Modifying Stuttering Attitudes: Who Changes and in What Direction?

The purpose of this study was to investigate the effect of integrated evaluation of resting static computed tomography perfusion (CTP) and coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR CT ) on therapeutic decision-making and predicting major adverse cardiovascular events (MACEs) in patients with suspected coronary artery disease. In this post hoc analysis of a prospective trial of CCTA in patients assigned to either CCTA or CCTA plus FFR CT arms, 500 patients in the CCTA plus FFR CT arm were analyzed. Both resting static CTP and FFR CT were evaluated by using the conventional CCTA. Perfusion defects in the myocardial segments with ≥50% degree of stenosis in the supplying vessels were defined as resting static CTP positive, and any vessel with an FFR CT value of ≤0.80 was considered positive. Patients were divided into 3 groups: (1) negative CTP-FFR CT match group (resting static CTP-negative and FFR CT -negative group); (2) mismatch CTP-FFR CT group (resting static CTP-positive and FFR CT -negative or resting static CTP-negative and FFR CT -positive group); and (3) positive CTP-FFR CT match group (resting static CTP-positive and FFR CT -positive group). We compared the revascularization-to-invasive coronary angiography ratio and the MACE rate among 3 subgroups at 1- and 3-year follow-ups. The adjusted Cox hazard proportional model was used to assess the prognostic value of FFR CT and resting static CTP to determine patients at risk of MACE. Patients in the positive CTP-FFR CT match group were more likely to undergo revascularization at the time of invasive coronary angiography compared with those in the mismatch CTP-FFR CT group (81.4% vs 57.7%, P =0.033) and the negative CTP-FFR CT match group (81.4% vs 33.3%, P= 0.001). At 1- and 3-year follow-ups, patients in the positive CTP-FFR CT match group were more likely to have MACE than those in the mismatch CTP-FFR CT group (10.5% vs 4.2%, P= 0.046; 35.6% vs 9.4%, P <0.001) and the negative CTP-FFR CT match group (10.5% vs 0.9%, P <0.001; 35.6% vs 5.4%, P <0.001). A positive CTP-FFR CT match was strongly related to MACE at 1-year (hazard ratio=8.06, P= 0.003) and 3-year (hazard ratio=6.23, P <0.001) follow-ups. In patients with suspected coronary artery disease, the combination of FFR CT with resting static CTP could guide therapeutic decisions and have a better prognosis with fewer MACE in a real-world scenario.

Background/AimsHigh-sensitivity cardiac troponin (hs-TnT) assays detect very low levels of cardiac troponin. This study examined the interval change between initial and subsequent hs-TnT levels and evaluated its ability to predict significant coronary stenosis.MethodsThe study analyzed 163 patients who presented with acute coronary syndrome (ACS) and underwent coronary angiography (CAG) between April 2014 and May 2018. The 0 and 3-hour hs-TnT were checked. The patients were subdivided into positive (n = 32) and negative (n = 131) interval change groups. The presence of significant coronary artery stenosis on CAG in the two groups was compared.ResultsThe positive interval change group was older and had higher 0 and 3-hour hs-TnT and blood glucose levels than the negative interval change group. Significant coronary stenosis was more common in the positive interval change group than in the negative interval change group (68.8% vs. 23.7%, p = 0.001). However, vasospasm was more common in the negative interval change group (6.3% vs. 31.3%, p = 0.003). The positive interval change group had higher rates of bifurcation lesions and received more percutaneous coronary intervention. In multivariate analysis, age, interval change of serial hs-TnT and diabetes mellitus were independent predictors of significant coronary artery stenosis.ConclusionsThis study identified a relationship between the serial change in cardiac biomarkers and the presence of significant coronary stenosis in patients with ACS. Serial hs-TnT change was associated with real angiographic stenosis in patients with ACS.

