Poor Clinical Performance Research Articles

Textbook outcome for evaluating the surgical quality of gastrectomy.

The textbook outcome (TO) is an indicator to evaluate surgical quality based on clinical, pathological, and surgical outcomes. To analyze the frequency, factors associated with achievement, and the prognostic impact of TO in gastric cancer treatment. Retrospective analysis of patients with gastric cancer operated with curative intent from 2009 to 2022 in a reference Cancer Center. During the period, 681 patients were included and 444 (65.2%) achieved TO. Major surgical complications were the most common not-achieved outcome (16.4%) and intraoperative complications were the most achieved (96.2%). Most of the patients have failed in only 1 outcome (n = 105, 44.3%). Failure to achieve TO was associated with Charlson-Deyo comorbidity index ≥1 (46.4% vs 34.7%, p = 0.003), American Society of Anesthesiologists classification III/IV (40.1% vs 24.1%, p < 0.001), higher mean neutrophil-to-lymphocyte ratio (2.7 vs 3.3, p = 0.024), D1 lymphadenectomy (26.2% vs 15.8%, p = 0.001), and elective postoperative Intensive Care Unit admission (46.4% vs 38.5%, p = 0.046). Disease-free and overall survival (both p < 0.001) were higher in the TO group even after the exclusion of cases with surgical mortality (p = 0.013 and p = 0.024, respectively). TO was achieved in most of the cases and its failure was associated with poor clinical performance and it impacts both early surgical results as well as long-term survival.

Enhancing the Biological Performance of Titanium Alloy through In Situ Modulation of the Surface Nanostructure: Near-Infrared-Responsive Antibacterial Function and Osteoinductivity.

The poor clinical performance of titanium and its alloy implants is mainly attributed to their lack of antibacterial ability and poor osseointegration. The key and challenge lie in how to enhance their osteoinductivity while imparting antibacterial capability. In this study, a titanium oxide metasurface with light-responsive behavior was constructed on the surface of titanium alloy using an alkaline-acid bidirectional hydrothermal method. The effects of the acid type, acid concentration, hydrothermal time, hydrothermal temperature, and subsequent heat treatments on the optical behavior of the metasurface were systematically investigated with a focus on exploring the influence of the metasurface and photodynamic reaction on the osteogenic activity of osteoblasts. Results show that the type of acid and heat treatment significantly affect the light absorption of the titanium alloy surface, with HCl and post-heat-treatment favoring redshift in the light absorption. Under 808 nm near-infrared (NIR) irradiation for 10 min, in vitro antibacterial experiments demonstrate that the antibacterial rate of the metasurface titanium alloy against Staphylococcus aureus and Escherichia coli were 96.87% and 99.27%, respectively. In vitro cell experiments demonstrate that the nanostructure facilitates cell adhesion, proliferation, differentiation, and expression of osteogenic-related genes. Surprisingly, the nanostructure promoted the expression of relevant osteogenic genes of MC3T3-E1 under 808 nm NIR irradiation. This study provides a method for the surface modification of titanium alloy implants.

Three-Dimensional Structure of Novel Liver Cancer Biomarker Liver Cancer-Specific Serine Protease Inhibitor Kazal (LC-SPIK) and Its Performance in Clinical Diagnosis of Hepatocellular Carcinoma (HCC).

