Minerva anestesiologica最新文献

Background: Invasive pulmonary aspergillosis (IPA) is increasingly recognized in non-neutropenic patients, where coexisting bacterial infections, particularly with Gram-negative pathogens, may impair susceptibility. However, validated tools for early risk stratification in this population remain unavailable.

Methods: We retrospectively analyzed 437 non-neutropenic adults with bacterial co-infection (derivation N.=331; validation N.=106) admitted between 2019 and 2024. Independent predictors of IPA were identified through multivariable logistic regression and incorporated into both a weighted clinical risk score and an ensemble machine learning (ML) model. Model performance was assessed using discrimination, calibration, and decision curve analysis, with subgroup validation in Gram-negative infection, intensive care unit (ICU) admission, and diabetes.

Results: Seven independent predictors of IPA were identified: nodular shadow, chronic respiratory disease, Gram-negative infection, corticosteroid exposure, ICU admission, smoking history, and diabetes. Gram-negative pathogens accounted for nearly half of infections, with Pseudomonas aeruginosa predominating. The ensemble score achieved a strong performance (area under the curve [AUC] 0.922 derivation; 0.862 validation) with superior calibration compared to traditional approaches. Risk stratification at a threshold score of ≥7.5 significantly enriched 28-day IPA incidence (log-rank P<0.001). Subgroup analyses confirmed score robustness in Gram-negative infection (AUC=0.898), ICU admission (AUC=0.888), and diabetes (AUC=0.914). However, the predictive contributions of respiratory disease and corticosteroid exposure were attenuated in diabetic patients.

Conclusions: Gram-negative bacterial co-infection synergistically amplifies IPA risk in non-neutropenic patients. The ensemble ML model integrating seven pragmatic predictors provides accurate, interpretable, and clinically actionable stratification, enabling precision prophylaxis and early antifungal intervention. Prospective multicenter validation is warranted before clinical implementation.

Background: Postoperative nausea and vomiting (PONV) remain a significant clinical challenge in pediatric squint surgeries, with potential serious complications. This randomized controlled trial aimed to evaluate the efficacy of preoperative ondansetron lozenges in preventing PONV among pediatric patients undergoing squint surgeries.

Methods: Eighty pediatric patients (aged 4-15 years) undergoing squint surgeries were randomly assigned to two equal groups: Group S received 4 mg ondansetron lozenge for two hours preoperatively, while Group C served as the control.

Results: The ondansetron lozenge group demonstrated significantly lower PONV incidence (22.5% vs. 52.5%, P=0.006, with relative risk (RR) of 0.43 (95% CI 0.22:0.82), with reduced severity across 0-2-, 2-12-, and 12-24-hour intervals. Time to onset of emesis was prolonged (269.11±214.87 vs. 115.24±65.68, P=0.005), and the oculocardiac reflex incidence was reduced (12.5% vs. 37.5%, P=0.018). Parental satisfaction was significantly higher in the Ondansetron group (8.95±1.38 vs. 7.83±1.99, P=0.004).

Conclusions: Preoperative ondansetron lozenges effectively reduce PONV incidence, severity, and complications in pediatric squint surgery, suggesting a promising prophylactic intervention.