Monocentric Cohort Study Research Articles

Aesthetic benefit of single-port laparoscopic ileo-caecal resection for Crohn's disease: a comparative study.

Single-port laparoscopy has been mainly studied for colonic cancer or cholecystectomy. Little is known about the cosmetic outcome for patients with Crohn's disease who are the best candidates for single-port surgery. This study aimed to assess cosmetic outcomes with single-port laparoscopy (SPL) vs. multiport laparoscopy (MPL) after ileocolic resection for Crohn's disease. This was a retrospective case-control study of a consecutive monocentric cohort. The study was conducted at a tertiary colorectal surgery referral centre. All consecutive patients who underwent an ileocolic resection by laparoscopy between 2012 and 2020 were included. The main outcomes measures, body image and cosmesis after surgery, were evaluated with a validated questionnaire. Secondary endpoints were conversion, morbidity, length of hospital stay and incisional hernia. Two hundred and six patients were included (SPL, n = 65, 32%). Most patients were operated on for stricturing disease (64%). Conversion rate to laparotomy was 0% in the SPL group and 17.7% in the MPL group (p < 0.001). The complication rate was similar in both groups (SPL, 29.2%; MPL, 38.3%; p = 0.21) as was length of stay (5days [4-7] in both groups). In total 124 (71%) responded to the questionnaire (MPL, n = 74, 67%; SPL, n = 50, 78%; p = 0.11). The SPL group scored better on the cosmesis scale (21.1 vs. 18.4, p < 0.001). In the SPL group, body image scale scores were better for patients with an intraumbilical incision (intraumbilical 5.2 (± 0.6) vs. periumbilical 6.4 (± 2), p = 0.04). After matching, body image scale scores were similar in both groups (SPL, 6; MPL, 6.4; p = 0.24), but cosmesis scale scores remained better in the SPL group (21.1 vs. 19.3, p = 0.03). Ileocolic resection for Crohn's disease with single-port laparoscopy has better cosmetic outcomes than with the multiport approach. Postoperative complications and long-term incisional hernia rate are similar. Routine use of an intraumbilical incision could improve cosmetics.

Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring

BackgroundAPRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings.MethodsThis retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes.Results20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR − 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO2- removal between both modes.ConclusionDespite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.

Risk factors for Staphylococcus aureus colonization in a general emergency department patient cohort – results of an observational cohort study

Background Testing for Staphylococcus aureus (SA) colonization in emergency department (ED) patients may guide prevention strategies against hospital acquired infections (HAI). This study determined the prevalence of SA carriers in a general ED population, characterized the population, and identified predictors for SA colonization. Methods A prospective monocentric observational cohort study in a tertiary care hospital collected nasopharyngeal swabs in 1,000 adult patients. PCR testing for methicillin resistant and methicillin sensitive SA (MRSA/MSSA) was performed. Risk factor questionnaires and routine data from the clinical information system were captured. Descriptive statistics and binary logistic regression models were applied to report prevalence and outcomes and to identify predictors. Results The prevalence for SA was 33.7% (n = 328; 95%-CI: 30.7-36.8): MSSA 30.9% (n = 301; 95%-CI: 28.0-34.0) and MRSA 2.8% (n = 27; 95%-CI: 1.8-4.0). POC PCR testing in the ED was feasible. Key predictors of SA colonization included having a catheter (OR 2.0, 95%-CI 1.0-4.0, p = 0.044) and requiring nursing care (OR 1.9, 95%-CI: 1.2-2.9, p = 0.007), even after adjusting for age and sex. Conclusion Testing strategies for SA detection in ED need to focus on vulnerable populations with an elevated risk for HAIs and associated adverse outcomes. Individuals requiring nursing care could be a key target population for screening efforts.

Return-to-sports after conservative treatment of ligamentous elbow dislocations: a monocentric retrospective cohort study. European journal of trauma and emergency surgery.