LC-SPIK is a liver cancer-specific isoform of Serine Protease Inhibitor Kazal and has been proposed as a new biomarker for the detection of HCC given its unique 3D structure, which differs from normal pancreatic SPIK. An ELISA technology based on its unique structure was developed to use LC-SPIK as an effective biomarker for the clinical diagnosis of HCC. AFP, the most widely used biomarker for HCC surveillance currently, suffers from poor clinical performance, especially in the detection of early-stage HCC. In one case-control study, which included 164 HCC patients and 324 controls, LC-SPIK had an AUC of 0.87 compared to only 0.70 for AFP in distinguishing HCC from liver disease controls (cirrhosis, HBV/HCV). LC-SPIK also performed significantly better than AFP for the 81 patients with early-stage HCC (BCLC stage 0 and A), with an AUC of 0.85 compared to only 0.61 for AFP. Cirrhosis is the major risk factor for HCC; about 80% of patients with newly diagnosed HCC have preexisting cirrhosis. LC-SPIK's clinical performance was also studied in HCC patients with viral and non-viral cirrhosis, including cirrhosis caused by metabolic dysfunction-associated steatotic liver disease (MASLD) and alcoholic liver disease (ALD). In a total of 163 viral cirrhosis patients with 93 HCC patients (50 early-stage), LC-SPIK had an AUC of 0.85, while AFP had an AUC of 0.70. For patients with early-stage HCC, LC-SPIK had a similar AUC of 0.83, while AFP had an AUC of only 0.60. For 120 patients with nonviral cirrhosis, including 62 HCC (23 early-stage) patients, LC-SPIK had an AUC of 0.84, while AFP had an AUC of only 0.72. For the 23 patients with early-stage HCC, LC-SPIK had a similar AUC of 0.83, while the AUC for AFP decreased to 0.65. All these results suggest that LC-SPIK exhibits significantly better performance in the detection of HCC than AFP in all etiologies of liver diseases. In addition, LC-SPIK accurately detected the presence of HCC in 71-91% of HCC patients with false-negative AFP test results in viral-associated HCC and non-viral-associated HCC.

FOXM1/KIF20A axis promotes clear cell renal cell carcinoma progression via regulating EMT signaling and affects immunotherapy response

BackgroundThe correlation between FOXM1 and KIF20A has not been revealed in clear cell renal cell carcinoma (ccRCC). MethodsPublic data was downloaded from The Cancer Genome Atlas (TCGA) database. R software was utilized for the execution of bioinformatic analysis. The expression levels of specific molecules (mRNA and protein) were detected using real-time quantitative PCR (qRT-PCR) and Western blot assays. The capacity of cell growth was assessed by employing CCK8 and colony formation assay. Cell invasion and migration ability were assessed using transwell assay. ResultsIn our study, we illustrated the association between FOXM1 and KIF20A. Our results indicated that both FOXM1 and KIF20A were associated with poor prognosis and clinical performance. The malignant characteristics of ccRCC cells can be significantly suppressed by inhibiting FOXM1 and KIF20A, as demonstrated by in vitro experiments. Moreover, we found that FOXM1 can upregulate KIF20A. Then, EMT signaling was identified as the underlying pathway FOXM1 and KIF20A are involved. WB results indicated that FOXM1/KIF20A axis can activate EMT signaling. Moreover, we noticed that FOXM1 and KIF20A can affect the immunotherapy response and immune microenvironment of ccRCC patients. ConclusionsOur results identified the role of the FOXM1/KIF20A axis in ccRCC progression and immunotherapy, making it the underlying target for ccRCC.

Individual regional associations between Aβ-, tau- and neurodegeneration (ATN) with microglial activation in patients with primary and secondary tauopathies

β-amyloid (Aβ) and tau aggregation as well as neuronal injury and atrophy (ATN) are the major hallmarks of Alzheimer’s disease (AD), and biomarkers for these hallmarks have been linked to neuroinflammation. However, the detailed regional associations of these biomarkers with microglial activation in individual patients remain to be elucidated. We investigated a cohort of 55 patients with AD and primary tauopathies and 10 healthy controls that underwent TSPO-, Aβ-, tau-, and perfusion-surrogate-PET, as well as structural MRI. Z-score deviations for 246 brain regions were calculated and biomarker contributions of Aβ (A), tau (T), perfusion (N1), and gray matter atrophy (N2) to microglial activation (TSPO, I) were calculated for each individual subject. Individual ATN-related microglial activation was correlated with clinical performance and CSF soluble TREM2 (sTREM2) concentrations. In typical and atypical AD, regional tau was stronger and more frequently associated with microglial activation when compared to regional Aβ (AD: βT = 0.412 ± 0.196 vs. βA = 0.142 ± 0.123, p < 0.001; AD-CBS: βT = 0.385 ± 0.176 vs. βA = 0.131 ± 0.186, p = 0.031). The strong association between regional tau and microglia reproduced well in primary tauopathies (βT = 0.418 ± 0.154). Stronger individual associations between tau and microglial activation were associated with poorer clinical performance. In patients with 4RT, sTREM2 levels showed a positive association with tau-related microglial activation. Tau pathology has strong regional associations with microglial activation in primary and secondary tauopathies. Tau and Aβ related microglial response indices may serve as a two-dimensional in vivo assessment of neuroinflammation in neurodegenerative diseases.

