Anterior Lesions Research Articles

Transperineal MRI-fusion targeted prostate biopsy utilizing the PrecisionPoint® Transperineal Access System versus a grid template: An assessment of outcomes.

To compare PrecisionPoint® and grid-based biopsies on rates of clinically significant prostate cancer detection and complications when transperineal MRI-fusion targeted biopsy is performed. We queried a prospectively maintained prostate biopsy database to identify men ages 18-89 who underwent transperineal MRI-fusion targeted prostate biopsies (including concurrent systematic biopsies) between August 1, 2020 and September 1, 2024. The primary outcome was detection of clinically significant prostate cancer in the MRI region of interest. 30-day complications and overall rates of clinically significant prostate cancer were examined at the patient level. Subgroup outcomes included cancer detection in anterior MRI lesions and stratification by prior biopsy status. Logistic regression was performed. 1,134 MRI lesions in 890 patients were included in the analysis (PrecisionPoint®: 542 patients/714 lesions; grid-based biopsy: 348 patients/420 lesions). There were no differences in prostate cancer detection between the two groups overall. For patients with a prior negative biopsy, a grid-based approach detected a higher rate of clinically significant prostate cancer (p = 0.021). On logistic regression, biopsy approach was not a significant predictor of clinically significant prostate cancer at either the patient (p = 0.797) or lesion (p = 0.473) levels. Complication rates and the ability to detect clinically significant prostate cancer in anterior lesions were similar between approaches. PrecisionPoint® and grid-based biopsies identified similar rates of prostate cancer, including in anterior MRI lesions, when transperineal MRI-targeted prostate biopsy was performed in this cohort. Complication rates were low and did not differ based on technique.

Network dynamics in post-stroke cognitive impairment: insights from effective connectivity analysis.

This study investigates post-stroke cognitive impairment (PSCI) by utilizing spectral dynamic causal modeling (spDCM) to examine changes in effective connectivity (EC) within the default mode, executive control, dorsal attention, and salience networks. Forty-one PSCI patients and 41 demographically matched healthy controls underwent 3D-T1WI and resting-state functional magnetic resonance imaging on a 3.0T MRI. The study compared EC among eight representative regions of interest using spDCM and analyzed the correlation between altered EC and cognitive test scores. Subgroup analysis was conducted based on lesion location. The study found a significant increase in EC in the PSCI group, specifically from the posterior cingulate cortex (PCC) to the left and right dorsolateral prefrontal cortex (L_DLPFC and R_DLPFC, respectively), and from the right insula to R_DLPFC (p < 0.05). These changes were significantly negatively correlated with cognitive scores. Subgroup analysis showed increased executive control in PSCI patients with left anterior circulation lesions. Validation through low-order functional connectivity analysis indicated abnormalities dominated by large-scale intra- and inter-network functional connectivity increases in patients with PSCI. The study suggests an increase in effective connectivity between networks, particularly within the triple network model. The findings implicate the PCC and R_DLPFC in the pathophysiology of PSCI, shedding light on its cognitive implications. This study emphasizes the importance of understanding network changes in PSCI from various perspectives, enhancing our understanding of the neural mechanisms underlying PSCI, and establishing a foundation for future research.

Outcomes Profile of Balloon Angioplasty for Symptomatic Intracranial Atherosclerotic Stenosis at Pelni Hospital from January 2021 to July 2024

Background: Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, posing challenges due to its progressive nature and high recurrence risk. Endovascular interventions like balloon angioplasty show promise in improving blood flow and stabilizing stenotic arteries, particularly in symptomatic ICAS (sICAS) patients unresponsive to medical therapy. This study evaluates outcomes of balloon angioplasty for sICAS at Pelni Hospital over 3.5 years. Methods: A retrospective cohort study of 31 sICAS patients undergoing balloon angioplasty (January 2021–July 2024) assessed demographics, lesion locations, procedural success, and outcomes. Standard endovascular techniques under fluoroscopic guidance were used, focusing on procedural success, complications, and patient stability. Results: Balloon angioplasty was successful in all patients (100%). Most lesions were in the posterior circulation, particularly the vertebrobasilar artery (54.8%), with anterior circulation lesions in the internal carotid (25.8%) and middle cerebral arteries (19.4%). Complications occurred in 2 patients (6.5%), both resulting in adverse outcomes, including death. The remaining 29 patients (93.5%) experienced no significant complications and remained stable during follow-up. Conclusions: Balloon angioplasty demonstrates high success with low complication rates for sICAS, offering a viable therapeutic option for severe stenosis unresponsive to medical therapy. Further research is needed to confirm long-term efficacy, refine patient selection, and enhance clinical outcomes. Keywords: Balloon Angioplasty, Endovascular Treatment, Intracranial Atherosclerotic Stenosis

