Single-center Retrospective Study Research Articles

Clinical and epidemiological differences in staphylococcal osteoarticular infections: insights for developing hospital-based infection control interventions

PurposeOsteoarticular infections (OAI) are serious clinical conditions with Staphylococcus aureus and Coagulase-negative Staphylococcus (CoNS) responsible for up to two-thirds of cases. This work aimed to compare the epidemiological, clinical, and microbiological characteristics of OAI caused by S. aureus versus CoNS to aid in clinical management and infection control strategies.MethodsA single-centre retrospective study was performed at the Centro Hospitalar e Universitário de Coimbra for the period of January 2011 to December 2021. A total of 458 cases of OAI were gathered. Data was retrieved from medical records and statistical analysis was performed with SPSS.ResultsS. aureus accounted for 60.7% of infections, followed by S. epidermidis (29.9%). Independent risk factors for S. aureus infections included being male (p < 0.001; OR = 0.47) and a history of osteomyelitis (p < 0.001; OR = 0.18). In contrast, CoNS infections were associated with older age (p = 0.018), carrying a prosthetic device (p < 0.001; OR = 2.92), and a prior periprosthetic infection (p = 0.023; OR = 1.86). Both groups exhibited significant antimicrobial resistance, with CoNS showing greater resistance to gentamicin, linezolid, teicoplanin and trimethoprim-sulfamethoxazole, while S. aureus was more commonly resistant to clindamycin.ConclusionOur findings show the distinct characteristics of OAI caused by S. aureus and CoNS, highlighting the need for targeted risk factor management and tailored empiric antibiotic therapy to reduce incidence and improve outcomes.

Outcomes and Disease Management in Patients With Atrial Fibrillation ≥80 Years: Data From a Consecutive 11-Year Real-World Registry.

As the population ages, atrial fibrillation (AF) prevalence increases, but data on optimal oral anticoagulation (OAC) in patients ≥80 years remain limited. This study tested whether direct OACs offer comparable benefits to vitamin K antagonists in patients ≥80 years with AF presenting to the emergency department. This single-center retrospective all-comer study used data from the Heidelberg Registry of Atrial Fibrillation, including patients with AF presenting to the emergency department of the University Hospital of Heidelberg from June 2009 until March 2020. Data were analyzed by age for outcomes and risk factors for predefined end points. Patients ≥80 years comprised 32.2% of AF cases. Hazard ratios (HRs) for the primary end point (all-cause mortality, stroke, or myocardial infarction) and secondary end point (including major bleeding) were 3.09 (95% CI, 2.73-3.21) and 2.96 (95% CI, 2.73-3.21) for patients ≥80 years, compared with younger patients. Anticoagulation rates were slightly lower in patients ≥80 years (67.9% versus 70.5%, P=0.0070). OAC use, particularly the use of direct OACs, increased over time. Patients ≥80 years without OACs had higher HRs for primary (3.48 [95% CI, 3.07-3.94]) and secondary end points (3.23 [95% CI, 2.86-3.64]) compared with those with OACs. Vitamin K antagonist use was linked to higher HR for stroke or major bleeding events (HR, 1.25 [95% CI, 1.05-1.50]), rising to 1.64 (95% CI, 1.34-2.01) after excluding reduced direct OAC doses. Our data highlight patients ≥80 years as an important and vulnerable subpopulation of patients with AF, where evidence for optimal OAC therapy remains conflicting. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05995561.

Comparative analysis of polypropylene and dual mesh incisional hernia repair methods in open surgery following organ transplantation: a single-center retrospective cohort study.

