Clinical Improvement Rate Research Articles

Surgical management options for childhood intracranial arachnoid cysts: a comparative study

BackgroundThe symptomatic and incidentally discovered childhood intracranial arachnoid cysts may make it challenging to define the best management option, which may be surgical or observational. The best surgical option is still in debate, either regarding the type or the indication of surgery. This study aims to evaluate cysto-peritoneal shunts, endoscopic fenestration, and our technique of microsurgical partial excision of the cyst wall with maintenance of subarachnoid patency as surgical treatment options for childhood intracranial arachnoid cysts.ResultsThis retrospective study was performed to compare three surgical options for treatment of childhood intracranial arachnoid cysts during the period from January 2015 to October 2022, with a follow-up of at least one year. These options included a cysto-peritoneal shunt, endoscopic fenestration, and microsurgical patency of the subarachnoid space without basal fenestration. Clinical improvement rating and operative complications showed insignificant differences between the three surgical options; however, total disappearance of the arachnoid cysts was significantly associated with the microsurgical option (p = 0.0312).ConclusionSurgical management of childhood arachnoid cysts either by cysto-peritoneal shunt, endoscopic fenestration, or microsurgical techniques was efficient according to the accessibility of the cysts, and the microsurgical patency of the subarachnoid space had the most significant effect on the disappearance of the cysts.

Neurocognitive impact of different irradiation modalities for patients with grade I-II skull base meningioma: a prospective multi-arm cohort study (CANCER COG)

BackgroundRadiotherapy as a complement or an alternative to neurosurgery has a central role in the treatment of skull base grade I-II meningiomas. Radiotherapy techniques have improved considerably over the last two decades, becoming more effective and sparing more and more the healthy tissue surrounding the tumour. Currently, hypo-fractionated stereotactic radiotherapy (SRT) for small tumours and normo-fractionated intensity-modulated radiotherapy (IMRT) or proton-therapy (PT) for larger tumours are the most widely used techniques. It is expected a decrease of the risk of cognitive impairment with these modern techniques. However prospective data about cognitive long-term consequences of partial brain irradiation with SRT, PT, or IMRT remain very scarce to date.MethodsCANCER COG is one of the first multicentric study in the world to prospectively assess the cognitive performances of patients following different modalities of cerebral radiotherapy (stereotactic radiotherapy, proton therapy, intensity modulated radiotherapy) for the treatment of grade I-II skull base meningioma, up to at least 10 years after the end of radiotherapy. This longitudinal study includes the follow-up of 3 cohorts, including: patients treated with PRT, IMRT, and SRT. An additionally control group will be formed. The primary objective is to report long-term cognitive deterioration in each cohort until 10 years after the end of irradiation. The rate of clinical symptomatology improvement over time after irradiation, the evolution of health-related quality-of-life, anxiety/depression, fatigue, over time after irradiation, the tumoral local control after irradiation, the progression-free survival (PFS), the professional reintegration for working-age patients will also be assessed. CANCER COG aims to help clinicians to choose the best irradiation techniques with the best benefit/risk ratio. Inclusions started on september 2023.Trial registrationThe study was registered on clinicaltrials.gov with the following number: NCT 06036706.

370. Swimming Against the Current: Outcomes of Standard versus Modified Outpatient Parenteral Antimicrobial Therapy (OPAT) Services

