Outcome of patient undergoing redo mitral valve surgery with incidence rate of mitral valve infective endocarditis.

BACKGROUND: The incidence of infective endocarditis (IE) in patients undergoing redo mitral valve (MV) surgery was evaluated. The outcomes of all the patients and the patients' specific characteristics were recorded. The patients were analyzed to further the research of IE in this population. METHOD: This was a retrospective review of patients admitted for redo MV surgery with a prospective follow-up of electronic medical records at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, from 2009 to 2019. Pre/intra/post-operative factors contributing to mortality, morbidity, and freedom of adverse events were analyzed. RESULT: A total of 211 patients underwent redo MV surgery, and 41 patients (19.4%) had IE; and 51% of this subset of patients, 21 individuals, developed IE after the initial MV surgery. MV stenosis was moderate/severe in 50 patients. Furthermore, MV regurgitation was present in 89 patients. Multivariate analysis of the data revealed multiple factors influencing mortality: age, peripheral vascular disease, concomitant procedures, peripheral vascular disease, red blood cell transfusions, preoperative mechanical valves, and active IE. In-hospital Mortality was 10.9%. The one-, five-, and ten-year survival was 88%, 79%, and 69% across all patients. CONCLUSION: Although redo MV surgery has acceptable outcomes; the presence of IE or concomitant procedures is a significant health detriment in these patients. Our study highlights the need for careful patient management and more in-depth research in this area to improve patient outcomes.

Concomitant ablation for non-paroxysmal atrial fibrillation: combined energy versus cryoablation alone.

Background: Surgical ablation of atrial fibrillation has been the most efficient treatment for atrial fibrillation (AF). Combined energy (CE) ablation and cryoablation alone (CA) are the most common energy modes used for ablation, however, comparative data is lacking. Objectives: To compare the efficacy of CE ablation with CA in the setting of concomitant biatrial ablation for non-paroxysmal AF. Methods: A retrospective analysis of 453 patients with non-paroxysmal AF undergone concomitant biatrial ablation from November 2007 to December 2022 during elective cardiac surgery using either combined bipolar radiofrequency with cryoenergy or cryoenergy alone was performed. Propensity score matching was conducted to balance the covariates in the groups. Results: There were 157 patients per group after matching. CE ablation was associated with lower odds of atrial tachyarrhythmia recurrence (OR = 0.13, 95% CI 0.02-0.91, p = 0.040), a significantly lower rate of hospital readmissions due to rhythm disruption (HR = 0.34, 95% CI 0.18-0.65, p < 0.001), and lower cumulative incidence of stroke (SHR = 0.38, 95% CI 0.15-0.97, p = 0.043). No significant difference in permanent pacemaker implantation was observed between the two groups. Conclusions: In the setting of concomitant biatrial ablation for non-paroxysmal AF, combined bipolar radiofrequency and cryoablation appear to be a superior treatment modality compared to cryoablation alone in achieving long-term freedom from atrial arrhythmias, in reducing arrhythmia-related hospital readmissions and ischemic strokes.

Immunogenicity and safety of different combinations involving a third booster dose of SARS-CoV-2 inactivated vaccine, inactivated quadrivalent influenza vaccine, and 23-valent pneumococcal polysaccharide vaccine in adults aged ≥60 years: a phase 4, randomized, open-label study.

