University Medical Center Research Articles

Implementation of teledermatological consultations at Leipzig University Medical Center

Numerous patients admitted to ageneral hospital present skin changes as secondary findings. Approximately 800 dermatological consultations are performed annually at the Leipzig University Medical Center. The aim of this study was, after implementation of teledermatological consulting, the retrospective evaluation of that and the resulting satisfaction of the physicians involved. We carried out an analysis of all consultation requests, which were answered using store-and-forward technology via the photo documentation app imitoCAM® (imito AG Zurich/Switzerland) and the clinical information system SAP® (SAP Deutschland SE & Co. KG Walldorf/Germany) from 1February to 31July 2023, as well as of questionnaires on satisfaction, which were sent to the participating physicians after the consultation. Our analysis included 419 consultation requests, 90of which were answered teledermatologically. The consultation dermatologists stated that 92% of the cases could be solved using only telemedical instruments. Moreover, 90.9% of the consulting physicians rated the technical implementation as good to very good and 47.5% of the consultation dermatologists estimated atime saving of at least 30-60 min. Our study shows the enormous potential of teledermatology in the inpatient setting. Implementation of teleconsultation enables more efficient consultations, reduces time- and cost-intensive transportation and offers patients amore comfortable dermatological evaluation with reduced risk of infection.

Characterization of the Phenotypic Consequences of the Duffy-Null Genotype.

A wealth of research focused on African American populations has connected rs2814778-CC ("Duffy-null") to decreased neutrophil (neutropenia) and leukocyte counts (leukopenia). While it has been proposed that this variant is benign, prior studies have shown that the misinterpretation of Duffy-null associated neutropenia and leukopenia can lead to unnecessary bone marrow biopsies, inequities in cytotoxic and chemotherapeutic treatment courses, under-enrollment in clinical trials, and other disparities. To investigate the phenotypic correlates of Duffy-null status, we conducted a phenome-wide association study (PheWAS) across more than 1,400 clinical conditions in All of Us, the Vanderbilt University Medical Center's Biobank, and the Million Veteran Program. This reveals that Duffy-null status is only reproducibly associated with changes in white blood cell count and not with any disease outcomes. Moreover, we find that Duffy-null associated neutropenia is on average less severe than other neutropenia cases in All of Us. We also show that this genotype is present in considerable frequencies in All of Us populations that are genetically similar to African (68%) and Middle Eastern (14%) 1000Genomes/Human Genetic Diversity Panel (HGDP) reference populations as well as those who identify with more than one race (12%), as Pacific Islander (7%), and as Hispanic (5%). Further, we find that race is not an accurate predictor of Duffy-null status or associated benign neutropenia. Our research suggests that broad genetic screening of rs2814778 across all populations could provide a more robust and accurate understanding of white blood cell count and mitigate resulting health disparities.

Hypertension at diagnosis of coarctation of the aorta as a risk factor for recoarctation.

Coarctation of the aorta (CoA) is a narrowing of the aorta that affects 5-8% of congenital heart defects. Treatment options include surgical repair or transcatheter management with endovascular stenting or balloon dilatation. Late complications after operative repair include systemic hypertension, aortic valve abnormalities, aortic aneurysm, and recoarctation. This study examines the association between the presence of hypertension at the diagnosis of CoA and recoarctation. This retrospective study analyzed medical records of patients at Soroka University Medical Center who underwent treatment for CoA between 1978 and 2021. The study included 128 patients diagnosed with CoA and who underwent repair; 9 were excluded, leaving 119 patients for analysis. Of the 119 patients, 28 developed recoarctation within 15 years of initial repair. Patients with hypertension at initial diagnosis were more likely to develop recoarctation, adjusted to sex and ethnicity. Other patient characteristics were not significantly associated with recoarctation. Hypertension at the time of initial CoA diagnosis is a risk factor for the development of recoarctation within 15 years of initial repair. Close monitoring and management of blood pressure may be important for patients with CoA. Future research should investigate whether hypertension control can reduce recoarctation risk in this population. Previous studies focus on post-repair hypertension in CoA. Limited research on hypertension during CoA diagnosis. Knowledge gap on its impact on recoarctation risk. Hypertension at CoA diagnosis may predict recoarctation. Enables tailored monitoring and timely intervention.

