Antwerp University Hospital Research Articles

Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023.

The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development. To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care. This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023. A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII > 75 %) and a nonsignificant increase in the lowest risk group (RISC II <15 %). The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.

Total Cranial Vault Remodelling Versus Minimally Invasive Suturectomy With Postoperative Helmet Therapy in Sagittal Craniosynostosis

Different surgical techniques have been explored over time to treat children with scaphocephaly. The objective of this study is to compare morbidity and cosmetic outcomes in total cranial vault remodelling (TCVR) and minimally invasive suturectomy with postoperative helmet therapy (MISPH) in patients with scaphocephaly. The authors performed a retrospective comparative cohort study, including 43 patients with isolated sagittal craniosynostosis who underwent TCVR (n=17) or MISPH (n=26) at the Antwerp University Hospital between April 2008 and December 2022. MISPH was associated with significantly shorter procedure duration (TCVR 199 ± 48 min, MISPH 69 ± 12 min, P&lt;0.001), decreased blood loss (TCVR 610 ± 298 mL, MISPH 85 ± 73 mL, P&lt;0.001) and lower transfusion rate (TCVR 100%, MISPH 54%, P&lt;0.001). Mean length of stay at the intensive care unit and the hospital were significantly shorter after MISPH (TCVR 6 ± 1 d, MISPH 3 ± 0.5 d). The change in CI after TCVR was significantly larger than after MISPH during the first postoperative year. However, the CI in the MISPH group was significantly higher during the first year compared with the TCVR group. Mean CI of the MISPH group reached normal limits during the first year, while in the TCVR group, mean CI reached normal values 5 years after surgery. The authors could not find a statistically significant difference in cosmetic outcome between the 2 groups. The authors conclude that MISPH is associated with decreased morbidity and comparable cosmetic results when compared with TCVR in the treatment of scaphocephaly.

Lung Transplantation in A Low-Volume Center: The Antwerp University Hospital Experience

Lung Transplantation in A Low-Volume Center: The Antwerp University Hospital Experience

Hypoglossal Nerve Stimulation Therapy in a Belgian Cohort of Obstructive Sleep Apnea Patients.

Hypoglossal nerve stimulation (HGNS) has emerged as a widespread and innovative treatment option for selected moderate-to-severe obstructive sleep apnea (OSA) patients who cannot be treated effectively with traditional treatment modalities. In this observational cohort study, the objective and subjective outcomes of Belgian OSA patients treated with HGNS therapy were analyzed at 6 and 12 months post-implantation. Thirty-nine patients implanted with a respiration-synchronized HGNS device at the Antwerp University Hospital w ere included in this study. Patients underwent baseline in-laboratory polysomnography and a follow-up sleep study 6 and 12 months post-implantation. Questionnaires on patient experience and daytime sleepiness were filled out and data on objective therapy usage were collected. All 39 patients completed the 6-month follow-up and 21 patients (54%) completed the 12-month follow-up. Median AHI decreased from 33.8 [26.1;45.0] to 10.2 [4.8;16.4] at the 6-month follow-up, and to 9.6 [4.1;16.4] at the 12-month follow-up (p < 0.001). The surgical success rate, according to the Sher20 criteria, was 80% and 76% at the 6- and 12-month follow-ups, respectively. Median ESS improved from 12.0 [7.0;18.0] at baseline to 6.0 [2.5;11.0] at 6 months (p < 0.001) and to 6.5 [2.8;11.5] at 12 months (p = 0.012). Objective therapy usage was 7.4 [6.6;8.0] and 7.0 [5.9:8.2] h/night at the 6- and 12-month follow-ups, respectively. A high overall clinical effectiveness of HGNS therapy, as shown by a mean disease alleviation of 58%, was demonstrated at 12 months post-implantation. Overall, HGNS therapy using respiration-synchronized neurostimulation of the XII cranial nerve resulted in a significant improvement in both objective and subjective OSA outcomes, with a high level of patient satisfaction and high treatment adherence.