Background: Concomitant administration of COVID-19, influenza, and pneumococcal vaccines could reduce the burden on healthcare systems. However, the immunogenicity and safety of various combinations of a third booster dose of SARS-CoV-2 inactivated vaccine (CoronaVac), inactivated quadrivalent influenza vaccine (IIV4), and 23-valent pneumococcal polysaccharide vaccine (PPV23), particularly in different age groups, is still unknown. Methods: A phase 4, randomized, open-label, controlled trial was conducted in Beijing, China. 636 healthy adults were divided into two age groups (18-59 and ≥60 years) and randomized equally into three groups: CoronaVac and IIV4 followed by PPV23; CoronaVac and PPV23 followed by IIV4; or CoronaVac followed by IIV4 and PPV23, with a 28-day interval between vaccinations. Immunogenicity was evaluated by measuring antibody titers, and safety was monitored. ClinicalTrials.gov Identifier: NCT05298800. Results: Co-administration of a third dose of CoronaVac, IIV4, and PPV23 in any combination was safe. Among adults aged 18-59, co-administration with PPV23 maintained non-inferiority of antibody levels for CoronaVac and IIV4, despite a slight reduction in antibody responses. This reduction was not observed in participants ≥60 years. Furthermore, co-administration of IIV4 and PPV23 affected seroconversion rates for both vaccines. Conclusions: Co-administration of the third dose of SARS-CoV-2 inactivated vaccine with the influenza vaccine, followed by PPV23, may be optimal for adults aged 18-59. In adults ≥60, all vaccine combinations were immunogenic, suggesting a flexible vaccination approach. Since antibody measurements were taken 28 days post-vaccination, ongoing surveillance is essential to assess the longevity of the immune responses.

Simultaneous incisional hernia repair and colorectal surgery: one or two-step procedure?

PURPOSE: Patients requiring colorectal surgery in the context of an incisional hernia are common, but it is not clear whether the repair should be performed as a single or two-step surgery. Our aim was to evaluate complications after concomitant abdominal wall repair and colorectal surgery compared to those after incisional hernia repair alone. METHODS: Adult patients who underwent elective incisional hernia surgery from 2012-2022 from the EVEREG registry were included. Patients who underwent midline incisional hernia repair as a single procedure and patients who underwent midline incisional hernia repair concomitant with colorectal surgery were included. The primary outcome was surgical site infection (SSI). The secondary outcomes were the Clavien-Dindo classification grade, in-hospital mortality and recurrence. RESULTS: A total of 7783 patients were included: 256(3.3%) who underwent concomitant surgery and 7527(96.7%) who underwent only midline incisional hernia repair. The first group included more comorbid patients and complex hernias. SSI was found in 55.4% of patients who underwent simultaneous surgery compared to 30.7% of patients who underwent hernia repair alone (P = 0.000). Multivariate analysis revealed that the risk factors for SSI were BMI (OR = 1.07, 95% CI 1.02-1.11; P = 0.004), smoking (OR = 1.89, 95% CI 1.12-3.19; P = 0.017), transverse diameter (OR = 1.06, 95% CI 1.01-1.11; P = 0.017), component separation (OR = 1.996, 95% CI 1.25-3.08; P = 0.037) and clean-contaminated and contaminated surgeries(OR = 3.86, 95% CI 1.36-10.66; P = 0.009). Higher grades of Clavien-Dindo (P = 0.001) and mortality rates (P < 0.001) were found in the colorectal surgery group, although specific risk factors were detected. No differences were observed in terms of recurrence (P = 0.104). CONCLUSIONS: Concomitant surgery is related to greater risk of complications, especially in patients with comorbidities and complex hernias. In properly selected cases, simultaneous procedures can yield satisfactory results.

The effects of simultaneous respiratory infections on the nasal shedding of Mycoplasmopsis bovirhinis in dairy calves.