Objective To summarize the clinical data of atypical hemolytic uremic syndrome (aHUS) and analyze the treatment and prognosis. Methods A prospective cohort study was conducted on 66 cases in Beijing Children's Hospital affiliated to Capital Medical University from January 2011 to December 2017. The children were divided into positive and negative auto-antibody groups according to the results of anti-factor H autoantibody test. The clinical characteristics, treatment plan and prognosis of the two groups were compared. Results Among the 66 children who met the inclusion criteria, there were 43 cases (65.2%) in the positive group, with an average onset age of(8.0±2.9) years. There were 23 cases (34.8%) in the negative group, with an average onset age of (3.0±2.6) years. On the basis of plasma treatment, in the positive group, the usage rate of hormone was 83.3%(35/42) and the usage rate of immunosuppressive agents was 42.9%(18/42), while in the negative group, the rates were 63.6%(14/22) and 13.6%(3/22) respectively. The average follow-up time was 19.3 months. One child in each group was lost to follow-up. In the positive group, 8 cases recurred (19.0%) and the average recurrence interval time was 16.1 months. In the negative group, 7 cases recurred (31.8%) and the average recurrence interval time was 9.3 months. And the recurrent interval time in the positive group was more longer than the negative group (P<0.05). A total of 85.9%(55/64) children had complete hemolysis control and complete recovery of renal function, in which the positive group was 85.7%(36/42) and negative group was 86.4%(19/22). However, 7.8%(5/64) children had abnormal renal function, in which the positive group was 9.5%(4/42) and the negative group was 4.5%(1/22). And 4.7%(3/64) children died, in which the positive group was 2.4%(1/42) and the negative group was 9.1%(2/22). The one left (1.6%) showed dialysis dependence, which was positive for the auto-antibody. Multifactor Cox regression analysis showed that the age of less than 3 years old was the risk factor of poor prognosis (HR=4.651, 95% CI 0.988-21.898, P=0.047). Conclusions The positive proportion of anti-factor H autoantibody in children with aHUS is high. The age of these children is older. Individualized therapy based on anti-factor H autoantibody and immunosuppressive therapy is of great significance for disease remission, preventing recurrence and improving the prognosis. Age less than 3 years old is the risk factor for poor prognosis. Key words: Hemolytic-uremic syndrome; Immunosuppression; Prognosis; Complement Factor H; Plasma exchange

Category:Ankle; OtherIntroduction/Purpose:Total ankle arthroplasty (TAA) is included in the Centers of Medicare andMedicaid Services' (CMS) Bundled Payments for Care Improvement (BPCI)initiative for lower extremity joint replacements. This model has beendemonstrated to be for total hip arthroplasty (THA) and total kneearthroplasty (TKA). However, there remains concern that the modelunderestimates expected costs for TAA due to the unique healthcare needs ofTAA patients including higher implant costs, longer procedures, and anincreased demand for postoperative acute care services due tonon-weightbearing. The purpose of this study was to analyze the breakdown ofcosts associated with inpatient and outpatient care and assess thedifference between Medicare beneficiary reimbursements and actual costs forthe episode of care.Methods:An IRB-approved retrospective review was conducted of patients with Medicarewho underwent TAA between July 2014 and June 2018. The surgeries wereperformed at seven facilities affiliated with a singular institutionhospital system. Patients undergoing TAA in this time period were identifiedusing an institutional arthroplasty database and were eligible for study. Of99 patients who met this criterion, financial data was available for 72.Demographics including age, gender, BMI, and comorbidities were collectedvia chart review. Episode start and end dates, first post-acute caredischarge destination, and total episode costs were recorded. Total episodecost was subdivided into inpatient facility cost, surgeon fees, andpost-acute care discharge costs (inpatient rehab facility costs, skillednursing facility expenses, or home health aide fees). Patients werestratified into two groups based on 90-day costs of care, a 'positive group'not exceeding the bundled payment allocation and a 'negative group' whichdid exceed.Results:No statistically significant difference was found among demographics betweenthe positive and negative patient groups. Average group age was 70.5 yearsand 72.9 years, respectively, and both groups had average BMI of 29.3kg/m2. Age-adjusted Charlson Comorbidity Index was 3.35 forthe positive group and 3.40 for the negative group. Total episode costs were50% higher in the negative group compared to the positive group ($31,462 vs.$15,845). The total post discharge costs for the negative group were $17,912which is significantly higher than those of the positive group ($2,502)(P<0.001). Thirteen patients (18.1%) attended skilled nursing facilities,and 12 of these patients exceeded the allocated budget. Average SNF cost was$13,089, which nearly matched the entire inpatient cost (facility + surgeonfees) of $13,400. Home health aide requirement was significant at 39%(n=28), and 15 of these patients (54%) also came in over budget.Conclusion:Results suggest that there is a considerable possibility for patientsundergoing TAA to have post-acute care requirements that drive cost overbudget, including admittance to skilled nursing facilities and home healthaide, likely sue to the added necessity for extended immobilization in anolder patient population. Such parameters should be factored into the BPCIreimbursement model for TAA.