Efficacy of Prostate Biopsies via Transperineal and Transrectal Routes for Significant Prostate Cancer Detection: A Multicenter Paired–Matched Study

Background: A transperineal approach to prostate biopsy is now recommended to reduce the risk of infectious complications associated with the transrectal route. Our aim is to compare the efficacy of transrectal- and transperineal-guided biopsies involving the magnetic resonance imaging (MRI) of index lesions in detecting significant prostate cancer (sPCas), and to evaluate the role of systematic biopsies. Methods: In a prospective and multicenter trial conducted in an opportunistic early detection program for sPCa in Catalonia (Spain), between 2021 and 2023, 4029 men suspected of having PCa underwent multiparametric MRI followed by guided and systematic biopsies. From this cohort, we retrospectively selected 1376 men with reports of the size and localization of their index lesions. A matched group of 325 pairs of men subjected to transrectal and transperineal biopsy were chosen to account for confounding variables. We compared sPCa detection rates determined via index lesions and systematic biopsies, as well as by lesion localization. Results: Transperineal and transrectal biopsies detected sPCa in 49.5% vs. 40.6% overall (p = 0.027), 44.6% vs. 30.8% from index lesions (p = 0.001), and 24.3% vs. 35.1% from systematic biopsies (p = 0.003). SPCa detection rates were higher in transperineal biopsies across all index lesion localizations, with significant increases in the anterior zone (47.8% vs. 20.8% at the mid-base, p = 0.039, and 52.9% vs. 24.2% at the apex, p = 0.024) and central zone (33.3% vs. 5.9%, p = 0.003). With regards to SPCa detected only in systematic biopsies, 10.5% of cases were detected in transrectal biopsies and 4.9% of cases were detected in transperineal biopsies (p = 0.012). Conclusions: Targeted biopsies conducted via the transperineal route showed higher sPCa detection rates than transrectal biopsies, particularly for anterior and apical lesions, with systematic biopsies showing reduced utility.

Postencephalitic Proper- and Common-name Anomia, Alexia With Agraphia, and Mild Semantic Deficit due to Left Anterior Temporal Lobe Lesion.

Here we report the case of an individual who developed proper- and common-name anomia with no category specificity, alexia with agraphia for kanji (Japanese morphograms), and mild verbal and semantic memory impairment after unilateral herpes simplex encephalitis. Although their common-name anomia, alexia with agraphia, and semantic memory impairment resolved within 2 years, this individual continued to experience proper-name anomia and verbal memory impairment. Encephalitic damage was limited to the left anterior temporal lobe (ATL), amygdala, hippocampus, and parahippocampal gyrus, sparing the mid-fusiform and posterior inferior temporal gyri. Although ATL lesions are not typically associated with semantic memory impairment, we suggest that damage to the left ATL can result in both proper- and common-name anomia, as was evident in the current case. In these cases, proper-name anomia may be more severe and persistent than common-name anomia, which may be mild and significantly improved within several years. In cases of semantic memory deficits, persistent common-name anomia, and severe alexia with agraphia, there is typically more extensive involvement of the temporal lobe than seen in the current case, including the mid-fusiform and posterior inferior temporal gyri.

Fusion MRI/Ultrasound-Guided Transperineal Biopsy: A Game Changer in Prostate Cancer Diagnosis.

