Medical Thoracoscopy and Intrapleural Fibrinolytic Therapy for the Management of Pleural Empyema: A Cohort Study.

BACKGROUND: Pleural empyema is associated with relevant morbidity and mortality, and it may be classified, according to evolution and ultrasound, into three stages: stage I (free-flowing effusion), stage II (viscous effusion with the tendency to loculate), and stage III (organizing phase). According to guidelines, antibiotic therapy and pleural drainage are recommended, with surgery being performed when patients fail and/or in case of organized empyema. OBJECTIVES: The aim of the study was to report the efficacy and safety of medical thoracoscopy in patients with pleural empyema stratified by chest ultrasound. METHOD: Observational retrospective cohort study analyzing patients with pleural empyema treated with medical thoracoscopy. Procedure success and mortality were evaluated at 30 days and 90 days after the procedure; complications were also reported. RESULTS: 131 patients were included. Intrapleural fibrinolytic therapy was performed thereafter in the majority of cases. Medical thoracoscopy was considered successful without subsequent intervention in 99 patients (76%); 19 patients (15%) underwent a second procedure (drainage, thoracoscopy, video-assisted thoracic surgery, or thoracotomy); and 6 patients (5%) died of the evolution of empyema. Patients treated in stages I and II showed significantly better post-procedure results compared with patients treated in stage III (100%, 83.3%, and 58.1%, respectively). Thoracoscopy complications were observed in 18 patients and were reversible in all cases. CONCLUSIONS: Patients with pleural empyema treated in earlier stages (free-flowing or multiloculated effusion) with medical thoracoscopy show significantly better results than patients treated in later stages (organized empyema). This approach is safe, minimally invasive, and efficient in these patients with disease having relevant mortality; however, patient selection remains essential.

Dermoscopic features of benign sebaceous proliferations in dogs: Description, assessment and inter-observer agreement.

BACKGROUND: Dermoscopy is a useful, noninvasive technique also used to assess sebaceous lesions in humans. Sebaceous hyperplasia, sebaceous adenoma and sebaceous epithelioma are common cutaneous lesions in dogs; however, their dermoscopic features have not been investigated. HYPOTHESIS/OBJECTIVES: The objectives of this study are to describe the dermoscopic features of canine sebaceous lesions and to assess the interobserver agreement on dermoscopic parameters. ANIMALS: Thirty-four lesions excised from 17 client-owned dogs, histologically confirmed as sebaceous proliferations, were included in this study. MATERIALS AND METHODS: Sebaceous lesions were evaluated in vivo at ×10 magnification with a handheld dermoscope. Each dermoscopic image was assessed independently by two ECVD board-certified veterinary referral clinicians and an ECVD resident. RESULTS: Thirty sebaceous hyperplasias, two sebaceous adenomas and two sebaceous epitheliomas were included. Dermoscopically, most lesions (91%) had single or multiple, well-defined, white-yellowish structures composed of grouped ovoid areas (clods). Irregular linear and, less commonly, arborising vessels were detected at the periphery of the yellow lobular-like structures in 93% of sebaceous hyperplasias and in 50% of neoplastic lesions. Erosions were seen in 6% of sebaceous hyperplasias and 50% of neoplastic lesions. Good interobserver agreement was found for white/yellowish clods (k = 0.75), yellow scales (k = 0.83), brown/grey dots (k = 0.80), erosions (k = 0.82) and red/brownish scales/crusts (k = 0.75). There was moderate agreement for fissures (k = 0.48) and vascular pattern (k = 0.51-0.53). CONCLUSIONS AND CLINICAL RELEVANCE: Dermoscopy represents a useful technique to assess sebaceous gland proliferations in dogs, as it is in humans.

Lack of efficacy of convalescent plasma in COVID-19 patients with concomitant hematological malignancies: An Italian retrospective study.

