Higher Rate In Group Research Articles

Does the type of the previous biopsy affect the fusion prostate biopsy results?

BackgroundIt has been more than a decade since fusion prostate biopsy (FPB) has been used in the diagnosis of prostate cancer (PCa). Therefore, patients with a previous history of negative FPB and ongoing suspicion of PCa are beginning to emerge. This study investigated whether the first biopsy type (standard or fusion) should be effective in deciding on a second biopsy. MethodsMale patients aged 40–75, with a serum prostate-specific antigen (PSA) value of less than 10 ng/mL and a negative biopsy history within the last 24 months, who underwent FPB in our clinic due to persistent PSA elevation and/or suspicious multiparametric prostate magnetic resonance imaging (MpMRI) findings were included to the study. Patients were divided into groups according to the type of first biopsy (Group 1; those whose first biopsy was FPB, Group 2; those whose first biopsy was standard prostate biopsy). Some demographic and clinical data of the groups, as well as PCa detection rates, were compared. A p value of less than 0.05 was considered statistically significant. ResultsA total of 275 patients (Group 1: 84, Group 2: 191) were included in this study. The groups were similar in terms of age, PSA values before the first biopsy, PSA values before the second biopsy, family history of PCa, and prostate volume. PCa was detected at a higher rate in Group 2 than Group 1 (23% vs 15.5%, p = 0.044). ConcluisonThe data obtained from this study indicate that the type of initial biopsy should be taken into account when deciding on FPB in secondary patients with a previous negative biopsy history.

P-027 Sperm motility and calcium ionophore treatment influence fertilization and pregnancy outcomes in TESE-ICSI

Abstract Study question Are there differences in fertilization and pregnancy rates post-TESE-ICSI between motile and immotile sperm, and do these vary in treatments with and without calcium ionophore? Summary answer Post-TESE-ICSI data reveals differences in fertilization and pregnancy rates when comparing motile vs. immotile sperm and treatments with and without calcium ionophore after TESE-ICSI. What is known already Testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) poses a challenge for every IVF laboratory. This is particularly true in patients exhibiting azoospermia, where only a few and mostly immotile sperm are present in testicular tissue. In these cases, a calcium ionophore treatment for activation of the oocyte may help to overcome poor prognosis fertilization outcome, and thereby enhancing the likelihood to achieve a transfer leading to a successful pregnancy. Although both techniques, TESE-ICSI and activating substances are commonly applied, detailed analyses for individual counselling of couples are missing. Study design, size, duration This study analyzed 787 TESE-ICSI cycles (2015-2023) regarding patient age, number of attempts, oocyte maturity, fertilization and pregnancy rate after fresh embryo transfer. Cycles were split into four groups: (A) at least one motile sperm was injected (n = 493); (B) only immotile sperm were used (n = 294); (C) calcium ionophore (n = 474); (D) no calcium ionophore (n = 313). 17 cycles were excluded from the study because no sperm were found on the day of TESE-ICSI and oocytes were vitrified. Participants/materials, setting, methods In our IVF clinic, calcium ionophore treatments are only offered if a pre-screening of TESE samples reveals the absence of motile spermatozoa or if a previously conducted TESE-ICSI attempt resulted in a low fertilization rate (<30%) or a total fertilization failure. Statistical analyses was performed to compare the motile and immotile sperm group and the groups with or without calcium ionophore treatment. Main results and the role of chance No differences were found in all groups (A-D) regarding age of female or male patient and number of collected oocytes per group. However, our results demonstrate a difference in the mean number of ICSI attempts when comparing motile sperm and immotile sperm (2.0±1.3 vs. 2.3±1.6, p < 0.05), and when comparing attempts with calcium ionophore treatment and those without (2.4±1.6 vs. 1.8±1.8, p < 0.0005). The mean fertilization rate (2PN stage) was higher in the motile sperm group (A) compared to the immotile group (B) (57.8% vs. 28.4%, p < 0.0005) and also higher in attempts of group (D) in comparison to attempts of group C (56.8% vs. 40.2%, p < 0.0005). While fertilization failure occurred less often in group (A) (3.2%) it occurred to a higher rate in group (B) (19.4%), followed by group (C) (12.0%). Biochemical (BPR) and clinical pregnancy rates (CPR) showed a significant difference between the motile and immotile sperm group (BCR: 33.2% vs. 12.3%, p < 0.0005; CPR: 25.6% vs. 9.3%, p < 0.0005), but no differences between the two calcium ionophore groups. Limitations, reasons for caution This analysis was done retrospectively. A potential subgroup analysis of groups (A) and (B) into calcium ionophore use and of groups (C) and (D) into motile or immotile sperm will reveal the effect of calcium ionophore on success rates regardless of sperm motility. Wider implications of the findings Our data provides insight into success rates of TESE-ICSI cycles, especially if only immotile sperm were present. This will serve as a helpful guide for physicians when counseling patients about their success rates and to optimize the outcome in cases with poor prognosis by using a calcium ionophore treatment. Trial registration number not applicable