Background/Objectives: Multiparametric-Magnetic Resonance Imaging(mp-MRI) presents the ability to detect clinically significant cancer, aiming to avoid biopsy if the results are negative or target an abnormal lesion if a suspected lesion of the prostate is found. Recent guidelines recommend the performance of 12 standard biopsies along with 3 to 5 targeted biopsies in suspected prostate lesions, depending on the size of the prostate lesion. In addition, prostate biopsy can be performed by either the transperineal or the transrectal approach. The aim of this comprehensive review is to highlight the role of both standard and targeted MRI/Ultrasound (US) fusion transperineal biopsy (TPB) in the diagnostic approach of prostate cancer cases, to report its diagnostic efficacy and complication rates and to suggest the promising usage of MRI/US fusion TPB in the future. Methods: A comprehensive review of the existing literature, including systematic reviews, meta-analyses, and clinical guidelines, was conducted to compare the efficacy and safety of transperineal and transrectal approaches in prostate cancer detection. Special emphasis was placed on mp-MRI-guided targeted biopsy and its combination with systematic sampling. Results: Prostate biopsy via the transperineal approach is related to increased detection rates, especially for anterior lesions, and decreased infection risk compared to the transrectal approach, while complication rates (hematuria, hemospermia, etc.) remain similar. Due to lower infection rates via the transperineal route, the performance of prostate biopsy using the transperineal approach is strongly recommended. Finally, transperineal fusion MRI/US biopsy can be valuable for repeat biopsies in patients who had an initial negative biopsy or for the follow-up of patients that undergo active surveillance. Conclusions: MRI/US fusion-guided TPB represents a significant advancement in prostate cancer diagnostics, combining improved precision with reduced infection risks. Although TPB presents higher detection rates for anterior prostatic lesions and lower post-biopsy infection rates, there is no significant difference in cancer detection rates compared to TRB. Targeted training and investment may reduce long-term expenses of TPB by lowering hospitalizations, antibiotic usage, and related costs. Future research should further refine this approach and explore its integration with emerging technologies like artificial intelligence for enhanced lesion targeting and diagnostic accuracy.

The DETECTION project part 1: An international Delphi survey about diagnostics and treatment of anterior mediastinal cystic lesions.

Differentiating benign anterior mediastinal cysts from malignancies is challenging in clinical practice. International guidelines on optimal diagnostics and treatment for anterior mediastinal cystic lesions are lacking. The first part of the DETECTION project focuses on possible heterogeneity in diagnostics and treatment of anterior mediastinal cystic lesions among international thoracic medical experts. A Delphi-survey was created by 14 multidisciplinary panel members, affiliated with three Dutch tertiary referral hospitals for thymic tumours. The survey contained 55 questions and was reviewed by international experts of the International Thymic Malignancy Interest Group (ITMIG) and Réseau tumeurs THYMiques et Cancer (RYTHMIC). The survey was launched online for members of the ITMIG and RYTHMIC from May 26th, 2023 till July 18th, 2023. The survey was completed by 21 thoracic surgeons, 15 radiologists, 15 medical oncologists, 11 pathologists, 9 pulmonologists, and 4 radiation oncologists from 24 countries. Heterogeneity was observed in performed diagnostic radiological imaging, laboratory tests, indications for surgery and follow-up of anterior mediastinal cysts. Cystic wall thickness of anterior mediastinal cysts was reported as clinical relevant in decision making more frequently by thoracic surgeons (76.2%) than pulmonologists (44.4%) and medical oncologists (15.4%) (p=0.015). The survey outcomes showed heterogeneity in the diagnostics and indication for resection of anterior mediastinal cysts among thoracic medical experts. A large variation in radiological imaging, laboratory tests, surgery, pathological analyses, and follow-up of anterior mediastinal cysts was observed. The development of evidence-based clinical practice guidelines may guide clinicians.

Uniportal Full Endoscopic 270° Decompression for Thoracic 1-2 Hard Disc Herniation With Ossification of the Ligamentum Flavum.

