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Background: Reactivation of cytomegalovirus (CMV) infection in transplant patients is high because of immunosuppression. We have evaluated the clinical and epidemiological characteristics of early versus late onset of CMV infection among renal transplant recipients. Methods: A single center retrospective observational study was conducted among renal transplant recipients who underwent kidney transplant between January 2002 and December 2021. CMV disease was classified as early or late depending on its detection prior to or after 90 days post-transplantation. Herein, we reported the differences between early and late onset of CMV disease with respect to clinical symptoms, the use of immunosuppression and the impact on graft outcomes. Results: Out of total 2164 renal transplant recipients, 156 patients (7.2%) were diagnosed with CMV disease. Among these 156 patients, 25 patients (16%) had early CMV while 131 patients (84%) had late CMV. Overall, the two groups did not differ with respect to the induction or maintenance of immunosuppressive agents. However, the proportion of CMV syndrome was greater among early (56.0%) than late (26.7%) CMV groups (p = 0.01). In contrast, tissue invasive disease was more frequent among late (73.3%) in comparison to early (44.0%) CMV groups (p = 0.01). Among clinical symptoms, diarrhea was more frequent in late (63.4%) vs. early (36%) CMVaffected patients (p = 0.01). Graft loss occurred in 4.0% of early CMV group vs. 25.2% of late CMV group (p = 0.03). Neither of the clinical groups differed with respect to occurrence of biopsy-proven allograft rejection postinfection. Conclusions: Early CMV disease presents more frequently as CMV syndrome while late CMV disease usually manifests itself as tissue invasive disease. Graft loss is more common in patients with late onset of CMV disease. [ABSTRACT FROM AUTHOR]

The age of drinking onset is a central concept for both policy and prevention of alcohol-related harm, yet evidence on the predictive value of the age of onset is lacking. This study compares alcohol outcomes of adolescents who started to drink early with those who started later, and tests if associations are moderated by other explanatory factors. Data from a two-wave longitudinal prospective cohort survey with a Swedish nationwide sample of 4,018 adolescents aged 15/16 years at baseline (T1) and 17/18 years at follow-up (T2) were used. Outcome variables at T2 were Alcohol Use Disorders Identification Test (AUDIT)–C, risky drinking, and binge drinking monthly or more often. A vast number of explanatory factors at T1 were controlled for. Early drinking onset predicted later higher AUDIT-C scores (β = 0.57, p value <.001), and higher probability of risky drinking (odds ratio = 1.95, 95% confidence interval = 1.56–2.44), and binge drinking (odds ratio = 1.38, confidence interval = 1.06–1.81), controlled for other explanatory factors. If binge drinking frequency at T1 was included, the associations remained for AUDIT-C and risky drinking, but not for binge drinking at T2. No significant interactions between early drinking onset and the explanatory factors were found. Early drinking onset predicts subsequent higher alcohol consumption in late adolescence. Adolescents who had an early drinking onset drank more after 2 years than their peers who started later. The age of drinking onset is an independent predictor of alcohol use outcomes, beyond the effect of age of binge drinking onset. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the performance of technical–tactical actions in two different types of tournaments and the influence of biological age on the performance of young basketball players. Thirty-seven under-13 male basketball players (age = 12.91 ± 0.57 years) were selected from four southeast Spanish teams to participate in two different tournaments on two consecutive days. The following technical–tactical variables were analysed: (a) Ball Obtained; (b) Ball Handler Player Actions; (c) Ball Handler Player Finished Actions; and (d) Ball Handler Shooting Performance. The results showed that reduced basket height and a closer three-point line promoted a higher number of balls obtained, 1 vs. 1 situations, finished ball player actions, shots, and the efficacy of offence phases. There was a significant increase in the number of balls obtained, 1 vs. 1 situations played, the number of plays finished with a lay-up or shot, number of received personal fouls, number of plays finished in 1 vs. 2, and those finished in equality and inferiority with a high defence opposition. The modified version presented a higher number of technical–tactical actions in Late Maturity players. The authors of this study believe that it is necessary to conduct more experimental studies and use bio-banding strategies in young basketball competitions. [ABSTRACT FROM AUTHOR]

Abstract Objectives To assess the impact of early tracheostomy (ET) versus late tracheostomy (LT) placement on mortality and decannulation rates of COVID patients. Methods A retrospective chart review was performed of all patients infected with COVID‐19 who underwent tracheostomy tube placement in an Ochsner‐affiliated hospital from March 2020 to May 2022. Patients were identified using the electronic medical record and data was collated using the “Epic SlicerDicer” tool. Descriptive statistics were gathered and compared between patients who underwent ET placement and those who underwent LT placement. Patient demographics, previous medical history, tracheostomy procedural details, arterial blood gases, complications, and outcomes including time to wean from the ventilator, and time to decannulation were recorded. Results Two‐hundred nineteen patients were included in the study. There were no statistically significant differences in liberation from mechanical ventilation rates between early and LT (62% vs. 55%, p = .19), or in decannulation rates (40% vs. 32%, p = .14). The mean duration of time to liberation from mechanical ventilation for early trach was 13.88 versus 18.17 days for late trach, however, no statistically significant difference was found (p = .12). Similarly, mean duration of time to decannulation was 41.17 days for early versus 47.72 for late trach (p = .15). Conclusion Contrary to some studies in the literature, the results presented here suggest ETs are not associated with hastened liberation from mechanical ventilation or increased decannulation rates. Further prospective studies may be warranted in assessing the impact of early versus LT in the COVID patient population. Level of Evidence III.

Objectives: To assess the impact of early tracheostomy (ET) versus late tracheostomy (LT) placement on mortality and decannulation rates of COVID patients. Methods: A retrospective chart review was performed of all patients infected with COVID‐19 who underwent tracheostomy tube placement in an Ochsner‐affiliated hospital from March 2020 to May 2022. Patients were identified using the electronic medical record and data was collated using the "Epic SlicerDicer" tool. Descriptive statistics were gathered and compared between patients who underwent ET placement and those who underwent LT placement. Patient demographics, previous medical history, tracheostomy procedural details, arterial blood gases, complications, and outcomes including time to wean from the ventilator, and time to decannulation were recorded. Results: Two‐hundred nineteen patients were included in the study. There were no statistically significant differences in liberation from mechanical ventilation rates between early and LT (62% vs. 55%, p =.19), or in decannulation rates (40% vs. 32%, p =.14). The mean duration of time to liberation from mechanical ventilation for early trach was 13.88 versus 18.17 days for late trach, however, no statistically significant difference was found (p =.12). Similarly, mean duration of time to decannulation was 41.17 days for early versus 47.72 for late trach (p =.15). Conclusion: Contrary to some studies in the literature, the results presented here suggest ETs are not associated with hastened liberation from mechanical ventilation or increased decannulation rates. Further prospective studies may be warranted in assessing the impact of early versus LT in the COVID patient population. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