Assessment of alpha-fetoprotein clinical performances in the diagnosis of the hepatocellular carcinoma at Sominé DOLO hospital of Mopti

Serum AFP as a poor clinical performance values especially when it comes to deal with the early and AFP-negative diagnostic of HCC. The aim of this work was to assess the contribution of AFP in the diagnosis of HCC. : A total of 95 subjects was enrolled a prospective observational study by consecutive enrolment and divided in two groups. The first group was made up with subjects in whom the diagnosis of HCC had been retained while the second was the control group which was free of HCC. AFP levels were performed by electrochemiluminescence immunoassay on the cobas e411. Data were captured in Excel and analyzed by Ri386 version 4.1.2 binary for macOS 10.13. The Log of median of AFP in HCC subjects was significantly greater than in non HCC subjects 6.91 ng/mL versus 1.43 ng/mL, Wilcoxon &amp;#60; 0.001. At the cut-off of 200 ng/mL, the clinical performances showed an acceptable sensitivity 97.1% CI 95% [93.7 – 100] but a poor specificity 73,8% CI 95% [64.9 – 82.6] and out of the 34 cases of HCC, one case (2.9%) was AFP-negative HCC. our data show an acceptable sensitivity but a weak specificity of AFP as a biomarker for HCC at cut-off 200 ng/mL. This suggests that AFP should be used with other biomarkers mainly for the early and AFP-negative HCC diagnosis.

CORRELATION OF CLINICAL FEATURES TO DNA METHYLATION-BASED PROGNOSTIC SUBTYPES IN CHORODOMA PATIENTS

Abstract Chordomas are rare aggressive primary bone cancers affecting the skull-base and spine. We have previously identified robust DNA methylation-based prognostic groups, immune infiltrated and cellular subtypes. Here we further characterize these prognostic subtypes with an extensively annotated clinical database to identify factors that correlate with subtype, and investigate methylation patterns between existing clinical scoring systems groups. METHODS: 68 patients from a multi-institutional 20-year series were identified. These patients’ tumor samples had undergone whole genome DNA methylation profiling on the Illumina EPIC array. Baseline clinical features, including clinical features, treatment details, outcomes parameters and imaging were analyzed using chi-squared or kruskal-wallis test, and differential methylation patterns were examined between clinically distinct groups based on the Sekhar scoring system. RESULTS: Of all the variables tested, age of onset (p-value 0.012), location (skull base vs spine vs sacral: p-value 0.0365) and histological subtype (classical vs chondroid: p-value 0.0132) were the only significant predictors of subgroup placement; older age, spinal location, and classical histological typing were predictors of immune infiltrated chordoma subtype, which has a poorer clinical performance. As expected, death from chordoma was significantly different between subtypes (p-value 0.0056). Patients survival stratified based on Shakur grading, and clustered together on unsupervised hierarchical analysis on methylation. CONCLUSION: Overall, there are limited variables that correlate with methylation subtype, meaning that the epigenetic chordoma subtypes cannot be reliably identified using clinical or imaging features in the absence of molecular data. However clinical grading systems remain a valuable tool for prognostication, and display distinct methylation patterns.

Hyper-Graph Attention Based Federated Learning Method For Mental Health Detection.