Peripheral oxygen saturation levels as a guide to avoid hyperoxia: an observational study

BackgroundAs iatrogenic hyperoxia has been related to adverse outcomes in critically ill patients, guidelines advise to titrate oxygen to physiological levels. In the prehospital setting where partial arterial oxygen (PaO2) values are often not readily available, titration of oxygen is based on peripheral oxygen saturations (SpO2). In this study we aimed to investigate the efficacy of SpO2 guided oxygen titration in the prevention of hyperoxia.MethodsIn a retrospective observational cohort study of patients included in the Acutelines data- and biobank of the University Medical Center Groningen between September 2020 and March 2023, we collected blood gas samples and triage data of sequentially included patients who received oxygen at the moment they were presented in the emergency department (ED). PaO2 values were compared to (concurrently measured) SpO2 values, and to patient- and treatment characteristics and P/F ratios were calculated in order to investigate the efficacy of SpO2 based oxygen titration for various subgroups.ResultsBlood gas samples were obtained for 1042 patients, of which 178 (17.1%) had hyperoxia (PaO2 levels > 13.5 kPa). SpO2 readings were available for 170 of these, 68 of which (40%) had SpO2 values above the recommended target range (94–98%; 88–92% for patients with COPD) whereas 102 patients (60%) had SpO2 values within- or even below the recommended target range. Many of these patients (44.1%) received oxygen through a low-flow device (nasal canula), and these patients almost invariably (84.4%) were not compromised in their ventilation (P/F ratio’s > 300).ConclusionWhen oxygen is titrated based on SpO2 levels, this results in hyperoxemia in a significant proportion of the patients. Health care providers should especially be reluctant to administer (low flow) oxygen as a standard of care to patients who do not have clear respiratory compromise, as these patients are at a high risk of developing (occult) hyperoxia.

Cerebral Hemodynamic Responses to Disease-Modifying and Curative Sickle Cell Disease Therapies.

Sickle cell disease (SCD) is a hemoglobinopathy resulting in hemoglobin-S production, hemolytic anemia, and elevated stroke risk. Treatments include oral hydroxyurea, blood transfusions, and hematopoietic stem cell transplantation (HSCT). Our objective was to evaluate the neurologic relevance of these therapies by characterizing how treatment-induced changes in hemoglobin (Hb) affect brain health biomarkers. In this interventional study, adults with and without SCD underwent a 3T-MRI at Vanderbilt University Medical Center at 2 time points before and after clinically indicated transfusion or HSCT or at 2 time points without the introduction of a new Hb-altering therapy (adult controls and patients with SCD on hydroxyurea). Cerebral blood flow (CBF; mL/100 g/min) and cerebral venous blood relaxation rate (s-1; a marker of Hb and blood oxygen content) responses were assessed to understand how these markers of brain health vary with Hb modulation. CBF was assessed with arterial spin labeling MRI, and blood relaxation rate was assessed using T2 relaxation under spin tagging MRI. Measures were pairwise compared within each cohort using a 2-tailed Wilcoxon signed-rank test, and regression was applied to evaluate the parameter and Hb change relationships. The significance criterion was 2-sided p < 0.05. Adults with (n = 43; age 28.7 ± 7.7 years; 42% male) and without (n = 13; age 33.5 ± 12.2 years; 46% male) SCD were evaluated. In adults receiving hydroxyurea (n = 10), neither Hb, CBF, nor venous relaxation rate changed between time 1 (Hb = 8.6 ± 1.2 g/dL) and time 2 (Hb = 9.0 ± 1.8 g/dL) (all p > 0.05). In transfusion patients (n = 19), Hb increased from 8.2 ± 1.4 g/dL to 9.3 ± 1.3 g/dL before vs after transfusion (p < 0.001), paralleling a CBF decrease of 14.2 mL/100 g/min (p < 0.001) toward control levels. The venous relaxation rate did not change after transfusion (p = 0.71). In HSCT patients (n = 14), Hb increased from 8.9 ± 1.9 g/dL to 12.9 ± 2.7 g/dL (p < 0.001) before vs after transplant, paralleling CBF decreases from 68.16 ± 20.24 to 47.43 ± 12.59 mL/100 g/min (p < 0.001) and increase in venous relaxation rate (p = 0.004). Across the Hb spectrum, a CBF decrease of 5.02 mL/100 g/min per g/dL increase in Hb was observed. Findings demonstrate improvement in cerebral hemodynamics after transfusion and transplant therapies compared with hydroxyurea therapy; quantitative relationships should provide a framework for using these measures as trial end points to assess how new SCD therapies affect brain health.