Ligamentous elbow dislocations often affect young patients with high functional and athletic demands. After reduction and clinical examination of joint stability, further treatment options are, therefore, the subject of controversial debate. In order to be able to advise patients adequately, an assessment of the possible return-to-sport based on experience is necessary. This study examines the medium to long-term return-to-sports after conservative treatment of a ligamentous elbow dislocation. In this clinical study, 42 patients (47.6% female, 52.4% male) who were treated conservatively for a ligamentous elbow dislocation at our clinic were surveyed. Conservative treatment was carried out for at least 6 weeks. Exclusion criteria were concomitant bony lesions requiring surgery, a tendency to dislocate between 30 and 130° of flexion after reduction, a positive apprehension test after reduction, and athletes with medial pop-up/instability and high valgus stress as part of their sporting activities. The Disabilities of the arm, shoulder and hand (DASH), the sport-DASH and the subjective elbow value (SEV) were tested. The sport-DASH was correlated with gender, age, arm dominance, and the type of sport practiced. Descriptive statistics and significant differences were determined using statistical analyses. The average age was 42.7 years (range 22-75). After an average follow-up after 4.5 years, the mean value of DASH was 2.44 (SD 4.77), the mean value of sports DASH was 4.17 (SD 11.04) and the mean value of SEV was 94.93% (SD 6.40). There were no significant differences in sports DASH depending on gender (p = 0.81), age (p = 0.68), dislocation side in relation to the dominant arm (p = 0.54) or the type of sport practiced (p = 0.94, p = 0.65, p = 0.71). 2 patients (4.8%) underwent surgery after 6 and 8 weeks of conservative treatment due to persistent elbow stiffness. In our patient cohort, a very good return-to-sports after conservative treatment of ligamentous elbow dislocation was demonstrated, taking into account the above exclusion criteria. Factors such as age, gender, the side of the dislocation in relation to the arm dominance, and the type of sport had no influence on the outcome of our study. The data help practitioners to advise patients better when deciding on treatment and the question of a possible return to sport.

P1013 Adverse Events of Methotrexate in Paediatric Inflammatory Bowel Disease: A Retrospective Cohort Study

Abstract Background Methotrexate (MTX) is frequently prescribed in paediatric inflammatory bowel disease (IBD), with laboratory monitoring routinely performed to detect adverse events (AEs) such as hepatotoxicity and myelotoxicity. However, data on the incidence of these AEs in paediatric IBD remain limited. This study aims to assess the incidence of MTX-induced AEs in paediatric IBD, and to identify factors associated with AEs. Methods We conducted a retrospective monocentre cohort study, including all paediatric IBD patients initiating MTX at the Amsterdam UMC between 2010 and 2023. We collected demographic data, disease characteristics, and laboratory results. We specifically evaluated the occurrence of hepatotoxicity, myelotoxicity, and gastrointestinal (GI) side effects (nausea and vomiting). The severity of AEs was assessed according to the Common Terminology Criteria for Adverse Events. Shortly, grade 1 hepatotoxicity was defined as upper limit of normal (ULN)-2.5 times ULN, grade 2 as 2.5-5 times ULN, and grade 3 as 5-20 times ULN. Myelotoxicity was defined as leukopenia, neutropenia and/or thrombocytopenia. Incidence rates were calculated, and regression analyses were performed to assess potential predictors of MTX-induced AEs. Results A total of 208 paediatric IBD patients (179 CD, 18 UC, 10 IBD-U) starting MTX therapy were identified, 111 of whom used MTX as immunomodulator alongside a biological. Mean dose at initiation was 13 mg/week (±3.21SD), and 66.5% received MTX orally, versus 33.5% subcutaneous administration. All used folic acid. Hepatotoxicity was observed in 85 patients (40.1%), of which the majority (n=52, 63.4%) classified as grade 1, while 10 patients (12.2%) showed grade 3 toxicity. Myelotoxicity occurred in 43 cases (20.7%), most of which presented as mild toxicity (n=35, 83.3%), with no cases of severe toxicity. GI side effects were reported in 95 patients (45.7%). MTX was permanently discontinued in 24 patients (11.5%) due to hepatotoxicity, in 2 patients (1.0%) due to myelotoxicity, and in 35 patients (16.8%) due to GI side effects. The incidence density of AEs was 0.25 per person-year, with a total of 480 events across 1908 person-years. Female sex (RR 1.4, 95% CI [1.12–1.78], p=0.004) and MTX dose (RR 0.9, 95% CI [0.89– 0.97], p=0.002) were significant predictors of hepato- and/or myelotoxicity. Female sex (RR 1.5, 95% CI [1.17–1.97], p=0.002) and subcutaneous administration of MTX (RR 0.5, 95% CI [0.41–0.73], p&amp;lt;0.01) were significant predictors of GI AEs. Conclusion Our findings indicate that severe MTX-induced AEs in paediatric IBD are uncommon, and that MTX-related AEs rarely necessitate therapy cessation. Female sex, MTX dosage, and subcutaneous administration were significant predictors of MTX-induced AEs.