Although there are several studies that described the possible participation of Mycoplasmopsis bovirhinis (formerly, Mycoplasma bovirhinis) in respiratory disease in calves worldwide, none of these evaluated the effects of concomitant infections on the shedding of this organism. Accordingly, this study evaluated the effects of simultaneous respiratory infections in dairy calves on the nasal shedding of M. bovirhinis. A statistical two-step model, using univariable and multivariable with logistic regression was developed to investigate and predict the possible effects of simultaneous infections by Histophilus somni, Mannheimia haemolytica, Pasteurella multocida, bovine coronavirus (BCoV), and ovine gammaherpesvirus 2 (OvGHV2) in dairy calves on the nasal shedding of M. bovirhinis. The multivariable analysis demonstrated that dairy calves infected with OvGHV2 have 2.59 times likelihood of nasal shedding of M. bovirhinis relative to calves not infected by OvGHV2, while the odds of nasal shedding of M. bovirhinis was 3.46 times higher in dairy calves infected by M. haemolytica. In contrast, simultaneous respiratory infections in dairy calves by H. somni, P. multocida, and BCoV had no direct effect on the nasal shedding of M. bovirhinis. Consequently, infections by OvGHV2 and M. haemolytica may be possible risk factors for the nasal shedding of M. bovirhinis in dairy calves. These results demonstrated the importance of disease modeling in veterinary medicine to predict and understand the complex outcomes of associations in animals concomitantly infected by several disease pathogens.

Concomitant Heart and Lung Surgery During Lung Transplantation.

INTRODUCTION: There is limited data concerning concomitant cardiac and lung surgery outcomes during lung transplantation (LTx). While some evidence suggests that cardiac surgery during LTx has no significant impact on surgical outcomes, scarce data examines the role of concomitant lung surgery (CLS). This study compares the survival outcomes of concomitant cardiac and lung surgeries during LTx. METHODS: A retrospective analysis of all single and double LTx patients from March 2012 to June 2023 at a single center was performed (n = 1099). Patients were stratified into three concomitant surgical groups: concomitant cardiac surgery (CCS), CLS, and no concomitant surgeries. Groups were compared on recipient demographics, diagnosis, and surgical intervention using analysis of variance and chi-square tests. Survival (5 y) was analyzed using Kaplan-Meier curves, log-rank test, and univariable Cox proportional hazard model where P value <0.05 was considered significant. RESULTS: In total, 1099 patients were analyzed in this study; 965 had no concomitant surgery, 100 had CCS (mode: coronary artery bypass grafting, n = 75), and 34 had CLS (mode: lung volume reduction surgery, n = 14). Between the three surgical groups, there was no significant difference in body mass index (P = 0.091), total ischemic time (P = 0.194), induction (P = 0.140), or cause of death (P = 0.240). Lung allocation score and length of stay were significantly higher in the concomitant surgical groups, especially the CLS group when compared to the no concomitant surgery group (P = 0.002, P = 004). Patients with no concomitant surgery had a higher incidence of single LTx and off-pump utilization than concomitant surgical groups (P < 0.001). Kaplan-Meier curves and log-rank tests found no significant difference in survival between groups (P = 0.849). This result is supported by Cox proportional hazard model with no significant difference in mortality risk between the CCS group (P = 0.522) and CLS group (P = 0.936) compared to no concomitant surgery during LTx. CONCLUSIONS: Our study provides promising data indicating that individuals undergoing concomitant heart or lung surgery during LTx have similar survival outcomes to those exclusively undergoing LTx. These results highlight the potential advantages of utilizing LTx to address concurrent thoracic surgical needs, such as coronary revascularization. This holds implications for optimizing patient care and decision-making when complex thoracic interventions are necessary.

Cat-Scratch Disease Mimicking Neoplastic Etiology in a Complex Clinical Presentation: A Case Report.

Cat-scratch disease (CSD), caused by Bartonella henselae (B. henselae), typically presents with regional lymphadenopathy following a cat scratch or bite. We report a case of a 50-year-old man with a complex medical history including HIV, Crohn's disease, coronary artery disease, and bipolar disorder, who presented with progressively enlarging cervical lymphadenopathy associated with fever, night sweats, and myalgias. Initial evaluation suggested a neoplastic etiology, prompting extensive laboratory investigations and imaging. However, subsequent history prompted serological testing and markedly elevated Bartonella antibody titers, leading to a clinical diagnosis of CSD. Empirical doxycycline therapy was initiated, resulting in the complete resolution of symptoms. This case underscores the importance of considering CSD in the differential diagnosis of lymphadenopathy, particularly in people living with HIV regardless of immunocompetency, and highlights the challenges of diagnosis and management in complex patients.