Endovascular Management of Chronic Limb-Threatening Ischemia (CLTI) in the Elderly: A Focus on Frailty, Wound Healing, and Outcomes

In India, a significant scarcity of published data exists regarding chronic limb-threatening ischemia (CLTI) and its management, especially among the elderly population. CLTI, often accompanied by frailty poses a significant healthcare challenge. While endovascular interventions offer hope, there remains a dearth of outcome data for this age group. This study seeks to address this critical gap by investigating the impact of frailty on outcomes, emphasizing amputation-free survival (AFS), wound healing, and health-related quality of life (HRQoL). Our study included 131 elderly CLTI patients aged ≥70 years who underwent infrainguinal endovascular interventions between April 2018 and August 2021, with a follow-up period of 2 years. Among the patients, 93.9% had diabetes mellitus and 82.4% had hypertension. Clinical frailty was assessed using the Clinical Frailty Scale (CFS). Patients were categorized into Group 1 (CFS 1-5) and Group 2 (CFS 6-9). Primary outcomes were AFS, wound healing, HRQoL, and their association with frailty. Secondary outcomes included technical success, procedure-related complications, major adverse limb events (MALE), major adverse cardiovascular events (MACE), vessel patency, re-intervention rates, and mortality rates including peri-procedural and overall mortality. Technical success was achieved in 86.3% of patients, with frailty significantly influencing this outcome. Group 2 exhibited reduced technical success (80.8%) compared to Group 1 (93.1%). The major amputation rate was 9.2%, with higher rates in Group 2 [univariate Hazard Ratio (HR): 5.20; p=0.033]. Similarly, Group 2 showed elevated overall mortality [univariate HR: 5.18; p < 0.001]. AFS at 1 and 2 years were 67.9% and 55% respectively, with higher rates in Group 1. Wound healing was achieved in 76.1% of patients (83/109), with frailty significantly associated with delayed wound healing (p < 0.001). Vessel patency at 1 year was observed in 88.8% of patients. HRQoL significantly improved post-intervention, with VascuQol-6 scores increasing from an average of 9 of 24 at baseline to 20 of 24 at 2 years. Frailty score significantly correlated with VascuQol-6 scores at 1 and 2 years (p < 0.0012). Group 1 exhibited higher VascuQol-6 scores compared to Group 2, indicating improved HRQoL during follow-up. Successful endovascular treatments in high-risk CLTI patients promote improved wound healing and post-treatment quality of life (QoL). Frailty should be assessed before endovascular interventions as it correlates with adverse outcomes, including amputations and mortality. While revascularization holds promise, caution is advised for frailer patients, emphasizing the importance of personalized care and tailored treatments for elderly CLTI patients.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18mmHg, and (3) IOP ≤ 15mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4mmHg and 32.3 ± 8.4mmHg, respectively, which significantly reduced to 14.5 ± 0.7mmHg and 11.6 ± 0.6mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Acute Kidney Injury Is Associated With In-Hospital Mortality of Patients with COVID-19, But Less Common Among Variant B.1.1.7 Positive SARS-Cov-2 Infection

