Prospective Observational Study Research Articles

Comparison of visual outcomes between corneal topography-guided FS-LASIK and SMILE for myopia and myopic astigmatism: a network meta-analysis

Objective: To compare the postoperative visual outcomes of corneal topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia and myopic astigmatism. Methods: Embase and PubMed were searched for randomized controlled trials (RCTs), prospective comparative studies, observational studies and retrospective studies of patients with myopia and/or myopic astigmatism treated by corneal topography-guided FS-LASIK, the other FS-LASIKs or SMILE (inception to November 2023). The studies meeting the criteria were collected and underwent quality assessment according to the Jadad scale for RCTs and the Newcastle-Ottawa scale for non-randomized studies. RevMan4.3.0 was used for network meta-analysis. Results: A total of 17 studies were included for meta-analysis, including 7 RCT and 10 observational studies. For the percentage of surgical eyes with uncorrected distance visual acuity≥20/20 (≤3 months), there were no statistically significant differences among corneal topography-guided FS-LASIK, the other FS-LASIKs and SMILE. The surface under the cumulative ranking curve (SUCRA) ranking from best to worst was corneal topography-guided FS-LASIK (86.7%), the other FS-LASIKs (53.1%) and SMILE (10.2%). For the percentage of surgical eyes with postoperative manifest refraction spherical equivalent (MRSE) within ±0.50 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses disclosed the relative risk (RR) of corneal topography-guided FS-LASIK significantly increased by 14% (RR=1.14, 95%CI:0.78-1.59) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (90.4%), SMILE (31.7%) and the other FS-LASIKs (27.9%). For the percentage of surgical eyes with postoperative MRSE within± 1.00 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses showed the RR of corneal topography-guided FS-LASIK significantly increased by 15% (RR=1.15, 95%CI:0.93-1.61) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (94.5%), the other FS-LASIKs (53.9%) and SMILE (1.7%). For the percentage of surgical eyes with postoperative corrected distance visual acuity improved by 1 or more lines (combined follow-up measure timepoint), the main analyses showed no statistical difference between corneal topography-guided FS-LASIK and the other FS-LASIKs, while the RR of SMILE was slightly lower than that of the other FS-LASIKs (RR=0.86, 95%CI:0.65-1.14). The sensitivity analyses disclosed the RR of corneal topography-guided FS-LASIK significantly increased by 40% (RR=1.40, 95%CI:0.06-24.00) as compared to that of the other FS-LASIKs, while SMILE had a slightly lower RR as compared with the other FS-LASIKs (RR=0.77, 95%CI:0.17-2.74). The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (72.4%), the other FS-LASIKs (67.3%) and SMILE (10.3%). Conclusions: Compared with SMILE, FS-LASIK showed a similar postoperative visual acuity improvement. The corneal topography-guided FS-LASIK had better predictability with a higher rate of MRSE within ±0.50 D/1.00 D.

Transseptal Sheath Perfused with High Concentration Heparinized Saline for Reducing Sheath-associated Thrombus.

Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated. AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20u/mL) was performed for the remaining procedure before and after catheter withdrawal. A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies. For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.

Mammographic parameters as predictors of molecular subtype of breast cancer: a prospective analysis

