Importance:Preoperative and perioperative nivolumab improve event-free survival in resectable non-small cell lung cancer. The role of adjuvant nivolumab after upfront surgery is unknown. Objective:To determine whether adjuvant nivolumab improves disease-free survival and overall survival in patients with resected non-small cell lung cancer with any tumor programmed death-ligand 1 (PD-L1) expression and in those with at least 50% PD-L1 expression. Design, Setting, and Participants:This open-label, randomized phase 3 study enrolled participants from May 2016 through September 2019, with median follow-up of 72.6 months at the data cutoff in December 2025. The study was conducted at 378 centers in the US National Clinical Trials Network. Patients were identified through a screening trial. Those with resected tumors at least 4 cm and/or who were lymph node positive (N1/N2) were eligible for inclusion after completion of planned standard adjuvant therapy if the tumor was adenocarcinoma without sensitizing sequence variants in EGFR and ALK or squamous cell carcinoma. Intervention:Patients were randomized in a 1:1 ratio to receive nivolumab 480 mg intravenously every 4 weeks for up to 1 year or standard care observation. Main Outcomes and Measures:Co-primary end points were disease-free survival in the intention-to-treat population and in those with tumoral PD-L1 expression at least 50%. Overall survival was examined if the corresponding test of disease-free survival was statistically significant. Results:A total of 466 patients (median age, 66 years; 241 [52%] male) were assigned to receive nivolumab and 469 (median age, 67 years; 245 [52%] male) to undergo standard care observation. The median duration of follow-up was 72.6 months. The trial was stopped for futility at 75% information. In the intention-to-treat population, median disease-free survival was 71.3 months with nivolumab and 68.8 months with observation (hazard ratio for progression or death, 0.97 [97% CI, 0.79-1.20]; [95% CI, 0.81-1.17]; 1-sided P = .39). In the subset of participants with PD-L1 of at least 50%, median disease-free survival was 89.8 months with nivolumab and 78.5 months with observation (hazard ratio for progression or death, 0.86 [98% CI, 0.55-1.34]; [95% CI, 0.59-1.25]; 1-sided P = .22). Conclusions and Relevance:Adjuvant nivolumab was not associated with improved disease-free survival in patients with resected non-small cell lung cancer without sensitizing EGFR and ALK alterations when given after planned adjuvant chemotherapy and/or radiotherapy. Trial Registration:Clinicaltrials.gov Identifier: NCT02595944.

Mirror Therapy (MT) effectively supports post-stroke upper-limb rehabilitation but requires professional supervision and often leads to low patient motivation. While digital MT systems address these limitations, they typically compromise the embodiment benefits of traditional mirrors. Through informant-driven design with interdisciplinary experts, we developed A-MIrror, an augmented reality mirror system that preserves the view of both mirrored hand and overlays digital guidance. Using dual cameras for eye and hand tracking, the system creates a visual illusion where both real and mirrored hands appear to naturally interact with virtual 3D objects on screen. Our evaluation with 14 post-stroke patients and 8 therapists demonstrates that A-MIrror significantly enhances motivation compared to traditional MT (p <.01) while achieving comparable embodiment experiences and even superior illusion latency (30.47% faster, p <.001) to traditional mirrors. This study presents a promising approach for independent post-stroke rehabilitation that integrates the strengths of both traditional and digital MT, offering insights for enhancing future digital rehabilitation applications.

Introduction Obesity is a well-established risk factor for the development, recurrence, and postoperative complications of ventral hernia repair. However, the relationship between obesity and inguinal hernia repair is less well defined, with limited evidence on how body mass index (BMI) influences operative approach and outcomes.Methods A retrospective review of the 2022-2023 ACS-NSQIP database was performed including all adult patients who underwent inguinal and femoral hernia repairs identified using CPT codes. Bivariate and multivariable regression analyses were used to examine the impact of obesity and BMI on operative approach, case acuity, operative time, and short-term outcomes after inguinal hernia repair.Results A total of 73 456 adult patients were identified with a mean age of 61 years. Higher BMI was associated with greater operative complexity, including longer operative times and increased use of robotic and combined approaches. Surgical site occurrences (SSOs) were uncommon overall (0.7%) but increased progressively with higher BMI. In multivariable analysis, the association between BMI and operative characteristics, SSOs, and major complications varied across BMI levels. Higher BMI was independently associated with increased odds of SSOs and major complications, while laparoscopic and robotic approaches were consistently associated with lower odds of adverse outcomes compared with open or combined approaches.Conclusion Higher BMI is associated with increased operative complexity and worse short-term postoperative outcomes following inguinal hernia repair, while minimally invasive approaches were associated with lower odds of obesity-related adverse outcomes. These findings highlight the importance of individualized risk stratification and preoperative optimization in inguinal hernia repairs.