The aim of this study is to compare the rates of acute kidney injury (AKI) occurence and mortality between hospitalized patients with SARS-CoV-2 infection variant B.1.1.7 positive and negative. 200 hospitalized patients with SARS-CoV-2 infection included in the study. The sociodemographic characteristics of the patients and the laboratory values were obtained retrospectively from the patient files and electronic records. 121 patients with variant B.1.1.7 positive SARS-CoV-2 (group I) and 79 patients with variant B.1.1.7 negative SARS-CoV-2 (group II) included in the study. Acute kidney injury developed at a higher rate in group II patients [15/79 (19%),] compared to group I patients [7/121 (5.8%)] (P=0.004). When 180 patients without chronic kidney disease included in the analysis, acute kidney injury developed in 7 (6.4%) of 110 variant-positive patients, while acute kidney injury developed in 13 (18.6%) of 70 variant-negative patients (P=0.011). It was shown that, AKI development was lower in variant positive patients compared to variant negative patients (OR: 0.32 and 95% CI: 0.12 – 0.88, P=0.027) and age was an independent risk factor for AKI (OR: 1.06 and 95% CI: 1.02 – 1.11, P=0.002). The development of AKI, presence of pre-dialysis chronic kidney disease and age were found to be independent risk factors for mortality [respectively (OR: 6.09 and 95% CI: 1.64 – 22.58, P=0.005), (OR: 5.37 and 95% CI: 1.38 – 20.93, P=0.016), (OR: 1.06 and 95% CI: 1.02 – 1.11, P=0.005)].

Evaluation of the optical coherence tomography findings of patients with idiopathic epiretinal membrane.

This study aimed to determine the relationship between basal visual acuity (VA) and basal optical coherence tomography (OCT) parameters of patients with idiopathic epiretinal membrane (iERM). The study included 200 eyes of 200 patients with iERM. In the evaluation of basal VAs, logMAR 0.3 (0.5 on Snellen chart) was accepted as the limit, and the patients were divided into two groups as Group 1 with VA values below logMAR 0.3 and Group 2 with those above logMAR 0.3. Using OCT, the ellipsoid zone (EZ), interdigitation zone (IZ), external limiting membrane (ELM) integrity, peaked appearance of EZ in the fovea, disorganization of the inner retinal layers (DRIL), central foveal thickness (CFT), maximum retinal thickness (MRT), total photoreceptor length (TPL), photoreceptor outer segment length (PROSL), photoreceptor deformity index (PDI), and inner retinal layer irregularity index (IRLII) were evaluated and compared between the groups. There were an equal number of patients in Group 1 and Group 2. The preservation of ELM, EZ, and IZ integrity and the peaked appearance of EZ in the fovea were observed at higher rates in Group 1, whereas the rate of DRIL was higher in Group 2 (p<0.05 for all). In the multiple regression analysis performed to evaluate categorical OCT parameters, only the presence of DRIL was found to be significantly associated with VA (p<0.003). CFT*, MRT*, and IRLII** were significantly lower in Group 1 (*p<0.001, **p=0.001). TPU, PROSL, and FDI were similar between the two groups (p>0.05 for all). According to the multiple regression analysis, only the presence of DRIL was correlated with lower VA values. Among the OCT parameters, an increase in CFT and MRT, as well as the IRLII value moving away from 1 were related to lower VA values.