BackgroundThe prevalence of breast cancer is increasing globally and its early detection is the need of hour for giving the patient a long disease-free meaningful life. The latest management regimes depend upon the biological behavior of the breast cancer that itself relies upon expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her 2) neu status for its molecular subtyping.AimTo determine the predictive value of mammographic parameters in identifying the estrogen and progesterone hormone receptor status, human epidermal growth factor receptor 2 (Her 2) neu expression and molecular subtypes of breast cancer.MethodsA prospective observational study was conducted from January 2021 to September 2022 in a tertiary care institute. The study enrolled 51 females with histopathologically proven invasive breast carcinoma. The patients underwent digital mammography followed by tissue biopsy. Mammographic parameters were based on Breast Imaging-Reporting and Data System (BI-RADS) imaging features. The molecular subtypes of breast cancer were grouped into four subtypes based on St. Gallen International Expert Consensus Panel 2013. The mammographic features were then statistically correlated with molecular subtypes of breast cancer.ResultsLuminal type A was the most common molecular subtype in our study [ 17 (33.33%)] followed by triple negative type [10(19.61%)]. Tumors with non-circumscribed margins were predicted to be Luminal A or Luminal B subtype (p value < 0.02). Tumor with microcalcification was strongly predicted to be Her 2 subtype with a statistically significant association (p value < 0.001). Circumscribed tumors with absence of microcalcification were predicted to be triple-negative type of breast cancer.ConclusionsKey features in mammography were significantly associated with breast cancer molecular subtypes. Knowledge of such correlations could help clinicians stratify breast cancer patients according to their likely molecular subtypes, potentially enabling earlier, more effective treatment or aiding in therapeutic decisions in countries where immunohistochemical (IHC) hormone receptor and Her 2 testing is not readily available.

Higher risk profile among patients with TET2-mutated giant cell arteritis: a cluster analysis

ObjectiveWe aimed to assess the prevalence of clonal haematopoiesis (CH) in patients with giant cell arteritis (GCA) compared with controls and individuals with other autoimmune diseases (AIDs) and to identify...

The anesthetic and recovery profiles of low-dose hypobaric mepivacaine and bupivacaine for spinal anesthesia in total hip and knee arthroplasty: a prospective observational study.

Same-day mobilization and early hospital discharge is increasingly emphasized following hip and knee arthroplasty. One challenge of spinal anesthesia in this setting is achieving adequate block height while avoiding excessively large local anesthetic doses and prolonged motor and sensory blockade. Using a hypobaric local anesthetic solution is one potential strategy, as its intrathecal distribution can be reliably manipulated by patient positioning to achieve adequate block height independent of dose. We conducted a prospective observational study to determine the clinical characteristics of spinal anesthesia with low-dose hypobaric mepivacaine and bupivacaine in patients undergoing hip and knee arthroplasty. Thirty patients scheduled for same-day discharge received 51mg of hypobaric 1.5% mepivacaine and 30 patients scheduled for inpatient stay received 10mg of hypobaric 0.33% bupivacaine. The mean (standard deviation) time to achieve sensory blockade at or above L1 and T10 in the operative limb was 5.7 (1.8) and 7.3 (3.3) min with mepivacaine and 6.2 (2.6) and 8.1 (4.8) min with bupivacaine, respectively. Anesthesia was adequate for surgical commencement in all patients regardless of spinal injection level. Four patients required anesthetic supplementation for surgical completion. Sensory block duration at or above T10 and L1 in the operative limb was 97 (27) and 115 (37) min with mepivacaine and 127 (32) and 161 (34) min with bupivacaine, respectively. Motor function returned by 145 (37) and 217 (43) min in mepivacaine and bupivacaine groups, respectively. The anesthetic profiles of low-dosehypobaric mepivacaine and bupivacaine were favorable for fast-track hip and knee arthroplasty with short and predictable operating times.

Association of Cerebrovascular Reactivity With 1-Year Imaging and Clinical Outcomes in Small Vessel Disease: An Observational Cohort Study.