Transplant patients face a risk of developing incisional hernias. Establishing a reliable and secure incisional hernia repair method for this patient population remains a challenge. In this retrospective cohort study, we gathered data from patients who had undergone liver and kidney transplantations and subsequently had developed postoperative incisional hernias. Patient follow-up was extended for a minimum of 18 months. Primary outcomes focused on recurrence, hematoma, and infection rates, comparing the complication profiles of propylene mesh and Dual Mesh incisional hernia repair methods. 122 transplant patients with incisional hernias were included. The incidence of recurrence and infection after incisional hernia repair surgery was 20.6% and 5.9% for Dual Mesh and 22.2% and 9.9% for polypropylene mesh (P = 0.721 and 1.000). In liver recipients, the Dual Mesh method showed a slightly lower incidence of recurrence (17.9% vs. 23.3%) and infection (3.6% vs. 10.0%) compared to polypropylene mesh (P = 0.782, 0.423). Kidney recipients exhibited insignificant higher recurrence (33.3% vs. 19%) and infection rates (16.7% vs. 9.5%) with Dual Mesh (P = 0.588, 0.545). The results suggest that while trends indicate a lower recurrence and infection rate with Dual Mesh in liver transplant patients and a slightly higher recurrence and infection rate with Dual Mesh in kidney transplant patients, these differences were not statistically significant. Therefore, no definitive advantage of one mesh type over the other can be concluded from the data.

Structured reporting of neuroendocrine tumors in PET/CT using [18F]SiTATE - impact on interdisciplinary communication

Our retrospective single-center study aims to evaluate the impact of structured reporting (SR) using a self-developed template on report quality compared to free-text reporting (FTR) in [18F]SiTATE Positron Emission Tomography/Computer Tomography (PET/CT) for the primary staging and therapy monitoring of patients diagnosed with neuroendocrine tumors (NET). In total 50 patients were included. FTRs and SRs were generated post-examination. All reports were evaluated by a radiologist and a surgeon through a questionnaire to determine their contribution to facilitating clinical decision-making and to assess their completeness, linguistic quality, and overall quality. SR significantly increased the capacity of facilitating therapy decision-making from 32% in FTR to 55% in SR (p < 0.001). Trust in the report was significantly higher in SR with a mean of 5.0 (SD = 0.5) vs. 4.7 (SD = 0.5) for FTR (p < 0.001). SR received significantly higher mean ratings regarding linguistic quality with 4.7 for SR vs. 4.4 for FTR (p = 0.004) and overall report quality with a mean of 4.9 for SR vs. 4.6 for FTR (p < 0.001). Concluding that SR enhances the overall quality of reports in [18F]SiTATE-PET/CTs for NET staging, serving as a tool to streamline clinical decision-making and enhance interdisciplinary communication in the future.

Comparative efficacy of pre-emptive TIPS and elective TIPS in EGVB patients with cirrhosis: A single-center retrospective study.

Transjugular intrahepatic portosystemic shunt (TIPS) is the main method to prevent the rebleeding of esophagogastric varices. Many studies have demonstrated that pre-emptive TIPS (p-TIPS) is superior to medicine combined with endoscopic standard therapy in the efficacy of high-risk patients, but very few relevant studies reported whether p-TIPS is more effective than elective TIPS. This study aims to compare the efficacy and prognosis of p-TIPS and elective TIPS for the treatment of esophagogastric variceal bleeding (EGVB) patients with cirrhosis. In this retrospective study, clinical data of 92 patients with cirrhosis who accepted TIPS treatment after EGVB of cirrhosis were collected. According to the different times of TIPS, the patients were divided into the p-TIPS group and the elective TIPS group. The following information is documented: clinical manifestations and laboratory examination at 1, 3, and 6 months after the operation, survival state, the rates of rebleeding at 6 weeks and 6 months, and postoperative complications and serious adverse events during follow-up. The Child-Pugh score (P = 0.002) and MELD score (P = 0.006) in the p-TIPS group were significantly lower than those in the elective TIPS group in the 6th month after treatment. The rate of no gastric coronary vein embolization in the p-TIPS group was higher than in the elective TIPS group (P = 0.034). The hospitalized days (P < 0.001) and hospitalized costs (P < 0.001) were significantly lower in the p-TIPS group than in the elective TIPS group. No significant differences were observed between the two groups concerning rebleeding, overt hepatic encephalopathy, ascites, complications, and serious adverse events, occurrence. The p-TIPS contributes to liver function recovery and enhances patient survival benefits at 6-months postoperation in the treatment of EGVB compared with elective TIPS, without increasing the incidence of complications and adverse events.

