BACKGROUND: Hearing-impaired persons with asymmetric hearing loss and a unilateral indication for a cochlear implant (CI) generally benefit from a bimodal hearing solution. The influence of bimodal fitting on speech comprehension (SC) over time has not yet been sufficiently investigated. The present study examines the influence of bimodal fitting on SC in bimodally fitted CI users with postlingual deafness at least 36 months after implantation and analyzes possible influencing factors.
METHODS: Included in this retrospective longitudinal study were 54 bimodally fitted speech-competent CI users with at least 36 months of CI experience. Audiometric data of these CI users at predefined timepoints were compared.
RESULTS: The change in the results of the Freiburg monosyllabic test (FT) over 36 months was significant (p < 5%) for the deafness group at <10 years for both the 65 dB sound pressure level (SPL) and at 80 dB SPL and also significant for the deafness group ≥10 years for 65 dB SPL. In the Oldenburg sentence test (OlSa) there was a highly significant change (p < 0.1%) for S0, S0N0, and S0NCI configurations and a very significant change (p < 1%) for S0NHA (HA: hearing aid). Age at implantation as a possible influencing factor could not be confirmed in the FT. In contrast, the duration of deafness was a negative influencing factor for SC with CI in the FT, whereas a longer duration of deafness was associated with worse results in the FT. The degree of hearing loss in the ear fitted with an HA did not influence SC. The median bimodal benefit (here: difference in SC with bimodal fitting compared to unilateral HA fitting for FT at 65 dB SPL) was 10% over the total study period. For a median of 79% of the test subjects, the bimodal benefit was found over the entire period of 36 months.
CONCLUSIONS: Over time, SC improves significantly with a CI for the bimodal test subjects. The investigated influencing factors (age, duration of deafness, and degree of hearing loss in the contralateral ear) support the indication for bimodal provision in accordance with the guideline in Germany for cochlear implantation-regardless of age, duration of deafness, and hearing ability of the contralateral ear.
UNASSIGNED: HINTERGRUND: Hörgeschädigte Menschen mit asymmetrischem Hörverlust und einseitiger Indikation für ein Cochleaimplantat (CI) profitieren in aller Regel deutlich von einer bimodalen Hörversorgung. Der Einfluss dieser Versorgungsart auf das Sprachverstehen (SV) im zeitlichen Verlauf ist bislang nicht hinreichend untersucht. Die vorliegende Studie untersucht den Einfluss einer bimodalen Versorgung auf das SV postlingual ertaubter, bimodal versorgter CI-Träger:innen nach einer Tragedauer von mindestens 36 Monaten und analysiert dabei mögliche Einflussfaktoren.
METHODS: Es wurden 54 bimodal versorgte lautsprachkompetente CI-Träger:innen mit einer CI-Erfahrung von mindestens 36 Monaten in diese retrospektive Längsschnittstudie eingeschlossen. Audiometrische Daten von diesen CI-Träger:innen wurden im zeitlichen Verlauf verglichen.
UNASSIGNED: Die Veränderung der Ergebnisse im Freiburger Einsilbertest (FBE) im Verlauf der 36 Monate war für die Ertaubungsgruppe < 10 Jahre sowohl für den Pegel 65 dB „sound pressure level“ (SPL) als auch für 80 dB SPL signifikant und für die Ertaubungsgruppe ≥ 10 Jahre für 65 dB SPL signifikant (p < 5 %). Beim Oldenburger Satztest (OlSa) ergab sich für die Konfigurationen S0, S0N0 und S0NCI eine hochsignifikante Veränderung (p < 0,1 %). und für S0NHG (HG: Hörgerät) eine sehr signifikante Veränderung (p < 1 %). Das Alter bei Versorgung als möglicher Einflussfaktor konnte durch den FBE nicht bestätigt werden. Die Ertaubungsdauer stellte dagegen einen negativen Einflussfaktor für das SV mit dem CI dar, wobei eine längere Ertaubungsdauer mit schlechteren Ergebnissen beim FBE assoziiert ist. Der Grad der Schwerhörigkeit des mit HG versorgten Ohrs beeinflusste das SV nicht. Im Median betrug der bimodale Nutzen (Differenz aus dem SV mit bimodaler Versorgung gegenüber einseitiger HG-Versorgung beim FBE für 65 dB SPL) über die gesamte Untersuchungszeit 10 %. Für im Median 79 % der Versuchspersonen war der bimodale Nutzen über den gesamten Zeitverlauf von 36 Monaten nachweisbar.
UNASSIGNED: Im zeitlichen Verlauf verbessert sich das SV mit dem CI der bimodalen Versuchspersonen signifikant. Die untersuchten Einflussfaktoren (Alter, Ertaubungsdauer und Grad der Schwerhörigkeit des Gegenohrs) unterstützen die leitliniengerechte Indikationsstellung einer bimodalen Versorgung in Deutschland – unabhängig von Alter, Ertaubungsdauer und Hörfähigkeit des Gegenohrs – eine Cochleaimplantation durchzuführen.