In patients with cerebral small vessel disease (SVD), impaired cerebrovascular reactivity (CVR) is related to worse concurrent SVD burden, but less is known about cerebrovascular reactivity and long-term SVD lesion progression and clinical outcomes. We investigated associations between cerebrovascular reactivity and 1-year progression of SVD features and clinical outcomes. Between 2018 and 2021, we recruited patients from the Edinburgh/Lothian stroke services presenting with minor ischemic stroke and SVD features as part of the Mild Stroke Study 3, a prospective observational cohort study (ISRCTN 12113543). We acquired 3T brain MRI at baseline and 1 year. At baseline, we measured cerebrovascular reactivity to 6% inhaled CO2 in subcortical gray matter, normal-appearing white matter, and white matter hyperintensities (WMH). At baseline and 1 year, we quantified SVD MRI features, incident infarcts, assessed stroke severity (NIH Stroke Scale), recurrent stroke, functional outcome (modified Rankin Scale), and cognition (Montreal Cognitive Assessment). We performed linear and logistic regressions adjusted for age, sex, and vascular risk factors, reporting the regression coefficients and odds ratios with 95% CIs. We recruited 208 patients of whom 163 (mean age and SD: 65.8 ± 11.2 years, 32% female) had adequate baseline CVR and completed the follow-up structural MRI. The median increase in WMH volume was 0.32 mL with (Q1, Q3) = (-0.48, 1.78) mL; 29% had a recurrent stroke or incident infarct on MRI. At 1 year, patients with lower baseline cerebrovascular reactivity in normal-appearing tissues had increased WMH (regression coefficient: B = -1.14 [-2.13, -0.14] log10 (%ICV) per %/mm Hg) and perivascular space volumes (B = -1.90 [-3.21, -0.60] log10 (%ROIV) per %/mm Hg), with a similar trend in WMH. CVR was not associated with clinical outcomes at 1 year. Lower baseline cerebrovascular reactivity predicted an increase in WMH and perivascular space volumes after 1 year. CVR should be considered in SVD future research and intervention studies.

Performance of the WID-qEC test to detect uterine cancers in black women with abnormal uterine bleeding: A prospective observational cohort study in Ghana.

The burden of uterine cancer is growing and, in the US and UK, mortality rates are poorest among black women. Early detection of these cancers is critical and poor performance of ultrasound in black women may contribute to adverse outcomes. Limited data on this topic are available from Africa. We assessed whether a simple DNA methylation test, the WID-qEC, enables detection of all epithelial uterine (endometrial and cervical) cancers in women presenting with abnormal uterine bleeding (AUB) in Ghana. Among 118 women ≥40 years presenting with AUB, 106 consented to the study and a cervicovaginal sample was obtained for WID-qEC testing. Subsequent to ultrasound assessment 102 women had a cervical or endometrial biopsy. Histopathology, ultrasound and WID-qEC testing were analyzed and compared. Among the 102 volunteers, 8 and 15 were diagnosed with endometrial and cervical cancer (EC and CC), respectively. The receiver operating characteristic (ROC) area under the curve (AUC) was 0.56 (95% confidence interval [CI] 0.25-0.86) for sonographic endometrial thickness (ET) and 0.98 (95% CI 0.94-1.00) for the WID-qEC test. Sensitivity and specificity of the prespecified ET ≥5 mm were 66.7% (95% CI 24.1-94.0) and 22.7 (95% CI 12.0-38.2) and for the prespecified WID-qEC SUM-PMR ≥ 0.3 were 100% (95% CI 56.1-100.0) and 76.1 (96%CI 60.9-86.9), respectively. In addition, 15 CCs were detected by the WID-qEC test [sensitivity 100% (95% CI 74.7-100.0)]. The WID-qEC test accurately detects both EC and CC in black women presenting with AUB.

Christmas article: Point-of-care test of optimal meat structure in Danish Pork Roasts - a prospective observational study

Pork Roast is an important part of the Danish holidays. The precise cooking of the pork roast is a controversial debate, which has been going on for decades. Newer techniques such as sous vide have been gaining popularity, but the optimal pork roast is yet to be determined. This study sought to evaluate the optimal meat structure for Christmas pork roast. Three pork roasts were analyzed using an ultrasound scanner regarding fluid content. Then the pork roasts were suis vided for 6 hours at 60 degrees Celsius and oven-roasted for 34 minutes. An unbiased tasting panel tested the pork roasts and rated their juiciness. The study was able to measure fluid content in the pork roasts. The two pork roasts (2 and 3) with the lowest fluid content were preferred by a panel of 40 taste testers. The pork roast with the highest fluid content also had the highest drop in weight during cooking. Lower fluid content correlated with higher preference. Ultrasound was effective in estimating fluid content, impacting perceived juiciness and quality. The pork roast with more fluid was less juicy and preferred, aligning with studies linking higher fat to juiciness. The study suggests selecting pork roasts with less fluid using ultrasound is viable for finding the best quality roast. Ultrasound testing is a viable point-of-care modality in selecting the most sensory-pleasing pork roast. Future studies should identify either a cut-off value or investigate if the fluid content to juiciness correlation is linear. none. none.