Abstract Background OPAT programs enable intravenous (IV) antibiotic treatment outside the hospital, either at home or in an outpatient facility. We established institutional OPAT criteria to identify patients who could safely complete OPAT at home (standard, or S-OPAT) and those with potential barriers (modified, or M-OPAT). The study aims to compare outcomes in both groups. Methods We conducted a retrospective cohort study analyzing data collected via OPAT program operations from July 2019 to March 2024. These data were collected using the REDCap electronic data capture system. Statistical analyses were performed with Stata 17. Results The analysis included 3,344 patients referred to the OPAT program, with 2,746 (82.1%) assigned to the S-OPAT group and 598 (17.9%) to the M-OPAT group. The median age was similar in both cohorts, and Male patients were 1,583 (58.9%) in S-OPAT and 389 (65.1%) in M-OPAT (p = 0.001). The most prevalent infection treated in both groups was Osteomyelitis: 535 (19.5%) patients in S-OPAT and 156 (26.1%) patients in M-OPAT (p< 0.001), followed by bacteremia at 484 (17.6%) patients in S-OPAT and 107 (17.9%) in M-OPAT (p= 0.859). A history of IV drug use was reported in 108 (4.0%) patients of S-OPAT and 200 (33.4%) patients of M-OPAT. M-OPAT patients reported barriers such as lack of social support (homelessness, inability to administer antibiotics at home, or requiring additional medical care) in 422(70.6%) patients, incarceration in 58 (9.7%) patients, and antibiotics received during dialysis sessions in 58 (9.7%) patients. Reported outcomes, including clinical improvement, were not significantly different between these groups [S-OPAT: 2367 (86.2%) vs. M-OPAT: 530 (88.8%); (p=0.11)]. Treatment completed as expected, extended, or discontinued were as follows: S-OPAT 2106 (76.7%) vs. M-OPAT 486 (81.3%), (p=0.015); S-OPAT 398 (14.5%) vs. M-OPAT 67 (11.2%), p=0.037; and S-OPAT 237 (8.6%) vs. M-OPAT 43 (7.2%), p=0.289. Conclusion Despite the higher prevalence of social and medical challenges in the M-OPAT cohort, treatment outcomes, including clinical improvement and completion rates, were comparable to those in the S-OPAT group; the study highlights the feasibility and effectiveness of outpatient antibiotic treatment, even in patients facing significant barriers to care. Disclosures Alisha Clemons, APRN, Gilead Sciences: Honoraria

A Systematic Review and Meta-Analysis of Surgical Approaches for Venous Thoracic Outlet Syndrome.

There is currently no consensus on the optimal surgical approach for the treatment of venous thoracic outlet syndrome (vTOS). Surgical exposures for vTOS decompression include infraclavicular (IC), supraclavicular (SC), paraclavicular (PC), and transaxillary (AX) approaches. The purpose of this study is to provide a comprehensive review of the outcomes and major complications of these four surgical techniques. This meta-analysis was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We performed a systematic search in the Cochrane Library trials register, Scopus, PubMed, EMBASE, Google Scholar, and the US National Library of Medicine clinical trial databases for studies that evaluated the above four surgical exposures for vTOS and included them. Three independent reviewers assessed studies for inclusion, extracted data, and assessed quality and risk of bias. Primary outcomes of interest were clinical improvement and postoperative primary patency rate. Secondary outcomes included rates of nerve injury, hematoma, hemothorax, pneumothorax, and other complications. Pooled proportions with 95% confidence intervals (CIs) of various outcomes were calculated using a random-effects model. Subgroup analyses according to surgical approach were conducted. A total of twenty-six studies were included in the final analysis. The cumulative number of studies by surgical approach was 8 IC, 5 SC, 6 PC, and 11 AX. Pooled results from these studies demonstrated a 0.94 clinical improvement following surgical intervention (95% CI, 0.87-1), with a rate of 1 (95% CI, 0.99-1) for IC, 0.84 (95% CI, 0.38-1) for SC, 0.97 (95% CI, 0.76-1) for PC, and 0.88 (95% CI, 0.78-0.96) for AX approach. Overall, postoperative patency rate was 0.92 (95% CI, 0.84-0.97), with rate of 0.95 (95% CI, 0.89-1) for IC, 0.95 (95% CI, 0.78-1) for SC, 1 (95% CI, 0.98-1) for PC, and 0.69 (95% CI, 0.54-0.82) for AX approach. Subgroup analysis demonstrated a significantly higher rate of clinical improvement (0.12) in the IC group compared to the AX group. Rates of postoperative primary patency were higher in the IC (0.26), SC (0.26), and PC (0.31) groups than the AX group. Our study highlights the importance of considering different surgical approaches for the decompression of vTOS. While the IC, SC, and PC methods demonstrate comparable postoperative primary patency and clinical improvement, the AX approach shows lower outcomes in these aspects. Surgeons should carefully weigh the benefits and limitations of each approach when determining the most suitable surgical technique for vTOS patients.

