Plant community responses to the individual and interactive effects of warming and herbivory across multiple years.

Anthropogenic climate warming affects plant communities by changing community structure and function. Studies on climate warming have primarily focused on individual effects of warming, but the interactive effects of warming with biotic factors could be at least as important in community responses to climate change. In addition, climate change experiments spanning multiple years are necessary to capture interannual variability and detect the influence of these effects within ecological communities. Our study explores the individual and interactive effects of warming and insect herbivory on plant traits and community responses within a 7-year warming and herbivory manipulation experiment in two early successional plant communities in Michigan, USA. We find stronger support for the individual effects of both warming and herbivory on multiple plant morphological and phenological traits; only the timing of plant green-up and seed set demonstrated an interactive effect between warming and herbivory. With herbivory, warming advanced green-up, but with reduced herbivory, there was no significant effect of warming. In contrast, warming increased plant biomass, but the effect of warming on biomass did not depend upon the level of insect herbivores. We found that these treatments had stronger effects in some years than others, highlighting the need for multiyear experiments. This study demonstrates that warming and herbivory can have strong direct effects on plant communities, but that their interactive effects are limited in these early successional systems. Because the strength and direction of these effects can vary by ecological context, it is still advisable to include levels of biotic interactions, multiple traits and years, and community type when studying climate change effects on plants and their communities.

More Efficient Chemical Recycling of Poly(ethylene terephthalate) by Intercepting Intermediates.

The research presented in this paper offers insight into the availability of intermediates in the depolymerization of Polyethylene Terephthalate (PET) to be used as feedstocks to create value added products. Monitoring the dispersity, molecular weight, end groups, and crystallinity of reaction intermediates during the heterogeneous depolymerization of PET offer insight into the mechanism by which the polymer chains evolve during the reaction. Our results show dispersity decreases and crystallinity increases, while the yield of insoluble PET remains high early in the reaction. Our interpretation of this data depicts a mechanism where chain scission targets amorphous tie-chains between crystalline phases. Targeting the tie-chains lowers the Mn of the polymer without changing the amount of recovered polymer flake. Chain scission of tie-chains and isolating highly crystalline PET lowers the dispersity ((D)) of the polymer chains, as the size of the crystalline lamellae guide the molecular weight of the depolymerized oligomers.  When sufficient end groups of PET chains are converted to alcohol groups, the PET flakes break apart into highly crystalline and less disperse polymer. Our results also demonstrate that the oligomeric depolymerization intermediates are readily repolymerized, offering new opportunities to more effectively and efficiently chemically recycle PET.

Links between climatic histories and the rise and fall of a Pacific chiefdom.

Sea level rise and climate change are shaping present societies, particularly those on oceanic islands. Few historical examples could serve as references for these changes. One such potential model is the Saudeleur Dynasty with its capital Nan Madol on the Pacific Island of Pohnpei. However, the timing of its construction, as well as the dynasty's fluctuations and potential environmental influences, has remained unresolved. Through the analyses of 230Th ages on 171 dates on corals fragments used as building materials and charcoal 14C ages from excavations, 2 major construction phases spanning from the 10th to the 15th century CE can be discerned. The results show that the first phase of the site's construction, spanning the 10th-12th century, marked the dynasty's rise. The second period, spanning from the late 12th to the early 15th century, provides the most substantial evidence for the demise of the island-scale chiefdom and a significant societal reorganization. The phases are centuries earlier than previously believed. With this new evidence, we propose the hypothesis that variations in the El Niño-Southern Oscillation and subsidence-related sea level rise presented major challenges for building and maintaining Nan Madol, and thus, influenced the course of the island's history. This case serves as a compelling example of how adverse climatic conditions can spur investments-in this case, in seawater defense under high sea levels-yet ultimately may contribute to abandonment. It offers lessons for island nations, showcasing coastal resilience in the face of worsening catastrophic events that unfolded over generations.