Does Prior Lower Abdominal Surgery Prevent Laparoscopic Hernia Repair (Totally Extraperitoneal or Transabdominal Preperitoneal)? A Prospective Observational Study.

Objective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P < .05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery.

Effectiveness of Relactation Supportive Program in Sustaining Exclusive Breastfeeding: A Prospective Observational Study

Effectiveness of Relactation Supportive Program in Sustaining Exclusive Breastfeeding: A Prospective Observational Study

Use of the high-flow helmet CPAP non-invasive ventilation device designed in Peru in patients with severe acute respiratory syndrome (COVID-19): A prospective multicenter study

High-flow non-invasive ventilation (NIV) devices reduce the morbidity and mortality of COVID-19. The objective was to evaluate the use of the non-invasive ventilation device with high-flow helmet CPAP designed in Peru in patients with severe acute respiratory syndrome (COVID-19) hospitalized in the emergency services of five hospitals. Prospective multicenter and cross-sectional observational study from five hospitals from July to August 2020. 19 patients were recruited and divided into two groups (G-1 n = 10; G-2 n = 9) applying clinical and gasometric parameters as indicators of disease evolution upon hospital admission and within 24 hours. A progressive increase in these parameters was observed in those patients who used the NIVCPAP helmet within the first 24 hours. In G-01, improvement was evident in 90% (n = 9/10): PaO2 (range 48–137; average: 82.49 ± 8.07; p-value = 0.008), CO2 (25.2–51.0; 36.62 ± 2.62; p-value p = 0.327), and the PaO2/FiO2 coefficient (87–318; 191.5 ± 18.68). 10% of patients did not progress optimally, being subjected to endotracheal intubation and invasive mechanical ventilation. In G-02 the values ​​were %SatO2 (range 92–98; 96 ± 0.76) and the SaO2/FiO2 coefficient (214–228; 223.2 ± 1.80), indicating significant improvement within 24 hours (p &amp;lt; 0.001). It is concluded that the use of the CPAP helmet non-invasive ventilation (NIV) device contributes to improving gasometric values ​​and clinical condition. Being an alternative to recover typical cases of COVID-19 in all hospitals in Peru.

Association of LVV-Hemorphin-7 with Sepsis and Shock: Roles of Cathepsin D and G in Hemoglobin Metabolism in a Prospective ICU Cohort Study

Background: Sepsis is a leading cause of mortality in intensive care units (ICUs). Cell-free hemoglobin (CFH) released during sepsis interacts with lysosomal enzymes from neutrophils and macrophages. This study aims to examine the association of LVV-hemorphin-7 (LVV-H7), cathepsin D, and cathepsin G with sepsis and shock in ICU patients. Methods: A prospective observational cohort study was conducted in the medical ICU of a tertiary referral hospital in Taiwan. The patients with an acute increasing sequential organ failure assessment (SOFA) score ≥ 2 between 2022 and 2023. Blood samples from 40 healthy controls were obtained from the hospital biobank. CFH metabolites, including LVV-H7 and lysosomal enzyme cathepsin D and cathepsin G, were compared between the sepsis (definite and probable) and non-sepsis (possible sepsis) groups. Multivariate logistic regression analyzed factors associated with sepsis and shock. Results: Among 120 patients, 75 were classified as septic and 45 as non-septic. Significant differences were observed in CFH, cathepsin D, cathepsin G, and LVV-H7 levels between sepsis and non-sepsis groups. LVV-H7 was a significant predictor for sepsis (adjusted OR [aOR] 1.009, 95% CI 1.005–1.013; p &lt; 0.001) and shock (aOR 1.005, 95% CI 1.002–1.008; p &lt; 0.05). Cathepsin G predicted non-shock (aOR 0.917, 95% CI 0.848–0.991; p &lt; 0.05), while cathepsin D predicted septic shock (aOR 1.001, 95% CI 1.000–1.002; p &lt; 0.05). Conclusions: LVV-H7, cathepsin D, and cathepsin G are associated with the classification of sepsis and shock episodes in critically ill patients with elevated SOFA scores.

