Purpose To prospectively evaluate prognostic capabilities of non-muscle invasive bladder cancer (NMIBC) biomarkers for predicting disease recurrence or progression after radical TURB (transurethral resection of bladder tumor). Methods Evaluated biomarkers included blood: plasminogen activator inhibitor 1 (PAI-1), soluble urokinase plasminogen activator receptor (suPAR), interleukin 8 (IL-8) and urine: IL-8, vascular endothelial growth factor (VEGF) and apolipoprotein E (APOE). Blood and urine samples acquired before TURB for NMIBC from 223 subjects were analysed. The primary outcome was tumor recurrence or progression. Results After 3 months follow-up with cystoscopy or TURB– 92 patients were tumor free (Group 1). In 131 subjects (Group 2) a recurrence of NMIBC (n = 120) or progression to muscle invasive bladder cancer (MIBC) (n = 11) has been observed. No major clinical differences between these two groups were spotted. The group 2 has presented with significantly higher concentrations of blood IL-8 and suPAR as well as urine VEGF and APOE. The serum IL-8 and urinary VEGF showed the highest prognostic abilities with AUROC of 0.611 (95% CI: 0.534–0.687, p = 0.0044) and 0.632 (95% CI: 0.557–0.707, p = 0.0006), respectively. Multivariable machine learning models which included all investigated biomarkers and European Organisation for Research and Treatment of Cancer (EORTC) risk scores have allowed to discriminate the two patient entities with AUROC of 0.84 (95% CI: 0.73–0.95, p < 0.0001). Conclusions The assessed biomarkers alone have shown unsatisfactory prognostic capabilities to be used for prognostication of outcomes after TURB. More complex multivariable prediction models may improve their prognostic performance. Trial registration The study was retrospectively registered at clinicaltrails.gov with National Clinical Trial number (NCT): NCT06235853.

Ultrasound (US) guided infraclavicular axillary vein (AXV) central venous catheterization is an emerging method for accessing central veins in critically i

Introduction: The superior vena cava collapsibility index (SVC-CI) is a potential marker of fluid responsiveness (FR) in mechanically ventilated patients. Few studies reporting its diagnostic performance are currently available.Material and methods: A systematic search, using the PRISMA approach, was performed using the Medline and EMBASE databases. Prospective studies evaluating the SVC-CI as a marker of FR in ventilated adult patients were included. A bivariate random-effect model was utilised to generate the summary receiver operating characteristic (SROC) curve. The area under the ROC curve (AUC), the sensitivity and specificity of the curve operating point were calculated.Results: We included eight studies with a total of 857 patients, in whom SVC-CI was evaluated a total of 1083 times prior to the volume expansion trial. In 609 (56.23%) trial cases FR was present. The SROC curve demonstrated that the test’s operating point has a sensitivity and specificity of 80.8% (95% CI: 66.3–90%) and 81.4% (95% CI: 76.4–85.5%), respectively. The model’s AUC was equal to 0.848 (95% CI: 0.824–0.863) with P < 0.001. No significant inter-study heterogeneity was found (I2 = 0%). A subgroup analysis revealed a significantly lower sensitivity of SVC-CI in patients with higher levels of positive end-expiratory pressure (PEEP) (> 5 cm H2O) (χ2 = 7.753, df = 2, P = 0.0207). The study setting and type of intervention for volume expansion did not significantly change the performance of the test.Conclusions: SVC-CI is a reliable predictor of FR for mechanically ventilated patients in intensive care units and operating rooms. A PEEP level exceeding 5 cm H2O may impair the sensitivity of the test.

This study is a post-hoc analysis of a previously published observational study. The aim is to characterize the epidemiology, etiology and antibiotic practices in KTRs admitted due to urosepsis (US) and urinary tract infection (UTI) to a tertiary transplantation center between the period 2014–2019.The two study groups consisted of 101 KTRs with a primary episode of US and 100 randomly selected KTRs hospitalized for UTI as a control group. A post-hoc analysis of clinical and microbiological data was performed, and a local microbiological map was created.The estimated yearly incidence of US in the study population was 21.1 (95% CI: 15.3–26.9) cases per 1000 KTRs per year. Urosepsis accounted for 85% of all sepsis cases. The most common causative pathogen in both groups was Escherichia coli. In 46% and 11% of US and UTI cases, initial empiric antibiotic therapy had to be escalated until day 3 due to lack of clinical response or proven bacterial resistance. This delay in appropriate antibiotic treatment in the US group was significantly associated with mortality (OR = 10.1 with p = 0.021), need for acute renal replacement therapy (OR = 4.73 with p = 0.012) and non-recovery from AKI (OR = 3.18 with p = 0.031). After discharge from hospital, almost 60% of all study subjects received a prophylactic antibiotic course for prevention of UTI recurrence, which did not translate into a lower frequency of readmission due to UTI in a multivariable analysis.US is a common insult that contributes to graft failure in KTRs. We recommend adjusting US and UTI treatments to center-specific microbiological maps in order to optimize treatment outcomes, reduce development of antibiotic resistance, and avoid unnecessary exposure to nephrotoxic antimicrobial drugs.

These guidelines provide evidence-based recommendations for central venous cannulation in critically ill patients in the intensive care unit. The document was developed by the Working Group of the Polish Society of Anaesthesiology and Intensive Therapy (Polskie Towarzystwo Anestezjologii i Intensywnej Terapii – PTAiIT) based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, which encompasses systematic reviews of the literature, meta-analyses, and – in the absence of sufficient data – expert consensus. These guidelines aim to standardise the approach to central venous cannulation, increase the effectiveness of procedures, and minimise the risk of complications. The guidelines address pre-procedural ultrasound assessment, selection of the optimal vascular access site, comparison of ultrasound-guided versus landmark cannulation at different access sites, confirmation of catheter position after cannulation, and the role of positional manoeuvres.