The impact of cancer on adult survivors of aggressive non-Hodgkin's Lymphoma (NHL) is understudied. We examined positive and negative life changes (health behaviors, relationships, financial situation) experienced by survivors of NHL and their association with physical and mental function. Using the Los Angeles County Cancer Surveillance Program, 744 questionnaires were mailed to adult survivors of NHL: 308 provided complete data for analyses (M age=59.8, SD=14.9). Perceptions of positive and negative life changes were common in our sample, with 77.9% of NHL survivors reporting at least one positive change and 78.6% reporting at least one negative change. Cancer had the greatest positive change on relationships and the most negative change on survivors' financial situation. There was an equal distribution of survivors classified as having experienced positive change and negative change on health behaviors. Regardless of whether positive and negative life change were entered into separate regression models or the same model, an increase in negative life change in each of the domains was significantly associated with a decrease in physical and mental functioning. Positive change was significantly associated only with physical functioning when examining overall change (p=.018) and health behaviors (p=.013), and the inclusion of negative change attenuated these associations. In designing interventions to improve the mental and physical function of NHL survivors, the greatest benefit may likely be achieved by reducing the negative effects of cancer. Perhaps positive life changes are related in more specific ways to other indexes of adjustment, but our findings failed to show a positive relationship with mental and physical function.

Introduction: Survival to hospital discharge is better for PEA than asystole in out-of-hospital cardiac arrest. Point of care ultrasound (PoCUS) is widely used in cardiac arrest, although not mandated by ACLS guidelines. This study examines if initial PoCUS findings combined with cardiac rhythm are predictive of outcomes including return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and hospital discharge (SHD). Methods: A database review was completed for patients arriving to a tertiary ED in asystole or PEA arrest from 2010 to 2014. Patients under 19y or with a previous DNR were excluded. Patients were grouped into those with cardiac activity on PoCUS and PEA on ECG (Positive group); those with no cardiac activity recorded on PoCUS and asystole on ECG (Negative group); and those with a mix of positive and negative findings (Indeterminate group). Data was analyzed for the frequency of ROSC, SHA, and SHD. Results: 186 patients met the study criteria, with 14 (8%) in the positive group, 134 (72%) in the negative group, and 38 (20%) in the indeterminate group. The positive group had significantly better initial outcomes than the negative group: ROSC: 78% (95% CI 49-95%) vs 17% (11-25%); OR 17.70 (4.57-168.5; p &lt; 0.0001) and SHA: 29% (8-58%) vs 7% (3-12%); OR 5.56 (1.45-21.28; p = 0.022), and then the combined negative and indeterminate groups: ROSC: 22% (16-29%), OR 12.93 (3.43-48.73; p &lt; 0.0001; SHA: 8% (5-13%); OR 4.51 (1.25-16.27; p = 0.033). There was no difference between the positive group and either the negative or combined groups for final outcome of SHD: 0% (0-23%) vs 1% (0-5%); OR 1.83 (0.08-39.97; p = 1.00; and vs 1% (0-5%); OR 1.67 (0.08-33.96; p = 1.00). The negative group had worse initial outcomes than the combined positive and indeterminate groups: ROSC 17% (11-25%) vs. 50% (36-64%) OR 0.21 (0.10-0.42; p &lt; 0.0001); SHA 6% (3-12%) vs. 8% (5-13%) OR 0.34 (0.13-0.92; p = 0.0490). There was no difference in SHD: 1% (0-5%) vs. 1% (0-5%) OR 0.77 (0.07-8.71; p = 1.00). Conclusion: Our results suggest that although finding positive cardiac activity on ECG (PEA) and also on PoCUS is associated with greater ROSC and SHA, it does not identify patients with a final outcome of SHD.

Protective effects of grape seed proanthocyanidins against iron overload-induced renal oxidative damage in rats

In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed. Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 ± 6.4 versus 25.8 ± 5.9 seconds, P < .01), longer cycle time (67.8 ± 15.9 versus 51.7 ± 9.9 seconds, P < .01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P = .01), and worse New York Heart Association class (P = .02) than those with a positive pattern. LFCT and LVEF did not differ between groups. Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function. A commentary on this article appears in this issue on page 1227. The trial is registered with Current Controlled Trials (www.controlled-trials.com; ISRCTN67500535) and Clinical Trials (www.clinicaltrials.gov; NCT01128816).