Development of an open access systematic review instructional video series accessible through the SPI-HubTM website

Given the key role of systematic reviews in informing clinical decision making and guidelines, it is important for individuals to have equitable access to quality instructional materials on how to design, conduct, report, and evaluate systematic reviews. In response to this need, Vanderbilt University Medical Center’s Center for Knowledge Management (CKM) created an open-access systematic review instructional video series. The educational content was created by experienced CKM information scientists, who worked together to adapt an internal training series that they had developed into a format that could be widely shared with the public. Brief videos, averaging 10 minutes in length, were created addressing essential concepts related to systematic reviews, including distinguishing between literature review types, understanding reasons for conducting a systematic review, designing a systematic review protocol, steps in conducting a systematic review, web-based tools to aid with the systematic review process, publishing a systematic review, and critically evaluating systematic reviews. Quiz questions were developed for each instructional video to allow learners to check their understanding of the material. The systematic review instructional video series launched on CKM’s Scholarly Publishing Information Hub (SPI-HubTM) website in Fall 2023. From January through August 2024, there were 1,662 international accesses to the SPI-HubTM systematic review website, representing 41 countries. Initial feedback, while primarily anecdotal, has been positive. By adapting its internal systematic review training into an online video series format suitable for asynchronous instruction, CKM has been able to widely disseminate its educational materials.

Esophageal Candida Infection and Esophageal Cancer Risk in Patients With Achalasia

Patients with achalasia face a higher risk of developing esophageal cancer (EC), but the surveillance strategies for these patients remain controversial due to the long disease duration and the lack of identified risk factors. To investigate the prevalence of esophageal Candida infection among patients with achalasia and to assess the association of Candida infection with EC risk within this population. This retrospective cohort study included patients with achalasia diagnosed at or referred for treatment and monitoring to the Erasmus University Medical Center in Rotterdam, the Netherlands, between January 1, 1980, and May 31, 2024. Data analysis was conducted from August 1 to October 31, 2024. Esophageal Candida infection. The primary outcomes were the prevalence of esophageal Candida infection and its association with EC development among patients with achalasia. Associations were estimated using time-dependent Cox proportional hazards regression models with esophageal Candida infection as a time-varying covariate, adjusting for age at diagnosis and sex. This study included 234 patients with achalasia (median [IQR] age at diagnosis, 45 [32-63] years; 117 [50%] male), with a median follow-up time of 13 (4-22) years. Esophageal Candida infection was identified in 29 patients (12%), while EC was observed in 24 patients (10%). Esophageal cancer risk analysis was performed for 207 patients with 2 or more consecutive endoscopy follow-up visits (median [IQR] age at diagnosis, 43 [32-60] years; 104 [50%] male). The median (IQR) follow-up time for this subgroup was 16 (9-26) years. Among these patients, esophageal Candida infection was independently associated with an increased risk of EC (adjusted hazard ratio [AHR], 8.24 [95% CI, 2.97-22.89]). Additionally, age at diagnosis (AHR, 1.06 [95% CI, 1.03-1.10]) and male sex (AHR, 3.34 [95% CI, 1.08-10.36]) were independently associated with EC risk. This retrospective cohort study found that prior esophageal Candida infection, older age at diagnosis, and male sex were associated with increased risk of EC among patients with achalasia. These findings provide an important rationale for optimizing the monitoring of patients with achalasia.

Critical reflection on the indication for computed tomography: an interdisciplinary survey of risk and benefit management in patients with sepsis

