Single-center Retrospective Study Research Articles

Pediatric RSV infection and respiratory coinfections: is a link related to clinical severity? Single center retrospective study

PurposeThe aim of the study was to assess whether there was a difference in terms of severity in paediatric patients assessed for respiratory symptoms in paediatric emergency departments between those who tested positive for RSV and those who presented with viral co-infections in addition to RSV. It was also assessed whether there was a difference between the two groups in terms of need for hospitalisation and ventilation. MethodsThis is a single center study from October 2022 to February 2023, compared two groups of patients: those infected with RSV and those coinfected with RSV and other viruses. Parameters examined included the severity of illness, as measured by the Clinical Respiratory Score (CRS), the need for and duration of hospitalization, and the need for ventilation via high flow nasal cannula (HFNC). ResultsThe correlation with disease severity assessed by CRS in the two groups with RSV only and coinfection was not statistically significant (p-value 0.281). The correlation in the two groups between the need for hospitalization (p-value 1) and the need for ventilation (p-value 0.302) was also not significant. No significant correlation was found between the age of patients and CRS (R=-0.26, p=0.119) and the age of patients and days of hospitalization (R=-0.013, p=0.938). ConclusionThese findings highlight the importance of careful management of RSV infections in children. Despite the limitations, the lack of significant differences in disease severity indicates the need to explore additional preventive strategies, such as RSV vaccination, to improve the clinical approach.

The association between acute kidney injury and dysglycaemia in critically ill patients with and without diabetes mellitus: a retrospective single-center study.

Critically ill patients in the intensive care unit (ICU) often experience dysglycaemia. However, studies investigating the link between acute kidney injury (AKI) and dysglycaemia, especially in those with and without diabetes mellitus (DM), are limited. We used the Medical Information Mart for Intensive Care IV database to investigate the association between AKI within 7 days of admission and subsequent dysglycaemia. The primary outcome was the occurrence of dysglycaemia (both hypoglycemia and hyperglycemia) after 7 days of ICU admission. Logistic regression analyzed the relationship between AKI and dysglycaemia, while a Cox proportional hazards model estimated the long-term mortality risk linked to the AKI combined with dysglycaemia. A cohort of 20,008 critically ill patients were included. The AKI group demonstrated a higher prevalence of dysglycaemia, compared to the non-AKI group. AKI patients had an increased risk of dysglycaemia (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.41-1.65), hypoglycemia (aOR 1.56, 95% CI 1.41-1.73), and hyperglycemia (aOR 1.53, 95% CI 1.41-1.66). In subgroup analysis, compared to DM patients, AKI showed higher risk of dysglycaemia in non-DM patients (aOR: 1.93 vs. 1.33, Pint<0.01). Additionally, the AKI with dysglycaemia group exhibited a higher risk of long-term mortality compared to the non-AKI without dysglycaemia group. Dysglycaemia also mediated the relationship between AKI and long-term mortality. AKI was associated with a higher risk of dysglycaemia, especially in non-DM patients, and the combination of AKI and dysglycaemia was linked to higher long-term mortality. Further research is needed to develop optimal glycemic control strategies for AKI patients.

Differences in total and differential white blood cell counts and in inflammatory parameters between psychiatric inpatients with and without recent consumption of cannabinoids, opioids, or cocaine: A retrospective single-center study

Differences in total and differential white blood cell counts and in inflammatory parameters between psychiatric inpatients with and without recent consumption of cannabinoids, opioids, or cocaine: A retrospective single-center study

Stereotactic ablative radiotherapy (SABR) for patients with lung tumor and severe pulmonary function impairment.