Impact of prolonged versus intermittent infusion of meropenem on mortality and clinical outcomes in patients with severe infection: A systematic review and meta-analysis.

To compare the clinical outcomes of patients with severe infection treated with prolonged or intermittent infusion of meropenem. PubMed, Embase, and Cochrane Central databases were searched until July 2023. Randomized controlled trials (RCTs) or observational studies comparing prolonged versus intermittent infusion of meropenem were considered eligible. The primary outcomes included all-cause mortality and clinical improvement, while secondary outcomes encompassed hospital and intensive care unit (ICU) stay duration, microbial eradication rate, and adverse events. A meta-analysis was conducted using a random-effects model. The risk of bias of included studies was assessed using the modified JADAD scale for RCTs and the Newcastle-Ottawa Scale for observational studies. Fourteen studies were included, with a total of 1,698 patients. Prolonged infusion of meropenem was associated with a significantly lower mortality rate compared to intermittent infusion (RR = 0.81, 95% CI: 0.68-0.98). It also significantly improved clinical improvement rates (RR = 1.35, 95% CI: 1.11-1.64) and microbial eradication rates (RR = 1.19, 95% CI: 1.08-1.32). There were no statistically significant differences in ICU length of stay or hospital length of stay. Subgroup analyses showed that prolonged infusion was significantly associated with lower mortality and better clinical improvement rates in patients with an APACHE II score < 20. Prolonged infusion of meropenem is more effective than intermittent infusion in reducing mortality, improving clinical outcomes, and enhancing microbial eradication, without increasing adverse events. These benefits are particularly evident in patients with lower disease severity (APACHE II < 20), emphasizing the importance of patient stratification in optimizing treatment strategies. This systematic review and meta-analysis is registered with PROSPERO (number: CRD42023445360).

Effectiveness of levamisole in the treatment of patients with severe COVID-19: a randomized controlled clinical trial.

Inflammation plays a role in coronavirus disease 2019 (COVID-19) pathophysiology and anti-inflammatory drugs may help reduce the disease severity. Levamisole is an anthelmintic drug with immunomodulatory and possible antiviral effects. This study aimed to evaluate the role of levamisole in the treatment of patients with COVID-19. In this randomized controlled clinical trial, hospitalized patients with confirmed severe COVID-19 (arterial oxygen saturation < 90%) were randomly assigned to either experimental (n = 41) or control (n = 45) groups. Levamisole 50 mg orally daily was prescribed for the first group until discharge or death, for a maximum of 7 days, along with other standard treatments. Only standard treatments were prescribed to the control group. Clinical response (either improvement or failure) at the end of the fifth and seventh days, changes in laboratory indices, length of hospitalization, and mortality rate during the study were evaluated and recorded. The rate of clinical improvement in the experimental group was significantly more than in the control group on the fifth (97.6% vs. 58.7%, p < 0.001) and seventh (95.8% vs. 66.7%, p = 0.007) days. Furthermore, the mean length of hospital stays in the experimental group (8.39 ± 3.54 days) was significantly shorter than in the control group (10.78 ± 5.40 days, p = 0.024). No patients died during the study. Administering levamisole to hospitalized patients with severe COVID-19 reduced hospitalization time and improved several clinical outcomes.

Ivermectin 1% Combined With Intense Pulsed Light Treatment for Dry Eye Disease Secondary to Demodex Blepharitis.

