Use of nebulized liposomal amphotericin B and posaconazole as antifungal prophylaxis in patients with severe SARS-CoV2 infection in intensive care unit.

PURPOSE: COVID-19 associated pulmonary aspergillosis (CAPA) is common and linked with high fatality rates. To assess the impact on the incidence and outcome of CAPA of an antifungal prophylaxis (AFP) we compared two cohorts of COVID-19 patients admitted to intensive care units (ICU) in Brescia, Italy, from January to August 2021. METHODS: The study cohort included all mechanically ventilated patients observed between April 2021 and August 2021 with SARS-CoV-2-pneumonia, who received AFP with oral posaconazole (200 mg every 6 h) and nebulized liposomal amphotericin B (50 mg every 2 weeks) from ICU admission to 7 days after discharge or, if applicable, until tracheostomy removal. The control cohort included COVID-19 patients admitted to the same ICU between January and March 2021 who did not receive any AFP. Subjects with CAPA at ICU admission were excluded. RESULTS: We included 270 patients, of whom 64 (23.7%) received AFP. In patients in the study group, CAPA-related mortality was significantly reduced (29% vs. 48% p = 0.04), as well as the incidence of CAPA (3.1% vs 12.1%, p = 0.03). Patients who developed CAPA were older (mean of 70-y-old vs 63-y-old, p < 0.001). One subject discontinued posaconazole due to an adverse reaction. Among the 46 patients who received it, only one patient reached an effective plasma concentration of posaconazole. CONCLUSION: AFP was associated with reduced incidence and mortality from CAPA and was well tolerated in patients with severe COVID-19. Posaconazole concentrations below the efficacy threshold in almost all patients may be attributable to drug interactions and prompt further studies to define its clinical significance.

Complementary contribution of the medial and lateral human parietal cortex to grasping: a repetitive TMS study.

The dexterous control of our grasping actions relies on the cooperative activation of many brain areas. In the parietal lobe, 2 grasp-related areas collaborate to orchestrate an accurate grasping action: dorsolateral area AIP and dorsomedial area V6A. Single-cell recordings in monkeys and fMRI studies in humans have suggested that both these areas specify grip aperture and wrist orientation, but encode these grasping parameters differently, depending on the context. To elucidate the causal role of phAIP and hV6A, we stimulated these areas, while participants were performing grasping actions (unperturbed grasping). rTMS over phAIP impaired the wrist orientation process, whereas stimulation over hV6A impaired grip aperture encoding. In a small percentage of trials, an unexpected reprogramming of grip aperture or wrist orientation was required (perturbed grasping). In these cases, rTMS over hV6A or over phAIP impaired reprogramming of both grip aperture and wrist orientation. These results represent the first direct demonstration of a different encoding of grasping parameters by 2 grasp-related parietal areas.

Follicular helper T cell signature of replicative exhaustion, apoptosis, and senescence in common variable immunodeficiency.

Common variable immunodeficiency (CVID) is the most frequent primary antibody deficiency whereby follicular helper T (Tfh) cells fail to establish productive responses with B cells in germinal centers. Here, we analyzed the frequency, phenotype, transcriptome, and function of circulating Tfh (cTfh) cells in CVID patients displaying autoimmunity as an additional phenotype. A group of patients showed a high frequency of cTfh1 cells and a prominent expression of PD-1 and ICOS as well as a cTfh mRNA signature consistent with highly activated, but exhausted, senescent, and apoptotic cells. Plasmatic CXCL13 levels were elevated in this group and positively correlated with cTfh1 cell frequency and PD-1 levels. Monoallelic variants in RTEL1, a telomere length- and DNA repair-related gene, were identified in four patients belonging to this group. Their blood lymphocytes showed shortened telomeres, while their cTfh were more prone to apoptosis. These data point toward a novel pathogenetic mechanism in CVID, whereby alterations in DNA repair and telomere elongation might predispose to antibody deficiency. A Th1, highly activated but exhausted and apoptotic cTfh phenotype was associated with this form of CVID.

Does Surgical Approach Influence Complication Rate of Hip Hemiarthroplasty for Femoral Neck Fractures? A Literature Review and Meta-Analysis.