To evaluate clinical outcomes after SABR in a cohort of early-stage non-small cell lung cancer (NSCLC) or pulmonary metastases in chronic obstructive pulmonary disease (COPD) patients with forced expiratory volume in the first second predicted (FEV1) ≤ 50%. Retrospective single-center study was performed to analyze clinical outcomes and toxicities in COPD patients with severe lung dysfunction treated with SABR from 1st June 2015 to 31st October 2022. Thirty four patients (forty locations) were enrolled for analysis. Median follow-up was 2.9years. Median age was 73.5years (range, 65.6-80.1). FEV1 was 38% (range, 28.2-50.0) prior to radiotherapy. Median overall survival (OS) was 41.1months (95% CI 38.9-not reached). OS rates at 2-, 3-, and 5- years were 79%, 71%, and 36%, respectively. Cancer-specific survival rates at 2-, 3-, and 5- years were 96%, 96%, and 68%, respectively. Local control rates at 2-, 3-, and 5- years were 88%, 83%, and 83%, respectively. No grade 4 or 5 toxicity was observed. The most common acute toxicity was pneumonitis (38.2%), of which only 1 patient (2.9%) reported grade 3 acute toxicity. Lung SABR in patients with poor pulmonary function may be effective with acceptable toxicity.

Tumor characteristics in immunosuppressed and renal dysfunction populations

PurposeRenal transplantation and end-stage renal disease are increasingly common. Renal dysfunction and immunosuppression are two risk factors in the development of renal cell carcinoma. Carcinomas in these patients are thought to be more indolent, however data are limited and mixed. Our objective was to describe the histology of resected tumors from the transplant and renal dysfunction population and compare them to a control population. Materials and MethodsThis was a single-center retrospective cohort study of all patients who had a nephrectomy for a renal mass from 2009 to 2019. All transplant status and end-stage renal disease diagnoses were identified by diagnostic or procedural coding and confirmed by chart review. Our primary endpoint was the pathology for each patient's tumor. Tumors were classified into aggressive or nonaggressive categories based on their histology and grade. ResultsWe identified 1,150 radical and partial nephrectomies, of which 1,057 met inclusion criteria. Of these, 68 patients (6.4%) had renal dysfunction or a kidney transplant on immunosuppression at time of nephrectomy. After pathologic review, 270 (25%) tumors were classified as aggressive, and 673 (64%) tumors were pT1a or pT1b. On multivariable logistic regression controlling for age and gender, renal dysfunction was not associated with having an aggressive tumor (OR 1.24, 95%CI 0.72–2.15; P = 0.44). ConclusionsWe did not observe a relationship between renal dysfunction status and aggressive pathology. These data suggest that renal dysfunction and transplant patients are at similar risk for aggressive pathology as the general population and should be managed according to the same clinical guidelines.

Body Habitus vs. Hepatic Steatosis: Understanding the Drivers of Non-Diagnostic Shear Wave Elastography

