Analysis of bronchiectasis patients who underwent video-assisted thoracoscopic surgery in a tertiary thoracic surgery center: Ten years of experience.

Background: This study aimed to analyze our video-assisted thoracic surgery (VATS) experience in the surgical treatment of bronchiectasis and the reasons limiting VATS application. Methods: Two hundred one patients (106 males, 95 females; mean age: 39.7±14.1 years; range, 12 to 68 years) who underwent surgical treatment for bronchiectasis between January 2012 and October 2021 were included in the retrospective study. Three groups were created based on the surgical technique used: VATS, thoracotomy, and patients who were converted from VATS to thoracotomy. Results: The most significant presenting symptoms were cough (43%) and excessive sputum expectoration (40%). Surgical intervention was applied to the left side of 60% of the patients, and the most common resection performed in all three groups was left lower lobectomy. The rate of conversion from VATS to thoracotomy was 28.8%, and it was found that dense pleural adhesions were the most common reason. Revision surgery was performed on a total of 11 (5.47%) patients. The frequency of revision surgery did not differ significantly among the three groups (p=0.943). The most common postoperative complication was prolonged air leakage. There was no statistically significant difference in postoperative complication rates among the groups (p=0.417). The rate of surgical treatment of bronchiectasis with VATS was observed to have increased from 11.1% to 77.7% in our clinic. Conclusion: In experienced hands, VATS can be safely applied in the surgical treatment of bronchiectasis.

The Relationship between Fragmented QRS and Myocardial Injury in Patients with Acute Carbon Monoxide Poisoning.

Background and Objectives: Carbon monoxide (CO) intoxication is one of the most common causes of poisoning-related deaths and complications. Myocardial injury is an important complication of CO poisoning. In our study, we aimed to evaluate the relationship between the presence and prevalence of fragmented QRS (fQRS) and myocardial injury in patients with CO intoxication. Materials and Methods: We retrospectively evaluated patients who presented to the emergency department of our tertiary care center with CO intoxication between January 2020 and December 2023. In our study, we performed subgroup analyses according to the presence of myocardial injury and fQRS. We evaluated the parameters and risk factors associated with myocardial injury. Results: Myocardial injury was detected in 44 patients, and fQRS was detected in 38 patients. In the myocardial injury (+) group, the fQRS rate was 38.6%, and the median number of leads with fQRS was 3 (2-6) and was significantly higher than in the myocardial injury (-) group (p < 0.001). We found that carboxyhemoglobin had a significant positive correlation with troponin (p = 0.001) and pro-B-type natriuretic peptide (proBNP) (p = 0.009). As a result of multivariate analysis, we determined that age, creatinine, proBNP, fQRS, and ≥3 leads with fQRS are independent risk factors for myocardial injury. Conclusions: Myocardial injury in CO intoxication patients is associated with proBNP, the presence of fQRS, and the number of leads with fQRS. Age, creatinine level, proBNP, the presence of fQRS, and ≥3 leads with fQRS are independent risk factors for myocardial injury in patients with CO intoxication.

Effects of essential oils on heat-stressed poultry: A review.

While certain animal species are sensitive to heat stress, poultry particularly modern breeds, are more susceptible to high ambient temperatures. This has major implications for the poultry industry, as heat stress causes large financial losses. These economic losses will probably increase as a consequence of a predicted rise in global temperatures. Heat stress adversely affects various aspects of poultry, including physiological responses, growth and production performance, meat quality, egg quality, and reproductive activities. These effects occur through specific molecular and metabolic pathways. To mitigate the impacts of heat stress, it is crucial to go beyond administrative practices and implement dietary interventions during high ambient temperature. Such interventions aim to optimize the development of stressed bird species in terms of performance, health, and profitability. Essential oils have shown promising in mitigating the negative effects of heat stress and improved antioxidant status, growth and yield performance, as well as meat and egg quality in poultry. They actively participate in certain metabolic and molecular pathways that help to counteract the effects of heat stress. The article discusses the impacts of essential oil supplementation on the relationships between antioxidant enzyme activity, these molecular, and metabolic pathways, as well as various parameters such as growth and yield performance, and product quality heat-stressed poultry.