Objective This study aimed to evaluate the usability and user experience of the FLEXO-Arm1 upper limb rehabilitation robot among stroke survivors and rehabilitation therapists. Methods A mixed-methods approach was employed, incorporating System Usability Scale (SUS) and User Experience Questionnaire (UEQ) assessments alongside semi-structured interviews. Participants included stroke survivors with varying degrees of upper limb dysfunction and rehabilitation therapists who utilized the FLEXO-Arm1 for Passive Movement Training (PMT) and task-oriented training (TOT). Results Overall SUS scores indicated that stroke survivors rated the robot's usability higher (A-, 87%) than rehabilitation therapists (B-, 67%). UEQ analysis revealed positive evaluations across all scales, particularly in attractiveness and clarity, with stroke survivors providing higher ratings than therapists. Semi-structured interviews highlighted operational challenges, particularly for those with severe upper limb dysfunction, while affirming the robot's acceptance and potential as a supplementary rehabilitation tool. Conclusion The FLEXO-Arm1 robot demonstrates favorable usability and user experience for both stroke survivors and therapists. While the device shows promise in rehabilitation settings, enhancements are necessary for users with severe impairments. Further studies should explore the device's long-term impact on rehabilitation practices.

BACKGROUND AND OBJECTIVES:Failure to rescue (FTR), defined as death following a postoperative complication, is an established quality metric; however, national data after pulmonary resection remain limited. We aim to identify patient-, procedural-, and hospital-level factors associated with FTR after pulmonary resection for lung cancer and evaluate related outcomes. METHODS:The National Inpatient Sample (2016-2022) was used to identify adults undergoing elective pulmonary resection for lung cancer who developed ≥ 1 major complication. FTR was defined as in-hospital mortality. Multivariable logistic regression identified predictors. Secondary outcomes included length of stay, costs, and discharge disposition. RESULTS:Among 14,575 patients with major complications, FTR occurred in 2.6%. Frailty (OR 3.44, 95% CI 2.73-4.35) and comorbidity burden (Elixhauser ≥ 2: OR 4.87, 1.54-15.43) were the strongest predictors. Pneumonectomy (OR 2.78, 1.82-4.23), age ≥ 75 years (OR 2.21, 1.47-3.32), and open approach (OR 1.78, 1.41-2.24) were also associated, while female sex and private insurance were protective. No hospital factors were independently associated. CONCLUSIONS:FTR is driven by patient vulnerability and procedural complexity rather than hospital characteristics. These findings emphasize preoperative risk stratification and complication management in high-risk patients but do not support regionalization to high-volume centers as a strategy to reduce FTR.

BACKGROUND AND OBJECTIVES: Flow diversion (FD) has become increasingly common over the past decade. Although predominantly used for unruptured aneurysms given the need for patients to take dual antiplatelet therapy, these devices have been increasingly leveraged for ruptured aneurysms. FD use remains selective, however, and aneurysm characteristics are unlikely to be the sole driver of FD utilization. This study characterizes recent trends in FD use, with emphasis on patient and hospital factors associated with increased rates of utilization. METHODS: This is a retrospective cohort study in which patients who underwent endovascular treatment of an aneurysm from 2020 to 2022 were selected from the National Inpatient Sample and characterized as unruptured or ruptured. Patients with other vascular malformations or traumatic hemorrhages were excluded. The Cochran-Armitage trend test was used to assess trends over time. Multivariable analysis was used to determine variables independently associated with FD use. RESULTS: In total, 9081 patients met inclusion criteria (5459 unruptured, 3622 ruptured). In the unruptured cohort, 2824 (51.7%) underwent FD. In the ruptured cohort, 500 (13.8%) underwent FD. In the unruptured cohort, FD use trended toward, but did not reach, a significant increase over the study period ( P = .07). However, the ruptured cohort did show a significant increase in FD use over time ( P = .01). The Pacific census division was significantly less likely to use FD in both the unruptured (odds ratio 0.931, P = .002) and ruptured (odds ratio 0.932, P = .020) cohorts. Older age was associated with decreased FD use only in the unruptured group ( P < .0001). CONCLUSION: As FD becomes an increasingly common way to treat aneurysms, it is important to assess practice trends and identify potential disparities in using these devices. FD use appears to be increasing for ruptured aneurysms. Determining whether lower FD use in the Pacific division is due to varying practice patterns across the country requires further investigation.

