Multicenter Study Research Articles

Internal radiation dose estimates in organs of Wistar rats exposed to sprayed neutron-activated 31SiO2 microparticles: first results of international multicenter study.

Neutron-activated 31Si is an almost pure beta emitter and is one of the short-lived radionuclides, including beta-gamma emitter 56Mn, which were created in a form of residual radioactivity in the early period after the atomic bombing of Hiroshima and Nagasaki. The features of the biological effects of internal irradiation by these radionuclides are a subject of scientific discussions and research. The publication presents data on internal radiation doses in experimental Wistar rats that were exposed to sprayed neutron-activated microparticles of 31SiO2. Doses of internal radiation could be conditionally divided into three groups according to their values. It has been found that elevated values of internal radiation doses in rats' organs/tissues as a result of exposure to sprayed 31SiO2 microparticles with initial activity of 3.2 × 107Bq varied from 10 to 120mGy (eyes, lungs, skin, stomach, jejunum, large intestine). The moderate dose values were in the range from 1.9 to 3.7mGy (trachea, esophagus, ileum). The smallest doses were received by the kidney, testis, blood, cerebellum, heart, liver, cerebrum, bladder, spleen and thymus (from 0.11 to 0.94mGy). The obtained data are important for interpreting the results of ongoing and planned biological experiments with 31SiO2 microparticles-in comparison with the previously published data on features of biological effects caused by beta-gamma emitting 56MnO2 neutron-activated microparticles.

Real-World Evidence on Prognostic Value of MRD in Multiple Myeloma Using Flow Cytometry.

Minimal residual disease (MRD) is one of the most important prognostic factors in multiple myeloma (MM) and a valid surrogate for progression-free survival (PFS) and overall survival (OS). Recently, MRD negativity was approved as an early clinical endpoint for accelerated drug approval in MM. Nevertheless, there is limited evidence of MRD utility in real-world setting. In this retrospective multicenter study, we report outcomes of 331 newly diagnosed MM patients with MRD evaluation at Day+100 after autologous stem cell transplantation using flow cytometry with a median limit of detection of 0.001%. MRD negativity was reached in 47% of patients and was associated with significantly prolonged median PFS (49.2 months vs. 18.4 months; hazard ratios (HR) = 0.37; p < 0.001) and OS (not reached vs. 74.9 months; HR = 0.50; p = 0.007). Achieving MRD negativity was associated with PFS improvements regardless of age, International Staging System (ISS) stage, lactate dedydrogenase (LDH) level, or cytogenetic risk. Importantly, MRD positive patients benefited from lenalidomide maintenance versus no maintenance (18-months PFS: 81% vs. 46%; HR = 0.24; p = 0.002) while in MRD negative patients such benefit was not observed (p = 0.747). The outcomes of our real-world study recapitulate results from clinical trials including meta-analyses and support the idea that MRD positive patients profit more from lenalidomide maintenance than MRD negative ones.

Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study.

This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach. In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6weeks postpartum for 3 to 6months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6weeks, 6months and 12months postpartum and were divided, by their own choice, into users and non-users of the pessary. Initially 857 women were enrolled. After 6weeks 137 pessary users and 133 non-users, after 12months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6weeks postpartum. At 12months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6weeks to 12months postpartum, among pessary users compared to non-users. Pessary users had a significantly greater improvement in pelvic floor function from 6weeks to 12months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group. The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.