This study aimed to: (1) identify all relevant studies reporting on the diagnostic accuracy of maternal circulating placental growth factor) alone or as a ratio with soluble fms-like tyrosine kinase-1), and of placental growth factor-based models (placental growth factor combined with maternal factors±other biomarkers) in the second or third trimester to predict subsequent development of preeclampsia in asymptomatic women; (2) estimate a hierarchical summary receiver-operating characteristic curve for studies reporting on the same test but different thresholds, gestational ages, and populations; and (3) select the best method to screen for preeclampsia in asymptomatic women during the second and third trimester of pregnancy by comparing the diagnostic accuracy of each method. A systematic search was performed through MEDLINE, Embase, CENTRAL, ClinicalTrials.gov , and the World Health Organization International Clinical Trials Registry Platform databases from January 1, 1985 to April 15, 2021. Studies including asymptomatic singleton pregnant women at >18 weeks' gestation with risk of developing preeclampsia were evaluated. We included only cohort or cross-sectional test accuracy studies reporting on preeclampsia outcome, allowing tabulation of 2×2 tables, with follow-up available for >85%, and evaluating performance of placental growth factor alone, soluble fms-like tyrosine kinase-1– placental growth factor ratio, or placental growth factor-based models. The study protocol was registered on the International Prospective Register Of Systematic Reviews (CRD 42020162460). Because of considerable intra- and interstudy heterogeneity, we computed the hierarchical summary receiver-operating characteristic plots and derived diagnostic odds ratios, β, θ i , and Λ for each method to compare performances. The quality of the included studies was evaluated by the QUADAS-2 tool. The search identified 2028 citations, from which we selected 474 studies for detailed assessment of the full texts. Finally, 100 published studies met the eligibility criteria for qualitative and 32 for quantitative syntheses. Twenty-three studies reported on performance of placental growth factor testing for the prediction of preeclampsia in the second trimester, including 16 (with 27 entries) that reported on placental growth factor test alone, 9 (with 19 entries) that reported on the soluble fms-like tyrosine kinase-1–placental growth factor ratio, and 6 (16 entries) that reported on placental growth factor-based models. Fourteen studies reported on performance of placental growth factor testing for the prediction of preeclampsia in the third trimester, including 10 (with 18 entries) that reported on placental growth factor test alone, 8 (with 12 entries) that reported on soluble fms-like tyrosine kinase-1–placental growth factor ratio, and 7 (with 12 entries) that reported on placental growth factor-based models. For the second trimester, Placental growth factor-based models achieved the highest diagnostic odds ratio for the prediction of early preeclampsia in the total population compared with placental growth factor alone and soluble fms-like tyrosine kinase-1–placental growth factor ratio (placental growth factor-based models, 63.20; 95% confidence interval, 37.62–106.16 vs soluble fms-like tyrosine kinase-1–placental growth factor ratio, 6.96; 95% confidence interval, 1.76–27.61 vs placental growth factor alone, 5.62; 95% confidence interval, 3.04–10.38); placental growth factor-based models had higher diagnostic odds ratio than placental growth factor alone for the identification of any-onset preeclampsia in the unselected population (28.45; 95% confidence interval, 13.52–59.85 vs 7.09; 95% confidence interval, 3.74–13.41). For the third trimester, Placental growth factor-based models achieved prediction for any-onset preeclampsia that was significantly better than that of placental growth factor alone but similar to that of soluble fms-like tyrosine kinase-1–placental growth factor ratio (placental growth factor-based models, 27.12; 95% confidence interval, 21.67–33.94 vs placental growth factor alone, 10.31; 95% confidence interval, 7.41–14.35 vs soluble fms-like tyrosine kinase-1–placental growth factor ratio, 14.94; 95% confidence interval, 9.42–23.70). Placental growth factor with maternal factors ± other biomarkers determined in the second trimester achieved the best predictive performance for early preeclampsia in the total population. However, in the third trimester, placental growth factor-based models had predictive performance for any-onset preeclampsia that was better than that of placental growth factor alone but similar to that of soluble fms-like tyrosine kinase-1–placental growth factor ratio. Through this meta-analysis, we have identified a large number of very heterogeneous studies. Therefore, there is an urgent need to develop standardized research using the same models that combine serum placental growth factor with maternal factors ± other biomarkers to accurately predict preeclampsia. Identification of patients at risk might be beneficial for intensive monitoring and timing delivery. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the performance of technical–tactical actions in two different types of tournaments and the influence of biological age on the performance of young basketball players. Thirty-seven under-13 male basketball players (age = 12.91 ± 0.57 years) were selected from four southeast Spanish teams to participate in two different tournaments on two consecutive days. The following technical–tactical variables were analysed: (a) Ball Obtained; (b) Ball Handler Player Actions; (c) Ball Handler Player Finished Actions; and (d) Ball Handler Shooting Performance. The results showed that reduced basket height and a closer three-point line promoted a higher number of balls obtained, 1 vs. 1 situations, finished ball player actions, shots, and the efficacy of offence phases. There was a significant increase in the number of balls obtained, 1 vs. 1 situations played, the number of plays finished with a lay-up or shot, number of received personal fouls, number of plays finished in 1 vs. 2, and those finished in equality and inferiority with a high defence opposition. The modified version presented a higher number of technical–tactical actions in Late Maturity players. The authors of this study believe that it is necessary to conduct more experimental studies and use bio-banding strategies in young basketball competitions.

Purpose: The incidence of osteoporotic compression fractures (VCFs) have been rising over the past decades. Presently, vertebral cement augmentation procedures such as balloon kyphoplasty and vertebroplasty are common treatments allowing pain relief and functional recovery. However, there is controversy on whether different timeframes for cement augmentation affects clinical outcomes. Hence, this study aimed to compare pain relief and complication rates between early versus late cement augmentation. Methods: A comprehensive systematic review of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared early versus late cement augmentation for VCFs. As the definitions of "early" and "late" phases across studies are heterogenous, we established the cut-off between early and late phase as intervals to accommodate as many studies as possible for analysis. We conducted two separate analyses with different cut-off intervals and included studies that reported interventions within these respective time intervals. In analysis 1, we included studies which grouped patients into "early" and "late" group based on a cut-off time frame of 2–4 weeks. On the other hand, in analysis 2, we included studies which grouped patients into "early" and "late" groups based on a cut-off time frame of 6–8 weeks. Meta-analysis was conducted via random-effect models, comparing outcomes of interest between early and late groups. Results: Eleven studies were included. The total cohort size was 712 and 775 patients in analysis 1 and 2 respectively. Mean follow-up was 12.9 ± 3.7 months and 11 ± 0.6 months respectively. VAS change at final follow-up was significantly greater in the early group for both analyses. (MD = − 0.66, p = 0.01; and MD = − 1.18, p < 0.005 respectively). There was no significant difference in post-operative absolute VAS score, number of cement leakage, number of adjacent compression fractures and local kyphotic angle, for both analyses. Patients in both groups experienced reductions in VAS score that exceeded the minimum clinically important difference. Conclusion: Both early and late timeframes for cement augmentation offered significant improvement in pain relief, with similar post-operative absolute pain score, kyphotic angle, cement leakage and adjacent vertebral fractures. Early surgery may offer substantial pain relief in patients presenting with pain as early as < 2–4 weeks of VCFs. [ABSTRACT FROM AUTHOR]

Background: ICU readmission is associated with poor outcomes. Few studies have directly compared the outcomes of early versus late readmissions, especially in Saudi Arabia. Objective: To compare the outcomes between early and late ICU readmissions, mainly with regards to hospital mortality. Methods: This retrospective study included unique patients who, within the same hospitalization, were admitted to the ICU, discharged to the general wards, and then readmitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 01, 2015, and June 30, 2022. Patients readmitted within 2 calendar days were grouped into the Early readmission group, while those readmitted after 2 calendar days were in the Late readmission group. Results: A total of 997 patients were included, of which 753 (75.5%) belonged to the Late group. The mortality rate in the Late group was significantly higher than that in the Early group (37.6% vs. 29.5%, respectively; 95% CI: 1%–14.8%; P = 0.03). The readmission length of stay (LOS) and severity score of both groups were similar. The odds ratio of mortality for the Early group was 0.71 (95% CI: 0.51–0.98, P = 0.04); other significant risk factors were age (OR = 1.023, 95% CI: 1.016–1.03; P < 0.001) and readmission LOS (OR = 1.017, 95% CI: 1.009–1.026; P < 0.001). The most common reason for readmission in the Early group was high Modified Early Warning Score, while in the Late group, it was respiratory failure followed by sepsis or septic shock. Conclusion: Compared with late readmission, early readmission was associated with lower mortality, but not with lower LOS or severity score.