Background Aortic morphology is an important consideration in patients who present with acute type B aortic dissection (TBAD). This study evaluates the relationship between the distal extent of dissection with malperfusion syndromes, clinical outcomes after thoracic endovascular aortic repair (TEVAR) and mortality. Methods The Vascular Quality Initiative (VQI) database was queried from 2012 to 2022 for patients undergoing TEVAR for acute TBAD. Primary exposure variable was distal extent of dissection, categorized as thoracic (zones 2-5), abdominal (zones 6-9) or iliac (zones 10-11). Primary endpoints were 30-day and 2-year mortality. Secondary endpoints included postoperative malperfusion, resolution of malperfusion following TEVAR, and reoperation. Outcomes were compared between cohorts. Results 2,455 patients were included. A more distal extent of dissection was associated with a stepwise increase in risk of lower extremity (5.8% vs. 8.7% vs. 27.4%), intestinal (5.1% vs. 13.6% vs. 19.8%) and renal (6.7% vs. 17.7% vs. 27.3%) ischemia on presentation (p<0.0001 for all). Distal extent of dissection was associated with increased rates of postoperative mesenteric (2.4% vs. 4.6% vs. 6.1%, p=0.0009) and renal (2.7% vs. 5.5% vs. 6.0%, p=0.0036) ischemia, and increased rates of reoperation (11.3% vs. 15.0% vs. 17.3%, p=0.0017). Distal extent of dissection was not associated with resolution of malperfusion after TEVAR, and not independently associated with 30-day or 2-year mortality (p>0.05 for all). Conclusion Although a more distal extent of aortic dissection is associated with increased rates malperfusion on presentation and increased rates of complications after TEVAR, it is not independently associated with mortality.

INTRODUCTION:Randomized trials demonstrate noninferiority of sublobar resection in well-selected patients with non-small cell lung cancer, while retrospective cohort studies suggest worse survival. To investigate this discrepancy, we analyzed conditional death rate for both approaches, hypothesizing that while overall death rate for sublobar resection would be higher, the conditional death rate would be stable regardless of resection extent. METHODS:The National Cancer Database was queried for adult patients undergoing lobar versus sublobar resection for pathologic stage I and II disease from 2006 to 2017. Data were stratified by stage. Covariates included demographic and clinical variables. Conditional death rate (probability of death given survival at start of year) was plotted and analyzed for divergence. RESULTS:A total of 139,965 patients were identified with 110,478 (78.9%) stage I patients and 29,487 (21.1%) stage II patients. Sublobar resection was associated with decreased 10-y overall survival (stage I 52% versus 60%; P < 0.001; stage II 28% versus 37%; P < 0.001). For stage I disease the conditional death rate for all approaches (wedge, segmentectomy, and lobectomy) remained proportional and positive throughout the study time-period (0.0002, 0.0004, and 0.0008, respectively). In contrast, for stage II disease, there was an accelerated drop for sublobar resection (wedge and segmentectomy) with a convergence with lobectomy at ∼84 mo (-0.0108, -0.0098, and -0.0074, respectively). CONCLUSIONS:In stage I disease there continues to be decreased survival for patients that undergo sublobar resection in retrospective cancer registries; however, the conditional death rate differs minimally based on extent of resection. This suggests a similar pattern of disease-related death post resection.