Outcome of adolescents and young adult acute myeloid leukemia patients compared with middle-aged patients: A single centre retrospective experience.

Adult acute myeloid leukemia (AML) patients under the age of 60 often receive similar intensive treatments, while outcomes between the adolescent and young adult (AYA) age group (18-39) and middle-aged adults (40-60 years) were seldom reported. We aim to study the characteristics and outcomes of AYA patients in comparison to middle-aged adults. A retrospective analysis was performed on AYA patients treated at Princess Margaret Cancer Center between 2008 and 2018. The primary outcomes include overall survival (OS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM). A total of 174 AYA patients and 176 middle-aged patients were included, with propensity score matching adjusting for potential major confounders. Comparing AYA and middle-aged patients, 5-year OS rates were similar at 54.6 % vs. 56.5 % (p=0.91), CIR rates at 29.5 % vs. 23.1 % (p=0.31), and similar NRM rates. Notably, non-transplanted AYA patients had a significantly higher CIR (39.8 %) compared to middle-aged patients (19.6 %) (p=0.0324), with more primary refractory/early relapsing disease. An observed trend toward improved OS in AYA patients post-2015 coincided with FLAG-IDA and haploidentical transplant implementations. In conclusion, the study suggests that AYA patients, particularly those not undergoing transplantation, may benefit from more intensive treatment strategies, emphasizing the need for tailored approaches in this age group.

Review of neuroimaging findings of intracranial angioinvasive fungal infections.

With increasing use of broad-spectrum antibiotics, advances in organ and stem-cell transplant therapy, and the continued diabetes mellitus II epidemic, as well as other risk factors, reports of fungal infections of the CNS have been increasing. The most lethal subset is the angioinvasive fungal infection. Aspergillus fumigatus, Mucor, and Fusarium tend to affect immunocompromised individuals depending on their risk factors. Exserohilum rostratum and Cladophialaphora species tend to infect immunocompetent individuals. Early diagnosis and treatment are imperative for improved outcomes and reduced morbidity and mortality. Clinical presentation is often nonspecific, while neuroimaging can be helpful for accurate diagnosis. CT of the head and/or the maxillofacial structures is the primary imaging modality. Once the infection begins to proliferate, areas of vasogenic and cytotoxic edema, with regional mass effect and shift of the midline structures may be seen. These findings, however, are often nonspecific and may also be seen in underlying neoplasm, inflammatory processes, and other intracranial infections. Characteristic findings on T1, T2, diffusion-weighted imaging (DWI), and gradient echo sequences (GRE) may help to further narrow the differential diagnoses. We present a review of neuroimaging findings that will aid the neuroradiologist in distinguishing intracranial angioinvasive fungal infections and lead to improved patient outcomes.

Internalized weight stigma and psychological distress mediate the association of perceived weight stigma with food addiction among young adults: A cross-sectional study.

BACKGROUND: Perceived weight stigma (PWS) and internalized weight stigma (IWS) are both associated with psychological distress and food addiction (FA). Using the previously proposed 'cyclic obesity/weight-based stigma' (COBWEBS) model, the present study extended the framework to investigate the mediating effects of IWS and psychological distress in the association between PWS and FA among young adults. Given that individuals who are overweight/have obesity have different vulnerabilities, this population was separately analyzed alongside the total study population. METHODS: An online survey comprising the Perceived Weight Stigma Scale, Weight Bias Internalization Scale (WBIS), Depression, Anxiety and Stress Scale-21 (DASS-21), and modified Yale Food Addiction Scale Version 2 was completed by 601 participants (59.6% females; mean age 29.3 years [SD = 6.07]). A total of 219 participants were categorized as being overweight/having obesity. RESULTS: A direct correlation was found between PWS and FA (standardized coefficient [ß] = 0.28, p < 0.001) among both populations, and was mediated by IWS and psychological distress (ß [95% CI] = 0.03 [0.01, 0.05] for WBIS score and 0.10 [0.06, 0.14] for DASS-21 score) among the total participants, but only mediated by psychological distress among participants who were overweight/had obesity (ß [95% CI] = 0.14 [0.06, 0.24]). CONCLUSIONS: The results demonstrated novel perspectives by showing the direct association between PWS and FA and the mediating roles of IWS and psychological distress. Treatment strategies such as psychological acceptance and psychoeducation could be used to reduce weight stigma, which could have positive downstream benefits of ameliorating FA. Future research may seek to study strategies for reducing weight stigma and psychological distress, to investigate their efficacy in improving disordered eating.

