The relevant metabolite biomarkers for risk prediction of early onset of ventricular fibrillation (VF) after ST-segment elevation myocardial infarction (STEMI) remain unstudied. Here, we aimed to identify these imetabolites and the important metabolic pathways involved, and explore whether these metabolites could be used as predictors for the phenotype. Plasma samples were obtained retrospectively from a propensity-score matched cohort including 42 STEMI patients (21 consecutive VF and 21 non-VF). Ultra-performance liquid chromatography and mass spectrometry in combination with a comprehensive analysis of metabolomic data using Metaboanalyst 5.0 version were performed. As a result, the retinal metabolism pathway proved to be the most discriminative for the VF phenotype. Furthermore, 9-cis-Retinoic acid (9cRA) and dehydrophytosphingosine proved to be the most discriminative biomarkers. Biomarker analysis through receiver operating characteristic (ROC) curve showed the 2-metabolite biomarker panel yielding an area under the curve (AUC) of 0.836. The model based on Monte Carlo cross-validation found that 9cRA had the greatest probability of appearing in the predictive panel of biomarkers in the model. Validation of model efficiency based on an ROC curve showed that the combination model constructed by 9cRA and dehydrophytosphingosine had a good predictive value for early-onset VF after STEMI, and the AUC was 0.884 (95% CI 0.714–1). Conclusively, the retinol metabolism pathway was the most powerful pathway for differentiating the post-STEMI VF phenotype. 9cRA was the most important predictive biomarker of VF, and a plasma biomarker panel made up of two metabolites, may help to build a potent predictive model for VF.

Objective: To evaluate whether discharge with a prednisone taper is associated with a reduced incidence of delayed facial nerve palsy (DFP) following acoustic neuroma resection. Methods: We conducted a retrospective weighted case‐control study of patients undergoing acoustic neuroma resection via middle fossa, retrosigmoid, or translabyrinthine approaches. Inclusion was restricted to patients with normal facial nerve function (House‐Brackmann grade I) preoperatively and at discharge. Cases were patients who developed DFP after discharge, defined as new‐onset House‐Brackmann grade ≥ II occurring ≥ 72 h postoperatively. Controls were patients without DFP from the same source population. The primary exposure was discharge with a standardized oral prednisone taper (60 mg daily for 9 days followed by a 10 mg/day taper). Inverse probability weighting (IPW) based on propensity scores was used to adjust for confounding by indication. Weighted logistic regression was performed to estimate the association between prednisone taper and DFP. Results: The study included 74 cases and 187 controls. Steroid taper was prescribed to 44.6% of cases and 51.3% of controls. In unadjusted analysis, prednisone taper was not associated with a reduction in DFP risk. After IPW adjustment, prednisone taper was not associated with DFP (OR 0.99, 95% CI: 0.48–2.07). Covariate balance was achieved after weighting (SMD < 0.1). Steroid attributable side effects were documented in 10% of treated patients. Conclusion: Discharge with a prednisone taper was not associated with a reduced incidence of delayed facial nerve palsy following acoustic neuroma resection. These findings do not support prophylactic corticosteroid use for prevention of DFP. Level of Evidence: 3.

Objectives: Gross tumour volume has been proposed as a complementary prognostic marker in laryngeal squamous cell carcinoma. This systematic review and meta-analysis evaluates the prognostic value of pre-treatment gross tumour volume. Methods: MEDLINE, Embase and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting pre-treatment gross tumour volume and survival outcomes in laryngeal cancer were included. The primary outcome was overall survival, and the secondary outcome was disease-free survival. Hazard ratios were pooled using random-effects meta-analysis. Risk of bias was assessed using the Quality in Prognosis Studies tool, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Eight retrospective studies including 1351 patients were included. Increasing gross tumour volume was significantly associated with worse overall survival (pooled hazard ratio per 1 cm ³ increase: 1.03; 95 per cent confidence interval: 1.02–1.05), with a similar association observed for disease-free survival. Overall risk of bias was moderate. Conclusions: Higher gross tumour volume is independently associated with poorer survival in laryngeal cancer and may provide prognostic information beyond tumour-node-metastasis staging.

Communication, carer-health care professional relationship, and power dynamics are important considerations in pediatric health care. There is paucity of evidence about best practice for addressing parents of children in a hospital care setting, potentially affecting health care provision. We surveyed parents attending Evelina London Children’s Hospital to assess the preferences of parents to different appellations used by health care professionals to address them and their impact on parents’ perception of involvement in the care of their child. Two hundred fifty-four (84.6%) parents responded to the survey. Two hundred one (92.6%) parents did not feel the way they were addressed contributed to them feeling their value was neglected from the care of their child. At the center studied, appellations most acceptable to parents were their first name or “Mum”/“Dad.” In current practice, the appellation used most is “Mum”/“Dad,” 112 (69.1%) and 40 (62%), respectively.