A multicenter retrospective study was designed to assess clinical outcome of COVID-19 in patients with hematological malignancies (HM) following treatment with anti-SARS-CoV-2 convalescent plasma (CP) or standard of care therapy. To this aim, a propensity score matching was used to assess the role of non-randomized administration of CP in this high-risk cohort of patients from the Italian Hematology Alliance on COVID-19 (ITA-HEMA-COV) project, now including 2049 untreated control patients. We investigated 30- and 90-day mortality, rate of admission to intensive care unit, proportion of patients requiring mechanical ventilatory support, hospitalization time, and SARS-CoV-2 clearance in 79 CP recipients and compared results with 158 propensity score-matched controls. Results indicated a lack of efficacy of CP in the study group compared with the untreated group, thus confirming the negative results obtained from randomized studies in immunocompetent individuals with COVID-19. In conclusion, this retrospective analysis did not meet the primary and secondary end points in any category of immunocompromized patients affected by HM.

Antibody Responses after Two Doses of COVID-19 mRNA Vaccine in Dialysis and Kidney Transplantation Patients Recovered from SARS-CoV-2 Infection.

Background and Objectives: Hemodialysis patients (HD) and kidney transplant recipients (KTRs) have been heavily impacted by COVID-19, showing increased risk of infection, worse clinical outcomes, and higher mortality rates than the general population. Although mass vaccination remains the most successful measure in counteracting the pandemic, less evidence is available on vaccine effectiveness in immunodepressed subjects previously infected and recovered from COVID-19. Materials and Methods: This study aimed at investigating the ability to develop an adequate antibody response after vaccination in a 2-dose series against SARS-CoV-2 in HD patients and KTR that was administered after laboratory and clinical recovery from COVID-19. Results: Comparing SARS-CoV-2 S1/S2 IgG levels measured before and after 2 doses of mRNA vaccine (BNT162b2 vaccine, Comirnaty, Pfizer-BioNTech or mRNA-1273 vaccine, Spikevax, Moderna), highly significant increases of antibody titers were observed. The antibody peak level was reached at 3 months following second dose administration, regardless of the underlying cause of immune depression and the time of pre-vaccine serology assessment after negativization. Conclusions: Our data indicate that HD patients and KTR exhibit a satisfying antibody response to a 2-dose series of mRNA vaccine, even in cases when infection-induced humoral immunity was poor or rapidly fading. Further studies are needed to evaluate the role of booster doses in conferring effective and durable protection in weak patient categories.

A kinematic and electromyographic comparison of a Grammont-style reverse arthroplasty combined with a l'Episcopo transfer compared to a lateralized humeral component reverse for restoration of active external rotation.

PURPOSE: To assess kinematic and electromyographic findings of two designs of reverse total shoulder arthroplasty (RTSA). We tested two hypotheses: (H1) Grammont-style (RTSA) with l'Episcopo tendon transfer gains similar postoperative kinematic findings of a lateralized humeral component RTSA without a tendon transfer; (H2) RTSA with lateralized humeral component induces earlier shoulder muscle activation during shoulder motion compared with standard Grammont prosthesis with l'Episcopo transfer. METHODS: Twenty-five patients with a cuff tear arthropathy, pseudoparalysis, and a positive dropping sign were sequentially included. A Grammont-style RTSA with a l'Episcopo tendon transfer was implanted in 13 patients (medialized humerus and transfer group) and an on-lay curved-stem RTSA in 12 (lateralized humerus group). Constant score; the disabilities of the arm, shoulder, and hand (DASH) score; and active shoulder range of motion (flexion, abduction, external rotation, and internal rotation) were measured pre- and postoperatively. Upper limb kinematic and surface electromyography (EMG) (anterior and posterior deltoid; upper, middle, and lower trapezius; and the upper and lower latissimus dorsi muscles) were recorded during active range of motion. RESULTS: At > 24 months of follow-up, the Constant and DASH scores and active shoulder range of motion improved in both groups (p < 0.0001). Internal rotation was significantly higher in the lateralized humerus group than in the medialized humerus and transfer group (p = 0.004). The dropping sign was found in 0/12 patients in the lateralized humerus group and in 5/13 patients in the medialized humerus and transfer group (p < 0.001). Kinematic findings were similar between groups (p = 0.286). A pattern of earlier muscle activation in the lateralized humerus group was found as compared to the transfer group as follows: (i) posterior deltoid during external rotation (p = 0.004); (ii) upper latissimus dorsi and middle and lower trapezius during flexion (p = 0.004, p = 0.005, and p = 0.042, respectively); (iii) lower latissimus dorsi during abduction (p = 0.016). CONCLUSION: RTSA with a lateralized humeral component provided similar active external rotation restoration to a Grammont-style RTSA with a l'Episcopo procedure in patients with a dropping sign. The posterior deltoid muscle underwent earlier activation during active external rotation in the lateralized humerus RTSA group as compared to the tendon transfer group. Our findings demonstrated the H1 and only partially demonstrated the H2 of the study.

Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older.

BACKGROUND: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. METHODS: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. RESULTS: RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). CONCLUSION: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.

Incidence and prevalence of pressure ulcers in cancer patients admitted to hospice: A multicentre prospective cohort study.

Pressure ulcers lead to discomfort for patients and may have an important impact on a patient's quality of life. Measure the incidence and prevalence of pressure ulcers in a Hospice environment; evaluate the risk factors associated with pressure ulcers; and calculate the incidence of Kennedy Terminal Pressure Ulcers. This multicentre prospective cohort study enrolled 440 cancer patients in advanced phase, consecutively admitted to five hospices of the AUSL della Romagna (Italy), during a period of 1 year. Five hundred more patients were excluded from the study because of inability to sign the consent form or refusal to participate. All patients were adults above 18 years of age. The National Pressure Advisory Panel Classification System was used to evaluate the pressure ulcers. Potential risk predictors were evaluated through the Braden Scale, the Numerical Scale, and the Pain Assessment in Advanced Dementia Scale. Starting in September 2016, 214 (48.6%) females and 226 (51.4%) males were analysed. The incidence of pressure ulcers in the total population was 17.3%. The risk factors that influence the development of pressure ulcers were age, proximity to death, and duration of stay in Hospice. The incidence of Kennedy Terminal Pressure Ulcers was 2.7%. This study demonstrates that 17.3% of all patients admitted to a hospice setting developed a pressure ulcer. The longer the patients stay in hospice and the clinical condition deteriorates, the higher the risk of developing a pressure ulcer.

Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up.

BACKGROUND: There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs. METHODS: Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component. RESULTS: Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P = .002) and lower rates of scapular notching (P = .0003), glenoid radiolucency (P = .016), and humeral bone remodeling (P = .004 and P = .030 for cortical thinning and spot weld, respectively). CONCLUSIONS: Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors.

Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants.

BACKGROUND: There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA. METHODS: A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation. RESULTS: Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P < .0001), with median American Shoulder and Elbow Surgeons and Simple Shoulder Test scores of 60 and 6 points, respectively. There were 11 (7%) repeated revision surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 "at-risk" glenoid components. CONCLUSION: Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes.

Comparison of shoulder replacement to treat osteoarthritis secondary to instability surgery and primary osteoarthritis: a retrospective controlled study of patient outcomes.

PURPOSE: We hypothesized that osteoarthritis developing after instability surgery is radiographically similar to primary arthritis and that arthroplasty provides comparable outcomes in patients with these two types of osteoarthritis. METHODS: Patients with osteoarthritis due to instability surgery (group I) and with primary osteoarthritis (group II) were included. Mean follow-up was 52.6 and 41.6 months, respectively. Hemiarthroplasties (HA) were 32% in group I and 27% in group II; total shoulder arthroplasties (TSA) were 68 and 73% respectively. Outcome measures included active shoulder mobility (anterior elevation [AAE], lateral elevation [ALE], external rotation [ER], and internal rotation [IR]), pain, Constant-Murley score, and Simple Shoulder Test. Pre-operative and post-operative radiographs were taken. Glenoid arthritis was assessed by computed tomography. RESULTS: Participants were 19 in the group I (mean age 44.5 years, 12 males, 7 females) and 30 in the group II (mean age 48.2 years, 28 males, 12 females). Both patient groups had pre-operative concentric arthritis. Group II had higher rates of A2 and B1 glenoids (p = 0.003). A longer interval from stabilization to replacement was associated with lower post-operative IR (p = 0.017) and ALE (p = 0.035). Post-operative ER and IR were higher in group I (p < 0.001 and p = 0.001, respectively). In group I, AFE and ALE were higher in HA than TSA patients (both p = 0.009). The CS and SST score increased significantly in both groups (both p < 0.001). Group II showed significantly greater humeral radiolucency (p = 0.025) and a higher rate of TSA revision to reverse prostheses compared with group I. CONCLUSIONS: Shoulder replacement provides similar clinical and radiographic outcomes in arthritis secondary to instability surgery and in primary osteoarthritis. Posterior glenoid wear is more common in primary osteoarthritis.