Correction: Flow and clogging of capillary droplets.

Correction for 'Flow and clogging of capillary droplets' by Yuxuan Cheng et al., Soft Matter, 2024, https://doi.org/10.1039/D4SM00752B.

Medication errors and mitigation strategies in obstetric anesthesia.

PURPOSE OF REVIEW: Medication administration errors represent a significant yet preventable cause of patient harm in the peripartum period. Implementation of best practices contained in this manuscript can significantly reduce medication errors and associated patient harm. RECENT FINDINGS: Cases of medication errors involving unintended intrathecal administration of tranexamic acid highlight the need to improve medication safety in peripartum patients and obstetric anesthesia. SUMMARY: In obstetric anesthesia, medication errors can include wrong medication, dose, route, time, patient, or infusion setting. These errors are often underreported, have the potential to be catastrophic, and most can be prevented. Implementation of various types of best practice cost effective mitigation strategies include recommendations to improve drug labeling, optimize storage, determine correct medication prior to administration, use non-Luer epidural and intravenous connection ports, follow patient monitoring guidelines, use smart pumps and protocols for all infusions, disseminate medication safety educational material, and optimize staffing models. Vigilance in patient care and implementation of improved patient safety measures are urgently needed to decrease harm to mothers and newborns worldwide.

Modulating Electrostatic Properties and Noncovalent Interactions via Structural Isomerism: The Microwave Spectra and Molecular Structures of (E)- and (Z)-1,2,3,3,3-Pentafluoropropene and Their Gas-Phase Heterodimers with the Argon Atom.

Microwave spectra of both the E and Z isomers of 1,2,3,3,3-pentafluoropropene along with all three of the singly substituted 13C isotopologues for each are obtained using broadband chirped-pulse Fourier transform microwave spectroscopy from 2.0-18.1 GHz. Associated quantum chemistry calculations show that the barrier to internal rotation of the CF3 group is significantly higher for the Z isomer, which is stabilized by an intramolecular hydrogen bond, although the barriers in both isomers are sufficiently high to prevent the observation of any effects due to internal rotation. The normal isotopologues of the argon heterodimers for both isomers are also observed in the broadband spectrum and a Balle-Flygare cavity Fourier transform microwave spectrometer is used to obtain the 5.0-20.6 GHz spectra of the corresponding 13C isotopologues. In each case, the argon atom locates so as to maximize its interactions with areas of significant electron density. However, mapped electrostatic potential surfaces indicate that the areas of greatest nucleophilicity are different for the two isomers, suggesting that they may interact differently in forming heterodimers with protic acids.

Radiochemistry and Complex Formation of the Cyclen-Derived Chelator DOTI-Me with Mn2+, Cu2+, Zn2+, Ga3+, In3+, Tb3+, and Lu3.