This article aims to demonstrate the uniportal full endoscopic surgery for treating complex anterior and posterior spinal pathology at the T1-2 level, offering a invasive, accessible, stable, and versatile approach to challenging anatomical situations. Uniportal full endoscopic surgery is one of the most minimally invasive spinal surgeries, utilizing slim, elongated, and compact instruments that provide access to lesions from any angle and distance. This characteristic makes the technique especially suitable for hard, such as the T1-2 level, where traditional approaches may be limited or difficult. We present the case of a 39-year-old male patient (height, 187 cm; weight, 130 kg) who developed myelopathy due to a hard disc herniation and ossification of the ligamentum flavum at the T1-2 leading to paraparesis, which was more severe on the left side. An anterior approach was challenging due to the anatomical constraints at the T1-2 level, as well as the patient's body size. A posterior access via the interlaminar approach facilitated the removal of the ossified ligamentum flavum. However, to the anterior lesion remained problematic without spinal cord retraction. Using the uniportal full endoscope, we were able to approach both anterior and posterior lesions through an incision 8 cm lateral to the midline, allowing for the treatment of the entire 270° arc of the pathology. The slim and elongated nature of the full endoscope enabled effective decompression without exerting pressure on the spinal cord, providing access from any angle and distance. This technique can be applied to a variety of cases involving difficult-to-access spinal.

Clinical manifestations of Florida spot keratopathy in dogs and cats: One hundred cases (2021-2024).

This study describes the ocular findings in dogs and cats diagnosed with Florida spot keratopathy (FSK) at a single institution. Affected animals underwent a single comprehensive ophthalmic examination, with no follow-ups conducted. Data on patient demographics and clinical findings were collected and analyzed. Based on the presence of round, white, fluorescein negative anterior stromal lesions, FSK was diagnosed in 84 dogs and 16 cats, with mean ± SD ages of 6.5 ± 3.7 and 5.9 ± 4.6 years, respectively. FSK was the presenting complaint in 18% of dogs and 12.5% of cats. Most patients had unilateral lesions, with 57% of dog eyes and 55% of cat eyes having more thanthree lesions per eye. Lesions varied in size (0.5-7.6 mm in dogs, pinpoint to 5 mm in cats) and were predominantly located in the central cornea of dogs, while scattered throughout the cornea of cats. Progression was reported in just 4% of dogs and 6% of cats, while transient irritation was reported in 18% of dogs and 12.5% of cats. Owners reported the presence of little fire ants (LFA) in the vicinity of 21% of dogs and 38% of cats. FSK should be considered a differential diagnosis for transient ocular irritation in dogs and cats, with most lesions being non-progressive. While an association with LFA has been suggested in both animals and humans, this link remains speculative and has not been confirmed by rigorous academic research.

Evaluation of Glenohumeral Joint Kinematics Following the Latarjet and Eden‐Hybinette Procedures a Dynamic Radiostereometric Cadaver Study

ABSTRACTAnterior shoulder instability with glenoid bone lesion can be treated with the Eden‐Hybinette procedure utilizing a tricortical iliac crest bone graft or the Latarjet procedure. This study aimed to evaluate the glenohumeral joint (GHJ) kinematics throughout an external shoulder rotation following the Eden‐Hybinette and Latarjet procedures. Nine human specimens were examined with dynamic radiostereometry during a GHJ external rotation with anteriorly directed loads from 0 to 30 N. In 30‐ and 60‐degree GHJ abduction, the kinematics (measured as the humeral head center and contact point) was sequentially recorded for a 15% anterior glenoid bone lesion, the Eden‐Hybinette, and the Latarjet procedure. The Latarjet and Eden‐Hybinette procedures resulted in up to 9.7 mm (95%CI 0.5; 18.8) more posterior and a 7.4 mm (95%CI 0.3; 14.4) superior humeral head center location compared to the glenoid bone lesion. With 0–20 N anterior directed loads, the Latarjet procedure resulted in a more posterior humeral head center and contact point of up to 7.6 mm (95%CI 3.6; 11.5), especially in 60 degrees of GHJ abduction, compared to the Eden‐Hybinette procedure. Opposite, at 30 N anterior‐directed load, the Eden‐Hybinette procedure resulted in a more posterior humeral head center of up to 7.6 mm (95%CI 0.3; 14.9) in 30 degrees GHJ abduction compared to the Latarjet procedure. The results support considering the Latarjet procedures in patients who need the stabilizing effect with the arm in the abducted and externally rotated position (e.g., throwers) and the Eden‐Hybinette procedure in patients exposed to high anterior‐directed loads with the arm at lower abduction angles (e.g., epilepsia).