Drusen volume as clincial outcome measure in subjects with malattia leventinese.

To assess if drusen volume can serve as structural clinical outcome marker in Malattia Leventinese (ML), and to evaluate whether cones or rods are more affected by its progression, using multimodal imaging and mesopic and two-color scotopic microperimetry. This was a prospective monocentric cross-sectional cohort study of participants with genetically confirmed ML. Participants were classified according to morphology. Mean drusen volume, calculated from SD-OCT, was compared to microperimetry parameters (mesopic retinal sensitivity, scotopic red and cyan function, difference between scotopic cyan-red function). Fourteen participants (28 eyes) were enrolled. Mean drusen volume increased (bilaterally P=0.028) and mesopic retinal sensitivity decreased with later stage (OD: P=0.028; OS: P=0.050). Scotopic microperimetry showed that scotopic cyan function was lower than scotopic red function in moderate stage. Scotopic red function decreased in severe stage. Mean drusen volume correlated to mesopic retinal sensitivity (OD: P<0.001; OS: P=0.007). Retinal sensitivity diminishes with ML progression. Rod function declines prior to cone function, while at late stages, cone loss predominates. Drusen accumulation, initially speckled around the macula and optic disc and confluent with disease progression, correlates well with visual function loss and impaired quality of life. Thus, therapeutically reducing drusen accumulation could be efficacious.

Similar risks of complications and reoperation rates in proximal femur megaprostheses for oncological and non-oncological indications.

Proximal femur megaprostheses (PFMPs) are used to manage large bone defects in both non-oncological indications (NOI) and oncological indications (OI). However, little is known about the comparative risks of reoperation and functional outcomes between these groups. This study aimed to evaluate the cumulative incidences of reoperation and functional results of PFMPs between NOI and OI. This retrospective, monocentric cohort study included 109 implants between 2005 and 2020 (NOI, n = 42; OI, n = 67). Competing risk analysis was used to estimate and compare cumulative incidence of reoperation and complications, with death as a competing event. The Musculoskeletal Tumour Society Score (MSTS) was retrospectively assessed to compare functional outcomes. The estimated cumulative incidence of reoperation at ten years did not statistically differ: 33.5% for NOI vs. 32.7% for OI (HR = 0.90, 95% CI (0.42-0.95), p = 0.791). The estimated cumulative incidence of complications at ten years did not statistically differ (HR = 1.50, 95%CI (0.80-2.80), p = 0.204). The MSTS score at ten years was significantly higher in the OI group (78.2% ± 19.5) compared to the NOI group (48.3% ± 10.9) (p = 0.012). PFMPs for NOI demonstrate a comparable risk of reoperation to OI, but with lower long-term functional outcomes.

Clinical Profiles, Survival, and Lung Function Outcomes in ANCA-Associated Interstitial Lung Disease: An Observational Study.

Background/Objectives: Anti-neutrophil cytoplasmic antibodies (ANCAs) have been found in interstitial lung disease (ILD) in recent years, although its impact on ILD prognosis is less known. To date, ANCAs are not included in the interstitial pneumonia with autoimmune features (IPAF) definition criteria. Therefore, ANCA-ILD, in the absence of known ANCA-associated vasculitis (AAV), could be underdiagnosed. Our aim was to analyze the clinical profile and prognosis of ANCA-ILD patients. Methods: Patients diagnosed with ILD and positive ANCA were enrolled in a retrospective, monocentric cohort study. Lung function outcomes and mortality were assessed according to clinical, serological, radiological, and treatment characteristics. Survival was analyzed using Kaplan-Meier curves and Cox regression models. Results: A total of 23 patients were included, mostly women, with a median time from ILD diagnosis of 36 (24-68) months and a predominant anti-MPO pattern (56.5%). Nearly half of the patients had AAV, mostly microscopic polyangiitis (MPA). The presence of AAV was significantly associated with anti-MPO antibodies and an NSIP radiographic pattern. Overall, the fibrotic pattern (either UIP or fibrotic NSIP) was the most common (73.9%), mainly UIP (51.2%). However, it appeared less frequently in the AAV-ILD group. During follow-up, lung function impairment or radiological progression was observed in 65.2% of patients. Cumulative mortality incidence was high (43.4%), largely due to ILD itself (80%). A UIP pattern was associated with a higher and earlier mortality (HR 34.4 [1.36-132]), while the use of immunosuppressants showed a trend towards lower ILD-related death. Conclusions: In our cohort, ANCA-ILD patients mostly presented with fibrotic patterns, with AAV in almost half of the cases and a high and early mortality rate, which suggests the need to assess ANCA in all ILD patients.