Analysis of Postoperative Outcomes in Unilateral Versus Bilateral DIEP Flap Reconstructions: A Single-Center Retrospective Study

Analysis of Postoperative Outcomes in Unilateral Versus Bilateral DIEP Flap Reconstructions: A Single-Center Retrospective Study

Prevalence of Post-stroke Cognitive Impairment and Dementia in a Sudanese Cohort: A Single-center Retrospective Study

Prevalence of Post-stroke Cognitive Impairment and Dementia in a Sudanese Cohort: A Single-center Retrospective Study

A deep learning approach for automatic 3D segmentation of hip cartilage and labrum from direct hip MR arthrography

The objective was to use convolutional neural networks (CNNs) for automatic segmentation of hip cartilage and labrum based on 3D MRI. In this retrospective single-center study, CNNs with a U-Net architecture were used to develop a fully automated segmentation model for hip cartilage and labrum from MRI. Direct hip MR arthrographies (01/2020-10/2021) were selected from 100 symptomatic patients. Institutional routine protocol included a 3D T1 mapping sequence, which was used for manual segmentation of hip cartilage and labrum. 80 hips were used for training and the remaining 20 for testing. Model performance was assessed with six evaluation metrics including Dice similarity coefficient (DSC). In addition, model performance was tested on an external dataset (40 patients) with a 3D T2-weighted sequence from a different institution. Inter-rater agreement of manual segmentation served as benchmark for automatic segmentation performance. 100 patients were included (mean age 30 ± 10 years, 64% female patients). Mean DSC for cartilage was 0.92 ± 0.02 (95% confidence interval [CI] 0.92–0.93) and 0.83 ± 0.04 (0.81–0.85) for labrum and comparable (p = 0.232 and 0.297, respectively) to inter-rater agreement of manual segmentation: DSC cartilage 0.93 ± 0.04 (0.92–0.95); DSC labrum 0.82 ± 0.05 (0.80–0.85). When tested on the external dataset, the DSC was 0.89 ± 0.02 (0.88–0.90) and 0.71 ± 0.04 (0.69–0.73) for cartilage and labrum, respectively.The presented deep learning approach accurately segments hip cartilage and labrum from 3D MRI sequences and can potentially be used in clinical practice to provide rapid and accurate 3D MRI models.

Prescribing patterns of SGLT-2 inhibitors and their association with heart failure readmissions: a single-center cross-sectional study from a low- and middle-income country

ABSTRACT Objectives Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce cardiovascular death and heart failure (HF) hospitalizations in patients with reduced and mildly reduced or preserved ejection fraction. This study assesses the effectiveness of SGLT2 inhibitors in reducing HF readmission rates and examines prescription patterns in hospitalized patients. Methods This single-center retrospective cross-sectional study evaluated the impact of SGLT2 inhibitors on HF readmission rates when initiated during index hospitalization or within 14 days of discharge. Patients were divided into an SGLT2 group and a non-SGLT2 group, with 6-month readmission rates compared to the groups. Results Of the 234 patients, 85 (36.3%) were prescribed SGLT2 inhibitors, while 149 (63.7%) were not. SGLT2 inhibitors were prescribed less frequently to patients with chronic kidney disease (CKD) and patients admitted under cardiology services were more likely to receive SGLT2 inhibitors. Among those prescribed SGLT2 inhibitors, the median ejection fraction was significantly lower compared to those not prescribed, while the median estimated glomerular filtration rate was higher. There were 107 total readmissions (45.7%), with most (55%) occurring within 30 days of the index hospitalization. Total readmissions and 30-day readmissions were significantly lower in the SGLT2 inhibitor group (31.8% vs 53.7%, p = 0.001) and (33.33% vs 62.50%, p = 0.029), respectively. Heart failure readmissions were also lower in the SGLT2 group (29.6% vs 21.3%, p = 0.37). Conclusion Our study demonstrated a significant reduction in heart failure readmission rates among patients prescribed with SGLT2 inhibitors. However, we also observed a gap in the prescription of SGLT2 inhibitors.