To examine the safety and efficacy of combined treatment with topical ivermectin 1% and intense pulsed light (IPL) for dry eye disease (DED) secondary to demodex blepharitis. A retrospective review of medical files of patients treated at a private clinic specializing in DED between November 2022 and February 2024 was performed. Sixty-one patients aged 18 years or older with DED because of demodex blepharitis, who received the IPL and ivermectin 1% combination therapy, were included. IPL was applied to the periocular area 4 times at 2- to 3-week intervals, and ivermectin 1% once daily for 1 to 2 months. Both eyes (n = 122) of each patient were evaluated before and immediately after treatment cessation. Blepharitis, meibomian gland secretion, corneal staining, patient satisfaction, and overall clinical improvement were recorded. Mean age was 59.6 ± 17.6 years and 50.8% (n = 31) were males. Meibomian gland secretion grading improved significantly after treatment from 2.74 ± 0.63 to 1.63 ± 0.63 (P < 0.001). Blepharitis was eliminated after treatment in 77.0% of patients (23.0% after treatment vs. 100.0% before, P < 0.001). The patient satisfaction rate was moderate to high (range 0-2, mean 1.54 ± 0.60). Clinical improvement rate was moderate to high as well (range 0-2, mean 1.52 ± 0.50). No significant side effects were observed. The combined application of topical ivermectin and IPL to the facial area induced significant improvement of demodex blepharitis and meibomian gland secretion grading along with a high rate of patient satisfaction. Further randomized controlled double-blinded studies are needed.

Efficacy of Ulinastatin in the Treatment of COVID-19: A Retrospective Study.

This retrospective study aimed to evaluate the efficacy of ulinastatin in the treatment of COVID-19 patients compared to conventional therapy. A total of 437 COVID-19 patients admitted to the Respiratory Oncology Department of our hospital between December 31, 2022, and July 8, 2023, were included in the study. Patients were classified into the observation group (n=62) receiving ulinastatin in addition to standard treatment and the control group (n=347) receiving standard treatment only. Clinical information, laboratory results, and treatment outcomes were collected and analyzed. The observation group showed an improvement in lymphocyte count compared to the control group. The clinical improvement rate in patients receiving ulinastatin for 7 days or longer was 92.1%, significantly higher than that of patients treated for less than 7 days (62.5%) and those receiving standard treatment (71.0%). No significant difference in total length of hospitalization was observed between the two groups, and no related adverse events occurred in either group. Ulinastatin treatment improves lymphocyte counts in severe COVID-19 patients, and the clinical improvement rate is significantly higher with treatment duration of 7 days or longer. Larger-scale randomized controlled trials are warranted to further explore the role of ulinastatin in the management of COVID-19.

Sintilimab plus decitabine for higher-risk treatment-naïve myelodysplastic syndromes: efficacy, safety, and biomarker analysis of a phase II, single-arm trial

BackgroundImmunotherapy combined with azacitidine was feasible in higher-risk myelodysplastic syndromes (MDSs) with limited sample size of treatment-naïve patients, while the optimization of treatment strategies, including the optimal immune checkpoint inhibitor...

RADT-33. GAMMA KNIFE RADIOSURGERY FOR ORBITAL CAVERNOUS HEMANGIOMA: A SYSTEMATIC REVIEW AND SINGLE-ARM META-ANALYSIS

Abstract Gamma knife radiosurgery (GKRS) for orbital cavernous hemangioma (OCH) has emerged as a promising method due to its significant clinical improvement and low incidence of complications. This study aimed to evaluate the safety and efficacy of GKRS for the treatment of OCH. Following the PRISMA framework, we searched PubMed, Cochrane Central, and Embase for studies reporting outcomes of GKRS for OCH, including complications, visual improvement, proptosis, tumor reduction rate, and tumor progression rate. From 1856 search results, six studies with 100 patients were included. Only five minor complications related to GKRS were reported, including three with orbital pain and two with periorbital chemosis, resulting in a complication rate of 13% (95% CI: 7% - 25%). Visual acuity and visual field improvement rates after GKRS were 80% (95% CI: 63% - 96%) and 71% (95% CI: 47% - 95%), respectively. Proptosis improved in 94% of cases (95% CI: 83% - 100%). The tumor reduction rate was 77% after GKRS (95% CI: 69% - 85%). In conclusion, GKRS for OCH appears to be a safe technique, as evidenced by the rate of clinical improvement and radiological improvement. However, studies are limited by the absence of a control group, and additional studies are needed to evaluate the relative efficacy of GKRS compared with alternative surgical modalities for OCH.