Computerized QT and QTc Measurements From Bedside ICU Monitors Are Similar to Those Derived From a Standard 12-Lead ECG.

Evaluate the agreement between computerized QT/QTc measurements from the bedside monitor (four leads) and a time-matched standard 12-lead ECG. Prospective observational study in three adult ICUs. QT/QTc measurements were obtained from a convenience sample, and the two ECG types were ≤ 30 min apart. Agreement was evaluated using Bland-Altman analysis. A total of 120 patients were evaluated for inclusion, and 60 (50%) had a 12-lead ECG for comparison. The mean bias difference for QT measurements was not statistically different (β = -2.47, 95% CI = 5.50 to -11.05; p = 0.44; limits of agreement (LOA) = -64.37 to 59.44). Similar non-statistical differences were observed for QTc (β = -3.20, 95% CI = 5.50 to -11.05; p = 0.44; LOA = -67.43 to 61.03). There was good agreement for both QT and QTc measurements between the two methods. These pilot data are promising and suggest QT/QTc measurements from bedside monitors (four leads) may be an acceptable alternative to obtaining additional standard 12-lead ECGs. Given that half of the ICU patients screened did not have a 12-lead ECG recorded, bedside monitor QT/QTc's could identify at-risk patients. However, an evaluation in a larger sample and non-ICU patients is warranted.

Factors That Limit Evaluation of Velopharyngeal Closure During Nasopharyngoscopy.

To assess the quality of nasopharyngoscopy video recordings used for velopharyngeal insufficiency (VPI) surgical planning and identify factors that limit evaluation of velopharyngeal closure. Prospective observational study. Metropolitan-based hospitals with craniofacial clinics in the United States and Canada. One-hundred and forty-two (142) patients with VPI across 10 hospitals. Nasopharyngoscopy video recordings used for VPI surgical planning . Ratability of nasopharyngoscopy video recordings, with "ratable" defined as the video (1) visualized the velum, lateral pharyngeal wall, and posterior pharyngeal walls at some point during speech production and (2) contained an oral speech sample at the phrase level or above. One-hundred and forty-two (142) nasopharyngoscopy video recordings were obtained from patients undergoing VPI evaluation, of which 59.9% (n=85) were ratable. A multilevel logistic regression model was used to identify factors that influenced the quality of nasopharyngoscopy video recordings. Factors associated with unratable nasopharyngoscopy videos were age (P=.030), sex (P=.005*), type of scope camera used (P=.039), presence of compensatory misarticulations (P=.008), and a limited speech sample (P=.040). A substantial proportion of nasopharyngoscopy video recordings obtained during VPI evaluation are not sufficient for rating velopharyngeal closure. Lack of ratability could impact the surgery selected to treat VPI. Younger patients, those with limited speech samples, or patients with extensive compensatory articulations may be more successful in completing other VPI imaging techniques, such as videofluoroscopy or magnetic resonance imaging.

Coaching stroke survivors to persevere with practice: An observational behavioural mapping study.