In this work, we describe the complex formation and radiochemistry of the cyclen-based chelator DOTI-Me bearing four methylimidazole arms. Radiolabeling properties were evaluated for 52gMn, 64Cu, 68Ga, 111In, 161Tb, and 177Lu, and DOTI-Me showed distinct differences to the structurally related H4DOTA. While radiochemical conversions (RCCs) for 52gMn and 111In were comparable to those of H4DOTA, DOTI-Me was not suited for 68Ga. Conversely, quantitative RCCs were achieved for 64Cu at ambient temperature, while elevated temperatures were required for complexation with H4DOTA. For 161Tb and 177Lu, good but not quantitative RCCs were obtained with DOTI-Me. With the exemption of 68Ga3+, radiolabeled complexes showed high stability in ligand challenge experiments and in human serum. X-ray analysis of the nonradioactive complexes revealed the formation of 8-coordinate Mn2+ and In3+ DOTI-Me complexes. Cu2+ adopted a unique distorted square-pyramidal 2 + 3 with the neutral DOTI-Me ligand and a Jahn-Teller distorted 4 + 2 coordination geometry for the diprotonated H2DOTI-Me2+ cation, respectively. For Zn2+, the complex with HDOTI-Me+ showed a distorted 4 + 3 pentagonal bipyramidal geometry. Summarizing, the ligand DOTI-Me may be an interesting alternative to H4DOTA for 52gMn, 64Cu, 111In, 161Tb, and 177Lu, covering diagnostic as well as therapeutic radionuclides. Further studies of targeted radiopharmaceuticals based on the DOTI-Me scaffold in combination with the set of radiometals presented herein are thus warranted.

Efficacy and Safety of Roxadustat for Anemia in Patients Receiving Chemotherapy for Nonmyeloid Malignancies: A Randomized, Open-Label, Active-Controlled Phase III Study.

PURPOSE: We evaluated the efficacy and safety of roxadustat, a first-in-class hypoxia-inducible factor prolyl hydroxylase inhibitor, for chemotherapy-induced anemia (CIA) in patients with nonmyeloid malignancies receiving multicycle treatments of chemotherapy. PATIENTS AND METHODS: In this open-label, noninferiority phase III study conducted at 44 sites in China, 159 participants age ≥18 years with CIA nonmyeloid malignancy and CIA were randomly assigned (1:1) to oral roxadustat or subcutaneous recombinant human erythropoietin-α (rHuEPO-α) three times a week for 12 weeks. Roxadustat starting dosages were 100, 120, and 150 mg three times a week for participants weighing 40-<50, 50-60, and >60 kg, respectively. rHuEPO-α starting dosage for all participants was 150 IU/kg three times a week. Both roxadustat and rHuEPO-α dosages could be modified. The primary end point was least-squares mean (LSM) change in hemoglobin (Hb) concentration from baseline to the concentration averaged over weeks 9-13. RESULTS: Of the 159 participants randomly assigned, 140 were included in the per-protocol set (roxadustat, n = 78; rHuEPO-α, n = 62). The LSM (95% two-sided CI) change from baseline to weeks 9-13 in Hb concentration was 17.1 (13.58 to 20.71) g/L with roxadustat and 15.4 (11.34 to 19.50) g/L with rHuEPO-α (mean difference [95% CI], 1.7 [-3.39 to 6.84]). The lower bound of the one-sided 97.5% CI for the treatment difference (‒3.4 g/L) was greater than the predefined noninferiority margin of ‒6.6 g/L, establishing noninferiority. Noninferiority was supported by five of six key secondary end points. Rates of adverse events were generally comparable between treatments and consistent with previous findings. CONCLUSION: Roxadustat was noninferior to rHuEPO-α in treating CIA in participants with nonmyeloid malignancies receiving multicycle treatments of myelosuppressive chemotherapy. The oral formulation of roxadustat may potentially increase compliance.

Artificial intelligence in pathologic diagnosis, prognosis and prediction of prostate cancer.

Histopathology, which is the gold-standard for prostate cancer diagnosis, faces significant challenges. With prostate cancer ranking among the most common cancers in the United States and worldwide, pathologists experience an increased number for prostate biopsies. At the same time, precise pathological assessment and classification are necessary for risk stratification and treatment decisions in prostate cancer care, adding to the challenge to pathologists. Recent advancement in digital pathology makes artificial intelligence and learning tools adopted in histopathology feasible. In this review, we introduce the concept of AI and its various techniques in the field of histopathology. We summarize the clinical applications of AI pathology for prostate cancer, including pathological diagnosis, grading, prognosis evaluation, and treatment options. We also discuss how AI applications can be integrated into the routine pathology workflow. With these rapid advancements, it is evident that AI applications in prostate cancer go beyond the initial goal of being tools for diagnosis and grading. Instead, pathologists can provide additional information to improve long-term patient outcomes by assessing detailed histopathologic features at pixel level using digital pathology and AI. Our review not only provides a comprehensive summary of the existing research but also offers insights for future advancements.