Microstructural Damage and Repair in the Spinal Cord of Patients With Early Multiple Sclerosis and Association With Disability at 5 Years.

The dynamics of microstructural spinal cord (SC) damage and repair in people with multiple sclerosis (pwMS) and their clinical relevance have yet to be explored. We set out to describe patient-specific profiles of microstructural SC damage and change during the first year after MS diagnosis and to investigate their associations with disability and SC atrophy at 5 years. We performed a longitudinal monocentric cohort study among patients with relapsing-remitting MS: first relapse <1 year, no relapse <1 month, and high initial severity on MRI (>9 T2 lesions on brain MRI and/or initial myelitis). pwMS and age-matched healthy controls (HCs) underwent cervical SC magnetization transfer (MT) imaging at baseline and at 1 year for pwMS. Based on HC data, SC MT ratio z-score maps were computed for each person with MS. An index of microstructural damage was calculated as the proportion of voxels classified as normal at baseline and identified as damaged after 1 year. Similarly, an index of repair was also calculated (voxels classified as damaged at baseline and as normal after 1 year). Linear models including these indices and disability or SC cross-sectional area (CSA) change between baseline and 5 years were implemented. Thirty-seven patients and 19 HCs were included. We observed considerable variability in the extent of microstructural SC damage at baseline (0%-58% of SC voxels). We also observed considerable variability in damage and repair indices over 1 year (0%-31% and 0%-20%), with 18 patients showing predominance of damage and 18 predominance of repair. The index of microstructural damage was associated positively with the Expanded Disability Status Scale score (r = 0.504, p = 0.002) and negatively with CSA change (r = -0.416, p = 0.02) at 5 years, independent of baseline SC lesion volume. People with early relapsing-remitting MS exhibited heterogeneous profiles of microstructural SC damage and repair. Progression of microstructural damage was associated with disability progression and SC atrophy 5 years later. These results indicate a potential for microstructural repair in the SC to prevent disability progression in pwMS.

Predictors of return to work after multidisciplinary rehabilitation program for patients with chronic low back pain.

Patients with chronic low back pain face functional, psychological, social and professional difficulties. Multidisciplinary Rehabilitation Programs (MRP) can be an effective treatment to help these patients to improve their condition and return to work. To determine baseline predictors for return to work after an MRP for patients with chronic low back pain struggling to maintain their job. A monocentric cohort study was conducted. Patients who had followed a MRP between January 2015 and December 2020 were included. The program consisted of physical activities and different workshops inspired by behavioural therapy, at full time during one month. Pain, lifestyle, history of the disease, function, psycho-social characteristics were evaluated at baseline. Return to work at different possible time point after the MRP was collected. A bivariate and a multivariate analysis were performed to evaluate which factors were associated with return to work. Overall, 251 patients were included. Professional status, duration off-work, intensity of low back pain, self-perceived disability, fear-avoidance beliefs at work were associated with return to work after the MRP on bivariate analysis. Having worked in the past 6 months and the absence of high fear-avoidance beliefs at work at baseline were associated with return to work on multivariate analysis. This study suggests that patients with chronic low back pain and professional difficulties need to be included quickly in a MRP, with specific attention to beliefs about pain.

SAFEty assessment of a REdirection process after TRIage (SAFE RETRI) by a triage nurse in an emergency department: a monocentric cohort study

SAFEty assessment of a REdirection process after TRIage (SAFE RETRI) by a triage nurse in an emergency department: a monocentric cohort study

Community-onset pediatric status epilepticus: Barriers to care and outcomes in a real-world setting.