Background: Femoral neck fractures are an epidemiologically significant issue with major effects on patients and health care systems, as they account for a large percentage of bone injuries in the elderly. Hip hemiarthroplasty is a common surgical procedure in the treatment of displaced femoral neck fractures. Several surgical approaches may be used to access the hip joint in case of femoral neck fractures, each with its own benefits and potential drawbacks, but none of them has consistently been found to be superior to the others. This article aims to systematically review and compare the different approaches in terms of the complication rate at the last follow-up. Methods: an in-depth search on PubMed/Scopus/Web of Science databases and a cross-referencing search was carried out concerning the articles comparing different approaches in hemiarthroplasty and reporting detailed data. Results: A total of 97,576 hips were included: 1030 treated with a direct anterior approach, 4131 with an anterolateral approach, 59,110 with a direct lateral approach, and 33,007 with a posterolateral approach. Comparing the different approaches, significant differences were found in both the overall complication rate and the rate of revision surgery performed (p < 0.05). In particular, the posterolateral approach showed a significantly higher complication rate than the lateral approach (8.4% vs. 3.2%, p < 0.001). Furthermore, the dislocation rate in the posterolateral group was significantly higher than in the other three groups considered (p < 0.026). However, the posterolateral group showed less blood loss than the anterolateral group (p < 0.001), a lower intraoperative fractures rate than the direct anterior group (p < 0.035), and shorter mean operative time than the direct lateral group (p < 0.018). Conclusions: The posterolateral approach showed a higher complication rate than direct lateral approach and a higher prosthetic dislocation rate than the other three types of surgical approaches. On the other hand, patients treated with posterolateral approach showed better outcomes in other parameters considered, such as mean operative time, mean blood loss and intraoperative fractures rate. The knowledge of the limitations of each approach and the most common associated complications can lead to choosing a surgical technique based on the patient's individual risk.

Epidemiology of Achilles Tendon Rupture in Italian First Division Football (Soccer) Players and Their Performance After Return to Play.

OBJECTIVE: To evaluate the epidemiology, incidence rate, incidence proportion, and prevalence of Achilles tendon ruptures (ATRs) in professional footballers and their performance after the injury. DATA SOURCES: Professional male footballers participating in Serie A in 11 consecutive seasons (2008/2009-2018/2019) were screened to identify ATRs through the online football archive transfermarkt.com. Exposure in matches and training was calculated. The number of matches played in the 5 seasons before and after ATRs was obtained, when possible, together with transfers to a different team or participation in lower Divisions. MAIN RESULTS: Eleven ATRs were found in 11 footballers with a mean age of 29.8 ± 4.4 years; 72% of ATR involved the nondominant leg; 58% occurred during matches and 42% during training, with no peculiar distribution along the playing season. The overall incidence proportion was 0.17% (0.11% during matches and 0.06% during training). The overall incidence rate was 0.007 injuries per 1000 hours of play (0.051 during matches and 0.003during training; P < 0.0001). All players returned to play soccer after a mean of 170 ± 35 days after ATRs and participated in an official match after a mean of 274 ± 98 days. However, 2 seasons after ATRs, 3 footballers were playing in a lower Division; 1 played less than 10 matches (compared with >25 matches in the 5 seasons before an ATR) and 1 had retired. CONCLUSIONS: An overall ATR rate of 0.007 per 1000 hours of soccer play and an incidence proportion of 0.17% were reported. All footballers return to play; however, up to 40% players decreased the level of play by reducing the number of games or participating in a lower Division 2 seasons after an ATR.

Machine learning methods detect arm movement impairments in a patient with parieto-occipital lesion using only early kinematic information.

Patients with lesions of the parieto-occipital cortex typically misreach visual targets that they correctly perceive (optic ataxia). Although optic ataxia was described more than 30 years ago, distinguishing this condition from physiological behavior using kinematic data is still far from being an achievement. Here, combining kinematic analysis with machine learning methods, we compared the reaching performance of a patient with bilateral occipitoparietal damage with that of 10 healthy controls. They performed visually guided reaches toward targets located at different depths and directions. Using the horizontal, sagittal, and vertical deviation of the trajectories, we extracted classification accuracy in discriminating the reaching performance of patient from that of controls. Specifically, accurate predictions of the patient's deviations were detected after the 20% of the movement execution in all the spatial positions tested. This classification based on initial trajectory decoding was possible for both directional and depth components of the movement, suggesting the possibility of applying this method to characterize pathological motor behavior in wider frameworks.