Impact of choroid plexus coagulation on the success of endoscopic third ventriculostomy in children with hydrocephalus: a single-center retrospective observational cohort study.

Hydrocephalus is a common condition in childhood, often treated with ventriculoperitoneal shunts (VPS). Endoscopic third ventriculostomy (ETV) has emerged as an effective alternative, and the addition of choroid plexus coagulation (CPC) is believed to enhance its success, particularly in children under 6months. In this observational study, a retrospective analysis was conducted on 167 pediatric patients who underwent ETV, with and without CPC, at the Hospital da Restauração in Pernambuco. The primary outcome was to evaluate the success rates of ETV and ETV + CPC at immediate postoperative or outcome at discharge and 6-month follow-up. Statistical analyses, including chi-square, univariate, and multivariate logistic regression, were employed to assess correlations between dependent and independent variables. ETV + CPC showed a significantly higher success rate in the immediate postoperative period (91%) compared to ETV alone (75%) (p = 0.007). After 6months, success rates were similar for both groups (67% for ETV + CPC and 66% for ETV), with no significant difference (p = 0.855). Univariate and multivariate analyses revealed that the type of surgery (ETV + CPC vs. ETV) was a significant predictor of immediate postoperative success (OR 2.81, 95%CI 1.18-6.72, p = 0.020). Age and sex did not correlate significantly with surgical outcomes. The addition of CPC to ETV significantly enhances immediate postoperative success in young children with hydrocephalus. Although long-term outcomes equalized, these findings suggest that CPC can be a valuable adjunct in optimizing short-term results.

Efficacy of transabdominal cerclage by open laparotomy relative to existing risk factors.

To prevent extreme preterm birth, women with cervical insufficiency are eligible for transabdominal cerclage in case of prior failure or technical impossibility for transvaginal cerclage. This study aimed to identify patient characteristics that affect the success rate of transabdominal cerclage to prevent extreme preterm birth in women with cervical insufficiency. Single-center retrospective cohort study in 87 women who underwent transabdominal cerclage by open laparotomy during first and early second trimester of pregnancy over a 20-year period. Participants were divided into subgroups according to indication for the intervention. Linear regression and meta-regression-analyses were performed to assess the effect of mean cervical length (before and after transabdominal cerclage placement) and gestational age of previous preterm birth, on gestational age at delivery. Kaplan-Meier analysis was performed to evaluate treatment effects on gestational age at delivery. Of 87 women, 62 women underwent a history-indicated and 25 an ultrasound-indicated transabdominal cerclage. Fetal survival was 92%: 91% in the history-indicated and 96% in the ultrasound-indicated group. Median gestational age at delivery was 37.3 weeks, with a median pregnancy prolongation of 163.0 days and with 92% of deliveries ≥34 weeks. Between groups, irrespective of singleton and twin pregnancies, outcomes were comparable. Gestational age at delivery was neither affected by cervical length before transabdominal cerclage, distance between transabdominal cerclage and external os, gestational age of previous preterm birth nor additional progesterone treatment. The efficacy of transvaginal cerclage placement via open laparotomy during high-risk pregnancy is favorable and relates to fetal survival of 92%. Regardless of indication, pregnancy outcomes after transabdominal cerclage are similar, and independent of gestational age at previous preterm birth, cervical length before transabdominal cerclage placement, distance between transabdominal cerclage and external os, and additional progesterone administration.

The Use of 8-mm Powered Articulation Endostapler for Sublobar Resection in Children. Preliminary Case Series.