Relationship between obesity severity and Helicobacter pylori eradication in patients undergoing bariatric and metabolic surgery: A post hoc analysis.

BACKGROUND: The global prevalence of obesity is increasing and represents a major public health challenge. However, there is a paucity of data regarding Helicobacter pylori (H pylori) eradication in people with obesity. The aim of the study is to examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric and metabolic surgery. METHODS: A post hoc analysis was conducted in a cohort of 204 adults patients (129 individuals diagnosed with obesity, 75 normal weight) H. pylori positive, included in two multicenter, prospective studies. Patients underwent a 14-day quadruple concomitant treatment, and H. pylori eradication was assessed using the 13C-urea breath test. The cohort was stratified according to body mass index (BMI), and statistical analyses were performed using chi-squared test, Kruskal-Wallis test, and logistic regression. RESULTS: Eradication rates were significantly lower in patients with obesity compared with normal weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13-0.63, p < 0.01). Furthermore, within the population diagnosed with obesity, the degree of obesity correlated with decreased eradication rates, with class 3 (BMI 40.0-49.9) and class 4 (BMI ≥ 50.0) obesity showing the lowest rates (67% and 51%, with an OR 0.28 and 0.15 respectively, p < 0.01). CONCLUSIONS: Our results indicate that obesity may influence H. pylori eradication, especially among severe obesity patients undergoing bariatric surgery, which could have implications for the development of ulcers and gastritis as well as the risk of gastric cancer. Tailored eradication strategies may be necessary to improve treatment efficacy in this population.

A Novel Treatment for Skin Manifestations in Dermatomyositis: A Case Report.

We present a case of refractory cutaneous dermatomyositis (DM) in a 51-year-old Hispanic female which failed multiple treatments but found symptomatic relief with anifrolumab. Anifrolumab was the only treatment that was associated with significant improvement in the rash and pruritis of the patient and lowered her corticosteroid needs. To our knowledge, this is the only second case report that has shown success in treating refractory cutaneous symptoms of DM with anifrolumab after failing standard and multiple combinations of therapies. Anifrolumab is a new first-in-class human monoclonal antibody, which inhibits type 1 interferon receptor (IFN-1) and is used to treat systemic lupus erythematosus (SLE). It is FDA-approved for non-renal manifestations of SLE. This IFN pathway seems to be also active in patients with DM. The presence of IFN-1 and IFN-2 has been reported in muscle biopsies of patients with inflammatory myopathies. Moreover, the IFN activation signature is present in the muscle, blood, and skin of patients with DM. IFN-1 has been assumed to activate toll-like receptors which activate the dendritic cells leading to the secretion of cytokines and chemokines. This potential pathophysiological role of IFN in DM may explain the symptom improvement experienced by our patient after starting anifrolumab treatment. Anifrolumab has additionally been shown to have a good safety profile when used to treat patients with SLE with up to three years of treatment on background conventional disease-modifying antirheumatic drug (DMARD) therapies. In conclusion, SLE and DM share similarities in their pathophysiology and cutaneous disease involvement and can be differentiated clinically. Skin manifestations of DM can persist despite combinations of therapies even when weakness resolves. With this case report, we aim to highlight the possibility of utilizing anifrolumab for treating DM skin manifestations, especially in refractory cases. More research is needed to guide where anifrolumab stands in the therapeutic algorithm for DM. It is unknown whether it treats the myositis component, DM-related arthritis, or coexistent rheumatoid arthritis.

Concomitant hiatal hernia repair with transoral incisionless fundoplication for the treatment of refractory gastroesophageal reflux disease: a systematic review.