Background: ICU readmission is associated with poor outcomes. Few studies have directly compared the outcomes of early versus late readmissions, especially in Saudi Arabia. Objective: To compare the outcomes between early and late ICU readmissions, mainly with regards to hospital mortality. Methods: This retrospective study included unique patients who, within the same hospitalization, were admitted to the ICU, discharged to the general wards, and then readmitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 01, 2015, and June 30, 2022. Patients readmitted within 2 calendar days were grouped into the Early readmission group, while those readmitted after 2 calendar days were in the Late readmission group. Results: A total of 997 patients were included, of which 753 (75.5%) belonged to the Late group. The mortality rate in the Late group was significantly higher than that in the Early group (37.6% vs. 29.5%, respectively; 95% CI: 1%–14.8%; P = 0.03). The readmission length of stay (LOS) and severity score of both groups were similar. The odds ratio of mortality for the Early group was 0.71 (95% CI: 0.51–0.98, P = 0.04); other significant risk factors were age (OR = 1.023, 95% CI: 1.016–1.03; P < 0.001) and readmission LOS (OR = 1.017, 95% CI: 1.009–1.026; P < 0.001). The most common reason for readmission in the Early group was high Modified Early Warning Score, while in the Late group, it was respiratory failure followed by sepsis or septic shock. Conclusion: Compared with late readmission, early readmission was associated with lower mortality, but not with lower LOS or severity score. [ABSTRACT FROM AUTHOR]

Background: An incidental durotomy (IDT) is a frequent complication of spinal surgery. The conventional management involving a period of flat bed rest is highly debatable. Indeed, there are scanty data and no consensus regarding the need or ideal duration of post-operative bed rest following IDT. Objective: To systematically evaluate the literature regarding the outcomes of mobilization within 24 h and after 24 h following IDT in open lumbar or thoracic surgery with respect to the length of hospital stay, minor and major complications. Methods: A systematic review of the literature using PubMed, Embase and Cochrane and dating up until September 2022 was undertaken following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. Results: Out of 532 articles, 6 studies met the inclusion criteria (1 Level-I, 4 level-III and 1 Level-IV evidence) and were analyzed. Overall, 398 patients of mean age 59.9 years were mobilized within 24 h. The average length of stay (LOS) for this group was 5.7 days. Thirty-four patients (8.5%) required reoperation while the rate of minor complications was 25.4%. Additionally, 265 patients of mean age 63 years with IDT were mobilized after 24 h. The average LOS was 7.8 days. Twenty patients (7.54%) required reoperation while the rate of minor complications was 55%. Meta-analysis comparing early to late mobilization, showed a significant reduction in the risk of minor complications and shorter overall LOS due to early mobilization, but no significant difference in major complications and reoperation rates. Conclusions: Although early mobilization after repaired incidental dural tears in open lumbar and thoracic spinal surgery has a similar major complication/ reoperation rates compared to late mobilization, it significantly decreases the risk of minor complications and length of hospitalization. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim is to characterise early and late respiratory and bloodstream co-infection in patients admitted to intensive care units (ICUs) with SARS-CoV-2-related acute hypoxemic respiratory failure (AHRF) needing respiratory support in seven ICUs within Wales, during the first wave of the COVID-19 pandemic. We compare the rate of positivity of different secondary pathogens and their antimicrobial sensitivity in three different patient groups: patients admitted to ICU with COVID-19 pneumonia, Influenza A or B pneumonia, and patients without viral pneumonia. Design Multicentre, retrospective, observational cohort study with rapid microbiology data from Public Health Wales, sharing of clinical and demographic data from seven participating ICUs. Setting Seven Welsh ICUs participated between 10 March and 31 July 2020. Clinical and demographic data for COVID-19 disease were shared by each participating centres, and microbiology data were extracted from a data repository within Public Health Wales. Comparative data were taken from a cohort of patients without viral pneumonia admitted to ICU during the same period as the COVID-19 cohort (referred to as no viral pneumonia or ‘no viral’ group), and to a retrospective non-matched cohort of consecutive patients with Influenza A or B admitted to ICUs from 20 November 2017. The comparative data for Influenza pneumonia and no viral pneumonia were taken from one of the seven participating ICUs. Participants A total of 299 consecutive patients admitted to ICUs with COVID-19 pneumonia were compared with 173 and 48 patients admitted with no viral pneumonia or Influenza A or B pneumonia, respectively. Main outcome measures Primary outcome was to calculate comparative incidence of early and late co-infection in patients admitted to ICU with COVID-19, Influenza A or B pneumonia and no viral pneumonia. Secondary outcome was to calculate the individual group of early and late co-infection rate on a per-patient and per-sample basis, with their antimicrobial susceptibility and thirdly to ascertain any statistical correlation between clinical and demographic variables with rate of acquiring co-infection following ICU admission. Results A total of 299 adults (median age 57, M/F 2:1) were included in the COVID-19 ICU cohort. The incidence of respiratory and bloodstream co-infection was 40.5% and 15.1%, respectively. Staphylococcus aureus was the predominant bacterial pathogen within the first 48 h. Gram-negative organisms from Enterobacterales group were predominantly seen after 48 h in COVID-19 cohort. Comparative no viral pneumonia cohort had lower rates of respiratory tract infection and bloodstream infection. The influenza cohort had similar rates respiratory tract infection and bloodstream infection. Mortality in all three groups was similar, and no clinical or demographic variables were found to increase the rate of co-infection and ICU mortality. Conclusions Higher incidence of bacterial co-infection was found in COVID-19 cohort as compared to the no viral pneumonia cohort admitted to ICUs for respiratory support.