Internet-Delivered Psychological Treatment (IDPT) has become necessary in the medical field. Deep neural networks (DNNs) require large, diverse patient populations to train models that achieve clinician-level performance. However, DNN models trained on limited datasets have poor clinical performance when used in a new location with different data. Thus, increasing the availability of diverse as well as distinct training data is vital. This study proposes a structural hypergraph as well as an emotional lexicon for word representation. An embedding model based on federated learning was developed for mental health symptom detection. The model treats text data as a collection of consecutive words. The model then learns a low-dimensional continuous vector while maintaining contextual linkage. The generated models with attention-based mechanisms as well as federated learning are then tested experimentally. Our strategy is suitable for vocabulary diversification, grammatical word representation, as well as dynamic lexicon analysis. The goal is to create semantic word representations using an attention network model. Later, clinical processes are used to mark the text by embedding it. Experimental results show the encoding of emotional words using the structural hypergraph. The 0.86 ROC was achieved using the bidirectional LSTM architecture with an attention mechanism.

Evaluation of Delafloxacin against a Burkholderia pseudomallei Efflux Mutant Panel.

ABSTRACTIn vitro activities of delafloxacin and ciprofloxacin were evaluated against Burkholderia pseudomallei mutants expressing or lacking defined resistance-nodulation-cell division (RND) efflux pumps using CLSI methodology at pHs of 5.8 and 7.2. Delafloxacin MIC values were as much as 8-fold lower at pH 5.8 than those at pH 7.2, while ciprofloxacin MICs increased as much as 8-fold. The data from this study suggest that compared to ciprofloxacin, delafloxacin may have improved efflux avoidance, notably at acidic pH. In contrast to ciprofloxacin, delafloxacin may thus retain its therapeutic potential, even in BpeEF-OprC efflux-pump-expressing B. pseudomallei strains that compromise the use of fluoroquinolones, such as ciprofloxacin.IMPORTANCE Resistance-nodulation-cell division (RND) efflux pumps play a major role in intrinsic and acquired antibiotic resistance in Burkholderia pseudomallei, and these pumps are its only known multidrug resistance determinants. Fluoroquinolones have performed poorly in clinical settings and are currently not recommended for treatment of B. pseudomallei infections. While the reasons for the poor clinical performance of this pathogen remain unclear, efflux may be partially responsible since fluoroquinolones like ciprofloxacin are prone to efflux by RND pumps, notably BpeEF-OprC. In vitro efficacy testing using a panel of efflux-proficient and efflux-deficient strains allows identification of fluoroquinolones that compared to ciprofloxacin are less prone to efflux.

Clinical Performance of a Lateral Flow SARS-CoV-2 Total Antibody Assay.

BackgroundSerological assays for SARS-CoV-2 are important tools for diagnosis in patients with negative RT-PCR testing, pediatric patients with multisystem inflammatory syndrome, and serosurveillance studies. However, lateral flow-based serological assays have previously demonstrated poor analytical and clinical performance, limiting their utility.MethodsWe assessed the ADEXUSDx COVID-19 lateral flow assay for agreement with diagnostic RT-PCR testing using 120 specimens from RT-PCR–positive patients, 77 specimens from symptomatic RT-PCR–negative patients, and 47 specimens obtained prepandemic. Specimens collected <14 days from symptom onset in RT-PCR–positive patients were compared relative to the Abbott SARS-CoV-2 IgG assay.ResultsThe ADEXUSDx COVID-19 Test yielded an overall positive percent agreement (PPA) of 92.5% (95%CI 85.8 to 96.3) and negative percent agreement of 99.2% (95% CI 94.9–100.0) relative to RT-PCR and in prepandemic specimens. Relative to days from symptom onset, the PPA after 13 days was 100% (95% CI 94.2–100); from 7 to 13 days, 89.7 (95% CI 71.5–97.2); and from 0 to 7 days, 53.8 (95% CI 26.1–79.6). The overall agreement between the Abbott and ADEXUSDx assays was 80.9%. Twenty-five specimens were positive by both assays, 9 specimens were negative by both assays, and 8 specimens were positive by only the ADEXUSDx assay.ConclusionsWe demonstrate high PPA and negative percent agreement of the ADEXUSDx COVID-19 assay and diagnostic testing by RT-PCR, with PPA approximately 90% by 7 days following symptom onset. The use of waived testing for antibodies to SARS-CoV-2 with high sensitivity and specificity provide a further tool for combatting the COVID-19 pandemic.

