residents in an area ranging from Zikhron Ya'akov in the north to Netanya in the south, from the Mediterranean coast in the west to Umm el-Fahm and the Green Line in the east. The center is named after Hillel Yaffe, a pioneering Yishuv doctor who worked in nearby Jewish settlements during the First Aliyah in the early 20th century.
Purpose Digital replantation is traditionally guided by injury mechanism, functional priority, ischemia time, and patient factors. Pediatric age is commonly considered a favorable indication, whereas advanced age is often assumed to reduce candidacy. We examined associations of age and area-level zone improvement plan (ZIP) -income quartile with digital replantation following complete traumatic thumb or other-finger amputation. Methods The National Inpatient Sample was queried from 2016 to 2021 for hospitalizations with complete traumatic upper-extremity amputations, including thumb, other-finger, wrist-region, and hand amputation. The primary analytic cohort was limited to complete thumb and other-finger amputations; wrist and hand amputations were retained only for descriptive context. The primary outcome was digital replantation during the included hospitalization, identified using prespecified International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) Reattachment procedure codes. Analyses used survey-weighted multivariable logistic regression to account for National Inpatient Sample discharge weights, strata, and hospital clusters. The model adjusted for patient demographics (age group, sex, race, payer, ZIP-income quartile), injury-related factors (digit group and additional injury diagnosis), and system-level characteristics (transfer-in status, hospital size, teaching status, region, weekend admission, and year). Results The primary digital cohort included 1,458 unweighted hospitalizations, representing 7,290 weighted hospitalizations nationally. Digital replantation was coded in 361 unweighted hospitalizations (weighted n = 1,805; 24.8%). In the adjusted model, higher area-level ZIP-income quartile was associated with digital replantation: compared with quartile 1, adjusted odds ratios (aORs) were 1.52 for quartile 2 (95% CI, 1.06–2.18), 1.83 for quartile 3 (95% CI, 1.24–2.70), and 2.23 for quartile 4 (95% CI, 1.44–3.44). Transfer-in status (aOR, 1.98; 95% CI, 1.49–2.62) and thumb amputation (aOR, 2.15; 95% CI, 1.64–2.81) were also associated with digital replantation. In contrast, no age category was statistically associated with digital replantation after adjustment. Children aged 0–12 years had an aOR of 0.96 (95% CI, 0.53–1.74), adolescents aged 13–17 years had an aOR of 0.84 (95% CI, 0.40–1.75), and adults aged 65 years or older had an aOR of 0.64 (95% CI, 0.32–1.27). Conclusions Among included hospitalizations, higher area-level ZIP-income quartile, transfer-in status, and thumb involvement were associated with digital replantation after adjustment for measured covariates. No age category was statistically associated with digital replantation after adjustment. These findings suggest that patterns of digital replantation may reflect not only anatomic factors but also area-level socioeconomic context and referral-related characteristics. Because the database lacked detailed information on injury mechanism, technical candidacy, comorbidity, and geographic access, these associations cannot distinguish differences in replantation candidacy from differences in referral access or treatment selection. Type of study/level of evidence Prognostic III.
Gallstones (cholelithiasis) are common, with a significant portion of affected individuals developing acute cholecystitis, which can lead to severe complications. While ultrasound (US) is typically the first imaging method used, multidetector computed tomography (MDCT) may be better at detecting more complex scenarios. This study aimed to compare the detection of imaging features and complications of acute cholecystitis between US and MDCT in a cohort of confirmed cases, and to evaluate their complementary roles in clinical practice. A retrospective study was conducted including 134 adults with clinically suspected acute cholecystitis who underwent same-day US and MDCT, with subsequent confirmation by pathology or intervention. Two radiologists independently reviewed all imaging studies, and the detection of imaging features and complications was compared. US showed significantly higher detection rates than MDCT for gallbladder wall thickening (98.5
Concomitant abdominoplasty and breast surgery has gained popularity among women seeking comprehensive esthetic rejuvenation. However, concerns remain regarding whether combining procedures increases perioperative risk compared with performing them in isolation. Compare complication rates following concomitant abdominoplasty and breast surgery versus isolated procedures. A systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library was conducted. Eligible studies included patients undergoing abdominoplasty, breast surgery, or both, with direct comparison of complication rates. Risk of bias was assessed using ROBINS-I, and certainty of evidence was graded with GRADE. Random-effects meta-analysis was performed to calculate pooled odds ratios with 95 www.springer.com/00266.
Glaucomatous optic neuropathy (GON), affecting an estimated 64.3 million people globally, causes irreversible vision loss when not detected early. Traditional diagnosis requires time-consuming ophthalmic examinations by specialists. Recent deep learning models for automating GON detection from colour fundus photographs (CFP) have shown promise but often suffer from limited generalizability across different ethnicities, disease groups and examination settings. To address these limitations, we introduce GONet, a robust deep learning model developed using seven independent datasets, including over 119 000 CFPs with gold-standard annotations and from patients of diverse geographic backgrounds. GONet consists of a DINOv2 pre-trained self-supervised vision transformer fine-tuned using a multisource domain strategy. GONet demonstrated high out-of-distribution generalizability, with an AUC of 0.88-0.99 in target domains. GONet performance was similar or superior to state-of-the-art works and the cup-to-disc ratio, by up to 18.4%. GONet is available via Lirot.ai (www.aimlab-technion.com/lirot-ai). We also contribute a new dataset consisting of 747 CFPs with GON labels as open access, available at https://doi.org/10.13026/pdxv-m215.
Background Pulmonary embolism (PE) is a leading cause of morbidity among cancer patients. The COVID-19 pandemic introduced new challenges to healthcare delivery. This study aimed to evaluate the impact of the COVID-19 pandemic on PE-related hospitalizations, treatment, and in-hospital outcomes in patients with active cancer. Methods We conducted a retrospective analysis using the National Inpatient Sample database from 2016 to 2021. Patients with active cancer and a primary diagnosis of acute PE were categorized into three groups: pre-COVID-19 (2016–2019), peak COVID-19 (2020), and ongoing COVID-19 (2021). We compared baseline characteristics, in-hospital procedures, and clinical outcomes among these groups. Multivariable logistic regression was employed to assess associations between COVID-19 periods and outcomes. Results Among 170,630 patients with PE and cancer, admission rates decreased during the pandemic. Patients hospitalized during the COVID-19 pandemic more frequently presented with severe PE phenotypes, including saddle PE (9.7% and 9.4% vs. 7.5%, p<0.001) and acute cor pulmonale (8.4% and 8.9% vs. 5.9%, p<0.001). Thrombolysis-based therapies increased during the pandemic, whereas adjusted odds of catheter-directed embolectomy were lower. Despite more severe presentations, in-hospital mortality remained relatively stable (6.0% pre-COVID-19, 6.0% peak, 5.5% ongoing; p=0.004). Conclusion The COVID-19 pandemic led to decreased PE-related hospitalizations among cancer patients but was associated with more severe presentations and shifts in therapeutic strategies. Notably, in-hospital mortality remained stable, which may be consistent with maintained PE care pathways during the pandemic. These findings highlight the need for robust, adaptable healthcare systems to ensure continuity of care for high-risk populations during global health crises.
