Frequent Site Research Articles

Tuberculous meningitis-related ischemic stroke: A retrospective study from a tertiary care hospital.

Patients with tuberculous meningitis (TBM) are at high risk of ischemic stroke, and stroke is a poor prognosticator of TBM. However, reports regarding the predictors of stroke in TBM patients are scanty. The aim of this study was to investigate the clinical characteristics and predictors of tuberculous meningitis-related ischemic stroke (TBMRIS). This retrospective study was conducted among TBM patients without traditional vascular risk factors from a tertiary care hospital between January 2017 and November 2022. Patients were divided into TBMRIS group and TBM-only group according to presence of stroke. Clinical, laboratory and radiological variables were compared between the two groups. Predictors of stroke were identified using binary logistic regression analysis. A total of 176 TBM patients were included in the study. Forty-nine patients with stroke were classified as TBMRIS group and 127 patients without stroke were classified as TBM-only group. In TBMRIS group, 41 (83.7%) patients experienced stroke within 3months after the onset of meningitis symptoms and 10 (20.4%) patients presented silent stroke. Stroke occurred in basal ganglia in 57.1% of patients. About 73.5% of patients showed multiple stroke lesions and 38.8% of patients had stroke involving multiple vascular territories. There were significant differences in focal neurological deficit, stage of meningitis, short-term outcome, serum sodium, cerebrospinal fluid (CSF) white cell count, CSF adenosine deaminase (ADA), CSF protein, leptomeningeal enhancement, tuberculoma between TBMRIS group and TBM-only group. Binary logistic regression analysis revealed that focal neurological deficit, CSF white cell count and leptomeningeal enhancement were the independent risk factors for stroke, and tuberculoma was negatively correlated with stroke. Most of TBMRIS develop within 3months after the onset of meningitis symptoms and basal ganglia is the most frequent site. Multiple stroke lesions and involvement of multiple vascular territories are commonly observed. Focal neurological deficit, CSF white cell count and leptomeningeal enhancement are the predictors of stroke in patients with TBM.

Adagrasib (Ada) + cetuximab (Cetux) for KRAS G12C -mutated metastatic colorectal cancer (mCRC): Longer follow-up analysis from KRYSTAL-1.

131 Background: KRAS G12C mutations occur in 3%–4% of CRC cases and are associated with poor prognosis. In the phase 1/2 KRYSTAL-1 study (NCT03785249), at a median follow-up of 11.9 months (mo), Ada (irreversible inhibitor of KRAS G12C ) in combination with Cetux (anti-EGFR antibody) demonstrated promising clinical activity (objective response rate [ORR] of 34% per blinded independent central review [BICR] and 43% per investigator [INV]) and was well tolerated in patients (pts) with previously treated KRAS G12C -mutated mCRC. Based on these findings, Ada + Cetux was granted accelerated approval in the United States for these pts. Here, we present longer-term follow-up analyses from this study. Methods: Adults with previously treated KRAS G12C -mutated mCRC and ECOG performance status of 0 or 1 were treated with Ada (600 mg BID) in combination with Cetux (400 mg/m 2 followed by 250 mg/m 2 QW or 500 mg/m 2 Q2W) until disease progression, unacceptable toxicity, withdrawal of consent, or death, in separate phase 1 and phase 2 cohorts. Primary endpoints were safety (phase 1) and ORR per BICR (phase 2). Secondary endpoints were duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety (phase 2). Results: A total of 94 pts received Ada + Cetux. The median number of prior lines of systemic therapy was 3 (range, 1–9); 23 pts (24%) had received ≥ 4 prior lines of systemic therapy. The most frequent sites of metastases at baseline were the lung (71%) and liver (64%). At a median follow-up of 20.4 mo, ORR per INV was 43% (95% CI 32–53) and all were partial responses; median DOR was 5.9 (95% CI 5.5–7.6) mo. Disease control rate per INV was 86% (95% CI 78–92). Median PFS per INV was 6.9 (95% CI 5.9–7.4) mo; 6- and 12-mo PFS rates were 61% and 19%, respectively. Median OS was 16.0 (95% CI 13.3–18.8) mo; 6- and 12-mo OS rates were 88% and 66%, respectively. Any-grade treatment-related adverse events (TRAEs) were reported in 100% of pts, 28% of which were grade 3/4. TRAEs led to discontinuation in 10% of pts. Efficacy analyses by BICR, subgroup analyses, and additional safety results will be presented. Conclusions: In heavily pretreated pts with KRAS G12C -mutated mCRC, Ada + Cetux continued to demonstrate clinically meaningful activity and tolerable safety with longer follow-up. These updated results are consistent with those from the primary analysis and constitute the longest duration of follow-up for dual KRAS G12C /EGFR blockade in this setting. Efficacy of second-line Ada + Cetux vs chemotherapy in KRAS G12C -mutated mCRC is being investigated in the phase 3 KRYSTAL-10 study (NCT04793958). Clinical trial information: NCT03785249 .