Status epilepticus (SE) is a neurological emergency in childhood, often leading to neuronal damage and long-term outcomes. The study aims to identify barriers in the pre-hospital and in-hospital management of community-onset pediatric SE and to evaluate the effectiveness of pediatric scores on outcomes prediction. This monocentric observational retrospective cohort study included patients treated for community-onset pediatric SE in a tertiary care hospital between 2010 and 2021. Data were extracted following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inclusion criteria were community-onset SE (according to the International League Against Epilepsy [ILAE] Task Force on SE Classification), admission to the pediatric emergency department (PED), age: 1 month to 18 years. Pre-hospital, in-hospital management and outcomes were analyzed. Pediatric scores for prediction of clinical worsening (Pediatric Early Warning Score - PEWS) and SE outcome (Status Epilepticus in Pediatric patients Severity Score - STEPSS; Pre-status Epilepticus PCPCS, background Electroencephalographic abnormalities, Drug refractoriness, Semiology and critical Sickness Score - PEDSS) were retrospectively assessed for their accuracy in predicting short-term and long-term outcomes. A total of 103 consecutive episodes of SE were included. Out-of-hospital rescue medications administration occurred in 54.4% of cases and was associated with higher SE resolution rate before PED admission (48.2% vs 27.6%, p = .033). Longer in-PED time to treatment was observed in case of delay to PED referral (r = 0.268, p = .048) or non-red triage labels (12 vs 5 min, p = 0.032), and was associated with longer in-PED duration of SE (r = 0.645, p < .001). Longer SE duration was observed in episodes leading to hospitalization compared to those discharged (50 vs 16 min, p < .001). In-PED electroencephalography (EEG) recordings were available in 39.8% of events. Predictive scores varied in accuracy, with PEWS ≥5 showing high sensitivity for intensive care unit (ICU) admission but low specificity. No patients died, 6.3% of SE was refractory. Effective pre-hospital administration of rescue medications and prompt PED management are crucial to reduce SE duration and improve outcomes. Predictive scores can aid in assessment of the severity and prognosis of SE; their utility is still not defined. Identifying and addressing actionable care barriers in SE management pathways is essential to enhance patient outcomes in pediatric SE.

Total knee arthroplasty in patient with poliomyelitis sequelae: maintaining a recurvatum is associated with better mid-term functional results.

Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underwent TKA; (2) to examine risk factors for poor functional outcome. A monocentric retrospective cohort study of all patients with poliomyelitis sequelae who underwent TKA between January 2006 and December 2019. Clinical, functional outcomes, radiographic results and occurrence of complications were collected. A total of 22 patients (24 knees) were included in the analysis, with a mean follow-up of 6.6 years (from 2 to 13.7 years). There was an improvement in KSS (28 +/- 23 vs. 81 +/- 6, respectively; p < 0.0001) as well as functional KSS (25 +/- 12 vs. 57.5 +/- 21, respectively; p = 0.0001). There was less occurrence of annual knee giving way episodes after total knee replacement (11.9+/-16.1 vs. 5.1+/-13.7, respectively; p = 0.04). Even though the total knee replacement allowed a slight recurvatum, it was smaller than the preoperative recurvatum (13° vs. 8°, respectively; p = 0.04). Seven complications with reintervention (7/24; 29%) were found. The presence of a residual post operative recurvatum correlated with better KSS (ρ = 0.53, CI95% [0.15; 0.77]; p = 0.008). The number of postoperative annual knee giving way episodes was inversely correlated with persistent postoperative recurvatum (ρ = -0.42, CI95% [-0.69; -0.01]; p = 0.04) but was not correlated with the type of constraint (ρ = -0.26, CI95% [-0.6; 0.15]; p = 0.21) nor with quadricipital muscle strength (ρ = 0.21, CI95% [-0.21; 0.56]; p = 0.33). TKA has a good mid-term functional outcome for knee osteoarthritis in patients with sequelae of poliomyelitis. Preserving a residual recurvatum postoperatively gives better clinical results without increasing the risk of ligament instability or early aseptic loosening. IV.