Lentiviral-mediated GATA-3 RNAi Decreases Allergic Airway Inflammation and Hyperresponsiveness

Purpose: Transperineal prostate biopsy has been widely recommended because of its low post-operative complications. We aim to evaluate the clinical value of routine urine culture in non-febrile patients on transperineal prostate biopsy, particularly in terms of infection-related complications and cancer detection rates. Materials and Methods: A retrospective analysis was conducted on patients who met the following inclusion criteria: (a) no fever, and (b) no antimicrobials in the 7-day period prior to transperineal prostate biopsy. Patients were categorized based on urine culture results: negative urine culture group, urine culture contamination group, and positive urine culture group. Results: Infectious complications were more common in the positive urine culture group (11.8%, p < 0.05) than the others. There were no sepsis or death events. In multi-variable logistic regression analysis, patients in the positive urine culture group had 6.54 times higher the odds of developing infection-related complications compared to those in the negative group (95% confidence interval [CI]: 1.805-23.731, p = 0.004). The cancer detection rate was higher in the negative urine culture group than the positive group (49% vs. 33.8%, p < 0.05). Patients in the negative urine culture group had 2.12 times higher the odds of cancer detection rate than patients in the positive group (95% CI: 1.175-3.83, p = 0.013). Conclusion: Urine culture prior to prostate biopsy remains clinically relevant. Furthermore, for patients with positive urine culture, who are non-febrile and have not received antibiotic treatment or prophylaxis, it would be meaningful to explore whether attempted antibiotic therapy could improve prostate cancer detection rates or avoid unnecessary prostate biopsies.

To predict the chemotherapy response in Malignant lymphoma (ML) using 99Tcm-MIBI imaging, and to evaluate whether 99Tcm-MIBI scintigraphy parameters may have a precise predictive value in the expression of MDR1 and multidrug resistance-related-protein genes. Twenty-three patients with histologically proved Malignant lymphoma underwent 99Tcm-MIBI scintigraphy before chemotherapy. Tumor-to-background [corrected] (T/B) ratios of both early (10 min) and late images (1 h) and the percentage rate of washout (WR%) were measured; The mRNA expressions of MDR1 and MRP were measured by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR); therapeutic reaction was evaluated by clinical and radiologic methods after completing 6 - 8 cycle chemotherapy with/without involved field radiotherapy for large tumors. The WR% (16 +/- 6) of both MDR1 and MRP simultaneously negative expression group was significance lower than both simultaneously positive expression group (33 +/- 5), and also lower than either MDR1 or MRP positive expression group (28 +/- 6) (both P < 0.01); There was no significant difference between the both simultaneously positive expression group and either MDR1 or MRP positive expression group (P = 0.26). The early images, late images T/B ratios and WR% of MDR1 positive group were 3.0 +/- 1.1, 2.5 +/- 0.8 and 17 +/- 7 respectively; MDR1 negative group were 3.4 +/- 1.0, 2.3 +/- 0.7 and 32 +/- 6 respectively. There were no significant difference between the MDR1 positive group and MDR1 negative group in either early images or late images T/B ratios (P > 0.05), but the WR% was significant different between them (P < 0.01). The early images, late images T/B ratios and WR% of MRP positive group were 3.1 +/- 1.2, 2.5 +/- 0.8 and 19 +/- 8 respectively; MRP negative group were 3.3 +/- 1.0, 2.3 +/- 0.7 and 31 +/- 6 respectively. The WR% of MRP positive group was significantly higher than that of MRP negative group (P = 0.003); T/B ratios of both early and late images were all significantly different between them (P = 0.72, P = 0.60). Both levels of MDR1 and WR% were significantly positively correlated with therapeutic response (both P < 0.05), but there was no significant correlation between levels of MRP and therapeutic response (P = 0.052). As a untraumatic imagology instrument, 99Tcm-MIBI can accurately reflect the expression and functional status of MDR1 and MRP, and can predict the therapeutic response of ML, thus could be used for individualized treatment planning. 99Tcm-MIBI would be benefit to ML patients.