ASSOCIATION OF HEALTH-RELATED QUALITY OF LIFE AND DEPRESSION AMONG UNDERGRADUATE NURSING STUDENTS

Depression is greatly affect the health related quality of life inundergraduate nursing students and the prevalence of depression is extended day by day, as thenursing students have to face variety of problems and issue likehealth related issue, poor qualityof life, difficulty in focusing, feeling embraced and death anxiety because of their poor academicsystem and clinical performance. During the clinical practice the nursing students have to takedecision that how to give proper care and attention to patient, so the lack of confidence andanxiety result into stress and depression. The educational institutes should make better strategiesto improve the poor academic and clinical practice and then automatically depression decreasesaswell asthe healthrelatedissuesresolve. Objective: The purpose of the study is to determine the association of health related quality oflifeand depression among undergraduate nursing students. Methods: This was observational study conducted on both female and male students at ShalimarTeaching Hospital, Lahore. A sample of 187 students was selected using non probabilitypurposive sampling. Students were selected by using predefined inclusion and exclusion criteria.After taking permission letter from the Hospital each student fill the Beck Depression Inventoryand SF (36) questionnaire. Data was analyzed by using SPSS version-21.0. Mean and standarddeviation were calculated for quantitative variables and data was presented in the form offrequency and percentage. Results: The result is evaluated by applying chi-square test which shows that there is strongassociation between physical health and depression because the (p&lt;0.05) and p value is 0.00,there is no association between mental health and depression among undergraduate nursingstudentsbecause the (p&gt;0.05) and in thegiven result the p value is0.13. Conclusion: The study concluded that their association of health related quality of life anddepression among undergraduate nursing student from the two variables of QoL, the physicalhealthisstronglyaffectedwithdepressionbutthementalhealthisnotaffectedwithdepression

ASSOCIATION OF HEALTH-RELATED QUALITY OF LIFE AND DEPRESSION AMONG UNDERGRADUATE NURSING STUDENTS

Depression is greatly affect the health related quality of life inundergraduate nursing students and the prevalence of depression is extended day by day, as thenursing students have to face variety of problems and issue likehealth related issue, poor qualityof life, difficulty in focusing, feeling embraced and death anxiety because of their poor academicsystem and clinical performance. During the clinical practice the nursing students have to takedecision that how to give proper care and attention to patient, so the lack of confidence andanxiety result into stress and depression. The educational institutes should make better strategiesto improve the poor academic and clinical practice and then automatically depression decreasesaswell asthe healthrelatedissuesresolve. Objective: The purpose of the study is to determine the association of health related quality oflifeand depression among undergraduate nursing students. Methods: This was observational study conducted on both female and male students at ShalimarTeaching Hospital, Lahore. A sample of 187 students was selected using non probabilitypurposive sampling. Students were selected by using predefined inclusion and exclusion criteria.After taking permission letter from the Hospital each student fill the Beck Depression Inventoryand SF (36) questionnaire. Data was analyzed by using SPSS version-21.0. Mean and standarddeviation were calculated for quantitative variables and data was presented in the form offrequency and percentage. Results: The result is evaluated by applying chi-square test which shows that there is strongassociation between physical health and depression because the (p&lt;0.05) and p value is 0.00,there is no association between mental health and depression among undergraduate nursingstudentsbecause the (p&gt;0.05) and in thegiven result the p value is0.13. Conclusion: The study concluded that their association of health related quality of life anddepression among undergraduate nursing student from the two variables of QoL, the physicalhealthisstronglyaffectedwithdepressionbutthementalhealthisnotaffectedwithdepression