COVID-19 in three waves in a tertiary referral hospital in Belgium: a comparison of patient characteristics, management, and outcome

PurposeFew studies have compared patient characteristics, clinical management, and outcome of patients with COVID-19 between the different epidemic waves. In this study, we describe patient characteristics, treatment, and outcome of patients admitted for COVID-19 in the Antwerp University Hospital over the first three epidemic waves of 2020–2021.MethodsRetrospective observational study of COVID-19 patients in a Belgian tertiary referral hospital. All adult patients with COVID-19, hospitalized between February 29, 2020, and June 30, 2021, were included. Standardized routine medical data was collected from patient records. Risk factors were assessed with multivariable logistic regression.ResultsWe included 722 patients, during the first (n = 179), second (n = 347) and third (n = 194) wave. We observed the lowest disease severity at admission during the first wave, and more elderly and comorbid patients during the second wave. Throughout the subsequent waves we observed an increasing use of corticosteroids and high-flow oxygen therapy. In spite of increasing number of complications throughout the subsequent waves, mortality decreased each wave (16.6%,15.6% 11.9% in 1st, 2nd and 3rd wave respectively). C-reactive protein above 150 mg/L was predictive for the need for intensive care unit admission (odds ratio (OR) 3.77, 95% confidence interval (CI) 2.32–6.15). A Charlson comorbidity index ≥ 5 (OR 5.68, 95% CI 2.54–12.70) and interhospital transfers (OR 3.78, 95% CI 2.05–6.98) were associated with a higher mortality.ConclusionsWe observed a reduction in mortality each wave, despite increasing comorbidity. Evolutions in patient management such as high-flow oxygen therapy on regular wards and corticosteroid use may explain this favorable evolution.

Effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence in polypharmacy patients postdischarge: protocol of a pre–post intervention study

IntroductionHealthcare providers usually manage medication for patients during hospitalisation, although patients are expected to self-manage their medication after discharge. A lack of self-management competencies is found to be associated with...

Retrospective cohort study on the bilateral occurrence of invasive lobular breast cancer

ObjectiveInvasive lobular carcinoma (ILC) is the second most common histological subtype of invasive breast cancer, following the no special type (NST) invasive carcinoma. It has historically been assumed that ILC occurs bilaterally in 20–29 % of cases, which has influenced the inclusion of MRI in the standard workup of ILC according to European guidelines. However, challenging this long-held belief regarding the bilateral occurrence of ILC opens up the possibility of revising the guidelines and using MRI only for more specific indications. This study aims to evaluate whether the previously reported high percentage of bilaterality still holds true and to question the added value of MRI in the standard workup of ILC. Study designA retrospective cohort study was conducted following approval from the institutional review board (EC 21/18/249) at Antwerp University Hospital (UZA). The cohort comprised female patients of all ages who had been diagnosed with either ILC or NST invasive carcinoma and had sought consultation at the UZA breast clinic. A comprehensive database was established to collect information on patient characteristics, imaging, and pathology. ResultsA total of 271 patients with ILC were included in the study, with incidence dates ranging from 01/01/2007 to 01/01/2023. Among these patients, a synchronous bilateral ILC lesion was observed in 1.85 % (5/271) of cases. This proportion is significantly lower than the reported percentage of patients with a bilateral lesion in the literature population, which stands at 4.95 %. The reference group consisted of 809 patients with NST invasive carcinoma, with incidence dates ranging from 01/01/2017 to 01/01/2023. In the control group, a synchronous bilateral NST lesion was observed in 3.96 % (32/809) of cases. There is no significant difference in the bilaterality rates between the group of ILC patients and the group of NST patients. Furthermore, MRI did not detect any histopathologically confirmed contralateral ILC lesion that had not already been detected by mammography or ultrasound. ConclusionsThe study results indicate a lower occurrence of bilateral ILC than previously assumed. Additionally, the incidence of synchronous bilateral lesions in ILC patients is not higher compared to patients with NST invasive carcinoma. Performing an MRI does not provide additional value in detecting bilateral carcinomas in ILC. Consequently, it is recommended that the current European guidelines be reassessed, and the indications for undergoing an MRI should be adjusted accordingly.