Radiomics based on MRI to predict recurrent L4-5 disc herniation after percutaneous endoscopic lumbar discectomy

BackgroundIn recent years, radiomics has been shown to be an effective tool for the diagnosis and prediction of diseases. Existing evidence suggests that imaging features play a key role in predicting the recurrence of lumbar disk herniation (rLDH). Thus, this study aimed to evaluate the risk of rLDH in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) using radiomics to facilitate the development of more rational surgical and perioperative management strategies.MethodThis was a retrospective case-control study involving 487 patients who underwent PELD at the L4/5 level. The rLDH and negative groups were matched using propensity score matching (PSM). A total of 1409 radiomic features were extracted from preoperative lumbar MRI images using intraclass correlation coefficient (ICC) analysis, t-test, and LASSO analysis. Afterward, 6 predictive models were constructed and evaluated using ROC curve analysis, AUC, specificity, sensitivity, confusion matrix, and 2 repeated 3-fold cross-validations. Lastly, the Shapley Additive Explanation (SHAP) analysis provided visual explanations for the models.ResultsFollowing screening and matching, 128 patients were included in both the recurrence and control groups. Moreover, 18 of the extracted radiomic features were selected for generating six models, which achieved an AUC of 0.551–0.859 for predicting rLDH. Among these models, SVM, RF, and XG Boost exhibited superior performances. Finally, cross-validation revealed that their accuracy was 0.674–0.791, 0.647–0.729, and 0.674–0.718.ConclusionRadiomics based on MRI can be used to predict the risk of rLDH, offering more comprehensive guidance for perioperative treatment by extracting imaging information that cannot be visualized with the naked eye. Meanwhile, the accuracy and generalizability of the model can be improved in the future by incorporating more data and conducting multicenter studies.

A systematic assessment of robustness in CNS safety pharmacology.

Irwin tests are key preclinical study elements for characterising drug-induced neurological side effects. This multicentre study aimed to assess the robustness of Irwin tests across multinational sites during three stages of protocol harmonisation. The projects were part of the Enhanced Quality in Preclinical Data framework, aiming to increase success rates in transition from preclinical testing to clinical application. Female and male NMRI mice were assigned to one of three groups (vehicle, MK-801 0.1and 0.3 mg kg-1). Irwin scores were assessed at baseline and multiple times following intraperitoneal injection of MK-801 using local protocols (Stage 1), shared protocols with harmonised environmental design (Stage 2) and fully harmonised Irwin scoring protocols (Stage 3). The analysis based on the four functional domains (motor, autonomic, sedation and excitation) revealed substantial data variability in Stages 1 and 2. Although there was still marked overall heterogeneity between sites in Stage 3 after complete harmonisation of the Irwin scoring scheme, heterogeneity was only moderate within functional domains. When comparing treatment groups versus vehicle, we found large effect sizes in the motor domain and subtle to moderate effects in the excitation-related and autonomic domains. The pronounced interlaboratory variability in Irwin datasets for the CNS-active compound MK-801 needs to be carefully considered when making decisions during drug development. While environmental and general study design had a minor impact, the study suggests that harmonisation of parameters and their scoring can limit variability and increase robustness.

Antimicrobial resistance genes acquisition among Dutch intercontinental travellers: a prospective multicentre study.

Antimicrobial resistance genes acquisition among Dutch intercontinental travellers: a prospective multicentre study.

Grip strength predicts postoperative ileus among patients undergoing abdominal minimally invasive surgery: a prospective multicenter cohort study.

Postoperative ileus (POI) is a prevalent complication following abdominal surgery, leading to extended hospitalization and escalated medical expenses. Few studies have investigated the association between grip strength and POI after abdominal minimally invasive surgery (MIS). A prospective multicenter cohort study was conducted using data from a prospectively registered database of patients undergoing abdominal MIS from March to December 2022. Grip strength levels were categorized and analyzed for their association with POI using multiple regression analysis with demographic adjustments. A smooth curve was generated to visualize the linear relationship. Out of 501 eligible patients, 393 were analyzed, with 67 (17.05%) developing POI. Grip strength was significantly and independently associated with POI, with each 1kg and 8.57kg (SD) increase in grip strength resulting in ORs of 0.94 and 0.61, respectively. Grip strength categories specific to sex and age were significantly associated with POI incidence, with individuals in the high grip strength group having a lower risk. Subgroup analysis showed grip strength as a significant predictor of POI risk, especially for males and older individuals. Higher grip strength was associated with a significantly lower risk of POI in males (OR = 0.29, 95% CI 0.09-0.90, p = 0.031) and older adults over 60years old (OR = 0.31, 95% CI 0.10-0.98, p = 0.046). Grip strength can predict the occurrence of POI in patients undergoing abdominal MIS. This can help identify high-risk individuals and improve perioperative management for better outcomes.