Isotretinoin Combined Laser/Light-Based Treatments Versus Isotretinoin Alone for the Treatment of Acne Vulgaris: A Meta-Analysis.

This study aims to compare the efficacy and safety of oral isotretinoin with and without laser/light-based treatments for acne. This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; this meta-analysis utilized data from PubMed, EMBASE, ClinicalTrial.gov, and the Cochrane Central Register of Controlled Trials until December 2023. We evaluated clinical improvement, lesion reduction, adverse events, as well as intraoperative and postoperative discomfort rates. Analyses were performed using Review Manager 5.3. This review included six articles with a total of 285 patients. Isotretinoin combined with laser/light therapy outperformed in clinical improvement rates, significantly reducing acne vulgaris and acne scars lesions compared to isotretinoin alone. Additionally, there was no significant difference in the incidence of adverse events between the two groups. The study suggests that combining isotretinoin with laser/light-based therapy for acne yields superior efficacy and satisfaction without increased complications (e.g., dryness, hyperpigmentation, and scarring). However, patients experience notable treatment-related discomfort.

Allopregnanolone and progesterone in relation to a single electroconvulsive therapy seizure and subsequent clinical outcome: an observational cohort study

BackgroundElectroconvulsive therapy (ECT) is an important treatment for several severe psychiatric conditions, yet its precise mechanism of action remains unknown. Increased inhibition in the brain after ECT seizures, mediated by γ-aminobutyric acid (GABA), has been linked to clinical effectiveness. Case series on epileptic patients report a postictal serum concentration increase of the GABAA receptor agonist allopregnanolone. Serum allopregnanolone remains unchanged after a full ECT series, but possible transient effects directly after a single ECT seizure remain unexplored. The primary aim was to measure serum concentrations of allopregnanolone and its substrate progesterone after one ECT seizure. Secondary aims were to examine whether concentrations at baseline, or postictal changes, either correlate with seizure generalization or predict clinical outcome ratings after ECT.MethodsA total of 130 participants (18–85 years) were included. Generalization parameters comprised peak ictal heart rate, electroencephalographic (EEG) seizure duration, and prolactin increase. Outcome measures were ratings of clinical global improvement, perceived health status and subjective memory impairment. Non-parametric tests were used for group comparisons and correlations. The prediction analyses were conducted with binary logistic and simple linear regression analyses.ResultsAllopregnanolone and progesterone remained unchanged and correlated neither with seizure generalization nor with clinical outcome. In men (n = 50), progesterone increased and allopregnanolone change correlated negatively with EEG seizure duration. In a subgroup analysis (n = 62), higher baseline allopregnanolone and progesterone correlated with postictal EEG suppression.ConclusionsECT seizures have different physiologic effects than generalized seizures in epilepsy. Progesterone might have implications for psychiatric illness in men.

Feasibility of a primary care-based program for supporting youth following traumatic events: First Approach Skills Training for Trauma (FAST-T)