To quantitatively describe therapists' use of coaching with stroke survivors, in a hospital-based rehabilitation setting, to promote perseverance with longer-term practice. Prospective observational behavioural mapping study. Rehabilitation unit of a regional public hospital in Queensland, Australia. A custom-designed behavioural mapping tool was used to collect rehabilitation session contextual data and therapists' use of coaching. Data were captured in 3-minute epochs for a maximum of 30 minutes. Data were analysed using descriptive statistics. Thirty-six rehabilitation sessions, including 34 participants (therapists n = 22, stroke survivors n = 12) were observed. Rehabilitation sessions were mostly inpatient (n = 33, 91.7%), one-on-one (n = 30, 83.3%), and conducted in the physiotherapy (n = 160, 45.5%) or occupational therapy (n = 155, 44.0%) gym. Strategies to promote perseverance were used in 76.7% (n = 267) of observed epochs. The most frequently used strategy was monitoring the quality of practice and the least frequently used strategy was utilising a support person to facilitate practice. Coaching that may promote perseverance with practice was regularly used by therapists during hospital-based rehabilitation sessions. Coaching that may enable longer-term perseverance beyond a therapist-dependent rehabilitation model was less commonly observed.

Age-Related Impact on Tympanoplasty Results in Adult Individuals: Prospective Observational Study

Age-Related Impact on Tympanoplasty Results in Adult Individuals: Prospective Observational Study

Real-World Study of EGFR-TKI Rechallenge With Another TKI After First-Line Osimertinib Discontinuation in Patients With EGFR-Mutated Non-Small Cell Lung Cancer: A Subset Analysis of the Reiwa Study.

First-line osimertinib is widely used to treat patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancers (NSCLC). In clinical practice, rechallenge therapy with another EGFR-tyrosine kinase inhibitor (TKI) is often performed after first-line TKI discontinuation owing to resistance or toxicity; however, the efficacy and toxicity of EGFR-TKI rechallenge after first-line osimertinib have not been adequately investigated. This study aimed to examine the efficacy and safety of EGFR-TKI rechallenge with another TKI. This multicenter prospective observational study enrolled patients with EGFR-mutated NSCLC who received first-line osimertinib and another EGFR-TKI as second- or third-line treatment between September 2018 and August 2020. Fifty-three patients received rechallenge with another EGFR-TKI in the second-line (n = 38, 71.7%) or third-line (n = 15, 28.3%) setting. The primary reason for first-line osimertinib discontinuation was toxicity in 32 (60.4%, 17 patients with pneumonitis) and disease progression in 20 (37.7%) patients. The most common rechallenge EGFR-TKI was afatinib (n = 24, 45.3%), followed by gefitinib (n = 16, 30.2%) and erlotinib (n = 8, 15.1%). The real-world time to treatment failure (rwTTF) was 7.3 months. The rwTTF for the toxicity discontinuation and progressive disease discontinuation groups was 9.3 months and 5.1 months, respectively, (HR 1.61, p = 0.119). EGFR-TKI rechallenge was discontinued due to toxicity in nine patients (17.0%), but no patient developed pneumonitis. EGFR-TKI rechallenge with another TKI is well tolerated in patients with EGFR-mutated NSCLC. Thus, it may be a useful treatment option after first-line osimertinib failure, especially after osimertinib discontinuation due to toxicity.

Optimal Timing for Postanesthesia Care Unit Discharge Using Physiological-Based Criteria in In-Patients Undergoing Low-Risk Surgery with General Anesthesia: A Prospective Observational Study

Objective: All postanesthesia patients must be monitored in the postanesthesia care unit (PACU) until they meet PACU discharge protocols. These included both physiological-based discharge (PBD) criteria and time-based discharge (TBD) criteria. The efficacy of using only PBD criteria to determine PACU discharge remains unclear. Therefore, this study aimed to determine the optimal timing for PACU discharge using PBD criteria alone for in-hospital patients undergoing low-risk surgeries. Material and Methods: This was a prospective observational study, involving 532 patients who had undergone elective low-risk surgery under general anesthesia (GA). At the PACU, the following data points were recorded: patient demographics, anesthesia and surgical data, the time required to meet PBD criteria, the actual PACU discharge time, complications during PACU admission, and causes of delayed PACU discharge. This study analyzed the comparison between the average time to meet PBD criteria and the ‘actual’ PACU discharge time. Results: A total of 532 patients admitted to the PACU were enrolled in this study. The mean PBD time was 12.6± 8.4 minutes, and the mean actual PACU time was 65.1±15.5 minutes: a difference that was statically significant [mean difference 52.5 (51.1, 54.0) minutes, p-value&lt;0.001]. No severe complications were observed. Severe pain was the most recorded complication during PACU admission. The highest cause of delayed PACU discharge was the unavailability of hospital patient transporters. Conclusion: The PACU discharge time for in-hospital patients undergoing low-risk surgery under GA, based on PBD criteria, was significantly shorter than that based on TBD criteria; additionally, no severe complications were reported.