BACKGROUND AND OBJECTIVES:Minimally invasive (MI) pulmonary metastasectomy may improve access in frail patients who are at high-risk for complications after thoracotomy. We compared postoperative complications among frail and non-frail patients undergoing pulmonary metastasectomy. METHODS:The Nationwide Readmissions Database (2017-2019) identified adult patients who underwent pulmonary metastasectomy. Frailty was determined using Johns Hopkins Adjusted Clinical Groups indicator. Independent propensity-score matches were performed for the open and MI cohorts. Odds ratio (OR) and incidence rate (IRR) were used to compare morbidity and length of stay (LOS). RESULTS:A total of 8778 patients underwent pulmonary metastasectomy, of which 3.1% (270/8778) were frail. In the open cohort after propensity-score matching (98-matched pairs), frail patients had more complications (OR 2.1; p < 0.0001) and increased LOS (IRR 2.6; p < 0.0001), both of which did not improve with a sublobar resection. In the MI cohort (167-matched pairs), frailty was associated with increased morbidity (OR 2.6; p < 0.001) and increased LOS (IRR 2.8; p < 0.001), but both were mitigated by sublobar resection (morbidity OR 0.44; p = 0.005; LOS IRR 0.66; p < 0.001). CONCLUSIONS:A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.

Mirror therapy (MT) is an effective approach in stroke recovery, but its impact on subcortical neural reorganization remains unclear. Thus, we aimed to investigate the neuroplastic effects on white matter due to MT. In this study, thirty-three participants with stroke were recruited and randomly assigned into the MT group (n=16) or the control group (n=17) for a 4-week intervention. Before and after the intervention, motor recovery was evaluated using the Fugl-Meyer Assessment upper limb subscale (FMA-UL), and the white matter structure and function were investigated using DTI and resting-state fMRI, focusing on the corticospinal tract and the corpus callosum. Significant correlations between the improvements of the FMA-UL and the baseline fractional anisotropy of ipsilesional corticospinal tract (p < 0.001) and corpus callosum (p = 0.009) were observed only in the MT group. Additionally, no significant structural alterations were found between the two groups after the intervention. The fractional amplitude of low-frequency fluctuation of ipsilesional corticospinal tract (p = 0.003) and corpus callosum (p = 0.005) were significantly enhanced only in the MT group, which were correlated with the improvements of the FMA-UL (p < 0.001). Furthermore, partial correlation analysis and subsequent mediation model analysis suggested that the changes of fractional amplitude of low-frequency fluctuation in corpus callosum partially mediated the effect of the baseline fractional anisotropy of ipsilesional corticospinal tract on the FMA-UL improvements in the MT group. This study provided neuroimaging evidence on white matter reorganization after MT, specifically the corpus callosum, suggesting a potential interhemispheric transcallosal neuroplastic mechanism of MT.

INTRODUCTION:Psychiatric comorbidities such as depression have previously been associated with adverse outcomes after neurosurgical interventions. Non-routine discharge, defined as discharge to any location other than the patient's home, has subsequently been associated with an increased likelihood of adverse post-discharge outcomes, readmission, and negative impacts on quality of life. To date, no prior studies have evaluated the association between depression, other psychiatric comorbidities, and clinical outcomes following surgical management of unruptured cerebral aneurysms (UCAs). METHODS:We conducted a retrospective analysis of the Nationwide Readmissions Database (NRD, 2016-2020). ICD-10-CM/PCS codes were used to select for patients who had (1) an unruptured aneurysm and (2) underwent open/endovascular treatment of their aneurysm. Patients with documented subarachnoid hemorrhage were excluded. Multivariable regression analyses were conducted to evaluate the association between comorbid depression and other psychiatric disease diagnoses (anxiety, schizophrenia, bipolar disorder, PTSD, etc.) with discharge disposition, length of stay (LOS), mortality, major complications, and 30-/90-day non-elective readmissions. RESULTS:From 2016 to 2020, 36,739 patients underwent repair (open or endovascular) of an UCA, and 15.4 % had a comorbid diagnosis of depression. Patients with depression were significantly more likely to have other psychiatric comorbidities such as anxiety (10.5 % vs 7.9 %, p < 0.001), identify as female (83.2 % vs 73.1 %, p < 0.001), and have an Elixhauser Comorbidity Index score of at least three (66.5 % vs 27.9 %, p < 0.001). After adjusting for covariates, both depression (RR 1.08, 95 % CI 1.02-1.14, p = 0.007) and other psychiatric comorbidities (RR 1.21, 95 % CI 1.14-1.29, p < 0.001) were associated with a higher likelihood of non-routine discharge. Depression was not associated with an increase in LOS or readmission rates; however, other psychiatric comorbidities were significantly associated with increases in both LOS (IRR 1.16, 95 % CI 1.09-1.24, p < 0.001) and 90-day readmission rates (OR 1.20, 95 % CI 1.05-1.38, p = 0.007). CONCLUSION:In patients undergoing surgical intervention for UCAs, comorbid depression and other psychiatric diagnoses are associated with higher likelihood of adverse discharge dispositions. This should be further queried to identify underlying, modifiable targets of intervention that may improve patient outcomes and lower overall cost of care.