Irritability in stroke: a protocol for a prospective study

BackgroundPoststroke irritability (PSI) is common among stroke survivors and can lead to a poor quality of life, difficulties in social interactions, criticism from caregivers, and caregiver stress. The planned study will evaluate the clinical, neuropsychological, and magnetic resonance imaging (MRI) correlates of PSI in a cohort of stroke survivors. In addition, the study will examine the 15-month progression of PSI.MethodsThis will be a prospective cohort study that will recruit 285 participants. Participants and their caregivers will undergo detailed assessments at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The irritability/lability subscale of the Chinese version of the Neuropsychiatric Inventory (CNPI) will be completed by caregivers. Potential covariates will also be measured. Patients will undergo MRI, including diffusion-weighted imaging, within 1 week of stroke onset. A stepwise logistic regression will be performed to evaluate the importance of lesions in the regions of interest (ROIs) along with other significant variables identified in univariate analyses. These analyses will be repeated for patients with and without PSI at T2 and T3. Repeated measures analysis of covariance (ANCOVA) will be used to assess changes in CNPI scores for the entire sample. In ANCOVA analyses, the frequency of infarcts in the ROIs will be treated as the predictor.DiscussionThis will be the first MRI study on PSI in stroke survivors. The findings will provide insights into the association of the orbitofrontal cortex, anterior cingulate cortex, anterior temporal lobe, insula, amygdala, thalamus, and basal ganglia lesions with the risk of PSI.

Optimized Bifrontal Craniotomy: Reducing Risks and Boosting Surgical Results.

Bifrontal craniotomy is one of the most common surgical approaches for dealing with anterior skull base lesions. However, this procedure occasionally present complications like anosmia, cerebrospinal fluid (CSF) leakage, infection, and cosmetic problems. Although previous reports suggested various solutions, there remains a need to further refine the procedure to ensure better outcomes. In this paper, we introduce our revised method and examine the clinical results. Our protocol pays attention to preventing avulsion of the olfactory bulb by brain movement, such as avoiding preoperative administration of hyperosmotic diuretic solution, mobilizing the olfactory tract from the frontal lobe base, and fixing the olfactory bulb to the cribriform plate. On opening, the frontal sinus mucosa is separated from the bone components and pushed into the frontonasal duct. After removing the inner table, the frontal sinus is completely covered by the pericranial flap. To prevent cosmetic problems, a Gigli wire saw is used to cut the supraorbital edge to minimize the bone defect. Surgical complications in 38 patients who underwent bifrontal craniotomy using these methods in our institute from 2005 to 2020 were investigated. Only one case (2.6%) experienced postoperative anosmia. There were no cases of CSF leakage, infections, or cosmetic problems. Through diligent practices and attention to minute details, such as gentle manipulations to preserve the olfactory nerve, reliable procedures for frontal sinus closure, and maximum attention to esthetic results, surgical techniques can be refined and developed to the level of highly skilled expertise with low rate of complications.

Validation and optimization of smart eye camera as teleophthalmology device for the reduction of preventable and treatable blindness in Nigeria.

Limited resources and staffing hinders efforts to reduce preventable blindness, especially in low- to middle-income countries. The slit-lamp examination (SLE), which is essential for ophthalmology practices, is often unavailable in primary and secondary eye care facilities due to the high costs and lengthy training required for operation. We conducted a cross-sectional, multicentre study exploring the potential for a smart eye camera (SEC; a tele-ophthalmology handheld device developed by OUI Inc., Japan) to address the limitations of the SLE. Ocular diagnoses, visual acuity assessments and examinations of the eyes were performed independently using both a conventional SLE and a SEC. Four independent assessors (blind to the study) reviewed the images captured by the SEC and the SLE as administered by separate investigators. All analyses were performed using R version 4.2.2 for macOS at a 5% level of statistical significance. The results of the image quality analysis demonstrated that the number of higher-quality images was significantly higher (p < 0.05) for the images captured using the SEC device compared to the SLE machine. Remarkably, up to 96% accuracy of diagnosis was recorded with SEC. Evaluation of diagnostic accuracy rates derived from images obtained from both machines revealed a degree of divergence in assessments among evaluators, yielding a Fleiss's Kappa value of 0.092. The sensitivity analysis for the SEC device revealed a reasonably strong capacity to correctly identify true positive cases, with an average sensitivity score of 90%. The results of this study indicate that SEC can effectively evaluate anterior segment lesions in ophthalmology.