Ongoing exposure to endocrine disrupting phthalates and alternative plasticizers in neonatal intensive care unit patients

Due to endocrine disrupting effects, di-(2-ethylhexyl) phthalate (DEHP), a plasticizer used to soften plastic medical devices, was restricted in the EU Medical Devices Regulation (EU MDR 2017/745) and gradually replaced by alternative plasticizers. Neonates hospitalized in the neonatal intensive care unit (NICU) are vulnerable to toxic effects of plasticizers. From June 2020 to August 2022, urine samples (n = 1070) were repeatedly collected from premature neonates (n = 132, 4–10 samples per patient) born at <31 weeks gestational age and/or <1500 g birth weight in the Antwerp University Hospital, Belgium. Term control neonates (n = 21, 1 sample per patient) were included from the maternity ward. Phthalate and alternative plasticizers’ metabolites were analyzed using liquid-chromatography coupled to tandem mass spectrometry. Phthalate metabolites were detected in almost all urine samples. Metabolites of alternative plasticizers, di-(2-ethylhexyl)-adipate (DEHA), di-(2-ethylhexyl)-terephthalate (DEHT) and cyclohexane-1,2-dicarboxylic-di-isononyl-ester (DINCH), had detection frequencies ranging 30–95 %. Urinary phthalate metabolite concentrations were significantly higher in premature compared to control neonates (p = 0.023). NICU exposure to respiratory support devices and blood products showed increased phthalate metabolite concentrations (p < 0.001). Phthalate exposure increased from birth until four weeks postnatally. The estimated phthalate intake exceeded animal-derived no-effect-levels (DNEL) in 10 % of samples, with maximum values reaching 24 times the DNEL. 29 % of premature neonates had at least once an estimated phthalate intake above the DNEL. Preterm neonates are still exposed to phthalates during NICU stay, despite the EU Medical Devices Regulation. NICU exposure to alternative plasticizers is increasing, though currently not regulated, with insufficient knowledge on their hazard profile.

Adjuvant Wilms’ tumour 1-specific dendritic cell immunotherapy complementing conventional therapy for paediatric patients with high-grade glioma and diffuse intrinsic pontine glioma: protocol of a monocentric phase I/II clinical trial in Belgium

IntroductionDiffuse intrinsic pontine glioma (DIPG) and paediatric high-grade glioma (pHGG) are aggressive glial tumours, for which conventional treatment modalities fall short. Dendritic cell (DC)-based immunotherapy is being investigated as a...

Comprehensive geriatric assessment as an essential tool to register or update DNR codes in a tertiary care hospital.

To investigate the prevalence of Do not Resuscitate (DNR) code registration in patients with a geriatric profile admitted to Antwerp University Hospital, a tertiary care hospital in Flanders, Belgium, and the impact of comprehensive geriatric assessment (CGA) on DNR code registration. Retrospective analysis of a population of 543 geriatric patients (mean age 82.4 ± 5.19years, 46.4% males) admitted to Antwerp University Hospital from 2018 to 2020 who underwent a CGA during admission. An association between DNR code registration status before and at hospital admission and age, gender, ethnicity, type of residence, clinical frailty score (CFS), cognitive and oncological status, hospital ward and stay on intensive care was studied. Admissions before and during the first wave of the pandemic were compared. At the time of hospital admission, a DNR code had been registered for 66.3% (360/543) of patients. Patients with a DNR code at hospital admission were older (82.7 ± 5.5 vs. 81.7 ± 4.6years, p = 0.031), more frail (CFS 5.11 ± 1.63 vs. 4.70 ± 1.61, p = 0.006) and less likely to be admitted to intensive care. During the hospital stay, the proportion of patients with a DNR code increased to 77% before and to 85.3% after CGA (p < 0.0001). Patients were consulted about and agreed with the registered DNR code in 55.8% and 52.1% of cases, respectively. The proportion of patients with DNR codes at the time of admission or registered after CGA did not differ significantly before and after the start of the COVID-19 pandemic. After CGA, a significant increase in DNR registration was observed in hospitalized patients with a geriatric profile.