Effect of body condition score on biochemical parameters and hormonal profiles during the mating period in Ouled Djellal ewes in arid zone

ABSTRACTThis study aims to evaluate the effect of body condition score (BCS) on hormonal profiles and to reveal their influence on the blood metabolites in Ouled Djellal ewes during the mating period. The experiment was conducted on thirty, clinically healthy and non-pregnant, Ouled Djellal ewes which have been kept into two groups according to their body condition score (Group I: BCS &lt; 2.50 units; n = 13, Group II: BCS &gt; 2.50 units; n = 17). In both groups, oestrus was synchronized using hormonal patterns then the ewes were left to be naturally inseminated. Blood samples were collected at the time of the sponge removal. Plasma concentrations of glucose, triglycerides, cholesterol, total protein, albumin, creatinine, urea, triiodothyronine, thyroxine and Progesterone were recorded. The plasma level of triglycerides and thyroid hormones (T3 and T4) increase significantly (P &lt; 0.01) in group II. Progesterone concentrations were similar (P ≥ 0.05) in both groups at mating period, although we recorded higher rate in group I. Therefore, we conclude that body condition score has a significant impact on some hormone profiles and blood parameters during the mating period.

Candidal Infections in the Neonatal Intensive Care Unit: A Retrospective Observational Study.

The aims of this study were to evaluate the demographic characteristics, risk factors, mortality rates, and laboratory findings of infants with fungal sepsis in the Neonatal Intensive Care Unit (NICU). This retrospective multicenter study included patients in NICU with Candida spp isolated in blood cultures between November 01, 2019, and September 01, 2022. The patients were evaluated in two groups as Group 1 infants with Candida albicans and Group 2 infants with Candida non-albicans positive blood cultures. Candida infection was detected in blood cultures in 57 of 3450 patients admitted to the NICU. A total of 57 infants included in the study. Candida infection was determined 1.6% of infants in the study population, and 57% of them were extremely pre-term infants. There was no significant difference between the two groups in terms of laboratory data. Normal vaginal birth was determined at a higher rate in Group 1. In Group 2, length of hospital stay, duration of total parenteral nutrition (TPN), and mechanical ventilation (MV) were determined to be longer. The mortality due to Candida fungemia was determined as 35%, and of these patients, 65% had an additional medical condition. In accordance with the literature, this study showed that prolonged MV and longer TPN increased the incidence of fungal sepsis. Therefore, to decrease the fungal sepsis rate of NICU, shortening the hospital stay and effective screening programs are recommended.

Endourologists vs urologists: The impact of surgical experience and annual case volume on percutaneous nephrolithotomy outcomes

Background/Aim: Surgeon experience, which is an important factor in reducing surgical complications, has been underestimated when analysing percutaneous nephrolithotomy (PNL) outcomes. Aim of this study was to investigate the impact of annual case volume (ACV) of endourologists and urologists on PNL outcomes including stone-free status (SFS) and complications. Methods: A total of 530 patients who underwent PNL in the Clinic between January 2018 and January 2023 were retrospectively analysed. The patients were divided into two groups: those operated by endourologists (Group 1, n = 324) and by urologists (Group 2, n = 206). The two groups were statistically compared in terms of postoperative SFS and complications. Results: There were two endourologists in Group 1 and four urologists in Group 2. The mean ACV was 73.56 ± 7.43 in Group 1 and 23.81 ± 9.09 in Group 2, indicating a statistically significantly higher rate in Group 1 (p &lt; 0.001). There was no statistically significant difference in the postoperative SFS rates between the groups (p = 0.064). In the perioperative period, the mean estimated blood loss and nephrostomy dwell time were significantly lower in Group 1 than Group 2 (p = 0.013 and p = 0.008, respectively). In the logistic regression analysis, a cut-off value of &gt; 24 for ACV and CROES scores were the significant predictors of SFS (p = 0.004 and p &lt; 0.001, respectively). The complication rate was significantly lower among surgeons with an ACV of &gt; 24 (p &lt; 0.001). Conclusion: Results from this study showed that an ACV of &gt; 24 increases SFS rate by 2.13 with lower complication rates in patients undergoing PNL. Further multi-centre, large-scale studies are required to investigate the effect of surgical experience and ACV on postoperative outcomes and to predict PNL outcomes with high accuracy.