Objective: The aim is to characterise early and late respiratory and bloodstream co-infection in patients admitted to intensive care units (ICUs) with SARS-CoV-2-related acute hypoxemic respiratory failure (AHRF) needing respiratory support in seven ICUs within Wales, during the first wave of the COVID-19 pandemic. We compare the rate of positivity of different secondary pathogens and their antimicrobial sensitivity in three different patient groups: patients admitted to ICU with COVID-19 pneumonia, Influenza A or B pneumonia, and patients without viral pneumonia. Design: Multicentre, retrospective, observational cohort study with rapid microbiology data from Public Health Wales, sharing of clinical and demographic data from seven participating ICUs. Setting: Seven Welsh ICUs participated between 10 March and 31 July 2020. Clinical and demographic data for COVID-19 disease were shared by each participating centres, and microbiology data were extracted from a data repository within Public Health Wales. Comparative data were taken from a cohort of patients without viral pneumonia admitted to ICU during the same period as the COVID-19 cohort (referred to as no viral pneumonia or 'no viral' group), and to a retrospective non-matched cohort of consecutive patients with Influenza A or B admitted to ICUs from 20 November 2017. The comparative data for Influenza pneumonia and no viral pneumonia were taken from one of the seven participating ICUs. Participants: A total of 299 consecutive patients admitted to ICUs with COVID-19 pneumonia were compared with 173 and 48 patients admitted with no viral pneumonia or Influenza A or B pneumonia, respectively. Main outcome measures: Primary outcome was to calculate comparative incidence of early and late co-infection in patients admitted to ICU with COVID-19, Influenza A or B pneumonia and no viral pneumonia. Secondary outcome was to calculate the individual group of early and late co-infection rate on a per-patient and per-sample basis, with their antimicrobial susceptibility and thirdly to ascertain any statistical correlation between clinical and demographic variables with rate of acquiring co-infection following ICU admission. Results: A total of 299 adults (median age 57, M/F 2:1) were included in the COVID-19 ICU cohort. The incidence of respiratory and bloodstream co-infection was 40.5% and 15.1%, respectively. Staphylococcus aureus was the predominant bacterial pathogen within the first 48 h. Gram-negative organisms from Enterobacterales group were predominantly seen after 48 h in COVID-19 cohort. Comparative no viral pneumonia cohort had lower rates of respiratory tract infection and bloodstream infection. The influenza cohort had similar rates respiratory tract infection and bloodstream infection. Mortality in all three groups was similar, and no clinical or demographic variables were found to increase the rate of co-infection and ICU mortality. Conclusions: Higher incidence of bacterial co-infection was found in COVID-19 cohort as compared to the no viral pneumonia cohort admitted to ICUs for respiratory support. [ABSTRACT FROM AUTHOR]

AbstractTracheostomy is a surgical procedure that frequently performed for patients in the intensive care units (ICUs). Prolonged mechanical ventilation (MV) is the main indication for tracheostomy in the ICU.This study aimed to compare the effect of early versus late tracheostomy on duration of mechanical ventilation and ICU length of stay in traumatic brain injury patients and to determine the appropriate timing to perform tracheostomy for those patients.A Prospective comparative study was performed for head trauma patients with Glasgow coma scale (GCS) less than eight who needed endotracheal intubation with or without mechanical ventilation in the ICU of Al-Sadr Teaching Hospital in Basrah from February 2019 up to December 2019.In this study, there were 94% males and 6% females, 52% were in the age group between 20-40 years, median duration on endotracheal tube in early tracheostomy (ET) group was 5 days while in late tracheostomy (LT) group was 11 days. Total duration on MV was significantly shorter in ET group (9.63±1.87 versus 17.81±6.66 days in LT group; p

The study's aim was to examine the effect of chronotype on cognitive performance during a single night shift. Data were collected from 72 (36f) young, healthy adults in a laboratory study. Participants had a 9 h sleep period (03:00-12:00) followed by an 8 h night shift (23:00-07:00). During the night shift, participants completed five test sessions, which included measures of subjective sleepiness, subjective alertness, and sustained attention (i.e., psychomotor vigilance task; PVT). Dim light melatonin onset (DLMO) was derived from saliva samples taken during the evening preceding the night shift. A tertile split of DLMO was used to determine three chronotype categories: earlier (DLMO = 20:22 ± 0:42), intermediate (DLMO = 21:31 ± 0:13), and later (DLMO = 22:54 ± 0:54). There were (a) significant main effects of test session (all p < 0.001); (b) no main effects of chronotype; and (c) no interaction effects between chronotype and test session on sleepiness, alertness, PVT response time, and PVT lapses. The results indicate that under controlled sleeping conditions, chronotype based on dim light melatonin onset did not affect nighttime performance. Differences in performance during night shift between chronotypes reported by field studies may be related to differences in the amount and/or timing of sleep before or between night shifts, rather than circadian timing. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence points to cardiac injury (CI) as a common coronavirus disease 2019 (COVID-19) related complication. The characteristics of early CI (occurred within 72 h of admission) and late CI (occurred after 72 h of admission) and its association with mortality in COVID-19 patients is unknown.Methods: This retrospective study analyzed patients confirmed with COVID-19 in Union Hospital (Wuhan, China) from Jan 29th to Mar 15th, 2020. Clinical outcomes (discharge, or death) were monitored to April 15, 2020, the latest date of follow-up. Demographic, clinical, laboratory, as well as treatment and prognosis were collected and analyzed in patients with early, late CI and without CI.Results: A total of 196 COVID-19 patients were included for analysis. The median age was 65 years [interquartile range (IQR) 56–73 years], and 112 (57.1%) were male. Of the 196 COVID-19 patients, 49 (25.0%) patients had early and 20 (10.2%) patients had late CI, 56.6% developed Acute-Respiratory-Distress-Syndrome (ARDS) and 43 (21.9%) patients died. Patients with any CI were more likely to have developed ARDS (87.0 vs. 40.2%) and had a higher in-hospital mortality than those without (52.2 vs. 5.5%, P < 0.001). Among CI subtypes, a significantly higher risk of in-hospital death was found in patients with early CI with recurrence [19/49 patients, adjusted odds ratio (OR) = 7.184, 95% CI 1.472–35.071] and patients with late CI (adjusted OR = 5.019, 95% CI 1.125–22.388) compared to patients with early CI but no recurrence.Conclusions: CI can occur early on or late after, the initial 72 h of admission and is associated with ARDS and an increased risk of in-hospital mortality. Both late CI and recurrent CI after the initial episode were associated with worse outcomes than patients with early CI alone. This study highlights the importance of early examination and periodical monitoring of cardiac biomarkers, especially for patients with early CI or at risk of clinical deterioration.

Chronotype reflects circadian timing and can be determined from biological markers (e.g., dim light melatonin onset; DLMO), or questionnaires (e.g., Morningness-Eveningness Questionnaire; MEQ, or Munich Chronotype Questionnaire; MCTQ). The study's aim was to quantify concordance between chronotype categorisations based on these measures. A total of 72 (36f) young, healthy adults completed the MEQ and MCTQ and provided saliva samples hourly in dim light during the evening in a laboratory. The corrected midpoint of sleep on free days (MSFsc) was derived from MCTQ, and tertile splits were used to define early, intermediate and late DLMO-CT, MEQ-CT and MSFsc-CT chronotype categories. DLMO correlated with MEQ score (r = -0.25, p = 0.035) and MSFsc (r = 0.32, p = 0.015). For early, intermediate and late DLMO-CT categories, mean(SD) DLMO were 20:25(0:46), 21:33(0:10) and 23:03(0:53). For early, intermediate and late MEQ-CT categories, mean(SD) MEQ scores were 60.5(5.3), 51.4(2.9) and 40.8 (5.0). For early, intermediate and late MSFsc-CT categories, mean(SD) MSFsc were 03:23(0:34), 04:37(0:12) and 05:55(0:48). Low concordance of categorisations between DLMO-CT and MEQ-CT (37%), and between DLMO-CT and MSFsc-CT (37%), suggests chronotype categorisations depend on the measure used. To enable valid comparisons with previous results and reduce the likelihood of misleading conclusions, researchers should select measures and statistical techniques appropriate to the construct of interest and research question. [ABSTRACT FROM AUTHOR]

Retinal folds are rare complications of rhegmatogenous retinal detachment surgery. They may be located in periphery or involve macula, with the latter ones being associated with severe visual loss. Due to the paucity of scientific reports, its management remains debatable. Most authors advocate an early surgical intervention for symptomatic macular folds (MF). We present 2 cases of symptomatic dry macular fold which were managed successfully after different time intervals. As evidence gets collected that late intervention also leads to good visual outcome, long standing MF should not be considered an absolute contraindication for surgical intervention.