PurposeShear Wave Elastography (SWE) is frequently non-diagnostic in obese patients, a key cohort at risk for liver disease. Subcutaneous fat and hepatic steatosis are suspected drivers, but their relative contribution is unknown. We compare ultrasound-guided attenuation parameter (UGAP), a marker of steatosis, body mass index (BMI), and skin-to-liver capsule distance (SCD) to predict non-diagnostic SWE. Materials and MethodsThis IRB approved, single center retrospective study included adults with SWE and diagnostic UGAP exams between June and December 2023. Fasting patients were imaged in supine position with right arm abducted, via an intercostal window during neutral breath hold. The median of 10 measurements in the right lobe was analyzed for SWE and UGAP. SWE measurements were ≥ 2 cm from the capsule while UGAP depth was fixed at 4 cm from the probe. Exams were considered non-diagnostic for SWE (measured in m/s) if the Interquartile Range/Median Ratio (IQR/M) was > 15% or if diagnostic measurements could not be obtained. UGAP IQR/M > 30% or complete measurement failure was considered non-diagnostic. Univariate Receiver Operating Characteristic (ROC) curves compared UGAP (dB/cm/MHz), BMI (kg/m2), and SCD (mm) prediction of non-diagnostic SWE by the DeLong test. Results87 participants (48 male) with mean age of 54.7 ± 15.7 years were analyzed. UGAP [OR: 1.63 per 0.1 dB/cm/MHz, p=0.02, AUC=0.66], BMI [OR: 1.23, p<0.001, AUC=0.77], and SCD [OR: 1.27, p<0.001, AUC=0.81) were predictors of non-diagnostic SWE. UGAP prediction of non-diagnostic SWE was similar in subgroups with the measurement region at least 1 cm (OR: 1.64, n = 68), and 2 cm (OR: 1.54, n = 16) from the liver capsule. UGAP was a worse predictor than SCD (p = 0.04), while not significantly different than BMI (p = 0.15). BMI and SCD did not differ in predicting non-diagnostic SWE (p = 0.44). ConclusionOur small preliminary study demonstrated that body habitus and hepatic attenuation, a marker of steatosis, both contribute to non-diagnostic SWE exams, however body wall thickness is the key driver. This informs patient selection for SWE exams and guides future research to mitigate these technical shortcomings. Clinical Relevance/ApplicationPatients with hepatic steatosis and large body habitus are at increased risk of non-diagnostic ultrasound shear wave elastography (SWE) exams. These patients, particularly those with increased body wall thickness, may benefit from liver fibrosis evaluation with alternative approaches following an initial non-diagnostic SWE exam. Researchers working to improve SWE technique should pay particular attention to mitigating attenuation and phase aberration from the body wall as this is the key driver of non-diagnostic exams.

Clinical significance of appendicoliths in elderly patients over eighty years old undergoing emergency appendectomy: A single-center retrospective study

BACKGROUND Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation. AIM To analyze the clinical data of elderly patients undergoing emergency appendectomy for acute appendicitis, aiming to improve treatment strategies. METHODS The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed. The patients were divided into two groups based on the presence of an appendicolith or not, and clinicopathological and surgery-related features were compared between the two groups. RESULTS The duration of abdominal pain in all 122 patients ranged from 5 to 168 h. All patients underwent emergency appendectomy: 6 had an open appendectomy, 101 had a laparoscopic appendectomy, and 15 required conversion from laparoscopic to open surgery, resulting in a conversion rate of 12.9% (15/116). The patients were divided into two groups: Appendicolith group (n = 46) and non-appendicolith group (n = 76). Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene (84.8% vs 64.5%, P = 0.010) and perforation (67.4% vs 48.7%, P = 0.044), and had a lower surgical conversion rate (2.2% vs 19.7%, P = 0.013). The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them. All patients were successfully discharged. CONCLUSION Around 40% of patients over 80 years old with acute appendicitis have an appendicolith, increasing their risk of developing appendiceal gangrene and perforation, and therefore should receive timely surgical treatment.

Diagnostic value of tissue plasminogen activator-inhibitor complex in sepsis-induced liver injury: A single-center retrospective case-control study

BACKGROUND Sepsis often causes severe liver injury and leads to poor patient outcomes. Early detection of sepsis-induced liver injury (SILI) and early treatment are key to improving outcomes. AIM To investigate the clinical characteristics of SILI patients and analyze the associated risk factors, to identify potential sensitive biomarkers. METHODS Retrospective analysis of clinical data from 546 patients with sepsis treated in the intensive care unit of the 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force between May 2018 and December 2022. The patients were divided into the sepsis group (n = 373) and SILI group (n = 173) based on the presence of acute liver injury within 2 hours of admission. We used the random forest algorithm to analyze risk factors and assessed potential diagnostic markers of SILI using the area under the receiver operating characteristic curve, Kaplan-Meier survival curves, subgroup analysis and correlation analysis. RESULTS Compared with the sepsis group, tissue plasminogen activator-inhibitor complex (t-PAIC) levels in serum were significantly higher in the SILI group (P &lt; 0.05). Random forest results showed that t-PAIC was an independent risk factor for SILI, with an area under the receiver operating characteristic curve of 0.862 (95% confidence interval: 0.832-0.892). Based on the optimal cut-off value of 11.9 ng/mL, patients at or above this threshold had significantly higher levels of lactate and Acute Physiology and Chronic Health Evaluation II score. The survival rate of these patients was also significantly worse (hazard ratio = 2.2, 95% confidence interval: 1.584-3.119, P &lt; 0.001). Spearman’s correlation coefficients were 0.42 between t-PAIC and lactate, and 0.41 between t-PAIC and aspartate transaminase. Subgroup analysis showed significant differences in t-PAIC levels between patients with different severity of liver dysfunction. CONCLUSION T-PAIC can serve as a diagnostic indicator for SILI, with its elevation correlated with the severity of SILI.