Prognostic value of biohumoral markers and echocardiography images in infective endocarditis

Abstract Introduction The incidence of infective endocarditis (IE) has risen due to an increasing at-risk population and improved diagnosis through the widespread use of imaging techniques. With the surge in COVID-19 cases during the pandemic, there have been more frequent reports of patients being diagnosed with IE, likely due to factors such as immunosuppressive therapies and the use of central venous or urinary catheters. Purpose To analyze the prognostic value of biohumoral markers and valvular impairement assessed by echocardiography. Methods We conducted a retrospective observational study involving 29 patients diagnosed with IE who were admitted to our department in 2021. During hospitalization, we monitored and analyzed various biological parameters, including blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum creatinine and blood cultures. We also interpreted findings from transthoracic and transesophageal echocardiography. Results Most patients were presented with signs of inflammatory syndrome: leukocytosis upon admission in 22 patients (75.8%), elevated CRP in 28 patients (96.5%), ESR in 27 patients (93.1%), and procalcitonin in 6 patients (20.6%). Our analysis also included biomarker parameters with prognostic significance in IE: anemia was present in 22 patients (75.8%), while thrombocytopenia was observed in 11 patients (37.9%). Renal impairment was noted in 11 patients (37.9%). Among the pathogens identified Staphylococcus spp. was detected in 11 patients (37.93%), Streptococcus spp. in 5 patients (17.24%), Enterococcus spp. in 2 patients (6.89%), Acinetobacter spp. in 1 patient (3.44%), and Escherichia coli in 1 patient (3.44%). A notable proportion of cases (31.03% - 9 patients) had negative blood cultures, contrasting with findings from other registries. Vegetations were predominantly localized on the aortic valve in 15 patients (51.72%), followed by the mitral valve in 6 patients (20.68%). Less common locations included prosthetic heart valves in 5 patients (17.24%) and the tricuspid valve in 3 patients (10.34%). Among valvular complications, valve abscesses were most frequently observed in 6 patients (20.6%), followed by valve ruptures in 5 patients (17.2%), and valvular pseudoaneurysms in 2 patients (6.8%). Conclusions CRP was the most sensitive inflammation marker for assessing infection severity, while the most relevant prognostic biomarkers were hemoglobin, platelet count, and serum creatinine. Diagnosing this condition required complex analyses, as a significant percentage of patients presented with negative blood cultures. Staphylococcus spp. was the most identified microorganism. The most frequent infection sites were the native aortic valve, followed by the native mitral valve. The most common local complications included valve abscesses and valve ruptures.

P-1475. Real-World Effectiveness and Safety of Cefiderocol in the Treatment of Patients with Serious Gram-negative Bacterial Infections: Results of the PROVE Chart Review Study

