Background/Objectives: Nonacute subdural hematomas (naSDHs) are a prevalent intracranial pathology, particularly in older people, due to increased brain atrophy, fall risk, and anticoagulant use. This study examines the impact of frailty on the surgical outcomes of craniotomy for naSDH over 20 years. Methods: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2021 were analyzed, including 251,597 patients who underwent cranial decompression for naSDH. Patients were selected using specific ICD codes. Frailty was calculated using the modified frailty index (mFI-5 and mFI-11) and the Charlson Comorbidity Index (CCI). Outcomes were compared using descriptive statistics and multivariable regression models. Results: 251,597 patients underwent craniotomy, with a mean age of 69.2 years. The cohort exhibited significant comorbid conditions, reflected in a mean Charlson Comorbidity Index (CCI) of 3.8, and a high frailty prevalence, with 23.49% of patients classified as frail and 20.14% as severely frail. The CCI demonstrated the highest predictive value for adverse outcomes, with an area under the curve (AUC) of 0.6346 for mortality and 0.6804 for complications. Frailty indices (mFI-5 and mFI-11) were also strongly associated with increased mortality (p < 0.001), complications (p < 0.001), and extended length of stay (p < 0.001). Age was not a significant predictor of outcomes. Conclusions: This study highlights the moderate impact of frailty on surgical outcomes for naSDH.

Surgical intervention utilizing various approaches is a cornerstone in the management of breast cancer. The surgical approaches include lumpectomy, mastectomy, axillary lymph node dissection, and primary or delayed reconstruction. Post-mastectomy radiotherapy is frequently recommended in cases of advanced tumors and extensive lymph node involvement. However, there are several adverse effects of radiotherapy. In this article, we critically reviewed the various complications. Additionally, we discussed the biological basis of radiation-induced tissue damage, the impact of implant-based and autologous tissue reconstruction, and the functional and aesthetic results of the reconstruction. Indeed, several radioprotective agents can attenuate the adverse effects of post-mastectomy radiotherapy while sustaining oncologic efficacy. Radioprotective agents, including free radical scavengers and antioxidants, offer promising strategies to protect tissues from the oxidative stress and inflammation induced by radiotherapy. The role of several radioprotective agents, including amifostine, N-acetylcysteine, tempol, manganese superoxide dismutase (MnSOD) plasmid liposomes, vitamin E, and betacarotene has been analyzed with a focus on their logistical applications in breast reconstruction. Despite several challenges, the integration of radioprotective agents into post-mastectomy radiotherapy protocols offers significant potential to improve reconstructive outcomes. Development of novel radioprotective agents with improved selectivity and fewer side effects and large-scale clinical trials in diverse group of patients are warranted to determine long-term safety and efficacy.

Objective: Randomized trials will ultimately determine whether stand-alone middle meningeal artery embolization (MMAE) is effective in preventing the recurrence of chronic subdural hematoma (cSDH). We therefore characterized in-hospital complications, length of stay, and discharge disposition among adults undergoing stand-alone MMAE for non-traumatic cSDH in the United States. Methods: We conducted a retrospective cohort analysis using the National Inpatient Sample (2016–2022) to identify adult patients (≥18 years) with a primary diagnosis of nontraumatic cSDH. Primary outcomes included inpatient complications, non-home discharge (NHD), and extended length of stay (eLOS). 1:5 Propensity score matching (PSM) and multivariable regression were adjusted for baseline differences, including demographics, frailty (mFI-5), illness severity (APR-DRG subclass), and comorbidities. Presenting symptomatology (encephalopathy, gait instability, weakness, headache, etc.) was incorporated into both matching and regression models. Results: Of 65,340 patients, 3390 (5.2%) underwent MMAE and 61,950 (94.8%) underwent surgery. After PSM, 1740 MMAE and 6525 surgical patients were analyzed. Following adjustment for demographics, frailty, illness severity, comorbidities, and presenting symptoms, standalone surgery remained significantly associated with increased inpatient morbidity and resource utilization. Compared to MMAE, surgery carried 1.8x the odds of any complication ( P < .0001), 3.1x the odds of non-home discharge ( P < .0001), and 2.2 times the odds of extended length of stay ( P < .0001). There were no significant differences in in-hospital mortality ( P = .991) or cost outlier status ( P = .558). Conclusions: In this nationally representative sample (unmatched and matched cohorts), stand-alone MMAE demonstrated a 3–4% inpatient mortality and a 20% overall complication rate.

Background: Fibrous dysplasia (FD) is a postzygotic mosaic disorder caused by activating GNAS mutations, resulting in the replacement of normal bone with fibro-osseous tissue. FD is classified as monostotic (MFD), polyostotic (PFD), or McCune-Albright syndrome (MAS), and skeletal lesions may demonstrate either aggressive or nonaggressive biological behavior. The purpose of this study was to evaluate whether FD subtype was associated with the biological behavior of craniofacial skeletal lesions. Methods: This was a retrospective cohort study of subjects with craniofacial FD/MAS treated at Boston Children’s Hospital from 1998 to 2025. The predictor variable was FD subtype, and the primary outcome was biological behavior. Categorical variables were analyzed using χ ² and Fisher tests. Continuous variables were assessed with ANOVA. Pairwise comparisons were performed for significant findings. Significance was defined as P <0.05. Results: Fifty-seven subjects were included, with a mean age of 10.4±4.7 years. Aggressive biological behavior was observed in 5 (62.5%) subjects with MAS, 15 (42.9%) with PFD, and 3 (21.4%) with MFD ( P =0.15). Craniofacial swelling was the most common presenting symptom in MFD (50.0%) and PFD (40.0%), and precocious puberty was the most common in MAS (62.5%). MAS was associated with higher rates of pelvic, spine, and rib involvement than PFD ( P <0.05). It also had greater rates of skull base, optic canal, and nasal involvement than MFD ( P <0.05). Conclusions: McCune-Albright syndrome demonstrated a high rate of aggressive craniofacial FD behavior, though not significantly greater than MFD or PFD. MAS demonstrated the most extensive craniofacial and noncraniofacial skeletal involvement.