Compare the Effectiveness of Systematic Steroids Verses Nebulizer in Pediatric Patients of Acute Exacerbation of Asthma

Aim: To compare efficacy of the nebulizer with systematic steroids in acute exacerbation of asthma patients. Study design: Prospective study Place and duration of study: Department of Pediatric Medicine, Sandeman Provincial Hospital, Quetta from 1st February 2022 to 31st July 2022. Methodology: One hundred patients with acute exacerbation of asthma and age of 1-10 years were included. Patients were divided into two groups where Group A was given flunisolide nebulization and comprised of 50 cases. The group B was given systematic steroid budesonide. The post outcomes of treatment were noted after two weeks. Results: The mean age in group A and B as 5.8±7.45 and 5.6±7.25years respectively. More boys were presented with acute exacerbation of asthma with a percentage of 66% and 68% in group A and B than girls as 34% and 32% respectively. The duration of asthma in Group A was found to be mean 3.5±6.60 years while in group B it was 4.2±4.20 years post treatment. Hospitalization was also observed at a significant higher rate in group B than Group A. Conclusion: The nebulizer has a better efficacy than systematic steroids in acute exacerbation of asthma. Keywords: Acute exacerbation, Asthma, Pediatrics, Efficacy

Acute Abdominal Complications in Deeply Neutropenic Onco-Hematology Patients: A Retrospective Series of 105 Cases.

Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients. All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage. Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14months and disease-free survival (DFS) of 10months. OS was not comparable between the groups, and the median length of survival in group 1 was 6months versus 8months in group 2 and 23months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups. The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.

P-693 IVF outcome in patients with thyroid disease

Abstract Study question What is the thyroid disease rate in IVF patients and how does it affect their IVF outcome? Summary answer The thyroid disease rate was 19,5%, mostly of inflammatory origin. IVF outcome in these patients was similar to controls, but coexisting endometriosis rate was higher. What is known already Thyroid disease is the most common endocrine disorder in females of reproductive age. It is estimated that 20% of infertile females has history of thyroid disease. Thyroid hormones importantly impact fertility, acting directly on oocytes, sperm and embryo during fertilization, implantation and placentation, regulating estrogen and androgen metabolism as well as the menstrual cycle. The most common causes of thyroid disfunction are autoimmune disorders. The prevalence of thyroid autoimmunity among women undergoing IVF treatment is higher compared to the general population. Women with thyroid autoimmunity have higher risk of miscarriage, preterm birth and it may impact the IVF-ET outcome. Study design, size, duration It was a single center trial at the Division of Obstetrics and Gynecology, Department of Human Reproduction in the University Medical Centre of Ljubljana, Slovenia. The study included women undergoing their first IVF treatment in a one-year period. Participants/materials, setting, methods A total of 226 women undergoing their first IVF treatment were included. In the first part of our study, Patient characteristics and IVF outcome according to different TSH serum levels (&amp;lt; 0,59 mE/L, 0,59 - 2,5 mE/L, 2,5 - 4,23 mE/L ter &amp;gt; 4,23 mE/L) were analysed. In the second part of the study, we compared patient characteristics and IVF outcome in patients with and without thyroid disease. Main results and the role of chance The average age was 33 ± 4,7 years, the average BMI was 24±4,9 kg/m2. Three percent of women had TSH levels &amp;lt;0,59 mE/L, 74% had TSH levels 0,59-2,5 mE/L,18% had TSH levels 2,5-4,23 mE/L and 6% had TSH levels &amp;gt;4,23 mE/L. The obesity rate (BMI&amp;gt;30 kg/m2) was significantly different in all four groups of patients with the highest rate in the group of TSH 2,5-4,23 mE/L. Thyroid disease was found in 19,5% of patients (thyroid autoimmunity 18%, Hashimoto's thyroiditis 7,5% of patients). The thyroid disease rate was significantly different in all four groups with highest rate in group having TSH &amp;gt;4,23 mE/L and the lowest rate in group having TSH 0,59-2,5 mE/L. Endometriosis was diagnosed in 22% of patients with highest rate in patients having highest TSH levels. There was no correlation between patient characteristics and reproductive history (age, irregular menstrual cycle, dysmenorrhea, pregnancy, spontaneous abortion, recurrent abortion, FSH and LH serum levels) and TSH levels or preexisting thyroid disease. There were no significant differences in the IVF outcome (numbers of retrieved oocytes, immature oocytes and number of embryos) according to TSH levels or preexisting thyroid disease. Thyroid disease rate was significantly higher in patients with endometriosis. Limitations, reasons for caution Our study limitation is a smaller sample size that may affect our results, specifically the differences in the IVF outcome. There was no statistical difference in miscarriage and recurrent miscarriage rate in women with thyroid disease and women with normal thyroid function. Wider implications of the findings Our study gives an insight to the characteristics of women with thyroid disease undergoing IVF treatment in our facility, although the differences were statistically insignificant. As a secondary outcome we discovered a statistically significant correlation of endometriosis and inflammatory thyroid disease, which is rarely mentioed in the literature. Trial registration number not applicable