Bacterial defense systems exhibit synergistic anti-phage activity.

Bacterial defense against phage predation involves diverse defense systems acting individually and concurrently, yet their interactions remain poorly understood. We investigated >100 defense systems in 42,925 bacterial genomes and identified numerous instances of their non-random co-occurrence and negative association. For several pairs of defense systems significantly co-occurring in Escherichia coli strains, we demonstrate synergistic anti-phage activity. Notably, Zorya II synergizes with Druantia III and ietAS defense systems, while tmn exhibits synergy with co-occurring systems Gabija, Septu I, and PrrC. For Gabija, tmn co-opts the sensory switch ATPase domain, enhancing anti-phage activity. Some defense system pairs that are negatively associated in E. coli show synergy and significantly co-occur in other taxa, demonstrating that bacterial immune repertoires are largely shaped by selection for resistance against host-specific phages rather than negative epistasis. Collectively, these findings demonstrate compatibility and synergy between defense systems, allowing bacteria to adopt flexible strategies for phage defense.

Engineered phage with antibacterial CRISPR-Cas selectively reduce E. coli burden in mice.

Antibiotic treatments have detrimental effects on the microbiome and lead to antibiotic resistance. To develop a phage therapy against a diverse range of clinically relevant Escherichia coli, we screened a library of 162 wild-type (WT) phages, identifying eight phages with broad coverage of E. coli, complementary binding to bacterial surface receptors, and the capability to stably carry inserted cargo. Selected phages were engineered with tail fibers and CRISPR-Cas machinery to specifically target E. coli. We show that engineered phages target bacteria in biofilms, reduce the emergence of phage-tolerant E. coli and out-compete their ancestral WT phages in coculture experiments. A combination of the four most complementary bacteriophages, called SNIPR001, is well tolerated in both mouse models and minipigs and reduces E. coli load in the mouse gut better than its constituent components separately. SNIPR001 is in clinical development to selectively kill E. coli, which may cause fatal infections in hematological cancer patients.

Brugada Phenocopy Induced by Hypovolemic Hyponatremia.

Brugada syndrome (BrS) is a hereditary channelopathy caused by an autosomal dominant mutation in the cardiac sodium channel gene SCN5A alpha subunit. In individuals without structural heart disease, the risk of sudden cardiac death (SCD) increases in this channelopathy with ST-segment elevation in V1-3 precordials. Brugada phenocopy (BrP) is a condition in which transient ST-segment elevations are observed, mimicking BrS electrocardiographic changes, which can occur with electrolyte and metabolic disorder scenarios. In this study, we share a case of BrP that occurred due to hypovolemic hyponatremia and recovered spontaneously with the correction of electrolyte disturbance.

QGIS-based weighted linear combination plugin for landfill site selection: a case study in Tokat Province, Turkey.

Proper disposal of solid waste is crucial for the protection of natural resources and human health. However, increasing population and changes in consumption habits have led to a global increase in solid waste production. Therefore, a site selection process for solid waste management that takes into account environmental, economic, and social factors is needed. The number of open-source GIS (geographic information system) software programs used in site selection analysis is increasing day by day. QGIS software is an open-source GIS software developed by free software developers, with its popularity increasing with each new version and allowing for the development of plugins with the Python programming language. The shareability of plugins developed with QGIS software brings together open-source GIS users around the world for common goals. In this study, a plugin called "LANDFILL SITE SELECTION (LFSS)" was developed in the QGIS software environment for solid waste landfill site selection and a suitability map was created for solid waste landfill site selection in Tokat, Turkey, using this plugin. For this purpose, 14 evaluation criteria and 8 exclusion criteria were selected, the importance levels of criteria and sub-criteria were determined using the AHP method, and a solid waste landfill site selection suitability map was created using the developed plugin.