Abstract Background The ongoing PROVE retrospective chart review study aims to assess real-world outcomes of cefiderocol treatment in patients with serious Gram-negative bacterial infections. Methods This is an interim analysis of hospitalized patients with suspected or confirmed Gram-negative bacterial infections in Europe and the USA treated with cefiderocol for the first time for ≥72 hours (Nov 2020–Feb 2024). A total of 1000 patients are planned. Baseline demographics, clinical characteristics, cefiderocol use, clinical cure, clinical response at end of treatment (EOT), in-hospital all-cause mortality (ACM), and adverse drug reactions (ADRs) were assessed. Results Of 774 patients analyzed, 498 (64.3%) were men and the median age (interquartile range [IQR]) was 59 (45–69) years (Table 1); 90.1% of patients had ≥1 risk factor for carbapenem-resistant infections. Overall, 59.8% were in the intensive care unit (ICU) and 48.1% received organ support. Cefiderocol was used as first-line therapy in 70.3% of patients; the median (IQR) duration was 11 (8–16) days. The most frequent infection site was the respiratory tract (RTI; 54.1%), and the most frequent species in monomicrobial infections was Pseudomonas aeruginosa (35.3%), followed by Acinetobacter baumannii (19.6%) (Figure 1). Overall, 64.0% of patients had clinical cure and 71.6% responded to cefiderocol treatment at EOT. ACM rates at days 14 and 30 were 15.6% and 24.3%, respectively (Table 2). Clinical cure and clinical response rates were 58.0% and 68.0% in patients with RTI, and 66.7% and 74.1% in patients with bloodstream infection (BSI), respectively. Among patients with RTI or BSI, 31.0% and 18.5% died by day 30, respectively. Among patients with P. aeruginosa infection, 67.0% and 75.8% had clinical cure and clinical response, and 22.3% died by day 30. In monomicrobial and polymicrobial infections, clinical cure rates were 63.6% and 65.0%, while ACM rates were 25.6% and 20.0% at day 30, respectively (Table 2). A total of 19 patients had 23 ADRs or serious ADRs, which led to discontinuation of cefiderocol for 11 events (Table 3). Conclusion Cefiderocol was efficacious and well tolerated for the treatment of serious Gram-negative bacterial infections in real-world settings in a patient population with high rates of ICU admission and organ support. Disclosures Cornelius J. Clancy, MD, Cidara: Grant/Research Support|Gilead: Honoraria|Merck: Grant/Research Support|Scynexis: Advisor/Consultant|Shionogi: Advisor/Consultant|Venatorx: Advisor/Consultant Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Abbvie: Honoraria|AiCuris: Advisor/Consultant|Akademie fur Infektionmedizin: Honoraria|Al-Jazeera Pharmaceuticals/Hikma: Honoraria|amedes: Honoraria|AstraZeneca: Honoraria|Basilea: Advisor/Consultant|Biocon: Advisor/Consultant|BMBF: Grant/Research Support|Boston Strategic Partners: Advisor/Consultant|CIdara: Advisor/Consultant|CIdara: Expert Testimony|CIdara: Grant/Research Support|CIdara: Participation on a DRC or DSMB|CoRe Consulting: Stocks/Bonds (Private Company)|Deutscher Arzteverlag: Honoraria|DZIF: Grant/Research Support|EasyRadiology: Stocks/Bonds (Private Company)|EU-DG RTD: Grant/Research Support|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|IQVIA: Advisor/Consultant|IQVIA: Participation on a DRC or DSMB|Janssen: Advisor/Consultant|Janssen: Participation on a DRC or DSMB|Matinas: Advisor/Consultant|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedPace: Participation on a DRC or DSMB|Medscape/WebMD: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Moderna: Honoraria|Molecular Partners: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|MSG-ERC: Advisor/Consultant|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Noscendo: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Pardes: Advisor/Consultant|Partner Therapeutics: Advisor/Consultant|Patent: US18/562644|Paul-Martini-Stiftung: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|PSI: Advisor/Consultant|PSI: Participation on a DRC or DSMB|Pulmocide: Participation on a DRC or DSMB|Sandoz: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seqirus: Advisor/Consultant|Seqirus: Honoraria|Seres: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria|streamedup!: Honoraria|The Prime Meridian Group: Advisor/Consultant|Touch Independent: Honoraria|Vitis: Honoraria Christine M. Slover, PharmD, Shionogi Inc.: Employee Sean T. Nguyen, PharmD, Shionogi Inc.: Employee Frank H. Kung, PhD, Shionogi Inc.: Employee Stefano Verardi, MD, Shionogi BV: Employee Christopher M. Longshaw, PhD, Shionogi BV: Employee Stephen Marcella, MD, MPH, Shionogi Inc.: Employee Bin Cai, MD, PhD, Shionogi Inc.: Employee

P-1148. Invasive Infections by Carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa in Children

Abstract Background Enterobacterales and Pseudomonas aeruginosa cause invasive infections and their spread of antimicrobial resistance is of great concern in the worldwide scientific community. Carbapenemases represent the main mechanism of resistance in Enterobacterales and can spread horizontally through mobile genetic elements. Clinical evidence suggests that mortality would be related to inadequate initial empirical treatment. Methods A prospective observational study was carried out in three tertiary care pediatric hospitals in Argentina, since 12/1/2021 to 11/30/2022, including children between 0 to 18 years of age with a positive culture for carbapenemase-producing Enterobacterales or P. aeruginosa isolated from a sterile site and/or tracheal aspirate with pulmonary radiological confirmation. Results We enrolled 29 patients, 62% male. Median age: 25 months (IQR 5-127). Median length of hospitalization: 44 days (IQR 17-91). Comorbidities: 93%, oncohematological disease: 40%; 62% (18/29) were admitted to Intensive Care Unit. The most frequent isolation was Klebsiella pneumoniae: 62% (18/29), Escherichia coli 17% (5/29), Enterobacter cloacae 10% (3/29), Serratia marcescens 7% (2/29), P. aeruginosa 7% (2/29). Bacteremia: 55% (16/29). Most frequent site of infection: urinary tract 44.8%. Metallobetalactamase (MBL) was detected in 48% (14/29), KPC: 34% (10/29), OXA: 14% (4/29). Initial empirical treatment: meropenem 53% (16/29). Adjustment of initial empirical treatment at 48 hours: 79% (23/29) according to cultures and antibiogram. Ceftazidime/avibactam: 48.2%; aztreonam combined in MBL strains. Extended infusion meropenem: 24% (7/29) if MIC ≤ 8 ug/ml. Overall mortality: 20.6%, in 6.8% it was related to infection. Conclusion In recent years we have seen an increase in antimicrobial resistance. Metallobetalactamases were the most frequently detected in patients hospitalized in critical areas. Resistance data in Argentina showed K. pneumoniae as one of the most prevalent bacteria in multidrug-resistant infections. Carbapenemes in high doses and extended infusions plus other antibiotics were useful to treat strains with low MIC values. Ceftazidime/avibactam was a good option for KPC and some OXA infections. Aztreonam in combined use was indicated for MBL strains. Disclosures All Authors: No reported disclosures

Identifying Primary Sites of Spinal Metastases: Expert-Derived Features vs. ResNet50 Model Using Nonenhanced MRI.