Remediation and detoxification of oil contaminated marine intertidal sites through lipopeptide assisted washing strategy: An experimental and kinetic validation approach

This paper presents a tightly coupled experimental and kinetic approach for efficient remediation of oil spill from contaminated marine intertidal zone surface through a methodical strategy that deals with biosurfactant mediated washing strategy. The study deals with production, optimization and characterization of lipopeptide biosurfactant from Bacillus subtilis T1 and its application in remediation of oil contaminants from mimic model system of various marine intertidal zone i.e. woodland-Group1, saltmarsh-Group2, mangrove-Group3 and mudflats-Group4. Results demonstrates enhanced washing performance with oil desorption rate of 35 % in Group 4, 17.22 %, 15.6 % and 11 % in Group 3, 2 and 1 along with bio surfactant recovery rate of 41 %, 48.7 %, 51.71 % and 50.3 % respectively. Further, the washing strategy was efficient in soil detoxification with highest rate in Group 4. The kinetic validation depicts good match among experimental data and Lagergren pseudo second order data.

Rectangular bone-patellar tendon bone grafts reduce early graft failure in chronic ACL-Deficient knees

BackgroundThe aim of this study was to assess early graft failure after anterior cruciate ligament (ACL) reconstruction according to chronicity of ACL deficiency (ACLD) and clarify predisposing factors. MethodsA total of 731 patients who underwent anatomic ACL reconstruction were divided into 3 groups based on chronicity of ACLD: <6 months (Group 1), 6 months to 2 years (Group 2), and >2 years (Group 3). Types of ACL grafts used included single-bundle hamstring tendon (HT), multiple-bundle HT, and rectangular bone-patellar tendon-bone (BTB) grafts. Preoperatively and immediately postoperatively, lateral radiographs in full extension were taken to examine anterior tibial subluxation (ATS). All ACL grafts were evaluated by MRI at 6 months to identify graft failure. The group with the highest failure rate was further examined to compare possible risk factors between the intact and failure subgroups, followed by multivariate logistic regression analysis to identify predisposing factors. ResultsEarly graft failure on MRI without any episode of postoperative trauma was observed in 7 (1.4%), 2 (1.8%), and 11 (9.2%) patients in Groups 1, 2, and 3, respectively, with a significantly higher rate in Group 3 (P < 0.001). Of the 119 patients in Group 3, significant differences were observed between intact and failure subgroups with regard to surgical procedure (P = 0.03), chondral lesions (P < 0.01), and preoperative ATS (P < 0.01). Multivariate logistic regression analysis revealed that surgical procedures (odds ratio, 3.8; 95%CI, 1.16–12.59) and preoperative ATS (odd ratio, 2.4; 95%CI, 1.26–4.38) were predisposing factors of early graft failure. ConclusionPatients with ACLD for >2 years experienced early graft failure with an incidence rate of 9.2%. Predisposing factors of early graft failure in these patients included the use of single-bundle HT grafts and preoperative ATS. The use of rectangular BTB grafts resulted in a lower graft failure rate. Study designCase Series.

Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation.

To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR). Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups. In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium. Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

Incidence of Cutibacterium acnes in open shoulder surgery.