Predictive Value of the SCORE, SCORE2, and Pooled Cohort Risk Equation Systems in Patients with Hypertension.

OBJECTIVE: The objective of this study is to assess and compare the accuracy of old and new versions of the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE and SCORE2) American Heart Association/American College of Cardiology Pooled Cohort Risk Assessment Evaluation (PCE) in predicting long-term cardiovascular events in patients with hypertension. METHODS: This retrospective study consisted of 788 patients diagnosed with hypertension between 2009 and 2018. The absolute risk for 10-year cardiovascular events was calculated with SCORE, SCORE2, SCORE-OP, and PCE systems based on patients' data obtained on the date of hypertension diagnosis. The study group was followed for the occurrence of major adverse cardiac and cerebrovascular events. The differences between observed and predicted risk calculated using SCORE, SCORE2, and PCE systems and their prognostic value were assessed. RESULTS: The mean age of the 788 patients included in the study, of whom 426 (54.1%) were female, was 54 ± 9 years. During a mean follow-up of 6 years, 173 (22.0%) patients experienced a major adverse cardiac and cerebrovascular event. In predicting the occurrence of major adverse cardiac and cerebrovascular events in hypertension patients over the long-term, PCE had a predictive power comparable and slightly superior to 'SCORE2-SCORE-OP (AUC 0.732 vs. 0.724, respectively)' whereas SCORE (AUC 0.689) was inferior to 'SCORE2-SCORE-OP.' CONCLUSION: In this study, the Pooled Cohort Risk Assessment Equation risk-scoring system was superior to the old and new versions of Systematic Coronary Risk Evaluation risk system in predicting the cardiovascular and cerebrovascular events that developed in patients with hypertension.

The Predictive Role of Small Airway Dysfunction in Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Surgery.

OBJECTIVE: Atrial fibrillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial fibrillation has been described previously. We aimed to evaluate the prognostic influence of small airway function on predicting postoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial fibrillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory flow (forced expiratory flow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups. RESULTS: The frequency of postoperative atrial fibrillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity % [80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory flow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were significantly lower in postoperative atrial fibrillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory flow 25%-75% were found to be independent predictors of postoperative atrial fibrillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory flow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial fibrillation with 63.8% sensitivity and 70.1% specificity. CONCLUSION: Our study demonstrated that small airway obstruction, as indicated by forced expiratory flow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial fibrillation in patients undergoing isolated CABG.

Robust Fingerprint of Location Trajectories Under Differential Privacy.

Location-based services have brought significant convenience to people in their daily lives, and the collected location data are also in high demand. However, directly releasing those data raises privacy and liability (e.g., due to unauthorized distribution of such datasets) concerns since location data contain users' sensitive information, e.g., regular moving patterns and favorite spots. To address this, we propose a novel fingerprinting scheme that simultaneously identifies unauthorized redistribution of location datasets and provides differential privacy guarantees for the shared data. Observing data utility degradation due to differentially-private mechanisms, we introduce a utility-focused post-processing scheme to regain spatiotemporal correlations between points in a location trajectory. We further integrate this post-processing scheme into our fingerprinting scheme as a sampling method. The proposed fingerprinting scheme alleviates the degradation in the utility of the shared dataset due to the noise introduced by differentially-private mechanisms (i.e., adds the fingerprint by preserving the publicly known statistics of the data). Meanwhile, it does not violate differential privacy throughout the entire process due to immunity to post-processing, a fundamental property of differential privacy. Our proposed fingerprinting scheme is robust against known and well-studied attacks against a fingerprinting scheme including random flipping attacks, correlation-based flipping attacks, and collusions among multiple parties, which makes it hard for the attackers to infer the fingerprint codes and avoid accusation. Via experiments on two real-life location datasets and two synthetic ones, we show that our scheme achieves high fingerprinting robustness and outperforms existing approaches. Besides, the proposed fingerprinting scheme increases data utility for differentially-private datasets, which is beneficial for data analyzers.