BackgroundIntegrated primary care (IPC) offers an opportunity to identify and support youth impacted by trauma. Trauma interventions with strong evidence exist but require adaptation for IPC. The First Approach Skills Training for Trauma (FAST-T) program was developed as a scalable, flexible, brief, stepped-care, cognitive-behavioral approach to supporting trauma-affected youth and families. ObjectiveThis paper describes program development and implementation of FAST-T in real-world IPC settings. All FAST-T resources, including modular child, teen and caregiver workbooks, handouts, training videos, and clinical guides/scripts are provided via hyperlink. Participants and SettingEight behavioral health clinicians (BHCs) from across Washington State were trained in FAST-T and provided de-identified treatment delivery and outcome data from all patients enrolled in FAST-T over three months. MethodsPosttraumatic stress symptom change and clinician-rated improvement were collected, as were data on treatment components used, number of sessions, and discharge disposition. Clinicians reported on acceptability, appropriateness, feasibility and other implementation outcomes. ResultsAcceptability, appropriateness and feasibility were rated by BHCs as favorable with good evidence of uptake in routine care at six months post-training. Nineteen youth received FAST-T and while the sample was underpowered to evaluate clinical outcomes, those with repeat measures of posttraumatic stress showed significant improvement. BHC ratings indicated most patients improved and none worsened during FAST-T. Conclusions: Findings offer preliminary support for addressing childhood trauma impact with flexible, brief programming within IPC.

Evaluating the Efficacy of Bacteriophage Therapy against Multidrug-Resistant Klebsiella pneumoniae Infections

Multidrug-resistant (MDR) Klebsiella pneumoniae poses a significant challenge to conventional antibiotic treatments. This study aims to assess the efficacy of bacteriophage therapy against MDR Klebsiella pneumoniae through a combination of in vitro assays, animal model experiments, and clinical case reviews. Phages isolated from environmental samples demonstrated potent lytic activity against MDR strains. In vitro assays showed that phages significantly reduced bacterial counts at a multiplicity of infection (MOI) of 1 or higher. Animal model experiments revealed that phage therapy, particularly using a cocktail of multiple phages, markedly improved survival rates and reduced bacterial loads in infected tissues compared to saline controls and standard antibiotics. Clinical case reviews indicated that patients receiving phage therapy experienced high rates of bacterial clearance and clinical improvement. These findings support the potential of bacteriophage therapy as an effective alternative or adjunct to traditional antibiotics in managing MDR Klebsiella pneumoniae infections.

Intraoperative neuromonitoring in Chiari I malformation surgery: a systematic review and meta-analysis.

Chiari Malformation Type I (CMI) is a prevalent neurosurgical condition characterized by the descent of cerebellar tonsils below the foramen magnum. Surgery, aimed at reducing symptomatology and syrinx size, presents risks, making intraoperative neuromonitoring (IONM) a potentially vital tool. Despite its widespread use in cervical spine surgery, the utility of IONM in CMI surgery remains controversial, with concerns over increased operative time, cost, restricted anesthetic techniques and tongue lacerations. This systematic review and meta-analysis followed the Cochrane Group standards and PRISMA framework. It encompassed an extensive search through PubMed, Embase, and Web of Science up to December 2023, focusing on clinical and surgical outcomes of IONM in CMI surgery. Primary outcomes included the use of various IONM techniques, complication rates, clinical improvement, reoperation, and mortality. The review, registered at PROSPERO (CRD42024498996), included both prospective and retrospective studies, with rigorous selection and data extraction processes. Statistical analysis was conducted using R software. The review included 16 studies, comprising 1358 patients. It revealed that IONM techniques predominantly involved somatosensory evoked potentials (SSEPs), followed by motor evoked potentials (MEPs) and Brainstem auditory evoked potentials (BAEPs). The estimated risk of complications with IONM was 6% (95% CI: 2-11%; I2 = 89%), lower than previously reported rates without IONM. Notably, the clinical improvement rate post-surgery was high at 99% (95% CI: 98-100%; I2 = 56%). The analysis also showed lower reoperation rates in surgeries with IONM compared to those without. Interestingly, no mortality was observed in the included studies. This systematic review and meta-analysis indicate that intraoperative neuromonitoring in Chiari I malformation surgery is associated with favorable clinical outcomes, including lower complication and reoperation rates, and high rates of clinical improvement.