ABSTRACTIn recent years, Cutibacterium acnes (C. acnes) has been reported to affect postoperative outcomes. The purpose of this study was to examine the detection rate and clinical features of C. acnes infection after open shoulder surgery. Fifty-nine patients (33 males and 26 females; mean age, 69.1 years) were included. Samples were collected from a skin swab at the incision site prior to skin preparation. Further samples were collected from synovial swabs at the glenohumeral joint immediately after incision and before incision closure. Samples with C. acnes-positive skin swab cultures were defined as Group A, and those with negative cultures were defined as Group N. Age, sex, presence of diabetes mellitus, operation time, presence of deep infection after surgery, and rate of positive synovial swab cultures were compared between groups. There were 27 patients in Group A (mean age 69.1±13.3 [SD], 21 males and 6 females) and 32 patients in Group N (mean age 69.1±11.0 [SD], 12 males and 20 females). No significant difference in the presence of diabetes mellitus and operation time were found between groups. From the glenohumeral joint immediately after incision, C. acnes was detected in 22.2% and 0% of patients in Group A and Group N, respectively. For the glenohumeral joint before incision closure, C. acnes was detected in 22.2% and 0% of patients in Group A and Group N, respectively, demonstrating a significantly higher rate in Group A. Our findings suggest that the route of infection following open shoulder surgery is via contamination.

Tailored therapy for recurrent glioblastoma: report of a personalized molecular approach.

Failure of clinical trials with targeted therapies in glioblastoma (GBM) is probably related to the enrollment of molecularly unselected patients. In this study we report the results of a precision medicine protocol in recurrent GBM. We prospectively evaluated 34 patients with recurrent GBM. We determined the expression of vascular endothelial growth factor (VEGF), epidermal growth factor receptor variant III (EGFRvIII), and phosphatase and tensin homolog (PTEN). According to the molecular pattern we administered bevacizumab alone in patients with VEGF overexpression, absence of EGFRvIII, and normal PTEN (group A; N.=16); bevacizumab + erlotinib in patients with VEGF overexpression, expression of EGFRvIII, and normal PTEN (group B; N.=14); and bevacizumab + sirolimus in patients with VEGF overexpression and loss of PTEN, irrespective of the EGFRvIII status (group C; N.=4). We evaluated the response rate, the clinical benefit rate, the 6-month progression-free survival (PFS-6), the 12-month PFS (PFS-12) and the safety profile of the treatment. Moreover, we compared our results with the ones of EORTC 26101 trial. Response rate was 50% in the whole cohort with the highest rate in group C (75%). Clinical benefit rate was 71% with the highest rate in group C (75%). PFS-6 was 56% in the whole cohort with the highest rate in group B (64%). PFS-12 was 21% in the whole cohort with the highest rate in group B (29%). When comparing our results with those from the combination arm of the EORTC 26101 trial we found a significantly higher PFS-6 and PFS-12 in our cohort. The precision medicine protocol for recurrent GBM is feasible and leads to improved results if compared with studies lacking molecular selection.

Comparison of early and delayed diagnosis of mortality in ERCP perforations: A high-volume patient experience.