A retrospective study comparing histopathological and immunopathological features of nasal planum dermatitis in 20 dogs with discoid lupus erythematosus or leishmaniosis.

BACKGROUND: In areas endemic for leishmaniosis, discoid lupus erythematosus (DLE) and canine leishmaniosis (CanL) are the most common differential diagnoses for nasal planum erosive-ulcerative dermatitis in dogs. HYPOTHESIS/OBJECTIVE: To compare histopathological and immunopathological features of canine nasal planum erosive-ulcerative dermatitis with depigmentation due to DLE or CanL. ANIMALS: Nasal planum biopsies from dogs with nasal planum loss of architecture, depigmentation, swelling, erosions or ulcerations due to DLE (n = 14) or CanL (n = 6). METHODS: Sections of paraffin-embedded samples, stained with haematoxylin and eosin were reviewed. Samples were examined using antibodies targeting T cells (CD3), B cells (CD20), macrophages (Mac387) and class II major histocompatibility complex (MHC II). Histopathological and immunophenotypical findings were compared between DLE and CanL cases. RESULTS: Lichenoid and interface dermatitis were observed in both DLE and CanL cases. A nodular-to-diffuse, superficial and/or deep dermatitis with macrophages, lymphocytes and plasma cells was present only in CanL samples. CD20-positive cells predominated over CD3- and Mac387-positive cells in the two conditions. The percentage of dermal Mac387-positive cells was higher in CanL compared to DLE samples and the difference was statistically significant (P = 0.025). CONCLUSIONS/CLINICAL IMPORTANCE: In this study, similar histopathological and immunopathological findings were observed in dogs with nasal planum lesions due to DLE or CanL. Therefore, in areas endemic for leishmaniosis, the presence of the parasite should be investigated in canine nasal planum dermatitis showing clinical and histopathological features suggestive of DLE.

Rifampicin treatment of canine pyoderma due to multidrug-resistant meticillin-resistant staphylococci: a retrospective study of 32 cases.

BACKGROUND: Rifampicin has received increased interest in veterinary dermatology because of its activity against multidrug-resistant meticillin-resistant staphylococci (MRS). There is limited knowledge about the efficacy and safety of rifampicin in dogs. HYPOTHESIS/OBJECTIVE: To provide information on response to treatment and adverse effects in dogs treated with rifampicin for multidrug-resistant MRS pyoderma. ANIMALS: Thirty two dogs treated with rifampicin for rifampicin-susceptible multidrug-resistant MRS pyoderma. METHODS: Retrospective review of medical records, including alanine aminotransferase (ALT) and alkaline phosphatase (ALP) serum activity levels and total bilirubin concentrations, obtained before and throughout the treatment, was performed. RESULTS: Oral rifampicin as sole systemic antimicrobial therapy (median dose 5 mg/kg twice daily) was effective in 71.88% of cases. Topical antimicrobials were used in most cases. Median duration of rifampicin treatment was five weeks for superficial pyoderma and four weeks for deep pyoderma. Gastrointestinal signs were reported in 15% of treated dogs. Statistically significant increases of ALT (P = 0.045) and ALP (P = 0.0002) values after 3-4 weeks of treatment was observed. The median increase was equal to 0.3 and ×1.5 the upper limit of the reference ranges for ALT and ALP, respectively. CONCLUSIONS/CLINICAL IMPORTANCE: Oral rifampicin combined with topical antimicrobials can be considered an effective therapeutic option for canine superficial and deep pyoderma caused by rifampicin-susceptible multidrug-resistant MRS. Liver enzyme induction might be the most important cause of ALT and ALP increase associated with rifampicin therapy in dogs.

Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures.

PURPOSE: The aim of this study was to assess the effectiveness of reverse total shoulder arthroplasty (RTSA) with an all-polyethylene glenosphere in patients with failed hemiarthroplasty (HH) or the sequelae of proximal humeral fractures. METHODS: Thirty-six patients were assessed at a mean follow-up of 36 months using clinical scores and recording shoulder range of movement (ROM). RESULTS: Active anterior elevation (p < 0.001), lateral elevation (p < 0.001) and internal rotation (p < 0.0001) improved significantly, whereas improvement in external rotation was not significant. The mean Constant score rose significantly from 8.5 ± 7.6 to 40.7 ± 15.7 (p < 0.001) and the Simple Shoulder Test score from 0.42 ± 0.85 to 5.5 ± 2.6 (p < 0.001). Pain improved significantly from 8.7 ± 0.9 to 2.3 ± 1.2 (p < 0.001). Implant radiographic survivorship was 84.6 %. Scapular notching was detected in 7/36 patients (17.5 %). There were five complications: one (stiffness) among patients with fracture sequelae and four among those with failed HH (instability, n = 2; humeral component disassembly, n = 1; pain, n = 1). The two groups did not exhibit significant differences in pain, clinical scores or ROM. DISCUSSION: RTSA with an all-polyethylene glenosphere may have the potential to reduce the risk of biological notching due to polyethylene osteolysis. Further long-term studies are required to assess its efficacy. CONCLUSIONS: The good clinical performance and reasonable rate of notching of the polyethylene glenosphere support its use in primary and revision shoulder arthroplasty. LEVEL OF EVIDENCE: Level 4, retrospective therapeutic case series.

Total shoulder replacement using a bone ingrowth central peg polyethylene glenoid component: a prospective clinical and computed tomography study with short- to mid-term follow-up.

AIM OF THE STUDY: To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC). METHODS: Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45-75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24-39). Early and late follow-up CT scans were available for 21/30 shoulders. RESULTS: Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p < 0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p < 0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p < 0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05). DISCUSSION: The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth. CONCLUSIONS: The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.

A comparison of femorocrural bypasses performed with modified heparin-bonded expanded polytetrafluorethylene grafts and those with great saphenous vein grafts to treat critical limb ischemia.

BACKGROUND: The purpose of this study was to evaluate our results involving femorocrural bypasses by comparing heparin-bonded expanded polytetrafluoroethylene (HePTFE) graft (Propaten) modified with handmade distal compliant HePTFE cuffs (mHePTFE graft) to great saphenous vein (GSV) graft. METHODS: A retrospective study involving 74 femorocrural bypasses performed from January 2010 to May 2013 at a single institution was carried out. The indication for revascularization was critical limb ischemia (Rutherford stages 4-6. Forty-one femorocrural bypasses were created in 37 patients with unavailable GSVs using modified ringed HePTFE grafts with a handmade distal radial stretch HePTFE cuff to reduce the mismatch compliance between the graft and the artery wall. Thirty-three femorocrural bypasses were created using a reversed GSV graft. The results were analyzed in terms of primary graft patency, limb salvage, and patient survival using univariate (Kaplan-Meier curves and log-rank test) and multivariate (Cox regression) analyses. RESULTS: The 2 groups were statistically comparable for main risk factors, Rutherford stage, and target artery for distal anastomoses. The run-off anatomy did not significantly differ between the prosthetic and the vein bypass group. The cumulative 30-day operative mortality rate was 2.9%. At 1, 2, and 3 years, the 2 groups were equivalent in primary graft patency (the mHePTFE group: 84%, 80%, and 70%, respectively; the GSV group: 84%,71%, and 71%, respectively; P = 0.93) and were also equivalent in terms of limb salvage (the mHePTFE group: 87%, 87%, and 76%, respectively; the GSV group: 84%, 75%, and 75%, respectively; P = 0.78) and patient survival (the mHePTFE group: 87%, 75%, and 75%, respectively; the GSV group: 87%, 73%, and 65%, respectively; P = 0.86). At Cox regression analysis, only postoperative treatment with warfarin therapy compared with double antiplatelet therapy was independently associated with poorer primary patency (P = 0.003; 95% confidence interval, 1.80-18.00; hazard ratio, 5.7). CONCLUSIONS: In this retrospective study regarding femorocrural bypasses, the mHePTFE grafts had 1-, 2-, and 3-year primary patency and limb salvage results which were not significantly different from those in the GSV grafts. Additional randomized data and larger studies are needed to confirm these results.