Association of neighborhood level socioeconomic status and patient reported clinical improvement following total shoulder arthroplasty

BackgroundPrior studies have demonstrated higher preoperative pain and decreased patient reported outcomes (PROs) following total shoulder arthroplasty (TSA) in individuals with lower socioeconomic status (SES). The goal of this study was to investigate the rate of clinical improvement following TSA in individuals with differing SES. MethodsIndividuals included in this study underwent anatomic (a)TSA or reverse (r)TSA by two surgeons between May 2018 and January 2021. Patients were split into three SES groups (low, moderate, and high) based on neighborhood SES level as determined by Area Deprivation Index (ADI). PROs were collected preoperatively and at 9 weeks, 26 weeks, 1 year, and 2 years postoperatively. Shoulder specific PROs included the American Shoulder and Elbows Surgeon’s shoulder score (ASES), 10-point visual analog scale (VAS) for pain, single assessment numeric evaluation (SANE), and Western Ontario Osteoarthritis of the Shoulder Index (WOOS). The Veterans Rand 12 item health survey (VR-12) was utilized to measure overall well-being. We utilized a mixed design analysis of variance (ANOVA) to determine the interaction of time and improvement in PROs following surgery followed by one-way ANOVA with post-hoc analysis. Results/Discussion170 individuals (low SES n=34, moderate n=90, high n=46) met inclusion criteria and were included in this study. There were no significant differences between groups for BMI or age at time of surgery. All groups significantly improved from baseline scores on all PROs (p<.001) with the majority of improvement being achieved within the first year after surgery. There were no significant differences in rate of clinical improvement on PROs among the groups when compared to their respective preoperative scores. Significant differences were discovered when comparing groups independent of time with the low and moderate SES groups scoring significantly lower on ASES when compared to the high SES group (p<.01) and the low SES group reporting significantly higher VAS pain when compared to the high SES group (p=.034). ConclusionIndividuals with lower SES at the neighborhood level report higher pain and decreased shoulder function both preoperatively and postoperatively following TSA; however, the rate of clinical improvement following surgery in this group is comparable to individuals with higher SES when compared to baseline scores. All groups demonstrated significant improvement following surgery, suggesting TSA remains a successful operation regardless of SES.

Surgery for subaxial cervical spine injuries: which is better: anterior, posterior, or anterior-posterior combined approach?: a systematic review and meta-analysis.

Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior-posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79-1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35-3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of -42.84 (95% CI, -64.39 to 21.29; p<0.0001); -212.91 (95% CI, -417.60 to 8.22; p=0.04), respectively, whereas the length of hospitalization did not (p=0.16). No difference was found between the groups when compared by clinical improvement and complication rate. Meanwhile, the anterior approach was superior to the posterior approach in terms of surgical duration, blood loss, and hospitalization length.

Impact of the First Twenty-Four-Hour Area Under the Concentration-Time Curve/Minimum Inhibitory Concentration of Vancomycin on Treatment Outcomes in Patients With Methicillin-Resistant Staphylococcus aureus Bacteremia.

Vancomycin regimens are designed to achieve an area under the concentration-time curve/minimum inhibitory concentration (AUC/MIC) ratio ranging between 400 and 600 µg·h/mL in the steady state. However, in cases of critical infections such as bacteremia requiring an early treatment approach, the clinical course may be affected by the AUC/MIC before reaching the steady state, that is, the AUC/MIC values 24 h after the first dose (first 24-h AUC/MIC). This study evaluated the relationship between the first 24-h AUC/MIC and the clinical course of methicillin-resistant Staphylococcus aureus (MRSA) infection. We retrospectively reviewed the records of patients with MRSA bacteremia in a university hospital between 2015 and 2022. The first 24-h AUC/MIC cutoff was set at 300 µg·h/mL based on the results of early response, and eligible patients were divided into groups with a first 24-h AUC/MIC either < 300 µg·h/mL (< 300 group, n = 32) or ≥ 300 µg·h/mL (≥ 300 group, n = 38). The primary endpoint was the rate of treatment efficacy, and the secondary endpoints were time to clinical and bacteriological improvement and 30-day survival rate. Treatment efficacy and 30-day survival rates were not significantly different between the two groups (78.1% vs. 79.0%, P = 0.933 and 83.9% vs. 87.2%, P = 0.674, respectively). Among patients who showed treatment efficacy, the median time to clinical and bacteriological improvement was 11.5 days and 8.0 days in the < 300 and ≥ 300 groups, respectively; compared to the ≥ 300 group, the < 300 group had a significantly longer time to improvement (P = 0.001). The first 24-h AUC/MIC had no effect on the treatment efficacy and 30-day survival rates. However, the time to clinical and bacteriological improvement was significantly prolonged in the < 300 group, indicating that the first 24-h AUC/MIC does not affect the rate of therapeutic efficacy but may affect the treatment period.