Increasing incidence of mycotoxicosis in South-Eastern Germany: a comprehensive analysis of mushroom poisonings at a University Medical Center

Abstract Background Mushrooms, an integral component of human diets, range from esteemed delicacies to potentially lethal toxins. The risk of severe poisoning from misidentified species, poses a significant challenge. For clinicians, recognizing mushroom poisoning amidst nonspecific symptoms and determining the specific mushroom ingested are critical yet complex tasks. Additionally, climate change affects the distribution and proliferation of mushroom species, potentially heightening the risk of exposure to toxic varieties. The identification of mushroom intoxication is critical for appropriate treatment. Poisoning with highly toxic species, such as Amanita phalloides (death cap), can result in acute liver and kidney failure. Considering the limited therapeutic options currently available for acute liver failure, we investigated the application of plasmapheresis, a procedure involving the replacement of the patient's plasma with donor plasma, as a potential intervention to improve clinical outcomes in severe cases of mushroom poisoning. Methods This study aimed to assess the trends and treatment outcomes of mushroom poisoning cases from 2005 to 2022, with a particular focus on the number of incidents and the potential impacts of climate change. We undertook a retrospective monocentric cohort study, evaluating 43 patients with mushroom poisoning. The study focused on identifying the variety of mushrooms involved, including psychotropic, spoiled, inedible, or toxic species, and closely examined patients with elevated transaminases indicative for liver damage. To assess clinical outcomes, we evaluated several aspects, including hepatic encephalopathy and other symptoms. Additionally, we monitored blood analysis results through serial measurements, including transaminases, bilirubin, INR, and creatinine levels. Furthermore, we explored the impact of climate changes on the incidence of mushroom poisoning. Results While the incidence of mushroom poisonings remained relatively stable during the first eight years of the study period, it nearly doubled over the past nine years. Nine distinct mushroom types were documented. The study showed no change in season patterns of mushroom poisonings. In cases of severe liver damage accompanied by coagulopathy, plasmapheresis was utilized to replace deficient clotting factors and mitigate the inflammatory response. This intervention proved effective in stabilizing coagulation parameters, such as the international normalized ratio (INR) Plasmapheresis was performed until the INR reached stable levels, preventing the occurrence of severe bleeding complications. In instances where liver failure was deemed irreversible, plasmapheresis functioned as a bridging therapy to manage bleeding risks and to stabilize the patient while awaiting liver transplantation. Conclusion The findings underscore the need for heightened awareness among healthcare professionals regarding mushroom poisoning and emphasize the importance of considering climate change as a factor that may alter mushroom distribution and toxicity. Additionally, this study highlights the potential of plasmapheresis in managing severe cases.

Intra-abdominal pressure, renal resistive index, sublingual microcirculation and total body water for guidance of volume resuscitation to avoid acute kidney injury during shock therapy

Background/objectivesShock and accompanying acute kidney injury (AKI) as a frequent complication is a well-known cause of morbidity and mortality worldwide. The current standard parameters to guide fluid resuscitation therapy (i.e., cardiac output, heart rate, blood pressure, central venous pressure) to avoid AKI and renal replacement therapy remain imprecise, and fluid overload with consequent organ oedema and high intestinal pressures result in further complications. The VoluKid study investigated additional non-invasive fluid volume parameters including assessment of total body water (TBW), renal vascular resistance [renal resistive index (RRI)], intra-abdominal pressure (IAP) and microcirculatory blood flow (MBF) to predict AKI during the first 72 h of intensive care therapy.Methods, design and analysisThis mono-centre observational cohort study included patients with shock who presented to the intensive care unit (ICU). Routine volume resuscitation parameters (i.e., cardiac output, heart rate, blood pressure, central venous pressure) were used to guide fluid therapy. In addition, four parameters, including MBF using sublingual incident dark-field microscopy, IAP, RRI assessed by duplex-sonography, and TBW using bioimpedance analysis (BIA), were measured daily and evaluated for predicting the primary outcome of acute kidney injury (AKI) and need for renal replacement therapy within the first 72 h of admission. Baseline and post-ICU admission values of these parameters were compared between patients with and without AKI.ResultsA total of 45 patients were enrolled in this study. Of those 45 patients, 37 could be followed for the entire study period of 72 h and 14 patients developed AKI (31.1%). Twelve patients (26.7%) had pre-existing renal impairment, one of whom died during the observation period. Nineteen patients (42.2%) had no renal impairment. RRI and IAP did not differ between patients with AKI and without AKI and did not predict AKI. TBW measured by BIA predicted AKI (p = 0.029). After adjustment for covariates (age, body mass index,and gender) this prediction was not significant [adjusted odds rato (OR) 0.99, p = 0.258, 95% confidence interval (CI) [0.97,1.01]]. MBF could not be estimated due a high number of missing values.ConclusionsBased on our limited data, none of the non-invasive parameters (TBA, IAP, RRI,) serve as predictors for AKI when assessed during the first 72 h after ICU admission, either when analysed separately or in combination.RegistrationClinicalTrials.gov Identifier: NCT02666404, registered 28/01/2016; URL: https://classic.clinicaltrials.gov/ct2/show/NCT02666404.