Assessing the prevalence, risk factors, and socio-demographic predictors of malaria among pregnant women in the Bono East Region of Ghana: a multicentre hospital-based mixed-method cross-sectional study

BackgroundMalaria is one of the world’s most lethal vector-borne diseases, causing significant health burdens in endemic countries. Several studies on the prevalence of malaria among pregnant women in Ghana have been conducted in various parts of the country, yielding evidence pointing to intra- and inter-regional variations. The current study assessed the prevalence, risk factors, and sociodemographic predictors of malaria among pregnant women in the Bono East Region of Ghana.MethodsThis multicentre hospital-based study employed a mixed-method cross-sectional design. A multistage sampling technique was used to select seven health facilities and recruited 1452 pregnant women who attended ANC at seven selected health facilities. Haematological examination, a structured closed-ended questionnaire, in-depth interviews (IDIs), and focus group discussions (FGDs) were used to obtain relevant data. Quantitative data were analysed with STATA 14 (StataCorp, College Station, USA). Likewise, the four-step thematic analysis was used to analyse qualitative data. A significant level was set at (p < 0.05) at a 95% confidence interval (CI).ResultsThe ages of the pregnant women at enrolment ranged between 17 and 40 years, with a mean (SD) of 28.8 ± 3.73 (95% C.I: 28.63–29.02). The overall prevalence of malaria infection among pregnant women was 10.8% (95% CI: 9.32–12.56). Presence of farm or domestic animals, living close to drainage tunnels, living near overgrown vegetation, not married, not having formal education, living in extended-type households, living in compound-type households, mud and thatch households, mud and iron sheet households, primigravidae, multiparity, first-time pregnant women, second-time, third-time, fourth-time, and fifth-time ANC visits, blood groups A, B, and AB were independent factors or predictors significantly associated with increased risk of malaria.ConclusionThe current study revealed an approximately 10.8% prevalence of malaria among pregnant women. The prevalence revealed, was, however, higher than the national prevalence of 8.6%. The high prevalence of malaria, associated risk factors, and sociodemographic and maternal predictors highlight the need to strengthen screening for malaria, administer treatments, monitor maternal and foetal health, and provide education and counselling.

Predictive model for identification of gangrenous or perforated appendicitis in adults: a multicenter retrospective study

BackgroundGangrene and perforation are severe complications of acute appendicitis, associated with a higher mortality rate compared to uncomplicated appendicitis. Accurate preoperative identification of Gangrenous or perforated appendicitis (GPA) is crucial for timely surgical intervention.MethodsThis retrospective multicenter study includes 796 patients who underwent appendectomy. Univariate and multivariate logistic regression analyses are used to develop a nomogram model for predicting GPA based on laboratory tests and computed tomography (CT) findings. The model is validated using an external dataset.ResultsSeven independent predictors were included in the nomogram: white blood cell count, lymphocyte count, D-dimer, serum glucose, albumin, maximum outer diameter of the appendix, and presence of appendiceal fecalith. The nomogram achieved good discrimination and calibration in both the training and testing sets. In the training set, the AUC was 0.806 (95%CI: 0.763–0.849), and the sensitivity and specificity were 82.1% and 66.9%, respectively. The Hosmer-Lemeshow test showed good calibration (P = 0.7378). In the testing set, the AUC was 0.799 (95%CI: 0.741–0.856), and the sensitivity and specificity were 70.5% and 75.3%, respectively. Decision curve analysis (DCA) confirmed the clinical utility of the nomogram.ConclusionThe laboratory test-CT nomogram model can effectively identify GPA patients, aiding in surgical decision-making and improving patient outcomes.