Contact X-ray Brachytherapy as a sole treatment in selected patients with early rectal cancer - Multi-centre study.

Background and purpose: Radical surgery is the standard of care for early rectal cancer. However, alternative organ-preserving approaches are attractive, especially in frail or elderly patients as these avoid surgical complications. We have assessed the efficacy of sole Contact X-ray Brachytherapy (CXB) treatment in stage-1 rectal cancer patients who were unsuitable for or declined surgery. Materials and methods: This retrospective multi-centre study (2009-2021) evaluated 76 patients with T1/2-N0-M0 rectal adenocarcinomas who were treated with CXB alone. Outcomes were assessed for the entire cohort and sub-groups based on the T-stage and the criteria for receiving CXB alone; Group A: patients who were fit enough for surgery but declined, Group B: patients who were high-risk for surgery and Group C: patients who had received prior pelvic radiation for a different cancer. Results: With a median follow-up of 26(IQR:12-49) months, initial clinical Complete Response (cCR) was 82(70-93)% with rates of local regrowth 18(8-29)%, 3-year actuarial local control (LC) 84(75-95)%, distant relapse 3 %, and no nodal relapse. 5-year disease-free survival (DFS) and overall survival (OS) were 66(48-78)% and 58(44-75)%. Lower OS was observed in Groups B [HR:2.54(95 %CI:1.17, 5.59), p = 0.02] and C [HR:2.75(95 %CI:1.15, 6.58), p = 0.03]. Previous pelvic radiation predicted lower cCR and OS. The main toxicity was G1-2 rectal bleeding (26 %) and symptoms of impaired anal sphincter function were not reported in any patients. Conclusion: CXB treatment alone achieved a high cCR rate with satisfactory LC and DFS. Inferior oncological outcomes were observed in patients who had received prior pelvic radiotherapy. CXB alone, with its favourable toxicity profile and avoidance of general anaesthesia and surgery risks, therefore, can be considered for patients who are unsuitable for or refuse surgery.

Impact of general anesthesia on the echocardiographic assessment of right ventricular function in pediatric patients with pulmonary arterial hypertension.

One of the great diagnostic challenges for children with pulmonary arterial hypertension is the need for general anesthesia (GA) to enable successful right heart catheterization. Here, for the first time, we describe how echocardiographic estimates of right ventricular function and pulmonary pressures change in pediatric patients during GA.

Pancreatitis pain quality changes at year 1 follow-up, but GP130 remains a biomarker for pain.

BACKGROUND/OBJECTIVES: Debilitating abdominal pain is a common symptom affecting patients with chronic pancreatitis (CP). CP pain is dynamic due to multiple underlying mechanisms. The objective of this study was to 1) evaluate changes in pain phenotype at one year follow-up and 2) validate putative pain biomarkers in a prospective cohort study. METHODS: The Neuropathic and Nociceptive PROMIS-PQ questionnaires were used to classify pain for participants with in the PROCEED study. Putative serum biomarkers were measured via immunoassay. RESULTS: At enrollment, 17.6 % (120/681) subjects with CP reported no pain in the previous year. Of those, 29 % experienced pain during the 1 yr follow-up whereas 18 % of those with pain prior to enrollment reported no pain during the 1 yr follow-up period. Of the 393 subjects with PROMIS-PQ data at enrollment, 212 also had follow-up data at 1 yr. Approximately half (53.3 %) of those individuals changed pain phenotype between baseline and follow-up. At 1 yr, serum TGFß1 level was negatively correlated with nociceptive T-scores (p = 0.006). GP130 was significantly correlated with both nociceptive (p = 0.012) and neuropathic T-scores (p = 0.043) at 1 yr, which is consistent with the previously published findings. CONCLUSIONS: The positive association between TGFß1 and pain is not maintained over time, suggesting it is a poor pain biomarker. However, serum GP130 is a consistent biomarker for mixed-type pain in CP. Preclinical studies show that targeting TGFß1 or IL-6 (ligand for GP130) is sufficient to inhibit CP pain supporting further investigation of this as a potential therapeutic target.