BACKGROUND: Transoral incisionless fundoplication (TIF) is safe and effective in select patients with hiatal hernias ≤ 2 cm with refractory gastroesophageal reflux disease (GERD). For patients with hiatal hernias > 2 cm, concomitant hiatal hernia (HH) repair with TIF (cTIF) is offered as an alternative to conventional anti-reflux surgery (ARS). Yet, data on this approach is limited. Through a comprehensive systematic review, we aim to evaluate the efficacy and safety of cTIF for managing refractory GERD in patients with hernias > 2 cm. STUDY DESIGN: We conducted a systematic review of studies evaluating cTIF outcomes from PubMed, EMBASE, SCOPUS, and Cochrane databases up to February 14, 2024. Primary outcomes included complete cessation of proton pump inhibitors (PPIs). Secondary outcomes included objective GERD assessment, adverse events, and treatment-related side effects. Pooled analysis was employed wherever feasible. RESULTS: Seven observational studies (306 patients) met the inclusion criteria. Five were retrospective cohort studies and two were prospective observational studies. The median rate of discontinuation of PPIs was 73.8% (range 56.4-94.4%). Significant improvements were observed in disease-specific, validated GERD questionnaires. The median rate for complications was 4.4% (range 0-7.9%), and the 30-day readmission rate had a median of 3.3% (range 0-5.3%). The incidence of dysphagia was 11 out of 164 patients, with a median of 5.3% (range 0-8.3%), while the incidence of gas bloating was 15 out of 127 patients, with a median of 6.9% (range 0-13.8%). CONCLUSION: Current data on cTIF suggests a promising alternative to ARS with comparable short-term efficacy and safety profile for managing refractory GERD with a low side effect profile. However, longer-term data and comparative efficacy studies are needed.

The use of concomitant medications on nephrotoxicity associated with teicoplanin: A retrospective observational study.

BACKGROUND: Teicoplanin (TEIC) is a nephrotoxic agent. However, little is known about the effects of concomitant medications on nephrotoxicity. In this study, we investigated the effects of concomitant drugs on nephrotoxicity. METHODS: A retrospective observational case-control study was conducted on patients (≥18 years) who started TEIC at the Tokyo Dental College, Ichikawa General Hospital, between January 2013 and April 2023. The primary outcome was nephrotoxicity, defined as an increase in serum creatinine levels of ≥50 % or ≥0.5 mg/dL from baseline. Logistic regression analysis was used to determine the risk factors for nephrotoxicity associated with TEIC. In addition, we investigated the relationship between nephrotoxicity and predicted free TEIC concentrations. RESULTS: Of 305 patients, 43 (14.1 %) developed nephrotoxicity. The multivariate logistic regression analysis identified that serum albumin (odds ratio [OR] = 0.50, 95 % confidence interval [CI] 0.27-0.89, p = 0.02), concomitant use of loop diuretics (OR = 2.22, 95 % CI 1.10-4.59, p = 0.03), antivirals (OR = 3.24, 95 % CI 1.32-7.62, p < 0.01), and vasopressors (OR = 2.57, 95 % CI 1.10-5.78, p = 0.03) were the associated risk factors for nephrotoxicity in patients administered with TEIC. In 216 patients, predicted TEIC concentrations were 3.6 [interquartile range (IQR), 2.6-4.9] µg/mL in the nephrotoxicity group versus 3.6 [IQR, 2.5-4.7] µg/mL in the non-nephrotoxicity group, with no significant difference (p = 0.69). CONCLUSION: Our results indicate the importance of modifying the concomitant use of loop diuretics, antivirals, and vasopressors.

Permanent pacemaker implantation after combined mitral- and tricuspid valve surgery-a nationwide multicentre study.