Optimal surgical timing for lung cancer following SARS-CoV-2 infection: a prospective multicenter cohort study

BackgroundWith the ongoing prevalence of the emerging variant and global vaccination efforts, the optimal surgical timing for patients with resectable lung cancer in the Omicron-dominant period requires further investigation.MethodsThis prospective multicenter study involved patients who underwent radical surgery for lung cancer between January 29, 2023 and March 31, 2023. Patients were categorized into four groups based on the interval between SARS-CoV-2 infection and surgery. The main outcomes evaluated were 30-day mortality and 30-day morbidity.ResultsA total of 2081 patients were enrolled in the study, of which 1837 patients (88.3%) had a confirmed SARS-CoV-2 diagnosis before surgery. Notably, no instances of 30-day mortality were observed in any patient. Patients without prior infection had a 30-day morbidity rate of 15.2%, with postoperative pneumonia occurring in 7.0% of cases. In contrast, patients diagnosed with SARS-CoV-2 before surgery had significantly higher rates of 30-day morbidity and postoperative pneumonia when surgery was performed within 4–5 weeks (adjusted odds ratio (aOR) (95% CI):2.18 (1.29–3.71) and 2.39 (1.21–4.79), respectively) or within 6–7 weeks (aOR (95% CI):2.07 (1.36–3.20) and 2.10 (1.20–3.85), respectively). Conversely, surgeries performed ≥ 8 weeks after SARS-CoV-2 diagnosis exhibited similar risks of 30-day morbidity and pneumonia compared to those in the no prior infection group (aOR (95% CI):1.13 (0.77–1.70) and 1.12 (0.67–1.99), respectively).ConclusionsThoracic surgery for lung cancer conducted 4–7 weeks after SARS-CoV-2 infection is still associated with an increased risk of 30-day morbidity in the Omicron-dominant period. Therefore, surgeons should carefully assess the individual risks and benefits to formulate an optimal surgical strategy for patients with lung cancer with a history of SARS-CoV-2 infection.

Deep learning model using planar whole-body bone scintigraphy for diagnosis of skull base invasion in patients with nasopharyngeal carcinoma

PurposeThis study assesses the reliability of deep learning models based on planar whole-body bone scintigraphy for diagnosing Skull base invasion (SBI) in nasopharyngeal carcinoma (NPC) patients.MethodsIn this multicenter study, a deep learning model was developed using data from one center with a 7:3 allocation to training and internal test sets, to diagnose SBI in patients newly diagnosed with NPC using planar whole-body bone scintigraphy. Patients were diagnosed based on a composite reference standard incorporating radiologic and follow-up data. Ten different convolutional neural network (CNN) models were applied to both whole-image and partial-image input modes to determine the optimal model for each analysis. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration, decision curve analysis (DCA), and compared with expert assessments by two nuclear medicine physicians.ResultsThe best-performing model using partial-body input achieved AUCs of 0.80 (95% CI: 0.73, 0.86) in the internal test set, 0.84 (95% CI: 0.77, 0.91) in the external cohort, and 0.78 (95% CI: 0.73, 0.83) in the treatment test cohort. Calibration curves and DCA confirmed the models’ excellent discrimination, calibration, and potential clinical utility across internal and external datasets. The AUCs of both nuclear medicine physicians were lower than those of the best-performing deep learning model in external test set (AUC: 0.75 vs. 0.77 vs. 0.84).ConclusionDeep learning models utilizing partial-body input from planar whole-body bone scintigraphy demonstrate high discriminatory power for diagnosing SBI in NPC patients, surpassing experienced nuclear medicine physicians.

Role of bridging RT in relapsed/refractory diffuse large B-cell lymphoma undergoing CAR-T therapy: a multicenter study.