Combination effect of levofloxacin and cefmenoxime against ocular isolates of Pseudomonas aeruginosa.

PURPOSE: This study aimed to investigate the effects of the combination of levofloxacin (LVFX) and cefmenoxime (CMX) on ocular isolates of Pseudomonas aeruginosa. METHODS: Twenty-three strains of P. aeruginosa isolated from microbial keratitis cases in Australia were utilized in this study. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of each antibiotic alone were determined and the combined susceptibility of antibiotics was assessed through fractional inhibitory concentration index (FICI). Additionally, tolerance of a ciprofloxacin tolerant P. aeruginosa isolate to each antibiotic alone and combination were analyzed. RESULTS: The median MIC and MBC values of CMX against P. aeruginosa were 16 µg/mL and 32 µg/mL, respectively. The median MIC and MBC values of LVFX were 0.5 µg/mL and 1 µg/mL, respectively, and all isolates were susceptible. In dual combination, the median of FICI of all strains was 0.63; seven strains showed synergistic effects (FICI≤0.5), and fifteen strains showed additive activities, while no strains exhibited antagonism. The isolate of P. aeruginosa that had previously exhibited tolerance to ciprofloxacin showed high tolerance to CMX alone and low tolerance to LVFX alone. This strain showed low tolerance to the combination of CMX and LVFX. CONCLUSION: The combination of LVFX with CMX may have beneficial interactions which increase antibacterial activity against P. aeruginosa isolates and may be a feasible option for addressing the issue of bacteria resistant to each antibiotic.

Burnout profiles among esports players: Associations with mental toughness and resilience.

The present study investigated burnout among esports players and its association with mental toughness and resilience. Esports players (N = 453; Mage = 23.0, SD = 4.18; in the top 40% of in-game rank) from seven team-based esports completed the Athlete Burnout Scale (ABO-S), Mental Toughness Questionnaire 18 (MTQ-18), and the Connor-Davidson Resilience Scale (CD-RISC-10). Latent profile analysis identified three distinct burnout profiles: "low burnout risk" (LBR; 33.8%), "medium burnout risk" (MBR; 28.0%), and "high burnout risk" (HBR; 38.3%). Low burnout profiles were associated with higher mental toughness and resilience. The LBR profile was characterized by low levels of reduced accomplishment (RA), physical exhaustion (PE), and negative feelings (NF), while [MBR and HBR reported similar PE and NF scores but] differed in RA, with HBR showing the highest RA and total burnout. This study is the first to show distinct burnout profiles among esports players, indicating a significant prevalence of burnout symptoms. This should be monitored by both players and support staff (e.g. club managers, programme managers, and high-performance support staff). Additionally, mental toughness and resilience appear to play a protective role against burnout.

Nigeria sodium study 2023 policy meeting on dietary sodium reduction in Nigeria.