Efficacy and safety of a 0.05 % nanoencapsulated imiquimod hydrogel for the treatment of actinic cheilitis: Drug release analysis and clinical study

Actinic cheilitis (AC) is a lip disorder, with no standard treatment. Imiquimod (IMIQ) is an immunomodulator that treat precancerous lesions; however, its commercial form causes severe adverse effects. This study aimed to assess IMQ release from a chitosan hydrogel containing 0.05 % nanoencapsulated (NANO) imiquimod (IMIQ-0.05 %-NANO) and its efficacy in AC treatment. The hydrogels were prepared by incorporating chitosan into polymeric nanocapsules (NCimiq) loaded with IMQ, produced using the interfacial deposition of preformed polymer method. IMQ release was evaluated using automated Franz Cells. A triple-blind randomized controlled trial (49 subjects) compared the efficacy of: IMIQ-0.05 %-NANO, 5 % free imiquimod (IMIQ-5 %), 0.05 % free imiquimod (IMIQ-0.05 %), and placebo hydrogel. The IMIQ-NANO-0.05 % and IMIQ-5 % groups exhibited significantly higher rates of clinical improvement (p < 0.05); however, the IMIQ-5 % group experienced more adverse effects (92.3 % of subjects) compared to other groups (p < 0.05). In conclusion, in the studied sample, IMIQ-NANO-0.05 % was a safe and effective option to treat AC.

Shunt options for normal pressure hydrocephalus: a comparison of complications, overdrainage rates and neurological outcomes between integra low flow regulated and Codman Hakim programmable shunts

Aims: Shunt surgery is the most commonly performed treatment for idiopathic normal pressure hydrocephalus, and shunt systems with different operating principles are employed. This study aimed to retrospectively compare programmable ventriculoperitoneal shunts and flow-regulated shunts in terms of complications, overdrainage rates, and neurological outcomes. Methods: Between January 2020 and May 2022, 44 patients who underwent shunt operation with a diagnosis of idiopathic normal pressure hydrocephalus at our clinic were retrospectively analyzed. Patients were categorized into two groups: the programmable ventriculoperitoneal shunt and the flow-regulated shunt group. Demographic characteristics, complications, rates of insufficient drainage/overdrainage, and surgical outcomes were compared. Results: There were 26 patients in the programmable ventriculoperitoneal shunt group and 18 patients in the flow-regulated shunt group. In the programmable ventriculoperitoneal shunt group, 14 patients (53.8%) required 27 shunt setting adjustments owing to excessive or inadequate drainage. Subdural effusion was observed in five patients (19.2%), and shunt revision was performed in one patient (3.8%). Subdural effusion was observed in two (11.1%) patients in the flow-regulated shunt group. One of these patients (5.5%) underwent shunt revision. There was no significant difference between the groups in terms of the development of subdural effusion and need for shunt revision (p&gt;0.05). The rate of improvement in at least one of the symptoms was 53.8% in the programmable ventriculoperitoneal shunt group at the 1st-month postoperative outpatient follow-up. In the flow-regulated shunt group, this rate was 72.2% and there was no statistically significant difference. Both groups showed similar clinical improvement at the 1-year follow-up. Conclusion: There was no difference between the groups in terms of neurological outcomes and the need for shunt revision. However, the use of flow-regulated shunts has demonstrated earlier rates of clinical improvement without the need for reprogramming.