MUCIN MRNA ISOFORM SIGNATURES AS POTENTIAL NOVEL BIOMARKERS TO EVALUATE DISEASE STATUS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Abstract Mucosal barrier dysfunction and aberrant mucin expression are major hallmarks in the pathophysiology of IBD. Mucins are highly polymorphic, and the presence of genetic differences can alter gene expression, resulting in several mRNA isoforms via alternative splicing. While most isoforms encode similar biological functions, others alter protein function, potentially resulting in progression towards disease. Currently, little attention has been given to the importance of mucin mRNA isoforms in IBD. The aim of our study is to investigate the potential of mucin mRNA isoforms as novel biomarkers for the evaluation of IBD activity and subtypes. To obtain this goal, RNA was extracted from colonic and terminal ileal biopsies of IBD patients that underwent an endoscopy at the Antwerp University Hospital (UZA). Additionally, patients without a history of IBD undergoing an endoscopy due to a positive iFOBT which show no endoscopic abnormalities, were included as controls. Library preparation was performed with the PacBio Iso-Seq multiplex protocol adapted for targeted transcriptome sequencing. Targeted capture was accomplished by using a custom-designed pool of probes, developed for the capture of all mucin gene transcripts. Samples were sequenced on the PacBio Sequel platform at the University of Antwerp. The data was analyzed by using the isoseq3-pipeline and additional filtering with SQANTI3 was performed. In total 106 biopsies were sequenced on the PacBio platform. The resulting intestinal mucin transcriptome was merged with the human reference transcriptome. On this combined mucin transcriptome Illumina bulk RNA sequencing data from over 2000 intestinal biopsies (GEO dataset GSE193677) were mapped to determine mucin isoform expression. An external dataset (GEO dataset GSE165512) was used for additional validation. A classification random forest was trained on this data to distinguish inflamed IBD from non-inflamed control patients based on the mucin isoform expression alone. The model performed well on train and test datasets but decreased in the external validation (Table 1). Dividing the samples based on disease phenotype greatly increases performance on the external validation dataset (Table 1). When only training on ileal biopsies, the model proved to be excellent in distinguishing Crohn’s disease patients from controls (Table 1). Classification of inflamed ulcerative colitis from control patients based on only the biopsies from the distal colon was similar to the latter (Table 1). Our machine learning model was able to distinguish Crohn’s disease from control patients and ulcerative colitis from control patients based on mucin mRNA isoform expression. In addition, our data suggests that the mucin isoform expression may vary between different regions within the colon. Table 1 Area under the receiver operator curve (AUCROC) from a random forest classifier trained on mucin isoform expression of inflamed biopsies of IBD and non-inflamed control patients.

Basal metabolic rate using indirect calorimetry among individuals living with overweight or obesity: The accuracy of predictive equations for basal metabolic rate

Weight reduction programs in people with overweight or obesity can be informed by indirect calorimetry (IC) which is the gold standard to measure basal metabolic rate (BMR). Since IC is labor intensive and expensive, predictive equations are often used as an alternative. In this study the accuracy rate was assessed and bias statistics of predictive equations were compared to IC among subjects with overweight or obesity. Secondly, differences in clinical features between individuals with over-, accurate or underestimation of their BMR were evaluated. This cross sectional study included 731 subjects from the outpatient obesity clinic of the Antwerp University Hospital, Belgium. Fourteen equations were evaluated. Overestimation and underestimation was defined as >10 % and <10 % of measured BMR. In the total population, mean age was 43±13 years, mean BMI 35.6±5.8kg/m2 and 79.5% were female. The highest accuracy rates were reached by the Henry (73%), Ravussin (73%) and Mifflin St. Jeor (73%) equations. In the total population, the Mifflin St. Jeor and Henry equation were unbiased. The Akern, Livingston and Ravussin equations were biased to underestimation. All other equations were biased to overestimation. Subjects with an underestimation of BMR had significantly higher waist-hip ratio (1.02±0.13 vs 0.91±0.11; P<0.001), higher visceral adipose tissue (239±96 vs 162±93; P<0.001), lower fat free mass (kg) (67.6 (45.4-95.9) vs 54.0 (39.6-95.5); P<0.001) and a higher prevalence of the Metabolic Syndrome (24 (77.4) vs 112 (37.5); P<0.001). Individuals with an overestimation of BMR had significantly higher subcutaneous adipose tissue (545±149 vs 612±149; P<0.05), lower fasting plasma insulin (81 (10-2019) vs 67 (27-253); P<0.001) and lower 2-h plasma glucose (132 (30-430) vs 116 (43-193); P<0.001) during OGTT. In this study, the Henry and Mifflin St. Jeor equations have the highest accuracy and lowest bias to estimate the basal metabolic rate in a Caucasian, predominantly female, population living with overweight or obesity. Visceral and subcutaneous adipose tissue and presence of metabolic syndrome were significantly different in individuals with over- or underestimation of BMR.