How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience

BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition. The optimal management strategy is still unclear. AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks. METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023. Clinical outcomes were analyzed, and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus, when feasible. RESULTS Among the whole series of 60 patients, an urgent surgery was required in 8 cases due to a septic state. Fifty-six patients were managed by endoscopic or hybrid treatments, obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus. The mean time to resolution was 54.95 ± 52.64 days, with a median of 35.5 days. No severe complications were recorded. Ten patients out of 56 (17.9%) developed pneumonia that was treated by specific antibiotic therapy, and in 6 cases (10.7%) an atrial fibrillation was recorded. Seven patients (12.5%) developed a stricture within 12 months, requiring one or two endoscopic pneumatic dilations to solve the problem. Mortality was 1.7%. CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

Comparison of functional outcome after intracerebral hemorrhage in patients with or without end stage renal disease on hemodialysis: a propensity-score matched study

Abstract Background End stage renal disease (ESRD) requiring hemodialysis (HD) increases mortality among patients with intracerebral hemorrhage (ICH). The aim of this study is to investigate the clinical characteristics and outcome of ICH patients with ESRD on HD versus propensity-score matched controls. Methods This is a single center retrospective study. Consecutive ICH admissions at the University of California, Irvine Medical Center from January 1, 2018 to July 31, 2022 were analyzed. Results Among 347 ICH admissions that met inclusion criteria, 24 patients (6.92%) had ESRD on HD. Compared to patients without ESRD, patients with ESRD on HD had significantly higher rate of diabetes mellitus (79.2% vs. 36.8%, p &lt; 0.01) and in-hospital mortality (25% vs. 7.43%, p &lt; 0.01). There were no significant differences in demographics, other comorbidities, clinical characteristics, good (mRS score 0–3) or poor (mRS score 4–5) functional outcomes, rate of comfort care and the time to comfort care decision between the 2 groups. After propensity score matching, the ESRD group had a significantly higher in-hospital mortality rate (27.3% vs. 8%, p = 0.012) and a lower rate of obesity (9.1% vs. 34.1%, p = 0.02). Among patients who died during admission, ESRD on HD status did not inadvertently influence end-of-life care decisions. Univariate logistic regression and area under curve analysis showed that ICH score ≥ 3 was a predictor of increased mortality in both ESRD and non-ESRD groups. Conclusions ICH patients with ESRD on HD had significantly higher in-hospital mortality and lower rate of obesity than propensity score matched controls, suggesting a survival benefit from obesity. ICH score ≥ 3 is an independent predictor for poor outcomes in both ESRD and non-ESRD groups.