Background: Video-assisted thoracoscopic surgery (VATS) is considered the treatment of choice in children with subpleural bullous lesions, in which endoscopic staplers are routinely used. Recently, a new generation of electronically powered stapling systems was developed. Our aim is to compare the use of a new 8-mm electronic endostapler with a 12-mm nonelectronic conventional device in thoracoscopic sublobar resection in children. Methods: We performed a retrospective single-center study in patients under 18 years who underwent VATS sublobar resection of subpleural bullae in our institution between January 2022 and December 2023. They were divided into two groups according to the type of endostapler used (8 mm electronic or 12 mm non-electronic). Demographic, clinical, intraoperative and postoperative outcomes were analyzed. Results: We included 8 patients (4 in each group), with a median age of 13.2 years (interquartile range [IQR]: 10.7-15.4 years), without demographic or clinical differences between them. Median surgery time was 42 minutes (IQR 35-55 minutes) in the 8-mm electronic group compared with 53 minutes (IQR 45-65 minutes) in the 12-mm group. There were no intraoperative complications and no reconversions to open surgery. Median length of drainage therapy did not show significant differences between them (3 days in both groups; P = .512). No postoperative complications were reported. Conclusion: Preliminary results of the 8-mm electronic endostapler appear to be comparable with the conventional mechanical stapler. Advantages include smaller incisions, as well as one-handed, push-button operation, which eliminates the manual firing force and possibly enables more precise resection. Further studies are still needed.

Percutaneous microwave ablation of cT1b renal cell carcinoma: safety and oncologic efficacy in a large, single-center elderly and comorbid cohort.

To evaluate safety and oncologic efficacy of percutaneous microwave ablation (MWA) for treating clinically localized T1b (cT1b) renal cell carcinoma (RCC). This single-center retrospective study was performed under a waiver of informed consent. Seventy-four consecutive patients (49M/25F) with 76 cT1b RCC (median tumor diameter 4.5cm) were treated with percutaneous MWA between 5/2012 and 8/2020. Patients were stratified into two groups by technique, depending on whether antennas were repositioned for additional ablation or not. Primary efficacy, complications, and local tumor progression (LTP) were compared using the Wilcoxon rank sum and Fisher's exact tests. The Kaplan Meier method was used for survival analysis. Patients were elderly (median age 69.5), obese (median BMI 34.5), and comorbid (Charlson Comorbidity Index=4). Most tumors were low-grade (grade 1-2) (67/89, 88%) and clear cell RCC was the most common histology (62/76, 82%). A median of three MWA antennas were powered at 65W for 7min for treatment. Renal masses were larger (4.6 vs 4.5cm, p=0.01) and procedure times longer (100min vs 80.5min, p=0.04) for the antenna reposition cohort (n=34, 45%). Primary efficacy and high-grade complication rates were 93% and 8%, respectively. The local tumor progression rate (LTP), at a median follow-up was 28.2 months, was 16%. Primary efficacy, low and high-grade complications, change in estimated glomerular filtration rate and LTP were similar between cohorts (p=0.20-0.55). Percutaneous MWA for cT1b RCC is safe in elderly and comorbid patients with acceptable oncologic efficacy. Repeat ablation is well-tolerated and can improve oncologic efficacy.

ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury

PurposeThis study aimed to investigate whether incorporating pre-injury health status, measured by the American Society of Anesthesiologists (ASA) score, improves outcome prediction models for moderate-to-severe traumatic brain injury (msTBI) patients.MethodsWe conducted a retrospective single-center study of msTBI patients (2005–2021). The primary outcome was 1-year Glasgow Outcome Scale (GOS, dichotomized as GOS1-3 (unfavorable) vs. 4–5 (favorable)), and secondary outcome was 90-day mortality. Logistic regression evaluated the contribution of ASA score to the International Mission for Prognosis and Clinical Trials in Traumatic Brain Injury (IMPACT) core + CT outcome prediction model incorporating age, admission GCS, pupillary reactivity, Marshall CT classification, hypoxia, hypotension, epidural hematoma, and subarachnoid hemorrhage.ResultsAmong the 720 adult patients that were included 51% had an unfavorable GOS at 1 year. The 90-day mortality was 19%. ASA score and TRISS were independently associated with both outcomes (p < 0.001). Incorporating the ASA score to our IMPACT model significantly enhanced its explanatory value of dichotomized GOS (35% vs. 32% variance explained, p < 0.001) and improved the model’s prognostic accuracy.ConclusionIn this retrospective single-center cohort study, we found that ASA score improves existing prognostic models for msTBI. Incorporating this simple comorbidity measure could enhance outcome prediction and support more personalized acute management. Future prospective studies are needed to validate these results.