Spatial heterogeneity in white matter hyperintensities revealed by postmortem MRI‐guided histopathological staining

AbstractBackgroundWhite matter (WM) hyperintensities are bright areas on T2 MRI that reflect increased interstitial fluid caused by demyelination and axonal loss; these tissue alterations have been associated with cognitive impairment. Previous in‐vivo studies have suggested that the underlying pathogenesis for WM changes differs between the anterior and posterior brain, with cerebrovascular disease contributing more to anterior WM lesions and neurodegenerative processes contributing more to posterior WM lesions.MethodPeriventricular (PV) and deep subcortical (DS) WM hyperintensities both in the anterior and posterior portions of the brain were identified using postmortem T2 MRI of cerebral hemispheres from the Biggs Institute Brain Bank (Figure 1) in 7 Alzheimer’s Disease patients (four male, three female, average age 75). Normal appearing (NA) WM at the base of the postcentral gyrus was selected as an internal control. Slide sections were obtained from these five regions across seven brains for 35 slides total using MRI landmarks to guide brain sectioning for histopathological analysis. The slides were stained using Luxol fast blue (LFB) and hematoxylin and eosin (H&amp;E) and scanned digitally. Myelin was measured with the LFB, and vacuolation was measured with the H&amp;E. Machine learning methods were used to segment and analyze the slides as the percent area stained in a selected region of interest (Figure 2).ResultsCompared to NA WM, areas of WM hyperintensities exhibited a lower average LFB‐stained area (p=0.001) and H&amp;E‐stained area (p&lt;0.001), indicating increased demyelination and vacuolation within the lesions. Anterior PV WM lesions demonstrated a higher extent of demyelination (p=0.055) and vacuolation (p=0.074) than posterior PV WM lesions (Table 1). Posterior DS WM lesions showed significantly more demyelination than posterior PV WM lesions (p=0.022).ConclusionThe variations in demyelination within the WM lesions suggest differing underlying pathogenesis. This may be mediated by the differences in contribution from vascular and neurodegenerative causes as confirmed in previous studies. These preliminary results encourage the use of additional histopathological methods to better understand how different heterogeneous etiologies contribute to the development of white matter damage and how this can be translated into prevention strategies.

A Comparative Study of Anterior and Posterior Tuberculosis Lesions for the Treatment of Thoracolumbar Tuberculosis disease: A Single Institution Experience in a Major Academic Hospital.

To compare the efficacy of anterior and posterior surgery for thoracolumbar tuberculosis disease. Clinical data of 30 patients with thoracolumbar tuberculosis disease undergoing anterior and posterior surgery from January 2021 to December 2023 were collected for a retrospective study. According to the two surgical procedures, patients were divided into two groups: 1) anterior group (n=15) and 2) posterior group (n=15). We compared the two groups regarding age, gender, body mass index, affected segments, past history (cardiovascular and cerebrovascular diseases, respiratory diseases, endocrine system diseases, metabolic diseases, and tuberculosis history), smoking history, drinking history, operation time, postoperative bleeding, postoperative drainage, postoperative time, postoperative complications (dural tear, lower limb intermuscular vein thrombosis, lower limb deep vein thrombosis, sinus infection, postoperative recurrence rate), and waist VAS score before and after surgery, waist ODI score, and JOA score. The intraoperative blood loss was significantly less in the posterior group than in the anterior group, and the difference was significant (P <0.05); the lumbar VAS score was lower in the posterior group than in the anterior group, and the difference between the two groups was significant (P <0.05). The analysis of the remaining data showed no significant difference between the two groups (P> 0.05), indicating that the efficacy of the two procedures was the same. In the treatment of thoracolumbar tuberculosis disease, there is no significant difference in the clinical efficacy of anterior surgery and posterior surgery. Intraoperative bleeding in posterior surgery was less than in anterior surgery, but the latter showed a significant improvement in postoperative pain relief. Therefore, spinal surgeons should choose the corresponding surgical treatment according to the actual situation of the patient in order to maximize the efficacy.