Surfactant therapy for COVID-19 related ARDS: a retrospective case-control pilot study.

BACKGROUND: COVID-19 causes acute respiratory distress syndrome (ARDS) and depletes the lungs of surfactant, leading to prolonged mechanical ventilation and death. The feasibility and safety of surfactant delivery in COVID-19 ARDS patients have not been established. METHODS: We performed retrospective analyses of data from patients receiving off-label use of exogenous natural surfactant during the COVID-19 pandemic. Seven COVID-19 PCR positive ARDS patients received liquid Curosurf (720 mg) in 150 ml normal saline, divided into five 30 ml aliquots) and delivered via a bronchoscope into second-generation bronchi. Patients were matched with 14 comparable subjects receiving supportive care for ARDS during the same time period. Feasibility and safety were examined as well as the duration of mechanical ventilation and mortality. RESULTS: Patients showed no evidence of acute decompensation following surfactant installation into minor bronchi. Cox regression showed a reduction of 28-days mortality within the surfactant group, though not significant. The surfactant did not increase the duration of ventilation, and health care providers did not convert to COVID-19 positive. CONCLUSIONS: Surfactant delivery through bronchoscopy at a dose of 720 mg in 150 ml normal saline is feasible and safe for COVID-19 ARDS patients and health care providers during the pandemic. Surfactant administration did not cause acute decompensation, may reduce mortality and mechanical ventilation duration in COVID-19 ARDS patients. This study supports the future performance of randomized clinical trials evaluating the efficacy of meticulous sub-bronchial lavage with surfactant as treatment for patients with COVID-19 ARDS.

Decoding Information for Grasping from the Macaque Dorsomedial Visual Stream.

Neurodecoders have been developed by researchers mostly to control neuroprosthetic devices, but also to shed new light on neural functions. In this study, we show that signals representing grip configurations can be reliably decoded from neural data acquired from area V6A of the monkey medial posterior parietal cortex. Two Macaca fascicularis monkeys were trained to perform an instructed-delay reach-to-grasp task in the dark and in the light toward objects of different shapes. Population neural activity was extracted at various time intervals on vision of the objects, the delay before movement, and grasp execution. This activity was used to train and validate a Bayes classifier used for decoding objects and grip types. Recognition rates were well over chance level for all the epochs analyzed in this study. Furthermore, we detected slightly different decoding accuracies, depending on the task's visual condition. Generalization analysis was performed by training and testing the system during different time intervals. This analysis demonstrated that a change of code occurred during the course of the task. Our classifier was able to discriminate grasp types fairly well in advance with respect to grasping onset. This feature might be important when the timing is critical to send signals to external devices before the movement start. Our results suggest that the neural signals from the dorsomedial visual pathway can be a good substrate to feed neural prostheses for prehensile actions.SIGNIFICANCE STATEMENT Recordings of neural activity from nonhuman primate frontal and parietal cortex have led to the development of methods of decoding movement information to restore coordinated arm actions in paralyzed human beings. Our results show that the signals measured from the monkey medial posterior parietal cortex are valid for correctly decoding information relevant for grasping. Together with previous studies on decoding reach trajectories from the medial posterior parietal cortex, this highlights the medial parietal cortex as a target site for transforming neural activity into control signals to command prostheses to allow human patients to dexterously perform grasping actions.

Clinical evaluation of hyponatremia and hypovolemia in critically ill adult neurologic patients: contribution of the use of cumulative balance of sodium.