Metastatic Progression of an Aggressive Hepatoblastoma Involving the Left Atrium and Ventricle.

Hepatoblastoma is the most common malignant liver tumor in early childhood. The metastatic extension of hepatoblastoma into the left atrium via the pulmonary vein and left ventricle is rare. Reported cases almost always involve right-sided approaches and occur in pediatric patients. However, we are reporting a case of a 22-year-old female with recurrent hepatoblastoma at multiple sites, including the left atrium, left ventricle, brain, and lung.

Privacy-Preserving Database Fingerprinting.

When sharing relational databases with other parties, in addition to providing high quality (utility) database to the recipients, a database owner also aims to have (i) privacy guarantees for the data entries and (ii) liability guarantees (via fingerprinting) in case of unauthorized redistribution. However, (i) and (ii) are orthogonal objectives, because when sharing a database with multiple recipients, privacy via data sanitization requires adding noise once (and sharing the same noisy version with all recipients), whereas liability via unique fingerprint insertion requires adding different noises to each shared copy to distinguish all recipients. Although achieving (i) and (ii) together is possible in a naïve way (e.g., either differentially-private database perturbation or synthesis followed by fingerprinting), this approach results in significant degradation in the utility of shared databases. In this paper, we achieve privacy and liability guarantees simultaneously by proposing a novel entry-level differentially-private (DP) fingerprinting mechanism for relational databases without causing large utility degradation. The proposed mechanism fulfills the privacy and liability requirements by leveraging the randomization nature of fingerprinting and transforming it into provable privacy guarantees. Specifically, we devise a bit-level random response scheme to achieve differential privacy guarantee for arbitrary data entries when sharing the entire database, and then, based on this, we develop an ϵ-entry-level DP fingerprinting mechanism. We theoretically analyze the connections between privacy, fingerprint robustness, and database utility by deriving closed form expressions. We also propose a sparse vector technique-based solution to control the cumulative privacy loss when fingerprinted copies of a database are shared with multiple recipients. We experimentally show that our mechanism achieves strong fingerprint robustness (e.g., the fingerprint cannot be compromised even if the malicious database recipient modifies/distorts more than half of the entries in its received fingerprinted copy), and higher database utility compared to various baseline methods (e.g., application-dependent database utility of the shared database achieved by the proposed mechanism is higher than that of the considered baselines).

Whole-Genome Sequencing of 11 High-Risk Clone ST111 Pseudomonas aeruginosa Isolates from French Hospitals.

This study reports high-quality genomes of 11 sequence type 111 (ST111) isolates of Pseudomonas aeruginosa. This ST is known for its worldwide dissemination and high capacity to acquire antibiotic resistance mechanisms. This study used long- and short-read sequencing to provide high-quality closed genomes for most of the isolates.

The Effect of Ideal/Standard Donor and Marginal Donor Use on Primary Graft Dysfunction After Lung Transplantation in Turkey.

OBJECTIVE: The transplantation waiting list is getting longer day by day with the spread of lung transplantation and awareness of it. However, the donor pool cannot keep up with this rate. Therefore, nonstandard (marginal) donors are widely used. By studying the lung donors presented at our center, we aimed to raise awareness of the donor shortage and compare clinical outcomes in recipients with standard and marginal donors. MATERIALS AND METHODS: The data from recipients and donors of lung transplants performed at our center between March 2013 and November 2022 were retrospectively reviewed and recorded. Transplants with ideal and standard donors were classified as group 1, and those with marginal donors were classified as group 2. Primary graft dysfunction rates, intensive care unit, and hospital stay days were compared. RESULTS: Eighty-nine lung transplants were performed. A total of 46 recipients were in group 1 and 43 were in group 2. There were no differences between groups in the development of stage 3 primary graft dysfunction. However, a significant difference was found in the marginal group for developing any stage primary graft dysfunction. Donors were mostly from the western and southern regions of the country and from the education and research hospitals. CONCLUSION: Because of the donor shortage in lung transplantation, transplant teams tend to use marginal donors. Stimulating and supportive education for healthcare professionals to recognize brain death and public education to raise awareness about organ donation are necessary to spread organ donation throughout the country. Although our results using marginal donors are similar with the standard group, each recipient and donor should be assessed individually.