The spinal column is a frequent site for metastases, affecting over 30% of solid tumor patients. Identifying the primary tumor is essential for guiding clinical decisions but often requires resource-intensive diagnostics. To develop and validate artificial intelligence (AI) models using noncontrast MRI to identify primary sites of spinal metastases, aiming to enhance diagnostic efficiency. Retrospective. A total of 514 patients with pathologically confirmed spinal metastases (mean age, 59.3 ± 11.2 years; 294 males) were included, split into a development set (360) and a test set (154). Noncontrast sagittal MRI sequences (T1-weighted, T2-weighted, and fat-suppressed T2) were acquired using 1.5 T and 3 T scanners. Two models were evaluated for identifying primary sites of spinal metastases: the expert-derived features (EDF) model using radiologist-identified imaging features and a ResNet50-based deep learning (DL) model trained on noncontrast MRI. Performance was assessed using accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (ROC-AUC) for top-1, top-2, and top-3 indicators. Statistical analyses included Shapiro-Wilk, t tests, Mann-Whitney U test, and chi-squared tests. ROC-AUCs were compared via DeLong tests, with 95% confidence intervals from 1000 bootstrap replications and significance at P < 0.05. The EDF model outperformed the DL model in top-3 accuracy (0.88 vs. 0.69) and AUC (0.80 vs. 0.71). Subgroup analysis showed superior EDF performance for common sites like lung and kidney (e.g., kidney F1: 0.94 vs. 0.76), while the DL model had higher recall for rare sites like thyroid (0.80 vs. 0.20). SHapley Additive exPlanations (SHAP) analysis identified sex (SHAP: -0.57 to 0.68), age (-0.48 to 0.98), T1WI signal intensity (-0.29 to 0.72), and pathological fractures (-0.76 to 0.25) as key features. AI techniques using noncontrast MRI improve diagnostic efficiency for spinal metastases. The EDF model outperformed the DL model, showing greater clinical potential. Spinal metastases, or cancer spreading to the spine, are common in patients with advanced cancer, often requiring extensive tests to determine the original tumor site. Our study explored whether artificial intelligence could make this process faster and more accurate using noncontrast MRI scans. We tested two methods: one based on radiologists' expertise in identifying imaging features and another using a deep learning model trained to analyze MRI images. The expert-based method was more reliable, correctly identifying the tumor site in 88% of cases when considering the top three likely diagnoses. This approach may help doctors reduce diagnostic time and improve patient care. 3 TECHNICAL EFFICACY: Stage 2.

Clinical patterns and outcomes of patients affected by primary malignant melanoma of the oral mucosa: A European multicenter retrospective chart review.

The purpose of this European multicenter study was to describe and assess the characteristics, diagnosis, management, and recurrence of oral malignant melanoma at different European oral and maxillofacial surgery centers. This study was based on a systematic computer-assisted database that allowed the recording of data for all primary oral mucosal melanomas treated in the involved surgical units across Europe between January 1, 2003 and December 31, 2022. The following data were recorded for each patient: gender, age, site, TNM staging, metastases, symptoms, imaging features, histopathological features, treatment, complications, recurrence, follow up, and survival. A total of 29 patients (15 females, 14 males) with a primary oral mucosal malignant melanoma fulfilled the inclusion criteria. The mean age was 64.4 years. The most frequent primary site was the vestibular and crestal maxillary gum. Nineteen patients had been diagnosed with a T3 oral melanoma, nine patients with a T4a oral melanoma, and one patient with a T4b neoplasm. Three patients had distant metastases at diagnosis. Clinically, the most frequently observed clinical features were hyperpigmentation, nodular appearance, ulceration, and hemorrhage. Among the 27 surgical cases, radical/clear margins were obtained in 24 cases, non-radical/invaded margins were obtained in two cases, while in one case a non-specific result of margin positivity was found. The overall 2-year survival was 62%. The 2-year disease-free survival was 52%. Oral mucosal melanoma is an aggressive and often asymptomatic malignancy. The overall long-term survival for patients with oral mucosal melanoma is poor, with a high rate of distant metastasis, independently from the performed treatment. Prevention and early diagnosis could be crucial to improving the disease-free survival of patients with oral mucosal melanomas.

Trends in Colorectal Cancer Peritoneal Metastases Research: A Comprehensive Bibliometric Analysis.