ObjectivesTo survey physicians’ views on the risks and benefits of computed tomography (CT) in the management of septic patients and indications for and contraindications to contrast media use in searching for septic foci.MethodsA web-based questionnaire was administered to physicians at a large European university medical center in January 2022. A total of 371 questionnaires met the inclusion criteria and were analyzed with physicians’ work experience, workplace, and medical specialty as independent variables. Chi-square tests were used for exploratory analysis.ResultsWhile physicians with all levels of work experience were included, the largest group (35.0%, n = 130/371) had 3–7 years of experience. Most physicians agreed that the benefits of CT outweigh its potential adverse effects in septic patients (90.5%, n = 336/371). Responders saw the strongest indication for contrast media administration in septic patients for (1) CT examinations of the abdomen (92.7%, n = 333/359) and (2) combined CT examinations of the chest, abdomen, and pelvis (94.1%, n = 337/358). While radiologists were most likely to consider manifest hyperthyroidism an absolute contraindication to contrast media administration (43.8%, n = 14/32), most other groups of physicians opted for appropriate preparation before contrast media administration in this subset of septic patients.ConclusionIn this survey, most participating physicians considered CT an essential diagnostic modality to detect an infectious focus in septic patients. Whereas the risk of ionizing radiation was regarded as justifiable by most physicians, different specialties varied in their assessment of the risks of contrast media administration.Key PointsPhysicians recognize CT as a relevant imaging modality in the diagnostic management of patients with sepsis.There is an interdisciplinary consensus that the use of ionizing radiation is justified in septic patients.There is disagreement about indications for and contraindications to contrast media administration among physicians from different medical specialties.Graphical

Associations of Essential and Non-Essential Trace Elements' Levels in the Blood, Serum, and Urine in Women with Premature Ovarian Insufficiency.

Premature ovarian insufficiency (POI) is poorly understood, with causes identified in only 25% of cases. Emerging evidence suggests links between trace elements (TEs) and POI. This study is the first to compare concentrations of manganese (Mn), copper (Cu), zinc (Zn), selenium (Se), molybdenum (Mo), arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) across urine, serum, and whole blood in women with POI compared to healthy controls (HC), aiming to explore their distribution and potential associations with POI. This cross-sectional-case-control study enrolled 81 participants (40 POI patients and 41 healthy controls) at the University Medical Centre Ljubljana, Slovenia. Blood and urine samples were collected to quantify basic biochemical parameters using standard clinical chemistry methods and concentrations of Mn, Cu, Zn, Se, Mo, As, Cd, Hg, and Pb using inductively coupled plasma-mass spectrometry (ICP-MS). Participants also completed questionnaires on socio-demographics, medical history, lifestyle, and nutrition. Data was analyzed using the Mann-Whitney U test, Student's t-tests, Fisher exact test, logistic regression models adjusted on body mass index (BMI), age, hematocrit, and Kendall's tau correlation. Women with POI had significantly higher BMI and red blood cell (RBC) indices, including hemoglobin, hematocrit, and red cell distribution width (RDW), compared to controls. A larger proportion of POI patients resided in rural agricultural areas. Liver and kidney function assessments showed no significant differences between the groups. Adjusted models revealed that POI patients had significantly lower urinary levels of Cu, Zn, Se, Mo, Cd, Hg, and Pb than controls, while whole blood Mn levels were higher. Serum Cu levels were significantly elevated in POI patients, whereas Pb, Cd, and Hg were lower. No significant differences were observed for As. Correlation analysis showed several strong to moderate associations among TEs across biofluids, but only weak correlations were found between TEs and demographic or biochemical factors. This study suggests potential associations between TEs and POI in women. Notably, most TEs (Zn, Se, Cu, Mo, Cd, Hg, Pb) were significantly lower in the urine of the POI group, while Cu, Cd, Hg, and Pb showed significant differences in both urine and serum.

Shoulder and Elbow Surgery Fellowship Applicants with Greater Research Productivity During Residency are Ranked Higher by Fellowship Programs.