Pattern of Follow-up among Patients Attending the Department of Psychiatry: A Prospective Study

Introduction: Adherence to drug regimen is a very important factor for improvement. Dropping out may affect the treatment outcome and also is as indication of poor clinical performance. Patient who left the treatment in between can lead to a deterioration in clinical condition, resulting in the need for more intensive therapy that significantly incurs higher social and economic loss. Therefore, improving medication compliance potentially reduces morbidity and suffering of patients and their families, and the cost of rehospitalisation. Aim: To study the pattern of follow-up among patients of various psychiatric disorders and also to study the therapist factors contributing in adherence to treatment and the sociodemographic profile of patients who drop out from study. Materials and Methods: This was a prospective analytical study conducted in the Department of Psychiatry, GGSMCH Faridkot, Punjab, India over one year. A total of 500 psychiatric patients were selected by the convenient non probability sampling technique in the age group between 18-45 years who met the inclusion criteria. These patients were evaluated for illness related variables using psychiatric proforma and Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS) was applied. After this all the patients were assessed for a period of one year, the factors affecting the pattern of follow-up, relating to the treatment and its side effects, disease progression as well as therapist-related factors using a semi-structured questionnaire. The data, thus generated, was subjected to appropriate statistical analysis. Results: In the socio-demographic profile among drop out education status, occupation, and duration of illness, statistically significant difference was found among different disorders (p&lt;0.05). CPOSS scale was applied among three follow-up groups in which highest mean was 53.03±10.05 in regular follow-up group followed by 49.49±9.06 in intermittent and 44.80±10.70 in drop out follow-up group. Total CPOSS mean was 49.19±10.66. Overall results were statistically significant (p=0.0001). Also in the medication, disease and physician related factors among followup groups, statistically significant results were found (p&lt;0.05). Conclusion: The study showed that various socio-demographic factors, medication, disease and physician related factors affect the follow-up patterns. So, it is very important to diagnose all these factors to improve adherence among various psychiatric patients.

Redefining Remission Induction Chemotherapy Ineligibility by Early Mortality in De Novo Acute Myeloid Leukemia.

The therapeutic strategies for acute myeloid leukemia (AML) patients ineligible for remission induction chemotherapy have been improving in the past decade. Therefore, it is important to define ineligibility for remission induction chemotherapy. We retrospectively assessed 153 consecutive adult de novo AML patients undergoing remission induction chemotherapy and defined early mortality as death within the first 60 days of treatment. The 153 patients were stratified into the early mortality group (n = 29) and the non-early mortality group (n = 124). We identified potential factors to which early mortality could be attributed, investigated the cumulative incidence of early mortality for each aspect, and quantified the elements. The early mortality rate in our study cohort was 19.0%. Age ≥ 65 years (odds ratio (OR): 3.15; 95% confidence interval (CI): 1.05–9.44; p = 0.041), Eastern Cooperative Oncology Group performance status ≥ 2 (OR: 4.87; 95% CI: 1.77–13.41; p = 0.002), and lactate dehydrogenase ≥ 1000 IU/L (OR: 4.20; 95% CI: 1.57–11.23; p = 0.004) were the risk factors that substantially increased early mortality in AML patients. Patients with two risk factors had a significantly higher early mortality rate than those with one risk factor (68.8% vs. 20.0%; p < 0.001) or no risk factors (68.8% vs. 9.2%; p < 0.001). In conclusion, older age, poor clinical performance, and a high tumor burden were risks for early mortality in AML patients receiving remission induction chemotherapy. Patients harboring at least two of these three factors should be more carefully assessed for remission induction chemotherapy.

P142. Rating spine surgeons: Physician rating websites versus a patient reported outcomes derived ranking

P142. Rating spine surgeons: Physician rating websites versus a patient reported outcomes derived ranking

Identifying leadership in medical trainees: evaluation of a competency-based approach

BackgroundAs medical professional roles diversify, it is essential to understand what makes effective medical leaders. This study develops and validates a medical leadership competency framework that can be used to...