Application of Intelligent Management Model Based on Electronic Patient-Reported Outcome During Immunotherapy in Patients with Gastric Cancer: A Single-Center Retrospective Study

Aims/Background Gastric cancer is the third leading cause of cancer-related death worldwide, which seriously affects the health of patients. Immunotherapy is a commonly used clinical treatment for gastric cancer, but the adverse events caused by it seriously affect the prognosis of patients. Therefore, it is necessary to control and manage the disease risk of patients during immunotherapy. To explore the effect of applying an intelligent management model based on electronic patient-reported outcome (ePRO) in patients with gastric cancer during immunotherapy. Methods The clinical data of 184 gastric cancer patients receiving immunotherapy in The Fourth Hospital of Hebei Medical University from September 2021 to September 2023 were retrospectively analyzed. Ninety patients receiving ePRO-based intelligent management were selected, and 85 patients were included in the observation group after excluding 5 patients. For the reference group, 94 patients receiving common case management were selected, with 90 patients being included after excluding 4 patients. After 6 months of follow-up, the nutritional status score, quality of life, treatment compliance and adverse events were compared between the two groups. Results No significant difference was detected in nutritional status and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores of the patients before discharge (p &gt; 0.05). After 2 months of follow-up, compared with the reference group, the observation group had a higher proportion of patients in grade A and grade B, which was not statistically significant (p &gt; 0.05), and significantly higher physiological and psychological scores (p &lt; 0.001), but showed no meaningful differences in other fields (p &gt; 0.05). After 4 months of follow-up, the nutritional status in the observation group was significantly improved (p &lt; 0.05), and the subjects displayed higher WHOQOL-BREF scores (p &lt; 0.05) than those in the reference group. No significant difference in the incidence of adverse events was detected (p &gt; 0.05). After 6 months of follow-up, the treatment compliance of the observation group was 83.53%, which was significantly higher than that of the reference group (70.00%; p &lt; 0.05). Conclusion The intelligent management model based on ePRO is conducive to improving the nutritional status of patients with gastric cancer during immunotherapy, as well as enhancing their quality of life and treatment compliance, making it worthy of clinical application.

Drainless Uniportal VATS Wedge Resection for Early Non-Small Cell Lung Cancer: Propensity Analysis of the Effect of Polyglycolic Acid Sheet (NeoveilTM)

Objectives: Absorbable biomaterials as adjuvant therapy after thoracoscopy are sometimes used in clinical scenarios. With the prevalence of enhanced rapid recovery in thoracic surgery, drainless video-assisted thoracoscopy surgery (VATS) is often adopted by thoracic surgeons. Here, we discuss utilizing an absorbable biomaterial, NeoveilTM (Polyglycolic Acid sheet), for drainless VATS to treat early lung cancer. Methods: This single-center retrospective study was conducted from January 2018 to December 2022 at the National Taiwan University Hospital. We included patients who underwent drainless VATS for early-stage non-small cell lung cancer (NSCLC) in our institute. Propensity analysis was used to minimize selection bias. Outcome measurements were in-hospital stay, operation time, rate of thoracocentesis or chest drain re-insertion, complication rate, and perioperative course. Results: During the study period, 158 lung cancer patients were performed with drainless VATS wedge resection. Among them, Neoveil for stapling line coverage was done in 72 patients, while 86 patients did not receive Neoveil. After propensity analysis, we had 58 patients using Neoveil after drainless thoracoscopic lung resection, compared fairly with 58 patients without Neoveil after the same procedure. The basic characteristics are comparable regarding age, gender, BMI, operation methods, and lung cancer stage after propensity matching. The in-hospital stay (3.2 days in the Neoveil group and 5.6 days in the non-Neoveil group) and operation time (95.7 min in the Neoveil group and 59.3 min in the non-Neoveil group) are significantly different (p = 0.0001). One versus four patients was noted for postoperative conversion chest drainage insertion in each group (p = 0.17). Neither late complications nor recurrence/metastasis occurred in both groups during the following. Conclusions: Based on our 5-year retrospective study, which is balanced with propensity analysis, drainless thoracoscopic surgery treating early lung cancer can be enhanced by Neoveil with faster recovery by reducing the hospital stay, though with longer operation time.