Shoulder and elbow surgery fellowships in the United States are recognized for their academic emphasis, yet the correlation between an applicant's research productivity and fellowship match results remains unclear. This study (1) analyzed temporal trends in research productivity among matched fellowship applicants, (2) evaluated the influence of quantity of publications and first authorships on match positions, and (3) investigated program variations in research productivity. This is a retrospective analysis of data from the San Francisco (SF) Match Database for shoulder and elbow surgery applicants matched between 2017 and 2024. Allopathic (MD), osteopathic (DO), and international medical graduates (IMGs) were included. PubMed was queried to quantify publications and first authorship before and during residency, analyzing their association with applicant and fellowship rank. Publication volumes per fellowship program were also calculated for institutions with at least five years of match data. 290 matched applicants were evaluated across 34 fellowship programs, comprising 229 MDs, 29 DOs, and 32 IMGs. There was almost a five-fold increase in the average number of publications per applicant, from 2.72 ± 3.54 in 2017 to 12.80 ± 15.88 in 2024 (B 1.30; p = 0.001). Similarly, first authorship publication counts increased almost three-fold, from 1.31 ± 2.12 in 2017 to 3.66 ± 5.01 in 2024 (B = 0.29, p = 0.02). Fellowship program analysis revealed wide variation in mean publication counts of matched applicants (p = 0.008), with Rush University Medical Center (27.88 ± 33.86), Massachusetts General Hospital (13.65 ± 26.62), Mayo Clinic (13.06 ± 14.77), Thomas Jefferson University Hospital (12.19 ± 10.64) exhibiting the highest averages. Candidates with more publications (p = 0.04), first authorships(p = 0.02), and total first authorships (p = 0.04) during residency were ranked higher by fellowship programs. There was a significant correlation between greater publication count during residency and more favorable fellowship rank (-0.15, p = 0.02) and applicant match position (-0.12, p = 0.049). No significant associations were found between pre-residency publications (p = 0.38), total publications (p = 0.13), and pre-residency first authorships (p = 0.20) with fellowship rank positions. Research productivity has increased substantially among matched applicants. The more academically productive residents tend to be ranked more favorably by fellowship programs and match higher on their list. However, these associations were relatively weak, highlighting the complexity of the fellowship selection process and the notion that research productivity alone does not guarantee placement in preferred programs.

Randomised double-blind placebo-controlled trial protocol to evaluate the therapeutic efficacy of lyophilised faecal microbiota capsules amended with next-generation beneficial bacteria in individuals with metabolic dysfunction-associated steatohepatitis

BackgroundThe spectrum of metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent, affecting 30% of the world’s population, with a significant risk of hepatic and cardiometabolic complications. Different stages of...

Reducing antibiotic duration for acute otitis media: clinician, administrator, and parental insights to inform implementation of system-level interventions.

This qualitative study aimed to understand facilitators and barriers to implementation of interventions to improve guideline-concordant antibiotic duration prescribing for pediatric acute otitis media (AOM). Clinicians and clinic administrators participated in semi-structured qualitative interviews, and parents of children 2 years of age or older with a recent diagnosis of AOM participated in focus groups. The Practical Robust Implementation and Sustainability Model (PRISM) guided the study. Interviews were analyzed using the Rapid Assessment Process. Denver Health and Hospital Authority (Denver, CO) led the study. Recruitment occurred at Vanderbilt University Medical Center (Nashville, TN) and Washington University in St. Louis Medical Center (St. Louis, MO). Purposeful sampling was used to recruit clinicians and administrators for qualitative interviews. Convenience sampling was used to recruit parents for focus groups. Thirty-one participants (15 clinicians, 4 administrators, and 12 parents) engaged in interviews and focus groups. Factors influencing antibiotic prescribing included patient history, years of practice, familiarity with the patient, concerns with patient medication adherence, and practice type. Clinicians endorsed electronic health record modifications and clinician prescribing feedback as methods to improve patient care and reduce the durations of prescribed antibiotics. Suggestions for intervention optimization and education needs were also obtained. Findings suggest that clinicians and administrators support reducing prescribed antibiotic durations for AOM and are receptive to the proposed interventions. More education is needed to increase parent awareness about antibiotic stewardship and AOM treatment options. RELAX: Reducing Length of Antibiotics for Children with Ear Infections (RELAX), NCT05608993, https://clinicaltrials.gov/study/NCT05608993.

Simplifying coronary artery disease risk stratification: development and validation of a questionnaire-based alternative comparable to clinical risk tools.