EVALUATION OF THREE COVID-19 ANTIGEN ASSAY VERSUS PCR DETECTION IN ROUTINE PRACTICE

According to WHO, molecular testing is the "Gold Standard" for the diagnosis of SARS-CoV-2 infection. However, these tests have some limitations in practice (well trained staff, specific equipment requirements, organization of area and time frame for reporting results). Thus, rapid antigen test (RAT) for the detection of one or several SARS-CoV-2 antigens have emerged. We evaluated the analytical performance of 3 RAT used in our laboratory : FREND® Ag COVID-19 (NanoEntek) (FA), STANDARD Q COVID-19 Ag (SD Biosensor) (BA), PANBIO™ COVID-19 Ag RAPID TEST DEVICE (Abbott) (PA) in comparaison to rRT-PCR results. Our study indicates that PA and SA antigen tests have a very good sensitivity to identify infected patients with COVID-19 specifically between in the 0-5 days time-window post onset of symptoms. Nevertheless, one out of three antigen tests (FA) showed very poor clinical performance.

Cyberknife\xae hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

PurposeThe introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature.MethodsAll patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE).ResultsWe analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%.The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively.Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%.ConclusionOur radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

Comparative evaluation of four SARS-CoV-2 antigen tests in hospitalized patients

ObjectivesRapid identification of infected subjects is a cornerstone for controlling a pandemic like the current one with the SARS-CoV-2. Easy to handle antigen tests can provide timely results, which is of particular importance in a primary care setting. However, concerns exist regarding their sensitivity, which led us to evaluate four commercially available tests in patients hospitalized for COVID-19. MethodsWe analyzed in parallel nasopharyngeal/oropharyngeal swabs from 154 consecutive patients admitted to our department with moderate to severe COVID-19, using quantitative RT-PCR (Cobas, Roche) and up to four antigen tests from different distributors. Antigen test results were linked to Ct (cycle threshold) values as markers for patients’ infectivity. ResultsWe found that two out of four antigen tests correctly identified subjects with high viral loads (Ct≤25), and three out of four tests detected more than 80% of subjects with a Ct≤30, which is considered the threshold for infectivity. However, one test investigated had a poor clinical performance. When investigating subjects with Ct values >30, we found that the antigen test was still positive in up to 45% of those cases. ConclusionMost antigen tests had a sufficient sensitivity to identify symptomatic subjects infected with SARS-CoV-2 and with transmissible infection. On the other hand, antigen testing may not be suitable to identify loss of infectivity in COVID-19 subjects during follow-up. Newly introduced antigen tests need to be validated in a clinical or primary care setting to define their clinical usefulness.

Effect of Facial Skin Temperature on the Perception of Anxiety: A Pilot Study.

The extent of anxiety and psychological stress can impact upon the optimal performance of simulation-based practices. The current study investigates the association between differences in skin temperature and perceived anxiety by under- (n = 21) and post-graduate (n = 19) nursing students undertaking a cardiopulmonary resuscitation (CPR) training. Thermal facial gradients from selected facial regions were correlated with the scores assessed by the State-Trait Anxiety Inventory (STAI) and the chest compression quality parameters measured using mannequin-integrated accelerometer sensors. A specific temperature profile was obtained depending on thermal facial variations before and after the simulation event. Statistically significant correlations were found between STAI scale scores and the temperature facial recordings in the forehead (r = 0.579; p < 0.000), periorbital (r = 0.394; p < 0.006), maxillary (r = 0.328; p < 0.019) and neck areas (r = 0.284; p < 0.038). Significant associations were also observed by correlating CPR performance parameters with the facial temperature values in the forehead (r = 0.447; p < 0.002), periorbital (r = 0.446; p < 0.002) and maxillary areas (r = 0.422; p < 0.003). These preliminary findings suggest that higher anxiety levels result in poorer clinical performance and can be correlated to temperature variations in certain facial regions.