Dermoscopic features in 12 cats with dermatophytosis and in 12 cats with self-induced alopecia due to other causes: an observational descriptive study.

BACKGROUND: Dermoscopy is a noninvasive technique allowing rapid magnified in vivo observation of the skin and structures that lie beneath the skin surface. Various congenital and acquired hair shaft abnormalities may also be evaluated by dermoscopy. Additionally, characteristic features of Microsporum canis-induced tinea capitis and trichotillomania in humans have been reported. OBJECTIVES: To describe the dermoscopic findings observed in cats with patchy alopecia due to M. canis infection and in cats with self-inflicted hair loss. ANIMALS: Twenty-four client-owned cats presented at a veterinary referral practice. METHODS: Dermoscopy was performed with a hand-held nonpolarized light dermoscope at 10-fold magnification. The glass plate of the dermoscope was applied gently to the lesions and no sedation was required. RESULTS: Twelve cats were diagnosed with dermatophytosis and 12 with self-induced alopecia due to other causes. At 10-fold magnification, the most characteristic findings observed in circumscribed lesions of cats with dermatophytosis were opaque, slightly curved, broken hairs of a homogeneous thickness (comma-like structures) and a variable amount of brown-to-yellow greasy scales. In cats with self-induced alopecia, multiple hairs with a normal shaft cleanly broken at different lengths, short tufts of hairs broken at an equal level and hook-like and coiled hairs were observed. CONCLUSIONS AND CLINICAL IMPORTANCE: This observational descriptive study suggests that dermoscopy may represent a helpful noninvasive in vivo technique in the differential diagnosis of patchy alopecia in cats.

Aortic balloon valvuloplasty outcome according to calcium distribution and valve geometry - The ABCD study.

BACKGROUND: There is little data on the outcome of balloon aortic valvuloplasty (BAV) in relation to valve dimensions and calcification patterns. The procedure is not standardized, particularly the choice of balloon size. METHODS: This retrospective multicenter study focused on BAV efficacy and safety by analyzing the relationship between balloon size, annulus geometry (i.e., diameters, perimeter, and area), and calcification patterns (total burden and calcium distribution over each individual leaflet). From March 2018 to March 2023, all consecutive patients who underwent clinically indicated BAV and ECG-gated multidetector computed tomography of the aorta were included, except those with a bicuspid valve. Calcium score was calculated on contrast-enhanced images based on a luminal attenuation threshold of +100 HU. RESULTS: One hundred and fifteen patients were included. Procedural success was 82.6 %. The balloon-to-annulus ratio (BAR) relative to diameter, perimeter, and area was higher in patients with successful BAV. Patients with unsuccessful BAV had a significantly higher aortic valve calcium burden. The complication rate was 4.3 % and there was no association with valve geometry or calcium burden. A trend towards a reduced complication rate was found as calcium asymmetry increased. BAR minimum annulus diameter was the best parameter in predicting procedural success, with a cut-off at 0.85. CONCLUSIONS: BAV efficacy is correlated directly with balloon size in relation to annulus dimension and inversely with total calcium burden. The minimum diameter of the valve may be adopted as a reference for balloon sizing.