Colorectal cancer (CRC) stands as the third most prevalent malignancy globally and is recognized as the second leading cause of cancer-related mortality. Notably, nearly 50% of individuals diagnosed with CRC ultimately develop metastatic disease, with the peritoneum emerging as the second most frequent site for metastatic spread. Recent advancements in therapeutic frameworks have enhanced both survival rates and quality of life metrics for patients afflicted with colorectal cancer peritoneal metastases (CRCPM). This study endeavors to facilitate an in-depth review of the current scientific landscape surrounding CRCPM, ultimately aiming to delineate future avenues for investigative research in this realm. Employing R software through the Bibliometrix package, alongside analytical tools such as CiteSpace and VOSviewer, we performed a comprehensive bibliometric analysis. This enabled us to assess pivotal keywords, prominent authors, influential countries, notable institutions, relevant literature, and key journals pertinent to the field of CRCPM research. Our findings illustrate a significant uptick in the volume of publications addressing CRCPM, with the USA leading in overall contribution, complemented by substantial input from distinguished scholars in the Netherlands and France. The author Ignace H. J. T. de Hingh emerged as the most prolific contributor. Current research endeavors have predominantly focused on the characterization of primary malignancies with peritoneal metastases, therapeutic interventions for CRCPM, and the orchestration of clinical trials. This analysis culminates in a systematic encapsulation of the prevailing research findings concerning CRCPM, underscoring current hotspots and predicting future trends within the global research spectrum. The exploration of treatment modalities for CRCPM remains vibrant, and ongoing multicenter clinical trials are anticipated to further enrich our understanding and management of this challenging clinical issue.

Masseter Hemangioma: A Case Report

Masseter hemangiomas are rare benign vascular tumors that arise from the proliferation of endothelial cells within the masseter muscle. While hemangiomas account for a significant proportion of vascular anomalies, intramuscular hemangiomas are exceedingly uncommon, particularly in the masseter region, which represents the most frequent site in the head and neck. Intense stretching of muscle fibers and associated nerves is believed to be a predisposing factor. This study aims to discuss the clinical presentation, diagnostic challenges, and management of masseter hemangiomas. We report a case of a patient diagnosed with a masseter hemangioma, treated successfully.

Vulvar extramedullar relapse (genitomegaly) of acute lymphoblastic leukemia

Introduction: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Relapse of ALL occurs in 15–20% of patients, with 2–6% occurring exclusively in extramedullary sites. Extramedullary relapse of leukemia is encountered more often than in the past. The reason is that leukemia survival rates increase with improved treatment schemes. The relapse of ALL usually involves the bone marrow, with the central nervous system being the most frequent extramedullary site. Relapses affect various organs but rarely the female genital tract. The frequency of gynecological involvement, from high to low, is ovary, cervix, uterus, and vulva. Case Report: We wanted to present a case of vulvar extramedullary recurrence one year after the application of an inadequate ALL chemotherapy protocol. Conclusion: The survival time of leukemia patients is increasing. The genital area is an area that chemotherapy drugs rarely penetrate. The physicians should be more careful about the genital area after the treatment of girls with leukemia.

Review of presentations and radiotherapy outcomes of patients with malignant spinal cord compression

Background: Malignant spinal cord compression (MSCC) is the commonest radiotherapy emergency. A high index of suspicion, prompt diagnosis, early referral and treatment is important to restore quality of life and improve survival in patients with MSCC.Aim: This study aimed to evaluate the clinical and treatment characteristics of patients presenting with MSCC at the Radiation Oncology department.Setting: The study was conducted at Steve Biko Academic Hospital, Radiation Oncology.Methods: This is a retrospective review of 110 patients who were treated for MSCC between January 2022 and November 2023. Information on patients’ characteristics, disease characteristics, imaging findings, radiotherapy dose prescription, clinical response and survival was extracted from clinical records.Results: Breast and prostate cancer were the most frequent primary disease sites. Most patients presented in a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS 4), de novo disease (63%) and multilevel vertebral involvement (70%). Eighty-four patients (76.4%) received a single fraction treatment (6 Gy – 8 Gy). The median overall survival was 145 days. Patients with a Rades score of 32–37 points had a statistically significant better overall survival at 1 year compared with those with a score of 22–31 points. There was no difference in survival between single versus multiple fraction treatment.Conclusion: A single fraction radiotherapy schedule is acceptable in this setting where most patients present with extensive disease and non-ambulatory baseline function.Contribution: The findings from this study could be used to establish protocols for treatment strategies in facilities with limited resources.

