The impact of Streptococcus pneumoniae coinfection on coronavirus disease 2019 (COVID-19) prognosis remains uncertain. We conducted a retrospective analysis of patients hospitalized with COVID-19 who underwent a pneumococcal urinary antigen (PUA) test to assess its clinical utility. Results showed that PUA-positive patients required more oxygen support, high-flow nasal cannula, and dexamethasone compared to PUA-negative patients.Furthermore, the significantly higher incidence of a National Early Warning Score ≥5 in the PUA-positive group (P<0.001) suggests that a positive PUA test is associated with a severe disease course. However, no significant difference in mortality was observed between the two groups, and antibiotics were used in almost all patients (96.2%). While the PUA test may help guide antibiotic use in COVID-19 patients, its interpretation should be approached with caution.

The impact of Streptococcus pneumoniae coinfection on coronavirus disease 2019 (COVID-19) prognosis remains uncertain. We conducted a retrospective analysis of patients hospitalized with COVID-19 who underwent a pneumococcal urinary antigen (PUA) test to assess its clinical utility. Results showed that PUA-positive patients required more oxygen support, high-flow nasal cannula, and dexamethasone compared to PUA-negative patients.Furthermore, the significantly higher incidence of a National Early Warning Score ≥5 in the PUA-positive group (P<0.001) suggests that a positive PUA test is associated with a severe disease course. However, no significant difference in mortality was observed between the two groups, and antibiotics were used in almost all patients (96.2%). While the PUA test may help guide antibiotic use in COVID-19 patients, its interpretation should be approached with caution.

The impact of Streptococcus pneumoniae coinfection on coronavirus disease 2019 (COVID-19) prognosis remains uncertain. We conducted a retrospective analysis of patients hospitalized with COVID-19 who underwent a pneumococcal urinary antigen (PUA) test to assess its clinical utility. Results showed that PUA-positive patients required more oxygen support, high-flow nasal cannula, and dexamethasone compared to PUA-negative patients.Furthermore, the significantly higher incidence of a National Early Warning Score ≥5 in the PUA-positive group (P<0.001) suggests that a positive PUA test is associated with a severe disease course. However, no significant difference in mortality was observed between the two groups, and antibiotics were used in almost all patients (96.2%). While the PUA test may help guide antibiotic use in COVID-19 patients, its interpretation should be approached with caution.

Postoperative thoracic epidural hematoma (PTEH) is a rare and complex condition that can lead to significant neurological deficits, persistent pain, and reduced functional abilities. Despite advancements in minimally invasive techniques such as unilateral biportal endoscopic (UBE) decompression, recurrence of PTEH remains a challenging clinical issue. This case report describes the innovative application of unilateral biportal endoscopy-assisted thoracic interbody fusion to manage recurrent thoracic idiopathic epidural hematoma. We discuss the surgical technique, clinical outcomes, and potential benefits of this method in reducing recurrence and stabilizing the thoracic spine. A 78-year-old woman without comorbidities underwent UBE decompression for symptomatic D11–12 and L1–2 spinal stenosis. She later developed delayed postoperative spinal epidural hematoma (SEH), causing paraparesis and bowel/bladder dysfunction. Despite 2 successful emergency hematoma evacuations with magnetic resonance imaging-confirmed clearance and symptom improvement, recurrences continued to take place, each occurring within shorter intervals. At the third recurrence, occult spinal microinstability was suspected as the cause of persistent bleeding. Unilateral biportal endoscopy-assisted thoracic interbody fusion was performed to address this issue. After fusion surgery, the patient experienced no further hematoma recurrences and fully regained neurological and functional capabilities at the 9-month follow-up. While surgical decompression is the standard for SEH, recurrent or delayed postoperative cases require a tailored approach. This case underscores the importance of considering thoracic interbody fusion for recurrent SEH to address microinstability and ongoing bleeding. Unilateral biportal endoscopy-assisted fusion offers a minimally invasive yet definitive solution, highlighting the need for individualized surgical strategies to achieve optimal outcomes.