OBJECTIVES: The threshold to perform concomitant TV repair (TVr) during primary mitral valve (MV) surgery has decreased, based on recent randomized evidence. Based on these developments, the indication for TVr during MV surgery is expected to increase further. However, concerns have been raised regarding the risk of permanent pacemaker implantation (PPI) during a concomitant procedure. Therefore, we aim to assess the incidence of PPI in combined MV and TV surgery in a nationwide registry. METHODS: The current study uniquely cross-linked the Cardiothoracic and Pacemaker/ICD registry of the Netherlands Heart Registration. Patients undergoing primary MV and TV surgery (± ASD closure, rhythm surgery, CABG) between January 1st-December 31st 2021 were included. The primary outcome was PPI within 30 days after surgery. Subgroup analyses were performed for isolated MV and TV surgery and MV repair. The association between concomitant TV surgery and PPI was assessed using multivariable binary logistic regression analyses. RESULTS: A total of 1060 patients (n = 833 MV, n = 227 MV+TV) were included. The overall incidence of PPI was 4.3%. No significant difference in PPI between MV and MV+TV surgery were found (3.7% vs 6.6%, P = 0.06). Concomitant TV surgery was not an independent risk factor for PPI after surgery after adjustment for covariates. These results were robust across subgroup and sensitivity analyses. CONCLUSIONS: The current study was not able to find a statistical difference between the PPI rate in MV surgery patients and MV + TV surgery patients. Extension of the waiting period prior to PPI, may result in decreased PPI rates.

Clinical features and prognosis of parotid metastasis of breast cancer: retrospective analysis of 57 cases.

Purpose: Parotid gland metastases originating from breast origin are extremely rare, with their clinical presentation, therapeutic approaches, and prognostic indicators remaining to be elucidate. Methods: A comprehensive retrospective review was conducted, analyzing the clinical characteristics and prognostic factors of 57 patients diagnosed with parotid metastasis of breast cancer in the existing literature. Notably, our study included two unique cases of patients who developed contralateral and ipsilateral parotid metastases, occurring 5 years and 32 years respectively after primary surgery. This analysis aimed to provide a deeper understanding of the disease presentation and identify potential prognostic indicators. Results: The primary clinical manifestation presented in breast cancer patients with parotid metastases was painless masses in the parotid glands, synchronously or metachronously occurred with primary breast tumors. The predominant pathological subtype among these patients was invasive ductal carcinoma. Out of the 57 patients studied, 24 (42.1%) exhibited metastases solely in the ipsilateral parotid gland, while 18 cases (31.6%) involved either the contralateral or bilateral parotid gland. Patients may solely exhibit metastasis in the parotid gland, or they may present with concurrent multiple metastases in other organs. Patients who suffered from parotid metastases, either merely or accompanied with bone-only metastasis, exhibited significantly longer overall survival (OS) rates compared to those who had concomitant metastases in other organs (1.23 ± 0.26 years vs 4.46 ± 0.77 years, P=0.046). While no statistically significant differences in OS were observed among patients presenting with metastases in the ipsilateral, contralateral, or bilateral parotid glands, a notable variance could be discerned from the Kaplan-Meier curve analysis. Additionally, no significant difference in survival was exhibited between patients with different interval of progression from primary breast sites to initial diagnosis of parotid metastases (uDF), nor for patients who were treated with surgery or palliative therapy. Conclusion: Parotid metastasis, a rare and distinctive form of breast cancer metastasis, demands particular scrutiny in patients exhibiting metastasis to multiple organs or contralateral or bilateral parotid glands.

Concomitant Boost With Six Fractions of Radiation a Week in Locally Advanced Head and Neck Cancer Patients: A Prospective Study.