The EXcellenT Trial: Exercise in Extended Oncogene Addicted Lung Cancer in Active Treatment.

INTRODUCTION: The discovery of oncogenic mutations that drive the growth and progression of Non-small-cell lung cancer (NSCLC) led to the development of a range of molecular targeted therapies. Tyrosine kinase inhibitors (TKIs) improve the overall outcome of patients with oncogene addicted NSCLC, ensure a better compliance to treatment and few side effects compared to traditional chemotherapy. However, the treatment is still completely "drug-centric", in a population of patients who usually survive for a long time and desire to regain their quality of life. Despite an extensive literature on the importance of complementary treatments and lifestyle promotion, the guidelines on physical exercise are general and usually refer to the entire lung cancer pathology. METHODS AND OBJECTIVES: EXcellenT is an Italian monocentric randomized prospective study enrolling 40 patients diagnosed with oncogene-addicted advanced NSCLC in active treatment with TKIs. Patients will be randomized (1:1 ratio) to an 'interventional' or a 'control' group. In the interventional arm (arm A), participants will receive a 3-month multicomponent personalized physical activity prescription combining a supervised coaching program at the training center and an app-based physical activity schedule at patients home. In the control group (arm B) patients will receive a fitness professional-guided montly session that will result in an unsupervised home-based physical activity counselling. Prospective collection of blood metabolome and immune phenotypes will be performed to investigate the integration with genetic alterations that drive the patient's disease. The overall aim of the project is to evaluate if a tailored physical program may have a significant impact on quality of life and performances of this specific homogeneous subgroup of patients. The exploratory goal is to elucidate a potential link between metabolites, immune parameters and genetic deregulations and how this interplay may be influenced by physical exercise. CONCLUSION: EXcellent trial aims to propose a new approach to personalized medicine in the specific subgroup of oncogene-addicted NSCLC patients, where targeted therapy is integrated with an equally tailored physical activity program. The homogeneity of this cancer population will provide insights on the influence of exercise on metabolism and immunity during treatment with TKIs.

Evaluation of the bacterial microflora of the conjunctival sac of healthy dogs and dogs with atopic dermatitis.

The aim of this case-control study was to evaluate and compare the bacterial microflora from the conjunctival sac of dogs with atopic dermatitis and healthy dogs. Twenty-one atopic dogs without clinical and/or cytopathological signs of bacterial blepharoconjunctivitis and 21 breed-matched healthy dogs were enrolled. Under topical anaesthesia, the inferior conjunctival sac of one eye was scraped twice. Material was collected with a Kimura spatula, spread over a slide and stained with a Diff Quick(®) -type stain (Medion Diagnostics GmbH, Düdingen, Switzerland) for cytological examination. An area of 0.5 cm(2) was examined at ×1000 magnification, and the types and numbers of cells and bacteria were recorded. A bacterial swab was collected and inoculated into culture media for the growth of aerobic bacteria. Before sampling, each atopic dog was evaluated for severity of cutaneous lesions, pruritus and conjunctival inflammation. Significant differences were observed between atopic and healthy dogs for the presence of bacteria on cytology (P = 0.015), keratinized (P = 0.001) and nonkeratinized epithelial cells (P = 0.013), eosinophils (P = 0.019) and lymphocytes (P = 0.008). Bacteria were recovered from 12 atopic dogs and three healthy dogs (P = 0.004). Staphylococcus pseudintermedius was the most commonly isolated species in atopic dogs (seven of 12). In atopic dogs, no significant relation was found between conjunctival bacterial colonization (on cytology and culture) and the severity of any of the clinical parameters. This study suggests differences in conjunctival bacterial colonization and cytological features between atopic and healthy dogs.

Implant sonication versus intraoperative tissue sample cultures for Periprosthetic Joint Infection (PJI) of Shoulder Arthroplasty.

Introduction Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI.  Sixty - five patients respected the criteria for admission to the study. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty - four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty - seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5%  and 93,1% (P < 0.01) respectively. Conclusion Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it's a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with  tissue cultures.