Background: This study assessed the association between chronic obstructive pulmonary disease (COPD) severity and postoperative mortality among patients undergoing thoracic endovascular aortic repair (TEVAR) and complex endovascular aortic repair (CEVAR). Methods: A retrospective review of the Vascular Quality Initiative database identified elective TEVAR and CEVAR cases from 2013 to 2022, with endograft proximal landing zone >= 2 for thoracic or complex abdominal aortic disease. Symptomatic diseases, ruptures, and urgent or emergent surgeries were excluded. Patients were stratified by COPD severity. The primary outcome was in-hospital mortality. Secondary outcomes included respiratory complications and 1-year mortality. Multivariable logistic regression was used for in-hospital mortality, respiratory complications, and 1-year mortality. Results: Among 11,336 patients with TEVAR and CEVAR, 66% did not have COPD, 9% had COPD not on medications, 20% had COPD on medications, and 6% had COPD on home supplemental oxygen. In-hospital mortality was 2.3%, 3.7%, 3.2%, and 4.5% (P = 0.0004) respectively, and was not associated with increased odds of mortality. Respiratory complications occurred in 4.3%, 4.5%, 6.4%, and 7.3% (P < 0.0001) and were associated with increased odds for COPD on medications (OR 1.3) and COPD on home supplemental oxygen (OR 1.7). 1-year survival was 91%, 87%, 86%, and 80% and associated with increased risk for each COPD group (HR 1.4, HR 1.4, HR 1.9). Conclusion: Patients with COPD undergoing TEVAR and CEVAR have increased rates of in-hospital mortality, respiratory complications, and 1-year mortality. COPD severity is independently associated with increased respiratory complications and 1-year mortality, which should be factored into preoperative decision-making.

Objective The relationship between cortisol and perceived stress is poorly understood. We sought to determine whether perceived stress is associated with cortisol biomarkers in adolescents. Methods We examined 229 adolescents (mean age = 15.8 years). We measured perceived stress with the 14-item Perceived Stress Scale (PSS) questionnaire, serum cortisol (sCOR), salivary Cortisol Awakening Response (CAR: 30-minute post-awakening - awakening), salivary Diurnal Cortisol Slope (DCS: evening-awakening), and total daily salivary cortisol (TDC). We used multivariable linear regression to estimate baseline associations between PSS, TDC, sCOR, and FBG. We used mixed effects linear regression to estimate baseline associations between PSS and CAR and DCS. We tested twelve-week longitudinal associations between PSS and cortisol biomarkers using random effects regression. Analyses were adjusted for age, gender, and BMI. Results There were statistically significant associations between PSS and TDC (beta= -104.36 ± 34.3; p = 0.002) at baseline and between PSS and DCS at 12 weeks (beta= -0.058 ± 0.02; p = 0.01), but no association between PSS and sCOR or CAR (p > 0.26 for all) at baseline or 12-weeks. There were no associations between change in PSS and change in cortisol biomarkers longitudinally. Conclusion In adolescents, perceived stress measured by the PSS was inconsistently associated with TDC and DCS, and consistently unassociated with CAR and sCOR. Studies reporting on PSS outcomes should exercise caution when making conclusions about cortisol biomarkers. There’s a need for an instrument that captures a global measure of perceived stress and is sensitive to HPA functioning.