e16162 Background: Serum alpha-fetoprotein (AFP) is widely accepted as a crucial tool for clinical diagnosis and screening of HCC. However, there are cases where patients test negative for AFP but are confirmed to have Hepatocellular Carcinoma through imaging or pathological examinations. Despite these findings, there is limited research focusing on the medicine selection for AFP-negative patients. Methods: This retrospective cohort study, involving 223 untreated advanced HCC patients, and the first-line regimen consisted of targeted therapy and TKI+ICIs therapy. Patients are categorized into negative and positive AFP groups based on initial serum levels. Main efficacy endpoint was progression free survival (PFS), evaluated in accordance with RECIST v1.1. Adverse events (AEs) were recorded according to CTCAE v5.0. Results: According to the level of serum AFP, they were divided into negative group(100) and positive group(123). The two groups showed no statistically significant differences in age, gender, Child-Pugh score and other baseline clinical characteristics( P&gt; 0.05). At data cut-off at February 2023, median OS was not matured and mPFS in negative group was higher than positive group(8.2 vs 5.3months, P&lt; 0.0001). In the ICIs+TKI therapy cohort, mPFS in the negative AFP group(52) was significantly higher than in the positive AFP group(70) (10 vs. 5.8 months, P = 0.0021). Considering all patients in the negative AFP group as a subgroup, an analysis of survival benefits between those receiving targeted therapy and those receiving TKI+ICIs therapy revealed no significant difference in PFS( P&gt; 0.05). Moreover, AEs were compared between the negative and positive group, with no significant differences observed in Any Grade or Grade 3/4( P&gt; 0.05). Conclusions: Patients with negative AFP exhibited superior survival benefits compared to those with positive AFP in first-line therapy. Regarding PFS, the TKI+ICIS therapy did not demonstrate a better benefit over targeted therapy in the negative AFP subgroup.

Background: This study aimed to analyze the changes in gut microorganism of patients with positive immune antibody associated recurrent abortion using 16s rRNA gene sequencing microbiome assay. Methods: The fecal samples from 20 recurrent abortion women with positive immune antibody (positive group) and 20 with negative immune antibody (negative group) were collected. After 16s rRNA gene sequencing, the obtained raw reads were performed quality filtering to obtain the clean tags and then classified into microbial genomes. All effective tags were clustered into operational taxonomic units (OTUs) and the representative sequence was selected for the annotation of taxonomic information, followed by alpha and beta diversity analyses. Results: A total of 43,116 OTUs were obtained in all 40 samples. Bacteroides had the highest relative abundance in the positive group. In the negative group, Bacteroides, Erysipelotrichaceae_UCG-003, Faecalibacterium and Prevotella_9 had high relative abundance. Alpha diversity analysis results showed that the community richness, community diversity, and phylogenetic diversity in the positive group were higher than that in the negative group. Prevotella_9, Enterococcus, Megasphaera and Anaerostipes presented significant differences between negative and positive groups. Conclusion: The present study for the first time investigated the gut microbiome involved in positive immune antibody associated recurrent abortion via 16s rRNA gene sequencing microbiome assay. The genera that were significantly differential between positive and negative groups may serve as therapeutic targets for positive immune antibody associated recurrent abortion.

Background This study is aimed at analyzing the changes in gut microorganism of patients with positive immune antibody-associated recurrent abortion using the 16s rRNA gene sequencing microbiome assay. Methods The fecal samples from 20 recurrent abortion women with positive immune antibody (positive group) and 20 with negative immune antibody (negative group) were collected. After 16s rRNA gene sequencing, the obtained raw reads underwent quality filtering to obtain the clean tags and then classified into microbial genomes. All effective tags were clustered into operational taxonomic units (OTUs), and the representative sequence was selected for the annotation of taxonomic information, followed by alpha and beta diversity analyses. Results A total of 43,116 OTUs were obtained in all 40 samples. Bacteroides had the highest relative abundance in the positive group. In the negative group, Bacteroides, Erysipelotrichaceae_UCG-003, Faecalibacterium, and Prevotella_9 had high relative abundance. Alpha diversity analysis results showed that the community richness, community diversity, and phylogenetic diversity in the positive group were higher than that in the negative group. Prevotella_9, Enterococcus, Megasphaera, and Anaerostipes presented significant differences between negative and positive groups. Conclusion The present study for the first time investigated the gut microbiome involved in positive immune antibody-associated recurrent abortion via the 16s rRNA gene sequencing microbiome assay. The genera that were significantly differential between positive and negative groups may serve as therapeutic targets for positive immune antibody-associated recurrent abortion.

Importance of nutrient balance in severe congenital diaphragmatic hernia: A retrospective case–control study