PURPOSE: Knowledge of the cumulative balance of sodium (CBS) is important for the diagnosis of salt disorders and water homeostasis and has the potential to predict hypovolemic status in acute neurological patients. However, an extensive application of the use of CBS is still lacking in the intensive care setting, where salt and water homeostasis represents a priority. METHODS: Records of consecutive series of acute neurological patients admitted to a neurointensive care unit over a 6-month period were retrospectively reviewed. CBS was calculated at the admission to the Emergency Department. Discrimination between cerebral salt-wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was performed on the basis of the classical criteria. Additionally, we used the findings of a negative CBS exceeding 2 mEq/kg for the diagnosis of CSWS. Two independent clinicians who were blinded to the CBS results performed diagnosis of the causes of hyponatremia and estimated the daily volemic status of the patients on the basis of clinical parameters. Logistic regression analysis was used to determine the independent prognostic factors of hypovolemia. RESULTS: Thirty-five patients were studied for a total of 418 days. Four patients (11.4%) fitted the criteria of CSWS and three patients (8.5%) had SIADH. The unavailability of the CBS led to a wrong diagnosis in three of the eight hyponatremic patients (37.5%). The risk of developing hypovolemia in patients with negative CBS was 7.1 times higher (CI 3.86-13.06; p < 0.001). Multivariate analysis revealed that negative cumulative fluid balance, negative CBS >2 mEq/kg, and CVP ≤5 cmH2O were independent prognostic factors for hypovolemia. CONCLUSIONS: CBS is likely to be a useful parameter in the diagnosis of CSWS and a surrogate parameter for estimating hypovolemia in acute neurological patients.

Similar neural states, but dissimilar decoding patterns for motor control in parietal cortex.

Discrete neural states are associated with reaching movements across the fronto-parietal network. Here, the Hidden Markov Model (HMM) applied to spiking activity of the somato-motor parietal area PE revealed a sequence of states similar to those of the contiguous visuomotor areas PEc and V6A. Using a coupled clustering and decoding approach, we proved that these neural states carried spatiotemporal information regarding behaviour in all three posterior parietal areas. However, comparing decoding accuracy, PE was less informative than V6A and PEc. In addition, V6A outperformed PEc in target inference, indicating functional differences among the parietal areas. To check the consistency of these differences, we used both a supervised and an unsupervised variant of the HMM, and compared its performance with two more common classifiers, Support Vector Machine and Long-Short Term Memory. The differences in decoding between areas were invariant to the algorithm used, still showing the dissimilarities found with HMM, thus indicating that these dissimilarities are intrinsic in the information encoded by parietal neurons. These results highlight that, when decoding from the parietal cortex, for example, in brain machine interface implementations, attention should be paid in selecting the most suitable source of neural signals, given the great heterogeneity of this cortical sector.

Applying HMMs to spiking activity recorded from the somato-motor parietal area PE revealed discrete neural states related to reaching movements. These states were extremely similar to those present in the neighbouring visuomotor areas PEc and V6A. Our decoding approach showed that these states conveyed spatiotemporal behaviour information across all three posterior parietal areas. However, decoding accuracy was lower in PE compared to V6A and PEc, with V6A excelling in target inference. These differences held true even when changing the decoding algorithm, indicating intrinsic dissimilarities in information encoding by parietal different areas. These findings highlight the importance of selecting the appropriate neural signal sources in applications such as brain machine interfaces and pave the way for further investigation of the nontrivial diversity within the parietal cortex.

Convolutional neural networks reveal properties of reach-to-grasp encoding in posterior parietal cortex.

Deep neural networks (DNNs) are widely adopted to decode motor states from both non-invasively and invasively recorded neural signals, e.g., for realizing brain-computer interfaces. However, the neurophysiological interpretation of how DNNs make the decision based on the input neural activity is limitedly addressed, especially when applied to invasively recorded data. This reduces decoder reliability and transparency, and prevents the exploitation of decoders to better comprehend motor neural encoding. Here, we adopted an explainable artificial intelligence approach - based on a convolutional neural network and an explanation technique - to reveal spatial and temporal neural properties of reach-to-grasping from single-neuron recordings of the posterior parietal area V6A. The network was able to accurately decode 5 different grip types, and the explanation technique automatically identified the cells and temporal samples that most influenced the network prediction. Grip encoding in V6A neurons already started at movement preparation, peaking during movement execution. A difference was found within V6A: dorsal V6A neurons progressively encoded more for increasingly advanced grips, while ventral V6A neurons for increasingly rudimentary grips, with both subareas following a linear trend between the amount of grip encoding and the level of grip skills. By revealing the elements of the neural activity most relevant for each grip with no a priori assumptions, our approach supports and advances current knowledge about reach-to-grasp encoding in V6A, and it may represent a general tool able to investigate neural correlates of motor or cognitive tasks (e.g., attention and memory tasks) from single-neuron recordings.