BACKGROUND: Fluoroquinolones are the most commonly prescribed antibiotics. Because of their known tendency to drive antimicrobial resistance, their prescribing patterns need to be more restricted. This study aimed to describe the clinical practice of fluoroquinolone prescription, dose adjustments for renal impairment patients and bacterial resistance profiles, eventually providing evidence-based recommendations to optimize antibiotic prescribing practices in the local population.
METHODS: This retrospective, cross-sectional study was conducted at An-Najah National University Hospital in Palestine. The data were collected from admitted patients who were given ciprofloxacin or levofloxacin from July 2021 to June 2023. Data from 692 inpatients across various hospital departments were examined (409 for levofloxacin and 283 for ciprofloxacin). Statistical analysis was performed via IBM SPSS version 23.0 to summarize the demographic, clinical, and epidemiological data.
RESULTS: The sociodemographic profile revealed diverse age distributions, with 25.4% and 39% older than 50 years for ciprofloxacin and levofloxacin, respectively. Ciprofloxacin was predominantly used in the oncology department (28.2%), with surgical prophylaxis (22.6%) and febrile or afebrile neutropenia (21.1%) being the most common indications. Levofloxacin was predominantly used in the medical ward (45.7%), mainly for lower respiratory tract infection (58.8%) and prophylaxis for bone marrow transplantation (16.5%). Enterococcus and methicillin-resistant Staphylococcus aureus were the most commonly isolated pathogens, with 62.5% of the isolates demonstrating resistance to ciprofloxacin. Moreover, extended-spectrum beta-lactamase-producing Enterobacterales were the most common pathogen isolated, with 33.3% being resistant to levofloxacin. Statistical analysis revealed a significant association between the choice of antibiotic and the approach to therapy. Levofloxacin was significantly more likely than ciprofloxacin to be used as empiric therapy (p < 0.001), whereas ciprofloxacin was more likely to be used as targeted therapy (p < 0.001).
CONCLUSIONS: This study investigated prescribing practices and resistance to levofloxacin and ciprofloxacin in a large hospital in a developing country. According to the bacterial resistance profiles, we conclude that there is a need for hospital departments to exercise greater restraint on the use of these antibiotics. To this end, further studies addressing the clinical efficacy of fluoroquinolones against the current treatment guidelines to evaluate their appropriateness should be carried out.

UNASSIGNED: Annual Chinese National negotiations for including innovative drugs in the National Reimbursement Drug List (NRDL) reveal an increasing number of new drugs with overlapping action mechanisms of action and similar indications. Yet, it is unclear if competition affects reimbursement decisions. Thus, we explored the impact of competition on reimbursement decisions for cancer drugs in China.
UNASSIGNED: We identified the cancer drugs involved in NRDL negotiations from 2017 to 2022 and focused on the initial reimbursement decision for eligible newly negotiated drugs. Drugs were classified as within-class competitors based on their equivalent biological mechanisms of action and approved indications, including identified and potential competitors. Other variables included drug type, clinical benefit and safety, monthly drug cost, and disease incidence rate. We employed traditional univariate and multivariate Firth\'s penalized logistic regression to assess the association between reimbursement decisions and variables at the indication and drug levels.
UNASSIGNED: Between 2017 and 2022, 102 cancer drugs corresponding to 141 indications were studied, and 66 drugs (64.7%) covering 95 indications (67.4%) were added to the NRDL. The proportion of reimbursements for indications with identified competition was significantly higher than that for indications without identified competition (84.6% vs 52.6%, p < 0.0001). However, the difference in reimbursement proportions between groups with and without potential competition was not statistically significant (66.7% vs 68.3%, p = 0.84). Firth\'s penalized logistic regression showed that identified competition was positively correlated with successful NRDL inclusion, whereas potential competition had no significant effect on negotiation outcomes. Improved overall survival or progression-free survival were positively associated with NRDL inclusion, whereas disease incidence negatively impacted reimbursement decisions.
UNASSIGNED: Improved clinical benefit and identified competition were positively correlated with NRDL inclusion. In China\'s value-based negotiation model, clinical benefits served as a crucial foundation of price negotiation for cancer drugs, and market competition helped these drugs enter the NRDL at more reasonable prices. This has important implications for reimbursement decisions and accessibility and affordability improvement for innovative drugs worldwide.
UNASSIGNED: National Natural Science Foundation of China (No. 72104151).