Background and objective Radiation therapy plays a significant role in the radical treatment of locally advanced head and neck cancers. Studies have shown the radiobiological advantage of accelerated chemoradiation over conventional chemoradiation as it reduces the chances of accelerated repopulation and decreases overall treatment time. This study aimed to assess the response and toxicities of accelerated concomitant chemoradiation in locally advanced head and neck cancer patients. Methods A total of 51 patients were enrolled and treated with accelerated concomitant chemoradiation, receiving one fraction of radiation per day, six fractions per week, with the sixth fraction as a boost on Saturdays, with weekly concurrent cisplatin at 40 mg/m2. Patients were followed up till six months after treatment completion. Radiological investigation was done to assess response according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.128, and acute toxicities were assessed according to Radiation Therapy Oncology Group (RTOG) criteria. Results The median follow-up period was six months; 28 patients (62.22%) had a complete response and 17 (37.78%) had a partial response at six months post-completion of the treatment. The maximum acute toxicities developed at the completion of treatment. Grade III and IV mucositis developed in 14 patients (31.11%) and grade III dermatitis developed in one patient (2.22%), without any grade IV dermatitis during the total duration of treatment. The toxicities were manageable, and most of them resolved after three months of treatment completion. Conclusions Accelerated concomitant chemoradiation with six fractions of radiation in a week led to a decrease in overall treatment time. Of note, 62.22% of patients had complete remission, with manageable acute mucositis and dermatitis, which resolved in 82% and 67%, respectively within three months of treatment completion. However, further studies involving larger samples and longer follow-ups are needed for this regimen to be established as the standard of care in the future.

Emergency-Driven Multiple Simultaneous Invasive Procedures in Haemophilia.

Despite the controversies regarding the appropriateness and justification of simultaneous bi- and multi-concomitant surgical procedures, this operative technique is increasingly undertaken for economic reasons. This paper discusses three cases of simultaneous interventions: two involving osteoarticular procedures and one involving a complex approach encompassing general and plastic surgery. The indications in emergency-driven cases are mandatory, life-saving, and limb-saving, and not subject to debate.

Concomitant sarcopenia and undernutrition: Impact on clinical outcomes in patients undergoing hemodialysis.

BACKGROUND: Sarcopenia and undernutrition are crucial in the cycle of frailty in patients requiring hemodialysis therapy, and their deleterious clinical consequences are well documented. However, little attention has been directed towards examining their combined impact on clinical outcomes. OBJECTIVE: This study aimed to elucidate the effects of concomitant sarcopenia and undernutrition on clinical outcomes in patients undergoing hemodialysis. METHODS: This prospective cohort study recruited outpatients undergoing hemodialysis from four facilities. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia, 2019. Undernutrition was determined using the Geriatric Nutritional Risk Index, with a score of <92 classified as undernutrition. Patients were classified into four groups according to the presence or absence of sarcopenia and undernutrition. Cox proportional hazards analysis was used to assess the independent association between concomitant sarcopenia and undernutrition, all-cause mortality, and cardiovascular (CV) events after adjusting for baseline characteristics. RESULTS: We included 450 patients in this analysis. Of the 450 patients, 69 (15.3%) had concomitant sarcopenia and undernutrition. The mean follow-up period was 1067 days, and there were 61 deaths and 60 CV events. The cumulative survival rate was significantly lower in the sarcopenia with undernutrition group (P = 0.011). The overlap of sarcopenia and undernutrition was significantly associated with a risk of mortality (hazard ratio 2.10; 95% confidence interval 1.05-4.21; P = 0.037). However, no association was observed between the co-occurrence of sarcopenia and undernutrition and the risk of CV events. CONCLUSIONS: Concomitant sarcopenia and undernutrition were significantly associated with an increased mortality risk among patients undergoing hemodialysis. This finding reaffirms the importance of managing sarcopenia and undernutrition in patients undergoing hemodialysis in daily clinical practice.

CD4+ T cells re-wire granuloma cellularity and regulatory networks to promote immunomodulation following Mtb reinfection.

Immunological priming-in the context of either prior infection or vaccination-elicits protective responses against subsequent Mycobacterium tuberculosis (Mtb) infection. However, the changes that occur in the lung cellular milieu post-primary Mtb infection and their contributions to protection upon reinfection remain poorly understood. Using clinical and microbiological endpoints in a non-human primate reinfection model, we demonstrated that prior Mtb infection elicited a long-lasting protective response against subsequent Mtb exposure and was CD4+ T cell dependent. By analyzing data from primary infection, reinfection, and reinfection-CD4+ T cell-depleted granulomas, we found that the presence of CD4+ T cells during reinfection resulted in a less inflammatory lung milieu characterized by reprogrammed CD8+ T cells, reduced neutrophilia, and blunted type 1 immune signaling among myeloid cells. These results open avenues for developing vaccines and therapeutics that not only target lymphocytes but also modulate innate immune cells to limit tuberculosis (TB) disease.