Management and long-term follow-up of basilar trunk artery aneurysms: a single center experience.

Basilar trunk artery (BTA) aneurysm is a serious disease, management of which remains controversial and challenging. We conducted a single-center retrospective cohort study of 67 patients with 72 BTA aneurysms diagnosed and treated at our institution. Finally, 39 participants underwent conservative treatment and 27 received endovascular surgical treatment, including one patient who underwent external carotid artery-radial artery-second segment of the posterior cerebral artery bypass. Data on patient clinical and aneurysm characteristics were collected and risk factors for unfavorable outcome and death analyzed. 33 patients presented with subarachnoid hemorrhage and 15 had a poor Hunt-Hess grade. Mean aneurysm diameter was 14.8 ± 12.6mm and 28 aneurysms were > 15mm. The total proportions of favorable outcome and mortality at discharge were 64.2% and 17.9%, respectively, while the corresponding proportions in the surgery groups were 53.6% and 17.9%. Moreover, we conducted long-term follow-up from initial diagnosis to 3 years. 57 patients had ≥ 6 months of follow-up and 31 patients reached 3 years. Mean follow-up time was 23.23 ± 21.58 months. The proportions of patients with unfavorable outcome and death increased in the group undergoing conservative treatment during the 3-year follow-up period. Further, the natural rupture rate increased from 43.3% initial diagnosis to 81.8% at 3 years. Poor Hunt-Hess grade was an important risk factor for unfavorable outcome and death. Undergoing surgery was a protective factor against death at six months; however, the complications rate was higher in the surgery group than that in patients receiving conservative treatment. In conclusion, although BTA aneurysm management remains controversial and unsatisfactory, patients with BTA aneurysm in the surgical intervention group appeared to have better outcomes.

Predictors of moderate, severe, and critical COVID-19 infection in a largely vaccinated kidney transplant recipient cohort during the Omicron era: the importance of timely booster vaccinations and early presentation to care.

Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period. This single-center retrospective study included KTRs aged ≥18 years diagnosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI); moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness. Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006-1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155-1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212-0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956-0.986). KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.

Impact of prism adaptation test on distance-near-deviation before strabismus surgery in patients with intermittent exotropia

ABSTRACT Purpose: To evaluate the effect of preoperative prism adaptation test (PAT) on the angle of squint in intermittent exotropia (XTint). Methods: In this single-center retrospective study, we reviewed the medical records of patients with the diagnosis of XTint, aged at least 12 years, who were treated by strabismus surgery for the first time. The maximum angle of squint (AOS) for far (F) and near (N) fixation and PAT results before surgery as well as AOS (F) and AOS (N) after surgery and results of binocular function tests were considered. PAT included wearing a prism based on the largest angle for about 60 min, without changing the prism power. Results: One hundred patients (between 12 and 78 years, mean age 32 ± 17 years) were included in the study. Before surgery, AOS was −33.6 ± 13.3 pdpt (F) and −34.4 ± 15.5 pdpt (N). After PAT, the mean AOS was not significantly different with AOS(F) = −32.7 ± 12.4 and AOS(N) = −34.6 ± 12.9 pdpt (p ≥ .057). However, in 82% of patients, AOS (F) and/or AOS (N) in- or decreased by at least 3 pdpt after PAT. The absolute distance-near difference (DND) was 6.6 ± 7.1 pdpt before PAT. After PAT, it was significantly lower with 3.5 ± 3.3 pdpt (p < .001). Conclusion: In 82% of patients with XTint, there was a change in AOS of more than the dose relevant angle change of ≥3 pdpt. The absolute distance-near difference decreased significantly after PAT. Therefore, we recommend using a PAT for preoperative examination of patients with XTint.