Brain biopsies are often considered for patients who cannot be diagnosed with various laboratory test results. However, physicians tend to be hesitant regarding their application in possibly non-neoplastic brain diseases, due to the invasiveness and risks. The aim was to determine the indications for brain biopsies in cases of neurological diseases of unknown etiology. We retrospectively evaluated diagnostic accuracy, laboratory findings (including a liquid biopsy for malignant lymphoma), magnetic resonance imaging (MRI) characteristics and the post-treatment outcomes of patients undergoing brain biopsies for neurological diseases of unknown etiology. The data of patients who had undergone a brain biopsy during their admission to Niigata University Hospital, between 2011 and 2024, were reviewed. Moreover, the laboratory data and MRI findings between patients with definitive and nonspecific biopsy diagnoses were compared. Twenty-six patients underwent a brain biopsy, and a definitive diagnosis was obtained in 14 patients (53.8%). Even in cases where a nonspecific diagnosis was made, biopsy findings helped rule out malignancy and guide clinical diagnosis and treatment decisions. The liquid biopsy for malignant lymphoma was performed in eight patients, with one yielding a positive result, consistent with primary central nervous system lymphoma. The sensitivity and specificity of liquid biopsy were 0.5 and 1, respectively. Diffusely contrasted cortical lesions and the presence of mass effects on MRI, were significantly associated with a definitive diagnosis, compared to a nonspecific diagnosis. In conclusion, brain MRI and liquid biopsies can assist in determining the appropriate indications for brain biopsies in neurological diseases of unknown etiology.

Transesophageal Echocardiography (TEE) is an important imaging method for the evaluation of cardiac structure and function, and it holds significant value in the clinical management of cardiovascular diseases. Unlike transthoracic echocardiography (TTE), which is non-invasive, TEE involves semi-invasive intracavity operations, leading to increasing attention to its safety and potential complications. Especially with the increasing demand for TEE applications in clinical practice and the rapid growth in the number of facilities utilizing it, the standardized application and safe operation of TEE technology have become particularly crucial. This article will review the literature and draw upon personal experience to analyze the complications and safety of TEE examinations from a technical perspective.

In recent years, with advancements in surgical techniques and the widespread utilization of extracorporeal cardiac assist devices such as extracorporeal membrane oxygenation (ECMO), the treatment outcomes for ALCAPA (Anomalous left coronary artery from the pulmonary artery) have demonstrated significant improvements. However, the surgical indications and methods of ALCAPA, especially the surgical methods of ALCAPA with intramural coronary artery, and whether to treat MR at the same time are still controversial. The long-term prognosis remain discouraging simultaneously, with significant variations in outcomes across different centers. The present review specifically addresses these aforementioned concerns. This article reviews the pathophysiology and classification, diagnosis, indications, surgical strategy and prognosis of ALCAPA. We believe that this review will provide some reference for future researchers and provide new ideas for reducing the adverse prognosis of children with congenital heart disease in future.

UNASSIGNED: More recently approved drugs have significantly fewer indications than drugs approved many years ago. One possible reason for this may be that, controlling for the number of years since approval or launch, more recently approved drugs have fewer indications (e.g. at the time of launch). The role of precision and personalised medicine has increased, and the goal of precision medicine is to provide a more precise approach for the prevention, diagnosis and treatment of disease. Drugs that have fewer indications may be \'more precise\' than drugs that have many indications.
UNASSIGNED: We use different kinds of data from two countries - France and the U.S. - to analyze the relationship across many drugs between the number of indications of a drug, the drug\'s vintage - i.e. the year in which the drug was first marketed or approved - and its age - the number of years it has been marketed.
UNASSIGNED: All the evidence from both countries indicates that, controlling for drug age, more recently approved drugs tend to have fewer indications than drugs approved many years ago. In the U.S., a 10-year increase in vintage is associated with a 10.7% decline in the effective number of indications of all drugs, and a 19.4% decline in the effective number of indications of drugs approved after 1989. In France, the positive effect on the number of indications of the increase in drug age was more than offset by the negative effect of the increase in drug vintage.
UNASSIGNED: More recently approved drugs are less likely to be \'general-purpose technologies\' (or even multi-purpose technologies) than older drugs. The relative importance of \'precision medicine\' has increased in recent decades. Drugs that have fewer indications may be \'more precise\' than drugs that have many indications.