The optimization of bridging regimen before chimeric antigen receptor (CAR)-T cell therapy in diffuse large B-cell lymphoma (DLBCL) may impact CAR-T efficacy and outcome. This retrospective study evaluates CAR-T outcome after bridging with radiotherapy (RT) and other bridging strategies. Among 148 patients with relapsed/refractory DLBCL who underwent leukapheresis for CAR-T manufacturing, 31 received RT-bridging, 84 chemotherapy (CT), 33 no-bridging or steroid-only. CAR-T cell were infused in 96.8% of RT-group, 89.2% of CT-group and 78.8% of no-bridge-group (p = 0.079). Response to bridging was generally poor, but patients receiving RT had a significant reduction in LDH levels between pre- and post-bridging (p = 0.05). The one-year PFS was 51.2% in the RT-group, 28.2% in the CT-group, and 47.6% in the no-bridge-group (p = 0.044, CT-bridging vs RT-bridging); 1-year OS was 86.7% in the RT-group, 52.7% in the CT-group and 69% in the no-bridge-group (p = 0.025, CT-bridging vs RT-bridging). We observed a higher incidence of ICANS in patients who received CT than in others (20.0% CT-group, 3.3% RT-group, 7.7% no-bridge group; p = 0.05). In conclusion, RT-bridging is associated with lower drop-out rate and CAR-T toxicity, and it might be preferred to other bridging strategies for patients with localized disease or for those with one prevalent symptomatic site.

The epidemiology of gram-negative bacteremia in Lebanon: a study in four hospitals

IntroductionGram-negative bacteremia is a life-threatening infection with high morbidity and mortality. Its incidence is rising worldwide, and treatment has become more challenging due to emerging bacterial resistance. Little data is available on the burden and outcome of such infections in Lebanon.MethodsWe conducted this retrospective study in four Lebanese hospitals. Data on medical conditions and demographics of 2400 patients diagnosed with a bloodstream infection based on a positive blood culture were collected between January 2014 and December 2020.ResultsMost bacteremias were caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, with the more resistant organisms being hospital-acquired. Third-generation cephalosporin and quinolone resistance was steady throughout the study, but carbapenem resistance increased. Mortality with such infections is high, but carbapenem resistance or infection with Pseudomonas or Acinetobacter species were significant risk factors for poor outcomes.ConclusionThis is the first multi-center study from Lebanon on gram-negative bacteremia, resistance patterns, and factors associated with a poor outcome. More surveillance is needed to provide data to guide empirical treatment for bacteremia in Lebanon.

Analysis of the outcomes of postdiverticulitis investigations: a multicentre cohort study including 1,120 patients.

The aim of this study was to assess the yield of the endoscopic investigations performed following the resolution of acute diverticulitis. A retrospective multicentre study included patients with multislice computed tomography (MSCT)-proven diverticulitis, in four NHS hospitals, between January 2016 and April 2023. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the nondiseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group. A total of 1,120 patients were included in the study, out of which 604 were females, with a median age of 61 years; 731 patients (65%) had uncomplicated diverticulitis (Hinchey 1A) while 389 (35%) had complicated diverticulitis (Hinchey 1B-4). Following the acute episode, 757 (74%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated diverticulitis was 0.14%. In the complicated diverticulitis group, the incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4% and 5.4%, respectively. Out of the 102 patients who underwent emergency colonic resection for suspected perforated diverticulitis, 18 (17.6%) had histological evidence of colonic malignancy. Endoscopic investigations following uncomplicated diverticulitis have a low yield for sinister colonic pathology. Colonoscopy should be planned following complicated diverticulitis and in patients with uncomplicated diverticulitis with suspicious radiological finding on index imaging or in patients with ongoing clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.