Introduction/Purpose: Reasons of postoperative readmissions may vary based on the timing of rehospitalization. This study characterizes predictors and causes for readmission after bariatric surgery on day-to-day basis after discharge. Materials and Methods: Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were identified. Perioperative factors of early readmissions (post-discharge days 0–9) were compared to those of late readmissions (post-discharge days 10–30). Multivariable analysis was conducted to identify predictors of early versus late readmissions. Reasons for readmissions were characterized on day-to-day basis. Results: Of 509,631 operations, 19,061 (3.7%) cases were readmitted. Of these, 9666 (50.7%) were early, while 9395 (49.3%) were late readmissions. White race (OR = 1.2, CI = [1.1–1.3]), revisional surgery (OR = 1.2, CI = [1.1–1.4]), Roux-en-Y gastric bypass (OR = 1.2, CI = [1.1–1.3]), pulmonary complication (OR = 1.8, CI = [1.5–2.3]), bleeding (OR = 2, CI = [1.6–2.6]), and post-acute care (OR = 1.8, CI = [1.2–2.6]) were predictors of early readmission. Late readmission was associated with body mass index ≥ 40 (CI = 0.83, OR = [0.77–0.89]), renal/urological complication (OR = 0.6, CI = [0.5–0.8]), and deep vein thrombosis (OR = 0.5, CI = [0.4–0.6]). PO intolerance or dehydration/electrolyte imbalance was the most common readmission reason, peaking on post-discharge days 19–30. Pain, medical complications, obstruction, and bleeding were causes of early readmissions. However, venous thromboembolism readmissions peaked after post-discharge day 9. Conclusion: Complex bariatric operations and patients who require post-discharge extended care are associated with early readmissions. Such readmissions are due to early post-discharge complications. However, late readmissions are driven by interrelated risk factors and complications. These findings suggest that targeting patients at risk for delayed rehospitalization is the most efficient approach to minimize readmissions after bariatric surgery. [ABSTRACT FROM AUTHOR]

This study aimed at exploring the role of inflammation in different stages of PD in a sample of PD patients in Al Madinah city, Saudi Arabia, and to identify the relationship between disease duration and level of the inflammatory markers. 22 Parkinson disease (PD) patients in Al Madinah City were subjected to a cross-sectional analysis. Motor and non-motor symptoms evaluation was carried out using the Unified Parkinson's Society Movement Disorders Rating Scale (NMSS) and the Hoehn and Yahr stages. Serum samples and C-reactive protein (CRP), erythrocytes (ESR), and IL-1 levels were measured, were taken. The mean level of CPR was significantly positive concerning the length of the PD, (NMSS), Hoehn-Yahr, and ESR, and important concerning Hoehn and Yahr. The average ESR level for participants was substantially positively correlated, with both the NMSS and the average IL-1 levels, although there was a substantial negative correlation between the average level IL-1 and the mean level Unified Parkinson's (UPDRS). This study recommended future studies done on larger samples that include comprehensive and combined biomarkers for effective PD diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract Background In here, we constructed personalized models for predicting breast cancer (BC) recurrence according to timing of recurrence (as early and late recurrence). Methods An efficient algorithm called group LASSO was used for simultaneous variable selection and risk factor prediction in a logistic regression model. Results For recurrence 5 years, stage 2 cancer (OR 1.67, 95% CI = 1.31–2.14) and radiotherapy+mastectomy (OR 2.45, 95% CI = 1.81–3.32) were significant predictors; furthermore, relative to mastectomy without radiotherapy (as reference for comparison), quadranectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence > 5 years (OR 7.62, 95% CI = 1.52–38.15 vs. OR 1.75, 95% CI = 1.32–2.32). Accuracy, sensitivity, and specificity of the model were 71%, 78.8%, and 55.8%, respectively. Conclusion For the first time, we constructed models for estimating recurrence based on timing of recurrence which are among the most applicable models with excellent accuracy (> 80%).

Background and Objective: Tracheostomy in neurosurgical patients has been shown in various studies to lower the length of ICU stay and the length of hospital stay by decreasing the incidence of ventilator associated pneumonia. In this regard, we wanted to evaluate the outcome of neurosurgical ICU patients based on timing of tracheostomy and ventilator associated pneumonia. Methods: This is a retrospective single centre study performed over a period of two and a half years. Early tracheostomy was defi ned as those done three days of intubation or earlier and late as those done then after. Statistical analysis was done using SPSS. Results: There were 56 patients over the study period of which 18 patients underwent early tracheostomy and 38 patients underwent late tracheostomy. There was no statistically significant difference between the two groups with regards to the length of ICU stay, the length of hospital stay or the length of tracheostomy tube in situ. But based on tracheal aspirate culture positivity, length of tracheostomy tube in situ was signifi cantly longer in those with positive bacterial cultures. Early tracheostomy does not improve neurosurgical outcome while documented pneumonia prolongs the length of tracheostomy tube in situ.

This systematic review and meta-analysis assessed the effects of early fortification (EF) versus late fortification (LF) of breast milk (BM) on growth of preterm infants. Randomized and quasi-randomized controlled trials (RCTs) dealing with the effects of EF versus LF on growth parameters, incidence of adverse events, and duration of hospital stay in preterm infants were included. Data were pooled using the RevMan 5.3 software. Quality of evidence for predefined outcomes was analyzed by GRADE. Available evidence (3 RCTs, 309 preterm infants) showed no statistically significant difference between EF and LF of BM for any of the growth parameters-weight (standardized mean difference (SMD) 0.13; 95% confidence interval (CI) - 0.09, 0.36); length (SMD 0.02; 95% CI - 0.20, 0.25); and head circumference (SMD - 0.10; 95% CI - 0.33, 0.12). Total parenteral nutrition days were similar. Duration of hospital stay was significantly higher with EF (MD 4.29; 95% CI 0.84, 7.75) with a trend of non-significant increase in feed intolerance and necrotizing enterocolitis (NEC).Conclusion: Very low quality evidence did not find any significant difference in growth parameters of preterm infants in association with EF or LF of BM. A significant increase in hospital stay and non-significant increase in feed intolerance and NEC were associated with EF.PROSPERO registration number: CRD42019139235What is Known:• Fortification of breast milk with essential macro- and micronutrients is necessary for optimization of nutrition in preterm infants.• There is no consensus regarding the breast milk feeding volume at which fortification should be initiated.What is New:• Very low quality evidence showed no significant difference between early and late fortification of breast milk on growth parameters of preterm infants.• Early fortification was associated with non-significant increase in feed intolerance and necrotizing enterocolitis and a significant increase in hospital stay. [ABSTRACT FROM AUTHOR]

Lactobacillus, Bifidobacterium and Enterococcus cultures are increasingly used as probiotics for humans and pigs. The aim of this study was to investigate if co-cultivation of porcine and human neutrophils with probiotics can lead to increased apoptosis in vitro. Ten adult Large white pigs and 10 healthy human donors were used in this study. Neutrophils were isolated by dextran sedimentation and cultivated with and without the lactic acid bacteria Bifidobacterium bifidum, Lactobacillus rhamnosus, and Enterococcus faecium for 2, 4, 24 and 48 h. Early and late apoptosis was measured using flow cytometry, and cell lysis was detected based on lactate dehydrogenase activity (LDH). A significant (P < 0.05; P < 0.01) increase in apoptotic neutrophils and LDH was observed at 24 h and 48 h in vitro. All probiotics exerted their greatest effects on the early apoptosis of porcine neutrophils, while the effects of L. rhamnosus were most pronounced on late apoptosis and those of B. bifidum on LDH release of human neutrophils. The increased neutrophil apoptosis caused by probiotic bacteria can be beneficial for more efficient efferocytosis and faster resolution of inflammation and tissue regeneration. In conclusion, we have demonstrated that the interaction of B. bifidum, L. rhamnosus, and E. faecium with human and porcine neutrophils leads to their apoptosis.