CoBUSters: organization and deployment of a mobile Covid-19 test team for large-scale testing in collectivities as a societal outreach from a university hospital.

During the summer of 2020, government agencies in Belgium were hasty to create additional test capacity for the diagnosis of acute infections with SARS-CoV-2. Large-scale initiatives were necessary to absorb the waves of covid-19 infections throughout all levels of society.&#x0D; Within the Antwerp University Hospital (UZA) we realized that it would be impossible to perform large-scale testing of schools, universities, companies, or other collectivities if sampling capacity would not be made available within the collectivities themselves. A large number of scholars or students would not be able to move toward test centers. So, we created a mobile testing team that on-call would be sent to the collectivities to perform testing within the schools, universities, and companies. The test team started in October 2020 with a single bus which was transformed to accommodate the administrative handling of the test e-form, the scanning of the eID of the person to be tested, as well as the sampling through a nasopharyngeal itself. The structure of the bus allowed to perform the testing of 12 students every 15 minutes. Within a couple of weeks, the demand for large-scale testing increased to more than 1000 a day. Towards the end of 2020, a second bus was put into operation. During the year 2021, additional vans were put into operation as the daily number of tests further increased.&#x0D; The mobile test team remained in operation until the end of May 2022. During this lifespan, more than 200,000 nasopharyngeal samples were collected by the test team. The highest number of tests on a single day was 4,200. The mobile test team operated within three Belgian provinces, serving more than 2,500,000 people. Besides the testing teams, we created a dispatching team which was evaluable 7/7 for calls and registration of demands for new testings. Besides schools, we performed collective testing in colleges, universities, nursing homes, large companies, prisons, and hospices for homeless people. We even performed large-scale tests within municipalities at the hights of the covid waves. TAT for reporting results was less than 24 hours after sampling.&#x0D; The mobile test team, CoBUSters, became known throughout the entire country as a truly innovative social project. Many wondered why a hospital developed a service that was well outside of the regular hospital-related activities. We however did this because this aligns with our mission as a community-based hospital with a strong societal-oriented focus. Hospitals should not remain within their walls, but when society needs them they should quickly develop activities to support society as a whole. This project allowed us also to interact on an almost daily basis with healthcare providers on the first line of healthcare (GPs, home care nurses). From the hospital, we provided the services that the first line could have never mobilized like administrative and nursing staff or manipulation of huge numbers of PCR tests. Together we were able to protect our collectivities against massive outbreaks of the SARS-CoV-2 virus. Even tertiary hospitals have a fundamental societal role when called upon. We should never forget this.

NOKA 'Navigating Oncology Map Antwerp'