A novel scoring system concept for de novo spinal infection treatment, the Spinal Infection Treatment Evaluation Score (SITE Score): a proof-of-concept study.

OBJECTIVE: De novo infections of the spine are an increasing healthcare problem. The decision for nonsurgical or surgical treatment is often made case by case on the basis of physician experience, specialty, or practice affiliation rather than evidence-based medicine. To create a more systematic foundation for surgical assessments of de novo spinal infections, the authors applied a formal validation process toward developing a spinal infection scoring system using principles gained from other spine severity scoring systems like the Spine Instability Neoplastic Score, Thoracolumbar Injury Classification and Severity Score, and AO Spine classification of thoracolumbar injuries. They utilized an expert panel and literature reviews to develop a severity scale called the "Spinal Infection Treatment Evaluation Score" (SITE Score). METHODS: The authors conducted an evidence-based process of combining literature reviews, extracting key elements from previous scoring systems, and obtaining iterative expert panel input while following a formal Delphi process. The resulting basic SITE scoring system was tested on selected de novo spinal infection cases and serially refined by an international multidisciplinary expert panel. Intra- and interobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Fleiss' and Cohen's kappa, respectively. A receiver operating characteristic analysis was performed for cutoff value analysis. The predictive validity was assessed through cross-tabulation analysis. RESULTS: The conceptual SITE scoring system combines the key variables of neurological symptoms, infection location, radiological variables for instability and impingement of neural elements, pain, and patient comorbidities. Ten patients formed the first cohort of de novo spinal infections, which was used to validate the conceptual scoring system. A second cohort of 30 patients with de novo spinal infections, including the 10 patients from the first cohort, was utilized to validate the SITE Score. Mean scores of 6.73 ± 1.5 and 6.90 ± 3.61 were found in the first and second cohorts, respectively. The ICCs for the total score were 0.989 (95% CI 0.975-0.997, p < 0.01) in the first round of scoring system validation, 0.992 (95% CI 0.981-0.998, p < 0.01) in the second round, and 0.961 (95% CI 0.929-0.980, p < 0.01) in the third round. The mean intraobserver reliability was 0.851 ± 0.089 in the third validation round. The SITE Score yielded a sensitivity of 97.77% ± 3.87% and a specificity of 95.53% ± 3.87% in the last validation round for the panel treatment decision. CONCLUSIONS: The SITE scoring concept showed statistically meaningful reliability parameters. Hopefully, this effort will provide a foundation for a future evidence-based decision aid for treating de novo spinal infections. The SITE Score showed promising inter- and intraobserver reliability. It could serve as a helpful tool to guide physicians' therapeutic decisions in managing de novo spinal infections and help in comparison studies to better understand disease severity and outcomes.

The association between ABO blood groups and TASC II classification in patients with peripheral artery disease.

OBJECTIVE: The aim of this study was to investigate the association between blood groups and severity of peripheral artery disease (PAD) using TASC II classification. METHODS: The patients who were diagnosed with PAD were retrospectively analyzed. The patients with 50% or more stenosis in the aorto-iliac or femoro-popliteal region detected by conventional or CT angiography were included in the study. These patients were divided into TASC II A, B, C, and D groups considering the severity of PAD. All patients' blood groups were recorded and compared between TASC II groups. RESULTS: While 38% of the study population was O blood group, 61% were non-O group. On the other hand, 90% of the entire study population were RH positive and 10% were RH negative. Non-O blood ratio was found to be significantly higher in patients with higher TASC II groups. (TASC IIA 51.6% vs. TASC IIB 57.9% vs. TASC IIC 61.3% vs. TASC IID 76.6%, p< .001) However, the frequencies of Rh types were similar in all groups. Multiple logistic regression analysis was applied for determining the predictors of severity and complexity of PAD (TASC II C and TASC II D lesions). CONCLUSIONS: Our study results revealed a clear association between ABO blood groups and severity of peripheral arterial disease. Non-O blood group was found to be the independent predictor of severe and complex PAD.