Adapted Low-FODMAP Diet in IBS Patients with and without Fibromyalgia: Long-Term Adherence and Outcomes

Background/Objectives: A low-FODMAPs Diet (LFD) is considered a “second line” dietary strategy for irritable bowel syndrome (IBS) but, after a period of strict restriction of all FODMAP foods, it has to be adapted and tailored to each patient (AdLFD). Fibromyalgia often coexists with IBS in up to 65% of cases. Our aims were to evaluate if comorbid fibromyalgia influenced the long-term clinical outcomes and adherence to an AdLFD in IBS patients. Methods: IBS patients with or without fibromyalgia who had started an AdLFD were enrolled. Patients had been evaluated before starting the LFD (T0). After a mean follow-up of 62.5 ± 22.7 months (T1), they were re-evaluated using questionnaires on disease severity, bowel habits, psychological status, and adherence to AdLFD. Results: In total, 51 IBS patients entered the study. Nineteen of them had comorbid fibromyalgia. Thirty patients reported a reduction in symptom severity at T1 in comparison with T0. Despite some slight differences in single IBS Symptom Severity Score items, comorbid fibromyalgia did not influence the IBS-SSS total score at T1. Patients with comorbid fibromyalgia showed a higher Hospital Anxiety and Depression Scale (HADS) score at baseline. A total of 44 patients showed good long-term adherence to the AdLFD. All patients improved their HADS score and had long-term adherence to the AdLFD. Conclusions: Comorbid fibromyalgia showed only a slight influence on long-term outcomes of an AdLFD on IBS symptoms, without affecting the relief of global symptoms. No influence on long-term adherence to AdLFD was detected. Hence, this approach can be taken into account in fibromyalgia patients for a nonpharmacological management of IBS symptoms. However, multicentric studies on larger samples would be welcome in the future.

Efficacy of abrocitinib and baricitinib on 'difficult-to-treat areas' in patients with atopic dermatitis: a multicentre study.

Efficacy of abrocitinib and baricitinib on 'difficult-to-treat areas' in patients with atopic dermatitis: a multicentre study.

Predictive value of radiomics for intracranial aneurysm rupture: a systematic review and meta-analysis

ObjectiveTo systematically review the literature on radiomics for predicting intracranial aneurysm rupture and conduct a meta-analysis to obtain evidence confirming the value of radiomics in this prediction.MethodsA systematic literature search was conducted in PubMed, Web of Science, Embase, and The Cochrane Library databases up to March 2024. The QUADAS-2 tool was used to assess study quality. Stata 15.0 and Review Manager 5.4.1 were used for statistical analysis. Outcomes included combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (−LR), diagnostic odds ratio (DOR), and their 95% confidence intervals (CI), as well as pre-test and post-test probabilities. The SROC curve was plotted, and the area under the curve (AUC) was calculated. Publication bias and small-study effects were assessed using the Deeks’ funnel plot.ResultsThe 9 included studies reported 4,284 patients, with 1,411 patients with intracranial aneurysm rupture (prevalence 32.9%). The overall performance of radiomics for predicting intracranial aneurysm rupture showed a combined Sen of 0.78 (95% CI: 0.74–0.82), Spe of 0.74 (95% CI: 0.70–0.78), +LR of 3.0 (95% CI: 2.7–3.4), −LR of 0.29 (95% CI: 0.25–0.35), DOR of 10 (95% CI: 9–12), and AUC of 0.83 (95% CI: 0.79–0.86). Significant heterogeneity was observed in both Sen (I2 = 90.93, 95% CI: 89.00–92.87%) and Spe (I2 = 94.28, 95% CI: 93.21–95.34%).ConclusionRadiomics can improve the diagnostic efficacy of intracranial aneurysm rupture. More large-sample, prospective, multicenter clinical studies are needed to further evaluate its predictive value.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/.

Upper Airway Stimulation for Children and Adolescents with Down Syndrome: Long-Term Follow-Up.