Background: Minimally invasive spine surgery techniques, including unilateral biportal endoscopy (UBE), have become popular due to reduced soft tissue trauma and quicker recovery. Traditional lumbar fusion approaches using a single polyetheretherketone (PEEK) or expandable cage present limitations in fusion surface area and sagittal correction. Methods: We developed a novel UBE-assisted lumbar interbody fusion technique utilizing a dual hybrid cage system: a PEEK cage placed contralaterally and an expandable cage inserted ipsilaterally. The procedure was performed in 3 patients with degenerative lumbar disease, and perioperative outcomes were evaluated. Results: All patients experienced significant symptom relief, early ambulation, and radiologic evidence of fusion without complications. The dual-cage configuration improved segmental stability, restored lordosis, and maximized graft integration. Conclusion This dual hybrid cage insertion method in UBE transforaminal lumbar interbody fusion provides a safe, effective, and minimally invasive strategy for lumbar fusion with promising clinical outcomes. Further studies are warranted to validate the long-term results.

Objective: Traumatic brain injury (TBI) often occurs alongside injuries to other body regions, worsening patient outcomes. This study evaluates the impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated TBI. Methods: This retrospective cross-sectional analysis was conducted using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) for 180,058 TBI patients admitted to 23 tertiary hospitals from January 1, 2020, to December 31, 2022. Patients were categorized into isolated TBI group (iTBI; n=127,673) and non-isolated TBI group (niTBI; n=52,385) based on injury diagnostic codes. Clinical outcomes—24-hour and 30-day mortality, hospital admission, and interhospital transfer—were compared. Multivariate logistic regression analyses adjusted for potential confounders were performed. Results: The niTBI patients exhibited significantly higher 24-hour mortality (1.5% vs. 0.4%), 30-day mortality (2.6% vs. 1.0%), hospital admissions (24.5% vs. 8.4%), and interhospital transfers (3.6% vs. 1.1%) than iTBI patients (all P<0.001). Concomitant injuries increased the adjusted odds of 24-hour mortality (adjusted odds ratio [aOR], 1.456; 95% confidence interval [CI], 1.286–1.648) and 30-day mortality (aOR, 1.111; 95% CI, 1.022–1.208). Thoracic injuries were the most significant predictor of adverse outcomes in niTBI patients, increasing the odds of 24-hour mortality by nearly sixfold (aOR, 5.958; 95% CI 5.057–7.019). Conclusions Concomitant injuries significantly worsen clinical outcomes in TBI patients, with thoracic injuries being the most critical predictor of mortality. These findings highlight the importance of comprehensive trauma assessments and targeted prevention strategies to improve survival rates and optimize resource allocation for patients with multiple injuries.

Purpose: Although bladder cancer occurs three to 4 times more frequently in men than in women, the relative number of deaths compared to incidence is higher in women, suggesting that women have a worse prognosis than men. Emerging evidence indicates that the activity of the sex steroid hormone pathway may play a role in bladder cancer development, with demonstrations that both androgens and estrogens have biological effects on bladder cancer in vitro and in vivo. This study investigates the influence of sex and menopausal status on recurrence and cancer-specific death (CSD) in bladder cancer patients undergoing radical cystectomy (RC). Materials and Methods: This retrospective analysis included 3,913 patients from the Korean Bladder Cancer Study Group Database who underwent RC between 2010 and 2019. Patients were categorized based on gender and menopausal status (≤50 years: premenopausal; >50 years: postmenopausal). Pathological factors, neoadjuvant chemotherapy, recurrence, and CSD rates were analyzed using chi-square and Fisher exact tests. Results: Among the 3,913 patients, 400 (10.2%) were female. Premenopausal females exhibited significantly lower recurrence rates (28.6%) compared to postmenopausal females (45.7%). CSD rates were similarly reduced in premenopausal females (12.0% vs. 22.2% in postmenopausal females). No significant sex differences in recurrence or CSD were observed among premenopausal patients. Pathological T stage, nodal status, and lymphovascular invasion were significantly associated with recurrence in males, while nodal status alone was significant in females. Neoadjuvant chemotherapy was significantly more frequently administered to male patients under the age of 50, while no difference was observed in the administration of neoadjuvant chemotherapy among female patients based on menopausal status. Conclusion Hormonal changes associated with menopause significantly influence bladder cancer outcomes in women. Premenopausal hormonal environments seem protective, underscoring the need for further research into hormone-driven mechanisms in bladder cancer.