Objective: To compare the clinical efficacy of early and late application of pulmonary surfactant（Ps） combined with nasal continuous positive airway pressure（NCPAP） in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods: 100 children with NRDS who were admitted to Sanya People’s Hospital from January 2014 to July 2018 were selected, they were divided into control group（n=50） and study group（n=50） according to the random number table method. The control group was treated with NCPAP, and the study group was treated with Ps on the basis of the control group. The children in study group were divided into early group（injected within 6 hours of birth, n=25） and late group（injected within 6 to 12 hours of birth, n=25） according to the injection time of Ps. The clinical effects of control group, early group and late group were observed and compared. The arterial pH（pH）, partial arterial carbon dioxide（PCO2）, arterial oxygen partial pressure（PO2）, end-expiratory positive pressure ventilation（PEEP）, oxygen concentration（FiO2） and complications were compared in three groups before and 1 d after treatment. Results: The total effective rate of early group was higher than that of control group and late group（P<0.05）, but there was no significant difference between control group and late group（P>0.05）. 1 d after treatment, PCO2 in three groups were lower than that before treatment, PO2 was higher than that before treatment, and PCO2 in early group was lower than that in control group and late group, PO2 was higher than that in control group and late group（P<0.05）. However, there was no significant difference in PCO2 and PO2 between control group and late group（P>0.05）. 1 day after treatment,PEEP and FiO2 in three groups were lower than those before treatment, and those in the early group were lower than those in control group and late group（P<0.05）, but there was no significant difference in PEEP and FiO2 between control group and late group（P>0.05）.There were no significant differences in the incidence of complications in three groups（P>0.05）. Conclusion: Compared with advanced stage, early application of Ps combined with NCPAP in the treatment of NRDS is effective. It can improve the blood gas and NCPAP parameters of children, and it will not increase adverse reactions. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is an uncommon complication occurring in up to 5% of trauma patients. In small previous studies, patients with long-bone fractures were associated with a higher risk of early PE while those with severe head injuries were at higher risk for late PE. This was a retrospective analysis at a single level I trauma center from 2010 to 2017. Patients with early PE (≤4 d) were compared to those with late PE (>4 d) using bivariate analysis and multivariable logistic regression analysis. We sought to confirm risk factors for early and late PE, hypothesizing that early PE is associated with long-bone fractures and late PE is associated with above-the-knee deep venous thrombosis (DVT). From 12,833 trauma admissions, 76 patients (0.6%) had a PE. Of these, 33 (43.4%) had an early PE and 43 (54.6%) were diagnosed with late PE. After adjusting for covariates, independent risk factors for late PE included above-the-knee DVT (odds ratio [OR] = 12.01, confidence interval [CI] = 1.34-107.52, P = 0.03), blood transfusion (OR = 8.99, CI = 1.75-46.22, P = 0.009), and craniotomy (OR = 8.82, CI = 1.03-75.97, P = 0.04), while the only independent risk factor for early PE was smoking (OR = 4.56, CI 1.06-19.66, P = 0.04). Severe head injury and long-bone fractures were not risk factors for early or late PE (P > 0.05) The strongest risk factor for late PE is above-the-knee DVT. Contrary to previous reports, long-bone extremity fractures and severe head injuries are not associated with early or late PE. The only risk factor for early PE was a history of smoking. [ABSTRACT FROM AUTHOR]

Objectives: Recurrence may most likely develop during the course of the disease in patients presented with early stage melanoma at initial diagnosis. The specific risk factors for early and late recurrences following definitive surgical excision have yet to be determined. The aim of this study was to analyze the early and late relapses in stage I-III cutaneous melanoma patients.Methods: Of 365 patients with relapses, 189 developed within the first 18 months following surgical intervention (early relapse [ER]) and the remaining 176 occurred later (late relapse [LR]) were analyzed.Results: ER patients were found to have thicker and ulcerated lesions with higher mitotic rates and lymphovascular invasion, and they were found to be more significantly associated with node involvements. Nearly half of the first recurrences were locoregional (49.9%) that were followed by distant metastases alone (26.6%). The distribution of the initial relapse patterns was similar between the ER and the LR groups. The lung was the most frequently metastasized site (43.1%), and it was followed by bone (21.0%), liver (20.7%) and brain (15.1%). On multivariate analysis risk factors in association with both ER and LR were found as follows: ulcerated lesions, high mitotic rate, and node-positive disease; however nodular histopathological subtype and lymphovascular invasion were found to have impact merely on ER, and male gender merely on LR.Conclusion: The current study has detected potential risk factors for relapse of patients who developed ER and LR. These indicators may be useful for rational follow-up programs of the patients. [ABSTRACT FROM AUTHOR]

Introduction: Young children who experience severe-to-profound sensory-neural hearing loss (SNHL) face challenges in developing spoken language since they are unable to detect acoustic-phonetic cues which are essential for speech recognition. Aim: The aim of this study was to examine the influence of age at implantation on children's language development to detect whether early intervention with cochlear implantation in children with severe to profound SNHL results in better linguistic outcomes. Subjects and Methods: 60 children from the cochlear implant unit from the Kasr El Ainy hospital were recruited to participate in this cross sectional study. They suffered from congenital bilateral severe to profound sensori-neural hearing loss since birth. They all had unilateral cochlear implant. Their ages ranged from 2 - 7 years old, 30 of them received cochlear implant prior to 5 years of age and the other 30 children received cochlear implant after 5 years of age. They all underwent formal language assessments. Results: Comparison between group I & group II in receptive, expressive and total language ages obtained by the Arabic Language Test with & without visual cues showed a significant difference between group I (early) and group II(late). [ABSTRACT FROM AUTHOR]