NOKA¹ is an application that focuses on providing reliable information or references and navigating the patient and their representatives throughout the landscape of well-being and healthcare services or providers in Antwerp such as physiotherapists, hairdressers, walk-in houses, … The aim of this application is to enhance selfcare management among oncology patients and their representatives by organizing the fragmented information from different, sometimes difficult to reach, information platforms into one application. The original target group are patients and their representatives, who are receiving an oncology treatment in a day hospital and are therefore at home for the rest of their treatment. However, the information given by NOKA can be serviceable for all oncology patients and their representatives, furthermore professional caregivers can benefit from the use of NOKA as well. &#x0D; PTOZA² assisted us in the realisation of this project. They conducted a survey aimed to define the ‘bottlenecks’ of information throughout the trajectory of an oncology patient’s treatment. The results of their survey implied that information is sparse once the treatment has started and difficult to reach when patients are not in the hospital. These findings correspond with the experience of our research-team, who are actively working with oncology patients, receiving numerous questions about the subject, leading to the fundamentals in starting this project. &#x0D; To address these issues, AP University assigned 7 researchers to implement NOKA in order to provide digital information and care at home. The research-team conducted several semi-structured interviews with patients and caregivers to provide useful input to create NOKA up to the needs of the users. The target group was reached through several day care hospitals in Antwerp: University Hospital Antwerp, GZA hospitals and ZNA hospitals. The results of these interviews provided both the design and content of the NOKA-application. &#x0D; The user-friendliness and content of the NOKA-application is regularly reviewed by an audience familiar with the use of the NOKA-app. These people are mostly patients and their surroundings who review the app through a digital survey available on the NOKA-application, or face to face when preferred. NOKA aims to contribute to the needs of oncology patients and their representatives by interacting continuously with them and ensuring their involvement throughout the entire project. &#x0D; Further surveys are imperative to improve our understanding of the success of NOKA. When the application is broadly used in Antwerp and well received by our target group, an expansion of the provided information and (non)-professional caregivers will be advised. This could result in enhanced selfcare throughout Belgium and perhaps not only in oncology but in other chronic illnesses as well.&#x0D; &#x0D; Digital access has become increasingly important over the years all over the world. This project could contribute to awareness and shows the importance of a valuable information flow for oncology patients and their representatives. The availability of information, as provided in NOKA, can be serviceable for professional caregivers as well, suggesting it is generally beneficial for different regions and countries.&#x0D; ¹Navigerende Oncologische Kaart Antwerpen&#x0D; ²Platform Transmurale Oncologische Zorg Antwerpen

Do-Not-ResuscitateDecision-Making during the COVID-19 Pandemic in a Teaching Hospital: Lessons Learned for the Future.

A cross-sectional survey study was conducted between February 2021 and April 2021 for all doctors and doctors in training, working in the Antwerp University Hospital during the COVID-19 pandemic. 127 doctors participated in this study. The familiarity with the different scores used in the triage during the COVID-10 pandemic was 51% for the Clinical Frailty Scale (CFS) and 20% for the Charlson Comorbidity Index (CCI). Participants indicated that their DNR decision is based on various aspects such as clinical assessment, comorbidities, patient's wishes, age, prognosis, and functional state. The familiarity with the different scores used during triage assessments is low. The total clinical picture of the patient is needed to make a considered decision, and this total picture of the patient seems to be well encompassed by frailty measurement (CFS). Although many participants indicated that the different scores do not offer much added value compared to their clinical assessment, it can help guide DNR decisions, especially for doctors in training.

Clinical Decision Support for Improved Neonatal Care: The Development of a Machine Learning Model for the Prediction of Late-onset Sepsis and Necrotizing Enterocolitis

To develop an artificial intelligence-based software system for predicting late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in infants admitted to the neonatal intensive care unit (NICU). Single-center, retrospective cohort study, conducted in the NICU of the Antwerp University Hospital. Continuous monitoring data of 865 preterm infants born at <32weeks gestational age, admitted to the NICU in the first week of life, were used to train an XGBoost machine learning (ML) algorithm for LOS and NEC prediction in a cross-validated setup. Afterward, the model's performance was assessed on an independent test set of 148 patients (internal validation). The ML model delivered hourly risk predictions with an overall sensitivity of 69% (142/206) for all LOS/NEC episodes and 81% (67/83) for severe LOS/NEC episodes. The model showed a median time gain of ≤10 hours (IQR, 3.1-21.0 hours), compared with historical clinical diagnosis. On the complete retrospective dataset, the ML model made 721 069 predictions, of which 9805 (1.3%) depicted a LOS/NEC probability of ≥0.15, resulting in a total alarm rate of <1 patient alarm-day per week. The model reached a similar performance on the internal validation set. Artificial intelligence technology can assist clinicians in the early detection of LOS and NEC in the NICU, which potentially can result in clinical and socioeconomic benefits. Additional studies are required to quantify further the effect of combining artificial and human intelligence on patient outcomes in the NICU.