Coronary artery disease (CAD) comprises one of the leading causes of morbidity and mortality both in the European population and globally. All established clinical risk stratification scores and models require blood lipids and physical measurements. The latest reports of the European Commission suggest that attracting health professionals to collect these data can be challenging, both from a logistic and cost perspective, which limits the usefulness of established models and makes them unsuitable for population-wide screening in resource-limited settings, i.e., rural areas. Therefore, the aim of this study was to develop and externally validate a questionnaire-based risk stratification model on a population scale at minimal cost, i.e., the Questionnaire-Based Evaluation for Estimating Coronary Artery Disease (QUES-CAD) to stratify the 10-year incidence of coronary artery disease. Cox proportional hazards (CoxPH) and Cox gradient boosting (CoxGBT) models were trained with 10-fold cross-validation using combinations of ten questionnaire variables on the White population of the UK Biobank (n=448,818) and internally validated the models in all ethnic minorities (n=27,433). The Lifelines cohort was employed as an independent external validation population (n=97,770). Additionally, we compared QUES-CAD's performance, containing only questionnaire variables, to clinically established risk prediction tools, i.e., Framingham Coronary Heart Disease Risk Score, American College of Cardiology/American Heart Association pooled cohort equation, World Health Organization cardiovascular disease risk charts, and Systematic Coronary Risk Estimation 2 (SCORE2). We conducted partial log-likelihood ratio (PLR) tests and C-index comparisons between QUES-CAD and established clinical prediction models. In the external validation set, QUES-CAD exhibited C-index values of CoxPH: 0.692 (95% Confidence Interval [CI]: 0.673-0.71) and CoxGBT: 0.699 (95% CI: 0.681-0.717) for the male population and CoxPH: 0.771 (95% CI: 0.748-0.794) and CoxGBT: 0.759 (95% CI: 0.736-0.783) for the female population. The addition of measurement-based variables and variables that require a prior medical examination (i.e., insulin use, number of treatments/medications taken, prevalent cardiovascular disease [other than CAD, and stroke diagnosed by a doctor]) and the further addition of biomarkers/other measurements (i.e., high-density lipoprotein [HDL] cholesterol, total cholesterol, and glycated haemoglobin) did not significantly improve QUES-CAD's performance in most instances. C-index comparisons and PLR tests showed that QUES-CAD performs and fits the data at least as well as the clinical prediction models. QUES-CAD performs comparably to established clinical prediction models and enables a population-wide identification of high-risk individuals for CAD. The model developed and validated herein relies solely on ten questionnaire variables, overcoming the limitations of existing models that depend on physical measurements or biomarkers. University Medical Center Groningen.

Examining the effect of direct-from-blood bacterial testing on antibiotic administration and clinical outcomes: a protocol and statistical analysis plan for a pragmatic randomised trial

IntroductionPatients with suspected bacterial infection frequently receive empiric, broad-spectrum antibiotics prior to pathogen identification due to the time required for bacteria to grow in culture. Direct-from-blood diagnostics identifying the presence...

Appendiceal Neuroendocrine Tumor: Clinicopathologic Characteristics of Six Cases and Review of the Literature.

Appendiceal neuroendocrine tumors (ANETs) are the most prevalent type of appendiceal neoplasm and the fifth most common neuroendocrine tumor in the gastrointestinal tract. In this study, we described the clinicopathological features of patients with ANET. We reviewed the clinicopathological findings and histopathological reports of six patients diagnosed with ANET between January 2014 and December 2023 at Korea University Medical Center, Anam Hospital. Six cases, comprising three males and three females, were diagnosed during procedures for lower abdominal pain or other medical reasons. Most tumors were less than 1 cm in size and located at the tip of the appendix. One patient had a large tumor (4.1 cm) with lymph node metastasis. Four tumors extended to the muscularis propria, whereas two infiltrated the subserosal soft tissue. The tumor cells exhibited a typical trabecular and nested pattern with monotonous round or oval nuclei. All patients had a mitotic count of less than 2 per 10 high-power fields and a Ki-67 labeling index of less than 1%, classifying them as having G1 well-differentiated tumors. Immunohistochemical staining showed that all cases were positive for CD56 and synaptophysin, and four were positive for chromogranin A. No recurrence or distant metastasis was observed during follow-up. ANETs are relatively uncommon and mostly benign in terms of prognosis. Because of their malignant potential, meticulous examination of appendectomy specimens is warranted to identify the presence of ANETs.

Economic evaluation of critically ill adult CAR-T cell recipients—analysis from a healthcare payer perspective