Visual sensitivity at the service of action control in posterior parietal cortex.

The posterior parietal cortex (PPC) serves as a crucial hub for the integration of sensory with motor cues related to voluntary actions. Visual input is used in different ways along the dorsomedial and the dorsolateral visual pathways. Here we focus on the dorsomedial pathway and recognize a visual representation at the service of action control. Employing different experimental paradigms applied to behaving monkeys while single neural activity is recorded from the medial PPC (area V6A), we show how plastic visual representation can be, matching the different contexts in which the same object is proposed. We also present data on the exchange between vision and arm actions and highlight how this rich interplay can be used to weight different sensory inputs in order to monitor and correct arm actions online. Indeed, neural activity during reaching or reach-to-grasp actions can be excited or inhibited by visual information, suggesting that the visual perception of action, rather than object recognition, is the most effective factor for area V6A. Also, three-dimensional object shape is encoded dynamically by the neural population, according to the behavioral context of the monkey. Along this line, mirror neuron discharges in V6A indicate the plasticity of visual representation of the graspable objects, that changes according to the context and peaks when the object is the target of one's own action. In other words, object encoding in V6A is a visual encoding for action.

rTMS over the human medial parietal cortex impairs online reaching corrections.

Indirect correlational evidence suggests that the posteromedial sector of the human parietal cortex (area hV6A) is involved in reaching corrections. We interfered with hV6A functions using repetitive transcranial magnetic stimulation (rTMS) while healthy participants performed reaching movements and in-flight adjustments of the hand trajectory in presence of unexpected target shifts. rTMS over hV6A specifically altered action reprogramming, causing deviations of the shifted trajectories, particularly along the vertical dimension (i.e., distance). This study provides evidence of the functional relevance of hV6A in action reprogramming while a sudden event requires a change in performance and shows that hV6A also plays a role in state estimation during reaching. These findings are in line with neurological data showing impairments in actions performed along the distance dimension when lesions occur in the dorsal posterior parietal cortex.

The impact of time since SARS-Cov-2 vaccination, age, sex and comorbidities on COVID-19 outcome in hospitalized patients with SARS-CoV-2 infection.

We evaluated the impact of COVID-19 vaccination on disease outcome in hospitalized patients with SARS-CoV-2 infection with a prospective study. 745 vaccinated and 451 unvaccinated patients consecutively admitted to a COVID-19 Hospital from 1st September 2021 to 1st September 2022 were included. Compared with unvaccinated cases, vaccinated patients were older, had more comorbidities, but had a lower risk of O2 need (odds ratio, OR, 0.46; 95 % CI 0.32-0.65) by logistic regression analysis adjusted for age, sex, comorbidity and WHO COVID-19 Clinical Progression Scale at admission. The ORs for O2 need were 0.38 (0.24-0.61), 0.50 (0.30-0.83) and 0.57 (0.34-0.96) in patients vaccinated 14-120, 121-180 and > 180 days prior to hospitalization, respectively. An anti-spike Ig titer higher than 5000 U/ml was associated with a reduced risk of O2 need (OR 0.52; 95 % CI 0.30-0.92). This study shows that COVID-19 vaccination has a significant impact on COVID-19 outcomes in hospitalized patients.

Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study.

OBJECTIVES: To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. METHODS: Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database. RESULTS: We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. CONCLUSIONS: Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.

The influence of action on perception spans different effectors.

Perception and action are fundamental processes that characterize our life and our possibility to modify the world around us. Several pieces of evidence have shown an intimate and reciprocal interaction between perception and action, leading us to believe that these processes rely on a common set of representations. The present review focuses on one particular aspect of this interaction: the influence of action on perception from a motor effector perspective during two phases, action planning and the phase following execution of the action. The movements performed by eyes, hands, and legs have a different impact on object and space perception; studies that use different approaches and paradigms have formed an interesting general picture that demonstrates the existence of an action effect on perception, before as well as after its execution. Although the mechanisms of this effect are still being debated, different studies have demonstrated that most of the time this effect pragmatically shapes and primes perception of relevant features of the object or environment which calls for action; at other times it improves our perception through motor experience and learning. Finally, a future perspective is provided, in which we suggest that these mechanisms can be exploited to increase trust in artificial intelligence systems that are able to interact with humans.