BACKGROUND: In line with the WHO Global Action Plan's objective to achieve a 30% relative reduction in the mean population intake of sodium by 2025, the Nigeria Sodium Study (NaSS) team, which aimed to evaluate the implementation and scale-up of national sodium reduction programme, hosted a policy meeting May 22, 2023, in Abuja, the Federal Capital Territory of Nigeria. The aim was to deliberate on strategies for translating data on salt levels in food and dietary patterns, intending to strengthen sodium policies in Nigeria, with the ultimate goal of producing evidence-based information that can effectively guide strategies and policies for sodium reduction. METHODS: Policymakers from federal, state, and local government levels attended, as well as representatives from national and international universities and non-governmental organizations. Topics presented and discussed included retail survey data from the NaSS to inform front-of-package labeling, salt targets for packaged food, and best practices for supporting stakeholders in implementing best-practice evidence-informed policymaking. RESULTS: The meeting brought together 72 participants from 38 organizations, including government ministries and agencies (n = 21), international and non-governmental organizations (n = 6), and international health organizations and institutes (n = 2). Participants took decisive policy actions, including stringent national-level food system monitoring by relevant government agencies, implementing front-of-package labeling for healthier choices, establishing mandatory sodium limits for both packaged and unpackaged foods and school meals, launching diverse sector-wide educational campaigns to reduce salt use, conducting mass mobilization campaigns for awareness, and advocating for salt reduction in fast food outlets. Salt substitutes were also recognized as integral to the comprehensive sodium reduction approach. CONCLUSION: To advance policy action, stakeholders should prioritize establishing robust monitoring systems, engage in public awareness campaigns, and collaborate with international organizations for insights. Exploring partnerships, addressing funding challenges, and implementing innovative strategies like low-sodium substitutes are crucial steps toward effective sodium reduction policies in Nigeria.

Total Thrombotic Occlusion of an Extracardiac Fontan Conduit in a Hemodynamically Stable Patient.

Cardiac and extracardiac complications of single-ventricle physiology are well described and carry significant morbidity and mortality risks. We present the case of a 32-year-old patient with a Fontan circulation who presented to the emergency department with epigastric pain, and with chest computed tomography angiography concerning for total thrombosis of the extracardiac conduit.

Risk Factors for Early Postoperative Morbidity and Mortality following Extremity Metastatic Pathologic or Impending Fracture Fixation.

Background: As cancer survivorship continues to improve, the perioperative morbidity and mortality following surgical treatment of metastatic bone disease become an increasingly important consideration. The objective of this study is to identify risk factors for early postoperative complications and mortality following extremity prophylactic fixation and pathologic fracture stabilization. Methods: A single-centre retrospective review of 185 patients (226 total surgeries) who underwent prophylactic fixation or pathologic fracture stabilization for extremity metastatic bone disease between 2005 and 2020 was performed. Skull, spine, pelvic, and revision surgeries along with diagnosis of primary bone neoplasm were excluded. Univariate, multivariate, and subgroup analyses were performed to identify predictors and independent risk factors for 30-day postoperative morbidity and mortality. Results: Primary cancers included lung (n = 41), breast (n = 36), multiple myeloma (n = 35), prostate (n = 16), lymphoma (n = 11), renal cell carcinoma (n = 10), and other (n = 36). The 30-day postoperative complication and mortality rates were 32.30% (n = 73) and 17.26% (n = 39), respectively. The most common complications were pulmonary-related, cardiac events, surgical site infection, sepsis, and thromboembolism. Pathologic fracture, presence of extra-skeletal metastases, longer surgical duration, and blood transfusion requirements were associated with 30-day postoperative complications overall. A past medical history for cardiac disease was also associated with systemic but not local surgical complications. Pathologic fracture, presence of extra-skeletal metastases, lung cancer, blood transfusion requirements, and increasing pack-year smoking history were predictors for 30-day mortality. In the multivariate analysis, pathologic fracture (p=0.016) and presence of extra-skeletal metastases (p=0.029) were independent predictors of complications. For mortality, pathologic fracture (p=0.014), presence of extra-skeletal metastases (p=0.0085), and increased blood transfusion requirements (p=0.048) were independent risk factors. Conclusions: The findings of this study provide additional guidance for perioperative risk assessment and patient counselling. Additionally, improving clinical assessment tools to identify and quantify patients at risk of pathologic fractures becomes increasingly important given the significant morbidity and mortality associated with pathologic fracture treatment.