Patients with central osteophytes in the lateral compartment may be poor candidates for unicompartmental knee arthroplasty (UKA) for medial knee arthritis given the thin overlying articular cartilage above the central osteophytes that is inadequate for supporting weight-bearing after UKA. Therefore, attempts should be made to detect central osteophytes to confirm suitability for UKA.

UNASSIGNED: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for biopsy of lung, peri-pulmonary tissue and lymph nodes under real-time ultrasound-guided biopsy. It is used in the diagnosis and/or staging of benign and malignant pulmonary and non-pulmonary diseases. Our study is based on a large sample size, in a diversified population which provides a representative real-world cohort for analysis.
UNASSIGNED: Patients who underwent EBUS-TBNA procedure between September 2019 and August 2022 were included in this retrospective study. For cases diagnosed as benign and unclassified lesions by EBUS-TBNA, the final diagnosis was determined by further invasive surgery or a combination of therapy and clinical follow-up for at least 6 months.
UNASSIGNED: A total of 618 patients were included in the study, including 182 females (29.4%) and 436 males (70.6%). The mean age of all patients was 61.9 ± 10.5 years. These patients were successfully punctured by EBUS-TBNA to obtain pathological results. The pathological diagnosis results of EBUS-TBNA were compared with the final clinical diagnosis results as follows: 133 cases (21.5%) of benign lesions and 485 cases (78.5%) of malignant lesions were finally diagnosed. Among them, the pathological diagnosis was obtained by EBUS-TBNA in 546 patients (88.3%) (464 malignant lesions and 82 benign conditions), while EBUS-TBNA was unable to define diagnosis in 72 patients (11.6%). 20/72 non-diagnostic EBUS-TBNA were true negative. The overall diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA were 91.3%, 100%, 100%, 27.8%, and 91.6% [95% confidence interval (CI): 89.1-93.6%], respectively. In this study, only one case had active bleeding without serious complications during the EBUS-TBNA procedure.
UNASSIGNED: Given its low invasiveness, high diagnostic accuracy, and safety, EBUS-TBNA is worth promoting in thoracic lesions.

BACKGROUND: The mortality rate associated with open abdominal surgery is a significant concern for patients and healthcare providers. This is particularly worrisome in Africa due to scarce workforce resources and poor early warning systems for detecting physiological deterioration in patients who develop complications.
METHODS: This prospective cohort study aimed to follow patients who underwent emergency or elective abdominal surgery at Lacor Hospital in Uganda. The participants were patients who underwent abdominal surgery at the hospital between April 27th, 2019 and July 07th, 2021. Trained research staff collected data using standardized forms, which included demographic information (age, gender, telephone contact, and location), surgical indications, surgical procedures, preoperative health status, postoperative morbidity and mortality, and length of hospital stay.
RESULTS: The present study involved 124 patients, mostly male, with an average age of 35 years, who presented with abdominal pain and varying underlying comorbidities. Elective cases constituted 60.2% of the total. The common reasons for emergency and elective surgery were gastroduodenal perforation and cholelithiasis respectively. The complication rate was 17.7%, with surgical site infections being the most frequent. The mortality rate was 7.3%, and several factors such as preoperative hypotension, deranged renal function, postoperative use of vasopressors, and postoperative assisted ventilation were associated with it. Elective and emergency-operated patients showed no significant difference in survival (P-value = 0.41) or length of hospital stay (P-value = 0.17). However, there was a significant difference in morbidity (p < 0.001).
CONCLUSIONS: Cholelithiasis and gastroduodenal perforation were key surgical indications, with factors like postoperative ventilation and adrenaline infusion linked to mortality. Emergency surgeries had higher complication rates, particularly surgical site infections, despite similar hospital stay and mortality rates compared to elective surgeries.