Caffeine as tested in the CAP trial is safe and effective for preterm infants with birthweights less than 1250 g. Evidence for its use beyond the indications and timing used in this trial is of low quality and conflicting. Some studies suggest that earlier use of caffeine increases the risk of mortality while others suggest it has important benefits. It appears that infants with apnea of prematurity and those receiving assisted ventilation are the most likely to benefit from caffeine. MPI-0479605 clinical trial Based on currently available evidence, routine early prescription of caffeine does not appear to be indicated. Infants continue to have potentially damaging episodes of hypoxia secondary to apnea beyond 34 weeks’ postmenstrual age. It is unclear whether prolonged use of caffeine improves outcomes in these infants. Randomized trials to resolve these uncertainties are required. They need to be large, at least the size of the CAP trial, and include neurodevelopmental outcomes.

Metabolic surgery is a standard treatment for obesity with type 2 diabetes (T2D), although the effects of metabolic surgery on the incidence rate of microvascular complications remain controversial.

We aimed to evaluate the effect of metabolic surgery versus nonsurgical treatments on the incidence rate of microvascular complications in obesity with T2D.

A meta-analysis of published studies.

We searched PubMed, Web of Science, and the Cochrane Library to identify clinical studies assessing the effect of metabolic surgery on the incidence rate of microvascular diabetic complications compared with that of nonsurgical treatments. We extracted the primary outcomes, including the incidence rate of microvascular complications after metabolic surgery.

A total of 32,756 participants from 12 studies were identified. Metabolic surgery reduced the incidence rate of microvascular complications (odds ratios [OR], .34; 95% confidence intervals [CI], .30-.39; P < .001) compared with that of nonsurgical treatments in obesity with T2D. Moreover, metabolic surgery also reduced the incidence of diabetic nephropathy (OR, .39; 95% CI, .30-.50; P<.001), diabetic retinopathy (OR, .52; 95% CI, .42-.65; P < .001) and diabetic neuropathy (OR, .27; 95% CI, .22-.34; P < .001) compared with nonsurgical treatments in obesity with T2D.

Metabolic surgery was superior to nonsurgical treatments in reducing the incidence of microvascular complications in obesity with T2D. Prospective studies, preferably randomized controlled trials, with evaluations of different types of metabolic surgery are warranted to provide guidelines for treatment preferences in obesity with T2D.

Metabolic surgery was superior to nonsurgical treatments in reducing the incidence of microvascular complications in obesity with T2D. Prospective studies, preferably randomized controlled trials, with evaluations of different types of metabolic surgery are warranted to provide guidelines for treatment preferences in obesity with T2D.

Risk stratification of cardiac surgery patients is usually based on the Society of Thoracic Surgeons (STS) score, that has limited predictive value in older persons. We aimed assessing whether the Short Physical Performance Battery (SPPB) improves, beyond the STS score, assessment of hospital prognosis in older patients undergoing elective cardiac surgery.

All patients aged 75+ years referred for elective cardiac surgery to Careggi University Hospital (Florence, Italy) from April 2013 to March 2017 were evaluated pre-operatively. Participants were classified according to the STS-Predicted Risk Of Mortality (STS-PROM) low (<4%), intermediate (4 to 8%), and high risk (>8%).Primary study outcomes were hospital mortality and STS-defined major morbidity. Length of hospital stay was an additional outcome.

Out of 235 participants (females 46.5%; mean age 79.6 years), 144 (61.3%) were at low, 67 (28.5%) at intermediate and 24 (10.2%) at high risk, based on the STS-PROM. SPPB (mean±SEM) was 8.8±0.2, 7.0±0.5, and 6.0±0.8 in participants at low, intermediate, and high risk, respectively (p<0.001). The primary outcome occurred in 62 participants (26.4%). In low-risk participants, the SPPB score predicted the primary endpoint (adjusted OR 0.77, 95% CI 0.66-0.89 per each point increase; p<0.001) controlling for STS-Major Morbidity or Operative Mortality (STS-MM) score. This result was not observed in the intermediate-high risk group.

SPPB predicts mortality and major morbidity in older patients undergoing elective cardiac surgery, classified as low risk with the STS risk score. The SPPB, applied preoperatively, might improve risk stratification in older patients undergoing elective cardiac surgery.

SPPB predicts mortality and major morbidity in older patients undergoing elective cardiac surgery, classified as low risk with the STS risk score. The SPPB, applied preoperatively, might improve risk stratification in older patients undergoing elective cardiac surgery.An osteochondral lesion of the talus (OLT) is an idiopathic acquired lesion of the subchondral bone that can lead to debilitating sequelae. The causes of OLT’s are still debatable, however, most agree that the etiology is repetitive microtrauma associated with vascular impairment. OLTs are most commonly described in the medial portion of the talus, while lateral involvement is less frequent. If not properly recognized and treated, an OLT may lead to numerous secondary conditions including premature osteoarthritis and functional limitations of the ankle joint. Multiple surgical and non-surgical treatment modalities have been described with varying results. Treatments are usually guided by the patients age, onset of symptoms, severity, and the disease stage according to the Berndt and Harty classification. Recent literature recommends curettage, drilling, or microfracture techniques for lesions which are no larger than 15mm in diameter and no deeper than 7mm. On the other hand, for large lesions or lesions that failed from primary bone marrow stimulation, surgery should be considered for autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATs or mosaicplasty), or osteochondral allograft transplantation [1]. This case study examines surgical treatment of an extensive OLT in a 53 year old man who suffered with continuous ankle pain for over 10 years, misdiagnosed as ankle joint arthritis. Level of clinical evidence Level of evidence 4.