Incidence and risk factors of adverse events after distal radius fracture fixation with volar locking plates: retrospective analysis of 2,790 cases

Background and purpose: 12–18% of patients encounter adverse events after distal radius fracture (DRF) surgery with volar locking plates (VLPs). Risk factors for which preventive measures could be administered are currently scarce. We aimed to examine the incidence of postoperative adverse events and assess the causes and risk factors for the adverse events after VLP fixation of DRFs.Methods: We performed a single-center retrospective cohort study evaluating all adult DRF patients treated with VLP fixation between 2009 and 2019 at Helsinki University Hospital. Patients with previous disabilities or ulnar fractures, other than styloid process fractures, in the affected extremity were excluded. We examined each patient’s treatment using the electronic medical records system and identified postoperative adverse events defined as any deviation from the ordinary postoperative course, showcasing clinical symptoms. We used multivariable binary logistic regression to assess the risk for adverse events.Results: 2,790 cases of DRF were included. The incidence of adverse events was 16%. Hardware complications (8.3%), predominantly intra-articular screws (4.9%), were the most commonly encountered adverse events. Other frequent adverse events included carpal tunnel syndrome (2.8%), tendon complications (2.8%), and surgical site infections (1.5%). In the multivariable analysis, smoking, higher body mass index (BMI), alcohol abuse, C-type fractures, residual intra-articular displacement, and dorsal tilt were found as risk factors for adverse events.Conclusion: The incidence of adverse events was 16% after VLP fixation of DRFs. We identified several new risk factors for adverse events, which included residual dorsal tilt, intra-articular dislocation, insufficiently corrected inclination, smoking, alcohol abuse, and higher BMI.

Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) versus surgical findings in assessment of urethral strictures length

Background and objective: Retrograde urethrography (RUG) combined with voiding cystourethrography (VCUG) is the most common and preferred imaging modality for evaluating urethral strictures, despite its well-known limitations and disadvantages. In this study, we assessed the clinical relevance of RUG + VCUG, along with intraoperative assessment in measuring male urethral strictures. Method: This study was a single-center retrospective study involving 134 male patients diagnosed with urethral stricture disease. All participants underwent RUG + VCUG before the intervention, and the results were interpreted by a single radiologist. The location and length of urethral strictures were assessed. The accuracy of urethral stricture measurements obtained from combined VCUG and RUG imaging was compared to intraoperative measurements, which served as the reference standard. Urethral strictures were classified into three types: membranous and bulbomembranous, bulbar, and penile. Results: A total of 130 patients were included (38.14 ± 12.05 years) in the study. For patients with membranous and bulbar strictures, there were statistically significant differences in stricture length measurements between VCUG + RUG and surgical evaluation ( p &lt; 0.05). However, for patients with penile strictures, the differences in stricture length measurements between VCUG + RUG and surgical evaluation were not statistically significant ( p = 0.448). Conclusion: This study suggests that RUG + VCUG may underestimate urethral stricture, particularly in the membranous and bulbar regions.

The Utility of Pre-Procedural Blood Tests in Neuraxial Blocks: A Retrospective Study in High-Risk Patients

Background/Objectives: The necessity and clinical utility of routine pre-procedural blood tests (PBTs) before neuraxial blockade remain controversial. This study evaluates the effectiveness of PBTs in identifying clinically significant conditions in an outpatient setting. Methods: This single-center retrospective study involved patients who received neuraxial blockades from January 2020 to August 2023. We extracted medical information and laboratory data from the electronic medical records during the pre-procedural period. Through a multivariate regression analysis, we identified patient factors associated with abnormal laboratory results. Results: Advanced age (OR, 1.021; p = 0.026) and a history of cancer (OR, 2.359; p = 0.016) were significantly associated with elevated CRP levels (&gt;0.30 mg/dL). Severe hyperglycemia (≥200 mg/dL) was found in 24 patients (3.88%), with a history of cancer being a strong predictor (OR, 6.764; p &lt; 0.001). No significant abnormalities were observed in PT or PTT. Reduced eGFR (&lt;60 mL/min/1.73 m2) was detected in 8.62% of patients, despite no prior history of renal dysfunction. A multivariate analysis revealed that advanced age, hypertension, cancer, and coronary artery disease were significant predictors of abnormal PBT results, highlighting the importance of selective testing in high-risk patients. Conclusions: Routine PBTs are not universally required for all patients undergoing neuraxial blockade but can provide crucial information in high-risk populations. A selective testing approach based on individual risk factors is recommended to optimize patient safety and resource utilization. Future studies should aim to establish clear guidelines for targeted PBT use.