Conscious sedation versus general anesthesia for transcatheter aortic valve implantation in patients with severe chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered a major risk factor for postoperative complications after transcatheter aortic valve implantation (TAVI). To date, there is no clear consensus on the best anesthesia management for these patients. We aimed to investigate the effects of types of anesthesia on clinical outcomes in patients with severe COPD undergoing TAVI. METHODS: This is a single-center, retrospective study comparing conscious sedation (CS) versus general anesthesia (GA) in 72 patients with severe COPD who underwent TAVI. The primary endpoints were 30-day all-cause mortality and postoperative pulmonary complications. RESULTS: The main outcome of interest of this study was that the frequency of pulmonary complications was statistically higher in the GA group (21.4% vs 3.3%, p = 0.038). These differences are most likely attributed to the GA because of prolonged mechanical ventilation, and longer ICU stay (2 (1.2-3) vs 2.5 (2-4) days, p = 0.029) associated with an increased risk of nosocomial infections. There were no significant differences in procedure complications and 30-day mortality between the two groups (GA; 19% vs CS; 13.3%, p = 0.521). One-year survival rates, compared by Kaplan-Meier analysis, were similar between groups (log-rank p = 0.733). CONCLUSION: In aortic stenosis patients with severe COPD undergoing TAVI, the use of GA compared with CS was associated with higher incidences of respiratory-related complications, and longer ICU length of stay. CS is a safe and viable option for these patients and should be considered the favored approach.

Influence of Locomotion Therapy With the Wearable Cyborg HAL on Bladder and Bowel Function in Acute and Chronic SCI Patients.

STUDY DESIGN: Retrospective survey. OBJECTIVES: Purpose of this study was to explore whether bowel and bladder management can be influenced by locomotion therapy with HAL Robot Suit. METHODS: 35 subjects with acute (< one year since injury, n = 13) or chronic (> one year since injury, n = 22) incomplete paraplegia (American Spinal Injury Association Impairment Scale (AIS) B, n = 1 / AIS C, n = 22 / AIS D, n = 7) or complete paraplegia (AIS A, n = 5) with zones of partial preservation (ZPP) participated. A retrospective survey was carried out asking for bowel incontinence (Wexner Score), constipation (Cleveland Clinic Constipation Scoring System (CCCS)) and bladder function (self-developed questionnaire) before and after completing a training period of 12 weeks with HAL. RESULTS: Wexner Score over all patients and for group of chronic patients decreased significantly. For group of acute patients Wexner Score decreased insignificantly. Patients from both groups with higher baseline scores could decrease significantly. CCCS was insignificantly reduced for all patients, group of acute and group of chronic patients. For subgroup of chronic patients with higher baseline scores, CCCS decreased at end of training period missing out significance. The self-developed questionnaire showed an improvement in bladder function in 28.24% of all patients, 31.43% of chronic patients, and 23.08% of acute patients. CONCLUSIONS: Our findings show trends of enhanced bladder and bowel function following exoskeleton training. Patients with higher baseline scores in Wexner Score and CCCS seem to benefit more than those with mild to moderate scores.

Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients.

STUDY DESIGN: Retrospective case series analysis. OBJECTIVE: To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. METHODS: We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as "failed treatment group" (FTG). Patients who experienced an uneventful course served as controls and were labeled as "nonsurgical group" (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. RESULTS: Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment ("FTG") within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. CONCLUSIONS: We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.