Effectiveness and Safety of Spesolimab in Patients with Generalized Pustular Psoriasis: A Single-centre Retrospective Study.

Effectiveness and Safety of Spesolimab in Patients with Generalized Pustular Psoriasis: A Single-centre Retrospective Study.

Cervical pedicle screw placement with patient-specific 3D-printed guides: accuracy and safety in a clinical experience.

Cervical pedicle screw (CPS) instrumentation offers significant biomechanical advantages compared to lateral mass or transarticular fixation. Nonetheless, malpositioning complications constitute a relevant concern. Customized patient-specific 3D-printed templates have been developed to improve CPS placement accuracy and safety. The aim of this study is to present our experience with this surgical technique and its accuracy and safety in a clinical setting. This single-center retrospective observational study of prospectively collected data included patients undergoing CPS fixation surgery using a patient-specific 3D template guide system. All patients underwent a 3D-volumetric high-resolution CT scan of the cervical spine for preoperative surgical planning. Postoperative CT scans were used to evaluate pedicle perforation, CPS trajectories, and deviations between the planned and the actual screw position. A total of 115 CPS were implanted in 25 patients, with 107 (93.1%) of the screws completely placed inside the pedicle. Cortical breach within 2mm was observed in 8 (6.9%) cases, with no cases of more severe pedicle infractions or perioperative neurovascular complication. No differences of CPS accuracies were found between each metameric fusion level, and between monolateral or bilateral templates. Mean total deviations were 0.75mm vertically and 0.51mm horizontally at the screw entry point, and 0.72mm vertically and horizontally at the narrowest pedicle point. Mean total sagittal and transverse angular deviations were 2.94° and 3.04°, respectively. Cervical pedicle screw placement using patient-specific guides is safe and accurate, supporting the feasibility of this technique in posterior cervical spine fusion surgery.

Utility of Mucorales PCR to diagnose Rhizomucor infections in neutropenic patients.

Mucormycoses are life-threatening infections related to fungi from the Mucorales order. Based on fungal culture, the most frequently involved genera are Rhizopus spp., Mucor spp. or Lichtheimia spp. However, since the introduction of Mucorales PCR, many diagnoses are made without positive fungal culture, biasing mucormycosis epidemiology. We conducted a single-center retrospective observational study on invasive mucormycosis cases diagnosed between April 2020 and December 2022. Cases were classified according to EORTC/MSGERC definitions, adding a "PCR-only" category for patients with a positive Mucorales PCR as the only mycological evidence. Genus/species identification was obtained by sequencing the Mucorales 18S rDNA directly on Mucorales PCR-positive samples. We identified 35 cases of mucormycosis, including 6 proven, 7 probable and 22 "PCR-only". Genus/species identification was achievable in 34 cases, and surprisingly revealed the genus Rhizomucor as the main aetiological agent (n=14, 41.2%). Interestingly, all the Rhizomucor infections, except one, were classified as "PCR-only", while fungal culture was positive in 11/20 (55%) for other Mucorales genera (p < 0.001). Moreover, in comparison with other genera, the genus Rhizomucor was significantly more associated with neutropenia (11/14 [78.6%] vs 2/20 [10%], p < 0.0001) and pulmonary localizations (11/14 [78.6%] vs 6/20 [30%], p = 0.01). Our study reveals the changing epidemiology of mucormycosis in our center with the use of Mucorales PCR and underlines the importance of the genus Rhizomucor especially in neutropenic patients. This highlights the benefits using Mucorales PCR in clinical practice for mucormycosis diagnosis in high-risk patients, and the need to include it in diagnostic criteria.