The impact of two different rituximab-based strategies in cryoglobulinaemic vasculitis secondary to Sjögren's disease: a monocentric cohort study.

To compare two different rituximab (RTX)-based therapeutic approaches on vasculitic and lymphoproliferative-related disease activity and on non-Hodgkin lymphoma (NHL) development in a cohort of patients affected by cryoglobulinaemic vasculitis secondary to Sjögren's disease (Sjögren-CryoVasc). Three Sjögren-CryoVasc treatment groups were identified: 1) early RTX induction followed by maintenance; 2) late RTX induction with possible on-demand retreatment; 3) no RTX treatment. The following outcomes were evaluated: a) changes in cumulative ESSDAI, considering vasculitic-related and lymphoproliferative-related domains and changes in ESSDAI specific to each single vasculitic-related and lymphoproliferative-related domain; b) development of NHL; c) occurrence of persistent hypogammaglobulinemia associated with serious infections. 13 Sjögren-CryoVasc patients were identified: 1) 5/13 treated earlier with RTX with subsequent maintenance; 2) 5/13 treated late with RTX with possible on-demand retreatment; 3) 3/13 not treated with RTX. The two RTX groups showed a decrease in the ESSDAI score with group 1 showing the most substantial reduction (p=0.028). Patients receiving RTX exhibited significant improvement in cutaneous, PNS, and articular vasculitic-related ESSDAI domains (p=0.007; p=0.006; p=0.03, respectively). By contrast RTX did not greatly affect the lymphoproliferative-related ESSDAI domains, even if an improvement was noted in the glandular and nodal domains for group 1 (p=0.03; p=0.03, respectively). No differences in NHL occurrence or safety concerns were observed between the groups. RTX is an effective and safe treatment to control Sjögren-CryoVasc disease activity with a greater impact when administered earlier with a maintenance regimen. RTX alone cannot, however, affect the possible evolution of Sjögren-CryoVasc into an overt NHL.

Acute astrocytic reaction is associated with 3-month functional outcome after stroke treated with endovascular therapy.

More than 50% of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT) remain severely disabled at 3 months. We hypothesized that acute astrocytic inflammatory response may play a pivotal role in post-AIS brain changes associated with poor functional outcome. We proposed to evaluate the level of YKL-40, a glycoprotein mainly released by reactive astrocytes. A monocentric prospective cohort study was conducted on consecutive LVO AIS patients treated with EVT. Three blood samples (before, within 1 and 24-hour post-EVT) were collected to measure plasma YKL-40 concentrations. Functional outcome was assessed according to the modified Rankin Scale (mRS) score at 3 months. Between 2016 and 2020, 120 patients were included. The plasma concentration of YKL-40 before EVT was statistically and independently associated with 3-month worse functional outcome (adjusted cOR, 1.59; 95% CI [1.05-2.44], p = 0.027) but not the two following samples 1-hour and 24-hour post-EVT. Accordingly, we found that excellent functional outcome was associated with a lower level of YKL-40 before and within 1 h after EVT (p = 0.005 and p = 0.003, respectively) but not when measured 24 h after EVT (p = 0.2). This study suggests that the astrocytic reaction to acute brain hypoxia, especially before recanalization, is associated with worse functional outcome. Such early biomarker of the astrocytic response in AIS may optimize individualized care in the future. http://www.clinicaltrials.gov. Unique identifier: NCT02900833.

Endothelial Glycocalyx Anomalies and Ocular Manifestations in Patients with Post-Acute COVID-19.