The optimal time of dialysis initiation among patients with chronic kidney disease (CKD) is unclear in recent years. We performed a meta‐analysis to assess the association of early vs. late initiation of dialysis with estimated glomerular filtration rate. PUBMED, EMBASE, the Cochrane Library, and article reference lists were searched for relevant observational trials. A pooled hazard ratio (HR) with 95% CI was used to estimate the mortality risk. Twenty‐six cohort studies and one randomized controlled trial were identified. Early start of dialysis was associated with the increased risk of mortality (HR = 1.23, 95% CI: 1.04–1.43) compared with late start of dialysis. In the subgroup analysis, age younger than 65 years at the early start of dialysis demonstrated higher mortality (HR = 1.20, 95% CI: 1.05–1.35) than the late start. Compared with peritoneal dialysis, the pooled HR with HD was 1.25 (95% CI: 1.17–1.34). Early start of dialysis increased the mortality risk compared with late start among patients with CKD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiovascular disease (CVD) is the primary cause of mortality in the world and Iran. The aim of this study was to determine the prognostic factors of short-term survival from acute myocardial infarction (AMI) in early and late patients in the Najafabad and Isfahan County, Iran. METHODS: This hospital-based cohort study was conducted using the hospital registry of 1999-2009 in Iran. All patients (n = 14426) with an AMI referred to hospitals of Isfahan and Najafabad were investigated. To determine prognostic factors of short-term (28-days) survival in early and late patients, unadjusted and adjusted hazard ratio (HR) was calculated using univariate and multivariate Cox regression. RESULTS: The short-term (28-day) survival rate of early and late patients was 96.6 and 89.4% (P < 0.001), respectively. In 80.0% of early and 79.3% of late patients, mortality occurred during the first 7 days of disease occurrence. HR of death was higher in women in the two groups; it was 1.97 in early patients was [confidence interval (CI) 95%: 1.32-2.92] and 1.35 in late patients (CI 95%: 1.19-1.53) compared to men. HR of death had a rising trend with the increasing of age in the two groups. CONCLUSION: Short-term survival rate was higher in early patients than in late patients. In addition, case fatality rate (CFR) of AMI in women was higher than in men. In both groups, sex, age, an atomic location of myocardial infarction based on the International Classification of Disease, Revision 10 (ICD10), cardiac enzymes, and clinical symptoms were significant predictors of survival in early and late patients following AMI.

Retinal folds are rare complications of rhegmatogenous retinal detachment surgery. They may be located in periphery or involve macula, with the latter ones being associated with severe visual loss. Due to the paucity of scientific reports, its management remains debatable. Most authors advocate an early surgical intervention for symptomatic macular folds (MF). We present 2 cases of symptomatic dry macular fold which were managed successfully after different time intervals. As evidence gets collected that late intervention also leads to good visual outcome, long standing MF should not be considered an absolute contraindication for surgical intervention. [ABSTRACT FROM AUTHOR]

Object: Cranioplasty has been considered for several decades as a protective and cosmetic procedure. It has recently been postulated that cranioplasty may have a therapeutic role, and improve the patient’s functional outcome after decompressive craniectomy (DC). The appropriate timing for cranioplasty remains unknown. In our current study, we review the literature for evaluating the relationship of cranioplasty timing and its complication rate and outcome. Methods: The PubMed database was searched to identify any relevant articles. The following terms were used as keywords: “cranioplasty”, “timing cranioplasty”, “early cranioplasty”, “late cranioplasty”, “delayed cranioplasty”, “early versus late cranioplasty”. Clinical studies with more than 10 participants, and closed head injury as the underlying cause for DC were included in our study. The study design, the timing performing cranioplasty, the complication rate, and the patients’ outcome were evaluated. Results: Ten clinical series met our inclusion criteria. The observed complication rate associated to cranioplasty after DC is not negligible. Several reports have demonstrated that late cranioplasty may minimize procedure-associated complications. Early cranioplasty has been associated with complications, but improves CSF dynamics, and regional cerebral perfusion and metabolism, minimizes the complications from a sunken scalp, reduces the overall length of hospitalization, and thus the overall cost of care. Conclusions: Cranioplasty is a relatively simple procedure that is nevertheless burdened by considerable morbidity. However, an early cranioplasty procedure may improve the outcome in selected cases. Prospective, large-scale studies are necessary to outline the actual complication rate, the neurological outcome, and define the optimal timing for a cranioplasty.

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Background: Cholecystitis is an inflammation of the gallbladder that most commonly occurs as a result of obstruction of the cystic duct by gallstones. The current standard of treatment for acute cholecystitis is cholecystectomy.Objective: Our goal was to discuss the benefits of and compare early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis.Materials and Methods: A Medline literature search was performed dating from January 1982 to July 2015. We limited the search to human studies written in English and using the keywords "Acute Cholecystitis," early vs. delayed laparoscopic cholecystectomy, surgical management, and surgical complications.Results: There were 225 articles reviewed, of which 25 met criteria for selection. Our recommendations are based on these 25 articles.Conclusion: Early laparoscopic cholecystectomy is preferred over delayed, due to overall better quality of life, lower morbidity rates, and lower hospital cost. Ultimately, management of acute cholecystitis by emergency physicians should be made based on patient's clinical status and available resources in their particular hospital. [ABSTRACT FROM AUTHOR]

Background and Objective: Tracheostomy in neurosurgical patients has been shown in various studies to lower the length of ICU stay and the length of hospital stay by decreasing the incidence of ventilator associated pneumonia. In this regard, we wanted to evaluate the outcome of neurosurgical ICU patients based on timing of tracheostomy and ventilator associated pneumonia. Methods: This is a retrospective single centre study performed over a period of two and a half years. Early tracheostomy was defi ned as those done three days of intubation or earlier and late as those done then after. Statistical analysis was done using SPSS. Results: There were 56 patients over the study period of which 18 patients underwent early tracheostomy and 38 patients underwent late tracheostomy. There was no statistically significant difference between the two groups with regards to the length of ICU stay, the length of hospital stay or the length of tracheostomy tube in situ. But based on tracheal aspirate culture positivity, length of tracheostomy tube in situ was significantly longer in those with positive bacterial cultures. Early tracheostomy does not improve neurosurgical outcome while documented pneumonia prolongs the length of tracheostomy tube in situ. [ABSTRACT FROM AUTHOR]

Lactobacillus, Bifidobacterium and Enterococcus cultures are increasingly used as probiotics for humans and pigs. The aim of this study was to investigate if co-cultivation of porcine and human neutrophils with probiotics can lead to increased apoptosis in vitro. Ten adult Large white pigs and 10 healthy human donors were used in this study. Neutrophils were isolated by dextran sedimentation and cultivated with and without the lactic acid bacteria Bifidobacterium bifidum, Lactobacillus rhamnosus, and Enterococcus faecium for 2, 4, 24 and 48 h. Early and late apoptosis was measured using flow cytometry, and cell lysis was detected based on lactate dehydrogenase activity (LDH). A significant (P < 0.05; P < 0.01) increase in apoptotic neutrophils and LDH was observed at 24 h and 48 h in vitro. All probiotics exerted their greatest effects on the early apoptosis of porcine neutrophils, while the effects of L. rhamnosus were most pronounced on late apoptosis and those of B. bifidum on LDH release of human neutrophils. The increased neutrophil apoptosis caused by probiotic bacteria can be beneficial for more efficient efferocytosis and faster resolution of inflammation and tissue regeneration. In conclusion, we have demonstrated that the interaction of B. bifidum, L. rhamnosus, and E. faecium with human and porcine neutrophils leads to their apoptosis. [ABSTRACT FROM AUTHOR]