Motor decoding from the posterior parietal cortex using deep neural networks.

Objective.Motor decoding is crucial to translate the neural activity for brain-computer interfaces (BCIs) and provides information on how motor states are encoded in the brain. Deep neural networks (DNNs) are emerging as promising neural decoders. Nevertheless, it is still unclear how different DNNs perform in different motor decoding problems and scenarios, and which network could be a good candidate for invasive BCIs.Approach.Fully-connected, convolutional, and recurrent neural networks (FCNNs, CNNs, RNNs) were designed and applied to decode motor states from neurons recorded from V6A area in the posterior parietal cortex (PPC) of macaques. Three motor tasks were considered, involving reaching and reach-to-grasping (the latter under two illumination conditions). DNNs decoded nine reaching endpoints in 3D space or five grip types using a sliding window approach within the trial course. To evaluate decoders simulating a broad variety of scenarios, the performance was also analyzed while artificially reducing the number of recorded neurons and trials, and while performing transfer learning from one task to another. Finally, the accuracy time course was used to analyze V6A motor encoding.Main results.DNNs outperformed a classic Naïve Bayes classifier, and CNNs additionally outperformed XGBoost and Support Vector Machine classifiers across the motor decoding problems. CNNs resulted the top-performing DNNs when using less neurons and trials, and task-to-task transfer learning improved performance especially in the low data regime. Lastly, V6A neurons encoded reaching and reach-to-grasping properties even from action planning, with the encoding of grip properties occurring later, closer to movement execution, and appearing weaker in darkness.Significance.Results suggest that CNNs are effective candidates to realize neural decoders for invasive BCIs in humans from PPC recordings also reducing BCI calibration times (transfer learning), and that a CNN-based data-driven analysis may provide insights about the encoding properties and the functional roles of brain regions.

Management of periprosthetic joint infection of shoulder arthroplasty: Single-stage versus two-stage protocols. A systematic review and meta-analysis of the literature.

Background: The treatment of shoulder prosthetic joint infections (PJIs) requiring removal of the prosthesis is not well defined. This article aims to systematically review and compare the results of the literature in single-stage and two-stage protocols in the treatment of shoulder PJI. Methods: An in-depth search on PubMed/Scopus/Web of Science databases and cross-referencing search was carried out concerning the articles reporting detailed data on the topic. Results: A total of 486 shoulder PJIs were included: 137 treated with single-stage and 349 with two-stage procedure. A similar distribution between early and not-early infections (19.1% vs 80.9%) was found between the two groups. The overall rate of success in terms of PJI eradication was significantly higher in the single-stage group (95.6% vs 85.7%, p < 0.001). The non-infection-related complications rate was 13.8% in the single-stage group and 37.6% in the two-stage group (p < 0.001), the non-infection-related revision rate was 8% and 18.9%, respectively (p = 0.005). Discussion: The single-phase protocol showed a higher success rate in eradicating the infection and a lower complication rate. However, the low number of patients included, the low quality of the articles, the lack of data on clinical severity and bacteriological virulence suggest caution in conclusions.

The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study).

BACKGROUND: The current organizational structure of the Italian healthcare system does not include the institutionalization of clinical ethics services. To describe the need for structured clinical ethics consultation services for ICU staff members in the intensive care unit (ICU), a monocentric observational survey study was performed utilizing a paper-based questionnaire. RESULTS: A total of 73 healthcare professionals (HCPs) responded out of a team of 84 people (87%). The results showed that the need for ethics consultation in the ICU is urgent, the institutionalization of the clinical ethics service is perceived as useful and should be a priority, and the issues on which the HCPs would like ethics consultation to focus are various and belong to "end of life" topics. CONCLUSIONS: HCPs believe that the clinical ethicist should become an integral part of ICU healthcare teams, offering consultations similar to the other specialistic consultations carried out in hospitals.