Objectives: To report ophthalmological and microvascular findings in patients with post-acute COVID-19. Methods: In this prospective, monocentric cohort study, we included patients with post-acute COVID-19 who presented with ophthalmological symptoms. All patients underwent indocyanine green angiography (ICGA), OCT, OCT-angiography, adaptive optics, and GlycoCheck assessments. Results: We included 44 patients, predominantly female (81.8%), with a mean age of 47.5 ± 11.5 years. Key ICGA findings revealed hyperreflective dots in 32 eyes (36.4%) and hemangioma-like lesions in 7 eyes (8.0%). Capillary non-perfusion in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was observed in 42 eyes (47.7%) and 21 eyes (23.9%), respectively. Eyes with hyperreflective dots exhibited a lower perfused boundary region (PBR), while those with superficial punctate keratitis showed a higher PBR (p = 0.02 and p = 0.002, respectively). Eyes with capillary non-perfusion in the SCP displayed lower capillary densities (CD4, CD5, and CD4-6; p = 0.001, 0.03, and 0.03, respectively), and eyes with non-perfusion in the DCP had lower CD4 (p = 0.03). A negative correlation was identified between capillary density and the wall-to-lumen ratio. Conclusions: Patients with post-acute COVID-19 demonstrate both retinal and choroidal vascular anomalies. Ocular pathology was associated with reduced capillary density. These injuries appear to stem more from microvascular disruptions than from persistent glycocalyx abnormalities.

Prevalence and Associated Risk Factors for Hypovitaminosis D in Patients Scheduled for Primary Total Knee Arthroplasty in Germany.

Several studies have reported a high prevalence of hypovitaminosis D in orthopedic patients. The purpose of this prospective observational study was to report on the prevalence of hypovitaminosis D in patients scheduled for elective primary total knee arthroplasty (TKA) and its associated risk factors. In this monocentric cohort study, 25(OH) vitamin D serum levels were measured in 687 consecutive patients undergoing primary total knee arthroplasty (TKA) over a period of twelve months. Vitamin D levels were classified into deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥30 ng/mL). The study assessed the association of vitamin D levels with demographic and clinical factors, including age, sex, BMI, smoking status, and season of measurement. Statistical analyses included chi-square tests, correlation analyses, and multiple linear regression to identify significant predictors of vitamin D levels. The cohort had a mean age of 67.70 ± 8.95 years and a mean BMI of 31.00 ± 5.71 kg/m2. Collectively, 33.9% of patients were vitamin D deficient, a further 32.9% were insufficient, and only 33.2% were sufficient. Vitamin D levels varied significantly with the season and were associated with obesity and smoking. Specifically, there was a small significant inverse correlation between BMI and vitamin D levels (r = -0.17, p < 0.01). Furthermore, regular nicotine abuse was linked to lower vitamin D levels (r = 0.14, p < 0.01). Multiple linear regression analysis reveals that age, BMI, nicotine abuse, and season were small significant predictors of preoperative vitamin D levels (R2 = 0.15, adjusted R2 = 0.12). A total of 121 (17.61%) patients reported routine vitamin D intake prior to surgery. Supplementing patients had a significantly higher mean serum vitamin D level and a significant reduction in the mean length of in-hospital stay (p < 0.01). The prevalence of vitamin D insufficiency and deficiency in patients undergoing elective primary TKA is alarmingly high. In ongoing efforts to optimize the efficacy and outcome of the TKA procedure, orthopedic surgeons should be advised to strongly implement the role of perioperative vitamin D levels in their routine practice.

Personalized nutrition after discharge for pancreatic surgery: A study protocol.

Background: Pancreatic cancer has an increasing incidence and prevalence trend. Its prognosis is negatively affected by poor/altered nutritional status. Therefore, nutritional interventions play a critical/pivotal role at any stage. Despite being included in the prehabilitation items of Enhanced Recovery After Surgery (ERAS) protocols for pancreatic surgery, nutritional recommendations concerning early post-discharge period are lacking. Aim: To assess the acceptability and feasibility of a personalized and standardized food plan for patients following pancreatic surgery. A secondary aim is to determine if adherence to a personalized food plan is linked to improved postoperative outcomes. Methods: A prospective monocentric cohort study will be performed, including 180 patients undergoing pancreatic surgery. Body composition, nutritional, muscular, and hydro-electrolyte status will be assessed with bio-impedance analysis (BIA). Patients will receive a personalized nutritional plan after discharge for the following 45 days. Summary: Detailed nutritional indications have been formulated with broad consensus for the pre-operative (prehabilitation) and postoperative period. No previous study has specifically formulated or validated a nutritional intervention focused on the early post-discharge period. The results of this study might contribute to paving the way for future research and to broaden nutritional recommendations within the ERAS protocol.