Abstract Background CAR-T cell (chimeric antigen receptor T) therapy is now part of standard of care treatment of B‑cell lineage malignancies. Although it is an effective treatment, it comes along with adverse side effects and toxicities that may require intensive care therapy. The costs related to critical care therapy in critically ill patients after CAR‑T administration have not been evaluated. Patients and methods Retrospective analysis of all patients who had received CAR‑T therapy and were admitted to the intensive care unit (ICU) of a tertiary care university medical centre in Germany between 1 January 2019 and 31 December 2022. Cause of admission and ICU therapy as well as treatment and total hospitals costs were evaluated. Results Thirty patients with a history of CAR-T cell therapy for underlying haematological malignancy were included. The median age of all patients was 60 years (interquartile range [IQR] 50–70) and 37% (n = 11) were female. 93% (n = 28) of patients had non-Hodgkin lymphoma and 7% (n = 2) had multiple myeloma. The cohort was stratified whether the ICU admission was CAR‑T therapy related (i.e. within 30 days after CAR‑T therapy; 73%, n = 22) or the admission was of an other cause (&gt; 30 days after CAR‑T therapy) (27%, n = 8). The median duration from CAR‑T therapy to ICU admission was 6 (range 5–8) days in CAR-T cell therapy associated ICU admissions compared with 52 (range 31–126) days in other admissions. The overall illness severity on admission was numerically higher in CAR-T-related ICU admission compared to other admissions (46 vs. 43 points, p = 0.18). Vasopressor therapy (50% vs. 75%; p = 0.19), invasive mechanical ventilation (27% vs. 50%; p = 0.24) and renal replacement therapy (14% vs. 50%; p &lt; 0.05) were used in CAR-T-associated admission compared to other admissions, respectively. The ICU mortality (23% vs. 50%; p = 0.15) was higher in patients with other ICU admission. Median total costs of the entire inpatient stay in hospital were € 27,845 (range 8661–368,286 €) in CAR-T-associated ICU admissions compared to € 59,234 (range 23,182–127,044 €) in the group of other ICU admissions (costs of the CAR‑T product not included). Conclusion In relation to the total costs of CAR-T-cell therapy (production of the CAR‑T product), therapy-associated complications have a relatively low impact on the costs and utilization of ICU resources.

The Diagnostics and Treatment of Acute Mediastinitis: A Single-Centre Experience in Vietnam

Background: Acute mediastinitis is a life-threatening condition requiring urgent intervention. Objectives: This study aims to describe the clinical, laboratory, imaging, and microbiological characteristics, as well as treatment outcomes, of acute mediastinitis cases. Methods: A retrospective, descriptive study was conducted on 32 patients treated at the University Medical Center Ho Chi Minh City from February 2016 to April 2024. Data were collected on patient demographics, clinical features, laboratory results, imaging findings, microbiological cultures, and treatment outcomes. Results: The mean age was 55.7 years, with males comprising 59.4% of cases. Fever and chest pain were the most common symptoms. Staphylococcus aureus was the most frequently identified organism. Computed tomography (CT) scans typically showed mediastinal air-fluid levels and fat stranding. Surgical interventions included neck drainage and thoracotomy. Complications included severe sepsis, septic shock, and pneumonia, with a mortality rate of 9.4%. Conclusions: Acute mediastinitis predominantly affects older males and presents significant clinical and diagnostic challenges. Effective multidisciplinary management is crucial for improving patient outcomes. This study provides valuable insights into the characteristics and treatment of acute mediastinitis in a Southeast Asian region.

Swab Testing to Optimize Pneumonia treatment with empiric Vancomycin (STOP-Vanc): study protocol for a randomized controlled trial

BackgroundVancomycin, an antibiotic with activity against methicillin-resistant Staphylococcus aureus (MRSA), is frequently included in empiric treatment for community-acquired pneumonia (CAP) despite the fact that MRSA is rarely implicated in CAP. Conducting polymerase chain reaction (PCR) testing on nasal swabs to identify the presence of MRSA colonization has been proposed as an antimicrobial stewardship intervention to reduce the use of vancomycin. Observational studies have shown reductions in vancomycin use after implementation of MRSA colonization testing, and this approach has been adopted by CAP guidelines. However, the ability of this intervention to safely reduce vancomycin use has yet to be tested in a randomized controlled trial.MethodsSTOP-Vanc is a pragmatic, prospective, single center, non-blinded randomized trial. The objective of this study is to test whether the use of MRSA PCR testing can safely reduce inappropriate vancomycin use in an intensive care setting. Adult patients with suspicion for CAP who are receiving vancomycin and admitted to the Medical Intensive Care Unit at Vanderbilt University Medical Center will be screened for eligibility. Eligible patients will be enrolled and randomized in a 1:1 ratio to either receive MRSA nasal swab PCR testing in addition to usual care (intervention group), or usual care alone (control group). PCR testing results will be transmitted through the electronic health record to the treating clinicians. Primary providers of intervention group patients with negative swab results will also receive a page providing clinical guidance recommending discontinuation of vancomycin. The primary outcome will be vancomycin-free hours alive, defined as the expected number of hours alive and free of the use of vancomycin within the first 7 days following trial enrollment estimated using a proportional odds ratio model. Secondary outcomes include 30-day all-cause mortality and time alive off vancomycin.DiscussionSTOP-Vanc will provide the first randomized controlled trial data regarding the use of MRSA nasal swab PCR testing to guide antibiotic de-escalation. This study will provide important information regarding the effect of MRSA PCR testing and antimicrobial stewardship guidance on clinical outcomes in an intensive care unit setting.Trial registrationClinicalTrials.gov NCT06272994. Registered on February 22, 2024.