Prevalence of vertebral fractures at death

Abstract Introduction Despite many studies on the prevalence of vertebral fractures (VFs), the VF prevalence at death in the Japanese population remains unclear. Materials and methods We evaluated the VF prevalence at death in a Japanese cohort using autopsy imaging computed tomography (AiCT). We enrolled 365 cadavers (188 men, 177 women, mean age of 84.6 years) donated for anatomical dissection at Shimane University School of Medicine. The VFs were diagnosed using the semiquantitative technique of Genant from the first cervical vertebra to the fifth lumbar vertebra. Results The overall VF prevalence was 69.6% (58.5%/81.4% in men/women), of which 46.0% (29.8%/63.3% in men/women) had thoracic VFs, and 58.1% (50.5%/66.1% in men/women) had lumbar VFs. The most frequent fracture site was lumbar spine 1 (L1) with 31.5% (22.9%/40.7% in men/women), followed by thoracic spine 12 (T12) with 31.0% (20.7%/41.8% in men/women). In terms of severity, 3.8% (4.8%/2.8% in men/women), 23.8% (27.1%/20.3% in men/women), and 41.9% (26.6%/58.2% in men/women) were Grades 1, 2, and 3. The VFs from T3 to L5 and of Grade 3 severity were significantly higher in women. VF and Grade 3 fractures were associated with a history of surgical intervention for femoral neck fractures. VFs were not associated with the following underlying causes of death: cancer, heart disease, senile death, cerebrovascular disease, pneumonia, and aspiration pneumonia. Conclusion The VF prevalence at death, assessed by AiCT in cadavers donated for anatomical dissection, was higher in both men and women compared with previous studies conducted on individuals aged ≥ 80 years in Japan.

Survival and toxicity outcomes of hypofractionated conformal radiotherapy compared to conventionally fractionated radiotherapy in the treatment of diffuse intrinsic pontine gliomas.

Diffuse intrinsic pontine gliomas are associated with dismal survival outcomes. Conventional fractionation radiation to a dose of 60Gy is the standard of treatment. This retrospective review aims to compare survival and toxicity outcomes of patients treated with conventional fractionation (CF) and hypofractionation (HF) radiotherapy. Treatment-naïve diffuse intrinsic pontine glioma patients undergoing radical radiation were analyzed. CF was delivered to a dose of 50-60Gy in 25-30 fractions, while HF was delivered as 38-40Gy in 12-15 fractions. All patients were planned via the volumetric modulated arc therapy (VMAT) technique. A total of 64 patients were eligible for analysis. The median age of presentation was 10years. Motor deficit was the most common presenting complaint in 51.6% of the patients, with a median symptom duration of 2months. The pons was the most frequent site of disease epicenter in 71.8% of the patients. After a median follow-up of 9.45months (range 0.23-72.63months), 23 patients died, and 28 patients experienced disease progression. The unadjusted hazard ratio (HR) for death in patients treated with HF as compared to CF was 1.330 (95% CI 0.522-3.386) (p-value 0.550, by Cox regression analysis). The median OS for the entire cohort was 13.9months, while it was 9.7months (95% CI 5.65-13.74) and 15.1months (95% CI 9.02-21.18) (p-value = 0.547) with CF and HF, respectively. On multivariate analysis, disease epicenter in the pons was the only significant factor associated with PFS. Hypofractionation was associated with a significantly higher aspiration rate and Ryle's tube requirement (p-value 0.027). Hypofractionated radiation can be considered for diffuse intrinsic pontine glioma with optimum supportive care.

ESBL- and pAmpC-producing Enterobacterales from Swedish dogs and cats 2017-2021: a retrospective study.

Antibiotic resistant bacteria are a threat to both human and animal health. Of special concern are resistance mechanisms that are transmissible between bacteria, such as extended-spectrum beta-lactamases (ESBL) and plasmid-mediated AmpC (pAmpC). ESBL/AmpC resistance is also of importance as it confers resistance to beta-lactam antibiotics including third generation cephalosporins. The Swedish Veterinary Agency (former English name National Veterinary Institute) performs confirmatory testing of suspected ESBL-/pAmpC-producing Enterobacterales. The aim of this study is to describe the clinical background, antibiotic susceptibility, and genetic relationships of confirmed isolates from dogs and cats in Sweden from 2017 to 2021. The study includes 92 isolates of ESBL/pAmpC-producing bacteria from 82 dogs, and 28 isolates from 23 cats. Escherichia coli was the most commonly isolated bacteria, and the most frequent sampling site was the urinary tract. From eight dogs and two cats, ESBL/pAmpC-producing bacteria were isolated on more than one occasion. Multi-resistance was more than twice as common in samples from dogs (50%) than in samples from cats (22%). Among dogs, sequence type (ST) 131 and ST372 were the dominant strains and blaCMY-2 and blaCTX-M-15 the dominant genes conferring reduced susceptibility to third-generation cephalosporins. Among cats, ST73 was the dominant strain and blaCTX-M-15 the dominant gene. Monitoring the resistance patterns and genetic relationships of bacteria over time is important to follow the results of measures taken to reduce resistance. Knowledge of the appropriate antibiotic usage is also crucial. In this study, a variety of STs and ESBL/pAmpC-genes were detected among the isolates. There were available antibiotics likely effective for treatment in all cases, based on resistance pattern, infection site and host species.