We report a single institution series of surgery followed by either early adjuvant or late radiotherapy for atypical meningiomas (AM). AM patients, by WHO 2007 definition, underwent subtotal resection (STR) or gross total resection (GTR). Sixty-three of a total 115 patients then received fractionated or stereotactic radiation treatment, early adjuvant radiotherapy (≤4 months after surgery) or late radiotherapy (at the time of recurrence). Kaplan Meier method was used for survival analysis with competing risk analysis used to assess local failure. Overall survival (OS) at 1, 2, and 5 years for all patients was 87%, 85%, 66%, respectively. Progression free survival (PFS) at 1, 2, and 5 years for all patients was 65%, 30%, and 18%, respectively. OS at 1, 2, and 5 years was 75%, 72%, 55% for surgery alone, and 97%, 95%, 75% for surgery + radiotherapy (log-rank p-value = 0.0026). PFS at 1, 2, and 5 years for patients undergoing surgery without early adjuvant radiotherapy was 64%, 49%, and 27% versus 81%, 73%, and 59% for surgery + early adjuvant radiotherapy (log-rank p-value = 0.0026). The cumulative incidence of local failure at 1, 2, and 5 years for patients undergoing surgery without early External Beam Radiation Therapy (EBRT) was 18.7%, 35.0%, and 52.9%, respectively, versus 4.2%, 13.3%, and 20.0% for surgery and early EBRT (p-value = 0.02). Adjuvant radiotherapy improves OS in patients with AM. Early adjuvant radiotherapy improves PFS, likely due to the improvement in local control seen with early adjuvant EBRT. [ABSTRACT FROM AUTHOR]

Background: Early tumor recurrence after curative resection typically indicates a poor prognosis. The objective of the current study was to investigate the risk factors, treatment, and prognosis of early recurrence of neuroendocrine tumor (NET) liver metastasis (NELM) after hepatic resection.Methods: A total of 481 patients who underwent curative-intent resection for NELM were identified from a multi-institutional database. Data on clinicopathological characteristics, intraoperative details, and outcomes were documented. The optimal cutoff value to differentiate early and late recurrence was determined to be 3 years based on linear regression.Results: With a median follow-up of 60 months, 223 (46.4%) patients developed a recurrence, including 158 (70.9%) early and 65 (29.1%) late recurrences. On multivariable analysis, pancreatic NET, primary tumor lymph node metastasis, and a microscopic positive surgical margin were independent risk factors for early intrahepatic recurrence. While recurrence patterns and treatments were comparable among patients with early and late recurrences, early recurrence was associated with worse disease-specific survival than late recurrences (10-year NELM-specific survival, 44.5 vs 75.8%, p < 0.001). Among the 34 (21.5%) patients who underwent curative treatment for early recurrence, post-recurrence disease-specific survival was better than non-curatively treated patients (10-year NELM-specific survival, 54.2 vs 26.3%, p = 0.028), yet similar to patients with late recurrences treated with curative intent (10-year NELM-specific survival, 54.2 vs 37.4%, p = 0.519).Conclusions: Early recurrence after surgery for NELM was associated with the pancreatic type, primary lymph node metastasis, and extrahepatic disease. Re-treatment with curative intent prolonged survival after recurrence, and therefore, operative intervention even for early recurrences of NELM should be considered. [ABSTRACT FROM AUTHOR]

INTRODUCTION: laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. The common opinion about treatment of acute cholecystitis is initially conservative treatment due to preventing complications of inflamation and following laparoscopic cholecystectomy after 6- 8 weeks. However with the increase of laparoscopic experience in recent years, early laparoscopic cholecystectomy has become more common. METHODS: we aimed to compare the outcomes of the patients to whom we applied early or late cholecystectomy after hospitalization from the emergency department with the diagnosis of AC between March 2012-2015. RESULTS: we retrospectively reviewed the files of totally 66 patients in whom we performed early cholecystectomy (within the first 24 hours) (n: 33) and to whom we firstly administered conservative therapy and performed late cholecystectomy (after 6 to 8 weeks) (n: 33) after hospitalization from the emergency department with the diagnosis of acute cholecystitis. The groups were made up of patients who had similar clinical and demographic characteristics. While there were no statistically significant differences between the durations of operation, the durations of hospitalization were longer in those who underwent early cholecystectomy. Moreover, more complications were seen in the patients who underwent early cholecystectomy although the difference was not statistically significant. CONCLUSION: early cholecystectomy is known to significantly reduce the costs in patients with acute cholecystitis. However, switching to open surgery as well as increase of complications in patients who admitted with severe inflammation attack and who have high comorbidity, caution should be exercised when selecting patients for early operation.

Introduction: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. The common opinion about treatment of acute cholecystitis is initially conservative treatment due to preventing complications of inflamation and following laparoscopic cholecystectomy after 6-8 weeks. However with the increase of laparoscopic experience in recent years, early laparoscopic cholecystectomy has become more common. Methods: We aimed to compare the outcomes of the patients to whom we applied early or late cholecystectomy after hospitalization from the emergency department with the diagnosis of AC between March 2012-2015. Results: We retrospectively reviewed the files of totally 66 patients in whom we performed early cholecystectomy (within the first 24 hours) (n: 33) and to whom we firstly administered conservative therapy and performed late cholecystectomy (after 6 to 8 weeks) (n: 33) after hospitalization from the emergency department with the diagnosis of acute cholecystitis. The groups were made up of patients who had similar clinical and demographic characteristics. While there were no statistically significant differences between the durations of operation, the durations of hospitalization were longer in those who underwent early cholecystectomy. Moreover, more complications were seen in the patients who underwent early cholecystectomy although the difference was not statistically significant. Conclusion: Early cholecystectomy is known to significantly reduce the costs in patients with acute cholecystitis. However, switching to open surgery as well as increase of complications in patients who admitted with severe inflammation attack and who have high comorbidity, caution should be exercised when selecting patients for early operation. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic spinal cord injury (SCI) is a catastrophic event for patients with neurologic deficit and for the society in terms of economic issues. The prevalence of SCI seems to be increasing. There is not enough evidence regarding late neurologic decompression in patients with spinal cord injury. Case Presentation: Here, we report on two patients with spinal cord injury, who were referred to our department after several days of trauma and both underwent decompression and posterior instrumented fusion (posterolateral decompression ) with favorable results. Conclusions: It seems that late neurologic decompression might have some benefits for patients with SCI.

BACKGROUND AND OBJECTIVE: Historically, patients were fasted following abdominal surgery until return of bowel sounds or passage of flatus. The aim of this study was to evaluate the effect of early feeding after caesarean section on the possible adverse gastrointestinal effects and womens satisfaction.METHODS: In a clinical trial at Shahid Sedughi hospital, Yazd, 220 women delivered by cesarean were randomly divided into two groups. A clear liquid drink was given to 110 women in the early feeding group 2 hours after surgery, and to 110 women in the control group 12 hours after surgery. If the drink was tolerated, solid foods were then given. Two groups were compared in terms of bowel sounds, flatus, nausea and vomiting, womens satisfaction and hospital stay. FINDINGS: Early feeding group was earlier in first bowel sound, first post operation flatus and defecation. Regular diet is tolerated earlier in early feeding group than delayed feeding group (8.6±2.1 versus 20.9±5.9 hour, p= 0.00). There were no significant differences in postoperative gastrointestinal complications. Mean duration of hospitalization was 26.6 ± 4.3 h in early feeding group and 54.1 ± 3.8 h in delayed feeding group (p=0.00). The womens satisfaction in the early feeding group was higher than delayed feeding group (79.2 ±12.1 vs 50.1± 13.9, p= 0.01).CONCLUSION: Early oral feeding after cesarean delivery was associated with early tolerated regular diet, low duration of hospitalization, high womens satisfaction and no significant adverse gastrointestinal effects compared with delayed feeding.