Long-term results of edge-to-edge and neochordal mitral repair for isolated anterior leaflet lesion: a propensity match analysis.

Mitral regurgitation due to anterior mitral leaflet lesions is associated with an increased risk of mitral regurgitation recurrence after mitral valve repair compared with posterior leaflet-related lesions. Both edge-to-edge (E-to-E) and neochordal repair, associated with ring annuloplasty, have been used in our institution to address isolated anterior mitral leaflet lesions. The aim of this study was to compare the clinical and echocardiographic long-term results of those two approaches for isolated anterior mitral leaflet lesions by means of a propensity match analysis. An institutional database retrospective review within the time-frame 2000 to 2021 was carried out. The Kaplan-Meier method and cumulative incidence function were employed. Cox regression was used to identify the risk factor for mortality during the follow-up. The estimated freedom from reoperative mitral valve surgery at 20 years was 78% in the E-to-E group and 64% in the neochordae group (P = 0.032). The longitudinal analysis performed to analyse the mitral regurgitation recurrence rate showed a higher rate of mitral regurgitation ≥3+ recurrence in the neochordae group at 5 (5.1% vs 8.7%), -10 (8.2% vs 13.2%), and 15 years (8.8% vs 16.5%) (P < 0.001). Isolated anterior leaflet pathology can be effectively treated with E-to-E or neochordal repair and ring annuloplasty. In our series, clinical and echocardiographic results were better in E-to-E group. The excellent durability of this technique up to 20 years of follow-up, together with its simplicity and reproducibility, confirms the role the E-to-E techniques as an excellent treatment option for severe mitral regurgitation due anterior mitral leaflets lesions.

Retrospective study on Encephalitozoon cuniculi infections in 118 cat and 9 dog eyes.

This study aims to inform about the clinical image, diagnostic possibilities, and treatment options for cats and dogs diagnosed with ocular encephalitozoonosis. Medical records of 7 dogs and 75 cats with ocular encephalitozoonosis presented at the Clinical Unit of Ophthalmology of the University of Veterinary Medicine Vienna between 08/2006 and 02/2022 have been compiled. Diagnosis was based on the presence of cataracts and positive antibody titer against Encephalitozoon cuniculi. Patient history, details on the characteristics of the cataracts, level of antibody titers, and the treatment regimen were summarized, as are the results of histological stainings of surgical samples to determine the presence of Encephalitozoon cuniculi, as well as PCR analyses to identify its sub-strains. Our analysis of the clinical data shows that focal cortical anterior cataracts often associated with anterior uveitis and lesions in the fundus are the most prevalent manifestation of ocular encephalitozoonosis in cats and dogs. Serological testing and PCR analysis of lens material are the most important diagnostic tools. Timely phacoemulsification with adjuvant anti-inflammatory and antiparasitic medication is the most promising therapy for Encephalitozoon cuniculi-induced cataracts.

Endovascular Treatment of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score.

Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large-vessel occlusion with tandem lesions, stratified by baseline ASPECTS. We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age ≥18 years, anterior circulation tandem lesions, endovascular thrombectomy <24 hours of symptom onset, and ≥70% internal carotid artery stenosis/occlusion. Patients were categorized into low (0-5) and high (6-10) ASPECTS. Inverse probability of treatment weighting matching was used to balance the groups. Primary outcomes included the following: 90-day modified Rankin Scale (mRS) score 0 to 2 and symptomatic intracranial hemorrhage. Secondary outcomes included the following: ordinal mRS, mRS 0 to 3, modified Thrombolysis in Cerebral Infarction ≥2b and 2c-3, petechial hemorrhage, parenchymal hematoma (1/2), early neurologic improvement, and mortality. Of 691 patients, 44 had ASPECTS 0 to 5 and 505 had ASPECTS 6 to 10. Patients with low ASPECTS had lower odds of 90-day mRS 0 to 2 (adjusted odds ratio [OR], 0.48; P=0.036) and higher odds of symptomatic intracranial hemorrhage (adjusted OR, 3.78; P=0.014). Additional significant differences were found in mRS shift, mRS 0 to 3, parenchymal hematoma 2, and mortality. In interaction analysis, the association between low ASPECTS and functional outcome persisted only in the internal carotid artery occlusion subgroup, with no significant interaction indicating no reason to suppose a difference between the effect of both subgroups. Endovascular thrombectomy in patients with tandem lesions with low ASPECTS is associated with reduced odds of functional recovery and increased symptomatic intracranial hemorrhage risk, when compared with patients with high ASPECTS. However, 30% of patients with low ASPECTS achieved 90-day functional independence, suggesting potential benefit for a nonnegligible proportion of patients.