Megalith of the Wharton's Duct: Review of Literature and a Case Report

ABSTRACT Sialolithiasis, the most common disorder affecting salivary glands, occurs when calcified formations obstruct the ducts or glands. Typically, these formations, known as sialoliths, measure between 5 and 10 mm; however, those exceeding 15 mm are classified as megaliths. While sialoliths commonly manifest in the submandibular glands, they can develop in any salivary gland duct, with the Wharton’s duct of the submandibular gland being a frequent site. These stones, formed from calcified organic material within the secretory system, can lead to pain, swelling, and disruptions in saliva flow. Chronic sialolithiasis, the primary contributor to acute and chronic infections in salivary glands, is closely associated with stone formation. The precise cause remains unclear, yet it is linked to chronic sialadenitis and partial obstruction. On the contrary, megaliths are exceptionally rare and tend to occur more frequently in male patients. The present article presents a case involving a 19 mm long megalith detected at the duct mouth of the left submandibular gland, which was treated through surgical intervention. Additionally, a comprehensive literature review on this specific topic was conducted.

A Rare Case of Testicular Tuberculosis Mimicking as Testicular Malignancy

Abstract Extrapulmonary tuberculosis (TB) represents 10%–15% of TB cases, with lymph nodes being the most frequent site in India. Genital TB is uncommon, and testicular TB is rarer, still accounting for only 3% of genital TB cases. Isolated testicular TB is extremely rare and often mimics other testicular conditions, such as malignancy, complicating diagnosis. We present a case involving a 49-year-old male with diabetes and a history of smoking, who experienced bilateral scrotal swelling and pain over 3 months, accompanied by weight loss. He had no history of respiratory complaints, fever, TB, or significant medical history. Physical examination revealed bilateral scrotal swelling (3 cm × 3 cm) and multiple inguinal lymph nodes. Scrotal ultrasound demonstrated bilateral heterogeneously hypoechoic masses, while magnetic resonance imaging of the scrotum and testis identified solid cystic lesions with heterogeneous enhancement. Serum alpha-fetoprotein and lactate dehydrogenase levels were within normal limits. Fluorodeoxyglucose positron emission tomography–computed tomography revealed metabolically active lesions in both testes and several lymph nodes. Chest X-ray was normal. With a strong suspicion of malignancy, the patient underwent bilateral high inguinal orchiectomy. Histopathological analysis of the excised tissue showed dense epithelioid granulomas with caseous necrosis, indicative of TB. The patient was commenced on antitubercular therapy, with plans for continued monitoring. Although rare, isolated testicular TB should be included in the differential diagnosis of testicular masses. Prompt recognition and appropriate treatment are essential to prevent unnecessary surgical procedures and ensure optimal management.

Drug-Induced Sleep Endoscopy Predicts Subjective Outcomes of Adenotonsillectomy.

Persistent obstructive sleep apnea (OSA) after adenotonsillectomy (AT) has been reported in 20%-30% of children. The aim of this study was to determine the predictive value of drug-induced sleep endoscopy (DISE) at the time of AT on subjective AT outcomes. This was a prospective cohort study of children aged 2-18 years being treated with AT for sleep disordered breathing (SDB) with one or more risk factors for AT failure: age >7 years, obesity, severe baseline OSA, Black race. All underwent DISE at the time of AT. Potential predictors of subjective AT outcome included age, sex, obesity, and DISE patterns. Multivariable linear regression was used to model predictors of post-AT Pediatric Sleep Questionnaire (PSQ) and OSA-18 outcomes. Pre- and post-AT PSQ/OSA-18 responses were available from 194 children. Mean age was 9.3 ± 3.5 years, with 59% obese, 50% female, and 67% White. After AT, mean PSQ score decreased from 0.60 ± 0.19 to 0.28 ± 0.22, p < 0.001 and mean OSA-18 score decreased from 66 ± 21 to 37 ± 18, p < 0.001. The most frequent sites of obstruction were the tonsils (92%), nasal airway (77%), adenoids (64%), and velopharynx (65%). Multivariable regression modeling demonstrated worse outcomes with obesity, male gender, and multilevel obstruction that included the nasal airway and tongue base in addition to adenotonsillar obstruction. Persistent OSA and symptom burden after AT was common in this population. Obesity, male gender, and multilevel obstruction during DISE were all associated with worse subjective outcomes. 3 Laryngoscope, 135:377-384, 2025.

Ultrasound tissue characterization and function of Achilles tendon in psoriatic arthritis patients: a cross-sectional study.