Immunogenicity and Safety of an Inactivated Quadrivalent Influenza Vaccine Administered Concomitantly with a 23-Valent Pneumococcal Polysaccharide Vaccine in Adults Aged 60 Years and Older.

The inactivated quadrivalent influenza vaccine (IIV4) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) have been administered for years and could be administered concomitantly if necessary. However, the immunogenicity and safety of the concomitant administration of these two vaccines have not been well documented, especially in the Chinese population. In this study, 480 participants aged 60 years and older were randomly assigned to the concomitant administration group (C group) or the separate administration group (S group) to receive IIV4 and PPSV23 either concomitantly or separately. Blood samples were collected before and 28 days after each vaccination. The antibodies against four influenza virus strains and twenty-three pneumococcus serotypes were tested. The results showed that the geometric mean titer (GMT) ratios (C group to S group) for the four influenza strains ranged from 0.72 to 0.95, with the lower limits of the 95% confidence intervals (CIs) ranging from 0.51 to 0.75, and the geometric mean concentration (GMC) ratios for the 23 pneumococcal serotypes ranged from 0.80 to 1.00, with the lower limits of 95% CIs ranging from 0.67 to 0.86. All values met the predefined criteria for non-inferiority. The incidence of adverse events was 0.63% in the C group and 1.56% in the S group. No serious adverse events were observed. In conclusion, the immunogenicity of the concomitant administration of IIV4 and PPSV23 was non-inferior to that of the separate administration, and the safety profile was favorable in adults aged 60 years and older in China.

Efficacy and safety of tegoprazan- and rabeprazole-based concomitant therapies for Helicobacter pylori infection: Real-world evidence.

BACKGROUND AND AIM: Tegoprazan, a novel potassium-competitive acid blocker, has been approved for Helicobacter pylori eradication in Korea. We compared the efficacy and safety of tegoprazan- and rabeprazole-based concomitant therapies for H. pylori eradication in real-world clinical practice. METHODS: We retrospectively analyzed data from patients with H. pylori infection treated with tegoprazan- or rabeprazole-based concomitant therapies. The primary endpoint was H. pylori eradication rate. The secondary endpoint was adverse events. RESULTS: Among the 1474 included patients, 620 and 854 received tegoprazan- and rabeprazole-based concomitant therapies, respectively. Intention-to-treat analysis showed no significant difference in the eradication rates between the tegoprazan- and rabeprazole-based concomitant therapy groups (74.7% [95% confidence interval [CI], 71.1-78.0%] vs 72.7% [95% CI, 69.7-75.6%], P = 0.400). Per-protocol analysis also demonstrated similar eradication rates for the groups (tegoprazan vs rabeprazole: 88.0% [95% CI, 85.0-90.6%] vs 85.9% [95% CI, 83.2-88.3%], P = 0.288). Although the overall adverse event rate did not differ between groups (tegoprazan vs rabeprazole, 39.2% vs 40.6%, P = 0.578), abdominal discomfort was less frequent in the tegoprazan group than in the rabeprazole group (1.3 vs 4.8%, P = 0.001). CONCLUSIONS: Tegoprazan- and rabeprazole-based concomitant therapies for H. pylori eradication showed comparable efficacy and overall safety. The effect of tegoprazan on dose increases or other regimens, such as bismuth-containing quadruple therapy, should be further evaluated, because the efficacy of tegoprazan-based concomitant therapy may be suboptimal in regions where the clarithromycin resistance rate is high.