Background: Structural inequities, in part, undergird urban–rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients’ access to and perceived importance of supportive cancer care resources. Methods: We used data collected from November 2017 to May 2018 from a larger cross-sectional needs assessment about patients’ support needs, use of services, and perceptions at a Midwestern United States cancer center. Oncology patients received a study packet during their outpatient clinic visit, and interested patients consented and completed the questionnaires. Results: Among the sample of 326 patients, 27% of the sample was rural. In adjusted logistic regression models, rural patients were less likely to report using any secondary support services (15% vs. 27%; OR = 0.43, 95%CI [0.22, 0.85], p = 0.02) and less likely than urban counterparts to perceive secondary support services as very important (51% vs. 64%; OR = 0.57, 95%CI [0.33, 0.94], p = 0.03). Conclusion: Structural inequities likely have implications on the reduced access to and importance of supportive care services observed for rural cancer patients. To eliminate persistent urban–rural disparities in cancer care, rural residents must have programs and policies that address cancer care and structural inequities.

The hyperdense middle cerebral artery sign on computed tomography indicates proximal middle cerebral artery occlusion. Recent reports suggest an association between the hyperdense sign and successful reperfusion. The prognostic value of the hyperdense middle cerebral artery sign in patients receiving mechanical thrombectomy has not been extensively studied. Our study aims to evaluate the association between the hyperdense middle cerebral artery sign and functional outcome in patients with M1 occlusions that had undergone mechanical thrombectomy. We conducted a single-center retrospective observational cohort study of 102 consecutive patients presenting with acute M1 occlusions that had undergone mechanical thrombectomy. Patients were stratified into cohorts based on the presence of hyperdense middle cerebral artery sign visually assessed on computed tomography by two readers. The outcomes of interests were functional disability measured by the ordinal Modified Rankin Scale (mRS) at 90 days, mortality, reperfusion status and hemorrhagic conversion. Out of the 102 patients with M1 occlusions, 71 had hyperdense middle cerebral artery sign. There was no significant difference between the cohorts in age, baseline mRS, NIHSS, ASPECTS, and time to reperfusion. The absence of hyperdense middle cerebral artery sign was associated with increased odds of being dependent or dying (higher mRS) (OR: 3.24, 95% CI: 1.30–8.06, p = 0.011) after adjusting for other significant predictors, including age, female sex, hypertension, presenting serum glucose, ASPECTS, CTA collateral score, and successful reperfusion. The absence of hyperdense middle cerebral artery sign is associated with worse functional outcome in patients presenting with M1 occlusions undergoing thrombectomy.

Endometriosis is associated with gastrointestinal (GI) and urogenital (UG) microbial dysbiosis in patients with endometriosis (P-EOSIS). Sexual partner exposure may contribute to microbial dysbiosis but has not been studied in P-EOSIS. We hypothesized that sexual partner number, hormonal and surgical therapy would affect GI/UG microbial dysbiosis in P-EOSIS. Urine, fecal and vaginal swabs from control (n = 15) and P-EOSIS (n = 33) were collected on the day of surgery (DOS) and ∼1-3 weeks post-surgical intervention (PSI). Control and P-EOSIS were grouped based on hormonal therapy (HT) to determine the effect of HT on microbial profiles, Control (HT n = 8; no HT n = 7) and P-EOSIS (HT n = 18; no HT n = 15). Samples underwent DNA extraction and sequencing of the V4 region of 16S rRNA gene. Sequences were processed using QIIME2 and amplicon sequence variants (ASV) were analyzed for microbial differences. Pearson's and Spearman correlation analyses determined associations among microbial features and sexual partner exposure. P-EOSIS had microbial dysbiosis characterized by unique GI/UG bacteria and altered microbial richness and diversity. Hormonal and surgical intervention in P-EOSIS restored GI microbial diversity. Increased sexual partner exposure decreased GI/UG microbial diversity. P-EOSIS who had 10 or more sexual partners had greater microbial dysbiosis compared to 4-6 partners. Surgical intervention negatively correlated with sexual partner numbers and GI/UG microbial abundance. Increased sexual partner exposure may enhance microbial dysbiosis in P-EOSIS and diminish the effectiveness of HT and surgical interventions.

Background: Body mass index (BMI) is an imperfect measure of patients' adiposity and operative risk. Radiographic and direct subcutaneous measurements have been utilized in attempts to more accurately characterize the risk of postoperative complications, including surgical site infection. This study aims to evaluate whether direct tissue depth measurement is a more accurate predictor of skin complication following direct anterior total hip arthroplasty (THA). Methods: A retrospective chart review of patients who underwent elective THA between April 30, 2020, and January 31, 2023, was performed. Baseline demographics, antibiotics, anticoagulation, and intraoperatively measured tissue depths at proximal, middle, and distal portions of the incision were recorded. Patient follow-up was reviewed to assess the development of skin complication in the acute postoperative period. Results: Data were collected from 280 patients who underwent THA via direct anterior approach by a single surgeon. The mean age was 66.0 years, and 52.1% were female. A total of 18/280 (6.4%) patients developed an abrasion (5/18) or superficial surgical site infection (13/18) within the first 60 days postoperatively. Patients who developed skin complications had a significantly higher BMI (33.7 kg/m(2) vs 29.9 kg/m(2); P = .0021). Patients with a BMI >30 kg/m(2) had more than 5 times increased odds of developing a superficial skin complication in the acute 60-day postoperative period compared to those with a BMI <30 kg/m(2) (Odds ratio = 5.318, P = .0059). None of the measured tissue depths, nor their average together, were shown to be significant predictors of skin complications. Conclusions: This study showed that BMI is a significant predictor of acute skin complications in direct anterior THA patients. No other significant predictors were found to be associated with increased risk, including proximal, middle, and distal tissue depths. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).