Bacteremic nosocomial pneumonia caused by Gram-negative bacilli: results from the nationwide ALARICO study in Italy.

To describe the clinical characteristics and outcomes of patients with nosocomial pneumonia (NP) causedby carbapenem-resistant Gram-negative bacilli (CR-GNB) and to compare them to patients with NP causedby carbapenem-susceptible (CS)-GNB. Prospective observational multicenter study including patients with bacteremic NP caused by GNB from the ALARICO Network (June 2018-January 2020). The primary outcome measure was 30-day mortality. A Cox regression analysis was performed to identify factors independently associated with 30-day mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated. Overall, 167 patients with GNB NP were included: 101 with bacteremic NP causedby CR-GNB (n = 39 by KPC-producing Klebsiella pneumoniae, n = 29 by carbapenem-resistant Acinetobacter baumannii, n = 28 by carbapenem-resistant Pseudomonas aeruginosa, n = 5 by MBL-producing Klebsiella pneumoniae) and 66 cases of bacteremic CS-GNB NP. Thirty-day mortality rate was higher in patients with NP causedby CR-GNB compared to those with NPcausedby CS-GNB (46.5% vs 30.3%, p = 0.036). On multivariable analysis, age (HR 1.044, 95% CI 1.021-1.067, p < 0.001), hematological malignancy (HR 4.307, 95% CI 1.924-9.643, p < 0.001) and septic shock (HR 3.668, 95% CI 2.001-6.724, p < 0.001) were factors independently associated with 30-day mortality, while the receipt of adequate antibiotic therapy within 24h from infection onset (HR 0.495, 95% CI 0.252-0.969, p = 0.04) was a protective factor. Carbapenem resistance was not associated with increased risk of mortality (HR 1.075, 95% CI 0.539-2.142, p = 0.837). Patients with bacteremic NP causedby CR-GNB have high mortality rate. Strategies to reduce the time from infection to the administration of adequate antibiotic therapy should be implemented in patients with NP.

Analysis of COVID-19 patients hospitalized in general wards and intensive care units: Insights from the RIMAC cardiopulmonary imaging registry across Latin American centers.

This study aimed to compare various aspects among coronavirus disease 2019 (COVID-19) patients admitted to general wards versus intensive care units (ICUs) in Latin American (LATAM), including demographics, comorbidities, imaging and laboratory findings, complications, treatments, and predictors of mortality. Data from the LATAM cardiopulmonary imaging registry of hospitalized COVID-19 patients (RIMAC) were analyzed. RIMAC is a prospective observational study conducted from March to December 2020 across 12 tertiary centers in nine LATAM countries. Out of 1,435 patients, 49.34% were admitted to general wards and 50.66% to ICUs. Significant differences were observed between the two groups. ICU patients had a higher incidence of comorbidities, elevated biomarker levels, and complications such as kidney and heart failure, and required more intensive treatments. They also showed more severe imaging findings and had longer hospital stays with higher mortality rates compared to ward patients. The study highlighted significant disparities between COVID-19 patients admitted to general wards and ICUs in LATAM. These disparities encompassed clinical severity, resource utilization, and mortality rates. Older age, obesity, extensive lung infiltrates, and kidney failure emerged as predictors of mortality. These findings underscore the need for tailored management strategies based on the severity of illness among COVID-19 patients in LATAM.