Etiologies and hearing status in bilateral vestibulopathy: a retrospective study of 315 patients

ImportanceThe development of a vestibular implant has reached milestones and seems to be a promising therapeutic tool for bilateral vestibulopathy (BV). Given the former lack of therapeutic options for BV, the disease has received scant attention in the previous research literature. It is therefore of major importance to gain more insight into the underlying pathology of BV. Furthermore, as some research groups specifically use a combined vestibulo-cochlear implant, the size of the group of BV patients with associated hearing loss is of special interest.ObjectivesThe study aimed to determine the definite and probable etiology in bilateral vestibulopathy (BV) patients and to report on their hearing status.DesignThis study involves multicenter retrospective study design.SettingThe research setting is at tertiary referral centers.ParticipantsConsecutive BV patients diagnosed at the Antwerp University Hospital between 2004 and 2018 at the Maastricht University Medical Center between 2002 and 2015 and at the Geneva University Hospital between 2013 and 2018, who met the BV diagnostic criteria of the Bárány Society.Main outcome measuresPrimary interests were the etiology and hearing status of BV patients. Moreover, the data of vestibular tests were examined (caloric irrigation, rotatory chair tests, and video-head impulse test).ResultsThe authors identified 315 BV patients, of whom 56% were male patients. Mean age at diagnosis was 58.6 ± 15.1 (range 7–91) years. The definite cause was determined in 37% of the patients and the probable cause in 26% of the patients. No cause was identified in 37% of BV patients. The largest subgroup included patients with genetic etiology (31%), most frequently COCH mutation. Only 21% of patients (n = 61) had bilateral normal hearing. Almost half of the patients (45%, n = 134) had profound hearing loss in at least one ear.ConclusionBV is a heterogeneous condition, with over a third of cases remaining idiopathic, and nearly three-quarters affected by hearing loss. COCH mutation is the most common non-idiopathic cause of BV in our population. Only 21% of our BV patients presented with bilateral normal hearing.

Cost-Effectiveness of Erythrocytapheresis in Children and Young Adults with Beta Thalassemia Major and Sickle Cell Disease