Low-intensity transcranial ultrasound stimulation (LITUS) is an emerging non-invasive neuromodulation technique for pain treatment, with the unique ability to modulate deep brain nuclei associated with pain. The aim of this study is to systematically review and summarize the evidence for the efficacy of LITUS in pain management and to elucidate the potential mechanisms underlying its analgesic effects. A systematic search was conducted across five databases up to Mar 31st, 2025. Controlled studies in both human and animal subjects were included. Two independent reviewers completed the screening and risk of bias assessment process following predefined inclusion and exclusion criteria. A total of thirteen studies were included in the review. These studies demonstrated LITUS’s potential in managing various types of pain among different populations and animal models, particularly targeting the anterior cingulate cortex, thalamus, insular cortex, primary sensorimotor cortex, and periaqueductal gray. Most included studies showed positive effects and verified the safety of LITUS on pain, reporting few adverse effects. LITUS is an effective and non-invasive tool for pain regulation in animals and humans, enabling precise modulation of deep brain circuits. Analgesic effects may be affected by pain-related risk factors, insufficient dosage, suboptimal protocols, and target selection. Initial evidence has highlighted the direct link between LITUS parameters, brain region responses, and pain behavior. Modulation of brain excitatory, nociceptive circuit, electrophysiological response, autonomic response, biochemistry, neuroinflammation, and psychology are proposed as the potential mechanisms underlying the efficacy of LITUS. More high-quality research is urgently needed to advance clinical LITUS use and reveal its mechanisms. • LITUS shows promising applications in pain management based on existing research. • The characteristics of LITUS enable precise modulation of deep pain-related nuclei. • Current research primarily originates from animal experiments and provoked pain in healthy subjects. • Some studies have begun to explore the mechanisms of LITUS for pain relief, but much remains unclear. • High-quality studies are needed to verify the analgesic effect LITUS and optimize stimulation protocols.

A machine learning model was developed and validated to predict postoperative complications in patients with acute type A aortic dissection (ATAAD) who underwent total arch replacement combined with frozen elephant trunk (TAR + FET), with the goal of improving postoperative survival quality and guiding clinical treatment. We retrospectively analyzed data from 635 ATAAD patients who underwent TAR + FET surgery at our institution between January 2018 and October 2023. Based on the International Aortic Arch Surgery Study Group definition of Major Adverse Outcomes (MAO), the entire dataset was divided into 160 patients with MAO and 475 patients without MAO. We utilized 66 variables to train 190 machine learning models. The SHAP method identified 11 strong predictors to create a simplified model. We evaluated the predictive performance and clinical utility of both models using receiver operating characteristic (ROC) curves, precision-recall curves (PRC), calibration plots, and clinical decision curves. The combination of Random Survival Forest (RSF) and Gradient Boosting Machine (GBM) was identified as the best predictive model. Both the full model and the simplified model achieved an area under the ROC curve above 0.85 and an area under the PRC curve above 0.703. The Brier values for the simplified model's calibration outcomes in the training and validation sets were 0.124 and 0.138, respectively, with a clinical utility risk threshold probability range of 0.2 to 0.9. A web-based simplified prediction model was developed (https://pmodel.shinyapps.io/pmodel/), enabling the prediction of complication risk in ATAAD patients undergoing TAR + FET surgery, thereby guiding clinical treatment decisions. The combination model of RSF and GBM effectively predicts the risk of postoperative complications in ATAAD patients, helping surgeons identify high-risk individuals and implement personalized perioperative management.

BACKGROUND:The Elixhauser (ECI) and Charlson-Deyo (CCI) comorbidity indices are two well-established measures used for assessing clinical prognosis and adjusting comorbidities in research. However, the optimal index is unclear within thoracic surgery. This study comparatively evaluates their effectiveness in predicting short-term outcomes (in-hospital mortality, complications, nonroutine discharge, and 30-/90-day readmissions) in minimally invasive pulmonary lobectomy (MIL) and minimally invasive Ivor Lewis esophagectomy (MIE). METHODS:Using the Healthcare Cost and Utilization Project National Readmission Database (2016-2018), MIL and MIE were identified using International Classification of Diseases, 10th Edition codes. Multivariable logistic regression models were constructed. The discriminative ability was quantified using the area under the receiver operating characteristic curve (AUC). The acceptable discriminative ability was defined as AUC > 0.70. RESULTS:CCI better predicted mortality (AUC 0.7866; 95% CI, 0.7549-0.8182) compared to ECI (AUC 0.7561; 95% CI, 0.7214-0.7908, p = 0.003) for MIL. The CCI marginally predicted nonroutine discharge (AUC 0.6427; 95% CI, 0.6362-0.6492 vs. ECI AUC 0.6399; 95% CI, 0.6333-0.6464, p = 0.01). In the MIE cohort, both the indices predicted mortality well (ECI 0.8038; 95% CI 0.7458-0.8618 vs. CCI 0.7969; 95% CI 0.7393-0.8546, p = 0.67). Neither index had acceptable discriminative ability for other outcomes. CONCLUSIONS:Based upon two commonly performed index thoracic procedures, the outcomes may differ by comorbidity measure employed and by surgery type, suggesting the need for careful selection of index, especially once patients are deemed fit for surgery. The CCI is superior in predicting mortality in patients with MIL. Both CCI and ECI are suitable for MIE. Furthermore, with the recent implementation of an updated ECI incorporating ICD-10 coding, these findings support the durability and robustness of the new ECI. Future research investigating their performances in predicting long-term outcomes in thoracic surgery may be warranted.