Predictive value of qSOFA and hypothermia combined with PT for prognosis in patients with severe trauma: a single-center retrospective cohort study

Predictive value of qSOFA and hypothermia combined with PT for prognosis in patients with severe trauma: a single-center retrospective cohort study

COVID-19 in children with somatic pathology

The coronavirus infection is a pressing issue in modern healthcare, yet the characteristics of the SARS-CoV-2 infection course in children with comorbidities remain insufficiently studied. The aim of this study was to evaluate the clinical form, severity, and duration of SARS-CoV-2 virus shedding in pediatric patients with somatic diseases, depending on the comorbid pathology. Materials and Methods. A comprehensive single-center retrospective study was conducted, analyzing 314 medical records of patients hospitalized in the infectious diseases department of the Russian Children’s Clinical Hospital in Moscow over 11 months in 2022. The inclusion criterion was the presence of a laboratory-confirmed COVID-19 diagnosis. Results. Children with comorbidities were found to be predisposed to a more severe course of SARS-CoV-2 infection compared to the pediatric population in general. Children with hematological diseases were at the highest risk of adverse outcomes from COVID-19. Patients with oncological and hematological diseases and primary immunodeficiencies shed the SARS-CoV-2 virus significantly longer than patients with other somatic pathologies. The duration of SARS-CoV-2 RNA detection in patients with severe COVID-19 was significantly longer, which also correlated with the severity of the underlying somatic disease. Conclusion. Children with comorbidities are at risk for a more severe and prolonged course of SARS-CoV-2 infection.

Metal stent versus plastic stent in endoscopic ultrasound-guided hepaticogastrostomy for unresectable malignant biliary obstruction: Large single-center retrospective comparative study.

Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS. In this single-center retrospective study, we included patients (MS/PS groups: n = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO). The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (-45.1% vs. -23.7%, P = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; P = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, P < 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, P = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (Pinteraction = 0.034). After endoscopic re-intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, P = 0.47). Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS-HGS.

CT-defined muscle density as a prognostic factor in multiple myeloma undergoing autologous stem cell therapy: a retrospective single center study.

Skeletal muscle quality assessment can be performed by cross-sectional imaging. Skeletal muscle density (SMD) identified to be of prognostic relevance of several clinically outcomes in patients with hematological diseases. The purpose of the present study was to establish the effect of SMD on overall survival (OS) and progression-free survival (PFS) in patients with multiple myeloma (MM). All patients with MM were retrospectively analyzed between 2009 and 2019. 127 patients were included into the analysis. Whole-body computed tomography (CT) was used to calculate skeletal muscle index (SMI), SMD, albumin-gauge score and intramuscular adipose tissue content (IMAC). Overall, 28 patients (22.0%) of the patient sample died. In the discrimination analysis muscle density was higher in non-survivors compared to survivors (mean 30.8 ± 12.5 versus 24.1 ± 15.8, p = 0.03) and IMAC was lower in non-survivors (-0.66 ± 1.8 versus -0.25 ± 0.21, p = 0.01). These differences, however, were not demonstrated in the logistic regression analysis, which could not show prognostic relevance for the investigated muscle density parameters on PFS or OS. CT-defined muscle density parameters have no prognostic relevance on survival in patients with MM undergoing autologous stem cell therapy, which was demonstrated in a comprehensive analysis. These results corroborate previous smaller studies that body composition might have a limited role in this tumor entity.

Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.

Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs. The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR. After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores. Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications. UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes. Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.