Hypoglossal nerve stimulation (HGNS) is safe and effective for patients with Down syndrome (DS) and severe persistent obstructive sleep apnea (OSA). Long-term outcomes for this patient population have not been evaluated. A prospective single-group multicenter cohort study with 1-year follow-up was conducted between 2015 and 2021 among 42 adolescent patients with DS and severe persistent OSA. Here, we evaluate long-term outcomes in this patient cohort. Patients were evaluated with polysomnogram (PSG) at three timepoints: pre-implantation (timepoint 1), 1-year post-implantation (timepoint 2), and long-term follow-up (timepoint 3). Long-term follow-up data were available for 33 of 42 patients. Mean (SD) of timepoint 3 was 4.0 (1.9) years after implantation. Using a therapy response definition of a 50% decrease in Apnea Hypopnea INdez (AHI) from timepoint 1, the response rate was 69.7% (23/33) at timepoint 2 and 87.9% (29/33) at timepoint 3. From timepoint 1, there was a mean (SD) decrease in AHI of 12.7 (13.4) events/h at timepoint 2 and 15.7 (13.1) events/h at timepoint 3. The mean percentage change in AHI between timepoints 1 and 2 was -51.1% (95% CI: -32.8% to -69.3%) and between timepoints 1 and 3 was -59.6% (95% CI: -42.0% to -77.3%). Patients with DS and severe persistent OSA who undergo HGNS implantation may continue to experience improvement in PSG parameters at long-term follow-up. Future studies are needed to assess additional long-term outcomes in this patient population, including neurocognition and quality of life. 3 Laryngoscope, 2024.

Extracorporeal membrane oxygenation for tuberculosis-related acute respiratory distress syndrome: An international multicentre retrospective cohort study

ObjectiveTo report the outcomes of patients with severe tuberculosis (TB)-related acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO), including predictors of 90-day mortality and associated complications.MethodsAn international multicenter retrospective study was conducted in 20 ECMO centers across 13 countries between 2002 and 2022.ResultsWe collected demographic data, clinical details, ECMO-related complications, and 90-day survival status for 79 patients (median APACHE II score of 20 [25th to 75th percentile, 16 to 28], median age 39 [28 to 48] years, PaO2/FiO2 ratio of 69 [55 to 82] mmHg before ECMO) who met the inclusion criteria. Thoracic computed tomography showed that 61 patients (77%) had cavitary TB, while 18 patients (23%) had miliary TB. ECMO-related complications included major bleeding (23%), ventilator-associated pneumonia (41%), and bloodstream infections (32%). The overall 90-day survival rate was 51%, with a median ECMO duration of 20 days [10 to 34] and a median ICU stay of 42 days [24 to 65]. Among patients on VV ECMO, those with miliary TB had a higher 90-day survival rate than those with cavitary TB (90-day survival rates of 81% vs. 46%, respectively; log-rank P = 0.02). Multivariable analyses identified older age, drug-resistant TB, and pre-ECMO SOFA scores as independent predictors of 90-day mortality.ConclusionThe use of ECMO for TB-related ARDS appears to be justifiable. Patients with miliary TB have a much better prognosis compared to those with cavitary TB on VV ECMO.

Factors and prediction model associated with resumption of social outings in stroke survivors 6 months after onset: a multicenter prospective study

ABSTRACT Objectives To identify factors associated with the resumption of social outings 6 months after stroke onset and develop a simple clinically practical prediction model. Materials and methods Participants were recruited from first-ever stroke survivors admitted to three rehabilitation wards, and resumption of social outings 6 months after stroke onset was assessed using the Japanese version of the Frenchay Activities Index. The association of physical and cognitive functions with activities of daily living at admission to the rehabilitation ward and resumption of social outings 6 months after stroke onset was examined using logistic regression and decision trees. Results Notably, 63.2% of the 57 stroke survivors who participated in this study had lower Frenchay Activities Index scores for social outings 6 months after stroke onset than before. Logistic regression analysis revealed that attention deficit and grooming on the Functional Independence Measure (FIMTM) were significantly associated with decreased social outing scores 6 months after stroke onset. A decision tree model was created to predict the resumption of social outings using the presence or absence of attention disorders and FIMTM grooming score (>2 or ≤ 2). Conclusions The results of this study suggest that attention deficit and beyond a certain level of independence in grooming (FIMTM >2) at admission to the rehabilitation ward are associated with recovery to the pre-stroke level of social outings 6 months after stroke onset. The decision tree created in this study holds promise as a simple model to predict the resumption of social outings among stroke survivors.