BACKGROUND:The ipsilesional hand after stroke has been shown to exhibit a minor deficit, impacting bimanual activities. This study investigates the effect of associated mirror therapy (AMT) on the less affected hand dexterity and explores the relationship between bilateral hand recovery poststroke. METHODS:An assessor-blinded, pilot randomized controlled study was conducted. Patients were assigned to the AMT or control group, receiving 30-minute training per time, five times a week for four weeks. The primary outcome was the ipsilesional Box and Block Test (BBT_I). The secondary outcomes included the contralesional Box and Block Test (BBT_C), Fugl-Meyer Assessment for Upper Extremity and Hand (FMA_UE and FMA_H), and Functional Independent Measure (FIM). Assessments were conducted at baseline, after 2-week, and 4-week treatment. RESULTS:All patients showed improved BBT_I, FMA_H, and FIM scores in the latter two weeks compared to the first two weeks (all P<0.05). The AMT group had higher FMA_H and FIM scores than the control group (P<0.001). Although the difference in BBT_I scores was insignificant (P=0.064), the AMT group performed better. Significant interaction effects were found in BBT_C and FMA_UE scores. The AMT group showed greater improvements in BBT_C and FMA_UE scores in 2-week and 4-week interventions than the control group (all P <0.05). Compared to the first two weeks, the AMT group showed improvements in FMA_UE and BBT_C scores during the last two weeks, while the control group only improved in FMA_UE scores (P<0.05). No correction was found in BBT_C and BBT_I change scores between bilateral hand recovery in either group during the first and the latter two weeks. CONCLUSIONS:AMT improves affected upper limb and hand motor impairment, hand dexterity, and daily activities, potentially enhancing dexterity in the less affected hand poststroke. There is no relationship between bilateral hand recovery during 4-week inpatient rehabilitation of subacute stroke.

OBJECTIVE:The use of flow diversion (FD) has rapidly increased over the last decade, particularly for treatment of complex aneurysms not amenable to conventional coil embolization (CE). We aimed to compare national outcomes and healthcare utilization associated with FD and CE of unruptured aneurysms. METHODS:The National Inpatient Sample (2019-2022) was used to identify patients with unruptured intracranial aneurysms who underwent CE or FD (patients undergoing both FD+CE were classified as FD). Pediatric patients, non-elective admissions, and patients with subarachnoid hemorrhage were excluded. Variables included sociodemographics (e.g., age, race, gender), hospital factors (e.g., size, ownership, teaching status, location), and basic clinical variables in bivariate and multivariable regression. Outcomes included in-hospital mortality, stroke, discharge disposition (favorable/unfavorable), length of stay, and total cost of hospitalization. RESULTS:7370 patients were identified, of which 4280 were CE and 3090 were FD. Given the elective nature of intervention, rates of mortality (0.19 %), unfavorable discharge disposition (2.77 %), and stroke (0.83 %) were low. On multivariable analysis, use of flow diversion was not associated with unfavorable discharge (OR 0.80, P = 0.211) or stroke (OR 0.91, P = 0.753). FD trended toward, but did not reach, statistical significance for elevated length of stay (IRR 1.04, P = 0.150); however, it did lead to a significantly higher overall cost (ß=$1260.98, P = 0.049) CONCLUSION: Nationally, short-term outcomes are similar between FD and CE, although use of FD does imbue a mildly higher hospitalization cost. Further work is needed to characterize large-scale, long-term outcome differences, particularly as FD use increases for more complex aneurysms not amenable to CE.