Introduction During the management of hemoglobinopathies, including sickle cell disease (SCD) and thalassemia, red blood cell (RBC) transfusions are crucial in treating symptomatic anemia. Repeated transfusions can lead to iron accumulation in soft tissues, causing inflammation, susceptibility to infections, and damage to vital organs. Currently treatment of iron overload with iron chelation therapy, does not always guarantee optimal and lasting responses. Erythrocytapheresis, an automated method for RBC exchange, has shown promising results in reducing iron overload in patients with SCD and adult patients with β-thalassemia. Studies show limited use in children and young adults, due to optimal flow and venous access problems. At the Antwerp University Hospital, erythrocytapheresis has been adopted as the standard of care in managing patients with both SCD and β-thalassemia major who develop iron overload, with the goals of reducing ferritin levels and preventing permanent complications. This study aimed to evaluate the efficacy and cost-effectiveness ratio associated with the inclusion of erythrocytapheresis in the overall management of these patients. Methods This retrospective study analyzed patients diagnosed with SCD or β-thalassemia major between 2015 and 2022, who were treated for transfusion related iron overload with iron chelation therapy with serum ferritin and hemoglobin (Hb) levels as indicators. The case cohort were treated with erythrocytapheresis alone or in combination with iron chelation therapy, whilst the control cohort was treated with oral iron chelation therapy alone. Long-term venous access was established in all patients utilizing one of two methods: 1) two high pressure intravenous 14-gauge catheters (Port-a-Cath®), one placed in the subclavian vein, and one placed in the inguinal vein 2) or a surgical arteriovenous fistula created in the cubital fossa. Erythrocytapheresis was performed with the Spectra Optia® system (Caridian BCT, Inc) Data to evaluate erythrocytapheresis therapy outcomes were collected at five different time points, until one year post commencing erythrocytapheresis therapy. Results Of the 19 patients, 11 (57,9%) were males with a M:F ratio of 1:0.7. The median age was 13 years (range 1 to 27 years). The cohort consisted of 10 (52,6%) patients with SCD, eight (42,1%) with β-thalassemia major and one (5,3%) with sickle-thalassemia. The cohort treated with erythrocytapheresis showed a significant decrease in serum ferritin ( p&amp;lt;0.001) whilst maintain steady Hb levels ( p&amp;lt;0.001). The cohort treated with oral iron chelation therapy alone, no significant decrease in serum ferritin was found ( p=0.156) but a decrease in Hb levels over time ( p=0.07). Comparing the evolution of median serum ferritin between therapy with erythrocytapheresis and iron chelation therapy showed a statistically significant difference ( p=0.008) ( Fig. 1). Patients with β-thalassemia major receiving erythrocytapheresis showed a greater reduction in serum ferritin compared to patients without ( p=0.036). A difference could not be shown between the erythrocytapheresis and iron chelation single therapies (p=0.100). Optimal continuous flow was achieved with two small Port-a-Cath® systems. A cost benefit analysis showed that the cost of a single erythrocytapheresis is comparable to the lowest dosage of Deferasirox ( Table 1). Erythrocytapheresis could be a financially viable treatment method for children and young adults independent of the resource setting. Conclusion Currently iron chelation therapy is not always sufficient in patients with hemoglobinopathies treated for iron overload. Patients treated with erythrocytapheresis showed more stable and higher hemoglobin levels and a more significant decline in serum ferritin levels compared to iron chelation therapy alone. This study showed that erythrocytapheresis can also be used in children with β-thalassemia major. Further studies are needed to optimize erythrocytapheresis in children and extrapolate these findings to a larger population.

Determining the clinical utility of a breath test for screening an asbestos-exposed population for pleural mesothelioma: baseline results

Pleural mesothelioma (PM) is an aggressive cancer of the serosal lining of the thoracic cavity, predominantly caused by asbestos exposure. Due to nonspecific symptoms, PM is characterized by an advanced-stage diagnosis, resulting in a dismal prognosis. However, early diagnosis improves patient outcome. Currently, no diagnostic biomarkers or screening tools are available. Therefore, exhaled breath was explored as this can easily be obtained and contains volatile organic compounds, which are considered biomarkers for multiple (patho)physiological processes. A breath test, which differentiates asbestos-exposed (AEx) individuals from PM patients with 87% accuracy, was developed. However, before being implemented as a screening tool, the clinical utility of the test must be determined. Occupational AEx individuals underwent annual breath tests using multicapillary column/ion mobility spectrometry. A baseline breath test was taken and their individual risk of PM was estimated. PM patients were included as controls. In total, 112 AEx individuals and six PM patients were included in the first of four screening rounds. All six PM patients were correctly classified as having mesothelioma (100% sensitivity) and out of 112 AEx individuals 78 were classified by the breath-based model as PM patients (30% specificity). Given the large false positive outcome, the breath test will be repeated annually for three more consecutive years to adhere to the ‘test, re-test’ principle and improve the false positivity rate. A low-dose computed tomography scan in those with two consecutive positive tests will correlate test positives with radiological findings and the possible growth of a pleural tumor. Finally, the evaluation of the clinical value of a breath-based prediction model may lead to the initiation of a screening program for early detection of PM in Aex individuals, which is currently lacking. This clinical study received approval from the Antwerp University Hospital Ethics Committee (B300201837007).

Evaluation of hearing levels and vestibular function and the impact on cognitive performance in (pre)-symptomatic patients with DFNA9: protocol for a prospective longitudinal study (Rosetta study)

IntroductionUntreated hearing loss is the largest potentially modifiable risk factor for dementia. Additionally, vestibular dysfunction has been put forward as a potential risk factor for accelerated cognitive decline. Patients with...