The Achilles tendon is one of the most frequent sites of tendinopathy in both healthy and pathological subjects. An innovative approach for the quantitative assessment of the Achilles tendon structure, named Ultrasound Tissue Characterization (UTC), has recently been developed. However, no previous study performed the UTC-based assessment of the tendon structure in rheumatologic patients affected by insertional Achilles tendinopathy. To characterize the Achilles tendon structure and function in psoriatic arthritis patients with symptomatic insertional tendinopathy. Cross-sectional study. University laboratory. Psoriatic arthritis patients (N.=17). Anthropometric measurements, administration of outcome and pain questionnaires, and tendon function and structure assessments were performed in a single experimental session. Pain intensity and interference and the perceived tendinopathy-related disability were moderate-severe. A relevant impairment of the strength (for both lower limbs) and walking performance was observed in all patients. In fact, the plantarflexion strength values (median values for the two sides: 10.0 and 11.5 kg) and fast walking speed (median value: 1.7 m/s) were lower than the normative values for healthy controls, respectively, in all patients for the strength values and in 14 out of 17 patients for the walking speed. The conventional ultrasound (i.e., the quantification of tendon thickness and the qualitative assessments of tendon structure and neovascularization) showed greater changes in the symptomatic (or more symptomatic) side compared with the asymptomatic (or less symptomatic) side of the insertional region of the Achilles tendon. The UTC imaging showed comparable impairment of the tendon structure between the symptomatic (or more symptomatic) side and the asymptomatic (or less symptomatic) side of the insertional region of the Achilles tendon (i.e., reduced echo-type I percentages in both tendons of all patients). Psoriatic arthritis patients with symptomatic insertional Achilles tendinopathy present moderate-severe pain and perceived disability, physical function impairments, and bilateral deterioration of the tendon structure (also in case of unilateral symptoms) that can be documented through the UTC analysis. The evaluation of the insertional Achilles tendinopathy through UTC imaging can be useful for the diagnostic and prognostic assessment of psoriatic arthritis patients in combination with the assessments of pain, disability, and functional performance.

Clinicomycological Correlation of Tinea Incognito

Background: Tinea incognito refers to the unusual clinical manifestation of dermatophytosis brought on by prior topical or systemic medication use. Given the widespread and easy diagnosis of dermatophytic infections, steroid usage has created a diagnostic conundrum, thus turning a straightforward infection that may be treated into a persistent, long-term skin disease. Objective: To examine the clinical characteristics of tinea incognito and correlate the clinical manifestations with the microbiological findings. Methods: An observational study was conducted with 100 cases in a department of microbiology, dermatology, venereology, and leprology, in India. The baseline data of the patients and clinical features of tinea incognito were recorded. To identify the causative agents, skin scrapes were collected and tested as per standard protocol. Results: In this study, 30% of the patients were between 31 and 40 years old. The male-to-female ratio was 2:1, 66% reported a history of application of the triple combination of steroids, and 34% used single steroids. Tinea corporis was seen in 30% of the patients, and the trunk/body (52%) was the most frequent site, followed by other sites (34%). Potassium hydroxide positivity was observed in 75% of the cases, cultural positivity in 77%, and both tests were positive in 75%. The most common organisms found were T. mentagrophytes (72.7 (56/77)%), T. rubrum (19.5 (15/77)%), and T. tonsurens 7.8 (6/77)%. Conclusion: Tinea incognito is a fungal skin infection that can present with various nonspecific clinical features. This steroid-modified dermatophytosis is largely under-reported because the underlying fungal infection is masked by the irrational use of topical steroids

A network dynamic nomogram for predicting overall survival and cancer-specific survival in patients with breast cancer liver metastases: an analysis based on the SEER database

The liver stands out as one of the most frequent sites for distant metastasis in breast cancer cases. However, effective risk stratification tools for patients with breast cancer liver metastases (BCLM) are still lacking. We identified BCLM patients from the SEER database spanning from 2010 to 2016. After meticulously filtering out cases with incomplete data, a total of 3179 patients were enrolled and randomly divided into training and validation cohorts at a ratio of 2:1. Leveraging comprehensive patient data, we constructed a nomogram through rigorous evaluation of a Cox regression model. Validation of the nomogram was conducted using a range of statistical measures, including the concordance index (C-index), calibration curves, time-dependent receiver operating characteristic curves, and decision curve analysis (DCA). Both univariable and multivariable analyses revealed significant associations between OS and CSS in BCLM patients and 14 variables, including age, race, and tumor stage, among others. Utilizing these pertinent variables, we formulated nomograms for OS and CSS prediction. Subsequent validation involved rigorous assessment using time-dependent ROC curves, decision curve analysis, C-index evaluations, and calibration curves. Our web-based dynamic nomogram represents a valuable tool for efficiently analyzing the clinical profiles of BCLM patients, thereby aiding in informed clinical decision-making processes.