Hemodynamic assessment of intracranial atherosclerotic stenosis: comparison between invasive non-hyperemic pressure ratio and angiography-derived quantitative flow ratio.

To evaluate the diagnostic accuracy of the quantitative flow ratio (QFR) for hemodynamic exploration of intracranial atherosclerotic stenosis, using the invasive cerebrovascular pressure ratio (CVPR) and resting full-cycle ratio (RFR) as reference standards. Patients with symptomatic unifocal intracranial atherosclerotic stenosis were included. The CVPR was defined as the ratio of the proximal and distal pressures. All patients underwent angioplasty under general anesthesia. The QFR was calculated based on digital subtraction angiography. Using the CVPR as a reference, we compared its correlation with the QFR across different degrees and locations of stenosis. The CVPR and QFR were measured in 34 vessels of 32 patients. The QFR demonstrated a high correlation and excellent agreement(r = 0.8227, p < 0.001) with the CVPR in distal stenosis before intervention. In the subgroup with diameter stenosis >80%, the QFR showed a high correlation (r = 0.8812, p < 0.001) with the CVPR. In the anterior circulation subgroup, the QFR showed an excellent correlation (r = 0.9066, p < 0.001) with the CVPR. In the posterior circulation subgroup, the QFR showed a high correlation with the CVPR (r = 0.7706, p < 0.001). Diameter stenosis rates showed a moderate negative correlation with the CVPR. There was a strong correlation between the QFR and wire-based CVPR, especially for anterior circulation lesions before intervention. The QFR may serve as a predictive factor for evaluating hemodynamic changes in intracranial atherosclerotic stenosis.

Contemporary Outcomes of Degenerative Mitral Valve Surgery in a Regional Tertiary Care Center.

Objective: As percutaneous mitral valve techniques become more prevalent, it is important to evaluate the contemporary outcomes of surgical mitral valve interventions. This study assessed the current results and procedural trends of mitral valve surgery for degenerative mitral regurgitation (DMR) at a regional tertiary care center. Methods: Data were analyzed from 693 consecutive DMR patients who underwent isolated mitral valve operations, with or without tricuspid valve repair and atrial fibrillation ablation between 2017 and 2024. The outcomes were defined according to MVARC criteria. The study endpoints included successful mitral valve repair, in-hospital results, and operative and long-term mortality. Logistic regression was applied to assess the impact of valve lesions and patient risk factors on the probability of valve repair. Survival was analyzed using Kaplan-Meier methodology. The follow up was 100% complete. Results: Mitral valve repair was performed in 90.9% of cases, with only 0.9% requiring the conversion to replacement due to unsuccessful repair. Posterior leaflet lesions had the highest success rate (93.4%), while anterior leaflet lesions had a lower rate (86.2%), with anterior pathology being a negative predictor of repair (OR 2.57, p = 0.02). The type of lesion (prolapse vs. flail), the commissural involvement, and the increased risk for SAM had no statistically significant impact on valve repair outcome. Less invasive transaxillary access was used in 63.2% of patients, and its adoption increased significantly (from 50.9% to 67.4% p = 0.03) over time, resulting in more frequent fast-track extubation and home discharges. The rate of in-hospital mortality was 0.6%, while the rate of 5-year survival was 95.5%. Conclusions: Contemporary surgical techniques for DMR lead to high repair rates and excellent recovery outcomes. Despite the rise in transcatheter options, our findings confirm that surgery remains the gold standard for most DMR patients.