Although ERCP (Endoscopic retrograde cholangiopancreatography) perforation is a rare complication, it results in high morbidity and mortality. In this study, clinical evaluation was performed concerning the incidence, clinical data and time of diagnosis for ERCP perforations that were either surgically or medically treated. To reduce the ERCP perforations and related mortality, in this study, we aimed to reveal the clinical features and compare them with the literature. In this clinical retrospective study, 51 perforations were detected in 8676 ERCP procedures performed in the past eight years in our hospital. We compared the two groups: early diagnosed patients [Group 1: n=40] and the delayed diagnosed patients [Group 2: n=11] concerning primary diagnosis, blood and biochemical tests before ERCP, perforation type, treatment method, clinical features, length of stay, and mortality. These groups were compared concerning stent placement, papillotomy choledochal dilatation and the number of ERCP procedures. The ERCP perforation rate in our hospital was 0.59%. The majority of patients who underwent ERCP procedures was due to the choledocholithiasis and periampullary tumors. The mean age was 62.78±17.13 (24-89 years old) and 56.9% of the patients (n=29) were women. Stapfer type II perforations (49%) were the most common type of perforation. However, 62.5% of the total mortality occurred in patients with type I perforation. The overall mortality rate was 13.72% (n=7). The duration of hospitalization (13.38±10.09 days) was higher in the patients who were treated surgically (n=24). Choledochal stents were utilized mostly in the medically treated patients (74.1%) (p=0.039). The patients in Group 1 were detected visually by the operator during the ERCP by leakage of contrast substance (13/40) or by abdominal tomography due to clinical suspicion. Patients in Group 2 had higher pre-ERCP leukocyte levels (p=0.044). The urgent surgery requirement in Group 2 was 72.7%, while the mortality rate was 36.4%. Significant mortality difference was observed between the early and late detection of perforations, indicating a higher rate in Group 2 (p=0.014). In the patients who were diagnosed early, fewer surgical interventions were required, except for the type I perforations. Type II perforations can often be safely treated non-surgically if there are no signs of acute abdomen and sepsis. Early diagnosis and treatment significantly reduce ERCP-related mortality.

Does the drain placement technique affect the amount of postoperative spinal epidural hematoma after microendoscopic decompressive laminotomy for lumbar spinal stenosis?

To prospectively evaluate with magnetic resonance imaging (MRI), the relationship between the distance from the incision of the drain output location and postoperative spinal epidural hematoma (SEH) in patients performed with microendoscopic decompressive laminotomy (MEDL) for lumbar spinal stenosis. Between January 2016 and June 2018, three different kinds of drain placement techniques, according to the drain output location, were performed to a total of 184 patients after MEDL for single-level spinal stenosis. The location of the drain output was within the incision in group 1, 1 cm lateral of the incision in group 2, and 5 cm lateral of the incision in group 3. At 24 h postoperatively, before removal of the drain, MRI examination was carried out in patients. A specific classification was developed by the authors to measure SEH, and the groups were evaluated by comparison. The mean postoperative dural sac cross-sectional area was 1.73 cm2 (standard deviation (SD): 0.711) in group 1, 1.66 cm2 (SD: 0.732) in group 2, and 1.52 cm2 in group 3 (SD: 0.841).The mean cross-sectional area of the postoperative hematoma was 1.45 cm2 (SD: 1.007) in group 1, 1.57 cm2 (SD: 1.053) in group 2, and 2.11 cm2 (SD: 1.024) in group 3. Four grades were defined according to the specific classification. According to this classification, grades C and D postoperative hematomas were determined at a statistically significantly higher rate in group 3 patients (drain output 5 cm lateral from the incision) compared to the other groups (p = 0.000). No significant difference was determined between groups 1 and 2 in respect of hematoma classification. In conclusion, it was determined that better drainage was provided in groups 1 and 2, where the drain output location was in the incision or close to it.

Controlled Infestation of Honeybee Colonies with Varroa Destructor Females

Abstract The development of female Varroa destructor mites in the bee colonies was examined in the apiculture season through a developed research system in which bee colonies were experimentally infested with fifty V. destructor females. Differences in infestation rates were observed between the control group (C) and the infested group (E). The average number of female mites per colony was determined at 513 in group E and 261.6 in group C. Natural daily mortality reached 0.16 mites in group E and 0.09 mites in group C. In group E, the number of V. destructors increased 7.96 to 13.32-fold, subject to colony. The size of V. destructor populations increased at a higher rate in group E than in group C (F= 12.39, P= 0.047). At the end of the experiment, the percentage of infested honey bee workers was determined at 0.97% in group E and 0.46% in group C. The results of this study confirmed that V. destructor mites continue to proliferate rapidly in honey bee colonies, and that the population growth rate in bee colonies and apiaries has to be closely monitored due to growing levels of resistance to acaricides.