Background Host inflammation contributes to determine whether SARS-CoV-2 infection causes mild or life-threatening disease. Tools are needed for early risk assessment. Methods We studied in 111 COVID-19 patients prospectively followed at a single reference Hospital fifty-three potential biomarkers including alarmins, cytokines, adipocytokines and growth factors, humoral innate immune and neuroendocrine molecules and regulators of iron metabolism. Biomarkers at hospital admission together with age, degree of hypoxia, neutrophil to lymphocyte ratio (NLR), lactate dehydrogenase (LDH), C-reactive protein (CRP) and creatinine were analysed within a data-driven approach to classify patients with respect to survival and ICU outcomes. Classification and regression tree (CART) models were used to identify prognostic biomarkers. Results Among the fifty-three potential biomarkers, the classification tree analysis selected CXCL10 at hospital admission, in combination with NLR and time from onset, as the best predictor of ICU transfer (AUC [95% CI] = 0.8374 [0.6233–0.8435]), while it was selected alone to predict death (AUC [95% CI] = 0.7334 [0.7547–0.9201]). CXCL10 concentration abated in COVID-19 survivors after healing and discharge from the hospital. Conclusions CXCL10 results from a data-driven analysis, that accounts for presence of confounding factors, as the most robust predictive biomarker of patient outcome in COVID-19. Graphic abstract
This review aims to give to the reader an overview selectively oriented on safety and efficacy of surgery, providing concise and direct answers about crucial questions of trainees and experts. Surgery for idiopathic epiretinal membrane (ERM) is a safe and effective procedure that can achieve long-term stable postoperative visual and anatomical improvement, with an overall low recurrence and complication rate. Young patients, with a short onset of symptoms and with better initial visual acuity achieve higher levels of visual outcome. The preoperative degree of metamorphopsia is the prognostic factor for their postoperative degree. Successful results may be obtained in eyes with specific optical coherence tomography criteria, such as thin ganglion cell layers, thin internal plexiform layer, longer photoreceptors outer segment, regular ellipsoid zone and cone outer segment tips line, and without ectopic inner foveal layer. Internal limiting membrane peeling demonstrates positive anatomical and functional outcomes, but final positions about its safety remain controversial.
OBJECTIVE Advantages of the fronto-orbitozygomatic (FOZ) approach have been reported extensively in the literature; nevertheless, restoration of normal anatomy and the esthetic impact of surgery are increasingly important issues for patients and neurosurgeons. The aim of this study was to analyze functional and cosmetic outcomes in a series of 169 patients with different pathologies who underwent surgery in which the FOZ approach was used. METHODS Between January 2000 and December 2014, 250 consecutive patients underwent surgery with an FOZ approach as the primary surgical treatment. Follow-up data were available for only 169 patients; 103 (60.9%) of these patients were female and 66 (39.1%) were male, and their ages ranged from 6 to 77 years (mean 46.9 years; SD 15.6 years). Mean follow-up time was 66 months (range 6-179 months; SD 49.5 months). Evaluation of clinical outcomes was performed with a focus on 4 main issues: surgical complications, functional outcome, cosmetic outcome, and patient satisfaction. The additional time needed to perform orbitotomy and orbital reconstruction was also evaluated. RESULTS The permanent postoperative complications included forehead hypesthesia (41.4%) and dysesthesia (15.3%), frontal muscle weakness (10.3%), exophthalmos (1.4%), enophthalmos (4.1%), diplopia (6.6%; 2% were related to surgical approach), and persistent periorbital and eyelid swelling (3%). Approximately 90% of the patients reported subjectively that surgery did not affect their quality of life or complained of only minor problems that did not influence their quality of life significantly. The mean time needed for orbitotomy and orbital reconstruction was approximately half an hour. CONCLUSIONS Comprehensive knowledge of the potential complications and overall clinical outcomes of the FOZ approach can be of great utility to neurosurgeons in balancing the well-known benefits of the approach with potential additional morbidities.
evaluate the 3-point measurement (OCT-CET3) stemmed from our clinical observation that CET could vary within the central 2 mm zone in eyes with sectoral LSCD and the 1-point measurement (OCT-CET1) might not be as accurate.We showed that the inter-observer measurements of CET were highly consistent (<5% variation) between the 2 masked observers. We calculated the repeatability coefficient of OCT-CET1 and OCT-CET3 measurements to be 11.15 mm and 3.58 mm, respectively. The intraclass correlation coefficient of OCT-CET1 and OCT-CET3 was 0.859 and 0.985, respectively. These results support a higher degree of reliability and smaller measurement error of OCT-CET3 than OCT-CET1.Limit of Agreement (LOA) would be necessary if the purpose of the study was to establish OCT as a surrogate of a gold standard test. We did not consider IVCM as the gold standard for CET measurement but as a control. Nevertheless, we performed the analysis and found that LOA of OCT-CET1 was larger than that of OCT-CET3 (-11.96 6 11.61 mm vs -9.78 6 9.67 mm), which is consistent with the correlation analysis.The area under the receiver operator characteristics curve (AUC) of OCT-CET3 was evaluated in our study, which was higher than that of the maximum limbal epithelial thickness in all four limbal regions. The AUC of OCT-CET1 (0.932) and IVCM-CET (0.911) were smaller than that of OCT-CET3 (0.973), which supports our conclusion that OCT-CET3 is a reliable value of CET as a diagnostic parameter to confirm LSCD.We agree with Dr. Wan and colleague that appropriate statistical analyses is necessary to support the conclusion of all research. In depth knowledge of the subject of investigation and correct data acquisition are equally important in conducting a sound and meaningful study.
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