Review and External Evaluation of Population Pharmacokinetic Models for Vedolizumab in Patients with Inflammatory Bowel Disease: Assessing Predictive Performance and Clinical Applicability

Background/Objectives: Several population pharmacokinetic models of vedolizumab (VDZ) are available for inflammatory bowel disease (IBD) patients. However, their predictive performance in real-world clinical settings remains unknown. This study aims to externally evaluate the published VDZ pharmacokinetic models, focusing on their predictive performance and simulation-based clinical applicability. Methods: A literature search was conducted through PubMed to identify VDZ population pharmacokinetic models. A total of 114 VDZ concentrations from 106 IBD patients treated at the University Medical Center “Zvezdara”, Republic of Serbia, served as the external evaluation cohort. The predictive performance of the models was assessed using prediction- and simulation-based diagnostics. Furthermore, the models were utilized for Monte Carlo simulations to generate concentration–time profiles based on 24 covariate combinations specified within the models. Results: Four published pharmacokinetic models of VDZ were included in the evaluation. Using the external dataset, the median prediction error (MDPE) ranged from 13.82% to 25.57%, while the median absolute prediction error (MAPE) varied between 41.64% and 47.56%. None of the models fully met the combined criteria in the prediction-based diagnostics. However, in simulation-based diagnostics, pvcVPC showed satisfactory results, despite wide prediction intervals. Analysis of NPDE revealed that only the models by Rosario et al. and Okamoto et al. fulfilled the evaluation criteria. Simulation analysis further demonstrated that the median VDZ concentration remains above 12 μg/mL at week 22 during maintenance treatment for approximately 45–60% of patients with the best-case covariate combinations and an 8-week dosing frequency. Conclusions: None of the published models satisfied the combined criteria (MDPE, MAPE, percentages of prediction error within ±20% and ±30%), rendering them unsuitable for a priori predictions. However, two models demonstrated better suitability for simulation-based applications.

Photobiomodulation Treatment for Second-Degree Burn Treatment-A Double-Blinded Controlled Pilot Trial.

Background: Photobiomodulation (PBM) is a technology that has gained much attention in recent years regarding its potential application for stimulating wound healing, alleviating pain, reducing inflammation, and aiding in the restoration of function. Due to a scarcity of evidence in the literature regarding PBM for the treatment of burns, our objective of this study was to test whether treatment with PBM in hospitalized patients with second-degree burns accelerated recovery. Methods: A double-blind controlled study was conducted on nine patients with up to 15% second-degree burns who were hospitalized at Hadassah-Hebrew University Medical Center, Ein Kerem Campus, Jerusalem Israel, between July 2022 and November 2022. Each patient recruited for the study received PBM treatment on part of the burn area (approximately 10%-20% of the burn area), while the control group was the burn area of the same patient treated only with the usual non-PBM. Treatment parameters were light emitting diode surface including continuous and/or pulsed red (660 nm) and near-infrared (840 nm), 5-16 mW/cm2, 2.4-7.7 J/cm2 per treatment session. Results: Patients received three to five treatments with a mean epithelization time of 16 days (±2.89 standard deviation [SD]) in the control area, while only 7.56 (±2.29 SD) in the treatment area. The mean percent reduction in healing time was 46.22% (±4.24 SD), which was found to be statistically significant (p = 0.004). Conclusion: Our study demonstrated a statistically significant acceleration of healing in second-degree burns following treatment with PBM for the treatment of burns in patients. However, further studies are needed to determine if these results translate to a reduction in hospitalization time and medical care costs.